Does vitamin D deficiency affect functional outcomes in hip fracture patients? A meta-analysis of cohort studies.

BACKGROUND: Vitamin D deficiency is common in patients with hip fractures and may negatively affect functional recovery and quality of life (QOL). OBJECTIVE: This study aimed to conduct a meta-analysis to quantify the effects of vitamin D deficiency on physical function and quality of life after hip fractures. METHODS: The PubMed, EMBASE, Scopus, and Cochrane Library databases were searched for relevant studies. The inclusion criteria were hip fracture, comparison between vitamin D deficiency and normal vitamin D levels in patients with hip fracture, and functional outcome as the primary outcome. The exclusion criteria were case reports, reviews, duplicates, studies with a high risk of bias, and non-comparable or missing data. Two independent reviewers selected studies, extracted data, assessed bias, and performed meta-analyses using the Review Manager. Heterogeneity and publication bias were also assessed. Two independent reviewers selected the studies, extracted data, and assessed the risk of bias. We performed a meta-analysis using Review Manager and assessed heterogeneity and publication bias. RESULTS: Seven studies with 1,972 patients were included. Vitamin D deficiency was defined as a 25(OH)D level < 20 ng/mL. There were no significant differences in the ability to walk (OR 0.68, 95% CI 0.31-1.53, I2 = 69%) or length of hospital stay (MD 2.27 days, 95% CI - 2.47 to 7.01, I2 = 93%) between patients with and without vitamin D deficiency. However, patients with vitamin D deficiency had significantly worse functional ability and quality of life (SMD - 1.50, 95% CI - 2.88 to - 0.12, I2 = 96%). CONCLUSIONS: Despite the limitations of this study, such as small sample size, heterogeneous outcome assessments, and variable vitamin D measurement techniques, the results demonstrated that screening for vitamin D status and optimizing levels through supplementation could facilitate rehabilitation, promote lifestyle changes, aid in the recovery of independence, and help reduce long-term burdens.

The Impact of Hypoalbuminemia on Postoperative Complications in Patients Undergoing Shoulder Arthroplasty: A Meta-Analysis.

OBJECTIVES: The objective of this meta-analysis was to investigate the association between hypoalbuminemia and postoperative complications in patients undergoing shoulder arthroplasty. METHODS: This meta-analysis study was registered in PROSPERO (CRD42023442466) and adhered to the PRISMA guidelines. Studies focused on shoulder arthroplasty that compared hypoalbuminemia and normal albumin levels were included. A systematic literature search was conducted in PubMed, EMBASE, Scopus, and the Cochrane Collaboration database. Seven comparative studies were included, and odds ratios with a 95% confidence interval were calculated for the dichotomous variables. A fixed-effect model was used when there was no statistical evidence of heterogeneity, and a random-effect model was used when significant heterogeneity was observed. Review Manager 5.4 software was used for data analysis. RESULTS: The meta-analysis included a total of 20,290 patients from seven studies. Hypoalbuminemia was significantly associated with a higher risk of readmissions (OR 2.92, 95%CI 1.74 to 4.91), reoperations (OR 3.23, 95%CI 1.98 to 5.27), an increase in hospital stay duration (MD 1.59, 95%CI 0.86 to 2.32), and complications such as death (OR 5.75, 95% CI 2.98 to 11.08; studies = 4), thromboembolic events (OR 2.43, 95% CI 1.46 to 4.06; studies = 4), cardiac events (OR 2.78, 95% CI 1.07 to 7.24; studies = 3), pulmonary infections (OR 3.09, 95% CI 1.54 to 6.20; studies = 3), systemic infections (OR 2.19, 95% CI 1.51 to 3.16; studies = 3), and transfusions (OR 3.16, 95% CI 2.23 to 4.48; studies = 2). However, there was no significant association between hypoalbuminemia and renal complications, surgical site infections, urinary tract infections, wound problems, or cardiovascular events. CONCLUSION: This meta-analysis provides strong evidence that hypoalbuminemia is associated with a higher risk of postoperative complications in patients undergoing shoulder arthroplasty.

[Translated article] Tumor ablation and vertebral augmentation in the treatment of vertebral metastases: A multicenter study.

INTRODUCTION: Treatment of metastatic vertebral fractures without neural compression is performed with percutaneous cementation techniques. The increase in intratumoral pressure by these techniques can send tumor cells into the bloodstream. To prevent this dissemination and improve pain treatment, ablation techniques have been introduced that would allow the creation of a cavity in the tumor prior to cementation or directly necrosing the metastasis when its size is small. MATERIAL: We present the experience with ablation of two hospitals and two different ablation techniques. The first group used radiofrequency ablation (A) in 14 patients (26 vertebrae), 4 of whom underwent vertebral arthrodesis. The second group used microwave ablation (B) in 93 patients (129 lesions) without associated vertebral instrumentation. RESULTS: In group A pain improvement in VAS was 7.7-2.6 at 6 weeks. There were no complications derived from the ablation. In most cases cementation was associated. In the group B pain improvement in VAS went from 6.8 to 1.7 at 6 weeks. Cementation was associated in all cases. There were no complications derived from the ablation. CONCLUSION: The association of ablation techniques with vertebral cementation is a safe technique that significantly improves the patient's pain and can help control the disease.

Tumor ablation and vertebral augmentation in the treatment of vertebral metastases: A multicenter study. / Ablación tumoral y cementación en el tratamiento de las metástasis vertebrales. Estudio multicéntrico.

INTRODUCTION: Treatment of metastatic vertebral fractures without neural compression is performed with percutaneous cementation techniques. The increase in intratumoral pressure by these techniques can send tumor cells into the bloodstream. To prevent this dissemination and improve pain treatment, ablation techniques have been introduced that would allow the creation of a cavity in the tumor prior to cementation or directly necrosing the metastasis when its size is small. MATERIAL: We present the experience with ablation of two hospitals and two different ablation techniques. The first group used radiofrequency ablation (A) in 14 patients (26 vertebrae), 4 of whom underwent vertebral arthrodesis. The second group used microwave ablation (B) in 93 patients (129 lesions) without associated vertebral instrumentation. RESULTS: In group A pain improvement in VAS was 7.7-2.6 at 6 weeks. There were no complications derived from the ablation. In most cases cementation was associated. In the group B pain improvement in VAS went from 6.8-1.7 at 6 weeks. Cementation was associated in all cases. There were no complications derived from the ablation. CONCLUSION: The association of ablation techniques with vertebral cementation is a safe technique that significantly improves the patient's pain and can help control the disease.

Valoración clínico-radiológica del vástago CLS Spotorno a largo plazo / Long-term clinical-radiological evaluation of the CLS Spotorno stem

Objetivo: Analizar los resultados a largo plazo del vástago no cementado de anclaje metafisario tipo CLS Spotorno (Sulzer/Zimmer). Material y métodos: Se han revisado 166 pacientes a los que se colocó, de forma primaria y consecutiva 189 vástagos CLS (CementLess Spotorno) (Sulzer/Zimmer). El seguimiento mínimo ha sido de 13 a˜nos. Los parámetros clínicos se han valorado según la escala de Harris modificada, y los radiológicos según las zonas de Gruen. También se ha analizado la medición del hundimiento del vástago. Resultados: El seguimiento medio ha sido de 180 meses (156-228) 12 pacientes (12 vástagos) habían fallecido y no se ha completado el seguimiento por diferentes motivos en 24 pacientes (29 vástagos). Así, el trabajo se ha realizado sobre 130 pacientes (148 vástagos) que tienen el seguimiento mínimo. La tasa de supervivencia global del vástago ha sido del 95% al final del seguimiento (intervalo de confianza 89-98). Las mediciones de la escala de Harris han pasado de 48 (9-76) puntos antes de la cirugía a 90 (63-100) puntos al final del seguimiento. Conclusiones: El vástago femoral CLS obtiene unos excelentes resultados tanto clínicos como de supervivencia a largo plazo (AU)

Objective: To analyse the long-term results of the cementless, metaphyseal anchorage type, CLS Spotorno stem (Sulzer/Zimmer). Material y methods: A review has been made of 166 patients in whom were implanted, primarily and consecutively, 189 CLS (CementLess Spotorno) (Sulzer/Zimmer) stems. The mean follow up was 13 years. The clinical parameters were assessed using a modified Harris scale, and the radiological ones according to the Gruen zones. The stem sinking measurements were also analysed. Results: The mean follow up was 180 (156-228) months. Twelve patients (12 stems) died and 24 patients (29 stems) did not complete the follow up for different reasons. Thus the study was carried out on 130 patients (148 stems) who had the minimum follow up. The overall survival rate of the stem was 95% (confidence interval 89-98%) at the end of follow up. The Harris scale scores increased from 48 (9-76) points before surgery to 90 (63-100) points at the end of follow up (AU)

[Biatrial thrombosis]. / Trombosis biauricular.

A fifty-eight year old patient presented subacute right heart failure. Transthoracic and transesophageal echocardiography revealed thrombi in both atria, and initial anticoagulation and subsequent surgical treatment were successful. Echocardiography is defined as being decisive to diagnosis, and the role of surgery in the treatment of these patients is commented.

Changes in intraosseous pressure at the distal femoral epiphysis induced by variations in knee-joint position and intracapsular saline infusion. An experimental study in dogs.

Hemodynamic changes at the distal femoral epiphysis measured by recording intraosseous pressure (IOP) were investigated in mature and juvenile dogs after changes in knee-joint position and intracapsular infusion of 3 ml isotonic saline solution. Juvenile and mature animals responded to infusion test with a similar 5-fold increase in intracapsular pressure. A 2-fold increase in IOP was found when knee-joint flexion passed from 30 degrees to complete flexion. In juvenile dogs, IOP values were lower than in adults both in complete knee flexion and during infusion test. The similar response to joint hyperpressure tests observed in adult and juvenile dogs suggests that the barrier effect of the growth plate for epiphyseal venous drainage has no major influence in the hemodynamics of the distal femoral epiphysis.

Discitis due to Clostridium perfringens.

Diagnosis of the infectious process of the intervertebral disc is often delayed due to the lack of specifity of the clinical picture. This delay in diagnosis and consequently in treatment can lead to severe neurologic sequela. In these cases, punction biopsy of the intervertebral disc is of special value. The authors found no mention in the literature concerning Chlostridium perfringens discitis verified by aspiration and fluid culture extracted by intervertebral disc puncture.

The flow-volume loop in tetraplegics.

We have studied the FVC and maximum flow-volume loop in 20 tetraplegics and the results have been compared with the predicted normal values. The FVC in sitting position is reduced at approximately half the normal predicted values and is significantly lower than in supine and Trendelenburg. At high lung volumes the flows are reduced at half the normal values. At low lung volumes the reduction is smaller (71.5 per cent).