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The Journal of Bone & Joint Surgery British Volume
Vol. 74-B, Issue 2 | Pages 261 - 264
1 Mar 1992
Parker M Myles J Anand J Drewett R

We have determined the quality-adjusted-life-years and cost of such in several types of hip fracture and various treatment options. Operative treatment proved more cost-effective than other methods for displaced subcapital fractures and for extracapsular fractures. For undisplaced subcapital fractures conservative treatment was almost as cost-effective as surgery


Bone & Joint 360
Vol. 11, Issue 1 | Pages 50 - 51
1 Feb 2022
Das A


The Bone & Joint Journal
Vol. 103-B, Issue 12 | Pages 1754 - 1758
1 Dec 2021
Farrow L Zhong M Ashcroft GP Anderson L Meek RMD

There is increasing popularity in the use of artificial intelligence and machine-learning techniques to provide diagnostic and prognostic models for various aspects of Trauma & Orthopaedic surgery. However, correct interpretation of these models is difficult for those without specific knowledge of computing or health data science methodology. Lack of current reporting standards leads to the potential for significant heterogeneity in the design and quality of published studies. We provide an overview of machine-learning techniques for the lay individual, including key terminology and best practice reporting guidelines.

Cite this article: Bone Joint J 2021;103-B(12):1754–1758.


The Bone & Joint Journal
Vol. 95-B, Issue 4 | Pages 459 - 466
1 Apr 2013
Fisher WD Agnelli G George DJ Kakkar AK Lassen MR Mismetti P Mouret P Turpie AGG

There is currently limited information available on the benefits and risks of extended thromboprophylaxis after hip fracture surgery. SAVE-HIP3 was a randomised, double-blind study conducted to evaluate the efficacy and safety of extended thromboprophylaxis with the ultra-low molecular-weight heparin semuloparin compared with placebo in patients undergoing hip fracture surgery. After a seven- to ten-day open-label run-in phase with semuloparin (20 mg once daily subcutaneously, initiated post-operatively), patients were randomised to once-daily semuloparin (20 mg subcutaneously) or placebo for 19 to 23 additional days. The primary efficacy endpoint was a composite of any venous thromboembolism (VTE; any deep-vein thrombosis and non-fatal pulmonary embolism) or all-cause death until day 24 of the double-blind period. Safety parameters included major and clinically relevant non-major bleeding, laboratory data, and treatment-emergent adverse events (TEAEs). Extended thromboprophylaxis with semuloparin demonstrated a relative risk reduction of 79% in the rate of any VTE or all-cause death compared with placebo (3.9% vs 18.6%, respectively; odds ratio 0.18 (95% confidence interval 0.07 to 0.45), p < 0.001). Two patients in the semuloparin group and none in the placebo group experienced clinically relevant bleeding. TEAE rates were similar in both groups. In conclusion, the SAVE-HIP3 study results demonstrate that patients undergoing hip fracture surgery benefit from extended thromboprophylaxis. Cite this article: Bone Joint J 2013;95-B:459–66


The Journal of Bone & Joint Surgery British Volume
Vol. 71-B, Issue 3 | Pages 471 - 474
1 May 1989
Pryor G Williams D

The rehabilitation of elderly patients after hip fractures is important: we report a prospective study which compares supported home rehabilitation with management in hospital in two similar groups of patients. Our results show that early discharge from hospital and home rehabilitation produces substantial savings in bed days, and also provides quicker and more effective recovery


The Journal of Bone & Joint Surgery British Volume
Vol. 74-B, Issue 2 | Pages 270 - 271
1 Mar 1992
Astrom J Beertema J

In a population-based study we identified a cohort of 282 women, whose children had been treated for osteoarthritis of the hip. The incidence of hip fracture in these mothers was 0.54 (95% CI 0.35 to 0.83) of that in the whole population of their age and sex. This finding could be explained by a genetic factor for increased rigidity of subchondral bone, making osteoarthritis more likely and osteoporosis less likely


The Journal of Bone & Joint Surgery British Volume
Vol. 69-B, Issue 2 | Pages 251 - 253
1 Mar 1987
Fairclough J Colhoun E Johnston D Williams L

Of 693 elderly patients admitted with suspected hip fractures, 43 had normal radiographs and were investigated by isotope bone scan. The 30 patients (70%) with normal scans were mobilised and none developed a fracture. All 13 of the patients with specific bone scan abnormalities were subsequently proved to have fractures, five of which became displaced. Clearly conventional radiography does not exclude fracture of the femoral neck in elderly patients; bone scanning is advisable in doubtful cases


The Journal of Bone & Joint Surgery British Volume
Vol. 78-B, Issue 1 | Pages 115 - 118
1 Jan 1996
Svensson O Strömberg L Öhlén G Lindgren U

We report a prospective study of 232 consecutive patients with hip fractures. All were over 64 years of age and living independently before admission to a geriatric orthopaedic ward. We assessed the value, at admission, of predicting factors for independent living at one year after injury. The most important factors were: (1) preinjury function in activities of daily living (grade A or B on the Katz et al (1963) scale); (2) absence of other medical conditions which would impair rehabilitation; and (3) cognitive function better than 7 on the Pfeiffer (1975) mental questionnaire. The odds ratios (95% CI) for these three predictors were 3.5 (1.3 to 9.1), 2.9 (1.3 to 6.1) and 2.4 (1.9 to 4.9), respectively. When all predictors were positive at admission, 92% were living independently at one year; with one, two or three negative predictors, the percentages living independently were 76, 61 and 27, respectively. The median values of the total number of days in hospital, irrespective of diagnosis, during the first year were 12, 24, 29 and 149 days for the four groups. The mortality at one year was predictable on admission only by the number of medical conditions: with no other diagnosis than the fracture the mortality was 0%; with one or two additional conditions the mortality was 14%; and with three or more additional diagnoses it was 24%. These simple and robust predictors can be used to optimise resources for rehabilitation


The Bone & Joint Journal
Vol. 100-B, Issue 4 | Pages 436 - 442
1 Apr 2018
Choi HG Lee YB Rhyu SH Kwon BC Lee JK

Aims

The aim of this study was to compare the rate of mortality and causes of death in Korean patients who undergo surgery for a fracture of the hip, up to 11 years after the injury, with a control group from the general population.

Materials and Methods

National cohort data from Korean Health Insurance Review and Assessment Service – National Sample Cohort were used. A ratio of 1:4 matched patients with a fracture who underwent surgery (3383, fracture group) between 2003 and 2012, and controls (13 532) were included. The matches were processed for age, gender, income, and region of residence. We also undertook analyses of subgroups according to age and gender. The mean follow-up was 4.45 years (1 to 11).


Bone & Joint Open
Vol. 1, Issue 11 | Pages 669 - 675
1 Nov 2020
Ward AE Tadross D Wells F Majkowski L Naveed U Jeyapalan R Partridge DG Madan S Blundell CM

Aims

Within the UK, around 70,000 patients suffer neck of femur (NOF) fractures annually. Patients presenting with this injury are often frail, leading to increased morbidity and a 30-day mortality rate of 6.1%. COVID-19 infection has a broad spectrum of clinical presentations with the elderly, and those with pre-existing comorbidities are at a higher risk of severe respiratory compromise and death. Further increased risk has been observed in the postoperative period. The aim of this study was to assess the impact of COVID-19 infection on the complication and mortality rates of NOF fracture patients.

Methods

All NOF fracture patients presenting between March 2020 and May 2020 were included. Patients were divided into two subgroup: those with or without clinical and/or laboratory diagnosis of COVID-19. Data were collected on patient demographics, pattern of injury, complications, length of stay, and mortality.


The Bone & Joint Journal
Vol. 103-B, Issue 3 | Pages 440 - 441
1 Mar 2021
Nikolaou VS Masouros P Floros T Chronopoulos E Skertsou M Babis GC


The Journal of Bone & Joint Surgery British Volume
Vol. 77-B, Issue 3 | Pages 494 - 496
1 May 1995
Calder S Anderson G Harper W Jagger C Gregg P

We report a randomised prospective trial of the early results of three types of treatment for displaced intracapsular hip fractures. We used a questionnaire sent to patients at about six months (Nottingham Health Profile, NHP) in addition to clinical assessments. There was a 67.4% usable response to the questionnaire, similar to that in other studies using the NHP. There were more responders from younger patients, those walking independently before injury and those with higher mental test scores on admission. In the younger group (65 to 79 years) we found a trend for better scores in most NHP indices after the use of a bipolar prosthesis rather than a unipolar prosthesis or internal fixation, particularly for social function, pain and physical mobility. Postal assessment using the NHP gave a satisfactory response rate even in the elderly, and can provide an extra assessment to complement or replace hospital follow-up in some circumstances


The Journal of Bone & Joint Surgery British Volume
Vol. 92-B, Issue 1 | Pages 116 - 122
1 Jan 2010
Parker MI Pryor G Gurusamy K

We undertook a prospective randomised controlled trial involving 400 patients with a displaced intracapsular fracture of the hip to determine whether there was any difference in outcome between treatment with a cemented Thompson hemiarthroplasty and an uncemented Austin-Moore prosthesis. The surviving patients were followed up for between two and five years by a nurse blinded to the type of prosthesis used.

The mean age of the patients was 83 years (61 to 104) and 308 (77%) were women. The degree of residual pain was less in those treated with a cemented prosthesis (p < 0.0001) three months after surgery. Regaining mobility was better in those treated with a cemented implant (p = 0.005) at six months after operation. No statistically significant difference was found between the two groups with regard to mortality, implant-related complications, re-operations or post-operative medical complications.

The use of a cemented Thompson hemiarthroplasty resulted in less pain and less deterioration in mobility than an uncemented Austin-Moore prosthesis with no increase in complications.


The Journal of Bone & Joint Surgery British Volume
Vol. 75-B, Issue 1 | Pages 163 - 164
1 Jan 1993
Fordham R


The Journal of Bone & Joint Surgery British Volume
Vol. 86-B, Issue 5 | Pages 777 - 777
1 Jul 2004
EHRENDORFER S


The Journal of Bone & Joint Surgery British Volume
Vol. 80-B, Issue 1 | Pages 184 - 184
1 Jan 1998
Goodier D


The Journal of Bone & Joint Surgery British Volume
Vol. 79-B, Issue 5 | Pages 884 - 884
1 Sep 1997
Laurence M


The Journal of Bone & Joint Surgery British Volume
Vol. 91-B, Issue 7 | Pages 922 - 927
1 Jul 2009
Lefaivre KA Macadam SA Davidson DJ Gandhi R Chan H Broekhuyse HM

Our aim was to determine the effect of delay to surgery on the time to discharge, in-hospital death, the presence of major and minor medical complications and the incidence of pressure sores in patients with a fracture of the hip. All patients admitted to Vancouver General Hospital with this injury between 1998 and 2001 inclusive were identified from our trauma registry. A review of the case notes was performed to determine the delay in time from admission to surgery, age, gender, type of fracture and medical comorbidities. A time-to-event analysis was performed for length of stay. Additionally, a Cox proportional hazards model was used to determine the effect of delay to surgery on the length of stay while controlling for other pertinent confounding factors. Using logistical regression we determined the effect of delay to surgery on in-hospital death, medical complications and the presence of pressure sores, while controlling for confounding factors.

Delay to surgery (p = 0.0255), comorbidity (p < 0.0001), age (p < 0.0001) and type of fracture (p = 0.0004) were all significant in the Cox proportional hazards model for increased time to discharge. Delay to surgery was not a significant predictor of in-hospital mortality. However, a delay of more than 24 hours was a significant predictor of a minor medical complication (odds ratio (OR) 1.53, 95% confidence interval (CI) 1.05 to 2.22), while a delay of more than 48 hours was associated with an increased risk of a major medical complication (OR 2.21, 95% CI 1.01 to 4.34), a minor medical complication (OR 2.27, 95% CI 1.38 to 3.72) and of pressure sores (OR 2.29, 95% CI 1.19 to 4.40).

Patients with a fracture of the hip should have surgery early to lessen the time to acute-care hospital discharge and to minimise the risk of complications.


The Journal of Bone & Joint Surgery British Volume
Vol. 71-B, Issue 3 | Pages 538 - 538
1 May 1989
Mjoberg B


The Journal of Bone & Joint Surgery British Volume
Vol. 83-B, Issue 1 | Pages 153 - 153
1 Jan 2001
Evans S