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Pedersen LT, Ipsen JA, Bruun IH, Egebæk HK, Andersen PT, Viberg B. Association between patient activation level and functional outcomes in older adults with hip fractures. Arch Gerontol Geriatr 2024; 124:105472. [PMID: 38728823 DOI: 10.1016/j.archger.2024.105472] [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: 02/26/2024] [Revised: 04/26/2024] [Accepted: 05/02/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND Hip fractures can significantly impact older adults' mobility and function. Effective rehabilitation is crucial to help them regain independence and quality of life. However, little is known about the association between patient activation and hip fracture rehabilitation. This study aims to assess the association between the PAM-13 scores and the level of physical function, mobility, and activities of daily living in older adults following a hip fracture rehabilitation program. METHOD An exploratory outcome study from a cluster-randomized stepped-wedge clinical controlled trial. Two hundred thirty-nine patients were classified into four Patient Activation Measure-Levels (PAM-13) according to their PAM-13 scores, reflecting their confidence and preparedness to manage their health. Level 1 represents the lowest level of confidence. The patient's mobility, function, and daily activities were evaluated at discharge and after 12 and 24 weeks. RESULTS The cohort had a median age of 78; 67% were female, and 50% lived alone. There were no significant differences in demographics between the PAM-Levels. PAM-Level 1 patients had longer hospital stays and lower mobility scores than PAM-Level 4 patients. However, all patients improved over time, and higher initial PAM levels resulted in better outcomes. PAM-Level 1 patients improved in Time Up and Go score from a median score of 54 seconds to 14 seconds at 24 weeks, while PAM-Level 4 patients improved from 26 to 9 seconds. CONCLUSION Our study found an association between PAM levels and functional outcomes in hip fracture rehabilitation. Patients with higher activation levels had better mobility and functional outcomes.
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Affiliation(s)
- Lars Tobiesen Pedersen
- Department of Physical Therapy and Occupational Therapy, Lillebaelt Hospital - University Hospital of Southern Denmark, Kolding, Denmark; Department of Regional Health Research, University of Southern Denmark, Odense, Denmark; Department of Health Education, University College South Denmark Esbjerg, Denmark.
| | - Jonas Ammundsen Ipsen
- Department of Physical Therapy and Occupational Therapy, Lillebaelt Hospital - University Hospital of Southern Denmark, Kolding, Denmark; Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Inge H Bruun
- Department of Physical Therapy and Occupational Therapy, Lillebaelt Hospital - University Hospital of Southern Denmark, Kolding, Denmark; Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Heidi Klakk Egebæk
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Frederiksberg, The Capital Region, Denmark; Department of Exercise Epidemiology, Institute for Sports Science and Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Pernille Tanggaard Andersen
- Department of Public Health, Unit for Health Promotion, University of Southern Denmark, Odense & Esbjerg, Denmark
| | - Bjarke Viberg
- Department of Orthopedic Surgery and Traumatology, Lillebaelt Hospital - University Hospital of Southern Denmark, Kolding, Denmark; Department of Orthopedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark
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Koh DJR, Yeo KSA, Kon KKC, Moo IH. The Utility and Necessity for Radiographic Follow-Up After Arthroplasty for Geriatric Neck of Femur Fractures. Geriatr Orthop Surg Rehabil 2024; 15:21514593241273208. [PMID: 39130165 PMCID: PMC11316266 DOI: 10.1177/21514593241273208] [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: 03/12/2024] [Revised: 07/04/2024] [Accepted: 07/09/2024] [Indexed: 08/13/2024] Open
Abstract
Background Hip fractures are a common and debilitating condition posing not only a huge health care but also socioeconomic burden. Surgical management for a neck of femur fracture is typically with arthroplasty in the form of total hip arthroplasty or hip hemiarthroplasty. Serial radiographs are typically performed routinely as part of follow-up to look for complications, although their clinical utility in asymptomatic patients is yet to be validated. Our paper therefore aims to review the utility and necessity of radiographic follow-up following arthroplasty for NOF fractures. Materials and Methods Patients who underwent operative management for acute fragility neck of femur fractures in the year from 1st January 2018 to 31st December 2018 at the author's institution were identified. All patients who underwent surgery, and had at least one pre and one post-operative plain film radiograph of the affected hip were included in this study. Exclusion criteria included patients who had undergone surgery for chronic fractures, avascular necrosis of the femoral head, mortality within 1 year, peri-prosthetic fractures, pathological fractures from metastases, had concomitant injuries, or had inaccessible or incomplete records. Clinical records were assessed for the number of visits, an abnormal presenting history or clinical examination, as well as changes in management of the patient. The number and type of radiographs were also assessed, and each radiograph analyzed for abnormal findings. Results A total of 157 patients were included in our study with a mean age of 79.5 at the time of surgery, and a mean follow up of 17.3 months. Data was collected from 626 clinical visits and a total of 973 radiographs. The 3 abnormal radiographic series identified with a corresponding normal consult did not result in a change of management for the patient. A negative change in management was only observed in 1 patient with an abnormal consult and a corresponding normal radiograph. Conclusion Post-operative complications following arthroplasty for NOF fractures are likely to result in a symptomatic presentation of the patient. Routine radiographic follow-up provides limited utility in asymptomatic patients and should only be performed if clinically indicated.
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Affiliation(s)
| | | | | | - Ing How Moo
- Singapore Changi General Hospital, Singapore
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Gao Y, Zhong F, Zhan X, Bao Y, Zhu X. Postoperative rehabilitation exercise experiences of geriatric patients with femoral neck fractures based on the perspective of medical staff: a qualitative study. BMC Geriatr 2024; 24:667. [PMID: 39117996 PMCID: PMC11308417 DOI: 10.1186/s12877-024-05266-w] [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: 03/12/2024] [Accepted: 07/31/2024] [Indexed: 08/10/2024] Open
Abstract
BACKGROUND The incidence of femoral neck fractures in older adults is increasing each year. Active and reasonable postoperative rehabilitation exercises can restore the activity of geriatric patients with femoral neck fractures to a great extent, while also avoiding bedridden complications and re-fractures. This study explores the perspectives, experiences, and recommendations of medical staff regarding the implementation status, existing problems, promoting factors, and hindering factors of post-surgical rehabilitation exercises for geriatric patients with femoral neck fractures. The ultimate goal is to further optimize rehabilitation exercise programs and to expedite this process for patients. METHODS A qualitative, descriptive phenomenological study was conducted. A total of 21 clinical medical staff were selected using the purposive sampling method for semi-structured interviews. A content analysis method was used to collate and analyze the collected interview data. RESULTS A total of 2 themes and 6 sub-themes were defined. The themes consisted of multiple obstacles occurring during the implementation of rehabilitation exercises and the scientific cognition of medical staff on these exercises. Respondents found that patient initiative during rehabilitation exercises was insufficient, that the comprehensiveness and continuity of exercises could not be guaranteed, and that unification between textbook theory and clinical practice was incomplete. Moreover, respondents believed that their professional quality should be excellent, but that staffing and organizational management required optimization, and that support was required for the implementation of rehabilitation exercises. CONCLUSION This study investigated the opinions and experiences of medical staff during postoperative rehabilitation exercises in geriatric patients with femoral neck fractures. Collaborative efforts should fully engage hospitals, communities, and families, enhance the alignment of health education with patient needs, advance the scientific development of an integrated medical model by refining the curriculum and teaching system, and significantly elevate the level of medical science and technology. This study will serve as a valuable reference for the establishment of future professional, and personalized rehabilitation programs tailored for geriatric patients with femoral neck fractures.
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Affiliation(s)
- Yazhuo Gao
- School of Nursing, Zhejiang Chinese Medical University, Hangzhou, 310053, China
| | - Fangfang Zhong
- School of Nursing, Zhejiang Chinese Medical University, Hangzhou, 310053, China
| | - Xiaoyan Zhan
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, 310006, China
| | - Yunchun Bao
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, 310006, China
| | - Xuehua Zhu
- School of Nursing, Zhejiang Chinese Medical University, Hangzhou, 310053, China.
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Yuan X, Zeng W, Wang H, Shu G, Wu C, Nie M, Wang J, Chen S. Predictive value of the early postoperative hemoglobin-to-red blood cell distribution width ratio for acute kidney injury in elderly intertrochanteric fracture patients. BMC Musculoskelet Disord 2024; 25:630. [PMID: 39113005 PMCID: PMC11308471 DOI: 10.1186/s12891-024-07745-y] [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: 12/31/2023] [Accepted: 07/29/2024] [Indexed: 08/10/2024] Open
Abstract
BACKGROUND Hemoglobin-to-red blood cell distribution width ratio (HRR) had great predictive value for the prognosis of malignant tumors and cardiovascular disease. However, its predictive value for the occurrence of acute kidney injury (AKI) in elderly intertrochanteric fracture patients remains unclear. This study aims to analyze the correlation between the early postoperative HRR and the risk of postoperative AKI in elderly intertrochanteric fracture patients. METHODS We reviewed the medical records of 307 elderly intertrochanteric fracture patients in this single-center retrospective cohort study. We performed univariate analysis on the relevant parameters, and parameters with significant differences were included in the following logistic regression model for multivariate analysis. Then, we used a receiver operating characteristic (ROC) curve to evaluate the predictive value of the early postoperative HRR level for AKI in elderly intertrochanteric fracture patients. Patients were divided into a high HRR group and a low HRR group according to the cutoff point determined by ROC curve analysis. Subsequently, the relevance between postoperative HRR and AKI was further determined using propensity score matching (PSM) and inverse probability of treatment weighting (IPTW). RESULTS The area under the curve of the early postoperative HRR for predicting postoperative AKI was 0.714 (95% CI: 0.618-0.809). The cutoff value was 5.44. The sensitivity was 72.7%, and the specificity was 70.8%. Patients were divided into low HRR (⩽ 5.44) and high HRR (> 5.44) groups according to the cutoff value. PSM and IPTW analysis indicated that the risk of AKI in the low HRR group was significantly higher than that in the high HRR group in both the matched cohort (OR = 6.914, 95% CI: 1.714-46.603, p = 0.016) and the weighted group (OR = 2.784, 95% CI: 1.415-5.811, p = 0.040). CONCLUSIONS Early postoperative HRR is an accurate, accessible, and economical blood test parameter that can predict the risk of postoperative AKI in elderly patients with femoral intertrochanteric fracture.
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Affiliation(s)
- Xin Yuan
- Center for Joint Surgery, Department of Orthopedic Surgery, The Second Affiliated Hospital of Chongqing Medical University, Linjiang road No.76, Yuzhong District, Chongqing, 400010, China
| | - Wang Zeng
- Center for Joint Surgery, Department of Orthopedic Surgery, The Second Affiliated Hospital of Chongqing Medical University, Linjiang road No.76, Yuzhong District, Chongqing, 400010, China
| | - Hao Wang
- Center for Joint Surgery, Department of Orthopedic Surgery, The Second Affiliated Hospital of Chongqing Medical University, Linjiang road No.76, Yuzhong District, Chongqing, 400010, China
| | - Guoyin Shu
- Center for Joint Surgery, Department of Orthopedic Surgery, The Second Affiliated Hospital of Chongqing Medical University, Linjiang road No.76, Yuzhong District, Chongqing, 400010, China
| | - Chen Wu
- Center for Joint Surgery, Department of Orthopedic Surgery, The Second Affiliated Hospital of Chongqing Medical University, Linjiang road No.76, Yuzhong District, Chongqing, 400010, China
| | - Ming Nie
- Center for Joint Surgery, Department of Orthopedic Surgery, The Second Affiliated Hospital of Chongqing Medical University, Linjiang road No.76, Yuzhong District, Chongqing, 400010, China
| | - Jiao Wang
- Center for Joint Surgery, Department of Orthopedic Surgery, The Second Affiliated Hospital of Chongqing Medical University, Linjiang road No.76, Yuzhong District, Chongqing, 400010, China.
| | - Shirong Chen
- Center for Joint Surgery, Department of Orthopedic Surgery, The Second Affiliated Hospital of Chongqing Medical University, Linjiang road No.76, Yuzhong District, Chongqing, 400010, China.
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Schouten B, Baartmans M, van Eikenhorst L, Gerritsen GP, Merten H, van Schoten S, Nanayakkara PWB, Wagner C. Fatal Adverse Events in Femoral Neck Fracture Patients Undergoing Hemiarthroplasty or Total Hip Arthroplasty-A Retrospective Record Review Study in a Nationwide Sample of Deceased Patients. J Patient Saf 2024; 20:e59-e72. [PMID: 38466141 DOI: 10.1097/pts.0000000000001226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
OBJECTIVES Patient safety is a core component of quality of hospital care and measurable through adverse event (AE) rates. A high-risk group are femoral neck fracture patients. The Dutch clinical guideline states that the treatment of choice is cemented total hip arthroplasty (THA) or hemiarthroplasty (HA). We aimed to identify the prevalence of AEs related to THA/HA in a sample of patients who died in the hospital. METHODS We used data of a nationwide retrospective record review study. Records were systematically reviewed for AEs, preventability and contribution to the patient's death. We drew a subsample of THA/HA AEs and analyzed these cases. RESULTS Of the 2998 reviewed records, 38 patients underwent THA/HA, of whom 24 patients suffered 25 AEs (prevalence = 68.1%; 95% confidence interval, 51.4-81.2), and 24 contributed to death. Patients with a THA/HA AE were of high age (median = 82.5 y) and had severe comorbidity (Charlson score ≥5). The majority of THA/HA AEs had a patient-related cause and was considered partly preventable. Examples of suggested actions that might have prevented the AEs: refraining from surgery, adhering to medication guidelines, uncemented procedures, comprehensive presurgical geriatric assessment, and better postsurgical monitoring. DISCUSSION Our study shows a high prevalence of (fatal) adverse events in patients undergoing THA/HA. This seems particularly valid for cemented implants in frail old patients, indicating room for improvement of patient safety in this group. Therefore, we recommend physicians to engage in comprehensive shared decision making with these patients and decide on a treatment fitting to a patient's preexisting health status, preferences, and values.
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Affiliation(s)
- Bo Schouten
- From the Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam
| | - Mees Baartmans
- Netherlands Institute for Health Services Research (NIVEL), Utrecht
| | | | - Gooitzen P Gerritsen
- From the Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam
| | - Hanneke Merten
- From the Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam
| | - Steffie van Schoten
- From the Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam
| | - Prabath W B Nanayakkara
- Amsterdam UMC location Vrije Universiteit Amsterdam, Section General Internal Medicine, Department of Internal Medicine, Amsterdam Public Health research institute, Amsterdam, the Netherlands
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Zhang X, Zheng C, Huang J, Chen H, Lei J, Huang C. Comparison of three different internal fixation methods in the treatment of femoral neck fracture. Heliyon 2024; 10:e34582. [PMID: 39149078 PMCID: PMC11325052 DOI: 10.1016/j.heliyon.2024.e34582] [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: 06/19/2023] [Revised: 06/26/2024] [Accepted: 07/11/2024] [Indexed: 08/17/2024] Open
Abstract
Objective This study aimed to assess the efficacy of three different fixation methods in treating femoral neck fractures in young patients. Methods A retrospective analysis was conducted on 35 young patients with femoral neck fractures who underwent surgical treatment. Among them, 16, 12, and 7 patients underwent fixation with three cannulated compression screws (3CS), the femoral neck system (FNS), and the compound compression system (CCS), respectively. Data, including fracture classification, injury-to-surgery time, surgery duration, intraoperative blood loss, fluoroscopy instances, fracture healing time, complications, and Harris score at the final follow-up, were collected and analyzed to compare clinical outcomes among the three fixation methods. Results All patients were followed for at least 6 months, exhibiting no significant differences in age, gender, injury side, fracture type, or injury-to-operation time among the three groups (P > 0.05). The FNS and CCS groups exhibited shorter operation durations and fewer intraoperative fluoroscopy instances compared to the 3CS group (P < 0.01). Despite the minimally invasive nature of 3CS, the FNS and CCS groups experienced higher intraoperative blood loss (P < 0.01). During follow-up, only one patient with 3CS fixation developed nonunion. Additionally, patients treated with 3CS demonstrated a higher incidence of femoral head necrosis and severe femoral neck shortening than the FNS and CCS groups. Excluding patients with combined nonunion, no significant difference in mean fracture healing time was observed among the three groups (P > 0.05). At the last follow-up, the FNS and CCS groups showed higher Harris scores (P < 0.05). Conclusions Both FNS and CCS are effective internal fixation systems for the treatment of femoral neck fractures in young patients, yielding more satisfactory clinical functional outcomes than 3CS. Comparatively, the CCS system presents a higher risk of iatrogenic rotation of the proximal fracture segment. Therefore, we advocate the insertion of two to three 2.5 mm Kirschner wires from the upper edge of the femoral neck along the axial direction before CCS lag screw insertion to resist iatrogenic rotational stress.
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Affiliation(s)
- Xinzhao Zhang
- Department of Orthopedics, Ningde Traditional Chinese Medicine Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fujian, Ningde, 352100, China
| | - Changling Zheng
- Department of Orthopedics, Ningde Traditional Chinese Medicine Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fujian, Ningde, 352100, China
| | - Jin Huang
- Department of Orthopedics, Ningde Traditional Chinese Medicine Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fujian, Ningde, 352100, China
| | - Hui Chen
- Department of Orthopedics, Ningde Traditional Chinese Medicine Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fujian, Ningde, 352100, China
| | - Jie Lei
- Department of Orthopedics, Ningde Traditional Chinese Medicine Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fujian, Ningde, 352100, China
| | - Cong Huang
- Department of Orthopedics, Ningde Traditional Chinese Medicine Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fujian, Ningde, 352100, China
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Núñez-Cortés R, López-Bueno L, Besoain-Saldaña Á, Cruz-Montecinos C, Solís-Navarro L, Suso-Martí L, López-Bueno R, Morral A, Calatayud J. Comorbidity burden and nutritional status are associated with short-term improvement in functional independence and pain intensity after hip fracture surgery in older adults with in-hospital rehabilitation. Geriatr Nurs 2024; 59:223-227. [PMID: 39053164 DOI: 10.1016/j.gerinurse.2024.07.011] [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: 02/19/2024] [Revised: 06/24/2024] [Accepted: 07/13/2024] [Indexed: 07/27/2024]
Abstract
PURPOSE Hip fracture is a common condition among older adults. The aim of this study was to explore the influence of nutritional status and comorbidity burden on changes in functionality, fall risk, and pain intensity one month after hip surgery in older adults with in-hospital rehabilitation. METHODS Thirty-six hip fracture patients (55.6% female) aged 65 years or older with indication for surgical resolution were recruited. The main outcomes were functional independence (Barthel Index), risk of falls (Downton Falls Risk Index) and pain intensity (Visual Analogue Scale), assessed preoperatively and one month after discharge. Covariates included age, sex, BMI, Charlson Comorbidity Index (CCI) and nutritional status (Mini Nutritional Assessment). For the inferential analysis, a one-way analysis of covariance (ANCOVA) was applied. RESULTS Significant improvements were observed in functional independence (11.0 points, 95% CI: 1.7 to 20.3), risk of falls (-2.8 points, 95% CI: -4.0 to -1.7) and pain intensity (-2.6 points, 95% CI: -3.4 to -1.9). Among the covariates, a significant interaction was found between the CCI and improvements in functional independence (F=7.03, p=0.010, η2p=0.093), while nutritional status showed a significant interaction with pain reduction (F=5.65, p=0.020, η2p=0.075). CONCLUSION A lower comorbidity burden was associated with greater postoperative functional independence, while better nutritional status was associated with a greater reduction in postoperative pain intensity.
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Affiliation(s)
- Rodrigo Núñez-Cortés
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile; Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain
| | - Laura López-Bueno
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, Valencia, Spain.
| | - Álvaro Besoain-Saldaña
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Carlos Cruz-Montecinos
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Lilian Solís-Navarro
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Luis Suso-Martí
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, Valencia, Spain
| | - Rubén López-Bueno
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, Valencia, Spain; Department of Physical Medicine and Nursing, University of Zaragoza, Zaragoza, Spain; National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Antoni Morral
- Blanquerna School of Health Sciences, Ramon Llull University, Barcelona, Spain
| | - Joaquín Calatayud
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, Valencia, Spain; National Research Centre for the Working Environment, Copenhagen, Denmark
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Siminiuc D, Gumuskaya O, Mitchell R, Bell J, Cameron ID, Hallen J, Birkenhead K, Hurring S, Baxter B, Close J, Sheehan KJ, Johansen A, Chehade MJ, Sherrington C, Balogh ZJ, Taylor ME, Sarkies M. Rehabilitation after surgery for hip fracture - the impact of prompt, frequent and mobilisation-focused physiotherapy on discharge outcomes: an observational cohort study. BMC Geriatr 2024; 24:629. [PMID: 39044173 PMCID: PMC11264512 DOI: 10.1186/s12877-024-05206-8] [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: 01/29/2024] [Accepted: 07/05/2024] [Indexed: 07/25/2024] Open
Abstract
PURPOSE To determine the relationship between three postoperative physiotherapy activities (time to first postoperative walk, activity on the day after surgery, and physiotherapy frequency), and the outcomes of hospital length of stay (LOS) and discharge destination after hip fracture. METHODS A cohort study was conducted on 437 hip fracture surgery patients aged ≥ 50 years across 36 participating hospitals from the Australian and New Zealand Hip Fracture Registry Acute Rehabilitation Sprint Audit during June 2022. Study outcomes included hospital LOS and discharge destination. Generalised linear and logistic regressions were used respectively, adjusted for potential confounders. RESULTS Of 437 patients, 62% were female, 56% were aged ≥ 85 years, 23% were previously living in a residential aged care facility, 48% usually walked with a gait aid, and 38% were cognitively impaired prior to their injury. The median acute and total LOS were 8 (IQR 5-13) and 20 (IQR 8-38) days. Approximately 71% (n = 179/251) of patients originally living in private residence returned home and 29% (n = 72/251) were discharged to a residential aged care facility. Previously mobile patients had a higher total LOS if they walked day 2-3 (10.3 days; 95% CI 3.2, 17.4) or transferred with a mechanical lifter or did not get out of bed day 1 (7.6 days; 95% CI 0.6, 14.6) compared to those who walked day 1 postoperatively. Previously mobile patients from private residence had a reduced odds of return to private residence if they walked day 2-3 (OR 0.38; 95% CI 0.17, 0.87), day 4 + (OR 0.38; 95% CI 0.15, 0.96), or if they only sat, stood or stepped on the spot day 1 (OR 0.29; 95% CI 0.13, 0.62) when compared to those who walked day 1 postoperatively. Among patients from private residence, each additional physiotherapy session per day was associated with a -2.2 (95% CI -3.3, -1.0) day shorter acute LOS, and an increased log odds of return to private residence (OR 1.76; 95% CI 1.02, 3.02). CONCLUSION Hip fracture patients who walked earlier, were more active day 1 postoperatively, and/or received a higher number of physiotherapy sessions were more likely to return home after a shorter LOS.
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Affiliation(s)
- Daniel Siminiuc
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Susan Wakil Health Building, Level 7 D18Western Avenue NSW 2006, Camperdown, Australia
| | - Oya Gumuskaya
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Susan Wakil Health Building, Level 7 D18Western Avenue NSW 2006, Camperdown, Australia
| | - Rebecca Mitchell
- Australian Institute of Health Innovation, Macquarie University, Macquarie Park, NSW, 2109, Sydney, Australia
| | - Jack Bell
- Allied Health Research Collaborative, The Prince Charles Hospital, QLD, 4032, Chermside, Australia
| | - Ian D Cameron
- Faculty of Medicine and Health, John Walsh Centre for Rehabilitation Research, Kolling Institute, Northern Sydney Local Health Districtand, University of Sydney, NSW, 2064, St Leonards, Australia
| | - Jamie Hallen
- Neuroscience Research Australia, University of New South Wales, NSW, 2031, Randwick, Australia
| | - Karen Birkenhead
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Susan Wakil Health Building, Level 7 D18Western Avenue NSW 2006, Camperdown, Australia
- Implementation Science Academy, Sydney Health Partners, NSW, Camperdown, Australia
| | - Sarah Hurring
- Te Whatu Ora Waitaha Canterbury, Christchurch, New Zealand
| | - Brett Baxter
- Physiotherapy Department, Princess Alexandra Hospital, QLD, 4102, Woolloongabba, Australia
| | - Jacqueline Close
- Neuroscience Research Australia, University of New South Wales, NSW, 2031, Randwick, Australia
- School of Clinical Medicine, University of New South Wales, NSW, 2052, Sydney, Australia
| | - Katie J Sheehan
- Bone & Joint Health, Blizard Institute, Queen Mary University of London, London, UK
| | - Antony Johansen
- School of Medicine, University Hospital of Walesand, Cardiff University, Cardiff, UK
| | - Mellick J Chehade
- Discipline of Orthopaedics and Trauma, Royal Adelaide Hospital, The University of Adelaide, Adelaide, SA, 5005, Australia
| | - Catherine Sherrington
- Institute for Musculoskeletal Health, The University of Sydneyand, Sydney Local Health District, Gadigal Land, NSW, 2006, Sydney, Australia
- Sydney School of Public Health and, Faculty of Medicine and Health, Sydney Musculoskeletal Health, The University of Sydney, Gadigal Land, NSW, 2006, Sydney, Australia
| | - Zsolt J Balogh
- Department of Traumatology, Trauma and Injury Research Program, John Hunter Hospital and University of Newcastle, Hunter Medical Research Institute, NSW, Newcastle, Australia
| | - Morag E Taylor
- Neuroscience Research Australia, University of New South Wales, NSW, 2031, Randwick, Australia
| | - Mitchell Sarkies
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Susan Wakil Health Building, Level 7 D18Western Avenue NSW 2006, Camperdown, Australia.
- Australian Institute of Health Innovation, Macquarie University, Macquarie Park, NSW, 2109, Sydney, Australia.
- Implementation Science Academy, Sydney Health Partners, NSW, Camperdown, Australia.
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Long X, Li W, Hou D, Li X, Cheng D. Enhanced recovery after surgery speeds up healing for hip fracture patients. Am J Transl Res 2024; 16:3231-3239. [PMID: 39114676 PMCID: PMC11301509 DOI: 10.62347/aevl7890] [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: 02/25/2024] [Accepted: 05/14/2024] [Indexed: 08/10/2024]
Abstract
OBJECTIVE To investigate the effects of enhanced recovery after surgery (ERAS) on the perioperative healing and stress response in patients with hip fractures. METHODS A retrospective analysis was conducted on the medical records of 86 patients with hip fractures admitted to the Affiliated Hospital of Southwest Medical University between January 2022 and August 2023. Among them, 48 patients in the research group received ERAS, while 38 patients in the control group received conventional nursing. Hip joint function, pain levels, stress response, fracture healing time, incidence of complications, and nursing satisfaction were compared between the two groups. RESULTS After nursing, the Harris scores notably increased in both groups, with the research group showing notably higher scores compared to the control group (P<0.05). The levels of cortisol and epinephrine, as well as the visual analog scale scores significantly decreased in both groups, with the research group showing significantly lower levels (P<0.05). In addition, the research group experienced significantly shorter fracture healing time (P<0.05), higher nursing satisfaction (P=0.014), and lower incidence of complications (P=0.028). Logistic regression analysis revealed that age, underlying diseases, nursing method, emotional disorders, and timing of surgery were independent factors influencing the post-nursing outcomes. CONCLUSION The ERAS mode can effectively alleviate pain, improve hip joint function, reduce fracture healing time and complications, mitigate stress response, and accelerate postoperative recovery in patients with hip fractures. It is worthy of application and promotion in clinical practice.
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Affiliation(s)
- Xia Long
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University Luzhou 646000, Sichuan, China
| | - Wen Li
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University Luzhou 646000, Sichuan, China
| | - Dan Hou
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University Luzhou 646000, Sichuan, China
| | - Xiaoyue Li
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University Luzhou 646000, Sichuan, China
| | - Dongyue Cheng
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University Luzhou 646000, Sichuan, China
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10
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Wang G, Tang C, Tang Y, Wang R, Shen T, Xu C, Yu J, Li G. Evaluation of the clinical efficacy of using an inverted triangular cannulated compression screw in combination with positive or negative buttress reduction for the healing of femoral neck fractures. BMC Musculoskelet Disord 2024; 25:544. [PMID: 39010006 PMCID: PMC11247803 DOI: 10.1186/s12891-024-07673-x] [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: 10/23/2023] [Accepted: 07/08/2024] [Indexed: 07/17/2024] Open
Abstract
OBJECTIVE We aimed to compare the clinical efficacy of inverted triangular cannulated compression screws combined with Gotfried positive or negative buttress reduction in the healing of femoral neck fractures. METHODS Between October 2017 and March 2021, 55 patients with femoral neck fractures underwent treatment using inverted triangular cannulated compression screws combined with Gotfried positive or negative buttress reduction. Among these patients, 29 received inverted triangular cannulated compression screws combined with Gotfried positive buttress reduction treatment. This group consisted of 16 males and 13 females, with an average age of 43.45 ± 8.23 years. Additionally, 26 patients received inverted triangular cannulated compression nails combined with Gotfried negative buttress reduction treatment. This group included 14 males and 12 females, with an average age of 41.96 ± 8.69 years. Postsurgery, various measurements were taken, including the degree of shortening of the femoral neck, degree of bone nonunion, degree of fixation failure, degree of ischemic necrosis of the femoral head, and Harris score of the hip joint. RESULTS All patients were followed up for a minimum of 18 months. The group that underwent treatment with an inverted triangular cannulated compression screw combined with Gotfried positive buttress reduction did not experience any cases of bone nonunion, fixation failure, or ischemic necrosis of the femoral head. In the group that received treatment with inverted triangle cannulated compression screws combined with Gotfried negative buttress reduction, there was one case of bone nonunion, three cases of early fixation failure, and one case of ischemic necrosis. Ultimately, five patients (19.23% of the total) underwent joint replacement surgery. The average shortening lengths in the vertical plane were 4.07 ± 1.98 mm and 8.08 ± 3.54 mm, respectively. In the horizontal plane, the average shortening lengths were 3.90 ± 1.57 mm and 7.77 ± 3.31 mm, respectively. At the last follow-up, the group that received Gotfried positive buttress reduction had a greater Harris hip joint score. CONCLUSION The success rate of combining inverted triangular cannulated compression screws with Gotfried positive buttress reduction surgery is relatively high. This surgical approach effectively prevents femoral neck shortening and improves hip joint function. Moreover, it is crucial to avoid negative buttress reduction when managing femoral neck fractures.
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Affiliation(s)
- Gang Wang
- School of Life and Health, Huzhou College, No. 1, Bachelor Road, Huzhou, 313000, Zhejiang, China
| | - Cui Tang
- Zhejiang Xinda Hospital, No 288, Xinguang Avenue, Huzhou, 313000, Zhejiang, China
| | - Yong Tang
- Department of Orthopedics, 72nd Group Army Hospital of the PLA, No 9, Chezhan Road, Huzhou, 313000, Zhejiang, China
| | - Rui Wang
- School of Life and Health, Huzhou College, No. 1, Bachelor Road, Huzhou, 313000, Zhejiang, China
| | - Tugang Shen
- Department of Orthopedics, South Taihu Hospital affiliated with Huzhou College, No. 1566, Gangnan Road, Huzhou, 313000, Zhejiang, China
| | - Chundao Xu
- Department of Orthopedics, South Taihu Hospital affiliated with Huzhou College, No. 1566, Gangnan Road, Huzhou, 313000, Zhejiang, China
| | - Jian Yu
- Department of Orthopedics, South Taihu Hospital affiliated with Huzhou College, No. 1566, Gangnan Road, Huzhou, 313000, Zhejiang, China
| | - Gaokai Li
- School of Life and Health, Huzhou College, No. 1, Bachelor Road, Huzhou, 313000, Zhejiang, China.
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11
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Wang W, Tang W, Yao W, Lv Q, Ding W. Glucose-albumin ratio (GAR) as a novel biomarker of postoperative urinary tract infection in elderly hip fracture patients. Front Med (Lausanne) 2024; 11:1366012. [PMID: 39076765 PMCID: PMC11284060 DOI: 10.3389/fmed.2024.1366012] [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] [Received: 01/05/2024] [Accepted: 05/10/2024] [Indexed: 07/31/2024] Open
Abstract
Purpose Postoperative urinary tract infections (UTIs) worsen the prognosis of elderly patients with hip fractures. This study aimed to assess the predictive ability of blood-based biomarkers, specifically the glucose-albumin ratio (GAR), in predicting postoperative UTIs. Methods A retrospective observational study of 1,231 patients from a Level I trauma center was conducted. We evaluated the prognostic and predictive value of 15 biomarkers, including the glucose-albumin ratio, in elderly patients with hip fractures. The primary outcome measure was the incidence of postoperative UTIs. Results The glucose to albumin ratio transformed into GAR was superior to any other biomarker in predicting postoperative UTIs in elderly hip fracture patients (AUC = 0.756, p < 0.001). Elevated GAR (using the best cut-off value of 0.18) was independently associated with postoperative UTIs (OR 3.20, 95% CI 2.23-4.58). Further analysis dividing GAR levels into four groups according to quartiles showed that compared to patients with GAR levels of Q1 (< 0.14), GAR levels of Q2 (0.14-0.17; OR 2.11, 95% CI 1.07-4.15), Q3 (0.17-0.21; OR 3.36, 95% CI 1.74-6.52) and Q4 (> 0.21; OR 7.55, 95% CI 3.84-14.83) patients had significantly higher odds of UTIs. Conclusion GAR holds potential as a novel biomarker for predicting postoperative UTIs in elderly patients with hip fractures.
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Affiliation(s)
- Wei Wang
- Department of Orthopedics, Dandong Central Hospital, China Medical University, Dandong, China
| | - Wanyun Tang
- Department of Orthopedics, Dandong Central Hospital, China Medical University, Dandong, China
| | - Wei Yao
- Department of Orthopedics, Dandong Central Hospital, China Medical University, Dandong, China
| | - Qiaomei Lv
- Department of Oncology, Dandong Central Hospital, China Medical University, Dandong, China
| | - Wenbo Ding
- Department of Orthopedics, Dandong Central Hospital, China Medical University, Dandong, China
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12
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Fan TD, Bei DK, Wang Q. Relationship between admission blood urea nitrogen levels and postoperative length of stay in patients with hip fracture: A retrospective study. Medicine (Baltimore) 2024; 103:e38918. [PMID: 38996118 PMCID: PMC11245248 DOI: 10.1097/md.0000000000038918] [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: 01/16/2024] [Accepted: 06/21/2024] [Indexed: 07/14/2024] Open
Abstract
To investigate the relationship between admission blood urea nitrogen (BUN) levels and postoperative length of stay (LOS) in hip fracture (HF) patients. This retrospective study retrieved related data from the MIMIC-IV database, of which the laboratory variables were taken preoperatively. The patients were divided into 4 groups according to the BUN quartile levels. After exploring the nonlinear relationship between BUN and LOS by generalized additive model, their connection was further analyzed using the generalized linear models, quantile regression models, and interaction analysis. Receiver operating characteristic curve analysis and decision curve analysis were performed to evaluate its value in predicting first intensive care unit admission and in-hospital mortality. Totally 1274 patients with HF were enrolled in the study. There was a nonlinear relationship between BUN and LOS (P < .05). Besides, BUN was an independent predictor for LOS after adjusting different covariates in 3 models (P < .05). Age served as a significant interactor in this relationship (P < .05). Moreover, receiver operating characteristic curve and decision curve analysis revealed the predictive value of BUN for intensive care unit admission and in-hospital mortality in HF. Admission BUN level as a cost-effective and easy-to-collect biomarker is significantly related to LOS in patients with HF. It helps clinicians to identify potential high-risk populations and take effective preventions before surgery to reduce postoperative LOS.
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Affiliation(s)
- Teng-di Fan
- Department of Orthopedics, Ningbo Medical Center Lihuili Hospital, Ningbo, Zhejiang, China
| | - Di-kai Bei
- Department of Orthopedics, Ningbo Medical Center Lihuili Hospital, Ningbo, Zhejiang, China
| | - Qi Wang
- Department of Medical Record Office, Ningbo Medical Center Lihuili Hospital, Ningbo, Zhejiang, China
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13
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Zhong Y, Liu M, Cheng Z, Yao Y, Yu Y, Luo G, Zheng B, Yan M. "Multidisciplinary fast-track" care can significantly reduce risk of mortality among hip fracture patients at least 80 years old: a single-center retrospective study. BMC Geriatr 2024; 24:592. [PMID: 38987709 PMCID: PMC11238416 DOI: 10.1186/s12877-024-05183-y] [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: 11/11/2023] [Accepted: 06/27/2024] [Indexed: 07/12/2024] Open
Abstract
BACKGROUND "Multidisciplinary fast-track" (MFT) care can accelerate recovery and improve prognosis after surgery, but whether it is effective in older people after hip fracture surgery is unclear. METHODS We retrospectively compared one-year all-cause mortality between hip fracture patients at least 80 years old at our institution who underwent hip fracture surgery between January 2014 and December 2018 and who then received MFT or conventional care. Multivariable regression was used to assess the association between MFT care and mortality after adjustment for confounders. RESULTS The final analysis included 247 patients who received MFT care and 438 who received conventional orthopedic care. The MFT group showed significantly lower one-year mortality (8.9% vs. 14.4%, P = 0.037). Log-rank testing of Kaplan-Meier survival curves confirmed the survival advantage. However, the two groups did not differ significantly in rates of mortality during hospitalization or at 30 or 90 days after surgery. Regression analysis confirmed that MFT care was associated with lower risk of one-year mortality (hazard ratio [HR] 0.47, 95% confidence interval [CI] 0.281-0.788, P = 0.04), and the survival benefit was confirmed in subgroups of patients with anemia (HR 0.453, 95% CI 0.268-0.767, P = 0.003) and patients with American Society of Anesthesiologists grade III (HR 0.202, 95% CI 0.08-0.51, P = 0.001). CONCLUSIONS MFT care can reduce one-year mortality among hip fracture patients at least 80 years old. This finding should be verified and extended in multi-center randomized controlled trials.
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Affiliation(s)
- Yinbo Zhong
- Department of Anesthesiology, Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou, Zhejiang, China
| | - Mingxia Liu
- Department of Anesthesiology, Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou, Zhejiang, China
- Department of Anesthesiology & Clinical Research Center for Anesthesia and Perioperative Medicine, Huzhou Central Hospital, The Affiliated Huzhou Hospital, Zhejiang University School of Medicine, The Fifth School of Clinical Medicine of Zhejiang Chinese Medical University, Affiliated Central Hospital Huzhou University, Huzhou, Zhejiang, China
| | - Zhenzhen Cheng
- Department of Anesthesiology, Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou, Zhejiang, China
| | - Yuanyuan Yao
- Department of Anesthesiology, Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou, Zhejiang, China
| | - Yang Yu
- Department of Anesthesiology, The First People's Hospital of Weifang, Weifang, Shandong, China
| | - Ge Luo
- Department of Anesthesiology, Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou, Zhejiang, China
| | - Bin Zheng
- Department of Surgery, University of Alberta, Edmonton, Canada
| | - Min Yan
- Department of Anesthesiology, Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou, Zhejiang, China.
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Qian D, Olumuyide E, Keswani A, Lin HM, Ouyang Y, DeMaria S, Poeran J, Park CH, Burnett GW. The Impact of Race/Ethnicity on Disparities in Utilization and Outcomes of Neuraxial Anesthesia for Hip and Femoral Shaft Fractures. J Clin Med 2024; 13:3999. [PMID: 39064039 PMCID: PMC11277043 DOI: 10.3390/jcm13143999] [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: 06/10/2024] [Revised: 07/01/2024] [Accepted: 07/06/2024] [Indexed: 07/28/2024] Open
Abstract
Background/Objectives: The use of neuraxial anesthesia versus general anesthesia for hip fracture surgery remains an active area of research, with recent studies demonstrating mixed findings supporting neuraxial over general anesthesia. The benefits of neuraxial anesthesia have been documented in associated surgeries, including total joint arthroplasty. However, racial disparities in the administration of neuraxial anesthesia have been identified in numerous procedures. We aimed to examine the association of race/ethnicity with neuraxial anesthesia use and the effect of neuraxial anesthesia on length of stay, non-home discharge, 30-day severe adverse events, and rates of readmission among patients undergoing isolated hip and femoral shaft fracture operations. Methods: The American College of Surgeons National Quality Improvement Program database was queried for isolated hip or femoral shaft fractures from 2015 to 2019. Stepwise logistic regression was performed to assess the relationship between race/ethnicity and neuraxial anesthesia use. Within each sex-race stratum, neuraxial anesthesia recipients were propensity-matched to general anesthesia recipients in a 1:2 ratio. Logistic regression and negative binomial regression were performed on the propensity-matched cohort. Results: A total of 12,004 neuraxial and 64,250 general anesthesia hip and femoral shaft fracture patients were identified. Compared to White patients, Black and Hispanic patients were between 0.64 and 0.61 times less likely to receive neuraxial anesthesia over general anesthesia, respectively (p < 0.05). 11,993 patients who received neuraxial anesthesia were propensity matched to 23,946 patients who received general anesthesia. Propensity-matched logistic regressions found that neuraxial anesthesia was associated with decreased length of stay, 30-day severe adverse events, and acute rehab/skilled nursing facility discharge for White patients (p < 0.05 for all), but only decreased length of stay in Black and Hispanic patients (p = 0.01 and p = 0.02, respectively). Conclusions: Notable disparities exist in the administration of neuraxial anesthesia for isolated hip and femoral shaft fracture patients. Hispanic and Black race/ethnicity in particular influences provision of neuraxial anesthesia. Further research is required to understand the degree of effect modification and root causes of regional anesthesia access and benefits for this high-volume patient population.
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Affiliation(s)
- Daniel Qian
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (D.Q.)
| | - Ezekiel Olumuyide
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (D.Q.)
| | - Aakash Keswani
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA (C.H.P.)
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY 10065, USA
| | - Hung-Mo Lin
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA (C.H.P.)
- Department of Anesthesiology, Yale School of Medicine, New Haven, CT 06510, USA
| | - Yuxia Ouyang
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA (C.H.P.)
| | - Samuel DeMaria
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA (C.H.P.)
| | - Jashvant Poeran
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, NY 10021, USA
| | - Chang H. Park
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA (C.H.P.)
| | - Garrett W. Burnett
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (D.Q.)
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA (C.H.P.)
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15
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Liao CS, He FZ, Li XY, Han PF. Proximal femoral nail antirotation versus InterTan nail for the treatment of intertrochanteric fractures: A systematic review and meta-analysis. PLoS One 2024; 19:e0304654. [PMID: 38980889 PMCID: PMC11233004 DOI: 10.1371/journal.pone.0304654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 05/15/2024] [Indexed: 07/11/2024] Open
Abstract
PURPOSE This meta-analysis compared the efficacy and safety of Proximal Femoral Nail Antirotation (PFNA) and InterTan Nail in the treatment of intertrochanteric fractures. Given the high incidence of femoral intertrochanteric fractures in the elderly population and its impact on quality of life, choosing the most effective and safest surgical option is crucial. PFNA and InterTan are currently two commonly used techniques, but there is a lack of systematic evaluation comparing their safety and effectiveness. This study aims to fill this knowledge gap through Meta-analysis, providing clinicians with evidence-based treatment recommendations. MATERIALS AND METHODS A computer search was used to search for published literature on PFNA and InterTan in the treatment of intertrochanteric fractures in PubMed (Medline), Web of Science, Embase, Cochrane Library (CENTRAL), Cinahl, CBM, and CNKI.A total of 853 related literatures were retrieved, and 15 literatures were finally included. Newcastle-Ottawa-Scale and Cochrane systematic review methodologies were used to assess the quality of the literature. Meta-analysis was performed using Review Manager 5.4 software, following data extraction. RESULTS The comparison found that during the surgical treatment of intertrochanteric fractures, the operation time, fluoroscopy time, and blood loss in the PFNA group were significantly shorter than those in the InterTan group, and the difference was statistically significant. In terms of postoperative complication rates, the InterTan group had a significant advantage over the PFNA group. Shaft fracture, varus collapse, cut out, screw migration, and pain of hip and thigh were the most likely to occur in the PFNA group, and the differences were all statistically significant. In terms of postoperative efficacy, the results of the PFNA group and the InterTan group were comparable, and there was no significant differences. CONCLUSIONS When selecting surgical techniques for the treatment of femoral intertrochanteric fractures, it is necessary to conduct individualized assessments based on the patient's overall health status, surgical tolerance, and post-operative recovery needs. For patients who cannot tolerate long-term surgery or are in poor physical condition, PFNA may be more appropriate. While for patients who can tolerate long-term surgery or have more complex conditions, InterTan may be more suitable.
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Affiliation(s)
- Chang-sheng Liao
- Department of Orthopaedics, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, P.R. China
- Department of Graduate School, Graduate Student Department of Changzhi Medical College, Changzhi, P.R. China
| | - Fang-zheng He
- Department of Orthopaedics, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, P.R. China
- Department of Graduate School, Graduate Student Department of Changzhi Medical College, Changzhi, P.R. China
| | - Xi-yong Li
- Department of Orthopaedics, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, P.R. China
- Department of Graduate School, Graduate Student Department of Changzhi Medical College, Changzhi, P.R. China
| | - Peng-fei Han
- Department of Orthopaedics, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, P.R. China
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16
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Hong H, Sha M, Chen Z, Li Y, Kang L. Comparison of dynamic hip screw with anti-rotation screw and femoral neck system internal fixation for the treatment of garden II-IV type femoral neck fractures. Technol Health Care 2024:THC231547. [PMID: 39031399 DOI: 10.3233/thc-231547] [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: 07/22/2024]
Abstract
BACKGROUND Femoral neck fractures, which are fractures occurring from the femoral head to the base of the femoral neck, are prevalent in the elderly population. With the progression of societal aging, the incidence of femoral neck fractures has been steadily increasing, making it a significant global issue that urgently needs to be addressed. OBJECTIVE To compare the efficacy and safety of dynamic hip screw (DHS) with anti-rotation screw and femoral neck system (FNS) internal fixation for the treatment of Garden II-IV type femoral neck fractures. METHODS A total of 90 patients with Garden II-IV type femoral neck fractures were randomly assigned to either the control group (n= 45) treated with DHS and anti-rotation screw or the experimental group (n= 45) treated with FNS. Surgical outcomes, including incision size, blood loss, operation time, fluoroscopy frequency, and fracture healing time, were compared. Postoperative complication rates, reoperation rates, Harris scores, and visual analogue scale (VAS) scores were also assessed. RESULTS The experimental group demonstrated significantly reduced incision length, blood loss, operation time, and fluoroscopy frequency compared to the control group (P< 0.01). No significant differences were observed in fracture healing time, Garden classification, or fracture reduction outcomes between the two groups (P> 0.05). At 6 months post-treatment, both groups showed significant improvements in Harris scores and VAS scores compared to pre-treatment (P< 0.05), with no significant differences between the groups (P> 0.05). The rates of internal fixation failure, nonunion, and avascular necrosis of the femoral head, as well as overall incidence of postoperative complications and reoperation rates, showed no significant differences between the two groups (P> 0.05). CONCLUSIONS Both DHS with anti-rotation screw and FNS internal fixation demonstrated comparable efficacy and safety profiles in the treatment of Garden II-IV type femoral neck fractures. The experimental group showed advantages in terms of reduced incision length, blood loss, operation time, and fluoroscopy frequency, while maintaining similar clinical outcomes and complication rates.
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17
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Heuser L, Schoeneberg C, Rascher K, Lendemans S, Knobe M, Aigner R, Ruchholtz S, Neuerburg C, Pass B. Validation of the Geriatrics at Risk Score (GeRi-Score) on 120-day follow-up, the influence of preoperative geriatric visits, and the time to surgery on the outcome of hip fracture patients: an analysis from the Registry for Geriatric Trauma (ATR-DGU). Osteoporos Int 2024:10.1007/s00198-024-07177-3. [PMID: 38963451 DOI: 10.1007/s00198-024-07177-3] [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: 03/26/2024] [Accepted: 06/27/2024] [Indexed: 07/05/2024]
Abstract
A validation of the GeRi-Score on 120-day mortality, the impact of a pre-operative visit by a geriatrician, and timing of surgery on the outcome was conducted. The score has predictive value for 120-day mortality. No advantage was found for surgery within 24 h or a preoperative geriatric visit. PURPOSE Numerous tools predict mortality among patients with hip fractures, but they include many variables, require time-consuming assessment, and are difficult to calculate. The GeRi-Score provides a quick method of pre-operative assessment. The aim of this study is to validate the score in the 120-day follow-up and determine the impact of a pre-operative visit by a geriatrician and timing of surgery on the patient outcome. METHODS A retrospective analysis of the AltersTraumaRegister DGU® from 2017 to 2021 was conducted, including all proximal femur fractures. The patients were divided into low-, moderate-, and high-risk groups based on the GeRi-Score. Mortality was analyzed using logistic regression. To determine the influence of the time to surgery and the preoperative visit by a geriatrician, matching was performed using the exact GeRi-Score, preoperative walking ability, type of fracture, and the time to surgery. RESULTS The study included 38,570 patients, divided into 12,673 low-risk, 18,338 moderate-risk, and 7,559 high-risk patients. The moderate-risk group had three times the mortality risk of the low-risk group (OR 3.19 (95% CI 2.68-3.79; p<0.001)), while the high-risk group had almost eight times the mortality risk than the low-risk group (OR 7.82 (95% CI 6.51-9.93; p<0.001)). No advantage was found for surgery within the first 24 h across all groups. There was a correlation of a preoperative geriatric visit and mortality showing an increase in the moderate and high-risk group on in-house mortality. CONCLUSIONS The GeRi-Score has predictive value for 120-day mortality. No advantage was found for surgery within 24 h. The analysis did not demonstrate a benefit of the preoperative geriatric visit, but more data are needed.
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Affiliation(s)
- Laura Heuser
- Department of Orthopedic and Emergency Surgery, Alfried Krupp Hospital, 45276, Essen, Germany
| | - Carsten Schoeneberg
- Department of Orthopedic and Emergency Surgery, Alfried Krupp Hospital, 45276, Essen, Germany
| | | | - Sven Lendemans
- Department of Orthopedic and Emergency Surgery, Alfried Krupp Hospital, 45276, Essen, Germany
| | - Matthias Knobe
- Department of Orthopaedic Trauma, Hospital Westmünsterland, Ahaus, Germany
| | - Rene Aigner
- Center for Orthopedics and Trauma Surgery, University Hospital Giessen and Marburg, Marburg, Germany
| | - Steffen Ruchholtz
- Center for Orthopedics and Trauma Surgery, University Hospital Giessen and Marburg, Marburg, Germany
| | - Carl Neuerburg
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Germany
| | - Bastian Pass
- Department of Orthopedic and Emergency Surgery, Alfried Krupp Hospital, 45276, Essen, Germany.
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18
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Sri-On J, Worawiwat T, Luksameearunothai K, Nirunsuk P, Vanichkulbodee A, Fusakul Y, Phisaiphun K, Kanokkarnjana P, Lerdruttanasoontorn D, Thong-on K. Enhancing Emergency Department Pain Management for Older Adults with the Hip Fracture Fast-Track (HFFT) Protocol in a Middle-Income Country. Clin Interv Aging 2024; 19:1225-1233. [PMID: 38974510 PMCID: PMC11227879 DOI: 10.2147/cia.s465006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 06/25/2024] [Indexed: 07/09/2024] Open
Abstract
Purpose This study aimed to evaluate the impact of the Hip Fracture Fast-Track (HFFT) protocol, designed specifically for older patients at our hospital, which commenced on January 1, 2022, on the management of emergency department (ED) pain in older adults with hip fractures. Patients and Methods Retrospective pre- and post-study data from electronic health records (EHR) at our hospital, using the International Classification of Diseases (ICD)-10 codes S72.0, S72.1, S72.8, and S72.9, were utilized. The study included patients aged 65 years or older who presented to the ED with low-energy, non-pathologic isolated hip fractures or proximal femur fractures. The pre-HFFT period included patients from January 1, 2020, to December 31, 2021, and the post-HFFT period included patients from January 1, 2022, to October 31, 2023. Data were compared for the proportion of patients undergoing pain evaluation in the ED, before discharge, time to first analgesia, number of patients receiving pain relief in the ED, and the use of fascia iliaca compartment blocks (FICBs) and pericapsular nerve group blocks (PENGBs). Results The final analysis involved 258 patients, with 116 in the pre-protocol group and 142 in the post-protocol group. The rate of analgesic use increased significantly in the post-HFFT group (78 [67.24%] vs 111 [78.17%], P = 0.049). The rate of pain score screening at triage increased from 51.72% before the HFFT protocol to 86.62% post-HFFT protocol (p < 0.001). Compared with the pre-HFFT protocol, the post-HFFT protocol exhibited a higher rate of FICB (0% vs 14.08%, p < 0.001) and PENGB (0% vs 5.63%, p = 0.009) administration. Conclusion The HFFT protocol's implementation was associated with improved ED pain evaluation and analgesic administration in older adults with hip fractures. These findings indicate that tailored protocols, such as the HFFT, hold promise for enhancing emergency care for this vulnerable population.
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Affiliation(s)
- Jiraporn Sri-On
- Geriatric Emergency Research Unit, Emergency Department, Vajira Hospital, Navamindradhiraj University, Dusit, Bangkok, Thailand
| | - Thitarat Worawiwat
- Emergency Department, Vajira Hospital, Navamindradhiraj University, Dusit, Bangkok, Thailand
| | | | - Pornsak Nirunsuk
- Orthopedic Department, Vajira Hospital, Navamindradhiraj University, Dusit, Bangkok, Thailand
| | - Alissara Vanichkulbodee
- Emergency Department, Vajira Hospital, Navamindradhiraj University, Dusit, Bangkok, Thailand
| | - Yupadee Fusakul
- Department of Rehabilitation Medicine, Vajira Hospital, Navamindradhiraj University, Dusit, Bangkok, Thailand
| | - Krit Phisaiphun
- Department of Anesthesiology, Faculty of Medicine, Chulalongkorn University, Pathumwan, Bangkok, Thailand
| | - Pornsiri Kanokkarnjana
- Emergency Department, Vajira Hospital, Navamindradhiraj University, Dusit, Bangkok, Thailand
| | | | - Kwannapa Thong-on
- Geriatric Emergency Research Unit, Emergency Department, Vajira Hospital, Navamindradhiraj University, Dusit, Bangkok, Thailand
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19
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Anish RJ, Nair A. Osteoporosis management-current and future perspectives - A systemic review. J Orthop 2024; 53:101-113. [PMID: 38495575 PMCID: PMC10940894 DOI: 10.1016/j.jor.2024.03.002] [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: 02/15/2024] [Revised: 02/23/2024] [Accepted: 03/01/2024] [Indexed: 03/19/2024] Open
Abstract
Introduction Osteoporosis is a geriatric metabolic ailment distinguished by low bone mineral density (BMD) and strength with enhanced micro-architectural retrogression of the extracellular matrix, further increasing bone fragility risk. Osteoporotic fractures and associated complications become common in women and men after 55 and 65 years, respectively. The loss in BMD markedly enhances the risk of fracture, non-skeletal injury, and subsequent pain, adversely affecting the quality of life. Methods Data summarised in this review were sourced and summarised, including contributions from 2008 to 2023, online from scientific search engines, based on scientific inclusion and exclusion criteria. Results Biochemical serum markers such as BALP, collagen, osteocalcin, and cathepsin-K levels can reveal the osteoporotic status. DEXA scan techniques evaluate the whole body's BMD and bone mineral content (BMC), crucial in osteoporosis management. Anabolic and anti-osteoporotic agents are commonly used to enhance bone formation, minimize bone resorption, and regulate remodelling. The challenges and side effects of drug therapy can be overcome by combining the various drug moieties. Conclusion The current review discusses the management protocol for osteoporosis, ranging from lifestyle modification, including physical exercise, pharmaceutical approaches, drug delivery applications, and advanced therapeutic possibilities of AI and machine learning techniques to reduce osteoporosis complications and fracture risk.
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Affiliation(s)
- Rajamohanan Jalaja Anish
- Department of Biochemistry, University of Kerala, Kariyavattom Campus, Trivandrum, 695581, India
| | - Aswathy Nair
- Department of Biochemistry, University of Kerala, Kariyavattom Campus, Trivandrum, 695581, India
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20
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Barchick SR, Masada KM, Fryhofer GW, Alqazzaz A, Donegan DJ, Mehta S. The hip fracture assessment tool: A scoring system to assess high risk geriatric hip fracture patients for post-operative critical care monitoring. Injury 2024; 55:111584. [PMID: 38762944 DOI: 10.1016/j.injury.2024.111584] [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: 03/04/2024] [Revised: 04/16/2024] [Accepted: 04/17/2024] [Indexed: 05/21/2024]
Abstract
INTRODUCTION Intensive care unit risk stratification models have been utilized in elective joint arthroplasty; however, hip fracture patients are fundamentally different in their clinical course. Having a critical care risk calculator utilizing pre-operative risk factors can improve resourcing for hip fracture patients in the peri‑operative period. METHODS A cohort of geriatric hip fracture patients at a single institution were reviewed over a three-year period. Non-operative patients, peri‑implant fractures, additional procedures performed under the same anesthesia period, and patients admitted to the intensive care unit (ICU) prior to surgery were excluded. Pre-operative laboratory values, Revised Cardiac Risk Index (RCRI), and American Society of Anesthesiologists (ASA) scores were calculated. Pre-operative ambulatory status was determined. The primary outcome measure was ICU admission in the post-operative period. Outcomes were assessed with Fisher's exact test, Kruskal-Wallis test, logistic regression, and ROC curve. RESULTS 315 patient charts were analyzed with 262 patients meeting inclusion criteria. Age ≥ 80 years, ASA ≥ 4, pre-operative hemoglobin < 10 g/dL, and a history of CVA/TIA were found to be significant factors and utilized within a "training" data set to create a 4-point scoring system after reverse stepwise elimination. The 4-point scoring system was then assessed within a separate "validation" data set to yield an ROC area under the curve (AUC) of 0.747. Score ≥ 3 was associated with 96.8 % specificity and 14.2 % sensitivity for predicting post-op ICU admission. Score ≥ 3 was associated with a 50 % positive predictive value and 83 % negative predictive value. CONCLUSION A hip fracture risk stratification scoring system utilizing pre-operative patient specific values to stratify geriatric hip patients to the ICU post-operatively can improve the pre-operative decision-making of surgical and critical care teams. This has important implications for triaging vital hospital resources. LEVEL OF EVIDENCE III (retrospective study).
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Affiliation(s)
- Stephen R Barchick
- Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
| | - Kendall M Masada
- Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - George W Fryhofer
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Aymen Alqazzaz
- Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Derek J Donegan
- Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Samir Mehta
- Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
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21
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Yamanaka T, Matsumura T, Ae R, Takeshita K. AO/OTA 31A3 fractures and postoperative complications in older patients. J Orthop Sci 2024; 29:1073-1077. [PMID: 37330352 DOI: 10.1016/j.jos.2023.05.010] [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: 09/15/2022] [Revised: 05/08/2023] [Accepted: 05/20/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND AO/OTA 31A3 fractures (A3 fractures) have risk for postoperative complications with major impact on morbidity and mortality. For older patients, limited information is available for factors associated with postoperative complications. We aimed to assess factors associated with postoperative complications after surgery using cephalomedullary nails. METHODS A retrospective cohort study was conducted using the information on patients aged ≥65 years who underwent surgery using cephalomedullary nails for trochanteric fractures due to low-energy trauma in three hospitals. Postoperative complications were diagnosed when patients were identified as nonunion, cutout of lag screw, or nail breakage. First, we compared differences including age, sex, body mass index, American Society of Anesthesiologists physical status classification system, preoperative waking ability, fracture type, nail length, neck shaft angle, reduction method, reduction quality and tip apex distance between patients with and without postoperative complications. Second, multivariable logistic regression analysis was employed to assess factors associated with postoperative complications resulting from A3 fractures. RESULTS Among 120 patients with A3 fractures, postoperative complications were identified in 12 patients (10.0%). Postoperative complications were significantly more likely to develop among patients with poor reduction quality (adjusted odds ratio [95% confidence interval], 35.0 [4.43-275.9]) and a tip-apex distance ≥25 mm (16.4 [1.92-140.3]). CONCLUSIONS These findings suggest that surgeons should aim to perform appropriate postoperative reduction and to prevent postoperative complications when using a cephalomedullary nail for A3 fractures among older patients.
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Affiliation(s)
- Takuya Yamanaka
- Department of Orthopedic Surgery, School of Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Tomohiro Matsumura
- Jichi Medical University Hospital Life Saving Emergency Center, Shimotsuke, Japan.
| | - Ryusuke Ae
- Division of Public Health, Center for Community Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Katsushi Takeshita
- Department of Orthopedic Surgery, School of Medicine, Jichi Medical University, Shimotsuke, Japan
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22
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Ko YS, Kang SY, Lee HJ, Kim HS, Yoo JJ. Trends in Hospital Stay, Complication Rate, and Mortality in Hip Fracture Patients: A Two-Decade Comparison at a National Tertiary Referral Center. J Clin Med 2024; 13:3666. [PMID: 38999232 PMCID: PMC11242650 DOI: 10.3390/jcm13133666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2024] [Revised: 06/16/2024] [Accepted: 06/19/2024] [Indexed: 07/14/2024] Open
Abstract
Background: Since the turn of the century, the age-adjusted incidence of proximal femoral fractures has caused a plateau or fall. However, it was anticipated that the number of patients with proximal femoral fractures would rise as life expectancy rose and the population over 80 years old expanded. The aim of this study was to compare the length of hospital stay, complication rate, and mortality in patients with proximal femoral fractures between two different time periods: 20 years ago and the present. Methods: We conducted a retrospective review of medical records of patients aged 65 years and above who underwent surgery for proximal femoral fractures between January 2000 and December 2001 and between January 2020 and December 2021. We collected information on age, gender, fracture type, length of hospital stay, and complication rate. Dates of death were obtained from the Ministry of the Interior and Safety. Results: We included 136 patients who were operated on between 2000 and 2001 and 134 patients between 2020 and 2021. The average age increased significantly from 71.6 years to 79.0 years (p < 0.001). The length of hospital stay decreased dramatically from 15.1 days to 6.0 days (p < 0.001). There was no statistically significant difference in delirium, urinary tract infection, or pneumonia. No difference was found in 30-day or 1-year mortality between the two groups. Conclusions: The complication rate and mortality between the two time periods appeared comparable, although the length of hospital stay decreased substantially. Therefore, we recommend considering expedited discharge from the acute care hospital for elderly hip fracture patients while implementing an individualized approach for better outcomes.
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Affiliation(s)
- Young-Seung Ko
- Department of Orthopedic Surgery, Hallym University Dong-Tan Sacred Heart Hospital, Hwaseong 18450, Republic of Korea
| | - Sang Yoon Kang
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Han Jin Lee
- Department of Orthopedic Surgery, Hanil General Hospital, Seoul 01450, Republic of Korea
| | - Hong Seok Kim
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Jeong Joon Yoo
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
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23
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Zhang N, Zhang D, Ren S, Gao Y, Sun W, Yang S. Relationship between preoperative hemoglobin levels and length of stay in elderly patients with hip fractures: A retrospective cohort study. Medicine (Baltimore) 2024; 103:e38518. [PMID: 38905374 PMCID: PMC11191984 DOI: 10.1097/md.0000000000038518] [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: 01/14/2024] [Accepted: 05/17/2024] [Indexed: 06/23/2024] Open
Abstract
Globally, hip fractures in elderly individuals are a prevalent and serious issue. Patients typically have a longer length of stay (LOS), which increases the risk of complications and increases hospitalization costs. Hemoglobin (Hb) is a routine blood test that is associated with disease prognosis. This study aimed to investigate the relationship between preoperative Hb and LOS in elderly hip fracture patients and to determine a reliable transfusion threshold. The clinical data of hip fracture patients (aged ≥ 60 years) admitted to the Department of Orthopaedics, Shenzhen Second People's Hospital, between January 2012 and December 2021 were retrospectively analyzed. Multiple linear regression analysis was used to assess the linear relationship between preoperative Hb and LOS. Smooth curve fitting was performed to investigate potential nonlinear relationships. In the case of discovering nonlinear relationships, a weighted two-piecewise linear regression model was built, and the inflection points were determined using a recursive algorithm. Subgroup analyses were conducted based on age and gender. A total of 1444 patients with an average age of (77.54 ± 8.73) years were enrolled. After adjusting for covariates, a nonlinear relationship was found between preoperative Hb and LOS. The two-piecewise linear regression model revealed an inflection point of 10 g/dL. On the left of the inflection point (Hb < 10 g/dL), the LOS was reduced by 0.735 days for every 1 g/dL increase in Hb (β = -0.735, 95% confidence interval: -1.346 to -0.124, P = .019). On the right side of the inflection point (Hb > 10 g/dL), the relationship was not statistically significant (β = 0.001, 95% confidence interval: -0.293 to 0.296, P = .992). In elderly hip fracture patients, there is a nonlinear association between preoperative Hb and LOS. However, when Hb levels were <10 g/dL, there was a negative correlation with the LOS. No correlation was observed when Hb levels were >10 g/dL. These findings underscore the importance of timely intervention to manage Hb levels in elderly patients with hip fractures, potentially reducing hospitalization durations and associated complications.
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Affiliation(s)
- Ning Zhang
- School of Nursing, Anhui Medical University, Hefei, China
| | - Daxue Zhang
- School of Nursing, Anhui Medical University, Hefei, China
| | - Shuqun Ren
- Guangxi University of Chinese Medicine, Nanning, China
| | - Yan Gao
- Department of Rehabilitation Medicine, Shenzhen Second People’s Hospital, Shenzhen, China
| | - Weichao Sun
- Department of Bone and Joint Surgery, Shenzhen Second People’s Hospital, Shenzhen, China
| | - Shiwei Yang
- School of Nursing, Anhui Medical University, Hefei, China
- Teaching Office, Shenzhen Second People’s Hospital, Shenzhen, China
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24
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Zhang YF, Ren C, Yao MX, Zhao SG, Ding K, Wang HC, Chen W, Zhang Q, Zhang YZ. Biomechanical comparison of the therapeutic effect of a novel proximal femoral bionic intramedullary nail and traditional inverted triangle hollow screw on femoral neck fracture. J Orthop Surg Res 2024; 19:359. [PMID: 38880901 PMCID: PMC11181575 DOI: 10.1186/s13018-024-04770-4] [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: 03/11/2024] [Accepted: 05/01/2024] [Indexed: 06/18/2024] Open
Abstract
OBJECTIVE A novel Proximal Femoral Bionic Nail (PFBN) has been developed by a research team for the treatment of femoral neck fractures. This study aims to compare the biomechanical properties of the innovative PFBN with those of the conventional Inverted Triangular Cannulated Screw (ITCS) fixation method through biomechanical testing. METHODS Sixteen male femoral specimens preserved in formalin were selected, with the donors' age at death averaging 56.1 ± 6.3 years (range 47-64 years), and a mean age of 51.4 years. The femurs showed no visible damage and were examined by X-rays to exclude diseases affecting bone quality such as tumors, severe osteoporosis, and deformities. The 16 femoral specimens were randomly divided into an experimental group (n = 8) and a control group (n = 8). All femurs were prepared with Pauwels type III femoral neck fractures, fixed with PFBN in the experimental group and ITCS in the control group. Displacement and stress limits of each specimen were measured through cyclic compression tests and failure experiments, and vertical displacement and strain values under a 600 N vertical load were measured in all specimens through vertical compression tests. RESULTS In the vertical compression test, the average displacement at the anterior head region of the femur was 0.362 mm for the PFBN group, significantly less than the 0.480 mm for the ITCS group (p < 0.001). At the fracture line area, the average displacement for the PFBN group was also lower than that of the ITCS group (0.196 mm vs. 0.324 mm, p < 0.001). The difference in displacement in the shaft area was smaller, but the average displacement for the PFBN group (0.049 mm) was still significantly less than that for the ITCS group (0.062 mm, p = 0.016). The situation was similar on the posterior side of the femur. The average displacements in the head area, fracture line area, and shaft area for the PFBN group were 0.300 mm, 0.168 mm, and 0.081 mm, respectively, while those for the ITCS group were 0.558 mm, 0.274 mm, and 0.041 mm, with significant differences in all areas (p < 0.001). The average strain in the anterior head area for the PFBN group was 4947 μm/m, significantly less than the 1540 μm/m for the ITCS group (p < 0.001). Likewise, in the fracture line and shaft areas, the average strains for the PFBN group were significantly less than those for the ITCS group (p < 0.05). In the posterior head area, the average strain for the PFBN group was 4861 μm/m, significantly less than the 1442 μm/m for the ITCS group (p < 0.001). The strain conditions in the fracture line and shaft areas also showed the PFBN group was superior to the ITCS group (p < 0.001). In cyclic loading experiments, the PFBN fixation showed smaller maximum displacement (1.269 mm vs. 1.808 mm, p < 0.001), indicating better stability. In the failure experiments, the maximum failure load that the PFBN-fixated fracture block could withstand was significantly higher than that for the ITCS fixation (1817 N vs. 1116 N, p < 0.001). CONCLUSION The PFBN can meet the biomechanical requirements for internal fixation of femoral neck fractures. PFBN is superior in biomechanical stability compared to ITCS, particularly showing less displacement and higher failure resistance in cyclic load and failure experiments. While there are differences in strain performance in different regions between the two fixation methods, overall, PFBN provides superior stability.
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Affiliation(s)
- Yi-Fan Zhang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Chuan Ren
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Meng-Xuan Yao
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Shu-Guang Zhao
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Kai Ding
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Hai-Cheng Wang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Wei Chen
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Qi Zhang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, People's Republic of China.
| | - Ying-Ze Zhang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, People's Republic of China.
- Chinese Academy of Engineering, Beijing, People's Republic of China.
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25
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Pliannuom S, Pinyopornpanish K, Buawangpong N, Wiwatkunupakarn N, Mallinson PAC, Jiraporncharoen W, Angkurawaranon C. Characteristics and Effects of Home-Based Digital Health Interventions on Functional Outcomes in Older Patients With Hip Fractures After Surgery: Systematic Review and Meta-Analysis. J Med Internet Res 2024; 26:e49482. [PMID: 38865706 PMCID: PMC11208838 DOI: 10.2196/49482] [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: 06/06/2023] [Revised: 10/07/2023] [Accepted: 04/29/2024] [Indexed: 06/14/2024] Open
Abstract
BACKGROUND Digital health interventions (DHIs) have been used to improve postoperative functional ability in older patients with hip fractures. However, there is limited information on the characteristics of home-based DHIs, and controversy exists regarding their impact on functional outcomes in this population. OBJECTIVE This study aims to provide an overview of the characteristics and effects of home-based DHIs on functional outcomes in older patients with hip fractures after surgery. METHODS We conducted a systematic review and meta-analysis following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Five electronic medical databases (PubMed, Embase, Cochrane, ProQuest, and CINAHL) were searched up until January 3, 2023. We included clinical trials or randomized controlled trials (RCTs) in English involving home-based DHIs for postoperative care among older patients with hip fractures. Excluded studies involved patients not hospitalized, not discharged to home, not directly using DHIs, or with inaccessible full text. The PROSPERO registration number is CRD42022370550. Two independent reviewers screened and extracted data (SP and NB). Disagreements were resolved through discussion and agreement with the third author (KP). Home-based DHIs were characterized in terms of purpose and content, mode of delivery, and health care provider. Functional outcomes assessed included Timed Up and Go (TUG) test, Short Physical Performance Battery (SPPB), and Functional Independence Measure (FIM). Summary measures were calculated using mean differences with 95% CIs. Risk of bias was assessed using the Risk-of-Bias 2 assessment tool for RCTs and ROBINS-I for non-RCTs. The quality of evidence was assessed using GRADE (Grading of Recommendations Assessment, Development and Evaluation). RESULTS Of 2125 identified studies, 16 were included in the systematic review, involving 1467 participants. Six studies were included in the meta-analysis (4 for TUG, 4 for SPPB, and 2 for FIM). Home-based DHIs predominantly involved communication and feedback, education, and telerehabilitation. Telephone calls were the most common mode of delivery, followed by web-based software and mobile apps. Physical therapists were the main health care providers. The meta-analysis showed that home-based DHIs improved functional outcomes compared with usual care, with decreased TUG scores (mean difference=-7.89; 95% CI -10.34 to -5.45; P<.001), significantly increased SPPB scores (mean difference=1.11; 95% CI 0.51-1.72; P<.001), and increased FIM scores (mean difference=7.98; 95% CI 5.73-10.24; P<.001). CONCLUSIONS Home-based DHIs that integrate communication and feedback, education, and telerehabilitation have demonstrated effectiveness in enhancing functional outcomes among older patients recovering from hip fractures after surgery. These interventions are commonly administered by physical therapists, who play a crucial role in facilitating and guiding the rehabilitation process. However, while the existing evidence supports the efficacy of such interventions, further research is needed to enhance our understanding and optimize the implementation of home-based DHIs for this specific population.
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Affiliation(s)
- Suphawita Pliannuom
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Global Health and Chronic Conditions Research Group, Chiang Mai University, Chiang Mai, Thailand
| | - Kanokporn Pinyopornpanish
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Global Health and Chronic Conditions Research Group, Chiang Mai University, Chiang Mai, Thailand
| | - Nida Buawangpong
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Global Health and Chronic Conditions Research Group, Chiang Mai University, Chiang Mai, Thailand
| | - Nutchar Wiwatkunupakarn
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Global Health and Chronic Conditions Research Group, Chiang Mai University, Chiang Mai, Thailand
| | - Poppy Alice Carson Mallinson
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Wichuda Jiraporncharoen
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Global Health and Chronic Conditions Research Group, Chiang Mai University, Chiang Mai, Thailand
| | - Chaisiri Angkurawaranon
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Global Health and Chronic Conditions Research Group, Chiang Mai University, Chiang Mai, Thailand
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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.
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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.
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Valdes AM, Ikram A, Taylor LA, Zheng A, Kouraki A, Kelly A, Ashraf W, Vijay A, Miller S, Nightingale J, Selby NM, Ollivere BJ. Preoperative inflammatory biomarkers reveal renal involvement in postsurgical mortality in hip fracture patients: an exploratory study. Front Immunol 2024; 15:1372079. [PMID: 38919625 PMCID: PMC11197399 DOI: 10.3389/fimmu.2024.1372079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 05/20/2024] [Indexed: 06/27/2024] Open
Abstract
Background Hip fractures in frail patients result in excess mortality not accounted for by age or comorbidities. The mechanisms behind the high risk of mortality remain undetermined but are hypothesized to be related to the inflammatory status of frail patients. Methods In a prospective observational exploratory cohort study of hospitalized frail hip fracture patients, 92 inflammatory markers were tested in pre-operative serum samples and markers were tested against 6-month survival post-hip fracture surgery and incidence of acute kidney injury (AKI). After correcting for multiple testing, adjustments for comorbidities and demographics were performed on the statistically significant markers. Results Of the 92 markers tested, circulating levels of fibroblast growth factor 23 (FGF-23) and interleukin-15 receptor alpha (IL15RA), both involved in renal disease, were significantly correlated with 6-month mortality (27.5% overall) after correcting for multiple testing. The incidence of postoperative AKI (25.4%) was strongly associated with 6-month mortality, odds ratio = 10.57; 95% CI [2.76-40.51], and with both markers plus estimated glomerular filtration rate (eGFR)- cystatin C (CYSC) but not eGFR-CRE. The effect of these markers on mortality was significantly mediated by their effect on postoperative AKI. Conclusion High postoperative mortality in frail hip fracture patients is highly correlated with preoperative biomarkers of renal function in this pilot study. The effect of preoperative circulating levels of FGF-23, IL15RA, and eGFR-CYSC on 6-month mortality is in part mediated by their effect on postoperative AKI. Creatinine-derived preoperative renal function measures were very poorly correlated with postoperative outcomes in this group.
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Affiliation(s)
- Ana M. Valdes
- Injury, Recovery and Inflammation Sciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- National Institute for Health and Care Research (NIHR) Nottingham Biomedical Research Centre, Nottingham, United Kingdom
| | - Adeel Ikram
- Injury, Recovery and Inflammation Sciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- National Institute for Health and Care Research (NIHR) Nottingham Biomedical Research Centre, Nottingham, United Kingdom
| | - Lauren A. Taylor
- Injury, Recovery and Inflammation Sciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- National Institute for Health and Care Research (NIHR) Nottingham Biomedical Research Centre, Nottingham, United Kingdom
| | - Amy Zheng
- Injury, Recovery and Inflammation Sciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- National Institute for Health and Care Research (NIHR) Nottingham Biomedical Research Centre, Nottingham, United Kingdom
| | - Afroditi Kouraki
- Injury, Recovery and Inflammation Sciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- National Institute for Health and Care Research (NIHR) Nottingham Biomedical Research Centre, Nottingham, United Kingdom
| | - Anthony Kelly
- Injury, Recovery and Inflammation Sciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- National Institute for Health and Care Research (NIHR) Nottingham Biomedical Research Centre, Nottingham, United Kingdom
| | - Waheed Ashraf
- Injury, Recovery and Inflammation Sciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- National Institute for Health and Care Research (NIHR) Nottingham Biomedical Research Centre, Nottingham, United Kingdom
| | - Amrita Vijay
- Injury, Recovery and Inflammation Sciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- National Institute for Health and Care Research (NIHR) Nottingham Biomedical Research Centre, Nottingham, United Kingdom
| | - Suzanne Miller
- Injury, Recovery and Inflammation Sciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- National Institute for Health and Care Research (NIHR) Nottingham Biomedical Research Centre, Nottingham, United Kingdom
| | - Jessica Nightingale
- Injury, Recovery and Inflammation Sciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- National Institute for Health and Care Research (NIHR) Nottingham Biomedical Research Centre, Nottingham, United Kingdom
| | - Nicholas M. Selby
- Centre for Kidney Research and Innovation, Academic Unit for Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Benjamin J. Ollivere
- Injury, Recovery and Inflammation Sciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- National Institute for Health and Care Research (NIHR) Nottingham Biomedical Research Centre, Nottingham, United Kingdom
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Laane D, Kroes T, van den Berg A, de Jongh M, The R, Van der Velde D, Nijdam T. Patient and proxy perspectives in decision-making for geriatric hip fracture management in the Netherlands: a qualitative study. BMJ Open 2024; 14:e082093. [PMID: 38858152 PMCID: PMC11168140 DOI: 10.1136/bmjopen-2023-082093] [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: 11/15/2023] [Accepted: 05/09/2024] [Indexed: 06/12/2024] Open
Abstract
OBJECTIVE The objective of this study was to explore the perspectives with the decision-making process between surgery and palliative, non-operative management of geriatric hip fracture patients and their proxies. DESIGN A qualitative interview study was performed. Patients and proxies were asked to participate in semi-structured interviews. Data were analysed using reflexive thematic analysis according to Braun and Clarke's six-step guide. SETTING AND PARTICIPANTS Hip fracture patients in the Netherlands were eligible for inclusion. For hip fracture patients with a pre-existing diagnosis of dementia and for patients who opted for palliative, non-operative management, proxies were included. RESULTS A total of 16 interviews were conducted, consisting of 4 patient interviews and 12 proxy interviews. Five themes were identified during thematic analysis: (1) underlying patient values, (2) the provision of information, (3) reasons to consider either palliative, non-operative management or surgery, (4) involvement in decision and (5) realisation of expectations. Information provided by the physician varied in terms of desired level of detail but involved discussing the advantages and disadvantages of surgery and palliative, non-operative management. Patients and proxies underscored the importance of achieving optimal quality of life, and the disparity between expected and actual treatment outcomes was unpleasant and negatively influenced the overall experience. CONCLUSIONS In-depth analysis provided a unique insight into the patient and proxy perspectives in shared decision-making for geriatric hip fracture management in the acute setting. Overall, there were differences between reported experiences and preferences of participants. This heterogeneity stresses the importance of keeping a person-centred approach during shared decision-making. Other key considerations during shared decision-making include physicians informing patients from professional experience and communicating sensitively about both treatment options and prognosis. Physicians should aim to provide realistic, sensitive and timely information to both patients and proxies during the choice between curation and palliation for their hip fracture.
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Affiliation(s)
- Duco Laane
- Department of Trauma Surgery, St Antonius Hospital Location Utrecht, Utrecht, Netherlands
| | - Thamar Kroes
- Department of Trauma Surgery, St Antonius Hospital Location Utrecht, Utrecht, Netherlands
| | - Arda van den Berg
- Brabant Trauma Registry, Network Emergency Care Brabant, Tilburg, Netherlands
| | - Mariska de Jongh
- Department Trauma TopCare, Elisabeth-TweeSteden Hospital, Brabant Trauma Registry, Network Emergency Care Brabant, Tilburg, Netherlands
| | - Regina The
- Brabant Trauma Registry, Network Emergency Care Brabant, Tilburg, Netherlands
| | - Detlef Van der Velde
- Department of Trauma Surgery, St Antonius Hospital Location Utrecht, Utrecht, Netherlands
| | - Thomas Nijdam
- Department of Trauma Surgery, St Antonius Hospital Location Utrecht, Utrecht, Netherlands
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Fan G, Zhong M, Su W, An Z, Zhu Y, Chen C, Dong L, Wu L, Zhang X. Effect of different anesthetic modalities on postoperative delirium in elderly hip fractures: A meta-analysis. Medicine (Baltimore) 2024; 103:e38418. [PMID: 38847680 PMCID: PMC11155603 DOI: 10.1097/md.0000000000038418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 05/09/2024] [Indexed: 06/10/2024] Open
Abstract
BACKGROUND Previous findings on the effect of general versus spinal anesthesia on postoperative delirium in elderly people with hip fractures are somewhat controversial. This article included the latest randomized controlled study for meta-analysis to evaluate the effect of general anesthesia (GA) and spinal anesthesia (SA) on delirium after hip fracture surgery in the elderly, so as to guide the clinical. METHODS Cochrane Library, PubMed, Web Of Science, and Embase were searched from inception up to January 16, 2024. Randomized controlled trial (RCT) was included to evaluate the postoperative results of GA and SA in elderly patients (≥50 years old) undergoing hip fracture surgery. Two researchers independently screened for inclusion in the study and extracted data. Heterogeneity was assessed by the I²and Chi-square tests, and P < .1 or I² ≥ 50% indicated marked heterogeneity among studies. The Mantel-Haenszel method was used to estimate the combined relative risk ratio (RR) and the corresponding 95% confidence interval (CI) for the binary variables. RESULTS Nine randomized controlled trials were included. There was no significant difference (RR = 0.93, 95% CI = 0.774-1.111, P > .05) in the incidence of postoperative delirium between the GA group and the SA group. In intraoperative blood transfusion (RR = 1.0, 95% CI = 0.77-1.28, Z = 0.04, P = .971), pulmonary embolism (RR = 0.795, 95% CI = 0.332-1.904, Z = 0.59, P = .606), pneumonia (RR = 1.47, 95% CI = 0.75-2.87, P = .675), myocardial infarction (RR = 0.97, 95% CI = 0.24-3.86, Z = 0.05, P = .961), heart failure (RR = 0.80, 95% CI = 0.26-2.42, Z = 0.40, P = .961), urinary retention (RR = 1.42, 95% CI = 0.77-2.61, Z = 1.11, P = .267) were similar between the 2 anesthetic techniques. CONCLUSION There is no significant difference in the effect of GA and SA on postoperative delirium in elderly patients with hip fracture, and their effects on postoperative complications are similar.
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Affiliation(s)
- Guangya Fan
- Department of Orthopedics,The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, People's Republic of China
- The Second Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, People's Republic of China
| | - Musen Zhong
- Department of Orthopedics,The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, People's Republic of China
- The Second Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, People's Republic of China
| | - Wenshuo Su
- Department of Orthopedics,The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, People's Republic of China
- The Second Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, People's Republic of China
| | - Zhongcheng An
- Department of Orthopedics,The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, People's Republic of China
| | - Yuchen Zhu
- Department of Orthopedics,The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, People's Republic of China
| | - Chen Chen
- Department of Orthopedics,The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, People's Republic of China
| | - Liqiang Dong
- Department of Orthopedics,The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, People's Republic of China
| | - Lianguo Wu
- Department of Orthopedics,The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, People's Republic of China
| | - Xiaoping Zhang
- Department of Geriatrics, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, People's Republic of China
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Alexiou K, Koutalos AA, Varitimidis S, Karachalios T, Malizos KN. Development of Prediction Model for 1-year Mortality after Hip Fracture Surgery. Hip Pelvis 2024; 36:135-143. [PMID: 38825823 PMCID: PMC11162873 DOI: 10.5371/hp.2024.36.2.135] [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: 06/28/2023] [Revised: 10/21/2023] [Accepted: 10/23/2023] [Indexed: 06/04/2024] Open
Abstract
Purpose Hip fractures are associated with increased mortality. The identification of risk factors of mortality could improve patient care. The aim of the study was to identify risk factors of mortality after surgery for a hip fracture and construct a mortality model. Materials and Methods A cohort study was conducted on patients with hip fractures at two institutions. Five hundred and ninety-seven patients with hip fractures that were treated in the tertiary hospital, and another 147 patients that were treated in a secondary hospital. The perioperative data were collected from medical charts and interviews. Functional Assessment Measure score, Short Form-12 and mortality were recorded at 12 months. Patients and surgery variables that were associated with increased mortality were used to develop a mortality model. Results Mortality for the whole cohort was 19.4% at one year. From the variables tested only age >80 years, American Society of Anesthesiologists category, time to surgery (>48 hours), Charlson comorbidity index, sex, use of anti-coagulants, and body mass index <25 kg/m2 were associated with increased mortality and used to construct the mortality model. The area under the curve for the prediction model was 0.814. Functional outcome at one year was similar to preoperative status, even though their level of physical function dropped after the hip surgery and slowly recovered. Conclusion The mortality prediction model that was developed in this study calculates the risk of death at one year for patients with hip fractures, is simple, and could detect high risk patients that need special management.
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Affiliation(s)
- Konstantinos Alexiou
- Department of Orthopaedic Surgery and Musculoskeletal Trauma, University General Hospital of Larissa, Larissa, Greece
| | - Antonios A. Koutalos
- Department of Orthopaedic Surgery and Musculoskeletal Trauma, University General Hospital of Larissa, Larissa, Greece
| | - Sokratis Varitimidis
- Department of Orthopaedic Surgery and Musculoskeletal Trauma, School of Health Sciences, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - Theofilos Karachalios
- Department of Orthopaedic Surgery and Musculoskeletal Trauma, School of Health Sciences, Faculty of Medicine, University of Thessaly, Larissa, Greece
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Hayashi M, Yamamoto N, Kuroda N, Kano K, Miura T, Kamimura Y, Shiroshita A. Peripheral Nerve Blocks in the Preoperative Management of Hip Fractures: A Systematic Review and Network Meta-Analysis. Ann Emerg Med 2024; 83:522-538. [PMID: 38385910 DOI: 10.1016/j.annemergmed.2024.01.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 01/15/2024] [Accepted: 01/18/2024] [Indexed: 02/23/2024]
Abstract
STUDY OBJECTIVE We conducted a systematic review and network meta-analysis to evaluate the comparative efficacy of peripheral nerve block types for preoperative pain management of hip fractures. METHODS We searched Cochrane, Central Register of Controlled Trials, MEDLINE, EMBASE, ICTRP, ClinicalTrials.gov, and Google Scholar for randomized clinical trials. We included participants aged more than 16 years with hip fractures who received peripheral nerve blocks or analgesics for preoperative pain management. The primary outcomes were defined as absolute pain score 2 hours after block placement, preoperative consumption of morphine equivalents, and length of hospital stay. We used a random-effects network meta-analysis conceptualized in the Bayesian framework. Confidence of evidence was assessed using Confidence in Network Meta-Analysis (CINeMA). RESULTS We included 63 randomized controlled studies (4,778 participants), of which only a few had a low risk of bias. The femoral nerve block, 3-in-1 block, fascia iliaca compartment block, and pericapsular nerve group block yielded significantly lowered pain scores at 2 hours after block placement compared with those with no block (standardized mean differences [SMD]: -1.1; 95% credible interval [CrI]: -1.7 to -0.48, [confidence of evidence: low]; SMD: -1.8; 95% CrI: -3.0 to -0.55, [low]; SMD: -1.4; 95% CrI: -2.0 to -0.72, [low]; SMD: -2.3; 95% CrI: -3.2 to -1.4, [moderate], respectively). The pericapsular nerve group block, 3-in-1 block, fascia iliaca compartment block, and femoral nerve block resulted in lower pain scores than the no-block group. Additionally, the pericapsular nerve group block yielded a lower pain score than femoral nerve block or fascia iliaca compartment block (SMD: -1.21; 95% CrI: -2.18 to -0.23, [very low]: SMD: -0.92; 95% CrI: -1.70 to -0.16, [low]). However, both the fascia iliaca compartment block and femoral nerve block did not show a reduction in morphine consumption compared with no block. To our knowledge, no studies have compared the pericapsular nerve group block with other methods regarding morphine consumption. Furthermore, no significant difference was observed between peripheral nerve blocks and no block in terms of the length of hospital stay. CONCLUSIONS Compared with no block, preoperative peripheral nerve blocks for hip fractures appear to reduce pain 2 hours after block placement. Comparing different blocks, pericapsular nerve group block might be superior to fascia iliaca compartment block and femoral nerve block for pain relief, though the confidence evidence was low in most comparisons because of the moderate to high risk of bias in many of the included studies and the high heterogeneity of treatment strategies across studies. Therefore, further high-quality research is needed.
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Affiliation(s)
- Minoru Hayashi
- Department of Emergency Medicine Fukui Prefectural Hospital, Yotsui, Fukui, Japan
| | - Norio Yamamoto
- Department of Epidemiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan; Scientific Research WorkS Peer Support Group (SRWS-PSG), Osaka, Japan.
| | - Naoto Kuroda
- Scientific Research WorkS Peer Support Group (SRWS-PSG), Osaka, Japan; Department of Pediatrics, Wayne State University, Detroit, MI; Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kenichi Kano
- Department of Emergency Medicine Fukui Prefectural Hospital, Yotsui, Fukui, Japan
| | - Takanori Miura
- Scientific Research WorkS Peer Support Group (SRWS-PSG), Osaka, Japan; Department of Orthopedic Surgery, Akita Rosai Hospital, Odate, Japan
| | - Yuji Kamimura
- Scientific Research WorkS Peer Support Group (SRWS-PSG), Osaka, Japan; Department of Anesthesiology and Intensive Care Medicin, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Akihiro Shiroshita
- Scientific Research WorkS Peer Support Group (SRWS-PSG), Osaka, Japan; Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN
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Yamanaka T, Matsumura T, Ae R, Hiyama S, Takeshita K. Risk of peri‑implant femoral fracture after cephalomedullary nailing in older patients with trochanteric fractures. Injury 2024; 55:111206. [PMID: 37996270 DOI: 10.1016/j.injury.2023.111206] [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: 07/05/2023] [Revised: 10/31/2023] [Accepted: 11/12/2023] [Indexed: 11/25/2023]
Abstract
INTRODUCTION Despite the recent increase in the use of cephalomedullary nails for trochanteric hip fractures, factors that may be associated with peri‑implant femoral fracture (PIFF) after cephalomedullary nailing for trochanteric fractures remain unknown. We investigated the factors associated with PIFF after cephalomedullary nailing of trochanteric hip fractures in older patients. METHODS A nested case-control study was conducted using a database of patients aged ≥65 years who underwent surgery with cephalomedullary nails for trochanteric fractures caused by low-energy trauma during 2005-2021. The cases were defined as patients who developed PIFF after surgery, while controls were patients who did not develop PIFF and who were followed up for ≥3 years after surgery. Four controls were randomly matched to each case for sex and age. First, potential factors associated with PIFF were compared between cases and controls. Second, multivariable conditional logistic regression analysis was employed to assess factors possibly associated with PIFF, controlling for potential confounding factors. RESULTS Of 1531 patients who underwent surgery with cephalomedullary nails because of trochanteric fractures, we assessed 34 cases and 136 controls (N = 170; mean age 85.7 ± 7 years; and females, 94 %). PIFF was significantly associated with patients having undergone total knee arthroplasty (adjusted odds ratios [95 % confidence intervals], 4.41 [1.16-16.8]) and those with AO/OTA classification 31A3 fracture (A3 fracture) (2.3 [1.12-4.76]), after adjusting for potential confounding factors. CONCLUSIONS Our results showed that PIFF was more likely to develop among older patients with a clinical history of total knee arthroplasty and A3 fracture. These findings suggest that such patients may require careful follow-up with rigorous assessments after cephalomedullary nailing for trochanteric fractures.
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Affiliation(s)
- Takuya Yamanaka
- Department of Orthopedic Surgery, School of Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Tomohiro Matsumura
- Department of Emergency and Critical Care Medicine, Jichi Medical University, Shimotsuke, Japan.
| | - Ryusuke Ae
- Division of Public Health, Center for Community Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Shuhei Hiyama
- Department of Orthopedic Surgery, School of Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Katsushi Takeshita
- Department of Orthopedic Surgery, School of Medicine, Jichi Medical University, Shimotsuke, Japan
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Jacob N, Ghobrial M, Parker M. Does delay from injury to surgery increase the risk of dislocation of a hip hemiarthroplasty? Injury 2024; 55:111446. [PMID: 38479318 DOI: 10.1016/j.injury.2024.111446] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 09/20/2023] [Accepted: 02/19/2024] [Indexed: 05/24/2024]
Abstract
Dislocation of a hip hemiarthroplasty used to treat a hip fracture is a serious complication. The aim of this study was to identify whether a delay in the time from fracture to surgery causes an increase in the rate of post-operative hip dislocation. From a single center, data from intracapsular neck of femur patients treated with hip hemiarthroplasty was collected between October 1986 to August 2021. The time from both fall to surgery and admission to surgery was recorded. Surviving patients were followed up for one year. The overall dislocation rate was 51 out of 4155 patients (1.2%). The 3019 patients who had surgery within two days of the injury had a lowest dislocation rate (29 dislocations, 0.96%). For the 197 patients with no history of a fall, there were 5 (2.5%) dislocations (p=0.036, 95% confidence interval of difference 0.15 to 0.97 for comparison with surgery within two days). For the 399 patients with a delay of more than four days from injury till surgery, there were nine dislocations (2.3%) (p=0.045, 95% confidence intervals of difference 0.20 to 0.89 for comparison with surgery within two days). This study demonstrates an increase in the risk of dislocation for those patients with no history of a fall and those with a delay of more than four days from injury to surgery.
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Affiliation(s)
- Neville Jacob
- Peterborough City Hospital (North West Anglia NHS Trust).
| | | | - Martyn Parker
- Peterborough City Hospital (North West Anglia NHS Trust), Peterborough City Hospital, Edith Cavell Campus, Bretton Gate, Peterborough, PE3 9GZ.
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Silas U, Berberich C, Anyimiah P, Szymski D, Rupp M. Risk of surgical site infection after hip hemiarthroplasty of femoral neck fractures: a systematic review and meta-analysis. Arch Orthop Trauma Surg 2024:10.1007/s00402-024-05384-5. [PMID: 38805084 DOI: 10.1007/s00402-024-05384-5] [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: 04/08/2024] [Accepted: 05/15/2024] [Indexed: 05/29/2024]
Abstract
INTRODUCTION Surgical site infection (SSI) is a major complication following hemiarthroplasty surgery for displaced neck of femur fractures. Our aim is to systematically analyse relevant peer-reviewed studies for recent clinical information on the quantitative risk of surgical site infection (SSI) after hemiarthroplasty (HA) of hip fracture patients and on the factors which influence the SSI rates. METHODS A comprehensive search of electronic databases (PubMed, Cochrane) was performed for clinical articles published between 2005 and 2023 and systematically reviewed with a defined list of inclusion and exclusion criteria. The methodology was undertaken and reported according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement checklist, while the detailed search strings and study protocol were published in PROSPERO (CRD42023458150). The pooled risks of SSIs were calculated in both primary and subgroup analyses. RESULTS The primary analysis showed a pooled superficial SSI rate after hemiarthroplasty of 1.3% (95% confidence interval (CI) 0.71; 2.04) from 17 studies with 29,288 patients and a deep SSI rate of 2.14% (1.87; 2.42) from 29 studies with 192,392 patients. Higher infection rates were observed with longer follow-up periods for deep SSI: pooled rates increased from 1.24% (0.73; 1.87) at 1 month to 2.64% (2.03; 3.31) at 12 months. Additionally, studies using defined criteria for infection diagnosis reported higher rates compared to undefined criteria: pooled deep SSI rates were 2.91% (1.40; 4.92) vs. 0.62% (0.34; 0.96) for defined vs. undefined criteria respectively, and 3.18% (2.23; 4.29) vs. 1.7% (1.44; 1.99) for superficial SSI. CONCLUSIONS The results of this study demonstrate a substantial SSI risk and a high variability of the infection rates following hemiarthroplasty for hip fracture patients. A standardization of infection criteria and an extended follow-up period are advisable and should be considered in guidelines aimed at improving the standard of care for these patients.
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Affiliation(s)
- Ubong Silas
- Coreva Scientific GmbH & Co. KG, Koenigswinter, Germany.
| | | | | | - Dominik Szymski
- Department of Trauma Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Markus Rupp
- Department of Trauma Surgery, University Hospital Regensburg, Regensburg, Germany
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Raper E, Kimmel LA, Burge AT, Harris IA, Ackerman IN, Page RS, Naylor JM, Hepworth G, Gabbe B, Ekegren CL, Harris A, Woode ME, Holland AE. Implementation of supplemental physiotherapy following hip fracture surgery: a protocol for the process evaluation of a randomised controlled trial. Trials 2024; 25:344. [PMID: 38790039 PMCID: PMC11127386 DOI: 10.1186/s13063-024-08143-4] [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: 01/16/2024] [Accepted: 04/29/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Patient outcomes following low-trauma hip fracture are suboptimal resulting in increased healthcare costs and poor functional outcomes at 1 year. Providing early and intensive in-hospital physiotherapy could help improve patient outcomes and reduce costs following hip fracture surgery. The HIP fracture Supplemental Therapy to Enhance Recovery (HIPSTER) trial will compare usual care physiotherapy to intensive in-hospital physiotherapy for patients following hip fracture surgery. The complex environments in which the intervention is implemented present unique contextual challenges that may impact intervention effectiveness. This study aims to complete a process evaluation to identify barriers and facilitators to implementation and explore the patient, carer and clinician experience of intensive therapy following hip fracture surgery. METHODS AND ANALYSIS The process evaluation is embedded within a two-arm randomised, controlled, assessor-blinded trial recruiting 620 participants from eight Australian hospitals who have had surgery for a hip fracture sustained via a low-trauma injury. A theory-based mixed method process evaluation will be completed in tandem with the HIPSTER trial. Patient and carer semi-structured interviews will be completed at 6 weeks following hip fracture surgery. The clinician experience will be explored through online surveys completed pre- and post-implementation of intensive therapy and mapped to domains of the Theoretical Domains Framework (TDF). Translation and behaviour change success will be assessed using the Reach Effectiveness-Adoption Implementation Maintenance (RE-AIM) framework and a combination of qualitative and quantitative data collection methods. These data will assist with the development of an Implementation Toolkit aiding future translation into practice. DISCUSSION The embedded process evaluation will help understand the interplay between the implementation context and the intensive therapy intervention following surgery for low-trauma hip fracture. Understanding these mechanisms, if effective, will assist with transferability into other contexts and wider translation into practice. TRIAL REGISTRATION ACTRN 12622001442796.
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Affiliation(s)
- Eleanor Raper
- Physiotherapy Department, Alfred Health, Melbourne, Australia.
- Central Clinical School, Monash University, Melbourne, VIC, Australia.
| | - Lara A Kimmel
- Physiotherapy Department, Alfred Health, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Angela T Burge
- Physiotherapy Department, Alfred Health, Melbourne, Australia
- Central Clinical School, Monash University, Melbourne, VIC, Australia
- Institute for Breathing and Sleep, Melbourne, VIC, Australia
| | - Ian A Harris
- Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Sydney, Australia
- School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Sydney, Australia
| | - Ilana N Ackerman
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Richard S Page
- Barwon Centre for Orthopaedic Research and Education, IMPACT, School of Medicine, Deakin University, Geelong, VIC, Australia
- John of God Geelong Hospital, Geelong, VIC, Australia
- Department of Orthopaedics, University Hospital Geelong, Barwon Health, Geelong, VIC, Australia
| | - Justine M Naylor
- Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Sydney, Australia
- School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Sydney, Australia
| | - Graham Hepworth
- Statistical Consulting Centre, The University of Melbourne, Melbourne, VIC, Australia
| | - Belinda Gabbe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Christina L Ekegren
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Melbourne, Australia
| | - Anthony Harris
- Centre for Health Economics, Monash University, Melbourne, Australia
| | - Maame Esi Woode
- Centre for Health Economics, Monash University, Melbourne, Australia
| | - Anne E Holland
- Physiotherapy Department, Alfred Health, Melbourne, Australia
- Central Clinical School, Monash University, Melbourne, VIC, Australia
- Institute for Breathing and Sleep, Melbourne, VIC, Australia
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Tan JR, Gao Y, Raghuraman R, Ting D, Wong KM, Cheng LTE, Oh HC, Goh SH, Yan YY. Application of deep learning algorithms in classification and localization of implant cutout for the postoperative hip. Skeletal Radiol 2024:10.1007/s00256-024-04692-6. [PMID: 38771507 DOI: 10.1007/s00256-024-04692-6] [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: 12/07/2023] [Revised: 04/03/2024] [Accepted: 04/22/2024] [Indexed: 05/22/2024]
Abstract
OBJECTIVE This study aims to explore the feasibility of employing convolutional neural networks for detecting and localizing implant cutouts on anteroposterior pelvic radiographs. MATERIALS AND METHODS The research involves the development of two Deep Learning models. Initially, a model was created for image-level classification of implant cutouts using 40191 pelvic radiographs obtained from a single institution. The radiographs were partitioned into training, validation, and hold-out test datasets in a 6/2/2 ratio. Performance metrics including the area under the receiver operator characteristics curve (AUROC), sensitivity, and specificity were calculated using the test dataset. Additionally, a second object detection model was trained to localize implant cutouts within the same dataset. Bounding box visualizations were generated on images predicted as cutout-positive by the classification model in the test dataset, serving as an adjunct for assessing algorithm validity. RESULTS The classification model had an accuracy of 99.7%, sensitivity of 84.6%, specificity of 99.8%, AUROC of 0.998 (95% CI: 0.996, 0.999) and AUPRC of 0.774 (95% CI: 0.646, 0.880). From the pelvic radiographs predicted as cutout-positive, the object detection model could achieve 95.5% localization accuracy on true positive images, but falsely generated 14 results from the 15 false-positive predictions. CONCLUSION The classification model showed fair accuracy for detection of implant cutouts, while the object detection model effectively localized cutout. This serves as proof of concept of using a deep learning-based approach for classification and localization of implant cutouts from pelvic radiographs.
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Affiliation(s)
- Jin Rong Tan
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore General Hospital, Block 2, Level 1 Outram Road, Singapore, 169608, Singapore.
- Radiological Sciences ACP, Duke-NUS Medical School, Singapore, Singapore.
| | - Yan Gao
- Health Services Research, Changi General Hospital, Singapore Health Services, Singapore, Singapore
| | - Raghavan Raghuraman
- Department of Orthopaedic Surgery, Changi General Hospital, Singapore, Singapore
| | - Daniel Ting
- Duke-NUS Medical School, Singapore Health Service (SingHealth), Singapore, Singapore
| | - Kang Min Wong
- Radiological Sciences ACP, Duke-NUS Medical School, Singapore, Singapore
- Department of Radiology, Changi General Hospital, Singapore, Singapore
| | - Lionel Tim-Ee Cheng
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore General Hospital, Block 2, Level 1 Outram Road, Singapore, 169608, Singapore
- Radiological Sciences ACP, Duke-NUS Medical School, Singapore, Singapore
| | - Hong Choon Oh
- Health Services Research, Changi General Hospital, Singapore Health Services, Singapore, Singapore
| | - Siang Hiong Goh
- Department of Emergency Medicine, Changi General Hospital, Singapore, Singapore
| | - Yet Yen Yan
- Radiological Sciences ACP, Duke-NUS Medical School, Singapore, Singapore
- Department of Radiology, Changi General Hospital, Singapore, Singapore
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Kashanian K, Bourget-Murray J, Horton I, Morris J, Papp SR, Grammatopoulos G. National Institute of Health and Care Excellence Guidelines for Displaced Intracapsular Hip Fractures: Examining Satisfaction With the Guidelines and Effects on Outcomes. J Arthroplasty 2024:S0883-5403(24)00481-9. [PMID: 38763481 DOI: 10.1016/j.arth.2024.05.037] [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: 12/14/2023] [Revised: 05/10/2024] [Accepted: 05/11/2024] [Indexed: 05/21/2024] Open
Abstract
BACKGROUND The objectives of the study were to: (1) evaluate satisfaction with the new 2023 National Institute of Health and Care Excellence (NICE) criteria for selecting total hip arthroplasty (THA) over hemiarthroplasty and surgical recommendations for treatment of displaced intracapsular hip fractures; (2) describe why THA is performed when NICE criteria are not met; and (3) determine whether satisfaction with these guidelines is associated with improved outcomes. METHODS A retrospective chart review of patients who had a displaced intracapsular hip fracture treated with THA at a single tertiary academic center between 2010 and 2022 was performed. Preoperative patient characteristics were reviewed to determine if the indication for THA met NICE criteria. Operative details, perioperative complications, reoperation, and revision arthroplasty within 12 months of surgery were recorded. RESULTS Data from 196 patients (63% women; age 67 ± 10 years) were used. There were 161 THAs (82.1%) that satisfied NICE criteria. The 2 most common reasons for performing a THA when NICE criteria were not met (n = 35) included preoperative radiographic osteoarthritis (Tönnis grade ≥ 2; 48.6%) and decreased patient age (< 65 years; 31.5%). Satisfaction with the NICE criteria was associated with fewer perioperative complications (0.6 versus 37.1%; P < .001), reoperations (0.6 versus 31.4%; P < .001), and revisions (0.6 versus 28.6%; P < .001). The most common reason for revision was periprosthetic fracture, possibly secondary to the use of uncemented femoral stems (171 of 196, 87.2%). CONCLUSIONS Satisfaction with the new NICE criteria is associated with improved perioperative outcomes. Further studies are necessary to determine if preexisting hip osteoarthritis and younger age merit consideration in patient selection.
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Affiliation(s)
- Koorosh Kashanian
- Division of Orthopaedic Surgery, Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Jonathan Bourget-Murray
- Division of Orthopaedic Surgery, Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada; Division of Orthopaedic Surgery, Department of Surgery, The Royal Inland Hospital, Kamloops, British Columbia, Canada
| | - Isabel Horton
- Division of Orthopaedic Surgery, Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Jared Morris
- Division of Orthopaedic Surgery, Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Steven Ray Papp
- Division of Orthopaedic Surgery, Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - George Grammatopoulos
- Division of Orthopaedic Surgery, Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
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González-Quevedo D, Rubia-Ortega C, Sánchez-Delgado A, Moriel-Garceso D, Sánchez-Siles JM, Bravo-Bardají M, García-de-Quevedo D, Tamimi I. Secondary osteoporosis prevention: three-year outcomes from a Fracture Liaison Service in elderly hip fracture patients. Aging Clin Exp Res 2024; 36:103. [PMID: 38704788 PMCID: PMC11070393 DOI: 10.1007/s40520-024-02761-3] [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: 03/18/2024] [Accepted: 04/19/2024] [Indexed: 05/07/2024]
Abstract
BACKGROUND Hip fractures are the most serious fragility fractures due to their associated disability, higher hospitalization costs and high mortality rates. Fracture Liaison Service (FLS) programs have enhanced the management of osteoporosis-related fractures and have shown their clinical effectiveness. AIMS To analyze the effect of the implementation of a FLS model of care over the survival and mortality rates following a hip fracture. METHODS We conducted a prospective cohort study on patients over 60 years of age who suffered a hip fracture before and after the implementation of the FLS in our center (between January 2016 and December 2019). Patients were followed for three years after the index date. Mortality, complications and refracture rates were compared between the two groups using a Multivariate Cox proportional hazard model. RESULTS A total of 1366 patients were included in this study (353 before FLS implementation and 1013 after FLS implementation). Anti-osteoporotic drugs were more frequently prescribed after FLS implementation (79.3% vs 12.5%; p < 0.01) and there was an increase in adherence to treatment (51.7% vs 30.2%; p < 0.01). A total of 413 (40.8%) patients after FLS implementation and 141 (39.9%) individuals before (p = 0.47) died during the three-years follow-up period. A second fracture occurred in 101 (10.0%) patients after FLS implementation and 37 (10.5%) individuals before (p = 0.78). Patients after the implementation of the FLS protocol had a lower all cause one-year mortality [adjusted Hazard Ratio (HR) 0.74 (0.57-0.94)] and a decreased risk of suffering a second osteoporotic fracture [adjusted HR 0.54 (0.39-0.75) in males and adjusted HR 0.46 (0.30-0.71) in females]. CONCLUSIONS The implementation of a FLS protocol was associated with a lower all-cause one-year mortality rate and a higher survivorship in elderly hip fracture patients. However, no three-year mortality rate differences were observed between the two groups. We also found a reduction in the complication and second-fracture rates.
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Affiliation(s)
- David González-Quevedo
- Department of Orthopedic Surgery and Traumatology, Regional University Hospital of Málaga, Carlos Haya Avenue, 29010, Málaga, Spain.
- Department of Surgical Specialties, Biochemistry and Immunology, School of Medicine, University of Málaga, Málaga, Spain.
| | - Carolina Rubia-Ortega
- Department of Orthopedic Surgery and Traumatology, Regional University Hospital of Málaga, Carlos Haya Avenue, 29010, Málaga, Spain
| | - Adriana Sánchez-Delgado
- Department of Orthopedic Surgery and Traumatology, Regional University Hospital of Málaga, Carlos Haya Avenue, 29010, Málaga, Spain
| | - Diego Moriel-Garceso
- Department of Orthopedic Surgery and Traumatology, Regional University Hospital of Málaga, Carlos Haya Avenue, 29010, Málaga, Spain
| | - Juan-Manuel Sánchez-Siles
- Department of Orthopedic Surgery and Traumatology, Regional University Hospital of Málaga, Carlos Haya Avenue, 29010, Málaga, Spain
| | - Manuel Bravo-Bardají
- Department of Orthopedic Surgery and Traumatology, Regional University Hospital of Málaga, Carlos Haya Avenue, 29010, Málaga, Spain
| | - David García-de-Quevedo
- Department of Orthopedic Surgery and Traumatology, Regional University Hospital of Málaga, Carlos Haya Avenue, 29010, Málaga, Spain
| | - Iskandar Tamimi
- Department of Orthopedic Surgery and Traumatology, Regional University Hospital of Málaga, Carlos Haya Avenue, 29010, Málaga, Spain
- Department of Surgical Specialties, Biochemistry and Immunology, School of Medicine, University of Málaga, Málaga, Spain
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Ogawa T, Onuma R, Sagae H, Schermann H, Kristensen MT, Fushimi K, Yoshii T, Jinno T. Association between additional weekend rehabilitation and functional outcomes in patients with hip fractures: does age affect the effectiveness of weekend rehabilitation? Eur Geriatr Med 2024:10.1007/s41999-024-00980-5. [PMID: 38703245 DOI: 10.1007/s41999-024-00980-5] [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: 10/01/2023] [Accepted: 04/15/2024] [Indexed: 05/06/2024]
Abstract
PURPOSE Rehabilitation after hip fracture surgery is crucial for improving physical function. Additional rehabilitation over the weekend or after working hours is reportedly associated with improved physical function; however, this may not apply to an aging population, including patients aged > 90 years. This study aimed to investigate the association between additional weekend rehabilitation and functional outcomes in different age groups. METHODS This study analyzed a cohort of patients aged ≥ 60 years who had hip fractures and were operated on from 2010 to 2018. Data were extracted from a nationwide multicentre database. Functional outcomes at discharge were compared between patients who underwent rehabilitation on weekdays only and those who underwent rehabilitation on both weekdays and weekends. The patient groups were selected using propensity score matching analysis. Furthermore, a subgroup-analysis was conducted on patients in their 60 s, 70 s, 80 s, and 90 s. RESULTS A total of 390,713 patients underwent surgery during the study period. After matching, each group comprised 129,583 pairs of patients. Patients who underwent weekend rehabilitation exhibited improved physical function in transferring, walking, and stair climbing at discharge, as compared with patients who did not (odds ratio [95% confidence interval]: 1.17 [1.15-1.19], 1.17 [1.15-1.2], and 1.06 [1.03-1.08], respectively). In subgroup analysis, except for stair climbing, the positive association between weekend rehabilitation and patient function was observed across all age groups. CONCLUSION Weekend rehabilitation was significantly associated with improved physical function. Given the limited healthcare resources, high-demand activities such as stair climbing may be reserved for younger age groups to optimise rehabilitation therapy.
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Affiliation(s)
- Takahisa Ogawa
- Department of Orthopaedic and Spine Surgery, Tokyo Medical and Dental University Graduate School of Medicine, 1 Chome-5-45 Yushima, Bunkyo, Tokyo, 113-8510, Japan
| | - Ryo Onuma
- Department of Rehabilitation, Tokyo Medical and Dental University Graduate School of Medicine, 1 Chome-5-45 Yushima, Bunkyo, Tokyo, 113-8510, Japan
| | - Hiromori Sagae
- Department of Orthopaedic Surgery, Yamagata University Faculty of Medicine, 2-2-2 Iidanishi, Yamagata, Yamagata, 990-9585, Japan
| | - Haggai Schermann
- Division of Orthopaedic Surgery, Laniado Hospital, Sanz Medical Center, Affiliated with Ariel University, Netanya, Israel
- Laniado Hospital, Sanz Medical Center, Affiliated with Ariel University, Ariel, Israel, Divrei Khayim St 16, 4244916, Netanya, Israel
| | - Morten Tange Kristensen
- Department of Physical and Occupational Therapy, Copenhagen University Hospital, Bispebjerg and Frederiksberg, University of Copenhagen, Nielsine Nielsens Vej 10, 2400, Copenhagen NV, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Kiyohide Fushimi
- Department of Health Informatics and Policy, Tokyo Medical and Dental University Graduate School of Medicine, 1 Chome-5-45 Yushima, Bunkyo, Tokyo, 113-8510, Japan
| | - Toshitaka Yoshii
- Department of Orthopaedic and Spine Surgery, Tokyo Medical and Dental University Graduate School of Medicine, 1 Chome-5-45 Yushima, Bunkyo, Tokyo, 113-8510, Japan
| | - Tetsuya Jinno
- Department of Orthopaedic and Spine Surgery, Tokyo Medical and Dental University Graduate School of Medicine, 1 Chome-5-45 Yushima, Bunkyo, Tokyo, 113-8510, Japan.
- Department of Orthopaedic Surgery, Dokkyo Medical University, Saitama Medical Center, 2-1-50 Minami-Koshigaya, Koshigaya, Saitama, 343-8555, Japan.
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Baumann AN, Talaski GM, Uhler MA, Anastasio AT, Walley KC, Pean CA, Tampi RR, Farivar M. The Utilization of Preoperative Steroids Safely Decreases the Risk of Postoperative Delirium in Geriatric Patients After Hip Fracture Surgery: A Systematic Review and Meta-analysis of Randomized Controlled Trials. J Orthop Trauma 2024; 38:e182-e190. [PMID: 38300234 DOI: 10.1097/bot.0000000000002781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/24/2024] [Indexed: 02/02/2024]
Abstract
OBJECTIVES Postoperative delirium is an acute neurocognitive complication that can have adverse effects on outcomes of geriatric patients after undergoing hip fracture surgery. The objective of this study was to examine the efficacy of preoperative steroids in preventing postoperative delirium after hip fracture surgery. METHODS DATA SOURCES A systematic review and meta-analysis was performed using PubMed, SPORTDiscus, CINAHL, MEDLINE, and Web of Science from database inception until September 28, 2023. STUDY SELECTION Inclusion criteria were randomized controlled trials of patients who underwent surgical intervention for hip fracture, were examined for postoperative delirium, and used preoperative steroids. DATA EXTRACTION Data included the risk of postoperative delirium, postoperative all-cause infection, and postoperative hyperglycemia. Articles were graded via the Cochrane Collaboration's tool. DATA SYNTHESIS Statistical analysis included a random-effects binary model with relative risk, 95% confidence intervals along with a defined "number needed to treat" threshold (number needed to treat). RESULTS Four randomized controlled trials were included from 128 articles initially retrieved. Patients (n = 416; average age: 82.2 ± 2.2 years) underwent surgical intervention for hip fracture after receiving either preoperative steroids (n = 209) or control interventions (n = 207). There was a statistically significant decrease in the incidence of postoperative delirium among patients who received preoperative steroids (12.9%; 27 cases) as compared with patients who received control interventions (26.7%; 55 cases) after hip fracture surgery ( P < 0.001; RR: 0.84). The absolute risk difference was 13.8%, and the number needed to treat was 7.2 patients. There was no statistically significant difference in the risk of postoperative all-cause infection among patients who received preoperative steroids as compared with patients who received normal saline as placebo after hip fracture surgery ( P = 0.850; RR: 0.96). CONCLUSIONS The utilization of preoperative steroids seems to decrease the risk of postoperative delirium after hip fracture surgery in elderly adults. Furthermore, this decreased risk of postoperative delirium was not associated with a significant increase in postoperative infection, indicating possible safety of preoperative steroid administration. LEVEL OF EVIDENCE Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Anthony N Baumann
- College of Medicine, Northeast Ohio Medical University, Rootstown, OH
| | | | - Mathias A Uhler
- College of Biological Sciences, University of Akron, Akron, OH
| | | | - Kempland C Walley
- Department of Orthopedic Surgery, University of Michigan, Ann Arbor, MI
| | | | - Rajesh R Tampi
- Department of Psychiatry, Creighton University, Omaha, NE
| | - Michel Farivar
- Department of Psychiatry, Cleveland Clinic Akron General, Akron, OH
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Soundarrajan D, Fanta HT, Singh R, Dhanasekararaja P, Rajkumar N, Rajasekaran S. Outcomes of conversion total hip arthroplasty for failed fixation of intertrochanteric fractures with monoblock distal-loading reconstruction stem. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:2113-2120. [PMID: 38548874 DOI: 10.1007/s00590-024-03907-9] [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: 01/12/2024] [Accepted: 03/07/2024] [Indexed: 05/19/2024]
Abstract
PURPOSE The aim of our study was to analyze the clinical and radiological outcomes of conversion total hip arthroplasty (THA) for failed fixation of proximal femur fractures with monoblock grit-blasted titanium reconstruction stem (Wagner self-locking stem, Zimmer). PATIENTS AND METHODS Thirty-nine patients were included in this retrospective analysis undergoing conversion THA for failed cephalomedullary nail or dynamic hip screw fixation for intertrochanteric fractures from January 2017 to January 2022. The clinical evaluation was done using Harris hip score. The radiological outcomes measured were subsidence, level of osteointegration, stem-canal fill ratio and heterotopic bone formation. The complications were noted postoperatively and during the follow-up. RESULTS The mean follow-up at the end of the study was 27.8 months (range, 14-72 months). There was a significant improvement in the Harris hip score over serial follow-ups (p < 0.001), but after 2 years, there was no statistically significant difference (p = 0.46). According to Engh's criteria, stable ingrowth was noted in 35 stems, fibrous stable ingrowth was noted in 4 stems and no patients had progressive subsidence and unstable stem. The mean stem-canal fill percentages were 91.8 ± 5.4% at the mid-stem and 80.3 ± 11.5% at the stem tip. Heterotopic ossification Brooker grade 2 was noted in 8 patients, and no patients had grade 3 or 4 heterotopic ossification. There were 7 (17.9%) intraoperative periprosthetic fractures, and greater trochanteric avulsion was noted in 2 patients in the follow-up. CONCLUSION Conversion THA using monoblock tapered distal loading stems bypasses the calcar deficiency and gives stable fixation in failed fixation of intertrochanteric fractures. It gives good radiological outcome and significant improvement in the clinical outcomes compared to the preoperative disability. However, caution should be noted for risk of intraoperative periprosthetic fractures in this subgroup of patients.
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MESH Headings
- Humans
- Male
- Female
- Arthroplasty, Replacement, Hip/methods
- Arthroplasty, Replacement, Hip/adverse effects
- Arthroplasty, Replacement, Hip/instrumentation
- Hip Fractures/surgery
- Retrospective Studies
- Middle Aged
- Aged
- Reoperation/statistics & numerical data
- Hip Prosthesis/adverse effects
- Adult
- Prosthesis Design
- Fracture Fixation, Internal/methods
- Fracture Fixation, Internal/instrumentation
- Fracture Fixation, Internal/adverse effects
- Treatment Outcome
- Aged, 80 and over
- Postoperative Complications/etiology
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Affiliation(s)
| | - Helawi Tewabe Fanta
- Department of Orthopaedics, Ganga Hospital, 313, Mettupalayam Road, Coimbatore, 641 043, India
| | - Rithika Singh
- Department of Orthopaedics, Ganga Hospital, 313, Mettupalayam Road, Coimbatore, 641 043, India
| | | | - Natesan Rajkumar
- Department of Orthopaedics, Ganga Hospital, 313, Mettupalayam Road, Coimbatore, 641 043, India
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Wang H, Ding K, Zhang Y, Ren C, Huo H, Zhu Y, Zhang Q, Chen W. A Controlled Variable Study of the Biomechanical Properties of the Proximal Femur before and after Cancellous Bone Removal. Orthop Surg 2024; 16:1215-1229. [PMID: 38520122 PMCID: PMC11062879 DOI: 10.1111/os.14044] [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: 10/29/2023] [Revised: 03/05/2024] [Accepted: 03/07/2024] [Indexed: 03/25/2024] Open
Abstract
OBJECTIVE The biomechanical characteristics of proximal femoral trabeculae are closely related to the occurrence and treatment of proximal femoral fractures. Therefore, it is of great significance to study its biomechanical effects of cancellous bone in the proximal femur. This study examines the biomechanical effects of the cancellous bone in the proximal femur using a controlled variable method, which provide a foundation for further research into the mechanical properties of the proximal femur. METHODS Seventeen proximal femoral specimens were selected to scan by quantitative computed tomography (QCT), and the gray values of nine regions were measure to evaluated bone mineral density (BMD) using Mimics software. Then, an intact femur was fixed simulating unilateral standing position. Vertical compression experiments were then performed again after removing cancellous bone in the femoral head, femoral neck, and intertrochanteric region, and data were recorded. According to the controlled variable method, the femoral head, femoral neck, and intertrochanteric trabeculae were sequentially removed based on the axial loading of the intact femur, and the displacement and strain changes of the femur samples under axial loading were recorded. Gom software was used to measure and record displacement and strain maps of the femoral surface. RESULTS There was a statistically significant difference in anteroposterior displacement of cancellous bone destruction in the proximal femur (p < 0.001). Proximal femoral bone mass explained 77.5% of the strength variation, in addition proximal femoral strength was mainly affected by bone mass at the level of the upper outer, lower inner, lower greater trochanter, and lesser trochanter of the femoral head. The normal stress conduction of the proximal femur was destroyed after removing cancellous bone, the stress was concentrated in the femoral head and lateral femoral neck, and the femoral head showed a tendency to subside after destroying cancellous bone. CONCLUSION The trabecular removal significantly altered the strain distribution and biomechanical strength of the proximal femur, demonstrating an important role in supporting and transforming bending moment under the vertical load. In addition, the strength of the proximal femur mainly depends on the bone density of the femoral head and intertrochanteric region.
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Affiliation(s)
- Haicheng Wang
- CangZhou Hospital of Integrated TCM‐WM in HebeiCangzhou CityChina
| | - Kai Ding
- Department of Orthopedic SurgeryHebei Medical University Third HospitalShijiazhuangChina
| | - Yifan Zhang
- Department of Orthopedic SurgeryHebei Medical University Third HospitalShijiazhuangChina
| | - Chuan Ren
- Department of Orthopedic SurgeryHebei Medical University Third HospitalShijiazhuangChina
| | - Haoyu Huo
- Department of Orthopedic SurgeryHebei Medical University Third HospitalShijiazhuangChina
| | - Yanbin Zhu
- Department of Orthopedic SurgeryHebei Medical University Third HospitalShijiazhuangChina
| | - Qi Zhang
- Department of Orthopedic SurgeryHebei Medical University Third HospitalShijiazhuangChina
| | - Wei Chen
- Department of Orthopedic SurgeryHebei Medical University Third HospitalShijiazhuangChina
- NHC Key Laboratory of Intelligent Orthopedic EquipmentHebei Medical University Third HospitalShijiazhuangChina
- Key Laboratory of Biomechanics of Hebei ProvinceShijiazhuangChina
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Yuan X, Liang Y, Yang H, Feng L, Sun H, Li C, Qin J. Applying Machine Learning Analysis Based on Proximal Femur of Abdominal Computed Tomography to Screen for Abnormal Bone Mass in Femur. Acad Radiol 2024; 31:2003-2010. [PMID: 37973518 DOI: 10.1016/j.acra.2023.10.035] [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: 09/05/2023] [Revised: 10/05/2023] [Accepted: 10/20/2023] [Indexed: 11/19/2023]
Abstract
RATIONALE AND OBJECTIVES To evaluate the performance of machine learning analysis based on proximal femur of abdominal computed tomography (CT) scans in screening for abnormal bone mass in femur. MATERIALS AND METHODS 222 patients aged 50 years or older who underwent abdominal CT and dual-energy X-ray absorptiometry scans within 14 days were retrospectively enrolled. The patients were randomly assigned to a training cohort (n = 155) and a testing cohort (n = 67) in a ratio of 7:3. A total of 2288 candidate radiomic features were extracted from the volume region of interest - the left proximal femur of the abdominal CT scans. The most valuable radiomic features were selected using minimum-Redundancy Maximum-Relevancy and the least absolute shrinkage and selection operator to construct the radiomics model. The predictive performance was assessed with receiver operating characteristic curve. RESULTS 13 features were chosen to establish the radiomics model. The radiomics model using logistic regression displayed excellent prediction performance in distinguishing normal bone mass and abnormal bone mass, with the area under the curve (AUC), accuracy, sensitivity and specificity of 0.917 (95% CI, 0.867-0.967), 0.826, 0.935 and 0.780 in the training cohort. The testing cohort indicated a better performance with AUC, accuracy, sensitivity and specificity of 0.963 (95% CI, 0.919-0.999), 0.851, 0.923 and 0.889. CONCLUSION The radiomics model based on proximal femur of abdominal CT scans had a high predictive performance to identify abnormal bone mass in femur, which can be used as a tool for opportunistic osteoporosis screening.
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Affiliation(s)
- Xiaoqing Yuan
- Department of Radiology, The Second Affiliated Hospital of Shandong First Medical University, Tai'an, 271000, China
| | - Yanbo Liang
- Department of Radiology, The Second Affiliated Hospital of Shandong First Medical University, Tai'an, 271000, China
| | - Hui Yang
- Department of Radiology, The Second Affiliated Hospital of Shandong First Medical University, Tai'an, 271000, China
| | - Lingling Feng
- Department of Radiology, The Second Affiliated Hospital of Shandong First Medical University, Tai'an, 271000, China
| | - Hao Sun
- Department of Radiology, The Second Affiliated Hospital of Shandong First Medical University, Tai'an, 271000, China
| | - Changqin Li
- Department of Radiology, The Second Affiliated Hospital of Shandong First Medical University, Tai'an, 271000, China
| | - Jian Qin
- Department of Radiology, The Second Affiliated Hospital of Shandong First Medical University, Tai'an, 271000, China.
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Scuderi GR, Mont MA. Goals of Care: A Patient-Centered Assessment. J Arthroplasty 2024; 39:1142-1143. [PMID: 38462139 DOI: 10.1016/j.arth.2024.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/12/2024] Open
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Ek S, Wennberg AM, Ding M, Meyer AC, Hedström M, Modig K. Characterizing the Individuals Who Regain or Maintain Walking Ability after a Hip Fracture: Insights Into Physical Resilience. J Am Med Dir Assoc 2024; 25:744-750.e3. [PMID: 38309302 DOI: 10.1016/j.jamda.2023.12.011] [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: 10/06/2023] [Revised: 12/19/2023] [Accepted: 12/19/2023] [Indexed: 02/05/2024]
Abstract
OBJECTIVES Maintaining walking ability is key to healthy aging. Hip fractures often lead to declined walking ability. This study investigated characteristics of individuals who regained walking ability after a hip fracture, an expression of physical resilience. DESIGN Register-based cohort study. SETTING AND PARTICIPANTS A total of 55,467 Swedish residents aged ≥60 years with a first hip fracture (71% women, mean age = 82.3 ± 8) included in the Swedish Hip Fracture Register. METHODS Information about diseases, medications, and socioeconomic (SES) factors came from registers. Individuals were classified by prefracture walking ability (independent or assisted walking) and whether their walking ability 4 months post-fracture was maintained (physical resilience or nonresilience). Cluster analyses were conducted among individuals who maintained their walking ability to assess different physical resilience profiles. RESULTS At baseline, 38,493 individuals walked independently (69%), and 16,982 were assisted walkers. Half of the independent walkers maintained their walking ability 4 months post-fracture. Among them, 3 clusters were identified: a "Low SES, Low Disease" cluster (n = 8580, mean age 81.1 ± 7.5); a "High SES, Low Disease" cluster (n = 7778, mean age 76.7 ± 7.4); and a third "High SES, High Disease" cluster (n = 4320, mean age 77.7 ± 7.4). Sixty percent of the pre-assisted walkers maintained their level of assisted walking ability. Also among them, 3 clusters were identified: a "Low SES-Independent Living" cluster (n = 3077, mean age 85.5 ± 7.1); a second "Care Home" cluster (n = 2912, mean age 87.0 ± 6.5) with a high proportion with dementia diagnosis; and a last "High SES" cluster (n = 4044, mean age 83.0 ± 7.0) with the largest proportion of men. CONCLUSIONS AND IMPLICATIONS Physical resilience is not characterized by one typical healthy profile, and it is possible to regain walking ability after a hip fracture despite unfavorable prerequisites in 1 domain. A favorable status in one domain may compensate for an unfavorable status in another, for example, a high disease burden in combination with high SES.
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Affiliation(s)
- Stina Ek
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
| | - Alexandra M Wennberg
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Mozhu Ding
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Anna C Meyer
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Margareta Hedström
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden; Trauma and Reparative Medicine Theme (TRM), Karolinska University Hospital, Stockholm, Sweden
| | - Karin Modig
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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Sadeghpour A, Mahdipour S, Ghanjpour Sales J, Aslani H, Moharrami MR, Alizadeh H. Non-cannulated versus cannulated cancellous screws for the internal fixation of femoral neck fractures in osteoporotic patients: A single-blind randomized clinical trial. J Orthop 2024; 51:32-38. [PMID: 38299065 PMCID: PMC10825919 DOI: 10.1016/j.jor.2023.11.074] [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: 07/11/2023] [Revised: 11/26/2023] [Accepted: 11/28/2023] [Indexed: 02/02/2024] Open
Abstract
Background The incidence of femoral neck fractures in osteoporotic patients is rising worldwide and is associated with significant increases in healthcare and social costs, as well as dependency. Improving minimally invasive treatment strategies, including internal fixation with screws, can result in favorable clinical outcomes and lesser incidence of complications, while preserving the hip. This study compared the outcomes of using non-cannulated cancellous screws (NCS) and cannulated cancellous screws (CS) in the internal fixation of undisplaced intracapsular femoral neck fractures (UIFNF) of osteoporotic patients of Iranian descent. Methods This randomized clinical trial was conducted on the patients referring to an institutional tertiary hospital in northwestern Iran between March 2020 and June 2021. The patients' preoperative, perioperative, and postoperative characteristics were evaluated for at least two years. Primary endpoints were defined as the incidence of hip-related complications, while secondary endpoints were assessed based on the patients' hip function using Harris Hip Score (HHS). Results Fifty-seven patients with osteoporosis and UIFNF were included in the final analysis, with 27 patients in the NCS group and 30 patients in the CS group. The surgical duration, the amount of intraoperative blood loss, and the frequency of C-arm were considerably lower in the CS group (p < 0.05). The incidence of implant failure was higher in the NCS group (p = 0.04). Screw migration occurred more frequently in the CS group (p = 0.03). The HHS values were significantly higher for the NCS group than those of the CS group at both the 1-year and 2-years of follow-up assessments (1 year, p = 0.007; 2 years, p = 0.001). Conclusion Fixation using CS was accompanied by enhanced perioperative outcomes and lower implant failure rates compared to the NCS group. However, patients in the NCS group posed a reduced risk of complications, including screw migration, and experienced a long-term improvement in HHS scores.
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Affiliation(s)
- Alireza Sadeghpour
- Department of Orthopedic Surgery, Shohada Educational Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Shahab Mahdipour
- Department of Orthopedic Surgery, Shohada Educational Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Jafar Ghanjpour Sales
- Department of Orthopedic Surgery, Shohada Educational Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hossein Aslani
- Department of Orthopedic Surgery, Shohada Educational Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Reza Moharrami
- Department of Orthopedic Surgery, Shohada Educational Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hadi Alizadeh
- Department of Orthopedic Surgery, Shohada Educational Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
- Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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Giordano V, Woolley PM, Heetveld MJ, Smith CS, de Ridder V. Geriatric proximal femur fracture updates. OTA Int 2024; 7:e323. [PMID: 38708041 PMCID: PMC11064807 DOI: 10.1097/oi9.0000000000000323] [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: 09/07/2023] [Revised: 12/26/2023] [Accepted: 12/28/2023] [Indexed: 05/07/2024]
Abstract
Proximal femur fractures in the aging population present a variety of challenges. Physiologically, patients incurring this fracture are typically frail, with significant medical comorbidities, yet require early surgical treatment to restore mobility to prevent deterioration. Socioeconomically, the occurrence of a fragility fracture may be the beginning of the loss of independence, and the burdens of rehabilitation and support are borne by the individual patient and health care systems.
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Affiliation(s)
- Vincenzo Giordano
- Serviço de Ortopedia e Traumatologia, Prof. Nova Monteiro—Hospital Municipal Miguel Couto, Rio de Janeiro, Brazil
- Clínica São Vicente—Rede D'or São Luiz, Rio de Janeiro, Brazil
| | - Pierre Marie Woolley
- Department of Orthopaedic Hopital, Universitaire de La Paix HUP, Port au Prince, Haiti
| | - Martin J. Heetveld
- Spaarne Gasthuis, Haarlem, The Netherlands
- Department of Trauma Surgery, Spaarne Gasthuis, AK Haarlem, The Netherlands
| | | | - Victor de Ridder
- Emergency Care and Logistics, Trauma and Pediatric Trauma University Medical Center Utrecht, Utrecht, Netherlands
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Koole C, Bleeser T, Hoogma DF, Coppens S, Teunkens A, Rex S. Haemodynamic effects of continuous spinal anaesthesia versus single-shot spinal anaesthesia or general anaesthesia for hip fracture surgery: a systematic review and meta-analysis. Br J Anaesth 2024; 132:1160-1162. [PMID: 38242801 DOI: 10.1016/j.bja.2023.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 12/13/2023] [Accepted: 12/18/2023] [Indexed: 01/21/2024] Open
Affiliation(s)
- Charlotte Koole
- Department of Anaesthesiology, UZ Leuven, Department of Cardiovascular Sciences, Group Biomedical Sciences, KU Leuven, Leuven, Belgium
| | - Tom Bleeser
- Department of Anaesthesiology, UZ Leuven, Department of Cardiovascular Sciences, Group Biomedical Sciences, KU Leuven, Leuven, Belgium
| | - Danny F Hoogma
- Department of Anaesthesiology, UZ Leuven, Department of Cardiovascular Sciences, Group Biomedical Sciences, KU Leuven, Leuven, Belgium
| | - Steve Coppens
- Department of Anaesthesiology, UZ Leuven, Department of Cardiovascular Sciences, Group Biomedical Sciences, KU Leuven, Leuven, Belgium
| | - An Teunkens
- Department of Anaesthesiology, UZ Leuven, Department of Cardiovascular Sciences, Group Biomedical Sciences, KU Leuven, Leuven, Belgium
| | - Steffen Rex
- Department of Anaesthesiology, UZ Leuven, Department of Cardiovascular Sciences, Group Biomedical Sciences, KU Leuven, Leuven, Belgium.
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Wang C, Hou M, Zhang C, Ma T, Li Z, Lin H, Zhang K, Huang Q. Biomechanical evaluation of a modified intramedullary nail for the treatment of unstable femoral trochanteric fractures. Heliyon 2024; 10:e29671. [PMID: 38660243 PMCID: PMC11040111 DOI: 10.1016/j.heliyon.2024.e29671] [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] [Received: 01/03/2024] [Revised: 04/11/2024] [Accepted: 04/12/2024] [Indexed: 04/26/2024] Open
Abstract
Background The Proximal Femoral Nail Antirotation (PFNA) device is the most commonly used implant to fix unstable femoral trochanteric fractures (UFTFs), but it has a relatively high incidence of complications. Due to this factor, the modified intramedullary nail (MIN) was created to treat patients with UFTFs. The aim was to exhibit the MIN and make a comparison with PFNA and InterTAN using biomechanical methods. Methods An adult UFTF model was developed using Mimics software. The PFNA, InterTAN nail, and MIN models were drawn referring to the corresponding parameters and installed in the fracture models. Vertical, anteroposterior (AP) bending, and torsion loads of the femoral head were set in advance and loaded onto the fracture models. The value of maximal displacement and von Mises stress was evaluated via finite element analysis (FEA). Results The MIN model had smaller values for maximal displacement than that of the PFNA model, and the increase in displacement was less pronounced for the MIN compared to PFNA under increasing vertical loads. For the indicator of von Mises stress, the MIN model showed lower stress compared with the PFNA model in vertical loads ranging from 300 N to 2100 N. Except for the maximal stress at implants under AP bending loads, the MIN demonstrated the most superior biomechanical properties under AP bending and torsional loads. Conclusion The MIN offered obvious advantages in terms of mechanical stability and stress distribution among the three studied implants, providing a promising implant option for patients with UFTFs.
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Affiliation(s)
- ChaoFeng Wang
- Department of Orthopedics, Hong Hui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, 710054, China
| | - MingMing Hou
- Department of Orthopedics, Hong Hui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, 710054, China
| | - CongMing Zhang
- Department of Orthopedics, Hong Hui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, 710054, China
| | - Teng Ma
- Department of Orthopedics, Hong Hui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, 710054, China
| | - Zhong Li
- Department of Orthopedics, Hong Hui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, 710054, China
| | - Hua Lin
- Department of Orthopedics, Hong Hui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, 710054, China
| | - Kun Zhang
- Department of Orthopedics, Hong Hui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, 710054, China
| | - Qiang Huang
- Department of Orthopedics, Hong Hui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, 710054, China
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Rostagno C, Mannarino GM, Cartei A, Rubbieri G, Ceccofiglio A, Gori AM, Civinini R, Marcucci R. Preoperative Drug Monitoring in Management of Patients with Hip Fracture on Treatment with Direct Oral Anticoagulants. Clin Interv Aging 2024; 19:655-664. [PMID: 38706637 PMCID: PMC11067930 DOI: 10.2147/cia.s444902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 04/09/2024] [Indexed: 05/07/2024] Open
Abstract
Purpose Aim of the present study was to evaluate whether monitoring direct oral anticoagulant (DOAC) levels may improve management of anticoagulated patients who need surgery for hip fracture. Patients and Methods A total of 147 out of 2231 (7.7%) patients with hip fracture admitted to a tertiary teaching hospital were on DOACs (group A), whereas 206 patients matched for age, sex, and type of fracture not on anticoagulant or P2Y12 platelet inhibitors were considered as control group (group B). Patients on DOACs were divided into two subgroups: A1 in which intervention was scheduled in relation to the last drug intake according to current guidelines, and A2 included patients in whom time of surgery (TTS) was defined according to DOAC levels. Neuraxial anesthesia was considered with DOAC levels <30 ng/mL, general anesthesia for levels in the range 30-50 ng/mL. Results and conclusions TTS was significantly lower in controls than in DOAC patients: surgery within 48 hours was performed in 80.6% of group B versus 51% in group A (p<0.0001). In A2, 41 patients underwent surgery within 48 hours (56%) in comparison to 32 A1 patients (45.1%; p=0.03). TTS and length of hospitalization were on average 1 day lower in patients with assay of DOAC levels. Finally, 35/39 (89%) patients with DOAC levels <50 ng/mL had surgery within 48 hours (26 under neuraxial anesthesia, without any neurological complication, and 13 in general anesthesia). Conclusion DOAC assay in patients with hip fracture may be useful for correct definition of time to surgery, particularly in patients who are candidates for neuraxial anesthesia. Two-thirds of patients with DOAC levels <50 ng/mL at 48 hours from last drug intake underwent uneventful neuraxial anesthesia, saving at least 24 hours in comparison to guidelines.
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Affiliation(s)
- Carlo Rostagno
- Dipartimento Medicina sperimentale e clinica, Università di Firenze, Firenze, Italy
- Medicina Interna e Post-Chirurgica, AOU Careggi, Firenze, Italy
| | | | | | - Gaia Rubbieri
- Medicina Interna e Post-Chirurgica, AOU Careggi, Firenze, Italy
| | | | - Anna Maria Gori
- Dipartimento Medicina sperimentale e clinica, Università di Firenze, Firenze, Italy
- Medicina Interna e Post-Chirurgica, AOU Careggi, Firenze, Italy
- Traumatologia e Ortopedia, AOU Careggi, Firenze, Italy
- Malattie aterotrombotiche, AOU Careggi, Firenze, Italy
| | | | - Rossella Marcucci
- Dipartimento Medicina sperimentale e clinica, Università di Firenze, Firenze, Italy
- Medicina Interna e Post-Chirurgica, AOU Careggi, Firenze, Italy
- Traumatologia e Ortopedia, AOU Careggi, Firenze, Italy
- Malattie aterotrombotiche, AOU Careggi, Firenze, Italy
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