Aims

To determine whether obesity and malnutrition have a synergistic effect on outcomes from skeletal trauma or elective orthopaedic surgery.

Aims. Hip fractures are a major cause of morbidity and mortality, and malnutrition is a crucial determinant of these outcomes. This meta-analysis aims to determine whether oral nutritional supplementation (ONS) improves postoperative outcomes in older patients with a hip fracture. Methods. A systematic literature search was conducted in August 2022. ONS was defined as high protein-based diet strategies containing (or not containing) carbohydrates, fat, vitamins, and minerals. Randomized trials documenting ONS in older patients with hip fracture (aged ≥ 50 years) were included. Two reviewers evaluated study eligibility, conducted data extraction, and assessed study quality. Results. There were 812 studies identified, of which 18 studies involving 1,522 patients met the inclusion criteria. The overall meta-analysis demonstrated that ONS was associated with significantly elevated albumin levels (weighted mean difference (WMD) 1.24 (95% confidence interval (CI) 0.95 to 1.53)), as well as a significant risk reduction in infective complications (odds ratio (OR) 0.54 (95% CI 0.39 to 0.76)), pressure ulcers (OR 0.54 (95% CI 0.33 to 0.88)), and total complications (OR 0.57 (95% CI 0.42 to 0.79)). Length of hospital stay (LOS) was also significantly reduced (WMD -2.36 (95% CI -4.14 to -0.58)), particularly in rehabilitation LOS (WMD -4.17 (95% CI -7.08 to -1.26)). There was a tendency towards a lower mortality risk (OR 0.93 (95% CI 0.62 to 1.4)) and readmission (OR 0.52 (95% CI 0.16 to 1.73)), although statistical significance was not achieved (p = 0.741 and p = 0.285, respectively). The overall compliance with ONS ranged from 64.7% to 100%, but no factors influencing compliance were identified. Conclusion. This meta-analysis is the first to quantitatively demonstrate that ONS could nearly halve the risk of infective complications, pressure ulcers, total complications, as well as improve serum albumin and reduce LOS. ONS should be a regular and integrated part of the perioperative care of these patients, especially given that the compliance with ONS is acceptable. Cite this article: Bone Joint J 2023;105-B(11):1149–1158

Hip fractures are a major cause of morbidity and mortality, and malnutrition is a critical determinant of these outcomes. This systematic review and meta-analysis aims to determine whether oral nutritional supplementation (ONS) improves postoperative outcomes in older patients with hip fracture. An electronic systematic literature search was conducted in August 2022 using four databases. Randomized trials documenting ONS in older patients with hip fracture (aged 50+) were included. Two reviewers evaluated study eligibility, data extraction and assessed study quality. There were 812 studies identified of which 18 studies involving 1,512 patients met the inclusion criteria. The overall meta-analysis demonstrates that ONS was associated with a significant risk reduction in infective complications (odds ratio (OR) 0.54, 95%CI 0.38, 0.76), pressure ulcers (OR 0.54, 95%CI 0.33, 0.88), total complications rate (OR 0.57, 95%CI 0.42, 0.79). Length of hospital stay (LOS) was also significantly reduced (weighted mean difference (WMD) −2.01, 95%CI −3.52, −0.5), particularly in the rehabilitation LOS (WMD −4.17, 95%CI −7.08, −1.26). There was a tendency towards lower risk in mortality (OR 0.93, 95%CI 0.62, 1.4) and readmission (OR 0.52, 95%CI 0.16, 1.73), though statistical significance was not achieved. The overall compliance to ONS ranged from 64.1% to 100%, but no factors influencing compliance were identified. This systematic review was the first to quantitatively demonstrate that ONS reduces half the risk of infective complications, pressure ulcers, total complication rate and reduces LOS. ONS should be a regular and integrated part of medical practice, especially given that the compliance to ONS is acceptable

Aims

Hip fracture commonly affects the frailest patients, of whom many are care-dependent, with a disproportionate risk of contracting COVID-19. We examined the impact of COVID-19 infection on hip fracture mortality in England.

Aims

Patients who sustain neck of femur fractures are at high risk of malnutrition. Our intention was to assess to what extent malnutrition was associated with worse patient outcomes.

Background: Protein energy malnutrition is an important determinant of clinical outcome in older patients after hip fracture but the effectiveness of nutritional support programs in routine clinical practice is controversial. Objective: To determine if nutritional supplementation decrease fracture-related complications in a selection of otherwise healthy patients with a hip fracture. Design: A prospective, randomised, controlled, non-placebo, non-blinded clinical trial. Setting: A University Hospital in Sweden. Subjects: 80 patients hospitalised for hip fracture. Methods: We randomised patients to intervention (n=40) or control (n=40). The control group were given ordinary hospital food and beverage. The intervention group were also given 1000 kcal daily intraveneous supplementary nutrition for three days, followed by 400 kcal oral nutritional supplementation for another 7 days. Daily fluid and energy intake during the first ten days of hospitalisation and fracture-related complications at day 3, day 10, discharge, day 30 and day 120 were recorded. Results: The total fluid and energy intake in the intervention group reached near optimal levels whereas the control group received only 54% and 64% of optimal energy and fluid intake, respectively. Six patients in the intervention group (15%) and 28 patients in the control group (70%) had at least one complication (p< 0.0001). Five patients (13%) in the control group and none in the intervention group were diagnosed with a pneumonia < 10 days from surgery (p=0.006). Twelve patients in the control group (30%) and two in the intervention group (5%) had a wound infection < 30 days from surgery (p=0.006). At day ten, a total of 16 complications in the control group and three in the intervention group had occurred (p=0.003). At one month, 33 complications in the control group and six in the intervention group were recorded (p< 0.0001). Four patients died within 120 days, all in the control group (p=0.04). Conclusions: Nutritional supplementation given daily for 10 days after hip fracture surgery increased the total fluid and energy intake in the intervention group to near optimal levels and the intervention group displayed fewer complications than the control group