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Sun SH, Chen CY, Lin KC. A New Postoperative Stability Score to Predict Loss of Reduction in Intertrochanteric Fractures in Elderly Patients. Life (Basel) 2024; 14:858. [PMID: 39063612 PMCID: PMC11277649 DOI: 10.3390/life14070858] [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: 05/19/2024] [Revised: 06/28/2024] [Accepted: 07/03/2024] [Indexed: 07/28/2024] Open
Abstract
The study aimed to validate a newly developed postoperative stability score for evaluating clinical follow-up in elderly patients with low-energy hip fractures. From 1 January 2020 to 31 December 2021, we enrolled patients aged over 65 who underwent cephalomedullary nail fixation using proximal femoral nail antirotation II (PFNAII) and had at least 6 months of follow-up; excluding multiple fractures, pathological fractures, and periprosthetic fractures. We collected general patient data. Parameters such as TAD, Parker's ratio (AP and lateral), and the new postoperative stability score were recorded. A loss of reduction was defined using the decline in the Chang reduction quality criteria (CRQC) score within one month. Among the 108 enrolled patients, 23 (21.3%) experienced a loss of reduction, with a mean age of 82.1 years and a mean follow-up time of 7.4 months. Univariate analysis showed no significant association between loss of reduction and general data. However, the new postoperative stability score correlated significantly with loss of reduction (mean scores: 6.68 vs. 4.83, p = 0.045). Multivariate analysis confirmed this association (odds ratio: 0.076, 95% confidence interval: 0.022-0.263, p < 0.05). The newly developed postoperative stability score, incorporating surgical technique assessment, improves prediction accuracy for loss of reduction in elderly intertrochanteric fracture (ITF) patients.
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Affiliation(s)
- Shih-Heng Sun
- Department of Rehabilitation, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan 330, Taiwan;
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
| | - Chun-Yu Chen
- Department of Orthopedics, Kaohsiung Veterans General Hospital, Kaohsiung 81341, Taiwan;
| | - Kai-Cheng Lin
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
- Department of Orthopedics, Kaohsiung Veterans General Hospital, Kaohsiung 81341, Taiwan;
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Ding Z, Yu Z, Sun Z, Liu X, Chen R. Potential mechanism of Taohong Siwu Decoction in preventing and treating postoperative delirium in intertrochanteric fracture patients based on retrospective analysis and network pharmacology. J Orthop Surg Res 2024; 19:369. [PMID: 38902693 PMCID: PMC11191233 DOI: 10.1186/s13018-024-04854-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Accepted: 06/14/2024] [Indexed: 06/22/2024] Open
Abstract
OBJECTIVE Elderly patients with hip fractures are at a greater risk of developing postoperative delirium (POD), which significantly impacts their recovery and overall quality of life. Neuroinflammation is a pathogenic mechanism of POD. Taohong Siwu Decoction (THSWD), known for its ability to promote blood circulation and remove blood stasis, can effectively reduce inflammation in the nervous system. Therefore, the objective of this article is to provide a comprehensive summary of the clinical efficacy of THSWD in the prevention of POD. Additionally, it aims to investigate the underlying mechanism of THSWD in the prevention and treatment of POD using network pharmacology and molecular docking. METHODS We conducted a retrospective analysis of patients with intertrochanteric fractures between January 2016 and October 2021. The patients were divided into two groups: the control and THSWD group. We performed a comparative analysis of hemoglobin (HB), albumin (ALB), C-reactive protein (CRP), blood urea nitrogen (BUN), and the blood urea nitrogen to creatinine ratio (BCR) on two different time points: the day before surgery (D0) and the third day after surgery (D3). Furthermore, we examined the incidence and duration of delirium, as well as the Harris Hip Score (HHS) at 3 months and 12 months post-surgery. Network pharmacology was employed to identify the primary targets and mechanisms of THSWD in the management of delirium. Molecular docking was employed to confirm the interaction between active ingredients and COX-2. Inflammatory cytokines, including cyclooxygenase-2 (COX-2), interleukin-1β (IL-1β), interleukin-6 (IL-6), and tumor necrosis factor- (TNF-α), were measured using the enzyme-linked immunosorbent assay (ELISA). The cognitive status of the patients was assessed using the Mini-Mental State Examination (MMSE) scoring system. RESULTS Regardless of whether it is in D0 or D3, THSWD treatment can increase HB levels while decreasing BCR. In D3, the THSWD group demonstrated a significant reduction in the expression of CRP and BUN when compared to the control group. However, there were no significant differences in ABL levels, surgery duration, and blood loss between the two groups. Additionally, THSWD treatment requires fewer blood transfusions and can reduce the incidence and duration of POD. The results of the logistic analysis suggest that both CRP levels and BCR independently contribute to the risk of POD. Network pharmacology analysis indicates that THSWD has the potential to prevent and treat POD possibly through inflammatory pathways such as IL-17 signaling pathways and NF-kappa B signaling pathways. Molecular docking validated the interaction between the active ingredient of THSWD and COX-2. Furthermore, THSWD treatment can reduce the levels of COX-2, IL-1β, IL-6, TNF-α, BUN and CRP in the blood of patients with POD, increase HB levels, and enhance MMSE scores. The expression of COX-2 is positively associated with other inflammatory markers (IL-1β, IL-6, TNF-α, and CRP), and inversely associated with MMSE. CONCLUSION THSWD has been found to have a preventive and therapeutic effect on POD in intertrochanteric fracture patients possibly through inflammatory pathways. This effect may be attributed to its ability to increase hemoglobin levels and reduce the levels of certain detrimental factors, such as blood urea nitrogen and inflammatory factors.
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Affiliation(s)
- Zhihong Ding
- Department of traumatic orthopedics, Xiangyang Hospital of Traditional Chinese Medicine [Xiangyang Institute of Traditional Chinese Medicine], Xiangyang, 441000, Hubei, China
| | - Zhiyong Yu
- Department of traumatic orthopedics, Xiangyang Hospital of Traditional Chinese Medicine [Xiangyang Institute of Traditional Chinese Medicine], Xiangyang, 441000, Hubei, China
| | - Zhibo Sun
- Department of traumatic orthopedics, Xiangyang Hospital of Traditional Chinese Medicine [Xiangyang Institute of Traditional Chinese Medicine], Xiangyang, 441000, Hubei, China
| | - Xinghui Liu
- School of Basic Medical Sciences, Hubei University of Arts and Science, No. 296 Longzhong Road, Xiangcheng District, Xiangyang, 441000, Hubei, China.
| | - Rong Chen
- Department of traumatic orthopedics, Xiangyang Hospital of Traditional Chinese Medicine [Xiangyang Institute of Traditional Chinese Medicine], Xiangyang, 441000, Hubei, China.
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Song M, Wang Y, Jiang Y, Pi H, Lyu H, Gao Y. Risk factors for subsequent fractures in hip fracture patients: a nested case-control study. J Orthop Surg Res 2024; 19:348. [PMID: 38867268 PMCID: PMC11167847 DOI: 10.1186/s13018-024-04833-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 06/02/2024] [Indexed: 06/14/2024] Open
Abstract
BACKGROUND The risk factors for subsequent fractures following an initial hip fracture are not entirely understood. This study examined the clinical characteristics of hip fracture patients to identify potential risk factors associated with a higher risk of experiencing subsequent fractures. METHODS We conducted a nested case-control study using data from the Chinese PLA General Hospital Hip Fracture Cohort between January 2008 and March 2022. The cases were individuals who experienced subsequent fractures following an initial hip fracture. Each case was matched with up to 2 controls who did not develop subsequent fractures. Important clinical factors were compared across groups, including traditional fracture risk factors and potential risk factors (e.g., comorbidities, falls risk, physical impairment, calcium or vitamin D use, and anti-osteoporosis medications). Conditional logistic regression analyses were used to evaluate the impact of these clinical features as potential risk factors for subsequent fractures. RESULTS A total of 96 individuals who suffered from subsequent fractures were matched with 176 controls. The median time between the initial hip fracture and the subsequent fracture was 2.1 years. The overall proportion of patients receiving anti-osteoporosis treatment after initial hip fracture was 25.7%. In the multivariable regression analysis, living in a care facility (OR = 3.78, 95%CI: 1.53-9.34), longer hospital stays (OR = 1.05, 95%CI: 1.00-1.11), and falls after discharge (OR = 7.58, 95%CI: 3.37-17.04) were associated with higher odds of subsequent fractures. CONCLUSIONS This study showed that living in a care facility, longer hospital stays, and falls after discharge may be independent risk factors for repeat fractures following an initial hip fracture. These findings could be used to identify and manage patients at high risk of subsequent fractures.
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Affiliation(s)
- Mi Song
- Medical School of Chinese PLA, No. 28, Fuxing Road, Beijing, 100853, People's Republic of China
- Department of Orthopedics, Chinese PLA General Hospital, No. 28, Fuxing Road, Beijing, 100853, People's Republic of China
- Department of nursing, Chinese PLA General Hospital, No. 28, Fuxing Road, Beijing, 100853, People's Republic of China
| | - Yilin Wang
- Medical School of Chinese PLA, No. 28, Fuxing Road, Beijing, 100853, People's Republic of China
- Department of Orthopedics, Chinese PLA General Hospital, No. 28, Fuxing Road, Beijing, 100853, People's Republic of China
| | - Yu Jiang
- Medical School of Chinese PLA, No. 28, Fuxing Road, Beijing, 100853, People's Republic of China
- Department of Orthopedics, Chinese PLA General Hospital, No. 28, Fuxing Road, Beijing, 100853, People's Republic of China
| | - Hongying Pi
- Military Health Service Training Center, Chinese PLA General Hospital, No. 28, Fuxing Road, Beijing, 100853, People's Republic of China.
| | - Houchen Lyu
- Department of Orthopedics, Chinese PLA General Hospital, No. 28, Fuxing Road, Beijing, 100853, People's Republic of China.
- National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, No. 28, Fuxing Road, Beijing, 100853, People's Republic of China.
| | - Yuan Gao
- Department of nursing, Chinese PLA General Hospital, No. 28, Fuxing Road, Beijing, 100853, People's Republic of China.
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Ramadanov N, Salzmann M, Voss M, Hable R, Hakam HT, Prill R, Dimitrov D, Becker R. The influence of operation time for hip hemiarthroplasty on complication rates and mortality in patients with femoral neck fracture: a retrospective data analysis. J Orthop Surg Res 2024; 19:311. [PMID: 38802945 PMCID: PMC11129483 DOI: 10.1186/s13018-024-04797-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 05/16/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND The aim of the present study was to investigate the influence of various factors, in particular operation time, on mortality and complication rates in patients with femoral neck fractures who have undergone hip hemiarthroplasty (HHA) and to determine a cut-off value above which mortality and complication rates increase significantly. METHODS Cases of patients with femoral neck fracture treated with HHA between 1 January 2017 and 31 December 2023 were screened for eligibility. Multiple logistic regressions were calculated to determine which factors (patient age, experience of surgeon, patient sex, ASA score, time to surgery, operation time) influenced the incidence of complications and mortality. The exact cut-off value for complications and mortality was determined using the Youden index of the ROC curve (sensitivity vs. specificity) of logistic regression. RESULTS A total of 552 patients were considered eligible for this study. During the 90-day follow-up period after HHA, 50 deaths and 34 complications were recorded, giving a mortality rate of 9.1%, and a complication rate of 6.2%. Of the 34 complications recorded, 32.3% were infections, 14.7% dislocations, 20.7% trochanteric avulsions, 11.8% periprosthetic fractures, 11.8% nerve injuries, and 8.8% deep vein thrombosis. The odds ratio (OR) of a patient experiencing a complication is 2.2% higher for every minute increase in operation time (Exponential Beta - 1 = 0.022; p = 0.0363). The OR of a patient dying is 8.8% higher for each year increase in age (Exponential Beta - 1 = 0.088; p = 0.0007). When surgery was performed by a certified orthopaedic surgeon the mortality rate lowered by 61.5% in comparison to the surgery performed by a trainee (1 - Exponential Beta = 0.594; p = 0.0120). Male patients have a 168.7% higher OR for mortality than female patients (Exponential Beta - 1 = 1.687; p = 0.0017). Patients with an operation time of ≥ 86 min. have a 111.8% higher OR for mortality than patients with an operation time of < 86 min. (Exponential Beta - 1 = 1.118). CONCLUSION This retrospective data analysis found that the risk of a patient experiencing a complication was 2.2% higher for every minute increase in operation time. Patients with an operation time above the cut-off of 86 min had a 111.8% higher risk of mortality than those with an operation time below the cut-off. Other influencing factors that operators should be aware of include patient age, male sex, and operator experience.
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Affiliation(s)
- Nikolai Ramadanov
- Center of Orthopaedics and Traumatology, University Hospital Brandenburg/Havel, Brandenburg Medical School Theodor Fontane, 14770, Brandenburg an der Havel, Germany.
- Faculty of Health Science Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany.
| | - Mikhail Salzmann
- Center of Orthopaedics and Traumatology, University Hospital Brandenburg/Havel, Brandenburg Medical School Theodor Fontane, 14770, Brandenburg an der Havel, Germany
- Faculty of Health Science Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
| | - Maximilian Voss
- Center of Orthopaedics and Traumatology, University Hospital Brandenburg/Havel, Brandenburg Medical School Theodor Fontane, 14770, Brandenburg an der Havel, Germany
- Faculty of Health Science Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
| | - Robert Hable
- Faculty of Applied Computer Science, Deggendorf Institute of Technology, Deggendorf, Germany
| | - Hassan Tarek Hakam
- Center of Orthopaedics and Traumatology, University Hospital Brandenburg/Havel, Brandenburg Medical School Theodor Fontane, 14770, Brandenburg an der Havel, Germany
- Faculty of Health Science Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
| | - Robert Prill
- Center of Orthopaedics and Traumatology, University Hospital Brandenburg/Havel, Brandenburg Medical School Theodor Fontane, 14770, Brandenburg an der Havel, Germany
- Faculty of Health Science Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
| | - Dobromir Dimitrov
- Department of Surgical Propedeutics, Faculty of Medicine, Medical University of Pleven, Pleven, Bulgaria
| | - Roland Becker
- Center of Orthopaedics and Traumatology, University Hospital Brandenburg/Havel, Brandenburg Medical School Theodor Fontane, 14770, Brandenburg an der Havel, Germany
- Faculty of Health Science Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
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Han S, Zhang ZY, Zhou K, Yin GK, Liu YC, Wang BJ, Wen Z. Positive buttress reduction in femoral neck fractures: a literature review. J Orthop Surg Res 2024; 19:262. [PMID: 38658987 PMCID: PMC11044489 DOI: 10.1186/s13018-024-04649-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 02/27/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Femoral neck fractures (FNFs) in young adults are usually caused by high-energy trauma, and their treatment remains a challenging issue for orthopedic surgeons. The quality of reduction is considered an important factor in improving the poor prognosis of patients with FNFs. In recent years, positive buttress closed reduction technique has received widespread attention in the treatment of FNFs. This comprehensive literature review is designed to encapsulate the impacts of both non-anatomic and anatomic reduction on the biomechanical stability, clinical outcomes, and postoperative complications in the management of FNFs, conjecture the efficacy of positively braced reduction techniques and provide a thorough summarization of the clinical outcomes. METHODS In this literature review, we have examined all clinical and biomechanical studies related to the treatment of FNFs using non-anatomical reduction or positive and negative buttress reduction. PubMed, Web of Science, Google Scholar and Embase Library databases were searched systematically for studies published before September 1, 2023. Published literature on fracture reduction techniques for treating FNFs was reviewed. In addition, we evaluated the included literature using the MINORs tool. RESULTS Although the "arch bridge" structure formed by the positive buttress reduction technique improved the support to the cortical bone and provided a more stable biomechanical structure, no significant differences were noted in the clinical efficacy and incidence of postoperative complications between the positive buttress reduction and anatomical reduction. CONCLUSION Positive buttress reduction is an effective treatment method for young patients with FNFs. When facing difficult-to-reduce FNF, positive buttress reduction should be considered first, followed by anatomical reduction. However, negative buttress reduction should be avoided.
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Affiliation(s)
- Shun Han
- Department of Orthopaedic, Affiliated Zhongshan Hospital of Dalian University, Liaoning Province, Dalian, 116001, P. R. China
| | - Ze-Yang Zhang
- Department of Orthopaedic, Affiliated Zhongshan Hospital of Dalian University, Liaoning Province, Dalian, 116001, P. R. China
| | - Ke Zhou
- Department of Orthopaedic, Affiliated Zhongshan Hospital of Dalian University, Liaoning Province, Dalian, 116001, P. R. China
| | - Gui-Kun Yin
- Department of Orthopaedic, Central Hospital of Zhuanghe City, Zhuanghe, 116400, P. R. China
| | - Yu-Chen Liu
- Department of Orthopaedic, Affiliated Zhongshan Hospital of Dalian University, Liaoning Province, Dalian, 116001, P. R. China
| | - Ben-Jie Wang
- Department of Orthopaedic, Affiliated Xinhua Hospital of Dalian University, Liaoning Province, Dalian, 116001, P. R. China.
| | - Zhun Wen
- Department of Orthopaedic, Central Hospital of Zhuanghe City, Zhuanghe, 116400, P. R. China.
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Zhou X, Guo S, Pan W, Zhang L, Ji H, Yang Y. The small screw-apex distance is potentially associated with femoral head osteonecrosis in adults with femoral neck fractures treated by closed reduction and percutaneous 3 parallel cannulated screws. BMC Musculoskelet Disord 2024; 25:286. [PMID: 38614975 PMCID: PMC11015589 DOI: 10.1186/s12891-024-07380-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 03/22/2024] [Indexed: 04/15/2024] Open
Abstract
OBJECTIVE Femoral neck fractures (FNFs) are among the most common fractures in elderly individuals. Surgery is the main treatment for FNFs, and osteonecrosis of the femoral head (ONFH) is one of the unacceptable complications. This study aimed to assess both the clinical and radiological outcomes in patients with FNFs treated with three parallel cannulated screws and to identify relationship between screws position and ONFH. PATIENTS AND METHODS A total of 100 patients who were treated with closed reduction and fixed with 3 parallel cannulated screws met the inclusion criteria between January 2014 and December 2020 at authors' institution. The follow-up duration, age, sex, affected side, and injury-to-surgery interval were collected; the neck-shaft angle of both hips, screw-apex distance (SAD) and the tip-apex distance (TAD)were measured; and the Garden classification, quality of reduction and presence of ONFH were evaluated. RESULTS The sample consisted of 37 males and 63 females, with 60 left and 40 right hips affected. The mean age of patients was 54.93 ± 12.24 years, and the mean follow-up was 56.3 ± 13.38 months. The overall incidence of ONFH was 13%. No significant difference was observed in the incidence of ONFH by affected side, age, fracture displacement, injury-to-surgery interval, neck-shaft angle deviation, or reduction quality. The SAD was significantly shorter in ONFH patients than in normal patients for all three screws (p = 0.02, 0.02, and 0.01, respectively). CONCLUSIONS The short SAD of all screws is associated with femoral head necrosis of FNFs treated with 3 cannulated screws. The short SAD indicated that screws malpositioning in the weight-bearing area of the femoral head, potentially harming the blood supply and compromising the anchorage of the primary compressive trabeculae in this region.
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Affiliation(s)
- Xiaoxiao Zhou
- Department of Orthopedics, Jiangwan Hospital of Hongkou District of Shanghai, Shanghai, China
| | - Shengyang Guo
- Department of Orthopedics, Shanghai University of Medicine & Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Wenjun Pan
- Department of Orthopedics, Taizhou Hospital of Zhejiang Province, Affiliated to Wenzhou Medical University, No. 150 Ximen Street, Linhai City, 317000, Zhejiang Province, China
| | - Linyuan Zhang
- Department of Orthopedics, Shanghai University of Medicine & Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Houlin Ji
- Jinji Lake Community Health Service Center of Suzhou Industrial Park, Jiangsu, 215000, China
| | - Yang Yang
- Department of Orthopedics, Taizhou Hospital of Zhejiang Province, Affiliated to Wenzhou Medical University, No. 150 Ximen Street, Linhai City, 317000, Zhejiang Province, China.
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Yan X, Huang J, Chen X, Lin M. Association between increased systemic immune-inflammation index and postoperative delirium in older intertrochanteric fracture patients. J Orthop Surg Res 2024; 19:219. [PMID: 38566241 PMCID: PMC10988850 DOI: 10.1186/s13018-024-04699-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 03/25/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND AND PURPOSE The systemic immune-inflammation index (SII), a novel inflammation index derived from the counts of circulating platelets, neutrophils and lymphocytes, has been studied in the treatment of acute cancer and ischemic stroke (AIS). However, the clinical value of the SII in postoperative delirium patients has not been further investigated. The purpose of our research was to study the incidence and preoperative risk factors for postoperative delirium (POD) and verify whether the SII could serve as a potential marker for POD in older intertrochanteric fracture patients. Finally, we created a novel nomogram for predicting POD in older patients with intertrochanteric fractures. METHODS We enrolled elderly patients with intertrochanteric fractures who underwent proximal femoral nail antirotation (PFNA) between February 2021 and April 2023. Univariate and multivariate logistic analyses were subsequently performed to confirm the risk factors and construct a nomogram model.Calibration curve and clinical decision curve analysis (DCA) were used to assess the model's fitting performance. The performance of the nomogram was evaluated for discrimination, calibration, and clinical utility. RESULTS A total of 293 patients were eligible for inclusion in the study, 25.6% (75/293) of whom had POD. The POD patients had higher SII values than the non-POD patients. The SII was strongly correlated with POD in older intertrochanteric fracture patients, and the optimal cutoff value was 752.6 × 109. Multivariate analysis revealed that age, diabetes, total albumin, SII > 752.6 × 109 and a CRP > 20.25 mg/L were independent risk factors for POD patients. By incorporating these 5 factors, the model achieved a concordance index of 0.745 (95% CI, 0.683-0.808) and had a well-fitted calibration curve and good clinical application value. CONCLUSION The SII is a simple and valuable biomarker for POD, and the new nomogram model can be used to accurately predict the occurrence of POD. They can be utilized in clinical practice to identify those at high risk of POD in older intertrochanteric fracture patients.
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Affiliation(s)
- Xiaoxiao Yan
- Department of Neurology, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Jin Huang
- Department of Neurology, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Xiachan Chen
- Department of Neurology, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Mian Lin
- Department of Orthopedics, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China.
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Shi LT, Feng Z, Zhu CM. A retrospective study: exploring preoperative hyponatremia in elderly patients with hip fractures. J Orthop Surg Res 2024; 19:186. [PMID: 38491543 PMCID: PMC10943773 DOI: 10.1186/s13018-024-04643-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 02/22/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND This research aims to examine the frequency, age-related distribution, and intensity of preoperative hyponatremia among elderly individuals with hip fractures. This study aims to provide valuable insights into the diagnosis of preoperative hyponatremia in this patient population. METHODS This research involved the analysis of clinical data obtained from 419 elderly individuals with hip fractures (referred to as the fracture group) and 166 elderly individuals undergoing routine health examinations (designated as the control group). A comprehensive comparison was conducted, examining baseline characteristics such as age, gender, and comorbidities between these two groups. We further investigated variations in the incidence rate of hyponatremia, age distribution, and the severity of hyponatremia. Additionally, a subgroup analysis compared patients with femoral neck fractures to those with intertrochanteric femur fractures, specifically examining the incidence rate and severity of hyponatremia in these distinct fracture types. RESULTS The incidence of cerebrovascular disease was found to be higher in the fracture group as compared to the control group in our research. Nevertheless, no significant differences in general health and other comorbidities were observed between the two groups. Notably, the fracture group exhibited a greater preoperative prevalence of hyponatremia, with its severity increasing with age. Furthermore, among elderly patients with intertrochanteric femur fractures, the incidence of preoperative hyponatremia was not only higher but also more severe when compared to those with femoral neck fractures. CONCLUSION Elderly individuals experiencing hip fractures exhibit a notable prevalence of preoperative hyponatremia, predominantly mild to moderate, with an escalating occurrence linked to advancing age. This phenomenon is especially conspicuous among patients with intertrochanteric fractures, warranting dedicated clinical scrutiny. The administration of sodium supplementation is advisable for the geriatric demographic as deemed necessary. Addressing hyponatremia becomes crucial, as it may play a role in the etiology of hip fractures in the elderly, and rectifying this electrolyte imbalance could potentially serve as a preventive measure against such fractures.
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Affiliation(s)
- Li-Tao Shi
- Trauma Department of Orthopedics, The Affiliated Hospital of Chengde Medical University, No. 36 of Nanyingzi Street, Shuangqiao District, Chengde, 067000, China.
| | - Zhen Feng
- Trauma Department of Orthopedics, The Affiliated Hospital of Chengde Medical University, No. 36 of Nanyingzi Street, Shuangqiao District, Chengde, 067000, China
| | - Cui-Min Zhu
- Department of Ultrasound, Longhua County Guo Jia Tun Central Hospital, Chengde, 067000, China
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Feng J, Tang G, Shui Y, Xiang J, Qin Z. Effects of ultrasound-guided lumbar plexus and sacral plexus block combined with general anesthesia on the anesthetic efficacy and surgical outcomes in elderly patients undergoing intertrochanteric fracture surgery: a randomized controlled trial. J Orthop Surg Res 2024; 19:171. [PMID: 38448954 PMCID: PMC10918949 DOI: 10.1186/s13018-023-04469-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 12/13/2023] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Surgery for intertrochanteric fractures in elderly patients is challenging due to the risk of severe pain and significant stress responses. We investigated the effects of a combined approach of ultrasound-guided lumbar plexus and sacral plexus block with general anesthesia on anesthetic efficacy and surgical outcomes in these patients. METHODS A randomized controlled trial was conducted involving 150 elderly patients, divided into two groups: the combined anesthesia group (receiving ultrasound-guided lumbar plexus and sacral plexus block along with general anesthesia) and the general anesthesia alone group. Outcome measures included hemodynamic parameters, postoperative pain levels (VAS scores), postoperative recovery times, and incidence of adverse reactions. RESULTS In the combined anesthesia group, the patients had more stable intraoperative hemodynamics, lower postoperative VAS scores at 1, 3, and 6 h, and faster recovery times (eye-opening upon command and return of respiratory function) compared to the general anesthesia group. Furthermore, the incidence of adverse reactions was significantly lower in the combined anesthesia group. CONCLUSIONS Ultrasound-guided lumbar plexus and sacral plexus block combined with general anesthesia enhanced the anesthetic efficacy and improved surgical outcomes in elderly patients undergoing intertrochanteric fracture surgery.
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Affiliation(s)
- Ji Feng
- Department of Anesthesiology, Sichuan Province Orthopedic Hospital, 132 West First Ring Road, Wuhou District, Chengdu City, 610041, Sichuan, China
| | - Guangyan Tang
- Department of Radiology, Sichuan Province Orthopedic Hospital, Chengdu City, 610041, Sichuan, China
| | - Yunhua Shui
- Department of Anesthesiology, Sichuan Province Orthopedic Hospital, 132 West First Ring Road, Wuhou District, Chengdu City, 610041, Sichuan, China
| | - Jilin Xiang
- Department of Anesthesiology, Sichuan Province Orthopedic Hospital, 132 West First Ring Road, Wuhou District, Chengdu City, 610041, Sichuan, China
| | - Zhijun Qin
- Department of Anesthesiology, Sichuan Province Orthopedic Hospital, 132 West First Ring Road, Wuhou District, Chengdu City, 610041, Sichuan, China.
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Zhou L, Huang C, Zhu X, Ma Z. Combined Systemic Immune-inflammatory Index (SII) and Geriatric Nutritional Risk Index (GNRI) predict survival in elderly patients with hip fractures: a retrospective study. J Orthop Surg Res 2024; 19:125. [PMID: 38321497 PMCID: PMC10845798 DOI: 10.1186/s13018-024-04585-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 01/26/2024] [Indexed: 02/08/2024] Open
Abstract
PURPOSE The Systemic Immune-inflammatory Index (SII) and Geriatric Nutritional Risk Index (GNRI) have undergone comprehensive examination and validation in forecasting the outcomes of diverse medical conditions. Nevertheless, the correlation between the combined use of GNRI and SII metrics and hip fractures has yet to be elucidated. This study aimed to determine whether the amalgamation of SII and GNRI scores constitutes an independent prognostic factor for elderly patients with hip fractures. METHODS We conducted a retrospective analysis of elderly patients admitted to our facility with hip fractures, encompassing both femoral neck and intertrochanteric fractures. Demographic information, experimental parameters, and postoperative complications were systematically recorded. The Geriatric Nutritional Risk Index (GNRI) and Systemic Immunoinflammatory Index (SII) were meticulously computed. Receiver operating characteristic (ROC) curves were generated, and optimal cutoff values for each parameter were determined. Subsequently, a multivariate Cox regression analysis was employed to assess the predictive utility of the SII-GNRI score in relation to 1-year postoperative mortality among elderly patients with hip fractures. RESULTS In a study involving 597 patients, 90 of whom experienced mortality within 1 year, it was observed that the SII-GNRI score in the group of patients who passed away was significantly higher compared to the group that survived. Following a multifactorial adjustment, it was established that a high SII-GNRI score served as an independent predictor of 1-year all-cause mortality in older patients with hip fractures. In addition to the SII-GNRI score, factors such as length of hospital stay, CCI > 2, and blood transfusion were also identified as independent risk factors for survival. Notably, the incidence of postoperative complications in patients with high SII-GNRI scores was significantly greater than in patients with low scores. CONCLUSION The SII-GNRI score proves valuable in predicting the 1-year survival rate for elderly patients with hip fractures who have undergone surgery.
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Affiliation(s)
- Ling Zhou
- Graduate School of Dalian Medical University, Dalian, China
- Department of Orthopaedic Surgery, Qingdao Municipal Hospital, Qingdao, China
| | - Chao Huang
- Department of Orthopaedic Surgery, People's Hospital of Rizhao, Rizhao, China
| | - Xianjie Zhu
- Department of Orthopaedic Surgery, Qingdao Municipal Hospital, Qingdao, China
| | - Zhenhua Ma
- Department of Orthopaedic Surgery, Qingdao Municipal Hospital, Qingdao, China.
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Yin BH, Liu CJ, Sherrier MC, Sun H, Zhang W. Compressive buttress compared with off-axial screw fixation for vertical femoral neck fractures in young adults: a prospective, randomized controlled trial. J Orthop Surg Res 2024; 19:42. [PMID: 38184587 PMCID: PMC10771671 DOI: 10.1186/s13018-023-04493-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 12/19/2023] [Indexed: 01/08/2024] Open
Abstract
BACKGROUND To compare the clinical outcomes of compressive buttress screw (CBS) fixation, a novel screw fixation strategy, to off-axial screw fixation (off-axial partial threaded cannulated screw, OPTCS) for vertical femoral neck fractures (FNFs) in young adults. METHODS A total of 146 adults younger than 55 years old with high-energy Pauwels type III FNFs were randomized to receive CBS fixation or OPTCS fixation. Primary outcomes were complication rates, including fixation failure, fracture nonunion, and avascular necrosis of the femoral head (ANFH) at 24 months after treatment. Fixation loosening, femoral neck shortening and varus collapse, patient function and quality of life using the Harris hip score (HHS), and EuroQol-5 dimensional-5 levels (EQ-5D-5L) questionnaire (including EQ-5D-5L and EQ-VAS) were assessed as secondary outcomes at 24 months. RESULTS CBS and OPTCS fixation groups were similar with regard to demographics at baseline. At 24 months, patients in the CBS fixation cohort had a significantly lower rate of fixation failure (10.5% vs. 25.0%, p = 0.041) and fracture nonunion (1.8% vs. 18.3%, p = 0.003) compared with patients who received OPTCS fixation. There was no difference in rate of ANFH (7.0% vs. 11.7%, p = 0.389) between groups. Additionally, patients managed with CBS fixation showed significantly less fixation loosening (19.3% vs. 58.3%, p < 0.001), less severe femoral neck shortening and varus collapse (10.5% vs. 25.0%, p = 0.007), higher HHS (93 vs. 83, p = 0.001) and more excellent grade (68.4% vs. 36.7%, p = 0.008), higher EQ-5D-5L (0.814 vs, 0.581, p < 0.001) and EQ-VAS (85 vs. 80, p = 0.002). CONCLUSION CBS screw fixation confers significantly lower complication rate in addition to higher functional and quality of life outcomes for young adults with high-energy FNF compared with OPTCS fixation. TRIAL REGISTRATION This prospective, randomized controlled trial was approved by the institutional review board of our center, Ethics Committee of Shanghai sixth people's Hospital, and registered at www.chictr.org.cn (Approval Number: ChiCTR1900026283; Registered 29 September 2019-Retrospectively registered, https://www.chictr.org.cn/showproj.html?proj=43164 ).
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Affiliation(s)
- Bo-Hao Yin
- Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
- Shanghai Sixth People's Hospital, National Center for Orthopaedics, Shanghai, 200233, China
| | - Chen-Jun Liu
- Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
- Shanghai Sixth People's Hospital, National Center for Orthopaedics, Shanghai, 200233, China
| | - Matthew C Sherrier
- Department of Orthopaedics and Physical Medicine, Medical University of South Carolina, Charleston, SC, 29425, USA
| | - Hui Sun
- Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China.
- Shanghai Sixth People's Hospital, National Center for Orthopaedics, Shanghai, 200233, China.
| | - Wei Zhang
- Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China.
- Shanghai Sixth People's Hospital, National Center for Orthopaedics, Shanghai, 200233, China.
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Gargano G, Asparago G, Spiezia F, Oliva F, Maffulli N. Small interfering RNAs in the management of human osteoporosis. Br Med Bull 2023; 148:58-69. [PMID: 37675799 PMCID: PMC10788844 DOI: 10.1093/bmb/ldad023] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 08/17/2023] [Accepted: 08/17/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND Osteoporosis results in reduced bone mass and consequent bone fragility. Small interfering RNAs (siRNAs) can be used for therapeutic purposes, as molecular targets or as useful markers to test new therapies. SOURCES OF DATA A systematic search of different databases to May 2023 was performed to define the role of siRNAs in osteoporosis therapy. Fourteen suitable studies were identified. AREAS OF AGREEMENT SiRNAs may be useful in studying metabolic processes in osteoporosis and identify possible therapeutic targets for novel drug therapies. AREAS OF CONTROVERSY The metabolic processes of osteoporosis are regulated by many genes and cytokines that can be targeted by siRNAs. However, it is not easy to predict whether the in vitro responses of the studied siRNAs and drugs are applicable in vivo. GROWING POINTS Metabolic processes can be affected by the effect of gene dysregulation mediated by siRNAs on various growth factors. AREAS TIMELY FOR DEVELOPING RESEARCH Despite the predictability of pharmacological response of siRNA in vitro, similar responses cannot be expected in vivo.
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Affiliation(s)
- Giuseppe Gargano
- Department of Trauma and Orthopaedic Surgery, AOU San Giovanni di Dio e Ruggi D’Aragona, Via San Leonardo 1, 84131 Salerno, Italy
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi (SA), Italy
- Department of Trauma and Orthopaedic Surgery, AOR San Carlo, Via Potito Petrone, 85100 Potenza, Italy
| | - Giovanni Asparago
- Department of Trauma and Orthopaedic Surgery, AOU San Giovanni di Dio e Ruggi D’Aragona, Via San Leonardo 1, 84131 Salerno, Italy
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi (SA), Italy
| | - Filippo Spiezia
- Department of Trauma and Orthopaedic Surgery, AOR San Carlo, Via Potito Petrone, 85100 Potenza, Italy
| | - Francesco Oliva
- Department of Trauma and Orthopaedic Surgery, AOU San Giovanni di Dio e Ruggi D’Aragona, Via San Leonardo 1, 84131 Salerno, Italy
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi (SA), Italy
| | - Nicola Maffulli
- Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, 275 Bancroft Road, London E1 4DG, UK
- School of Pharmacy and Bioengineering, Keele University School of Medicine, Thornburrow Drive, Stoke on Trent, UK
- Department of Orthopaedic Surgery and Traumatology, University of Rome La Sapienza, Hospital Sant’Andrea, Rome, Italy
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Lai CY, Liu CH, Lai PJ, Hsu YH, Chou YC, Yu YH. Perioperative peri-implant fracture after osteosynthesis for geriatric femoral pertrochanteric fracture with the linear compression integrated screw intramedullary nail system (INTERTAN™): a retrospective study. J Orthop Surg Res 2023; 18:932. [PMID: 38057901 DOI: 10.1186/s13018-023-04441-w] [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: 10/03/2023] [Accepted: 12/03/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Osteosynthesis for geriatric femoral pertrochanteric fractures using the linear compression integrated screw intramedullary nail system (INTERTAN™) has become popular. Nonetheless, cases of perioperative peri-implant fractures have been reported following this surgical technique. The factors responsible for this complication remain unclear. Therefore, we investigated perioperative peri-implant fracture risk factors and incidence, as well as overall outcomes, using the INTERTAN™ system for geriatric femoral pertrochanteric fractures. METHODS We retrospectively reviewed 98 consecutive patients with geriatric femoral pertrochanteric fractures after INTERTAN™ fixation, with at least a 12-month follow-up period between May 2020 and April 2022 at a single medical institute. The patients' demographic characteristics, fracture pattern, quality of reduction, quality of fixation, nail length, morphology of the femur, and perioperative complications were recorded and analyzed. RESULTS Among the 98 patients, 92 achieved union during follow-up. Twelve perioperative peri-implant fractures (12.2%) were recorded, all of which occurred during or within 1 month of osteosynthesis. Except for one patient who underwent re-osteosynthesis, the others underwent nonoperative treatment, and all achieved union. Multiple regression analysis revealed morphology of the femur with low-lesser trochanter width (odds ratio (OR) 0.532, 95% confidence interval (CI) 0.33-0.86, p = 0.01) to be the only factor contributing to perioperative peri-implant fractures. When the Youden index was used, the optimal cut-off value was 20.2 mm of low-lesser trochanter width. Low-lesser trochanter width < 20.2 mm was found to be a potential factor causing perioperative peri-implant fractures (OR 17.81, 95% CI 1.67-19.76, p = 0.017). CONCLUSIONS Morphology of the femur with a low-lesser trochanter width smaller than 20.2 mm was found to be the only potential contributor to perioperative peri-implant fractures when using INTERTAN™ for geriatric femoral pertrochanteric fractures. Care should be taken during osteosynthesis, focusing not only on the fracture site but also on the femoral cortex around the implant. Although perioperative peri-implant fractures were observed within one month following osteosynthesis, the majority of these cases were effectively treated without surgical intervention.
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Affiliation(s)
- Chih-Yang Lai
- Department of Orthopedic Surgery, Musculoskeletal Research Center, Chang Gung Memorial Hospital, Linkou Branch, and Chang Gung University, Taoyuan, Taiwan
| | - Chang-Heng Liu
- Department of Orthopedic Surgery, Musculoskeletal Research Center, Chang Gung Memorial Hospital, Linkou Branch, and Chang Gung University, Taoyuan, Taiwan
| | - Po-Ju Lai
- Department of Orthopedic Surgery, Musculoskeletal Research Center, Chang Gung Memorial Hospital, Linkou Branch, and Chang Gung University, Taoyuan, Taiwan
| | - Yung-Heng Hsu
- Department of Orthopedic Surgery, Musculoskeletal Research Center, Chang Gung Memorial Hospital, Linkou Branch, and Chang Gung University, Taoyuan, Taiwan
| | - Ying-Chao Chou
- Department of Orthopedic Surgery, Musculoskeletal Research Center, Chang Gung Memorial Hospital, Linkou Branch, and Chang Gung University, Taoyuan, Taiwan
| | - Yi-Hsun Yu
- Department of Orthopedic Surgery, Musculoskeletal Research Center, Chang Gung Memorial Hospital, Linkou Branch, and Chang Gung University, Taoyuan, Taiwan.
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14
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Li Y, Dong B. Development and validation of risk prediction nomograms for acute respiratory failure in elderly patients with hip fracture. J Orthop Surg Res 2023; 18:899. [PMID: 38007467 PMCID: PMC10676597 DOI: 10.1186/s13018-023-04395-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 11/19/2023] [Indexed: 11/27/2023] Open
Abstract
BACKGROUND Hip fractures in the elderly often lead to acute respiratory failure, but there is currently no tool to assess the prognosis of such patients. This study aims to develop a risk prediction model for respiratory failure in these patients. METHODS A retrospective cross-sectional study was conducted using the Medical Information Mart for Intensive Care (MIMIC)-IV database, incorporating data from 3,266 patients with hip fractures aged over 55 years from 2008 to 2019. Data included demographic information, laboratory indicators, comorbidities, and treatment methods. Patients were divided into a training group (70%) and a validation group (30%). Least Absolute Shrinkage and Selection Operator (LASSO) regression was applied to select prognostic predictors, and a visualized nomogram model was constructed using multivariate logistic regression analysis. Model performance and clinical applicability were assessed. Statistical analyses were done using R4.2.2, with P < 0.05 deemed significant. RESULTS Seven key factors, including age, height, albumin, chloride, pneumonia, acute kidney injury (AKI), and heparin use, were associated with respiratory failure risk. The model demonstrated good performance with area under the curve (AUC) values of 0.77 and 0.73 in the training and validation sets, respectively. The calibration curve showed good agreement, and decision curve analysis (DCA) indicated the model's clinical benefit. CONCLUSIONS This risk prediction model can effectively predict respiratory failure in hip fracture patients, assisting clinicians in identifying high-risk individuals and providing evidence-based references for treatment strategies.
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Affiliation(s)
- Yue Li
- Pain ward of Rehabilitation Department, Honghui Hospital, Xi'an Jiaotong University, No. 555 Youyi East Road, Beilin District, Xi'an, 710054, Shaanxi Province, China
| | - Bo Dong
- Pain ward of Rehabilitation Department, Honghui Hospital, Xi'an Jiaotong University, No. 555 Youyi East Road, Beilin District, Xi'an, 710054, Shaanxi Province, China.
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15
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Yang TI, Kuo YJ, Huang SW, Chen YP. Minimal short-term decline in functional performance and quality of life predicts better long-term outcomes for both in older Taiwanese adults after hip fracture surgery: a prospective study. J Orthop Surg Res 2023; 18:791. [PMID: 37872535 PMCID: PMC10594772 DOI: 10.1186/s13018-023-04278-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 10/10/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND Hip fracture can lead to long-term loss of mobility and self-care ability in older adults. Despite initial decreases in functional performance after hip fracture surgery, patients tend to gradually recover. However, recovery can vary, with some regaining their abilities quickly while others becoming functionally dependent. In this study, we investigated whether the level of short-term postoperative decline in activity of daily living (ADL) performance and quality of life (QoL) can predict the 1-year outcomes for both following hip fracture surgery in older Taiwanese adults. METHODS This prospective cohort study included 427 older adults (≥ 60 years) who underwent hip fracture surgery at a single tertiary medical center in Taiwan between November 2017 and March 2021. We collected pre-fracture data, including the patients' demographics, Charlson comorbidity index (CCI) scores, and responses to a questionnaire (Short Portable Mental State Questionnaire [SPMSQ]) for dementia screening. Moreover, their scores on the EuroQol-5D questionnaire (for evaluating QoL) and the Barthel Index (for assessing ADL performance) were collected at pre-fracture status and at 3- and 12-months following surgery. Changes in ADL and QoL three months post-surgery compared to pre-fracture status were evaluated, and the associations of these parameters (and other potential factors) with 1-year outcomes for ADL and QoL were investigated. RESULTS We analyzed the data of 318 patients with hip fracture and complete follow-up data regarding ADL performance and QoL at 3- and 12-months post-surgery. After adjusting for covariates, multivariate linear regression revealed that changes in ADL and QoL at 3 months post-surgery from pre-fracture status were positively and significantly associated with 1-year outcomes for both (p < .001 for both). Furthermore, pre-fracture CCI and SPMSQ scores were independent predictive factors associated with 1-year ADL outcomes (p = .042 and < .001, respectively). CONCLUSIONS Patients who exhibit a smaller decline in functional performance and quality of life three months after hip fracture surgery from pre-fracture status are likely to have improved long-term ADL and QoL. TRIAL REGISTRATION TMU-JIRB N201709053.
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Affiliation(s)
- Tzu-I Yang
- Department of Orthopedic Surgery, Changhua Christian Hospital, Changhua, Taiwan
| | - Yi-Jie Kuo
- Department of Orthopedics, Wan Fang Hospital, Taipei Medical University, No. 111, Sec. 3, Xinglong Rd., Wenshan Dist., Taipei City, 116, Taiwan
- Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Shu-Wei Huang
- Department of Orthopedics, Wan Fang Hospital, Taipei Medical University, No. 111, Sec. 3, Xinglong Rd., Wenshan Dist., Taipei City, 116, Taiwan
- Graduate Institute of Health and Biotechnology Law, Taipei Medical University, Taipei, 116, Taiwan
| | - Yu-Pin Chen
- Department of Orthopedics, Wan Fang Hospital, Taipei Medical University, No. 111, Sec. 3, Xinglong Rd., Wenshan Dist., Taipei City, 116, Taiwan.
- Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
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Yao W, Tang W, Wang W, Lv Q, Ding W. Correlation between admission hypoalbuminemia and postoperative urinary tract infections in elderly hip fracture patients. J Orthop Surg Res 2023; 18:774. [PMID: 37838687 PMCID: PMC10576304 DOI: 10.1186/s13018-023-04274-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 10/08/2023] [Indexed: 10/16/2023] Open
Abstract
PURPOSE This study aimed to evaluate the correlation between hypoalbuminemia upon admission and the incidence of postoperative urinary tract infections (UTIs) in elderly patients with hip fractures. METHODS A retrospective analysis was performed on the medical records of elderly patients who underwent surgical treatment for hip fractures at a level I trauma center from 2013 to 2023. Serum albumin levels were measured upon admission, and hypoalbuminemia was defined as a total albumin level < 35 g/L. Multivariable logistic regression and propensity score matching analysis were utilized to control and reduce potential confounding factors, aiming to obtain adjusted odds ratios (ORs) and 95% confidence intervals (CI) for UTIs to determine the strength of the association. RESULTS This observational cohort study included 1279 patients, among whom 298 (23.3%) developed UTIs. Patients with albumin levels < 35 g/L had significantly greater odds of developing UTIs compared to those with albumin levels ≥ 35 g/L (OR 1.86, 95% CI 1.28-2.70). Further analysis, dividing albumin levels into quartiles, demonstrated that patients in the Q2 group (38.0-40.9 g/L; OR 1.38, 95% CI 0.88-2.17), Q3 group (35.0-37.9 g/L; OR 1.69, 95% CI 1.06-2.71), and Q4 group (15.3-34.9 g/L; OR 2.67, 95% CI 1.61-4.43) had notably higher odds of developing UTIs compared to those in the Q1 group (41.0-52.0 g/L). CONCLUSIONS The presence of hypoalbuminemia upon admission in elderly patients undergoing hip fracture surgery is strongly correlated with the occurrence of postoperative UTIs. Furthermore, this association exhibits a clear dose-response relationship.
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Affiliation(s)
- Wei Yao
- Department of Orthopedics, Dandong Central Hospital, China Medical University, No. 338 Jinshan Street, Zhenxing District, Dandong, 118002, Liaoning Province, People's Republic of China
| | - Wanyun Tang
- Department of Orthopedics, Dandong Central Hospital, China Medical University, No. 338 Jinshan Street, Zhenxing District, Dandong, 118002, Liaoning Province, People's Republic of China
| | - Wei Wang
- Department of Orthopedics, Dandong Central Hospital, China Medical University, No. 338 Jinshan Street, Zhenxing District, Dandong, 118002, Liaoning Province, People's Republic of China
| | - Qiaomei Lv
- Department of Oncology, Dandong Central Hospital, China Medical University, Dandong, People's Republic of China
| | - Wenbo Ding
- Department of Orthopedics, Dandong Central Hospital, China Medical University, No. 338 Jinshan Street, Zhenxing District, Dandong, 118002, Liaoning Province, People's Republic of China.
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Liu H, Gao E, Zhong Z, Wu W, Zhang Z. Clinical application of modified hip joint lateral position in femoral neck fracture. J Orthop Surg Res 2023; 18:698. [PMID: 37723505 PMCID: PMC10506282 DOI: 10.1186/s13018-023-04183-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 09/10/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND To show the femoral neck better in hip lateral view of X-ray, we design a modified hip lateral view and then investigate the value in femoral neck fractures. METHODS CT images of 10 normal hip joints for 3D reconstruction were selected, the Mimics Medical 21.0 was used, and rotating the proximal femur was to find the most suitable angle for showing the femoral neck well, designed the modified lateral view according to this angle. We collected 35 healthy cases and 35 femoral neck fractures as the normal and fracture group. And two groups were all taken hip anteroposterior view, cross-table lateral view and modified lateral view, which were analyzed by two radiologists to score the anatomical structures of the articular surface, femoral head, head neck junction, femoral neck, basal region and intertrochanteric region. Friedman test was used to analyze the score of femoral neck at different angles. T test and Wilcoxon signed-rank test were to compare inter-groups. RESULTS The modified lateral view was designed as follows: The subjects were supine, with the sagittal axis biased toward the healthy side at an angle of approximately 20° to the long axis of the examination table, the hip joint flexed at 45°, the lower extremity abducted at 40°, the centerline inclined 45° toward the head and the centerline aligned with the center of the groin. The modified lateral view showed the femoral head, head neck junction and femoral neck more clearly than the cross-table lateral view, but the cross-table lateral view showed the femoral neck basal and intertrochanteric region better. In addition, the time of taking the modified lateral view was significantly less than the cross-table lateral view (normal group: 0.789 min ± 0.223 vs 0.623 min ± 0.207, P < 0.001; fracture group: 1.131 min ± 0.362 vs 0.946 min ± 0.390, P < 0.001). CONCLUSIONS The modified lateral view can obtain a standard sagittal image of femoral neck, which can show the dislocation and angulation of the sagittal femoral neck fracture clearly, and improve the accuracy of diagnosis. And it is more convenient and easier for patients to cooperate, which is worthy promoting and applying in clinical work.
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Affiliation(s)
- Haitian Liu
- Department of CT/MR, Hebei Medical University Third Hospital, No. 139 Ziqiang Road, Shijiazhuang, 050051, Hebei Province, China
| | - Enpeng Gao
- Department of Radiology, Hebei Medical University Third Hospital, No. 139 Ziqiang Road, Shijiazhuang, 050051, Hebei Province, China
| | - Zhiwei Zhong
- Department of Radiology, Hebei Medical University Third Hospital, No. 139 Ziqiang Road, Shijiazhuang, 050051, Hebei Province, China
| | - Wenjuan Wu
- Department of Radiology, Hebei Medical University Third Hospital, No. 139 Ziqiang Road, Shijiazhuang, 050051, Hebei Province, China
| | - Zuzhuo Zhang
- Department of Radiology, Hebei Medical University Third Hospital, No. 139 Ziqiang Road, Shijiazhuang, 050051, Hebei Province, China.
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Krogh AC, Thillemann JK, Hansen TB, Holck K, Kristensen MT, Palm H, Stilling M. No effect of hydroxyapatite-coated sliding hip screw threads on screw migration in the femoral head/neck of pertrochanteric fractures: a randomized controlled trial using radiostereometric analysis. J Orthop Surg Res 2023; 18:686. [PMID: 37710269 PMCID: PMC10503211 DOI: 10.1186/s13018-023-04170-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 09/07/2023] [Indexed: 09/16/2023] Open
Abstract
INTRODUCTION Cut-out is the most frequently reported mechanical failure of internal fixation of pertrochanteric fractures. The purpose of this study was to examine if hydroxyapatite-coated screw thread on a sliding hip screw (SHS) could reduce screw migration within the femoral head in patients with stable pertrochanteric fractures. MATERIALS AND METHODS In a double-blinded randomized controlled study, 37 patients at mean age 78 (range 56-96), with pertrochanteric fracture (Evans I, II, IV) received surgery with a SHS with a hydroxyapatite-coated or a non-coated lag screw thread. Radiostereometry and standard radiographs were obtained 1 day, 6 weeks, 3- and 6 months post-operatively to evaluate screw and fracture migration and fracture reposition. The two groups were combined to describe fracture migration. RESULTS There was similar and small screw migration in the femoral head between the two groups at 6 weeks, 3- and 6 months (p > 0.12). Fracture migration occurred predominantly in the first 6 weeks, where fracture impaction was 5.95 mm (CI 95% 2.87 to 9.04) and anterior rotation of the femoral head was -2.94° (CI 95% - 5.22 to - 0.66). Migration of the fracture (total translation) correlated to the post-operative fracture reposition (p = 0.002), but not significantly to screw migration (p = 0.09). Neither screw total translation (rho 0.06, p = 0.79) nor fracture total translation (rho 0.04, p = 0.77) correlated with bone mineral density. CONCLUSION There was no clinical benefit of hydroxyapatite coating on lag screw migration in this patient cohort. Migration of the pertrochanteric fractures was higher with poor fracture reposition but fractures generally stabilized after 6 weeks follow-up. The study was registered at ClinicalTrials.gov (NCT05677061). LEVEL OF EVIDENCE II Patient-blinded prospective randomized study. Trial registration number The study was registered at ClinicalTrials.gov (NCT05677061).
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Affiliation(s)
- August Christoffer Krogh
- Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark.
- AutoRSA Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Aarhus N, Denmark.
- Department of Orthopedics, Palle Juul-Jensens Boulevard 165, Crossing J501, 8200, Aarhus N, Denmark.
| | - Janni Kjærgaard Thillemann
- Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
- AutoRSA Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Aarhus N, Denmark
- University Clinic for Hand, Hip and Knee Surgery, Gødstrup Regional Hospital, Herning, Denmark
| | - Torben Bæk Hansen
- Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
- University Clinic for Hand, Hip and Knee Surgery, Gødstrup Regional Hospital, Herning, Denmark
| | - Kim Holck
- Department of Orthopedics, Hvidovre Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Morten Tange Kristensen
- Department of Orthopedics, Hvidovre Hospital, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Physical and Occupational Therapy, Copenhagen University-Hospital, Bispebjerg-Frederiksberg, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Henrik Palm
- Department of Orthopedics, Hvidovre Hospital, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Orthopedics, Bispebjerg Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Maiken Stilling
- Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
- AutoRSA Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Aarhus N, Denmark
- University Clinic for Hand, Hip and Knee Surgery, Gødstrup Regional Hospital, Herning, Denmark
- Department of Orthopedics, Aarhus University Hospital, Aarhus N, Denmark
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19
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Yao W, Wang W, Tang W, Lv Q, Ding W. Neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune inflammation index (SII) to predict postoperative pneumonia in elderly hip fracture patients. J Orthop Surg Res 2023; 18:673. [PMID: 37697317 PMCID: PMC10496383 DOI: 10.1186/s13018-023-04157-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 09/01/2023] [Indexed: 09/13/2023] Open
Abstract
PURPOSE Investigate the association between the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII) about the presence of postoperative pneumonia (POP) in geriatric patients with hip fractures. Compare the predictive value of these biomarkers for POP and assess their potential for early detection of POP. METHODS We retrospectively included elderly patients with hip fractures who underwent surgical treatment at our institution. POP was diagnosed according to the guidelines provided by the American Thoracic Society. We collected neutrophil, lymphocyte, and platelet counts upon admission to calculate the NLR, PLR, and SII. Receiver operating characteristic curves were utilized to establish the optimal cutoff values for each index. Multivariate logistic regression analysis and propensity score matching analysis were utilized to assess the independent association between each index and POP after adjusting for demographic, comorbidity, and surgery-related variables. RESULTS The study included a total of 1199 patients, among whom 111 cases (9.26%) developed POP. NLR exhibited the highest predictive value for POP in elderly patients with hip fractures compared to PLR and SII (AUC = 0.648, 95% CI 0.594-0.701). A high NLR, using the optimal cutoff value of 5.84, was significantly associated with an increased incidence of POP (OR = 2.24, 95% CI 1.43-3.51). This finding remained statistically significant even after propensity score matching (OR = 2.04, 95% CI 1.31-3.20). CONCLUSIONS Among the three inflammatory/immune markers considered, the NLR demonstrates the highest reliability as a predictor for POP in elderly patients with hip fractures. Therefore, it serves as a valuable tool for early identification.
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Affiliation(s)
- Wei Yao
- Department of Orthopedics, Dandong Central Hospital, China Medical University, No. 338 Jinshan Street, Zhenxing District, Dandong, 118002, Liaoning Province, People's Republic of China
| | - Wei Wang
- Department of Orthopedics, Dandong Central Hospital, China Medical University, No. 338 Jinshan Street, Zhenxing District, Dandong, 118002, Liaoning Province, People's Republic of China
| | - Wanyun Tang
- Department of Orthopedics, Dandong Central Hospital, China Medical University, No. 338 Jinshan Street, Zhenxing District, Dandong, 118002, Liaoning Province, People's Republic of China
| | - Qiaomei Lv
- Department of Oncology, Dandong Central Hospital, China Medical University, Dandong, China
| | - Wenbo Ding
- Department of Orthopedics, Dandong Central Hospital, China Medical University, No. 338 Jinshan Street, Zhenxing District, Dandong, 118002, Liaoning Province, People's Republic of China.
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20
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Yao W, Zhang K, Lv Q, Deng Z, Ding W. D-dimer-albumin ratio (DAR) as a new biomarker for predicting preoperative deep vein thrombosis after geriatric hip fracture patients. J Orthop Surg Res 2023; 18:645. [PMID: 37653556 PMCID: PMC10470167 DOI: 10.1186/s13018-023-04139-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 08/25/2023] [Indexed: 09/02/2023] Open
Abstract
PURPOSE Hip fractures in the elderly are complicated by preoperative deep vein thrombosis (DVT). The objective of this study is to determine the usefulness of blood-based biomarkers, particularly the D-dimer-albumin ratio (DAR), in predicting preoperative DVT. METHODS A retrospective observational study was carried out on 1149 patients from a single hospital, and subsequently validated on an additional 626 patients from a separate hospital. The aim was to evaluate the prognostic and predictive value of 10 biomarkers, with a specific emphasis on DAR, in both cohorts. The primary measure of interest was the occurrence of preoperative DVT. RESULTS The ratio of D-dimer to albumin demonstrated superior predictive capability for preoperative DVT in older patients with hip fractures compared to other biomarkers (AUC = 0.677). Using the optimal cutoff point of 0.24, high DAR was significantly associated with preoperative DVT (OR 3.45, 95% CI 2.00-5.95). Notably, all the DAR definitions detailed above were successfully validated in an external, independent cohort. CONCLUSIONS DAR may be a valuable biomarker for predicting preoperative DVT in elderly patients with hip fractures.
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Affiliation(s)
- Wei Yao
- Department of Orthopedics, Dandong Central Hospital, China Medical University, Dandong, China
| | - Kaihua Zhang
- Department of Orthopedics, Third Affiliated Hospital of Jinzhou Medical University, Jinzhou, China
| | - Qiaomei Lv
- Department of Oncology, Dandong Central Hospital, China Medical University, Dandong, China
| | - Ziyang Deng
- Department of Orthopedics, Third Affiliated Hospital of Jinzhou Medical University, Jinzhou, China.
| | - Wenbo Ding
- Department of Orthopedics, Dandong Central Hospital, China Medical University, Dandong, China.
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Wang X, Zhang Y, Lou L, Xu L, Fei W, Dai J, Wang J. Robotic-assisted systems for the safe and reliable treatment of femoral neck fractures: retrospective cohort study. J Orthop Surg Res 2023; 18:633. [PMID: 37641097 PMCID: PMC10463292 DOI: 10.1186/s13018-023-04070-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 08/02/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Robots are being used in a wide range of surgical procedures. However, in clinical practice, the efficacy of orthopedic robotic-assisted treatment of femoral neck fractures is still poorly reported, particularly in terms of screw placement accuracy, femoral neck fracture healing rates and postoperative functional recovery. Moreover, there is a lack of comparative analysis between robot-assisted surgery and traditional surgical approaches. PURPOSE The purpose of this study was to compare the clinical outcomes of patients with femoral neck fractures treated with TiRobot-assisted hollow screw fixation with those of patients with femoral neck fractures treated with traditional surgical approaches. METHODS This study included 112 patients with femoral neck fracture who were treated from March 2017 to October 2021 with percutaneous hollow screw internal fixation. These included 56 cases in the TiRobot-assisted surgery group and 56 cases in the standard surgery group. After at least 1 year of follow-up, the treatment outcomes of the two groups were compared, including the amount of intraoperative bleeding, the duration of intraoperative fluoroscopy, the number of guide pin positioning adjustments, the length of hospital stay, the accuracy rate of screw placement, the final Harris Hip Score, the fracture healing rate, and the rate of femoral head necrosis. Statistical analysis software was used to process and analyze the result. RESULTS The TiRobot-assisted group had a statistically significant improvement over the control group in terms of intraoperative bleeding, the duration of intraoperative fluoroscopy, the number of guide pin positioning adjustments, length of hospital stay, accuracy of screw placement and incidence of femoral head necrosis (P < 0.05). There was no statistically significant difference in time to surgery, final Harris hip score and fracture healing rate (P > 0.05). CONCLUSION This study shows that TiRobot-assisted surgery has the advantages of short hospital stay, high safety, minimally invasive, high success rate of nail placement, and can reduce the amount of intraoperative radiation and the incidence of femoral head necrosis, thus achieving satisfactory clinical outcomes, and is worthy of clinical promotion.
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Affiliation(s)
- Xiaofei Wang
- Dalian Medical University, Dalian, 116044, China
- Department of Orthopedics, Northern Jiangsu People's Hospital, Clinical Medical College, Yangzhou University, Yangzhou, 225001, China
| | - Yaxin Zhang
- Dalian Medical University, Dalian, 116044, China
| | - Linbing Lou
- Dalian Medical University, Dalian, 116044, China
| | - Lei Xu
- Department of Orthopedics, Northern Jiangsu People's Hospital, Clinical Medical College, Yangzhou University, Yangzhou, 225001, China
| | - Wenyong Fei
- Department of Orthopedics, Northern Jiangsu People's Hospital, Clinical Medical College, Yangzhou University, Yangzhou, 225001, China.
| | - Jihang Dai
- Department of Orthopedics, Northern Jiangsu People's Hospital, Clinical Medical College, Yangzhou University, Yangzhou, 225001, China.
| | - Jingcheng Wang
- Department of Orthopedics, Northern Jiangsu People's Hospital, Clinical Medical College, Yangzhou University, Yangzhou, 225001, China.
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Yang F, Li X, Zhao L, Yang Q. Dual-screw versus single-screw cephalomedullary nails for intertrochanteric femoral fractures: a systematic review and meta-analysis. J Orthop Surg Res 2023; 18:607. [PMID: 37599361 PMCID: PMC10440877 DOI: 10.1186/s13018-023-04103-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 08/15/2023] [Indexed: 08/22/2023] Open
Abstract
BACKGROUND Internal fixation with cephalomedullary nails has been widely used in the treatment of intertrochanteric femoral fractures (IFF). Yet, the difference in efficacy and safety between the commonly used integrated dual-screw cephalomedullary nail (InterTAN) and single-screw cephalomedullary nail remains inconclusive. Thus we performed the present systematic review and meta-analysis. METHODS Randomized controlled trials (RCTs) or observational studies comparing InterTAN with proximal femoral nail anti-rotation (PFNA), the Asian PFNA (PFNA-II), or the Gamma3 nail in treating IFF were searched on PubMed, EMBASE, Web of Science and Cochrane Library from inception to April 30, 2023. The differences in perioperative parameters and clinical and radiological outcomes were evaluated by mean difference (MD) with 95% confidence interval (95%CI). The risks of various complications and mortality were assessed by risk ratio (RR) with 95%CI. RESULTS Twenty-three studies comprising 3566 patients were included. Compared with single-screw cephalomedullary nails (PFNA/PFNA-II, Gamma3), InterTAN conferred significantly reduced risk of implant failures (RR = 0.37, 95%CI 0.26 to 0.51, P < 0.001), hip and thigh pain (RR = 0.70, 95%CI 0.55 to 0.90, P = 0.006) and all-cause revision/reoperation (RR = 0.38, 95%CI 0.26 to 0.57, P < 0.001). Moreover, patients treated with InterTAN had significantly higher 1-year Harris Hip Score (MD = 0.82, 95%CI 0.20-1.44, P = 0.010) and shorter time to union/healing (MD = - 0.66 days, 95%CI - 1.16 to - 0.16, P = 0.009). Femoral neck shortening, time to full bearing, and incidences of non-union, infection, deep venous thrombosis, and mortality were comparable between both groups. CONCLUSIONS The integrated dual-screw InterTAN construct has superior performance in reducing risks of complications and improving clinical and functional outcomes in the treatment of IFF. More well-designed, high-quality RCTs are warranted to confirm these findings.
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Affiliation(s)
- Fan Yang
- Department of Traumatic Orthopedics, Yuncheng Central Hospital, Shanxi Medical University, No. 3690, Hedong East Street, Yanhu District, Yuncheng City, 044000, Shanxi Province, China.
| | - Xiafei Li
- Department of Traumatic Orthopedics, Yuncheng Central Hospital, Shanxi Medical University, No. 3690, Hedong East Street, Yanhu District, Yuncheng City, 044000, Shanxi Province, China
| | - Lei Zhao
- Department of Traumatic Orthopedics, Yuncheng Central Hospital, Shanxi Medical University, No. 3690, Hedong East Street, Yanhu District, Yuncheng City, 044000, Shanxi Province, China
| | - Qi Yang
- Department of Traumatic Orthopedics, Yuncheng Central Hospital, Shanxi Medical University, No. 3690, Hedong East Street, Yanhu District, Yuncheng City, 044000, Shanxi Province, China
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Guo J, He Q, Peng C, Dai R, Li W, Su Z, Li Y. Machine learning algorithms to predict risk of postoperative pneumonia in elderly with hip fracture. J Orthop Surg Res 2023; 18:571. [PMID: 37543618 PMCID: PMC10403839 DOI: 10.1186/s13018-023-04049-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 07/25/2023] [Indexed: 08/07/2023] Open
Abstract
BACKGROUND Hip fracture (HF) is one of the most common fractures in the elderly and is significantly associated with high mortality and unfavorable prognosis. Postoperative pneumonia (POP), the most common postoperative complication of HF, can seriously affect patient prognosis and increase the burden on the healthcare system. The aim of this study was to develop machine learning models for identifying elderly patients at high risk of pneumonia after hip fracture surgery. METHODS From May 2016 to November 2022, patients admitted to a single central hospital for HF served as the study population. We extracted data that could be collected within 24 h of patient admission. The dataset was divided into training and validation sets according to 70:30. Based on the screened risk factors, prediction models were developed using seven machine learning algorithms, namely CART, GBM, KNN, LR, NNet, RF, and XGBoost, and their performance was evaluated. RESULTS Eight hundred five patients were finally included in the analysis and 75 (9.3%) patients suffered from POP. Age, CI, COPD, WBC, HB, GLU, STB, GLOB, Ka+ which are used as features to build machine learning models. By evaluating the model's AUC value, accuracy, sensitivity, specificity, Kappa value, MCC value, Brier score value, calibration curve, and DCA curve, the model constructed by XGBoost algorithm has the best and near-perfect performance. CONCLUSION The machine learning model we created is ideal for detecting elderly patients at high risk of POP after HF at an early stage.
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Affiliation(s)
- Jiale Guo
- Department of Orthopedics, Chaohu Hospital of Anhui Medical University, Hefei, China
| | - Qionghan He
- Chaohu Hospital of Anhui Medical University, Hefei, China
| | - Caiju Peng
- Department of Orthopedics, Chaohu Hospital of Anhui Medical University, Hefei, China
| | - Ru Dai
- Department of Orthopedics, Chaohu Hospital of Anhui Medical University, Hefei, China
| | - Wei Li
- Department of Orthopedics, Chaohu Hospital of Anhui Medical University, Hefei, China
| | - Zhichao Su
- Department of Orthopedics, Chaohu Hospital of Anhui Medical University, Hefei, China
| | - Yehai Li
- Department of Orthopedics, Chaohu Hospital of Anhui Medical University, Hefei, China.
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Wang T, Yang S, Wang Z, Guo J, Hou Z. Incidence and risk factors of admission deep venous thrombosis in nonagenarians and centenarians with intertrochanteric fracture: a retrospective study. J Orthop Surg Res 2023; 18:558. [PMID: 37533045 PMCID: PMC10394886 DOI: 10.1186/s13018-023-04032-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 07/19/2023] [Indexed: 08/04/2023] Open
Abstract
PURPOSE The objective of this study was to identify the risk factors for admission deep venous thrombosis (aDVT) and proximal aDVT in nonagenarians and centenarians with intertrochanteric fracture (IF). METHODS We collected statistics on nonagenarians and centenarians with IF admitting from January 2010 to October 2022. Patients with aDVT were considered as the aDVT group and those without aDVT as the non-aDVT group. Additionally, we also conducted a subgroup analysis based on the location of aDVT to investigate the predictors of proximal aDVT. The demographics, comorbidities and admission laboratory examinations of patients were computed by univariate analysis, logistic regression analysis, and receiver operating characteristic (ROC) curve analysis. RESULTS In our study, the rate of aDVT (109 of 318) was 34.3%, and 5.7% (18 of 318) of patients had proximal aDVT. Logistic regression analysis showed that female patients and a high level of D-dimer were risk factors for aDVT. Similarly, hypoproteinemia and a high level of D-dimer were found to be risk factors for proximal aDVT. ROC curve analysis indicated the cut-off values of D-dimer to predict the aDVT and proximal aDVT were 1.28 mg/L and 1.485 mg/L, respectively. CONCLUSIONS Our findings investigated the risk factors of aDVT and proximal aDVT in nonagenarians and centenarians with IF and identified the cut-off values of D-dimer, helping us assess the risk of aDVT and proximal aDVT to manage early targeted interventions. LEVEL OF EVIDENCE III
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Affiliation(s)
- Tao Wang
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
- Orthopaedic Research Institute of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Shuo Yang
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
- Orthopaedic Research Institute of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Zhiqian Wang
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
- Orthopaedic Research Institute of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Junfei Guo
- Department of Joint Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, People's Republic of China.
| | - Zhiyong Hou
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China.
- Orthopaedic Research Institute of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China.
- NHC Key Laboratory of Intelligent Orthopaedic Equipment (The Third Hospital of Hebei Medical University), Shijiazhuang, People's Republic of China.
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Panagopoulos A, Argyropoulou E, Kokkalis ZT, Parchas N, Tserpes K. Study protocol: biomechanical testing, finite element analysis and prospective, randomized, clinical study of single screw cephalomedullary nailing versus integrated dual interlocking screw fixation for unstable (31A2 1-3) intertrochanteric fractures in patients > 70 years old. J Orthop Surg Res 2023; 18:542. [PMID: 37507795 PMCID: PMC10386776 DOI: 10.1186/s13018-023-04009-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 07/14/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Hip fractures are an increasingly common consequence of falls in older people that are associated with a high risk of death and reduced function. The vast majority of intertrochanteric fractures require surgical treatment to withstand early mobilization and weight bearing, which prevents complications due to prolonged bed rest and aids in fracture healing. METHODS This study is compromised by two parts, the experimental study and the clinical part. In the first part, a standard 130° nail will be used with the appropriate lag screw(s) and dynamic distal locking in synthetic osteoporotic femurs and the transmission of forces in the proximal femur, measured by a cortical surface-strain distribution, will be evaluated using digital image correlation. Finite element parametric models of the bone, the nails and their interface will be also developed. Finite element computations of surface strains in implanted femurs, after being validated against biomechanical testing measurements, will be used to assist the comparison of the nails by deriving important data on the developed stress and strain fields, which cannot be measured through biomechanical testing. In the other part, will set up a prospective, randomized, comparative clinical study among the Gamma3 and IT cephalomedullary nailing, in order to investigate if there are any statistical important differences in the main radiological measurements and functional status in closed unstable intertrochanteric fractures (A21-3) in patients aged over 70 years old at the 24-week follow-up evaluation using patient reported disease-specific outcomes. DISCUSSION This study will be the first to compare clinical, radiological and biomechanical measurements of the two different cephalomedullary nails. Our main hypothesis is that the IT nail would provide better radiological outcome and probably better clinical results than the Gama3 nail. Clinical trial registration International Standard Randomized Controlled Trial Number (ISRCTN): https://doi.org/10.1186/ISRCTN15588442 , registered on 19/4/2022.
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Affiliation(s)
- Andreas Panagopoulos
- Department of Orthopaedics, Patras University Hospital, Medical School, Patras University, Papanikolaou 1, 26504, Rio-Patras, Greece.
| | - Evangelia Argyropoulou
- Department of Orthopaedics, Patras University Hospital, Medical School, Patras University, Papanikolaou 1, 26504, Rio-Patras, Greece
| | - Zinon T Kokkalis
- Department of Orthopaedics, Patras University Hospital, Medical School, Patras University, Papanikolaou 1, 26504, Rio-Patras, Greece
| | - Nicolaos Parchas
- Department of Orthopaedics, Patras University Hospital, Medical School, Patras University, Papanikolaou 1, 26504, Rio-Patras, Greece
| | - Konstantinos Tserpes
- Laboratory of Technology and Strength of Materials, Department of Mechanical Engineering and Aeronautics, University of Patras, Patras, Greece
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Zhou SL, Zhang SY, Si HB, Shen B. Regional versus general anesthesia in older patients for hip fracture surgery: a systematic review and meta-analysis of randomized controlled trials. J Orthop Surg Res 2023; 18:428. [PMID: 37312156 PMCID: PMC10262548 DOI: 10.1186/s13018-023-03903-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 06/02/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND The optimal anesthesia technique for older patients undergoing hip fracture surgery remains controversial. We performed a systematic review and meta-analysis of updated randomized controlled trials (RCTs) to assess whether regional anesthesia was superior to general anesthesia in hip fracture surgery. METHODS We searched PubMed, EMBASE, Web of Science, and the Cochrane Central Register of Controlled Trials from January 2000 until April 2022. RCTs directly comparing regional and general anesthesia in hip fracture surgery were included in the analysis. The incidence of delirium and mortality were the primary outcomes and other perioperative outcomes including complications were secondary outcomes. RESULTS Thirteen studies involving 3736 patients were included in this study. There was no significant difference in the incidence of delirium (odds ratio [OR] 1.09; 95% confidence interval [CI] 0.86, 1.37) and mortality (OR 1.08; 95% CI 0.71, 1.64) between the two groups. Patients receiving regional anesthesia in hip fracture surgery were associated with a reduction in operative time (weighted mean difference [WMD]: - 4.74; 95% CI - 8.85, - 0.63), intraoperative blood loss (WMD: - 0.25; 95% CI - 0.37, - 0.12), postoperative pain score (WMD: - 1.77; 95% CI - 2.79, - 0.74), length of stay (WMD: - 0.10; 95% CI - 0.18, - 0.02), and risk of acute kidney injury (AKI) (OR 0.56; 95% CI 0.36, 0.87). No significant difference was observed in the other perioperative outcomes. CONCLUSIONS For older patients undergoing hip fracture surgery, RA did not significantly reduce the incidence of postoperative delirium and mortality compared to GA. Due to the limitations of this study, the evidence on delirium and mortality was still inconclusive and further high-quality studies are needed.
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Affiliation(s)
- Sheng-Liang Zhou
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guoxue Road, Sichuan Province, 610041, Chengdu, People's Republic of China
| | - Shao-Yun Zhang
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guoxue Road, Sichuan Province, 610041, Chengdu, People's Republic of China
- Department of Orthopedics, The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, Sichuan Province, People's Republic of China
| | - Hai-Bo Si
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guoxue Road, Sichuan Province, 610041, Chengdu, People's Republic of China
| | - Bin Shen
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guoxue Road, Sichuan Province, 610041, Chengdu, People's Republic of China.
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Tian M, Li W, Wang Y, Tian Y, Zhang K, Li X, Zhu Y. Risk factors for perioperative acute heart failure in older hip fracture patients and establishment of a nomogram predictive model. J Orthop Surg Res 2023; 18:347. [PMID: 37165391 PMCID: PMC10170845 DOI: 10.1186/s13018-023-03825-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 05/03/2023] [Indexed: 05/12/2023] Open
Abstract
AIM This study aims to explore the risk factors for perioperative acute heart failure in older patients with hip fracture and establish a nomogram prediction model. METHODS The present study was a retrospective study. From January 2020 to December 2021, patients who underwent surgical treatment for hip fracture at the Third Hospital of Hebei Medical University were included. Heart failure was confirmed by discharge diagnosis or medical records. The samples were randomly divided into modeling and validation cohorts in a ratio of 7:3. Relevant demographic and clinic data of patients were collected. IBM SPSS Statistics 26.0 performed univariate and multivariate logistic regression analysis, to obtain the risk factors of acute heart failure. The R software was used to construct the nomogram prediction model. RESULTS A total of 751 older patients with hip fracture were enrolled in this study, of which 138 patients (18.37%, 138/751) developed acute heart failure. Heart failure was confirmed by discharge diagnosis or medical records. Respiratory disease (odd ratio 7.68; 95% confidence interval 3.82-15.43; value of P 0.001), history of heart disease (chronic heart failure excluded) (odd ratio 2.21, 95% confidence interval 1.18-4.12; value of P 0.010), ASA ≥ 3 (odd ratio 14.46, 95% confidence interval 7.78-26.87; value of P 0.001), and preoperative waiting time ≤ 2 days (odd ratio 3.32, 95% confidence interval 1.33-8.30; value of P 0.010) were independent risk factors of perioperative acute heart failure in older patients with hip fracture. The area under the curve (AUC) of the prediction model based on these factors was calculated to be 0.877 (95% confidence interval 0.836-0.918). The sensitivity and specificity were 82.8% and 80.9%, respectively, and the fitting degree of the model was good. In the internal validation group, the AUC was 0.910, and the 95% confidence interval was 0.869-0.950. CONCLUSIONS Several risk factors are identified for acute heart failure in older patients, based on which pragmatic nomogram prediction model is developed, facilitating detection of patients at risk early.
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Affiliation(s)
- Miao Tian
- Department of Orthopedic Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, 050051 Hebei People’s Republic of China
| | - Wenjing Li
- Department of Orthopedic Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, 050051 Hebei People’s Republic of China
| | - Yan Wang
- Department of Orthopedic Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, 050051 Hebei People’s Republic of China
| | - Yunxu Tian
- Department of Orthopedic Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, 050051 Hebei People’s Republic of China
| | - Kexin Zhang
- Department of Orthopedic Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, 050051 Hebei People’s Republic of China
| | - Xiuting Li
- Department of Orthopedic Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, 050051 Hebei People’s Republic of China
| | - Yanbin Zhu
- Department of Orthopedic Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, 050051 Hebei People’s Republic of China
- Hebei Orthopedic Research Institute, Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, 050051 Hebei People’s Republic of China
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Zhang D, Zhang Y, Yang S, Sun L, Zhang N, Huang S. Relationship between preoperative red blood cell distribution width and postoperative pneumonia in elderly patients with hip fracture: a retrospective cohort study. J Orthop Surg Res 2023; 18:253. [PMID: 36978138 PMCID: PMC10043522 DOI: 10.1186/s13018-023-03732-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 03/18/2023] [Indexed: 03/30/2023] Open
Abstract
OBJECTIVE The relationship between the preoperative red blood cell distribution width and postoperative pneumonia in elderly patients with hip fractures remains unclear. This study investigated whether the preoperative red blood cell distribution width was associated with postoperative pneumonia in elderly patients with hip fractures. METHODS Clinical data of patients with hip fractures in the Department of orthopedics of a hospital from January 2012 to December 2021 were retrospectively analyzed. A generalized additive model was used to identify both linear and nonlinear relationships between red blood cell distribution width and postoperative pneumonia. A two-piecewise linear regression model was used to calculate the saturation effect. Subgroup analyses were performed using stratified logistic regression. RESULTS This study included a total of 1444 patients. The incidence of postoperative pneumonia was 6.30% (91/1444), the mean age of the patients was 77.55 ± 8.75 years, and 73.06% of them (1055/1444) were female. After full adjustment for covariates, the preoperative red blood cell distribution width showed a nonlinear relationship with postoperative pneumonia. The two-piecewise regression model showed an inflection point at 14.3%. On the left side of the inflection point, the incidence of postoperative pneumonia increased by 61% for every 1% increase in red blood cell distribution width (OR: 1.61, 95% CI 1.13-2.31, P = 0.0089). The effect size was not statistically significant on the right side of the inflection point (OR: 0.83, 95% CI 0.61-1.12, P = 0.2171). CONCLUSION The relationship between preoperative red blood cell distribution width and incidence or postoperative pneumonia was nonlinear in elderly patients with hip fractures. The incidence of postoperative pneumonia was positively correlated with red blood cell distribution width when it was < 14.3%. A saturation effect was observed when the red blood cell distribution width reached 14.3%.
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Affiliation(s)
- Daxue Zhang
- School of Nursing, Anhui Medical University, Hefei, China
| | - Yu Zhang
- Department of Orthopedics, Zhejiang Hospital, Hangzhou, China
| | - Shiwei Yang
- School of Nursing, Anhui Medical University, Hefei, China.
- Teaching Office, Shenzhen Second People's Hospital, 3002 Sungang Road West, Futian District, Shenzhen City, 518000, China.
- First Affiliated Hospital of Shenzhen University, Shenzhen, China.
| | - Lixin Sun
- School of Nursing, Anhui Medical University, Hefei, China
| | - Ning Zhang
- School of Nursing, Anhui Medical University, Hefei, China
| | - Shaocai Huang
- Department of Bone and Joint Bone Oncology, Shenzhen Second People's Hospital, Shenzhen, China
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Use of the Heracles straight blade in the treatment of intertrochanteric hip fractures: a prospective study with a 1-year follow-up. Injury 2023; 54:964-969. [PMID: 36509563 DOI: 10.1016/j.injury.2022.11.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 11/11/2022] [Accepted: 11/26/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The treatment of intertrochanteric fractures in the elderly remains challenging for orthopedic surgeons, due to aging, comorbidities, and poor bone quality. The Heracles straight blade has proven a lower rate of cut-out and femoral head displacement in biomechanical studies; however, there are currently no published clinical studies using this nail. PURPOSE To analyze the clinical and radiological results of the Heracles nail with the straight cephalic Heracles blade as a device to treat osteoporotic intertrochanteric fractures of the proximal femur. METHODS A total of 136 patients with trochanteric hip fractures were operated on by the same surgeon, using the Heracles nail with a straight cephalic blade. However, only 86 patients completed the 1-year follow-up both clinically and radiologically. According to the Association of Osteosynthesis classification, 38 patients (44.1%) had 31-A1, 36 patients (41.6%) had 31-A2, and 12 patients (14.1%) had 31-A3. Functional outcomes were assessed according to the Katz and Barthel scores, finding that 58% of patients recovered their original functional level, According to Barthel score, a mean loss of 11.8 points was found. RESULTS The mean hospital stay was 8.22 days (mean preoperative stay of 2.71 days). The mean tip-apex distance was 15.2 mm. During the follow-up, 6 complications (6.96%) were detected: 4 cut-out, 1 cut-in, and 1 nail breakage. According to the Katz score, 58% of the patients recovered their previous functional status and 20.58% needed an additional walking aid. The mean loss in the Barthel score was 11.8 points. CONCLUSION The Heracles nail using a cephalic straight blade has proven to be a valid treatment of trochanteric fractures, due to the functional recovery of the patients and low level of complications.
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Xu H, Liu Y, Sezgin EA, Tarasevičius Š, Christensen R, Raina DB, Tägil M, Lidgren L. Comparative effectiveness research on proximal femoral nail versus dynamic hip screw in patients with trochanteric fractures: a systematic review and meta-analysis of randomized trials. J Orthop Surg Res 2022; 17:292. [PMID: 35658909 PMCID: PMC9164432 DOI: 10.1186/s13018-022-03189-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 05/18/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The treatments for trochanteric fractures try to regain early mobility and limit morbidity and risk of reoperations. The most currently used dynamic hip screw (DHS) and the proximal femoral nail (PFN) are both with pros and cons. We aimed to assess the comparative effectiveness of these interventions for trochanteric fractures by evaluating the surgical performance and postoperative outcomes. METHODS PubMed, Web of Science and Cochrane Central Register were searched for RCTs comparing DHS and PFN for trochanteric fractures. All selected studies and the risk of bias were assessed. Clinical data including operative time, intraoperative blood loss, intraoperative fluoroscopy time, successful closed reduction and complications like nonunion, implant failure and reoperation were recorded. Random-effects models were used in Review Manager software, and GRADE was applied for the interpretation of the evidence. RESULTS From 286 identified trials, twelve RCTs including 1889 patients were eligible for inclusion; six RCTs directly comparing DHS with PFN, while other six compared DHS with proximal femoral nail antirotation (PFNA). Compared to DHS, PFN had shorter operative time and led to less intraoperative blood loss. However, DHS need less intraoperative fluoroscopy time than PFN. No difference was seen for the achievement of closed reduction. For risk of postoperative complications, no difference was seen between PFN and DHS for non-union, risk of implant failure and revision surgery. CONCLUSIONS PFN(A) resulted in a shorter operative time and less intraoperative blood loss compared to DHS. However, no difference was seen for postoperative complications. Trial registration PROSPERO: CRD42021239974.
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Affiliation(s)
- Hong Xu
- Department of Orthopaedics, Xiaoshan Traditional Chinese Medical Hospital, Hangzhou, Zhejiang Province, China.
| | - Yang Liu
- Department of Clinical Sciences Lund, The Faculty of Medicine, Orthopedics, Lund University, Lund, Sweden
| | - Erdem Aras Sezgin
- Department of Orthopaedics&Traumatology, Faculty of Medicine, Aksaray University, Aksaray, Turkey
| | - Šarūnas Tarasevičius
- Department of Orthopedics, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Robin Christensen
- Section for Biostatistics and Evidence-Based Research, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
- Research Unit of Rheumatology, Department of Clinical Research, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Deepak Bushan Raina
- Department of Clinical Sciences Lund, The Faculty of Medicine, Orthopedics, Lund University, Lund, Sweden
| | - Magnus Tägil
- Department of Clinical Sciences Lund, The Faculty of Medicine, Orthopedics, Lund University, Lund, Sweden
| | - Lars Lidgren
- Department of Clinical Sciences Lund, The Faculty of Medicine, Orthopedics, Lund University, Lund, Sweden
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The correlation between cutout and eccentric distance (ED) of the cephalic fixator tip in geriatric intertrochanteric fractures with internal fixation. J Orthop Surg Res 2022; 17:263. [PMID: 35562761 PMCID: PMC9107135 DOI: 10.1186/s13018-022-03153-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 05/01/2022] [Indexed: 11/22/2022] Open
Abstract
Background The location of cephalic fixator tip with different eccentric distance (ED) should have different risks of cutout. This study aims to evaluate the cephalic fixator tip position by measuring ED of the cephalic fixator tip in geriatric ITF patients with single-screw cephalomedullary nail (SCMN) fixation and analyze the correlation between the cutout and the ED. Methods Firstly, we assumed all the femoral head was a regular sphere and standardized the radius of the femoral head (RFD) as “3” no matter how big the RFD was for complete match of the Cleveland zone system and convenient identification of artificial intelligence. Secondly, we measured the ED of the cephalic fixator tip by calculating the distances from the cephalic fixator tip to the geometric central axis of the femoral neck and head on both AP view and lateral view radiographs. Thirdly, we evaluated all the ED of the cephalic fixator tip in the eligible 123 geriatric ITF patients and analyzed the correlation between the cutout and the ED. Results The ED in cutout group (1.25 ± 0.43) is much bigger than that in non-cutout group (0.64 ± 0.34) with significant difference (OR = 50.01, 95% CI 8.42–297.19, p < 0.001). The probability of cutout increased with ED increasing, especially when “ED ≥ 1.” The best cutoff value of ED for predicting cutout was “1.022” (“1.022” was just a little bit more than 1/3 times of RFD because “RFD = 3,” sensitivity = 73.3%, specificity = 86.1%, and AUC = 0.867, p < 0.001). Conclusion ED is suitable for evaluation of the cephalic fixator tip position for predicting cutout in geriatric ITF patients with SCMN fixation, and ED can potentially be used as artificial intelligence application during surgery. The smaller the ED, the lower the cutout rate. For avoiding cutout, the ED of the cephalic fixator tip should be less than one-third times of the radius of the femoral head.
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Total hip arthroplasty compared to bipolar and unipolar hemiarthroplasty for displaced hip fractures in the elderly: a Bayesian network meta-analysis. Eur J Trauma Emerg Surg 2022; 48:2655-2666. [PMID: 35182161 PMCID: PMC9360085 DOI: 10.1007/s00068-022-01905-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 01/29/2022] [Indexed: 11/17/2022]
Abstract
Purpose Displaced femoral neck fractures (FNF) usually require surgical treatment with either a total hip arthroplasty (THA), unipolar hemiarthroplasty (U-HHA), or bipolar hemiarthroplasty (B-HHA). However, there is still controversy regarding the optimal implant. This network meta-analysis compared the outcomes and complication rates of THA versus B-HHA and versus U-HHA in elderly patients with FNF. Material and methods This study was conducted according to the PRISMA extension statement for reporting of systematic reviews, and incorporated network meta-analyses of health care interventions. The literature search was performed in September 2020. All randomized clinical trials comparing two or more of the index surgical interventions for displaced FNF in the elderly were eligible for inclusion. For the Bayesian network meta-analysis, the standardized mean difference (SMD) and Log Odd Ratio (LOR) were used. Results Data from 24 RCTs (2808 procedures) were analysed. The mean follow-up was 33.8 months. The THA group had the longest surgical time (SMD 85.74) and the greatest Harris Hip Score (SMD − 17.31). THA scored similarly in terms of mortality (LOR 3.89), but had lower rates of revision surgeries (LOR 2.24), higher rates of dislocations (LOR 2.60), and lower rates of acetabular erosion (LOR − 0.02). Cementless implants required a shorter surgical duration (− 18.05 min; P = 0.03). Mortality was positively associated with acetabular erosion (P = 0.006), female gender (P = 0.007), revision (P < 0.0001). Conclusion THA led to the highest Harris Hip scores and lowest rate of revision surgery compared to B-HHA and U-HHA. However, B-HHA had the lowest dislocation rate when compared with U-HHA and THA. No significant differences in functional outcomes and complication rates were found between cemented and uncemented implants; however, a tendency for lower mortality, revision and dislocation rates in cemented implants was evidenced. Level of evidence I, Bayesian network meta-analysis of RCTs.
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Migliorini F, Giorgino R, Hildebrand F, Spiezia F, Peretti GM, Alessandri-Bonetti M, Eschweiler J, Maffulli N. Fragility Fractures: Risk Factors and Management in the Elderly. MEDICINA-LITHUANIA 2021; 57:medicina57101119. [PMID: 34684156 PMCID: PMC8538459 DOI: 10.3390/medicina57101119] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 10/05/2021] [Accepted: 10/13/2021] [Indexed: 02/08/2023]
Abstract
Given the progressive ageing of Western populations, the fragility fractures market has a growing socioeconomic impact. Fragility fractures are common in the elderly, negatively impacting their quality of life, limiting autonomy, increasing disability, and decreasing life expectancy. Different causes contribute to the development of a fractures in frail individuals. Among all, targeting fragile patients before the development of a fracture may represent the greatest challenge, and current diagnostic tools suffer from limitations. This study summarizes the current evidence on the management of fragility fractures, discussing risk factors, prevention, diagnosis, and actual limitations of the clinical therapeutic options, putting forward new ideas for further scientific investigation.
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Affiliation(s)
- Filippo Migliorini
- Department of Orthopaedics, Trauma and Reconstructive Surgery, RWTH Aachen University, 52074 Aachen, Germany; (F.M.); (F.H.); (J.E.)
| | - Riccardo Giorgino
- Residency Program in Orthopedics and Traumatology, University of Milan, 20122 Milan, Italy;
| | - Frank Hildebrand
- Department of Orthopaedics, Trauma and Reconstructive Surgery, RWTH Aachen University, 52074 Aachen, Germany; (F.M.); (F.H.); (J.E.)
| | - Filippo Spiezia
- Department of Orthopaedic and Trauma Surgery, Ospedale San Carlo Potenza, Via Potito Petrone, 85100 Potenza, Italy;
| | - Giuseppe Maria Peretti
- Department of Biomedical Sciences for Health, University of Milan, 20133 Milan, Italy;
- IRCCS Orthopedic Institute Galeazzi, 20161 Milan, Italy
| | | | - Jörg Eschweiler
- Department of Orthopaedics, Trauma and Reconstructive Surgery, RWTH Aachen University, 52074 Aachen, Germany; (F.M.); (F.H.); (J.E.)
| | - Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy
- School of Pharmacy and Bioengineering, Keele University Faculty of Medicine, Thornburrow Drive, Stoke-on-Trent ST4 7QB, UK
- Centre for Sports and Exercise Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Mile End Hospital, London E1 4DG, UK
- Correspondence:
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