Outcomes of cement augmentation in fragility trochanteric hip fractures - A multicenter randomized controlled trial follow-up.

PURPOSE: Cement augmentation is considered to improve the bone-implant construct stability in hip fragility fractures, additionally biomechanical studies show that cement augmentation improves the pull-out strength and increases resistance to failure. Thus far, the advantage of these technique used in a clinical scenario is yet to be determined METHODS: a randomized, multicenter, single-blinded clinical trial was conducted in patients aged 65 years or older who were admitted to two level I trauma centers with a fragility intertrochanteric hip fracture during September 2015 and December 2017. Patients were stratified into 2 groups: patients between 65 and 85 years and older than 85 years. A balanced block randomization was performed using blocks of 6 patients: 3 patients assigned to the control group (no augmentation) and 3 patients to the intervention group. Follow-up visits were done at 1, 3, 6 and 12 postoperative months documenting the tip-apex distance (TAD) as well as followed up after 5 to 7 years of surgical procedure documenting EQ5D, Parker Mobility Score and mortality rates at these different time points. RESULTS: A total of 90 patients were included but only 53 patients completed a one-year follow up. The mean immediate postoperative and one-year follow up TAD measurement from the whole cohort (20.99 mm vs 21.3 mm, respectively) showed no statistical significance (P = 0.18). For patients in the control group, the difference of TAD measurements from the immediate postoperative and one-year follow-up was -0.25 mm (P = 0.441). For patients included in the intervention group, the difference of TAD measurement from the immediate postoperative and 1-year follow up was -0.48 mm (P = 0.383). No statistical difference was found when stratified by age (p = 0.78). One patient from the control group had an implant failure after 1-month postoperative. Readmission after 30 days showed no statistical difference between both groups (7 vs. 7 patients, p = 0.754). Augmentation did not show a difference in most of the functional outcomes nor quality of life after 5 to 7 years of surgical procedure. CONCLUSIONS: The use of augmentation can be considered a safe procedure for the fixation of fragility hip fractures.

Climate vulnerability assessment of key fishery resources in the Northern Humboldt Current System.

The Northern Humboldt Current System sustains one of the most productive fisheries in the world. However, climate change is anticipated to negatively affect fish production in this region over the next few decades, and detailed analyses for many fishery resources are unavailable. We implemented a trait-based Climate Vulnerability Assessment based on expert elicitation to estimate the relative vulnerability of 28 fishery resources (benthic, demersal, and pelagic) to the impacts of climate change by 2055; ten exposure factors (e.g., temperature, salinity, pH, chlorophyll) and 13 sensitivity attributes (biological and population-level traits) were used. Nearly 36% of the species assessed had "high" or "very high" vulnerability. Benthic species were ranked the most vulnerable (gastropod and bivalve species). The pelagic group was the second most vulnerable; the Pacific chub mackerel and the yellowfin tuna were amongst the most vulnerable pelagic species. The demersal group had the relatively lowest vulnerability. This study allowed identification of vulnerable fishery resources, research and monitoring priorities, and identification of the key exposure factors and sensitivity attributes which are driving that vulnerability. Our findings can help fishery managers incorporate climate change into harvest level and allocation decisions, and assist stakeholders plan for and adapt to a changing future.