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

Scarring patterns and relative mortality rates of Indian Ocean whale sharks

This study recorded the scarring rate and severity for whale sharks Rhincodon typus from three Indian Ocean aggregations (Australia, Seychelles and Mozambique), and examined whether scarring (mostly attributed to boat strikes and predator attacks) influences apparent survival rates using photo-identification libraries. Identifications were based on spot-and-stripe patterns that are unique to individual whale sharks. Scarring was most prevalent in the Seychelles aggregation (67% of individuals). Predator bites were the most frequent source of scarring (aside from minor nicks and abrasions) and 27% of individuals had scars consistent with predator attacks. A similar proportion of whale sharks had blunt trauma, laceration and amputation scars, the majority of which appeared to be caused by ship collisions. Predator bites were more common (44% of individuals) and scars from ship collisions were less common at Ningaloo Reef than at the other two locations (probability of among-site differences occurring randomly = 0.0007 based on a randomized multinomial contingency analysis). In all aggregations, scars occurred most often on the caudal fin, which may result from the fin being the body part closest to the surface when boats pass over, or they may provide a large target for predator attack. No evidence was found for an effect of scarring on apparent survival (φ; mean ± s.e.) for the Ningaloo (not scarred φ = 0.858 ± 0.033; scarred φ = 0.929 ± 0.033) or Seychelles populations (not scarred φ = 0.502 ± 0.060; scarred φ = 0.538 ± 0.070). The lower apparent survival of the Seychelles population may be attributed to a high number of transient whale sharks in this aggregation that might bias estimates. This study indicates that while scarring from natural predators and smaller vessels appears to be unrelated to whale shark survival, the effect of deaths related to ship strike need to be quantified to assist in future management of this species. © 2008 The Authors