EPIDEMIOLOGICAL PROFILE OF PROXIMAL FEMORAL FRACTURES IN OLDER ADULTS AT THE REGIONAL HOSPITAL IN COTIA - SP, BRAZIL.

Objective: To identify the epidemiological profile of older patients with proximal femoral fractures treated at the Hospital Regional de Cotia, SP - Brazil, and describe the nutritional status of these patients. Methods: Data were obtained from the electronic patient medical records from August 2020 to April 2021. The variables studied were age, gender, ethnicity, weight and height (for BMI calculation), and presence of comorbidities. Fracture circumstances were also assessed, including trauma mechanism, anatomical location, and treatment. Moreover, the nutritional profile of patients was assessed using the Mini Nutritional Assessment (MAN). Results: Most patients were white women, with a mean age of 80 years and an average BMI of 23.55 kg/m2. Almost all patients suffered the fracture at home and the most common comorbidities were systemic arterial hypertension, diabetes mellitus, and Alzheimer's disease. Most patients were considered to be malnourished or at risk of malnutrition. Conclusion: The nutritional status of older adults seems to be directly related to the risk of proximal fractures of the femur. Level of Evidence II, Retrospective Study.

Objetivo: Traçar o perfil epidemiológico dos pacientes idosos com fratura de fêmur proximal atendidos no Hospital Regional de Cotia - SP, além de descrever o estado nutricional desses pacientes. Método: As informações para confecção deste trabalho foram obtidas a partir dos prontuários eletrônicos dos pacientes atendidos no período agosto de 2020 a abril de 2021. As variáveis estudadas foram: idade, sexo, etnia, peso e altura (para cálculo do índice de massa corporal - IMC) e presença de comorbidades. Também foram avaliadas as circunstâncias da fratura, tais como mecanismo do trauma, localização anatômica e tratamento instituído. Ainda, avaliou-se o perfil nutricional dos pacientes por meio da Mini Avaliação Nutricional (Mini-MAN). Resultados: Predominaram pacientes do sexo feminino, brancas, com média de 80 anos de idade e IMC médio de 23,55 kg/m 2 . Quase todos os pacientes se acidentaram em casa, e as comorbidades mais observadas foram hipertensão arterial sistêmica, diabetes mellitus e doença de Alzheimer. A grande maioria dos pacientes foi considerada desnutrida ou em risco de desnutrição. Conclusão: O estado nutricional dos idosos parece estar diretamente relacionado ao risco de fraturas proximais do fêmur. Nível de Evidência II, Estudo Retrospectivo.

Epidemiological profile of proximal femoral fractures in older adults at the regional hospital in cotia - sp, brazil / Perfil epidemiológico em fratura de fêmur proximal de idosos no hospital regional de cotia - sp

ABSTRACT Objective: To identify the epidemiological profile of older patients with proximal femoral fractures treated at the Hospital Regional de Cotia, SP - Brazil, and describe the nutritional status of these patients. Methods: Data were obtained from the electronic patient medical records from August 2020 to April 2021. The variables studied were age, gender, ethnicity, weight and height (for BMI calculation), and presence of comorbidities. Fracture circumstances were also assessed, including trauma mechanism, anatomical location, and treatment. Moreover, the nutritional profile of patients was assessed using the Mini Nutritional Assessment (MAN). Results: Most patients were white women, with a mean age of 80 years and an average BMI of 23.55 kg/m2. Almost all patients suffered the fracture at home and the most common comorbidities were systemic arterial hypertension, diabetes mellitus, and Alzheimer's disease. Most patients were considered to be malnourished or at risk of malnutrition. Conclusion: The nutritional status of older adults seems to be directly related to the risk of proximal fractures of the femur. Level of Evidence II, Retrospective Study.

RESUMO Objetivo: Traçar o perfil epidemiológico dos pacientes idosos com fratura de fêmur proximal atendidos no Hospital Regional de Cotia - SP, além de descrever o estado nutricional desses pacientes. Método: As informações para confecção deste trabalho foram obtidas a partir dos prontuários eletrônicos dos pacientes atendidos no período agosto de 2020 a abril de 2021. As variáveis estudadas foram: idade, sexo, etnia, peso e altura (para cálculo do índice de massa corporal - IMC) e presença de comorbidades. Também foram avaliadas as circunstâncias da fratura, tais como mecanismo do trauma, localização anatômica e tratamento instituído. Ainda, avaliou-se o perfil nutricional dos pacientes por meio da Mini Avaliação Nutricional (Mini-MAN). Resultados: Predominaram pacientes do sexo feminino, brancas, com média de 80 anos de idade e IMC médio de 23,55 kg/m 2 . Quase todos os pacientes se acidentaram em casa, e as comorbidades mais observadas foram hipertensão arterial sistêmica, diabetes mellitus e doença de Alzheimer. A grande maioria dos pacientes foi considerada desnutrida ou em risco de desnutrição. Conclusão: O estado nutricional dos idosos parece estar diretamente relacionado ao risco de fraturas proximais do fêmur. Nível de Evidência II, Estudo Retrospectivo.

A comparative study of "plasmacup" and "porous-coated" acetabular components: survival after 10 to 12 years of follow-up.

OBJECTIVES: Our primary aim was to compare the long-term survivorship rates and the rates of successful osseointegration between two different types of uncemented acetabular components. INTRODUCTION: Two types of alloys have primarily been used for the manufacture of the uncemented acetabular components: titanium-based and cobalt-based alloys. A titanium-based alloy appears to be more effective with regard to interface stress transfer to the host bone because of its lower elastic modulus relative to a cobalt-based alloy. This supposed mechanical advantage of a titanium-based alloy component motivated this comparative study. METHODS: Two uncemented acetabular components, a porous-coated acetabulum and a Plasmacup®, were compared with a focus on long-term prosthesis survivorship and the development of acetabular osseointegration. Five radiographic signs of osseointegration were evaluated at the last follow-up appointment: (1) absence of radiolucent lines, (2) presence of a superolateral buttress, (3) medial stress-shielding, (4) radial trabeculae, and (5) an inferomedial buttress. We considered the presence of any three of these radiographic signs, in the absence of acetabular dislocation or symptoms, to be indicative of successful acetabular osseointegration. RESULTS: Among 70 patients implanted with the porous-coated acetabulum, 80% achieved osseointegration over a mean follow-up time of 11.9 years versus 75.3% of the 73 patients who received a Plasmacup insert over a mean of 10.7 years. Prosthesis survivorship rates were not different between the two groups. Revision surgery due to mild or severe acetabular osteolysis, polyethylene wear, and aseptic loosening occurred in eight patients (11.4%) with a PCA versus nine (12.3%) with a Plasmacup. CONCLUSIONS: We conclude that, during the first ten years after surgery, there is no significant difference between these two types of uncemented cups with regard to either prosthesis survivorship or successful osseointegration.

A comparative study of "plasmacup" and "porous-coated" acetabular components: survival after 10 to 12 years of follow-up

OBJECTIVES: Our primary aim was to compare the long-term survivorship rates and the rates of successful osseointegration between two different types of uncemented acetabular components. INTRODUCTION: Two types of alloys have primarily been used for the manufacture of the uncemented acetabular components: titanium-based and cobalt-based alloys. A titanium-based alloy appears to be more effective with regard to interface stress transfer to the host bone because of its lower elastic modulus relative to a cobalt-based alloy. This supposed mechanical advantage of a titanium-based alloy component motivated this comparative study. METHODS: Two uncemented acetabular components, a porous-coated acetabulum and a Plasmacup®, were compared with a focus on long-term prosthesis survivorship and the development of acetabular osseointegration. Five radiographic signs of osseointegration were evaluated at the last follow-up appointment: (1) absence of radiolucent lines, (2) presence of a superolateral buttress, (3) medial stress-shielding, (4) radial trabeculae, and (5) an inferomedial buttress. We considered the presence of any three of these radiographic signs, in the absence of acetabular dislocation or symptoms, to be indicative of successful acetabular osseointegration. RESULTS: Among 70 patients implanted with the porous-coated acetabulum, 80 percent achieved osseointegration over a mean follow-up time of 11.9 years versus 75.3 percent of the 73 patients who received a Plasmacup insert over a mean of 10.7 years. Prosthesis survivorship rates were not different between the two groups. Revision surgery due to mild or severe acetabular osteolysis, polyethylene wear, and aseptic loosening occurred in eight patients (11.4 percent) with a PCA versus nine (12.3 percent) with a Plasmacup. CONCLUSIONS: We conclude that, during the first ten years after surgery, there is no significant difference between these two types of uncemented cups with regard to either prosthesis survivorship or successful osseointegration.

Epidemiologia das lesões traumáticas de alta energia em idosos / Epidemiology of high-energy trauma injuries among the elderly

O aumento proporcional de idosos na população mundial associado à melhoria nas condições de saúde e suporte preventivo para essa faixa etária, permite forma de vida mais ativa, expondo-os a risco mais elevado de acidentes e traumas de alta energia. Esses pacientes têm características fisiológicas, doenças associadas, padrão comportamental e complicações pós-operatórias que levam a resposta sistêmica diferente dos demais grupos etários. Esse trabalho avaliou prospectivamente 28 pacientes com idade superior a 65 anos - 16 mulheres e 12 homens. O mecanismo de trauma mais prevalente foi atropelamento, resultando principalmente, em fraturas dos membros inferiores. O tempo de internação foi superior ao de pacientes de faixas etárias inferiores e 90 por cento dos casos apresentaram algum tipo de complicação clínica após a osteossíntese. A idade age isoladamente como fator preditivo positivo para tais complicações no paciente politraumatizado. As doenças prévias e a idade dos doentes não influenciaram o desenvolvimento de complicações ortopédicas. As lesões associadas às fraturas apresentaram correlação com o mecanismo de trauma. Estes pacientes normalmente precisam ser operados para tratamento definitivo de suas fraturas. O fato de serem mais idosos e apresentarem doenças anteriormente ao acidente não aumenta o período pré-cirúrgico.

The increasing proportion of elderly people in the world's population, together with improvements in their health status and the preventive support for this age group, have allowed them to have more active lifestyles, which have exposed them to higher risks of high-energy accidents and trauma. These patients have physiological characteristics, associated diseases, behavioral patterns and postoperative complications that lead to different systemic responses from those on other age groups. This study prospectively evaluated 28 patients aged over 65 years - 16 women and 12 men. The most prevalent trauma mechanism was trampling, which mainly resulted in leg fractures. The period of hospitalization for these patients was greater than in younger age groups, and 90 percent of the cases presented some type of clinical complication following osteosynthesis. Age alone acted as a positive predictive factor for such complications among patients with multiple traumas. Previous diseases and patients' ages did not have any influence on the development of orthopaedic complications. The injuries associated with the fractures presented a correlation with the trauma mechanism. These patients usually require surgery for definitive treatment of their fractures. Being older and presenting diseases prior to the accident did not increase the length of time before surgery.

[Desire for information and participation in therapeutic decisions concerning severe diseases, in patients of a university hospital]. / Desejo de informação e participação nas decisões terapêuticas em caso de doenças graves em pacientes atendidos em um hospital universitário.

BACKGROUND: The purpose of our study was to evaluate the desire of the patients on being informed about diagnosis of severe diseases, the desire to have their families informed about this situation and to participate in therapeutic decisions. METHODS: 363 patients (outpatients and inpatients) of a General Internal Medicine division of a University Hospital were interviewed. The questionnaire contained specific questions on their desire to be informed of the diagnosis in case of cancer or AIDS and on their desire to have their families informed as well. Specific questions on whether they wanted to be informed of and participate of the therapeutic discussion process in case of abdominal tumors were also included. RESULTS: 96.1% of men and 92.6% of women showed the desire of being informed in case of cancer diagnosis and 87.7% of men and 84.2% of women wanted to have their families informed, 94.2% of men and 91% of women wanted to know the diagnosis of AIDS. While 86% of women and 76.6% of men wanted be informed in the case of a diagnosis of an abdominal tumor, only 58.5% of women and 39.6% of men wanted to give their opinion about in the case of different therapeutic alternatives. The desire to participate in therapeutic decisions was significantly lower (p<0.05) in men, people older than 60 years and inpatients. CONCLUSIONS: Our results showed that the great majority of the population that seeks for medical support in a Brazilian university hospital wishes to be informed on this health condition, even in case of serious illness. In addition, there are intense familiar bonds that make patients want to have their families also informed.

Desejo de informação e participação nas decisões terapêuticas em caso de doenças graves em pacientes atendidos em um hospital universitário / Desire of information and participation in therapeutic decisions concerning severe diseases, in patients of a University Hospital

OBJETIVO: Avaliar o desejo de pacientes serem informados sobre diagnóstico de doenças graves, de informação às suas famílias e de participação nas decisões terapêuticas. MÉTODOS: 363 pessoas atendidas no ambulatório ou internadas na enfermaria de um serviço universitário de Clínica Geral foram entrevistadas. O questionário continha perguntas sobre desejo de ser informado e de que familiares também fossem informados em casos de diagnósticos de câncer e síndrome da imunodeficiência adquirida (Aids) e de ser informado e participar de decisões terapêuticas em caso de tumores abdominais. RESULTADOS: Homens (96,1 por cento) e mulheres (92,6 por cento) mostraram desejo de serem informados do diagnóstico de câncer e 87,7 por cento dos homens e 84,2 por cento das mulheres desejaram que sua família também fosse informada; 94,2 por cento dos homens e 91 por cento das mulheres afirmaram querer saber do diagnóstico de Aids. Enquanto 86 por cento das mulheres e 76,6 por cento dos homens mostraram desejo de serem informados das opções terapêuticas em caso de tumor abdominal, apenas 58,5 por cento das mulheres e 39,6 por cento dos homens desejaram opinar sobre o tratamento. O desejo de participar das decisões terapêuticas foi menor nos homens, nas pessoas com mais de 60 anos e em quem estava internado (p<0.05). CONCLUSÕES: A grande maioria da população que procura um hospital universitário deseja ser informada sobre suas condições de saúde, incluindo eventuais diagnósticos de doenças graves. Por outro lado, existem vínculos familiares intensos, sendo que os pacientes desejam, também, que suas famílias sejam informadas.