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Neumann CJ, Kaiser TD, Smektala R. Anticoagulant Medication in Endoprosthetically Treated Proximal Femur Fracture - Complications and Mortality Considering the Time of Treatment as a Quality Criterion. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2024. [PMID: 38889762 DOI: 10.1055/a-2324-1877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Abstract
There is an international debate on the optimal time to surgery following hip fracture in older patients. Pre-existing anticoagulation seems to be a major concern when it comes to a delay in operative fracture treatment. The aim of this study was to examine complication and mortality rates for elderly anticoagulated hip fracture patients considering early (< 24 h) vs. delayed (> 24 h) surgery.Our Analysis is based on data of the external inpatient quality assurance of North Rhine Westphalia as the most populous German federal state. We identified 13,201 hip fracture patients with antithrombotic medication and a minimum age of 65 years treated from January 2015 to December 2017.Delayed surgery was associated with significantly higher rates of general and surgical complications as well as mortality. Except for pre-existing heart failure, we were not able to identify certain comorbidities that could clearly indicate, why there might have been a delay.In most cases, patients with antithrombotic medication have a poor outcome to be expected due to serious comorbidity. If there was a delay in surgery for those patients, treatment results were even worse. Thus, surgery with a delay of > 24 h must be avoided to reduce the risk of complications.
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Affiliation(s)
- Christoph Johannes Neumann
- Klinik für Unfallchirurgie und Orthopädie, Universitätsklinikum Knappschaftskrankenhaus Bochum GmbH, Bochum, Deutschland
| | - Tim Dario Kaiser
- Klinik für Unfallchirurgie und Orthopädie, Universitätsklinikum Knappschaftskrankenhaus Bochum GmbH, Bochum, Deutschland
| | - Rüdiger Smektala
- Knappschaftskrankenhaus Bochum Langendreer Orthopädie und Unfallchirurgie, Universitätsklinikum der Ruhr-Universität Bochum, Bochum, Deutschland
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Steffann F, Rubens-Duval B, Huten D. Should trochanteric fractures in elderly patients be treated by arthroplasty or internal fixation? Orthop Traumatol Surg Res 2024; 110:103778. [PMID: 38040114 DOI: 10.1016/j.otsr.2023.103778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 03/27/2023] [Indexed: 12/03/2023]
Abstract
Most trochanteric fractures are treated by fixation, most often intramedullary. Nevertheless, the desire to have patients walk as soon as possible and the fear of fixation failure has driven some surgeons to carry out an arthroplasty instead, especially for unstable fractures and/or in patients with severe osteoporosis, in order to avoid the difficult conversion to arthroplasty later on if the fixation fails. The aim of this review was to specify the role, technique and results of performing arthroplasty in this context. In which fractures? Unstable fractures (A2.2, A2.3 and A3), especially in osteoporotic bone, which are the most difficult to reduce and fix, and in cases with associated osteoarthritis. For which patients? Arthroplasty should not be done in patients who have ASA≤3 due to greater blood loss and longer operative time. Since the postoperative Parker score often drops, arthroplasty should not be done in patients having a Parker score<6. What are the technical problems? Arthroplasty must be done by an experienced surgeon because of the lack of anatomical landmarks, although fracture fixation has its own demands (satisfactory reduction, appropriate length and position of cervicocephalic screw). What are the results and complications? Despite several comparative studies (randomized trials, meta-analysis and prospective studies), it is difficult to draw any conclusions. These studies show worse performance of dynamic hip screws relative to intramedullary nails. The complication and revision rates were higher for nails than arthroplasty, but not in every study, while the functional outcomes with nails (with or without immediate weightbearing) were better than those of arthroplasty beyond 6 months. What is the mortality rate? It was lower after nailing in a few studies but was mainly determined by the patient's comorbidities and preoperative Parker score. The best indication for arthroplasty may be self-sufficient patients over 70 years of age who have an unstable fracture with severe osteoporosis. Nevertheless, new studies should be done to compare arthroplasty to nailing with immediate return to weightbearing in patients having the same type of fracture, defined using 3D CT scan. Level of evidence: Expert advice.
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Affiliation(s)
- François Steffann
- Clinique des Cèdres, 5, rue des Tropiques, Parc sud Galaxie, 38130 Échirolles, France.
| | - Brice Rubens-Duval
- Service de chirurgie de l'arthrose et du sport, urgences traumatiques des membres, hôpital Sud, CHU de Grenoble-Alpes, avenue de Kimberley, 38130 Échirolles, France
| | - Denis Huten
- Service de chirurgie orthopédique et réparatrice, hôpital Pontchaillou, CHU de Rennes, 2, rue H.-Le-Guilloux, 35000 Rennes, France
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Garcia-Barreiro G, Huespe I, Llano L, Dozo M, Benchimol JA, Rebecchi P, Taype D, Barla J, Sancineto C, Carabelli G. Patients with trochanteric hip fractures and pre-existing osteoarthritis can be treated with nailing osteosynthesis without significant decrease in functional status. Injury 2023; 54 Suppl 6:110735. [PMID: 38143114 DOI: 10.1016/j.injury.2023.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 03/25/2023] [Accepted: 04/12/2023] [Indexed: 12/26/2023]
Abstract
PURPOSE Functional outcome in patients after trochanteric fracture fixation with pre-existing radiographic osteoarthritis (OA) is unclear. Analyzing their function and independence, before and after fracture, could optimize their treatment and decrease the socioeconomic burden in this particular group. METHODS The influence of pre-existing radiographic hip OA on functional outcome was retrospectively analyzed with a cohort of patients undergoing proximal femoral nailing for trochanteric fracture. OA was graded according to the Tonnis classification. Functional outcome was assessed preoperatively and 12 months after surgery by the Parker Mobility Score (PMS). We consider a meaningful reduction a difference between preoperatively PMS and 12 months after surgery ≥ 2. In order to evaluate if OA is related to PMS reduction ≥ 2, we calculate the SubHazard ratio (SHR) performing a competing risk regression model considering death as a competing risk event, adjusting by confounders. Death, reoperations, readmissions, surgical time, and fracture reduction quality in patients with and without osteoarthritis were recorded. RESULTS 375 trochanteric hip fractures treated with cephalomedullary nails were included, from which 80 (21% CI95% 17%-21%) were classified as Tonnis 2 or 3. This group of patients with pre-existing OA was significantly older (mean age of 88.6 [SD 5.65] vs 85.5 years [SD 6.95]) than the group without OA. The preoperatively PMS score was 6.28 (2.71) in non-OA patients and 5.69 (2.67) in OA patients. The mean PMS reduction 12 months after surgery was 1.3 (SD 2.05) in OA patients and 1.07 (SD 2.2) in non-OA patients (p = 0.43). Competing risks analysis, adjusted by confounders had an SHR of 1.15 (IC95% 0.77 - 1.69). Death, readmission, reoperations, surgical time, and fracture reduction quality did not differ in both groups. CONCLUSIONS Patients with pre-existing radiographic OA treated with femoral nailing have a similar reduction in functional outcomes compared to the non-OA group at one-year follow-up. Further studies will be needed to compare the results of the functional outcome in arthroplasty with those of femoral nailing for the treatment of trochanteric femur fractures in patients with OA.
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Affiliation(s)
- Gonzalo Garcia-Barreiro
- Orthopaedic Surgery Department, Hospital Italiano de Buenos Aires, Buenos Aires C1199ABB, Argentina.
| | - Ivan Huespe
- Orthopaedic Surgery Department, Hospital Italiano de Buenos Aires, Buenos Aires C1199ABB, Argentina.
| | - Lionel Llano
- Orthopaedic Surgery Department, Hospital Italiano de Buenos Aires, Buenos Aires C1199ABB, Argentina.
| | - Marcelo Dozo
- Orthopaedic Surgery Department, Hospital Italiano de Buenos Aires, Buenos Aires C1199ABB, Argentina
| | - Javier Alberto Benchimol
- Orthopaedic Surgery Department, Hospital Italiano de Buenos Aires, Buenos Aires C1199ABB, Argentina
| | - Pilar Rebecchi
- Orthopaedic Surgery Department, Hospital Italiano de Buenos Aires, Buenos Aires C1199ABB, Argentina.
| | - Danilo Taype
- Orthopaedic Surgery Department, Hospital Italiano de Buenos Aires, Buenos Aires C1199ABB, Argentina.
| | - Jorge Barla
- Orthopaedic Surgery Department, Hospital Italiano de Buenos Aires, Buenos Aires C1199ABB, Argentina.
| | - Carlos Sancineto
- Orthopaedic Surgery Department, Hospital Italiano de Buenos Aires, Buenos Aires C1199ABB, Argentina.
| | - Guido Carabelli
- Orthopaedic Surgery Department, Hospital Italiano de Buenos Aires, Buenos Aires C1199ABB, Argentina.
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Lambers AP, D'Alessandro P, Yates P. Defining Cephalomedullary Nail Breakage Rates: A Systematic Review and Meta-Analysis. J Orthop Trauma 2023; 37:S33-S40. [PMID: 37710373 DOI: 10.1097/bot.0000000000002673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/11/2023] [Indexed: 09/16/2023]
Abstract
OBJECTIVE To establish the background rate of breakage of cephalomedullary nails. DATA SOURCES MEDLINE, PubMed, and Web of Science were searched on April 3, 2023. STUDY SELECTION All English-language studies that examined trochanteric with or without subtrochanteric fractures and identified cephalomedullary nail breakage as an outcome measure and a breakage rate could be derived were included. Implants captured were predominantly the TFNA, TFN, and PFN by DePuy Synthes, various versions of the Gamma nail by Stryker, the Zimmer Natural Nail by Zimmer Biomet, and the Intertan by Smith and Nephew. DATA EXTRACTION The author, year of publication, dates of implant insertion, study design, method of detection of breakages, implant used, number of implant breakages, number of implants inserted, breakage rate, and follow-up were extracted. DATA SYNTHESIS Meta-analysis of included studies used descriptive nonparametric statistics and a noncomparative proportion for the pooled result. Differences in results between study design types were compared using the mean breakage rate per study design. CONCLUSIONS Cephalomedullary nail breakage is a rare complication with a median reported rate of 0.6% and a pooled result rate of 0.4%. Ninety-five percent of studies had a breakage rate of 1.3% or less, which sets a benchmark from the reported literature for future studies. There is wide variability in rates of breakage reported between different types of study designs with single-center review studies reporting breakage rates nearly 4-fold greater than large-scale administrative database reviews. The rate of implant breakage should not be used in isolation to judge an implant's performance. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Anton Philip Lambers
- Division of Surgery, Medical School, The University of Western Australia, Perth, Western Australia, Australia
- Department of Traumatology and Orthopaedic Surgery, Fiona Stanley Hospital, Perth, Western Australia, Australia; and
| | - Peter D'Alessandro
- Division of Surgery, Medical School, The University of Western Australia, Perth, Western Australia, Australia
- Department of Traumatology and Orthopaedic Surgery, Fiona Stanley Hospital, Perth, Western Australia, Australia; and
- Orthopaedic Research Foundation Western Australia (ORFWA), Claremont, Western Australia, Australia
| | - Piers Yates
- Division of Surgery, Medical School, The University of Western Australia, Perth, Western Australia, Australia
- Department of Traumatology and Orthopaedic Surgery, Fiona Stanley Hospital, Perth, Western Australia, Australia; and
- Orthopaedic Research Foundation Western Australia (ORFWA), Claremont, Western Australia, Australia
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Zhao H, Deng X, Liu W, Chen W, Wang L, Zhang Y, Wang Z, Wang Y, Lian X, Hou Z, Zhang Q, Zhang Y. Proximal femoral bionic nail (PFBN)-an innovative surgical method for unstable femoral intertrochanteric fractures. INTERNATIONAL ORTHOPAEDICS 2023; 47:1089-1099. [PMID: 36719445 DOI: 10.1007/s00264-023-05696-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 01/07/2023] [Indexed: 02/01/2023]
Abstract
PURPOSE Intertrochanteric femoral fractures (IFF) are one of the most common traumatic conditions, but there are no established treatment methods for this condition due to implant failure and re-operation rates. The proximal femoral bionic nail (PFBN), which is a new design of the cephalomedullary nail, was developed by our team. The objective of this study was to assess the clinical and radiographic outcomes of PFBN in patients with unstable IFF. METHODS From October 2020 to August 2021, 12 patients diagnosed with unstable IFF (31-A2, 3) were treated with PFBN at the Third Hospital of Hebei Medical University. We evaluated the clinical therapeutic effects of this treatment by measuring peri-operative indicators and post-operative complications. Clinical outcomes, specific radiographic parameters, and post-operative complications were collected and analyzed within the first post-operative year. RESULTS The average age of the patients was 72.4 ± 16.1 years (five males and seven females). The mean operation time was 90.4 ± 16.0 min, whereas the operation time of 31-A2 fractures (83.1 ± 12.2 min) was shorter than that of 31-A3 fractures (105.0 ± 12.9 min) (p < 0.05). The blood loss was 175 ml (range: 50 to 500 ml), and the length of hospitalization was 10.0 ± 1.9 days. The prognosis evaluation was assessed at three, six and 12 months after the operation; for these time points, the Harris hip scores were 69.6 ± 4.1, 77.8 ± 3.8, and 82.6 ± 4.6, respectively, and the Parker-Palmer scores were 5.3 (5.0, 7.0), 6.3 (5.3, 7.0), and 7.8 (7.0, 8.0), respectively. CONCLUSION PFBN has shown advantages in the treatment of unstable IFF (particularly in geriatric patients) and possesses both stability and safety. This innovative method may provide a new option for treating unstable IFFs.
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Affiliation(s)
- Haiyue Zhao
- School of Medicine, Nankai University, Tianjin, 300071, China
| | - Xiangtian Deng
- Trauma Medical Center, Department of Orthopedics Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Weijian Liu
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Wei Chen
- Department of Orthopedic Surgery of Hebei Province, Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, China
| | - Lei Wang
- School of Medicine, Nankai University, Tianjin, 300071, China
| | - Yiran Zhang
- School of Medicine, Nankai University, Tianjin, 300071, China
| | - Zhongzheng Wang
- Department of Orthopedic Surgery of Hebei Province, Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, China
| | - Yuchuan Wang
- Department of Orthopedic Surgery of Hebei Province, Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, China
| | - Xiaodong Lian
- Department of Orthopedic Surgery of Hebei Province, Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, China
| | - Zhiyong Hou
- Department of Orthopedic Surgery of Hebei Province, Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, China
| | - Qi Zhang
- Department of Orthopedic Surgery of Hebei Province, Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, China.
| | - Yingze Zhang
- Department of Orthopedic Surgery of Hebei Province, Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, China.
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Jäger M, Portegys E, Busch A, Wegner A. [Femoral neck fractures]. ORTHOPADIE (HEIDELBERG, GERMANY) 2023; 52:332-346. [PMID: 36867225 DOI: 10.1007/s00132-023-04364-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/20/2023] [Indexed: 03/04/2023]
Abstract
Femoral neck fractures (FNF) are the most frequent fractures in the older population and are also of high socioeconomic importance due to the high risk of mortality. The diagnostics are based on the clinical examination and imaging procedures. The classification systems used in the routine clinical practice are oriented towards the prognosis and are therefore a valuable aid in making decisions for the selection of the treatment procedure. Early surgery is decisive for the success of treatment. Older patients (> 60 years) with arthritically damaged hips and a high degree of fracture dislocation benefit from prompt hip replacement (bipolar systems, total hip arthroplasty, dual mobility systems). In contrast, joint-preserving surgery by osteosynthesis is indicated in younger patients with a low degree of dislocation. This article summarizes the clinically relevant aspects of FNF and gives an overview of current treatment strategies with inclusion of the scientific literature.
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Affiliation(s)
- M Jäger
- Lehrstuhl für Orthopädie und Unfallchirurgie, University of Duisburg-Essen, Kaiserstr. 50, 45468, Mülheim a. d. R., Deutschland.
- Department of Orthopaedics, Trauma and Reconstructive Surgery, St. Marien Hospital Mülheim a. d. Ruhr, Kaiserstr. 50, 45468, Mülheim a. d. R., Deutschland.
- Klinik für Orthopädie, Unfall- und Wiederherstellungschirurgie, Katholisches Klinikum Essen Philippus-Stift, Hülsmannstr. 17, 45355, Essen, Deutschland.
| | - E Portegys
- Department of Orthopaedics, Trauma and Reconstructive Surgery, St. Marien Hospital Mülheim a. d. Ruhr, Kaiserstr. 50, 45468, Mülheim a. d. R., Deutschland
| | - A Busch
- Klinik für Orthopädie, Unfall- und Wiederherstellungschirurgie, Katholisches Klinikum Essen Philippus-Stift, Hülsmannstr. 17, 45355, Essen, Deutschland
| | - A Wegner
- Lehrstuhl für Orthopädie und Unfallchirurgie, University of Duisburg-Essen, Kaiserstr. 50, 45468, Mülheim a. d. R., Deutschland
- Klinik für Unfallchirurgie, Orthopädie, Handchirurgie, Klinikum Wolfsburg, Sauerbruchstr. 7, 38440, Wolfsburg, Deutschland
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Mortality and Complications Following Early Conversion Arthroplasty for Failed Hip Fracture Surgery. J Arthroplasty 2022; 38:843-848. [PMID: 36496047 DOI: 10.1016/j.arth.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 11/29/2022] [Accepted: 12/02/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Hip fracture in older patients leads to high morbidity and mortality. Patients who are treated surgically but fail acutely face a more complex operation with conversion total hip arthroplasty (THA). This study investigated mortalities and complications in patients who experienced failure within one year following hip fracture surgery requiring conversion THA. METHODS Patients aged 60 years or more undergoing conversion THA within one year following intertrochanteric or femoral neck fracture were identified and propensity-matched to patients sustaining hip fractures treated surgically but not requiring conversion within the first year. Patients who had two-year follow-up (91 conversions; 247 comparisons) were analyzed for 6-month, 12-month, and 24-month mortalities, 90-day readmissions, surgical complications, and medical complications. RESULTS Nonunion and screw cutout were the most common indications for conversion THA. Mortalities were similar between groups at 6 months (7.7% conversion versus 6.1% nonconversion, P = .774), 12 months (11% conversion versus 12% nonconversion, P = .999), and 24 months (14% conversion versus 22% nonconversion, P = .163). Survivorships were similar between groups for the entire cohort and by fracture type. Conversion THA had a higher rate of 90-day readmissions (14% versus 3.2%, P = .001), and medical complications (17% versus 6.1%, P = .006). Inpatient and 90-day orthopaedic complications were similar. CONCLUSION Conversion THA for failed hip fracture surgery had comparable mortality rates to hip fracture surgery, with higher rates of perioperative medical complications and readmissions. Conversion THA following hip fracture represents a potential "second hit" that both surgeons and patients should be aware of with initial decision-making.
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Jiang L, Zhou X, Xu K, Hu P, Bao J, Li J, Zhu J, Wu L. miR-7/EGFR/MEGF9 axis regulates cartilage degradation in osteoarthritis via PI3K/AKT/mTOR signaling pathway. Bioengineered 2021; 12:8622-8634. [PMID: 34629037 PMCID: PMC8806962 DOI: 10.1080/21655979.2021.1988362] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Osteoarthritis (OA) is a common degenerative disease in middle-aged and elderly people. Our previous study has proved that microRNA-7 (miR-7) exacerbated the OA process. This study was aimed to explore the downstream genes and mechanism regulated by miR-7 to affect OA. Multiple EGF-like-domains 9 (MEGF9) was the predicted target of miR-7 by databases. Luciferase report experiment results confirmed that MEGF9 could bind to miR-7. Among the 10 collected pairs of OA and healthy samples, the expression levels of miR-7 and MEGF9 were both up-regulated when compared with healthy subjects by qRT-PCR and immunohistochemistry (IHC). The increased MEGF9 levels were due to the interaction with epidermal growth factor receptor (EGFR) by co-immunoprecipitation. Evaluations found that upregulation of miR-7 or MEGF9 can increase the expression of EGFR, matrix metalloproteinase-13 (MMP-13) and a disintegrin like and metallopeptidase with thrombospondin type 1 motif 5 (ADAMTS-5), so as to aggravate cartilage degradation. In addition, this effect induced by miR-7/EGFR/MEGF9 axis was by activation of PI3K/AKT signaling. The IHC and western blot assay results on OA model mice also demonstrated that miR-7/EGFR/MEGF9 axis regulated cartilage degradation in vivo. In summary, miR-7/EGFR/MEGF9 axis may perform a crucial function in the regulation of OA, providing potential for OA treatment.
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Affiliation(s)
- Lifeng Jiang
- Department of Orthopedics Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xindie Zhou
- Department of Orthopedics, The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Changzhou, China
| | - Kai Xu
- Department of Orthopedics Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Pengfei Hu
- Department of Orthopedics Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jiapeng Bao
- Department of Orthopedics Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jin Li
- Department of Orthopedics Surgery, The Second Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Junfeng Zhu
- Department of Orthopedics Surgery, Suichang Branch of the Second Affiliated Hospital, Zhejiang University School of Medicine (Suichang County People's Hospital in Zhejiang Province), Suichang, LiShui, China
| | - Lidong Wu
- Department of Orthopedics Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Fletcher JWA, Sommer C, Eckardt H, Knobe M, Gueorguiev B, Stoffel K. Intracapsular Femoral Neck Fractures-A Surgical Management Algorithm. ACTA ACUST UNITED AC 2021; 57:medicina57080791. [PMID: 34440996 PMCID: PMC8400014 DOI: 10.3390/medicina57080791] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 07/28/2021] [Accepted: 07/28/2021] [Indexed: 01/04/2023]
Abstract
Background and Objectives: Femoral neck fractures are common and constitute one of the largest healthcare burdens of the modern age. Fractures within the joint capsule (intracapsular) provide a specific surgical challenge due to the difficulty in predicting rates of bony union and whether the blood supply to the femoral head has been disrupted in a way that would lead to avascular necrosis. Most femoral neck fractures are treated surgically, aiming to maintain mobility, whilst reducing pain and complications associated with prolonged bedrest. Materials and Methods: We performed a narrative review of intracapsular hip fracture management, highlighting the latest advancements in fixation techniques, generating an evidence-based algorithm for their management. Results: Multiple different fracture configurations are encountered within the category of intracapsular hip fractures, with each pattern having different optimal surgical strategies. Additionally, these injuries typically occur in patients where further procedures due to operative complications are associated with a considerable increase in mortality, highlighting the need for choosing the correct index operation. Conclusions: Factors such as pathological causes for the fracture, pre-existing symptomatic osteoarthritis, patient’s physiological age and fracture displacement all need to be considered when choosing optimal management.
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Affiliation(s)
- James W. A. Fletcher
- AO Research Institute Davos, 7270 Davos, Switzerland;
- Department for Health, University of Bath, Bath BA2 7AY, UK
- Correspondence:
| | | | - Henrik Eckardt
- University Hospital Basel, 4052 Basel, Switzerland; (H.E.); (K.S.)
| | - Matthias Knobe
- Department of Orthopaedics and Trauma Surgery, Lucerne Cantonal Hospital, 6000 Lucerne, Switzerland;
| | | | - Karl Stoffel
- University Hospital Basel, 4052 Basel, Switzerland; (H.E.); (K.S.)
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Martinho T, Stoffel K. Treatment of Intertrochanteric Femur Fractures with Hip Arthroplasty in Older Patients: A Narrative Review of Indications and Outcomes. MEDICINA-LITHUANIA 2021; 57:medicina57080763. [PMID: 34440969 PMCID: PMC8400749 DOI: 10.3390/medicina57080763] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 07/26/2021] [Indexed: 12/28/2022]
Abstract
Intertrochanteric femur fractures are common in older patients and often have a significant impact on disability. The treatment aims to achieve a rapid return to the prior functional level with a low rate of complications and mortality. Surgical management by internal fixation is the mainstay of treatment for most of these fractures. Even when treated with intramedullary nails, the overall complication rates are high, especially for unstable or highly comminuted fractures or in the presence of poor bone quality. Hip arthroplasty is an alternative in older patients with intertrochanteric femur fractures at high risk of fixation failure or with concomitant intraarticular pathologies. Especially patients whose condition precludes prolonged bedrest and who are at risk of significant deterioration if their locomotor function cannot be restored rapidly are likely to benefit from hip arthroplasty. The choice of the surgical technique mainly depends on the surgeon’s preferences and the fracture characteristics. Bipolar hemiarthroplasty is the most common type of prosthesis used with primary or revision femoral stems. Compared with intramedullary nails, hip arthroplasty has a better early functional outcome and lower rates of surgical complications as well as reoperations. However, the functional outcome and the mortality rate in the longer term tend to favor intramedullary nails, even though the results are inconsistent, and a statistically significant difference cannot always be obtained. Currently, there are no guidelines that define the role of hip arthroplasty in the treatment of intertrochanteric femur fractures in older patients. The literature only offers an overview of the possibilities of the usage of hip arthroplasty, but methodological limitations are common, and evidence levels are low. Further studies are needed to identify the intertrochanteric fractures that are at high risk of internal fixation failure, the characteristics that determine which patients may benefit most from hip arthroplasty, and the optimal surgical technique.
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Affiliation(s)
- Tiago Martinho
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Street 22, 81675 Munich, Germany;
- Division of Orthopedics and Trauma Surgery, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland
| | - Karl Stoffel
- Department of Orthopaedics and Traumatology, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
- Correspondence:
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Management of subtrochanteric fractures by nail osteosynthesis: a review of tips and tricks. INTERNATIONAL ORTHOPAEDICS 2019; 44:645-653. [DOI: 10.1007/s00264-019-04404-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 08/27/2019] [Indexed: 10/26/2022]
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Churchill AW, Malacova E, Journeaux SF, Richardson M, Crawford R, Vickers ML. A decade of Australian and New Zealand orthopaedic publications: a bibliometric trend analysis from 2008 to 2018. INTERNATIONAL ORTHOPAEDICS 2019; 43:2217-2226. [PMID: 31243521 DOI: 10.1007/s00264-019-04359-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Accepted: 06/10/2019] [Indexed: 12/31/2022]
Abstract
PURPOSE We aimed to apply bibliometric tools to Australian and New Zealand orthopaedic publications produced between 2008 and 2018 to identify the most highly cited publications, author and institution collaboration networks and topic trends. Analysis of the literature can highlight areas of emerging interest and knowledge gaps, and direct future research. METHODS A systematic search was conducted using Clarivate Analytics Web of Science. Citation analysis was carried out using Web of Science. Collaboration networks were constructed using chord diagrams. Trends in publication topics were analysed using simple linear regression to find the rate of change of publication volume on each topic. RESULTS A total of 3097 publications contributed to by 8855 individual authors met inclusion criteria. Across the study period, there was a large increase in the annual volume of publications on the topic of ACL (Anterior Cruciate Ligament) surgery. We also found that collaboration between Australian and New Zealand authors was very low with only 1% (n = 31) of publications including authors from both countries and 0.4% (n = 12) including orthopaedic surgeons or trainees from both. CONCLUSIONS Publications on ACL surgery have increased over the past decade, likely due to the presence of competing surgical approaches and the recently recognized risk of osteoarthritis following ACL reconstruction. The overall collaboration between Australian and New Zealand authors was very low which lends itself to opportunities for future research.
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Affiliation(s)
| | - Eva Malacova
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Simon F Journeaux
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Department of Orthopaedics, Mater Health Services, Brisbane, Queensland, Australia
| | - Martin Richardson
- Department of Surgery, Epworth Clinical School, The University of Melbourne, Melbourne, Victoria, Australia
| | - Ross Crawford
- Biomedical Engineering and Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
- Orthopaedic Department, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Mark L Vickers
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
- Biomedical Engineering and Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia.
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Kumar P, Rajnish RK, Sharma S, Dhillon MS. Proximal femoral nailing is superior to hemiarthroplasty in AO/OTA A2 and A3 intertrochanteric femur fractures in the elderly: a systematic literature review and meta-analysis. INTERNATIONAL ORTHOPAEDICS 2019; 44:623-633. [PMID: 31201487 DOI: 10.1007/s00264-019-04351-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Accepted: 05/21/2019] [Indexed: 02/25/2023]
Abstract
INTRODUCTION Unstable intertrochanteric femoral fractures in the elderly require either fixation or joint sacrificing surgery; proximal femoral nail (PFN) and bipolar hemiarthroplasties (BPH) are the most common interventions. PFN is considered to be the ideal construct for these fractures; however, the usage of hemiarthroplasties to facilitate earlier mobilization has been on a rise. Currently there is no consensus on the superiority of one of these two techniques over the other and the present review was done to determine this. RESEARCH QUESTION Is PFN a better alternative to BPH for unstable intertrochanteric femur fractures in the elderly? OBJECTIVE The present systematic review and meta-analysis was conducted to determine the superiority of PFN over BPH by comparing the primary outcomes like mortality, Harris Hip scores (HHS), complications, and re-operations. Additionally, secondary outcomes like blood loss, duration of surgery, and period of hospital stays were also compared. METHODOLOGY Three databases of PubMed, EMBASE, and SCOPUS were searched for relevant articles that directly compared PFN and BPH in unstable intertrochanteric femur fractures in the elderly. RESULTS We analyzed a total of seven studies published between the years 2005 to 2017. There were four retrospective and three prospective randomized controlled studies. The number of patients in these studies ranged from 53 to 303. PRIMARY OUTCOMES There was a significant difference in HHS between two groups with standard mean difference of - 0.51 (range - 0.67 to -0.36), favouring the PFN group. The rate of mortality was higher in the BPH group with odds ratio of 2.07 (range 1.40-3.08). Implant-related complications like fractures and subsidence were more in BPH group but this was not significant. SECONDARY OUTCOMES Mean surgical time (standard mean difference 2.19) and blood loss (3.75) were significantly less in the PFN group. The duration of hospital stay was also found to be significantly less in the PFN group (2.66). CONCLUSION Proximal femoral nails are superior to bipolar hemiarthroplasties for unstable intertrochanteric femoral fractures in the elderly. PFN imparts better functional outcomes and has lower rates of overall mortality. Additionally it is faster surgery, with lesser blood loss contributing to better results.
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Affiliation(s)
- Prasoon Kumar
- Department of Orthopaedics, Post Graduate Institute of Medical Education and Research, Sector-12, Chandigarh, 160012, India
| | - Rajesh Kumar Rajnish
- Department of Orthopaedics, Post Graduate Institute of Medical Education and Research, Sector-12, Chandigarh, 160012, India
| | - Siddhartha Sharma
- Department of Orthopaedics, Post Graduate Institute of Medical Education and Research, Sector-12, Chandigarh, 160012, India
| | - Mandeep Singh Dhillon
- Department of Orthopaedics, Post Graduate Institute of Medical Education and Research, Sector-12, Chandigarh, 160012, India.
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