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

Synchronization of Sub-Picosecond Electron and Laser Pulses

Sub-picosecond laser-electron synchronization is required to take full advantage of the experimental possibilities arising from the marriage of modern high intensity lasers and high brightness electron beams in the same laboratory. Two particular scenarios stand out in this regard, injection of ultra-short electron pulses in short wavelength laser-driven plasma accelerators, and Compton scattering of laser photons from short electron pulses. Both of these applications demand synchronization, which is subpicosecond, with tens of femtosecond synchronization implied for next-generation experiments. Typically, an RF electron accelerator is synchronized to a short pulse laser system by detecting the repetition signal of a laser oscillator, adjusted to an exact subharmonic of the linac RF frequency, and multiplying or phase locking this signal to produce the master RF clock. Pulse-to-pulse jitter characteristic of self-mode-locked laser oscillators represents a direct contribution to the ultimate timing jitter between a high intensity laser focus and electron beam at the interaction point, or a photocathode drive laser in an RF photoinjector. This timing jitter problem has been addressed most seriously in the context of the RF photoinjector, where the electron beam properties are sensitive functions of relative timing jitter. The timing jitter achieved in synchronized photocathode drive laser systems is near, or slightly below one picosecond. The ultimate time of arrival jitter of the beam at the photoinjector exit is typically a bit smaller than the photocathode drive-laser jitter due to velocity compression effects in the first RF cell of the gun. This tendency of the timing of the electron beam arrival at a given spatial point to lock to the RF lock is strongly reinforced by use of magnetic compression

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