Background: Trigger fingers, a common cause of hand pain and dysfunction, are routinely treated with injected corticosteroids; however, the most efficacious formulation remains unknown. We conducted a randomized, double-blind trial and hypothesized that a 0.5 mL injection of triamcinolone (40 mg/mL) would be the most efficacious injection compared with dexamethasone (4 mg/mL) or triamcinolone (10 mg/mL) for preventing escalation to surgery. Methods: Ninety-five digits from 85 adult patients were assigned to receive 0.5 mL lidocaine plus 0.5 mL of triamcinolone (40 mg/mL), triamcinolone (10 mg/mL), or dexamethasone (4 mg/mL). Patients with continued triggering at 6 weeks received a second injection. At 12 weeks, patients who remained symptomatic were offered surgery. Final assessment occurred at 6 months. The primary outcome was treatment success, defined as no need for a second injection or surgery during the study period. Secondary outcomes included PROMIS Upper Extremity, Green Classification of Trigger Finger, QuickDASH, and VAS pain scores. Results: There were no significant differences in the groups’ demographic characteristics, grade of trigger finger, or outcome scores at baseline ( P >0.05). At 6 months, treatment success did not differ between groups ( P =0.82). The dexamethasone group had more patients with full relief by Green grade at 6 weeks ( P =0.02); however, this was not reflected in patient-reported outcomes or pain scores. There were no significant differences in secondary outcome measures by 12 weeks ( P >0.05). Conclusions: There was no statistically significant difference in treatment success between treatment groups. Hand surgeons may confidently use their preferred corticosteroid formulation.
Background and Purpose: Internal fixation (IF) and total hip arthroplasty (THA) are both used as treatments for femoral neck fracture (FNF). The decision on the surgical method is made on an individual level, depending on the patient’s functional demands, fracture type, and the amount of fracture displacement. The goal of this study was to evaluate whether THA provides a better functional outcome compared with IF when evaluated by the Oxford Hip Score (OHS). Patients and Methods: A total of 132 FNF patients were included. Ninety-six (73%) patients underwent THA, and 36 (27%) underwent IF. The mean age was 68 (SD=9) years, and 86 (65%) were female. The results were analyzed using a linear mixed-effects model. Results: At 1 year, the mean difference in OHS scores between the patients treated with THA and those treated with IF was 7.5 points (95% CI: 3.6–11.4, P =0.0003). When the patients who underwent reoperation during the follow-up time were removed from the analysis, the difference decreased but was still statistically significant with a mean difference of 4.4 points (95% CI: 0.7–8.0, P =0.02). Five (14%) patients in the IF group and one (1%) patient in the THA group underwent reoperations. When the reoperated patients were removed from the sample, the difference was mitigated but still statistically significant with a mean difference of 4.35 points (95% CI: 0.65–8.05, P =0.02). Interpretation: The patients treated with THA had a better functional outcome compared with IF at the 1-year follow-up.
Background: Frailty is characterized by decreased physiological reserves and impaired functioning of multiple systems. This study investigated the association between frailty and hospital outcomes such as postoperative complications, length of hospital stays, readmission rates, and functional outcomes following THA. Methods: Data for this study were retrieved from the Nationwide Inpatient Sample (NIS) database, 2018–2021. Adult patients 18 years and above with a primary diagnosis of THA were identified using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-10-CM) codes. We identified frail patients using the Hospital Frailty Risk Score (HFRS). The main outcomes of this study were surgical complications, medical complications, in-hospital mortality, and prolonged length of stay. Results: There were 1,725,550 THA hospitalizations, of which 9.1% (156,275) were frail. Logistic regression analysis showed that frailty was associated with significantly greater odds of surgical complications (OR, 4.77, 95% CI: 4.27–5.33), medical complications (OR, 2.68, 95% CI: 2.59–2.76), other complications (OR, 8.13, 95% CI: 7.53–8.78), any complications (OR, 3.17, 95% CI: 3.08–3.27), mortality (OR, 2.74, 95% CI: 1.99–3.54), and prolonged length of stay (OR, 5.25, 95% CI: 5.05–5.45). Conclusion: Frailty significantly impacts postoperative outcomes in patients undergoing THA, leading to increased complications, in-hospital mortality, and prolonged hospital stays. A proactive approach for managing frailty could lead to better resource utilization and enhanced recovery following THA.
