Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 7.229
Filtrar
1.
Praxis (Bern 1994) ; 110(2): 105-107, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33530775

RESUMO

In adults, an isolated non-traumatic fracture of the lesser trochanter should arouse strong suspicion of an underlying malignant pathology. In this article, we present the case of a 55-year-old male patient who presented with a non-traumatic isolated fracture of the lesser trochanter secondary to a delayed diagnosis of metastases of bronchial carcinoma.


Assuntos
Fratura Avulsão , Fraturas do Quadril , Adulto , Fêmur , Fraturas do Quadril/diagnóstico por imagem , Fraturas do Quadril/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade
2.
Hu Li Za Zhi ; 68(1): 90-96, 2021 Feb.
Artigo em Chinês | MEDLINE | ID: mdl-33521923

RESUMO

Hip fracture commonly occurs in adult patients over 65 years old at a prevalence rate that is estimated to be 756 per 100 thousand cases. Thus, hip fracture surgery is one of the most common emergency operations in older adult populations. In addition, the incidence rate in older adults of post-operative delirium, which leads to symptoms of disturbance related to cognition, attention, perception, logic, memory, psychological activities, mood, and sleep, has been reported as 5%-61%. The many possible complications of post-operative delirium, including death, increase medical costs and family burdens if not managed properly. Proper management involves healthcare providers initiating early assessments, reducing accelerated factors, and providing appropriate care. As diagnosing and differentiating post-operative delirium in clinical practice is difficult, this condition is easily neglected by healthcare teams, resulting in adequate care not being provided to this population. The aim of this paper was to review the definition, relevant physiological and pathological mechanisms and etiologies, and medical management and nursing care of post-operative delirium using an evidence-based literature review. Suggestions for healthcare providers to improve the detection and management of post-operative delirium include using appropriate evaluation tools to detect and diagnose high-risk patients as early as possible, implementing older-adult life planning strategies, and conducting medical consultations. Furthermore, healthcare providers may initiate pain control, nutrient and body fluid supplementation, and sensory/cognition enhancement therapies to reduce the incidence of delirium, length of hospital stay, complications, and in-hospital mortality, thereby improving the quality of care provided to older adult patients with hip fractures and their caregivers.


Assuntos
Delírio , Fraturas do Quadril , Idoso , Delírio/diagnóstico , Delírio/epidemiologia , Delírio/etiologia , Enfermagem Baseada em Evidências , Fraturas do Quadril/cirurgia , Humanos , Incidência , Tempo de Internação , Complicações Pós-Operatórias/terapia
3.
Bone Joint J ; 103-B(2): 264-270, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33517718

RESUMO

AIMS: Few studies have investigated potential consequences of strained surgical resources. The aim of this cohort study was to assess whether a high proportion of concurrent acute surgical admissions, tying up hospital surgical capacity, may lead to delayed surgery and affect mortality for hip fracture patients. METHODS: This study investigated time to surgery and 60-day post-admission death of patients 70 years and older admitted for acute hip fracture surgery in Norway between 2008 and 2016. The proportion of hospital capacity being occupied by newly admitted surgical patients was used as the exposure. Hip fracture patients admitted during periods of high proportion of recent admissions were compared with hip fracture patients admitted at the same hospital during the same month, on similar weekdays, and times of the day with fewer admissions. RESULTS: Among 60,072 patients, mean age was 84.6 years (SD 6.8), 78% were females, and median time to surgery was 20 hours (IQR 11 to 29). Overall, 14% (8,464) were dead 60 days after admission. A high (75th percentile) proportion of recent surgical admission compared to a low (25th percentile) proportion resulted in 20% longer time to surgery (95% confidence interval (CI) 16 to 25) and 20% higher 60-day mortality (hazard ratio 1.2, 95% CI 1.1 to 1.4). CONCLUSION: A high volume of recently admitted acute surgical patients, indicating probable competition for surgical resources, was associated with delayed surgery and increased 60-day mortality. Cite this article: Bone Joint J 2021;103-B(2):264-270.


Assuntos
Fixação de Fratura/estatística & dados numéricos , Recursos em Saúde/provisão & distribução , Fraturas do Quadril/cirurgia , Hospitalização/estatística & dados numéricos , Tempo para o Tratamento/estatística & dados numéricos , Doença Aguda , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Fraturas do Quadril/mortalidade , Humanos , Masculino , Noruega/epidemiologia , Resultado do Tratamento
4.
Bone Joint J ; 103-B(2): 271-278, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33517719

RESUMO

AIMS: Echocardiography is commonly used in hip fracture patients to evaluate perioperative cardiac risk. However, echocardiography that delays surgical repair may be harmful. The objective of this study was to compare surgical wait times, mortality, length of stay (LOS), and healthcare costs for similar hip fracture patients evaluated with and without preoperative echocardiograms. METHODS: A population-based, matched cohort study of all hip fracture patients (aged over 45 years) in Ontario, Canada between 2009 and 2014 was conducted. The primary exposure was preoperative echocardiography (occurring between hospital admission and surgery). Mortality rates, surgical wait times, postoperative LOS, and medical costs (expressed as 2013$ CAN) up to one year postoperatively were assessed after propensity-score matching. RESULTS: A total of 2,354 of 42,230 (5.6%) eligible hip fracture patients received a preoperative echocardiogram during the study period. Echocardiography ordering practices varied among hospitals, ranging from 0% to 23.0% of hip fracture patients at different hospital sites. After successfully matching 2,298 (97.6%) patients, echocardiography was associated with significantly increased risks of mortality at 90 days (20.1% vs 16.8%; p = 0.004) and one year (32.9% vs 27.8%; p < 0.001), but not at 30 days (11.4% vs 9.8%; p = 0.084). Patients with echocardiography also had a mean increased delay from presentation to surgery (68.80 hours (SD 44.23) vs 39.69 hours (SD 27.09); p < 0.001), total LOS (19.49 days (SD 25.39) vs 15.94 days (SD 22.48); p < 0.001), and total healthcare costs at one year ($51,714.69 (SD 54,675.28) vs $41,861.47 (SD 50,854.12); p < 0.001). CONCLUSION: Preoperative echocardiography for hip fracture patients is associated with increased postoperative mortality at 90 days and one year but not at 30 days. Preoperative echocardiography is also associated with increased surgical delay, postoperative LOS, and total healthcare costs at one year. Echocardiography should be considered an urgent test when ordered to prevent additional surgical delay. Cite this article: Bone Joint J 2021;103-B(2):271-278.


Assuntos
Ecocardiografia , Fixação de Fratura , Cardiopatias/diagnóstico por imagem , Fraturas do Quadril/cirurgia , Cuidados Pré-Operatórios/métodos , Idoso , Idoso de 80 Anos ou mais , Bases de Dados Factuais , Ecocardiografia/economia , Feminino , Seguimentos , Fixação de Fratura/economia , Cardiopatias/complicações , Fraturas do Quadril/complicações , Fraturas do Quadril/economia , Fraturas do Quadril/mortalidade , Custos Hospitalares/estatística & dados numéricos , Humanos , Tempo de Internação/economia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Ontário , Cuidados Pré-Operatórios/economia , Pontuação de Propensão , Medição de Risco , Tempo para o Tratamento
5.
Bone Joint J ; 103-B(2): 222-233, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33517730

RESUMO

AIMS: Current guidelines recommend surgery within 48 hours among patients presenting with hip fractures; however, optimal surgical timing for patients on oral anticoagulants (OACs) remains unclear. Individual studies are limited by small sample sizes and heterogeneous outcomes. The aim of this study was to conduct a systematic review and meta-analysis to summarize the effect of pre-injury OACs on time-to-surgery (TTS) and all-cause mortality among older adults with hip fracture treated surgically. METHODS: We searched MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials (CENTRAL) from inception to 14 October 2019 to identify studies directly comparing outcomes among hip fracture patients receiving direct oral anticoagulants (DOACs) or vitamin K antagonists (VKAs) prior to hospital admission to hip fracture patients not on OACs. Random effects meta-analyses were used to pool all outcomes (TTS, in-hospital mortality, and 30-day mortality). RESULTS: A total of 34 studies (involving 39,446 patients) were included in our systematic review. TTS was 13.7 hours longer (95% confidence interval (CI) 9.8 to 17.5; p < 0.001) among hip fracture patients on OACs compared to those not on OACs. This translated to a three-fold higher odds of having surgery beyond the recommended 48 hours from admission (odds ratio (OR) 3.0 (95% CI 2.1 to 4.3); p = 0.001). In-hospital mortality was higher (OR 1.4 (95% CI 1.0 to 1.8); p < 0.03) among anticoagulated patients. Among studies comparing anticoagulants, there was no statistically significant difference in time-to-surgery between patients taking a DOAC compared to a VKA. CONCLUSION: Patients presenting with a hip fracture who were taking OACs prior to injury experience a delay in time-to-surgery and higher mortality than non-anticoagulated patients. Patients on DOACs may be at risk of further delays. Evaluating expedited surgical protocols in hip fracture patients on OACs is an urgent priority, with the potential to decrease morbidity and mortality in this group of high-risk patients. Cite this article: Bone Joint J 2021;103-B(2):222-233.


Assuntos
Anticoagulantes/uso terapêutico , Fixação de Fratura , Fraturas do Quadril/cirurgia , Tromboembolia/tratamento farmacológico , Tromboembolia/prevenção & controle , Tempo para o Tratamento , Administração Oral , Fraturas do Quadril/complicações , Fraturas do Quadril/mortalidade , Humanos , Tromboembolia/complicações , Resultado do Tratamento
6.
Ann R Coll Surg Engl ; 103(2): e56-e58, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33559559

RESUMO

Instrument breakage during orthopaedic procedures is relatively uncommon, but it remains a challenging problem to orthopaedic surgeons. We report a case of a broken guidewire during intramedullary nail fixation of a proximal femur fracture with subtrochanteric extension. We also report a simple yet effective technique for removal of a broken guidewire from the medulla of the proximal femur without causing much iatrogenic trauma.


Assuntos
Fios Ortopédicos/efeitos adversos , Remoção de Dispositivo/métodos , Falha de Equipamento , Fixação Intramedular de Fraturas/efeitos adversos , Fraturas do Quadril/cirurgia , Redução Aberta/efeitos adversos , Idoso de 80 Anos ou mais , Pinos Ortopédicos , Remoção de Dispositivo/efeitos adversos , Fixação Intramedular de Fraturas/instrumentação , Humanos , Doença Iatrogênica/prevenção & controle , Masculino , Redução Aberta/instrumentação
7.
Instr Course Lect ; 70: 85-100, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33438906

RESUMO

There have been major changes in the treatment of various hip fracture patterns in the proximal femur. The orthopaedic surgeon should be up to date on device management, current guidelines, and techniques in the care of hip fracture patterns.


Assuntos
Fraturas do Quadril , Fêmur , Fraturas do Quadril/cirurgia , Humanos , Morbidade
8.
BMJ Open ; 11(1): e040273, 2021 01 17.
Artigo em Inglês | MEDLINE | ID: mdl-33455926

RESUMO

INTRODUCTION: Blood transfusion and anaemia are frequent and are associated with poor outcomes in patients with hip fracture (HF). We hypothesised that preoperative intravenous iron and tranexamic acid (TXA) may reduce the transfusion rate in these patients. METHODS AND ANALYSIS: The HiFIT study is a multicentre, 2×2 factorial, randomised, double-blinded, controlled trial evaluating the effect of iron isomaltoside (IIM) (20 mg/kg) vs placebo and of TXA (intravenously at inclusion and topically during surgery) versus placebo on transfusion rate during hospitalisation, in patients undergoing emergency surgery for HF and having a preoperative haemoglobin between 95 and 130 g/L. 780 patients are expected. The primary endpoint is the proportion of patients receiving an allogenic blood transfusion of packed red blood cells from the day of surgery until hospital discharge (or until D30 if patient is still hospitalised). Enrolment started on March 2017 in 11 French hospitals. The study was stopped between July 2017 and August 2018 (because of investigation of serious AEs with IIM in Spain) and slowed down since March 2020 (COVID-19 crisis). The expected date of final follow-up is May 2022. Analyses of the intent-to-treat and per-protocol populations are planned. ETHICS AND DISSEMINATION: The HiFIT trial protocol has been approved by the Ethics Committee of Comité de Protection des Personnes Ouest II and the French authorities (ANSM). It will be carried out according to the principles of the Declaration of Helsinki and the Good Clinical Practice guidelines. The results will be disseminated through presentation at scientific conferences and publication in peer-reviewed journals. The HiFIT trial will be the largest study evaluating iron and TXA in patients with HF. TRIAL REGISTRATION NUMBER: clinicalTrials.gov identifier: NCT02972294; EudraCT Number 2016-003087-40.


Assuntos
Anemia/tratamento farmacológico , Transfusão de Sangue/estatística & dados numéricos , Fraturas do Quadril/cirurgia , Ferro/uso terapêutico , Ácido Tranexâmico/uso terapêutico , Administração Intravenosa , Antifibrinolíticos/uso terapêutico , Perda Sanguínea Cirúrgica/prevenção & controle , Ensaios Clínicos Fase III como Assunto , Método Duplo-Cego , França , Hemoglobinas/análise , Fraturas do Quadril/complicações , Humanos , Estudos Multicêntricos como Assunto , Cuidados Pré-Operatórios/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
9.
Bone Joint J ; 103-B(2): 256-263, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33390029

RESUMO

AIMS: Surgical treatment of hip fracture is challenging; the bone is porotic and fixation failure can be catastrophic. Novel implants are available which may yield superior clinical outcomes. This study compared the clinical effectiveness of the novel X-Bolt Hip System (XHS) with the sliding hip screw (SHS) for the treatment of fragility hip fractures. METHODS: We conducted a multicentre, superiority, randomized controlled trial. Patients aged 60 years and older with a trochanteric hip fracture were recruited in ten acute UK NHS hospitals. Participants were randomly allocated to fixation of their fracture with XHS or SHS. A total of 1,128 participants were randomized with 564 participants allocated to each group. Participants and outcome assessors were blind to treatment allocation. The primary outcome was the EuroQol five-dimension five-level health status (EQ-5D-5L) utility at four months. The minimum clinically important difference in utility was pre-specified at 0.075. Secondary outcomes were EQ-5D-5L utility at 12 months, mortality, residential status, mobility, revision surgery, and radiological measures. RESULTS: Overall, 437 and 443 participants were analyzed in the primary intention-to-treat analysis in XHS and SHS treatment groups respectively. There was a mean difference of 0.029 in adjusted utility index in favour of XHS with no evidence of a difference between treatment groups (95% confidence interval -0.013 to 0.070; p = 0.175). There was no evidence of any differences between treatment groups in any of the secondary outcomes. The pattern and overall risk of adverse events associated with both treatments was similar. CONCLUSION: Any difference in four-month health-related quality of life between the XHS and SHS is small and not clinically important. There was no evidence of a difference in the safety profile of the two treatments; both were associated with lower risks of revision surgery than previously reported. Cite this article: Bone Joint J 2021;103-B(2):256-263.


Assuntos
Placas Ósseas , Parafusos Ósseos , Fixação Intramedular de Fraturas/instrumentação , Fraturas do Quadril/cirurgia , Qualidade de Vida , Idoso , Idoso de 80 Anos ou mais , Método Duplo-Cego , Feminino , Seguimentos , Fixação Intramedular de Fraturas/métodos , Indicadores Básicos de Saúde , Humanos , Análise de Intenção de Tratamento , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
10.
Rev Esp Anestesiol Reanim ; 68(2): 65-72, 2021 02.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-33461768

RESUMO

COVID-19 became a threat to the public health system, compromising the health of the population. Patients with hip fractures, due to their age and comorbidity, were high-risk patients in this pandemic. The purpose of this study was to observe how the pandemic affected the management of hip fractures in elderly patients. METHODS: This is a descriptive, retrospective study of all patients over the age of 65 diagnosed with a hip fracture that came to the emergency room of Vall d'Hebron University Hospital in the COVID-19 pandemic period, from the 11th of March to the 24th of April 2020. They were followed up during their hospital stay and 30 days after the fracture. RESULTS: A total of 63 patients were included, 18 (28.6%) of whom had a positive RT-qPCR for COVID-19. Four could not be operated on due to the severity of the disease they presented with upon admission, dying a few days afterwards. Three of these patients had COVID-19. The 83.3% of the patients with positive RT-qPCR presented respiratory symptoms during their hospitalization. The length of hospital stays of patients with a positive RT-qPCR (18.25±8.99 days) was longer than that of patients that were RT-qPCR negative (10.9±4.52 days) (P=.01). In-hospital mortality in operated patients was 20% in patients with a positive RT-qPCR, compared with 2.3% in the group of patients who tested negative (P=.018). Mortality at 30 days was 40% in the group with positive RT-qPCR vs 6.8% in patients not infected by SARS-CoV-2 (P=.002). CONCLUSION: SARS-CoV-2 infection in elderly patients with hip fractures increases both the length of hospital stay, as well as in-hospital and 30-day mortality.


Assuntos
/mortalidade , Fraturas do Quadril/mortalidade , Mortalidade Hospitalar , Pandemias , Idoso , Idoso de 80 Anos ou mais , /estatística & dados numéricos , Feminino , Fraturas do Quadril/cirurgia , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Prevalência , Estudos Retrospectivos , Fatores Sexuais , Espanha/epidemiologia
11.
Medicine (Baltimore) ; 100(2): e24233, 2021 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-33466205

RESUMO

RATIONALE: In general, in the case of an intertrochanteric hip fracture, surgery is performed using a fracture table and by fixing the patient's foot to the boot piece. In patients with amputation of the affected lower limb, it is impossible to fix the foot to the boot piece; therefore, the traction and rotation of the fracture site cannot be maintained, leading to improper patient positioning. In such cases, a fracture table cannot be used intraoperatively to stabilize the fracture site. We report 2 cases of successful intertrochanteric fracture reduction using a fracture table for patients with below- or above-knee amputation. PATIENTS CONCERNS: Both patients presented with left hip pain resulting from a fall. DIAGNOSIS: Two elderly male patients with prior limb amputations below or above the knee presented with intertrochanteric hip fractures. Previous amputation of the lower limb on the same side of the fracture made it difficult to use a fracture table intraoperatively to stabilize the fracture site. INTERVENTION: We performed fracture reduction using a modified fracture table for each patient. By altering the rotation of the boot piece and using additional skin traction bands, we could maintain proper patient positioning and rotation direction and obtain sufficient traction force. OUTCOMES: The chosen outcomes were fracture alignment and union at the end of follow-up and the ability to walk and perform activities of daily living. Reduction and intramedullary nail fixation using the fracture table were successful in both cases. Appropriate fracture union was achieved within 6 months, and the preoperative walking ability and activities of daily living were recovered in both patients, who were followed-up for 28 and 24 months. LESSONS: Modification of the usual fracture table to suit patients with lower limb amputation helped us successfully perform intertrochanteric hip fracture surgery with the usual levels of traction and rotation required of the fracture site.


Assuntos
Amputação , Fixação de Fratura/métodos , Fraturas do Quadril/cirurgia , Acidentes por Quedas , Idoso de 80 Anos ou mais , Amputados , Fraturas do Quadril/etiologia , Humanos , Masculino , Resultado do Tratamento
12.
BMJ Case Rep ; 14(1)2021 Jan 18.
Artigo em Inglês | MEDLINE | ID: mdl-33462049

RESUMO

Hip dislocations are common orthopaedic emergencies which need early intervention to have a better outcome. They usually occur as a result of high energy trauma with motor vehicle accidents being the most common cause followed by fall from height. Posterior hip dislocation is more common than anterior. However, bilateral hip dislocations are rare compared with unilateral. Here we report our case with bilateral posterior hip dislocation with one side having head of femur fracture and contralateral side acetabulum fracture. Both hips were reduced under general anaesthesia on the same day of the trauma. Staged definitive treatment was carried out. The patient had an early recovery with no complications. This case represents an unusual, type of injury resulting from a high speed motor vehicle accident. Early diagnosis, immediate resuscitation and reduction of the hip joints followed by a careful and planned definitive treatment is necessary to have a better outcome.


Assuntos
Acetábulo/lesões , Cabeça do Fêmur/lesões , Luxação do Quadril/diagnóstico por imagem , Luxação do Quadril/etiologia , Fraturas do Quadril/diagnóstico por imagem , Fraturas do Quadril/etiologia , Acidentes de Trânsito , Adulto , Luxação do Quadril/cirurgia , Fraturas do Quadril/cirurgia , Humanos , Masculino
13.
Bone Joint J ; 103-B(1): 170-177, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33380201

RESUMO

AIMS: Infection after surgery increases treatment costs and is associated with increased mortality. Hip fracture patients have historically had high rates of methicillin-resistant Staphylococcus aureus (MRSA) colonization and surgical site infection (SSI). This paper reports the impact of routine MRSA screening and the "cleanyourhands" campaign on rates of MRSA SSI and patient outcome. METHODS: A total of 13,503 patients who presented with a hip fracture over 17 years formed the study population. Multivariable logistic regression was performed to determine risk factors for MRSA and SSI. Autoregressive integrated moving average (ARIMA) modelling adjusted for temporal trends in rates of MRSA. Kaplan-Meier estimators were generated to assess for changes in mortality. RESULTS: In all, 6,189 patients were identified before the introduction of screening and 7,314 in the post-screening cohort. MRSA infection fell from 69 cases to 15 in the post-screening cohort (p < 0.001). The ARIMA confirmed a significant reduction in MRSA SSI post-screening (p = 0.043) but no significant impact after hand hygiene alone (p = 0.121). Overall SSI fell (2.4% to 1.5%), however deep infection increased slightly (0.89% to 1.06%). ARIMA showed neither intervention affected overall SSI ("cleanyourhands" -0.172% (95% confidence interval (CI) -0.39% to 0.21); p = 0.122, screening -0.113% per year, (95% CI -0.34 to 0.12); p = 0.373). One-year mortality after deep SSI was unchanged after screening (50% vs 45%; p = 0.415). Only warfarinization (OR 3.616 (95% CI 1.366 to 9.569); p = 0.010) and screening (OR 0.189 (95% CI 0.086 to 0.414); p < 0.001) were significant covariables for developing MRSA SSI. CONCLUSION: While screening and decolonization may reduce MRSA-associated SSI, the benefit to patient outcome remains unclear. Overall deep SSI remains an unsolved problem that has seen little improvement over time. Preventing other hospital-associated infections should not be forgotten in the fight against MRSA. Cite this article: Bone Joint J 2021;103-B(1):170-177.


Assuntos
Infecção Hospitalar/microbiologia , Fraturas do Quadril/cirurgia , Staphylococcus aureus Resistente à Meticilina , Infecções Estafilocócicas/microbiologia , Infecção da Ferida Cirúrgica/microbiologia , Idoso , Idoso de 80 Anos ou mais , Infecção Hospitalar/mortalidade , Infecção Hospitalar/prevenção & controle , Feminino , Higiene das Mãos , Fraturas do Quadril/mortalidade , Humanos , Masculino , Fatores de Risco , Infecções Estafilocócicas/mortalidade , Infecções Estafilocócicas/prevenção & controle , Infecção da Ferida Cirúrgica/mortalidade , Infecção da Ferida Cirúrgica/prevenção & controle
15.
Rev Esp Anestesiol Reanim ; 68(2): 99-102, 2021 02.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-33358246

RESUMO

Since its first description in china in January 2020, COVID-19 pandemia outbreak has affected health organization and conventional care in all settings as wards, intensive care and surgery. Hip fracture patients usually are older and have a lot of comorbidities. This type of patientes benefit from early surgery. However, surgery in COVID-19 patients with active infection is associate with bad outcomes and mortality. We present three patients with COVID infection undergoing hip fracture surgery. Surgery was performed tree weeks after admission. Despite have risk factor (old age, arterial hypertension, elevated inflammatory parameters) the outcome was good and were discharged from hospital without events.


Assuntos
/complicações , Fraturas do Quadril/complicações , Idoso de 80 Anos ou mais , Biomarcadores/sangue , /diagnóstico , Feminino , Fraturas do Quadril/cirurgia , Humanos , Masculino , Alta do Paciente , Resultado do Tratamento
16.
Artigo em Inglês | MEDLINE | ID: mdl-33322161

RESUMO

The objective of this study was to determine the impact of a postoperative educational intervention program on the health-related quality of life (HRQoL) of patients with hip fracture using a controlled clinical trial in a randomized, multicenter study. In total, 102 patients (45.5%) from trauma units at the two University Hospitals of the province of Cáceres received the educational program, whereas 122 (54.5%) did not. Patients were consecutively included in either an intervention or a control group. Patients from the intervention group received an educational program during admission and the postoperative period. Patients from the control group did not receive any educational program. These patients were managed according to routine protocols. The patients were predominantly female (76.3%), aged 84.6 years (SD 6.1). All dimensions in both groups at 12 months showed a significant decrease with respect to baseline, except for bodily pain in both groups (p = 0.447; p = 0.827) and social functioning in the intervention group (p = 0.268). Patients receiving the educational program showed higher levels in the dimensions of the Mental Component Summary (MCS-12) (p = 0.043), vitality (p = 0.010), and social functioning (p < 0.001), as well as in the dimensions of the SF-12 health survey questionnaire of HRQoL 12 months after surgery. In conclusion, our study of the intervention group showed that there were significant improvements in MCS-12, vitality, and social function dimensions compared to the control group.


Assuntos
Fraturas do Quadril/psicologia , Dor/prevenção & controle , Educação de Pacientes como Assunto/métodos , Cuidados Pós-Operatórios/métodos , Qualidade de Vida , Idoso de 80 Anos ou mais , Feminino , Serviços de Saúde para Idosos , Fraturas do Quadril/cirurgia , Humanos , Masculino , Avaliação de Resultados em Cuidados de Saúde , Inquéritos e Questionários
17.
Beijing Da Xue Xue Bao Yi Xue Ban ; 52(6): 1102-1106, 2020 Dec 18.
Artigo em Chinês | MEDLINE | ID: mdl-33331321

RESUMO

OBJECTIVE: To evaluate the surgical technique and clinical effect of less invasive intrame-dullary nail fixation combined with titanium cable cerclage in the treatment of subtrochanteric fractures. METHODS: A retrospective study was performed in 46 cases of subtrochanteric fractures in Peking University People's Hospital from January 2015 to December 2017. Among them, there were 14 males and 32 females, with an average age of (77.83±10.66) years (44-92 years); 17 cases on the left side and 29 cases on the right side. The causes of injury included crash from a height, traffic accident and accidental fall. According to Seinsheimer classification, there were 26 cases of type Ⅱ, 11 cases of type Ⅲ, 9 cases of type Ⅳ, and these cases were all closed injury. After admission, these patients underwent continuous tibial tuberosity bone traction to maintain the length and force line of the lower extremity, so as to reduce the difficulty of intraoperative fracture reduction. Anticoagulant therapy was given before operation to reduce perioperative thrombotic complications. All the patients were treated with less invasive intramedullary nail fixation combined with titanium cable cerclage. Operation time, blood loss during surgery, time of fracture healing were recorded, Harris and Sanders scoring system were used to assess hip function after operation at each follow-up time point. RESULTS: All the included patients underwent surgery successfully. Average operative time and intraoperative blood loss of these patients were (131.09 ± 20.06) min and (191.96±111.03) mL, respectively. All the patients were followed up satisfactorily, with an average follow-up time of 28 months. The fractures received bone healing within 3-6 months, average hospital stay was (10.61±2.85) days. The Sanders score was excellent in 3 cases, good in 37 cases and common in 6 cases, with an excellent and good rate of 86.96%. The Harris score was excellent in 6 cases, good in 36 cases, with an excellent and good rate of 91.30%. There were no cases of wound infection, loss of reduction, nonunion of fracture or internal fixation failure. Hip pain symptoms were effectively relieved in most patients. CONCLUSION: Less invasive intramedullary nail fixation combined with titanium cable cerclage can obtain good alignment and stability of fracture ends, which is an effective method for the treatment of subtrochanteric fractures.


Assuntos
Fixação Intramedular de Fraturas , Fraturas do Quadril , Idoso , Idoso de 80 Anos ou mais , Pinos Ortopédicos , Feminino , Consolidação da Fratura , Fraturas do Quadril/cirurgia , Humanos , Masculino , Estudos Retrospectivos , Titânio , Resultado do Tratamento
18.
Zhongguo Gu Shang ; 33(12): 1161-5, 2020 Dec 25.
Artigo em Chinês | MEDLINE | ID: mdl-33369325

RESUMO

OBJECTIVE: A3 intertrochanteric fracture is an extremely unstable fracture, which is often treated with intramedullary nail, but the implant failure is common due to the posterior medial fragment cannot be reconstructed. A new medial sustainable nail (MSN-Ⅱ) which can reconstruct the femoral medial support by sustainable screw was introduced in this study. The mechanical effect was verified by biomechanical experiment. METHODS: The loss medial support model of intertrochanteric fracture (A3) was made by artificial Sawbones model, fixed with MSN-Ⅱ and PFNA-Ⅱ, underwent axial loading and axial failure tests. The axial stiffness, yield load, displacement of head-neck fragment and torsional angle of fracture site of these nails were recorded and compared for biomechanical differences. The effect of early reconstruction of medial support with MSN-Ⅱ was determined. RESULTS: The axial stiffness, yield load, the displacement of head and neck fragment when the axial load was 1 800 N and torsional angle of the fracture site after the axial failure test of MSN-Ⅱ were (222.76 ±62.46) N /mm, (4 241.71 ±847.42) N, (11.51 ±0.62) mm, (1.71 ±0.10)° respectively, while the PFNA -Ⅱ was (184.58±40.59) N /mm, (3 058.76±379.63) N, (16.15±1.36) mm, (2.52±0.26)°respectively. The difference between the two groups was statistically significant. CONCLUSION: The axial stiffness of MSN-Ⅱ is better than that of PFNA-Ⅱ. The MSN-Ⅱ can bear more loads when fixed A3.3 intertrochanteric fracture and has greater axial and rotational stability. It is an effective means to reconstruct the medial support of A3 intertrochanteric fracture.


Assuntos
Fixação Intramedular de Fraturas , Fraturas do Quadril , Fenômenos Biomecânicos , Pinos Ortopédicos , Parafusos Ósseos , Fêmur , Fraturas do Quadril/cirurgia , Humanos
19.
Medicine (Baltimore) ; 99(52): e23378, 2020 Dec 24.
Artigo em Inglês | MEDLINE | ID: mdl-33350726

RESUMO

BACKGROUND: A femoral neck fracture (FNF) is one of the most destructive and familiar injuries encountered via the orthopedic surgeons. However, this is no guideline for the treatment of the Garden I hip fractures because the current evidence is limited from the poor study design and small sample size. The objective of our research is to compare the safety and effectiveness of the surgical treatment and conservative treatment in the non-displaced FNFs. METHODS: This is a randomized trial, which will be implemented from December 2020 to December 2021. The experiment was granted through the Research Ethics Committee of the Zhenhai District People's Hospital of Ningbo (2014005). Hundred patients meet inclusion criteria and exclusion criteria are included. Patients who are eligible for the following conditions will be included: those over 75 years old with Garden I hip fractures diagnosed by CT or X-ray. Patients with the following conditions will be excluded: patients age under 75 years old, the avascular necrosis of the femoral head, pathological fracture, infection, former symptomatic hip pathology, the history of hip fracture, as well as the lower limb deformity. The primary outcome contains pain at 1 month, 3 months and 6 months and hip function at 1 month, 3 months and 6 months. Secondary outcome includes the life quality, mortality rate, complications such as deep venous thrombosis, pulmonary embolism. RESULTS: Comparison of outcome indicators in 2 groups after conservative treatment or surgical treatment (Table). CONCLUSION: The current trial will offer better evidence for the future treatment selection for Garden 1 FNFs for patients older than 75years old. TRIAL REGISTRATION NUMBER: researchregistry6147.


Assuntos
Tratamento Conservador , Hemiartroplastia , Fraturas do Quadril/terapia , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Idoso , Fraturas do Quadril/cirurgia , Humanos
20.
BMJ Case Rep ; 13(12)2020 Dec 21.
Artigo em Inglês | MEDLINE | ID: mdl-33370952

RESUMO

A 60-year-old man presented to our hospital with complaints of pain and deformity on his right thigh for the past 2 days following a history of accidental slip and fall. Radiological investigations suggested a pathological type 2 Seinsheimer subtrochanteric fracture of the right femur with a 'bone within bone' appearance, which posed a diagnostic dilemma as this radiological appearance is seen in a spectrum of conditions. Radiographic skeletal survey failed to identify a similar appearance elsewhere in the body. Laboratory investigations pointed in favour of bone mineral disease, and histopathological examination of the bone narrowed it down to Paget's disease. The fracture was fixed with a contralateral distal femur locking compression plate. The fracture site failed to show signs of union until 6 months postsurgery and hence the patient was advised for grafting procedure. The patient deferred surgery and remains without major complications until 18 months of follow-up.


Assuntos
Acidentes por Quedas , Fixação Interna de Fraturas/instrumentação , Fraturas Espontâneas/diagnóstico , Fraturas do Quadril/diagnóstico , Osteíte Deformante/diagnóstico , Biópsia , Placas Ósseas , Distúrbio Mineral e Ósseo na Doença Renal Crônica/diagnóstico , Diagnóstico Diferencial , Fêmur/diagnóstico por imagem , Fêmur/lesões , Fêmur/patologia , Fêmur/cirurgia , Fraturas Espontâneas/etiologia , Fraturas Espontâneas/cirurgia , Fraturas do Quadril/etiologia , Fraturas do Quadril/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Osteíte Deformante/complicações , Osteíte Deformante/patologia , Radiografia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA