Introduction:Atypical femoral fractures (AFFs) are insufficiency fractures of the lateral femoral cortex and represent a rare but significant complication of long-term bisphosphonate or denosumab therapy. Our report explores the surgical techniques utilised to avoid varus malalignment in these two complex cases, both of which fulfilled the American Society for Bone and Mineral Research (ASBMR) criteria for AFFs. Case Presentation:Case 1 presents a woman in her early 60s with over 8 years of bisphosphonate use, who developed simultaneous AFFs. She underwent bilateral internal fixation with cephalomedullary nails. This was followed by revision surgery and a valgus correction for right femoral fracture nonunion.Case 2 presents a man in his late 60s with prior exposure to bisphosphonates and denosumab (< 7 years), who sustained a left AFF. Initial cephalomedullary nailing was complicated by nonunion and hardware failure, necessitating revision with a valgus correction. Conclusion:Our cases emphasise the importance of recognising symptoms during follow-up assessments and provide a detailed account of the surgical techniques employed in the revision fixation of AFFs, with a particular emphasis on achieving valgus alignment, maintaining a medial entry point and avoiding varus malalignment to optimise mechanical stability, reduce the risk of postoperative nonunion and promote fracture healing.

Aims In hip fracture surgery, blood transfusions are common. Allogenic blood transfusions can be associated with adverse effects, and so their use should be reduced where possible. The current study aims to further the knowledge base around the use of tranexamic acid (TXA) in hip fracture surgery patients. This study will focus on outcomes following the use of perioperative TXA in hip fracture patients, with the primary aim of assessing transfusion rates and thromboembolic events. Methods This was a single-centre, retrospective cohort study performed in a high-volume academic trauma unit managing 416 hip fractures per year. Patients undergoing surgery for a hip fracture between August 1, 2019, and August 1, 2020 were included. Two groups, based on whether or not the patient received TXA, were identified. Primary outcomes of interest were transfusion rates, postoperative haemoglobin levels, and the rate of venous thromboembolism (VTE). Results A total of 351 patients were included, 178 in the control group and 173 in the TXA group. On univariate analysis, there were four variables associated with postoperative transfusion: age (RR 1.03, 95% CI 1.01-1.04, p < 0.0001), American Society of Anaesthesiologists (ASA) (RR 1.75, 95% CI 1.35-2.27, p < 0.001), TXA (RR 0.64, 95% CI 0.45-0.94, p = 0.022), and preoperative haemoglobin level (RR 0.93, 95% CI 0.90-0.94, p < 0.0001). On multivariate analysis, both the preoperative haemoglobin (p < 0.0001) and administration of TXA (p = 0.047) were significantly associated with a reduced need for postoperative transfusions. Day 1 haemoglobin levels in the TXA group were significantly higher compared to the no-TXA group (107 g/L, s = 19.9, 95% CI 103.1-109.8 vs 101 g/L, s = 19.2, 95% CI 97.9-104.1, p = 0.0183). With regards to VTE, there was no statistically significant increase in the rate of VTE with the use of TXA for deep venous thrombosis (DVT) (p = 0.242) or pulmonary embolism (PE) (p = 0.242). Conclusion Administering intraoperative TXA is associated with reduced postoperative transfusion rates and improved postoperative haemoglobin levels in hip fracture patients, while not increasing VTE events. Further research in this field should focus on determining an ideal dose, mode of delivery, and timing of TXA administration to optimise its efficacy.

Background The suprapatellar (SP) approach to tibial intramedullary nailing has evolved substantially over the past three decades, transitioning from a technically innovative alternative to the infrapatellar (IP) method into a globally recognized standard for tibial shaft fracture management. This bibliometric study aimed to evaluate global publication trends, research themes, and evidence evolution surrounding SP tibial nailing between 1995 and 2025. Methods A comprehensive bibliometric and evidence-based analysis was performed using the PubMed/MEDLINE and Crossref databases. Studies published from January 1995 to October 2025 were identified using predefined search terms. Eligible articles addressing suprapatellar or semi-extended tibial nailing were screened for design, origin, citation impact, and evidence level. Results A total of 128 eligible studies were identified, including clinical trials, cadaveric analyses, and systematic reviews. Global publication output increased exponentially after 2012, coinciding with the introduction of specialized SP instrumentation. The United States, United Kingdom, Germany, China, and Australia collectively contributed over two-thirds of publications. Recent years (2020–2025) demonstrated a transition from observational studies to high-level evidence, with six randomized controlled trials and six meta-analyses identified. Quantitative trends revealed reduced operative times, improved alignment, and lower rates of anterior knee pain with SP compared to IP nailing. Conclusion Bibliometric and evidence synthesis confirms a steady progression in research quality and international collaboration in SP tibial nailing. The accumulated body of evidence supports SP nailing as a safe, efficient, and reproducible technique with distinct advantages over the infrapatellar approach. Continued longitudinal and cost-effectiveness analyses are warranted to consolidate its role in modern orthopaedic trauma practice.

OBJECTIVES:Prognostic models have the potential to aid clinical decision-making after hip fracture. This systematic review aimed to identify, critically appraise, and summarize multivariable prediction models for mortality or other long-term recovery outcomes occurring at least 30 days after hip fracture. STUDY DESIGN AND SETTING:MEDLINE, Embase, Scopus, Web of Science, and CINAHL databases were searched up to May 2023. Studies were included that aimed to develop multivariable models to make predictions for individuals at least 30 days after hip fracture. Risk of bias (ROB) was dual-assessed using the Prediction model Risk Of Bias ASsessment Tool. Study and model details were extracted and summarized. RESULTS:From 5571 records, 80 eligible studies were identified. They predicted mortality in n = 55 studies/81 models and nonmortality outcomes (mobility, function, residence, medical, and surgical complications) in n = 30 studies/45 models. Most (n = 46; 58%) studies were published since 2020. A quarter of studies (n = 19; 24%) reported using 'machine-learning methods', while the remainder used logistic regression (n = 54; 68%) and other statistical methods (n = 11; 14%) to build models. Overall, 15 studies (19%) presented 18 low ROB models, all predicting mortality. Common concerns were sample size, missing data handling, inadequate internal validation, and calibration assessment. Many studies with nonmortality outcomes (n = 11; 37%) had clear data complexities that were not correctly modeled. CONCLUSION:This review has comprehensively summarized and appraised multivariable prediction models for long-term outcomes after hip fracture. Only 15 studies of 55 predicting mortality were rated as low ROB, warranting further development of their models. All studies predicting nonmortality outcomes were high or unclear ROB. Careful consideration is required for both the methods used and justification for developing further nonmortality prediction models for this clinical population.

Purpose: Intertrochanteric hip fractures are significant and costly injuries and there remains controversy within the orthopaedic literature over the best method of fixation. The Irish Hip Fracture Database (IHFD) was established in 2012 to drive improvements in clinical outcomes and the quality of hip fracture care. This paper will review the outcomes of dynamic hip screw (DHS) versus intra-medullary nailing (IMN) in the treatment of intertrochanteric hip fractures in Ireland. Methods: Eligible cases for this study include patients >60 years of age with trochanteric hip fractures treated by DHS or IMN between January 2016 and December 2020. Outcomes recorded and compared include length of stay, inpatient mortality, mobilisation on postoperative day 1 (POD 1), and discharge destination. Results: 5668 hip fractures treated with DHS or IMN were identified. There was no significant difference between inpatient mortality, re -operation rate or length of stay between the two groups. Females and patients with a high ASA grade (IV and V) were more likely to receive IMN. Patients receiving DHS were more likely to be mobilised day 1 post -operatively and be discharged directly home. It was noted that the use of IMN increased from 42% of cases in 2016 to 70% in 2020. Conclusion: IMN use for intertrochanteric fractures continues to increase. However, patients treated with DHS were more likely to mobilise early post -operatively and to go directly home. Notwithstanding the limitations of national registry data research, the dramatic rise in the use of IMN for these fractures appears unsupported by the evidence. (c) 2023 Published by Elsevier Ltd.

Introduction (contexte de la recherche) Depuis la première promotion du Diplôme d’études spécialisées (DES) d’allergologie en 2017, 205 postes ont été ouverts et tous ont été pourvus. L’Association des jeunes allergologues français (AJAF) et le Conseil national professionnel d’allergologie (CNPA) ont souhaité faire un état des lieux concernant l’orientation des premiers allergologues diplômés et les projets de ceux encore en formation. Objectif Évaluer les projets professionnels des jeunes allergologues français, issus du DES d’allergologie.Méthodes Nous avons réalisé une enquête entre le 29/10 et le 09/12/2023, via un questionnaire diffusé sur les réseaux sociaux et les listes de diffusion de l’AJAF et du CNPA. Résultats Soixante-dix-sept questionnaires ont été recueillis, soit un taux de réponse de 38 % (sur 205 sondés) dont 10 à 14 réponses par promotion, par l’ensemble des subdivisions (1 à 10 réponses par subdivision).Concernant les perspectives d’exercice, 79 % envisagent une activité mixte, 36 % libérale, 35 % hospitalière, 10 % salariée et 9 % dans un laboratoire de recherche. Les Unités Transversales d’Allergologie (UTA) intéressent 74 % des personnes.Quarante-cinq pour cent souhaitent dédier leur temps de travail à respectivement 60 % pour les consultations et 40 % pour les hospitalisations de jour.Quatre-vingt-quatorze pour cent des personnes se disent heureuses dans cette spécialité même si plusieurs craintes ont été soulevées : le faible nombre d’internes formés malgré la demande croissante, la faible cotation des actes, la concurrence des postes avec ceux d’autres DES faisant des formations complémentaires en allergologie. Conclusions Si la spécialité est attrayante, le faible effectif d’allergologues formés est préoccupant à la lumière des prévisions de l’Organisation mondiale de la santé pour 2050, estimant à 50 % la prévalence des maladies allergiques à l’échelle mondiale. Les jeunes allergologues aspirent majoritairement à une pratique mixte. L’enjeu des prochaines années sera de conforter la place des allergologues face à la pluralité des spécialités qui peuvent se former en allergologie et valoriser leur exercice, que ce soit au sein d’UTA ou non.

Background: Hip fractures are increasing in incidence due to increasing life expectancy. Mortality continues to improve but it is important to explore which factors are responsible for driving improvements. Methods: A cohort of hip fracture patients predating SARS-CoV-2 was examined to determine the predictors of adherence to the six Irish Hip Fracture Standards (IHFS) and the impact of adherence on short (30 day) and long term (1 year) mortality. Our primary aim was assess the impact of a single HFS and cumulative number of HFS on mortality after hip fracture. Our secondary aim was to determine the impact of the HFS which are intrinsically linked to specialist Geriatric care. Results: Across 962 patients, over 5 years, the factors which were associated with adherence to HFS were female gender, increasing ASA grade and being nursed on an orthopaedic ward. Patients with increasing ASA were more likely to have met HFS 4-6 (Geriatrician review HFS4, bone health HFS5 & specialist falls assessment HFS6), less likely to have surgery within 48 h are more likely to develop a pressure ulcer. If the patient was not nursed on an orthopaedic ward all HFS were less likely to be met. At 30 days HFS 4-6 were associated with a statistically significant odds ratio (OR) of being alive, while at one year HFS 1 (admitted to an orthopaedic ward within 4 h), 5 and 6 were associated with a statistically significant OR of being alive. As increasing numbers of hip fracture standards were met patients were more likely to be alive at 30 days and one year. Conclusion: This study has identified that improved adherence to hip fracture standards are associated with improved mortality at 30 days and one year. (c) 2023 Published by Elsevier Ltd on behalf of Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland.

This study performed an in-depth investigation into the myeloid cellular landscape in the synovium of patients with rheumatoid arthritis (RA), “individuals at risk” of RA, and healthy controls (HC). Flow cytometric analysis demonstrated the presence of a CD40-expressing CD206 + CD163 + macrophage population dominating the inflamed RA synovium, associated with disease activity and treatment response. In-depth RNA sequencing and metabolic analysis demonstrated that this macrophage population is transcriptionally distinct, displaying unique inflammatory and tissue-resident gene signatures, has a stable bioenergetic profile, and regulates stromal cell responses. Single-cell RNA sequencing profiling of 67,908 RA and HC synovial tissue cells identified nine transcriptionally distinct macrophage clusters. IL-1B + CCL20 + and SPP1 + MT2A + are the principal macrophage clusters in RA synovium, displaying heightened CD40 gene expression, capable of shaping stromal cell responses, and are importantly enriched before disease onset. Combined, these findings identify the presence of an early pathogenic myeloid signature that shapes the RA joint microenvironment and represents a unique opportunity for early diagnosis and therapeutic intervention.

Background: The aim of this study was to analyse the association between use of cement for stem fixation in hip hemiarthroplasty and the outcomes of mobility, mortality, and discharge destination. Methods: The Irish Hip Fracture Database was examined from 2016 to 2020 to assess for any difference in post op mobility, 7-day, 14-day and inpatient mortality, and discharge destination. Results: A total of 7109 hemi-arthroplasties were identified from 2016 to 2020. 71.6% were cemented (n 1/4 5,172), with 28.4 % uncemented (1,937). There was no difference in day 1 post op mobilisation (79.7 % vs 80.9 %) or cumulative ambulatory score on discharge (2.5 vs 2.4). The mortality rate was equivocal at all time points between the cemented and uncemented groups (7 day (.9 % vs 1.2 %), 14 day (1.9 % vs 2.3 %), inpatient (4 % vs 5.1 %)). There was no difference in length of stay (11 vs 12 days) or discharge to home directly (21 % vs 27 %). Conclusion: The use of cement did not have any significant difference on post op mortality, mobility or discharge destination.

BACKGROUND:The tibial tuberosity-trochlear groove (TTTG) distance is used to assess patellofemoral instability (PFI) and the likelihood of the development of patellofemoral disorders. The current gold standard in the assessment of the TTTG is computed tomography (CT) or magnetic resonance imaging (MRI). The current image software used for viewing these CT images does not allow for easy assessment of the TTTG.AIMS:This study presents a simple method to measure the TTTG on any image software, utilizing easily available and affordable stationary.METHODS:Four consecutive patients with no known knee pathologies were selected from recent studies at our institution. Their TTTGs were measured using this study's method and validated using the standard, freely available image analysis software Fiji. Pre-defined anatomical landmarks were located and marked using adhesive pieces of paper. The TTTG was defined as the distance between parallel lines through the apex of the tibial tuberosity and trough of the trochlear groove, where each of these lines is perpendicular to the Dorsal Condylar Line.RESULTS:The TTTG measured using this study's method was found to be in agreement with the measurements made using Fiji software.CONCLUSIONS:This study demonstrates that the TTTG can be simply and quickly assessed using readily available and affordable stationery, without the need for expensive or complex secondary analysis software. This could allow for the assessment of PFI in the outpatient clinic whilst the patient is present, offering valuable assistance to the orthopaedic surgeon in clinical decision making.

Le FIRE Syndrome ou Food-Induced Immediate Response in the œsophagus syndrome (FIREs) décrit récemment dans l’œsophagite à éosinophile (EoE), se caractérise principalement par une douleur aiguë rétrosternale angoissante pouvant être confondue avec un syndrome oral ou une crise d’asthme. Décrire les caractéristiques allergologiques des patients présentant un FIREs afin de sensibiliser le clinicien. Étude rétrospective monocentrique incluant des patients avec un FIREs. Les prick-tests sont réalisés avec des extraits allergéniques (ALK, Stallergène) et des aliments natifs. Le profil de sensibilisation moléculaire repose sur des IgE spécifiques (unitaire ou puce ISAC, ThermoFisher). Au total, 9 patients, âgés de 12 à 38 ans, majoritairement des hommes ont été inclus. 1 patient n’a aucune allergie. Les comorbidités atopiques les plus fréquentes sont la rhino-conjonctivite pollinique (78 %), l’asthme, l’allergie alimentaire puis la dermatite atopique. Tous sont sensibilisés aux pollens dont graminées (67 %), oléacées (56 %), plantain (56 %), bouleau (44 %), et 75 % à un allergène per annuel. Une majorité présente une sensibilisation aux panallergènes : PR10 (56 %), LTP (44 %), Profiline (44 %), TLP (22 %). 3 patients sont sensibilisés aux protéines de stockage des graines, 2 à la parvalbumine et 2 à la tropomyosine. Tous présentent une marche atopique classique, l’EoE apparaissant en dernier. Le SAPA précède toujours le FIREs. Pour 8 patients, il est le premier signe clinique d’EoE, précédant en moyenne de 6 ans la dysphagie (6/9), le pyrosis (1/9) et l’impaction (4/9). Il a conduit à une gastroscopie chez 5 patients. L’EoE est confirmée dans un délai moyen de 9 ans. La thérapeutique repose sur les IPP (7/9), la corticothérapie locale (5/9) ou leur association (6/9). La réponse clinique est complète pour 6 patients, partielle pour 1 et non évaluée pour 2. Sous traitement, le régime d’éviction a été élargi. Le FIREs est présent principalement chez des hommes atopiques, polliniques avec un SAPA. Il précède les autres signes évocateurs d’EoE de plusieurs années. Sa connaissance sur ce terrain pourrait réduire les délais diagnostics. Ces données sont à confirmer sur une plus large cohorte.

AB073. SOH23ABS_133. Service-level factors associated with total arthroplasty rate and time to arthroplasty surgery after hip fracture in Ireland: analysis of the national Irish Hip Fracture Database 2017–2020

L’acide clavulanique (AC) fait partie des bêtalactamines, et plus précisément des uréidopénicillines. Elle s’administre le plus souvent en association avec l’amoxicilline pour son activité anti-pénicillinase. L’allergie à l’AC est rare et seulement très peu de cas ont été décrit dans la littérature. Elle concernerait 15 à 35 % des allergies à l’Augmentin® [1]. Nous décrivons ici 4 cas d’anaphylaxies survenues après un 1er comprimé d’Augmentin® et les moyens diagnostiques mis en œuvre pour prouver l’allergie à l’AC. Nous avons réalisé un bilan allergologique associant prick-test (PT), intradermoréaction (IDR), test de provocation (TPO) et test d’activation des basophiles (TAB) si réalisable. La première patiente a présenté une anaphylaxie de grade 2 selon la classification de Ring et Messmer avec angiœdème du visage, nausées et malaise 30 min après la prise du comprimé. L’IDR Augmentin® (2 mg/mL) était positive. L’IDR amoxicilline (20 mg/mL) était négative et tout comme le TPO jusqu’à la dose de 500 mg. La deuxième patiente a présenté une urticaire et un angiœdème du visage (grade 2) 15 min après la prise. Le PT (20 mg/mL) et l’IDR amoxicilline (0,2 mg/mL) étaient négatifs, alors que le PT (20 mg/mL) et l’IDR Augmentin® (0,2 mg/mL) étaient positifs tout comme le TAB. Le 3e patient a présenté des vomissements, une urticaire et une perte de connaissance dans l’heure suivant la prise (grade 3). Les IDR (20 mg/mL) étaient douteuses pour l’amoxicilline et l’Augmentin®. Le TAB était positif pour l’Augmentin® et négatif pour l’amoxicilline. Le 4e patient a présenté une urticaire, une dyspnée et une hypotension (grade 3) 30 min après la prise. Le PT, l’IDR (2 mg/mL) et le TAB à l’amoxicilline étaient négatifs, tout comme le TPO. L’IDR (0,2 mg/mL) et le TAB à l’Augmentin® étaient positifs. L’allergie à l’AC est rare. Nous recommandons de tester systématiquement l’Augmentin® et l’amoxicilline en cas de suspicion d’allergie à l’Augmentin® afin de ne pas méconnaître cette allergie.

Background Fragility fractures are described as fractures resulting from low-energy trauma and are considered diagnostic of reduced bone mineral density or osteoporosis. They often present as hip fractures with hip fractures remaining a common but devastating injury among older patients. Many factors influence a patient’s risk of hip fracture and their subsequent risk of death. Aim In this study, we examined if previous fragility fracture impacts upon mortality after hip fracture. Methods This was a retrospective single-center cohort study of patients included in the Irish Hip Fracture registry over a 5-year time period. Epidemiological data including gender, age, type of fracture, type of surgery, bone protection medication, American Society of Anesthetics (ASA) grade, and post-fracture outcomes including death at 30 days and death at 1 year were recorded. The presence or absence of a previous fragility fracture was examined to explore if a previous fragility fracture was an independent predictor of mortality. Results There were 964 patients included, and 290 of whom had sustained a previous fragility fracture; 289 patients were males and 675 females, 33 patients had died in the 30 days following their surgery, and 180 patients had died within 1 year. We found statistically significant results for gender and age but not for previous fragility fracture influencing mortality ( p value 0.230). Conclusion We found that previous fragility fracture does not impact upon mortality in a hip fracture cohort. However, gender and age did impact upon mortality in this study.