Background: Observational studies have suggested that accelerated surgery is associated with improved outcomes in patients with a hip fracture. The HIP ATTACK trial assessed whether accelerated surgery could reduce mortality and major complications. Methods:We randomised 2970 patients from 69 hospitals in 17 countries. Patients with a hip fracture that required surgery and were ≥45 years of age were eligible. Patients were randomly assigned to accelerated surgery (goal of surgery within 6 hours of diagnosis; 1487 patients) or standard care (1483 patients). The co-primary outcomes were 1.) mortality, and 2.) a composite of major complications (i.e., mortality and non-fatal myocardial infarction, stroke, venous thromboembolism, sepsis, pneumonia, life-threatening bleeding, and major bleeding) at 90 days after randomisation. Outcome adjudicators were masked to treatment allocation, and patients were analysed according to the intention-to-treat principle; ClinicalTrials.gov, NCT02027896. Findings:The median time from hip fracture diagnosis to surgery was 6 hours (interquartile range [IQR] 4-9) in the accelerated-surgery group and 24 hours (IQR 10-42) in the standard-care group, p<0.0001. Death occurred in 140 patients (9%) assigned to accelerated surgery and 154 patients (10%) assigned to standard care; hazard ratio (HR) 0.91, 95% CI 0.72-1.14; absolute risk reduction (ARR) 1%, 95% CI -1-3%; p=0.40. The primary composite outcome occurred in 321 patients (22%) randomised to accelerated surgery and 331 patients (22%) randomised to standard care; HR 0.97, 95% CI 0.83-1.13; ARR 1%, 95% CI -2-3%; p=0.71.Interpretation: Among patients with a hip fracture, accelerated surgery did not significantly lower the risk of mortality or a composite of major complications compared to standard care.

purpose. To evaluate radiological and clinical outcome of minimally invasive plate osteosynthesis (MIPO) for tibial plateau fractures. Methods. 35 men and 6 women aged 19 to 75 (mean, 40; standard deviation [SD], 14) years underwent MIPO for displaced tibial plateau fractures. According to the Schatzker system, the tibial plateau fractures were classified as types I (n=3), II (n=9), III (n=11), IV (n=6), V (n=7), and VI (n=5). Six patients had open fractures; 2 of them underwent debridement before MIPO. 10 patients needed additional bone grafting. Radiological (at immediate postoperation) and clinical (at the 12-month follow-up) assessments based on the Rasmussen anatomic and functional scoring system were recorded using a proforma. Patients with acceptable and unacceptable outcomes were compared in terms of age. results. The mean Rasmussen anatomic score was 15.1 (SD, 2.2; range, 10-18); the mean Rasmussen functional score was 25.3 (SD, 3.2; range, 14-29); and

Background The standard treatment of displaced femoral neck fracture is arthroplasty. THA is reportedly superior to BHA in terms of hip pain, function and reoperation rate. On the other hand THA has a higher rate of dislocation. Total hip replacement with dual mobility cup increases the range of motion and reduces the chances of dislocation. The aim of this study is to compare the functional outcome, rate of dislocation, complications and mortality between BHA and THA with dual mobility cuff for the treatment of displaced neck of femur fracture. Patients and method This is a non-commercialized retrospective cohort study conducted at our tertiary care level 1 trauma centre. Patients of age group 60 years and above who underwent hip arthroplasty (BHA or THA with dual mobility implant) between 2015 and 2017 for displaced neck of femur fracture with a complete follow up for one year were included. Both groups were assessed for postoperative surgical complications including dislocation, fracture, surgical site infection, and medical complications, one-year mortality and functional outcome were analysed via Harris Hip Score (HHS) at the latest follow up. Results Overall 104 patients were included in the study out of which 77 patients underwent BHA while 27 underwent THA with dual mobility cup. Baseline characteristics were found to be similar in both groups. Mean pre-op HHS for bipolar group was found to be 71.01 while for THA with dual mobility cup group it was 73.52 with the difference being statistically insignificant (P = 0.12). Mean post-op HHS for bipolar group was noted to be 68.82 whereas for THA with dual mobility cup group it was 76.81. The difference was found to be statistically significant with a P-value of <0.01. With regards to post-operative complications and one-year post-operative mortality, no significant difference was noted between both groups. Conclusion In relatively young and active elderly patients with displaced neck of femur fracture, a THA with dual mobility cuff provides better hip functional outcome, does not increase mortality or morbidity as compared to BHA and can be considered as primary treatment modality.

BackgroundOsteopetrosis (OP) is a group of rare inheritable genetic disorders which show increased bone radiodensity on radiography. As no cure exists, careful symptomatic treatment is the mainstay in management due to brittle bone and frequent complications. We would like to present a case series of OP patients, their management, a review of literature about this rare disease and its genetic and inheritance patterns.Materials and methodsRetrospective case series of 6 patients with OP seen at our institution from 2010 to January 2018. We searched PubMed and Google Scholar for articles using the following keywords: Osteopetrosis, Radiology, Fracture and Management to review literature.Cases presentationWe present 6 cases of OP each showing diverse history of frequent fractures and describe the challenges faced during management and the long-term follow-up results.ResultsAbnormal osteoclast activity in OP results in defective bone resorption with patients having varied clinical presentations. Bones are brittle, increasing risk of fractures. Osteosynthesis is the recommended first-choice treatment for osteopetrotic fractures despite the risk of failure. Good preoperative planning is critical. Genetic studies showed multiple genes to be involved and varied patterns of inheritance in different types of OP. Conservative management could including varied therapies has also been proposed.ConclusionWith all-inclusive preoperative planning and careful postoperative care surgical treatment of fractures in OP is effective. The cases presented showed that plate osteosynthesis and intramedullary nailing are suitable options. Genetic factors and inheritance pattern should be discussed with patients.

Background Hip fractures usually occur in old aged patients with osteoporotic bone. Management of hip fractures in old aged patient is aimed to ambulate patient immediately and to restore the pre-operative ambulation. Proximal femur replacement is an effective treatment option in elderly patient with osteoporotic bones. It allow immediate weight bearing and early return to preoperative ambulatory status and minimizes the chances of systemic complication associated with prolong bed rest associated with internal fixation. This study is aimed to review the outcome of the patients whom underwent proximal femur replacement as primary treatment for the patient with comminuted intertrochanteric and sub trochanteric fracture. Patients and method This is a study conducted in our university hospital which is a tertiary-care level-1 trauma center. A retrospective analysis of 21 patients who underwent proximal femur replacement for comminuted intertrochanteric and sub trochanteric fracture, age more than 60 years during the period from April 2011 to March 2018 was conducted. Data collected included: age, gender, comorbidities, mechanism of injury, type of fracture, functional outcome (calculated via Harris Hip Score) and one year mortality. Results The mean age of the patients was 74.05(range 64–91) years, out of which 13 (61.8%) were female and 8 (38.0%) were male. The mean follow up was 32.6(8–91 months).Immediate post-operative ambulation status was full weight bearing (FWB) in 17 patients (80.9%) of the patients while three patients (19.0%) had non-weight bearing (NWB) due to associated co-morbidities. The mean preoperative Harris Hip score was 68.0, while the mean postoperative Harris Hip score was 66.5 at last follow up. Post operatively one patient (4.7%) developed pulmonary embolism, one patient developed dislocation. One patent (4.7%) died of sepsis from implant infection at 8 months after surgery Conclusion Primary Proximal femoral replacement in a viable option in old aged patients with poor bone quality who developed intertrochanteric and subtrochanteric fracture. According to our study, with mortality rate comparable to that of primary fixation, yet with the added advantage of immediate post op ambulation and reduced incidences of decubitus ulcers, atelectasis and DVT.