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Nathalie Tafer,1 Wilson Belaieff,1 Céline Cuérel,1 Matthieu Zingg,1 Pierre Hoffmeyer,1 Ilker Uçkay1,2 1Orthopedic Surgery Department, 2Division of Infectious Diseases, University of Geneva Hospitals and Medical School, Geneva, Switzerland Abstract: The pace of the aging population is steadily rising worldwide with a parallel increase in the demand for joint replacement procedures. With the increasing number of patients undergoing arthroplasty, there is also an increased risk for arthroplasty infection that may lead to severe complications, poorer outcome, and substantial extra costs for health care systems. Current rates of prosthetic joint infection are not dramatically different from the 1960s or 1970s, but some general principles are now better defined, and their management has been studied extensively during the past decades, thus resulting in a change in clinical practice. The purpose of this review is to summarize important principles of prosthetic joint infection to guide the clinician and to contribute to the optimal diagnosis, prevention, and management of periprosthetic joint infections. Keywords: arthroplasty infection, antibiotic therapy, biofilm, surgery, prevention

In light of changes in patient demographics together with constant developments in burn care, the predictive accuracy of the Abbreviated Burns Severity Index (ABSI) - first described in 1982 - for estimating the mortality of present day burns patients, may be questionable. We reviewed the records of 2813 burns patients treated between January 1968 and December 2008 in the intensive care unit at our institution, aiming to identify emerging discrepancies between the estimated and calculated outcome, based on each of the ABSI variables and the total burn score. The predictive value of each of the defined ABSI variables was confirmed to be highly significant. Univariable and multivariable analysis revealed an exponential increase in odds ratio (OR) for mortality for patients older than 60 years and more than 30% TBSA burned and showed OR values over 10 times higher than other significant variables like inhalation injury. Nevertheless, the ABSI for the estimation of mortality in our entire patient collective was highly accurate and could not be optimised by adapting the point distribution to the increase in OR. Our data indicates that despite significant changes in patient demographics and medical advances over the past 30 years, the ABSI scoring system is still an accurate and valuable tool in the prediction of burn patient mortality. [ABSTRACT FROM AUTHOR]

Beat Knechtle,1 Matthias Alexander Zingg,2 Patrizia Knechtle,1 Thomas Rosemann,2 Christoph Alexander Rüst2 1Gesundheitszentrum St Gallen, St Gallen, 2Institute of Primary Care, University of Zurich, Zurich, Switzerland Abstract: Recent studies investigating ultraendurance athletes showed an association between excessive fluid intake and swelling of the lower limbs such as the feet. To date, this association has been investigated in single-stage ultraendurance races, but not in multistage ultraendurance races. In this case study, we investigated a potential association between fluid intake and feet swelling in a multistage ultraendurance race such as a Deca Iron ultratriathlon with ten Ironman triathlons within 10 consecutive days. A 49-year-old well-experienced ultratriathlete competed in autumn 2013 in the Deca Iron ultratriathlon held in Lonata del Garda, Italy, and finished the race as winner within 129:33 hours:minutes. Changes in body mass (including body fat and lean body mass), foot volume, total body water, and laboratory measurements were assessed. Food and fluid intake during rest and competing were recorded, and energy and fluid turnovers were estimated. During the ten stages, the volume of the feet increased, percentage body fat decreased, creatinine and urea levels increased, hematocrit and hemoglobin values decreased, and plasma [Na+] remained unchanged. The increase in foot volume was significantly and positively related to fluid intake during the stages. The poststage volume of the foot was related to poststage total body water, poststage creatinine, and poststage urea. This case report shows that the volume of the foot increased during the ten stages, and the increase in volume was significantly and positively related to fluid intake during the stages. Furthermore, the poststage volume of the foot was related to poststage total body water, poststage creatinine, and poststage urea. The continuous feet swelling during the race was most probably due to a combination of a high fluid intake and a progressive decline in renal function (ie, continuous increase in creatinine and urea), leading to body fluid retention (ie, increase in total body water). Keywords: swimming, cycling, running, fluid

Beat Knechtle,1,2 Raphael Knechtle,2 Michael Stiefel,2 Matthias Alexander Zingg,2 Thomas Rosemann,2 Christoph Alexander Rüst21Gesundheitszentrum St Gallen, St Gallen, 2Institute of Primary Care, University of Zurich, Zurich, SwitzerlandObjective: This narrative review summarizes findings for Ironman triathlon performance and intends to determine potential predictor variables for Ironman race performance in female and male triathletes.Methods: A literature search was performed in PubMed using the terms “Ironman”, “triathlon”, and “performance”. All resulting articles were searched for related citations.Results: Age, previous experience, sex, training, origin, anthropometric and physiological characteristics, pacing, and performance in split disciplines were predictive. Differences exist between the sexes for anthropometric characteristics. The most important predictive variables for a fast Ironman race time were age of 30–35 years (women and men), a fast personal best time in Olympic distance triathlon (women and men), a fast personal best time in marathon (women and men), high volume and high speed in training where high volume was more important than high speed (women and men), low body fat, low skin-fold thicknesses and low circumference of upper arm (only men), and origin from the United States of America (women and men).Conclusion: These findings may help athletes and coaches to plan an Ironman triathlon career. Age and previous experience are important to find the right point in the life of a triathlete to switch from the shorter triathlon distances to the Ironman distance. Future studies need to correlate physiological characteristics such as maximum oxygen uptake with Ironman race time to investigate their potential predictive value and to investigate socio-economic aspects in Ironman triathlon.Keywords: swimming, cycling, running, age, body fat, sex

Beat Knechtle,1,2 Matthias Alexander Zingg,1 Thomas Rosemann,1 Michael Stiefel,1 Christoph Alexander Rüst11Institute of Primary Care, University of Zurich, Zurich, Switzerland; 2Gesundheitszentrum St Gallen, St Gallen, Switzerland Objective: This narrative review summarizes recent intentions to find potential predictor variables for ultra-triathlon race performance (ie, triathlon races longer than the Ironman distance covering 3.8 km swimming, 180 km cycling, and 42.195 km running). Results from studies on ultra-triathletes were compared to results on studies on Ironman triathletes. Methods: A literature search was performed in PubMed using the terms “ultra”, “triathlon”, and “performance” for the aspects of “ultra-triathlon”, and “Ironman”, “triathlon”, and “performance” for the aspects of “Ironman triathlon”. All resulting papers were searched for related citations. Results for ultra-triathlons were compared to results for Ironman-distance triathlons to find potential differences. Results: Athletes competing in Ironman and ultra-triathlon differed in anthropometric and training characteristics, where both Ironmen and ultra-triathletes profited from low body fat, but ultra-triathletes relied more on training volume, whereas speed during training was related to Ironman race time. The most important predictive variables for a fast race time in an ultra-triathlon from Double Iron (ie, 7.6 km swimming, 360 km cycling, and 84.4 km running) and longer were male sex, low body fat, age of 35–40 years, extensive previous experience, a fast time in cycling and running but not in swimming, and origins in Central Europe. Conclusion: Any athlete intending to compete in an ultra-triathlon should be aware that low body fat and high training volumes are highly predictive for overall race time. Little is known about the physiological characteristics of these athletes and about female ultra-triathletes. Future studies need to investigate anthropometric and training characteristics of female ultra-triathletes and what motivates women to compete in these races. Future studies need to correlate physiological characteristics such as maximum oxygen uptake (VO2max) with ultra-triathlon race performance in order to investigate whether these characteristics are also predictive for ultra-triathlon race performance. Keywords: swimming, cycling, running, age, experience, ultra-endurance

Beat Knechtle,1,2 Thomas Rosemann,1 Matthias A Zingg,1 Michael Stiefel,1 Christoph A Rüst11Institute of Primary Care, University of Zurich, Zurich, 2Gesundheitszentrum St Gallen, St Gallen, SwitzerlandAbstract: Pacing strategy has been investigated in elite 100 km and elite 161 km (100 mile) ultra-marathoners, but not in age group ultra-marathoners. This study investigated changes in running speed over segments in male elite and age group 100 km ultra-marathoners with the assumption that running speed would decrease over segments with increasing age of the athlete. Running speed during segments in male elite and age group finishers for 5-year age groups (ie, 18–24 to 65–69 years) in the 100 km Lauf Biel in Switzerland was investigated during the 2000–2009 period. Average running speed over segment time station (TS) TS1–TS2 (56.1 km) was compared with running speed Start–TS1 (38 km) and Start–TS3 (76.7 km) and running speed TS2–TS3 was compared with running speed Start–Finish. For the top ten athletes in each edition, running speed decreased from 2000 to 2009 for TS1–TS2 and TS2–TS3 (P0.05). During TS1–TS2, athletes were running at 98.0%±2.1% of the running speed of Start–TS1. In TS2–TS3, they were running at 94.6%±3.4% of the running speed of TS1–TS2. In TS3–Finish, they were running at 95.5%±3.8% of running speed in TS2–TS3. For age group athletes, running speed decreased in TS1–TS2 and TS2–TS3. In TS3–Finish, running speed remained unchanged with the exception of the age group 40–44 years for which running speed increased. Running speed showed the largest decrease in the age group 18–24 years. To summarize, the top ten athletes in each edition maintained their running speed in the last segment (TS3–Finish) although running speed decreased over the first two segments (TS1–TS2 and TS2–TS3). The best pacers were athletes in the age group 40–44 years, who were able to achieve negative pacing in the last segment (TS3–Finish) of the race. The negative pacing in the last segment (TS3–Finish) was likely due to environmental conditions, such as early dawn and the flat circuit in segment TS3–Finish of the race.Keywords: running, men, long distance, master athlete

Matthias A Zingg,1 Beat Knechtle,1,2 Thomas Rosemann,1 Christoph A Rüst1 1Institute of Primary Care, University of Zurich, Zurich, Switzerland; 2Gesundheitszentrum St Gallen, St Gallen, Switzerland Abstract: Anecdotal reports have assumed that women would be able to outrun men in long-distance running. The aim of this study was to test this assumption by investigating the changes in performance difference between sexes in the best ultramarathoners in 50-mile, 100-mile, 200-mile, 1,000-mile, and 3,100-mile events held worldwide between 1971 and 2012. The sex differences in running speed for the fastest runners ever were analyzed using one-way analysis of variance with subsequent Tukey–Kramer posthoc analysis. Changes in sex difference in running speed of the annual fastest were analyzed using linear and nonlinear regression analyses, correlation analyses, and mixed-effects regression analyses. The fastest men ever were faster than the fastest women ever in 50-mile (17.5%), 100-mile (17.4%), 200-mile (9.7%), 1,000-mile (20.2%), and 3,100-mile (18.6%) events. For the ten fastest finishers ever, men were faster than women in 50-mile (17.1%±1.9%), 100-mile (19.2%±1.5%), and 1,000-mile (16.7%±1.6%) events. No correlation existed between sex difference and running speed for the fastest ever (r2=0.0039, P=0.91) and the ten fastest ever (r2=0.15, P=0.74) for all distances. For the annual fastest, the sex difference in running speed decreased linearly in 50-mile events from 14.6% to 8.9%, remained unchanged in 100-mile (18.0%±8.4%) and 1,000-mile (13.7%±9.1%) events, and increased in 3,100-mile events from 12.5% to 16.9%. For the annual ten fastest runners, the performance difference between sexes decreased linearly in 50-mile events from 31.6%±3.6% to 8.9%±1.8% and in 100-mile events from 26.0%±4.4% to 24.7%±0.9%. To summarize, the fastest men were ~17%–20% faster than the fastest women for all distances from 50 miles to 3,100 miles. The linear decrease in sex difference for 50-mile and 100-mile events may suggest that women are reducing the sex gap for these distances. Keywords: running, sex difference, running speed, ultraendurance

Beat Knechtle,1 Matthias A Zingg,2 Thomas Rosemann,2 Christoph A Rüst21Gesundheitszentrum St Gallen, St Gallen, Switzerland; 2Institute of General Practice and Health Services Research, University of Zurich, Zurich, SwitzerlandAbstract: This study investigated changes in performance and sex difference in top performers for ultra-triathlon races held between 1978 and 2013 from Ironman (3.8 km swim, 180 km cycle, and 42 km run) to double deca iron ultra-triathlon distance (76 km swim, 3,600 km cycle, and 844 km run). The fastest men ever were faster than the fastest women ever for split and overall race times, with the exception of the swimming split in the quintuple iron ultra-triathlon (19 km swim, 900 km cycle, and 210.1 km run). Correlation analyses showed an increase in sex difference with increasing length of race distance for swimming (r2=0.67, P=0.023), running (r2=0.77, P=0.009), and overall race time (r2=0.77, P=0.0087), but not for cycling (r2=0.26, P=0.23). For the annual top performers, split and overall race times decreased across years nonlinearly in female and male Ironman triathletes. For longer distances, cycling split times decreased linearly in male triple iron ultra-triathletes, and running split times decreased linearly in male double iron ultra-triathletes but increased linearly in female triple and quintuple iron ultra-triathletes. Overall race times increased nonlinearly in female triple and male quintuple iron ultra-triathletes. The sex difference decreased nonlinearly in swimming, running, and overall race time in Ironman triathletes but increased linearly in cycling and running and nonlinearly in overall race time in triple iron ultra-triathletes. These findings suggest that women reduced the sex difference nonlinearly in shorter ultra-triathlon distances (ie, Ironman), but for longer distances than the Ironman, the sex difference increased or remained unchanged across years. It seems very unlikely that female top performers will ever outrun male top performers in ultra-triathlons. The nonlinear change in speed and sex difference in Ironman triathlon suggests that female and male Ironman triathletes have reached their limits in performance.Keywords: triathlon, swimming, cycling, running, ultra-endurance

Matthias Zingg,1 Beat Knechtle,1,2 Christoph A Rüst,1 Thomas Rosemann,1 Romuald Lepers3 1Institute of General Practice and Health Services Research, University of Zurich, Zurich, Switzerland; 2Gesundheitszentrum St Gallen, St Gallen, Switzerland; 3INSERM U1093, Faculty of Sport Sciences, University of Burgundy, Dijon, France Background: Participation and performance trends for athletes by age group have been investigated for marathoners and ultramarathoners competing in races up to 161 km, but not for longer distances of more than 200 km. Methods: Participation and performance trends in athletes by age group in the Badwater (217 km) and Spartathlon (246 km) races were compared from 2000 to 2012. Results: The number of female and male finishers increased in both races across years (P < 0.05). The age of the annual five fastest men decreased in Badwater from 42.4 ± 4.2 years to 39.8 ± 5.7 years (r2 = 0.33, P = 0.04). For women, the age remained unchanged at 42.3 ± 3.8 years in Badwater (P > 0.05). In Spartathlon, the age of the annual five fastest finishers was unchanged at 39.7 ± 2.4 years for men and 44.6 ± 3.2 years for women (P > 0.05). In Badwater, running speed increased in men from 7.9 ± 0.7 km/hour to 8.7 ± 0.6 km/hour (r2 = 0.51, P < 0.01) and in women from 5.4 ± 1.1 km/hour to 6.6 ± 0.5 km/hour (r2 = 0.61, P < 0.01). In Spartathlon, running speed remained unchanged at 10.8 ± 0.7 km/hour in men and 8.7 ± 0.5 km/hour in women (P > 0.05). In Badwater, the number of men in age groups 30–34 years (r2 = 0.37, P = 0.03) and 40–44 years (r2 = 0.75, P < 0.01) increased. In Spartathlon, the number of men increased in the age group 40–44 years (r2 = 0.33, P = 0.04). Men in age groups 30–34 (r2 = 0.64, P < 0.01), 35–39 (r2 = 0.33, P = 0.04), 40–44 (r2 = 0.34, P = 0.04), and 55–59 years (r2 = 0.40, P = 0.02) improved running speed in Badwater. In Spartathlon, no change in running speed was observed. Conclusion: The fastest finishers in ultramarathons more than 200 km in distance were 40–45 years old and have to be classified as “master runners” by definition. In contrast to reports of marathoners and ultramarathoners competing in races of 161 km in distance, the increase in participation and the improvement in performance by age group were less pronounced in ultramarathoners competing in races of more than 200 km. Keywords: ultra-endurance, master runner, running speed, sex difference

Matthias A Zingg,1 Beat Knechtle,1,2 Christoph Alexander Rüst,1 Thomas Rosemann,1 Romuald Lepers3 1Institute of General Practice and Health Services Research, University of Zurich, Zurich, Switzerland; 2Gesundheitszentrum St Gallen, St Gallen, Switzerland; 3INSERM U1093, Faculty of Sport Sciences, University of Burgundy, Dijon, France Background: The performance in master marathoners has been investigated in flat city marathons but not in mountain marathons. This study examined changes in the sex differences in performance across time in female and male master runners competing in a mountain marathon compared to a flat city marathon. Methods: The association between age and performance of finishers in the Jungfrau Marathon, Switzerland, with 1830 meter changes in altitude and a flat city marathon (Lausanne Marathon), Switzerland, were analyzed from 2000 to 2011. Results: In both events, athletes in the 35–44 years age group showed the highest number of finishers. In the mountain marathon, the number of female master runners aged > 35 years increased in contrast to female finishers aged < 35 years, while the number of male finishers was unchanged in all age groups. In the city marathon, the number of female finishers was unchanged while the number of male finishers in the age groups for 25–34-year-olds and 35–44-year-olds decreased. In female marathoners, performance improved in athletes aged 35–44 and 55–64 years in the city marathon. Male marathoners improved race time in age group 45–54 years in both the city marathon and the mountain marathon. Female master runners reduced the sex difference in performance in the 45–54-year age group in both competitions and in the 35–44-year age group in the mountain marathon. The sex difference in performance decreased in the 35–44-year age group from 19.1% ± 4.7% to 16.6% ± 1.9% in the mountain marathon (r2 = 0.39, P = 0.03). In age groups 45–54 years, the sex difference decreased from 23.4% ± 1.9% to 15.9% ± 6.1% in the mountain marathon (r2 = 0.39, P < 0.01) and from 34.7% ± 4.6% to 11.8% ± 6.2% in the city marathon (r2 = 0.39, P < 0.01). Conclusion: These findings suggest that female master runners aged 35–54 years reduced sex differences in their performance in both mountain and city marathon running. Keywords: endurance, age, female, male

Explores the improvements in the GT11NMC compressor of Alstom as of November 2004. Ways by which Alstom provides customers with solutions that keep their power plant competitive; Features of the GT11NM turbine upgrade introduced by the company in 1997; Functions of the GT11NMC turbine package.

Alterations in the RAS-MAPK signaling cascade are common across multiple solid tumor types and are a driver for many cancers. NST-628 is a potent pan-RAF-MEK molecular glue that prevents the phosphorylation and activation of MEK by RAF, overcoming the limitations of traditional RAS-MAPK inhibitors and leading to deep durable inhibition of the pathway. Cellular, biochemical, and structural analyses of RAF-MEK complexes show that NST-628 engages all isoforms of RAF and prevents the formation of BRAF-CRAF heterodimers, a differentiated mechanism from all current RAF inhibitors. With a potent and durable inhibition of the RAF-MEK signaling complex as well as high intrinsic permeability into the brain, NST-628 demonstrates broad efficacy in cellular and patient-derived tumor models harboring diverse MAPK pathway alterations, including orthotopic intracranial models. Given its functional and pharmacokinetic mechanisms that are differentiated from previous therapies, NST-628 is positioned to make an impact clinically in areas of unmet patient need. Significance: This study introduces NST-628, a molecular glue having differentiated mechanism and drug-like properties. NST-628 treatment leads to broad efficacy with high tolerability and central nervous system activity across multiple RAS- and RAF-driven tumor models. NST-628 has the potential to provide transformative clinical benefits as both monotherapy and vertical combination anchor., (©2024 The Authors; Published by the American Association for Cancer Research.)

Purpose: In patients undergoing total hip arthroplasty, limping is a significant symptom, often assessed with the limping sub-score of the Harris Hip Score. However, the reliability of this sub-score has not been specifically investigated. The purpose of this study is to investigate the intra- and inter-rater reliability of this sub-score., Methods: Thirty patients undergoing THA were recruited and performed a gait analysis before surgery and three months after surgery. In addition, 30 asymptomatic participants were included. In total, 90 visits were analysed in this study. The HHS limping sub-score was assessed for each visit using a video (front and back view side-by-side) of a ten metre walk at a self-selected speed. Two orthopaedic surgeons evaluated the limping of each video in two different grading sessions with a one week delay. To avoid recall bias, the patient's number identity was randomized and different for each grading session and each rater. The weighted Cohen's Kappa coefficient was used to quantify the intra- and inter-reliability. The reliability of three components was studied: the presence of limping, its severity, and the compensation type., Results: For all components, the agreement for intra-rater reliability ranged from moderate to strong and from none to moderate for the inter-rater reliability., Conclusion: These results do not encourage the use of HHS-limping sub-score for data involving different raters in both clinical and research contexts. It calls for improved consensus on limping definitions or the creation of objective measures., (© 2024. The Author(s).)

Background and Purpose: We aimed to evaluate the long-term predictive value of radiographic abnormality and/or hip pain assessed 5 years following primary total hip arthroplasty (THA) and the occurrence of revision for aseptic loosening between 5 and 25 years postoperatively., Patients and Methods: We included all primary THAs performed between 1996 and 2011 (same uncemented cup, polyethylene-ceramic bearing, 28 mm head, cemented stem) and prospectively enrolled in the institutional registry, for whom baseline and follow-up radiographs were available. At 5 years radiographically we assessed femoral osteolysis and/or stem migration. Pain was evaluated with the Harris Hip pain subscore. Kaplan-Meier survival and Cox regression analyses were performed., Results: 1,317 primary THAs were included. 25 THAs (2%) were revised for aseptic stem loosening. Any abnormal radiographic sign at 5 years was present in 191 THAs (14%). Occasional hip pain was reported by 20% and slight to severe pain by 12% of patients at 5 years. In patients < 60 years, 10 of the 12 later revised for aseptic stem loosening had abnormal radiographs at 5 years vs. 5 of the 13 later revised in those ≥ 60 years. Hazard ratios (HR) were 34 (95% confidence interval [CI] 7-155) in younger vs. 4 (CI 1-11) in the older group. HR for association of hip pain at 5 years with future revision was 3 (CI 1-5)., Conclusion: The presence of abnormal radiographic signs 5 years after THA was strongly associated with later revision for aseptic stem loosening, especially in patients < 60 years. The association between pain at 5 years and future revision was much weaker.

3D printing is a technology that has been evolving rapidly over the past twenty years. It is an additive manufacturing process which allows the creation of objects without geometry restrictions. This process has applications in orthopaedic surgery through personalized cutting guides and implants which offer the possibility to treat complex pathologies such as tumoral surgery, architectural defects of the acetabulum and malunions. Although their use cannot be recommended for routine knee and hip prosthetic surgery, their value in high tibial osteotomies seems promising. Despite its high cost, this technology is of growing interest in orthopaedic surgery., Competing Interests: Les auteurs n’ont déclaré conflit d’intérêts en relation avec cet article.

Femoroacetabular impingement (FAI) is a frequent cause of hip pain in young people and athletes. It requires a complete work-up, including X-rays, hip arthro-MRI and CT coxometry with measurement of femoral torsion. The surgical management of CFA must be adapted to the morphological anomalies of the femur (cam), acetabulum (pincer) and femoral torsional disorders. Most CFA can be treated by hip arthroscopy, with correction of the cam and suture of the labrum. Some CFA with a bulky or posterior cam require surgical hip dislocation. A femoral rotation or derotation osteotomy can correct an associated torsional disorder. In cases of marked retroversion of the acetabulum, anteverting periacetabular osteotomy can reorient the acetabulum., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Background: Pelvic ring injuries are potentially lethal lesions associated with polytrauma patients and need an efficient trauma team for their management. The purpose of this study was to evaluate the incidence of high-energy blunt pelvic ring injuries and the absolute number of polytrauma patients in a single level I trauma center during the 2020 pseudo-lockdown period related to the Coronavirus pandemic, and to compare it with corresponding periods in 2014-2019 in order to better understand the need of organized and dedicated personnel and infrastructures., Methods: This retrospective cohort study was based on data prospectively recorded into the institutional Severely Injured Patients' Registry. Data were obtained for each year period (January 1st to December 31st) and corresponding pseudo-lockdown period (March 16th to June 19th). High-energy blunt pelvic ring injuries inclusion criteria were: (1) Registry entry between January 1st, 2014 and December 31st, 2020; (2) age ≥ 16 years old; and (3) pelvic ring injury presence. Corresponding exclusion criteria were: (1) death before admission; (2) transfer from another institution > 24 h after trauma; (3) penetrating, blast, burn and electrical injuries, drownings; (4) patients living outside the defined institution's catchment area; and (5) any document attesting the patient's will to not participate in any study. Polytrauma patients inclusion criteria were: (1) Registry entry between January 1st, 2014 and December 31st, 2020; (2) age ≥ 16 years old; and (3) Injury Severity Score ≥ 16. Corresponding exclusion criteria were: (1) death before admission; (2) transfer from another institution > 24 h after trauma; and (3) any document attesting the patient's will to not participate in any study. Categorical variables were reported using proportions and continuous variables using medians and interquartile ranges. Because data were exhaustive for the authors' level I trauma center, no inferential statistics were computed., Results: The incidence of high-energy blunt pelvic ring injuries and the absolute number of polytrauma patients remained within range of previous years despite pseudo-lockdown measures., Conclusions: These observations bring better knowledge about pseudo-lockdown's impact on trauma and may help for future health strategy planning by pointing out the importance of maintaining the activity of level I trauma centers in terms of personnel and infrastructures., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Background: Total hip arthroplasty is a widely performed surgical procedure, which enables patients to regain mobility, alleviates pain, and improves overall quality of life. Periarticular multimodal drug infiltration (PAI) is increasingly being used as an effective postoperative pain management, decreasing the systemic consumption of opioids. Extensive postoperative skin necrosis without a deep joint infection as a complication of total hip arthroplasty with PAI has not yet been described., Case Presentation: A 71-year-old patient who underwent total hip arthroplasty of the right hip for primary osteoarthritis through the Direct Anterior Approach presented postoperatively a large area of necrotic skin at the incision. Joint infection was excluded. An extensive debridement was performed and the tissue defect was reconstructed by a pedicled anterolateral thigh flap. The skin maintained a satisfactory appearance at 1 year postoperatively, and the hip was pain-free with restored ranges of motion. The patient was able to walk with no support and without limitation., Conclusion: We address the possible risk factors, discuss the use of epinephrine in PAI and explore possible treatment options for such a complication., (© 2023. The Author(s).)

Dislocation after hip replacement is a complication that can have dramatic consequences for the patient. The purpose of this article is to review the different parameters influencing stability and how to reduce this risk. The approach, the diameter of the femoral head, and the use of dual-mobility acetabular cups have led to a drastic reduction in the rate of dislocation, particularly in patients at risk, in cases of imbalance of the spino-pelvic complex, or in cases of revision surgery. The inclusion of patients in dedicated clinical pathways and participation in preoperative education sessions also contribute to the reduction of dislocation risk., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Bi-plane X-ray provides 3D measurements of the lower limb based on the identification of anatomical landmarks in sagittal and frontal X-rays. In clinical practice, such measurements involve multiple operators and sessions. This study aimed at evaluating the reliability of anatomical landmarks identification and geometric parameters of the pelvis and femur measured with bi-plane X-rays before and after total hip arthroplasty (THA). Twenty-eight patients undergoing primary THA were selected retrospectively. Two operators performed three reconstructions for each patient before and after THA. Intraclass correlation (ICC) and smallest detectable change (SDC) were computed for intra-operator, inter-operator, and test-retest conditions. Most anatomical landmark positions had good to excellent SDC (< 5 mm) apart from the centre of the sacral slope, greater trochanter, and anterior superior iliac spines (up to 7.1, 16.9, and 21.5 mm respectively). Geometric parameters had moderate to excellent SDC, apart from femoral and stem torsion, pelvic incidence, and APP inclination with poor SDC (9-12°). The sagittal view had significantly higher measurement errors than the frontal view. Test-retest and inter-operator conditions had no significant differences suggesting a low influence of patient posture. Osteoarthritis and the presence of implants did not seem to influence reliability and measurement error. This study could be used as a reference when assessing lower limb structure with bi-plane X-rays., (© 2022. The Author(s).)

Background: Studies on the association of open tibia fractures and acute compartment syndrome (ACS) show confusing results, with some papers highlighting a positive association, and others failing to do so. The aim of this study was to determine if an open tibia fracture is at increased risk of ACS occurrence, when compared to a closed fracture., Hypothesis: Skin injury in the setting of an open tibia fracture does not prevent from ACS occurrence, because the energy transmitted to the limb during trauma may lead to soft tissue lesions, including skin lacerations and ACS., Patients and Methods: In total, 711 consecutive adult patients (mean age 44.6 years; 65.8% males) sustaining 725 tibia fractures between 01.01.2005 and 31.12.2009 were included in this retrospective study. The outcome measure was ACS. The following variables were assessed: soft tissue condition, age, sex, low- vs. high-energy injury, type of fracture, associated contiguous skeletal injury. A logistic regression model was used and adjustment was performed for age and sex., Results: ACS occurred in 10.4% of proximal intra-articular fractures, 10.4% of extra-articular fractures and 3.3% of distal intra-articular fractures, and in 8.7% of closed fractures, 7.8% of open Gustilo 1 fractures and 13.3% of open Gustilo 2 and 3 fractures. Open lesions were not associated with ACS when tibia fractures were considered as a whole. When stratifying by types of fractures, open Gustilo 2 and 3 lesions were associated with ACS in proximal intra-articular fractures (p=0.048). There was no association with closed or any type of open lesions for extra-articular fractures. There were not enough ACS cases among distal intra-articular fractures to draw conclusions., Discussion: As ACS may occur with any type of open tibia fractures, clinicians should not be wrongly reassured by an open fracture, assuming that the wound would relieve the pressure inside the muscle compartments. There is a weak association between open Gustilo 2 and 3 lesions and ACS in proximal intra-articular fractures only. These findings are important for surgeons treating these injuries, especially by intubated, sedated or obtunded patients., Level of Evidence: III; retrospective diagnostic study., (Copyright © 2021 The Author(s). Published by Elsevier Masson SAS.. All rights reserved.)

Background: The optimal postoperative antibiotic duration has not been determined for aseptic revision total knee arthroplasty (R-TKA) where the risk of periprosthetic joint infection (PJI) is 3%-7.5%. This study compared PJI rates in aseptic R-TKA performed with extended oral antibiotic prophylaxis (EOAP) to published rates., Methods: Aseptic R-TKAs consecutively performed between 2013 and 2017 at a tertiary care referral center in the American Midwest were retrospectively reviewed. All patients were administered intravenous antibiotics while hospitalized and discharged on 7-day oral antibiotic prophylaxis. Infection rates and antibiotic-related complications were assessed., Results: Sixty-seven percent of the 176 analysis patients were female, with an average age of 64 years and body mass index of 35 kg/m 2 . Instability and aseptic loosening comprised 86% of revision diagnoses. Overall, 87.5% of intraoperative cultures were negative, and the remainder were single positive cultures considered contaminants. PJI rates were 0% at 90 days, 1.8% (95% confidence interval 0.4%-5.3%) at 1 year, and 2.2% (95% confidence interval 0.6%-5.7%) at mean follow-up of approximately 3 years (range, 7-65 months)., Conclusion: EOAP after aseptic R-TKA resulted in a PJI rate equivalent to primary TKA, representing a 2- to-4-fold decrease compared with published aseptic R-TKA infection rates. Further study on the benefits and costs of EOAP after aseptic R-TKA is encouraged., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Acetabular peri-prosthetic fractures are rare but their incidence is rising due to the increased prevalence of total hip arthroplasty, the increasing life expectancy and the growing functional demand of an ageing population, the incidence of primary total hip arthroplasty is increasing. They are either intra-operative or post-operative and have various aetiologies. Several factors such as implant stability, bone loss, remaining bone stock, fracture pattern, timing, age and co-morbidities of the patients must be considered for adequate treatment. To date, the literature on this subject has been sparse and no universally recognized treatment algorithm exists. Their rarity makes them a little-known entity and their surgical management represents a challenge for most orthopaedic surgeons. This review aims to present an update on epidemiology, the diagnostic work up, existing classification systems, surgical approaches and therapeutic options for acetabular peri-prosthetic fractures.

Giant cell tumor is a benign epiphyseo-metaphyseal bone tumor affecting the young patient. It is characterized by an extensive osteolysis, a high potential for recurrence, a risk of malignant transformation and pulmonary metastases. Curettage and cavity filling is the most common treatment, even in the case of a pathological fracture. A wide resection with prosthetic reconstruction must sometimes be considered. Better knowledge of the role of RANK-L in the pathophysiology of these tumors has led to clinical trials involving denosumab. Treatment with denosumab is suggested for inoperable lesions, or for aggressive lesions, in particular of the spine, pelvis, and sacrum before en bloc resection., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Since 1996, the Geneva Arthroplasty Registry at the University Hospitals of Geneva (HUG) has been collecting, archiving and disseminating relevant high-quality information on primary total hip and knee arthroplasties and revision procedures performed at the Division of Orthopaedics and Traumatology. Patients are followed throughout their lifetime with the prosthesis. The registry has been essential to better understand and subsequently improve the care of patients with hip and knee replacements. It will continue to fulfil its mission and to work towards an even more effective transfer of the knowledge obtained to all stakeholders and as well as towards its implementation., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Background: The purpose of this study was to evaluate the association between epidemiological, clinical and radiographic factors of patients with tibial shaft fractures and the occurrence of acute compartment syndrome., Methods: 270 consecutive adult patients sustaining 273 tibial shaft fractures between January 2005 and December 2009 were included in this retrospective cohort study. The outcome measure was acute compartment syndrome. Patient-related (age, sex), fracture-related (high- vs. low-energy injury, isolated trauma vs. polytrauma, closed vs. open fracture) and radiological parameters (AO/OTA classification, presence or absence of a noncontiguous tibial plateau or pilon fracture, distance from the centre of the tibial fracture to the talar dome, distance between tibial and fibular fracture if associated, and angulation, translation and over-riding of main tibial fragments) were evaluated regarding their potential association with acute compartment syndrome. Univariate analysis was performed and each covariate was adjusted for age and sex. Finally, a multivariable logistic regression model was built, and odds ratios and 95% confidence intervals were obtained. Statistical significance was defined as p < 0.05., Results: Acute compartment syndrome developed in 31 (11.4%) cases. In the multivariable regression model, four covariates remained statistically significantly associated with acute compartment syndrome: polytrauma, closed fracture, associated tibial plateau or pilon fracture and distance from the centre of the tibial fracture to the talar dome ≥15 cm., Conclusions: One radiological parameter related to the occurrence of acute compartment syndrome has been highlighted in this study, namely a longer distance from the centre of the tibial fracture to the talar dome, meaning a more proximal fracture. This observation may be useful when clinical findings are difficult to assess (doubtful clinical signs, obtunded, sedated or intubated patients). However, larger studies are mandatory to confirm and refine the prediction of acute compartment syndrome occurrence. Radiographic signs of significant displacement were not found to be correlated to acute compartment syndrome development. Finally, the higher rate of acute compartment syndrome occurring in tibial shaft fractures associated to other musculoskeletal, thoraco-abdominal or cranio-cerebral injuries must raise the level of suspicion of any surgeon managing multiply injured patients.