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

(Table 1) Strontium isotope ratios of planktonic foraminifera and ostracoda from ODP Hole 120-748B on the Kerguelen Plateau, Indian Ocean

Stable and radiogenic isotopic and sedimentological data from sub-Antarctic deep sea sediment cores reveal a temporal link between changes in seawater 87Sr/86Sr ratios and major episodes of late Eocene-early Oligocene climate change. The 87Sr/86Sr records show two major inflections, one at 38-39 Ma near the middle/late Eocene boundary, followed by another at 33.4 Ma. Similarly, the oxygen isotope, ice-rafted debris, and clay assemblage records indicate two important climatic events: the appearance of alpine glaciers and/or small ice-sheets on Antarctica in the late Eocene at 38-39 Ma, followed by a rapid transition to larger and more permanent temperate ice-sheets in the early Oligocene at 33.4 Ma. Moreover, during the early Oligocene 30-33 Ma. three to four inferred peaks in glacial activity appear to coincide with subtle steps in the 87Sr/86Sr record. The coupled variations in climate and seawater Sr isotope ratios during the Eocene/Oligocene imply a strong causal link between the two. Either changes in climate directly influenced patterns of continental weathering and hence seawater chemistry, and/or a tectonic event e.g., uplift.as reflected in weathering and seawater chemistry triggered relatively abrupt changes in global climate

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