Factors Associated with Revision Surgery after Internal Fixation of Hip Fractures

Background: Femoral neck fractures are associated with high rates of revision surgery after management with internal fixation. Using data from the Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH) trial evaluating methods of internal fixation in patients with femoral neck fractures, we investigated associations between baseline and surgical factors and the need for revision surgery to promote healing, relieve pain, treat infection or improve function over 24 months postsurgery. Additionally, we investigated factors associated with (1) hardware removal and (2) implant exchange from cancellous screws (CS) or sliding hip screw (SHS) to total hip arthroplasty, hemiarthroplasty, or another internal fixation device. Methods: We identified 15 potential factors a priori that may be associated with revision surgery, 7 with hardware removal, and 14 with implant exchange. We used multivariable Cox proportional hazards analyses in our investigation. Results: Factors associated with increased risk of revision surgery included: female sex, [hazard ratio (HR) 1.79, 95% confidence interval (CI) 1.25-2.50; P = 0.001], higher body mass index (fo

Elementos para uma história da neuroascese Elements for a history of neuroascese

O espetacular progresso das neurociências e o intenso processo de popularização, via mídia, de imagens e informações que associam a atividade cerebral a praticamente todos os aspectos da vida produzem, no imaginário social, crescente percepção do cérebro como detentor das propriedades e autor das ações que definem o que é ser alguém. Nesse contexto sociocultural, aumenta o interesse pela neuroascese, isto é, discursos e práticas a respeito de como agir sobre o cérebro para maximizar sua performance. Com o objetivo de traçar alguns elementos da história da ascese cerebral, resgatam-se momentos históricos do século XIX em que práticas neuroascéticas eram comuns. O artigo problematiza a continuidade dessas práticas na atualidade, levando em conta os diferentes contextos socioculturais e históricos nos quais se originam.<br>The spectacular progress of the neurosciences, as well as the intense process of popularization by the media of images and information that associate cerebral activity with practically every aspect of life, have produced a growing perception of the brain as the site and agent of all the properties and actions that define us as human beings. Today's socio-cultural context has seen increased interest in 'neuroascese', that is, discourses and practices aimed at maximizing brain performance. Tracing elements of the history of 'brain ascese' back to historical moments of the nineteenth century in which neuroascetic practices were commonplace, the article examines their continued use today, taking into account the social, cultural, and historical contexts in which they originated

Fracture fixation in the operative management of hip fractures (FAITH): an international, multicentre, randomised controlled trial

Background Reoperation rates are high after surgery for hip fractures. We investigated the effect of a sliding hip screw versus cancellous screws on the risk of reoperation and other key outcomes. Methods For this international, multicentre, allocation concealed randomised controlled trial, we enrolled patients aged 50 years or older with a low-energy hip fracture requiring fracture fixation from 81 clinical centres in eight countries. Patients were assigned by minimisation with a centralised computer system to receive a single large-diameter screw with a side-plate (sliding hip screw) or the present standard of care, multiple small-diameter cancellous screws. Surgeons and patients were not blinded but the data analyst, while doing the analyses, remained blinded to treatment groups. The primary outcome was hip reoperation within 24 months after initial surgery to promote fracture healing, relieve pain, treat infection, or improve function. Analyses followed the intention-to-treat principle. This study was registered with ClinicalTrials.gov, number NCT00761813. Findings Between Mar