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This study aimed to investigate the outcomes of elderly acetabular fractures according to the reduction of impacted dome fragments. A retrospective cohort study was performed in two institutions. Fifty-four patients aged ≥ 60 years with acetabular fractures were enrolled. Data for dome impaction and postoperative reduction was collected. Patients were divided into the good reduction group (displacement ≤ 3 mm) and poor reduction group (displacement > 3 mm). Postoperative osteoarthritis (OA), Harris hip score (HHS), total hip arthroplasty conversion, good/poor outcomes were compared between the two groups. The good reduction group (N = 45) demonstrated a lower proportion of radiographic OA (18 vs. 77%, P  = 0.001), higher HHS (82.1 vs. 68.6, P  = 0.022), and higher proportion of good outcomes than the poor reduction group (N = 9) (89 vs. 22%, P  < 0.001). In a subgroup analysis of the patients with dome impaction, the good reduction group had a higher proportion of good outcomes (80 vs. 20%, P  = 0.031). On comparing within the good reduction group, dome impaction did not influence clinical outcomes. Elderly acetabular fractures demonstrated favorable outcomes when adequate reduction was achieved even with dome impaction. Well-reduced dome impaction could achieve satisfactory outcomes in elderly acetabular fractures.

The Figure-of-Eight Walk Test (F8WT) can assess straight- and curved-path walking ability, but the validity and reliability of automated measurement of the F8WT using digital device has not yet been studied. The aim of this study was to verify the validity (method comparison) and test-retest reliability of the automated FW8T (aFW8T) using a digital device based on image analysis by comparing the results of the aF8WT with those of the manual F8WT (mF8WT). Community-dwelling older adults underwent the mF8WT performed by a physiotherapist and the aF8WT using the Digital Senior Fitness Test system. To verify the test-retest reliability, the aF8WT was administered again to a randomly selected group of participants one week after the baseline test. The intraclass correlation coefficient (ICC) and Pearson's correlation analysis were used to verify the degree of agreement between the results of and correlation between the mF8WT and aF8WT, respectively. The 95% confidence interval (CI) of the limits of agreement (LoA) was obtained using Bland-Altman analysis. The analysis included 83 participants (mean age 71.6 ± 4.7 years). The participants' mF8WT and aF8WT results were 29.1 ± 4.9 and 29.8 ± 4.9 seconds, respectively. Pearson's correlation analysis showed a very strong correlation between the mF8WT and aF8WT results with r = 0.91 (p < 0.001), and the ICC between the mF8WT and aF8WT results was 0.95 (0.91-0.97), showing excellent agreement. The 95% CI of the LoA was -0.7 (-4.8 to 3.3) seconds in the Bland-Altman analysis. In an analysis of the test-retest reliability of the aF8WT, participants' aF8WT results were 30.9 ± 4.7 seconds (baseline) and 29.6 ± 4.9 seconds (retest), with an ICC of 0.94 (0.81-0.98, p < 0.001), indicating excellent reliability. Automated measurement of the F8WT using a digital device showed excellent validity and reliability. The aF8WT can be used to assess and monitor the walking ability of community-dwelling older adults.

Sagittally unstable intertrochanteric fracture (SUITF) is the posterior displacement of the shaft fragment (posterior sagging, [PS]) which causes difficulty in achieving an acceptable closed reduction in lateral view. This study aimed to validate the morphological characteristics of SUITF. Data of patients with acute intertrochanteric fractures who underwent surgery were retrospectively reviewed. Altogether, 382 patients were enrolled and classified into the PS and control groups, based on the presence of PS. We obtained morphological characteristics on plain radiographs based on literature (Long medial beak, anterosuperior obliquity, lesser trochanter (LT) detachment, extramedullary beak, and V shape cortical defect). Comparison between groups and multivariable analysis were performed using a multiple Firth logistic regression analysis. For all morphological characteristics, the proportion of patients was significantly higher in the PS group than in the control group. In the multiple Firth logistic regression analysis, ‘long medial beak distal to lesser trochanter (LT)’ (OR, 7.93; 95%CI: 1.72–36.59; P  = 0.008); ‘anterosuperior obliquity’ (OR, 23.87; 95%CI: 1.37–415.54; P  = 0.030); ‘LT detachment,’ (OR, 10.15; 95%CI: 2.03–50.83; P  = 0.005); and ‘extramedullary beak’ (OR, 39.47; 95%CI: 2.14–727.26; P  = 0.013) were significantly associated with PS presence. These morphological characteristics will be helpful in preoperative detection of SUITF for direct manipulation of fractures.

Background The quality of reduction is an important factor affecting clinical outcomes for displaced femoral neck fractures (FNFs). However, concerns remain about the invasiveness of open reduction and internal fixation (ORIF) as compared to that of closed reduction and internal fixation (CRIF), and the choice between ORIF and CRIF as an optimal treatment strategy for displaced pediatric FNF remains controversial. Materials and Methods MEDLINE, Embase, and the Cochrane Library were systematically searched for studies published up to December 22, 2022, that compared ORIF and CRIF techniques for treating FNF in children. Pooled analysis identified differences in surgical outcomes between ORIF and CRIF, especially regarding postoperative complications, such as osteonecrosis of the femoral head (ONFH), nonunion, coxa vara deformity, leg-length discrepancy LLD, and premature physeal closure (PPC). Results We included 15 studies with 635 pediatric FNF cases in our review. Of these, 324 and 311 were treated with ORIF and CRIF, respectively. The pooled analysis revealed that no significant differences existed between each reduction technique for ONFH (odds ratio [OR] = 0.89; 95% confidence interval [CI] 0.51–1.56; P  = 0.69), nonunion (OR = 0.51; 95% CI 0.18–1.47; P  = 0.21), coxa vara deformity (OR = 0.58; 95% CI 0.20–1.72; P  = 0.33), LLD (OR = 0.57; 95% CI 0.18–1.82; P  = 0.35), and PPC (OR = 0.72; 95% CI 0.11–4.92; P  = 0.74). Conclusions Despite concerns about the invasiveness of ORIF, no differences in complications exist between ORIF and CRIF after FNF in children. Therefore, we believe that ORIF should be performed in FNF when the fracture is irreducible by closed manner.

Postoperative delirium is common in elderly patients with hip fracture. Pain is a major risk factor for delirium, and regional nerve blocks (RNBs) effectively control pain in hip fractures. This study aimed to evaluate the effect of RNB on delirium after hip surgery in elderly patients. This retrospective comparative study was performed in a single institution, and the data were collected from medical records between March 2018 and April 2021. Patients aged ≥60 years who underwent proximal femoral fracture surgery were included, while those with previous psychiatric illness and cognitive impairment were excluded. Two hundred and fifty-two patients were enrolled and divided into an RNB or a control group according to RNB use. Delirium was assessed as the primary outcome and postoperative pain score, pain medication consumption, and rehabilitation assessment as the secondary outcomes. Between the RNB (n = 129) and control groups (n = 123), there was no significant difference in the baseline characteristics. The overall incidence of delirium was 21%; the rate was lower in the RNB group than in the control group (15 vs. 27%, respectively, p = 0.027). The average pain score at 6 h postoperatively was lower in the RNB group than in the control group (2.8 ± 1.5 vs. 3.3 ± 1.6, respectively, p = 0.030). There was no significant difference in the pain score at 12, 24, and 48 h postoperatively, amount of opioids consumed for 2 postoperative days, and time from injury to wheelchair ambulation. We recommend RNB as a standard procedure for elderly patients with hip fracture due to lower delirium incidence and more effective analgesia in the early postoperative period.

Skin cancer should be excised with sufficient margin to reduce recurrence rate. However, the surgeon always has to worry about the reconstruction method of skin defects after excision. In particular, defects in the plantar surface of the foot are difficult to reconstruct due to their position and structure, and various methods are applied by each surgeon. Surgeons think which methods are easier to apply to patients and less morbidity. To alleviate these concerns, we applied artificial dermal substitute to skin defects after skin cancer. Bowen's disease (squamous cell carcinoma in situ) and melanoma in situ on the plantar surface of the foot were subjected to wide excision with sufficient margin. After excision, a skin defect with exposed plantar fascia was applied with a matrix defect and vacuum. A granulation tissue (dermal matrix) was formed and a split-thickness skin graft was performed. Both patients had good functional results and no problems with skin donor sites. Thus, we report a skin graft method that is relatively easy to apply after skin cancer excision on the plantar surface of the foot.

The supracondylar process is a beak-shaped bony process on the anteromedial aspect of the distal humerus. The ligament of Struthers is a fibrous band extending from the tip of the process to the medial epicondyle. The median nerve and brachial artery pass under the ligament of Struthers and consequently can be compressed, causing supracondylar process syndrome. As a rare cause of proximal median nerve entrapment, supracondylar process syndrome is triggered when the median nerve is located in the superficial or deep layer of the ligament of Struthers as a result of anatomical variation. The supracondylar process can be easily detected on X-ray images obtained in oblique views but may not be identified in only anteroposterior or lateral views. In this article, we present 2 cases of supracondylar process syndrome and describe the process of diagnosis and treatment and results of a literature review.

IntroductionThe treatment of unstable intertrochanteric fracture in elderly patients is challenging and how to treat these patients remains controversial. The purposes of this study were to compare (1) reoperation rate, (2) mortality and (3) the postoperative change of walking ability between patients undergoing internal fixation (IF) and those undergoing bipolar hemiarthroplasty (HA) due to this type of fracture based on the data from the Korean Hip Fracture Registry.Materials and methodsBetween July 2014 and June 2016, we extracted 623 unstable intertrochanteric fractures (616 patients aged ≥ 65 years) according to the classification of the Association for the Study of Internal Fixation-American Orthopaedic Trauma Association. Among the 564 patients, 396 were treated with IF (IF group) and 168 with bipolar HA (HA group). We compared the reoperation rate and mortality between IF group and HA group. In patients, who were followed up more than 2 years after the surgery, we compared the postoperative change of walking activity from ambulatory outdoors (Koval’s grade 1, 2, 3) to housebound (Koval’s grade 4, 5, 6).ResultsThe rate of reoperation was higher in the IF group (24/396, 6.1%) than in the HA (4/168, 2.4%) (p = 0.046). At the final follow-up, 79 (35.7%) of the 221 IF patients became housebound, whereas 21 (23.3%) of the 90 HA patients became housebound (p = 0.022).ConclusionThis study showed HA was associated with lower rate of reoperation and lower decrement rate of walking ability compared to IF in elderly patients with unstable intertrochanteric fractures.

Vertically oriented femoral neck fractures (FNFs) are known to be especially unstable FNFs, and they have a higher associated risk of failure. The dynamic hip screw (DHS) technique and the cannulated cancellous screw (CCS) technique are the two main fixation techniques used in the treatment of FNFs. However, no large clinical study has compared the DHS and CCS techniques in patients with high-shear-angle FNFs. MEDLINE, Embase, Cochrane Library, and Web of Science were systematically searched for studies that compared the DHS and CCS techniques for the treatment of Pauwels type II or type III FNF. Pooled analysis was performed to identify differences between the DHS and CCS techniques in Pauwels type II or type III FNF, with a focus on postoperative complications such as fracture nonunion and osteonecrosis of the femoral head (ONFH). We included five studies with a total of 252 patients. The DHS technique was used in 96 patients (DHS group), and the CCS technique was used in 156 patients (CCS group). The pooled analysis revealed that the nonunion rate in the CCS group was significantly higher than that in the DHS group (OR = 0.32; 95% CI, 0.11–0.96; p = 0.04, I2 = 0%), but there was no difference in the incidence of ONFH between the groups (OR = 0.98; 95% CI, 0.20–4.73; p = 0.98, I2 = 53%). For vertically oriented FNFs, the DHS technique is more favorable and has a lower risk of fracture nonunion than the CCS technique.

Scapular fractures are uncommon and among them acromial fractures are even more uncommon. Because the vast majority of acromial fractures are either non-displaced or minimally displaced, symptomatic and nonoperative management was performed. We describe a case of avulsion fracture of the acromial physis displaced by acromioclavicular ligament treated with open reduction and internal fixation, and include a review of the literature.