Hasil untuk "Orthopedic surgery"

A.N. Toro-Ibarguen, E. Sánchez Benito, J.M. Cortés Villar

Background and objective: The primary objective is to evaluate the clinical and functional outcomes of tape reinforcement in anterior cruciate ligament (ACL) reconstructions, recording complications, as well as the rate of reinterventions and graft failure. Materials and methods: Retrospective analysis of ACL reconstructions with hamstring (HS) autograft that were reinforced with high-strength tape. We included patients in whom we obtained a graft of HS <8 mm or ≥8 mm of poor quality. Age, sex, body mass index (BMI), and previous activity were recorded. Clinical and functional evaluation were made and postoperative range of motion (ROM), pain, and Lysholm functional scale were recorded. Complication rate, graft failure rate, and reintervention rate were analyzed. Results: A total of 160 patients were included, with a mean age of 29.19 years. Of these, 98 were male and 62 female, with a mean BMI of 23.5. The mean follow-up period was 31.7 months. The average ROM was 137.2°, the mean pain level was 0.8, and the average Lysholm score was 95.1. The complication rate was 11%, with 5% requiring reoperation. The graft failure rate was 1.3%. A graft diameter <8 mm was associated with females with Fisher's exact test of p < .0001. In the other parameters, no statistically significant differences were found between patients with grafts <8 mm and those with grafts ≥8 mm. Conclusions: This study demonstrates that tape reinforcement in ACL reconstruction is a safe procedure, offering excellent clinical and functional outcomes with low reinterventions and graft failure rates. Resumen: Antecedentes y objetivo: El objetivo primario es evaluar los resultados clínicos y funcionales del refuerzo con cinta en las reconstrucciones del ligamento cruzado anterior (LCA), registrando las complicaciones, así como la tasa de reintervenciones y de fracaso del injerto del LCA. Materiales y métodos: Análisis retrospectivo de reconstrucciones del LCA con autoinjerto de isquiotibiales (IQT) a los que se les asoció un refuerzo con cinta de alta resistencia. Incluimos pacientes en los que obtuvimos un injerto de IQT <8 mm o ≥8 mm de mala calidad. Se registró edad, sexo, índice de masa corporal (IMC) y actividad previa. Se realizó una evaluación clínica y funcional donde se registró el rango de movilidad posoperatoria (ROM), el dolor y la escala funcional de Lysholm. Se analizaron la tasa de complicaciones, la tasa de fallo del injerto y la tasa de reintervenciones. Resultados: Se incluyeron un total de 160 pacientes con una edad media de 29,19 años. De estos, 98 eran varones y 62 mujeres, y el IMC medio fue de 23,5. El seguimiento medio fue de 31,7 meses. El ROM medio fue de 137,2°, el dolor medio fue de 0,8 y la puntuación media en la escala de Lysholm fue de 95,1. Detectamos una tasa de complicaciones del 11%, de los cuales hubo que reintervenir al 5%. La tasa de fallo del injerto fue del 1,3%. Se asoció la obtención de una plastia <8 mm al sexo femenino con una p < 0,0001 con el test exacto de Fischer. En los demás parámetros, no encontramos diferencias estadísticamente significativas entre aquellos pacientes que habían recibido un injerto <8 mm y aquellos con injertos ≥8 mm. Conclusiones: El presente estudio muestra que el uso de un refuerzo en la reconstrucción del LCA es un procedimiento seguro, que ofrece excelentes resultados clínicos y funcionales y una baja tasa de reintervenciones y de fallo del injerto.

Tinghua Jiang, Xinuo Zhang, Qingjun Su et al.

ABSTRACT Purpose Long‐segment spinal fusions are associated with lumbosacral complications (LSC), but the associated risk factors are not known. This study aimed to identify the risk factors for LSC after long‐segment instrumented fusion with distal fixation to the L5 vertebral body in adult degenerative scoliosis (ADS). Methods We retrospectively evaluated 294 patients with ADS who underwent long‐segment floating fusion between January 2014 and March 2022, with follow‐up for at least 2 years. Patients were matched to the baseline data using fusion level > 5 as a grouping variable. Patients who completed matching were divided into two groups according to the presence or absence of LSC. Univariate logistic regression was applied to identify potential risk factors for LSC, and multivariate logistic regression was used to identify independent risk factors for postoperative LSC. Results The overall incidence of LSC was 21.77% in the 294 patients, with disc degeneration in 28 (9.52%) and radiographic ASD in 44 (14.97%) patients. The mean time to LSC development after surgery was 26.91 ± 8.43 months. A total of 54 pairs of patients were matched and grouped, and the complication group had higher Oswestry Disability Index (ODI) and visual analog scale (VAS) scores at the last follow‐up. Multivariate analysis showed that gender (OR = 0.274, p = 0.026 [0.087, 0.859]); levels of fusion > 5 (OR = 3.127, p = 0.029 [1.120, 8.730]), main curve correction rate (OR = 0.009, p = 0.005 [0.000, 0.330]), and postoperative pelvic incidence minus lumbar lordosis (PI‐LL) > 15° (OR = 3.346, p = 0.022 [1.195, 9.373]) were independent risk factors for postoperative LSC. The area under the curve value of the prediction model was 0.804, with a 95% confidence interval of 0.715–0.892, indicating that the model had a high prediction accuracy. Collinearity statistics showed no collinearity between variables. Conclusion Sex, level of fusion > 5, main curve correction rate, and postoperative PI‐LL > 15° were independent risk factors for the development of LSC after long‐segment floating fusion. These results will improve our ability to predict personal risk conditions and provide better medical optimisation for surgery.

Jennifer S. Hanberg, Faith Selzer, Elena Losina et al.

Background: Bilateral knee osteoarthritis (KOA) is common, but evidence for the effect of bilateral versus unilateral KOA on functional outcomes is conflicting. We aimed to examine the association between bilateral versus unilateral KOA and physical performance measures over two years. Methods: Our cohort included adults with symptomatic, radiographic KOA. Study assessments at baseline, 12 and 24 months included the 30-s chair sit-to-stand task (CST) and 40-m walk (40 ​MW). We defined bilateral KOA as Kellgren-Lawrence grade ≥2 and Knee Osteoarthritis Outcome Pain Scale ≥17/100 in both knees. We used linear mixed models to (1) assess the cross-sectional association between the presence of bilateral versus unilateral KOA at each timepoint and performance measures, and (2) assess the association between bilateral versus unilateral KOA at baseline and longitudinal changes in performance measures. Models were adjusted for clinical and demographic covariates. Results: 101 participants were included. At baseline, 43/101 (43 ​%) had bilateral KOA. In adjusted models, bilateral, versus unilateral, KOA was associated with 1.0 fewer stands on the CST (95 ​% CI: 2.2–0.1), and a 0.03 ​m/s slower 40 ​MW (95 ​% CI: 0.10–0.04). Average 2-year change in CST was −0.6 stands in those with baseline bilateral KOA and −0.7 in those with unilateral KOA (between-group difference, 0.1 stands (95 ​% CI: 1.7–1.8)). The baseline bilateral KOA group had greater worsening in 40 ​MW time (between-group difference −0.10 ​m/s (95 ​% CI: -0.20–0.00)). Conclusions: We did not find clinically significant associations between bilateral vs unilateral KOA and performance on two physical performance tasks over two years of follow-up in this cohort study.

Shyla Gupta, Anna Paliczak, Diego Delgado

ABSTRACT Introduction: Platelet-rich plasma (PRP) is an autologous blood-derived product that contains platelet concentrations at least 2/3 times above the normal level and includes platelet-related growth factors. The concept of PRP began in the 1970s in the field of hematology to treat patients with thrombocytopenia. In the 1980s and 1990s, PRP began to be used in surgical procedures such as maxillofacial surgery and plastic surgery. Since then, PRP had been used in orthopedic procedures, cardiac surgery, sports injuries, plastic surgery, gynecology, urology, and more recently in medical esthetics. Areas covered: This review analyzes the mechanisms of action, current indications, clinical evidence, safety and future directions of PRP in the management of various medical conditions. The literature search methodology included using medical subject headings terms to search in PubMed. Articles used were screened and critically appraised by the coauthors of this review. Expert Opinion: Platelet-rich plasma is a therapeutic option used to treat many medical conditions. PRP could be used alone or in combination with other procedures. The effectiveness and safety of PRP has been demonstrated in many medical scenarios, however there is limited availability of large randomized clinical trials.

Mark H.F. Keulen, MD, Yoeri F.L. Bemelmans, MSc, PhD, B. Boonen, MD, PhD et al.

Background: Optimization of clinical pathways and logistics led to the introduction of outpatient joint arthroplasty of the hip and knee. Nevertheless, little is known about what these current protocols look like and how they differ from ''standard'' inpatient protocols. This study aimed to find preoperative, intraoperative, and postoperative differences between outpatient and inpatient pathways. Methods: A questionnaire (ranging between 23 and 37 items) was developed and administered by email to orthopedic surgeons who were a member of the Dutch Hip Society and Dutch Knee Society. Survey response rate was 38% (N = 117). Results: No significant differences were found in preoperative pathway characteristics. The administration regime for tranexamic acid significantly differed between outpatient and inpatient pathways (P < .001 and P = .002 for hip and knee arthroplasty, respectively), with outpatient pathways using a combined (eg, oral and intravenous) administration regime more frequently. The perioperative antibiotic prophylaxis regime also significantly differed between outpatient and inpatient pathways (P < .001 and P = .014, respectively), with outpatient pathways more frequently incorporating fewer antibiotic doses. Same-day postoperative mobilization significantly less often occurred if surgery took place later that day in inpatient hip arthroplasty pathways (24%; P = .034). Postoperative hemoglobin-check occurred significantly more often on indication in outpatient than in inpatient hip and knee arthroplasty pathways (∼75% vs ∼25%; P = .001). Conclusions: Few intraoperative and postoperative differences in outpatient and inpatient pathways were found and probably mainly relied on logistical grounds. Nonetheless, findings suggested that outpatient pathways tended to be more up-to-date and innovative than inpatient pathways.

Mohammed Shaath, Mark Falworth, William Rudge et al.

W. Ng, A. Jerath, M. Wąsowicz

P. Everts, J. Knape, G. Weibrich et al.

Strategies to reduce blood loss and transfusion of allogeneic blood products during surgical procedures are important in modern times. The most important and well-known autologous techniques are preoperative autologous predonation, hemodilution, perioperative red cell salvage, postoperative wound blood autotransfusion, and pharmacologic modulation of the hemostatic process. At present, new developments in the preparation of preoperative autologous blood component therapy by whole blood platelet-rich plasma (PRP) and platelet-poor plasma (PPP) sequestration have evolved. This technique has been proven to reduce the number of allogeneic blood transfusions during open heart surgery and orthopedic operations. Moreover, platelet gel and fibrin sealant derived from PRP and PPP mixed with thrombin, respectively, can be exogenously applied to tissues to promote wound healing, bone growth, and tissue sealing. However, to our disappointment, not many well-designed scientific studies are available, and many anecdotic stories exist, whereas questions remain to be answered. We therefore decided to study perioperative blood management in more detail with emphasis on the application and production of autologous platelet gel and the use of fibrin sealant. This review addresses a large variety of aspects relevant to platelets, platelet-rich plasma, and the application of platelet gel. In addition, an overview of recent animal and human studies is presented.

Tyler S. Wahl, L. Graham, M. Hawn et al.

Giuseppe La Rocca, Edoardo Mazzucchi, Fabrizio Pignotti et al.

Abstract Background Minimally invasive spine surgery is a field of active and intense research. Image-guided percutaneous pedicle screw (PPS) placement is a valid alternative to the standard free-hand technique, thanks to technological advancements that provide potential improvement in accuracy and safety. Herein, we describe the clinical results of a surgical technique exploiting integration of neuronavigation and intraoperative neurophysiological monitoring (IONM) for minimally invasive PPS. Materials and Methods An intraoperative-computed tomography (CT)-based neuronavigation system was combined with IONM in a three-step technique for PPS. Clinical and radiological data were collected to evaluate the safety and efficacy of the procedure. The accuracy of PPS placement was classified according to the Gertzbein–Robbins scale. Results A total of 230 screws were placed in 49 patients. Only two screws were misplaced (0.8%); nevertheless, no clinical sign of radiculopathy was experienced by these patients. The majority of the screws (221, 96.1%) were classified as grade A according to Gertzbein–Robbins scale, seven screws were classified as grade B, one screw was classified as grade D, and one last screw was classified as grade E. Conclusions The proposed three-step, navigated, percutaneous procedure offers a safe and accurate alternative to traditional techniques for lumbar and sacral pedicle screw placement. Level of Evidence Level 3. Trial registration Not applicable.

C. Tremolada, Valeria Colombo, C. Ventura

In the past few years, interest in adipose tissue as an ideal source of mesenchymal stem cells (MSCs) has increased. These cells are multipotent and may differentiate in vitro into several cellular lineages, such as adipocytes, chondrocytes, osteoblasts, and myoblasts. In addition, they secrete many bioactive molecules and thus are considered “mini-drugstores.” MSCs are being used increasingly for many clinical applications, such as orthopedic, plastic, and reconstructive surgery. Adipose-derived MSCs are routinely obtained enzymatically from fat lipoaspirate as SVF and/or may undergo prolonged ex vivo expansion, with significant senescence and a decrease in multipotency, leading to unsatisfactory clinical results. Moreover, these techniques are hampered by complex regulatory issues. Therefore, an innovative technique (Lipogems®; Lipogems International SpA, Milan, Italy) was developed to obtain microfragmented adipose tissue with an intact stromal vascular niche and MSCs with a high regenerative capacity. The Lipogems® technology, patented in 2010 and clinically available since 2013, is an easy-to-use system designed to harvest, process, and inject refined fat tissue and is characterized by optimal handling ability and a great regenerative potential based on adipose-derived MSCs. In this novel technology, the adipose tissue is washed, emulsified, and rinsed and adipose cluster dimensions gradually are reduced to about 0.3 to 0.8 mm. In the resulting Lipogems® product, pericytes are retained within an intact stromal vascular niche and are ready to interact with the recipient tissue after transplantation, thereby becoming MSCs and starting the regenerative process. Lipogems® has been used in more than 7000 patients worldwide in aesthetic medicine and surgery, as well as in orthopedic and general surgery, with remarkable and promising results and seemingly no drawbacks. Now, several clinical trials are under way to support the initial encouraging outcomes. Lipogems® technology is emerging as a valid intraoperative system to obtain an optimal final product that may be used immediately for regenerative purposes.

Hugo Barret, MD, Olivier Bozon, MD, Guillaume Fassot, MD et al.

Background: Scapulectomy is one of the surgical options in the case of malignant lesions in the scapula with an indication of surgical removal. Very few series in the literature have looked at postoperative quality of life and emotional acceptance, particularly in the case of scapulectomy without reconstruction. The objective is to assess the midterm results of scapulectomies in terms of function, quality of life, and acceptance for the patient. Methods: With a mean follow-up of 85 months (range 42 months-180 months), 11 scapulectomies for malignant tumors were performed with a mean age of 50 years: 5 partial scapulectomies, 4 total scapulectomies, and 2 subtotal scapulectomies. There were 6 chondrosarcomas, 2 high-grade osteosarcomas, 1 malignant peripheral nerve sheath tumor, and 1 low-grade atypical epithelioid sarcoma. The radio-clinical analysis was focused on functional results and mental health evaluation. Results: The mean Musculoskeletal Tumor Society score of 11 scapulectomies was 20 ± 5 at 66% of normal, with the Disabilities of the Arm, Shoulder and Hand (DASH) score of 35 ± 26, and the Toronto Extremity Salvage Score of 76%. Patients had controlled pain (mean visual analog scale 1/10). Mobilities of the 11 scapulectomies were correct: average active anterior elevation of 89.5 ± 43 degrees, average abduction of 81 ± 42 degrees, average external rotation of 30 ± 25 degrees, and average internal rotation was at L5. Scapulectomy results in impaired physical and mental health compared with the general population (PCS-12 = -9; MCS-12 = -7). Partial scapulectomy, compared to total scapulectomy, gave better results: Musculoskeletal Tumor Society score (14 ± 1 vs. 24 ± 1 P = .0175), acceptance (45 ± 9 vs. 92 ± 16, P = .0184), mental health (MCS-12: 29 ± 1 vs. 55 ± 4, P = .0175), and Toronto Extremity Salvage Score (84 ± 5 vs. 68 ± 7, P = .0195). Partial and subtotal scapulectomies were better accepted (45 ± 9 vs. 86 ± 23, P = .0323) and tolerated (MCS-12: 29 ± 1 vs. 52 ± 6, P = .0099) by the patient compared to total scapulectomy. Conclusion: Total or partial scapulectomies without scapula reconstruction remain a disabling procedure performed with consequences on the physical and mental health of the patients. Partial or subtotal scapulectomy should be performed whenever possible because it seems to be associated with a better functional prognosis as well as less poor mental health and emotional acceptance of the patients, even though total scapulectomy may be necessary to obtain a complete curative tumor resection, which is the main goal.

Masashi Shimamura, Ken Iwata, Takaaki Fujiki et al.

Background Developmental dysplasia of the hip (DDH) is the main factor that causes secondary osteoarthritis of the hip (hip OA). Acetabular retroversion results in pincer‐type femoroacetabular impingement (FAI), and this is also known to cause secondary hip OA. However, few cases of DDH with acetabular retroversion have been reported, and there is no definite opinion on the optimal treatment. We report a rare case of DDH and FAI owing to acetabular retroversion and dysostosis of the sacroiliac joint that was treated with eccentric acetabular rotational osteotomy (ERAO) using navigation guidance. Case Presentation A 27‐year‐old woman presented with DDH and acetabular retroversion with FAI and dysostosis of the sacroiliac joint on the contralateral side. We performed ERAO using computed navigation guidance and improved the coverage and retroversion of the acetabulum. The acetabular anteversion angle improved from 1° retroversion to 9° anteversion after surgery, the center edge angle improved from 18° to 43°, and the acetabular head index improved from 69% to 93%. The cam lesion of the femur was resected. The Harris Hip Score improved from 55.7 to 100 points at the final examination 2 years after surgery. Conclusions In this rare case of DDH and FAI, ERAO using computed navigation guidance accurately improved the coverage and retroversion of the acetabulum.

B, Nacime Salomão Barbachan Mansur, Vineel Mallavarapu et al.

Objective: To assess whether traditional hallux valgus (HV) measurements obtained with conventional radiography (CR) correspond to those obtained with weight-bearing computed tomography (WBCT). Methods: In this retrospective case-control study, 26 HV feet and 20 control feet were analyzed with CR and WBCT. Hallux valgus angle (HVA), intermetatarsal angle (IMA), interphalangeal angle (IPA), distal metatarsal articular angle (DMAA), sesamoid station (SS), and first metatarsal head shape were measured. Chi-square tests were used to compare hallux valgus and control patients. T-tests were used to compare CR and WBCT. P-values less than 0.05 were considered significant. Results: WBCT was capable of discriminating patients with HV from controls, showing higher mean values for HV patients than controls in HVA (35.29 and 9.02, p < 0.001), IMA (16.01 and 10.01, p < 0.001), and DMAA (18.90 and 4.10, p < 0.001). When comparing the two methods, differences were not significant between CR and WBCT measurements in HVA (-0.84, p = 0.79), IMA (-0.93, p = 0.39), IPA (1.53, p = 0.09), or SS (p = 0.40), but were significant for DMAA (13.43, p < .0001). CR analysis yielded varied metatarsal head shapes, while all WBCT shape classifications were round.  Conclusion: Unidimensional HV measurements were similar between WBCT and CR, while more three-dimensional findings were not. CR may be used to assess the axial aspects of HV, but multidimensional aspects of the deformity may not be accurately assessed with plain radiographs. Level of Evidence III; Therapeutic Studies; Retrospective Case-Control Study.

Zunhan Liu, Xuetao Yang, Yuhan Li et al.

Abstract Background To determine whether multiple drilling is effective in postponing the need for total hip arthroplasty (THA) in early-stage nontraumatic osteonecrosis of the femoral head (ONFH). Methods We identified 514 patients who were diagnosed with early-stage ONFH between January 2008 and December 2018. One hundred ninety-six patients underwent multiple drilling, and 318 patients had a natural course of progression. One hundred fifty-nine patients were selected for each group after case-control matching for preoperative demographics and modified Ficat and Arlet stage. The rates of THA conversion were compared. We also performed Cox regression to identify risk factors associated with THA conversion in patients who underwent multiple drilling. Results Kaplan-Meier survivorship with an endpoint of THA for nontraumatic reasons were not significantly different between the multiple drilling group (75.6, 95% confidence interval 67.8–83.4%) and the natural course group (72.2, 95% confidence interval 64.8–79.6%) at 5 years (log-rank, P = .191). In the Cox regression model, a larger extent of necrotic lesion, bone marrow edema (BME), and higher postoperative work intensity significantly increased the risk of THA conversion (P < .05). Among patients treated with autogenous bone grafting, there was a lower risk of failure in patients with necrotic lesion less than 15% (P < .05). Conclusions Multiple drilling is not effective in reducing the rate of THA conversion in early-stage nontraumatic ONFH. The risk of conversion to THA after multiple drilling is increased by a larger extent of necrotic lesion, presence of BME, and higher postoperative work intensity in patients with early-stage ONFH. Trial registration The trial was registered in the Chinese Clinical Trial Registry ( ChiCTR2000035180 ) dated 2 August 2020.

Tomohiro Matsumura MD, PhD, Tsuneari Takahashi MD, PhD, Mitsuharu Nakashima MD et al.

Introduction: The TFN-ADVANCED Proximal Femoral Nailing System (TFNA) 235 mm (DePuySynthes) and Proximal Femoral Nail Antirotation (PFNA)-II 240 mm (DePuySynthes) were developed to obtain better stability for patients with trochanteric hip fractures without increasing surgical time and amount of blood loss. However, there are currently no studies concerning clinical and radiological outcomes of patients treated using these proximal femoral nails (PFNs) that have been performed in the Japanese population. The aim of this study was to retrospectively evaluate the clinical outcomes associated with 235 to 240 mm PFNs for Japanese patients >70 years old with trochanteric hip fractures who could walk independently before the injury. Materials and Methods: This study involved a retrospective analysis of data on trochanteric hip fracture patients who had undergone internal fixation from March 2016 to June 2018. The inclusion criteria were patients >70 years old with trochanteric hip fractures who could walk independently before the injury and were followed up for ≥3 months after surgery. Initially, 124 patients were identified, but 33 of these were excluded because other implants were used for internal fixation. Of the remaining 91 patients in whom PFNs were used at the time of internal fixation who were included for the perioperative evaluation, 66 patients followed up for ≥3 months were included in the clinical evaluations. Results: The average surgical time was 56.8 ± 19.6 minutes (range, 23-123 minutes). The average blood loss was 89 ± 41 mL (range, 0-245 mL). The union rate was 98%. Discussion: There were no cases of nail jamming, and all nails were successfully inserted below the end of the distal isthmus without additional reaming to dilate the canal. Conclusions: Proximal femoral nails were a useful implant in Japanese elderly patients with trochanteric hip fractures and gave comparable clinical outcomes despite the femoral length being short and occurrence of intensive bowing.

Gennadiy N. Ponomarenko, Konstantin K. Shcherbina, Ludmila M. Smirnova et al.

Introduction The archives, which include 670 medical cases filed at the Leningrad Research Institute for Prosthetics (LNIIP) during the siege of the city, is unique for understanding the specific scope of medical work during the tragic time of the Great Patriotic war. The purpose of the study was to analyze the activities of the Leningrad Research Institute for Prosthetics in the besieged Leningrad during the Great Patriotic war. Methods The analysis of the LNIIP archives using the methods of content analysis, deduction, induction and synthesis was carried out. 670 cases related to the time of the Great Patriotic war were studied. Statistical data processing was performed. Results The LNIIP hospital worked as a front-line evacuation station from 01.09.1941 to 30.12.1942 and treated a total of 1,221 patients. 131 medical records of military officers and soldiers treated there during that period were found. The reason for hospitalization in 65 % of those patients was the consequences of shrapnel wounds, gunshot and mine explosion injuries were less frequent. In the period from 25.05.1943 to 19.06.1945, there were 539 medical records of civilians. In 51 % of the cases, the reason for hospitalization was shrapnel wounds, gunshot and mine explosion wounds and only 2 % were pre-war cases. Discussion The nature of injuries the civilian population of the besieged Leningrad did not differ from that of the front-line soldiers. The front passed right through the besieged city, and its inhabitants were soldiers of that front. 1428 medical interventions were performed including 31 % of operative plasty procedures (re-amputation, skin and bone grafting, amputation) and 32 % were surgical interventions. 356 individuals were provided with prostheses, 10 with orthopedic devices, and 48 with orthopedic shoes. Preparation for prosthetic fitting was complicated by avitaminosis, dystrophy, and scurvy. The work of LNIIP in the extreme conditions of the war and blockade is a vivid example of the contribution of medical workers to the victory of the whole country. The experience of organizing a medical hospital in special conditions has not lost its relevance today.

Michael S. Kain, David Saper, Kyle Lybrand et al.

In current clinical practice, orthopedic surgeons often delay the surgery intervention on geriatric hip fracture patients to optimize the international normalized ratio (INR), in order to decrease the risk of postoperative hematological complications. However, some evidence suggests that full reversal protocols may not be necessary, especially for patients with prior thromboembolic history. Our study aims to compare the surgical outcomes of patients with normal versus elevated INR values. We conducted a retrospective chart review on 217 patients who underwent surgeries on hip fractures at two academic trauma centers. We found that in our group (n = 124) of patients with an INR value of 1.5–3.0, there was only one reoperation for a hematoma, but there was a trend for more blood transfusions. There was no statistically significant difference in the odds of reoperation or overall complications. Nevertheless, there were significantly more events of postoperative anemia in this high INR patient group.

Turan Cihan Dülgeroğlu, Baran Şen

Platelet-rich fibrin (PRF) is a naturally derived fibrinscaffold and second-generation platelet concentrate with great potential forpromoting wound healing and the regenerative process via the secretion ofdifferent cytokines and growth factors, enhanced osteoblast adhesion, andaugmentation of collagen protein expression. Given the significance of thescope of PRF in the field of orthopedic surgery, this study presents an overviewfor the role of PRF in the recovery and the regenerative process with emphasison its rationale for use and outcome in orthopedic surgery. In conclusion, PRFoffers a new dimension for clinical research with expanded range of potentialapplications in orthopedic surgery with a simpler preparation protocol, astronger and more stable fibrin polymerization leading to a physiologicarchitecture, occurrence of natural clot formation allowing formation of aflexible and fine fibrin network and a continual and steady release ofcytokines and growth factors, mimicking the requirements of the reparativetissue and wound healing processes.

William Dias Belangero, Carlos Miguel Zublin, Sergio Nicolas Martinez Siekavizza et al.

Purpose: To present transversal data (demographic and clinical) on isolated humeral shaft fractures (HSFs) in Latin American countries. Methods: Patients were enrolled between December 2015 and April 2017 at 11 medical institutions from six Latin America countries. Inclusion criteria: Age ≥18 years and a closed, isolated 12A, 12B, or 12C fracture (Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA) classification). The patients’ demographic, comorbidity, and other baseline data were recorded. The outcome measures included the basal results of the research and the associations among the demographic factors, fracture features, and type of treatment applied. Results: A total of 123 patients were included. There was a preponderance of men (61.8%), whose mean age was significantly lower than that of the women (31.48 vs. 60.55). Overweight or obesity was present in 61.0% of women; 56.1% of patients were sedentary, 75.6% were nonsmokers, and 74.0% had no chronic disease. The type or treatment (operative/nonoperative) was not significantly associated with the patient’s or fracture’s characteristics. Falls and traffic accidents were the main causes of HSFs. Intramedullary nailing treatment was performed significantly more often in women, elderly patients, patients who did not participate in sports, and patients participating in only home activities. Minimally invasive plate osteosynthesis was performed significantly more frequently in men and in those who were self-employed. Open reduction internal fixation was performed significantly more often when the cause of the fracture was a traffic accident and when radial nerve palsy was present. Conclusion: The demographics and etiological differences observed in comparison to the current literature show the importance of regional studies for both preventive measures and educational guidance.