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The treatment of proximal humeral fractures is controversial, and operative treatment is increasing despite sparse evidence to support any surgical method over another. We present the 5-year results of the DelPhi (Delta-PHILOS) trial, in which the hypothesis was that reverse total shoulder arthroplasty (RTSA) yields better clinical results compared with open reduction and internal fixation (ORIF). The DelPhi trial was a multicenter single-blinded randomized controlled trial comparing RTSA versus ORIF for the treatment of displaced AO/OTA type-B2 and C2 proximal humeral fractures in patients 65 to 85 years of age. One hundred and twenty-four patients were allocated to RTSA (64 patients) or ORIF (60 patients). The primary outcome was the Constant score, and secondary outcomes included the Oxford Shoulder Score, radiographic measurements, and quality of life. The results were reported as the mean difference between the groups, with the 95% confidence interval (CI). The mean age was 75 years, and 90% of the patients were female. Overall, 65 of the 124 patients were available at a minimum of 5 years. The mean Constant score was 71.7 (95% CI, 67.1 to 76.3) for the RTSA group, compared with 58.3 (95% CI, 50.6 to 65.9) for the ORIF group, representing a significant difference of 13.4 (95% CI, 5.2 to 21.7) in favor of RTSA (p = 0.002). Among patients with type-C2 fractures, the mean Constant score was 73.3 (95% CI, 67.5 to 79.2) for the RTSA group and 56.0 (95% CI, 47.4 to 64.7) for the ORIF group, representing a significant difference of 17.3 (95% CI, 7.5 to 27.0) in favor of RTSA (p = 0.001). Patients with type-B2 fractures demonstrated a nonsignificant difference of 8.1 (95% CI, −7.3 to 23.3) in favor of RTSA (p = 0.29). Patients 65 to 74 years of age showed a significant mean difference of 15.7 (95% CI, 4.9 to 26.7) in favor of RTSA (p = 0.006), whereas patients 75 to 85 years of age showed a nonsignificant difference of 10.8 (95% CI, −3.0 to 24.6) in favor of RTSA. In the present study, RTSA was superior to plate fixation for displaced AO/OTA type-B2 and C2 fractures in elderly patients at 5 years. Patients 65 to 74 years of age and patients with type-C2 fractures benefited the most. Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

Background: Liposomal bupivacaine (LB) is a long-lasting local anesthetic agent that was developed for use in the surgical setting to help manage postoperative pain. The objective of this study was to evaluate the effect of LB on postoperative pain, function, and overall hospital course in patients with intracapsular hip fractures who were treated with hip hemiarthroplasty. Methods: This was a single-center, randomized prospective double-blinded study of 50 patients with an isolated intracapsular femoral neck fracture who were treated with hip hemiarthroplasty from 2018 to 2022. The study group consisted of 25 patients who were treated with intraoperative LB and bupivacaine hydrochloride injections, while the control group consisted of 25 patients who were treated with intraoperative bupivacaine hydrochloride injections only. Primary outcomes were a visual analog scale (VAS) score for pain, total morphine milligram equivalents (MME), delirium, and time to ambulation with physical therapy. Results: No significant differences between the study and control groups were found in any of the outcomes measured. Most notably, there were no differences in the average postoperative pain score (VAS, 2.26 versus 2.7; p = 0.34), total MME used postoperatively (11.73 versus 9.98 MME; p = 0.71), and postoperative day of discharge (4.00 versus 3.88 days; p = 0.82). Conclusions: The results of our study suggest that use of LB is not associated with substantially improved postoperative pain or function or with a shorter hospital course following hip hemiarthroplasty for a femoral neck fracture. Given the higher cost of LB compared with standard postoperative pain modalities, it is worth questioning its use in the setting of geriatric hip fractures. Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

Background/Objectives: A neck of femur (NOF) fracture is one of the most common fractures, and its treatment in the geriatric population using cemented bipolar hemiarthroplasty (HA) is a standard procedure worldwide. Various surgical approaches have been described for this operation, aiming to reduce complications and improve early mobilization. The present study compares two minimally invasive approaches, the anterolateral minimally invasive approach (ALMIS) and the direct superior approach (DSA), with respect to their intraoperative and early postoperative complications in cemented bipolar HA. Methods: The medical records of all patients undergoing cemented bipolar HA for a NOF fracture between January 2017 and December 2023 were analyzed. The aim of the study was to compare the two surgical approaches. The evaluation focused on intraoperative parameters and early complications. Results: A total of 226 patients were included in the analysis, with 62 undergoing DSA and 164 ALMIS, with an average age of 83.5 years. The two approaches did not differ significantly in terms of stem implantation quality, length of hospital or intensive care unit stay, postoperative mobilization, or the need for transfusions. However, the ALMIS was associated with a significantly shorter operative time (DSA: 89.7 min vs. ALMIS: 77.2 min; p < 0.01). On the other hand, the DSA had a significantly lower complication rate (DSA: 0/61 vs. ALMIS: 11/163; p = 0.04). Conclusions: In a comparison of the two minimally invasive approaches, DSA and ALMIS, for treating a NOF fracture with cemented bipolar HA, the DSA demonstrated a lower complication rate, though it had a slightly longer operating time. [ABSTRACT FROM AUTHOR]

An in vivo animal model of a weight‐bearing intra‐articular implant is crucial to the study of implant osseointegration and aseptic loosening caused by osseointegration failure. Osseointegration, defined as a direct structural and functional attachment between living bone tissue and the surface of a load‐carrying implant, is essential for implant stability and considered a prerequisite for the long‐term clinical success of implants in total joint arthroplasty. Compared to large animal models, murine models offer extensive genetic tools for tracing cell differentiation and proliferation. The 18‐ to 22‐week‐old C57BL/6J background mice underwent either press‐fitted or loose implantation of a titanium implant, achieving osseointegration or fibrous integration. A protocol was developed for both versions of the procedure, including a description of the relevant anatomy. Samples were subjected to microcomputed tomography and underwent biomechanical testing to access osseointegration. Lastly, samples were fixed and embedded for histological evaluation. The absence of mineralized tissue and weakened maximum pull‐out force in loose implantation samples indicated that these implants were less mechanically stable compared to the control at 4 weeks postoperation. Histological analysis demonstrated extensive fibrotic tissue in the peri‐implant area of loose implantation samples and excellent implant osseointegration in press‐fitted samples at 4 weeks. Both mechanically stable and unstable hemiarthroplasty models with either osseous ingrowth or a robust periprosthetic fibrosis were achieved in mice. We hope that this model can help address current limitations for in vivo study of aseptic loosening and lead to necessary translational benefits. [ABSTRACT FROM AUTHOR]

Introduction: The purpose of this study was to describe how hip fractures differentially affect male and female patients regarding fracture pattern, hospital course, and postoperative course. Materials and Methods: This retrospective case series was performed in a metropolitan healthcare system involving 2996 hip fracture patients >59 years old who underwent surgical management (eg, intramedullary nail, hemiarthroplasty, percutaneous pinning, etc.). Male patients were matched to female patients using 1:2 nearest neighbor matching on the basis of age and Charlson Comorbidity Index. Outcomes of interest included AO/OTA fracture classification, 30- and 90-day readmission, and 30-day and 1-year mortality rates. Results: The cohort was predominantly female (64.5%). Female patients were more likely to sustain a type 31A fracture compared to males (P =.016). The average CCI was higher for males vs females (3.0 ± 2.5 vs 2.6 ± 2.3, P <.001). Males were more likely to be readmitted at 30 (P <.001) and 90 (P =.015) days after discharge. The 30-day mortality was higher for males vs females (6.6% vs 4.5%, P =.015). Approximately 19.9% of male patients vs 15.1% of females died within a year of surgery (P <.001). The average time to surgery was longer for males vs females (23.8 ± 18.8 vs 22.5 ± 21.9 h, P =.048). Males were more likely to die within a year if they underwent surgery >24 h after admission (P =.029). Discussion: Hip fractures have different implications for male and female patients. With age, the incidence of IT fractures increased in females, while it decreased in males. On average, males with hip fractures are sicker than females, which likely contributes to the longer time to surgery as well as increased readmission and mortality rates seen in males. Conclusions: Male and female hip fracture patients are not similar in baseline health status, fracture pattern, or postoperative morbidity and mortality. Orthogeriatricians and other providers that care for this patient population should be aware of these differences when implementing treatment strategies to optimize the recovery of their patients, and while educating patients and their families about postoperative expectations. [ABSTRACT FROM AUTHOR]

Background & Objective: Peripheral nerve blocks are one of the peri-operative analgesic options that abolish surgical stress response, reduce the use of opioids, and control postoperative pain. During the previous few decades regional anesthesia and analgesia techniques have been widely used, especially with the enhanced safety and precision in these procedures with the use of ultrasound. We compared the efficacy of Erector Spinae Plane Block (ESPB) with Fascia Iliaca Block (FIB) for postoperative pain in hemiarthroplasty surgery. Methodology: This randomized double-blind trial included sixty-eight cases scheduled for hemiarthroplasty under spinal anesthesia. Patients were randomly divided into two equal groups: Group ES received ESPB, and Group FI received FIB. Blocks were performed preoperatively using 15 mL bupivacaine 0.25%- and 15 mL lidocaine 2%. Postoperatively, pain was assessed with Visual Analogue Scale (VAS) at 1 h, 2 h, 6 h, 12 h and 24 h. Results: The mean time to first dose and the amount of morphine used in the first 24 hours were comparable between Group ES and Group FI. Visual analogue scale measurements at rest and movement showed insignificant differences between both groups at 1 h, 2 h, 6 h, 12 h and 24 h. Quadriceps motor impairment revealed significant reduction in Group ES compared to Group FI (11.76 vs 44.12%, P = 0.006). Conclusions: In hemiarthroplasty, the analgesic profile of erector spinae plane block was comparable with fascia iliaca block with superiority of the former in preserving the quadriceps motor power. [ABSTRACT FROM AUTHOR]

Introduction: The Ascend Flex short stem implant has been reported to have good early clinical outcomes and low revision rates. This retrospective study aimed to evaluate the early to mid-term radiographic and clinical outcomes of patients who underwent primary shoulder arthroplasty with this implant. Methods: All consecutive patients who underwent primary shoulder arthroplasty with short uncemented Ascend Flex stems with a minimum of 24-month follow-up were included. The primary outcomes were revision and reoperation rate. The secondary outcomes included stress shielding and Oxford Shoulder Score (OSS). Results: Totally, 151 shoulders were eligible for inclusion. Out of which 73 were anatomic total shoulder arthroplasty, 77 were reverse geometry, and 1 was a hemiarthroplasty. Mean follow-up duration was 52 ± 17.2 months. The revision and reoperation rates were 0.6% and 2.6%, respectively. 1.3% anatomic total shoulder arthroplasty (aTSA) cases and 6.5% RSA cases demonstrated stress shielding. OSS improved from 16.1 ± 8.5 to 34.1 ± 12.3 in aTSA cases (Z = −3.98, p < 0.001) and from 15.6 ± 8.4 to 30.0 ± 13.5 in RSA cases (Z = −3.41, p < 0.001). Conclusion: These findings demonstrate reassuring outcomes for this implant at a mean of 52 months. Further reports are required to document the long-term outcomes for this component. [ABSTRACT FROM AUTHOR]

Background: Treatment options for correcting limb-length discrepancy after limb-salvage reconstruction for proximal tibial osteosarcoma in children have several limitations. Therefore, we aimed to evaluate the feasibility, complications, prognosis, and clinical outcomes of reconstruction using hemiarthroplasty after tumor resection in pediatric patients with proximal tibial osteosarcoma. Methods: We conducted a comprehensive retrospective analysis of the data of pediatric patients with osteosarcoma of the proximal tibia who underwent surgery between December 2008 and November 2018 at our center. We enrolled 49 consecutive patients who underwent hemiarthroplasty. The cruciate ligaments of all patients were reconstructed using special spacers, and the medial and lateral collateral ligaments of the knee and joint capsule were reconstructed using a mesh. Postoperatively, if the unequal length of both lower limbs exceeded 4 cm or knee instability occurred, a second-stage surgery was performed for limb lengthening and replacing the distal femoral prosthesis. We analyzed the oncological prognosis, complications of hemiarthroplasty, postoperative stability, and postoperative function. Results: The follow-up period ranged between 11 and 159 months, with a median of 84 (62, 129) months. The overall 5-year survival rate was 83.2%. Thirty-nine patients survived at the end of the follow-up period with 34 prostheses (87.2%). The overall prosthesis survival rate was 87.4% after 5 years, indicating the long-term benefits of the procedure. Limb length was measured in 28 adult patients. The average limb-length discrepancy was 33 ± 15 mm with a median of 33 mm (21, 47); the femur and tibia caused a discrepancy of 8.5 ± 9.9 mm and 24.8 ± 15.5 mm, respectively. The patients had 30–135° of knee motion, with a mean of 82 ± 24°. The femoral tibial angle was greater on the affected side than on the healthy side, with a mean difference of 4.5°±3.6°. The Musculoskeletal Tumor Society (MSTS) score was 25 ± 3. Five patients underwent second-stage distal femoral prosthesis replacement, with mean MSTS scores of 24 ± 2 and 28 ± 1 before and after second-stage surgery, respectively. Conclusions: Hemiarthroplasty in children reduces limb-length discrepancy in adulthood by rebuilding cruciate ligaments, lateral collateral ligaments, and the joint capsule, thereby improving knee stability. [ABSTRACT FROM AUTHOR]

Background: Elderly patients with femoral neck fractures, particularly those with severe comorbidities or living in regions with limited medical resources, may experience delays in surgical treatment. Although the benefits of preoperative rehabilitation (prehabilitation) in hip arthroplasty have been reported, pain management remains a challenge. The pericapsular nerve group (PENG) block, known for its exceptional analgesic effect and motor function preservation, may be a promising intervention during prehabilitation in these patients. Case: We enrolled ten patients with Garden classification 3-4 femoral neck fractures scheduled for hip arthroplasty. After receiving a PENG block with 20 ml of 0.375% ropivacaine, all patients underwent initial prehabilitation sessions comprising 9 mobility levels, ranging from bed-sitting to walking. One patient was excluded due to experiencing high blood pressure during prehabilitation. Six of the nine remaining patients (66.7%) were successfully transferred from bed to wheelchair. Conclusions: The PENG block enhanced prehabilitation for patients with femoral neck fractures undergoing hip arthroplasty. [ABSTRACT FROM AUTHOR]

Introduction : Hip arthroplasty, including hemiarthroplasty and total hip arthroplasty is a common surgical procedure for patients suffering from hip joint disorders with an aim of complication free early return to activities of daily living. Various minimally invasive surgical approaches have been described to achieve this aim including a relatively new SPAIRE approach. This case series shows our technique of hip arthroplasty using the SPAIRE technique with the help of conventional instruments in an Indian Scenario at a tertiary care center in Eastern India along with our short-term functional outcomes till a follow up period of 6 months. Materials and method : This was the prospective observational study done between May 2022 to Oct 2023 in Tata Main hospital, Jamshedpur. Total 35 patients were operated by this technique. Data including age, gender, time to return orthotic assisted mobility, Harris hip score at 2 months & any complications till the follow up of 6 months were recorded for each patient who underwent Hemiarthroplasty or Total Hip arthroplasty using the SPAIRE technique with conventional instruments for hip arthroplasty (performed by single surgeon – the senior author) in our tertiary care center. Results : 35 patients were operated during this span by using the SPAIRE technique. There were 30 cases of hip hemiarthroplasty and 5 cases of total hip arthroplasty (1 bilateral). 5 patients were lost to follow up during the period of 6 months. Harris hip score was measured for each patient at 2 months and mean Harris hip score was 83.16. Out of 35 patients, 9 patients had excellent outcome, 14 patients had good outcome and 7 patients had fair outcome. No patient had complications such as infection, delayed wound healing, periprosthetic fractures or sciatic nerve injury. One patient reported dislocation at 3 months following a fall. Mean time to return to orthotic assisted ambulation was 1.5 days for all 35 patients. Conclusion : SPAIRE technique is one of the safe surgical approaches for primary hip arthroplasties. This minimally invasive tendon sparing approach which preserves quadricep coxa provides excellent hip stability, early return to preinjury activities. It also reduces postoperative complications such as dislocation. [ABSTRACT FROM AUTHOR]

The purpose of this study was to define the optimal combination of surgical technique and postoperative rehabilitation protocol for elderly patients undergoing either hemiarthroplasty (HA) or reverse total shoulder arthroplasty (rTSA) for acute proximal humerus fracture (PHF) by performing a network meta-analysis of the comparative studies in the literature. A systematic review of the literature using Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines of MEDLINE, EMBASE, and Cochrane Library was screened from 2007 to 2023. Inclusion criteria were level I-IV studies utilizing primary HA and/or rTSA published in a peer-reviewed journal, that specified whether humeral stems were cemented or noncemented, specified postoperative rehabilitation protocol, and reported results of HA and/or rTSA performed for PHF. Early range of motion (ROM) was defined as the initiation of active ROM at ≤3 weeks after surgery. Level of evidence was evaluated based on the criteria by the Oxford Centre for Evidence-Based Medicine. Clinical outcomes were compared using a frequentist approach to network meta-analysis with a random-effects model that was performed using the netmeta package version 0.9-6 in R. A total of 28 studies (1119 patients) were included with an average age of 74 ± 3.7 and mean follow-up of 32 ± 11.1 months. In the early ROM cohort (Early), the mean time to active ROM was 2.4 ± 0.76 weeks compared to 5.9 ± 1.04 weeks in the delayed ROM cohort (Delayed). Overall, rTSA-Pressfit-Early resulted in statistically superior outcomes including postoperative forward elevation (126 ± 27.5), abduction (116 ± 30.6), internal rotation (5.27 ± 0.74, corresponding to L3-L1), American Shoulder and Elbow Surgeons score (71.8 ± 17), tuberosity union (89%), and lowest tuberosity nonunion rate (9.6%) in patients ≥65 year old with acute PHF undergoing shoulder arthroplasty (all P ≤.05). In total there were 277 (14.5%) complications across the cohorts, of which 89/277 (34%) were in the HA-Cement-Delayed cohort. HA-Cement-Delayed resulted in 2-times higher odds of experiencing a complication when compared to rTSA-Cement-Delayed (P =.005). Conversely, rTSA-Cement-Early cohort followed by rTSA-Pressfit-Early resulted in a total complication rate of 4.7% and 5.4% (odds ratios, 0.30; P =.01 & odds ratios, 0.42; P =.05), respectively. The total rate of scapular notching was higher in the cemented rTSA subgroups (16.5%) vs. (8.91%) in the press fit rTSA subgroups (P =.02). Our study demonstrates that patients ≥65 years of age, who sustain a 3-or 4-part PHF achieve the most benefit in terms of ROM, postoperative functional outcomes, tuberosity union, and overall complication rate when undergoing rTSA with a noncemented stem and early postoperative ROM when compared to the mainstream preference–rTSA-Cement-Delayed. [ABSTRACT FROM AUTHOR]

The decision to treat shoulder osteoarthritis (OA) definitively with shoulder arthroplasty (SA) is multifactorial, considering objective findings, subjective information, and patient goals. The first goal of this study was to determine if Patient Reported Outcome Measurement Information System (PROMIS) measures correlated with patients with shoulder OA who underwent SA within 1 year. The second goal of this study was to determine if score cut-offs in PROMIS domains could further discriminate which shoulder OA patients underwent SA within 1 year. This retrospective case-control study examined patients with a diagnosis of shoulder OA who consulted an orthopedic provider from November 1, 2020 to May 23, 2022, and recorded PROMIS measures in the domains of Physical Function, Depression, and/or Pain Interference. A surgical group was defined as patients who underwent SA within 1 year of the most recent PROMIS measures and the nonsurgical patients were defined as the control group. Mean PROMIS scores were compared between the surgical and control groups. Separate logistic regression models controlling for age, race, ethnicity, and comorbidity count were performed for each PROMIS domain as a 1) continuous variable, and then as 2) binary variable defined by PROMIS score cut-off points to determine which scores correlated with undergoing SA to further characterize the potential clinical utility of PROMIS score cut-offs in relating to undergoing SA. The surgical group of 478 patients was older (68.2 vs. 63.8 years), more often of White race (82.6% vs. 70.9%), and less often of Hispanic Ethnicity (1.5% vs. 2.9%) than the control group of 3343 patients. Using optimal cut-offs in PROMIS scores, Pain Interference ≥63 (odds ratio [OR] = 2.97 (2.41-3.64), P <.001), Physical Function ≤39 (OR = 1.81 (95% confidence interval, 1.48-2.22), P <.001), and depression ≥49 (OR = 1.82 (95% confidence interval, 1.50-2.22), P <.001) were all found to correlate with undergoing SA within 1 year in multivariable logistic regressions. The results of this study demonstrate that cut-off scores for PROMIS measures differentiated patients undergoing SA within 1 year. These cut-off scores may have clinical utility in aiding in decision-making regarding surgical candidates for SA. Further research is needed to validate these cut-off scores and determine how they relate to patient outcomes after SA. [ABSTRACT FROM AUTHOR]

Background: Insufficient tuberosity healing is the most common reason for poor outcome after treatment of proximal humerus fractures (PHFs) using hemiarthroplasty (HA). In these cases, revision to reverse total shoulder arthroplasty (RTSA) can improve function and reduce pain in the short term, however, long-term results remain scarce. Aim of this study was to evaluate the clinical and radiological mid- to long-term results in patients with a revision RTSA after failed HA for PHF. Methods: In this retrospective study all patients that received a revision to RTSA after failed fracture HA between 2006 and 2018 were included. A total of 49 shoulders in 48 patients (38 female, 10 male; mean age 82 ± 9 years) were identified in our database. A total of 20 patients (17 female, 3 male; mean age was 79 ± 9 years) were available for follow-up examination after a mean time period of approximately eight years (3–14 years) after revision surgery. At final follow-up, patients were assessed using a subjective shoulder value (SSV), range of motion (ROM), visual analogue score (VAS), the Constant Score (CS) and the 12-Item Short Form Survey (SF-12). Results: At final follow-up, mean CS was 55 ± 19 (19–91), VAS averaged 3 ± 3 (0–8) and mean SSV was 61 ± 18% (18–90%). Mean SF-12 was 44 (28–57) with a mean physical component summary (PCS) of 38 (21–56) and a mean mental component summary (MCS) of 51 (29–67). On average active forward flexion (FF) was 104° (10–170°), active abduction (ABD) was 101° (50–170°), active external rotation (ER) was 19° (10–30°) and active internal rotation (IR) of the lumbosacral transition was reached. Three patients presented with a periprosthetic humeral fracture after RTSA implantation and underwent a reoperation (15%) during follow-up period. Conclusions: Revision RTSA results in promising clinical results in patients after initial failed HA after PHF. A complication and reoperation rate of 15% is tolerable in consideration of satisfactory functional and psychological outcome. Trial registration: Retrospectively registered. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to compare the clinical outcomes and differences in biomechanical characteristics between the femoral neck system (FNS) and cannulated cancellous screws (CCSs) in the treatment of femoral neck fractures. Methods: This study retrospectively analysed a cohort of 38 registered cases of femoral neck fractures treated surgically with either the FNS (n = 17) or CCSs (n = 21) between January 2020 and December 2023. Indicators such as fluoroscopy frequency, length of hospital stay, and fracture healing time were compared between the two groups. Functional status was evaluated via the Harris hip score (HHS) and visual analogue scale (VAS), whereas prognosis was assessed based on changes in the neck shaft angle and femoral neck shortening. Additionally, six sets of femoral neck fracture models were developed based on Pauwels angles of 30°, 40°, 50°, 60°, 70°, and 80°. Two experimental groups, FNS and CCS, were established, and a joint reaction force of 1800 N was applied to the proximal femur. The displacement, stress, and stiffness of the components of interest in the different models were tested and compared. Results: The distributions of all the baseline characteristics were similar between the two groups (p > 0.05). The FNS group presented significantly shorter fluoroscopy frequency, length of hospital stay, and fracture healing time (p < 0.05). Harris and VAS scores were higher in the FNS group than in the CCS group (p < 0.05). Postoperative changes in the neck shaft angle and femoral neck shortening were significantly lower in the FNS group than in the CCS group (p < 0.05). The results of the finite element analysis indicated that the maximum stress on the femoral head and varus angle were generally lower in the FNS group than in the CCS group and that the maximum displacement of the femoral head and FNS was generally lower in the FNS group than in the CCS group. However, the superiority of FNS over CCS decreased with increasing Pauwels angle. Additionally, the effectiveness of FNS in limiting displacement of the femoral neck upper wall was not as favourable as that of CCS. Conclusions: The treatment of femoral neck fractures with FNS is superior and contributes to improved hip joint function. Biomechanical research has confirmed its structural stability and advantages in resisting femoral head varus. However, challenges to its fixation efficacy persist, particularly at higher Pauwels angles. [ABSTRACT FROM AUTHOR]

As the age profile of our population expands, we can expect subsequent increase in patients presenting with intracapsular fracture. The onus remains on the surgeon to make all reasonable efforts to find new and innovative means of reducing associated morbidity and mortality of the treatment of these injuries. This challenge is particularly relevant in the elderly and in patients with multiple co-morbidities. In this study, 100 patients were randomly allocated into two groups. One group had dissection to the level of the hip joint under direct diathermy control; the other group had dissection using a scalpel with supplementary electrocautery. Intraoperative total blood loss prior to dissection of the abductors was measured by collecting blood using wound swabs using a local protocol and results were statistically analysed using PROC GLM SAS. We demonstrate a clear advantage in the use of diathermy to create a hip incision showing a significant reduction in wound-related blood loss and a reduction, whilst not statistically significant, in total operative blood loss using diathermy incision. Larger randomised prospective trials are necessary to study the effects of this intervention in a larger patient population so that these end-points can be adequately assessed. [ABSTRACT FROM AUTHOR]

Acute fractures around the hip are prevalent injuries associated with potentially devastating outcomes. The growing utilization of arthroplasty for femoral neck fractures in the elderly is likely a result of improvements in reoperation rates and postoperative function. Compared to hemiarthroplasty, total hip arthroplasty is associated with a slight functional benefit that is unlikely noticeable for many patients, as well as minimal differences in complications and patient reported outcome measures. However, the evidence supporting cement use in femoral stem fixation is robust. Multiple high power randomized controlled trial-based studies indicate cement fixation brings more predictable outcomes and fewer reoperations. In the setting of acute acetabular fracture, total hip arthroplasty is a favorable approach for elderly patients and fracture patterns associated with increased risk of revision after open reduction and internal fixation. Variations in patient characteristics and fracture patterns demand careful consideration whenever selecting the optimal treatment. In fracture patient populations, comanagement is an important consideration when seeking to reduce complications and promote cost-effective quality care. [ABSTRACT FROM AUTHOR]

Femoral neck fractures (FNFs) in elderly patients are associated with major morbidity and mortality. The influence of postoperative discharge location on recovery and outcomes after arthroplasty for hip fractures is not well understood. A multisite retrospective cohort from 9 academic centers identified patients who had FNF treated with hemiarthroplasty or total hip arthroplasty between 2010 and 2019. Patients who had diagnoses of dementia, stroke, age > 80 years, or high energy fracture were excluded. Discharge location was identified, including home-based health services (HHS), inpatient rehabilitation (IPR), or a skilled nursing facility (SNF). Rates of reoperation, periprosthetic joint infection (PJI), and mortality were compared between cohorts. Multivariate logistic regressions were performed, adjusting for age, American Society of Anesthesiologists (ASA) score, body mass index, sex, and tobacco use. Statistical significance was defined as P <.05. A total of 672 patients (315 HHS, 144 IPR, and 213 SNF) were included in this study. The average follow-up was 30 months. The SNF cohort was significantly older (P <.0001) with higher ASA scores (P <.0001) than the HHS cohort. In a logistic regression model adjusting for age, ASA score, and body mass index, the SNF cohort had higher mortality rates than the HHS cohort (P =.0296) and were more likely to have PJI within 90 days (odds ratio = 4.55, 95% confidence interval = 1.40, 4.74) and within 1 year (odds ratio = 3.08, 95% confidence interval = 1.08, 8.78). Time to PJI was significantly shorter in the SNF cohort (SNF 38 versus HHS 231 days, P =.0155). No differences were seen in dislocation or reoperation rates between the SNF and HHS cohorts. No differences were seen in complication rates between the IPR and HHS cohorts. Discharge to a SNF after arthroplasty for FNF is associated with increased mortality and higher rates of PJI. Hip fracture care pathways that uniformly discharge patients to SNFs may need to be re-evaluated, and surgeons should consider discharge to home with HHS when possible. [ABSTRACT FROM AUTHOR]

Biconcave (B2) glenoids, characterized by significant posterior glenoid bone loss and a biconcave wear pattern, are a challenging pathology in shoulder surgery. Significant bone defects present in B2 glenoids increases the risk of complications and rates of failure for operative patients with glenohumeral osteoarthritis. Diagnosing this entity is of pivotal importance, and can be accomplished with imaging and a comprehensive clinical investigation. There are no clear-cut guidelines for management, but options include hemiarthroplasty, anatomic total shoulder arthroplasty, and reverse shoulder arthroplasty. In recent years, modern techniques such as corrective reaming, bone grafts, and the use of augmented components have improved patient outcomes. Educating prospective patients is essential for reaching a shared management decision, setting appropriate expectations, and optimizing prognostic outcomes. [ABSTRACT FROM AUTHOR]

Background/aim: This study aimed to scrutinize nationwide utilization trends of shoulder arthroplasty for proximal humerus fractures (PHFs) using a comprehensive national surgical database. Materials and methods: A retrospective study was conducted with 4181 patients who underwent shoulder arthroplasty due to PHF between 2016 and 2022 using national health records. They are grouped as hemiarthroplasty (HA), anatomical total shoulder arthroplasty (TSA), and reverse shoulder arthroplasty (RSA). The patients' demographic data, length of hospital stay, revision histories, transfusion rates, mortality data, trends in arthroplasty methods over the years, the distribution of cases by hospital characteristics and geographical regions were analyzed. Results: Treatment with HA was administered to 22.1% of patients, TSA to 30.2%, and RSA to 47.7%. The lowest revision rate was observed after HA (4.3%), while higher rates were recorded after TSA (7.9%) and RSA (7.4%) (p = 0.019). It was observed that there was a significant increasing trend in RSA rates and a decreasing trend in HA and TSA rates over time (p < 0.001). Conclusion: From 2016 to 2022, there appears to have been a significant increase in the utilization of RSA for the arthroplasty treatment of proximal humeral fractures in Türkiye, and it is used more frequently than HA. However, revision rates after RSA are still higher than those after HA. [ABSTRACT FROM AUTHOR]

Purpose: The objective of the study is to determine if there was a difference in medical complications and in-hospital mortality among the patients who underwent THA for femoral neck fracture relative to same procedure for elective patients with coxarthrosis. Methods: We compared characteristics and short-term outcomes during the rehabilitative postsurgical period. We included all patients older than 45 years who underwent THA for primary/secondary hip arthritis and displaced femoral neck fractures type Garden III and IV. Clinical examination, functional outcome and radiographic evaluation were performed during follow-up. Patients were evaluated at the following time points: preoperatively, postoperatively at three days, six weeks, 12 weeks and one year and we registered Visual Analogue Scale (VAS) pain score, Harris Hip Score (HHS), the Western Ontario McMaster Osteoarthritis Index (WOMAC), internal and external rotation of the hip and operated limb length compared with the opposite. Results: There is no significant statistically differences between the two groups regarding the preoperative comorbidities. The frequencies of patients experiencing in-hospital and 30-day postoperative complications were generally low and same in groups we studied. The mean quantity of surgical blood loos during the operation was significantly higher in the hip fracture group compared with elective patient group with OA (340.09 ± 86.03 vs 309.43 ± 102.52). With respect to postoperative recovery the patients with THA after FNF were mobilized by active walking a little bit faster as the patient with OA (2.77 ± 1.18 days vs 3.1 ± 1.14 days). The average inpatient hospital length of stay after THA for OA was 11.07 days compared to 13.41 days following a THA for FNF. Conclusion: Our study showed that THA for treatment of an acute fracture of the femoral neck in an elderly patient can provide results comparable to those of patients who received THA for OA and we found that the results are similar. [ABSTRACT FROM AUTHOR]

The study addresses the growing number of hemodialysis (HD) patients undergoing joint arthroplasty, who are at higher risk of complications and mortality. Previous research has often overlooked deaths after discharge. This study aimed to examine early outcomes in a large nationwide cohort of patients who underwent arthroplasty for elective and fracture-related reasons. Between 2016 and 2022, a study was conducted using the e-Nabız database of the Türkiye Ministry of Health, focusing on patients aged 18 years and above who underwent elective or fracture-related arthroplasty. This study included 1,287 patients reliant on dialysis who underwent total hip arthroplasty, total knee arthroplasty, or hemiarthroplasty (HA), with 7.7% of them receiving dialysis for the first time. Propensity score matching was used to create an equally sized group of non-dialysis-dependent patients, ensuring demographic balance in terms of age, sex, a comorbidity index, and surgery type. The primary objective was to compare mortality rates 10, 30, and 90 days after arthroplasty. The first-time dialysis patients who underwent HA had significantly higher 30- and 90-day mortality rates compared to the chronic dialysis group (P =.040 and P <.001, respectively). Also, the HD patients consistently exhibited higher 90-day mortality rates across all surgery types. With total knee arthroplasty, HD patients had a mortality rate of 8.7%, in stark contrast to 0% among non-HD patients (P <.001). Similarly, with total hip arthroplasty, HD patients had a 12% mortality rate, while non-HD patients had a markedly lower rate of 2.7% (P =.008). In the case of HA, HD patients had a significantly elevated 90-day mortality rate of 31.9%, in contrast to 17.1% among non-HD patients (P <.001). Joint arthroplasty has higher rates of mortality and complications among HD patients. Surgical decisions must be based on patients' overall health, necessitating collaboration among specialists. These patients should be closely monitored. [ABSTRACT FROM AUTHOR]

Proximal humerus fracture (PHF) is a risk factor for 1-year mortality. This study aimed to determine if surgery is associated with lower mortality compared to nonoperative treatment following PHF in older patients. This retrospective cohort study used the Medicare Limited Data set. Patients aged 65 years and older with a PHF diagnosis in 2017-2020 were included. Treatment was classified as nonoperative, open reduction internal fixation (ORIF), total shoulder arthroplasty (TSA), or hemiarthroplasty. Multivariable logistic regression models examined (a) predictors of treatment type and (b) the association of treatment type with 1-year mortality, adjusting for patient demographics, comorbidities, frailty, and fracture severity among other variables. A subgroup analysis examined how the relationship between treatment type and 1-year mortality varied based on fracture severity. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) are reported. In total, 49,072 patients were included (mean age = 76.6 years, 82.3% female). Most were treated nonoperatively (77.5%), 10.9% underwent ORIF, 10.6% underwent TSA, and 1.0% underwent hemiarthroplasty. Examples of factors associated with receipt of operative (versus nonoperative treatment) included worse fracture severity and lower frailty. The 1-year mortality rate after the initial PHF diagnosis was 11.0% for the nonoperative group, 4.0% for ORIF, 5.2% for TSA, and 6.0% for hemiarthroplasty. Compared to nonoperative treatment, ORIF (aOR 0.55; 95% CI [0.47, 0.64]; P <.001) and TSA (aOR 0.59; 95% CI [0.50, 0.68]; P <.001) were associated with decreased odds of 1-year mortality. In the subgroup analysis, ORIF and TSA were associated with a lower 1-year mortality risk for 2-part and 3-/4-part fractures. Compared to nonoperative treatment, surgery (particularly TSA and ORIF) was associated with a decreased odds of 1-year mortality. This relationship remained significant for 2-part and 3-/4-part fractures after stratifying by fracture severity. [ABSTRACT FROM AUTHOR]

INTRODUCTION During the 20th century, the life expectancy increased by 30 years. At the same time, the number of people living longer than that has grown significantly. The aim of this study was to investigate whether total hip or knee arthroplasty (THA or TKA) in patients over 80 years of age does not reduce their life expectancy. MATERIAL AND METHODS The study examined the data of patients who had undergone THA or TKA between 1994 and 2002 and were older than 80 years at the time of surgery. The study group was divided into a group of patients in whom elective total hip or knee arthroplasty was performed for arthritis and into a group of patients who underwent the same procedure for proximal femur fracture. The investigated parameter was the real survival, which was compared with the life expectancy predicted by the Institute of Health Information and Statistics of the Czech Republic. We also monitored postoperative mortality and postoperative interval after which the life expectancy was no longer reduced. RESULTS The study included 547 patients. Of whom, 96 patients underwent elective surgery (36%) and 351 patients underwent surgery for intracapsular hip fracture (64%). In the elective surgery group, the survival was longer than the national average: In the 80–84-year group, the median survival was 6.0 years vs. median life expectancy of 5.6 years; in the 85–89-year group, the median survival was 6.3 years vs. median life expectancy of 3.9 years. The fracture surgery group showed a decrease in the life expectancy compared to the national average – in the 80–84-year group, the median survival was 3.5 years vs. median life expectancy of 5.6 years, and in the 85–89-year group, the median survival was 2.9 years vs. median life expectancy of 3.9 years. The likelihood of postoperative mortality was significantly higher in the fracture group than in the elective group (p = 0.05 vs. 0.01), with the difference being the highest in the first 8 weeks after surgery. CONCLUSIONS Correctly indicated THA or TKA in patients over 80 years of age improves the quality of life of these patients and does not reduce the life expectancy. Intracapsular femoral neck fractures in patients of that age can still be considered as an indication for surgical treatment as a life-saving procedure. [ABSTRACT FROM AUTHOR]

Abstract Background Treatment options for correcting limb-length discrepancy after limb-salvage reconstruction for proximal tibial osteosarcoma in children have several limitations. Therefore, we aimed to evaluate the feasibility, complications, prognosis, and clinical outcomes of reconstruction using hemiarthroplasty after tumor resection in pediatric patients with proximal tibial osteosarcoma. Methods We conducted a comprehensive retrospective analysis of the data of pediatric patients with osteosarcoma of the proximal tibia who underwent surgery between December 2008 and November 2018 at our center. We enrolled 49 consecutive patients who underwent hemiarthroplasty. The cruciate ligaments of all patients were reconstructed using special spacers, and the medial and lateral collateral ligaments of the knee and joint capsule were reconstructed using a mesh. Postoperatively, if the unequal length of both lower limbs exceeded 4 cm or knee instability occurred, a second-stage surgery was performed for limb lengthening and replacing the distal femoral prosthesis. We analyzed the oncological prognosis, complications of hemiarthroplasty, postoperative stability, and postoperative function. Results The follow-up period ranged between 11 and 159 months, with a median of 84 (62, 129) months. The overall 5-year survival rate was 83.2%. Thirty-nine patients survived at the end of the follow-up period with 34 prostheses (87.2%). The overall prosthesis survival rate was 87.4% after 5 years, indicating the long-term benefits of the procedure. Limb length was measured in 28 adult patients. The average limb-length discrepancy was 33 ± 15 mm with a median of 33 mm (21, 47); the femur and tibia caused a discrepancy of 8.5 ± 9.9 mm and 24.8 ± 15.5 mm, respectively. The patients had 30–135° of knee motion, with a mean of 82 ± 24°. The femoral tibial angle was greater on the affected side than on the healthy side, with a mean difference of 4.5°±3.6°. The Musculoskeletal Tumor Society (MSTS) score was 25 ± 3. Five patients underwent second-stage distal femoral prosthesis replacement, with mean MSTS scores of 24 ± 2 and 28 ± 1 before and after second-stage surgery, respectively. Conclusions Hemiarthroplasty in children reduces limb-length discrepancy in adulthood by rebuilding cruciate ligaments, lateral collateral ligaments, and the joint capsule, thereby improving knee stability.

Background: This study compares open reduction and internal fixation (ORIF) versus hemiarthroplasty (HA) in the management of complex proximal humerus fractures. MATERIALS AND METHODS: Neer three- and four-part fracture-dislocations, surgical neck fracture-dislocations with severe articular impaction, and any head-split fracture treated surgically at our institution were studied retrospectively. Constant–Murley scores, Disability of the Arm, Shoulder, and Hand (DASH), American Shoulder and Elbow Surgeons (ASES) Shoulder, and 36-item Short-Form Health Survey (SF-36) scores were obtained and compared between ORIF versus HA treatment. Results: Thirty patients were included in the analysis: 15 treated with ORIF were compared to 15 treated with HA with an average follow-up of 60 months. The mean Constant score (72 ± 15 vs. 54 ± 19; P = 0.005), DASH score (13 ± 17 vs. 29 ± 18; P = 0.006), ASES score (87 ± 13 vs. 66 ± 22; P = 0.003), and SF-36 physical composite score (PCS) (50 ± 11 vs. 40 ± 11; P = 0.02) all favored the ORIF group. Because of the potential confounding variable posed by including younger patients, we performed a subgroup analysis of patients older than 50 years. In this group, the Constant, DASH, ASES, and PCS scores remained significantly better in the ORIF group. Conclusion: Results of this retrospective study show improved patient-reported outcomes and quality of life scores in patients undergoing ORIF for complex proximal humerus fractures as compared to patients undergoing HA, despite a higher revision rate in the ORIF cohort. When considering patients older than 50 years, outcomes after ORIF were better than HA.

Abstract Background Insufficient tuberosity healing is the most common reason for poor outcome after treatment of proximal humerus fractures (PHFs) using hemiarthroplasty (HA). In these cases, revision to reverse total shoulder arthroplasty (RTSA) can improve function and reduce pain in the short term, however, long-term results remain scarce. Aim of this study was to evaluate the clinical and radiological mid- to long-term results in patients with a revision RTSA after failed HA for PHF. Methods In this retrospective study all patients that received a revision to RTSA after failed fracture HA between 2006 and 2018 were included. A total of 49 shoulders in 48 patients (38 female, 10 male; mean age 82 ± 9 years) were identified in our database. A total of 20 patients (17 female, 3 male; mean age was 79 ± 9 years) were available for follow-up examination after a mean time period of approximately eight years (3–14 years) after revision surgery. At final follow-up, patients were assessed using a subjective shoulder value (SSV), range of motion (ROM), visual analogue score (VAS), the Constant Score (CS) and the 12-Item Short Form Survey (SF-12). Results At final follow-up, mean CS was 55 ± 19 (19–91), VAS averaged 3 ± 3 (0–8) and mean SSV was 61 ± 18% (18–90%). Mean SF-12 was 44 (28–57) with a mean physical component summary (PCS) of 38 (21–56) and a mean mental component summary (MCS) of 51 (29–67). On average active forward flexion (FF) was 104° (10–170°), active abduction (ABD) was 101° (50–170°), active external rotation (ER) was 19° (10–30°) and active internal rotation (IR) of the lumbosacral transition was reached. Three patients presented with a periprosthetic humeral fracture after RTSA implantation and underwent a reoperation (15%) during follow-up period. Conclusions Revision RTSA results in promising clinical results in patients after initial failed HA after PHF. A complication and reoperation rate of 15% is tolerable in consideration of satisfactory functional and psychological outcome. Trial registration Retrospectively registered.

Purpose: Heterotopic ossification (HO) can occur after hemiarthroplasty (HA) for femoral neck fractures (FNF). This study aimed to investigate the frequency and factors contributing to the development of HO after HA. Methods: The study included data from 92 of 183 patients (26 male and 66 female) who sustained FNF and underwent HA between April 2019 and January 2022. HO was identified on postoperative radiographic images. Patient background, operative duration, blood loss, and presence of free bone fragments immediately after surgery were compared between the HO and non-HO groups. Statistical analyses included the independent-sample t-test for continuous variables and the chi-squared test for categorical variables. A multivariate logistic regression analysis was performed using HO as an objective variable. Results: HO occurred in 50 of the 92 (54%) patients. There were no statistically significant differences in patient backgrounds. Univariate analysis revealed significantly longer mean operative duration and greater blood loss in the HO group. Free bone fragments in the immediate postoperative period were observed in 29 of 50 (58%) patients in the HO group and in 3 of 42 (7.1%) patients in the non-HO group, a statistically significant difference. Logistic regression analysis revealed that the presence of free bone fragments was an independent explanatory factor for HO development. Conclusion: The presence of free bone fragments immediately after surgery may be significantly associated with the development of HO. Therefore, it is necessary to sufficiently remove such fragments during surgery because they may trigger HO. [ABSTRACT FROM AUTHOR]

Purpose: Selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed for psychiatric conditions. Previous studies have shown that SSRIs can increase bleeding risk by affecting platelet aggregation. However, their impact on perioperative outcomes in hip surgery remains uncertain. This case-control study examines the link between preoperative SSRI use and perioperative transfusion requirements in hip surgery patients. Methods: Data from the M161Ortho dataset of Pearl Diver patient records database were utilized. Patients who underwent hip joint surgery between 2010 and 2022 and had documented preoperative SSRI use within one month prior to surgery were included. Patients with coagulopathy disorders or coagulopathy medication use were excluded. Perioperative transfusion need was defined as receiving red blood cell or whole blood transfusions on the same date or within 10 days following the surgery. Results: A total of 75,374 patients with preoperative SSRI use were matched with an equal number of non-SSRI users. Preoperative SSRI use was associated with an increased risk of requiring perioperative transfusion (5.7% vs. 5.1%, P < 0.001). Subgroup analysis demonstrated increased transfusion risk in patients undergoing pinning (2.6% vs. 1.8%, P = 0.02), open reduction with internal fixation (ORIF) (8.9% vs. 8.2%, P = 0.007), and total hip arthroplasty (THA) (3.8% vs. 3.4%, P < 0.001), but no significant difference was observed in patients undergoing hemiarthroplasty. Conclusion: Clinicians should be aware of the potential risk of increased perioperative transfusion requirements in hip surgery patients using SSRIs, especially during pinning, ORIF, and THA procedures. It is essential to consider this when managing patients on SSRIs before hip surgery. [ABSTRACT FROM AUTHOR]

Purpose: Achieving the initial stability of implants is necessary for hip hemiarthroplasty (HHA), especially in elderly patients, and this can be achieved with a cement mantle of quality. The direct anterior approach (DAA) for HHA lately has shown positive results. However, evidence is lacking of HHA in elderly patients with osteoporosis after femoral neck fracture (FNF). This study compares differences in cement mantle quality after HHA, its complications, radiological outcomes and functional status in elderly patients with FNF intervened through different approaches. Methods: A non-interventional, retrospective case–control study was conducted. 150 cases were selected based on the surgical approach (DAA, DLA and PLA) in a 1:1:1 proportion between 2018 and 2019. Under 75 years old suspicion or confirmation of a pathological fracture were excluded. Antibiotic-loaded cement was utilized. Cement preparation involved vacuum centrifugation and standard instructions for preparation canal and filling, and prosthesis placement were followed. Results: No statistically significant differences in cement mantle quality, radiological outcomes, and the majority of the postoperative complications and functional status considering the surgical approach (p > 0.05). However, the DAA was associated significantly with shorter hospital stays (8.3 days vs 11.3 and 13 days for DLA and PLA) a decrease in postoperative blood transfusion (22% vs 34% and 53%), and lower rate of loss of walking (8% vs 20% and 28.6%). Conclusion: The DAA for HHA in patients with FNF provides a high-quality cement mantle, similar to other approaches. Also, the DAA shows advantages like shorter hospital stays and lower transfusion rates in elderly patients. [ABSTRACT FROM AUTHOR]

1. Abstract: Objectives: Bipolar hemiarthroplasty is commonly performed to treat displaced femoral neck fractures in osteoporotic patients. This study aimed to assess the occurrence and outcomes of unplanned return visits to the emergency department (ED) within 90 days following bipolar hemiarthroplasty for displaced femoral neck fractures. Methods: The clinical data of 1322 consecutive patients who underwent bipolar hemiarthroplasty for osteoporotic femoral neck fractures at a tertiary medical center were analyzed. Data from the patients’ electronic medical records, including demographic information, comorbidities, and operative details, were collected. The risk factors and mortality rates were analyzed. Results: Within 90 days after surgery, 19.9% of patients returned to the ED. Surgery-related reasons accounted for 20.2% of the patient's returns. Older age, a high Charlson comorbidity index score, chronic kidney disease, and a history of cancer were identified as significant risk factors for unplanned ED visits. Patients with uncemented implants had a significantly greater risk of returning to the ED due to periprosthetic fractures than did those with cemented implants (P = 0.04). Patients who returned to the ED within 90 days had an almost fivefold greater 1-year mortality rate (15.2% vs 3.1%, P

Abstract Introduction Hip hemiarthroplasty (HHA) is one of the most common types of orthopedic surgery. With the prevalence and utilization of the surgery increasing year after year, this procedure is found to be associated with severe postoperative complications and eventually mortality. Thus, it is crucial to understand the factors that increase the risk of mortality following HHA. Methods Using the Nationwide Inpatient Sample (NIS) database, patients undergoing HHA from 2016 to 2019 were identified. This sample was stratified into a mortality group and a control group. The data regarding patients’ demographics, co-morbidities, and associated complications were compared between the groups. Results Of the 84,067 patients who underwent the HHA procedures, 1,327 (1.6%) patients died. Additionally, the mortality group had a higher percentage of patients who were non-electively admitted (P 70 years (OR: 2.11, 95% CI [1.74, 2.56], P

METHODS: One hundred and forty-seven elderly patients (≥ 65 years of age) with displaced femoral neck fractures were admitted from January 2016 to January 2021, of whom 88 had total hip arthroplasty (total hip arthroplasty group) and 59 had artificial femoral head replacement (hemiarthroplasty group). For the patients' preoperative comorbidities, the age-corrected Charlson Comorbidity Scale was used to quantify the scores and calculate patient frailty. The propensity score matching method was used to match the two groups 1:1 and to compare the operation time, bleeding, postoperative hospitalization time, hospitalization cost, nutritional index, postoperative complications, and mortality between the two groups after matching. Postoperative survival time was determined by Kaplan-Meier Survival analysis. RESULTS AND CONCLUSION: (1) After propensity score matching, a total of 42 matched pairs were successful in both groups, and the preoperative data of patients in both groups were balanced and comparable after matching (P > 0.05). (2) Compared with the hemiarthroplasty group, operation time (79.71 minutes vs. 59.07 minutes, P < 0.001), bleeding volume (839.64 mL vs. 597.83 mL, P=0.001), and hospitalization cost (56 508.15 yuan vs. 41 702.85 yuan, P < 0.001) were significantly higher in the total hip arthroplasty group. However, the mortality rate was lower in the total hip arthroplasty group than in the hemiarthroplasty group (36% vs. 57%, HR=0.44, 95%CI: 0.23-0.87, P=0.018), and the mean survival time was longer in the total hip arthroplasty group than in the hemiarthroplasty group (59.4 months vs. 43.7 months, P=0.024). (3) There were no statistically significant differences in postoperative hospitalization time, preoperative and postoperative nutritional indicators, and overall postoperative complication rate between the two groups (P > 0.05). However, in terms of postoperative pain, the incidence of pain was significantly higher in the hemiarthroplasty group than that in the total hip arthroplasty group (24% vs. 7%, P=0.035). (4) Overall, total hip arthroplasty has a better prognosis for survival, while hemiarthroplasty is more appropriate for patients with poor physical fitness. At the same time, postoperative pain may largely affect the quality and survival time of patients after hip arthroplasty. [ABSTRACT FROM AUTHOR]

Introduction: The surgical approach of hemiarthroplasty for displaced femoral neck fractures remains debated. The study objective was to compare in-hospital outcomes for geriatric displaced femoral neck fractures treated with hemiarthroplasty based on surgical approach (direct lateral vs. posterior approach). Materials and Methods: This retrospective cohort study included geriatric patients (≥60 y/o) admitted 7/1/2016-3/31/2020 treated with hemiarthroplasty. Outcomes included: operative time (incision to closure), length of stay (HLOS), and blood loss volume (mL). The Harding direct lateral approach was compared to the posterior approach; P <.05. Results: There were 164 patients (59% direct lateral, 41% posterior). Patients treated with the direct lateral approach had an advanced directive (P =.03), dementia, (P =.03), or were functionally dependent (P =.03) more often than patients treated with the posterior approach. Time to surgery was comparable between groups (P =.52). The direct lateral approach was associated with a shorter operative time (2.3 vs. 2.8 h, P =.03), a longer HLOS (5.0 vs. 4.0 days, P <.01), and a lower median volume of blood loss (50 vs. 100 mL, P =.01), than the posterior approach, respectively. In a stratified analysis, for those who were not functionally dependent, did not have dementia or an advanced directive, the direct lateral approach led to a longer HLOS (P =.03) and shorter operative time (P =.04) than the posterior approach. Whereas among those who were functionally dependent, had dementia or had an advanced directive, the direct lateral approach led to less blood loss (P =.02) than the posterior approach. Discussion: While those treated with the direct lateral approach lost significantly less blood, they had a significantly longer HLOS than those treated with the posterior approach. Comorbidities significantly modified outcomes, which may suggest their presence could assist with treatment decisions. Conclusions: This study found neither approach, the direct lateral nor posterior, to be superior. Surgical approach could remain physician preference. [ABSTRACT FROM AUTHOR]

Introduction: Adherence to best practices for care of hip fracture patients is fundamental to decreasing morbidity and mortality in older adults. This includes timely transfer from the hospital to rehabilitation soon after their surgical care. Hospitals experience challenges in implementing several best practices. We examined the potential barriers associated with timely discharge for patients who underwent a hip fracture surgery in an academic hospital in Ontario, Canada. Methods: We conducted a retrospective cross-sectional review of a local database. We used descriptive statistics to characterize individuals according to the time of discharge after surgery. Multivariable binary logistic regression was used to evaluate factors associated with delayed discharge (>6 days post-surgery). Results: A total of 492 patients who underwent hip fracture surgery between September 2019 and August 2020 were included in the study. The odds of having a delayed discharge occurred when patients had a higher frailty score (odds ratios [OR] 1.19, 95% confidence interval [CI] 1.02;1.38), experienced an episode of delirium (OR 2.54, 95% CI 1.35;4.79), or were non-weightbearing (OR 3.00, 95% CI 1.07;8.43). Patients were less likely to have a delayed discharge when the surgery was on a weekend (OR.50, 95% CI.32;.79) compared to a weekday, patients had a total hip replacement (OR.28, 95% CI.10;.80) or dynamic hip screw fixation (OR.49, 95% CI.25;.98) compared to intramedullary nails, or patients who were discharged to long-term care (OR.05, 95% CI.02;.13), home (OR.26, 95% CI.15;.46), or transferred to another specialty in the hospital (OR.49, 95% CI.29;.84) compared to inpatient rehabilitation. Conclusions: Clinical and organizational factors can operate as potential barriers to timely discharge after hip fracture surgery. Further research is needed to understand how to overcome these barriers and implement strategies to improve best practice for post-surgery hip fracture care. [ABSTRACT FROM AUTHOR]

Introduction: A minority of geriatric hip fracture patients pursue non-operative treatment. Compared with surgical patients, non-operative patients have higher mortality rates. However, patient satisfaction following non-operative vs operative treatment has not been investigated extensively. The purpose of this study was to compare satisfaction among non-operatively vs operatively treated hip fracture patients. Methods: We identified patients aged 60+ years with proximal femur fractures treated over a 10-year period. Excluded were patients with isolated greater/lesser trochanteric fractures. Patients or relatives were asked to complete a 6-question survey about their treatment satisfaction. Results: Survey responses from 56 operative and 28 non-operative patients were recorded. Overall, 91.1% of operative and 82.1% of non-operative patients were satisfied with their treatment course (P = 0.260). However, only 71.4% of non-operative patients were satisfied with treatment option explanations vs 83.9% of operative patients (P = 0.014). While only 64.3% of non-operative respondents were satisfied with the ultimate treatment outcome (vs 85.7% of operative patients, P = 0.025), 89.3% of patients in each cohort would choose the same treatment plan again. Discussion: Our findings highlight the complexity of defining patient satisfaction, particularly in a geriatric hip fracture population. Unlike previous studies, we chose a direct approach to quantifying patient satisfaction by asking participants specifically about satisfaction with treatment outcome and the overall treatment course. Additional survey questions were then included to assess factors considered important in treatment satisfaction, such as health care provider treatment explanations, post-treatment mobility, and palliative care service involvement. Conclusions: We identified significant differences between non-operatively and operatively treated geriatric hip fracture patients regarding satisfaction with the explanation of treatment options, and ultimate treatment outcomes. There was no significant difference in overall satisfaction with the treatment course or likelihood of choosing the same treatment again. Further research investigating patient satisfaction following geriatric hip fracture treatment is warranted. [ABSTRACT FROM AUTHOR]

Background: Hip fractures are a common and debilitating condition posing not only a huge health care but also socioeconomic burden. Surgical management for a neck of femur fracture is typically with arthroplasty in the form of total hip arthroplasty or hip hemiarthroplasty. Serial radiographs are typically performed routinely as part of follow-up to look for complications, although their clinical utility in asymptomatic patients is yet to be validated. Our paper therefore aims to review the utility and necessity of radiographic follow-up following arthroplasty for NOF fractures. Materials and Methods: Patients who underwent operative management for acute fragility neck of femur fractures in the year from 1st January 2018 to 31st December 2018 at the author's institution were identified. All patients who underwent surgery, and had at least one pre and one post-operative plain film radiograph of the affected hip were included in this study. Exclusion criteria included patients who had undergone surgery for chronic fractures, avascular necrosis of the femoral head, mortality within 1 year, peri-prosthetic fractures, pathological fractures from metastases, had concomitant injuries, or had inaccessible or incomplete records. Clinical records were assessed for the number of visits, an abnormal presenting history or clinical examination, as well as changes in management of the patient. The number and type of radiographs were also assessed, and each radiograph analyzed for abnormal findings. Results: A total of 157 patients were included in our study with a mean age of 79.5 at the time of surgery, and a mean follow up of 17.3 months. Data was collected from 626 clinical visits and a total of 973 radiographs. The 3 abnormal radiographic series identified with a corresponding normal consult did not result in a change of management for the patient. A negative change in management was only observed in 1 patient with an abnormal consult and a corresponding normal radiograph. Conclusion: Post-operative complications following arthroplasty for NOF fractures are likely to result in a symptomatic presentation of the patient. Routine radiographic follow-up provides limited utility in asymptomatic patients and should only be performed if clinically indicated. [ABSTRACT FROM AUTHOR]

Introduction: The influence of prior colostomy or ileostomy on patients undergoing joint arthroplasty remains poorly understood. Our study aimed to assess whether patients with an ostomy undergoing hip and knee arthroplasties have worse postoperative outcomes and increased rates of revisions. Method: A single-center, retrospective review of patients with a history of bowel ostomy who underwent a primary total hip arthroplasty (THA), hemiarthroplasty (HA), and total knee arthroplasty (TKA) from 2012 to 2021. A total of 24 THAs, 11 HAs, and 25 TKAs in patients with open small or large bowel stoma were identified. A ten-to-one propensity score match was utilized to establish cohorts with comparable demographics but no prior ostomy procedure. Results: Patients with stomas undergoing elective THA showed greater 90-day ED visits (20.0 vs. 5.0%, P = 0.009), 90-day all-cause readmissions (20.0 vs. 5.0%, P = 0.009), 90-day non-orthopedic readmissions (10.0 vs. 0.5%, P < 0.001), 90-day readmissions for infection (5.0 vs. 0.5%, P = 0.043), all-cause revisions (15.0 vs. 0.5%, P < 0.001), revisions for PJI (5.0 vs. 0%, P = 0.043), and revisions for peri-prosthetic fracture (10.0 vs. 0%, P < 0.001). Patients with stomas undergoing non-elective hip arthroplasties exhibited a longer mean LOS (12.1 vs. 7.0 days, P < 0.001) and increased 90-day all-cause readmissions (40.0 vs. 17.3%, P = 0.034), 90-day orthopedic readmissions (26.7 vs. 6.0%, P = 0.005), all-cause revisions (13.3 vs. 2.0%, P = 0.015), revisions for peri-prosthetic fracture (6.7 vs. 0%, P = 0.002), and revisions for aseptic loosening (6.7 vs. 0%, P = 0.002). There were no significant differences in readmission or revision rates between ostomy patients undergoing TKA and a matched control group. Conclusion: Patients undergoing hip arthroplasties with an open stoma are at an increased risk of hospital encounters and revisions, whereas TKA patients with stomas are not at increased risk of complications. These findings emphasize the importance of recognizing and addressing the unique challenges associated with this patient population. [ABSTRACT FROM AUTHOR]

Purpose: Intraoperative periprosthetic femoral fracture (IPFF) is a known iatrogenic complication during hemiarthroplasty (HA) which may lead to inferior outcomes. The risk factors for IPFF during HA in displaced femoral neck fractures (FNF) remains to be fully elucidated. This study aims to compare IPFF rates between compaction broaching and conventional broaching techniques for cementless HA in FNF. Methods: We retrospectively reviewed institutional surgical data of patients who underwent cementless HA for displaced FNF from January 2010 to January 2022. Patients were stratified into two groups based on the broaching system: conventional broaching and compaction broaching. The presence, location, and treatment of IPFF were assessed for both groups. Effect of IPFF on postoperative weight-bearing status, mortality readmission and revision rates were compared between groups. Results: A total of 1,586 patients included in the study. 1252 patients (78.9%) in the conventional broaching group and 334 patients (21.1%) in the compaction broaching group. A total of 104 IPFF were found (6.5%). As compared to conventional broaching, compaction broaching was associated with significant higher IPFF rates (12.9% vs. 4.9%, p < 0.001, OR 2.84, CI 1.88–4.30). The location of the IPFF was similar between groups (p = 0.366), as well as the intraoperative treatment (p = 0.103) and postoperative weight-bearing status (p = 0.640). Surgical time, mortality rates, readmission rates and revision rates were comparable between groups. In a multivariate regression analysis, compaction broaching (OR, 4.24; p < 0.001) was independently associated with IPFF. Conclusions: This study reveals higher rates of IPFF associated with compaction broaching. Although this finding may have minimal clinical relevance, surgeons should consider these results when considering implant selection. [ABSTRACT FROM AUTHOR]

Introduction: Surgical site infection (SSI) is a major complication following hemiarthroplasty surgery for displaced neck of femur fractures. Our aim is to systematically analyse relevant peer-reviewed studies for recent clinical information on the quantitative risk of surgical site infection (SSI) after hemiarthroplasty (HA) of hip fracture patients and on the factors which influence the SSI rates. Methods: A comprehensive search of electronic databases (PubMed, Cochrane) was performed for clinical articles published between 2005 and 2023 and systematically reviewed with a defined list of inclusion and exclusion criteria. The methodology was undertaken and reported according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement checklist, while the detailed search strings and study protocol were published in PROSPERO (CRD42023458150). The pooled risks of SSIs were calculated in both primary and subgroup analyses. Results: The primary analysis showed a pooled superficial SSI rate after hemiarthroplasty of 1.3% (95% confidence interval (CI) 0.71; 2.04) from 17 studies with 29,288 patients and a deep SSI rate of 2.14% (1.87; 2.42) from 29 studies with 192,392 patients. Higher infection rates were observed with longer follow-up periods for deep SSI: pooled rates increased from 1.24% (0.73; 1.87) at 1 month to 2.64% (2.03; 3.31) at 12 months. Additionally, studies using defined criteria for infection diagnosis reported higher rates compared to undefined criteria: pooled deep SSI rates were 2.91% (1.40; 4.92) vs. 0.62% (0.34; 0.96) for defined vs. undefined criteria respectively, and 3.18% (2.23; 4.29) vs. 1.7% (1.44; 1.99) for superficial SSI. Conclusions: The results of this study demonstrate a substantial SSI risk and a high variability of the infection rates following hemiarthroplasty for hip fracture patients. A standardization of infection criteria and an extended follow-up period are advisable and should be considered in guidelines aimed at improving the standard of care for these patients. [ABSTRACT FROM AUTHOR]

Introduction: The indication for shoulder resurfacing arthroplasty is controversial, and survival of these implants is somewhat inconsistent. This study aimed to evaluate the long-term survivorship of resurfacing humeral head implants (RHHIs) and determine risk factors for complications and revisions. Materials and methods: This retrospective cohort study consisted of 275 cases and two types of RHHIs. The survival rate was evaluated using the Kaplan–Meier method and Cox regression for risk factor analysis. Demographic factors were studied, and the change in the humerus centre of rotation (COR) was measured. Results: The mean follow-up time was 8.7 years (SD 2.7 months, range 2.8–15.9 years). The mean age of the patients was 67.6 years (SD 9.6, range 33.5–84.9). Ten-year cumulative RHHI survival was 94.1%. The cumulative estimate without any complication was 98.9% at 5 years, 80.0% at 10 years and at 15 years it was 61.5%. The most common complication was persistent pain in 13.8% of the RHHIs. The risk factors for complications and revisions were implant type, preoperative conditions and change of COR > 5 mm. Conclusions: RRHIs showed excellent long-term survival, but many complications were found. The most common complication was persistent pain, which seemed to be caused by a change of COR and was more related to one type of implant. [ABSTRACT FROM AUTHOR]

Purpose: The management of geriatric femoral neck fractures, which includes options like hemiarthroplasty (HA), total hip arthroplasty (THA), and fixation, exhibits regional and healthcare setting variations. However, there is a lack of information on global variations in practice patterns and surgical decision factors for this injury. Methods: Survey data were collected from April 2020 to June 2023 via Orthobullets Case Studies, a global clinical case collaboration platform hosted on a prominent orthopedic educational website. Collaboratively developed standardized polls, based on the best available evidence and a comprehensive, peer-reviewed, evidence-based item list, were used to capture surgeons' treatment preferences worldwide. Subsequent analyses explored preferences within subspecialties and practice settings. Multivariable regression analysis identified associations between subspecialty, practice type, the likelihood of choosing THA, and the preferred femoral fixation method. Results: Our study encompassed 2595 respondents from 76 countries. Notably, 51.5% of participants (n = 1328; 51.5%, 95% CI 49.6–53.4%) leaned towards THA and 44.9% for HA, while 3.6% favoured surgical fixation. Respondents affiliated with academic institutions and large non-university-affiliated hospitals were 1.74 times more likely to favour THA, and arthroplasty specialists exhibited a 1.77-fold preference for THA. There was a 19-fold variation for cemented femoral fixation between the United Kingdom (UK) and USA with the UK favouring cemented fixation. Conclusion: Our study reveals a significant shift towards THA preference for managing geriatric femoral neck fractures, influenced by subspecialty and practice settings. We also observed a pronounced predominance of cement fixation in specific geographic locations. These findings highlight the evolving fracture management landscape, emphasizing the need for standardization and comprehensive understanding across diverse healthcare settings. [ABSTRACT FROM AUTHOR]

Purpose: Periprosthetic femoral fractures (PPFs) around the hip are challenging complications in orthopaedic surgery, particularly Vancouver type B2 (VTB2) fractures. The surgical management of these fractures is crucial and depends on various factors. Cementless short taper stem with plate osteosynthesis is an alternative surgical technique. This study aims to compare the outcomes of this surgical technique with revision arthroplasty (RA) with long stem in the treatment of VTB2 PPFs. Methods: This retrospective study was conducted in a single medical institute from February 2010 to May 2019. Patients who had received either total hip arthroplasty or bipolar hemiarthroplasty and subsequently developed a VTB2 PPF were included; patients who sustained intra-operative fractures or received a cemented stem previously were excluded from the analysis. The patients were divided into two groups: group I received RA with cementless long stem, while group II underwent RA with cementless short taper stem with plate osteosynthesis. Demographic data, radiographic and functional outcomes, and complications were analyzed between the two groups. Results: A total of 85 patients diagnosed with VTB2 PPFs were included in the study. There were no significant differences between the two groups in terms of demographic data, including age, gender, mean follow-up times, estimated blood loss, and operative times. The radiographic results showed that there was no significant difference in the incidence of subsidence and implant stability between the two groups. However, group II tended to have less subsidence and periprosthetic osteolysis. Patients in group II had significantly better functional scores (mean Harris hip score: post-operative: 60.2 in group I and 66.7 in group ii; last follow-up: 77.4 in group 1 and 83.2 in group II (both p < 0.05)). There were no significant differences in the overall complication rate, including infection, dislocation, re-fracture, and revision surgery, between the two groups. Conclusions: Both surgical techniques, cementless long stem and cementless short taper stem with plate osteosynthesis, are effective in the treatment of Vancouver B2 PPFs, with no significant differences in outcomes or complications. However, patients in cementless short taper stem with plate osteosynthesis had better functional scores at both post-operative and the last follow-up. [ABSTRACT FROM AUTHOR]

Background: Total hip arthroplasty (THA) is a standard treatment for a displaced femoral neck fracture in the elderly. In contemporary healthcare, there is a global shift towards fast-track treatment modalities, prioritizing early hospital discharge for patients. Consequently, routine postoperative blood tests may become redundant, offering significant time and cost savings. We aim to evaluate postoperative hemoglobin levels in trauma-related THA cases and identify patient profiles for whom these tests hold significance. Methods: A retrospective review of 176 THA procedures performed between 2018 and 2022, focusing on individuals undergoing THA for displaced femoral neck fractures. Multivariable logistic regression analysis was employed to identify factors associated with postoperative hemoglobin levels below 8.5 g/dL. Results: Of the 176 patients included, 109 (61.9%) were women and the mean age was 69.09 ± 8.13 (range 27 to 90) years. The majority of the patients underwent surgery within 48 hours of admission. The mean preoperative hemoglobin (Hb) level was 13.1 ± 1.4 g/dL, while the mean postoperative Hb level was 10.5 ± 1.2 g/dL. Only six patients (3.41%) exhibited postoperative Hb levels of ≤8.5 g/dL. No significant associations were found between postoperative Hb levels ≤ 8.5 and any demographic, surgical, or medical characteristics. Conclusions: Our findings suggest that routine postoperative blood count testing may not be necessary for most patients undergoing THA for displaced femoral neck fractures, particularly those without complications or significant comorbidities. [ABSTRACT FROM AUTHOR]

Objective: Total hip arthroplasty (THA) remains the primary treatment option for femoral neck fractures in elderly patients. This study aims to explore the risk factors associated with allogeneic blood transfusion after surgery and to develop a dynamic prediction model to predict post‐operative blood transfusion requirements. This will provide more accurate guidance for perioperative humoral management and rational allocation of medical resources. Methods: We retrospectively analyzed data from 829 patients who underwent total hip arthroplasty for femoral neck fractures at three third‐class hospitals between January 2017 and August 2023. Patient data from one hospital were used for model development, whereas data from the other two hospitals were used for external validation. Logistic regression analysis was used to screen the characteristic subsets related to blood transfusion. Various machine learning algorithms, including logistic regression, SVA (support vector machine), K‐NN (k‐nearest neighbors), MLP (multilayer perceptron), naive Bayes, decision tree, random forest, and gradient boosting, were used to process the data and construct prediction models. A 10‐fold cross‐validation algorithm facilitated the comparison of the predictive performance of the models, resulting in the selection of the best‐performing model for the development of an open‐source computing program. Results: BMI (body mass index), surgical duration, IBL (intraoperative blood loss), anticoagulant history, utilization rate of tranexamic acid, Pre‐Hb, and Pre‐ALB were included in the model as well as independent risk factors. The average area under curve (AUC) values for each model were as follows: logistic regression (0.98); SVA (0.91); k‐NN (0.87) MLP, (0.96); naive Bayes (0.97); decision tree (0.87); random forest (0.96); and gradient boosting (0.97). A web calculator based on the best model is available at: (https://nomo99.shinyapps.io/dynnomapp/). Conclusion: Utilizing a computer algorithm, a prediction model with a high discrimination accuracy (AUC > 0.5) was developed. The logistic regression model demonstrated superior differentiation and reliability, thereby successfully passing external validation. The model's strong generalizability and applicability have significant implications for clinicians, aiding in the identification of patients at high risk for postoperative blood transfusion. [ABSTRACT FROM AUTHOR]

Background: Interleukin-6 (IL-6) is a cytokine released in response to tissue injury. Elevated serum IL-6 levels in trauma patients have been linked with increased risk of complications such as inapparent hypoxia (SpO2 < 94%), acute respiratory distress syndrome, fat embolism syndrome (FES), systemic inflammatory response syndrome, multiple organ dysfunction syndrome and sepsis. This study aims to determine the role of serum IL-6 as surrogate biomarker of post-operative complications after invasive orthopaedic surgeries. Methods: Thirty-seven adults between 18 and 65 years of age undergoing invasive orthopaedic surgeries were included in this hospital-based study. Serum IL-6 levels were estimated serially in the pre-operative period, after 24 h and 7 days post-operatively. Cases were monitored for post-operative complications. Results: Serum IL-6 levels showed maximum rise in the first 24 h post-operatively especially among older patients (> 60 years). Older patients undergoing bipolar hemiarthroplasty for neck of femur fracture showed highest median post-operative IL-6 level of 258 pg/ml. Serum IL-6 level > 130 pg/ml measured 24 h after surgery was predictive of post-operative complications (sensitivity of 75%). Among the cases with post-operative complications, inapparent hypoxia was the most common complication/event observed. Cases with sub-clinical FES had highest level of serum IL-6 in first 24 h following surgery with median IL-6 level of 300 pg/ml (range 155–444 pg/ml). Conclusion: Monitoring serum IL-6 level may help in both anticipation and early detection of post-operative complications in patients undergoing invasive orthopaedic surgeries; potentially enhancing patient safety. [ABSTRACT FROM AUTHOR]

Distal humerus fractures are common, and when they occur in elderly patients with osteoporotic bone or poor subchondral bone stock, intra-articular fragmentation is common and management can be challenging. Osteosynthesis may be impossible or associated with a high risk of complications in this subset of patients, and total elbow replacement may be the preferred treatment. Elbow hemiarthroplasty for unreconstructable distal humerus fractures has emerged as an alternative treatment option and now accounts for over 50% of arthroplasty procedures for distal humerus fractures in England. This article aims to look at the indications, contraindications, surgical anatomy and technique as well as the outcomes and complications of elbow hemiarthroplasties. [ABSTRACT FROM AUTHOR]

Background: In the last years, there has been increasing use of shoulder arthroplasty. As a result, an increasing incidence of periprosthetic humerus fractures (PPHF) is expected. Therefore, this retrospective, multicenter analysis aimed to collect demographic data from patients with PPHF, their treatment strategies, and associated complications. Methods: Demographics of patients with PPHF were collected retrospectively from the database of six trauma hospitals between January 2000 and December 2020. All fractures were categorized according to the Wright and Cofield, and Worland classifications. In addition, the type of treatment for PPHF, as well as subsequent complications, were evaluated. Results: A total of 72 patients with a PPHF were identified. The mean age of the 55 female and 17 male patients was 77 years. PPHF occurred a mean of 50 months after primary arthroplasty implantation, almost exclusively as a result of a fall from standing height (n = 67). In-situ implant was a RTSA in 40 patients and a hemiarthroplasty in 32 patients. More than half of the fractures (n = 38) were type B fractures, according to Wright and Cofield. According to Worland, the majority of patients also had a type B fracture (type B1 (n = 22), type B2 (n = 28), type B3 (n = 10)). Associated comorbidities were found in 21 patients. A total of 31 patients were treated non-operatively, 27 with Open Reduction Internal Fixation (ORIF), and 14 with a revision arthroplasty. Nine primary radial nerve palsies were found (pre-operatively), and seven secondarily (post-operatively). Nine patients suffered from non-union (ORIF 4, non operative 4, stem replacement 1). Conclusion: The treatment strategy for PPHF is primarily tailored to the individual patient. Decisive factors such as patient's age, fracture type, and primary palsies have to be considered for optimal treatment. In type B1 fractures, there is a recommendation for ORIF because of high non-union rates under non-operative treatment. In contrast, in type B2 fractures, a non-operative approach should be preferred, provided there are no radial nerve lesions. Level of evidence: Level IV, epidemiologic study. [ABSTRACT FROM AUTHOR]

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