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.

The level of bifurcation of peroneal artery and its implications for posterolateral approach to the ankle: a CT angiography study.

PURPOSE: This study aims to provide data, with the use of computed tomography angiography, regarding the level of bifurcation of the peroneal artery to the anterior perforating branch and the lateral calcaneal branch, in relation to the osseous anatomic structures of the tibial plafond, the medial malleolus and the lateral malleolus. METHODS: The study included patients who underwent diagnostic computed tomography angiography of the lower extremities. Measurements were performed in two-dimensional reconstructions and included the perpendicular distance from peroneal artery bifurcation into anterior perforating branch and lateral calcaneal branch to the lowest level of tibial plafond (D1), medial malleolus (D2) and lateral malleolus (D3). The distances were also normalized to the length of the tibia. RESULTS: Sixty patients and a total of 115 limbs were enrolled in this study. The mean distance ± standard deviation from peroneal artery bifurcation to tibial plafond (D1) was 4.33 ± 1.12 cm (normalized 0.12 ± 0.03) (range 2.54-8.26 cm), to medial malleolus (D2) was 5.53 ± 1.18 cm (normalized 0.16 ± 0.03) (range 3.27-9.5 cm) and to lateral malleolus (D3) was 6.53 ± 1.17 cm (normalized 0.18 ± 0.03) (range 4.71-10.2 cm), respectively. There was no significant difference between right and left limb measurements (p > 0.05). Females presented lower, but not statistically significant (p > 0.05), D1, D2 and D3 measurements compared to males. CONCLUSION: The bifurcation of the peroneal artery takes place at lower level compared to previously published studies and consequently extreme caution should be exercised when performing the posterolateral approach to the ankle. This study adds to the understanding of the relevant vascular anatomy of the region and assists in performing the posterolateral approach to the ankle with safety.

Anterior hip dislocation with simultaneous anterior column and anterior wall acetabular fracture: A case report.

INTRODUCTION: Isolated anterior column and anterior wall fractures are a relatively rare subgroup of acetabular fractures. They represent 6,3% of all acetabular fractures. Surgical treatment is indicated for fractures with displacement more than 5 mm and when incongruence of the articular surface and/or instability of the joint is evident, in order to allow early mobilization and prevent further complications, such as posttraumatic hip arthritis. Open reduction and internal fixation is the usual standard of care. Closed reduction and percutaneous fixation can be performed in minimally displaced fractures. In the herein article, we describe the unique combination of anterior hip dislocation along with anterior column and anterior wall fractures in a middle-aged patient, after a fall from small height. CASE REPORT: A 56-year-old female patient was brought to the emergency department after an accidental fall from height less than 2 m. Upon arrival her right hip was abducted, shortened and externally rotated. CT scan of the pelvis revealed anterior dislocation of the right hip, an impaction injury of the femoral head, and fractures of anterior column and anterior wall of the acetabulum. Closed reduction of the hip was performed. Open reduction and internal fixation of the fractures was carried out utilizing the extended Smith-Petersen approach in a scheduled manner 5 days after admission. At one-year follow-up after the injury the patient had returned to all of her pre-injury activities and she was able to walk exercising full weight bearing without residual pain. CONCLUSION: Anterior hip dislocation with simultaneous isolated anterior column and anterior wall fracture is an injury of rare incidence. Orthopaedic surgeons treating fractures should be aware of this entity and the herein article can serve as a reference regarding the management of such an uncommon injury.