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

Preparing School Leaders to Confront Opportunity Gaps in Suburban Districts

The advantages of suburban life do not necessarily guarantee a secure future for many young people of color. A recent US study indicates that despite being raised in elite neighborhoods, Black males raised in affluent conditions are less likely than White males to maintain their wealth status into adulthood. While strong instruction, adult support, and inclusive cultures have been proven to mitigate a myriad of risk factors for historically marginalized groups of students, opportunity gaps continue to face young people of color, even in affluent suburban districts, where the appearance of a level playing field can lead educators to underestimate their role in building social capital in their students. High graduation rates notwithstanding, school leaders in suburban districts must be prepared to lead staff to understand the critical impact of disparities in preparation on the competitiveness of their students of color and first-generation students. They must seek to uncover critical differences in how opportunities are parceled out, address subtle barriers to access, resist the “opportunity hoarding” that works to maintain the status quo in many districts, and develop in staff the pedagogical and relational skills that engage students of color in the highest opportunities available to them. Though many school administrators may be white, middle class, and personally unfamiliar with some of the racial and socioeconomic challenges that face many suburban districts today, their effectiveness in eliminating achievement and opportunity gaps will hinge on their ability to prepare all students for competition on a playing field that remains anything but level

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