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Raven TF, Friedl W, Moghaddam A. Treatment of Traumatic Femoral Neck Fractures with an Intramedullary Nail in Osteoporotic Bones. Indian J Orthop 2021; 55:621-628. [PMID: 33995865 PMCID: PMC8081773 DOI: 10.1007/s43465-020-00292-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 10/12/2020] [Indexed: 02/04/2023]
Abstract
PURPOSE Sufficient anchoring of intramedullary osteosynthesis in the femoral head in a femoral neck fracture is a challenge with increasing age of the patients and decreasing bone quality. For older patients with inferior bone quality, it has not been investigated whether the application of an intramedullary force carrier, as a minimally invasive and rapid intervention, can provide a considerable benefit and reduce the postoperative complication and lethality rate. This retrospective study aimed to investigate the stability and functionality after the acute treatment of a femoral neck fracture in osteoporotic bone using an intramedullary force carrier even with higher grade fracture types. MATERIAL AND METHODS The retrospective analysis was based on a collective of 82 patients over 60 years of age with a femoral neck fracture treated with a gliding nail in our centre between 1999 and 2006. RESULTS The average time to follow-up was 69.05 months (median 71.0; minimum 27.0-maximum 108.0). Female patients made up more than two-thirds of the patient collective at 63 of the 82 patients (76.83%). The average age of the patients was 77.76 years (median 78.00; range 60.00-93.00).In 66 patients (80.49%), the implantation showed good results and no complications or further treatments. 24/82 patients of our collective had died in our re-evaluation. In no case, a pseudarthrosis or severe impaction with neck shortening occurred (loss of offset).11/82 patients had femoral head necrosis which led to total hip replacement in 8 cases, a hemiarthroplasty in 2 cases and in 1 case a remaining Girdlestone situation because of a deep infection. Another five patients also had to undergo a total hip replacement because of a central perforation of the blade in one case, breakout of the blade after another fall in another two cases and a lateral dislocation of the blade in two cases. CONCLUSION The use of an intramedullary force carrier in the osteoporotic bone can mean distinct advantages for the selected patient as a minimally invasive and rapid surgical method compared to extensive surgery, even in the case of severe injuries. However, the advantages and disadvantages for the patient should be considered critically.
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Affiliation(s)
- Tim Friedrich Raven
- ATORG-Aschaffenburg Trauma and Orthopaedic Research Group, Center for Orthopaedics, Trauma Surgery and Sports Medicine, Hospital Aschaffenburg-Alzenau, Am Hasenkopf 1, 63739 Aschaffenburg, Germany
| | - Wilhelm Friedl
- Division of Orthopaedics and Trauma Surgery, Rotkreuzklinik Wertheim gGmbH, Rotkreuzstraße 2, 97877 Wertheim am Main, Germany
| | - Arash Moghaddam
- ATORG-Aschaffenburg Trauma and Orthopaedic Research Group, Center for Orthopaedics, Trauma Surgery and Sports Medicine, Hospital Aschaffenburg-Alzenau, Am Hasenkopf 1, 63739 Aschaffenburg, Germany
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Ho-Le TP, Tran TS, Bliuc D, Pham HM, Frost SA, Center JR, Eisman JA, Nguyen TV. Epidemiological transition to mortality and refracture following an initial fracture. eLife 2021; 10:61142. [PMID: 33558009 PMCID: PMC7924952 DOI: 10.7554/elife.61142] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 01/25/2021] [Indexed: 02/06/2023] Open
Abstract
This study sought to redefine the concept of fracture risk that includes refracture and mortality, and to transform the risk into "skeletal age". We analysed data obtained from 3521 women and men aged 60 years and older, whose fracture incidence, mortality, and bone mineral density (BMD) have been monitored since 1989. During the 20-year follow-up period, among 632 women and 184 men with a first incident fracture, the risk of sustaining a second fracture was higher in women (36%) than in men (22%), but mortality risk was higher in men (41%) than in women (25%). The increased risk of mortality was not only present with an initial fracture, but was accelerated with refractures. Key predictors of post-fracture mortality were male gender (hazard ratio [HR] 2.4; 95% CI, 1.79–3.21), advancing age (HR 1.67; 1.53–1.83), and lower femoral neck BMD (HR 1.16; 1.01–1.33). A 70-year-old man with a fracture is predicted to have a skeletal age of 75. These results were incorporated into a prediction model to aid patient-doctor discussion about fracture vulnerability and treatment decisions.
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Affiliation(s)
- Thao Phuong Ho-Le
- Healthy Ageing Theme, Garvan Institute of Medical Research, Darlinghurst, Australia.,Swinburne University of Technology, Melbourne, Australia.,Faculty of Engineering and Information Technology, Hatinh University, Hatinh, Viet Nam
| | - Thach S Tran
- Healthy Ageing Theme, Garvan Institute of Medical Research, Darlinghurst, Australia.,St Vincent Clinical School, UNSW Sydney, Sydney, Australia
| | - Dana Bliuc
- Healthy Ageing Theme, Garvan Institute of Medical Research, Darlinghurst, Australia.,St Vincent Clinical School, UNSW Sydney, Sydney, Australia
| | - Hanh M Pham
- Healthy Ageing Theme, Garvan Institute of Medical Research, Darlinghurst, Australia.,Fertility Department, Andrology and Fertility Hospital of Hanoi, Hanoi, Viet Nam
| | - Steven A Frost
- Healthy Ageing Theme, Garvan Institute of Medical Research, Darlinghurst, Australia
| | - Jacqueline R Center
- Healthy Ageing Theme, Garvan Institute of Medical Research, Darlinghurst, Australia.,St Vincent Clinical School, UNSW Sydney, Sydney, Australia
| | - John A Eisman
- Healthy Ageing Theme, Garvan Institute of Medical Research, Darlinghurst, Australia.,St Vincent Clinical School, UNSW Sydney, Sydney, Australia.,School of Medicine Sydney, University of Notre Dame Australia, Sydney, Australia
| | - Tuan V Nguyen
- Healthy Ageing Theme, Garvan Institute of Medical Research, Darlinghurst, Australia.,St Vincent Clinical School, UNSW Sydney, Sydney, Australia.,School of Medicine Sydney, University of Notre Dame Australia, Sydney, Australia.,School of Biomedical Engineering, University of Technology, Sydney, Australia
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Yanagisawa Y, Watanabe Y, Yamazaki M. Successful treatment of an open tibial fracture in a 102-year-old woman: a case report. J Rural Med 2020; 15:221-224. [PMID: 33033546 PMCID: PMC7530588 DOI: 10.2185/jrm.2020-019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 05/07/2020] [Indexed: 11/27/2022] Open
Abstract
Introduction: As the average life expectancy is increasing, the number of patients aged >100 years who have fragility fractures will increase in the future. In female patients, the incidence of open fractures increases with age. Case Presentation: We present the case of a 102-year-old woman with open tibial and fibular diaphyseal fractures (Gustilo-Anderson classification type IIIb) treated with temporary external fixation, advancement flap, and negative pressure wound therapy in the first-stage surgery and treatment, and open reduction and internal fixation with skin grafting in the second-stage surgery. Open wound and bone healing were attained. Conclusion: Surgery should not be denied on the basis of age alone. Medical evaluation should focus on identifying risk factors, assessing risk in detail, optimizing status, predicting complications, and making the appropriate surgical plan for the patient status. Moreover, in the present case, meticulous postoperative management was the main reason for the successful surgical treatment.
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Affiliation(s)
| | - Yu Watanabe
- Department of Orthopaedic Surgery, University of Tsukuba, Japan
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Gioffrè-Florio M, Murabito LM, Visalli C, Pergolizzi FP, Famà F. Trauma in elderly patients: a study of prevalence, comorbidities and gender differences. G Chir 2019; 39:35-40. [PMID: 29549679 DOI: 10.11138/gchir/2018.39.1.035] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM Trauma, in geriatric patients, increases with age, and is a leading cause of disability and institutionalization, resulting in morbidity and mortality. The aim of our study was to analyse the prevalence of trauma, the related risk factors, mortality and sex differences in the prevalence in a geriatric population. PATIENTS AND METHOD We observed 4,554 patients (≥65 years) with home injuries or car accidents. Patients were evaluated with ISS (Injury Severity Score) and major trauma with ATLS (Advanced Trauma Life Support). The instrumental investigation was in the first instance, targeted X-Ray or whole-body CT. RESULTS In over four years of study we treated 4,554 geriatric: 2,809 females and 1,745 Males. When the type of trauma was analysed the most common was head injury, followed by fractures of lower and upper limbs. In our experience hospitalization mainly involved patients over 80. In all patients mortality during assessment was 0.06%. DISCUSSION The geriatric patient is often defined as a "frail elderly", for the presence of a greater "injury sensitivity". This is due to the simultaneous presence of comorbidity, progressive loss of full autonomy and exposure to a high risk of traumatic events. Optimal management of the trauma patient can considerable reduce mortality and morbidity. CONCLUSIONS Falls and injuries in geriatric age are more frequent in women than in men. Among typical elder comorbidities, osteoporosis certainly causes a female preponderance in the prevalence of fractures. Our discharge data demonstrate that disability, which requires transfer to health care institutions, has a greater effect on women than men.
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Moral-Cuesta D, Rodríguez-Sánchez I, Menéndez-Colino R, Díaz-Sebastián J, Alarcón T, Martín Maestre I, González-Montalvo JI. [Functional consequences of fragile pelvis fracture. Description of several cases attended by a consultation Geriatrics team]. Rev Esp Geriatr Gerontol 2018; 53:81-84. [PMID: 28784246 DOI: 10.1016/j.regg.2017.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 06/06/2017] [Accepted: 06/09/2017] [Indexed: 06/07/2023]
Abstract
INTRODUCTION The prevalence of pelvic fracture (PF) due to frailty is increasing, leading to an increase in functional impairment in the patient, as well as increasing morbidity and mortality. The aim of the present study is to gain knowledge about the sociodemographic characteristics, as well as the functional features, of patients admitted to hospital with PF and evaluated by a Geriatrics department. The functional burden of PF and the potential influence of geriatric interventions are also assessed. MATERIAL AND METHODS A retrospective study conducted between 1995 and 2015 on all patients older than 65 years old with PF admitted to the Traumatology department, and then assessed in the Geriatrics Department. Sociodemographic information was also collected (age, gender and place of residence), as well as data from the geriatric assessment (baseline situation and at hospital admission), hospital stay, within hospital mortality, and discharge. RESULTS The study included 271 patients with a mean age of 81.1±7 years, and mainly women (81.2%). The median hospital stay was 9 days (interquartile range 5 to 14 days). The ability to walk independently decreased after PF from 72.3% to 3.6%. Severe disability cases increased in activities of daily living from 7.9% to 79.5%. Within hospital mortality was 2.2%. As regards medical follow-up consultations, the mean length of stay was significantly reduced compared to the assessment consultations (10.0±7.8 vs 16.1±12.0 days, P<.001) CONCLUSION: PF patients evaluated by the Geriatrics Department were mainly women, with advanced age, and a severe functional impairment secondary to PF. The intervention of a geriatrician could contribute to optimise hospital resources.
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Affiliation(s)
- Debora Moral-Cuesta
- Servicio de Geriatría, Instituto de Investigación del Hospital La Paz (IdiPAZ), Madrid, España.
| | | | - Rocío Menéndez-Colino
- Servicio de Geriatría, Instituto de Investigación del Hospital La Paz (IdiPAZ), Madrid, España
| | | | - Teresa Alarcón
- Servicio de Geriatría, Instituto de Investigación del Hospital La Paz (IdiPAZ), Madrid, España
| | - Isabel Martín Maestre
- Servicio de Geriatría, Instituto de Investigación del Hospital La Paz (IdiPAZ), Madrid, España
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Ravindrarajah R, Hazra NC, Charlton J, Jackson SHD, Dregan A, Gulliford MC. Incidence and mortality of fractures by frailty level over 80 years of age: cohort study using UK electronic health records. BMJ Open 2018; 8:e018836. [PMID: 29358434 PMCID: PMC5781050 DOI: 10.1136/bmjopen-2017-018836] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE This study aimed to estimate the association of frailty with incidence and mortality of fractures at different sites in people aged over 80 years. DESIGN Cohort study. SETTING UK family practices from 2001 to 2014. PARTICIPANTS 265 195 registered participants aged 80 years and older. MEASUREMENTS Frailty status classified into 'fit', 'mild', 'moderate' and 'severe' frailty. Fractures, classified into non-fragility and fragility, including fractures of femur, pelvis, shoulder and upper arm, and forearm/wrist. Incidence of fracture, and mortality within 90 days and 1 year, were estimated. RESULTS There were 28 643 fractures including: non-fragility fractures, 9101; femur, 12 501; pelvis, 2172; shoulder and upper arm, 4965; and forearm/wrist, 6315. The incidence of each fracture type was higher in women and increased with frailty category (femur, severe frailty compared with 'fit', incidence rate ratio (IRR) 2.4, 95% CI 2.3 to 2.6). Fractures of the femur (95-99 years compared with 80-84 years, IRR 2.7, 95% CI 2.6 to 2.9) and pelvis (IRR 2.9, 95% CI 2.5 to 3.3) were strongly associated with age but non-fragility and forearm fractures were not. Mortality within 90 days was greatest for femur fracture (adjusted HR, compared with forearm fracture 4.3, 95% CI 3.7 to 5.1). Mortality was higher in men and increased with age (HR 5.3, 95% CI 4.3 to 6.5 in those over 100 years compared with 80-84 years) but was less strongly associated with frailty category. Similar associations with fractures were seen at 1-year mortality. CONCLUSIONS The incidence of fractures at all sites was higher in women and strongly associated with advancing frailty status, while the risk of mortality after a fracture was greater in men and was associated with age rather than frailty category.
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Affiliation(s)
- Rathi Ravindrarajah
- Department of Primary Care and Public Health Sciences, King’s College London, London, UK
| | - Nisha C Hazra
- Department of Primary Care and Public Health Sciences, King’s College London, London, UK
| | - Judith Charlton
- Department of Primary Care and Public Health Sciences, King’s College London, London, UK
| | - Stephen H D Jackson
- National Institute for Health Research Biomedical Research Centre at Guy’s and St Thomas’ National Health Service Foundation Trust, Kings’ College London, London, UK
| | - Alex Dregan
- Department of Primary Care and Public Health Sciences, King’s College London, London, UK
- National Institute for Health Research Biomedical Research Centre at Guy’s and St Thomas’ National Health Service Foundation Trust, Kings’ College London, London, UK
- Department of Clinical Gerontology, King’s College London, London, UK
| | - Martin C Gulliford
- Department of Primary Care and Public Health Sciences, King’s College London, London, UK
- National Institute for Health Research Biomedical Research Centre at Guy’s and St Thomas’ National Health Service Foundation Trust, Kings’ College London, London, UK
- Department of Clinical Gerontology, King’s College London, London, UK
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Kirshenbom D, Ben-Zaken Z, Albilya N, Niyibizi E, Bala M. Older Age, Comorbid Illnesses, and Injury Severity Affect Immediate Outcome in Elderly Trauma Patients. J Emerg Trauma Shock 2017; 10:146-150. [PMID: 28855778 PMCID: PMC5566026 DOI: 10.4103/jets.jets_62_16] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Introduction: Trauma in elderly population is frequent and is associated with significant mortality, not only due to age but also due to complicated factors such as the severity of injury, preexisting comorbidity, and incomplete general assessment. Our primary aim was to determine whether age, Injury Severity Score (ISS), and preexisting comorbidities had an adverse effect on the outcome in patients aged 65 years and above following blunt trauma. Methods: We included 1027 patients aged ≥65 years who were admitted to our Level I Trauma Center following blunt trauma. Patients’ charts were reviewed for demographics, ISS, mechanism of injury, preexisting comorbidities, Intensive Care Unit and hospital length of stay, complications, and in-hospital mortality. Results: The mean age of injured patients was 78.8 ± 8.3 years (range 65–109). The majority of patients had mild injury severity (ISS 9–14, 66.8%). Multiple comorbidities (≥3) were found in 233 patients (22.7%). Mortality during the hospitalization stay (n = 35, 3.4%) was associated with coronary artery disease, renal failure, dementia, and warfarin use (P < 0.05). Chronic anticoagulation treatment was recorded in 13% of patients. The addition of a single comorbidity increased the odds of wound infection to 1.29 and sepsis to 1.25. Both age and ISS increased the odds of death as −1.08 and −2.47, respectively. Conclusions: Our analysis shows that age alone in elderly trauma population is not a robust measure of outcome, and more valuable predictors such as injury severity, preexisting comorbidities, and medications are accounted for adverse outcome. Trauma care in this population with special considerations should be tailored to meet their specific needs.
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Affiliation(s)
| | - Zila Ben-Zaken
- Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Nehama Albilya
- Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Eva Niyibizi
- Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Miklosh Bala
- Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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Lloret A, Coiffier G, Couchouron T, Perdriger A, Guggenbuhl P. Risk factors of mortality during the first year after low energy osteoporosis fracture: a retrospective case-control study. ACTA ACUST UNITED AC 2016; 13:123-126. [PMID: 27920808 DOI: 10.11138/ccmbm/2016.13.2.123] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Osteoporotic fractures are a major public health problem because of the morbidity and mortality of fracture complications. The objective of this study was to examine predictive factors of mortality during the first year after an osteoporotic fracture. METHODS It is a retrospective case-control study using data of a group of 1081 patients aged over 50 years with severe osteoporotic fractures by the Rennes university hospital emergency department from August 2007 to September 2008. Patients (cases) who died during the year following the fracture were compared with others who had survived (controls) one year after the fracture, matched on age, sex and type of fracture. Pre-fracture comorbidities and complications after the fractures were studied. RESULTS Forty-two cases and 126 controls were analyzed without significant differences in age, sex or type of fracture. On univariate analysis, previous neoplasia, neurodegenerative disease, walking aids, thromboembolic complication, post fracture infection, post fracture heart failure, post fracture acute respiratory failure were associated with more mortality after osteoporotic fracture. After multivariate analysis, only previous neoplasia (OR = 4.63 [1.79 - 11.95]; p = 0.02) and acute respiratory failure after fracture (OR = 28.15 [5.75 - 137.9]; p<0.001) were retained as predictive factors during the year following the fracture. CONCLUSION Patients died more often from their co-morbidities than direct complications of their fractures. Osteoporotic fracture seems to be a marker of poor health status and a factor which may hasten the death.
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Affiliation(s)
- Aurore Lloret
- Service de Rhumatologie, CHU de Rennes Hôpital Sud, Rennes, Cedex 2, France
| | - Guillaume Coiffier
- Service de Rhumatologie, CHU de Rennes Hôpital Sud, Rennes, Cedex 2, France
| | - Tiffen Couchouron
- Service de Rhumatologie, CHU de Rennes Hôpital Sud, Rennes, Cedex 2, France
| | - Aleth Perdriger
- Service de Rhumatologie, CHU de Rennes Hôpital Sud, Rennes, Cedex 2, France
| | - Pascal Guggenbuhl
- Service de Rhumatologie, CHU de Rennes Hôpital Sud, Rennes, Cedex 2, France; INSERM UMR 991, Rennes, France
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Abstract
INTRODUCTION To date, there is a lack of valid data with larger populations of patients in their 10th decade of life in the analyses of proximal femoral fractures. MATERIAL AND METHODS The inclusion criteria focused on all proximal femoral fractures in patients 90-99 years of age who underwent surgical treatment between 2009 and 2012. After a period of at least 2 years post-surgery, a retrospective collection of empiric data, including the survival time and surgical revision rate, was performed. Missing data were collected per telephone interview. RESULTS A total of 121 proximal femoral fractures in 117 patients in their 10th decade of life were treated. The mean age was 92.3 years. 61 fractures of the femoral neck received hemi- or total hip arthroplasty, while 60 pertrochanteric or subtrochanteric fractures were treated by osteosynthesis using proximal femoral nail (PFN) or dynamic hip screw (DHS). At the time of follow-up, 83/117 patients (71%) were already deceased. The mortality after 30 days, 6 months, 1 year and 2 years was 16%, 37%, and 43%, and 55%, respectively. A total of 22 surgical revisions (19%) were performed: 10 due to early infections, 8 due to haematomas, and 4 due to implant failures with a "cut out" of the femoral neck screw exclusively in DHS. The duration of surgery (with regard to surgical revision) and ASA classification (with regard to survival rate) were significant influence factors. Contralateral proximal femoral fractures were identified in 24/117 patients (20%), irrespective of study period. CONCLUSIONS The proximal femoral fractures in the 10th decade of life are associated with high postoperative mortality within the first 6 months. Surgical revision due to complications did not result in a statistically significant reduction of the survival time. From the osteosynthetic perspective, the DHS was associated with a significantly higher "cut-out" rate compared to PFN procedure. With regard to the alloarthoplasty, there were no significant differences observed between hemi- and total hip arthroplasty. A contralateral femoral fractures was observed in 20% of the total study population, but peri-implant or periprosthetic femoral fractures have not been observed in any of the cases thus far.
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Raschke MJ, Alt N. [Complications after osteosynthesis of the proximal femur]. DER ORTHOPADE 2014; 43:35-46. [PMID: 24384889 DOI: 10.1007/s00132-013-2122-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Fractures of the proximal femur are among the most common fractures of all bones. Currently nearly every trauma surgeon has to be able to treat proximal femur fractures either with osteosynthesis or with a prosthesis. An increase of 200-300 % of fractures of the proximal femur is expected within the next 30 years. In addition an increase of periprosthetic fractures of the proximal and distal femur can be observed. The correct treatment of these complications is a challenging objective for the trauma surgeon. OBJECTIVES This article provides an overview on complications after osteosynthesis of the proximal femur. It contributes treatment options depending on the implant, the patient specific risk factors and the special problems of postoperative care. METHODS A selective review of the literature using Pubmed under consideration of experiences gained in the treatment of complications after osteosynthesis of the proximal femur was performed. CONCLUSIONS Due to the increasing incidence of fractures of the proximal femur on the one hand and complications after operative treatment of these fractures on the other, the trauma surgeon must provide differentiated therapy concepts depending on the individual risk factors of different patients. Moreover, trauma surgeons must know how to treat the potential complications of these procedures.
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Affiliation(s)
- M J Raschke
- Klinik für Unfall-, Hand- undWiederherstellungschirurgie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, Gebäude W1, 48149, Münster, Deutschland,
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Bala M, Willner D, Klauzni D, Bdolah-Abram T, Rivkind AI, Gazala MA, Elazary R, Almogy G. Pre-hospital and admission parameters predict in-hospital mortality among patients 60 years and older following severe trauma. Scand J Trauma Resusc Emerg Med 2013; 21:91. [PMID: 24360246 PMCID: PMC3878042 DOI: 10.1186/1757-7241-21-91] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2013] [Accepted: 12/03/2013] [Indexed: 11/10/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | - Gidon Almogy
- Department of Surgery and Trauma Unit, Hadassah University Hospital, Ein Kerem, pob 12000, Jerusalem, 91120, Israel.
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