Summary: The prognostic nutritional index (PNI) is a useful tool for assessing nutritional status using serum albumin and lymphocyte count. This study indicates that a higher preoperative PNI correlates with improved mobility and health-related quality of life during the initial postoperative period in elderly patients with hip fractures. Purpose: To investigate the prognostic value of the prognostic nutritional index (PNI) in predicting mobility and health-related quality of life (HRQoL) in elderly hip fracture patients after surgery. Methods: We prospectively involved patients aged 65 and above, who could walk freely before injury and underwent surgery between 2018 and 2019. Admission PNI was calculated as serum albumin (g/L) + 5 × total lymphocyte count (× 10⁹/L). Patients were classified into two groups based on PNI median value. All patients were followed up by telephone for four times (30-day, 120-day, 1-year, and 3-year after surgery). The Fracture Mobility Score (FMS) and EuroQol 5-Dimension 5-Level (EQ-5D 5L) were used to evaluate mobility and HRQoL, respectively. Results: Of 705 eligible patients, 487 completed all assessments. Patients in the higher PNI group had a significantly increased possibility of achieving unrestricted mobility at the 120-day follow-up (OR 1.69, 95% CI 1.10–2.61, P.adj = 0.017), while no significant differences were observed at other follow-ups. Additionally, patients in the higher PNI group had a significantly higher EQ-5D utility value at the 30-day follow-up (P.adj = 0.015). A linear regression model with adjusting for all confounders showed that admission PNI value was positively associated with EQ-5D utility values at 30-day, 120-day, and 1-year follow-up assessments (P.adj = 0.011, P.adj = 0.001, and P.adj = 0.030, respectively). However, this correlation was not observed at the 3-year time point (P.adj = 0.079). Conclusion: The PNI is a valuable predictor of functional outcomes in elderly patients with hip fractures following surgery.

Objective: The prognostic nutritional index (PNI) has been reported as a significant predictor in various diseases. However, the prognostic value of the PNI in geriatric hip fracture patients has not been thoroughly evaluated. This study aimed to investigate the association between admission PNI and 3‐year mortality in those patients.Methods: In this post hoc analysis, we included patients aged ≥65 years who underwent surgery for hip fracture between 2018 and 2019. The admission PNI was calculated as serum albumin (g/L) +5 × total lymphocyte count (×10⁹/L). Patients were categorized into four groups based on PNI quartiles (≤ 43.55, 43.55–46.55, 46.55–49.20, and >49.20, respectively). The median follow‐up duration was 3.1 years. Cox proportional hazards models were used to calculate the hazard ratio (HR). Receiver operating characteristic curve (ROC) was conducted for using PNI to predict mortality.Results: Of the 942 eligible patients, 190 (20.2%) patients died during the follow‐up. Compared to patients in the first quartile (Q1), those in the second (Q2), third (Q3), and fourth (Q4) quartiles had significantly lower mortality risks (HRs 0.50, 95% CI 0.35–0.74; 0.41, 95% CI 0.26–0.64; and 0.26, 95% CI 0.15–0.45, respectively). The optimal cutoff of PNI for predicting mortality was set as 45.275 (sensitivity, 0.674; specificity, 0.692; area under the curve (AUC), 0.727). Patients with higher PNI (>45.275) had a significant lower mortality risk (HR 0.39, 95% CI 0.28–0.55) compared to those with lower PNI (≤ 45.275).Conclusion: PNI is a reliable and independent predictor of 3‐year mortality after hip fracture surgery in the elderly.

Background: Perioperative bleeding from cancellous bone remains a clinically relevant challenge in orthopaedic surgery. Bone wax has long been used as a simple and inexpensive mechanical hemostatic agent, but previous reviews have focused mainly on total joint arthroplasty or on the material history of bone wax and its substitutes. The broader clinical evidence across orthopaedic subspecialties has not been comprehensively mapped. Methods: This scoping review followed the Arksey and O’Malley framework, with methodological refinements proposed by Levac et al., and was reported in accordance with PRISMA-ScR. Five electronic sources and grey literature were searched through May 2025. Clinical studies evaluating bone wax in orthopaedic surgery were eligible regardless of study design; a relevant clinical trial registry record with sufficient methodological detail was also retained to map ongoing evidence. Preclinical and purely material-based studies were excluded. The protocol was registered in the Open Science Framework (DOI: 10.17605/OSF.IO/K3ZAV). Results: Of 486 identified records, 15 met the inclusion criteria. Eight records concerned joint replacement, two spinal surgery, three excision of abnormal bony structures, and two sealing applications. The strongest comparative evidence came from arthroplasty, where bone wax was generally associated with reduced intraoperative or perioperative blood loss without clear evidence of adverse effects on early postoperative recovery outcomes reported in the included studies. Evidence for spinal and nontraditional applications was more heterogeneous and was derived mainly from small observational studies, case series, technical reports, or a trial registry record. Complications such as foreign-body reaction and chronic inflammation were described primarily in spine-related reports of retained nonabsorbable wax. Conclusions: Bone wax remains a useful and inexpensive adjunct for hemostasis in orthopaedic surgery. The strongest clinical evidence is concentrated in arthroplasty, whereas spinal and nontraditional applications remain supported by limited and heterogeneous data. Future research should clarify indication-specific benefits and risks and evaluate the safety and effectiveness of bioresorbable alternatives in well-designed clinical studies.

BACKGROUND It is unclear whether preoperative thyroid-stimulating hormone (TSH) level is correlated with long-term mortality in the elderly after hip fracture surgery. We aimed to assess the association between TSH levels and 3-year mortality in these patients. MATERIAL AND METHODS We enrolled patients aged 65 and above who had hip fracture surgery and thyroid function tests upon admission from 2018 to 2019. Patients were categorized based on TSH median value, quartiles, or thyroid function status. The median follow-up time was 3.1 years. Cox proportional hazards models were used to examine the correlation between TSH levels and mortality, adjusting for covariates. RESULTS Out of 799 eligible patients, 92.7% (741/799) completed the follow-up, with 20.6% (153/741) of those having died by the end of the follow-up. No statistically significant differences in mortality risks were found when stratified by TSH median value (HR 0.88, 95% CI 0.64-1.22, P=0.448) or quartiles (HR ranging from 0.90 to 1.13, P>0.05). Similarly, when categorized based on admission thyroid function status, patients who presented with hypothyroidism, subclinical hypothyroidism, hyperthyroidism, and subclinical hyperthyroidism upon admission did not demonstrate a statistically significant difference in mortality risk compared to those who were considered euthyroid (HR 1.34, 95% CI 0.72-2.49, P=0.359; HR 0.77, 95% CI 0.38-1.60, P=0.489; HR 1.15, 95% CI 0.16-8.30, P=0.890; HR 1.07, 95% CI 0.34-3.38, P=0.913, respectively). CONCLUSIONS Admission TSH is not significantly associated with 3-year mortality in geriatric patients after hip fracture surgery.

Purpose: To compare the mobility and health‐related quality of life (HRQoL) for femoral neck fractures (FNFs) in the elderly treated with either hemiarthroplasty (HA) or total hip arthroplasty (THA). Methods: This study constitutes a post hoc analysis of a prospective cohort study. In this secondary analysis, we enrolled patients aged ≥ 65 years who underwent arthroplasty for FNFs at a tertiary hospital in Beijing, China, between 2018 and 2019. Patients were stratified into the HA group and THA group based on the surgical type. All patients were followed up via telephone at 30, 120, and 365 days postoperatively. The Fracture Mobility Score (FMS) was utilized to assess patients' mobility, while the EuroQol 5‐Dimension (EQ‐5D) instrument was adopted to evaluate their HRQoL. Intergroup comparisons, multivariate logistic regression models, and linear regression models were used to compare outcomes between the two groups and analyze the impact of surgical type on these outcomes. Results: Among 416 eligible patients, 333 completed all three follow‐up evaluations, including 250 patients in the HA group and 83 in the THA group. Multivariate logistic regression models adjusted for potential confounders indicated that patients in the THA group were significantly more likely to achieve unrestricted mobility at 120 and 365 days postoperatively compared with the HA group (OR [95% CI] = 2.407 [1.210–4.788], p .adj = 0.012; OR [95% CI] = 2.410 [1.120–5.183], p .adj = 0.024), with no significant difference observed at the 30‐day follow‐up. In addition, multivariate linear regression models adjusted for 12 covariates demonstrated that the THA group achieved significantly higher EQ‐5D scores at 30 and 120 days postoperatively ( p .adj = 0.003 and p .adj = 0.003, respectively). However, this advantage was not sustained at the 365‐day follow‐up ( p .adj = 0.100). Conclusion: THA may yield a higher probability of independent mobility recovery and better postoperative HRQoL than HA in elderly patients with FNFs.

Objectives: The prognostic relevance of postoperative blood pressure after return to the ward is unclear. In this exploratory post hoc analysis, we investigated the associations of postoperative systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and pulse pressure (PP) with three-year all-cause mortality in older hip fracture patients. Methods: This single-centre post hoc analysis used prospectively collected data from patients aged 65 years or older who underwent hip fracture surgery under neuraxial anaesthesia between November 2018 and November 2019. Immediate postoperative blood pressure was defined as the first non-invasive cuff measurement recorded after return to the ward. PP was calculated as SBP minus DBP, and MAP as (SBP + 2 × DBP)/3. All 1052 patients were included in time-to-event analyses; patients lost to follow-up were right-censored on the date they were last known to be alive. Each blood pressure parameter was assessed in a separate adjusted Cox proportional hazards model. Restricted cubic splines were used to assess nonlinearity. Results: Among 865 patients with known three-year vital status, 192 had died and 673 were alive; 187 patients were censored before three years. Mean PP was lower among patients who died than among survivors (58.68 mmHg (SD 19.45) vs. 62.46 mmHg (SD 20.81); p = 0.019). Each 10 mmHg increase in PP was associated with a lower hazard of mortality (adjusted hazard ratio (HR) 0.914, 95% confidence interval (CI) 0.834 to 0.990; p = 0.033). Spline analysis showed an overall association for PP (p = 0.033), with no evidence of nonlinearity (p = 0.201). Continuous SBP, DBP, and MAP, and DBP < 60 mmHg were not independently associated with mortality. Conclusions: In this exploratory post hoc analysis, lower immediate postoperative PP was associated with a higher risk of three-year all-cause mortality. But PP should not be interpreted as a causal or therapeutic target.