Causes for Delay to Surgery in Hip Fractures and How It Impacts on Mortality: a Single Level 1 Trauma Center Experience.

PURPOSE OF THE STUDY The increasing number of hip fractures puts enormous demand on our level 1 trauma centre. Because we have to synchronize hip fracture treatment with all other injuries delays to surgery can occur. In this study, we analysed the reasons for delay to surgery and how it impacts on mortality of hip fracture patients in our institution. MATERIAL AND METHODS We retrospectively studied 641 patients operated for hip fractures in one year period. Investigated characteristics were: age, gender, American Society of Anaesthesiologists score (ASA), time of hospital admission, time of surgery, type of surgery, anticoagulant therapy (ACT) and non-routine pre-operative tests (NRPT). Trochanteric (TF) and femoral neck fractures (FNF) were analysed separately. The surgery in first 48 hours was considered early. The time of death was obtained from the federal database. Univariate and multivariable analysis were performed. P-values <0.05 were considered statistically significant. RESULTS All tested characteristics were significantly different in both time groups. Delay to surgery was significantly influenced by the type of surgery - arthroplasty, odds ratio (OR) 17.2, ACT (OR 6.9) and NRPT (OR 4.0) in FNF group of patients and by ACT (OR 31.1) and ASA (OR 2.2) in TF. 30-day mortality rate was 5.1% and 1-year mortality was 18.4%. ASA (OR 1.9), preinjury residence (OR 1.4) and age (OR 1.1) had statistical influence on survival, but not delay to surgery. CONCLUSIONS The majority of delays are due to unavailability of operative capacities, after patient optimization. We see solution in dedicated operation rooms and teams for hip fracture treatment. Mortality is influenced by the patients' characteristics, but not by delay to surgery. A multidisciplinary approach and skilled surgical teams are, besides early operation, the most important assurance of a good outcome. Key words: trochanteric fracture, femoral neck fracture, timing, mortality.

Population structure and attribution of human clinical Campylobacter jejuni isolates from central Europe to livestock and environmental sources.

Campylobacter jejuni is among the most prevalent causes of human bacterial gastroenteritis worldwide. Domesticated animals and, especially, chicken meat are considered to be the main sources of infections. However, the contribution of surface waters and wildlife in C. jejuni transmission to humans is not well understood. We have evaluated the source attribution potential of a six-gene multiplex PCR (mPCR) method coupled with STRUCTURE analysis on a set of 410 C. jejuni strains isolated from environment, livestock, food and humans in central Europe. Multiplex PCR fingerprints were analysed using Subclade prediction algorithm to classify them into six distinct mPCR clades. A subset of C. jejuni isolates (70%) was characterized by multilocus sequence typing (MLST) demonstrating 74% congruence between mPCR and MLST. The correspondence analysis of mPCR clades and sources of isolation indicated three distinct groups in the studied C. jejuni population-the first one associated with isolates from poultry, the second one with isolates from cattle, and the third one with isolates from the environment. The STRUCTURE analysis attributed 7.2% and 21.7% of human isolates to environmental sources based on MLST and mPCR fingerprints, respectively.

Radiological Changes after Interspinous Dynamic Stabilisation for Lateral Stenosis of Lumbar Spinal Canal: A Parallel Group Randomised Trial.

PURPOSE OF THE STUDY Interspinous dynamic stabilisation devices (IDSDs) are used for stabilisation and indirect decompression of the spinal motion segment in minimally invasive treatment of degenerative conditions of lumbar spine. Good methodological quality studies on biomechanical effects of IDSDs are lacking in scientific literature. The purpose of this study was to evaluate the biomechanical effect of dynamic IDSD implantation on a spinal motion segment. MATERIAL AND METHODS We conducted a parallel group randomised trial (RT) on twelve patients, comparing radiological stabilisation and indirect decompression outcome measures between groups of patients with an isolated degenerative condition of L4-L5 motion segment and unilateral L5 nerve root radiculopathy. One group of six patients was operated by decompression and dynamic IDSD implantation and the other group of six patients by decompression alone. The radiological assessment was performed 6 months postoperatively in all patients. RESULTS Dynamic IDSD implantation significantly decreased segmental intervertebral angle (IA) and significantly increased segmental foraminal height (FH) and foraminal width (FW). The implantation had no effect on segmental range of motion (ROM) and posterior disc height (PDH). CONCLUSIONS The studied dynamic IDSD improved radiological indirect decompression outcome measures while only partially improved radiological stabilisation outcome measures. Oxford Centre for Evidence-Based Medicine 2011 Level 3: randomised trial with small effect size. Key words: lumbar spine, degenerative lateral stenosis, interspinous dynamic stabilisation, DIAM, randomised trial.

Microstructural analysis of implant-bone interface of hydroxyapatite-coated and uncoated Schanz screws.

The aim of the study was to compare the pin-bone interface microstructural characteristics of hydroxyapatite-coated (HAC) and stainless steel Schanz screws after 2, 4 and 6 months of implantation in a sheep model. The microstructure and composition of the hydroxyapatite coating were analyzed using scanning electron microscopy (SEM) and X-ray diffraction (XRD) analysis. Twelve coated and 12 uncoated screws were implanted into both femora of three sheep, each sheep receiving eight screws. Specimens of polished bone with screws were examined with SEM and light microscope for morphometric analyses. The HAC was approx. 40 microm thick, the grain size ranged from 5 to 40 microm, with pores less than 20 microm. The atomic ratio of Ca/P was 1.62. SEM showed that the bone-implant contact was better with HAC than with uncoated implants. The ingrowth of the bone in the HAC was clearly seen. Morphometric analysis showed good bone-implant contact in 65.1 (+/-24.6)% in the HAC and 32.0 (+/-23.3)% in the uncoated group (p<0.001). Although the percentage of good contact increased with time for both groups, it was significantly higher for HAC screws. Our investigation demonstrated a time dependent improvement of implant-bone contact of the HAC compared to standard stainless steel implants in the chosen experimental conditions.

Femur osteomyelitis due to a mixed fungal infection in a previously healthy man.

We describe a previously healthy, 22-year-old man who, after a closed fracture of the femur and subsequent operation, developed chronic osteomyelitis. Within a few days, infected bone fragments, bone, and wound drainage repeatedly yielded three different filamentous fungi: Aspergillus fumigatus, Aspergillus flavus, and Chalara ellisii. Histologic examination of the bone revealed septate hyphae. After sequential necrotomies of the femur and irrigation-suction drainage with added antimycotic therapy, the infection ceased and the fracture healed. This case is unique in that it is the only known instance in which a long bone was affected in an immunocompetent individual, with no evidence of any systemic infection, by a mixed population of two different Aspergillus spp. and the rare filamentous fungus C. ellisii. Environmental factors that could potentiate the infection include blood and edema fluid resulting from the surgical procedure and the presence of the osteosynthetic plate.

Avulsion of the anterior superior iliac spine in two adolescent sisters: operative versus conservative treatment.

We compared the results of treatment of identical injuries to the anterior superior iliac spine in two adolescent sisters, one treated conservatively and the other operatively. The functional results of both treatments were good, but the rehabilitation period was shorter with operative treatment, allowing an earlier return to athletic activity. Treatment by open reduction and internal fixation should be considered in patients requiring a short convalescence. Familial coincidence of avulsion fracture of the anterior superior iliac spine has not previously been described in the literature.

Comparison of Lauren's, Ming's and WHO histological classifications of gastric cancer as a prognostic factor for operated patients.

The prognostic significance of the above mentioned histological classifications is evaluated. The survival data of 259 supposedly radically resected patients is analyzed. The survival curves have been calculated according to the Kaplan-Meier method and compared with the Mantel-Cox test. The most important prognostic factors have been found and used in the stratification analysis. The diffuse type of cancer (according to Lauren) has significantly worse prognosis than the intestinal type only considering the same pT (pT3) and sex (male) or age group from 50 to 70 years. The infiltrative type of cancer (according to Ming) has a worse prognosis than expansive. The difference is insignificant even after stratification analysis. Worse prognosis of diffuse (or infiltrative) cancer is influenced more by the infiltration of regional lymph nodes than by the depth of infiltration, age or sex. WHO classification is less important as a prognostic factor. Signet ring cell type cancer has a worse prognosis considering age group 50-70 years.

[Late results of 351 femoral neck fractures (1986-1987 treatment period)]. / Spätergebnisse von 351 Schenkelhalsbrüchen (Behandlungszeitraum 1986-1987).

A total of 351 femoral neck fractures were treated from 1986 to 1987. The fractures were classified into three groups according to Pauwels. Nineteen percent of fractures were treated conservatively; in 65% internal fixation was performed, while in 16% total hip endoprosthesis was done. Of these patients 254 were reexamined three years later. In only 24.4% of the 254 patients were poor results--necrosis of the femoral head--found.