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BACKGROUND The distal radius is an optional site for evaluation of bone quality in postmenopausal women before cementless total hip arthroplasty. We hypothesized that dual-energy X-ray absorptiometry (DXA) and pulse-echo ultrasonometry of the distal radius may help discriminate subjects at high risk of femoral stem subsidence. METHODS A prospective cohort of postmenopausal women with primary hip osteoarthritis underwent total hip arthroplasty with implantation of a parallel-sided femoral stem. Postoperative stem migration was measured using radiostereometric analysis. Preoperatively, subjects had multisite DXA measurement of bone mineral density (BMD) and pulse-echo ultrasonometry of the cortical-bone thickness. The diagnostic abilities of these methods to discriminate less then 2 mm and ≥2 mm femoral stem subsidence were tested. RESULTS The accuracy of the distal radius BMD and cortical-bone thickness of the distal radius were moderate (area under the curve, 0.737 and 0.726, respectively) in discriminating between less then 2 mm and ≥2 mm stem subsidence. Women with low cortical-bone thickness of the radius were more likely (odds ratio = 6.7; P = .002) to develop stem subsidence ≥2 mm. These subjects had lower total hip BMD (P = .007) and reduced thickness of the medial cortex of the proximal femur (P = .048) with lower middle (P less then .001) and distal (P = .004) stem-to-canal fill ratios. CONCLUSION Femoral stem stability and resistance to subsidence are sensitive to adequate bone stock and unaltered anatomy. DXA and pulse-echo ultrasonometry of the distal radius may help discriminate postmenopausal women at high risk of stem subsidence. BACKGROUND Patients with reduced lumbar spine mobility are at higher risk of dislocation following total hip arthroplasty (THA). Therefore our study aimed to (1) define the optimal protocol for identifying patients with mobile hips and stiff lumbar spines and (2) determine clinical and standing radiographic parameters predicting these patients. METHODS A cohort of 113 patients with end-stage hip osteoarthritis awaiting THA was prospectively studied. Clinical data, patient-reported outcome measures, and spinopelvic radiographs were assessed with the patient in the standing, "relaxed-seated," and "deep-flexed seated" position. A "hip user index" was calculated quantifying the percentage of sagittal hip movement compared to overall movement between the standing and deep-flexed seated position. RESULTS Radiographs in the relaxed-seated position had an accuracy of 56% (95% confidence interval 46-65) to detect patients with stiff lumbar spines, compared to a detected rate of 100% in the deep-flexed seated position. A standing pelvic tilt of ≥19° was the only predictor for being a hip user with a sensitivity of 90% and specificity of 71% (area under the curve 0.83). Patients with a standing pelvic tilt ≥19° and an unbalanced spine with a flatback deformity had a 30× fold relative risk (95% confidence interval 4-226, P less then .001) of being a hip user. CONCLUSION Patients awaiting THA and having combined high hip and reduced lumbar spine mobility can be screened for with lateral standing radiographs of the spinopelvic complex. Hip user verification should be done utilizing radiographs in the deep-flexed seated position due to a higher accuracy compared to relaxed-seated radiographs. LEVEL OF EVIDENCE Level II, diagnostic study. BACKGROUND Wandering spleen is defined as the localization of the spleen in the lower parts of the abdomen or the pelvic region, rather than the left upper quadrant. The torsion of wandering spleen is a rare clinical condition. CASE REPORT We evaluate a case diagnosed with torsion of wandering spleen and underwent splenectomy in our hospital and discuss it in light of the literature. A 26-year-old man presented to the emergency department with abdominal pain and abdominal distention. The patient was diagnosed with the torsion of wandering spleen based on computed tomography scan results. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS? The torsion of wandering spleen is rare in patients presenting with acute abdominal pain, but it is an important condition that should be considered in the differential diagnosis. The diagnosis of wandering spleen should be made before the development of potentially life-threatening complications. Emergency surgery should be undertaken in patients with splenic infarction. BACKGROUND There have been previous cases of medication-induced hyponatremia with various causative agents reported. Severe hyponatremia, a common medical emergency, can vary widely in its presentation, ranging from seizures and comas to no clinical manifestations. CASE REPORT An 81-year-old female patient presented to the Emergency Department with history of a fall. She had a known case of hypertension and was recently started on hydrochlorothiazide. When evaluated at the hospital, her sodium level was measured as 106 mmol/L and her clinical symptoms were unremarkable. She was simultaneously diagnosed with a urinary tract infection, for which she was treated with intravenous ciprofloxacin. Hygromycin B A few hours after administration, her sodium level fell even further, and she quickly developed symptoms of hyponatremia. After discontinuation of ciprofloxacin and treatment with hypertonic saline (3% NS), she improved and made a full recovery. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS? We present an unusual case of minimally symptomatic, severe consecutive multi-medication-induced hyponatremia. As hyponatremia can present asymptomatically, routinely checking sodium levels is recommended, especially when caring for patients who recently experienced a fall or started a thiazide diuretic. BACKGROUND Infectious disease-related factors that may contribute to or complicate falls have received relatively little attention in the literature. OBJECTIVE Our aim was to determine the prevalence of, and risk factors for, coexisting systemic infections (CSIs) in patients admitted to the hospital because of a fall or its complications. METHODS We conducted a retrospective cohort study of adult patients seen at a tertiary care hospital emergency department and subsequently hospitalized because of a fall or its complications. RESULTS Of 1,456 evaluable cases, 775 patients (53.2%) were female. Mean age was 71.6 years (range 18-104 years). CSI was diagnosed in 303 patients (20.8%), of which 166 (54.8%) were urinary tract infections and 108 (35.6%) were pneumonia cases; 14 patients (4.6%) were bacteremic. CSI was not initially suspected by providers in 98 (32.5%) subsequently diagnosed cases. Age ≥50 years (odds ratio [OR] 5.6; 95% confidence interval [CI] 1.2-24.9), inability to get up on own after the index fall (OR 2.
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