RESUMO
BACKGROUND: The management of the valgus-impacted neck of femur fracture (AO/OTA 31-B1) remains contentious. The objective of this study was to determine whether operative intervention is cost-effective. METHODS: We conducted a systematic review using electronic databases (Medline, Embase, Cochrane, Ebsco, Scholar) identifying studies published in the English language concerning valgus-impacted neck of femur fractures until June 2022. Additional studies were identified through hand searches of major orthopaedic journals, and bibliographies of major orthopaedic textbooks. MeSH terms (hip fracture and femoral neck fracture) and keywords (undisplaced, valgus-impacted, valgus, subcapital, Garden) connected by the Boolean operators "AND" and "OR" were used to identify studies. 2 reviewers independently extracted the data using standardised forms and recording spreadsheet. Methodological validity prior to inclusion in the review using standardized critical appraisal instruments from the Joanna Briggs Institute Meta-analysis of Statistics Assessment and Review Instrument. Meta-analysis was undertaken. Outcome measures were rate of displacement, avascular necrosis, non-union, mortality and requirement of further operative intervention. A cost utility analysis was then conducted to compare the 2 groups on the basis of the cost of initial treatment and the potential requirement of secondary intervention to hemiarthroplasty. RESULTS: 47 studies met the inclusion criteria. Meta-analysis data demonstrated a significant difference in the displacement rate of 22.8% and 2.8% between the nonoperative and internal fixation groups respectively (p = 0.05). The overall incidence of further operative intervention for each group was 23% and 10% respectively. There was no significant difference with respect to avascular necrosis, mortality or union rates. The cost utility analysis revealed nonoperative management to be approximately 60% more costly than initial internal fixation when the costs of subsequent surgery were included. CONCLUSIONS: This meta-analysis of the existing literature concludes that whilst nonoperative management is possible for valgus impacted neck of femur fractures, it is associated with higher complication rates and greater expense than management by internal fixation.
Assuntos
Fraturas do Colo Femoral , Fixação Interna de Fraturas , Humanos , Fraturas do Colo Femoral/cirurgia , Fraturas do Colo Femoral/economia , Fraturas do Colo Femoral/terapia , Fixação Interna de Fraturas/economia , Fixação Interna de Fraturas/métodos , Análise Custo-BenefícioRESUMO
The incidence rates of hip fracture have been increasing in Japan. Length of stay among hip fracture patients in Japan is much longer than other developed countries, and the Japanese government introduced financial incentives for regionally coordinated femoral neck fracture care to reduce health care resource utilization. The objective of this study was to evaluate whether the financial incentives reduce health care resource utilization among patients 75 years or older with femoral neck fracture in Japan. Claims data from the Fukuoka Prefecture Regional Association for Late-Stage Healthcare for Older People were analyzed for the period from April 2010 to March 2016. The authors identified 4641 eligible subjects after femoral neck fracture surgery, and categorized them into groups based on care pathways: coordinated care, integrated care, and other. Length of stay by care phase and total charges were used as measures of health care resource utilization. The models showed that coordinated and integrated care were significantly associated with shorter length of stay during perioperative care: coordinated care, multiplicative effect, 0.90 (P < 0.001); integrated care, 0.77 (P < 0.001). However, only integrated care was associated with shorter rehabilitation and overall length of stay: 0.66 (P < 0.001) in rehabilitation; 0.70 (P < 0.001) in overall duration. Integrated care also was associated with lower total charges: 0.70 (P < 0.001). Current financial incentives for regionally coordinated femoral neck fracture care do not affect health care resource utilization. Further health care reforms should be implemented to promote effective regional care coordination in Japan.
Assuntos
Demandas Administrativas em Assistência à Saúde , Continuidade da Assistência ao Paciente , Fraturas do Colo Femoral , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Demandas Administrativas em Assistência à Saúde/economia , Demandas Administrativas em Assistência à Saúde/estatística & dados numéricos , Idoso de 80 Anos ou mais , Continuidade da Assistência ao Paciente/economia , Continuidade da Assistência ao Paciente/estatística & dados numéricos , Feminino , Fraturas do Colo Femoral/economia , Fraturas do Colo Femoral/epidemiologia , Fraturas do Colo Femoral/terapia , Humanos , Japão/epidemiologia , Masculino , Estudos RetrospectivosRESUMO
BACKGROUND: We examined trends in the treatment of femoral neck fractures over the last two decades. METHODS: We used Medicare Part A administrative data to identify patients hospitalized for closed femoral neck fracture from 1991 to 2008. We used codes from the International Classification of Diseases, Ninth Revision, to categorize treatment as nonoperative, internal fixation, hemiarthroplasty, and total hip arthroplasty. We examined differences in treatment according to hospital hip fracture volume, hospital location (rural or urban), and teaching status. RESULTS: Our sample consisted of 1,119,423 patients with intracapsular hip fractures occurring from 1991 to 2008. We found a generally stable trend over time in the percentage of patients managed with nonoperative treatment, internal fixation, hemiarthroplasty, and total hip arthroplasty. We found little difference in surgical treatment across different groups of hospitals (high volume compared with low volume, urban compared with rural, and teaching compared with nonteaching). The percentage of acute care hospitals treating hip fractures remained fairly constant (74.8% in 1991 to 1993 and 69.0% in 2006 to 2008). The median number of hip fractures treated per hospital did not change (thirty-three in 1991 to 1993 and thirty-three in 2006 to 2008). There was no increase in the percentage of fractures treated in high-volume hospitals over time (57.7% in 1991 to 1993 and 57.1% in 2006 to 2008) and little reduction in the percentage of fractures treated in low-volume hospitals (5.8% in 1991 to 1993 and 5.5% in 2006 to 2008). CONCLUSIONS: There has been little change in the trends of operative and nonoperative treatment for proximal femoral fractures over the last two decades, and there was little evidence of regionalization of hip fracture treatment to higher-volume hospitals.
Assuntos
Fraturas do Colo Femoral/cirurgia , Hospitais/tendências , Medicare/tendências , Ortopedia/tendências , Feminino , Fraturas do Colo Femoral/terapia , Humanos , Masculino , Resultado do Tratamento , Estados UnidosRESUMO
OBJECTIVE: To analyze various clinical parameters of elderly hip fractures so as to improve the management of elder hip fractures in China. METHODS: The data of elder patients with hip fracture (primary diagnosis was fracture of femoral neck or intertrochanter) admitted into our department between 2002 to 2010 were collected. And the relevant clinical parameters included case number, age, ratio of concurrent chronic disease and duration and cost of hospitalization. The software of SAS was used for statistical analysis. RESULTS: A total of 1626 patients (M/F = 547/1079) ≥ 65 yr old with femoral neck fracture were admitted. Average age was 74.7 ± 6.4 yr (65 - 99) and annual average increasing rate 0.5% (-0.1% - 1.8%). The ratio of concurrent chronic disease was 53.3%. Average duration of hospitalization was 18.3 ± 10.9 days (1 - 114) and annual average increasing rate was -6.3% (-19.2% - 8.4%). Average cost of hospitalization was 38 758.04 ± 24 558.15 yuan (76.8 - 339 987.49) and annual average increasing rate 6.4% (-8.7% - 40.0%). A total of 892 patients (M/F = 362/530) ≥ 65 yr with femoral intertrochanteric fracture were admitted. Average age was 76.7 ± 6.8 yr (65 - 105) and annual average increasing rate 1.3% (-1.8% - 4.3%). The ratio of concurrent chronic disease was 55.8%. Average duration of hospitalization was 15.7 ± 8.7 days (1 - 78) and annual average increasing rate -4.5% (-22.1% - 8.0%). Average cost of hospitalization was 35 183.45 ± 21 427.47 yuan (75.3 - 148 150.41) and annual average increasing rate 18.3% (-3.7% - 79.9%). CONCLUSION: The number, age and therapeutic cost of elder patients with hip fracture are increasing continuously. Elderly hip fracture is becoming a serious problem of public health.
Assuntos
Fraturas do Quadril/economia , Fraturas do Quadril/terapia , Idoso , Idoso de 80 Anos ou mais , Honorários Médicos , Feminino , Fraturas do Colo Femoral/economia , Fraturas do Colo Femoral/terapia , Hospitalização/economia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
Hip hemiarthroplasties are frequently performed for displaced femoral neck fractures. The purpose of this study was to identify the costs associated with cementless and cemented hemiarthroplasties, compare operative times, and identify complications. The hypothesis was that cementless hemiarthroplasties cost less than cemented hemiarthroplasties, require less operative time, and have fewer perioperative complications. A retrospective review was conducted of 2 surgeons' patients admitted for displaced femoral neck fractures between 2006 and 2010. Group 1 included 45 patients who underwent monopolar hemiarthroplasties with cementless femoral components via a standard posterior approach by a single surgeon. Group 2 included 49 patients who underwent monopolar hemiarthroplasties with cemented femoral components via a modified lateral approach by a single surgeon. Surgical and anesthesia times and the cost of implants and accessories were recorded. The cost for cementless components was $3275.60 (femoral stem, $2800; monopolar head, $400; sleeve, $75.60), whereas the cost of cemented components was $3694.47 (femoral stem, $1800; monopolar head, $400; sleeve, $75.60, 3 Simplex with tobramycin cement packets, $1221; cement mixer/irrigator with tip/centralizer and plug/pressurizer, $197.87), a cost savings of 12.7% ($418.87). Operative time was significantly reduced in group 1 vs group 2 (mean, 32.9 vs 56.1 minutes, respectively; P<.01). Anesthesia time was also significantly reduced in group 1 (mean, 82.3 vs 102.9 minutes, respectively; P<.01). The difference in mean anesthetic times demonstrates an overall cost savings of 18.6%, or $1161.30. No difference in complications was noted between the groups perioperatively. Regional cost variances, vendor-hospital contracts, and surgeons' operative times are factors that may influence cost savings. This study demonstrates significantly lower operative and anesthetic times and observable cost savings with cementless femoral implants.
Assuntos
Artroplastia de Quadril/economia , Fraturas do Colo Femoral/economia , Fraturas do Colo Femoral/terapia , Fraturas Mal-Unidas/economia , Fraturas Mal-Unidas/terapia , Custos de Cuidados de Saúde/estatística & dados numéricos , Idoso de 80 Anos ou mais , Artroplastia de Quadril/estatística & dados numéricos , Cimentos Ósseos/economia , Cimentos Ósseos/uso terapêutico , Feminino , Fraturas do Colo Femoral/epidemiologia , Fraturas Mal-Unidas/epidemiologia , Humanos , Masculino , New Mexico/epidemiologia , Prevalência , Resultado do TratamentoRESUMO
Proximal femoral fractures (PFFs) are a major health concern in the elderly population. Improvements made in implants and surgical techniques resulted in faster rehabilitation and shorter length of hospital stay. Despite this, the reduced physiological reserve, associated co-morbidities and polypharmacy intake of the elderly population put them at high risk of postoperative complications particularly of infectious origin. Out of 10061 patients with proximal femoral fractures 105 (1.05%) developed surgical site infection; 76 (72%) infections occurred in patients who had sustained intracapsular (IC) fractures with the remaining 29 (28%) infections occurring in patients with extracapsular (EC) neck of femur fractures. The median number of additional surgical debridements was 2 (range 1-7). MRSA was isolated in 49 (47%) of the cases; 38 patients (36%) ultimately underwent a Girdlestone's excisional arthroplasty. Mortality at 30 days and 3 months was 10% and 31%, respectively. It was noted that post-operative hip infection predisposed to a prolonged length of stay in the acute unit and subsequently to a more dependent destination after discharge.
Assuntos
Fraturas do Fêmur/cirurgia , Complicações Pós-Operatórias/terapia , Infecção da Ferida Cirúrgica/terapia , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Feminino , Fraturas do Fêmur/epidemiologia , Fraturas do Colo Femoral/epidemiologia , Fraturas do Colo Femoral/cirurgia , Fraturas do Colo Femoral/terapia , Custos de Cuidados de Saúde , Fraturas do Quadril/epidemiologia , Fraturas do Quadril/cirurgia , Fraturas do Quadril/terapia , Humanos , Tempo de Internação , Masculino , Complicações Pós-Operatórias/epidemiologia , Reoperação , Infecção da Ferida Cirúrgica/epidemiologiaRESUMO
BACKGROUND: Major obstacles to operative treatment of elderly patients with femoral neck fractures frequently encountered in clinical practice include poor overall health, lack of consent to have an operation, and general medical or anaesthesiological contraindications. In such cases, conservative treatment is the only possibility. This aims at maximally improving the patient's functional status, an approach best termed "movement-oriented patient management". MATERIAL AND METHODS: The study population consisted of 51 patients (31 F, 20 M) with femoral neck fractures in whom surgery was contraindicated. The patients took part in a movement-oriented management programme. The study consisted in evaluating movement abilities, self-care and locomotion of the patients using the Harris and Lazansky scales. Patients were evaluated twice: at discharge from hospital and at three months after discharge. RESULTS: In patients assessed using the Lazansky score, Evaluation 1 revealed 88% poor results and 12% satisfactory results, compared to 63% poor results and 37% satisfactory results at evaluation 2. Harris scores did not differ between Evaluations 1 and 2, with 100% of the patients achieving the lowest scores. CONCLUSIONS: 1) The study population of patients with femoral neck fractures in whom surgery was contraindicated did not demonstrate a definite improvement or deterioration of their functional status following "movement-oriented management"; 2) "movement-oriented management" cannot be regarded as having any effect on change in functional status, which should therefore be improved using a more beneficial method of treatment.
Assuntos
Atividades Cotidianas , Artroplastia de Quadril , Terapia por Exercício/métodos , Fraturas do Colo Femoral/terapia , Nível de Saúde , Idoso , Contraindicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Inquéritos e Questionários , Resultado do TratamentoAssuntos
Fraturas do Colo Femoral/terapia , Reestruturação Hospitalar/organização & administração , Unidades Hospitalares/organização & administração , Gestão da Qualidade Total/organização & administração , Atividades Cotidianas , Benchmarking , Inglaterra , Necessidades e Demandas de Serviços de Saúde , Humanos , Decoração de Interiores e Mobiliário , Tempo de Internação/estatística & dados numéricos , Modelos de Enfermagem , Papel do Profissional de Enfermagem , Enfermagem Ortopédica/organização & administração , Indicadores de Qualidade em Assistência à SaúdeAssuntos
Custos de Cuidados de Saúde , Osteoporose/economia , Osteoporose/terapia , Redução de Custos/economia , Fraturas do Colo Femoral/economia , Fraturas do Colo Femoral/etiologia , Fraturas do Colo Femoral/prevenção & controle , Fraturas do Colo Femoral/terapia , Humanos , Dor Lombar/economia , Dor Lombar/etiologia , Dor Lombar/prevenção & controle , Dor Lombar/terapia , Osteoporose/complicações , Osteoporose/diagnóstico , Fraturas da Coluna Vertebral/economia , Fraturas da Coluna Vertebral/etiologia , Fraturas da Coluna Vertebral/prevenção & controle , Fraturas da Coluna Vertebral/terapiaAssuntos
Fraturas do Colo Femoral/terapia , Fraturas Espontâneas/terapia , Fraturas do Quadril/terapia , Osteoporose/complicações , Acidentes por Quedas/economia , Acidentes por Quedas/prevenção & controle , Artroplastia de Quadril/economia , Artroplastia de Quadril/normas , Efeitos Psicossociais da Doença , Análise Custo-Benefício , Fraturas do Colo Femoral/economia , Fraturas do Colo Femoral/etiologia , Fixação Interna de Fraturas/economia , Fraturas Espontâneas/economia , Fraturas Espontâneas/etiologia , Custos de Cuidados de Saúde , Fraturas do Quadril/economia , Fraturas do Quadril/etiologia , Humanos , Osteoporose/economia , Garantia da Qualidade dos Cuidados de Saúde/economiaRESUMO
As in many countries, a significant increase in the number of hip fractures is predicted due to the demographic changes in the population. To reduce the consequences for the patients and the social costs, hip protectors are considered to be effective in reducing the impact force on the hip and so to reduce the risk of hip fractures. The effectiveness of hip protectors has been investigated as well in experimental impact tests as in clinical studies, but there is still an uncertainty about their mechanical protection effect. Therefore, laboratory tests are an effective way to investigate the mechanical behaviour of hip protectors. A fracture is initiated by exceeding an ultimate compressive or tensile stress. In our model, stresses in the femoral neck are estimated by using the Euler beam formula. A standard femur was defined consisting of all mechanical parameters that have been identified to influence the mechanical resistance to external loads, such as the effective cross-sectional area (CSA), cross-sectional moment of inertia (CSMI), femoral neck width (FNW), centre of mass and other geometric parameters of the femur. In this study the necessary formulae as well as first results of assessing hip protectors on the basis of stresses in the femoral neck are presented. The results show that the methodology facilitates assessment and improvement of hip protectors, as the biomechanical parameters of real femora are the basis of the model.
Assuntos
Fenômenos Biomecânicos/métodos , Fraturas do Colo Femoral/patologia , Fraturas do Colo Femoral/terapia , Colo do Fêmur/patologia , Engenharia Biomédica/métodos , Estudos de Avaliação como Assunto , Fêmur/patologia , Humanos , Teste de Materiais , Modelos Estatísticos , Falha de Prótese , Equipamentos de Proteção , Reprodutibilidade dos Testes , Risco , Estresse Mecânico , Fatores de TempoAssuntos
Análise Custo-Benefício , Osteoporose/economia , Osteoporose/terapia , Idoso , Idoso de 80 Anos ou mais , Feminino , Fraturas do Colo Femoral/economia , Fraturas do Colo Femoral/terapia , Fraturas de Estresse/economia , Fraturas de Estresse/terapia , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Fraturas da Coluna Vertebral/economia , Fraturas da Coluna Vertebral/terapiaRESUMO
We performed a retrospective analysis of all patients admitted to a single unit over 4 years with fractured neck of femur. Of the 760 patients admitted over this period of time 36 (4.7%) were found to also have a fracture of the upper limb. The associated upper limb fractures were distal radius (n=28), olecranon (n=2) and neck of humerus (n=5) and fifth metacarpal (n=1), with the same ratio of intracapsular to extracapsular fractures as the whole group. The female to male ratio in the isolated hip fracture group was 2.4:1 and for the combined fractures group was 8:1 (difference P=0.014). The mean patient age was 77.3 years for isolated hip fractures and 83.9 for the combined group (P=0.037). The mean total length of stay in hospital for isolated hip fracture was 15.6 days and for combined fractures was 20.4 days (P=0.010). We have demonstrated that combined upper limb and neck of femur fractures occur in a population that is older and predominantly female. They are associated with a significant increase in hospital stay and increased difficulties in mobilisation as a consequence of the combined fractures. It is therefore important to recognise this specific subgroup of patients presenting with hip fractures in order to ensure that they receive adequate treatment and rehabilitation and that the use of valuable health care resources are optimised.
Assuntos
Traumatismos do Braço/complicações , Fraturas do Colo Femoral/complicações , Traumatismo Múltiplo/terapia , Acidentes por Quedas , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Traumatismos do Braço/terapia , Feminino , Fraturas do Colo Femoral/terapia , Humanos , Fraturas do Úmero/complicações , Fraturas do Úmero/terapia , Tempo de Internação , Masculino , Fraturas do Rádio/complicações , Fraturas do Rádio/terapia , Estudos Retrospectivos , Fatores de Risco , Distribuição por SexoAssuntos
Resgate Aéreo , Cooperação Internacional , Transporte de Pacientes , Resgate Aéreo/economia , Fraturas do Fêmur/cirurgia , Fraturas do Fêmur/terapia , Fraturas do Colo Femoral/cirurgia , Fraturas do Colo Femoral/terapia , Humanos , Satisfação do Paciente , Transporte de Pacientes/economia , ViagemRESUMO
This study developed a method for the construction of hospital markets in a metropolitan area, focusing on users of the Unified Health System (SUS) with hip fractures and admitted to municipal hospitals in Rio de Janeiro in 1994-1995. The study used a spatial smoothing technique based on a Kernel (quartic) estimate for constructing areas of care for each hospital and subsequently for hospital markets. Areas of the city were presented where there was a market domain and a secondary domain for treating patients with hip fractures. Hospital market analysis can help health planners organize resources in the health care system.
Assuntos
Fraturas do Colo Femoral/terapia , Setor de Assistência à Saúde/estatística & dados numéricos , Características de Residência/estatística & dados numéricos , Brasil , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Hospitalização , Hospitais Públicos/estatística & dados numéricos , Hospitais Urbanos/estatística & dados numéricos , Humanos , Marketing de Serviços de SaúdeRESUMO
BACKGROUND: The number of publications evaluating economic and social aspects of the treatment of proximal femur fractures increased steadily in the last 20 years in the foreign literature. Due to the absence of similar studies in the domestic literature the authors decided to investigate this issue in the Czech Republic and to present outcomes. The aim of the presented study is to inform about the costs of treatment of patients with proximal femur fractures in an orthopaedic department and estimate the costs of such treatment on a nationwide scale. METHODS AND RESULTS: A detailed follow up of 244 patients treated for a proximal femur fracture was carried out at the Orthopaedic Clinic of the 3rd Medical Faculty and Faculty Hospital, Královské Vinohrady in 1997, including economic aspects and the fate of patients after their discharge from the hospital in the course of one year after their injury or surgery. The average cost of primary treatment of a patient in this group amounted to 38,000 Kc, on a nation-wide scale this sum totalled 29,000. The obtained results were compared with national data acquired from the Institute of Health Care Informations and Statistics and from the General Health Insurance Company. The monitored group accounted for 2% of the national group of patients with this diagnosis. CONCLUSIONS: Exact data on the costs of primary treatment of patients with a proximal femur fracture were obtained only in the monitored group of our patients, in 1997 these costs amounted to 9,389,848 CZK. The costs in the whole Czech Republic may be only estimated at approximately 450 million CZK.
Assuntos
Custos de Cuidados de Saúde , Fraturas do Quadril/economia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Fraturas do Colo Femoral/economia , Fraturas do Colo Femoral/terapia , Fraturas do Quadril/terapia , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
To evaluate the differences between the outcome of elderly patients with severe injuries and that of their contemporaries with a less severe injury, we reviewed 42 severely injured elderly patients and compared them with 76 patients with a femoral neck fracture. We analysed the influence of injury severity and host factors (age, sex and pre-injury medical status) on outcome. The in-hospital mortality rate was 31 per cent in the severely injured patients and 3 per cent in those with a femoral neck fracture. Home was the main discharge destination in the severely injured elderly (34 per cent) and a nursing home in patients with a femoral neck fracture (65 per cent). Functional outcome 1 year after injury was better in the severely injured elderly group. Long-term survival was mainly determined by host factors and not by injury severity. Physicians and policy makers should be careful in predicting the outcome of elderly injured patients merely on the basis of injury severity, because host factors are of greater importance.
Assuntos
Traumatismo Múltiplo/terapia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Estudos de Avaliação como Assunto , Feminino , Fraturas do Colo Femoral/mortalidade , Fraturas do Colo Femoral/reabilitação , Fraturas do Colo Femoral/terapia , Seguimentos , Custos de Cuidados de Saúde , Humanos , Escala de Gravidade do Ferimento , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Traumatismo Múltiplo/mortalidade , Traumatismo Múltiplo/reabilitação , Fatores Sexuais , Taxa de Sobrevida , Resultado do TratamentoRESUMO
A retrospective analysis of 41 adult patients treated for a femoral neck fracture was performed to determine the variables that best predict total hospital charges. The patients were treated for an isolated femoral neck fracture at our hospital from January 1993 through December 1994. There were 13 men and 28 women. The average age at the time of injury was 63 years. The average length of stay was 12.1 days, and the average total hospital charges per patient were $16,072. No physician fees were included in our analysis. Detailed multivariate regression analysis of 10 variables was performed for each patient. Stepwise linear regression analysis, which controlled for all variable (such as age at injury, number of medical illnesses, gender, and others), revealed that the strongest predictors of total hospital charges were the number of medical illnesses (P < 0.0001), age at injury (P = 0.023), length of stay (P < 0.0001), and number of complications (P = 0.0007).
Assuntos
Fraturas do Colo Femoral/economia , Preços Hospitalares , Tempo de Internação , Complicações Pós-Operatórias/economia , Adulto , Idoso , Idoso de 80 Anos ou mais , Custos e Análise de Custo , Feminino , Fraturas do Colo Femoral/fisiopatologia , Fraturas do Colo Femoral/terapia , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Complicações Pós-Operatórias/fisiopatologia , Estudos RetrospectivosRESUMO
Twenty-three consecutive children with isolated closed femur fractures treated with early spica casts were studied to determine the impact of this treatment on family, school, and other support systems. Mobility was identified by families as the major problem. In families with two working parents, a mean of 3 weeks time off work was needed. None of the children was accepted into school in cast. Home tutoring for a mean of 8 weeks was used, with 48 tutor-hours per child. Despite this, none of the children fell permanently behind their class, and only two temporarily. No child required physical therapy beyond instruction in walking, and 12 had no physical therapy at all. Mean time to independent walking was 5 days and to running, 25 days; skills returned faster in younger children. All aspects of spica treatment were easier for preschool children. This study highlights some of the adaptations necessary with this treatment method and aids in advance planning.