Introduction/Objective. The purpose of this study was to determine if patient-related factors, such as length of stay in hospital, and preoperative usage of walking aids, and geometrical factors, measured with antero-posterior radiographs of hip, affect the risk of hip dislocation after total hip arthroplasty. Methods. A total of 36 of 433 (8.31%) patients with hip dislocation were identified in the institutional registry during the two years period. The data for patients with and without hip dislocation were matched and compared. Results Hip dislocation more often occurred in patients who had used the walking aids before the operation compared to the ones who had not (p < 0.001). Also, the difference in the number of HD was noticed between the patients who stayed longer in the hospital after THA (p < 0.001) The patients with higher acetabular inclination angle (p < 0.005) and height of greater trochanter (p < 0.001) on radiographs had been more prone to hip dislocation. In addition to this, the "safe-zone" was not identified in our study (p > 0.005) Conclusion. Several factors, which influence hip dislocation, were identified in this study: patients characteristics and radiograph characteristics. Both groups of factors require attention and monitoring in future studies.

Introduction. Peri-implant femoral fractures (PIFF) are defined as fractures of the femur with the presence of previously implanted non-prosthetic osteosynthetic material. A review of available literature revealed that there are several proposed classifications and sets of guidelines for surgical treatment of PIFF. Case outline. A 49-year-old patient was injured from a fall on the same level, the day before admission to the hospital. The anamnesis at admission showed that six months earlier, he had sustained a pertrochanteric fracture of the left femur, which had been treated surgically with a short cephalomedullary nail. Two years prior to hospital admission, the patient had sustained a tibial plateau fracture of the same leg, which was treated non-surgically with above the knee cast immobilization. After the fracture had healed, paresis of the peroneal nerve was diagnosed, while subsequent follow-up revealed secondary post-traumatic arthrosis of the knee joint. Reduction and fixation of the fracture was performed on a surgical extension table, with the use of fluoroscopy. Previously implanted osteosynthetic material was removed, a short cephalomedullary nail, and fixation of the fracture was carried out with a long cephalomedullary nail. Six months after the operation, the patient can ambulate independently, without assistance. He reports no pain in the left groin and upper leg but reports pain and limitation of movement in the left knee joint. Conclusion. By reviewing the available literature, we found that the patient was cared for in our hospital in keeping with all current recommendations for surgical treatment of this type of fracture.

Introduction. Joint dislocation is the loss of congruence of the joint surfaces. This is a relatively common injury of the musculoskeletal injury. Among the large joints, shoulder joint dislocation has the highest incidence of 24/100,000/year, of which 94?97% are anterior, 1% are inferior, and the remaining injuries are posterior shoulder dislocations. The second most frequent injury is elbow dislocation, with an incidence of 5.2/100,000/year. Among these, over 80% are posterolateral dislocations. Case outline. A 57-year-old female patient was injured during an accidental ground-level fall sustaining combined injuries ? anterior dislocation of the shoulder joint and a posterolateral dislocation of the elbow joint. Upon sustaining the described injuries, she was treated conservatively with good functional results. Conclusion. A review of the literature reveals that the combination of ipsilateral shoulder and elbow joint dislocations is a rare injury, with shoulder dislocation often being overlooked. Proper anamnesis, along with a thorough examination of the joints both proximally and distally to the injured joint, is crucial. If performed adequately, these injuries can often be successfully managed nonoperatively, with closed reduction, immobilization, and rehabilitation, leading to satisfactory functional recovery.

Background: The optimal route of tranexamic acid (TXA) administration remains one of the most debated topics in total knee arthroplasty. This study aimed to compare the effects of intravenous (IV), intra-articular (IA), and combined TXA protocols on total blood loss (TBL) and hidden blood loss (HBL), while identifying independent predictors of perioperative bleeding. Methods: In a prospective cohort study of 245 patients undergoing primary TKA, participants were assigned into four groups: IV TXA (15 mg/kg), IA TXA (1 g), combined (IV + IA), and a control group. TBL and HBL were calculated using the Gross formula. A multivariate linear regression model was used to assess independent associations of each protocol. Results: The IV group demonstrated significantly lower TBL (mean 898 mL) and HBL (mean 568 mL) compared with both the control (1329 mL and 894 mL; p = 0.002) and IA groups (1129 mL and 748 mL; p = 0.008). While IA TXA reduced 24 h drain output (p < 0.001), it did not significantly reduce TBL (p = 0.539) or HBL (p = 0.875). No significant differences were found between the IV-only and combined groups (p > 0.05). Multivariate regression identified the IV route as an independent predictor of reduced TBL (B = −383.7, p = 0.001). Conclusions: A single intravenous dose of TXA was associated with lower total and hidden blood loss compared with intra-articular administration. The lack of additional benefit in the combined group suggests a possible plateau effect of systemic administration, which is hypothesis-generating and limited by the study design for blood conservation in TKA. Level of Evidence: Level II, Prospective Cohort Study.