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Background: C-reactive protein (CRP) to Albumin ratio (CAR) has been used in multiple clinical settings to predict early mortality. However, there is a lack of evidence on the predictive role of CAR in 30-day mortality after a hip fracture. The purpose of this study was to establish a potential association between CAR and 30-day mortality and to assess if the CAR Receiving Operating Characteristics curve (ROC) can be a reliable predictor of early mortality. Methods: We retrospectively reviewed the charts of 676 patients (>65 years) treated for hip fracture between 2006 and 2018. All hip fractures were included. Treatment strategies included closed reduction and internal fixation, open reduction and internal fixation, hemiarthroplasty, or total joint arthroplasty. Statistical analysis included T-test, Pearson correlation for CAR and other markers, ROC curves and area under the curve, Youden Model, and Odds Ratio. Results: The 30-day mortality rate analysis showed that higher preoperative levels of CAR were associated with higher early mortality. When analyzing the area under the ROC curve (AUROC) for 30-day mortality, the reported value was 0.816. The point of the ROC curve corresponding to 14.72 was considered a cut-off with a specificity of 87% and a sensibility of 40.8%. When analyzing values higher than 14.72, the 30-day mortality rate was 17.9%, whilst, for values lower than 14.72, the 30-day mortality rate was 1.8%. Conclusions: Patients older than 65 years affected by a hip fracture with increased preoperative levels of CAR are associated with higher 30-day mortality. Despite a moderate sensibility, considering the low cost and the predictivity of CAR, it should be considered a standard predictive marker. [ABSTRACT FROM AUTHOR]

In humans the acquisition of the bipedalism caused different structural changes to achieve the new functional demands. In particular, several changes have occurred in the spine and pelvis. In recent years the sagittal morphology of the spine and pelvis has become one of the most focused topics in spine research. The sample consists of 348 volunteers, with no history of low back pain, without any previous major trauma at the spine or at the pelvis. Aged between 20 and 29 years. The presence and severity of zygoapophyseal facet arthrosis were investigated in accordance with Pathria's classification (it considered four parameters: width of interarticular space, the presence of osteophytes, the presence of facet hypertrophy and presence of areas of bone erosion). Volunteers were divided into two group based on sagittal balance subtype classified by Roussouly in 2005. 98 volunteers (35.76%) belongs to group A (subtype I and II), and 176 volunteers (64.24%) belongs to group III and IV. The different weight distribution in the lumbar spine suggests that different subtype of sagittal balance could develop zygoapophyseal facet arthrosis more frequently. Considering the different Groups, a statistically significant difference was found: people belonging in group B (subtype III and IV), shows a prevalence of 36,36% compared with a prevalence of 24.5% for group A (subtype I and II). [ABSTRACT FROM AUTHOR]

Posterior fixation of the lumbar spine using screw and bar is a commonly used surgical approach for the treatment of a wide series of spine pathologies. Despite the improvement in surgical technique and in the development of the material, the incidence of misplaced screw at the lumbar spine is about 4.8% (range, 3% to 6%) [1]. The L5 pedicle lateral tilt classification was introduced recently [1]. This classification is based on the morphological changes that occur at the L5 and L4 bone anatomy and on the distance between pedicles and nervous structures. It subdivides the population in three groups based on the lateral tilt of L5 pedicle. The purpose of this study is to evaluate the validity of the L5 PLT Classification. After obtaining internal institutional aboard approval we retrospectively analyzed data from 218 patients that underwent posterior spine stabilization of one or more level. In total 436 screws were positioned at the pedicles of L5. Screw positioning was evaluated using Zdchivasky classification on a CT scan of the lumbar spine. The incidence of screw misplacement was 5.3% (23 screws), a statistically significant difference was found between people that belong in group U (narrowed lateral tilt) and people that belongs to the other two groups W and V (p-value < 0.05). The results obtained in this study was conducted to confirm the theorized hypothesis that the lateral tilt of L5 pedicles must be considered as risk factor for screw misplacement during lumbar spine posterior stabilization. In conclusion the L5 PLT classification is valid. [ABSTRACT FROM AUTHOR]

Intramedullary suction cementing technique of the tibial component has the theoretical advantage to allow a deeper cement penetration trough the cancellous bone. The aim of this study is to compare the cement penetration under the tibial component between patients that underwent tibial component cementation with or without the use of intramedullary suction. Two-hundred-twenty-four patients underwent primary total knee arthroplasty (TKA) during the study period, One-hundred-twenty-two TKAs using intramedullary suction with negative pressure (55.4%), while one-hundred-two TKAs without intramedullary suction (44.6%). We found that the intra-operative suction during cement application increase the depth of cement penetration better than pulsed lavage alone., Competing Interests: Giorgio Cacciola and Federico De Meo do not declare any conflict of interest. Pietro Cavaliere is a paid consultant from G21 s.r.l. and Gruppo Bioimpianti., (© 2019 Professor P K Surendran Memorial Education Foundation. Published by Elsevier B.V. All rights reserved.)