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Çelen ZE. Predictive value of the systemic immune-inflammation index on one-year mortality in geriatric hip fractures. BMC Geriatr 2024; 24:340. [PMID: 38622572 PMCID: PMC11020614 DOI: 10.1186/s12877-024-04916-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 03/25/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND Geriatric hip fractures are associated with a high incidence of mortality. This study examines the predictive value of the systemic immune-inflammation index (SII) on one-year mortality in elderly hip fracture patients. METHODS A single-center retrospective study was conducted between February 2017 and October 2020. Three hundred and eleven surgically treated consecutive hip fracture patients were included in the study. Admission, postoperative first day, and postoperative fifth-day SII values were calculated. The receiver operating characteristic (ROC) curve was used to calculate the cut-off values, and patients were divided into high and low groups according to these cut-off values. After univariate Cox regression analysis, significant factors were included in the multivariate Cox proportional hazards model to adjust the effect of covariates and explore independent predictive factors associated with mortality. Further subgroup analysis was performed to evaluate the accuracy of the results for different clinical and biological characteristics. RESULTS The mean age was 80.7 ± 8.0 years, and women made up the majority (67.8%) of the patients. The one-year mortality rate was 28.0%. After univariate and multivariate analyses, high postoperative fifth-day SII remained an independent predictor of one-year mortality (adjusted HR 2.16, 95% CI 1.38-3.38, p = 0.001). Older age, male gender, Charlson comorbidity index (CCI) ≥ 2, and hypoalbuminemia were found to be other independent predictors. The optimal cut-off value of the postoperative fifth-day SII was calculated at 1751.9 units (p < 0.001). CONCLUSION The postoperative fifth-day SII is a simple and useful inflammatory biomarker for predicting one-year mortality in patients with hip fracture.
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Affiliation(s)
- Zekeriya Ersin Çelen
- Department of Orthopaedics and Traumatology, Ankara Bilkent City Hospital, Ankara, Turkey.
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Jeong SH, Lee HJ, Kim SH, Park EC, Jang SY. Effect of dementia on all-cause mortality in hip fracture surgery: a retrospective study on a nationwide Korean cohort. BMJ Open 2023; 13:e069579. [PMID: 37173102 DOI: 10.1136/bmjopen-2022-069579] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/15/2023] Open
Abstract
OBJECTIVES We aimed to evaluate the effect of dementia on the 1-year all-cause mortality in elderly patients who underwent hip fracture surgery, using a nationwide cohort in Korea. DESIGN, SETTING, AND PARTICIPANTS This was a nationwide, retrospective study. Elderly patients (≥60 years) with and without dementia who underwent hip fracture surgery between January 2005 and December 2012 were distinguished using the data from the Korean National Health Insurance Service-Senior cohort. INTERVENTIONS None. PRIMARY AND SECONDARY OUTCOME MEASURES The mortality rates with 95% CIs and the impact of dementia on all-cause mortality were calculated using a generalised linear model with Poisson distribution and a multivariable-adjusted Cox proportional hazards model, respectively. RESULTS Among the 10 833 patients who underwent hip fracture surgery, 13.4% were diagnosed with dementia. During the 1-year follow-up period, 1586 patients with hip fracture without dementia died in 8356.5 person-years (incidence rate (IR)=189.2 per 1000 person-years, 95% CI 179.91 to 198.99), while 340 deaths were confirmed in patients with hip fracture with dementia in 1240.8 person-years (IR, 273.1 per 1000 person-years, 95% CI 244.94 to 304.58). Patients with hip fracture and dementia were 1.23 times more likely to die than those in the control group in the same period (HR=1.23, 95% CI 1.09 to 1.39). CONCLUSION Dementia is a risk factor for 1-year all-cause mortality after hip fracture surgery. To improve the postoperative outcomes of patients with dementia who have undergone hip fracture surgery, effective treatment models such as multidisciplinary diagnosis and strategic rehabilitation should be established.
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Affiliation(s)
- Sung Hoon Jeong
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyeon Ji Lee
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
- National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea
| | - Seung Hoon Kim
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
- Department of Preventive Medicine, Eulji University School of Medicine, Daejeon, Republic of Korea
| | - Eun-Cheol Park
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Suk-Yong Jang
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
- Department of Healthcare Management, Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea
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Abeygunasekara T, Lekamwasam S, Lenora J, Alwis G. Quality of Life and Functional Independence of Hip Fracture Patients: Data from a Single Center Follow-Up Study in Sri Lanka. Ann Geriatr Med Res 2021; 25:98-104. [PMID: 34120437 PMCID: PMC8273002 DOI: 10.4235/agmr.21.0016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 06/02/2021] [Indexed: 11/17/2022] Open
Abstract
Background Data on the functional outcomes of hip fracture patients in Sri Lanka are limited. As this information is required for the design of long-term care plans, we assessed the physical activities (activities of daily living [ADL]) and quality of life (QoL) of hip fracture survivors in Sri Lanka. Methods A group of 180 consecutive patients with incident hip fractures admitted to a tertiary care center in Southern Sri Lanka were followed up for 12 months. The Sinhala versions of the Barthel Index, 36-Item Short-Form Survey, and Mini-Mental State Examination were used to assess ADL, QoL, and mental status, respectively. Results Of the 180 patients (149 women), 107 underwent surgery. An initial sharp decline and partial recovery of ADL and QoL were observed among patients with hip fractures. Furthermore, patients who underwent surgical treatment showed faster recovery of ADL and QoL than did patients who were managed conservatively. Similarly, patients who did not have complications during the hospital stay showed faster recovery of ADL and QoL than did patients with one or more complications. Conclusions Hip fractures profoundly affected both ADL and QoL, and recovery remained incomplete at 12 months post fracture. Patients who underwent surgery had a faster recovery than did patients who did not undergo surgery; similarly, patients without complications also had a faster recovery than did those with complications.
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Affiliation(s)
- Thilina Abeygunasekara
- Department of Nursing, Faculty of Allied Health Sciences, University of Ruhuna, Matara, Sri Lanka
| | - Sarath Lekamwasam
- Department of Medicine, Faculty of Medicine, University of Ruhuna, Matara, Sri Lanka
| | - Janaka Lenora
- Department of Physiology, Faculty of Medicine, University of Ruhuna, Matara, Sri Lanka
| | - Gayani Alwis
- Department of Anatomy, Faculty of Medicine, University of Ruhuna, Matara, Sri Lanka
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Metabolic Shock in Elderly Pertrochanteric or Intertrochanteric Surgery. Comparison of Three Surgical Methods. Is there a Much Safer? Rom J Anaesth Intensive Care 2020; 27:17-26. [PMID: 34056129 PMCID: PMC8158320 DOI: 10.2478/rjaic-2020-0016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Introduction Trochanteric fractures are a major trauma in the elderly population and represent a significant part of public health spending. Various fixation devices are used as treatment for these fractures. This study aimed to evaluate three surgical methods in the treatment of pertrochanteric femoral fractures. Materials and methods From January 1, 2013, to December 31, 2014, 86 patients were divided into 3 groups. Fifteen patients were treated with osteosynthesis by reamed intramedullary nailing (RIMN), 15 patients were treated with unreamed intramedullary nailing (UIMN), and 13 patients were treated with dynamic hip screw (DHS) plate osteosynthesis. All patients were >75 years of age. They were evaluated with a clinical radiological follow-up and laboratory examination (LDH, CPK, IL-1-B, IL-8, TNF-α, alpha-1-acid glycoprotein, D-dimer, fibrinogen, ESR, CRP, and procalcitonin). Results IL-8, TNF-α, fibrinogen, D-dimer and alpha-1-acid glycoprotein levels were higher in the DHS group compared with the other two groups at 1 month after surgery (P<0.05). LDH, IL-1β, and IL-6 levels were higher in the DHS group compared with the other two groups at 3 months after surgery (P<0.05). From 3 to 6 months after surgery, the TNF-α level was high in the DHS and RIMN groups (P<0.05). Infection markers did not demonstrate a difference among the 3 groups. Twelve patients died during the 12-month follow-up. Regardless of the method used, morbidity and mortality are linked to enticement and comorbidities rather than surgery within 48 hours after the trauma. Conclusions From our study, we can affirm that the values of cytokines and interleukins observed remain high during the 12-month follow up, regardless of whatever fixation devices or surgery type was performed within 48 hours of injury. Inflammatory markers are higher in patients in the DHS group. This can probably be explained by the fact that DHS technique is performed by open surgery, and this can create a higher inflammation of soft tissue. Mortality is reduced in the first 30 days after surgery if patients are mobilized early. Therefore, mortality in our study population of patients aged >75 years is linked more to the chronic inflammatory state and comorbidities, rather than fixation device or surgical type used. However, future studies are needed to answer further questions that go beyond the scope of our study.
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Bingol O, Ozdemir G, Kulakoglu B, Keskin OH, Korkmaz I, Kilic E. Admission neutrophil-to-lymphocyte ratio and monocyte-to-lymphocyte ratio to predict 30-day and 1-year mortality in geriatric hip fractures. Injury 2020; 51:2663-2667. [PMID: 32739153 DOI: 10.1016/j.injury.2020.07.048] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 07/04/2020] [Accepted: 07/24/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Elderly patients with hip fractures exhibit a high incidence of mortality and morbidity. The aim of this study was to evaluate the factors that may predict mortality in patients with geriatric hip fracture. METHODS Included in this retrospective study were 241 patients who were admitted to the hospital with hip fractures between May 2017 and March 2019. The effect of the modified 5-item frailty index (mFI-5) on 30-day and 1-year mortality was evaluated. In addition, admission neutrophil-to-lymphocyte ratios (NLRs) and monocyte-to-lymphocyte ratios (MLRs) were also examined. RESULTS The mFI-5 was not found to be a statistically significant predictive indicator for 30-day and 1-year mortality (P = 0.485 and P = 0.484, respectively). Chronic obstructive pulmonary disease or current pneumonia was found to increase mortality by 2.702 times (P = 0.002). The 30-day mortality rates of patients aged ≥80 years were significantly higher than those aged 65-79 years (P < 0.05). However, there was no statistical difference in the mortality rates between the age groups after 30 days postoperatively (P = 0.114). Admission NLRs and MLRs were significantly higher in the 30-day and 1-year mortality groups. The cut-off values of the admission NLRs and MLRs for 30-day mortality were calculated as 6.55 and 0.65, respectively, while the same cut-off values for 1-year mortality were calculated as 6.55 and 0.635, respectively. CONCLUSIONS Admission NLRs and MLRs are useful hematological data for the prediction of 30-day and 1-year mortality in geriatric hip fracture patients.
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Affiliation(s)
- Olgun Bingol
- Ankara City Hospital, Orthopaedics and Traumatology Clinic, Cankaya, Ankara, Turkey.
| | - Guzelali Ozdemir
- Ankara City Hospital, Orthopaedics and Traumatology Clinic, Cankaya, Ankara, Turkey
| | - Burak Kulakoglu
- Ankara City Hospital, Orthopaedics and Traumatology Clinic, Cankaya, Ankara, Turkey
| | - Omer Halit Keskin
- Ankara City Hospital, Orthopaedics and Traumatology Clinic, Cankaya, Ankara, Turkey
| | - Izzet Korkmaz
- Ankara City Hospital, Orthopaedics and Traumatology Clinic, Cankaya, Ankara, Turkey
| | - Enver Kilic
- Ankara City Hospital, Orthopaedics and Traumatology Clinic, Cankaya, Ankara, Turkey
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Mallick A, Jehan S, Omonbude D. Outcome of surgery in neck of femur fracture patients with poor pre-fracture mobility. Hip Int 2020; 30:805-809. [PMID: 31578085 DOI: 10.1177/1120700019879107] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Hip fractures are common with a UK incidence of over 70,000 cases and total healthcare costs of over £2 billion per year. Mortality rates of 10% at 30 days and up to 30% at 1-year have been reported. We wanted to assess the outcome of hip fracture surgery in patients with reduced pre-fracture mobility as this has not been exclusively studied previously. METHODS We retrospectively reviewed 168 hip fracture patients with reduced pre-fracture mobility (wheelchair bound, bed bound, walking with 2 aids or a frame) who underwent hip fracture surgery at our institution between 2008 and 2013 using case notes, discharge letters, outpatient clinic letters and laboratory test results. Measured outcomes included 30-day renal, cardiac and respiratory morbidity as well as 30-day and 1-year mortality. RESULTS Our study comprised 27% males and 73% females with a mean age of 82 years. The 30-day chest infection, acute renal failure and acute coronary syndrome rates were 26%, 7.7% and 4% respectively. In those patients who were either wheelchair or bed bound, 30-day and 1-year mortality rates were 11.8% and 52% respectively whereas in those who could mobilise with the help of 2 aids or frame, 30-day and 1-year mortality rates were 4.34% and 39.70% respectively. CONCLUSION Our study highlighted increased 30-day and 1-year morbidity and mortality rates following hip fracture surgery with notable high rates of respiratory and renal complications in patients with reduced pre-fracture mobility. We would recommend pre- and postoperative optimisation with orthogeriatric review, chest physiotherapy and intravenous fluid hydration to reduce complication rates and improve morbidity and mortality.
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Affiliation(s)
- Arijit Mallick
- Hull and East Yorkshire Hospitals NHS Trust, Hull, East Yorkshire, UK
| | - Shah Jehan
- Hull and East Yorkshire Hospitals NHS Trust, Hull, East Yorkshire, UK
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Liu Y, Zhang CW, Zhao XD. Long-term survival of femoral neck fracture patients aged over ninety years: Arthroplasty compared with nonoperative treatment. BMC Musculoskelet Disord 2020; 21:217. [PMID: 32268893 PMCID: PMC7140318 DOI: 10.1186/s12891-020-03249-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 03/27/2020] [Indexed: 02/08/2023] Open
Abstract
Background The aging of the Chinese population is expected to lead to an increase in nonagenarians and centenarians. The mortality rate in nonagenarian hip fracture patients is equivalent to the mortality rate in the average population at 5 years after injury. It is imperative to evaluate 5-year mortality in this small but very challenging subgroup of patients to optimize patient management. The primary purpose of the current retrospective study was to compare five-year survival in patients aged over 90 years who received arthroplasty or nonoperative treatment for femoral neck fracture during a 16-year period. Methods From January 1998 to December 2014, all consecutive nonagenarian and centenarian patients with femoral neck fracture admitted to our hospital were included in the evaluation. The primary outcome was defined as thirty-day, 1-year, 3-year, and 5-year mortality after injury. Survival analysis was performed with the Kaplan-Meier method. Using the log-rank test, stratified analyses were performed to compare differences in the overall cumulative mortality and mortality at three time points (1 year, 3 years, and 5 years) after injury and differences in survival distributions. Results Over the 16-year study period, the arthroplasty group and the nonoperative treatment group included 33 and 53 patients, respectively. The long-term survival probability of the arthroplasty group was significantly higher than that of the nonoperative treatment group (p = 0.002). The survival time of the arthroplasty group was significantly higher than that of the nonoperative treatment group (median (P75-P25) = 53 (59) versus median (P75-P25) = 22 (52), p = 0.001). The mortality differences, except for 30-day mortality, at five time points (1, 2, 3, 4, and 5 years) between the nonoperative group and arthroplasty group were significant. The stratified analyses of overall cumulative mortality and mortality at three time points (1, 3, and 5 years) after injury demonstrated that the nonoperative treatment group had significantly higher cumulative mortality than the arthroplasty group. Conclusions Our study demonstrates that arthroplasty is more likely to improve long-term survival in femoral neck fracture patients aged over 90 years than nonoperative treatment. It can be expected that nearly half of patients will survive more than 5 years after surgery.
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Affiliation(s)
- Yang Liu
- Department of Orthopedic Surgery, National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Wai Nan Guo Xue Lane No. 37, Wuhou District, Chengdu, Sichuan Province, P.R. China, 610041.
| | - Chong-Wei Zhang
- Department of Laboratory Medicine, West China Hospital of Sichuan University, Wai Nan Guo Xue Lane No. 37, Wuhou District, Chengdu, Sichuan Province, P.R. China, 610041
| | - Xiao-Dan Zhao
- Department of Orthopedic Surgery, National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Wai Nan Guo Xue Lane No. 37, Wuhou District, Chengdu, Sichuan Province, P.R. China, 610041
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Souza IAGD, Pereira CCDA, Monteiro AL. Assessment of quality of life using the EQ-5D-3L instrument for hospitalized patients with femoral fracture in Brazil. Health Qual Life Outcomes 2018; 16:194. [PMID: 30249245 PMCID: PMC6154817 DOI: 10.1186/s12955-018-1017-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 09/10/2018] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Quality of life has become a key outcome in assessing the effectiveness of treatments and interventions in health. METHODS Accordingly, this research study aimed to measure quality of life using the EQ-5D-3L instrument for patients from the Jamil Haddad National Institute of Traumatology and Orthopedics (Instituto Nacional de Traumatologia e Ortopedia Jamil Haddad - INTO) with femoral fractures, hospitalized between 11/2015 and 10/2016. RESULTS A total of 165 orthopedic trauma patients with femoral fractures, aged 18 years or older, who were hospitalized and operated upon in the INTO were assessed. The assessment instruments were applied at admission and in the first and second follow-up visits to the outpatient clinic. Most study subjects were women and older than 60 years. Proximal femoral fracture was the most commonly found fracture. The Visual Analog Scale (VAS) assessments over the study period showed an increasing gain in self-assessed quality of life. Similarly, the EQ-5D-3L showed significant improvements in quality of life assessed in the five dimensions of the instrument: mobility, self-care, usual activities, pain/discomfort and anxiety/depression. CONCLUSION This type of assessment may help in decision-making and cost-utility assessments related to orthopedic trauma.
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Affiliation(s)
- Ivanise Arouche Gomes de Souza
- Instituto Nacional de Traumatologia e Ortopedia – INTO, Avenida Brasil n° 500, 9° andar - sala GRISC, São Cristóvão, Rio de Janeiro, RJ CEP: 20940-070 Brazil
| | | | - Andrea Liborio Monteiro
- College of Pharmacy, University of Illinois at Chicago, 833 S. Wood St, Chicago, IL 60612 USA
- Instituto Nacional de Cardiologia, Nucleo de Avaliacao de Tecnologias em Saude, Rua das Laranjeiras 374, Rio de Janeiro, RJ Brazil
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Chiu HC, Chen CM, Su TY, Chen CH, Hsieh HM, Hsieh CP, Shen DL. Dementia predicted one-year mortality for patients with first hip fracture: a population-based study. Bone Joint J 2018; 100-B:1220-1226. [PMID: 30168771 DOI: 10.1302/0301-620x.100b9.bjj-2017-1342.r1] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims We aimed to determine the effect of dementia and Parkinson's disease on one, three and 12-month mortality following surgery for fracture of the hip in elderly patients from an Asian population. Patients and Methods Using a random sample of patients taken from the Taiwan National Health Insurance Research Database, this retrospective cohort study analyzed the data on 6626 elderly patients who sustained a fracture of the hip between 1997 and 2012 who had ICD-9 codes within the general range of hip fracture (820.xx). We used Cox regression to estimate the risk of death associated with dementia, Parkinson's disease or both, adjusting for demographic, clinical, treatment, and provider factors. Results Among 6626 hip fracture patients, 10.20% had dementia alone, 5.60% had Parkinson's disease alone, and 2.67% had both. Corresponding one-year mortality rates were 15.53%, 11.59%, and 15.82%, compared with 9.22% for those without neurological illness. Adjusted hazard ratio for one-year mortality was 1.45 (95% confidence intervals (CI) 1.17 to 1.79) for those with dementia, and 1.57 (95% CI 1.07 to 2.30) with both dementia and Parkinson's disease versus patients with neither. There was no significant association with death for Parkinson's disease alone. Age, male gender and comorbidities were also associated with a higher risk of mortality. Conclusion Dementia, with or without Parkinson's disease, is an independent predictor of mortality following surgery for fractures of the hip. Age, male gender and comorbidities also increase the risk of death. Parkinson's disease alone has no significant effect. Cite this article: Bone Joint J 2018;100-B:1220-6.
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Affiliation(s)
- H-C Chiu
- Research Education and Epidemiology Centre, Changhua Christian Hospital, Changhua, Taiwan, Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, Taiwan, Institute of Hospital Management, Tsinghua University, China, and Department of Health Policy and Management, Bloomberg School of Public Health, John Hopkins University, USA
| | - C-M Chen
- Research Education and Epidemiology Centre, Changhua Christian Hospital, Changhua, Taiwan
| | - T-Y Su
- Center of Cancer Program Development, E-DA Cancer Hospital, Kaohsiung, Taiwan
| | - C-H Chen
- Orthopedic Research Centre, Kaohsiung Medical University; Department of Orthopedics, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - H-M Hsieh
- Department of Public Health, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - C-P Hsieh
- Department of Orthopedic Surgery, Changhua Christian Hospital, Changhua, Taiwan
| | - D-L Shen
- Department of Orthopedic Surgery, Changhua Christian Hospital, Changhua, Taiwan
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Farrow L, Hall A, Wood AD, Smith R, James K, Holt G, Hutchison J, Myint PK. Quality of Care in Hip Fracture Patients: The Relationship Between Adherence to National Standards and Improved Outcomes. J Bone Joint Surg Am 2018; 100:751-757. [PMID: 29715223 DOI: 10.2106/jbjs.17.00884] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Optimizing the perioperative care of patients with a hip fracture is a key health-care priority. We aimed to determine whether adherence to the Scottish Standards of Care for Hip Fracture Patients (SSCHFP) was associated with improved patient outcomes. METHODS In this retrospective cohort study of prospectively collected data from the Scottish National Hip Fracture Audit, we assessed adherence to the SSCHFP in 21 Scottish hospitals over a 9-month period in 2014 and examined the effect of the guidelines on 30 and 120-day mortality, length of hospital stay, and discharge destination. RESULTS A total of 1,162 patients who were ≥50 years old and admitted with a hip fracture were included. There was a significant association between low adherence to the SSCHFP and increased mortality at 30 and 120 days (odds ratio [OR], 3.58 [95% confidence interval (CI), 1.75 to 7.32; p < 0.001] and 2.01 [95% CI, 1.28 to 3.12; p = 0.003], respectively). Low adherence was associated with a reduced likelihood of a short length of stay (OR, 0.58; 95% CI, 0.42 to 0.78; p < 0.0001), but increased odds of discharge to a high-care setting (OR, 1.63; 95% CI, 1.12 to 2.36; p = 0.01). Early physiotherapy input and occupational therapy input were associated with a reduced likelihood of discharge to a high-care setting (OR, 0.64 [95% CI, 0.44 to 0.98; p = 0.04] and 0.34 [95% CI, 0.23 to 0.48; p <0.001], respectively). CONCLUSIONS Adherence to the SSCHFP is associated with better patient outcomes. These findings confirm the clinical utility of the SSCHFP and support their use as a benchmarking tool to improve quality of care for hip fractures. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Luke Farrow
- School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, United Kingdom
| | - Andrew Hall
- School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, United Kingdom.,University Hospital Crosshouse, Kilmarnock, United Kingdom
| | - Adrian D Wood
- School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, United Kingdom
| | - Rik Smith
- NHS National Services Scotland, Edinburgh, United Kingdom
| | - Kate James
- NHS National Services Scotland, Edinburgh, United Kingdom
| | - Graeme Holt
- University Hospital Crosshouse, Kilmarnock, United Kingdom
| | - James Hutchison
- School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, United Kingdom
| | - Phyo K Myint
- School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, United Kingdom
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Kassam AM, Tillotson L, Whitehouse SL, Charity J. The Exeter Trauma Stem: A radiographic follow-up at minimum of five years post implantation. Injury 2017; 48:2773-2777. [PMID: 29031824 DOI: 10.1016/j.injury.2017.09.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 09/11/2017] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The Exeter Trauma Stem (ETS) has been recommended by National Institute of Clinical Excellence (NICE) guidelines in the United Kingdom as a proven, cemented stem. A single laboratory study in the literature has raised possible concerns about the polished finish of the ETS and subsequent potential for accelerated loosening although there is little clinical evidence to support or refute this. METHODS The aim of this study was to assess clinical outcomes of the ETS at a minimum of five years post implantation. Primary outcomes were radiological loosening at a minimum of five years along with survivorship of the implant. Patient demographics were prospectively collected and followed up. RESULTS 218 ETS's (in 214 patients) were implanted from June 2002 until August 2008 in a single centre by a wide variety of surgeons of differing grades. Of these, 16 underwent revision surgery for fracture (2), dislocation (3), infection (1) and acetabular erosion (10) but there were no revisions for aseptic loosening of the implant. There were 64.0% (137/214) patients that had died by the time of this study. Of the remaining patients, 90 had radiographs of their hips at a minimum of 5 years with 36 of these at a minimum of 7 years post implantation. None of these had evidence of loosening. CONCLUSION The ETS is a robust and suitable stem for implantation in patients with hip fractures. There are no clinical suspicions or increased rates of loosening with the ETS in our study. The concerns about surface finish are not borne out in our clinical study which shows no evidence of loosening at a minimum of five years post operation. It confers many advantages including ease of revision and it should continue to be used as per NICE guidelines.
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Affiliation(s)
- A M Kassam
- Exeter Hip Unit, Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter NHS Foundation Trust, Barrack Road, Exeter, EX2 5DW UK
| | - L Tillotson
- Exeter Hip Unit, Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter NHS Foundation Trust, Barrack Road, Exeter, EX2 5DW UK
| | - S L Whitehouse
- Orthopaedic Research Unit, Institute of Health and Biomedical Innovation, Queensland University of Technology, The Prince Charles Hospital, Chermside, Queensland, 4037 Australia
| | - J Charity
- Exeter Hip Unit, Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter NHS Foundation Trust, Barrack Road, Exeter, EX2 5DW UK.
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Jang IY, Lee YS, Jung HW, Chang JS, Kim JJ, Kim HJ, Lee E. Clinical Outcomes of Perioperative Geriatric Intervention in the Elderly Undergoing Hip Fracture Surgery. Ann Geriatr Med Res 2016. [DOI: 10.4235/agmr.2016.20.3.125] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Abstract
Older patients presenting with hip fractures are some of the frailest and sickest patients in hospital. In addition to complex medical problems and comorbidities, they have to overcome the additional physiological challenges posed by the hip fracture itself, and subsequent surgery. Hip fracture associated morbidity and mortality at one year remains high. Published guidelines stress the need for a multidisciplinary approach and the importance of the care environment for good outcomes. A combined management approach identifies and addresses not only the surgical but also the complex analgesic, medical, cognitive, nutritional, social and rehabilitation needs of our patients, thereby improving outcome for our patients.
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Affiliation(s)
- Anna H K Riemen
- Speciality Registrar in Trauma and Orthopaedics, STMTI-Wellcome Trust Clinical Fellow, Regenerative Medicine Group, Arthritis and Musculoskeletal Medicine Programme, University of Aberdeen, Institute of Medical Sciences, Foresterhill, UK. Conflict of interest: none declared
| | - James D Hutchison
- Speciality Registrar in Trauma and Orthopaedics, STMTI-Wellcome Trust Clinical Fellow, Regenerative Medicine Group, Arthritis and Musculoskeletal Medicine Programme, University of Aberdeen, Institute of Medical Sciences, Foresterhill, UK. Conflict of interest: none declared
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Enhanced interdisciplinary care improves self-care ability and decreases emergency department visits for older Taiwanese patients over 2 years after hip-fracture surgery: A randomised controlled trial. Int J Nurs Stud 2016; 56:54-62. [DOI: 10.1016/j.ijnurstu.2015.12.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 11/03/2015] [Accepted: 12/14/2015] [Indexed: 12/29/2022]
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Sutherland AG, Cook A, Miller C, Duncan L, Yuecel R, Heys SD, Hutchison JD, Liversidge J. Older Patients Are Immunocompromised by Cytokine Depletion and Loss of Innate Immune Function After HIP Fracture Surgery. Geriatr Orthop Surg Rehabil 2015; 6:295-302. [PMID: 26623165 PMCID: PMC4647197 DOI: 10.1177/2151458515605564] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE/INTRODUCTION We have examined the immune status of elderly patients who underwent surgery for a hip fracture, an injury associated with poor postoperative outcomes, to identify specific immune defects. METHODS In a cohort observational study, 16 patients undergoing surgery for hip fractures had immune function evaluation prior to surgery, and then at 3 and 7 days postoperatively, using flow cytometry for phenotype and for monocyte and granulocyte phagocytic function and respiratory burst. Serum samples were stored and batch analyzed using a human cytokine 25-plex panel. RESULTS We report significant loss of innate immune function, related specifically to reduced granulocyte numbers by day 7 (P < .0001, flow cytometry; P < .05 white blood cells), and although granulocyte ability to take up opsonized Escherichia coli was increased (P < .05), the ability of those cells to generate a respiratory burst was reduced at days 3 and 7 (P < .05). Monocyte respiratory burst was also significantly reduced (P < .05). Serum cytokine levels indicated very poor T-cell function. CONCLUSION We have demonstrated that the antimicrobial immune response is profoundly reduced after surgery in elderly patients with hip fractures. The effect was sustained up to 7 days postoperatively, identifying these patients as particularly vulnerable to bacterial infections.
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Affiliation(s)
| | - Alistair Cook
- Section of Immunology and Infection, University of Aberdeen, Foresterhill, United Kingdom
| | - Clare Miller
- Division of Applied Medicine, School of Medicine and Dentistry, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, United Kingdom
| | - Linda Duncan
- Division of Applied Medicine, School of Medicine and Dentistry, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, United Kingdom
| | - Raif Yuecel
- Division of Applied Medicine, School of Medicine and Dentistry, Iain Fraser Cytometry Centre, University of Aberdeen, Foresterhill, United Kingdom
| | - Steven D Heys
- Division of Applied Medicine, School of Medicine and Dentistry, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, United Kingdom
| | - James D Hutchison
- Division of Applied Medicine, School of Medicine and Dentistry, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, United Kingdom
| | - Janet Liversidge
- Section of Immunology and Infection, University of Aberdeen, Foresterhill, United Kingdom
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Henzman C, Ong K, Lau E, Seligson D, Roberts CS, Malkani AL. Complication Risk After Treatment of Intertrochanteric Hip Fractures in the Medicare Population. Orthopedics 2015; 38:e799-805. [PMID: 26375538 DOI: 10.3928/01477447-20150902-58] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Accepted: 01/06/2015] [Indexed: 02/03/2023]
Abstract
The study evaluated the incidence of and complications associated with the use of an intramedullary nail vs open reduction and internal fixation (ORIF) with a sliding compression hip screw and plate in treating intertrochanteric fractures. The authors hypothesized that the biomechanically stronger and less invasive intramedullary nail would have superior results and fewer complications compared with ORIF. Patients followed for up to 1 year postoperatively were identified from the 5% nationwide sample of Medicare administrative claims data (1998-2007) using the corresponding International Classification of Diseases, 9th revision, Clinical Modification, codes 820.21 and 820.31. There were 9157 patients treated with intramedullary nails and 27,687 treated with compression screw and plate fixation. Intertrochanteric hip fractures treated with an intramedullary nail during this period increased from 3.3% to 63.1% compared with ORIF. Patients treated with an intramedullary nail had a higher adjusted risk of pulmonary embolism at 90 days (P=.003) and a higher risk of mortality at 1 year (P<.001) compared with those treated with ORIF. Patients who underwent intramedullary nailing during 2006 to 2007 had a lower adjusted risk of conversion to total hip replacement at 1 year (P=.037) compared with those who had ORIF. Over the decade of the study, intramedullary nail usage increased 59.8% compared with ORIF. Increased use of intramedullary nails compared with ORIF has not shown improved outcomes or decreased complications in patients with intertrochanteric hip fractures. The increased use of intramedullary nails for intertrochanteric hip fractures appears to be multifactorial, including the less invasive nature of the surgery and increased experience with the closed surgical technique.
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Witham MD, Band MM, Littleford RC, Avenell A, Soiza RL, McMurdo MET, Sumukadas D, Ogston SA, Lamb EJ, Hampson G, McNamee P. Does oral sodium bicarbonate therapy improve function and quality of life in older patients with chronic kidney disease and low-grade acidosis (the BiCARB trial)? Study protocol for a randomized controlled trial. Trials 2015; 16:326. [PMID: 26231610 PMCID: PMC4522127 DOI: 10.1186/s13063-015-0843-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Accepted: 07/01/2015] [Indexed: 12/24/2022] Open
Abstract
Background Metabolic acidosis is more common with advancing chronic kidney disease, and has been associated with impaired physical function, impaired bone health, accelerated decline in kidney function and increased vascular risk. Although oral sodium bicarbonate is widely used to correct metabolic acidosis, there exist potential risks of therapy including worsening hypertension and fluid overload. Little trial evidence exists to decide whether oral bicarbonate therapy is of net benefit in advanced chronic kidney disease, particularly in older people who are most commonly affected, and in whom physical function, quality of life and vascular health are at least as important outcomes as decline in renal function. Methods/Design BiCARB is a multi-centre, double-blind, placebo controlled, randomised trial evaluating the clinical and cost-effectiveness of oral sodium bicarbonate in the management of older people with chronic kidney disease and severely reduced glomerular filtration rate (GFR) who have a mild degree of metabolic acidosis. The trial will recruit 380 patients from renal, Medicine for the Elderly, and primary care services across centres in the United Kingdom. Male and female patients aged 60 years and older with an estimated glomerular filtration rate of <30 mL/min/1.73 m2, not on dialysis, and with serum bicarbonate concentrations <22 mmol/L will be eligible for participation. The primary clinical outcome for the trial is the between-group difference in the Short Physical Performance Battery score at 12 months. Secondary outcomes include muscle strength, quality of life measured using the EQ-5D score and KDQoL tools, cost effectiveness, renal function, presence of albuminuria and blood pressure. Markers of bone turnover (25-hydroxyvitamin D, 1,25-hydroxyvitamin D, tartrate-resistant acid phosphatase-5b and bone-specific alkaline phosphatase) and vascular health (B-type natriuretic peptide) will be measured. Participants will receive a total of 24 months of either bicarbonate or placebo. The results will provide the first robust test of the overall clinical and cost-effectiveness of this commonly used therapy in older patients with severely reduced kidney function. Trial registration www.isrctn.com; ISRCTN09486651, registered 17 February 2012
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Affiliation(s)
- Miles D Witham
- Medical Research Institute, University of Dundee, Ninewells Hospital, Dundee, DD1 9SY, UK.
| | - Margaret M Band
- Tayside Clinical Trials Unit, University of Dundee / NHS Tayside, Dundee, UK.
| | | | - Alison Avenell
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK.
| | - Roy L Soiza
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK.
| | - Marion E T McMurdo
- Medical Research Institute, University of Dundee, Ninewells Hospital, Dundee, DD1 9SY, UK.
| | - Deepa Sumukadas
- Medical Research Institute, University of Dundee, Ninewells Hospital, Dundee, DD1 9SY, UK.
| | - Simon A Ogston
- Epidemiology and Biostatistics Unit, University of Dundee, Dundee, UK.
| | - Edmund J Lamb
- Department of Clinical Biochemistry, East Kent NHS Trust, Canterbury, UK.
| | - Geeta Hampson
- Department of Chemical Pathology, Guy's and St Thomas' Hospitals, London, UK.
| | - Paul McNamee
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK.
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18
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Stollenwerk B, Bartmus T, Klug F, Stock S, Müller D. Cost-effectiveness of hip protector use on a geriatric ward in Germany: a Markov model. Osteoporos Int 2015; 26:1367-79. [PMID: 25572047 DOI: 10.1007/s00198-014-3008-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 12/15/2014] [Indexed: 10/24/2022]
Abstract
UNLABELLED In this study, we determined the cost-effectiveness of hip protector use compared with no hip protector on a geriatric ward in Germany. From both the societal and the statutory health insurance (SHI) perspectives, the cost-effectiveness ratios for the provision of hip protectors were below <euro>12,000/quality-adjusted life year (QALY) even if unrelated costs in added life years were included. INTRODUCTION The aim of this study is to determine the cost-effectiveness of the provision of hip protectors compared with no hip protectors on a geriatric ward in Germany. METHODS A lifetime decision-analytic Markov model was developed. Costs were measured from the societal and from the statutory health insurance (SHI) perspectives and comprised direct medical, non-medical and unrelated costs in additional life years gained. Health outcomes were measured in terms of quality-adjusted life years (QALYs). To reflect several levels of uncertainty, first- and second-order Monte Carlo simulation (MCS) approaches were applied. RESULTS Hip protector use compared with no hip protector results in savings (costs, -5.1/QALYs, 0.003) for the societal perspective. For the SHI perspective, the incremental cost-effectiveness ratio was <euro>4416 <euro>/QALY (costs, +13.4). If unrelated costs in life years gained were included, the cost-effectiveness ratio increases to <euro>9794/QALY for the societal perspective and to <euro>11,426/QALY for the SHI perspective. In the MCS, for the societal perspective without unrelated costs, 47 % of simulations indicated hip protectors to be cost saving (i.e. lower costs and higher effects). CONCLUSION Although the gain in QALYs due to the provision of providing hip protectors to patients on geriatric wards is small, all scenarios showed acceptable cost-effectiveness ratios or even savings.
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Affiliation(s)
- B Stollenwerk
- Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Health Economics and Health Care Management, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany,
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Khan SK, Rushton SP, Shields DW, Corsar KG, Refaie R, Gray AC, Deehan DJ. The risk of cardiorespiratory deaths persists beyond 30 days after proximal femoral fracture surgery. Injury 2015; 46:358-62. [PMID: 24650942 DOI: 10.1016/j.injury.2014.02.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Revised: 02/09/2014] [Accepted: 02/16/2014] [Indexed: 02/02/2023]
Abstract
INTRODUCTION 30-day mortality is routinely used to assess proximal femoral fracture care, though patients might remain at risk for poor outcome for longer. This work has examined the survivorship out to one year of a consecutive series of patients admitted for proximal femoral fracture to a single institution. We wished to quantify the temporal impact of fracture upon mortality, and also the influence of patient age, gender, surgical delay and length of stay on mortality from both cardiorespiratory and non-cardiorespiratory causes. PATIENTS AND METHODS Data were analysed for 561 consecutive patients with 565 fragility type proximal femoral fractures treated surgically at our trauma unit. Dates and causes of death were obtained from death certificates and also linked to data from the Office of National Statistics. Mortality rates and causes were collated for two time periods: day 0-30, and day 31-365. RESULTS Cumulative incidence analysis showed that mortality due to cardiorespiratory causes (pneumonia, myocardial infarction, cardiac failure) rose steeply to around 100 days after surgery and then flattened reaching approximately 12% by 1 year. Mortality from non-cardiorespiratory causes (kidney failure, stroke, sepsis etc.) was more progressive, but with a rate half of that of cardiorespiratory causes. Progressive modelling of mortality risks revealed that cardiorespiratory deaths were associated with advancing age and male gender (p<0.001 for both), but the effect of age declined after 100 days. Non-cardiorespiratory deaths were not time-dependent. CONCLUSION We believe this analysis extends our understanding of the temporal impact of proximal femoral fracture and its surgical management upon outcome beyond the previously accepted standard (30 days) and supports the use of a new, more relevant timescale for this high risk group of patients. It also highlights the need for planning and continuing physiotherapy, respiratory exercises and other chest-protective measures from 31 to 100 days.
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Affiliation(s)
- Sameer K Khan
- Royal Victoria Infirmary, Newcastle upon Tyne University Hospitals NHS Trust, Newcastle upon Tyne, United Kingdom.
| | - Stephen P Rushton
- School of Biology, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - David W Shields
- Royal Victoria Infirmary, Newcastle upon Tyne University Hospitals NHS Trust, Newcastle upon Tyne, United Kingdom
| | - Kenneth G Corsar
- Royal Victoria Infirmary, Newcastle upon Tyne University Hospitals NHS Trust, Newcastle upon Tyne, United Kingdom
| | - Ramsay Refaie
- Royal Victoria Infirmary, Newcastle upon Tyne University Hospitals NHS Trust, Newcastle upon Tyne, United Kingdom
| | - Andrew C Gray
- Royal Victoria Infirmary, Newcastle upon Tyne University Hospitals NHS Trust, Newcastle upon Tyne, United Kingdom
| | - David J Deehan
- Royal Victoria Infirmary, Newcastle upon Tyne University Hospitals NHS Trust, Newcastle upon Tyne, United Kingdom
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20
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Gumieiro DN, Murino Rafacho BP, Buzati Pereira BL, Cavallari KA, Tanni SE, Azevedo PS, Polegato BF, Mamede Zornoff LA, Dinhane DI, Innocenti Dinhane KG, Cação Pereira GJ, de Paiva SAR, Minicucci MF. Vitamin D serum levels are associated with handgrip strength but not with muscle mass or length of hospital stay after hip fracture. Nutrition 2014; 31:931-4. [PMID: 26015388 DOI: 10.1016/j.nut.2014.12.022] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 12/11/2014] [Accepted: 12/20/2014] [Indexed: 12/21/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the association between serum levels of 25(OH) vitamin D3 with midupper arm muscle circumference (MUAMC), handgrip strength and length of hospital stay (LOS) after hip fracture. METHODS In total, 102 consecutive patients with hip fracture over the age of 65 were admitted to the orthopedic unit and prospectively evaluated. All of the patients were treated according to specific protocols depending on the type of fracture. Anthropometric measurements and handgrip strength were performed, and blood samples were taken for serum biochemistry and 25(OH) vitamin D3 analysis within the first 72 h of admission. All of the patients were followed during their hospital stay, and the length of stay was recorded. RESULTS Of the patients, two were excluded because of pathologic fractures. In total, 100 patients with a mean age of 80 ± 7 y were included in the analysis. Among these patients, 73% were female, and 37% had vitamin D deficiency. The median LOS was 7 (5-11) d. Patients with vitamin D deficiency had lower handgrip strength in univariate analysis. In the multiple linear regression analysis with robust standard error, serum vitamin D levels adjusted by age and sex were associated with handgrip strength but not with MUAMC and LOS after hip fracture. CONCLUSIONS In conclusion, vitamin D serum levels were associated with handgrip strength but not with muscle mass or length of hospital stay after hip fracture.
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Affiliation(s)
- David Nicoletti Gumieiro
- Surgery and Orthopedic Department, Botucatu Medical School, UNESP - Univ Estadual Paulista, Botucatu, Brazil
| | | | | | - Karelin Alvisi Cavallari
- Internal Medicine Department, Botucatu Medical School, UNESP - Univ Estadual Paulista, Botucatu, Brazil
| | - Suzana Erico Tanni
- Internal Medicine Department, Botucatu Medical School, UNESP - Univ Estadual Paulista, Botucatu, Brazil
| | - Paula Schmidt Azevedo
- Internal Medicine Department, Botucatu Medical School, UNESP - Univ Estadual Paulista, Botucatu, Brazil
| | - Bertha Furlan Polegato
- Internal Medicine Department, Botucatu Medical School, UNESP - Univ Estadual Paulista, Botucatu, Brazil
| | | | - Daniel Innocenti Dinhane
- Surgery and Orthopedic Department, Botucatu Medical School, UNESP - Univ Estadual Paulista, Botucatu, Brazil
| | | | - Gilberto José Cação Pereira
- Surgery and Orthopedic Department, Botucatu Medical School, UNESP - Univ Estadual Paulista, Botucatu, Brazil
| | | | - Marcos Ferreira Minicucci
- Internal Medicine Department, Botucatu Medical School, UNESP - Univ Estadual Paulista, Botucatu, Brazil.
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21
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Gu Q, Koenig L, Mather RC, Tongue J. Surgery for hip fracture yields societal benefits that exceed the direct medical costs. Clin Orthop Relat Res 2014; 472:3536-46. [PMID: 25091223 PMCID: PMC4182375 DOI: 10.1007/s11999-014-3820-6] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 07/14/2014] [Indexed: 01/31/2023]
Abstract
BACKGROUND A hip fracture is a debilitating condition that consumes significant resources in the United States. Surgical treatment of hip fractures can achieve better survival and functional outcomes than nonoperative treatment, but less is known about its economic benefits. QUESTIONS/PURPOSES We asked: (1) Are the societal benefits of hip fracture surgery enough to offset the direct medical costs? (2) Nationally, what are the total lifetime benefits of hip fracture surgery for a cohort of patients and to whom do these benefits accrue? METHODS We estimated the effects of surgical treatment for displaced hip fractures through a Markov cohort analysis of patients 65 years and older. Assumptions were obtained from a systematic literature review, analysis of Medicare claims data, and clinical experts. We conducted a series sensitivity analyses to assess the effect of uncertainty in model parameters on our estimates. We compared costs for medical care, home modification, and long-term nursing home use for surgical and nonoperative treatment of hip fractures to estimate total societal savings. RESULTS Estimated average lifetime societal benefits per patient exceeded the direct medical costs of hip fracture surgery by USD 65,000 to USD 68,000 for displaced hip fractures. With the exception of the assumption of nursing home use, the sensitivity analyses show that surgery produces positive net societal savings with significant deviations of 50% from the base model assumptions. For an 80-year-old patient, the breakeven point for the assumption on the percent of patients with hip fractures who would require long-term nursing home use with nonoperative treatment is 37% to 39%, compared with 24% for surgical patients. Nationally, we estimate that hip fracture surgery for the cohort of patients in 2009 yields lifetime societal savings of USD 16 billion in our base model, with benefits and direct costs of USD 21 billion and USD 5 billion, respectively. For an 80-year-old, societal benefits ranged from USD 2 billion to USD 32 billion, using our range of estimates for nursing home use among nonoperatively treated patients who are immobile after the fracture. CONCLUSIONS Surgical treatment of hip fractures produces societal savings. Although the magnitude of these savings depends on model assumptions, the finding of societal savings is robust to a range of parameter values. LEVEL OF EVIDENCE Level III, economic and decision analyses. See the Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Qian Gu
- Econometrica, Inc, Bethesda, MD USA
| | - Lane Koenig
- KNG Health Consulting LLC, 15245 Research Blvd, Suite 305, Rockville, MD 20850 USA
| | | | - John Tongue
- Oregon Health and Science University, Tualatin, OR USA
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Kassam AA, Griffiths S, Higgins G. Historical implant or current best standard? Minimum five year follow-up outcomes of cemented Thompson hemiarthroplasties. J Arthroplasty 2014; 29:1745-8. [PMID: 24890999 DOI: 10.1016/j.arth.2014.04.032] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 04/08/2014] [Accepted: 04/27/2014] [Indexed: 02/01/2023] Open
Abstract
UK NICE guidelines recommend abandoning the Thompson hemiarthroplasty (TH) in favour of a 'proven prosthesis' such as the Exeter Trauma Stem. The aim of this study was to assess the hip fracture treatment with the TH. Between 2002 and 2006, 430 cemented THs were performed (minimum 5 year follow-up). Death rates at 1 year and 5 years were 26.6% and 67.4% with low complication (Dislocation 1.4%) and revision rate (1.2%). The TH remains a reliable and proven implant in appropriate patients (over the age of 80, with low activity levels, low ambulatory status and who maybe cognitively impaired), due to low complication and revision rates. Modern implants may provide better function or longevity, but there is little evidence to support abandoning the TH.
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Affiliation(s)
- Al-Amin Kassam
- Department of Trauma and Orthopaedics, Torbay Hospital, South Devon NHS Foundation, Trust, Lawes Bridge, Torquay, TQ2 7AA
| | - Shelley Griffiths
- Department of Trauma and Orthopaedics, Torbay Hospital, South Devon NHS Foundation, Trust, Lawes Bridge, Torquay, TQ2 7AA
| | - Gordon Higgins
- Department of Trauma and Orthopaedics, Torbay Hospital, South Devon NHS Foundation, Trust, Lawes Bridge, Torquay, TQ2 7AA
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Risk analysis for second hip fracture in patients after hip fracture surgery: a nationwide population-based study. J Am Med Dir Assoc 2014; 15:725-31. [PMID: 25017390 DOI: 10.1016/j.jamda.2014.05.010] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 05/16/2014] [Accepted: 05/19/2014] [Indexed: 11/23/2022]
Abstract
OBJECTIVES The current treatment program for fragility hip fractures (HFx) emphasizes a combination of early surgery, rehabilitation, and tertiary prevention strategy for osteoporosis; however, the effect is unclear and little information is available on the risk factors predicting the occurrence of a second hip fracture (SHFx). The aim of this study was to explore the incidence, risk factors, and subsequent mortality of SHFx in patients after their first hip fracture surgery (HFxS). DESIGN, SETTING, AND PARTICIPANTS We performed a nationwide population-based longitudinal observational study using the National Health Insurance Research Database (NHIRD) of Taiwan with a logistic regression model analysis. Of 87,415 patients undergoing HFxS during the period 2004 to 2007, we identified 8027 patients who had sustained an SHFx for analyses. MEASUREMENTS Data collected included patient characteristics (demographics, comorbidities, and concurrent medication use), incidence and hazard ratios of SHFx after HFxS, and subsequent age-specific mortality. RESULTS The overall incidence of SHFx was 9.18% and the age-specific mortality was increased 1.6- to 2.2-fold in patients with SHFx compared with those without after HFxS in this 7-year longitudinal study. The identified risk factors included age (AOR = 1.84, 95% CI: 1.24-2.89), female gender (AOR = 1.12, 95% CI: 1.03-2.30), obesity (AOR = 2.89, 95% CI: 1.81-3.01), diabetes (AOR = 3.85, 95% CI: 2.54-4.05), arterial hypertension (AOR = 2.45, 95% CI: 1.83-2.62), hyperlipidemia (AOR = 2.77, 95% CI: 1.27-3.19), stroke/TIA (AOR = 2.85, 95% CI: 2.20-3.23), blindness/low vision (AOR = 3.09, 95% CI: 2.54-3.73), and prolonged use of analgesics and anti-inflammatory medications (all AOR ≥ 3.05, all P values ≤.012). Bisphosphonate therapy after HFxS had a significant negative risk association with the development of an SHFx (20.8% vs 32.3%, P = .023; AOR = 2.24, 95% CI: 1.38-2.90). CONCLUSION We concluded that the occurrence of an SHFx and subsequent mortality in patients after HFxS is rather high. An understanding of the risk factors predicting the occurrence of an SHFx provides a valuable basis to improve health care for geriatric populations.
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Omsland TK, Emaus N, Tell GS, Magnus JH, Ahmed LA, Holvik K, Center J, Forsmo S, Gjesdal CG, Schei B, Vestergaard P, Eisman JA, Falch JA, Tverdal A, Søgaard AJ, Meyer HE. Mortality following the first hip fracture in Norwegian women and men (1999-2008). A NOREPOS study. Bone 2014; 63:81-6. [PMID: 24607943 DOI: 10.1016/j.bone.2014.02.016] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Revised: 02/24/2014] [Accepted: 02/25/2014] [Indexed: 10/25/2022]
Abstract
Hip fractures are associated with increased mortality and their incidence in Norway is one of the highest worldwide. The aim of this nationwide study was to examine short- and long-term mortality after hip fractures, burden of disease (attributable fraction and potential years of life lost), and time trends in mortality compared to the total Norwegian population. Information on incident hip fractures between 1999 and 2008 in all persons aged 50 years and older was collected from Norwegian hospitals. Death and emigration dates of the hip fracture patients were obtained through 31 December 2010. Standardized mortality ratios (SMRs) were calculated and Poisson regression analyses were used for the estimation of time trends in SMRs. Among the 81,867 patients with a first hip fracture, the 1-year excess mortality was 4.6-fold higher in men, and 2.8-fold higher in women compared to the general population. Although the highest excess mortality was observed during the first two weeks post fracture, the excess risk persisted for twelve years. Mortality rates post hip fracture were higher in men compared to women in all age groups studied. In both genders aged 50 years and older, approximately 5% of the total mortality in the population was related to hip fractures. The largest proportion of the potential life-years lost was in the relatively young-old, i.e. less than 80 years. In men, the 1-year absolute mortality rates post hip fracture declined significantly between 1999 and 2008, by contrast, the mortality in women increased significantly relatively to the population mortality.
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Affiliation(s)
- Tone K Omsland
- Department of Global Public Health and Primary Care, University of Bergen, Norway; Institute of Health and Society, Department of Community Medicine, University of Oslo, Norway; Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway.
| | - Nina Emaus
- Department of Health and Care Sciences, University of Tromsø, Norway
| | - Grethe S Tell
- Department of Global Public Health and Primary Care, University of Bergen, Norway
| | - Jeanette H Magnus
- Institute of Health and Society, Department of Community Medicine, University of Oslo, Norway
| | - Luai Awad Ahmed
- Department of Health and Care Sciences, University of Tromsø, Norway
| | - Kristin Holvik
- Department of Global Public Health and Primary Care, University of Bergen, Norway; Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway
| | - Jacqueline Center
- Osteoporosis and Bone Biology Program, Garvan Institute of Medical Research, Sydney, NSW, Australia; Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Siri Forsmo
- Institute of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Clara G Gjesdal
- Department of Rheumatology, Haukeland University Hospital, Bergen, Norway; Department of Clinical Science, Faculty of Medicine and Dentistry, University of Bergen, Norway
| | - Berit Schei
- Institute of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Obstetrics and Gynecology, St. Olav's University Hospital, Trondheim, Norway
| | | | - John A Eisman
- Osteoporosis and Bone Biology Program, Garvan Institute of Medical Research, Sydney, NSW, Australia; Clinical Translation and Advanced Education, Garvan Institute of Medical Research, Sydney, NSW, Australia; Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia; School of Medicine Sydney, University of Notre Dame Australia, Sydney, NSW, Australia
| | - Jan A Falch
- Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway
| | - Aage Tverdal
- Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway
| | | | - Haakon E Meyer
- Institute of Health and Society, Department of Community Medicine, University of Oslo, Norway; Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway
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Hung LW, Tseng WJ, Huang GS, Lin J. High short-term and long-term excess mortality in geriatric patients after hip fracture: a prospective cohort study in Taiwan. BMC Musculoskelet Disord 2014; 15:151. [PMID: 24886144 PMCID: PMC4020382 DOI: 10.1186/1471-2474-15-151] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Accepted: 04/30/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hip fracture has a high mortality rate, but the actual level of long-term excess mortality and its impact on population-wide mortality remains controversial. The present prospective study investigated short- and long-term excess mortality after hip fractures with adjustment of other risk factors. We calculated the population attributable risk proportion (PARP) to assess the impact of each risk factor on excess mortality. METHODS We recruited 217 elders with hip fractures and 215 age- and sex-matched patients without fractures from the geriatric department of the same hospital. The mean follow-up time was 46.1 months (range: 35 to 57 months). We recorded data on 55 covariates, including baseline details about health, function, and bone mineral density. We used the multivariate Cox proportional hazards model to analyze hazard ratios (HRs) of short-term (<12 months follow-up) and long-term (≧ 2 months follow-up) excess mortality for each covariate and calculated their PARP. RESULTS Patients with hip fractures had a higher short-term mortality than non-fractured patients, and the long-term excess mortality associated with hip fracture remained high. The significant risk factors for short-term mortality were hip fracture, comorbidities, and lower (below cutoff) Mini Mental State Examination score with HRs of 2.4, 2.3, and 2.3, respectively. Their PARPs were 44.7%, 38.1%, and 34.3%, respectively. The significant risk factors for long-term mortality were hip fracture (HR: 2.7; PARP: 48.0%), lower T-score (HR: 3.3; PARP: 36.2%), lower body mass index (HR: 2.5; PARP: 42.8%), comorbidities (HR: 2.1; PARP: 34.8%), difficulty in activities of daily living (HR: 1.9; PARP: 31.8%), and smoking (HR: 2.5; PARP: 19.2%). CONCLUSIONS After comprehensive adjustment, hip fracture was a significant risk factor and contributed the most to long-term as well as short-term excess mortality. Its adequate prevention and treatment should be targeted.
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Affiliation(s)
| | | | | | - Jinn Lin
- Department of Orthopedic Surgery, National Taiwan University Hospital, Taipei, Taiwan, No,7 Chung-Shan S, Rd, Taipei, Taiwan, 100.
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Graham J, Bowen TR, Strohecker KA, Irgit K, Smith WR. Reducing mortality in hip fracture patients using a perioperative approach and "Patient- Centered Medical Home" model: a prospective cohort study. Patient Saf Surg 2014; 8:7. [PMID: 24490635 PMCID: PMC3914378 DOI: 10.1186/1754-9493-8-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Accepted: 01/22/2014] [Indexed: 11/16/2022] Open
Abstract
Background Hip fracture patients experience high morbidity and mortality rates in the first post-operative year after discharge. We compared mortality, utilization, costs, pain and function between two prospective cohorts of hip fracture patients, both managed with identical perioperative protocols and one group subsequently managed via a “Patient-Centered Medical Home” (PCMH) primary care management model. Methods We analyzed 6 and 12-month outcomes from two matched cohorts of patients who were surgically treated for hip fracture from January 1, 2010 to June 30, 2011 at two hospitals (n = 194). Controls did not receive PCMH and were matched to cases on surgery date, sex, age, and comorbidities. Mortality and healthcare utilization were the primary outcomes studied, with medical costs, quality of life, pain and function at 12 months assessed as secondary outcomes in a subgroup. Survival analysis, regression and Student-t testing were used with p < 0.05 considered significant. Results At 6 months, PCMH patients had significantly lower mortality than patients receiving standard care (11% vs. 26%, p < 0.01). At 12 months, a difference persisted (23% vs. 30%, p = 0.12) but was no longer statistically significant. Mean quality of life scores were similar (0.73 vs. 0.76, p = 0.49) and Harris Hip score was slightly improved for PCMH (73 vs. 64, p = 0.04). Mean costs per patient per month were lower for PCMH but not significantly different ($69 vs. $141, p = 0.20 for pharmacy costs; $1212 vs. $1452, p = 0.45 for non-pharmacy costs). Conclusions Patients receiving aggressive post-discharge care from a PCMH program showed significant benefits in terms of reduced mortality at 6 months, with similar costs and functional outcomes at 12 months. PCMH was not shown to improve all outcomes studied, but these results suggest that ongoing Medical Home management can have some benefit for patients without negatively impacting function or cost.
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Affiliation(s)
- Jove Graham
- Geisinger Center for Health Research, 100 N, Academy Ave,, Danville PA 17822, USA.
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Devlin H, Whelton C. Can mandibular bone resorption predict hip fracture in elderly women? A systematic review of diagnostic test accuracy. Gerodontology 2013; 32:163-8. [PMID: 24128044 DOI: 10.1111/ger.12077] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The aim of this systematic review was to determine the diagnostic accuracy of the mandibular cortical width measurements and porosity in detecting hip osteoporosis. BACKGROUND All of the included studies used measurements on panoramic radiographs. MATERIALS AND METHODS Studies were included if they compared the radiographic measurements (or index tests) with central dual energy X-ray absorptiometry (DXA) of the hip as the reference standard. A measure of diagnostic accuracy such as sensitivity and specificity or area under the receiver operating characteristic curve was also required for inclusion. RESULTS Seven studies were identified. Meta-analysis was not possible because of the heterogeneity of the studies. The studies all demonstrated moderate diagnostic accuracy. CONCLUSION If a patient with a thin or porous mandibular cortex is identified by a chance radiographic finding, additional clinical risk factors need to be considered and the patient referred for further investigation with DXA where necessary.
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Affiliation(s)
- Hugh Devlin
- School of Dentistry, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
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Finnes TE, Meyer HE, Falch JA, Medhus AW, Wentzel-Larsen T, Lofthus CM. Secular reduction of excess mortality in hip fracture patients >85 years. BMC Geriatr 2013; 13:25. [PMID: 23496953 PMCID: PMC3610125 DOI: 10.1186/1471-2318-13-25] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Accepted: 03/05/2013] [Indexed: 11/14/2022] Open
Abstract
Background More than 20% of the hip fracture patients die within the first year after the incident. Few data are available on the trends in mortality following a hip fracture. The present aim was to study changes in excess mortality after hip fracture from 1978/79 up to 1996/97. Methods Data on 5180 hip fracture patients aged ≥ 50 years, identified in three earlier, well validated, incidence studies from Oslo were used. The studies took place in the two years periods 1978–79 and 1989–89 and in a one year period from 1st of May 1996 to 30th of April 1997. The study was designed as a historic cohort study. Exposure was sustaining a hip fracture in the registration periods. Outcome was death of all causes. Age- and sex-specific one year-mortality rates were provided by Statistics Norway. Standardized mortality ratios (SMR) were calculated for the three cohorts for each sex and age-group, for the 0–6 months, 6–12 months, 0–1 year, 1–5 years and 5–10 years intervals after fracture. To assess the duration of the excess mortality in hip fracture patients, time-framed Kaplan-Meier curves for consecutive 5-years intervals were conducted for the hip fracture patients and the corresponding background population. Only patients still alive at the start of the time interval were included. One sample log rank tests were used to test for statistical significance. Results The one-year SMR ranged from 3.64 (2.82 – 4.61) to 4.53 (3.67 – 5.54) in men and from 2.78 (2.39 – 3.19) to 3.60 (3.19 – 4.05) in women. In the 0–6 months interval a reduction in SMR from 1978/79 to 1996/97 was observed in women aged ≥85 years. The duration of excess mortality ranged from two years in men ≥85 years to more than ten years in men and women aged 65–84 years. Conclusion Excess mortality among hip fracture patients remains high. Over the decades, a reduced excess mortality was mainly seen in the oldest patients, suggesting that specific efforts intending to improve prevention and treatment of osteoporosis and osteoporotic fractures in the youngest elderly are required.
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Affiliation(s)
- Trine E Finnes
- Department of Internal Medicine, Innlandet Hospital Trust, Skolegata 32, Hamar, N-2318, Norway.
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Identifying clinically relevant groups of hip fracture patients at risk of adverse outcomes by using classification tree analysis. Int J Orthop Trauma Nurs 2013. [DOI: 10.1016/j.ijotn.2012.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Petheram TG, Bone M, Joyce TJ, Serrano-Pedraza I, Reed MR, Partington PF. Surface finish of the Exeter Trauma Stem. Bone Joint J 2013; 95-B:173-6. [DOI: 10.1302/0301-620x.95b1.31001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Recent guidance recommends the use of a well-proven cemented femoral stem for hemiarthroplasty in the management of fractures of the femoral neck, and the Exeter Trauma Stem (ETS) has been suggested as an example of such an implant. The design of this stem was based on the well-proven Exeter Total Hip Replacement stem (ETHRS). This study assessed the surface finish of the ETS in comparison with the ETHRS. Two ETSs and two ETHRSs were examined using a profilometer with a precision of 1 nm and compared with an explanted Exeter Matt stem. The mean roughness average (RA) of the ETSs was approximately ten times higher than that of the ETHRSs (0.235 μm (0.095 to 0.452) versus 0.025 μm (0.011 to 0.059); p < 0.001). The historical Exeter Matt stem roughness measured a mean RA of 0.973 μm (0.658 to 1.159). The change of the polished Exeter stem to a matt surface finish in 1976 resulted in a high stem failure rate. We do not yet know whether the surface differences between ETS and ETHRS will be clinically significant. We propose the inclusion of hemiarthroplasty stems in national joint registries. Cite this article: Bone Joint J 2013;95-B:173–6.
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Affiliation(s)
- T. G. Petheram
- Wansbeck General Hospital, Woodhorn
Lane, Ashington, Northumberland
NE63 9JJ, UK
| | - M. Bone
- Newcastle University, Claremont
Road, Newcastle upon Tyne NE1 1RU, UK
| | - T. J. Joyce
- Newcastle University, Claremont
Road, Newcastle upon Tyne NE1 1RU, UK
| | - I. Serrano-Pedraza
- Complutense University of Madrid, Campus
De Somosaguas, Madrid 28223, Spain
| | - M. R. Reed
- Wansbeck General Hospital, Woodhorn
Lane, Ashington, Northumberland
NE63 9JJ, UK
| | - P. F. Partington
- Wansbeck General Hospital, Woodhorn
Lane, Ashington, Northumberland
NE63 9JJ, UK
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Biochemical lung, liver and kidney markers and early death among elderly following hip fracture. Arch Orthop Trauma Surg 2012; 132:1753-8. [PMID: 22996053 DOI: 10.1007/s00402-012-1611-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Indexed: 02/09/2023]
Abstract
INTRODUCTION In the elderly, hip fracture is a common injury associated with high early mortality dominated by cardiorespiratory and thromboembolic events. Identification of risk factors that can be modified by treatment has caught attention over the last years. This study was conducted to assess biological markers on perioperative organ dysfunction and its association with early mortality within 3 months after surgery. METHOD Blood samples were collected before, during and until 4 days after surgery. Analyses on PaO(2), alanine aminotransaminase (ALAT), gamma-glutamyl transpeptidase (g-GT) and creatinine were performed and used as markers on lung, liver and kidney functions. PATIENTS Three hundred and two patients over 75 years of age with acute dislocated hip fracture were consecutively enrolled from two hospitals in Norway. RESULTS We found a positive correlation between the plasma levels of ALAT, creatinine and death, and an inverse relationship between PaO(2) and death. After controlling for confounding factors such as sex, age and comorbidity, ALAT and creatinine levels were shown to be significantly and independently related to risk for fatal outcome. CONCLUSION Our results provide data on clinically important biomarkers in patients undergoing hip fracture surgery. We suggest a stronger emphasis on monitoring and correcting these biomarkers when possible.
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Huddleston JM, Gullerud RE, Smither F, Huddleston PM, Larson DR, Phy MP, Melton LJ, Roger VL. Myocardial infarction after hip fracture repair: a population-based study. J Am Geriatr Soc 2012; 60:2020-6. [PMID: 23110362 DOI: 10.1111/j.1532-5415.2012.04205.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To quantify the occurrence of myocardial infarction (MI) occurring in the early postoperative period after surgical hip fracture repair and estimate the effect on 1-year mortality. DESIGN A population-based, historical cohort study of individuals who underwent surgical repair of a hip fracture that used the computerized medical record linkage system of the Rochester Epidemiology Project. SETTING Academic and community hospitals, outpatient offices, and nursing homes in Olmsted County, Minnesota. PARTICIPANTS Over the 15-year study period (1988-2002), 1,116 elderly adults underwent surgical repair of a hip fracture. MEASUREMENTS At the end of the first 7 days after hip fracture repair, participants were classified into one of three groups: clinically verified MI (cv-MI), subclinical myocardial ischemia, and no myocardial ischemia. One-year mortality was compared between these groups. Multivariate models assessed risk factors for early postoperative cv-MI and 1-year mortality. RESULTS Within the first 7 days after hip fracture repair, 116 (10.4%) participants experienced cv-MI and 41 (3.7%) subclinical myocardial ischemia. Overall 1-year mortality was 22%, with no difference between those with subclinical myocardial ischemia and those with no myocardial ischemia. One-year mortality for those with cv-MI (35.8%) was significantly higher than for the other two groups. Occurrence of early postoperative cv-MI, male sex, and history of heart failure or dementia were independently associated with greater 1-year mortality, whereas prefracture home residence and preoperative higher hemoglobin were protective. CONCLUSION Rates of early postoperative, cv-MI after hip fracture repair exceed rates after other major orthopedic surgeries and are independently associated with greater 1-year mortality.
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Affiliation(s)
- Jeanne M Huddleston
- Divisions of Hospital Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA.
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Madsen CM, Jørgensen HL, Lind B, Ogarrio HW, Riis T, Schwarz P, Duus BR, Lauritzen JB. Secondary hyperparathyroidism and mortality in hip fracture patients compared to a control group from general practice. Injury 2012; 43:1052-7. [PMID: 22261083 DOI: 10.1016/j.injury.2011.12.025] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2011] [Revised: 12/23/2011] [Accepted: 12/23/2011] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Previously, little attention has been paid as to how disturbances in the parathyroid hormone (PTH)-calcium-vitamin D-axis, such as secondary hyperparathyroidism (SHPT), relate to mortality amongst hip fracture patients. This study aimed to (1) determine if SHPT is associated with mortality in this group of patients, (2) investigate the association between serum (s-) PTH, s-total calcium, s-25-hydroxyvitamin D (s-25(OH)D) and mortality and (3) determine the prevalence of SHPT amongst hip fracture patients and a control group. METHOD The study included 562 hip fracture patients (HF) (age ≥ 70 years) admitted to a Danish university hospital. The hip fracture patients were prospectively enrolled in a dedicated hip fracture database. Each hip fracture patient was exactly matched according to age and sex with two controls randomly chosen from a control population of 21,778 subjects who had s-PTH, s-total calcium and s-25(OH)D measured at the Copenhagen General Practitioners Laboratory after referral from their general practitioner. The control group (Con) thus consisted of 1124 subjects. RESULTS General 1-year mortality: Con-female 8.4%, Con-male 15.3%, HF-female 24.6%, HF-male 33.3%, p<0.0001 (log rank). SHPT AND RELATED 1-YEAR MORTALITY: Con-no SHPT 8.9%, Con-SHPT 16.8%, HF-no SHPT 22.7%, HF-SHPT 34.9%, p<0.0001 (log rank). The mortality rates were higher for controls with SHPT (OR 2.06, 95% CI: 1.32-3.23), hip fracture patients without SHPT (OR 3.00, 95% CI: 2.14-4.20) and hip fracture patients with SHPT (OR 5.46, 95% CI: 3.32-8.97) compared to the controls without SHPT. PREVALENCE OF SHPT: Con 16%, HF 20%, p=0.09 (Chi-square). CONCLUSIONS Our study clearly shows that SHPT is significantly associated with mortality in both hip fracture patients and the control group. In the multivariate Cox regression analysis, s-PTH and s-total calcium were both significantly associated with mortality, whereas s-25(OH)D was not associated with mortality in this analysis. Our study furthermore indicates that SHPT is almost equally prevalent amongst the hip fracture patients and the control group.
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Vochteloo AJH, Borger van der Burg BLS, Tuinebreijer WE, de Vries MR, Niggebrugge AHP, Bloem RM, Maier AB, Nelissen RGHH, Pilot P. Do clinical characteristics and outcome in nonagenarians with a hip fracture differ from younger patients? Geriatr Gerontol Int 2012; 13:190-7. [DOI: 10.1111/j.1447-0594.2012.00885.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Ricci G, Longaray MP, Gonçalves RZ, Neto ADSU, Manente M, Barbosa LBH. EVALUATION OF THE MORTALITY RATE ONE YEAR AFTER HIP FRACTURE AND FACTORS RELATING TO DIMINISHED SURVIVAL AMONG ELDERLY PEOPLE. Rev Bras Ortop 2012; 47:304-9. [PMID: 27042638 PMCID: PMC4799399 DOI: 10.1016/s2255-4971(15)30103-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2011] [Accepted: 10/25/2011] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To evaluate the mortality rate after one year and correlated preoperative factors, among patients with hip fractures. METHODS We prospectively studied 202 out of a total of 376 patients with a diagnosis of hip fracture who were admitted to the Hospital Cristo Redentor, between October 2007 and March 2009. The database with the epidemiological analysis was set up during their hospitalization, and follow-up data were obtained preferentially by phone. RESULTS The overall mortality rate after one year of follow-up was 28.7% or 58 deaths, among which 11 (5.45%) occurred during hospitalization. Fractures were more prevalent among women (71.3%) and rare among blacks (5%). Among the comorbidities, dementia and depression showed a statistically significant reduction in survival (p = 0.018 and 0.007, respectively). CONCLUSION The mortality rate after one year of follow-up was 28.7%. Dementia and depression increased this rate.
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Affiliation(s)
- Guilherme Ricci
- Orthopedist at the Orthopedics and Traumatology Service, Hospital Regina, Novo Hamburgo, RS, Brazil
| | - Maurício Portal Longaray
- Orthopedist at Conceição Children's Hospital (HCC) (a unit of the Conceição Hospital Group), Porto Alegre, RS, Brazil
| | - Ramiro Zilles Gonçalves
- Orthopedist at the Orthopedics and Traumatology Service, Hospital Cristo Redentor (a unit of the Conceição Hospital Group), Porto Alegre, RS, Brazil
| | - Ary da Silva Ungaretti Neto
- Orthopedist at the Orthopedics and Traumatology Service, Hospital Cristo Redentor (a unit of the Conceição Hospital Group), Porto Alegre, RS, Brazil
| | - Marislei Manente
- General Clinician at Hospital Cristo Redentor (a unit of the Conceição Hospital Group), Porto Alegre, RS, Brazil
| | - Luíza Barbosa Horta Barbosa
- Undergraduate Student in the 11 Semester of the Medical Course, Lutheran University of Brazil, Canoas, RS, Brazil
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Svejme O, Ahlborg HG, Nilsson JÅ, Karlsson MK. Early menopause and risk of osteoporosis, fracture and mortality: a 34-year prospective observational study in 390 women. BJOG 2012; 119:810-6. [PMID: 22531019 DOI: 10.1111/j.1471-0528.2012.03324.x] [Citation(s) in RCA: 99] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE A prospective evaluation of the long-term effects of early menopause on mortality, risk of fragility fracture and osteoporosis. DESIGN Prospective population-based observational study. SETTING Malmö, Sweden. POPULATION A total of 390 white north European women aged 48 years at the start of the study. METHODS At baseline, bone mineral density (BMD) was measured by single-photon absorptiometry (SPA) in the distal forearm and menopausal status was noted. Menopause was determined according to the World Health Organization criterion of a minimum of 12 months of continuous amenorrhoea. Women were divided into early menopause (occurring before age 47 years) and late menopause (occurring at age 47 years or later). At age 77, forearm BMD was re-measured by SPA and proximal femur and lumbar spine BMD were measured by dual-energy X-ray absorptiometry (DXA). The prevalence of osteoporosis was determined using the DXA data. Mortality rate and the incidence of fractures were registered up until age 82. Data are presented as means with 95% confidence intervals (95% CI). MAIN OUTCOME MEASURES Incidence of fragility fractures, mortality, prevalence of osteoporosis at age 77. RESULTS Women with early menopause had a risk ratio of 1.83 (95% CI 1.22-2.74) for osteoporosis at age 77, a risk ratio of 1.68 (95% CI 1.05-2.57) for fragility fracture and a mortality risk of 1.59 (95% CI 1.04-2.36). CONCLUSIONS Menopause before age 47 is associated with increased mortality risk and increased risk of sustaining fragility fractures and of osteoporosis at age 77.
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Affiliation(s)
- O Svejme
- Clinical and Molecular Osteoporosis Unit, Department of Clinical Sciences, Lund University, Sweden.
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Vochteloo AJH, van Vliet-Koppert ST, Maier AB, Tuinebreijer WE, Röling ML, de Vries MR, Bloem RM, Nelissen RGHH, Pilot P. Risk factors for failure to return to the pre-fracture place of residence after hip fracture: a prospective longitudinal study of 444 patients. Arch Orthop Trauma Surg 2012; 132:823-30. [PMID: 22311748 PMCID: PMC3356520 DOI: 10.1007/s00402-012-1469-8] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2011] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Long-term place of residence after hip fracture is not often described in literature. The goal of this study was to identify risk factors, known at admission, for failure to return to the pre-fracture place of residence of hip fracture patients in the first year after a hip fracture. METHODS This is a prospective longitudinal study of 444 consecutive admissions of hip fracture patients aged ≥ 65 years. Place of residence prior to admission, at discharge, after 3 and 12 months was registered. Patients admitted from a nursing home (n = 49) were excluded from statistical analysis. Multivariable logistic regression analysis was performed, using age, gender, presence of a partner, ASA-score, dementia, anaemia at admission, type of fracture, pre-fracture level of mobility and level of activities of daily living (ADL) as possible risk factors. RESULTS Two hundred eighty-nine patients lived in their own home, 31.8% returned at discharge, 72.9% at 3 months and 72.8% at 12 months. Age, absence of a partner, dementia, and a lower pre-fracture level of ADL or mobility were independent contributors to failure to return to their own home at discharge, 3 or 12 months. 106 patients lived in a residential home; 33.3% returned at discharge, 68.4% at 3 months and 64.4% at 12 months. Age was an independent contributor to failure to return to a residential home. CONCLUSIONS Age, dementia and a lower pre-fracture level of ADL were the main significant risk factors for failure to return to the pre-fracture residence. As the 3- and 12-month return-rates were similar, 3-month follow-up might be used as an endpoint in future research.
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Affiliation(s)
- Anne J. H. Vochteloo
- Department of Orthopaedic Surgery, Leiden University Medical Centre, P.O. Box 9600, 2300 RC Leiden, The Netherlands ,Department of Orthopaedic Surgery, Reinier de Graaf Group, Delft, The Netherlands
| | | | - Andrea B. Maier
- Department of Gerontology and Geriatrics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Wim E. Tuinebreijer
- Department of Surgery-Traumatology, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
| | - Maarten L. Röling
- Department of Orthopaedic Surgery, Reinier de Graaf Group, Delft, The Netherlands
| | - Mark R. de Vries
- Department of Surgery, Reinier de Graaf Group, Delft, The Netherlands
| | - Rolf M. Bloem
- Department of Orthopaedic Surgery, Reinier de Graaf Group, Delft, The Netherlands
| | - Rob G. H. H. Nelissen
- Department of Orthopaedic Surgery, Leiden University Medical Centre, P.O. Box 9600, 2300 RC Leiden, The Netherlands
| | - Peter Pilot
- Department of Orthopaedic Surgery, Reinier de Graaf Group, Delft, The Netherlands
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Karantana A, Boulton C, Bouliotis G, Shu KSS, Scammell BE, Moran CG. Epidemiology and outcome of fracture of the hip in women aged 65 years and under: a cohort study. ACTA ACUST UNITED AC 2011; 93:658-64. [PMID: 21511933 DOI: 10.1302/0301-620x.93b5.24536] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
We examined prospectively collected data from 6782 consecutive hip fractures and identified 327 fractures in 315 women aged ≤65 years. We report on their demographic characteristics, treatment and outcome and compare them with a cohort of 4810 hip fractures in 4542 women aged > 65 years. The first significant increase in age-related incidence of hip fracture was at 45, rather than 50, which is when screening by the osteoporosis service starts in most health areas. Hip fractures in younger women are sustained by a population at risk as a result of underlying disease. Mortality of younger women with hip fracture was 46 times the background mortality of the female population. Smoking had a strong influence on the relative risk of 'early' (≤ 65 years of age) fracture. Lag screw fixation was the most common method of operative treatment. General complication rates were low, as were re-operation rates for cemented prostheses. Kaplan-Meier implant survivorship of displaced intracapsular fractures treated by reduction and lag screw fixation was 71% (95% confidence interval 56 to 81) at five years. The best form of treatment remains controversial.
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Affiliation(s)
- A Karantana
- Nottingham University, Hospitals NHS Trust, Queen's Medical Centre Campus, Derby Road, Nottingham NG7 2UH, UK.
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