Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 16.916
Filtrar
1.
Endocr Pract ; 27(5): 408-412, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33934751

RESUMO

OBJECTIVE: To investigate the added value of 1/3 radius (1/3R) for the diagnosis of osteoporosis by spine and hip sites and its correlation with prevalent fractures and predicted fracture risk. METHODS: Fracture Risk Assessment Tool (FRAX) scores for hip and major osteoporotic fractures (MOF) with/without trabecular bone score were considered proxy for fracture risk. The contribution of 1/3R to risk prediction was depicted via linear regression models with FRAX score as the dependent variable-first only with central and then with radius T-score as an additional covariate. Significance of change in the explained variance was compared by F-test. RESULTS: The study included 1453 patients, 86% women, aged 66 ± 10 years. A total of 32% (n = 471) were osteoporotic by spine/hip and 8% (n = 115) by radius only, constituting a 24.4% increase in the number of subjects defined as osteoporotic (n = 586, 40%). Prior fracture prevalence was similar among patients with osteoporosis by spine/hip (17.4%) and radius only (19.1%) (P = .77). FRAX prediction by a regression model using spine/hip T-score yielded explained variance of 51.8% and 49.9% for MOF and 39.8% and 36.4% for hip (with/without trabecular bone score adjustment, respectively). The contribution of 1/3R was statistically significant (P < .001) and slightly increased the explained variance to 52.3% and 50.4% for MOF and 40.9% and 37.4% for hip, respectively. CONCLUSION: Reclassification of BMD results according to radius measurements results in higher diagnostic output. Prior fractures were equally prevalent among patients with radius-only and classic-site osteoporosis. FRAX tool performance slightly improved by incorporating radius BMD. Whether this approach may lead to a better fracture prediction warrants further prospective evaluation.


Assuntos
Fraturas do Quadril , Osteoporose , Fraturas por Osteoporose , Absorciometria de Fóton , Idoso , Densidade Óssea , Feminino , Fraturas do Quadril/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Osteoporose/diagnóstico por imagem , Osteoporose/epidemiologia , Fraturas por Osteoporose/epidemiologia , Rádio (Anatomia)/diagnóstico por imagem , Medição de Risco , Fatores de Risco
2.
Bone Joint J ; 103-B(5): 881-887, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33934649

RESUMO

AIMS: The aim of this study was to determine whether national standards of best practice are associated with improved health-related quality of life (HRQoL) outcomes in hip fracture patients. METHODS: This was a multicentre cohort study conducted in 20 acute UK NHS hospitals treating hip fracture patients. Patients aged ≥ 60 years treated operatively for a hip fracture were eligible for inclusion. Regression models were fitted to each of the "Best Practice Tariff" indicators and overall attainment. The impact of attainment on HRQoL was assessed by quantifying improvement in EuroQol five-dimension five-level questionnaire (EQ-5D-5L) from estimated regression model coefficients. RESULTS: A total of 6,532 patients provided both baseline and four-month EQ-5D-5L, of whom 1,060 participants had died at follow-up. Best practice was achieved in the care of 57% of participants; there was no difference in age, cognitive ability, and mobility at baseline for the overall attainment and non-attainment groups. Attaining at least 'joint care by surgeon and orthogeriatrician', 'delirium assessment', and 'falls assessment' was associated with a large, clinically relevant increase in four months EQ-5D-5L of 0.094 (bootstrapped 95% confidence interval (CI) 0.046 to 0.146). CONCLUSION: National standards with enhanced remuneration in hip fracture care results in improvement in individual patients' HRQoL. Cite this article: Bone Joint J 2021;103-B(5):881-887.


Assuntos
Fraturas do Quadril/cirurgia , Qualidade de Vida , Reembolso de Incentivo , Idoso , Idoso de 80 Anos ou mais , Feminino , Fidelidade a Diretrizes , Fraturas do Quadril/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Reino Unido/epidemiologia
3.
Arch Osteoporos ; 16(1): 73, 2021 04 17.
Artigo em Inglês | MEDLINE | ID: mdl-33866438

RESUMO

We analyzed the overall knowledge structure, development trends, and research hotspots of 7684 publications related to hip fracture through the bibliometric method. Our results indicate this area has received more and more attention from researchers. Prevention of complications will be the focus of future studies. INTRODUCTION: Hip fracture is an international public health problem, with high morbidity, mortality, and associated health care costs. Research on hip fracture has been developed rapidly in recent years, but no bibliometric studies have been performed. We aimed to identify the publication changes in scientific output relating to hip fracture over the past two decades. METHODS: The scientific output relating to hip fracture from 2000 to 2019 was identified and selected from the Web of Science Core Collection. Excel 2019 was used to summarize the quantitative indicators including publication number, citations, H-index, journal's impact factors, and journal citation reports. VOS viewer and CiteSpace software tools were used for co-authorship, citation, co-citation, and co-occurrence analyses between countries, institutions, journals, authors, references, and keywords. Data were analyzed on November 13, 2020. RESULTS: A total of 7684 publications were extracted. The USA was the leading contributor in this field with the largest publications (1876, 24.41%), the most citations (75,423 times), and the highest H-index (124). The number of publications in the Western European region is 1.82 times higher than that of North America region, and 3.59 times that of Eastern Asia region. The most productive institutions on hip fracture were University of Maryland (160). Injury (506) had the highest number of publications, while Osteoporosis International (20,483 times) was the most co-cited journal. Magaziner J and Parker MJ were the key researchers. The keywords were stratified into five clusters: cluster 1 ("operative approaches study"), cluster 2 ("rehabilitation study"), cluster 3 ("osteoporosis study"), cluster 4 ("outcomes and complications study"), and cluster 5 ("epidemiology study"). For hotspots, "tranexamic acid" showed a relatively latest average appearing years of 2017.52, followed by "30-day-mortality," "readmission," and "length of stay." CONCLUSIONS: There will be an increasing number of publications on the hip fracture research based on the current global trends, and the USA stays ahead in this field. In terms of region, Western Europe had the greater impact than North America. It is recommended to pay attention to the promising hotspots, such as tranexamic acid, 30-day-mortality, readmission, and length of stay.


Assuntos
Fraturas do Quadril , Osteoporose , Bibliometria , Europa (Continente) , Extremo Oriente , Fraturas do Quadril/epidemiologia , Humanos
4.
Artigo em Inglês | MEDLINE | ID: mdl-33809573

RESUMO

Hip fractures are an important socio-economic problem in western countries. Over the past 60 years orthogeriatric care has improved the management of older patients admitted to hospital after suffering hip fractures. Quality of care in orthogeriatric co-management units has increased, reducing adverse events during acute admission, length of stay, both in-hospital and mid-term mortality, as well as healthcare and social costs. Nevertheless, a large number of areas of controversy regarding the clinical management of older adults admitted due to hip fracture remain to be clarified. This narrative review, centered in the last 5 years, combined the search terms "hip fracture", "geriatric assessment", "second hip fracture", "surgery", "perioperative management" and "orthogeriatric care", in order to summarise the state of the art of some questions such as the optimum analgesic protocol, the best approach for treating anemia, the surgical options recommendable for each type of fracture and the efficiency of orthogeriatric co-management and functional recovery.


Assuntos
Serviços de Saúde para Idosos , Fraturas do Quadril , Idoso , Fraturas do Quadril/terapia , Hospitalização , Hospitais , Humanos , Tempo de Internação
5.
Rev Med Suisse ; 17(735): 780-783, 2021 Apr 21.
Artigo em Francês | MEDLINE | ID: mdl-33881240

RESUMO

Osteoporosis is a major public health problem linked to fractures and more particularly to those of the hip, which is the major complication in terms of morbidity, mortality and costs. As the risk of a new fragility fracture is greatly increased after a first fracture episode, the concept of the « Osteoporosis pathway ¼ or « Fracture Liaison Service ¼, led by an interdisciplinary team with a coordinator, was developed for the secondary prevention of fractures. Osteoporosis pathways for which key performance indicators have recently been described, have demonstrated their ability to reduce the incidence of new fractures with a favorable cost-effectiveness ratio. Over the past two years, the development of the osteoporosis pathways network in Switzerland has been the main initiative led by the Swiss Association against Osteoporosis.


Assuntos
Fraturas do Quadril , Osteoporose , Fraturas por Osteoporose , Humanos , Osteoporose/epidemiologia , Fraturas por Osteoporose/epidemiologia , Fraturas por Osteoporose/prevenção & controle , Prevenção Secundária , Suíça/epidemiologia
6.
J Surg Orthop Adv ; 30(1): 50-54, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33861195

RESUMO

The advent of computed tomography and development of three-dimensional (3-D) reconstructions has allowed for profound advances in the understanding of complex acetabular fractures. The authors sought to determine the impact of 3-D reconstructions on understanding of the morphology of these injuries. A survey of 20 fellowship-trained orthopaedic trauma surgeons was undertaken to assess the utility of these reconstructions on understanding three complex posterior acetabulum fractures. Respondents noted significantly better understanding of posterior wall and transverse-posterior wall fracture patterns compared to a posterior column-posterior wall pattern when utilizing two-dimensional imaging only. The respondent#x02019;s understanding of all three patterns was improved with the addition of 3-D reconstructions. With regards to individual images, posterior iliac oblique reconstructions obtained at 36-degree and 54-degree from posterior were reported to be most helpful in improving understanding of fracture morphology. Three-dimensional reconstructions of posterior acetabular fractures are effective in enhancing understanding of fracture morphology. (Journal of Surgical Orthopaedic Advances 30(1):050-054, 2021).


Assuntos
Fraturas Ósseas , Fraturas do Quadril , Acetábulo/diagnóstico por imagem , Acetábulo/cirurgia , Fixação Interna de Fraturas , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/cirurgia , Humanos , Imageamento Tridimensional , Tomografia Computadorizada por Raios X
7.
Arch Osteoporos ; 16(1): 63, 2021 04 08.
Artigo em Inglês | MEDLINE | ID: mdl-33829364

RESUMO

Individual process indicators often do not enable the benchmarking of hospitals and often lack an association with outcomes of care. The composite hip fracture process indicator, textbook process, might be a tool to detect hospital variation and is associated with better outcomes during hospital stay. PURPOSE: The aim of this study was to determine hospital variation in quality of hip fracture care using a composite process indicator (textbook process) and to evaluate at patient level whether fulfilment of the textbook process indicator was associated with better outcomes during hospital stay. METHODS: Hip fracture patients aged 70 and older operated in five hospitals between 1 January 2018 and 31 December 2018 were included. Textbook process for hip fracture care was defined as follows: (1) assessment of malnutrition (2) surgery within 24 h, (3) orthogeriatric management during admission and (4) operation by an orthopaedic trauma certified surgeon. Hospital variation analysis was done by computing an observed/expected ratio (O/E ratio) for textbook process at hospital level. The expected ratios were derived from a multivariable logistic regression analysis including all relevant case-mix variables. The association between textbook process compliance and in-hospital complications and prolonged hospital stay was determined at patient level in a multivariable logistic regression model, with correction for patient, treatment and hospital characteristics. In-hospital complications were anaemia, delirium, pneumonia, urinary tract infection, in-hospital fall, heart failure, renal insufficiency, pulmonary embolism, wound infection and pressure ulcer. RESULTS: Of the 1371 included patients, 753 (55%) received care according to textbook process. At hospital level, the textbook compliance rates ranged from 38 to 76%. At patient level, textbook process compliance was significantly associated with fewer complications (38% versus 46%) (OR 0.66, 95% CI 0.52-0.84), but not with hospital stay (median length of hospital stay was 5 days in both groups) (OR 1.01, 95% CI 0.78-1.30). CONCLUSION: The textbook process indicator for hip fracture care might be a tool to detect hospital variation. At patient level, this quality indicator is associated with fewer complications during hospital stay.


Assuntos
Fraturas do Quadril , Indicadores de Qualidade em Assistência à Saúde , Idoso , Idoso de 80 Anos ou mais , Fraturas do Quadril/epidemiologia , Fraturas do Quadril/terapia , Hospitalização , Hospitais , Humanos , Tempo de Internação
8.
Arch Osteoporos ; 16(1): 64, 2021 04 08.
Artigo em Inglês | MEDLINE | ID: mdl-33834297

RESUMO

We calculated in-hospital, 30-day, and 1-year mortality rates and analyzed potential mortality risk factors in 2742 patients with low-trauma hip fractures. We found a high mortality rate at 30 days and 1 year after hip fracture. The high mortality can be explained by a very high number of conservatively treated fractures. PURPOSE: Data on mortality after low-trauma hip fracture in Romania is scarce and comes from a single-hospital study. Our aim was to calculate mortality rates and risk factors in all patients admitted for low-trauma hip fracture in the largest university medical center of Romania. METHODS: We retrospectively analyzed the charts of all patients (>40 years old) admitted for hip fracture in a 12-month period in hospitals with an Orthopedic Department in Bucharest, Romania, and surrounding Ilfov County and calculated the crude in-hospital, 30-day, and 1-year mortality rates after low-trauma hip fractures. A number of potential clinical risk factors for mortality were evaluated. RESULTS: We analyzed 2742 low-trauma hip fractures. The in-hospital, 30-day, and 1-year all-cause mortality rates were 4.26% (n=117), 9.59% (n=263), and 29.72% (n=815) respectively. Four hundred and fifty (16.41%) fractures were managed conservatively with a 1-year mortality HR of 3.05 (p<0.001) compared to surgically treated fractures. The 1-year mortality rate in conservatively treated fractures was 56.44% compared to 24.47% in surgically treated fractures. Age, male sex, length of stay in hospital, day of surgery, post-surgical complications, and late surgery were significantly associated (p<0.001) with mortality after hip fracture. The lowest 1-year mortality rate was in surgically treated patients with a length of stay in hospital between 6 and 10 days. CONCLUSION: We found a high mortality rate at 30 days and 1 year after low-trauma hip fracture. The high mortality rates can be attributable, in part, to the high number of conservatively treated fractures.


Assuntos
Fraturas do Quadril , Universidades , Adulto , Feminino , Fraturas do Quadril/epidemiologia , Humanos , Tempo de Internação , Masculino , Estudos Retrospectivos , Fatores de Risco , Romênia/epidemiologia
9.
BMC Geriatr ; 21(1): 214, 2021 03 31.
Artigo em Inglês | MEDLINE | ID: mdl-33789569

RESUMO

BACKGROUND: Situational factors during a fall among three common types of fractures of the distal forearm, hip, and vertebrae among older women in Taiwan were investigated. METHODS: In 2016 ~ 2017, study participants were identified from those aged ≥65 years who visited emergency departments due to a fall in two university-affiliated hospitals in Taipei. In addition to individual characteristics, situational factors during the fall (location, activity, change of center of mass, fall mode, fall direction, initiating a protective response, and being hit) were collected. A sample of 203 distal-forearm fractures, 189 vertebral fractures, and 375 hip fractures was recruited, while 717 women with a soft-tissue injury were used as a control group. The identification of situational risk factors for each type of fracture was validated by using those who sustained one of the other two types of fracture as a control group. RESULTS: After adjusting for age and other individual characteristics, compared to soft-tissue injuries, distal-forearm fractures were significantly more likely to occur with slips (odds ratio [OR] = 11.0; 95% confidence interval [CI] = 4.76 ~ 25.4), trips (OR = 3.40; 95% CI = 1.42 ~ 8.17), step-downs (OR = 4.95; 95% CI = 2.15 ~ 11.4), and from sideways falls (OR = 1.73; 95% CI = 1.12 ~ 2.67) and significantly less likely to occur indoors (OR = 0.62; 95% CI = 0.42 ~ 0.90) or from backwards falls (OR = 0.62; 95% CI = 0.41 ~ 0.95). Hip fractures were significantly more likely to occur with step-downs (OR = 1.76; 95% CI = 1.13 ~ 2.75) and from backwards (OR = 3.16; 95% CI = 2.15 ~ 4.64) or sideways falls (OR = 5.56; 95% CI = 3.67 ~ 8.41) and significantly less likely when hitting an object (OR = 0.26; 95% CI = 0.13 ~ 0.52) or initiating a protective response (OR = 0.58; 95% CI = 0.36 ~ 0.93). Vertebral fractures were significantly more likely to occur with slips (OR = 2.42; 95% CI = 1.30 ~ 4.50), step-downs (OR = 2.53; 95% CI = 1.43 ~ 4.48), and backwards falls (OR = 2.15; 95% CI = 1.39 ~ 3.32). Similar results were found in the validation analyses. CONCLUSIONS: Large variations in situational risk factors for the three types of fracture in older women existed. A combination of individual and situational risk factors may display a more-comprehensive risk profile for the three types of fracture, and an intervention that adds training programs on safe landing strategies and effective compensatory reactions may be valuable in preventing serious injuries due to a fall.


Assuntos
Antebraço , Fraturas do Quadril , Acidentes por Quedas , Idoso , Feminino , Fraturas do Quadril/diagnóstico , Fraturas do Quadril/epidemiologia , Humanos , Fatores de Risco , Coluna Vertebral , Taiwan/epidemiologia
10.
BMC Geriatr ; 21(1): 224, 2021 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-33794804

RESUMO

BACKGROUND: This study describes the process evaluation of an intervention developed to reduce fear of falling (FoF) after hip fracture, within an inpatient geriatric rehabilitation setting. This 'FIT-HIP intervention' is a multicomponent cognitive behavioral intervention, conducted by physiotherapists and embedded in usual care in geriatric rehabilitation in the Netherlands. A previous study (cluster randomized controlled trial) showed no beneficial effects of this intervention when compared to usual care. The aim of this study was to gain insight into factors related to the intervention process that may have influenced the effectiveness of the intervention. METHODS: This process evaluation was conducted using an observational prospective study design. Based on quantitative and qualitative data derived from session logs, evaluation questionnaires and interviews, we addressed: 1] recruitment and reach; 2] performance according to protocol; 3] patients' adherence; and 4] opinions of patients and facilitators on the intervention. Participants in this study were: a) patients from 6 geriatric rehabilitation units, who were invited to participate in the intervention (39 adults aged ≥65 years with hip fracture and FoF) and; b) intervention facilitators (14 physiotherapists and 8 psychologists who provide coaching to the physiotherapists). RESULTS: Thirty-six patients completed the intervention during inpatient geriatric rehabilitation. Apart from cognitive restructuring and telephonic booster (which was not provided to all patients), the intervention was performed to a fair degree in accordance with protocol. Patients' adherence to the intervention was very good, and patients rated the intervention positively (average 8.1 on a scale 0-10). Although most facilitators considered the intervention feasible, a limited level of FoF (possibly related to timing of intervention), and physiotherapists' limited experience with cognitive restructuring were identified as important barriers to performing the intervention according to protocol. CONCLUSIONS: The FIT-HIP intervention was only partly feasible, which may explain the lack of effectiveness in reducing FoF. To improve the intervention's feasibility, we recommend selecting patients with maladaptive FoF (i.e. leading to activity restriction), being more flexible in the timing of the intervention, and providing more support to the physiotherapists in conducting cognitive restructuring. TRIAL REGISTRATION: Netherlands Trial Register: NTR5695 (7 March 2016).


Assuntos
Acidentes por Quedas , Fraturas do Quadril , Acidentes por Quedas/prevenção & controle , Idoso , Cognição , Medo , Estudos de Viabilidade , Fraturas do Quadril/diagnóstico , Fraturas do Quadril/terapia , Humanos , Países Baixos/epidemiologia , Estudos Prospectivos
11.
Artigo em Inglês | MEDLINE | ID: mdl-33799571

RESUMO

Early surgical intervention in hip fractures is associated with lower complications. This study aimed to determine the appropriate operation time among Asian geriatric patients. The data of 1118 elderly patients with hip fracture at Mackay Memorial Hospital from 1 January 2011, to 31 July 2019, were retrospectively examined. Association between operation waiting time and the occurrence of complications was calculated using a cubic spline model. Significantly increased incidence of pneumonia, myocardial infarction, and heart failure was observed in 30 and 90 days when the patient's surgical waiting time exceeded 36 h. The incidence rates of pneumonia across the early and delayed groups within 30 and 90 days were 4.4% vs. 7.9%, and 6.2% vs. 10.7%, those of myocardial infarction were 3.0% vs. 7.2%, and 5.7% vs. 9.3%, and those of heart failure were 15.2% vs. 26.8%, and 16.2% vs. 28.5%. Deep vein thrombosis and pulmonary embolism were not associated with surgical delay. The overall 30-day mortality rate was 5.4%, and no significant difference was observed when the surgical waiting time exceeded 36 h. In summary, operation waiting time exceeding 36-h was associated with increased rates of pneumonia, myocardial infarction, and heart failure in Asian geriatric patients undergoing hip fracture surgery.


Assuntos
Fraturas do Quadril , Listas de Espera , Idoso , Fraturas do Quadril/epidemiologia , Fraturas do Quadril/cirurgia , Hospitais , Humanos , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Taiwan/epidemiologia
12.
BMC Geriatr ; 21(1): 234, 2021 04 07.
Artigo em Inglês | MEDLINE | ID: mdl-33827444

RESUMO

BACKGROUND: Frailty and low handgrip strength (HGS) are associated with adverse outcomes after hip fracture (HF) surgery. We aimed to compare the predictive role of frailty and HGS for adverse outcome in HF patients. METHODS: We included older patients (age ≥ 65 years) who underwent HF surgery to compare the predictive role of HGS and hip-multidimensional frailty score (Hip-MFS) for postoperative complications and mortality. The Hip-MFS was calculated based on comprehensive geriatric assessment (CGA), and HGS was measured with a hand dynamometer. The primary outcome was a composite of postoperative complications (e.g., pneumonia, urinary tract infection, delirium, acute pulmonary thromboembolism, and unplanned intensive care unit admission). The secondary outcomes were 6-month mortality and mortality at the end of follow-up. RESULTS: The median observation time was 620.5 days (interquartile range: 367.0-784.8 days). Among the 242 patients (mean age: 81.5 ± 6.7 years, 73.1% women), 106 (43.8%) experienced postoperative complications. The 6-month mortality and mortality at the end of follow-up were 7.4% (n = 18) and 20.7% (n = 50), respectively. The Hip-MFS (odds ratio [OR], 1.250; 95% confidence interval [CI], 1.092-1.432) and HGS (OR, 1.147; 95% CI, 1.082-1.215) could predict postoperative complications. The Hip-MFS could predict both 6-month mortality (hazard ratio [HR], 1.403; 95% CI, 1.027-1.917) and mortality at the end of follow-up (HR, 1.493; 95% CI, 1.249-1.769) after adjustment, while HGS was only associated with mortality at the end of follow-up (HR, 1.080; 95% CI, 1.024-1.139). For mortality at the end of follow-up, predictive models with the Hip-MFS were superior to those with HGS in the time-dependent receiver-operating curve analysis after adjustment (p = 0.017). Furthermore, the addition of Hip-MFS or HGS to the American Society of Anesthesiologists (ASA) classification improved its prognostic ability. CONCLUSIONS: Both the Hip-MFS and HGS could predict postoperative complications and improve prognostic utility when combined with the ASA classification. The Hip-MFS was a stronger predictor of mortality than HGS after HF surgery. HGS could be a useful pre-screening tool to identify patients at a high risk of postoperative complications and those who may benefit from further CGA.


Assuntos
Fragilidade , Fraturas do Quadril , Idoso , Idoso de 80 Anos ou mais , Feminino , Fragilidade/diagnóstico , Avaliação Geriátrica , Força da Mão , Fraturas do Quadril/diagnóstico , Fraturas do Quadril/cirurgia , Humanos , Masculino , Complicações Pós-Operatórias , Estudos Retrospectivos , Fatores de Risco
13.
BMC Geriatr ; 21(1): 249, 2021 04 15.
Artigo em Inglês | MEDLINE | ID: mdl-33858356

RESUMO

BACKGROUND: People living with dementia seem to be more likely to experience delirium following hip fracture. The association between mental disorders (MD) and hip fracture remains controversial. We conducted a nationwide study to examine the prevalence of MD in geriatric patients with hip fractures undergoing surgery and conducted a related risk factor analysis. MATERIAL AND METHODS: This retrospective cohort study used data from Taiwan's National Health Insurance Research Database between 2000 and 2012 and focused on people who were older than 60 years. Patients with hip fracture undergoing surgical intervention and without hip fracture were matched at a ratio of 1:1 for age, sex, comorbidities, and index year. The incidence and hazard ratios of age, sex, and multiple comorbidities related to MD and its subgroups were calculated using Cox proportional hazards regression models. RESULTS: A total of 1408 patients in the hip fracture group and a total of 1408 patients in the control group (no fracture) were included. The overall incidence of MD for the hip fracture and control groups per 100 person-years were 0.8 and 0.5, respectively. Among MD, the incidences of transient MD, depression, and dementia were significantly higher in the hip fracture group than in the control group. CONCLUSIONS: The prevalence of newly developed MD, especially transient MD, depression, and dementia, was higher in the geriatric patients with hip fracture undergoing surgery than that in the control group. Prompt and aggressive prevention protocols and persistent follow-up of MD development is highly necessary in this aged society.


Assuntos
Fraturas do Quadril , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Fraturas do Quadril/diagnóstico , Fraturas do Quadril/epidemiologia , Humanos , Incidência , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Risco , Taiwan/epidemiologia
14.
Arch Osteoporos ; 16(1): 62, 2021 04 07.
Artigo em Inglês | MEDLINE | ID: mdl-33825998

RESUMO

There was a reduction in the hospitalization rate for major osteoporotic fractures. As per our analysis, hospitalization for site-specific fractures showed a declining trend for hip and vertebral fractures for both the sexes. However, an increasing trend was noted in women regarding hospitalization for forearm fracture. PURPOSE: Major osteoporotic fractures (MOFs) constitute a large proportion of the total expenditures for public healthcare. Knowing the secular trends of MOF will allow for more efficient use of healthcare resources, but such data are insufficient for the current population of Taiwan. Therefore, we investigated the epidemiological data of MOF hospitalization from adults 50 years of age or older in Taiwan during the period 2000-2015. METHODS: The data analyzed were acquired from the Taiwan National Health Insurance Research Database (NHIRD) entries between 2000 and 2015. All study subjects were 50 years of age or older at the time of admission and diagnosed as having MOF. RESULTS: A general decline was observed in the incidence rate (IR) of MOF hospitalization for the whole population, from 74.52 per 10,000 person-years (PYs) in 2000 to 55.19 in 2015. Females aged ≥65 years had the highest rates of hospitalization for MOF among the subgroups analyzed. Apart from the wrist fracture hospitalization rates in both sexes, which remained steady, all other site-specific fracture hospitalization rates exponentially increased with age. Among men, the IRs of all MOF hospitalization were steady, except for a slight decrease in hip and vertebral fracture hospitalizations. In women, hip and vertebral fracture hospitalization rates gradually decreased, humerus and wrist fracture hospitalization remained steady, and forearm fracture hospitalization increased. CONCLUSIONS: Hospitalization rates of MOF decreased. The trend of site-specific fracture hospitalization analysis showed that hip and vertebral fractures decreased for both sexes. However, an increasing trend in forearm fracture hospitalization was noticed among females.


Assuntos
Fraturas do Quadril , Fraturas por Osteoporose , Fraturas da Coluna Vertebral , Adulto , Idoso , Feminino , Humanos , Incidência , Masculino , Fraturas por Osteoporose/epidemiologia , Fraturas da Coluna Vertebral/epidemiologia , Taiwan/epidemiologia
15.
Arch Osteoporos ; 16(1): 67, 2021 04 10.
Artigo em Inglês | MEDLINE | ID: mdl-33839996

RESUMO

In Korean adults aged 50 years and older, the overall risk of fractures increased with greater BMI variability among both men and women, specifically, spinal fractures for men and both spinal and hip fractures for women. PURPOSE: The bone-health-related outcome, such as fractures due to BMI fluctuation, has been understudied within Asian populations. In this large-scale, population-based cohort study in Korea, we aimed to investigate the relationship between variability in body mass index (BMI) and the risk of fractures. METHODS: The study included 166,932 subjects aged ≥ 50 years from the National Health Insurance Service-Health Screening Cohort. The BMI variability value from three follow-up examinations during 2002-2007 was categorized into quartiles. The hazard ratios (HRs) with 95% confidence intervals (CIs) for the effects of BMI variability on the risk of admission from hip, spine, and upper extremity fractures during 2008-2015 were evaluated using a Cox proportional hazards regression analysis. RESULTS: Compared to those in the lowest BMI variability (1st quartile), men in the highest BMI variability (4th quartile) showed an increased risk of spinal fractures (aHR 1.21, 95% CI 1.07-1.36) with a significant linear trend (P for trend = 0.021). Compared to those in the lowest BMI variability (1st quartile), women in the highest BMI variability (4th quartile) showed an increased risk of hip and spinal fractures (aHR 1.35, 95% CI 1.05-1.69; aHR 1.16, 95% CI 1.05-1.28) with significant linear trends (P for trend = 0.021; P for trend = 0.003, respectively). There was no association between BMI variability and incidents of upper extremity fractures for men or women. CONCLUSION: Association between BMI variability and increased fracture risk depended on sex and fracture types. BMI maintenance, instead of high BMI fluctuation, may be beneficial in terms of lowering the overall fracture risk for Korean adults over 50 years old.


Assuntos
Fraturas do Quadril , Adulto , Idoso , Índice de Massa Corporal , Estudos de Coortes , Feminino , Fraturas do Quadril/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , República da Coreia/epidemiologia , Fatores de Risco
16.
Arch Osteoporos ; 16(1): 68, 2021 04 12.
Artigo em Inglês | MEDLINE | ID: mdl-33846869

RESUMO

This study analyzed the outcome of orthogeriatric patients with hip fracture 4 months after surgery. The overall mortality rate was 12.2%. Sixty-five percent presented a degradation in walking ability, and 16% had to move to a nursing home. Early geriatric rehabilitation reduces the mortality rate and increases the rate of anti-osteoporotic treatment. PURPOSE: Hip fractures are increasingly common with severe consequences. Therefore, the German Trauma Society (DGU) implemented an orthogeriatric co-management and developed the concept for certified Centre for Geriatric Trauma DGU. The patients' treatment data and the optional 120 days of follow-up were collected in the Registry for Geriatric Trauma DGU (ATR-DGU). This study analyzed these 4-month treatment results. METHODS: A retrospective analysis of the ATR-DGU was conducted. Outcome parameters were the rate of readmission, rate of re-surgery, anti-osteoporotic therapy, housing, mortality, walking ability, and quality of life (QoL) 120 days post-surgery. The influence of the early geriatric rehabilitation (EGR) was evaluated using a regression analysis. RESULTS: The follow-up data from 9780 patients were included. After 120 days, the mortality rate was 12.2%, the readmission rate 4%, and the re-surgery rate 3%. The anti-osteoporotic treatment increased from 20% at admission to 32%; 65% of the patients had a degradation in walking ability, and 16% of the patients who lived in their domestic environment pre-surgery had to move to a nursing home. QoL was distinctly reduced. The EGR showed a positive influence of anti-osteoporotic treatment (p<0.001) and mortality (p=0.011) but led to a slight reduction in QoL (p=0.026). CONCLUSION: The 4-month treatment results of the ATR-DGU are comparable to international studies. The EGR led to a significant rise in anti-osteoporotic treatment and a reduction in mortality with a slight reduction in QoL.


Assuntos
Fraturas do Fêmur , Fraturas do Quadril , Idoso , Fraturas do Fêmur/cirurgia , Fêmur , Fraturas do Quadril/cirurgia , Humanos , Qualidade de Vida , Estudos Retrospectivos , Centros de Traumatologia
17.
J Orthop Surg Res ; 16(1): 237, 2021 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-33794939

RESUMO

BACKGROUND: Concerns of contracting the highly contagious disease COVID-19 have led to a reluctance in seeking medical attention, which may contribute to delayed hospital arrival among traumatic patients. The study objective was to describe differences in time from injury to arrival for patients with traumatic hip fractures admitted during the pandemic to pre-pandemic patients. MATERIALS AND METHODS: This retrospective cohort study at six level I trauma centers included patients with traumatic hip fractures. Patients with a non-fall mechanism and those who were transferred in were excluded. Patients admitted 16 March 2019-30 June 2019 were in the "pre-pandemic" group, patients were admitted 16 March 2020-30 June 2020 were in the "pandemic" group. The primary outcome was time from injury to arrival. Secondary outcomes were time from arrival to surgical intervention, hospital length of stay (HLOS), and mortality. RESULTS: There were 703 patients, 352 (50.1%) pre-pandemic and 351 (49.9%) during the pandemic. Overall, 66.5% were female and the median age was 82 years old. Patients were similar in age, race, gender, and injury severity score. The median time from injury to hospital arrival was statistically shorter for pre-pandemic patients when compared to pandemic patients, 79.5 (56, 194.5) min vs. 91 (59, 420), p = 0.04. The time from arrival to surgical intervention (p = 0.64) was statistically similar between groups. For both groups, the median HLOS was 5 days, p = 0.45. In-hospital mortality was significantly higher during the pandemic, 1.1% vs 3.4%, p = 0.04. CONCLUSIONS: While time from injury to hospital arrival was statistically longer during the pandemic, the difference may not be clinically important. Time from arrival to surgical intervention remained similar, despite changes made to prevent COVID-19 transmission.


Assuntos
/epidemiologia , Fraturas do Quadril/epidemiologia , Admissão do Paciente , Tempo para o Tratamento , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Fraturas do Quadril/cirurgia , Mortalidade Hospitalar , Humanos , Tempo de Internação/estatística & dados numéricos , Assistência de Longa Duração , Masculino , Pandemias , Alta do Paciente , Estudos Retrospectivos , Instituições de Cuidados Especializados de Enfermagem , Centros de Traumatologia , Estados Unidos/epidemiologia
18.
Bone Joint J ; 103-B(4): 755-761, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33789474

RESUMO

AIMS: This study sought to compare the rate of deep surgical site infection (SSI), as measured by the Centers for Disease Control and Prevention (CDC) definition, after surgery for a fracture of the hip between patients treated with standard dressings and those treated with incisional negative pressure wound therapy (iNPWT). Secondary objectives included determining the rate of recruitment and willingness to participate in the trial. METHODS: The study was a two-arm multicentre randomized controlled feasibility trial that was embedded in the World Hip Trauma Evaluation cohort study. Any patient aged > 65 years having surgery for hip fracture at five recruitment centres in the UK was considered to be eligible. They were randomly allocated to have either a standard dressing or iNPWT after closure of the wound. The primary outcome measure was deep SSI at 30 and 90 days, diagnosed according to the CDC criteria. Secondary outcomes were: rate of recruitment; further surgery within 120 days; health-related quality of life (HRQoL) using the EuroQol five-level five-dimension questionnaire (EQ-5D-5L); and related complications within 120 days as well as mobility and residential status at this time. RESULTS: A total of 462 valid randomizations were carried out (232 and 230 in the standard dressing and iNPWT groups, respectively). In the standard dressing group, 14 of 218 patients (6.4%) developed deep SSI. In the iNPWT group, four of 214 patients (1.9%) developed deep SSI. This gives a total rate of SSI of 4.2% (95% confidence interval (CI) 2.7% to 6.5%). Patients and surgeons were willing to participate in the study with 462 patients being recruited from a possible 749 (62.3%). CONCLUSION: The rate of deep SSI 30 days after surgery for a fracture of the hip was 4%, which makes a study comparing the clinical effectiveness of standard dressings and iNPWT feasible. Cite this article: Bone Joint J 2021;103-B(4):755-761.


Assuntos
Bandagens , Fraturas do Quadril/cirurgia , Tratamento de Ferimentos com Pressão Negativa , Infecção da Ferida Cirúrgica/prevenção & controle , Cicatrização , Idoso , Idoso de 80 Anos ou mais , Estudos de Viabilidade , Feminino , Humanos , Masculino , Reino Unido
19.
BMJ Case Rep ; 14(4)2021 Apr 05.
Artigo em Inglês | MEDLINE | ID: mdl-33820804

RESUMO

This is a case of a 54-year-old woman managed as a case of osteogenesis imperfecta type 1 who sustained a left subtrochanteric fracture and eventual ankylosis of both hips after surgery and immobilisation. These injuries rendered her bedridden, maximally assisted in transitions and transfers, and unable to be positioned past 30° of backrest elevation. The patient underwent a bilateral Girdlestone procedure and had tailored progressive postoperative rehabilitation in both the inpatient and outpatient settings. The patient also continued to receive bisphosphonates during her preoperative and postoperative period, to improve bone stock and aid in relieving pain. Through the efforts of a team of physiatrists, geneticists and orthopaedic surgeons, the patient was able to achieve pain-free sitting, independent transitions and short-distance ambulation, which have allowed her to care for herself more effectively and return to her work and activities of daily living.


Assuntos
Fraturas do Quadril , Osteogênese Imperfeita , Atividades Cotidianas , Adulto , Difosfonatos , Feminino , Humanos , Pessoa de Meia-Idade , Osteogênese Imperfeita/complicações
20.
Zhong Nan Da Xue Xue Bao Yi Xue Ban ; 46(2): 142-148, 2021 Feb 28.
Artigo em Inglês, Chinês | MEDLINE | ID: mdl-33678650

RESUMO

OBJECTIVES: To screen the risk factors for predicting venous thromboembolism (VTE) risk after hip fracture in the elderly, to establish a prediction model based on these factors, and to analyze its prediction efficacy. METHODS: A total of 52 hip fracture patients over 60 years old with VTE admitted to the Department of Orthopaedic Trauma, Xiangya Hospital, Central South University from March 2017 to April 2019 were selected as a thrombus group, and another 52 hip fracture patients over 60 years old without VTE were selected as a control group. The differences of hospitalization data and examination results between the 2 groups were compared. Logistic regression model was used to explore the influence of risk factors on VTE risk after hip fracture in the elderly and construct the prediction model based on these factors. The receiver operating characteristic curve was used to analyze the predictive effectiveness of model, Hosmer-lemeshow goodness of fit test was used to evaluate the fitting degree of prediction model. RESULTS: Univariate analysis showed that injury-admission interval, Caprini score, WBC count, platelet count, neutrophil count, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, systemic immune-inflammatory index (SII), and fibrinogen in the thrombus group were higher than those in the control group (all P<0.05). Logistic regression analysis showed that injury-admission interval, Caprini score, and SII were independent predictors of VTE risk after hip fracture in the elderly. The AUC was 0.949 (95% CI 0.901 to 0.996) when the sensitivity and specificity were 82.70% and 96.20%, respectively, which were significantly higher than each single index, and the prediction model had perfect fitting degree (Hosmer-lemeshow χ2=14.078, P>0.05). CONCLUSIONS: SII, Caprini score, and injury-admission interval are independent predictors of VTE after hip fracture in the elderly. The prediction model based on these 3 factors has a good efficacy on the prediction of VTE risk, and could provide important reference for the prevention, management, and treatment of VTE after hip fracture in the elderly.


Assuntos
Fraturas do Quadril , Tromboembolia Venosa , Idoso , Fraturas do Quadril/complicações , Fraturas do Quadril/cirurgia , Humanos , Pessoa de Meia-Idade , Curva ROC , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Tromboembolia Venosa/epidemiologia , Tromboembolia Venosa/etiologia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...