Do patients with diabetes have an increased risk of impaired fracture healing? A systematic review and meta-analysis.

BACKGROUND: The majority of the existing evidence showing an association between diabetes and impaired fracture healing comes from basic scientific research. This systematic review and meta-analysis aimed to summarize the current clinical literature that investigates fracture healing in patients with diabetes. METHODS: The outcome of interest was impaired fracture healing including non-union, delayed union and malunion. Studies that compared fracture healing outcomes between patients with and without diabetes were included in this study. Subgroup analyses regarding different fracture sites, types of fracture and classifications of diabetes were performed. RESULTS: A total of 14 studies involving 695 patients with diabetes and 4937 controls fulfilled the inclusion criteria. Diabetes was associated with an increased risk of impaired fracture healing (odds ratio (OR): 2.11, 95% confidence interval (CI) 1.33-3.37, P = 0.002). Subgroup analyses showed that diabetes was associated with a significantly higher incidence of impaired fracture healing in lower extremity fractures (OR 2.63, 95% CI 1.30-5.30, P = 0.007), short bone fractures (OR 2.64, 95% CI 1.35-5.20, P = 0.005), long bone fractures (OR 2.13, 95% CI 1.23-3.70, P = 0.007) and osteoporosis-unrelated fractures (OR 2.39, 95% CI 1.19-4.80, P = 0.01). Both insulin-dependent diabetes (OR 4.04, 95% CI 1.05-15.56, P = 0.04) and non-insulin-dependent diabetes (OR 5.83, 95% CI 1.73-19.58, P = 0.004) were associated with significantly higher risks of impaired fracture healing. CONCLUSIONS: Patients with diabetes have an increased risk of impaired fracture healing when compared to patients without diabetes. Fracture healing in the lower extremities, short bones and osteoporosis-unrelated fractures is affected more severely by diabetes.

Risk of Dislocation After Total Hip Arthroplasty in Patients with Crowe Type IV Developmental Dysplasia of the Hip.

OBJECTIVE: To investigate whether the risk of dislocation after total hip arthroplasty (THA) in patients with Crowe type IV developmental dysplasia of the hip (DDH) is high and to further identify the risk factors for postoperative dislocation in these patients. METHODS: This retrospective cohort study reviewed Crowe type IV DDH patients undergoing THA between January 2009 and December 2017 in our institution. Each Crowe type IV DDH patient was matched with three Crowe type I, II, or III DDH patients according to gender, side and date of operation. The primary outcome of this study was postoperative dislocation after THA. Occurrence, rate, classification, treatment and outcome of dislocation were documented in detail for all patients. The dislocation rates were compared between Crowe type IV DDH patients and Crowe type I, II, or III DDH patients. Demographic data, implant factors, and surgical factors were compared between the dislocation and no dislocation groups. Multiple logistic regression analysis was used to determine the independent risk factors for dislocation in Crowe type IV hips. RESULTS: A total of 131 Crowe type IV hips were followed up for a mean of 76.5 ± 28.1 months. Three hundred and ninety-three Crowe type I, II and III hips, including 261 type I hips, 94 type II hips, and 38 type III hips, were identified as controls and followed up for a mean of 76.4 ± 28.2 months. No significant difference was observed in follow-up time between two groups (P = 0.804). One or more dislocations occurred in 22 of the 524 dysplasia hips (4.20%). Of the 22 dislocated hips, 20 hips (90.9%) were successfully managed with non-operative treatment. Two patients (9.1%, one Crowe type I and one Crowe type IV) experienced recurrent dislocation and required revision surgery. Crowe type IV hips had a significantly higher postoperative dislocation rate than type I, II, and III hips (11.45% vs 1.78%, P < 0.001). The use of a 22-mm femoral head (odds ratio [OR] = 23.55, 95% confidence interval [CI] = 1.901-291.788, P = 0.014), older age (OR = 1.128, 95% CI = 1.037-1.275, P = 0.031), and absence of false acetabulum (OR = 12.425, 95% CI = 1.982-77.879, P = 0.007) were identified as independent risk factors for dislocation in Crowe type IV hips. CONCLUSIONS: Crowe type IV DDH patients were at a high risk of dislocation after THA, and using large femoral heads and improving abductor muscle strength may help decrease the rate of postoperative dislocation in such patients.

Limited Influence of Comorbidities on Length of Stay after Total Hip Arthroplasty: Experience of Enhanced Recovery after Surgery.

OBJECTIVES: To identify predictors of length of stay (LOS) after total hip arthroplasty (THA) in an enhanced recovery after surgery (ERAS) program and evaluate the safety and cost-efficiency of the ERAS program with reduced LOS for unselected patients in a Chinese population. METHODS: A total of 311 consecutive, unselected patients undergoing primary THA at a single institution were retrospectively reviewed and divided into two groups: LOS ≤ 3 and LOS > 3 group. All patients were managed with the same ERAS protocol and went back home after discharge. Multivariate logistic regression analysis was used to determine independent risk factors for LOS > 3. Harris Hip Score at 90-day follow-up, 90-day readmission rate, and hospitalization costs were compared between two groups. RESULTS: Multivariate regression analysis identified female gender (odds ratio [OR] = 2.623), living alone (OR = 4.127), and primary osteoarthritis of hip (OR = 3.565) to be correlated with LOS > 3. Preoperative hemoglobin (HB), postoperative HB, drain use, blood transfusion, diabetes, respiratory disease, osteoporosis, number of comorbidities, and CCI score showed no significant influence on LOS after adjusting for other risk factors in the multivariate model. Harris Hip Score and readmission rate at 90-day follow-up showed no significant differences between two groups. Patients in LOS > 3 group had approximately 3948.6 Chinese yuan higher hospital costs. CONCLUSION: Female gender, living alone, and primary osteoarthritis of hip were identified as independent risk factors for prolonged LOS. The experience from our institution suggested aggressive management of comorbidities in the ERAS program can minimize the influence of comorbidities on LOS. The safety, efficiency, and costs-saving benefits of the ERAS program with reduced LOS for unselected patients was confirmed in this study.

Triterpenoid saponins and anti-inflammatory activity of Codonopsis lanceolata.

The ethanolic root extract of Codonopsis lanceolata were evaluated for anti-inflammatory activity using the carrageenan induced rat hind paw edema model and displayed a significant activity of 51.82% inhibition at 200 mg/kg at 3 h (p < 0.05). Further isolation of the extract yielded two new triterpenoid saponins, named codonolaside I (1) and codonolaside II (2). The spectroscopic and chemical data revealed their structures to be 3-O-[beta-D-xylopyranosyl (1->3)-(6'-O-methyl)-beta-D-glucuronopyranosyl]-30, 16a-dihydroxyolean-12-ene-28-oic acid 28-O-[P-D-xylopyranosyl (1-->4)-alpha-L-rhamnpyranosyl (1-->2)-alpha-L-arabinopyranosyl] ester (1), and 3beta, 16alpha-dihydroxyolean-12-ene-28-oic acid 28-O-[beta-D-xylopyranosyl (1-->3)-beta-D-xylopyranosyl (1-->4)-alpha-L-rhamnpyranosyl (1-->2)-alpha-L-arabinopyranosyl] ester (2).