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BackgroundClinical management in orthogeriatric units and outcome indicators are similar for extracapsular fragility hip fractures, without discriminating between subtrochanteric and pertrochanteric fractures.HypothesisGeriatric patients, 75 years or older, with subtrochanteric fractures have worse clinical and functional outcomes than those with pertrochanteric fractures.Materials and methodsRetrospective observational study of data prospectively collected by the Spanish Hip Fracture Registry including patients 75 years or older, admitted for extracapsular hip fractures from January 2017 to June 2019. Demographic and baseline status, pre-operative, post-operative and 30-day follow-up data were included.ResultsA total of 13,939 patients with extracapsular hip fractures were registered: 12,199 (87.5%) pertrochanteric and 1740 (12.5%) subtrochanteric. At admission, patients with subtrochanteric fractures were younger (86.5 ± 5.8 versus 87.1 ± 5.6 years old), had better pre-fracture mobility (3.7 ± 2.7 versus 3.9 ± 2.8) (1-to-10 scale, 1 being independent) and were more likely to be living at home; those with pertrochanteric fractures had worse cognitive function (Pfeiffer 3.3 ± 3.3 versus 3.8 ± 3.5). The subtrochanteric fracture group showed worse post-fracture mobility (7.3 ± 2.7 versus 6.7 ± 2.7) and greater deterioration of mobility (3.7 ± 3.0 versus 2.9 ± 2.7). Among individuals living at home at baseline, those with subtrochanteric fractures were more likely to remain in an assisted facility at 30-day follow-up. In-hospital mortality during acute admission was higher for the subtrochanteric group (5.6% versus 4.5%) (p = 0.028). To our knowledge, this is the first paper highlighting the differences between these two fracture groups in the geriatric population.ConclusionsSubtrochanteric fractures in the older population are a different and worse entity, with greater morbimortality and functional decline than pertrochanteric fractures. Despite being younger and fitter at admission, older patients with subtrochanteric fractures have a higher risk of remaining non-weight bearing and undergoing re-operation and institutionalization. Orthogeriatric units should be aware of this and manage subtrochanteric fractures accordingly.Level of evidence: IV.

Supervised, center-based, daily physiotherapy presents limitations: transport, need for an accompanying person, or risk of infection. Home-based rehabilitation protocols (HBRP) can be effective alternatives. We use a HBRP for the non-surgically treated proximal humeral fractures (PHF) in older patients. Objectives To assess patient satisfaction and preferences of using a booklet, videos, or an app to guide physiotherapy. Patients and methods Prospective, single-center observational study of patients ≥55 years old who sustained a non-surgically treated PHF. The HBRP consisted of immediate mobilization, followed by 5 physiotherapist-guided, weekly sessions of rehabilitation and standard physiotherapy after 3 months, if needed. A booklet with images, videos, or a smartphone application were offered to guide the patients. Results Mean degree of satisfaction (1-5) was 4.66 ± .9: 84 patients (82.4%) were very satisfied, 11 patients (10.8%) were satisfied, and 5 patients (4.9%) were not satisfied at all. Mean Oxford Shoulder Score achieved was 40.5 ± 6.6. 59.8% patients preferred the booklet and 29.4% the videos. Exercise compliance was considered very high in 87.3% of patients, while 4% hardly never followed the HBRP. Only 17.7% patients needed center-based physiotherapy after the HBRP. Discussion Reasons for satisfaction were good final functional outcome, no need for transportation, being away from hospital, immediate rehabilitation availability and being capable of maintaining independence. Adherence is a major concern. Videos are more didactic explaining the exercises. Conclusion If standard physiotherapy is not available, the HBRP can be a valid treatment option for PHF management in older patients, with a high degree of patient satisfaction. Older patients preferred the booklet to guide physiotherapy.

Purpose The purpose of this study was to compare results of partial proximal fasciotomy (PPF) with proximal medial gastrocnemius release (PMGR) in the treatment of chronic plantar fasciitis (CPF). Method This retrospective study compares 30 patients with CPF that underwent PPF with 30 that underwent isolated PMGR. Both groups were matched in terms of previous treatments and time from onset of symptoms to surgery. Different standardised evaluation scales (VAS, Likert, AOFASh) were used to evaluate results. Results Plantar fasciotomy had satisfactory results in just 60 % of patients, with an average ten weeks needed to resume work and sports. Patient satisfaction in the PMGR group reached 95 %, being back to work and sports at three weeks on average. Functional and pain scores were considerably better for PMGR and fewer complications registered. Conclusion In our series, isolated PMGR is a simple and reliable procedure to treat patients with CPF. It provides far better results than conventional fasciotomy with less morbidity and better patient satisfaction, and thus has become our surgical procedure of choice in recalcitrant CPF.

BackgroundThe incidence of all periprosthetic fractures (PPF), which require complex surgical treatment associated with high morbidity and mortality, is predicted to increase. The evolving surgical management has created a knowledge gap regarding its impact on immediate outcomes. This study aimed to describe current management strategies for PPF and their repercussions for in-hospital outcomes as well as to evaluate their implications for the community.MethodsPIPPAS (Peri-Implant PeriProsthetic Survival Analysis) was a prospective multicentre observational study of 1387 PPF performed during 2021. Descriptive statistics summarized the epidemiology, fracture characteristics, management, and immediate outcomes. A mixed-effects logistic regression model was employed to evaluate potential predictors of in-hospital mortality, complications, discharge status, and weight-bearing restrictions.ResultsThe study encompassed 32 (2.3%) shoulder, 4 (0.3%) elbow, 751 (54.1%) hip, 590 (42.5%) knee, and 10 (0.7%) ankle PPF. Patients were older (median 84 years, IQR 77–89), frail [median clinical frailty scale (CFS) 5, IQR 3–6], presented at least one comorbidity [median Charlson comorbidity index (CCI) 5, IQR 4–7], were community dwelling (81.8%), and had outdoor ambulation ability (65.6%). Femoral knee PPF were most frequently associated with uncemented femoral components, while femoral hip PPF occurred equally in cemented and uncemented stems. Patients were managed surgically (82%), with co-management (73.9%), through open approaches (85.9%) after almost 4 days (IQR, 51.9–153.6 h), with prosthesis revision performed in 33.8% of femoral hip PPF and 6.5% of femoral knee PPF. For half of the patients, the discharge instructions mandated weight-bearing restrictions. In-hospital mortality rates were 5.2% for all PPF and 6.2% for femoral hip PPF. Frailty, age > 84 years, mild cognitive impairment, CFS > 3, CCI > 3, and non-geriatric involvement were candidate predictors for in-hospital mortality, medical complications, and discharge to a nursing care facility. Management involving revision arthroplasty by experienced surgeons favoured full weight-bearing, while an open surgical approach favoured weight-bearing restrictions.ConclusionsCurrent arthroplasty fixation check and revision rates deviate from established guidelines, yet full weight-bearing is favoured. A surgical delay of over 100 h and a lack of geriatric co-management were related to in-hospital mortality and medical complications. This study recommends judicious hypoaggressive approaches. Addressing complications and individualizing the surgical strategy can lead to enhanced functional outcomes, alleviating the economic and social burdens upon hospital discharge.Level of Evidence Level IV case series.Trial registration: registered at ClinicalTrials.gov (NCT04663893), protocol ID: PI 20-2041.

Background Periprosthetic femoral fractures following hip arthroplasty (FH-PPF) represent a severe complication, especially in elderly patients with compromised health. Traditionally, revision arthroplasty is recommended for B2–B3 FH-PPF, yet internal fixation has emerged as a debated alternative in select patients. The hypothesis was that fixation, in selected patients with B2–B3 FH-PPF, decreases mortality and surgical complication rates with the same functional outcomes as revision arthroplasty. Materials and methods PIPPAS is a multicenter prospective observational study. This cohort substudy includes 485 patients across 57 hospitals with B2–B3 FH-PPF between January 2021 and May 2023. Management strategy, revision or fixation, was at the attending surgeon’s discretion. Propensity score matching, controlled for age, age-adjusted Charlson Comorbidity Index (a-CCI), prefracture mobility, Pfeiffer scale, and ASA score, was done. Mortality risk factors were assessed using univariate and multivariate analysis. Results Out of 485 patients, 164 received fixation, and 321 underwent revision. Fixation patients were older (88 versus 82 years, p  < 0.001) and frailer. Fixation was associated with shorter hospital stay (13 versus 15 days, p  = 0.003) but higher 1-year mortality (25% versus 14.3%, p  = 0.04). There were no differences in medical or surgical complications ( p  = 0.83 and p  = 0.36) at any time, but dislocation rate was higher in the revision group ( p  = 0.001). The 1-year mortality rate in patients with no weight-bearing restrictions was higher for the revision group ( p  = 0.01). The propensity score matching showed higher 1-year mortality rate in the fixation group but no differences in functional outcomes, complications, or up to 6-months mortality. In the multivariate analysis a-CCI, cognitive impairment, B3 fractures, and prefracture independent walking impairment were independent mortality risk factors. Conclusions Revision arthroplasty showed less 1-year mortality rate and weight-bearing restrictions than fixation. However, frail patients with B2–B3 FH-PPF managed with fixation allowing full weight-bearing showed a lower 1-year mortality rate. Fixation in B2–B3 FH-PPF is a treatment option in frail patients, while aiming for stable constructions allowing full weight-bearing. Level of Evidence II: prospective cohort study. Trial registration: ClinicalTrials.gov (NCT04663893) Graphical Abstract