The Effect of Consultation-Liaison Psychiatry on Postoperative Delirium in Elderly Hip Fracture Patients in the General Hospital.

OBJECTIVE: The low recognition rate of postoperative delirium has gradually aroused clinical attention in China. The present study was to investigate the impact of consultation-liaison psychiatry on postoperative delirium in elderly hip fracture patients. METHODS: From March 2012 to September 2013, 89 patients with hip fractures hospitalized in Wuhan Mental Health Center were included in this prospective study as the consultation-liaison group. A total of 81 patients selected from August 2010 to February 2012 were defined as the conventional group. The delirium was evaluated using the confusion assessment method (CAM) recommended by the American Psychiatric Association guidelines. RESULTS: There was no difference of sex, age, trauma, surgical methods, and anesthesia between two groups (p > 0.05). The consultation rate of consultation-liaison group was significantly higher than that of conventional group (37.07% vs 17.28%, p < 0.05). After the consultation, there were 26 cases (78%) and nine cases (64%) of delirium in the consultation-liaison and conventional group, respectively (p > 0.05). In the consultation-liaison group, three patients (9.09%) were diagnosed with anxiety and three patients (9.09%) were diagnosed with depression, while in the conventional group, three patients (21.42%) were diagnosed with communication and one patient (7.14%) was diagnosed with depression. In addition, this study showed the incidence of delirium in consultation-liaison group was significantly higher than that of conventional group (29.21% vs 11.11%, p < 0.05). The average hospital stay in consultation-liaison group was significantly lower than that of conventional group (11.42 ± 2.63 vs. 15.17 ± 2.38 days, p < 0.01). CONCLUSION: Consultation-liaison psychiatry could improve the recognition rate of postoperative delirium in elderly hip fracture patients, shorten hospitalization time. The training of mental health knowledge for non-psychiatrists could improve the ability of early identification and treatment of delirium.

Early Intervention of Perioperative Delirium in Older Patients (>60 years) with Hip Fracture: A Randomized Controlled Study.

OBJECTIVE: To explore the effect of early intervention for perioperative delirium in older (> 60 years) hip fracture patients. METHODS: This prospective study enrolled hip fracture patients aged ≥60 years who were admitted into our hospital between July 2011 and August 2019. Hip fractures were classified according to the Arbeitsgemeinschaft für Osteo-synthesefragen (AO) classification. This study included patients with isolated hip fracture and excluded patients with pathological or peri prosthetic fracture or patients with multiple traumatic injuries and high-energy trauma. They were randomized to receive conventional orthopedic care group (n = 65) or comprehensive orthopedic care group including preoperative psychological counseling and preventative risperidone (n = 63). Daily assessment was based on patient interview with the CAM-CR, and delirium was diagnosed by the Delirium Rating Scale (DRS-R-98). The rate, severity and duration of perioperative delirium and the length of postoperative stay were analyzed. RESULTS: Totally 200 patients were screened for eligibility. Twenty patients were excluded due to alcohol abuse and 40 were excluded because of brain lesions on head CT. In addition, 12 patients were excluded because of impaired cognition. Finally 128 patients were enrolled. Their mean age was 75.3 ± 2.2 years for the comprehensive orthopedic care group and 73.5 ± 6.1 years for the conventional orthopedic care group, and 53.9% of the patients were female. Sixty-eight (53.1%) patients had intertrochanteric fracture, 39.8% patients had femoral head fracture, and 7.0% patients had subtrochanteric fracture. In addition, 58.6% patients underwent internal fixation and 41.4% patients received arthroplasty. In this study, 63 patients were randomized to the comprehensive orthopedic care group and 65 patients to the conventional orthopedic care group. The two groups were comparable in demographic and baseline characteristics (P > 0.05). The rate of perioperative delirium was significantly lower in the comprehensive care group vs the conventional care group (15.9% vs. 30.8%; P < 0.05). The comprehensive care group had significantly reduced length of postoperative hospital stay vs the conventional care group (11.3 ± 2.5 days vs. 14.2 ± 2.2 days, P < 0.01). The mean DRS-R-98 score was 7.1 ± 2.7 for the comprehensive care group, and was significantly lower than that of the conventional orthopedic care group (11.2 ± 3.0; P < 0.05). CONCLUSIONS: Our early intervention may reduce the incidence of perioperative delirium in elderly hip fracture patients (>60 years).

Self-made wire-rope button plate: A novel option for the treatment of distal tibiofibular syndesmosis separation.

OBJECTIVE: To compare the clinical effect of the self-made wire-rope button plate and cortical screw in the treatment of the distal tibiofibular syndesmosis separation. METHODS: Total 26 patients with distal tibiofibular syndesmosis separation were treated with internal fixation with a self-made wire-rope button plate and cortical screw. They were divided into a self-made wire-rope button plate group and cortical screw group. self-made wire-rope button plate group: 12 cases of inferior tibiofibular syndesmosis were reconstructed by self-made wire-rope button plate. Cortical screw group: 14 cases of inferior tibiofibular syndesmosis were reconstructed by cortical screw. The follow-up data of 2, 6, 12 weeks and 6 and 12 months after operation were collected. RESULTS: There was no significant difference in operative time, the amount of intraoperative bleeding and postoperative complications between the two groups (P > 0.05). Comparison of postoperative complications: There was no loosening and rupturing of internal fixation in the self-made wire-rope button plate group. In the cortical screw group, the rupture of screws was found in 1 case, which occurred in the 10th weeks after the operation, and the broken screws were removed after 1 year with other internal fixations. Within 12 weeks of reoperation to remove the internal fixation rate: There was a significant difference in the rate of reoperation to remove the internal fixation within 12 weeks (p < 0.05). At the last follow-up, the AOFAS score of the ankle joint were 94 ± 4.79 in the self-made wire-rope button plate group and 92.8 ± 6.73 in the cortical screw group. There was no significant difference (P > 0. 05). CONCLUSION: The self-made wire-rope button plate and cortical screw can effectively treat the separation of the tibiofibular syndesmosis. It provides a new choice for the treatment of inferior tibiofibular syndesmosis.

[Treatment of dislocation of shoulder with manipulation of proneposition modified hippocrates method].

OBJECTIVE: To explore the method of reduction of anterior dislocation of shoulder joint, evaluate the clinical effects of proneposition modified Hippocrates methods. METHODS: From February 1998 to April 2011, 1 028 patients, 689 males and 339 females, with anterior dislocation of shoulder joint were treated with manipulation of proneposition modified Hippocrates methods. The average age was 38.3 years (ranged from 11 to 86 years). Thirty-two cases by Hippocrates method failure to reset success, 86 cases combined with geater tuberosity tore of humerus. RESULTS: One thousand and twenty-seven example applications, it took average 50 s, 1 case was cured due to a combination of humerus surgical neck fracture. Eighty-six cases combined with greater tuberosity tore of humerus, 84 cases reached anatomical reattachment or nearly anatomical reattachment, 2 cases of large bone pieces instability were reduced by percutaneous needle. According to Neer score, there are 1 012 excellent cases, 15 good cases. CONCLUSION: Proneposition modified Hippocrates method is better than Hippocrates. It has the advantage of anesthesia, lower expense, short replacement, less pain, easier to master, and worth applying widely.