Interimplant femoral fracture: analysis of risk factors

Interimplant fractures present a significant challenge for orthopedic surgeons. Despite a noticeable rise in these cases in recent years, our understanding of this specific fracture type remains limited. This study aims to analyze and identify the primary risk factors associated with interimplant femoral fractures. We conducted a retrospective analysis involving 20 patients with interimplant femoral fracture (case group) and 18 patients who had both proximal and distal femoral implants but did not experience interimplant fractures (control group). Our analysis focused on demographic factors (age, sex, BMI) and radiographic parameters (implant types, gap between implants, cortical thickness, femoral canal area) to identify potential risk factors. In the case group, all patients were females, whereas in the control group, 16 patients were female and 2 were males. The mean age in the case group was 88 [Formula: see text] 9 years and in the control group was 87 [Formula: see text] 12 years. None of the demographic differences reached statistical significance. The mean cortical thickness in the case group was 6 [Formula: see text] 2.25 mm, whereas in the control group, it was 9 [Formula: see text] 1.75 mm (p-value < 0.001). The median gap between the proximal and distal tips of the implants measured 194 [Formula: see text] 126 mm in the case group and 66 [Formula: see text] 78 mm in the control group (p-value < 0.001). Additionally, the mean femoral canal area was 284 [Formula: see text] 102 mm2 in the case group and 227 [Formula: see text] 26 mm2 in the control group (p-value < 0.010). Our data indicate that a small cortical thickness, a wide femoral canal area, and having a hip arthroplasty despite a gap between the implants exceeding 110 mm are factors that elevate the risk of interimplant femoral fracture. Notably, osteoporosis therapy emerges as a protective factor against these fractures.

Chronobiology of acute pancreatitis in a single Italian centre

OBJECTIVE

Seasonal variation may occur in many different diseases hence influencing awareness in clinical practice. This study aimed to establish seasonal variations of acute pancreatitis by using a validated chronobiological analysis.

PATIENTS AND METHODS

All cases of acute pancreatitis consecutively observed in fifteen years, i.e., from January 2003 to December 2017, at St. Anna University Hospital of Ferrara, Italy, were included in this study. Accurate statistical and logistic regression analyses were applied to our database.

RESULTS

A total number of 1883 consecutive cases of acute pancreatitis were observed. A significant peak was identified in the summer period (p=0.014). Patient stratification, according to age, showed that elderly people had an increased incidence of acute pancreatitis in autumn and summer (being the biliary stone disease the main cause, p=0.011) vs. other seasons (p=0.003). Mortality occurred more prominently in males vs. females, although the latter gender was more prone to acute pancreatitis (p=0.017).

CONCLUSIONS

In a single centre of Northern East of Italy, we demonstrated that acute pancreatitis had a clear seasonal variation with a prominent incidence during summer. Various associated factors could contribute to this chronobiological pattern, including gender, age, and biliary stone disease.