Two surgical pathways for isolated hip fractures:A comparative study

BACKGROUND Hip fractures(HF)are common among the aging population,and surgery within 48 h is recommended.Patients can be hospitalized for surgery through different pathways,either trauma or medicine admitting services.AIM To compare management and outcomes among patients admitted through the trauma pathway(TP)vs medical pathway(MP).METHODS This Institutional Review Board-approved retrospective study included 2094 patients with proximal femur fractures(AO/Orthopedic Trauma Association Type 31)who underwent surgery at a level 1 trauma center between 2016-2021.There were 69 patients admitted through the TP and 2025 admitted through the MP.To ensure comparability between groups,66 of the 2025 MP patients were propensity matched to 66 TP patients by age,sex,HF type,HF surgery,and American Society of Anesthesiology score.The statistical analyses included multivariable analysis,group characteristics,and bivariate correlation comparisons with theχ^(2)test and t-test.RESULTS After propensity matching,the mean age in both groups was 75-years-old,62%of both groups were females,the main HF type was intertrochanteric(TP 52%vs MP 62%),open reduction internal fixation was the most common surgery(TP 68%vs MP 71%),and the mean American Society of Anesthesiology score was 2.8 for TP and 2.7 for MP.The majority of patients in TP and MP(71%vs 74%)were geriatric(≥65-years-old).Falls were the main mechanism of injury in both groups(77%vs 97%,P=0.001).There were no significant differences in pre-surgery anticoagulation use(49%vs 41%),admission day of the week,or insurance status.The incidence of comorbidities was equal(94%for both)with cardiac comorbidities being dominant in both groups(71%vs 73%).The number of preoperative consultations was similar for TP and MP,with the most common consultation being cardiology in both(44%and 36%).HF displacement occurred more among TP patients(76%vs 39%,P=0.000).Time to surgery was not statistically different(23 h in both),but length of surgery was significantly longer for TP(59 min vs 41 min,P=0.000).Intensive care unit and hospital length of stay were not statistically different(5 d vs 8 d and 6 d for both).There were no statistical differences in discharge disposition and mortality(3%vs 0%).CONCLUSION There were no differences in outcomes of surgeries between admission through TP vs MP.The focus should be on the patient’s health condition and on prompt surgical intervention.

Unusual capitate fracture with dorsal shearing pattern and concomitant carpometacarpal dislocation with a 6-year follow-up:A case report

BACKGROUND Isolated capitate fractures are rare carpal fractures.Following high-energy injuries,capitate fractures are usually associated with other carpal fractures or ligament injuries.The management of capitate fractures depends on the fracture pattern.Here,we report an unusual capitate fracture with a dorsal shearing pattern and concomitant carpometacarpal dislocation,with a 6-year follow-up.To the best of our knowledge,this fracture pattern and surgical management have not been previously reported.CASE SUMMARY A 28-year-old man presented with left-hand volar tenderness and decreased grip strength that persisted for one month after a traffic accident.Radiography showed a distal capitate fracture with carpometacarpal joint incongruence.Computed tomography(CT)revealed a distal capitate fracture with carpometacarpal joint dislocation.The distal fragment was rotated by 90°in the sagittal plane,and an oblique shearing fracture pattern was noted.Open reduction and internal fixation(ORIF)with a locking plate were performed using the dorsal approach.The imaging studies performed 3 mo and 6 years following surgery revealed a healed fracture,and the Disabilities of the Arm,Shoulder,and Hand and visual analog scale scores were significantly improved.CONCLUSION CT can detect capitate fractures with dorsal shearing pattern and concomitant carpometacarpal dislocation.ORIF using a locking plate are possible.

Ipsilateral simultaneous fracture of the trochlea involving the lateral end clavicle and distal end radius：a rare combination and a unique mechanism of injury

Isolated trochlea fracture in adults is a rare surgical entity as compared to its capitellar counterpart.It has been only mentioned sporadically in the literature as case reports.Fracture of the trochlea is accompanied by other elbow injuries like elbow dislocation,capitellum fracture,ulnar fracture and extraarticular condylar fracture.Here we report a unique case of isolated displaced trochlea fracture associated with fractures of the lateral end clavicle and the distal end radius.We propose a unique mechanism for this rare combination of injuries：typical triad of injury,i.e.fracture of the distal end radius with trochlea and fracture of the lateral end of the clavicle.Nonoperative treatment is recommended for undisplaced humeral trochlea fractures;but for displaced ones,anatomical reduction and internal fixation are essential to maintain the congruous trochleacoronoid articulation and hence to maintain the intrinsic stability of the elbow.

Neglected bilateral radial head fracture with a rare presentation： A case report

Isolated radial head fractures are rare and comprise about 2% of all fractures around the elbow. Bilateral radial head fractures are even rarer and few cases have been reported. We present a case of bilateral elbow effusion in a 28-year-old male patient. An initial diagnosis of inflammatory arthritis was made but on investigation it turned out to be a case of bilateral radial head fracture. The patient was managed conservatively with 10 days of immobilisation in above elbow slab followed by active elbow range of movement exercises. On follow-up at 6 months, the patient had near normal range of movements without pain or elbow instability.