Hip fractures after falls in hospital: A retrospective observational cohort study

Objectives

To compare the prevalence and characteristics of hip fractures sustained after inpatient falls (hospital subgroup) to those presenting with a fall in the community (control group).

Design

Retrospective observational cohort study.

Setting

University teaching hospital.

Participants

5879 hip fractures occurred over an 8-year period, 327 of these took place after a fall as a hospital inpatient.

Outcome measures

Comparison of 30-day and 1 year mortality, co-morbidities, length of post-fracture hospital stay, specific complication rates and cognitive function between the hospital and control group. Other specific data on those falling in hospital was also collected.

Results

There were significantly higher rates (p < 0.001) of cerebrovascular, chronic obstructive airways and renal disease, diabetes, malignancy and polypharmacy in patients suffering falls in hospital. Mini-mental test scores (MTS) were also significantly reduced in this subgroup (p < 0.001). 30-day and 1 year mortality rates were 9% and 26%, respectively in the control group and almost double this in the hospital subgroup, being 18% and 47%, respectively (30 days, 95% CI 2.00 (1.54-2.60): p < 0.001; 1 year, 95% CI 2.04 (1.73-2.40): p < 0.001). There was no statistical difference between post-operative complications or length of stay post-fracture. 55% of falls in hospital took place on medical/geriatric wards with an additional 14% occurring on psychiatric units.

Discussion

Patients suffering hip fractures after falls in hospital are frailer with impaired cognitive function and have more co-morbidities than those suffering a fracture in the community. These patients have increased mortality, with almost 50% dead within 1 year of the fall. The majority of hip fractures after falls occur in medical or geriatric wards, but the highest risk group appears to be elderly patients on psychiatric wards. Therefore, falls risk assessment and falls prevention schemes in hospital elderly patients are of paramount importance.     

Television tip-overs: The Starship Children's Hospital experience and literature review

Background

Injuries sustained from television (TV) sets tipping over onto children are uncommon when compared to other forms of trauma, ^{[4] and [5]} but because of the weight of some TVs relative to the size of small children, severe and sometimes fatal injuries can result. The international literature is limited in describing this form of trauma and none is available for the Australasian region.

Aim

The aims of the present paper are to describe the characteristics and immediate outcomes of children admitted to Starship Children's Hospital following TV tip-overs and review the international literature on this topic.

Methods

Patients admitted to Starship Hospital were identified retrospectively from the Paediatric Trauma database, and the case notes reviewed. Structured telephone interviews were then conducted with each of the families involved.

Results

Over the 28-month period (June 2006-October 2008) reviewed, 13 children under 15 years of age were identified, with an almost even sex distribution. 5 required admission to the Paediatric Intensive Care Unit (PICU). 9/13 sustained head injuries and 1 patient died from their injuries. Mechanism of injury was in keeping with behaviour to be expected of toddlers. Parents and caregivers were unaware of the dangers posed by TV sets and no precautions had been taken to prevent injury.

Conclusions

The injuries sustained by children from TV tip-overs are often serious and most commonly involve the head and upper body. This is a common finding in all papers reviewed, but numbers of patients studied are still limited. There is a need for both education of families and improvement in the design of TV sets, to prevent this form of trauma in the paediatric population.     

Alpine ski and snowboarding traumatic injuries: incidence, injury patterns, and risk factors for 10 years

Background

Alpine skiing and snowboarding are popular winter sports in Canada. Every year participation in these activities results in traumatic injury. The purpose of this study was to identify the incidence and injury patterns, as well as risk factors associated with ski and snowboarding injuries.

Methods

A comprehensive 10-year retrospective review of Alpine ski and snowboarding injuries from 1996 to 2006 was conducted. The Alberta Trauma Registry was used as the primary source of data.

Results

A total of 196 patients (56.6% skiers, 43.4% snowboarders) were identified as having major traumatic injuries (Injury Severity Score, ≥12). Forty-three patients required intensive care unit support. The majority of injuries were related to falls and collisions with natural objects. Head injuries were most common, followed by chest, spinal, and extremity trauma. Seventy-nine patients required emergency surgery.

Conclusions

Skiing and snowboarding represent activities with high potential for traumatic injury. Safety initiatives should be developed to target this population.     

Integrity of posterior retinaculum after displaced femoral neck fractures

Introduction

It is widely thought that the posterior retinaculum is intact only in relatively undisplaced intracapsular fractures, and interruption of the arterial flow through the retinacular arteries to the femoral head is the main cause of avascular necrosis after fracture of the neck.

Patients

In order to test the hypothesis that the posterior retinaculum is torn after a displaced femoral neck fracture, 112 patients (45 males and 67 females), 75 years old on average, underwent a hemiarthroplasty for a displaced femoral neck fracture. There were 71 Garden type III and 41 Garden type IV fractures. The integrity of the posterior retinaculum was examined intraoperatively in every patient during the procedure.

Results

The posterior retinaculum was found intact in all of the Garden type III fractures and in 39 Garden type IV fractures. The posterior retinaculum was found torn in two Garden type IV fractures. There was no tearing in any other part of the capsule of the hip joint in any patient.

Conclusions

The posterior retinaculum of the hip joint remains intact after a displaced femoral neck fracture in all of Garden type III fractures and in the great majority of Garden type IV fractures.     

The risk of child abuse in infants and toddlers with lower extremity injuries

Purpose

The aim of this study was to assess the risk of child abuse in children younger than 18 months admitted to a pediatric trauma service with lower extremity injuries.

Methods

An Institutional Review Board-approved retrospective case series of children admitted to a regional pediatric trauma center with lower extremity injuries from 1998 to 2002 (n = 5497) was performed. Factors analyzed included age, injuries, and injury mechanism.

Results

Among 5497 trauma patients, the incidence of abuse was 104 (2%) of 4942 children 18 months or older and 175(32%) of 555 children younger than 18 months (odds ratio [OR], 21.4 ± 2.9, P < .001). There were 1252 (23%) patients with lower extremity injuries in the entire sample, and 66 of these were younger than 18 months. In the extremity trauma group, for patients 18 months or older, 16 (1%) of 1186 were abused compared with 44 (67%) of 66 patients younger than 18 months (OR, 146 ± 53, P < .001). Among all trauma patients younger than 18 months, 41 of 55 lower extremity fractures were linked to abuse, whereas 134 of 500 other injuries were caused by abuse (OR, 8.0 ± 2.6, P < .001). Among the 41 abuse-related fractures, femur fracture was the most common (22), followed by tibia fracture (14).

Conclusions

Among children 18 months or older, abuse is an uncommon cause of lower extremity trauma. In children younger than 18 months, lower extremity injuries, particularly fractures, are highly associated with child abuse. Clinicians must thoroughly investigate lower extremity injuries in this age group.     

Management of traumatic sacral fractures: A retrospective case-series study and review of the literature

Background

Being the result of high-energy trauma in most cases, traumatic sacral fractures are rare, difficult to recognise and frequently misdiagnosed. Furthermore they may lead to vascular injuries, mechanical instability, neurological impairment and increased morbidity. As a result, patients with traumatic sacral fractures may suffer major socio-economic consequences.

Objective

This retrospective case-series study evaluated the functional, neurological, mental and emotional status of patients who had suffered traumatic sacral fractures and either followed conservative or underwent operative treatment at our department.

Patients and methods

We evaluated the clinical and radiographic results of all patients who had suffered traumatic sacral fractures between December 2003 and June 2007. The case-notes of all patients were reviewed, all co-existing injuries were registered and an ISS was calculated for each patient. At the latest follow-up visit, all patients completed the Short Form-36 questionnaire as well.

Results

Sixteen patients (eleven male, five female) were included in this study. At the time of initial admission, the mean age of the patients was 30 years (range: 14-53) and the mean ISS was 33.2 points (range: 21-59). The mean follow-up period was 24.1 months (range: 13-40). Six patients were treated operatively (four patients diagnosed with some type of neurological impairment at their initial physical examination and two patients due to pelvic instability). The mean ISS of the patients who were treated operatively was 41.1 points (range: 21-59), whereas of those who were treated conservatively was 28.5 points (range: 21-45). No patient had any neurological deficit at his/her latest re-evaluation. Patients who were treated conservatively achieved the best scores in every domain of the SF-36 questionnaire, when compared with those who were treated operatively.

Conclusion

The diagnosis and management of sacral fractures may pose several dilemmas in everyday's clinical praxis. Patients suffering from traumatic sacral fractures who were treated conservatively seem to have better functional and mental/emotional outcomes, probably because their injuries were less severe than those of the patients who were treated conservatively.     

The omentum is a site of stromal cell-derived factor 1α production and reservoir for CXC chemokine receptor 4-positive cell recruitment

Background

The mechanism of the omental response to injury remains poorly defined. This study investigates the omental reaction to a foreign body, examining the role of a chemokine ligand/receptor pair known to play a crucial role in angiogenesis and wound healing.

Methods

A ventral hernia, surgically created in the abdominal wall of 6 swine, was repaired with silicone sheeting to activate the omentum. Omental thickness was determined by ultrasonography. Serial stromal cell-derived factor 1α (SDF-1α) concentrations were measured in blood, wound, and peritoneal fluids by enzyme-linked immunosorbent assay.

Results

During the 14-day study period, serial ultrasonography showed a 20-fold increase in omental thickness, and enzyme-linked immunosorbent assay revealed a 4-fold increase in SDF-1α concentration in local wound fluid. Omental vessel count and vascular surface area were 8- to 10-fold higher in reactive omentum. Immunohistochemistry showed nearly complete replacement of control omental fat with CXC chemokine receptor 4 (CXCR4)-positive cells by day 14.

Conclusions

Activated omentum, important in the SDF-1α/CXCR4 axis, may serve as an intraperitoneal reservoir for recruitment of circulating bone marrow-derived cells vital to healing.     

Bicycle-related injuries in children: Disturbing profile of a growing problem

Context

We observed a changing pattern of bicycle-related injuries in children, with the focus changing from head trauma to thoracic and abdominal injuries, and a trend to increasingly severe injuries.

Objective

To assess the changing injury pattern, and investigate the development of preventive measures to improve safety.

Design, setting, and participants

Retrospective record review of 142 paediatric patients admitted to our Department of Paediatric Surgery between 1996 and 2005 following bicycle-related injuries. Clinical, laboratory, diagnostic, and therapeutic aspects were analysed. Additional information concerning children's bicycle-related injuries in Israel was obtained from the Gertner Institute (Israel National Center for Trauma and Emergency Medicine Research) and from Beterem (The National Center for Children's Safety & Health, the Safe Kids Israeli Chapter) National Report on Child Injuries in Israel 2006.

Main outcome measures

The nature and severity of injuries were reviewed, and two 5-year periods compared—from 1996 to 2000 (53 children—Group 1), and from 2001 to 2005 (89 children—Group 2).

Results

Head trauma was more common in the Group 1 patients (52.6% vs. 45.2%), but skull fractures and intracranial haemorrhage occurred more frequently in Group 2 (28.5% vs. 16.7%; 21.3% vs. 8.3%, respectively). Injury to the stomach or duodenum, kidneys and liver were all more common in Group 2. Splenic injury occurred with equal frequency in both groups, but more severe injuries were seen in Group 2. More children in Group 2 required intensive care (31% vs. 19.3%).

Conclusions

There is a changing pattern of bicycle-related injuries in children, with chest and abdominal injuries dominating, and an increasing incidence of more severe injury. These findings are important in decision-making regarding preventive measures.     

Do sentinel node micrometastases predict recurrence risk in ductal carcinoma in situ and ductal carcinoma in situ with microinvasion?

Background

Because the implications of micrometastases found on sentinel node biopsy (SNB) for ductal carcinoma in situ (DCIS) or ductal carcinoma in situ with microinvasion (DCISM) are largely unknown, we wished to determine if SNB pathology predicted recurrence risk in DCIS/DCISM.

Methods

Retrospective chart review identified patients with DCIS/DCISM who underwent SNB. SNB findings and all local and distant recurrences were determined.

Results

A total of 322 patients underwent SNB for DCIS/DCISM. There were 13 local recurrences (4.0%) and 1 (.03%) distant recurrence at a median follow-up of 47.9 months (range 0 to 110.6), 12 in patients with negative SNBs; 1 patient had a positive SNB. There were 4 recurrences after mastectomy and 9 after lumpectomy. In 29 patients with positive SNBs, there was only 1 recurrence (3.4%).

Conclusions

Positive SNBs in patients with DCIS or DCISM are not associated with higher risk of local or distant recurrence. Other features of DCIS and DCISM may be important in predicting recurrence risk.     

Sidérose superficielle secondaire du système nerveux central : à propos de trois cas et revue de la littérature

Background

Superficial siderosis (SS) is an under-recognized entity. It is due to repeated microhemorrhages in the subarachnoid spaces resulting in a deposit of hemosiderin at the surface of the central nervous system and/or the cranial nerves. The origin of microhemorrhages remains unknown in almost one third of cases and therefore no treatment can be recommended. Through a literature review and new observations, our goal is to detail the outcome of patients with a recognized etiology of SS and treated surgically.

Methods

Series of three cases and review of the literature.

Results

We present three patients with symptomatic SS for whom the origin of microhemorrhages was found. The first two patients complained of longstanding ataxia and neurosensory deafness while the third patient presented with urinary retention, vertigo, diplopia and facial paresis. Neuroradiological explorations revealed a left temporoparietal cavernoma, a fronto-orbital arterio-venous malformation and a cauda equina myxopapillary ependymoma respectively. Surgical resection of the source of hemorrhage was performed in all cases. All outcomes were good with improvement of their SS-related symptoms. These cases are discussed and the current literature is reviewed.

Conclusion

It is important to recognize SS since the treatment of the bleeding source may prevent further deterioration and may even in some cases improve the clinical condition.     

Emergent embolization of the gastroduodenal artery in the treatment of upper gastrointestinal bleeding. The experience from a surgeon-initiated interventional program

Background

Intractable nonvariceal upper gastrointestinal bleeding (UGIB) is associated with significant morbidity and mortality. Endovascular therapy is an alternative to surgery for high-risk patients.

Materials and methods

Review of prospectively collected data from patients who underwent emergent gastroduodenal artery embolization for UGIB.

Results

Eight patients (mean age 68.5 years) were identified. They all had significant comorbidities and were deemed to be at high risk for surgical intervention. Endoscopy was performed in 7 patients. Active extravasation was present at the time of embolization in 5 (62.5%) patients. The technical success and clinical response rates were each 100%. The 30-day mortality rate was 8%. There were no procedure-related complications. During mean follow-up of 9 months, 1 patient developed recurrent bleeding that was managed conservatively.

Comments

Endovascular embolization is a safe alternative to open surgical intervention after failed endoscopic treatment for UGIB. Surgeons with endovascular skills can perform this procedure with superior results.     

Lung Transplantation With Grafts From Elderly Donors: A Single-Center Experience

Introduction

Use of extended criteria donors is one of the strategies to face the scarcity of donors for lung transplantation.

Methods

Between November 2002 and May 2009, we performed 52 LTs in 50 recipients, 10 of whom (group A) received lungs from donors aged 55 years or older (median, 58.5; range, 56-66 years) for comparison with 28 patients (group B) transplanted with lungs from donors younger than 55 years (median, 25.5; range, 15-54 years). We excluded 9 children and 3 recipients of combined liver plus lung transplantations from the study.

Results

Recipient age, gender, and indications for transplantation did not differ significantly between the 2 groups. Neither were there significant differences in PaO2/FiO2 ratios before lung retrieval, or length of the ischemic time The first PaO2/FiO2 on arrival to the intensive care unit (ICU) and the median length of ICU stay were similar. All patients, except 2 who died in the operating theatre, were extubated between 3 and 216 hours after the transplantation. Hospital mortality was similar in both groups: 3 patients in group A and 2 in group B (P = .1). The median portions of the predicted 1-second forced expiratory volume (FEV1) at 6 months after transplantation did not differ in the 2 groups: 62.4% in group A versus 70% in group B (P = .85).

Conclusion

Lung grafts from donors older than 55 years can be effectively used for transplantation, thus increasing the total organ pool.     

Spinal injuries in children

Background/purpose

Traumatic spinal injury (TSI) is an uncommon source of morbidity and mortality in children. The aim of this study was to describe childhood TSI in a single level 1 urban pediatric trauma center.

Methods

The authors retrospectively analyzed all children younger than 14 years with TSI, treated at a level I pediatric trauma center between 1991 and 2002 (n = 406, 4% total registry). All children were stratified according to demographics, mechanisms, type and level of injury, radiologic evaluations, associated injuries, and mortality.

Results

The mean age was 9.48 ± 3.81 years. The most common overall mechanism of injury was motor vehicle crash (MVC; 29%) and ranked highest for infants. Falls ranked highest for ages 2 to 9 years. Sports ranked highest in the 10 to 14 year age group. Paravertebral soft tissue injuries were 68%. The most common injury level was the high cervical spine (O-C4). The incidence of spinal cord injury without radiologic abnormality (SCIWORA) was 6%. Traumatic brain injury (37%) was the most common associated injury. Overall mortality rate was 4% in this urban catchment.

Conclusions

TSI in children requires a different preventive and therapeutic logarithm compared with that of adults. The potential devastating nature of TSI warrants that the health care team always maintains a high index of suspicion for injury. Future prospective studies are needed to further elucidate injury patterns.     

Should pregnancy be a sole criterion for trauma code activation: a review of the trauma registry

Background

Trauma complicates 5% to 7% of all pregnancies and the majority are noncatastrophic events.

Methods

All pregnant patients in the trauma registry from April 2004 to December 2008 were reviewed retrospectively for trauma code activation criteria: pregnancy as sole criterion versus anatomic/physiologic criteria. The incidence of emergent cesarean sections also was assessed.

Results

There were a total of 85 Level 2 Trauma activations. Fifty-seven of the 85 activations were for pregnancy only. There were 2 cesarean sections in the pregnancy-alone group and 5 cesarean sections in the anatomic/physiologic group. A Fisher exact test was used to compare the groups. The pregnancy-alone group had a significantly lower number of cesarean sections with a P value of .0364.

Conclusions

Patients with pregnancy as the sole criterion for Level 2 activations had minor injuries and a lower incidence of cesarean sections.     

Appendiceal fecalith is associated with early perforation in pediatric patients

Purpose

A fecalith is a fecal concretion that can obstruct the appendix leading to acute appendicitis. We hypothesized that the presence of a fecalith would lead to an earlier appendiceal perforation.

Methods

Between January 2001 and December 2005, the charts of all patients younger than 18 years old who underwent appendectomy at our institution were reviewed. Duration of symptoms and timing between presentation and operation were noted along with radiologic, operative, and pathologic findings.

Results

There were 388 patients who met the study criteria. A fecalith was present in 31% of patients (n = 121). The appendix was perforated in 57% of patients who had a fecalith vs 36% in patients without a fecalith (P < .001). The overall rate of interval appendectomies was 12%. A fecalith was present on the initial radiologic studies of 36% of the patients who had interval appendectomies, and the appendix was perforated significantly sooner in these patients when compared to those without a fecalith (91 vs 150 hours; P = .036).

Conclusion

The presence of fecalith is associated with earlier and higher rates of appendiceal perforation in pediatric patients with acute appendicitis. An expedient appendectomy should therefore be performed in the pediatric patient with a radiologic evidence of fecalith.     

Open minimally invasive Achilles tendon repair with early rehabilitation: Functional results of 25 consecutive patients

Background

Various treatment techniques have been described for the treatment of acute Achilles tendon rupture. However, there is no consensus among orthopaedic surgeons regarding the surgical technique and the postoperative rehabilitation program. Mid-term functional outcome results of the patients who had undergone open minimally invasive repair of fresh Achilles tendon ruptures followed by an early rehabilitation programme were evaluated.

Methods

Twenty-five consecutive patients who underwent open minimally invasive repair of Achiles tendon ruptures during January 2004-October 2005 were independently reviewed at an average follow-up of 34 months (range 24-45 months). The mean age of the patients was 41 (35-47). A functional rehabilitation protocol based on early range of motion exercises was used after surgery. The American Orthopaedic Foot and Ankle Society score was used to evaluate the outcomes of the patients. Ankle range of motion; thigh, calf and ankle circumferences of the injured leg and the contralateral side, return to work and sports activities time were evaluated.

Results

One patient had a partial rerupture and one had superficial wound infection. The mean American Orthopaedic Foot and Ankle Society score was 93 (80-100). Patients returned to work at 3 weeks (range 1-5 weeks) and to preinjury sportive activities at 3 months (range 2-4 months). Ankle ROM and circumference measurements did not reveal a significant difference between the two sides.

Conclusion

These results suggest that open minimally invasive Achilles tendon repair and an early rehabilitation programme provides satisfactory results with early return to previous functional status with low complication rates.     

Projected incidence of proximal femoral fracture in England: a report from the NHS Hip Fracture Anaesthesia Network (HIPFAN)

Aims

This study was designed to estimate trends in the number of proximal femoral fractures (PFFs), and consequent bed day requirements and financial implications for England until 2033.

Methods

Trends in the number of coded PFFs from 1998 to 2008 (collected from Hospital Episode Statistics Online) were projected forward to 2033, and modified according to published data concerning population demographics and declining PFF prevalence. Estimates of 30 day postoperative mortality were calculated according to projected demographic data. Financial estimates were calculated according to current cost and adjusted according to projected inflation.

Results

Despite a decline in the prevalence of PFF among the aging population (2.98% since 2002), we estimate that approximately 100,000 patients annually will require surgery for fractured neck of femur by 2033 in England, with a 30d mortality of 8.9-9.3%, costing £3.6-5.6 billion (inflation adjusted) in total care.

Conclusions

The evaluation and implementation of cost-effective preventive and therapeutic strategies in the short term may help to ameliorate the future financial burden of PFF, and, more importantly, improve the outcome and quality of life for the elderly after fracture.     

Non-operative management of right side thoracoabdominal penetrating injuries—The value of testing chest tube effluent for bile

Introduction

While mandatory surgery for all thoracoabdominal penetrating injuries is advocated by some, the high rate of unnecessary operations challenges this approach. However, the consequences of intrathoracic bile remains poorly investigated. We sought to evaluate the outcome of patients who underwent non-operative management of right side thoracoabdominal (RST) penetrating trauma, and the levels of bilirubin obtained from those patients’ chest tube effluent.

Patients and methods

We managed non-operatively all stable patients with a single RST penetrating injury. Chest tube effluent samples were obtained six times within (4-8 h; 12-16 h; 20-24 h; 28-32 h; 36-40 h; 48 h and 72 h) of admission for bilirubin measurement and blood for complete blood count, bilirubin, alanine (ALT) and aspartate aminotransferases (AST) assays. For comparison we studied patients with single left thoracic penetrating injury.

Results

Forty-two patients with RST injuries were included. All had liver and lung injuries confirmed by CT scans. Only one patient failed non-operative management. Chest tube bilirubin peaked at 48 h post-trauma (mean 3.3 ± 4.1 mg/dL) and was always higher than both serum bilirubin (p < 0.05) and chest tube effluent from control group (27 patients with left side thoracic trauma). Serum ALT and AST were higher in RST injury patients (p < 0.05). One RST injury patient died of line sepsis.

Conclusion

Non-operative management of RST penetrating trauma appears to be safe. Bile originating from the liver injury reaches the right thoracic cavity but does not reflect the severity of that injury. The highest concentration was found in the patient failing non-operative management. The presence of intrathoracic bile in selected patients who sustain RST penetrating trauma, with liver injury, does not preclude non-operative management. Our study suggests that monitoring chest tube effluent bilirubin may provide helpful information when managing a patient non-operatively.     

Factors determining functional outcomes after radical prostatectomy: robot-assisted versus retropubic

Background

Early studies reported comparative results of functional outcomes between robot-assisted (RARP) and retropubic radical prostatectomy (RRP). However, well-controlled single-surgeon prospective studies comparing the outcomes are rare.

Objective

To compare functional outcomes after RARP and RRP performed by a single surgeon, and to identify factors predictive of early return of continence and potency.

Design, setting, and participants

A total of 763 consecutive patients undergoing RP between 2007 and 2010 were prospectively included and serially followed postoperatively for comparative analysis.

Intervention

RARP was performed in 528 patients, and 235 underwent RRP.

Measurements

Continence was defined as being completely pad free. Potency was defined as having erection sufficient for intercourse with or without a phosphodiesterase type 5 inhibitor. Continence and potency recovery were checked serially by interview and questionnaire at 1, 3, 6, 9, 12, 18, and 24 mo postoperatively. Cox proportional hazards method analyses was performed to determine predictive factors for early recovery.

Results and limitations

After the initial 132 cases, patients who underwent RARP demonstrated faster recovery of urinary continence compared to RRP patients. Potency recovery was more rapid in the RARP group at all evaluation time points, beginning from the initial cases. In multivariate analysis, younger age and longer preoperative membranous urethral length seen by prostate magnetic resonance imaging (MRI) demonstrated statistical significance as independent prognostic factors for continence recovery; younger age, surgical method (RARP vs RRP), and higher preoperative serum testosterone were independent prognostic factors for potency recovery. The limitations of the present study were that it was nonrandomized and used interview to evaluate potency recovery.

Conclusions

Patients after RARP demonstrated superior functional recovery. Moreover, membranous urethral length on preoperative MRI and patient age were factors independently predictive of continence recovery, while patient age and higher preoperative serum testosterone were independent prognostic factors for potency recovery.     

Ipsilateral talar and calcaneal fractures: A retrospective review of complications and sequelae

Background

Ipsilateral talar and calcaneal fractures represent a rare combination injury that has only recently been reported in the literature with small case series.

Objective

To identify the commonly observed fracture patterns, complications, and outcomes of a consecutive series of patients with ipsilateral talar and calcaneal fractures.

Methods

Forty-five cases of ipsilateral talus and calcanal fractures were identified from an orthopaedic trauma registry at a University-based, level I trauma center for retrospective review.

Main outcome measurements

Post-operative complications, the need for secondary surgery, and the visual analogus pain score.

Results

Five patients were treated with an early below knee amputation (BKA). Five patients were treated with a primary subtalar arthrodesis. Twenty-eight of the 35 patients who did not undergo early BKA or primary subtalar arthrodesis developed subtalar arthritis. Five patients had deep wound complications. Four patients had talar body collapse from avascular necrosis. There were 13 open fractures of which 8 resulted in an eventual BKA. The mean visual analogus pain score for the patient population was 4.0.

Conclusion

The combination of ipsilateral talar and calcaneal fractures represents a severe injury pattern that is associated with significant morbidity. Subtalar arthritis was a common finding regardless of treatment. Open fractures frequently resulted in a below knee amputation.