The purpose of this retrospective cohort study was to evaluate whether there is an increased rate of short-term medical complications following short vs long cephalomedullary nails for the treatment of intertrochanteric hip fractures. A total of 899 patients treated surgically with cephalomedullary nails from January 1, 2005, to September 1, 2014, were included. Patients who received short nails (n=334) were older and had a higher incidence of coronary artery disease and diabetes mellitus compared with patients who received long nails (n=565). The incidences of 30-day medical complications, including myocardial infarction, stroke, deep venous thrombosis, pulmonary embolism, blood transfusion, non-surgical site infection, surgical site infection, and mortality, were recorded. The orthopedic complications of periprosthetic fracture of the ipsilateral hip and implant failure through the latest outpatient follow-up were recorded. No significant difference was found between nails for any studied medical complication (63.5% short vs 66.0% long, P=.4393) or mortality (6.9% short vs 5.3% long, P=.3322). There was also no significant difference in the incidence of orthopedic complications (P=.70). Longer operating room time was associated with superficial surgical site infection. [Orthopedics. 2018; 41(5):e636-e642.].
In the Special Administrative Region of Hong Kong, a former British territory in southern China returned to the People’s Republic as a semi-autonomous enclave in 1997, media capture has distinct characteristics. On one hand, Hong Kong offers a case of media capture in an uncensored media sector and open market economy similar to those of Western industrialized democracies. Yet Hong Kong’s comparatively small size, close proximity, and broad economic exposure to the authoritarian markets and politics of neighboring Mainland China, which practices strict censorship, place unique pressures on Hong Kong’s nominally free press. Building on the literature on media and politics in Hong Kong post-handover and drawing on interviews with journalists in Hong Kong, this article examines the dynamics of media capture in Hong Kong. It highlights how corporate-owned legacy media outlets are increasingly deferential to the Beijing government’s news agenda, while social media is fostering alternative spaces for more skeptical and aggressive voices. This article develops a scholarly vocabulary to describe media capture from the perspective of local journalists and from the academic literature on media and power in Hong Kong and China since 1997.
To examine if rates of appropriate thromboprophylaxis prescribing at the time of discharge would be higher in patients admitted to the orthopaedic service. Second, to see if improvements could be made in the rates of these missed events after a structured intervention.Retrospective Cohort Study, Prospective Interventional.Level 1 Academic Hospital.Two hundred forty-six patients undergoing a hip hemiarthroplasty for femoral neck fracture discharged to an extended care facility.A letter was sent to the internal quality control committee detailing our preintervention study.We looked at the differences among admitting services for missed thromboembolic prophylaxis (TPx) at the time of hospital discharge and rates of appropriate TPx after a structured intervention.No statistically significant differences existed in relation to patient age, gender, body mass index, or postoperative discharge day in the preintervention group. Orthopaedic surgery prescribed adequate TPx at discharge for 76 of 77 patients (98.7%), general trauma surgery for 26 of 30 patients (86.7%), and internal medicine for 85 of 96 patients (86.7%) in the preintervention group. There was a statistically significant difference when comparing adequate TPx between orthopaedic surgery and other services (P < 0.013 and <0.021, respectively). Our postintervention data found a significant decrease in the rates of missed TPx on discharge. In our preintervention sample group compared with our postintervention sample group, we saw a decrease in missed TPx of 5/39 versus 0/43 events (P = 0.021).We found that a letter sent to all members of a hospital internal quality committee decreased incidences of missed TPx. Specifically, this letter explained the details of our study that kept track of rates of missed TPx among different admitting services. We found that after our intervention, which consisted of a letter and a multidisciplinary discussion, the rate of missed thromboembolic prophylaxis events improved from 5/39 (12%) to 0/43 (0%) (P = 0.021).Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
The objective of this study was to determine the predictive value of tip-apex distance (TAD) and Parker's ratio for screw cutout after treatment of intertrochanteric hip fractures with a long cephalomedullary nail. A total of 97 patients with AO/OTA 31-A1-A3 intertrochanteric fractures and a minimum follow-up of 8 weeks were included. Increased Parker's ratio on the anteroposterior radiograph (OR = 1.386, p < .003) and lateral radiograph (OR = 1.138, p < .028) was significantly associated with screw cutout. In a multivariable regression analysis, only the Parker's anteroposterior ratio was significantly associated with risk of screw cutout (OR = 1.393, p = .004), but TAD (OR = 0.977, p = .764) and Parker's lateral ratio (OR 1.032, p = .710) were not independent predictors of cutout. The study concluded that Parker's anteroposterior ratio is the most helpful measurement in predicting screw cutout. (Journal of Surgical Orthopaedic Advances 28(2):115-120, 2019).
Background The purpose of this study was to investigate the stability of dual-taper modular hip implants following impaction forces delivered in varying directions as measured by the distraction forces required to disassemble the components.
Methods Distraction of the head-neck and neck-stem tapers of dual-taper modular implants with 0°, 8°, and 15° neck angles were measured utilizing a custom-made distraction fixture attached to a servohydraulic materials test machine. Distraction was measured after hand-pressing the components as well as following a simulated firm hammer blow impaction. Impacts to the 0°, 8°, 15° necks were directed axially in-line with the neck, 10° anterior, and 10° proximal to the axis of the neck, respectively.
Results Distraction forces required to disassemble the neck-stem taper were significantly higher following impaction (1125- 1743 N) when compared to hand pressed assembly (248–302 N). Off-axis impacts resulted in significantly reduced mean (±95% CI) distraction forces (8° neck = 1125 ±117 N; 15° neck = 1212 ±73 N), which were up to 35% lower than the mean distraction force for axial impacts to the 0° neck (1743 ±138 N).
Conclusion The direction of impaction has a significant effect on the stability of dual taper modular implants, measured by the component distraction force. Greatest stability at the modular interface was achieved with impaction directed in line with the longitudinal axis of the taper junction. Off axis impaction of the 8° and 15° neck led to significantly reduced stability at the neck-stem junction.
Chronic kidney disease (CKD) is a documented risk factor for hip fracture mortality. CKD represents a spectrum of disease and there is no clear evidence differentiating the risk between patients with early versus end-stage CKD. The purpose of this study was to explore the relationship between the stages of CKD and mortality following operative treatment of hip fractures. Four hundred ninety-eight patients were analyzed; 81 were identified as having CKD. This study followed overall patient mortality at 90 days and at 1 year postoperatively. Patients with CKD had higher mortality at both 90 days and 1 year compared with those without CKD (hazard ratio 1.69 and 1.84, respectively). In a subgroup analysis to determine the effect of CKD stage, only stage 3 CKD was associated with increased mortality. The orthopaedic surgeon can play a key role in identifying at-risk patients and help to facilitate additional management. (Journal of Surgical Orthopaedic Advances 27(3):226-230, 2018).
The purpose of this study was to investigate the stability of dual-taper modular implants following impaction forces delivered at varying locations as measured by the distraction forces required to disassemble the components.Distraction of the head-neck and neck-stem (NS) tapers of dual-taper modular implants with 0°, 8°, and 15° neck angles were measured utilizing a custom-made distraction fixture attached to a servohydraulic materials test machine. Distraction was measured after hand pressing the components as well as following a simulated firm hammer blow impaction. Impacts to the 0°, 8°, 15° necks were directed axially in line with the neck, 10° anterior, and 10° proximal to the axis of the neck, respectively.Impaction increased the range of NS component distraction forces when compared to hand pressed components (1125-1743 N vs 248-302 N, respectively). Off-axis impacts resulted in significantly reduced mean (±95% confidence interval) distraction forces (8° neck, 1125 ± 117 N; 15° neck, 1212 ± 73 N), which were up to 35% lower than the mean distraction force for axial impacts to the 0° neck (1743 ± 138 N).Direction of impaction influences stability of the modular interface. The greatest stability was achieved with impaction directed in line with the longitudinal axis of the taper junction. Off-axis impaction of the 8° and 15° neck led to significantly reduced stability at the NS. Improving stability of dual-taper modular hip prostheses with appropriately directed impaction may help to minimize micromotion, component settling, fretting corrosion, and subsequent failure.
There is concern that the direct anterior (DA) approach is associated with a steeper learning curve than the posterolateral (PL) approach in total hip arthroplasty (THA). The purpose of this study was to investigate if the learning curve is similar for newly trained arthroplasty fellowship-trained surgeons using the DA and PL approaches.
