1
|
Uzuegbunam CO, Katchy AU, Anyaehie UE, Agu CC, Ede O, Iyidobi EC, Nwadinigwe CU, Muoghalu ON, Ngwangwa CL, Essien-Adetula U, Uzodimma SC. Does the Proximal Femur Geometry Predict Early Functional Outcome after Plate Fixation of Geriatric Pertrochanteric Fractures? Niger J Clin Pract 2023; 26:1647-1651. [PMID: 38044769 DOI: 10.4103/njcp.njcp_282_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 07/19/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND The proximal femur geometry determines the hip force distribution. The femoral neck axis length (FNAL), the hip axis length (HAL), the femoral head diameter, and the femoral neck-shaft angle (FNSA) could influence the risk and outcome of pertrochanteric fractures. Restoring these parameters to their prefracture values could predict early hip function. AIM To determine if the postoperative proximal femur geometry of geriatric patients with plating for pertrochanteric fractures predicts the early functional outcome. MATERIALS AND METHODS The study was a prospective study carried out at the National Orthopaedic Hospital Enugu for 18 months. Geriatric patients who had Proximal Femoral Locking fixation for pertrochanteric fractures were recruited. Radiological parameters of the proximal femur in the unaffected and fixed hips were measured and compared. The functional outcomes of the patients were measured at 3 months postoperative period using the Harris hip score (HHS). Multiple linear regression was conducted on the parameters to determine the HHS. RESULTS Thirty patients participated in the study, with a significant difference (P < 0.001) in the mean FNSA between unaffected (M = 128.69, standard deviation (SD) =2.93) and operated hips (M = 121.81, SD = 8.86). The FNSA was the only significant predictor of hip function, with a 1-degree increase improving the HHS by 1.30. CONCLUSION There is a significant difference in the FNSA between the unaffected and the operated hips. The FNSA significantly predicts the early hip function and should be reconstructed to within normal range during surgery.
Collapse
Affiliation(s)
- C O Uzuegbunam
- Department of Orthopaedics and Trauma, National Orthopaedic Hospital, Enugu, Nigeria
| | - A U Katchy
- Department of Accident and Emergency, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu State, Nigeria
| | - U E Anyaehie
- Department of Orthopaedics and Trauma, National Orthopaedic Hospital, Enugu, Nigeria
| | - C C Agu
- Department of Radiology, National Orthopaedic Hospital, Enugu, Nigeria
| | - O Ede
- Department of Orthopaedics and Trauma, National Orthopaedic Hospital, Enugu, Nigeria
| | - E C Iyidobi
- Department of Orthopaedics and Trauma, National Orthopaedic Hospital, Enugu, Nigeria
| | - C U Nwadinigwe
- Department of Orthopaedics and Trauma, National Orthopaedic Hospital, Enugu, Nigeria
| | - O N Muoghalu
- Department of Orthopaedics and Trauma, National Orthopaedic Hospital, Enugu, Nigeria
| | - C L Ngwangwa
- Department of Orthopaedics and Trauma, National Orthopaedic Hospital, Enugu, Nigeria
| | | | - S C Uzodimma
- Department of Orthopaedics and Trauma, National Orthopaedic Hospital, Enugu, Nigeria
| |
Collapse
|
2
|
Zhao F, Xue Y, Wang X, Zhan Y. Efficacy of Supercapsular Percutaneously-Assisted Total Hip Arthroplasty in the Elderly With Femoral Neck Fractures: A Meta-analysis. Geriatr Orthop Surg Rehabil 2022; 13:21514593221074176. [PMID: 35186423 PMCID: PMC8855386 DOI: 10.1177/21514593221074176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 12/27/2021] [Indexed: 11/28/2022] Open
Abstract
Introduction Supercapsular Percutaneously-Assisted Total Hip (SuperPATH) approach is a
novel minimally invasive surgical technique for total hip arthroplasty
(THA). This meta-analysis was conducted to evaluate the outcomes following
THA via the SuperPATH approach in elderly patients with femoral neck
fractures (FNFs), compared with those via traditional surgical
approaches. Methods Eligible studies were retrieved through searching 7 electronic databases and
manually screening related references. Objectives were surgical-related
parameters, functional outcomes, and incidence of postoperative
complications. Results 9 comparative studies were included. Pooled results suggested that at the
cost of longer operative time (WMD: 14.25, 95% CI: 3.25 to 25.25), the
SuperPATH technique was superior to traditional approaches regarding
incision length (WMD: −4.51, 95% CI: −6.46 to −2.56), intraoperative blood
loss (WMD: −80.47, 95% CI: −122.36 to −38.57), and hospital stays (WMD:
−3.35, 95% CI: −5.05 to −1.65). SuperPATH groups exhibited significantly
increased Harris Hip Scores within 1 month after surgery (7d, WMD: 9.85, 95%
CI: 6.40 to 13.30; 14d, WMD: 10.68, 95% CI: 8.29 to 13.08; 1 month, WMD:
6.17, 95% CI: 3.56 to 8.78) and had a reduced incidence of overall
complications (OR: .19, 95% CI: .09 to .41). No significant differences were
found between the 2 groups regarding postoperative pain relief. Conclusion Elderly patients with FNFs are potential candidates for THA treatment via the
SuperPATH technique, which is associated with improved surgical outcomes,
better short-term functional recovery, and lower risk of total complications
as compared to traditional approaches. Additional studies are needed to
further confirm our conclusions and validate the long-term efficacy of
SuperPATH.
Collapse
Affiliation(s)
- Fulong Zhao
- Department of Trauma Orthopedics, Beijing Luhe Hospital Affiliated to Capital Medical University, Beijing, China
| | - Yang Xue
- Department of Trauma Orthopedics, Beijing Luhe Hospital Affiliated to Capital Medical University, Beijing, China
| | - Xuefei Wang
- Department of Trauma Orthopedics, Beijing Luhe Hospital Affiliated to Capital Medical University, Beijing, China
| | - Yunjia Zhan
- Department of Trauma Orthopedics, Beijing Luhe Hospital Affiliated to Capital Medical University, Beijing, China
| |
Collapse
|
3
|
Midterm Survivorship of an Uncemented Hydroxyapatite-Coated Titanium Femoral Component and Clinically Meaningful Outcomes in Patients Older Than 75 Years. J Clin Med 2021; 10:jcm10051019. [PMID: 33801479 PMCID: PMC7958839 DOI: 10.3390/jcm10051019] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 02/17/2021] [Accepted: 02/24/2021] [Indexed: 11/17/2022] Open
Abstract
Purpose: It remains controversial whether cementless femoral components are safe in elderly patients. The aim of this study was (1) to determine the stem survival rate in patients >75 years of age who were treated with an uncemented femoral component and (2) to report clinically significant results on a mid-term follow-up. Methods: 107 total hip arthroplasties (THA) were retrospectively evaluated in 97 patients over 75 years of age (mean age 78 years, range 75–87) treated with an uncemented femoral stem. The minimum follow-up was five years (mean 6.4 years, range 5–8). Stem survival rates, clinically meaningful outcomes, and incidence of complications were evaluated. Results: Kaplan-Meier survival analysis, with the endpoint revision for any reason, showed a 6.4-year survival rate of 98% (95% CI, 95–99%; 63 hips at risk). The survival rates were comparable for male and female patients (log-rank test, p = 0.58). The modified Harris Hip Score (mHHS) improved from 42.2 (12 to 85) points to 81.1 (22 to 97) points (p < 0.0001). Mid-term minimal clinically important difference (MCID), substantial clinical benefit (SCB), and patient acceptable symptomatic state (PASS) were 25, 84, and 70, respectively. Conclusion: An uncemented stem is a viable option in patients over 75 years with good clinical outcomes and survivorship. Periprosthetic fractures were not a relevant failure mechanism with the stem used.
Collapse
|
4
|
Zhu W, Xie K, Zhang X, Yang J, Xu L, Zhu J, Fang S, Zhu C. Development and validation of a predictive nomogram for postoperative osteonecrosis of the femoral head with cannulated screws fixation. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:281. [PMID: 33708908 PMCID: PMC7944296 DOI: 10.21037/atm-20-4866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Osteonecrosis of the femoral head (ONFH) remains a major complication of femoral neck fractures. Early interventions require preliminary prediction and detection. In this study, we aimed to evaluate the perioperative variables of postoperative ONFH in femoral neck fracture patients with closed reduction and cannulated screw fixation. We also established and validated an individualized nomogram for the prediction of postoperative ONFH. Methods We included 470 patients with ONFH from two hospitals [First Affiliated Hospital of University of Science and Technology of China (n=360) and Southern Branch of the First Affiliated Hospital of the University of Science and Technology of China (n=110)]. We evaluated the prognostic value of multiple perioperative variables using a Cox regression model in the training cohort. We developed a nomogram for the prediction of ONFH using a logistic regression model. We assessed the performance of this nomogram in a validation cohort and evaluated its clinical value. Results Of the 470 patients who met the inclusion criteria, 141 (30.0%) developed postoperative ONFH. We found alcohol use [odds ratio (OR), 1.743, 95% confidence interval (CI), 1.042-2.901, P=0.033], cerebrovascular disease (OR, 5.357, 95% CI, 2.318-13.13, P<0.001), interval to surgery (OR, 5.273, 95% CI, 2.724-10.43, P<0.001), Garden classification (OR, 23.17, 95% CI, 6.812-145.3, P<0.001), Garden index (OR, 5.935, 95% CI, 2.670-14.184, P<0.001), interval to partial weight-bearing (OR, 0.053, 95% CI, 0.006-0.296, P=0.002), and six-month Harris hip score (OR, 0.856; 95% CI, 0.792-0.919, P<0.001) were independent predictors of postoperative development of ONFH. Based on these variables, we developed a nomogram that showed good discrimination in both the training [area under the curve (AUC) =0.865] and the validation cohort (AUC =0.877). The favorable performance of this nomogram was also confirmed in the validation cohort. Conclusions We developed and validated an easy-to-use nomogram for predicting postoperative ONFH. This nomogram can aid decision-making of intraoperative interventions and postoperative rehabilitation plans for patients, surgeons, and osteo-rehabilitative physicians.
Collapse
Affiliation(s)
- Wanbo Zhu
- Department of Orthopaedics, Affiliated Anhui Provincial Hospital of Anhui Medical University, Hefei, China.,Department of Orthopaedics, the First Affiliated Hospital of University of Science and Technology of China, Hefei, China
| | - Kai Xie
- Department of Orthopaedics, the First Affiliated Hospital of University of Science and Technology of China, Hefei, China
| | - Xianzuo Zhang
- Department of Orthopaedics, the First Affiliated Hospital of University of Science and Technology of China, Hefei, China
| | - Jiazhao Yang
- Department of Orthopaedics, the First Affiliated Hospital of University of Science and Technology of China, Hefei, China
| | - Lei Xu
- Department of Orthopaedics, the First Affiliated Hospital of University of Science and Technology of China, Hefei, China
| | - Junchen Zhu
- Department of Orthopaedics, the Second Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, China
| | - Shiyuan Fang
- Department of Orthopaedics, Affiliated Anhui Provincial Hospital of Anhui Medical University, Hefei, China.,Department of Orthopaedics, the First Affiliated Hospital of University of Science and Technology of China, Hefei, China
| | - Chen Zhu
- Department of Orthopaedics, the First Affiliated Hospital of University of Science and Technology of China, Hefei, China
| |
Collapse
|
5
|
What Predicts Health-Related Quality of Life for Patients With Displaced Femoral Neck Fractures Managed With Arthroplasty? A Secondary Analysis of the HEALTH Trial. J Orthop Trauma 2020; 34 Suppl 3:S29-S36. [PMID: 33027163 DOI: 10.1097/bot.0000000000001933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Total hip arthroplasty (THA) has been argued to improve health-related quality of life (HRQoL) and function in femoral neck fracture patients compared with hemiarthroplasty (HA). The HEALTH trial showed no clinically important functional advantages of THA over HA. The current analysis explores factors associated with HRQoL and function in this population. METHODS Using repeated measures regression, we estimated the association between HRQoL and function [Short Form-12 (SF-12) physical component score (PCS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) function score] and 23 variables. RESULTS THA as compared to monopolar HA, but not bipolar HA, was more likely to improve PCS scores (adjusted mean difference [AMD] 1.88 points, P = 0.02), whereas higher American Society of Anesthesiologists score (AMD -2.64, P < 0.01), preoperative use of an aid (AMD -2.66, P < 0.01), and partial weight-bearing status postoperatively (AMD -1.38, P = 0.04) demonstrated less improvement of PCS scores over time. THA improved WOMAC function scores over time compared with monopolar HA (but not bipolar HA) (AMD -2.40, P < 0.01), whereas higher American Society of Anesthesiologists classification (AMD 1.99, P = 0.01) and preoperative use of an aid (AMD 5.39, P < 0.01) were associated with lower WOMAC function scores. Preoperative treatment for depression was associated with lower functional scores (AMD 7.73, P < 0.01). CONCLUSION Patients receiving THA are likely to receive small and clinically unimportant improvements in health utility and function compared with those receiving monopolar HA and little improvement compared with those receiving bipolar HA. Patient-specific characteristics seem to play a larger role in predicting functional improvement among femoral neck fracture patients. LEVEL OF EVIDENCE Prognostic Level II.
Collapse
|
6
|
Cuestionario CUPAX: desarrollo y validación de una nueva escala para la valoración del nivel funcional de pacientes mayores de 65 años con fractura de cadera. Med Clin (Barc) 2020; 154:481-487. [DOI: 10.1016/j.medcli.2019.07.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 07/22/2019] [Accepted: 07/31/2019] [Indexed: 12/29/2022]
|
7
|
Duijnisveld BJ, van den Hout JAAM, Wagenmakers R, Koenraadt KLM, Bolder SBT. No Learning Curve of the Direct Superior Approach in Total Hip Arthroplasty. Orthop Surg 2020; 12:852-860. [PMID: 32424969 PMCID: PMC7307249 DOI: 10.1111/os.12689] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 03/11/2020] [Accepted: 03/27/2020] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES To assess the learning curve of the direct superior approach (DSA) for total hip arthroplasty (THA) and to compare surgical, clinical, and radiological results with a matched control group using the mini posterior approach (MPA). METHODS A prospective cohort study was performed from October 2016 to May 2017 including our first 52 patients undergoing THA using the DSA. Patients with primary osteoarthritis or osteonecrosis and a body mass index (BMI) < 35 who were eligible for surgery were included. As a control group, 52 patients who underwent the MPA were included, matched based on age, BMI, and ASA classification. In the DSA group, damage to the iliotibial tract and the distal external rotators, including the external obturator and quadriceps femoris muscles, was avoided. Outcome measures were collected, including surgical time, blood loss, postoperative pain, length of stay, implant position, use of walking aids, patient reported outcome measures (PROM), and complications. Unpaired t-tests were used to analyze differences between the DSA and the MPA group in surgical time, blood loss, length of stay, and acetabular and femoral component position. χ2 -tests were used to analyze mobility and the number of complications. Two-way repeated measures ANOVA was used to analyze pain scores and PROM between the DSA and the MPA groups. RESULTS The mean surgical time of 61 min (SD 8) in the DSA group was longer (P < 0.001) compared to that in the MPA group, 46 min (SD 12). No differences were found in blood loss, postoperative pain, or mean length of stay in the hospital. After 6 weeks, 94% of the patients in the DSA group were able to walk inside their home without walking aids compared to 90% in the MPA group. The mobility scores were not different after follow up of 6 weeks and 1 year (P = 0.12 and P = 0.36 respectively). All PROM improved postoperatively in both the DSA and the MPA group (P < 0.01). Acetabular cup and femoral stem position were not compromised by the DSA. Complications included two Vancouver B2 periprosthetic fractures in the DSA group, of which there was one surgical-related fracture and one fracture after a traffic accident. Complications in the MPA group included one periprosthetic fracture, two hip dislocations, and one ischial neuropathy. No infections or thromboembolic events were observed. The 1-year complication rate was not different between the MPA and DSA groups (P = 0.40). CONCLUSION The DSA can be safely introduced as no learning curve in the prosthesis position or the complication rate was found.
Collapse
Affiliation(s)
- Bouke J Duijnisveld
- Department of Orthopaedic Surgery, Sint Maartenskliniek, Nijmegen, The Netherlands
| | | | - Robert Wagenmakers
- Department of Orthopaedic Surgery, Amphia Hospital, Breda, The Netherlands
| | - Koen L M Koenraadt
- Foundation for Orthopaedic Research, Care and Education, Amphia Hospital, Breda, The Netherlands
| | - Stefan B T Bolder
- Department of Orthopaedic Surgery, Amphia Hospital, Breda, The Netherlands
| |
Collapse
|
8
|
Balzer-Geldsetzer M, Buecking B, Ruchholtz S, Kis B, Dodel R, Hessmann P. Association between longitudinal clinical outcomes in patients with hip fracture and their pre-fracture place of residence. Psychogeriatrics 2020; 20:11-19. [PMID: 30920108 DOI: 10.1111/psyg.12450] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 01/05/2019] [Accepted: 02/24/2019] [Indexed: 01/15/2023]
Abstract
BACKGROUND Clinical outcomes of patients with proximal femoral fracture within 1 year after hospitalization are presented. In particular, associations between the patients' clinical status and their pre-fracture residence were evaluated (community-dwelling vs nursing home). METHODS Patients aged ≥60 years with proximal femoral fractures were included in a prospective, single-centre observational study and followed for 12 months. Patients' clinical status at baseline was compared to their health status at follow-up 12 months later. Several standardized questionnaires were used to evaluate the patients' functional and cognitive capacity (e.g. Lawton Instrumental Activities of Daily Living Scale, Barthel Index, and Mini-Mental State Examination), mobility (timed up-and-go test, Tinetti Test, and Harris Hip Score), quality of life (EuroQol-5 Dimensions index and EuroQol Visual Analogue Scale), and psychological status (Geriatric Depression Scale). RESULTS This study included 402 patients (mean age: 81.3 ± 8.2 years, 72% women). Patients stayed in hospital for 13.7 ± 6.1 days on average. The comparison of patients' clinical status at baseline and at 12-month follow-up revealed that the Mini-Mental State Examination and Charlson Comorbidity Index remained unchanged (P = 0.527 and P = 0.705), the level of depression (Geriatric Depression Scale) significantly decreased (P < 0.001), and quality of life (EuroQol-5 Dimensions index) diminished (P < 0.001). Although patients' mobility increased after 12 months (P < 0.001 for timed up-and-go test and Harris Hip Score), their functional capacity was significantly reduced (P < 0.001 for Barthel Index and Lawton Instrumental Activities of Daily Living Scale). Nursing home residents showed a significantly higher impairment at baseline than community-dwelling individuals and less improvement in functional and cognitive tests at 12-month follow-up. CONCLUSIONS Clinical outcomes after hip fracture are significantly associated with patients' pre-fracture residence status. Place of residence as well as functional and cognitive status on admission may lead to differences in functional recovery and affect therapeutic and rehabilitative decision-making.
Collapse
Affiliation(s)
- Monika Balzer-Geldsetzer
- University Hospital Essen, Geriatric Centre Haus Berge, Contilia GmbH, Germany.,Department of Neurology, Philipps-University Marburg, Giessen, Germany
| | - Benjamin Buecking
- Department of Trauma, Hand and Reconstructive Surgery, Philipps-University Marburg, Germany
| | - Steffen Ruchholtz
- Department of Trauma, Hand and Reconstructive Surgery, Philipps-University Marburg, Germany
| | - Bernhard Kis
- Department of Psychiatry and Psychotherapy, University Medical Center, Goettingen, Germany
| | - Richard Dodel
- University Hospital Essen, Geriatric Centre Haus Berge, Contilia GmbH, Germany.,Department of Neurology, Philipps-University Marburg, Giessen, Germany
| | - Philipp Hessmann
- Department of Psychiatry and Psychotherapy, University Medical Center, Goettingen, Germany
| |
Collapse
|
9
|
Xu BY, Yan S, Low LL, Vasanwala FF, Low SG. Predictors of poor functional outcomes and mortality in patients with hip fracture: a systematic review. BMC Musculoskelet Disord 2019; 20:568. [PMID: 31775693 PMCID: PMC6882152 DOI: 10.1186/s12891-019-2950-0] [Citation(s) in RCA: 137] [Impact Index Per Article: 27.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 11/14/2019] [Indexed: 12/17/2022] Open
Abstract
Background Hip fracture is an important and prevalent medical condition associated with adverse outcomes. The aim of this article is to systematically review and summarise the predictors of poor functional outcomes and mortality for patients with hip fractures. Methods We conducted a systemic literature search using PubMed, EMBASE and Cochrane Library. We included English peer-reviewed cohort studies that examined predictors of poor functional outcomes (such as independence in Activities of Daily Living) and mortality for patients with hip fracture published in the past 15 years (from 1 Jan 2004 up to 30 May 2019). Two independent researchers evaluated the articles for eligibility. Consensus on the eligibility was sought and a third researcher was involved if there was disagreement. A standardised form was used to extract relevant data. The Newcastle-Ottawa Scale (NOS) was used to assess the quality of the included studies. Results We retrieved 4339 and included 81 articles. We identified two emerging predictors of poor functional outcomes and mortality for patients with hip fractures: low hand grip strength and frailty in line with an emerging concept of “physical performance”. The predictors identified in this systematic review can be grouped into 1) medical factors, such as presence of co-morbidities, high American Society of Anesthesiologists (ASA) grade, sarcopenia, 2) surgical factors including delay in operation (e.g. > 48 h), type of fracture s, 3) socio-economic factors which include age, gender, ethnicity, and 4) system factors including lower case-volume centers. Conclusions This systematic review identified multiple significant predictors of poor functional outcomes and mortality, with the hand grip strength and frailty being important emerging predictors in the most recent literature. These predictors would further inform healthcare providers of their patients’ health status and allow for early intervention for modifiable predictors.
Collapse
Affiliation(s)
- Bang Yu Xu
- Department of Post Acute and Continuity Care, SingHealth Community Hospital - Sengkang, 1 Anchorvale St, Singapore, 544835, Singapore.
| | - Shi Yan
- Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
| | - Lian Leng Low
- Department of Family Med & Continuing Care, Singapore General Hospital, Outram Rd, Singapore, 169608, Singapore
| | - Farhad Fakhrudin Vasanwala
- Department of Post Acute and Continuity Care, SingHealth Community Hospital - Sengkang, 1 Anchorvale St, Singapore, 544835, Singapore
| | - Sher Guan Low
- Department of Post Acute and Continuity Care, SingHealth Community Hospital - Sengkang, 1 Anchorvale St, Singapore, 544835, Singapore
| |
Collapse
|
10
|
Shah SRM, Velander J, Mathur P, Perez MD, Asan NB, Kurup DG, Blokhuis TJ, Augustine R. Split-Ring Resonator Sensor Penetration Depth Assessment Using In Vivo Microwave Reflectivity and Ultrasound Measurements for Lower Extremity Trauma Rehabilitation. SENSORS (BASEL, SWITZERLAND) 2018; 18:E636. [PMID: 29466312 PMCID: PMC5855979 DOI: 10.3390/s18020636] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 02/14/2018] [Accepted: 02/19/2018] [Indexed: 11/16/2022]
Abstract
In recent research, microwave sensors have been used to follow up the recovery of lower extremity trauma patients. This is done mainly by monitoring the changes of dielectric properties of lower limb tissues such as skin, fat, muscle, and bone. As part of the characterization of the microwave sensor, it is crucial to assess the signal penetration in in vivo tissues. This work presents a new approach for investigating the penetration depth of planar microwave sensors based on the Split-Ring Resonator in the in vivo context of the femoral area. This approach is based on the optimization of a 3D simulation model using the platform of CST Microwave Studio and consisting of a sensor of the considered type and a multilayered material representing the femoral area. The geometry of the layered material is built based on information from ultrasound images and includes mainly the thicknesses of skin, fat, and muscle tissues. The optimization target is the measured S11 parameters at the sensor connector and the fitting parameters are the permittivity of each layer of the material. Four positions in the femoral area (two at distal and two at thigh) in four volunteers are considered for the in vivo study. The penetration depths are finally calculated with the help of the electric field distribution in simulations of the optimized model for each one of the 16 considered positions. The numerical results show that positions at the thigh contribute the highest penetration values of up to 17.5 mm. This finding has a high significance in planning in vitro penetration depth measurements and other tests that are going to be performed in the future.
Collapse
Affiliation(s)
- Syaiful Redzwan Mohd Shah
- Microwaves in Medical Engineering Group, Solid State Electronics, Department of Engineering Sciences, Angstrom Laboratory, Uppsala University, Box 534, SE 75121 Uppsala, Sweden.
| | - Jacob Velander
- Microwaves in Medical Engineering Group, Solid State Electronics, Department of Engineering Sciences, Angstrom Laboratory, Uppsala University, Box 534, SE 75121 Uppsala, Sweden.
| | - Parul Mathur
- Department of Electronics and Communication, Amrita School of Engineering, Amrita Vishwa Vidyapeetham, Bengaluru , 560035, India.
| | - Mauricio D Perez
- Microwaves in Medical Engineering Group, Solid State Electronics, Department of Engineering Sciences, Angstrom Laboratory, Uppsala University, Box 534, SE 75121 Uppsala, Sweden.
| | - Noor Badariah Asan
- Microwaves in Medical Engineering Group, Solid State Electronics, Department of Engineering Sciences, Angstrom Laboratory, Uppsala University, Box 534, SE 75121 Uppsala, Sweden.
| | - Dhanesh G Kurup
- Department of Electronics and Communication, Amrita School of Engineering, Amrita Vishwa Vidyapeetham, Bengaluru , 560035, India.
| | - Taco J Blokhuis
- Department of surgery, Maastricht University Medical Center, PO Box 5800 6202 AZ Maastricht, The Netherlands.
| | - Robin Augustine
- Microwaves in Medical Engineering Group, Solid State Electronics, Department of Engineering Sciences, Angstrom Laboratory, Uppsala University, Box 534, SE 75121 Uppsala, Sweden.
| |
Collapse
|
11
|
Gagnier JJ, Huang H, Mullins M, Marinac-Dabić D, Ghambaryan A, Eloff B, Mirza F, Bayona M. Measurement Properties of Patient-Reported Outcome Measures Used in Patients Undergoing Total Hip Arthroplasty. JBJS Rev 2018; 6:e2. [DOI: 10.2106/jbjs.rvw.17.00038] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
|
12
|
Aigner R, Buecking B, Hack J, Eschbach D, Oberkircher L, Ruchholtz S, Bliemel C. Pre-fracture hospitalization is associated with worse functional outcome and higher mortality in geriatric hip fracture patients. Arch Osteoporos 2017; 12:32. [PMID: 28349470 DOI: 10.1007/s11657-017-0327-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 03/16/2017] [Indexed: 02/03/2023]
Abstract
UNLABELLED Hip fractures are common in elderly people. Despite great progress in surgical care, the outcomes of these patients remain disappointing. This study determined pre-fracture hospital admission as a prognostic variable for inferior functional outcomes and increased mortality rates in the perioperative phase and in the first postoperative year. PURPOSE The influence of a pre-fracture hospitalization on outcomes in hip fracture patients has not yet been investigated. METHODS Four hundred two patients who were surgically treated for hip fracture were prospectively enrolled. Patients with a hospital stay within the last 3 months prior to a hip fracture were compared to patients without a pre-fracture hospitalization. Postoperative functional outcomes and mortality rates were compared between groups at the time of hospital discharge and additionally at the six- and twelve-month follow-up appointments. A multivariate regression analysis was performed. RESULTS A pre-fracture hospitalization was reported by 67 patients (17%). In 63% of cases, patients were admitted due to non-surgical, general medical conditions. In 37% of cases, patients were treated due to a condition related to a surgical subject. In the multivariate analysis, pre-fracture hospitalization was an independent risk factor for reduced values on the Barthel Index at 6 months after surgery (B, -9.918; 95%CI of B, -19.001--0.835; p = 0.032) and on the Tinetti Test at 6 months (B, -2.914; 95%CI of B, -1.992--0.047; p = 0.047) and 12 months after surgery (B, -4.680; 95%CI of B, -8.042--1.319; p = 0.007). Pre-fracture hospitalization was additionally associated with increased mortality rates at 6 months (OR 1.971; 95%CI 1.052-3.693; p = 0.034) and 12 months after surgery (OR 1.888; 95%CI 1.010-9.529; p = 0.046). CONCLUSIONS Hip fracture patients with a recent pre-fracture hospital admission are at a substantial risk for inferior functional outcomes and increased mortality rates not only in the perioperative phase but also in the first postoperative year. As a simple dichotomous variable, pre-fracture hospitalization might be a suitable tool for future geriatric hip fracture screening instruments.
Collapse
Affiliation(s)
- Rene Aigner
- Center for Orthopaedics and Trauma Surgery, University Hospital Marburg, Baldingerstrasse, 35043, Marburg, Germany
| | - Benjamin Buecking
- Center for Orthopaedics and Trauma Surgery, University Hospital Marburg, Baldingerstrasse, 35043, Marburg, Germany
| | - Juliana Hack
- Center for Orthopaedics and Trauma Surgery, University Hospital Marburg, Baldingerstrasse, 35043, Marburg, Germany
| | - Daphne Eschbach
- Center for Orthopaedics and Trauma Surgery, University Hospital Marburg, Baldingerstrasse, 35043, Marburg, Germany
| | - Ludwig Oberkircher
- Center for Orthopaedics and Trauma Surgery, University Hospital Marburg, Baldingerstrasse, 35043, Marburg, Germany
| | - Steffen Ruchholtz
- Center for Orthopaedics and Trauma Surgery, University Hospital Marburg, Baldingerstrasse, 35043, Marburg, Germany
| | - Christopher Bliemel
- Center for Orthopaedics and Trauma Surgery, University Hospital Marburg, Baldingerstrasse, 35043, Marburg, Germany.
| |
Collapse
|
13
|
Abstract
INTRODUCTION With the rising number of total hip arthroplasties (THAs) each year, it is increasingly important for surgeons to have evidence-based information on which to determine how often patients should be examined postoperatively. The purpose of this research was to determine whether it is possible to identify - based on Harris Hip Score (HHS) - early signs or predictors of THA failure so that methods of postoperative follow-up can be scheduled in advance of the time frame indicated by those predictors of failure. METHODS The HHS of 9,949 primary THAs performed from 1973 to 2012 was reviewed retrospectively to identify the clinical predictors of failure. 1,131 hips were completely lost to follow-up, leaving 8,331 primary THAs in 6,979 patients. Time to failure was recorded with Kaplan-Meier analysis performed with aseptic loosening or revision of any component as the endpoint. RESULTS Regression analysis revealed that a pain score of 30 or less at any time of follow-up (p<0.0001) was a significant risk and strongly indicative of later failing. A low distance walked score of 5 or less at 6 months (p = 0.0087) and 1 year (p = 0.0167) served as an early predictor of future failure. A lower stairs score of 2 or less was also an early predictor at 1 year (p = 0.0343) and at 3 years (p = 0.0245). A lower limp score of 8 or less was a mid-term predictor at 3 (p = 0.0001), 5 (p = 0.0002), 7 (p = 0.0191) and 10 (0.0028) years postoperative follow-up. CONCLUSIONS Pain, walk, stairs and limp scores are predictive of THA failure. Surgeons with patients who present with these indicators should optimise postoperative follow-ups to alert their patients.
Collapse
|
14
|
Correlation between the level of physical activity as measured by accelerometer and the Harris Hip Score. Hip Int 2016; 25:461-5. [PMID: 25952909 DOI: 10.5301/hipint.5000245] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/10/2015] [Indexed: 02/04/2023]
Abstract
BACKGROUND The most widely used method to assess the outcome of total hip arthroplasty (THA) is the Harris Hip Score (HHS). Patients' expectations about the benefits of hip arthroplasty are increasing and are no longer limited to pain reduction. Patients believe they will be able to do recreational activity and sport after surgery. It is also essential to assess the level of physical activity after arthroplasty insofar as it is associated with early failure of the components. The purpose of this study is to explore correlation of the HHS with physical activity in patients with THA. METHODS This is a cross-sectional study on 47 patients with THA. Correlation of HHS with the results of physical activity obtained objectively using accelerometer worn for a week and subjectively using the IPAQ questionnaire and the UCLA scale. FINDING There was no correlation between the HHS and the activity measured using accelerometers, or with the IPAQ activity questionnaire. The HHS reported moderately significant correlations with the UCLA scale. CONCLUSIONS The HHS may not be as discriminatory as other instruments at assessing patient activity levels after THA.
Collapse
|
15
|
Sköldenberg O, Chammout G, Mukka S, Muren O, Nåsell H, Hedbeck CJ, Salemyr M. HOPE-trial: hemiarthroplasty compared to total hip arthroplasty for displaced femoral neck fractures in the elderly-elderly, a randomized controlled trial. BMC Musculoskelet Disord 2015; 16:307. [PMID: 26480938 PMCID: PMC4617887 DOI: 10.1186/s12891-015-0763-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 10/08/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A femoral neck fracture (FNF) is a common cause of suffering and premature death in the elderly population. Optimizing the treatment for improved outcome and a reduced need for secondary surgery is important both for the patient and the society. The choice of primary total or hemiarthroplasty in patients over eighty years are controversial. We hypothesized that total hip arthroplasty has an equal or better outcome in patient-reported outcome compared with hemiarthroplasty. METHODS/DESIGN A prospective, randomized, single-blinded trial will be conducted. We will include 120 patients, 80 years of age and over with an acute (<36 h) displaced femoral neck fracture. The patients will be randomized in a 1:1 ratio to either total hip arthroplasty or hemiarthroplasty. The primary endpoints are Harris hip Score and EQ-5D. Secondary endpoints include pain measured with visual analogue scale, surgical time, reoperations, complications and radiological measurement of erosion in patients operated with hemiarthroplasty. Follow-up will be performed postoperatively after three months, 1, 2, 4 and 10 years. DISCUSSION To our knowledge, this is the first randomized controlled trial comparing total hip arthroplasty and hemiarthroplasty for displaced femoral neck fracture in patients age 80 years and over. TRIAL REGISTRATION Clinicaltrial.gov: NCT02246335.
Collapse
Affiliation(s)
- Olof Sköldenberg
- Department of Clinical Sciences, Division of Orthopaedics, Karolinska Institutet at Danderyd Hospital, S-182 88, Danderyd, Sweden.
| | - Ghazi Chammout
- Department of Clinical Sciences, Division of Orthopaedics, Karolinska Institutet at Danderyd Hospital, S-182 88, Danderyd, Sweden
| | - Sebastian Mukka
- Department of Surgical and Perioperative Science, Umeå University, S-901 85, Umeå, Sweden
| | - Olle Muren
- Department of Clinical Sciences, Division of Orthopaedics, Karolinska Institutet at Danderyd Hospital, S-182 88, Danderyd, Sweden
| | - Hans Nåsell
- Department of Clinical Sciences, Division of Orthopaedics, Karolinska Institutet at Danderyd Hospital, S-182 88, Danderyd, Sweden
| | - Carl-Johan Hedbeck
- Department of Clinical Sciences, Division of Orthopaedics, Karolinska Institutet at Danderyd Hospital, S-182 88, Danderyd, Sweden
| | - Mats Salemyr
- Department of Clinical Sciences, Division of Orthopaedics, Karolinska Institutet at Danderyd Hospital, S-182 88, Danderyd, Sweden
| |
Collapse
|
16
|
Wang F, Zhang H, Zhang Z, Ma C, Feng X. Comparison of bipolar hemiarthroplasty and total hip arthroplasty for displaced femoral neck fractures in the healthy elderly: a meta-analysis. BMC Musculoskelet Disord 2015; 16:229. [PMID: 26316274 PMCID: PMC4552391 DOI: 10.1186/s12891-015-0696-x] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 08/25/2015] [Indexed: 02/08/2023] Open
Abstract
Background Displaced femoral neck fractures (FNFs) in healthy elderly patients have traditionally been managed with hemiarthroplasty (HA) or total hip arthroplasty (THA), with studies suggesting that THA may be the better option. However, it has recently been reported that bipolar HA (BHA) also provides good outcomes, and it is not clear as to whether BHA or THA is most appropriate. The purpose of this study was to conduct a meta-analysis of randomized controlled trials (RCTs) comparing the outcomes of BHA with THA for treating FNF in healthy elderly patients. Methods We searched the following databases from inception to May 2015 for relevant RCTs without language restrictions: PubMed, the Cochrane Central Register of Controlled Trials, Ovid MEDLINE and EMBASE, CINAHL, the China Biological Medicine Database, International Clinical Trials Registry Platform, Current Controlled Trials, and ClinicalTrials.gov. RCTs that met the inclusion criteria were statistically analyzed using the Cochrane review methods. Results Eight RCTs were included (total 1,014 patients; 523 had BHA and 491 had THA). The data from included RCTs were divided into four subgroups according to different follow-up durations. The Harris Hip Score after BHA was not different from that after THA in all subgroups. Both reoperation rate and acetabular erosion rate were higher after BHA after more than 4 years, while there was a higher dislocation rate associated with THA within 4 years. THA was more favorable regarding the EQindex-5D and the mobility and pain rate, while BHA was more favorable regarding operating time. No significant differences were found regarding infection rate, general complications, 1-year mortality, blood loss, and length of postoperative hospital stay. Conclusions For healthy elderly patients with displaced FNFs, treatment with BHA led to better outcomes regarding dislocation rate, while THA was better regarding acetabular erosion rate and reoperation rate. When comparing BHA with THA, there were no significant differences in other important outcomes such as Harris Hip Score, infection rate, general complications, and 1-year mortality. Further high-quality RCTs are needed to provide robust evidence and evaluate the treatment options.
Collapse
Affiliation(s)
- Feng Wang
- Department of Orthopedics, the Fourth Affiliated Hospital of China Medical University, Chongshan Road, Shenyang, 110032, Liaoning, People's Republic of China.
| | - Haifei Zhang
- Department of Orthopedics, the Fourth Affiliated Hospital of China Medical University, Chongshan Road, Shenyang, 110032, Liaoning, People's Republic of China.
| | - Zhiyu Zhang
- Department of Orthopedics, the Fourth Affiliated Hospital of China Medical University, Chongshan Road, Shenyang, 110032, Liaoning, People's Republic of China.
| | - Chengbin Ma
- Department of Orthopedics, the Fourth Affiliated Hospital of China Medical University, Chongshan Road, Shenyang, 110032, Liaoning, People's Republic of China.
| | - Ximin Feng
- Department of Orthopedics, the Fourth Affiliated Hospital of China Medical University, Chongshan Road, Shenyang, 110032, Liaoning, People's Republic of China.
| |
Collapse
|
17
|
Potter LJ, Doleman B, Moppett IK. A systematic review of pre-operative anaemia and blood transfusion in patients with fractured hips. Anaesthesia 2015; 70:483-500. [PMID: 25764405 DOI: 10.1111/anae.12978] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2014] [Indexed: 12/18/2022]
Abstract
We systematically reviewed the observational associations of anaemia with outcomes and the effects of interventions to increase haemoglobin concentrations following hip fracture in older people. Anaemia on hospital admission was associated with increased mortality, relative risk 1.64 (95% CI 1.47-1.82), p < 0.0001. After adjustment for co-morbidities, the association of anaemia with increased mortality remained in four of eight observational studies. There was no association of postoperative transfusion with mortality after adjusting for covariates. Transfusion at 80 g.l(-1) vs 100 g.l(-1) increased acute myocardial infarction, relative risk 1.67 (95% CI 1.01-2.77), p = 0.05. Transfusion threshold was not associated with differences in other outcomes. There were insufficient high-quality studies to inform pre-operative blood transfusion or the use of peri-operative iron or erythropoietin. Studies for most interventions recruited too few participants to determine effects on infections, mortality or function.
Collapse
Affiliation(s)
- L J Potter
- Anaesthesia and Critical Care Research Group, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | | | | |
Collapse
|
18
|
Minimally invasive direct anterior approach for total hip arthroplasty in the management of femoral neck fractures in older patients. CURRENT ORTHOPAEDIC PRACTICE 2015. [DOI: 10.1097/bco.0000000000000179] [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]
|
19
|
Colombo M, Vitali S, Cutaia C, Marelli E, Guaita A. Rehabilitative Outcomes after Hip Fracture in a Special Care Unit for Persons with Dementia and Behavioral and Psychotic Symptoms. Health (London) 2015. [DOI: 10.4236/health.2015.79132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
20
|
Restoration of hip architecture with bipolar hemiarthroplasty in the elderly: does it affect early functional outcome? Arch Orthop Trauma Surg 2014; 134:31-8. [PMID: 24202407 DOI: 10.1007/s00402-013-1878-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Reconstruction of the anatomic architecture correlates with functional outcome in patients receiving elective total hip arthroplasty. In theory similar rules should apply for bipolar hemiarthroplasty in femoral neck fractures. The influence of anatomic restoration after bipolar hemiarthroplasty on short-term clinical and functional outcome is explored in this study. PATIENTS AND METHODS Patients receiving bipolar hemiarthroplasty for intracapsular femoral neck fractures between 2010 and 2012 were included into a retrospective cohort study. Radiologic and functional outcome parameters were recorded during the acute care phase and geriatric rehabilitation. Postoperative mobilization data were recorded and co-morbidities documented for each case. Outcome parameters were obtained during geriatric rehabilitation: Barthel index, Tinetti score, Timed up and go test, Mini-Mental State Examination. The FO-ratio (ratio of femoral offset to the body weight lever arm), HC-ratio (ratio of the height of the hip center to the pelvic height) and the BWLA ratio (ratio of the body weight lever arm to the pelvic height) were obtained from postoperative radiographs. RESULTS A total of 193 patients with a median age of 84 (IQR = 78-94, 72% female) were analyzed. The in-hospital mortality rate was 5.7%. There was a high proportion of patients with prior co-morbidities (96% with at least one co-morbidity). During rehabilitation the Barthel index improved significantly (p < 0.001) from 40 to 55. The median Tinetti score on rehabilitation discharge was 15.5 (IQR = 10-19.5). The patients significantly improved in the timed up and go test from a median of 22 to 19 s. A significant difference (p < 0.001) was found comparing the FO ratios of the operated vs. non-operated side. None of the radiographic measures, representing the reconstructed anatomic hip geometry, significantly influenced the clinical and geriatric outcome. CONCLUSIONS Applying the short-term functional outcome scores used in this study, optimized anatomic restoration in hemiarthroplasty may not be a major influencing factor in a cohort of elder, multi-morbid patients.
Collapse
|
21
|
Ceccarelli F, Calderazzi F, Pedrazzi G. Is there a relation between AOFAS ankle-hindfoot score and SF-36 in evaluation of Achilles ruptures treated by percutaneous technique? J Foot Ankle Surg 2013; 53:16-21. [PMID: 24239424 DOI: 10.1053/j.jfas.2013.09.005] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Indexed: 02/03/2023]
Abstract
The percutaneous technique of Achilles tendon repair seems to offer satisfactory clinical and functional results, although these results have been evaluated mainly using objective rating scales. Recently, some "subjective" rating scales have been combined to evaluate the results of various surgical treatments. The purpose of the present study was to compare the results of a percutaneous Achilles tendon repair evaluated objectively using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and subjectively using the Medical Outcomes Study, short-form, 36-item questionnaire (SF-36) questionnaire. A total of 17 consecutive patients were treated for acute Achilles tendon rupture using the modified percutaneous Ma and Griffith technique. We reviewed all patients with a follow-up of 24 to 64 months (mean 45.5). At the final follow-up visit, the AOFAS ankle-hindfoot score of each patient was compared with each 1 of the 8 domains of the SF-36 questionnaire, using the parametric Pearson correlation coefficient and the equivalent nonparametric Spearman rho correlation coefficient. The relation between the objective (AOFAS) and subjective (SF-36) results showed a significant correlation (Pearson's correlation coefficient) between the physical functioning (r = 0.597, p = .011) and bodily pain (r = 0.663, p = .004) SF-36 domains, and a nonstatistically significant correlation with the other SF-36 domains. Very similar results were found using the nonparametric Spearman rho correlation coefficient. These results suggest that regarding pain and function, the AOFAS ankle-hindfoot score and SF-36 provide complementary information; therefore, we believe that the SF-36 questionnaire should be used with the AOFAS ankle-hindfoot score for a more complete evaluation of the outcome.
Collapse
Affiliation(s)
- Francesco Ceccarelli
- Full Professor, Clinica Ortopedica Operative Unit, Department of Surgical Sciences, University of Parma, Ospedale Maggiore, Parma, Italy
| | - Filippo Calderazzi
- Staff, Clinica Ortopedica Operative Unit, Department of Surgical Sciences, University of Parma, Ospedale Maggiore, Parma, Italy.
| | - Giuseppe Pedrazzi
- Associate Professor, Physics Unit, Department of Public Health, University of Parma, Italy
| |
Collapse
|
22
|
Buecking B, Wack C, Oberkircher L, Ruchholtz S, Eschbach D. Do concomitant fractures with hip fractures influence complication rate and functional outcome? Clin Orthop Relat Res 2012; 470:3596-606. [PMID: 22707068 PMCID: PMC3492635 DOI: 10.1007/s11999-012-2419-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2011] [Accepted: 05/24/2012] [Indexed: 01/31/2023]
Abstract
BACKGROUND Owing to the aging population, the incidence of hip fractures is increasing. While concomitant fractures are not uncommon, it is unclear how they influence subsequent function. QUESTIONS/PURPOSES Therefore, we determined (1) the incidence, type and treatment of concomitant fractures accompanying hip fractures, (2) the length of hospital stay, (3) the impact of concomitant fractures on mortality and complication rate, and (4) patients' function. METHODS We retrospectively reviewed 402 patients older than 60 years with hip fractures. We recorded the presence of concomitant fractures and their treatment. We analyzed the duration of hospital stays, in-hospital mortality, perioperative complications, and function. We recorded function with the Barthel Index, Harris hip score, and timed up and go test. For this study we followed patients 1 year. RESULTS Twenty-two patients (5%) had concomitant fractures, the most frequent being proximal humeral fractures (n = 8) and distal radius fractures (n = 6). Patients without and with concomitant fractures had similar lengths of hospitalization (mean, 14 days; 95% CI, 13-15 days), in-hospital mortality (5% with concomitant fractures, 6% without concomitant fractures), and incidence of complications (41% versus 40%). Function at discharge and last followup were similar in both groups. CONCLUSION The most frequent concomitant fractures were typical osteoporotic fractures (radial and humeral fractures). Concomitant fractures did not influence length of hospitalization, in-hospital mortality, complication rate, and function. Hip fracture and comorbidities predicted the incidence of complications and patients' function. LEVEL OF EVIDENCE Level II, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Benjamin Buecking
- Department of Trauma, Hand and Reconstructive Surgery, University of Giessen and Marburg GmbH, Baldingerstrasse, 35043 Marburg, Germany.
| | | | | | | | | |
Collapse
|