Enhanced recovery after surgery speeds up healing for hip fracture patients.

OBJECTIVE: To investigate the effects of enhanced recovery after surgery (ERAS) on the perioperative healing and stress response in patients with hip fractures. METHODS: A retrospective analysis was conducted on the medical records of 86 patients with hip fractures admitted to the Affiliated Hospital of Southwest Medical University between January 2022 and August 2023. Among them, 48 patients in the research group received ERAS, while 38 patients in the control group received conventional nursing. Hip joint function, pain levels, stress response, fracture healing time, incidence of complications, and nursing satisfaction were compared between the two groups. RESULTS: After nursing, the Harris scores notably increased in both groups, with the research group showing notably higher scores compared to the control group (P<0.05). The levels of cortisol and epinephrine, as well as the visual analog scale scores significantly decreased in both groups, with the research group showing significantly lower levels (P<0.05). In addition, the research group experienced significantly shorter fracture healing time (P<0.05), higher nursing satisfaction (P=0.014), and lower incidence of complications (P=0.028). Logistic regression analysis revealed that age, underlying diseases, nursing method, emotional disorders, and timing of surgery were independent factors influencing the post-nursing outcomes. CONCLUSION: The ERAS mode can effectively alleviate pain, improve hip joint function, reduce fracture healing time and complications, mitigate stress response, and accelerate postoperative recovery in patients with hip fractures. It is worthy of application and promotion in clinical practice.

Comparison of CT and MRI in diagnosing occult hip fracture: a systematic review and meta-analysis.

OBJECTIVE: To compare the diagnostic accuracy of computed tomography (CT) scans and magnetic resonance imaging (MRI) in detecting occult hip fractures. METHODS: We conducted a systematic literature review and identified 12 articles involving 1,819 participants for inclusion. Data extraction and quality assessment were performed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Publication bias was assessed with the Deek funnel plot asymmetry test. We conducted a meta-analysis using a random-effects model to derive pooled estimates of sensitivity, specificity, positive and negative likelihood ratios, and the diagnostic odds ratio, along with their 95% confidence intervals. A summary receiver operating characteristic curve was generated to illustrate the overall diagnostic accuracy. RESULTS: The methodological quality of the included studies was high, with minimal concerns about the applicability of the tests in clinical settings. Both CT and MRI showed good diagnostic efficacy for occult hip fractures. However, MRI consistently outperformed CT, exhibiting significantly higher sensitivity, specificity, and likelihood ratios, thereby providing superior accuracy in confirming or excluding occult fractures. Meta-regression analysis revealed that sequence parameters and sample size significantly influenced the differences in sensitivity and specificity between CT and MRI. CONCLUSION: Both CT and MRI are effective modalities for detecting occult hip fractures, with MRI demonstrating greater diagnostic accuracy. This meta-analysis supports the use of MRI when higher sensitivity and specificity are required in clinical practice.

Understanding musculoskeletal disorders in dancers: The role of lumbopelvic muscles and movement competency.

OBJECTIVE: To investigate whether transversus abdominis activation (TrA), hip strength, and movement competency are associated with the incidence of musculoskeletal disorder episodes (MDEs) in dancers when controlling for confounding variables. The secondary objectives were to determine if there were differences between professional and preprofessional dancers for the aforementioned factors, as well as to determine if there were differences in TrA activation and hip strength between the dominant and non-dominant sides. DESIGN: Prospective cohort study. METHODS: 118 dancers were recruited. The independent variables were collected at the beginning of the dance season: 1) TrA activation, 2) hip strength, and 3) movement competency. To assess the development of MDEs, a weekly electronic diary was used over a 38-week period. MDEs were compiled for each dancer's whole body and subdivided into total musculoskeletal disorder episodes (all body parts) and lower quadrant musculoskeletal disorder episodes (lower limb and lower back). RESULTS: Lower TrA, as well as higher hip abductor and external rotator strength, were associated with a lower incidence of MDEs. TrA activation (ß = 0.260, p = 0.023) and hip external rotator strength (ß = -0.537, p = 0.002) could significantly explain 25.4% of the variance of total MDEs, as well as 20.9% of the variance of lower quadrant musculoskeletal disorder episodes (ß = 0.272, p = 0.016; ß = -0.459, p = 0.011). No significant associations were found between movement competency and MDEs. CONCLUSIONS: Higher hip strength could be a protective factor for MDEs among dancers. Further studies are needed to better understand the involvement of the transversus abdominis in MDEs.

Alcohol and drug use in adults younger than 60 years with hip fracture - A comparison of validated instruments and the clinical eye: A prospective multicenter cohort study of 218 patients.

BACKGROUND: It is a common preconception that young individuals sustaining hip fractures have alcohol and/or drug use disorder. It is important to evaluate the actual use to avoid complications and plan the rehabilitation. AIM: The primary objective was to assess alcohol and drug consumption in hip fracture patients <60 years using the validated Alcohol Use Disorders Identification Test (AUDIT) and Drug Use Disorders Identification Test (DUDIT) scores. We secondarily investigated the agreement between the instruments and the physicians' clinical evaluation of usage. MATERIAL AND METHODS: This is a sub-study of 91 women and 127 men from a multicenter cohort study of patients with an acute hip fracture treated at four hospitals in Denmark and Sweden. AUDIT and DUDIT forms were completed by the patients. In addition, the researchers made an evaluation of the patients' alcohol/drug use based on direct patient contact and information on previous alcohol/drug use from medical charts. AUDIT ranges 0-40 with 6 (women) and 8 (men) as the cut-off for hazardous use. DUDIT ranges 0-44 with cut-offs of 2 and 6 indicating drug-related problems. RESULTS: According to the AUDIT, 29 % of the patients had a hazardous alcohol use (25 % women, 31 % men), whilst the clinical evaluation identified 26 % (24 % women, 28 % men). However, there was a low agreement between "the clinical eye" and AUDIT, as the clinical evaluation only correctly identified 35 of 56 individuals with AUDIT-scores indicating hazardous alcohol use. DUDIT equaled drug related problems in 8 % (5 % women, 10 % men), the clinical evaluation depicted 8 % with drug related problems (4 % women, 10 % men). The agreement was low between "the clinical eye" and DUDIT; only 7 of 15 with DUDIT-scores indicating drug related problems were correctly identified. CONCLUSION: Hazardous alcohol consumption is more common in non-elderly hip fracture patients than in the general population. Considering both self-reported alcohol use and clinical evaluation, women have almost as high rate as men. DUDIT indicated drug related problems to be slightly more common than in the population. Still, a majority did not exhibit troublesome use of neither alcohol nor drugs. The two screening methods do not identify the same individuals, and further investigation in clinical practice is needed.

Classification of the foot kinematics during gait and the characteristics of the knee and hip kinematics in individuals with pronated foot.

Overuse injuries are often caused by pronated foot and the associated abnormal lower-extremity kinematics during dynamic activities. Various patterns of foot kinematics are observed among individuals with pronated feet during dynamic activities, resulting in different dynamic kinematics of the proximal joint. This study aimed to identify the foot kinematic patterns during gait among individuals with pronated feet and evaluate the relationship between these foot kinematic patterns and the hip and knee kinematics. A three-dimensional motion capture system was used to collect data regarding the foot, knee, and hip kinematics during the stance phase of gait of 42 individuals with pronated feet. A hierarchical cluster analysis method was used to identify the optimal number of clusters based on the foot kinematics, including navicular height (NH) at initial contact and dynamic navicular drop (DND). The differences in the cluster and demographic variables were examined. One-dimensional statistical parametric mapping was used to evaluate the differences in the time histories of the NH, knee, and hip kinematics during the stance phase. Three subgroups were identified on the basis of the NH and DND: Cluster 1, moderate NH at initial contact and larger DND; Cluster 2, highest NH at initial contact and smaller DND; and Cluster 3, lowest NH at initial contact and smaller DND. The hip adduction angle of Cluster 1 was significantly higher than that of Cluster 3 from the 0% to 51% stance phases. Further longitudinal studies are needed to clarify the relationship between identified subgroups and the development of overuse injuries.

Feasibility of interdisciplinary evaluation in non-arthritic hip pain: A randomized trial.

BACKGROUND: Physical therapy and orthopaedic surgery are two common treatments for non-arthritic hip pain. Interdisciplinary evaluation across these disciplines may produce a more supportive treatment-planning process; however, the feasibility of such an evaluation remains unknown. HYPOTHESIS OBJECTIVE: To assess the feasibility of an interdisciplinary evaluation with an orthopaedic surgeon and physical therapist for non-arthritic hip pain. STUDY DESIGN: Observational feasibility study of a randomized controlled trial. METHODS: Participants were randomized to an interdisciplinary (surgeon + physical therapist) or standard (surgeon) evaluation in a hip preservation clinic. Recruitment rate was recorded. Retention rate was calculated for all variables of interest. Enrollment and refusal reasons were recorded as patient quotes and categorized by a single grader. Time spent in clinic was compared across groups using Mann Whitney U tests (P ≤ 0.05). Study clinicians were interviewed, and responses were categorized based on pre-determined themes. RESULTS: Eighty-one percent of eligible patients enrolled over a 15-month recruitment period. Willingness(n = 16), urgency to resolve pain(n = 10), financial compensation(n = 1), interest in research(n = 42), physical therapy(n = 6), or multiple-provider care(n = 15) were participants' enrollment reasons; reason was not recorded for 22 participants. Time(n = 11), preference for single-provider care(n = 6), current physical therapy treatment(n = 1), and disinterest in physical therapy(n = 7) or research(n = 2) were refusal reasons of patients who did not enroll. Retention for primary variables of interest was 100% in both groups. Participants spent, on average, 23.5 min more time in clinic for the interdisciplinary evaluation compared to the standard (P < 0.001). CONCLUSIONS: An interdisciplinary evaluation for patients with non-arthritic hip pain that included a physical therapist and orthopaedic surgeon in a hip preservation clinic was feasible and may better inform the treatment planning process.

Capsular and fascial closure with barbed sutures reduces blood loss compared to traditional interrupted sutures in total hip arthroplasty.

BACKGROUND: STRATAFIX, a recently introduced barbed suture device, incorporates self-anchoring, knotless sutures with higher tensile strength and enhanced tissue-holding capacity compared to traditional braided absorbable sutures. This study aimed to compare the efficacy of barbed sutures and interrupted sutures in capsular and fascial closure during total hip arthroplasty. METHODS: We retrospectively reviewed the records of patients who underwent total hip arthroplasty between April 2017 and March 2021. Overall, 547 patients were evaluated, comprising 77 men and 470 women (mean age: 64.5 years). Among them, 330 patients were in the interrupted suture (control) group, while 217 were in the barbed suture (BS) group. Data on surgical time, perioperative hemoglobin, length of hospital stay, complications such as transfusions and delayed wound healing, and dislocation rates were collected during the latest outpatient follow-up and compared between the two groups. RESULTS: No differences were observed in intraoperative blood loss between the groups. However, the BS group exhibited significantly longer operative time, as well as significantly lower postoperative blood loss, total blood loss, and postoperative hemoglobin drop compared to the control group. Dislocation was reported in two cases within the control group, whereas no instances were recorded in the BS group. CONCLUSION: The use of barbed sutures demonstrated effectiveness in reducing perioperative blood loss for capsular and fascial closure during total hip arthroplasty.

Rehabilitation-Specific Predictors of Pain Intensity and Physical Activity Levels in Individuals With Acetabular Dysplasia 6 Months After Periacetabular Osteotomy.

INTRODUCTION: Individuals with acetabular dysplasia often report hip joint instability, pain, and poor hip-related function. Periacetabular osteotomy (PAO) is a surgical procedure that aims to reposition the acetabulum to improve joint congruency and improve pain and function. We aimed to examine the influence of presurgery clinical measures on functional recovery following PAO and the associations among clinical outcomes after PAO. METHODS: We screened 49 potential participants, 28 were enrolled, and 23 completed both study visits (pre-PAO and 6 months post-PAO). We evaluated dynamometer-measured hip and thigh strength, loading patterns during a squat and countermovement jump (CMJ), pain intensity, and device-measured physical activity (PA) levels (light, moderate-to-vigorous PA [MVPA], and daily steps). We used linear regression models to examine the influence of muscle strength (peak torque; limb symmetry index [LSI]) and loading patterns before PAO on pain intensity and PA levels in individuals 6 months following PAO. Additionally, we used Pearson correlation coefficient to examine cross-sectional associations among all variables 6 months following PAO. RESULTS: Lower extremity muscle strength and loading patterns during the squat and CMJ before PAO did not predict pain intensity or device-measured PA levels in individuals 6 months following PAO (p > 0.05). Six months following PAO, higher knee extensor LSI was associated with higher time spent in MVPA (r = 0.56; p = 0.016), higher hip abductor LSI was associated with both lower pain (r = 0.50; p = 0.036) and higher involved limb loading during the squat task (r = 0.59; p = 0.010). Lastly, higher hip flexor LSI was associated with higher CMJ takeoff involved limb loading (r = 0.52; p = 0.021) and higher involved hip extensor strength was associated with higher CMJ landing involved limb loading (r = 0.56; p = 0.012). CONCLUSION: Six months after PAO, higher hip and thigh muscle strength and strength symmetry were associated with lower pain, higher PA levels, and greater normalized limb loading during dynamic movement tasks.

Association between composite indices of femoral neck strength and odds of hip fracture.

This study aimed to assess the association between composite indices of femoral neck strength and the odds of hip fracture in Chinese adults.After adjusting for confounders, higher values of CSI and ISI were associated with a lower risk of fracture. They may provide useful information for improving hip fracture risk assessment. PURPOSE: With the increased incidence of hip fractures worldwide, numerous studies have reported that composite indices of femoral neck strength can improve hip fracture risk assessment. This study aimed to assess the association between composite indices of femoral neck strength and the odds of hip fracture in Chinese adults. METHODS: This retrospective cross-sectional study conducted at Changzhou Second People's Hospital included 937 Chinese adults (248 with hip fractures). After overnight fasting for ≥ 8 h, blood samples were collected from all participants within 24 h of admission. Composite indices of femoral neck strength were derived by combining bone mineral density, weight, and height with femoral axis length and width, which were measured by dual-energy X-ray absorptiometry. RESULTS: In total, 937 participants (293 men and 644 women) were enrolled. The mean age was 68.3 years (SD 10.5). After adjusting for confounders, higher values of CSI and ISI were associated with a lower odd of hip fracture. Increase in CSI (per 1 g/m·kg) was associated with a 46% decrease in the odd of hip fracture (OR = 0.54; 95% CI, 0.39-0.74), and increase in ISI (per 0.1 g/m·kg) was associated with an 82% decrease (OR, 0.18; 95% CI, 0.11-0.30). Effect sizes of CSI and ISI on the odds of hip fracture remained robust and reliable in subgroup analyses. CONCLUSIONS: Increased CSI and ISI were associated with a lower odd of hip fracture, especially in women, suggesting that composite indices of femoral neck strength may provide useful information for improving hip fracture risk assessment.

Impact of the American Society of Anesthesiologists (ASA) classification on hip fracture surgery outcomes: insights from a retrospective analysis.

BACKGROUND: The American Society of Anesthesiologists (ASA) classification is the most used system to assess patient health status before surgery, ranging from I to V levels. This study aims to explore the impact of different ASA risk classes (ASA II [mild risk] and ASA III [severe risk]) on clinical outcomes following hip fracture surgery, including all-cause mortality and postoperative complications. METHODS: A retrospective analysis from 2019 to 2021 across three Jordanian centers was conducted. The study included patients aged 65 and above who underwent hip fracture repair surgeries. Preoperative measures, intraoperative management protocols, and postoperative care were collected. Clinical data were extracted from electronic medical records, including demographics, fracture type, intraoperative data, and postoperative outcomes. RESULTS: The analysis included 1033 patients, with 501 (48.5%) in the mild anesthetic risk group (ASA I-II) and 532 (51.5%) in the severe anesthetic risk group (ASA III-V). The mean age was 73 years, with a higher prevalence of males in the severe risk group. Patients in the severe risk group had more comorbidities, higher ICU admissions (15.23% vs. 6.18%), longer hospital stays (median 7 vs. 6 days), and higher rates of postoperative thromboembolic complications (3.39% vs. 1.39%) compared to the mild risk group. Additionally, the severe risk group showed higher mortality rates both in-hospital mortality (3.38% vs. 1.39%) and all-cause mortality (16.92% vs. 10.36%). Multivariate analysis identified higher ASA score as independent risk factors for increased all-cause mortality (HR = 1.64 95%CI 1.51-2.34) and thromboembolic complications (OR = 2.85 95%CI 1.16-7). Length of hospital stay was significantly associated with higher ASA score (OR = 1.04 95%CI 0.96-1.11). CONCLUSION: The study underscores the significant impact of anesthetic risk on the outcomes of hip fracture surgeries. Patients with higher ASA scores associated with severe systemic diseases may have at increased risk of adverse outcomes.

Hip microinstability and its association with femoroacetabular impingement: A scoping review.

Introduction: Hip microinstability has become a recognized cause of non-arthritic hip pain and disability in young patients. However, its pathophysiology remains unclear. We want to (1) present an overview of the evidence of hip microinstability and of its association with femoroacetabular impingement (FAI), (2) map out the type of evidence available, and (3) make recommendations for future research. Methods: A deductive analysis and extraction method was used to extract information. In addition, diagnostic accuracy statistics were extracted or calculated. Results: Of the 2,808 identified records, 123 were eligible for inclusion. Different definitions for microinstability exist. A standardized terminology and clear diagnostic criteria are lacking. FAI and microinstability may be associated and may aggravate each other. Conservative treatment strategies for FAI and microinstability are similar. The reported prevalence of microinstability in combination with FAI ranges from 21% to 42% in adults undergoing hip arthroscopy or magnetic resonance arthrography (MRA) of the hip. Conclusion: Hip microinstability and FAI may be associated, occur together, or exacerbate each other. To better address this topic, a standardized terminology for microinstability is essential. Achieving consensus on physical examination and diagnosis is also necessary. Initial efforts to establish uniform diagnostic criteria have been made, but further work is needed. Specifically, randomized controlled trials are required to evaluate the effectiveness of training programmes aimed at reducing symptoms in individuals with microinstability, with or without FAI. Such studies will enable clinicians to manage microinstability with greater confidence within this context.

Magnetic Resonance Imaging Patterns of Common Injuries in Pediatric and Adolescent Athletes.

Injuries in pediatric and adolescent athletes continue to rise in the United States, with increases in year-round sports participation, earlier sport specialization, and inadequate access to neuromuscular training programs. In this setting, the use of magnetic resonance imaging (MRI) provides a critical diagnostic tool. This review article describes the utility of MRI in diagnosing common pediatric and adolescent sports injuries and presents imaging findings associated with these pathologies.

Coloarticular Fistula as a Long-Term Sequela of the Hartmann Procedure.

Coloarticular fistula is a rare complication of the Hartmann procedure, reported in the literature only a few times. Risk factors may include underlying colonic malignancy and other proinflammatory conditions. Herein, we describe the case of a 78-year-old female with a recent history of total hip replacement, misdiagnosed Crohn's disease, and a Hartmann procedure for perforated diverticulitis who developed a psoas abscess. Further investigation, including gastrografin enema and computerized tomography, revealed significant fistulization between her hip prosthesis, rectal stump, adnexa, and cecum. Intervention required extensive interdisciplinary decision-making, and the patient underwent interventional radiology-guided abscess drainage, arthroplasty revision, and exploratory laparotomy.

CT-based comprehensive scoring system for assessing hip arthropathy in ankylosing spondylitis: feasibility study with clinical correlation.

OBJECTIVE: To develop a CT-based scoring system for assessment of hip arthropathy in AS. METHODS: All AS patients were prospectively recruited, consented, and underwent whole-body stereoradiographs and pelvis CT, which were assessed by two independent radiologists. Stereoradiographs were assessed according to Kellgreen-Lawrence and BASRI-h. For the Hip arthropathy CT score in AS (HACTSAS), joints were divided into 7 segments and scored for joint space, osteophytes, subchondral cysts/erosions. Patients were clinically assessed for range of motion (ROM), pain, and clinical scores (BASMI, BASFI, ASQol, BASDAI and ASDAS). Radiological scores correlations with clinical parameters were compared. ROM sensitivity and specificity for hip arthropathy (BASRI-h ≥ 2) were calculated. RESULTS: Sample included 112 patients, with 36/112 females and 76/112 males. Average age was 51.0 ± 11.2 years and mean duration of AS was 20.9 ± 9.6 years. ICC for HACTSAS, Kellgreen-Lawrence and BASRI-h were 0.89, 0.89 and 0.82 respectively. HACTSAS showed moderate absolute correlation with ROM (ρ=-0.41) and BASMI (ρ = 0.45), and weak with pain (ρ = 0.18) and BASFI (ρ = 0.25). BASRI-h and Kellgreen-Lawrence exhibited moderate correlation with ROM (ρ=-0.44 and ρ=-0.40, respectively), weak with pain (ρ=-.27and ρ=-0.23, respectively) and BASFI (ρ=-0.16 and ρ=-0.18, respectively), but only weak with BASMI (ρ=-0.34 and ρ=-0.36, respectively). Internal rotation <15°, abduction <31°, and intermalleolar distance <75cm were, respectively, 73%, 70% and 73% sensitivity and 81%, 65% and 68% specific for hip arthropathy. CONCLUSION: HACTSAS exhibited higher correlation with BASMI and BASFI when compared with BASRI-h, but less correlation with pain and ROM. Internal rotation was the best clinical discriminator for hip arthropathy.

Development of an aid to detect adults acetabular hip dysplasia (the ALPHA alert): A mixed methods study.

OBJECTIVES: To identify the signs and symptoms that people living with acetabular hip dysplasia (AHD) describe and to provide an aid for translating the findings into practice. METHODS: A three-phased mixed methods study. Phase 1 employed an open-question online survey that enabled people with AHD (aged ≥16 years) to describe features associated with their condition. Responses were thematically analysed. A Phase 2 survey used these themes to establish how common those features were. Phase 3 created a mnemonic that prompts clinicians to suspect AHD. RESULTS: Ninety-eight respondents completed Phase 1 and sixty-two completed Phase 2. From the responses, five themes were identified: Demographic and Diagnostic Profile; Characteristics of Posture and Gait; Pain; Childhood Hip and Family History; and Hip Joint Characteristics. Within these themes, 19 common signs and symptoms were reported, represented by the ALPHA mnemonic. ALPHA describes a young age at onset of problems (Age), a limp (Limp), progressing pain (Pain), a history of childhood and family hip anomalies (History) as well as hip joint hypermobility and instability (Articulation). CONCLUSION: The findings extend current understanding of AHD indicators. ALPHA alerts clinicians to suspect a diagnosis of AHD. ALPHA may facilitate timelier referral of patients for diagnostic X-Ray and appropriate treatment. Future studies should evaluate its clinical utility.

Ultrasound-guided arthrocentesis and intra-articular injection of the hip and shoulder joints in the dog.

OBJECTIVE: To provide a video tutorial on ultrasound-guided arthrocentesis and injection of the canine hip and shoulder joints. ANIMALS: Dogs undergoing arthrocentesis or intra-articular injection for diagnostic or therapeutic purposes. METHODS: The target joint is visualized in long axis with a 70% isopropyl alcohol medium and linear array probe with a frequency range of 2 to 14 MHz and footprint of 50 mm after clipping a window and preparing the region sterilely. The needle is inserted, bevel up, in long axis with the probe angled at the appropriate trajectory to enter the joint space. The needle is advanced until the tip is visualized entering the joint. Aspiration to obtain synovial fluid can further confirm needle placement or provide diagnostic sampling prior to injection. The aspirate syringe is exchanged for that containing the therapeutic agent, and injectate can then be visualized entering and/or expanding the joint upon injection. RESULTS: Ultrasound-guided arthrocentesis will help identify deep appendicular joints (hip and shoulder), avoid surrounding vasculature, confirm needle placement, and target joint fluid pocketing. Needle guidance into a joint can reduce iatrogenic tissue damage from inappropriate needle placement and/or by minimizing attempts. CLINICAL RELEVANCE: For arthrocentesis, ultrasound guidance can maximize joint fluid volume acquisition for diagnostic purposes (cytology, culture, and fluid analysis) while also avoiding blood contamination. For joint injections, ultrasound will help ensure real-time intra-articular delivery of the injectate (regardless of attaining synovial fluid feedback) to maximize the therapeutic effect. For either purpose, iatrogenic tissue damage and procedure time are minimized.

Optimizing Orthogeriatric Hip Fracture Care: Why Fracture Type Matters.

Hip fractures significantly impact morbidity and mortality among frail older adults, posing ongoing challenges in orthogeriatric care despite significant advancements. Established in the 1960s by Devas and Irvine, this field integrates orthopedics, trauma services, and geriatric medicine to address the complex needs of this population comprehensively. A critical and underexplored aspect is the precise identification and tailored treatment of various fracture types, each linked to unique clinical challenges and outcomes. This special article emphasizes the complex interplay between specific fracture types, their management options, and the roles of comorbidity and polypharmacy, highlighting the essential role of orthogeriatricians. Orthogeriatricians navigate the complexities posed by comorbidities, frailty, and polypharmacy, significantly influencing treatment outcomes. Their roles have expanded to include decision making about both operative and nonoperative strategies, emphasizing patient-centered care and moving beyond simplistic categorizations of "hip fractures." As future experts on the nuances of fracture types and their broader health implications, orthogeriatricians are also crucial in advancing treatment protocols that address preoperative and postoperative needs. Their comprehensive knowledge ensures effective in-hospital management and postdischarge planning, aligning treatment strategies with the holistic needs of frail older adults. The ongoing evolution of orthogeriatric practices promises to enhance decision-making and patient outcomes through a more informed and integrated care approach.

Two genetic variants in the HIBCH and FTCDNL1 genes are associated with susceptibility to developmental dysplasia of the hips among the Han Chinese population of Southwest China.

BACKGROUND: Developmental dysplasia of the hip (DDH) is a common cause of childhood disability, and the incidence of DDH shows significant familial aggregation. As the genetic factors of DDH remain unknown, the correlation between five candidate single nucleotide polymorphisms (SNPs) and DDH was evaluated in the Han Chinese population of Southwest China. METHODS: A case‒control association study was conducted in 276 patients with DDH and 318 healthy controls. SNP genotyping in the case and control groups was performed by SNPshot and multiple PCR. SNPs were genotyped in the case and control groups by multiplex PCR. The relationship between DDH and candidate SNPs was evaluated using the χ2 test. RESULTS: The genotype distributions of rs291412 in HIBCH and rs769956 in FTCDNL1 were different between the case and control groups (P < 0.05). After genetic model analysis, logistic regression analysis revealed that the C allele of rs291412 had a protective effect on DDH (OR = 0.605, P = 0.010) and that the G allele of rs769956 was a risk factor (OR = 2.939, P = 0.010).s. CONCLUSION: These SNPs could be associated with susceptibility to DDH but larger population-based studies should confirm the current results.

Comparison of mid-term clinical and radiological results of short and conventional femoral stems in total hip arthroplasty.

This study aims to answer the question: Which are superior-conventional or short femoral stems?. An Optymis stem was used as a short-femoral stem, and an Accolade II stem was used as a conventional-femoral stem. There were 95 patients in the short femoral stem group (Group 1) and 90 in the conventional stem group (Group 2). The SF-36 Life Quality Score, thigh pain, and the Harris Hip Score were used to evaluate the patients' clinical outcomes. Pre-operative, immediate post-operative, and final follow-up x-rays were used for radiological evaluation. Stem varus/valgus alignment, hip offset changing, acetabular anteversion/inclination changing, femoral migration, acetabular migration, periarticular ossification, and osteointegration evaluation were assessed for both groups. The mean follow-up time was 5.5 years for Group 1 and 5.2 years for Group 2. No significant difference existed between the two groups in terms of clinical scores (Harris Hip Score, SF-36). Thigh pain was significantly higher in Group 2 (p = 0.0001). As for radiological parameters, Group 1 exhibited more varus position-related results. In terms of angular stability, Group 1 was found to be more unstable than Group 2 (p = 0.0001). The power to reconstruct femoral offset was superior in Group 1. Periarticular ossification was more frequent in Group 2. Femoral osteointegration was denser proximally in Group 1 and distally in Group 2. When mid-term radiological and clinical results of both femoral stems are evaluated, they have no superiority over each other.

Clinical outcomes of total joint arthroplasty in patients with bowel ostomies.

INTRODUCTION: The influence of prior colostomy or ileostomy on patients undergoing joint arthroplasty remains poorly understood. Our study aimed to assess whether patients with an ostomy undergoing hip and knee arthroplasties have worse postoperative outcomes and increased rates of revisions. METHOD: A single-center, retrospective review of patients with a history of bowel ostomy who underwent a primary total hip arthroplasty (THA), hemiarthroplasty (HA), and total knee arthroplasty (TKA) from 2012 to 2021. A total of 24 THAs, 11 HAs, and 25 TKAs in patients with open small or large bowel stoma were identified. A ten-to-one propensity score match was utilized to establish cohorts with comparable demographics but no prior ostomy procedure. RESULTS: Patients with stomas undergoing elective THA showed greater 90-day ED visits (20.0 vs. 5.0%, P = 0.009), 90-day all-cause readmissions (20.0 vs. 5.0%, P = 0.009), 90-day non-orthopedic readmissions (10.0 vs. 0.5%, P < 0.001), 90-day readmissions for infection (5.0 vs. 0.5%, P = 0.043), all-cause revisions (15.0 vs. 0.5%, P < 0.001), revisions for PJI (5.0 vs. 0%, P = 0.043), and revisions for peri-prosthetic fracture (10.0 vs. 0%, P < 0.001). Patients with stomas undergoing non-elective hip arthroplasties exhibited a longer mean LOS (12.1 vs. 7.0 days, P < 0.001) and increased 90-day all-cause readmissions (40.0 vs. 17.3%, P = 0.034), 90-day orthopedic readmissions (26.7 vs. 6.0%, P = 0.005), all-cause revisions (13.3 vs. 2.0%, P = 0.015), revisions for peri-prosthetic fracture (6.7 vs. 0%, P = 0.002), and revisions for aseptic loosening (6.7 vs. 0%, P = 0.002). There were no significant differences in readmission or revision rates between ostomy patients undergoing TKA and a matched control group. CONCLUSION: Patients undergoing hip arthroplasties with an open stoma are at an increased risk of hospital encounters and revisions, whereas TKA patients with stomas are not at increased risk of complications. These findings emphasize the importance of recognizing and addressing the unique challenges associated with this patient population.