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BackgroundDespite significant medical progress and improved treatment, surgical procedures of proximal femur fractures in older patients are still associated with a high postoperative complication and mortality rate. Recently, several authors investigated the phenomenon of immunoageing, indicating differences in the ageing immune system.The aim of the present multi-center prospective clinical trial was to analyze differences in the posttraumatic immune response of old patients compared to young patients.MethodsBlood was collected from young patients (<50 y, n = 20) with long bone fractures (YF), old patients (>70 y, n = 21) with proximal femur fractures (OF) upon clinical admission and within 6 hours after surgery, and two healthy age matched control groups (YH & OH). Serum TRAIL- and cytokine concentrations were analyzed via cytometric bead array, Fas-Ligand and TNF-Receptor-I via ELISA. CD15+ magnetic bead-isolated neutrophils (PMN) were TUNEL stained.ResultsIL-6 was significantly increased only in OF after trauma and surgery whereas YF patient exhibited a marked decrease of TNF after trauma. Interestingly, a significant increase of GM-CSF serum levels was observed in YF only, whereas OF exhibited a decrease of systemic IFN-γ concentrations after trauma and after surgery. The healthy controls, old and young, had more or less similar inflammation levels.Moreover, TRAIL serum levels were diminished in OF after trauma and even further after surgery whereas in YF this was only observed after the surgical procedure. Fas-L concentrations were reduced only in YF after surgery or trauma. PMN apoptosis was significantly reduced only in YF, indicating activation of the innate immune system.DiscussionIn summary, our data suggest that the posttraumatic immune response is differently regulated in old and young trauma patients. The operative procedure further impacts these differences after trauma. Whether the decreased activation of PMNs and phagocytes along with the observed dysregulation of the posttraumatic inflammatory response contributes to the high perioperative mortality rate of the elderly suffering from a proximal femoral fracture requires further investigation.

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Purpose: Non-contact ACL injury is a common and debilitating injury among athletes, with high rates of recurrence and long-term consequences. Identifying individuals who are at risk of ACL injury can help prevent or reduce the severity of these injuries. The aim of this study is to assess the role of alpha angle in patients with ACL rupture. Methodology: This is a case-control study which includes a total of 105 subjects. Hip radiographs were taken in all the subjects using the modified Dunn View radiograph with patient in supine position, hip flexed 45o and abducted 20o. Osirix MD was used to analyse the radiographs and SPSS v.23 for statistical analysis. Results: The majority of injuries were caused by football (58.1%), followed by jumping sports (23.8%) and skiing (18.1%). A mean difference of 5o of the alpha angle between the groups was measured. Statistical tests showed significant difference between the groups (p<0.001) and logistic regression showing 12-20% risk increase for every degree of alpha angle raise. Conclusion: The findings showed a substantial correlation between higher alpha angles and an increased likelihood of ACL injury, with patients who ruptured their ACLs having higher mean alpha angles than those who did not. We recommend that young athletes who are actively participating in sports have their hip alpha angles measured so that those with higher alpha angle can follow special prevention programs.