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Introduction: Factor XI (FXI) deficiency is a hematologic condition that is rarely encountered by the arthroplasty surgeon. Effective risk assessment and perioperative management are paramount in minimizing the risk of intra- and post-operative bleeding in this patient population. An interdisciplinary approach is crucial in minimizing complications and achieving successful outcomes. We present the case of a patient that successfully underwent conversion total hip arthroplasty (THA) following failed internal fixation of a proximal femur fracture. Case Report: A 71-year-old man with a history of FXI deficiency presented with significant right-sided hip pain secondary to post-traumatic arthritis from a previously treated right proximal femur fracture. The patient underwent removal of the cephalomedullary nail and conversion to a THA. Before the procedure, a comprehensive perioperative plan was enacted to manage the patient’s FXI deficiency. The patient underwent several infusions of aminocaproic acid and tranexamic acid (TXA) in an effort to prevent intra- and post-operative bleeding. The surgery was completed with excellent hemostasis and no post-operative complications. Conclusion: Patients with FXI deficiency can successfully undergo conversion THA surgery; however, an individualized hematologic plan must be enacted to minimize complications and maximize surgical outcomes and patient satisfaction. This case demonstrates that the antifibrinolytic agents, aminocaproic acid and TXA, can be successfully used for hematologic prophylaxis in the perioperative period for this population of patients.

The bony and ligamentous structure of the foot is a complex kinematic interaction, designed to transmit force and motion in an energy-efficient and stable manner. Visible deformity of the foot or atypical patterns of swelling should raise significant concern for foot trauma. In some instances, disruption of either bony structure or supporting ligaments is identified years after injury due to chronic pain in the hindfoot or midfoot. This article will focus on injuries relating to the peritalar complex, the bony articulation between the tibia, talus, calcaneus, and navicular bones, supplemented with multiple ligamentous structures. Attention will be given to the five most common peritalar injuries to illustrate the nature of each and briefly describe methods for achieving the correct diagnosis in the context of acute trauma. This includes subtalar dislocations, chopart joint injuries, talar fractures, navicular fractures, and occult calcaneal fractures.

Uncertainty information in natural hazard forecasts is increasingly being explicitly\ud communicated. This study was designed to determine whether different ways of\ud communicating uncertainty graphically affects decisions and interpretations of forecasts and whether expertise was a factor in decisions and interpretations from forecasts explicitly showing uncertainty. In a hypothetical decision-making task regarding ice thickness and shipping, 138 experts and non-experts received ice-thickness forecasts in four different presentations expressing uncertainty: worded probability, spaghetti plot, fan plot, and box plot. These forecasts contained no measures of central tendency. There was no consistent difference in decision or best-guess forecast (deterministic ice thickness forecast based on the forecast representation) between the different forecast representations. However, participants interpreted different amounts of uncertainty across the different forecast representations. Experts made significantly more economically rational decisions than non-experts, interpreted lower best-guess forecasts, and inferred significantly more uncertainty than nonexperts. These results suggest that care be taken in choosing how uncertainty is represented in forecasts, especially between expert and non-expert audiences.

Caring for an injured, pregnant patient can be a management challenge. We report the case of an 18-year-old female who sustained a left acetabulum fracture with a concurrent hip dislocation at 35 weeks’ gestation following a motor vehicle accident. Through an interdisciplinary, team-based approach, the patient was guided through obstetric delivery and orthopedic surgical fracture fixation without complication. By being familiar with the unique challenges in management posed by pregnant patients, orthopedic surgeons can be better equipped to minimize morbidity and mortality in this patient population while maximizing clinical outcomes.