RESUMEN
UNLABELLED: We determined age-standardized first hip fracture rates in British Columbia between 1990 and 2004. We found sex and fracture type rates in keeping with previous reports and that fracture rates have decreased approximately 18% overall in both men and women. INTRODUCTION: To determine whether there have been changes in the age-, sex-, and subtype-specific first hip fracture rates in Canadian province of British Columbia (BC) between 1990 and 2004. METHODS: Records of all persons aged 60 years and older hospitalized with hip fractures in BC between 1985 and 2004 were obtained from the Canadian Institute for Health Information Discharge Abstract Database. Only the first hip fracture records were included, and fractures likely due to causes other than trauma were excluded. Age- and sex-specific rates were calculated using population denominators from Statistics Canada and direct standardization was used. Age-standardized rates allowed for comparison across years with adjustment for age distribution. RESULTS: There were 41,990 records of first hip fracture included, and 73% were in women. Trends in age-specific rates by fracture type were similar to previous reports. Between 1990 and 2004, there has been an age-adjusted 18% decrease in first hip fracture rates in women, and 19% decrease in first hip fracture rates in men. The decrease was statistically significant in femoral neck fractures in women, but not in men. CONCLUSIONS: There has been a decrease in age-adjusted hip fracture rates in BC between 1990 and 2004, which is in contrast to previous projections for hip fracture rates in Canada.
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Fracturas de Cadera/epidemiología , Distribución por Edad , Anciano , Anciano de 80 o más Años , Colombia Británica/epidemiología , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Distribución por SexoRESUMEN
UNLABELLED: A comprehensive review of literature was conducted to investigate variation in hip fracture incident rates around the world. The original crude incidence rates were standardized for age and sex for comparability. After standardization, the highest rates of hip fracture were found in Scandinavia and the lowest rates in Africa. INTRODUCTION: This study was conducted to investigate the geographic trends of the incidence of osteoporotic hip fractures through a comprehensive review of literature. METHODS: Studies were identified for inclusion in the review by searching the MEDLINE database via PubMed and applying strict inclusion and exclusion criteria. Age-specific incidence rates were extracted from the articles, and in order to provide a common platform for analysis, we used directly age-standardized and age-sex-standardized rates (using the 2005 United Nations estimates of the world population as standard) to complete the analysis. RESULTS: Forty-six full text articles spanning 33 countries/regions were included in the review. For ease of comparison, the results were analyzed by geographic regions: North America, Latin America, Scandinavia, Europe (excluding Scandinavia), Africa, Asia, and Australia. The highest hip fracture rates were found in Scandinavia and the lowest in Africa. We found comparable rates from countries in North America, Australia, and Europe outside of Scandinavia. The diverse makeup of the Asian continent also resulted in quite variable hip fracture rates: ranging from relatively high rates in Iran to low rates, comparable to those from Africa, in mainland China. CONCLUSIONS: Given the aging of populations globally, and in the industrialized countries specifically, hip fractures will become a progressively larger public health burden. The geographic trends observed in hip fracture incidence rates can provide important clues to etiology and prevention.
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Fracturas de Cadera/epidemiología , África/epidemiología , Asia/epidemiología , Australia/epidemiología , Europa (Continente)/epidemiología , Femenino , Salud Global , Humanos , Incidencia , América Latina/epidemiología , Masculino , Persona de Mediana Edad , América del Norte/epidemiología , Países Escandinavos y Nórdicos/epidemiologíaRESUMEN
UNLABELLED: We performed a systematic review of the literature pertaining to the functional outcomes of the surgical management of acetabular fractures. A total of 69 articles met our inclusion criteria, revealing that eight generic outcome instruments were used, along with five specific instruments. The majority of studies reported outcomes using a version of the d'Aubigne and Postel score, which has not been validated for use in acetabular fracture. Few validated outcome measures were reported. No psychometric testing of outcome instruments was performed. The current assessment of outcomes in surgery for acetabular fractures lacks scientific rigour, and does not give reliable outcome data for either scientific comparison or patient counselling. TAKE HOME MESSAGE: The use of non-validated functional outcome measures is a major limitation of the current literature pertaining to surgical management of acetabular fractures; future studies should use validated outcome measures to ensure the legitimacy of the reported results. Cite this article: Bone Joint J 2016;98-B:690-5.
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Acetábulo/cirugía , Fracturas Óseas/cirugía , Evaluación del Resultado de la Atención al Paciente , Acetábulo/lesiones , Evaluación de la Discapacidad , Fijación Interna de Fracturas , Humanos , Encuestas y CuestionariosRESUMEN
Femoral neck non union is a relatively uncommon complication following intracapsular hip fracture in the young patient. Almost all patients with femoral neck non union are symptomatic for which they will require some form of revision surgery. This review discusses the role of valgus osteotomy in managing the younger patient with femoral neck non union.
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Fracturas del Cuello Femoral/complicaciones , Fracturas no Consolidadas/etiología , Fracturas no Consolidadas/cirugía , Osteotomía/métodos , Adolescente , Adulto , Placas Óseas , Fracturas del Cuello Femoral/cirugía , Curación de Fractura , Humanos , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
INTRODUCTION: Minimal-invasive placement of screws into the posterior column of the acetabulum (PC) is challenging. Due to the saddle-shaped curvature of the medial cortical border of the PC, the standard fluoroscopic views of the pelvis cannot provide the desired safety during screw insertion. The aim of this study was to define a view tangentially to the medial cortex of the PC and to evaluate its accuracy and inter-observer reproducibility. METHODS: Radio-dense markers on the medial cortex of the PC along the axis of a PC screw were brought in line and landmarks of the new "Down the PC" view were determined. Kirschner wires were placed into the PC of a pelvis composite model and five pelvic cadaver specimens in a total of 34 different correct and incorrect positions. Based on either only the "Down the PC" view, only the standard views, or a combination of both, three fellowship-trained orthopaedic surgeons had to decide if the inserted wires were in bone in the posterior column or had exited cortex, and if they penetrated the acetabulum. Sensitivity, specificity, and the intra-class correlation coefficient were calculated. RESULTS: A view using three radiographic landmarks (pelvic brim, medial cortical wall of the body of the ischium, ischial spine) was found. Sensitivity and specificity to detect perforation out of the bone were 1.00 and 0.97 for the "Down the PC" view, 0.46 and 0.97 if only the standard views were used, and 1.00 and 0.95 for a combination of both. Sensitivity and specificity to detect intra-articular wire placement were 1.00 and 0.96 for the "Down the PC" view, 0.72 and 0.95 if only the standard views were used, and 0.94 and 0.99 for a combination of both. Inter-observer agreement using only the "Down the PC" view was excellent with an ICC of 0.92 for perforation and ICC of 0.82 for intra-articular wire placement. CONCLUSIONS: The "Down the PC" view is a useful addendum in the orthopaedic trauma surgeon's tool box. Using simple landmarks, it is easily to reproduce and thereby shows excellent accuracy and inter-observer agreement in order to detect medial perforation or intra-articular implant position.
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Acetábulo/lesiones , Fluoroscopía/instrumentación , Fijación Interna de Fracturas/métodos , Fracturas Óseas/cirugía , Cirugía Asistida por Computador/métodos , Tornillos Óseos , Fracturas Óseas/patología , Humanos , Posicionamiento del Paciente , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Tomografía Computarizada por Rayos XRESUMEN
Patients participating in a modern prospective orthopaedic trauma database may be asked to complete many functional outcome measures, adding to the burden of study participation. This prospective study assessed the utility and responsiveness of the generic Short Form 36 (SF-36) and the disease specific Short Musculoskeletal Function Assessment (SMFA) and the Western Ontario McMaster Osteoarthritis (WOMAC) questionnaires in 55 patients treated operatively for tibial plateau fractures with the goal of determining if there was clear benefit of using multiple measures in a lower extremity peri-articular fracture population. There was very good correlation between all three scores at 6 and 12 months, indicating they are measuring similar factors. Responsiveness was assessed using the standard response mean (SRM), proportion of patients attaining the minimal clinically important difference (MCID) between 6 and 12 months, and floor and ceiling effects. The SRM for the SF-36 was statistically higher than the SRM for the SMFA or the WOMAC. Significantly more patients were found to have a MCID between 6 and 12 months post-surgery based on the SF-36 than the other two functional scores. There was no floor effect found on any of the 3 functional scores evaluated; however, a significant ceiling effect was noted with the WOMAC but not with the SF-36 or the SMFA. These results, along with the usefulness of the SF-36 for comparing disease burden across populations, favour the SF-36 as the instrument of choice in assessing functional outcome in patients with tibial plateau fractures.
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Actividades Cotidianas , Fracturas de la Tibia/fisiopatología , Actividades Cotidianas/psicología , Adulto , Anciano , Canadá/epidemiología , Evaluación de la Discapacidad , Femenino , Indicadores de Salud , Humanos , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Periodo Posoperatorio , Estudios Prospectivos , Psicometría , Índice de Severidad de la Enfermedad , Encuestas y Cuestionarios , Fracturas de la Tibia/psicología , Fracturas de la Tibia/cirugía , Resultado del TratamientoRESUMEN
We performed a systematic review of the literature to evaluate the use and interpretation of generic and disease-specific functional outcome instruments in the reporting of outcome after the surgical treatment of disruptions of the pelvic ring. A total of 28 papers met our inclusion criteria, with eight reporting only generic outcome instruments, 13 reporting only pelvis-specific outcome instruments, and six reporting both. The Short-Form 36 (SF-36) was by far the most commonly used generic outcome instrument, used in 12 papers, with widely variable reporting of scores. The pelvis-specific outcome instruments were used in 19 studies; the Majeed score in ten, Iowa pelvic score in six, Hannover pelvic score in two and the Orlando pelvic score in one. Four sets of authors, all testing construct validity based on correlation with the SF-36, performed psychometric testing of three pelvis-specific instruments (Majeed, IPS and Orlando scores). No testing of responsiveness, content validity, criterion validity, internal consistency or reproducibility was performed. The existing literature in this area is inadequate to inform surgeons or patients in a meaningful way about the functional outcomes of these fractures after fixation.
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Evaluación de la Discapacidad , Fracturas Óseas/cirugía , Huesos Pélvicos/lesiones , Estudios de Seguimiento , Fijación de Fractura/rehabilitación , Fracturas Óseas/rehabilitación , Indicadores de Salud , Humanos , Huesos Pélvicos/cirugía , Psicometría , Recuperación de la Función , Resultado del TratamientoRESUMEN
The use of tension band wire technique for patella fractures fixation is a well-established technique. However, the standard technique, which involves using two Kirschner wires through the patella, can cause problems with prominent hardware, and difficulty capturing the change to figure of eight wire. Here we describe a modified technique using four Kirschner wires, which allows each wire to be bent, and well-impacted in order to avoid these problems. The basic surgical technique, and our case series are reviewed.
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Hilos Ortopédicos , Fijación Interna de Fracturas/métodos , Fracturas Óseas/cirugía , Rótula/lesiones , Tornillos Óseos , Remoción de Dispositivos , Fracturas no Consolidadas/cirugía , Humanos , Complicaciones Posoperatorias/cirugía , ReoperaciónRESUMEN
We describe our early operative experience with a new pelvic reduction frame and the standard of reduction of fractures of the pelvic ring which we achieved in the first 35 consecutive patients, with 34 acute fractures and one nonunion. The pre-operative and immediate post-operative radiographs were measured, using two methods, to find the maximum radiological displacement of the fracture and the quality of the reduction according to the criteria of Tornetta and Matta. There were 19 vertical shear fractures and 16 compression injuries. The mean age of the patients was 33.5 years (10 to 59) and mean delay to surgery was 4.6 days (0 to 16) in the 34 acute injuries. The mean operative time in isolated procedures was 103.4 minutes (SD 6.5). All but one patient had iliosacral screws implanted, 18 had screws in the anterior column, six had plates at the symphysis pubis and 12 had anterior external fixators. The mean maximum horizontal or vertical displacement was improved from 30.8 mm (SD 2.7) to a mean of 7.1 mm (SD 0.7). The reduction was assessed as excellent in ten patients, good in 18, and fair in the remainder. There was no significant influence on the quality of the reduction caused by obesity (p = 0.34), the type of fracture (p = 0.41) or delay to surgery (p = 0.83). The frame was shown to be effective, allowing the surgeon to obtain a satisfactory reduction and fixation of acute displaced disruptions of the pelvic ring.
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Fijadores Externos , Fijación Interna de Fracturas/métodos , Curación de Fractura/fisiología , Fracturas Óseas/cirugía , Huesos Pélvicos/lesiones , Adolescente , Adulto , Niño , Femenino , Fijación Interna de Fracturas/instrumentación , Fracturas Óseas/diagnóstico por imagen , Humanos , Puntaje de Gravedad del Traumatismo , Masculino , Persona de Mediana Edad , Huesos Pélvicos/diagnóstico por imagen , Huesos Pélvicos/cirugía , Radiografía , Resultado del Tratamiento , Adulto JovenRESUMEN
Our aim was to determine the effect of delay to surgery on the time to discharge, in-hospital death, the presence of major and minor medical complications and the incidence of pressure sores in patients with a fracture of the hip. All patients admitted to Vancouver General Hospital with this injury between 1998 and 2001 inclusive were identified from our trauma registry. A review of the case notes was performed to determine the delay in time from admission to surgery, age, gender, type of fracture and medical comorbidities. A time-to-event analysis was performed for length of stay. Additionally, a Cox proportional hazards model was used to determine the effect of delay to surgery on the length of stay while controlling for other pertinent confounding factors. Using logistical regression we determined the effect of delay to surgery on in-hospital death, medical complications and the presence of pressure sores, while controlling for confounding factors. Delay to surgery (p = 0.0255), comorbidity (p < 0.0001), age (p < 0.0001) and type of fracture (p = 0.0004) were all significant in the Cox proportional hazards model for increased time to discharge. Delay to surgery was not a significant predictor of in-hospital mortality. However, a delay of more than 24 hours was a significant predictor of a minor medical complication (odds ratio (OR) 1.53, 95% confidence interval (CI) 1.05 to 2.22), while a delay of more than 48 hours was associated with an increased risk of a major medical complication (OR 2.21, 95% CI 1.01 to 4.34), a minor medical complication (OR 2.27, 95% CI 1.38 to 3.72) and of pressure sores (OR 2.29, 95% CI 1.19 to 4.40). Patients with a fracture of the hip should have surgery early to lessen the time to acute-care hospital discharge and to minimise the risk of complications.
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Fracturas de Cadera/mortalidad , Úlcera por Presión/epidemiología , Anciano , Anciano de 80 o más Años , Canadá/epidemiología , Femenino , Fracturas de Cadera/complicaciones , Fracturas de Cadera/cirugía , Mortalidad Hospitalaria , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , Alta del Paciente/estadística & datos numéricos , Úlcera por Presión/cirugía , Modelos de Riesgos Proporcionales , Factores de TiempoRESUMEN
OBJECTIVES: To determine if there is a difference in morbidity and mortality in orthopaedic trauma patients with femoral shaft fractures undergoing early definitive care with intramedullary (IM) nails in the supine versus the lateral position. DESIGN: Retrospective cohort study, single centered. SETTING: One level 1 trauma center. PATIENTS: Nine hundred eighty-eight patients representing 1027 femoral shaft fractures treated with IM nails were identified through a prospectively gathered database between 1987 and 2006. INTERVENTION: Antegrade IM nail insertion with reaming of the femoral canal in either the supine or lateral position. OUTCOME MEASURES: Mortality was the primary outcome. Admission to intensive care unit (ICU) was the secondary outcome measure and a surrogate measure of morbidity. Literature review was performed to identify factors shown to contribute to morbidity and mortality in orthopaedic trauma patients. Intraoperative position in either the supine or lateral position was added to this list. Logistic regression analysis was performed to determine the magnitude and effect of the independent variables on each of the study end points. To determine if a more significant trend toward less favorable outcomes was observed with increasing severity of injury, particularly injuries of the chest and thorax, subgroup analysis was performed for all those with a femur fracture and an Injury Severity Score > or =18 and all those with a femur fracture and an Abbreviated Injury Score chest > or =3. RESULTS: Intraoperative position in either the supine or lateral position was not a significant predictor of mortality or ICU admission for the original cohort or the subgroup of Injury Severity Score > or =18. However, for the subgroup of Abbreviated Injury Score chest > or =3, intraoperative positioning in the lateral position had a statistically significant protective effect against ICU admission (P = 0.044). CONCLUSIONS: For polytrauma patients with femoral shaft fractures, surgical stabilization using IM nails inserted with reaming of the femoral canal in the lateral position is not associated with an increased risk of mortality or ICU admission.