The Impact of Hospital Transfers on Surgical Delay and Associated Postoperative Outcomes for Hip Fracture Patients in Scotland : A Cohort Study

Acknowledgments: We are grateful to the Lorraine Donaldson and Kirsty Ward at the Scottish Hip Fracture Audit for assistance in obtaining the relevant data and necessary approvals. We are also grateful to the Local Audit Coordinators who collect SHFA data on behalf of Public Health Scotland, and to the patients whose data was utilized in the study.Peer reviewe

Future demand for primary hip and knee arthroplasty in Scotland

ACKNOWLEDGEMENTS The authors are grateful to the Scottish Arthroplasty Project for the data utilised in this manuscript. No funding was received for this study.Peer reviewedPublisher PD

Does quality of care in hip fracture vary by day of admission?

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A systematic review of tranexamic acid in hip fracture surgery

Aim: To systematically examine and quantify the efficacy and safety of Tranexamic acid in hip fracture surgery.  Methods: A systematic literature search was conducted using Medline, EMBASE, AMED, CiNAHL, and the Cochrane Central Registry of Controlled Trials. Two assessors independently screened search outputs for potentially relevant articles which met the eligibility criteria. The primary outcome measure was requirement of post-operative blood transfusion. Risk of bias assessment was performed using the Cochrane Collaboration’s risk of bias tool for RCT’s and the ROBINS-I tool for observational studies. Meta-analysis was performed to estimate risk ratio (RR), risk difference (RD) and mean difference (MD) values for dichotomous and continuous data outcomes respectively. The interpretation of each outcome was made using the GRADE approach.  Results: Of 102 studies identified, seven met the inclusion criteria including a total of 770 participants (TXA: 341; Control: 429). On meta-analysis, intra-venous TXA resulted in a 46% risk reduction in blood transfusion requirement compared to a placebo/control group (RR:0.54; 95% CI: 0.35 to 0.85; I2: 78%; Inconsistency (Chi2) p=<0.0001; N=750). There was also a significantly higher post-operative haemoglobin for TXA versus placebo/control (MD:0.81; 95% CI: 0.45 to 1.18; I2: 46%; Inconsistency (Chi2) p=0.10; N=638). There was no increased risk of thromboembolic events (RD:0.01; 95% CI: -0.03, 0.05; I2: 68%; Inconsistency (Chi2) p=0.007, N=683).  Conclusion: There is moderate quality evidence that TXA reduces blood transfusion in hip fracture surgery, with low quality evidence suggesting no increased risk of thrombotic events. These findings are consistent with TXA use in other orthopaedic procedures

A review of trauma and orthopaedic randomised clinical trials published in high-impact general medical journals

Acknowledgements The authors are grateful for Shaun Treweek for his expert insight into the nuances of Randomised Clinical Trial design. Funding The authors did not receive support from any organisation for the submitted work.Peer reviewedPublisher PD

The influence of hospital-level variables on hip fracture outcomes

Acknowledgements: The authors are grateful to Dr Lorna Aucott for her advice regarding design of the study and statistical analysesPeer reviewedPostprin

Lateral wall thickness is not associated with revision risk of medially stable intertrochanteric fractures fixed with a sliding hip screw

Funding Information: The authors report that they received open access funding for this manuscript from the National Key R&D Program of China (2021YFC2501702), Suzhou Key Disciplines (SZXK202104).Peer reviewe

Does early surgery improve outcomes for periprosthetic fractures of the hip and knee? : A systematic review and meta-analysis

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Acute kidney injury in patients undergoing elective primary lower limb arthroplasty

Acknowledgements The authors would like to thank Abhi Punit for his contributions in data collection towards the above article Funding No funds, grants or other support was received.Open access via springer agreementPeer reviewedPublisher PD

Brachial artery characteristics and micro-vascular filtration capacity in rock climbers

Rock climbers perform repeated isometric forearm muscle contractions subjecting the vasculature to repeated ischaemia and distorted haemodynamic signals. This study investigated forearm vascular characteristics in rock climbers compared to healthy untrained controls. Eight climbers (CLIMB) (BMI; 22.3, s = 2.0 kg/m2, isometric handgrip strength; 46, s = 8 kg) were compared against eight untrained controls (CON) (BMI; 23.8, s = 2.6 kg/m2, isometric handgrip strength; 37, s = 9 kg). Brachial artery diameter and blood flow were measured, using Doppler ultrasound, at rest and following 5-mins ischaemia (peak diameter) and ischaemic exercise (maximal dilation) to calculate flow mediated dilation (FMD) and dilatory capacity (DC). Capillary filtration capacity was assessed using venous occlusion plethysmography. Resting (4.30, s = 0.26 vs. 3.79, s = 0.39 mm), peak (4.67, s = 0.31 vs. 4.12, s = 0.45 mm) and maximal (5.14, s = 0.42 vs. 4.35, s = 0.47 mm) diameters were greater (P < 0.05) in CLIMB than CON, respectively, despite no difference in FMD (9.2, s = 2.6 vs. 8.7, s = 2.9%). Peak reactive hyperaemic blood flow (1136, s = 504 vs. 651, s = 221 ml/min) and capillary filtration capacity (3.8, s = 0.9 vs. 5.2, s = 0.7 ml.min−1.mmHg−1.100 ml tissue−1 × 10−3) were greater (P < 0.05) in CLIMB compared to CON, respectively. Rock climbers exhibit structural vascular adaptation compared to untrained control participants but have similar vascular function. This may contribute to the enhanced ability of climbers to perform repeated isometric contractions