Predictors of fixation failure in peri-trochanteric fractures

Introduction: Successful treatment of hip fractures during the first operative episode is paramount in minimizing patient morbidity and socio-economic costs. Peri-trochanteric hip fractures are a subtype of unstable intertrochanteric hip fractures which experience an increased rate of fixation failure. Although current literature suggests that successful surgical treatment of peri-trochanteric fractures is dependent on fracture pattern, quality of fracture reduction, implant choice and implant position, there is no agreement either to the relative importance of each or their inter-relationship. Consequently, the overall aim of this thesis was to assess the predictors of fixation failure and their relationship to each other in the treatment of peri-trochanteric fractures. Methods: A retrospective review of 796 patients with peri-trochanteric fractures treated at a tertiary referral trauma centre between 2008 and 2012 was undertaken. Analysis of pre-operative, intra-operative and post-operative radiographs was performed using Centricity PACS. Analysis of potential confounding factors included age, gender, fracture classification, reduction quality, Cleveland zone, tip-apex distance, implant type (DHS versus short Gamma nail versus long Gamma nail), and fixation points in Gamma nails, specifically the lateral cortex, greater trochanter, and fit of the nail in the intramedullary canal at its narrowest point. Results: Unstable fractures had a 7.6 (OR 3.0-19.6) times increased risk of fixation failure (p 20 mm incurred a 2.2 (OR 1.7-2.73) increased risk of failure (p<0.001), it was not powerful enough to mitigate against fixation failure in the event of poor fracture reduction (p<0.004). Nail fit was noted to be a predictor of fixation failure, with a 10.3 (OR 8.1-28.4) times increased risk of failure if the nail filled < 70% of the intramedullary canal (p<0.001). There was no significant difference in choice of implant or increased rate of failure when using a DHS or Gamma nail except in reverse oblique type factures. Fixation points of the lateral cortex and greater trochanter were not associated with successful osteosynthesis. Discussion: Unstable fracture type, poor fracture reduction, non optimal cephalomedullary screw positioning, and inadequate fit of IM recon nails in the intramedullary canal were predictors of fixation failure. These factors are closely interrelated: unstable fractures may be difficult to reduce which in turn leads to difficulty in achieving correct positioning of implants. A poorly reduced fracture will not be mitigated from fixation failure by correct positing of implants. Treatment of peri-trochanteric fractures should therefore be aimed at obtaining a high quality of fracture reduction prior to ensuring optimal lag screw position and intramedullary nail fit to maximize the success rate of osteosynthesis

Regulation of the production of pro-inflammatory cytokines and antagonists during chemotherapy-induced neutropenia in patients with haematological malignancies

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Norse-Icelandic Skaldic Poetry of the Scandinavian Middle Ages - an electronic edition

This presentation aims to describe an international project to edit the corpus of Old Norse-Icelandic skaldic poetry and to outline some issues related to electronic aspects of the project, both in its organisation and in its publication. Prof. Clunies Ross will outline the nature of the project and the place of the electronic edition. Tarrin Wills will present information relating to the electronic encoding of the corpus. This will include explanation and discussion of issues related to the collation of electronic facsimiles of the manuscripts and the encoding of skaldic verse, in particular, the encoding of the native poetic devices known as 'kenningar' and 'heiti'.Hosted by the Scholarly Text and Imaging Service (SETIS), the University of Sydney Library, and the Research Institute for Humanities and Social Sciences (RIHSS), the University of Sydney

Gonadal function in males after chemotherapy for early-stage Hodgkin's lymphoma treated in four subsequent trials by the European Organisation for Research and Treatment of Cancer: EORTC Lymphoma Group and the Groupe d'Etude des Lymphomes de l'Adulte.

Contains fulltext : 51705.pdf (publisher's version ) (Open Access)PURPOSE: To analyze fertility in male patients treated with various combinations of radiotherapy and chemotherapy, with or without alkylating agents, or with radiotherapy alone for Hodgkin's lymphoma. PATIENTS AND METHODS: Follicle-stimulating hormone (FSH) levels were measured in patients with early-stage upper-diaphragmatic disease enrolled in four European Organisation for Research and Treatment of Cancer (EORTC) trials (H6-H9). Median follow-up after therapy was 32 months. Patients with FSH measurement at least 12 months after end of treatment (n = 355) were selected to assess post-treatment fertility. Patients with FSH measurement 0 to 9 months after therapy (n = 349) were selected to analyze fertility recovery; of these, patients with elevated FSH (> 10 U/L; n = 101) were followed until recovery. Factors predictive for therapy-related infertility were assessed by logistic regression. RESULTS: The proportion of elevated FSH was 3% and 8% in patients treated with radiotherapy only or with nonalkylating chemotherapy (doxorubicin, bleomycin, vinblastine, dacarbazine [ABVD], epirubicin, bleomycin, vinblastine, prednisone [EBVP]); it was 60% (P < .001) after chemotherapy containing alkylating agents (mechlorethamine, vincristine, procarbazine, prednisone [MOPP], MOPP/doxorubicin, bleomycin, vinblastine [ABV], bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, prednisone [BEACOPP]). After a median time of 19 months, recovery of fertility occurred in 82% of patients treated without alkylating chemotherapy. This proportion was 30%, statistically (P < .001) lower in those treated with alkylating chemotherapy, and median time to recovery was 27 months. The post-treatment proportion of elevated FSH increased significantly (P < .001) with the dose of alkylating chemotherapy administered, and recovery was less frequent and slower after higher doses. Age more than 50 years and stage II disease also contributed to poor outcome. CONCLUSION: Fertility can be secured after nonalkylating chemotherapy for Hodgkin's lymphoma. In contrast, alkylating chemotherapy has a dismal effect, even after a limited number of cycles

Vragen rond aanvullende radiotherapie bij patiënten met de ziekte van Hodgkin stadium III of IV, in remissie na chemotherapie

Contains fulltext : 25222___.PDF (publisher's version ) (Open Access)rights: (c)RU Radboud Universiteit Nijmegen, 199

New type of t(14;18) in a non-Hodgkin's lymphoma provides insight in molecular events in early B-cell differentiation

Contains fulltext : 20725.PDF (publisher's version ) (Open Access)rights: (c)RU Radboud Universiteit Nijmegen, 199

Treatment of stage I and II hodgkin's lymphoma.

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De nieuwe purine analoga

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Vragen rond aanvullende radiotherapie bij patienten met de ziekte van Hodgkin stadium III of IV, in remissie na chemotherapie

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