Impact of a Secondary Prevention Program for Fragility Fractures at the Orthogeriatric Clinical Care Center at the Fundación Santa Fe de Bogotá, 2014-2020.

Introduction: The presence of a fragility fracture increases the risk of new fractures. The timely and prompt initiation of treatment for osteoporosis can reduce the incidence of new fractures, for which adherence to management is a determining factor. The main objective of the study was to characterize the secondary prevention program for fragility hip fractures in patients older than 65 years, determine adherence to treatment and its effect on the appearance of new fractures in the established follow-up period. Materials and Methods: A descriptive retrospective cohort study was carried out. Patients older than 65 years with a fragility hip fracture treated by an Orthogeriatric Clinical Care Center between May 2014 and April 2020 who completed a one-year follow-up were included. Results: A final sample of 290 patients was obtained (226 women and 64 men) with an average age of 82.27 years. It was found that 84.5% of patients received indications to start osteoporotic management prior to hospital discharge and only 35.2% started the treatment in the first 6 postoperative months. 16.6% (n = 48) of patients presented a new fracture, with no significant difference between those who started their osteoporosis treatment in a timely manner. Out of the 48 patients, 5 patients (10.4%) met therapeutic failure criteria. Discussion: Most patients (84.5%) received indications for starting osteoporotic treatment before hospital discharge, nevertheless 35.2% started it during the first 6 postoperative months. 16.6% of patients presented a new fracture during follow up, of which only five met therapeutic failure criteria. Conclusions: No significant differences were found between the presence of new fractures and early initiation of osteoporotic management. However, literature shows that prompt and timely osteoporotic treatment reduces the incidence of new fractures, thus measures must be implemented to strengthen the adherence and surveillance of patients to the indicated treatment.

Acute Dislocations of the Sternoclavicular Joint: A Review Article.

Acute dislocations of the sternoclavicular joint are uncommon injuries, and it is difficult for physicians to develop expertise in treating these injuries because of their infrequent nature. No level I evidence currently exists for these injuries, but several retrospective studies and surgical techniques have been described. For acute injuries, current recommendations include early treatment with closed reduction. If unable to attain or maintain reduction after a closed attempt, open management should be considered. Previous reviews have outlined relevant anatomy, physical examination findings, and imaging for these injuries. This article aims to review updated information from the past decade regarding techniques for reduction, outcomes, and complications related to the injury and surgical management.

Recommendations for fracture management in patients with osteopetrosis: case report.

INTRODUCTION: Osteopetrosis is caused by general increase in bone density and obliteration of the medullary canal. Fractures are a frequent complication and their management is considered a challenge due to increased resistance to reaming and screw positioning; reduction maneuvers have to be done more carefully to avoid intraoperative fractures, and there is an increased risk of drill breakage. There is also a higher risk of infection and malunion, which increases the incidence of surgical revisions in this population. CASE REPORT: 55-year-old male with osteopetrosis and a history of two previous proximal femur fractures, who sustained an oblique supracondylar fracture of the left humerus and a simple, intra-articular, rotated fragment with capitelum involvement, as well as a fracture in the base of the coronoid process was admitted in our hospital. We performed an open reduction and internal fixation (ORIF) and 12 months after surgery, the patient's bone has healed and he recovered flexion (110˚) and extension (-10˚) without complications. DISCUSSION: During ORIF, two drill bits were broken and screw fixation was challenging due to the strength required. Bone overheating was also present during drilling, evidenced by smoke production and increased temperature of both bone and drill bits. Recommendations to avoid these problems include continuous cold saline irrigation, frequent drill bit changing, and spaced cycles with low-speed drilling. Additionally, high-resistance and high-speed electric drill bits can also be effective. Finally, patients should be closely followed postoperatively due to the high incidence of refracture, infection and malunion. CONCLUSIONS: Fracture fixation in patients with osteopetrosis requires strategies to overcome the technical difficulties found during the procedure. Preoperative planning must include the availability of multiple metal drill bits, electric drills, and bone substitutes, having in mind drilling techniques, drilling speed, and temperature control. Patients should be closely followed to evidence any complications such as infections and malunions.

Prospective monitoring improves outcomes of primary total hip replacement: a cohort study.

BACKGROUND: Over the past decade several studies have questioned current standards of patient safety in health care delivery. In response, our institution started a clinical pathway for total hip replacement in 1996. Prospective monitoring with regular feedback sessions to the individuals involved in patient care did however not start until 2003. The present study evaluates the effect of prospective monitoring on outcomes of total hip replacement. METHODS: Clinical records of patients undergoing primary elective total hip replacement between 1997 and 2004 were reviewed. Data on adverse events as well as adherence to protocols for venous thromboembolism prophylaxis were extracted retrospectively for the period 1997 to 2001 and prospectively from 2003 to 2004. Results were compared and analyzed in order to establish possible improvement in outcomes. Data was analyzed with Chi-square or Fisher's Exact test for categorical variables and Student's t-test for continuous variables. Alpha was set as less than 5% and analysis was performed with Stata 9.0 for Macintosh. RESULTS: Two-hundred and eighty-three patients were included from 1997 to 2001, and 62 from 2003 to 2004. Mean age, male to female ratio and initial diagnosis were similar in both groups. At least one adverse event occurred in 45% of patients in 1997-2001 and in 21% in 2003-2004 (p < 0.001). In-hospital hip dislocations occurred in 6% and 0% (p = 0.05), oliguria in 19% and 5% (p = 0.007), SSI and VTE in 3% and 0% (p = 0.37), adverse drug reactions in 11% and 13% (p = 0.66) and non-adherence to VTE prophylaxis protocols in 15% and 2% of cases respectively (p = 0.002). CONCLUSION: Overall rate of adverse events as well as in-hospital hip dislocations, oliguria and non-adherence to VTE prophylaxis protocols were significantly reduced during the second period. We conclude that clinical pathways alone are insufficient to improve patient safety and require prospective monitoring and continuous feedback to health care providers in order to achieve the desired effect.

Advantages of submuscular bridge plating for complex pediatric femur fractures.

Conventional treatments of pediatric femoral shaft fractures may result in an unacceptable rate of complications, especially in complex fractures. These fractures include high-energy injuries resulting in unstable fracture patterns, fractures in the proximal or distal third, and fractures occurring in large or multiply injured children. Our goal was to evaluate whether a minimally invasive submuscular bridge plating technique provides stability for early functional treatment (without protective casting or bracing) and predictable healing. Fifty-one patients with an average age of 10 years were studied. Sixty-seven percent had high-energy injuries and 55% had unstable fracture patterns. With an average followup of 14.2 months, all fractures united with excellent clinical results. Two (4%) significant complications occurred: fracture of one 3.5-mm LC-DCP Ti plate, and refracture of a pathologic fracture after early plate removal. Four patients (8%) had a leg-length discrepancy ranging from 23-mm short to 10-mm long. The average operative time was 106 minutes, with average fluoroscopy time of 84 seconds. Procedures were done by 15 surgeons in five university medical centers. This technique offers the advantage of adequate stability for early functional treatment and predictable healing with maintenance of length and alignment for all pediatric femoral shaft fractures.