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Objective: To compare major reoperations in elderly patients with pertrochanteric and subtrochanteric fractures receiving a short versus a long intramedullary nail (IMN). Design: Multicenter cohort studySetting: Eleven orthopedic departments across Denmark delivered data from the Danish Multidisciplinary Hip Fracture Registry (DMHFR) and review of healthcare records.Patients: Using surgical procedure codes for pertrochanteric and subtrochanteric fractures treated with IMN, the DMRHF was used to identify patients over 65 years of age between 2008 and 2013.Outcome measures: Major reoperations, defined as any reoperation (simple hardware removal excluded), were retrieved from the DMHFR and all healthcare records were reviewed for type of IMN and missed reoperations, including peri-implant fractures, with 2 years of follow-up. Crude logistic regression and adjustment for age, sex, and comorbidity was performed, yielding odds ratios (ORs) with 95% confidence intervals.Results: Of 2,245 pertrochanteric fractures, 1,867 were treated with a short IMN and 378 were treated with a long IMN. There was a 4.0% rate of major reoperations in the short IMN group compared to a 6.4% rate in the long IMN group. This yielded a crude OR of 1.61 (1.01-2.60) and an adjusted OR of 1.67 (1.04-2.70).Of 909 subtrochanteric fractures, 308 were treated with a short IMN and 601 with a long IMN.The rate of major reoperations was 8.4% in the short IMN group and 4.0% in the long IMN group, yielding a crude OR of 0.45 (0.25-0.80) and an adjusted OR of 0.45 (0.25-0.81). Conclusion:This is the first study confirming the theory that, for subtrochanteric fractures, a long IMN has lower rate of major reoperations compared to a short IMN. In contrast, a short IMN has lower rate of major reoperations compared to a long IMN for pertrochanteric fractures but with a lower absolute risk reduction compared to subtrochanteric IMN results. There is a need for validation of these results in other large studies, especially for pertrochanteric fractures.

Context Parabens are used as preservatives in consumer products but are suspected of having endocrine-disrupting properties. A recent study reported an association between in utero exposure to butyl paraben and overweight in childhood, with a stronger trend in girls. Objective We therefore studied the association between parabens in maternal urine in third trimester and fat percentage in children aged 7 years. Design, setting & Participants We used data from the Odense Child Cohort, a mother-child cohort with enrollment from 2010-2012, in which the children are followed. Paraben concentration was assessed in maternal urine at median gestational week 28.7 and body composition measured as total, gynoid, and android fat percentages assessed by Dual Xray Absorptiometry in their children at age 7 years. Main Outcome Measurements Total, Gynoid, and Android fat percentages and z-score for BMI. Interventions None Results Paraben exposure was low. In multivariate linear regressions, detection of butylparaben in maternal urine was associated with an increase of 17% (95% confidence intervals CI 3.0%;32%) in total body fat percentage and an increase of 23% (95% CI 5.1%;43%) in android fat percentage in boys, compared to boys whose mother had no detectable butylparaben in urine. No significant associations between in utero exposure to methyl-, ethyl- or propyl parabens and body composition were found, and no significant associations were seen in girls. Conclusion Our findings suggest that parabens, which are believed to have low toxicity, may affect obesity development at vulnerable time periods during development