Application of an in-hospital, surgeon-led anti-osteoporotic medication algorithm in patients with hip fractures improves persistence to medication and can prevent the second fragility fracture.

INTRODUCTION: Secondary fracture prevention is an essential part of hip fracture treatment. Despite this, many patients are discharged without the appropriate anti-osteoporotic medication. The aim of this study is to report the outcomes of the application of an in-hospital, surgeon-led anti-osteoporotic medication algorithm to patients with hip fractures. MATERIALS AND METHODS: This prospective cohort study followed patients with hip fractures who were treated at a tertiary referral hospital between 2020 and 2022. At discharge, anti-osteoporotic medication according to the Arbeitsgemeinschaft für Osteosynthesefragen (AO) Foundation algorithm was prescribed to all patients. Multivariate Cox regression analysis was used to investigate the risks of non-persistence to medication and of secondary fracture. RESULTS: Two hundred thirteen consecutive patients were prospectively followed. Mean follow-up was 17.2 ± 7.1 months. Persistence to medication at 2 years was 58% (95%CI 51-65%). A secondary osteoporotic fracture occurred in 1/126 (0.8%) persistent patients and 9/87 (11.4%) non-persistent patients. Multivariable Cox regression analysis confirmed that persistence to medication was significantly associated with a lower risk of secondary fracture (cause-specific hazard ratio [csHR] 0.05; 95%CI 0.01-0.45; p = 0.007). CONCLUSION: The application of the surgeon-led AO Foundation algorithm enables the in-hospital initiation of anti-osteoporotic treatment, leading to better persistence to medication and decreased incidence of secondary osteoporotic fractures.

Anterior Column and Anterior Dome Marginal Impaction Acetabular Fracture Treated with a Modified Smith-Petersen Approach along with Anterior Superior Iliac Spine Osteotomy using the Two-level Reconstruction Technique.

Introduction: A case of anterior column (AC) and anterior dome marginal impaction acetabular fracture with concomitant injury of the common femoral artery (CFA) is presented. Case Report: A 31-year-old patient suffered an anterior hip dislocation with ipsilateral fracture of the AC of the acetabulum and anterior dome impaction along with CFA injury. The fracture was treated utilizing the Smith-Petersen approach along with Anterior Superior Iliac Spine osteotomy. The impacted anterior dome and was stabilized using the two-level reconstruction technique. The patient was mobilized the first post-operative day and toe-touch weight bearing was exercised for 12 weeks. At 36 months post-operative, the patient was free of any hip symptoms and no radiographic signs of hip arthritis were present. Conclusions: This above surgical approach provided adequate exposure of the anterior dome impaction fracture with subsequent excellent reduction and secure fixation. Surgeons treating these types of injuries should be aware of this surgical option.

Fracture blisters: pathophysiology and management.

Open fractures are considered an orthopaedic emergency due to the severe soft tissue disruption that might potentially lead to devastating complications. On the other hand, closed fractures, and especially those resulting from high-energy mechanisms, are also often accompanied by severe soft tissue trauma. Soft tissue envelope compromise can have a detrimental effect on the final outcome of the patients. Fracture blisters in particular, develop as a sign of significant local tissue trauma and appear in a time period between 6 to 72 hours post-injury. They can delay the definitive fracture treatment for a considerable amount of time and at the same time they also increase the risk for post-operative wound complications. Awareness of fracture blisters pathophysiology and their management options are crucial for orthopaedic surgeons, in order to achieve a favorable clinical outcome. In the herein study we present a concise synopsis of the pathophysiology pathways and management options of fracture blisters.

Ulnar Nerve Injuries Post Closed Forearm Fractures in Paediatric Population: A Review of the Literature.

Ulnar nerve injury as a result of closed forearm fractures in children is a rare but disastrous complication, affecting significantly the function of the upper extremity. The management of these injuries is still controversial in the literature. This is a review of small case series and case reports, in which an algorithm of treatment is proposed. A brief description of a relative case, which was treated successfully in our department, is presented as well. This case motivated the authors to perform this study.

Hand compartment syndrome as a result of intravenous contrast extravasation.

Hand compartment syndrome is a rare condition which can result from crush injuries, fractures, burns, intravenous fluid extravasation, etc. Failing to recognize and treat it early leads to significant functional deficits of the hand. Few cases of iatrogenic hand compartment syndrome have been described in the literature so far. We present a case of a hand intravenous (IV) contrast medium extravasation injury in a 72-year-old female patient, during a CT scan. As soon as the swelling of the hand was noticed, elevation of the limb was suggested and ice was applied. Few hours later though the patient developed compartment syndrome of the hand with paresthesias and severe pain with passive movement of the fingers. Left hand emergent fasciotomies were performed leading to a good functional outcome.