Use of recombinant human bone morphogenetic protein-2 in spine surgery

To evaluate the long-term outcome after surgical management of posterior hip dislocations associated with posterior wall acetabular fracture and to depict prognostic factors that may affect surgical results. Retrospective review. Level I trauma center. Between 1983 and 1991, 19 patients with traumatic posterior hip dislocation associated with posterior wall fracture of the acetabulum were retrospectively reviewed. The clinical criteria proposed by Merle d'Aubigne were used for the evaluation of the patient's clinical status. Matta's radiologic scoring system was used for the analysis of the radiologic data. The Brooker scoring system was used to assess the extent of heterotopic ossification after acetabular fracture surgery. There were 17 male patients and two female. The age range at the time of injury was 16 to 54 years with a mean age of 36 years. Follow-up ranged from 15 to 23 years (mean, 18.5 years). At final follow-up, radiographic outcomes were excellent in six patients (31.58%), good in 11 (57.89%), and fair in two (10.53%) patients. The mean clinical score was 15, ranging from 9 to 18. Clinical outcome was excellent in 10 cases (52.63%), good in six cases (31.58%), and fair in three cases (15.79%). When an anatomic reduction was achieved intraoperatively, excellent or good radiographic and clinical results were shown in 100% and 87.50% of the patients, respectively. The adequacy of surgical reduction will determine the long-term outcome of surgically managed posterior hip dislocations associated with posterior wall acetabular fracture. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Postoperative delirium (POD) and postoperative cognitive dysfunction (POCD) are common complications following total knee arthroplasty (TKA) and total hip arthroplasty (THA), affecting the length of hospital stay and increasing medical complications. Although many papers have been published on both conditions in this setting, no reviews have currently been written. Thus, the purpose of our study is to summarize the current literature and provide information about POD and POCD following elective THA or TKA. Our literature search was conducted in the electronic databases PubMed and the Cochrane library. We found that POD is a common complication following elective THA or TKA, with a median incidence of 14.8%. Major risk factors include older age, cognitive impairment, dementia, preoperative (pre-op) comorbidities, substance abuse, and surgery for fracture. Diagnosis can be achieved using tools such as the confusion assessment method (CAM), which is sensitive, specific, reliable, and easy to use, for the identification of POD. Treatment consists of risk stratification and the implementation of a multiple component prevention protocol. POCD has a median incidence of 19.3% at 1 week, and 10% at 3 months. Risk factors include older age, high BMI, and cognitive impairment. Treatment consists of reversing risk factors and implementing protocols in order to preserve physiological stability. POD and POCD are common and preventable complications following TKA and THA. Risk stratification and specific interventions can lower the incidence of both syndromes. Every physician involved in the care of such patients should be informed on every aspect of these conditions in order to provide the best care for their patients.