Proximal femoral fractures in patients with COVID-19 : Pneumonia and admission from a nursing home are the strongest predictors of mortality.

BACKGROUND: Proximal femoral fractures are severe injuries in geriatric patients. Additionally, geriatric patients are at a high risk of death due to coronavirus disease 2019 (COVID-19). OBJECTIVE: To identify predictors of mortality in geriatric patients with COVID-19 and concurrent proximal femoral fractures. MATERIAL AND METHODS: Patients who underwent surgical treatment for proximal femoral fractures and also tested positive for COVID-19 were included. The age, gender, the American Society of Anesthesiology (ASA) score and the admission from a nursing home were considered as variables. The rate of reoperations, the mortality at 3 months and discharge home were evaluated as outcomes. RESULTS: In this study 46 patients with COVID-19 (female/male 31/15, median age 87.0 years with an interquartile range [IQR] of 9.8 years) met the inclusion criteria. Of these, 32 patients (69.6%) had to be cared for in the intensive care unit and 26 patients (56.5%) had a severe course of COVID-19 with pneumonia. The median length of hospital stay for survivors was 19 (IQR 17.5) days and 4 of the patients (8.7%) required surgical revision. The in-hospital and 3­month mortality were 40.0% (n = 17) and 43.5% (n = 20), respectively. The factors which influenced the in-hospital and 3­month mortality rates were admission from a nursing home, the presence of pneumonia (increased the risk of death) and female gender (protective). CONCLUSION: The occurrence of COVID-19 in patients with proximal femoral fractures has a high mortality. Admission from a nursing home and the presence of pneumonia increased the risk of death, whereas women were at lower risk.

[Which factors influence the inpatient course for patients with spondylodiscitis?] / Welche Parameter haben Einfluss auf den stationären Verlauf bei Patienten mit Spondylodiszitis?

BACKGROUND: Spondylodiscitis is a rare disease with an increasing incidence. METHODS: In this retrospective study 112 patients with spondylodiscitis surgically treated from 1 January 2005 to 31 December 2012 in a level I spine center were investigated with respect to potential prognostic criteria. The time period covered by the investigation was the duration of hospitalization. The parameters analyzed were mortality, age, localization of the spondylodiscitis, detection of abscesses and pathogens, neurological status and body mass index (BMI). RESULTS: The average age of the patients was 68.3 years (±12.9 years). The mortality rate during hospitalization was 10.7% (N = 12). Older patients had a significantly higher in-hospital mortality rate (p = 0.008). Abscess formation was found in 49.1% of the patients and was associated with a significantly longer hospital stay (p = 0.001) and in the intensive care unit (ICU, p = 0.001) as well as a higher risk of revision surgery (p = 0.018). In addition, obese patients had a significantly higher occurrence of abscesses (p = 0.034). Pathogen detection was successful in 60.7 % of the cases with Staphylococcus aureus as the most frequent pathogen. Detection of pathogens was associated with a longer hospital stay (p = 0.006) and a greater need of intensive care monitoring (p = 0.017). Patients with a nephropathy had a significantly increased mortality, longer duration of hospitalization and a more frequent occurrence of multilevel afflictions. CONCLUSION: Old age, abscess formation, positive detection of pathogens and renal failure can be used as prognostic criteria. Risk factors for formation of abscesses include a lumbar localization of spondylodiscitis, nephropathy as well as detection of a pathogen and obesity.

Factors affecting duration of inability to work after intramedullary stabilization of displaced midshaft clavicular fractures.

BACKGROUND: Duration of inability to work (DIW) after displaced midshaft clavicular fractures (DMCF) is an important clinical and socioeconomic treatment outcome. However, evidence on DIW after DMCF intramedullary stabilization (IMS) is still limited. We aimed to examine DIW and identify medical and socioeconomic predictors with direct or indirect impact on DIW after IMS of DMCF. HYPOTHESIS: Socioeconomic predictors can explain the unique proportion of the DIW variance after IMS of DMCF above the variance explained by medical predictors. PATIENTS AND METHODS: Using a retrospective cohort unicentric design, we included patients surgically treated with IMS after DMCF from 2009-2022 with employment status subject to compulsory social security contributions, and without major postoperative complications, in one level II trauma center in Germany. In total, we tested the impact of 17 different medical (i.e., smoking, body mass index [BMI], operative duration, etc.) and socioeconomic predictors (i.e., health insurance type, physical workload, etc.) on DIW. Statistics included multiple regression and path analyses. RESULTS: A total of 166 patients met the eligibility criteria, with DIW 35.1±31.1days. Operative duration, physical workload, and physical therapy prolonged the DIW (p<0.001). In contrast, enrollment in private health insurance reduced the DIW (p<0.05). Furthermore, the effect of BMI and fracture complexity on DIW was fully mediated by operative duration. The model explained 43% of the DIW variance. DISCUSSION: Socioeconomic factors were found to directly predict the DIW, even after controlling for medical predictors, which confirmed our research question. This is in line with previous findings and highlights the relevance of socioeconomic predictors in this context. We believe that the proposed model can serve surgeons and patients as an orientation guide to estimate the DIW after IMS of DMCF. LEVEL OF EVIDENCE: IV - retrospective observational cohort study with no control group.

Injuries in supercross - Evaluation of trauma during a two-day international indoor motocross event.

INTRODUCTION: Supercross is characterized by fast and skillful movements, with high concentration being required on an indoor competition circuit, due to the demanding jumps and short distances to the next obstacle. The injuries can turn out to be diverse, including polytraumatization. This paper aims to evaluate the accidents and possible injuries in a single Supercross competition. To what extent is the presence of medical staff required? METHODS: During the 17th International Supercross Event in Chemnitz, 93 participants started in 5 classes. Severe injuries were treated at the track, through the emergency department and hospital stay to their discharge. RESULTS: Overall 5 participants (4.65%) had to be admitted to the clinic. CONCLUSION: Injuries from risky jumps at relatively high speed can range from minor contusions to fractures and serious injuries. The permanent readiness of medical staff and emergency doctors at the site is therefore justified and required. The variety of injuries in a Supercross event can affect the head and face, the upper- and lower extremities, thoracal- and abdominal traumas and especially the spine. In addition, a special training concept in terms of preventive measures to prevent falls would be desirable.

Complementary medicine in orthopaedic and trauma surgery: a cross-sectional survey on usage and needs.

OBJECTIVES: Complementary and alternative medicine (CAM) is frequently used in Western countries within general medicine and internal medicine. Information on the use in orthopaedic and trauma surgery is widely lacking. The aim of this study was to investigate usage and needs regarding CAM for these patients. DESIGN: Prospective paper-based, pseudoanonymous, cross-sectional survey. SETTING: From August to December 2018, a questionnaire composed of 17 questions was distributed to all eligible patients. PARTICIPANTS: In-house patients in orthopaedic and trauma surgery at a high-volume medical centre in Germany. PRIMARY AND SECONDARY OUTCOME MEASURES: Previous or current usage of CAM, interest and requests towards CAM as well as communication about CAM. RESULTS: Overall, 457 orthopaedic and trauma surgical patients took part in the survey. They were on average 52 years old and 54% were male. Most of the patients were admitted due to bone fractures and most underwent operative therapy. Previous or current CAM usage was stated by 76% and 30% of patients, respectively. Most of the patients stated to be interested in usage of CAM and demanded for more clinical usage of CAM and reliable information about CAM. More than 90% of patients did not discuss CAM interest or usage with their treating physicians. Patients stated that physicians should have knowledge about CAM. They wish to be treated in a holistic manner and want to strengthen self-efficacy. CONCLUSIONS: Usage of CAM of patients in orthopaedic and trauma surgery appears to be high. Only a few patients discuss their interest and usage of CAM with their treating physician. Therefore, surgeons should ask their patients about CAM and should consider evidence-based CAM approaches for complementary treatment. TRIAL REGISTRATION NUMBER: DRKS0001544.