1
|
Tosounidis T, Chalidis B. Management of geriatric acetabular fractures: Contemporary treatment strategies. World J Clin Cases 2024; 12:2151-2156. [PMID: 38808354 PMCID: PMC11129118 DOI: 10.12998/wjcc.v12.i13.2151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 02/15/2024] [Accepted: 03/28/2024] [Indexed: 04/25/2024] Open
Abstract
Acetabular fractures in the geriatric population are typically low-energy fractures resulting from a fall from standing height. Compromised bone quality in the elderly, as well as this population's concomitant medical comorbidities, render the management of such fractures challenging and controversial. Non-operative management remains the mainstay of treatment, although such a choice is associated with numerous and serious complications related to both the hip joint as well as the general condition of the patient. On the other hand, operatively treating acetabular fractures (e.g., with osteosynthesis or total hip arthroplasty) is gaining popularity. Osteosynthesis can be performed with open reduction and internal fixation or with minimally invasive techniques. Total hip arthroplasty could be performed either in the acute phase combined with osteosynthesis or as a delayed procedure after a period of non-operative management or after failed osteosynthesis of the acetabulum. Regardless of the implemented treatment, orthogeriatric co-management is considered extremely crucial, and it is currently one of the pillars of a successful outcome after an acetabular fracture.
Collapse
Affiliation(s)
- Theodoros Tosounidis
- Academic Department of Orthopaedic Surgery, Heraklion University Hospital, University of Crete, Greece, Heraklion 71500, Greece
| | - Byron Chalidis
- 1st Department of Orthopaedic, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki 57010, Greece
| |
Collapse
|
2
|
Ohta R, Nitta T, Shimizu A, Sano C. Role of family medicine physicians in providing nutrition support to older patients admitted to orthopedics departments: a grounded theory approach. BMC PRIMARY CARE 2024; 25:121. [PMID: 38641569 PMCID: PMC11027398 DOI: 10.1186/s12875-024-02379-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 04/09/2024] [Indexed: 04/21/2024]
Abstract
BACKGROUND Care of older adults requires comprehensive management and control of systemic diseases, which can be effectively managed by family physicians. Complicated medical conditions in older patients admitted to orthopedic departments (orthopedic patients) necessitate interprofessional collaboration. Nutrition is one of the essential components of management involved in improving the systemic condition of older patients. Nutrition support teams play an important role in nutrition management and can be supported by family physicians. However, the role of family physicians in nutrition support teams is not well documented. This study aimed to investigate the role of family physicians in supporting nutrition management in orthopedic patients. METHODS This qualitative study was conducted between January and June 2023 using constructivist grounded theory methodology. Eight family medicine physicians, three orthopedic surgeons, two nurses, two pharmacists, four rehabilitation therapists, four nutritionists, and one laboratory technician working in Japanese rural hospitals participated in the research. Data collection was performed through ethnography and semi-structured interviews. The analysis was performed iteratively during the study. RESULTS Using a grounded theory approach, four theories were developed regarding family physicians' role in providing nutrition support to orthopedic patients: hierarchical and relational limitation, delay of onset and detection of the need for geriatric care in orthopedic patients, providing effective family medicine in hospitals, and comprehensive management through the nutrition support team. CONCLUSIONS The inclusion of family physicians in nutrition support teams can help with early detection of the rapid deterioration of orthopedic patients' conditions, and comprehensive management can be provided by nutrition support teams. In rural primary care settings, family physicians play a vital role in providing geriatric care in community hospitals in collaboration with specialists. Family medicine in hospitals should be investigated in other settings for better geriatric care and to drive mutual learning among healthcare professionals.
Collapse
Affiliation(s)
- Ryuichi Ohta
- Community Care, Unnan City Hospital, 96-1 Iida, Daito-cho, Unnan, Shimane, 699-1221, Japan.
| | - Tachiko Nitta
- Community Care, Unnan City Hospital, 96-1 Iida, Daito-cho, Unnan, Shimane, 699-1221, Japan
| | - Akiko Shimizu
- Community Care, Unnan City Hospital, 96-1 Iida, Daito-cho, Unnan, Shimane, 699-1221, Japan
| | - Chiaki Sano
- Department of Community Medicine Management, Faculty of Medicine, Shimane University, 89-1 Enya cho, Izumo, Shimane, 693-8501, Japan
| |
Collapse
|
3
|
Wang L, Yang M, Ge Y, Liu Y, Wang G, Su Y, Guo Z, Yin L, Huang P, Geng J, Blake GM, He B, Zhu S, Cheng X, Wu X, Aro HT, Vlug A, Engelke K. Risk prediction of second hip fracture by bone and muscle density of the hip varies with time after first hip fracture: A prospective cohort study. Bone Rep 2024; 20:101732. [PMID: 38226335 PMCID: PMC10788229 DOI: 10.1016/j.bonr.2023.101732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 12/16/2023] [Accepted: 12/20/2023] [Indexed: 01/17/2024] Open
Abstract
Purpose Predictors of 'imminent' risk of second hip fracture are unknown. The aims of the study were to explore strength of hip areal bone mineral density (aBMD), and muscle area and density for predicting second hip fracture at different time intervals. Methods Data of the Chinese Second Hip Fracture Evaluation were analyzed, a longitudinal study to evaluate the risk of second hip fracture (of the contralateral hip) by using CT images obtained immediately after first hip fracture. Muscle cross-sectional area and density were measured of the gluteus maximus (G.MaxM) and gluteus medius and minimus (G.Med/MinM) and aBMD of the proximal femur at the contralateral unfractured side. Patients were followed up for a median time of 4.5 years. Separate Cox models were used to predict second hip fracture risk at different time intervals after first event adjusted for age, sex, BMI and diabetes. Results The mean age of subjects with imminent (within 1st or 2nd year) second hip fracture was 79.80 ± 5.16 and 81.56 ± 3.64 years. In the 1st year after the first hip fracture, femoral neck (FN) aBMD predicted second hip fracture (HR 5.88; 95 % CI, 1.32-26.09). In the remaining years of follow-up after 2nd year, muscle density predicted second hip fracture (G.MaxM HR 2.13; 95 % CI, 1.25-3.65,G.Med/MinM HR 2.10; 95 % CI, 1.32-3.34). Conclusions Our results show that femoral neck aBMD is an important predictor for second hip fracture within the first year and therefore suggest supports the importance concept of early and rapid-acting bone-active drugs to increase hip BMD. In addition, the importance of muscle density predicting second hip fracture after the second year suggest post hip fracture rehabilitation and exercise programs could also be important to reduce muscle fatty infiltration.
Collapse
Affiliation(s)
- Ling Wang
- Department of Radiology, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100035, China
| | - Minghui Yang
- Departments of Traumatic Orthopedics, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
| | - Yufeng Ge
- Departments of Traumatic Orthopedics, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
| | - Yandong Liu
- Department of Radiology, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100035, China
| | - Gang Wang
- Department of Radiology, The First People's Hospital of Yunnan Province, Kunming, Yunnan, China
| | - Yongbin Su
- Department of Radiology, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100035, China
| | - Zhe Guo
- Department of Radiology, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100035, China
| | - Lu Yin
- Information Center, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Fuwai Hospital, Beijing 100037, China
| | - Pengju Huang
- Department of Radiology, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100035, China
| | - Jian Geng
- Department of Radiology, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100035, China
| | - Glen M. Blake
- School of Biomedical Engineering & Imaging Sciences, King's College London, St Thomas' Hospital, London, United Kingdom
| | - Bo He
- Department of Radiology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Shiwen Zhu
- Departments of Traumatic Orthopedics, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
| | - Xiaoguang Cheng
- Department of Radiology, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100035, China
| | - Xinbao Wu
- Departments of Traumatic Orthopedics, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
| | - Hannu T. Aro
- Department of Orthopaedic Surgery and Traumatology, Turku University Hospital and University of Turku, Turku, Finland
| | - Annegreet Vlug
- Center for Bone Quality, Department of Internal Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - Klaus Engelke
- Department of Medicine 3, FAU University Erlangen-Nürnberg, Universitätsklinikum Erlangen, Erlangen, Germany
- Institute of Medical Physics, University of Erlangen, Erlangen, Germany
| |
Collapse
|
4
|
Che YJ, Qian Z, Chen Q, Chang R, Xie X, Hao YF. Effects of rehabilitation therapy based on exercise prescription on motor function and complications after hip fracture surgery in elderly patients. BMC Musculoskelet Disord 2023; 24:817. [PMID: 37838680 PMCID: PMC10576877 DOI: 10.1186/s12891-023-06806-y] [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: 01/08/2023] [Accepted: 08/17/2023] [Indexed: 10/16/2023] Open
Abstract
BACKGROUND Exercise rehabilitation training is an important measure for improving the prognosis of patients with hip fractures. However, the particular program that works effectively and the efficiency of exercise therapy are still controversial. OBJECTIVE To compare the effects of usual postoperative care combined with rehabilitation based on exercise prescription on motor function and complications in elderly patients who underwent surgery for hip fracture. METHODS This was an observational study. A total of 71 elderly patients with hip fractures who were treated with hip arthroplasty and internal fixation of the proximal femur with an intramedullary nail at Suzhou Municipal Hospital from October 2020 to December 2021 were included; 11 cases were excluded (eight cases were excluded due to loss of follow-up, two due to deaths from other causes, and one due to other reasons). Finally, 60 patients (18 males and 42 females) were included. Patients were randomly assigned to the control (n = 30) and experimental (n = 30) groups using a random number generator. Patients in the control group received usual postoperative care, whereas those in the experimental group received usual postoperative care combined with rehabilitation training based on the principles of exercise prescription. We recorded the motor function (Harris hip score), daily living ability (Barthel Index), and complications at discharge and 1, 3, and 6 months postoperatively for statistical analysis. RESULTS The Harris hip score and Barthel Index score were significantly higher at 1, 3, and 6 months postoperatively than at discharge in both groups (p < 0.05). The Harris hip score and Barthel Index score at discharge and 1, 3, and 6 months postoperatively were significantly higher in the experimental group than in the control group (p < 0.05). The incidence of complications at 6 months postoperatively was significantly lower in the experimental group than in the control group (13% vs. 37%). CONCLUSIONS Rehabilitation therapy based on exercise prescription helps improve hip function and the ability to perform activities of daily living and related postoperative complications after hip fracture surgery in elderly patients. The findings of our study will guide decision-making in clinical practice and improve the clinical management of hip fractures in elderly patients postoperatively.
Collapse
Affiliation(s)
- Yan-Jun Che
- Orthopedics and Sports Medicine Center, Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu Province, 215008, China
| | - Zongna Qian
- Orthopedics and Sports Medicine Center, Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu Province, 215008, China
| | - Qi Chen
- Orthopedics and Sports Medicine Center, Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu Province, 215008, China
| | - Rui Chang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, 999077, China
| | - Xiaofeng Xie
- Orthopedics and Sports Medicine Center, Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu Province, 215008, China
| | - Yue Feng Hao
- Orthopedics and Sports Medicine Center, Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu Province, 215008, China.
| |
Collapse
|
5
|
Rehabilitation after Hip Fracture Surgery: A Survey on Italian Physiotherapists’ Knowledge and Adherence to Evidence-Based Practice. Healthcare (Basel) 2023; 11:healthcare11060799. [PMID: 36981456 PMCID: PMC10048225 DOI: 10.3390/healthcare11060799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/03/2023] [Accepted: 03/07/2023] [Indexed: 03/11/2023] Open
Abstract
The average life expectancy of the Italian population has increased over the last decades, with a consequent increase in the demand for healthcare. Rehabilitation after hip fracture surgery is essential for autonomy, recovery, and reintegration into the social context. The aim of this study was to determine the level of knowledge and adherence to the recent treatment recommendations of the Italian physiotherapists. A web-based survey, composed of 21 items, was conducted and the frequencies and percentages of the responses were analyzed to evaluate if there was an integration and adherence to the recommendations of greater than 70%, with respect to the desired response. A total of 392 responses were collected and analyzed. Recommendations regarding the multidisciplinary approach, early mobilization, and progressive muscle strength training, achieved the desired value in the inpatient setting. Intensive rehabilitation and full weight bearing did not reach the threshold values. The results of this survey show a partial integration of the recommendations for rehabilitation after hip fracture surgery by Italian physiotherapists. Adherence seems to be better in the inpatient setting and with physiotherapists with higher levels of education.
Collapse
|
6
|
Guillaumin M, Poirson B, Gerazime A, Puyraveau M, Tannou T, Mauny F, Toussirot É. Fractures reduction with osteoporotic treatments in patients over 75-year-old: A systematic review and meta-analysis. FRONTIERS IN AGING 2022; 3:845886. [PMID: 36404990 PMCID: PMC9667050 DOI: 10.3389/fragi.2022.845886] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 10/13/2022] [Indexed: 11/06/2022]
Abstract
Background: Osteoporosis consists in the reduction of bone mineral density and increased risk of fracture. Age is a risk factor for osteoporosis. Although many treatments are available for osteoporosis, there is limited data regarding their efficacy in older people. Objective: To evaluate the efficacy of osteoporosis treatments in patients over 75 years old. Methods: We reviewed all published studies in MEDLINE, Cochrane and EMBASE including patients over 75 years old, treated by osteoporosis drugs, and focused on vertebral fractures or hip fractures. Results: We identified 4,393 records for review; 4,216 were excluded after title/abstract review. After full text review, 19 records were included in the systematic review. Most studies showed a reduction in vertebral fracture with osteoporosis treatments, but non-significant results were observed for hip fractures. Meta-analysis of 10 studies showed that lack of treatment was significantly associated with an increased risk of vertebral fractures at one (OR = 3.67; 95%CI = 2.50–5.38) and 3 years (OR = 2.19; 95%CI = 1.44–3.34), and for hip fractures at one (OR = 2.14; 95%CI = 1.09–4.22) and 3 years (OR = 1.31, 95%CI = 1.12–1.53). Conclusion: A reduction in the risk of vertebral fractures with osteoporosis treatments was observed in most of the studies included and meta-analysis showed that lack of treatment was significantly associated with an increased risk of vertebral fractures. Concerning hip fractures, majority of included studies did not show a significant reduction in the occurrence of hip fractures with osteoporotic treatments, but meta-analysis showed an increased risk of hip fractures without osteoporotic treatment. However, most of the data derived from post hoc and preplanned analyses or observational studies.
Collapse
Affiliation(s)
- Michel Guillaumin
- Département de Gériatrie, CHU, Besançon, France
- *Correspondence: Michel Guillaumin,
| | | | - Aurélie Gerazime
- Unité de Méthodologie, INSERM CIC-1431 Centre Investigation Clinique CHU, Besançon, France
| | - Marc Puyraveau
- Unité de Méthodologie, INSERM CIC-1431 Centre Investigation Clinique CHU, Besançon, France
| | | | - Fréderic Mauny
- Unité de Méthodologie, INSERM CIC-1431 Centre Investigation Clinique CHU, Besançon, France
| | - Éric Toussirot
- INSERM CIC-1431 Centre d’Investigation Clinique, CHU, Besançon, France
- INSERM CIC-1431 Centre Investigation Clinique et Département de Rhumatologie, CHU, Besançon, France
| |
Collapse
|
7
|
Fuggle N, Al-Daghri N, Bock O, Branco J, Bruyère O, Casado E, Cavalier E, Cortet B, de Wit M, Giusti A, Halbout P, Harvey NC, Hiligsmann M, Kaufman JM, Kurth A, Maggi S, Matijevic R, Minisola S, Palacios S, Radermecker RP, Thomasius F, Tuzun S, Veronese N, Kanis JA, Reginster JY, Rizzoli R, Cooper C. Novel formulations of oral bisphosphonates in the treatment of osteoporosis. Aging Clin Exp Res 2022; 34:2625-2634. [PMID: 36331798 PMCID: PMC9675642 DOI: 10.1007/s40520-022-02272-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 10/03/2022] [Indexed: 11/06/2022]
Abstract
Oral bisphosphonates are a key intervention in the treatment of osteoporosis and in reducing the risk of fragility fractures. Their use is supported by over 3 decades of evidence; however, patient adherence to oral bisphosphonates remains poor in part due to complex dosing instructions and adverse events, including upper gastrointestinal symptoms. This problem has led to the development of novel oral bisphosphonate formulations. Buffered, effervescent alendronate is dissolved in water and so seeks to reduce upper gastro-intestinal adverse events, and gastro-resistant risedronate aims to reduce the complexity of dosing procedure (e.g. fasting prior to consumption) whilst still maintaining the efficacy of fracture risk reduction. Clinical trials and real-world data have been employed to demonstrate some benefits in terms of reduced upper gastro-intestinal adverse events, adherence, persistence and health economic outcomes. This report describes the result of an ESCEO (European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis) expert working group, which explores where oral bisphosphonates sit in current clinical practice guidelines, review their risk-benefit profile and the consequences of poor adherence before exploring novel oral bisphosphonate formulations and their potential clinical and health economic impact. Further research is required but there are signs that these novel, oral bisphosphonate formulations may lead to improved tolerance of oral bisphosphonates and thus, improved adherence and fracture outcomes.
Collapse
Affiliation(s)
- Nicholas Fuggle
- MRC Lifecourse Epidemiology Centre, University of Southampton, Tremona Road, Southampton, SO16 6YD, UK
| | - Nasser Al-Daghri
- Chair for Biomarkers of Chronic Diseases, Biochemistry Department, College of Science, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Olivier Bock
- Department of Osteoporosis, Inselspital-Bern University Hospital, University of Bern, Bern, Switzerland
- International Osteoporosis Foundation, Nyon, Switzerland
| | - Jaime Branco
- Centro Hospitalar de Lisboa Ocidental-Hospital Egas Moniz, CEDOC/NOVA Medical School, Nova University of Lisbon, Lisbon, Portugal
| | - Olivier Bruyère
- Division of Public Health, Epidemiology and Health Economics, WHO Collaborating Center for Public Health Aspects of Musculo-Skeletal Health and Ageing, University of Liège, Avenue Hippocrate 13, CHU B23, 4000, Liege, Belgium
| | - Enrique Casado
- Department of Rheumatology, University Hospital Parc Taulí, I3PT Research Institute (UAB), Sabadell, Barcelona, Spain
| | - Etienne Cavalier
- Department of Clinical Chemistry, University of Liège, CIRM, CHU Sart-Tilman, 4000, Liège, Belgium
| | - Bernard Cortet
- Department of Rheumatology, Univ. Lille, CHU Lille, MABlab ULR 4490, 59000, Lille, France
| | - Maarten de Wit
- Department of Medical Humanities, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - Andrea Giusti
- Metabolic Bone Diseases Unit and Fracture Liaison Service, Rheumatology Unit, Department of Medical Specialties, Local Health Trust 3, Via Missolungi 14, 16147, Genoa, Italy
| | | | - Nicholas C Harvey
- MRC Lifecourse Epidemiology Centre, University of Southampton, Tremona Road, Southampton, SO16 6YD, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, UK
| | - Mickaël Hiligsmann
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Jean-Marc Kaufman
- Department of Endocrinology, Ghent University Hospital, 9000, Ghent, Belgium
| | - Andreas Kurth
- Department of Orthopaedic and Trauma Surgery, Community Clinics Middle Rhine, Campus Kemperhof, Koblenz, Germany
| | - Stefania Maggi
- Institute of Neuroscience, Aging Branch, CNR, Padua, Italy
| | - Radmila Matijevic
- Faculty of Medicine, Clinic for Orthopedic Surgery and Traumatology, Clinical Center of Vojvodina, University of Novi Sad, Novi Sad, Serbia
| | - Salvatore Minisola
- Department of Clinical, Internal, Anaesthesiology, and Cardiovascular Sciences, Sapienza University of Rome, 00185, Rome, Italy
| | | | - Régis Pierre Radermecker
- Department of Diabetes, Nutrition and Metabolic Disorders, Clinical Pharmacology, University of Liège, CHU de Liège, Liège, Belgium
| | | | - Sansin Tuzun
- Department of Physical Medicine and Rehabilitation, Cerrahpaşa Medical Faculty, Istanbul University Cerrahpaşa, Istanbul, Turkey
| | - Nicola Veronese
- Department of Internal Medicine, Geriatrics Section, University of Palermo, Palermo, Italy
| | - John A Kanis
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK
| | - Jean-Yves Reginster
- Centro Hospitalar de Lisboa Ocidental-Hospital Egas Moniz, CEDOC/NOVA Medical School, Nova University of Lisbon, Lisbon, Portugal
| | - René Rizzoli
- Department of Osteoporosis, Inselspital-Bern University Hospital, University of Bern, Bern, Switzerland
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Centre, University of Southampton, Tremona Road, Southampton, SO16 6YD, UK.
- Department of Rheumatology, Univ. Lille, CHU Lille, MABlab ULR 4490, 59000, Lille, France.
- NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK.
| |
Collapse
|
8
|
Bardesono F, Trombetta S, Gullone L, Bonardo A, Gindri P, Castiglioni C, Milano E, Massazza G, Di Monaco M. A screening test is not enough to define the prognostic role of cognitive impairment after hip fracture: a short-term prospective study. Aging Clin Exp Res 2022; 34:2977-2984. [PMID: 36057082 DOI: 10.1007/s40520-022-02233-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 08/17/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Cognitive impairment assessed by easy-to-administer tests successfully predicts function after hip fracture, whereas the prognostic role of additional cognitive evaluations is largely unknown. AIMS To investigate the capability of further assessments to discriminate cognitive impairment with prognostic relevance in hip-fracture women defined cognitively intact or mildly impaired on the Short Portable Mental Status Questionnaire (SPMSQ). METHODS We prospectively investigated women with subacute hip fracture admitted to our rehabilitation facility. The women who made ≤4 errors on the SPMSQ were further assessed by 4 tests: Montreal Cognitive Assessment, Rey Auditory Verbal Learning Test (immediate and delayed recall) and Frontal Assessment Battery. Activities of daily living (ADL) were measured by the Barthel index. Successful rehabilitation was defined with a Barthel index score ≥85. RESULTS Data from 127 women were available. Each of the 4 cognitive tests assessed at admission significantly predicted the Barthel index scores measured at discharge. The predictive role persisted after multiple adjustments. For a change in cognitive scores corresponding to the difference between 25° and 75° percentiles in their distribution in the sample, the adjusted odds ratio to achieve successful rehabilitation roughly ranged from 2 to 4, depending on which cognitive test was adopted. DISCUSSION The women with subacute hip fracture defined cognitively intact or mildly impaired on the SPMSQ could have cognitive impairment revealed by further examination, with prognostic disadvantages in ADL. CONCLUSIONS Assessing cognition by the SPMSQ seems not enough to exclude the presence of cognitive impairment with relevant prognostic disadvantage in hip-fracture women.
Collapse
Affiliation(s)
- Francesca Bardesono
- Division of Physical and Rehabilitation Medicine, Osteoporosis Research Center, Fondazione Opera San Camillo, Presidio di Torino, strada Santa Margherita 136, 10131, Turin, Italy
| | - Silvia Trombetta
- Neuropsychology Service, Fondazione Opera San Camillo, Presidio di Torino, Turin, Italy
| | - Laura Gullone
- Neuropsychology Service, Fondazione Opera San Camillo, Presidio di Torino, Turin, Italy
| | - Alessandra Bonardo
- Neuropsychology Service, Fondazione Opera San Camillo, Presidio di Torino, Turin, Italy
| | - Patrizia Gindri
- Neuropsychology Service, Fondazione Opera San Camillo, Presidio di Torino, Turin, Italy
| | - Carlotta Castiglioni
- Division of Physical and Rehabilitation Medicine, Osteoporosis Research Center, Fondazione Opera San Camillo, Presidio di Torino, strada Santa Margherita 136, 10131, Turin, Italy
| | - Edoardo Milano
- Neuropsychology Service, Fondazione Opera San Camillo, Presidio di Torino, Turin, Italy
| | - Giuseppe Massazza
- Division of Physical and Rehabilitation Medicine, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Marco Di Monaco
- Division of Physical and Rehabilitation Medicine, Osteoporosis Research Center, Fondazione Opera San Camillo, Presidio di Torino, strada Santa Margherita 136, 10131, Turin, Italy.
| |
Collapse
|
9
|
Fu M, Guo J, Zhang Y, Zhao Y, Zhang Y, Hou Z, Wang Z. Effect of integrated management bundle on 1-year overall survival outcomes and perioperative outcomes in super elderly patients aged 90 and over with hip fracture: non-concurrent cohort study. BMC Musculoskelet Disord 2022; 23:778. [PMID: 35971104 PMCID: PMC9377134 DOI: 10.1186/s12891-022-05720-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 07/29/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Due to concomitant factors like frailty and comorbidity, super elderly (≥90 years) patients with hip fracture differ from patients aged 65-89 years in perioperative complications and mortality. The integrated management bundle referred to bundled application of multiple clinical measures. The aim of this study was to analyze effect of integrated management bundle on 1-year overall survival and perioperative outcomes in super elderly patients with hip fracture, with multidisciplinary management group serving as the control group. METHODS In this retrospective cohort study, super elderly patients with hip fracture were included from Jan 2017 to Nov 2020. Patients were retrospectively divided to multidisciplinary management group and integrated management bundle group. The primary outcome was 1- year overall survival, and the secondary outcome was perioperative outcomes. Kaplan-Meier methods was used to compare survival probability. Multivariable Cox's modeling was used to explain the effect of integrated bundle on 1-year overall survival adjusted for confounders. The perioperative outcomes including complications and in-hospital data of two groups were compared. The multivariable logistic regression was used to explain the effect of integrated bundle on the occurrence of perioperative complications adjusted for confounders. Prognostic factors related to survival was identified by multivariable Cox's regression analysis. RESULTS Ninety-seven patients comprised multidisciplinary management group, and 83 comprised integrated management bundle group. The Kaplan-Meier plots showed that the survival probability of integrated management bundle group was significantly better than multidisciplinary management group (HR:0.435, 95%CI:0.207-0.914, P = 0.039). Multivariable analysis after adjustment for confounders showed a 42.8% lower incidence of mortality integrated management bundle group than multidisciplinary management group (HR:0.428, 95%CI:0.186-0.986, P = 0.046). Incidence of hypoproteinemia, and electrolyte disturbance in integrated management bundle group was significantly lower than multidisciplinary management group (all P < 0.05). In addition, significant reduction was observed in length of stay (P < 0.05) in integrated management bundle group. Multivariable logistic regression showed integrated management bundle was independent protective factor of hypoproteinemia, and electrolyte disturbance. mECM score ≥ 6 and ASA score > 2 were independent risk factors of overall survival (HR: 1.940, 95%CI: 1.067-3.525,P = 0.030; HR: 2.281, 95%CI: 1.113-4.678,P = 0.024). CONCLUSIONS The integrated management bundle improved 1-year overall survival and played positive effects in improving perioperative outcomes. It might be a more suitable management modality for super elderly patients with hip fracture.
Collapse
Affiliation(s)
- Mingming Fu
- Department of Geriatric Orthopedics, Third Hospital of Hebei Medical University, Hebei, 050051, Shijiazhuang, People's Republic of China
| | - Junfei Guo
- Department of Orthopedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, People's Republic of China
| | - Yaqian Zhang
- Department of Geriatric Orthopedics, Third Hospital of Hebei Medical University, Hebei, 050051, Shijiazhuang, People's Republic of China
| | - Yuqi Zhao
- Department of Geriatric Orthopedics, Third Hospital of Hebei Medical University, Hebei, 050051, Shijiazhuang, People's Republic of China
| | - Yingze Zhang
- Department of Orthopedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, People's Republic of China.,NHC Key Laboratory of Intelligent Orthopedic Equipment (The Third Hospital of Hebei Medical University), Hebei, 050051, Shijiazhuang, People's Republic of China.,Chinese Academy of Engineering, Beijing, 100088, People's Republic of China
| | - Zhiyong Hou
- Department of Orthopedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, People's Republic of China. .,NHC Key Laboratory of Intelligent Orthopedic Equipment (The Third Hospital of Hebei Medical University), Hebei, 050051, Shijiazhuang, People's Republic of China.
| | - Zhiqian Wang
- Department of Geriatric Orthopedics, Third Hospital of Hebei Medical University, Hebei, 050051, Shijiazhuang, People's Republic of China.
| |
Collapse
|
10
|
Fu M, Zhang Y, Guo J, Zhao Y, Hou Z, Wang Z, Zhang Y. Application of integrated management bundle incorporating with multidisciplinary measures improved in-hospital outcomes and early survival in geriatric hip fracture patients with perioperative heart failure: a retrospective cohort study. Aging Clin Exp Res 2022; 34:1149-1158. [PMID: 35067910 PMCID: PMC9135836 DOI: 10.1007/s40520-021-02038-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 11/18/2021] [Indexed: 12/13/2022]
Abstract
Background In elderly, hip fracture is often complicated by perioperative heart failure, related to worse prognosis. We aimed to analyze the effects of integrated management bundle incorporating with multidisciplinary measures on in-hospital outcomes and early survival in elderly hip fracture patients with perioperative heart failure. Methods In this retrospective cohort study, a total of 421 hip fracture patients aged 65 and over who developed perioperative heart failure were included. According to different perioperative management modes applied, patients were retrospectively divided into multidisciplinary management group (Group A), including 277 patients, and integrated management bundle group (Group B), including 144 patients. The B-type natriuretic peptide (BNP) and C-reactive protein (CRP) levels, complications, length of stay, and hospitalization costs were observed and compared between two groups. Overall survival was compared by Kaplan–Meier methods. Cox regression analysis was used to identify prognostic factors associated with overall survival. Results A total of 421 patients were enrolled for analysis, including 277 in Group A and 144 in Group B. BNP and CRP levels were significantly decreased compared with admission (P < 0.05). Furthermore, BNP and CRP in Group B decreased much more than those in Group A (P < 0.05). The reductions were observed in length of stay, hospitalization costs and incidence of pulmonary infection, hypoproteinemia, and acute cerebral infarction in Group B (all P < 0.05). The Kaplan–Meier plots showed significantly superior overall survival in Group B. Integrated management bundle was independent favorable prognostic factors. Conclusions The integrated management bundle incorporating with multidisciplinary measures significantly improved the therapeutic effect of perioperative heart failure, reduced inflammatory response, and yielded better hospital outcomes. It brought better survival benefits for geriatric hip fracture patients with perioperative heart failure. The results of this study can play an important role in clinical work and provide a valuable theoretical basis for selection of management model in elderly hip fracture patients with perioperative heart failure.
Collapse
Affiliation(s)
- Mingming Fu
- Department of Geriatric Orthopedics, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, People's Republic of China
| | - Yaqian Zhang
- Department of Geriatric Orthopedics, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, People's Republic of China
| | - Junfei Guo
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, People's Republic of China
| | - Yuqi Zhao
- Department of Geriatric Orthopedics, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, People's Republic of China
| | - Zhiyong Hou
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, People's Republic of China
- NHC Key Laboratory of Intelligent Orthopeadic Equipment (The Third Hospital of Hebei Medical University), Hebei, People's Republic of China
| | - Zhiqian Wang
- Department of Geriatric Orthopedics, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, People's Republic of China.
| | - Yingze Zhang
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, People's Republic of China.
- NHC Key Laboratory of Intelligent Orthopeadic Equipment (The Third Hospital of Hebei Medical University), Hebei, People's Republic of China.
- Chinese Academy of Engineering, Beijing, 100088, People's Republic of China.
| |
Collapse
|
11
|
Prommik P, Tootsi K, Veske K, Strauss E, Saluse T, Kolk H, Märtson A. Isolated greater trochanter fracture may impose a comparable risk on older patients' survival as a conventional hip fracture: a population-wide cohort study. BMC Musculoskelet Disord 2022; 23:394. [PMID: 35477499 PMCID: PMC9044808 DOI: 10.1186/s12891-022-05336-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 04/19/2022] [Indexed: 11/18/2022] Open
Abstract
Background Isolated greater trochanter fracture (IGT) and conventional hip fracture (HF) affect the same anatomical area but are usually researched separately. HF is associated with high mortality, and its management is well established. In contrast, IGT’s effect on mortality is unknown, and its best management strategies are unclear. This study aims to compare these patient populations, their acute- and post-acute care, physical and occupational therapy use, and up to three-year mortality. Methods This retrospective cohort study is based on population-wide data of Estonia, where routine IGT management is non-operative and includes immediate weight-bearing as tolerated. The study included patients aged ≥ 50 years with a validated index HF or IGT diagnosis between 2009–2017. The fracture populations’ acute- and post-acute care, one-year physical and occupational therapy use and three-year mortality were compared. Results A total of 0.4% (50/11,541) of included patients had an IGT. The baseline characteristics of the fracture cohorts showed a close resemblance, but the IGT patients received substantially less care. Adjusted analyses showed that the IGT patients’ acute care was 4.5 days [3.4; 5.3] shorter they had 39.2 percentage points [25.5; 52.8] lower probability for receiving post-acute care, and they had 50 percentage points [5.5: 36]] lower probability for receiving physical and occupational therapy. The IGT and HF patients’ mortality rates were comparable, being 4% and 9% for one month, 28% and 31% for one year, and 46% and 49% for three years, respectively. Crude and adjusted analyses could not find significant differences in their three-year mortality, showing a p-value of 0.6 and a hazard ratio of 0.9 [0.6; 1.3] for the IGT patients, retrospectively. Conclusions Despite IGT being a relatively minor injury, the evidence from this study suggests that it may impose a comparable risk on older patients’ survival, as does HF due to the close resemblance of the two fracture populations. Therefore, IGT in older patients may signify an underlying need for broad-based medical attention, ensuring need-based, ongoing, coordinated care. Trial registration Retrospectively registered.
Collapse
Affiliation(s)
- Pärt Prommik
- Department of Traumatology and Orthopaedics, University of Tartu, L. Puusepa 8, 50406, Tartu, Estonia. .,Traumatology and Orthopaedics Clinic, Tartu University Hospital, L. Puusepa 8, 50406, Tartu, Estonia.
| | - Kaspar Tootsi
- Department of Traumatology and Orthopaedics, University of Tartu, L. Puusepa 8, 50406, Tartu, Estonia.,Traumatology and Orthopaedics Clinic, Tartu University Hospital, L. Puusepa 8, 50406, Tartu, Estonia
| | - Karin Veske
- Traumatology and Orthopaedics Clinic, Tartu University Hospital, L. Puusepa 8, 50406, Tartu, Estonia
| | - Eiki Strauss
- Traumatology and Orthopaedics Clinic, Tartu University Hospital, L. Puusepa 8, 50406, Tartu, Estonia
| | - Toomas Saluse
- Traumatology and Orthopaedics Clinic, Tartu University Hospital, L. Puusepa 8, 50406, Tartu, Estonia
| | - Helgi Kolk
- Department of Traumatology and Orthopaedics, University of Tartu, L. Puusepa 8, 50406, Tartu, Estonia.,Traumatology and Orthopaedics Clinic, Tartu University Hospital, L. Puusepa 8, 50406, Tartu, Estonia
| | - Aare Märtson
- Department of Traumatology and Orthopaedics, University of Tartu, L. Puusepa 8, 50406, Tartu, Estonia.,Traumatology and Orthopaedics Clinic, Tartu University Hospital, L. Puusepa 8, 50406, Tartu, Estonia
| |
Collapse
|
12
|
Li XP, Zhang P, Zhu SW, Yang MH, Wu XB, Jiang XY. All-cause mortality risk in aged femoral intertrochanteric fracture patients. J Orthop Surg Res 2021; 16:727. [PMID: 34930355 PMCID: PMC8686562 DOI: 10.1186/s13018-021-02874-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 12/05/2021] [Indexed: 12/17/2022] Open
Abstract
Introduction The 1-year mortality rate after femoral intertrochanteric fracture is higher than that of femoral neck fracture, which also belongs to hip fracture (Cui et al. in Arch Osteoporos 14(1):55, 2019). With the application of the concept of co-management model of orthopedics and geriatrics, the short-term and long-term mortality of all types of hip fractures has decreased (Van Heghe et al. in Calcif Tissue Int, 2021, https://doi.org/10.1007/s00223-021-00913-5). However, the mortality of Chinese femoral intertrochanteric fracture patients under this model has not been reported in the literatures. Aim This paper aims to study the risk factors of postoperative all-cause mortality in aged patients with femoral intertrochanteric fracture under the co-management model of orthopedics and geriatrics. Materials and methods This is a single-center prospective cohort study based on the real world, under the co-management of orthopedics and geriatrics, 363 patients aged ≥ 65 years with femoral intertrochanteric fracture were enrolled and followed up for 2–3 years; 52 patients were lost to follow up. Age, gender, body mass index (BMI), history of comorbidities, hip Bone Mineral Density (BMD), fracture history, 25(OH)D level, hemoglobin level, anti-osteoporosis treatment were risk factors to be tested. Kaplan–Meier survival curves and multivariate Cox proportional hazards models were constructed to analyze the impact of factors on all-cause mortality. Results (1) Most of the dead patients were older (the mean age was 83.4 years, compared with 79.8 years for surviving patients), with more complications and without anti-osteoporosis medication; gender, pre-fracture history, BMI, total hip BMD, hemoglobin, 25(OH)D had no difference between the dead and the living patients. (2) Elderly patients with Intertrochanteric fracture can benefit from the early treatment of Zoledronic Acid (within 3 days after the operation). Conclusion Under the co-management of orthopedics and geriatrics, to Chinese patients with Femoral Intertrochanteric fracture, Doctors should pay more attention to their age and chronic disease, and give anti-osteoporosis treatment if allowed.
Collapse
Affiliation(s)
- Xin-Ping Li
- Department of Geriatrics, Beijing Jishuitan Hospital, the 4th Medical College of Peking University, Beijing, 100035, China
| | - Ping Zhang
- Department of Geriatrics, Beijing Jishuitan Hospital, the 4th Medical College of Peking University, Beijing, 100035, China
| | - Shi-Wen Zhu
- Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, the 4th Medical College of Peking University, Beijing, 100035, China
| | - Ming-Hui Yang
- Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, the 4th Medical College of Peking University, Beijing, 100035, China.
| | - Xin-Bao Wu
- Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, the 4th Medical College of Peking University, Beijing, 100035, China
| | - Xie-Yuan Jiang
- Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, the 4th Medical College of Peking University, Beijing, 100035, China
| |
Collapse
|
13
|
Liu Y, Fu M, Zhou Q, Tian M, Zhang X, Wang Z. The application of patient-centered care bundle significantly reduces incidence of perioperative respiratory complications in hip fracture patients aged 80 and over. Geriatr Nurs 2021; 43:213-218. [PMID: 34929520 DOI: 10.1016/j.gerinurse.2021.11.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 11/19/2021] [Accepted: 11/20/2021] [Indexed: 01/07/2023]
Abstract
This study was designed as a pilot test to analyze the effect of patient-centered care (PCC) bundle intervention on perioperative respiratory complications and other outcomes in hip fracture patients aged ≥80. Between Jan 2018 and Dec 2019, 198 patients comprised the routine care group and 187 comprised the PCC bundle group. After propensity score matching, 151 remained in each group. Incidence of perioperative respiratory complications in the PCC bundle group was significantly lower than in the routine care group (all P < 0.05). Furthermore, significant reductions were observed in surgery delay, length of stay, incidence of arrhythmia, hypoproteinemia, and electrolyte disturbance (all P < 0.05) in the PCC bundle group. Age-Adjusted Charlson Comorbidity Index score was related, but only weakly, to length of stay and the number of perioperative complications. These results suggested that the PCC bundle might be a more suitable care modality for patients ≥80 with hip fracture.
Collapse
Affiliation(s)
- Yan Liu
- The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, P.R. China
| | - Mingming Fu
- Department of Geriatric Orthopedics, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, P.R. China
| | - Qi Zhou
- Department of Geriatric Orthopedics, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, P.R. China
| | - Miao Tian
- Department of Geriatric Orthopedics, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, P.R. China
| | - Xiuguo Zhang
- The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, P.R. China.
| | - Zhiqian Wang
- Department of Geriatric Orthopedics, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, P.R. China.
| |
Collapse
|