ABSTRACT
BACKGROUND: Hip fractures constitute a major public health problem for older individuals. They are associated with functional deterioration, limited mobility, and increased mortality, while contributing to economic and social hardships that are compounded by a second hip fracture. With the aging US population and increasing rates of hip fractures, it is essential to understand factors surrounding subsequent contralateral hip fractures. MATERIALS AND METHODS: This descriptive study was a retrospective review of patients 60 years and older who were identified in the institutional geriatric hip fracture database as having had an initial and subsequent contra-lateral hip fracture, with the second treated at our tertiary referral center. RESULTS: The incidence of subsequent hip fracture was 13.2%. The mean time to second hip fracture was 3.5 years after the initial injury. The first fracture tended to be a femoral neck fracture, whereas the second injury was more likely to have an intertrochanteric pattern. There was a higher complication rate after a subsequent hip fracture. Patients taking osteoporosis and adjuvant medication prior to admission for the second fracture tended to have a lower 90-day mortality rate. Patients with a history of any fracture prior to the first hip fracture, with cancer, and with osteopenia had shorter intervals to the subsequent event. CONCLUSION: Subsequent hip fractures carry high morbidity and mortality rates. Steps should be taken after the initial injury to optimize outcomes in the case of a subsequent event. Patients discharged after initial hip fracture should be maintained with osteoporosis medication. [Orthopedics. 202x;4x(x):xx-xx.].
ABSTRACT
A 71-year-old male presented to the clinic with two multiloculated cystic masses located over the distal bicep of his left upper extremity, causing discomfort when flexing the extremity. Referral and point-of-care ultrasound at an outside location suggested cystic masses that were consistent with that of a ganglion cyst. Physical exam and clinical presentation were also consistent with this diagnosis. Due to the patient's symptomatic presentation, surgical intervention was proposed, and the patient consented. Intraoperatively, it was discovered that the patient's mass was unexpectedly due to an arteriovenous malformation, revealing the importance of careful workup for cystic masses presenting in unusual locations.
ABSTRACT
Surgical site infections (SSIs) contribute to patient morbidity and health expenditure. An increasing elderly population, the expanding use of implants in surgical procedures, drug-resistant microorganisms, and patient-related comorbidities all contribute to SSIs. Daptomycin is an antibiotic known to cause rhabdomyolysis, a life-threatening complication that may lead to acute compartment syndrome (ACS). We present a case of a patient treated with daptomycin for a penile-implant infection complicated by rhabdomyolysis and ACS of his bilateral forearms. He underwent emergent fasciotomies and retained function in his upper extremities long-term. It is vital that physicians closely monitor patients treated with IV-daptomycin therapy and educate patients on alarm symptoms to allow for prompt recognition of life and limb-saving treatments. Orthopedic surgeons should always have a high index of suspicion for ACS and should be aware of the relationship between rhabdomyolysis and ACS.
ABSTRACT
BACKGROUND: Tension band plate and screw implants (TBI) are frequently used for temporary hemiepiphyseodeses to manage angular deformity in growing children. The reported implant breakage rate, when TBI is used for deformities in patients with Blount disease, is much higher than when used in other diagnoses. Our hypothesis is that perioperative factors can identify risks for TBI breakage. METHODS: A retrospective case-control study was performed of 246 TBI procedures in 113 patients with Blount disease at 8 tertiary pediatric orthopaedic centers from 2008 to 2018. Patient demographics, age at diagnosis, weight, body mass index (BMI), radiographic deformity severity measures, location, and types of implants were studied. The outcome of implant breakage was compared with these perioperative factors using univariate logistic regression with Bonferroni correction for multiplicity to significance tests. RESULTS: There were 30 broken implants (12%), failing at mean 1.6 years following implantation. Most failures involved the metaphyseal screws. Increased BMI was associated with increased implant breakage. Increased varus deformity was directly associated with greater implant breakage and may be a more important factor in failure for those below 7 years compared with those 8 years or above at diagnosis. There was a 50% breakage rate for TBI with solid 3.5 mm screws in Blount disease with onset 8 years or above of age. No demographic or implant factors were found to be significant. CONCLUSIONS: Breakage of TBI was associated with increased BMI and varus deformity in patients with Blount disease. Larger studies are required to determine the relative contribution and limits of each parameter. Solid 3.5 mm screws should be used with caution in TBI for late-onset Blount disease. LEVEL OF EVIDENCE: Level III.