Injury
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Open pelvic ring injuries are rare clinical entities that require multidisciplinary care. Due to the scarcity of this injury, there is no well-defined treatment algorithm. As a result, conflicting evidence surrounding various aspects of care including wound management and fecal diversion remain. ⋯ While clear indications are lacking due to limited studies, previous studies have reported benefits. Further large-scale studies are necessary for adequate evaluation of treatment protocols of open pelvic ring injuries. Understanding the role of fecal diversion, avoidance of primary closure in open pelvic ring injuries, and importance of well-coordinated care amongst surgical teams can optimize patient outcomes.
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Review Practice Guideline
Periprosthetic distal femur fractures around total knee replacements: A comprehensive review.
With a growing number of patients undergoing total knee replacements globally, coupled with an elderly population, the incidence of periprosthetic fractures around total knee replacements is increasing. As such, this is a highly topical subject that is gaining increasing interest within the orthopaedic community. ⋯ We review the related epidemiology, initial patient evaluation, the evolution and relevance of the classification systems and treatment options, particularly related to endoprosthetics and hybrid fixation constructs. The latest orthopaedic evidence related to this topic has been included.
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Multicenter Study
Physical activity in young hip fracture patients is associated with health-related quality of life and strength; results from a multicenter study.
The World Health Organization recommends a minimum of 150 min of moderate intensity exercise per week or 75 min of strenuous activity weekly for adults. Younger hip fracture patients are often assumed less active than the general population, however, knowledge on physical activity (PA) and health-related quality of life (HRQoL) in younger hip fracture patients is limited. ⋯ We found that close to two-thirds of the patients had a pre-fracture PA level below WHO recommendations. Being more active was associated with better handgrip strength, HRQoL, and ASA score. Our findings indicate that individuals under 60 years who sustain a hip fracture form a heterogeneous group, some severely comorbid and others highly active and seemingly healthy. This suggests a more nuanced approach to rehabilitation, as the more active patient might need a more individualized plan than the standard program can offer.
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To investigate the feasibility and short-term clinical efficacy of the arthrography-assisted joystick technique for the treatment of adolescent transitional ankle fracture. ⋯ The arthrography-assisted joystick technique for the treatment of adolescent transitional ankle fracture offers advantages, such as minimal trauma, simple operation, ideal reduction effect, and the recent curative effect is satisfactory.
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The incidence of hip fractures in the elderly is increasing. Minimally displaced and undisplaced hip fractures can be treated with either internal fixation or hemiarthroplasty. ⋯ Fixation methods for Garden I and II hip fractures in elderly patients are associated with a higher revision rate than hemiarthroplasty. CHF has the highest revision rate at 14.4% followed by DHS and hemiarthroplasty. Female patients, patients over the age of 80 and patients with poor bone quality are considered high risk for fixation failure with CHF. Hemiarthroplasty is a suitable alternative with lowest revision rates. When considering an internal fixation method, DHS is more robust than a screw construct.