This study aimed to examine the incidence rate of early reoperations following hip fracture surgery and determine the safety of resuming direct oral anticoagulants. Many orthopedic surgeons are reluctant to resume chronic anticoagulation therapy for patients after surgical intervention for hip fractures. One of the main reasons is the potential for reoperation in the case of surgical complications. We conducted a retrospective cohort study at an Academic Level I trauma center, reviewing the records of 425 geriatric patients (age > 60) who underwent hip fracture surgery between 2018 and 2020, including a subgroup treated with direct oral anticoagulants prior to hospitalization. The study assessed the incidence rate of complications requiring early reoperation. Out of the 425 patients, only nine (2%) required reoperation within a month after discharge, with two (0.5%) on chronic anticoagulation therapy. None of the reoperations were urgent, and all were performed at least 24 h after re-admission. The findings revealed a very low incidence rate of reoperations in patients who underwent hip fracture surgery, with no reoperations performed within 24 h of re-admission. Consequently, we believe that resuming chronic direct oral anticoagulants is a safe and effective approach when discharging patients after hip fracture surgery.

OBJECTIVES: To assess the outcomes of a dual-plating fixation technique for proximal humerus fractures using a lateral locking plate and an additional anterior reduction plate, without the use of adjuvant grafts. METHODS: Design: Retrospective study. Setting: Tertiary referral hospital. Patient Selection Criteria: Included were adult patients with displaced proximal humerus fractures (OTA/AO 11A-C) who underwent dual plate fixation with a lateral locking plate and supplemental anterior plate, without adjunctive grafts, between 2018 and 2024. Outcome Measures and Comparisons: Primary outcomes were union rate and reoperations. Additional clinical outcomes included osteoarthritis, avascular necrosis (AVN), head-shaft angle, and patient-reported outcome measures assessed at a minimum of six months postoperatively, consisting of the QuickDASH and the numerical rating scale for pain (NRSP). RESULTS: Forty patients were included (26 female, 65%) with an average age of 60.2 years (SD 15.1, range 27–86). There were 35 (87.5%) OTA/AO type 11B and 11C fractures and 5 (12.5%) with 11A fractures. Twenty-eight patients (70.0%) had 4-part fractures, 7 patients (17.5%) had 3-part fractures, and 5 patients (12.5%) had a comminuted 2-part surgical neck fractures. Thirteen (32.5%) patients had medial comminution. The average follow-up was 25.8 months (SD 20.4, range 3.2–73.2). All patients achieved union after the index procedure (100%). Three patients (7.5%) required reoperation with reverse total shoulder arthroplasty because of AVN, and 1 had reoperation because of infection (2.5%). In total, 97.5% healed with <10 degrees loss of humeral head-shaft angle. Four patients (10.0%) showed radiologic signs of AVN resulting in articular screw penetration after fracture healing, and 6 (15.0%) had signs of osteoarthritis. The average QuickDASH score was 18.3 (SD 16.1, range 0–59.1) and the average numerical rating scale for pain was 1.9 (SD 2.1, range 0–8). CONCLUSIONS: In a cohort of 40 patients with complex proximal humerus fractures (70.0% 4-part, 17.5% 3-part, 32.5% with medial comminution) treated with a lateral locking plate and an additional anterior plate without adjunctive grafts, the union rate was 100%, reoperations related to AVN occurred in 3 patients (7.5%), and patient-reported outcomes were satisfactory at a minimum of 6 months. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

OBJECTIVES: To compare the clinical outcomes of plate fixation with and without coracoclavicular (CC) suture Endobutton augmentation in the management of displaced lateral clavicle fractures. METHODS: Design : Retrospective study. Setting: Tertiary referral hospital. Patient Selection Criteria: Included were adult patients with displaced lateral clavicle fractures (OTA/AO 15.3) who underwent plate fixation between June 2021 and April 2024. The Augmentation group received adjunctive suture Endobutton fixation, while the Control group did not. Outcome Measures and Comparisons: Clinical outcomes including union, coracoclavicular (CC) distance, infection, re-operation, and self-reported functional outcomes consisting of the Quick Disabilities of the Arm, Shoulder, and Hand Questionnaire (QuickDASH) and numerical rating scale for pain (NRSP) were evaluated and compared between the two groups. To normalize for magnification, the ratio of CC distance to midclavicular width (CCD/MCW) was used to compare the CC distance over time. RESULTS: Forty-nine patients were included, 21 in the Augmentation group (76.2% male, mean age 47.5 years) and 28 in the Control group (75% male, mean age 46.6 years). In the Augmentation group, 15 patients (71.4%) underwent dual plating and 6 (28.6%) underwent single plate fixation. In the Control group, 15 patients (53.6%) underwent dual plating, 10 (35.7%) underwent single plate fixation, and 3 (10.7%) underwent hook plate fixation. The mean study follow-up was 33.7 months (range 4.2-118.6). Union was achieved in all patients (100%) in the Augmentation group, compared to 92.8% in the Control group (p = 0.19). Preoperative CCD/MCW ratios were 2.6 for the Augmentation group and 2.3 for the Control group (p = 0.12). Intraoperative ratios were reduced to 1.4 in both groups (p = 0.6), and maintained at 1.4 during follow-up (p = 0.3). There were no infections. Two patients (9.5%) in the Augmentation group and 7 patients (25%) in the control underwent hardware removal. The median QuickDASH score was 2.3 in both groups (p=0.7), and the median NRSP score was 0.0 in the Augmentation group and 0.5 in the control (p=0.3) CONCLUSIONS: In displaced lateral clavicle fractures, plate fixation with CC ligament suture Endobutton Augmentation achieved a 100% union rate, long-term CC stability, and excellent functional results. With the numbers available in the study, the lower (92.8%) healing rate in the control group without Endobutton Augmentation did not reach statistical significance. LEVEL OF EVIDENCE: A level IV therapeutic retrospective cohort study.