The ion resonance and bromelain-vitamin C vs bromelainvitamin C to prevent ankle complications in post-operative bimalleolar surgery

Aim To investigate whether the use of ion resonance and bromelain-vitamin C or bromelain-vitamin C is the best to prevent ankle complications in post operative bimalleolar surgery. Methods A total of 61 patients treated with bimalleolar surgery were enrolled. The patients were divided into three groups: the first group (n=22) treated only with the surgery, the second group (n=18) treated by ion resonance and bromelain-vitamin C, and the third group (n=21) was treated with bromelain-vitamin C. All patients in the second and third group underwent adjuvant therapy for 50 days. The criteria to evaluate the three groups during the clinical and radiological follow-up were as follows: complications and soft tissue status. Bone healing measured by the Radiographic Union Score Ankle (RUSA), and functional results were evaluated according to the American Foot & Ankle Score (AFAS). Results In the first group nine (out of 22; 40.90%) patients developed complications, in the second group three (out of 18; 16.67%) and in the third group seven (out of 21; 33.33%) presented complications. There is no statistical difference between the three groups regarding the type of fractures, mean age, gender ratio. The worst radiographic and stiffness results in the first group were found (p=0.006). The second group showed better bone healing (p=0.049), better performance in functional recovery measured by AFAS (p=0.039). Conclusion Ion resonance and bromelain-vitamin C group showed better outcomes to improve the functional outcome; it allows reduction of complications, consequently, an early return to quality life, and a corresponding improvement of the quality of life.

IMPACT-Global Hip Fracture Audit: Nosocomial infection, risk prediction and prognostication, minimum reporting standards and global collaborative audit. Lessons from an international multicentre study of 7,090 patients conducted in 14 nations during the COVID-19 pandemic

Aims

This international study aimed to assess: 1) the prevalence of preoperative and postoperative COVID-19 among patients with hip fracture, 2) the effect on 30-day mortality, and 3) clinical factors associated with the infection and with mortality in COVID-19-positive patients.

Methods

A multicentre collaboration among 112 centres in 14 countries collected data on all patients presenting with a hip fracture between 1st March-31st May 2020. Demographics, residence, place of injury, presentation blood tests, Nottingham Hip Fracture Score, time to surgery, management, ASA grade, length of stay, COVID-19 and 30-day mortality status were recorded.

Results

A total of 7090 patients were included, with a mean age of 82.2 (range 50–104) years and 4959 (69.9%) being female. Of 651 (9.2%) patients diagnosed with COVID-19, 225 (34.6%) were positive at presentation and 426 (65.4%) were positive postoperatively. Positive COVID-19 status was independently associated with male sex (odds ratio (OR) 1.38, p = 0.001), residential care (OR 2.15, p < 0.001), inpatient fall (OR 2.23, p = 0.003), cancer (OR 0.63, p = 0.009), ASA grades 4 (OR 1.59, p = 0.008) or 5 (OR 8.28, p < 0.001), and longer admission (OR 1.06 for each increasing day, p < 0.001). Patients with COVID-19 at any time had a significantly lower chance of 30-day survival versus those without COVID-19 (72.7% versus 92.6%, p < 0.001). COVID-19 was independently associated with an increased 30-day mortality risk (hazard ratio (HR) 2.83, p < 0.001). Increasing age (HR 1.03, p = 0.028), male sex (HR 2.35, p < 0.001), renal disease (HR 1.53, p = 0.017), and pulmonary disease (HR 1.45, p = 0.039) were independently associated with a higher 30-day mortality risk in patients with COVID-19 when adjusting for confounders.

Conclusion

The prevalence of COVID-19 in hip fracture patients during the first wave of the pandemic was 9%, and was independently associated with a three-fold increased 30-day mortality risk. Among COVID-19-positive patients, those who were older, male, with renal or pulmonary disease had a significantly higher 30-day mortality risk.

Fractures around Trochanteric Nails: The "Vergilius Classification System"

INTRODUCTION

The fractures that occurred around trochanteric nails (perinail fractures, PNFs) are becoming a huge challenge for the orthopaedic surgeon. Although presenting some specific critical issues (i.e., patients' outcomes and treatment strategies), these fractures are commonly described within peri-implant ones and their treatment was based on periprosthetic fracture recommendations. The knowledge gap about PNFs leads us to convene a research group with the aim to propose a specific classification system to guide the orthopaedic surgeon in the management of these fractures.

MATERIALS AND METHODS

A steering committee, identified by two Italian associations of orthopaedic surgeons, conducted a comprehensive literature review on PNFs to identify the unmet needs about this topic. Subsequently, a panel of experts was involved in a consensus meeting proposing a specific classification system and formulated treatment statements for PNFs. Results and Discussion. The research group considered four PNF main characteristics for the classification proposal: (1) fracture localization, (2) fracture morphology, (3) fracture fragmentation, and (3) healing status of the previous fracture. An alphanumeric code was included to identify each characteristic, allowing to describe up to 54 categories of PNFs, using a 3- to 4-digit code. The proposal of the consensus-based classification reporting the most relevant aspects for PNF treatment might be a useful tool to guide the orthopaedic surgeon in the appropriate management of these fractures.