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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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Drew S, Fox F, Gregson CL, Gooberman-Hill R. Model of multidisciplinary teamwork in hip fracture care: a qualitative interview study. BMJ Open 2024; 14:e070050. [PMID: 38417961 PMCID: PMC10900388 DOI: 10.1136/bmjopen-2022-070050] [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] [Indexed: 03/01/2024] Open
Abstract
OBJECTIVES Hip fractures are common injuries in older age with high mortality requiring multidisciplinary clinical care. Despite guidance, there is considerable variation in hip fracture services and patient outcomes; furthermore, little is known about how successful multidisciplinary working can be enabled. This study aimed to characterise professionals' views about the core components of multidisciplinary teamwork in hip fracture care. DESIGN The study comprised qualitative interviews with healthcare professionals delivering hip fracture care. Interviews were audio recorded, transcribed and analysed abductively: material was coded inductively and grouped into higher level concepts informed by theories and frameworks relating to teamwork. SETTING Four hospitals in England. PARTICIPANTS Participants were 40 healthcare professionals including orthopaedic surgeons, orthogeriatricians, physiotherapists and service managers. RESULTS Results identified four components of successful multidisciplinary teamwork: (1) defined roles and responsibilities, (2) information transfer processes, (3) shared goals and (4) collaborative leadership. These were underpinned by a single concept: shared responsibility. Defined roles and responsibilities were promoted through formal care pathways, reinforced through induction and training with clear job plans outlining tasks. Information transfer processes facilitated timely information exchange to appropriate individuals. Well-defined common purpose was hindered by complex interdisciplinary professional relationships, particularly between orthogeriatric and orthopaedic staff, and encouraged through multidisciplinary team meetings and training. Clinical service leads were integral to bridging interdisciplinary boundaries. Mutual trust and respect were based on recognition of the value of different professional groups. Teamwork depended on formal clinical leads with facilitative and motivational roles, and on hospital leadership that created an environment supporting collaboration. Shared responsibility for patients was encouraged by joint orthopaedic and orthogeriatric care models. Staff shared responsibility by assisting colleagues when needed. CONCLUSIONS Shared responsibility across the multidisciplinary team is fundamental to delivery of hip fracture care. Findings will inform development of clinical practice recommendations and training to build teamworking competencies.
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Affiliation(s)
- Sarah Drew
- Musculoskeletal Research Unit, Bristol Medical School, University of Bristol, Bristol, UK
| | - Fiona Fox
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Celia L Gregson
- Musculoskeletal Research Unit, Bristol Medical School, University of Bristol, Bristol, UK
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Jing B, Chen D, Dai H, Liu J, Chen C, Dai M, Hu J, Lu Z, Wang J. Association between neutrophil-to-lymphocyte ratio and postoperative fatigue in elderly patients with hip fracture. Heliyon 2023; 9:e22314. [PMID: 38144319 PMCID: PMC10746395 DOI: 10.1016/j.heliyon.2023.e22314] [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: 05/09/2023] [Revised: 11/09/2023] [Accepted: 11/09/2023] [Indexed: 12/26/2023] Open
Abstract
Background and purpose: Postoperative fatigue (POF) is a common and distressing post-operative symptom. This study aimed to explore the relationship between neutrophil-to-lymphocyte ratio (NLR) and POF in elderly patients with hip fracture. Method Elderly patients (age ≥65 years) with acute hip fracture admitted to the Department of Orthopedics of Anqing Municipal Hospital from June 2018 to June 2020 were included. Fatigue was assessed using the Fatigue Severity Scale at the 3-month follow-up postoperatively. Univariate and multivariate analyses were performed to explore the associations between NLR and POF. The diagnostic performance of NLR was analysed using Receiver Operating Characteristic (ROC) curve analysis and the Delong test. Result A total of 321 elderly patients with hip fractures were included; 120 (37.4 %) of them were diagnosed with POF. Univariate analysis indicated significant differences in NLR, platelet-to-lymphocyte ratio (PLR), education, neutrophil count, lymphocyte count, Hamilton Depression Scale (HAMD) and Insomnia Severity Index (ISI) scores (P < 0.05). Multivariate analysis indicated neutrophil count (odds ratio [OR], 1.46; 95 % confidence interval [CI] 1.27-1.67), lymphocyte count (OR 0.32, 95 % CI 0.19-0.53), NLR (OR1.81, 95 % CI 1.50-2.17) and PLR (OR 1.005, 95 % CI 1.001-1.009) were significantly associated with POF. The areas under the ROC curves (AUCs) of neutrophil count, lymphocyte count, NLR and PLR were 0.712, 0.667, 0.775 and 0.605, respectively. The Delong test indicated that NLR had the best diagnostic performance (p < 0.05). Conclusion NLR independently predicts POF in elderly patients with acute hip fracture.
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Affiliation(s)
- Baosheng Jing
- Department of Orthopedics, AnQing Municipal Hospitals, Anqing, China
| | - Dangui Chen
- Department of Hematology, AnQing Municipal Hospitals, Anqing, China
| | - Huming Dai
- Department of Orthopedics, AnQing Municipal Hospitals, Anqing, China
| | - Jingrui Liu
- Department of Orthopedics, AnQing Municipal Hospitals, Anqing, China
| | - Cheng Chen
- Department of Orthopedics, AnQing Municipal Hospitals, Anqing, China
| | - Mingjun Dai
- Department of Orthopedics, AnQing Municipal Hospitals, Anqing, China
| | - Jing Hu
- Department of Orthopedics, AnQing Municipal Hospitals, Anqing, China
| | - Zhengfeng Lu
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Jianjun Wang
- Department of Orthopedics, AnQing Municipal Hospitals, Anqing, China
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Decaix T, Gautier S, Royer L, Laprévote O, Tritz T, Siguret V, Teillet L, Sellier C, Pépin M. Importance of cytochrome 3A4 and 2D6-mediated drug-drug interactions in oxycodone consumption among older adults hospitalized for hip fracture: a cross-sectional study. Aging Clin Exp Res 2023; 35:2471-2481. [PMID: 37861957 DOI: 10.1007/s40520-023-02569-7] [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: 07/05/2023] [Accepted: 09/18/2023] [Indexed: 10/21/2023]
Abstract
Hip fracture is a common injury and represents a major health problem with an increasing incidence. In older adults, opioids such as oxycodone are often preferred to other analgesics such as tramadol because of a lower risk of delirium. Different parameters, such as inhibition of cytochrome P450 (CYP450) 2D6 and/or 3A4, can potentially lead to pharmacokinetic variations of oxycodone representing a risk of adverse drugs effects or lack of drug response. There is a risk of drug-drug interactions involving CYP450 in older adults due to the high prevalence of polypharmacy. This study sought to identify patient characteristics that influence oxycodone administration. A single-center observational study included 355 patients with a hip fracture hospitalized in a geriatric postoperative unit. Composite endpoint based on form, duration, and timing to intake separated patients into three groups: "no oxycodone", "low oxycodone ", and "high oxycodone ". CYP450 interactions were studied based on a composite variable defining the most involved CYP450 pathways between CYP2D6 and CYP3A4. CYP450 interactions with CYP2D6 pathway involved were associated with the risk of "high oxycodone" [odds ratio adjusted on age and the type of hip fracture (OR*) 4.52, 95% confidence interval (CI) 1.39-16.83, p = 0.02)], as well as serum albumin levels (OR* 1.09, 95% CI 1.02-1.17, p = 0.01). Cognitive impairment was negatively associated with the risk of "high oxycodone" (OR* 0.38, 95% CI 0.18-0.77, p = 0.02). This study showed an association between CYP2D6 interactions and higher oxycodone consumption indirectly reflecting the existence of uncontrolled postoperative pain.
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Affiliation(s)
- Théodore Decaix
- Department of Geriatrics, APHP, GHU Paris-Saclay University, Ambroise Paré Hospital, Boulogne-Billancourt, France.
- CNRS, CiTCoM, Paris-Cité University, 75006, Paris, France.
| | - Sylvain Gautier
- Epidemiology and Public Health Department, AP-HP, GHU Paris-Saclay University, Raymond Poincaré Hospital, Garches, France
- Primary Care and Prevention Team, UVSQ, Inserm U1018, CESP, Paris-Saclay University, Villejuif, France
| | - Luca Royer
- Department of Geriatrics, APHP, GHU Paris-Saclay University, Ambroise Paré Hospital, Boulogne-Billancourt, France
| | - Olivier Laprévote
- CNRS, CiTCoM, Paris-Cité University, 75006, Paris, France
- Department of Biochemistry, APHP, GHU Paris-Cité University, European Georges Pompidou Hospital, Paris, France
| | - Thomas Tritz
- Department of Pharmacy, APHP, GHU Paris-Saclay University, Ambroise Paré Hospital, Boulogne-Billancourt, France
| | - Virginie Siguret
- Hematology Laboratory, APHP, Hospital Group Lariboisière-Fernand Widal, Paris-Cité University, Paris, France
- Therapeutic Innovations in Hemostasis, Inserm UMR-S 1140, Paris-Cité University, Paris, France
| | - Laurent Teillet
- Department of Geriatrics, APHP, GHU Paris-Saclay University, Ambroise Paré Hospital, Boulogne-Billancourt, France
| | - Cyril Sellier
- Department of Geriatrics, APHP, GHU Paris-Saclay University, Ambroise Paré Hospital, Boulogne-Billancourt, France
| | - Marion Pépin
- Department of Geriatrics, APHP, GHU Paris-Saclay University, Ambroise Paré Hospital, Boulogne-Billancourt, France
- Clinical Epidemiology, UVSQ, Inserm U1018, CESP, Paris-Saclay University, Villejuif, France
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Takeda K, Wada M, Yorozuya K, Hara Y, Watanabe T, Hanaoka H. Factors Associated with Improvement in Activities of Daily Living during Hospitalization: A Retrospective Study of Older Patients with Hip Fractures. Ann Geriatr Med Res 2023; 27:220-227. [PMID: 37635672 PMCID: PMC10556722 DOI: 10.4235/agmr.23.0040] [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: 03/18/2023] [Revised: 07/04/2023] [Accepted: 08/18/2023] [Indexed: 08/29/2023] Open
Abstract
BACKGROUND In this study, we aimed to examine the changes in delirium during hospitalization of patients and its association with behavioral and psychological symptoms of dementia (BPSD), as well as improvements in activities of daily living (ADL). METHODS A longitudinal, retrospective cohort study was conducted involving 83 older adults (≥65 years) with hip fractures. We collected Mini-Mental State Examination (MMSE) and Functional Independence Measure-motor domain (m-FIM) assessment results from the medical charts at two time points: baseline (first week of hospitalization) and pre-discharge (final week before discharge). Additionally, we collected data on delirium and BPSD at three points: baseline, week 2 post-admission, and pre-discharge. We performed univariate logistic regression analysis using changes in m-FIM scores as the dependent variable and MMSE and m-FIM scores at baseline and pre-discharge, along with delirium and BPSD subtypes at baseline, week 2 post-admission, and pre-discharge, as the explanatory variables. Finally, we performed a multivariate logistic regression analysis incorporating the significant variables from the univariate analysis to identify factors associated with ADL improvement during hospitalization. RESULTS We observed significant correlations between ADL improvement during hospitalization and baseline m-FIM and MMSE scores, hypoactive delirium state, and BPSD subtype pre-discharge. Notably, all participants with hypoactive symptoms before discharge exhibited some subtype of delirium and BPSD at baseline. CONCLUSION Besides ADL ability and cognitive function at admission, the presence of hypoactive delirium and BPSD subtype before discharge may hinder ADL improvement during hospitalization.
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Affiliation(s)
- Kazuya Takeda
- Department of Rehabilitation, Kaneda Hospital, Okayama, Japan
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Mineko Wada
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Kyosuke Yorozuya
- Faculty of Rehabilitation and Care, Seijoh University, Aichi, Japan
| | - Yuhei Hara
- Department of Occupational Therapy, Chiba Medical Welfare Professional Training College, Chiba, Japan
| | - Toyoaki Watanabe
- Department of Rehabilitation Occupational Therapy, Aichi Medical College, Aichi, Japan
| | - Hideaki Hanaoka
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Adams J, Jones GD, Sadler E, Guerra S, Sobolev B, Sackley C, Sheehan KJ. Physiotherapists' perspectives of barriers and facilitators to effective community provision after hip fracture: a qualitative study in England. Age Ageing 2023; 52:afad130. [PMID: 37756647 PMCID: PMC10531122 DOI: 10.1093/ageing/afad130] [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: 11/11/2022] [Indexed: 09/29/2023] Open
Abstract
PURPOSE to investigate physiotherapists' perspectives of effective community provision following hip fracture. METHODS qualitative semi-structured interviews were conducted with 17 community physiotherapists across England. Thematic analysis drawing on the Theoretical Domains Framework identified barriers and facilitators to implementation of effective provision. Interviews were complemented by process mapping community provision in one London borough, to identify points of care where suggested interventions are in place and/or could be implemented. RESULTS four themes were identified: ineffective coordination of care systems, ineffective patient stratification, insufficient staff recruitment and retention approaches and inhibitory fear avoidance behaviours. To enhance care coordination, participants suggested improving access to social services and occupational therapists, maximising multidisciplinary communication through online notation, extended physiotherapy roles, orthopaedic-specific roles and seven-day working. Participants advised the importance of stratifying patients on receipt of referrals, at assessment and into appropriately matched interventions. To mitigate insufficient staff recruitment and retention, participants proposed return-to-practice streams, apprenticeship schemes, university engagement, combined acute-community rotations and improving job description advertisements. To reduce effects of fear avoidance behaviour on rehabilitation, participants proposed the use of patient-specific goals, patient and carer education, staff education in psychological strategies or community psychologist access. Process mapping of one London borough identified points of care where suggested interventions to overcome barriers were in place and/or could be implemented. CONCLUSION physiotherapists propose that effective provision of community physiotherapy following hip fracture could be improved by refining care coordination, utilising stratification techniques, employing enhanced recruitment and retainment strategies and addressing fear avoidance behaviours.
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Affiliation(s)
- Jodie Adams
- Department of Population Health Sciences, School of Life Course and Population Sciences, Kings College London, London, UK
- Department of Physiotherapy, Guys and St Thomas’s NHS Foundation Trust, London, UK
| | - Gareth D Jones
- Department of Physiotherapy, Guys and St Thomas’s NHS Foundation Trust, London, UK
- Centre for Human and Applied Physiological Sciences (CHAPS), School of Basic and Medical Biosciences, Kings College London, London, UK
| | - Euan Sadler
- Faculty of Environmental and Life Sciences, School of Health Sciences, University of Southampton, Southampton, UK
| | - Stefanny Guerra
- Department of Population Health Sciences, School of Life Course and Population Sciences, Kings College London, London, UK
| | - Boris Sobolev
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Catherine Sackley
- Department of Population Health Sciences, School of Life Course and Population Sciences, Kings College London, London, UK
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Katie J Sheehan
- Department of Population Health Sciences, School of Life Course and Population Sciences, Kings College London, London, UK
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Zheng C, Liu F, Zheng Y, Chen P, Zhou M, Zhang H. Psychometric properties of the Chinese version of the self-care scale for older adults undergoing hip fracture surgery: A translation and validation study. Front Public Health 2023; 11:1119630. [PMID: 37006555 PMCID: PMC10050582 DOI: 10.3389/fpubh.2023.1119630] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 02/20/2023] [Indexed: 03/17/2023] Open
Abstract
ObjectiveThe purpose of this study was to translate and verify the reliability and validity of the Chinese version of the self-care scale for older adults undergoing hip fracture surgery.MethodsA total of 502 older adult/adults patients after hip fracture surgery were recruited from Liaoning, Shanxi, and Beijing, China. The reliability of the Chinese version of the scale was measured by internal consistency, split-half reliability, and retest reliability, and the validity was evaluated by the content validity index and structure validity index.ResultsThe Chinese version of the HFS-SC scale had a Cronbach's alpha coefficient of 0.848, and the Cronbach's alpha coefficients for the five dimensions ranged from 0.719 to 0.780. The split-half reliability of the scale was 0.739, and the retest reliability was 0.759. The content validity index (S-CVI) was 0.932. The five-factor structure, supported by the eigenvalues, total variance explained, and the scree plot accounted for 66.666% of the total variance. In confirmatory factor analysis, the model fit results were as follows, X2/df = 1.847, GFI = 0.914, AGFI = 0.878, PGFI = 0.640, IFI = 0.932, TLI = 0.912, CFI = 0.931, RMSEA = 0.058, PNFI = 0.679. The indicators of the model's fit were within reasonable bounds.ConclusionThe Chinese version of the self-care scale for older adults undergoing hip fracture surgery has suitable reliability and validity. The scale can be used to assess the level of older adult/adults self-care in China following hip replacement surgery and serves as a useful benchmark for identifying potential intervention targets to raise the level of older adult/adults self-care following hip replacement surgery.
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Affiliation(s)
- Chen Zheng
- School of Nursing, Jinzhou Medical University, Jinzhou, Liaoning, China
| | - FangLin Liu
- School of Nursing, Jinzhou Medical University, Jinzhou, Liaoning, China
| | - Yan Zheng
- Operating Room of People's Hospital, Xinzhou, Shanxi, China
| | - Ping Chen
- School of Nursing, Jinzhou Medical University, Jinzhou, Liaoning, China
| | - MingYue Zhou
- School of Nursing, Jinzhou Medical University, Jinzhou, Liaoning, China
| | - Huijun Zhang
- School of Nursing, Jinzhou Medical University, Jinzhou, Liaoning, China
- *Correspondence: Huijun Zhang
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Fox F, Drew S, Gregson CL, Patel R, Chesser TJS, Johansen A, Javaid MK, Griffin XL, Gooberman-Hill R. Complex organisational factors influence multidisciplinary care for patients with hip fractures: a qualitative study of barriers and facilitators to service delivery. BMC Musculoskelet Disord 2023; 24:128. [PMID: 36797702 PMCID: PMC9933012 DOI: 10.1186/s12891-023-06164-9] [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: 06/30/2022] [Accepted: 01/16/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Hip fractures are devastating injuries, with high health and social care costs. Despite national standards and guidelines, substantial variation persists in hospital delivery of hip fracture care and patient outcomes. This qualitative study aimed to identify organisational processes that can be targeted to reduce variation in service provision and improve patient care. METHODS Interviews were conducted with 40 staff delivering hip fracture care in four UK hospitals. Twenty-three anonymised British Orthopaedic Association reports addressing under-performing hip fracture services were analysed. Following Thematic Analysis of both data sources, themes were transposed onto domains both along and across the hip fracture care pathway. RESULTS Effective pre-operative care required early alert of patient admission and the availability of staff in emergency departments to undertake assessments, investigations and administer analgesia. Coordinated decision-making between medical and surgical teams regarding surgery was key, with strategies to ensure flexible but efficient trauma lists. Orthogeriatric services were central to effective service delivery, with collaborative working and supervision of junior doctors, specialist nurses and therapists. Information sharing via multidisciplinary meetings was facilitated by joined up information and technology systems. Service provision was improved by embedding hip fracture pathway documents in induction and training and ensuring their consistent use by the whole team. Hospital executive leadership was important in prioritising hip fracture care and advocating service improvement. Nominated specialty leads, who jointly owned the pathway and met regularly, actively steered services and regularly monitored performance, investigating lapses and consistently feeding back to the multidisciplinary team. CONCLUSION Findings highlight the importance of representation from all teams and departments involved in the multidisciplinary care pathway, to deliver integrated hip fracture care. Complex, potentially modifiable, barriers and facilitators to care delivery were identified, informing recommendations to improve effective hip fracture care delivery, and assist hospital services when re-designing and implementing service improvements.
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Affiliation(s)
- F Fox
- Bristol Medical School, University of Bristol, Bristol, UK.
| | - S Drew
- grid.5337.20000 0004 1936 7603Bristol Medical School, University of Bristol, Bristol, UK
| | - CL Gregson
- grid.5337.20000 0004 1936 7603Bristol Medical School, University of Bristol, Bristol, UK
| | - R Patel
- grid.5337.20000 0004 1936 7603Bristol Medical School, University of Bristol, Bristol, UK
| | - TJS Chesser
- grid.418484.50000 0004 0380 7221Department of Trauma and Orthopaedics, North Bristol NHS Trust, Bristol, UK
| | - A Johansen
- grid.5600.30000 0001 0807 5670University Hospital of Wales and School of Medicine, Cardiff University, Cardiff, UK
| | - MK Javaid
- grid.4991.50000 0004 1936 8948Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - XL Griffin
- grid.4868.20000 0001 2171 1133Bone and Joint Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK ,grid.139534.90000 0001 0372 5777Barts Health NHS Trust, London, UK
| | - R Gooberman-Hill
- grid.5337.20000 0004 1936 7603Bristol Medical School, University of Bristol, Bristol, UK ,grid.5337.20000 0004 1936 7603National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, UK
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Thomas BK, Bajada S, Williams RL. Albumin is an Independent Predictor of up to 9-Year Mortality for Intracapsular Femoral Neck Fractures Aiding in Decision-Making for Total Hip Arthroplasty or Hemiarthroplasty. J Arthroplasty 2023; 38:135-140. [PMID: 35964858 DOI: 10.1016/j.arth.2022.08.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 08/02/2022] [Accepted: 08/07/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Intracapsular femoral neck fractures in the geriatric population are usually treated with hemiarthroplasty or total hip arthroplasty. The patients' medium-term to long-term mortality is a consideration to help decide which procedure to perform. The aim of this study is to examine whether easily identifiable serum investigations and patient identifiable factors on admission are associated with medium-term and long-term mortality. METHODS A consecutive series of 331 patients who sustained intracapsular femoral neck fractures and were over the age of 55 years were identified and retrospectively reviewed. American Society of Anesthesiologists (ASA) grade, cognitive function, gender, age, mobility status, and admission serum investigations were considered. RESULTS Low albumin levels, advanced age, men, and a combination of high ASA with lower mobility status were independent predictors of mean 5-year mortality. Similarly, low albumin levels and a combination of high ASA with lower mobility status were found to be independent predictors of longer term mortality (7-9 years). The optimal albumin cut-off to identify patient survival was >42 g/L with an area under the curve of 0.71. CONCLUSION We suggest that serum albumin on admission can be utilized as a factor to identify patients who are likely to survive at up to 9-year mean follow-up, to guide decision for total hip arthroplasty over hemiarthroplasty.
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Affiliation(s)
- Bijai K Thomas
- Department of Trauma and Orthopaedics, Hywel Dda University Heath Board, Glangwili General Hospital, Carmarthen, Dyfed, United Kingdom
| | - Stefan Bajada
- Department of Trauma and Orthopaedics, Hywel Dda University Heath Board, Glangwili General Hospital, Carmarthen, Dyfed, United Kingdom
| | - Rhodri L Williams
- Department of Trauma and Orthopaedics, Hywel Dda University Heath Board, Glangwili General Hospital, Carmarthen, Dyfed, United Kingdom
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Lu Y, Huang Q, Xu Y, Ren C, Sun L, Dong W, Li M, Xue H, Li Z, Zhang K, Ma T, Wang Q. Predictors of long-term mortality after intertrochanteric fractures surgery: a 3-year retrospective study. BMC Musculoskelet Disord 2022; 23:472. [PMID: 35590357 PMCID: PMC9118842 DOI: 10.1186/s12891-022-05442-2] [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: 01/27/2022] [Accepted: 05/16/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Intertrochanteric fractures are associated with high mortality rates; however, long-term data on survival and predictors remain scarce. Therefore, this study investigated risk factors associated with 3-year mortality in elderly patients with intertrochanteric fractures. Methods In a retrospective study, 156 elderly patients with intertrochanteric fractures who underwent surgery between January 2017 to January 2018 at our center were included. Association-affecting variables, such as gender, age, time from injury to surgery, hemoglobin (Hb), total lymphocyte count (TLC), albumin, malnutrition, and co-morbidities, were recorded and analyzed. Afterward, logistic regression was used to analyze the significant variables and find independent predictors for 3-year mortality. Results A total of 156 patients were followed up for 3 years. The 1-year, 2-year, and 3-year postoperative cumulative mortality rates were 9.6% (15/156), 16.7% (26/156), and 24.4% (38/156), respectively. Simple analyses found that age, Hb, albumin, and malnutrition were associated with 3-year mortality (p < 0.05). Multivariable analysis confirmed that advanced age (p < 0.001) and low albumin (p = 0.014) were independent risk factors for 3-year mortality. Conclusion Low serum albumin and advanced age were independent risk factors for long-term mortality in elderly patients with intertrochanteric fractures. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05442-2.
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Affiliation(s)
- Yao Lu
- Department of Orthopaedic Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, 710054, Shaan'xi Province, China
| | - Qiang Huang
- Department of Orthopaedic Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, 710054, Shaan'xi Province, China
| | - Yibo Xu
- Department of Orthopaedic Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, 710054, Shaan'xi Province, China
| | - Cheng Ren
- Department of Orthopaedic Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, 710054, Shaan'xi Province, China
| | - Liang Sun
- Department of Orthopaedic Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, 710054, Shaan'xi Province, China
| | - Wenchao Dong
- Shaanxi University of Chinese Medicine, Xian yang, 710000, Shaanxi, China
| | - Ming Li
- Department of Orthopaedic Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, 710054, Shaan'xi Province, China
| | - Hanzhong Xue
- Department of Orthopaedic Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, 710054, Shaan'xi Province, China
| | - Zhong Li
- Department of Orthopaedic Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, 710054, Shaan'xi Province, China
| | - Kun Zhang
- Department of Orthopaedic Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, 710054, Shaan'xi Province, China
| | - Teng Ma
- Department of Orthopaedic Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, 710054, Shaan'xi Province, China.
| | - Qian Wang
- Department of Orthopaedic Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, 710054, Shaan'xi Province, China.
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Ghosh S, Thomas B, D'sa P, John A, Amico GD, Williams R, Bajada S. Patients With Un-Displaced Or Displaced Intra Capsular Proximal Femur Fractures Do Not Represent A Different Patient Group And Have Similar Short And Long Term Mortality. Injury 2022; 53:1490-1495. [PMID: 35086679 DOI: 10.1016/j.injury.2022.01.014] [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: 10/28/2021] [Revised: 12/27/2021] [Accepted: 01/04/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Proximal femur fractures in geriatric patients are associated with substantial mortality. Management of intracapsular proximal femur fractures has been based on age, displacement, cognition, and pre-injury mobility. However, over the last decade, there has been a tendency to offer arthroplasty rather than internal fixation for these patients irrespective of displacement, to allow early mobilisation and negate the higher rate of reoperation due to failed internal fixation. There are no previous investigations analysing whether the severity of fracture displacement is related to different patient characteristics. AIM This study examines whether patients sustaining undisplaced or displaced intracapsular proximal femur fractures represent different patient groups with different pre-injury characteristics and post-operative mortality, irrespective of treatment modality. METHODS A retrospective series of 329 consecutive patients over the age of 55 years who sustained intracapsular proximal femur fractures, who underwent surgical management at a district general hospital over a period of 2 years (2012-2013) were identified using the national hip fracture database. Demographics, American Society of Anaesthesiologist (ASA) grade, pre-injury outdoor mobility status, cognitive status, and admission serum investigations, fracture displacement, type of surgery, and mortality rates at short term (2 years) & long-term (7-9 years) were reviewed. RESULTS There were 109 male and 220 female patients with a minimum follow-up of 7 years. The mean age at surgery was 81.6 years (range 55-103 years). There were 63 (19.1%) undisplaced fractures (Garden 1 &2) and, 265 (80.5%) displaced fractures (Garden 3 & 4). The median survival in this cohort was 2.95 years (95% CI 2.3-3.6). Mortality rates were 77.4% (n=257) at long-term (7-9 years) follow-up. Admission patient characteristics showed no statistically significant difference between displaced and undisplaced fracture groups. This included ASA, pre-operative cognition, and mobility status. Fracture displacement was not an independent predictor of mortality at short or long term. CONCLUSION In patients sustaining intracapsular proximal femur fractures, the degree of displacement is not a caveat for a different patient group. Fracture displacement is not predicted by the pre-injury level of function and does not predict short or long-term mortality.
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Affiliation(s)
- Soubhik Ghosh
- Hywel Dda University Health Board, Dolgwili Road, Carmarthen, SA31 2AF, United Kingdom.
| | - Bijai Thomas
- Hywel Dda University Health Board, Dolgwili Road, Carmarthen, SA31 2AF, United Kingdom.
| | - Prashanth D'sa
- Hywel Dda University Health Board, Dolgwili Road, Carmarthen, SA31 2AF, United Kingdom.
| | - Anoop John
- Hywel Dda University Health Board, Dolgwili Road, Carmarthen, SA31 2AF, United Kingdom.
| | - Giovanni Dall' Amico
- Hywel Dda University Health Board, Dolgwili Road, Carmarthen, SA31 2AF, United Kingdom.
| | - Rhodri Williams
- Hywel Dda University Health Board, Dolgwili Road, Carmarthen, SA31 2AF, United Kingdom.
| | - Stefan Bajada
- Hywel Dda University Health Board, Dolgwili Road, Carmarthen, SA31 2AF, United Kingdom.
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Reduced Concentrations of NSE, S100β, Aβ, and Proinflammatory Cytokines in Elderly Patients Receiving Ultrasound-Guided Combined Lumbar Plexus-Sciatic Nerve Block during Hip Replacement. Genet Res (Camb) 2022; 2022:1384609. [PMID: 35356751 PMCID: PMC8933066 DOI: 10.1155/2022/1384609] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 02/16/2022] [Indexed: 11/25/2022] Open
Abstract
Objective The increase of hip fractures is related to the aging of the population, which has caused a huge medical burden in many countries. Hip replacement has been approved as a highly successful surgical intervention for the patients with hip fractures. Different anesthesia choices in the surgical intervention are associated with the prognosis of patients. This study focused on investigating the application of ultrasound-guided combined lumbar plexus-sciatic nerve block in elderly patients with hip fractures. Methods In this retrospective study, 62 elderly patients received combined spinal-epidural anesthesia and 58 elderly patients underwent ultrasound-guided combined lumbar plexus-sciatic nerve block during the surgery. Hemodynamic monitoring including pulse oxygen saturation (SpO2), heart rate and blood pressure, the assessment of pain intensity using Visual Analogue Scale (VAS), cognitive function assessment through Montreal Cognitive Assessment (MoCA) and biomarkers consisting of serum levels of neuron specific-enolase (NSE), S100 beta protein (S100-β), and amyloid beta protein (Aβ), as well as immune function by interleukin-6 (IL-6), interleukin-1β (IL-1β), tumor necrosis factor-α (TNF-α), and high sensitivity C-reactive protein (hs-CRP) were detected in this study. Furthermore, length of hospital stay (LOS) and adverse reactions including hematoma, hypotension, nausea, and vomit were analyzed. Results The findings indicated that comparing with the patients receiving combined spinal-epidural anesthesia, those undergoing ultrasound-guided combined lumbar plexus-sciatic nerve block showed significantly lower level of heart rate, higher level of SpO2, and lower level of diastolic pressure and systolic pressure at 5 minutes and 30 minutes after anesthesia and after surgery (P < 0.05), indicated obviously lower VAS score at 12, 24, and 48 hours after surgery (P < 0.05), and revealed higher MoCA score at 12 days after surgery (P < 0.05). A significantly higher level of NSE, S100β, Aβ, IL-6, IL-1β, TNF-α, and hs-CRP was revealed in the two groups receiving different anesthesia methods at 10 days after surgery compared with that before surgery (P < 0.05). However, the patients receiving ultrasound-guided combined lumbar plexus-sciatic nerve block had obviously lower expression of NSE, S100β, Aβ, IL-6, IL-1β, TNF-α, and hs-CRP compared with the group accepting combined spinal-epidural anesthesia (P < 0.05). The two groups indicated no significant difference in incidence of hypotension and vomit, etc. (P < 0.05), but showed remarkable difference referring to total incidence of adverse reactions and LOS (P < 0.05). Conclusion The application of ultrasound-guided combined lumbar plexus-sciatic nerve block in hip replacement contributes to the stability of hemodynamics and alleviation of postoperative pain intensity. It can reduce cognitive and immune impairment of the elderly patients with hip fractures.
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Yaacobi E, Marom O, Gutman N, Zabarqa S, Brin Y, Ohana N. Mortality following surgery for geriatric hip fractures: is it the timing or the co-morbidities? Hip Int 2022; 32:271-275. [PMID: 32718199 DOI: 10.1177/1120700020945942] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Hip fractures are prevalent in the elderly population and present serious health, social and economic problems, with an impact on morbidity and mortality. Today, it is common practice to surgically repair these fractures as early as possible, preferably within 48 hours of hospital admission. However, there is conflicting evidence in the literature about the effect of the timing of surgery on postoperative mortality. OBJECTIVES To assess the association between surgery delay and other demographic and clinical variables with an increased mortality rate after surgical treatment of hip fractures in the elderly. METHODS A retrospective study was conducted on patients aged ⩾65 years with a primary diagnosis of hip fracture. All patients underwent surgery in our Medical Center from 2015 to 2017. A multivariate model of logistic regression, Cox regression model and Kaplan-Meier survival analysis were used to evaluate the relationship between various variables and mortality rates at 3- and 12-month follow-ups. RESULTS A total of 877 patients were included, 30% were men and 70% women; the mean age was 83.3 years. Multivariate analysis showed that mortality was significantly higher among patients who underwent late surgery, after adjusting for gender, age, co-morbidity, age of surgeon, duration of surgery and duration of hospitalisation (p = 0.030). Surgical delay was significantly associated with higher mortality rates both at 3 month (p = 0.041) and at 12 months after surgery (p = 0.013). The presence of ischemic heart disease, congestive heart failure, paroxysmal atrial fibrillation and chronic renal failure, as well as male gender and older age, were also significantly associated with higher early and late mortality. CONCLUSIONS In elderly patients, hip fracture surgery should be performed within 48 hours of admission. Male and older patients, as well as patients with the aforementioned co-morbidities, are at higher risk of mortality at 3 and 12 months after surgery.
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Affiliation(s)
- Eyal Yaacobi
- Orthopaedic Department, Meir Medical Center, Kfar Saba, Affiliated to Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Omer Marom
- Orthopaedic Department, Meir Medical Center, Kfar Saba, Affiliated to Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Nadav Gutman
- Orthopaedic Department, Meir Medical Center, Kfar Saba, Affiliated to Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Shatha Zabarqa
- Hadassah Medical School, The Hebrew University, Jerusalem, Israel
| | - Yaron Brin
- Orthopaedic Department, Meir Medical Center, Kfar Saba, Affiliated to Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Nissim Ohana
- Orthopaedic Department, Meir Medical Center, Kfar Saba, Affiliated to Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
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Stabilisation of AO OTA 31-A unstable proximal femoral fractures: Does the choice of intramedullary nail affect the incidence of post-operative complications? A systematic literature review and meta-analysis. Injury 2022; 53:827-840. [PMID: 35151468 DOI: 10.1016/j.injury.2022.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine if there was a difference in the risk of post-operative complications associated with the use of different intramedullary (IM) devices in the treatment of unstable AO OTA 31-A trochanteric fractures. DESIGN Systematic literature review and meta-analysis. METHODS A systematic literature review was carried out in January 2022 in the Embase, MEDLINE and Cochrane databases. Studies comparing INTERTAN™ to other intramedullary nails for the treatment of AO OTA 31-A trochanteric fractures were selected for inclusion. After data extraction, meta-analyses were carried out on postoperative outcomes, with specific focus placed on unstable fracture patterns. RESULTS Twenty-three studies were suitable for inclusion, of which seventeen reported on outcomes in unstable fractures. INTERTAN reduced the risk of revision/reoperation by 64% (RR 0.36, 95% CI 0.25 to 0.54, p <0.0001), implant failures by 62% (RR 0.38, 95% CI 0.25 to 0.57, p<0.0001) and hip and thigh pain by 50% (RR 0.50, 95% CI 0.35 to 0.71, p=0.0001) in unstable fractures. No differences were noted between IM nail designs for infection rates, healing time, non-union rates, femoral shortening, or Harris Hip Score. CONCLUSIONS The INTERTAN IM nail may reduce incidence of implant-related complications, hip and thigh pain, and the need for revision/reoperation without compromising clinical and functional outcomes.
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15
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Velarde-Mayol C, de la Hoz-García B, Angulo-Sevilla D, Torres-Barriga C. [Health consequences (mortality and institutionalization) of hip fracture among the elderly people: Population cohort study in Segovia]. Aten Primaria 2021; 53:102129. [PMID: 34157660 PMCID: PMC8220413 DOI: 10.1016/j.aprim.2021.102129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 04/23/2021] [Accepted: 04/25/2021] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE In order to know the social and health consequences of hip fractures (HF). DESIGN A retrospective cohort study of an entire health area was carried out in patients aged 75 or more, over a period of 5 years. SITE: Segovia Health Area. PARTICIPANTS All patients older than 75 years with a diagnosis of HF, excluding displaced and passerby. INTERVENTIONS The socio-sanitary changes that occur after the HF in respect to their baseline situation (family situation, comorbidities, dependence and mental situation) and the variables which most influence mortality and institutionalization after the HF were analyzed. MAIN MEASUREMENTS One thousand one hundred fifty-nine HF were recorded, with a constant annual incidence of 10.7‰. The prevalence was higher in women: 7.4% versus 3.7%. RESULTS The baseline profile is a pluripatological, non-institutionalized, 87-year-old woman, who retains her independent in her daily life and suffers from a HF due to an accidental fall in her home. At the end of the study period 51% were permanently institutionalized, negatively influencing having worse mental deterioration, worse dependence and subsequent readmissions and in addition, 45.5% died, 25.5% during the first year. The most unfavorable conditions were being previously dependent, having severe mental deterioration, male and within the comorbidities the most influential was previously having an anemia. CONCLUSIONS Our data confirms the deterioration of the autonomy-functional capacity after a HF, in line with what has been published, and has allowed to identify which elderly people are at the greatest risk of complications in the short and medium term (institutionalization and death).
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Affiliation(s)
| | | | - David Angulo-Sevilla
- Medicina de Familia y Comunitaria, Centro de Salud Segovia 1 y Unidad Docente Multiprofesional de Atención Familiar y Comunitaria de Segovia, Segovia, España
| | - Corina Torres-Barriga
- Medicina de Familia y Comunitaria, Centro de Salud Segovia 1 y Unidad Docente Multiprofesional de Atención Familiar y Comunitaria de Segovia, Segovia, España
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16
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Huang CF, Pan PJ, Chiang YH, Yang SH. A Rehabilitation-Based Multidisciplinary Care Model Reduces Hip Fracture Mortality in Older Adults. J Multidiscip Healthc 2021; 14:2741-2747. [PMID: 34616155 PMCID: PMC8488040 DOI: 10.2147/jmdh.s331136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 09/22/2021] [Indexed: 12/21/2022] Open
Abstract
Purpose In older adults, the one-year mortality rate after experiencing a hip fracture ranges between 8% and 36%. The purpose of this study was to look at the efficacy of rehabilitation-based multidisciplinary care for older individuals who had hip fractures. Patients and Methods The study included 185 people (aged 65 and over) with a history of hip fracture surgery between February 2014 and March 2017. A survey was conducted one month and six months following the operation to assess the recovery of 93 individuals who were part of a rehabilitation-based multidisciplinary care program and 92 patients who were getting standard therapy with surgery and unsupervised physical therapy. Results Physical activity, gait, balance evaluation, and depression scale ratings all had statistical significance (P < 0.05) after participants received rehabilitation-based care services from multidisciplinary medical professionals. Furthermore, the refracture and one-year mortality rates in this rehabilitation-based multidisciplinary care model were lower than in the groups getting standard therapy. Conclusion The research indicates the efficacy of a multidisciplinary rehabilitation strategy provided by a collaborative medical team to older individuals with hip fractures.
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Affiliation(s)
- Chun-Feng Huang
- Department of Family Medicine, National Yang Ming Chiao Tung University Hospital, Yilan, Taiwan (R.O.C).,Department of Leisure Services Management, Chaoyang University of Technology, Taichung, Taiwan (R.O.C)
| | - Po-Jung Pan
- Department of Physical Medicine and Rehabilitation, National Yang Ming Chiao Tung University Hospital, Yilan, Taiwan (R.O.C)
| | - Yi-Hung Chiang
- Department of Orthopedics, National Yang Ming Chiao Tung University Hospital, Yilan, Taiwan (R.O.C)
| | - Shung-Haur Yang
- Department of Surgery, National Yang Ming Chiao Tung University Hospital, Yilan, Taiwan (R.O.C)
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17
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Fell A, Malik-Tabassum K, Rickman S, Arealis G. Thirty-day mortality and reliability of Nottingham Hip Fracture Score in patients with COVID19 infection. J Orthop 2021; 26:111-114. [PMID: 34305350 PMCID: PMC8283006 DOI: 10.1016/j.jor.2021.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 07/11/2021] [Indexed: 11/25/2022] Open
Abstract
In March 2020 Coronavisus-19 pandemic led to significant changes in operations in healthcare in the United Kingdom with national lockdown measures imposed to help protect the vulnerable and prevent transmission. Those deemed vulnerable fall into the cohort of patients at risk of fragility fractures such as fracture neck of femur (NOF). British Orthopaedic Association released guidelines advising that NOF fractures should continue to be treated urgently. AIM Our unit aimed to identify changes in NOF caseload during the national lockdown and identify if Nottingham Hip Fracture Scores (NHFS) were reliable at predicting 30-day mortality in COVID-19 positive patients. METHODS A retrospective observational study identifying NOF admissions over a 6-week period in 2020 during lockdown period, where demographics, NHFS, and 30-day mortality rates were compared against the same period in 2019. RESULTS There was a reduction in NOF admissions by 17.8% (55 vs 67). No significant difference in patient demographics between groups. 30-day mortality rates were not significantly increased in 2020 compared with 2019. COVID-19 positive patients had significantly increased 30-day mortality rates (54%, p = 0.001) compared to COVID-19 negative (9.1%, p = 0.395) and 2019 (6%). DISCUSSION NHFS was not reliable as a predictor for 30-day mortality in COVID-19 positive patients. Our unit reports increased mortality rates in NOF patients with covid-19 infection. This adds to the building evidence that COVID-19 is an independent predictor for mortality in NOF patients irrespective of NHFS. This should be communicated to patients who are admitted to hospital with NOF and units should continue with efforts to prevent hospital acquired COVID-19 infection.
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Affiliation(s)
- Adam Fell
- St Peters and Ashford Hospital Foundation Trust, United Kingdom
| | | | - Stephen Rickman
- East Kent University Hospitals Foundation Trust, United Kingdom
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18
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Rogers C. Perspectives: Evaluation of Older Adult Cochlear Implant Candidates for Fall Risk in a Developing Country Setting. Front Neurol 2021; 12:678773. [PMID: 34122319 PMCID: PMC8187949 DOI: 10.3389/fneur.2021.678773] [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: 03/10/2021] [Accepted: 04/14/2021] [Indexed: 11/13/2022] Open
Abstract
Dizziness, vertigo, and falls are common in older adults. Data suggest that cochlear implant candidates are no different and could be argued to be at elevated risk due to the presence of hearing loss and likely vestibular involvement. Perspectives contextualizes current testing and screening paradigms for vestibular deficits and fall risk and suggests a protocol suitable for use in developing country settings.
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Affiliation(s)
- Christine Rogers
- Department of Health and Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Tarazona-Santabalbina FJ, Ojeda-Thies C, Figueroa Rodríguez J, Cassinello-Ogea C, Caeiro JR. Orthogeriatric Management: Improvements in Outcomes during Hospital Admission Due to Hip Fracture. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:3049. [PMID: 33809573 PMCID: PMC7999190 DOI: 10.3390/ijerph18063049] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 03/05/2021] [Accepted: 03/12/2021] [Indexed: 12/13/2022]
Abstract
Hip fractures are an important socio-economic problem in western countries. Over the past 60 years orthogeriatric care has improved the management of older patients admitted to hospital after suffering hip fractures. Quality of care in orthogeriatric co-management units has increased, reducing adverse events during acute admission, length of stay, both in-hospital and mid-term mortality, as well as healthcare and social costs. Nevertheless, a large number of areas of controversy regarding the clinical management of older adults admitted due to hip fracture remain to be clarified. This narrative review, centered in the last 5 years, combined the search terms "hip fracture", "geriatric assessment", "second hip fracture", "surgery", "perioperative management" and "orthogeriatric care", in order to summarise the state of the art of some questions such as the optimum analgesic protocol, the best approach for treating anemia, the surgical options recommendable for each type of fracture and the efficiency of orthogeriatric co-management and functional recovery.
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Affiliation(s)
- Francisco José Tarazona-Santabalbina
- Department of Geriatric Medicine, Hospital Universitario de la Ribera, Alzira, 46600 Valencia, Spain
- CIBERFES, Centro de Investigación Biomédica en Red Fragilidad y Envejecimiento Saludable, Instituto Carlos III, 28029 Madrid, Spain
| | - Cristina Ojeda-Thies
- Department of Orthopaedic Surgery and Traumatology, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain;
| | - Jesús Figueroa Rodríguez
- Department of Physical Medicine and Rehabilitation, Complejo Hospitalario Universitario de Santiago de Compostela, 15706 Santiago de Compostela, Spain;
| | | | - José Ramón Caeiro
- Department of Orthopaedics and Traumatology, Complejo Hospitalario Universitario de Santiago de Compostela, 15706 Santiago de Compostela, Spain;
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20
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Wignall A, Giannoudis V, De C, Jimenez A, Sturdee S, Nisar S, Pandit H, Gulati A, Palan J. The impact of COVID-19 on the management and outcomes of patients with proximal femoral fractures: a multi-centre study of 580 patients. J Orthop Surg Res 2021; 16:155. [PMID: 33627153 PMCID: PMC7903025 DOI: 10.1186/s13018-021-02301-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 02/11/2021] [Indexed: 12/14/2022] Open
Abstract
Background On the 11th March 2020, the World Health Organization declared the COVID-19 outbreak a pandemic. Multiple new guidelines were proposed and existing models of social, domestic and hospital care altered. Most healthcare systems were largely unprepared for this, and the pandemic has tested their adaptability. This study aimed to assess the impact of COVID-19 on the demographics, presentation, clinical management and outcomes of patients with proximal femoral (hip) fractures comparing them to a similar cohort of patients admitted a year earlier. Methods This retrospective multi-centre cohort study compared all patients admitted with hip fractures between 1st March and 30th May 2019 (group PC: pre-COVID-19) with hip fracture patients admitted over the same time period during the pandemic in 2020 (group C: COVID-19). The data was obtained from the hospitals’ local and National Hip Fracture Databases. Mortality data was checked with the Office for National Statistics (ONS). Primary outcomes were time to theatre, in-patient length of stay and 30-day mortality. Results A total of 580 patients were included (304 group PC, 276 group C). Patient demographics including Charlson Comorbidity Index and Nottingham Hip Fracture Scores were broadly similar across the two cohorts. There was a significant reduction in the percentage of total hip replacements (11 to 5%, p = 0.006) in group C. There was an increase in conservative management (1 to 5%, p = 0.002) in group C. Time to theatre was significantly delayed in group C (43.7 h) vs group PC (34.6 h) (p ≤ 0.001). The overall length of hospital stay was significantly longer in group PC (16.6 days) vs group C (15 days) (p = 0.025). The 30-day mortality rate in group C was 9.8% compared to 8.2% in group PC (p = 0.746), but for COVID-19 (+) patients, it was significantly higher at 38.2% vs 5.8% in COVID-19 (−) patients (p < 0.001). Conclusion This is one of the largest multi-centre comparative cohort study in the literature to date examining the impact of the COVID-19 pandemic on the management of hip fracture patients. Whilst mortality rates were similar in both groups, COVID-19-positive patients were almost seven times more likely to die, reflecting the seriousness of the COVID-19 infection and its sequelae in such elderly, vulnerable patients.
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Affiliation(s)
| | | | - Chiranjit De
- Sandwell & West Birmingham Hospitals NHS Trust, Lyndon, UK
| | | | | | | | | | - Aashish Gulati
- Sandwell & West Birmingham Hospitals NHS Trust, Lyndon, UK
| | - Jeya Palan
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Makridis KG, Badras LS, Badras SL, Karachalios TS. Searching for the 'winner' hip fracture patient: the effect of modifiable and non-modifiable factors on clinical outcomes following hip fracture surgery. Hip Int 2021; 31:115-124. [PMID: 31547719 DOI: 10.1177/1120700019878814] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Various factors, other than the quality of surgery, may influence clinical outcomes of hip fracture patients. We aimed to evaluate the relative impact of several factors on functional outcome, quality of life, re-fracture and mortality rates following surgery for hip fractures. METHODS We studied 498 (62.2%) women and 302 (37.8%) men with a mean age of 81.3 years (range, 60-95) with hip fractures (femoral neck and pertrochanteric). The mean follow-up was 74 months (range 58-96). Various patient-related and surgery-related parameters were recorded and correlated to both objective and subjective mobility, functional recovery and quality of life scales. Mortality and re-fracture rates were also evaluated. RESULTS Using multiple regression analysis, age >80 years (p = 0.000; 95% CI, 1.077-1.143) and ASA score III and IV (p = 0.000; 95% CI, 2.088-3.396) (both non-modifiable factors) both proved to be independent (s.s.) factors affecting mortality rates. Age <80 years (p = 0.000; 95% CI, 0.932-0.974), surgery delay less (modifiable factor) than 48 hours (p = 0.046; 95% CI, 0.869-0.999), low dementia CDR index (p = 0.005; 95% CI, 0.471-0.891) (non-modifiable factor), and osteoporosis medical treatment (modifiable factor) (p = 0.006; 95% CI, 0.494-0.891) were shown to be independent (s.s.) factors affecting HOOS-symptoms. Osteoporosis medical treatment used proved to be an independent (s.s.) factor affecting HOOS-daily activities (p = 0.049; 95% CI, 0.563-1.000) and quality of life (E-Qol-5D) (p = 0.036; 95% CI, 0.737-1.325). CONCLUSIONS A hip fracture patient aged <80 years old, with an ASA I-II, with low dementia CDR index and on osteoporosis medication has a better chance of an improved outcome (winner patient).
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Affiliation(s)
| | | | - Stelios L Badras
- Orthopaedic Department, University General Hospital of Larissa, Greece
| | - Theofilos S Karachalios
- Orthopaedic Department, University General Hospital of Larissa, Greece.,School of Health Sciences, Faculty of Medicine, University of Thessalia, Larissa, Greece
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Zaragoza Sosa D, González Laureani J, King Martínez AC. Fractura de cadera en adultos mayores: Impacto del tratamiento quirúrgico oportuno en la morbimortalidad. REVISTA DE LA FACULTAD DE MEDICINA 2020. [DOI: 10.22201/fm.24484865e.2019.62.6.04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction: Hip fracture, may occur in the femoral head, neck or in the intertrochanteric line. It is one of the most important causes of morbidity and mortality in elderly patients and it affects the physical, mental, functional and social equilibrium of these patients. Up to 50% of patients with hip fracture die in the first six months after the injury and many of those who survive don’t recover their previous level of independence and functionality. Early surgical resolution diminishes mortality and complications. Every two days that the surgery is postponed doubles the risk of death. Case report study: A 74-year-old female patient who presented a fall from her own height, is rendered incapable of walking and presents progressive pain in her right hip. She consults an orthopedic doctor for examination 42 days after the fall. Physical examination: right pelvic lower limb with an external rotation and a 1 cm shortness, hip mobility arches limited by pain. Muscle group strength was not examined because of the pain. An AP x-ray of the pelvis was performed that showed a simple trace at subcapital level on the right hip. A total arthroplasty of the right hip was performed 52 days after the patient’s fall. Conclusions: Hip fracture is a common problem in elderly patients and is associated with a high morbimortality. It is important to handle these cases early to diminish the risk of complications and mortality.
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Affiliation(s)
- Daniela Zaragoza Sosa
- Secretaría de Salud (Ssa), Hospital General "Dr. Manuel Gea González", División de Ortopedia, Médico pasante de servicio social, Ciudad de México, México
| | - Jesús González Laureani
- Secretaría de Salud (Ssa), Hospital General "Dr. Manuel Gea González", División de Ortopedia, Ciudad de México, México
| | - Ana Cristina King Martínez
- Secretaría de Salud (Ssa), Hospital General "Dr. Manuel Gea González", División de Ortopedia, Ciudad de México, México
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23
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Bell JJ, Pulle RC, Lee HB, Ferrier R, Crouch A, Whitehouse SL. Diagnosis of overweight or obese malnutrition spells DOOM for hip fracture patients: A prospective audit. Clin Nutr 2020; 40:1905-1910. [PMID: 32994070 DOI: 10.1016/j.clnu.2020.09.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 09/09/2020] [Accepted: 09/09/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND/AIMS Crude diagnostic parameters such as BMI limit recognition of malnutrition in overweight and obese patients. This study applied a robust malnutrition diagnostic measure to investigate whether malnutrition impacts clinical outcomes in overweight or obese hip fracture inpatients. METHODS A prospective, consecutive 12-month audit of inpatients admitted to a dedicated hip fracture unit with a BMI of ≥25 for surgical intervention. Univariate and logistic regression analyses were performed to investigate the relationship of demographics (age, gender), comparative measures (type of fracture, Charlson Comorbidity Index (CCI) on admission, time to surgery, type of surgery and anaesthesia, nutrition status) and outcome measures (delirium, time to mobilise post-operatively, length of stay, 12-month mortality). Malnutrition was defined using the International Classification of Diseases, Tenth Revision - Australian Modification protein-energy malnutrition criteria. RESULTS 127 overweight or obese hip fracture patients for surgical intervention were included in analyses. Patients were predominantly older females (median 81.0, range 48-97 years; 66.9%). Malnutrition prevalence was not infrequent (18.3%) despite the median BMI of 28.3 (range 25.0-63.9). Mortality at 12-months (17.3%) was lower than routinely reported across broader hip fracture populations. Logistic regression modelling demonstrated that malnutrition increased the likelihood of 12-month mortality (OR: 4.47, 95% CI 1.27-15.77; p = 0.020), post-operative delirium (OR: 3.64, 95% CI 1.00 to 13.33; p = 0.051), and delayed post-operative mobility (OR: 3.29, 95% CI 1.05 to 10.31; p = 0.041), in overweight or obese hip fracture patients. Length of stay demonstrated poor association with all predictor measures. CONCLUSION Hip fracture patients who are both overweight or obese, and malnourished, have significantly and substantially worse clinical outcomes than their well-nourished, albeit overweight or obese, counterparts. Comprehensive nutrition assessment measures should be applied to all hip fracture inpatients to ensure appropriate clinical nutrition care is appropriately directed.
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Affiliation(s)
- Jack J Bell
- The Prince Charles Hospital, Metro North Hospital and Health Service, Brisbane, Queensland, 4032, Australia; School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, 4072, Australia.
| | - Ranjeev C Pulle
- The Prince Charles Hospital, Metro North Hospital and Health Service, Brisbane, Queensland, 4032, Australia
| | - Hui Bing Lee
- School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology, Victoria Park Rd, Kelvin Grove, Queensland, 4059, Australia
| | - Rebecca Ferrier
- The Prince Charles Hospital, Metro North Hospital and Health Service, Brisbane, Queensland, 4032, Australia
| | - Alisa Crouch
- The Prince Charles Hospital, Metro North Hospital and Health Service, Brisbane, Queensland, 4032, Australia
| | - Sarah L Whitehouse
- Orthopaedic Research Unit, The Prince Charles Hospital and Institute of Health and Biomedical Innovation (IHBI), Queensland University of Technology (QUT), Brisbane, Queensland, Australia
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Abstract
In the UK the incidence of hip fractures is nearly 76 000 cases per year, with the vast majority of these fractures occurring in patients over the age of 70 years. Most patients who sustain a hip fracture will have significant comorbidities and up to 40% will have cognitive impairment. For patients, sustaining a hip fracture can potentially be a devastating event. This article provides an overview of the presentation, assessment and management of hip fractures for core surgical, acute care common stem and emergency medicine trainees.
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Affiliation(s)
- Lily Li
- Department of Trauma and Orthopaedics, Chelsea and Westminster NHS Foundation Trust, London, UK
| | - Katharine Bennett-Brown
- Department of Trauma and Orthopaedics, Chelsea and Westminster NHS Foundation Trust, London, UK
| | - Catrin Morgan
- Department of Trauma and Orthopaedics, Chelsea and Westminster NHS Foundation Trust, London, UK
| | - Rupen Dattani
- Department of Trauma and Orthopaedics, Chelsea and Westminster NHS Foundation Trust, London, UK
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25
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Non-Pharmacological Interventions towards Preventing the Triad Osteoporosis-Falls Risk-Hip Fracture, in Population Older than 65. Scoping Review. J Clin Med 2020; 9:jcm9082329. [PMID: 32707829 PMCID: PMC7463822 DOI: 10.3390/jcm9082329] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/10/2020] [Accepted: 07/20/2020] [Indexed: 02/01/2023] Open
Abstract
Osteoporosis leads to increased risk of falls, and thus an increase in fractures, highlighting here hip fractures, that result in high mortality, functional disability, and high medical expenditure. The aim is to summarise the available evidence on effective non-pharmacological interventions to prevent the triad osteoporosis/falls risk/hip fracture. A scoping review was conducted consulting the Scientific Electronic Library Online (Scielo), National Institute for Health and Care Excellence (NICE), Cumulative Index to Nursing & Allied Health Literature (CINAHL) y PubMed.databases. Inclusion criteria were articles published between 2013 and 2019, in Spanish or English. In addition, publications on a population over 65 years of age covering non-pharmacological interventions aimed at hip fracture prevention for both institutionalised patients in long-stay health centres or hospitals, and patients cared for at home, both dependent and non-dependent, were included. Sixty-six articles were selected and 13 non-pharmacological interventions were identified according to the Nursing Interventions Classification taxonomy, aimed at preventing osteoporosis, falls, and hip fracture. The figures regarding the affected population according to the studies are alarming, reflecting the importance of preventing the triad osteoporosis, falls risk, and hip fracture among the population over 65 years of age. The most effective interventions were focused on increasing Bone Mineral Density through diet, exercise, and falls prevention. As a conclusion, primary prevention should be applied to the entire adult population, with special emphasis on people with osteoporosis.
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26
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Garceau SP, Igbokwe EN, Warschawski Y, Neufeld ME, Safir OA, Wade JP, Guy P, Wolfstadt JI. Management Options and Outcomes for Patients with Femoral Fractures with Post-Polio Syndrome of the Lower Extremity: A Critical Analysis Review. JBJS Rev 2020; 8:e0146. [PMID: 32487976 DOI: 10.2106/jbjs.rvw.19.00146] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Post-polio syndrome is characterized by a late functional deterioration (usually after >=15 years from the initial infection) in patients with a history of paralytic poliomyelitis infection, and it is defined by the March of Dimes criteria. Patients with post-polio syndrome are at increased risk for falls and associated hip and femoral fractures as a result of lower bone mineral density, decreased lean muscle mass, and musculoskeletal deformities.
Current evidence suggests that treatment modalities for femoral fractures should emphasize fixation that allows early progressive weight-bearing and ambulation to optimize functional outcomes. Good results after hip arthroplasty have been described with both cemented and uncemented implants in patients who have been treated for osteoarthritis, but there has been little evidence guiding hip fracture management. Anatomic challenges that are encountered are osteoporotic bone, a valgus neck-shaft angle, increased femoral anteversion, and a small femoral canal diameter.
Intramedullary nailing of hip and femoral fractures can be challenging due to the small femoral canal diameter that frequently is encountered. Alternative methods of fixation have shown promising results. These include the use of sliding hip screws for hip fracture management and fixed-angle locking plates for hip and femoral fracture management.
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Affiliation(s)
- Simon P Garceau
- Division of Orthopaedics, Joseph and Wolf Lebovic Health Complex, Mount Sinai Hospital, Toronto, Ontario, Canada
| | | | - Yaniv Warschawski
- Division of Orthopaedics, Joseph and Wolf Lebovic Health Complex, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Michael E Neufeld
- Division of Orthopaedics, Department of Adult Joint Reconstruction, Western University, London, Ontario, Canada
| | - Oleg A Safir
- Division of Orthopaedics, Joseph and Wolf Lebovic Health Complex, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - John P Wade
- Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Pierre Guy
- Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jesse I Wolfstadt
- Division of Orthopaedics, Joseph and Wolf Lebovic Health Complex, Mount Sinai Hospital, Toronto, Ontario, Canada
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27
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Kulachote N, Sa-Ngasoongsong P, Sirisreetreerux N, Chulsomlee K, Thamyongkit S, Wongsak S. Predicting Factors for Return to Prefracture Ambulatory Level in High Surgical Risk Elderly Patients Sustained Intertrochanteric Fracture and Treated With Proximal Femoral Nail Antirotation (PFNA) With and Without Cement Augmentation. Geriatr Orthop Surg Rehabil 2020; 11:2151459320912121. [PMID: 32201631 PMCID: PMC7068744 DOI: 10.1177/2151459320912121] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 02/10/2020] [Indexed: 01/31/2023] Open
Abstract
Introduction: Postoperative outcomes in the elderly patients with intertrochanteric fracture were
generally poor with a low rate of return to prefracture ambulatory level (RPAL). Recent
studies showed that proximal femoral nail antirotation (PFNA) with cement augmentation
might be useful for postoperative functional recovery. This study aimed to compare the
outcomes in elderly patients with high surgical risk, American Society of
Anesthesiologist (ASA) grade 3 or 4, who sustained intertrochanteric fractures and were
treated with PFNA with and without cement augmentation, and to correlate perioperative
surgical factors with the RPAL. Methods: A retrospective consecutive series was conducted based on 135 patients with prefracture
ambulation classified as independent in community with or without a single cane (68 in
augmented group and 67 in control group). Perioperative data and data on the
complications within 1-year postsurgery were collected and compared. Predictive factors
for RPAL were analyzed via logistic regression analysis. Results: The overall 1-year postoperative mortality rate was 10% (n = 14) with no significant
difference between groups (P = .273). The proportion of elderly
patients with RPAL in the augmented group was significantly higher than for those in the
control group (48% vs 29%, P = .043). Via univariate analysis, ASA
grade 4 (P = .077), history of stroke (P = .035), and
use of cement augmentation (P = .041) were correlated with RPAL.
However, multivariate regression analysis showed that ASA grade 4 (odds ratio [OR] =
0.40, 95% confidence interval [CI]: 0.18-0.90, P = .026) and use of
cement augmentation (OR = 2.72, 95% CI: 1.22-6.05, P = .014) were the
significant predictors for RPAL. Discussion and Conclusions: The results of the present study showed that PFNA with cement augmentation is safe and
effectiveness in the intertrochanteric fracture treatment of elderly. Postoperative
functional recovery, like RPAL, in elderly patients who sustained intertrochanteric
fractures is relatively low, especially in those with ASA grade 4. However, cement
augmentation with PFNA might be helpful for increasing the RPAL in high-surgical-risk
geriatric patients.
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Affiliation(s)
- Noratep Kulachote
- Department of Orthopedics, Mahidol University, Samut Prakan, Thailand
| | | | | | - Kulapat Chulsomlee
- Department of Orthopedics, Mahidol University, Samut Prakan, Thailand.,Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Samut Prakan, Thailand
| | - Sorawut Thamyongkit
- Department of Orthopedics, Mahidol University, Samut Prakan, Thailand.,Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Samut Prakan, Thailand
| | - Siwadol Wongsak
- Department of Orthopedics, Mahidol University, Samut Prakan, Thailand
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Gamboa-Arango A, Duaso E, Formiga F, Marimón P, Sandiumenge M, Salgado M, Escalante E, Lumbreras C, Tarrida A. Prognostic factors of good functionality at 12 months of a hip fracture. Maluc Anoia study. Rev Esp Cir Ortop Traumatol (Engl Ed) 2020. [DOI: 10.1016/j.recote.2019.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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29
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Gamboa-Arango A, Duaso E, Formiga F, Marimón P, Sandiumenge M, Salgado MT, Escalante E, Lumbreras C, Tarrida A. Pronostic factors of good functionality at 12 months of a hip fracture. Maluc Anoia study. Rev Esp Cir Ortop Traumatol (Engl Ed) 2019; 64:57-63. [PMID: 31377157 DOI: 10.1016/j.recot.2019.06.007] [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: 04/15/2019] [Revised: 05/24/2019] [Accepted: 06/11/2019] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Hip fracture usually occurs in frail elderly patients and is associated with an important morbi-mortality in the first year. The objective of the study is to describe the prognostic factors that would allow maintaining functionality at 12 months. METHOD From June 1, 2010 to May 31, 2013, all patients older than 69 years with hip fracture due to bone fragility admitted to the Geriatric Acute Unit of our hospital were included. We define as functional maintenance those patients who have lost between 0-15 points in the Barthel Index with respect to the previous to the fracture. Prospective study of bivariate data analysis for related and multivariate prognostic factors for predictive predictors. RESULTS 271 patients were included, of them, 146 (54.8%), maintained functionality at 12 months and 122 (45.2%) no. Patients who maintain functional status are younger: average age 83.4 vs 85.80 years (P=.002); with better scores in the indexes of: Lawton prior to fracture 4.42 vs 2.40 (P<.001) and Barthel at discharge 34.2 vs. 27.1 (P=.002). There are also differences in the score of the "Geriatric Dementia Scale" 2.59 vs. 3.13 (P=.009), in the score of the "American Society Anesthesiologist"<II 62.2% vs 37.8% (P=0.006) and have presented less delirium during hospitalization 4.7% vs 35.3% (P=.002). In the multivariate analysis they maintained statistical significance, age OR: 1.044 (95% CI: 1.002-1.088) (P=.04) and the Lawton Index OR: 0.869 (95% CI: 0.804-0.940) (P <.001). CONCLUSIONS Prognostic factors of functional maintenance at 12 months are age and the ability to perform instrumental activities of daily life.
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Affiliation(s)
- A Gamboa-Arango
- Unidad Geriátrica de Agudos, Servicio de Geriatría, Hospital de Igualada, Igualada, España.
| | - E Duaso
- Unidad Geriátrica de Agudos, Servicio de Geriatría, Hospital de Igualada, Igualada, España
| | - F Formiga
- Programa de Geriatría, Medicina Interna, Hospital Universitario de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, España
| | - P Marimón
- Unidad Geriátrica de Agudos, Servicio de Traumatología y Cirugía Ortopédica, Hospital de Igualada, Igualada, España
| | - M Sandiumenge
- Unidad Geriátrica de Agudos, Servicio de Geriatría, Hospital de Igualada, Igualada, España
| | - M T Salgado
- Servicio de Fisioterapia, Fundación Sanitaria San José, Igualada, España
| | - E Escalante
- Unidad Geriátrica de Agudos, Servicio de Geriatría, Hospital de Igualada, Igualada, España
| | - C Lumbreras
- Unidad Geriátrica de Agudos, Servicio de Geriatría, Hospital de Igualada, Igualada, España
| | - A Tarrida
- Unidad Geriátrica de Agudos, Servicio de Geriatría, Hospital de Igualada, Igualada, España
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Doger Echegaray P, González Laureani J, King Martínez AC. Fractura de cadera: Un reto multidisciplinario. REVISTA DE LA FACULTAD DE MEDICINA 2019. [DOI: 10.22201/fm.24484865e.2019.62.4.03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Saribal D, Hocaoglu-Emre FS, Erdogan S, Bahtiyar N, Caglar Okur S, Mert M. Inflammatory cytokines IL-6 and TNF-α in patients with hip fracture. Osteoporos Int 2019; 30:1025-1031. [PMID: 30701344 DOI: 10.1007/s00198-019-04874-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 01/22/2019] [Indexed: 12/24/2022]
Abstract
UNLABELLED Mortality and remaining bedridden following the hip fracture surgery are not rare. We tried to measure the levels of inflammatory markers tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6) following the hip fracture surgery and compare their levels with controls. We aimed to show a relationship between the levels of these markers and post-operative mortality and walking capability. INTRODUCTION Osteoporosis is a condition, causing the hip fractures in the elderly. Hip fractures have a high rate of overall mortality up to 30% following the incident. Cytokines such as IL-6 and TNF-α are suggested to play a role in bone resorption and, thus, in the etiology of osteoporosis. METHODS Plasma levels of IL-6 and TNF-α were measured pre-operatively and on the first and second days after the surgery in 40 Turkish hip fracture patients. The levels of these cytokines were compared with 40 Turkish age-matched healthy controls. The levels of these cytokines were compared between the deceased and surviving patients, as well as the existence of walking capability following the surgery. RESULTS Significantly higher IL-6 levels were shown on the first and second days after the surgery (p = 0.005; p = 0.01, respectively). The overall death rate of our study group within the 2-year follow-up time was found to be 35%. No statistical significance was found in the means of 2-year follow-up mortality between the patients. Presence of walking capability did not differ between the patients, as well. CONCLUSION We demonstrated an association between IL-6 levels and hip fracture in our study group following the surgery. We also suggest that TNF-α and IL-6 levels are not related to the occurrence of death and walking capability after the surgery. However, these findings need further functional and clinical confirmation.
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Affiliation(s)
- D Saribal
- Department of Biophysics, Istanbul University Cerrahpaşa Medical Faculty, Istanbul, Turkey
| | - F S Hocaoglu-Emre
- Department of Nutrition and Dietetics, Beykent University, Istanbul, Turkey.
| | - S Erdogan
- Department of Orthopedic Surgery, Istanbul Metin Sabanci Baltalimanı Training and Research Hospital for Bone Diseases, Istanbul, Turkey
| | - N Bahtiyar
- Department of Biophysics, Istanbul University Cerrahpaşa Medical Faculty, Istanbul, Turkey
| | - S Caglar Okur
- Department of Physical Treatment and Rehabilitation, Bakirkoy Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - M Mert
- Department of Orthopedic Surgery, Yeniyuzyil University Medical School, Istanbul, Turkey
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Walton TJ, Bellringer SF, Edmondson M, Stott P, Rogers BA. Does a dedicated hip fracture unit improve clinical outcomes? A five-year case series. Ann R Coll Surg Engl 2019; 101:215-519. [PMID: 30602304 PMCID: PMC6400913 DOI: 10.1308/rcsann.2018.0220] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2018] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The aim of the study was to establish whether a dedicated hip fracture unit, geographically separate from the local major trauma centre, could improve clinical outcomes for patients sustaining proximal femoral fragility fractures. MATERIALS AND METHODS This study was a retrospective case series, using data collected from Brighton and Sussex University Hospitals NHS Trust's submissions to the National Hip Fracture Database between 1 April 2011 and 16 September 2016. The outcomes measured were mortality, length of hospital stay, time from admission to surgical intervention and return to premorbid residence. Patients were compared before and after reconfiguration of services into a separate dedicated hip fracture unit geographically distinct from the major trauma centre. RESULTS A total of 2117 patients (2178 injuries) were managed before the existence of the hip fracture unit, while 660 patients (673 injuries) were treated within the hip fracture unit. During the five-year study period, the 30-day mortality rate (pre-hip fracture unit 5.47% vs hip fracture unit 3.13%, P = 0.014), variance in the length of hospital stay (P < 0.001), mean time to surgical intervention (P = 0.044) and return to premorbid residence were significantly improved. An immediate 12-month comparison demonstrated significantly improved variance in length of hospital stay (P = 0.020) and return to premorbid residence (P = 0.015). DISCUSSION The reconfiguration of services significantly reduced variance in length of stay, enabling accurate resource planning in future. Multiple incremental improvements in service provision, in addition to the hip fracture unit, may explain the lower mortality observed. CONCLUSION While further research is required, replication of the hip fracture unit service model may potentially afford significant clinical and financial gains.
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Affiliation(s)
- TJ Walton
- Trauma and Orthopaedics, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - SF Bellringer
- Trauma and Orthopaedics, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - M Edmondson
- Trauma and Orthopaedics, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - P Stott
- Trauma and Orthopaedics, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - BA Rogers
- Trauma and Orthopaedics, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
- Brighton and Sussex Medical School, Brighton, UK
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Middleton M. Orthogeriatrics and Hip Fracture Care in the UK: Factors Driving Change to More Integrated Models of Care. Geriatrics (Basel) 2018; 3:geriatrics3030055. [PMID: 31011092 PMCID: PMC6319212 DOI: 10.3390/geriatrics3030055] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 08/24/2018] [Accepted: 08/24/2018] [Indexed: 02/02/2023] Open
Abstract
In the United Kingdom (UK), approximately 80,000 hip fractures each year result in an estimated annual cost of two billion pounds in direct healthcare costs alone. Various models of care exist for collaboration between orthopaedic surgeons and geriatricians in response to the complex medical, rehabilitation, and social needs of this patient group. Mounting evidence suggests that more integrated models of orthogeriatric care result in superior quality of care indicators and clinical outcomes. Clinical governance through national guidelines, audit through the National Hip Fracture Database (NHFD), and financial incentives through the Best Practice Tariff (providing a £1335 bonus for each patient) have driven hip fracture care in the UK forward. The demanded improvement in quality indicators has increased the popularity of collaborative care models and particularly integrated orthogeriatric services. A significant fall in 30-day mortality has resulted nationally. Ongoing data collection by the NHFD will lead to greater understanding of the impact of all elements of hip fracture care including models of orthogeriatrics.
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Affiliation(s)
- Mark Middleton
- Department of Trauma and Orthopaedics, St George's University Hospitals NHS Foundation Trust, Blackshaw Road, Tooting, London SW17 0QT, UK.
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Gudnadottir M, Thorsteinsdottir TK, Mogensen B, Aspelund T, Thordardottir EB. Accidental injuries among older adults: An incidence study. Int Emerg Nurs 2018; 40:12-17. [PMID: 29661594 DOI: 10.1016/j.ienj.2018.03.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Revised: 03/16/2018] [Accepted: 03/21/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND To date, the majority of studies assessing accidental injuries among the elderly have focused on fall injuries, while studies of other mechanisms of injuries have been lacking. Therefore, the main objective of this study was to investigate all injury-related visits among older adults to an emergency department and risk factors for injuries. METHODS Data were collected on all registered visits of adults, ≥67 years old, living in the capital of Iceland, to the emergency department of Landspitali, the National University Hospital, in 2011 and 2012. RESULTS The yearly incidence rate for injuries was 106 per 1000 adults, ≥67 years old. Of all injuries (n = 4,469), falls were the most common mechanism of injury (78 per 1000), followed by being struck or hit (12 per 1000) and being crushed, cut or pierced (8 per 1000). Other mechanisms of injury, such as acute overexertion, foreign body in natural orifice, injuries caused by thermal and chemical effect and other and unspecified mechanism were less common (8 per 1000). Fractures were the most common consequences of injuries (36 per 1000). The most frequent place of injury was in or around homes (77 per 1000), with men being more likely than women to be injured outside of the home (60 per 1000 vs. 36 per 1000). CONCLUSION Results indicate that falls are the main cause of accidental injuries, followed by being struck and hit injuries but other causes contributed to the rest. Falls constitute a major public health problem and fall-related injuries can have a substantial impact on the lives of older adults. As life expectancy continues to increase, fall risk is expected to increase. Since falls constitute a major impact on the lives of older adults and can lead to not only declines in physical activity and functional status, but to considerable health care costs, the health care system needs to intervene.
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Affiliation(s)
- Maria Gudnadottir
- Centre of Public Health Sciences, University of Iceland, Reykjavik, Iceland.
| | - Thordis Katrin Thorsteinsdottir
- Research Institute in Emergency Care, Landspitali, The National University Hospital of Iceland, Iceland; Faculty of Nursing, University of Iceland, Reykjavik, Iceland.
| | - Brynjolfur Mogensen
- Research Institute in Emergency Care, Landspitali, The National University Hospital of Iceland, Iceland; Faculty of Medicine, University of Iceland, Reykjavik, Iceland.
| | - Thor Aspelund
- Centre of Public Health Sciences, University of Iceland, Reykjavik, Iceland; Icelandic Heart Association, Iceland.
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Costa ML, Griffin XL, Achten J, Metcalfe D, Judge A, Pinedo-Villanueva R, Parsons N. World Hip Trauma Evaluation (WHiTE): framework for embedded comprehensive cohort studies. BMJ Open 2016; 6:e011679. [PMID: 27797994 PMCID: PMC5093367 DOI: 10.1136/bmjopen-2016-011679] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Osteoporotic hip fractures present a significant global challenge to patients, clinicians and healthcare systems. It is estimated that hip fracture accounts for 1.4% of total social and healthcare costs in the established market economies. METHODS AND ANALYSIS The World Hip Trauma Evaluation (WHiTE) was set up to measure outcome in a comprehensive cohort of UK patients with hip fracture. All patients in the cohort are treated under a single comprehensive treatment pathway. A core outcome set, including health-related quality of life, is collected on all the patients. This protocol describes the current multicentre project that will be used as a vehicle to deliver a series of embedded observational studies. ETHICS AND DISSEMINATION Research Ethics Committee approval was granted (Rec reference 11/LO/0927, approved 18/8/2011) and each hospital trust provided National Health Service (NHS) approvals. TRIAL REGISTRATION NUMBER The study is registered with National Institute of Health Research Portfolio (UKCRN ID 12351) and the ISRCTN registry (ISRCTN63982700).
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Affiliation(s)
- Matthew L Costa
- NDORMS (Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences), Kadoorie Centre, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Xavier L Griffin
- NDORMS (Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences), Kadoorie Centre, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Juul Achten
- NDORMS (Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences), Kadoorie Centre, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - David Metcalfe
- NDORMS (Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences), Kadoorie Centre, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Andrew Judge
- NDORMS (Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences), University of Oxford, Oxford, UK
| | - Rafael Pinedo-Villanueva
- NDORMS (Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences), University of Oxford, Oxford, UK
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Madsen CM, Jantzen C, Lauritzen JB, Abrahamsen B, Jorgensen HL. Temporal trends in the use of antithrombotics at admission. Acta Orthop 2016; 87:368-73. [PMID: 27301556 PMCID: PMC4967279 DOI: 10.1080/17453674.2016.1195662] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Background and purpose - Currently, no clear evidence exists on the pattern of use of antithrombotics at admission in hip fracture patients and how this has changed over time. We investigated temporal trends in-and factors associated with-the use of antithrombotics in patients admitted with a fractured hip. Patients and methods - This was a population-based cohort study including all patients aged 18 years or above who were admitted with a hip fracture in Denmark from 1996 to 2012. The Danish national registries were used to collect information on medication use, vital status, and comorbidity. Results - From 1996 to 2012, the proportion of patients using antithrombotics in general increased by a factor of 2.3 from 19% to 43% (p < 0.001). More specifically, the use of anticoagulants increased by a factor of 6.8 and the use of antiplatelets increased by a factor of 2.1. When we adjusted for possible confounders, the use of antithrombotics still increased for every calendar year (relative risk (RR) = 1.03, CI: 1.03-1.04; p < 0.001). Age, sex, and Charlson comorbidity index were all associated with the use of antithrombotics (all p < 0.001). Interpretation - The proportion of hip fracture patients using antithrombotics at admission has increased substantially in Denmark over the last 2 decades. This highlights the need for evidence-based guidelines on how to handle patients using antithrombotics to ensure safe surgery and to avoid surgical delay.
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Affiliation(s)
- Christian Medom Madsen
- Department of Orthopaedic Surgery, Bispebjerg Hospital, University of Copenhagen; ,Correspondence:
| | - Christopher Jantzen
- Department of Orthopaedic Surgery, Bispebjerg Hospital, University of Copenhagen;
| | - Jes Bruun Lauritzen
- Department of Orthopaedic Surgery, Bispebjerg Hospital, University of Copenhagen;
| | - Bo Abrahamsen
- Department of Medicine, Holbæk Hospital, Holbæk; ,Odense Patient Data Explorative Network, University of Southern Denmark, Odense;
| | - Henrik L Jorgensen
- Department of Clinical Biochemistry, Bispebjerg Hospital, University of Copenhagen, Denmark
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Tarazona-Santabalbina FJ, Belenguer-Varea Á, Rovira E, Cuesta-Peredó D. Orthogeriatric care: improving patient outcomes. Clin Interv Aging 2016; 11:843-56. [PMID: 27445466 PMCID: PMC4928624 DOI: 10.2147/cia.s72436] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Hip fractures are a very serious socio-economic problem in western countries. Since the 1950s, orthogeriatric units have introduced improvements in the care of geriatric patients admitted to hospital because of hip fractures. During this period, these units have reduced mean hospital stays, number of complications, and both in-hospital mortality and mortality over the middle term after hospital discharge, along with improvements in the quality of care and a reduction in costs. Likewise, a recent clinical trial has reported greater functional gains among the affected patients. Studies in this field have identified the prognostic factors present upon admission or manifesting themselves during admission and that increase the risk of patient mortality or disability. In addition, improved care afforded by orthogeriatric units has proved to reduce costs. Nevertheless, a number of management issues remain to be clarified, such as the optimum anesthetic, analgesic, and thromboprophylactic protocols; the type of diagnostic and therapeutic approach best suited to patients with cognitive problems; or the efficiency of the programs used in convalescence units or in home rehabilitation care. Randomized clinical trials are needed to consolidate the evidence in this regard.
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Affiliation(s)
- Francisco José Tarazona-Santabalbina
- Geriatric Medicine Unit, Internal Medicine Department, Hospital Universitario de la Ribera; Medical School, Universidad Católica de Valencia San vicente Mártir, Valencia, Spain
| | - Ángel Belenguer-Varea
- Geriatric Medicine Unit, Internal Medicine Department, Hospital Universitario de la Ribera; Medical School, Universidad Católica de Valencia San vicente Mártir, Valencia, Spain
| | - Eduardo Rovira
- Geriatric Medicine Unit, Internal Medicine Department, Hospital Universitario de la Ribera; Medical School, Universidad Católica de Valencia San vicente Mártir, Valencia, Spain
| | - David Cuesta-Peredó
- Geriatric Medicine Unit, Internal Medicine Department, Hospital Universitario de la Ribera; Medical School, Universidad Católica de Valencia San vicente Mártir, Valencia, Spain
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