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Zhang W, Chen P, Qi J, Fan Z, Yu X, Wang H. Impact of the nail insertion angle on the wedge effect in intramedullary nail fixation of intertrochanteric hip fractures. Orthop Traumatol Surg Res 2024:103989. [PMID: 39245265 DOI: 10.1016/j.otsr.2024.103989] [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: 05/03/2024] [Revised: 08/09/2024] [Accepted: 09/05/2024] [Indexed: 09/10/2024]
Abstract
BACKGROUND The wedge effect is known to be influenced by the insertion of the proximal femoral intramedullary nail through the fracture line and the large proximal diameter of the nail. However, the impact of the nail insertion angle (NIA) on the wedge effect remains unclear. This study aimed to investigate: (1) how to evaluate the NIA intraoperatively, (2) whether the NIA is associated with the wedge effect, (3) whether the NIA can serve as a reliable predictor of the wedge effect, (4) which factors affect the NIA, and (5) which surgical techniques can prevent the occurrence of the wedge effect associated with the NIA. HYPOTHESIS We hypothesized that an excessive NIA is related to the wedge effect and that lateral deviation of the entry point is associated with an excessive NIA. PATIENTS AND METHODS Intraoperative fluoroscopy images of patients who underwent intramedullary nail fixation for intertrochanteric hip fractures between 2013 and 2023 were analyzed. NIA and insertion point distance (IPD) were measured on hip anteroposterior radiographs with the guidewire inserted. Femoral shaft lateralization (FSL) and neck-shaft angle (NSA) were measured on hip anteroposterior radiographs before and after nail insertion; differences in FSL and NSA were calculated. A negative difference in FSL combined with a positive difference in NSA indicated the occurrence of the wedge effect. Pearson's correlation test was used to determine relationships between continuous variables (NIA, FSL, NSA, and IPD). Binary logistic regression analyzed the association between NIA and the wedge effect. Receiver operating characteristic (ROC) curve analysis was used to determine the threshold value of NIA, with predictive performance assessed using the area under the ROC curve (AUC). Other potential factors influencing the wedge effect were also examined. RESULTS A total of 408 patients were included. The mean NIA was 15.61 ± 4.49 °. Post-nail insertion, the average increase in FSL was 3.20 mm, and the average decrease in NSA was 1.90 °. Pearson's correlation test revealed that NIA was negatively correlated with the difference in FSL (R = 0.565, P < 0.001) and positively correlated with the difference in NSA (R = 0.509, P < 0.001). Binary logistic regression showed a significant correlation between NIA and the wedge effect (P < 0.001). ROC analysis indicated that the AUC for NIA was 0.813, with an optimal cutoff point of 14.85 °. IPD was positively correlated with NIA (R = 0.519, P < 0.001). Unstable fractures were associated with increased lateralization of the femoral shaft after nail insertion (P = 0.003). DISCUSSION The NIA is positively correlated with the wedge effect in intramedullary nail fixation of intertrochanteric hip fractures. The wedge effect tends to occur when the NIA is >14.85 °, particularly in unstable fractures. Lateral deviation of the entry point is associated with an excessive NIA. Adducting the affected limb, moving the entry point slightly medial and using a medial pusher may help control the NIA to less than 14.85 ° to reduce the wedge effect. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Wenhui Zhang
- Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, 510006 Guangzhou, China
| | - Ping Chen
- Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, 510006 Guangzhou, China
| | - Ji Qi
- Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, 510006 Guangzhou, China
| | - Zhirong Fan
- Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, 510006 Guangzhou, China
| | - Xiubing Yu
- Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, 510006 Guangzhou, China
| | - Haizhou Wang
- Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, 510006 Guangzhou, China.
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2
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Mekkawy KL, Chaudhry YP, Mowers C, Wenzel A, Raad M, Rao SS, Sotsky RB, Khanuja HS, Amin RM. Comparison of estimated glomerular filtration rate using five equations to predict acute kidney injury following hip fracture surgery. Orthop Traumatol Surg Res 2024:103987. [PMID: 39241909 DOI: 10.1016/j.otsr.2024.103987] [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: 08/18/2022] [Revised: 07/22/2024] [Accepted: 09/03/2024] [Indexed: 09/09/2024]
Abstract
BACKGROUND Decreased estimated glomerular filtration rate (eGFR) is associated with acute kidney injury (AKI) following hip fracture surgery. Delaying surgery for preoperative treatment of comorbidities is controversial in this patient population. The purpose of this study was 1) to assess differences in demographics and comorbidities between AKI and non-AKI groups, 2) to analyze equations used in calculating eGFR, and 3) to identify the equation which best predicts the development of AKI following hip fracture surgery. We hypothesize that one of the equations used to calculate eGFR will be superior to the others. PATIENTS AND METHODS 124,002 cases of hip fracture surgery were performed from 2012 to 2019, based upon a query of the National Surgical Quality Improvement Program (NSQIP). Preoperative eGFR was calculated using the following: Modification of Diet in Renal Disease (MDRD) II, re-expressed MDRD II, Chronic Kidney Disease Epidemiology Collaboration, Mayo quadratic, and Cockcroft-Gault equations. Independent associations between preoperative eGFR and postoperative renal failure were evaluated using multivariate regression analysis. The predictive ability of each equation was determined using the Akaike information criterion (AIC). RESULTS AKI was diagnosed in 584 (0.71%) out of the 82,326 patients following hip fracture surgery. The AKI and no AKI cohorts differed significantly by patient sex (p = <0.001), race (p = <0.001), BMI (p = < 0.001), preoperative hematocrit (p = <0.001), preoperative albumin (p = <0.001), diabetes mellitus (p = <0.001), hypertension (p = <0.001), and congestive heart failure (p = <0.001). The Mayo equation (84.0 ± 23.7) was the equation with the highest calculated mean eGFR, followed by the CKD-EPI equation (83.6 ± 20.0), MDRD II equation (83.0 ± 38.9), CG equation (74.7 ± 35.5), and finally the re-expressed MDRD II equation (68.5 ± 36.0) which had the lowest calculated mean eGFR.. All five equations detected that a decrease in preoperative eGFR was associated with an increased risk of postoperative AKI. Lower preoperative eGFR, as calculated by each of the five equations, was significantly associated with an increased risk of AKI following surgical fixation of hip fracture. The AIC was the lowest in the Mayo equation, demonstrating the best fit of the equations to predict postoperative AKI CONCLUSIONS: We propose that using the equation that best identifies those at risk of developing postoperative AKI may help with perioperative decision making and treatment to improve outcomes, which we found to be the Mayo equation. The risk of postoperative AKI was independently associated with decreased preoperative eGFR. The results of this study may warrant further investigation utilizing prospective studies. LEVEL OF EVIDENCE III; retrospective cohort study.
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Affiliation(s)
- Kevin L Mekkawy
- From the Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Yash P Chaudhry
- From the Department of Orthopaedic Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA
| | - Colton Mowers
- From the Department of Orthopaedic Surgery, Rush University, Chicago, IL, USA
| | - Alyssa Wenzel
- From the Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Micheal Raad
- From the Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sandesh S Rao
- From the Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Rachel B Sotsky
- From the Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Harpal S Khanuja
- From the Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Raj M Amin
- From the Department of Orthopaedic Surgery, Rush University, Chicago, IL, USA; From the Department of Orthopaedic Surgery, University of California San Francisco, University Orthopaedic Associates, Fresno, CA, USA
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Saad BN, Menken LG, Keller DM, Rampertaap Y, Tang A, Hong IS, Liporace FA, Yoon RS, Jankowski JM. Does a delay to surgery for preoperative echocardiogram affect outcomes in patients with hip fracture? OTA Int 2024; 7:e338. [PMID: 38863460 PMCID: PMC11164006 DOI: 10.1097/oi9.0000000000000338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 04/10/2024] [Accepted: 04/16/2024] [Indexed: 06/13/2024]
Abstract
Introduction Delay to surgery >24 hours has been shown to correlate with mortality rates in patients with hip fracture when left untreated. Many of these patients have multiple comorbidities, including aortic stenosis (AS), and undergo workup for operative clearance, which may delay time to surgery. The purpose of this study was to examine whether preoperative echocardiogram workup affects time to surgery, complications, and mortality after operative fixation for hip fracture. Methods Our institutional hip fracture registry was retrospectively reviewed for inclusion over a 3-year period. Patients who had a preoperative echocardiogram (yECHO) for operative clearance were compared with those who did not (nECHO). Demographic data, time to surgery, overall complication rate, and mortality at 30 days, 90 days, and 1 year were collected. Results Two cohorts consisted of 136 yECHO patients (45.8%) and 161 nECHO patients (54.2%). Thirty-two yECHO patients (23.5%) had AS. Patients in the yECHO cohort were more likely to have a complication for any cause compared with nECHO patients (25.7% vs. 10.6%, P = 0.01) and have a higher mortality rate at 1 year (38.9% vs. 17.4%, P = 0.001). There was no association found between AS and all-cause complication (P = 0.54) or 30-day (P = 0.13) or 90-day mortality rates (P = 0.79). However, patients with AS had a significantly higher mortality rate at 1 year (45.8% vs. 25.1%, P = 0.03). Conclusion This study reinforces the benefits of ensuring less than a 24-hour time to surgery in the setting of a hip fracture and identifies an area of preoperative management that can be further optimized to prevent unnecessary prolongation in time to surgery. Patients with known aortic stenosis are not associated with increased 30-day or 90-day mortality or all-cause complications. Surgical delays in the yECHO cohort were attributed to preoperative medical assessments, including echocardiograms and the management of comorbidities. Therefore, the selective utilization of preoperative echocardiograms is needed and should be reserved to ensure they have a definitive role in guiding the perioperative care of patients with hip fracture. Level of Evidence III.
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Affiliation(s)
- Bishoy N. Saad
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center—RWJBarnabas Health, Livingston/Jersey City, NJ
| | - Luke G. Menken
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center—RWJBarnabas Health, Livingston/Jersey City, NJ
| | - David M. Keller
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center—RWJBarnabas Health, Livingston/Jersey City, NJ
| | - Yajesh Rampertaap
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center—RWJBarnabas Health, Livingston/Jersey City, NJ
| | - Alex Tang
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center—RWJBarnabas Health, Livingston/Jersey City, NJ
| | - Ian S. Hong
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center—RWJBarnabas Health, Livingston/Jersey City, NJ
| | - Frank A. Liporace
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center—RWJBarnabas Health, Livingston/Jersey City, NJ
| | - Richard S. Yoon
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center—RWJBarnabas Health, Livingston/Jersey City, NJ
| | - Jaclyn M. Jankowski
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center—RWJBarnabas Health, Livingston/Jersey City, NJ
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Chen CM, Huang WT, Sung SF, Hsu CC, Hsu YH. Statin use associated with a reduced risk of hip fracture in patients with gout. Bone Rep 2024; 22:101799. [PMID: 39252698 PMCID: PMC11381807 DOI: 10.1016/j.bonr.2024.101799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 06/27/2024] [Accepted: 08/18/2024] [Indexed: 09/11/2024] Open
Abstract
Studies show that statins users are at reduced risk of fracture and improved bone mineral density. However, the clinical effectiveness of statin use in patients with gout has not been investigated. This retrospective cohort study used data from Taiwan's National Health Insurance Research Database, consisting of 3443 patients with gout using statins aged 50 years and above and 6886 gout patients of non-statin users matched by sex, age and propensity score. The Cox proportional hazards regression analysis showed that statin use was associated with a reduced risk of hip fracture (adjusted hazard ratio [aHR] = 0.78, 95 % confidence interval [CI] = 0.64-0.94) after controlling for potential confounding factors. The association was significant in both genders aged 50-64 years, with aHRs of near 0.35, but not in the elderly. In addition, women aged 50-64 years who used statins also exhibited a lower risk of vertebral fracture (aHR = 0.70, 95 % CI = 0.50-0.99), but not men. In conclusion, the stating use in gout patients could reduce fracture risk for younger patients. Further research is warranted to confirm these findings.
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Affiliation(s)
- Chun-Ming Chen
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi 60002, Taiwan
| | - Wan-Ting Huang
- Clinical Medicine Research Center, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi 60002, Taiwan
| | - Sheng-Feng Sung
- Division of Neurology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi 60002, Taiwan
- Department of Beauty & Health Care, Min-Hwei Junior College of Health Care Management, Tainan 73658, Taiwan
| | - Chih-Cheng Hsu
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli 35053, Taiwan
- Department of Family Medicine, Min-Sheng General Hospital, Taoyuan 33044, Taiwan
| | - Yueh-Han Hsu
- Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi 60002, Taiwan
- Department of Nursing, Min-Hwei Junior College of Health Care Management, Tainan 73658, Taiwan
- Department of Medical Research, China Medical University Hospital, Taichung 40447, Taiwan
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Niu X, Xiao S, Huang R, Huang D, Aifantis KE, Yu H, Xue C, Yin L, Dunne N, Li X. ZIF-8-modified hydrogel sequentially delivers angiogenic and osteogenic growth factors to accelerate vascularized bone regeneration. J Control Release 2024; 374:154-170. [PMID: 39127448 DOI: 10.1016/j.jconrel.2024.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Revised: 08/05/2024] [Accepted: 08/07/2024] [Indexed: 08/12/2024]
Abstract
To realize high-quality vascularized bone regeneration, we developed a multifunctional hydrogel (SHPP-ZB) by incorporating BMP-2@ZIF-8/PEG-NH2 nanoparticles (NPs) into a sodium alginate/hydroxyapatite/polyvinyl alcohol hydrogel loaded with PDGF-BB, allowing for the sequential release of angiogenic and osteogenic growth factors (GFs) during bone repair. ZIF-8 served as a protective host for BMP-2 from degradation, ensuring high encapsulation efficiency and long-term bioactivity. The SHPP-ZB hydrogel exhibited enhanced mechanical strength and injectability, making it suitable for complex bone defects. It provided a swelling interface for tissue interlocking and the early release of Zn2+ and tannin acid (TA) to exert antioxidant and antibacterial effects, followed by the sequential release of angiogenic and osteogenic GFs to promote high-quality vascularized bone regeneration. In vitro experiments demonstrated the superior angiogenic and osteogenic properties of SHPP-ZB compared to other groups. In vivo experiments indicated that the sequential delivery of GFs via SHPP-ZB hydrogel could improve vascularized bone regeneration. Further, RNA sequencing analysis of regenerative bone tissue revealed that SHPP-ZB hydrogel promoted vascularized bone regeneration by regulating JUN, MAPK, Wnt, and calcium signaling pathways in vivo. This study presented a promising approach for efficient vascularized bone regeneration in large-scale bone defects.
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Affiliation(s)
- Xiaolian Niu
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing 100083, China
| | - Shengzhao Xiao
- Department of Orthodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology; Shanghai Research Institute of Stomatology, Shanghai 200011, China.
| | - Ruoyu Huang
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing 100083, China
| | - Di Huang
- Department of Biomedical Engineering, Research Center for Nano-Biomaterials & Regenerative Medicine, College of Biomedical Engineering, Taiyuan University of Technology, Taiyuan 030024, China
| | - Katerina E Aifantis
- Department of Mechanical and Aerospace Engineering, University of Florida, Gainesville, FL 32611, USA
| | - Han Yu
- Senior Department of Orthopedics, the Fourth Medical Center of PLA General Hospital, Beijing 100048, China
| | - Chao Xue
- Senior Department of Orthopedics, the Fourth Medical Center of PLA General Hospital, Beijing 100048, China
| | - Lan Yin
- Key Laboratory of Advanced Materials of Ministry of Education, Tsinghua University, Beijing 100084, China
| | - Nicholas Dunne
- Centre for Medical Engineering Research, School of Mechanical and Manufacturing Engineering, Dublin City University, Stokes Building, Collins Avenue, Dublin 9, Ireland
| | - Xiaoming Li
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing 100083, China.
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Gao Y, Zhong F, Zhan X, Bao Y, Zhu X. Postoperative rehabilitation exercise experiences of geriatric patients with femoral neck fractures based on the perspective of medical staff: a qualitative study. BMC Geriatr 2024; 24:667. [PMID: 39117996 PMCID: PMC11308417 DOI: 10.1186/s12877-024-05266-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 07/31/2024] [Indexed: 08/10/2024] Open
Abstract
BACKGROUND The incidence of femoral neck fractures in older adults is increasing each year. Active and reasonable postoperative rehabilitation exercises can restore the activity of geriatric patients with femoral neck fractures to a great extent, while also avoiding bedridden complications and re-fractures. This study explores the perspectives, experiences, and recommendations of medical staff regarding the implementation status, existing problems, promoting factors, and hindering factors of post-surgical rehabilitation exercises for geriatric patients with femoral neck fractures. The ultimate goal is to further optimize rehabilitation exercise programs and to expedite this process for patients. METHODS A qualitative, descriptive phenomenological study was conducted. A total of 21 clinical medical staff were selected using the purposive sampling method for semi-structured interviews. A content analysis method was used to collate and analyze the collected interview data. RESULTS A total of 2 themes and 6 sub-themes were defined. The themes consisted of multiple obstacles occurring during the implementation of rehabilitation exercises and the scientific cognition of medical staff on these exercises. Respondents found that patient initiative during rehabilitation exercises was insufficient, that the comprehensiveness and continuity of exercises could not be guaranteed, and that unification between textbook theory and clinical practice was incomplete. Moreover, respondents believed that their professional quality should be excellent, but that staffing and organizational management required optimization, and that support was required for the implementation of rehabilitation exercises. CONCLUSION This study investigated the opinions and experiences of medical staff during postoperative rehabilitation exercises in geriatric patients with femoral neck fractures. Collaborative efforts should fully engage hospitals, communities, and families, enhance the alignment of health education with patient needs, advance the scientific development of an integrated medical model by refining the curriculum and teaching system, and significantly elevate the level of medical science and technology. This study will serve as a valuable reference for the establishment of future professional, and personalized rehabilitation programs tailored for geriatric patients with femoral neck fractures.
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Affiliation(s)
- Yazhuo Gao
- School of Nursing, Zhejiang Chinese Medical University, Hangzhou, 310053, China
| | - Fangfang Zhong
- School of Nursing, Zhejiang Chinese Medical University, Hangzhou, 310053, China
| | - Xiaoyan Zhan
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, 310006, China
| | - Yunchun Bao
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, 310006, China
| | - Xuehua Zhu
- School of Nursing, Zhejiang Chinese Medical University, Hangzhou, 310053, China.
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7
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Nietsch KS, Shrestha N, Mazudie Ndjonko LC, Ahmed W, Mejia MR, Zaidat B, Ren R, Duey AH, Li SQ, Kim JS, Hidden KA, Cho SK. Can Large Language Models (LLMs) Predict the Appropriate Treatment of Acute Hip Fractures in Older Adults? Comparing Appropriate Use Criteria With Recommendations From ChatGPT. J Am Acad Orthop Surg Glob Res Rev 2024; 8:01979360-202408000-00007. [PMID: 39137403 PMCID: PMC11319315 DOI: 10.5435/jaaosglobal-d-24-00206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Accepted: 06/16/2024] [Indexed: 08/15/2024]
Abstract
BACKGROUND Acute hip fractures are a public health problem affecting primarily older adults. Chat Generative Pretrained Transformer may be useful in providing appropriate clinical recommendations for beneficial treatment. OBJECTIVE To evaluate the accuracy of Chat Generative Pretrained Transformer (ChatGPT)-4.0 by comparing its appropriateness scores for acute hip fractures with the American Academy of Orthopaedic Surgeons (AAOS) Appropriate Use Criteria given 30 patient scenarios. "Appropriateness" indicates the unexpected health benefits of treatment exceed the expected negative consequences by a wide margin. METHODS Using the AAOS Appropriate Use Criteria as the benchmark, numerical scores from 1 to 9 assessed appropriateness. For each patient scenario, ChatGPT-4.0 was asked to assign an appropriate score for six treatments to manage acute hip fractures. RESULTS Thirty patient scenarios were evaluated for 180 paired scores. Comparing ChatGPT-4.0 with AAOS scores, there was a positive correlation for multiple cannulated screw fixation, total hip arthroplasty, hemiarthroplasty, and long cephalomedullary nails. Statistically significant differences were observed only between scores for long cephalomedullary nails. CONCLUSION ChatGPT-4.0 scores were not concordant with AAOS scores, overestimating the appropriateness of total hip arthroplasty, hemiarthroplasty, and long cephalomedullary nails, and underestimating the other three. ChatGPT-4.0 was inadequate in selecting an appropriate treatment deemed acceptable, most reasonable, and most likely to improve patient outcomes.
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Affiliation(s)
- Katrina S. Nietsch
- From the Icahn School of Medicine at Mount Sinai, New York, NY (Ms. Nietsch, Mr. Ahmed, Mr. Mejia, Mr. Zaidat, Ms. Ren, and Mr. Duey); the Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL (Ms. Shrestha); the Northwestern University, Chicago, IL (Ms. Mazudie Ndjonko); the PGY-6, Department of Orthopedic Surgery and Neurosurgery, Mount Sinai Hospital, New York, NY (Dr. Li); the Department of Orthopedics and Orthopedic Surgery, Mount Sinai Hospital, New York, NY (Dr. Kim); the Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN (Dr. Hidden); and the Department of Orthopedic Surgery and Neurosurgery, Mount Sinai Hospital, New York, NY (Dr. Cho)
| | - Nancy Shrestha
- From the Icahn School of Medicine at Mount Sinai, New York, NY (Ms. Nietsch, Mr. Ahmed, Mr. Mejia, Mr. Zaidat, Ms. Ren, and Mr. Duey); the Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL (Ms. Shrestha); the Northwestern University, Chicago, IL (Ms. Mazudie Ndjonko); the PGY-6, Department of Orthopedic Surgery and Neurosurgery, Mount Sinai Hospital, New York, NY (Dr. Li); the Department of Orthopedics and Orthopedic Surgery, Mount Sinai Hospital, New York, NY (Dr. Kim); the Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN (Dr. Hidden); and the Department of Orthopedic Surgery and Neurosurgery, Mount Sinai Hospital, New York, NY (Dr. Cho)
| | - Laura C. Mazudie Ndjonko
- From the Icahn School of Medicine at Mount Sinai, New York, NY (Ms. Nietsch, Mr. Ahmed, Mr. Mejia, Mr. Zaidat, Ms. Ren, and Mr. Duey); the Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL (Ms. Shrestha); the Northwestern University, Chicago, IL (Ms. Mazudie Ndjonko); the PGY-6, Department of Orthopedic Surgery and Neurosurgery, Mount Sinai Hospital, New York, NY (Dr. Li); the Department of Orthopedics and Orthopedic Surgery, Mount Sinai Hospital, New York, NY (Dr. Kim); the Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN (Dr. Hidden); and the Department of Orthopedic Surgery and Neurosurgery, Mount Sinai Hospital, New York, NY (Dr. Cho)
| | - Wasil Ahmed
- From the Icahn School of Medicine at Mount Sinai, New York, NY (Ms. Nietsch, Mr. Ahmed, Mr. Mejia, Mr. Zaidat, Ms. Ren, and Mr. Duey); the Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL (Ms. Shrestha); the Northwestern University, Chicago, IL (Ms. Mazudie Ndjonko); the PGY-6, Department of Orthopedic Surgery and Neurosurgery, Mount Sinai Hospital, New York, NY (Dr. Li); the Department of Orthopedics and Orthopedic Surgery, Mount Sinai Hospital, New York, NY (Dr. Kim); the Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN (Dr. Hidden); and the Department of Orthopedic Surgery and Neurosurgery, Mount Sinai Hospital, New York, NY (Dr. Cho)
| | - Mateo Restrepo Mejia
- From the Icahn School of Medicine at Mount Sinai, New York, NY (Ms. Nietsch, Mr. Ahmed, Mr. Mejia, Mr. Zaidat, Ms. Ren, and Mr. Duey); the Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL (Ms. Shrestha); the Northwestern University, Chicago, IL (Ms. Mazudie Ndjonko); the PGY-6, Department of Orthopedic Surgery and Neurosurgery, Mount Sinai Hospital, New York, NY (Dr. Li); the Department of Orthopedics and Orthopedic Surgery, Mount Sinai Hospital, New York, NY (Dr. Kim); the Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN (Dr. Hidden); and the Department of Orthopedic Surgery and Neurosurgery, Mount Sinai Hospital, New York, NY (Dr. Cho)
| | - Bashar Zaidat
- From the Icahn School of Medicine at Mount Sinai, New York, NY (Ms. Nietsch, Mr. Ahmed, Mr. Mejia, Mr. Zaidat, Ms. Ren, and Mr. Duey); the Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL (Ms. Shrestha); the Northwestern University, Chicago, IL (Ms. Mazudie Ndjonko); the PGY-6, Department of Orthopedic Surgery and Neurosurgery, Mount Sinai Hospital, New York, NY (Dr. Li); the Department of Orthopedics and Orthopedic Surgery, Mount Sinai Hospital, New York, NY (Dr. Kim); the Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN (Dr. Hidden); and the Department of Orthopedic Surgery and Neurosurgery, Mount Sinai Hospital, New York, NY (Dr. Cho)
| | - Renee Ren
- From the Icahn School of Medicine at Mount Sinai, New York, NY (Ms. Nietsch, Mr. Ahmed, Mr. Mejia, Mr. Zaidat, Ms. Ren, and Mr. Duey); the Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL (Ms. Shrestha); the Northwestern University, Chicago, IL (Ms. Mazudie Ndjonko); the PGY-6, Department of Orthopedic Surgery and Neurosurgery, Mount Sinai Hospital, New York, NY (Dr. Li); the Department of Orthopedics and Orthopedic Surgery, Mount Sinai Hospital, New York, NY (Dr. Kim); the Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN (Dr. Hidden); and the Department of Orthopedic Surgery and Neurosurgery, Mount Sinai Hospital, New York, NY (Dr. Cho)
| | - Akiro H. Duey
- From the Icahn School of Medicine at Mount Sinai, New York, NY (Ms. Nietsch, Mr. Ahmed, Mr. Mejia, Mr. Zaidat, Ms. Ren, and Mr. Duey); the Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL (Ms. Shrestha); the Northwestern University, Chicago, IL (Ms. Mazudie Ndjonko); the PGY-6, Department of Orthopedic Surgery and Neurosurgery, Mount Sinai Hospital, New York, NY (Dr. Li); the Department of Orthopedics and Orthopedic Surgery, Mount Sinai Hospital, New York, NY (Dr. Kim); the Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN (Dr. Hidden); and the Department of Orthopedic Surgery and Neurosurgery, Mount Sinai Hospital, New York, NY (Dr. Cho)
| | - Samuel Q. Li
- From the Icahn School of Medicine at Mount Sinai, New York, NY (Ms. Nietsch, Mr. Ahmed, Mr. Mejia, Mr. Zaidat, Ms. Ren, and Mr. Duey); the Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL (Ms. Shrestha); the Northwestern University, Chicago, IL (Ms. Mazudie Ndjonko); the PGY-6, Department of Orthopedic Surgery and Neurosurgery, Mount Sinai Hospital, New York, NY (Dr. Li); the Department of Orthopedics and Orthopedic Surgery, Mount Sinai Hospital, New York, NY (Dr. Kim); the Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN (Dr. Hidden); and the Department of Orthopedic Surgery and Neurosurgery, Mount Sinai Hospital, New York, NY (Dr. Cho)
| | - Jun S. Kim
- From the Icahn School of Medicine at Mount Sinai, New York, NY (Ms. Nietsch, Mr. Ahmed, Mr. Mejia, Mr. Zaidat, Ms. Ren, and Mr. Duey); the Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL (Ms. Shrestha); the Northwestern University, Chicago, IL (Ms. Mazudie Ndjonko); the PGY-6, Department of Orthopedic Surgery and Neurosurgery, Mount Sinai Hospital, New York, NY (Dr. Li); the Department of Orthopedics and Orthopedic Surgery, Mount Sinai Hospital, New York, NY (Dr. Kim); the Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN (Dr. Hidden); and the Department of Orthopedic Surgery and Neurosurgery, Mount Sinai Hospital, New York, NY (Dr. Cho)
| | - Krystin A. Hidden
- From the Icahn School of Medicine at Mount Sinai, New York, NY (Ms. Nietsch, Mr. Ahmed, Mr. Mejia, Mr. Zaidat, Ms. Ren, and Mr. Duey); the Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL (Ms. Shrestha); the Northwestern University, Chicago, IL (Ms. Mazudie Ndjonko); the PGY-6, Department of Orthopedic Surgery and Neurosurgery, Mount Sinai Hospital, New York, NY (Dr. Li); the Department of Orthopedics and Orthopedic Surgery, Mount Sinai Hospital, New York, NY (Dr. Kim); the Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN (Dr. Hidden); and the Department of Orthopedic Surgery and Neurosurgery, Mount Sinai Hospital, New York, NY (Dr. Cho)
| | - Samuel K. Cho
- From the Icahn School of Medicine at Mount Sinai, New York, NY (Ms. Nietsch, Mr. Ahmed, Mr. Mejia, Mr. Zaidat, Ms. Ren, and Mr. Duey); the Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL (Ms. Shrestha); the Northwestern University, Chicago, IL (Ms. Mazudie Ndjonko); the PGY-6, Department of Orthopedic Surgery and Neurosurgery, Mount Sinai Hospital, New York, NY (Dr. Li); the Department of Orthopedics and Orthopedic Surgery, Mount Sinai Hospital, New York, NY (Dr. Kim); the Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN (Dr. Hidden); and the Department of Orthopedic Surgery and Neurosurgery, Mount Sinai Hospital, New York, NY (Dr. Cho)
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Long X, Li W, Hou D, Li X, Cheng D. Enhanced recovery after surgery speeds up healing for hip fracture patients. Am J Transl Res 2024; 16:3231-3239. [PMID: 39114676 PMCID: PMC11301509 DOI: 10.62347/aevl7890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Accepted: 05/14/2024] [Indexed: 08/10/2024]
Abstract
OBJECTIVE To investigate the effects of enhanced recovery after surgery (ERAS) on the perioperative healing and stress response in patients with hip fractures. METHODS A retrospective analysis was conducted on the medical records of 86 patients with hip fractures admitted to the Affiliated Hospital of Southwest Medical University between January 2022 and August 2023. Among them, 48 patients in the research group received ERAS, while 38 patients in the control group received conventional nursing. Hip joint function, pain levels, stress response, fracture healing time, incidence of complications, and nursing satisfaction were compared between the two groups. RESULTS After nursing, the Harris scores notably increased in both groups, with the research group showing notably higher scores compared to the control group (P<0.05). The levels of cortisol and epinephrine, as well as the visual analog scale scores significantly decreased in both groups, with the research group showing significantly lower levels (P<0.05). In addition, the research group experienced significantly shorter fracture healing time (P<0.05), higher nursing satisfaction (P=0.014), and lower incidence of complications (P=0.028). Logistic regression analysis revealed that age, underlying diseases, nursing method, emotional disorders, and timing of surgery were independent factors influencing the post-nursing outcomes. CONCLUSION The ERAS mode can effectively alleviate pain, improve hip joint function, reduce fracture healing time and complications, mitigate stress response, and accelerate postoperative recovery in patients with hip fractures. It is worthy of application and promotion in clinical practice.
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Affiliation(s)
- Xia Long
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University Luzhou 646000, Sichuan, China
| | - Wen Li
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University Luzhou 646000, Sichuan, China
| | - Dan Hou
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University Luzhou 646000, Sichuan, China
| | - Xiaoyue Li
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University Luzhou 646000, Sichuan, China
| | - Dongyue Cheng
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University Luzhou 646000, Sichuan, China
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9
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Wang W, Tang W, Yao W, Lv Q, Ding W. Glucose-albumin ratio (GAR) as a novel biomarker of postoperative urinary tract infection in elderly hip fracture patients. Front Med (Lausanne) 2024; 11:1366012. [PMID: 39076765 PMCID: PMC11284060 DOI: 10.3389/fmed.2024.1366012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 05/10/2024] [Indexed: 07/31/2024] Open
Abstract
Purpose Postoperative urinary tract infections (UTIs) worsen the prognosis of elderly patients with hip fractures. This study aimed to assess the predictive ability of blood-based biomarkers, specifically the glucose-albumin ratio (GAR), in predicting postoperative UTIs. Methods A retrospective observational study of 1,231 patients from a Level I trauma center was conducted. We evaluated the prognostic and predictive value of 15 biomarkers, including the glucose-albumin ratio, in elderly patients with hip fractures. The primary outcome measure was the incidence of postoperative UTIs. Results The glucose to albumin ratio transformed into GAR was superior to any other biomarker in predicting postoperative UTIs in elderly hip fracture patients (AUC = 0.756, p < 0.001). Elevated GAR (using the best cut-off value of 0.18) was independently associated with postoperative UTIs (OR 3.20, 95% CI 2.23-4.58). Further analysis dividing GAR levels into four groups according to quartiles showed that compared to patients with GAR levels of Q1 (< 0.14), GAR levels of Q2 (0.14-0.17; OR 2.11, 95% CI 1.07-4.15), Q3 (0.17-0.21; OR 3.36, 95% CI 1.74-6.52) and Q4 (> 0.21; OR 7.55, 95% CI 3.84-14.83) patients had significantly higher odds of UTIs. Conclusion GAR holds potential as a novel biomarker for predicting postoperative UTIs in elderly patients with hip fractures.
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Affiliation(s)
- Wei Wang
- Department of Orthopedics, Dandong Central Hospital, China Medical University, Dandong, China
| | - Wanyun Tang
- Department of Orthopedics, Dandong Central Hospital, China Medical University, Dandong, China
| | - Wei Yao
- Department of Orthopedics, Dandong Central Hospital, China Medical University, Dandong, China
| | - Qiaomei Lv
- Department of Oncology, Dandong Central Hospital, China Medical University, Dandong, China
| | - Wenbo Ding
- Department of Orthopedics, Dandong Central Hospital, China Medical University, Dandong, China
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10
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Zhong Y, Liu M, Cheng Z, Yao Y, Yu Y, Luo G, Zheng B, Yan M. "Multidisciplinary fast-track" care can significantly reduce risk of mortality among hip fracture patients at least 80 years old: a single-center retrospective study. BMC Geriatr 2024; 24:592. [PMID: 38987709 PMCID: PMC11238416 DOI: 10.1186/s12877-024-05183-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 06/27/2024] [Indexed: 07/12/2024] Open
Abstract
BACKGROUND "Multidisciplinary fast-track" (MFT) care can accelerate recovery and improve prognosis after surgery, but whether it is effective in older people after hip fracture surgery is unclear. METHODS We retrospectively compared one-year all-cause mortality between hip fracture patients at least 80 years old at our institution who underwent hip fracture surgery between January 2014 and December 2018 and who then received MFT or conventional care. Multivariable regression was used to assess the association between MFT care and mortality after adjustment for confounders. RESULTS The final analysis included 247 patients who received MFT care and 438 who received conventional orthopedic care. The MFT group showed significantly lower one-year mortality (8.9% vs. 14.4%, P = 0.037). Log-rank testing of Kaplan-Meier survival curves confirmed the survival advantage. However, the two groups did not differ significantly in rates of mortality during hospitalization or at 30 or 90 days after surgery. Regression analysis confirmed that MFT care was associated with lower risk of one-year mortality (hazard ratio [HR] 0.47, 95% confidence interval [CI] 0.281-0.788, P = 0.04), and the survival benefit was confirmed in subgroups of patients with anemia (HR 0.453, 95% CI 0.268-0.767, P = 0.003) and patients with American Society of Anesthesiologists grade III (HR 0.202, 95% CI 0.08-0.51, P = 0.001). CONCLUSIONS MFT care can reduce one-year mortality among hip fracture patients at least 80 years old. This finding should be verified and extended in multi-center randomized controlled trials.
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Affiliation(s)
- Yinbo Zhong
- Department of Anesthesiology, Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou, Zhejiang, China
| | - Mingxia Liu
- Department of Anesthesiology, Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou, Zhejiang, China
- Department of Anesthesiology & Clinical Research Center for Anesthesia and Perioperative Medicine, Huzhou Central Hospital, The Affiliated Huzhou Hospital, Zhejiang University School of Medicine, The Fifth School of Clinical Medicine of Zhejiang Chinese Medical University, Affiliated Central Hospital Huzhou University, Huzhou, Zhejiang, China
| | - Zhenzhen Cheng
- Department of Anesthesiology, Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou, Zhejiang, China
| | - Yuanyuan Yao
- Department of Anesthesiology, Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou, Zhejiang, China
| | - Yang Yu
- Department of Anesthesiology, The First People's Hospital of Weifang, Weifang, Shandong, China
| | - Ge Luo
- Department of Anesthesiology, Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou, Zhejiang, China
| | - Bin Zheng
- Department of Surgery, University of Alberta, Edmonton, Canada
| | - Min Yan
- Department of Anesthesiology, Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou, Zhejiang, China.
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11
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Zhong H, Poeran J, Illescas A, Reisinger L, Cozowicz C, Memtsoudis SG, Liu J. Time to surgical treatment for hip fracture care. J Am Geriatr Soc 2024. [PMID: 38963068 DOI: 10.1111/jgs.19063] [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: 12/07/2023] [Revised: 05/20/2024] [Accepted: 05/30/2024] [Indexed: 07/05/2024]
Abstract
BACKGROUND Studies have demonstrated beneficial outcomes associated with timely surgical treatment of hip fracture. Subsequently, practice recommendations changed with 24-48 h as the recommended time for surgery from admission; however, recent data on timing of hip fracture surgery and how this impacts outcomes are lacking. METHODS This retrospective cohort study included patients who had a primary diagnosis of hip fracture and underwent a subsequent surgical repair within 3 days of admission (Premier Healthcare claims 2006-2021 data). The primary exposure of interest was time from hip fracture diagnosis to surgery (categorized as 0-1 day, 2 days, and 3 days). Outcomes included any major complication, mortality, and intensive care unit (ICU) admission. Mixed-effects models measured the association between timing of surgery and outcomes. We report odds ratios (OR) and 95% confidence intervals. RESULTS Among 501,267 surgical hip fracture patients, 26.0%, 56.0%, and 18.1% of patients received surgery on days 0-1, 2, and 3, respectively. The median ages were 83, 84, and 84 years old, and there were 73.3%, 72.2%, and 68.8% female in each group respectively. Compared with repair on day 0-1, hip fracture surgical treatment on day 2 or day 3 was associated with increased odds of major complications (OR 1.06, 95% CI 1.03-1.08 and OR 1.17, 95% CI 1.13-1.2), mortality (OR 1.08, 95% CI 1.02-1.14 and OR 1.2, 95% CI 1.12-1.28), and ICU admission (OR 1.06, 95% CI 1.04-1.09 and OR 1.36, 95% CI 1.32-1.4) after adjusting major comorbidities; all p < 0.001. CONCLUSION Despite the publication of society guidelines in 2015, most fracture patients still received surgery on day 2 or day 3 of admission and were associated with worse outcomes. Balancing optimization of clinical factors with timing of surgery can be challenging, and further research is needed. Nonetheless, our findings reiterate the importance of timely surgical intervention.
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Affiliation(s)
- Haoyan Zhong
- Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, New York, USA
| | - Jashvant Poeran
- Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, New York, USA
- Department of Orthopaedic Surgery/Institute for Healthcare Delivery Science, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Alex Illescas
- Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, New York, USA
| | - Lisa Reisinger
- Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, New York, USA
- Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Crispiana Cozowicz
- Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Stavros G Memtsoudis
- Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, New York, USA
- Department of Anesthesiology, Weill Cornell Medicine, New York, New York, USA
| | - Jiabin Liu
- Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, New York, USA
- Department of Anesthesiology, Weill Cornell Medicine, New York, New York, USA
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12
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de Haan E, van Oosten B, van Rijckevorsel VAJIM, Kuijper TM, de Jong L, Roukema GR. Validation of the Charlson Comorbidity Index for the prediction of 30-day and 1-year mortality among patients who underwent hip fracture surgery. Perioper Med (Lond) 2024; 13:67. [PMID: 38961483 PMCID: PMC11223422 DOI: 10.1186/s13741-024-00417-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 06/10/2024] [Indexed: 07/05/2024] Open
Abstract
INTRODUCTION The aim of our study was to validate the original Charlson Comorbidity Index (1987) (CCI) and adjusted CCI (2011) as a prediction model for 30-day and 1-year mortality after hip fracture surgery. The secondary aim of this study was to verify each variable of the CCI as a factor associated with 30-day and 1-year mortality. METHODS A prospective database of two-level II trauma teaching hospitals in the Netherlands was used. The original CCI from 1987 and the adjusted CCI were calculated based on medical history. To validate the original CCI and the adjusted CCI, the CCI was plotted against the observed 30-day and 1-year mortality, and the area under the curve (AUC) was calculated. RESULTS A total of 3523 patients were included in this cohort study. The mean of the original CCI in this cohort was 5.1 (SD ± 2.0) and 4.6 (SD ± 1.9) for the adjusted CCI. The AUCs of the prediction models were 0.674 and 0.696 for 30-day mortality for the original and adjusted CCIs, respectively. The AUCs for 1-year mortality were 0.705 and 0.717 for the original and adjusted CCIs, respectively. CONCLUSIONS A higher original and adjusted CCI is associated with a higher mortality rate. The AUC was relatively low for 30-day and 1-year mortality for both the original and adjusted CCIs compared to other prediction models for hip fracture patients in our cohort. The CCI is not recommended for the prediction of 30-day and 1-year mortality in hip fracture patients.
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Affiliation(s)
- Eveline de Haan
- Surgery Department, Maasstad Hospital, Rotterdam, 3007 AC, the Netherlands.
- Surgery Department, Franciscus Hospital, Rotterdam, 3045 PM, the Netherlands.
| | - Benthe van Oosten
- Surgery Department, Maasstad Hospital, Rotterdam, 3007 AC, the Netherlands
| | | | - T Martijn Kuijper
- Maasstad Academy, Maasstad Hospital, Rotterdam, 3079 DZ, the Netherlands
| | - Louis de Jong
- Surgery Department, Maasstad Hospital, Rotterdam, 3007 AC, the Netherlands
| | - Gert R Roukema
- Surgery Department, Maasstad Hospital, Rotterdam, 3007 AC, the Netherlands
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13
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Lin X, Wu R, Zhang R, Chen D, Fu G, Zheng Q, Ma Y. Preoperative transthoracic echocardiography does not lead to decreased postoperative mortality but with increased time to surgery and length of stay in Chinese geriatric hip fracture patients. Eur Geriatr Med 2024:10.1007/s41999-024-01006-w. [PMID: 38888712 DOI: 10.1007/s41999-024-01006-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 06/10/2024] [Indexed: 06/20/2024]
Abstract
PURPOSE The present study aimed to investigate the influence of preoperative TTE on postoperative short-term mortality, surgery delay, as well as other economic and clinical outcomes in Chinese geriatric hip fracture patients. METHODS This retrospective, matched-cohort study enrolled geriatric hip fracture patients (≥ 60 years) who underwent surgical interventions at our center between 2015 and 2020. The primary exposure was inpatient preoperative TTE. Demographic and clinical data that were reported as risk factors for postoperative mortality were retrieved from the medical data center as the covariates. The primary clinical outcomes were all-cause mortality at 30 days, 90 days, 180 days, and 1 year. Time from hospital presentation to surgery, length of stay (LOS), inpatient cost, frequency of cardiology consultation and coronary angiography (CAG) were also assessed. The propensity score matching (PSM) was performed in a ratio of 1:1. RESULTS 447 patients were identified and 216 of them received a preoperative TTE (48.3%). After successfully matching 390 patients (87.2%), patients receiving TTE showed significantly higher 30-day mortality (6.6% vs 2.0%, P = 0.044). But no significant difference was found in 90-day, 180-day, and 365-day mortality as well as the 1-year accumulated survival rate. Receipt of TTE was also associated with significant increases in LOS (13.6 days vs 11.4 days, P = 0.017), waiting time for surgery (5.9 days vs 4.3 days, P < 0.001), and lower proportion of receiving surgery within 48 h (7.2% vs. 26.2%, P < 0.001). According to the multivariable logistic analysis, only ejection fraction (30 days, 90 days), aorta diameter (30 days, 90 days, 180 days, 365 days), left ventricular posterior wall diameter (90 days, 180 days, 365 days), aortic valve velocity (90 days) and mitral valve A-peak (90 days, 180 days) were association with postoperative mortality among the 17 parameters in the TTE reports. Besides, TTE has no influence on the frequency of preoperative cardiology consultation. CONCLUSION Preoperative TTE does not lead to decreased postoperative mortality but with increased time to surgery and length of stay in Chinese geriatric hip fracture patients. The predictive ability of TTE parameters is limited for postoperative mortality.
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Affiliation(s)
- Xian Lin
- Department of Ultrasound, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Rongjie Wu
- Department of Orthopedics, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
- Shantou University Medical College, Shantou, China
| | - Ruiying Zhang
- Department of Orthopedics, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Duanyong Chen
- Department of Orthopedics, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Guangtao Fu
- Department of Orthopedics, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China.
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.
| | - Qiujian Zheng
- Department of Orthopedics, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China.
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.
| | - Yuanchen Ma
- Department of Orthopedics, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China.
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.
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Pliannuom S, Pinyopornpanish K, Buawangpong N, Wiwatkunupakarn N, Mallinson PAC, Jiraporncharoen W, Angkurawaranon C. Characteristics and Effects of Home-Based Digital Health Interventions on Functional Outcomes in Older Patients With Hip Fractures After Surgery: Systematic Review and Meta-Analysis. J Med Internet Res 2024; 26:e49482. [PMID: 38865706 PMCID: PMC11208838 DOI: 10.2196/49482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 10/07/2023] [Accepted: 04/29/2024] [Indexed: 06/14/2024] Open
Abstract
BACKGROUND Digital health interventions (DHIs) have been used to improve postoperative functional ability in older patients with hip fractures. However, there is limited information on the characteristics of home-based DHIs, and controversy exists regarding their impact on functional outcomes in this population. OBJECTIVE This study aims to provide an overview of the characteristics and effects of home-based DHIs on functional outcomes in older patients with hip fractures after surgery. METHODS We conducted a systematic review and meta-analysis following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Five electronic medical databases (PubMed, Embase, Cochrane, ProQuest, and CINAHL) were searched up until January 3, 2023. We included clinical trials or randomized controlled trials (RCTs) in English involving home-based DHIs for postoperative care among older patients with hip fractures. Excluded studies involved patients not hospitalized, not discharged to home, not directly using DHIs, or with inaccessible full text. The PROSPERO registration number is CRD42022370550. Two independent reviewers screened and extracted data (SP and NB). Disagreements were resolved through discussion and agreement with the third author (KP). Home-based DHIs were characterized in terms of purpose and content, mode of delivery, and health care provider. Functional outcomes assessed included Timed Up and Go (TUG) test, Short Physical Performance Battery (SPPB), and Functional Independence Measure (FIM). Summary measures were calculated using mean differences with 95% CIs. Risk of bias was assessed using the Risk-of-Bias 2 assessment tool for RCTs and ROBINS-I for non-RCTs. The quality of evidence was assessed using GRADE (Grading of Recommendations Assessment, Development and Evaluation). RESULTS Of 2125 identified studies, 16 were included in the systematic review, involving 1467 participants. Six studies were included in the meta-analysis (4 for TUG, 4 for SPPB, and 2 for FIM). Home-based DHIs predominantly involved communication and feedback, education, and telerehabilitation. Telephone calls were the most common mode of delivery, followed by web-based software and mobile apps. Physical therapists were the main health care providers. The meta-analysis showed that home-based DHIs improved functional outcomes compared with usual care, with decreased TUG scores (mean difference=-7.89; 95% CI -10.34 to -5.45; P<.001), significantly increased SPPB scores (mean difference=1.11; 95% CI 0.51-1.72; P<.001), and increased FIM scores (mean difference=7.98; 95% CI 5.73-10.24; P<.001). CONCLUSIONS Home-based DHIs that integrate communication and feedback, education, and telerehabilitation have demonstrated effectiveness in enhancing functional outcomes among older patients recovering from hip fractures after surgery. These interventions are commonly administered by physical therapists, who play a crucial role in facilitating and guiding the rehabilitation process. However, while the existing evidence supports the efficacy of such interventions, further research is needed to enhance our understanding and optimize the implementation of home-based DHIs for this specific population.
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Affiliation(s)
- Suphawita Pliannuom
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Global Health and Chronic Conditions Research Group, Chiang Mai University, Chiang Mai, Thailand
| | - Kanokporn Pinyopornpanish
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Global Health and Chronic Conditions Research Group, Chiang Mai University, Chiang Mai, Thailand
| | - Nida Buawangpong
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Global Health and Chronic Conditions Research Group, Chiang Mai University, Chiang Mai, Thailand
| | - Nutchar Wiwatkunupakarn
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Global Health and Chronic Conditions Research Group, Chiang Mai University, Chiang Mai, Thailand
| | - Poppy Alice Carson Mallinson
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Wichuda Jiraporncharoen
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Global Health and Chronic Conditions Research Group, Chiang Mai University, Chiang Mai, Thailand
| | - Chaisiri Angkurawaranon
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Global Health and Chronic Conditions Research Group, Chiang Mai University, Chiang Mai, Thailand
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Liu Y, Ma Y, Yang W, Lin Q, Xing Y, Shao H, Li P, He Y, Duan W, Wei X. Integrated proteomics and metabolomics analysis of sclerosis-related proteins and femoral head necrosis following internal fixation of femoral neck fractures. Sci Rep 2024; 14:13207. [PMID: 38851808 PMCID: PMC11162501 DOI: 10.1038/s41598-024-63837-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 06/03/2024] [Indexed: 06/10/2024] Open
Abstract
Femoral head necrosis (FHN) is a serious complication after femoral neck fractures (FNF), often linked to sclerosis around screw paths. Our study aimed to uncover the proteomic and metabolomic underpinnings of FHN and sclerosis using integrated proteomics and metabolomics analyses. We identified differentially expressed proteins (DEPs) and metabolites (DEMs) among three groups: patients with FNF (Group A), sclerosis (Group B), and FHN (Group C). Using the Kyoto Encyclopedia of Genes and Genomes and Gene Ontology enrichment analyses, we examined the roles of these proteins and metabolites. Our findings highlight the significant differences across the groups, with 218 DEPs and 44 DEMs identified between the sclerosis and FNF groups, 247 DEPs and 31 DEMs between the FHN and sclerosis groups, and a stark 682 DEPs and 94 DEMs between the FHN and FNF groups. Activities related to carbonate dehydratase and hydrolase were similar in the FHN and sclerosis groups, whereas extracellular region and lysosome were prevalent in the FHN and FNF groups. Our study also emphasized the involvement of the PI3K-Akt pathway in sclerosis and FHN. Moreover, the key metabolic pathways were implicated in glycerophospholipid metabolism and retrograde endocannabinoid signaling. Using western blotting, we confirmed the pivotal role of specific genes/proteins such as ITGB5, TNXB, CA II, and CA III in sclerosis and acid phosphatase 5 and cathepsin K in FHN. This comprehensive analyses elucidates the molecular mechanisms behind sclerosis and FHN and suggests potential biomarkers and therapeutic targets, paving the way for improved treatment strategies. Further validation of the findings is necessary to strengthen the robustness and reliability of the results.
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Affiliation(s)
- Yang Liu
- Department of Orthopaedics, Second Hospital of Shanxi Medical University, Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, No. 382, Wuyi Road, Taiyuan, 030001, Shanxi, China
| | - Yongsheng Ma
- Department of Orthopaedics, Second Hospital of Shanxi Medical University, Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, No. 382, Wuyi Road, Taiyuan, 030001, Shanxi, China
| | - Wenming Yang
- Department of Orthopaedics, Second Hospital of Shanxi Medical University, Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, No. 382, Wuyi Road, Taiyuan, 030001, Shanxi, China
| | - Qitai Lin
- Department of Orthopaedics, Second Hospital of Shanxi Medical University, Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, No. 382, Wuyi Road, Taiyuan, 030001, Shanxi, China
| | - Yugang Xing
- Department of Orthopaedics, Second Hospital of Shanxi Medical University, Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, No. 382, Wuyi Road, Taiyuan, 030001, Shanxi, China
| | - Huifeng Shao
- School of Mechanical Engineering, Hangzhou Dianzi University, Hangzhou, 310018, China
- Key Laboratory of 3D Printing Process and Equipment of Zhejiang Province, School of Mechanical Engineering, Zhejiang University, No. 866, Yuhang Tang Road, Hangzhou, 310027, Zhejiang, China
| | - Pengcui Li
- Department of Orthopaedics, Second Hospital of Shanxi Medical University, Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, No. 382, Wuyi Road, Taiyuan, 030001, Shanxi, China
| | - Yong He
- Key Laboratory of 3D Printing Process and Equipment of Zhejiang Province, School of Mechanical Engineering, Zhejiang University, No. 866, Yuhang Tang Road, Hangzhou, 310027, Zhejiang, China.
| | - Wangping Duan
- Department of Orthopaedics, Second Hospital of Shanxi Medical University, Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, No. 382, Wuyi Road, Taiyuan, 030001, Shanxi, China.
| | - Xiaochun Wei
- Department of Orthopaedics, Second Hospital of Shanxi Medical University, Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, No. 382, Wuyi Road, Taiyuan, 030001, Shanxi, China
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Mao W, Liu CD, Chang SM, Yang AL, Hong CC. Anteromedial Cortical Support in Reduction of Trochanteric Hip Fractures: From Definition to Application. J Bone Joint Surg Am 2024; 106:1008-1018. [PMID: 38683886 DOI: 10.2106/jbjs.23.01023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
➤ The concept of anteromedial cortical support (AMCS) serves as valuable guidance for the intraoperative reduction of trochanteric hip fractures.➤ Positive medial cortical support (MCS) and positive or neutral anterior cortical support (ACS) are desirable. Some evidence has suggested that positive MCS is potentially superior to neutral MCS.➤ Experimental studies underscore the vital importance of the anteromedial wall and reveal why positive MCS potentially outperforms neutral MCS.➤ Incorporating the AMCS concept, the Chang reduction quality criteria (CRQC) are a reliable alternative approach to evaluate the reduction quality of trochanteric hip fractures.
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Affiliation(s)
- Wei Mao
- Department of Orthopaedic Surgery, Yangpu Hospital, School of Medicine, Tongji University, Shanghai, People's Republic of China
- Department of Orthopaedic Surgery, National University Hospital, National University Health System, Singapore
| | - Chen-Dong Liu
- Department of Orthopaedic Surgery, Yangpu Hospital, School of Medicine, Tongji University, Shanghai, People's Republic of China
| | - Shi-Min Chang
- Department of Orthopaedic Surgery, Yangpu Hospital, School of Medicine, Tongji University, Shanghai, People's Republic of China
| | - Ao-Lei Yang
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, People's Republic of China
| | - Choon Chiet Hong
- Department of Orthopaedic Surgery, National University Hospital, National University Health System, Singapore
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DeCook R, Muffly BT, Mahmood S, Holland CT, Ayeni AM, Ast MP, Bolognese MP, Guild GN, Sheth NP, Pean CA, Premkumar A. AI-Generated Graduate Medical Education Content for Total Joint Arthroplasty: Comparing ChatGPT Against Orthopaedic Fellows. Arthroplast Today 2024; 27:101412. [PMID: 38912098 PMCID: PMC11190484 DOI: 10.1016/j.artd.2024.101412] [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: 01/15/2024] [Revised: 03/20/2024] [Accepted: 04/28/2024] [Indexed: 06/25/2024] Open
Abstract
Background Artificial intelligence (AI) in medicine has primarily focused on diagnosing and treating diseases and assisting in the development of academic scholarly work. This study aimed to evaluate a new use of AI in orthopaedics: content generation for professional medical education. Quality, accuracy, and time were compared between content created by ChatGPT and orthopaedic surgery clinical fellows. Methods ChatGPT and 3 orthopaedic adult reconstruction fellows were tasked with creating educational summaries of 5 total joint arthroplasty-related topics. Responses were evaluated across 5 domains by 4 blinded reviewers from different institutions who are all current or former total joint arthroplasty fellowship directors or national arthroplasty board review course directors. Results ChatGPT created better orthopaedic content than fellows when mean aggregate scores for all 5 topics and domains were compared (P ≤ .001). The only domain in which fellows outperformed ChatGPT was the integration of key points and references (P = .006). ChatGPT outperformed the fellows in response time, averaging 16.6 seconds vs the fellows' 94 minutes per prompt (P = .002). Conclusions With its efficient and accurate content generation, the current findings underscore ChatGPT's potential as an adjunctive tool to enhance orthopaedic arthroplasty graduate medical education. Future studies are warranted to explore AI's role further and optimize its utility in augmenting the educational development of arthroplasty trainees.
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Affiliation(s)
- Ryan DeCook
- Philadelphia College of Osteopathic Medicine, Swannee, GA, USA
| | - Brian T. Muffly
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Sania Mahmood
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | | | - Ayomide M. Ayeni
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | | | - Michael P. Bolognese
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - George N. Guild
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Neil P. Sheth
- Department of Orthopaedic Surgery, Perelman School of Medicine, Philadelphia, PA, USA
| | - Christian A. Pean
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Ajay Premkumar
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, GA, USA
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Sağlam S, Arıcan M, Karaduman ZO, Yücel MO, Değirmenci E, Uludağ V. The Characteristics and Outcomes of Contralateral Non-Concurrent Hip Fractures: A Retrospective Study in Geriatric Patients. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:928. [PMID: 38929545 PMCID: PMC11206099 DOI: 10.3390/medicina60060928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 05/22/2024] [Accepted: 05/30/2024] [Indexed: 06/28/2024]
Abstract
Background and Objectives: This study aimed to determine the relationship between non-simultaneous contralateral hip fractures, urban and rural differences, fracture localization, time between fractures, physiotherapy applications, comorbidity, and the second fracture outcomes. Materials and Methods: We retrospectively analyzed 107 patients aged 65 and older with proximal femur fractures (PFFs) who underwent surgery at Düzce University Medical Faculty between January 2010 and December 2022. High-energy fractures, pathological fractures, and patients with a history of old fractures were excluded. Results: The study included 66 females (61.7%) and 41 males (38.3%), with a mean age of 83.76 years. The mean interval between two fractures was 28.3 months. There was no statistical difference between the localization of the first and second fractures (p = 0.107). However, there was a significant difference in the first PFF localizations of patients living in rural areas (p = 0.023). Patients with heart failure, respiratory failure, osteoporosis, and cognitive impairment had shorter intervals between fractures (p < 0.001). Conclusions: This study shows that age, female gender, place of residence, comorbid diseases, and whether physical therapy is received after the first fracture are significant risk factors for a second hip fracture in patients over 65 years of age.
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Affiliation(s)
- Sönmez Sağlam
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Duzce University, 81620 Duzce, Turkey; (M.A.); (Z.O.K.); (M.O.Y.); (E.D.); (V.U.)
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Gounot A, Charlot A, Guillon P, Schaefer A, Moslemi A, Boutroux P, Sautet A. The use of uncemented stems in femoral neck fractures in elderly patients: A comparative study of 671 cases. Orthop Traumatol Surg Res 2024; 110:103878. [PMID: 38582221 DOI: 10.1016/j.otsr.2024.103878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 10/07/2023] [Accepted: 02/14/2024] [Indexed: 04/08/2024]
Abstract
INTRODUCTION The use of cemented stems in elderly patients is associated with the risk of intraoperative embolic complications. Uncemented stems eliminate this risk, but their use is controversial because of the risk of mechanical complications, with estimated subsidence between 3.6 and 30% and periprosthetic fractures between 2.1 and 11% at 6 weeks. A retrospective multicenter comparative study was conducted using a propensity score analysis to evaluate mechanical performances of uncemented stems in femoral neck fractures in elderly patients to (1) compare the risk of mechanical complications and (2) assess the use of metaphyseal-anchored stems for this indication. HYPOTHESIS There is no difference in the risk of mechanical complications, intraoperatively or postoperatively, between these stems. MATERIALS AND METHODS We conducted a multicenter retrospective comparative study including 358 uncemented and 313 cemented stems. The mean age was 84.5 years [83.9-85.1]. The inclusion criteria were patients 70 years and older and a follow-up of at least 6 weeks. The primary endpoint was a composite endpoint comprised of stem subsidence≥2mm or periprosthetic fracture (up to 3 months postoperatively). The secondary endpoints were infection, stem subsidence≥2mm, and operative time. These endpoints were analyzed using a propensity score to control confounding factors. A secondary analysis used the same endpoints to compare metaphyseal-anchored (short stems) versus Corail-like stems. RESULTS After adjusting for the propensity score, we found 11.17% mechanical complications in the uncemented group (n=40, 5.59% subsidence, and 5.59% fractures) versus 13.42% for the cemented group (n=42, 7.99% subsidence, and 5.43% fractures). There was no statistically significant difference between the 2 values (Odds Ratio [OR]=0.64 [95% Confidence Interval [CI]: 0.14-2.85] [p=0.7]). The mortality rate due to cement embolism was 1%. There was no difference in the rate of subsidence (OR=0.55 [95% CI: 0.02-12.5] [p=0.7]), periprosthetic fracture (OR=0.65 [95% CI: 0.13-3.12] [p=0.7]) or infection (OR=0.71 [95% CI: 0.32-1.55] [p=0.4]). However, the operative times were longer in the cemented group (p=0.03 for hemiarthroplasties [mean additional time 16minutes] and p=0.02 for total hip arthroplasties [mean additional time 22minutes]). No difference was observed between the metaphyseal-anchored (short stems) and Corail-like stems regarding operative time, rate of infection, and rate of stem subsidence or periprosthetic fractures. DISCUSSION This is one of the first studies to highlight cemented stem subsidence when used for femoral neck fractures in elderly patients. Using uncemented stems in this indication is still warranted, especially since they do not bring about more mechanical complications in the first few months. Metaphyseal-anchored short stems seem to give the same results as "standard" stems. However, these findings need to be assessed in the longer term. LEVEL OF EVIDENCE III; retrospective comparative study.
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Affiliation(s)
- Alexandre Gounot
- Département de chirurgie orthopédique et traumatologique, GHI Le Raincy Montfermeil, 10, rue du Général-Leclerc, 93370 Montfermeil, France.
| | - Anahita Charlot
- Département de chirurgie orthopédique et traumatologique, GHI Le Raincy Montfermeil, 10, rue du Général-Leclerc, 93370 Montfermeil, France
| | - Pascal Guillon
- Département de chirurgie orthopédique et traumatologique, GHI Le Raincy Montfermeil, 10, rue du Général-Leclerc, 93370 Montfermeil, France
| | - Augustin Schaefer
- Département d'anesthésie, hôpital Ambroise-Paré, Assistance publique-Hôpitaux de Paris (AP-HP), 9, avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France
| | - Aymane Moslemi
- Département de chirurgie orthopédique et traumatologique, hôpital Saint-Antoine, Assistance publique-Hôpitaux de Paris (AP-HP), 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France
| | - Pierre Boutroux
- Département de chirurgie orthopédique et traumatologique, hôpital Saint-Antoine, Assistance publique-Hôpitaux de Paris (AP-HP), 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France
| | - Alain Sautet
- Département de chirurgie orthopédique et traumatologique, hôpital Saint-Antoine, Assistance publique-Hôpitaux de Paris (AP-HP), 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France
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Guo T, Zhang F, Xiong L, Huang Z, Zhang X, Wan J, Mo J. Association of Handgrip Strength with Hip Fracture and Falls in Community-dwelling Middle-aged and Older Adults: A 4-Year Longitudinal Study. Orthop Surg 2024; 16:1051-1063. [PMID: 38485456 PMCID: PMC11062856 DOI: 10.1111/os.14029] [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: 08/26/2023] [Revised: 02/13/2024] [Accepted: 02/20/2024] [Indexed: 05/03/2024] Open
Abstract
OBJECTIVE Hip fracture and falls are significant health concerns. Handgrip strength (HGS) is closely associated with overall muscle strength and physical health. However, the longitudinal relationship between HGS and the risk of hip fractures and falls remains unclear, particularly regarding gender differences. This longitudinal study aimed to investigate the association between HGS and the risk of hip fracture and falls in individuals aged 45 years and above, considering gender-specific differences over a 4-year period. METHODS This study included 10,092 participants (4471 men and 5621 women) aged 45 years and above from the China Health and Retirement Longitudinal Study (CHARLS). Incidents of hip fractures and falls were recorded during a 4-year follow-up, along with various demographic and clinical factors. Participants were categorized into five groups based on their HGS quintiles. Logistic regression models were employed to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs) to assess the relationship between HGS and hip fracture/fall risk. RESULTS During the 4-year follow-up period, 223 cases of hip fracture (2.2%) and 1831 cases of falls (18.1%) were documented. Notably, higher HGS demonstrated a strong inverse association with the risk of hip fracture in both males and females (p < 0.05). In comparison to the lowest HGS quintile, the adjusted odds ratios (ORs) for hip fracture were 0.46 (0.27-0.78) for the total population, 0.4 (0.19-0.81) for males and 0.48 (0.23-0.98) for females in the highest HGS quintile. Furthermore, a profound and statistically significant negative correlation between HGS and falls was detected (p < 0.05). The adjusted ORs for falls in the highest HGS quintile, compared to the lowest quintile, were 0.62 (0.51-0.76) in the overall population, 0.59 (0.44-0.78) in males, and 0.78 (0.62-0.99) in females. CONCLUSION Our findings highlight the significant inverse association between HGS and the risk of hip fracture and falls in both males and females aged 45 years and above. Assessing handgrip strength may serve as a valuable tool for predicting fracture and fall risk.
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Affiliation(s)
- Tianting Guo
- Department of OrthopedicsGanzhou Hospital of Guangdong Provincial People's Hospital (Ganzhou Municipal Hospital)GanzhouChina
| | - Fei Zhang
- Department of OrthopedicsThe First Affiliated Hospital of Gannan Medical UniversityGanzhouChina
| | - Lijiao Xiong
- Department of Geriatrics, The Second Clinical Medical CollegeJinan University (Shenzhen People's Hospital)ShenzhenChina
| | | | - Xiaoan Zhang
- Department of OrthopedicsGanzhou Hospital of Guangdong Provincial People's Hospital (Ganzhou Municipal Hospital)GanzhouChina
| | - Junming Wan
- Department of OrthopaedicsThe Seventh Affiliated Hospital, Sun Yat‐sen UniversityGanzhouChina
| | - Jianwen Mo
- Department of OrthopedicsThe First Affiliated Hospital of Gannan Medical UniversityGanzhouChina
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Paradis BE, Klein BJ, Bartlett LE, Cohn RM, Bitterman AD. Goals of Care Discussions in Orthopaedic Surgery: Geriatric Hip Fractures. J Arthroplasty 2024; 39:1144-1148. [PMID: 38462140 DOI: 10.1016/j.arth.2024.03.001] [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: 01/29/2024] [Revised: 02/29/2024] [Accepted: 03/01/2024] [Indexed: 03/12/2024] Open
Abstract
BACKGROUND Due to the severity of hip fracture complications in the geriatric population, including major morbidity and mortality, it is crucial to establish treatment goals and manage expectations as a patient-centered multidisciplinary team. Goals of care (GOC) are personalized treatment programs designed to align with the individual patient's values and preferences. There is a paucity of literature on the topic of GOC discussions, especially regarding orthopaedic injuries. Therefore, this narrative review aims to provide an account of GOC discussions related to geriatric hip fractures. METHODS We reviewed articles published on GOC between 1978 and 2024. The articles were identified by searching PubMed and Google Scholar. We utilized the search terms GOC discussions and hip fracture, with additional descriptors including arthroplasty and geriatric. RESULTS There were 11 articles that met the selection criteria and were published between 1978 and 2024. Five articles were published on GOC discussions in orthopaedic surgery, while the remaining 6 articles were published in non-orthopaedic fields. There was one systematic review, 2 narrative reviews, 6 observational studies, and 2 descriptive studies. Supplemental commentary from non-orthopaedic specialties and the fields of law and medical ethics was included to assist in highlighting barriers to GOC discussions and to explore potential strategies to enhance GOC discussions. CONCLUSIONS Goals of care discussions provide a framework for treatment decisions based on an individual patient's values and cultural beliefs; however, these conversations may be limited by perceived time constraints, patient health care literacy, and physicians' misconceptions of what is most important to discuss. While no clear consensus was identified regarding strategies for improving GOC discussions in geriatric patients who have hip fractures, the authors recommend standardized training programs, expedited family meetings, multidisciplinary team involvement, assistive technology such as Outcome Prioritization Tool, and the incorporation of GOC discussions into institutional hip fracture pathways.
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Affiliation(s)
- Brienne E Paradis
- University of New England College of Osteopathic Medicine, Biddeford, Maine
| | - Brandon J Klein
- Zucker School of Medicine at Hofstra/Northwell Health, Huntington Hospital Orthopaedic Surgery Residency Program, Huntington, New York
| | - Lucas E Bartlett
- Zucker School of Medicine at Hofstra/Northwell Health, Huntington Hospital Orthopaedic Surgery Residency Program, Huntington, New York
| | - Randy M Cohn
- Zucker School of Medicine at Hofstra/Northwell Health, Huntington Hospital Orthopaedic Surgery Residency Program, Huntington, New York
| | - Adam D Bitterman
- Zucker School of Medicine at Hofstra/Northwell Health, Huntington Hospital Orthopaedic Surgery Residency Program, Huntington, New York
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22
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Scuderi GR, Mont MA. Goals of Care: A Patient-Centered Assessment. J Arthroplasty 2024; 39:1142-1143. [PMID: 38462139 DOI: 10.1016/j.arth.2024.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/12/2024] Open
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Jensen TM, Pedersen JK, Waldorff FB, Søndergaard J, Overgaard S, Christensen K. Trends in Incidence of Hip Fracture and Hip Replacement in Denmark, 1996 to 2018. JAMA Netw Open 2024; 7:e249186. [PMID: 38691358 PMCID: PMC11063804 DOI: 10.1001/jamanetworkopen.2024.9186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 03/01/2024] [Indexed: 05/03/2024] Open
Abstract
Importance The past several decades have witnessed substantial changes in treatments that are particularly relevant for older patients. Objectives To assess changes in national-level incidence rates of fracture- and musculoskeletal-related (ie, arthritis-related) hip replacement procedures for individuals aged 40 to 104 years over a 23-year period in Denmark. Design, Setting, and Participants This cohort study used national Danish health registers to include the Danish population aged 40 to 104 years from January 1, 1996, to December 31, 2018. Data were analyzed from May 31, 2022, to February 14, 2024. Main Outcomes and Measures Age- and period-specific incidence rates of hip fracture and hip replacement stratified on fracture-related vs arthritis-related indication. Results From 1996 to 2018, a total of 3 664 979 individuals were followed up for a mean (SD) of 14.6 (7.7) years, resulting in a follow-up time of 53 517 861 person-years and 158 982 (first) hip fractures, of which 42 825 involved fracture-related hip replacement procedures. A further 104 422 individuals underwent arthritis-related hip replacement. During the first 2 decades of the 21st century, hip fracture rates declined by 35% to 40% for individuals aged 70 to 104 years, and the proportion of the population undergoing fracture-related hip replacement increased by 50% to 70%, with modest variation across those aged 75 to 99 years. Rates of arthritis-related hip replacements peaked for individuals aged 75 to 79 years, but with the largest relative rate increase (75%-100%) occurring for those aged 80 to 94 years, primarily from 2001 to 2015, whereafter it remained nearly unchanged. The decline in rates of arthritis-related hip replacement after 75 to 79 years of age was gradual and did not suggest an upper age limit for access to arthritis-related hip replacement. Conclusions and Relevance The findings of this cohort study suggest that during the past several decades in Denmark, the incidence of hip fractures declined by 35% to 40% among patients aged 80 to 104 years, while the proportion receiving fracture-related hip replacement remained relatively constant after 75 years of age. During the first decades of the 21st century, arthritis-related hip replacement incidence increased by 50% to 100% among older patients and stabilized hereafter, with no apparent cutoff age for this type of procedure. These patterns indicate a positive overall trend with declining hip fracture incidence over the last decades in Denmark, and the observed hip replacement incidence suggests that age is currently not a major determining factor guiding this type of surgery.
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Affiliation(s)
- Troels Mygind Jensen
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense
- Danish Aging Research Center, Department of Public Health, University of Southern Denmark, Odense
- Research Unit for Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, Odense
| | - Jacob Krabbe Pedersen
- Danish Aging Research Center, Department of Public Health, University of Southern Denmark, Odense
- Research Unit for Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, Odense
| | - Frans Boch Waldorff
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense
- Danish Aging Research Center, Department of Public Health, University of Southern Denmark, Odense
- Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Jens Søndergaard
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense
- Danish Aging Research Center, Department of Public Health, University of Southern Denmark, Odense
| | - Søren Overgaard
- Department of Orthopaedic Surgery and Traumatology, Copenhagen University Hospital, Bispebjerg, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Kaare Christensen
- Danish Aging Research Center, Department of Public Health, University of Southern Denmark, Odense
- Research Unit for Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, Odense
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Wang LX, Guan LJ, Deng MH, Zhou LH. Risk Factors of Serious Adverse Events for Geriatric Hip Fractures: Is it the Frailty or the Timing? Geriatr Orthop Surg Rehabil 2024; 15:21514593241250165. [PMID: 38681064 PMCID: PMC11047255 DOI: 10.1177/21514593241250165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 03/13/2024] [Accepted: 04/02/2024] [Indexed: 05/01/2024] Open
Abstract
Objective Preoperative frailty and surgical waiting times are associated with the occurrence of adverse outcomes in patients with hip fractures. Specifically, we aimed to investigate the influence of frailty status and surgical timing on the risk of serious adverse events during hospitalization. Methods This study utilized an observational single cohort design and included patients aged ≥60 years with a primary diagnosis of hip fracture. Frailty was assessed using the chart-derived frailty index (CFI), which was calculated based on demographic and routine laboratory variables. The primary outcome of interest was the occurrence of in-hospital serious adverse events. A multivariate logistic regression model was utilized to examine the risk factors influencing outcomes. Results The study included 427 participants, with a mean age of 80.28 ± 8.13 years and 64.2% of whom were female. Patients with high CFI have more comorbidities (P < .001), lower surgical rates (P = .002), and delayed surgical times (P = .033). A total of 239 patients (56.0%) experienced serious adverse events. The high CFI group had a significantly higher occurrence of serious adverse events compared to the low CFI group (73.4% vs 48.5%, P < .001). After adjusting for surgical timing and covariates, the multivariate logistic regression analysis revealed that high frailty significantly increased the risk for serious adverse events (OR = 2.47, 95% CI 1.398-4.412), infection (OR = 1.99, 95% CI 1.146-3.446), acute heart failure (OR = 3.37, 95% CI 1.607-7.045). However, the timing of surgery did not demonstrate any association with these outcomes. In addition, after adjusting for surgical factors, high CFI remains an independent risk factor for these complications. Conclusions Frailty serves as a reliable predictor of the probability of encountering severe adverse events while hospitalized for elderly individuals with hip fractures. This method has the potential to pinpoint particular modifiable factors that necessitate intervention, whereas the impact of surgical timing remains uncertain and necessitates additional research.
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Affiliation(s)
- Ling-xiao Wang
- Department of gerontology and geriatrics, Chengdu Fifth People’s Hospital (The Second Clinical Medical College, Affiliated Fifth People’s Hospital of Chengdu University of Traditional Chinese Medicine), Chengdu, China
| | - Li-juan Guan
- Department of gerontology and geriatrics, Chengdu Fifth People’s Hospital (The Second Clinical Medical College, Affiliated Fifth People’s Hospital of Chengdu University of Traditional Chinese Medicine), Chengdu, China
| | - Ming-hong Deng
- Department of gerontology and geriatrics, Chengdu Fifth People’s Hospital (The Second Clinical Medical College, Affiliated Fifth People’s Hospital of Chengdu University of Traditional Chinese Medicine), Chengdu, China
| | - Li-hua Zhou
- Department of gerontology and geriatrics, Chengdu Fifth People’s Hospital (The Second Clinical Medical College, Affiliated Fifth People’s Hospital of Chengdu University of Traditional Chinese Medicine), Chengdu, China
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Lin D, Zhu F, Chen P, Lin C, Chen B, Zheng K, Zheng S, Lin F. Pre-sliding of the femoral neck system to prevent postoperative shortening of femoral neck fractures. Heliyon 2024; 10:e29187. [PMID: 38601698 PMCID: PMC11004876 DOI: 10.1016/j.heliyon.2024.e29187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 03/27/2024] [Accepted: 04/02/2024] [Indexed: 04/12/2024] Open
Abstract
Objective The purpose of this study is to evaluate the effect of pre-sliding of the femoral neck system (FNS) in the prevention of postoperative femoral neck shortening in femoral neck fractures. Method This study was designed to retrospectively analyze data from 109 patients with femoral neck fractures who were admitted to a Level I trauma center between April 2020 and June 2022. Of these patients, 90 were followed up for more than 12 months. The study included 52 males and 38 females, with 35 cases of Garden I and II fractures and 55 cases of Garden III and IV fractures. The Harris Hip Score at 12 months postoperatively were recorded. The patients were divided into two groups based on their surgical records and postoperative radiography: the Pre-sliding group and the No-pre-sliding group. The purpose of this study is to analyze the role of pre-sliding in preventing femoral neck shortening, fracture healing time, degree of postoperative shortening, complications, and Harris Hip Score, and to make a comparison between the two groups. Results All 90 patients were followed up for over one year after surgery. A statistically significant difference was observed in the preoperative Garden classification (P < 0.05). At 1 year after the operation, the shortening distance was 6.5 ± 6.4 mm in the No-pre-sliding group and 3.9 ± 3.4 mm in the Pre-sliding group. The Harris Hip Score were 88.7 (79.8, 93.5) in the No-pre-sliding group and 94.8 (87.7, 96.9) in the Pre-sliding group, with a statistically significant difference between the two groups (P < 0.05). Shortening was concentrated at 3 months postoperatively and reached a stable state within 6 months, with less persistent shortening occurring after 6 months. There was no statistically significant difference in the preoperative baseline data. Conclusion Pre-sliding of the FNS prevents postoperative shortening of the femoral neck and improves hip function as measured by the Harris Hip Score.
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Affiliation(s)
| | | | - Peisheng Chen
- Department of Orthopaedics, Fuzhou Second General Hospital, Fuzhou Second Hospital of Xiamen University, School of Clinical Medicine of Fujian Medical University, Fujian Provincial Clinical Medical Research Center for First Aid and Rehabilitation in Orthopaedic Trauma, Fuzhou, 350007, China
| | - Chaohui Lin
- Department of Orthopaedics, Fuzhou Second General Hospital, Fuzhou Second Hospital of Xiamen University, School of Clinical Medicine of Fujian Medical University, Fujian Provincial Clinical Medical Research Center for First Aid and Rehabilitation in Orthopaedic Trauma, Fuzhou, 350007, China
| | - Bin Chen
- Department of Orthopaedics, Fuzhou Second General Hospital, Fuzhou Second Hospital of Xiamen University, School of Clinical Medicine of Fujian Medical University, Fujian Provincial Clinical Medical Research Center for First Aid and Rehabilitation in Orthopaedic Trauma, Fuzhou, 350007, China
| | - Ke Zheng
- Department of Orthopaedics, Fuzhou Second General Hospital, Fuzhou Second Hospital of Xiamen University, School of Clinical Medicine of Fujian Medical University, Fujian Provincial Clinical Medical Research Center for First Aid and Rehabilitation in Orthopaedic Trauma, Fuzhou, 350007, China
| | - Shunze Zheng
- Department of Orthopaedics, Fuzhou Second General Hospital, Fuzhou Second Hospital of Xiamen University, School of Clinical Medicine of Fujian Medical University, Fujian Provincial Clinical Medical Research Center for First Aid and Rehabilitation in Orthopaedic Trauma, Fuzhou, 350007, China
| | - Fengfei Lin
- Department of Orthopaedics, Fuzhou Second General Hospital, Fuzhou Second Hospital of Xiamen University, School of Clinical Medicine of Fujian Medical University, Fujian Provincial Clinical Medical Research Center for First Aid and Rehabilitation in Orthopaedic Trauma, Fuzhou, 350007, China
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Rasheed MA, Amin MS, Chaudhry MN, Nadeem F, Mushtaq Khan A, Fatima A, Noor I. Role of Anteromedial Cortical Support for Unstable Intertrochanteric Fractures Being Treated With Cephalomedullary Nails. Cureus 2024; 16:e58303. [PMID: 38752047 PMCID: PMC11095060 DOI: 10.7759/cureus.58303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2024] [Indexed: 05/18/2024] Open
Abstract
INTRODUCTION Reduction quality is of paramount importance for an optimal outcome in unstable pertrochanteric fractures. The non-anatomical functional anteromedial buttress is proposed to prevent impending mechanical complications. We aimed to evaluate the role of anteromedial cortical support in preventing mechanical complications following fixation with the cephalomedullary nail. MATERIALS AND METHODS A prospective, single-arm interventional study was conducted in the Orthopaedics Department of a Combined Military Hospital (CMH) in Rawalpindi. The duration of the study was 24 months. Patients were recruited by the purposive sampling technique as per inclusion/exclusion criteria. Preoperatively, the reduction was categorized as per Baumgartner's and Chang's criteria. Post-operatively, weight bearing as tolerated was advised. Radiographs prior to discharge for loss of reduction were evaluated. Follow-up radiographic measurements of neck length, neck shaft angle, and their loss as per protocol were done at three and six months. RESULTS A total of 202 patients were operated on from October 21 until August 23. Mortality at six months in 39 patients (19.3%) and loss to follow-up in 31 patients (15.3%) resulted in 132 patients with complete follow-up and having developed complications in 12 patients (9.09%). The mean age was 76.3 ± 7.98 years; males were 105 (79.5%), and females were 27 (20.5%). Closed reduction was 58 (43.9%), and additional manoeuvres were required in 74 (56.1%). The mean tip apex distance (TAD) was 24.56 ± 2.76, and the Calcar gap was 5.16 ± 1.27. Cleveland zone centre-centre in 54 (40.9%), inferior-centre in 65 (49.2%), and inferior-posterior (9.9%) were statistically significant for mechanical complications (p≤0.001). There was a significant association between the grading of Chang's and Baumgartner's poor groups for the development of mechanical complications (p≤0.001). The mean time to full weight bearing without support was 21 ± 1.22 weeks. The mean Hip Harris score at six months was 69.27 ± 7.68. CONCLUSION Results suggest that anteromedial cortical support can lead to fewer potential mechanical complications at six months. A higher Chang's grade drives surgeons to engage in additional manoeuvres. Anteromedial cortical support is worth consideration for unstable pertrochanteric fractures.
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Affiliation(s)
- Muhammad Asif Rasheed
- Department of Orthopaedics and Traumatology, Combined Military Hospital, Rawalpindi, PAK
| | - Muhammad Suhail Amin
- Department of Orthopaedics and Traumatology, Combined Military Hospital, Rawalpindi, PAK
- Department of Orthopaedics, Army Medical College, Rawalpindi, Rawalpindi, PAK
| | | | - Faisal Nadeem
- Department of Orthopaedics and Traumatology, Combined Military Hospital, Rawalpindi, PAK
| | - Ahmed Mushtaq Khan
- Department of Orthopaedics and Traumatology, Combined Military Hospital, Rawalpindi, PAK
| | - Areej Fatima
- Department of Orthopaedics and Traumatology, Combined Military Hospital, Rawalpindi, PAK
| | - Irbah Noor
- Department of Orthopaedics and Traumatology, Combined Military Hospital, Rawalpindi, PAK
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Yao W, Sun X, Tang W, Wang W, Lv Q, Ding W. Risk factors for hospital-acquired pneumonia in hip fracture patients: A systematic review and meta-analysis. Medicine (Baltimore) 2024; 103:e35773. [PMID: 38457536 PMCID: PMC10919500 DOI: 10.1097/md.0000000000035773] [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: 06/19/2023] [Revised: 09/04/2023] [Accepted: 10/03/2023] [Indexed: 03/10/2024] Open
Abstract
BACKGROUND This study aimed to comprehensively assess the prevalence and risk factors for Hospital-acquired pneumonia (HAP) in hip fracture patients by meta-analysis. METHODS Systematically searched 4 English databases and 4 Chinese databases from inception until October 20, 2022. All studies involving risk factors of HAP in patients with hip fractures will be considered. Newcastle-Ottawa Scale was used to evaluate the quality of the included studies. The results were presented through Review Manager 5.4 with the pooled odds ratio (OR) and 95% confidence interval. RESULTS Of 35 articles included in this study, the incidence of HAP was 8.9%. 43 risk factors for HAP were initially included, 23 were eventually involved in the meta-analysis, and 21 risk factors were significant. Among them, the 4 most frequently mentioned risk factors were as follows: Advanced age (OR 1.07, 95% CI 1.05-1.10), chronic obstructive pulmonary disease (COPD) (OR 3.44, 95% CI 2.83-4.19), time from injury to operation (OR 1.09, 95% CI 1.07-1.12), time from injury to operation ≥ 48 hours (OR 3.59, 95% CI 2.88-4.48), and hypoalbuminemia < 3.5g/dL (OR 2.68, 95% CI 2.15-3.36). DISCUSSION Hip fracture patients diagnosed with COPD have a 3.44 times higher risk of HAP compared to the general hip fracture patients. The risk of HAP also increases with age, with patients over 70 having a 2.34-fold higher risk and those over 80 having a 2.98-fold higher risk. These findings highlight the need for tailored preventive measures and timely interventions in vulnerable patient populations. Additionally, hip fracture patients who wait more than 48 hours for surgery have a 3.59-fold higher incidence of HAP. This emphasizes the importance of swift surgical intervention to minimize HAP risk. However, there are limitations to consider in this study, such as heterogeneity in selected studies, inclusion of only factors identified through multivariate logistic regression, and the focus on non-randomized controlled trial studies.
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Affiliation(s)
- Wei Yao
- Department of Orthopedics, Dandong Central Hospital, China Medical University, Dandong, China
| | - Xiaojia Sun
- Department of Pediatrics, Dandong Central Hospital, China Medical University, Dandong, China
| | - Wanyun Tang
- Department of Orthopedics, Dandong Central Hospital, China Medical University, Dandong, China
| | - Wei Wang
- Department of Orthopedics, Dandong Central Hospital, China Medical University, Dandong, China
| | - Qiaomei Lv
- Department of Oncology, Dandong Central Hospital, China Medical University, Dandong, China
| | - Wenbo Ding
- Department of Orthopedics, Dandong Central Hospital, China Medical University, Dandong, China
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Feng J, Tang G, Shui Y, Xiang J, Qin Z. Effects of ultrasound-guided lumbar plexus and sacral plexus block combined with general anesthesia on the anesthetic efficacy and surgical outcomes in elderly patients undergoing intertrochanteric fracture surgery: a randomized controlled trial. J Orthop Surg Res 2024; 19:171. [PMID: 38448954 PMCID: PMC10918949 DOI: 10.1186/s13018-023-04469-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 12/13/2023] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Surgery for intertrochanteric fractures in elderly patients is challenging due to the risk of severe pain and significant stress responses. We investigated the effects of a combined approach of ultrasound-guided lumbar plexus and sacral plexus block with general anesthesia on anesthetic efficacy and surgical outcomes in these patients. METHODS A randomized controlled trial was conducted involving 150 elderly patients, divided into two groups: the combined anesthesia group (receiving ultrasound-guided lumbar plexus and sacral plexus block along with general anesthesia) and the general anesthesia alone group. Outcome measures included hemodynamic parameters, postoperative pain levels (VAS scores), postoperative recovery times, and incidence of adverse reactions. RESULTS In the combined anesthesia group, the patients had more stable intraoperative hemodynamics, lower postoperative VAS scores at 1, 3, and 6 h, and faster recovery times (eye-opening upon command and return of respiratory function) compared to the general anesthesia group. Furthermore, the incidence of adverse reactions was significantly lower in the combined anesthesia group. CONCLUSIONS Ultrasound-guided lumbar plexus and sacral plexus block combined with general anesthesia enhanced the anesthetic efficacy and improved surgical outcomes in elderly patients undergoing intertrochanteric fracture surgery.
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Affiliation(s)
- Ji Feng
- Department of Anesthesiology, Sichuan Province Orthopedic Hospital, 132 West First Ring Road, Wuhou District, Chengdu City, 610041, Sichuan, China
| | - Guangyan Tang
- Department of Radiology, Sichuan Province Orthopedic Hospital, Chengdu City, 610041, Sichuan, China
| | - Yunhua Shui
- Department of Anesthesiology, Sichuan Province Orthopedic Hospital, 132 West First Ring Road, Wuhou District, Chengdu City, 610041, Sichuan, China
| | - Jilin Xiang
- Department of Anesthesiology, Sichuan Province Orthopedic Hospital, 132 West First Ring Road, Wuhou District, Chengdu City, 610041, Sichuan, China
| | - Zhijun Qin
- Department of Anesthesiology, Sichuan Province Orthopedic Hospital, 132 West First Ring Road, Wuhou District, Chengdu City, 610041, Sichuan, China.
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Cai L, Zheng W, Chen C, Hu W, Chen H, Wang T. Comparison of young femoral neck fractures treated by femoral neck system, multiple cancellous screws and dynamic hip screws: a retrospectively comparison study. BMC Musculoskelet Disord 2024; 25:188. [PMID: 38431562 PMCID: PMC10908085 DOI: 10.1186/s12891-024-07319-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 02/28/2024] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND Implant choice for the fixation of femoral neck fracture is one of the most important management controversies. This study aims to evaluate and compare the short-term outcomes associated with the use of the Femoral Neck System (FNS), Multiple Cancellous Screws (MCS), and Dynamic Hip Screws (DHS) in treating femoral neck fractures in a young patient population. METHODS From June 2018 to June 2021, a total of 120 surgeries for a primary femoral neck fracture were retrospectively analyzed. This review encompassed demographic details of the patients and the mechanisms behind the injuries. Key surgical parameters such as operation duration, intraoperative blood loss, fluoroscopy duration, and hospital stay were meticulously documented. The employed surgical technique was described. All patients were followed up at 6 weeks, 3 months, 6 months, and 12 months postoperatively. Avascular necrosis of the femoral head (AVN), nonunion, malreduction, implant failure or other complications were noted. The functional status at the last follow-up was assessed using the Harris functional scoring criteria. RESULTS There were 90 males and 30 females, with a mean age of 40.4 years. As to patient characteristics, there were no significant differences between the three groups. DHS group showed longer operation time(52.15 ± 4.80 min), more blood loss(59.05 ± 5.87 ml) and longer time of hospitalization(7.6 ± 0.90 d) than FNS group (39.65 ± 2.84 min, 45.33 ± 9.63 ml and 4.87 ± 0.48 d) and MCS group (39.45 ± 3.10 min, 48.15 ± 7.88 ml and 5.04 ± 0.49 d) (p < 0.05). In addition, the time of fluoroscopy in FNS group (15.45 ± 3.67) was less than that in MCS group (26.3 ± 4.76) and DHS group (27.1 ± 5.67) (p < 0.05). The cost of FNS group(44.51 ± 2.99 thousand RMB) was significantly higher than the MCS and DHS groups. The FNS, MCS and DHS groups showed a similar mean length of femoral neck shortening (LFNS) and Harris score. The FNS, MCS and DHS groups showed a similar mean rate of AVN and internal fixation failure. CONCLUSIONS Following successful fracture reduction, FNS, MCS, and DHS are effective for in the young femoral neck fractures. No difference was found in complications between the three groups. However, the reduced fluoroscopy time associated with FNS contributes to shorter operation durations. The adoption of minimally invasive techniques correlates with decreased blood loss and shorter hospital stays. Nevertheless, these advantages may be offset by the potential economic burden they impose.
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Affiliation(s)
- Leyi Cai
- Department of Orthopaedic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109 Xueyuanxi Road, Wenzhou, Zhejiang, 325000, China
| | - Wenhao Zheng
- Department of Orthopaedic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109 Xueyuanxi Road, Wenzhou, Zhejiang, 325000, China
| | - Chunhui Chen
- Department of Orthopaedic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109 Xueyuanxi Road, Wenzhou, Zhejiang, 325000, China
| | - Wei Hu
- Department of Orthopaedic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109 Xueyuanxi Road, Wenzhou, Zhejiang, 325000, China
| | - Hua Chen
- Department of Orthopaedic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109 Xueyuanxi Road, Wenzhou, Zhejiang, 325000, China
| | - Te Wang
- Department of Orthopaedic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109 Xueyuanxi Road, Wenzhou, Zhejiang, 325000, China.
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Zhao YK, Zhang C, Zhang YW, Li RY, Xie T, Bai LY, Chen H, Rui YF. Efficacy and safety of tranexamic acid in elderly patients with femoral neck fracture treated with hip arthroplasty: A systematic review and meta-analysis. J Orthop Sci 2024; 29:542-551. [PMID: 36797125 DOI: 10.1016/j.jos.2023.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 01/14/2023] [Accepted: 01/16/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND Elderly patients with femoral neck fracture have high perioperative blood loss according to the trauma and hip arthroplasty surgery. Tranexamic acid is a fibrinolytic inhibitor and has been widely used in hip fracture patients to against perioperative anemia. The aim of the present meta-analysis was to evaluate the efficacy and safety of Tranexamic acid (TXA) in elderly patients with femoral neck fracture undergoing hip arthroplasty. METHODS We performed search using Pubmed, EMBASE, Cochrane Reviews, and Web of Science databases to identify all relevant research studies published from inception to June 2022. Randomized controlled studies and high-quality cohort studies that reported the perioperative use of TXA in patients with femoral neck fractures treated with arthroplasty, and made a comparison with the control group were included. Meta-analysis was performed using Review Manager 5.3 to assess the efficacy and safety of TXA. Subgroup analysis was conducted to further investigate the impact caused by surgery types and administration routes on the efficacy and safety outcomes. RESULTS Five randomized controlled trials (RCTs) and eight cohort studies published from January 2015 to June 2022 were included in this meta-analysis. The results showed significant reductions in the rate of allogeneic blood transfusion, total blood loss (TBL) and postoperative hemoglobin (Hb) drop in the TXA group compared with the control group, while no significant difference was found in the intraoperative blood loss, postoperative drainage, hospital length of stay (LOS), re-admission rate, and wound complications between the two groups. The incidence of thromboembolic events and mortality showed no significant difference. Subgroup analysis indicated that surgery types and administration routes did not change the overall tendency. CONCLUSION The current evidence shows that both intravascular administration (IV) and topical administration of TXA can significantly decrease the perioperative transfusion rate and TBL without increasing the risk of thromboembolic complications in elderly patients with femoral neck fracture.
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Affiliation(s)
- Ya-Kuan Zhao
- Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, PR China; Orthopaedic Trauma Institute (OTI), Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, PR China; Multidisciplinary Team (MDT) for Elderly Hip Fracture Comprehensive Management, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, PR China; Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, PR China; School of Medicine, Southeast University, NO. 87 Ding Jia Qiao, Nanjing, Jiangsu 210009, PR China; The Fourth Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, 210000, PR China
| | - Cheng Zhang
- Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, PR China; Orthopaedic Trauma Institute (OTI), Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, PR China; Multidisciplinary Team (MDT) for Elderly Hip Fracture Comprehensive Management, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, PR China; Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, PR China; School of Medicine, Southeast University, NO. 87 Ding Jia Qiao, Nanjing, Jiangsu 210009, PR China
| | - Yuan-Wei Zhang
- Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, PR China; Orthopaedic Trauma Institute (OTI), Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, PR China; Multidisciplinary Team (MDT) for Elderly Hip Fracture Comprehensive Management, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, PR China; Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, PR China; School of Medicine, Southeast University, NO. 87 Ding Jia Qiao, Nanjing, Jiangsu 210009, PR China
| | - Ru-Ya Li
- Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, PR China; Orthopaedic Trauma Institute (OTI), Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, PR China; Multidisciplinary Team (MDT) for Elderly Hip Fracture Comprehensive Management, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, PR China; Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, PR China; School of Medicine, Southeast University, NO. 87 Ding Jia Qiao, Nanjing, Jiangsu 210009, PR China
| | - Tian Xie
- Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, PR China; Orthopaedic Trauma Institute (OTI), Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, PR China; Multidisciplinary Team (MDT) for Elderly Hip Fracture Comprehensive Management, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, PR China; Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, PR China; School of Medicine, Southeast University, NO. 87 Ding Jia Qiao, Nanjing, Jiangsu 210009, PR China
| | - Li-Yong Bai
- Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, PR China; Orthopaedic Trauma Institute (OTI), Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, PR China; Multidisciplinary Team (MDT) for Elderly Hip Fracture Comprehensive Management, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, PR China; Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, PR China; School of Medicine, Southeast University, NO. 87 Ding Jia Qiao, Nanjing, Jiangsu 210009, PR China
| | - Hui Chen
- Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, PR China; Orthopaedic Trauma Institute (OTI), Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, PR China; Multidisciplinary Team (MDT) for Elderly Hip Fracture Comprehensive Management, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, PR China; Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, PR China
| | - Yun-Feng Rui
- Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, PR China; Orthopaedic Trauma Institute (OTI), Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, PR China; Multidisciplinary Team (MDT) for Elderly Hip Fracture Comprehensive Management, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, PR China; Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, PR China; School of Medicine, Southeast University, NO. 87 Ding Jia Qiao, Nanjing, Jiangsu 210009, PR China.
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Luck T, Zaki PG, Slotkin EM, Michels R, Ong A, Butts CA. Age-Adjusted Modified Frailty Index: Association With Hip Fracture Discharge Functional Dependence. J Surg Res 2024; 295:214-221. [PMID: 38039726 DOI: 10.1016/j.jss.2023.10.021] [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: 03/01/2023] [Revised: 09/20/2023] [Accepted: 10/28/2023] [Indexed: 12/03/2023]
Abstract
INTRODUCTION Hip fractures are a common traumatic injury that carry significant morbidity and mortality, and prognostication of functional outcome is becoming increasingly salient. Across multiple surgical specialties, the five-item and 11-item Modified Frailty Index (mFI-5 and mFI-11) have been found to be convenient, quick, and sensitive tools for identifying patients at risk for perioperative complications. A prior study described the superiority of an Age-Adjusted Modified Frailty Index (aamFI) for predicting perioperative complications compared to the mFI-5 in an elective hip surgery. We sought to externally validate the aamFI in a multicenter hip fracture cohort and hypothesize that these risk scores would not only predict functional dependence (FD) at discharge, but that the aamFI would outperform the mFI-5 and mFI-11. METHODS The Pennsylvania Trauma Systems Foundation registry was queried from 2010 to 2020 for CPT codes, ICD-9 and ICD-10 codes pertaining to hip fracture patients. Patients with missing locomotion and transfer mobility data were excluded. FD status was determined by discharge locomotion and transfer mobility scores per existing methodology. Univariable and Multivariable analysis as well as receiver operator characteristic curves were used to evaluate and compare the three indices for prediction of functional status at discharge. P value < 0.05 was considered significant. RESULTS Twelve thousand seven hundred and forty patients met inclusion criteria (FD: 8183; functional independent 4557). On univariable logistic regression analysis, the mFI-11 (odds ratio [OR] 1.52, 95% confidence interval [CI] 1.47-1.58, P < 0.05), mFI-5 (OR 1.57, 95% CI 1.51-1.63), and aamFI (OR 1.57, 95% CI 1.52-1.62, P < 0.05) were associated with FD. On multivariable logistic regression analysis for predictors of FD, when controlling for age (for the mFI-11 and mFI-5), sex, injury severity score, and admission vitals (systolic blood pressure and respiratory rate), higher mFI-11 and mFI-5 scores independently predicted FD at discharge (OR 1.23, 95% CI 1.18-1.28, P < 0.05 and OR 1.23, 95% CI 1.18-1.29P < 0.05 respectively). Higher aaMFI scores had superior association with functional dependence (OR 1.59, 95% CI 1.54-1.64, P < 0.05). Receiver operator characteristic curves for the mFI-11, mFI-5, and aaMFI showed comparable diagnostic strength (area under curve [AUC] = 0.63 95% CI 0.62-0.64, P < 0.05; AUC = 0.63 95% CI 0.62-0.64, P < 0.05; and AUC = 0.67 95% CI 0.65-0.67, P < 0.05 respectively). CONCLUSIONS The mFI-11, mFI-5, and aamFI are predictive of functional outcome following hip fracture. By including age, the aamFI retains the ease of use of the mFI-5 while improving its prognostic utility for functional outcome.
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Affiliation(s)
- Trevor Luck
- Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Peter G Zaki
- Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Eric M Slotkin
- Division of Orthopedic Surgery, Department of Surgery, Reading Hospital, West Reading, Pennsylvania
| | - Ryan Michels
- Division of Orthopedic Surgery, Department of Surgery, Reading Hospital, West Reading, Pennsylvania
| | - Adrian Ong
- Division of Trauma, Department of Surgery, Acute Care Surgery, and Surgical Critical Care, Reading Hospital-Tower Health, West Reading, Pennsylvania
| | - Christopher A Butts
- Division of Trauma, Department of Surgery, Acute Care Surgery, and Surgical Critical Care, Reading Hospital-Tower Health, West Reading, Pennsylvania.
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Howard C, Sell T, Abraham C, Anderson JM, Norris B, Anderson RM, Vu TK, Vassar M, Checketts JX. Inadequate harms reporting among randomized controlled trials cited as supporting evidence in the AAOS management of hip fractures in older adults clinical practice guideline recommendations. Injury 2024; 55:111326. [PMID: 38262332 DOI: 10.1016/j.injury.2024.111326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 11/11/2023] [Accepted: 01/12/2024] [Indexed: 01/25/2024]
Abstract
BACKGROUND Recommendations within clinical practice guidelines (CPGs) are heavily influenced by results from randomized controlled trials (RCTs). Therefore, it is imperative that all RCT outcomes are reported thoroughly to ensure CPGs are created using accurate information. Here, we evaluate the quality of harms reporting using the CONSORT Extension for Harms in RCTs underpinning recommendations in the American Academy of Orthopedic Surgeons (AAOS) Management of Hip Fractures in Older Adults CPG. METHODS Each RCT cited as evidence for recommendations in the AAOS Management of Hip Fractures in Older Adults CPG was evaluated using the CONSORT Extension for Harms to determine the quality of harms reporting. Descriptive statistics (frequencies, percentages, 95 % confidence intervals) were used to summarize adherence to CONSORT Harms items. A linear regression model was used to evaluate the CONSORT Harms influence on the quality of reporting over time. RESULTS Among the 156 RCTs identified, there were a total of 31,848 participants. Most RCTs were conducted at a single center (137; 87.8 %) and in a single-blind manner (130; 83.3 %). Fifty-four (34.6 %) RCTs did not provide funding statements. Trials adequately reported an average of 6.65 out of 18 CONSORT Extension for Harms items (37.0 %). One RCT adequately reported all items, while five reported zero items. Forty-seven RCTs (30.1 %) reported ≥ 50 % of items and 73 (46.8 %) reported ≤ 33.3 % of items. The linear regression model demonstrated no significant increase in mean adherence over time (adjusted R2 = -0.006; p = 0.563). CONCLUSION Our results highlight inadequate harms reporting among RCTs in the AAOS Management of Hip Fractures in Older Patients CPG. While the CONSORT Harms Extension was intended to enhance reporting, the linear regression model did not demonstrate significant improvements over time.
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Affiliation(s)
- Conner Howard
- Oklahoma State University, Center for Health Sciences, Tulsa, OK, USA.
| | - Tianna Sell
- Burrell College of Osteopathic Medicine, Las Cruces, NM, USA
| | - Christena Abraham
- Kansas City University College of Osteopathic Medicine, Kansas City, MO, USA
| | - J Michael Anderson
- Oklahoma State University Medical Center, Department of Orthopaedic Surgery, Tulsa, OK, USA
| | - Brent Norris
- Oklahoma State University Medical Center, Department of Orthopaedic Surgery, Tulsa, OK, USA; Orthopaedic Trauma Services of Oklahoma, Tulsa, OK, USA
| | - Reece M Anderson
- Oklahoma State University, Center for Health Sciences, Tulsa, OK, USA
| | - Thuc K Vu
- Kansas City University College of Osteopathic Medicine, Kansas City, MO, USA
| | - Matt Vassar
- Oklahoma State University, Center for Health Sciences, Tulsa, OK, USA
| | - Jake X Checketts
- Oklahoma State University Medical Center, Department of Orthopaedic Surgery, Tulsa, OK, USA
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Shitahodo T, Murata S, Kitano Y, Mera Y, Iwahashi H, Inoue S, Kawamura K, Yamada H. Benefits of surgical treatment within 48 h of proximal femoral fracture in centenarians: a retrospective cohort study. Front Surg 2024; 11:1349434. [PMID: 38476756 PMCID: PMC10927821 DOI: 10.3389/fsurg.2024.1349434] [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: 12/04/2023] [Accepted: 02/16/2024] [Indexed: 03/14/2024] Open
Abstract
Introduction Proximal femoral fractures in aging populations represent a significant concern, with an increasing prevalence among individuals aged ≥100 years. The existing research does not provide robust guidance for clinicians managing older patients aged ≥100 years with proximal femoral fractures. We investigated the safety and efficacy of surgical treatment in patients aged ≥100 years with proximal femoral fractures and evaluated the impact of early surgery on their outcomes. Methods This retrospective cohort study involved 15 patients aged ≥100 years who underwent surgical treatment of proximal femoral fractures; the control group included 137 patients in their 90s. Data were collected between January 2010 and December 2017. Evaluation items included patient characteristics, surgical details, perioperative complication rates, length of hospital stay, the proportion of patients discharged to the same facility or home, rate of regaining walking ability, and 1-year survival rate. Results The patients aged ≥100 years and those in their 90s had comparable outcomes. Thus, age alone does not dictate surgical success. Early surgery (≤48 h) was associated with trends toward improved perioperative complications, ambulatory ability, and return to original living environment. Discussion This study underscores the potential benefits of surgical intervention for proximal femoral fractures in patients aged ≥100 years, indicating the relevance of early surgery (≤48 h). Our findings emphasized the importance of timely intervention and evidence-based decision-making for this demographic. Clinicians, policymakers, and patients could benefit from our insights to enhance fracture management strategies, along with future research endeavors to validate and expand our results in larger multicenter cohorts.
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Affiliation(s)
- Toshiya Shitahodo
- Department of Orthopedic Surgery, Shingu Municipal Medical Center, Shingu, Wakayama, Japan
| | - Shizumasa Murata
- Department of Orthopedic Surgery, Shingu Municipal Medical Center, Shingu, Wakayama, Japan
| | - Yoji Kitano
- Department of Orthopedic Surgery, Shingu Municipal Medical Center, Shingu, Wakayama, Japan
| | - Yoshimasa Mera
- Department of Orthopedic Surgery, Shingu Municipal Medical Center, Shingu, Wakayama, Japan
| | - Hiroki Iwahashi
- Department of Orthopedic Surgery, Shingu Municipal Medical Center, Shingu, Wakayama, Japan
| | - Shingo Inoue
- Department of Orthopedic Surgery, Shingu Municipal Medical Center, Shingu, Wakayama, Japan
| | - Kota Kawamura
- Department of Orthopedic Surgery, Shingu Municipal Medical Center, Shingu, Wakayama, Japan
| | - Hiroshi Yamada
- Department of Orthopedic Surgery, Wakayama Medical University, Wakayama, Japan
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Tang W, Ni X, Yao W, Wang W, Lv Q, Ding W, He R. The correlation between admission hyperglycemia and 30-day readmission after hip fracture surgery in geriatric patients: a propensity score-matched study. Front Endocrinol (Lausanne) 2024; 15:1340435. [PMID: 38449856 PMCID: PMC10915248 DOI: 10.3389/fendo.2024.1340435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 01/08/2024] [Indexed: 03/08/2024] Open
Abstract
Purpose This study aimed to investigate the association between admission hyperglycemia and 30-day readmission after hip fracture surgery in geriatric patients. Methods This retrospective study included 1253 geriatric hip fracture patients. Patients were categorized into normoglycemia(<6.10 mmol/L) and hyperglycemia groups(≥6.10 mmol/L) based on admission blood glucose. We performed multivariable logistic regression analyses and propensity score matching (PSM) to estimate adjusted odds ratios and 95% confidence intervals for 30-day readmission, controlling for potential confounding factors. An analysis of the dose-dependent association between admission blood glucose and the probability of 30-day readmission was performed. Additional subgroup analysis was conducted to examine the impact of other factors on the relationship between admission blood glucose and 30-day readmission. Results Patients with hyperglycemia had higher 30-day readmission rates than normoglycemic patients before (19.1% vs 9.7%, p<0.001) and after PSM (18.1% vs 12.3%, p=0.035). Admission hyperglycemia was an independent predictor of increased 30-day readmission risk, with an adjusted odds ratio of 1.57 (95% CI 1.08-2.29, p=0.019) after multivariable regression and 1.57 (95% CI 1.03-2.39, p=0.036) after PSM. A dose-response relationship was observed between higher glucose levels and increased readmission risk. Conclusion Admission hyperglycemia is an independent risk factor for 30-day readmission after hip fracture surgery in the elderly. Routine glucose testing upon admission and perioperative glycemic control may help reduce short-term readmissions in this vulnerable population.
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Affiliation(s)
- Wanyun Tang
- Department of Orthopedics, Zigong First People’s Hospital, Zigong, China
- Department of Orthopedics, Dandong Central Hospital, China Medical University, Dandong, China
| | - Xiaomin Ni
- Department of Orthopedics, Zigong Fourth People’s Hospital, Zigong, China
| | - Wei Yao
- Department of Orthopedics, Dandong Central Hospital, China Medical University, Dandong, China
| | - Wei Wang
- Department of Orthopedics, Dandong Central Hospital, China Medical University, Dandong, China
| | - Qiaomei Lv
- Department of Endocrinology, Dandong Central Hospital, China Medical University, Dandong, China
| | - Wenbo Ding
- Department of Orthopedics, Dandong Central Hospital, China Medical University, Dandong, China
| | - Renjian He
- Department of Orthopedics, Zigong First People’s Hospital, Zigong, China
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Jia X, Qiang M, Zhang K, Han Q, Jia G, Shi T, Wu Y, Chen Y. Accuracy of detecting burst of the lateral wall in intertrochanteric hip fractures with plain radiographs: Is postoperative CT necessary? Heliyon 2024; 10:e25389. [PMID: 38356592 PMCID: PMC10865257 DOI: 10.1016/j.heliyon.2024.e25389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 01/15/2024] [Accepted: 01/25/2024] [Indexed: 02/16/2024] Open
Abstract
Background Postoperative burst of the lateral femoral wall is thought to be the main predictor of reoperation for intertrochanteric fractures, which is routinely evaluated using plain radiographs. We retrospectively compared computed tomography (CT) scans and radiographs regarding the ability to detect burst of the lateral wall. We also investigated whether intramedullary nails may cause iatrogenic burst of the lateral wall. Methods From January 2010 to December 2021, patients aged 65 years and older who undergone intertrochanteric fractures treated with the proximal femoral nail antirotation 2 (PFNA-Ⅱ) were included. The incidence of burst of the lateral wall was evaluated with two different imaging modalities by two observers. Two rounds of evaluation were performed: (1) with plain radiographs alone; and (2) with CT scans combined with radiographs. Interobserver and intraobserver agreement (κ value) for evaluation of the lateral wall burst was assessed. Results A total of 1507 patients were included (362 males and 1145 females). Compared with radiographs alone (12.0 %, 181/1507 patients), a higher rate of lateral wall burst was found by CT scans combined with radiographs (72.9 %, 1098/1507 patients) for observer 1 at first reading (P < 0.001). Similar results were seen in other evaluations. Interobserver and intraobserver agreement was substantial for radiographs alone (κ, 0.659-0.727) and almost perfect for CT scans combined with radiographs (κ, 0.847-0.926). Conclusions Computed tomography combined with radiographs is superior to radiographs alone for detecting burst of the lateral wall after intertrochanteric fracture fixation. Additionally, PFNA-Ⅱ could cause iatrogenic burst of the lateral wall for intertrochanteric fractures in the elderly.
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Affiliation(s)
- Xiaoyang Jia
- Department of Orthopedic Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Rd, Shanghai, 200032, China
| | - Minfei Qiang
- Department of Orthopedic Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Rd, Shanghai, 200032, China
| | - Kun Zhang
- Research and Development Department, Yangfeng (Shanghai) Science and Technology CO., LTD, Shanghai, 200439, China
| | - Qinghui Han
- Department of Orthopedic Trauma, East Hospital, Tongji University School of Medicine, 150 Jimo Rd, Shanghai, 200120, China
| | - Gengxin Jia
- Department of Orthopedic Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Rd, Shanghai, 200032, China
| | - Tianhao Shi
- Department of Orthopedic Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Rd, Shanghai, 200032, China
| | - Ying Wu
- Department of Biostatistics, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangdong, Guangzhou, 510515, China
| | - Yanxi Chen
- Department of Orthopedic Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Rd, Shanghai, 200032, China
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Postler A, Posten C, Schubert M, Beyer F, Lützner J, Vicent O, Kleber C, Goronzy J, Kamin K. Patients risk for mortality at 90 days after proximal femur fracture - a retrospective study in a tertiary care hospital. BMC Geriatr 2024; 24:130. [PMID: 38310209 PMCID: PMC10838409 DOI: 10.1186/s12877-024-04733-8] [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: 11/05/2023] [Accepted: 01/20/2024] [Indexed: 02/05/2024] Open
Abstract
BACKGROUND Despite improving the management of proximal femur fractures (PFF) with legal requirements of timing the surgery within 24 h, mortality rates in these patients remain still high. The objective of our study was to analyze potential cofactors which might influence the mortality rate within 90 days after surgery in PFF to avoid adverse events, loss of quality of life and high rates of mortality. METHODS In this retrospective, single-center study all patients with PFF aged 65 years and older were included. We recorded gender, age, type of fracture, surgery and anesthesia, time, comorbidities and medication as well as complications and mortality rate at 90 days. Separate logistic regression models were used to assess which parameters were associated with patients' mortality. The mortality rate was neither associated with timing, time and type of surgery nor time and type of anesthesia, but with higher age (OR 1.08 per year; 95% CI 1.034-1.128), lower BMI (OR 0.915 per kg/m2; 95% CI 0.857-0.978), higher CCI (OR 1.170 per point; 95% CI 1.018-1.345), dementia (OR 2.805; 95% CI 1.616-4.869), non-surgical complications (OR 2.276; 95% CI 1.269-4.083) and if mobilization was impossible (OR 10.493; 95% CI 3.612-30.479). RESULTS We analyzed a total of 734 patients (age ≥ 65 years) who had a PFF in 2019 and 2020 and received surgery. 129 patients (17.6%) died until 90 days at an median age of 89.7 years (range 65-101 years). CONCLUSION The proportion of patients who died until 90 days after surgery is still high. It is less extend influenced by surgical and anaesthesiologic factors than by patient-related factors like age or lower BMI. Physicians should be aware of the importance of avoiding adverse events and the importance of patients' mobilization to reduce mortality and improve patients' outcome.
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Affiliation(s)
- Anne Postler
- University Center of Orthopaedic, Trauma and Plastic Surgery, University Hospital, TU Dresden, Fetscherstr. 74, 01307, Dresden, Germany.
| | - Charlotte Posten
- University Center of Orthopaedic, Trauma and Plastic Surgery, University Hospital, TU Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Melanie Schubert
- University Center of Orthopaedic, Trauma and Plastic Surgery, University Hospital, TU Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Franziska Beyer
- University Center of Orthopaedic, Trauma and Plastic Surgery, University Hospital, TU Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Jörg Lützner
- University Center of Orthopaedic, Trauma and Plastic Surgery, University Hospital, TU Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Oliver Vicent
- University Center of Orthopaedic, Trauma and Plastic Surgery, University Hospital, TU Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Christian Kleber
- Department of Orthopaedic, Trauma and Plastic Surgery, University of Leipzig, Leipzig, Germany
| | - Jens Goronzy
- University Center of Orthopaedic, Trauma and Plastic Surgery, University Hospital, TU Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Konrad Kamin
- University Center of Orthopaedic, Trauma and Plastic Surgery, University Hospital, TU Dresden, Fetscherstr. 74, 01307, Dresden, Germany
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Lucas A, Faizal A. Evaluation of Clinical and Radiological Outcomes in the Management of Intracapsular Fracture Neck of Femur in Elderly Treated With Cemented Bipolar Prosthesis. Cureus 2024; 16:e55283. [PMID: 38562269 PMCID: PMC10983056 DOI: 10.7759/cureus.55283] [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: 01/31/2024] [Accepted: 02/29/2024] [Indexed: 04/04/2024] Open
Abstract
INTRODUCTION Hip fractures, including femoral neck fractures (FNFs), represent a significant health challenge globally. Fractures of the hip can be categorized as either intracapsular or extracapsular. Among the elderly, FNFs are particularly prevalent and account for approximately half of all hip fractures. AIM This study aimed to evaluate the clinical and radiological outcomes of intracapsular FNFs in the elderly treated with cemented bipolar prostheses. Objectives: This study aims to: (i) assess the clinical outcomes, including pain relief, functional mobility, and patient satisfaction, in elderly individuals with intracapsular FNFs treated with cemented bipolar prosthesis; (ii) examine the radiological outcomes of intracapsular FNFs in the elderly following treatment with cemented bipolar prosthesis, focusing on factors such as implant stability, fracture healing, and any signs of complications. METHODS A prospective study included elderly patients (aged 55 and above) with intracapsular FNFs treated with cemented bipolar prostheses. Data were collected using a structured proforma, and outcomes were assessed through clinical and radiological evaluations at regular follow-ups. RESULTS The study included 60 participants with a mean age of 65.25 years. Most fractures were subcapital, and the majority of participants did not experience complications after surgery. The average length of the pre-operative hospital stay was 2.35 days, and the post-operative hospital stay was 6.75 days. Functional outcomes, evaluated using the Harris Hip Scoring System, showed varying degrees, with 70% of participants experiencing good outcomes. CONCLUSION The management of intracapsular femoral neck fractures in the elderly with cemented bipolar prostheses demonstrated favorable outcomes, including low morbidity, simple operative procedures, and satisfactory early functional results. The study supports the recommendation of cemented bipolar prostheses for femoral neck fractures in individuals over 60, emphasizing their superiority over bipolar hemiarthroplasty. The results contribute valuable insights for treatment decisions in hip fractures, especially considering evolving reimbursement mechanisms and merit-based incentive payments.
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Affiliation(s)
- Ajay Lucas
- Radiodiagnosis, Saveetha Institute of Medical and Technical Sciences (SIMATS) Saveetha Medical College and Hospital, Chennai, IND
| | - Afwaan Faizal
- Radiodiagnosis, Saveetha Institute of Medical and Technical Sciences (SIMATS) Saveetha Medical College and Hospital, Chennai, IND
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Mou Z, Xiang L, Ni Y. Comparative effectiveness of pericapsular nerve group block versus fascia iliac compartment block on postoperative wound pain management in patients undergoing hip fracture surgery: A systematic review and meta-analysis. Int Wound J 2024; 21:e14637. [PMID: 38332471 PMCID: PMC10853491 DOI: 10.1111/iwj.14637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 12/17/2023] [Accepted: 12/17/2023] [Indexed: 02/10/2024] Open
Abstract
Hip fracture surgeries are challenging, with postoperative pain management being a critical component of patient care. This systematic review and meta-analysis aimed to compare the effectiveness of Pericapsular nerve group block (PENGB) and fascia iliac compartment block (FICB) in postoperative wound pain management for patients undergoing hip fracture surgery. The study followed the PRISMA guidelines and was structured around the PICO framework. Comprehensive searches were conducted across PubMed, Embase, Web of Science, and the Cochrane Library. Inclusion criteria were limited to RCTs comparing the effectiveness of PENGB and FICB in adult patients undergoing hip fracture surgery. Key outcomes included pain control effectiveness, safety, and complication incidence. The quality of studies was assessed using the Cochrane Collaboration's risk of bias tool. Statistical heterogeneity was evaluated using I2 statistics, and meta-analysis effect values were calculated using random-effects or fixed-effect models, depending on the degree of heterogeneity. The search identified 1095 articles, with 5 studies meeting inclusion criteria. The meta-analysis revealed that PENGB and FICB were comparable in managing postoperative pain and opioid consumption. However, PENGB significantly reduced the incidence of quadriceps muscle weakness (RR = 0.12, p < 0.05) and did not increase the risk of PONV (RR = 1.36, p = 0.51), suggesting its advantage in maintaining motor function without adding to PONV complications. No significant publication bias was detected. PENGB is comparable to FICB in pain and opioid consumption management after hip fracture surgeries. Its significant benefit lies in reducing the incidence of quadriceps muscle weakness, facilitating better postoperative mobility. Additionally, PENGB does not increase the risk of postoperative nausea and vomiting, underlining its suitability for comprehensive postoperative care in hip fracture patients.
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Affiliation(s)
- Zhefei Mou
- Second Department of OrthopaedicsWenzhou City Central HospitalWenzhouChina
| | - Lingping Xiang
- Department of NursingYueqing Panshi Town Health CenterWenzhouChina
| | - Yueping Ni
- Second Department of OrthopaedicsWenzhou City Central HospitalWenzhouChina
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Song Q, Wang D, Li H, Wang Z, Sun S, Wang Z, Liu Y, Lin S, Li G, Zhang S, Zhang P. Dual-response of multi-functional microsphere system to ultrasound and microenvironment for enhanced bone defect treatment. Bioact Mater 2024; 32:304-318. [PMID: 37876555 PMCID: PMC10590728 DOI: 10.1016/j.bioactmat.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 09/21/2023] [Accepted: 10/07/2023] [Indexed: 10/26/2023] Open
Abstract
Using bone tissue engineering strategies to achieve bone defect repair is a promising modality. However, the repair process outcomes are often unsatisfactory. Here we properly designed a multi-functional microsphere system, which could deliver bioactive proteins under the dual response of ultrasound and microenvironment, release microenvironment-responsive products on demand, reverse bone injury microenvironment, regulate the immune microenvironment, and achieve excellent bone defect treatment outcomes. In particular, the MnO2 introduced into the poly(lactic-co-glycolic acid) (PLGA) microspheres during synthesis could consume the acid produced by the degradation of PLGA to protect bone morphogenetic protein-2 (BMP-2). More importantly, MnO2 could consume reactive oxygen species (ROS) and produce Mn2+ and oxygen (O2), further promoting the repair of bone defects while reversing the microenvironment. Moreover, the reversal of the bone injury microenvironment and the depletion of ROS promoted the polarization of M1 macrophages to M2 macrophages, and the immune microenvironment was regulated. Notably, the ultrasound (US) irradiation used during treatment also allowed the on-demand release of microenvironment-responsive products. The multi-functional microsphere system combines the effects of on-demand delivery, reversal of bone injury microenvironment, and regulation of the immune microenvironment, providing new horizons for the clinical application of protein delivery and bone defect repair.
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Affiliation(s)
- Qingxu Song
- Department of Spine Surgery, The First Hospital of Jilin University, Changchun, 130021, China
- Key Laboratory of Polymer Ecomaterials, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, Changchun, 130022, China
| | - Dianwei Wang
- Key Laboratory of Polymer Ecomaterials, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, Changchun, 130022, China
| | - Haoyu Li
- Department of Spine Surgery, The First Hospital of Jilin University, Changchun, 130021, China
- Key Laboratory of Polymer Ecomaterials, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, Changchun, 130022, China
| | - Zongliang Wang
- Key Laboratory of Polymer Ecomaterials, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, Changchun, 130022, China
| | - Songjia Sun
- Department of Dermatology, Second Hospital of Jilin University, Changchun, 130022, China
| | - Zhenyu Wang
- Department of Spine Surgery, The First Hospital of Jilin University, Changchun, 130021, China
| | - Yi Liu
- Department of Spine Surgery, The First Hospital of Jilin University, Changchun, 130021, China
| | - Sien Lin
- Department of Orthopaedics and Traumatology and Li Ka Shing Institute of Health Sciences, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region of China
| | - Gang Li
- Department of Orthopaedics and Traumatology and Li Ka Shing Institute of Health Sciences, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region of China
| | - Shaokun Zhang
- Department of Spine Surgery, The First Hospital of Jilin University, Changchun, 130021, China
| | - Peibiao Zhang
- Key Laboratory of Polymer Ecomaterials, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, Changchun, 130022, China
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Song Y, Zhang D, Wang Q, Liu Y, Chen K, Sun J, Shi L, Li B, Yang X, Mi W, Cao J. Prediction models for postoperative delirium in elderly patients with machine-learning algorithms and SHapley Additive exPlanations. Transl Psychiatry 2024; 14:57. [PMID: 38267405 PMCID: PMC10808214 DOI: 10.1038/s41398-024-02762-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 01/04/2024] [Accepted: 01/10/2024] [Indexed: 01/26/2024] Open
Abstract
Postoperative delirium (POD) is a common and severe complication in elderly patients with hip fractures. Identifying high-risk patients with POD can help improve the outcome of patients with hip fractures. We conducted a retrospective study on elderly patients (≥65 years of age) who underwent orthopedic surgery with hip fracture between January 2014 and August 2019. Conventional logistic regression and five machine-learning algorithms were used to construct prediction models of POD. A nomogram for POD prediction was built with the logistic regression method. The area under the receiver operating characteristic curve (AUC-ROC), accuracy, sensitivity, and precision were calculated to evaluate different models. Feature importance of individuals was interpreted using Shapley Additive Explanations (SHAP). About 797 patients were enrolled in the study, with the incidence of POD at 9.28% (74/797). The age, renal insufficiency, chronic obstructive pulmonary disease (COPD), use of antipsychotics, lactate dehydrogenase (LDH), and C-reactive protein are used to build a nomogram for POD with an AUC of 0.71. The AUCs of five machine-learning models are 0.81 (Random Forest), 0.80 (GBM), 0.68 (AdaBoost), 0.77 (XGBoost), and 0.70 (SVM). The sensitivities of the six models range from 68.8% (logistic regression and SVM) to 91.9% (Random Forest). The precisions of the six machine-learning models range from 18.3% (logistic regression) to 67.8% (SVM). Six prediction models of POD in patients with hip fractures were constructed using logistic regression and five machine-learning algorithms. The application of machine-learning algorithms could provide convenient POD risk stratification to benefit elderly hip fracture patients.
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Affiliation(s)
- Yuxiang Song
- Department of Anesthesiology, The First Medical Center of PLA General Hospital, Beijing, China
| | - Di Zhang
- Department of Anesthesiology, The First Medical Center of PLA General Hospital, Beijing, China
| | - Qian Wang
- Department of Anesthesiology, The First Medical Center of PLA General Hospital, Beijing, China
| | - Yuqing Liu
- Department of Anesthesiology, The First Medical Center of PLA General Hospital, Beijing, China
| | - Kunsha Chen
- Department of Anesthesiology, The First Medical Center of PLA General Hospital, Beijing, China
| | - Jingjia Sun
- Department of Anesthesiology, The First Medical Center of PLA General Hospital, Beijing, China
| | - Likai Shi
- Department of Anesthesiology, The First Medical Center of PLA General Hospital, Beijing, China
| | - Baowei Li
- Department of Anesthesiology, The First Medical Center of PLA General Hospital, Beijing, China
| | - Xiaodong Yang
- Institute of Computing Technology, Chinese Academy of Sciences, Beijing, China
| | - Weidong Mi
- Department of Anesthesiology, The First Medical Center of PLA General Hospital, Beijing, China.
- National Clinical Research Center for Geriatric Diseases, People's Liberation Army General Hospital, 100853, Beijing, China.
| | - Jiangbei Cao
- Department of Anesthesiology, The First Medical Center of PLA General Hospital, Beijing, China.
- National Clinical Research Center for Geriatric Diseases, People's Liberation Army General Hospital, 100853, Beijing, China.
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Kaieda M, Fujimoto Y, Arishima Y, Togo Y, Ogura T, Taniguchi N. Impact of preoperative echocardiographic delay on timing of hip fracture surgery in elderly patients. SAGE Open Med 2024; 12:20503121231222345. [PMID: 38249951 PMCID: PMC10798123 DOI: 10.1177/20503121231222345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 12/07/2023] [Indexed: 01/23/2024] Open
Abstract
Objectives Early surgery is recommended for hip fractures in elderly patients. This study was performed to evaluate factors contributing to delayed surgery and associated outcomes in a secondary hospital in Japan with a rehabilitation centre. Methods We retrospectively reviewed the records of 895 patients aged >50 years [median age, 86 (81-91) years] treated for hip fractures at our institution from 2016 to 2020. We defined surgical delay as surgery performed >48 h after admission. We evaluated several risk factors for surgical delay and associated outcomes: mortality, length of hospital stay and walking status. Results Binomial logistic regression analysis showed that several factors, including preoperative echocardiographic delay (odds ratio, 9.38; 95% confidence interval, 5.95-15.28), were risk factors for surgical delay. In the multiple regression analyses, surgical delay was a significant risk factor for a longer hospital stay (partial regression coefficient, 6.99; 95% confidence interval, 3.67-10.31). Conclusions Our findings indicated that preoperative echocardiographic delay was one of the risk factors for surgical delay of hip fractures in elderly patients. Surgical delay was a risk factor for a longer hospital stay, including rehabilitation.
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Affiliation(s)
- Mitsuyoshi Kaieda
- Department of Orthopaedic Surgery, Kohshinkai Ogura Hospital, Kagoshima, Japan
- Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Yusuke Fujimoto
- Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Yoshiya Arishima
- Department of Orthopaedic Surgery, Kohshinkai Ogura Hospital, Kagoshima, Japan
- Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Yasuhisa Togo
- Department of Orthopaedic Surgery, Kohshinkai Ogura Hospital, Kagoshima, Japan
| | - Tadashi Ogura
- Department of Orthopaedic Surgery, Kohshinkai Ogura Hospital, Kagoshima, Japan
| | - Noboru Taniguchi
- Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
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Heuer A, Müller J, Strahl A, Fensky F, Daniels R, Theile P, Frosch KH, Kluge S, Hubert J, Thiesen D, Roedl K. Outcomes in very elderly ICU patients surgically treated for proximal femur fractures. Sci Rep 2024; 14:1376. [PMID: 38228666 DOI: 10.1038/s41598-024-51816-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 01/09/2024] [Indexed: 01/18/2024] Open
Abstract
Proximal femur fractures (PFF) are a common injury in elderly patients that significantly impact mobility and daily living activities. Mortality rates in this population are also high, making effective treatment essential. Recent advances in intensive and geriatric care have enabled complex surgical interventions that were previously not feasible. However, there is a lack of studies focusing on outcome parameters in very elderly patients (≥ 90 years) who receive intensive care treatment following PFFs. In this retrospective study, we analyzed multi-layered data of 148 patients who were 90 years or older and received intensive care after trauma and orthopedic surgical treatment for PFFs or periprosthetic fractures between 2009 and 2019. All patients received a 365-day follow-up. To identify potential predictors of mortality, all deceased and surviving patients were subjected to multiple logistic regression analyses. We found that 22% of patients deceased during in-hospital care, and one-year survival was 44%. Independent predictors of one-year all-cause mortality included higher CCI and SOFA scores at ICU admission. Overall, 53% of patients who resided in private dwellings prior to admission were able to return home. Our study highlights the utility of using CCI and SOFA scores at ICU admission as prognostic indicators in critically ill very elderly patients who undergo surgical treatment for PFFs. These scores can provide valuable insight into the severity of illness and potential outcomes, which can inform resource allocation, prioritize endangered patients, and aid in end-of-life discussions and planning with patients and their families. Our findings can help improve the management of PFFs in very elderly patients and contribute to optimized patient care.
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Affiliation(s)
- Annika Heuer
- Department of Trauma and Orthopedic Surgery, University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, 20246, Hamburg, Germany.
| | - Jakob Müller
- Department of Intensive Care Medicine, University Medical Centre Hamburg-Eppendorf (UKE), Martinistraße 52, 20246, Hamburg, Germany
- Department of Anaesthesiology, Tabea Hospital, Hamburg, Germany
| | - André Strahl
- Department of Trauma and Orthopedic Surgery, University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, 20246, Hamburg, Germany
| | - Florian Fensky
- Department of Trauma and Orthopedic Surgery, University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, 20246, Hamburg, Germany
| | - Rikus Daniels
- Department of Intensive Care Medicine, University Medical Centre Hamburg-Eppendorf (UKE), Martinistraße 52, 20246, Hamburg, Germany
| | - Pauline Theile
- Department of Intensive Care Medicine, University Medical Centre Hamburg-Eppendorf (UKE), Martinistraße 52, 20246, Hamburg, Germany
| | - Karl-Heinz Frosch
- Department of Trauma and Orthopedic Surgery, University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, 20246, Hamburg, Germany
| | - Stefan Kluge
- Department of Intensive Care Medicine, University Medical Centre Hamburg-Eppendorf (UKE), Martinistraße 52, 20246, Hamburg, Germany
| | - Jan Hubert
- Department of Trauma and Orthopedic Surgery, University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, 20246, Hamburg, Germany
| | - Darius Thiesen
- Department of Trauma and Orthopedic Surgery, University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, 20246, Hamburg, Germany
| | - Kevin Roedl
- Department of Intensive Care Medicine, University Medical Centre Hamburg-Eppendorf (UKE), Martinistraße 52, 20246, Hamburg, Germany
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Qi H, Li Z, Ma T, Jiang Y, Ren C, Xu Y, Huang Q, Zhang K, Lu Y, Li M. Robot Navigation System Assisted PFNA Fixation of Femoral Intertrochanteric Fractures in the Elderly: A Retrospective Clinical Study. Clin Interv Aging 2024; 19:11-19. [PMID: 38204959 PMCID: PMC10777025 DOI: 10.2147/cia.s412397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 12/01/2023] [Indexed: 01/12/2024] Open
Abstract
Objective The incidence of hip fracture in the elderly is increasing. Robot navigation technology has the advantages of minimally invasive and accurate. To explore the difference between the clinical effects of proximal femoral anti-rotation intramedullary nail (PFNA) assisted by robot navigation in the treatment of femoral intertrochanteric fracture and traditional PFNA in the treatment of femoral intertrochanteric fracture in the elderly; analyze the advantages and feasibility of PFNA assisted by robot navigation in the treatment of femoral intertrochanteric fracture in the elderly. Patients and Methods From February 2021 to October 2022, the elderly (>65 years old) with femoral intertrochanteric fracture underwent surgery in our center. Divided the patients included in the study into 2 groups based on the surgical method. The surgical method of robot group was PFNA fixation assisted by robot navigation, while the surgical method of traditional group was classic PFNA fixation, Baseline data (general condition, Evans classification, time from injury to operation, preoperative hemoglobin) and observation indicators (intraoperative bleeding, operation time, the length of incision for mail nail insertion, postoperative hemoglobin drop, blood transfusion rate and the Harris score of hip joint 1 year after operation) of the two groups were collected to compare whether there were differences between the two groups. Results There was no statistical difference in baseline data between the two groups (P>0.05). The intraoperative bleeding in the robot group was 68.17±10.66 mL, the intraoperative bleeding in the traditional group was 174±8.11mL (P<0.001). The operation time in the robot group was 68.81 ± 6.89 min, in the traditional group, the operation time was 76.94 ± 8.18 min (P<0.001). The length of incision for mail nail insertion in the robot group was 3.53 ± 0.63 cm, the length of the incision for mail nail insertion in the traditional group was 4.23 ± 0.71 cm (P<0.001). 5 patients (13.9%) in the robot group received blood transfusion treatment, and 13 patients (36.1%) in the traditional group received blood transfusion treatment (P=0.029). The hemoglobin in the robot group decreased by 14.81 ± 3.27 g/l after operation compared with that before operation, while that in the traditional group decreased by 16.69 ± 3.32 g/l (P=0.018). The Harris score of the hip joint of the affected limb in the robot group was excellent in 25 cases, good in 8 cases and poor in 3 cases one year after the operation; In the traditional group, Harris scores were excellent in 18 cases, good in 11 cases and poor in 7 cases (P=0.021). Conclusion PFNA fixation of femoral intertrochanteric fracture with robot navigation assistance has the advantages of minimally invasive and accurate, shorter operation time, less bleeding and lower blood transfusion rate than traditional surgical methods, and has certain advantages in reducing postoperative complications of elderly patients.
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Affiliation(s)
- Hongfei Qi
- Department of Orthopaedics and Trauma, Hong Hui Hospital, Xi’an Jiaotong University College of Medicine, Xi’an, Shaanxi, 710000, People’s Republic of China
| | - Zhong Li
- Department of Orthopaedics and Trauma, Hong Hui Hospital, Xi’an Jiaotong University College of Medicine, Xi’an, Shaanxi, 710000, People’s Republic of China
| | - Teng Ma
- Department of Orthopaedics and Trauma, Hong Hui Hospital, Xi’an Jiaotong University College of Medicine, Xi’an, Shaanxi, 710000, People’s Republic of China
| | - Yangyang Jiang
- Xi’an Medical College, Xi’an, Shaanxi, 710000, People’s Republic of China
| | - Cheng Ren
- Department of Orthopaedics and Trauma, Hong Hui Hospital, Xi’an Jiaotong University College of Medicine, Xi’an, Shaanxi, 710000, People’s Republic of China
| | - Yibo Xu
- Department of Orthopaedics and Trauma, Hong Hui Hospital, Xi’an Jiaotong University College of Medicine, Xi’an, Shaanxi, 710000, People’s Republic of China
| | - Qiang Huang
- Department of Orthopaedics and Trauma, Hong Hui Hospital, Xi’an Jiaotong University College of Medicine, Xi’an, Shaanxi, 710000, People’s Republic of China
| | - Kun Zhang
- Department of Orthopaedics and Trauma, Hong Hui Hospital, Xi’an Jiaotong University College of Medicine, Xi’an, Shaanxi, 710000, People’s Republic of China
| | - Yao Lu
- Department of Orthopaedics and Trauma, Hong Hui Hospital, Xi’an Jiaotong University College of Medicine, Xi’an, Shaanxi, 710000, People’s Republic of China
| | - Ming Li
- Department of Orthopaedics and Trauma, Hong Hui Hospital, Xi’an Jiaotong University College of Medicine, Xi’an, Shaanxi, 710000, People’s Republic of China
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Yao W, Sun X, Tang W, Wang W, Lv Q, Ding W. Risk factors for hospital-acquired pneumonia in hip fracture patients: a systematic review and meta-analysis. BMC Musculoskelet Disord 2024; 25:6. [PMID: 38166762 PMCID: PMC10759764 DOI: 10.1186/s12891-023-07123-0] [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: 04/20/2023] [Accepted: 12/15/2023] [Indexed: 01/05/2024] Open
Abstract
OBJECTIVE This study aimed to systematically assess the incidence and risk factors for hospital-acquired pneumonia (HAP) in hip fracture patients by meta-analysis. METHODS Systematically searched four English databases (PubMed, EMBASE, The Cochrane Library, and Web Of Science) and four Chinese databases (CNKI, CQVIP, Sinomed, and WAN FANG) from inception until 20 November 2023. All studies involving risk factors of HAP in patients with hip fractures were considered. Newcastle-Ottawa Scale was used to evaluate the quality of the included studies. The results were presented with the pooled odds ratio (OR) and 95% confidence interval (95% CI). RESULTS Of 35 articles (337,818 patients) included in this study, the incidence of HAP was 89 per 1000 cases. Twenty-three risk factors were eventually involved in the meta-analysis, and 21 risk factors were significant. Our study has identified four significant risk factors (advanced age, preoperative time, COPD, and hypoalbuminemia) associated with HAP, as follows: Advanced age as a continuous variable (OR 1.07, 95% CI 1.05-1.10), Advanced age > 70 years (OR 2.34, 95% CI 1.77-3.09), Advanced age > 80 years (OR 2.98, 95% CI 2.06-4.31), Chronic obstructive pulmonary disease (COPD) (OR 3.44, 95% CI 2.83-4.19), Time from injury to operation as a continuous variable (OR 1.09, 95% CI 1.07-1.12), Time from injury to operation ≥48 h (OR 3.59, 95% CI 2.88-4.48), Hypoalbuminemia < 3.0 g/dL (OR 3.03, 95% CI 1.93-4.73), and Hypoalbuminemia < 3.5 g/dL (OR 2.68, 95% CI 2.15-3.36). However, it is important to note that all the studies included in our research were retrospective in nature, which introduces certain limitations to the level of evidence and the ability to establish causal inferences. DISCUSSION Patients who have suffered hip fractures are at an increased risk of developing postoperative hospital-acquired pneumonia, which can lead to prolonged hospital stays and adverse clinical outcomes. Consequently, the identification of these risk factors offers novel insights and methodologies for healthcare professionals in terms of both prevention and treatment. TRIAL REGISTRATION Registration number: INPLASY2022100091.
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Affiliation(s)
- Wei Yao
- Department of Orthopedics, Dandong Central Hospital, China Medical University, No. 338 Jinshan Street, Zhenxing District, Dandong, Liaoning Province, 118002, People's Republic of China
| | - Xiaojia Sun
- Department of Pediatrics, Dandong Central Hospital, China Medical University, Dandong, China
| | - Wanyun Tang
- Department of Orthopedics, Dandong Central Hospital, China Medical University, No. 338 Jinshan Street, Zhenxing District, Dandong, Liaoning Province, 118002, People's Republic of China
| | - Wei Wang
- Department of Orthopedics, Dandong Central Hospital, China Medical University, No. 338 Jinshan Street, Zhenxing District, Dandong, Liaoning Province, 118002, People's Republic of China
| | - Qiaomei Lv
- Department of Oncology, Dandong Central Hospital, China Medical University, Dandong, China.
| | - Wenbo Ding
- Department of Orthopedics, Dandong Central Hospital, China Medical University, No. 338 Jinshan Street, Zhenxing District, Dandong, Liaoning Province, 118002, People's Republic of China.
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Arroyo-Huidobro M, de la Fuente JL, Pagespetit MR, Perez OM, Morera JR, López AMA, Casanova DA, Garcia-Lerma E, Pérez-López C, Rodríguez-Molinero A. Incidence of urinary incontinence after hip fracture surgery and associated risk factors: a prospective study. BMC Geriatr 2024; 24:3. [PMID: 38166670 PMCID: PMC10763427 DOI: 10.1186/s12877-023-04597-4] [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: 05/10/2023] [Accepted: 12/14/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND The contribution of the postoperative process to developing or worsening urinary incontinence (UI) after hip fracture surgery (HFS) remains unclear. We aimed to evaluate UI incidence and worsening among older patients undergoing HFS, and explore associated risk factors. METHODS This prospective cohort study included patients ≥ 75 years admitted between October 2019 and October 2021 to the Traumatology Service of three hospitals in the Consorci Sanitari de Alt-Penedès i Garraf (Barcelona, Spain) with hip fracture requiring surgical treatment. UI was assessed using the first two questions of the International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF) at baseline and at days 30 (± 3 days) and 90 (± 3 days) after HFS. Surgery-related data and post-surgical complications were recorded. RESULTS A total of 248 patients with a mean (SD) age of 85.8 (6.78) years were included; 77.8% were female and 154 (62.1%) had UI at baseline. After HFS, 3.24% experienced urinary tract infections (UTIs), 3.64%, acute urinary retention (AUR), 8.57%, constipation, and 53.9%, prolonged catheterization (> 24 h). Fifty-eight patients without baseline UI developed UI at 30 days, resulting in a UI incidence of 61.7% (95% CI 51.1-71.54) between days 0 and 30. Of the 248 patients, 146 (59.1%) experienced worsening of UI. AUR and UTIs were identified as risk factors for UI development and worsening after HFS, respectively. CONCLUSION The incidence of UI in older patients after HFS is significant. Patient management protocols should consider AUR and UTIs to reduce or eliminate the incidence of UI in older patients undergoing HFS.
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Affiliation(s)
- Marta Arroyo-Huidobro
- Hospital Residencia Sant Camil, Consorci Santiari Alt'Pènedes i Garraf, Sant Pere de Ribes, Barcelona, Spain.
- Geriatrics Unit, Department of Internal Medicina, Hospital Clinic de Barcelona, C. de Villarroel, 170, Barcelona, 08036, Spain.
| | - Josefa López de la Fuente
- Hospital Residencia Sant Camil, Consorci Santiari Alt'Pènedes i Garraf, Sant Pere de Ribes, Barcelona, Spain
| | - Mar Riera Pagespetit
- Hospital Residencia Sant Camil, Consorci Santiari Alt'Pènedes i Garraf, Sant Pere de Ribes, Barcelona, Spain
| | - Oscar Macho Perez
- Hospital Residencia Sant Camil, Consorci Santiari Alt'Pènedes i Garraf, Sant Pere de Ribes, Barcelona, Spain
| | - Jaume Roig Morera
- Geriatrics Area, Hospital Vilafranca, Consorci Santiari Alt'Pènedes i Garraf, Vilafranca del Penedès, Barcelona, Spain
| | - Anna Maria Abelleira López
- Geriatrics Area, Hospital Vilafranca, Consorci Santiari Alt'Pènedes i Garraf, Vilafranca del Penedès, Barcelona, Spain
| | - David Aivar Casanova
- Hospital Residencia Sant Camil, Consorci Santiari Alt'Pènedes i Garraf, Sant Pere de Ribes, Barcelona, Spain
| | - Esther Garcia-Lerma
- Biostatistics Unit, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospital de Llobregat, Barcelona, Spain
| | - Carlos Pérez-López
- Area de Recerca, Consorci Sanitari Alt'Pènedes I Garraf, Villafranca del Penedès, Barcelona, Spain
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Tol MCJM, Willigenburg NW, Rasker AJ, Willems HC, Gosens T, Heetveld MJ, Schotanus MGM, Eggen B, Kormos M, van der Pas SL, van der Vaart AW, Goslings JC, Poolman RW. Posterolateral or Direct Lateral Surgical Approach for Hemiarthroplasty After a Hip Fracture: A Randomized Clinical Trial Alongside a Natural Experiment. JAMA Netw Open 2024; 7:e2350765. [PMID: 38206628 PMCID: PMC10784859 DOI: 10.1001/jamanetworkopen.2023.50765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 11/20/2023] [Indexed: 01/12/2024] Open
Abstract
Importance Hip fractures in older adults are serious injuries that result in disability, higher rates of illness and death, and a substantial strain on health care resources. High-quality evidence to improve hip fracture care regarding the surgical approach of hemiarthroplasty is lacking. Objective To compare 6-month outcomes of the posterolateral approach (PLA) and direct lateral approach (DLA) for hemiarthroplasty in patients with acute femoral neck fracture. Design, Setting, and Participants This multicenter, randomized clinical trial (RCT) comparing DLA and PLA was performed alongside a natural experiment (NE) at 14 centers in the Netherlands. Patients aged 18 years or older with an acute femoral neck fracture were included, with or without dementia. Secondary surgery of the hip, pathological fractures, or patients with multitrauma were excluded. Recruitment took place between February 2018 and January 2022. Treatment allocation was random or pseudorandom based on geographical location and surgeon preference. Statistical analysis was performed from July 2022 to September 2022. Exposure Hemiarthroplasty using PLA or DLA. Main Outcome and Measures The primary outcome was health-related quality of life 6 months after surgery, quantified with the EuroQol Group 5-Dimension questionnaire (EQ-5D-5L). Secondary outcomes included dislocations, fear of falling and falls, activities of daily living, pain, and reoperations. To improve generalizability, a novel technique was used for data fusion of the RCT and NE. Results A total of 843 patients (542 [64.3%] female; mean [SD] age, 82.2 [7.5] years) participated, with 555 patients in the RCT (283 patients in the DLA group; 272 patients in the PLA group) and 288 patients in the NE (172 patients in the DLA group; 116 patients in the PLA group). In the RCT, mean EQ-5D-5L utility scores at 6 months were 0.50 (95% CI, 0.45-0.55) after DLA and 0.49 (95% CI, 0.44-0.54) after PLA, with 77% completeness. The between-group difference (-0.04 [95% CI, -0.11 to 0.04]) was not statistically significant nor clinically meaningful. Most secondary outcomes were comparable between groups, but PLA was associated with more dislocations than DLA (RCT: 15 of 272 patients [5.5%] in PLA vs 1 of 283 patients [0.4%] in DLA; NE: 6 of 113 patients [5.3%]) in PLA vs 2 of 175 patients [1.1%] in DLA). Data fusion resulted in an effect size of 0.00 (95% CI, -0.04 to 0.05) for the EQ-5D-5L and an odds ratio of 12.31 (95% CI, 2.77 to 54.70) for experiencing a dislocation after PLA. Conclusions and Relevance This combined RCT and NE found that among patients treated with a cemented hemiarthroplasty after an acute femoral neck fracture, PLA was not associated with a better quality of life than DLA. Rates of dislocation and reoperation were higher after PLA. Randomized and pseudorandomized data yielded similar outcomes, which suggests a strengthening of these findings. Trial Registration ClinicalTrials.gov Identifier: NCT04438226.
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Affiliation(s)
- Maria C. J. M. Tol
- Department of Orthopedic Surgery, Joint Research, OLVG Hospital, Amsterdam, the Netherlands
| | - Nienke W. Willigenburg
- Department of Orthopedic Surgery, Joint Research, OLVG Hospital, Amsterdam, the Netherlands
| | - Ariena J. Rasker
- Department of Orthopedic Surgery, Joint Research, OLVG Hospital, Amsterdam, the Netherlands
| | - Hanna C. Willems
- Department of Internal Medicine and Geriatrics, Amsterdam UMC, Amsterdam, the Netherlands
| | - Taco Gosens
- Department of Orthopedics and Trauma Surgery, ETZ, Tilburg, the Netherlands
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands
| | - Martin J. Heetveld
- Department of Trauma Surgery, Spaarne Gasthuis, Haarlem, the Netherlands
| | - Martijn G. M. Schotanus
- Department of Orthopedic Surgery & Traumatology, Zuyderland Medical Center, Heerlen, Sittard-Geleen, the Netherlands
- School of Care and Public Health Research Institute, Faculty of Health, Medicine and Life Science, Maastricht University, the Netherlands
| | - Bart Eggen
- Delft University of Technology, Electrical Engineering, Mathematics and Computer Science, Delft, the Netherlands
| | - Mate Kormos
- Delft University of Technology, Electrical Engineering, Mathematics and Computer Science, Delft, the Netherlands
| | - Stéphanie L. van der Pas
- Amsterdam UMC location Vrije Universiteit Amsterdam, Epidemiology and Data Science, Amsterdam, the Netherlands
- Amsterdam Public Health, Methodology, Amsterdam, the Netherlands
| | - Aad W. van der Vaart
- Delft University of Technology, Electrical Engineering, Mathematics and Computer Science, Delft, the Netherlands
| | - J. Carel Goslings
- Department of Trauma Surgery, OLVG Hospital, Amsterdam, the Netherlands
| | - Rudolf W. Poolman
- Department of Orthopedic Surgery, Joint Research, OLVG Hospital, Amsterdam, the Netherlands
- Department of Orthopedic Surgery, LUMC, Leiden, the Netherlands
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Panth S, Wilson E, Chen B, Clement ND. Accelerated Care of Patients with Hip Fractures is Associated with Lower Risk of Delirium and Infection, and a Shorter Length of Hospital Stay: Systematic Review and Meta-analysis of Level One Evidence. Indian J Orthop 2024; 58:1-10. [PMID: 38161403 PMCID: PMC10754779 DOI: 10.1007/s43465-023-01026-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 10/12/2023] [Indexed: 01/03/2024]
Abstract
Objectives The aim of this systematic review was to assess the impact of time to surgery on patient mortality, peri-operative complication rates and length of stay following a hip fracture using level one data. Data Sources Multiple databases (PubMed, Embase, Medline (Ovid), and Cochrane Library) were searched using terms for "hip fracture" and the intervention "early surgery". Results were filtered to only included randomised controlled trials in the English language published from the year 2000. Study Selection All results were imported into Covidence and screened by two separate reviewers with conflicts resolved by a third reviewer. Studies were included if they reported data on the relationship between time to theatre and at least one of the outcome measures (mortality, peri-operative complications, and length of stay in hospital). Three papers were finalised to include in this review. Data Extraction Once selected, each paper had a bias assessment completed by two separate reviewers using the Cochrane RoB2 tool. Any conflicts were resolved by a third reviewer. Data Synthesis Data from each paper were inputted into RevMan5 for analysis. Approximated sample mean and standard deviation were collected from each paper and included for analysis. RevMan5 was then used to generate forest plots and report data on relative risk and mean difference. Conclusions This review has shown that accelerated care of patients with hip fractures was associated with lower risks of delirium and infection, and a shorter length of hospital stay. However, the effect of time to surgery on patient mortality is not clear, as the standard care group had a lower mortality than expected for the population at risk and had surgery on average within 24-h of presentation.
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Affiliation(s)
- S. Panth
- University of Edinburgh Medical School, 47 Little France Cres, Little France, Edinburgh, EH16 4TJ UK
| | - E. Wilson
- University of Edinburgh Medical School, 47 Little France Cres, Little France, Edinburgh, EH16 4TJ UK
| | - B. Chen
- Department of Orthopaedics, Second Affiliated Hospital of Soochow University, Suzhou, China
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Little France, Edinburgh, UK
| | - N. D. Clement
- University of Edinburgh Medical School, 47 Little France Cres, Little France, Edinburgh, EH16 4TJ UK
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Little France, Edinburgh, UK
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Wang L, Wang X, Zhang R, He C. Emerging trends and prospects in telerehabilitation for hip fracture: Bibliometric and visualization study. Digit Health 2024; 10:20552076241255465. [PMID: 38798887 PMCID: PMC11128182 DOI: 10.1177/20552076241255465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 04/26/2024] [Indexed: 05/29/2024] Open
Abstract
Background Telerehabilitation provide distant physical rehabilitation services and help overcome the barriers associated with face-to-face interventions for hip fractures. This study aims to analyse the progress of the application of telerehabilitation in hip fracture and reveal its research profile, hotspots and development trends. Methods The articles and reviews related to telerehabilitation in hip fracture were retrieved from 1992 to 2024. A bibliometric visualization and comparative analysis of countries, institutions, journals, authors, references and keywords were conducted using Java-based CiteSpace and VOSviewer. Results A total of 79 documents were obtained. Spain was the most academically influential country. The University of Granada was the most prolific institution. The author Ariza-vega P listed first in terms of publications and citations. Most publications were published in high academic impact journals. The major frontier keywords were "older adults," "functional recovery," "reliability," "mortality," "rehabilitation," "mobility" and "quality of life." The most popular keywords from 2020 to 2024 were "geriatric medicine," "family caregiver" and "digital health." Conclusions The historical and prospective perspective in telerehabilitation following hip fracture were presented. A primary focus in the early years was the impact of telerehabilitation on functional independence for hip fracture patients. Future outcomes are expected to include patient satisfaction, health-related quality of life and psychiatric symptoms. Exercise was also designed to eliminate travel burdens and strengthen self-efficacy, and improve the physical and psychosocial function of hip fracture patients. This work will provide a fundamental reference as well as a directional guide for future research.
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Affiliation(s)
- Liqiong Wang
- Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, P. R. China
- Rehabilitation Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, P. R. China
| | - Xiangxiu Wang
- Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, P. R. China
- Rehabilitation Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, P. R. China
| | - Ruishi Zhang
- Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, P. R. China
- Rehabilitation Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, P. R. China
| | - Chengqi He
- Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, P. R. China
- Rehabilitation Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, P. R. China
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Llombart R, Mariscal G, Barrios C, de la Rubia Ortí JE, Llombart-Ais R. Impact of vitamin D deficiency on mortality in patients with hip fracture: A meta-analysis. J Am Geriatr Soc 2024; 72:268-279. [PMID: 37772615 DOI: 10.1111/jgs.18601] [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: 05/25/2023] [Revised: 08/29/2023] [Accepted: 09/04/2023] [Indexed: 09/30/2023]
Abstract
BACKGROUND Vitamin D deficiency has been linked to numerous health issues, including an increased risk of hip fractures. This meta-analysis aimed to investigate the relationship between vitamin D deficiency and mortality in patients with hip fracture. To assess the impact of different levels of vitamin D deficiency on mortality in patients with hip fractures and examine the influence of potential confounding factors. METHODS A systematic search of PubMed, EMBASE, Scopus, and Cochrane Collaboration Library was conducted, resulting in nine eligible cohort studies (n = 4409). Patients with hip fractures were categorized based on their vitamin D levels as severe, moderate, or insufficient. Mortality was the primary outcome measure in this study. Subgroup analyses were performed according to the follow-up time. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using a random-effects model in Review Manager 5.4. RESULTS Nine studies, with a pool of 4409 patients, were included. Vitamin D insufficiency was significantly associated with increased mortality (OR 1.24, 95% CI 1.05-1.46; I2 = 4%). Severe deficiency also led to a significant increase in mortality (OR 2.08, 95% CI 1.09-3.97; I2 = 42%), whereas moderate deficiency did not show a significant effect (OR 1.06, 95% CI 0.79-1.44; I2 = 0%). Subgroup analysis revealed significant associations between vitamin D insufficiency and increased mortality at 1-year (OR 1.37, 95% CI 1.06-1.77) and 2-year follow-ups (OR 1.78, 95% CI 1.01-3.15). After adjusting for potential confounders, no significant increase in the mortality rate was observed. CONCLUSIONS This meta-analysis suggests that vitamin D insufficiency and severe deficiency are associated with increased mortality in patients with hip fracture. However, after adjusting for confounding factors, this association was not statistically significant. Further research is necessary to understand the role of vitamin D deficiency in this population.
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Affiliation(s)
- Rafael Llombart
- Orthopedic Surgery Department, University Clinic of Navarra, Pamplona, Spain
| | - Gonzalo Mariscal
- Institute for Research on Musculoskeletal Disorders, School of Medicine, Valencia Catholic University, Valencia, Spain
| | - Carlos Barrios
- Institute for Research on Musculoskeletal Disorders, School of Medicine, Valencia Catholic University, Valencia, Spain
| | | | - Rafael Llombart-Ais
- Institute for Research on Musculoskeletal Disorders, School of Medicine, Valencia Catholic University, Valencia, Spain
- Traumacenter Valencia, La Salud Hospital, Valencia, Spain
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Liu Y, Liu H, Zhang F. Development and Internal Validation of a Nomogram for Predicting Postoperative Cardiac Events in Elderly Hip Fracture Patients. Clin Interv Aging 2023; 18:2063-2078. [PMID: 38107187 PMCID: PMC10725632 DOI: 10.2147/cia.s435264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 12/01/2023] [Indexed: 12/19/2023] Open
Abstract
Purpose Postoperative cardiac events (PCEs) are among the main adverse events after hip fracture surgery in the elderly. Existing cardiac risk assessment tools have some limitations and are not specifically designed for elderly patients undergoing hip fracture surgery. This study aimed to develop and internally validate a nomogram for prediction of PCEs in these patients. Patients and Methods We performed a retrospective study of 992 patients aged ≥65 years undergoing hip fracture surgery in our hospital from July 2015 to December 2021. Patients' demographics and clinical data were collected. Least Absolute Shrinkage and Selection Operator (LASSO) regression was used to select predictors, and multivariate logistic regression was employed to construct a nomogram. Internal validation was performed by bootstrapping. The discriminatory ability of the model was determined by the area under the receiver operating characteristic curve (AUC). The calibration and clinical utility of the model were assessed. The predictive power and clinical benefit of the nomogram were compared with the Revised Cardiac Risk Index (RCRI). Results The nomogram was constructed including seven variables: general anesthesia, the American Society of Anesthesiologists (ASA) classification, history of heart failure, history of severe arrhythmia, history of coronary artery disease, preoperative platelet count, and serum creatinine. The nomogram had an excellent predictive ability (AUC = 0.875, 95% confidence interval [CI]: 0.828-0.918). Satisfactory calibration was shown by calibration plots and the Hosmer-Lemeshow goodness-of-fit test (P = 0.520). Clinical usefulness was confirmed by decision curve analysis and clinical impact curve. The predictive power and clinical utility of the nomogram were superior to RCRI. Conclusion We developed an easy-to-use nomogram for prediction of PCEs in elderly hip fracture patients. This prediction model could effectively identify patients at high risk of PCEs and may be useful for perioperative management optimization.
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Affiliation(s)
- Yuanmei Liu
- Department of Geriatrics, Peking University Third Hospital, Beijing, 100191, People’s Republic of China
| | - Huilin Liu
- Department of Geriatrics, Peking University Third Hospital, Beijing, 100191, People’s Republic of China
| | - Fuchun Zhang
- Department of Geriatrics, Peking University Third Hospital, Beijing, 100191, People’s Republic of China
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