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Hip fragility fractures incidence is constantly increasing, and outcomes are mostly poor in terms of both morbidity and mortality. Surgery is the treatment of choice for most hip fractures, but the choice between the various fixation devices is difficult. We conducted a survey on the treatment of trochanteric fractures among orthopedic surgeons in Campania using a Google form questionnaire. The preferred treatment was cephalomedullary distal locked nailing for most fractures, while sliding hip screws and hip replacement were limited to 31 A1.2 and 31.B2 fractures.

Lung ultrasound (LUS) can be used to assess loss of aeration, which is associated with outcome in patients with coronavirus disease 2019 (COVID-19) presenting to the emergency department. We hypothesized that LUS scores are associated with outcome in critically ill COVID-19 patients receiving invasive ventilation. This retrospective international multicenter study evaluated patients with COVID-19–related acute respiratory distress syndrome (ARDS) with at least one LUS study within 5 days after invasive mechanical ventilation initiation. The global LUS score was calculated by summing the 12 regional scores (range 0–36). Pleural line abnormalities and subpleural consolidations were also scored. The outcomes were successful liberation from the ventilator and intensive care mortality within 28 days, analyzed with multistate, competing risk proportional hazard models. One hundred thirty-seven patients with COVID-19–related ARDS were included in our study. The global LUS score was associated with successful liberation from mechanical ventilation (hazard ratio [HR]: 0.91 95% confidence interval [CI] 0.87–0.96; P = 0.0007) independently of the ARDS severity, but not with 28 days mortality (HR: 1.03; 95% CI 0.97–1.08; P = 0.36). Subpleural consolidation and pleural line abnormalities did not add to the prognostic value of the global LUS score. Examinations within 24 hours of intubation showed no prognostic value. To conclude, a lower global LUS score 24 hours after invasive ventilation initiation is associated with increased probability of liberation from the mechanical ventilator COVID–19 ARDS patients, independently of the ARDS severity.

Introduction The treatment of intracapsular femoral neck fractures (FNFs) in the elderly is usually based on hip replacement, both total hip arthroplasty (THA) and hemiarthroplasty (HA). Recently, several tissue-sparing approaches for hip arthroplasty had been described with promising results in terms of hospitalization length, blood loss and dislocation rate. The aim of the present study was to compare the blood loss and the transfusion rate in a cohort of patients with FNF treated using an HA through both the SuperPath (SP) and the traditional posterolateral (PL) approaches. Materials and methods We retrospectively collected data from patients affected by FNFs between January 2018 and February 2020. All patients with intracapsular FNF treated with a single HA implant (Profemur L, MicroPort Orthopedics Inc., USA) via PL or SP approaches were included. Exclusion criteria were pathological fractures, polytrauma and preoperatively transfused patients. Results Thirty-five patients were included and analysed in the present study. 17 patients were classified in the SP group, and 18 in the PL one. The rate of antithrombotic therapy was higher in the SP group compared with the PL group [10 (58, 82%) vs 4 (22, 2%)]. While the two groups did not differ in terms of preoperative haemoglobin (Hb), 48 h postoperative Hb and Hb reduction, a significative difference was observed in terms of blood transfusion rate (1 SP vs 9 PL, p = 0.0072). Conclusions The SuperPath approach in patients with FNF under antithrombotic therapy assures lower transfusion rate, potentially reducing complication rates and improving patients' outcomes.

Introduction. Intramedullary nail is an important component of modern treatment of pertrochanteric femur fractures. Objective. In elderly population, pertrochanteric fractures treated with unreamed intramedullary nails cause less deep infections when compared to reamed intramedullary nails. Patients and Methods. From April, 2010 to May, 2012 at the Department of Orthopedics and Traumatology, Gaetano Rummo Hospital (Benevento, Italy), 156 patients with pertrochanteric fracture, average age 82.7 years (75-102 years), were treated. In the analyzed case, there were 90 females and 66 males with pertrochanteric fractures. The respondents were divided into two groups. The first group consisted of 78 respondents who were treated with reamed intramedullary nails and the second group of 78 respondents treated with unreamed intramedullary nails. Discussion. Infections are not the most common postoperative complications. The risk of infection is increased in patients with comorbidity and in cases when there is an empty space between the intramedullary nail fixation and bone. Proximal femoral fractures carry a high mortality, but its causes are unclear. Conclusion. Our research has shown that the application of unreamed intramedullary nails in the treatment of pertrochanteric femoral fractures reduces a mortality risk and risk of infection.