Rare case of a low energy traumatic anterior dislocation of the native hip.

Anterior dislocations of the native hip are rare injuries, and normally a result of high energy trauma such as road traffic accidents. Delays in reduction of over 12 hours have been shown to increase the risk of avascular necrosis to the head of the femur significantly. We report the case of an elderly man who sustained an anterior dislocation of his native hip following a fall. The case highlights that prompt appropriate management can lead to excellent clinical outcomes.

Increased 30-day mortality rate in patients admitted with hip fractures during the COVID-19 pandemic in the UK.

INTRODUCTION: Hip fractures are the most common traumatic injury in the UK's elderly population. Patients are often extremely frail with multiple comorbidities and so are at high risk of death should they contract COVID-19. This study aims to quantify the effects of COVID-19 on patients presenting with hip fractures to the Norfolk and Norwich University Hospital (NNUH). METHODS: This is a single centre, prospective, observational cohort study of patients over the age of sixty admitted with a hip fracture to NNUH between March 24th and April 22nd, 2020 and comparing them retrospectively with controls in April 2019. Patients were followed up for 30 days; data collected includes demographics, COVID-19 PCR results, date/cause of death and other prognostic indicators. RESULTS: 66 consecutive patients managed for hip fractures were included in the study. 30-day mortality increased from 8.5% in April 2019 to 18.2% in April 2020. The 30-day mortality rate was 80% for those patients who test positive for COVID-19 as an inpatient, and was 13.8% for patients COVID-19 negative and for those who were untested. Those admitted from a healthcare institution were more likely to test positive for COVID-19 and had a higher 30-day mortality (p = 0.04 & p = 0.006, respectively). Suspected COVID-19-positive patients at time of admission had a delayed time to theatre, 46.7 h versus 27.1 h (p = 0.007), however this had no significant effect on mortality (p = 0.7). CONCLUSIONS: The combination of fragility hip fracture and COVID-19 is associated with poor outcomes. COVID-19 has also indirectly increased mortality in this patient group.

Unicompartmental Knee Arthroplasty: The Past, Current Controversies, and Future Perspectives.

Unicompartmental knee arthroplasty (UKA) is a bone conserving and ligament-sparing procedure that reliably restores normal knee kinematics and function for arthritis limited either to the medial or the lateral compartment of the knee. Although there is enough evidence to demonstrate that the UKA offers good medium to long-term success given the correct patient selection, prosthesis design, and implantation technique, there are several reports to suggest inferior survival rates in comparison with the total knee arthroplasty (TKA). Furthermore, it is a specialized procedure which works well in the hands of the experienced operator and therefore different authors' tend to draw different conclusions based on the same evidence, and as a result, there is great variability in the usage of the UKA. The aim of this current concept's review is to present to the readers the history of the UKA especially with reference to implant design, discuss current controversies, and outline the future perspectives of this novel procedure.