Improving fragility hip fracture care through data: a multicentre experience from a country with an emerging economy during the COVID-19 pandemic.

INTRODUCTION: In low-to-middle-income countries (LMIC), the orthogeriatric model of care is still in its early stages of development. This study describes the initial results of the first online fragility hip fracture database to be setup in the Philippines using a modified minimum common dataset to generate outcomes data based on current hospital practices. METHODS: A multicentre prospective cohort study among 12 Philippine hospitals was conducted from June 2020 to February 2021. Thirty-day mortality, morbidity and mobility were measured. Significant factors associated with mortality were determined. RESULTS: 158 elderly patients with fragility hip fractures were included in the study. Nine patients (5.7%) were confirmed or suspected to have COVID-19 infection. Median time of injury to admission was at least 3 days (IQR: 1.0-13.7). Overall, 80% of patients underwent surgical intervention with a median time from admission to surgery of at least 5 days (IQR: 2.5-13.6). Thirty-day mortality and morbidity rates for acute fragility fractures were 3.7%. Factors significantly associated with early mortality were poor prefracture mobility, COVID-19 infection, radiograph of the abnormal chest and conservative treatment. Non-surgical patients had no functional mobility or were wheelchair users and had a significantly higher morbidity rate than surgically treated patients (13.6% vs 1.8%; p=0.031). CONCLUSION: Despite treatment delays unique to an LMIC, short-term outcomes remain favourable for non-COVID-19 fragility hip fracture patients treated with surgery. Prompt admission and multidisciplinary care for elderly hip fracture patients while maintaining protective measures for COVID-19 infection control are recommended. The quality of data collected illustrates how this online database can provide a framework for a sustainable audit or registry as well as provide a platform for the introduction of orthogeriatric concepts at a multiregional scale.

Tension band wiring of the olecranon: A biochemical study

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> Hardware prominence is the most common cause of reoperation in patients who have undergone tension band wiring for fractures of the olecranon. The study was conducted to compare the strength of four different constructs of tension band wiring of the olecranon.<br /><strong>METHODS:</strong> A transverse fracture was created in twenty cadaveric ulnas which were equally divided into four groups according to the method of fixation: 1-Single tension band, transcortical k-wire fixation; 2-Single tension band, intramedullary k-wire fixation; 3-Double tension band, transcortical k-wire fixation; 4-Double tension band, intramedullary k-wire fixation. All specimens were mounted on a universal testing machine using a custom-made fixation jig. They were tested under a single cycle load to failure. The maximum failure load was measured for all specimens.<br /><strong>RESULTS:</strong> There was no significant difference in the maximum load to failure among the four treatment groups.<br /><strong>CONCLUSION:</strong> No differences in the maximum load to failure noted in between treatment groups, regardless if single or double tension band wiring was done, and regardless if k-wire fixation was transcortical or medullary. These findings would support the argument that any of the desired fixation methods may be used.</p>