Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 782
Filtrar
1.
Ann Intern Med ; 174(1): JC9, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33395342

RESUMO

SOURCE CITATION: Black DM, Geiger EJ, Eastell R, et al. Atypical femur fracture risk versus fragility fracture prevention with bisphosphonates. N Engl J Med. 2020;383:743-53. 32813950.


Assuntos
Fraturas do Fêmur , Fraturas por Osteoporose , Difosfonatos/efeitos adversos , Feminino , Fraturas do Fêmur/induzido quimicamente , Fraturas do Fêmur/epidemiologia , Fêmur , Humanos , Fraturas por Osteoporose/induzido quimicamente , Fraturas por Osteoporose/epidemiologia
2.
Rev Assoc Med Bras (1992) ; 66(12): 1702-1706, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33331580

RESUMO

OBJECTIVES: To describe the incidence by gender and region, lethality, and costs associated with the treatment of femoral fractures in the elderly (≥ 60 years) hospitalized in the Unified Health System (SUS) of Brasil between 2008 and 2018. METHODS: This is a cross-sectional, descriptive, retrospective study of hospitalizations of elderly people due to femoral fractures by analyzing secondary data obtained from the SUS Hospital Information System (SIH/SUS) between 2008 and 2018; for calculation of epidemiological coefficients, we used information from demographic censuses (2000 and 2010) of the Brazilian Geography and Statistics Institute (IBGE). RESULTS: A total of 478,274 hospitalizations were recorded in the period; the incidence was 1.7 times higher in females (overall average of 274.91/100,000 for women and 161/100,000 for men). The Southeast region had the highest absolute number of hospitalizations and the South region presented the highest annual overall average incidence (224.02/100,000). The average annual cost for SUS for the treatment of femoral fractures in the elderly was R$ 99,718,574.30. CONCLUSIONS: In the evaluated period (2008-2018), femoral fractures in the elderly had a high incidence (478,274 hospitalizations; 224.02 cases/100,000 elderly), a predominance of females (1.7F/1.0M), a higher absolute number of hospitalizations in the Southeast region and a higher incidence in the South region; the lethality was high (an increase of 17.46%; overall mean coefficient of 4.99%/year); and the costs for the SUS were huge (an increase of 126.24%; average annual expenditure of R$ 99,718,574.30).


Assuntos
Fraturas do Fêmur , Idoso , Brasil/epidemiologia , Estudos Transversais , Feminino , Fraturas do Fêmur/epidemiologia , Hospitalização , Humanos , Incidência , Masculino , Estudos Retrospectivos
3.
J Orthop Trauma ; 34(10): e389-e397, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32947590

RESUMO

Fifty-eight percent of the total infections in Italy of COVID-19 were found in northern Italy, in particular, Lombardy. From February 21, 2020, to March 23, 2020, 20 patients with a fracture and a diagnosis of COVID-19 were hospitalized. Demographic data, COVID-19 symptoms, laboratory and radiographic examinations, and treatment methods were recorded. At 1-month follow-up, patients were assessed with the SF-36 score. This case series includes 20 patients (16 women and 4 men), with an average age of 82.35 years (range 59-95). Eleven patients (55%) had a femur fracture. Fourteen patients (70%) had 3 or more comorbidities or previous pathologies. Three patients with severe comorbidities died during the hospitalization. Thirteen patients (65%) had fever, 18 patients (90%) asthenia, and 17 patients (85%) dyspnea. All patients (100%) were given antibiotic therapy, whereas 16 patients (80%) underwent hydroxychloroquine therapy and 8 (40%) were treated with corticosteroids. Eighteen patients (90%) underwent antithromboembolic prophylaxis. Eighteen patients (90%) had lymphopenia. All 20 patients (100%) required noninvasive mechanical ventilation. High D-dimer and polymerase chain reaction values were found in all patients (100%), whereas lactate dehydrogenase was increased in 18 patients (90%). Patients with fractures, especially in the lower limbs, frequently require hospitalization, making these patients more subjected to the risk of COVID-19 infection. COVID-19 infection therefore does not seem to influence the fracture pattern in the elderly population but can lead to health deterioration with increased mortality. The typical symptoms of COVID-19 disease have not changed when associated with a fracture or trauma. Laboratory data are in line with what is reported in recent studies, whereas a more invasive assisted ventilation is associated with a poor prognosis. Finally, analyzing the data obtained from the SF-36 score, significantly lower values emerged when compared with those reported in the literature. LEVEL OF EVIDENCE:: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Gerenciamento Clínico , Fraturas do Fêmur/cirurgia , Fixação de Fratura/métodos , Pneumonia Viral/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Infecções por Coronavirus/complicações , Infecções por Coronavirus/terapia , Feminino , Fraturas do Fêmur/diagnóstico , Fraturas do Fêmur/epidemiologia , Seguimentos , Humanos , Incidência , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/terapia , Prognóstico , Radiografia , Estudos Retrospectivos , Fatores de Tempo
4.
J Biol Regul Homeost Agents ; 34(3 Suppl. 2): 77-81, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32856444

RESUMO

Proximal femur fractures are increasing, together with the aging of world population. One of the complications worsening this condition is infection. In this study, we try to identify risk factors that can lead to infection. We identified 122 patients with femoral neck fracture. The occurrence of infectious events were recorded (respiratory, urinary, superficial wound and periprostethic infection). There were 15 infections, mostly urinary and pulmonary, and all were treated using antibiotics. No statistical differences were found between infection and control group regarding waiting time for surgery, mean time of surgery, age, kind of fracture, type of surgery. Fever onset >38° within 72 hours from surgery was statistically correlated with early infections. Future studies must be led to identify risk factors for infection and to create a strategy to prevent this possibly lethal complication.


Assuntos
Fraturas do Fêmur , Infecções , Fraturas do Fêmur/epidemiologia , Fêmur , Fixação Interna de Fraturas , Humanos , Estudos Retrospectivos , Fatores de Risco
5.
N Engl J Med ; 383(8): 743-753, 2020 08 20.
Artigo em Inglês | MEDLINE | ID: mdl-32813950

RESUMO

BACKGROUND: Bisphosphonates are effective in reducing hip and osteoporotic fractures. However, concerns about atypical femur fractures have contributed to substantially decreased bisphosphonate use, and the incidence of hip fractures may be increasing. Important uncertainties remain regarding the association between atypical femur fractures and bisphosphonates and other risk factors. METHODS: We studied women 50 years of age or older who were receiving bisphosphonates and who were enrolled in the Kaiser Permanente Southern California health care system; women were followed from January 1, 2007, to November 30, 2017. The primary outcome was atypical femur fracture. Data on risk factors, including bisphosphonate use, were obtained from electronic health records. Fractures were radiographically adjudicated. Multivariable Cox models were used. The risk-benefit profile was modeled for 1 to 10 years of bisphosphonate use to compare associated atypical fractures with other fractures prevented. RESULTS: Among 196,129 women, 277 atypical femur fractures occurred. After multivariable adjustment, the risk of atypical fracture increased with longer duration of bisphosphonate use: the hazard ratio as compared with less than 3 months increased from 8.86 (95% confidence interval [CI], 2.79 to 28.20) for 3 years to less than 5 years to 43.51 (95% CI, 13.70 to 138.15) for 8 years or more. Other risk factors included race (hazard ratio for Asians vs. Whites, 4.84; 95% CI, 3.57 to 6.56), height, weight, and glucocorticoid use. Bisphosphonate discontinuation was associated with a rapid decrease in the risk of atypical fracture. Decreases in the risk of osteoporotic and hip fractures during 1 to 10 years of bisphosphonate use far outweighed the increased risk of atypical fracture among Whites but less so among Asians. After 3 years, 149 hip fractures were prevented and 2 bisphosphonate-associated atypical fractures occurred in Whites, as compared with 91 and 8, respectively, in Asians. CONCLUSIONS: The risk of atypical femur fracture increased with longer duration of bisphosphonate use and rapidly decreased after bisphosphonate discontinuation. Asians had a higher risk than Whites. The absolute risk of atypical femur fracture remained very low as compared with reductions in the risk of hip and other fractures with bisphosphonate treatment. (Funded by Kaiser Permanente and others.).


Assuntos
Conservadores da Densidade Óssea/efeitos adversos , Difosfonatos/efeitos adversos , Fraturas do Fêmur/induzido quimicamente , Fraturas do Quadril/prevenção & controle , Osteoporose Pós-Menopausa/tratamento farmacológico , Fraturas por Osteoporose/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Americanos Asiáticos , Conservadores da Densidade Óssea/uso terapêutico , Difosfonatos/uso terapêutico , Grupo com Ancestrais do Continente Europeu , Feminino , Fraturas do Fêmur/epidemiologia , Fraturas do Fêmur/etnologia , Fraturas do Quadril/epidemiologia , Humanos , Incidência , Pessoa de Meia-Idade , Análise Multivariada , Osteoporose Pós-Menopausa/complicações , Fraturas por Osteoporose/induzido quimicamente , Fraturas por Osteoporose/epidemiologia , Modelos de Riscos Proporcionais , Medição de Risco , Fatores de Risco , Fatores de Tempo
6.
J Pediatr Orthop ; 40(6): 277-282, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32501908

RESUMO

BACKGROUND: Isolated pediatric femur fractures have historically been treated at local hospitals. Pediatric referral patterns have changed in recent years, diverting patients to high volume centers. The purpose of this investigation was to assess the treatment location of isolated pediatric femur fractures and concomitant trends in length of stay and cost of treatment. METHODS: A cross-sectional analysis of surgical admissions for femoral shaft fracture was performed using the 2000 to 2012 Kids' Inpatient Database. The primary outcome was hospital location and teaching status. Secondary outcomes included the length of stay and mean hospital charges. Polytrauma patients were excluded. Data were weighted within each study year to produce national estimates. RESULTS: A total of 35,205 pediatric femoral fracture cases met the inclusion criteria. There was a significant shift in the treatment location over time. In 2000, 60.1% of fractures were treated at urban, teaching hospitals increasing to 81.8% in 2012 (P<0.001). Mean length of stay for all hospitals decreased from 2.59 to 1.91 days (P<0.001). Inflation-adjusted total charges increased during the study from $9499 in 2000 to $25,499 in 2012 per episode of treatment (P<0.001). Total charges per hospitalization were ∼$8000 greater at urban, teaching hospitals in 2012. CONCLUSIONS: Treatment of isolated pediatric femoral fractures is regionalizing to urban, teaching hospitals. Length of stay has decreased across all institutions. However, the cost of treatment is significantly greater at urban institutions relative to rural hospitals. This trend does not consider patient outcomes but the observed pattern appears to have financial implications. LEVEL OF EVIDENCE: Level III-case series, database study.


Assuntos
Fraturas do Fêmur , Hospitais Rurais/economia , Hospitais de Ensino/economia , Inovação Organizacional/economia , Criança , Análise Custo-Benefício , Estudos Transversais , Bases de Dados Factuais/estatística & dados numéricos , Feminino , Fraturas do Fêmur/economia , Fraturas do Fêmur/epidemiologia , Fraturas do Fêmur/cirurgia , Hospitalização/economia , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Estados Unidos
9.
Enferm. clín. (Ed. impr.) ; 30(supl.5): 151-156, jun. 2020. tab
Artigo em Inglês | IBECS | ID: ibc-196657

RESUMO

OBJECTIVE: To evaluate the effectiveness of pre-operative exercise of muscle strength before surgery, maintains muscle strength and prepare early postoperative ambulation lower limb fracture. METHOD: Design research was a quasi-experiment with control and post-test only (unpaired t-test) with 28 respondents (14 respondents intervention group and 14 respondents control group). The intervention group was given muscle strength exercise before surgery, for ±1 week. Every day patients do strength exercise 3 times a day, for ±5-10min. The post-operative assessment was conducted in both groups with Modified Level of Assistance Scale (MILAS), to find out the difference in the ability to do early ambulation. RESULTS: The results of the independent t-test were significant differences of ambulation ability of the intervention group were better than the control group. The difference in average ambulation ability after operation between the intervention group and the control group, the average ambulation ability of respondents in the intervention group was 14.14 with a standard deviation (SD=2.93), while for the control group, the average ambulation ability was 18.50 with the standard deviation (SD=5.56). Statistical test results obtained p-value of 0.017 (α<0.005), meaning that at alpha 5% a significant difference was seen in the average ability of early ambulation between respondents in the intervention group and the control group. CONCLUSION: There is evidence to suggest that pre-operative exercise of muscle strength is beneficial to early ambulation postoperative lower limb fracture


No disponible


Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Resultado do Tratamento , Período Pré-Operatório , Força Muscular/fisiologia , Deambulação Precoce/métodos , Exercício Físico , Fraturas do Fêmur/epidemiologia , Fraturas da Tíbia/epidemiologia , Extremidade Inferior/lesões , Análise Multivariada , Hospitalização
10.
Medicine (Baltimore) ; 99(8): e19195, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32080105

RESUMO

RATIONALE: Less-Invasive Stabilization System (LISS) plate is an internal fixation commonly used for the periprosthetic distal femur fractures. Failure associated with LISS plate has been rarely reported, and the reasons for LISS plate failure are multitudinous. Various advantages have been reported, but failures continue. PATIENT CONCERNS: We present 3 cases illustrating the failure of Less-Invasive Stabilization System (LISS) plating for periprosthetic distal femur fractures. The shaft screws of the LISS plate broke in 2 cases, and the plate placement was incorrect in 1 case. Early weight bearing, obesity, osteoporosis, and lateral collateral ligament injury due to incorrect plate placement constituted the etiologies of LISS plate failure. DIAGNOSIS: Failure of Less-Invasive Stabilization System (LISS) plating for periprosthetic distal femur fractures after Total knee arthroplasty. INTERVENTIONS: Three patients underwent Less-Invasive Stabilization System plates removal with replacement of the total knee arthroplasty revision surgery with rotating hinged knee prosthesis. OUTCOMES: After completing the total knee arthroplasty revision surgery, all patients underwent regular follow-up examinations. Case 2 could walk unaided, without pain, final union was confirmed for both case 1 and case 3. CONCLUSION: Less-Invasive Stabilization System (LISS) plate provides satisfactory results in periprosthetic fractures after Total knee arthroplasty (TKA). The LISS plate has many advantages, but failures continue to occur. The causes for failure were early weight bearing, obesity, osteoporosis, and lateral collateral ligament (LCL) injury due to incorrect plate placement in our series. We recommend that protection or properly delay of weight-bearing, active anti-osteoporosis treatment, and intraoperative fluoroscopy are the effective methods to avoid failure.


Assuntos
Placas Ósseas/efeitos adversos , Fraturas do Fêmur/cirurgia , Fixação Interna de Fraturas/efeitos adversos , Fixação Interna de Fraturas/métodos , Fraturas Periprotéticas/cirurgia , Idoso , Artroplastia do Joelho/métodos , Falha de Equipamento , Feminino , Fraturas do Fêmur/epidemiologia , Humanos , Obesidade/epidemiologia , Osteoporose/epidemiologia , Fraturas Periprotéticas/epidemiologia , Suporte de Carga/fisiologia
11.
Surgeon ; 18(1): 19-23, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31196725

RESUMO

INTRODUCTION: The demand for joint arthroplasty has risen as our elderly population increases and ages. With this so to has the number of patients suffering periprosthetic fractures (PPF). The aim of our study was to quantify the burden of PPF and provide an up to date reference of the epidemiology of PPF in Ireland. We also sought to assess length of stay (LOS), resource utilisation and mortality associated with this cohort of patients. METHODS: An eleven-year retrospective observational study was conducted of a consecutive series of patients treated for a femoral PPF. Costs were obtained from activity based tariffs provided by the hospital inpatient enquiry system and mortality was confirmed using the national death events publication system. RESULTS: Over the 11-year study period 174 procedures for a femoral PPF were performed. Mean age of patients was 77.6 years (SD 11.1 years) with 44.7% male. Median ASA grade was 3 (range 1-4) and mean LOS was 19 days. There was a 700% increase in patients undergoing surgery for a PPF over the study period. The mean cost of care was €24,413 in 2017. Thirty-day mortality was 2.9% while one-year mortality was 12.4%. CONCLUSIONS: PPF occur in an elderly comorbid cohort of patients. Care of these patients now makes up a considerable part of the orthopaedic workload and consumes a significant portion of healthcare resources. Patients should be treated in tertiary referral centres with surgeons skilled in their management. Better access to rehabilitation is needed.


Assuntos
Artroplastia de Quadril/efeitos adversos , Fraturas do Fêmur/epidemiologia , Previsões , Fraturas Periprotéticas/epidemiologia , Idoso , Feminino , Seguimentos , Humanos , Incidência , Irlanda/epidemiologia , Masculino , Estudos Retrospectivos
12.
Acta Orthop ; 91(1): 109-114, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31795876

RESUMO

Background and purpose - Knee fracture treatment burden remains unknown, impeding proper use of hospital resources. We examined 20-year trends in incidence rates (IRs) and patient-, fracture-, and treatment-related characteristics of knee fracture patients.Patients and methods - This nationwide cohort study of prospectively collected data including patients with distal femoral, patellar, and proximal tibial fractures from the Danish National Patient Registry during 1998-2017, assesses IRs of knee fractures (per 105 inhabitants) as well as patient-, fracture-, and treatment-related characteristics of knee fracture patients.Results - During 1998-2017, 60,823 patients (median age 55; 57% female) sustained 74,106 knee fractures. 74% of the study population had a Charlson Comorbidity Index (CCI) of 0 and 18% a CCI of ≥ 2. 51% were proximal tibial fractures, 31% patellar fractures, and 18% distal femoral fractures. At the time of knee fracture, 20% patients had concomitant near-knee fractures (femur/tibia/fibula shaft/hip/ankle), 13% concomitant fractures (pelvic/spine/thorax/upper extremities), 5% osteoporosis, and 4% primary knee osteoarthritis. Over 1/3 knee fractures were surgically treated and of these 86% were open-reduction internal fixations, 9% external fixations, and 5% knee arthroplasties. The most common surgery type was proximal tibia plating (n = 4,868; 60% female). Knee fracture IR increased 12% to 70, females aged > 51 had the highest knee fracture IR, proximal tibial fracture had the highest knee fracture type IR (32) and surgically treated knee fracture IR increased 35% to 23.Interpretation - Knee fracture IRs, especially of surgically treated knee fractures, are increasing and proximal tibial fracture has the highest knee fracture type IR. Females aged > 51 and patients with comorbidity are associated with knee fracture, proximal tibial fracture, proximal tibial fracture surgery, and posttraumatic knee arthroplasty.


Assuntos
Fraturas do Fêmur/epidemiologia , Fraturas Múltiplas/epidemiologia , Traumatismos do Joelho/epidemiologia , Patela/lesões , Fraturas da Tíbia/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Artroplastia do Joelho , Placas Ósseas , Criança , Pré-Escolar , Estudos de Coortes , Dinamarca/epidemiologia , Feminino , Fraturas do Fêmur/cirurgia , Fixação Interna de Fraturas , Fraturas Múltiplas/cirurgia , Humanos , Incidência , Lactente , Recém-Nascido , Traumatismos do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Redução Aberta , Patela/cirurgia , Crescimento Demográfico , Fraturas da Tíbia/cirurgia , Adulto Jovem
13.
Arch Orthop Trauma Surg ; 140(8): 1037-1045, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31845060

RESUMO

PURPOSE: To compare the outcomes of simple versus complicated femoral shaft fracture (FSF) treated by early intramedullary nail. METHODS: Retrospective cohort study in level 1 trauma center including patients with FSF. Management consisted of intramedullary nailing (IMN) after adequate resuscitation within 24 h. Data were prospectively collected on admission (trauma base) consisted of demographics, biological parameters, associated injuries and injury severity score (ISS). Complicated fractures consisted of type C fracture or any type associated with bilateral femur fracture, floating knee, associated femoral neck fracture, dislocated hip, concomitant neurovascular injury. Simple fractures were Isolated type A and B fracture. Simple and complicated fracture groups were compared using stratification by ISS (ISS < 16; 16 ≤ ISS < 25; ISS ≥ 25). RESULTS: Inclusion of 191 consecutive patients: simple FSF (N = 109) versus complicated FSF (N = 82) (type 32C, n = 36; bilateral, n = 44; associated neck of femur fracture, n = 15; floating knee, n = 36; concomitant femoral artery injury, n = 3 or sciatic nerve injury, n = 7). Complicated fractures were associated with higher rate of associated injuries (thoracic, 56.1 vs. 40.4%, p = 0.04; head 25.6 vs 10.1%, p = 0.005) and ARDS (12.2% vs. 3.7%, p = 0.046); longer ICU stay (12.8 vs. 7.3 days, p = 0.019) and hospital stay (24.3 vs. 15.7 days, p < 0.001). After stratification, differences in morbidity between simple and complicated FSF were significant solely in range 16≤ISS < 25. Complicated fractures had longer operation duration (297 vs. 151 min, p < 0.001) due to additional IMN (tibial, humeral) requirements (24% vs. 1.8%, p < 0.001) and longer femoral IMN duration (133 vs. 104 min, p < 0.05). Pseudarthrosis was higher in complicated fracture group (9.6 vs. 3.7%, p = 0.002). CONCLUSION: Complicated femoral fractures are associated with higher morbidity, especially in less severely injured polytrauma, which eventually results in longer hospital stay. Patients with moderate ISS and complicated fracture may have an increased risk of ARDS.


Assuntos
Fraturas do Fêmur , Fixação Intramedular de Fraturas , Fraturas do Fêmur/complicações , Fraturas do Fêmur/epidemiologia , Fraturas do Fêmur/cirurgia , Fêmur/cirurgia , Humanos , Escala de Gravidade do Ferimento , Tempo de Internação/estatística & dados numéricos , Estudos Retrospectivos
15.
JAMA Netw Open ; 2(12): e1917141, 2019 12 02.
Artigo em Inglês | MEDLINE | ID: mdl-31825502

RESUMO

Importance: Androgen deficiency is common among male opioid users, and opioid use has emerged as a common antecedent of testosterone treatment. The long-term health outcomes associated with testosterone therapy remain unknown, however. Objective: To compare health outcomes between long-term opioid users with testosterone deficiency who filled testosterone prescriptions and those with the same condition but who did not receive testosterone treatment. Design, Setting, and Participants: This cohort study focused on men in the care of the Veterans Health Administration (VHA) facilities throughout the United States from October 1, 2008, to September 30, 2014. It included male veterans who were long-term opioid users, had low testosterone levels (<300 ng/dL), and received either a testosterone prescription or any other prescription. It excluded male patients with HIV infection, gender dysphoria, or prostate cancer and those who received testosterone in fiscal year 2008. Data were analyzed from April 1, 2017, to April 30, 2019. Exposure: Prescription for testosterone. Main Outcomes and Measures: All-cause mortality and incidence of major adverse cardiovascular events (MACE), vertebral or femoral fractures, and anemia during the 6-year follow-up through September 30, 2015. Results: After exclusions, 21 272 long-term opioid users (mean [SD] age, 53 [10] years; n = 16 689 [78.5%] white) with low total or free testosterone levels were included for analysis, of whom 14 121 (66.4%) received testosterone and 7151 (33.6%) did not. At baseline, compared with opioid users who did not receive testosterone, long-term opioid users who received testosterone treatment were more likely to have obesity (43.7% vs 49.0%; P < .001), hyperlipidemia (43.0% vs 48.8%; P < .001), and hypertension (53.9% vs 55.2%; P = .07) but had lower prevalence of coronary artery disease (15.9% vs 12.9%; P < .001) and stroke (2.4% vs 1.3%; P < .001). After adjusting for covariates, opioid users who received testosterone had significantly lower all-cause mortality (hazard ratio [HR] = 0.51; 95% CI, 0.42-0.61) and lower incidence of MACE (HR = 0.58; 95% CI, 0.51-0.67), femoral or hip fractures (HR = 0.68; 95% CI, 0.48-0.96), and anemia (HR = 0.73; 95% CI, 0.68-0.79) during the follow-up period of up to 6 years, compared with their counterparts without a testosterone prescription. In covariate-adjusted models, men who received opioids plus testosterone were more likely to have resolved anemia compared with those who received opioids only during the 6-year follow-up (HR = 1.16; 95% CI, 1.02-1.31). Similar results were obtained in propensity score-matched models and when analyses were restricted to opioid users with noncancer pain or those who did not receive glucocorticoids. Conclusions and Relevance: This study found that, in the VHA system, male long-term opioid users with testosterone deficiency who were treated with opioid and testosterone medications had significantly lower all-cause mortality and significantly lower incidence of MACE, femoral or hip fractures, and anemia after a multiyear follow-up. These results warrant confirmation through a randomized clinical trial to ascertain the efficacy of testosterone in improving health outcomes for opioid users with androgen deficiency.


Assuntos
Androgênios/deficiência , Androgênios/uso terapêutico , Doenças do Sistema Endócrino/tratamento farmacológico , Transtornos Relacionados ao Uso de Opioides/complicações , Testosterona/deficiência , Testosterona/uso terapêutico , Saúde dos Veteranos , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etiologia , Causas de Morte , Doenças do Sistema Endócrino/etiologia , Doenças do Sistema Endócrino/mortalidade , Fraturas do Fêmur/epidemiologia , Fraturas do Fêmur/etiologia , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Transtornos Relacionados ao Uso de Opioides/mortalidade , Fraturas da Coluna Vertebral/epidemiologia , Fraturas da Coluna Vertebral/etiologia , Resultado do Tratamento , Estados Unidos
16.
Med. clín (Ed. impr.) ; 153(12): 446-453, dic. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-188454

RESUMO

Antecedentes y objetivo: La fractura de fémur (FF) es una lesión frecuente en personas de edad avanzada. El objetivo fue evaluar la efectividad de una intervención educativa multidisciplinar en pacientes con FF para favorecer el regreso al domicilio y disminuir las complicaciones hospitalarias. Material y método: Estudio cuasiexperimental con medidas repetidas al ingreso, al alta, a los 30días y al año de seguimiento. Se incluyeron pacientes ≥65años con FF ingresados en la unidad de ortogeriatría entre febrero de 2016 y enero de 2017. La intervención educativa constó de dos actuaciones coordinadas: una educación sanitaria durante la hospitalización y un soporte multimodal durante la transición al domicilio. Resultados: Se incluyeron 67 pacientes (77,6% mujeres; edad 84,19±7,78 años). Regresaron al domicilio el 70,1%, doblando la cifra de los años 2014-2015. Hubo un 8,5% de reingresos a los 30días y al año. Al año, el nivel de dependencia fue cercano al nivel prefractura (Barthel: 86,67±19,31; 94,33±14,66), la movilidad mejoró respecto al alta (Parker: 4,73±1,84; 6,73±2,76; Timed Up and Go test: 38,29±21,27; 21,91±10,97) y el rendimiento cognitivo no empeoró de forma significativa. La percepción de pacientes, cuidadores y profesionales fue que la educación sanitaria mejoró la autonomía del paciente. La satisfacción con el proceso asistencial fue alta. Conclusiones: Este estudio aporta como novedad, a los beneficios ya descritos en los modelos asistenciales ortogeriátricos, el incremento del número de pacientes que regresan al domicilio en condiciones de seguridad


Background and objective: Hip fracture is a common injury among elderly patients. The main goal of our study was to assess the effectiveness of a multidisciplinary educational intervention aimed at hip fracture patients to promote home discharges and reduce in-hospital complications. Material and method: A quasi-experimental study was performed by taking repeated measurements at hospital admission, at hospital discharge, and at both 30days and one year of discharge. Patients aged ≥65years with hip fracture who were admitted to the Orthogeriatric Service between February 2016 and January 2017 were included in the study. The educational intervention consisted in two coordinated actions: patient education administered during their hospitalization and multimodal support provided during their discharge home. Results: A total of 67 patients were included in the study (77.6% of whom were women; 84.19±7,78 years old). Of these, 70.1% were discharged home, which doubles the figures recorded in the 2014-2015 period. The rate of readmission at 30days and one year of the discharge was 8.5%. At the one-year follow-up, the patient's dependence to perform basic activities of daily living was nearer to the pre-fracture level (Barthel: 86.67±19.31; 94.33±14.66), their mobility had improved in comparison with the time of discharge (Parker: 4.73±1.84; 6.73±2.76; Timed Up and Go Test: 38.29±21.27; 21.91±10.97), and their cognitive function had not worsened significantly. The patient education measures improved the patients' autonomy as perceived by the patients, the caregivers, and the healthcare providers. Satisfaction with the healthcare received was high. Conclusions: As a novelty to the already described benefits in orthogeriatric care models, this study would contribute by proving an increase of the number of patients discharged home in a safe condition


Assuntos
Humanos , Idoso , Idoso de 80 Anos ou mais , Resultado do Tratamento , Comunicação Interdisciplinar , Fraturas do Fêmur/epidemiologia , Hospitalização , Educação em Saúde , Pesquisa Interdisciplinar/educação , Educação de Pacientes como Assunto , Autonomia Pessoal , Qualidade de Vida , Recuperação de Função Fisiológica/fisiologia
17.
J. bras. nefrol ; 41(4): 518-525, Out.-Dec. 2019. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1056611

RESUMO

ABSTRACT Introduction: Proximal femur fractures affect the mortality and morbidity of elderly individuals. Recent studies have shown an association between fragility fractures and hyponatremia, a common fluid and electrolyte balance disorder. Objectives: This study aimed to investigate the occurrence of hyponatremia in patients with fragility fractures of the proximal femur. Methods: The authors looked into the data from the medical records of patients admitted to the emergency unit of the Real Hospital Português for fragility fractures of the proximal femur from 2014 to 2017. The study included patients with serum sodium levels recorded in their charts. Results: Fourteen of 69 (20.3%) patients with proximal femur fractures had hyponatremia. The main factors linked to hyponatremia were lung disease, and prescription of amiodarone and/or antidepressants. Conclusion: In elderly individuals, fragility fractures of the proximal femur may correlate with hyponatremia, particularly among patients on amiodarone or antidepressants.


RESUMO Introdução: Fratura de fêmur proximal tem impacto na mortalidade e morbidade de idosos. Estudos recentes vêm demonstrando associação entre fratura por fragilidade e hiponatremia, um distúrbio hidroeletrolítico comum na prática médica. Objetivos: Investigar a ocorrência de hiponatremia em pacientes com fratura proximal de fêmur por fragilidade. Metodologia: Foram coletados dados a partir de prontuários de pacientes admitidos na emergência do Real Hospital Português devido à fratura proximal de fêmur por fragilidade, entre 2014 e 2017, e aqueles com natremia disponível no prontuário eletrônico foram incluídos no estudo. Resultado: Dentre os 69 pacientes com fratura de fêmur proximal, houve uma ocorrência de 14 pacientes com hiponatremia, o que corresponde a 20,3%. Os principais fatores associados à hiponatremia no estudo foram doença pulmonar, uso de amiodarona e antidepressivos. Conclusão: Em idosos, a fratura de fêmur proximal por fragilidade pode estar correlacionada com hiponatremia, principalmente quando estão sob uso de amiodarona ou antidepressivos.


Assuntos
Humanos , Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , Fraturas Ósseas/sangue , Fraturas do Fêmur/sangue , Hiponatremia/complicações , Equilíbrio Hidroeletrolítico/fisiologia , Brasil/epidemiologia , Comorbidade , Estudos Transversais , Fraturas Ósseas/epidemiologia , Fraturas do Fêmur/epidemiologia , Amiodarona/efeitos adversos , Hiponatremia/diagnóstico , Hiponatremia/etiologia , Pneumopatias/complicações , Antiarrítmicos/efeitos adversos , Antidepressivos/efeitos adversos
18.
ANZ J Surg ; 89(12): 1647-1651, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31674136

RESUMO

BACKGROUND: Periprosthetic femur fractures (PFFs) following hip arthroplasty can lead to significant morbidity due to their impact on mobility and the need for surgery. Its incidence often measured by the prosthesis revision rate reported in joint replacement registries. However, many PFFs are also treated with prosthesis retention and internal fixation. Minimally displaced and stable fractures may be treated without surgery. Knowledge of the difference between the number of femoral revisions for PFF (well reported in registries) and the number of surgeries for PFF overall would allow us to estimate the overall surgical burden. This study aims to determine the number of post-operative PFF in three hospitals and compare those treated with revision surgery to those PFF treated with internal fixation and femoral stem retention. By determining this difference, we can ascertain a more accurate estimate of the overall surgical burden of PFF. METHOD: Patients 50 years and older who sustained a post-operative PFF between 1 January 2011 and 31 December 2017 at three public hospitals were extracted from hospital records. The number of revision procedures was compared to the number of re-operations of any type. RESULTS: There were 200 patients admitted for management of PFF. One hundred and forty-three (71.5%) required an operation of which 67 (47%) were revision arthroplasty. CONCLUSION: The overall surgical burden of PFF is approximately twice that represented by the revision rate.


Assuntos
Artroplastia de Quadril/estatística & dados numéricos , Fraturas do Fêmur/cirurgia , Fixação Interna de Fraturas/estatística & dados numéricos , Fraturas Periprotéticas/cirurgia , Reoperação/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Feminino , Fraturas do Fêmur/diagnóstico , Fraturas do Fêmur/epidemiologia , Prótese de Quadril , Humanos , Masculino , Seleção de Pacientes , Fraturas Periprotéticas/diagnóstico , Fraturas Periprotéticas/epidemiologia , Estudos Retrospectivos
19.
Bol Med Hosp Infant Mex ; 76(6): 259-264, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31769437

RESUMO

Background: Osteogenesis imperfecta (OI) is the most common hereditary bone disorder with an incidence of one in 10,000-25,000 births. It is caused mainly by mutations in the genes that code for Type I collagen chains. In most cases, it shows an autosomal dominant inheritance pattern. OI is characterized by an increase in bone fragility that leads to frequent fractures, which cause pain, deformity and disability associated with other alterations. The objective of this study was to present the clinical and epidemiological characteristics of a series of pediatric patients diagnosed with OI evaluated at the University of Los Andes. Methods: A series of 37 pediatric cases with diagnosis of OI according to the clinical and radiological classification of sillence is analyzed, which were evaluated in the medical genetics unit of the University of Los Andes consultation between January 2006 and December 2018. Results: Type I was the most frequent OI type, with 31 patients (83.78%). Additionally, the femur was the most affected bone. Blue scleras were the most frequent additional finding in 32 patients (86.49%). Conclusions: OI represents the main reason for consultation of alterations in the skeletal system in the medical genetics unit of the University of Los Andes. Given the broad clinical presentation, the evaluation must be individual and interdisciplinary. Further study will provide timely family genetic counseling.


Assuntos
Osteogênese Imperfeita , Adolescente , Criança , Pré-Escolar , Feminino , Fraturas do Fêmur/epidemiologia , Fraturas Ósseas/etiologia , Humanos , Lactente , Recém-Nascido , Masculino , Osteogênese Imperfeita/complicações , Osteogênese Imperfeita/diagnóstico , Osteogênese Imperfeita/epidemiologia , Osteogênese Imperfeita/genética , Linhagem , Fraturas do Rádio/epidemiologia , Venezuela/epidemiologia
20.
Acta Chir Orthop Traumatol Cech ; 86(5): 330-333, 2019.
Artigo em Tcheco | MEDLINE | ID: mdl-31748107

RESUMO

PURPOSE OF THE STUDY The pilot study deals with the current situation in proximal femoral fractures in culturally diverse regions, namely in Afghanistan (AFG) and in the Czech Republic (CZ). The study aimed to find out whether there are any differences in proximal femoral fractures in dependence on the selected criteria between the two culturally diverse areas. The study used the data of patients who underwent surgery for proximal femoral fracture at the Department of Orthopaedics of the 1 s t Medical Faculty of the Charles University and the Military University Hospital and at the Military Base Hospital Kabul. MATERIAL AND METHODS The study included patients aged 21 years or older who sustained a proximal femoral fracture in the period from October 2013 to February 2014. For the period concerned, the evaluation comprised 44 patients with a proximal femoral fracture from the Military Base Hospital Kabul, of whom 25 women and 19 men, and a total of 71 patients with a proximal femoral fracture from the Department of Orthopaedics of the 1st Medical Faculty of the Charles University and the Military University Hospital, of whom 43 women and 28 men. Based on the medical documentation, the following evaluation parameters were selected: age, sex, type of fracture. The data was processed using descriptive statistics, one-way and multifactorial analysis (ANOVA) and the POST-HOC test (Fisher LSD test, confidence interval = 95%) RESULTS The mean age of all the patients who suffered a fracture of proximal femur in AFG (58 years) was considerably lower (p < 0.001) than in patients in CZ (81 years). Similarly, a significant difference (p <0.001) was identified in the age of men and women treated for a proximal femoral fracture in both the countries. In AFG there was a statistically significant difference (p = 0.002) between the age of men and women, where women sustaining fractures were younger (54 years) compared to men (63 years). In CZ no significant age difference was reported (83 years vs 78 years). In AFG, the observed fractures occurred generally in their 6th and 7th decade, whereas in CZ only in their 9th decade. The incidence of proximal femoral fractures in Afghan women is the highest in their 5th and 6th decade. Pertrochanteric fractures and intracapsular fractures prevailed in both countries. The lowest age in both types of the fracture was reported in Afghan women (52 years in femoral neck fracture, p <0.001, 54 years in trochanteric fracture, p = 0.039). DISCUSSION Significant differences between the patients in AFG and CZ concern several factors. Afghanistan is a country with the lowest average life expectancy. In the Afghan population a major Vitamin D deficiency was confirmed. This is related to the conservative dress code, especially in women, when the Vitamin D synthesis is suppressed. That can cause the occurrence of osteoporosis in women at a considerably younger age than in the population in the Czech Republic, which is subsequently accompanied by an increased incidence of proximal femoral fractures. Similar results, however, were also obtained in men. One of the risk factors of osteoporosis development is also low physical activity throughout the lifetime. This risk factor is significant primarily in female population in the Muslim world. Afghanistan also faces serious malnutrition. All of that is reflected in low life expectancy in the given country, incidence of osteoporosis and injuries in this region. There is reasonable evidence that the mortality in a causal relationship with proximal femoral fracture is substantially higher in this region than in Western Europe. CONCLUSIONS The results of the pilot study showed that there are significant differences in age and frequency of fractures in dependence on sex and country. The obtained results can be considered valuable since there are virtually no scientific or professional studies on osteoporosis and fractures in the given area that would help physicians get ready for significant differences. These results may become a source of valuable information not only for medical practitioners coming to Afghanistan to help as volunteers in the framework of developmental assistance from all over the world, but also for physicians from Europe, with respect to the wave of migrants coming from this area. Key words: proximal femur, fracture, gender, age, Afghanistan, Czech Republic.


Assuntos
Fraturas do Fêmur/epidemiologia , Fraturas por Osteoporose/epidemiologia , Afeganistão/epidemiologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , República Tcheca/epidemiologia , Feminino , Fraturas do Fêmur/etiologia , Fraturas do Colo Femoral/epidemiologia , Fraturas do Colo Femoral/etiologia , Fraturas do Quadril/epidemiologia , Fraturas do Quadril/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Fraturas por Osteoporose/etiologia , Projetos Piloto , Fatores Sexuais
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...