Low-energy Mechanism Research Articles

260. Comparing outcomes and mortality of upper cervical and subaxial cervical spine trauma in elderly patients

<h3>BACKGROUND CONTEXT</h3> In contrast to younger patients, the elderly are more likely to sustain severe cervical spine trauma from relatively low energy mechanisms of injury. The presence of preexisting spine pathology such as osteoporosis, cervical stenosis, ankylosis, spondylosis, and degenerative changes can predispose elderly patients to fractures and neurologic injury in both the upper and subaxial cervical spine. <h3>PURPOSE</h3> To date, there has been little research comparing outcomes and mortality rates of patients with upper cervical (occiput-C2) versus subaxial (C3-C7) cervical spine injuries. Given the paucity of data on this subject, this current study compares mortality rates and outcomes between elderly patients with upper cervical and subaxial cervical spine injuries using our prospective trauma database. <h3>STUDY DESIGN/SETTING</h3> Using data extracted from our clinical trauma registry, we conducted a single center retrospective cohort study. Retrospective chart review was performed to assess treatment rendered, complications, and outcome measures and then stored in a deidentified database. <h3>PATIENT SAMPLE</h3> All elderly (65+) trauma patients with cervical spine injuries who presented to a single, high-volume, level I trauma center between 2010-2019 were identified. <h3>OUTCOME MEASURES</h3> Outcomes such as medical and surgical complication rates, length of hospitalization, and mortality at various time points were collected. <h3>METHODS</h3> Imaging characteristics of patients including psoas index (a marker for sarcopenia) and L3 Hounsfield Unit (an indicator of osteoporosis) were calculated using standard technique and recorded into the database. Patients with cervical spine trauma were sorted into upper cervical (occipital condyle, C1, and C2 vertebral fractures and ligamentous injuries) and subaxial (C3-7) cohorts and by treatment (operative vs nonoperative management). Surgical and medical morbidity variables recorded include surgical site infection, pneumonia, STEMI, DVT/PE and stroke. Pearson's Chi-squared tests were used to compare rates of mortality and complications between groups. <h3>RESULTS</h3> A total of 922 patients were identified, with 545 upper cervical (59%), and 377 subaxial (41%) trauma patients. Patients with upper cervical spine trauma were significantly older (p<0.001), more sarcopenic (p=0.002), osteoporotic (p=0.002), and had higher rates of dementia (p=0.003). There was no significant difference in cardiac or pulmonary comorbidities between the two groups (p=0.7). Patients with subaxial injuries had a higher injury burden, with significantly higher Injury Severity Scale (ISS) scores (p=0.008), non-contiguous spine injuries (p=0.016), closed head injury (p=0.04), and pelvic fractures (p=0.04). Comparing operative cohorts, there was a statistically significant higher proportion of medical and surgical complications in the upper cervical group (p=0.006), and specifically a higher incidence of pneumonia (p=0.009). There was also found to be higher overall mortality in all upper cervical injuries both operative and nonoperatively managed as compared to the subaxial cohort (p=0.015). There was no significant difference in in-hospital mortality between the two groups (p=0.25). <h3>CONCLUSIONS</h3> Although patients with subaxial injuries were found to be more severely traumatized with higher energy mechanisms and more severe associated injuries, our data demonstrate that patients with upper cervical trauma are at higher risk for medical and surgical complication and mortality, regardless of need for operative intervention. This is likely secondary to poor reserve given their older age, advanced sarcopenia, and the increased morbidity associated with both operative management and nonoperative immobilization. In conclusion, we have demonstrated in the largest study to date that patients with upper cervical injuries, although less severely traumatized, should be more critically evaluated given their increased risk for morbidity and mortality, which can help guide discussions with the patient and family about expected outcomes and functional status. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Paediatric pelvic injuries: a retrospective epidemiological study from four level 1 trauma centers.

Epidemiologic evaluation of pelvic ring injuries in children. Retrospective analysis over a period of 13years, excluding pathological fractures. AO/OTA type, epidemiological data, type of treatment, and complications were recorded. Data were assessed using Fisher's exact test and Wilcoxon test. 243 boys, 115 girls, mean age (SD) 14.1 ± 3.0years, AO/OTA types: 281 A, 52 B, 25 C. Multiple trauma: 62, combined trauma: 59, mono-trauma: 237. 281 patients were treated non-operatively, 97 surgically. traffic accidents 88, falls from a great height 37, crushing injuries four, and sports injuries 192, simple falls 30, others seven. High-energy mechanisms prevailed in types B and C. Low-energy mechanism in type A (p < 0.0001). Similar differences were found between type A (p = 0.0009) and in case type C requiring surgery and cases treated non-operatively (p < 0.0001). Twenty-six patients (7.3%) had complications (pelvic asymmetry 5, neurological deficits 5, non-union 1, ectopic calcification 4, others 7). Higher complication rates were associated with types B and C (p = 0.0015), with surgically treated cases (p < 0.0001) and multiple trauma (p = 0.0305). Results of this trial were comparable with other studies. Sports injuries accounted for most type A injuries, while types B and C tended to be associated with high-energy trauma. Complications were associated with the severity of pelvic trauma, more common in surgically treated group of patients; this is primarily linked to the surgical cases being more serious as well as the associated injuries.

Does operative treatment of geriatric pelvic ring injuries lead to a high risk of one-year mortality?

IntroductionNon-operative management of pelvic ring injuries in the elderly is associated with a high risk of one-year mortality. The majority of these injuries are the result of a low-energy mechanism, however, due to the multiple medical comorbidities in this patient population the injuries are associated with a high degree of morbidity. The purpose of this study was to determine the one-year mortality risk after operative treatment of pelvic ring injuries in a geriatric patient population and the effect of patient and injury characteristics on the risk of mortality. Patients and methodsWe performed a retrospective review of patients over the age of 70 who underwent operative fixation of a pelvic ring injury at two Level 1 trauma centers between January 2016 and June 2019. Medical records were reviewed for patient and injury characteristics including: Charlson Comorbidity Index (CCI), American Society of Anesthesiologists (ASA) physical status score or Injury Severity Score (ISS), hospital and intensive care unit (ICU) length of stay (LOS). The primary outcome of interest was the one-year mortality risk following operative treatment. Secondary outcomes included the effect of patient and injury characteristics on the one-year mortality risk and the hospital LOS. ResultsNinety patients were included with an average age of 79.8 ± 6.5 years. The overall mortality was 8.9% (n = 8) and was significantly associated with the CCI. There was no significant effect related to the ASA physical status score or ISS. The average hospital LOS was 9.2 ± 7.3 days and was associated with the CCI, ASA physical status score, and ISS. DiscussionNon-operative management of pelvic ring injuries in geriatric patients is associated with a high risk of one-year mortality. Our findings suggest operative treatment of these fractures is associated with an acceptable risk of one-year mortality that falls below the commonly reported range for non-operatively managed injuries. Furthermore, the risk of mortality was significantly associated with the patient's pre-injury state as determined by the CCI.

Evaluation and management of low-energy pelvic ring fractures in elderly patients: a narrative review

The incidence of pelvic ring fractures has shown a steady increase in elderly patients that has been caused by a rapidly aging population and increased life expectancy. Many of these injuries result from a low-energy mechanism such as a fall from standing height. Classification systems such as the Young and Burgess and Tile classifications commonly are used to describe these fractures. One of the major distinctions to be made is whether the fracture pattern is stable or unstable in order to determine treatment. The goal of treatment is to restore patients back to their preinjury level of function. Mortality rate has previously been shown to be high in these injuries (20% at 30 days).

Comparative Analysis of Open Reduction Internal Fixation and Closed Reduction Percutaneous Pinning of Hand Fractures: Single Academic Center Retrospective Review.

The purpose of our study was to compare postoperative outcomes between patients receiving closed reduction percutaneous pinning (CRPP) to open reduction internal fixation (ORIF) following metacarpal and phalanx fractures. A retrospective chart review was performed at a single academic center for all patients suffering a metacarpal or phalanx fracture and receiving either CRPP or ORIF between 2012 and 2018. Patients were divided into fracture mechanism, high-energy mechanism of injury, low-energy mechanism of injury, or unknown, and treatment of fracture with either ORIF or CRPP. High-energy mechanism of injury included gunshot wounds, motor vehicle crash, and blast injuries, whereas low-energy mechanism of injury included all other causes. Patient demographics, postoperative complications, 30-day readmission, and return to the operating room were recorded. A total of 408 patients, with 524 fractures, were included in the study. There were 127 fractures that resulted from high-energy mechanisms and 394 fractures that resulted from low-energy mechanisms. Open reduction internal fixation was used to treat 299 fractures, whereas CRPP was used for 225 fractures. Among fracture fixation, there was a total of 8.4% complication rate with ORIF, accounting for 10.4% of complications, and CRPP accounting for 5.8%. Among the fracture mechanism, the high-energy mechanism of injury had a 21.3% complication rate, whereas the low-energy mechanism of energy was 4.3%. When comparing the above variables, only high-energy mechanism of injury was a statistically significant predictor of complications (odds ratio, 3.2; confidence interval, 1.5-7.0; P = 0.002). The average operating room time for the ORIF group was 124.82 minutes compared with 97.6 minutes for the CRPP group. Patients with hand fractures corrected by ORIF appeared to have a higher postoperative complication rate. When the 2 procedures, ORIF and CRPP, were controlled for mechanism of injury, there was not a statistically significant difference in postoperative complication rate (P = 0.14). However, a fracture sustained by a high-energy mechanism was a statistically significant predictor of postoperative complications (P = 0.002).

Анализ отдаленных результатов оперативного лечения пациентов с переломами проксимального отдела большеберцовой кости аппаратом Илизарова

Introduction Fractures of the tibial plateau are classified by the location of the fracture line, associated capsular ligamentous injuries to the knee and can result from different types of high – or low-energy mechanisms of injury in patients of any age with different bone quality. These factors are responsible for different long-term functional outcomes and the lack of a generally accepted algorithm for diagnosis and treatment. The objective of the study was to analyze the long-term functional outcomes in patients with tibial plateau fractures treated with the Ilizarov external fixation. Material and methods The review included long-term outcomes of 59 patients with tibial plateau fractures treated with the Ilizarov external fixator. Long-term results were evaluated in 53 patients out of 59 (89.83 %) using a subjective and objective clinical assessment system.The follow-up period ranged from 2 to 4 years. Patients were requested to complete the Oxford Knee Score questionnaire used in subjective outcome. Results Knee joint function of patients with tibial plateau fractures treated with the Ilizarov external fixation were rated as satisfactory (n = 34; 64.15 %); 16 (30.19 %) and 3 (5.66 %) patients were diagnosed with mild and moderate gonarthrosis, respectively. No infection that would affect the outcome was recorded in the study group. The mean Oxford Knee Score was 43.06 ± 3.44 (SD) in Schatzker type I split fractures of the lateral femoral condyle; 40.50 ± 5.57 (SD) in Schatzker type II split fractures combined with lateral articular surface depression; 40.71 ± 4.27 (SD) in Schatzker type III depression fractures; 42.33 ± 4.22 (SD) in Schatzker type IV medial condylar fractures; 38.50 ± 7.19 (SD) in Schatzker type V bicondylar fractures and 37.50 ± 5.17 (SD) in Schatzker type VI bicondylar fractures with dissociation of the metaphysis and diaphysis. Conclusions Tibial plateau fractures can be treated with the Ilizarov external fixation and also with the use of screws at any point of time that allows closed or open reduction of the fracture to ensure the early function of the operated limb, stable bone fixation, control of the fixation stiffness at any stage of treatment facilitating good and excellent functional outcomes.

Interfacial piezoelectric polarization locking in printable Ti3C2Tx MXene-fluoropolymer composites

Piezoelectric fluoropolymers convert mechanical energy to electricity and are ideal for sustainably providing power to electronic devices. To convert mechanical energy, a net polarization must be induced in the fluoropolymer, which is currently achieved via an energy-intensive electrical poling process. Eliminating this process will enable the low-energy production of efficient energy harvesters. Here, by combining molecular dynamics simulations, piezoresponse force microscopy, and electrodynamic measurements, we reveal a hitherto unseen polarization locking phenomena of poly(vinylidene fluoride–co–trifluoroethylene) (PVDF-TrFE) perpendicular to the basal plane of two-dimensional (2D) Ti3C2Tx MXene nanosheets. This polarization locking, driven by strong electrostatic interactions enabled exceptional energy harvesting performance, with a measured piezoelectric charge coefficient, d33, of −52.0 picocoulombs per newton, significantly higher than electrically poled PVDF-TrFE (approximately −38 picocoulombs per newton). This study provides a new fundamental and low-energy input mechanism of poling fluoropolymers, which enables new levels of performance in electromechanical technologies.

Peri-implant fractures of the upper and lower extremities: a case series of 61 fractures.

To assess outcomes for patients who sustained peri-implant fractures (PIFs). Medical records of patients who sustained a PIF were reviewed for demographic, injury, outcome, and radiographic data. PIFs were classified using a reproducible system and stratified into cohorts based on fracture location. Clinical outcomes were evaluated for each cohort. Fifty-six patients with 61 PIFs with at least 6months of follow-up were included. The mean age of the cohort was 60.4 ± 19.5years. Twenty-two (36.1%) PIFs occurred in males, while 39 (63.9%) occurred in females. Fifty-two (85.2%) PIFs were sustained from a low-energy injury mechanism. PIFs were most often treated with plate/screw constructs (50.8%). Complications included: 6 (9.8%) nonunions, 5 of which were successfully treated to healing, 5 (8.2%) fracture related infections (FRI), and 1 (1.6%) hardware failure. Sixty (98.4%) PIFs ultimately demonstrated radiographic healing. PIFs are usually treated surgically and have a relatively high incidence of complications, with nonunion in femoral PIFs being the greatest. Despite this, the rate of ultimate healing is quite high.

Defining major trauma: a Delphi study

IntroductionRetrospective trauma scores are often used to categorise trauma, however, they have little utility in the prehospital or hyper-acute setting and do not define major trauma to non-specialists. This study employed a Delphi process in order to gauge degrees of consensus/disagreement amongst expert panel members to define major trauma.MethodA two round modified Delphi technique was used to explore subject-expert consensus and identify variables to define major trauma through systematically collating questionnaire responses.After initial descriptive analysis of variables, Kruskal-Wallis tests were used to determine statistically significant differences (p < 0.05) in response to the Delphi statements between professional groups. A hierarchical cluster analysis was undertaken to identify patterns of similarity/difference of response.A grounded theory approach to qualitative analysis of data allowed for potentially multiple iterations of the Delphi process to be influenced by identified themes.ResultsOf 55 expert panel members invited to participate, round 1 had 43 participants (Doctor n = 20, Paramedic n = 20, Nurse n = 5, other n = 2). No consistent patterns of opinion emerged with regards to professional group. Cluster analysis identified three patterns of similar responses and coded as trauma minimisers, the middle ground and the risk averse. Round 2 had 35 respondents with minimum change in opinion between rounds.Consensus of > 70% was achieved on many variables which included the identification of life/limb threatening injuries, deranged physiology, need for intensive care interventions and that extremes of age need special consideration. It was also acknowledged that retrospective injury severity scoring has a role to play but is not the only method of defining major trauma. Various factors had a majority of agreement/disagreement but did not meet the pre-set criteria of 70% agreement. These included the topics of burns, spinal immobilisation and whether a major trauma centre is the only place where major trauma can be managed.ConclusionBased upon the output of this Delphi study, major trauma may be defined as: “Significant injury or injuries that have potential to be life-threatening or life-changing sustained from either high energy mechanisms or low energy mechanisms in those rendered vulnerable by extremes of age”.

Fratura da Tuberosidade Anterior da Tíbia em Jovem Atleta de Basquetebol

The increase on sports practice among children and adolescents increased the number of visits to the Emergency Department of this age group due to injuries of the musculoskeletal system originated in the sports context. Tibial tuberosity fractures are rare and occur in a population with a maturing skeleton. These often occur during the ascending or descending phase of a jump and have been increasingly associated with the practice of some sports, with a relatively low energy mechanism, but which often causes disproportionate and extensive tissue lesions, which can compromise the return to sports. We describe a case of a young basketball player who suffered a fracture and avulsion of the anterior tibial tuberosity with extension of the fracture line posteriorly along the proximal tibial physis to the posterior metaphyseal cortical.

Dorsal Approach For Impacted Comminuted Distal Radius Fracture By Open Reduction And Internal Fixation By Plate And Screws With Bone Grafting

Background: The distal radius fracture is the most common fracture seen in an emergency, making up 17% of all fractures. It is complex to treat affected comminuted distal radius fracture. Especially when the fractures are dorsally comminuted, internal fixation via a dorsal approach should be considered. Objective: To evaluate the results of dorsal plating in patients with impacted comminuted distal radius fracture. Patients and methods: This study was done at Al-Azhar University Hospitals, Air-Force military hospital & El-Mattaryah teaching hospital, during the period of December 2019 and December 2020. 13 males and 7 females (20 fractures) aged 22 to 59 (mean 43.2) years underwent fixation of distal radius fracture by dorsal plating with bone grafting. The mode of trauma was high energy mechanism in 11 patients and low energy mechanism in 9 patients. Radiological and clinical outcomes was evaluated. Results: In the outpatient clinic, twenty patients were followed up for evaluation of fracture healing, ROM, hand grip and return to work. The Modified Mayo Wrist Score was 72.5% after at least 6 months follow up. Conclusion: Dorsal plating with bone grafting for impacted distal radius with dorsal comminution allows accurate reduction and maintenance with early mobilization, good function and an early return to work. Keywords: ORIF, Distal radius, Dorsal approach, Intra-articular, Bone grafting.

Walking Greater Than 5 Feet After Hip Fracture Surgery Is Associated With Fewer Complications, Including Death.

Hip fractures in the elderly are associated with notable morbidity. The influence of postoperative ambulation on outcomes is not well described. We hypothesized that patients who mobilize faster after surgical intervention would demonstrate fewer postoperative complications. A retrospective review was performed on patients with hip fractures from October 2015 through September 2017. All ambulatory patients at least 65 years old (y/o), with a low-energy mechanism of injury, and who underwent surgical treatment were included. Physical therapy notes were used to track postoperative ambulation, and medical records were reviewed for 90-day postoperative complications. One hundred sixty-three patients were included (64 femoral neck, 88 intertrochanteric, and 11 subtrochanteric fractures). Eighty patients had postoperative complication(s). Walking >5 feet by 72 hours postoperatively was associated with decreased morbidity (complication rate: 31% versus 77% (≤5 feet ambulation), P < 0.001). Walking >5 feet by 72 hours postoperatively decreased the likelihood of myocardial infarction (P = 0.003), pneumonia (P = 0.021), intensive care unit admission (P < 0.001), and death or hospice transfer (P < 0.001). Ambulating >5 feet within 72 hours postoperatively is associated with a lower postoperative complication rate. To our knowledge, this study is the first to quantify the relationship between postoperative hip fracture mobilization and morbidity and mortality. Prognostic, Level III.

Early Ambulation After Hip Fracture Surgery Is Associated With Decreased 30-Day Mortality.

Hip fractures frequently present in complicated patients and are fraught with high morbidity and mortality rates. Postoperatively, delayed ambulation has been identified as a factor associated with increased mortality, although its magnitude has yet to be quantified. Therefore, this article aims to evaluate mortality after hip fracture surgery because it relates to early postoperative ambulation, taking into account preexisting comorbidity burden. This is a retrospective review of patients older than age 65 years who underwent surgical fixation for hip fractures because of a low-energy mechanism. Ambulation during the first 3 postoperative days was recorded along with age and preexisting comorbidity burden (Modified 5-Factor Frailty Index), and 30-day and 1-year mortality statuses were examined. Multivariable logistic regression was used to analyze the association between postoperative ambulation and mortality. Of 485 patients initially identified, 218 met the inclusion criteria. Overall mortality rates were 6.4% at 30 days and 18.8% at 1 year. Two-thirds of patients ambulated in the first 3 postoperative days versus one-third who did not. Patients who did not ambulate had both significantly increased 30-day mortality (odds ratio [OR] 4.42, P = 0.010, 95% confidence intervals [CIs] 1.42 to 13.75) and 1-year mortality (OR 2.26, P = 0.022, 95% CI 1.12 to 4.53). After multivariable logistic regression accounting for age and comorbidity status, ambulation remained strongly associated with 30-day (OR 3.87, P = 0.024, 95% CI 1.20 to 12.50) but not 1-year mortality (OR 1.66, P = 0.176, 95% CI 0.80 to 3.48). Although neither were significant at 30 days, both increasing age (OR 1.05, P = 0.020, 95% CI 1.01 to 1.10) and Modified 5-Factor Frailty Index (OR 1.62, P = 0.005, 95% CI 1.16 to 2.26) correlated with increased mortality at 1 year. Early ambulation after hip fracture surgery bears a notable, almost four-fold, association with early postoperative mortality independent of age and medical comorbidities. Our results support a growing body of evidence that ambulation is a powerful tool that should continue to be emphasized to optimize mortality in hip fracture patients.

Midterm outcome after posterior stabilization of unstable Midthoracic spine fractures in the elderly

BackgroundThe evidence for the treatment of midthoracic fractures in elderly patients is weak. The aim of this study was to evaluate midterm results after posterior stabilization of unstable midthoracic fractures in the elderly.MethodsRetrospectively, all patients aged ≥65 suffering from an acute unstable midthoracic fracture treated with posterior stabilization were included. Trauma mechanism, ASA score, concomitant injuries, ODI score and radiographic loss of reduction were evaluated. Posterior stabilization strategy was divided into short-segmental stabilization and long-segmental stabilization.ResultsFifty-nine patients (76.9 ± 6.3 years; 51% female) were included. The fracture was caused by a low-energy trauma mechanism in 22 patients (35.6%). Twenty-one patients died during the follow-up period (35.6%). Remaining patients (n = 38) were followed up after a mean of 60 months. Patients who died were significantly older (p = 0.01) and had significantly higher ASA scores (p = 0.02). Adjacent thoracic cage fractures had no effect on mortality or outcome scores. A total of 12 sequential vertebral fractures occurred (35.3%). The mean ODI at the latest follow up was 31.3 ± 24.7, the mean regional sagittal loss of reduction was 5.1° (± 4.0). Patients treated with long segmental stabilization had a significantly lower rate of sequential vertebral fractures during follow-up (p = 0.03).ConclusionUnstable fractures of the midthoracic spine are associated with high rates of thoracic cage injuries. The mortality rate was rather high. The majority of the survivors had minimal to moderate disabilities. Thereby, patients treated with long segmental stabilization had a significantly lower rate of sequential vertebral body fractures during follow-up.

Modeling of the thermal migration mechanisms of atomic oxygen in Ar, Kr, and Xe crystals.

Accommodation and migration of the ground-state (2s22p4 3P) oxygen atom in the ideal Ar, Kr, and Xe rare gas crystals are investigated using the classical model. The model accounts for anisotropy of interaction between guest and host atoms, spin-orbit coupling, and lattice relaxation. Interstitial and substitutional accommodations are found to be the only thermodynamically stable sites for trapping atomic oxygen. Mixing of electronic states coupled to lattice distortions justifies that its long-range thermal migration follows the adiabatic ground-state potential energy surface. Search for the migration paths reveals a common direct mechanism for interstitial diffusion. Substitutional atoms are activated by the point lattice defects, whereas the direct guest-host exchange meets a higher activation barrier. These three low-energy migration mechanisms provide plausible interpretation for multiple migration activation thresholds observed in Kr and Xe free-standing crystals, confirmed by reasonable agreement between calculated and measured activation energies. An important effect of interaction anisotropy and a minor role of spin-orbit coupling are emphasized.

ASA Physical Status Classification Improves Predictive Ability of a Validated Trauma Risk Score.

Introduction:The Score for Trauma Triage in the Geriatric and Middle-Aged (STTGMA) is a validated mortality risk score that evaluates 4 major physiologic criteria: age, comorbidities, vital signs, and anatomic injuries. The aim of this study was to investigate whether the addition of ASA physical status classification system to the STTGMA tool would improve risk stratification of a middle-aged and elderly trauma population.Methods:A total of 1332 patients aged 55 years and older who sustained a hip fracture through a low-energy mechanism between October 2014 and February 2020 were included. The STTGMA and STTGMAASA mortality risk scores were calculated. The ability of the models to predict inpatient mortality was compared using area under the receiver operating characteristic curves (AUROCs) by DeLong’s test. Patients were stratified into minimal, low, moderate, and high risk cohorts based on their risk scores. Comparative analyses between risk score stratification distribution of mortality, complications, length of stay, ICU admission, and readmission were performed using Fisher’s exact test. Total cost of admission was fitted by univariate linear regression with STTGMA and STTGMAASA.Results:There were 27 inpatient mortalities (2.0%). When STTGMA was used, the AUROC was 0.742. When STTGMAASA was used, the AUROC was 0.823. DeLong’s test resulted in significant difference in predictive capacity for inpatient mortality between STTGMA and STTGMAASA (p = 0.04). Risk score stratification yielded significantly different distribution of all outcomes between risk cohorts (p < 0.01). STTGMAASA stratification produced a larger percentage of all negative outcomes with increasing risk cohort. Total hospital cost was statistically correlated with both STTGMAASA (p < 0.01) and STTGMA (p = 0.02).Conclusion:Including ASA physical status as a variable in STTGMA improves the model’s ability to predict inpatient mortality and risk stratify middle-aged and geriatric hip fracture patients.

Distal radius fractures: current concepts

ABSTRACT Distal radius fractures (DRFs) are commonly encountered in the elderly population, secondary to low-energy injury mechanisms. In the younger population, DRFs are mainly secondary to high-energy trauma. Stable DRFs can be treated conservatively. However, in the elderly population group, DRFs are often unstable and are likely to benefit from surgical intervention. They are often compounded by comorbid medical conditions requiring optimisation. When treating the elderly group, one should be aware of sarcopaenia, as this may have a bearing on return to function. Recent literature reports an increasing trend in the surgical management of these fractures. Current classification systems fail to consistently guide the management of these fractures. Although evidence is still limited in guiding decision-making in the treatment of these fractures, one should consider the economic implications of prolonged immobilisation in young patients in addition to defined indications for surgery. Improvement in implants allows safe dorsal fixation in patients with dorsal comminution, with low complication rates reported. This narrative review summarises current trends and the body of evidence. Level of evidence: Level 5 Keywords: distal radius, fracture management, osteoporosis

Low-energy ferroelectric–paraelectric phase transitions of three-dimensional A(II)B(I)X3-type perovskite ferroelectrics: How to realize high phase transition temperatures

Organohalide lead perovskites are widely used in memory components, sensors, and photocells, owing to their excellent (opto)electronic or ferroelectric properties, especially light weight, and easy processing compared to pure inorganic perovskites. For their commercialization, the exploration of environmentally friendly lead-free perovskites has become a hot issue. Recently, a class of metal-free three-dimensional (3D) halide perovskites has been synthesized, and these perovskites exhibit superior ferroelectricity. With reference to the experiment-synthesized (MDABCO)(NH4)I3 (MDABCO = N-methyl-N′-diazabicyclo[2.2.2]octonium), two new perovskites (MDABCO)KI3 and (MDABCO)RbI3 are designed through replacing NH4+ by metal ions. By using the first-principles calculations, we find that these (MDABCO)BI3 (B = NH4+, K+, and Rb+) perovskites all have a similar phase transition mechanism with ignorable barriers but prominent ferroelectricity (large spontaneous polarizations and high phase transition temperatures). Our design strategy can have important implications for the development of novel 3D perovskite ferroelectrics following this specific low-energy phase transition mechanism.

Outcomes of COVID-19 Negative Hip Fracture Patients During the Acute and Subacute Pandemic.

Objectives:To better elucidate how the COVID-19 pandemic has affected the operatively treated geriatric hip fracture population and how the health care system adapted to pandemic dictated procedures.Design:Retrospective cohort study.Setting:A community hospital.Participants:Individuals ≥65 years of age presented with a proximal femoral fracture from a low-energy mechanism undergoing operative treatment from January 17, 2020 to July 2, 2020 (N = 125).Measurements:We defined 3 phases of healthcare system response: pre-COVID-19, acute phase, and subacute phase. Thirty-day mortality, time to operating room (OR), length of stay, time to start physical therapy, perioperative complications, delirium rate, hospice admission rate, discharge dispositions, readmission rate, and the reason of surgery delay were assessed.Results:The number of hip fractures has remained constant during the pandemic. The 30-day mortality rate, time to OR, and length of stay were higher in the pandemic compared to the pre-pandemic. Those who had a longer wait time to OR (≥ 24 hours) had more complications and increased 30-day mortality rates. Some of the surgery delays were related to OR unavailability as a consequence of the COVID-19 pandemic. Surgery was delayed in 3 patients who were on direct oral anticoagulants (DOACs) in pandemic but none for pre-pandemic period.Conclusion:This is the first study to compare the effect of the acute and subacute phases of the pandemic on uninfected hip fracture patients. In the age of COVID-19, to provide the best care for the vulnerable geriatric orthopedic populations, the healthcare system must adopt new protocols. We should still aim to promote prompt surgical care when indicated. It is important to ensure adequate resource availability, such as OR time and staff so that hip fracture patients may continue to receive rapid access to surgery. A multidisciplinary approach remains the key to the management of fragility hip fracture patients during the pandemic.

Outcome of DCS (Dynamic Condylar Screw) in failed proximal femur nails in intertrochanteric fractures: A retrospective study

Introduction: Intertrochanteric Femur fractures comprise approximately more than half of hip fractures caused by low energy mechanism seen more commonly in geriatric people, women,osteoporosis,a history of fall and gait abnormality. There are surgical managments available for this kind of fractures but still there are some failures. Above mentioned factors are responsible for failures. For that revision surgery is required. Here we are going to search outcomes of DCS in failed PFN in IT fractures. Materials and Methods: A retrospective study of 10 patients, treated with dynamic condylar screw (DCS) for implant failure after doing PFN in Intertrochanteric fracture were stastastically reviewed from march 2017 to march 2018. Observation and Results: Out of 10 cases 4 were young (60years). 4 out of 4 young patients and 3 out of 6 elder patients were united properly. Nonunion was seen in 1 patient. Delayed union was seen in 1 patient and Implant failure was seen in 1 cases (10%). Restricted weight bearing status post-operatively was associated with significantly lower incidence of implant failure.Using the DCS, the results were good in the young patients with high-energy injuries. However, the implant failure rate is high in elderly patients who suffer low-energy fractures. The DCS should not be used if weight bearing cannot be minimized in this group. Conclusion: The dynamic condylar screw is a safe and reliable implant for the management of Periimplant Subtrochanteric fractures in previously operated with PFN with predictable results when principles of open reduction and internal fixation is followed as compare to other methods of fixation in developing country. Keywords: Proximal femur nail, Dynamic condylar screw, Intertrochentric fracture, Revision surgery.