301
|
Liu Y, Zhang CW, Zhao XD. Long-term survival of femoral neck fracture patients aged over ninety years: Arthroplasty compared with nonoperative treatment. BMC Musculoskelet Disord 2020; 21:217. [PMID: 32268893 PMCID: PMC7140318 DOI: 10.1186/s12891-020-03249-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 03/27/2020] [Indexed: 02/08/2023] Open
Abstract
Background The aging of the Chinese population is expected to lead to an increase in nonagenarians and centenarians. The mortality rate in nonagenarian hip fracture patients is equivalent to the mortality rate in the average population at 5 years after injury. It is imperative to evaluate 5-year mortality in this small but very challenging subgroup of patients to optimize patient management. The primary purpose of the current retrospective study was to compare five-year survival in patients aged over 90 years who received arthroplasty or nonoperative treatment for femoral neck fracture during a 16-year period. Methods From January 1998 to December 2014, all consecutive nonagenarian and centenarian patients with femoral neck fracture admitted to our hospital were included in the evaluation. The primary outcome was defined as thirty-day, 1-year, 3-year, and 5-year mortality after injury. Survival analysis was performed with the Kaplan-Meier method. Using the log-rank test, stratified analyses were performed to compare differences in the overall cumulative mortality and mortality at three time points (1 year, 3 years, and 5 years) after injury and differences in survival distributions. Results Over the 16-year study period, the arthroplasty group and the nonoperative treatment group included 33 and 53 patients, respectively. The long-term survival probability of the arthroplasty group was significantly higher than that of the nonoperative treatment group (p = 0.002). The survival time of the arthroplasty group was significantly higher than that of the nonoperative treatment group (median (P75-P25) = 53 (59) versus median (P75-P25) = 22 (52), p = 0.001). The mortality differences, except for 30-day mortality, at five time points (1, 2, 3, 4, and 5 years) between the nonoperative group and arthroplasty group were significant. The stratified analyses of overall cumulative mortality and mortality at three time points (1, 3, and 5 years) after injury demonstrated that the nonoperative treatment group had significantly higher cumulative mortality than the arthroplasty group. Conclusions Our study demonstrates that arthroplasty is more likely to improve long-term survival in femoral neck fracture patients aged over 90 years than nonoperative treatment. It can be expected that nearly half of patients will survive more than 5 years after surgery.
Collapse
Affiliation(s)
- Yang Liu
- Department of Orthopedic Surgery, National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Wai Nan Guo Xue Lane No. 37, Wuhou District, Chengdu, Sichuan Province, P.R. China, 610041.
| | - Chong-Wei Zhang
- Department of Laboratory Medicine, West China Hospital of Sichuan University, Wai Nan Guo Xue Lane No. 37, Wuhou District, Chengdu, Sichuan Province, P.R. China, 610041
| | - Xiao-Dan Zhao
- Department of Orthopedic Surgery, National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Wai Nan Guo Xue Lane No. 37, Wuhou District, Chengdu, Sichuan Province, P.R. China, 610041
| |
Collapse
|
302
|
Abstract
BACKGROUND Reverse intertrochanteric fractures are usually initially treated with closed reduction. However, sometimes these fractures are not amenable to closed reduction and require open reduction. To date, few studies have been conducted on predictors of and reduction techniques for irreducible reverse intertrochanteric fractures. Therefore, this study aimed to summarize the displacement patterns of irreducible reverse intertrochanteric fractures and corresponding reduction techniques, and explore predictors of irreducibility. METHODS We reviewed 1174 cases of trochanteric fractures treated in our hospital from January 2006 to October 2018, 113 of which were reverse intertrochanteric fractures. An irreducible fracture was determined according to intra-operative fluoroscopy imaging after closed manipulation. Fractures were assessed for displacement patterns, radiographic features of irreducibility, and reduction techniques. Logistic regression analysis was performed on potential predictors for irreducibility, including gender, age, body mass index, AO Foundation/Orthopaedic Trauma Association (AO/OTA) classification, and radiographic features. RESULTS Seventy-six irreducible fractures were identified, accounting for 67% of reverse intertrochanteric fractures. Six patterns of fracture displacement after closed manipulation were identified; the most common pattern was medial displacement and posterior sagging of the femoral shaft relative to the head-neck fragment. Multivariate logistic regression analysis identified three predictors of irreducibility: a medially displaced femoral shaft relative to the head-neck fragment on the anteroposterior (AP) view (odds ratio [OR], 8.00; 95% confidence interval [CI], 3.04-21.04; P < 0.001), a displaced lesser trochanter (OR, 3.61; 95% CI, 1.35-9.61; P = 0.010), and a displaced lateral femoral wall (OR, 2.92; 95% CI, 1.02-8.34; P = 0.046). CONCLUSIONS A high proportion of reverse intertrochanteric fractures are not amenable to closed reduction. Six patterns of fracture displacement after closed manipulation were identified. Different reduction techniques are required for different displacement patterns. Predictors of irreducibility include a medially displaced femoral shaft relative to the head-neck fragment on the AP view, a displaced lesser trochanter, and a displaced lateral femoral wall. These patients warrant special consideration in terms of recognition and management.
Collapse
|
303
|
The accuracy of intra-operative fluoroscopy in evaluating the reduction quality of intertrochanteric hip fractures. INTERNATIONAL ORTHOPAEDICS 2020; 44:1201-1208. [DOI: 10.1007/s00264-020-04533-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 03/04/2020] [Indexed: 10/24/2022]
|
304
|
Feng L, Xu L, Yuan W, Xu Z, Feng Z, Zhang H. Preoperative anemia and total hospitalization time are the independent factors of preoperative deep venous thromboembolism in Chinese elderly undergoing hip surgery. BMC Anesthesiol 2020; 20:72. [PMID: 32241254 PMCID: PMC7114807 DOI: 10.1186/s12871-020-00983-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Accepted: 03/10/2020] [Indexed: 12/25/2022] Open
Abstract
Background This study was designed to explore the prevalence and risk factors of preoperative deep venous thromboembolism (DVT) in Chinese elderly with hip fracture. Methods From January 1, 2012, to December 31, 2018, 273 elderly patients over 70 years old with elective hip surgery were collected from the electronic medical records. Collected data included demographic characteristics, comorbidities, ASA classification, types of previous operations, types of anesthesia, operation time, fracture to operation time, preoperative hemoglobin level, anemia, blood-gas analysis, cardiac function, whether transfusion, preoperative hospitalization, postoperative hospitalization, electrocardiograph, lower limb venous ultrasonography and total hospitalization time. Results In these 273 patients, 15(5.6%) had ultrasonography evidence of DVT in affected limbs before surgery. Three of all patients received an temporary inferior vena cave filter placement preoperatively. Fracture to surgery time, preoperative hemoglobin level, anemia, preoperative hospitalization, pulmonary disease and total hospitalization time were statistically different between DVT group and non-DVT group (P < 0.05 for all). Moreover, preoperative anemia (OR: 0.144, 95%CI: 0.026–0.799, P = 0.027) and total hospitalization time (OR: 1.135; 95%CI: 1.023–1.259, P = 0.017) were the two independent risk factors for preoperative DVT. Conclusion Preoperative anemia and total hospitalization time were independent risk factors for venous DVT in Chinese elderly with hip fracture.
Collapse
Affiliation(s)
- Long Feng
- Medicine School of Chinese PLA, No.28, Fuxing Road, Beijing, 100853, China.,Department of Anesthesia, Hainan Hospital of Chinese PLA General Hospital, No.80, Jianglin Road, Sanya, 572000, China
| | - Longhe Xu
- Department of Anesthesia Operation Center, Chinese PLA General Hospital, No.28, Fuxing Road, Beijing, 100853, China
| | - Weixiu Yuan
- Department of Anesthesia, Hainan Hospital of Chinese PLA General Hospital, No.80, Jianglin Road, Sanya, 572000, China
| | - Zhipeng Xu
- Department of Anesthesia Operation Center, Chinese PLA General Hospital, No.28, Fuxing Road, Beijing, 100853, China
| | - Zeguo Feng
- Department of Anesthesia Operation Center, Chinese PLA General Hospital, No.28, Fuxing Road, Beijing, 100853, China.
| | - Hong Zhang
- Medicine School of Chinese PLA, No.28, Fuxing Road, Beijing, 100853, China. .,Department of Anesthesia Operation Center, Chinese PLA General Hospital, No.28, Fuxing Road, Beijing, 100853, China.
| |
Collapse
|
305
|
Sivasundaram L, Tanenbaum JE, Mengers SR, Trivedi NN, Su CA, Salata MJ, Ochenjele G, Voos JE, Wetzel RJ. Identifying a clinical decision tool to predict discharge disposition following operative treatment of hip fractures in the United States. Injury 2020; 51:1015-1020. [PMID: 32122627 DOI: 10.1016/j.injury.2020.02.108] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 02/19/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Post-discharge management following operative treatment of hip fractures continues to be performed on a case-by-case basis, with no uniform guidelines dictating management. Predicting discharge to post-acute care (PAC) facilities (i.e. skilled nursing facilities and inpatient rehabilitation facilities) can assist preoperative planning and potentially decrease length of stay secondary to disposition issues. The goal of this study was to develop a nomogram using easily identified variables to preoperatively predict discharge disposition following operative treatment of hip fractures. METHODS Using the National Surgical Quality Improvement Program database, patients who underwent surgical intervention for hip fractures between 2012 and 2015 were identified. A multivariable logistic regression model was used to identify risk factors for discharge to a PAC facility, and a predictive nomogram was created based on these results. RESULTS From 2012 to 2015, 33,371 hip fractures were identified: 13,336 (40%) femoral neck fractures, and 20,035 (60%) intertrochanteric femur fractures. Of the patients identified, 26,082 (78.2%) were discharged to a PAC while the remainder were discharged home with or without home health. 70% of patients were female and 92.4% were Caucasian. When accounting for comorbidities, using the American Society of Anesthesiologists (ASA) classification system, 6,122 patients (18.4%) had 'Mild Systemic Disease' (ASA 2), 20,872 (62.6%) patients had 'Severe Systemic Disease' (ASA 3), and 6,006 (18.1%) had 'Life Threatening Disease' (ASA 4/5). The majority of patients were brought in from a 'Home' setting, while 10.4% of patients were admitted from a 'Long-Term Care' setting. After controlling for confounding variables, older age and increasing ASA class were predictive of an increased risk of discharge to a PAC. Diabetes, dyspnea, congestive heart failure, and chronic obstructive pulmonary disease were not associated with an increased risk of discharge to a PAC. DISCUSSION Discharge disposition following operative treatment of hip fractures can be reliably predicted using a nomogram with commonly identified preoperative variables. LEVEL OF EVIDENCE Level III, Retrospective Cohort Design, Observational Study.
Collapse
Affiliation(s)
- Lakshmanan Sivasundaram
- University Hospitals of Cleveland, Case Western Reserve University, Cleveland, OH, United States; MetroHealth Medical Center, Cleveland, OH, United States
| | - Joseph E Tanenbaum
- University Hospitals of Cleveland, Case Western Reserve University, Cleveland, OH, United States
| | - Sunita Rp Mengers
- University Hospitals of Cleveland, Case Western Reserve University, Cleveland, OH, United States.
| | - Nikunj N Trivedi
- University Hospitals of Cleveland, Case Western Reserve University, Cleveland, OH, United States
| | - Charles A Su
- University Hospitals of Cleveland, Case Western Reserve University, Cleveland, OH, United States
| | - Michael J Salata
- University Hospitals of Cleveland, Case Western Reserve University, Cleveland, OH, United States
| | - George Ochenjele
- University Hospitals of Cleveland, Case Western Reserve University, Cleveland, OH, United States
| | - James E Voos
- University Hospitals of Cleveland, Case Western Reserve University, Cleveland, OH, United States
| | - Robert J Wetzel
- University Hospitals of Cleveland, Case Western Reserve University, Cleveland, OH, United States
| |
Collapse
|
306
|
Wei J, Lane NE, Bolster MB, Dubreuil M, Zeng C, Misra D, Lu N, Choi HK, Lei G, Zhang Y. Association of Tramadol Use With Risk of Hip Fracture. J Bone Miner Res 2020; 35:631-640. [PMID: 32020683 PMCID: PMC8282603 DOI: 10.1002/jbmr.3935] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 11/19/2019] [Accepted: 12/01/2019] [Indexed: 12/21/2022]
Abstract
Several professional organizations have recommended tramadol as one of the first-line or second-line therapies for patients with chronic noncancer pain and its prescription has been increasing rapidly worldwide; however, the safety profile of tramadol, such as risk of fracture, remains unclear. This study aimed to examine the association of tramadol with risk of hip fracture. Among individuals age 50 years or older without a history of hip fracture, cancer, or opioid use disorder in The Health Improvement Network (THIN) database in the United Kingdom general practice (2000-2017), five sequential propensity score-matched cohort studies were assembled, ie, participants who initiated tramadol or those who initiated one of the following medications: codeine (n = 146,956) (another commonly used weak opioid), naproxen (n = 115,109) or ibuprofen (n = 107,438) (commonly used nonselective nonsteroidal anti-inflammatory drugs [NSAIDs]), celecoxib (n = 43,130), or etoricoxib (n = 27,689) (cyclooxygenase-2 inhibitors). The outcome was incident hip fracture over 1 year. After propensity-score matching, the included participants had a mean age of 65.7 years and 56.9% were women. During the 1-year follow-up, 518 hip fracture (3.7/1000 person-years) occurred in the tramadol cohort and 401 (2.9/1000 person-years) occurred in the codeine cohort. Compared with codeine, hazard ratio (HR) of hip fracture for tramadol was 1.28 (95% confidence interval [CI] 1.13 to 1.46). Risk of hip fracture was also higher in the tramadol cohort than in the naproxen (2.9/1000 person-years for tramadol, 1.7/1000 person-years for naproxen; HR = 1.69, 95% CI 1.41 to 2.03), ibuprofen (3.4/1000 person-years for tramadol, 2.0/1000 person-years for ibuprofen; HR = 1.65, 95% CI 1.39 to 1.96), celecoxib (3.4/1000 person-years for tramadol, 1.8/1000 person-years for celecoxib; HR = 1.85, 95% CI 1.40 to 2.44), or etoricoxib (2.9/1000 person-years for tramadol, 1.5/1000 person-years for etoricoxib; HR = 1.96, 95% CI 1.34 to 2.87) cohort. In this population-based cohort study, the initiation of tramadol was associated with a higher risk of hip fracture than initiation of codeine and commonly used NSAIDs, suggesting a need to revisit several guidelines on tramadol use in clinical practice. © 2020 American Society for Bone and Mineral Research.
Collapse
Affiliation(s)
- Jie Wei
- Health Management Center, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- The Mongan Institute, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Nancy E. Lane
- Center for Musculoskeletal Health and Department of Medicine, University of California School of Medicine, Sacramento, California, USA
| | - Marcy B. Bolster
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Maureen Dubreuil
- Boston University School of Medicine, Boston, Massachusetts, USA
- VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Chao Zeng
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- The Mongan Institute, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Devyani Misra
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Na Lu
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Arthritis Research Canada, Richmond, British Columbia, Canada
| | - Hyon K. Choi
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- The Mongan Institute, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Guanghua Lei
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yuqing Zhang
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- The Mongan Institute, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
307
|
Shimodan S, Sato D, Takahashi K, Nakamura Y, Hyakkan R, Watanabe T, Hishimura R, Ota M, Shimizu H, Hojo Y, Hasegawa Y, Chubachi T, Yasui K, Tsujimoto T, Tsukuda Y, Asano T, Takahashi D, Takahata M, Iwasaki N, Shimizu T. Ten years change in post-fracture care for hip fracture patients. J Bone Miner Metab 2020; 38:222-229. [PMID: 31583538 DOI: 10.1007/s00774-019-01047-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 09/03/2019] [Indexed: 11/26/2022]
Abstract
INTRODUCTION This multicenter, retrospective study aimed to clarify the changes in postoperative care provided by orthopaedic surgeons after hip fractures and clarify the incidence of secondary fractures requiring surgery. MATERIALS AND METHODS Subjects were patients with hip fracture treated surgically in seven hospitals during the 10-year period from January 2008 to December 2017. Data on patient demographics, comorbidities, preoperative and postoperative osteoporosis treatments, and secondary fractures were collected from the medical records. RESULTS In total, 4764 new hip fractures in 982 men and 3782 women (mean age: 81.3 ± 10.0 years) were identified. Approximately 10% of patients had a history of osteoporosis drug treatment and 35% of patients received postoperative drug treatment. The proportion of patients receiving postoperative drug therapy increased by approximately 10% between 2009 and 2010, 10% between 2010 and 2011, and 10% between 2011 and 2013. Although the rate of secondary fractures during the entire period and within 3 years decreased from 2011, the rate of secondary fracture within 1 year remained at around 2% every year. CONCLUSIONS The approval of new osteoporosis drugs and the establishment of osteoporosis liaison services have had a positive effect on the use of postoperative drug therapy in the orthopedic field. Our finding that the rate of secondary fracture within 1 year of the initial fracture remained around 2% every year, despite improvements in postoperative drug therapy, suggests that both rehabilitation for preventing falls and early postoperative drug therapy are essential to prevent secondary fractures.
Collapse
Affiliation(s)
- Shun Shimodan
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15 Nishi-7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
- Department of Orthopaedic Surgery, Kushiro City General Hospital, Kushiro, Hokkaido, Japan
| | - Dai Sato
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15 Nishi-7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
- Department of Orthopaedic Surgery, Iwamizawa City Hospital, Iwamizawa, Hokkaido, Japan
| | - Kaname Takahashi
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15 Nishi-7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
- Department of Orthopaedic Surgery, Hakodate General Central Hospital, Hakodate, Hokkaido, Japan
| | - Yumejiro Nakamura
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15 Nishi-7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
- Department of Orthopaedic Surgery, Hakodate General Central Hospital, Hakodate, Hokkaido, Japan
| | - Ryota Hyakkan
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15 Nishi-7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
- Department of Orthopaedic Surgery, Hakodate General Central Hospital, Hakodate, Hokkaido, Japan
| | - Takamasa Watanabe
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15 Nishi-7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
- Department of Orthopaedic Surgery, Hakodate General Central Hospital, Hakodate, Hokkaido, Japan
| | - Ryosuke Hishimura
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15 Nishi-7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
- Department of Orthopaedic Surgery, Ebetsu City Hospital, Ebetsu, Hokkaido, Japan
| | - Masahiro Ota
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15 Nishi-7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
- Department of Orthopaedic Surgery, Hokushokai Hospital, Iwamizawa, Hokkaido, Japan
| | - Hirokazu Shimizu
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15 Nishi-7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
- Department of Orthopaedic Surgery, Kushiro Rosai Hospital, Kushiro, Hokkaido, Japan
| | - Yoshihiro Hojo
- Department of Orthopaedic Surgery, Kushiro Rosai Hospital, Kushiro, Hokkaido, Japan
| | - Yuichi Hasegawa
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15 Nishi-7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
- Department of Orthopaedic Surgery, Obihiro Kosei Hospital, Obihiro, Hokkaido, Japan
| | - Toshiya Chubachi
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15 Nishi-7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
- Department of Orthopaedic Surgery, Obihiro Kosei Hospital, Obihiro, Hokkaido, Japan
| | - Keigo Yasui
- Department of Orthopaedic Surgery, Obihiro Kosei Hospital, Obihiro, Hokkaido, Japan
| | - Takeru Tsujimoto
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15 Nishi-7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
- Department of Orthopaedic Surgery, Otaru City Hospital, Otaru, Hokkaido, Japan
| | - Yukinori Tsukuda
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15 Nishi-7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
- Department of Orthopaedic Surgery, Otaru City Hospital, Otaru, Hokkaido, Japan
| | - Tsuyoshi Asano
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15 Nishi-7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Daisuke Takahashi
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15 Nishi-7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Masahiko Takahata
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15 Nishi-7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15 Nishi-7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Tomohiro Shimizu
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15 Nishi-7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan.
| |
Collapse
|
308
|
Lopes-Coutinho L, Dias-Carvalho A, Esteves N, Sousa R. Traditional distance "tip-apex" vs. new calcar referenced "tip-apex" - which one is the best peritrochanteric osteosynthesis failure predictor? Injury 2020; 51:674-677. [PMID: 31983422 DOI: 10.1016/j.injury.2020.01.024] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 12/09/2019] [Accepted: 01/20/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION In the treatment of trochanteric fractures, the distance between the tip of the screw and the apex of the femoral head or tip-to-apex distance (TAD) was popularized by Baumgaertner about 20 years ago as an important predictor of failure. Recently, a new reference point for determining the apex has been advocated. In this new calcar tip-to-apex (calTAD) the femoral head apex is referenced to the femoral calcar and not the center of the neck. The aim of this study is to evaluate which of these two indexes is better in predicting failure of pertrochanteric fracture fixation. MATERIALS AND METHODS We conducted a retrospective study focusing on pertrochanteric fractures operated in our institution between 2010-2013. Radiographic measurement of both indexes was performed. Demographic information, as well as several variables with recognized influence on the rate of failure, were collected. Finally, logistic regression analysis was used to identify variables independently associated with fixation failure. RESULTS A total of 463 pertrochanteric fractures were operated during this time period. One hundred and seventy cases were excluded because of early loss of follow-up (n = 143) or inadequate fluroscopic imaging (n = 27) control precluding accurate measurements. Two hundred and ninety-three fractures were included. Traditional TAD and calTAD were significantly different in the failure group: 24.9 vs. 18.0 mm (p < 0.001) and 29.2 vs. 22.6 mm (p < 0.001) respectively. No other registered variable was significantly different. Multivariate analysis confirms traditional TAD (p = 0.003; OR = 1.10) and calTAD (p = 0.002; OR = 1.12) as independent risk factors for failure. DISCUSSION/CONCLUSION Both the traditional TAD and the new calTAD have shown to be relevant indexes and independently predictive of the likelihood of failure of pertrochanteric fracture fixation. Interestingly, we found the optimal threshold for the traditional TAD to be lower (<20 mm) than the traditional cutoff (<25 mm). Our study did not confirm calTAD to be superior to the traditional TAD. From the surgical practice point of view, the authors argue that the ideal position of the screw is the central region of the femoral head (minimal traditional TAD). In case of deviation, it must be infero-central in order to maintain a low calTAD thus minimizing the risk of fixation failure.
Collapse
Affiliation(s)
- Luís Lopes-Coutinho
- Resident of the Orthopaedics Department, Centro Hospitalar Universitário do Porto - Hospital de Santo António, Portugal.
| | - André Dias-Carvalho
- Resident of the Orthopaedics Department, Centro Hospitalar Universitário do Porto - Hospital de Santo António, Portugal
| | - Nuno Esteves
- Orthopaedic Surgeon, Hospital Santa Maria Maior, Barcelos, Portugal
| | - Ricardo Sousa
- Orthopaedic Surgeon, Centro Hospitalar Universitário do Porto - Hospital de Santo António, Portugal
| |
Collapse
|
309
|
Do current comorbidity indices accurately predict adverse events after operative fixation of hip fractures? A retrospective database review. CURRENT ORTHOPAEDIC PRACTICE 2020. [DOI: 10.1097/bco.0000000000000852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
310
|
Ferrara MC, Andreano A, Tassistro E, Rapazzini P, Zurlo A, Volpato S, Mussi C, Corsi M, Lunardelli ML, Martini E, Castoldi G, De Filippi F, Pizzonia M, Monacelli F, Barone A, Pilotto A, March A, Ungar A, Capelli R, Galmarini V, Franzoni S, Terragnoli F, Bianchetti A, Cazzulani I, Gandossi C, Valsecchi MG, Bellelli G. Three-year National report from the Gruppo Italiano di Ortogeriatria (GIOG) in the management of hip-fractured patients. Aging Clin Exp Res 2020; 32:1245-1253. [PMID: 32026420 DOI: 10.1007/s40520-020-01488-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 01/17/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Hip fractures (HF) are a major issue worldwide. We aimed at evaluating the practices in delivering care to patients with HF among several Italian Orthogeriatric centers. METHODS The study took place from February 2016 to July 2018. Seven performance indicators (pre-surgical cognitive assessment, surgery performed ≤ 48 h from fracture, removal of urinary catheter/absence of delirium/start of physiotherapy on the first post-operative day, prescription of bone protection at discharge, and discharge toward rehabilitation) were collected. RESULTS The 14 participating hospitals totally recruited 3.017 patients. Patients were old (median age 86 years; Inter Quartile Range [IQR] 80-90), mostly females (77%). Nearly 55% of them were already impaired in mobility and about 10% were nursing home residents. Median time-to-surgery was 41 h (IQR 23-62). Models of care greatly varied among centers, only 49.3% of patients being co-managed by geriatricians and orthopedics. There was high variability across centers in four indicators ("pre-surgical cognitive assessment", "bone protection prescription", "use of urinary catheter" and "start of physiotherapy"), moderate in two indicators ("surgery performed ≤ 48 h from fracture" and "discharge toward rehabilitation" and low in one ("absence of delirium on day following surgery"). Comparison with international studies suggests very different ways of providing care to HF Italian patients. CONCLUSIONS The study results suggest high inter-center variability in the key-performance indicators, and different approaches in providing care to our HF patients in comparison to other countries. A National debate on the topic is required in Italy to harmonize practices of orthogeriatric care.
Collapse
|
311
|
Agarwalla A, Liu JN, Gowd AK, Amin NH, Werner BC. Differential Use of Narcotics in Total Hip Arthroplasty: A Comparative Matched Analysis Between Osteoarthritis and Femoral Neck Fracture. J Arthroplasty 2020; 35:471-476. [PMID: 31564525 DOI: 10.1016/j.arth.2019.09.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 08/21/2019] [Accepted: 09/05/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The United States is currently in an opioid epidemic as it consumes the majority of narcotic medications. The purpose of this investigation is to identify the incidence and risk factors for prolonged opioid usage following total hip arthroplasty (THA) due to hip fracture (Fx) or osteoarthritis (OA). METHODS The PearlDiver database was reviewed for patients undergoing THA from 2007 through the first quarter of 2017. Following a 3:1 match based on comorbidities and demographics, patients were divided into THA due to Fx (n = 1801) or OA (n = 5403). Preoperative and prolonged postoperative narcotic users were identified. Multivariate logistic regression analysis was performed to identify demographics, comorbidities, or diagnoses as risk factors for prolonged opioid use and preoperative and postoperative opioid use as risk factors for complications. RESULTS One thousand seven hundred ninety-four OA patients (33.2%) were prescribed narcotics preoperatively and 1655 patients (30.6%) were using narcotics postoperatively, while 418 Fx patients (23.2%) were prescribed narcotics preoperatively and 499 patients (27.7%) were using narcotics postoperatively. Diagnosis of Fx (odds ratio [OR] 1.51, 95% confidence interval [CI] 1.28-1.72, P < .001) and preoperative narcotic use (OR 6.12, 95% CI 5.27-6.82, P < .001) were the most significant risk factors for prolonged postoperative narcotic use. Prolonged postoperative narcotic use was associated with increased infection, dislocation, and revision THA in both Fx and OA groups. CONCLUSION Diagnosis of femoral neck fracture and overall preoperative narcotic use were significant predictors of chronic postoperative opioid use. Patients with significant risk factors for opioid dependence should receive additional consultation and more prudent follow-up with regards to pain management. LEVEL OF EVIDENCE Therapeutic, Level III.
Collapse
Affiliation(s)
- Avinesh Agarwalla
- Department of Orthopaedic Surgery, Westchester Medical Center, Valhalla, NY
| | - Joseph N Liu
- Department of Orthopaedic Surgery, Loma Linda University Medical Center, Loma Linda, CA
| | - Anirudh K Gowd
- Department of Orthopaedic Surgery, Wake Forest University Baptist Medical Center, Winston-Salem, NC
| | - Nirav H Amin
- Department of Orthopaedic Surgery, Loma Linda University Medical Center, Loma Linda, CA
| | - Brian C Werner
- Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, VA
| |
Collapse
|
312
|
Rehabilitation protocols in unstable trochanteric fractures treated with cephalomedullary nails in elderly: current practices and outcome. Eur J Trauma Emerg Surg 2020; 46:1267-1280. [PMID: 31900496 DOI: 10.1007/s00068-019-01294-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 12/23/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Optimal rehabilitation treatment after surgery for fixation of unstable trochanteric fractures is challenging in elderly patients. PURPOSE The objective of this study is to analyse the existing literature on available rehabilitation protocols with regards to permitting or restricting early weight bearing following fixation of unstable trochanteric fractures treated by the use of cephalomedullary nails in patients at least 65 years of age. METHODS A systematic review was performed based on the checklist of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Studies published between 1948 and 2018 on elderly patients with unstable trochanteric fractures treated with cephalomedullary nails that offered information on the postoperative rehabilitation protocol have been selected. Subsequently, the results and complications have been analysed according to the protocols. RESULTS Fifteen of the 7056 initial articles have been selected for analysis. Authors who did not restrict weight bearing to their patients reported a shorter hospitalization time and a lower orthopaedic complication rate but a greater systemic complication rate, worse functional scores, and a higher reoperation and mortality rates. Those results should be taken with caution because of the heterogeneity of provided clinical information and the fact that none of the included studies considered the different rehabilitation protocols as study variables to analyse its influence on the results. CONCLUSION With evidence available to date, there is no clear agreement on the postoperative rehabilitation protocol following fixation of an unstable trochanteric fracture by cephalomedullary nail in the elderly.
Collapse
|
313
|
|
314
|
Wang XD, Lan H, Hu ZX, Li KN, Wang ZH, Luo J, Long XD. SuperPATH Minimally Invasive Approach to Total Hip Arthroplasty of Femoral Neck Fractures in the Elderly: Preliminary Clinical Results. Orthop Surg 2019; 12:74-85. [PMID: 31885193 PMCID: PMC7031608 DOI: 10.1111/os.12584] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 10/31/2019] [Accepted: 11/06/2019] [Indexed: 11/30/2022] Open
Abstract
Objective To investigate the clinical efficacy and advantages of the SuperPATH minimally invasive approach to total hip arthroplasty in the treatment of femoral neck fractures in the elderly. Methods From January 2016 to September 2018, 110 cases of elderly patients with femoral neck fractures were included in the present study. According to the method of operation, the patients were divided into two groups for comparison. There were 55 cases of the SuperPATH minimally invasive approach to total hip arthroplasty and 55 cases with the conventional posterolateral approach to total hip arthroplasty. The operation time, the length of incision, the amount of operative blood loss, the hospitalization time, and the hospitalization cost were compared between the two groups. The position of total hip prosthesis was observed during the follow‐up period. All patients were evaluated for the degree of hip joint pain and the function of the hip joint using the visual analog score (VAS) and the Harris score at 1 week, 1 month, 3 months, 6 months, and 12 months after the operation. Results All patients were followed up for at least 12 months. The operation time was 108.58 ± 15.87 min in the SuperPATH group and 102.51 ± 19.61 min in the conventional group. The length of incision was 6.65 ± 1.53 cm in the SuperPATH group and 17.08 ± 1.40 cm in the conventional group. The amount of operative blood loss was 147.51 ± 28.84 mL in the SuperPATH group and 170.22 ± 25.34 mL in the conventional group. The hospitalization time was 10.05 ± 2.52 days in the SuperPATH group and 13.36 ± 3.39 days in the conventional group. The hospitalization cost was 6871.78 ± 141.63 dollars in the SuperPATH group and 7791.09 ± 184.88 dollars in the conventional group. Compared with the conventional group, the SuperPATH group had shorter incision length, less blood loss, shorter hospitalization time, and lower hospitalization cost. There was significant difference between the two groups (P < 0.05). In the two groups, there were no complications such as infection, lower extremity venous thrombosis, prosthesis loosening, periprosthetic fracture, and dislocation during the follow‐up period. The VAS score was 4.45 ± 0.94 in the SuperPATH group and 4.89 ± 0.79 in the conventional group at 1 week after the operation. There was significant difference between the two groups (P < 0.05). The Harris score was 75.36 ± 3.36 and 80.25 ± 3.09 in the SuperPATH group and 68.80 ± 3.25 and 77.35 ± 3.77 in the conventional group at 1 week and 1 month after the operation, respectively. There was significant difference between the two groups (P < 0.05). In the analysis of the operation time, the VAS score at 1 month, 3 months, 6 months, and 12 months after the operation, and the Harris score at 3 months, 6 months, and 12 months after surgery, there was no significant difference between the two groups (P > 0.05). Conclusion The SuperPATH minimally invasive approach to total hip arthroplasty is an ideal method for the treatment of femoral neck fractures in the elderly. This method has the advantages of the relatively simple operation, short incision, less blood loss, and less trauma. The patients had short hospitalization times, low hospitalization costs, and good recovery of hip joint function.
Collapse
Affiliation(s)
- Xiao-Dong Wang
- Zunyi Medical University, Zunyi, China.,Department of Orthopaedics, Affiliated Hospital of Chengdu University, Chengdu, China
| | - Hai Lan
- Department of Orthopaedics, Affiliated Hospital of Chengdu University, Chengdu, China
| | - Zheng-Xia Hu
- Department of Orthopaedics, Affiliated Hospital of Chengdu University, Chengdu, China
| | - Kai-Nan Li
- Department of Orthopaedics, Affiliated Hospital of Chengdu University, Chengdu, China
| | - Zheng-Hao Wang
- Zunyi Medical University, Zunyi, China.,Department of Orthopaedics, Affiliated Hospital of Chengdu University, Chengdu, China
| | - Jin Luo
- Zunyi Medical University, Zunyi, China.,Department of Orthopaedics, Affiliated Hospital of Chengdu University, Chengdu, China
| | - Xu-Dong Long
- Zunyi Medical University, Zunyi, China.,Department of Orthopaedics, Affiliated Hospital of Chengdu University, Chengdu, China
| |
Collapse
|
315
|
Alcântara ACS, Assis I, Prada D, Mehle K, Schwan S, Costa-Paiva L, Skaf MS, Wrobel LC, Sollero P. Patient-Specific Bone Multiscale Modelling, Fracture Simulation and Risk Analysis-A Survey. MATERIALS (BASEL, SWITZERLAND) 2019; 13:E106. [PMID: 31878356 PMCID: PMC6981613 DOI: 10.3390/ma13010106] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 12/16/2019] [Accepted: 12/17/2019] [Indexed: 12/26/2022]
Abstract
This paper provides a starting point for researchers and practitioners from biology, medicine, physics and engineering who can benefit from an up-to-date literature survey on patient-specific bone fracture modelling, simulation and risk analysis. This survey hints at a framework for devising realistic patient-specific bone fracture simulations. This paper has 18 sections: Section 1 presents the main interested parties; Section 2 explains the organzation of the text; Section 3 motivates further work on patient-specific bone fracture simulation; Section 4 motivates this survey; Section 5 concerns the collection of bibliographical references; Section 6 motivates the physico-mathematical approach to bone fracture; Section 7 presents the modelling of bone as a continuum; Section 8 categorizes the surveyed literature into a continuum mechanics framework; Section 9 concerns the computational modelling of bone geometry; Section 10 concerns the estimation of bone mechanical properties; Section 11 concerns the selection of boundary conditions representative of bone trauma; Section 12 concerns bone fracture simulation; Section 13 presents the multiscale structure of bone; Section 14 concerns the multiscale mathematical modelling of bone; Section 15 concerns the experimental validation of bone fracture simulations; Section 16 concerns bone fracture risk assessment. Lastly, glossaries for symbols, acronyms, and physico-mathematical terms are provided.
Collapse
Affiliation(s)
- Amadeus C. S. Alcântara
- Department of Computational Mechanics, School of Mechanical Engineering, University of Campinas—UNICAMP, Campinas, Sao Paulo 13083-860, Brazil; (A.C.S.A.); (D.P.)
| | - Israel Assis
- Department of Integrated Systems, School of Mechanical Engineering, University of Campinas—UNICAMP, Campinas, Sao Paulo 13083-860, Brazil;
| | - Daniel Prada
- Department of Computational Mechanics, School of Mechanical Engineering, University of Campinas—UNICAMP, Campinas, Sao Paulo 13083-860, Brazil; (A.C.S.A.); (D.P.)
| | - Konrad Mehle
- Department of Engineering and Natural Sciences, University of Applied Sciences Merseburg, 06217 Merseburg, Germany;
| | - Stefan Schwan
- Fraunhofer Institute for Microstructure of Materials and Systems IMWS, 06120 Halle/Saale, Germany;
| | - Lúcia Costa-Paiva
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas—UNICAMP, Campinas, Sao Paulo 13083-887, Brazil;
| | - Munir S. Skaf
- Institute of Chemistry and Center for Computing in Engineering and Sciences, University of Campinas—UNICAMP, Campinas, Sao Paulo 13083-860, Brazil;
| | - Luiz C. Wrobel
- Institute of Materials and Manufacturing, Brunel University London, Uxbridge UB8 3PH, UK;
- Department of Civil and Environmental Engineering, Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro 22451-900, Brazil
| | - Paulo Sollero
- Department of Computational Mechanics, School of Mechanical Engineering, University of Campinas—UNICAMP, Campinas, Sao Paulo 13083-860, Brazil; (A.C.S.A.); (D.P.)
| |
Collapse
|
316
|
Chen J, Ma JX, Wang Y, Bai HH, Sun L, Wang Y, Lu B, Dong BC, Tian AX, Ma XL. Finite element analysis of two cephalomedullary nails in treatment of elderly reverse obliquity intertrochanteric fractures: zimmer natural nail and proximal femoral nail antirotation-ΙΙ. J Orthop Surg Res 2019; 14:422. [PMID: 31823801 PMCID: PMC6902592 DOI: 10.1186/s13018-019-1468-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 11/12/2019] [Indexed: 11/10/2022] Open
Abstract
Background More elderly patients are suffering from intertrochanteric fractures. However, the choice of internal fixation is still controversial, especially in the treatment of unstable intertrochanteric fracture; thus, previous implants continue to be improved, and new ones are being developed. The purpose of our study was to compare the biomechanical advantages between the zimmer natural nail (ZNN) and proximal femoral nail antirotation-II (PFNA-II) in the treatment of elderly reverse obliquity intertrochanteric fractures. Methods A three-dimensional finite element was applied for reverse obliquity intertrochanteric fracture models (AO31-A3.1) fixed with the ZNN or PFNA-II. The distribution, peak value and position of the von Mises stress and the displacement were the criteria for comparison between the two groups. Results The stresses of the internal fixation and femur in the ZNN model were smaller than those in the PFNA-II model, and the peak values of the two groups were 364.8 MPa and 171.8 MPa (ZNN) and 832.3 MPa and 1795.0 MPa (PFNA-II). The maximum amount of displacement of the two groups was similar, and their locations were the same, i.e., in the femoral head vertex (3.768 mm in the ZNN model and 3.713 mm in the PFNA-II model). Conclusions The displacement in the two models was similar, but the stresses in the implant and bone were reduced with the ZNN. Therefore, the ZNN implant may provide biomechanical advantages over PFNA-II in reverse obliquity intertrochanteric fractures, as shown through the finite element analysis. These findings from our study may provide a reference for the perioperative selection of internal fixations.
Collapse
Affiliation(s)
- Jian Chen
- Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin, 300052, People's Republic of China
| | - Jian-Xiong Ma
- Institute of Orthopedics, Tianjin Hospital, Tianjin University, Tianjin, 300050, People's Republic of China
| | - Ying Wang
- Institute of Orthopedics, Tianjin Hospital, Tianjin University, Tianjin, 300050, People's Republic of China
| | - Hao-Hao Bai
- Institute of Orthopedics, Tianjin Hospital, Tianjin University, Tianjin, 300050, People's Republic of China
| | - Lei Sun
- Institute of Orthopedics, Tianjin Hospital, Tianjin University, Tianjin, 300050, People's Republic of China
| | - Yan Wang
- Institute of Orthopedics, Tianjin Hospital, Tianjin University, Tianjin, 300050, People's Republic of China
| | - Bin Lu
- Institute of Orthopedics, Tianjin Hospital, Tianjin University, Tianjin, 300050, People's Republic of China
| | - Ben-Chao Dong
- Institute of Orthopedics, Tianjin Hospital, Tianjin University, Tianjin, 300050, People's Republic of China
| | - Ai-Xian Tian
- Institute of Orthopedics, Tianjin Hospital, Tianjin University, Tianjin, 300050, People's Republic of China
| | - Xin-Long Ma
- Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin, 300052, People's Republic of China.
| |
Collapse
|
317
|
Schuijt HJ, Bos J, Smeeing DPJ, Geraghty O, van der Velde D. Predictors of 30-day mortality in orthogeriatric fracture patients aged 85 years or above admitted from the emergency department. Eur J Trauma Emerg Surg 2019; 47:817-823. [PMID: 31802136 PMCID: PMC8187176 DOI: 10.1007/s00068-019-01278-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 11/26/2019] [Indexed: 11/26/2022]
Abstract
Purpose Orthogeriatric trauma patients are at risk for functional decline and mortality. It is important to identify high-risk patients in an early stage, to improve outcomes and make better informed treatment decisions. The aim of this study was to identify independent risk factors for 30-day mortality in patients aged 85 years or above admitted from the emergency department with a fracture. Methods All orthopaedic trauma patients 85 years or above admitted from the emergency department were included. After a 30-day follow-up, mortality was determined by consulting the patient records. Multivariable logistics regression analysis generated odd ratios for mortality risk factors. A subgroup analysis was performed for patients undergoing hip fracture surgery. Results The 30-day mortality in geriatric fracture patients admitted to the hospital was 12%. Risk factors for 30-day mortality were: increased age, male sex, decreased hemoglobin levels, living in an institutional care facility and a decreased BMI. For geriatric patients undergoing hip fracture surgery 30-day mortality was 11%. Independent risk factors for this group were: increased age, male sex, and a decreased BMI. Conclusion Orthopaedic trauma patients aged 85 years or above who are admitted to the hospital with a fracture are at high risk for mortality. This study identified older age, male sex, and decreased BMI as predictors of 30-day mortality in admitted geriatric fracture patients and in geriatric hip fracture patients undergoing surgery.
Collapse
Affiliation(s)
- Henk Jan Schuijt
- Department of Surgery, Sint Antonius Hospital, Nieuwegein, Postbus 2500, 3430 EM, Utrecht, The Netherlands.
- Department of Surgery, University Medical Center, Utrecht, The Netherlands.
| | - Jelle Bos
- Department of Surgery, Sint Antonius Hospital, Nieuwegein, Postbus 2500, 3430 EM, Utrecht, The Netherlands
| | | | - Olivia Geraghty
- Department of Internal Medicine and Geriatrics, Sint Antonius Hospital, Utrecht, The Netherlands
| | - Detlef van der Velde
- Department of Surgery, Sint Antonius Hospital, Nieuwegein, Postbus 2500, 3430 EM, Utrecht, The Netherlands
| |
Collapse
|
318
|
Bhandari M, Einhorn TA, Guyatt G, Schemitsch EH, Zura RD, Sprague S, Frihagen F, Guerra-Farfán E, Kleinlugtenbelt YV, Poolman RW, Rangan A, Bzovsky S, Heels-Ansdell D, Thabane L, Walter SD, Devereaux PJ. Total Hip Arthroplasty or Hemiarthroplasty for Hip Fracture. N Engl J Med 2019; 381:2199-2208. [PMID: 31557429 DOI: 10.1056/nejmoa1906190] [Citation(s) in RCA: 237] [Impact Index Per Article: 47.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Globally, hip fractures are among the top 10 causes of disability in adults. For displaced femoral neck fractures, there remains uncertainty regarding the effect of a total hip arthroplasty as compared with hemiarthroplasty. METHODS We randomly assigned 1495 patients who were 50 years of age or older and had a displaced femoral neck fracture to undergo either total hip arthroplasty or hemiarthroplasty. All enrolled patients had been able to ambulate without the assistance of another person before the fracture occurred. The trial was conducted in 80 centers in 10 countries. The primary end point was a secondary hip procedure within 24 months of follow-up. Secondary end points included death, serious adverse events, hip-related complications, health-related quality of life, function, and overall health end points. RESULTS The primary end point occurred in 57 of 718 patients (7.9%) who were randomly assigned to total hip arthroplasty and 60 of 723 patients (8.3%) who were randomly assigned to hemiarthroplasty (hazard ratio, 0.95; 95% confidence interval [CI], 0.64 to 1.40; P = 0.79). Hip instability or dislocation occurred in 34 patients (4.7%) assigned to total hip arthroplasty and 17 patients (2.4%) assigned to hemiarthroplasty (hazard ratio, 2.00; 99% CI, 0.97 to 4.09). Function, as measured with the total Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) total score, pain score, stiffness score, and function score, modestly favored total hip arthroplasty over hemiarthroplasty. Mortality was similar in the two treatment groups (14.3% among the patients assigned to total hip arthroplasty and 13.1% among those assigned to hemiarthroplasty, P = 0.48). Serious adverse events occurred in 300 patients (41.8%) assigned to total hip arthroplasty and in 265 patients (36.7%) assigned to hemiarthroplasty. CONCLUSIONS Among independently ambulating patients with displaced femoral neck fractures, the incidence of secondary procedures did not differ significantly between patients who were randomly assigned to undergo total hip arthroplasty and those who were assigned to undergo hemiarthroplasty, and total hip arthroplasty provided a clinically unimportant improvement over hemiarthroplasty in function and quality of life over 24 months. (Funded by the Canadian Institutes of Health Research and others; ClinicalTrials.gov number, NCT00556842.).
Collapse
Affiliation(s)
- Mohit Bhandari
- The affiliations of the members of the writing committee are as follows: the Division of Orthopaedic Surgery, Department of Surgery (M.B., S.S., S.B.), the Department of Health Research Methods, Evidence, and Impact (M.B., G.G., S.S., D.H.-A., L.T., S.D.W., P.J.D.), the Department of Medicine (G.G., P.J.D.), and the Population Health Research Institute (P.J.D.), McMaster University, Hamilton, and the Department of Surgery, University of Western Ontario, London (E.H.S.) - all in Ontario, Canada; the Department of Orthopedic Surgery, New York University Langone Medical Center, New York (T.A.E.); the Department of Orthopedic Surgery, Louisiana State University Health Sciences Center, New Orleans (R.D.Z.); the Division of Orthopedic Surgery, Oslo University Hospital, Oslo (F.F.); the Department of Traumatology, Orthopedic Surgery, and Emergency, Hospital Vall d'Hebrón, Barcelona (E.G.-F.); the Department of Orthopedic and Trauma Surgery, Deventer Ziekenhuis, Deventer (Y.V.K.), and the Department of Orthopedic Surgery, OLVG, Amsterdam (R.W.P.) - both in the Netherlands; and the Department of Orthopaedic Surgery, James Cook University Hospital, Middlesbrough, the Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, and the Department of Health Sciences, University of York, York - all in the United Kingdom (A.R.)
| | - Thomas A Einhorn
- The affiliations of the members of the writing committee are as follows: the Division of Orthopaedic Surgery, Department of Surgery (M.B., S.S., S.B.), the Department of Health Research Methods, Evidence, and Impact (M.B., G.G., S.S., D.H.-A., L.T., S.D.W., P.J.D.), the Department of Medicine (G.G., P.J.D.), and the Population Health Research Institute (P.J.D.), McMaster University, Hamilton, and the Department of Surgery, University of Western Ontario, London (E.H.S.) - all in Ontario, Canada; the Department of Orthopedic Surgery, New York University Langone Medical Center, New York (T.A.E.); the Department of Orthopedic Surgery, Louisiana State University Health Sciences Center, New Orleans (R.D.Z.); the Division of Orthopedic Surgery, Oslo University Hospital, Oslo (F.F.); the Department of Traumatology, Orthopedic Surgery, and Emergency, Hospital Vall d'Hebrón, Barcelona (E.G.-F.); the Department of Orthopedic and Trauma Surgery, Deventer Ziekenhuis, Deventer (Y.V.K.), and the Department of Orthopedic Surgery, OLVG, Amsterdam (R.W.P.) - both in the Netherlands; and the Department of Orthopaedic Surgery, James Cook University Hospital, Middlesbrough, the Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, and the Department of Health Sciences, University of York, York - all in the United Kingdom (A.R.)
| | - Gordon Guyatt
- The affiliations of the members of the writing committee are as follows: the Division of Orthopaedic Surgery, Department of Surgery (M.B., S.S., S.B.), the Department of Health Research Methods, Evidence, and Impact (M.B., G.G., S.S., D.H.-A., L.T., S.D.W., P.J.D.), the Department of Medicine (G.G., P.J.D.), and the Population Health Research Institute (P.J.D.), McMaster University, Hamilton, and the Department of Surgery, University of Western Ontario, London (E.H.S.) - all in Ontario, Canada; the Department of Orthopedic Surgery, New York University Langone Medical Center, New York (T.A.E.); the Department of Orthopedic Surgery, Louisiana State University Health Sciences Center, New Orleans (R.D.Z.); the Division of Orthopedic Surgery, Oslo University Hospital, Oslo (F.F.); the Department of Traumatology, Orthopedic Surgery, and Emergency, Hospital Vall d'Hebrón, Barcelona (E.G.-F.); the Department of Orthopedic and Trauma Surgery, Deventer Ziekenhuis, Deventer (Y.V.K.), and the Department of Orthopedic Surgery, OLVG, Amsterdam (R.W.P.) - both in the Netherlands; and the Department of Orthopaedic Surgery, James Cook University Hospital, Middlesbrough, the Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, and the Department of Health Sciences, University of York, York - all in the United Kingdom (A.R.)
| | - Emil H Schemitsch
- The affiliations of the members of the writing committee are as follows: the Division of Orthopaedic Surgery, Department of Surgery (M.B., S.S., S.B.), the Department of Health Research Methods, Evidence, and Impact (M.B., G.G., S.S., D.H.-A., L.T., S.D.W., P.J.D.), the Department of Medicine (G.G., P.J.D.), and the Population Health Research Institute (P.J.D.), McMaster University, Hamilton, and the Department of Surgery, University of Western Ontario, London (E.H.S.) - all in Ontario, Canada; the Department of Orthopedic Surgery, New York University Langone Medical Center, New York (T.A.E.); the Department of Orthopedic Surgery, Louisiana State University Health Sciences Center, New Orleans (R.D.Z.); the Division of Orthopedic Surgery, Oslo University Hospital, Oslo (F.F.); the Department of Traumatology, Orthopedic Surgery, and Emergency, Hospital Vall d'Hebrón, Barcelona (E.G.-F.); the Department of Orthopedic and Trauma Surgery, Deventer Ziekenhuis, Deventer (Y.V.K.), and the Department of Orthopedic Surgery, OLVG, Amsterdam (R.W.P.) - both in the Netherlands; and the Department of Orthopaedic Surgery, James Cook University Hospital, Middlesbrough, the Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, and the Department of Health Sciences, University of York, York - all in the United Kingdom (A.R.)
| | - Robert D Zura
- The affiliations of the members of the writing committee are as follows: the Division of Orthopaedic Surgery, Department of Surgery (M.B., S.S., S.B.), the Department of Health Research Methods, Evidence, and Impact (M.B., G.G., S.S., D.H.-A., L.T., S.D.W., P.J.D.), the Department of Medicine (G.G., P.J.D.), and the Population Health Research Institute (P.J.D.), McMaster University, Hamilton, and the Department of Surgery, University of Western Ontario, London (E.H.S.) - all in Ontario, Canada; the Department of Orthopedic Surgery, New York University Langone Medical Center, New York (T.A.E.); the Department of Orthopedic Surgery, Louisiana State University Health Sciences Center, New Orleans (R.D.Z.); the Division of Orthopedic Surgery, Oslo University Hospital, Oslo (F.F.); the Department of Traumatology, Orthopedic Surgery, and Emergency, Hospital Vall d'Hebrón, Barcelona (E.G.-F.); the Department of Orthopedic and Trauma Surgery, Deventer Ziekenhuis, Deventer (Y.V.K.), and the Department of Orthopedic Surgery, OLVG, Amsterdam (R.W.P.) - both in the Netherlands; and the Department of Orthopaedic Surgery, James Cook University Hospital, Middlesbrough, the Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, and the Department of Health Sciences, University of York, York - all in the United Kingdom (A.R.)
| | - Sheila Sprague
- The affiliations of the members of the writing committee are as follows: the Division of Orthopaedic Surgery, Department of Surgery (M.B., S.S., S.B.), the Department of Health Research Methods, Evidence, and Impact (M.B., G.G., S.S., D.H.-A., L.T., S.D.W., P.J.D.), the Department of Medicine (G.G., P.J.D.), and the Population Health Research Institute (P.J.D.), McMaster University, Hamilton, and the Department of Surgery, University of Western Ontario, London (E.H.S.) - all in Ontario, Canada; the Department of Orthopedic Surgery, New York University Langone Medical Center, New York (T.A.E.); the Department of Orthopedic Surgery, Louisiana State University Health Sciences Center, New Orleans (R.D.Z.); the Division of Orthopedic Surgery, Oslo University Hospital, Oslo (F.F.); the Department of Traumatology, Orthopedic Surgery, and Emergency, Hospital Vall d'Hebrón, Barcelona (E.G.-F.); the Department of Orthopedic and Trauma Surgery, Deventer Ziekenhuis, Deventer (Y.V.K.), and the Department of Orthopedic Surgery, OLVG, Amsterdam (R.W.P.) - both in the Netherlands; and the Department of Orthopaedic Surgery, James Cook University Hospital, Middlesbrough, the Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, and the Department of Health Sciences, University of York, York - all in the United Kingdom (A.R.)
| | - Frede Frihagen
- The affiliations of the members of the writing committee are as follows: the Division of Orthopaedic Surgery, Department of Surgery (M.B., S.S., S.B.), the Department of Health Research Methods, Evidence, and Impact (M.B., G.G., S.S., D.H.-A., L.T., S.D.W., P.J.D.), the Department of Medicine (G.G., P.J.D.), and the Population Health Research Institute (P.J.D.), McMaster University, Hamilton, and the Department of Surgery, University of Western Ontario, London (E.H.S.) - all in Ontario, Canada; the Department of Orthopedic Surgery, New York University Langone Medical Center, New York (T.A.E.); the Department of Orthopedic Surgery, Louisiana State University Health Sciences Center, New Orleans (R.D.Z.); the Division of Orthopedic Surgery, Oslo University Hospital, Oslo (F.F.); the Department of Traumatology, Orthopedic Surgery, and Emergency, Hospital Vall d'Hebrón, Barcelona (E.G.-F.); the Department of Orthopedic and Trauma Surgery, Deventer Ziekenhuis, Deventer (Y.V.K.), and the Department of Orthopedic Surgery, OLVG, Amsterdam (R.W.P.) - both in the Netherlands; and the Department of Orthopaedic Surgery, James Cook University Hospital, Middlesbrough, the Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, and the Department of Health Sciences, University of York, York - all in the United Kingdom (A.R.)
| | - Ernesto Guerra-Farfán
- The affiliations of the members of the writing committee are as follows: the Division of Orthopaedic Surgery, Department of Surgery (M.B., S.S., S.B.), the Department of Health Research Methods, Evidence, and Impact (M.B., G.G., S.S., D.H.-A., L.T., S.D.W., P.J.D.), the Department of Medicine (G.G., P.J.D.), and the Population Health Research Institute (P.J.D.), McMaster University, Hamilton, and the Department of Surgery, University of Western Ontario, London (E.H.S.) - all in Ontario, Canada; the Department of Orthopedic Surgery, New York University Langone Medical Center, New York (T.A.E.); the Department of Orthopedic Surgery, Louisiana State University Health Sciences Center, New Orleans (R.D.Z.); the Division of Orthopedic Surgery, Oslo University Hospital, Oslo (F.F.); the Department of Traumatology, Orthopedic Surgery, and Emergency, Hospital Vall d'Hebrón, Barcelona (E.G.-F.); the Department of Orthopedic and Trauma Surgery, Deventer Ziekenhuis, Deventer (Y.V.K.), and the Department of Orthopedic Surgery, OLVG, Amsterdam (R.W.P.) - both in the Netherlands; and the Department of Orthopaedic Surgery, James Cook University Hospital, Middlesbrough, the Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, and the Department of Health Sciences, University of York, York - all in the United Kingdom (A.R.)
| | - Ydo V Kleinlugtenbelt
- The affiliations of the members of the writing committee are as follows: the Division of Orthopaedic Surgery, Department of Surgery (M.B., S.S., S.B.), the Department of Health Research Methods, Evidence, and Impact (M.B., G.G., S.S., D.H.-A., L.T., S.D.W., P.J.D.), the Department of Medicine (G.G., P.J.D.), and the Population Health Research Institute (P.J.D.), McMaster University, Hamilton, and the Department of Surgery, University of Western Ontario, London (E.H.S.) - all in Ontario, Canada; the Department of Orthopedic Surgery, New York University Langone Medical Center, New York (T.A.E.); the Department of Orthopedic Surgery, Louisiana State University Health Sciences Center, New Orleans (R.D.Z.); the Division of Orthopedic Surgery, Oslo University Hospital, Oslo (F.F.); the Department of Traumatology, Orthopedic Surgery, and Emergency, Hospital Vall d'Hebrón, Barcelona (E.G.-F.); the Department of Orthopedic and Trauma Surgery, Deventer Ziekenhuis, Deventer (Y.V.K.), and the Department of Orthopedic Surgery, OLVG, Amsterdam (R.W.P.) - both in the Netherlands; and the Department of Orthopaedic Surgery, James Cook University Hospital, Middlesbrough, the Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, and the Department of Health Sciences, University of York, York - all in the United Kingdom (A.R.)
| | - Rudolf W Poolman
- The affiliations of the members of the writing committee are as follows: the Division of Orthopaedic Surgery, Department of Surgery (M.B., S.S., S.B.), the Department of Health Research Methods, Evidence, and Impact (M.B., G.G., S.S., D.H.-A., L.T., S.D.W., P.J.D.), the Department of Medicine (G.G., P.J.D.), and the Population Health Research Institute (P.J.D.), McMaster University, Hamilton, and the Department of Surgery, University of Western Ontario, London (E.H.S.) - all in Ontario, Canada; the Department of Orthopedic Surgery, New York University Langone Medical Center, New York (T.A.E.); the Department of Orthopedic Surgery, Louisiana State University Health Sciences Center, New Orleans (R.D.Z.); the Division of Orthopedic Surgery, Oslo University Hospital, Oslo (F.F.); the Department of Traumatology, Orthopedic Surgery, and Emergency, Hospital Vall d'Hebrón, Barcelona (E.G.-F.); the Department of Orthopedic and Trauma Surgery, Deventer Ziekenhuis, Deventer (Y.V.K.), and the Department of Orthopedic Surgery, OLVG, Amsterdam (R.W.P.) - both in the Netherlands; and the Department of Orthopaedic Surgery, James Cook University Hospital, Middlesbrough, the Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, and the Department of Health Sciences, University of York, York - all in the United Kingdom (A.R.)
| | - Amar Rangan
- The affiliations of the members of the writing committee are as follows: the Division of Orthopaedic Surgery, Department of Surgery (M.B., S.S., S.B.), the Department of Health Research Methods, Evidence, and Impact (M.B., G.G., S.S., D.H.-A., L.T., S.D.W., P.J.D.), the Department of Medicine (G.G., P.J.D.), and the Population Health Research Institute (P.J.D.), McMaster University, Hamilton, and the Department of Surgery, University of Western Ontario, London (E.H.S.) - all in Ontario, Canada; the Department of Orthopedic Surgery, New York University Langone Medical Center, New York (T.A.E.); the Department of Orthopedic Surgery, Louisiana State University Health Sciences Center, New Orleans (R.D.Z.); the Division of Orthopedic Surgery, Oslo University Hospital, Oslo (F.F.); the Department of Traumatology, Orthopedic Surgery, and Emergency, Hospital Vall d'Hebrón, Barcelona (E.G.-F.); the Department of Orthopedic and Trauma Surgery, Deventer Ziekenhuis, Deventer (Y.V.K.), and the Department of Orthopedic Surgery, OLVG, Amsterdam (R.W.P.) - both in the Netherlands; and the Department of Orthopaedic Surgery, James Cook University Hospital, Middlesbrough, the Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, and the Department of Health Sciences, University of York, York - all in the United Kingdom (A.R.)
| | - Sofia Bzovsky
- The affiliations of the members of the writing committee are as follows: the Division of Orthopaedic Surgery, Department of Surgery (M.B., S.S., S.B.), the Department of Health Research Methods, Evidence, and Impact (M.B., G.G., S.S., D.H.-A., L.T., S.D.W., P.J.D.), the Department of Medicine (G.G., P.J.D.), and the Population Health Research Institute (P.J.D.), McMaster University, Hamilton, and the Department of Surgery, University of Western Ontario, London (E.H.S.) - all in Ontario, Canada; the Department of Orthopedic Surgery, New York University Langone Medical Center, New York (T.A.E.); the Department of Orthopedic Surgery, Louisiana State University Health Sciences Center, New Orleans (R.D.Z.); the Division of Orthopedic Surgery, Oslo University Hospital, Oslo (F.F.); the Department of Traumatology, Orthopedic Surgery, and Emergency, Hospital Vall d'Hebrón, Barcelona (E.G.-F.); the Department of Orthopedic and Trauma Surgery, Deventer Ziekenhuis, Deventer (Y.V.K.), and the Department of Orthopedic Surgery, OLVG, Amsterdam (R.W.P.) - both in the Netherlands; and the Department of Orthopaedic Surgery, James Cook University Hospital, Middlesbrough, the Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, and the Department of Health Sciences, University of York, York - all in the United Kingdom (A.R.)
| | - Diane Heels-Ansdell
- The affiliations of the members of the writing committee are as follows: the Division of Orthopaedic Surgery, Department of Surgery (M.B., S.S., S.B.), the Department of Health Research Methods, Evidence, and Impact (M.B., G.G., S.S., D.H.-A., L.T., S.D.W., P.J.D.), the Department of Medicine (G.G., P.J.D.), and the Population Health Research Institute (P.J.D.), McMaster University, Hamilton, and the Department of Surgery, University of Western Ontario, London (E.H.S.) - all in Ontario, Canada; the Department of Orthopedic Surgery, New York University Langone Medical Center, New York (T.A.E.); the Department of Orthopedic Surgery, Louisiana State University Health Sciences Center, New Orleans (R.D.Z.); the Division of Orthopedic Surgery, Oslo University Hospital, Oslo (F.F.); the Department of Traumatology, Orthopedic Surgery, and Emergency, Hospital Vall d'Hebrón, Barcelona (E.G.-F.); the Department of Orthopedic and Trauma Surgery, Deventer Ziekenhuis, Deventer (Y.V.K.), and the Department of Orthopedic Surgery, OLVG, Amsterdam (R.W.P.) - both in the Netherlands; and the Department of Orthopaedic Surgery, James Cook University Hospital, Middlesbrough, the Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, and the Department of Health Sciences, University of York, York - all in the United Kingdom (A.R.)
| | - Lehana Thabane
- The affiliations of the members of the writing committee are as follows: the Division of Orthopaedic Surgery, Department of Surgery (M.B., S.S., S.B.), the Department of Health Research Methods, Evidence, and Impact (M.B., G.G., S.S., D.H.-A., L.T., S.D.W., P.J.D.), the Department of Medicine (G.G., P.J.D.), and the Population Health Research Institute (P.J.D.), McMaster University, Hamilton, and the Department of Surgery, University of Western Ontario, London (E.H.S.) - all in Ontario, Canada; the Department of Orthopedic Surgery, New York University Langone Medical Center, New York (T.A.E.); the Department of Orthopedic Surgery, Louisiana State University Health Sciences Center, New Orleans (R.D.Z.); the Division of Orthopedic Surgery, Oslo University Hospital, Oslo (F.F.); the Department of Traumatology, Orthopedic Surgery, and Emergency, Hospital Vall d'Hebrón, Barcelona (E.G.-F.); the Department of Orthopedic and Trauma Surgery, Deventer Ziekenhuis, Deventer (Y.V.K.), and the Department of Orthopedic Surgery, OLVG, Amsterdam (R.W.P.) - both in the Netherlands; and the Department of Orthopaedic Surgery, James Cook University Hospital, Middlesbrough, the Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, and the Department of Health Sciences, University of York, York - all in the United Kingdom (A.R.)
| | - Stephen D Walter
- The affiliations of the members of the writing committee are as follows: the Division of Orthopaedic Surgery, Department of Surgery (M.B., S.S., S.B.), the Department of Health Research Methods, Evidence, and Impact (M.B., G.G., S.S., D.H.-A., L.T., S.D.W., P.J.D.), the Department of Medicine (G.G., P.J.D.), and the Population Health Research Institute (P.J.D.), McMaster University, Hamilton, and the Department of Surgery, University of Western Ontario, London (E.H.S.) - all in Ontario, Canada; the Department of Orthopedic Surgery, New York University Langone Medical Center, New York (T.A.E.); the Department of Orthopedic Surgery, Louisiana State University Health Sciences Center, New Orleans (R.D.Z.); the Division of Orthopedic Surgery, Oslo University Hospital, Oslo (F.F.); the Department of Traumatology, Orthopedic Surgery, and Emergency, Hospital Vall d'Hebrón, Barcelona (E.G.-F.); the Department of Orthopedic and Trauma Surgery, Deventer Ziekenhuis, Deventer (Y.V.K.), and the Department of Orthopedic Surgery, OLVG, Amsterdam (R.W.P.) - both in the Netherlands; and the Department of Orthopaedic Surgery, James Cook University Hospital, Middlesbrough, the Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, and the Department of Health Sciences, University of York, York - all in the United Kingdom (A.R.)
| | - P J Devereaux
- The affiliations of the members of the writing committee are as follows: the Division of Orthopaedic Surgery, Department of Surgery (M.B., S.S., S.B.), the Department of Health Research Methods, Evidence, and Impact (M.B., G.G., S.S., D.H.-A., L.T., S.D.W., P.J.D.), the Department of Medicine (G.G., P.J.D.), and the Population Health Research Institute (P.J.D.), McMaster University, Hamilton, and the Department of Surgery, University of Western Ontario, London (E.H.S.) - all in Ontario, Canada; the Department of Orthopedic Surgery, New York University Langone Medical Center, New York (T.A.E.); the Department of Orthopedic Surgery, Louisiana State University Health Sciences Center, New Orleans (R.D.Z.); the Division of Orthopedic Surgery, Oslo University Hospital, Oslo (F.F.); the Department of Traumatology, Orthopedic Surgery, and Emergency, Hospital Vall d'Hebrón, Barcelona (E.G.-F.); the Department of Orthopedic and Trauma Surgery, Deventer Ziekenhuis, Deventer (Y.V.K.), and the Department of Orthopedic Surgery, OLVG, Amsterdam (R.W.P.) - both in the Netherlands; and the Department of Orthopaedic Surgery, James Cook University Hospital, Middlesbrough, the Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, and the Department of Health Sciences, University of York, York - all in the United Kingdom (A.R.)
| |
Collapse
|
319
|
Mao W, Ni H, Li L, He Y, Chen X, Tang H, Dong Y. Comparison of Baumgaertner and Chang reduction quality criteria for the assessment of trochanteric fractures. Bone Joint Res 2019; 8:502-508. [PMID: 31728190 PMCID: PMC6825041 DOI: 10.1302/2046-3758.810.bjr-2019-0032.r1] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objectives Different criteria for assessing the reduction quality of trochanteric fractures have been reported. The Baumgaertner reduction quality criteria (BRQC) are relatively common and the Chang reduction quality criteria (CRQC) are relatively new. The objectives of the current study were to compare the reliability of the BRQC and CRQC in predicting mechanical complications and to investigate the clinical implications of the CRQC. Methods A total of 168 patients were assessed in a retrospective observational study. Clinical information including age, sex, fracture side, American Society of Anesthesiologists (ASA) classification, tip-apex distance (TAD), fracture classification, reduction quality, blade position, BRQC, CRQC, bone quality, and the occurrence of mechanical complications were used in the statistical analysis. Results A total of 127 patients were included in the full analysis, and mechanical complications were observed in 26 patients. The TAD, blade position, BRQC and CRQC were significantly associated with mechanical complications in the univariate analysis. Only the TAD (p = 0.025) and the CRQC (p < 0.001) showed significant results in the multivariate analysis. In the comparison of the receiver operating characteristic curves, the CRQC also performed better than the BRQC. Conclusion The CRQC are reliable in predicting mechanical complications and are more reliable than the BRQC. Future studies could use the CRQC to assess fracture reduction quality. Intraoperatively, the surgeon should refer to the CRQC to achieve good reduction in trochanteric fractures. Cite this article: Bone Joint Res 2019;8:502–508.
Collapse
Affiliation(s)
- Wei Mao
- Department of Orthopaedics, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, China
| | - Haofei Ni
- Department of Orthopaedics, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, China
| | - Linli Li
- Department of Orthopaedics, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, China
| | - Yiqun He
- Department of Orthopaedics, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, China
| | - Xujun Chen
- Department of Orthopaedics, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, China
| | - Han Tang
- Department of Orthopaedics, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, China
| | - Youhai Dong
- Department of Orthopaedics, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, China
| |
Collapse
|
320
|
Li J, Yin P, Zhang L, Chen H, Tang P. Medial anatomical buttress plate in treating displaced femoral neck fracture a finite element analysis. Injury 2019; 50:1895-1900. [PMID: 31455504 DOI: 10.1016/j.injury.2019.08.024] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 08/17/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Displaced femoral neck fractures in young adults are most likely to result from high energy trauma that causes a vertically-oriented shearing injury through the femoral neck. The optimal strategy for treatment of displaced femoral neck fractures remains an unsolved challenge in orthopedic surgery. METHODS our group has previously designed a medial anatomical buttress plate (MABP) based on the analysis of the computed tomography (CT) data of anatomical structures derived from a large sample population. In this study, finite element analyses (FEA) were carried out to compare the outcomes of the combination of our MABP with cannulated screws to those of the combination of tubular plate with cannulated screws, and to those of using cannulated screws alone. RESULTS MABP resulted in a more stable fixation as compared to the other two approaches, with respect to the femur and the stress distributions, stress peaks, and Z axis displacements. CONCLUSIONS The FEA encouraged us that addition of a medial buttress plate not only achieved superior medial buttress stability but also achieves superior performance because it perfectly fits with the existing anatomic structure of medial femoral neck. The results from our study may provide references for clinical decision making in dealing with such patients.
Collapse
Affiliation(s)
- Jia Li
- Department of Orthopedics, Chinese PLA General Hospital, Beijing 100853, China.
| | - Pengbin Yin
- Department of Orthopedics, Chinese PLA General Hospital, Beijing 100853, China.
| | - Licheng Zhang
- Department of Orthopedics, Chinese PLA General Hospital, Beijing 100853, China.
| | - Hua Chen
- Department of Orthopedics, Chinese PLA General Hospital, Beijing 100853, China.
| | - Peifu Tang
- Department of Orthopedics, Chinese PLA General Hospital, Beijing 100853, China.
| |
Collapse
|
321
|
Chen W, Wang B, Bai X, Gao H, Liu Z, Li Y, Zhao L. [Analysis of perioperative blood loss by fast track protocol in cephalomedullary nailing for geriatric intertrochanteric fractures]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2019; 33:1265-1269. [PMID: 31544437 PMCID: PMC8337631 DOI: 10.7507/1002-1892.201904143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 07/27/2019] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To analyze the effectiveness of fast track protocol of geriatric intertrochanteric fracture on operative waiting time, operation time, perioperative blood loss, providing data support for clinical therapy. METHODS The clinical data of 240 elderly patients with intertrochanteric fracture admitted between January 2015 and December 2018 were retrospectively analyzed. They were divided into traditional protocol group (148 cases, group A) and fast track group (92 cases, group B). All patients were treated with closed reduction intramedullary nail (proximal femoral nail antirotation) surgery. There was no significant difference in gender, age, sides, fracture classification, fracture type, complications, the proportion of patients with more than 3 kinds of medical diseases, and the time from injury to admission between the two groups ( P>0.05). Analysis index included operative waiting time (hospitalization to operation time), operation time, percentage of operation performing in 48 and 72 hours, percentage of transfusion, changes of hematocrit (Hct) at different stage (admission, operation day, and postoperative 1, 3 days), blood loss by fracture and cephalomedullary nail, intraoperative dominant blood loss, total blood loss in perioperative period were recorded and compared. RESULTS The operative waiting time, operation time, Hct on operation day and postoperative 3 days, blood loss by fracture, transfusion volume, and total blood loss in perioperative period in group B were significantly less than those in group A ( P<0.05), and the percentage of operation performing in 48 and 72 hours in group B were significantly higher than those in group A ( P<0.05). There was no signifcant difference in Hct on admission and postoperative 1 day, intraoperative dominant blood loss, percentage of transfusion, blood loss by cephalomedullary nail between the two groups ( P>0.05). CONCLUSION Fast track can shorten the operative waiting time of geriatric intertrochanteric fracture, reduce the blood loss by fracture, total blood loss in perioperative period, and transfusion volume. Early operation is conducive to improve the anemia status of patients during perioperative period.
Collapse
Affiliation(s)
- Wentao Chen
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, P.R.China
| | - Baojun Wang
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050,
| | - Xiaodong Bai
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, P.R.China
| | - Hua Gao
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, P.R.China
| | - Zhenyu Liu
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, P.R.China
| | - Yadong Li
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, P.R.China
| | - Liang Zhao
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, P.R.China
| |
Collapse
|
322
|
Gao YS. Re: Comparison of outcomes between hip fracture patients with concurrent upper limb injuries and patients with an isolated hip fracture. ANZ J Surg 2019; 89:1173. [PMID: 31522475 DOI: 10.1111/ans.15276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 04/14/2019] [Indexed: 11/30/2022]
Affiliation(s)
- You-Shui Gao
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,Centre for Orthopaedic Research, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia
| |
Collapse
|
323
|
Shin WC, Moon NH, Jang JH, Jeong JY, Suh KT. Three-dimensional analyses to predict surgical outcomes in non-displaced or valgus impaction fractures of the femoral neck: A multicenter retrospective study. Orthop Traumatol Surg Res 2019; 105:991-998. [PMID: 31324521 DOI: 10.1016/j.otsr.2019.03.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Revised: 02/26/2019] [Accepted: 03/14/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The aim of our study was to (1) report our surgical outcomes of internal fixation in patients with non-displaced or valgus impaction fractures of the femoral neck, (2) introduce our new three-dimensional assessment method using a combination of X-ray and CT imaging, and (3) determine which radiologic measurements significantly predicted fixation failure. HYPOTHESIS We hypothesized that high posterior tilt angle and retroversion angle are related to high incidence of non-union and osteonecrosis. MATERIALS AND METHODS From January 2009 to December 2016, 64 elderly patients in two institutions with non-displaced or valgus impaction fractures of the femoral neck who had internal fixation using multiple parallel cannulated screws were enrolled. To determine the independent predictors of non-union, osteonecrosis, and re-operation, various clinical variables and radiologic variables, including the valgus angle on coronal CT images, the posterior tilt angle on Lorenz images, and the retroversion angle on axial CT images, were analyzed. RESULTS Non-union was identified in nine of the 64 patients (14.1%) and nine of the 55 patients (16.4%) who achieved bony union had femoral head osteonecrosis with subsequent segmental collapse. The multiple logistic regression model showed that a low bone mineral density of the femur, a higher posterior tilt angle on Lorenz image, and a higher retroversion angle on axial CT images were independent predictors of non-union and re-operation. DISCUSSION Primary hip arthroplasty should be considered when a posterior tilt angle of more than 9 degrees on Lorenz images or a retroversion angle of more than 13 degrees on axial CT images is identified in patients with osteoporotic valgus impaction fractures. TYPE OF STUDY AND LEVEL OF PROOF III, Retrospective comparative study.
Collapse
Affiliation(s)
- Won Chul Shin
- Department of Orthopaedic Surgery, Pusan National University Yangsan Hospital, Republic of Korea
| | - Nam Hoon Moon
- Department of Orthopaedic Surgery, Bio-medical Research Institute, Pusan National University Hospital, 179, Gudeok-Ro Seo-Gu, 49241 Busan, Republic of Korea.
| | - Jae Hoon Jang
- Department of Orthopaedic Surgery, Bio-medical Research Institute, Pusan National University Hospital, 179, Gudeok-Ro Seo-Gu, 49241 Busan, Republic of Korea
| | - Jae Yoon Jeong
- Department of Orthopaedic Surgery, Bio-medical Research Institute, Pusan National University Hospital, 179, Gudeok-Ro Seo-Gu, 49241 Busan, Republic of Korea
| | - Kuen Tak Suh
- Department of Orthopaedic Surgery, Pusan National University Yangsan Hospital, Republic of Korea
| |
Collapse
|
324
|
High incidence of early periprosthetic joint infection following total hip arthroplasty with concomitant or previous hardware removal. Arch Orthop Trauma Surg 2019; 139:1051-1056. [PMID: 30778724 DOI: 10.1007/s00402-019-03149-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Indexed: 02/09/2023]
Abstract
INTRODUCTION Hardware removal preceding total hip arthroplasty may increase the risk of prosthetic joint infection (PJI). Whether hardware removal and total hip arthroplasty (THA) should be performed in a single- or two-stage procedure remains controversial. In this comparative retrospective study, the incidence of PJI following either single- or two-stage THA with hardware removal was assessed in a consecutive series. PATIENTS AND METHODS All patients that underwent THA preceded by hardware removal from January 2006 until March 2018 were retrospectively reviewed and checked for the occurrence of early PJI. Recognized risk factors for PJI at the time of surgery were evaluated and the incidence of early PJI was compared between one- and two-stage THA regarding hardware removal. RESULTS 145 patients underwent THA and hardware removal (52 two-stage surgery and 93 single-stage surgery). There were no significant differences between both groups regarding pre-operative hemoglobulin levels, time interval between internal fixation and THA, antibiotic-loaded-cement use, BMI and ASA classification. Overall the incidence of early PJI was 6.9%. The incidence of PJI was 8.6% in the single-stage group versus 3.8% in the two-stage group (P = 0.234). CONCLUSION Irrespective of single- or two-stage procedures, a high incidence of PJI was encountered. Despite non-significance, a trend towards a higher proportion of patients developing PJI after single-stage surgery was encountered. We recommend a two-stage surgical procedure regarding hardware removal and THA in patients that are expected to tolerate this surgical strategy. When considering a one-stage procedure, it should be preceded by a thorough pre-operative workup including joint aspiration and serum determination of inflammatory parameters. Multiple tissue samples should be obtained during hardware removal in either one- or two-stage procedures since the risk for development of PJI is relevant.
Collapse
|
325
|
Tian J, Cheng C, Zhang FJ. Comment on “Perioperative myocardial infarction in elderly patients with hip fracture. Is there a role for early coronary angiography?”. Int J Cardiol 2019; 288:28. [DOI: 10.1016/j.ijcard.2019.04.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 04/10/2019] [Indexed: 11/26/2022]
|
326
|
|
327
|
Kuroshima S, Sasaki M, Sawase T. Medication-related osteonecrosis of the jaw: A literature review. J Oral Biosci 2019; 61:99-104. [DOI: 10.1016/j.job.2019.03.005] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 03/22/2019] [Accepted: 03/29/2019] [Indexed: 10/26/2022]
|
328
|
Abstract
Aims Total hip arthroplasty (THA) is gaining popularity as a treatment for displaced femoral neck fractures (FNFs), especially in physiologically younger patients. While THA for osteoarthritis (OA) has demonstrated low complication rates and increased quality of life, results of THA for acute FNF are not as clear. Currently, a THA performed for FNF is included in an institutional arthroplasty bundle without adequate risk adjustment, potentially placing centres participating in fracture care at financial disadvantage. The purpose of this study is to report on perioperative complication rates after THA for FNF compared with elective THA performed for OA of the hip. Patients and Methods The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database between 2008 and 2016 was queried. Patients were identified using the THA Current Procedural Terminology (CPT) code and divided into groups by diagnosis: OA in one and FNF in another. Univariate statistics were performed. Continuous variables were compared between groups using Student’s t-test, and the chi-squared test was used to compare categorical variables. Multivariate and propensity-matched logistic regression analyses were performed to control for risk factors of interest. Results Analyses included 139 635 patients undergoing THA. OA was the indication in 135 013 cases and FNF in 4622 cases. After propensity matching, mortality within 30 days (1.8% vs 0.3%; p < 0.001) and major morbidity (24.2% vs 19%; p < 0.001) were significantly higher among FNF patients. Re-operation (3.7% vs 2.7%; p = 0.014) and re-admission (7.3% vs 5.5%; p = 0.002) were significantly higher among FNF patients. Hip fracture patients had significantly longer operative time and length of stay (LOS), and were significantly less likely to be discharged to their home. Multivariate analyses gave similar results. Conclusion This large database study showed a higher risk of postoperative complications including mortality, major morbidity, re-operation, re-admission, prolonged operative time, increased LOS, and decreased likelihood of discharge home in patients undergoing THA for FNF compared with OA. While THA is a good option for FNF patients, there are increased costs and financial risks to centres with a joint arthroplasty bundle programme participating in fracture care. Cite this article: Bone Joint J 2019;101-B(6 Supple B):84–90.
Collapse
Affiliation(s)
- R. S. Charette
- Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - M. Sloan
- Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - G-C. Lee
- Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| |
Collapse
|
329
|
Warren J, Sundaram K, Anis H, McLaughlin J, Patterson B, Higuera CA, Piuzzi NS. The association between weight-bearing status and early complications in hip fractures. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2019; 29:1419-1427. [DOI: 10.1007/s00590-019-02453-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 05/20/2019] [Indexed: 01/30/2023]
|
330
|
Boughton OR, Ma S, Cai X, Yan L, Peralta L, Laugier P, Marrow J, Giuliani F, Hansen U, Abel RL, Grimal Q, Cobb JP. Computed tomography porosity and spherical indentation for determining cortical bone millimetre-scale mechanical properties. Sci Rep 2019; 9:7416. [PMID: 31092837 PMCID: PMC6520408 DOI: 10.1038/s41598-019-43686-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 04/23/2019] [Indexed: 12/11/2022] Open
Abstract
The cortex of the femoral neck is a key structural element of the human body, yet there is not a reliable metric for predicting the mechanical properties of the bone in this critical region. This study explored the use of a range of non-destructive metrics to measure femoral neck cortical bone stiffness at the millimetre length scale. A range of testing methods and imaging techniques were assessed for their ability to measure or predict the mechanical properties of cortical bone samples obtained from the femoral neck of hip replacement patients. Techniques that can potentially be applied in vivo to measure bone stiffness, including computed tomography (CT), bulk wave ultrasound (BWUS) and indentation, were compared against in vitro techniques, including compression testing, density measurements and resonant ultrasound spectroscopy. Porosity, as measured by micro-CT, correlated with femoral neck cortical bone's elastic modulus and ultimate compressive strength at the millimetre length scale. Large-tip spherical indentation also correlated with bone mechanical properties at this length scale but to a lesser extent. As the elastic mechanical properties of cortical bone correlated with porosity, we would recommend further development of technologies that can safely measure cortical porosity in vivo.
Collapse
Affiliation(s)
- Oliver R Boughton
- The MSk Lab, Department of Surgery and Cancer, Imperial College London, London, United Kingdom.
- The Biomechanics Group, Department of Mechanical Engineering, Imperial College London, London, United Kingdom.
| | - Shaocheng Ma
- The MSk Lab, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
- The Biomechanics Group, Department of Mechanical Engineering, Imperial College London, London, United Kingdom
| | - Xiran Cai
- Sorbonne Université, INSERM, CNRS, Laboratoire d'Imagerie Biomédicale, F-75006, Paris, France
| | - Liye Yan
- Department of Materials, University of Oxford, Oxford, United Kingdom
| | - Laura Peralta
- Sorbonne Université, INSERM, CNRS, Laboratoire d'Imagerie Biomédicale, F-75006, Paris, France
| | - Pascal Laugier
- Sorbonne Université, INSERM, CNRS, Laboratoire d'Imagerie Biomédicale, F-75006, Paris, France
| | - James Marrow
- Department of Materials, University of Oxford, Oxford, United Kingdom
| | - Finn Giuliani
- Centre for Advanced Structural Ceramics, Department of Materials, Imperial College London, London, United Kingdom
| | - Ulrich Hansen
- The Biomechanics Group, Department of Mechanical Engineering, Imperial College London, London, United Kingdom
| | - Richard L Abel
- The MSk Lab, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Quentin Grimal
- Sorbonne Université, INSERM, CNRS, Laboratoire d'Imagerie Biomédicale, F-75006, Paris, France
| | - Justin P Cobb
- The MSk Lab, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| |
Collapse
|
331
|
Yonekura H, Ide K, Onishi Y, Nahara I, Takeda C, Kawakami K. Preoperative Echocardiography for Patients With Hip Fractures Undergoing Surgery. Anesth Analg 2019; 128:213-220. [DOI: 10.1213/ane.0000000000003888] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
332
|
Cram P, Lix LM, Bohm E, Yan L, Roos L, Matelski J, Gandhi R, Landon B, Leslie WD. Hip fracture care in Manitoba, Canada and New York State, United States: an analysis of administrative data. CMAJ Open 2019; 7:E55-E62. [PMID: 30755412 PMCID: PMC6404962 DOI: 10.9778/cmajo.20180126] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Nearly 30 years ago, a series of studies showed increased hip fracture mortality in Manitoba compared to the United States, but these data have not been updated. Our objective was to compare the organization of hip fracture care and short-term outcomes in Manitoba and New York State using contemporary data. METHODS This was a retrospective cohort study of administrative data for all adults aged 50 years or more admitted to hospital with hip fracture between Jan. 1, 2011, and Oct. 31, 2013 in Manitoba and New York State. We compared the 2 jurisdictions with respect to: 1) the proportion of hospitals treating hip fracture and annual hip fracture volume, 2) hospital length of stay, 3) death and 4) hospital readmission. We used descriptive statistics, univariate methods and regression models to compare differences in care between jurisdictions. RESULTS We identified 2845 patients (mean age 82.2 yr, 2061 women [72.4%]) with hip fracture in Manitoba and 31 524 patients (mean age 81.9 yr, 22 973 women [72.9%]) with hip fracture in New York. A smaller proportion of hospitals in Manitoba than in New York treated hip fracture (7/30 [23%] v. 180/239 [75.3%]) (p < 0.001); the mean annual hospital hip fracture volume was higher in Manitoba (140.0) than in New York (68.9), but the difference did not reach statistical significance (p = 0.2). For patients with femoral neck fractures, the median hospital length of stay was longer in Manitoba than in New York (13 d v. 7 d). The rate of death within 7 days of admission was similar in Manitoba and New York (1.3% v. 2.0%, p = 0.07), although the rate of in-hospital death was higher in Manitoba (5.7% v. 3.5%, p < 0.001). Readmission within 30 days of discharge was less frequent in Manitoba than in New York (9.8% v. 12.0%, p = 0.02). Results were similar for patients with intertrochanteric fractures. INTERPRETATION Poor short-term outcomes for patients with hip fracture in Manitoba that were documented in the 1980s seem to have been eliminated. Our results should provide optimism that reengineering of clinical care can produce substantive improvements in quality.
Collapse
Affiliation(s)
- Peter Cram
- North American Observatory on Health Systems and Policies (Cram), Institute for Health Policy, Management and Evaluation, University of Toronto; Departments of Medicine (Cram) and Surgery (Gandhi), University of Toronto; Division of General Internal Medicine and Geriatrics (Cram), Sinai Health System and University Health Network, Toronto, Ont.; Departments of Community Health Sciences (Lix, Bohm, Yan, Roos), Surgery (Bohm) and Medicine (Leslie), University of Manitoba, Winnipeg, Man.; Biostatistics Research Unit (Matelski) and Arthritis Program (Gandhi), University Health Network, Toronto, Ont.; Department of Health Care Policy (Landon), Harvard Medical School; Division of General Medicine and Primary Care (Landon), Beth Israel Deaconess Medical Center, Boston, Mass.
| | - Lisa M Lix
- North American Observatory on Health Systems and Policies (Cram), Institute for Health Policy, Management and Evaluation, University of Toronto; Departments of Medicine (Cram) and Surgery (Gandhi), University of Toronto; Division of General Internal Medicine and Geriatrics (Cram), Sinai Health System and University Health Network, Toronto, Ont.; Departments of Community Health Sciences (Lix, Bohm, Yan, Roos), Surgery (Bohm) and Medicine (Leslie), University of Manitoba, Winnipeg, Man.; Biostatistics Research Unit (Matelski) and Arthritis Program (Gandhi), University Health Network, Toronto, Ont.; Department of Health Care Policy (Landon), Harvard Medical School; Division of General Medicine and Primary Care (Landon), Beth Israel Deaconess Medical Center, Boston, Mass
| | - Eric Bohm
- North American Observatory on Health Systems and Policies (Cram), Institute for Health Policy, Management and Evaluation, University of Toronto; Departments of Medicine (Cram) and Surgery (Gandhi), University of Toronto; Division of General Internal Medicine and Geriatrics (Cram), Sinai Health System and University Health Network, Toronto, Ont.; Departments of Community Health Sciences (Lix, Bohm, Yan, Roos), Surgery (Bohm) and Medicine (Leslie), University of Manitoba, Winnipeg, Man.; Biostatistics Research Unit (Matelski) and Arthritis Program (Gandhi), University Health Network, Toronto, Ont.; Department of Health Care Policy (Landon), Harvard Medical School; Division of General Medicine and Primary Care (Landon), Beth Israel Deaconess Medical Center, Boston, Mass
| | - Lin Yan
- North American Observatory on Health Systems and Policies (Cram), Institute for Health Policy, Management and Evaluation, University of Toronto; Departments of Medicine (Cram) and Surgery (Gandhi), University of Toronto; Division of General Internal Medicine and Geriatrics (Cram), Sinai Health System and University Health Network, Toronto, Ont.; Departments of Community Health Sciences (Lix, Bohm, Yan, Roos), Surgery (Bohm) and Medicine (Leslie), University of Manitoba, Winnipeg, Man.; Biostatistics Research Unit (Matelski) and Arthritis Program (Gandhi), University Health Network, Toronto, Ont.; Department of Health Care Policy (Landon), Harvard Medical School; Division of General Medicine and Primary Care (Landon), Beth Israel Deaconess Medical Center, Boston, Mass
| | - Leslie Roos
- North American Observatory on Health Systems and Policies (Cram), Institute for Health Policy, Management and Evaluation, University of Toronto; Departments of Medicine (Cram) and Surgery (Gandhi), University of Toronto; Division of General Internal Medicine and Geriatrics (Cram), Sinai Health System and University Health Network, Toronto, Ont.; Departments of Community Health Sciences (Lix, Bohm, Yan, Roos), Surgery (Bohm) and Medicine (Leslie), University of Manitoba, Winnipeg, Man.; Biostatistics Research Unit (Matelski) and Arthritis Program (Gandhi), University Health Network, Toronto, Ont.; Department of Health Care Policy (Landon), Harvard Medical School; Division of General Medicine and Primary Care (Landon), Beth Israel Deaconess Medical Center, Boston, Mass
| | - John Matelski
- North American Observatory on Health Systems and Policies (Cram), Institute for Health Policy, Management and Evaluation, University of Toronto; Departments of Medicine (Cram) and Surgery (Gandhi), University of Toronto; Division of General Internal Medicine and Geriatrics (Cram), Sinai Health System and University Health Network, Toronto, Ont.; Departments of Community Health Sciences (Lix, Bohm, Yan, Roos), Surgery (Bohm) and Medicine (Leslie), University of Manitoba, Winnipeg, Man.; Biostatistics Research Unit (Matelski) and Arthritis Program (Gandhi), University Health Network, Toronto, Ont.; Department of Health Care Policy (Landon), Harvard Medical School; Division of General Medicine and Primary Care (Landon), Beth Israel Deaconess Medical Center, Boston, Mass
| | - Rajiv Gandhi
- North American Observatory on Health Systems and Policies (Cram), Institute for Health Policy, Management and Evaluation, University of Toronto; Departments of Medicine (Cram) and Surgery (Gandhi), University of Toronto; Division of General Internal Medicine and Geriatrics (Cram), Sinai Health System and University Health Network, Toronto, Ont.; Departments of Community Health Sciences (Lix, Bohm, Yan, Roos), Surgery (Bohm) and Medicine (Leslie), University of Manitoba, Winnipeg, Man.; Biostatistics Research Unit (Matelski) and Arthritis Program (Gandhi), University Health Network, Toronto, Ont.; Department of Health Care Policy (Landon), Harvard Medical School; Division of General Medicine and Primary Care (Landon), Beth Israel Deaconess Medical Center, Boston, Mass
| | - Bruce Landon
- North American Observatory on Health Systems and Policies (Cram), Institute for Health Policy, Management and Evaluation, University of Toronto; Departments of Medicine (Cram) and Surgery (Gandhi), University of Toronto; Division of General Internal Medicine and Geriatrics (Cram), Sinai Health System and University Health Network, Toronto, Ont.; Departments of Community Health Sciences (Lix, Bohm, Yan, Roos), Surgery (Bohm) and Medicine (Leslie), University of Manitoba, Winnipeg, Man.; Biostatistics Research Unit (Matelski) and Arthritis Program (Gandhi), University Health Network, Toronto, Ont.; Department of Health Care Policy (Landon), Harvard Medical School; Division of General Medicine and Primary Care (Landon), Beth Israel Deaconess Medical Center, Boston, Mass
| | - William D Leslie
- North American Observatory on Health Systems and Policies (Cram), Institute for Health Policy, Management and Evaluation, University of Toronto; Departments of Medicine (Cram) and Surgery (Gandhi), University of Toronto; Division of General Internal Medicine and Geriatrics (Cram), Sinai Health System and University Health Network, Toronto, Ont.; Departments of Community Health Sciences (Lix, Bohm, Yan, Roos), Surgery (Bohm) and Medicine (Leslie), University of Manitoba, Winnipeg, Man.; Biostatistics Research Unit (Matelski) and Arthritis Program (Gandhi), University Health Network, Toronto, Ont.; Department of Health Care Policy (Landon), Harvard Medical School; Division of General Medicine and Primary Care (Landon), Beth Israel Deaconess Medical Center, Boston, Mass
| |
Collapse
|
333
|
Robbins GT, Yih E, Chou R, Gundersen AI, Schnieder JC, Bean JF, Zafonte RD. Geriatric rehabilitation. HANDBOOK OF CLINICAL NEUROLOGY 2019; 167:531-543. [PMID: 31753153 DOI: 10.1016/b978-0-12-804766-8.00029-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Rehabilitation of elderly persons is accompanied by unique challenges, as the physiologic changes with aging may be compounded by a multitude of psychologic, social, and genetic factors. In this chapter we present an overview of the impairments that develop with aging. We discuss factors to consider when evaluating a patient with functional complaints and opportunities for treatment. We provide an overview of common injuries encountered in the elderly, prognostication, and general strategies employed for rehabilitation. New treatment options and areas of ongoing research are also discussed.
Collapse
Affiliation(s)
- Gregory T Robbins
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, United States; Massachusetts General Hospital, Boston, MA, United States; Brigham and Women's Hospital, Boston, MA, United States; Boston Veterans Administration, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Erika Yih
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, United States; Massachusetts General Hospital, Boston, MA, United States; Brigham and Women's Hospital, Boston, MA, United States; Boston Veterans Administration, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Raymond Chou
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, United States; Massachusetts General Hospital, Boston, MA, United States; Brigham and Women's Hospital, Boston, MA, United States; Boston Veterans Administration, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Alex I Gundersen
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, United States; Massachusetts General Hospital, Boston, MA, United States; Brigham and Women's Hospital, Boston, MA, United States; Boston Veterans Administration, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Jeffrey C Schnieder
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, United States; Massachusetts General Hospital, Boston, MA, United States; Brigham and Women's Hospital, Boston, MA, United States; Boston Veterans Administration, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Jonathan F Bean
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, United States; Massachusetts General Hospital, Boston, MA, United States; Brigham and Women's Hospital, Boston, MA, United States; Boston Veterans Administration, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Ross D Zafonte
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, United States; Massachusetts General Hospital, Boston, MA, United States; Brigham and Women's Hospital, Boston, MA, United States; Boston Veterans Administration, Boston, MA, United States; Harvard Medical School, Boston, MA, United States.
| |
Collapse
|
334
|
|
335
|
Kawai M, Tanji A, Nishijima T, Tateyama K, Yoda Y, Iizuka A, Kamata Y, Urabe T. Association between time to surgery and 90-day mortality after hip fracture: A retrospective cohort study of 1734 cases. J Orthop Sci 2018; 23:987-991. [PMID: 30119928 DOI: 10.1016/j.jos.2018.07.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 07/06/2018] [Accepted: 07/22/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND It remains unclear whether early surgical intervention can reduce mortality after surgery in hip fracture patients. The aim of this study was to investigate the association between time from injury to surgery and mortality rate within 90 days after hip fracture surgery. METHODS We retrospectively identified 1827 patients who underwent hip fracture surgery in a tertiary care center in Japan between April 2007 and March 2017. After applying exclusion criteria (patients with spontaneous fracture, multiple fractures, revision surgery, total hip arthroplasty, or a refusal to participate), 1734 patients were included. We extracted data concerning patients' age, race, sex, operative procedure, American Society of Anesthesiologists (ASA) score, days from injury to surgery (injury-surgery days), and days from admission to surgery (admission-surgery days), which could affect 90-day mortality after surgery. Variables associated with 90-day mortality were determined using multivariate logistic regression analysis. RESULTS The 90-day postoperative mortality rate was 3.5% (60 of 1734). Multivariable analysis showed that injury-surgery days were not associated with 90-day mortality (odds ratio [OR], 0.91; 95% confidence interval [CI], 0.80 to 1.05; P = 0.19), and that older age (OR, 1.06; 95% CI, 1.02 to 1.10; P = 0.005), male sex (OR, 3.62; 95% CI, 1.86 to 7.03; P < 0.001) and high ASA score (OR, 2.10; 95% CI, 1.06 to 4.18; P = 0.034) significantly increased 90-day mortality. In addition, admission-surgery days were not associated with 90-day mortality (OR, 0.95; 95% CI, 0.83 to 1.09; P = 0.45). CONCLUSION Our results demonstrated that time from injury to surgery was not associated with mortality within 90 days after surgery after adjusting for age, sex, operative procedure, and ASA score.
Collapse
Affiliation(s)
- Momotaro Kawai
- Department of Orthopedic Surgery, Ashikaga Red Cross Hospital, Tochigi, Japan.
| | - Atsushi Tanji
- Department of Orthopedic Surgery, Ashikaga Red Cross Hospital, Tochigi, Japan
| | - Takayuki Nishijima
- Department of Orthopedic Surgery, Ashikaga Red Cross Hospital, Tochigi, Japan
| | - Koichi Tateyama
- Department of Orthopedic Surgery, Ashikaga Red Cross Hospital, Tochigi, Japan
| | - Yuhei Yoda
- Department of Orthopedic Surgery, Ashikaga Red Cross Hospital, Tochigi, Japan
| | - Ai Iizuka
- Department of Orthopedic Surgery, Ashikaga Red Cross Hospital, Tochigi, Japan
| | - Yusaku Kamata
- Department of Orthopedic Surgery, Ashikaga Red Cross Hospital, Tochigi, Japan
| | - Tadahisa Urabe
- Department of Orthopedic Surgery, Ashikaga Red Cross Hospital, Tochigi, Japan
| |
Collapse
|
336
|
Klestil T, Röder C, Stotter C, Winkler B, Nehrer S, Lutz M, Klerings I, Wagner G, Gartlehner G, Nussbaumer-Streit B. Impact of timing of surgery in elderly hip fracture patients: a systematic review and meta-analysis. Sci Rep 2018; 8:13933. [PMID: 30224765 PMCID: PMC6141544 DOI: 10.1038/s41598-018-32098-7] [Citation(s) in RCA: 218] [Impact Index Per Article: 36.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 08/31/2018] [Indexed: 01/13/2023] Open
Abstract
We aimed to assess the impact of timing of surgery in elderly patients with acute hip fracture on morbidity and mortality. We systematically searched MEDLINE, the Cochrane Library, Embase, PubMed, and trial registries from 01/1997 to 05/2017, as well as reference lists of relevant reviews, archives of orthopaedic conferences, and contacted experts. Eligible studies had to be randomised controlled trials (RCTs) or prospective cohort studies, including patients 60 years or older with acute hip fracture. Two authors independently assessed study eligibility, abstracted data, and critically appraised study quality. We conducted meta-analyses using the generic inverse variance model. We included 28 prospective observational studies reporting data of 31,242 patients. Patients operated on within 48 hours had a 20% lower risk of dying within 12 months (risk ratio (RR) 0.80, 95% confidence interval (CI) 0.66-0.97). No statistical significant different mortality risk was observed when comparing patients operated on within or after 24 hours (RR 0.82, 95% CI 0.67-1.01). Adjusted data demonstrated fewer complications (8% vs. 17%) in patients who had early surgery, and increasing risk for pressure ulcers with increased time of delay in another study. Early hip surgery within 48 hours was associated with lower mortality risk and fewer perioperative complications.
Collapse
Affiliation(s)
- Thomas Klestil
- Danube University Krems, Faculty of Health and Medicine, Department for Health Sciences and Biomedicine, Center for Medical Specialisations, Dr. Karl-Dorrek-Str. 30, A-3500, Krems, Austria.
- LK Baden-Mödling-Hainburg, Department of Orthopedics and Traumatology, Waltersdorferstraße 75, A-2500, Baden, Austria.
| | - Christoph Röder
- LK Baden-Mödling-Hainburg, Department of Orthopedics and Traumatology, Waltersdorferstraße 75, A-2500, Baden, Austria
| | - Christoph Stotter
- LK Baden-Mödling-Hainburg, Department of Orthopedics and Traumatology, Waltersdorferstraße 75, A-2500, Baden, Austria
- Danube University Krems, Faculty of Health and Medicine, Department for Health Sciences and Biomedicine, Center for Regenerative Medicine and Orthopedics, Dr. Karl-Dorrek-Str. 30, A-3500, Krems, Austria
| | - Birgit Winkler
- LK Baden-Mödling-Hainburg, Department of Orthopedics and Traumatology, Waltersdorferstraße 75, A-2500, Baden, Austria
| | - Stefan Nehrer
- Danube University Krems, Faculty of Health and Medicine, Department for Health Sciences and Biomedicine, Center for Regenerative Medicine and Orthopedics, Dr. Karl-Dorrek-Str. 30, A-3500, Krems, Austria
- UK Krems, Department of Orthopedic Surgery, Mitterweg 10, A-3500, Krems, Austria
| | - Martin Lutz
- Landeskrankenhaus Hall, Department of Orthopedics and Traumatology, Milser Straße 10, A-6060, Hall in Tirol, Austria
| | - Irma Klerings
- Danube University Krems, Department of Evidence-based Medicine and Clinical Epidemiology, Dr. Karl-Dorrek-Str. 30, A-3500, Krems, Austria
| | - Gernot Wagner
- Danube University Krems, Department of Evidence-based Medicine and Clinical Epidemiology, Dr. Karl-Dorrek-Str. 30, A-3500, Krems, Austria
| | - Gerald Gartlehner
- Cochrane Austria, Danube University Krems, Dr. Karl-Dorrek-Str. 30, A-3500, Krems, Austria
- RTI International, 3040 Cornwallis Road, Research Triangle Park, North Carolina, NC, 27790, United States
| | - Barbara Nussbaumer-Streit
- Danube University Krems, Department of Evidence-based Medicine and Clinical Epidemiology, Dr. Karl-Dorrek-Str. 30, A-3500, Krems, Austria
- Cochrane Austria, Danube University Krems, Dr. Karl-Dorrek-Str. 30, A-3500, Krems, Austria
| |
Collapse
|
337
|
Sierra P, Gómez-Luque A, Llau JV, Ferrandis R, Cassinello C, Hidalgo F. Recommendations for perioperative antiplatelet treatment in non-cardiac surgery. Working Group of the Spanish Society of Anaesthesiology-Resuscitation and Pain Therapy, Division of Haemostasis, Transfusion Medicine, and Perioperative Fluid Therapy. Update of the Clinical practice guide 2018. ACTA ACUST UNITED AC 2018; 66:18-36. [PMID: 30166124 DOI: 10.1016/j.redar.2018.07.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 07/13/2018] [Indexed: 12/24/2022]
Affiliation(s)
- P Sierra
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Fundación Puigvert (IUNA), Barcelona, España.
| | - A Gómez-Luque
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital Universitario Virgen de la Victoria, Universidad de Málaga, Málaga, España
| | - J V Llau
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital Dr. Peset, Universitat de València, Valencia, España
| | - R Ferrandis
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Hopital Clínic i Universitari La Fe, Universitat de València, Valencia, España
| | - C Cassinello
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital Universitario Miguel Servet, Zaragoza, España
| | - F Hidalgo
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Clínica Universidad de Navarra, Pamplona, España
| |
Collapse
|
338
|
Rostagno C, Cartei A, Civinini R, Prisco D. Hip fracture unit: beyond orthogeriatrics. Intern Emerg Med 2018; 13:637-639. [PMID: 29508226 DOI: 10.1007/s11739-018-1818-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 03/01/2018] [Indexed: 12/26/2022]
Affiliation(s)
- Carlo Rostagno
- Dipartimento Medicina Sperimentale e Clinica Università di Firenze, Viale Morgagni 85, 50134, Florence, Italy.
| | | | | | - Domenico Prisco
- Dipartimento Medicina Sperimentale e Clinica Università di Firenze, Viale Morgagni 85, 50134, Florence, Italy
| |
Collapse
|
339
|
Pemmari A, Leppänen T, Paukkeri EL, Eskelinen A, Moilanen T, Moilanen E. Gene expression in adverse reaction to metal debris around metal-on-metal arthroplasty: An RNA-Seq-based study. J Trace Elem Med Biol 2018; 48:149-156. [PMID: 29773173 DOI: 10.1016/j.jtemb.2018.03.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Revised: 03/15/2018] [Accepted: 03/16/2018] [Indexed: 01/23/2023]
Abstract
Joint replacement surgery is a standard treatment of advanced osteoarthritis (OA). Since 2000, cobalt-chromium (CoCr) metal-on-metal (MoM) implants were widely used in hip arthroplasties. Some patients developed "adverse reaction to metal debris" (ARMD) around the prosthesis, resulting in a need for revision surgery. In the present study, we addressed the pathogenesis of ARMD by genome-wide expression analysis. Pseudosynovial ARMD tissue was obtained from revision surgery of Articular Surface Replacement (ASR, DePuy, Warsaw, IN, USA) hip arthroplasties. Control tissue was 1) OA synovium from primary hip arthroplasties and 2) inflammatory pseudosynovial tissue from metal-on-plastic (MoP) implant revisions. In ARMD tissue, the expression of 1446 genes was significantly increased and that of 1881 decreased as compared to OA synovium. Genes associated with immune response, tissue development and certain leukocyte signaling pathways were enriched in the differently (FC > 2) expressed genes. The network analysis proposed PRKACB, CD2, CD52 and CD53 as the central regulators of the greatest (FC > 10) differences. When ARMD tissue was compared to MoP tissue, the expression of 16 genes was significantly higher and that of 21 lower. Many of these genes were associated with redox homeostasis, metal ion binding and transport, macrophage activation and apoptosis. Interestingly, genes central to myofibroblast (AEBP1 and DES) and osteoclast (CCL21, TREM2 and CKB) development were upregulated in the MoP tissue. In network analysis, IL8, NQO1, GSTT1 and HMOX1 were identified as potential central regulators of the changes. In conclusion, excessive amounts of CoCr debris produced by MoM hip implants induces in a group of patients a unique adverse reaction characterized with enhanced expression of genes associated with inflammation, redox homeostasis, metal ion binding and transport, macrophage activation and apoptosis.
Collapse
Affiliation(s)
- Antti Pemmari
- The Immunopharmacology Research Group, Faculty of Medicine and Life Sciences, University of Tampere and Tampere University Hospital, Tampere, Finland
| | - Tiina Leppänen
- The Immunopharmacology Research Group, Faculty of Medicine and Life Sciences, University of Tampere and Tampere University Hospital, Tampere, Finland
| | - Erja-Leena Paukkeri
- The Immunopharmacology Research Group, Faculty of Medicine and Life Sciences, University of Tampere and Tampere University Hospital, Tampere, Finland
| | | | - Teemu Moilanen
- The Immunopharmacology Research Group, Faculty of Medicine and Life Sciences, University of Tampere and Tampere University Hospital, Tampere, Finland; Coxa Hospital for Joint Replacement, Tampere, Finland
| | - Eeva Moilanen
- The Immunopharmacology Research Group, Faculty of Medicine and Life Sciences, University of Tampere and Tampere University Hospital, Tampere, Finland.
| |
Collapse
|
340
|
Awasthi H, Mani D, Singh D, Gupta A. The underlying pathophysiology and therapeutic approaches for osteoporosis. Med Res Rev 2018; 38:2024-2057. [DOI: 10.1002/med.21504] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 02/28/2018] [Accepted: 04/04/2018] [Indexed: 12/11/2022]
Affiliation(s)
- Harshika Awasthi
- Herbal Medicinal Products Department; CSIR-Central Institute of Medicinal and Aromatic Plants; Lucknow India
| | - Dayanandan Mani
- Herbal Medicinal Products Department; CSIR-Central Institute of Medicinal and Aromatic Plants; Lucknow India
| | - Divya Singh
- Division of Endocrinology; CSIR-Central Drug Research Institute; Lucknow India
| | - Atul Gupta
- Medicinal Chemistry Department; CSIR-Central Institute of Medicinal and Aromatic Plants; Lucknow India
| |
Collapse
|
341
|
Aicale R, Maffulli N. Greater rate of cephalic screw mobilisation following proximal femoral nailing in hip fractures with a tip-apex distance (TAD) and a calcar referenced TAD greater than 25 mm. J Orthop Surg Res 2018; 13:106. [PMID: 29720223 PMCID: PMC5930512 DOI: 10.1186/s13018-018-0814-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 04/17/2018] [Indexed: 01/13/2023] Open
Abstract
Background To ascertain whether the tip–apex distance (TAD), calcar referenced TAD (CalTAD), and the sum of both (TADcalTAD) are predictive measurements of mobilisation of the cephalic screw in patients with trochanteric hip fractures. Methods Between 2014 and 2015, 68 patients (mean age 86 years, 45 females, 23 males) with a trochanteric hip fracture underwent intramedullary nailing. The TAD and CalTAD were measured, and for each parameter, we calculated sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). Results There is evidence of a statistically significant association between a TAD and CalTAD greater than 25 mm and a TADcalTAD greater than 50 mm and mobilisation of the cephalic screw. All measurements have similar sensitivity, but the TAD presents the highest specificity (p < 0.01). Conclusion To avoid the risk of mobilisation of the cephalic screw and possible subsequent failure of the construct, surgeons should strive for a TAD and CalTAD less than 25 mm and a TADcalTAD less than 50 mm when using intramedullary fixation.
Collapse
Affiliation(s)
- Rocco Aicale
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Salerno, Italy
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Salerno, Italy. .,Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, 275 Bancroft Road, London, E1 4DG, England.
| |
Collapse
|
342
|
Lee SY, Beom J, Kim BR, Lim SK, Lim JY. Comparative effectiveness of fragility fracture integrated rehabilitation management for elderly individuals after hip fracture surgery: A study protocol for a multicenter randomized controlled trial. Medicine (Baltimore) 2018; 97:e10763. [PMID: 29768364 PMCID: PMC5976332 DOI: 10.1097/md.0000000000010763] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Although it is essential to provide comprehensive rehabilitation after hip fracture to restore the patient to preoperative physical functioning, feasibility issues remain. Here, we describe a protocol for a randomized controlled trial (RCT) to evaluate the effectiveness of fragility fracture integrated rehabilitation management (FIRM) for elderly individuals after hip fracture surgery. We also examine the feasibility of applying FIRM in a chronic-care hospital or community-based setting. METHODS AND ANALYSIS Elderly patients will be randomly assigned to either the FIRM, conventional, or control group for a 2-week intervention period following hip fracture surgery. The primary outcome of this study is Koval walking ability. All functional outcomes will be measured 1 and 3 weeks, 3, 6, and 12 months after the surgical intervention. Researchers will be blind to group allocation, and participants will be blind to outcome. A sample size of 282 participants will be necessary to demonstrate the effect of the FIRM program. After the RCT has been conducted in 3 core hospitals, FIRM will be applied in 6 community-based local hospitals to investigate the feasibility of the program. The data will be analyzed using the intention-to-treat principle. TRIAL REGISTRATION NUMBER NCT03430193.
Collapse
Affiliation(s)
- Sang Yoon Lee
- Department of Rehabilitation Medicine, Seoul National University Boramae Medical Center Department of Physical Medicine and Rehabilitation, Chung-Ang University Hospital, Seoul Department of Rehabilitation Medicine, Jeju National University Hospital, Jeju National University College of Medicine, Jeju Department of Rehabilitation Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Changwon Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | | | | | | | | | | |
Collapse
|
343
|
|
344
|
Sanford AM, Morley JE, McKee A. Editorial: Orthogeriatrics and Hip Fractures. J Nutr Health Aging 2018; 22:457-462. [PMID: 29582883 DOI: 10.1007/s12603-018-1007-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- A M Sanford
- John E. Morley, MB,BCh, Division of Geriatric Medicine, Saint Louis University School of Medicine, 1402 S. Grand Blvd., M238, St. Louis, MO 63104,
| | | | | |
Collapse
|