1
|
Song M, Wang Y, Jiang Y, Pi H, Lyu H, Gao Y. Risk factors for subsequent fractures in hip fracture patients: a nested case-control study. J Orthop Surg Res 2024; 19:348. [PMID: 38867268 PMCID: PMC11167847 DOI: 10.1186/s13018-024-04833-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 06/02/2024] [Indexed: 06/14/2024] Open
Abstract
BACKGROUND The risk factors for subsequent fractures following an initial hip fracture are not entirely understood. This study examined the clinical characteristics of hip fracture patients to identify potential risk factors associated with a higher risk of experiencing subsequent fractures. METHODS We conducted a nested case-control study using data from the Chinese PLA General Hospital Hip Fracture Cohort between January 2008 and March 2022. The cases were individuals who experienced subsequent fractures following an initial hip fracture. Each case was matched with up to 2 controls who did not develop subsequent fractures. Important clinical factors were compared across groups, including traditional fracture risk factors and potential risk factors (e.g., comorbidities, falls risk, physical impairment, calcium or vitamin D use, and anti-osteoporosis medications). Conditional logistic regression analyses were used to evaluate the impact of these clinical features as potential risk factors for subsequent fractures. RESULTS A total of 96 individuals who suffered from subsequent fractures were matched with 176 controls. The median time between the initial hip fracture and the subsequent fracture was 2.1 years. The overall proportion of patients receiving anti-osteoporosis treatment after initial hip fracture was 25.7%. In the multivariable regression analysis, living in a care facility (OR = 3.78, 95%CI: 1.53-9.34), longer hospital stays (OR = 1.05, 95%CI: 1.00-1.11), and falls after discharge (OR = 7.58, 95%CI: 3.37-17.04) were associated with higher odds of subsequent fractures. CONCLUSIONS This study showed that living in a care facility, longer hospital stays, and falls after discharge may be independent risk factors for repeat fractures following an initial hip fracture. These findings could be used to identify and manage patients at high risk of subsequent fractures.
Collapse
Affiliation(s)
- Mi Song
- Medical School of Chinese PLA, No. 28, Fuxing Road, Beijing, 100853, People's Republic of China
- Department of Orthopedics, Chinese PLA General Hospital, No. 28, Fuxing Road, Beijing, 100853, People's Republic of China
- Department of nursing, Chinese PLA General Hospital, No. 28, Fuxing Road, Beijing, 100853, People's Republic of China
| | - Yilin Wang
- Medical School of Chinese PLA, No. 28, Fuxing Road, Beijing, 100853, People's Republic of China
- Department of Orthopedics, Chinese PLA General Hospital, No. 28, Fuxing Road, Beijing, 100853, People's Republic of China
| | - Yu Jiang
- Medical School of Chinese PLA, No. 28, Fuxing Road, Beijing, 100853, People's Republic of China
- Department of Orthopedics, Chinese PLA General Hospital, No. 28, Fuxing Road, Beijing, 100853, People's Republic of China
| | - Hongying Pi
- Military Health Service Training Center, Chinese PLA General Hospital, No. 28, Fuxing Road, Beijing, 100853, People's Republic of China.
| | - Houchen Lyu
- Department of Orthopedics, Chinese PLA General Hospital, No. 28, Fuxing Road, Beijing, 100853, People's Republic of China.
- National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, No. 28, Fuxing Road, Beijing, 100853, People's Republic of China.
| | - Yuan Gao
- Department of nursing, Chinese PLA General Hospital, No. 28, Fuxing Road, Beijing, 100853, People's Republic of China.
| |
Collapse
|
2
|
Kawanishi K, Nakamoto M, Mityashita T, Ogita S, Kudo S. Seated Virtual Reality-Guided Exercise Improved Gait in a Patient With Trunk Dysfunction Due to Hip Fracture: A Single-Case Design Study. Cureus 2024; 16:e62433. [PMID: 39011203 PMCID: PMC11249055 DOI: 10.7759/cureus.62433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2024] [Indexed: 07/17/2024] Open
Abstract
Physical therapy for mobilization after a hip fracture is effective in improving muscle strength and balance training of the lower extremities; however, effective interventions targeting the trunk muscles remain to be established. The efficacy of virtual reality (VR)-based exercise therapy has been recently reported. This case report demonstrates the effectiveness of VR-based intervention in improving the gait of a female patient in her 90s with a femoral neck fracture who had difficulty in independent gait postoperatively due to trunk dysfunction. The patient had undergone bipolar hip hemiarthroplasty for a right femoral neck fracture sustained via a fall at home. Standard physical therapy, including range of motion exercises, resistance training, and gait training, was commenced gradually the day after surgery. An improvement in lower extremity pain was reported at the two-month follow-up visit but without any improvement in the gait ability. Trunk flexion was observed during gait, and the patient had difficulty in independent gait and walking without upper limb support. Withdrawal and reversal designs (BAB) were employed, and each period lasted one week. Standard physiotherapy supplemented with trunk reach training in a seated position using VR equipment was commenced subsequently. An improvement in the maximum anterior pelvic tilt angle and sitting and standing postures, increased hip extension range of motion and step length during gait, and decreased gait speed were observed during the intervention phase. These results highlight the importance of physiotherapy interventions targeting the trunk muscle and the effectiveness of VR-guided trunk training in patients with femoral neck fractures.
Collapse
Affiliation(s)
- Kengo Kawanishi
- Inclusive Medical Sciences Research Institute, Morinomiya University of Medical Sciences, Osaka, JPN
| | - Masami Nakamoto
- Inclusive Medical Sciences Research Institute, Morinomiya University of Medical Sciences, Osaka, JPN
| | - Toshinori Mityashita
- Inclusive Medical Sciences Research Institute, Morinomiya University of Medical Sciences, Osaka, JPN
| | - Seiji Ogita
- Emergency Center, Kano General Hospital, Osaka, JPN
| | - Shintatou Kudo
- Inclusive Medical Sciences Research Institute, Morinomiya University of Medical Sciences, Osaka, JPN
| |
Collapse
|
3
|
Rougereau G, Bourdier JA, Langlais T, Boisrenoult P, Pujol N. Is there a femoral morphology at risk of a cervical or pertrochanteric fracture? Description and validation of the "Neck shaft ratio" and the "Intertrochanteric distal ratio" after analyzing a continuous cohort of 126 bilateral fractures of the proximal femur. Orthop Traumatol Surg Res 2024; 110:103874. [PMID: 38556208 DOI: 10.1016/j.otsr.2024.103874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 07/24/2023] [Accepted: 02/07/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND Proximal femur fractures constitute a public health concern given their high frequency and the aging population. The frequency of a contralateral fracture occurring can reach up to 15% of cases. Certain historical or demographic factors constitute risk factors for refracture, but the type of fracture, either of the femoral neck (FN) or pertrochanteric (PT), cannot be predicted. The objectives of this retrospective study were: firstly, to analyze several anatomical markers in order to determine whether they predispose to a certain type of fracture in the event of contralateral refracture, and secondly, to determine the predictive power of these possible radiological markers for the type of contralateral fracture. HYPOTHESIS The hypothesis was that the "Neck shaft ratio" (NSR) and the "Intertrochanteric distal ratio" (ITDR) made it possible to determine a proximal femoral morphology at risk of FN and/or PT fracture in the event of a second fracture. MATERIAL AND METHODS This continuous retrospective single-center series from January 2011 to December 2019 of patients who presented with bilateral fractures of the proximal femurs was analyzed. Radiographs, taken after the first fracture, of the contralateral femur were studied. Morphological measurements previously described in the literature were carried out as well as the NSR (ratio of the medial cortical thicknesses of the femoral neck at its narrowest and basicervical level) and the ITDR (ratio of the medial diaphyseal cortical thicknesses at 5mm and 20mm from the distal portion of the lesser trochanter). One hundred and twenty-six patients were included: 46/126 (36.5%) had bilateral FN, 50/126 (39.7%) bilateral PT and 30/126 (23.8%) one of each. RESULTS Only NSR and ITDR were significant predictive measures for FN or PT fracture type [0.54±0.11 vs. 0.81±0.16 (p<0.0001) and 0. 85±0.1 vs. 0.68±0.1 (p<0.0001), respectively]. These two ratios had an excellent predictive value for the type of fracture occurring on the contralateral side [NSR: AUC ROC = 0.91 (95% CI; 0.86-0.96); ITDR: AUC ROC = 0.81 (95% CI; %, 0.74-0.89)]. The NSR had excellent intra- and inter-observer reproducibility with an interclass correlation coefficient of 0.93 [95% CI: 0.86-0.97] and 0.91 [95% CI: 0.82-0.96] respectively, the same also applied for the ITDR with interclass correlation coefficient values of 0.93 [95% CI: 0.87-0.97] and 0.86 [95% CI: 0.73-0.93] respectively. DISCUSSION The NSR and ITDR ratios offer a simple and reproducible means to predict a morphological predisposition to a certain fracture type, respectively an FN and PT on the side contralateral to an initial osteoporotic proximal femur fracture. A prospective cohort study would be useful in defining a possible prognostic nature on the occurrence and/or time until refracture. LEVEL OF EVIDENCE III; retrospective control case.
Collapse
Affiliation(s)
- Grégoire Rougereau
- Service de chirurgie orthopédique et traumatologique, Hôpital Mignot, Université Versailles Saint-Quentin-en-Yvelines, Centre hospitalier de Versailles, 177, rue de Versailles, 78150 Le Chesnay-Rocquencourt, France; Service de chirurgie orthopédique, Université Sorbonne, Hôpital de la Pitié Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
| | - Jean-Arthur Bourdier
- Service de chirurgie orthopédique et traumatologique, Hôpital Mignot, Université Versailles Saint-Quentin-en-Yvelines, Centre hospitalier de Versailles, 177, rue de Versailles, 78150 Le Chesnay-Rocquencourt, France
| | - Tristan Langlais
- Service de chirurgie orthopédique, Université de Toulouse, Hôpital des enfants Purpan, 330, avenue de Grande Bretagne, 31300 Toulouse, France
| | - Philippe Boisrenoult
- Service de chirurgie orthopédique et traumatologique, Hôpital Mignot, Université Versailles Saint-Quentin-en-Yvelines, Centre hospitalier de Versailles, 177, rue de Versailles, 78150 Le Chesnay-Rocquencourt, France
| | - Nicolas Pujol
- Service de chirurgie orthopédique et traumatologique, Hôpital Mignot, Université Versailles Saint-Quentin-en-Yvelines, Centre hospitalier de Versailles, 177, rue de Versailles, 78150 Le Chesnay-Rocquencourt, France
| |
Collapse
|
4
|
Chapman PN, Georgiadis GM, Seegert S, Russell B, O'Mara-Gardner K, Bair JM, Tank JC. Outcomes and Risks Associated With Subsequent Contralateral Hip Fractures. Orthopedics 2024:1-6. [PMID: 38810129 DOI: 10.3928/01477447-20240520-05] [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: 05/31/2024]
Abstract
BACKGROUND Hip fractures constitute a major public health problem for older individuals. They are associated with functional deterioration, limited mobility, and increased mortality, while contributing to economic and social hardships that are compounded by a second hip fracture. With the aging US population and increasing rates of hip fractures, it is essential to understand factors surrounding subsequent contralateral hip fractures. MATERIALS AND METHODS This descriptive study was a retrospective review of patients 60 years and older who were identified in the institutional geriatric hip fracture database as having had an initial and subsequent contra-lateral hip fracture, with the second treated at our tertiary referral center. RESULTS The incidence of subsequent hip fracture was 13.2%. The mean time to second hip fracture was 3.5 years after the initial injury. The first fracture tended to be a femoral neck fracture, whereas the second injury was more likely to have an intertrochanteric pattern. There was a higher complication rate after a subsequent hip fracture. Patients taking osteoporosis and adjuvant medication prior to admission for the second fracture tended to have a lower 90-day mortality rate. Patients with a history of any fracture prior to the first hip fracture, with cancer, and with osteopenia had shorter intervals to the subsequent event. CONCLUSION Subsequent hip fractures carry high morbidity and mortality rates. Steps should be taken after the initial injury to optimize outcomes in the case of a subsequent event. Patients discharged after initial hip fracture should be maintained with osteoporosis medication. [Orthopedics. 202x;4x(x):xx-xx.].
Collapse
|
5
|
Lourenço BC, Amorim-Barbosa T, Lemos C, Rodrigues-Pinto R. Risk factors for refracture after proximal femur fragility fracture. Porto Biomed J 2023; 8:e207. [PMID: 37152628 PMCID: PMC10158875 DOI: 10.1097/j.pbj.0000000000000207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 02/21/2023] [Indexed: 05/09/2023] Open
Abstract
Introduction Proximal femur fragility fractures (PFFFs) are a growing worldwide concern. Recognizing the risk factors for subsequent fracture is essential for secondary prevention. This study aimed to analyze the risk factors for refracture and mortality rates in patients who suffered a PFFF. Methods Patients aged 65 years or older with PFFF who underwent surgical treatment during the year of 2017 in the same institution were retrospectively analyzed and at least four years after the index fracture were evaluated. Results From a total of 389 patients, 299 patients were included, with a median age of 83 years, and 81% female. Thirty-two (10.7%) suffered a refracture, with a mean time to refracture of 19.8 ± 14.80 months, being the female sex a risk factor for refracture (OR-4.69; CI [1.05-20.95]). The 1-year mortality rate was 15.4%. Seventy-three (24.4%) patients had previous fragility fractures. After the index fracture, 79% remained untreated for osteoporosis. No statistical association was found between antiosteoporotic treatment and refracture. Patients with refracture had higher prefracture functional level compared with patients without refracture (OR-1.33; CI [1.08-1.63]) and were discharged more often to rehabilitation units (31% versus 16%, P =.028). After 4 years of follow-up, patients with refracture had lower functional level compared with patients without. Chronic kidney disease was a risk factor (P = .029) for early refracture (<24 months). Conclusion Female sex and higher prefracture functional level may increase the risk of refracture. Chronic kidney disease was associated with a shorter refracture time. Despite having a PFFF or other fragility fractures, the majority of patients remained untreated for osteoporosis.
Collapse
Affiliation(s)
| | - Tiago Amorim-Barbosa
- Department of Orthopaedics, Centro Hospitalar Universitário do Porto, Porto, Portugal
- Corresponding author: Address: Department of Orthopaedics, Centro Hospitalar Universitário do Porto, Hospital de Santo António, Largo Prof. Abel Salazar, 4099-001 Porto, Portugal. Email address: (Tiago Amorim-Barbosa)
| | - Carolina Lemos
- Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal
- UnIGENe, i3S-Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
| | - Ricardo Rodrigues-Pinto
- Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal
- Department of Orthopaedics, Centro Hospitalar Universitário do Porto, Porto, Portugal
- Department of Orthopaedics, Spinal Unit (UVM), Centro Hospitalar Universitário do Porto, Porto, Portugal
| |
Collapse
|
6
|
A nomogram to predict postoperative infection for older hip fracture patients. Arch Orthop Trauma Surg 2023; 143:847-855. [PMID: 34625815 DOI: 10.1007/s00402-021-04171-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 09/05/2021] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Postoperative infection is one of the most common postoperative complications in hip fracture surgery. It is related with increased morbidity and mortality. This study aimed at developing a nomogram to predict the individual probability of postoperative infection to facilitate perioperative decision-making. MATERIALS AND METHODS In this retrospective study, we included all patients over 65 years old admitted for hip fracture in West China Hospital of Sichuan University from 1 January 2015 to 31 December 2019. Univariate and multivariate logistic regression analyses were used to identify significant predictors. We used all-subsets regression to screen an optimal model, and visualized the model through drawing nomogram. To evaluate the model performance, we applied receiver operating characteristic curve and calibration curve. RESULTS We enrolled 677 older patients. 136 (20.1%) patients developed postoperative infection during hospitalization. Variables retained in the final model were albumin [odds ratio (OR) 0.90, 95% confidence interval (CI) 0.84-0.96], cholesterol (OR 1.49, 95% CI 1.04-2.15), blood phosphorus (OR 0.16, 95% CI 0.05-0.48), high-density lipoprotein (OR 0.42, 95% CI 0.19-0.89), surgery type (OR 2.27, 95% CI 1.35-3.90), smoking (OR 1.95, 95% CI 1.02-3.66), American Society of Anesthesiologists classification [class III (OR 1.02, 95% CI 0.55-1.93); class IV (OR 1.93, 95% CI 0.76-4.82)], and chronic pulmonary disease (OR 2.16, 95% CI 1.25-3.68). The C-index of the nomogram was 0.752 (95% CI 0.697-0.806). Calibration curve showed good agreement between predicted value and observed outcome. In the validation group, our nomogram showed an area under the receiver operating characteristic curve of 0.723 (95% CI 0.639-0.807). CONCLUSION Our nomogram showed good discrimination ability in predicting individual probability of postoperative infection among older patients with hip fracture surgery. The nomogram could help clinicians identify patients at high risk of postoperative infection before surgery.
Collapse
|
7
|
Corrao G, Biffi A, Porcu G, Ronco R, Adami G, Alvaro R, Bogini R, Caputi AP, Cianferotti L, Frediani B, Gatti D, Gonnelli S, Iolascon G, Lenzi A, Leone S, Michieli R, Migliaccio S, Nicoletti T, Paoletta M, Pennini A, Piccirilli E, Rossini M, Tarantino U, Brandi ML. Executive summary: Italian guidelines for diagnosis, risk stratification, and care continuity of fragility fractures 2021. Front Endocrinol (Lausanne) 2023; 14:1137671. [PMID: 37143730 PMCID: PMC10151776 DOI: 10.3389/fendo.2023.1137671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 03/27/2023] [Indexed: 05/06/2023] Open
Abstract
Background Fragility fractures are a major public health concern owing to their worrying and growing burden and their onerous burden upon health systems. There is now a substantial body of evidence that individuals who have already suffered a fragility fracture are at a greater risk for further fractures, thus suggesting the potential for secondary prevention in this field. Purpose This guideline aims to provide evidence-based recommendations for recognizing, stratifying the risk, treating, and managing patients with fragility fracture. This is a summary version of the full Italian guideline. Methods The Italian Fragility Fracture Team appointed by the Italian National Health Institute was employed from January 2020 to February 2021 to (i) identify previously published systematic reviews and guidelines on the field, (ii) formulate relevant clinical questions, (iii) systematically review literature and summarize evidence, (iv) draft the Evidence to Decision Framework, and (v) formulate recommendations. Results Overall, 351 original papers were included in our systematic review to answer six clinical questions. Recommendations were categorized into issues concerning (i) frailty recognition as the cause of bone fracture, (ii) (re)fracture risk assessment, for prioritizing interventions, and (iii) treatment and management of patients experiencing fragility fractures. Six recommendations were overall developed, of which one, four, and one were of high, moderate, and low quality, respectively. Conclusions The current guidelines provide guidance to support individualized management of patients experiencing non-traumatic bone fracture to benefit from secondary prevention of (re)fracture. Although our recommendations are based on the best available evidence, questionable quality evidence is still available for some relevant clinical questions, so future research has the potential to reduce uncertainty about the effects of intervention and the reasons for doing so at a reasonable cost.
Collapse
Affiliation(s)
- Giovanni Corrao
- National Centre for Healthcare Research and Pharmacoepidemiology, Laboratory of the University of Milano-Bicocca, Milan, Italy
- Department of Statistics and Quantitative Methods, Unit of Biostatistics, Epidemiology, and Public Health, University of Milano-Bicocca, Milan, Italy
- *Correspondence: Giovanni Corrao, ; Maria Luisa Brandi,
| | - Annalisa Biffi
- National Centre for Healthcare Research and Pharmacoepidemiology, Laboratory of the University of Milano-Bicocca, Milan, Italy
- Department of Statistics and Quantitative Methods, Unit of Biostatistics, Epidemiology, and Public Health, University of Milano-Bicocca, Milan, Italy
| | - Gloria Porcu
- National Centre for Healthcare Research and Pharmacoepidemiology, Laboratory of the University of Milano-Bicocca, Milan, Italy
- Department of Statistics and Quantitative Methods, Unit of Biostatistics, Epidemiology, and Public Health, University of Milano-Bicocca, Milan, Italy
| | - Raffaella Ronco
- National Centre for Healthcare Research and Pharmacoepidemiology, Laboratory of the University of Milano-Bicocca, Milan, Italy
- Department of Statistics and Quantitative Methods, Unit of Biostatistics, Epidemiology, and Public Health, University of Milano-Bicocca, Milan, Italy
| | | | - Rosaria Alvaro
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | | | | | - Luisella Cianferotti
- Italian Bone Disease Research Foundation, Fondazione Italiana Ricerca sulle Malattie dell’Osso (FIRMO), Florence, Italy
| | - Bruno Frediani
- Department of Medicine, Surgery and Neurosciences, Rheumatology Unit, University of Siena, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - Davide Gatti
- Rheumatology Unit, University of Verona, Verona, Italy
| | - Stefano Gonnelli
- Department of Medicine, Surgery and Neuroscience, Policlinico Le Scotte, University of Siena, Siena, Italy
| | - Giovanni Iolascon
- Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Andrea Lenzi
- Department of Experimental Medicine, Sapienza University of Rome, Viale del Policlinico, Rome, Italy
| | - Salvatore Leone
- AMICI Onlus, Associazione Nazionale per le Malattie Infiammatorie Croniche dell’Intestino, Milan, Italy
| | - Raffaella Michieli
- Italian Society of General Medicine and Primary Care Società Italiana di Medicina Generale e delle cure primarie (SIMG), Florence, Italy
| | - Silvia Migliaccio
- Department of Movement, Human and Health Sciences, Foro Italico University, Rome, Italy
| | - Tiziana Nicoletti
- CnAMC, Coordinamento nazionale delle Associazioni dei Malati Cronici e rari di Cittadinanzattiva, Rome, Italy
| | - Marco Paoletta
- Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Annalisa Pennini
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Eleonora Piccirilli
- Department of Clinical Sciences and Translational Medicine, University of Rome “Tor Vergata”, Rome, Italy
- Department of Orthopedics and Traumatology, “Policlinico Tor Vergata” Foundation, Rome, Italy
| | | | - Umberto Tarantino
- Department of Clinical Sciences and Translational Medicine, University of Rome “Tor Vergata”, Rome, Italy
- Department of Orthopedics and Traumatology, “Policlinico Tor Vergata” Foundation, Rome, Italy
| | - Maria Luisa Brandi
- Italian Bone Disease Research Foundation, Fondazione Italiana Ricerca sulle Malattie dell’Osso (FIRMO), Florence, Italy
- *Correspondence: Giovanni Corrao, ; Maria Luisa Brandi,
| |
Collapse
|
8
|
Lott A, Pflug EM, Parola R, Egol KA, Konda SR. Predicting the Subsequent Contralateral Hip Fracture: Is FRAX the Answer? J Orthop Trauma 2022; 36:599-603. [PMID: 36399671 DOI: 10.1097/bot.0000000000002441] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/20/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To (1) determine the ability of the Fracture Risk Assessment Tool (FRAX) to identify the probability of contralateral hip fractures within 2 years of index fracture and (2) identify independent risk factors for a subsequent hip fracture. DESIGN Retrospective. SETTING Urban, academic medical center. PATIENTS This study included a consecutive series of patients treated for unilateral hip fractures between September 2015 and July 2019. RESULTS Eight hundred thirty-two consecutive patients were included in the analysis with a mean age of 81.2 ± 9.9 years. Thirty-one (3.7%) patients sustained a contralateral hip fracture within 2 years with these patients sustaining the second fracture at a mean 294.1 days ± 197.7 days. The average FRAX score for the entire cohort was 11.9 ± 7.4, and the area under receiving operating characteristic curve (AUROC) for FRAX score was 0.682 (95% CI, 0.596-0.767). Patients in the high-risk FRAX group had a >7% risk of contralateral hip fracture within 2 years. Independent risk factors for contralateral hip fracture risk included patient age 80 years or older and decreasing BMI. CONCLUSIONS This study demonstrates the strong ability of the FRAX score to triage patients at risk of subsequent contralateral hip fracture within 2 years. In this high-risk FRAX group, patients age older than 80 years and who have decreasing BMI after their index fracture have a 12.5% increased risk of fracture within 2 years which is 4× higher than the current World Health Organization 10-year 3% hip fracture risk standard used to initiate pharmacologic treatment. Therefore, high-risk patients identified using this methodology should be targeted more aggressively with preventative measures including social, medical, and potentially surgical interventions. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Ariana Lott
- NYU Langone Orthopedic Hospital, NYU Langone Medical Center, New York, NY
| | | | | | | | | |
Collapse
|
9
|
Yu S, Li C, Zhong Y, Zang J, Zhou Z, Wang S, Zhang Y. Risk factors for contralateral hip refractures in patients aged over 80 years with intertrochanteric femoral fractures. Front Surg 2022; 9:924585. [PMID: 36176341 PMCID: PMC9513157 DOI: 10.3389/fsurg.2022.924585] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 08/22/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose The purpose of this study was to identify which of the risk factors would contribute to the contralateral fracture in very elderly patients after intramedullary nail fixation. Methods Clinical data of 227 intertrochanteric fracture patients aged 80 years or older were retrospectively reviewed. Intramedullary nails (IMNs) were used on all of the patients. Potential risk factors for contralateral hip refractures were determined using univariate and logistic regression analyses. Results Contralateral hip refractures occurred in 11 patients (4.84%). Univariate analysis revealed that age, gender, body mass index, fracture classification, hematocrit, D-dimer, and CRP level were not associated with contralateral fractures (P > 0.05). However, neurological diseases, cardiovascular disease, and visual impairments were significantly associated with contralateral fractures (P < 0.05). Multivariate analysis further revealed that neurological diseases (OR 4.25, P = 0.044) and visual impairments (OR 5.42, P = 0.015) were independent risk factors associated with contralateral refractures. Conclusion To prevent contralateral refractures, more attention should be paid to elderly intertrochanteric fracture patients with underlying neurological disease and visual impairments.
Collapse
Affiliation(s)
- Shujun Yu
- The First Department of Hip Traumatology, Tianjin Hospital, Tianjin, China
| | - Chen Li
- The First Department of Hip Traumatology, Tianjin Hospital, Tianjin, China
| | - Yuqiao Zhong
- Department of Radiology, Tianjin Hospital, Tianjin, China
| | - Jiacheng Zang
- The First Department of Hip Traumatology, Tianjin Hospital, Tianjin, China
| | - Zhanzhe Zhou
- Department of Orthopedics, Tianjin Xiqing Hospital, Tianjin, China
| | - Song Wang
- The First Department of Hip Traumatology, Tianjin Hospital, Tianjin, China
- Correspondence: Song Wang Yinguang Zhang
| | - Yinguang Zhang
- The First Department of Hip Traumatology, Tianjin Hospital, Tianjin, China
- Correspondence: Song Wang Yinguang Zhang
| |
Collapse
|
10
|
Solou K, Tyllianakis M, Kouzelis A, Lakoumentas J, Panagopoulos A. Morbidity and Mortality After Second Hip Fracture With and Without Nursing Care Program. Cureus 2022; 14:e23373. [PMID: 35475067 PMCID: PMC9018923 DOI: 10.7759/cureus.23373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2022] [Indexed: 12/11/2022] Open
Abstract
Background Hip fractures are an increasingly common injury among older people who usually experience significantly worse mobility, independence in function, health, quality of life, and high rates of institutionalization. Studies have shown that only 40-60% of participants recover their pre-fracture level of mobility and ability to perform instrumental activities of daily living, while for those who are independent in self-care prior to the fracture, 20-60% still require assistance for various tasks one or two years after the fracture. As the cumulative incidence of a second hip fracture has been estimated to reach 8.4%, prevention of the second hip fracture is a major concern of the health system and the society focused mainly on lifestyle modifications, osteoporotic treatment, and fall-prevention strategies. The aim of the present study was to compare morbidity/mortality, functional results, and type of recovery between the first and second hip fractures in elderly patients. Methods Patients with a contralateral hip fracture were prospectively recruited during a three-year period (2016-2019). Level of independence, gait aids, type of rehabilitation, American Society of Anesthesiologists (ASA) physical status, Harris Hip Score (HHS), and Western Ontario and McMaster Universities Arthritis Index (WOMAC) scale were evaluated at admission for the second fracture and at the last reexamination. Results Twenty-seven out of 33 patients, aged 87.93±6.6, underwent surgery for contralateral hip fracture and followed up for 42.52±16.46 months; the mean interval between the two fractures was 39.63 months. The HHS averaged 86.19±12.18 and 59.01±32.83 and the WOMAC 86.37±12.09 and 68.22±26.18 before and after the second fracture, respectively. The mortality rate was 37.03%, 14.8±12.93 months after the second operation, with a significant relationship between the mortality time and the interval between fractures (p=0.028). Twelve and 14 of the patients received geriatric nursing care after the first and second fracture, respectively, without significant improvement in their functional results compared to home care. Mobility of nursing care patients after the second fracture was significantly improved (p=0.019). Conclusions Mortality is higher in the second year after the second hip fracture and strongly correlated with the time interval between fractures. A higher possibility to return in previous mobility status occurs after geriatric nursing care.
Collapse
|
11
|
Van Haecke A, Viste A, Desmarchelier R, Roy P, Mercier M, Fessy MH. Incidence and risk factors for bilateral proximal femoral fractures. Orthop Traumatol Surg Res 2022; 108:102887. [PMID: 33711506 DOI: 10.1016/j.otsr.2021.102887] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 09/06/2020] [Accepted: 09/18/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Proximal femoral fractures (PFFs) are a public health issue due to their high frequency. The frequency of a second PFF on the other side is estimated at 10%. This estimation is controversial, however, and the risk factors have not been evaluated in a large population of French patients. The objective of this retrospective case-control study was to determine: (1) the incidence of second PFFs and (2) their risk factors. HYPOTHESIS The incidence of second PFFs is >2% after 1 year and >5% after 3 years. MATERIAL AND METHODS We conducted a case-control study in a population of consecutive patients managed surgically for PPF at the Lyon Sud Hospital between 2013 and 2014. We analysed the following clinical factors: age, sex, body mass index (BMI), institutionalisation, the Parker score, the American Society of Anesthesiologists score (ASA), comorbidities, and the use of psychoactive drugs. RESULTS We included 474 PFFs (trochanter, n=240 and neck, n=234) of which 36 were bilateral. The contralateral fracture occurred within 1 year of the first fracture in 6/474 (1.3%) cases and within 3 years in all 36 cases (7.6%). The case-control study comprised 49 cases with bilateral PFF and 161 controls with no second hip fracture within 3 years. Risk factors for a second hip fracture were age older than 90 years (odds ratio [OR]=5.44; 95% confidence interval [95%CI], 112-2642 (p=0.002)) and a history of heart disease (OR, 2.18; 95%CI, 1.06-4.47 [p=0.03]). A Parker score≥6 was protective (OR, 0.84; 95%CI, 0.71-0.99 [p=0.03]). Mortality after 3 years was 42% (201/474), and 13% (63/474) of patients were lost to follow-up. DISCUSSION Age older than 90 years, a Parker score below 6, and a history of heart disease are risk factors for a second PFF within 3 years after the first PFF. LEVEL OF EVIDENCE III; case-control study.
Collapse
Affiliation(s)
- Adrien Van Haecke
- Hospices Civils de Lyon, Hôpital Lyon Sud, Service de Chirurgie Orthopédique et Traumatologique, 165 Chemin du Grand Revoyet, Pierre Bénite Cedex, France; Université de Lyon, Université Claude Bernard Lyon 1, Université Gustave Eiffel, IFSTTAR, LBMC UMRT_9406, Lyon, France
| | - Anthony Viste
- Hospices Civils de Lyon, Hôpital Lyon Sud, Service de Chirurgie Orthopédique et Traumatologique, 165 Chemin du Grand Revoyet, Pierre Bénite Cedex, France; Université de Lyon, Université Claude Bernard Lyon 1, Université Gustave Eiffel, IFSTTAR, LBMC UMRT_9406, Lyon, France.
| | - Romain Desmarchelier
- Hospices Civils de Lyon, Hôpital Lyon Sud, Service de Chirurgie Orthopédique et Traumatologique, 165 Chemin du Grand Revoyet, Pierre Bénite Cedex, France
| | - Pascal Roy
- Université de Lyon, Université Claude Bernard Lyon 1, Université Gustave Eiffel, IFSTTAR, LBMC UMRT_9406, Lyon, France; CNRS UMR 5558, Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique- Santé, Villeurbanne, France
| | - Marcelle Mercier
- Hospices Civils de Lyon, Hôpital Lyon Sud, Service de Chirurgie Orthopédique et Traumatologique, 165 Chemin du Grand Revoyet, Pierre Bénite Cedex, France
| | - Michel-Henri Fessy
- Hospices Civils de Lyon, Hôpital Lyon Sud, Service de Chirurgie Orthopédique et Traumatologique, 165 Chemin du Grand Revoyet, Pierre Bénite Cedex, France; Université de Lyon, Université Claude Bernard Lyon 1, Université Gustave Eiffel, IFSTTAR, LBMC UMRT_9406, Lyon, France
| |
Collapse
|
12
|
Vluggen TPMJ, van Vugt R, Boonen B, Keulen MHF. Management of two-level proximal femoral fractures. BMJ Case Rep 2021; 14:14/5/e240684. [PMID: 34059536 DOI: 10.1136/bcr-2020-240684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We present the case of an 82-year-old female, who experienced a ground-level fall on the trochanter of the right femur. X-rays showed a proximal femoral fracture (PFF) with an unclear and unusual fracture pattern. Three-dimensional CT images were obtained and showed a displaced femoral neck fracture and ipsilateral fracture of the greater trochanter. Our patient underwent unipolar hemiarthroplasty and fixation of the greater trochanter with a hook plate and cable grip. At 11 months, functional outcomes, patient satisfaction and quality of life were excellent. Primary osteoporosis was diagnosed and treatment with bisphosphonates was initiated.Two-level PFFs are rare and complex. Due to ageing and a subsequent increase in osteoporosis, numbers of PFFs with complex fracture patterns might increase in the future. Adequate treatment and early prevention of osteoporosis are key to reduce this risk and lower the overall burden. Surgical treatment should be patient-tailored and focus on minimising the risk of complications and reinterventions.
Collapse
Affiliation(s)
| | - Raoul van Vugt
- The Department of Orthopaedic and Trauma Surgery, Zuyderland Medical Centre Heerlen, Heerlen, Limburg, The Netherlands.,The Department of General Surgery, Zuyderland Medical Centre Heerlen, Heerlen, Limburg, The Netherlands
| | - Bert Boonen
- The Department of Orthopaedic and Trauma Surgery, Zuyderland Medical Centre Heerlen, Heerlen, Limburg, The Netherlands
| | - Mark Hendrik Franciscus Keulen
- The Department of Orthopaedic and Trauma Surgery, Zuyderland Medical Centre Heerlen, Heerlen, Limburg, The Netherlands.,The Department of General Surgery, Zuyderland Medical Centre Heerlen, Heerlen, Limburg, The Netherlands
| |
Collapse
|
13
|
McCarthy CJ, Kelly MA, Kenny PJ. Assessment of previous fracture and anti-osteoporotic medication prescription in hip fracture patients. Ir J Med Sci 2021; 191:247-252. [PMID: 33687665 DOI: 10.1007/s11845-021-02571-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 02/26/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Hip fracture prevention is an essential component in elderly patient care. History of prior fracture is a significant risk factor for subsequent hip fracture. There are variable rates of treatment for these groups of patients. The aims of this study were to make an assessment of how many hip fracture patients over a 1 year period had a previous fracture and to assess whether or not these patients were on anti-osteoporotic medication. METHODS Assessment on whether or not patients had a prior fracture using the national radiology imaging system checking radiology reports for all previous imaging performed. Checking patients bone health status using the hip fracture database for our hospital. RESULTS There were 225 hip fractures in 221 patients over a 1-year period. About 42.6% of females and 35.9% of males had a history of previous fracture. Vertebral fractures were the most common type of fracture. We found 7% of patients had a contralateral hip fracture. There were 81% of patients with prior fracture, and 71% of those without prior fracture were on anti-osteoporotic medication. DISCUSSION Vertebral fractures were the most common preceding fracture in hip fracture patients. There were many patients with a history of fragility fractures that were not on preventative medication. Overall there were good prescription rates of anti-osteoporotic medication. There were significantly higher rates of prescription amongst females compared with males.
Collapse
|
14
|
Stephens A, Rudd H, Stephens E, Ward J. Secondary Prevention of Hip Fragility Fractures During the COVID-19 Pandemic: Service Evaluation of "MRS BAD BONES". JMIR Aging 2020; 3:e25607. [PMID: 33326412 PMCID: PMC7772051 DOI: 10.2196/25607] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 12/09/2020] [Accepted: 12/14/2020] [Indexed: 11/22/2022] Open
Abstract
Background Management of osteoporosis is an important consideration for patients with femoral neck fractures due to the morbidity and mortality it poses. The input of orthogeriatric teams is invaluable in coordinating secondary fragility fracture prevention. The COVID-19 pandemic resulted in the rapid restructuring of health care teams and led to the redeployment of orthogeriatricians. Objective This study aimed to determine the impact COVID-19 had on the secondary prevention of fragility fractures among patients with femoral neck fractures, and to optimize management in this population. Methods A retrospective audit was conducted of patients with femoral neck fractures before and after the lockdown in response to the COVID-19 pandemic in the United Kingdom. A reaudit was conducted following the development of our new mnemonic, “MRS BAD BONES,” which addressed key factors in the assessment and management of osteoporosis: medication review, rheumatology/renal advice, smoking cessation; blood tests, alcohol limits, DEXA (dual energy X-ray absorptiometry) scan; bone-sparing medications, orthogeriatric review, nutrition, exercise, supplements. The Fisher exact test was used for comparison analyses between each phase. Results Data for 50 patients were available in each phase. The orthogeriatric team reviewed 88% (n=44) of patients prelockdown, which fell to 0% due to redeployment, before recovering to 38% (n=19) in the postintervention period. The lockdown brought a significant drop in the prescription of vitamin D/calcium supplements from 81.6% (n=40) to 58.0% (n=29) (P=.02); of bone-sparing medications from 60.7% (n=17) to 18.2% (n=4) (P=.004), and DEXA scan requests from 40.1% (n=9) to 3.6% (n=1) (P=.003). Following the implementation of our mnemonic, there was a significant increase in the prescription of vitamin D/calcium supplements to 85.7% (n=42) (P=.003), bone-sparing medications to 72.4% (n=21) (P<.001), and DEXA scan requests to 60% (n=12) (P<.001). Conclusions The redeployment of the orthogeriatric team, due to the COVID-19 pandemic, impacted the secondary prevention of fragility fractures in the study population. The “MRS BAD BONES” mnemonic significantly improved management and could be used in a wider setting.
Collapse
Affiliation(s)
- Alastair Stephens
- Trauma and Orthopaedic Department, University Hospital Coventry and Warwickshire, Coventry, United Kingdom
| | - Hannah Rudd
- Trauma and Orthopaedic Department, University Hospital Coventry and Warwickshire, Coventry, United Kingdom
| | - Emilia Stephens
- Trauma and Orthopaedic Department, University Hospital Coventry and Warwickshire, Coventry, United Kingdom
| | - Jayne Ward
- Trauma and Orthopaedic Department, University Hospital Coventry and Warwickshire, Coventry, United Kingdom
| |
Collapse
|
15
|
Saad R, Beydoun M, Fuleihan GEH. Management of Hip Fractures at an Academic Center: Challenges and Opportunities. J Clin Densitom 2020; 23:524-533. [PMID: 30691870 DOI: 10.1016/j.jocd.2019.01.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 12/26/2018] [Accepted: 01/02/2019] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To assess characteristics of patients with hip fractures and investigate the extent of osteoporosis-related care they receive at a tertiary referral center in Lebanon. METHODS A retrospective review of charts of 400 patients admitted with a hip fracture to the American University of Beirut-Medical Center, between January 1, 2011 and December 31, 2015. We reviewed medical records of adults admitted with a nonpathologic/nontraumatic hip fracture, and evaluated basic demographics and relevant clinical information, associated risk factors, and the management received. RESULTS The mean age of the population was 78 ± 10 years and men constituted 37%. Women were more likely to be assessed and/or treated. On admission, 21% were taking calcium and 18% vitamin D supplementation. During hospitalization, vitamin D level was assessed in only 39% of patients; a dietary and an osteoporosis consult were requested on only 32% and 22% of the cases, respectively. One-fourth to a third of patients were discharged on calcium or vitamin D, and less than 5% on bisphosphonates. Bone mineral density was measured in a minority although 21% had a history of previous contralateral hip fracture. One year mortality rate in a subset where follow-up available was 12% in men and 7% in women. CONCLUSION A large care gap in the management of patients admitted with hip fracture persists despite clear national osteoporosis guidelines. This study provides a strong impetus for establishing and monitoring a fracture liaison service to understand and address barriers to providing optimal care to patients with osteoporosis.
Collapse
Affiliation(s)
- Randa Saad
- American University of Beirut-Medical Center, Beirut, Lebanon
| | - Maya Beydoun
- American University of Beirut-Medical Center, Beirut, Lebanon
| | - Ghada El-Hajj Fuleihan
- American University of Beirut-Medical Center, Beirut, Lebanon; Calcium Metabolism and Osteoporosis Program, WHO Collaborating Center for Metabolic Bone Disorders at the American University of Beirut-Medical Center, Beirut, Lebanon.
| |
Collapse
|
16
|
Efremov K, Caterini A, De Maio F, Farsetti P. A simultaneous bilateral asymmetric hip fracture in an elderly patient: A case report and review of the literature. Int J Surg Case Rep 2020; 72:377-380. [PMID: 32563825 PMCID: PMC7306533 DOI: 10.1016/j.ijscr.2020.06.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 06/03/2020] [Accepted: 06/04/2020] [Indexed: 12/04/2022] Open
Abstract
Simultaneous bilateral hip fractures in the elderly are rare and usually have a symmetric pattern. Intracapsular fractures on one side and trochanteric on the other are even rarer. They are caused by a spontaneous fracture which causes a fall on the contralateral side. The trochanteric fracture should be operated first to avoid possible complications.
Introduction Simultaneous bilateral hip fractures are usually associated with high energy trauma, seizures, metabolic diseases and bisphosphonates use. They are observed rarely in the elderly population after simple trauma and usually have the same fracture pattern (symmetric). We report a rare case of asymmetric fracture and discuss mechanism of injury and treatment, analyzing the literature. Presentation of case We report a case of an 86-year old woman with a simultaneous bilateral asymmetric hip fracture (trochanteric on the right side and subcapital on the left), occurred after a fall at home. The patient was surgically treated by open reduction and internal fixation with an intramedullary nail on the right and by hemiarthroplasty on the left performed during the same surgical session, with good results. Discussion Simultaneous bilateral hip fractures in the elderly are rare and usually are symmetric. In the majority of the cases these fractures are intracapsular and are treated by hemiarthroplasties. On the contrary, simultaneous bilateral hip fractures with a different pattern, as the described case, are extremely rare. The possible mechanism of injury is a spontaneous fracture on one side, which causes a fall the contralateral side. The surgical treatment may be performed bilaterally, treating first the trochanteric fracture. Conclusion Simultaneous bilateral asymmetric hip fracture are extremely rare and may occur in elderly patient with a specific mechanism of injury. We believe that the trochanteric fracture should be operated first to avoid possible complications.
Collapse
Affiliation(s)
- Kristian Efremov
- Department of Orthopaedic Surgery, University of Tor Vergata, Viale Oxford 81, 00133 Rome, Italy
| | - Alessandro Caterini
- Department of Orthopaedic Surgery, University of Tor Vergata, Viale Oxford 81, 00133 Rome, Italy
| | - Fernando De Maio
- Department of Orthopaedic Surgery, University of Tor Vergata, Viale Oxford 81, 00133 Rome, Italy
| | - Pasquale Farsetti
- Department of Orthopaedic Surgery, University of Tor Vergata, Viale Oxford 81, 00133 Rome, Italy.
| |
Collapse
|
17
|
Murena L, Ratti C, Maritan G, Rasio N, Pistorio S, Cusitore M, Canton G. Epidemiology and risk factors for contralateral proximal femur fracture: a single center retrospective cohort study on 1022 patients. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:115-121. [PMID: 32555086 PMCID: PMC7944826 DOI: 10.23750/abm.v91i4-s.9716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 05/05/2020] [Indexed: 11/23/2022]
Abstract
Summary. BACKGROUND AND AIM OF THE WORK Given the high impact of proximal femur fractures (PFFs) on elderly patients and healthcare systems, the burden of contralateral PFFs might be overlooked. Aim of the study is to analyze the epidemiology and risk factors of contralateral proximal femur fractures. Secondary aim is to detect mortality rate differences in first and contralateral PPF. METHODS A population of 1022 patients admitted for proximal femur fractures in a single center was studied. Prevalence at admission as well as incidence of contralateral PFF during a 18 to 36 months follow-up was recorded. Epidemiology of contralateral PFF was studied recording number of events, time to second fracture and fracture type. Mortality at 1-year was recorded for all patients and compared between first and second PFF patients. Comorbidities, pharmacotherapy, BMI, MNA and SPMSQ were studied as possible risk factors. RESULTS Prevalence and incidence of contralateral PFFs were 9.4% and 6.5% respectively. Median time to second fracture was 12 months. One-year mortality of contralateral PFFs was significantly lower (20.5% vs 25.1%, p 0.003) than first PFF. Contralateral fracture patients had a significantly lower BMI and a significantly lower proportion of malnourished patients. CONCLUSIONS The incidence and prevalence of contralateral PFFs is relevant. Mortality of contralateral PFFs results to be lower than first PFF. Patients with higher BMI and malnourished patients have a lower risk of contralateral PFF.
Collapse
Affiliation(s)
- Luigi Murena
- Orthopaedics and Traumatology Unit, Cattinara Hospital - ASUITS, Strada di Fiume 447, 34149 Trieste (Italy).
| | - Chiara Ratti
- Orthopaedics and Traumatology Unit, Cattinara Hospital - ASUITS, Strada di Fiume 447, 34149 Trieste (Italy).
| | - Guido Maritan
- Orthopaedics and Traumatology Unit, Cattinara Hospital - ASUITS, Strada di Fiume 447, 34149 Trieste (Italy).
| | - Nicholas Rasio
- Orthopaedics and Traumatology Unit, Cattinara Hospital - ASUITS, Strada di Fiume 447, 34149 Trieste (Italy).
| | - Sabrina Pistorio
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada di Fiume 447, 34149 Trieste (Italy).
| | - Marcello Cusitore
- Orthopaedics and Traumatology Unit, Cattinara Hospital - ASUGI, Strada di Fiume 447, 34149 Trieste (Italy).
| | - Gianluca Canton
- Orthopaedics and Traumatology Unit, Cattinara Hospital - ASUITS, Strada di Fiume 447, 34149 Trieste (Italy).
| |
Collapse
|
18
|
Nishi M, Okano I, Sawada T, Midorikawa N, Inagaki K. Cementless Bipolar Hemiarthroplasty for Low-energy Intracapsular Proximal Femoral Fracture in Elderly East-Asian Patients: A Longitudinal 10-year Follow-up Study. Hip Pelvis 2019; 31:206-215. [PMID: 31824875 PMCID: PMC6892899 DOI: 10.5371/hp.2019.31.4.206] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 08/07/2019] [Accepted: 08/07/2019] [Indexed: 12/26/2022] Open
Abstract
Purpose Short-term outcomes following cemented and cementless hemiarthroplasties (HAs) are reported to be comparable, however, long-term outcomes of cementless HA—especially among Asian patients—is limited. We aimed to assess long-term outcomes in elderly East-Asian patients with intracapsular proximal femoral fractures treated with cementless HA. Materials and Methods We enrolled 135 patients treated with cementless HA who met our inclusion criteria. We documented bone/implant-related complications (e.g., incidences of revision hip surgery, femoral stem subsidence, dislocation, intraoperative and postoperative periprosthetic fractures, contralateral hip fractures). We included those patients who are still alive 10 years after the index surgery in the final functional analysis of the existence of pain, ambulatory status, and residential status. Results The mean age at injury was 78.3 years (range: 60–85 years). At the 10-year follow-up, 26 of the original patients (19.3%) had survived. During follow-up, revision hip surgery was conducted in two patients (1.5%). We recorded the incidence of intraoperative fractures, postoperative periprosthetic fractures, and contralateral fractures in two (1.5%), eight (5.9%), and six patients (4.4%), respectively. Among the 10-year survivors, six patients (23.1% of the survivors) complained of groin pain, but generally reported the pain to be tolerable. Conclusion Among elderly East-Asian patients, the incidence of revision surgery after cementless HA may be lower than that in their European counterparts, whereas the incidence of periprosthetic fractures can still be considerably higher. For patients undergoing cementless HA, prevention of such secondary fractures is of critical importance.
Collapse
Affiliation(s)
- Masanori Nishi
- Department of Orthopaedic Surgery, Ohta-Nishinouchi Hospital, Fukushima, Japan.,Department of Orthopaedic Surgery, Showa University School of Medicine, Tokyo, Japan
| | - Ichiro Okano
- Department of Orthopaedic Surgery, Ohta-Nishinouchi Hospital, Fukushima, Japan
| | - Takatoshi Sawada
- Department of Orthopaedic Surgery, Ohta-Nishinouchi Hospital, Fukushima, Japan
| | - Natsuki Midorikawa
- Department of Orthopaedic Surgery, Ohta-Nishinouchi Hospital, Fukushima, Japan
| | - Katsunori Inagaki
- Department of Orthopaedic Surgery, Showa University School of Medicine, Tokyo, Japan
| |
Collapse
|
19
|
Postoperative Medical Complications and Intermediate Care Unit/Intensive Care Unit Admission in Joint Replacement Surgery: A Prospective Risk Model. J Arthroplasty 2019; 34:717-722. [PMID: 30718172 DOI: 10.1016/j.arth.2018.12.034] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Revised: 12/09/2018] [Accepted: 12/27/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Postoperative complications are the main consumers of technical, medical, and human resources. Especially in the field of elective joint replacement surgery, a specialized, easy-to-obtain, and cost-efficient preoperative stratification and risk-estimation model is missing. METHODS With preoperatively surveyed patient parameters, we identified the most relevant parameters to predict postoperative medical complications. We devised a prospective risk model, measuring the individual probability for intermediate care unit (IMC) or intensive care unit (ICU) admission. The study includes all patients (n = 649) treated with primary or revision total knee arthroplasty in our clinic from 2008 to 2012. RESULTS The association between general comorbidity scores and mortality risk is well known. Among different comorbidity scores, the Charlson Comorbidity Index is not only relevant for overall postoperative complications (odds ratios [OR] = 2.20) but also predictive of specific complications such as the postoperative need for blood transfusion (OR = 1.94) and unexpected adverse events (OR = 1.74). Considering adverse events, c-reactive protein and leukocyte levels are also highly relevant. Upon predicting a necessary postoperative transfer to an IMC or ICU, the preoperative hemoglobin level, the Charlson Comorbidity Index, and the Index of Coexistent Disease stood out. The latter indicates an increased rate for an IMC/ICU stay by 341% per point. Condensing the most influential predictors, the probability for postoperative IMC/ICU transfer can be calculated for each individual patient. Using the routinely assessed patient's variables, no steadier prediction is possible. CONCLUSION The introduced risk-estimation model offers a specialized preoperative resource-stratification method in knee joint replacement surgery. It condenses the most influential, individual risk factors to avoid clinical test redundancy and improve resource efficiency and presurgical care planning. A prospective follow-up study could help validating the risk model in clinical routine.
Collapse
|
20
|
Sucharitpongpan W, Daraphongsataporn N, Saloa S, Philawuth N, Chonyuen P, Sriruanthong K, Waiwattana K. Epidemiology of fragility hip fractures in Nan, Thailand. Osteoporos Sarcopenia 2019; 5:19-22. [PMID: 31008374 PMCID: PMC6452923 DOI: 10.1016/j.afos.2019.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 03/06/2019] [Accepted: 03/11/2019] [Indexed: 10/27/2022] Open
Abstract
Objectives Hip fracture is the most serious consequence of falling in elderly with osteoporosis. Patients with hip fractures suffer functional deterioration and increased morbidity especially during the first year after fracture. Rapid increase in the proportion of the elderly increases the prevalence of hip fractures in Thailand, leading to major problem for public health. There is substantial variation in the incidence of hip fracture in different regions of Thailand. Demographic data are required to improve management and prevention. This study was aimed to describe the demographic data and to determine the incidence of fragility hip fractures in Nan, Thailand. Methods A retrospective, cohort study had been conducted in Nan and Pua hospital. Patients with hip fractures were sorted by International Classification of Diseases 10th Revision (S72.0-S72.2) from September 1, 2014 to December 31, 2017. Statistical analyses were conducted using descriptive analysis and 95% confidence interval. Results The incidence of hip fractures in Nan province in 2015-2017 were 211.6, 214.9 and 238.5 per 100,000 person-years, respectively. There were 876 patients in this study. Higher incidence was found in female (ratio, 2.5:1). About 87.2% of the fracture occurred inside the house. There were 5.9% who had refracture. The median for refracture time was 143 weeks. Conclusions The incidence of hip fractures in Nan province was classified as moderate severity and was increasing between 2015 and 2017. A coordinated, multidisciplinary approach in homecare management especially in fall prevention are important factors to reduce incidence of fragility hip fracture.
Collapse
Affiliation(s)
| | | | - Surapot Saloa
- Department of Orthopaedic Surgery, Nan Hospital, Nan, Thailand
| | | | - Prapan Chonyuen
- Department of Orthopaedic Surgery, Nan Hospital, Nan, Thailand
| | | | | |
Collapse
|
21
|
Müller F, Galler M, Zellner M, Bäuml C, Roll C, Füchtmeier B. Comparative analysis of non-simultaneous bilateral fractures of the proximal femur. Eur J Trauma Emerg Surg 2018; 45:1053-1057. [PMID: 30014273 DOI: 10.1007/s00068-018-0981-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 07/10/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE We performed a monocenter cohort study to determine surgical revision and mortality after sustaining an initial and a non-simultaneous contralateral proximal femoral fracture. METHODS We identified all patients surgically treated for a contralateral femoral fracture between 2006 and 2015. Patient demographic characteristics and follow-up were identified by our electronic database; failed information regarding revision and mortality were obtained by telephone, as well as the evaluation of the mobility for all alive patients. The endpoint of the study was set for every patient at least 2 years postoperatively. RESULTS Within a total of 2296 patients, we identified 250 patients (10.8%) treated for a contralateral fracture. The mean interval between the two occurrences was 5.2 years and the mean age at the time of contralateral fracture was 84.4 years. Almost every third fracture occurred later than 5 years after the initial fracture, and even every tenth fracture later than 10 years. More than 50% of the patients also had dementia at this time. The total surgical revision rate was 17.2% after initial, and 20.4% after contralateral fracture, but this difference was statistically not significant (p = 0.31). However, revisions for infection or hematoma were more than twice after contralateral fracture (p = 0.006). The 1-year mortality rate was 36%, and dementia (log rank p < 0.001) and male gender (log rank p < 0.001) were significant negative predictors for the survival rate. After a mean of 42 months, the follow-up of the 67 alive patients recorded a mean Parker Score of 5.2 items. CONCLUSION Contralateral femoral fracture was accompanied by a higher revision and mortality rate-but patients were also 5 years older. Dementia and male gender were significant negative variables for the survival time. In the future, the highest priority will be the prophylaxis of falling to avoid or at least to decline the number of these fractures in geriatric patients.
Collapse
Affiliation(s)
- Franz Müller
- Hospital Barmherzige Brüder, Regensburg, Germany
| | | | | | | | | | | |
Collapse
|
22
|
Sprague S, Madden K, Slobogean G, Petrisor B, Adachi JD(R, Bogoch E, Kleinlugtenbelt YV, Bhandari M. A Missed Opportunity in Bone Health: Vitamin D and Calcium Use in Elderly Femoral Neck Fracture Patients Following Arthroplasty. Geriatr Orthop Surg Rehabil 2017; 8:215-224. [PMID: 29318083 PMCID: PMC5755842 DOI: 10.1177/2151458517735201] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 07/12/2017] [Accepted: 09/12/2017] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Introduction: Adequate calcium and vitamin D from diet and supplementation is recommended for elderly hip fracture patients. Using data from the multinational hip fracture arthroplasty trial (HEALTH), we determined the proportion of patients who consistently took vitamin D and calcium and which characteristics/prescribing practices were associated with consistency of supplement use. METHODS HEALTH is a multicenter randomized trial of elderly hip fracture patients treated with hemi-arthroplasty and total hip arthroplasty. Patients were categorized as consistent users, inconsistent users, or nonusers of calcium and vitamin D. We used multinomial regression to determine the characteristics associated with calcium and vitamin D use. RESULTS 603 HEALTH participants were included in the analysis. 34.7% of patients never took vitamin D within 12 months after surgery, 26.2% took vitamin D inconsistently, and 39.1% took vitamin D consistently. 36.0% of patients never took calcium within 12 months after surgery, 28.4% took calcium inconsistently, and 35.7% took calcium consistently. There was great variation in prescribed/recommended doses. Compared to nonusers, consistent users of the supplements were more likely to be female, North American, prescribed/recommended vitamin D and/or calcium postoperatively, and presented to a facility with comprehensive fragility fracture protocols. CONCLUSIONS A low proportion of elderly hip fracture patients are consistently taking vitamin D and calcium, which may contribute to poorer bone health. Surgeons should be educated to prescribe/ recommend vitamin D and calcium, institutions should develop comprehensive fragility fracture protocols and patient education strategies to ensure that patients with osteoporosis receive bone health management beyond fracture care.
Collapse
Affiliation(s)
- Sheila Sprague
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Kim Madden
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Gerard Slobogean
- Department of Orthopaedic Surgery, University of Maryland, Baltimore, MD, USA
| | - Brad Petrisor
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | | | - Earl Bogoch
- Department of Orthopaedic Surgery, St Michael’s Hospital, Toronto, Ontario, Canada
| | | | - Mohit Bhandari
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| |
Collapse
|
23
|
Abstract
OBJECTIVES Our aim was to investigate whether patients presenting with fragility fractures of the proximal femur are receiving osteoporosis treatment and to assess the number of other fragility fractures they have sustained prior to admission. METHODS All patients presenting to our institution with fragility fractures of the proximal femur within an 18-month period (January 2012-August 2013) were included. Patient demographics; fracture classification (AO/OTA); American Society of Anesthesiologists (ASA) grade; Abbreviated Mental Test Score (AMTS) on admission; type of operation; time to operation; peri-operative complications; length of hospital stay (LOS); walking status; osteoporotic medication; Dual-energy X-ray absorptiometry (DEXA) results; additional fragility fractures; and mortality were collected and analysed. RESULTS A total of 1004 patients (278 male) met the inclusion criteria and were included into the study. The mean age was 82.01 years and mean LOS was 19.54days. Fifty-four per cent of the patients were admitted from their own homes whereas 43% were capable to walk indoors without any aids before their injury. Mean time to surgery was 2.06days (Median: 1.31, range: 0-26days). Three hundred and six patients (30.5%) had at least another fragility fracture before the index episode (mean 1.40 fractures; SD: 0.71 fractures; range: 1-6 fractures). Only 16.4% were under complete osteoporosis treatment on admission, defined as receiving calcium with vitamin D and a bisphosphonate or an alternative agent. When we compared patients without a history of a previous fragility fracture (Group A) and patients with at least another previous fragility fracture (Group B), we found that patients in Group B had a significantly lower AMTS score, lower bone mineral density (BMD) as evident on the DEXA scan, an inferior mobility before admission and a higher incidence of extracapsular fractures (p<0.05). On discharge, patients in Group B had a higher chance of receiving complete bone protection compared to group A (27.9% versus 41.7%; p<0.01). Following discharge, 11.2% of the patients sustained an additional fragility fracture. The mean time from the index episode to the additional fracture was 0.65 years, whilst these injuries were more frequent in Group B (RR=1.638; p<0.05). CONCLUSION Patients presenting with a hip fracture are generally under-treated for osteoporosis. Post-operative assessment by a designated geriatrician and use of a standardised protocol is of paramount importance for reducing the risk of additional fragility fractures. Additionally, screening of the elderly population for identifying the patients who suffer from osteoporosis can potentially reduce the risk of sustaining a further fragility fracture.
Collapse
|
24
|
Guy P, Sobolev B, Sheehan KJ, Kuramoto L, Lefaivre KA. The burden of second hip fractures: provincial surgical hospitalizations over 15 years. Can J Surg 2017; 60:101-107. [PMID: 28234218 DOI: 10.1503/cjs.008616] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Second hip fractures account for up to 15% of all hip fractures. We sought to determine if the proportion of hip fracture surgeries for second hip fracture changed over time in terms of patient and fracture characteristics. METHODS We reviewed the records of patients older than 60 years hospitalized for hip fracture surgery between 1990 and 2005 in British Columbia. We studied the proportion of surgeries for second hip fracture among all hip fracture surgeries. Linear regression tested for trends across fiscal years for women and men. RESULTS We obtained 46 341 patient records. Second hip fracture accounted for 8.3% of hip fracture surgeries. For women the proportion of second hip fracture surgeries increased linearly from 4% to 13% with each age decade (p = 0.001) and across fiscal years (p = 0.002). In men the proportion of second hip fracture surgeries was 5% for each age decade between the ages of 60 and 90 years across fiscal years, increasing to 8% for men older than 90 years across fiscal years (p = 0.20). These sex-specific trends were similar for both pertrochanteric and transcervical fracture types. CONCLUSION Second hip fracture surgeries account for an increasing proportion of hip fracture surgeries and may require more health care resources to minimize poorer reported outcomes. Future research should determine whether more health care resources are required to manage these patients and optimize their outcomes.
Collapse
Affiliation(s)
- Pierre Guy
- From the Department of Orthopedics, University of British Columbia, Vancouver, BC (Guy, Lefaivre); the School of Population and Public Health, University of British Columbia, Vancouver, BC (Sobolev, Sheehan); and the Vancouver Coastal Health Research Institute, Vancouver, BC (Kuramoto)
| | - Boris Sobolev
- From the Department of Orthopedics, University of British Columbia, Vancouver, BC (Guy, Lefaivre); the School of Population and Public Health, University of British Columbia, Vancouver, BC (Sobolev, Sheehan); and the Vancouver Coastal Health Research Institute, Vancouver, BC (Kuramoto)
| | - Katie Jane Sheehan
- From the Department of Orthopedics, University of British Columbia, Vancouver, BC (Guy, Lefaivre); the School of Population and Public Health, University of British Columbia, Vancouver, BC (Sobolev, Sheehan); and the Vancouver Coastal Health Research Institute, Vancouver, BC (Kuramoto)
| | - Lisa Kuramoto
- From the Department of Orthopedics, University of British Columbia, Vancouver, BC (Guy, Lefaivre); the School of Population and Public Health, University of British Columbia, Vancouver, BC (Sobolev, Sheehan); and the Vancouver Coastal Health Research Institute, Vancouver, BC (Kuramoto)
| | - Kelly Ann Lefaivre
- From the Department of Orthopedics, University of British Columbia, Vancouver, BC (Guy, Lefaivre); the School of Population and Public Health, University of British Columbia, Vancouver, BC (Sobolev, Sheehan); and the Vancouver Coastal Health Research Institute, Vancouver, BC (Kuramoto)
| |
Collapse
|
25
|
Yi C, Wang M, Wei J, Wang J, Wang L, Cheng X. Preoperative QCT assessment of femoral head for assessment of femoral head bone loss. Exp Ther Med 2017; 13:1470-1474. [PMID: 28413494 PMCID: PMC5377297 DOI: 10.3892/etm.2017.4136] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 01/23/2017] [Indexed: 12/03/2022] Open
Abstract
We quantified differences in trabecular volumetric bone mineral density (BMD) of the femoral head between patients with proximal femoral fractures and healthy subjects in the control group by using quantitative computed tomography (QCT) with the purpose of providing guidance for the choice of head screw in the intramedullary nail fixation. Participants suffering from intertrochanteric fractures (n=536 patients) were recruited. In addition, 497 fracture-free, age-matched cases were considered as the control group. The volumetric BMD of different regions of interest (ROI) in the proximal femur scanned by QCT were analyzed between the fracture and control groups. BMD of proximal femur in the fracture group was markedly lower than that in the control group. There were significant differences at distinct regions for male and female between the two groups. Furthermore, the trend of BMD changes among the femoral head, femoral neck and intertrochanter were not parallels in terms of their average value. In conclusion, osteoporosis has been demonstrated to be a main risk factor of the proximal femoral fracture. BMD value of proximal femur was often inconsistent with that of femoral head. Given this, preoperative QCT assessment plays an important role in choosing proper head screw in the intramedullary nail fixation.
Collapse
Affiliation(s)
- Chen Yi
- Medical Center, Tsinghua University, Beijing 100084, P.R. China
| | - Manyi Wang
- Department of Traumatic Orthopedics, Beijing Jishuitan Hospital, Beijing 100035, P.R. China
| | - Jie Wei
- Department of Traumatic Orthopedics, Beijing Jishuitan Hospital, Beijing 100035, P.R. China
| | - Jun Wang
- Department of Traumatic Orthopedics, Beijing Jishuitan Hospital, Beijing 100035, P.R. China
| | - Ling Wang
- Department of Radiology, Beijing Jishuitan Hospital, Beijing 100035, P.R. China
| | - Xiaoguang Cheng
- Department of Radiology, Beijing Jishuitan Hospital, Beijing 100035, P.R. China
| |
Collapse
|
26
|
Kastanis G, Topalidou A, Alpantaki K, Rosiadis M, Balalis K. Is the ASA Score in Geriatric Hip Fractures a Predictive Factor for Complications and Readmission? SCIENTIFICA 2016; 2016:7096245. [PMID: 27293978 PMCID: PMC4880678 DOI: 10.1155/2016/7096245] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 04/19/2016] [Indexed: 05/26/2023]
Abstract
Hip fractures are the second cause of hospitalization in geriatric patients. The American Society of Anesthesiologists (ASA) classification scheme is a scoring system for the evaluation of the patients' health and comorbidities before an operative procedure. The purpose of this study was to determine whether the ASA score is a predictive factor for perioperative and postoperative complications and a cause of readmission of geriatric patients with hip fractures. The study included 198 elderly patients. The mean values of hospitalization were 6.4 ± 2.1 days for the patients with ASA II, 10.4 ± 3.4 days for the patients with ASA III, and 13.5 ± 4.4 days for the patients with ASA IV. The patients with ASA II exhibited minor complications, while patients with ASA III presented cutaneous ulcer and respiratory dysfunction. Five patients with ASA IV had pulmonary embolism, two patients had myocardial infarction, and three patients died. The ASA score seems to have direct correlation with multiple factors, such as the hospitalization days, the severity of the complications, and the total hospitalization costs. The treatment of geriatrics hip fractures in patients with a high ASA score requires a multidisciplinary approach and a special assessment in order to decrease postoperative morbidity and mortality and offer optimal functionality.
Collapse
Affiliation(s)
- G. Kastanis
- Department of Orthopaedics and Traumatology, University Hospital of Heraklion, Faculty of Medicine, University of Crete, Crete, Greece
| | - A. Topalidou
- Department of Orthopaedics and Traumatology, University Hospital of Heraklion, Faculty of Medicine, University of Crete, Crete, Greece
| | - K. Alpantaki
- Department of Orthopaedics and Traumatology, University Hospital of Heraklion, Faculty of Medicine, University of Crete, Crete, Greece
| | - M. Rosiadis
- Department of Orthopaedics and Traumatology, University Hospital of Heraklion, Faculty of Medicine, University of Crete, Crete, Greece
| | - K. Balalis
- Department of Orthopaedics and Traumatology, University Hospital of Heraklion, Faculty of Medicine, University of Crete, Crete, Greece
| |
Collapse
|
27
|
Besalduch M, Carrera I, Gómez-Masdeu M, De Caso J. Antiresorptive treatment, when initiated after a first hip fracture, may not protect of a second contralateral episode in elderly population: A study with 685 patients. Injury 2016; 47:877-80. [PMID: 26892501 DOI: 10.1016/j.injury.2016.01.040] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 12/02/2015] [Accepted: 01/29/2016] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Osteoporosis predisposes for a higher risk of hip fracture and its treatment is frequently underprescribed. Our purpose was to assess the relation between having a second hip fracture and receiving osteoporosis treatment. Also to assess the relation between this second fracture and using central nervous system drugs or being institutionalised. PATIENTS AND METHODS We reviewed all the patients that were admitted to our hospital with an osteoporotic proximal femoral fracture between September 2009 and February 2011. We identified 685 patients, 74 of which presented a contralateral fracture. We evaluated if they were receiving osteoporosis treatment or taking any medication that could affect the central nervous system and if they were institutionalised. RESULTS A 10.8% of patients had a second fracture and the mean time between the two of them was 20 months (1-122). There was a clear female predominance (76.35%). The mean age at occurrence of the primary fracture was 83.02 years and 85 for the second. A 90.8% did not follow any type of osteoporosis medication before the first fracture. A 50.9% did not receive central nervous system drugs and 79.1% lived at home at the time of the first fracture. 12.8% of the patients that did not follow the osteoporosis treatment, had a contralateral fracture, 3% more than those that did follow some kind of treatment, but this difference was not significant (p=0.2). DISCUSSION We identified a similar number of patients undergoing osteoporotic treatment as registered in literature. There was no significant difference between suffering a second hip fracture and following osteoporosis treatment, using psychotropic drugs or being institutionalised.
Collapse
Affiliation(s)
- M Besalduch
- Department of Orthopaedic Surgery and Traumatology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Spain.
| | - I Carrera
- Department of Orthopaedic Surgery and Traumatology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Spain
| | - M Gómez-Masdeu
- Department of Orthopaedic Surgery and Traumatology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Spain
| | - J De Caso
- Department of Orthopaedic Surgery and Traumatology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Spain
| |
Collapse
|
28
|
Moll MA, Bachmann LM, Joeris A, Goldhahn J, Blauth M. Parameters Pointing at an Increased Risk for Contralateral Hip Fractures: Systematic Review. Geriatr Orthop Surg Rehabil 2016; 7:45-61. [PMID: 26929857 PMCID: PMC4748160 DOI: 10.1177/2151458515618490] [Citation(s) in RCA: 6] [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] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Early identification of hip fracture (HF) patients bearing an increased risk for a contralateral occurrence would allow providing preventive measures timely. OBJECTIVES To summarize the available evidence describing risk scores, prognostic instruments, or (groups of) parameters predicting contralateral HFs at the time point of the first fracture. Methods/Systematic Review: Articles were identified through searches in MEDLINE and Scopus from inception to April 2014, checking of reference lists of the included studies and reviews. One reviewer assessed all articles for inclusion and abstracted the data. Uncertain cases were discussed and decided with a second reviewer. Salient study and population characteristics were abstracted for each article. Studies reporting the association of a set of risk factors for second HFs were further examined and compared. The number of studies reporting on a risk parameter was assessed. RESULTS Searches identified 3560 records, and 47 studies were included in this review. There was a large spectrum of study designs, patient populations, and follow-up periods. Among 11 studies reporting on a set of parameters, female gender was assessed most commonly (7 times), followed by age (5) and parameters of general health, vision, and stroke (each 4 times). We were unable to depict stringent patterns of risk parameters to be used for decision making in clinical practice. CONCLUSIONS The findings of this article call for a conjoint effort to achieve an expert consensus regarding a critical set of parameters for a risk instrument identifying patients bearing an increased risk for contralateral HFs early.
Collapse
Affiliation(s)
- Maria A Moll
- Medical University of Innsbruck, Innsbruck, Austria
| | | | - Alexander Joeris
- AO Clinical Investigation and Documentation, Dübendorf, Switzerland
| | | | | |
Collapse
|
29
|
Iolascon G, Moretti A, Giamattei MT, Migliaccio S, Gimigliano F. Prevalent fragility fractures as risk factor for skeletal muscle function deficit and dysmobility syndrome in post-menopausal women. Aging Clin Exp Res 2015. [PMID: 26204997 DOI: 10.1007/s40520-015-0417-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Fragility fractures are a major burden for health and social care in elderly people. In order to identify earlier the "frail elders", new concepts of "dysmobility syndrome" and skeletal muscle function deficit (SMFD), including sarcopenia, osteoporosis, obesity, and mobility limitation, leading to a higher risk of fractures, have been recently introduced. There are very few studies investigating the association between fragility fractures and both the dysmobility syndrome and the SMFD. AIMS The objective of our study is to investigate the role of previous fragility fractures as a risk factor in determining the dysmobility syndrome and/or the SMFD in post-menopausal women. METHODS In this case-control study, we retrospectively examined data from the medical records of post-menopausal women aged 50 or older. We divided the study population in two groups. The first group includes women with a previous fragility fracture (cases) and the other group includes women without any previous osteoporotic fracture (controls). We identified the subjects with "dysmobility syndrome", "dynapenic SMFD", "sarcopenic SMFD", and "mixed SMFD" in both groups. Data collected refer to a 6-month period. RESULTS We retrieved data of 121 post-menopausal women, 77 (63.64%) had already sustained a fragility fracture at any site (cases). The risk for dysmobility syndrome was significantly higher (adjusted OR for age and serum 25-OH vitamin D3 of 2.46) in the cases compared with the controls. DISCUSSION AND CONCLUSIONS An early diagnosis of conditions limiting mobility, including dysmobility syndrome, might be useful to identify, among patients with osteoporotic fractures, those who might have a higher risk of a new fragility fracture.
Collapse
Affiliation(s)
- Giovanni Iolascon
- Department of Medical and Surgical Specialties and Dentistry, Second University of Naples, Naples, Italy.
| | - Antimo Moretti
- Department of Medical and Surgical Specialties and Dentistry, Second University of Naples, Naples, Italy
| | - Maria Teresa Giamattei
- Department of Medical and Surgical Specialties and Dentistry, Second University of Naples, Naples, Italy
| | - Silvia Migliaccio
- Department of Movement, Human and Health Sciences, Unit of Endocrinology, University of Rome "Foro Italico", Largo Lauro De Bosis 15, 00195, Rome, Italy
| | - Francesca Gimigliano
- Department of Mental and Physical Health and Preventive Medicine, Second University of Naples, Naples, Italy
| |
Collapse
|
30
|
Tan WLB, Low SL, Shen L, Das De S. Osteoporotic hip fractures: 10-year review in a Singaporean hospital. J Orthop Surg (Hong Kong) 2015; 23:150-4. [PMID: 26321539 DOI: 10.1177/230949901502300206] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To review records of 2702 patients with osteoporotic hip fractures in a Singaporean hospital. METHODS Medical records of 1905 women and 797 men, aged 50 to 112 (median, 78) years, who were admitted to a Singaporean hospital with an osteoporotic hip fracture (ICD9 820) between January 2000 and December 2010 were reviewed. RESULTS Female patients were significantly older than male patients (p<0.0005). The trend for the median patient age over the 10-year period has increased significantly in women (r=0.826, p=0.002) but not in men. Of the hip fractures, 49.4% were femoral neck fractures and 50.6% were intertrochanteric/ basicervical fractures. The rate of intertrochanteric/ basicervical fractures was higher in men than women (61.2% vs. 46.1%, p<0.0005). Increased age, ischaemic heart disease, Parkinson's disease, and being Malay or Caucasian or Sikh were more likely to have intertrochanteric/basicervical fractures than femoral neck fractures. Femoral neck fractures were usually treated with hemiarthroplasty (68.8%), cancellous screw fixation (20.6%), and conservative methods (20.5%), whereas intertrochanteric/basicervical fractures were usually treated with dynamic hip screw fixation (76.3%) and conservative methods (15.6%). 84 women and 26 men sustained a subsequent osteoporotic hip fracture on the contralateral side after a median interval of 2 (range, 0-8) years. 11 of these 110 patients were already on osteoporosis medication. CONCLUSION The rate of osteoporotic hip fractures has increased, particularly among women, over the 10- year period. The rate of intertrochanteric/basicervical fractures was higher in men than women.
Collapse
Affiliation(s)
- Wei Loong Barry Tan
- University Orthopaedics, Hand and Reconstructive Microsurgery Cluster, National University Hospital, Singapore
| | - Siew Leng Low
- University Orthopaedics, Hand and Reconstructive Microsurgery Cluster, National University Hospital, Singapore
| | - Liang Shen
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Shamal Das De
- University Orthopaedics, Hand and Reconstructive Microsurgery Cluster, National University Hospital, Singapore
| |
Collapse
|
31
|
Sobolev B, Sheehan KJ, Kuramoto L, Guy P. Risk of second hip fracture persists for years after initial trauma. Bone 2015; 75:72-6. [PMID: 25681701 DOI: 10.1016/j.bone.2015.02.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 01/29/2015] [Accepted: 02/04/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Secondary prevention often targets women who suffer from higher rates of second hip fracture than men, especially in the early years after first fracture. Yet, the occurrence of second hip fracture by certain times also depends on the death rate, which is higher in men than women. We compared the risk of sustaining second hip fracture by a certain time between women and men remaining alive at that time. METHODS We retrieved 38,383 hospitalization records of patients aged 60 years or older, who were discharged alive after admission for hip fracture surgery between 1990 and 2005 in British Columbia, Canada. The outcome variable was the time to a subsequent hip fracture. RESULTS During ten years of follow-up, 2,902 (8%) patients sustained a second hip fracture, and 21,428 (56%) died before sustaining a second hip fracture. The risk of second hip fracture in the surviving post-fracture patients was higher in women than in men: 2% vs 2%, 5% vs 4%, 9% vs 7%, 15% vs 13%, and 35% vs 30% at 1, 2, 3, 5, and 10 years after initial trauma, respectively, crude OR=1.25 (95% CI: 1.13-1.39). However, the risk did not differ between women and men after adjustment, OR=1.09 (95% CI: 0.98-1.21). CONCLUSIONS The risk of second hip fracture persists for at least ten years among hip fracture survivors, and therefore secondary prevention should continue beyond an early post-fracture period. Women and men have similar risks of second hip fracture and both should be considered for secondary prevention.
Collapse
Affiliation(s)
- Boris Sobolev
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada; Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, BC, Canada
| | - Katie Jane Sheehan
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada; Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, BC, Canada.
| | - Lisa Kuramoto
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, BC, Canada
| | - Pierre Guy
- Department of Orthopedics, University of British Columbia, Vancouver, BC, Canada; Centre for Hip Health and Mobility, University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
32
|
Complications and institutionalization are almost doubled after second hip fracture surgery in the elderly patient. J Orthop Trauma 2015; 29:e103-8. [PMID: 25210832 DOI: 10.1097/bot.0000000000000233] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine patient and hip fracture characteristics, early postoperative complication rate, and need for institutionalization at the time of discharge from the hospital in patients treated for a second contralateral hip fracture. METHODS During a 6-year period (2003-2009), 71 patients (60 women and 11 men; age range, 54-94 years) underwent first hip fracture surgery and subsequent contralateral hip fracture surgery at our hospital. Variables, including age, gender, American Society of Anesthesiologists classification (ASA), AO fracture classification, time between both hip fractures, rate and severity of early postoperative complications, and destination of discharge were obtained from the electronic medical records. Data from both hospitalization periods were compared. RESULTS Forty-six percent of second hip fractures occurred within 2 years after the first hip fracture. After the first hip fracture surgery, 13 patients had 1 or multiple complications compared with 23 patients after a second hip fracture surgery (P = 0.02). The mean time (±SD) between the first and second hip fractures in patients without complications after the second injury was 4.3 (±4.2) years, compared with 2.6 (±2.1) years in patients with complications after the second injury (P = 0.03). The mean ASA classification of patients without complications after the second hip fracture surgery was 2.6 (±0.6) versus 3.0 (±0.6) in patients with complications (P = 0.04). After the first hip fracture surgery, 27 patients (38%) were discharged to an institutional care facility, whereas 72% of patients resided at an institutional care facility after a second hip fracture. CONCLUSIONS Early complication rate in patients sustaining a second contralateral hip fracture was almost twice that documented after the first hip fracture. After the second hip fracture surgery, most patients resided in an institutional care facility. LEVEL OF EVIDENCE Prognostic level II. See Instructions for Authors for a complete description of levels of evidence.
Collapse
|
33
|
Liu S, Zhu Y, Chen W, Sun T, Cheng J, Zhang Y. Risk factors for the second contralateral hip fracture in elderly patients: a systematic review and meta-analysis. Clin Rehabil 2015; 29:285-94. [PMID: 25027445 DOI: 10.1177/0269215514542358] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To achieve a quantitative and comprehensive conclusion concerning the risk factors for the second contralateral hip fracture in elderly patients with initial hip fractures. DATA SOURCES This search was applied to Medline, Embase, Cochrane central database (all up to April 2014). METHODS All the studies on bilateral hip fractures in elderly patients published in English were reviewed and qualities of included studies were assessed using the Newcastle-Ottawa Scale. All the data were carefully and independently abstracted by two reviewers, any disagreement was settled by discussion. Data was pooled and a meta-analysis completed. RESULTS A total of 13 case-control studies were identified for the meta-analysis. The significant risk factors were female (odds ratio (OR), 1.30; 95% confidence interval (CI), 1.02-1.64), living in institutions (OR, 2.53; 95% CI, 1.33-4.85), osteoporosis (OR, 10.02; 95% CI, 5.41-18.57), low vision (OR, 2.09; 95% CI, 1.06-4.12), dementia (OR, 2.02; 95% CI, 1.54-2.65), dizziness (OR, 2.87; 95% CI, 1.42-5.87) cardiac diseases (OR, 1.33; 95% CI, 1.00-1.78) and respiration diseases (OR, 2.58; 95% CI, 1.22-5.47). No significant difference was found in admission age between patients with the unilateral hip fracture and the first hip fracture of bilateral hip groups (standardized mean difference, 0.02, 95% CI, -0.30 to 0.35]. CONCLUSIONS Patients involved with female, living in institutions, osteoporosis, low vision, dizziness, dementia, respiration diseases and cardiac diseases were at risk for a second contralateral hip fracture after the initial hip fracture.
Collapse
Affiliation(s)
- Song Liu
- Department of Orthopaedic Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, People's Republic of China
| | - Yanbin Zhu
- Department of Orthopaedic Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, People's Republic of China
| | - Wei Chen
- Department of Orthopaedic Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, People's Republic of China
| | - Tao Sun
- Department of Orthopaedic Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, People's Republic of China
| | - Jiaxiang Cheng
- Department of Orthopaedic Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, People's Republic of China
| | - Yingze Zhang
- Department of Orthopaedic Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, People's Republic of China
| |
Collapse
|
34
|
Subsequent contralateral hip fractures: can at-risk patients be identified? An observational study of 5,102 patients. INTERNATIONAL ORTHOPAEDICS 2015; 39:755-60. [DOI: 10.1007/s00264-014-2646-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 12/15/2014] [Indexed: 11/25/2022]
|
35
|
Zhu Y, Chen W, Sun T, Zhang Q, Liu S, Zhang Y. Epidemiological characteristics and outcome in elderly patients sustaining non-simultaneous bilateral hip fracture: A systematic review and meta-analysis. Geriatr Gerontol Int 2014; 15:11-8. [PMID: 25363019 DOI: 10.1111/ggi.12368] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Yanbin Zhu
- Department of Orthopedic Surgery; the Third Hospital of Hebei Medical University; Shijiazhuang Hebei China
| | - Wei Chen
- Department of Orthopedic Surgery; the Third Hospital of Hebei Medical University; Shijiazhuang Hebei China
| | - Tao Sun
- Department of Orthopedic Surgery; the Third Hospital of Hebei Medical University; Shijiazhuang Hebei China
| | - Qi Zhang
- Department of Orthopedic Surgery; the Third Hospital of Hebei Medical University; Shijiazhuang Hebei China
| | - Song Liu
- Department of Orthopedic Surgery; the Third Hospital of Hebei Medical University; Shijiazhuang Hebei China
| | - Yingze Zhang
- Key laboratory of biomechanics of Hebei Province; the Third Hospital of Hebei Medical University; Shijiazhuang Hebei China
| |
Collapse
|
36
|
Lau JCF, Ho KW, Sadiq S. Patient characteristics and risk of subsequent contralateral hip fracture after surgical management of first fracture. Injury 2014; 45:1620-3. [PMID: 24947502 DOI: 10.1016/j.injury.2014.05.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 05/23/2014] [Indexed: 02/02/2023]
Abstract
BACKGROUND Sequential hip fractures are associated with increased morbidity and mortality. Understanding of risk factors is important for secondary prevention. Although hip fractures have a multifactorial aetiology related to falls, it is unknown whether fracture management approach influences the risk of sequential hip fractures. OBJECTIVES Our objective is to explore whether subsequent contralateral hip fractures are more common following femoral head replacement or salvage procedures for the treatment of hip fractures. METHODS Patients older than 50, admitted to a single regional trauma unit in Worcestershire between 2010 and 2012 were identified from the national database. 700 patients matched our inclusion criteria and case notes were reviewed. The male to female ratio was 1:3.3 and the mean age was 82.8 years (standard deviation: 8.9 years). Contralateral fractures were identified from admission X-rays. Risk factors were analysed based on patient demographics and data related to first hip fracture management. RESULTS Seventy-one patients presented with contralateral fractures, of which 19 had their first fracture during the data collection period, estimating a period prevalence of 10.1%, and incidence of 2.9%. Contralateral fracture rates were not significantly different between femoral head salvage and replacement procedures (P-value 0.683). Older institutionalised females with poorer mobility status were at greatest risk of contralateral hip fractures. Half (50.7%) of these occurred within 2 years of their first fracture. CONCLUSION No additional risk was seen in either fixation approaches. Risk factors identified were in keeping with existing literature, which can help to identify high-risk groups for targeted prevention strategies.
Collapse
Affiliation(s)
| | - Ki Wai Ho
- Chinese University of Hong Kong, China
| | | |
Collapse
|
37
|
Cumulative incidence and treatment of non-simultaneous bilateral femoral neck fractures in a cohort of one thousand two hundred and fifty patients. INTERNATIONAL ORTHOPAEDICS 2014; 38:2335-42. [DOI: 10.1007/s00264-014-2447-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Accepted: 06/22/2014] [Indexed: 12/26/2022]
|
38
|
Risk analysis for second hip fracture in patients after hip fracture surgery: a nationwide population-based study. J Am Med Dir Assoc 2014; 15:725-31. [PMID: 25017390 DOI: 10.1016/j.jamda.2014.05.010] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 05/16/2014] [Accepted: 05/19/2014] [Indexed: 11/23/2022]
Abstract
OBJECTIVES The current treatment program for fragility hip fractures (HFx) emphasizes a combination of early surgery, rehabilitation, and tertiary prevention strategy for osteoporosis; however, the effect is unclear and little information is available on the risk factors predicting the occurrence of a second hip fracture (SHFx). The aim of this study was to explore the incidence, risk factors, and subsequent mortality of SHFx in patients after their first hip fracture surgery (HFxS). DESIGN, SETTING, AND PARTICIPANTS We performed a nationwide population-based longitudinal observational study using the National Health Insurance Research Database (NHIRD) of Taiwan with a logistic regression model analysis. Of 87,415 patients undergoing HFxS during the period 2004 to 2007, we identified 8027 patients who had sustained an SHFx for analyses. MEASUREMENTS Data collected included patient characteristics (demographics, comorbidities, and concurrent medication use), incidence and hazard ratios of SHFx after HFxS, and subsequent age-specific mortality. RESULTS The overall incidence of SHFx was 9.18% and the age-specific mortality was increased 1.6- to 2.2-fold in patients with SHFx compared with those without after HFxS in this 7-year longitudinal study. The identified risk factors included age (AOR = 1.84, 95% CI: 1.24-2.89), female gender (AOR = 1.12, 95% CI: 1.03-2.30), obesity (AOR = 2.89, 95% CI: 1.81-3.01), diabetes (AOR = 3.85, 95% CI: 2.54-4.05), arterial hypertension (AOR = 2.45, 95% CI: 1.83-2.62), hyperlipidemia (AOR = 2.77, 95% CI: 1.27-3.19), stroke/TIA (AOR = 2.85, 95% CI: 2.20-3.23), blindness/low vision (AOR = 3.09, 95% CI: 2.54-3.73), and prolonged use of analgesics and anti-inflammatory medications (all AOR ≥ 3.05, all P values ≤.012). Bisphosphonate therapy after HFxS had a significant negative risk association with the development of an SHFx (20.8% vs 32.3%, P = .023; AOR = 2.24, 95% CI: 1.38-2.90). CONCLUSION We concluded that the occurrence of an SHFx and subsequent mortality in patients after HFxS is rather high. An understanding of the risk factors predicting the occurrence of an SHFx provides a valuable basis to improve health care for geriatric populations.
Collapse
|
39
|
Zhu Y, Chen W, Sun T, Zhang Q, Cheng J, Zhang Y. Meta-analysis of risk factors for the second hip fracture (SHF) in elderly patients. Arch Gerontol Geriatr 2014; 59:1-6. [PMID: 24657007 DOI: 10.1016/j.archger.2014.02.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Revised: 02/24/2014] [Accepted: 02/27/2014] [Indexed: 01/11/2023]
Abstract
This study aims to quantitatively summarize the risk factors for the incidence of SHF. A meta-analysis was performed with the data obtained from 22 relevant papers published in Pubmed, Embase and Cochrane central database (all through January 2014) following strict selection. The pooled odds ratios (ORs) or standardized mean difference (SMD) with 95% confidence intervals (CIs) were calculated for potential risk factors associated with SHF. Our meta-analysis indicated the significant risk factors for SHF were female (OR, 1.46; 95%CI, 1.29-1.66), living in institutions (OR, 2.23; 95%CI, 1.29-3.83), osteoporosis (Singh index (SI) 1-3) (OR, 10.02; 95%CI, 5.41-18.57), low vision (OR, 2.09; 95%CI, 1.06-4.12), dementia (OR, 1.89; 95%CI, 1.47-2.43), Parkinson (OR, 2.90; 95%CI, 1.41-5.95), cardiac diseases (OR, 1.32; 95%CI, 1.02-1.70) and respiratory disease (OR, 1.97; 95%CI, 1.16-3.32). Related strategies must be implemented on those involved with above-mentioned medical conditions to effectively prevent a SHF.
Collapse
Affiliation(s)
- Yanbin Zhu
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei 050051, PR China; Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei 050051, PR China
| | - Wei Chen
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei 050051, PR China; Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei 050051, PR China
| | - Tao Sun
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei 050051, PR China; Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei 050051, PR China
| | - Qi Zhang
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei 050051, PR China; Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei 050051, PR China
| | - Jiaxiang Cheng
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei 050051, PR China; Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei 050051, PR China
| | - Yingze Zhang
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei 050051, PR China; Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei 050051, PR China.
| |
Collapse
|
40
|
Beraldi R, Masi L, Parri S, Partescano R, Brandi ML. The role of the orthopaedic surgeon in the prevention of refracture in patients treated surgically for fragility hip and vertebral fracture. CLINICAL CASES IN MINERAL AND BONE METABOLISM : THE OFFICIAL JOURNAL OF THE ITALIAN SOCIETY OF OSTEOPOROSIS, MINERAL METABOLISM, AND SKELETAL DISEASES 2014; 11:31-35. [PMID: 25002877 PMCID: PMC4064438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
UNLABELLED THE ROLE OF THE ORTHOPAEDIC SURGEON IN THE TREATMENT OF PATIENTS WITH FRAGILITY FRACTURES IS TWOFOLD: the conservative or surgical treatment of the fracture, and the prevention of further fractures, establishing diagnostic and therapeutic procedures for osteoporosis. We evaluated 72 patients treated surgically for fragility vertebral fracture and 801 patients treated surgically for fragility hip fracture, operated from 2009 to 2010 at O.U. Orthopaedics and Traumatology of S.M. Annunziata Hospital of Florence, that have followed a treatment for refractures prevention according to the TARGET (Appropriate Treatment for Refractures GEriatric in Tuscany) Project of Tuscany Region. The average follow-up was 34 months. Patients with vertebral fracture treated for refractures prevention were 58 (80.6%), while patients with hip fracture treated for refractures prevention were 307 (38.3). RESULTS the number of patients with vertebral fracture who had a refracture in the first two years after surgery was 12 (16.6%), of which 9 patients were not treated for osteoporosis. The percentage of refracture at 1 year after surgery in patients with hip fractures was 3.19% in 2009 and 2.17% in 2010, compared to 5.16% of refracture of 2006 when the TARGET Project was not yet started. Mortality at 1 year after surgery in patients with hip fracture treated for osteoporosis was 19% compared to 25-31% in the patients not treated for osteoporosis.
Collapse
Affiliation(s)
- Rosella Beraldi
- O.U. Orthopaedics and Traumatology, S.M. Annunziata Hospital, Florence, Italy
| | - Laura Masi
- University of Florence, Department of Internal Medicine, Florence, Italy
| | - Simone Parri
- University of Florence, Department of Internal Medicine, Florence, Italy
| | - Raffaele Partescano
- O.U. Orthopaedics and Traumatology, S.M. Annunziata Hospital, Florence, Italy
| | - Maria Luisa Brandi
- University of Florence, Department of Internal Medicine, Florence, Italy
| |
Collapse
|
41
|
Brandi ML. Evaluation of fracture risk and fracture prevention: an Italian picture. CLINICAL CASES IN MINERAL AND BONE METABOLISM : THE OFFICIAL JOURNAL OF THE ITALIAN SOCIETY OF OSTEOPOROSIS, MINERAL METABOLISM, AND SKELETAL DISEASES 2012; 9:73-75. [PMID: 23087713 PMCID: PMC3476518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Italy has one of the longest life expectancies when compared to other countries in the world, with 20% of the entire population being over 65 years of age and about 6% of these being already 80 years and over. Increased life expectancy is associated with a greater frailty index, typical of the elderly population, with higher prevalence of chronic and degenerative disorders, including fragility fractures. Data have been accumulating about the incidence of fragility fractures in the Italian population, with numbers that are truly alarming for the future decades. In this scenario, the need for the use of antifracture agents becomes strategic in our Country. Therapeutic options currently available for fracture prevention include both antiresorptive and anabolic compounds. Despite the incorporation of this evidence from randomized trials into clinical practice guidelines, these interventions are considerably underutilized. Furthermore, adherence to these therapies is a critical parameter affecting the effectiveness of treatments. Results of institutional databases pose the problem of unsatisfactory outcomes of compliance to antifracture agents prescriptions recorded within regional pharmaceutical databases. These care gaps highlight the finding that additional effort is needed to optimize management of osteoporosis in patients at risk of fragility fractures. Given that there is evidence that appropriate management of osteoporosis decreases fractures, it is felt that the use of appropriate management as the primary outcome is per se relevant. Future efforts should consider treatment appropriateness, treatment sustainability and treatment adherence, as the needed parameters to be applied to programs of osteoporosis care in a community setting.
Collapse
Affiliation(s)
- Maria Luisa Brandi
- Address for correspondence: Maria Luisa Brandi, MD, PhD Head, Mineral and Bone Metabolism Unit, University Hospital of Careggi, Viale Pieraccini 6 - 50139 Florence, Italy, Phone: +39 055 2337800 - Fax: +39 055 2337867, E-mail:
| |
Collapse
|