Postoperative hyponatremia (POH) is thought to be a fearsome complication of orthopedic surgery. Primary aim of this cohort study was to evaluate the incidence of POH and its clinical relevance in elective surgery, outlining differences between total knee arthroplasty (TKA) and total hip arthroplasty, looking for the presence of any risk factor commonly related to POH. Four hundred two patients that underwent total hip arthroplasty and total knee arthroplasty performed between 2016 and 2017 were retrospectively examined. Serum electrolytes, hemoglobin, hematocrit, glucose, and creatinine were evaluated preoperatively and at day 0-I-II from surgery. Age, sex, body mass index, comorbidities, drugs, surgery data, transfusions, postoperative symptoms, and length of stay (LOS) were determined. All surgeries were performed by the same equipe. Patients had the same perioperative management, excluded those that took thiazides, already at risk of POH. Patients were divided in 2 groups: group A, patients with normal postoperative natremia (294 patients) and group B, patients who developed POH (108, 26.9%); 66.7% of these developed POH within 24 hours postoperatively. In group B mean postoperative natremia was 133.38 (127.78–134.85) mmol/L. Two patients (1.8%) developed moderate hyponatremia, no severe hyponatremia was documented. Type of surgery, operation time, LOS, and presence of postoperative symptoms did not show statistically significant differences within groups. At multivariate logistic analysis chronic use of thiazides was the only variable associated to a decreased risk of developing POH (OR = 0.39; P = .03). Hemoglobin postoperative values (OR = 1.22; P = .03), the need of postoperative transfusion (OR = 2.50; P = .02) and diabetes (OR = 2.70; P = .01) were associated to an increased risk of POH. Although 26.9% of our patients exhibited POH, the onset of this disorder had no implication on postoperative symptoms and on LOS. Diabetes and transfusion are factors most often associated to POH.

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Background: Fifth metatarsal base fracture are a common occurrence in the orthopaedic practice. Literature on the epidemiology of such fractures is scarce. The aim of this analysis was to study the relationship between Body Mass Index (BMI) and the zone of the fifth metatarsal base involved by the fracture. Methods: Data on adult patients who have been diagnosed with isolated fifth metatarsal base fracture were gathered at our Institution (blinded for review). Age, sex, height, weight and injury mechanism were collected from electronic medical records. Fractures were classified according to the Lawrence and Botte classification (Zone 1, 2 and 3) by three independent reviewers. Results: From March 2016 to December 2018, 149 patients (109 women and 40 men) have been diagnosed with fifth metatarsal base fracture. Average age and BMI at the time of injury were 51.9 (SD 17.1, range 18-84) and 24.0 (SD 3.8, range 16.4-36.7) respectively. Fracture distribution was 63.8% in zone 1, 23.5% in zone 2, 12.7% in zone 3. 12.1% of patients had a BMI < 20 kg/m 2 , 57.7% between 20 and 24.9 kg/m 2 , 22.2% between 25 and 29.9 kg/m 2 and 8.0% over 30 kg/m 2. No statistically significant differences attributable to sex (p = 0.774) or age (p = 0.379) were found between different zones of fracture. Average BMI was found to be higher in the zone 3 (26.1 ± 4.7 kg/m 2) fracture group than in zone 1 (23.7 ± 2.9 kg/m 2) (p = 0.031). Conclusion: The prevalence of proximal diaphysis (zone 3) fractures rises proportionally with BMI in our sample study. BMI appears to have an impact on fifth metatarsal base fractures pattern.