Delirium is associated with adverse outcomes following hip fracture, but the prevalence and significance of delirium for the prognosis and ongoing rehabilitation needs of patients admitted from home is less well studied. Here, we analyzed relationships between delirium in patients admitted from home with 1) mortality; 2) total length of hospital stay; 3) need for post-acute inpatient rehabilitation; and 4) hospital readmission within 180 days. This observational study used routine clinical data in a consecutive sample of hip fracture patients aged ≥ 50 years admitted to a single large trauma centre during the COVID-19 pandemic between 1 March 2020 and 30 November 2021. Delirium was prospectively assessed as part of routine care by the 4 A’s Test (4AT), with most assessments performed in the emergency department. Associations were determined using logistic regression adjusted for age, sex, Scottish Index of Multiple Deprivation quintile, COVID-19 infection within 30 days, and American Society of Anesthesiologists grade.Aims
Methods
Successful cell therapy in hip osteonecrosis (ON) may help to avoid ON progression or total hip arthroplasty (THA), but the achieved bone regeneration is unclear. The aim of this study was to evaluate amount and location of bone regeneration obtained after surgical injection of expanded autologous mesenchymal stromal cells from the bone marrow (BM-hMSCs). A total of 20 patients with small and medium-size symptomatic stage II femoral head ON treated with 140 million BM-hMSCs through percutaneous forage in the EudraCT 2012-002010-39 clinical trial were retrospectively evaluated through preoperative and postoperative (three and 12 months) MRI. Then, 3D reconstruction of the original lesion and the observed postoperative residual damage after bone regeneration were analyzed and compared per group based on treatment efficacy.Aims
Methods
We report the clinical and radiological outcome
of subcapital osteotomy of the femoral neck in the management of symptomatic
femoroacetabular impingement (FAI) resulting from a healed slipped
capital femoral epiphysis (SCFE). We believe this is only the second
such study in the literature. We studied eight patients (eight hips) with symptomatic FAI after
a moderate to severe healed SCFE. There were six male and two female
patients, with a mean age of 17.8 years (13 to 29). All patients underwent a subcapital intracapsular osteotomy of
the femoral neck after surgical hip dislocation and creation of
an extended retinacular soft-tissue flap. The mean follow-up was
41 months (20 to 84). Clinical assessment included measurement of
range of movement, Harris Hip Score (HHS) and Western Ontario and McMaster
Universities Osteoarthritis score (WOMAC). Radiological assessment
included pre- and post-operative calculation of the anterior slip
angle (ASA) and lateral slip angle (LSA), the anterior offset angle
(AOA) and centre head–trochanteric distance (CTD). The mean HHS
at final follow-up was 92.5 (85 to 100), and the mean WOMAC scores
for pain, stiffness and function were 1.3 (0 to 4), 1.4 (0 to 6)
and 3.6 (0 to 19) respectively. There was a statistically significant
improvement in all the radiological measurements post-operatively.
The mean ASA improved from 36.6° (29° to 44°) to 10.3° (5° to 17°)
(p <
0.01). The mean LSA improved from 36.6° (31° to 43°) to 15.4°
(8° to 21°) (p <
0.01). The mean AOA decreased from 64.4° (50°
to 78°) 32.0° (25° to 39°) post-operatively (p <
0.01). The mean
CTD improved from -8.2 mm (-13.8 to +3.1) to +2.8 mm (-7.6 to +11.0)
(p <
0.01). Two patients underwent further surgery for nonunion.
No patient suffered avascular necrosis of the femoral head. Subcapital osteotomy for patients with a healed SCFE is more
challenging than subcapital re-orientation in those with an acute
or sub-acute SCFE and an open physis. An effective correction of
the deformity, however, can be achieved with relief of symptoms
related to impingement. Cite this article:
