[Results following the implementation of a clinical pathway in the process of care to elderly patients with osteoporotic hip fracture in a second level hospital]. / Resultados tras la aplicación de una vía clínica en el proceso de atención al paciente geriátrico con fractura de cadera osteoporótica en un hospital de segundo nivel.

PURPOSE: To evaluate the efficiency of a clinical pathway in the management of elderly patients with fragility hip fracture in a second level hospital in terms of length of stay time to surgery, morbidity, hospital mortality, and improved functional outcome. MATERIAL AND METHODS: A comparative and prospective study was carried out between two groups of patients with hip fracture aged 75 and older prior to 2010 (n=216), and after a quality improvement intervention in 2013 (n=196). A clinical pathway based on recent scientific evidence was implemented. The degree of compliance with the implemented measures was quantified. RESULTS: The characteristics of the patients in both groups were similar in age, gender, functional status (Barthel Index) and comorbidity (Charlson Index). Median length of stay was reduced by more than 45% in 2013 (16.61 vs. 9.08 days, p=.000). Also, time to surgery decreased 29.4% in the multidisciplinary intervention group (6.23 vs. 4.4 days, p=.000). Patients assigned to the clinical pathway group showed higher medical complications rate (delirium, malnutrition, anaemia and electrolyte disorders), but a lower hospital mortality (5.10 vs. 2.87%, p>.005). The incidence of surgical wound infection (p=.031) and functional efficiency (p=.001) also improved in 2013. An increased number of patients started treatment for osteoporosis (14.80 vs. 76.09%, p=.001) after implementing the clinical pathway. CONCLUSION: The implementation of a clinical pathway in the care process of elderly patients with hip fracture reduced length of stay and time to surgery, without a negative impact on associated clinical and functional outcomes.

Giant cell tumor of the foot phalanges in children: a case report.

Giant cell tumor of the bone is infrequent in the phalanges of the toes and is extremely rare in children. A case of giant cell tumor of the proximal phalanx of the big toe on the left foot in a 12-year-old boy is reported. The tumor was treated by partial resection of the phalanx and repair of the osseous defect with an autologous iliac crest graft. A literature review showed few cases of giant cell tumor at this site.