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Hayashi M, Yamamoto N, Kuroda N, Kano K, Miura T, Kamimura Y, Shiroshita A. Peripheral Nerve Blocks in the Preoperative Management of Hip Fractures: A Systematic Review and Network Meta-Analysis. Ann Emerg Med 2024; 83:522-538. [PMID: 38385910 DOI: 10.1016/j.annemergmed.2024.01.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 01/15/2024] [Accepted: 01/18/2024] [Indexed: 02/23/2024]
Abstract
STUDY OBJECTIVE We conducted a systematic review and network meta-analysis to evaluate the comparative efficacy of peripheral nerve block types for preoperative pain management of hip fractures. METHODS We searched Cochrane, Central Register of Controlled Trials, MEDLINE, EMBASE, ICTRP, ClinicalTrials.gov, and Google Scholar for randomized clinical trials. We included participants aged more than 16 years with hip fractures who received peripheral nerve blocks or analgesics for preoperative pain management. The primary outcomes were defined as absolute pain score 2 hours after block placement, preoperative consumption of morphine equivalents, and length of hospital stay. We used a random-effects network meta-analysis conceptualized in the Bayesian framework. Confidence of evidence was assessed using Confidence in Network Meta-Analysis (CINeMA). RESULTS We included 63 randomized controlled studies (4,778 participants), of which only a few had a low risk of bias. The femoral nerve block, 3-in-1 block, fascia iliaca compartment block, and pericapsular nerve group block yielded significantly lowered pain scores at 2 hours after block placement compared with those with no block (standardized mean differences [SMD]: -1.1; 95% credible interval [CrI]: -1.7 to -0.48, [confidence of evidence: low]; SMD: -1.8; 95% CrI: -3.0 to -0.55, [low]; SMD: -1.4; 95% CrI: -2.0 to -0.72, [low]; SMD: -2.3; 95% CrI: -3.2 to -1.4, [moderate], respectively). The pericapsular nerve group block, 3-in-1 block, fascia iliaca compartment block, and femoral nerve block resulted in lower pain scores than the no-block group. Additionally, the pericapsular nerve group block yielded a lower pain score than femoral nerve block or fascia iliaca compartment block (SMD: -1.21; 95% CrI: -2.18 to -0.23, [very low]: SMD: -0.92; 95% CrI: -1.70 to -0.16, [low]). However, both the fascia iliaca compartment block and femoral nerve block did not show a reduction in morphine consumption compared with no block. To our knowledge, no studies have compared the pericapsular nerve group block with other methods regarding morphine consumption. Furthermore, no significant difference was observed between peripheral nerve blocks and no block in terms of the length of hospital stay. CONCLUSIONS Compared with no block, preoperative peripheral nerve blocks for hip fractures appear to reduce pain 2 hours after block placement. Comparing different blocks, pericapsular nerve group block might be superior to fascia iliaca compartment block and femoral nerve block for pain relief, though the confidence evidence was low in most comparisons because of the moderate to high risk of bias in many of the included studies and the high heterogeneity of treatment strategies across studies. Therefore, further high-quality research is needed.
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Affiliation(s)
- Minoru Hayashi
- Department of Emergency Medicine Fukui Prefectural Hospital, Yotsui, Fukui, Japan
| | - Norio Yamamoto
- Department of Epidemiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan; Scientific Research WorkS Peer Support Group (SRWS-PSG), Osaka, Japan.
| | - Naoto Kuroda
- Scientific Research WorkS Peer Support Group (SRWS-PSG), Osaka, Japan; Department of Pediatrics, Wayne State University, Detroit, MI; Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kenichi Kano
- Department of Emergency Medicine Fukui Prefectural Hospital, Yotsui, Fukui, Japan
| | - Takanori Miura
- Scientific Research WorkS Peer Support Group (SRWS-PSG), Osaka, Japan; Department of Orthopedic Surgery, Akita Rosai Hospital, Odate, Japan
| | - Yuji Kamimura
- Scientific Research WorkS Peer Support Group (SRWS-PSG), Osaka, Japan; Department of Anesthesiology and Intensive Care Medicin, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Akihiro Shiroshita
- Scientific Research WorkS Peer Support Group (SRWS-PSG), Osaka, Japan; Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN
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Yamanaka T, Matsumura T, Ae R, Hiyama S, Takeshita K. Risk of peri‑implant femoral fracture after cephalomedullary nailing in older patients with trochanteric fractures. Injury 2024; 55:111206. [PMID: 37996270 DOI: 10.1016/j.injury.2023.111206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 10/31/2023] [Accepted: 11/12/2023] [Indexed: 11/25/2023]
Abstract
INTRODUCTION Despite the recent increase in the use of cephalomedullary nails for trochanteric hip fractures, factors that may be associated with peri‑implant femoral fracture (PIFF) after cephalomedullary nailing for trochanteric fractures remain unknown. We investigated the factors associated with PIFF after cephalomedullary nailing of trochanteric hip fractures in older patients. METHODS A nested case-control study was conducted using a database of patients aged ≥65 years who underwent surgery with cephalomedullary nails for trochanteric fractures caused by low-energy trauma during 2005-2021. The cases were defined as patients who developed PIFF after surgery, while controls were patients who did not develop PIFF and who were followed up for ≥3 years after surgery. Four controls were randomly matched to each case for sex and age. First, potential factors associated with PIFF were compared between cases and controls. Second, multivariable conditional logistic regression analysis was employed to assess factors possibly associated with PIFF, controlling for potential confounding factors. RESULTS Of 1531 patients who underwent surgery with cephalomedullary nails because of trochanteric fractures, we assessed 34 cases and 136 controls (N = 170; mean age 85.7 ± 7 years; and females, 94 %). PIFF was significantly associated with patients having undergone total knee arthroplasty (adjusted odds ratios [95 % confidence intervals], 4.41 [1.16-16.8]) and those with AO/OTA classification 31A3 fracture (A3 fracture) (2.3 [1.12-4.76]), after adjusting for potential confounding factors. CONCLUSIONS Our results showed that PIFF was more likely to develop among older patients with a clinical history of total knee arthroplasty and A3 fracture. These findings suggest that such patients may require careful follow-up with rigorous assessments after cephalomedullary nailing for trochanteric fractures.
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Affiliation(s)
- Takuya Yamanaka
- Department of Orthopedic Surgery, School of Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Tomohiro Matsumura
- Department of Emergency and Critical Care Medicine, Jichi Medical University, Shimotsuke, Japan.
| | - Ryusuke Ae
- Division of Public Health, Center for Community Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Shuhei Hiyama
- Department of Orthopedic Surgery, School of Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Katsushi Takeshita
- Department of Orthopedic Surgery, School of Medicine, Jichi Medical University, Shimotsuke, Japan
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Jacob N, Ghobrial M, Parker M. Does delay from injury to surgery increase the risk of dislocation of a hip hemiarthroplasty? Injury 2024; 55:111446. [PMID: 38479318 DOI: 10.1016/j.injury.2024.111446] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 09/20/2023] [Accepted: 02/19/2024] [Indexed: 05/24/2024]
Abstract
Dislocation of a hip hemiarthroplasty used to treat a hip fracture is a serious complication. The aim of this study was to identify whether a delay in the time from fracture to surgery causes an increase in the rate of post-operative hip dislocation. From a single center, data from intracapsular neck of femur patients treated with hip hemiarthroplasty was collected between October 1986 to August 2021. The time from both fall to surgery and admission to surgery was recorded. Surviving patients were followed up for one year. The overall dislocation rate was 51 out of 4155 patients (1.2%). The 3019 patients who had surgery within two days of the injury had a lowest dislocation rate (29 dislocations, 0.96%). For the 197 patients with no history of a fall, there were 5 (2.5%) dislocations (p=0.036, 95% confidence interval of difference 0.15 to 0.97 for comparison with surgery within two days). For the 399 patients with a delay of more than four days from injury till surgery, there were nine dislocations (2.3%) (p=0.045, 95% confidence intervals of difference 0.20 to 0.89 for comparison with surgery within two days). This study demonstrates an increase in the risk of dislocation for those patients with no history of a fall and those with a delay of more than four days from injury to surgery.
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Affiliation(s)
- Neville Jacob
- Peterborough City Hospital (North West Anglia NHS Trust).
| | | | - Martyn Parker
- Peterborough City Hospital (North West Anglia NHS Trust), Peterborough City Hospital, Edith Cavell Campus, Bretton Gate, Peterborough, PE3 9GZ.
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Raper E, Kimmel LA, Burge AT, Harris IA, Ackerman IN, Page RS, Naylor JM, Hepworth G, Gabbe B, Ekegren CL, Harris A, Woode ME, Holland AE. Implementation of supplemental physiotherapy following hip fracture surgery: a protocol for the process evaluation of a randomised controlled trial. Trials 2024; 25:344. [PMID: 38790039 PMCID: PMC11127386 DOI: 10.1186/s13063-024-08143-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 04/29/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Patient outcomes following low-trauma hip fracture are suboptimal resulting in increased healthcare costs and poor functional outcomes at 1 year. Providing early and intensive in-hospital physiotherapy could help improve patient outcomes and reduce costs following hip fracture surgery. The HIP fracture Supplemental Therapy to Enhance Recovery (HIPSTER) trial will compare usual care physiotherapy to intensive in-hospital physiotherapy for patients following hip fracture surgery. The complex environments in which the intervention is implemented present unique contextual challenges that may impact intervention effectiveness. This study aims to complete a process evaluation to identify barriers and facilitators to implementation and explore the patient, carer and clinician experience of intensive therapy following hip fracture surgery. METHODS AND ANALYSIS The process evaluation is embedded within a two-arm randomised, controlled, assessor-blinded trial recruiting 620 participants from eight Australian hospitals who have had surgery for a hip fracture sustained via a low-trauma injury. A theory-based mixed method process evaluation will be completed in tandem with the HIPSTER trial. Patient and carer semi-structured interviews will be completed at 6 weeks following hip fracture surgery. The clinician experience will be explored through online surveys completed pre- and post-implementation of intensive therapy and mapped to domains of the Theoretical Domains Framework (TDF). Translation and behaviour change success will be assessed using the Reach Effectiveness-Adoption Implementation Maintenance (RE-AIM) framework and a combination of qualitative and quantitative data collection methods. These data will assist with the development of an Implementation Toolkit aiding future translation into practice. DISCUSSION The embedded process evaluation will help understand the interplay between the implementation context and the intensive therapy intervention following surgery for low-trauma hip fracture. Understanding these mechanisms, if effective, will assist with transferability into other contexts and wider translation into practice. TRIAL REGISTRATION ACTRN 12622001442796.
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Affiliation(s)
- Eleanor Raper
- Physiotherapy Department, Alfred Health, Melbourne, Australia.
- Central Clinical School, Monash University, Melbourne, VIC, Australia.
| | - Lara A Kimmel
- Physiotherapy Department, Alfred Health, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Angela T Burge
- Physiotherapy Department, Alfred Health, Melbourne, Australia
- Central Clinical School, Monash University, Melbourne, VIC, Australia
- Institute for Breathing and Sleep, Melbourne, VIC, Australia
| | - Ian A Harris
- Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Sydney, Australia
- School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Sydney, Australia
| | - Ilana N Ackerman
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Richard S Page
- Barwon Centre for Orthopaedic Research and Education, IMPACT, School of Medicine, Deakin University, Geelong, VIC, Australia
- John of God Geelong Hospital, Geelong, VIC, Australia
- Department of Orthopaedics, University Hospital Geelong, Barwon Health, Geelong, VIC, Australia
| | - Justine M Naylor
- Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Sydney, Australia
- School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Sydney, Australia
| | - Graham Hepworth
- Statistical Consulting Centre, The University of Melbourne, Melbourne, VIC, Australia
| | - Belinda Gabbe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Christina L Ekegren
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Melbourne, Australia
| | - Anthony Harris
- Centre for Health Economics, Monash University, Melbourne, Australia
| | - Maame Esi Woode
- Centre for Health Economics, Monash University, Melbourne, Australia
| | - Anne E Holland
- Physiotherapy Department, Alfred Health, Melbourne, Australia
- Central Clinical School, Monash University, Melbourne, VIC, Australia
- Institute for Breathing and Sleep, Melbourne, VIC, Australia
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Tan JR, Gao Y, Raghuraman R, Ting D, Wong KM, Cheng LTE, Oh HC, Goh SH, Yan YY. Application of deep learning algorithms in classification and localization of implant cutout for the postoperative hip. Skeletal Radiol 2024:10.1007/s00256-024-04692-6. [PMID: 38771507 DOI: 10.1007/s00256-024-04692-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 04/03/2024] [Accepted: 04/22/2024] [Indexed: 05/22/2024]
Abstract
OBJECTIVE This study aims to explore the feasibility of employing convolutional neural networks for detecting and localizing implant cutouts on anteroposterior pelvic radiographs. MATERIALS AND METHODS The research involves the development of two Deep Learning models. Initially, a model was created for image-level classification of implant cutouts using 40191 pelvic radiographs obtained from a single institution. The radiographs were partitioned into training, validation, and hold-out test datasets in a 6/2/2 ratio. Performance metrics including the area under the receiver operator characteristics curve (AUROC), sensitivity, and specificity were calculated using the test dataset. Additionally, a second object detection model was trained to localize implant cutouts within the same dataset. Bounding box visualizations were generated on images predicted as cutout-positive by the classification model in the test dataset, serving as an adjunct for assessing algorithm validity. RESULTS The classification model had an accuracy of 99.7%, sensitivity of 84.6%, specificity of 99.8%, AUROC of 0.998 (95% CI: 0.996, 0.999) and AUPRC of 0.774 (95% CI: 0.646, 0.880). From the pelvic radiographs predicted as cutout-positive, the object detection model could achieve 95.5% localization accuracy on true positive images, but falsely generated 14 results from the 15 false-positive predictions. CONCLUSION The classification model showed fair accuracy for detection of implant cutouts, while the object detection model effectively localized cutout. This serves as proof of concept of using a deep learning-based approach for classification and localization of implant cutouts from pelvic radiographs.
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Affiliation(s)
- Jin Rong Tan
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore General Hospital, Block 2, Level 1 Outram Road, Singapore, 169608, Singapore.
- Radiological Sciences ACP, Duke-NUS Medical School, Singapore, Singapore.
| | - Yan Gao
- Health Services Research, Changi General Hospital, Singapore Health Services, Singapore, Singapore
| | - Raghavan Raghuraman
- Department of Orthopaedic Surgery, Changi General Hospital, Singapore, Singapore
| | - Daniel Ting
- Duke-NUS Medical School, Singapore Health Service (SingHealth), Singapore, Singapore
| | - Kang Min Wong
- Radiological Sciences ACP, Duke-NUS Medical School, Singapore, Singapore
- Department of Radiology, Changi General Hospital, Singapore, Singapore
| | - Lionel Tim-Ee Cheng
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore General Hospital, Block 2, Level 1 Outram Road, Singapore, 169608, Singapore
- Radiological Sciences ACP, Duke-NUS Medical School, Singapore, Singapore
| | - Hong Choon Oh
- Health Services Research, Changi General Hospital, Singapore Health Services, Singapore, Singapore
| | - Siang Hiong Goh
- Department of Emergency Medicine, Changi General Hospital, Singapore, Singapore
| | - Yet Yen Yan
- Radiological Sciences ACP, Duke-NUS Medical School, Singapore, Singapore
- Department of Radiology, Changi General Hospital, Singapore, Singapore
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González-Quevedo D, Rubia-Ortega C, Sánchez-Delgado A, Moriel-Garceso D, Sánchez-Siles JM, Bravo-Bardají M, García-de-Quevedo D, Tamimi I. Secondary osteoporosis prevention: three-year outcomes from a Fracture Liaison Service in elderly hip fracture patients. Aging Clin Exp Res 2024; 36:103. [PMID: 38704788 PMCID: PMC11070393 DOI: 10.1007/s40520-024-02761-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 04/19/2024] [Indexed: 05/07/2024]
Abstract
BACKGROUND Hip fractures are the most serious fragility fractures due to their associated disability, higher hospitalization costs and high mortality rates. Fracture Liaison Service (FLS) programs have enhanced the management of osteoporosis-related fractures and have shown their clinical effectiveness. AIMS To analyze the effect of the implementation of a FLS model of care over the survival and mortality rates following a hip fracture. METHODS We conducted a prospective cohort study on patients over 60 years of age who suffered a hip fracture before and after the implementation of the FLS in our center (between January 2016 and December 2019). Patients were followed for three years after the index date. Mortality, complications and refracture rates were compared between the two groups using a Multivariate Cox proportional hazard model. RESULTS A total of 1366 patients were included in this study (353 before FLS implementation and 1013 after FLS implementation). Anti-osteoporotic drugs were more frequently prescribed after FLS implementation (79.3% vs 12.5%; p < 0.01) and there was an increase in adherence to treatment (51.7% vs 30.2%; p < 0.01). A total of 413 (40.8%) patients after FLS implementation and 141 (39.9%) individuals before (p = 0.47) died during the three-years follow-up period. A second fracture occurred in 101 (10.0%) patients after FLS implementation and 37 (10.5%) individuals before (p = 0.78). Patients after the implementation of the FLS protocol had a lower all cause one-year mortality [adjusted Hazard Ratio (HR) 0.74 (0.57-0.94)] and a decreased risk of suffering a second osteoporotic fracture [adjusted HR 0.54 (0.39-0.75) in males and adjusted HR 0.46 (0.30-0.71) in females]. CONCLUSIONS The implementation of a FLS protocol was associated with a lower all-cause one-year mortality rate and a higher survivorship in elderly hip fracture patients. However, no three-year mortality rate differences were observed between the two groups. We also found a reduction in the complication and second-fracture rates.
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Affiliation(s)
- David González-Quevedo
- Department of Orthopedic Surgery and Traumatology, Regional University Hospital of Málaga, Carlos Haya Avenue, 29010, Málaga, Spain.
- Department of Surgical Specialties, Biochemistry and Immunology, School of Medicine, University of Málaga, Málaga, Spain.
| | - Carolina Rubia-Ortega
- Department of Orthopedic Surgery and Traumatology, Regional University Hospital of Málaga, Carlos Haya Avenue, 29010, Málaga, Spain
| | - Adriana Sánchez-Delgado
- Department of Orthopedic Surgery and Traumatology, Regional University Hospital of Málaga, Carlos Haya Avenue, 29010, Málaga, Spain
| | - Diego Moriel-Garceso
- Department of Orthopedic Surgery and Traumatology, Regional University Hospital of Málaga, Carlos Haya Avenue, 29010, Málaga, Spain
| | - Juan-Manuel Sánchez-Siles
- Department of Orthopedic Surgery and Traumatology, Regional University Hospital of Málaga, Carlos Haya Avenue, 29010, Málaga, Spain
| | - Manuel Bravo-Bardají
- Department of Orthopedic Surgery and Traumatology, Regional University Hospital of Málaga, Carlos Haya Avenue, 29010, Málaga, Spain
| | - David García-de-Quevedo
- Department of Orthopedic Surgery and Traumatology, Regional University Hospital of Málaga, Carlos Haya Avenue, 29010, Málaga, Spain
| | - Iskandar Tamimi
- Department of Orthopedic Surgery and Traumatology, Regional University Hospital of Málaga, Carlos Haya Avenue, 29010, Málaga, Spain
- Department of Surgical Specialties, Biochemistry and Immunology, School of Medicine, University of Málaga, Málaga, Spain
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Baumann AN, Talaski GM, Uhler MA, Anastasio AT, Walley KC, Pean CA, Tampi RR, Farivar M. The Utilization of Preoperative Steroids Safely Decreases the Risk of Postoperative Delirium in Geriatric Patients After Hip Fracture Surgery: A Systematic Review and Meta-analysis of Randomized Controlled Trials. J Orthop Trauma 2024; 38:e182-e190. [PMID: 38300234 DOI: 10.1097/bot.0000000000002781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/24/2024] [Indexed: 02/02/2024]
Abstract
OBJECTIVES Postoperative delirium is an acute neurocognitive complication that can have adverse effects on outcomes of geriatric patients after undergoing hip fracture surgery. The objective of this study was to examine the efficacy of preoperative steroids in preventing postoperative delirium after hip fracture surgery. METHODS DATA SOURCES A systematic review and meta-analysis was performed using PubMed, SPORTDiscus, CINAHL, MEDLINE, and Web of Science from database inception until September 28, 2023. STUDY SELECTION Inclusion criteria were randomized controlled trials of patients who underwent surgical intervention for hip fracture, were examined for postoperative delirium, and used preoperative steroids. DATA EXTRACTION Data included the risk of postoperative delirium, postoperative all-cause infection, and postoperative hyperglycemia. Articles were graded via the Cochrane Collaboration's tool. DATA SYNTHESIS Statistical analysis included a random-effects binary model with relative risk, 95% confidence intervals along with a defined "number needed to treat" threshold (number needed to treat). RESULTS Four randomized controlled trials were included from 128 articles initially retrieved. Patients (n = 416; average age: 82.2 ± 2.2 years) underwent surgical intervention for hip fracture after receiving either preoperative steroids (n = 209) or control interventions (n = 207). There was a statistically significant decrease in the incidence of postoperative delirium among patients who received preoperative steroids (12.9%; 27 cases) as compared with patients who received control interventions (26.7%; 55 cases) after hip fracture surgery ( P < 0.001; RR: 0.84). The absolute risk difference was 13.8%, and the number needed to treat was 7.2 patients. There was no statistically significant difference in the risk of postoperative all-cause infection among patients who received preoperative steroids as compared with patients who received normal saline as placebo after hip fracture surgery ( P = 0.850; RR: 0.96). CONCLUSIONS The utilization of preoperative steroids seems to decrease the risk of postoperative delirium after hip fracture surgery in elderly adults. Furthermore, this decreased risk of postoperative delirium was not associated with a significant increase in postoperative infection, indicating possible safety of preoperative steroid administration. LEVEL OF EVIDENCE Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Anthony N Baumann
- College of Medicine, Northeast Ohio Medical University, Rootstown, OH
| | | | - Mathias A Uhler
- College of Biological Sciences, University of Akron, Akron, OH
| | | | - Kempland C Walley
- Department of Orthopedic Surgery, University of Michigan, Ann Arbor, MI
| | | | - Rajesh R Tampi
- Department of Psychiatry, Creighton University, Omaha, NE
| | - Michel Farivar
- Department of Psychiatry, Cleveland Clinic Akron General, Akron, OH
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Soundarrajan D, Fanta HT, Singh R, Dhanasekararaja P, Rajkumar N, Rajasekaran S. Outcomes of conversion total hip arthroplasty for failed fixation of intertrochanteric fractures with monoblock distal-loading reconstruction stem. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:2113-2120. [PMID: 38548874 DOI: 10.1007/s00590-024-03907-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 03/07/2024] [Indexed: 05/19/2024]
Abstract
PURPOSE The aim of our study was to analyze the clinical and radiological outcomes of conversion total hip arthroplasty (THA) for failed fixation of proximal femur fractures with monoblock grit-blasted titanium reconstruction stem (Wagner self-locking stem, Zimmer). PATIENTS AND METHODS Thirty-nine patients were included in this retrospective analysis undergoing conversion THA for failed cephalomedullary nail or dynamic hip screw fixation for intertrochanteric fractures from January 2017 to January 2022. The clinical evaluation was done using Harris hip score. The radiological outcomes measured were subsidence, level of osteointegration, stem-canal fill ratio and heterotopic bone formation. The complications were noted postoperatively and during the follow-up. RESULTS The mean follow-up at the end of the study was 27.8 months (range, 14-72 months). There was a significant improvement in the Harris hip score over serial follow-ups (p < 0.001), but after 2 years, there was no statistically significant difference (p = 0.46). According to Engh's criteria, stable ingrowth was noted in 35 stems, fibrous stable ingrowth was noted in 4 stems and no patients had progressive subsidence and unstable stem. The mean stem-canal fill percentages were 91.8 ± 5.4% at the mid-stem and 80.3 ± 11.5% at the stem tip. Heterotopic ossification Brooker grade 2 was noted in 8 patients, and no patients had grade 3 or 4 heterotopic ossification. There were 7 (17.9%) intraoperative periprosthetic fractures, and greater trochanteric avulsion was noted in 2 patients in the follow-up. CONCLUSION Conversion THA using monoblock tapered distal loading stems bypasses the calcar deficiency and gives stable fixation in failed fixation of intertrochanteric fractures. It gives good radiological outcome and significant improvement in the clinical outcomes compared to the preoperative disability. However, caution should be noted for risk of intraoperative periprosthetic fractures in this subgroup of patients.
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MESH Headings
- Humans
- Male
- Female
- Arthroplasty, Replacement, Hip/methods
- Arthroplasty, Replacement, Hip/adverse effects
- Arthroplasty, Replacement, Hip/instrumentation
- Hip Fractures/surgery
- Retrospective Studies
- Middle Aged
- Aged
- Reoperation/statistics & numerical data
- Hip Prosthesis/adverse effects
- Adult
- Prosthesis Design
- Fracture Fixation, Internal/methods
- Fracture Fixation, Internal/instrumentation
- Fracture Fixation, Internal/adverse effects
- Treatment Outcome
- Aged, 80 and over
- Postoperative Complications/etiology
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Affiliation(s)
| | - Helawi Tewabe Fanta
- Department of Orthopaedics, Ganga Hospital, 313, Mettupalayam Road, Coimbatore, 641 043, India
| | - Rithika Singh
- Department of Orthopaedics, Ganga Hospital, 313, Mettupalayam Road, Coimbatore, 641 043, India
| | | | - Natesan Rajkumar
- Department of Orthopaedics, Ganga Hospital, 313, Mettupalayam Road, Coimbatore, 641 043, India
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Wang H, Ding K, Zhang Y, Ren C, Huo H, Zhu Y, Zhang Q, Chen W. A Controlled Variable Study of the Biomechanical Properties of the Proximal Femur before and after Cancellous Bone Removal. Orthop Surg 2024; 16:1215-1229. [PMID: 38520122 PMCID: PMC11062879 DOI: 10.1111/os.14044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 03/05/2024] [Accepted: 03/07/2024] [Indexed: 03/25/2024] Open
Abstract
OBJECTIVE The biomechanical characteristics of proximal femoral trabeculae are closely related to the occurrence and treatment of proximal femoral fractures. Therefore, it is of great significance to study its biomechanical effects of cancellous bone in the proximal femur. This study examines the biomechanical effects of the cancellous bone in the proximal femur using a controlled variable method, which provide a foundation for further research into the mechanical properties of the proximal femur. METHODS Seventeen proximal femoral specimens were selected to scan by quantitative computed tomography (QCT), and the gray values of nine regions were measure to evaluated bone mineral density (BMD) using Mimics software. Then, an intact femur was fixed simulating unilateral standing position. Vertical compression experiments were then performed again after removing cancellous bone in the femoral head, femoral neck, and intertrochanteric region, and data were recorded. According to the controlled variable method, the femoral head, femoral neck, and intertrochanteric trabeculae were sequentially removed based on the axial loading of the intact femur, and the displacement and strain changes of the femur samples under axial loading were recorded. Gom software was used to measure and record displacement and strain maps of the femoral surface. RESULTS There was a statistically significant difference in anteroposterior displacement of cancellous bone destruction in the proximal femur (p < 0.001). Proximal femoral bone mass explained 77.5% of the strength variation, in addition proximal femoral strength was mainly affected by bone mass at the level of the upper outer, lower inner, lower greater trochanter, and lesser trochanter of the femoral head. The normal stress conduction of the proximal femur was destroyed after removing cancellous bone, the stress was concentrated in the femoral head and lateral femoral neck, and the femoral head showed a tendency to subside after destroying cancellous bone. CONCLUSION The trabecular removal significantly altered the strain distribution and biomechanical strength of the proximal femur, demonstrating an important role in supporting and transforming bending moment under the vertical load. In addition, the strength of the proximal femur mainly depends on the bone density of the femoral head and intertrochanteric region.
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Affiliation(s)
- Haicheng Wang
- CangZhou Hospital of Integrated TCM‐WM in HebeiCangzhou CityChina
| | - Kai Ding
- Department of Orthopedic SurgeryHebei Medical University Third HospitalShijiazhuangChina
| | - Yifan Zhang
- Department of Orthopedic SurgeryHebei Medical University Third HospitalShijiazhuangChina
| | - Chuan Ren
- Department of Orthopedic SurgeryHebei Medical University Third HospitalShijiazhuangChina
| | - Haoyu Huo
- Department of Orthopedic SurgeryHebei Medical University Third HospitalShijiazhuangChina
| | - Yanbin Zhu
- Department of Orthopedic SurgeryHebei Medical University Third HospitalShijiazhuangChina
| | - Qi Zhang
- Department of Orthopedic SurgeryHebei Medical University Third HospitalShijiazhuangChina
| | - Wei Chen
- Department of Orthopedic SurgeryHebei Medical University Third HospitalShijiazhuangChina
- NHC Key Laboratory of Intelligent Orthopedic EquipmentHebei Medical University Third HospitalShijiazhuangChina
- Key Laboratory of Biomechanics of Hebei ProvinceShijiazhuangChina
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Yuan X, Liang Y, Yang H, Feng L, Sun H, Li C, Qin J. Applying Machine Learning Analysis Based on Proximal Femur of Abdominal Computed Tomography to Screen for Abnormal Bone Mass in Femur. Acad Radiol 2024; 31:2003-2010. [PMID: 37973518 DOI: 10.1016/j.acra.2023.10.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/05/2023] [Accepted: 10/20/2023] [Indexed: 11/19/2023]
Abstract
RATIONALE AND OBJECTIVES To evaluate the performance of machine learning analysis based on proximal femur of abdominal computed tomography (CT) scans in screening for abnormal bone mass in femur. MATERIALS AND METHODS 222 patients aged 50 years or older who underwent abdominal CT and dual-energy X-ray absorptiometry scans within 14 days were retrospectively enrolled. The patients were randomly assigned to a training cohort (n = 155) and a testing cohort (n = 67) in a ratio of 7:3. A total of 2288 candidate radiomic features were extracted from the volume region of interest - the left proximal femur of the abdominal CT scans. The most valuable radiomic features were selected using minimum-Redundancy Maximum-Relevancy and the least absolute shrinkage and selection operator to construct the radiomics model. The predictive performance was assessed with receiver operating characteristic curve. RESULTS 13 features were chosen to establish the radiomics model. The radiomics model using logistic regression displayed excellent prediction performance in distinguishing normal bone mass and abnormal bone mass, with the area under the curve (AUC), accuracy, sensitivity and specificity of 0.917 (95% CI, 0.867-0.967), 0.826, 0.935 and 0.780 in the training cohort. The testing cohort indicated a better performance with AUC, accuracy, sensitivity and specificity of 0.963 (95% CI, 0.919-0.999), 0.851, 0.923 and 0.889. CONCLUSION The radiomics model based on proximal femur of abdominal CT scans had a high predictive performance to identify abnormal bone mass in femur, which can be used as a tool for opportunistic osteoporosis screening.
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Affiliation(s)
- Xiaoqing Yuan
- Department of Radiology, The Second Affiliated Hospital of Shandong First Medical University, Tai'an, 271000, China
| | - Yanbo Liang
- Department of Radiology, The Second Affiliated Hospital of Shandong First Medical University, Tai'an, 271000, China
| | - Hui Yang
- Department of Radiology, The Second Affiliated Hospital of Shandong First Medical University, Tai'an, 271000, China
| | - Lingling Feng
- Department of Radiology, The Second Affiliated Hospital of Shandong First Medical University, Tai'an, 271000, China
| | - Hao Sun
- Department of Radiology, The Second Affiliated Hospital of Shandong First Medical University, Tai'an, 271000, China
| | - Changqin Li
- Department of Radiology, The Second Affiliated Hospital of Shandong First Medical University, Tai'an, 271000, China
| | - Jian Qin
- Department of Radiology, The Second Affiliated Hospital of Shandong First Medical University, Tai'an, 271000, China.
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Scuderi GR, Mont MA. Goals of Care: A Patient-Centered Assessment. J Arthroplasty 2024; 39:1142-1143. [PMID: 38462139 DOI: 10.1016/j.arth.2024.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/12/2024] Open
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Ek S, Wennberg AM, Ding M, Meyer AC, Hedström M, Modig K. Characterizing the Individuals Who Regain or Maintain Walking Ability after a Hip Fracture: Insights Into Physical Resilience. J Am Med Dir Assoc 2024; 25:744-750.e3. [PMID: 38309302 DOI: 10.1016/j.jamda.2023.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 12/19/2023] [Accepted: 12/19/2023] [Indexed: 02/05/2024]
Abstract
OBJECTIVES Maintaining walking ability is key to healthy aging. Hip fractures often lead to declined walking ability. This study investigated characteristics of individuals who regained walking ability after a hip fracture, an expression of physical resilience. DESIGN Register-based cohort study. SETTING AND PARTICIPANTS A total of 55,467 Swedish residents aged ≥60 years with a first hip fracture (71% women, mean age = 82.3 ± 8) included in the Swedish Hip Fracture Register. METHODS Information about diseases, medications, and socioeconomic (SES) factors came from registers. Individuals were classified by prefracture walking ability (independent or assisted walking) and whether their walking ability 4 months post-fracture was maintained (physical resilience or nonresilience). Cluster analyses were conducted among individuals who maintained their walking ability to assess different physical resilience profiles. RESULTS At baseline, 38,493 individuals walked independently (69%), and 16,982 were assisted walkers. Half of the independent walkers maintained their walking ability 4 months post-fracture. Among them, 3 clusters were identified: a "Low SES, Low Disease" cluster (n = 8580, mean age 81.1 ± 7.5); a "High SES, Low Disease" cluster (n = 7778, mean age 76.7 ± 7.4); and a third "High SES, High Disease" cluster (n = 4320, mean age 77.7 ± 7.4). Sixty percent of the pre-assisted walkers maintained their level of assisted walking ability. Also among them, 3 clusters were identified: a "Low SES-Independent Living" cluster (n = 3077, mean age 85.5 ± 7.1); a second "Care Home" cluster (n = 2912, mean age 87.0 ± 6.5) with a high proportion with dementia diagnosis; and a last "High SES" cluster (n = 4044, mean age 83.0 ± 7.0) with the largest proportion of men. CONCLUSIONS AND IMPLICATIONS Physical resilience is not characterized by one typical healthy profile, and it is possible to regain walking ability after a hip fracture despite unfavorable prerequisites in 1 domain. A favorable status in one domain may compensate for an unfavorable status in another, for example, a high disease burden in combination with high SES.
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Affiliation(s)
- Stina Ek
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
| | - Alexandra M Wennberg
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Mozhu Ding
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Anna C Meyer
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Margareta Hedström
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden; Trauma and Reparative Medicine Theme (TRM), Karolinska University Hospital, Stockholm, Sweden
| | - Karin Modig
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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Sadeghpour A, Mahdipour S, Ghanjpour Sales J, Aslani H, Moharrami MR, Alizadeh H. Non-cannulated versus cannulated cancellous screws for the internal fixation of femoral neck fractures in osteoporotic patients: A single-blind randomized clinical trial. J Orthop 2024; 51:32-38. [PMID: 38299065 PMCID: PMC10825919 DOI: 10.1016/j.jor.2023.11.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 11/26/2023] [Accepted: 11/28/2023] [Indexed: 02/02/2024] Open
Abstract
Background The incidence of femoral neck fractures in osteoporotic patients is rising worldwide and is associated with significant increases in healthcare and social costs, as well as dependency. Improving minimally invasive treatment strategies, including internal fixation with screws, can result in favorable clinical outcomes and lesser incidence of complications, while preserving the hip. This study compared the outcomes of using non-cannulated cancellous screws (NCS) and cannulated cancellous screws (CS) in the internal fixation of undisplaced intracapsular femoral neck fractures (UIFNF) of osteoporotic patients of Iranian descent. Methods This randomized clinical trial was conducted on the patients referring to an institutional tertiary hospital in northwestern Iran between March 2020 and June 2021. The patients' preoperative, perioperative, and postoperative characteristics were evaluated for at least two years. Primary endpoints were defined as the incidence of hip-related complications, while secondary endpoints were assessed based on the patients' hip function using Harris Hip Score (HHS). Results Fifty-seven patients with osteoporosis and UIFNF were included in the final analysis, with 27 patients in the NCS group and 30 patients in the CS group. The surgical duration, the amount of intraoperative blood loss, and the frequency of C-arm were considerably lower in the CS group (p < 0.05). The incidence of implant failure was higher in the NCS group (p = 0.04). Screw migration occurred more frequently in the CS group (p = 0.03). The HHS values were significantly higher for the NCS group than those of the CS group at both the 1-year and 2-years of follow-up assessments (1 year, p = 0.007; 2 years, p = 0.001). Conclusion Fixation using CS was accompanied by enhanced perioperative outcomes and lower implant failure rates compared to the NCS group. However, patients in the NCS group posed a reduced risk of complications, including screw migration, and experienced a long-term improvement in HHS scores.
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Affiliation(s)
- Alireza Sadeghpour
- Department of Orthopedic Surgery, Shohada Educational Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Shahab Mahdipour
- Department of Orthopedic Surgery, Shohada Educational Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Jafar Ghanjpour Sales
- Department of Orthopedic Surgery, Shohada Educational Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hossein Aslani
- Department of Orthopedic Surgery, Shohada Educational Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Reza Moharrami
- Department of Orthopedic Surgery, Shohada Educational Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hadi Alizadeh
- Department of Orthopedic Surgery, Shohada Educational Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
- Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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Giordano V, Woolley PM, Heetveld MJ, Smith CS, de Ridder V. Geriatric proximal femur fracture updates. OTA Int 2024; 7:e323. [PMID: 38708041 PMCID: PMC11064807 DOI: 10.1097/oi9.0000000000000323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 12/26/2023] [Accepted: 12/28/2023] [Indexed: 05/07/2024]
Abstract
Proximal femur fractures in the aging population present a variety of challenges. Physiologically, patients incurring this fracture are typically frail, with significant medical comorbidities, yet require early surgical treatment to restore mobility to prevent deterioration. Socioeconomically, the occurrence of a fragility fracture may be the beginning of the loss of independence, and the burdens of rehabilitation and support are borne by the individual patient and health care systems.
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Affiliation(s)
- Vincenzo Giordano
- Serviço de Ortopedia e Traumatologia, Prof. Nova Monteiro—Hospital Municipal Miguel Couto, Rio de Janeiro, Brazil
- Clínica São Vicente—Rede D'or São Luiz, Rio de Janeiro, Brazil
| | - Pierre Marie Woolley
- Department of Orthopaedic Hopital, Universitaire de La Paix HUP, Port au Prince, Haiti
| | - Martin J. Heetveld
- Spaarne Gasthuis, Haarlem, The Netherlands
- Department of Trauma Surgery, Spaarne Gasthuis, AK Haarlem, The Netherlands
| | | | - Victor de Ridder
- Emergency Care and Logistics, Trauma and Pediatric Trauma University Medical Center Utrecht, Utrecht, Netherlands
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Koole C, Bleeser T, Hoogma DF, Coppens S, Teunkens A, Rex S. Haemodynamic effects of continuous spinal anaesthesia versus single-shot spinal anaesthesia or general anaesthesia for hip fracture surgery: a systematic review and meta-analysis. Br J Anaesth 2024; 132:1160-1162. [PMID: 38242801 DOI: 10.1016/j.bja.2023.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 12/13/2023] [Accepted: 12/18/2023] [Indexed: 01/21/2024] Open
Affiliation(s)
- Charlotte Koole
- Department of Anaesthesiology, UZ Leuven, Department of Cardiovascular Sciences, Group Biomedical Sciences, KU Leuven, Leuven, Belgium
| | - Tom Bleeser
- Department of Anaesthesiology, UZ Leuven, Department of Cardiovascular Sciences, Group Biomedical Sciences, KU Leuven, Leuven, Belgium
| | - Danny F Hoogma
- Department of Anaesthesiology, UZ Leuven, Department of Cardiovascular Sciences, Group Biomedical Sciences, KU Leuven, Leuven, Belgium
| | - Steve Coppens
- Department of Anaesthesiology, UZ Leuven, Department of Cardiovascular Sciences, Group Biomedical Sciences, KU Leuven, Leuven, Belgium
| | - An Teunkens
- Department of Anaesthesiology, UZ Leuven, Department of Cardiovascular Sciences, Group Biomedical Sciences, KU Leuven, Leuven, Belgium
| | - Steffen Rex
- Department of Anaesthesiology, UZ Leuven, Department of Cardiovascular Sciences, Group Biomedical Sciences, KU Leuven, Leuven, Belgium.
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Esper GW, Anil U, Cavaleri SG, Furgiuele DL, Zaretsky J, Konda SR, Egol KA. Preoperative Workup of Operative Hip Fracture Patients: A Survey. HSS J 2024; 20:237-244. [PMID: 39281995 PMCID: PMC11393624 DOI: 10.1177/15563316231158546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 12/13/2022] [Indexed: 09/18/2024]
Abstract
Background: There may be disagreement among stakeholders on the need for preoperative cardiac screening for elderly hip fracture patients. Purpose: We sought to assess preoperative workup perceptions among physicians for hip fracture patients across specialties, specifically considering a patient's cardiovascular risk. Methods: A case-based survey was distributed to 50 physicians in each of the 4 departments involved in preoperative patient care: orthopedic surgery (OS), anesthesiology (A), cardiology (C), and hospital medicine (HM). The survey asked about which clinical presentations required a cardiology consult, as well as about further preoperative imaging and laboratory work. Single score intraclass correlation coefficient (ICC) was used to compare agreement. Results: Of the 200 surveys sent out, 33 responses (16.5% response rate) were received. Between all specialties, there was 72% agreement about preoperative cardiology consult need (intraclass correlation coefficient [ICC] = 0.063 or poor) and 71% agreement about preoperative transthoracic echocardiogram (TTE) need (ICC = 0.188 or poor). Within each specialty (A, C, HM, OS) ICCs measuring agreement for the need for cardiology consult were 0.812 (good), 0.561 (moderate), 0.457 (poor), and 0.414 (poor), respectively, and for the need for preoperative TTE were 0.852 (good), 0.441 (poor), 0.848 (good), and 0.188 (poor), respectively. Common preoperative testing requested included complete blood count, basic metabolic panel in all cases, and electrocardiogram with troponins if perioperative acute coronary syndrome symptoms were present. Conclusion: This survey suggests that there may be varying levels of agreement within specialties and poor agreement between specialties on the need for cardiology consultation and preoperative imaging for hip fracture patients. This suggests the need for established, reliable preoperative workup protocols with input from different specialties to streamline preoperative care for patients before hip fracture surgery.
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Affiliation(s)
- Garrett W Esper
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
| | - Utkarsh Anil
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
| | | | - David L Furgiuele
- Department of Anesthesiology, NYU Grossman School of Medicine, New York, NY, USA
| | - Jonah Zaretsky
- Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - Sanjit R Konda
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
- Department of Orthopedic Surgery, Jamaica Hospital Medical Center, Richmond Hill, NY, USA
| | - Kenneth A Egol
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
- Department of Orthopedic Surgery, Jamaica Hospital Medical Center, Richmond Hill, NY, USA
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Wang C, Hou M, Zhang C, Ma T, Li Z, Lin H, Zhang K, Huang Q. Biomechanical evaluation of a modified intramedullary nail for the treatment of unstable femoral trochanteric fractures. Heliyon 2024; 10:e29671. [PMID: 38660243 PMCID: PMC11040111 DOI: 10.1016/j.heliyon.2024.e29671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 04/11/2024] [Accepted: 04/12/2024] [Indexed: 04/26/2024] Open
Abstract
Background The Proximal Femoral Nail Antirotation (PFNA) device is the most commonly used implant to fix unstable femoral trochanteric fractures (UFTFs), but it has a relatively high incidence of complications. Due to this factor, the modified intramedullary nail (MIN) was created to treat patients with UFTFs. The aim was to exhibit the MIN and make a comparison with PFNA and InterTAN using biomechanical methods. Methods An adult UFTF model was developed using Mimics software. The PFNA, InterTAN nail, and MIN models were drawn referring to the corresponding parameters and installed in the fracture models. Vertical, anteroposterior (AP) bending, and torsion loads of the femoral head were set in advance and loaded onto the fracture models. The value of maximal displacement and von Mises stress was evaluated via finite element analysis (FEA). Results The MIN model had smaller values for maximal displacement than that of the PFNA model, and the increase in displacement was less pronounced for the MIN compared to PFNA under increasing vertical loads. For the indicator of von Mises stress, the MIN model showed lower stress compared with the PFNA model in vertical loads ranging from 300 N to 2100 N. Except for the maximal stress at implants under AP bending loads, the MIN demonstrated the most superior biomechanical properties under AP bending and torsional loads. Conclusion The MIN offered obvious advantages in terms of mechanical stability and stress distribution among the three studied implants, providing a promising implant option for patients with UFTFs.
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Affiliation(s)
- ChaoFeng Wang
- Department of Orthopedics, Hong Hui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, 710054, China
| | - MingMing Hou
- Department of Orthopedics, Hong Hui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, 710054, China
| | - CongMing Zhang
- Department of Orthopedics, Hong Hui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, 710054, China
| | - Teng Ma
- Department of Orthopedics, Hong Hui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, 710054, China
| | - Zhong Li
- Department of Orthopedics, Hong Hui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, 710054, China
| | - Hua Lin
- Department of Orthopedics, Hong Hui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, 710054, China
| | - Kun Zhang
- Department of Orthopedics, Hong Hui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, 710054, China
| | - Qiang Huang
- Department of Orthopedics, Hong Hui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, 710054, China
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Rostagno C, Mannarino GM, Cartei A, Rubbieri G, Ceccofiglio A, Gori AM, Civinini R, Marcucci R. Preoperative Drug Monitoring in Management of Patients with Hip Fracture on Treatment with Direct Oral Anticoagulants. Clin Interv Aging 2024; 19:655-664. [PMID: 38706637 PMCID: PMC11067930 DOI: 10.2147/cia.s444902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 04/09/2024] [Indexed: 05/07/2024] Open
Abstract
Purpose Aim of the present study was to evaluate whether monitoring direct oral anticoagulant (DOAC) levels may improve management of anticoagulated patients who need surgery for hip fracture. Patients and Methods A total of 147 out of 2231 (7.7%) patients with hip fracture admitted to a tertiary teaching hospital were on DOACs (group A), whereas 206 patients matched for age, sex, and type of fracture not on anticoagulant or P2Y12 platelet inhibitors were considered as control group (group B). Patients on DOACs were divided into two subgroups: A1 in which intervention was scheduled in relation to the last drug intake according to current guidelines, and A2 included patients in whom time of surgery (TTS) was defined according to DOAC levels. Neuraxial anesthesia was considered with DOAC levels <30 ng/mL, general anesthesia for levels in the range 30-50 ng/mL. Results and conclusions TTS was significantly lower in controls than in DOAC patients: surgery within 48 hours was performed in 80.6% of group B versus 51% in group A (p<0.0001). In A2, 41 patients underwent surgery within 48 hours (56%) in comparison to 32 A1 patients (45.1%; p=0.03). TTS and length of hospitalization were on average 1 day lower in patients with assay of DOAC levels. Finally, 35/39 (89%) patients with DOAC levels <50 ng/mL had surgery within 48 hours (26 under neuraxial anesthesia, without any neurological complication, and 13 in general anesthesia). Conclusion DOAC assay in patients with hip fracture may be useful for correct definition of time to surgery, particularly in patients who are candidates for neuraxial anesthesia. Two-thirds of patients with DOAC levels <50 ng/mL at 48 hours from last drug intake underwent uneventful neuraxial anesthesia, saving at least 24 hours in comparison to guidelines.
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Affiliation(s)
- Carlo Rostagno
- Dipartimento Medicina sperimentale e clinica, Università di Firenze, Firenze, Italy
- Medicina Interna e Post-Chirurgica, AOU Careggi, Firenze, Italy
| | | | | | - Gaia Rubbieri
- Medicina Interna e Post-Chirurgica, AOU Careggi, Firenze, Italy
| | | | - Anna Maria Gori
- Dipartimento Medicina sperimentale e clinica, Università di Firenze, Firenze, Italy
- Medicina Interna e Post-Chirurgica, AOU Careggi, Firenze, Italy
- Traumatologia e Ortopedia, AOU Careggi, Firenze, Italy
- Malattie aterotrombotiche, AOU Careggi, Firenze, Italy
| | | | - Rossella Marcucci
- Dipartimento Medicina sperimentale e clinica, Università di Firenze, Firenze, Italy
- Medicina Interna e Post-Chirurgica, AOU Careggi, Firenze, Italy
- Traumatologia e Ortopedia, AOU Careggi, Firenze, Italy
- Malattie aterotrombotiche, AOU Careggi, Firenze, Italy
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Konstantinou P, Kostretzis L, Fragkiadakis G, Touchtidou P, Mavrovouniotis A, Davitis V, Ditsiou AZ, Gigis I, Nikolaides AP, Niakas D, Papadopoulos P, Ditsios K. Exploring Quality of Life and Mortality in Pertrochanteric Fragility Hip Fractures in Northern Greece: A Single Tertiary Center Study. J Clin Med 2024; 13:2478. [PMID: 38731006 PMCID: PMC11084555 DOI: 10.3390/jcm13092478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 04/11/2024] [Accepted: 04/19/2024] [Indexed: 05/13/2024] Open
Abstract
Background: Fragility-related pertrochanteric fractures have become a significant public health concern, with a rising incidence attributed to the expanding elderly demographic. Assessing patient-reported health-related quality of life (HRQoL), mortality, and factors correlated with them serves as a crucial metric in evaluating the effectiveness of hip fracture surgery. Methods: In a single-center retrospective study, 259 patients underwent surgical treatment with a cephalomedullary nail, with a mean follow-up of 21.7 months. Health-related quality of life (HRQoL) was assessed using SF-12 (12-item Short Form) and EQ-5D (EuroQoL-5 Dimensions) questionnaires. Mobility status was measured by the Crude Mobility Index (CMI). Surveys were administered during hospitalization and six months postoperatively. Statistical analysis involved descriptive statistics, non-parametric controls (Kendall, Mann-Whitney, and Wilcoxon), and Spearman correlation and logistic regression analysis, which were conducted using IBM SPSS version 28. Results: A statistically significant decrease was observed in the mean EQ-5D and SF-12 scores at 6 months post-op compared to the pre-fracture status. The ASA (American Society of Anaesthesiologists) score showed a significant correlation with the decrease in HRQoL measured by the SF-12 questionnaire. The 30-day post-operative mortality rate was 9.3%, increasing to 32.4% at 1 year. Notably, the 30-day mortality significantly rose during the pandemic era (5.0% vs. 12.0%; p = 0.003). Conclusions: Pertrochanteric hip fractures cause a lasting decline in quality of life. Annual mortality is high, and further investigations are needed to formulate policies that prevent hip fractures and reduce mortality rates.
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Affiliation(s)
- Panagiotis Konstantinou
- 2nd Orthopaedic Department, Aristotle University of Thessaloniki, “G. Gennimatas” Hospital, Eth. Aminis 41, 546 35 Thessaloniki, Greece; (L.K.); (P.T.); (A.M.); (V.D.); (I.G.); (P.P.); (K.D.)
- University Hospitals Birmingham NHS Foundation Trust, Birmingham B7 5TE, UK;
| | - Lazaros Kostretzis
- 2nd Orthopaedic Department, Aristotle University of Thessaloniki, “G. Gennimatas” Hospital, Eth. Aminis 41, 546 35 Thessaloniki, Greece; (L.K.); (P.T.); (A.M.); (V.D.); (I.G.); (P.P.); (K.D.)
| | - Georgios Fragkiadakis
- Healthcare Management, School of Social Science, Hellenic Open University, 263 35 Patra, Greece; (G.F.); (D.N.)
| | - Panagiota Touchtidou
- 2nd Orthopaedic Department, Aristotle University of Thessaloniki, “G. Gennimatas” Hospital, Eth. Aminis 41, 546 35 Thessaloniki, Greece; (L.K.); (P.T.); (A.M.); (V.D.); (I.G.); (P.P.); (K.D.)
| | - Argyrios Mavrovouniotis
- 2nd Orthopaedic Department, Aristotle University of Thessaloniki, “G. Gennimatas” Hospital, Eth. Aminis 41, 546 35 Thessaloniki, Greece; (L.K.); (P.T.); (A.M.); (V.D.); (I.G.); (P.P.); (K.D.)
| | - Vasileios Davitis
- 2nd Orthopaedic Department, Aristotle University of Thessaloniki, “G. Gennimatas” Hospital, Eth. Aminis 41, 546 35 Thessaloniki, Greece; (L.K.); (P.T.); (A.M.); (V.D.); (I.G.); (P.P.); (K.D.)
| | - Athina Zacharoula Ditsiou
- School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece;
| | - Ioannis Gigis
- 2nd Orthopaedic Department, Aristotle University of Thessaloniki, “G. Gennimatas” Hospital, Eth. Aminis 41, 546 35 Thessaloniki, Greece; (L.K.); (P.T.); (A.M.); (V.D.); (I.G.); (P.P.); (K.D.)
| | | | - Dimitris Niakas
- Healthcare Management, School of Social Science, Hellenic Open University, 263 35 Patra, Greece; (G.F.); (D.N.)
| | - Pericles Papadopoulos
- 2nd Orthopaedic Department, Aristotle University of Thessaloniki, “G. Gennimatas” Hospital, Eth. Aminis 41, 546 35 Thessaloniki, Greece; (L.K.); (P.T.); (A.M.); (V.D.); (I.G.); (P.P.); (K.D.)
| | - Konstantinos Ditsios
- 2nd Orthopaedic Department, Aristotle University of Thessaloniki, “G. Gennimatas” Hospital, Eth. Aminis 41, 546 35 Thessaloniki, Greece; (L.K.); (P.T.); (A.M.); (V.D.); (I.G.); (P.P.); (K.D.)
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Heiberg KE, Beckmann M, Bruun-Olsen V. Prediction of walking speed one year following hip fracture based on pre-fracture assessments of mobility and physical activity. BMC Geriatr 2024; 24:358. [PMID: 38649830 PMCID: PMC11036605 DOI: 10.1186/s12877-024-04926-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 03/28/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Older people with hip fracture are often medically frail, and many do not regain their walking ability and level of physical activity. The aim of this study was to examine the relationship between pre-fracture recalled mobility, fear of falling, physical activity, walking habits and walking speed one year after hip fracture. METHODS The study had a longitudinal design. Measurements were performed 3-5 days postoperatively (baseline) and at one year after the hip fracture. The measurements at baseline were all subjective outcome measures recalled from pre-fracture: The New Mobility Scale (NMS), the 'Walking Habits' questionnaire, The University of California, Los Angeles (UCLA) Activity Scale, Fear of Falling International (FES-I) and demographic variables. At one year 4-meter walking speed, which was a part of the Short Physical Performance Battery (SPPB) was assessed. RESULTS At baseline 207 participants were included and 151 were assessed after one year. Their age was mean (SD) 82.7 (8.3) years (range 65-99 years). Those with the fastest walking speed at one year had a pre-fracture habit of regular walks with a duration of ≥ 30 min and/or a frequency of regular walks of 5-7 days a week. Age (p =.020), number of comorbidities (p <.001), recalled NMS (p <.001), and recalled UCLA Activity Scale (p =.007) were identified as predictors of walking speed at one year. The total model explained 54% of the variance in walking speed. CONCLUSIONS Duration and frequency of regular walks before the hip fracture play a role in walking speed recovery one year following the fracture. Subjective outcome measures of mobility and physical activity, recalled from pre-fracture can predict walking speed at one year. They are gentle on the old and medically frail patients in the acute phase after hip fracture, as well as clinically less time consuming.
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Affiliation(s)
- Kristi Elisabeth Heiberg
- ¹Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway.
- ²Department of Medical Research, Clinic of Bærum Hospital, Vestre Viken Hospital Trust, Drammen, Norway.
| | - Monica Beckmann
- ²Department of Medical Research, Clinic of Bærum Hospital, Vestre Viken Hospital Trust, Drammen, Norway
| | - Vigdis Bruun-Olsen
- ²Department of Medical Research, Clinic of Bærum Hospital, Vestre Viken Hospital Trust, Drammen, Norway
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71
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Kasahara K, Tanaka-Mizuno S, Tsuji S, Ohashi M, Kasahara M, Kawasaki T, Murakami T. Pregnancy and lactation-associated osteoporosis as a major type of premenopausal osteoporosis: a retrospective cohort study based on real-world data. BMC Pregnancy Childbirth 2024; 24:301. [PMID: 38649869 PMCID: PMC11034016 DOI: 10.1186/s12884-024-06520-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 04/15/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Pregnancy and lactation-associated osteoporosis (PLO), as well as premenopausal osteoporosis, might be a predictor of future fracture. This study aimed to describe the clinical features of PLO as a subtype of premenopausal osteoporosis and to evaluate medical interventions for it. METHODS From an administrative claims database including 4,224,246 people in Japan, we classified women for whom the date of childbirth had been defined and who had suffered low-trauma fracture between the ages of 18-47 years as the premenopausal osteoporosis group. A fracture site for which the odds ratio for fractures occurring between 5 months before and 12 months after childbirth (around childbirth) was greater than 1 was considered the PLO site. We classified patients with a fracture at the PLO site around childbirth as the PLO group. The control group consisted of 500 women without fragility fractures. We investigated some drugs and diseases to explore fracture-causing factors, as well as medical interventions such as osteoporosis diagnosis, bone densitometry, anti-osteoporosis pharmacotherapy, and lactation inhibitors. RESULTS In total, 231 parous women were classified into the premenopausal osteoporosis group. The most common fracture was vertebral fracture and was likely to occur around childbirth, followed by distal radius and sacral fractures, which were rare around childbirth. Considering vertebral, pelvic, and proximal femoral fractures as PLO sites, 56 women with 57 PLO fractures were classified into the PLO group. The incidence of PLO was estimated at 460 per million deliveries. Ovulation disorder and high maternal age were associated with the development of PLO. Vertebral fracture was the most common PLO fracture. It was mainly diagnosed a few months, and possibly up to 1 year, postpartum. PLO patients with vertebral fractures underwent more medical interventions than did those with other fractures, but they were still inadequate. CONCLUSIONS PLO with vertebral fracture was one of the major types of premenopausal osteoporosis. The prevalence of PLO is considered to be higher than previously thought, indicating the presence of potentially overlooked patients. More timely interventions for PLO might lead to the improved management of latent patients with premenopausal osteoporosis and reduce future fracture risk.
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Affiliation(s)
- Kyoko Kasahara
- The Department of Obstetrics and Gynecology, Shiga University of Medical Science, Otsu, Shiga, Japan.
| | - Sachiko Tanaka-Mizuno
- The Laboratory of Epidemiology and Prevention, Kobe Pharmaceutical University, Kobe, Japan
| | - Shunichiro Tsuji
- The Department of Obstetrics and Gynecology, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Mizuki Ohashi
- The Department of Obstetrics and Gynecology, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Makiko Kasahara
- The Department of Obstetrics and Gynecology, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Taku Kawasaki
- The Department of Orthopedic Surgery, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Takashi Murakami
- The Department of Obstetrics and Gynecology, Shiga University of Medical Science, Otsu, Shiga, Japan
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Pareja Sierra T, Hünicken Torrez FL, Pablos Hernández MC, López Velasco R, Ortés Gómez R, Cervera Díaz MDC, Hormigo Sánchez AI, Perdomo Ramírez B, Mora Fernández J, Jiménez Mola S, Rodriguez Piñera MA, Condorhuaman Alvarado PY, Sanchez Juan C, Ramos Clemente JI, Veses Martín S, Rodríguez Manzano I, González-Colaço Harmand M, Camprubí Robles M, Martín Aguilar A, Saez Lopez P. A Prospective, Observational Study of the Effect of a High-Calorie, High-Protein Oral Nutritional Supplement with HMB in an Old and Malnourished or at-Risk-of-Malnutrition Population with Hip Fractures: A FracNut Study. Nutrients 2024; 16:1223. [PMID: 38674912 PMCID: PMC11053940 DOI: 10.3390/nu16081223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 04/12/2024] [Accepted: 04/13/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Hip fractures are prevalent among older people, often leading to reduced mobility, muscle loss, and bone density decline. Malnutrition exacerbates the prognosis post surgery. This study aimed to evaluate the impact of a 12-week regimen of a high-calorie, high-protein oral supplement with β-hydroxy-β-methylbutyrate (HC-HP-HMB-ONS) on nutritional status, daily activities, and compliance in malnourished or at-risk older patients with hip fractures receiving standard care. SUBJECTS AND METHODS A total of 270 subjects ≥75 years of age, residing at home or in nursing homes, malnourished or at risk of malnutrition, and post hip fracture surgery, received HC-HP-HMB-ONS for 12 weeks. Various scales and questionnaires assessed outcomes. RESULTS During the 12 weeks of follow-up, 82.8% consumed ≥75% of HC-HP-HMB-ONS. By week 12, 62.4% gained or maintained weight (+0.3 kg), 29.2% achieved normal nutritional status (mean MNA score +2.8), and 46.8% improved nutritional status. Biochemical parameters improved significantly. Subjects reported good tolerability (mean score 8.5/10), with 87.1% of healthcare providers concurring. CONCLUSIONS The administration of HC-HP-HMB-ONS markedly enhanced nutritional status and biochemical parameters in older hip-fracture patients, with high compliance and tolerability. Both patients and healthcare professionals expressed satisfaction with HC-HP-HMB-ONS.
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Affiliation(s)
- Teresa Pareja Sierra
- Department of Geriatrics, University Hospital of Guadalajara, 19002 Guadalajara, Spain;
| | | | | | - Rosario López Velasco
- Department of Geriatrics, University Hospital Nuestra Señora de Valme, 41014 Sevilla, Spain
| | - Raquel Ortés Gómez
- Department of Geriatrics, University Hospital San Pedro de Alcántara, 10003 Cáceres, Spain
| | | | | | - Beatriz Perdomo Ramírez
- Department of Geriatrics, University Hospital Fundación Alcorcón, 28922 Alcorcón, Spain (P.S.L.)
| | - Jesús Mora Fernández
- Department of Geriatrics, Instituto de Investigación del Hospital Clínico San Carlos (IdISSC), Universidad Complutense, 28040 Madrid, Spain
| | - Sonia Jiménez Mola
- Department of Geriatrics, Complejo Asistencial Universitario de León, 24008 León, Spain
| | | | | | - Carlos Sanchez Juan
- Department of Endocrinology and Nutrition, Hospital General University of Valencia, 46014 València, Spain
| | | | - Silvia Veses Martín
- Departament of Endocrinology, Doctor Peset University Hospital, 46017 València, Spain
| | - Ingrid Rodríguez Manzano
- Departament of Geriatrics, University Hospital Gran Canaria Doctor Negrín, 35010 Las Palmas de Gran Canaria, Spain
| | | | | | | | - Pilar Saez Lopez
- Department of Geriatrics, University Hospital Fundación Alcorcón, 28922 Alcorcón, Spain (P.S.L.)
- La Paz Hospital Research Institute (IdiPAZ), 28029 Madrid, Spain
- Head Coordinator of the Spanish National Hip Fracture Registry, Madrid, Spain
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Wang JM, Pan YT, Yang CS, Liu MC, Ji SC, Han N, Liu F, Sun GX. Effect of inflammatory response on joint function after hip fracture in elderly patients: A clinical study. World J Orthop 2024; 15:337-345. [PMID: 38680675 PMCID: PMC11045470 DOI: 10.5312/wjo.v15.i4.337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 01/27/2024] [Accepted: 03/15/2024] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND Excellent hip joint function facilitates limb recovery and improves the quality of survival. This study aimed to investigate the potential risk factors affecting postoperative joint functional activity and outcomes in elderly hip fractures patients and to provide evidence for patient rehabilitation and clinical management. AIM To explore the relationship between inflammatory factors and hip function and the interaction between inflammation and health after hip fracture in elderly patients. METHODS The elderly patients who had hip fracture surgery at our hospital between January 1, 2021, and December 31, 2022 were chosen for this retrospective clinical investigation. Patients with excellent and fair postoperative hip function had their clinical information and characteristics gathered and compared. Age, gender, fracture site, surgical technique, laboratory indices, and other variables that could have an impact on postoperative joint function were all included in a univariate study. To further identify independent risk factors affecting postoperative joint function in hip fractures, risk factors that showed statistical significance in the univariate analysis were then included in a multiple logistic regression analysis. In addition to this, we also compared other outcome variables such as visual analogue scale and length of hospital stay between the two groups. RESULTS A total of 119 elderly patients with hip fractures were included in this study, of whom 37 were male and 82 were female. The results of univariate logistic regression analysis after excluding the interaction of various factors showed that there was a statistically significant difference in interleukin (IL)-6, IL-8, IL-10, C-reactive protein (CRP), and complement C1q (C1q) between the fair and excellent joint function groups (P < 0.05). The results of multiple logistic regression analysis showed that IL-6 > 20 pg/mL [(Odds ratio (OR) 3.070, 95%CI: 1.243-7.579], IL-8 > 21.4 pg/ mL (OR 3.827, 95%CI: 1.498-9.773), CRP > 10 mg/L (OR 2.142, 95%CI: 1.020-4.498) and C1q > 233 mg/L (OR 2.339, 95%CI: 1.094-5.004) were independent risk factors for poor joint function after hip fracture surgery (all P < 0.05). CONCLUSION After hip fractures in older patients, inflammatory variables are risk factors for fair joint function; therefore, early intervention to address these markers is essential to enhance joint function and avoid consequences.
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Affiliation(s)
- Jia-Ming Wang
- Department of Traumatic Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai 200092, China
| | - Yu-Tao Pan
- Department of Traumatic Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai 200092, China
| | - Chen-Song Yang
- Department of Traumatic Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai 200092, China
| | - Ming-Chong Liu
- Department of Traumatic Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai 200092, China
| | - Sheng-Chao Ji
- Department of Traumatic Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai 200092, China
| | - Ning Han
- Department of Traumatic Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai 200092, China
| | - Fang Liu
- Department of Traumatic Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai 200092, China
| | - Gui-Xin Sun
- Department of Traumatic Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai 200092, China
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Zhou X, Chen T, Jiang YL, Chen DB, Tian ZY. Comparison of the clinical outcomes between proximal femoral nail anti-rotation with cement enhancement and hemiarthroplasty among elderly osteoporotic patients with intertrochanteric fracture. BMC Musculoskelet Disord 2024; 25:290. [PMID: 38622692 PMCID: PMC11017484 DOI: 10.1186/s12891-024-07414-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 04/04/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND The proximal femoral nail anti-rotation (PFNA) with cement enhancement enhances the anchorage ability of internal fixation in elderly with osteoporotic intertrochanteric fracture. However, whether it is superior to hemiarthroplasty is still controversial. The present study aimed to determine which treatment has better clinical outcomes among older patients. METHODS We retrospectively analyzed 102 elderly patients with osteoporosis who developed intertrochanteric fractures and underwent PFNA combined with cement-enhanced internal fixation (n = 52, CE group), and hemiarthroplasty (n = 50, HA group) from September 2012 to October 2018. All the intertrochanteric fractures were classified according to the AO/OTA classification. Additionally, the operative time, intraoperative blood loss, intraoperative and postoperative blood transfusion rates, postoperative weight-bearing time, hospitalization time, Barthel Index of Activities Daily Living, Harris score of hip function, visual analog (VAS) pain score, and postoperative complications were compared between the two groups. RESULTS The CE group had significantly shorter operative time, lesser intraoperative blood loss, lower blood transfusion rate, and longer postoperative weight-bearing time than the HA group. The CE group had lower Barthel's Index of Activities of Daily Living, lower Harris' score, and higher VAS scores in the first and third months after surgery than the HA group, but no difference was observed between the two groups from 6 months to 12 months. There was no significant difference in the total post-operative complications between the two groups. CONCLUSION The use of PFNA combined with a cement-enhanced internal fixation technique led to shorter operative time and lesser intraoperative blood loss and trauma in elderly patients as compared to HA.
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Affiliation(s)
- Xiang Zhou
- Department of Articular and Traumatic Orthopedic Surgery, the Fourth People's Hospital of Guiyang, 91# Jiefang west Road, Guiyang, 550001, China
| | - Tao Chen
- Department of Articular and Traumatic Orthopedic Surgery, the Fourth People's Hospital of Guiyang, 91# Jiefang west Road, Guiyang, 550001, China
| | - Yu-Lin Jiang
- Department of Articular and Traumatic Orthopedic Surgery, the Fourth People's Hospital of Guiyang, 91# Jiefang west Road, Guiyang, 550001, China
| | - De-Bin Chen
- Department of Articular and Traumatic Orthopedic Surgery, the Fourth People's Hospital of Guiyang, 91# Jiefang west Road, Guiyang, 550001, China
| | - Zhi-Yong Tian
- Department of Articular and Traumatic Orthopedic Surgery, the Fourth People's Hospital of Guiyang, 91# Jiefang west Road, Guiyang, 550001, China.
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Liu J, Ge Y, Wang Y, Yang Q, Yibulayimu S, Wu X, Tian W, Shi C, Liu Y, Yang M. Sagittal support rather than medial cortical support matters in geriatric intertrochanteric fracture: A finite element analysis study. Heliyon 2024; 10:e28606. [PMID: 38571577 PMCID: PMC10988050 DOI: 10.1016/j.heliyon.2024.e28606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 03/20/2024] [Accepted: 03/21/2024] [Indexed: 04/05/2024] Open
Abstract
Hip fracture, increasing exponentially with age, is osteoporosis's most severe clinical consequence. Intertrochanteric fracture, one of the main types of hip fracture, is associated with higher mortality and morbidity. The current research hotspots lay in improving the treatment effect and optimizing the secondary stability after intertrochanteric fracture surgery. Cortex buttress reduction is a widely accepted method for treating intertrochanteric fracture by allowing the head-neck fragment to slide and rigidly contact the femoral shaft's cortex. Medial cortical support is considered a more effective option in treating young patients. However, osteo-degenerations features, including bone weakness and cortical thickness thinning, affect the performance of cortex support in geriatric intertrochanteric fracture treatment. Literature focusing on the age-specific difference in cortex performance in the fractured hip is scarce. We hypothesized that this osteo-19 degenerative feature affects the performance of cortex support in treating intertrochanteric fractures between the young and the elderly. We established twenty models for the old and the young with intertrochanteric fractures and performed static and dynamic simulations under one-legged stance and walking cycle conditions. The von Mises stress and displacement on the femur, proximal femoral nail anti-rotation (PFNA) implant, fracture plane, and the cutting volume of cancellous bone of the femur were compared. It was observed that defects in the anterior and posterior cortical bone walls significantly increase the stress on the PFNA implant, the displacement of the fracture surface, and cause a greater volume of cancellous bone to be resected. We concluded that ensuring the integrity and alignment of the anterior and posterior cortical bones is essential for elderly patients, and sagittal support is recommended. This finding suggests that the treatment method for intertrochanteric fracture may differ, considering the patient's age difference.
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Affiliation(s)
- Jixuan Liu
- Institue of Medical Equipment Science and Engineering (IMESE), Huazhong University of Science and Technology, Wuhan, 430074, China
| | - Yufeng Ge
- Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
| | - Yu Wang
- School of Biological Science and Medical Engineering, Beihang University, Beijing, 100083, China
| | - Qing Yang
- School of Biological Science and Medical Engineering, Beihang University, Beijing, 100083, China
| | - Sutuke Yibulayimu
- School of Biological Science and Medical Engineering, Beihang University, Beijing, 100083, China
| | - Xinbao Wu
- Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
| | - Wei Tian
- Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
| | - Chao Shi
- School of Biological Science and Medical Engineering, Beihang University, Beijing, 100083, China
| | - Yanzhen Liu
- School of Biological Science and Medical Engineering, Beihang University, Beijing, 100083, China
| | - Minghui Yang
- Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
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Smolle MA, Fischerauer SF, Vukic I, Leitner L, Puchwein P, Widhalm H, Leithner A, Sadoghi P. 30-day and one-year readmission rate in 11,270 patients with surgical treatment for proximal femoral fractures across Austria. Bone Jt Open 2024; 5:294-303. [PMID: 38599585 PMCID: PMC11007600 DOI: 10.1302/2633-1462.54.bjo-2024-0002.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/12/2024] Open
Abstract
Aims Patients with proximal femoral fractures (PFFs) are often multimorbid, thus unplanned readmissions following surgery are common. We therefore aimed to analyze 30-day and one-year readmission rates, reasons for, and factors associated with, readmission risk in a cohort of patients with surgically treated PFFs across Austria. Methods Data from 11,270 patients with PFFs, treated surgically (osteosyntheses, n = 6,435; endoprostheses, n = 4,835) at Austrian hospitals within a one-year period (January to December 2021) was retrieved from the Leistungsorientierte Krankenanstaltenfinanzierung (Achievement-Oriented Hospital Financing). The 30-day and one-year readmission rates were reported. Readmission risk for any complication, as well as general medicine-, internal medicine-, and surgery/injury-associated complications, and factors associated with readmissions, were investigated. Results The 30-day and one-year readmission rates due to any complication were 15% and 47%, respectively. The 30-day readmission rate (p = 0.001) was higher in endoprosthesis than osteosynthesis patients; this was not the case for the one-year readmission rate (p = 0.138). Internal medicine- (n = 2,273 (20%)) and surgery/injury-associated complications (n = 1,612 (14%)) were the most common reason for one-year readmission. Regardless of the surgical procedure, male sex was significantly associated with higher readmission risk due to any, as well as internal medicine-associated, complication. Advanced age was significantly associated with higher readmission risk after osteosynthesis. In both cohorts, treatment at mid-sized hospitals was significantly associated with lower readmission risk due to any complication, while prolonged length of stay was associated with higher one-year readmission risks due to any complication, as well as internal-medicine associated complications. Conclusion Future health policy decisions in Austria should focus on optimization of perioperative and post-discharge management of this vulnerable patient population.
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Affiliation(s)
- Maria A. Smolle
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
- Department of Orthopaedics, Balgrist University Hospital, Zurich, Switzerland
| | | | - Ines Vukic
- Federal Ministry of Social Affairs, Health, Care and Consumer Protection, Vienna, Austria
| | - Lukas Leitner
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - Paul Puchwein
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - Harald Widhalm
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - Andreas Leithner
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - Patrick Sadoghi
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
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Chiang YW, Chang YJ, Huang HJ, Hsieh CP, Lu YH. Does post acute care reduce the mortality of octogenarian and nonagenarian patients undergoing hip fracture surgery? BMC Geriatr 2024; 24:322. [PMID: 38589787 PMCID: PMC11000408 DOI: 10.1186/s12877-024-04936-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 03/30/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND With the increasing number of elderly individuals worldwide, a greater number of people aged 80 years and older sustain fragility fracture due to osteopenia and osteoporosis. METHODS This retrospective study included 158 older adults, with a median age of 85 (range: 80-99) years, who sustained hip fragility fracture and who underwent surgery. The patients were divided into two groups, one including patients who joined the post-acute care (PAC) program after surgery and another comprising patients who did not. The mortality, complication, comorbidity, re-fracture, secondary fracture, and readmission rates and functional status (based on the Barthel index score, numerical rating scale score, and Harris Hip Scale score) between the two groups were compared. RESULTS The patients who presented with fragility hip fracture and who joined the PAC rehabilitation program after the surgery had a lower rate of mortality, readmission rate, fracture (re-fracture and secondary fracture), and complications associated with fragility fracture, such as urinary tract infection, cerebrovascular accident, and pneumonia (acute coronary syndrome, out-of-hospital cardiac arrest, or in-hospital cardiac arrest. CONCLUSIONS PAC is associated with a lower rate of mortality and complications such as urinary tract infection, bed sore, and pneumonia in octogenarian and nonagenarian patients with hip fragility fracture.
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Affiliation(s)
- Yu-Wei Chiang
- Department of Orthopedics, Changhua Christian Hospital, No. 135, Nanxiao St., Changua City, Changhua County, 500054, Taiwan R.O.C
| | - Yu-Jun Chang
- Big Data Center, Changhua Christian Hospital, No. 135, Nanxiao St., Changua City, Changhua County, 500054, Taiwan R.O.C
| | - Hui-Jen Huang
- Department of Nursing, Changhua Christian Hospital, No. 135, Nanxiao St., Changua City, Changhua County, 500054, Taiwan R.O.C
| | - Cheng-Pu Hsieh
- Department of Orthopedics, Changhua Christian Hospital, No. 135, Nanxiao St., Changua City, Changhua County, 500054, Taiwan R.O.C
- Orthopedics & Sports Medicine Laboratory, Changhua Christian Hospital, No. 135, Nanxiao St., Changua City, Changhua County, 500054, Taiwan R.O.C
- Department of Post-Baccalaureate Medicine, National Chung Hsing University, No. 145 Xingda Rd., South District, Taichung, 40227, Taiwan R.O.C
| | - Yueh-Hsiu Lu
- Department of Orthopedics, Changhua Christian Hospital, No. 135, Nanxiao St., Changua City, Changhua County, 500054, Taiwan R.O.C..
- Institute of Biomedical Sciences, National Chung Hsing University, No. 145 Xingda Rd., South District, Taichung, 40227, Taiwan R.O.C..
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78
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Melsen IM, Szépligeti SK, Gundtoft PH, Pedersen AB. Time trends in opioid use for patients undergoing hip fracture surgery in 1997-2018: A Danish population-based cohort study. Eur J Pain 2024. [PMID: 38581227 DOI: 10.1002/ejp.2271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 02/28/2024] [Accepted: 03/19/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND Although opioids are a mainstay for perioperative pain management in hip fracture patients, no studies have described changes in opioid use over the last two decades. The aim of this study was to describe time trends in opioid use in a population-based cohort of patients undergoing a first-time hip fracture surgery during 1997-2018. METHODS Opioid-naïve hip fracture patients >55 years old were identified in Danish medical databases (n = 115,962). By 2-year calendar periods, we calculated prevalence rates (PR) of opioid use in the four quarters after surgery (Q1-Q4). Corresponding prevalence rate ratios (PRR) with 1997-1998 as a reference were estimated with 95% confidence intervals. Further, we calculated the median morphine milligram equivalents (MME) for each quarter. RESULTS For Q1, the PR of opioid use increased from 29% in 1997-1998 to 78% in 2017-2018 corresponding to a PRR of 2.7 (2.6-2.8). For Q4, the PR was 15% in 1997-1998, peaked in 2003-2004 and then decreased, but stayed high at 13% in 2017-2018. The median MME did not increase when comparing 2017-2018 with 1997-1998, irrespective of the quarter. Tramadol was most frequently used in 1997-1998 shifting to oxycodone in 2017-2018. CONCLUSION The PRs of opioid use in Q1 after surgery increased substantially from 1997 to 2018, but this did not translate into increased opioid use up to 1 year after hip fracture surgery or higher dosage. Our findings underline the importance of sustained focus on opioid tapering, dosage and use of opioids with the lowest potential for addiction and other adverse events. SIGNIFICANCE STATEMENT Overall, opioid use in Q1 after hip fracture surgery increased 2.7 times from 1997 to 2018, but the doses and opioid use up to 1 year after surgery remained stable. Compared to elderly, younger patients were more likely to use opioid in Q1, while the tendency was opposite in Q2-Q4. The most used opioid type changed from tramadol to oxycodone. Our findings underline the importance of personalized opioid tapering and doses, and use of opioids with the lowest potential for addiction and other adverse events.
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Affiliation(s)
- I M Melsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - S K Szépligeti
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - P H Gundtoft
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - A B Pedersen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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79
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Chiavarini M, Ricciotti GM, Genga A, Faggi MI, Rinaldi A, Toscano OD, D’Errico MM, Barbadoro P. Malnutrition-Related Health Outcomes in Older Adults with Hip Fractures: A Systematic Review and Meta-Analysis. Nutrients 2024; 16:1069. [PMID: 38613102 PMCID: PMC11013126 DOI: 10.3390/nu16071069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 03/28/2024] [Accepted: 04/03/2024] [Indexed: 04/14/2024] Open
Abstract
Hip fracture is a common condition in older adults, leading to disability and mortality. Several studies have demonstrated the association between nutritional status and the risk of a negative health outcome after fractures. In this systematic review, we evaluated the association between malnutrition and mortality, changes in mobility/living arrangements, and postoperative complications, such as delirium, in older patients with hip fractures. A literature search on the PubMed, Web of Science, and Scopus databases, up to September 2023, was conducted to identify all studies involving older subjects that reported an association between MNA/GNRI/PNI/CONUT and health outcome after hip fracture. Meta-analysis was performed by a random-effects model using risk values (RR, OR, and HR) extracted from the 14 eligible selected studies. Malnutrition significantly increased the risk of any analyzed adverse outcome by 70% at 1 month, and up to 250% at 1 year. Malnutrition significantly increased delirium risk by 275% (OR = 2.75; 95% CI 1.80-4.18; p ≤ 0.05), mortality risk by 342% (OR = 3.42; 95% CI 2.14-5.48; p ≤ 0.05), mortality hazard risk by 351% (HR = 3.51; 95% CI 1.63-7.55; p ≤ 0.05) at 1 month, and transfer-to-more-supported-living-arrangements risk by 218% (OR = 2.18; 95% CI 1.58-3.01; p ≤ 0.05), and declined mobility risk by 41% (OR = 1.41; 95% CI 1.14-1.75; p ≤ 0.05), mortality risk by 368% (OR = 3.68; 95% CI 3.00-4.52; p ≤ 0.05), and mortality hazard risk by 234% (HR = 2.34; 95% CI 1.91-2.87; p ≤ 0.05) at 1 year. Malnutrition of older patients increases the risk of death and worsens mobility and independence after hip fractures. The results of the present study highlight the importance of nutritional status evaluation of older subjects with hip fractures in order to prevent potential adverse outcomes (Registration No: CRD42023468751).
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Affiliation(s)
| | | | - Anita Genga
- Department of Biomedical Sciences and Public Health, Section of Hygiene, Preventive Medicine and Public Health, Polytechnic University of the Marche Region, 60126 Ancona, Italy; (M.C.); (G.M.R.); (M.I.F.); (A.R.); (O.D.T.); (M.M.D.)
| | | | | | | | | | - Pamela Barbadoro
- Department of Biomedical Sciences and Public Health, Section of Hygiene, Preventive Medicine and Public Health, Polytechnic University of the Marche Region, 60126 Ancona, Italy; (M.C.); (G.M.R.); (M.I.F.); (A.R.); (O.D.T.); (M.M.D.)
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80
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Lee TS, Kwon HM, Park JY, Park MC, Choi YS, Park KK. Evaluating Pain Management from Peripheral Nerve Block for Geriatric Patients following Bipolar Hemiarthroplasty for Displaced Femoral-Neck Fracture. Gerontology 2024; 70:603-610. [PMID: 38574472 PMCID: PMC11177891 DOI: 10.1159/000538614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 03/26/2024] [Indexed: 04/06/2024] Open
Abstract
INTRODUCTION The purpose of this study was to evaluate peripheral nerve block (PNB) effectiveness in postoperative pain management and surgical outcomes for displaced femoral-neck fracture in geriatric patients (>70 years) who underwent bipolar hemiarthroplasty (BHA). METHODS From January 2017 to December 2021, 231 geriatric patients with displaced femoral-neck fracture who consecutively underwent BHA were retrospectively reviewed. Patients were divided into two groups: the patient-controlled analgesia (PCA) group (n = 132) who received only intravenous (IV) PCA for postoperative pain management, and all others who received PNB with IV PCA (PNB+PCA) such as femoral nerve block or fascia iliaca compartment block after surgery (n = 99). Primary outcomes were postoperative visual analog scale (VAS) at rest and during activity at 6, 24, and 48 h postoperatively. Secondary outcomes were postoperative complications, changes in hemoglobin, length of hospital stay, and total morphine usage after surgery. RESULTS Postoperative resting VAS at 6 h and 48 h was significantly lower in the PNB+PCA group compared with the PCA group (p = 0.075, p = 0.0318, respectively). However, there was no significant difference in either resting VAS at 24 h or active VAS. Complications of pneumonia and delirium until 1 month postoperative were significantly lower in the PNB + PCA group than the PCA group (p = 0.0022, p = 0.0055, respectively). CONCLUSION PNB with IV PCA seems to have a beneficial effect on geriatric femoral-neck patients who underwent BHA with postoperative analgesia for reducing postoperative resting pain and complications, especially pneumonia and delirium.
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Affiliation(s)
- Tae Sung Lee
- Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Hyuck Min Kwon
- Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Jun Young Park
- Department of Orthopedic Surgery, Yong-in Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Min Cheol Park
- Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Yong Seon Choi
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Kwan Kyu Park
- Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
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81
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Riaz MH, Riaz J, Mahmood A, Tariq M, Sahar N, Ali RS, Ahmad N, Irshad S, Ahmad MH, Arshad H, Khan TM. Risk Factors of Postoperative Acute Heart Failure in Elderly Patients After Hip Fracture Surgery. Cureus 2024; 16:e58967. [PMID: 38800267 PMCID: PMC11127705 DOI: 10.7759/cureus.58967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2024] [Indexed: 05/29/2024] Open
Abstract
Background Postoperative acute heart failure (AHF) in elderly patients after hip fracture surgery is a common complication. Therefore, this study aimed to identify the risk factor of AHF after hip fracture surgery among the older population. Methods This retrospective cohort study was performed on 88 admitted patients whose hip fractures were fixed via internal fixation surgery in a tertiary care hospital in Rawalpindi, Pakistan, from January 2022 to March 2023. Recruitment of patients was made through established inclusion and exclusion criteria. Ethical approval and informed consent were also gained before the data collection. A self-designed form was used to collect data. Data analysis was carried out in the IBM SPSS Statistics for Windows, Version 25 (Released 2017; IBM Corp., Armonk, New York, United States). Both descriptive and inferential statistics were applied to compare the attributes of the patients with AHF and patients without AHF. Multivariate logistic regression was used to evaluate the association between the postoperative AHF and its potential risk factors. Results Out of 88 enrolled patients, 12 (13.64%) had developed postoperative AHF. Age ≥ 65 years (OR = 2.606, 95% CI = 1.035~4.160, p = 0.010), anemia (OR = 3.178, 95% CI = 1.847~5.990, p = 0.029), hypertension (OR = 2.019, 95% CI = 1.110~4.034, p = 0.012), diabetes mellitus (OR = 2.003, 95% CI = 1.115~4.012, p = 0.015), hypoalbuminemia (OR = 2.486, 95% CI = 1.218~4.619, p = 0.030), and operation time ≥ 120 minutes (OR = 1.702, 95% CI = 1.099~2.880, p = 0.018), were the risk factors of postoperative AHF in elderly patients after hip fracture surgery. Conclusions In the study population, the incidence of postoperative heart failure was significant and age ≥ 65 years, anemia, hypertension, diabetes mellitus, hypoalbuminemia, and operation time ≥ 120 were significantly involved in the development of it. Preoperative identification and management of AHF risk factors could lead to the prevention of postoperative complications.
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Affiliation(s)
| | - Javaria Riaz
- Medicine, Mohi-ud-Din Islamic Medical College, Mirpur, PAK
| | - Asim Mahmood
- Cardiology, Lahore General Hospital, Lahore, PAK
| | | | - Nabiha Sahar
- Internal Medicine, Allama Iqbal Medical College, Lahore, PAK
| | - Rana Shahzaib Ali
- Orthopedic Surgery, Sheikh Zayed Medical College and Hospital, Rahim Yar Khan, PAK
| | - Nadeem Ahmad
- Cardiology, Allama Iqbal Medical College, Lahore, PAK
| | - Sumbal Irshad
- Internal Medicine, Philadelphia College of Osteopathic Medicine, Philadelphia, USA
| | | | - Hamid Arshad
- Surgery, Allama Iqbal Medical College, Lahore, PAK
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82
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Li DY, Zhang K, Wang H, Zhuang Y, Zhang BF, Zhang DL. Preoperative Serum Calcium Level Predicts Postoperative Mortality in Older Adult Patients with Hip Fracture: A Prospective Cohort Study of 2333 Patients. J Am Med Dir Assoc 2024; 25:655-660. [PMID: 37660723 DOI: 10.1016/j.jamda.2023.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 08/02/2023] [Accepted: 08/03/2023] [Indexed: 09/05/2023]
Abstract
OBJECTIVES Hip fractures are a significant cause of mortality among older adults. However, predictive markers for an unfavorable prognosis are still lacking. Serum calcium is an essential element in several biochemical reactions in the body. This study investigated the role of the preoperative serum calcium level as a prognostic parameter for postoperative mortality in older adult patients with hip fractures. DESIGN We conducted a prospective cohort study at the trauma center in our hospital, from January 1, 2015, to September 30, 2019. A total of 2333 older patients with hip fractures were recruited. This prospective cohort study was conducted in accordance with the criteria of STROCSS. SETTING AND PARTICIPANTS Older adult patients with hip fractures were screened between January 2015 and September 2019 at the trauma center of our hospital. METHODS Demographic and clinical characteristics of the patients were collected. Linear and nonlinear multivariate Cox regression models were used to identify the association between preoperative serum calcium level and all-cause mortality. All analyses were performed using EmpowerStats and the R software. RESULTS A total of 2333 older adult patients with hip fractures were included in the study. The mean follow-up was 37.5 months. Overall, 770 patients (33%) died of all causes. The preoperative serum calcium concentrations were 2.18 ± 0.13 mmol/L. Linear multivariate Cox regression models showed that preoperative serum calcium levels were associated with mortality [hazard ratio (HR) 0.37, 95% CI 0.21-0.67; P = .0009] after adjusting for confounders. However, the linear association was unstable, and nonlinearity was identified. A preoperative serum calcium level of 2.3 mmol/L was an inflection point for prediction. When the preoperative serum calcium concentration was below 2.3 mmol/L, serum calcium concentration increased by 1 mmol/L, and mortality risk decreased by 77% (HR 0.23, 95% CI 0.13-0.43, P < .0001). In contrast, when the preoperative serum calcium concentration was more significant than 2.3 mmol/L, the mortality risk increased with serum calcium concentration (HR 6.27, 95% CI 1.65-23.74, P = .0069). CONCLUSIONS AND IMPLICATIONS The preoperative serum calcium level is nonlinearly associated with mortality in older adults with hip fractures, with a U-shaped association, and could be used as a potential predictor of prognosis.
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Affiliation(s)
- Dong-Yang Li
- Department of Orthopedic Trauma, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Kun Zhang
- Department of Orthopedic Trauma, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Hu Wang
- Department of Orthopedic Trauma, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Yan Zhuang
- Department of Orthopedic Trauma, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Bin-Fei Zhang
- Department of Joint Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China.
| | - Dan-Long Zhang
- Department of Orthopedic Trauma, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
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83
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Li J, Li P, Li Y. Effect of rapid rehabilitation care on surgical site wound infection and pain in patients with intertrochanteric femoral fractures: A meta-analysis. Int Wound J 2024; 21:e14540. [PMID: 38069603 PMCID: PMC10961049 DOI: 10.1111/iwj.14540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 11/18/2023] [Accepted: 11/19/2023] [Indexed: 03/25/2024] Open
Abstract
This study examines the effects of rapid rehabilitation on surgical site wound infections and pain in patients with intertrochanteric femoral fractures. A computerised search was conducted for randomised controlled trials (RCTs) on rapid rehabilitation care in patients undergoing surgery for intertrochanteric femoral fractures published in the China National Knowledge Infrastructure, China Biomedical Literature Database, Wanfang Database, VIP, PubMed, Embase, Cochrane Library and Web of Science. The search was conducted from the time of the database construction to August 2023. Two investigators independently performed literature screening, data extraction and quality assessment based on predefined inclusion and exclusion criteria. Meta-analysis was performed via RevMan 5.4 software. Encompassing 21 studies involving 2004 patients, with 1007 patients receiving rapid rehabilitation care and 997 receiving routine care, our analysis revealed that rapid rehabilitation care significantly reduced postoperative complications (odds ratio [OR] = 0.24, 95% confidence interval [CI]: 0.17-0.33, p < 0.001), wound infections (OR = 0.30, 95% CI: 0.14-0.65, p = 0.002) and hospital stay (mean difference [MD] = -5.23, 95% CI: -6.03 to -4.43, p < 0.001). Moreover, compared with routine care, it notably improved wound pain (MD = -1.51, 95% CI: -1.98 to -1.05, p < 0.001) in patients undergoing surgery for intertrochanteric femoral fractures. Our findings underscore the effectiveness of rapid rehabilitation care in reducing wound pain, postoperative complications and wound infections among patients with intertrochanteric femoral fractures.
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Affiliation(s)
- Jun‐Hong Li
- Department of Cardiac Care UnitJinan City People's HospitalJinanShandongChina
| | - Ping Li
- Department of Trauma OrthopedicsJinan City People's HospitalJinanShandongChina
| | - Yao Li
- Department of Cardiac Care UnitJinan City People's HospitalJinanShandongChina
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84
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Abane C, Gominard P, Hardy J, Alain A, Marcheix PS. Should recommended laboratory-test cut-offs allowing surgery be followed for proximal femoral fractures in patients on direct oral anticoagulant therapy? Orthop Traumatol Surg Res 2024; 110:103819. [PMID: 38278346 DOI: 10.1016/j.otsr.2024.103819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 07/10/2023] [Accepted: 10/11/2023] [Indexed: 01/28/2024]
Abstract
BACKGROUND Proximal femoral fractures (PFFs) in elderly patients must receive prompt surgical treatment. Optimal PFF-surgery timing in patients on direct oral anticoagulant (DOA) therapy is a specific but common clinical issue. Recommendations exist about the anti-Xa or anti-IIa levels and creatinine clearance values required to allow surgery. The objectives of this study in patients older than 75 years who required PFF surgery were to evaluate bleeding when the recommendations were versus were not applied and to assess concordance between DOA-activity-assay results and creatinine clearance used to help determine the wait to surgery. HYPOTHESIS Peri-operative bleeding is more marked when surgery is performed while the DOA is still active. PATIENTS AND METHODS This single-centre, retrospective, comparative, observational study included 87 patients older than 75 years who required arthroplasty or intra-medullary nailing for PFF and were taking DOA therapy. Surgery was performed after versus before the laboratory-test results fell below the recommended cut-offs in 68 patients (Rec+ group) versus 19 patients (Rec- group), respectively. The study outcomes were blood loss estimated using the Mercuriali's formula and the proportion of patients requiring post-operative blood transfusions. RESULTS Mean blood loss was 287.1mL in the Rec+ group and 411.7mL in the Rec- group (p=0.12). Blood transfusions were required by a post-operative haemoglobin level below 0.8g/dL in 11 (16.2%) Rec+ patients and 6 (31.6%) Rec- patients (p=0.2). Concordance was poor between DOA activity and creatinine clearance (Cohen's κ, 0.16; p=0.146). DISCUSSION Peri-operative bleeding was not significantly more severe when PFF surgery was performed while DOA therapy was still active. These data suggest that PFF surgery within 48h may be appropriate in patients older than 75 years on DOA therapy. LEVEL OF EVIDENCE IV; retrospective single-centre study.
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Affiliation(s)
- Cynthia Abane
- Service d'orthopédie-traumatologie, CHU Dupuytren, 2, avenue Martin-Luther-King, 87042 Limoges cedex, France
| | - Pierre Gominard
- Service d'orthopédie-traumatologie, CHU Dupuytren, 2, avenue Martin-Luther-King, 87042 Limoges cedex, France
| | - Jérémy Hardy
- Service d'orthopédie-traumatologie, CHU Dupuytren, 2, avenue Martin-Luther-King, 87042 Limoges cedex, France
| | - Armand Alain
- Service d'orthopédie-traumatologie, CHU Dupuytren, 2, avenue Martin-Luther-King, 87042 Limoges cedex, France
| | - Pierre-Sylvain Marcheix
- Service d'orthopédie-traumatologie, CHU Dupuytren, 2, avenue Martin-Luther-King, 87042 Limoges cedex, France.
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85
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Tang W, Yao W, Wang W, Ding W, Ni X, He R. Association between admission albumin levels and 30-day readmission after hip fracture surgery in geriatric patients: a propensity score-matched study. BMC Musculoskelet Disord 2024; 25:234. [PMID: 38528491 PMCID: PMC10962201 DOI: 10.1186/s12891-024-07336-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 03/05/2024] [Indexed: 03/27/2024] Open
Abstract
PURPOSE This study aimed to evaluate the correlation admission albumin levels and 30-day readmission after hip fracture surgery in geriatric patients. METHODS In this retrospective cohort study, 1270 geriatric patients admitted for hip fractures to a level I trauma center were included. Patients were stratified by clinical thresholds and albumin level quartiles. The association between admission albumin levels and 30-day readmission risk was assessed using multivariate logistic regression and propensity score-matched analyses. The predictive accuracy of albumin levels for readmission was evaluated by ROC curves. The dose-response relationship between albumin levels and readmission risk was examined. RESULTS The incidence of 30-day readmission was significantly higher among hypoalbuminemia patients than those with normal albumin levels (OR = 2.090, 95%CI:1.296-3.370, p = 0.003). Furthermore, propensity score-matched analyses demonstrated that patients in the Q2(35.0-37.9 g/L) (OR 0.621, 95%CI 0.370-1.041, p = 0.070), Q3(38.0-40.9 g/L) (OR 0.378, 95%CI 0.199-0.717, p < 0.001) and Q4 (≥ 41 g/L) (OR 0.465, 95%CI 0.211-0.859, p = 0.047) quartiles had a significantly lower risk of 30-day readmission compared to those in the Q1(< 35 g/L) quartile. These associations remained significant after propensity score matching (PSM) and subgroup analyses. Dose-response relationships between albumin levels and 30-day readmission were observed. CONCLUSIONS Lower admission albumin levels were independently associated with higher 30-day readmission rates in elderly hip fracture patients. Our findings indicate that serum albumin may assist perioperative risk assessment, and prompt correction of hypoalbuminemia and malnutrition could reduce short-term readmissions after hip fracture surgery in this high-risk population.
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Affiliation(s)
- Wanyun Tang
- Department of Orthopedics, Zigong First People's Hospital, Zigong, China
- Department of Orthopedics, Dandong Central Hospital, China Medical University, Dandong, China
| | - Wei Yao
- Department of Orthopedics, Dandong Central Hospital, China Medical University, Dandong, China
| | - Wei Wang
- Department of Orthopedics, Dandong Central Hospital, China Medical University, Dandong, China
| | - Wenbo Ding
- Department of Orthopedics, Dandong Central Hospital, China Medical University, Dandong, China
| | - Xiaomin Ni
- Department of Orthopedics, Zigong Fourth People's Hospital, Zigong, China
| | - RenJian He
- Department of Orthopedics, Zigong First People's Hospital, Zigong, China.
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86
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Sheng YH, Wu TY, Liaw CK, Hsiao SH, Kuo KL, Tsai CY. Real world fracture prediction of fracture risk assessment tool (FRAX), osteoporosis self-assessment tool for Asians (OSTA) and one-minute osteoporosis risk test: An 11-year longitudinal study. Bone Rep 2024; 20:101742. [PMID: 38404728 PMCID: PMC10884405 DOI: 10.1016/j.bonr.2024.101742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 02/02/2024] [Accepted: 02/06/2024] [Indexed: 02/27/2024] Open
Abstract
Introduction Fractures affect people's quality of life especially in the elders. One of the most important risk factors is osteoporosis. There are many screening tools to predict osteoporosis and fractures. We aimed to compare the predictive validity of three commonly used screening tools: fracture risk assessment tool (FRAX), osteoporosis self-assessment tool for Asians (OSTA) and one-minute osteoporosis risk test. Among them, OSTA and one-minute osteoporosis risk test were originally developed to predict osteoporosis risks and FRAX was to predict fracture risks. Methods This is an 11-year longitudinal study. We enrolled 708 senior people from health examinees in Taiwan in 2010. A standardized questionnaire and blood tests were provided. Annual telephone interview was conducted to assess the real fracture status. We calculated risk scores of FRAX, OSTA, and one-minute osteoporosis risk test and compared with real-world fracture records. Results The mean age of the participants were 74.9 (SD 6.4). There were 356 (50.3 %) men. From 2010 to 2020, a total of 105 (14.8 %) persons suffered from fractures. Compared to people without fractures, people with fractures had higher FRAX major osteoporotic fracture risk scores (14.0 % ± 7.6 % vs.11.3 % ± 5.7 %), higher hip fracture risk scores, and higher OSTA risk (5.9 % ± 1.4 % vs. 5.3 % ± 1.3 %). Cox regression analysis showed that hazard ratios for fracture of high FRAX risk was 1.53 (95 % confidence interval (CI) 1.05-2.21), and for high OSTA risk was 1.37 (95 % CI 1.04-1.82). Conclusions Only OSTA and FRAX scores were satisfactory in predicting 10-year fractures.
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Affiliation(s)
- Yueh-Hsuan Sheng
- Department of Family Medicine, Renai Branch, Taipei City Hospital, No. 10, Sec. 4, Renai Rd., Daan Dist., Taipei City, Taiwan
| | - Tai-Yin Wu
- Department of Family Medicine, Zhongxing Branch, Taipei City Hospital, No. 145, Zhengzhou Rd., Datong Dist., Taipei City, Taiwan
- Institute of Epidemiology and Preventive Medicine, National Taiwan University, No. 17, Xuzhou Rd., Zhongzheng Dist., Taipei City, Taiwan
- Department of Health and Welfare, University of Taipei, No. 101, Sec. 2, Zhongcheng Rd., Shilin Dist., Taipei City, Taiwan
| | - Chen-Kun Liaw
- Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, No. 250, Wuxing St., Xinyi Dist., Taipei City, Taiwan
- Department of Orthopedics, Shuang Ho Hospital, Taipei Medical University, No. 291, Zhongzheng Rd., Zhonghe Dist., New Taipei City, Taiwan
- Research Center of Biomedical Device, College of Biomedical Engineering, Graduate Institute of Biomedical Optomechatronics, Taipei Medical University, No. 250, Wuxing St., Xinyi Dist., Taipei City, Taiwan
- TMU Biodesign Center, Taipei Medical University, No. 250, Wuxing St., Xinyi Dist., Taipei City, Taiwan
| | - Sheng-Huang Hsiao
- Department of Neurosurgery, Taipei City Hospital, Renai Branch, No. 10, Sec. 4, Ren'ai Rd., Da'an Dist., Taipei City, Taiwan
- Department of Psychology, National Chengchi University, No. 64, Sec. 2, Zhinan Rd., Wenshan Dist., Taipei City, Taiwan
| | - Kuan-Liang Kuo
- Department of Family Medicine, Renai Branch, Taipei City Hospital, No. 10, Sec. 4, Renai Rd., Daan Dist., Taipei City, Taiwan
- Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong St., Beitou Dist., Taipei City, Taiwan
- The Bachelor's Program in Medical Informatics and Innovative Applications, Fu Jen University, No. 510, Zhongzheng Rd., Xinzhuang Dist., New Taipei City, Taiwan
| | - Ching-Yao Tsai
- Department of Health and Welfare, University of Taipei, No. 101, Sec. 2, Zhongcheng Rd., Shilin Dist., Taipei City, Taiwan
- Department of Ophthalmology, Taipei City Hospital, No. 145, Zhengzhou Rd., Datong Dist., Taipei City, Taiwan
- Institute of Public Health, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong St., Beitou Dist., Taipei City, Taiwan
- Department of Business Administration, Fu Jen Catholic University, No. 510, Zhongzheng Rd., Xinzhuang Dist., New Taipei City, Taiwan
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87
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Kleinsmith RM, Doxey SA, Huyke FA, Cunningham BP. Outcomes of Name-brand Versus Generic Cephalomedullary Nail Fixation for Intertrochanteric and Subtrochanteric Fractures: A Matched Cohort Study. J Am Acad Orthop Surg Glob Res Rev 2024; 8:01979360-202403000-00008. [PMID: 38442079 PMCID: PMC10917135 DOI: 10.5435/jaaosglobal-d-23-00186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 01/17/2024] [Accepted: 01/25/2024] [Indexed: 03/07/2024]
Abstract
This study aims to compare 90-day and 6-month outcomes and implant costs of intertrochanteric and subtrochanteric fracture fixation using cephalomedullary nails (CMNs) from a single name-brand company to fixation using generic CMNs. This was a retrospective matched cohort study. All CMN procedures for a single surgeon in a single US metropolitan institution from 2021 to 2022 were identified using current procedural terminology codes. Nearest neighbor 1:1 matching was conducted between the name-brand and generic cohorts controlling for (1) age, (2) American Society of Anesthesiologists score, and (3) Charlson Comorbidity Index. A total of 50 patients were successfully matched (25 namebrand versus 25 generic). The average implant cost per case for the name-brand group was $3,587 versus $1,615 for the generic group. Cost of disposables averaged $109 for the generic implant sets versus $916 for the name-brand (P < 0.001). Overall, a cost savings of 61% could be generated per case with the use of generic implants and disposables. Fixation of intertrochanteric and subtrochanteric fractures using generic CMNs produces similar outcomes compared with using name-brand CMNs for approximately half the implant cost.
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Affiliation(s)
- Rebekah M. Kleinsmith
- From the Department of Orthopaedic Surgery, TRIA Orthopedic Center, Bloomington, MN (Dr. Kleinsmith, Dr. Doxey, Dr. Huyke, and Dr. Cunningham), and the Department of Orthopaedic Surgery, Methodist Hospital, St. Louis Park, MN (Dr. Kleinsmith, Dr. Doxey, Dr. Huyke, and Dr. Cunningham)
| | - Stephen A. Doxey
- From the Department of Orthopaedic Surgery, TRIA Orthopedic Center, Bloomington, MN (Dr. Kleinsmith, Dr. Doxey, Dr. Huyke, and Dr. Cunningham), and the Department of Orthopaedic Surgery, Methodist Hospital, St. Louis Park, MN (Dr. Kleinsmith, Dr. Doxey, Dr. Huyke, and Dr. Cunningham)
| | - Fernando A. Huyke
- From the Department of Orthopaedic Surgery, TRIA Orthopedic Center, Bloomington, MN (Dr. Kleinsmith, Dr. Doxey, Dr. Huyke, and Dr. Cunningham), and the Department of Orthopaedic Surgery, Methodist Hospital, St. Louis Park, MN (Dr. Kleinsmith, Dr. Doxey, Dr. Huyke, and Dr. Cunningham)
| | - Brian P. Cunningham
- From the Department of Orthopaedic Surgery, TRIA Orthopedic Center, Bloomington, MN (Dr. Kleinsmith, Dr. Doxey, Dr. Huyke, and Dr. Cunningham), and the Department of Orthopaedic Surgery, Methodist Hospital, St. Louis Park, MN (Dr. Kleinsmith, Dr. Doxey, Dr. Huyke, and Dr. Cunningham)
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88
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Huang YW, Chien CH, Chiang YH, Liu CY, Huang XY. Social participation, positive affect, and negative affect in postoperative patients with hip fractures: A cross-sectional study. J Health Psychol 2024; 29:303-316. [PMID: 37776243 DOI: 10.1177/13591053231200318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/02/2023] Open
Abstract
This study investigated the social participation, positive affect (PA), and negative affect (NA) of patients with hip fractures after surgery and determined their possible predictive factors. We used a cross-sectional study design to recruit 154 participants with hip fractures post-surgery. Assessment tools included the Barthel Index, the Automatic Thoughts Questionnaire, the Assessment of Life Habits, and the Positive and Negative Affect Schedule. Patients with better functioning in daily living activities experienced more social participation, higher PA, and lower NA. Patients with more positive automatic thoughts experienced more social participation and higher PA. Patients with more negative automatic thoughts experienced more social participation, lower PA, and higher NA. Early rehabilitation and psychosocial interventions should be provided for postoperative hip fracture patients to improve their activities of daily living and emotional well-being.
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Affiliation(s)
- Yi-Wen Huang
- National Taipei University of Nursing and Health Sciences
- National Yang Ming Chiao Tung University Hospital
| | | | | | - Chieh-Yu Liu
- National Taipei University of Nursing and Health Sciences
| | - Xuan-Yi Huang
- National Taipei University of Nursing and Health Sciences
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89
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Kubo Y, Noritake K, Noguchi T, Hayashi T. Phase Angle as a Nutritional Assessment Method in Patients with Hip Fractures: A Cross-Sectional Study. Ann Geriatr Med Res 2024; 28:95-100. [PMID: 38263547 PMCID: PMC10982439 DOI: 10.4235/agmr.23.0140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 01/11/2024] [Accepted: 01/18/2024] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Phase angle, which is associated with cellular health, has attracted attention as a noninvasive and objective method for nutritional assessment. However, the association between malnutrition and phase angle in older inpatients with hip fractures has not been reported. Therefore, this study investigated this association in older inpatients (aged ≥65 years) with hip fractures and determined the cutoff phase angle for determining malnutrition. METHODS This cross-sectional study retrospectively analyzed the data of 96 inpatients with hip fractures who were hospitalized in rehabilitation units after surgery (male, 29.4%; mean age, 82.4±6.2 years). Nutritional status was assessed using the Geriatric Nutritional Risk Index (GNRI), with malnutrition defined as a GNRI ≥98. Bioelectrical impedance analysis was used to measure phase angles. RESULTS The phase angle was associated with malnutrition (B=-1.173; odds ratio=0.310; 95% confidence interval 0.58-0.83; p=0.015). The area under the receiver operating characteristic curve was 0.71. The cutoff phase angle for malnutrition was 3.96° (sensitivity=0.85, specificity=0.63). CONCLUSION Phase angle could be an indicator of malnutrition in older inpatients with hip fractures. Our findings will help formulate rehabilitation strategies for these patients.
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Affiliation(s)
- Yuta Kubo
- Division of Occupational Therapy, Faculty of Rehabilitation and Care, Seijoh University, Tokai, Aichi, Japan
| | - Kento Noritake
- Department of Rehabilitation, Faculty of Health Sciences, Nihon Fukushi University, Handa, Aichi, Japan
| | - Taiji Noguchi
- Department of Social Science, Center for Gerontology and Social Science, Research Institute, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan
| | - Takahiro Hayashi
- Division of Physical Therapy, Faculty of Rehabilitation and Care, Seijoh University, Tokai, Aichi, Japan
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90
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Tunçez M, Bulut T, Süner U, Önder Y, Kazımoğlu C. Prognostic nutritional index (PNI) is an independent risk factor for the postoperative mortality in geriatric patients undergoing hip arthroplasty for femoral neck fracture? A prospective controlled study. Arch Orthop Trauma Surg 2024; 144:1289-1295. [PMID: 38265465 DOI: 10.1007/s00402-024-05201-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 01/03/2024] [Indexed: 01/25/2024]
Abstract
INTRODUCTION Hip fracture is very common in advanced ages, and it is very likely that this condition is accompanied by nutritional deficiencies. The aim of this study was to investigate the effect of prognostic nutritional index (PNI) on postoperative mortality in geriatric patients who underwent hip arthroplasty for femoral neck fracture. MATERIALS AND METHODS Geriatric patients (aged ≥ 70 years) who underwent hip arthroplasty for femoral neck fracture were prospectively recruited. The patients' demographic data, time until surgery, total hospital stay, perioperative blood transfusion, duration of surgery and anesthesia, serum albumin level, total lymphocyte count, PNI value, and first-year mortality were examined. They were divided into two groups as patients who died and those who did not die within the 1st year, and between-group comparisons for continuous and categorical variables were made using independent t test and Chi-square test, respectively. Receiver operating characteristic (ROC) curve was constructed, and a cutoff value for PNI was determined based on sensitivity and specificity values. RESULTS The total number of participants was 124. The mean age was 80.40 ± 7.19 years: 77 (62.1%) were female and 47 (37.9%) were male. PNI was statistically significant for 1-year mortality in multivariate Cox regression analysis (p < 0.05). According to ROC curve analysis, the area under the curve for PNI level was found to be 0.764 (95% CI 0.670-0.857), and this value was statistically significant (p < 0.001). The sensitivity and specificity for the 38.4 cutoff value were 83.9% and 39.8%, respectively. The mean age, time after surgery, total hospital stay, and preoperative blood transfusion need were found to be statistically higher in the patients with low PNI levels (≤ 38.4) than those in the other patients (> 38.4) (p < 0.05 for all). CONCLUSION PNI seems to be an independent risk factor on mortality after hip fracture surgery in geriatric patients. PNI is a preventable and correctable risk factor that affects patient survival.
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Affiliation(s)
- Mahmut Tunçez
- Department of Orthopedics and Traumatology, Izmir Katip Celebi University Ataturk Training and Research Hospital, Ataturk Egitim Ve Arastirma Hastanesi Basin Sitesi, 35360, Karabağlar, Izmir, Turkey.
| | - Tuğrul Bulut
- Department of Orthopedics and Traumatology, Izmir Katip Celebi University Ataturk Training and Research Hospital, Ataturk Egitim Ve Arastirma Hastanesi Basin Sitesi, 35360, Karabağlar, Izmir, Turkey
| | - Uğurcan Süner
- Department of Orthopedics and Traumatology, Izmir Katip Celebi University Ataturk Training and Research Hospital, Ataturk Egitim Ve Arastirma Hastanesi Basin Sitesi, 35360, Karabağlar, Izmir, Turkey
| | - Yılmaz Önder
- Department of Orthopedics and Traumatology, Izmir Katip Celebi University Ataturk Training and Research Hospital, Ataturk Egitim Ve Arastirma Hastanesi Basin Sitesi, 35360, Karabağlar, Izmir, Turkey
| | - Cemal Kazımoğlu
- Department of Orthopedics and Traumatology, Izmir Katip Celebi University Ataturk Training and Research Hospital, Ataturk Egitim Ve Arastirma Hastanesi Basin Sitesi, 35360, Karabağlar, Izmir, Turkey
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91
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Surís X, Vela E, Larrosa M, Llargués E, Pueyo-Sánchez MJ, Cancio-Trujillo JM. Impact of major osteoporotic fractures on the use of healthcare resources in Catalonia, Spain. Bone 2024; 180:116993. [PMID: 38145863 DOI: 10.1016/j.bone.2023.116993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 11/30/2023] [Accepted: 12/18/2023] [Indexed: 12/27/2023]
Abstract
OBJECTIVES To estimate the impact of first major osteoporotic fractures (MOF) on health resource use and healthcare expenditures in people aged ≥50 years in Catalonia, Spain. DESIGN Observational, retrospective study. The Catalan Health Surveillance System (CHSS) registry was used to obtain sociodemographic, clinical and expenditure data from all public centres in Catalonia (Spain). SETTING AND PARTICIPANTS Males and females aged ≥50 years who sustained a first major osteoporotic fracture between January 1, 2018, and December 31, 2020. METHODS Data on admissions to the emergency department, hospitalization and skilled nursing facilities, primary and specialized care visits, nonemergency medical transport, outpatient rehabilitation and pharmacy prescriptions were retrieved for each patient. Monthly and yearly mean usage rates, expenditure in euros (€) and incremental costs one and two years after fracture were calculated. RESULTS There were 64,403 patients with first MOF: 47,555 females and 16,848 males with a mean age (standard deviation) of 76.5 (12.0) years. The average annual expenditure increased from €4564 in the year before to €12,331 in the year following a hip fracture. For forearm fractures, the expenditure increased from €2511 to €4251, for vertebral fractures from €4146 to €6659, for pelvic fractures from €4442 to €7124, for humerus fractures from €3058 to €5992, and for multiple fractures from €4598 to €12,028. The average cost for overall fractures experienced a 110.3 % increase. The leading cause of health expenditure in the year following MOF was hospital admission. Expenditure in the second year post-fracture returned to pre-fracture levels. The use of some healthcare resources, especially visits to emergency services, increased in the prefracture month. Male sex, older age and high previous comorbidities were associated with a higher expenditure. CONCLUSIONS In people with a first MOF, healthcare expenditure doubled during the first-year post-facture, mostly in relation to inpatient care. The healthcare resource use increased during the previous month. This increase could potentially be attributed to the worsening of pre-existing comorbidities.
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Affiliation(s)
- Xavier Surís
- Department of Health, Master Plan of Musculoskeletal Diseases, Barcelona, Spain; Rheumatology Department, Hospital General de Granollers, Granollers, Spain; School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Spain; Catalan Health Service.
| | - Emili Vela
- Catalan Health Service; Knowledge and Information Unit; Digitalization for the Sustainability of the Healthcare System.
| | - Marta Larrosa
- Department of Health, Master Plan of Musculoskeletal Diseases, Barcelona, Spain
| | - Esteve Llargués
- School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Spain; Internal Medicine Department, Hospital General de Granollers, Granollers, Spain.
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Ho YS, Giordano V, Mauffrey C, Giannoudis PV. Trends of impact factor contributors to the Injury Journal: A bibliometric analysis. Injury 2024; 55:111255. [PMID: 38042694 DOI: 10.1016/j.injury.2023.111255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 11/21/2023] [Accepted: 11/26/2023] [Indexed: 12/04/2023]
Abstract
PURPOSE This study aims to analyse papers concerning journal impact factors published in the Injury-International Journal of the Care of the Injured between 1997 and 2022. Through this analysis, the research offers valuable insights into the publication performance and contributors to the journal impact factor, encompassing papers, authors, institutions, and countries. METHODS Articles and reviews published in the Injury between 1995 and 2021 were examined using the Science Citation Index Expanded database. The study employed the journal impact factor contributing indicator to compare highly cited and high journal impact factor papers across various aspects, including papers, authors, institutions, and countries. RESULTS A notable correlation exists between prolific authors, institutions, and countries, alongside those who contribute to high journal impact factors. However, a less distinct connection was observed between highly cited papers/authors and high journal impact factor contributors. The Injury serves as a well-regarded international journal. Notably, editorial members of the journal play a substantial role, serving as model editors and contributing significantly to the journal's success. Out of the Top 25 IF contributing papers with the CN of 34 or more the following themes were noted to dominate: bone healing/tissue regeneration (40 %) of papers, covid-19 pandemic (24 %), polytrauma/coagulopathy (12 %) and infection (8 %). CONCLUSIONS Utilizing the journal impact factor to assess research performance at the individual, institutional, or national levels appears not to be the most appropriate method. The results show that highly cited authors did not hold the distinction of being the primary contributors to the IF. Analysis revealed a low significant relationship among the primary contributors to the IF, highly cited papers, and the most influential papers in 2022. A more effective indicator could involve considering the total number of citations a publication receives from its year of publication up to the end of the most recent year.
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Affiliation(s)
- Yuh-Shan Ho
- Trend Research Centre, Asia University, No. 500, Lioufeng Road, Taichung 41354, Taiwan
| | - Vincenzo Giordano
- Serviço de Ortopedia e Traumatologia Prof. Nova Monteiro, Hospital Municipal Miguel Couto, Rua Mario Ribeiro, 117/2° Andar, Gávea, Rio de Janeiro, RJ 22430‑160, Brazil
| | - Cyril Mauffrey
- Department of orthopedic surgery, physical medicine and rehabilitation, Denver Health Medical Center, University of Colorado, Denver, USA
| | - Peter V Giannoudis
- Trauma & Orthopaedic Surgery, School of Medicine, University of Leeds, UK; NIHR Leeds Biomedical Research Center, Chapel Allerton Hospital, Leeds, UK.
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Lai A, Sun J, Dai Z, Guo L, Tao D, Li H, Chen B, Zhou R. Unraveling IGFBP3-mediated m6A modification in fracture healing. Pathol Res Pract 2024; 255:155220. [PMID: 38432050 DOI: 10.1016/j.prp.2024.155220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 11/24/2023] [Accepted: 02/18/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND This study investigates the role of IGFBP3-mediated m6A modification in regulating the miR-23a-3p/SMAD5 axis and its impact on fracture healing, aiming to provide insights into potential therapeutic targets. METHODS Utilizing fracture-related datasets, we identified m6A modification-related mRNA and predicted miR-23a-3p as a regulator of SMAD5. We established a mouse fracture healing model and conducted experiments, including Micro-CT, RT-qPCR, Alizarin Red staining, and Alkaline phosphatase (ALP) staining, to assess gene expression and osteogenic differentiation. RESULTS IGFBP3 emerged as a crucial player in fracture healing, stabilizing miR-23a-3p through m6A modification, leading to SMAD5 downregulation. This, in turn, inhibited osteogenic differentiation and delayed fracture healing. Inhibition of IGFBP3 partially reversed through SMAD5 inhibition, restoring osteogenic differentiation and fracture healing in vivo. CONCLUSION The IGFBP3/miR-23a-3p/SMAD5 axis plays a pivotal role in fracture healing, highlighting the relevance of m6A modification. IGFBP3's role in stabilizing miR-23a-3p expression through m6A modification offers a potential therapeutic target for enhancing fracture healing outcomes.
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Affiliation(s)
- Aining Lai
- Section Ⅱ, Department of Orthopedics, the 72nd Army Hospital of PLA, Huzhou 313000, P. R. China
| | - Junjian Sun
- Section Ⅴ, Department of Orthopedics, the 72nd Army Hospital of PLA, Huzhou 31300, PR China
| | - Zhiyuan Dai
- Thoracic surgey, the 72nd Army Hospital of PLA, Huzhou 313000, PR China
| | - Long Guo
- Section Ⅱ, Department of Orthopedics, the 72nd Army Hospital of PLA, Huzhou 313000, P. R. China
| | - Degang Tao
- Section Ⅱ, Department of Orthopedics, the 72nd Army Hospital of PLA, Huzhou 313000, P. R. China
| | - Haitang Li
- Section Ⅱ, Department of Orthopedics, the 72nd Army Hospital of PLA, Huzhou 313000, P. R. China
| | - Bin Chen
- Section Ⅱ, Department of Orthopedics, the 72nd Army Hospital of PLA, Huzhou 313000, P. R. China.
| | - Rong Zhou
- Section Ⅱ, Department of Orthopedics, the 72nd Army Hospital of PLA, Huzhou 313000, P. R. China.
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Tang W, Ni X, Yao W, Wang W, Lv Q, Ding W, He R. The correlation between admission hyperglycemia and 30-day readmission after hip fracture surgery in geriatric patients: a propensity score-matched study. Front Endocrinol (Lausanne) 2024; 15:1340435. [PMID: 38449856 PMCID: PMC10915248 DOI: 10.3389/fendo.2024.1340435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 01/08/2024] [Indexed: 03/08/2024] Open
Abstract
Purpose This study aimed to investigate the association between admission hyperglycemia and 30-day readmission after hip fracture surgery in geriatric patients. Methods This retrospective study included 1253 geriatric hip fracture patients. Patients were categorized into normoglycemia(<6.10 mmol/L) and hyperglycemia groups(≥6.10 mmol/L) based on admission blood glucose. We performed multivariable logistic regression analyses and propensity score matching (PSM) to estimate adjusted odds ratios and 95% confidence intervals for 30-day readmission, controlling for potential confounding factors. An analysis of the dose-dependent association between admission blood glucose and the probability of 30-day readmission was performed. Additional subgroup analysis was conducted to examine the impact of other factors on the relationship between admission blood glucose and 30-day readmission. Results Patients with hyperglycemia had higher 30-day readmission rates than normoglycemic patients before (19.1% vs 9.7%, p<0.001) and after PSM (18.1% vs 12.3%, p=0.035). Admission hyperglycemia was an independent predictor of increased 30-day readmission risk, with an adjusted odds ratio of 1.57 (95% CI 1.08-2.29, p=0.019) after multivariable regression and 1.57 (95% CI 1.03-2.39, p=0.036) after PSM. A dose-response relationship was observed between higher glucose levels and increased readmission risk. Conclusion Admission hyperglycemia is an independent risk factor for 30-day readmission after hip fracture surgery in the elderly. Routine glucose testing upon admission and perioperative glycemic control may help reduce short-term readmissions in this vulnerable population.
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Affiliation(s)
- Wanyun Tang
- Department of Orthopedics, Zigong First People’s Hospital, Zigong, China
- Department of Orthopedics, Dandong Central Hospital, China Medical University, Dandong, China
| | - Xiaomin Ni
- Department of Orthopedics, Zigong Fourth People’s Hospital, Zigong, China
| | - Wei Yao
- Department of Orthopedics, Dandong Central Hospital, China Medical University, Dandong, China
| | - Wei Wang
- Department of Orthopedics, Dandong Central Hospital, China Medical University, Dandong, China
| | - Qiaomei Lv
- Department of Endocrinology, Dandong Central Hospital, China Medical University, Dandong, China
| | - Wenbo Ding
- Department of Orthopedics, Dandong Central Hospital, China Medical University, Dandong, China
| | - Renjian He
- Department of Orthopedics, Zigong First People’s Hospital, Zigong, China
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95
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Liu B, Chen X, Li M, Zhang X, Zhang B, Li H. Existing hip joint disease is associated with an increased incidence of hip fracture in adults: A retrospective survey of 9710 individuals from a single center. Heliyon 2024; 10:e25249. [PMID: 38318022 PMCID: PMC10839588 DOI: 10.1016/j.heliyon.2024.e25249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 10/23/2023] [Accepted: 01/23/2024] [Indexed: 02/07/2024] Open
Abstract
Objective In hip disease patients, pain and movement restrictions might cause changes in bone strength and increase the likelihood of falls, finally leading to hip fracture. The aim of this study was to identify the incidence of, characteristics of and risk factors for hip fracture in patients with existing hip disease. Methods This was a retrospective cohort study. Patients with existing hip disease treated at both outpatient and inpatient departments of our institute were identified by searching the electronic medical record system and followed retrospectively for the occurrence of hip fracture. Demographic and clinical characteristics, such as age, sex and kind of primary hip disease, were collected from the electronic medical record system. The incidence and timing of hip fracture were estimated, and a Cox regression model was built to identify the independent risk factors for hip fracture in these patients. Results A total of 9710 eligible patients were included. After a mean follow-up of 3.97 years, hip fractures were identified in 95 patients, for an estimated incidence of hip fracture of 978.37 per 100,000 patients. The femoral neck was involved in 49 fractures (51.58 %), and the femoral trochanter was involved in 45 fractures (47.37 %). Four independent risk factors and one protective factor for hip fracture in patients with hip diseases were identified: age (HR = 1.116, 95 % CI = 1.094-1.138), the presence of osteonecrosis of the femoral head (HR = 2.201, 95 % CI = 1.217-3.980), a lower Harris hip score (HR = 0.966, 95 % CI = 0.949-0.982), a history of previous hip surgery (HR = 2.126, 95 % CI = 1.304-3.466) and the use of walking aids (HR = 0.588, 95 % CI = 0.354-0.975). A scoring system with a total score of 20 points was built, which included all of the above risk factors. The predictive scores for a low risk (estimated incidence of hip fracture ≤30 %), a moderate risk (estimated incidence of hip fracture 31 %-69 %), and a high risk (estimated incidence of hip fracture ≥70 %) of hip fracture were ≤8.5 points, 9.0-13.0 points and ≥13.5 points, respectively. Conclusion The incidence of hip fracture in the special population of patients with existing hip disease was determined. Elderly patients, patients with a history of hip surgery, patients with osteonecrosis and patients with poor Harris hip scores were at increased risk of hip fracture. In patients with a predictive score greater than 9 points, indicating a moderate to high risk of hip fracture, the use of a walking aid might reduce the risk of hip fracture.
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Affiliation(s)
- Bo Liu
- Department of Osteonecrosis and Hip Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, PR China
| | - Xiao Chen
- Department of Osteonecrosis and Hip Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, PR China
| | - Mengnan Li
- Department of Osteonecrosis and Hip Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, PR China
| | - Xiaoxuan Zhang
- Department of Osteonecrosis and Hip Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, PR China
| | - Binquan Zhang
- Department of Osteonecrosis and Hip Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, PR China
| | - Huijie Li
- Department of Osteonecrosis and Hip Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, PR China
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Zhao W, Fu M, Wang Z, Hou Z. Risk factors and prognosis of perioperative acute heart failure in elderly patients with hip fracture: case-control studies and cohort study. BMC Musculoskelet Disord 2024; 25:143. [PMID: 38355490 PMCID: PMC10868018 DOI: 10.1186/s12891-024-07255-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 02/03/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Elderly patients with hip fracture who develop perioperative acute heart failure (AHF) have a poor prognosis. The aim of the present study is to investigate the potential risks of AHF in elderly hip-fracture patients in the postoperative period and to evaluate the prognostic significance of AHF. METHODS A retrospective analysis was conducted on hip fracture patients at the Third Hospital of Hebei Medical University, who were continuously in hospital from September 2018 to August 2020. To identify independent risk factors for AHF in elderly patients with hip fracture, univariate and multivariate Logistic regression analysis was employed. The Kaplan-Meier survival curve illustrated the relationship between all-cause mortality in the AHF and non-AHF groups. An assessment of the correlation between baseline factors and all-cause mortality was conducted by means of univariable and multivariable Cox proportional hazards analysis. RESULTS We eventually recruited 492 patients,318 of whom were in the AHF group. Statistical significance was found between the two groups for age group, concomitant coronary heart disease, COPD, haemoglobin level below 100 g/L on admission, albumin level below 40 g/L on admission, and increased intraoperative blood loss. Age over 75, concomitant coronary artery disease, hemoglobin level below 100 g/L and albumin level below 40 g/L on admission were independent risk factors for AHF in older hip fracture patients. The AHF group exhibited a higher incidence of perioperative complications, such as anemia, cardiovascular issues, and stress hyperglycemia, as well as all-cause mortality. Based on our COX regression analysis, we have identified that the main risk factors for all-cause mortality in AHF patients are concomitant coronary heart disease, absence of pulmonary infection, absence of diabetes, absence of cancer, and absence of urinary tract infection. CONCLUSION Enhancing hip fracture prevention for AHF is particularly important. It is crucial to make informed decisions to avoid poor prognoses. Patients whose age over 75 years old, concomitant coronary heart disease, hemoglobin < 100 g/L and album< 40 g/L on admission are more likely to develop perioperative AHF. To avert complications and potential fatalities, patients with AHF must receive appropriate care during the perioperative period.
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Affiliation(s)
- Wei Zhao
- Department of Geriatric Orthopedics, The Third Hospital of Hebei Medical University, No.139 ZiQiang Lu, Shijiazhuang, 050051, Hebei PR, China
| | - Mingming Fu
- Department of Geriatric Orthopedics, The Third Hospital of Hebei Medical University, No.139 ZiQiang Lu, Shijiazhuang, 050051, Hebei PR, China
| | - Zhiqian Wang
- Department of Geriatric Orthopedics, The Third Hospital of Hebei Medical University, No.139 ZiQiang Lu, Shijiazhuang, 050051, Hebei PR, China.
| | - Zhiyong Hou
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, No.139, ZiQiang Lu, Shijiazhuang, 050051, Hebei PR, China.
- NHC Key Laboratory of Intelligent Orthopeadic Equipment, The Third Hospital of Hebei Medical University, No.139, ZiQiang Lu, Shijiazhuang, People's Republic of China.
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97
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March MK, Dennis SM, Caruana S, Mahony C, Elliott JM, Polley S, Thomas B, Lin C, Harmer AR. Boosting inpatient exercise after hip fracture using an alternative workforce: a mixed methods implementation evaluation. BMC Geriatr 2024; 24:149. [PMID: 38350882 PMCID: PMC10865645 DOI: 10.1186/s12877-024-04730-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 01/19/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Hip fracture has a devastating impact on individuals and is an increasing burden for health systems and society. Compared to usual care, increased physiotherapy provision has demonstrated efficacy in improving patient and health service outcomes in this population. However, physiotherapy workforce challenges prevent sustained implementation. METHODS Our aim was to evaluate the safety, feasibility, acceptability, effectiveness and implementation cost of thrice daily physiotherapy for patients in the acute care setting after hip fracture at two public hospitals. We added twice-daily exercise implemented by an alternative workforce, to usual care consisting of daily mobility practice by a physiotherapist. Sites identified their preferred alternative workforce, with pre-registration physiotherapy students and allied health assistants chosen. We used a mixed methods approach, using the Consolidated Framework for Implementation Research (CFIR) as a determinant framework to guide implementation planning and data collection. We compared hospital length of stay data to a reference cohort. RESULTS We recruited 25 patients during the study period. Acute care hospital length of stay decreased from 11 days in the reference cohort to 8 days in the BOOST cohort (mean difference - 3.3 days, 95%CI -5.4 to -1.2 days, p = 0.003). Intervention fidelity was 72% indicating feasibility, no safety concerns were attributed to the intervention, and uptake was 96% of all eligible patients. The intervention was acceptable to patients, carers and healthcare providers. This intervention was cost-effective from the acute orthopaedic service perspective. CONCLUSION Higher daily frequency of physiotherapy can be safely, feasibly and effectively implemented by an alternative workforce for patients in the acute care setting following hip fracture surgery.
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Affiliation(s)
- Marie K March
- Physiotherapy Department, Blacktown Mt Druitt Hospitals, Western Sydney Local Health District, Blacktown, NSW, Australia.
- Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia.
| | - Sarah M Dennis
- Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
- South Western Sydney Local Health District, Liverpool, NSW, Australia
- Ingham Institute of Applied Medical Research, Liverpool, NSW, Australia
| | - Sarah Caruana
- Physiotherapy Department, Blacktown Mt Druitt Hospitals, Western Sydney Local Health District, Blacktown, NSW, Australia
| | - Christopher Mahony
- Physiotherapy Department, Hornsby Ku-ring-gai Hospital, Northern Sydney Local Health District, Hornsby, NSW, Australia
| | - James M Elliott
- Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
- The Kolling Institute, St Leonards, NSW, Australia
| | - Stephanie Polley
- Department of Rehabilitation and Aged Care, Blacktown Mt Druitt Hospitals, Western Sydney Local Health District, Blacktown, NSW, Australia
- Department of Aged Care, Hornsby Ku-ring-gai Hospital, Northern Sydney Local Health District, Hornsby, NSW, Australia
| | - Bijoy Thomas
- Department of Orthopaedic Surgery, Blacktown Mt Druitt Hospital, Western Sydney Local Health District, Blacktown, NSW, Australia
| | - Charlie Lin
- Department of Orthopaedic Surgery, Hornsby Ku-ring-gai Hospital, Northern Sydney Local Health District, Hornsby, NSW, Australia
| | - Alison R Harmer
- Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
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98
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Wu W, Guo Z, Gu Z, Mao Y, She C, Gu J, Lv B, Xu W, Li L. GLIM criteria represent a more suitable tool to evaluate the nutritional status and predict postoperative motor functional recovery of older patients with hip fracture: A retrospective study. Medicine (Baltimore) 2024; 103:e37128. [PMID: 38335434 PMCID: PMC10860930 DOI: 10.1097/md.0000000000037128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 01/02/2024] [Accepted: 01/10/2024] [Indexed: 02/12/2024] Open
Abstract
Early recognition of malnutrition is essential to improve the prognosis of older patients with hip fracture. The Nutritional Risk Screening 2002 (NRS-2002), the Short-Form Mini Nutritional Assessment (MNA-SF) and the Global Leadership Initiative on Malnutrition (GLIM) are widely used in malnutrition diagnosis. However, criteria for predicting postoperative hip joint motor function in older patients with hip fractures are still necessary. The objective of this study was to select the most appropriate criteria from the NRS-2002, the MNA-SF and the GLIM in predicting the postoperative hip joint motor function recovery 1 year after surgery. This retrospective observational study included 161 patients aged ≥ 65 years with hip fractures. The nutritional status of patients was determined by the NRS-2002, MNA-SF and GLIM. The Harris hip joint score (HHS), the primary outcome of this study, was used to evaluate hip joint motor function. HHS was classified as excellent (HHS > 75) or non-excellent outcomes (HHS ≤ 75). Logistic regression models for hip joint motor function recovery were constructed. Both the receiver operating characteristic curve and the decision curve analysis were used to select the most predictive criteria. The overall mean age of the 161 patients was 77.90 ± 8.17. As a result, NRS-2002 (OR:0.06, 95%CI [0.01, 0.17]), MNA-SF (OR:0.05, 95%CI [0.00, 0.23]) and GLIM (OR of moderate: 0.03, 95%CI [0.01, 0.11]; OR of severe: 0.02 [0.00, 0.07]) were predictive for recovery of hip joint motor function. Additionally, both the area under curve of the receiver operating characteristic curve (NRS-2002: 81.2 [73.8, 88.6], MNA-SF: 76.3 [68.5, 84.2], GLIM: 86.2 [79.6,92.8]) and the decision curve analysis showed the GLIM was better than others. Compared with NRS-2002 and MNA-SF, GLIM was a more suitable nutritional assessment criteria to predict the postoperative recovery of hip joint motor function for older patients with hip fracture 1 year after surgery.
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Affiliation(s)
- Weicheng Wu
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Zhening Guo
- Department of Pharmacy, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Zenghui Gu
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Yongtao Mao
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Chang She
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Jun Gu
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Bo Lv
- Department of Pharmacy, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Wei Xu
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Liubing Li
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou, China
- State Key Laboratory of Radiation Medicine and Protection, Soochow University, Suzhou, China
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99
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Postler A, Posten C, Schubert M, Beyer F, Lützner J, Vicent O, Kleber C, Goronzy J, Kamin K. Patients risk for mortality at 90 days after proximal femur fracture - a retrospective study in a tertiary care hospital. BMC Geriatr 2024; 24:130. [PMID: 38310209 PMCID: PMC10838409 DOI: 10.1186/s12877-024-04733-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 01/20/2024] [Indexed: 02/05/2024] Open
Abstract
BACKGROUND Despite improving the management of proximal femur fractures (PFF) with legal requirements of timing the surgery within 24 h, mortality rates in these patients remain still high. The objective of our study was to analyze potential cofactors which might influence the mortality rate within 90 days after surgery in PFF to avoid adverse events, loss of quality of life and high rates of mortality. METHODS In this retrospective, single-center study all patients with PFF aged 65 years and older were included. We recorded gender, age, type of fracture, surgery and anesthesia, time, comorbidities and medication as well as complications and mortality rate at 90 days. Separate logistic regression models were used to assess which parameters were associated with patients' mortality. The mortality rate was neither associated with timing, time and type of surgery nor time and type of anesthesia, but with higher age (OR 1.08 per year; 95% CI 1.034-1.128), lower BMI (OR 0.915 per kg/m2; 95% CI 0.857-0.978), higher CCI (OR 1.170 per point; 95% CI 1.018-1.345), dementia (OR 2.805; 95% CI 1.616-4.869), non-surgical complications (OR 2.276; 95% CI 1.269-4.083) and if mobilization was impossible (OR 10.493; 95% CI 3.612-30.479). RESULTS We analyzed a total of 734 patients (age ≥ 65 years) who had a PFF in 2019 and 2020 and received surgery. 129 patients (17.6%) died until 90 days at an median age of 89.7 years (range 65-101 years). CONCLUSION The proportion of patients who died until 90 days after surgery is still high. It is less extend influenced by surgical and anaesthesiologic factors than by patient-related factors like age or lower BMI. Physicians should be aware of the importance of avoiding adverse events and the importance of patients' mobilization to reduce mortality and improve patients' outcome.
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Affiliation(s)
- Anne Postler
- University Center of Orthopaedic, Trauma and Plastic Surgery, University Hospital, TU Dresden, Fetscherstr. 74, 01307, Dresden, Germany.
| | - Charlotte Posten
- University Center of Orthopaedic, Trauma and Plastic Surgery, University Hospital, TU Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Melanie Schubert
- University Center of Orthopaedic, Trauma and Plastic Surgery, University Hospital, TU Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Franziska Beyer
- University Center of Orthopaedic, Trauma and Plastic Surgery, University Hospital, TU Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Jörg Lützner
- University Center of Orthopaedic, Trauma and Plastic Surgery, University Hospital, TU Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Oliver Vicent
- University Center of Orthopaedic, Trauma and Plastic Surgery, University Hospital, TU Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Christian Kleber
- Department of Orthopaedic, Trauma and Plastic Surgery, University of Leipzig, Leipzig, Germany
| | - Jens Goronzy
- University Center of Orthopaedic, Trauma and Plastic Surgery, University Hospital, TU Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Konrad Kamin
- University Center of Orthopaedic, Trauma and Plastic Surgery, University Hospital, TU Dresden, Fetscherstr. 74, 01307, Dresden, Germany
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100
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Storbjerg DK, Gadgaard NR, Pedersen AB. Any infection among patients with hip fracture: Predictive ability of Charlson, Elixhauser, Rx-Risk, and Nordic comorbidity indices. Surgeon 2024; 22:e61-e68. [PMID: 37989653 DOI: 10.1016/j.surge.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 10/13/2023] [Accepted: 11/07/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND In studies on infection after hip fracture surgery, a common and serious complication, it remains unknown which comorbidity index is best for case-mix confounder adjustment. We evaluated the predictive ability of Charlson Comorbidity Index (CCI), Elixhauser Comorbidity Index (ECI), Rx-Risk Index (Rx-Risk), and Nordic Multimorbidity Index (NMI) for any infection up to 1 year from discharge after hip fracture surgery. METHODS Using Danish medical registries, we included 92,600 patients (mean age 83 years) surgically treated for hip fracture between 2004 and 2018. Comorbidity-index scores were calculated using prevalence of diagnosis codes, prescription codes, or both. Lookback periods of 1, 5, and 10 years were applied. Logistic regression was used to calculate c-index to assess discrimination of comorbidity indices individually and in combination with a base model of age and sex. Outcome was any infection (not only surgical site infection) in-hospital and 1 year after discharge. RESULTS At 10-year lookback period, the c-index for individual comorbidity indices for in-hospital infections varied from 0.53 to 0.56, similar to base model alone (0.56). The predictive ability of comorbidity indices in combination with base model varied from 0.56 to 0.57. Within 1 year after discharge, NMI in combination with base model had best predictive ability for infection (c-index = 0.62), followed by CCI and ECI (c-index = 0.60) and Rx-Risk (c-index = 0.58). Discrimination was similar for all lookback periods. CONCLUSIONS Comorbidity indices have low predictive ability for any infection up to 1 year after hip fracture surgery, similar to that of age and sex alone. For case-mix adjustment, evaluated comorbidity indices are of equal value.
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Affiliation(s)
- Dorete K Storbjerg
- Department of Clinical Epidemiology, Aarhus University Hospital and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Nadia R Gadgaard
- Department of Clinical Epidemiology, Aarhus University Hospital and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Alma B Pedersen
- Department of Clinical Epidemiology, Aarhus University Hospital and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
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