Hip Fractures in the Elderly: Perioperative Management and Prevention of Medical Complications

Elderly patients with hip fractures are at an increased risk of developing medical complications with higher mortality rates. Most patients require surgical treatment, and an early surgical intervention can reduce complications and lower mortality risk. A restrictive red blood cell transfusion strategy is usually applied, and the amount of transfusion can be reduced through medications such as tranexamic acid. Delirium can be prevented using non-pharmacological methods. In addition, it is necessary to prevent venous thromboembolism through mechanical or chemical prophylaxis. A multidisciplinary approach using the ERAS (Enhanced Recovery After Surgery) protocol and orthogeriatric care can help to reduce medical complications and mortality.

Local Postoperative Complications after Surgery for Intertrochanteric Fractures Using Cephalomedullary Nails / 대한고관절학회지

PURPOSE: Cephalomedullary nails (CMN) are commonly used for the surgical treatment of intertrochanteric fractures. This study aimed to evaluate overall postoperative local complications by reviewing patients who received surgical treatment using three different types of implants. MATERIALS AND METHODS: The study sample included 353 patients (107 males, 246 females) who underwent surgery using CMN for intertrochanteric fractures. Three different types of implants were used: i) the Gamma3® (Stryker) in 80 cases, ii) the Targon® PF (Aesculap) in 225 cases, and iii) the Compression Hip Nail® (Trademedics) in 48 cases. The mean age was 82.6 (range, 60–109) years and the average follow-up period was 15 (range, 6–80) months. Postoperative local complications and risk factors of cut-out were assessed. RESULTS: The most common complication was cut-out (n=26). Other complications included non-union (n=3), periprosthetic fracture (n=2), avascular necrosis (n=1), heterotopic ossification (n=1), and sleeve pull out (n=1). Multivariate analysis revealed that the cut-out group had a higher rate of poor reduction compared to the non-complicated group (P < 0.001). Although the mean tip-apex distance (TAD) was 18.4 mm in the non-complicated group, lower than that of the cut-out group (P=0.001), multivariate analysis revealed that TAD was not a significant risk factor for cut-out (P=0.065). CONCLUSION: Cut-out is the most common local complication associated with surgical treatment of intertrochanteric fractures using CMN. Proper reduction appears to be important in lowering the risk of cut-out. Maintaining low TAD is another critical factor in achieving sufficient fixation of lag screw to the subchondral bone of the femoral head.

Management of Polytrauma / 대한정형외과학회잡지

To optimize results for polytrauma patients, prompt evacuation and early management are critical. These patients also require a multidisciplinary team effort, involving multiple departments, as they are likely to have not only musculoskeletal injuries but also specific organ injuries or compromised general status. In the 1980s, the goal was definitive fracture fixation in the early stages after injury (early total care). Since the 1990s, however, the goal has shifted to temporary fixation, with a delay of several days prior to definitive fixation (damage control orthopedics). Recently, the timing and extent of treatment have been determined by the condition of patients based on objective indicators. Because surgery may result in secondary damage, it is desirable to minimize potential tissue injury with either temporary fixation or a delay in definitive fixation.

The Correlation between Posterior Tibial Slope and Maximal Angle of Flexion after Total Knee Arthroplasty

PURPOSE: The purpose of this study was to evaluate the correlation between the posterior tibial slope and the maximal angle of flexion after total knee arthroplasty.

Photodynamic Therapy Combined with Intravitreal Bevacizumab in a Patient with Choroidal Neovascularization Secondary to Choroidal Osteoma

Choroidal osteoma is a benign ossified tumor that is found predominantly in healthy young women during their second and third decades of life. The lesions are white-to-cream or orange in color, are located in the peripapillary and macular areas, and are unilateral in most patients. The symptoms of choroidal osteoma include decreased visual acuity and metamorphopsia or scotoma corresponding to the location of the osteoma, but some patients have no symptoms. Prognosis of vision varies according to tumor location, retinal pigment epithelial and sensory retinal degeneration, subretinal fluid and hemorrhage, and development of a subretinal neovascular membrane.