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The Neutrophil-to-Lymphocyte Ratio and Preoperative Pulmonary Function Test Results as Predictors of In-Hospital Postoperative Complications after Hip Fracture Surgery in Older Adults. J Clin Med 2022; 12:jcm12010108. [PMID: 36614909 PMCID: PMC9821284 DOI: 10.3390/jcm12010108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 12/21/2022] [Accepted: 12/22/2022] [Indexed: 12/24/2022] Open
Abstract
Purpose: This study retrospectively evaluated the usefulness of the neutrophil-to-lymphocyte ratio (NLR), prognostic nutritional index (PNI), and pulmonary function test (PFT) results as objective predictors of in-hospital postoperative complications after hip fracture surgery in older adults. Methods: The patients aged >65 years who underwent hip fracture surgery under general anaesthesia were enrolled. In-hospital postoperative complications with preoperative NLR, PNI and PFT results were evaluated. The NLR was calculated as the preoperative neutrophil count/lymphocyte count in peripheral blood. The PNI was calculated as the serum albumin (g/dL) × 10 + total lymphocyte count × 0.005 (/mm3). Results: One hundred ninety nine patients were analysed. The most common postoperative complications were respiratory complications. Compared with patients who did not have postoperative complications, patients with postoperative complications had a significantly higher NLR (8.01 ± 4.70 vs. 5.12 ± 4.34, p < 0.001), whereas they had a significantly lower PNI (38.33 ± 6.80 vs. 42.67 ± 6.47, p < 0.001), preoperative functional vital capacity (FVC; 2.04 ± 0.76 vs. 2.45 ± 0.71 L, p < 0.001), and forced expiratory volume at 1 s (FEV1; 1.43 ± 0.53 vs. 1.78 ± 0.58 L, p < 0.001). Multiple logistic regression analysis identified NLR (odds ratio [OR], 1.142; 95% confidence interval [CI], 1.060−1.230; p < 0.001) and FEV1 (OR, 0.340; 95% CI, 0.191−0.603; p < 0.001) as risk factors for postoperative complications after hip fracture surgery. Conclusion: Preoperative NLR and FEV1 are objective predictors of in-hospital postoperative complications after hip fracture surgery in older patients.
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Vitiello R, Perisano C, Greco T, Cianni L, Polichetti C, Comodo RM, De Martino I, La Vergata V, Maccauro G. Intramedullary nailing vs modular megaprosthesis in extracapsular metastases of proximal femur: clinical outcomes and complication in a retrospective study. BMC Musculoskelet Disord 2022; 22:1069. [PMID: 36100879 PMCID: PMC9472329 DOI: 10.1186/s12891-022-05728-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 08/04/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Extracapsular proximal femur metastasis could be treated by synthesis or resection and megaprosthesis. No universal accepted guidelines are present in the literature. The aim of our study is to analyze of patients with metastases in the trochanteric region of the femur treated by a single type of intramedullary nailing or hip megaprosthesis. METHODS We retrospectively reviewed all patients affected by extracapsular metastases of proximal femur. Anthropometric and anamnestic data, routine blood exams and complications were collected. VAS score and MSTS score was administered before the surgery, ad 1-6-12 months after surgery. An un-paired T test and Chi-square were used. Multiple linear regression and logistic regression was performed. Significance was set for p < 0.05. RESULT Twenty patients were assigned in intramedullary Group, twenty-five in megaprostheses Group. The mean operative time is shorter in intramedullary group. Differential shows a higher anemization in megaprostheses group (2 ± 2 vs 3.6 ± 1.3; p = 0.02). The patients of intramedullary group showed malnutrition (Albumin: 30.5 ± 6.5 vs 37.6 ± 6 g/L; p = 0.03) and pro-inflammatory state (NLR: 7.1 ± 6.7 vs 3.8 ± 2.4; p = 0.05) (PLR: 312 ± 203 vs 194 ± 99; p = 0.04) greater than megaprostheses group. The patients in intramedullary groups shows a higher functional performance score than megaprostheses group at 1 month follow-up (MSTS: 16.4 ± 6.3 vs 12.2 ± 3.7; p = 0.004). A multivariate analysis confirms the role of type of surgery (p = 0.001), surgery duration (p = 0.005) and NLR (p = 0.02) in affecting the MSTS. Globally eight complications were recorded, no statistical difference was noticed between the two groups (p = 0.7), no predictor was found at logistic analysis. CONCLUSION Intramedullary nailing guarantees a rapid functional recovery, compared to patients undergoing hip megaprosthesis who instead improve gradually over time. The selection of patients with poor prognosis allows the correct surgical indication of nailing, while in the case of a more favorable prognosis, the intervention of hip megaprosthesis is to be preferred.
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Affiliation(s)
- Raffaele Vitiello
- Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy.
- Università Cattolica Del Sacro Cuore, Rome, Italy.
| | - Carlo Perisano
- Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Tommaso Greco
- Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
- Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Luigi Cianni
- Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
- Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Chiara Polichetti
- Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
- Università Cattolica Del Sacro Cuore, Rome, Italy
| | | | - Ivan De Martino
- Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Vincenzo La Vergata
- Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Giulio Maccauro
- Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
- Università Cattolica Del Sacro Cuore, Rome, Italy
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Vitiello R, Ziranu A, Oliva MS, Meluzio MC, Cauteruccio M, Maccauro G, Liuzza F, Saccomanno MF. The value of megaprostheses in non-oncological fractures in elderly patients: A short-term results. Injury 2022; 53:1241-1246. [PMID: 34602244 DOI: 10.1016/j.injury.2021.09.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 09/13/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The management of both hip and distal femur fractures as well as periprosthetic fractures can be challenging for orthopaedic surgeons. The use of megaprosthetic implants could provide substantial advantages in elderly population affected by complex fractures. The aim of the study was to evaluate the effectiveness of megaprosthetic implants for treating hip and distal femur fractures as well as periprosthetic fractures in elderly. MATERIAL AND METHODS From January 1st 2015 to December 31st 2019, patients treated for proximal or distal femoral fractures with severe bone loss or failure of previous surgery were retrospectively reviewed. Patients were divided into two group based on diagnosis: proximal femur fractures (group A) and distal femur fractures (group B). Subsequently, patients underwent hip (group A) or knee (group B) megaprosthesis. Self-assessed questionnaires were administered to all patients pre and postoperatively. Primary outcome was the Activity Daily Living. Secondary outcomes were: Instrumental Activity Daily Living, Short Form-12, Oxford knee or hip score, complications. Charlson score, Harris classification for hip or Anderson Orthopaedic Research Institute score and complication were recorded. All patients underwent a radiological follow up to rule out implant loosening and mobilization. Pre and postoperative functional score comparisons in each group were undertaken. Significance was set p ≤ 0.05. RESULTS Twelve patients were finally included in the study. There were 6 male and 6 females, the mean age was 72,9 years old (± 7,4); the mean BMI was 29,8 points (± 4.5). The mean follow-up was 2.9 years (± 1.4). No differences could be found between pre and postoperative evaluation in each group. No aseptic loosening, dislocation, mobilization or radiolucency were recorded during the follow-up. In group A, two surgical site infections (2/6 patients) and one pneumonia (1/6 patients) were recorded. In group B, two surgical site infections occurred (2/6 patients). All patients were treated by antimicrobial oral therapy with complete regression. CONCLUSION The use of hip and knee megaprosthetic implants in traumatology is a safe and viable option in elderly patients.
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Affiliation(s)
- Raffaele Vitiello
- Fondazione Policlinico Universitario A. Gemelli IRCSS, Roma, Italia; Università Cattolica Del Sacro Cuore, Roma, Italia
| | - Antonio Ziranu
- Fondazione Policlinico Universitario A. Gemelli IRCSS, Roma, Italia; Università Cattolica Del Sacro Cuore, Roma, Italia
| | - Maria Serena Oliva
- Fondazione Policlinico Universitario A. Gemelli IRCSS, Roma, Italia; Università Cattolica Del Sacro Cuore, Roma, Italia.
| | - Maria Concetta Meluzio
- Fondazione Policlinico Universitario A. Gemelli IRCSS, Roma, Italia; Università Cattolica Del Sacro Cuore, Roma, Italia
| | - Michele Cauteruccio
- Fondazione Policlinico Universitario A. Gemelli IRCSS, Roma, Italia; Università Cattolica Del Sacro Cuore, Roma, Italia
| | - Giulio Maccauro
- Fondazione Policlinico Universitario A. Gemelli IRCSS, Roma, Italia; Università Cattolica Del Sacro Cuore, Roma, Italia
| | - Francesco Liuzza
- Fondazione Policlinico Universitario A. Gemelli IRCSS, Roma, Italia; Università Cattolica Del Sacro Cuore, Roma, Italia
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Cazzato G, Oliva MS, Masci G, Vitiello R, Smimmo A, Matrangolo MR, Palmacci O, D'Adamio S, Ziranu A. Femoral neck fracture: the reliability of radiologic classifications. BMC Musculoskelet Disord 2022; 22:1063. [PMID: 35078436 PMCID: PMC8787877 DOI: 10.1186/s12891-022-05007-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 01/07/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Femoral neck fractures (FNF) are one of the most common injury in the elderly. A valid radiographic classification system is mandatory to perform the correct treatment and to allow surgeons to facilitate communication. This study aims to evaluate reliability of 2018 AO/OTA Classification, AO/OTA simplified and Garden classification. METHODS Six Orthopaedic surgeons, divided in three groups based on trauma experience, evaluated 150 blinded antero-posterior and latero-lateral radiography of FNF using Garden classification, 2018 AO/OTA and simplified AO/OTA classification. One month later, the radiographs were renumbered and then each observer performed a second evaluation of the radiographs. The Kappa statistical analysis was used to determine the reliability of the classifications. Cohen's Kappa was calculated to determine intra and inter observer reliability. Fleiss' Kappa was used to determine multi-rater agreement. RESULTS The k values of interobserver reliability for Garden classification was from 0,28 to 0,73 with an average of 0,49. AO classification showed reliability from 0,2 to 0,42, with average of 0,30. Simplified AO/OTA classification showed a reliability from 0,38 to 0,58 with an average of 0,48. The values of intra observer reliability for Garden classification was from 0,48 to 0,79 with an average of 0,63. AO classification showed reliability from 0,2 to 0,64 with an average of 0,5. Simplified AO/OTA classification showed a reliability from 0,4 to 0,75 with an average of 0,61. CONCLUSION The revised 2018 AO/OTA classification simplified the previous classification of intracapsular fracture but remain unreliable with only fair interobserver reliability. The simplified AO/OTA classification show a reliability similar to Garden classification, with a moderate interobserver reliability. The experience of the surgeons seems not to improve reliability. No classification has been shown to be superior in terms of reliability.
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Affiliation(s)
- Gianpiero Cazzato
- RomaPRO Center for Hip and Knee Arthroplasty, Polo Sanitario San Feliciano, Rome, Italy
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maria Serena Oliva
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giulia Masci
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
- UOC Orthopaedic and Traumatology, Children's Hospital Bambino Gesù, Rome, Italy
| | - Raffaele Vitiello
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alessandro Smimmo
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Maria Rosaria Matrangolo
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Osvaldo Palmacci
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Stefano D'Adamio
- RomaPRO Center for Hip and Knee Arthroplasty, Polo Sanitario San Feliciano, Rome, Italy
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antonio Ziranu
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
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Zhu J, Hu H, Deng X, Zhang Y, Cheng X, Tan Z, Zhu Y, Zhang Y. Nomogram for predicting reoperation following internal fixation of nondisplaced femoral neck fractures in elderly patients. J Orthop Surg Res 2021; 16:544. [PMID: 34470653 PMCID: PMC8408942 DOI: 10.1186/s13018-021-02697-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 08/26/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE We aimed to evaluate risk factors and develop a nomogram for reoperation after internal fixation of nondisplaced femoral neck fractures (FNFs) in elderly patients. METHODS We conducted a retrospective study involving a total of 255 elderly patients who underwent closed reduction and internal fixation with cannulated screw system for nondisplaced FNFs between January 2016 and January 2019. We collected data on demographics, preoperative radiological parameters, surgery, serum biochemical markers, and postoperative rehabilitation. In addition, we performed univariate and multivariate logistic regression analyses to determine independent risk factors for reoperation, and then developed a nomogram to assess the risks of reoperation. Besides, discriminative ability, calibration, and clinical usefulness of the nomogram were evaluated using the concordance index (C-index), the receiver operating characteristic (ROC) curve, calibration curve and decision curve analysis (DCA), respectively. We employed bootstrap method to validate the performance of the developed nomogram. RESULTS Our analysis showed that among the 255 patients, 28 (11.0%) underwent reoperation due to osteonecrosis of the femoral head (14 cases), mechanical failure (8 cases) or nonunion (6 cases). All of the 28 patients underwent conversion surgery to arthroplasty. The multivariate logistic regression analysis demonstrated that preoperative posterior tilt angle ≥ 20°, Pauwel's III type, younger patients, preoperative elevated levels of alkaline phosphatase (ALP), preoperative hypoalbuminemia, and early postoperative weight-bearing were independent risk factors for reoperation. In addition, the C-index and the bootstrap value of the developed nomogram was 0.850 (95% CI = 0.803-0.913) and 0.811, respectively. Besides, the calibration curve showed good consistency between the actual diagnosed reoperation and the predicted probability, while the DCA indicated that the nomogram was clinically valuable. CONCLUSIONS Our analysis showed we successfully developed and validated a nomogram for personalized prediction of reoperation after internal fixation of nondisplaced FNFs in elderly patients. This model would help in individualized evaluation of the need for reoperation and inform strategies aimed at eliminating the need for the reoperation.
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Affiliation(s)
- Jian Zhu
- School of Medicine, Nankai University, Tianjin, 300071, People's Republic of China.,Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, People's Republic of China.,Key Laboratory of Biomechanics of Hebei Province, Orthopedic Research Institution of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China.,NHC Key Laboratory of Intelligent Orthopedic Equipment, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Hongzhi Hu
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, People's Republic of China
| | - Xiangtian Deng
- School of Medicine, Nankai University, Tianjin, 300071, People's Republic of China.,Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, People's Republic of China.,Key Laboratory of Biomechanics of Hebei Province, Orthopedic Research Institution of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China.,NHC Key Laboratory of Intelligent Orthopedic Equipment, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Yiran Zhang
- School of Medicine, Nankai University, Tianjin, 300071, People's Republic of China.,Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, People's Republic of China.,Key Laboratory of Biomechanics of Hebei Province, Orthopedic Research Institution of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China.,NHC Key Laboratory of Intelligent Orthopedic Equipment, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Xiaodong Cheng
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, People's Republic of China.,Key Laboratory of Biomechanics of Hebei Province, Orthopedic Research Institution of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China.,NHC Key Laboratory of Intelligent Orthopedic Equipment, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Zhanchao Tan
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, People's Republic of China.,Key Laboratory of Biomechanics of Hebei Province, Orthopedic Research Institution of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China.,NHC Key Laboratory of Intelligent Orthopedic Equipment, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Yanbin Zhu
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, People's Republic of China.,Key Laboratory of Biomechanics of Hebei Province, Orthopedic Research Institution of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China.,NHC Key Laboratory of Intelligent Orthopedic Equipment, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Yingze Zhang
- School of Medicine, Nankai University, Tianjin, 300071, People's Republic of China. .,Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, People's Republic of China. .,Key Laboratory of Biomechanics of Hebei Province, Orthopedic Research Institution of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China. .,NHC Key Laboratory of Intelligent Orthopedic Equipment, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, People's Republic of China.
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Wang B, Xiao X, Zhang J, Han W, Hersi SA, Tang X. Epidemiology and microbiology of fracture-related infection: a multicenter study in Northeast China. J Orthop Surg Res 2021; 16:490. [PMID: 34384457 PMCID: PMC8357967 DOI: 10.1186/s13018-021-02629-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 07/24/2021] [Indexed: 11/12/2022] Open
Abstract
Objective This study aimed to explore the epidemiological and microbiological characteristics of fracture-related infection (FRI), analyze the drug resistance characteristics of major pathogens, and provide timely and relatively complete clinical and microbiological data for antimicrobial treatment of FRI. Methods The clinical and microbiological data of patients with FRI from January 1, 2011, to December 31, 2020, were collected from three tertiary hospitals in Northeast China. The automatic microbial analysis system was used for strain identification and drug susceptibility testing, and the drug susceptibility results were determined in accordance with the latest Clinical and Laboratory Standards Institute (CLSI) criteria (as applicable each year). Results A total of 744 patients with FRI were enrolled. The incidence of FRI was about 1.5%, and 81.7% were male patients, with an average age of 48.98 ± 16.01 years. Open fractures accounted for 64.8%. Motor crush (32.8%) and falling (29.8%) were the main causes of injuries. The common sites of infection were the tibia and fibula (47.6%), femur (11.8%), foot (11.8%), and hand (11.6%). A total of 566 pathogenic bacteria were cultured in 378 patients with positive bacterial cultures, of which 53.0% were Gram-positive bacteria and 47.0% were Gram-negative bacteria. The most common pathogen at all sites of infection is Staphylococcus aureus. Staphylococcus aureus had a high resistance rate to penicillin (PEN), erythromycin (ERY), and clindamycin (CLI), exceeding 50%. Methicillin-resistant Staphylococcus aureus (MRSA) was more than 80% resistant to CLI and ERY. Conclusions The incidence of FRI in Northeast China was at a low level among major medical centers nationwide. Staphylococcus aureus was still the main pathogen causing bone infections, and the proportion of MRSA was lower than reported abroad, but we have observed an increase in the proportion of infections. Enterobacteriaceae have a higher resistance rate to third-generation cephalosporins and quinolones. For Enterobacteriaceae, other sensitive treatment drugs should be selected clinically.
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Affiliation(s)
- Baisheng Wang
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, 116011, People's Republic of China.,Dalian Medical University, Dalian, Liaoning, 116044, People's Republic of China
| | - Xiaoguang Xiao
- Department of Clinical Laboratory, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, 116011, People's Republic of China
| | - Jingdong Zhang
- Department of Orthopedics, Northeast International Hospital, Shenyang, Liaoning, 110004, People's Republic of China
| | - Wenfeng Han
- Department of Orthopedics, The General Hospital of Northern Theater Command, Shenyang, Liaoning, 110016, People's Republic of China
| | - Salad Abdirahman Hersi
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, 116011, People's Republic of China.,Dalian Medical University, Dalian, Liaoning, 116044, People's Republic of China
| | - Xin Tang
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, 116011, People's Republic of China. .,Dalian Medical University, Dalian, Liaoning, 116044, People's Republic of China.
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Ren Z, Yuan Y, Qi W, Li Y, Wang P. The incidence and risk factors of deep venous thrombosis in lower extremities following surgically treated femoral shaft fracture: a retrospective case-control study. J Orthop Surg Res 2021; 16:446. [PMID: 34243792 PMCID: PMC8268537 DOI: 10.1186/s13018-021-02595-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 06/28/2021] [Indexed: 11/29/2022] Open
Abstract
Background There is still a lack of data on deep vein thrombosis (DVT) following surgically treated femoral shaft fracture (FSF). The goal of this study was to investigate the characteristics of postoperative DVT and the association between the occurrence of DVT and risk factors in patients undergoing surgical treatment for FSF. Methods This observational retrospective case-control study reviewed 308 patients who received surgical treatment of FSF between January 2016 and October 2020 at a university hospital. Univariate analyses were performed on the data of demographics, comorbidities, laboratory biomarkers, and operation-related indexes. The receiver operating characteristic (ROC) curve analysis, univariate analyses, and multivariate logistic regression analysis were employed to identify the independent risk factors associated with DVT. Results In total, 308 patients with surgically treated FSF were included, among whom 48 (15.6%) patients had postoperative DVTs. The univariate analyses showing significant differences regarding DVT were American Society of Anesthesiologists (ASA) classification, diabetes mellitus, current smoking, aspartate transaminase (AST), and very-low-density lipoprotein (VLDL) level among the 34 factors. According to the ROC results, the optimal cutoff values for intraoperative blood loss, d-dimer, and age were 350 ml, 1.08 μg/ml, and 35 years, respectively. The multivariable model demonstrated 4 significantly independent associations with postoperative DVT, including current smoking, intraoperative blood loss (> 550 ml), age (> 35 years), and d-dimer > 1.09 μg/ml. Conclusion These risk factors as screening tools contribute to risk stratification of the occurrence of thromboembolic events. In addition, our findings would help orthopedic surgeons make a cross-specialty decision and implement targeted precaution measures for patients with FSF.
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Affiliation(s)
- Zhixin Ren
- Department of Orthopaedic Surgery, The 3rd Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Yufei Yuan
- Department of Orthopaedic Surgery, Handan Central Hospital, Handan, 056000, Hebei, People's Republic of China
| | - Wei Qi
- Department of Orthopaedic Surgery, The First People's Hospital of Taian, Tai'an, 271000, Shandong, People's Republic of China
| | - Yanbao Li
- Department of Orthopaedic Surgery, Handan Central Hospital, Handan, 056000, Hebei, People's Republic of China
| | - Pengcheng Wang
- Department of Orthopaedic Surgery, The 3rd Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China.
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Rahimi M, Taban-Sadeghi M, Nikniaz L, Pashazadeh F. The relationship between preoperative serum vitamin D deficiency and postoperative atrial fibrillation: A systematic review and meta-analysis. J Cardiovasc Thorac Res 2021; 13:102-108. [PMID: 34326963 PMCID: PMC8302893 DOI: 10.34172/jcvtr.2021.25] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 01/24/2021] [Indexed: 11/09/2022] Open
Abstract
Postoperative atrial fibrillation (POAF) is the most common arrhythmia seen in the first days following cardiac surgeries. Recently, there is a growing discussion regarding the link between vitamin D deficiency and POAF development. This systematic review and meta-analysis of the observational studies aimed at evaluating the association between preoperative vitamin D deficiency and Postoperative atrial fibrillation. In this study, using PubMed, Scopus, Google Scholar, EMBASE, Web of Science, and Cochrane Libraries, we searched for records published before July 2020. Two reviewers screened for studies that examined the relationship between preoperative vitamin D levels and the generation of POAF. Data regarding study design, patient characteristics, definition of atrial fibrillation (AF), type of surgery, vitamin D levels, and measurement methods were extracted. Five studies were included in the meta-analysis. Our primary analysis showed a significant relationship between preoperative levels of vitamin D and POAF development (mean differences (MD) = -2.851, 95% confidence interval (CI) =-5.506 to -0.195; P value 0.035). Our meta-analysis suggested serum vitamin D deficiency is associated with an increased risk of POAF development. Further large scale interventional studies are needed to explore whether vitamin D supplementation will prevent POAF.
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Affiliation(s)
- Mehran Rahimi
- Student Research Committee, Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Leila Nikniaz
- Tabriz Health Services Management Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Fariba Pashazadeh
- Research Center for Evidence-based Medicine, Iranian EBM Centre: A Joanna Briggs Institute (JBI) Centre of Excellence, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
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9
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Vitiello R, Bellieni A, Oliva MS, Di Capua B, Fusco D, Careri S, Colloca GF, Perisano C, Maccauro G, Lillo M. The importance of geriatric and surgical co-management of elderly in muscoloskeletal oncology: A literature review. Orthop Rev (Pavia) 2020; 12:8662. [PMID: 32913597 PMCID: PMC7459364 DOI: 10.4081/or.2020.8662] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 06/17/2020] [Indexed: 12/16/2022] Open
Abstract
People over 65 years old are the fastestgrowing part of the population and also the most common population in oncological practice. The geriatric co-assessment when involved in the management of orthopedic elderly patients could improve the survival and clinical outcomes of the patients. The aim of this review is to understand the importance of comprehensive geriatric assessment in elderly cancer orthopaedic patients affected by bone and soft tissue sarcoma in order to apply it and identify the mean surgical prognostic factors of this population.
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Affiliation(s)
- Raffaele Vitiello
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome
| | - Andrea Bellieni
- Department of Geriatrics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome
| | - Maria Serena Oliva
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome
| | - Beatrice Di Capua
- Department of Geriatrics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome
| | - Domenico Fusco
- Department of Geriatrics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome
| | - Silvia Careri
- Department of Orthopaedics and Traumatology, Paediatric Hospital Bambino Gesù IRCCS, Rome
| | | | - Carlo Perisano
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome
| | - Giulio Maccauro
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome
| | - Marco Lillo
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome
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10
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Noia G, Basilico M, Vitiello R, Perna A, Leone A, Rumi N, Tamburrelli FC. Thoracic spine fracture associated with an extradural lipoma: Case report and systematic review of the literature. Orthop Rev (Pavia) 2020; 12:8684. [PMID: 32913612 PMCID: PMC7459376 DOI: 10.4081/or.2020.8684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 06/17/2020] [Indexed: 02/08/2023] Open
Abstract
Isolated extradural lipoma (IEL), not associated to spinal dysraphisms, is a rare condition. Frequently IEL was confused with much more frequent diffuse lipomatosis. The lesion can be completely asymptomatic and occasionally diagnosed with magnetic resonance (MR) imaging. This paper describes a case of a patient with an axial compression fracture of the thoracic spine associated with an extradural lipoma. We also performed a systematic review of the pertinent literature in order to retrieve the key information regarding: the diagnosis, the clinical features and the treatment.
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Affiliation(s)
| | | | | | | | - Antonio Leone
- Istituto di Radiologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome; Università Cattolica del Sacro Cuore, Rome, Italy
| | - Nicolò Rumi
- Istituto di Radiologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome; Università Cattolica del Sacro Cuore, Rome, Italy
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11
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Santagada DA, Perna A, Meluzio MC, Ciolli G, Proietti L, Tamburrelli FC. Symptomatic vertebral hemangioma during pregnancy period: A case series and systematic literature review. Orthop Rev (Pavia) 2020; 12:8685. [PMID: 32913613 PMCID: PMC7459382 DOI: 10.4081/or.2020.8685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 06/17/2020] [Indexed: 12/11/2022] Open
Abstract
Vertebral Hemangioma (VH) is a benign tumor usually symptomless and discovered incidentally. Pregnancy, because of several hormonal and physiologic changes, is a recognized risk factor coinciding with the development of a rapid onset of neurological symptoms in patients affected by VH. In the Literature, sporadic cases of neurological symptoms have been described, which occurred during pregnancy, but only rarely the onset of symptoms was reported after pregnancy and childbirth. Usually surgical treatment is reserved for severe cases with rapid onset of neurological symptoms. However, the use of conservative treatments is still a topic of debate In the present study, we report a series of patients affected by VH become symptomatic during or after pregnancy along with a systematic review of the Literature.
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Affiliation(s)
- Domenico Alessandro Santagada
- Istituto di Clinica Ortopedica, UOC di Chirurgia Vertebrale, Fondazione Policlinico Universitario "A.Gemelli" IRCCS, Rome; Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Andrea Perna
- Istituto di Clinica Ortopedica, UOC di Chirurgia Vertebrale, Fondazione Policlinico Universitario "A.Gemelli" IRCCS, Rome; Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Maria Concetta Meluzio
- Istituto di Clinica Ortopedica, UOC di Chirurgia Vertebrale, Fondazione Policlinico Universitario "A.Gemelli" IRCCS, Rome; Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Gianluca Ciolli
- Istituto di Clinica Ortopedica, UOC di Chirurgia Vertebrale, Fondazione Policlinico Universitario "A.Gemelli" IRCCS, Rome; Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Luca Proietti
- Istituto di Clinica Ortopedica, UOC di Chirurgia Vertebrale, Fondazione Policlinico Universitario "A.Gemelli" IRCCS, Rome; Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Francesco Ciro Tamburrelli
- Istituto di Clinica Ortopedica, UOC di Chirurgia Vertebrale, Fondazione Policlinico Universitario "A.Gemelli" IRCCS, Rome; Università Cattolica Del Sacro Cuore, Rome, Italy
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12
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Vergani E, Bruno C, Silvestrini A, Meucci E, Proietti L, Perna A, Tamburrelli FC, Mancini A. Oxidative stress and anabolic hormones in back pain: Current concept and preliminary analysis in male cohort. Orthop Rev (Pavia) 2020; 12:8686. [PMID: 32913614 PMCID: PMC7459380 DOI: 10.4081/or.2020.8686] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 06/17/2020] [Indexed: 01/22/2023] Open
Abstract
Back Pain (BP) is a common medical problem; anabolic hormones, through the modulation of oxidative stress (OS), could influence fracture risk. We evaluated the prevalence of anabolic hormonal deficiencies and their relationship with OS in males with BP, associated or not to nontraumatic fractures. 49 males with BP, from 36 to 80 years, were divided in two groups according to radiological evidence of nontraumatic fractures; group A (n=25): non-fractured; group B (n=24): fractured. A different prevalence of hormonal deficits was observed: 24% of hypotestosteronemia in A, 0% in B; 16% of GHD in A, 29% in B; Total Antioxidant Capacity (TAC) showed a trend toward higher levels in B. In A, despite lower TAC, a significant inverse correlation was present between TAC and IGF-1. A greater prevalence of GHD in patients with vertebral fractures was seen and, in a subgroup, OS could mediate the deleterious effects of hyposecretory GH state.
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Affiliation(s)
- Edoardo Vergani
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome.,Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome
| | - Carmine Bruno
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome.,Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome
| | - Andrea Silvestrini
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome.,Dipartimento di Scienze Biotecnologiche di base, cliniche intensivologiche e peri-operatorie, Università Cattolica del Sacro Cuore, Rome
| | - Elisabetta Meucci
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome.,Dipartimento di Scienze Biotecnologiche di base, cliniche intensivologiche e peri-operatorie, Università Cattolica del Sacro Cuore, Rome
| | - Luca Proietti
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome.,Dipartimento di Scienze geriatriche e ortopediche, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Andrea Perna
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome.,Dipartimento di Scienze geriatriche e ortopediche, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Ciro Tamburrelli
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome.,Dipartimento di Scienze geriatriche e ortopediche, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antonio Mancini
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome.,Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome
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