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4. A Machine Learning Algorithm to Identify Patients at Risk of Unplanned Subsequent Surgery After Intramedullary Nailing for Tibial Shaft Fractures

Author

Bhandari, M., Bulstra, A.E.J., Bzovsky, S., Doornberg, J.N., Goslings, J.C., Hendrickx, L.A.M., Jaarsma, R.L., Jeray, K.J., Kerkhoffs, G.M.M.J., Petrisor, B., Ring, D., Schemitsch, E.H., Swiontkowski, M., Sanders, D., Sprague, S., Tornetta, P., Walter, S.D., Heels-Ansdell, D., Buckingham, L., Leece, P., Viveiros, H., Mignott, T., Ansell, N., Sidorkewicz, N., Agel, J., Bombardier, C., Berlin, J.A., Bosse, M., Browner, B., Gillespie, B., Jones, A., O'Brien, P., Poolman, R., Macleod, M.D., Carey, T., Leitch, K., Bailey, S., Gurr, K., Konito, K., Bartha, C., Low, I., MacBean, L.V., Ramu, M., Reiber, S., Strapp, R., Tieszer, C., Kreder, H.J., Stephen, D.J.G., Axelrod, T.S., Yee, A.J.M., Richards, R.R., Finkelstein, J., Gofton, W., Murnaghan, J., Schatztker, J., Ford, M., Bulmer, B., Conlan, L., Laflamme, G.Y., Berry, G., Beaumont, P., Ranger, P., Laflamme, G.H., Gagnon, S., Malo, M., Fernandes, J., Poirier, M.F., McKee, M.D., Waddell, J.P., Bogoch, E.R., Daniels, T.R., McBroom, R.R., Vicente, M.R., Storey, W., Wild, L.M., McCormack, R., Perey, B., Goetz, T.J., Pate, G., Penner, M.J., Panagiotopoulos, K., Pirani, S., Dommisse, I.G., Loomer, R.L., Stone, T., Moon, K., Zomar, M., Webb, L.X., Teasdall, R.D., Birkedal, J.P., Martin, D.F., Ruch, D.S., Kilgus, D.J., Pollock, D.C., Harris, M.B., Wiesler, E.R., Ward, W.G., Shilt, J.S., Koman, A.L., Poehling, G.G., Kulp, B., Creevy, W.R., Stein, A.B., Bono, C.T., Einhorn, T.A., Brown, T.D., Pacicca, D., Sledge, J.B., Foster, T.E., Voloshin, I., Bolton, J., Carlisle, H., Shaughnessy, L., Obremskey, W.T., LeCroy, C.M., Meinberg, E.G., Messer, T.M., Craig, W.L., Dirschl, D.R., Caudle, R., Harris, T., Elhert, K., Hage, W., Jones, R., Piedrahita, L., Schricker, P.O., Driver, R., Godwin, J., Kregor, P.J., Tennent, G., Truchan, L.M., Sciadini, M., Shuler, F.D., Driver, R.E., Nading, M.A., Neiderstadt, J., Vap, A.R., Vallier, H., Patterson, B.M., Wilber, J.H., Wilber, R.G., Sontich, J.K., Moore, T.A., Brady, D., Cooperman, D.R., Davis, J.A., Cureton, B.A., Mandel, S., Orr, R.D., Sadler, J.T.S., Hussain, T., Rajaratnam, K., Drew, B., Bednar, D.A., Kwok, D.C.H., Pettit, S., Hancock, J., Cole, P.A., Smith, J.J., Brown, G.A., Lange, T.A., Stark, J.G., Levy, B.A., Garaghty, M.J., Salzman, J.G., Schutte, C.A., Tastad, L., Vang, S., Seligson, D., Roberts, C.S., Malkani, A.L., Sanders, L., Dyer, C., Heinsen, J., Smith, L., Madanagopal, S., Frantz-Bush, L., Coupe, K.J., Tucker, J.J., Criswell, A.R., Buckle, R., Rechter, A.J., Sheth, D.S., Urquart, B., Trotscher, T., Anders, M.J., Kowalski, J.M., Fineberg, M.S., Bone, L.B., Phillips, M.J., Rohrbacher, B., Stegemann, P., Mihalko, W.M., Buyea, C., Augustine, S.J., Jackson, W.T., Solis, G., Ero, S.U., Segina, D.N., Berrey, H.B., Agnew, S.G., Fitzpatrick, M., Campbell, L.C., Derting, L., McAdams, J., Ponsen, K.J., Luitse, J., Kloen, P., Joosse, P., Winkelhagen, J., Duivenvoorden, R., Teague, D.C., Davey, J., Sullivan, J.A., Ertl, W.J.J., Puckett, T.A., Pasque, C.B., Tompkins, J.F., Gruel, C.R., Kammerlocher, P., Lehman, T.P., Puffinbarger, W.R., Carl, K.L., Weber, D.W., Jomha, N.M., Goplen, G.R., Masson, E., Beaupre, L.A., Greaves, K.E., Schaump, L.N., Goetz, D.R., Westberry, D.E., Broderick, J.S., Moon, B.S., Tanner, S.L., Powell, J.N., Buckley, R.E., Elves, L., Connolly, S., Abraham, E.P., Steele, T., Ellis, T., Herzberg, A., Crawford, D.E., Hart, R., Hayden, J., Orfaly, R.M., Vigland, T., Vivekaraj, M., Bundy, G.L., Miclau, T., Matityahu, A., Coughlin, R.R., Kandemir, U., McClellan, R.T., Lin, C.H.H., Karges, D., Cramer, K., Watson, J.T., Moed, B., Scott, B., Beck, D.J., Orth, C., Puskas, D., Clark, R., Jones, J., Egol, K.A., Paksima, N., France, M., Wai, E.K., Johnson, G., Wilkinson, R., Gruszczynski, A.T., Vexler, L., Mallee, W.H., Schipper, I.B., and SPRINT Investigators

Subjects
prediction model, intramedullary nailing, machine learning, subsequent surgery, tibia shaft fracture, Orthopedics and Sports Medicine, Surgery, General Medicine
Abstract

Objectives: In the SPRINT trial, 18% of patients with a tibial shaft fracture (TSF) treated with intramedullary nailing (IMN) had one or more unplanned subsequent surgical procedures. It is clinically relevant for surgeon and patient to anticipate unplanned secondary procedures, other than operations that can be readily expected such as reconstructive procedures for soft tissue defects. Therefore, the objective of this study was to develop a machine learning (ML) prediction model using the SPRINT data that can give individual patients and their care team an estimate of their particular probability of an unplanned second surgery. Methods: Patients from the SPRINT trial with unilateral TSFs were randomly divided into a training set (80%) and test set (20%). Five ML algorithms were trained in recognizing patterns associated with subsequent surgery in the training set based on a subset of variables identified by random forest algorithms. Performance of each ML algorithm was evaluated and compared based on (1) area under the ROC curve, (2) calibration slope and intercept, and (3) the Brier score. Results: Total data set comprised 1198 patients, of whom 214 patients (18%) underwent subsequent surgery. Seven variables were used to train ML algorithms: (1) Gustilo-Anderson classification, (2) Tscherne classification, (3) fracture location, (4) fracture gap, (5) polytrauma, (6) injury mechanism, and (7) OTA/AO classification. The best-performing ML algorithm had an area under the ROC curve, calibration slope, calibration intercept, and the Brier score of 0.766, 0.954, -0.002, and 0.120 in the training set and 0.773, 0.922, 0, and 0.119 in the test set, respectively. Conclusions: An ML algorithm was developed to predict the probability of subsequent surgery after IMN for TSFs. This ML algorithm may assist surgeons to inform patients about the probability of subsequent surgery and might help to identify patients who need a different perioperative plan or a more intensive approach.

Published
2021

5. Heterotopic Ossification Following Arthroplasty for Femoral Neck Fracture

Author

Comeau-Gauthier, M., Zura, R.D., Bzovsky, S., Schemitsch, E.H., Axelrod, D., Avram, V., Manjoo, A., Poolman, R.W., Frihagen, F., Heels-Ansdell, D., Bhandari, M., Sprague, S., and HLTH Investigators

Subjects
Male, Reoperation, musculoskeletal diseases, medicine.medical_specialty, WOMAC, medicine.medical_treatment, Arthroplasty, Replacement, Hip, Osteoarthritis, Severity of Illness Index, Article, 03 medical and health sciences, 0302 clinical medicine, Postoperative Complications, Risk Factors, Prevalence, Medicine, Humans, Orthopedics and Sports Medicine, 030212 general & internal medicine, Prospective Studies, Femoral neck, Randomized Controlled Trials as Topic, Hip surgery, 030222 orthopedics, Hip fracture, business.industry, Proportional hazards model, Ossification, Heterotopic, General Medicine, Middle Aged, medicine.disease, Arthroplasty, Surgery, Femoral Neck Fractures, medicine.anatomical_structure, Treatment Outcome, Quality of Life, Heterotopic ossification, Female, business, Follow-Up Studies
Abstract

Background: Heterotopic ossification (HO) is a frequent complication following hip surgery. Using data from the Hip Fracture Evaluation with Alternatives of Total Hip Arthroplasty versus Hemiarthroplasty (HEALTH) trial, we aimed to (1) determine the prevalence of HO following total hip arthroplasty (THA) for femoral neck fracture in patients ≥50 years of age, (2) identify whether HO is associated with an increased risk of revision surgery within 24 months after the fracture, and (3) determine the impact of HO on functional outcomes. Methods: We performed a multivariable Cox regression analysis using revision surgery as the dependent variable and HO as the independent variable. We compared Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores between participants with and those without HO at 24 months. Results: Of 1,441 participants in the study, 287 (19.9%) developed HO within 24 months. HO was not associated with subsequent revision surgery. Grade-III HO was associated with statistically significant and clinically relevant deterioration in the total WOMAC score, which was mainly related to the function component of the score, compared with grade I or II. Conclusions: The impact of grade-III HO on the functional outcomes and quality of life after THA for hip fracture is clinically important, and HO prophylaxis for selected high-risk patients may be appropriate. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Published
2021

7. What factors increase revision surgery risk when treating displaced femoral neck fractures with arthroplasty

Author

Blankstein, M., Schemitsch, E.H., Bzovsky, S., Poolman, R.W., Frihagen, F., Axelrod, D., Heels-Ansdell, D., Bhandari, M., Sprague, S., Schottel, P.C., and HEALTH Investigators

Subjects
Reoperation, medicine.medical_specialty, Arthroplasty, Replacement, Hip, medicine.medical_treatment, Population, Femoral Neck Fractures, law.invention, 03 medical and health sciences, Femoral head, 0302 clinical medicine, Randomized controlled trial, law, medicine, Humans, Orthopedics and Sports Medicine, education, Aged, Femoral neck, 030222 orthopedics, education.field_of_study, Hip fracture, femoral neck fracture, business.industry, Bone Cements, revision surgery, 030208 emergency & critical care medicine, General Medicine, medicine.disease, Arthroplasty, Surgery, Treatment Outcome, medicine.anatomical_structure, Female, Hemiarthroplasty, business, Body mass index
Abstract

Objectives HEALTH was a randomized controlled trial comparing total hip arthroplasty with hemiarthroplasty in low-energy displaced femoral neck fracture patients aged ≥50 years with unplanned revision surgery within 24 months of the initial procedure being the primary outcome. No significant short-term differences between treatment arms were observed. The primary objective of this secondary HEALTH trial analysis was to determine if any patient and surgical factors were associated with increased risk of revision surgery within 24 months after hip fracture. Methods We analyzed 9 potential factors chosen a priori that could be associated with revision surgery. The factors included age, body mass index, major comorbidities, independent ambulation, type of surgical approach, length of operation, use of femoral cement, femoral head size, and degree of femoral stem offset. Our statistical analysis was a multivariable Cox regression using reoperation within 24 months of index surgery as the dependent variable. Results Of the 1441 patients included in this analysis, 8.1% (117/1441) experienced reoperation within 24 months. None of the studied factors were found to be predictors of revision surgery (P > 0.05). Conclusion Both total and partial hip replacements are successful procedures in low-energy displaced femoral neck fracture patients. We were unable to identify any patient or surgeon-controlled factors that significantly increased the need for revision surgery in our elderly and predominately female patient population. One should not generalize our findings to an active physiologically younger femoral neck fracture population. Level of evidence Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Published
2020

8. Clockwise torque of sliding hip screws: is there a right side?

Author

Wurdemann, F.S., Poolman, R.W., Krijnen, P., Bzovsky, S., Sprague, S., Kaptein, B.L., Hegeman, J.H., Schemitsch, E.H., Bhandari, M., Swiontkowski, M., Schipper, I.B., Dutch Hip Fracture Audit Grp, FAITH Investigators, and Public Health

Subjects
Bone Screws, sliding hip screw, Dentistry, Logistic regression, biomechanics, Fracture Fixation, Internal, 03 medical and health sciences, 0302 clinical medicine, left, right, medicine, Humans, Orthopedics and Sports Medicine, Clinical significance, Femoral neck, 030222 orthopedics, Hip fracture, femoral neck fracture, Hip Fractures, business.industry, Biomechanics, side, Implant failure, 030208 emergency & critical care medicine, General Medicine, Odds ratio, medicine.disease, Confidence interval, Femoral Neck Fractures, Reconstructive and regenerative medicine Radboud Institute for Health Sciences [Radboudumc 10], medicine.anatomical_structure, Torque, implant failure, clockwise torque, Female, Surgery, business, rotational stability
Abstract

Contains fulltext : 228691.pdf (Publisher’s version ) (Closed access) OBJECTIVES: This study evaluated whether patients with a left-sided femoral neck fracture (FNF) treated with a sliding hip screw (SHS) had a higher implant failure rate than patients treated for a right-sided FNF. This was performed to determine the clinical relevance of the clockwise rotational torque of the femoral neck lag screw in a SHS, in relation to the rotational stability of left and right-sided FNFs after fixation. METHODS: Data were derived from the FAITH trial and Dutch Hip Fracture Audit (DHFA). Patients with a FNF, aged ≥50, treated with a SHS, with at least 3-month follow-up data available, were included. Implant failure was analyzed in a multivariable logistic regression model adjusted for age, sex, fracture displacement, prefracture living setting and functional mobility, and American Society for Anesthesiologists Class. RESULTS: One thousand seven hundred fifty patients were included, of which 944 (53.9%) had a left-sided and 806 (46.1%) a right-sided FNF. Implant failure occurred in 60 cases (3.4%), of which 31 were left-sided and 29 right-sided. No association between fracture side and implant failure was found [odds ratio (OR) for left vs. right 0.89, 95% confidence interval (CI) 0.52-1.52]. Female sex (OR 3.02, CI: 1.62-6.10), using a mobility aid (OR 2.02, CI 1.01-3.96) and a displaced fracture (OR 2.51, CI: 1.44-4.42), were associated with implant failure. CONCLUSIONS: This study could not substantiate the hypothesis that the biomechanics of the clockwise screw rotation of the SHS contributes to an increased risk of implant failure in left-sided FNFs compared with right-sided fractures. LEVEL OF EVIDENCE: Therapeutic Level II.See Instructions for Authors for a complete description of levels of evidence.

Published
2020

9. Predictors of long-term pain after hip arthroplasty in patients with femoral neck fractures

Author

Noori, A., Sprague, S., Bzovsky, S., Schemitsch, E.H., Poolman, R.W., Frihagen, F., Axelrod, D., Heels-Ansdell, D., Bhandari, M., Busse, J.W., and HEALTH Investigators

Subjects
medicine.medical_specialty, Arthroplasty, Replacement, Hip, medicine.medical_treatment, Osteoarthritis, Femoral Neck Fractures, law.invention, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, law, Internal medicine, medicine, Humans, Orthopedics and Sports Medicine, pain, hip arthroplasty, hemiarthroplasty, Aged, Ontario, 030222 orthopedics, Hip fracture, femoral neck fracture, business.industry, Absolute risk reduction, 030208 emergency & critical care medicine, General Medicine, medicine.disease, Arthroplasty, Confidence interval, Treatment Outcome, predictors, Female, Surgery, business, Cohort study
Abstract

Objectives To identify factors associated with the development of prolonged pain after hip fracture surgery. Design Secondary analysis of a randomized controlled trial. Setting Eighty hospitals in 10 countries. Patients/participants One thousand four hundred forty-one hip fracture patients in the HEALTH trial. Interventions Total hip arthroplasty or hemiarthroplasty. Main outcome measures Moderate-to-severe pain (at least 2 activities on the Western Ontario and McMaster Universities Osteoarthritis questionnaire pain subscale with scores ≥2) at 12 and 24 months after hip arthroplasty. Results Of 840 and 726 patients with complete baseline data and outcomes at 1-year and 2-year follow-up, 96 (11.4%) and 80 (11.0%) reported moderate-to-severe pain, respectively. An increased risk of pain at both 1 and 2 years after surgery was associated with reporting moderate-to-severe hip pain before fracture [absolute risk increase (ARI) 15.3%, 95% confidence interval (CI) 6.44%-24.35%; ARI 12.5%, 95% CI 2.85%-22.12%, respectively] and prefracture opioid use (ARI 15.6%, 95% CI 5.41%-25.89%; ARI 21.1%; 95% CI 8.23%-34.02%, respectively). Female sex was associated with an increased risk of persistent pain at 1 year (ARI 6.2%, 95% CI 3.53%-8.84%). A greater risk of persistent pain at 2 years was associated with younger age (≤79-year-old; ARI 6.3%; 95% CI 2.67%-9.91%) and higher prefacture functional status (ARI 10.7%; 95% CI 3.80%-17.64%). Conclusions Among hip fracture patients undergoing arthroplasty, approximately one in 10 will experience moderate-to-severe pain up to 2 years after surgery. Younger age, female sex, higher functioning prefracture, living with hip pain prefracture, and use of prescription opioids were predictive of persistent pain. Level of evidence Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Published
2020

10. What predicts health-related quality of life for patients with displaced femoral neck fractures managed with arthroplasty?

Author

Axelrod, D., Comeau-Gauthier, M., Bzovsky, S., Schemitsch, E.H., Poolman, R.W., Frihagen, F., Guerra-Farfan, E., Heels-Ansdell, D., Bhandari, M., Sprague, S., and HEALTH Investigators

Subjects
medicine.medical_specialty, WOMAC, Arthroplasty, Replacement, Hip, medicine.medical_treatment, Population, Osteoarthritis, Femoral Neck Fractures, femoral neck fractures, 03 medical and health sciences, 0302 clinical medicine, Quality of life, Internal medicine, medicine, Humans, Orthopedics and Sports Medicine, education, Femoral neck, 030222 orthopedics, education.field_of_study, function, business.industry, Repeated measures design, 030208 emergency & critical care medicine, General Medicine, medicine.disease, Arthroplasty, health-related quality of life, Treatment Outcome, medicine.anatomical_structure, Quality of Life, Surgery, Hemiarthroplasty, business
Abstract

BACKGROUND: Total hip arthroplasty (THA) has been argued to improve health-related quality of life (HRQoL) and function in femoral neck fracture patients compared with hemiarthroplasty (HA). The HEALTH trial showed no clinically important functional advantages of THA over HA. The current analysis explores factors associated with HRQoL and function in this population. METHODS: Using repeated measures regression, we estimated the association between HRQoL and function [Short Form-12 (SF-12) physical component score (PCS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) function score] and 23 variables. RESULTS: THA as compared to monopolar HA, but not bipolar HA, was more likely to improve PCS scores (adjusted mean difference [AMD] 1.88 points, P = 0.02), whereas higher American Society of Anesthesiologists score (AMD -2.64, P < 0.01), preoperative use of an aid (AMD -2.66, P < 0.01), and partial weight-bearing status postoperatively (AMD -1.38, P = 0.04) demonstrated less improvement of PCS scores over time. THA improved WOMAC function scores over time compared with monopolar HA (but not bipolar HA) (AMD -2.40, P < 0.01), whereas higher American Society of Anesthesiologists classification (AMD 1.99, P = 0.01) and preoperative use of an aid (AMD 5.39, P < 0.01) were associated with lower WOMAC function scores. Preoperative treatment for depression was associated with lower functional scores (AMD 7.73, P < 0.01). CONCLUSION: Patients receiving THA are likely to receive small and clinically unimportant improvements in health utility and function compared with those receiving monopolar HA and little improvement compared with those receiving bipolar HA. Patient-specific characteristics seem to play a larger role in predicting functional improvement among femoral neck fracture patients. LEVEL OF EVIDENCE: Prognostic Level II.

Published
2020

11. Arthroplasty versus internal fixation for the treatment of undisplaced femoral neck fractures

Author

Afaq, S., OʼHara, N.N., Schemitsch, E.H., Bzovsky, S., Sprague, S., Poolman, R.W., Frihagen, F., Heels-Ansdell, D., Bhandari, M., Tan, E.C.T.H., Kampen, A. van, Biert, J., Edwards, M.J.R., Frolke, J.P.M., Poelhekke, L.M.S.J., Waal Malefijt, M.C. de, Schreurs, B.W., Swiontkowski, M., and Slobogean, G.P.

Subjects
Male, Reoperation, medicine.medical_specialty, medicine.medical_treatment, Arthroplasty, Replacement, Hip, Femoral Neck Fractures, law.invention, 03 medical and health sciences, Fracture Fixation, Internal, 0302 clinical medicine, Randomized controlled trial, law, medicine, Risk of mortality, internal fixation, Internal fixation, Humans, Orthopedics and Sports Medicine, undisplaced femoral neck fracture, Aged, Retrospective Studies, Aged, 80 and over, 030222 orthopedics, business.industry, Mortality rate, 030208 emergency & critical care medicine, Retrospective cohort study, General Medicine, Odds ratio, Middle Aged, Arthroplasty, Surgery, Reconstructive and regenerative medicine Radboud Institute for Health Sciences [Radboudumc 10], Reconstructive and regenerative medicine Radboud Institute for Molecular Life Sciences [Radboudumc 10], Treatment Outcome, Quality of Life, arthroplasty, Female, Hemiarthroplasty, business
Abstract

Contains fulltext : 228684.pdf (Publisher’s version ) (Closed access) OBJECTIVE: To compare the 24-month risk of mortality between arthroplasty and internal fixation for undisplaced femoral neck fractures (FNFs). DESIGN: Retrospective cohort study. SETTING: Secondary data analysis of 2 multinational randomized controlled trials. PARTICIPANTS: Patients aged 50 years or older with a FNF. INTERVENTION: Arthroplasty (n = 1441), including total hip arthroplasty and hemiarthroplasty, performed for a displaced FNF versus internal fixation (n = 734), including sliding hip screw or multiple cancellous screws, performed for an undisplaced FNF. MAIN OUTCOME MEASUREMENT: The primary outcome was mortality within 24 months of injury. Secondary outcomes included reoperation and health-related quality of life. RESULTS: The 24-month mortality rate was 15.0% (n = 327). Arthroplasty was associated with a significant reduction in the odds of mortality [adjusted odds ratio (aOR): 0.56, 95% confidence interval (CI): 0.44-0.72, P < 0.01] compared with treatment with internal fixation. 11.4% (n = 248) of the study patients required reoperation within 24 months of injury. The odds of reoperation were 59% lower with arthroplasty treatment than with internal fixation (aOR: 0.41, 95% CI: 0.32-0.55, P < 0.01). The 24-month SF-12 physical component scores were 2.7 points higher in arthroplasty patients compared with internal fixation patients (95% CI: 1.6-3.8, P < 0.01). CONCLUSIONS: Our findings suggest arthroplasty for a FNF may reduce the risk of mortality and reoperation compared with internal fixation of undisplaced fractures. This finding is counter to many current surgical practices but consistent with a mounting body of evidence. Before widespread adoption of arthroplasty for undisplaced fractures, these results should be confirmed in a definitive comparative trial. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Published
2020

12. Factors Associated With Mortality After Surgical Management of Femoral Neck Fractures

Author

Bzovsky, S., Comeau-Gauthier, M., Schemitsch, E.H., Swiontkowski, M., Heels-Ansdell, D., Frihagen, F., Tan, E.C.T.H., Kampen, A. van, Biert, J., Edwards, M.J.R., Frölke, J.P., Poelhekke, L.M.S.J., Waal Malefijt, M.C. de, Bhandari, M., and Sprague, S.

Subjects
medicine.medical_specialty, medicine.medical_treatment, Arthroplasty, Replacement, Hip, Femoral Neck Fractures, 03 medical and health sciences, Fracture Fixation, Internal, 0302 clinical medicine, Risk Factors, Risk of mortality, Medicine, Internal fixation, Humans, Orthopedics and Sports Medicine, Femoral neck, Aged, Retrospective Studies, 030222 orthopedics, Hip fracture, business.industry, Hip Fractures, Mortality rate, 030208 emergency & critical care medicine, General Medicine, medicine.disease, Arthroplasty, Surgery, Reconstructive and regenerative medicine Radboud Institute for Health Sciences [Radboudumc 10], medicine.anatomical_structure, Reconstructive and regenerative medicine Radboud Institute for Molecular Life Sciences [Radboudumc 10], business, Kidney disease
Abstract

Contains fulltext : 228698.pdf (Publisher’s version ) (Closed access) BACKGROUND: Hip fractures are recognized as one of the most devastating injuries impacting older adults because of the complications that follow. Mortality rates postsurgery can range from 14% to 58% within one year of fracture. We aimed to identify factors associated with increased risk of mortality within 24 months of a femoral neck fracture in patients aged ≥50 years enrolled in the FAITH and HEALTH trials. METHODS: Two multivariable Cox proportional hazards regressions were used to investigate potential prognostic factors that may be associated with mortality within 90 days and 24 months of hip fracture. RESULTS: Ninety-one (4.1%) and 304 (13.5%) of 2247 participants died within 90 days and 24 months of suffering a femoral neck fracture, respectively. Older age (P < 0.001), lower body mass index (P = 0.002), American Society of Anesthesiologists (ASA) class III/IV/V (P = 0.004), use of an ambulatory aid before femoral neck fracture (P < 0.001), and kidney disease (P < 0.001) were associated with a higher risk of mortality within 24 months of femoral neck fracture. Older age (P = 0.03), lower body mass index (P = 0.02), use of an ambulatory aid before femoral neck fracture (P < 0.001), and having a comorbidity (P = 0.04) were associated with a higher risk of mortality within 90 days of femoral neck fracture. CONCLUSIONS: Our analysis found that factors that are indicative of a poorer health status were associated with a higher risk of mortality within 24 months of femoral neck fracture. We did not find a difference in treatment methods (internal fixation vs. joint arthroplasty) on the risk of mortality. LEVEL OF EVIDENCE: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

Published
2020

13. The biomechanics of human femurs in axial and torsional loading: comparison of finite element analysis, human cadaveric femurs, and synthetic femurs

Author

Papini, M., Zdero, R., Schemitsch, E.H., and Zalzal, P.

Subjects
Finite element method -- Usage, Biomechanics -- Research, Femur -- Properties, Elasticity -- Measurement, Engineering and manufacturing industries, Science and technology
Abstract

To assess the performance of femoral orthopedic implants, they are often attached to cadaveric femurs, and biomechanical testing is performed. To identify areas of high stress, stress shielding, and to facilitate implant redesign, these tests are often accompanied by finite element (FE) models of the bone/implant system. However, cadaveric bone suffers from wide specimen to specimen variability both in terms of bone geometry, and mechanical properties, making it virtually impossible for experimental results to be reproduced. An alternative approach is to utilize synthetic femurs of standardized geometry, having material behavior approximating that of human bone, but with very. small specimen to specimen variability. This approach allows for repeatable experimental results and a standard geometry for use in accompanying FE models. While the synthetic bones appear to be of appropriate geometry to simulate bone mechanical behavior, it has not, however, been established what bone quality they most resemble, i.e., osteoporotic or osteopenic versus healthy bone. Furthermore, it is also of interest to determine whether FE models of synthetic bones, with appropriate adjustments in input material properties or geometric size, could be used to simulate the mechanical behavior of a wider range of bone quality and size. To shed light on these questions, the axial and torsional stiffness of cadaveric femurs were compared to those measured on synthetic femurs. A FE model previously validated by the authors to represent the geometry of a synthetic femur, was then used with a range of input material properties and change in geometric size, to establish whether cadaveric results could be simulated. Axial and torsional stiffnesses and rigidities were measured for 25 human cadaveric femurs (simulating poor bone stock) and three synthetic 'third generation composite' femurs (3GCF) (simulating normal healthy bone stock) in the midstance orientation. The measured results were compared, under identical loading conditions, to those predicted by a previously validated three-dimensional finite element model of the 3GCF at a variety of Young's modulus values. A smaller FE model of the 3GCF was also created to examine the effects of a simple change in bone size. The 3GCF was found to be significantly stiffer (2.3 times in torsional loading, 1.7 times in axial loading) than the presently utilized cadaveric samples. Nevertheless, the FE model was able to successfully simulate both the behavior of the 3GCF, and a wide range of cadaveric bone data scatter by an appropriate adjustment of Young's modulus or geometric size. The synthetic femur had a significantly higher stiffness than the cadaveric bone samples. The finite element model provided a good estimate of upper and lower bounds for the axial and torsional stiffness of human femurs because it was effective at reproducing the geometric properties of a femur Cadaveric bone experiments can be used to calibrate FE models' input material properties so that bones of varying quality can be simulated. [DOI: 10.1115/1.2401178] Keywords: biomechanics, finite element analysis, cadaveric femur, torsional stiffness, axial stiffness

Published
2007

14. The FAITH and HEALTH Trials: Are We Studying Different Hip Fracture Patient Populations?

Author

Blankstein, M., Schemitsch, E.H., Bzovsky, S., Axelrod, D., Poolman, R.W., Frihagen, F., Bhandari, M., Swiontkowski, M., Tan, E.C.T.H., Kampen, A. van, Sprague, S., Schottel, P.C., Blankstein, M., Schemitsch, E.H., Bzovsky, S., Axelrod, D., Poolman, R.W., Frihagen, F., Bhandari, M., Swiontkowski, M., Tan, E.C.T.H., Kampen, A. van, Sprague, S., and Schottel, P.C.

Abstract

Contains fulltext : 228739.pdf (Publisher’s version ) (Closed access), BACKGROUND: Over the past decade, 2 randomized controlled trials were performed to evaluate 2 surgical strategies (internal fixation and arthroplasty) for the treatment of low-energy femoral neck fractures in patients aged ≥50 years. We evaluated whether patient populations in both the FAITH and HEALTH trials had different baseline characteristics and compared the displaced femoral neck fracture cohort from the FAITH trial to HEALTH trial patients. METHODS: Patient demographics, medical comorbidities, and fracture characteristics from both trials were compared. FAITH trial patients with displaced fractures were then compared with HEALTH patients. T-tests and χ tests were performed to compare differences for sex, age, osteoporosis status, and ASA class. RESULTS: The mean age of the 1079 FAITH trial patients was 72 versus 79 years for the 1441 HEALTH trial patients. HEALTH patients were older, mostly White, used more medication, and had more comorbidities than FAITH patients. Of the 1079 FAITH trial patients, 32% (346/1079) had displaced fractures. Their mean age was significantly lower than that of HEALTH patients (66 vs. 79 years; P < 0.001). HEALTH trial patients were significantly more likely to be female, have ASA classification Class III/IV/V, and carry a diagnosis of osteoporosis, as compared with the subgroup of FAITH patients with displaced femoral neck fractures (P < 0.001). CONCLUSION: This study demonstrates significant differences between patients enrolled in the 2 trials. Although both studies focused on femoral neck fractures with similar enrollment criteria, patient populations differed. This sheds light on a noteworthy limitation of discordant patient enrollment into randomized trials, despite similar eligibility criteria. LEVEL OF EVIDENCE: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

Published
2020

15. Venous Thromboembolism in Hip Fracture Patients: A Subanalysis of the FAITH and HEALTH Trials

Author

MacDonald, D.R.W., Neilly, D., Schneider, P.S., Bzovsky, S., Sprague, S., Axelrod, D., Poolman, R.W., Frihagen, F., Bhandari, M., Swiontkowski, M., Tan, E.C.T.H., Kampen, A. van, Schemitsch, E.H., Stevenson, I.M., MacDonald, D.R.W., Neilly, D., Schneider, P.S., Bzovsky, S., Sprague, S., Axelrod, D., Poolman, R.W., Frihagen, F., Bhandari, M., Swiontkowski, M., Tan, E.C.T.H., Kampen, A. van, Schemitsch, E.H., and Stevenson, I.M.

Abstract

Contains fulltext : 228746.pdf (Publisher’s version ) (Closed access), BACKGROUND: The primary objective of this study was to determine the incidence of symptomatic venous thromboembolism (VTE), including pulmonary embolism (PE) and deep vein thrombosis (DVT), in the hip fracture population. Secondary objectives included determining timing of VTE diagnosis, VTE thromboprophylaxis given, and identifying any factors associated with VTE. METHODS: Using data from the FAITH and HEALTH trials, the incidence of VTE, including DVT and PE, and the timing of VTE were determined. A multivariable Cox regression analysis was used to determine which factors were associated with increased risk of VTE, including age, treatment for comorbidity, thromboprophylaxis, time to surgery, and method of fracture management. RESULTS: 2520 hip fracture patients were included in the analysis. Sixty-four patients (2.5%) had a VTE [DVT: 36 (1.4%), PE: 28 (1.1%)]. Thirty-five (54.7%) were diagnosed less than 6 weeks postfracture and 29 (45.3%) more than 6 weeks postfracture. One thousand nine hundred ninety-three (79%) patients received thromboprophylaxis preoperatively and 2502 (99%) received thromboprophylaxis postoperatively. The most common method of preoperative (46%) and postoperative (73%) thromboprophylaxis was low molecular weight heparin. Treatment with arthroplasty compared to internal fixation was the only variable associated with increased risk of VTE (hazard ratio 2.67, P = 0.02). CONCLUSIONS: The incidence of symptomatic VTE in hip fracture patients recruited to the 2 trials was 2.5%. Although over half of the cases were diagnosed within 6 weeks of fracture, VTE is still prevalent after this period. The majority of patients received thromboprophylaxis. Treatment with arthroplasty rather than fixation was associated with increased incidence of VTE. LEVEL OF EVIDENCE: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

Published
2020

16. Arthroplasty Versus Internal Fixation for the Treatment of Undisplaced Femoral Neck Fractures: A Retrospective Cohort Study

Author

Afaq, S., OʼHara, N.N., Schemitsch, E.H., Bzovsky, S., Sprague, S., Poolman, R.W., Frihagen, F., Heels-Ansdell, D., Bhandari, M., Tan, E.C.T.H., Kampen, A. van, Biert, J., Edwards, M.J.R., Frolke, J.P.M., Poelhekke, L.M.S.J., Waal Malefijt, M.C. de, Schreurs, B.W., Swiontkowski, M., Slobogean, G.P., Afaq, S., OʼHara, N.N., Schemitsch, E.H., Bzovsky, S., Sprague, S., Poolman, R.W., Frihagen, F., Heels-Ansdell, D., Bhandari, M., Tan, E.C.T.H., Kampen, A. van, Biert, J., Edwards, M.J.R., Frolke, J.P.M., Poelhekke, L.M.S.J., Waal Malefijt, M.C. de, Schreurs, B.W., Swiontkowski, M., and Slobogean, G.P.

Abstract

Contains fulltext : 228684.pdf (Publisher’s version ) (Closed access), OBJECTIVE: To compare the 24-month risk of mortality between arthroplasty and internal fixation for undisplaced femoral neck fractures (FNFs). DESIGN: Retrospective cohort study. SETTING: Secondary data analysis of 2 multinational randomized controlled trials. PARTICIPANTS: Patients aged 50 years or older with a FNF. INTERVENTION: Arthroplasty (n = 1441), including total hip arthroplasty and hemiarthroplasty, performed for a displaced FNF versus internal fixation (n = 734), including sliding hip screw or multiple cancellous screws, performed for an undisplaced FNF. MAIN OUTCOME MEASUREMENT: The primary outcome was mortality within 24 months of injury. Secondary outcomes included reoperation and health-related quality of life. RESULTS: The 24-month mortality rate was 15.0% (n = 327). Arthroplasty was associated with a significant reduction in the odds of mortality [adjusted odds ratio (aOR): 0.56, 95% confidence interval (CI): 0.44-0.72, P < 0.01] compared with treatment with internal fixation. 11.4% (n = 248) of the study patients required reoperation within 24 months of injury. The odds of reoperation were 59% lower with arthroplasty treatment than with internal fixation (aOR: 0.41, 95% CI: 0.32-0.55, P < 0.01). The 24-month SF-12 physical component scores were 2.7 points higher in arthroplasty patients compared with internal fixation patients (95% CI: 1.6-3.8, P < 0.01). CONCLUSIONS: Our findings suggest arthroplasty for a FNF may reduce the risk of mortality and reoperation compared with internal fixation of undisplaced fractures. This finding is counter to many current surgical practices but consistent with a mounting body of evidence. Before widespread adoption of arthroplasty for undisplaced fractures, these results should be confirmed in a definitive comparative trial. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Published
2020

17. Predictors of Medical Serious Adverse Events in Hip Fracture Patients Treated With Arthroplasty

Author

Neilly, D. (David), Macdonald, D.R.W. (David), Sprague, S. (Sheila), Bzovsky, S. (Sofia), Axelrod, D. (Daniel), Poolman, R.W. (Rudolf), Frihagen, F. (Frede), Heels-Ansdell, D. (Diane), Bhandari, M. (Mohit), Schemitsch, E.H. (Emil), Stevenson, I.M. (Iain), Neilly, D. (David), Macdonald, D.R.W. (David), Sprague, S. (Sheila), Bzovsky, S. (Sofia), Axelrod, D. (Daniel), Poolman, R.W. (Rudolf), Frihagen, F. (Frede), Heels-Ansdell, D. (Diane), Bhandari, M. (Mohit), Schemitsch, E.H. (Emil), and Stevenson, I.M. (Iain)

Abstract

AIM: Patients with hip fractures are often frail with multiple comorbidities and at risk of medical serious adverse events (SAEs). We investigated the HEALTH trial patient population to ascertain predictors of SAEs. METHODS: We performed a multivariable Cox regression analysis. Occurrence of SAEs was included as the dependent variable with 31 potential prognostic factors being included as independent variables. RESULTS: One thousand four hundred forty-one patients were included in this analysis. Three hundred seventy (25.6%) patients suffered from an SAE. The most common events were cardiac (38.4%, n = 105), respiratory (20.8%, n = 77), and neurological (14.1%, n = 77). The majority of SAEs (50.8%, n = 188) occurred in the first 90 days after hip fracture with 35.4% occurring in the first 30 days (n = 131). Body mass index (BMI) between 18.5 and 24.9 compared with BMI between 25 and 29.9 [hazard ratio (HR) 1.32, P = 0.03] and receiving a total hip arthroplasty compared with a bipolar hemiarthroplasty (HR 1.36, P = 0.03) were associated with a higher risk of a medical SAE within 24 months of femoral neck fracture. Age (P = 0.09), use of femoral cement (P = 0.59), and use of canal pressurization (P = 0.37) were not associated with a medical SAE. CONCLUSION: Total hip arthroplasty is associated with more SAEs in the immediate postoperative period, and care should be taken in selecting patients for this treatment compared with a hemiarthroplasty. A higher BMI may be protective in hip fracture patients while age alone does not predict SAEs and neither does the use of femoral cement and/or pressurization. LEVEL OF EVIDENCE: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Published
2020
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18. Clockwise Torque of Sliding Hip Screws: Is There a Right Side?

Author

Würdemann, F.S. (Franka), Poolman, R.W. (Rudolf), Krijnen, P. (Pieta), Bzovsky, S. (Sofia), Sprague, S. (Sheila), Kaptein, B.L. (Bart), Hegeman, J.H. (Johannes), Schemitsch, E.H. (Emil), Bhandari, M. (Mohit), Swiontkowski, M.F. (Marc ), Schipper, I.B. (Inger), Würdemann, F.S. (Franka), Poolman, R.W. (Rudolf), Krijnen, P. (Pieta), Bzovsky, S. (Sofia), Sprague, S. (Sheila), Kaptein, B.L. (Bart), Hegeman, J.H. (Johannes), Schemitsch, E.H. (Emil), Bhandari, M. (Mohit), Swiontkowski, M.F. (Marc ), and Schipper, I.B. (Inger)

Abstract

OBJECTIVES: This study evaluated whether patients with a left-sided femoral neck fracture (FNF) treated with a sliding hip screw (SHS) had a higher implant failure rate than patients treated for a right-sided FNF. This was performed to determine the clinical relevance of the clockwise rotational torque of the femoral neck lag screw in a SHS, in relation to the rotational stability of left and right-sided FNFs after fixation. METHODS: Data were derived from the FAITH trial and Dutch Hip Fracture Audit (DHFA). Patients with a FNF, aged ≥50, treated with a SHS, with at least 3-month follow-up data available, were included. Implant failure was analyzed in a multivariable logistic regression model adjusted for age, sex, fracture displacement, prefracture living setting and functional mobility, and American Society for Anesthesiologists Class. RESULTS: One thousand seven hundred fifty patients were included, of which 944 (53.9%) had a left-sided and 806 (46.1%) a right-sided FNF. Implant failure occurred in 60 cases (3.4%), of which 31 were left-sided and 29 right-sided. No association between fracture side and implant failure was found [odds ratio (OR) for left vs. right 0.89, 95% confidence interval (CI) 0.52-1.52]. Female sex (OR 3.02, CI: 1.62-6.10), using a mobility aid (OR 2.02, CI 1.01-3.96) and a displaced fracture (OR 2.51, CI: 1.44-4.42), were associated with implant failure. CONCLUSIONS: This study could not substantiate the hypothesis that the biomechanics of the clockwise screw rotation of the SHS contributes to an increased risk of implant failure in left-sided FNFs compared with right-sided fractures. LEVEL OF EVIDENCE: Therapeutic Level II.See Instructions for Authors for a complete description of levels of evidence.

Published
2020
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19. Factors Associated With Mortality After Surgical Management of Femoral Neck Fractures

Author

Bzovsky, S. (Sofia), Comeau-Gauthier, M. (Marianne), Schemitsch, E.H. (Emil), Swiontkowski, M.F. (Marc ), Heels-Ansdell, D. (Diane), Frihagen, F. (Frede), Bhandari, M. (Mohit), Sprague, S. (Sheila), Bzovsky, S. (Sofia), Comeau-Gauthier, M. (Marianne), Schemitsch, E.H. (Emil), Swiontkowski, M.F. (Marc ), Heels-Ansdell, D. (Diane), Frihagen, F. (Frede), Bhandari, M. (Mohit), and Sprague, S. (Sheila)

Abstract

BACKGROUND: Hip fractures are recognized as one of the most devastating injuries impacting older adults because of the complications that follow. Mortality rates postsurgery can range from 14% to 58% within one year of fracture. We aimed to identify factors associated with increased risk of mortality within 24 months of a femoral neck fracture in patients aged ≥50 years enrolled in the FAITH and HEALTH trials. METHODS: Two multivariable Cox proportional hazards regressions were used to investigate potential prognostic factors that may be associated with mortality within 90 days and 24 months of hip fracture. RESULTS: Ninety-one (4.1%) and 304 (13.5%) of 2247 participants died within 90 days and 24 months of suffering a femoral neck fracture, respectively. Older age (P < 0.001), lower body mass index (P = 0.002), American Society of Anesthesiologists (ASA) class III/IV/V (P = 0.004), use of an ambulatory aid before femoral neck fracture (P < 0.001), and kidney disease (P < 0.001) were associated with a higher risk of mortality within 24 months of femoral neck fracture. Older age (P = 0.03), lower body mass index (P = 0.02), use of an ambulatory aid before femoral neck fracture (P < 0.001), and having a comorbidity (P = 0.04) were associated with a higher risk of mortality within 90 days of femoral neck fracture. CONCLUSIONS: Our analysis found that factors that are indicative of a poorer health status were associated with a higher risk of mortality within 24 months of femoral neck fracture. We did not find a difference in treatment methods (internal fixation vs. joint arthroplasty) on the risk of mortality. LEVEL OF EVIDENCE: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

Published
2020
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20. Who Did the Arthroplasty? Hip Fracture Surgery Reoperation Rates are Not Affected by Type of Training-An Analysis of the HEALTH Database

Author

DeAngelis, R.D. (Ryan), Minutillo, G.T. (Gregory), Stein, M.K. (Matthew), Schemitsch, E.H. (Emil), Bzovsky, S. (Sofia), Sprague, S. (Sheila), Bhandari, M. (Mohit), Donegan, D.J. (Derek), Mehta, S. (Samir), DeAngelis, R.D. (Ryan), Minutillo, G.T. (Gregory), Stein, M.K. (Matthew), Schemitsch, E.H. (Emil), Bzovsky, S. (Sofia), Sprague, S. (Sheila), Bhandari, M. (Mohit), Donegan, D.J. (Derek), and Mehta, S. (Samir)

Abstract

OBJECTIVES: This study compares outcomes for patients with displaced femoral neck fractures undergoing hemiarthroplasty (HA) or total hip arthroplasty (THA) by surgeons of different fellowship training. DESIGN: Retrospective review of HEALTH trial data. SETTING: Eighty clinical sites across 10 countries. PATIENTS/PARTICIPANTS: One thousand four hundred forty-one patients ≥50 years with low-energy hip fractures requiring surgical intervention. INTERVENTION: Patients were randomized to either HA or THA groups in the initial data set. Surgeons' fellowship training was ascertained retrospectively, and outcomes were compared. MAIN OUTCOME MEASUREMENTS: The main outcome was an unplanned secondary procedure at 24 months. Secondary outcomes included death, serious adverse events, prosthetic joint infection (PJI), dislocation, discharge disposition, and

Published
2020
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21. Venous Thromboembolism in Hip Fracture Patients: A Subanalysis of the FAITH and HEALTH Trials

Author

Macdonald, D.R.W. (David), Neilly, D. (David), Schneider, P.S. (Prism), Bzovsky, S. (Sofia), Sprague, S. (Sheila), Axelrod, D. (Daniel), Poolman, R.W. (Rudolf), Frihagen, F. (Frede), Bhandari, M. (Mohit), Swiontkowski, M.F. (Marc ), Schemitsch, E.H. (Emil), Stevenson, I.M. (Iain), Macdonald, D.R.W. (David), Neilly, D. (David), Schneider, P.S. (Prism), Bzovsky, S. (Sofia), Sprague, S. (Sheila), Axelrod, D. (Daniel), Poolman, R.W. (Rudolf), Frihagen, F. (Frede), Bhandari, M. (Mohit), Swiontkowski, M.F. (Marc ), Schemitsch, E.H. (Emil), and Stevenson, I.M. (Iain)

Abstract

BACKGROUND: The primary objective of this study was to determine the incidence of symptomatic venous thromboembolism (VTE), including pulmonary embolism (PE) and deep vein thrombosis (DVT), in the hip fracture population. Secondary objectives included determining timing of VTE diagnosis, VTE thromboprophylaxis given, and identifying any factors associated with VTE. METHODS: Using data from the FAITH and HEALTH trials, the incidence of VTE, including DVT and PE, and the timing of VTE were determined. A multivariable Cox regression analysis was used to determine which factors were associated with increased risk of VTE, including age, treatment for comorbidity, thromboprophylaxis, time to surgery, and method of fracture management. RESULTS: 2520 hip fracture patients were included in the analysis. Sixty-four patients (2.5%) had a VTE [DVT: 36 (1.4%), PE: 28 (1.1%)]. Thirty-five (54.7%) were diagnosed less than 6 weeks postfracture and 29 (45.3%) more than 6 weeks postfracture. One thousand nine hundred ninety-three (79%) patients received thromboprophylaxis preoperatively and 2502 (99%) received thromboprophylaxis postoperatively. The most common method of preoperative (46%) and postoperative (73%) thromboprophylaxis was low molecular weight heparin. Treatment with arthroplasty compared to internal fixation was the only variable associated with increased risk of VTE (hazard ratio 2.67, P = 0.02). CONCLUSIONS: The incidence of symptomatic VTE in hip fracture patients recruited to the 2 trials was 2.5%. Although over half of the cases were diagnosed within 6 weeks of fracture, VTE is still prevalent after this period. The majority of patients received thromboprophylaxis. Treatment with arthroplasty rather than fixation was associated with increased incidence of VTE. LEVEL OF EVIDENCE: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

Published
2020
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23. What Predicts Health-Related Quality of Life for Patients With Displaced Femoral Neck Fractures Managed With Arthroplasty? A Secondary Analysis of the HEALTH Trial

Author

Axelrod, D. (Daniel), Comeau-Gauthier, M. (Marianne), Bzovsky, S. (Sofia), Schemitsch, E.H. (Emil), Poolman, R.W. (Rudolf), Frihagen, F. (Frede), Guerra-Farfán, E. (Ernesto), Heels-Ansdell, D. (Diane), Bhandari, M. (Mohit), Sprague, S. (Sheila), Axelrod, D. (Daniel), Comeau-Gauthier, M. (Marianne), Bzovsky, S. (Sofia), Schemitsch, E.H. (Emil), Poolman, R.W. (Rudolf), Frihagen, F. (Frede), Guerra-Farfán, E. (Ernesto), Heels-Ansdell, D. (Diane), Bhandari, M. (Mohit), and Sprague, S. (Sheila)

Abstract

BACKGROUND: Total hip arthroplasty (THA) has been argued to improve health-related quality of life (HRQoL) and function in femoral neck fracture patients compared with hemiarthroplasty (HA). The HEALTH trial showed no clinically important functional advantages of THA over HA. The current analysis explores factors associated with HRQoL and function in this population. METHODS: Using repeated measures regression, we estimated the association between HRQoL and function [Short Form-12 (SF-12) physical component score (PCS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) function score] and 23 variables. RESULTS: THA as compared to monopolar HA, but not bipolar HA, was more likely to improve PCS scores (adjusted mean difference [AMD] 1.88 points, P = 0.02), whereas higher American Society of Anesthesiologists score (AMD -2.64, P < 0.01), preoperative use of an aid (AMD -2.66, P < 0.01), and partial weight-bearing status postoperatively (AMD -1.38, P = 0.04) demonstrated less improvement of PCS scores over time. THA improved WOMAC function scores over time compared with monopolar HA (but not bipolar HA) (AMD -2.40, P < 0.01), whereas higher American Society of Anesthesiologists classification (AMD 1.99, P = 0.01) and preoperative use of an aid (AMD 5.39, P < 0.01) were associated with lower WOMAC function scores. Preoperative treatment for depression was associated with lower functional sc

Published
2020
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24. Predictors of Long-Term Pain After Hip Arthroplasty in Patients With Femoral Neck Fractures: A Cohort Study

Author

Noori, A. (Atefeh), Sprague, S. (Sheila), Bzovsky, S. (Sofia), Schemitsch, E.H. (Emil), Poolman, R.W. (Rudolf), Frihagen, F. (Frede), Axelrod, D. (Daniel), Heels-Ansdell, D. (Diane), Bhandari, M. (Mohit), Busse, J.W. (Jason), Noori, A. (Atefeh), Sprague, S. (Sheila), Bzovsky, S. (Sofia), Schemitsch, E.H. (Emil), Poolman, R.W. (Rudolf), Frihagen, F. (Frede), Axelrod, D. (Daniel), Heels-Ansdell, D. (Diane), Bhandari, M. (Mohit), and Busse, J.W. (Jason)

Abstract

OBJECTIVES: To identify factors associated with the development of prolonged pain after hip fracture surgery. DESIGN: Secondary analysis of a randomized controlled trial. SETTING: Eighty hospitals in 10 countries. PATIENTS/PARTICIPANTS: One thousand four hundred forty-one hip fracture patients in the HEALTH trial. INTERVENTIONS: Total hip arthroplasty or hemiarthroplasty. MAIN OUTCOME MEASURES: Moderate-to-severe pain (at least 2 activities on the Western Ontario and McMaster Universities Osteoarthritis questionnaire pain subscale with scores ≥2) at 12 and 24 months after hip arthroplasty. RESULTS: Of 840 and 726 patients with complete baseline data and outcomes at 1-year and 2-year follow-up, 96 (11.4%) and 80 (11.0%) reported moderate-to-severe pain, respectively. An increased risk of pain at both 1 and 2 years after surgery was associated with reporting moderate-to-severe hip pain before fracture [absolute risk increase (ARI) 15.3%, 95% confidence interval (CI) 6.44%-24.35%; ARI 12.5%, 95% CI 2.85%-22.12%, respectively] and prefracture opioid use (ARI 15.6%, 95% CI 5.41%-25.89%; ARI 21.1%; 95% CI 8.23%-34.02%, respectively). Female sex was associated with an increased risk of persistent pain at 1 year (ARI 6.2%, 95% CI 3.53%-8.84%). A greater risk of persistent pain at 2 years was associated with younger age (≤79-year-old; ARI 6.3%; 95% CI 2.67%-9.91%) and higher prefacture functional status (ARI 10.7%; 95% CI 3.80%-17.64%). CONCLUSIONS: Among hip fracture patients undergoing arthroplasty, approximately one in 10 will experience moderate-to-severe pain up to 2 years after surgery. Younger age, female sex, higher functioning prefracture, living with hip pain prefracture, and use of prescription opioids were predictive of persistent pain. LEVEL OF EVIDENCE: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Published
2020
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25. Predictors of Loss to Follow-up in Hip Fracture Trials: A Secondary Analysis of the FAITH and HEALTH Trials

Author

Sivaratnam, S. (Surabhi), Comeau-Gauthier, M. (Marianne), Sprague, S. (Sheila), Schemitsch, E.H. (Emil), Poolman, R.W. (Rudolf), Frihagen, F. (Frede), Bhandari, M. (Mohit), Swiontkowski, M.F. (Marc ), Bzovsky, S. (Sofia), Sivaratnam, S. (Surabhi), Comeau-Gauthier, M. (Marianne), Sprague, S. (Sheila), Schemitsch, E.H. (Emil), Poolman, R.W. (Rudolf), Frihagen, F. (Frede), Bhandari, M. (Mohit), Swiontkowski, M.F. (Marc ), and Bzovsky, S. (Sofia)

Abstract

BACKGROUND: Hip fracture trials often suffer substantial loss to follow-up due to difficulties locating and communicating with participants or when participants, or their family members, withdraw their consent. We aimed to determine which factors were associated with being unable to contact FAITH and HEALTH participants for their 24-month follow-up and to also determine which factors were associated with their withdrawal of consent. METHODS: We conducted 2 multivariable logistic regression analyses to determine which factors were predictive of being unable to contact participants at 24 months postfracture and withdrawal of consent within 24 months of their fracture. Results were reported as odds ratios, 95% confidence intervals, and associated P-values. All tests were 2-tailed with alpha = 0.05. RESULTS: We were unable to contact 123 of 2520 participants (4.9%) for their 24-month follow-up visits and 124 (4.9%) withdrew their consent from the trial. Being non-White (P = 0.003), enrolled from a non-European hospital (P < 0.001), and treated with arthroplasty (P < 0.001) were associated with an increased odds of not completing the 24-month follow-up visit. Being enrolled from a hospital in the United States (P = 0.02), from a hospital in Oceania, India, or South Africa (P < 0.001) as compared to a European hospital, and treated with arthroplasty (P < 0.001) were associated with an increased odds of consent withdrawal. DISCUSSION: Certain factors may be predictive of loss to follow-up in hip fracture trials. We suggest that the identification of such factors may be used to inform and improve retention strategies in future orthopaedic hip fracture trials. LEVEL OF EVIDENCE: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Published
2020
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26. What Factors Increase Revision Surgery Risk When Treating Displaced Femoral Neck Fractures With Arthroplasty: A Secondary Analysis of the HEALTH Trial

Author

Blankstein, M. (Michael), Schemitsch, E.H. (Emil), Bzovsky, S. (Sofia), Poolman, R.W. (Rudolf), Frihagen, F. (Frede), Axelrod, D. (Daniel), Heels-Ansdell, D. (Diane), Bhandari, M. (Mohit), Sprague, S. (Sheila), Schottel, P.C. (Patrick), Blankstein, M. (Michael), Schemitsch, E.H. (Emil), Bzovsky, S. (Sofia), Poolman, R.W. (Rudolf), Frihagen, F. (Frede), Axelrod, D. (Daniel), Heels-Ansdell, D. (Diane), Bhandari, M. (Mohit), Sprague, S. (Sheila), and Schottel, P.C. (Patrick)

Abstract

OBJECTIVES: HEALTH was a randomized controlled trial comparing total hip arthroplasty with hemiarthroplasty in low-energy displaced femoral neck fracture patients aged ≥50 years with unplanned revision surgery within 24 months of the initial procedure being the primary outcome. No significant short-term differences between treatment arms were observed. The primary objective of this secondary HEALTH trial analysis was to determine if any patient and surgical factors were associated with increased risk of revision surgery within 24 months after hip fracture. METHODS: We analyzed 9 potential factors chosen a priori that could be associated with revision surgery. The factors included age, body mass index, major comorbidities, independent ambulation, type of surgical approach, length of operation, use of femoral cement, femoral head size, and degree of femoral stem offset. Our statistical analysis was a multivariable Cox regression using reoperation within 24 months of index surgery as the dependent variable. RESULTS: Of the 1441 patients included in this analysis, 8.1% (117/1441) experienced reoperation within 24 months. None of the studied factors were found to be predictors of revision surgery (P > 0.05). CONCLUSION: Both total and partial hip replacements are successful procedures in low-energy displaced femoral neck fracture patients. We were unable to identify any patient or surgeon-controlled factors that significantly increased the need for revision surgery in our elderly and predominately female patient population. One should not generalize our findings to an active physiologically younger femoral neck fracture population. LEVEL OF EVIDENCE: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Published
2020
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27. Arthroplasty Versus Internal Fixation for the Treatment of Undisplaced Femoral Neck Fractures: A Retrospective Cohort Study

Author

Afaq, S. (Shaikh), O'Hara, N.N. (Nathan), Schemitsch, E.H. (Emil), Bzovsky, S. (Sofia), Sprague, S. (Sheila), Poolman, R.W. (Rudolf), Frihagen, F. (Frede), Heels-Ansdell, D. (Diane), Bhandari, M. (Mohit), Swiontkowski, M.F. (Marc ), Slobogean, G.P. (Gerard), Afaq, S. (Shaikh), O'Hara, N.N. (Nathan), Schemitsch, E.H. (Emil), Bzovsky, S. (Sofia), Sprague, S. (Sheila), Poolman, R.W. (Rudolf), Frihagen, F. (Frede), Heels-Ansdell, D. (Diane), Bhandari, M. (Mohit), Swiontkowski, M.F. (Marc ), and Slobogean, G.P. (Gerard)

Abstract

OBJECTIVE: To compare the 24-month risk of mortality between arthroplasty and internal fixation for undisplaced femoral neck fractures (FNFs). DESIGN: Retrospective cohort study. SETTING: Secondary data analysis of 2 multinational randomized controlled trials. PARTICIPANTS: Patients aged 50 years or older with a FNF. INTERVENTION: Arthroplasty (n = 1441), including total hip arthroplasty and hemiarthroplasty, performed for a displaced FNF versus internal fixation (n = 734), including sliding hip screw or multiple cancellous screws, performed for an undisplaced FNF. MAIN OUTCOME MEASUREMENT: The primary outcome was mortality within 24 months of injury. Secondary outcomes included reoperation and health-related quality of life. RESULTS: The 24-month mortality rate was 15.0% (n = 327). Arthroplasty was associated with a significant reduction in the odds of mortality [adjusted odds ratio (aOR): 0.56, 95% confidence interval (CI): 0.44-0.72, P < 0.01] compared with treatment with internal fixation. 11.4% (n = 248) of the study patients required reoperation within 24 months of injury. The odds of reoperation were 59% lower with arthroplasty treatment than with internal fixation (aOR: 0.41, 95% CI: 0.32-0.55, P < 0.01). The 24-month SF-12 physical component scores were 2.7 points higher in arthroplasty patients compared with internal fixation patients (95% CI: 1.6-3.8, P < 0.01). CONCLUSIONS: Our findings suggest arthroplasty for a FNF may reduce the risk of mortality and reoperation compared with internal fixation of undisplaced fractures. This finding is counter to many current surgical practices but consistent with a mounting body of evidence. Before widespread adoption of arthroplasty for undisplaced fractures, these results should be confirmed in a definitive comparative trial. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Published
2020
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28. Predictors of Loss to Follow-up in Hip Fracture Trials: A Secondary Analysis of the FAITH and HEALTH Trials

Author

Sivaratnam, S., Comeau-Gauthier, M., Sprague, S., Schemitsch, E.H., Poolman, R.W., Frihagen, F., Bhandari, M., Tan, E.C.T.H., Kampen, A. van, Edwards, M.J.R., Swiontkowski, M., Bzovsky, S., Sivaratnam, S., Comeau-Gauthier, M., Sprague, S., Schemitsch, E.H., Poolman, R.W., Frihagen, F., Bhandari, M., Tan, E.C.T.H., Kampen, A. van, Edwards, M.J.R., Swiontkowski, M., and Bzovsky, S.

Abstract

Contains fulltext : 228720.pdf (Publisher’s version ) (Closed access), BACKGROUND: Hip fracture trials often suffer substantial loss to follow-up due to difficulties locating and communicating with participants or when participants, or their family members, withdraw their consent. We aimed to determine which factors were associated with being unable to contact FAITH and HEALTH participants for their 24-month follow-up and to also determine which factors were associated with their withdrawal of consent. METHODS: We conducted 2 multivariable logistic regression analyses to determine which factors were predictive of being unable to contact participants at 24 months postfracture and withdrawal of consent within 24 months of their fracture. Results were reported as odds ratios, 95% confidence intervals, and associated P-values. All tests were 2-tailed with alpha = 0.05. RESULTS: We were unable to contact 123 of 2520 participants (4.9%) for their 24-month follow-up visits and 124 (4.9%) withdrew their consent from the trial. Being non-White (P = 0.003), enrolled from a non-European hospital (P < 0.001), and treated with arthroplasty (P < 0.001) were associated with an increased odds of not completing the 24-month follow-up visit. Being enrolled from a hospital in the United States (P = 0.02), from a hospital in Oceania, India, or South Africa (P < 0.001) as compared to a European hospital, and treated with arthroplasty (P < 0.001) were associated with an increased odds of consent withdrawal. DISCUSSION: Certain factors may be predictive of loss to follow-up in hip fracture trials. We suggest that the identification of such factors may be used to inform and improve retention strategies in future orthopaedic hip fracture trials. LEVEL OF EVIDENCE: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Published
2020

29. Factors associated with health-related quality of life, hip function, and health utility after operative management of femoral neck fractures

Author

Sprague, S., Bhandari, M., Heetveld, M.J., Liew, S., Scott, T., Bzovsky, S., Heels-Ansdell, D., Zhou, Q., Kampen, A. van, Biert, J., Vugt, A.B. van, Edwards, M.J.R., Blokhuis, T.J., Frolke, J.P.M., Geeraedts, L.M.G., Gardeniers, J.W.M., Tan, E.C.T.H., Poelhekke, L.M.S.J., Waal Malefijt, M.C. de, Schreurs, B.W., Swiontkowski, M., and Schemitsch, E.H.

Subjects
Male, medicine.medical_specialty, Health utility, Femoral Neck Fractures, Disability Evaluation, Fracture Fixation, Internal, 03 medical and health sciences, 0302 clinical medicine, Quality of life, Medicine and Health Sciences, medicine, Humans, Orthopedics and Sports Medicine, In patient, 030212 general & internal medicine, Aged, Pain Measurement, Femoral neck, Aged, 80 and over, Health related quality of life, 030222 orthopedics, Hip fracture, business.industry, Middle Aged, Prognosis, medicine.disease, Reconstructive and regenerative medicine Radboud Institute for Health Sciences [Radboudumc 10], Treatment Outcome, medicine.anatomical_structure, Reconstructive and regenerative medicine Radboud Institute for Molecular Life Sciences [Radboudumc 10], Quality of Life, Physical therapy, Female, Surgery, business
Abstract

Aims The primary aim of this prognostic study was to identify baseline factors associated with physical health-related quality of life (HRQL) in patients after a femoral neck fracture. The secondary aims were to identify baseline factors associated with mental HRQL, hip function, and health utility. Patients and Methods Patients who were enrolled in the Fixation using Alternative Implants for the Treatment of Hip Fractures (FAITH) trial completed the 12-item Short Form Health Survey (SF-12), Western Ontario and McMaster Universities Arthritis Index, and EuroQol 5-Dimension at regular intervals for 24 months. We conducted multilevel mixed models to identify factors potentially associated with HRQL. Results The following were associated with lower physical HRQL: older age (-1.42 for every ten-year increase, 95% confidence interval (CI) -2.17 to -0.67, p Conclusion We identified several baseline factors associated with lower HRQL, hip function, and utility after a femoral neck fracture. These findings may be used by clinicians to inform treatment and outcomes. Cite this article: Bone Joint J 2018;100-B:361–9.

Published
2018

30. Factors Associated with Revision Surgery after Internal Fixation of Hip Fractures

Author

Sprague, S. (Sheila), Schemitsch, E.H. (Emil H.), Swiontkowski, M.F. (Marc ), Della Rocca, G.J. (Gregory J.), Jeray, K.J. (Kyle J.), Liew, S. (Susan), Slobogean, G.P. (Gerard P.), Bzovsky, S. (Sofia), Heels-Ansdell, D. (Diane), Zhou, Q. (Qi), Bhandari, M. (Mohit), Sprag, S. (Sheila), Devereaux, P.J., Guyatt, G.H. (Gordon), Heetveld, M.J. (Martin J.), Richardson, M. (Martin), Thabane, L. (Lehana), Tornetta III, P. (Paul), Walter, S.D. (Stephen D.), McKay, P. (Paula), Scott, T. (Taryn), Garibaldi, A. (Alisha), Viveiros, H. (Helena), Swinton, M. (Marilyn), Gichuru, M. (Mark), Buckingham, L. (Lisa), Duraikannan, A. (Aravin), Maddock, D. (Deborah), Simunovic, N. (Nicole), Agel, J. (Julie), Lieshout, E.M.M. (Esther) van, Zielinski, S.M. (Stephanie), Rangan, A. (Amar), Hanusch, B.C. (Birgit C.), Kottam, L. (Lucksy), Clarkson, R. (Rachel), Haverlag, R. (Robert), McCormack, R. (Robert), Apostle, K. (Kelly), Boyer, D. (Dory), Moola, F. (Farhad), Perey, B. (Bertrand), Stone, T. (Trevor), Viskontas, D. (Darius), Lemke, H.M. (H. Michael), Zomar, M. (Mauri), Moon, K. (Karyn), Moon, R. (Raely), Oatt, A. (Amber), Buckley, R.E. (Richard E.), Duffy, P. (Paul), Korley, R. (Robert), Puloski, S. (Shannon), Powell, J. (James), Johnston, K. (Kelly), Carcary, K. (Kimberly), Lorenzo, M. (Melissa), McKercher, R. (Ross), Sanders, D. (David), MacLeod, M. (Mark), Lawendy, A.-R. (Abdel-Rahman), Tieszer, C. (Christina), Stephen, D. (David), Kreder, H. (Hans), Jenkinson, R. (Richard), Nousiainen, M. (Markku), Axelrod, T. (Terry), Murnaghan, J. (John), Nam, D. (Diane), Wadey, V. (Veronica), Yee, A. (Albert), Milner, K. (Katrine), Kunz, M. (Monica), Ghent, W. (Wesley), McKee, M.D. (Michael D.), Hall, J.A. (Jeremy A.), Nauth, A. (Aaron), Ahn, H. (Henry), Whelan, D.B. (Daniel B.), Vicente, M.R. (Milena R.), Wild, L.M. (Lisa M.), Khan, R.M. (Ryan M.), Hidy, J.T. (Jennifer T.), Coles, C. (Chad), Leighton, R. (Ross), Biddulph, M. (Michael), Johnston, D. (David), Glazebrook, M. (Mark), Alexander, D. (David), Coady, C. (Catherine), Dunbar, M. (Michael), Amirault, J.D. (J. David), Gross, M. (Michael), Oxner, W. (William), Reardon, G. (Gerald), Richardson, C.G. (C. Glen), Trenholm, J.A. (J. Andrew), Wong, I. (Ivan), Trask, K. (Kelly), MacDonald, S. (Shelley), Dobbin, G. (Gwendolyn), Bicknell, R. (Ryan), Yach, J. (Jeff), Bardana, D. (Davide), Wood, G. (Gavin), Harrison, M. (Mark), Yen, D. (David), Lambert, S. (Sue), Howells, F. (Fiona), Ward, A. (Angela), Zalzal, P. (Paul), Brien, H. (Heather), Naumetz, V. (V.), Weening, B. (Brad), Wai, E.K. (Eugene K.), Papp, S. (Steve), Gofton, W.T. (Wade T.), Liew, A. (Allen), Kingwell, S.P. (Stephen P.), Johnson, G. (Garth), O'Neil, J. (Joseph), Roffey, D.M. (Darren M.), Borsella, V. (Vivian), Avram, V. (Victoria), Oliver, T.M. (Todd M.), Jones, V. (Vicki), Vogt, M. (Michelle), Jones, C.B. (Clifford B.), Ringler, J.R. (James R.), Endres, T.J. (Terrence J.), Sietsema, D.L. (Debra L.), Walker, J.E. (Jane E.), Broderick, J.S. (J. Scott), Goetz, D.R. (David R.), Pace, T.B. (Thomas B.), Schaller, T.M. (Thomas M.), Porter, S.E. (Scott E.), Beckish, M.L. (Michael L.), Adams, J.D. (John D.), Barden, B.B. (Benjamin B.), Creek, A.T. (Aaron T.), Finley, S.H. (Stephen H.), Foret, J.L. (Jonathan L.), Gudger, G.K. (Garland K.), Gurich, R.W. (Richard W.), Hill, A.D. (Austin D.), Hollenbeck, S.M. (Steven M.), Jackson, L.T. (Lyle T.), Kruse, K.K. (Kevin K.), Lackey, W.G. (Wesley G.), Langan, J.W. (Justin W.), Lee, J. (Julia), Leffler, L.C. (Lauren C.), Miller, T.J. (Timothy J.), Murphy, R.L. (R. Lee), O'Malley, L.K. (Lawrence K.), Peters, M.E. (Melissa E.), Price, D.M. (Dustin M.), Tanksley, J.A. (John A.), Torres, E.T. (Erick T.), Watson, D.J. (Dylan J.), Watson, S.T. (Scott T.), Tanner, S.L. (Stephanie L.), Snider, R.G. (Rebecca G.), Nastoff, L.A. (Lauren A.), Bielby, S.A. (Shea A.), Teasdall, R.J. (Robert J.), Switzer, J.A. (Julie A.), Cole, P.A. (Peter A.), Anderson, S.A. (Sarah A.), Lafferty, P.M. (Paul M.), Li, M. (Mengnai), Ly, T.V. (Thuan V.), Marston, S.B. (Scott B.), Foley, A.L. (Amy L.), Vang, S. (Sandy), Wright, D.M. (David M.), Marcantonio, A.J. (Andrew J.), Kain, M.S.H. (Michael S.H.), Iorio, R. (Richard), Specht, L.M. (Lawrence M.), Tilzey, J.F. (John F.), Lobo, M.J. (Margaret J.), Garfi, J.S. (John S.), Vallier, H.A. (Heather A.), Dolenc, A. (Andrea), Breslin, M. (Mary), Prayson, M.J. (Michael J.), Laughlin, R. (Richard), Rubino, L.J. (L. Joseph), May, J. (Jedediah), Rieser, G.R. (Geoffrey Ryan), Dulaney-Cripe, L. (Liz), Gayton, C. (Chris), Shaer, J. (James), Schrickel, T. (Tyson), Hileman, B. (Barbara), Gorczyca, J.T. (John T.), Gross, J.M. (Jonathan M.), Humphrey, C.A. (Catherine A.), Kates, S. (Stephen), Ketz, J.P. (John P.), Noble, K. (Krista), McIntyre, A.W. (Allison W.), Pecorella, K. (Kaili), Davis, C.A. (Craig A.), Weinerman, S. (Stuart), Weingarten, P. (Peter), Stull, P. (Philip), Lindenbaum, S. (Stephen), Hewitt, M. (Michael), Schwappach, J. (John), Baker, J.K. (Janell K.), Rutherford, T. (Tori), Newman, H. (Heike), Lieberman, S. (Shane), Finn, E. (Erin), Robbins, K. (Kristin), Hurley, M. (Meghan), Lyle, L. (Lindsey), Mitchell, K. (Khalis), Browner, K. (Kieran), Whatley, E. (Erica), Payton, K. (Krystal), Reeves, C. (Christina), Cannada, L.K. (Lisa K.), Karges, D.E. (David E.), Dawson, S.A. (Sarah A.), Mehta, S. (Samir), Esterhai, J. (John), Ahn, J. (Jaimo), Donegan, D. (Derek), Horan, A.D. (Annamarie D.), Hesketh, P.J. (Patrick J.), Bannister, E.R. (Evan R.), Keeve, J.P. (Jonathan P.), Anderson, C.G. (Christopher G.), McDonald, M.D. (Michael D.), Hoffman, J.M. (Jodi M.), Tarkin, I. (Ivan), Siska, P. (Peter), Gruen, G. (Gary), Evans, A. (Andrew), Farrell, D.J. (Dana J.), Irrgang, J. (James), Luther, A. (Arlene), Cross, W.W. (William W.), Cass, J.R. (Joseph R.), Sems, S.A. (Stephen A.), Torchia, M.E. (Michael E.), Scrabeck, T. (Tyson), Jenkins, M. (Mark), Dumais, J. (Jules), Romero, A.W. (Amanda W.), Sagebien, C.A. (Carlos A.), Butler, M.S. (Mark S.), Monica, J.T. (James T.), Seuffert, P. (Patricia), Hsu, J.R. (Joseph R.), Stinner, D. (Daniel), Ficke, J. (James), Charlton, M. (Michael), Napierala, M. (Matthew), Fan, M. (Mary), Tannoury, C. (Chadi), Carlisle, H. (Hope), Silva, H. (Heather), Archdeacon, M. (Michael), Finnan, R. (Ryan), Le, T. (Toan), Wyrick, J. (John), Hess, S. (Shelley), Brennan, M.L. (Michael L.), Probe, R. (Robert), Kile, E. (Evelyn), Mills, K. (Kelli), Clipper, L. (Lydia), Yu, M. (Michelle), Erwin, K. (Katie), Horwitz, D. (Daniel), Strohecker, K. (Kent), Swenson, T.K. (Teresa K.), Schmidt, A.H. (Andrew H.), Westberg, J.R. (Jerald R.), Aurang, K. (Kamran), Zohman, G. (Gary), Peterson, B. (Brett), Huff, R.B. (Roger B.), Baele, J. (Joseph), Weber, T. (Timothy), Edison, M. (Matt), McBeth, J.C. (Jessica Cooper), Shively, K. (Karl), Ertl, J.P. (Janos P.), Mullis, B. (Brian), Parr, J.A. (J. Andrew), Worman, R. (Ripley), Frizzell, V. (Valda), Moore, M.M. (Molly M.), DePaolo, C.J. (Charles J.), Alosky, R. (Rachel), Shell, L.E. (Leslie E.), Hampton, L. (Lynne), Shepard, S. (Stephanie), Nanney, T. (Tracy), Cuento, C. (Claudine), Cantu, R.V. (Robert V.), Henderson, E.R. (Eric R.), Eickhoff, L.S. (Linda S.), Hammerberg, E.M. (E. Mark), Stahel, P. (Philip), Hak, D. (David), Mauffrey, C. (Cyril), Henderson, C. (Corey), Gissel, H. (Hannah), Gibula, D. (Douglas), Zamorano, D.P. (David P.), Tynan, M.C. (Martin C.), Pourmand, D. (Deeba), Lawson, D. (Deanna), Crist, B.D. (Brett D.), Murtha, Y.M. (Yvonne M.), Anderson, L.K. (Linda K.), Linehan, C. (Colleen), Pilling, L. (Lindsey), Lewis, C.G. (Courtland G.), Caminiti, S. (Stephanie), Sullivan, R.J. (Raymond J.), Roper, E. (Elizabeth), Obremskey, W. (William), Kregor, P. (Philip), Richards, J.E. (Justin E.), Stringfellow, K. (Kenya), Dohm, M.P. (Michael P.), Zellar, A. (Abby), Segers, M.J.M. (Michiel), Zijl, J.A.C. (Jacco A.C.), Verhoeven, B. (Bart), Smits, A.B. (Anke B.), De Vries, J.P.P.M. (Jean Paul P.M.), Fioole, B. (Bram), Van Der Hoeven, H. (Henk), Theunissen, E.B.M. (Evert B.M.), De Vries Reilingh, T.S. (Tammo S.), Govaert, L. (Lonneke), Wittich, P. (Philippe), De Brauw, M. (Maurits), Wille, J.C. (Jan), Go, P.M.N.Y.M. (Peter M.N.Y.M.), Ritchie, E.D. (Ewan D.), Wessel, R.N. (Ronald N.), Hammacher, E.R. (Eric), Visser, G.A. (Gijs A.), Stockmann, H. (Heyn), Silvis, R. (Rob), Snellen, J.P. (Jaap P.), Rijbroek, B. (Bram), Scheepers, J.J. (Joris J.), Vermeulen, E.G.J. (Erik G.J.), Siroen, M.P.C. (Michiel P.C.), Vuylsteke, R. (Ronald), Brom, H.L.F., Rijna, H., Rijcke, P.A.R. (Piet), Koppert, C.L. (Cees L.), Buijk, S.E. (Steven E.), Groenendijk, R.P.R. (Richard), Dawson, I. (Imro), Tetteroo, G.W.M. (Geert), Bruijninckx, M.M.M. (Milko), Doornebosch, P. (Pascal), Graaf, E.J.R. (Eelco) de, Elst, M. (Maarten) van der, Pol, C. (Carmen) van der, Riet, M. (Martijne) van 't, Karsten, T.M. (Thomas), Vries, M.R. (Mark) de, Stassen, L.P.S. (Laurents P.S.), Schep, N.W.L. (Niels), Ben Schmidt, G. (G.), Hoffman, W.H. (W. H.), Poolman, R.W. (Rudolf), Simons, M.P., Heijden, F.H.W.M. (Frank) van der, Willems, W.J. (Jaap), De Meulemeester, F.R.A.J. (Frank R.A.J.), Hart, C.P. (Cor P.) van der, Turckan, K. (Kahn), Festen, S. (Sebastiaan), Nies, F. (Frank) de, Out, N.J.M. (Nico J.M.), Bosma, J. (Jan), Kampen, A. (A.) van, Biert, J. (Jan), Van Vugt, A.B. (Arie B.), Edwards, M.J.R. (Michael J.R.), Blokhuis, T.J. (Taco J.), Frölke, J.P.M. (Jan Paul), Geeraedts, L.M.G. (Leo M.G.), Gardeniers, J.W.M. (Jean W.M.), Tan, E.C.T.H. (Edward C.T.H.), Poelhekke, L.M.S.J., De Waal Malefijt, M.C. (Maarten C.), Schreurs, B. (Bart), Roukema, G.R. (Gert), Josaputra, H.A. (Hong A.), Keller, P. (Paul), De Rooij, P.D. (Peter D.), Kuiken, H. (Hans), Boxma, H. (Han), Cleffken, B.I. (Berry), Liem, R. (Ronald), Rhemrev, S. (Steven), Bosman, C.H.R. (Coks H.R.), De Mol Van Otterloo, A. (Alexander), Hoogendoorn, J. (Jochem), Vries, A.C. (Alexander) de, Meylaerts, S.A.G. (Sven), Verhofstad, M.H.J. (Michiel), Meijer, J. (Joost), Van Egmond, T. (Teun), Van Der Brand, I. (Igor), Patka, P. (Peter), Eversdijk, M.G. (Martin), Peters, R. (Rolf), Hartog, D. (Dennis) den, Waes, O.J.F. (Oscar) van, Oprel, P.P. (Pim), Vis, H.M. (Harm) van der, Campo, M. (Martin), Verhagen, R. (Ronald), Albers, G.H.R. (G.H. Robert), Zurcher, A.W. (Arthur W.), Simmermacher, R.K.J., Van Mulken, J. (Jeroen), Wessem, K.J.P. van, Van Gaalen, S.M. (Steven M.), Leenen, L.P.H., Bronkhorst, M.W.G.A. (Maarten), Guicherit, O.R. (Onno R.), Goslings, J.C. (Carel), Ponsen, K.J. (Kees-jan), Bhatia, M. (Mahesh), Arora, V. (Vinod), Tyagi, V. (Vivek), Bedi, H. (Harvinder), Carr, A. (Ashley), Curry, H. (Hamish), Chia, A. (Andrew), Csongvay, S. (Steve), Donohue, C. (Craig), Doig, S. (Stephen), Edwards, E. (Elton), Etherington, G. (Greg), Esser, M. (Max), Gong, A. (Andrew), Jain, A. (Arvind), Li, D. (Doug), Miller, R. (Russell), Moaveni, A. (Ash), Russ, M. (Matthias), Ton, L. (Lu), Wang, O. (Otis), Dowrick, A. (Adam), Murdoch, Z. (Zoe), Sage, C. (Claire), Frihagen, F. (Frede), Clarke-Jenssen, J. (John), Hjorthaug, G. (Geir), Ianssen, T. (Torben), Amundsen, A. (Asgeir), Brattgjerd, J.E. (Jan Egil), Borch, T. (Tor), Bøe, B. (Berthe), Flatøy, B. (Bernhard), Hasselund, S. (Sondre), Haug, K.J. (Knut Jørgen), Hemlock, K. (Kim), Hoseth, T.M. (Tor Magne), Jomaas, G. (Geir), Kibsgård, T. (Thomas), Lona, T. (Tarjei), Moatshe, G. (Gilbert), Müller, O. (Oliver), Molund, M. (Marius), Nicolaisen, T. (Tor), Nilsen, F. (Fredrik), Rydinge, J. (Jonas), Smedsrud, M. (Morten), Stødle, A. (Are), Trommer, A. (Axel), Ugland, S. (Stein), Karlsten, A. (Anders), Ekås, G. (Guri), Vesterhus, E.B. (Elise Berg), Brekke, A.C. (Anne Christine), Gupta, A. (Ajay), Jain, N. (Neeraj), Khan, F. (Farah), Sharma, A. (Ateet), Sanghavi, A. (Amir), Trivedi, M. (Mittal), Rai, A. (Anil), Subash, (), Rai, K. (Kamal), Yadav, V. (Vineet), Singh, S. (Sanjay), Tetsworth, K. (Kevin), Donald, G. (Geoff), Weinrauch, P. (Patrick), Pincus, P. (Paul), Yang, S. (Steven), Halliday, B. (Brett), Gervais, T. (Trevor), Holt, M. (Michael), Flynn, A. (Annette), Prasad, A.S. (Amal Shankar), Mishra, V. (Vimlesh), Sundaresh, D.C. (D. C.), Khanna, A. (Angshuman), Cherian, J.J. (Joe Joseph), Olakkengil, D.J. (Davy J), Sharma, G. (Gaurav), Pirpiris, M. (Marinis), Love, D. (David), Bucknill, A. (Andrew), Farrugia, R.J. (Richard J), Pape, H.-C. (Hans-Christoph), Knobe, M. (Matthias), Pfeifer, R. (Roman), Hull, P. (Peter), Lewis, S. (Sophie), Evans, S. (Simone), Nanda, R. (Rajesh), Logishetty, R. (Rajanikanth), Anand, S. (Sanjeev), Bowler, C. (Carol), Dadi, A. (Akhil), Palla, N. (Naveen), Ganguly, U. (Utsav), Rai, B.S. (B. Sachidananda), Rajakumar, J. (Janakiraman), Jennings, A. (Andrew), Chuter, G. (Graham), Rose, G. (Glynis), Horner, G. (Gillian), Clark, C. (Callum), Eke, K. (Kate), Reed, M.R. (Mike), Inman, D. (Dominic), Herriott, C. (Chris), Dobb, C. (Christine), Sprague, S. (Sheila), Schemitsch, E.H. (Emil H.), Swiontkowski, M.F. (Marc ), Della Rocca, G.J. (Gregory J.), Jeray, K.J. (Kyle J.), Liew, S. (Susan), Slobogean, G.P. (Gerard P.), Bzovsky, S. (Sofia), Heels-Ansdell, D. (Diane), Zhou, Q. (Qi), Bhandari, M. (Mohit), Sprag, S. (Sheila), Devereaux, P.J., Guyatt, G.H. (Gordon), Heetveld, M.J. (Martin J.), Richardson, M. (Martin), Thabane, L. (Lehana), Tornetta III, P. (Paul), Walter, S.D. (Stephen D.), McKay, P. (Paula), Scott, T. (Taryn), Garibaldi, A. (Alisha), Viveiros, H. (Helena), Swinton, M. (Marilyn), Gichuru, M. (Mark), Buckingham, L. (Lisa), Duraikannan, A. (Aravin), Maddock, D. (Deborah), Simunovic, N. (Nicole), Agel, J. (Julie), Lieshout, E.M.M. (Esther) van, Zielinski, S.M. (Stephanie), Rangan, A. (Amar), Hanusch, B.C. (Birgit C.), Kottam, L. (Lucksy), Clarkson, R. (Rachel), Haverlag, R. (Robert), McCormack, R. (Robert), Apostle, K. (Kelly), Boyer, D. (Dory), Moola, F. (Farhad), Perey, B. (Bertrand), Stone, T. (Trevor), Viskontas, D. (Darius), Lemke, H.M. (H. Michael), Zomar, M. (Mauri), Moon, K. (Karyn), Moon, R. (Raely), Oatt, A. (Amber), Buckley, R.E. (Richard E.), Duffy, P. (Paul), Korley, R. (Robert), Puloski, S. (Shannon), Powell, J. (James), Johnston, K. (Kelly), Carcary, K. (Kimberly), Lorenzo, M. (Melissa), McKercher, R. (Ross), Sanders, D. (David), MacLeod, M. (Mark), Lawendy, A.-R. (Abdel-Rahman), Tieszer, C. (Christina), Stephen, D. (David), Kreder, H. (Hans), Jenkinson, R. (Richard), Nousiainen, M. (Markku), Axelrod, T. (Terry), Murnaghan, J. (John), Nam, D. (Diane), Wadey, V. (Veronica), Yee, A. (Albert), Milner, K. (Katrine), Kunz, M. (Monica), Ghent, W. (Wesley), McKee, M.D. (Michael D.), Hall, J.A. (Jeremy A.), Nauth, A. (Aaron), Ahn, H. (Henry), Whelan, D.B. (Daniel B.), Vicente, M.R. (Milena R.), Wild, L.M. (Lisa M.), Khan, R.M. (Ryan M.), Hidy, J.T. (Jennifer T.), Coles, C. (Chad), Leighton, R. (Ross), Biddulph, M. (Michael), Johnston, D. (David), Glazebrook, M. (Mark), Alexander, D. (David), Coady, C. (Catherine), Dunbar, M. (Michael), Amirault, J.D. (J. David), Gross, M. (Michael), Oxner, W. (William), Reardon, G. (Gerald), Richardson, C.G. (C. Glen), Trenholm, J.A. (J. Andrew), Wong, I. (Ivan), Trask, K. (Kelly), MacDonald, S. (Shelley), Dobbin, G. (Gwendolyn), Bicknell, R. (Ryan), Yach, J. (Jeff), Bardana, D. (Davide), Wood, G. (Gavin), Harrison, M. (Mark), Yen, D. (David), Lambert, S. (Sue), Howells, F. (Fiona), Ward, A. (Angela), Zalzal, P. (Paul), Brien, H. (Heather), Naumetz, V. (V.), Weening, B. (Brad), Wai, E.K. (Eugene K.), Papp, S. (Steve), Gofton, W.T. (Wade T.), Liew, A. (Allen), Kingwell, S.P. (Stephen P.), Johnson, G. (Garth), O'Neil, J. (Joseph), Roffey, D.M. (Darren M.), Borsella, V. (Vivian), Avram, V. (Victoria), Oliver, T.M. (Todd M.), Jones, V. (Vicki), Vogt, M. (Michelle), Jones, C.B. (Clifford B.), Ringler, J.R. (James R.), Endres, T.J. (Terrence J.), Sietsema, D.L. (Debra L.), Walker, J.E. (Jane E.), Broderick, J.S. (J. Scott), Goetz, D.R. (David R.), Pace, T.B. (Thomas B.), Schaller, T.M. (Thomas M.), Porter, S.E. (Scott E.), Beckish, M.L. (Michael L.), Adams, J.D. (John D.), Barden, B.B. (Benjamin B.), Creek, A.T. (Aaron T.), Finley, S.H. (Stephen H.), Foret, J.L. (Jonathan L.), Gudger, G.K. (Garland K.), Gurich, R.W. (Richard W.), Hill, A.D. (Austin D.), Hollenbeck, S.M. (Steven M.), Jackson, L.T. (Lyle T.), Kruse, K.K. (Kevin K.), Lackey, W.G. (Wesley G.), Langan, J.W. (Justin W.), Lee, J. (Julia), Leffler, L.C. (Lauren C.), Miller, T.J. (Timothy J.), Murphy, R.L. (R. Lee), O'Malley, L.K. (Lawrence K.), Peters, M.E. (Melissa E.), Price, D.M. (Dustin M.), Tanksley, J.A. (John A.), Torres, E.T. (Erick T.), Watson, D.J. (Dylan J.), Watson, S.T. (Scott T.), Tanner, S.L. (Stephanie L.), Snider, R.G. (Rebecca G.), Nastoff, L.A. (Lauren A.), Bielby, S.A. (Shea A.), Teasdall, R.J. (Robert J.), Switzer, J.A. (Julie A.), Cole, P.A. (Peter A.), Anderson, S.A. (Sarah A.), Lafferty, P.M. (Paul M.), Li, M. (Mengnai), Ly, T.V. (Thuan V.), Marston, S.B. (Scott B.), Foley, A.L. (Amy L.), Vang, S. (Sandy), Wright, D.M. (David M.), Marcantonio, A.J. (Andrew J.), Kain, M.S.H. (Michael S.H.), Iorio, R. (Richard), Specht, L.M. (Lawrence M.), Tilzey, J.F. (John F.), Lobo, M.J. (Margaret J.), Garfi, J.S. (John S.), Vallier, H.A. (Heather A.), Dolenc, A. (Andrea), Breslin, M. (Mary), Prayson, M.J. (Michael J.), Laughlin, R. (Richard), Rubino, L.J. (L. Joseph), May, J. (Jedediah), Rieser, G.R. (Geoffrey Ryan), Dulaney-Cripe, L. (Liz), Gayton, C. (Chris), Shaer, J. (James), Schrickel, T. (Tyson), Hileman, B. (Barbara), Gorczyca, J.T. (John T.), Gross, J.M. (Jonathan M.), Humphrey, C.A. (Catherine A.), Kates, S. (Stephen), Ketz, J.P. (John P.), Noble, K. (Krista), McIntyre, A.W. (Allison W.), Pecorella, K. (Kaili), Davis, C.A. (Craig A.), Weinerman, S. (Stuart), Weingarten, P. (Peter), Stull, P. (Philip), Lindenbaum, S. (Stephen), Hewitt, M. (Michael), Schwappach, J. (John), Baker, J.K. (Janell K.), Rutherford, T. (Tori), Newman, H. (Heike), Lieberman, S. (Shane), Finn, E. (Erin), Robbins, K. (Kristin), Hurley, M. (Meghan), Lyle, L. (Lindsey), Mitchell, K. (Khalis), Browner, K. (Kieran), Whatley, E. (Erica), Payton, K. (Krystal), Reeves, C. (Christina), Cannada, L.K. (Lisa K.), Karges, D.E. (David E.), Dawson, S.A. (Sarah A.), Mehta, S. (Samir), Esterhai, J. (John), Ahn, J. (Jaimo), Donegan, D. (Derek), Horan, A.D. (Annamarie D.), Hesketh, P.J. (Patrick J.), Bannister, E.R. (Evan R.), Keeve, J.P. (Jonathan P.), Anderson, C.G. (Christopher G.), McDonald, M.D. (Michael D.), Hoffman, J.M. (Jodi M.), Tarkin, I. (Ivan), Siska, P. (Peter), Gruen, G. (Gary), Evans, A. (Andrew), Farrell, D.J. (Dana J.), Irrgang, J. (James), Luther, A. (Arlene), Cross, W.W. (William W.), Cass, J.R. (Joseph R.), Sems, S.A. (Stephen A.), Torchia, M.E. (Michael E.), Scrabeck, T. (Tyson), Jenkins, M. (Mark), Dumais, J. (Jules), Romero, A.W. (Amanda W.), Sagebien, C.A. (Carlos A.), Butler, M.S. (Mark S.), Monica, J.T. (James T.), Seuffert, P. (Patricia), Hsu, J.R. (Joseph R.), Stinner, D. (Daniel), Ficke, J. (James), Charlton, M. (Michael), Napierala, M. (Matthew), Fan, M. (Mary), Tannoury, C. (Chadi), Carlisle, H. (Hope), Silva, H. (Heather), Archdeacon, M. (Michael), Finnan, R. (Ryan), Le, T. (Toan), Wyrick, J. (John), Hess, S. (Shelley), Brennan, M.L. (Michael L.), Probe, R. (Robert), Kile, E. (Evelyn), Mills, K. (Kelli), Clipper, L. (Lydia), Yu, M. (Michelle), Erwin, K. (Katie), Horwitz, D. (Daniel), Strohecker, K. (Kent), Swenson, T.K. (Teresa K.), Schmidt, A.H. (Andrew H.), Westberg, J.R. (Jerald R.), Aurang, K. (Kamran), Zohman, G. (Gary), Peterson, B. (Brett), Huff, R.B. (Roger B.), Baele, J. (Joseph), Weber, T. (Timothy), Edison, M. (Matt), McBeth, J.C. (Jessica Cooper), Shively, K. (Karl), Ertl, J.P. (Janos P.), Mullis, B. (Brian), Parr, J.A. (J. Andrew), Worman, R. (Ripley), Frizzell, V. (Valda), Moore, M.M. (Molly M.), DePaolo, C.J. (Charles J.), Alosky, R. (Rachel), Shell, L.E. (Leslie E.), Hampton, L. (Lynne), Shepard, S. (Stephanie), Nanney, T. (Tracy), Cuento, C. (Claudine), Cantu, R.V. (Robert V.), Henderson, E.R. (Eric R.), Eickhoff, L.S. (Linda S.), Hammerberg, E.M. (E. Mark), Stahel, P. (Philip), Hak, D. (David), Mauffrey, C. (Cyril), Henderson, C. (Corey), Gissel, H. (Hannah), Gibula, D. (Douglas), Zamorano, D.P. (David P.), Tynan, M.C. (Martin C.), Pourmand, D. (Deeba), Lawson, D. (Deanna), Crist, B.D. (Brett D.), Murtha, Y.M. (Yvonne M.), Anderson, L.K. (Linda K.), Linehan, C. (Colleen), Pilling, L. (Lindsey), Lewis, C.G. (Courtland G.), Caminiti, S. (Stephanie), Sullivan, R.J. (Raymond J.), Roper, E. (Elizabeth), Obremskey, W. (William), Kregor, P. (Philip), Richards, J.E. (Justin E.), Stringfellow, K. (Kenya), Dohm, M.P. (Michael P.), Zellar, A. (Abby), Segers, M.J.M. (Michiel), Zijl, J.A.C. (Jacco A.C.), Verhoeven, B. (Bart), Smits, A.B. (Anke B.), De Vries, J.P.P.M. (Jean Paul P.M.), Fioole, B. (Bram), Van Der Hoeven, H. (Henk), Theunissen, E.B.M. (Evert B.M.), De Vries Reilingh, T.S. (Tammo S.), Govaert, L. (Lonneke), Wittich, P. (Philippe), De Brauw, M. (Maurits), Wille, J.C. (Jan), Go, P.M.N.Y.M. (Peter M.N.Y.M.), Ritchie, E.D. (Ewan D.), Wessel, R.N. (Ronald N.), Hammacher, E.R. (Eric), Visser, G.A. (Gijs A.), Stockmann, H. (Heyn), Silvis, R. (Rob), Snellen, J.P. (Jaap P.), Rijbroek, B. (Bram), Scheepers, J.J. (Joris J.), Vermeulen, E.G.J. (Erik G.J.), Siroen, M.P.C. (Michiel P.C.), Vuylsteke, R. (Ronald), Brom, H.L.F., Rijna, H., Rijcke, P.A.R. (Piet), Koppert, C.L. (Cees L.), Buijk, S.E. (Steven E.), Groenendijk, R.P.R. (Richard), Dawson, I. (Imro), Tetteroo, G.W.M. (Geert), Bruijninckx, M.M.M. (Milko), Doornebosch, P. (Pascal), Graaf, E.J.R. (Eelco) de, Elst, M. (Maarten) van der, Pol, C. (Carmen) van der, Riet, M. (Martijne) van 't, Karsten, T.M. (Thomas), Vries, M.R. (Mark) de, Stassen, L.P.S. (Laurents P.S.), Schep, N.W.L. (Niels), Ben Schmidt, G. (G.), Hoffman, W.H. (W. H.), Poolman, R.W. (Rudolf), Simons, M.P., Heijden, F.H.W.M. (Frank) van der, Willems, W.J. (Jaap), De Meulemeester, F.R.A.J. (Frank R.A.J.), Hart, C.P. (Cor P.) van der, Turckan, K. (Kahn), Festen, S. (Sebastiaan), Nies, F. (Frank) de, Out, N.J.M. (Nico J.M.), Bosma, J. (Jan), Kampen, A. (A.) van, Biert, J. (Jan), Van Vugt, A.B. (Arie B.), Edwards, M.J.R. (Michael J.R.), Blokhuis, T.J. (Taco J.), Frölke, J.P.M. (Jan Paul), Geeraedts, L.M.G. (Leo M.G.), Gardeniers, J.W.M. (Jean W.M.), Tan, E.C.T.H. (Edward C.T.H.), Poelhekke, L.M.S.J., De Waal Malefijt, M.C. (Maarten C.), Schreurs, B. (Bart), Roukema, G.R. (Gert), Josaputra, H.A. (Hong A.), Keller, P. (Paul), De Rooij, P.D. (Peter D.), Kuiken, H. (Hans), Boxma, H. (Han), Cleffken, B.I. (Berry), Liem, R. (Ronald), Rhemrev, S. (Steven), Bosman, C.H.R. (Coks H.R.), De Mol Van Otterloo, A. (Alexander), Hoogendoorn, J. (Jochem), Vries, A.C. (Alexander) de, Meylaerts, S.A.G. (Sven), Verhofstad, M.H.J. (Michiel), Meijer, J. (Joost), Van Egmond, T. (Teun), Van Der Brand, I. (Igor), Patka, P. (Peter), Eversdijk, M.G. (Martin), Peters, R. (Rolf), Hartog, D. (Dennis) den, Waes, O.J.F. (Oscar) van, Oprel, P.P. (Pim), Vis, H.M. (Harm) van der, Campo, M. (Martin), Verhagen, R. (Ronald), Albers, G.H.R. (G.H. Robert), Zurcher, A.W. (Arthur W.), Simmermacher, R.K.J., Van Mulken, J. (Jeroen), Wessem, K.J.P. van, Van Gaalen, S.M. (Steven M.), Leenen, L.P.H., Bronkhorst, M.W.G.A. (Maarten), Guicherit, O.R. (Onno R.), Goslings, J.C. (Carel), Ponsen, K.J. (Kees-jan), Bhatia, M. (Mahesh), Arora, V. (Vinod), Tyagi, V. (Vivek), Bedi, H. (Harvinder), Carr, A. (Ashley), Curry, H. (Hamish), Chia, A. (Andrew), Csongvay, S. (Steve), Donohue, C. (Craig), Doig, S. (Stephen), Edwards, E. (Elton), Etherington, G. (Greg), Esser, M. (Max), Gong, A. (Andrew), Jain, A. (Arvind), Li, D. (Doug), Miller, R. (Russell), Moaveni, A. (Ash), Russ, M. (Matthias), Ton, L. (Lu), Wang, O. (Otis), Dowrick, A. (Adam), Murdoch, Z. (Zoe), Sage, C. (Claire), Frihagen, F. (Frede), Clarke-Jenssen, J. (John), Hjorthaug, G. (Geir), Ianssen, T. (Torben), Amundsen, A. (Asgeir), Brattgjerd, J.E. (Jan Egil), Borch, T. (Tor), Bøe, B. (Berthe), Flatøy, B. (Bernhard), Hasselund, S. (Sondre), Haug, K.J. (Knut Jørgen), Hemlock, K. (Kim), Hoseth, T.M. (Tor Magne), Jomaas, G. (Geir), Kibsgård, T. (Thomas), Lona, T. (Tarjei), Moatshe, G. (Gilbert), Müller, O. (Oliver), Molund, M. (Marius), Nicolaisen, T. (Tor), Nilsen, F. (Fredrik), Rydinge, J. (Jonas), Smedsrud, M. (Morten), Stødle, A. (Are), Trommer, A. (Axel), Ugland, S. (Stein), Karlsten, A. (Anders), Ekås, G. (Guri), Vesterhus, E.B. (Elise Berg), Brekke, A.C. (Anne Christine), Gupta, A. (Ajay), Jain, N. (Neeraj), Khan, F. (Farah), Sharma, A. (Ateet), Sanghavi, A. (Amir), Trivedi, M. (Mittal), Rai, A. (Anil), Subash, (), Rai, K. (Kamal), Yadav, V. (Vineet), Singh, S. (Sanjay), Tetsworth, K. (Kevin), Donald, G. (Geoff), Weinrauch, P. (Patrick), Pincus, P. (Paul), Yang, S. (Steven), Halliday, B. (Brett), Gervais, T. (Trevor), Holt, M. (Michael), Flynn, A. (Annette), Prasad, A.S. (Amal Shankar), Mishra, V. (Vimlesh), Sundaresh, D.C. (D. C.), Khanna, A. (Angshuman), Cherian, J.J. (Joe Joseph), Olakkengil, D.J. (Davy J), Sharma, G. (Gaurav), Pirpiris, M. (Marinis), Love, D. (David), Bucknill, A. (Andrew), Farrugia, R.J. (Richard J), Pape, H.-C. (Hans-Christoph), Knobe, M. (Matthias), Pfeifer, R. (Roman), Hull, P. (Peter), Lewis, S. (Sophie), Evans, S. (Simone), Nanda, R. (Rajesh), Logishetty, R. (Rajanikanth), Anand, S. (Sanjeev), Bowler, C. (Carol), Dadi, A. (Akhil), Palla, N. (Naveen), Ganguly, U. (Utsav), Rai, B.S. (B. Sachidananda), Rajakumar, J. (Janakiraman), Jennings, A. (Andrew), Chuter, G. (Graham), Rose, G. (Glynis), Horner, G. (Gillian), Clark, C. (Callum), Eke, K. (Kate), Reed, M.R. (Mike), Inman, D. (Dominic), Herriott, C. (Chris), and Dobb, C. (Christine)

Abstract

Background: Femoral neck fractures are associated with high rates of revision surgery after management with internal fixation. Using data from the Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH) trial evaluating methods of internal fixation in patients with femoral neck fractures, we investigated associations between baseline and surgical factors and the need for revision surgery to promote healing, relieve pain, treat infection or improve function over 24 months postsurgery. Additionally, we investigated factors associated with (1) hardware removal and (2) implant exchange from cancellous screws (CS) or sliding hip screw (SHS) to total hip arthroplasty, hemiarthroplasty, or another internal fixation device. Methods: We identified 15 potential factors a priori that may be associated with revision surgery, 7 with hardware removal, and 14 with implant exchange. We used multivariable Cox proportional hazards analyses in our investigation. Results: Factors associated with increased risk of revision surgery included: female sex, [hazard ratio (HR) 1.79, 95% confidence interval (CI) 1.25-2.50; P = 0.001], higher body mass index (for

Published
2018
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31. Factors associated with health-related quality of life, hip function, and health utility after operative management of femoral neck fractures

Author

Sprague, S. (S.), Bhandari, M. (Mohit), Heetveld, M.J. (M. J.), Liew, S. (S.), Scott, T. (T.), Bzovsky, S. (S.), Heels-Ansdell, D. (Diane), Zhou, Q. (Q.), Swiontkowski, M.F. (Marc ), Schemitsch, E.H. (E. H.), Sprague, S. (S.), Bhandari, M. (Mohit), Heetveld, M.J. (M. J.), Liew, S. (S.), Scott, T. (T.), Bzovsky, S. (S.), Heels-Ansdell, D. (Diane), Zhou, Q. (Q.), Swiontkowski, M.F. (Marc ), and Schemitsch, E.H. (E. H.)

Abstract

Aims The primary aim of this prognostic study was to identify baseline factors associated with physical health-related quality of life (HRQL) in patients after a femoral neck fracture. The secondary aims were to identify baseline factors associated with mental HRQL, hip function, and health utility. Patients and Methods Patients who were enrolled in the Fixation using Alternative Implants for the Treatment of Hip Fractures (FAITH) trial completed the 12-item Short Form Health Survey (SF-12), Western Ontario and McMaster Universities Arthritis Index, and EuroQol 5-Dimension at regular intervals for 24 months. We conducted multilevel mixed models to identify factors potentially associated with HRQL. Results The following were associated with lower physical HRQL: Older age (-1.42 for every ten-year increase, 95% confidence interval (CI) -2.17 to -0.67, p < 0.001); female gender (-1.52, 95% CI - 3.00 to -0.05, p = 0.04); higher body mass index (-0.69 for every five-point increase, 95% CI - 1.36 to -0.02, p = 0.04); American Society of Anesthesiologists class III (versus class I) (-3.19, 95% CI -5.73 to -0.66, p = 0.01); and sustaining a displaced fracture (-2.18, 95% CI -3.88 to - 0.49, p = 0.01). Additional factors were associated with mental HRQL, hip function, and health utility. Conclusion We identified several baseline factors associated with lower HRQL, hip function, and utility after a femoral neck fracture. These findings may be used by clinicians to inform treatment and outcomes.

Published
2018
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32. Factors Associated With Revision Surgery After Internal Fixation of Hip Fractures

Author

Sprague, S., Schemitsch, E.H., Swiontkowski, M., Rocca, G.J. Della, Jeray, K.J., Liew, S., Slobogean, G.P., Bzovsky, S., Heels-Ansdell, D., Kampen, A. van, Biert, J., Vugt, A.B. van, Edwards, M.J.R., Blokhuis, T.J., Frolke, J.P.M., Geeraedts, L.M.G., Gardeniers, J.W.M., Tan, E.C.T.H., Poelhekke, L.M.S.J., Waal Malefijt, M.C. de, Schreurs, B.W., Zhou, Q., Bhandari, M., Sprague, S., Schemitsch, E.H., Swiontkowski, M., Rocca, G.J. Della, Jeray, K.J., Liew, S., Slobogean, G.P., Bzovsky, S., Heels-Ansdell, D., Kampen, A. van, Biert, J., Vugt, A.B. van, Edwards, M.J.R., Blokhuis, T.J., Frolke, J.P.M., Geeraedts, L.M.G., Gardeniers, J.W.M., Tan, E.C.T.H., Poelhekke, L.M.S.J., Waal Malefijt, M.C. de, Schreurs, B.W., Zhou, Q., and Bhandari, M.

Abstract

Item does not contain fulltext, BACKGROUND: Femoral neck fractures are associated with high rates of revision surgery after management with internal fixation. Using data from the Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH) trial evaluating methods of internal fixation in patients with femoral neck fractures, we investigated associations between baseline and surgical factors and the need for revision surgery to promote healing, relieve pain, treat infection or improve function over 24 months postsurgery. Additionally, we investigated factors associated with (1) hardware removal and (2) implant exchange from cancellous screws (CS) or sliding hip screw (SHS) to total hip arthroplasty, hemiarthroplasty, or another internal fixation device. METHODS: We identified 15 potential factors a priori that may be associated with revision surgery, 7 with hardware removal, and 14 with implant exchange. We used multivariable Cox proportional hazards analyses in our investigation. RESULTS: Factors associated with increased risk of revision surgery included: female sex, [hazard ratio (HR) 1.79, 95% confidence interval (CI) 1.25-2.50; P = 0.001], higher body mass index (for every 5-point increase) (HR 1.19, 95% CI 1.02-1.39; P = 0.027), displaced fracture (HR 2.16, 95% CI 1.44-3.23; P < 0.001), unacceptable quality of implant placement (HR 2.70, 95% CI 1.59-4.55; P < 0.001), and smokers treated with cancellous screws versus smokers treated with a sliding hip screw (HR 2.94, 95% CI 1.35-6.25; P = 0.006). Additionally, for every 10-year decrease in age, participants experienced an average increased risk of 39% for hardware removal. CONCLUSIONS: Results of this study may inform future research by identifying high-risk patients who may be better treated with arthroplasty and may benefit from adjuncts to care (HR 1.39, 95% CI 1.05-1.85; P = 0.020). LEVEL OF EVIDENCE: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Published
2018

35. Fracture fixation in the operative management of hip fractures (FAITH): an international, multicentre, randomised controlled trial

Author

Nauth, A. (Aaron), Creek, A.T. (Aaron T.), Zellar, A. (Abby), Lawendy, A.-R. (Abdel-Rahman), Dowrick, A. (Adam), Gupta, A. (Ajay), Dadi, A. (Akhil), Kampen, A. (A.) van, Yee, A. (Albert), Vries, A.C. (Alexander) de, de Mol van Otterloo, A. (Alexander), Garibaldi, A. (Alisha), Liew, A. (Allen), McIntyre, A.W. (Allison W.), Prasad, A.S. (Amal Shankar), Romero, A.W. (Amanda W.), Rangan, A. (Amar), Oatt, A. (Amber), Sanghavi, A. (Amir), Foley, A.L. (Amy L.), Karlsten, A. (Anders), Dolenc, A. (Andrea), Bucknill, A. (Andrew), Chia, A. (Andrew), Evans, A. (Andrew), Gong, A. (Andrew), Schmidt, A.H. (Andrew H.), Marcantonio, A.J. (Andrew J.), Jennings, A. (Andrew), Ward, A. (Angela), Khanna, A. (Angshuman), Rai, A. (Anil), Smits, A.B. (Anke B.), Horan, A.D. (Annamarie D.), Brekke, A.C. (Anne Christine), Flynn, A. (Annette), Duraikannan, A. (Aravin), Stødle, A. (Are), van Vugt, A.B. (Arie B.), Luther, A. (Arlene), Zurcher, A.W. (Arthur W.), Jain, A. (Arvind), Amundsen, A. (Asgeir), Moaveni, A. (Ash), Carr, A. (Ashley), Sharma, A. (Ateet), Hill, A.D. (Austin D.), Trommer, A. (Axel), Rai, B.S. (B. Sachidananda), Hileman, B. (Barbara), Schreurs, B. (Bart), Verhoeven, B. (Bart), Barden, B.B. (Benjamin B.), Flatøy, B. (Bernhard), Cleffken, B.I. (Berry), Bøe, B. (Berthe), Perey, B. (Bertrand), Hanusch, B.C. (Birgit C.), Weening, B. (Brad), Fioole, B. (Bram), Rijbroek, B. (Bram), Crist, B.D. (Brett D.), Halliday, B. (Brett), Peterson, B. (Brett), Mullis, B. (Brian), Richardson, C.G. (C. Glen), Clark, C. (Callum), Sagebien, C.A. (Carlos A.), Pol, C. (Carmen) van der, Bowler, C. (Carol), Humphrey, C.A. (Catherine A.), Coady, C. (Catherine), Koppert, C.L. (Cees L.), Coles, C. (Chad), Tannoury, C. (Chadi), DePaolo, C.J. (Charles J.), Gayton, C. (Chris), Herriott, C. (Chris), Reeves, C. (Christina), Tieszer, C. (Christina), Dobb, C. (Christine), Anderson, C.G. (Christopher G.), Sage, C. (Claire), Cuento, C. (Claudine), Jones, C.B. (Clifford B.), Bosman, C.H.R. (Coks H.R.), Linehan, C. (Colleen), Hart, C.P. (Cor P.) van der, Henderson, C. (Corey), Lewis, C.G. (Courtland G.), Davis, C.A. (Craig A.), Donohue, C. (Craig), Mauffrey, C. (Cyril), Sundaresh, D.C. (D. C.), Farrell, D.J. (Dana J.), Whelan, D.B. (Daniel B.), Horwitz, D. (Daniel), Stinner, D. (Daniel), Viskontas, D. (Darius), Roffey, D.M. (Darren M.), Alexander, D. (David), Karges, D.E. (David E.), Hak, D. (David), Johnston, D. (David), Love, D. (David), Wright, D.M. (David M.), Zamorano, D.P. (David P.), Goetz, D.R. (David R.), Sanders, D. (David), Stephen, D. (David), Yen, D. (David), Bardana, D. (Davide), Olakkengil, D.J. (Davy J), Lawson, D. (Deanna), Maddock, D. (Deborah), Sietsema, D.L. (Debra L.), Pourmand, D. (Deeba), Hartog, D. (Dennis) den, Donegan, D. (Derek), Heels-Ansdell, D. (Diane), Nam, D. (Diane), Inman, D. (Dominic), Boyer, D. (Dory), Li, D. (Doug), Gibula, D. (Douglas), Price, D.M. (Dustin M.), Watson, D.J. (Dylan J.), Hammerberg, E.M. (E. Mark), Tan, E.T.C.H. (Edward T.C.H.), Graaf, E.J.R. (Eelco) de, Vesterhus, E.B. (Elise Berg), Roper, E. (Elizabeth), Edwards, E. (Elton), Schemitsch, E.H. (Emil), Hammacher, E.R. (Eric), Henderson, E.R. (Eric R.), Whatley, E. (Erica), Torres, E.T. (Erick T.), Vermeulen, E.G.J. (Erik G.J.), Finn, E. (Erin), Lieshout, E.M.M. (Esther) van, Wai, E.K. (Eugene K.), Bannister, E.R. (Evan R.), Kile, E. (Evelyn), Theunissen, E.B.M. (Evert B.M.), Ritchie, E.D. (Ewan D.), Khan, F. (Farah), Moola, F. (Farhad), Howells, F. (Fiona), Nies, F. (Frank) de, Heijden, F.H.W.M. (Frank) van der, de Meulemeester, F.R.A.J. (Frank R.A.J.), Frihagen, F. (Frede), Nilsen, F. (Fredrik), Schmidt, G.B. (G. Ben), Albers, G.H.R. (G.H. Robert), Gudger, G.K. (Garland K.), Johnson, G. (Garth), Gruen, G. (Gary), Zohman, G. (Gary), Sharma, G. (Gaurav), Wood, G. (Gavin), Tetteroo, G.W.M. (Geert), Hjorthaug, G. (Geir), Jomaas, G. (Geir), Donald, G. (Geoff), Rieser, G.R. (Geoffrey Ryan), Reardon, G. (Gerald), Slobogean, G.P. (Gerard P.), Roukema, G.R. (Gert), Visser, G.A. (Gijs A.), Moatshe, G. (Gilbert), Horner, G. (Gillian), Rose, G. (Glynis), Guyatt, G. (Gordon), Chuter, G. (Graham), Etherington, G. (Greg), Rocca, G.J.D. (Gregory J. Della), Ekås, G. (Guri), Dobbin, G. (Gwendolyn), Lemke, H.M. (H. Michael), Curry, H. (Hamish), Boxma, H. (Han), Gissel, H. (Hannah), Kreder, H. (Hans), Kuiken, H. (Hans), Brom, H.L.F., Pape, H.-C. (Hans-Christoph), Vis, H.M. (Harm) van der, Bedi, H. (Harvinder), Vallier, H.A. (Heather A.), Brien, H. (Heather), Silva, H. (Heather), Newman, H. (Heike), Viveiros, H. (Helena), van der Hoeven, H. (Henk), Ahn, H. (Henry), Johal, H. (Herman), Rijna, H., Stockmann, H. (Heyn), Josaputra, H.A. (Hong A.), Carlisle, H. (Hope), van der Brand, I. (Igor), Dawson, I. (Imro), Tarkin, I. (Ivan), Wong, I. (Ivan), Parr, J.A. (J. Andrew), Trenholm, J.A. (J. Andrew), Goslings, J.C. (Carel), Amirault, J.D. (J. David), Broderick, J.S. (J. Scott), Snellen, J.P. (Jaap P.), Zijl, J.A.C. (Jacco A.C.), Ahn, J. (Jaimo), Ficke, J. (James), Irrgang, J. (James), Powell, J. (James), Ringler, J.R. (James R.), Shaer, J. (James), Monica, J.T. (James T.), Biert, J. (Jan), Bosma, J. (Jan), Brattgjerd, J.E. (Jan Egil), Frölke, J.P.M. (Jan Paul), Wille, J.C. (Jan), Rajakumar, J. (Janakiraman), Walker, J.E. (Jane E.), Baker, J.K. (Janell K.), Ertl, J.P. (Janos P.), de Vries, J.P.P.M. (Jean Paul P.M.), Gardeniers, J.W.M. (Jean W.M.), May, J. (Jedediah), Yach, J. (Jeff), Hidy, J.T. (Jennifer T.), Westberg, J.R. (Jerald R.), Hall, J.A. (Jeremy A.), van Mulken, J. (Jeroen), McBeth, J.C. (Jessica Cooper), Hoogendoorn, J. (Jochem), Hoffman, J.M. (Jodi M.), Cherian, J.J. (Joe Joseph), Tanksley, J.A. (John A.), Clarke-Jenssen, J. (John), Adams, J.D. (John D.), Esterhai, J. (John), Tilzey, J.F. (John F.), Murnaghan, J. (John), Ketz, J.P. (John P.), Garfi, J.S. (John S.), Schwappach, J. (John), Gorczyca, J.T. (John T.), Wyrick, J. (John), Rydinge, J. (Jonas), Foret, J.L. (Jonathan L.), Gross, J.M. (Jonathan M.), Keeve, J.P. (Jonathan P.), Meijer, J. (Joost), Scheepers, J.J. (Joris J.), Baele, J. (Joseph), O'Neil, J. (Joseph), Cass, J.R. (Joseph R.), Hsu, J.R. (Joseph R.), Dumais, J. (Jules), Lee, J. (Julia), Switzer, J.A. (Julie A.), Agel, J. (Julie), Richards, J.E. (Justin E.), Langan, J.W. (Justin W.), Turckan, K. (Kahn), Pecorella, K. (Kaili), Rai, K. (Kamal), Aurang, K. (Kamran), Shively, K. (Karl), Wessem, K.J.P. van, Moon, K. (Karyn), Eke, K. (Kate), Erwin, K. (Katie), Milner, K. (Katrine), Ponsen, K.J. (Kees-jan), Mills, K. (Kelli), Apostle, K. (Kelly), Johnston, K. (Kelly), Trask, K. (Kelly), Strohecker, K. (Kent), Stringfellow, K. (Kenya), Kruse, K.K. (Kevin K.), Tetsworth, K. (Kevin), Mitchell, K. (Khalis), Browner, K. (Kieran), Hemlock, K. (Kim), Carcary, K. (Kimberly), Jørgen Haug, K. (Knut), Noble, K. (Krista), Robbins, K. (Kristin), Payton, K. (Krystal), Jeray, K.J. (Kyle J.), Rubino, L.J. (L. Joseph), Nastoff, L.A. (Lauren A.), Leffler, L.C. (Lauren C.), Stassen, L.P. (Laurents), O'Malley, L.K. (Lawrence K.), Specht, L.M. (Lawrence M.), Thabane, L. (Lehana), Geeraedts, L.M.G. (Leo M.G.), Shell, L.E. (Leslie E.), Anderson, L.K. (Linda K.), Eickhoff, L.S. (Linda S.), Lyle, L. (Lindsey), Pilling, L. (Lindsey), Buckingham, L. (Lisa), Cannada, L.K. (Lisa K.), Wild, L.M. (Lisa M.), Dulaney-Cripe, L. (Liz), Poelhekke, L.M.S.J., Govaert, L. (Lonneke), Ton, L. (Lu), Kottam, L. (Lucksy), Leenen, L.P.H. (Luke), Clipper, L. (Lydia), Jackson, L.T. (Lyle T.), Hampton, L. (Lynne), de Waal Malefijt, M.C. (Maarten C.), Simons, M.P., Elst, M. (Maarten) van der, Bronkhorst, M.W.G.A. (Maarten), Bhatia, M. (Mahesh), Swiontkowski, M.F. (Marc ), Lobo, M.J. (Margaret J.), Swinton, M. (Marilyn), Pirpiris, M. (Marinis), Molund, M. (Marius), Gichuru, M. (Mark), Glazebrook, M. (Mark), Harrison, M. (Mark), Jenkins, M. (Mark), MacLeod, M. (Mark), Vries, M.R. (Mark) de, Butler, M.S. (Mark S.), Nousiainen, M. (Markku), van ‘t Riet, M. (Martijne), Tynan, M.C. (Martin C.), Campo, M. (Martin), Eversdijk, M.G. (Martin), Heetveld, M.J. (Martin), Richardson, M. (Martin), Breslin, M. (Mary), Fan, M. (Mary), Edison, M. (Matt), Napierala, M. (Matthew), Knobe, M. (Matthias), Russ, M. (Matthias), Zomar, M. (Mauri), de Brauw, M. (Maurits), Esser, M. (Max), Hurley, M. (Meghan), Peters, M.E. (Melissa E.), Lorenzo, M. (Melissa), Li, M. (Mengnai), Archdeacon, M. (Michael), Biddulph, M. (Michael), Charlton, M. (Michael), McDonald, M.D. (Michael D.), McKee, M.D. (Michael D.), Dunbar, M. (Michael), Torchia, M.E. (Michael E.), Gross, M. (Michael), Hewitt, M. (Michael), Holt, M. (Michael), Prayson, M.J. (Michael J.), Edwards, M.J.R. (Michael), Beckish, M.L. (Michael L.), Brennan, M.L. (Michael L.), Dohm, M.P. (Michael P.), Kain, M.S.H. (Michael S.H.), Vogt, M. (Michelle), Yu, M. (Michelle), Verhofstad, M.H.J. (Michiel), Segers, M.J.M. (Michiel J.M.), Segers, M.J.M. (Michiel), Siroen, M.P.C. (Michiel P.C.), Reed, M.R. (Mike), Vicente, M.R. (Milena R.), Bruijninckx, M.M.M. (Milko), Trivedi, M. (Mittal), Bhandari, M. (Mohit), Moore, M.M. (Molly M.), Kunz, M. (Monica), Smedsrud, M. (Morten), Palla, N. (Naveen), Jain, N. (Neeraj), Out, N.J.M. (Nico J.M.), Simunovic, N. (Nicole), Schep, N.W.L. (Niels), Müller, O. (Oliver), Guicherit, O.R. (Onno R.), Waes, O.J.F. (Oscar) van, Wang, O. (Otis), Doornebosch, P. (Pascal), Seuffert, P. (Patricia), Hesketh, P.J. (Patrick J.), Weinrauch, P. (Patrick), Duffy, P. (Paul), Keller, P. (Paul), Lafferty, P.M. (Paul M.), Pincus, P. (Paul), Tornetta III, P. (Paul), Zalzal, P. (Paul), McKay, P. (Paula), Cole, P.A. (Peter A.), de Rooij, P.D. (Peter D.), Hull, P. (Peter), Go, P.M.N.Y.M. (Peter M.N.Y.M.), Patka, P. (Peter), Siska, P. (Peter), Weingarten, P. (Peter), Kregor, P. (Philip), Stahel, P. (Philip), Stull, P. (Philip), Wittich, P. (Philippe), Rijcke, P.A.R. (Piet), Oprel, P.P. (Pim), Devereaux, P.J. (P. J.), Zhou, Q. (Qi), Lee Murphy, R. (R.), Alosky, R. (Rachel), Clarkson, R. (Rachel), Moon, R. (Raely), Logishetty, R. (Rajanikanth), Nanda, R. (Rajesh), Sullivan, R.J. (Raymond J.), Snider, R.G. (Rebecca G.), Buckley, R.E. (Richard E.), Iorio, R. (Richard), Farrugia, R.J. (Richard J), Jenkinson, R. (Richard), Laughlin, R. (Richard), Groenendijk, R.P.R. (Richard), Gurich, R.W. (Richard W.), Worman, R. (Ripley), Silvis, R. (Rob), Haverlag, R. (Robert), Teasdall, R.J. (Robert J.), Korley, R. (Robert), McCormack, R. (Robert), Probe, R. (Robert), Cantu, R.V. (Robert V.), Huff, R.B. (Roger B.), Simmermacher, R.K.J., Peters, R. (Rolf), Pfeifer, R. (Roman), Liem, R. (Ronald), Wessel, R.N. (Ronald N.), Verhagen, R. (Ronald), Vuylsteke, R. (Ronald), Leighton, R. (Ross), McKercher, R. (Ross), Poolman, R.W. (Rudolf), Miller, R. (Russell), Bicknell, R. (Ryan), Finnan, R. (Ryan), Khan, R.M. (Ryan M.), Mehta, S. (Samir), Vang, S. (Sandy), Singh, S. (Sanjay), Anand, S. (Sanjeev), Anderson, S.A. (Sarah A.), Dawson, S.A. (Sarah A.), Marston, S.B. (Scott B.), Porter, S.E. (Scott E.), Watson, S.T. (Scott T.), Festen, S. (Sebastiaan), Lieberman, S. (Shane), Puloski, S. (Shannon), Bielby, S.A. (Shea A.), Sprague, S. (Sheila), Hess, S. (Shelley), MacDonald, S. (Shelley), Evans, S. (Simone), Bzovsky, S. (Sofia), Hasselund, S. (Sondre), Lewis, S. (Sophie), Ugland, S. (Stein), Caminiti, S. (Stephanie), Tanner, S.L. (Stephanie L.), Zielinski, S.M. (Stephanie), Shepard, S. (Stephanie), Sems, S.A. (Stephen A.), Walter, S.D. (Stephen D.), Doig, S. (Stephen), Finley, S.H. (Stephen H.), Kates, S. (Stephen), Lindenbaum, S. (Stephen), Kingwell, S.P. (Stephen P.), Csongvay, S. (Steve), Papp, S. (Steve), Buijk, S.E. (Steven E.), Rhemrev, S. (Steven), Hollenbeck, S.M. (Steven M.), van Gaalen, S.M. (Steven M.), Yang, S. (Steven), Weinerman, S. (Stuart), Subash, (), Lambert, S. (Sue), Liew, S. (Susan), Meylaerts, S.A.G. (Sven), Blokhuis, T.J. (Taco J.), de Vries Reilingh, T.S. (Tammo S.), Lona, T. (Tarjei), Scott, T. (Taryn), Swenson, T.K. (Teresa K.), Endres, T.J. (Terrence J.), Axelrod, T. (Terry), van Egmond, T. (Teun), Pace, T.B. (Thomas B.), Kibsgård, T. (Thomas), Schaller, T.M. (Thomas M.), Ly, T.V. (Thuan V.), Miller, T.J. (Timothy J.), Weber, T. (Timothy), Le, T. (Toan), Oliver, T.M. (Todd M.), Karsten, T.M. (Thomas), Borch, T. (Tor), Hoseth, T.M. (Tor Magne), Nicolaisen, T. (Tor), Ianssen, T. (Torben), Rutherford, T. (Tori), Nanney, T. (Tracy), Gervais, T. (Trevor), Stone, T. (Trevor), Schrickel, T. (Tyson), Scrabeck, T. (Tyson), Ganguly, U. (Utsav), Naumetz, V. (V.), Frizzell, V. (Valda), Wadey, V. (Veronica), Jones, V. (Vicki), Avram, V. (Victoria), Mishra, V. (Vimlesh), Yadav, V. (Vineet), Arora, V. (Vinod), Tyagi, V. (Vivek), Borsella, V. (Vivian), Willems, W.J. (Jaap), Hoffman, W.H. (W. H.), Gofton, W.T. (Wade T.), Lackey, W.G. (Wesley G.), Ghent, W. (Wesley), Obremskey, W. (William), Oxner, W. (William), Cross, W.W. (William W.), Murtha, Y.M. (Yvonne M.), Murdoch, Z. (Zoe), Nauth, A. (Aaron), Creek, A.T. (Aaron T.), Zellar, A. (Abby), Lawendy, A.-R. (Abdel-Rahman), Dowrick, A. (Adam), Gupta, A. (Ajay), Dadi, A. (Akhil), Kampen, A. (A.) van, Yee, A. (Albert), Vries, A.C. (Alexander) de, de Mol van Otterloo, A. (Alexander), Garibaldi, A. (Alisha), Liew, A. (Allen), McIntyre, A.W. (Allison W.), Prasad, A.S. (Amal Shankar), Romero, A.W. (Amanda W.), Rangan, A. (Amar), Oatt, A. (Amber), Sanghavi, A. (Amir), Foley, A.L. (Amy L.), Karlsten, A. (Anders), Dolenc, A. (Andrea), Bucknill, A. (Andrew), Chia, A. (Andrew), Evans, A. (Andrew), Gong, A. (Andrew), Schmidt, A.H. (Andrew H.), Marcantonio, A.J. (Andrew J.), Jennings, A. (Andrew), Ward, A. (Angela), Khanna, A. (Angshuman), Rai, A. (Anil), Smits, A.B. (Anke B.), Horan, A.D. (Annamarie D.), Brekke, A.C. (Anne Christine), Flynn, A. (Annette), Duraikannan, A. (Aravin), Stødle, A. (Are), van Vugt, A.B. (Arie B.), Luther, A. (Arlene), Zurcher, A.W. (Arthur W.), Jain, A. (Arvind), Amundsen, A. (Asgeir), Moaveni, A. (Ash), Carr, A. (Ashley), Sharma, A. (Ateet), Hill, A.D. (Austin D.), Trommer, A. (Axel), Rai, B.S. (B. Sachidananda), Hileman, B. (Barbara), Schreurs, B. (Bart), Verhoeven, B. (Bart), Barden, B.B. (Benjamin B.), Flatøy, B. (Bernhard), Cleffken, B.I. (Berry), Bøe, B. (Berthe), Perey, B. (Bertrand), Hanusch, B.C. (Birgit C.), Weening, B. (Brad), Fioole, B. (Bram), Rijbroek, B. (Bram), Crist, B.D. (Brett D.), Halliday, B. (Brett), Peterson, B. (Brett), Mullis, B. (Brian), Richardson, C.G. (C. Glen), Clark, C. (Callum), Sagebien, C.A. (Carlos A.), Pol, C. (Carmen) van der, Bowler, C. (Carol), Humphrey, C.A. (Catherine A.), Coady, C. (Catherine), Koppert, C.L. (Cees L.), Coles, C. (Chad), Tannoury, C. (Chadi), DePaolo, C.J. (Charles J.), Gayton, C. (Chris), Herriott, C. (Chris), Reeves, C. (Christina), Tieszer, C. (Christina), Dobb, C. (Christine), Anderson, C.G. (Christopher G.), Sage, C. (Claire), Cuento, C. (Claudine), Jones, C.B. (Clifford B.), Bosman, C.H.R. (Coks H.R.), Linehan, C. (Colleen), Hart, C.P. (Cor P.) van der, Henderson, C. (Corey), Lewis, C.G. (Courtland G.), Davis, C.A. (Craig A.), Donohue, C. (Craig), Mauffrey, C. (Cyril), Sundaresh, D.C. (D. C.), Farrell, D.J. (Dana J.), Whelan, D.B. (Daniel B.), Horwitz, D. (Daniel), Stinner, D. (Daniel), Viskontas, D. (Darius), Roffey, D.M. (Darren M.), Alexander, D. (David), Karges, D.E. (David E.), Hak, D. (David), Johnston, D. (David), Love, D. (David), Wright, D.M. (David M.), Zamorano, D.P. (David P.), Goetz, D.R. (David R.), Sanders, D. (David), Stephen, D. (David), Yen, D. (David), Bardana, D. (Davide), Olakkengil, D.J. (Davy J), Lawson, D. (Deanna), Maddock, D. (Deborah), Sietsema, D.L. (Debra L.), Pourmand, D. (Deeba), Hartog, D. (Dennis) den, Donegan, D. (Derek), Heels-Ansdell, D. (Diane), Nam, D. (Diane), Inman, D. (Dominic), Boyer, D. (Dory), Li, D. (Doug), Gibula, D. (Douglas), Price, D.M. (Dustin M.), Watson, D.J. (Dylan J.), Hammerberg, E.M. (E. Mark), Tan, E.T.C.H. (Edward T.C.H.), Graaf, E.J.R. (Eelco) de, Vesterhus, E.B. (Elise Berg), Roper, E. (Elizabeth), Edwards, E. (Elton), Schemitsch, E.H. (Emil), Hammacher, E.R. (Eric), Henderson, E.R. (Eric R.), Whatley, E. (Erica), Torres, E.T. (Erick T.), Vermeulen, E.G.J. (Erik G.J.), Finn, E. (Erin), Lieshout, E.M.M. (Esther) van, Wai, E.K. (Eugene K.), Bannister, E.R. (Evan R.), Kile, E. (Evelyn), Theunissen, E.B.M. (Evert B.M.), Ritchie, E.D. (Ewan D.), Khan, F. (Farah), Moola, F. (Farhad), Howells, F. (Fiona), Nies, F. (Frank) de, Heijden, F.H.W.M. (Frank) van der, de Meulemeester, F.R.A.J. (Frank R.A.J.), Frihagen, F. (Frede), Nilsen, F. (Fredrik), Schmidt, G.B. (G. Ben), Albers, G.H.R. (G.H. Robert), Gudger, G.K. (Garland K.), Johnson, G. (Garth), Gruen, G. (Gary), Zohman, G. (Gary), Sharma, G. (Gaurav), Wood, G. (Gavin), Tetteroo, G.W.M. (Geert), Hjorthaug, G. (Geir), Jomaas, G. (Geir), Donald, G. (Geoff), Rieser, G.R. (Geoffrey Ryan), Reardon, G. (Gerald), Slobogean, G.P. (Gerard P.), Roukema, G.R. (Gert), Visser, G.A. (Gijs A.), Moatshe, G. (Gilbert), Horner, G. (Gillian), Rose, G. (Glynis), Guyatt, G. (Gordon), Chuter, G. (Graham), Etherington, G. (Greg), Rocca, G.J.D. (Gregory J. Della), Ekås, G. (Guri), Dobbin, G. (Gwendolyn), Lemke, H.M. (H. Michael), Curry, H. (Hamish), Boxma, H. (Han), Gissel, H. (Hannah), Kreder, H. (Hans), Kuiken, H. (Hans), Brom, H.L.F., Pape, H.-C. (Hans-Christoph), Vis, H.M. (Harm) van der, Bedi, H. (Harvinder), Vallier, H.A. (Heather A.), Brien, H. (Heather), Silva, H. (Heather), Newman, H. (Heike), Viveiros, H. (Helena), van der Hoeven, H. (Henk), Ahn, H. (Henry), Johal, H. (Herman), Rijna, H., Stockmann, H. (Heyn), Josaputra, H.A. (Hong A.), Carlisle, H. (Hope), van der Brand, I. (Igor), Dawson, I. (Imro), Tarkin, I. (Ivan), Wong, I. (Ivan), Parr, J.A. (J. Andrew), Trenholm, J.A. (J. Andrew), Goslings, J.C. (Carel), Amirault, J.D. (J. David), Broderick, J.S. (J. Scott), Snellen, J.P. (Jaap P.), Zijl, J.A.C. (Jacco A.C.), Ahn, J. (Jaimo), Ficke, J. (James), Irrgang, J. (James), Powell, J. (James), Ringler, J.R. (James R.), Shaer, J. (James), Monica, J.T. (James T.), Biert, J. (Jan), Bosma, J. (Jan), Brattgjerd, J.E. (Jan Egil), Frölke, J.P.M. (Jan Paul), Wille, J.C. (Jan), Rajakumar, J. (Janakiraman), Walker, J.E. (Jane E.), Baker, J.K. (Janell K.), Ertl, J.P. (Janos P.), de Vries, J.P.P.M. (Jean Paul P.M.), Gardeniers, J.W.M. (Jean W.M.), May, J. (Jedediah), Yach, J. (Jeff), Hidy, J.T. (Jennifer T.), Westberg, J.R. (Jerald R.), Hall, J.A. (Jeremy A.), van Mulken, J. (Jeroen), McBeth, J.C. (Jessica Cooper), Hoogendoorn, J. (Jochem), Hoffman, J.M. (Jodi M.), Cherian, J.J. (Joe Joseph), Tanksley, J.A. (John A.), Clarke-Jenssen, J. (John), Adams, J.D. (John D.), Esterhai, J. (John), Tilzey, J.F. (John F.), Murnaghan, J. (John), Ketz, J.P. (John P.), Garfi, J.S. (John S.), Schwappach, J. (John), Gorczyca, J.T. (John T.), Wyrick, J. (John), Rydinge, J. (Jonas), Foret, J.L. (Jonathan L.), Gross, J.M. (Jonathan M.), Keeve, J.P. (Jonathan P.), Meijer, J. (Joost), Scheepers, J.J. (Joris J.), Baele, J. (Joseph), O'Neil, J. (Joseph), Cass, J.R. (Joseph R.), Hsu, J.R. (Joseph R.), Dumais, J. (Jules), Lee, J. (Julia), Switzer, J.A. (Julie A.), Agel, J. (Julie), Richards, J.E. (Justin E.), Langan, J.W. (Justin W.), Turckan, K. (Kahn), Pecorella, K. (Kaili), Rai, K. (Kamal), Aurang, K. (Kamran), Shively, K. (Karl), Wessem, K.J.P. van, Moon, K. (Karyn), Eke, K. (Kate), Erwin, K. (Katie), Milner, K. (Katrine), Ponsen, K.J. (Kees-jan), Mills, K. (Kelli), Apostle, K. (Kelly), Johnston, K. (Kelly), Trask, K. (Kelly), Strohecker, K. (Kent), Stringfellow, K. (Kenya), Kruse, K.K. (Kevin K.), Tetsworth, K. (Kevin), Mitchell, K. (Khalis), Browner, K. (Kieran), Hemlock, K. (Kim), Carcary, K. (Kimberly), Jørgen Haug, K. (Knut), Noble, K. (Krista), Robbins, K. (Kristin), Payton, K. (Krystal), Jeray, K.J. (Kyle J.), Rubino, L.J. (L. Joseph), Nastoff, L.A. (Lauren A.), Leffler, L.C. (Lauren C.), Stassen, L.P. (Laurents), O'Malley, L.K. (Lawrence K.), Specht, L.M. (Lawrence M.), Thabane, L. (Lehana), Geeraedts, L.M.G. (Leo M.G.), Shell, L.E. (Leslie E.), Anderson, L.K. (Linda K.), Eickhoff, L.S. (Linda S.), Lyle, L. (Lindsey), Pilling, L. (Lindsey), Buckingham, L. (Lisa), Cannada, L.K. (Lisa K.), Wild, L.M. (Lisa M.), Dulaney-Cripe, L. (Liz), Poelhekke, L.M.S.J., Govaert, L. (Lonneke), Ton, L. (Lu), Kottam, L. (Lucksy), Leenen, L.P.H. (Luke), Clipper, L. (Lydia), Jackson, L.T. (Lyle T.), Hampton, L. (Lynne), de Waal Malefijt, M.C. (Maarten C.), Simons, M.P., Elst, M. (Maarten) van der, Bronkhorst, M.W.G.A. (Maarten), Bhatia, M. (Mahesh), Swiontkowski, M.F. (Marc ), Lobo, M.J. (Margaret J.), Swinton, M. (Marilyn), Pirpiris, M. (Marinis), Molund, M. (Marius), Gichuru, M. (Mark), Glazebrook, M. (Mark), Harrison, M. (Mark), Jenkins, M. (Mark), MacLeod, M. (Mark), Vries, M.R. (Mark) de, Butler, M.S. (Mark S.), Nousiainen, M. (Markku), van ‘t Riet, M. (Martijne), Tynan, M.C. (Martin C.), Campo, M. (Martin), Eversdijk, M.G. (Martin), Heetveld, M.J. (Martin), Richardson, M. (Martin), Breslin, M. (Mary), Fan, M. (Mary), Edison, M. (Matt), Napierala, M. (Matthew), Knobe, M. (Matthias), Russ, M. (Matthias), Zomar, M. (Mauri), de Brauw, M. (Maurits), Esser, M. (Max), Hurley, M. (Meghan), Peters, M.E. (Melissa E.), Lorenzo, M. (Melissa), Li, M. (Mengnai), Archdeacon, M. (Michael), Biddulph, M. (Michael), Charlton, M. (Michael), McDonald, M.D. (Michael D.), McKee, M.D. (Michael D.), Dunbar, M. (Michael), Torchia, M.E. (Michael E.), Gross, M. (Michael), Hewitt, M. (Michael), Holt, M. (Michael), Prayson, M.J. (Michael J.), Edwards, M.J.R. (Michael), Beckish, M.L. (Michael L.), Brennan, M.L. (Michael L.), Dohm, M.P. (Michael P.), Kain, M.S.H. (Michael S.H.), Vogt, M. (Michelle), Yu, M. (Michelle), Verhofstad, M.H.J. (Michiel), Segers, M.J.M. (Michiel J.M.), Segers, M.J.M. (Michiel), Siroen, M.P.C. (Michiel P.C.), Reed, M.R. (Mike), Vicente, M.R. (Milena R.), Bruijninckx, M.M.M. (Milko), Trivedi, M. (Mittal), Bhandari, M. (Mohit), Moore, M.M. (Molly M.), Kunz, M. (Monica), Smedsrud, M. (Morten), Palla, N. (Naveen), Jain, N. (Neeraj), Out, N.J.M. (Nico J.M.), Simunovic, N. (Nicole), Schep, N.W.L. (Niels), Müller, O. (Oliver), Guicherit, O.R. (Onno R.), Waes, O.J.F. (Oscar) van, Wang, O. (Otis), Doornebosch, P. (Pascal), Seuffert, P. (Patricia), Hesketh, P.J. (Patrick J.), Weinrauch, P. (Patrick), Duffy, P. (Paul), Keller, P. (Paul), Lafferty, P.M. (Paul M.), Pincus, P. (Paul), Tornetta III, P. (Paul), Zalzal, P. (Paul), McKay, P. (Paula), Cole, P.A. (Peter A.), de Rooij, P.D. (Peter D.), Hull, P. (Peter), Go, P.M.N.Y.M. (Peter M.N.Y.M.), Patka, P. (Peter), Siska, P. (Peter), Weingarten, P. (Peter), Kregor, P. (Philip), Stahel, P. (Philip), Stull, P. (Philip), Wittich, P. (Philippe), Rijcke, P.A.R. (Piet), Oprel, P.P. (Pim), Devereaux, P.J. (P. J.), Zhou, Q. (Qi), Lee Murphy, R. (R.), Alosky, R. (Rachel), Clarkson, R. (Rachel), Moon, R. (Raely), Logishetty, R. (Rajanikanth), Nanda, R. (Rajesh), Sullivan, R.J. (Raymond J.), Snider, R.G. (Rebecca G.), Buckley, R.E. (Richard E.), Iorio, R. (Richard), Farrugia, R.J. (Richard J), Jenkinson, R. (Richard), Laughlin, R. (Richard), Groenendijk, R.P.R. (Richard), Gurich, R.W. (Richard W.), Worman, R. (Ripley), Silvis, R. (Rob), Haverlag, R. (Robert), Teasdall, R.J. (Robert J.), Korley, R. (Robert), McCormack, R. (Robert), Probe, R. (Robert), Cantu, R.V. (Robert V.), Huff, R.B. (Roger B.), Simmermacher, R.K.J., Peters, R. (Rolf), Pfeifer, R. (Roman), Liem, R. (Ronald), Wessel, R.N. (Ronald N.), Verhagen, R. (Ronald), Vuylsteke, R. (Ronald), Leighton, R. (Ross), McKercher, R. (Ross), Poolman, R.W. (Rudolf), Miller, R. (Russell), Bicknell, R. (Ryan), Finnan, R. (Ryan), Khan, R.M. (Ryan M.), Mehta, S. (Samir), Vang, S. (Sandy), Singh, S. (Sanjay), Anand, S. (Sanjeev), Anderson, S.A. (Sarah A.), Dawson, S.A. (Sarah A.), Marston, S.B. (Scott B.), Porter, S.E. (Scott E.), Watson, S.T. (Scott T.), Festen, S. (Sebastiaan), Lieberman, S. (Shane), Puloski, S. (Shannon), Bielby, S.A. (Shea A.), Sprague, S. (Sheila), Hess, S. (Shelley), MacDonald, S. (Shelley), Evans, S. (Simone), Bzovsky, S. (Sofia), Hasselund, S. (Sondre), Lewis, S. (Sophie), Ugland, S. (Stein), Caminiti, S. (Stephanie), Tanner, S.L. (Stephanie L.), Zielinski, S.M. (Stephanie), Shepard, S. (Stephanie), Sems, S.A. (Stephen A.), Walter, S.D. (Stephen D.), Doig, S. (Stephen), Finley, S.H. (Stephen H.), Kates, S. (Stephen), Lindenbaum, S. (Stephen), Kingwell, S.P. (Stephen P.), Csongvay, S. (Steve), Papp, S. (Steve), Buijk, S.E. (Steven E.), Rhemrev, S. (Steven), Hollenbeck, S.M. (Steven M.), van Gaalen, S.M. (Steven M.), Yang, S. (Steven), Weinerman, S. (Stuart), Subash, (), Lambert, S. (Sue), Liew, S. (Susan), Meylaerts, S.A.G. (Sven), Blokhuis, T.J. (Taco J.), de Vries Reilingh, T.S. (Tammo S.), Lona, T. (Tarjei), Scott, T. (Taryn), Swenson, T.K. (Teresa K.), Endres, T.J. (Terrence J.), Axelrod, T. (Terry), van Egmond, T. (Teun), Pace, T.B. (Thomas B.), Kibsgård, T. (Thomas), Schaller, T.M. (Thomas M.), Ly, T.V. (Thuan V.), Miller, T.J. (Timothy J.), Weber, T. (Timothy), Le, T. (Toan), Oliver, T.M. (Todd M.), Karsten, T.M. (Thomas), Borch, T. (Tor), Hoseth, T.M. (Tor Magne), Nicolaisen, T. (Tor), Ianssen, T. (Torben), Rutherford, T. (Tori), Nanney, T. (Tracy), Gervais, T. (Trevor), Stone, T. (Trevor), Schrickel, T. (Tyson), Scrabeck, T. (Tyson), Ganguly, U. (Utsav), Naumetz, V. (V.), Frizzell, V. (Valda), Wadey, V. (Veronica), Jones, V. (Vicki), Avram, V. (Victoria), Mishra, V. (Vimlesh), Yadav, V. (Vineet), Arora, V. (Vinod), Tyagi, V. (Vivek), Borsella, V. (Vivian), Willems, W.J. (Jaap), Hoffman, W.H. (W. H.), Gofton, W.T. (Wade T.), Lackey, W.G. (Wesley G.), Ghent, W. (Wesley), Obremskey, W. (William), Oxner, W. (William), Cross, W.W. (William W.), Murtha, Y.M. (Yvonne M.), and Murdoch, Z. (Zoe)

Abstract

Background Reoperation rates are high after surgery for hip fractures. We investigated the effect of a sliding hip screw versus cancellous screws on the risk of reoperation and other key outcomes. Methods For this international, multicentre, allocation concealed randomised controlled trial, we enrolled patients aged 50 years or older with a low-energy hip fracture requiring fracture fixation from 81 clinical centres in eight countries. Patients were assigned by minimisation with a centralised computer system to receive a single large-diameter screw with a side-plate (sliding hip screw) or the present standard of care, multiple small-diameter cancellous screws. Surgeons and patients were not blinded but the data analyst, while doing the analyses, remained blinded to treatment groups. The primary outcome was hip reoperation within 24 months after initial surgery to promote fracture healing, relieve pain, treat infection, or improve function. Analyses followed the intention-to-treat principle. This study was registered with ClinicalTrials.gov, number NCT00761813. Findings Between Marc

Published
2017
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36. Fracture fixation in the operative management of hip fractures (FAITH): an international, multicentre, randomised controlled trial.

Author

Nauth, A., Creek, A.T., Zellar, A., Lawendy, A.R., Dowrick, A., Gupta, A., Dadi, A., Kampen, A. van, Yee, A., Vries, A.C. de, Mol van Otterloo, A., Garibaldi, A., Liew, A., McIntyre, A.W., Prasad, A.S., Romero, A.W., Rangan, A., Oatt, A., Sanghavi, A., Foley, A.L., Karlsten, A., Dolenc, A., Bucknill, A., Chia, A., Gong, A., Schmidt, A.H., Marcantonio, A.J., Jennings, A., Khanna, A., Rai, A., Horan, A.D., Brekke, A.C., Flynn, A., Duraikannan, A., Stodle, A., Vugt, A.B. van, Luther, A., Zurcher, A.W., Jain, A., Amundsen, A., Moaveni, A., Carr, A., Sharma, A., Hill, A.D., Trommer, A., Rai, B.S., Hileman, B., Schreurs, B.W., Verhoeven, B., Barden, B.B., Flatoy, B., Cleffken, B.I., Boe, B., Perey, B., Hanusch, B.C., Weening, B., Fioole, B., Rijbroek, B., Crist, B.D., Halliday, B., Peterson, B., Mullis, B., Richardson, C.G., Clark, C., Sagebien, C.A., Pol, C.C. van der, Bowler, C., Humphrey, C.A., Coady, C., Koppert, C.L., Tannoury, C., Paolo, C.J. de, Gayton, C., Herriott, C., Reeves, C., Tieszer, C., Dobb, C., Anderson, C.G., Sage, C, Cuento, C., Jones, C.B., Bosman, C.H.R., Linehan, C., Hart, C.P. van der, Henderson, C., Lewis, C.G., Davis, C.A., Donohue, C., Mauffrey, C., Sundaresh, D.C., Farrell, D.J., Whelan, D.B., Horwitz, D., Stinner, D., Viskontas, D., Roffey, D.M., Alexander, D., Karges, D.E., Love, D., Wright, D.M., Zamorano, D.P., Goetz, D.R., Sanders, D., Yen, D., Bardana, D., Olakkengil, D.J., Lawson, D., Maddock, D., Sietsema, D.L., Pourmand, D., Hartog, D. Den, Donegan, D., Heels-Ansdell, D., Nam, D., Inman, D., Boyer, D., Li, D., Gibula, D., Price, D.M., Hammerberg, E.M., Tan, E.C.T.H., Graaf, E.J. de, Vesterhus, E.B., Roper, E., Edwards, E., Schemitsch, E.H., Hammacher, E.R., Henderson, E.R., Whatley, E., Torres, E.T., Vermeulen, E.G.J., Finn, E., Lieshout, E.M. van, Wai, E.K., Bannister, E.R., Kile, E., Theunissen, E.B.M., Ritchie, E.D., Moola, F., Howells, F., Nies, F. de, Heijden, F.H. van der, Meulemeester, F.R. de, Frihagen, F., Nilsen, F., Schmidt, G.B., Albers, G.H.R., Gudger, G.K., Johnson, G., Gruen, G., Zohman, G., Wood, G, Tetteroo, G.W., Hjorthaug, G., Jomaas, G., Donald, G., Rieser, G.R., Reardon, G., Slobogean, G.P., Roukema, G.R., Visser, G., Moatshe, G., Horner, G., Gardeniers, J.W.M., Waal Malefijt, M.C. de, et al., Nauth, A., Creek, A.T., Zellar, A., Lawendy, A.R., Dowrick, A., Gupta, A., Dadi, A., Kampen, A. van, Yee, A., Vries, A.C. de, Mol van Otterloo, A., Garibaldi, A., Liew, A., McIntyre, A.W., Prasad, A.S., Romero, A.W., Rangan, A., Oatt, A., Sanghavi, A., Foley, A.L., Karlsten, A., Dolenc, A., Bucknill, A., Chia, A., Gong, A., Schmidt, A.H., Marcantonio, A.J., Jennings, A., Khanna, A., Rai, A., Horan, A.D., Brekke, A.C., Flynn, A., Duraikannan, A., Stodle, A., Vugt, A.B. van, Luther, A., Zurcher, A.W., Jain, A., Amundsen, A., Moaveni, A., Carr, A., Sharma, A., Hill, A.D., Trommer, A., Rai, B.S., Hileman, B., Schreurs, B.W., Verhoeven, B., Barden, B.B., Flatoy, B., Cleffken, B.I., Boe, B., Perey, B., Hanusch, B.C., Weening, B., Fioole, B., Rijbroek, B., Crist, B.D., Halliday, B., Peterson, B., Mullis, B., Richardson, C.G., Clark, C., Sagebien, C.A., Pol, C.C. van der, Bowler, C., Humphrey, C.A., Coady, C., Koppert, C.L., Tannoury, C., Paolo, C.J. de, Gayton, C., Herriott, C., Reeves, C., Tieszer, C., Dobb, C., Anderson, C.G., Sage, C, Cuento, C., Jones, C.B., Bosman, C.H.R., Linehan, C., Hart, C.P. van der, Henderson, C., Lewis, C.G., Davis, C.A., Donohue, C., Mauffrey, C., Sundaresh, D.C., Farrell, D.J., Whelan, D.B., Horwitz, D., Stinner, D., Viskontas, D., Roffey, D.M., Alexander, D., Karges, D.E., Love, D., Wright, D.M., Zamorano, D.P., Goetz, D.R., Sanders, D., Yen, D., Bardana, D., Olakkengil, D.J., Lawson, D., Maddock, D., Sietsema, D.L., Pourmand, D., Hartog, D. Den, Donegan, D., Heels-Ansdell, D., Nam, D., Inman, D., Boyer, D., Li, D., Gibula, D., Price, D.M., Hammerberg, E.M., Tan, E.C.T.H., Graaf, E.J. de, Vesterhus, E.B., Roper, E., Edwards, E., Schemitsch, E.H., Hammacher, E.R., Henderson, E.R., Whatley, E., Torres, E.T., Vermeulen, E.G.J., Finn, E., Lieshout, E.M. van, Wai, E.K., Bannister, E.R., Kile, E., Theunissen, E.B.M., Ritchie, E.D., Moola, F., Howells, F., Nies, F. de, Heijden, F.H. van der, Meulemeester, F.R. de, Frihagen, F., Nilsen, F., Schmidt, G.B., Albers, G.H.R., Gudger, G.K., Johnson, G., Gruen, G., Zohman, G., Wood, G, Tetteroo, G.W., Hjorthaug, G., Jomaas, G., Donald, G., Rieser, G.R., Reardon, G., Slobogean, G.P., Roukema, G.R., Visser, G., Moatshe, G., Horner, G., Gardeniers, J.W.M., Waal Malefijt, M.C. de, and et al.

Abstract

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Published
2017

38. Hip fracture evaluation with alternatives of total hip arthroplasty versus hemiarthroplasty (HEALTH): Protocol for a multicentre randomised trial

Author

Bhandari, M. (Mohit), Devereaux, P.J., Einhorn, T.A. (Thomas), Thabane, L. (Lehana), Schemitsch, E.H. (Emil), Koval, K. (Kenneth), Frihagen, F. (Frede), Poolman, R.W. (Rudolf), Tetsworth, K. (Kevin), Guerra-Farfán, E. (Ernesto), Madden, K. (Kim), Sprague, S. (Sheila), Guyatt, G.H. (Gordon), Bhandari, M. (Mohit), Devereaux, P.J., Einhorn, T.A. (Thomas), Thabane, L. (Lehana), Schemitsch, E.H. (Emil), Koval, K. (Kenneth), Frihagen, F. (Frede), Poolman, R.W. (Rudolf), Tetsworth, K. (Kevin), Guerra-Farfán, E. (Ernesto), Madden, K. (Kim), Sprague, S. (Sheila), and Guyatt, G.H. (Gordon)

Abstract

Introduction: Hip fractures are a leading cause of mortality and disability worldwide, and the number of hip fractures is expected to rise to over 6 million per year by 2050. The optimal approach for the surgical management of displaced femoral neck fractures remains unknown. Current evidence suggests the use of arthroplasty; however, there is lack of evidence regarding whether patients with displaced femoral neck fractures experience better outcomes with total hip arthroplasty (THA) or hemiarthroplasty (HA). The HEALTH trial compares outcomes following THA versus HA in patients 50 years of age or older with displaced femoral neck fractures. Methods and analysis: HEALTH is a multicentre, randomised controlled trial where 1434 patients, 50 years of age or older, with displaced femoral neck fractures from international sites are randomised to receive either THA or HA. Exclusion criteria include associated major injuries of the lower extremity, hip infection(s) and a history of frank dementia. The primary outcome is unplanned secondary procedures and the secondary outcomes include functional outcomes, patient quality of life, mortality and hiprelated complications-both within 2 years of the initial surgery. We are using minimisation to ensure balance between intervention groups for the following factors: age, prefracture living, prefracture functional status, American Society for Anesthesiologists (ASA) Class and centre number. Data analysts and the HEALTH Steering Committee are blinded to the surgical allocation throughout the trial. Outcome analysis will be performed using a X2 test (or Fisher 's exact test) and Cox proportional hazards modelling estimate. All results will be presented with 95% CIs. Ethics and dissemination: The HEALTH trial has received local and McMaster University Research Ethics Board (REB) approval (REB#: 06-151). Results: Outcomes from the primary manuscript will be disseminated through publications in academic journals and presentations at rel

Published
2015
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44. Patient-oriented functional outcome after repair of distal biceps tendon ruptures using a single-incision technique

Author

McKee, M.D., Hirji, R., Schemitsch, E.H., Wild, L.M., and Waddell, J.P.

Abstract

Using a patient-oriented outcome questionnaire, in addition to standard outcome measures, we sought to determine the outcome of patients who had repair of a complete rupture of the distal biceps tendon via a single anterior incision technique with suture anchors. We identified 62 patients who were treated operatively by a single surgeon over an 8-year period for a diagnosis of complete rupture of the distal biceps tendon. Of the patients, 9 could not be located for final follow-up, and 53 of 62 (85%) participated in the study. All patients were men, and their mean age was 42 years. All repairs were performed via a single anterior incision by use of 2 suture anchors in the bicipital tuberosity on an outpatient basis. There were 4 complications (4/53 [7.5%]): 1 wound infection, 2 transient paresthesias in the lateral cutaneous nerve distribution, and 1 posterior interosseous nerve palsy that resolved in 6 weeks (no reoperations). There were no reruptures, and no patient lost more than 5^o of elbow flexion- extension or forearm rotation. All patients completed the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. The mean DASH score was 8.2 +/- 11.6 (95% CI, 5.2 to 11.9), which was similar to the mean DASH score in population controls of 6.2 (DASH User Manual). The strengths of our study include the consistent surgical technique by a single surgeon, the large number of patients, and the use of a patient-oriented outcome measure. Distal biceps tendon rupture repair via a single-incision technique with suture anchors was effective in restoring injured arms to normal, as measured by limb-specific patient-oriented measures, with minimal morbidity and a low complication rate.

Published
2005
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45. INDIRECT REDUCTION AND PERCUTANEOUS FIXATION LED TO A RAPID RECOVERY AND BETTER FUNCTION THAN OPEN REDUCTION FOR INTRA-ARTICULAR FRACTURES OF THE DISTAL END OF THE RADIUS.

Author

Kreder, H.J., Hanel, D.P., Agel, J., McKee, M., Schemitsch, E.H., Trumble, T.E., and Stephen, D.

Subjects
WRIST injuries, INTERNAL fixation in fractures, EXTERNAL skeletal fixation (Surgery), BONE fractures, RADIAL bone, ARTICULAR cartilage, HEALTH outcome assessment, ORTHOPEDICS
Abstract

The article addresses the question of how indirect reduction and percutaneous fixation compare with open reduction and internal fixation in patients with displaced intra-articular fractures of the distal end of the radius. A randomized, unblinded, controlled trial with 24-month followup was conducted. It involve two medical centers in the United States and one in Canada. It was concluded that in patients with displaced intraarticular fractures of the distal end of the radius, indirect reduction with percutaneous fixation led to a more rapid return of grip strength and a better functional outcome than did open reduction and internal fixation.

Published
2006
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46. Review: Unreamed Intramedullary Nailing Reduces Reoperation Rates More Than External Fixation in Open Tibial Fracture.

Author

Guyatt, Bhandari M., Guyatt, G.H., Swiontkowski, M.F., and Schemitsch, E.H.

Subjects
INTRAMEDULLARY fracture fixation, INTERNAL fixation in fractures, EXTERNAL skeletal fixation (Surgery)
Abstract

Question: In patients with open tibial shaft fractures, what is the effectiveness of external fixation, plating, and reamed or unreamed intramedullary nailing on rates of reoperation, nonunion, and infection? Data sources: Studies were identified by searching Medline (1969 to 1998), SCISEARCH, and the Cochrane Library; by hand-searching major orthopaedic journals and proceedings; and by contacting experts in the field. Study selection: Randomized or quasirandomized controlled trials (RCTs or QRTs) comparing external fixation, plate fixation, and reamed or unreamed intramedullary nailing in patients with open fractures of the tibial diaphysis. The primary outcome was reoperation. Data extraction: Data on patient characteristics, interventions, and outcomes were extracted. Study quality was assessed with respect to randomization procedures, blinding, follow-up, and analysis. An overall quality score was graded as a percentage. Main results: 8 trials (4 RCTs and 4 QRTs) were included. The quality scores ranged from 18% to 71%. 1 QRT (56 patients) compared plate fixation with external fixation. The rates of reoperation were lower in the externalfixation group (6.7% vs. 50%, P < 0.01). The groups did not differ for nonunion or deep infection rates. 5 RCTs (396 patients) compared unreamed nailing with external fixation. Reoperation rates were lower in the unreamednailing group (P < 0.001) (table). The rates of nonunion and deep infection were also lower in the nailing group, but the differences did not reach statistical significance (P = 0.067 and P = 0.054, respectively) (table). 2 RCTs (132 patients) compared reamed nailing with unreamed nailing. The groups did not differ for rates of reoperation (P = 0.32), nonunion (P = 0.24), or deep infection (P = 0.98). Conclusions: In patients with open tibial shaft fractures, the use of unreamed intramedullary nailing reduces reoperation rates more than does the use of external fixation. Reamed and unreamed nailing do not... [ABSTRACT FROM AUTHOR]

Published
2001

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