Objective: To report the mortality data and life expectancy of geriatric hip fracture patients who underwent nonoperative management and compare that with a matched operative cohort. Design: Retrospective cohort study. Setting: Level 1 trauma center. Patients: Geriatric (65 years of age and older) femoral neck or intertrochanteric fracture (OTA/AO 31A and 31B) patients. Intervention: Operative treatment with either arthroplasty, cannulated screws, sliding hip screw device, or cephalomedullary nail compared with nonoperative cohort. Main Outcome Measurements: In-hospital, 30-day, and 1-year mortality. Results: Two hundred thirty-one patients, comprising 154 operative and 77 nonoperative patients, were compared. There were no significant differences among age, sex, fracture location, Charlson Comorbidity Index, preinjury living location, dementia, and history of cardiac arrhythmia between the 2 cohorts. Nonoperatively managed patients were found to have a significantly higher percent in-hospital (28.6 vs. 3.9; P < 0.0001), 30-day (63.6 vs. 11.0; <0.0001), and 1-year (84.4 vs. 36.4; P < 0.0001) mortality. The mean life expectancy after a hip fracture for the nonoperative cohort was significantly shorter than the operative group (221 vs. 1024 days; P < 0.0001). Conclusions: Nonoperatively treated hip fracture patients had an 84.4% 1-year mortality that was significantly higher than a matched operative cohort. Our results demonstrate the bleak overall prognosis for nonoperatively treated geriatric hip fractures as well as the associated reduction in mortality with surgical treatment. Our findings offer helpful information by providing updated mortality data when discussing nonoperative hip fracture management with patients and their family. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

The coracoacromial ligament (CAL) was first described as a pain generator by Dr Charles Neer in the early 1970s. Since that time, considerable controversy regarding CAL management during acromioplasty has persisted. This review aims to better understand the role of the CAL in shoulder physiology and pathology. Sixty-six articles from 1958 to 2016 were identified using an electronic search of PubMed, Cochrane Library, AccessMedicine, and MD Consult for case series as well as cohort and prospective studies. The authors used “coracoacromial ligament” and “coracoacromial veil” as medical subject headings (MeSH). In addition, reference lists from all identified articles were reviewed for studies that the search terms may have omitted. The CAL plays an important role in shoulder biomechanics, joint stability, and proprioception. Morphological variance of the CAL is evident throughout the literature. Age-dependent changes due to chronic stress and cellular degradation cause thickening and stiffening of the CAL that may contribute to a spectrum of shoulder pathology from capsular tightness to rotator cuff tear arthropathy and impingement syndrome. The CAL is an integral component of the coracoacromial arch. CAL release during acromioplasty remains controversial. Future clinical outcomes research should endeavor to advance the understanding of the CAL to refine clinical and intraoperative decision making regarding its management.

This is the 1st series describing orthogonal locked compression plating using modern implants for periprosthetic femoral nonunions. This technique should be considered in periprosthetic femur fracture nonunions around a well-fixed stem.

Slipped capital femoral epiphysis (SCFE), a common cause of adolescent hip pain, is a displacement of the femoral head through the proximal femoral physis. The exact etiology of SCFE is unknown, but both biochemical and biomechanical factors, including obesity, femoral retroversion, increased physeal obliquity, puberty, and endocrinopathies, play a role. Patients often present with hip, groin, or knee pain and an antalgic gait. On physical examination, obligate external rotation of the lower limb with passive hip flexion is a hallmark of SCFE. The diagnosis is confirmed with radiographs, with advanced imaging reserved for atypical presentations. Any degree of SCFE is an indication for internal stabilization. Percutaneous in situ fixation remains the gold-standard treatment for slipped capital femoral epiphysis. The procedure is performed with the following steps: (1) the patient is positioned supine on a fracture table with the contralateral lower limb in the hemilithotomy position; (2) a 1-cm longitudinal incision is made over the anterolateral aspect of the proximal part of the femur; (3) under fluoroscopic guidance, a guidewire is advanced freehand into the "center-center" of the epiphysis, stopping approximately 3 mm short of the articular surface; (4) the guidewire is overdrilled, and a 6.5-mm partially threaded cannulated screw of appropriate length is inserted into the epiphysis; (5) the proximal part of the femur is brought through a full range of internal-external rotation under fluoroscopy to confirm that the screw has not violated the joint cavity; and (6) the wound is closed in layers and a sterile dressing is applied. Postoperatively, the patient's weight-bearing status is advanced on the basis of the stability of the SCFE. Radiographic follow-up is performed at six-month intervals to monitor the contralateral hip until skeletal maturity. Treatment outcomes and complications such as osteonecrosis and chondrolysis correlate with the severity and stability of the slip on presentation. Long-term follow-up has shown good-to-excellent outcomes after in situ screw fixation of stable slips.

medications were prescribed for supportive care, we found the most common subclass was anti-hypertensives.Implications for Research, Policy, or Practice. These results highlight the need for clinicians to critically evaluate the portfolio of medications in patients with advanced illness as part of a comprehensive palliative care plan.