[Secondary prevention in osteoporotic fractures. The GIOS project]. / Prevención secundaria en fracturas osteoporóticas. Resultados del proyecto GIOS.

BACKGROUND AND OBJECTIVE: The aim of this report is to describe and evaluate the results of a secondary prevention program in osteoporotic fractures in 70 Spanish hospitals. This project was started to improve the treatment of these fractures, with the inhospital implementation of software collecting epidemiological data on patients with osteoporotic fractures. PATIENTS AND METHODS: A prospective case study was conducted between March 2003 and March 2006 involving a consecutive sample of 24,534 patients with established fragility fracture seen in 70 hospitals. The study exclusion criterion was secondary osteoporotic fracture. The project consists of implementing software in hospitals, designed to collect such epidemiological data among these patients. Based on this information and on the published scientific evidence, the software automatically generates drug therapy recommendations and non pharmacologic measures of prevention to be included in the discharge report. RESULTS: The number of patients with osteoporotic fractures included in the program totalled 24,534 subjects. Of these patients, only 22.7% were receiving treatment for osteoporosis. Implementation of the program made it possible to discharge 19,033 patients (77.6%) with prescribed treatment, but in only 15,153 patients (61.8%) the treatment was correct. CONCLUSIONS: The GIOS project has proved effective in increasing the identification of fragility fractures and improve the percentage of secondary prevention measures, both pharmacological and non pharmacological, for patients with these fractures.

Long-term remodeling in proximal femur around a hydroxyapatite-coated anatomic stem: ten years densitometric follow-up.

Bone remodeling after a hip arthroplasty has been quantified with dual energy x-ray absorptiometry, usually for short-term follow-up. We used this technique to determine the long-term remodeling produced by a hydroxyapatite-coated, anatomic stem. Eighty patients with unilateral hip osteoarthritis were included in the study. The contralateral, healthy hip was taken as control. Bilateral dual energy x-ray absorptiometry scans were done before the surgery, at 15 days, and 1 and 10 years postoperatively. There was a decrease of bone mineral density in zones 1 and 7, which ranged from 12.2% to 27.3% at the end of the first year. There were no changes in zones 1 to 6 from the 1st to the 10th year, but there was a late decrease, up to 42.9%, in zone 7. The changes of bone mineral density promoted by this stem occurred in the first postoperative year. Late loss was seen only in area 7.

Estratificación de riesgo en pacientes con infarto agudo de miocardio mediante el uso de varias escalas

RESUMEN Introducción: Existen varias escalas a nivel mundial en la predicción de riesgo de los pacientes con infarto, pero aún no se ha encontrado la "escala ideal". Objetivos: Determinar la capacidad de discriminación para la mortalidad hospitalaria por infarto agudo de miocardio de las escalas GRACE, TIMI Risk Score, InTIME e ICR. Método: Se realizó un estudio prospectivo en el Servicio de Cardiología del Hospital General Docente Dr. Ernesto Guevara de la Serna de Las Tunas, Cuba, entre 2018 y 2019. El universo estuvo conformado por 452 pacientes ingresados en las primeras 24 horas del infarto y la muestra, por 430 casos a los cuales se les pudo recoger la totalidad de las variables en estudio. Se utilizó la estadística descriptiva. Para determinar la capacidad de discriminación de la escalas de riesgo se determinaron sensibilidad, especificidad y área bajo la curva. Resultados: El 70% de los pacientes fallecidos eran del sexo masculino y su media de edad fue 10 años mayor que en los egresados vivos. La hipertensión arterial fue el factor asociado más frecuente tanto en los pacientes fallecidos (90%) como en los egresados vivos (73.4%). El 70% de los fallecidos presentaron algún grado de disfunción sistólica del ventrículo izquierdo. El área bajo la curva de las escalas ICR, InTIME y GRACE fue de 0,683; 0,681 y 0,662, respectivamente. El TIMI Risk Score presentó un área bajo la curva de 0,598. Conclusiones: Las escalas ICR, InTime y GRACE presentaron pobre capacidad predictiva para la mortalidad hospitalaria. La escala TIMI Risk Score presentó una fallida capacidad predictiva.

ABSTRACT Introduction: There are several scores worldwide for risk stratification in patients with myocardial infarction, but the "ideal score" has not yet been found. Objectives: To determine the discriminatory capacity of GRACE, TIMI Risk Score, InTIME and ICR scores for in-hospital mortality due to acute myocardial infarction. Method: A prospective study was carried out in the Department of Cardiology of the Hospital General Docente Dr. Ernesto Guevara de la Serna of Las Tunas, Cuba, between 2018 and 2019. The study's population consisted of 452 patients admitted in the first 24 hours after myocardial infarction, and the sample consisted of 430 cases from which all the variables under study could be collected. Descriptive statistics were used. Sensitivity, specificity and area under the curve were determined to be able to determine the discriminatory capacity of the risk scores as well. Results: The 70% of the deceased patients were male and their mean age was 10 years older than in the patients discharged alive. High blood pressure was the most frequent associated risk factor in both deceased patients (90%) and in those who left the hospital alive (73.4%). The 70% of deaths had certain degree of left ventricular systolic dysfunction. The area under the curve of ICR, InTIME and GRACE scores was of 0.683; 0.681 and 0.662 respectively. TIMI Risk Score had an area under the curve of 0.598. Conclusions: ICR, InTime and GRACE scores had poor predictive capacity for in-hospital mortality. TIMI Risk Score had a very poor predictive capacity.

Rotator interval closure after arthroscopic capsulolabral repair: a technical variation.

Rotator interval tear is one of the lesions identified in patients with glenohumeral instability. We present our technique for arthroscopic interval capsule repair. After having performed Bankart reconstruction, we pull the anterosuperior cannula back some millimeters and introduce a Penetrator suture retriever forceps (Arthrex, Naples, FL) through the upper interval capsule into the joint. Then we also remove some millimeters of the anterior cannula and introduce a suture passer (Spectrum; Linvatec, Largo, FL) loaded with a monofilament suture through the lower interval capsule. The suture is pushed into the joint and, using the Penetrator suture retriever forceps, we retrieve it out of the joint. This suture is replaced if desired by a permanent braided suture. Next, a suture passer (Arthrex) advances the end of the suture from the anterosuperior portal into the joint. The suture is retrieved out of the joint from the anterior cannula with a crochet hook. We tie the suture down the anterior cannula to close the anterior capsule. Because we use cannulas, we can use a sliding knot. The degree of tightening can be observed directly under arthroscopic view but the knot is outside of the capsule. We believe that this method is easy, effective, and reproducible.

Extraspinal bone hydatidosis.

BACKGROUND: Bone hydatidosis caused by the tapeworm larva, Echinococcus granulosis, is rare. Extraspinal locations are even rarer. We report our experience with the treatment of twenty-six patients with extraspinal osseous hydatidosis. METHODS: Between 1972 and 1998, we treated twenty-six patients with extraspinal hydatidosis. There were sixteen men and ten women, with a mean age of 51.5 years. The mean duration of follow-up was 12.8 years. The infected area was the ilium in four patients, the ilium and sacral ala in two, the ilium and hip in eight, the femoral head and the acetabular roof in five, the femoral shaft in one, the distal part of the femur in one, the femoral head in one, the scapula in two, and the ribs in two. All patients were treated with curettage or wide resection. Chemotherapy was used in all but five patients. RESULTS: Nineteen patients (73%) were free of disease at the time of the last follow-up. Repeated curettage or wide resection was necessary in nine of these patients; it was required in three of the nine because of surgical wound infection and in six because of recurrence. Of the seven patients who were not free of disease at the time of the last follow-up, six had persistent chronic productive sinuses and one had a chronic wound infection. The cases involving both the ilium and the hip were the most difficult to treat. Radical surgery is difficult in this location, and numerous surgical procedures were always required. CONCLUSIONS: The results of treatment of osseous hydatidosis are satisfactory only in locations where complete and wide excision is possible. In the pelvis and hip, where radical surgery is almost impossible, the results are disappointing.

Outcome and structural integrity of rotator cuff after arthroscopic treatment of large and massive tears with double row technique: a 2-year followup.

Purpose. The purpose of this study was to evaluate the functional outcome and the tendon healing after arthroscopic double row rotator cuff repair of large and massive rotator cuff tears. Methods. 82 patients with a full-thickness large and massive rotator cuff tear underwent arthroscopic repair with double row technique. Results were evaluated by use of the UCLA, ASES, and Constant questionnaires, the Shoulder Strength Index (SSI), and range of motion. Follow-up time was 2 years. Magnetic resonance imaging (MRI) studies were performed on each shoulder preoperatively and 2 years after repair. Results. 100% of the patients were followed up. UCLA, ASES, and Constant questionnaires showed significant improvement compared with preoperatively (P < 0.001). Range of motion and SSI in flexion, abduction, and internal and external rotation also showed significant improvement (P < 0.001). MRI studies showed 24 cases of tear after repair (29%). Only 8 cases were a full-thickness tear. Conclusions. At two years of followup, in large and massive rotator cuff tears, an arthroscopic double row rotator cuff repair technique produces an excellent functional outcome and structural integrity.

The treatment of proximal humerus nonunions in older patients with reverse shoulder arthroplasty.

INTRODUCTION: Experience with treating proximal humeral nonunions with reverse total shoulder arthroplasty is limited. We report our results. PATIENTS: Eighteen patients with proximal humeral atrophic nonunion were treated with reverse total shoulder prosthesis. There were 12 women and 6 men, with a mean age of 78.8 years (range, 75-84 years). The mean follow up after reverse arthroplasty was 28 months (range, 24-32 months). Extensive proximal humeral bone loss that was found in six cases was treated adding a proximal humeral allograft. A long humeral stem was always used. RESULTS: The mean Constant score increased from 26% preoperatively to 55% postoperatively (p <0.0001). The average anterior elevation increased from 35° to 90° (p<0.0001), abduction from 35° to 85° (p<0.0001), external rotation from 15° to 30° (p <0.0001) and internal rotation from 25° to 55° (p <0.0001). The average subjective shoulder score increased from 10% preoperatively to 50% postoperatively (p <0.0001). All but 4 patients would undergo the same procedure again if faced with the same problem. Eight patients were very satisfied, 6 satisfied and 4 unhappy with the operation. We had one case of transitory axillary nerve palsy and two cases of infection. Two prosthetic dislocations occurred; they were successfully treated by revision with a larger polyethylene glenosphere of 44 mm. CONCLUSIONS: Reverse total shoulder arthroplasty improves function and motion in patients with proximal humeral fracture sequelae. However, the rate of dislocation is high.

WITHDRAWN: The treatment of proximal humerus nonunions in older patients with the reverse shoulder arthroplasty.

This article has been withdrawn at the request of the editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy.

Internal fixation and strut allograft augmentation for periprosthetic humeral fractures.

PURPOSE: To report 6 patients with periprosthetic humeral fractures treated with open reduction and internal fixation with plate and strut allograft augmentation. METHODS: 6 women aged 69 to 79 (mean, 73) years underwent open reduction and internal fixation with plate and strut allograft augmentation for periprosthetic humeral fractures (type C) after a fall. They had undergone reverse shoulder arthroplasty for rotator cuff arthropathy. The mean interval between the initial arthroplasty and the fracture was 17 (range, 11-21) months. RESULTS: The mean follow-up period was 14 (range, 12-16) months. The mean time to union was 5.4 (range, 4-6) months. All fractures united without complications. The mean Constant score at the last follow-up was 64 (range, 56-80). The range of shoulder movement and patient satisfaction were restored to pre-fracture status in all patients, except for one who had more pain in the lateral area of the arm (probably because of soft-tissue irritation by the plate and wires). Three patients had evidence of graft-to-host union and 3 others had graft resorption. CONCLUSION: Internal fixation with plate, cable wires and strut allogaft augmentation achieves satisfactory results for periprosthetic humeral fractures.

Role of parenteral iron in the management of anaemia in the elderly patient undergoing displaced subcapital hip fracture repair: preliminary data.

INTRODUCTION: An important percentage of patients affected by hip fracture require the administration of allogenic blood transfusion (ABT) to avoid the risks of perioperative acute anaemia. However, concerns about ABT risks have led to the search for alternatives, especially in elective orthopaedic surgery. MATERIALS AND METHODS: We have prospectively investigated the effect of preoperative intravenous 200-300 mg (group 2; n=20) iron sucrose on ABT requirements and postoperative morbid-mortality in patients undergoing surgery for displaced subcapital hip fracture (DSHF) repair. A previous series of 57 DSHF patients served as the control group (group 1). All patients were older than 65 years, were operated on the 3rd day after admission to the hospital, by the same medical team, and using the same implant. Age, gender, ASA classification, surgical procedure, perioperative haemoglobin, requirements for ABT, postoperative infection, length of hospital stay (LOS) and 30-day mortality rate were examined. RESULTS: No adverse reactions to the iron administration were observed. The iron group had a lower transfusion rate (15% vs 36.8%), lower transfusion index (0.26 vs 0.77 units per patient), lower 30d mortality rate (0 vs 19.3%), shorter LOS (11.9 vs 14.1 days), as well as a trend to a lower postoperative infection rate (15% vs 33%). CONCLUSION: Preoperative parenteral iron administration could be a safe and effective way to reduce the ABT requirements in DSHF patients. This reduction in the ABT requirements is accompanied by a reduction in the morbid-mortality rate and LOS. A large, randomised, controlled trial to confirm these results is warranted.

Treatment of humeral shaft nonunions: nailing versus plating.

INTRODUCTION: The aim of this study was to compare plating and nailing for treating nonunions of the upper two-thirds of the humerus. MATERIALS AND METHODS: Fifty nonunions of the upper two-thirds of the humerus were treated by two different methods: 24 of them by unreamed locked nailing and bone graft (group A), and the other 26 by plate fixation and bone grafting (group B). RESULTS: All fractures healed in both groups. In group A, the time required for healing was 4.2 months (range 4-6 months), whereas in group B it was 4.7 months (range 4-6 months). This difference was statistically significant ( p<0.05). Functional results and the range of motion of the shoulder and elbow were similar with both techniques. In group B there were 3 cases of transient, iatrogenic, radial nerve palsy. CONCLUSIONS: We feel that both plate fixation and the unreamed humeral locked nail are good alternatives for the treatment of humeral shaft nonunions, although nailing achieves union earlier and has fewer complications.

Good results with unreamed nail and bone grafting for humeral nonunion: a retrospective study of 21 patients.

21 patients with humeral shaft nonunions were treated by retrograde nailing with the unreamed humeral nail. In all cases, we reamed the fracture site and performed a bone graft. Union of the fracture occurred in every case. The mean healing time was 4.2 (4-6) months. The range of motion of the shoulder and elbow was excellent in 14 patients, that of the shoulder moderate in 6 and poor in 1, and that of the elbow moderate in 7. The functional results were excellent in 13 patients, good in 5 and fair in 3. Given the good functional results in this series, retr grade locked nailing and bone grafting appears to be a good method for treating humeral shaft nonunions.

Patients with pertrochanteric hip fracture may benefit from preoperative intravenous iron therapy: a pilot study.

BACKGROUND: Patients undergoing pertrochanteric hip fracture (PHF) repair surgery often receive perioperative allogeneic blood transfusions (ABTs) to avoid the deleterious effects of anemia. Nevertheless, concerns about adverse effects of ABTs have prompted the review of transfusion practice and the search for a safer treatment of perioperative anemia. MATERIAL AND METHODS: The effect of preoperative 200 to 300 mg of intravenous (IV; Group 2; n = 55) iron sucrose administration on transfusion requirements and postoperative morbidity-mortality in patients with PHF has been prospectively investigated. A previous series of 102 PHF patients served as the control group (Group 1). All patients were older than 65 years and were operated on at the third day after admission to the hospital, by the same medical team and with the same implant. RESULTS: Iron sucrose was well tolerated and reduced the transfusion rate in patients with admission hemoglobin levels of greater than 120 g per L (p < 0.05) who also received fewer units of red blood cells (p < 0.05). In addition, iron sucrose reduced postoperative infection rate (p < 0.05), but not 30-day mortality rate or mean length of hospital stay. CONCLUSION: The administration of IV iron sucrose seems to reduce ABT requirements in patients with PHF and is associated to lower postoperative morbidity. The possible mechanisms involved in these effects are discussed.