Delay to surgery beyond 12 hours is associated with increased hip fracture mortality.

PURPOSE: Time to surgery from admission is one of the few variables known to influence outcome after a hip fracture. We reviewed our hip fracture database to determine correlation between delays to surgery and mortality in our elderly hip fracture population. METHODS: Data on all hip fracture patients admitted to a large district hospital were prospectively collected between January 1989 and August 2021. Time of the injury, time of admission and time of surgery were recorded. Patients over 60 years old with a hip fracture requiring operative management were included. Patients with pathological fractures, those managed conservatively, and patients delayed for medical reasons were excluded. Surgical timing categories were divided into; under 12 h, 12-24 h, 24-72 h and over 72 h. RESULTS: Time from admission to surgery was recorded for 10,659 patients, of these time of fall was available for 10,346 patients. Mean age was 82.2 years (sd 8.39) for the cohort and 30 day mortality was 6.20%. Odds of 30-day mortality was 1.43 (CI 1.057-1.988, p = 0.025) for delay to surgery from admission of over 12 h compared to under 12 h. Odds ratios for 30-day mortality were not significant at any other time threshold. The odds of 30-day mortality for delay to surgery from time of fall were 1.550 (CI 1.026-2.459, p = 0.048) at the 12 h threshold. CONCLUSION: This is the largest prospective study to date in elderly patients with hip fractures demonstrating a statistically significant increase in 30-day mortality with a delay to surgery over 12 h.

Atraumatic Bilateral Acute Compartment Syndrome of the Lower Legs: A Review of the Literature.

Bilateral acute compartment syndrome of the legs is a very rare presentation that requires emergency surgical intervention. Atraumatic bilateral cases are almost unheard of in medicine. There is currently no link between compartment syndrome and cognitive impairment or mental health. A systematic literature search was performed in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines using the following keywords in multiple databases: compartment syndrome, atraumatic, spontaneous, bilateral, both, lower leg, acute, compartmental pressure, and fasciotomy. Atraumatic, bilateral, acute, and confirmed compartment syndrome cases were included. In total, 33 cases of atraumatic bilateral acute compartment syndrome (ABACS) were identified, of those 72.7% of cases were males. A form of cognitive impairment was found in 66% of cases. The medical history of the cases included substance abuse (nine patients), mental health illness (seven patients), and hypothyroidism (four patients). Within the reports, there was evidence of a misdiagnosis or delayed management in 19 cases (57.6%). Creatinine kinase (CK) was measured in 28 cases with a mean CK of 110,893 IU/L. Compartment pressure measurements were used in only 12 cases. A total of 29 cases were managed with bilateral four-compartment fasciotomy. This review highlights that ABACS is a condition with high rates of misdiagnosis or delay in treatment. Associations found included patients with cognitive impairment on presentation, mental health conditions, substance misuse, and elevated levels of CK. In addition, this review demonstrates that this condition is less rare than previously thought with serious morbidity and mortality.

Reverse Shoulder Arthroplasty Humeral Lateralisation: A Systematic Review.

Different studies on reverse shoulder arthroplasty (RSA) have proposed changes to the humeral design to lateralise the humeral centre of rotation (COR), with humeral inclination to 135 or 145 from 155 degrees or to switch to onlay humeral trays from inlay design; with both having also been used in combination. There have been many studies and systematic reviews to show the difference in outcomes and complications to the variations in glenoid design but to date, there have been no systematic studies to compare different humeral inclinations for RSA implants. Searches using keywords were used in common medical search engines in a systematic fashion. The article was reviewed for the class of evidence and bias, summarised and compared in meta-analysis. Inclusion criteria included studies on adults with RSA that compared lateralised humeral implants to medialised. The search produced 349 articles; of these, we identified nine studies that met the inclusion criteria. Our review identified a total of 562 patients who had been included in studies directly comparing lateralised humerus to a more medial design. Meta-analysis showed a significantly reduced risk of scapular notching in lateralised humerus compared to the standard medialised component. The external rotation range of motion in the lateralised group was statistically significant. The improvement in scapular notching and gain in the range of motion without any apparent downside in the form of reduced patient-reported outcome measures or complications suggest a lateralised humeral component is superior to the more medialised design in RSA. A large RCT with a longer-term follow-up is needed to confirm whether there is clinically significant benefit from the lateralisation of the humerus.