Early Operative Intervention Is Associated With Better Patient Survival in Patients With Intracapsular Femur Fractures But Not Extracapsular Fractures

The purpose of this study was to determine patients' survival after undergoing an early or delayed operation. We retrospectively assessed 1849 files of patients operated for proximal femoral fracture, divided into two diagnostic groups: intracapsular (n = 640) and extracapsular (n = 1209). 1163 (63%) were treated within 48 h from hospital admission and 686 (37%) were treated > 48 h afterwards. Delayed operation in patients with intracapsular fractures was associated with a 1.8-fold excess risk for 1-year mortality (HR = 1.83, P = 0.008), while no effect was observed for patients with extracapsular fractures. Males had a higher HR for mortality in both diagnostic groups. Early surgical intervention is beneficial for intra-capsular femoral fractures; male gender and a high ASA score are associated with an increased mortality hazard risk.     

Posterior-only correction of Scheuermann kyphosis using pedicle screws: economical optimization through screw density reduction

Introduction

Posterior-only approach using pedicle screws’ fixation has emerged as the preferred surgical technique for Scheuermann kyphosis (SK) correction. Insertion of multiple pedicle screws while increasing stability increases also the risk of complications related to screw malpositioning and surgical cost. The optimal screw density required in surgical correction of SK remains unclear. This study compares the safety and efficacy of low screw density (LSD) versus high screw density (HSD) technique used in posterior-only correction of SK.

Methods

Twenty-one patients underwent surgical correction of SK between 2007 and 2011 and were reviewed after a mean of 29 months. HSD technique (i.e., 100 % of available pedicles, averaged 25.2 ± 4 screws) was used in 10 cases and LSD technique (i.e., 54–69 % of available pedicles in a pre-determined pattern, averaged 16.8 ± 1.3 screws; p < 0.001) was used in 11 cases. Kyphosis correction was assessed by comparing thoracic kyphosis, lumbar lordosis and sagittal balance on preoperative and postoperative radiographs. Cost saving analysis was performed for each group.

Results

Preoperative thoracic kyphosis, lumbar lordosis and sagittal balance were similar for both groups. The average postoperative kyphosis correction was similar in both HSD and LSD groups (29° ± 9° vs. 34° ± 6°, respectively; p = 0.14). Complication occurred in four patients (19 %) in the HSD group and in two patients (9 %) in the LSD group (p = 0.56). Three patients required re-operation. Compared to HSD using LSD saves 4,200£ per patient in hardware and 88,200£ for the entire cohort.

Conclusion

LSD technique is as safe and effective as HSD technique in posterior-only correction of SK. Implant-related cost could be reduced by 32 %.     

Influence of forced swimming stress on 5-HT1A receptors and serotonin levels in mouse brain

Several stressful factors are able to modify 5-HT1A receptors; for example, different schemes of forced swimming-induced stress (FS) produce a variety of changes in synthesis as well as in 5-HT1A binding in the brain. In addition, it is known that the concentration of 5-HT in the brain is modified as a consequence of acute stressing. The main purpose of this study was to characterize the influence of 15 min of FS on 5-HT levels and on 5-HT1A receptor density in specific brain areas. Mice stressed 24 h before were sacrificed and their brains processed by means of a quantitative autoradiography technique. The following areas were studied: dorsal raphe nucleus (DRN); median raphe nucleus (MRN); thalamus; hypothalamus; amygdala, and hippocampus. 5-HT and 5-hydroxyindolacetic acid (5-HIAA) concentrations in the brainstem, thalamus-hypothalamus, and hippocampus of stressed (ST) mice were analyzed 24 h after stressing by high performance liquid chromatography (HPLC) with fluorometric detection. All data were compared with corresponding unstressed (UST) controls. A significant decrease in 5-HT1A receptor density in DRN, MRN, and hippocampus, accompanied by an increase in labeling of 5-HT1A receptor in thalamus, hypothalamus, and amygdala was observed in ST animals. FS induced a decrease in the 5-HT concentration in the thalamus-hypothalamus, accompanied by an increase in hippocampus areas without affecting 5-HT concentration in the brainstem. Additionally, 5-HIAA/5-HT ratio in the thalamus-hypothalamus area was increased. This study showed that stress alters both 5-HT concentration and 5-HT1A receptors in a region-specific manner.