The edition · Orthopaedics
Waiting for a theatre, not for a medical workup, is what kills hip fracture patients
Delay past 36 hours purely for capacity carried a 37% higher one-year mortality; plus which cement and mixing order gets vancomycin out of a spacer, what vitamin D is worth in stress fractures, and a block you can stop doing after ACL reconstruction.
The edition in brief
The orthopaedic desk opens with a matched-cohort study that separates the two reasons hip fracture surgery is delayed. Among 2,358 patients aged 65 and over, 54% waited more than 36 hours purely because no theatre was available; after propensity-score matching, that group had a higher hazard of death at one year (hazard ratio 1.37, 95% CI 1.15 to 1.63), concentrated in the first 30 days (1.71, 95% CI 1.11 to 2.65) and in patients with a Clinical Frailty Scale score above 4. An in vitro study of 60 polymethylmethacrylate discs shows that brand, viscosity and mixing order change high-dose vancomycin elution substantially: Palacos MV mixed monomer-first gave the greatest cumulative release at 2,897 µg/mL, 120% more than Simplex P mixed the same way, while polymer-first Simplex P gave the highest first-hour release. A meta-analysis of 15 studies and 4,183 participants found stress fracture cases had lower 25-hydroxyvitamin D than controls (mean difference −5.82 nmol/L), significant in military personnel and men but not in athletes or women. A National Joint Registry analysis of 238,455 primary hip replacements found surgeon and institutional factors explained 32.4% and 22.9% of the variation in dual-mobility use, against about 10% for patient factors. A pearl covers the occult femoral neck fracture. The edition closes with a level 1 trial showing adductor canal block adds nothing to local infiltration analgesia in anterior cruciate ligament reconstruction.
Capacity delay, not medical delay, and it costs lives at one year
Order the trauma list by frailty as well as waiting time — the frail patient is the one a day's delay actually harms.
The cement you pick and the order you mix it change the antibiotic dose
Specify cement brand and mixing order in your spacer protocol — the same 4 g of vancomycin can deliver twice as much.
Vitamin D and stress fractures: the signal is in recruits, not in athletes
Correct vitamin D in high-load groups as prevention, and stop using a post-fracture level to explain the injury.
Who gets a dual-mobility hip depends mostly on which surgeon they meet
Check whether your unit's dual-mobility rate is explained by its patients or by its surgeons, and record the indication every time.
A normal radiograph does not clear the painful hip in an older patient
If an older patient cannot weight-bear, believe the patient over the radiograph and get magnetic resonance imaging.
Adductor canal block adds nothing after ACL reconstruction
Stop adding a routine adductor canal block to anterior cruciate ligament reconstruction when local infiltration analgesia is already given.
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