Introduction: Hospital admission due to fragility hip fracture has increased significantly in recent years. In patients with hip fracture, perioperative pain management is usually with opioids, whose dosage is difficult to adjust and have many side effects, especially in older adults. The purpose of this study was to determine the impact and the advantages of the implementation of the fascia iliaca blockade in older adults with hip fracture due to fragility included in the Orthogeriatric Clinical Care Center of the Fundación Santa Fe de Bogotá and the San José Infantil University Hospital in Bogotá, Colombia. The primary outcome of our study is the incidence of delirium during hospitalization. Methods: A retrospective observational cohort study was conducted. The data was collected from patients older than 65 years treated for a fragility fracture of the hip in two fourth-level hospitals in Bogotá, Colombia from the beginning of 2019 until the end of 2020. Results: A sample of 218 patients was obtained, of which 119 received conventional analgesic management. 99 patients underwent fascia iliaca blockade. No significant difference was found between the use of the block and the development of delirium ( p = 0.442). There was a higher consumption of opioids in the conventional analgesia group compared to the block group (27.61 mg vs 16.34 mg, respectively, p = 0.003), longer duration of the surgical procedure (90.84 vs 81.08 min, respectively, p = 0.030) and longer hospital stay (6.06 vs 5.41 days, respectively, p = 0.641). Conclusions: While this study found no significant difference in the incidence of delirium, fascia iliaca blockade was associated with significant reductions in opioid consumption and shorter procedural times. These findings suggest that fascia iliaca blockade may improve pain management efficiency in older adults with hip fractures.

Background/Objectives: Periprosthetic joint infection (PJI) is a challenging problem in orthopedic surgery and is often associated with high morbidity. The treatment becomes even more challenging whenever the microorganism is virulent and/or not widely known as a causative organism on these occasions. This study aims to report on the clinical outcomes of hip hemiarthroplasty prosthetic hip joint infection by an atypical, rare microorganism, Morganella morganii (M. morganii), focusing on morbidity, revisions, and mortality. Methods: This is a retrospective series of four cases of prosthetic joint infections with Morganella morganii, a rare Gram-negative opportunistic facultative anaerobic pathogen, in four patients who received hip hemiarthroplasty for displaced femoral neck fractures at a level 1 trauma center. Clinical notes, laboratory findings, and radiographs were reviewed to extract relevant information regarding the history and outcomes. Results: The patients were four females, with a mean age of 84.27 years at the time of surgery. Two cases (50%) underwent surgical debridement and implant retention, followed by lifelong antibiotic suppression for symptomatic control of persistent wound drainage, and the other two underwent implant removal and resection arthroplasty (one patient) or received an antibiotic spacer (one patient), followed by chronic antibiotic therapy until wound closure. Conclusions: Periprosthetic hemiarthroplasty infection secondary to M. morganii was associated with overall poor outcomes. Antibiotic suppression could be a reasonable option after the surgical debridement or implant removal in M. morganii PJI to control the symptoms.

Background: The effectiveness of hip hemiarthroplasty in managing femoral neck fractures in individuals with cerebral palsy has seldom been reported. Objectives: Given the complex neuromuscular issues associated with cerebral palsy (CP), this retrospective study aims to document the outcomes and characterize the complications of hip hemiarthroplasty for fractures of the femoral neck in a series of patients with CP, emphasizing the role of precision medicine in management. Methods: Six cases of hip hemiarthroplasty in six male patients with cerebral palsy and displaced femoral neck fractures have been reviewed in this study. The patients’ mean age at the time of surgery was 55.6 ± 14.1 years (range, 33–71). All the patients were independent indoor ambulators before their femoral neck fracture and had various medical comorbidities. Five patients had intellectual disabilities. Results: The mean clinical and radiographic follow-ups for the patients included in this series were 91.5 and 71.3 months, respectively. All the patients developed significant heterotopic ossification (HO) around the operated hip, which was observed as early as the second week postoperatively on radiographs. HO progressed throughout the follow-up for all the patients. One patient had an early postoperative dislocation with femoral stem loosening, which was managed by implant revision. Another patient had an acetabular protrusion, leading to the loss of their weight-bearing ability and mobility due to pain. Four patients were deceased at a mean of 86.5 months after the index surgery. Conclusions: After considering the preliminary evidence provided with this small case series, this study suggests the overall guarded outcomes of hip hemiarthroplasty in patients with CP. Given the 100% rate of heterotopic ossification, a precision medicine framework with consideration for HO prophylaxis may be recommended after hip hemiarthroplasty in patients with CP. It may also be reasonable to scrutinize a personalized risk assessment approach in this patient subset regarding decision making, surgical approach, and rehabilitation program. The clinical outcomes and the risks of complications following hemiarthroplasty should be sensibly presented to patients with cerebral palsy and their caregivers to achieve reasonable postoperative expectations.

Background: Toggling of the short cephalomedullary nail is an understudied phenomenon characterized by a change in the longitudinal axis of the nail in relation to the longitudinal axis of the femoral medullary canal, with subsequent potential loss of reduction. This retrospective study aims to examine the incidence and impact of toggling of short cephalomedullary nails in cases with wide femoral canals. Methods: One thousand two hundred fifty-six (1256) cases that received short proximal femoral nails for intertrochanteric fractures were reviewed. Of them, 101 cases that had wide femoral canals (≥15 mm) and a minimum radiographic follow-up of 6 weeks were included in this study. Outcome measures included nail toggling, varus malunion and revision surgery. Results: After a mean radiographic follow-up of 53.5 weeks, sixteen cases (15.8%) showed significant nail toggling of more than 4 degrees and had subsequent varus displacement of the fracture. In all 16 cases, there was deficient proximal nail fixation, in the form of either a lag device not engaging the lateral wall (2 cases), lateral proximal femoral wall fracture/incompetency (7 cases), or a combination of the two factors (7 cases). Despite this, all sixteen cases achieved fracture union. Five additional cases had complications related to poor initial reduction (four cases) or femoral head avascular necrosis (one case). The other 80 cases had minimal (0–4 degrees) nail toggling and healed without varus malunion, and none of them required revision surgery. Conclusions: Short cephalomedullary nails may toggle in patients with wide femoral canals. The effect of femoral canal width on nail movement and subsequent varus malunion may be abolished when the lag device engages the lateral proximal femoral cortex, and the lateral cortical bone is intact. In patients with wide femoral medullary canals or cases with proximal lateral femoral cortical fracture, the utilization of long or intermediate length cephalomedullary nails may be a more viable option.

OBJECTIVES: To determine when patients with surgically treated right femoral fractures achieve objective criteria for driving readiness after surgery. METHODS: Design : Prospective cohort study. Setting: Single Level I trauma center. Patient Selection Criteria: Patients aged ≥18 years who are licensed drivers and sustained a surgically treated right femoral fracture (OTA/AO 31–33) at a single Level I trauma center were prospectively enrolled after surgery between 2020 and 2024 and underwent braking simulator testing during postoperative follow-up visits. Patients were weight-bearing as tolerated at the time of testing, and those with associated fractures or neurologic deficits were excluded. Outcome Measures and Comparisons: Brake reaction time (BRT) and maximum brake force (BF) were measured using a custom braking simulator during postoperative visits. Driving readiness was defined as BRT 350 N, consistent with conservative published thresholds. Patients were classified as meeting both thresholds (I), BRT only (II), BF only (III), or neither (IV), and category distributions were reported across four postoperative intervals: 1–25, 26–75, 76–125, and >125 days. RESULTS: Forty-five patients were included in this study. Patients were 23 females and 22 males, with a mean age of 58.9 years (range, 18-90). The number of simulator tests performed was 18 at 1–25 days, 33 at 26–75 days, 25 at 76–125 days, and 24 at >125 days. Within the first 25 postoperative days, one patient met both thresholds, while 50% were category III-IV. Mean brake reaction time was 0.87 ± 0.40 seconds at 26–75 days and 0.77 ± 0.22 seconds at 76–125 days, while mean maximum brake force was 333.1 ± 136.9 N and 352.6 ± 110.0 N, respectively. At >125 days postoperatively, a majority of testing observations met both thresholds, with 62.5%, 12.5%, 20.8%, and 4.2% falling into categories I, II, III, and IV, respectively. CONCLUSIONS: Patients with right femoral fractures generally did not meet the predefined simulator braking time thresholds in the first 25 days postoperatively, whereas a majority first met both thresholds after 125 days. Simulator-based assessment may help guide individualized postoperative counseling. LEVEL OF EVIDENCE: Level II