Cooperheller5007

High-energy pilon fractures are challenging for patients and surgeons. Joint-spanning external fixation can be used successfully as temporary stabilization in a staged fashion. Despite this common strategy, there are varying types of external fixator applications. The authors present an efficient and easily reproducible modification to the classic delta frame configuration, which may afford improved fracture reduction and prevent decubitus lesions. [Orthopedics. 2020;43(x)exx-exx.]. Copyright 2020, SLACK Incorporated.Hip arthroscopy for femoral and acetabular pathologies has increased dramatically. However, there is little literature analyzing procedures as predictors of revision arthroscopy or arthroplasty. From February 2008 to November 2015, patients undergoing hip arthroscopy for a labral tear with minimum 2-year follow-up and between 18 and 60 years old were retrospectively reviewed. Those with previous surgeries, Tönnis grade greater than 1, and previous hip conditions were excluded. Follow-up was obtained for 1118 patients (1249 hips; 81.7%) with a mean age of 38.7 years (range, 18.0-60.0 years), mean body mass index of 26.4 kg/m2 (range, 16.3-48.9 kg/m2), and mean follow-up of 50.2 months (range, 24.0-111.9 months). A total of 122 (9.8%) patients converted to total hip arthroplasty (mean, 35.3 months; range, 1.4-95.2 months). Multivariate analysis for predictors of total hip arthroplasty found age at surgery (hazard ratio, 1.064/y; P less then .05), body mass index (nonlinear; P less then .05), labral debridement (HR, 1.558; P=.03), and notchplasty (HR, 2.128; P less then .05), with trochanteric bursectomy (HR, 0.367; P less then .05) identified as associated with higher survivorship. A total of 124 (9.9%) patients underwent revision hip arthroscopy at a mean of 21.7 months (range, 0.10-83.3 months). Apocynin ic50 Multivariate analysis for predictors of revision surgery found workers' compensation (HR, 3.352; P less then .05), capsular repair (HR, 1.950; P less then .05), and femoral head microfracture (HR, 2.844; P=.04) to be significant, with age at date of surgery (HR, 0.973/y; P less then .05) and femoral head chondroplasty (HR, 0.241; P=.05) associated with higher survivorship. Understanding risk factors for conversion to total hip arthroplasty or revision is paramount during discussions with patients. [Orthopedics. 2020;43(x)xx-xx.]. Copyright 2020, SLACK Incorporated.The objective of this study was to develop a risk stratification index (RSI) system to guide intensive care unit (ICU) resource use for elderly patients after hip fracture surgery. The authors' first study cohort consisted of 302 elderly patients with hip fractures who had surgical treatment at their hospital. The authors conducted multivariate logistic regression analysis to investigate relevant risk factors for ICU resource utilization postoperatively. An RSI system was developed based on the significant risk factors from regression analysis. A second study cohort consisted of 205 elderly patients, among whom the authors applied the RSI system to guide ICU resource assignment. Among the first cohort of 302 hip fracture patients, 89 were transferred to ICU postoperatively, of whom 81 were planned to be transferred to ICU and 8 were not. Multivariate stepwise regression analysis revealed that age (≥80 years), preoperative pulmonary disease, perioperative anemia (hemoglobin 2 mmol/L) were independent risk factors for postoperative ICU management. The authors then constructed a weighted RSI with these risk factors. In addition, they manually added American Society of Anesthesiologists classification (III/IV) and types of anesthesia as additional risk factors based on their clinical experience. It was determined that an RSI score greater than 4 required postoperative ICU care. The RSI system was then prospectively applied to an independent cohort of 205 elderly surgical patients with hip fractures, among whom only 40 required ICU care. More importantly, there were no later transfers from the general ward to ICU after the application of RSI. The RSI system is effective for guiding postoperative ICU transfer without compromising patient care and minimizes unexpected transfers from the general ward to the postoperative ICU. [Orthopedics. 2020;43(x)xx-xx.]. Copyright 2020, SLACK Incorporated.This year the medical community was pleasantly surprised by the results of the first large outcome trial that primarily examined the renal effects of the sodium-glucose cotransporter 2 (SGLT2) inhibitor canagliflozin (CANA) in subjects with diabetes and impaired kidney function. The Evaluation of the Effects of Canagliflozin on Renal and Cardiovascular Outcomes in Participants With Diabetic Nephropathy (CREDENCE) trial showed that CANA, relative to placebo, reduces the risk for end-stage renal disease, doubling of creatinine or renal death by 34% [hazard ratio 0.66 (95% confidence interval 0.53-0.81]. These effects were consistent across baseline estimated glomerular filtration rate (eGFR) and haemoglobin A1c subgroups. In this review we combine the results of the CREDENCE trial with those of several cardiovascular outcome trials with SGLT2 inhibitors and show that, unexpectedly, patients with lower eGFR levels may have greater benefit with respect to cardiovascular outcome than patients with normal kidney function. The cardio- and renoprotective effects of SGLT2 inhibitors seem to be independent of their glucose-lowering effects, as shown in several post hoc analyses. In this review we discuss the alleged mechanisms of action that explain the beneficial effects of this novel class of drugs. Moreover, we discuss whether these findings indicate that this class of drugs may also be beneficial in non-diabetic chronic kidney diseases. © The Author(s) 2020. Published by Oxford University Press on behalf of ERA-EDTA.The rationale for using sodium-glucose cotransporter 2 (SGLT2) inhibitors in patients with type 2 diabetes (T2D) has evolved over the last decade. Due to the effects on glucosuria and body weight loss, SGLT2 inhibitors were originally approved for glycemic control in T2D. Since glucosuria is attenuated in chronic kidney disease (CKD) Stages 3-5, initial regulatory approval for SGLT2 inhibitor use was limited to patients with T2D and preserved estimated glomerular filtration rate. Over time, however, it has become increasingly apparent that these therapies have a variety of important pharmacodynamic and clinical effects beyond glycemic lowering, including antihypertensive and antialbuminuric properties, and the ability to reduce glomerular hypertension. Importantly, these sodium-related effects are preserved across CKD stages, despite attenuated glycemic effects, which are lost at CKD Stage 4. With the completion of cardiovascular (CV) outcome safety trials-EMPA-REG OUTCOME, CANVAS Program and DECLARE TIMI-58-in addition to reductions in CV events, SGLT2 inhibition consistently reduces hard renal endpoints.