Association between falling direction and age in older patients with hip fractures

Construction and validation of a predictive model for the risk of prolonged preoperative waiting time in patients with intertrochanteric fractures

Background

Intertrochanteric fractures are one of the most common types of hip fractures, with delayed surgical treatment beyond 48 h associated with increased postoperative complications and mortality, especially in older adults. This study aimed to develop a predictive model for delayed preoperative waiting times in intertrochanteric fracture cases, based on previous research, to offer a valuable reference for clinical decision-making.

Methods

A retrospective analysis was conducted on 1,116 patients with intertrochanteric fractures admitted to the Affiliated Hospital of Shandong University of Traditional Chinese Medicine for internal fixation surgery from January 2017 to January 2024. Patient demographic data and clinical examination results were collected. A logistic regression model was used to construct a predictive model, which was then visualized through a nomogram. The model's performance was subsequently validated.

Results

The predictive model developed from 728 patients in the training cohort, identified key predictors, including age, sex, lower extremity deep vein thrombosis, injury location, and biochemical markers. The model demonstrated strong discriminative ability, with an area under the receiver operating characteristic curve of 0.749 (95% confidence interval: 0.621-0.801) for the training set, and 0.745 in the validation set. Calibration curves indicated that the predicted risk of surgical delay closely aligned with observed outcomes. Furthermore, decision curve analysis verified the model's clinical utility, demonstrating its effectiveness in guiding treatment decisions.

Conclusion

The nomogram model developed in this study provides a reliable tool for predicting delayed surgical intervention in patients with intertrochanteric femur fractures. It offers clinicians a valuable reference to anticipate delays in surgical treatment and aids in the formulation of more timely and appropriate treatment strategies, potentially improving patient outcomes.

Characteristics of fragility hip fracture-related falls in the older adults: A systematic review

BACKGROUND AND OBJECTIVES

With the global aging trend, the incidence of falls and hip fractures is projected to rise, leading to an increased associated burden. Over 90% of hip fractures result from falls, yet not all falls cause fractures, suggesting specific fall characteristics may contribute to hip fractures. This review provides insights into fragility hip fracture-related falls among the older adults, aiding in understanding and developing effective fall prevention strategies for this population.

METHODS

Searches encompassed PubMed, OVID, EMBASE, Cochrane Library, and Web of Science, supplemented by citation checks. We included non-randomized studies detailing characteristics of fragility hip fracture-related falls in the older individuals, with or without a non-hip fracture control. Evaluated fall characteristics included height, location, direction, time, mechanism, activity during the fall, hip impact, protective responses, walking aid use, and impact surface. Results were analyzed using a narrative synthesis approach. The quality of these studies was assessed using the revised Risk of Bias Assessment tool for Non-randomized Studies 2 (RoBANS2).

RESULTS

A total of 30 articles were reviewed, comprising 23 non-case control and 7 case-control studies, with a mean age of 75.6 years. Studies presented varied details on fall characteristics. Hip-fracture related falls typically occur indoors at or around standing height during daytime, often involving sideways or backward motions with inadequate protective responses. Slipping is predominant, yet lost balance and weakness/collapse are notable. Walking precedes many falls, but stationary activities (lack of forward motion, changing positions, sitting or standing still, transfer) also contribute. Low usage of walking aids and impact on hard surfaces are common features of these falls.

CONCLUSIONS

This review underscores fall characteristics associated with fragility hip fractures in older adults, highlighting features more aligned with age-related physical frailty than general falls. Such insights can guide healthcare providers in implementing tailored interventions to reduce hip fractures and related challenges.

Social participation, positive affect, and negative affect in postoperative patients with hip fractures: A cross-sectional study

This study investigated the social participation, positive affect (PA), and negative affect (NA) of patients with hip fractures after surgery and determined their possible predictive factors. We used a cross-sectional study design to recruit 154 participants with hip fractures post-surgery. Assessment tools included the Barthel Index, the Automatic Thoughts Questionnaire, the Assessment of Life Habits, and the Positive and Negative Affect Schedule. Patients with better functioning in daily living activities experienced more social participation, higher PA, and lower NA. Patients with more positive automatic thoughts experienced more social participation and higher PA. Patients with more negative automatic thoughts experienced more social participation, lower PA, and higher NA. Early rehabilitation and psychosocial interventions should be provided for postoperative hip fracture patients to improve their activities of daily living and emotional well-being.

Degenerative cervical myelopathy delays responses to lateral balance perturbations regardless of predictability

The aim of this study was to quantify balance impairments in standing in people with degenerative cervical myelopathy (PwDCM) in response to external perturbations. PwDCM have damage to their spinal cord due to degeneration of the cervical vertebral column, but little is known about balance. Balance was quantified by capturing kinetics, kinematic, and electromyographic data during standing in response to lateral waist pulls. Participants received pulls during predictable and unpredictable contexts in three stance widths at two magnitudes. In response to lateral waist pulls, PwDCM had larger center of mass excursion (P < 0.001) and delayed gluteus medius electromyography onset (P < 0.001) and peak (P < 0.001) timing. These main effects of history of myelopathy were consistent across predictability, stance width, and magnitude. A multilinear regression determined that gluteus medius peak timing + tibialis anterior peak timing most strongly predicted center of mass excursion (R2 = 0.50, P < 0.001). These data suggest that PwDCM have delays in generating voluntary and reactive motor commands, contributing to balance impairments. Future rehabilitation strategies should focus on generating rapid muscular contractions. Additionally, frontal plane postural control is regulated by the gluteus medius and the tibialis anterior, whereas other muscles (e.g. gluteus minimus, ankle invertors/evertors) not studied here may also contribute.NEW & NOTEWORTHY Frontal plane reactive postural control is impaired in persons with degenerative cervical myelopathy because of delayed muscle responses. Additionally, postural control varies across stance width, predictability, and perturbation magnitude.