Environmental predictors of Escherichia coli concentration at marine beaches in Vancouver, Canada: a Bayesian mixed-effects modelling analysis.

Understanding historical environmental determinants associated with the risk of elevated marine water contamination could enhance monitoring marine beaches in a Canadian setting, which can also inform predictive marine water quality models and ongoing climate change preparedness efforts. This study aimed to assess the combination of environmental factors that best predicts Escherichia coli (E. coli) concentration at public beaches in Metro Vancouver, British Columbia, by combining the region's microbial water quality data and publicly available environmental data from 2013 to 2021. We developed a Bayesian log-normal mixed-effects regression model to evaluate predictors of geometric E. coli concentrations at 15 beaches in the Metro Vancouver Region. We identified that higher levels of geometric mean E. coli levels were predicted by higher previous sample day E. coli concentrations, higher rainfall in the preceding 48 h, and higher 24-h average air temperature at the median or higher levels of the 24-h mean ultraviolet (UV) index. In contrast, higher levels of mean salinity were predicted to result in lower levels of E. coli. Finally, we determined that the average effects of the predictors varied highly by beach. Our findings could form the basis for building real-time predictive marine water quality models to enable more timely beach management decision-making.

Immediate SVF-Gel Injection Reduced Incision Scar Formation: A Prospective, Double-Blind, Randomized, Self-control Trial.

BACKGROUND: Skin incision scars are cosmetically displeasing; the effects of current treatments are limited, and new methods to reduce scar formation need to be found. OBJECTIVE: We sought to determine whether immediate postoperative injection of stromal vascular fraction gel (SVF-gel) could reduce scar formation at skin incision sites. METHODS: A prospective, randomized, double-blind, self-controlled trial was conducted in patients who underwent breast reduction. SVF-gel was intradermally injected into the surgical incision on one randomly selected side, with the other side receiving saline as a control. At the 6-month follow-up, the incision scars were evaluated using the Vancouver scar scale (VSS) and visual analog scale (VAS). Antera 3D camera was used for objective evaluation. RESULTS: The VSS score and VAS score were significantly different between the SVF-gel-treated side (3.80 ± 1.37, 3.37±1.25) and the control side (5.25 ± 1.18, 4.94 ± 1.28). Moreover, the SVF-gel-treated side showed statistically significant improvements in scar appearance, based on evidences from Antera 3D camera. LIMITATIONS: This was a single-center, single-race, and single-gender study. Furthermore, the results were available only for the 6-month interim follow-up period. CONCLUSION: Postoperative immediate SVF-gel injection in surgical incisions can reduce scar formation, and exert a preventive effect on scars. LEVEL OF EVIDENCE I: Evidence obtained from at least one properly designed randomized controlled trial. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors   www.springer.com/00266 .

Long stem revision versus short stem revision with plate osteosynthesis for Vancouver type B2 periprosthetic femoral fracture: a comparative study of eighty five cases.

PURPOSE: Periprosthetic femoral fractures (PPFs) around the hip are challenging complications in orthopaedic surgery, particularly Vancouver type B2 (VTB2) fractures. The surgical management of these fractures is crucial and depends on various factors. Cementless short taper stem with plate osteosynthesis is an alternative surgical technique. This study aims to compare the outcomes of this surgical technique with revision arthroplasty (RA) with long stem in the treatment of VTB2 PPFs. METHODS: This retrospective study was conducted in a single medical institute from February 2010 to May 2019. Patients who had received either total hip arthroplasty or bipolar hemiarthroplasty and subsequently developed a VTB2 PPF were included; patients who sustained intra-operative fractures or received a cemented stem previously were excluded from the analysis. The patients were divided into two groups: group I received RA with cementless long stem, while group II underwent RA with cementless short taper stem with plate osteosynthesis. Demographic data, radiographic and functional outcomes, and complications were analyzed between the two groups. RESULTS: A total of 85 patients diagnosed with VTB2 PPFs were included in the study. There were no significant differences between the two groups in terms of demographic data, including age, gender, mean follow-up times, estimated blood loss, and operative times. The radiographic results showed that there was no significant difference in the incidence of subsidence and implant stability between the two groups. However, group II tended to have less subsidence and periprosthetic osteolysis. Patients in group II had significantly better functional scores (mean Harris hip score: post-operative: 60.2 in group I and 66.7 in group ii; last follow-up: 77.4 in group 1 and 83.2 in group II (both p < 0.05)). There were no significant differences in the overall complication rate, including infection, dislocation, re-fracture, and revision surgery, between the two groups. CONCLUSIONS: Both surgical techniques, cementless long stem and cementless short taper stem with plate osteosynthesis, are effective in the treatment of Vancouver B2 PPFs, with no significant differences in outcomes or complications. However, patients in cementless short taper stem with plate osteosynthesis had better functional scores at both post-operative and the last follow-up.

Health-related quality of life (EQ-5D) after revision arthroplasty following periprosthetic femoral fractures Vancouver B2 and B3 in geriatric trauma patients.

INTRODUCTION: The aim of this study was to determine the outcome parameters of revision arthroplasties for periprosthetic femoral fractures (PPFF) with a particular attention to quality of life (QoL) and mobility. MATERIALS AND METHODS: Retrospective single-center study of PPFF with loose implants that underwent revision arthroplasty. Depending on individual patient characteristics, either an uncemented or cemented revision stem was chosen. Data collection included demographics, complications, clinical course and outcome parameters. Follow-up took place at least one year postoperatively. RESULTS: Between 2008 and 2016, 43 patients could be included. Most patients (63%) were able to walk independently or with a walking aid after one year and amongst the surveyed patients 77% were able to reside at home. Concerning the QoL assessment, a high index of 0.8 ± 0.1 has been reached after one year. Mortality pointed out to be 9% after one year and 28% in general. CONCLUSION: The treatment of PPFF remains challenging. Although complication rates and mortality are high in this frail collective of geriatric patients, revision arthroplasty leads to good postoperative results regarding mobility and quality of life.

Analysis of complications in 97 periprosthetic Vancouver B2 fractures treated either by internal fixation or revision arthroplasty.

INTRODUCTION: The treatment of Vancouver B2 periprosthetic fractures after hip arthroplasty is still a matter of debate. Revision Arthroplasty (RA) was long thought to be the treatment of choice, however several recent papers suggested that Open Reduction and Internal Fixation (ORIF) is a viable option for selected B2 fractures. Complication rates of 14-26% have been reported following surgical treatment of B2 fractures. No significant difference between RA and ORIF in the complication rates nor in the functional outcome was observed. METHOD: We conducted a retrospective analysis of 97 consecutive Vancouver B2 fractures treated according to the algorithm at our institution from 2007 to 2020 and recorded complications and patient specific data. RESULT: From the 97 patient, 45 fractures were treated with RA while 52 fractures were treated with ORIF. Thirteen patients in the RA group had a complication that needed revision (28%) and 11 patients in the ORIF group needed revision (21%). There was no significant difference between complication rates. The reason for failure in the 13 RA patients were infection (n = 4), stem subsidence (n = 1), refracture after a new fall (n = 3), secondary dislocation of the greater trochanter (n = 1) and dislocation (n = 4). The reason for failure in the 11 ORIF patients that were revised were infection (n = 5), persistent symptomatic stem loosening (n = 3) and refracture (n = 3) after a new fall. CONCLUSION: ORIF can be used to revise cemented and non-cemented shafts in more than half of Vancouver B2 fractures with no difference in complication rates when compared to RA. A periprosthetic fracture around the hip has a 21-28% risk of a re-operation after revision surgery with infection and re-fracture after a new fall being the most frequent cause of re-operation.

Vancouver B2 periprosthetic hip fractures treatment: fix or replace? A retrospective study comparing both techniques.

INTRODUCTION: Vancouver B2 periprosthetic hip fractures involve stem stability and they have been classically treated with revision surgery. Crucial factors such as age, clinical comorbidities and functional status are often neglected. The current study aims to compare clinical outcomes between patients treated with open reduction and internal fixation (ORIF) or femoral stem exchange. METHODS: This is a retrospective study that includes all Vancouver B2 periprosthetic hip fractures in a tertiary referral hospital from 2016 to 2020. Patients were divided into two groups: Group 1. Patients treated with an ORIF and Group 2. Patients treated with stem replacement. The outcomes that were compared between groups included demographic data, functional capacity, complications and mortality. RESULTS: 29 periprosthetic Vancouver B2 fractures were finally analyzed. 11 (37.9%) were treated with ORIF (Group 1) and 18 (62.1%) by stem replacement (Group 2). Surgery time (143 vs. 160 min), hemoglobin drop (1.8 vs. 2.5 g/dL) and hospital stance (25.5 vs. 29.6 days) were shorter in Group 1. According to complications, 18.2% of patients in the ORIF group had orthopedic complications compared with 44.4% in the revision group. In the revision group, 3 cases needed a two-stage revision and one of these revisions ended up with a resection arthroplasty (Girdlestone). The first-year mortality rate was 27% in Group 1 and 11% in Group 2. DISCUSSION: ORIF treatment seems to be a less aggressive and complex procedure which can lead to a faster general recovery. Revision surgery can imply a higher risk of orthopedic complications which can be severe and may require further aggressive solutions. The ORIF group mortality was similar to the proximal femur fracture rate (20-30%). In conclusion, ORIF treatment seems to be a good option especially in fragile patients with low functional demand when anatomical reduction is possible.

Locking plate for periprosthetic femoral fractures according to Vancouver C: Outcome and radiological subanalysis of 40 patients.

PURPOSE: Periprosthetic femoral fractures (PFF) according to type Vancouver C are less common and outcome is limited reported. Therefore, we conducted this retrospective single center study. METHODS: We performed analysis of patients who underwent open reduction and internal fixation (ORIF) with locking plates for PPF occurring distally of a primary standard hip stem. Data on demographics, revisions, fracture patterns, and mortality were evaluated. At least two years after operation, we examined outcome using the Parker and Palmer mobility score. Primary aim of this study was revision, outcome and mortality. Secondary aim was evaluation of fracture subtypes within type Vancouver C fractures. RESULTS: Between 2008 and 2020, 383 patients with periprosthetic femoral fracture after hip replacement were surgically treated according to our database. Among them, 40 patients (10.4%) with type Vancouver C fractures were enrolled for this study. The mean patient age was 81.5 years (59-94) at the time of fracture. Thirty-three patients were women, and 22 fractures were on the left side. Without exception, locking plates were used. The 1-year mortality rate for the sample was 27.5% (n = 11). Three revisions (7.5%) were performed for plate breakage. Rate of infection and non-union was zero. Three different fracture patterns were assessed: (1) transverse or oblique fractures below the tip of the stem (n = 9); (2) spiral-shaped fractures within the diaphysis (n = 19); and (3) burst fractures at the supracondylar region (n = 12). Demographic or outcome effects between fracture patterns were not found. On average of 4.2 years (2.0-10.4) after treatment, the mean reported Parker score was 5.5 (1-9). CONCLUSION: ORIF with a single lateral locking plate is safe for type Vancouver C fractures with a well-fixed hip stem. Therefore, we do not recommend routinely revision arthroplasty or orthogonal double plating. Three subtypes of fractures within Vancouver C demonstrated no significant differences in baseline data and outcome.

Vancouver Symptom Score for Dysfunctional Elimination Syndrome: Hindi translation and validation.

BACKGROUND: Bladder and bowel dysfunction (BBD) is a common problem in school-aged children and is evaluated using questionnaires. Among available questionnaires, "Vancouver Symptom Score for Dysfunctional Elimination Syndrome" (VSSDES) is considered superior in validity and reliability. We translated VSSDES into Hindi and performed validity and reliability testing of Hindi-VSSDES in children aged 4-16 years with lower urinary tract dysfunction (LUTD). METHODS: In this cross-sectional study, we followed Consensus-based Standards for the selection of health Measurement Instruments recommendation to develop Hindi-VSSDES. Forward-translation-harmonization-back-translation-expert committee review-prefinal version sequence of translation was followed by cognitive debriefing. One hundred and sixteen children with symptoms suggestive of LUTD and 106 healthy controls were recruited. Construct validity of Hindi-VSSDES was assessed via structural validity (factor analysis) and hypotheses testing. In addition, test-retest reliability and internal-consistency reliability were assessed. RESULTS: Hindi-VSSDES had acceptable face validity. Factor analysis identified four factors representing three domains. All a priori hypotheses were met. The questionnaire displayed excellent convergent validity and discriminative ability (area under receiver operating characteristic curve 0.83). The cutoff scores for screening and diagnosis were 7 and 11, respectively. Scores were comparable whether children self-filled the questionnaire or parents were proxy. Scores in girls were significantly higher. It had an excellent test-retest reliability (intraclass correlation coefficient = 0.96) and Cronbach's ɑ was 0.62. The smallest detectable change was 4.1 points. Median time to complete the questionnaire was 7 min and majority (91%) rated it as easy. CONCLUSIONS: Hindi-VSSDES is the first validated and reliable Hindi questionnaire for children with BBD. Clinimetric properties of responsiveness and interpretability are yet to be tested.

Outcomes of fixation of Vancouver B periprosthetic fractures around cemented versus uncemented stems.

BACKGROUND: The incidence of periprosthetic femur fracture (PPFF) in the setting of total hip arthroplasty (THA) is steadily increasing. We seek to address whether there is a difference in outcomes between Vancouver B fracture types managed with ORIF when the original stem was a press-fit stem versus a cemented stem. METHODS: In this retrospective cohort study at a level 1 trauma center, we identified 136 patients over 65 years-of-age with Vancouver B-type fractures sustained between 2005 and 2019. Patients were treated by ORIF and had either cemented or press-fit stems prior to their injury. Outcomes were subsidence of the femoral implant, time to full weight bearing, rate of the hip implant revision, estimated blood loss (EBL), postoperative complications, and the one-year mortality rate. RESULTS: A total of 103 (75.7%) press-fit and 33 (24.3%) cemented patients were reviewed. Patient baseline characteristics, Vancouver fracture sub-types, and implant characteristics were not found to be significantly different between groups. The difference in subsidence rates, postoperative complications, and time to weight bearing were not significantly different between groups. EBL and one-year mortality rate were significantly higher in the cemented group. CONCLUSIONS: In geriatric patients with Vancouver B type periprosthetic fractures managed with ORIF, patients with an originally press fit stem may have lower mortality, lower estimated blood loss, and similar subsidence and hospital length of stays when compared to those with a cemented stem.

Vancouver's Alcohol Knowledge Exchange: lessons learned from creating a peer-involved alcohol harm reduction strategy in Vancouver's Downtown Eastside.

Despite high rates of harm attributable to alcohol use itself and the associated marginalization of illicit drinkers in Vancouver's Downtown Eastside (DTES), alcohol-specific harm reduction services there are under-resourced and highly disconnected from one another. In response to these conditions and high rates of death amongst its membership, the Eastside Illicit Drinkers Group for Education, an affiliate group of the Vancouver Area Network of Drug Users, convened a regular meeting of stakeholders, termed a "community of practice" in 2019 to bring together peers who used beverage and non-beverage alcohol, shelter and harm reduction service providers, public health professionals, clinicians, and policymakers to improve system-level capacity to reduce alcohol-related harm. The discussions that followed from these meetings were transformed into the Vancouver Alcohol Strategy (VAS), a comprehensive, harm reduction-oriented policy framework for alcohol harm reduction in the DTES. This article highlights our experiences producing community-led alcohol policy through the VAS with specific attention to the ways in which people who use alcohol themselves were centred throughout the policy development process. We also provide summary overviews of each of the VAS document's 6 thematic areas for action, highlighting a sampling of the 47 total unique recommendations. Historically, people who use non-beverage alcohol and whose use of alcohol in public spaces is criminalized due to housing precarity and visible poverty have been excluded from the development of population-level alcohol policies that can harm this specific population. The process of policy development undertaken by the VAS has attempted to resist this top-down approach to public health policy development related to alcohol control by intentionally creating space for people with lived experience to guide our recommendations. We conclude by suggesting that a grassroots enthusiasm for harm reduction focused policy development exists in Vancouver's DTES, and requires resources from governmental public health institutions to meaningfully prevent and reduce alcohol-related and policy-induced harms.

Outcomes of Nonoperatively Treated Vancouver B1 Fractures: Is Failure Common?

BACKGROUND: Periprosthetic fractures (PPFx) are a severe complication of total hip and hemiarthroplasty. Surgical treatment is typically performed but can result in major morbidity. Nonoperative PPFx management may provide a successful treatment alternative in select patients. METHODS: Vancouver B1 PPFx patients treated over a 10-year period were identified. Patient demographic data were retrospectively recorded. Injury and postoperative radiographs were reviewed. There were 48 patients who met the study criteria. Patients were divided into operative and nonoperative comparative cohorts. Outcome comparisons between the 2 cohorts included 1-year mortality, unplanned surgery within 24 months of injury, fracture union rate, and return to preinjury ambulation status. RESULTS: There was no difference in 1-year mortality between the nonoperative and operative cohorts (17 versus 8%; P = .32). We found no significant difference in unplanned surgery between the nonoperative and operative groups (8.7 versus 12%; P = .71), fracture union (100 versus 96%, P = .34), or return to ambulation status (86 versus 91%; P = .86). Nonoperative fractures were minimally displaced and within the metaphyseal region of the proximal femur without stem subsidence. Nonoperative fractures with subsequent treatment failure had initial fracture extension closer to the tip of the stem compared to successfully treated nonoperative fractures (5.5 versus 10.2 centimeters; P = .02). CONCLUSION: Select nonoperatively treated patients had infrequent need for unplanned surgery, high union rate, and return to their preinjury ambulation status. Nonoperative management is not appropriate for all Vancouver B1 PPFx, but those patients who have minimally displaced meta-diaphyseal fractures and partial remaining distal fixation can be successfully treated.

Hip Arthroplasty Femoral Stem Designs and Their Association With Early Postoperative Periprosthetic Femoral Fractures.

BACKGROUND: Periprosthetic femoral fractures (PFFs) in total hip arthroplasty (THA), especially those in contact with the diaphyseal stem, carry high morbidity. This study evaluated how stem design influences the risk of early Vancouver B PFF or other PFF requiring operative intervention after THA. METHODS: A multicenter, retrospective study of 3,433 primary cementless THAs performed from 2014 to 2021 included 2,302 single-taper (micro M/L [n = 1,169]; M/L [n = 1,133]) and 1,131 double-taper (fit-and-fill [n = 420]; compaction-collared [n = 711]) stems. Mean follow-up was 2.2 years (range, 0.3 to 6.5 years). Primary outcomes were Vancouver B and surgically treated postoperative PFFs among differing femoral stems. Secondary outcomes included rates of intraoperative and postoperative Vancouver A and C PFFs. RESULTS: Forty five postoperative PFFs (1.3%) occurred within 8.8 weeks (median), 25 of which were Vancouver B (0.7%) and 20 total PFFs that required operative intervention (0.6%). Compaction-collared stems had a decreased risk of Vancouver B (hazard ratio 0.18, 95% confidence interval: 0.03-0.97 P = .044) and any surgically treated PFF (hazard ratio 0.10, 95% confidence interval: 0.01-0.95; P = .037). Intraoperative PFFs were most common with fit-and-fill stems (3.6%, P < .001) and Vancouver A with compaction-collared stems (1.8%, P < .001). The cohort with PFF had a higher Charlson comorbidity index (P = .004), more women (P = .001), more Dorr A or C femora (P = .013), and more posterior or lateral surgical approaches compared to those without PFF (P ≤ .001). CONCLUSION: After controlling for confounding variables, compaction-collared stems had a significantly lower risk of postoperative Vancouver B and PFF requiring operative treatment than single-taper and double-taper stems.

The Stability of Fixation of Vancouver B2 Periprosthetic Femoral Fractures: Effect of Implantation Technique.

BACKGROUND: Due to increasing volume of total hip arthroplasties, periprosthetic femoral fractures have become a common complication with increased revision burden and perioperative morbidity. The objective of this study was to evaluate the fixation stability of Vancouver B2 fractures treated with 2 techniques. METHODS: A common B2 fracture was created by reviewing 30 type B2 cases. The fracture was then reproduced in 7 pairs of cadaveric femora. The specimens were divided into 2 groups. In Group I ("reduce-first"), the fragments were reduced first, followed by implantation of a tapered fluted stem. In Group II ("ream-first"), the stem was implanted in the distal femur first, followed by fragment reduction and fixation. Each specimen was loaded in a multiaxial testing frame with 70% of peak load during walking. A motion capture system was used to track the motion of the stem and fragments. RESULTS: The average stem diameter in Group II was 16.1 ± 0.4 mm, versus 15.4 ± 0.5 mm in Group I. The fixation stability was not significantly different in the 2 groups. After the testing, the average stem subsidence was 0.36 ± 0.31 mm and 0.19 ± 0.14 mm (P = .17) and the average rotation was 1.67 ± 1.30° and 0.91 ± 1.11° (P = .16) in Groups I and II, respectively. Compared to the stem, there was less motion of the fragments and there was no difference between the 2 groups (P > .05). CONCLUSIONS: When tapered fluted stems were used in combination with cerclage cables for treatment of Vancouver type B2 periprosthetic femoral fractures, both the "reduce-first" and "ream-first" techniques showed adequate stem and fracture stability.

Drilling the cement mantle in well-fixed periprosthetic femur fractures is not associated with arthroplasty-related complications.

OBJECTIVE: To determine if screw fixation across a cement mantle is safe and effective during plate fixation of well-fixed periprosthetic femur fractures. DESIGN: Retrospective cohort study. SETTING: Academic Level I Trauma Center. PATIENTS: Twenty-eight patients with AO/OTA 32A[B1] or 32A[C] periprosthetic femur fractures treated with open reduction and internal plate and screw fixation after cemented or uncemented hip arthroplasty. INTERVENTION: Screw placement into the cement mantle during internal fixation. OUTCOME MEASUREMENTS: Primary outcome was revision arthroplasty for aseptic loosening. Secondary outcomes included radiographic evidence of aseptic loosening, infection, nonunion, implant failure, and overall reoperation rate. RESULTS: There were 28 patients who met inclusion criteria. A total of 9 patients had screws placed in the cement mantle while the remaining 19 patients had screws placed around an uncemented stem. At a mean of 3.7-year follow-up, there were no cases of revision arthroplasty or aseptic loosening in either group. There were no significant differences in rates of infection, nonunion, implant failure, or reoperation rate between patients who had screw placement into a cement mantle vs around an uncemented stem. CONCLUSION: Drilling into the cement mantle during fixation of a periprosthetic femur fracture around a well-fixed cemented hip stem appears safe and effective. When possible, surgeons can consider bicortical screws around a cemented stem, given the biomechanical advantages over unicortical screw or cerclage fixation. Larger prospective trials confirming the safety of this technique are warranted prior to routine implementation. LEVEL OF EVIDENCE: III.

Cementless, modular, titanium stem in Vancouver B2 and B3 periprosthetic femoral fractures.

INTRODUCTION: The periprosthetic femoral fracture (PFF) is a serious complication after primary total hip arthroplasty. We conducted a retrospective study to determine whether the PRIUS® system presented similar survival to other existing implants for the treatment of Vancouver B2 or B3 PFFs. Bone consolidation rate, functional results and complications were analysed. METHOD: This is a bi-centric retrospective study between 2012 and 2017 including 39 patients with (B2/B3) PFFs treated by senior surgeons using a PRIUS® femoral implant. Implant survival, radiological outcome (fracture healing) and clinical scores (Oxford-OHS, Harris Hip Score-HHS, Postel Merle d'Aubigné-PMA, Devane and Charnley) were analysed. 10 patients had died before data collection and 5 patients were lost to follow-up. A total of 21 patients were able to undergo a clinical and radiological evaluation. The mean follow-up period was 3 years. RESULTS: The 3-year PRIUS® stem survival rate was 88.6% [95% CI, 77.2-100]. The consolidation rate was 81% (17/21). The rate of satisfied or very satisfied patients was 85.6% (18/21). Regarding the Devane score, activity level was maintained in 70.6% of cases (12/17) and decreased in 29.4% of cases (5/17), the Charnley score was stable in 94% of cases (16/17) and decreased in 6% of cases (1/17). The mean Oxford score was 28.8/48 (9.3; 16-48), the mean HHS was 67/100 (16.4; 46-91) and the mean PMA score was 12.6/18 (4.5; 2-18). CONCLUSION: The results in terms of survival rate and bone consolidation are comparable to other literature series. The PRIUS® System can be added to the surgical arsenal in the treatment of (B2/B3) PFF, subject to confirmation of these results in the longer term.

Abandoning the SRO: Public Health Withdrawal from Sanitary Enforcement in Vancouver's Downtown Eastside.

This paper situates a ten-year period of political upheaval in addressing the problem of Single Room Occupancy (SRO) housing in Vancouver, Canada, within an epistemic transformation of public health. Until 1970, the Vancouver Health Department exemplified a colonial history of public health in establishing the city's skid road as a cordon sanitaire. But the 1970s saw a sudden fading of the Department's authority just as a more collaborative approach to housing policy was emerging. The sunsetting of sanitary enforcement was driven in part by the arrival of a "new public health" that became primarily concerned with defining public health problems and solutions through the regulation of racialized bodies and behaviors-a cordon thérapeutique. By the 1980s, this shift constituted an epistemic and regulatory abandonment of SRO housing, leading to the accelerated deterioration of the entire housing stock and costing incalculable human suffering and the loss of lives.

The race for the classification of proximal periprosthetic femoral fractures : Vancouver vs Unified Classification System (UCS) - a systematic review.

BACKGROUND: Periprosthetic femoral fractures (PFFs) represent a major cause for surgical revision after hip arthroplasty with detrimental consequences for patients. The Vancouver classification has been traditionally used since its introduction in 1995. The Unified Classification System (UCS) was described in 2014, to widen the spectrum by aiming for a more comprehensive approach. The UCS also aimed to replace the Vancouver classification by expanding the idea of the Vancouver classification to the whole musculoskeletal apparatus. After introduction of the UCS, the question was raised, whether the UCS found its place in the field of analysing PFFs. Therefore, this systematic review was performed to investigate, the use of the UCS compared to the established Vancouver classification. METHODS: Medline was searched for reports published between 1 January 2016 and 31 November 2020, without language restriction. Included were original articles, irrespective of the level of evidence and case reports reporting on a PFF and using either the Vancouver or the UCS to classify the fractures. Excluded were reviews and systematic reviews. RESULTS: One hundred forty-six studies were included in the analysis. UCS has not been used in a single registry study, giving a pooled cohort size of 3299 patients, compared to 59,178 patients in studies using the Vancouver classification. Since 2016, one study using UCS was published in a top journal, compared to 37 studies using the Vancouver classification (p=0.29). During the study period, the number of yearly publications remained stagnant (p=0.899). CONCLUSIONS: Despite valuable improvement and expansion of the latter UCS, to date, the Vancouver system clearly leads the field of classifying PFFs in the sense of the common use.

Open reduction and locked compression plate fixation, with or without allograft strut, for periprosthetic fractures in patients who had a well-fixed femoral stem: a retrospective study with an average 2-year follow-up.

BACKGROUND: The use of cortical strut allograft has not been determined for Vancouver type B1 or C fracture. This study aimed to evaluate the short-term efficacy of locking compression plating with or without cortical strut allograft in managing these types of fractures. METHODS: We retrospectively assessed 32 patients (17 males, 15 females; 23-88 years, mean: 67.2 years) with Vancouver type B1 or C fractures. Seventeen patients (Group A; B1 fractures in 15 hips, C fractures in 2 hips) were treated with open reduction and internal fixation with locking compression plates (group A). The other 15 patients (Group B; B1 in 14 hips, C in 1 hip) were fixed by locking compression plating combined with cortical strut allografting (group B). The fracture healing rate, healing time, complications and function were compared between these two groups. RESULTS: The mean follow-up time was 32.4 months (12 to 66), and the overall fracture union rate of the 32 patients was 96.9%. Group B had a higher fracture union rate than Group A, but the difference was not statistically significant. Group A had one case of nonunion of type B1 fracture and one case of malunion; the mean time to fracture healing was 5.3 months (3 to 9). In group B, all patients reached bony union without malunion, with a mean time of fracture healing of 5.1 months (3 to 8). CONCLUSION: Treatment of Vancouver type B1 or C fractures by locking compression plating, with or without cortical strut allografting, resulted in similar union rates in these patients. This suggest that, the use of cortical strut allografting should be decided cautiously.

Vancouver B and C periprosthetic fractures around the cemented Exeter Stem: sex is associate with fracture pattern.

INTRODUCTION: The aim of this study was to identify factors associated with the level of periprosthetic fracture involving a cemented polished tapered stem: Vancouver B or Vancouver C. METHODS: A retrospective cohort study of 181 unilateral periprosthetic fractures involving Exeter stems was assessed by three observers (mean age 78.5, range 39-103; mean BMI 27.1, 17-39; 97 (54%) male). Patient demographics, deprivation scores, BMI and time since primary prosthesis were recorded. Femoral diameter, femoral cortical thickness, Dorr classification and distal cement mantle length were measured from calibrated radiographs. Interobserver reliability was calculated using intraclass correlation coefficients (ICCs). Univariate and multivariate analysis was performed to identify associations with Vancouver B or C fractures. RESULTS: 160/181 (88%) Vancouver B and 21/181 (12%) Vancouver C-level fractures occurred at a mean of 5.9 ± 5.4 years (0.2-26.5) following primary surgery. Radiographic measurements demonstrated excellent agreement (ICC > 0.8, p < 0.001). Mortality was significantly higher following Vancouver C compared to B fractures: 90 day 14/160 Vs 5/21 (p = 0.05); 1 year 29/160 Vs 8/21 (p = 0.03). Univariate analysis demonstrated that Vancouver C fractures were associated with female sex, bisphosphonate use, cortical bone thickness, and distal cement mantle length (p < 0.05). On multivariate analysis, only female sex was an independent predictor of Vancouver C-level fractures (R2 =0.354, p = 0.005). CONCLUSION: Most PFFs involving the Exeter stem design are Vancouver B-type fractures and appear to be independent of osteoporosis. In contrast, Vancouver C periprosthetic fractures display typical fragility fracture characteristics and are associated with female sex, thinner femoral cortices, longer distal cement mantles and high mortality.

Post-operative peri-prosthetic fracture rates following the use of cemented polished taper-slip stems for primary total hip arthroplasty: a systematic review.

INTRODUCTION: Peri-prosthetic fractures (PPFs) are a serious complication of total hip arthroplasty (THA) associated with significant morbidity, mortality and re-operation similar to the rates seen following femoral neck fractures. When exploring the PPF rates around cemented stems, many studies combine the results of composite beam and taper-slip stems despite their different philosophies. This review looks specifically at PPFs with the use of cemented stems of the taper-slip philosophy to evaluate the demographics, PPF rate and fracture patterns in this patient cohort. MATERIALS AND METHODS: A systematic search of Embase, Medline and CINAHL databases was performed to seek studies involving the use of cemented, polished, taper-slip stems, reporting on a rate of post-operative PPF and not involving patient cohorts that were exclusively hip fracture or revision arthroplasty. RESULTS: 27 studies reported on 505 PPFs with an average time from primary operation to PPF of 71.2 months (2-301 months). The average age of patients who sustained PPFs was 70.6 years (53.5-82 years) and the majority were female (64.2%). The Vancouver B2 fracture type was most common (39.5%). Open reduction and internal fixation represented the management of choice in 61.2% of PPFs. There was a re-operation rate of 11.4%. CONCLUSION: This review suggests an association with being older and female, and a greater risk of PPFs secondary to low energy falls in cemented polished taper-slip stems.