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Artigo em Inglês | MEDLINE | ID: mdl-34100140


INTRODUCTION: An increasing number of patients sustaining a fragility hip fracture (FHF) have either an active diagnosis or a history of cancer. However, little is known about the outcomes of non-malignant related FHF in this group of patients. We aimed to evaluate the mortality and complications rates during hospitalization, as well as at 1-year follow-up within this population. METHODS: A retrospective cohort study of patients 65 years of age and above, who underwent surgery for the treatment of proximal femoral fractures between January 2012 and June 2016 was conducted. Patients diagnosed with malignancies, both solid (Carcinomas) and a hematological neoplasias (Lymphomas, Multiple Myeloma) were included, along with consecutive controls without a diagnosis of cancer in the 5 years prior to the study period. Demographic, clinical and radiographic parameters were recorded and analyzed. RESULTS: Seven hundred and fifty-two patients with FHF were included, of whom 51 had a malignancy diagnosis within the 5-year period preceding the fracture (18% metastatic disease). The mean time from malignancy diagnosis to FHF was 4.3 ± 4.8 years. Time to surgery did not differ between groups, and the vast majority of patients from both groups (over 87%) were operated within the desirable 48 h from admission. Patients with malignancy had a higher probability of being admitted to an internal medicine department both pre and post-surgically (p < 0.001), and were more susceptible to pre-operative anemia (p = 0.034). In-hospital mortality did not differ between groups, yet 1-year mortality was higher for the malignancy group (41.2% vs 19.5%, p < 0.001). At 1-year post-operatively, orthopedic complications were similar between groups. CONCLUSION: Patients with a history of malignancy in the 5-years prior to a non-neoplastic FHF, showed similar mortality and complications rates during admission but increased 1 year mortality rate when compared to patients without cancer undergoing surgical treatment of a non-neoplastic proximal femoral fracture.

Arch Orthop Trauma Surg ; 141(1): 39-44, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32361954


INTRODUCTION: Holocaust survivors (HS) were under an immense continues physical and mental stressors in their younger years, putting them at increased risk for both fragility hip fractures and worse medical and functional outcomes. We aimed to evaluate whether being a HS could affect the functional outcomes of fragility hip fractures in patients 80 years of age and older following surgery. MATERIALS AND METHODS: A retrospective study comparing consecutive patients, 80 years and older, who were operated for fragility hip fractures between 2011 and 2016. HS survival status was self-defined by survivors who were born in European and northern African countries that were later occupied by the Nazi regime during World War II and experienced incarceration in concentration camps, forced labor camps and mass transport. Primary outcomes were mortality either within hospital or in the post-operative year. Secondary outcomes were in-hospital complications, recurrent hospitalizations and orthopedic complications within the post-operative year. RESULTS: Two hundred thirty-one HS and 339 controls, ages 86.4 ± 4.4 years who were operated for fragility hip fracture between January 2011 to June of 2016 were included in the study. Patients from both groups were of similar age, Carlson's co-morbidity index score, leaving arrangement and pre-fracture mobility. Among HS there were more women (p = 0.029). HS did not have lower survival rates either within hospital or in the post- operative year. Both length of stay and in-hospital complication rates were similar between groups. In the post-operative year, HS were less likely to be hospitalized than controls (p = 0.021). The rate of orthopedic complications was also similar. CONCLUSIONS: Holocaust survivors patients do not achieve worse outcome following fragility hip fracture surgery and present distinctive resilience.

Fraturas do Quadril , Holocausto , Idoso de 80 Anos ou mais , Comorbidade , Feminino , Fraturas do Quadril/epidemiologia , Fraturas do Quadril/mortalidade , Fraturas do Quadril/cirurgia , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Sobreviventes , Resultado do Tratamento
Harefuah ; 159(11): 797-803, 2020 Nov.
Artigo em Hebraico | MEDLINE | ID: mdl-33210849


BACKGROUND: Several demographic and medical factors have an established effect on mortality and function after hip fractures, however varying fracture characteristics and surgical factors have been less thoroughly investigated. The study assessed the impact of specific fracture patterns on mortality and mobility one year post hip fracture. Other surgical factors including the type of intervention, major complications and sequential fractures were assessed as well. METHODS: An institutional hip fracture registry was reviewed. Mobility status scores were calculated one year post-operatively. RESULTS: Thirty days mortality was 4.6% and one year mortality was 19.9%. There was no significant effect of fracture type on mortality. However, patients receiving hemiarthroplasty had a significantly higher mortality (28.1%) than other patients receiving internal fixation (18.6%) or total hip arthroplasty (4%). An increased mobility status after intra-capsular fractures over extracapsular fractures was demonstrated. Patients receiving total hip arthroplasty had significantly better mobility at one year than patients with fracture fixation or hemiarthroplasty. Major complications and sequential fractures had no significant effect on outcome. CONCLUSIONS: Critical factors that influence decision making for orthopedic surgeons are revealed to have a lesser effect on the patient's ultimate outcome.

Artroplastia de Quadril , Hemiartroplastia , Fraturas do Quadril , Artroplastia de Quadril/efeitos adversos , Fixação Interna de Fraturas , Fraturas do Quadril/cirurgia , Humanos , Amplitude de Movimento Articular
Isr Med Assoc J ; 20(9): 553-556, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30221868


BACKGROUND: Mortality and decrease in function after hip fracture are significantly related to patient factors including age, gender, co-morbidities, and mental status. Several studies demonstrated ethnic disparities in incidence, mortality, and functional outcome after hip fractures in the United States. OBJECTIVES: To assess the relationship between ethnicity and hip fracture incidence and outcomes of mortality, functional change, and perioperative complications in the Israeli population. METHODS: We reviewed our institutional hip fracture registry for all patients from 2014-2015. Patients with incomplete data, < 60 years of age, or pathologic and periprosthetic fractures were excluded. Our study comprised 693 patients. Ethnicity was based on country of birth. Specifically, for those born in Israel, the nationality of either Jewish or Arab was further dichotomized. Perioperative complications, mortality, and mobility status at 1 year follow-up were recorded. The ethnicities of 27,130 patients admitted to the medicine and surgical wards during the same time interval served as a control group for the hip fracture cohort. RESULTS: Immigrants from Europe and America had the highest incidence of hip fractures. Fracture types varied in incidence in groups with 70% of extracapsular hip fractures occurring in Arabs and immigrants from Eastern countries, compared to 60% in immigrants from Western countries and the former Soviet Union. Mortality, perioperative complications, and mobility at 1 year were similar in all ethnic groups. CONCLUSIONS: Our study demonstrated significant differences in incidence and fracture characteristic among ethnicities, but no difference in patient outcome. These findings differed from the available North American studies.

Emigrantes e Imigrantes/estatística & dados numéricos , Grupos Étnicos/estatística & dados numéricos , Fraturas do Quadril/etnologia , Fraturas do Quadril/mortalidade , Recuperação de Função Fisiológica , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Incidência , Israel/epidemiologia , Masculino , Pessoa de Meia-Idade , Sistema de Registros , Estudos Retrospectivos
Injury ; 48(7): 1584-1588, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28465007


INTRODUCTION: Hip fractures in the elderly are a major cause of morbidity and mortality. The treatment settings of these patients may change their outcomes. The aim of this study is to compare the outcomes of patients with displaced femoral neck fractures who were admitted to the orthopedic vs. geriatric wards. PATIENTS AND METHODS: A retrospective study was conducted on 217 consecutive older patients with 219 displaced femoral neck fractures admitted either to the orthopedic or the geriatric ward between Jan. 2013 and Jun. 2015. Information regarding demographic, medical history, surgical management, hospitalization, and one year readmissions and mortality data was retrieved from electronic charts. RESULTS: 102 hemiarthroplasty patients were admitted to the orthopedic ward and 117 to the geriatric ward. Patients' characteristics, including age, living arrangements, mobility status and the Charlson Comorbidity Index were similar between groups. Patients from the orthopedic ward had shorter hospitalization time (9±5.1 vs. 10.8±6.7days, p=0.022) and presented a lower in-hospital complication rates (0.6±0.96 vs. 1±1.9, p=0.022), namely fewer events of urinary retentions, urinary tract infections and pneumonias (8.8% vs. 23.9%, p=0.004, 3.9% vs. 14.5%, p=0.010 and 2.9% vs. 12.2%, p=0.034, respectfully). Readmission rates were similar. Neither in hospital nor one year mortality rates differed between groups. CONCLUSIONS: Our study found that geriatric care was not superior to orthopedic directed management in the treatment of elderly patients with hip fractures in terms of in-hospital complications, and hospitalization times.

Fraturas do Colo Femoral/reabilitação , Enfermagem Geriátrica , Hemiartroplastia/reabilitação , Hospitalização , Enfermagem Ortopédica , Complicações Pós-Operatórias , Idoso de 80 Anos ou mais , Feminino , Fraturas do Colo Femoral/enfermagem , Fraturas do Colo Femoral/cirurgia , Avaliação Geriátrica , Enfermagem Geriátrica/normas , Humanos , Masculino , Enfermagem Ortopédica/normas , Avaliação de Resultados em Cuidados de Saúde , Complicações Pós-Operatórias/enfermagem , Complicações Pós-Operatórias/reabilitação , Estudos Retrospectivos
Germs ; 3(1): 8-13, 2013 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-24432280


INTRODUCTION: The history of HIV/AIDS in Romania is different compared to the rest of the world. Here, the vast majority of HIV-positive patients have been infected since infancy and have been receiving HAART treatment for at least ten years. This situation is a unique environment to check for long-term cardiac involvement in HIV-positive patients with a long evolution of the infection. METHODS: A group of 40 HIV-positive patients were randomly selected to undergo an echocardiogram to check for cardiac involvement. Data collection took place at the National Institute for Infectious Diseases "Prof.Dr. Matei Bals" in Bucharest, Romania, from September 2011 to February 2012. Patients were examined and compared based on cardiovascular risk factors and disease risk factors described in field literature, including: age, gender, blood pressure, lipid profile, glucose, HbA1c, lifestyle habits, time from infection, duration of treatment and drug class use. RESULTS: The median age of patients was 23, with a mean time from infection of 20.85 years and a duration of treatment of 15.9 years. Out of the 40 patients included in the study, 15 (37.5%) had cardiac involvement such as hyperkinetic syndrome, hypertrophy, atheroma, pulmonary hypertension or overlapping syndromes. The main risk factors were: male gender (OR 3.187, 90%CI 1.038-9.779), high cholesterol (>200 mg/dL) or smoking (OR 2.538, 90%CI 0.789-8.163), with a high risk for cardiac involvement in patients that were smokers and also had high levels of cholesterol (OR 5.75, 90%CI 1.263-26.169). CONCLUSION: An important aspect of this study is that both major risk factors identified are modifiable to an extent, and while cholesterol levels can be controlled with lipid-lowering medication, smoking can be stopped with or without replacement therapy. We need to stress on the importance of smoke-reducing policies and, particularly, encouraging young patients to not start smoking.