Bishopberger0879

Femoral neck fractures (FNFs) are one of the most common injuries in the elderly. Treatment is either internal fixation or primary arthroplasty. The main aim of this study is to assess the risk factors associated with fixation failure leading to further arthroplasty in FNFs treated with cannulated screws.

Data on internal fixations of FNFs performed at Turku University Hospital between January 1, 2012 and December 31, 2017 were collected retrospectively from the patient database. Radiographical measurements were performed for preoperative displacement and posterior tilt, postoperative displacement, reduction quality, and implant shaft angle.

Altogether 301 cases were included in the study. The overall reoperation rate was 25% and conversion to arthroplasty was performed in 16% of cases. In the multiple variant analysis, adjusted for age and gender, nondisplaced fractures with a 0°-20° preoperative posterior tilt had a significantly lower risk of later conversion to arthroplasty than did nondisplaced fractures with a ≤0° or ≥20° posterior tilt (odds ratio [OR] 4.0, 95% confidence interval [Cl] 1.8-8.6, P= .0005) and displaced fractures (OR 7.2, 95% CI 3.0-17.4, P < .0001). No statistically significant association was found between preoperatively nondisplaced fractures with a <0° or ≥20° posterior tilt and displaced fractures (OR 0.6, 95% Cl 0.2-1.3,P=.2).

Displaced fractures and fractures with a preoperative posterior tilt of <0° or ≥20° have a considerably increased risk of reoperation and conversion to arthroplasty. Phenol Red sodium Primary arthroplasty should be considered as treatment for displaced FNFs and fractures with >20° or <0° posterior tilt, especially in fragile patients, to avoid further operations.

20° or less then 0° posterior tilt, especially in fragile patients, to avoid further operations.

It is recommended revision for periprosthetic hip fractures (PPHF) with a loose stem. However, several authors have argued that under certain conditions, this fracture could be treated using osteosynthesis. The aim is to compare stem revision versus internal fixation in the treatment of PPHF with a loose stem.

All patients with PPHF with a loose stem treated by osteosynthesis and stem revision between January 2009 and January 2019 were included. We assessed hospital stay, American Society of Anesthesiologists, Charlson comorbidity index, surgery time, blood transfusion, complications, reoperation rate, first-year mortality, radiological, and functional results.

A total of 57 patients were included (40 osteosyntheses and 17 stem revision), with an average follow-up time of 3.1 years. Their mean age was 78.47 years (R 45-92). In the osteosynthesis group, fewer patients required blood transfusion (32.5% vs. 70.6%), surgical times were shorter (108minutes vs. 169minutes), and the cost was lower, both in terms of total cost (€14,239.07 vs. €21,498.45 and operating room cost (€5014.63 vs. €8203.34). No significant differences were found between the groups in terms of complications, reoperation rate, or functional outcomes.

Compared with stem revision, osteosynthesis requires less surgery time, has a lower need for blood transfusions, and a reduced hospital cost. Stem revision remains the treatment of choice in PPHF with a loose stem, but in V-B2 fractures in elderly patients with low functional demand, high anesthetic risk (American Society of Anesthesiologists ≥3), and many comorbidities (Charlson comorbidity index ≥5) in whom anatomic reconstruction is possible, osteosynthesis can be a viable option.

Historical cohorts. Level III.

Historical cohorts. Level III.

The optimal length of aspirin prophylaxis to minimize venous thromboembolism (VTE) following total knee arthroplasty (TKA) remains unknown. This study aimed to determine the timing of VTE after TKA in patients who received low and high dose aspirin, and determine if 30 days of prophylaxis remains adequate.

We retrospectively reviewed records of 9208 patients undergoing primary TKA between 2010 and 2020 who received either low (81 mg twice daily, n= 4413) or high (325 mg twice daily, n= 4795) dose aspirin for VTE prophylaxis. Symptomatic VTEs occurring within 90 days of surgery were identified from medical records and phone call logs. Major bleeding events (MBE) within the first 30 days were also documented. Time to event was recorded.

Overall, 88 patients (1.0%) developed symptomatic VTE, with no significant differences in incidence between the low (n= 40, 0.9%) and high (n= 48, 1.0%) dose groups (P= .669). The median time to VTE was 8 days (interquartile range [IQR] 2-15.5), median time to deep vein thrombosis was 12 days (IQR 5-18), and median time to pulmonary embolism was 5 days (IQR 1.5-15). There was a similar distribution in time to VTE in both the low and high dose groups. Aside from a single DVT occurring at day 44, all VTE occurred within 30 days of surgery. During the prophylactic time period, 41 patients (0.4%) developed MBE, which tended to occur more frequently (0.6% vs 0.3%, P= .018) and earlier in the high dose group.

Based on the findings, a 30-day low or high dose aspirin regimen remains optimal for prevention of VTE without increasing MBE in TKA patients.

Based on the findings, a 30-day low or high dose aspirin regimen remains optimal for prevention of VTE without increasing MBE in TKA patients.Over the past decade, there have been important breakthroughs in our understanding of the regulation and function of sex hormone-binding globulin (SHBG). A recent genome-wide association and Mendelian randomization study has provided new insights at the population level. Thorough study of genetic variants affecting serum SHBG has identified de novo lipogenesis as one of the mechanistic links between the metabolic syndrome and reduced serum SHBG levels in humans. Furthermore, careful deduction of the Mendelian randomization results suggests a direct, causal role for SHBG in the pathogenesis of type 2 diabetes, as a hepatokine, in women. These findings prompt the development of SHBG-raising therapies as a means to prevent or treat disorders such as type 2 diabetes and polycystic ovary syndrome.