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Background: The clinical effectiveness of multidisciplinary co-managed care for hip fracture patients in China has been demonstrated in a multicenter non-randomized controlled study. This study aims to estimate the cost-effectiveness of the co-managed care. Methods: The study is based on a multicenter clinical trial (n = 2071) in China. We developed a state transition microsimulation model to estimate the cost-effectiveness of the co-managed care compared with usual care for hip fracture patients from healthcare system perspective. The costs incorporated into the model included hospitalization costs, post-discharge expenses, and secondary fracture therapy costs. Effectiveness was measured using quality-adjusted life years (QALYs). Costs and effects were discounted at 5% annually. A simulation cycle length of 1-year and a lifetime horizon were employed. The cost-effectiveness threshold was established at USD 37,118. To address uncertainties, one-way deterministic sensitivity analysis and probabilistic sensitivity analysis were conducted. Findings: In the base case analysis, the co-managed care group had a lifetime cost of USD 31,571 and achieved an effectiveness of 3.22 QALYs, whereas the usual care group incurred a cost of USD 27,878 and gained 2.85 QALYs. The incremental cost-effectiveness ratio was USD 9981 per QALY gained; thus the co-managed care model was cost-effective. The cost-effectiveness was sensitive to the age of having hip fractures and hospitalization costs in the intervention group. Interpretation: The co-managed care in hip fracture patients represents value for money, and should be scaled up and prioritized for funding in China. Funding: The study is supported by Capital's Funds for Health Improvement and Research (2022-1-2071, 2018-1-2071).
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BACKGROUND: The displacement and rotation of the Kirschner wire (K-wire) in the traditional tension band wiring (TBW) led to a high rate of postoperative complications. The anti-rotation tension band wiring (ARTBW) could address these issues and achieve satisfactory clinical outcomes. This study aimed to investigate the biomechanical performance of the ARTBW in treating transverse patellar fracture compared to traditional TBW using finite element analysis (FEA) and mechanical testing. METHODS: We conducted a FEA to evaluate the biomechanical performance of traditional TBW and ARTBW at knee flexion angles of 20°, 45°, and 90°. Furthermore, we compared the mechanical properties under a 45° knee flexion through static tensile tests and dynamic fatigue testing. The K-wire pull-out test was also conducted to evaluate the bonding strength between K-wires and cancellous bone of two surgical approaches. RESULTS: The outcome of FEA demonstrated the compression force on the articular surface of ARTBW was 28.11%, 27.32%, and 52.86% higher than traditional TBW at knee flexion angles of 20°, 45°, and 90°, respectively. In mechanical testing, the mechanical properties of ARTBW were similar to the traditional TBW. In the K-wire pull-out test, the pull-out strength of ARTBW was significantly greater than the traditional TBW (111.58 ± 2.38 N vs. 64.71 ± 4.22 N, P < 0.001). CONCLUSIONS: The ARTBW retained the advantages of traditional TBW, and achieved greater compression force of articular surface, and greater pull-out strength of K-wires. Moreover, ARTBW effectively avoided the rotation of the K-wires. Therefore, ARTBW demonstrates potential as a promising technique for treating patellar fractures.
Subject(s)
Bone Wires , Finite Element Analysis , Fractures, Bone , Patella , Humans , Patella/surgery , Patella/injuries , Fractures, Bone/surgery , Fracture Fixation, Internal/methods , Fracture Fixation, Internal/instrumentation , Mechanical Tests/methods , Biomechanical Phenomena , Rotation , Male , Range of Motion, ArticularABSTRACT
OBJECTIVE: To evaluate the clinical effectiveness of orthogeriatric co-management care in long-lived elderly hip fracture patients (age ≥ 90). METHODS: Secondary analysis was conducted in long-lived hip fracture patients between 2018 to 2019 in 6 hospitals in Beijing, China. Patients were divided into the orthogeriatric co-management group (CM group) and traditional consultation mode group (TC group) depending on the management mode. With 30-day mortality as the primary outcome, multivariate regression analyses were performed after adjusting for potential covariates. 30-day mobility and quality of life were compared between groups. RESULTS: A total of 233 patients were included, 223 of whom completed follow-up (125 in CM group, 98 in TC group). The average age was 92.4 ± 2.5 years old (range 90-102). The 30-day mortality in CM group was significantly lower than that in TC group after adjustments for (2.4% vs. 10.2%; OR = 0.231; 95% CI 0.059 ~ 0.896; P = 0.034). The proportion of patients undergoing surgery and surgery performed within 48 h also favored the CM group (97.6% vs. 85.7%, P = 0.002; 74.4% vs. 24.5%, P < 0.001; respectively). In addition, much more patients in CM group could walk with or without aids in postoperative 30 days than in the TC group (87.7% vs. 60.2%, P < 0.05), although differences were not found after 1-year follow-up. And there was no significant difference in total cost between the two groups (P > 0.05). CONCLUSIONS: For long-lived elderly hip fracture patients, orthogeriatric co-management care lowered early mortality, improved early mobility and compared with the traditional consultation mode.
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Hip Fractures , Quality of Life , Aged , Humans , Aged, 80 and over , Prospective Studies , Hip Fractures/surgery , China , HospitalsABSTRACT
BACKGROUND: There is well-established evidence to understand the characteristics of falls among the older patients with hip fracture in many countries, but very little knowledge existed in China. This study described the characteristics of falls in older patients with hip fractures from six Chinese hospitals. METHODS: This cross-sectional study is a post-hoc descriptive analysis of a recently completed trial. Eligible patients were aged 65 years and older, with confirmed hip fractures due to falls, and were admitted to the hospital within 21 days of the fracture. All patients were consecutively enrolled and screened within one year (November 15, 2018, to November 14, 2019). The collected data included patient demographics and fall-related information. RESULTS: A total of 1,892 patients' fall-related information were described. Most patients with hip fractures caused by falls were in the oldest old age group (60.4% in age group ≥ 80), with an overall average age of 80.7 (7.6) years. There were more females (n = 1,325, 70.0%) than males (n = 567, 30.0%). The majority lived in urban (n = 1,409, 74.5%). Most falls (n = 1,237, 67.3%) occurred during the daytime (6:01-18:00). There were 1,451 patients had their falls occurring at home (76.7%). Lost balance (n = 1,031, 54.5%) was reported as the primary reason to cause falls. The most common activity during a fall was walking (n = 1,079, 57.0%). CONCLUSIONS: Although the incidence of fall-related hip fractures in China is unclear, preventing falls and fall-related hip fractures in older people remains an urgent health concern as the ageing society increases. Studies with larger sample size and diverse population are needed to robustly understand this growing epidemic.
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Hip Fractures , Male , Aged, 80 and over , Female , Humans , Aged , Cross-Sectional Studies , Hip Fractures/epidemiology , Hip Fractures/prevention & control , Walking , Hospitals , Risk FactorsSubject(s)
Patella Fracture , Tibial Fractures , Humans , Retrospective Studies , Fracture Fixation, InternalABSTRACT
Background: Patellar fracture is a common phenomenon observed in orthopedic clinics. Many methods have been shown to be effective in the fixation of patellar fracture. However, there are few studies on the antirotation effect of these methods. The purpose of this study is to present a new strategy of K-wire tension band therapy for patellar fracture and explore the antirotation effect of the modified tension band method on patellar fracture. Methods: A retrospective clinical observation study was conducted on 75 patients with patellar fracture. Totally, 46 patients were enrolled to the traditional group, who received the traditional K-wire tension band therapy. The modified group included 29 patients on whom our new strategy was implemented. The operation time, intraoperative blood loss, and fracture healing time were collected to compare the two operations and the knee society score (KSS) scores after the operations, and complications were recorded and retrieved to indicate the effectiveness of the two treatments. Results: The preoperative baseline data (gender, age, fracture types) of the two groups showed no significant statistical difference. Similarly, there was no significant difference in the operation time, intraoperative blood loss, and fracture healing time between the two groups. The KSS clinical scores 1 year after operation was 90 (84, 95) for the traditional group as compared with 99 (97, 100) for the modified group (p < 0.05). The KSS functional scores 1 year after operation in the two groups were 90 (65, 90) and 100 (90, 100) (p < 0.05). The incidences of complications due to the rotation of K-wires in the traditional group and the modified group were 76.1% (35 of 46) and 6.9% (2 of 29) with a significant statistical difference (p < 0.05). Conclusion: This study shows that our modified tension band therapy is an effective strategy for antirotation in the treatment of patellar fracture and proves that it can achieve better clinical outcomes than the traditional K-wire tension band method. This new strategy may be a safe and effective clinical technique for the treatment of patellar fracture. However, more prospective randomized controlled trials with larger sample sizes are still needed to further prove its efficacy.
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[This corrects the article DOI: 10.3389/fsurg.2021.756614.].
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BACKGROUND: Clinical guidelines recommend orthogeriatric care to improve older hip fracture patients' outcomes, but few studies have been conducted in China. This study evaluated the effects of an orthogeriatric co-management care model in six Chinese hospitals. METHODS: This non-randomised controlled study was designed as an exploratory trial and was conducted in 3 urban and 3 suburban hospitals. Eligible patients were aged ≥ 65 years with X-ray confirmed hip fracture and admitted to hospital within 21 days of injury. All patients received three times follow-ups within one year (1-month, 4-month and 12-month post admission). Co-management care was implemented in 1 urban hospital, while usual care continued in 5 urban and suburban hospitals. Patient demographics, pre-, peri- and post-operative information, complications and mortality were collected at baseline and follow-ups. The primary outcome was proportion of patients receiving surgery within 48 hours from ward arrival. Secondary outcomes included osteoporosis assessment, in-hospital rehabilitation, length of hospital stay, in-hospital mortality and one-year cumulative mortality. FINDINGS: There were 2,071 eligible patients enrolled (1,110 intervention, 961 control). Compared to usual care, a significantly higher proportion of intervention patients received surgery within 48 hours (75% vs 27%, p<0.0001), osteoporosis assessment (99.9% vs 60.6%, p<0.0001), rehabilitation (99.1% vs 3.9%, p<0.0001) and shorter length of hospital stay (6.1 days vs 12.0 days, p<0.0001). The intervention group saw a significant lower in-hospital mortality rate than the control group (adjusted relative risk 0.021, 95% CI 0.001 to 0.45, P=0.01). One-year cumulative mortality was also significantly reduced in the intervention group (hazard ratio 0.59, 95% CI 0.38 to 0.80, p=0.01). INTERPRETATION: Co-management care of older hip fracture patients resulted in better outcomes, including decreased time to surgery, improved clinical management, and reduced one-year mortality. A randomised controlled trial is needed to provide definitive evidence. FUNDING: The study is supported by Capital's Funds for Health Improvement and Research (2018-1-2071).
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Background: Intertrochanteric femur fractures, which are common geriatric osteoporotic fractures, have imposed a huge economic and social burden. This study clarified the global status of research on intertrochanteric fractures between 2001 and 2020 and predicted future research trends in this field using bibliometric and visualized studies. Methods: Publications related to intertrochanteric fractures were retrieved from the Web of Science (WoS) database. All studies were published between 2001 and 2020. Bibliometric and co-occurrence analyses were conducted using VoS viewer software. Results: In total, 2,632 studies were retrieved. The number of global publications regarding intertrochanteric fractures increased annually. The United States was the largest contributor, ranking first in total publications, citations, and the H-index. Switzerland had the highest average citation frequency among the 10 countries with the highest number of publications. The journal that published the most articles regarding intertrochanteric fractures was the Injury International Journal of The Care of The Injured, with 290 articles published. This journal also ranked first in the citation frequency. MJ Parker, an author, published the most papers in the field, and the University of California research team at San Francisco contributed the most publications in this field. During the co-occurrence analysis, all keywords were divided into four clusters: internal fixation study, complication study, risk-factor study, and survival and prognosis analysis study. The internal fixation and survival and prognosis analysis studies were predicted as the next hot topics in the field of intertrochanteric fractures. Conclusions: Intertrochanteric fractures are gaining increasing research attention according to the current global trend, and the number of publications regarding intertrochanteric hip fractures will continue to increase. The United States currently publishes the most articles on intertrochanteric fractures. The number of studies related to internal fixation, survival, and prognosis analysis is increasing, suggesting that these topics may become the next research hotspots in the area of intertrochanteric fractures.