Introduction: Fractures of the neck of femur has a considaerable impact on the NHS and due to the elderly group of population it involves morbidity can be very costly. We assesed the outcome of trauma patients with these fractures after providing
Introduction. In the
Objectives: To determine the effect of an
In aged trauma patients the basic prerequisite is early mobilization and full weight-bearing, as immobilization can trigger various complications such as pressure ulcers, pneumonia, urinary tract infections and others. Mortality of elderly patients increases significantly in fracture patients with partial weight-bearing compared to populations with total weight-bearing. Besides the limited physical strength in these patients, partial-weight bearing is however frequently used for the aftercare of hip fracture patients. Therefore, the present study aims to evaluate mobility of aged hip fracture patients with regards to weight-bearing and postoperative mobility. An insole mobile force sensor was used to measure the post-operative weight-bearing by assessing the compressive forces between foot and shoe. Only patients (n=15) that suffered a trochanteric fracture >75 years of age were included and compared to a study group of patients (n=18) with fractures of the lower limb <40 years of age. Patients with cognitive disorders such as delirium and other diseases limiting the realization of partial weight-bearing were excluded. Both groups were instructed to maintain partial weight bearing of the affected limb following surgery. Following five days of training by our department of physiotherapy, the patients were requested to perform a gait analysis with the insole mobile force sensor. During gait analysis the maximum load was measured (kg) and the time over which the partial load could be maintained was determined.Abstract
Methods
National hip fracture registries audit similar aspects of care but there is variation in the actual data collected; these differences restrict international comparison, benchmarking, and research. The Fragility Fracture Network (FFN) published a revised minimum common dataset (MCD) in 2022 to improve consistency and interoperability. Our aim was to assess compatibility of existing registries with the MCD. We compared 17 hip fracture registries covering 20 countries (Argentina; Australia and New Zealand; China; Denmark; England, Wales, and Northern Ireland; Germany; Holland; Ireland; Japan; Mexico; Norway; Pakistan; the Philippines; Scotland; South Korea; Spain; and Sweden), setting each of these against the 20 core and 12 optional fields of the MCD.Aims
Methods
The aim of this study was to assess the effect of time to surgical intervention from admission on mortality and morbidity for patients with hip fractures. MEDLINE and Embase were searched from inception to June 2020. Reference lists were manually assessed to identify additional papers. Primary comparative research studies that recruited patients aged over 60 years, with non-pathological primary proximal femoral fractures that were treated surgically, were included. Studies that did not include a group operated on within 24 hours or which reported time to surgery in calendar days were excluded. Two investigators extracted data on study characteristics, methods, and outcomes. The pre-defined primary outcome was 30-day mortality. Secondary outcomes were complications and mortality at other time points. Relative risks (RRs) with 95% confidence intervals (CIs) were aggregated and were grouped by study-level characteristics.Aims
Methods
There has been extensive research into neck of femur fractures in the elderly. Fragility non-hip femoral fractures share many of the same challenges [1]. Surgical management is complex, patients are frail and mortality rates have been reported as high as 38% [2]. Despite this, relatively little data is available evaluating the level of MDT care provided to non-hip femoral fractures. This audit aimed to evaluate the standard of MDT care provided for patients with non-hip femoral fractures according to the NHFD key performance indicators. The following fractures were included in the dataset: distal femoral, femoral shaft and peri-prosthetic femoral. Patients under 65 were excluded. Data was retrospectively collected using post-operative and medical documentation. Performance was assessed according to five key performance indicators:. Did
Aims. This study aimed to identify risk factors (patient, healthcare system, and socioeconomic) for mortality after hip fractures and estimate their relative importance. Further, we aimed to elucidate mortality and survival patterns following fractures and the duration of excess mortality. Methods. Data on 37,394 hip fractures in the Norwegian Hip Fracture Register from January 2014 to December 2018 were linked to data from the Norwegian Patient Registry, Statistics Norway, and characteristics of acute care hospitals. Cox regression analysis was performed to estimate risk factors associated with mortality. The Wald statistic was used to estimate and illustrate relative importance of risk factors, which were categorized in modifiable (healthcare-related) and non-modifiable (patient-related and socioeconomic). We calculated standardized mortality ratios (SMRs) comparing deaths among hip fracture patients to expected deaths in a standardized reference population. Results. Mean age was 80.2 years (SD 11.4) and 67.5% (n = 25,251) were female. Patient factors (male sex, increasing comorbidity (American Society of Anesthesiologists grade and Charlson Comorbidity Index)), socioeconomic factors (low income, low education level, living in a healthcare facility), and healthcare factors (hip fracture volume, availability of
Aims. The aim of this study was to describe the current pathways of care for patients with a fracture of the hip in five low- and middle-income countries (LMIC) in South Asia (Nepal and Sri Lanka) and Southeast Asia (Malaysia, Thailand, and the Philippines). Methods. The World Health Organization Service Availability and Readiness Assessment tool was used to collect data on the care of hip fractures in Malaysia, Thailand, the Philippines, Sri Lanka, and Nepal. Respondents were asked to provide details about the current pathway of care for patients with hip fracture, including pre-hospital transport, time to admission, time to surgery, and time to weightbearing, along with healthcare professionals involved at different stages of care, information on discharge, and patient follow-up. Results. Responses were received from 98 representative hospitals across the five countries. Most hospitals were publicly funded. There was consistency in clinical pathways of care within country, but considerable variation between countries. Patients mostly travel to hospital via ambulance (both publicly- and privately-funded) or private transport, with only half arriving at hospital within 12 hours of their injury. Access to surgery was variable and time to surgery ranged between one day and more than five days. The majority of hospitals mobilized patients on the first or second day after surgery, but there was notable variation in postoperative weightbearing protocols. Senior medical input was variable and specialist
Osteoporosis is a disease when bone mass and tissue is lost, with a consequent increase in bone fragility and increase susceptibility to develop fracture. The osteoporosis prevalence increases markedly with age, from 2% at 50 years to more than 25% at 80 years. 1. in women. The vast majority of distal radius fractures (DRFs) can be considered fragility fractures. The DRF is usually the first medical presentation of these fractures. With an aging population, all fracture clinics should have embedded screening for bone health and falls risk. DRF is the commonest type of fracture in perimenopausal women and is associated with an increased risk of later non-wrist fracture of up to one in five in the subsequent decade. 2. . According to the national guidelines in managing the fragility fractures of distal radius with regards the bone health review, we, as orthopedic surgeons, are responsible to detect the risky patients, refer them to the responsible team to perform the required investigations and offer the treatment. We reviewed our local database (E-trauma) all cases of fracture distal radius retrospectively during the period from 01/08/2019 to 29/09/2019. We included total of 45 patients who have been managed conservatively and followed up in fracture clinic. Our inclusion criteria was: women aged 65 years and over, men aged 75 years and over with risk factors, patients who are more than 50 years old and sustained low energy trauma whatever the sex is or any patient who has major risk factor (current or frequent recent use of oral or systemic glucocorticoids, untreated premature menopause or previous fragility fracture). We found that 96% of patients were 50 years old or more and 84% of the patients were females. 71% of patients were not referred to Osteoporosis clinic and 11% were already under the
Background. Polypharmacy of elderly trauma patients entails further difficulties in addition to the fracture treatment. Impaired renal function, altered metabolism and drugs that are potentially delirious or inhibit ossification, are only a few examples which must be carefully considered for the medication in elderly patients. The aim of this study was to investigate, if medication errors could be prevented by
Abstract. Introduction. The management of hip fractures has advanced on all aspects from prevention, specialised hip fracture units, early operative intervention and rehabilitation in line with increasing incidence in an aging population. Accurate data analysis on the incidence and trends of hip fractures is imperative to guide future management planning. Methods. A review of all articles published on mortality after hip fracture over a twenty year period (1999–2018) was undertaken to determine any changes that had occurred in the demographics and mortality over this period. This article complements and expands upon the findings of a previous article by the authors assessing a four decade period (1959 – 1998) and attempts to present trends and geographical variations over sixty years. Results. The mean age of patients sustaining hip fractures has increased from 73 years (1960s) to 81 years (2000s) to 82 years (2010s). Over the six decade period one-year mortality has reduced from 27% (1960s) to 20% (2010s). The proportion of female hip fractures has decreased from 84% (1960s) to 70% in 2010s. Intracapsular fractures have drecreased from 54% (1970s) to 49% (2000s) and 48% (2010s). Conclusion. Our study indicates that progress has been made with preventative planning, medical management, specialised
Fractures of the neck of femur are common in the older adult with significant morbidity and mortality rates. This patient cohort is associated with frailty and multiple complex medical and social needs requiring a multidisciplinary team to provide optimal care. The aim of this study was to assess the outcomes at 5 years following implementation of a collaborative service between the Orthopaedic and Geriatric departments of Southland Hospital in 2012. Retrospective data was collected for patients aged 65 years and older who were admitted with a fragility hip fracture. Data was collated for 2011 (pre-implementation) and 2017 (post-implementation). Demographics and ASA scores were recorded. We assessed 30-day and 1-year mortality, surgical data, length of stay and complications. There were 74 patient admissions in 2011 and 107 in 2017. Mean age at surgery was 84.2 years in 2011 and 82.6 years in 2017 (p>0.05). Between the 2011 and 2017 groups there has been a non-significant reduction in length of stay on the orthopaedic ward (9.8 days vs 7.5 days, p=0.138) but a significant reduction in length of stay on the rehabilitation ward (19.9 vs 9 days, p<0.001). There was a significant decrease in frequency of patients with a complication (71.6% vs 57%, p=0.045) and a marginal reduction in number of complications (p=0.057). Through logistic regression controlling for age, sex and ASA score, there was a reduction in the odds of having a complication by 12% between 2011 and 2017 (p<0.001). There was no difference in mortality between the groups. The
Introduction. Aged trauma patients with proximal femur fractures are prone to various complications. They may be associated with their comorbidities which also need to be adressed. These complications limit the patient”s postoperative health status and subsequently their activity and independency. As an attempt to improve the postoperative management of aged hip fracture patients a better understanding of the postoperative condition in these patients is necessary. Therefore, this meta-analysis is intended to provide an overview of postoperative complications in the elderly hip fracture patients and to improve the understanding of an adequate postoperative management. Material and method. Medline was used to screen for studies reporting on the complication rates of hip fracture patients > 65 years. The search criteria were: “proximal femur fracture, elderly, complication”. In addition to surgical studies, internal medicine and geriatric studies were also included. Randomized studies, retrospective studies as well as observation studies were included. Furthermore, reoperation rates as well as treatment-related complications were recorded. The 1-year mortality was calculated as outcome parameter. Results. Overall 54 studies were enrolled, published between 2011 and 2016. The mean age of the 9812 patients was 81 years (65–99 years). Follow-up was at least one year. The reoperation rate after osteosynthesis of pertrochanteric femur fractures was 8.7%. The reoperation rate was dependent on the type of fracture and the surgical method. Pneumonia (9,5%) and urinary tract infections (27%) were the most common postoperative infections. With 23%, delirium was one of the most common medical complications. The 1-year mortality rate was 18.7%. Conclusion.
Introduction. Open fragility ankle fractures involve complex decision making. There is no consensus on the method of surgical management. Our aim in this study was to analyse current management of these patients in a major trauma centre (MTC). Materials & Methods. This cohort study evaluates the management of geriatric (≥65years) open ankle fractures in a MTC (November 2020–November 2022). The method, timing(s) and personnel involved in surgical care were assessed. Weightbearing status over the treatment course was monitored. Patient frailty was measured using the clinical frailty score (CFS). Results. There were 35 patients, mean age 77 years (range 65–97 years), 86% female. Mean length of admission in the MTC was 26.4 days (range 3–78). Most (94%) had a low-energy mechanism of injury. Only 57% of patients underwent one-stage surgery (ORIF n=15, hindfoot nail n=1, external frame n=4) with 45% being permitted to fully weightbear (FWB). Eleven (31.4%) underwent two-stage surgery (external fixator; ORIF), with 18% permitted to FWB. Of those patients with pre-injury mobility, 12 (66%) patients were able to FWB following definitive fixation. Delay in weightbearing ranged from 2–8weeks post-operatively. Seven patients (20%) underwent an initial Orthoplastic wound debridement. Ten patients (28.6%) required plastic surgery input (split-skin grafts n=9, local or free flaps n=3), whereby four patients (40%) underwent one stage Orthoplastic surgery. Eighteen (51.4%) patients had a CFS ≥5. Patients with a CFS of ≥7 had 60% 90-day mortality. Only 17% patients had orthogeriatrician input during admission. Conclusions. These patients have high frailty scores, utilise a relatively large portion of resources with multiple theatre attendances and protracted ward occupancy in an MTC. Early FWB status needs to be the goal of treatment, ideally in a single-staged procedure. Poor access to
Background: Recognising the need for
Literature suggests that joint orthopaedic and geriatric care, and geriatric orthopaedic rehabilitation units, would provide best care for fractured neck of femur (NOF) patients. These are often elderly frail patients with concurrent illnesses and co-morbidities who also have a fracture. There is to date no quantitative data. This completed audit quantifies the care provided on the orthopaedic wards in the first phase solely by orthopaedic team, and in the repeat phase with additional regular geriatric input from an
For some years, there has been vast international interest in creating models for joint efforts between geriatricians and orthopedic surgeons. We present data from two such models. For the first time in Denmark, the Department of Orthopedics Bispebjerg University Hospital (BUP) recruited two full-time geriatricians in September 2009. They were assigned an independent unit meant for severely ill orthopaedic patients with high comorbidity and polypharmacy. These two geriatricians had, during the previous two years, consulted another orthopaedic department at Gentofte University Hospital (GUH) in a neighbouring community three times a week. The aim of their intervention was then to optimize treatment for comorbidity, to clarify indication of acute fall-assessment, osteoporosis diagnosis and treatment, presence of delirium and dementia. Methods. A total of 1344 hip fracture patients (age 70 years) divided into three populations were included in this study. Mortality data were collected from the Danish Civil Registry. Population 1 (P1), n = 645 was included at GUH from January 1, 2006 to December 31, 2007. During the entire period, the patients had access to a senior consultant in geriatric medicine three times a week. In this population, the majority of patients were assessed for dementia (n = 636), delirium (n = 627) and Barthel Index (Barthel100) at admission (n = 394). Population 2 (P2), n = 381 included at BUH from September 1, 2009 until July 8, 2010 with
Aims. To compare the early management and mortality of older patients
sustaining major orthopaedic trauma with that of a younger population
with similar injuries. Patients and Methods. The Trauma Audit Research Network database was reviewed to identify
eligible patients admitted between April 2012 and June 2015. Distribution
and severity of injury, interventions, comorbidity, critical care
episodes and mortality were recorded. The population was divided
into young (64 years or younger) and older (65 years and older) patients. Results. Of 142 765 adults sustaining major trauma, 72 942 (51.09 %) had
long bone or pelvic fractures and 45.81% of these were >
65 years
old. Road traffic collision was the most common mechanism in the
young (40.4%) and, in older people, fall from standing height (80.4%)
predominated. The 30 day mortality in older patients with fractures
is greater (6.8% versus 2.5%), although critical
care episodes are more common in the young (18.2% versus 9.7%).
Older people are less likely to be admitted to critical care beds
and are often managed in isolation by surgeons. Orthopaedic surgery
is the most common admitting and operating specialty and, in older
people, fracture surgery accounted for 82.1% of procedures. . Conclusion. Orthopaedic trauma in older people is associated with mortality
that is significantly greater than for similar fractures in the
young. As with the hip fracture population, major trauma in the
elderly is a growing concern which highlights the need for a review
of admission pathways and shared