The characteristics and predictors of mortality in periprosthetic fractures around the knee.

Aims: Periprosthetic fractures (PPFs) around the knee are challenging injuries. This study aims to describe the characteristics of knee PPFs and the impact of patient demographics, fracture types, and management modalities on in-hospital mortality. Methods: Using a multicentre study design, independent of registry data, we included adult patients sustaining a PPF around a knee arthroplasty between 1 January 2010 and 31 December 2019. Univariate, then multivariable, logistic regression analyses were performed to study the impact of patient, fracture, and treatment on mortality. Results: Out of a total of 1,667 patients in the PPF study database, 420 patients were included. The in-hospital mortality rate was 6.4%. Multivariable analyses suggested that American Society of Anesthesiologists (ASA) grade, history of peripheral vascular disease (PVD), history of rheumatic disease, fracture around a loose implant, and cerebrovascular accident (CVA) during hospital stay were each independently associated with mortality. Each point increase in ASA grade independently correlated with a four-fold greater mortality risk (odds ratio (OR) 4.1 (95% confidence interval (CI) 1.19 to 14.06); p = 0.026). Patients with PVD have a nine-fold increase in mortality risk (OR 9.1 (95% CI 1.25 to 66.47); p = 0.030) and patients with rheumatic disease have a 6.8-fold increase in mortality risk (OR 6.8 (95% CI 1.32 to 34.68); p = 0.022). Patients with a fracture around a loose implant (Unified Classification System (UCS) B2) have a 20-fold increase in mortality, compared to UCS A1 (OR 20.9 (95% CI 1.61 to 271.38); p = 0.020). Mode of management was not a significant predictor of mortality. Patients managed with revision arthroplasty had a significantly longer length of stay (median 16 days; p = 0.029) and higher rates of return to theatre, compared to patients treated nonoperatively or with fixation. Conclusion: The mortality rate in PPFs around the knee is similar to that for native distal femur and neck of femur fragility fractures. Patients with certain modifiable risk factors should be optimized. A national PPF database and standardized management guidelines are currently required to understand these complex injuries and to improve patient outcomes.

The cadaveric research model for calcaneus fractures: A scoping review of biomechanical, anatomical, radiographic and fracture fixation studies.

BACKGROUND: Calcaneal fractures remain a big challenge in orthopaedic surgery and lead to long lasting disabilities. Cadaveric research plays an important role in determining optimal fracture treatment. This scoping review aims to provide insight into cadaveric research that has been conducted on calcaneal fractures, including biomechanics, fixation, approaches and radiographic studies. METHODOLOGY: A search strategy was created and implemented as per PRISMA guidance. 3 databases, Medline, Embase and Scopus, were used when conducting this review. RESULTS: 484 individual studies were retrieved across the 3 databases, of which 186 duplicates were excluded. Study abstracts were individually reviewed, of which 208 studies were excluded in accordance with study criteria. 90 papers were sought for retrieval, of which 83 full text papers were successfully retrieved. Of the full papers retrieved, 22 did not meet our inclusion criteria, and 19 papers related only to talus fractures. In the end, 43 cadaveric studies pertaining to this scoping review were included and reviewed. DISCUSSION: Studies were grouped into biomechanical, anatomical, fixation and radiographic studies for review. CONCLUSION: Evaluation of current cadaveric studies pertaining to calcaneal fractures has allowed greater insight into the myriad challenges in the management of these injuries. Effects of intra-articular fractures on calcaneal biomechanics assist in establishing surgical goals. Whilst fixation studies showing good stability of nail fixations could encourage further development in minimally invasive techniques. Avoiding pitfalls seen in the extensile lateral approach. Recommendations of areas for further research include use of external fixators, fixation in non-Sanders Type 2 fractures, and comparison of intraoperative CT/3D fluoroscopy with o conventional fluoroscopy.

Predictors of mortality in periprosthetic fractures of the hip: Results from the national PPF study.

INTRODUCTION: Periprosthetic fractures (PPFs) around the hip joint are increasing in prevalence. In this collaborative study, we aimed to investigate the impact of patient demographics, fracture characteristics, and modes of management on in-hospital mortality of PPFs involving the hip. METHODS: Using a multi-centre cohort study design, we retrospectively identified adults presenting with a PPF around the hip over a 10-year period. Univariate and multivariable logistic regression analyses were performed to study the independent correlation between patient, fracture, and treatment factors on mortality. RESULTS: A total of 1,109 patients were included. The in-hospital mortality rate was 5.3%. Multivariable analyses suggested that age, male sex, abbreviated mental test score (AMTS), pneumonia, renal failure, history of peripheral vascular disease (PVD) and deep surgical site infection were each independently associated with mortality. Each yearly increase in age independently correlates with a 7% increase in mortality (OR 1.07, p=0.019). The odds of mortality was 2.99 times higher for patients diagnosed with pneumonia during their hospital stay [OR 2.99 (95% CI 1.07-8.37) p=0.037], and 7.25 times higher for patients that developed renal failure during their stay [OR 7.25 (95% CI 1.85-28.47) p=0.005]. Patients with history of PVD have a six-fold greater mortality risk (OR 6.06, p=0.003). Mode of treatment was not a significant predictor of mortality. CONCLUSION: The in-hospital mortality rate of PPFs around the hip exceeds 5%. The fracture subtype and mode of management are not independent predictors of mortality, while patient factors such as age, AMTS, history of PVD, pneumonia, and renal failure can independently predict mortality. Peri-operative optimisation of modifiable risk factors such as lung and kidney function in patients with PPFs around the hip during their hospital stay is of utmost importance.

Clinical and Haematological Abnormalities in Decompensated Chronic Liver Disease Patients.

The liver is the largest organ of the body weighing 1-1.5 kg, which is 1.5-2.5% of the lean body mass. It plays a major role in protein synthesis, nutrient regulation, metabolism, and the combination of bilirubin and drugs, detoxification, bile production, and immune maintenance. Pathogenesis of hematological changes is multifactorial and included portal hypertension induce sequestration, alteration in bone marrow stimulating factors, viral and toxin-induced bone marrow suppression. Anemia of diverse etiology occurs in about 75% of patients of CLD. Causes of anemia in CLD are iron deficiency, hypersplenism, anemia of chronic disease, autoimmune hemolytic anemia, folic acid deficiency, aplastic anemia, and as an effect of an antiviral drug. Alcohol is a widely used drug with side effects that include hematopoiesis suppression. MATERIAL: To assess the clinical and hematological abnormalities in chronic liver disease patients, a cross sectional study was conducted in Shyam Shah medical college and associated Sanjay Gandhi Memorial Hospital during the period from Jan 2020 to June 2021. About 78 patients will be included in the present study. All the cases included in the study were admitted to the hospital ward evaluated for chronic liver disease and hematological abnormalities. OBSERVATION: In our study, we had 71 male and 7 female patients with an average age of 46.61±12.73 years. About 58.97% of the patients were alcoholics. Abdominal distension (74.36%) and Jaundice (56.41%) were the most common presenting complaints. Pallor was present in 54 (69.23%) cases. Splenomegaly was present in 30 (50.84%) chronic liver patients. All 78 patients had anemia and the most common type of anemia was normocytic normochromic anemia (58.97%). CONCLUSION: In this study, we can conclude that, in chronic liver patients, various hematological changes are very common which need to be identified and corrected early to reduce morbidity and mortality. It is important to typify anemia in cirrhosis with respective etiology, characterizing hematological abnormalities may help in better clinical management and help to improve prognosis.

A Clinical Study of Cirrhosis with Special Reference to Thyroid Function.

It is known that impaired thyroid function affects liver function and similarly liver disorders, also affect thyroid function. In this study, we looked at the clinical profile of cirrhosis and studied the correlation between cirrhosis and thyroid function. MATERIAL: The study was conducted as an observational cross-sectional study on patients with cirrhosis of liver reporting at the Department of Medicine, SSMC Rewa (M.P.) during the study period of 15 months i.e. from 1st April 2020 to 30th June 2021. Detailed history regarding risk factors, duration of liver disease, history pertaining to its etiology was obtained. The severity of liver disease was assessed using the Child-Pugh score. All the patients were then subjected to relevant investigations including Serum T3, T4, TSH. OBSERVATION: A total of 100 cases of liver cirrhosis were enrolled in our study with a mean age of 53.26±12.54 years. We observed a statistically significant association of Child Pugh Score with T3, T4 as well as TSH (p<0.05). We observed a moderate correlation of Child-Pugh score with T3 levels and TSH (r=0.452 and 0.311 respectively; p<0.05), and a weak correlation was observed with T4 (r=0.240; p<0.05). CONCLUSION: In cirrhosis of the liver majority of subjects show impaired thyroid functions. Thyroid hormone levels help assess the severity as well as the course of cirrhosis and among T3, T4, TSH values, Total T3 is considered as a better predictor of severity of cirrhosis.

Screening neonatal jaundice based on the sclera color of the eye using digital photography.

A new screening technique for neonatal jaundice is proposed exploiting the yellow discoloration in the sclera. It involves taking digital photographs of newborn infants' eyes (n = 110) and processing the pixel colour values of the sclera to predict the total serum bilirubin (TSB) levels. This technique has linear and rank correlation coefficients of 0.75 and 0.72 (both p<0.01) with the measured TSB. The mean difference ( ± SD) is 0.00 ± 41.60 µmol/l. The receiver operating characteristic curve shows that this technique can identify subjects with TSB above 205 µmol/l with sensitivity of 1.00 and specificity of 0.50, showing its potential as a screening device.

Antecolic laparoscopic Roux-en-Y gastric bypass is not associated with higher complication rates.

Since its introduction in 1994, laparoscopic Roux-en-Y gastric bypass (LRYGB) has rapidly gained popularity for the treatment of morbid obesity. Historically, the operation is performed in a retrocolic fashion; however antecolic LRYGB has been advocated as a safe alternative. We reviewed our experience with both techniques. From January 2003 to November 2004, the new UCLA Laparoscopic Bariatric Surgery Program performed 341 LRYGBs. In March 2004, our program transitioned from a retrocolic to an antecolic approach for all gastric bypass procedures. Institutional review board approval was obtained, and the data for all patients was collected into a prospective database. The patient characteristics for the two groups were similar. The significant differences between the two groups were average body mass index and the percentage of patients with diabetes and sleep apnea. The complication profiles for the two groups were also similar. There were significant differences between the two groups in the reoperation rate, antecolic 2.0 per cent versus retrocolic 7.8 per cent, and length of stay, antecolic 2.57 versus retrocolic 2.89 days. There were no anastomotic leaks or deaths in either group. Antecolic LRYGB is safe and may be associated with fewer complications. Only long-term weight loss results and complication rates will provide a definitive answer.