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Introduction: The optimal positioning of the cephalic screw in intertrochanteric fractures (ITFs) is crucial for minimizing the risk of cut-out. This study assesses the predictive value of the tip-to-apex distance (TAD) and tip-to-apex distance referenced to calcar (calTAD) for cut-outs in patients undergoing fixation with cephalomedullary nails. Method: We analyzed 158 consecutive patients aged over 65 years (mean 83.6 ± 15.9) with intertrochanteric hip fractures who underwent cephalomedullary nailing between January 2016 and July 2022. Receiver operating characteristic (ROC) curves were used to determine the optimal cut-off points for TAD and calTAD. Uni- and multivariate logistic regression analyses were conducted to identify independent predictors of cut-out, considering demographic data, comorbidities, fracture type (AO/OTA), reduction quality (according to Baumgartner classification), TAD, and calTAD. Results: Cut-out occurred in 12 patients (7.5%). ROC analysis identified 18.99 mm as the optimal cut-off for TAD (sensitivity 83.3%, specificity 63.7%; area under the curve—AUC- 0.703, p = 0.009) and 24.95 mm for calTAD (sensitivity 100%, specificity 82.9%, AUC = 0.906, p = < 0.0001). Univariate analysis revealed no significant differences in demographics, fracture type, or reduction quality between patients with and without cut-outs. Multivariate analysis identified calTAD > 24.95 mm as the only independent predictor of cut-out, with an Odds ratio of 24.62 (95% Confidence Interval 27.61–68.92, p = 0.001). Conclusion: Our findings suggest that calTAD is a helpful measure for predicting cut-outs in intertrochanteric fracture fixation using cephalomedullary nails in the context of good fracture reduction. Surgeons should aim to keep calTAD values below 24.95 mm to reduce the risk of cut-out, as values above this threshold significantly increase the risk. [ABSTRACT FROM AUTHOR]

Introduction: The objective of this retrospective study was to assess the effect of the nail to canal ratio and the number and configuration of distal locking screws in bone healing in tibial shaft fractures. Methods: We analyzed 223 consecutive tibial shaft fractures treated with reamed intramedullary nailing between January 2014 and December 2020. We recorded and evaluated the nail to canal ratio (NCR) and the number and configuration of distal locking screws. Median NCR was 0.87 (IQR 0.82-0.94). Ten (4.48%) fractures were treated with one distal locking screw, 173 (77.57%) with two, and 40 (17.93%) with three. Uniplanar fixation was used in 63 (28.25%), biplanar in 150 (67.26%), and triplanar in 10 (4.48%) cases. Uni-, bi-, and multivariate analyses were performed to compare patients who achieved bone union with those who did not. Results: Bone union was achieved in 195 (87.44%) patients. Uni- and bivariate analyses showed that bone union increased significantly with larger NCR (p = 0.0001) and a greater number of locking planes (p = 0.001) and distal screws (p = 0.046). NCR > 0.78 (OR 48.77 CI 95% 15.39–154.56; p = < 0.0001) and distal locking screw configuration (OR 2.91 CI 95% 1.12–9.91; p = 0.046) were identified as independent variables for union. Conclusion: Our findings suggest that in tibial shaft fractures treated with intramedullary nailing, NCR should be equal to or greater than 0.79. Additionally, distal locking screws should be used with a biplanar or triplanar configuration. [ABSTRACT FROM AUTHOR]

Objective: To describe injuries and illnesses across traditional and new sports among the participating athletes of the Buenos Aires 2018 Youth Olympic Summer Games (BA YOG) (6-18 October 2018).Methods: We recorded the daily number of athlete injuries and illnesses (1) through the reporting of all National Olympic Committee (NOC) medical teams and (2) in the polyclinic and medical venues manned by the BA YOG 2018 medical staff.Results: In total, 3.984 athletes from 206 NOCs were observed. NOCs and BA YOG 2018 medical staff reported 619 injuries and 334 illnesses, equalling 15.5 injuries and 8.4 illnesses per 100 athletes over the 13-day period. The eight new sports on the Youth Olympic programme (futsal, beach handball, karate, roller speed skating, kitesurfing, BMX freestyle, climbing and break dancing) fell in between the other sports with respect to injury and illness risk. Injury incidence was highest in rugby (43% of all rugby players), followed by boxing (33%) and badminton (24%), and lowest in swimming, archery, roller speed skating, equestrian, climbing and rowing (<5%). The highest incidences of illness were recorded in golf (20%), followed by triathlon (16%), beach volleyball and diving (both 14%). Of the illnesses, 50% affected the respiratory system and 15% the gastrointestinal system. Injury and illness incidences varied between continents with athletes representing Europe having significantly fewer injuries and illnesses compared with other continents, apart from a similar illness incidence to Asian athletes.Conclusion: The overall injury incidence of 15.5 injuries per 100 athletes was higher, while the overall illness incidence of 8.4 illnesses per 100 athletes was similar to previous youth and Olympic Games. The new sports did not differ significantly compared with the other sports with respect to injury and illness risk. [ABSTRACT FROM AUTHOR]

Introduction: The optimal positioning of the cephalic screw in intertrochanteric fractures (ITFs) is crucial for minimizing the risk of cut-out. This study assesses the predictive value of the tip-to-apex distance (TAD) and tip-to-apex distance referenced to calcar (calTAD) for cut-outs in patients undergoing fixation with cephalomedullary nails., Method: We analyzed 158 consecutive patients aged over 65 years (mean 83.6 ± 15.9) with intertrochanteric hip fractures who underwent cephalomedullary nailing between January 2016 and July 2022. Receiver operating characteristic (ROC) curves were used to determine the optimal cut-off points for TAD and calTAD. Uni- and multivariate logistic regression analyses were conducted to identify independent predictors of cut-out, considering demographic data, comorbidities, fracture type (AO/OTA), reduction quality (according to Baumgartner classification), TAD, and calTAD., Results: Cut-out occurred in 12 patients (7.5%). ROC analysis identified 18.99 mm as the optimal cut-off for TAD (sensitivity 83.3%, specificity 63.7%; area under the curve-AUC- 0.703, p = 0.009) and 24.95 mm for calTAD (sensitivity 100%, specificity 82.9%, AUC = 0.906, p =  < 0.0001). Univariate analysis revealed no significant differences in demographics, fracture type, or reduction quality between patients with and without cut-outs. Multivariate analysis identified calTAD > 24.95 mm as the only independent predictor of cut-out, with an Odds ratio of 24.62 (95% Confidence Interval 27.61-68.92, p = 0.001)., Conclusion: Our findings suggest that calTAD is a helpful measure for predicting cut-outs in intertrochanteric fracture fixation using cephalomedullary nails in the context of good fracture reduction. Surgeons should aim to keep calTAD values below 24.95 mm to reduce the risk of cut-out, as values above this threshold significantly increase the risk., Competing Interests: Declarations. Conflict of interest: The authors have no relevant financial or non-financial interests to disclose. Ethical approval: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. (Project number 12189). Informed consent: Informed consent was obtained from all individual participants included in the study., (© 2024. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.)

Background : The first objective of this retrospective study was to assess infection control rates in patients with chronic post-traumatic osteomyelitis (CPTO) of the femur or tibia treated with antibiotic cement-coated nails. The second objective was to compare the efficacy of custom-made nails versus commercially available antibiotic-coated nails in terms of infection control and need for reoperation. Methods : We reviewed a consecutive series of CPTO patients treated with antibiotic-coated nails who had a minimum follow-up of 24 months. We recorded the characteristics of the initial injury, the type of nail used, cement-nail debonding, infecting microorganisms, operating time, infection control, need for reoperation, and failure rate. We performed a comparative analysis between nails manufactured in the operating room (i.e., custom-made) and those commercially available. Results : Thirty patients were included. The affected bones were the femur ( n = 15 ) and the tibia ( n = 15 ). Twenty-one of the 30 initial injuries were open fractures. Staphylococcus aureus was the most frequently isolated microorganism (50 %). Sixteen patients were treated with custom-made nails and 14 with commercially available antibiotic-coated nails. At the time of extraction, four out of five custom-made antibiotic-coated nails experienced cement-bone debonding. Commercial nails were associated with shorter operating times ( p < 0.0001 ). The overall infection control rate was 96.66 %. Eight (26.66 %) patients needed reoperation. There was one failure (3.33 %) in the group treated with custom-made antibiotic-coated nails. We did not find significant differences between nail types in terms of reoperation, infection control, and failure rate. Conclusions : The use of antibiotic cement-coated nails proved useful in CPTO treatment. Commercially available nails had significantly shorter operating times and did not present cement-bone debonding during removal. Our results seem to indicate that both nail types are similar in terms of infection control and reoperation rates., Competing Interests: The contact author has declared that neither they nor their co-authors have any competing interests., (Copyright: © 2021 Germán Garabano et al.)

Background: Hip fractures have a significant impact on morbidity and mortality in the elderly. Aims : We retrospectively evaluated the predictive role of the Charlson Comorbidity Index (CCI) for 1-year mortality in elderly patients with unstable intertrochanteric hip fractures (ITHF) treated with bipolar hemiarthroplasty. The secondary objective was to identify other relationships, if any, between the variables recorded and mortality., Methods: We included ≥75-year-old patients with unstable ITHF treated with bipolar hemiarthroplasty. We recorded patient gender, age, Body Mass Index, pre-fracture walking ability (Parker Mobility score, modified Harris Hip Score), America Society of Anesthesiologists (ASA) score, Charlson Comorbidity Index (CCI), time to surgery, time to mobilization, hospital stay, and postoperative complications. Uni- and multivariate logistic regression analysis were performed. Sensitivity and specificity were calculated using a ROC curve., Results: A total of 135 patients with a mean age of 87.34 ± 5.5 years were included. The overall 1-year mortality rate was 18.5%. The CCI (OR 1.64 CI 95% 1.21-2.23; p 0.00821) and postoperative complications (OR 3.5 CI 95% 1.19-10.23 p 0.0202) were identified as independent predictors of 1-year mortality in the univariate regression and confirmed in the multivariate regression. CCI sensitivity to predict 1-year mortality was 80%., Conclusion: CCI has shown acceptable sensitivity in the prediction of 1-year mortality in elderly patients with unstable ITHF treated with bipolar hemiarthroplasty. It is of utmost importance to prevent postoperative complications due to their significant impact on 1-year mortality., Competing Interests: None., (© 2021 Delhi Orthopedic Association. All rights reserved.)