Periprosthetic hip fracture: the 48-hour rule may not carry over

The edition in brief

A target trial emulation of 4,564 Japanese patients with periprosthetic hip fracture found no clear difference in 30- or 90-day mortality between surgery within two days and surgery on days 3-10 (90-day risk 2.35% vs 2.31%), suggesting the native hip fracture 48-hour standard should not be applied to these fractures purely to reduce short-term deaths - though avoidable delay is still not justified. A meta-analysis of 18 retrospective studies of cervical fractures in ankylosing spondylitis linked the anterior approach to about three times the complications of the posterior approach, with no difference in neurological recovery or mortality. A single-centre series of renal cell carcinoma long-bone metastases found similar reoperation rates after intralesional surgery and resection, with higher mortality after intralesional surgery that was not seen for solitary metastases. A small randomised trial found adding a live session or an app to booklet education before hip replacement changed neither length of stay nor satisfaction. The pearl covers neck pain after minor trauma in ankylosing spondylitis.