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Attoh-Mensah E, Pothier K, Loggia G, Morello R, Chavoix C, Marcelli C. Involvement of cognitive abilities in the occurrence of fractures in fallers aged 55 years or older: a cross-sectional study. Aging Clin Exp Res 2024; 36:180. [PMID: 39212862 PMCID: PMC11364792 DOI: 10.1007/s40520-024-02830-7] [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: 06/24/2024] [Accepted: 08/05/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND Both bone fragility and poor cognitive functions are known to contribute to fracture occurrence, but it remains unclear whether their contribution is independent of each other and which cognitive dysfunctions are most involved. This study aimed to clarify the involvement of various cognitive abilities in fall-related fractures among community-dwelling fallers aged 55 and over, and to determine whether poor cognitive abilities is a risk factor independent of bone fragility. METHODS In a cross-sectional study, we collected sociodemographic and medical data, including bone mineral density (BMD), and performed cognitive and mobility assessments in 189 individuals with a history of fall in the previous year. RESULTS Fallers with a fracture had poorer cognitive and mobility performance than non-injured fallers. Multivariate regressions revealed that cognition, BMD and other risk factors were independently associated with fracture among all participants (OR = 1.04, 95% CI = 1.01-1.08, p = 0.034 for completion time on part A of the Trail Making Test [TMT-A], and OR = 0.53, 95% CI = 0.33-0.84, p < 0.001 for BMD), particularly in women (OR = 0.77, 95% CI = 0.60-0.98, p = 0.039 for backward digit span score, and OR = 0.43, 95% CI = 0.25-0.75, p = 0.001 for BMD). CONCLUSION Thus, poor cognition, especially poor processing speed and working memory, is associated with an increased risk of fracture in fallers, particularly in women, regardless of BMD or other fracture risk factors. Hence, an in-depth cognitive evaluation should enhance the detection of fallers at risk of fracture, particularly in the absence of signs of osteoporosis, and thus ensure the best possible prevention.
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Affiliation(s)
- Elpidio Attoh-Mensah
- Normandie Univ, UNICAEN, INSERM, COMETE, CYCERON, Caen, 14000, France.
- Permanent address: Univ. Limoges, HAVAE, 123 Avenue Albert Thomas, UR, 20217, F-87000, Limoges, Limoges, France.
| | - Kristell Pothier
- Department of Psychology, PAVeA Laboratory (UR 2114), University of Tours, Tours, 37000, France
| | - Gilles Loggia
- Normandie Univ, UNICAEN, INSERM, COMETE, CYCERON, Caen, 14000, France
- Department of Geriatrics, Normandie Univ, UNICAEN, CHU de Caen, Caen, 14000, France
| | - Remy Morello
- Department of Statistics and Clinical Research, Normandie Univ, UNICAEN, CHU de Caen, Caen, 14000, France
| | - Chantal Chavoix
- Normandie Univ, UNICAEN, INSERM, COMETE, CYCERON, Caen, 14000, France
| | - Christian Marcelli
- Normandie Univ, UNICAEN, INSERM, COMETE, CYCERON, Caen, 14000, France
- Department of Rheumatology, Normandie Univ, CHU de Caen, Caen, 14000, France
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Gvozdenović N, Šarac I, Ćorić A, Karan S, Nikolić S, Ždrale I, Milešević J. Impact of Vitamin D Status and Nutrition on the Occurrence of Long Bone Fractures Due to Falls in Elderly Subjects in the Vojvodina Region of Serbia. Nutrients 2024; 16:2702. [PMID: 39203838 PMCID: PMC11356805 DOI: 10.3390/nu16162702] [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: 07/22/2024] [Revised: 08/09/2024] [Accepted: 08/12/2024] [Indexed: 09/03/2024] Open
Abstract
Bone fractures are a significant public health issue among elderly subjects. This study examines the impact of diet and vitamin D status on the risk of long bone fractures due to falls in elderly subjects in Vojvodina, Serbia. Conducted at the University Clinical Center of Vojvodina in autumn/winter 2022-2023, the study included 210 subjects >65 years: 105 (F: 80/M: 15) with long bone fractures due to falls and 105 (F: 80/M: 15) controls. Groups were similar regarding age and BMI. Dietary intakes (by two 24-h recalls) and serum vitamin D levels were analyzed. The fracture group had a significantly lower median daily vitamin D intake (1.4 μg/day vs. 5.8 μg/day), intake of calcium, energy, proteins, fats, fibers, dairy products, eggs, fish, edible fats/oils, and a higher intake of sweets (p < 0.001 for all). Serum vitamin D levels were significantly lower in the fracture group (40.0 nmol/L vs. 76.0 nmol/L, p < 0.001). Logistic regression identified serum vitamin D as the most important protective factor against fractures, and ROC curve analysis indicated that serum vitamin D levels > 50.5 nmol/L decreased fracture risk. Nutritional improvements (increased intake of vitamin D and protein sources such as fish, eggs, and dairy), increased sun exposure, and routine vitamin D supplementation during winter are advised.
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Affiliation(s)
- Nemanja Gvozdenović
- Faculty of Medicine, University of Novi Sad, 21137 Novi Sad, Serbia; (N.G.); (A.Ć.); (S.K.); (S.N.); (I.Ž.)
- Clinic for Orthopedic Surgery and Traumatology, University Clinical Center of Vojvodina, 21137 Novi Sad, Serbia
| | - Ivana Šarac
- Center of Research Excellence in Nutrition and Metabolism, Institute for Medical Research, National Institute of Republic of Serbia, University of Belgrade, 11129 Belgrade, Serbia;
| | - Andrijana Ćorić
- Faculty of Medicine, University of Novi Sad, 21137 Novi Sad, Serbia; (N.G.); (A.Ć.); (S.K.); (S.N.); (I.Ž.)
| | - Saša Karan
- Faculty of Medicine, University of Novi Sad, 21137 Novi Sad, Serbia; (N.G.); (A.Ć.); (S.K.); (S.N.); (I.Ž.)
- Clinic for Orthopedic Surgery and Traumatology, University Clinical Center of Vojvodina, 21137 Novi Sad, Serbia
| | - Stanislava Nikolić
- Faculty of Medicine, University of Novi Sad, 21137 Novi Sad, Serbia; (N.G.); (A.Ć.); (S.K.); (S.N.); (I.Ž.)
- Center of Laboratory Medicine, University Clinical Center of Vojvodina, 21137 Novi Sad, Serbia
| | - Isidora Ždrale
- Faculty of Medicine, University of Novi Sad, 21137 Novi Sad, Serbia; (N.G.); (A.Ć.); (S.K.); (S.N.); (I.Ž.)
| | - Jelena Milešević
- Center of Research Excellence in Nutrition and Metabolism, Institute for Medical Research, National Institute of Republic of Serbia, University of Belgrade, 11129 Belgrade, Serbia;
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Bergdahl C, Wolf O, Rydberg EM, Möller M, Wennergren D. Low risk of early conversion to surgery in non-surgically treated proximal humeral fractures - An observational cohort study of 31,761 fractures from the Swedish Fracture Register. Injury 2024; 55:111679. [PMID: 38897070 DOI: 10.1016/j.injury.2024.111679] [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: 06/11/2024] [Accepted: 06/12/2024] [Indexed: 06/21/2024]
Abstract
INTRODUCTION The majority of all proximal humeral fractures (PHFs) are treated non-surgically. Due to the risk of early secondary fracture displacement patients with non-surgically treated PHFs routinely undergo serial clinical and radiological evaluations. However, the value of these routine follow-up visits is unclear. This study aimed to examine the rate of early conversion to surgery in non-surgically treated PHFs. Moreover, the associations between patient and fracture characteristics and the risk of conversion to surgery were explored in order to assess the need for routine follow-ups. METHODS Data on all patients aged ≥18 years with a non-surgically treated PHF registered between 2013 and 2021 were extracted from the Swedish Fracture Register. Early change of treatment from non-surgical to surgical is an optional treatment modality in the SFR. The rate of early conversion to surgery within 60 days from injury was analyzed in relation to age and sex of the patient, energy level at injury and fracture morphology according to the AO/OTA classification. RESULTS A total of 31,761 primarily non-surgically treated PHFs (mean age 70 years: 76 % female) were included in the study. The overall rate of early conversion to surgery was 3.7 %. Younger age and increasing fracture severity were associated with a higher conversion rate to surgery. Patients ≥80 years and those with the three most common fracture types (A1, A2, and B1) had <2 % early conversion to surgery. In contrast, patients with C-type fractures, unstable/displaced fractures (A3, B2, and C2), or fracture dislocations (A1.3, B3, and C3) had a substantially higher risk (5.0-20 %) of early conversion. CONCLUSION The overall risk of early conversion to surgery in non-surgically treated PHFs is low and can be further predicted based on patient age and fracture morphology. These results could have implications regarding which patients are in need of routine follow-ups. LEVEL OF EVIDENCE Level II; Retrospective design; Prognosis study.
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Affiliation(s)
- Carl Bergdahl
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg/Mölndal, Sweden.
| | - Olof Wolf
- Department of Surgical Sciences, Orthopaedics, Uppsala University, Uppsala, Sweden
| | - Emilia Möller Rydberg
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg/Mölndal, Sweden
| | - Michael Möller
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg/Mölndal, Sweden
| | - David Wennergren
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg/Mölndal, Sweden
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Axenhus M, Magnéli M. Trend, disparities, and projection analysis of public data on foot fractures in Sweden: a retrospective analysis of 179 129 fractures. BMC Musculoskelet Disord 2024; 25:592. [PMID: 39068413 PMCID: PMC11282693 DOI: 10.1186/s12891-024-07711-8] [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: 02/22/2024] [Accepted: 07/19/2024] [Indexed: 07/30/2024] Open
Abstract
INTRODUCTION Orthopedic injuries to the foot constitute a significant portion of lower extremity injuries, necessitating an understanding of trends for effective preventive strategies and resource allocation. Demographic shifts, improved traffic safety, and lifelong physical activity may alter incidence rates, trauma mechanisms, and fracture distribution. This study explores the prevalence of foot fractures in Sweden using publicly available data. METHODS Utilizing data from the Swedish National Board of Health and Welfare (SNBHW) spanning 2008-2022, retrospective study focuses on foot fractures in Sweden. Analysis includes calculating annual incidence rates per 100,000 person-years, assessing temporal trends, and exploring seasonal variations. Poisson regression analysis was used for projections into 2035. RESULTS Between 2008-2022, the average annual foot fracture incidence was 11,942, with notable fluctuations influenced by the COVID-19 pandemic. Age and sex disparities impact rates, and seasonal variance highlights increased incidence in summer. By 2035, foot fractures will decreasae amongst several demographic groups. CONCLUSION This study provides insights into temporal trends, sex differences, and seasonal variations foot fracture patterns in Sweden. The identified trends suggest the utilization of targeted preventive strategies, efficient resource allocation, and informed healthcare planning. Despite limitations, this research offers valuable insights into foot fractures within the Swedish population, utilizing publicly aggregated data.
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Affiliation(s)
- Michael Axenhus
- Department of Orthopaedic Surgery, Danderyd Hospital, Stockholm, Sweden.
- Department of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
| | - Martin Magnéli
- Department of Orthopaedic Surgery, Danderyd Hospital, Stockholm, Sweden
- Department of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
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Zhang D, Litvak A, Lin N, Pirkle S, Strelzow J, Hynes K. Current Trends in the Surgical Treatment of Fibular Fractures: A National Database Study of Intramedullary vs. Plate Fixation Practice Patterns, Complications, and Cost. Adv Orthop 2024; 2024:7506557. [PMID: 39036541 PMCID: PMC11260212 DOI: 10.1155/2024/7506557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 05/14/2024] [Accepted: 06/24/2024] [Indexed: 07/23/2024] Open
Abstract
Existing primary evidence comparing fibular intramedullary fixation (IMF) with traditional plate fixation (PF) for the treatment of distal fibular fractures remains limited by modest sample sizes. Using a large national database, this study aims to compare use rates, fracture patterns, patient characteristics, time to surgery, complication rates, and cost between fibular IMF and PF within the United States. Adults treated with fibular IMF or PF between October 2015 and October 2021 were identified within the PearlDiver Database. The ratio of IMF-treated to PF-treated patients was tracked temporally to compare use rates. Fracture patterns were determined using fracture diagnoses within one-month preceding surgery. Further comparisons of IMF- and PF-treated groups only included patients with at least 12 months of follow-up, and patients with upper tibia or tibia shaft fractures were excluded. An analysis of cohorts matched at a 1 : 4 (IMF: PF) ratio to control for risk factors was performed to compare time to surgery, complication rates (infection, nonunion, malunion, revision, hardware removal, pulmonary embolism, and deep vein thrombosis), and cost. 39329 patients (2294 IMF and 37035 PF) were identified. IMF use trended upwards relative to PF use over time. Tibia and fibula shaft fractures were the most common injuries in IMF patients versus bimalleolar and trimalleolar fractures in PF patients. A higher proportion of IMF patients had open fractures. IMF patients were younger, with higher mean ECI, fewer female patients, and higher rates of CKD. Percutaneous approaches were more common among IMF patients. There were no significant differences in time to surgery or complication rates. IMF was less costly. The popularity of IMF trended upwards across the study period. IMF was used more commonly in injuries involving higher energy trauma and soft tissue disruption. Overall, IMF patients were younger with more comorbidities. When used in similar populations, IMF appears to be a cost-effective alternative to PF.
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Affiliation(s)
- Douglas Zhang
- The University of Chicago Pritzker School of Medicine, Chicago, IL 60637, USA
| | - Audrey Litvak
- The University of Chicago Pritzker School of Medicine, Chicago, IL 60637, USA
| | - Nicholas Lin
- The University of Chicago Pritzker School of Medicine, Chicago, IL 60637, USA
| | - Sean Pirkle
- Department of Orthopaedics and Sports MedicineUniversity of Washington, Seattle, WA 98195, USA
| | - Jason Strelzow
- Department of Orthopaedic Surgery and Rehabilitation MedicineUniversity of Chicago Medicine, Chicago, IL 60637, USA
| | - Kelly Hynes
- Department of Orthopaedic Surgery and Rehabilitation MedicineUniversity of Chicago Medicine, Chicago, IL 60637, USA
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Thompson E, Qureshi A. Pathogens in FRI - Do bugs matter? - An analysis of FRI studies to assess your enemy. J Orthop 2024; 53:59-72. [PMID: 38476676 PMCID: PMC10925936 DOI: 10.1016/j.jor.2024.02.011] [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: 08/31/2023] [Accepted: 02/09/2024] [Indexed: 03/14/2024] Open
Abstract
Fracture-related infection (FRI) is a devasting complication for both patients and their treating Orthopaedic surgeon that can lead to loss of limb function or even amputation. The unique and unpredictable features of FRI make its diagnosis and treatment a significant challenge. It has substantial morbidity and financial implications for patients, their families and healthcare providers. In this article, we perform an in-depth and comprehensive review of FRI through recent and seminal literature to highlight evolving definitions, diagnostic and treatment approaches, focusing on common pathogens such as Staphylococcus aureus, polymicrobial infections and multi-drug-resistant organisms (MDRO). Furthermore, multiple resistance mechanisms and adaptations for microbial survival are discussed, as well as modern evidence-based medical and surgical advancements in treatment strategies in combating FRI.
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Affiliation(s)
- Emmet Thompson
- Limb Reconstruction Service, Trauma & Orthopaedic Department, University Hospital Southampton, Southampton, UK
| | - Amir Qureshi
- Limb Reconstruction Service, Trauma & Orthopaedic Department, University Hospital Southampton, Southampton, UK
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Fischer CS, Lohr C, Ziegler P, Schüll D, Finger FC, Histing T, Herbst M, Hemmann P. Clinical and radiological outcome following trauma-related reverse shoulder arthroplasty. Arch Orthop Trauma Surg 2024; 144:3103-3111. [PMID: 38847836 PMCID: PMC11319594 DOI: 10.1007/s00402-024-05395-2] [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: 04/15/2024] [Accepted: 05/29/2024] [Indexed: 08/13/2024]
Abstract
BACKGROUND Reverse shoulder arthroplasty (RSA) is a frequently used therapy for complex proximal humeral fractures and posttraumatic disorders. The present study's purpose was to assess the clinical and radiological outcome of primary and secondary RSA, and to analyze the impact of refixation of the greater tuberosity (GT). PATIENTS AND METHODS 28 patients with primary fracture RSA and 18 patients with RSA due to posttraumatic disorders were examined with a mean clinical follow-up of 2.5 ± 1.73 years. Operative details and radiographs were retrospectively reviewed. Additional analyses were performed for healed and non-healed GT in primary RSA. RESULTS Patients with fracture RSA had higher Constant-Murley score (CMS) than secondary RSA without reaching significance (p = 0.104). No significant difference was present for the quality of life measured by the Short Form 36 (SF 36) and the range of motion. In primary RSA, 78.6% GT healed anatomically. Compared to non-healed GT, patients with healed GT had a significantly higher CMS (p = 0.011), external rotation (p = 0.026) and forward flexion (p = 0.083), whereas DASH score was lower without a significant difference (p = 0.268). SF 36 showed no significant difference. Patients with healed GT had a more neutral glenoid version (p = 0.009). CONCLUSION Superior range of motion and clinical outcome scores were present for anatomically healed GT. Therefore, refixation of the tuberosities is recommended. Secondary RSA can result in inferior results compared to primary RSA, so patients need to be adequately informed.
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Affiliation(s)
- Cornelius Sebastian Fischer
- Department of Traumatology and Reconstructive Surgery, BG Unfallklinik Tübingen, Eberhard Karls University Tübingen, Schnarrenbergstraße 95, 72076, Tübingen, Germany.
| | - Christian Lohr
- Department of Traumatology and Reconstructive Surgery, BG Unfallklinik Tübingen, Eberhard Karls University Tübingen, Schnarrenbergstraße 95, 72076, Tübingen, Germany
| | - Patrick Ziegler
- Department of Traumatology and Reconstructive Surgery, BG Unfallklinik Tübingen, Eberhard Karls University Tübingen, Schnarrenbergstraße 95, 72076, Tübingen, Germany
- Department of Orthopaedics and Trauma Surgery, Klinik Gut, Via Arona 34, St. Moritz, 7500, Switzerland
| | - Daniel Schüll
- Department of Traumatology and Reconstructive Surgery, BG Unfallklinik Tübingen, Eberhard Karls University Tübingen, Schnarrenbergstraße 95, 72076, Tübingen, Germany
| | - Felix Christioph Finger
- Department of Traumatology and Reconstructive Surgery, BG Unfallklinik Tübingen, Eberhard Karls University Tübingen, Schnarrenbergstraße 95, 72076, Tübingen, Germany
| | - Tina Histing
- Department of Traumatology and Reconstructive Surgery, BG Unfallklinik Tübingen, Eberhard Karls University Tübingen, Schnarrenbergstraße 95, 72076, Tübingen, Germany
| | - Moritz Herbst
- Department of Traumatology and Reconstructive Surgery, BG Unfallklinik Tübingen, Eberhard Karls University Tübingen, Schnarrenbergstraße 95, 72076, Tübingen, Germany
| | - Philipp Hemmann
- Department of Traumatology and Reconstructive Surgery, BG Unfallklinik Tübingen, Eberhard Karls University Tübingen, Schnarrenbergstraße 95, 72076, Tübingen, Germany
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Ghattas YS, Zeblisky P, Cassinat J, Aceto M, Spindler KP, Cannada LK. Pickleball-Related Fractures in the United States From 2002 to 2022: An Analysis Using the NEISS Database. Orthop J Sports Med 2024; 12:23259671241255674. [PMID: 38881851 PMCID: PMC11179465 DOI: 10.1177/23259671241255674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 02/02/2024] [Indexed: 06/18/2024] Open
Abstract
Background Pickleball is one of the fastest-growing sports in the United States, with more than an 11-fold increase in injuries from 2010 to 2019. Purpose To (1) determine the prevalence and demographic variables associated with pickleball-related fractures among patients evaluated at emergency departments in the United States between 2002 and 2022 and (2) identify variables influencing patient disposition status. Study Design Descriptive epidemiology study. Methods The US Consumer Product Safety and Commission's publicly available database, the National Electronic Injury Surveillance System (NEISS), was used in this study. Analyses consisted of descriptive statistics for fracture prevalence and demographic variables as well as univariate analysis for disposition status (discharged home vs hospital admission). Results A total of 397 pickleball-related fractures were recorded between 2002 and 2022, which indicated a 90-fold increase in our study period. Based on weighted national average of NEISS sampling, this equated to approximately 5400 fractures annually. Players who sustained pickleball fractures were primarily aged >60 years (n = 344 [87%]; P < .001) and female (n = 273 [69%]; P < .001). Most fractures involved the upper extremity (n = 262 [66%]; P < .001), with the most common ones involving the radius (n = 79 [30%]), humerus (n = 22 [8%]), and ulna (n = 8 [3%]). Fractures were due most commonly to falls (n = 365 [92%]; P < .001) and occurred in the winter months (n = 142 [36%]; P < .001). There was a significant difference in disposition status, with most patients discharged (n = 320 [81%] vs n = 77 [19%] for hospital admission; P < .001). Univariate analysis revealed that age >60 years, male sex, and fractures to the trunk and lower extremity all led to significantly increased odds of being admitted (odds ratios: 2.27, 2.31, 2.89, and 13.8, respectively). Conclusion Between 2002 and 2022, there was a 90-fold increase in pickleball-related fractures. Most fractures were of the upper extremity after a fall in women aged >60 years. Despite female fracture predominance, men were 2.3 times more likely to be admitted after sustaining a fracture.
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Affiliation(s)
- Yasmine S Ghattas
- University of Central Florida College of Medicine, Orlando, Florida, USA
| | - Peter Zeblisky
- University of Central Florida College of Medicine, Orlando, Florida, USA
| | - Joshua Cassinat
- University of Central Florida College of Medicine, Orlando, Florida, USA
| | - Matthew Aceto
- University of Central Florida College of Medicine, Orlando, Florida, USA
| | - Kurt P Spindler
- Cleveland Clinic Florida, Sports Medicine, Weston, Florida, USA
| | - Lisa K Cannada
- University of Central Florida College of Medicine, Orlando, Florida, USA
- Novant Health, Charlotte, North Carolina, USA
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Green AH, Alter TH, Varghese BB, Ferrera F, Doss T, Hawes J, Frias GC, Guerrero KD, Tawfik AM, Katt BM, Monica JT. Evaluation of Patient Expectations and Outcomes after Distal Radius Fractures. Hand (N Y) 2024:15589447241243063. [PMID: 38606964 DOI: 10.1177/15589447241243063] [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] [Indexed: 04/13/2024]
Abstract
BACKGROUND Patient expectations influence patient-reported outcomes after musculoskeletal injuries. The goal of this study is to determine how pretreatment expectations correlate with outcomes in patients with distal radius fractures. METHODS Seventy-five patients with an isolated distal radius fracture were prospectively enrolled into nonoperative and operative cohorts. The Trauma Expectation Factor-Trauma Outcome Measure (TEF-TOM) score was the primary outcome measure. Trauma Expectation Factor scores were recorded at the time of enrollment, and TOM scores were recorded at 3, 6, and 12 months. Quick Disabilities of the Arm, Shoulder, and Hand (qDASH) and Patient-Rated Wrist Evaluation (PRWE) scores were also recorded. RESULTS Trauma Outcome Measure scores at all time points were worse than expected (P < .01). Expectations were higher for patients younger than 65 years than for the 65+ group (P = .02). In patients aged 65+ years, mean TOM at 3 months was not significantly different than expected (P = .11) but decreased by 6 (P = .04) and 12 months (P < .01). Baseline TEF and TEF-TOM scores were not significantly different between operative and nonoperative groups (P = .37). Quick Disabilities of the Arm, Shoulder, and Hand and PRWE scores were not significantly different between age or treatment groups at the final follow-up. CONCLUSIONS The overall treatment of distal radial injuries in our study did not meet patient expectations. Patients aged 65 years or older had lower expectations but were not able to predict their outcomes better than patients aged <65 years. There were no differences in TEF or TOM by treatment method. Patients demonstrated improved functional outcomes (qDASH/PRWE) at all time points regardless of age and treatment method.
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Affiliation(s)
- Anna H Green
- Department of Orthopaedic Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Todd H Alter
- Department of Orthopaedic Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Bobby B Varghese
- Department of Orthopaedic Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | | | - Thomas Doss
- Department of Orthopaedic Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Joseph Hawes
- Department of Orthopaedic Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Giulia C Frias
- Department of Orthopaedic Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Kevin D Guerrero
- Department of Orthopaedic Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Amr M Tawfik
- Department of Orthopaedic Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Brian M Katt
- Department of Orthopaedic Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - James T Monica
- Department of Orthopaedic Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
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10
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Haidari S, Buijs MAS, Plate JDJ, Zomer JJ, IJpma FFA, Hietbrink F, Govaert GAM. Costs of fracture-related infection: the impact on direct hospital costs and healthcare utilisation. Eur J Trauma Emerg Surg 2024:10.1007/s00068-024-02497-9. [PMID: 38592465 DOI: 10.1007/s00068-024-02497-9] [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: 01/08/2024] [Accepted: 03/10/2024] [Indexed: 04/10/2024]
Abstract
PURPOSE Fracture-Related Infection (FRI) is associated with high medical costs and prolonged healthcare utilization. However, limited data is available on the financial impact. The purpose of this study was to investigate the impact of FRI on direct hospital costs and healthcare utilization. METHODS This was a retrospective cohort study in a level-1 trauma centre in the Netherlands. Patients ≥ 18 years, after open reduction and internal fixation of a long bone fracture between January 1st 2016 and November 1st 2021, were included. Exclusion criteria were Injury Severity Score (ISS) ≥ 16, indefinable data on costs or incomplete follow-up. Hospital costs related to fracture treatment were individually calculated based on procedure codes raised with a fixed percentage of overhead expenses, in line with hospital billing policies. RESULTS In total, 246 patients were included with a median follow-up of 1 year (IQR 0.6-1.8). A total of 45 patients developed FRI, of whom 15 patients had an FRI recurrence. Compared to non-FRI patients, median hospital costs from an FRI patient without and with recurrence, were respectively three (3.1) and seven (7.6) times higher. Compared to non-FRI patients, increased costs in patients with FRI or recurrent FRI are due to respectively a fivefold or even tenfold prolonged length-of-stay, two or seven additional infection-related surgeries, and 21 or 55 days of intravenous antibiotic treatment. CONCLUSION Direct healthcare costs of patients with single occurrence of FRI after long bone fracture treatment are three times higher compared to non-FRI patients. In case of FRI-recurrence, the differences in costs might even increase to sevenfold. To put this in perspective, cost of severely injured trauma patients were recently established at approximately 25.000 euros. Compared to non-FRI patients, increased costs in patients with FRI or recurrent FRI are due to respectively a fivefold or even tenfold prolonged length-of-stay, two or seven additional infection-related surgeries and 21 or 55 days of intravenous antibiotic treatment. Not only from patient perspective but also from a financial aspect, it is important to focus on prevention of (recurrent) FRI.
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Affiliation(s)
- S Haidari
- Department of Trauma Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - M A S Buijs
- Department of Trauma Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - J D J Plate
- Department of Surgery, Radboud University Medical Centre, Nijmegen, Tilburg, The Netherlands
| | - J J Zomer
- Finance Department, University Medical Centre Utrecht, Utrecht, The Netherlands
- Finance Department, Wageningen University and Research, Wageningen, The Netherlands
| | - F F A IJpma
- Department of Trauma Surgery, University Medical Centre Groningen, Groningen, The Netherlands
| | - F Hietbrink
- Department of Trauma Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - G A M Govaert
- Department of Trauma Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands.
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11
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Robioneck MW, Pishnamaz M, Becker N, Bolierakis E, Hildebrand F, Horst K. Development of early complications after treatment of trochanteric fractures with an intramedullary sliding hip screw in a geriatric population. Eur J Trauma Emerg Surg 2024; 50:329-337. [PMID: 38081966 DOI: 10.1007/s00068-023-02404-8] [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: 09/01/2023] [Accepted: 11/12/2023] [Indexed: 04/23/2024]
Abstract
PURPOSE Although trochanteric fractures (TF) are a frequent event in the geriatric population, studies reporting on complication rates associated with surgical treatment are sparse. Thus, this study investigated the relevance of fracture-, implant-, and surgery-associated complications in TF. Furthermore, the role of possible risk factors for the before mentioned complications was investigated. METHODS A consecutive series of patients with TF treated by intramedullary nailing with a sliding screw device was evaluated. Data were sampled retrospectively from the hospital patient information system and anonymized at the source. Demographic data and information regarding fracture pattern, the treatment performed, hospital stay, and evaluation of operative and follow-up radiographs were analyzed. Intraoperative problems (i.e., technical problems with the implant, intraoperative fracture) and postoperative complications were investigated. RESULTS Postoperative surgical complications were noted in 11.7%. The most frequent surgical problem was a difficult fracture reduction (13%) and intraoperative fracture dislocation (3.6%). The most frequent postoperative complication was intra-hospital mortality (3.6%), delayed/non-union (2.7%), and a cut-out of the lag screw in the femoral head (2.3%). Implant failure (1,4%) was significantly associated with morbid obesity while cut-out (2,3%) correlated with a higher tip-apex distance (TAD). A complex fracture type and a suboptimal screw position significantly increased the cut-out rate to 5% (p = 0.018). CONCLUSION Complications after TF treatment occur frequently. While patient-associated variables such as morbid obesity cannot be influenced by the surgeon, correct fracture reduction and implant positioning remain to be of highest importance.
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Affiliation(s)
| | - Miguel Pishnamaz
- Department of Orthopaedic Trauma and Reconstructive Surgery, University Hospital RWTH, Aachen, Germany
| | - Nils Becker
- Department of Orthopaedic Trauma and Reconstructive Surgery, University Hospital RWTH, Aachen, Germany
| | - Eftychios Bolierakis
- Department of Orthopaedic Trauma and Reconstructive Surgery, University Hospital RWTH, Aachen, Germany
| | - Frank Hildebrand
- Department of Orthopaedic Trauma and Reconstructive Surgery, University Hospital RWTH, Aachen, Germany
| | - Klemens Horst
- Department of Orthopaedic Trauma and Reconstructive Surgery, University Hospital RWTH, Aachen, Germany
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12
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Raudasoja L, Vastamäki H, Aspinen S, Ryhänen J, Hulkkonen S. Distal radial fractures: a nationwide register study on corrective osteotomies after malunion. J Hand Surg Eur Vol 2024; 49:329-333. [PMID: 37694946 PMCID: PMC10882945 DOI: 10.1177/17531934231193849] [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] [Indexed: 09/12/2023]
Abstract
The aim of the present study was to explore the incidence of corrective osteotomies after conservatively treated distal radial fracture and the risk for late correction depending on the patient's age. Based on data from the Finnish National Care Register of Health Care, Specialist Care, on all corrective osteotomies carried out in Finland during 2015-2019 in adults aged ≥20 years, we calculated the mean annual incidence rates per 100,000 person-years, standardized with the European Standard Population 2013. Using multivariable logistic regression, we calculated the risk of corrective osteotomies in various age groups. In total, 41,418 distal radial fractures were identified. Of those, 10,577 received surgical treatment in the acute phase. The incidence rate of primary operations for distal radial fractures was 47.9 per 100, 000 person-years. A total of 321 conservatively treated fractures needed corrective osteoteomy, with a surprisingly low mean annual incidence rate of 1.5 per 100,000 person-years. The risk for this was highest in patients in their fourth or fifth decade.Level of evidence: III.
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Affiliation(s)
- Leena Raudasoja
- Department of Hand Surgery, Helsinki University Hospital, University of Helsinki, HUS, Finland
| | - Heidi Vastamäki
- Sports Trauma Research Unit, Hospital Mehilainen Neo, Turku, Finland
| | - Samuli Aspinen
- Department of Hand Surgery, Helsinki University Hospital, University of Helsinki, HUS, Finland
| | - Jorma Ryhänen
- Department of Hand Surgery, Helsinki University Hospital, University of Helsinki, HUS, Finland
| | - Sina Hulkkonen
- Department of Hand Surgery, Helsinki University Hospital, University of Helsinki, HUS, Finland
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13
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Gigis I, Kyriakidis T, Katsimentzas T, Nenopoulos A, Heikenfeld R, Ditsios K, Papadopoulos P. Satisfactory Short-Term Outcomes of Reverse Shoulder Arthroplasty for Complex Three- and Four-Part Fractures of the Humeral Head in Octogenarians. Cureus 2024; 16:e53604. [PMID: 38449969 PMCID: PMC10915686 DOI: 10.7759/cureus.53604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Proximal humeral fractures with severe comminution and poor bone quality are among the most common injuries in the elderly population. Reverse shoulder arthroplasty (RSA) has been widely used to manage complex three- and four-part humeral head fractures. The purpose of the present study was to report the result of this technique in the demanding population of octogenarians. MATERIALS AND METHODS Twenty-six patients above the age of 80 years were included in the study and followed for a minimum of one-year follow-up. To assess the functional outcomes the postoperative range of motion (ROM), the Constant score, the visual analog scale for pain, and the disability of the arm and shoulder score (DASH) were measured at 6 and 12 months. Radiological assessment and potential complications were also recorded. RESULTS The mean age of the study population was 81.9 years (81-86) at the time of surgery. There was a statistically significant improvement in all outcomes over the follow-up intervals. Shoulder ROM was 125.7o for flexion, 98.2o for abduction, 42.2o for internal rotation, and 43.2o for external rotation at 12 months. The mean Constant, DASH, and VAS scores at the last follow-up were 61.3, 31.9, and 0.5, respectively. Reported complications include one superficial surgical site infection. CONCLUSION RSA is a safe and reliable surgical option with satisfactory outcomes to manage complex three- and four-part fractures of the humeral head as it can provide prompt pain relief and function in octogenarians.
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Affiliation(s)
- Ioannis Gigis
- 2nd Orthopaedic Department, General Hospital "G. Gennimatas" Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Theofylaktos Kyriakidis
- 2nd Orthopaedic Department, General Hospital "G. Gennimatas" Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Triantafyllos Katsimentzas
- 2nd Orthopaedic Department, General Hospital "G. Gennimatas" Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Alexandros Nenopoulos
- 2nd Orthopaedic Department, General Hospital "G. Gennimatas" Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Roderich Heikenfeld
- Center for Orthopaedics and Traumatology, St. Elisabeth Group - Catholic Hospitals Rhein-Ruhr, Herne, DEU
| | - Konstantinos Ditsios
- 2nd Orthopaedic Department, General Hospital "G. Gennimatas" Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Periklis Papadopoulos
- 2nd Orthopaedic Department, General Hospital "G. Gennimatas" Aristotle University of Thessaloniki, Thessaloniki, GRC
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Reider L, Falvey JR, Okoye SM, Wolff JL, Levy JF. Cost of U.S emergency department and inpatient visits for fall injuries in older adults. Injury 2024; 55:111199. [PMID: 38006782 DOI: 10.1016/j.injury.2023.111199] [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: 06/19/2023] [Revised: 11/01/2023] [Accepted: 11/12/2023] [Indexed: 11/27/2023]
Abstract
BACKGROUND Falls are a leading cause of injury and hospital readmissions in older adults. Understanding the distribution of acute treatment costs across inpatient and emergency department settings is critical for informed investment and evaluation of fall prevention efforts. METHODS This study used the 2016-2018 National Inpatient Sample and National Emergency Department Sample. Annual treatment cost of fall injury among adults 65 years and older was estimated from charges, applying cost-to-charge and professional fee ratios. Weighted multivariable generalized linear models were used to separately estimate cost for inpatient and emergency department (ED) setting by injury type and individual demographic and health characteristics after adjusting for payer and hospital level characteristics. RESULTS Older adults incurred an estimated 922,428 inpatient and 2.3 million ED visits annually due to falls with combined annual costs of $19.8 billion. Over half of inpatient visits for fall injury were for fracture. Notably, 23% of inpatient visits were for fractures other than hip fracture and 14% of inpatient visits were for multiple fractures with costs totaling $3.4 billion and $2.5 billion, respectively. Annual ED costs were driven by superficial injury totaling $1.5 billion. Cost of ED visits were higher for adults 85 years and older (adjusted cost ratio (aCR): 1.11, 95% Confidence Interval (CI)I: 1.11-1.12) and those with dementia (aCR: 1.14, 95% CI: 1.13-1.15). Higher inpatient and ED visit cost was also associated with high-energy falls and discharge to post-acute care. CONCLUSION The study found that more than 3 million older adults in the United States seek hospital care for fall injuries annually, a major concern given increasing capacity strain on hospitals and EDs. The $20 billion in annual acute treatment costs attributed to fall injury indicate an urgent need to implement evidence-based fall prevention interventions and underscores the importance of newly launched ED-based fall prevention efforts and investments in geriatric emergency departments.
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Affiliation(s)
- Lisa Reider
- Johns Hopkins Bloomberg School of Public Health, Department of Health Policy, and Management, 624N. Broadway, Baltimore MD 21205, United States.
| | - Jason R Falvey
- Department of Physical Therapy and Rehabilitation Science, Department of Epidemiology and Public Health, University of Maryland School of Medicine, United States
| | - Safiyyah M Okoye
- Department of Graduate Nursing, Drexel University College of Nursing and Health Professions, United States; Department of Health Management and Policy, Drexel University Dornsife School of Public Health Philadelphia, PA, United States
| | - Jennifer L Wolff
- Johns Hopkins Bloomberg School of Public Health, Department of Health Policy, and Management, 624N. Broadway, Baltimore MD 21205, United States
| | - Joseph F Levy
- Johns Hopkins Bloomberg School of Public Health, Department of Health Policy, and Management, 624N. Broadway, Baltimore MD 21205, United States
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15
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Tapper V, Reito A, Pamilo K, Ylitalo A, Toom A, Paloneva J. Complications and secondary operations after non-operative and operative treatment of tibial plateau fractures: a population-based study of 562 patients with mean follow-up of 7 years. Arch Orthop Trauma Surg 2024; 144:269-280. [PMID: 37921992 DOI: 10.1007/s00402-023-05102-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 10/10/2023] [Indexed: 11/05/2023]
Abstract
INTRODUCTION The incidence of tibial plateau fractures (TPF) is 1% of all fractures and increases with age. Whether non-operatively or operatively treated, complications (infection, malalignment, loss of reduction and delayed union or nonunion) and post-traumatic osteoarthritis are not uncommon, and the risk for complications has generally been assumed to rise with age. This study investigated all post-TPF complications and secondary surgery after non-operative and operative treatment. Secondary aims were to determine the incidence and epidemiology of TPF in the population of the Central Finland region. MATERIALS AND METHODS All patients over age 18 years with a TPF, including incidence, etiology, fracture type, and possible complications and reoperations, sustained during the period 1998-2019 were retrospectively identified from hospital records. RESULTS The annual mean incidence of TPF was 14.4/100,000, with older women at highest risk. The proportions of non-operative and operatively treated patients who had undergone at least one additional surgical operation were 6% and 26%, respectively. Age and female gender were identified as risk factors for complications and secondary operations. The risk peaked in patients aged 60-65 years, decreasing thereafter. Non-operative treatment showed low risk for both non-union and loss of reduction. CONCLUSIONS Older women were at the highest risk for TPF and for subsequent complications and secondary operations after TPF. Secondary operations after operatively treated TPF were not uncommon and patients aged 60-65 years were at highest risk. Given the low rates of complications and re-operations, non-operative treatment may be a safe option in cases of all minimally displaced TPF.
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Affiliation(s)
- Valtteri Tapper
- Department of Surgery, Hospital Nova, Wellbeing Services County of Central Finland, Keskussairaalantie 19, 40620, Jyvaskyla, Finland.
| | - Aleksi Reito
- Department of Surgery, Tampere University Hospital, Tampere, Finland
| | - Konsta Pamilo
- Coxa Hospital for Joint Replacement, Tampere, Finland
| | - Antti Ylitalo
- Department of Surgery, Tampere University Hospital, Tampere, Finland
| | - Alar Toom
- Department of Surgery, Hospital Nova, Wellbeing Services County of Central Finland, Keskussairaalantie 19, 40620, Jyvaskyla, Finland
| | - Juha Paloneva
- Department of Surgery, Hospital Nova, Wellbeing Services County of Central Finland, Keskussairaalantie 19, 40620, Jyvaskyla, Finland
- University of Eastern Finland, Kuopio, Finland
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16
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Fernández-Cortiñas AB, Seoane-Pillado T, Marco Martínez F. Blood transfusion and surgical treatment increase mortality in patient with proximal humeral fractures. Injury 2023; 54 Suppl 7:111091. [PMID: 38225160 DOI: 10.1016/j.injury.2023.111091] [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: 01/07/2023] [Revised: 09/23/2023] [Accepted: 10/02/2023] [Indexed: 01/17/2024]
Abstract
INTRODUCTION Proximal humeral fractures (PHFs) often occur in elderly patients with osteoporosis and associated comorbidities. These patients constitute a special risk group. This study aimed to identify associations between comorbidities, treatment type, and mortality risk. PATIENTS AND METHODS We conducted a retrospective chart review of a cohort of 350 patients with a diagnosis of PHF and a mean follow-up of 4.5 years. We analysed the 19 prefracture comorbidities included in the Charlson Comorbidity Index (CCI), haemoglobin (Hb) levels, blood transfusion needs, and treatment administered (surgery versus conservative). The nonparametric Kaplan-Meier method and Cox proportional hazards model were used to estimate the mortality risk. RESULTS Over a 4.5-year average follow-up of 350 patients, primarily elderly females, with proximal humerus fractures, several factors were associated with increased mortality. The Charlson Comorbidity Index (CCI) was a significant predictor, with patients having a CCI > 5 facing higher mortality risks, especially if they underwent surgery. Additionally, osteosynthesis was linked to a lower mortality rate compared to arthroplasty. Age, dementia, medical complications, and postfracture Hb level also influenced mortality rates. CONCLUSIóN: These findings emphasize the importance of considering comorbidities, specifically the Charlson Comorbidity Index (CCI), in determining patient outcomes, especially amongst elderly patients with proximal humerus fractures. Factors like age, dementia, and postfracture Hb level also play a crucial role in influencing mortality rates. TRIAL REGISTRATION The study received written approval from the regional Ethics Committee for Clinical Research (code 2016/125).
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Affiliation(s)
| | - Teresa Seoane-Pillado
- Preventive Medicine and Public Health Unit, Department of Health Sciences, University of A Coruña-INIBIC, Spain
| | - Fernando Marco Martínez
- Shoulder and Elbow Unit, Department of Traumatology and Orthopaedic Surgery, Clínico San Carlos Hospital, Madrid, Spain; Department of Surgery, Complutense University, Madrid, Spain
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Dong W, Lisitano LSJ, Marchand LS, Reider LM, Haller JM. Weight-bearing Guidelines for Common Geriatric Upper and Lower Extremity Fractures. Curr Osteoporos Rep 2023; 21:698-709. [PMID: 37973761 DOI: 10.1007/s11914-023-00834-2] [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] [Accepted: 11/03/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE OF REVIEW The purpose of this review paper is to summarize current weight-bearing guidelines for common geriatric fractures, around weight-bearing joints, of the upper and lower extremities. RECENT FINDINGS There is an increasing amount of literature investigating the safety and efficacy of early weight-bearing in geriatric fractures, particularly of the lower extremity. Many recent studies, although limited, suggest that early weight-bearing may be safe for geriatric distal femur and ankle fractures. Given the limited data pertaining to early weight-bearing in geriatric fractures, it is difficult to establish concrete weight-bearing guidelines in this population. However, in the literature available, early weight-bearing appears to be safe and effective across most injuries. The degree and time to weight-bearing vary significantly based on fracture type and treatment method. Future studies investigating postoperative weight-bearing protocols should focus on the growing geriatric population and identify methods to address specific barriers to early weight-bearing in these patients such as cognitive impairment, dependence on caregivers, and variations in post-acute disposition.
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Affiliation(s)
- Willie Dong
- Department of Orthopaedic Surgery, University of Utah, 590 Wakara Way, Salt Lake City, UT, 84108, USA
| | - Leonard S J Lisitano
- Department of Orthopaedic Surgery, University of Utah, 590 Wakara Way, Salt Lake City, UT, 84108, USA
| | - Lucas S Marchand
- Department of Orthopaedic Surgery, University of Utah, 590 Wakara Way, Salt Lake City, UT, 84108, USA
| | - Lisa M Reider
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Justin M Haller
- Department of Orthopaedic Surgery, University of Utah, 590 Wakara Way, Salt Lake City, UT, 84108, USA.
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Farzad M, MacDermid J, Hemmati M, Farhoud AR. Occupational Performance 1 Year After a Distal Radius Fracture From the Perspective of the International Classification of Functioning, Disability and Health. Am J Occup Ther 2023; 77:7705205040. [PMID: 37793017 DOI: 10.5014/ajot.2023.050180] [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: 10/06/2023] Open
Abstract
IMPORTANCE Distal radius fractures (DRFs) frequently compromise independent functioning. OBJECTIVE To analyze occupational performance post-DRF using the Canadian Occupational Performance Measure (COPM) and related interviews, guided by the International Classification of Functioning, Disability and Health (ICF). COPM score was compared with standard metrics: Patient-Reported Wrist Evaluation (PRWE) and Participation Behavior Questionnaire (PBQ). METHOD Through a semistructured COPM interview, participants highlighted self-care, productivity, and leisure. They completed the PRWE and PBQ, linking results to ICF sets. DESIGN Prospective cohort. SETTING Outpatient hand surgery clinic at a trauma center. PARTICIPANTS Patients (N = 120), 1 yr post-DRF. OUTCOMES AND MEASURES Incorporated COPM, PRWE, and PBQ, linked to ICF. RESULTS Analysis identified 73 codes, aligning with 30 ICF Hand Conditions codes. Main concerns related to self-care (15.21%), leisure (12.16%), and productivity (16.22%). Major challenges pertained to domestic (67.00%) and civic life (64.53%) within ICF. Occupational performance was positively correlated with participation (r = .62) and inversely with disability (r = -.62). CONCLUSIONS AND RELEVANCE DRFs result in varied occupational challenges that are not always reflected in standard measures. The COPM offers a comprehensive insight into post-DRF patient challenges, emphasizing the value of diverse clinical assessment approaches. What This Article Adds: This study highlights the importance of a holistic approach in occupational therapy for DRF patients, revealing that standard measurements might overlook key challenges that they face. By adopting broader evaluative methods, occupational therapists can better address patient-specific needs and enhance their rehabilitation outcomes.
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Affiliation(s)
- Maryam Farzad
- Maryam Farzad, PhD, MSc, BSc, is Postdoctoral Associate, School of Physical Therapy, Department of Health and Rehabilitation Sciences, University of Western Ontario, London, Ontario, Canada, and Assistant Professor, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran;
| | - Joy MacDermid
- Joy MacDermid, PhD, MSc, BSc, is Professor, Department of Physical Therapy and Surgery, Western University, London, Ontario, Canada; Codirector, Clinical Research Laboratory, Hand and Upper Limb Center, St. Joseph's Health Center, London, Ontario, Canada; and Professor, Department of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Motahar Hemmati
- Motahar Hemmati, BSc OT, is Master's Student, Department of Occupational Therapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Amir Reza Farhoud
- Amir Reza Farhoud, MD, is Assistant Professor, Department of Orthopedic Surgery, Imam Hospital Complex, Tehran University of Medical Sciences, Joint Reconstruction Research Center, Tehran, Iran
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Rau Y, Amtsfeld J, Reimers N, Matrisch L, Frese J, Schulz AP. The development, incidence and treatment trends of trochanteric fractures in Germany: a cohort study. J Orthop Surg Res 2023; 18:491. [PMID: 37430277 PMCID: PMC10331963 DOI: 10.1186/s13018-023-03981-5] [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: 03/04/2023] [Accepted: 07/04/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND Hip fractures are a major public health problem worldwide and can lead to disability, increased mortality, and reduced quality of life. We aim to provide a nationwide epidemiological analysis of trochanteric and subtrochanteric fractures and their respective surgical treatments. METHODS Data were retrieved from the national database of the German Department of the Interior. ICD-10-GM and OPS data from the period of 2006 to 2020 were analysed and all patients with trochanteric and subtrochanteric fractures as their main diagnosis, who were treated in a German hospital, were included. Patients were grouped by age and gender and linear regression was performed where suitable to calculate statistically significant correlations between variables and incidences. RESULTS 985,104 pertrochanteric fractures and 178,810 subtrochanteric fractures were reported during the analysed period. We calculated a mean incidence of 80.08 ± 6.34 for pertrochanteric and 14.53 ± 1.50 for subtrochanteric fractures per million inhabitants. In both fracture types, a distinct dependence of incidence on age can be determined. Incidence rates equally rise in both sexes through the age groups with an increase of about 288-fold from those under the age of 60 to those over the age of 90 in pertrochanteric fractures, and about 123-fold in subtrochanteric fractures. Intramedullary nailing was the most common kind of treatment for both fracture types with augmentative cerclages on the rise throughout the whole period. Plate and dynamic compression screws were decreasing in frequency over the analysed period in both fractures. CONCLUSIONS We provided incidence data on per- and subtrochanteric fractures and their treatment. We calculated an economic impact of approximately 1.563 billion € per year in Germany. With regards to recent literature on costs of treatment and our findings regarding the implementation and utilization of different treatment methods, we conclude that the reinforcement of nationwide prevention programs is a relevant step in lessening the economic burden. We welcome the increased utilisation of intramedullary nailing as many studies show beneficiary outcomes and cost effectiveness in most of the included fracture types.
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Affiliation(s)
- Yannick Rau
- Faculty of Medicine, Universität zu Lübeck, Lübeck, Germany.
- Zentrum Klinische Forschung, BG Klinikum Hamburg, Hamburg, Germany.
| | - Jasper Amtsfeld
- Chair of Technology Management, Christian-Albrechts-Universität zu Kiel, Kiel, Germany
| | - Nils Reimers
- Stryker Trauma GmbH, Schoenkirchen, Germany
- Queensland University of Technology, Brisbane City, Australia
| | | | - Jasper Frese
- Zentrum Klinische Forschung, BG Klinikum Hamburg, Hamburg, Germany
- Department of Trauma Surgery, Orthopaedics and Sports Traumatology, BG Klinikum Hamburg, Hamburg, Germany
| | - Arndt-Peter Schulz
- Faculty of Medicine, Universität zu Lübeck, Lübeck, Germany
- Zentrum Klinische Forschung, BG Klinikum Hamburg, Hamburg, Germany
- Department of Trauma Surgery, Orthopaedics and Sports Traumatology, BG Klinikum Hamburg, Hamburg, Germany
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20
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Xu Z, Zhang Y, Lu D, Zhang G, Li Y, Lu Z, Wang F, Wang G. Antisenescence ZIF-8/Resveratrol Nanoformulation with Potential for Enhancement of Bone Fracture Healing in the Elderly. ACS Biomater Sci Eng 2023; 9:2636-2646. [PMID: 37036053 DOI: 10.1021/acsbiomaterials.3c00090] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Abstract
Accumulation of senescent cells in the elderly impairs bone homeostasis. It is important to alleviate cell senescence and scavenge excessive oxidative stress for enhanced bone fracture healing in elderly patients. In this study, resveratrol (RSV), an antioxidant drug, was encapsulated in a biocompatible zeolitic imidazolate framework-8 (ZIF-8) nanoparticle to protect it from oxidation and improve its bioavailability. Cells responsible for bone healing, including osteoblasts, bone marrow-derived mesenchymal stem cells (BMSCs), macrophages, and endothelial cells, were used to evaluate the regulatory role of the nanoformulation in the alleviation of cellular senescence and promotion of cell functions. It was proved that the nanoformulation sustainably released RSV with well-preserved bioactivity and improved bioavailability. Cell experiments confirmed that ZIF-8/RSV was capable of alleviating the senescence of cells [human osteoblasts (HOBs), BMSCs, H2O2-induced senescent vascular endothelial cells (HUVECs)] and scavenging excessive intracellular reactive oxygen species (ROS). Excitingly, the ZIF-8/RSV improved the osteogenic ability of senescent osteoblasts and promoted macrophage M2 polarization. In addition, the ZIF-8/RSV also enhanced the angiogenic function of senescent HUVECs. More importantly, the ZIF-8/RSV nanoformulation outperformed the REV alone, indicating the critical role of encapsulation using ZIF-8. These findings suggest that the ZIF-8/RSV nanoformulation exhibits potential for bone fracture treatment in elderly patients.
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Affiliation(s)
- Zhengjiang Xu
- Research Center for Human Tissues & Organs Degeneration, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Guangdong 518055, Shenzhen, China
- University of Chinese Academy of Sciences, Beijing 100049, China
| | - Yuan Zhang
- Research Center for Human Tissues & Organs Degeneration, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Guangdong 518055, Shenzhen, China
| | - Danping Lu
- Research Center for Human Tissues & Organs Degeneration, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Guangdong 518055, Shenzhen, China
| | - Guofang Zhang
- Laboratory of Immunology and Nanomedicine, Laboratory of Inflammation and Vaccines, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Guangdong 518055, Shenzhen, China
| | - Yang Li
- Laboratory of Immunology and Nanomedicine, Laboratory of Inflammation and Vaccines, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Guangdong 518055, Shenzhen, China
| | - Zufu Lu
- Tissue Engineering & Biomaterials Research Unit, School of Biomedical Engineering, The University of Sydney, Sydney 2006, NSW, Australia
| | - Fei Wang
- Department of Spine Surgery, Shenzhen University General Hospital, Shenzhen 518055, China
| | - Guocheng Wang
- Research Center for Human Tissues & Organs Degeneration, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Guangdong 518055, Shenzhen, China
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21
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Batty M, Challa S, Bejarano-Pineda L, DiGiovanni C, Kwon JY. Reduction of Weber B Fibular Fractures in the Setting of Severe Osteopenia: A Technique Tip. Foot Ankle Int 2023; 44:251-254. [PMID: 36905301 DOI: 10.1177/10711007231152881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/12/2023]
Affiliation(s)
- Miles Batty
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Sravya Challa
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | | | | | - John Y Kwon
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA
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22
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Rischen R, Köppe J, Stolberg-Stolberg J, Freistühler M, Faldum A, Raschke MJ, Katthagen JC. Treatment Reality of Proximal Humeral Fractures in the Elderly-Trending Variants of Locking Plate Fixation in Germany. J Clin Med 2023; 12:jcm12041440. [PMID: 36835975 PMCID: PMC9963188 DOI: 10.3390/jcm12041440] [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: 01/09/2023] [Revised: 01/26/2023] [Accepted: 02/01/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND The surgical treatment of proximal humeral fractures (PHFs) with locking plate fixation (LPF) in the elderly is associated with high complication rates, especially in osteoporotic bone. Variants of LPF such as additional cerclages, double plating, bone grafting and cement augmentation can be applied. The objective of the study was to describe the extent of their actual use and how this changed over time. METHODS Retrospective analysis of health claims data of the Federal Association of the Local Health Insurance Funds was performed, covering all patients aged 65 years and older, who had a coded diagnosis of PHF and were treated with LPF between 2010 and 2018. Differences between treatment variants were analyzed (explorative) via chi-squared or Kruskal-Wallis tests. RESULTS Of the 41,216 treated patients, 32,952 (80%) were treated with LPF only, 5572 (14%) received additional screws or plates, 1983 (5%) received additional augmentations and 709 (2%) received a combination of both. During the study period, relative changes were observed as follows: -35% for LPF only, +58% for LPF with additional fracture fixation and +25% for LPF with additional augmentation. Overall, the intra-hospital complication rate was 15% with differences between the treatment variants (LPF only 15%, LPF with additional fracture fixation 14%, LPF with additional augmentation 19%; p < 0.001), and a 30-day mortality of 2%. CONCLUSIONS Within an overall decrease of LPF by approximately one-third, there is both an absolute and relative increase of treatment variants. Collectively, they account for 20% of all coded LPFs, which might indicate more personalized treatment pathways. The leading variant was additional fracture fixation using cerclages.
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Affiliation(s)
- Robert Rischen
- Clinic for Radiology, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building A1, 48149 Muenster, Germany
- Correspondence: ; Tel.: +49-251-83-47302
| | - Jeanette Köppe
- Institute of Biostatistics and Clinical Research, University of Muenster, Schmeddingstrasse 56, 48149 Muenster, Germany
| | - Josef Stolberg-Stolberg
- Department of Trauma-, Hand- and Reconstructive Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building W1, 48149 Muenster, Germany
| | - Moritz Freistühler
- Medical Management Division—Medical Controlling, University Hospital Muenster, Niels-Stensen-Straße 8, 48149 Muenster, Germany
| | - Andreas Faldum
- Institute of Biostatistics and Clinical Research, University of Muenster, Schmeddingstrasse 56, 48149 Muenster, Germany
| | - Michael J. Raschke
- Department of Trauma-, Hand- and Reconstructive Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building W1, 48149 Muenster, Germany
| | - J. Christoph Katthagen
- Department of Trauma-, Hand- and Reconstructive Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building W1, 48149 Muenster, Germany
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23
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Double Plating for Complex Proximal Humeral Fractures: Clinical and Radiological Outcomes. J Clin Med 2023; 12:jcm12020696. [PMID: 36675625 PMCID: PMC9860712 DOI: 10.3390/jcm12020696] [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: 11/30/2022] [Revised: 12/19/2022] [Accepted: 01/09/2023] [Indexed: 01/17/2023] Open
Abstract
Double plating for proximal humeral fractures (PHF) is an option to increase the primary fixation stability. Clinical data is missing for assessment of clinical and radiological outcome, as well as complications. We retrospectively examined 35 patients with unilateral PHF, who were treated with double plating for PHF between 2013 and 2019. The mean age was 59.5 ± 12 years and the leading fracture type was a varus dislocation (Resch type IV in 55.3%). A head-split was present in 22.9% of the cases. The primary outcome measurement was the radiological neck shaft angle (NSA). The radiological follow-up was 21 ± 16.6 months and the NSA did not differ between the intraoperative and follow-up time point (131.5 ± 6.9° vs. 136.6 ± 13.7°; p = 0.267). The clinical follow-up was 29.5 ± 15.3 months. The Constant-score was 78.5 ± 17 points, the simple-shoulder-test (SST) was 9.3 ± 3.2 points and the subjective shoulder value (SSV) was 78.8 ± 19.5%. The over-all complication rate was 31.4%, and without stiffness 14.3%. An avascular necrosis occurred in two patients (5.7%). In conclusion, this study shows good radiological and functional outcomes after double plating of highly complex proximal humeral fractures, while the complication rate is comparable to the literature. Double plating is a viable option especially for younger patients with complex fractures as a potential alternative to fracture arthroplasty.
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24
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Nguyen MQ, Dalen I, Iversen MM, Harboe K, Paulsen A. Ankle fractures: a systematic review of patient-reported outcome measures and their measurement properties. Qual Life Res 2023; 32:27-45. [PMID: 35716224 PMCID: PMC9829578 DOI: 10.1007/s11136-022-03166-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2022] [Indexed: 01/13/2023]
Abstract
PURPOSE Ankle fractures are commonly occurring fractures, especially in the aging population, where they often present as fragility fractures. The disease burden and economic costs to the patient and society are considerable. Choosing accurate outcome measures for the evaluation of the management of ankle fractures in clinical trials facilitates better decision-making. This systematic review assesses the evidence for the measurement properties of patient-reported outcome measures (PROMs) used in the evaluation of adult patients with ankle fractures. METHODS Searches were performed in CINAHL, EMBASE, Medline and Google Scholar from the date of inception to July 2021. Studies that assessed the measurement properties of a PROM in an adult ankle fracture population were included. The included studies were assessed according to the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) methodology for systematic reviews of PROMs. RESULTS In total, 13 different PROMs were identified in the 23 included articles. Only the Ankle Fracture Outcome of Rehabilitation Measure (A-FORM) presented some evidence on content validity. The Olerud-Molander Ankle Score (OMAS) and Self-reported Foot and Ankle Score (SEFAS) displayed good evidence of construct validity and internal consistency. The measurement properties of the OMAS, LEFS and SEFAS were most studied. CONCLUSION The absence of validation studies covering all measurement properties of PROMs used in the adult ankle fracture population precludes the recommendation of a specific PROM to be used in the evaluation of this population. Further research should focus on validation of the content validity of the instruments used in patients with ankle fractures.
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Affiliation(s)
- Michael Quan Nguyen
- Department of Orthopedic Surgery, Stavanger University Hospital, Helse Stavanger HF, Stavanger, Norway.
- Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway.
| | - Ingvild Dalen
- Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
- Department of Research, Stavanger University Hospital, Helse Stavanger HF, Stavanger, Norway
| | - Marjolein Memelink Iversen
- Centre on Patient-Reported Outcomes, Department of Research and Development, Haukeland University Hospital, Helse Bergen HF, Bergen, Norway
- Department of Health and Caring Sciences, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Knut Harboe
- Department of Orthopedic Surgery, Stavanger University Hospital, Helse Stavanger HF, Stavanger, Norway
- Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Aksel Paulsen
- Department of Orthopedic Surgery, Stavanger University Hospital, Helse Stavanger HF, Stavanger, Norway
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
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25
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Abstract
AIMS Distal third clavicle (DTC) fractures are increasing in incidence. Due to their instability and nonunion risk, they prove difficult to treat. Several different operative options for DTC fixation are reported but current evidence suggests variability in operative fixation. Given the lack of consensus, our objective was to determine the current epidemiological trends in DTC as well as their management within the UK. METHODS A multicentre retrospective cohort collaborative study was conducted. All patients over the age of 18 with an isolated DTC fracture in 2019 were included. Demographic variables were recorded: age; sex; side of injury; mechanism of injury; modified Neer classification grading; operative technique; fracture union; complications; and subsequent procedures. Baseline characteristics were described for demographic variables. Categorical variables were expressed as frequencies and percentages. RESULTS A total of 859 patients from 18 different NHS trusts (15 trauma units and three major trauma centres) were included. The mean age was 57 years (18 to 99). Overall, 56% of patients (n = 481) were male. The most common mechanisms of injury were simple fall (57%; n = 487) and high-energy fall (29%; n = 248); 87% (n = 748) were treated conservatively and 54% (n = 463) were Neer type I fractures. Overall, 32% of fractures (n = 275) were type II (22% type IIa (n = 192); 10% type IIb (n = 83)). With regards to operative management, 89% of patients (n = 748) who underwent an operation were under the age of 60. The main fixation methods were: hook plate (n = 47); locking plate (n = 34); tightrope (n = 5); and locking plate and tight rope (n = 7). CONCLUSION Our study is the largest epidemiological review of DTC fractures in the UK. It is also the first to review the practice of DTC fixation. Most fractures are being treated nonoperatively. However, younger patients, suffering a higher-energy mechanism of injury, are more likely to undergo surgery. Hook plates are the predominantly used fixation method followed by locking plate. The literature is sparse on the best method of fixation for optimal outcomes for these patients. To answer this, a pragmatic RCT to determine optimal fixation method is required.Cite this article: Bone Jt Open 2022;3(12):953-959.
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Affiliation(s)
- Parag Raval
- University Hospitals of Leicester, Leicester, UK,AToMS - Academic Team of Musculoskeletal Surgery, University Hospitals of Leicester NHS Trust, Leicester, UK,Correspondence should be sent to Mr Parag Raval. E-mail:
| | - Abbas See
- Trauma and Orthopaedics, Northampton General Hospital, Kettering, UK
| | - Harvinder P. Singh
- University Hospitals of Leicester, Leicester, UK,AToMS - Academic Team of Musculoskeletal Surgery, University Hospitals of Leicester NHS Trust, Leicester, UK
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26
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Grisdela P, Williams C, Challa S, Henson P, Agarwal-Harding K, Kwon JY. Screw-only fibular construct for Weber B ankle fractures: A retrospective clinical and cost comparison to assess feasibility for resource-limited settings. Injury 2022; 53:4146-4151. [PMID: 36289020 DOI: 10.1016/j.injury.2022.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 10/05/2022] [Accepted: 10/16/2022] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Ankle fractures are one of the most common injuries sustained worldwide, with the majority being isolated lateral malleolus fractures. The majority of the world's population live in Low and Middle Income Countries (LMIC), where implant cost may limit surgical treatment of ankle fractures. We investigate if Weber B ankle fractures could be effectively treated with a lower-cost technique using two screws between the fibula and the tibia to neutralize an interfragmentary lag screw. METHODS After IRB approval, consecutive patients from January 1, 2020 to December 31, 2020 with Weber-B ankle fractures were treated using AO technique (AOT) with plate osteosynthesis neutralizing an interfragmentary screw. Syndesmotic injuries, as well as injuries to the medial malleolus or foot were treated according to the surgeon's preferences. From January 1, 2021 to December 31, 2021 these injuries were treated with a screw-only technique (SOT) with two fibula pro tibia screws to neutralize an interfragmentary screw. Patient demographics including age, sex, BMI, smoking status, associated rheumatoid arthritis, and associated diabetes mellitus were recorded. The primary outcome variable was a stable radiographic mortise at six weeks post-surgery, secondary outcome variables included clinical union, infection, hardware removal, and implant cost for lateral malleolar fixation charged to the hospital. RESULTS Seventeen AOT and 10 SOT constructs were included. Demographic characteristics were similar between groups. All fractures maintained a stable mortise with clinical union at 6 weeks without infection. There was a statistically significant difference in hardware removal (17.6% AOT, 50% SOT, p = 0.012). The average implant cost to the hospital of the lateral malleolar fixation was significantly less in the SOT group ($592 (SD $229)), compared to the AOT group ($1,949.97 (SD $562)), (p < 0.0001). CONCLUSION We introduce proof of concept of a novel lower-cost fixation strategy for Weber B ankle fractures that maintained a stable mortise with clinical union at six weeks post-surgery. However, there was a significantly higher rate of hardware removal following fixation with a screw-only construct.
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Affiliation(s)
- Phillip Grisdela
- Harvard Combined Orthopaedics Residency Program, 55 Fruit St. Boston, MA 02114.
| | - Caroline Williams
- Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston MA 02215.
| | - Sravya Challa
- Harvard Combined Orthopaedics Residency Program, 55 Fruit St. Boston, MA 02114.
| | - Philip Henson
- Ichan School of Medicine at Mt. Sinai, 1 Gustave L. Levy Pl, New York NY 10029.
| | | | - John Y Kwon
- Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston MA 02215.
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27
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Epidemiology of 936 humeral shaft fractures in a large Finnish trauma center. J Shoulder Elbow Surg 2022; 32:e206-e215. [PMID: 36435484 DOI: 10.1016/j.jse.2022.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 10/06/2022] [Accepted: 10/20/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Humeral shaft fractures are relatively common injuries and are classified according to location and fracture morphology. Epidemiological studies improve understanding of injury patterns and lay foundations for future research. There are only a few published larger epidemiological studies on humeral shaft fractures. METHODS We retrospectively analyzed the medical records of adult patients having sustained a humeral shaft fracture treated in the Helsinki University Hospital between 2006 and 2016. We recorded patient and fracture characteristics, timing and mechanism of injury, associated injuries, and 1-year mortality. RESULTS We identified 914 patients (489 females, median age = 61.4 years; 425 males, median age = 50.4 years) with 936 fractures. Over 60% of these fractures were sustained from simple falls. The patient age distribution was bimodal, with highest fracture rates in elderly females and young males. We divided the fractures into typical traumatic, periprosthetic, and pathological fractures. Of the 872 typical traumatic fractures, 3.0% were open. In addition, there were 24 (2.6%) periprosthetic and 40 (4.3%) pathological fractures. An associated injury was found in 24% of patients, with primary radial nerve palsy (PRNP) being the most common (10%). PRNPs were more common in distal shaft fractures and high energy injuries. The 1-year mortality was 9.2%. CONCLUSIONS In this study, the most common injury mechanism was a simple fall. The most common associated injury was PRNP. The observed bimodal fracture distribution is consistent with previous literature.
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28
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Peuchot H, Falguières J, Cermolacce M, Le Baron M, Flecher X. Resumption of complete weight bearing after osteosynthesis of bimalleolar fractures using locking plates. Orthop Traumatol Surg Res 2022; 108:103382. [PMID: 35908733 DOI: 10.1016/j.otsr.2022.103382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 10/27/2021] [Accepted: 04/25/2022] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Bimalleolar fractures represent 9% of fractures and affect 187/100,000 people per year. The gold standard for osteosynthesis is a one-third tubular or lateral locking plate and compression screwing or use of tension band wiring, with complete weight bearing planned around the 6th week. The development of locking plates seems to allow earlier resumption of weight bearing. The objective of our study was to evaluate the clinical and radiological results after internal fixation of bimalleolar fractures using locking plates with complete weight bearing authorized from the outset. The hypothesis was that this does not predispose to cutaneous or mechanical complications. HARDWARE AND METHOD A continuous multi-operator retrospective study was performed. The clinical and radiological data of 55 patients operated on for bimalleolar fractures were collected. All underwent osteosynthesis with medial and lateral locking plates with authorization for weight bearing from the outset. RESULTS Complete weight bearing was resumed at 27.4 days 14.7 [7-60] postoperatively. No non-union or malunion was found. Two patients presented with delayed medial healing without the need for hardware removal. Two patients required removal of the lateral Plate 1 month postoperatively due to infection. Seven patients presented with discomfort related to hardware, justifying its removal at 1 year. The Kitaoka score at 1 year was 94.6 7.7 [71-100]. CONCLUSION The use of medial and lateral locking plates in bimalleolar fractures associated with complete weight bearing authorized from the outset allows complete consolidation. There was no increase in cutaneous or mechanical complications. LEVEL OF EVIDENCE IV, retrospective study.
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Affiliation(s)
- Henri Peuchot
- Institut du mouvement et de l'appareil locomoteur, CHU Marseille Nord, chemin des Bourrely, 13015 Marseille, France.
| | - Julie Falguières
- Institut du mouvement et de l'appareil locomoteur, CHU Marseille Nord, chemin des Bourrely, 13015 Marseille, France
| | - Mathieu Cermolacce
- Institut du mouvement et de l'appareil locomoteur, CHU Marseille Nord, chemin des Bourrely, 13015 Marseille, France
| | - Marie Le Baron
- Institut du mouvement et de l'appareil locomoteur, CHU Marseille Nord, chemin des Bourrely, 13015 Marseille, France
| | - Xavier Flecher
- Institut du mouvement et de l'appareil locomoteur, CHU Marseille Nord, chemin des Bourrely, 13015 Marseille, France
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29
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Haas Y, Stimmer H, Biberthaler P. [Postoperative imaging of the musculoskeletal system : Clinical aspects]. RADIOLOGIE (HEIDELBERG, GERMANY) 2022; 62:817-824. [PMID: 35796756 DOI: 10.1007/s00117-022-01039-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/10/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Postoperative imaging in trauma surgery is an essential part of documenting optimal osteosynthetic care. A precise and goal-oriented analysis with a justifiable indication is essential. The clinical information has a great impact on the quality of imaging. An objective evaluation and structured reporting complete the postoperative imaging procedure. MATERIALS AND METHODS Conventional x‑rays in two planes is the standard of postoperative imaging in musculoskeletal surgery. In specific anatomic structures, additional images may be necessary. The postoperative x‑ray is the simplest way to visualize a successful osteosynthesis and combines the most important points of postoperative management. Computed tomography (CT) is mostly used in emergencies, but also in the postoperative management of some elective procedures, including patients with surgery of the spine, hip or to the proximal long bones of the extremities. Furthermore, CT is useful in postoperative imaging of complicated ankle fractures. Magnetic resonance imaging (MRI) plays a modest role in postoperative imaging and is mostly used in musculoskeletal cancer surgery. Ultrasound rather plays a subordinated role in postoperative management, but it is increasingly becoming established as a tool for postoperative quality control. The great advantage is dynamic visualization in real time. CONCLUSION Postoperative imaging remains challenging, but can detect most issues regarding osteosynthesis, which can be then be treated or monitored. Various imaging modalities are available to make reliable statements on osteosynthetic material, bone and soft tissue.
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Affiliation(s)
- Y Haas
- Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar, Ismaninger Str. 22, 81675, München, Deutschland.
| | - H Stimmer
- Institut für Radiologische und interventionelle Diagnostik, Klinikum rechts der Isar, München, Deutschland
| | - P Biberthaler
- Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar, Ismaninger Str. 22, 81675, München, Deutschland
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30
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Practical approach to the native distal femur fractures in the elderly: A rapid review over the recent trends. Injury 2022; 53:2389-2394. [PMID: 35644641 DOI: 10.1016/j.injury.2022.05.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 05/16/2022] [Accepted: 05/17/2022] [Indexed: 02/02/2023]
Abstract
Significant work has been done in recent years on treatment strategies for distal femur fractures. Inclusive reviews on periprosthetic fractures of distal femur have been carried out recently, but there is a lack of such reviews on the subject of native distal femur fractures in the recent literature. In this narrative review, we are set out to address the latest updates on geriatric non-periprosthetic distal femur fractures, and perform a rapid review over different treatment options, arriving at a summarized proposed treatment algorithm.
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31
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Nwankwo H, Mason J, Costa ML, Parsons N, Redmond A, Parsons H, Haque A, Kearney RS. Cost-utility analysis of cast compared to removable brace in the management of adult patients with ankle fractures. Bone Jt Open 2022; 3:455-462. [PMID: 35658671 PMCID: PMC9233419 DOI: 10.1302/2633-1462.36.bjo-2022-0036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Aims To compare the cost-utility of removable brace compared with cast in the management of adult patients with ankle fracture. Methods A within-trial economic evaluation conducted from the UK NHS and personnel social services (PSS) perspective. Health resources and quality-of-life data were collected as part of the Ankle Injury Rehabilitation (AIR) multicentre, randomized controlled trial over a 12-month period using trial case report forms and patient-completed questionnaires. Cost-utility analysis was estimated in terms of the incremental cost per quality adjusted life year (QALY) gained. Estimate uncertainty was explored by bootstrapping, visualized on the incremental cost-effectiveness ratio plane. Net monetary benefit and probability of cost-effectiveness were evaluated at a range of willingness-to-pay thresholds and visualized graphically. Results The incremental cost and QALYs of using brace over a 12-month period were £46.73 (95% confidence interval (CI) £-9 to £147) and 0.0141 (95% CI -0.005 to 0.033), respectively. The cost per QALY gained was £3,318. The probability of brace being cost-effective at a £30,000 per QALY willingness-to-pay threshold was 88%. The results remained robust to a range of sensitivity analyses. Conclusion This within-trial economic evaluation found that it is probable that using a removable brace provides good value to the NHS when compared to cast, in the management of adults with ankle fracture. Cite this article: Bone Jt Open 2022;3(6):455–462.
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Affiliation(s)
- Henry Nwankwo
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - James Mason
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Matthew L. Costa
- Oxford Trauma and Emergency Care, Nuffield Department of Rheumatology, Musculoskeletal and Orthopaedic Sciences, University of Oxford, Oxford, UK
| | | | - Anthony Redmond
- Leeds Institute for Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Helen Parsons
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Aminul Haque
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
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32
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Fragility Fracture Systems: International Perspectives - Asia & Australia. OTA Int 2022; 5:e195. [PMID: 35949496 PMCID: PMC9359027 DOI: 10.1097/oi9.0000000000000195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 12/23/2021] [Accepted: 01/04/2022] [Indexed: 11/26/2022]
Abstract
Background: The incidence and burden of fragility fractures have reached the level where comprehensive systematic care is warranted to optimize the care of these patients. Hip fractures are the most frequently lethal and independence level changing fragility fractures, responsible for 30-day mortality comparable to high-energy trauma patients with injury severity scores over 12. It is a reasonable expectation that countries have a hip fracture treating system of care in place for this high-risk population. This review explores the systems of care from the Asia-Pacific Perspective. Methods: From the International Orthopaedic Trauma Association's member societies, nations from the Asia-Pacific Region were requested to contribute with an overview of their fragility fracture management systems. The content or the review was standardized by a template of headings, which each country endeavored to cover. Results: Australia, Japan, and South Korea contributed voluntarily from the 5 member countries of the region. Each country has made considerable efforts and achievements with diverse approaches to standardize and improve the care of fragility fractures, particularly hip fractures. Beyond the individual nations’ efforts there is also an existing Asia-Pacific Collaborative. The data collection and in some counties the existence of a registry is promising; funding and recognition of the problem among competing health care budget priorities are common. Conclusions: Our review covers some of the countries with strongest economy and highest health care standards. The lack of a universal robust system for hip fracture care is apparent. The data collection from registry initiations is expected to drive system development further in these countries and hopefully fast track the development in other countries within the most populous geographical region of the Earth.
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Oehme F, Kremo V, van Veelen N, Mühlhäusser J, Brunner J, Peek J, van de Wall BJM, Link BC, Knobe M, Babst R, Beeres FJP. Routine x-rays after the osteosynthesis of distal radius and ankle fractures—a prospective randomized controlled trial on the necessity of routine imaging. DEUTSCHES ÄRZTEBLATT INTERNATIONAL 2022; 119:279-284. [PMID: 35140009 PMCID: PMC9437839 DOI: 10.3238/arztebl.m2022.0099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 01/17/2021] [Accepted: 01/03/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND The utility of routine x-rays after the osteosynthesis of distal radius fractures and ankle fractures is questionable. We performed a trial to determine whether such x-rays are justified in patients who have undergone standardized imaging with C-arm fluoroscopy during surgery. METHODS Patients requiring surgery for a distal radius fracture or an ankle fracture were candidates for inclusion in this prospective, randomized, controlled, non-blinded trial. Standardized intraoperative images were obtained with C-arm fluoroscopy and stored at the end of the operation. The next day, patients in the control group underwent imaging with a standard postoperative x-ray, while those in the intervention group did not. The primary endpoint was a change in the treatment plan, defined as additional imaging or a second operation. The secondary endpoints included the range of motion, pain as rated on the Visual Analog Scale, and a functional outcome analysis (PRWE/FAOS). RESULTS 316 patients were included in the trial (163 in the control group, 153 in the intervention group), of whom 202 (64%) had radius fractures and 114 (36%) had ankle fractures. The treatment plan changed in twelve patients (3.8%; four in the control group and eight in the intervention group), seven of whom (2.2%; three in the control group and four in the intervention group) underwent a second operation. The frequency of changes in the treatment plan and of reoperations was comparable in the two groups (p = 0.36). On follow-up at six weeks and one year, the results with respect to functional outcomes and pain were comparable. CONCLUSION In this trial, routine postoperative x-rays after the osteosynthesis of distal radial fractures and ankle fractures did not improve the care of patients who had undergone standardized intraoperative imaging.
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Xu J, Zhan S, Ling M, Jiang D, Hu H, Sheng J, Ding J. How can medial support for proximal humeral fractures be achieved when positioning of regular calcar screws is challenging? Slotting and off-axis fixation strategies. J Shoulder Elbow Surg 2022; 31:782-791. [PMID: 34619347 DOI: 10.1016/j.jse.2021.08.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 08/21/2021] [Accepted: 08/29/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Achieving medial support for proximal humeral fractures (PHFs) by regular calcar screw positioning is challenging when the humeral head is small or locking plates are placed distally, as there are unable inserted calcar screws into the humeral head. We aimed to investigate the suitability of the 2 strategies, slotting calcar screw (SCS) and off-axis calcar screw (OCS), to achieve medial support for PHFs. METHODS Regular calcar screw (RCS), SCS, OCS, and noncalcar screw (NCS) were tested via mechanical experiments and finite element analysis (FEA), using synthetic bones for biomechanical comparisons. All PHFs treated in our hospital from March 2017 to March 2019 were reviewed. The patients were divided into 3 groups based on the calcar screw fixation: RCS, SCS, and OCS. The postoperative varus collapse (neck-shaft angle changed to less than 120°) and Disabilities of the Arm, Shoulder and Hand (DASH) scores were recorded. RESULTS The properties of RCS, SCS, and OCS against the torsion and varus force were superior to those of NCS, whereas the stiffness of SCS, OCS, and RCS were similar. FEA predicted lower peri-screw strains in the OCS and SCS than in the RCS, indicating a lower risk of cut-out. Patients (n = 125; 75 female, 50 male) aged 55.9 ± 13.0 years were evaluated. Compared with the RCS (5/55), varus collapse incidences were not significantly higher following SCS (0/29, P = .094) or OCS (3/41, P = .756), and neither were DASH scores (P = .867 and .736, respectively). CONCLUSIONS This study is a preliminary study demonstrating that the SCS and OCS fixation strategies could be useful alternatives when regular calcar fixation is not possible using the plate at hand.
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Affiliation(s)
- Jian Xu
- Orthopedic Biomechanical Laboratory of Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Shi Zhan
- Orthopedic Biomechanical Laboratory of Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Ming Ling
- Department of Orthopedics, Fudan University Affiliated Huadong Hospital, Shanghai, China
| | - Dajun Jiang
- Orthopedic Biomechanical Laboratory of Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Hai Hu
- Orthopedic Biomechanical Laboratory of Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China; Department of Orthopedic Surgery, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Jiagen Sheng
- Department of Orthopedic Surgery, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Jian Ding
- Department of Orthopedic Surgery, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China.
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Legg HS, Arnold CM, Farthing JP, Lanovaz JL. Age differences in upper extremity joint moments and strength during a laboratory-based tether-release forward fall arrest in older women. J Biomech 2022; 138:111107. [DOI: 10.1016/j.jbiomech.2022.111107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 02/11/2022] [Accepted: 04/25/2022] [Indexed: 11/16/2022]
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C3 geriatric distal humeral fracture - ORIF or replace with an endoprosthesis. Injury 2022; 53:218-220. [PMID: 34980463 DOI: 10.1016/j.injury.2021.12.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Mahdavi M, Farzad M, Mehta SP, MacDermid JC, Vahedi M, Hosseini SA, Shafiee E, Farhoud AR. Severity of persistent pain and disability can accurately screen for presence of pain catastrophizing and fear of performing wrist movements in individuals with distal radius fracture. Musculoskelet Sci Pract 2022; 57:102474. [PMID: 34773896 DOI: 10.1016/j.msksp.2021.102474] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 10/22/2021] [Accepted: 10/27/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND The evidence indicating presence of psychological factors concerns in individuals who report persistent residual pain and disability over a longer term after distal radius fractures (DRF) is emerging but requires further inquiry. OBJECTIVES To examine the associations of persistent wrist pain and disability at 6-months after DRF with the presence of psychological factors. METHODS Eighty-five patients with DRF were evaluated for wrist pain and disability with subscales of Patient-rated wrist evaluation (PRWE), 6-months after the fracture. The associations of wrist pain and disability with these psychological factors at 6-months after DRF were examined using multivariable logistic regression models. The ability of PRWE scores at 6-months after DRF to accurately classify individuals with and without these psychological factors was examined using the area under the receiver operating characteristic curve (AUC). RESULTS Higher PRWE-P scores were significantly associated with worse pain catastrophizing, having emotional distress, and fear of performing wrist movements. In addition, higher PRWE-F scores were also highly associated with worse pain catastrophizing, having emotional distress, and fear of performing wrist movements. The PRWE-P or PRWE-F Scores of ≥18/50 showed the best combination of sensitivity and specificity in identifying individuals with pain catastrophizing, emotional distress, and fear of performing wrist movements at 6-months after DRF (AUC values of ≥0.88). CONCLUSION The novel finding of this study is that scores of ≥18/50 PRWE-P or PRWEF can be used to screen for the presence of these psychological factors.
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Affiliation(s)
- Mohammad Mahdavi
- Department of Occupational Therapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
| | - Maryam Farzad
- School of Physical Therapy, Department of Health and Rehabilitation Sciences, University of Western Ontario, London, Ontario, Canada; University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
| | - Saurabh P Mehta
- School of Physical Therapy, Marshall University, Huntington, WV, USA; Department of Orthopedic Surgery, Joan C Edwards School of Medicine, Marshall University, Huntington, WV, USA.
| | - Joy C MacDermid
- Physical Therapy and Surgery, Western University, London, ON, Canada; Co-director Clinical Research Lab, Hand and Upper Limb Center, St. Joseph's Health Center, London, Ontario, Canada; Professor Rehabilitation Science McMaster University, Hamilton, ON, Canada.
| | - Mohsen Vahedi
- Department of Biostatistics and Epidemiology, University of Social Welfare and Rehabilitation Science, Tehran, Iran.
| | - Seyed Ali Hosseini
- Department of Occupational Therapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
| | - Erfan Shafiee
- School of Physical Therapy, Department of Health and Rehabilitation Sciences, University of Western Ontario, London, Ontario, Canada.
| | - Amir Reza Farhoud
- Imam Hospital Complex, Tehran University of Medical Sciences, Joint Reconstruction Research Center, Iran.
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Dey Hazra RO, Illner J, Szewczyk K, Warnhoff M, Ellwein A, Blach RM, Lill H, Jensen G. Age-Independent Clinical Outcome in Proximal Humeral Fractures: 2-Year Results Using the Example of a Precontoured Locking Plate. J Clin Med 2022; 11:408. [PMID: 35054102 PMCID: PMC8781715 DOI: 10.3390/jcm11020408] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/05/2022] [Accepted: 01/11/2022] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION The optimal treatment strategy for the proximal humeral fracture (PHF) remains controversial. The debate is centered around the correct treatment strategy in the elderly patient population. The present study investigated whether age predicts the functional outcome of locking plate osteosynthesis for this fracture entity. METHODS A consecutive series of patients with surgically treated displaced PHF between 01/2017 and 01/2018 was retrospectively analyzed. Patients were treated by locking plate osteosynthesis. The cohort was divided into two groups: Group 1 (≥65 years) and Group 2 (<65 years). At the follow-up examination, the SSV, CMS, ASES, and Oxford Shoulder Score (OS), as well as a radiological follow-up, was obtained. The quality of fracture reduction is evaluated according to Schnetzke et al. Results: Of the 95 patients, 79 were followed up (83.1%). Group 1 consists of 42 patients (age range: 65-89 years, FU: 25 months) and Group 2 of 37 patients (28-64 years, FU: 24 months). The clinical results showed no significant differences between both groups: SSV 73.4 ± 23.4% (Group 1) vs. 80.5 ± 189% (Group 2). CMS: 79.4 ± 21 vs. 81.9 ± 16, ASES: 77.2 ± 20.4 vs. 77.5 ± 23.1, OS: 39.5 ± 9.1 vs. 40.8 ± 8.2; OS: 39.5 ± 9.1 vs. 40.8 ± 8.2. In the radiological follow-up, fractures healed in all cases. Furthermore, the quality of fracture reduction in both groups is comparable without significant differences. The revision rate was 9.5% in Group 1 vs. 16.2% in Group 2. DISCUSSION Both age groups show comparable functional outcomes and complication rates. Thus, the locking plate osteosynthesis can be used irrespective of patient age; the treatment decision should instead be based on fracture morphology and individual patient factors.
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Affiliation(s)
- Rony-Orijit Dey Hazra
- Department of Orthopedic and Trauma Surgery, Diakovere Friederikenstift and Henriettenstift, 30169 Hannover, Germany; (J.I.); (K.S.); (M.W.); (A.E.); (R.M.B.); (H.L.); (G.J.)
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Rupp M, Kern S, Walter N, Anastasopoulou L, Schnettler R, Heiss C, Alt V. Surgical treatment outcome after serial debridement of infected nonunion-A retrospective cohort study. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2022; 32:183-189. [PMID: 33772662 PMCID: PMC8741665 DOI: 10.1007/s00590-021-02930-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 03/06/2021] [Indexed: 11/15/2022]
Abstract
PURPOSE Reported outcome after multiple staged surgical treatment of infected nonunion is scarce. We, therefore, asked: (1) What is the clinical outcome in infected nonunion patients after multiple staged revision surgery? (2) Are different pathogens evidenced after surgical treatment in patients who have undergone more or less surgeries? METHODS All enrolled patients were surgically treated for long bone-infected nonunion between January 2010 and March 2018. Besides patients´ demographics outcome in terms of bony consolidation and major complications defined as death during inward treatment, amputation and recurrence of infection during follow-up of at least 12 months were assessed. Microbiological findings were assessed and compared between two groups with less than five versus five or more surgical revisions. RESULTS Bone consolidation was achieved in 86% of the patients while complications such as femoral or transtibial amputation, recurrence of infection or even death during inpatient treatment could be evidenced in six patients (14%). In patients who underwent multiple-stage surgery for five or more times, germ changes and repeated germ detection was more common than in patients with less surgeries. CONCLUSIONS Surgical treatment of infected nonunions poses a high burden on the patients with major complications occurring in about 14% of the patients using a multiple staged treatment concept. Future prospective studies comparing outcomes after limited with multiple staged revision surgeries are necessary.
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Affiliation(s)
- Markus Rupp
- Department of Trauma Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany.
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Giessen and Marburg, Campus Giessen, Rudolf-Buchheim-Strasse 7, 35385, Giessen, Germany.
| | - Stefanie Kern
- Experimental Trauma Surgery, Justus-Liebig-University Giessen, Aulweg 128, 35392, Giessen, Germany
| | - Nike Walter
- Department of Trauma Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Lydia Anastasopoulou
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Giessen and Marburg, Campus Giessen, Rudolf-Buchheim-Strasse 7, 35385, Giessen, Germany
| | - Reinhard Schnettler
- Faculty of Medicine, Justus-Liebig-University Giessen, Klinikstrasse 23, 35392, Giessen, Germany
| | - Christian Heiss
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Giessen and Marburg, Campus Giessen, Rudolf-Buchheim-Strasse 7, 35385, Giessen, Germany
- Experimental Trauma Surgery, Justus-Liebig-University Giessen, Aulweg 128, 35392, Giessen, Germany
| | - Volker Alt
- Department of Trauma Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Giessen and Marburg, Campus Giessen, Rudolf-Buchheim-Strasse 7, 35385, Giessen, Germany
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Leino OK, Lehtimäki KK, Mäkelä K, Äärimaa V, Ekman E. Proximal humeral fractures in Finland : trends in the incidence and methods of treatment between 1997 and 2019. Bone Joint J 2022; 104-B:150-156. [PMID: 34969281 DOI: 10.1302/0301-620x.104b1.bjj-2021-0987.r1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
AIMS Proximal humeral fractures (PHFs) are common. There is increasing evidence that most of these fractures should be treated conservatively. However, recent studies have shown an increase in use of operative treatment. The aim of this study was to identify the trends in the incidence and methods of treatment of PHFs in Finland. METHODS The study included all Finnish inhabitants aged ≥ 16 years between 1997 and 2019. All records, including diagnostic codes for PHFs and all surgical procedure codes for these fractures, were identified from two national registers. Data exclusion criteria were implemented in order to identify only acute PHFs, and the operations performed to treat them. RESULTS During the 23-year study period, 79,676 PHFs were identified, and 14,941 operations were performed to treat them. The incidence of PHFs steadily increased. In 2019, the overall incidence was 105 per 100,000 person-years (105). The sex-adjusted incidence for females was 147.1 per 105, and the age-adjusted incidence for patients aged ≥ 80 years was 407.1 per 105. The incidence of operative treatment for PHFs rose during the first half of the study period and decreased during the second half. The use of plate osteosynthesis in particular decreased. In 2019, the incidence of operative treatment for PHFs was 13.2 per 105, with 604 operations. CONCLUSION Although the incidence of PHFs is steadily increasing, particularly in elderly females, the incidence of operative treatment is now decreasing, which is in line with current literature regarding their treatment. Cite this article: Bone Joint J 2022;104-B(1):150-156.
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Affiliation(s)
- Oskari K Leino
- Department of Orthopaedics and Traumatology, Turku University Hospital TYKS, Turku, Finland.,Faculty of Medicine, University of Turku, Turku, Finland
| | - Kaisa K Lehtimäki
- Department of Orthopaedics and Traumatology, Turku University Hospital TYKS, Turku, Finland.,Faculty of Medicine, University of Turku, Turku, Finland
| | - Keijo Mäkelä
- Department of Orthopaedics and Traumatology, Turku University Hospital TYKS, Turku, Finland.,Faculty of Medicine, University of Turku, Turku, Finland
| | - Ville Äärimaa
- Department of Orthopaedics and Traumatology, Turku University Hospital TYKS, Turku, Finland.,Faculty of Medicine, University of Turku, Turku, Finland
| | - Elina Ekman
- Department of Orthopaedics and Traumatology, Turku University Hospital TYKS, Turku, Finland.,Faculty of Medicine, University of Turku, Turku, Finland
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Otake K, Tagami T, Tanaka C, Maejima R, Kanaya T, Kido N, Watanabe A, Mochizuki T, Matsuda K, Yokobori S. Trends in isolated pelvic fracture and 30-day survival over 15 years in Japan: a nationwide observational study from the Japan Trauma Data Bank. J NIPPON MED SCH 2021; 89:309-315. [PMID: 34840215 DOI: 10.1272/jnms.jnms.2022_89-306] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BackgroundThe epidemiology and treatment of isolated pelvic fracture is not well understood in Japan. This study aimed to evaluate epidemiological trends in isolated pelvic trauma and in-hospital survival rates over 15 years.MethodsThis retrospective cohort study analyzed data from the Japan Trauma Data Bank for 2004-2018. Patients of any age with isolated pelvic fracture were grouped according to time period: 2004-2008 (Phase 1), 2009-2013 (Phase 2), and 2014-2018 (Phase 3). The main outcome was 30-day in-hospital survival rate. The data were analyzed using chi-squared, Kruskal-Wallis, and Mantel-Haenszel trend tests. We analyzed changes in the main outcome over time in a multiple logistic regression analysis fitted with a generalized estimating equation, accounting for the within-cluster association.ResultsIn total, 5348 isolated pelvic fractures occurred during the study period. There was no significant between-phase difference in proportions of patients who underwent resuscitative balloon occlusion of the aorta or external fixation. The proportion of patients who underwent transcatheter arterial embolization increased year by year (p=0.003). There was a significant increase in the survival rate over time (Phase 1, 77%; Phase 2, 86%; and Phase 3, 91%; p<0.001). The 30-day in-hospital mortality rate was significantly lower in Phase 3 than in Phase 1 or Phase 2, even after adjustment for hospital clustering and other confounders (p<0.01).ConclusionsThere was an improvement in the 30-day in-hospital survival rate after isolated pelvic fracture over a 15-year period in Japan.
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Affiliation(s)
- Kosuke Otake
- Department of Emergency and Critical Care Center, Nippon Medical School Musashi Kosugi Hospital.,Department of Emergency and Critical Care Medicine, Nippon Medical School
| | - Takashi Tagami
- Department of Emergency and Critical Care Center, Nippon Medical School Musashi Kosugi Hospital.,Department of Emergency and Critical Care Medicine, Nippon Medical School
| | - Chie Tanaka
- Department of Emergency and Critical Care Medicine, Nippon Medical School.,Department of Emergency and Critical Care Center, Nippon Medical School Tama Nagayama Hospital
| | - Riko Maejima
- Department of Emergency and Critical Care Center, Nippon Medical School Musashi Kosugi Hospital.,Department of Emergency and Critical Care Medicine, Nippon Medical School
| | - Takahiro Kanaya
- Department of Emergency and Critical Care Center, Nippon Medical School Musashi Kosugi Hospital.,Department of Emergency and Critical Care Medicine, Nippon Medical School
| | - Norihiro Kido
- Department of Emergency and Critical Care Center, Nippon Medical School Musashi Kosugi Hospital.,Department of Emergency and Critical Care Medicine, Nippon Medical School
| | - Akihiro Watanabe
- Department of Emergency and Critical Care Center, Nippon Medical School Musashi Kosugi Hospital.,Department of Emergency and Critical Care Medicine, Nippon Medical School
| | - Toru Mochizuki
- Department of Emergency and Critical Care Center, Nippon Medical School Musashi Kosugi Hospital.,Department of Emergency and Critical Care Medicine, Nippon Medical School
| | - Kiyoshi Matsuda
- Department of Emergency and Critical Care Center, Nippon Medical School Musashi Kosugi Hospital.,Department of Emergency and Critical Care Medicine, Nippon Medical School
| | - Shoji Yokobori
- Department of Emergency and Critical Care Medicine, Nippon Medical School
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Iliaens J, Onsea J, Hoekstra H, Nijs S, Peetermans WE, Metsemakers WJ. Fracture-related infection in long bone fractures: A comprehensive analysis of the economic impact and influence on quality of life. Injury 2021; 52:3344-3349. [PMID: 34474918 DOI: 10.1016/j.injury.2021.08.023] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 08/18/2021] [Accepted: 08/19/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Fracture-related infection (FRI) is a feared complication with substantial clinical and economic consequences. The main objective of this study was to compare direct and indirect healthcare costs related to long bone fractures in patients with and without FRI and to assess its impact on the patient's quality of life (QoL). PATIENTS AND METHODS Between January 2015 and March 2019, 175 patients with FRI were treated at the University Hospitals Leuven (Belgium). Using a matched-pair analysis, patients with an FRI were matched by age, sex, and fracture location (humeral, femoral, or tibial shaft) to a non-FRI cohort treated during the same time period. Clinical and process-related variables, direct hospital-related healthcare costs, and indirect costs due to absenteeism were compared between the two groups. Furthermore, the patient's QoL was evaluated using Patient-Reported Outcomes Measurement Information System (PROMIS) physical function and pain interference. RESULTS After matched-pair analysis, 15 patients in both the FRI and non-FRI group were included. FRI was associated with direct hospital-related costs being eight times that of non-FRI patients (€ 47,845 [€ 43,072-€ 82,548] vs. € 5,983 [€ 4,519-€ 8,428], p < 0.001). Furthermore, FRI was associated with prolonged absenteeism (340 [340-676] vs. 86 [65-216] days, p = 0.007) and a median indirect cost that was nearly four times that of patients without FRI (€ 77,909 vs. € 19,706). Lastly, FRI patients showed significantly poorer outcomes on both physical function (35.6 vs. 48.4, p < 0.001) and pain interference (60.4 vs. 46.3, p < 0.001) PROMIS scales. CONCLUSION Direct hospital-related healthcare costs of FRI are eight times that of non-FRI long bone fractures. Total healthcare costs are mainly driven by hospitalisation costs, wherein FRI is associated with prolonged length of stay. To the best of our knowledge, this study is the first to demonstrate that FRI is also associated with substantial absenteeism, which is almost four times higher compared to non-FRI patients. In addition to this economic impact, FRI significantly deteriorates QoL. Generalizing the outcome of this study should be done cautiously due to the small sample size of 15 patients in both the FRI and non-FRI group after matched-pair analysis.
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Affiliation(s)
- Jorien Iliaens
- Department of Trauma Surgery, University Hospitals Leuven, Herestraat 49, Leuven 3000, Belgium
| | - Jolien Onsea
- Department of Trauma Surgery, University Hospitals Leuven, Herestraat 49, Leuven 3000, Belgium; Department of Development and Regeneration, KU Leuven, Belgium
| | - Harm Hoekstra
- Department of Trauma Surgery, University Hospitals Leuven, Herestraat 49, Leuven 3000, Belgium; Department of Development and Regeneration, KU Leuven, Belgium
| | - Stefaan Nijs
- Department of Trauma Surgery, University Hospitals Leuven, Herestraat 49, Leuven 3000, Belgium; Department of Development and Regeneration, KU Leuven, Belgium
| | - Willy E Peetermans
- Department of general internal medicine, University Hospitals Leuven, Leuven, Belgium; Department of Microbiology, Immunology and Transplantation, Laboratory of clinical infectious and inflammatory disease, KU Leuven, Belgium
| | - Willem-Jan Metsemakers
- Department of Trauma Surgery, University Hospitals Leuven, Herestraat 49, Leuven 3000, Belgium; Department of Development and Regeneration, KU Leuven, Belgium.
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Neubert A, Jaekel C, Metzendorf MI, Richter B. Surgical versus non-surgical interventions for treating ankle fractures in adults. Hippokratia 2021. [DOI: 10.1002/14651858.cd014930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Anne Neubert
- Department of Orthopaedics and Traumatology; Medical Faculty of the Heinrich-Heine-University Düsseldorf; Düsseldorf Germany
| | - Carina Jaekel
- Department of Orthopaedics and Traumatology; Medical Faculty of the Heinrich-Heine-University Düsseldorf; Düsseldorf Germany
| | | | - Bernd Richter
- Cochrane Metabolic and Endocrine Disorders Group; Institute of General Practice, Medical Faculty of the Heinrich-Heine-University Düsseldorf; Düsseldorf Germany
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Kaftandziev I, Bakota B, Trpeski S, Arsovski O, Spasov M, Cretnik A. The effect of the ankle syndesmosis reduction quality on the short-term functional outcome following ankle fractures. Injury 2021; 52 Suppl 5:S70-S74. [PMID: 33934883 DOI: 10.1016/j.injury.2021.04.047] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 04/11/2021] [Accepted: 04/11/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION A few radiographic techniques have been proposed to evaluate ankle syndesmosis reduction. The purpose of this study was to analyze post-operatively with CT-scanning the quality of ankle syndesmotic reduction. Moreover, to assess the impact of quality of syndesmotic reduction to functional outcome. MATERIALS AND METHODS A prospective cohort study focused on patients older than 17 years with lateral and medial malleolar fracture with verified syndesmotic disruption. EXCLUSION CRITERIA open fracture, concomitant injury, surgery delayed for more than 24 hours, additional posterior malleolar fracture, ASA score of ≥ 3, complication requiring revision surgery, articular step or gap of ≥ 2mm on the postoperative CT scans. RESULTS Out of 41 patients, 34 participants completed the follow-up. There was a male predominance (20 patients - 58.82%) and the mean age was 48.46±16.1 years (range (20-72 years). 22 patients (64.71%) have sustained type B fracture, while in 12 patients (35.29%) the fracture was of a type C. The reduction was classified as anatomical in 26 patients (76.50%), while in 8 patients (23.50%) the reduction of the syndesmosis was non-anatomical. In those 26 patients in whom the reduction was anatomical, 17 (65.39%) were males and there were 18 (66.67%) type B fractures. In the patients with non-anatomical reduction, 3 patients (37.5%) were of a male gender and there was the equal number of type B and C fractures. The statistical analysis showed significantly favorable scores for both AOFAS score and VAS scale for the patients with anatomical reduction. CONCLUSION Functional analysis showed a strong association with the CT observed reduction quality and both the AOFAS score and VAS scale. Further studies are desirable to provide further evidence in relation to the findings of this study.
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Affiliation(s)
- Igor Kaftandziev
- University Clinic of Traumatology - Medical faculty of Skopje, North Macedonia, Macedonia
| | - Bore Bakota
- Trauma and Orthopaedics Department, Medical University Hospital LKH Graz, Austria
| | - Simon Trpeski
- University Clinic of Traumatology - Medical faculty of Skopje, North Macedonia, Macedonia
| | - Oliver Arsovski
- University Clinic of Traumatology - Medical faculty of Skopje, North Macedonia, Macedonia
| | - Marko Spasov
- University Clinic of Traumatology - Medical faculty of Skopje, North Macedonia, Macedonia.
| | - Andrej Cretnik
- Traumatology Department, University Medical Center Maribor, Slovenia
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Lee G, Hasegawa I, Obana K, Min KS. Analyzing outcomes after proximal humerus fractures in patients <65 years: a systematic review and meta-analysis. JSES REVIEWS, REPORTS, AND TECHNIQUES 2021; 1:165-170. [PMID: 37588955 PMCID: PMC10426542 DOI: 10.1016/j.xrrt.2021.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Background There has been an increasing amount of interest and research examining best practices for the treatment of proximal humerus fractures (PHF). Recent, high-level randomized control trials and many retrospective cohort studies have failed to demonstrate clear benefit of surgical management for these injuries especially in the elderly (generally defined as ≥65 years old). There is a paucity of research available on outcomes after surgical and nonsurgical treatment of proximal humerus fractures in adults younger than 65 years, and comparative data are almost nonexistent. The purpose of our study was to perform a systematic review and meta-analysis on the available data to determine if the literature supports surgical management over conservative treatment for PHFs in adults younger than 65 years. Materials and methods Adhering to PRISMA guidelines, a systematic review of proximal humerus fractures was performed using MEDLINE and Google Scholar databases. Studies were included if they reported useable data such as outcome measures for adult patients younger than 65 years. Quality of nonrandomized studies was assessed utilizing the MINORs criteria. Extracted data were analyzed using statistical software with P-value set at 0.05. Results Six studies were included in the study for data extraction and statistical analysis. When comparing Constant Scores (CS) and Oxford Shoulder Scores (OSS) of operatively and nonoperatively treated adult patients aged less than 65 years, no statistical differences were found. Furthermore, no statistical differences in CS or OSS were found comparing elderly patients (defined as ≥65 years) and adult patients (defined as 18 to <65 years). Analysis of DASH outcome data did show statistical differences of the three cohorts (nonoperative <65, operative <65, and operative ≥65). Thus, only the limb-specific (not joint specific) outcome score (DASH) was found to be significantly different upon data analysis. Differences in shoulder-specific outcome scores (OSS and CS) failed to meet significance. Conclusion The available literature does not demonstrate a clear clinical benefit of operative treatment over nonoperative management of proximal humeral fractures in adult patients younger than 65 years. These results challenge the widely accepted practice of choosing surgical treatment in adult patients younger than 65 years with PHFs.
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Affiliation(s)
- Gordon Lee
- Orthopaedic Surgery Department, University of Hawaii – John A. Burns School of Medicine, Honolulu, HI, USA
| | - Ian Hasegawa
- Orthopaedic Surgery Department, University of Hawaii – John A. Burns School of Medicine, Honolulu, HI, USA
| | - Kyle Obana
- Orthopaedic Surgery Department, University of Hawaii – John A. Burns School of Medicine, Honolulu, HI, USA
| | - Kyong S. Min
- Orthopaedic Surgery Department, University of Hawaii – John A. Burns School of Medicine, Honolulu, HI, USA
- Department of Orthopaedic Surgery, Tripler Army Medical Center, Honolulu, HI, USA
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Komisar V, Robinovitch SN. The Role of Fall Biomechanics in the Cause and Prevention of Bone Fractures in Older Adults. Curr Osteoporos Rep 2021; 19:381-390. [PMID: 34105101 DOI: 10.1007/s11914-021-00685-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/22/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW Adults over age 65 experience the highest rates of bone fracture, and 90% of fractures in older adults are caused by falls from standing height or lower. Advances in fracture prevention rely on our ability to prevent falls, reduce the severity of falls, and enhance the resistance of bone to trauma. To help guide these efforts, we need improved understanding on the types of falls that cause fractures. RECENT FINDINGS In this review, we describe recent evidence on how the mechanics of falls in older adults influence the risk for fractures to the hip, wrist, vertebrae, and humerus. We discuss how fracture risk depends on fall height, fall direction, and landing configuration. We also review the benefits of exercise, wearable protective gear, and environmental modifications in preventing fractures in older adults. Our findings highlight promising new directions in fracture prevention, and the need for collaboration between the bone and falls research communities to implement proven strategies and generate new solutions.
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Affiliation(s)
- Vicki Komisar
- School of Engineering, The University of British Columbia, Kelowna, BC, Canada
| | - Stephen Neil Robinovitch
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada.
- School of Engineering Science, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada.
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Spek RWA, Smeeing DPJ, van den Heuvel L, Kokke MC, Bhashyam AR, Kelder JC, Verleisdonk EJMM, Houwert RM, van der Velde D. Complications After Surgical Treatment of Geriatric Ankle Fractures. J Foot Ankle Surg 2021; 60:712-717. [PMID: 33789807 DOI: 10.1053/j.jfas.2019.12.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 12/04/2019] [Indexed: 02/03/2023]
Abstract
The incidence of geriatric ankle fractures is rising and the potential for complications is high in this population. Little is known about factors associated with increased postoperative complications after surgical fixation of ankle fractures in older-age patients. The purpose of this retrospective cohort study was to assess the epidemiology and risk factors for complications after surgically treated ankle fractures in geriatric patients. All patients who were 65 years or older and had a surgically treated ankle fracture were included. Pilon fractures, patients who were initially treated conservatively or who had less than 1 month of follow-up were excluded. Postoperative complications, demographic-, fracture- and surgical data of 282 patients were recorded from two level 2 trauma centers between 2012 and 2017. A total of 87 (30.9%) patients developed a complication, of which wound related complications were most frequently reported. Superficial and deep wound infections were observed in 27 (9.6%) and 18 (6.4%) patients, respectively. Multivariate regression analysis demonstrated increased age to be an independent predictive variable for the occurrence of postoperative complications (odds ratio 1.04; 95% confidence interval 1.00-1.09), while cast immobilization for more than 2 weeks was a protective factor for the development of wound related complications (odds ratio 0.34; 95% confidence interval 0.17-0.66). In conclusion, the incidence of postoperative complications among geriatric patients after surgical treatment of ankle fractures is high and patients should be informed accordingly.
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Affiliation(s)
- Reinier W A Spek
- Medical Student, Department of Trauma, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Diederik P J Smeeing
- Surgical Resident, Department of Surgery, Slingeland Hospital, Doetinchem, The Netherlands
| | - Linda van den Heuvel
- Physician Assistant, Department of Surgery, St Antonius Hospital, Utrecht, The Netherlands
| | - Marike C Kokke
- Trauma Surgeon, Department of Surgery, St Antonius Hospital, Utrecht, The Netherlands
| | - Abhiram R Bhashyam
- Resident, Harvard Combined Orthopaedic Surgery Residency Program, Boston, MA
| | - Johannes C Kelder
- Medical Doctor, Department of Cardiology, St Antonius Hospital, Nieuwegein, The Netherlands
| | | | - Roderick M Houwert
- Trauma Surgeon, Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands; Trauma Surgeon, Utrecht Trauma Center, Utrecht, The Netherlands
| | - Detlef van der Velde
- Trauma Surgeon, Department of Surgery, St Antonius Hospital, Utrecht, The Netherlands
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Fenelon C, Galbraith JG, Fahey T, Kearns SR. The Operative Treatment of Ankle Fractures: A 10-Year Retrospective Study of 1529 Patients. J Foot Ankle Surg 2021; 60:663-668. [PMID: 33509713 DOI: 10.1053/j.jfas.2020.03.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 03/19/2020] [Accepted: 03/29/2020] [Indexed: 02/03/2023]
Abstract
Ankle fractures are the second most common fracture of the lower limb and account for nearly 10% of all fractures. They range from simple to complex injuries and approximately 40% require surgical intervention. The aim of our study was to provide an up-to-date reference of the epidemiology, fracture, and fixation characteristics of operatively treated ankle fractures. We also sought to determine the number of patients undergoing further surgery through revision, implant removal, or ankle fusion. A retrospective observational study was conducted of 1529 consecutive patients that underwent operative intervention for an unstable ankle fracture between 2007 and 2017. Fractures of the distal tibia and pilon injuries were excluded. The mean age of patients was 41.8 years with 50.7% male. Unimalleolar fixation was performed in 60.1%, while bimalleolar and trimalleolar fixation was performed in 31.2% and 5%, respectively. Isolated syndesmotic fixation was performed in 3.8%. A posterior malleolus fracture was present in 28.6%, of which 31.6% underwent fixation. A further procedure was performed in 234 (15.3%) patients. Revision open reduction internal fixation was required in 1.4% and 0.8% underwent future ankle fusion. Treatment of ankle fractures makes up a sizeable part of orthopedic trauma practice with more than 1 in 7 patients requiring a second procedure. More complex fractures were predominantly seen in older females, while patients who suffered trimalleolar fractures have an increased likelihood of requiring future ankle fusion or revision. Despite this the rate of ankle fusion was <1%.
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Affiliation(s)
- Christopher Fenelon
- Orthopaedic Registrar, Department of Orthopaedic Surgery, Galway University Hospital, Galway, Ireland.
| | - John G Galbraith
- Consultant Orthopaedic Surgeon, Department of Orthopaedic Surgery, Galway University Hospital, Galway, Ireland
| | - Tom Fahey
- Professor of General Practice, Department of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Stephen R Kearns
- Professor and Consultant Orthopaedic Surgeon, Department of Orthopaedic Surgery, Galway University Hospital, Galway, Ireland
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Mortality after distal femur fractures in the elderly. Injury 2021; 52 Suppl 4:S71-S75. [PMID: 33992422 DOI: 10.1016/j.injury.2021.03.066] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 03/01/2021] [Accepted: 03/02/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION the frequency of distal femur fractures in the elderly is rapidly increasing. A study of these fractures was conducted in our center in order to evaluate the comorbidities and the mortality associated with this entity. MATERIAL AND METHODS all the distal femur fractures by low energy in patients over 65 years old at a tertiary center were included, between January 2010 and December 2016. Baseline characteristics, the type of fracture, comorbidities, and functional status before admission, were collected. The relationship of each of these variables to the final functional class, immediate and late complications and mortality during the follow-up. Fifty-nine patients were included, with a median age of 85.3 years (IQR 78.6-91.6). Fifty-one patients were women. In 10 patients, the fractures were atraumatic (postural change mainly in non-walking patients), and in 54 of the cases were treated surgically (6 with retrograde intramedullary nailing and 48 with lateral locking plate). The median time to surgery was 4.5 days (IQR 2-6) and 14 patients were operated within 48 hours. The median follow-up was 26.3 months. RESULTS fourteen patients died during the first year of follow-up. Factors independently associated with death during the first year after the fracture were: conservative treatment, and the inability to ambulate before the episode. The absence of certain comorbidities, such as chronic heart disease, and cancer, and an age under 80 years, behaved as protective factors. CONCLUSION low-energy distal femur fractures comprise a severe injury in the elderly and are associated with high mortality. Surgical treatment showed better outcomes in terms of survival, with no significant differences depending on the type of fracture, the type of implant or the median time to surgery.
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Reider L, Pollak A, Wolff JL, Magaziner J, Levy JF. National trends in extremity fracture hospitalizations among older adults between 2003 and 2017. J Am Geriatr Soc 2021; 69:2556-2565. [PMID: 34062611 DOI: 10.1111/jgs.17281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 04/29/2021] [Accepted: 05/01/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND Fractures in late life are highly consequential for health, services use, and spending. Little is known about trends in extremity fracture hospitalizations among older adults in the United States. DESIGN Retrospective longitudinal cohort study. SETTING The 2003-2017 National Inpatient Sample (NIS), a representative sample of U.S. community hospitals. PARTICIPANTS Hospitalized adults aged 65 and older with a diagnosis of upper or lower extremity fracture. MEASUREMENTS Incidence of extremity fracture hospitalization and mortality, using NIS discharge and trend weights, and population denominators derived from the U.S. Census Bureau. Incidence was reported separately for men and women by age, fracture diagnosis, and injury mechanism. Weighted linear regression was used to test for significant trends over time. RESULTS Incidence of extremity fracture hospitalizations declined in both women (15.7%, p trend < 0.001) and men (3.2%, p trend < 0.001) between 2003 and 2017. This trend was primarily attributed to a decline in low energy femur fractures which accounted for 65% of all fracture hospitalizations. Among older adults with an extremity fracture hospitalization, mortality declined from 5.1% in 2003 to 3.3% in 2017 in men, and from 2.6% to 1.9% in women (p trend < 0.001). High energy fractures were due to falls (53%), motor vehicle accidents (34%), and other high impact injuries (13%). Overall, 12% of extremity fracture hospitalizations were attributed to high-energy injuries: increases were observed among men ages 65-74 (20%; p trend < 0.001) and 75-84 (10%; p trend = 0.013), but not among women of any age. CONCLUSION Observed declines in the incidence of extremity fracture hospitalizations and related mortality are encouraging. However, increasing incidence of fracture hospitalization from high energy injuries among men suggests that older adults with complex injuries will be seen with more prevalence in the future.
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Affiliation(s)
- Lisa Reider
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Andrew Pollak
- School of Medicine, Department of Orthopaedics, University of Maryland, Baltimore, Maryland, USA
| | - Jennifer L Wolff
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jay Magaziner
- School of Medicine, Department of Epidemiology and Public Health, University of Maryland, Baltimore, Maryland, USA
| | - Joseph F Levy
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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