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.

Salvage for intramedullary nailing breakage after operative treatment of trochanteric fractures.

BACKGROUND: Trochanteric fractures are one of the most common fractures in elderly people. The use of intramedullary nails is an option for their treatment, especially in unstable patterns. Nail breakage is a rarely reported complication. The aim of this study was to determine the prevalence of nail breakage in our center. Secondary objectives are to show the management of this complication in our institution as well as the technical problems, complications and final outcomes of these patients in our hands. MATERIAL AND METHODS: In a retrospective case series review between 2010 and 2015, we analyzed 1481 patients with trochanteric and subtrochanteric fractures who had been treated by cephalomedullary nailing in our centre. 13 patients with nail breakage were identified. RESULTS: The percentage failure rate in our institution is 0.87%. 9 (69.2%) patients were women and 4 (3.8%) were men, with a mean age of 74.6 years (range 47-90). In all cases the mechanism of injury was a simple fall from standing height. Initial fracture types were: 1 case of AO/OTA 31A1, 6 cases of AO/OTA 31A2 and 6 cases of AO/OTA 31A3. Only 3 cases had a good overall reduction with a correct TAD, an optimal femoral neck-shaft angle and absence of fracture gaps >5 mm after surgery. The average time from the first surgery to the diagnosis of implant breakage was 333 days (range 70-1460), 11 months. Breakage occurred at the nail junction with the lag screw in 11 cases and in the distal nail aperture in 2 cases. CONCLUSIONS: An insufficient reduction with varus and fracture gaps >5 mm, the use of short nails in unstable patterns with subtrochanteric involvement and patients with certain comorbidities are facts observed that can contribute to the development of delayed or nonunion with subsequent nail breakage. Different salvage treatments, conversion to hip arthroplasty or revision osteosynthesis, may be considered but we think that prevention has to be the best treatment.

Evaluación de un programa de musicoterapia en una unidad de cuidados paliativos. La perspectiva de los cuidadores / Evaluation of a music therapy program in a palliative care unit. The caregivers perspective

INTRODUCCIÓN: La integración de la musicoterapia (MT) en el equipo de cuidados paliativos puede ayudar a pacientes y cuidadores a manejar algunas necesidades físicas, emocionales, sociales y espirituales que se presentan: facilitar cambios en la percepción del dolor y la ansiedad, normalizar el entorno, mejorar el estado de ánimo, relajar, facilitar la expresión y canalización de emociones, conectar con aspectos espirituales y ofrecer apoyo para saber decir adiós o facilitar el proceso de duelo. OBJETIVOS: Valorar la satisfacción de los cuidadores y los beneficios obtenidos con la intervención musicoterapéutica recibida en el programa de MT implantado en una unidad de cuidados paliativos (UCP) de la Comunidad de Madrid. MÉTODO: Estudio cualitativo descriptivo prospectivo tras el diseño y la puesta en marcha del programa de MT. Elaboramos un cuestionario de satisfacción ad hoc a los familiares participantes, como indicador para su evaluación, que consta de 18 preguntas: 5 referidas a datos personales, 6 de tipo cerrado, 4 de tipo abierto y 3 con escalas de valoración de 0 a 10 puntos. El cuestionario se entregó a los familiares/cuidadores al finalizar la sesión de MT. Se interrumpió la entrega y recogida de cuestionarios tras alcanzar 100 encuestas recibidas. Las respuestas fueron analizadas a través de una estadística descriptiva con hoja de cálculo Excel para los datos cuantitativos y mediante el programa Atlas. ti (v.5.2) para los aspectos cualitativos. RESULTADOS: El perfil del acompañante durante las sesiones de MT es el de una mujer de 55 años, hija del enfermo/a. Cantar (47%) y tocar o improvisar con instrumentos (46%) son las técnicas preferidas. El apoyo emocional (valorado en 9,1/10) y la relajación (9/10) son los beneficios más considerados. Las respuestas cualitativas se clasifican en 3 temas: verbalización de la enfermedad, beneficios de la musicoterapia y sugerencias para el programa. Entre los beneficios destacan la percepción de apoyo, participación activa en familia, relajación y bienestar, facilitación de la comunicación, mejora del estado de ánimo, percepción diferente del paso del tiempo y conexión con el mundo espiritual. La valoración global del programa de MT recibe una puntuación media de 9,43/10. CONCLUSIONES: La MT recibe una valoración muy positiva por parte de los cuidadores de los pacientes ingresados en la UCP. Los beneficios descritos incluyen la percepción de apoyo, la relajación, el cambio en el estado de ánimo y la facilitación de comunicación verbal y no verbal

INTRODUCTION: The integration of music therapy (MT) in a palliative care team may help patients and caregivers to handle arising needs in the physical, emotional, social and spiritual dimensions: facilitating changes in the perception of pain and anxiety, normalizing the environment, improving mood, promoting relaxation, facilitating the emotional management, tuning into spiritual aspects, as well as offering support to help the farewell and grieving process for relatives and friends. OBJECTIVE: To evaluate the satisfaction of caregivers and the benefits achieved with the intervention with a MT programme implemented in a Palliative Care Unit (PCU) in Madrid. METHOD: A pilot descriptive qualitative study was conducted following the design and starting up of the MT programme. We designed a specific satisfaction questionnaire with 18 questions: 5 of them referred to personal details, 6 with closed questions, 4 with open questions, and 3 with evaluation scales from 0 to 10 points. The questionnaire was delivered to the relatives/carers once the MT session was finished. Distribution and collection of questionnaires ended once 100 surveys were collected. The answers were analyzed using descriptive statistics with an Excel spreadsheet for the quantitative information, and with Atlas. ti (v.5.2) program for the qualitative aspects. RESULTS: A 55 year old woman, daughter of the patient is the usual profile of the patient's companion during MT performances. Preferred techniques are singing (47%) and playing or improvising with instruments (46%). Emotional support (9.1/10) and relaxation (9/10) are the main achievements obtained. Qualitative responses are distributed into three categories: Verbalization of the illness, benefits of the MT, and suggestions for the program. The most emphasized benefits are: perception of support, active family participation, relaxation and well-being, simplification of the communication, mood improvement, different perception of time passing and connection with spirituality. The overall evaluation of the MT programme received a mean score of 9.43/10. CONCLUSIONS: MT is highly valued by relatives and friends of the patients cared for in the PCU. Reported benefits include perception of support, relaxation, positive mood changes and facilitation of verbal and nonverbal communication (AU)

Traumatic floating clavicle: a case report.

Most published reports of a floating clavicle consist of a dislocation of both ends of the clavicle and are associated with a high-energy injury. We report a 71 year old patient with a fracture of the medial end of the clavicle with anterior sternoclavicular dislocation and a nondisplaced fracture of the lateral end of the same clavicle distal to the insertion of coracoclavicular ligaments due to a low velocity fall.

Lateral subtalar dislocation associated with bimalleolar fracture: case report and literature review.

Subtalar dislocation is an uncommon injury that affects the talocalcaneal and talonavicular joints, with the tibiotalar and calcaneocuboid joints remaining intact. The 4 types of subtalar dislocation are medial, lateral, anterior, and posterior, although the latter 2 are rare. These injuries-especially lateral dislocation-occur as a result of high-energy trauma. Medial dislocation is the most common type, and lateral dislocation is associated with osteochondral fractures of the talus and calcaneus, as well as with open injuries; hence, its worse prognosis. We report the case of a 62-year-old woman diagnosed with lateral subtalar dislocation accompanied by an ipsilateral bimalleolar fracture after a fall downstairs. She underwent emergency reduction of the dislocation under sedation. Surgical treatment of the bimalleolar fracture was delayed 9 days to avoid cutaneous complications. This is the first report of a subtalar dislocation accompanied by a bimalleolar fracture.