The Perioperative Management of Antiplatelet and Anticoagulant Drugs in Hip Fractures: Do the Surgery as Early as Possible

Hip fractures are among the most common fractures operated by orthopedic surgeons. Many elderly patients, who account for a significant percentage of hip fractures, suffer from medical conditions requiring antiplatelet and anticoagulant administration. Meanwhile, considerable evidence recommends early surgery within 48b hours of admission. We aim to review the existing evidence regarding the perioperative management of antiplatelet and anticoagulant drugs in hip fractures. It was concluded that surgery for hip fractures in patients with antiplatelet drug consumption should not be delayed unless a clear contraindication exists. Active reversal strategies are indicated for patients with hip fractures and warfarin therapy. However, evidence for the safety of these agents in pregnancy, breastfeeding state, and adolescence has not yet been established. Little data exists about perioperative management of direct-acting oral anticoagulants in hip fractures. Early surgery after 12-24 hours of drug cessation has been suggested in studies; however, it should be employed cautiously. Despite extensive research, the importance of the issue necessitates additional higher-quality studies.

Intrapelvic Migration of Dynamic Hip Screw Postoperatively Leading to Total Hip Arthroplasty: A Case Report

Background: This study aimed to present a rare case of a failed dynamic hip screw (DHS) used for fixation of intertrochanteric fracture sliding into the pelvis and to review the most common causes of DHS failure in order to prevent this from happening in the future. Case Report: A 68-year-old woman was referred to the orthopedics clinic with left hip pain and limping from 6 months ago. In our evaluation, she had DHS failure and intrapelvic protrusion. Conclusion: There have been several aspects of the previously described DHS failure. We performed a two-stage total hip arthroplasty (THA) for the patient with a good one-year follow-up in the present case.

Parsonage-Turner Syndrome and Closed-Incision Negative-Pressure Wound Therapy After Total Hip Arthroplasty in a Case of Marfan Syndrome

Negative pressure wound therapy (NPWT) is a postoperative wound care method, which has recently become an ongoing field of research in hip and knee arthroplasty. We report the successful management of wound dehiscence and infection after THA in a case of Marfan syndrome by closed-incision negative-pressure wound therapy (ciNPWT). Our patient also developed a rare postoperative neurologic complication, that is, Parsonage-Turner syndrome (PTS). To our knowledge, this is the first report of PTS and ciNPWT use for SSI after THA in a Marfan patient. As wound dehiscence and infection can occur after THA in Marfan patients, we propose ciNPWT as an option to treat or even prevent (prophylactic use) such complications in this rare group of patients.

Asymmetric Bilateral Hip Fracture-Dislocation: A Case Report and Literature Review

Background: Asymmetric bilateral hip dislocation is a rare condition, especially when it is accompanied by a bilateral femoral head fracture. Case Report: A 28-year-old man who sustained a motor vehicle accident, was presented to the our center (Imam Khomeini Hospital Complex) with asymmetric bilateral hip fracture-dislocation. In the initial step, closed reduction was performed, followed by bilateral open reduction and fixation of the femoral head fragment by screws. The results were satisfactory after 5 years of follow-up. Conclusion: Although rare, paradoxical femoral head fracture should be considered in patients with hip dislocation. We recommend our therapeutic approach in a similar situation.

Serum interleukine-6 concentration, but not interleukine-18, is associated with head and neck squamous cell carcinoma progression

Inflammation has been linked to various steps in tumorigenesis. Interleukin (IL)-6 and IL-18 are two inflammatory cytokines whose serum concentrations are elevated in several types of cancer, including head and neck squamous cell carcinoma (HNSCC) in some studies. This study was designed to analyze the serum concentrations of these cytokines in Iranian HNSCC patients. Serum IL-6 and IL-18 concentrations were assayed by ELISA commercial kits in 65 untreated patients and 20 healthy volunteers. Serum IL-6 concentration was significantly increased in patients compared to healthy individuals (p < 0.000). IL-6 concentration increased as the tumor stage progressed, and a significant difference appeared between stage IV vs. stage I/II/III (p = 0.03) disease. Although serum IL-18 concentration was higher in patients than in healthy individuals, the difference was not statistically significant (p = 0.06). Moreover, there was no association between serum IL-18 concentration and tumor stage (p = 0.47). A significant difference was observed in serum IL-18 concentration according to the gender with higher IL-18 concentration in male patients (p = 0.01). In conclusion, serum concentration of IL-6 might correlate with the stage of tumor progression in Iranian HNSCC patients. Further studies with larger numbers of patients are required to exclude the possible minor correlation of serum IL-18 concentration with tumor stage.