OBJECTIVES:Falls cause more than 85% of hip fractures in older adults. Older adults with cognitive impairment have been largely excluded from research on people who have sustained a hip fracture. As a consequence, whether exercise reduces fall risk in this high-risk population is unknown. We address this gap by examining the effect of a home-based exercise program on fall risk in older adults with mild cognitive impairment after hip fracture. METHODS:This was a 6-month randomized controlled trial comparing the effect of the Otago Exercise Program (OEP) versus standard care (SC) on fall risk measured with the Physiological Profile Assessment. Participants with mild cognitive impairment (Montreal Cognitive Assessment score <26/30 and no dementia) who sustained a hip fracture were included. Secondary outcomes included the Short Physical Performance Battery, gait speed, Digit Symbol Substitution Test, Rey Auditory Verbal Learning Test immediate and delayed recall, and Clinical Frailty Scale. RESULTS:Sixty participants, mean age 80 years (SD 7 years), were randomized (OEP, n = 30; SC, n = 30). At 6 months, compared with SC participants, OEP participants had significantly better Physiological Profile Assessment performance (estimated mean difference -0.73; 95% CI [-1.45, -0.11]; p = 0.048), delayed recall performance (estimated mean difference 1.11; 95% CI [0.14, 2.09]; p = 0.025), and Clinical Frailty scores (estimated mean difference -0.71; 95% CI [-1.40, -0.01]; p = 0.046). There were no effects of the intervention on other secondary outcomes at 6 months. CONCLUSIONS:The Otago Exercise Program was efficacious at reducing fall risk in older adults with mild cognitive impairment after hip fracture. Exercise also improved cognitive function and frailty, highlighting its critical role in recovery after hip fracture in this high-risk population.

Sophisticated biofidelic finite element (FE) models of sideways falls are an emerging tool for predicting hip fracture risk. We adapted an existing experimental setup for in-silico trials by creating an automated workflow to build FE models of the experiment and characterizing it with respect to the effects of limited CT scan coverage. Limited CT scan coverage was simulated by shortening the femur (25–175mm distal to the greater trochanter), misaligning the femur up to 5 degrees, and using a morphed template pelvis. We compared impact force error (EBL) of the FE results to the existing experimental results. We then characterized the limited CT scan coverage with respect to the impact force (EI), femur force (EF), and fragility ratios based on the impact force (EFRI) and the femur force (EFRF) by comparing results to a model without any of these scan-related errors introduced. In general, the baseline simulations agreed well with the experiments (EBL: μ = − 0.007 kN, σ = 0.409 kN). When scan coverage errors were introduced, the errors were small (EI: μ = 0.082kN, σ = 0.232kN; EF: μ = 0.063 kN, σ = 0.228 kN; EFRI: μ = − 0.00, σ = 0.058; EFRF: μ = − 0.012, σ = 0.074). The pelvis template used explained the most variance of the output measures (EI R2 = 0.876; EF R2 = 0.880; EFRI R2 = 0.901; EFRFR2 = 0.884). These results indicate that this automated methodology is suitable for typical scan coverages encountered clinically, and future work should use this workflow to explore fragility fractures in larger clinical cohorts.

Abstract The challenge of achieving delayed primary closure of fasciotomy wounds is well known, and multiple techniques of achieving either delayed primary closure or alternative forms of soft-tissue reconstruction have been described in the literature. However, a universally accepted consensus of the optimal management strategy has yet to be established. We describe our experience with a device designed to use the mechanical concept of dermatotraction—a surgical technique that uses the skin's natural elasticity to close wounds. This device (ABRA Surgical, Southmedic, Inc) promotes a delayed primary wound healing environment and facilitates dynamic approximation of wound edges in complex fasciotomy defects. During ward-based dynamic closure fasciotomy defects transition to a state where primary closure is safely achievable. This avoids the need for soft-tissue reconstruction which is associated with variable outcomes and cosmetic acceptance. Here, we present our surgical technique and case series using this dynamic closure device.

To evaluate whether near-infrared spectroscopy (NIRS) can noninvasively characterize dynamic muscle oxygenation during treadmill running and differentiate healthy physiology from chronic exertional compartment syndrome (CECS). Methods: Bilateral anterior compartment NIRS monitoring was performed in 45 asymptomatic participants (90 legs) and in a female patient with bilateral exertional leg pain referred for CECS evaluation. Tissue oxygenation index (TOI) was measured during standardized treadmill running and supine recovery. Symptomatic limbs underwent invasive intercompartmental pressure (ICP) testing. Results: Asymptomatic legs demonstrated a consistent positive.TOI post-exercise signature (increased oxygenation during running), independent of sex, limb side, and fitness level. BMI, height, weight, and age modulated.TOI responses. In contrast, symptomatic limbs demonstrated negative.TOI post-exercise, concordant with post-exercise ICP elevation. Resting TOI did not differentiate cohorts; differences emerged only under dynamic loading. Conclusion: NIRS-derived.TOI reflects exertional perfusion-oxygenation coupling and may serve as a noninvasive physiological surrogate for CECS diagnosis. Optical signatures aligned qualitatively with ICP, supporting continued translational development.

OBJECTIVES:To evaluate a new compartment pressure monitor reporting continuous pressures and its contribution to Acute Compartment Syndrome (ACS) diagnosis. METHODS:Design: Multicenter, non-randomized, prospective study. SETTING:Six Level-I Trauma Centers. PATIENT SELECTION CRITERIA:Enrolled were patients with acute long bone fractures (OTA 11-13, 2R, 2U, 31-33, and 41-43) where the Micro Electric Mechanical Sensor (MEMS) device was inserted either pre- or post-operatively into the compartment most likely to develop ACS, as deemed by the surgeon. Intracompartmental pressures (ICP) were continuously measured for up to 18 hours (as indicated by the FDA and Health Canada); clinical signs were simultaneously assessed for canonical compartment syndrome signs. OUTCOME MEASURES AND COMPARISONS:The primary measurement outcomes were ease of use, accuracy, and safety of the device across all participating sites. Ease of use was assessed through surveys completed by surgeons, which evaluated their confidence in the device's functionality and usability. Accuracy was determined by analyzing patient outcomes, using surgical findings and clinical resolution as the gold standards, to assess whether the device's results corresponded to true positive and true negative cases of compartment syndrome. Feasibility was defined as the device's ability to integrate into the clinical workflow, operate reliably under typical conditions, and provide actionable data for ACS diagnosis. The secondary outcomes included continuous intracompartmental pressure (ICP) measurements and their diagnostic value. Sensitivity and specificity were evaluated by comparing continuous ICP data with clinical assessments based on the "6 P's" (pain, pallor, paresthesia, pulselessness, poikilothermia, and paralysis) to determine their combined utility in diagnosing ACS. RESULTS:A total of 100 patients, 68 males and 32 females with an average age of 42 years old (17-80 years old), were enrolled. All of the patients had suffered a fracture, 25 proximal tibias (OTA/AO-41), 40 midshaft tibias (OTA/AO42), 13 distal tibias (OTA/AO43), 11 forearms (OTA/AO 2R.2U), 6 femurs (OTA/AO31-33), 5 humerus (OTA/AO 11-13). Eighty-nine patients received the MEMS device post-operatively and 11 patients pre-operatively. 93% of participating surgeons reported confidence in the device's function and ease of use. Pressures were measured on average for 16h36 (3h-18h). No complications were reported. Post-operative ICPs (25.4 mmHg) were higher (p =0.0462) on average than pre-operative ICPs (18.9 mmHg). Patients that did not develop Compartment Syndrome had their post-operative pressures trend down after 4 hours (23.8mmHg). Sensitivity and specificity analyses of ICP alone, delta P alone, pressure trends alone, or a combination of the three metrics were conducted using patient outcomes as the gold standard for diagnostic accuracy. The trend of the curve in continuous monitoring pressure measurements proved more reliable than a single absolute pressure value in aiding in the correct diagnosis of ACS deviating from standard ACS diagnosis literature The MEMS device allowed earlier diagnosis of ACS by 4 hours (. When continuous pressure measurement was combined with standard clinical examination, the sensitivity and specificity reached 100%. CONCLUSIONS:The MEMS-based device reliably enabled continuous compartment pressure monitoring in all the study institutions. Further examination of continuous trends and accompanying perfusion pressure could allow surgeons the clinical adjunct to diagnose ACS many hours earlier than clinical signs alone. LEVEL OF EVIDENCE:Level II - Prospective study.

In a resource limited environment, clinicians need to prioritize care. Identifying who would most benefit from care, specifically early care, could inform this decision. We introduce a new way to identify patients who will benefit the most when deciding who should be treated first, in hip fracture cases where timing of surgery matters. We assess the probability that the surgery timing is a necessary and sufficient cause for reduction of in-hospital mortality. This approach, Unit Selection based on counterfactual logic developed by Mueller and Pearl, provides a deeper understanding of individual benefits compared to traditional risk assessment tools. We studied hospital records of patient undergoing hip fracture in Canada over 8 years, using the CIHI Discharge Abstract Database. First, we compared the effect of having surgery within two days to waiting longer on 64 groups (strata) of patients with different health, age, hospital, and care factors. Using a Unit Selection approach, we estimated the probability of benefit (decreased probability of mortality), or how likely each group was to benefit from early surgery. We measured the benefit for each person by comparing their potential outcomes after early and delayed surgery. In a cohort of 139,119 patients (74.3% women, 45.8% 85 years or older, 67% receiving early surgery -within 2 days), the average effect showed 8 fewer deaths per 1,000 surgeries when treatment was received early, within 2 days. In 14 out of 64 groups there was a much greater benefit from early surgery than the stated average: with their upper bound ranging from 7% to 15%. We identified Pre-hospital place of residence, Age, Type of Surgery (arthroplasty vs fixation) and Care environment (teaching vs community hospital), as important factors that define the population that may benefit from early surgery (Fig 1) Measuring probability of benefit using the Unit Selection method helped identify “who should go first” by looking at how likely it is that an individual patient benefit from early surgery. We created a Personalized Decision Making Tool that compares the individual-level benefit in different groups based on their clinical and care factors. This could assist doctors in determining which patients should receive hip fracture surgery first when prioritization is necessary. For any figures or tables, please contact the authors directly.

BACKGROUND:Radiographic imaging is an essential tool for surgeons in classifying injury, guiding treatment decision-making, and assessing for adequate intraoperative reduction. However, the heterogeneity in radiographic outcome measures utilized in clinical studies evaluating proximal humerus fracture treatment has made it difficult for surgeons to interpret and analyze the available evidence, leading to continued controversy in the optimal management of these injuries. The aims of this systematic review are to 1) examine the literature to describe the methods for measuring and interpreting radiographic outcomes for malunion and 2) identify studies that have correlated functional outcome measures and radiographic outcome measures. METHODS:In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline, a systematic review of the literature was performed using EMBASE, MEDLINE, and the Cochrane Database of Systematic Reviews from inception to January 30, 2024. Outcomes of interest included radiographic outcome measures and functional outcome measures including pain assessment and range of motion measurements. RESULTS:A total of 36 studies that used radiographic measures of alignment following treatment and union of proximal humerus fractures were identified. The most common measure was the head-shaft angle, utilized in 33 studies (92%). Tuberosity position was reported in 22 studies (61%). Only 21 studies (58%) provided a clear and reproducible technique for obtaining radiographic measures. The interpretation for radiographic malunion varied between studies. Varus malunion, using head-shaft angle measures, was defined as under 105° to under 130° in different studies. Although there is known variation between patients, only 3 studies utilized the imaging from the contralateral shoulder to define patient specific measures for malunion. Twenty-two studies assessed for an association between head-shaft angle malunion and patient functional outcome measures. DISCUSSION AND CONCLUSION:Given the broad and inconsistent definition of malunion used between the included studies, there remains a lack of clear threshold for radiographic measures of alignment that surgeons can use in their clinical decision-making for proximal humerus fractures. Based on the evidence available, we propose a consistent definition of head-shaft angle measurement drawn from specified radiographic views, with varus malunion defined as <125° and valgus malunion >140°. To optimize the management and outcome of these fractures, radiographic outcomes must be standardized and correlated with function.

The anterior intrapelvic (AIP) approach has become a standard technique for the fixation of acetabular fractures. While the critical steps for performing the AIP approach are well described in the literature, a comprehensive overview of the anatomical structures at risk remains limited. This review aims to provide an in-depth understanding of the AIP approach with a focus on the historically "nonorthopaedic" surgical anatomy and associated risks. Ultimately, this knowledge empowers orthopaedic trauma surgeons to perform acetabular surgery with improved exposure, safety, and confidence.

BACKGROUND:Fall-related traumas like hip fracture are a common yet devastating injury with poor outcomes. Characterizing fracture biomechanics and bone-implant kinematics is essential to increase our understanding of these events to inform treatment and prevention strategies. METHODS:This study developed a bilateral high-speed x-ray methodology for the real-time capture of fracture and kinematic data near the hip during fall impacts. High speed x-ray was applied to capture fall impacts of seven cadaveric pelvis-femur specimens encased in a soft tissue surrogate, using a previously developed method. In these specimens, the intact proximal femur had been prophylactically reinforced with an intramedullary nailing system intended to prevent fragility fractures. The feasibility of extracting 3D kinematic data from x-ray data was investigated. FINDINGS:The HSXR system demonstrated visual clarity and sufficient resolution for capturing skeletal fracture and kinematics. The data in this study revealed fracture and newly-seen deformations of the pelvis, highlighting the ability of the x-ray system to document real-time fracture and kinematic events. Kinematic data in 3D was extracted with sufficient accuracy for one specimen. INTERPRETATION:These results demonstrate the merit of high-speed x-ray for studying periprosthetic fracture, which is of increasing relevance due to increasing populations with orthopedic hardware. Application of this method advances our understanding of impact-related biomechanics and fracture mechanics during a clinically-relevant fall from standing.

Objective: Pelvic fractures often require fixation through iliosacral joint, typically guided by fluoroscopy using an untracked C-arm device. However, this involves ionizing radiation exposure and potentially inaccurate screw placement. We introduce the Navigated Orthopaedic Fixations using Ultrasound System (NOFUSS), a radiation-free ultrasound (US)-based end-to-end system for providing real-time navigation for iliosacral screw (ISS) insertions. Methods: We performed surgeries on 8 human cadaver specimens, inserting four ISSs per specimen to directly compare NOFUSS against conventional fluoroscopy. Six specimens yielded usable (marginal or adequate quality) US images. Results: The median screw entry error, midpoint error, and angulations errors for NOFUSS were 8.4 mm, 7.0 mm, and 1.4(degrees), compared to 7.5 mm (p = 0.52), 5.7 mm (p = 0.30), and 4.4(degrees) (p = 0.001) for fluoroscopy respectively. NOFUSS resulted in 6 (50%) breaches, compared to 2 (16.7%) in fluoroscopy (p = 0.19). The median insertion time was 7m 37s and 12m 36s per screw for NOFUSS and fluoroscopy respectively (p = 0.002). The median radiation exposure during the fluoroscopic procedure was 2m 44s, (range: 1m 44s - 3m 18s), with no radiation required for NOFUSS. When considering the three cadavers that yielded only adequate-quality US images (12 screws), the measured entry errors were 3.6 mm and 8.1 mm respectively for NOFUSS and fluoroscopy (p = 0.06). Conclusion: NOFUSS achieved insertion accuracies on par with the conventionalfluoroscopicmethod,andreducedinsertiontimesandradiation exposure significantly. Significance: This study demonstrated the feasibility of an automated, radiation-free, US-based surgical navigation system for ISS insertions.

Hip fracture prevention approaches like prophylactic augmentation devices have been proposed to strengthen the femur and prevent hip fracture in a fall scenario. The aim of this study was to validate the finite element model (FEM) of specimens augmented by prophylactic intramedullary nailing in a simulated sideways fall impact against ex vivo experimental data. A dynamic inertia-driven sideways fall simulator was used to test six cadaveric specimens (3 females, 3 males, age 63-83 years) prophylactically implanted with an intramedullary nailing system used to augment the femur. Impact force measurements, pelvic deformation, effective pelvic stiffness, and fracture outcomes were compared between the ex vivo experiments and the FEMs. The FEMs over-predicted the effective pelvic stiffness for most specimens and showed variability in terms of under- and over-predicting peak impact force and pelvis compression depending on the specimen. A significant correlation was found for time to peak impact force when comparing ex vivo and FEM data. No femoral fractures were found in the ex vivo experiments, but two specimens sustained pelvic fractures. These two pelvis fractures were correctly identified by the FEMs, but the FEMs made three additional false-positive fracture identifications. These validation results highlight current limitations of these sideways fall impact models specific to the inclusion of an orthopaedic implant. These FEMs present a conservative strategy for fracture prediction in future applications. Further evaluation of the modelling approaches used for the bone-implant interface is recommended for modelling augmented specimens, alongside the importance of maintaining well-controlled experimental conditions.

Background: There are concerns as to the reliability of proximal humerus radiographic measurements, particularly regarding the rotational position of the humerus when obtaining radiographs. Methods: Twenty-four patients with proximal humerus fractures fixed surgically with locked plates received postoperative anteroposterior radiographs with the humerus in neutral rotation and in 30 degrees of internal and external rotation. Radiographic measurements for head shaft angle, humeral offset and humeral head height were performed in each humeral rotation position. Intra-class correlation coefficient was used to assess inter-rater and intra-rater reliability. Mean differences (md) in measurements between humeral positions was evaluated using one-way ANOVA. Results: Head shaft angle demonstrated good-to-excellent reliability; the highest estimates for interrater reliability (ICC: 0.85; 95% CI: 0.76, 0.94) and intra-rater reliability (ICC: 0.96; 95% CI: 0.93, 0.98) were achieved in neutral rotation. There were significant differences in measurement values between each rotational position, with mean head shaft angle of 133.1 degrees in external rotation, and increasingly valgus measurements in neutral (md: 7.6 degrees; 95% CI: 5.0, 10.3 degrees; p < 0.001) and internal rotation (md: 26.4 degrees; 95% CI: 21.8, 30.9 degrees; p < 0.001). Humeral head height and humeral offset showed good-to-excellent reliability in neutral and external rotation, but poor inter-rater reliability in internal rotation. Humeral head height was significantly greater using internal compared to external rotation (md: 4.5 mm; 95% CI: 1.7, 7.3 mm; p = 0.002). Humeral offset was significantly greater in external compared to internal rotation (md: 4.6 mm; 95% CI: 2.6, 6.6 mm; p < 0.001). Conclusions: Views of the humerus in neutral rotation and 30 degrees of external rotation displayed superior reliability. Differences in radiographic measurement values, depending on humeral rotation views, can make for problematic correlations with patient outcome measures. Studies assessing radiographic outcomes following proximal humerus fractures should ensure standardized humeral rotation for obtaining anteroposterior shoulder radiographs, with neutral rotation and external rotation views likely yielding the most reliable results. Level of Evidence: Level IV (c) 2023 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.

OBJECTIVE:Osteoporosis, a known complication of rheumatoid arthritis (RA), increases the risk of hip fracture, which is associated with high morbidity and mortality. Fracture risk estimates in patients with RA treated with contemporary treatment strategies are lacking. The objectives were (1) estimate age-specific and sex-specific incidence rates and compare the risk of hip fractures in RA relative to age-matched and sex-matched general population controls, and (2) compare the risk of all-cause mortality in RA and general population controls after hip fracture. METHODS:A longitudinal study of a population-based incident cohort of patients with RA diagnosed between 1997 and 2009, followed until 2014, with age-matched and sex-matched controls from the general population of British Columbia, using administrative health data. Hip fracture outcomes (International Classification of Diseases, Ninth Edition, Clinical Modification [ICD-9-CM] codes 820.0 or 820.2; ICD-10-Canada code S72.0 to S72.2) and mortality at predefined intervals after fracture (in hospital, 90 days, 1-year, 5-year) were identified. Hip fracture incidence rates for RA and controls, and incidence rate ratios (IRRs), were calculated. Cox proportional hazards models compared hip fracture and mortality risk in RA versus controls; logistic regression compared in-hospital mortality risk. RESULTS:Overall, 1,314 hip fractures over 360,521 person-years were identified in 37,616 individuals with RA and 2,083 over 732,249 person-years in 75,213 controls, yielding a 28% greater fracture risk in RA (IRR 1.28 [95% confidence interval 1.20-1.37]). Mean age at time of fracture was slightly younger for RA than controls (79.6 ± 10.8 vs 81.6 ± 9.3 years). Postfracture mortality risk at one-year and five-years did not differ between RA and general population controls. Results were similar in a sensitivity analysis including only individuals with RA who received disease-modifying antirheumatic drugs. CONCLUSION:People with RA had a greater risk of hip fractures, but no greater risk of mortality post fracture, than the general population. The relative risk of hip fractures observed was not as high as previously reported, likely reflecting better treatment of inflammation and management of osteoporosis and its risk factors.

INTRODUCTION:Complex regional pain syndrome (CRPS) is a common complication following distal radius fractures that is difficult to diagnose and can lead to permanent disability. While various proposed prophylaxis and treatment modalities exist, high-quality evidence guiding practice is limited. This survey of Orthopaedic Trauma Association (OTA) and Canadian Orthopaedic Association (COA) members was conducted with the primary aim of assessing practice patterns in distal radius fractures complicated with CRPS. METHODS:An electronic survey was distributed to practicing orthopaedic surgeons in the COA and OTA. Questions assessed practice setting, preference in management of distal radius fractures and CRPS, comfort level in managing CRPS, and identification of gaps in management. Responses were anonymized and collected over 8 months. Response data was analyzed using descriptive statistics; thematic analysis was used on free text response. RESULTS:134 survey responses were completed. 84% of respondents felt the incidence of CRPS in distal radius fractures was 1-10%, while 15% felt it was closer to 11-20%. 24% of respondents utilized the "Budapest Criteria" to diagnose CRPS. 40% offered prophylaxis in patients felt to be at high risk of developing CRPS. 66% of surgeons felt neutral, uncomfortable, or very uncomfortable managing CRPS in distal radius fractures. When asked to consider adopting a prophylactic therapy, 38% of surgeons indicated that a therapy that reduced the absolute risk of CRPS by 6-10% would change their practice. Gaps in current practice included lack of evidence-based treatment and prevention strategies and diagnostic uncertainty. CONCLUSION:This study identified that amongst orthopaedic surgeons in the COA and OTA, diagnosis, treatment, and prophylaxis strategies for CRPS in distal radius fractures are heterogeneous. Surgeons are not confident in their treatment of CRPS. Future studies using rigorous research methods are warranted to improve management.

We sought to compare outcomes and reoperation rates for the surgical treatment of proximal humerus fractures (excluding head-splitting fractures, fracture-dislocations, and isolated greater-tuberosity fractures) in men and women older than 60 years. We searched MEDLINE, Embase, and Cochrane through to Feb. 1, 2022, and included all English-language randomized trials comparing operative versus nonoperative treatment; open reduction and internal fixation (ORIF) with locking plate versus intramedullary nail; arthroplasty versus ORIF; and reverse shoulder arthroplasty versus hemiarthroplasty. Outcomes of interest were functional outcomes (e.g., Constant score), pain outcomes (visual analogue scale scores), and reoperation rates for the interventions of interest when available. We rated the quality of the evidence and strength of recommendations using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. This guideline will benefit patients considering surgical intervention for fractures of the proximal humerus by improving counselling on surgical treatment options and possible outcomes. It will also benefit surgical providers by improving their knowledge of various surgical approaches. Data presented could be used to develop frameworks and tools for shared decision-making. Nous avons cherché à comparer les résultats et les taux de réintervention à la suite d'un traitement chirurgical pour une fracture de l'humérus proximal (excluant les fractures de la tête humérale, les fractures-luxations et les fractures isolées de la grande tubérosité) chez les hommes et les femmes âgés de plus de 60 ans. Nous avons effectué des recherches dans les bases de données MEDLINE, Embase, et Cochrane jusqu'au 1er février 2022 et avons inclus tous les essais randomisés publiés en anglais comparant différents duos d'interventions : traitements chirurgicaux ou non chirurgicaux; réductions ouvertes avec fixation interne (ROFI) réalisées à l'aide d'une plaque verrouillée ou enclouages centromédullaires; arthroplasties ou ROFI; et arthroplasties inversées de l'épaule ou hémiarthroplasties. Les paramètres d'intérêt étaient la capacité fonctionnelle (p. ex., score de Constant), la douleur (p. ex., échelle analogique visuelle) et le taux de réintervention pour les interventions d'intérêt, selon les données disponibles. Nous avons évalué la qualité des données probantes et la solidité des recommandations à l'aide de l'approche GRADE (Grading of Recommendations, Assessment, Development and Evaluation). Cette ligne directrice profitera aux patients qui envisagent une intervention chirurgicale après une fracture de l'humérus proximal en améliorant les consultations sur les options de traitement chirurgical et les résultats escomptés. Elle aidera aussi les chirurgiens en améliorant leurs connaissances sur différentes approches chirurgicales. Les données présentées pourraient servir à mettre au point des cadres et des outils pour une prise de décision partagée.

Background Distal radius fractures are commonly seen among the elderly, though studies examining their long-term outcomes are limited.Purpose The aim of this study was to describe the 5-year trajectory of recovery of distal radius fractures treated with open reduction and internal fixation (ORIF).Methods Patients with distal radius fractures (AO/OTA 23.A-C) treated by ORIF were prospectively studied. Patient-Rated Wrist Evaluation (PRWE) score was measured at baseline (preinjury recall) and postoperatively at 6 months, 1 year, and 5 years. Clinically relevant change in PRWE score was assessed using the minimal clinically important difference (MCID).Results A total of 390 patients were included, of which 75% completed 5-year follow-up. Mean baseline PRWE score was 1.25 (standard deviation, SD: 2.9). At 6 months, mean PRWE score was at its highest up to 20.2 (SD: 18.4; p < 0.01). A significant improvement in mean PRWE score was observed at 1 year down to 15.2 (SD: 17.6; p < 0.01); 44% of patients were still one MCID outside of their baseline PRWE score at 1 year. Further significant improvement in mean PRWE score occurred at 5 years down to 9.4 (SD: 13.4; p < 0.01); 29% of patients remained one MCID outside of their baseline PRWE score at 5 years.Conclusion Recovery after ORIF for distal radius fractures showed significant worsening after surgery, followed by significant improvements up to 1 year and between years 1 and 5, albeit to a lesser extent. Statistically and clinically relevant wrist pain and disability persisted at 5 years. Future research should examine different treatment modalities and include a nonoperative treatment arm for comparison.

Aims Acetabular fractures are associated with long - term morbidity. Our prospective cohort study sought to understand the recovery trajectory of this injury over five years. Methods Eligible patients at a level I trauma centre were recruited into a longitudinal registry of surgical acetabular fractures between June 2004 and August 2019. Patient- reported outcome measures (PROMs), including the 36 - Item Short Form Health Survey (SF - 36) physical component summary (PCS), were recorded at baseline pre- injury recall and six months, one year, two years, and five years postoperatively. Comparative analyses were performed for elementary and associated fracture patterns. The proportion of patients achieving minimal clinically important difference (MCID) was determined. The rate of, and time to, conversion to total hip arthroplasty (THA) was also established. Results We recruited 251 patients (253 fractures), with a 4:1 male to female ratio and mean age of 46.1 years (SD 16.4). Associated fracture patterns accounted for 56.5% of fractures (n = 143). Trajectory analysis showed all timepoints had significant disability versus base- line, including final follow - up (p < 0.001). Elementary fractures had higher SF - 36 PCS at six months (p = 0.023) and one year (p = 0.007) compared to associated fractures, but not at two years (p = 0.135) or five years (p = 0.631). The MCID in SF - 36 PCS was observed in 37.3% of patients (69/185) between six months and one year, 26.9% of patients (39/145) between one and two years, and 23.3% of patients (20/86) between two and five years, highlighting the long recovery potential of these injuries. A significant proportion of pa- tients failed to attain the MCID after five years (38.1%; 40/105). Conversion to THA occurred in 13.1% of patients (11/110 elementary and 22/143 associated fractures). Approximately two- thirds of THAs (21/33 patients; 63.6%) were performed within two years of index sur- gery. Conclusion Acetabular fractures significantly impact physical function. Recovery trajectory is often elongated beyond one year, with two- thirds of our patients displaying persistent clinically relevant long - term disability.

Fragility fracture of the hip is a global health concern with generally poor outcomes. Clinical studies have shown prophylactic augmentation of the femur to be a plausible intervention with success in some approaches; however, its use is not yet widespread in the clinical community. We aimed to evaluate the efficacy and clinical safety of prophylactic intramedullary nailing for hip fracture prevention after a fall impact in six cadaveric pelvis-femurs. Post-fall fracture status of the native specimens was determined in a virtual control group built using a validated and peer-reviewed finite element method. A commercially available intramedullary nailing system was prophylactically implanted in all specimens. After augmentation, specimens were subjected to an experimental sideways fall impact and inspected for fracture. Overall, fracture status was unchanged or lowered in severity in the augmented group compared to the native control group. No sign of femur fracture was found in the group augmented by intramedullary nailing, but two augmented specimens exhibited pelvis fractures after the impact. No safety concerns associated with prophylactic nailing were found. These results suggest that prophylactic nailing may reduce the potential for hip fracture in a sideways fall impact but would not reduce the likelihood of pelvis fracture, and may shift femur fractures to instead be pelvis fractures. This study provides a robust biomechanical evaluation of prophylactic augmentation with a device already familiar to orthopedic surgeons, broadening the options currently considered for the prevention of hip fractures.

Various femoral augmentation designs have been investigated over the past decade for the prevention of geriatric hip fracture. The experimental methods used to evaluate the efficacy of these augmentations have not been critically evaluated or compared in terms of biofidelity, robustness, or ease of application. Such parameters have significant relevance in characterizing future clinical success. In this study we aimed to use a scoping review to summarize the experimental studies that evaluate femoral augmentation approaches, and critically evaluate commonly applied protocols and identify areas for concordance with the clinical situation. We conducted a literature search targeting studies that used experimental test methods to evaluate femoral augmentation to prevent geriatric fragility fracture. A total of 25 studies met the eligibility criteria. The most commonly investigated augmentation to date is the injection of bone cement or another material that cured in situ, and a popular subsequent method for biomechanical evaluation was to load the augmented proximal femur until fracture in a sideways fall configuration. We noted limitations in the clinical relevance of sideways fall scenarios being modeled and large variance in the concordance of many of the studies identified. Our review brings about recommendations for enhancing the fidelity of experimental methods modeling clinical sideways falls, which include an improved representation of soft tissue effects, using outcome metrics beyond load-to-failure, and applying loads inertially. Effective augmentations are encouraging for their potential to reduce the burden of hip fracture; however, the likelihood of this success is only as strong as the methods used in their evaluation.