Pre-Hospital Delays Represent Unnoticed Intervals That Affect Mortality Rates in Geriatric Hip Fractures: A Prospective Cohort Study.

Introduction Surgery is recommended within 24-48 hours for geriatric hip fractures. In developing countries. However, delayed presentation to the hospital due to various factors often precludes surgery from occurring within these recommended intervals. Therefore, our objective was to identify the hurdles that prevent early surgery for geriatric hip fractures and assess their effect on mortality. Methods A prospective cohort study was conducted with 78 geriatric patients (age > 60 years) who suffered hip fractures between September 2019 and November 2020. The demographic, American Society of Anesthesiologists (ASA) classification, Charlson Comorbidity Index (CCI), injury to admission, admission to surgery, and injury to surgery time were all recorded for each patient. A follow-up was conducted at one month and six months postoperatively for each patient. Mortality rate at 30 days and causes for delay in presentation to the hospital and delayed surgery were assessed. Multivariate logistic regression was done to assess the risk factors for 30-day mortality. Results The mean age of the patients was 74.2 years, and 64.1% of the patients were female. The mean (SD) injury-to-admission time was 3.45 (5.50) days, and the admission-to-surgery time was 4.28 (3.03) days. A total of 41% of patients had delayed presentation, commonly due to a lack of local healthcare infrastructure, financial constraints, and a lack of care providers. Furthermore, 65.3% of the patients underwent delayed surgery, and 44% faced organizational delays. Thus, the 30-day mortality rate was calculated at 19.2%, while the six-month mortality rate was 25.6%. The injury to admission time (OR 1.22 [1.03-1.44; p = 0.018]) and CCI were found to be risk factors in the 30-day mortality (OR 1.76 [0.93-3.33; p = 0.085]). Conclusions Pre-hospital delays and CCI are risk factors for short-term mortality following hip fractures. This underlines the need to generate awareness, improve the referral chain, and establish protocol-based care in hospitals. Further studies are required to assess the socioeconomic factors involved in the delayed treatment of geriatric hip fractures in developing countries.

Comparison of functional outcomes among subtypes of Fraser's type â ¡ floating knee.

PURPOSE: The poor prognosis in patients with floating knee injuries is mainly contributed to articular involvement (Fraser's type Ⅱ). This study aims to evaluate and compare the functional outcomes among different Fraser's type Ⅱ floating knee injuries after surgical management. METHODS: Twenty-seven patients with Fraser's type Ⅱ floating knee injuries (54 fractures) between September 2014 and December 2015 were enrolled prospectively in this study and were distributed according to Fraser's floating knee classification into three different groups as type ⅡA (ipsilateral femoral shaft and tibial intra-articular involvement, n = 11), type ⅡB (ipsilateral tibial shaft and femoral intra-articular involvement, n = 9) and type ⅡC (both femoral and tibial intra-articular involvement, n = 7). The differences among the groups were evaluated and compared. The functional outcomes of these injuries at one year were analyzed using Knee Injury and Osteoarthritis Outcome Score (KOOS) which covers 5 subscales of pain, other symptoms, activities of daily living, sports and recreation, and quality of life. The result was also compared with standardized age-sex matched healthy population using paired samples t-test. RESULTS: All the patients were male, and the injury mechanism was solely roadside accident. The mean age was 29.8 years and injury severity score 17.9 (comparable in all the three groups). Most injuries were observed on the right side (20 cases, 74.1%). Based on paired samples t-test, the KOOS score of patients with Fraser's type ⅡA was found to be better than that of type ⅡB and type ⅡC. Compared with the reference age-sex matched control group, patients with Fraser's type ⅡB and ⅡC fractures had significantly lower mean score in all KOOS subscales (all p < 0.01). However, Fraser's type ⅡA only revealed significant difference regarding the subscales of activities of daily living (p < 0.0001), sports and recreation (p < 0.0001), and quality of life (p < 0.0001). CONCLUSION: The results of this study show that patients with Fraser's type ⅡA fractures had a better functional outcome as compared to those with type ⅡB and ⅡC fractures. This might be due to the open intra-articular involvement of the distal femur of the latter two fracture types.

Complex knee injury scenario in tertiary level care in North India: An epidemiological study.

Floating knee injury has been considered as one of the severe orthopedic injury, and is often associated with major systemic trauma involving other organs. OBJECTIVE: To identify the incidence of floating knee injury, severity of injury and associated orthopaedic and non-orthopaedic injury. METHODS: Epidemiologic study conducted from 1 Jan 2014 to 31 Dec 2014. RESULTS: A total of 136 cases with floating knee injury were registered. Modified Fraser classification showed 58 patients had type 1, 74 had type 2 and 4 had type 3 floating knees. 119(87.5%) patients had open fractures and Gustilo-Anderson type IIIA(29.4%) being the commonest. No Mortality was found. 16 (11.76%) of floating knees had to undergo amputation of afflicted limb. CONCLUSION: Statics of such data would be helpful in planning and preparing ourselves as healthcare professionals to prevent high mortality and morbidity/disability in floating knee injury. STUDY DESIGN: Retrospective Epidemiological. LEVEL OF EVIDENCE: Level 4 (Case Study).

Multiple Brown Tumors Caused by a Parathyroid Adenoma Mimicking Metastatic Bone Disease from Giant Cell Tumor.

Brown tumor affects multiple bones in the body with variable clinical symptoms, which may be misdiagnosed as multiple bone metastases or primary bone tumor. In the present case report, we report the usefulness of 99mTc-MDP bone scan and 99mTc-MIBI whole body scan in differentiating brown tumor of hyperparathyroidism from giant cell tumor.

Significant Incidence of Extra-Articular Tibia Vara Affects Radiological Outcome of Total Knee Arthroplasty.

PURPOSE: To identify and quantify the presence of extra-articular tibia vara that might influence the mechanical axis alignment after total knee arthroplasty (TKA). MATERIALS AND METHODS: A total of 48 TKAs in 30 osteoarthritic Indian patients were prospectively evaluated. The hip-knee-ankle angle (HKA), joint line convergence angle, and varus angulation at the femur and tibia were measured from the preoperative and postoperative standing hip-to-ankle radiographs. Four different methods were used to measure the varus angulation at the tibia: metaphyseo-diaphyseal angle (MDA), the angle between the anatomical axis and mechanical axis of the tibia, the angle between the proximal third and distal third of tibia and the angle between the proximal half and distal half of tibia. RESULTS: Extra-articular tibia vara quantified using MDA had the most positive correlation with HKA. Receiver operating characteristic plotting showed that MDA of >4° predicts abnormal postoperative HKA. Twenty-eight out of 48 knees had MDA of >4°, and 78.6% of these had postoperative HKA under-correction and 21.4% had less than ideal tibial component position. CONCLUSIONS: A significant inherent extra-articular varus angulation best measured using MDA exists in the proximal tibia in osteoarthritic Indian patients undergoing TKA. MDA of >4° is associated with abnormal postoperative HKA. Computer navigation may be useful for achieving ideal correction in such cases.