Introduction: This study aims to investigate whether early surgery in patients under active DOAC (direct oral anticoagulation) therapy with trochanteric, proximal femur fractures leads to higher postoperative blood loss. Material and methods: A prospective cohort study on DOAC patients with trochanteric, proximal femur fractures undergoing early surgery (≤ 24 h) was conducted. Propensity score matching with a retrospective control group of DOAC patients with trochanteric, proximal femur fractures undergoing delayed surgery (> 24 h) was performed for comparison. Key outcome measurements included peri- and postoperative blood loss, transfusion rates, time to surgery and hospital length of stay (LOS). Results: No differences in the median blood loss in patients undergoing early surgery vs. delayed surgery on postoperative day 1 (1078.35 ml (IQR 745.86) vs. 1120.79 ml (IQR 928.50); p = 0.824) or postoperative day 3 (1592.39 ml (IQR 1304.91) vs. 1339.73 ml (IQR 735.57); p = 0.165) was seen. No differences in the rate of blood transfusion (72.5% vs. 68.1%; p = 0.576) or the number of transfused red blood cells (RBCs) (2 units (IQR 2) vs. 2 units (IQR 3); p = 0.567) were detected. A significantly longer median time to surgery, and a significantly longer LOS was seen in the delayed surgery group ( p < 0.001). No difference in the rates of perioperative complications was detected between both groups. Conclusion: Early surgery of trochanteric, proximal femur fractures within 24 h under active DOAC therapy does not increase postoperative blood loss or the need for postoperative blood transfusions but leads to a significantly shorter length of stay. Level of evidence: IIb

Background/Objectives: The calcaneus is the most commonly injured tarsal bone, potentially resulting in long-term functional deficiencies and disability. The type of treatment mainly depends on fracture type and morphology. Treatment of these fractures can be challenging due to a limited soft tissue envelope and is frequently associated with complications. The aim of this study was to classify fracture types and identify factors associated with in-hospital complications. Methods: Patients with calcaneal fractures treated at our level I trauma center between 1997 and 2017 were included. Demographic data, comorbidities, fracture characteristics, type of treatment, complications and revisions, compliance and accompanying injuries were evaluated. Results: A total of 238 patients (m = 163, f = 75) at a mean age of 40 years sustaining either uni- or bilateral calcaneal fracture resulting in a total of 288 calcaneal fractures. Concomitant injuries were present in 103 patients (35.9%). Traumatic spine lesions were present in 21.9%. Complications were recorded in 59 fractures (20.5%). Open fractures were more likely to develop complications (76.0% vs. 15.2%, p < 0.001). Significant complication (33% vs. 14%, p < 0.001) and wound complication rates (29% vs. 10%, p < 0.001) were found in multiple-injured patients. All open fractures were surgically treated on the day of admission. In calcaneal fractures with a Böhler angle below 0 degrees, more complications were seen (33% vs. 17%, p < 0.05). Conclusions: High complication rates following calcaneal fractures were detected, with an increased likelihood in open fractures and in patients with multiple injuries. A negative Böhler angle was associated with worse outcomes.

Background/objectives: This study prospectively evaluated clinical outcomes and osseous consolidation in patients with symptomatic scaphoid non-union treated with avascular bone grafting and percutaneous screw fixation. Two imaging methods, MDCT (multi-detector computed tomography) and HR-pQCT (high-resolution peripheric quantitative computer tomography), were employed to assess bone healing. Methods: In Vienna, eight consecutive patients with nine symptomatic scaphoid non-unions underwent revision surgery. Clinical outcomes were measured using DASH and PRWE scores, grip strength, and thumb strength. MDCT and HR-pQCT imaging were conducted 6 and 12 weeks post-operatively. Results: The median DASH score improved significantly from 43.3 (range 3.3–76.7) pre-operatively to 26.6 (p = 0.024) at 3 months and 16.2 (p = 0.06) at 12 months post-operatively. At 5–6 years, the median DASH score was 2 (range 0–15). At 6 weeks, both MDCT and HR-pQCT detected >50% bone healing at the distal interface. At the proximal interface, HR-pQCT detected >50% healing in all cases, whereas MDCT still showed 50% osseous consolidation at both interfaces. Conclusions: Avascular iliac grafting with screw fixation achieved excellent long-term clinical outcomes for symptomatic scaphoid non-union. HR-pQCT proved superior to MDCT for assessing early bone healing.