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

Fator chave para Anticarsia gemmatalis Hübner, 1818 (Lepidoptera: Noctuidae) em cultura de soja, para o estado de São Paulo Key factor for Anticarsia gemmatalis Hübner, 1818 (Lepidoptera: Noctuidae) in soybean fields in the state of São Paulo

Estudou-se a biologia e a flutuação de Anticarsia gemmatalis em campos de soja com o objetivo de construir tabelas de vida ecológica visando determinar o estágio e o fator chave. Os experimentos foram conduzidos durante os períodos agrícolas de 1992 a 1997. Em cada ano foram realizados dois estudos biológicos. Simultaneamente durante o ciclo da soja, nos seis anos estudados, foram realizadas amostragens para determinar a flutuação natural de ovos e de lagartas de A. gemmatalis. De posse desses dados foram construídas tabelas de vida ecológica, tendo-se observado que a taxa líquida de reprodução da espécie aumentou de 2,9 a 7,5 vezes em relação a população inicial, sendo que, para a tabela construída com a média dos dados, esse valor subiu para 15,5 vezes. O tempo médio de duração nas gerações variou de 33,5 a 40,2 dias, com média de 37,9 dias, acarretando uma sobrevivência, por geração entre 1,2 a 3,2%, porém, na média, esta subiu para 6,6%. O estágio chave da população não pôde ser determinado com precisão devido aos baixos valores de R2 obtidos mas, o fator chave, responsável pela mortalidade da população, foi a fertilidade real de fêmeas.<br>The biology and fluctuation of Anticarsia gemmatalis was studied in soybean fields to determine the key stage and factor. Experiments were conducted from 1992 through 1997. Two biological studies were performed each year. In each season, the natural occurrence of eggs and larvae were determined, which allowed the construction of ecological life tables. The net reproduction rate of the species was observed to increase 2.9-to 7.5-fold in relation to the initial population, but the increse was estimated as 15.5-fold for the life table constructed from the averages of annual values. Mean duration time for progenies varied from 33.5 to 40.2 days (mean of 37.9), leading to an average survival per generation between 1.2 and 3.2% (mean of 6.6). The key stage of the population was not determined due the observed low R2. The key factor accounting for population mortality was the fertility of females

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