Post-operative Functional Outcome in Fracture Distal Shaft of Femur Treated with Retrograde Nailing

Background: To determine the functional outcome of retrograde femoral nailing in terms of Tegner Lysholm score for distal femoral farctures. Methods: This prospective cross-sectional study was done at the Department of Orthopaedics, Benazir Bhutto Hospital, Rawalpindi from 20th January 2018 to 19th January 2019. The study comprised of 35 patients who presented with simple, extra-articular distal femur fracture. All patients were treated with retrograde femoral nailing using anterior (Para patellar) approach. Functional outcome was assessed at 6-months using Tegner Lysholm score. Data was analyzed using SPSS version 22. Results: Out of the 35 patients, majority were females (60%). Mean age of patients was 51.4±11.4 years. Most common age group in males was 41-50 years while in females it was 61 years and above. Average BMI of patients was 22.7±2.8 kg/m2. At 6-months post-operatively, Tegner Lysholm score was between 86-100, 71-85 and 56-70 in 65.7%, 25.7% and 8.6% cases, respectively. Tegner Lysholm score between genders was insignificant (p=0.4). Conclusion: Retrograde femoral nailing has excellent functional outcome in patients with extra-articular distal femoral fractures

SARS-CoV-2 vaccination modelling for safe surgery to save lives: data from an international prospective cohort study

Background: Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods: The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18-49, 50-69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. Results: NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year. Conclusion: As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population