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Anti-inflammatory task involving endophytic microbe isolates through Emilia sonchifolia (Linn.) Electricity.
Objective To evaluate inpatient outcomes among hip fracture patients treated during the COVID-19 pandemic in New York City. Design Multicenter retrospective cohort study SETTING One Level 1 Trauma Center and one orthopaedic specialty hospital in New York CityPatients/Participants Fifty-nine consecutive patients (average age 85, range 65 - 100 years) treated for a hip fracture (OTA/AO 31, 32.1) over a 5-week period, March 20, 2020 to April 24, 2020, during the height of the COVID-19 crisis. Main outcome measurements COVID-19 infection status was used to stratify patients. The primary outcome was inpatient mortality. Secondary outcomes were admission to the intensive care unit, unexpected intubation, pneumonia, deep venous thrombosis, pulmonary embolus, myocardial infarction, cerebrovascular accident, urinary tract infection, and transfusion. Baseline demographics, comorbidities, treatment characteristics, and COVID-related symptomatology were also evaluated. Results Ten patients (15%) tested positive for COVID-19 (COVID+) (n=9; 7 preoperatively, 2 postoperatively) or were presumed positive (n=1), 40 (68%) patients tested negative, and 9 (15%) patients were not tested in the primary hospitalization. American Society of Anesthesiologists (ASA) scores were higher in the COVID+ group (d=-0.83; p=0.04); however, the Charlson Comorbidity Index was similar between the study groups (d=-0.17; p=0.63). Inpatient mortality was significantly increased in the COVID+ cohort (56% vs. 4%; OR 30.0, 95% CI 4.3-207; p=0.001). Including the one presumed positive case in the COVID+ cohort increased this difference (60% vs. 2%; OR 72.0, 95% CI 7.9-754; p less then 0.001). Conclusions Hip fracture patients with concomitant COVID-19 infection had worse ASA scores but similar baseline comorbidities with significantly higher rates of inpatient mortality compared to those without concomitant COVID-19 infection. Level of evidence Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.Objectives To examine one health system's response to the essential care of its hip fracture population during the COVID-19 pandemic and report on its effect on patient outcomes. Design Prospective cohort study SETTING Seven musculoskeletal care centers with New York City and Long Island. Patients/participants 138 recent and 115 historical hip fracture patients. Intervention Patients with hip fractures occurring between February 1, 2020 and April 15, 2020 or between February 1, 2019 and April 15, 2019 were prospectively enrolled in an orthopedic trauma registry and chart reviewed for demographic and hospital quality measures. Patients with recent hip fractures were identified as COVID positive (C+), COVID suspected (Cs) or COVID negative (C-). Main outcome measurements Hospital quality measures, inpatient complications and mortality rates. Results Seventeen (12.2%) patients were confirmed C+ by testing and another 14 (10.1%) were suspected (Cs) of having had the virus but were never tested. The C+ cohort, when compared to Cs and C- cohorts, had an increased mortality rate (35.3% vs 7.1% vs 0.9%), increased length of hospital stay, a greater major complication rate and a greater incidence of ventilator need postoperatively. Conclusions COVID-19 had a devastating effect on the care of hip fracture patients during the pandemic. Although practice patterns generally remained unchanged, treating physicians need to understand the increased morbidity and mortality in hip fracture patients complicated by COVID-19. Level of evidence Prognostic Level III. See Instructions for Authors for a complete description of Levels of Evidence.Maintaining surgical field sterility during fracture surgery is critical for reducing the likelihood of post-operative infection. Fluorouracil Lateral fluoroscopic views are frequently obtained by rotating the emitter under the bed and up immediately adjacent to the sterile field on the side of the injured limb. Contamination can be prevented by sterilely covering the emitter with each rotation from the upright to the lateral positions. Here we describe a novel draping setup which maintains fluoroscopic coverage in a "hands-free" manner. The technique uses widely available materials and allows the surgeon to proceed with surgery without the need for additional hands to manage the drape.Objectives To (1) report the thermal changes encountered at the pin/skin interface in a cadaver with a knee-spanning external fixator inside the MRI bore and (2) report on the quality of the MRI sequences collected. Methods Three commonly used external fixation systems were placed on cadaveric lower extremities to simulate knee external fixation. Fiber optic thermal probes were placed at the pin/skin interface of a femoral and tibial pin. A control probe was embedded in the soft tissues of the thigh. Full knee MRI scans were performed using a 1.5 Tesla magnet. Real-time thermal data were collected. A clinically significant increase in temperature compared to the control was defined as 2°C. Two blinded radiologists evaluated the images for image quality and overall diagnostic utility using a standardized 5 point grading scale. Results There were statistically significant differences in the temperature changes between the femoral/tibial pin sites and the control probe sites during each phase of the MRI scan. However, there was only one clinically significant difference in temperature change during a single sequence of one MRI scan of one of the external fixator devices. Overall image quality was graded as a 4 for each image set with 100% interobserver agreement (k = 1.0). Conclusions Despite significant differences in temperature changes between the pin sites and controls over multiple MRI sequences in commonly used external fixator devices, the differences in temperature change are likely not clinically relevant. Overall image quality and interpretability of the images were excellent.Comminuted proximal fibula fractures or arcuate fractures (OTA/AO 4F1B fractures), can defunction the posterolateral corner and result in posterolateral knee instability. Ongoing posterolateral knee instability can limit function, cause significant pain, and lead to early knee arthrosis. The anatomy of the posterolateral corner and proximal fibula limit the options for repair of this injury. The ideal method for osteosynthesis of these injuries has not been established. The goals of treatment include reconstitution of posterolateral stability, restoration of the anatomic relationship of posterolateral corner structures, and restoration of bone stock that would permit future reconstruction. This article characterizes the injury pattern, outlines the technique, and provides the clinical and radiographic outcomes of osteosynthesis of comminuted fibular head fractures using a novel application of the tension-slide technique.
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