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Among the various hip fracture predictors explored to date, modifiable risk factors warrant special consideration, since they present promising targets for preventative measures. This systematic review and meta-analysis aims to assess various modifiable risk factors.We searched four online databases in September 2017. We included studies that reported on modifiable lifestyle risk factors for sustaining fragility hip fractures. The quality of the included studies was assessed using the Newcastle-Ottawa Scale (NOS). The inclusion criteria consisted of (1) adult patients with osteoporotic hip fracture, (2) original study, (3) availability of full text articles in English, and (4) report of a modifiable lifestyle risk factor.Thirty-five studies, containing 1,508,366 subjects in total, were included in this study. The modifiable risk factors that were significantly associated with an increased risk of hip fracture were the following: weight 58 kg (128 lbs) (pooled OR 4.01, 95% CI 1.62-9.90), underweight body mass index (BMI) ( 18.5) (pooled OR 2.83, 95% CI 1.82-4.39), consumption of ≥ 3 cups of coffee daily (pooled OR 2.27, 95% CI 1.04-4.97), inactivity (pooled OR 2.14, 95% CI 1.21-3.77), weight loss (pooled OR 1.88, 95% CI 1.32-2.68), consumption of ≥ 27 g (approx. 2 standard drinks) alcohol per day (pooled OR 1.54, 95% CI 1.12-2.13), and being a current smoker (pooled OR 1.50, 95% CI 1.22-1.85). Conversely, two factors were significantly associated with a decreased risk of hip fracture: obese BMI ( 30) (pooled OR 0.58, 95% CI 0.34-0.99) and habitual tea drinking (pooled OR 0.72, 95% CI 0.66-0.80).Modifiable factors may be utilized clinically to provide more effective lifestyle interventions for at risk populations. We found that low weight and underweight BMI carried the highest risk, followed by high coffee consumption, inactivity, weight loss, and high daily alcohol consumption.

There is evidence of increased incidence, rapid progression, and poor prognosis of COVID‐19 in patients with underlying comorbidities such as diabetes and epilepsy. Developing effective treatment regimens for COVID‐19 patients with multiple comorbidities is crucial, as patients' past medical history is an essential contributor to possible organ injuries in COVID‐19 patients. Herein, we report a confirmed case of COVID‐19 patient with a history of multiple underlying diseases, including diabetes, epilepsy, and gout. The patient developed multiple organ failure and died a week after intensive care unit (ICU) admission. Multiple organ failure is the most common cause of death in COVID‐19 patients., Developing effective treatment regimens for COVID‐19 patients with multiple comorbidities—especially diabetes and epilepsy—is crucial, as patients' past medical history is an essential contributor to possible organ injuries in COVID‐19 patients.

Plaster of Paris (PoP) has been the predominant treatment option for most acute and chronic orthopedic conditions. Water immersion significantly decreases the PoP bandage strength. Moreover, concerns have been raised about the possibility of breaks in PoP splints and cast failures once solid. The current study was designed to account for the increase in weight associated with increased PoP layers. The authors hypothesized that by controlling for weight variation as layers increased, they could determine the number of layers of PoP bandage that truly results in optimal mechanical properties. They assessed whether adequate plaster weight control while increasing layers could improve the mechanical properties of the splint. [ Orthopedics . 2022;45(1):e57–e61.]

Background Nonunion following treatment of supracondylar femur fractures with lateral locked plates (LLP) has been reported to be as high as 21 %. Implant related and surgeon-controlled variables have been postulated to contribute to nonunion by modulating fracture-fixation construct stiffness. The purpose of this study is to evaluate the effect of surgeon-controlled factors on stiffness when treating supracondylar femur fractures with LLPs: Does plate length affect construct stiffness given the same plate material, fracture working length and type of screws? Does screw type (bicortical locking versus bicortical nonlocking or unicortical locking) and number of screws affect construct stiffness given the same material, fracture working length, and plate length? Does fracture working length affect construct stiffness given the same plate material, length and type of screws? Does plate material (titanium versus stainless steel) affect construct stiffness given the same fracture working length, plate length, type and number of screws? Methods Mechanical study of simulated supracondylar femur fractures treated with LLPs of varying lengths, screw types, fractureworking lenghts, and plate/screw material. Overall construct stiffness was evaluated using an Instron hydraulic testing apparatus. Results Stiffness was 15 % higher comparing 13-hole to the 5-hole plates (995 N/mm849N vs. /mm, p = 0.003). The use of bicortical nonlocking screws decreased overall construct stiffness by 18 % compared to bicortical locking screws (808 N/mm vs. 995 N/mm, p = 0.0001). The type of screw (unicortical locking vs. bicortical locking) and the number of screws in the diaphysis (3 vs. 10) did not appear to significantly influence construct stiffness (p = 0.76, p = 0.24). Similarly, fracture working length (5.4 cm vs. 9.4 cm, p = 0.24), and implant type (titanium vs. stainless steel, p = 0.12) did also not appear to effect stiffness. Discussion Using shorter plates and using bicortical nonlocking screws (vs. bicortical locking screws) reduced overall construct stiffness. Using more screws, using unicortical locking screws, increasing fracture working length and varying plate material (titanium vs. stainless steel) does not appear to significantly alter construct stiffness. Surgeons can adjust plate length and screw types to affect overall fracture-fixation construct stiffness; however, the optimal stiffness to promote healing remains unknown.

Background: Many orthopedic surgeries utilize intraoperative fluoroscopy. The mini C-arm is an advantageous device as it can be easily used without the need for a dedicated radiology technician. However, there are concerns that the mini C-arm may represent a potential source of contamination and subsequent postoperative infection. Previous investigations of standard C-arm drapes have shown high rates of contamination. Similar contamination rates would be even more concerning for the mini C-arm as it requires physically maneuvering the machine. This study aimed to determine the rate of mini C-arm drape contamination and identify high-risk areas. Methods: Fifty foot and ankle surgeries requiring the use of mini C-arm fluoroscopy were included. Eight locations on the mini C-arm drape were sampled at the conclusion of each procedure. Culture Q-swabs were used for sampling defined locations. Swab samples were then assessed for bacterial growth on a 5% blood agar plate using a semiquantitative technique. Results: In 70% of surgical cases, contamination was observed in at least 1 location. Six of the 8 evaluated locations were found to have significantly higher contamination in comparison with their corresponding negative controls (Mann-Whitney U test, P < .05). The “outer portion of the upper arm” (location 1) exhibited bacteria growth in 26% ( P < .0001) of cases. The “superior portion of the x-ray source” (location 2) exhibited growth in 30% ( P < .0001) of cases. These were the highest-risk areas for contamination and were both significantly more likely to be involved than the “inferior portion of the x-ray source” and “superior portion of the beam receiver,” locations 4 and 5, respectively. Fourteen percent (7/50) C-arm cases and 1.72% (1/58) Achilles tendon surgery control cases developed surgical site infection ( P = .0234; OR, 9.27). Conclusion: Bacterial contamination of the mini C-arm drape was found to be common after foot and ankle procedures. Contamination was more prevalent on the outer ring areas of the C-arm, both at the emitter and receiver. Level of Evidence: Level III.

Hip fracture is a severe complication of osteoporosis and is associated with a significant healthcare burden worldwide. This meta-analysis explores the association between combined multivitamin use and hip fracture risk. Our results provide more patient-centered insight into the impact of supplement use on osteoporosis outcomes. We searched three online databases in August 2019 and included studies that reported on multivitamin use in patients with osteoporotic hip fractures. The inclusion criteria were (1) adult patients with osteoporotic hip fractures, (2) availability of full-text articles in English, and (3) at least 1 year of follow-up. No suitable randomized controlled trials could be identified for inclusion in the analysis. The quality of the included studies was assessed using the Newcastle-Ottawa Scale (NOS). Eight studies containing 80,148 subjects in total were included in this study. Among these, 4237 cases of fragility hip fracture were reported. The average age was 69±5.3 years, and 21% of subjects were male. Multivitamin use was found to be significantly associated with a lower risk of sustaining a fragility hip fracture (OR 0.49, 95%CI: 0.32–0.77). The Begg and Mazumdar test and funnel plot indicated that no significant publication bias was present. Combined multivitamins are amongst the most widely used supplements and are often preferred over single vitamins. Our meta-analysis indicates that multivitamin use is significantly protective against osteoporotic hip fracture. In the future, randomized controlled trials should be performed to establish multivitamins as effective preventative measures for this injury.

Category: Other; Ankle Introduction/Purpose: Fluoroscopy is critical for orthopaedic surgery. The mini C-arm is popular among foot and ankle surgeons owing ease of easy, maneuverability, and cost effectiveness. However, there are concerns that the mini C-arm may represent a potential source of contamination and increasing the risk of postoperative infection. Evaluation of large c-arm drapes have shown high rates of contamination. However, the mini C-arm may be even more concerning due to how it is handled. The mini c-arm is continuously manipulated by the surgical team who then return to the surgical field carrying with them any potential cross-contamination.Objective: We hypothesize that there is significant contamination of the drape, and that specific locations of the drape are at higher risk. Methods: 50 foot and ankle surgery cases which required the use of mini C-arm fluoroscopy were included. Eight locations on the mini C-arm drape were chosen for sampling. Locations were defined based on commonly touched areas on the drape by the surgical team, and their proximity to the non-sterile field. Negative controls were obtained by separately sampling an additional 20 mini C-arm drapes after draping c-arm and waiting for average surgery time. Positive controls were obtained by sampling non- sterile surfaces within the OR.Culture Q-swabs were used for sampling defined locations, using an established semiquantitative technique. Plates were incubated at 37 °C for 48 hours. Based on the number of quadrants on plate where colony growth was observed, bacterial growth was graded on a scale of 0, 1+, 2+, 3+, or 4+. Contamination threshold was defined as any growth pattern of 1+ or higher. Results: Figure 1 shows the contamination rates of the sampled areas of the c-arm drape. Contamination was noted in 70% of the cases for at least one area, and in two or more areas in 38% of cases.Contamination rates were significantly higher on defined locations in comparison with their relative negative control, except for locations 4 and 5. (PConclusion: Bacterial contamination of the drape was found to be common (70% of cases) after foot and ankle surgery. Contamination was more common on the superior and inferior aspects of the mini c-arm. This correlates to the area that is most commonly manipulated by the surgical team to position the arms of the c-arm. This information can be utilized by surgeons to identify and avoid high risk areas and, in high risk cases, they may consider changing gloves or re-draping the mini c-arm part way through the case.