Implementation of a standardized protocol to manage elderly patients with low energy pelvic fractures: can service improvement be expected?

Purpose: The incidence of low energy pelvic fractures (FPFs) in the elderly is increasing. Comorbidities, decreased bone-quality, problematic fracture fixation and poor compliance represent some of their specific difficulties. In the absence of uniform management, a standard operating procedure (SOP) was introduced to our unit, aiming to improve the quality of services provided to these patients. Methods: A cohort study was contacted to test the impact of (1) using a specific clinical algorithm and (2) using different antiosteoporotic drugs. Multivariate regression analysis was used to determine prognostic factors. Study endpoints were the time-to-healing, length-of-stay, return to pre-injury mobility, union status, mortality and complications. Results: A total of 132 elderly patients (≥65 years) admitted during the period 2012–2014 with FPFs were enrolled. High-energy fractures, acetabular fractures, associated trauma affecting mobility, pathological pelvic lesions and operated FPFs were used as exclusion criteria. The majority of included patients were females (108/132; 81.8%), and the mean age was 85.8 years (range 67–108). Use of antiosteoporotics was associated with a shorter time of healing (p = 0.036). Patients treated according to the algorithm showed a significant protection against malunion (p < 0.001). Also, adherence to the algorithm allowed more patients to return to their pre-injury mobility status (p = 0.039). Conclusions: The use of antiosteoporotic medication in elderly patients with fragility pelvic fractures was associated with faster healing, whilst the adherence to a structured clinical pathway led to less malunions and non-unions and return to pre-injury mobility state

Simultaneous bilateral total ankle replacement using a 3-component prosthesis: Outcome in 26 patients followed for 2–10 years

Total ankle replacement is an established surgical procedure in patients with end-stage ankle osteoarthritis. We analyzed complications and medium-term results in patients with simultaneous bilateral total ankle replacement

Use and efficacy of bone morphogenetic proteins in fracture healing

Signal transduction in aging related disease

Evaluation of toxic and interactive toxic effects of three agrochemicals and copper using a battery of microbiotests

Three commonly used test organisms of different trophic levels (Vibrio fischeri, Pseudokirchneriella subcapitata and Daphnia magna) were exposed to selected agrochemicals (fosthiazate, metalaxyl-M, imidacloprid) and copper, in single doses or in binary mixtures. The toxicity of each single compound varied up to two orders of magnitude, depending on the test species examined. V fischeri was the most sensitive test organism regarding fosthiazate and metalaxyl-M, indicating an IC50 value of 0.20 mg/L (0.17-0.25 mg/L) and 0.88 mg/L (0.35-1.57 mg/L), respectively. Imidacloprid was the least toxic compound, indicating an EC50 value on D. magna of 64.6 mg/L (43.3-122.5 mg/L) and an IC50 value on V fischeri of 226 mg/L (159322 mg/L), while for imidacloprid at a concentration of 1000 mg/L the effect on P subcapitata was lower than 50%. Copper was the most toxic compound towards all test organisms exhibiting the highest toxic effect on P. subcapitata, with an IC50 value of 0.05 mg/L (0.003-0.008 mg/L). The toxic effects of the binary mixtures have been compared to the theoretically expected effect, resulting from a simple mathematical model based on the theory of probabilities. The independent action model was used in order to predict the theoretically expected effect. The interactive effects were mostly antagonistic or additive, while in few cases (interactive effects of metalaxyl-M and copper on V. fischeri) a synergistic mode of action was observed for some concentration combinations. Experiments showed that interactive effects of chemicals may vary depending on the test species used as well as on the chemicals and their respective concentrations. Although most of the concentrations of chemicals tested in this study are higher than the ones usually found in natural environment, the evaluation of their interactive toxic effects using a battery of bioassays may comprise a useful tool for the estimation of the environmental hazard of chemicals. (c) 2009 Elsevier B.V. All rights reserved

Toxic and interactive toxic effects of agrochemical substances and copper on Vibrio fischeri

The toxic and interactive toxic effects of two agrochemicals (fosthiazate and metalaxyl-M) and copper were investigated in this study on the photobacterium Vibrio fischeri. The toxicities of all tested compounds were generally comparable. The order of toxicity was: copper > fosthiazate > metalaxyl-M. The interactive effects of fosthiazate and metalaxyl-M mixtures were found to be additive for most of the concentration combinations tested. For the binary mixtures of fosthiazate and copper the interactive effect was antagonistic for all concentration combinations tested. Both agrochemicals showed a similar toxic response, while the toxicity of copper increased significantly by the increase of exposure time and a steep increase of copper toxicity was observed with a small increase of its concentration