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Introduction: We aim to review the incidence and risk factors for the development of intraoperative periprosthetic femur fractures while performing a bipolar hemiarthroplasty for displaced neck of femur fractures. Our secondary aim is to characterize the types of intraoperative periprosthetic fractures, the steps leading to the fractures, and the salvage treatments instituted.Materials and Methods: 271 patients treated with bipolar hemiarthroplasty after traumatic displaced femoral neck fractures were retrospectively analyzed. Demographic data, co-morbidities, vitamin D level, consumption of steroids, ASA score, surgical approach, surgeon experience, use of cemented or uncemented implants, proximal femur morphology, and types of anaesthesia were analyzed statistically.Results: There were 28 patients (10.3%) with intraoperative periprosthetic femur fractures. We found two significant independent risk factors which were the use of uncemented prosthesis (OR 4.15; 95% CI 1.65-10.46; p = 0.003) and Dorr type C proximal femurs (Dorr A OR 3.6; 95% CI 1.47-8.82; p = 0.005). In addition, patients with Dorr type C proximal femurs who underwent uncemented bipolar hemiarthroplasty were more likely to sustain an intraoperative periprosthetic fracture (14(73.7%) out of 19 patients; p = 0.002). There were no significant differences found in other risk factors. The most common location for these fractures was at the greater trochanter at 11 (39.3%) cases. Majority of them, 15 (53.6%), had intraoperative fractures during trial implant insertion and reduction.Conclusion: The overall incidence of intraoperative periprosthetic femur fractures during hemiarthroplasty for displaced neck of femur fractures was 10.3%. The incidence was significantly higher for uncemented (14.7%) when compared to cemented prosthesis (5.4%) and the greater trochanter was the commonest area for periprosthetic fractures during trial implant insertion and reduction. Uncemented prosthesis and Dorr type C proximal femurs were two significant independent risk factors contributing to intraoperative periprosthetic fractures. By identifying these risk factors, surgeons can take ample precautions to prevent complications. [ABSTRACT FROM AUTHOR]

Fractures of the scapular body that extend to involve the neck and glenoid articular surface with a large gap pose a significant problem for surgical exposure. Several surgical approaches for scapula fixation have been described, but all give limited exposure to the entire scapular body, neck and articular surface. Here, we describe our 'Reverse Judet' technique, with cadaveric dissections and discuss a clinical case. We believe this approach gives a wide exposure of the infraspinous scapular body, neck and glenoid articular surface while keeping away from vital neural structures. [ABSTRACT FROM AUTHOR]

We report a case of avascular necrosis of the scaphoid, lunate and triquetrum in a young 21- year- old patient, after a purely ligamentous peri-lunate dislocation of the wrist. He presented with a Mayfield III peri-lunate dislocation after a road traffic accident and underwent an open reduction and internal fixation. Post-operatively, the scapho-lunate gap widened after removal of the temporary K-wires, and he gradually developed avascular necrosis of the scaphoid, lunate and triquetrum, and osteoarthritis of his wrist. We present this unusual case of simultaneous avascular necrosis of multiple carpal bones and discuss the possible risk factors and subsequent management plans for this complex injury. Our patient has no identifiable contributing factors to developing avascular necrosis. We suspect that the violence of the injury and surgery may have compromised the circulation, and advise caution when treating and counseling these patients pre-operatively. [ABSTRACT FROM AUTHOR]

Background and purpose: Chemothromboprophylaxis for hip fracture surgery has been underpracticed in Asia. We investigate the postoperative incidence of venous thrombotic events (VTE) in elderly Asian patients with hip fractures. Patients and methods: Patients over 60 years old with surgically treated hip fractures were reviewed. All patients followed a hip fracture protocol, which included a post-operative ultrasound Doppler venous scan of both lower limbs five days after injury to detect any deep vein thrombosis (DVT). All patients were given mechanical prophylaxis. Patients who had additional chemoprophylaxis were included. Results: From 2010 to 2012, 454 patients were reviewed. The overall incidence of DVT was 6.4% (29 patients). The incidence of PE was 1.3% (six patients). There was no significant correlation between DVT and age, gender, race, hypertension, diabetes mellitus, end stage renal failure, type of fracture and operation, preoperative haemoglobin, platelet count or urea and creatinine levels. Sixteen DVTs (55.2%) were on the ipsilateral side as the fracture, eight (27.6%) were on the contralateral side and five (17.2%) were bilateral. Chemoprophylaxis was not given to 399 patients, of which 27 (6.8%) developed DVT. Ten (2.5%) were proximal DVTs in which four (1%) developed PE. One (0.25%) patient developed PE without DVT. Fifty-five patients were on chemoprophylaxis, of which two (3.6%) developed DVT. Both were proximal DVTs with one subsequently developing PE. Conclusions: The incidence of VTE in Asian patients may be lower compared to Western populations when mechanical prophylaxis is used. Chemoprophylaxis may assist in reducing the rates of DVT but not PE. The low incidence may not justify the use of routine chemoprophylaxis. [ABSTRACT FROM AUTHOR]