Aims

A systematic literature review focusing on how long before surgery concurrent viral or bacterial infections (respiratory and urinary infections) should be treated in hip fracture patients, and if there is evidence for delaying this surgery.

Introduction

Hip fracture is a worldwide problem, not only as far as epidemiology is concerned but also regarding economical issues. Surgery is the current standard treatment. However owing to age, and patients co-morbidities complications are common. Surgical site infection is directly related to operative procedure, and surgeons' experience may be very important when making plans for outcome improvement. In this paper we study the role of hip surgeons versus general orthopaedic surgeons in relation to postoperative site infection. Operative hypothesis determines that hip surgeons have less infection rates than general orthopaedic surgeons. Null hypothesis that infection rates are rather the same.

Introduction and purpose: Infections of total hip prostheses are one of the most serious complications that beset this procedure. Their incidence in the world literature is of 1%. However this figure rises to 16% in the case of implants secondary to fractures in patients with multiple pathologies. In this study we conduct a descriptive analysis of the qualitative variables after the implementation of an action protocol to address this complication.

Materials and methods: A consecutive series of 694 patients was studied (420 females, 60.52%, and 274 males, 39.48%). Out of these 233 cases were secondary to fractures ( 60 males and 173 females), which meant that treatment was administered as an emergency (in the first 48 hours), and 461 were primary (241 males and 247 females). The variables related to an infection risk were studied, a distinction being made between an acute and a chronic infection based on CCD criteria. In acute cases, surgical cleaning was performed; in subacute cases, a two-stage replacement was chosen and for chronic infections we performed a resection arthroplasty if the two-stage replacement failed.

Results: We performed a frequency and exponential chi square study which yielded 37 cases (5.33%) of implant infection (11 males, 26 females).The most frequently isolated germ was Staphilococus Aureus. 74% of cases treated with surgical cleaning after a diagnosis of acute infection are now infection-free after a two-year follow-up. 60% of subacute cases, where a two-stage replacement was performed, show a satisfactory result. As regards resection arthroplasty, the success of treatment was around 92%,with a p< 0.005 value.

Conclusions: Careful patient selection and early diagnosis are fundamental to obtain good results in the treatment of THP infections.

Introduction and purpose: Cases of unstable extracapsular fractures of the proximal femur should be treated by endomedullary nailing; the PFN (Synthes) nail has proved to be a good option for this approach. The purpose of our paper is to make a descriptive study analyzing the medical and technical complications derived from the use of the PFN nail.

Materials and methods: This study reviews a consecutive series of 432 patients implanted with a PFN, out of whom 352 have had a follow-up longer than 6 months. Mean age is 76.3 years and the male/female ratio is 2:1. An analysis was made of the variables related to medical complications inherent in the fracture itself and in the patient characteristics (AO fracture type, ASA surgical risk, organic complications, infection risk factors, duration of hospital stay and mortality) and to secondary mechanical complications caused by implant design or the surgical technique chosen (implant protrusions, system cutting out, osteolysis and intraoperative and postoperative fractures propagated from the tip of the implant).

Results: We performed a frequency analysis and an exponential chi square study which told us that the most frequent fracture was type A2 (AO classification) and the most frequent patient type was ASA III (ASA classification). Mean hospital stay was 6.66 days. During follow-up, medical complications were 17.5% and mechanical ones 11%.

Conclusions: The PFN nail is an efficient means for treating extracapsular fractures of the proximal femur although its use is not free from complications, which could be minimized by employing a careful surgical technique. We found that there is a direct relationship between surgical success and patient ASA type.

Aims: The purpose of this study was to describe the histologic adaptation of the femoral artery wall to the strechtening derived from femoral lengthening by callus distraction. Methods: In 32 New Zealand white rabbits a left femoral bone lengthening was carried out with a total distraction of 30% of initial length. The study was divided into eight progressives stages and at the end of each stage both femoral arteries were excised and prepared for light microscopy and ultrastructural analysis. Results: Light microscopy: Changes in the media layer architecture were observed since lengthening of the 15% of the initial length, reaching its maximum by lengthening of 30% of initial length. Six month after the end of the distraction, the media layer still showed morphologic changes compared to the unlengthened group. U.E.: During the greatest distraction period and one month thereafter the Smooth Muscle cells of the media lost its contractile characteristics and greatly increased their syntesis organelles, and mytosis and isolated binuclear cells are observed representing and accelerated cell proliferation. Six months after the end of the distraction the muscular cells returned almost completely to the normal contractile state. Conclusions: The response of the arterial wall against the strechtening is more a regenerative response due to the muscle cells than a reparative response of the connective tissue. This study suggest that with the greatest distraction, and one month later, the muscle cells change from the original contractile phenotype to a synthetic phenotype, that is a prerequisite for cellular proliferation. The return to the original characteristics six months thereafter could support the reversibility of the cellular phenotype opposite to the progressive elongation.