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PurposeThe most significant advance in our time about limb lengthening is the magnetic lengthening nail, as the first reports appeared to show good results with accurate lengthening rates and good regenerate bone formation. The described complication rate is generally low. They avoid external fixation elements, and are activated transcutaneously, so the patient’s pain and discomfort are reduced and the rehabilitation is faster and more effective. The aim of authors is to describe a special technical issue of the PRECICE system: the nail can be extended inside the patient limb (after the osteotomy), but it also can be retracted inside the limb after achieving the bone union.MethodsThe authors present a case in which the limb lengthening has been performed in consecutive lengthening periods using the same nail. The nail was extended and retracted by altering the settings on the external remote control as well as accurately setting the rate of distraction.ResultsAfter two consecutive femoral lengthening with the same PRECICE nail, the patient no longer has a significant lower limb length discrepancy and patient satisfaction was high. During this clinical case, we were not confronted with any type of complications.ConclusionThis technique utilizes the principles and advantages of lengthening over an magnetic lengthening nail, avoids the necessity of nail removal and minimizes the complication rates and the overall time for complete recovery.Level of evidenceLevel IV.

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Introduction: Increased occurrences of falls after discharge are reported, especially in elderly people. Falls are a major cause of disability and identification of risk factors associated with falls is required to plan preventive actions. This study aims to determine the occurrence of falls in the three months after discharge and risk factors in elderly patients. Materials and Methods: 100 patients over 65 admitted to an Internal Medicine Ward participated. Questionnaires were given during hospitalization and three months after discharge. Follow-up information was unavailable for 31 patients (25 deceased, 6 unreachable). Results: Of those analyzed 52% were males with 80 ± 8.1 years (mean ± SD). Polymedication (p = 0.002), use of psychoactive drugs (p = 0.007), analgesics (p = 0.034) and walking devices (p = 0.006) were associated with a higher incidence of falls 6 months before hospitalization. Post-discharge follow-up was obtained for 69 patients: 18 reported falling during the follow-up. There was a higher risk of fall in patients with a history of falls in the 6 months before admission (p = 0.015 RR = 2.76). Patients who had one or more falls after discharge had a significantly shorter length of hospital stay compared to those who didn't fall (p = 0.012). In multivariate logistic regression, we found that patients who were hospitalized more than 7 days had a lower risk of falling in the post-discharge period (OR = 0.195, p = 0.017) independently of the history of falls 6 months prior to admission. Conclusions: Further studies are required to validate the risk factors identified after discharge and to evaluate preventive measures. Elderly patients discharged from an Internal Medicine Ward should be screened to determine the risk of falls, specifically previous history of falls and medication. These patients should integrate a fall prevention program. How to cite this paper: Caetano, P., Freitas, J., Brandão, C., Teófilo, T., Campos, I., Laíns, J. and Veríssimo, M. (2018) Risk Factors for Fall in Elderly Patients: Follow-Up Study after Hospital Discharge. Open Journal of Internal Medicine, 8, 220-231.