Survival and functional outcome according to hip fracture type: a one-year prospective cohort study in elderly women with an intertrochanteric or femoral neck fracture

All-Cause Mortality Risk in Elderly Patients with Femoral Neck and Intertrochanteric Fractures: A Predictive Model Based on Machine Learning

Introduction

The aim of this study was to identify the influencing factors for all-cause mortality in elderly patients with intertrochanteric and femoral neck fractures and to construct predictive models.

Methods

This study retrospectively collected elderly patients with intertrochanteric fractures and femoral neck fractures who underwent hip fractures surgery in the Third Hospital of Hebei Medical University from January 2020 to December 2022. Cox proportional hazards regression is used to explore the association between fractures type and mortality. Boruta algorithm was used to screen the risk factors related to death. Multivariate logistic regression was used to determine the independent risk factors, and a nomogram prediction model was established. The ROC curve, calibration curve and DCA decision curve were drawn by R language, and the prediction model was established by machine learning algorithm.

Results

Among the 1373 patients. There were 6 variables that remained in the model for intertrochanteric fractures: age (HR 1.048, 95% CI 1.014-1.083, p = 0.006), AMI (HR 4.631, 95% CI 2.190-9.795, P < 0.001), COPD (HR 3.818, 95% CI 1.516-9.614, P = 0.004), CHF (HR 2.743, 95% CI 1.510-4.981, P = 0.001), NOAF (HR 1.748, 95% CI 1.033-2.956, P = 0.037), FBG (HR 1.116, 95% CI 1.026-1.215, P = 0.011). There were 3 variables that remained in the model for femoral neck fractures: age (HR 1.145, 95% CI 1.097-1.196, P < 0.001), HbA1c (HR 1.264, 95% CI 1.088-1.468, P = 0.002), BNP (HR 1.001, 95% CI 1.000-1.002, P = 0.019). The experimental results showed that the model has good identification ability, calibration effect and clinical application value.

Conclusion

Intertrochanteric fractures is an independent risk factor for all-cause mortality in elderly patients with hip fractures. By constructing a prognostic model based on machine learning, the risk factors of mortality in patients with intertrochanteric fractures and femoral neck fractures can be effectively identified, and personalized treatment strategies can be developed.

Postoperative outcomes in patients operated for extra- and intracapsular hip fractures - a secondary analysis of two randomized controlled trials

BACKGROUND

Hip fractures are among the most common and serious injuries in older adults. There has been a perception that extracapsular hip fractures have worse outcome than intracapsular hip fractures. We aimed to examine postoperative outcomes in patients operated for extra- and intracapsular hip fractures.

METHODS

This is a secondary analysis of data from two randomized controlled trials evaluating the effect of orthogeriatric care. Bivariate analyses were conducted, comparing patients with extracapsular fracture to patients with intracapsular fracture. Mortality, length of hospital stay (LOS), new nursing home admissions, operative data and measures of functional and cognitive performance were assessed as endpoints.

RESULTS

The primary analysis included 711 patients; 283 patients had an extracapsular fracture and 428 an intracapsular fracture. At four months follow-up, the intracapsular fracture group had significantly better Short Physical Performance Battery (SPPB) (5.0 vs. 4.0, p = 0.007), personal Activities of Daily Living (p-ADL) (17.0 vs. 16.0, p = 0.007) and instrumental ADL (i-ADL) (32.5 vs. 28.0, p = 0.049). There were no statistically significant differences between the groups at 12 months.

CONCLUSIONS

Patients with an extracapsular fracture had worse mobility and ADL levels four months postoperatively, but there were no clinically relevant differences at 12 months postoperatively.

Based on CT scans at the 12th thoracic spine level, assessing the impact of skeletal muscle and adipose tissue index on one-year postoperative mortality in elderly hip fracture patients: a propensity score-matched multicenter retrospective study

BACKGROUND

Research has demonstrated that individuals with sarcopenia or sarcopenic obesity who experience fractures or undergo major surgical interventions exhibit a poorer prognosis compared to the general population. However, few studies have investigated the relationship between the skeletal muscle and adipose tissue indices, as measured at the 12th thoracic spine level, and adverse outcomes following orthopedic surgery. Therefore, this study aimed to prove whether skeletal muscle and adipose tissue index measured by computed tomography (CT) images based on a single layer are associated with one-year postoperative mortality in elderly hip fracture patients.

METHODS

A total of 334 participants from two institutions were enrolled in this study to obtain skeletal muscle index (SMI), subcutaneous fat index (SFI), visceral fat index (VFI), and the visceral-to-subcutaneous ratio of the fat area (VSR) at T12 levels and divide them into death and survival groups based on the results of follow-up after 1 year. Propensity score matching (PSM) was employed to evaluate one-year postoperative mortality.

RESULTS

Institution 1's results identified that a lower SMI significantly heightened the risk of one-year postoperative mortality (OR = 0.799,95%CI 0.677-0.943, P = 0.008), making SMI an independent predictor. Institution 2's results identified that age (OR = 1.081, 95%CI 1.005-1.163, P = 0.036), SMI (OR = 0.881, 95%CI 0.784-0.991, P = 0.035) as independent predictors of one-year postoperative mortality in elderly hip fracture. Receiver operator characteristics analysis revealed area under the curve (AUC) values for institution 1: SMI (0.738 (95%CI 0.626-0.851), significant), VFI (0.605 (95%CI 0.476-0.734)), VSR (0.583 (95%CI 0.451-0.715)); and for institution 2: SMI (0.742 (95%CI 0.612-0.872), significant) and Age (0.775 (95%CI 0.677-0.874), significant). Collectively, these results underscore that SMI serves as an independent predictor of one-year postoperative mortality in elderly hip fracture patients.

CONCLUSION

This study demonstrated that the T12-based SMI was independently associated with one-year mortality following hip fracture in geriatric patients, with lower preoperative SMI correlating with higher mortality rates post-surgery.

Predictors for 1-year mortality in geriatric patients following fragile intertrochanteric fracture surgery

OBJECTIVE

To investigate the risk factors influencing 1-year mortality after intramedullary nail fixation for fragile intertrochanteric fracture in elderly individuals.

METHODS

The medical records of 622 consecutive elderly patients (aged ≥ 65 years) with fragile intertrochanteric fractures treated with proximal femoral nail anti-rotation (PFNA) and followed-up were retrospectively analyzed. The patients were divided into death and survival groups according to their survival status within 1 year after surgery, and the differences in age, sex, region of residence, tobacco use, alcohol use, body mass index (BMI), comorbidities (hypertension, diabetes mellitus, coronary heart disease, stroke, dementia, chronic obstructive pulmonary disease, pneumonia), preoperative hemoglobin, preoperative albumin, deep vein thrombosis, fracture type (AO classification), injury-to-surgery time, American Society of Anesthesiologists (ASA) score, anesthesia modality, duration of surgery, intraoperative blood loss, and blood transfusion were compared. The Kaplan-Meier method was used for univariate analysis to screen for statistically significant differences between the two groups, and the data were entered into the Cox proportional hazards model for multivariate analysis to determine independent risk factors affecting 1-year postoperative mortality. For subgroup analysis, we explored the varying effects of hypoproteinemia and being underweight in patients of different genders, as well as the effects of different age ranges, different injury-to-surgery times, and different blood transfusion volumes on 1-year postoperative mortality.

RESULTS

The mortality rates at 1, 3, and 6 months, and 1 year after surgery were 3.9%, 7.2%, 10.1%, and 15.3%, respectively. Univariate analysis showed that advanced age, male sex, tobacco use, underweight (BMI < 18.5), coronary heart disease, stroke, dementia, pneumonia, number of comorbidities ≥ 3, hypoproteinemia and injury-to-surgery time ≤ 2 days were associated with the 1-year postoperative survival status (P < 0.1). Multivariate analysis revealed that advanced age, male sex, dementia, number of comorbidities ≥ 3, hypoalbuminemia, and being underweight were independent risk factors for 1-year postoperative mortality. Subgroup analysis showed that being underweight was associated with 1-year postoperative mortality only in male patients but not in female patients, whereas hypoproteinemia was associated with 1-year postoperative mortality in both male and female patients. Furthermore, an injury-to-surgery time of less than 2 days improved patient survival, and patients more than 80 years old showed an elevated risk of postoperative mortality.

CONCLUSIONS

Preoperative health status is a critical predictor of postoperative outcomes in elderly patients with fragile intertrochanteric fractures. Priority care should be given to the patients who are elderly, male, have dementia, have comorbidities, or are malnourished. Prompt nutritional reinforcement should be provided to patients with intertrochanteric fractures with comorbid hypoproteinemia and underweight. Furthermore, surgery should be performed as early as possible in patients with fewer comorbidities.

Optimizing Orthogeriatric Hip Fracture Care: Why Fracture Type Matters

Hip fractures significantly impact morbidity and mortality among frail older adults, posing ongoing challenges in orthogeriatric care despite significant advancements. Established in the 1960s by Devas and Irvine, this field integrates orthopedics, trauma services, and geriatric medicine to address the complex needs of this population comprehensively. A critical and underexplored aspect is the precise identification and tailored treatment of various fracture types, each linked to unique clinical challenges and outcomes. This special article emphasizes the complex interplay between specific fracture types, their management options, and the roles of comorbidity and polypharmacy, highlighting the essential role of orthogeriatricians. Orthogeriatricians navigate the complexities posed by comorbidities, frailty, and polypharmacy, significantly influencing treatment outcomes. Their roles have expanded to include decision making about both operative and nonoperative strategies, emphasizing patient-centered care and moving beyond simplistic categorizations of "hip fractures." As future experts on the nuances of fracture types and their broader health implications, orthogeriatricians are also crucial in advancing treatment protocols that address preoperative and postoperative needs. Their comprehensive knowledge ensures effective in-hospital management and postdischarge planning, aligning treatment strategies with the holistic needs of frail older adults. The ongoing evolution of orthogeriatric practices promises to enhance decision-making and patient outcomes through a more informed and integrated care approach.

A Novel Internal Fixation Design for the Treatment of AO/OTA-31A3.3 Intertrochanteric Fractures: Finite Element Analysis

OBJECTIVE

AO/OTA 31-A3.3 intertrochanteric fracture is the most unstable type of intertrochanteric fracture, with a high rate of postoperative complications and implant failure. We have designed a new intramedullary fixation, proximal femoral totally bionic nail (PFTBN), for the treatment of A3.3 intertrochanteric fracture. To test its biomechanical performance, we adopted the method of finite element analysis and compared PFTBN with proximal femoral nail antirotation (PFNA) and proximal femoral bionic nail (PFBN, another internal fixation we previously designed for stable intertrochanteric fractures).

METHODS

Mimics, 3-matic, ANSYS, and other software were used to construct a highly precise and realistic 3D digital model of the human femur. An AO/OTA 31-A3.3 intertrochanteric fracture of the femur was constructed according to the 2018 classification of AO/OTA, and then assembled with PFNA, PFBN and PFTBN models, respectively. The stress distribution and displacement distribution of the three groups of constructs were tested under three times the body weight load and one-foot standing configuration.

RESULTS

In terms of maximum stress and maximum displacement, the PFTBN group outperforms the PFBN group, and the PFBN group, in turn, surpasses the PFNA group. The maximum stress of PFTBN group was 408.5 Mpa, that of PFBN group was 525.4 MPa, and that of PFNA group was 764.3 Mpa. Comparatively, the maximum stress in the PFTBN group was reduced by 46.6% when contrasted with the PFNA group. Moreover, the stress dispersion within the PFTBN group was more evenly distributed than PFNA group. Regarding maximum displacement, the PFTBN group displayed the least displacement at 5.15 mm, followed by the PFBN group at 7.32 mm, and the PFNA group at 7.73 mm. Notably, the maximum displacement of the PFTBN group was 33.4% less than that observed in the PFNA group. Additionally, the relative displacement between the fragment and implant at the tip of pressure screw or helical blade was 0.22 mm in the PFTBN group, 0.34 mm in the PFBN group, and substantially higher 0.51 mm in the PFNA group.

CONCLUSION

The "lever-reconstruction-balance" theory provides a new perspective for us to understand the mechanical conduction of the proximal femur. Compared with PFNA, in treating A3.3 intertrochanteric fractures PFTBN can better reconstruct the function of lateral wall, restore physiological mechanical conduction, increase postoperative stability, and finally reduce the risk of postoperative cut-out and implant failure. It might be a better alternative for the treatment of A3.3 intertrochanteric fracture.

One-year mortality risk in older individuals with femoral intertrochanteric fracture: a tertiary center in China

BACKGROUND

The accelerated growth of older individuals worldwide has increased the number of patients presenting with fragility hip fractures. Having a hip fracture can cause excess mortality, and patients with hip fracture have a higher risk of death than those without hip fracture. Most studies have treated hip fracture as a single, homogeneous condition, but hip fracture includes two major anatomic types: intertrochanteric fracture and femoral neck fracture. Few studies have specifically evaluated 1-year mortality risk in older individuals with femoral intertrochanteric fracture. The aim of this study was to evaluate 1-year mortality and factors associated with mortality in older individuals with femoral intertrochanteric fracture.

METHODS

A retrospective review was conducted of 563 patients ≥ 65 years old who underwent surgery for femoral intertrochanteric fractures at our institution between January 2010 and August 2018. Patient demographics, comorbidities, and treatment were collected by retrospective chart review. Age, sex, Body Mass Index (BMI), American Society of Anesthesiologists (ASA) classification, Charlson comorbidity index (CCI), Arbeitsgemeinschaft Für Osteosynthesefragen (AO) fracture classification, haemoglobin value at admission, time to surgery, operation time, and intraoperative blood loss were risk factors to be tested. Multivariable logistic regression was used to evaluate associations between variables and death.

RESULTS

Among the 563 patients, 49 died within 1 year after surgery, and the 1-year mortality rate was 8.7%. Multivariate analysis identified age > 80 years (OR = 4.038, P = 0.011), haemoglobin < 100 g/l (OR = 2.732, P = 0.002), ASA score ≥ 3 (OR = 2.551, P = 0.005), CCI ≥ 3 (OR = 18.412, P = 0.018) and time to surgery > 14 d (OR = 3.907, P = 0.030) as independent risk factors for 1-year mortality. Comorbidities such as myocardial infarction and chronic pulmonary disease were associated with 1-year mortality after adjusting for age > 80 years and time to surgery > 14 days.

CONCLUSIONS

Patients over 80 years old with haemoglobin < 100 g/l, ASA score ≥ 3, CCI ≥ 3, and multiple comorbidities, especially myocardial infarction and chronic pulmonary disease before surgery, are at a higher risk of 1-year mortality. Doctors should pay more attention to these vulnerable patients, and a surgical delay greater than 14 days should be avoided.

Differences in femoral fracture localizations in men and women in Switzerland between 1998 and 2021-reversal of the secular trend?

Number and age-standardized incidences of femoral fractures by sex and localization were determined annually between 1998 and 2021 in subjects aged 45 years or older living in Switzerland. The number and incidences of femoral neck, pertrochanteric, subtrochanteric, and femoral shaft fractures followed distinct unexpected trend patterns.

INTRODUCTION

Long-term incidence trends for femoral fractures by individual localizations are unknown.

METHODS

Annual absolute number of hospitalizations and median age at hospital admission between 1998 and 2021 were extracted from the medical database of the Swiss Federal Office of Statistics by sex and 10-year age groups for the following 10th International Classification of Diseases (ICD-10) codes: femoral neck (ICD-10 S72.0), pertrochanteric (S72.1), subtrochanteric (S72.2), and femoral shaft fractures (S72.3). Age-standardized incidence rates (ASI) and corresponding trends were calculated.

RESULTS

Over 24 years, the number of femoral neck fractures increased in men (+ 45%) but decreased in women (- 7%) with ASI significantly decreasing by 20% and 37% (p < 0.001 for trend for both), respectively. By contrast, the number of pertrochanteric fractures increased by 67% and 45% in men and women, respectively, corresponding to a horizontal ASI-trend in men (n.s.) and a modest significant decreasing ASI-trend in women (p < 0.001). The number of subtrochanteric fractures increased in both sexes with corresponding modest significant reductions in ASI-trends (p = 0.015 and 0.002, respectively). Femoral shaft fractures almost doubled in men (+ 71%) and doubled in women (+ 100%) with corresponding significant increases in ASI-trends (p = 0.001 and p < 0.001, respectively). Age at admission increased for all fracture localizations, more so in men than in women and more so for subtrochanteric and shaft fractures than for "typical" hip fractures.

CONCLUSION

Incidence changes of pertrochanteric fractures and femoral shaft fractures deserve increased attention, especially in men. Pooling diagnostic codes for defining hip fractures may hide differing patterns by localization and sex.

Low Hand Grip Strength, Mid-Upper Arm Muscle Area, Calf Circumference, Serum Albumin Level, and Muscle Fiber Diameter as Risk Factors for Independent Walking Inability in Patients with Hip Fracture 6 Weeks after Bipolar Hemiarthroplasty Surgery

Background

Bipolar hemiarthroplasty, one of the main treatment modalities for hip fracture, does not always promise the ability to walk independently after surgery. Patients with the same fracture characteristics and comorbidities, implants, and operators may also have different outcomes. Sarcopenia is thought to be one of the causes of the inability to walk independently after this operation; however, it has not been widely studied and is often overlooked.

Methods

This study used a case-control design with 23 patients in the case group (patients unable to walk independently) and 23 patients in the control group (patients able to walk independently). Sampling was carried out consecutively according to the inclusion and exclusion criteria based on the medical records of patients with hip fractures after bipolar hemiarthroplasty at our hospital. In the preoperative period, hand grip strength (HGS), mid-upper arm muscle area (MUAMA), calf circumference (CC), serum albumin level, and total lymphocyte count were measured. A muscle biopsy was performed intraoperatively from the gluteus muscle with the amount of 200-350 mg. The patient's walking ability was assessed in the polyclinic using the Timed Up and Go test 6 weeks postoperatively. The statistical tests used were descriptive statistics, proportion comparison analysis with the chi-square test, and multiple logistic regression test.

Results

Univariate analysis using chi-square test proved HGS, MUAMA, CC, serum albumin level, and muscle fiber diameter as risk factors for inability to walk independently 6 weeks after bipolar hemiarthroplasty (p = 0.003, p = 0.003, p = 0.006, p = 0.044, and p = 0.000, respectively). Logistic regression test proved 3 direct risk factors for the inability to walk independently 6 weeks after bipolar hemiarthroplasty, namely MUAMA, serum albumin level, and muscle fiber diameter, as the strongest predictive factor (adjusted odds ratio, 63.12).

Conclusions

Low MUAMA, serum albumin levels, and muscle fiber diameter are direct risk factors for the inability to walk independently in hip fracture patients 6 weeks after bipolar hemiarthroplasty.

Nail fixation of unstable trochanteric fractures with or without cement augmentation: A cost-utility analysis in the United States: Cost-utility of cement augmentation

OBJECTIVES

Recent clinical studies have shown favorable outcomes for cement augmentation for fixation of trochanteric fracture. We assessed the cost-utility of cement augmentation for fixation of closed unstable trochanteric fractures from the US payer's perspective.

METHODS

The cost-utility model comprised a decision tree to simulate clinical events over 1 year after the index fixation surgery, and a Markov model to extrapolate clinical events over patients' lifetime, using a cohort of 1,000 patients with demographic and clinical characteristics similar to that of a published randomized controlled trial (age ≥75 years, 83 % female). Model outputs were discounted costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratio (ICER) over a lifetime. Deterministic and probabilistic sensitivity analyses were performed to assess the impact of parameter uncertainty on results.

RESULTS

Fixation with augmentation reduced per-patient costs by $754.8 and had similar per-patient QALYs, compared to fixation without augmentation, resulting in an ICER of -$130,765/QALY. The ICER was most sensitive to the utility of revision surgery, mortality risk ratio after the second revision surgery, mortality risk ratio after successful index surgery, and mortality rate in the decision tree model. The probability that fixation with augmentation was cost-effective compared with no augmentation was 63.4 %, 58.2 %, and 56.4 %, given a maximum acceptable ceiling ratio of $50,000, $100,000, and $150,000 per QALY gained, respectively.

CONCLUSION

Fixation with cement augmentation was the dominant strategy, driven mainly by reduced costs. These results may support surgeons in evidence-based clinical decision making and may be informative for policy makers regarding coverage and reimbursement.

Excess Mortality for Femoral Intertrochanteric Fracture Patients Aged 50 Years and Older Treated Surgically and Conservatively in Tianjin, China: A Cohort Study

OBJECTIVE

Intertrochanteric fracture is one type of hip fracture, which is the most serious consequence of osteoporosis. Along with the growing elderly population, intertrochanteric fracture is expected to rise increasingly. The aim of this study was to assess excess mortality after intertrochanteric fractures and to identify the predictors of long-term mortality by therapy among patients aged 50 years and older in Tianjin.

METHODS

This is a retrospective cohort study on mortality for 3029 patients aged 50 years and older in Tianjin experiencing an intertrochanteric fracture between December 26, 2014 and December 31, 2018. Data were from Tianjin Hospital Hip Fracture (THHF) cohort. Follow-up period was until March 31, 2022. Mortality, excess mortality, and comorbidities were analyzed and stratified by therapy and gender. Time dependent Cox models were performed to estimate the effects of the variables.

RESULTS

Absolute mortality for all the patients was 5.90% at 3 months, 12.55% at 12 months, 19.92% at 24 months and 27.28% at 36 months. Absolute mortality for surgical group was 1.57% at 3 months, 4.77% at 12 months, 8.49% at 24 months and 12.07% at 36 months, significantly lower than conservative group: 10.50% at 3 months, 20.73% at 12 months, 31.96% at 24 months and 43.04% at 36 months. We found a substantially lower mortality (hazard ratio [HR] 0.34, 95% confidence internal, [CI]: 0.23-0.52, p = 0.000) among patients undergoing surgical therapy than those undergoing conservative therapy, even when controlled for gender, age, the length of hospital stay, and all the comorbidities. Female patients (HR 0.68, 95% CI: 0.58-0.79, p = 0.000) were less likely to die than male patients after an intertrochanteric fracture. Patients treated by the two methods were both found to have excess mortality rates compared to the general population, although in different levels. The excess mortality rates for patients in the conservative therapy group were 14.46% in males and 17.93% in females, while in the surgical therapy group, 2.78% in females and 4.37% in males. The comorbidities moderate or severe renal disease (HR 2.19, 95% CI: 1.61-2.98, p = 0.000), metastatic solid tumor (HR 6.35, 95% CI: 1.56-25.85, p = 0.010), hypoproteinemia (HR 1.22, 95% CI: 1.01-1.47, p = 0.034), and older age (HR 1.89, 95% CI: 1.73-2.08, p = 0.000) were also risk factors on mortality. A worse-case analysis for the primary outcome were performed as sensitivity analysis and it was consistent with the original conclusion.

CONCLUSION

Intertrochanteric factures for people aged 50 years older were found to have excess mortality compared to the general population in Tianjin city, and preventing the fractures in the hip for elderly people was imperative. After controlling tfor comorbidities and age, female gender and surgical therapy were protective factors for the death after fractures, which could provide strong evidence for patients and surgeons to make decisions.

Pertrochanteric hip fracture is associated with mobility decline and poorer physical performance 4 to 6 months post-hip fracture

BACKGROUND

To study the effect of hip fracture type on physical performance, functional ability and change in mobility four to six months after the injury.

METHODS

A total of 1331 patients out of consecutive 2052 patients aged ≥ 65 years who underwent hip fracture surgery were included in the study. Patient information was collected on admission, during hospitalization, by phone interview and at the geriatric outpatient clinic 4 to 6 months after the fracture. Of the 1331 eligible patients, Grip strength, Timed Up and Go -test (TUG), Elderly Mobility Scale (EMS), mobility change compared to pre-fracture mobility level, Basic Activities of Daily Living (BADL) and Instrumental Activities of Daily Living (IADL) were used to determine physical performance and functional ability. Logistic regression was used for the analyses which was adjusted for gender, age, American Society of Anesthesiologists score, diagnosis of cognitive disorder, pre-fracture living arrangements, mobility and need of mobility aid.

RESULTS

Patients with pertrochanteric hip fracture had an EMS lower than 14 (Odds Ratio (OR) 1.38, 95% confidence intervals (CI) 1.00-1.90), TUG time ≥ 20 s (OR 1.69, 95% CI 1.22-2.33) and they had declined in mobility (OR 1.58, 95% CI 1.20-2.09) compared to femoral neck fracture patients 4 to 6 months post-hip fracture in multivariable-adjusted logistic regression analyses. Grip strength and functional ability (IADL, BADL) 4 to 6 months after hip fracture did not differ between fracture types. There were no statistically significant differences in physical performance in patients with a subtrochanteric fracture compared to patients with a femoral neck fracture.

CONCLUSIONS

Pertrochanteric hip fracture independently associated with poorer physical performance 4 to 6 months post hip fracture compared to other hip fracture types. Pertrochanteric hip fracture patients should be given special attention in terms of regaining their previous level of mobility.

Subtype consideration in hip fracture research: patient variances in inter- and intra-classification levels highlight the need for future research deliberation. A 2-years follow-up prospective-historical cohort

Current research on elderly patients with hip fractures often neglects specific subtypes, either grouping all fracture types or overlooking them entirely. By categorizing elderly patients based on fracture subtypes, we observed diverse baseline characteristics but found no discrepancies in measured outcomes. This emphasizes the need for caution in future research dealing with different or broader measured outcomes that were not covered by the scope of this research.

PURPOSE/INTRODUCTION

Existing research in elderly patients with hip fractures often overlooks the distinct subtypes or lumps all fracture types together. We aim to examine the differences between hip fracture subtypes to assess if these differences are meaningful for clinical outcomes and should be considered in future research.

METHODS

Patients above 65 years who underwent hip fracture surgeries during a three-year period were retrospectively reviewed. Cases were grouped based on fracture subtype: non-displaced femoral neck (nDFN), displaced femoral neck (DFN), stable intertrochanteric (sIT), and unstable intertrochanteric (uIT).

RESULTS

Among the 1,285 included cases, the nDFN-group had lower ASA scores (p = 0.009) and younger patients (p < 0.001), followed by the DFN-group (p = 0.014). The uIT-group had a higher proportion of female patients (72.3%, p = 0.004). Differences in preoperative ambulation status were observed (p = 0.001). However, no significant associations were found between fracture type and postoperative outcomes, including ambulation, transfusions, complications, reoperations, or mortality. Gender and preoperative ambulation status were predictors of mortality across all time frames. ASA score predicted mortality only within the first year after surgery. Age and gender were predictors of postoperative blood transfusions, while age and preoperative ambulation status were predictors of postoperative complications.

CONCLUSIONS

Variations in baseline characteristics of hip fractures were observed, but no significant differences were found in measured outcomes. This indicates that the hip fracture group is not homogeneous, emphasizing the need for caution in research involving this population. While grouping all types of proximal femur fractures may be acceptable depending on the outcome being studied, it's essential not to extrapolate these results to outcomes beyond the study's scope. Therefore, we recommend consider hip fracture subtypes when researching different outcomes not covered by this study.

Preoperative hemoglobin levels and mortality outcomes after hip fracture patients

PURPOSE

Hip fracture surgery is associated with a risk of morbidity and mortality, with admission hemoglobin levels being a significant predictor of mortality risk. The aim of this study is to evaluate the relationship between the preoperative hemoglobin (Hb) levels and mortality in patients who underwent hip fracture surgeries, with the goal of enhancing prognosis prediction and reducing complications within this patient subset. In addition, to assess the characteristics of patients at a higher risk of postoperative mortality.

METHODS

This retrospective study was conducted at Jordan University Hospital, a single tertiary care and educational center. It included patients with hip fractures who underwent surgical repair at the Department of Orthopedic Surgery and were recruited between December 2019 and February 2022. We examined the relationships between preoperative hemoglobin status and variables such as age at admission, gender, fracture type, surgery type, comorbidities, duration of hospital stay, intensive care unit (ICU) admission, and survival outcomes.

RESULTS

We included 626 patients; the mean age was 76.27 ± 9.57 years. 3-month and 6-month mortality rates were 11.2% and 14.1%, respectively. The highest mortality was observed in patients aged over 80 years (n = 53/245, 21.6%), and in male patients (n = 53/300, 17.7%). The Hb level upon admission was lower in individuals who died within 6 months compared to those who survived (10.97 ± 2.02 vs. 11.99 ± 2.39, p < 0.001). In multivariate analysis, the independent factors that were statistically significant in the model included gender (OR = 1.867; 95% CI 1.122-3.107, p = 0.016), age (OR = 1.060; 95% CI 1.029-1.092; p < 0.001), hemoglobin level upon admission (OR = 0.827; 95% CI 0.721-0.949; p = 0.007), history of renal disease (OR = 1.958; 95% CI 1.014-3.784; p = 0.045), length of hospital stay (OR = 1.080; 95% CI 1.036-1.126; p < 0.001), and ICU admission (OR = 1.848; 95% CI 1.049-3.257; p = 0.034).

CONCLUSION

Our study illustrates that low hemoglobin levels, history of renal disease, along with male gender, advanced age, extended hospital stays, and ICU admission were significantly associated with 6-month mortality. Future investigations should consider assessing varying degrees of anemia based on hemoglobin concentrations to provide a more comprehensive understanding of anemia's impact on mortality. This study investigated the relationship between preoperative hemoglobin levels, patient characteristics, and mortality in patients who underwent hip fracture surgeries. The results showed that lower hemoglobin levels, history of renal disease, male gender, advanced age, extended hospital stays, and ICU admission were significant predictors for mortality.

Use of the Shizuoka Hip Fracture Prognostic Score (SHiPS) to Predict Long-Term Mortality in Patients With Hip Fracture in Japan: A Cohort Study Using the Shizuoka Kokuho Database

Hip fractures are common in patients of advanced age and are associated with excess mortality. Rapid and accurate prediction of the prognosis using information that can be easily obtained before surgery would be advantageous to clinical management. We performed a population-based retrospective cohort study using an 8.5-year Japanese claims database (April 2012-September 2020) to develop and validate a predictive model for long-term mortality after hip fracture. The study included 43,529 patients (34,499 [79.3%] women) aged ≥65 years with first-onset hip fracture. During the observation period, 43% of the patients died. Cox regression analysis identified the following prognostic predictors: sex, age, fracture site, nursing care certification, and several comorbidities (any malignancy, renal disease, congestive heart failure, chronic pulmonary disease, liver disease, metastatic solid tumor, and deficiency anemia). We then developed a scoring system called the Shizuoka Hip Fracture Prognostic Score (SHiPS); this system was established by scoring based on each hazard ratio and classifying the degree of mortality risk into four categories based on decision tree analysis. The area under the receiver operating characteristic (ROC) curve (AUC) (95% confidence interval [CI]) of 1-year, 3-year, and 5-year mortality based on the SHiPS was 0.718 (95% CI, 0.706-0.729), 0.736 (95% CI, 0.728-0.745), and 0.758 (95% CI, 0.747-0.769), respectively, indicating good predictive performance of the SHiPS for as long as 5 years after fracture onset. Even when the SHiPS was individually applied to patients with or without surgery after fracture, the prediction performance by the AUC was >0.7. These results indicate that the SHiPS can predict long-term mortality using preoperative information regardless of whether surgery is performed after hip fracture.

Serum HMGB1 levels and its clinical significance in elderly patients with intertrochanteric fractures after intramedullary fixation surgery

BACKGROUND

Intramedullary fixation is a valuable alternative for the treatment of intertrochanteric fractures. However, further development of new biomarkers to predict the prognosis of the patient is still needed for timely and effective treatment and intervention. The present study aimed to explore the serum high-mobility group box 1 (HMGB1) levels in the prognosis of intertrochanteric fracture patients and its correlation with clinical results.

METHODS

The present prospective cohort study recruited 115 intertrochanteric fracture patients who were admitted from January 2015 to December 2019. All patients were evaluated preoperatively and treated (proximal femoral nail antirotation or intramedullary proximal femoral nail) by the same team. The serum HMGB1, interleukin-6, interleukin-1β, tumor necrosis factor α, and C-reactive protein levels were measured by enzyme-linked immunosorbent assay. Demographic and clinical data of all patients were collected. Harris score was used to assess the prognosis of intertrochanteric fracture patients after 6 months of treatment. Statistical analysis was conducted using SPSS software with P < .05 as statistically different.

RESULTS

The time of the operation and the amount of bleeding in intramedullary proximal femoral nail were remarkably elevated compared with the proximal femoral nail antirotation group (P < .05). The age, proportion of complications and visual analogue score VAS after 72 hours of surgery in the Harris score < 80 group were remarkably increased compared with Harris score ≥ 80 group (P < .05). In addition, we found that the serum HMGB1 levels in Harris score < 80 group were markedly elevated than the patients in Harris score ≥ 80 group at all time points (P < .05). The results showed that the serum HMGB1 levels at postoperative 48 hours had the highest predictive value for predicting poor prognosis in intertrochanteric fracture patients. It was found that HMGB1, age and VAS after 72 hours of surgery were the risk factors for poor prognosis of intertrochanteric fracture patients.

CONCLUSION

This study showed that the serum HMGB1 levels was significantly decreased in intertrochanteric fracture patients with bad prognoses. This study may provide a new approach to screening intertrochanteric fracture patients with worse prognoses in advance.

Comparison of complication profiles for femoral neck, intertrochanteric, and subtrochanteric geriatric hip fractures

INTRODUCTION

Most geriatric hip fractures occur in the femoral neck (FN) and intertrochanteric (IT) regions of the femur, while a minority occur in the subtrochanteric (ST) region. Relative outcomes based on the anatomical subtype of fracture are not well studied. This study characterizes postoperative complications and outcomes of hip fractures distinguished by anatomic region.

MATERIALS AND METHODS

The targeted hip fracture series of the American College of Surgeons National Surgical Quality Improvement Program database was queried to identify geriatric (≥ 65 years) patients who sustained operative FN, IT, and ST hip fractures. Primary patient demographic and perioperative data were collected and correlated with 30-day postoperative complications and outcomes. Multivariate regression was used to calculate relative risks of adverse events (AEs) between groups.

RESULTS

In total, 8220 geriatric hip fracture patients were identified. Risk-adjusted 30-day mortality was not significantly different between patients with ST (5.8%, p = 0.735) and IT (7.3%, p = 0.169) femur fractures relative to those with FN fractures (6.6%). The overall risk-adjusted rate of minor and major medical AEs within 30 days and risk-adjusted rate of wound complications was not significantly different between FN, IT, and ST fractures. Patients with IT [34.4%, OR 2.35 (2.35-3.08), p < 0.001] and ST fractures [49.8%, OR 5.94 (4.58-7.70), p < 0.00] had higher risk-adjusted incidence of postoperative blood transfusion relative to FN fractures (18.5%). Furthermore, patients with IT fractures had a slightly lower risk-adjusted incidence of unplanned reoperation [2.1 vs. 2.7%, OR 0.69 (0.47-0.99), p = 0.046] and hospital readmission (7.8 vs. 9.2%, OR 0.76 [0.63-0.91], p = 0.003) than patients with FN fractures.

CONCLUSIONS

With respect to anatomic region, geriatric hip fractures have similar short-term mortality and medical AE profiles with differences in transfusion, reoperation, and readmission rates. Knowledge of these short-term outcomes may guide surgeons in counseling hip fracture patients peri-operatively.

High-density lipoprotein cholesterol levels is negatively associated with intertrochanter bone mineral density in adults aged 50 years and older

BACKGROUND

High-density lipoprotein cholesterol (HDL-C) has long been viewed as a protective factor for cardiovascular health. Yet, higher HDL-C was not necessarily beneficial. The purpose of this study was to investigate the relationship between HDL-C levels and intertrochanter bone mineral density.

METHODS

The study collected the most recent data from the 2017-2020 National Health and Nutrition Examination Survey (NHANES). Weighted multiple regression analysis was used to evaluate the relationship between HDL-C and intertrochanter BMD, and further subgroup analysis and threshold effect analysis were conducted. Finally, the relationship between HDL-C and intertrochanter BMD was analyzed by fitting smooth curves.

RESULTS

The study included 3,345 people ranging in age from 50 to 80. HDL-C was discovered to be negatively correlated with intertrochanter BMD (β = -0.03, 95%CI: -0.04, -0.01, P = 0.0002). In subgroup analysis, the negative correlation was found among 60-70-year-olds (β = -0.04, 95%CI: -0.06, -0.02, P = 0.0010), additionally, non-Hispanic whites (β = -0.03, 95%CI: -0.05, -0.01, P = 0.0140), and obese individuals (β = -0.03, 95%CI: -0.05, -0.01, P = 0.0146). The negative correlation, on the other hand, remained significant and consistent across genders, menstruation status, hormone usage, and long-term use of steroids. The relationship between HDL-C and intertrochanter BMD was an inverted U-shaped curve in men and hormone users, with inflection points of 1.01 mmol/L and 1.71 mmol/L, and an U-shaped curve in other Hispanic and premenopausal individuals, with inflection points of 0.96 mmol/L and 1.89 mmol/L.

CONCLUSIONS

HDL-C was negatively associated with intertrochanter BMD in people over 50 years of age, non-Hispanic whites, and obesity.

Vitamin D Supplementation and Its Impact on Different Types of Bone Fractures

Vitamin D helps to balance the levels of calcium and phosphorus to maintain proper bone structure. It is also involved in essential biological roles and displays a wide spectrum of potential benefits in the human body. Since there are many types of fractures that occur at specific ages and due to different circumstances, the influence of vitamin D on the frequency of a particular fracture may differ. Thus, the authors investigated the possible preventive effect of vitamin D on the risks of vertebral fractures, hip fractures, stress fractures and pediatric fractures. Additional aspects of vitamin D, especially on recuperation after injures and its impact on the severity of particular fractures, were also discussed. It was suggested that vitamin D supplementation may contribute to a reduction in hip fracture risk due to reduced bone turnover, decreased frequency of falls and improved muscle function. Furthermore, vitamin D appears to lower the risk of stress fractures in athletes and military recruits. Due to a nonunified protocol design, presented investigations show inconsistencies between vitamin D supplementation and a decreased risk of vertebral fractures. However, a vitamin D preventive effect on pediatric fractures seems to be implausible.

The Influence of Static Load and Sideways Impact Fall on Extramedullary Bone Plates Used to Treat Intertrochanteric Femoral Fracture: A Preclinical Strength Assessment

Hip fracture accounts for a large number of hospitalizations, thereby causing substantial economic burden. Majority (> 90%) of all hip fractures are associated to sideways fall. Studies on sideways fall usually involve loading at quasi-static or at constant displacement rate, which neglects the physics of actual fall. Understanding femur resonance frequency and associated mode shapes excited by dynamic loads is also critical. Two commercial extramedullary implants, proximal femoral locking plate (PFLP) and variable angle dynamic hip screw (VA-DHS), were chosen to carry out the preclinical assessments on a simulated Evans-I type intertrochanteric fracture. In this study, we hypothesized that the behavior of the implant depends on the loading types-axial static and transverse impact-and a rigid implanted construct will absorb less impact energy for sideways fall. The in silico models were validated using experimental measurements of full-field strain data obtained from a 2D digital image correlation (DIC) study. Under peak axial load of 3 kN, PFLP construct predicted greater axial stiffness (1.07 kN/mm) as opposed to VA-DHS (0.85 kN/mm), although the former predicted slightly higher proximal stress shielding. Further, with greater mode 2 frequency, PFLP predicted improved performance in resisting bending due to sideways fall as compared to the other implant. Overall, the PFLP implanted femur predicted the least propensity to adverse stress intensities, suggesting better structural rigidity and higher capacity in protecting the fractured femur against fall.

Determinants of Higher Mortality at Six Months in Patients with Hip Fracture: A Retrospective Study

(1) Background: Hip fracture is a pathology with high mortality, but the lack of a universal adaptation of the factors associated with death makes it difficult to predict risk and implement prevention in this group. This study aimed to identify the factors that determine a higher mortality at six months following hip fracture. (2) Methods: A retrospective longitudinal study, whose study population consisted of patients over 65 years of age. The main variable was mortality at 6 months of fracture. Relevant data related to sociodemographic and clinical variables for subsequent bivariate (χ²) and multivariate analysis were obtained. (3) Results: In all, 665 people participated in the study, 128 of whom died within 6 months of the fracture. The multivariate adjusted analysis demonstrated significant relationships between the main variable and aspects such as institutionalization at discharge (Odds Ratio (OR) = 2.501), a worse overall functional capacity (OR = 2.453) and cognitive capacity (OR = 3.040) at admission, and complications such as heart failure (OR = 5.767) or respiratory infection (OR = 5.308), in addition to the taking of certain drugs and the presence of a greater number of comorbidities. (4) Conclusions: There are certain factors related to higher mortality at six months in patients with hip fracture who are aged 65 years or older.

Physicians' perspectives of prognosis and goals of care discussions after hip fracture

BACKGROUND

Hip fracture often represents a major transition in patients' health, with a 1-year mortality rate between 25% and 30% and a challenging recovery course. Caring for hip fracture patients presents opportunities for goals of care discussions that include prognostic information and guidance about functional dependence.

METHODS

We conducted qualitative, semi-structured interviews with 23 attending physicians involved with the care of hip fracture patients, including orthopedic surgeons, anesthesiologists, internists, and geriatricians, across 13 health systems in the United States and Canada. Questions addressed knowledge and interpretation of prognosis, discussing prognosis and goals of care, and timing and prioritization of surgery. Interviews were analyzed using a constructivist grounded theory approach to identify themes and develop a coding taxonomy.

RESULTS

Physicians agreed that hip fracture had a considerable 1-year mortality, felt that it was important to discuss prognostic outcomes and the recovery process, wanted to elucidate patients' priorities, and often promoted timely surgery. Physicians perceived challenges when discussing mortality data with new patients in an acute setting. They more easily discussed outcomes related to functional dependence and quality of life. Some physicians used iterative communication as a strategy to have in-depth conversations in a busy perioperative setting.

CONCLUSION

Providing timely, compassionate care for hip fracture patients is challenging. There are opportunities to study iterative communication to encourage dialogue at key points of patient care to better discuss prognosis and recovery and bolster coordinated multidisciplinary care that focuses on patients' goals and values.

All-cause mortality risk in aged femoral intertrochanteric fracture patients

Introduction

The 1-year mortality rate after femoral intertrochanteric fracture is higher than that of femoral neck fracture, which also belongs to hip fracture (Cui et al. in Arch Osteoporos 14(1):55, 2019). With the application of the concept of co-management model of orthopedics and geriatrics, the short-term and long-term mortality of all types of hip fractures has decreased (Van Heghe et al. in Calcif Tissue Int, 2021, https://doi.org/10.1007/s00223-021-00913-5). However, the mortality of Chinese femoral intertrochanteric fracture patients under this model has not been reported in the literatures.

Aim

This paper aims to study the risk factors of postoperative all-cause mortality in aged patients with femoral intertrochanteric fracture under the co-management model of orthopedics and geriatrics.

Materials and methods

This is a single-center prospective cohort study based on the real world, under the co-management of orthopedics and geriatrics, 363 patients aged ≥ 65 years with femoral intertrochanteric fracture were enrolled and followed up for 2–3 years; 52 patients were lost to follow up. Age, gender, body mass index (BMI), history of comorbidities, hip Bone Mineral Density (BMD), fracture history, 25(OH)D level, hemoglobin level, anti-osteoporosis treatment were risk factors to be tested. Kaplan–Meier survival curves and multivariate Cox proportional hazards models were constructed to analyze the impact of factors on all-cause mortality.

Results

(1) Most of the dead patients were older (the mean age was 83.4 years, compared with 79.8 years for surviving patients), with more complications and without anti-osteoporosis medication; gender, pre-fracture history, BMI, total hip BMD, hemoglobin, 25(OH)D had no difference between the dead and the living patients. (2) Elderly patients with Intertrochanteric fracture can benefit from the early treatment of Zoledronic Acid (within 3 days after the operation).

Conclusion

Under the co-management of orthopedics and geriatrics, to Chinese patients with Femoral Intertrochanteric fracture, Doctors should pay more attention to their age and chronic disease, and give anti-osteoporosis treatment if allowed.

Predictive factors of non-treatment and non-persistence to osteoporosis medication after fragility hip fractures at 3 years after discharge: a multicentre, prospective cohort study in the northern Kyushu district of Japan

We examined osteoporosis medication use and factors affecting persistence in 497 patients with fragility hip fractures. Only 25.5% of patients received continuous medication for 3 years, and 44.1% of patients received no treatment. Low Barthel index at discharge was a risk factor for both non-treatment and non-persistence to osteoporosis medication.

PURPOSE

Fragility hip fractures (FHF) caused by osteoporosis decrease the quality of life and worsen life expectancy. Use of osteoporosis medication may be an efficient method in the prevention of secondary FHF. However, previous studies have reported low rates of osteoporosis medication and persistence after FHF. This study aimed to evaluate osteoporosis medication use and factors affecting persistence in patients with FHF in the northern Kyushu area of Japan.

METHODS

A total of 497 FHF patients aged ≥ 60 years with a 3-year follow-up were included. We prospectively collected data from questionnaires sent every 6 months regarding compliance with osteoporosis medication. We compared baseline characteristics among three groups: no treatment (NT), no persistence (NP), and persistence (P), and conducted multivariable regression models to determine covariates associated with non-treatment (NT vs. NP/P) and non-persistence (NP vs. P).

RESULTS

There were 219 (44.1%), 151 (30.4%), and 127 (25.5%) patients in the NT, NP, and P groups, respectively. Factors associated with non-treatment were male sex, chronic kidney disease, no previous osteoporosis treatment, and low Barthel index (BI) at discharge. The only factor associated with non-persistence was a low BI at discharge. Factors associated with a low BI at discharge were male sex, older age, trochanteric fracture, and surgical delay.

CONCLUSION

Low BI at discharge is a risk factor for both non-treatment and non-persistence to osteoporosis medication. Therefore, appropriate interventions to improve BI may result in persistence to osteoporosis medication.

Does the type of hip fracture affect functional recovery in elderly patients undergoing inpatient rehabilitation?

BACKGROUND

Hip fractures should not be considered as a single, homogeneous condition. Various determinants of functional recovery of patients with hip fracture have been proposed, such as age or type of fracture. The aim of this study was to determine if patients with an intertrochanteric fracture (ITF) had lower functional recovery characteristics with respect to those with a femoral neck fracture (FNF).

METHODS

A retrospective study was carried out on 531 elderly patients with hip fracture, surgically treated, admitted to a rehabilitation institute between December 1, 2014, and December 31, 2017. Patients underwent an individualized rehabilitation program for improving their physical function. The outcome measures of this study were the length of stay (LOS) in the rehabilitation institute, the Functional Independence Measure (FIM) gain, i.e. the difference in FIM score between discharge and admission, and the FIM efficiency, which represents the daily gain. Patients were also stratified by age categories and by different levels of functional independence, as evaluated with the FIM total score at baseline.

RESULTS

Age (p<0.05), LOS (p<0.005) and rehabilitation outcomes (FIM score and efficiency; p<0.05) differed significantly between patients with FNF and ITF. In particular, patients with ITF were older and more dependent at baseline. Moreover, they showed a lower FIM efficiency with respect to patients with FNF (p<0.05), which obtained a similar improvement in FIM total score of about 26 points but were discharged on average 3 days before. With aging, FIM efficiency decreased, while LOS increased. Patients highly dependent at baseline (FIM total score <40) had the lowest FIM gain and efficiency and the longest LOS respect to the more independent patients. Moreover, in older (85+ years) and in higher dependent patients the differences in the outcome measures between ITF and FNF were reduced.

CONCLUSIONS

The type of hip fracture could affect the LOS and FIM efficiency of younger and more independent patients with hip fracture during inpatient rehabilitation. In particular, patients with ITF require a longer rehabilitation period to achieve a similar functional gain as those with FNF.

Are extracapsular and intracapsular hip-fracture patients two distinct rehabilitation subpopulations?

PURPOSE

To assess whether intracapsular and extracapsular hip fracture patients in a post-acute rehabilitation setting differ in their background characteristics and whether fracture type affects rehabilitation outcome.

METHODS

A retrospective cohort study.

OUTCOME MEASURES

Functional Independence Measure (FIM), motor FIM (mFIM), mFIM effectiveness, length of stay (LOS), and discharge destination. Various tests assessed associations (the Mann-Whitney U, the chi-square, logistic regression), population differences (t-test), and independent predictors of discharge FIM score (multiple linear regression model).

RESULTS

Six hundred and eighty-seven patients completed the rehabilitation program. The intracapsular hip fracture patient group was characterized by significantly higher percentages of males, higher education levels, and living with a caregiver compared with the extracapsular hip fracture patient group. Intracapsular hip fracture patients were younger, had longer latency time from fracture to surgery, exhibited higher functional levels on admission and upon discharge, higher cognitive function and shorter rehabilitation time than extracapsular hip fracture patients. Both study groups possessed similar comorbidities, rehabilitation achievements, and discharge destination. Regression analyses showed that the fracture type was not associated with discharge FIM score, nor with the probability of achieving a favorable functional gain.

CONCLUSIONS

Post-acute extracapsular and intracapsular hip fracture patients are demographically and clinically two distinct subpopulations. Nevertheless, given additional time, extracapsular hip fracture patients will attain similar functional achievements as intracapsular hip fracture patients.Implications for rehabilitationPost-acute extracapsular and intracapsular hip fracture patients are demographically and clinically two distinct subpopulations.Given additional time, extracapsular hip fracture patients can attain similar functional achievements as intracapsular hip fracture patients.

Prevalence of sarcopenia and the association of sarcopenia, premorbid factors, early functional outcome and 1-year mortality in Hong Kong Chinese fragility hip fracture patients

Background/purpose:

Sarcopenia is a predictor of fall, which is a leading cause of fragility hip fractures (FHF). Dual energy X-ray absorptiometry (DXA) is a costly measurement method for sarcopenia. Rehabilitation and prognosis can be determined by early functional outcomes. Meanwhile, 1-year mortality of FHF patients is high.

Aims:

(i) To report the prevalence of sarcopenia. (ii) To investigate the relationships of sarcopenia, premorbid factors, early functional outcomes and 1-year mortality in Hong Kong Chinese FHF patients.

Methods:

FHF patients admitted to Queen Elizabeth Hospital in Hong Kong from April 2016 to March 2017 were reviewed, including outcomes of relative appendicular skeletal muscle mass index (RASM), handgrip strength (HGS), New Mobility Score (NMS), Modified Functional Ambulation Classification (MFAC), Modified Barthel Index (MBI), Cumulated Ambulation Score (CAS), Elderly Mobility Scale (EMS) and 1-year mortality.

Results:

One hundred sixty nine FHF patients, aged 82.68 ± 7.32 years, were reviewed. Prevalence of sarcopenia in male and female were 71.4% and 37.7%, respectively. RASM was correlated with HGS of both dominant ( r = 0.366, p < 0.001) and non-dominant side ( r = 0.383, p < 0.001), NMS ( rs = 0.239, p < 0.001), MFAC ( rs = 0.192, p = 0.013), MBI ( rs = 0.182, p = 0.018) and CAS ( rs = 0.183, p = 0.019). RASM was not significantly correlated with EMS-1 ( rs = 0.050, p = 0.525) and EMS-DC ( rs = 0.092, p = 0.249). There was significant correlation between Sarcopenia and EMS-DC ( rrb = −0.226, p = 0.004). Sarcopenia was marginally not associated with 1-year mortality ( χ 2 = 3.745, p = 0.053). One-year mortality of FHF patients with Sarcopenia and without Sarcopenia were 16.5% and 7.1%, respectively. FHF patients with Sarcopenia were not statistically significant to be more likely to face mortality within 1 year ( R 2 = 0.030, OR = 2.638, p = 0.060).

Conclusions:

Prevalence of sarcopenia was high in FHF patients and RASM was correlated with HGS and NMS, which can be easily administered as screening tools. Sarcopenia was correlated with early functional outcome but not with 1-year mortality. Early detection of Sarcopenia is crucial for early implementation of rehabilitation and treatment.

The Financial Burden of Delayed Hip Fracture Surgery: A Single-Center Experience

Fragility hip fractures have become a worldwide epidemic with serious socioeconomic implications. The projected number of hip fractures by 2050 is estimated to reach 4.5 million cases. The aim of this study was to calculate the in-hospital financial burden on public health insurance funds related to the delayed treatment of hip fractures. This research took place in a tertiary university hospital that is a major trauma center in Thessaloniki, which is second largest city in Greece . A retrospective search was conducted in the electronic hospital database for patients older than 65 years, with low energy hip fractures that were surgically treated between November 18, 2018, and October 20, 2019. Age, length of stay (LOS), days to surgery, postoperative LOS, anticoagulation medication, major and minor complications, and the reimbursement that the hospital received from public health insurance funds were recorded. Cost deviation from the standard tariff for the treatment of these fractures was also calculated. Of a total of 145 patients, 32.4% had early surgery as opposed to 67.6% who were operated after 48 hours from admission. The excess financial burden from the baseline reimbursement for those operated within 48 hours from admission was 4,074.64€, while for the group that received delayed surgery it was 45,654.14€. Patients under any form of anticoagulation therapy were seven times more probable to have delayed surgery [OR=6.8; 95% confidence interval (CI): 2.97-18.18; p<0.01] and were 3.5 times more probable to have minor complications (OR: 3.6; 95% CI: 1.19-11.23; p<0.017). Early surgery is beneficial to the patient and reduces the economic burden on healthcare public funds. Every effort should be made to manage these patients in a timely manner.

Physical Therapy Management of Older Adults With Hip Fracture

Hip fracture is a leading cause of profound morbidity in individuals aged 65 years and older, ranking in the top 10 causes of loss of disability-adjusted life-years for older adults. Worldwide, the number of people with hip fracture is expected to rise significantly due to the aging population and other factors. Physical therapist management is recommended within medical, surgical, and multidisciplinary clinical practice guideline (CPGs) and is considered to be the standard of care in rehabilitation for people with hip fracture. The goal of this CPG was to review the evidence relevant to physical therapist management and to provide evidence-based recommendations for physical therapy diagnosis, prognosis, intervention, and assessment of outcome in adults with hip fracture. J Orthop Sports Phys Ther 2021;51(2):CPG1-CPG81. doi:10.2519/jospt.2021.0301.

Inferior Outcome after Unstable Trochanteric Fracture Patterns Compared to Stable Fractures in the Elderly

BACKGROUND

Various risk factors affecting outcome of elderly patients after proximal femur fracture have been identified. The present study aims to evaluate the impact of the fracture pattern in trochanteric fractures on postoperative mobility and complications.

METHODS

Ninety-two patients with a mean age of 84 years were included. According to the revised AO/OTA classification, fractures were divided into stable (AO 31A1) and unstable (AO 31A2/3) patterns. A follow-up examination was performed 12 months after cephalomedullary fixation to assess outcome parameters for mobility/activities of daily living (Parker Mobility Score (PMS)/Barthel Index (BI)) and complications (increase in requirement of care, hospital readmission, mortality rate).

RESULTS

At follow-up, patients with unstable trochanteric fracture patterns presented with lower PMS and BI compared to stable fractures (p < 0.05). Further, higher requirement of care and higher readmission rates compared to stable patterns were observed.

CONCLUSION

Unstable trochanteric fractures presented inferior outcome compared to simple fracture patterns. This might be explained by the increasing surgical trauma in unstable fractures as well as by the mechanical impact of the lesser trochanter, which provides medial femoral support and is of functional relevance. Subsequent studies should assess if treatment strategies adapted to the specific fracture pattern (refixation of lesser trochanter) influence outcome in unstable trochanteric fractures.

One-year mortality rates and factors affecting mortality after surgery for fracture neck of femur in the elderly

Context:

Fractures around hip in elderly are associated with significant morbidity and mortality.

Aim:

This sudy aims to investigate 1-year mortality rates and risk factors associated with this mortality. Effect of delay in surgery on mortality rates will also be studied. Our null-hypothesis was that there is no association between common comorbid conditions or delay in surgery on 1-year mortality rates.

Study Settings and Design:

Patients 60-years and above who underwent operative treatment for fracture of neck of femur between January 2018 and February 2019 were included in this retrospective study.

Materials and Methods:

Demographic and clinical data were collected from hospital information system and inpatient case records. Patients were followed up with quality of life (QoL) assessment with short form-12 (SF-12) at 1 year. Mortality during this period was also evaluated.

Statistical Analysis:

Continuous factors were expressed as means, standard deviations. Different risk factors between the patients alive and dead were studied using Fisher's exact test.

Results:

Nineteen out of 95 patients died at the end of 1 year. Smoking, hypertension, diabetes, low hemoglobin, raised total leukocyte count, low serum albumin, delay in surgery (>1 week), higher American Society of Anesthesiologist grade, and postoperative blood transfusion were significantly associated with higher mortality rates. Mean SF-12 QoL scores at 1 year was 35.6 ± 6.3.

Conclusion:

Hip fractures in elderly are associated with higher mortality rates. Results of this study indicate that patients at a higher risk of mortality may be identified and help in preoperative optimization with the aim to reduce mortality. However, these findings need to be verified by further studies with a relatively larger sample size and longer follow-up period.

Magnesium oxide and hip fracture in the elderly: a population-based retrospective cohort analysis

Using national insurance claims of Taiwan, we found that magnesium oxide (MgO) use is associated with an increased risk of hip fracture in the elderly. Further studies are warranted to explore the mechanisms associated with MgO use that lead to hip fracture.

PURPOSE

The purpose of this study was to investigate the association between MgO use and hip fracture risk in the elderly (age > 65 years).

METHODS

This nationwide population-based retrospective study was conducted from 1996 to 2013. Individuals with (n = 26,069) and without (n = 26,069) MgO use were enrolled after propensity score matching. Primary outcome was a hip fracture. After adjusting for age, sex, comorbidities, and medications, multivariate Cox proportional hazards regression models were used to calculate incidences and risk of hip fracture [hazard ratio (HR)].

RESULTS

During the mean follow-up duration of 4.8 years in the MgO cohort and 5.7 years in the non-MgO cohort, respectively 1547 and 1107 cases developed a hip fracture. MgO use was identified as a risk factor for hip fracture in both univariate [crude HR, 1.68; 95% confidence interval (CI), 1.55-1.81; p < 0.001] and multivariate [adjusted HR (aHR), 1.66; 95% CI, 1.54-1.80; p < 0.001] Cox proportional hazards regression models. The cumulative incidence of hip fracture was significantly higher in the MgO cohort than in the non-MgO cohort (1.23 per 100 person-years vs. 0.74 per 100 person-years, logrank test, p < 0.001).

CONCLUSION

MgO use is an independent risk factor for hip fracture in the elderly.

Holistic Management of Older Patients With Hip Fractures

As the silver tsunami hits the world, older patients with hip fractures are expected to increase to 6.3 million by the year 2050, of which the majority will occur in Asia. The estimated global cost of hip fractures in the year 2050 is estimated to reach U.S. $130 billion. Hence, in addition to implementation of prevention strategies, it is important to develop an optimal model of care for older patients with hip fracture to minimize the huge medical and socioeconomic burden, especially in rapidly aging nations. This review summarizes the complications of hip fractures, importance of comprehensive geriatric assessment, and multidisciplinary rehabilitation, as well as predictors of rehabilitation outcome in older patients with hip fracture.

Perioperative nutritional supplementation and skeletal muscle mass in older hip-fracture patients

Older people with hip fractures are often malnourished at the time of fracture, which can have substantial influence on mortality and clinical outcomes, as well as functional outcome and quality of life. A close relationship between protein intake and muscle maintenance has been demonstrated. Skeletal muscle weakness is an independent risk factor for falls and fall-related injuries in the elderly and is an independent marker of prognosis. However, the effect of perioperative nutritional interventions on outcomes in elderly hip-fracture patients remains controversial. In this narrative review, an overview is presented of the existing literature on nutritional status and sarcopenia in elderly hip-fracture patients, clinical outcomes, and the effects of nutritional intervention on outcome and rehabilitation in this patient group.

Risk Factors for Functional Outcomes of the Elderly with Intertrochanteric Fracture: A Retrospective Cohort Study

Objective

To identify baseline factors relevant to functional outcomes and health‐related quality of life in the elderly with intertrochanteric fractures.

Methods

For the present study, 168 patients with intertrochanteric fracture who were assigned to different treatments between January 2016 and December 2017 were retrospectively selected. Hip function was assessed by Harris hip score (HHS), and health‐related quality of life was evaluated by Barthel index (BI) of activities of daily living (ADL) and EuroQol 5‐dimensions (EQ‐5D) score, respectively. Data were analyzed by t‐test, ANOVA, Pearson's correlation, χ²‐test, and multivariate linear regression.

Results

A total of 164 (97.6%) patients completed the follow‐up, with an average follow‐up time of 15.7 ± 6.9 months; 39 (23.8%) patients died during the follow‐up period and 125 (76.2%) patients were eligible for the functional analysis. HHS at final follow‐up of 125 patients was 71.8 ± 13.1, and the following were associated with hip functional recovery: age (−0.45, 95% confidence interval (CI) −0.73 to −0.18, P < 0.01), serum albumin (0.65, 95% CI 0.04 to 1.27, P < 0.05), and ADL at discharge (0.18, 95% CI 0.01 to 0.33, P < 0.05). The Barthel index at final follow up in this cohort was 80.2 ± 18.1, and multivariable linear regression analysis showed that age (−0.49, 95% CI −0.85 to −0.12; P < 0.05), ADL score at discharge (0.29, 95% CI 0.07 to 0.51; P < 0.05) and internal fixation (16.3, 95% CI 3.3 to 29.3; P < 0.05) were associated with ADL at final follow‐up. EQ‐5D at final follow‐up was 0.74 ± 0.2, with which HHS (0.012, 95% CI 0.011 to 0.013; P < 0.01) was positively associated.

Conclusion

We identify several baseline factors associated with hip functional outcome, health utility, and ADL in the elderly after an intertrochanteric fracture, of which we could modify mutable factors to achieve better outcomes. These findings could help to inform treatment and functional prognosis.

Prediction of mortality at one year after surgery for pertrochanteric fracture in the elderly via a Bayesian belief network

BACKGROUND

Pertrochanteric fractures in the elderly are common and associated with considerable mortality and disability. However, the predictors of the fracture mortality have been somewhat controversial. The aim of this study was to use univariate, multivariate analyses and a Bayesian belief network (BBN) model, which are graphic and intuitive to the clinician, to understand of the prognosis of pertrochanteric fractures.

METHODS

Records of patients undergoing surgery at our hospital between January 2013 and June 2018 were retrospectively reviewed. Univariate and multivariate regression as well as a machine-learned BBN model were used to estimate mortality at one year after surgery for pertrochanteric fracture in the elderly.

RESULTS

Complete data were available for 448 surgically treated patients who were followed up for 12 months (age ≥60 years). Multivariate regression analysis revealed that hypertension, diabetes mellitus, chronic obstructive pulmonary disease, albumin, serum potassium, blood urea nitrogen and blood lactate were independent risk factors for death in surgical treatment patients (P < 0.05). First-degree predictors of mortality following surgery were established: the number of comorbid diseases, serum albumin, blood lactate and blood urea nitrogen. Following cross-validation, the area under the ROC curve was 0.85 (95% CI: 0.76-0.91) for the one-year probability of postoperative mortality.

CONCLUSION

We believe cohesive models such as the Bayesian belief network can be useful as clinical decision-support tools and provide clinicians with information to the treatment of old pertrochanteric fracture. This method warrants further development and must be externally validated in other patient populations.

Impact of type 2 diabetes on postoperative outcome after hip fracture: nationwide population-based study in Taiwan

The impact of diabetes mellitus (DM) on hip fracture (HFx) is still controversial. We used nationwide population-based data in Taiwan to observe postoperative outcomes of HFx in patients with type 2 diabetes mellitus (T2DM) and found that the impact of T2DM may be related to medication of blood glucose control.

OBJECTIVE

Published studies evaluating diabetic patients with HFx have shown controversial outcomes. We assessed the impact of T2DM on postoperative outcomes after HFx in elderly patients using the nationwide population database in Taiwan.

RESEARCH DESIGN AND METHODS

We used data from the National Health Research Institute in Taiwan to recruit patients who had undergone operations for HFx between 2000 and 2009. The recruited patients with T2DM were divided into the oral antidiabetic drug (OAD) cohort and the insulin cohort according to the use or non-use of insulin. Patients without DM were propensity score matched in a 1:1 ratio by four variables. We used the χ² test, linear regression and Cox proportional hazards model to assess variables, including length of hospital stay, medical cost, complications, early readmission, and 1-year mortality.

RESULTS

We identified 5490 subjects in total. The insulin cohort exhibited prolonged hospital stay (11.8 days), higher medical costs, more complications within 30 and 90 after hip surgery, earlier readmission, and higher 1 year mortality rate (25.8%) than the OAD and non-DM cohorts. The OAD cohort had longer hospital stay (10.1 days) and higher readmission rate but fewer complications and mortality rates (14.9%) than the non-DM cohort.

CONCLUSIONS

After matching confounding factors, the T2DM with OAD control groups were not associated with higher complication or mortality rates but were associated with higher readmission rates. However, diabetic patients with insulin control have poor outcome. The impact of T2DM on the postoperative outcomes of patients with HFx may be related to blood glucose control medication.

Impact of Frailty on 30-Day Morbidity and Mortality of Patients With Intertrochanteric Femur Fractures

The aim of this study was to evaluate the association between frailty and 30-day morbidity and mortality in patients with intertrochanteric femur fractures. Furthermore, the authors sought to identify a specific frailty index score that would help identify high-risk patients. This retrospective study evaluated 229 consecutive patients 50 years or older who presented to a single level I trauma center for surgical fixation of an intertrochanteric femur fracture. Frailty was determined using a previously validated 11-point modified frailty index (mFI) scale. Primary outcome variables included 30-day morbidity and mortality. Of the 229 patients included in this study, 82 (36%) had a postoperative complication and there were 10 (4%) mortalities. The most common complications were delirium (n=40; 17%) and acute kidney injury (n=25; 11%). Mean mFI score for those who developed a postoperative complication was 0.24 compared with 0.14 for those who did not (P<.001). The mortality rate increased from 0% for mFI of 0 to 11% for mFI of 0.27 or more. Patients with an mFI of 0.27 or more were more than 9 times as likely to have a mortality compared with patients with an mFI of less than 0.27 (P=.006). This study demonstrates that the mFI is associated with 30-day morbidity and mortality in patients aged 50 years or older with intertrochanteric femur fractures. The authors identified an mFI score of 0.27 or more as the most robust predictor of increased 30-day morbidity and mortality following surgical fixation of intertrochanteric femur fractures. [Orthopedics. 2019; 42(6):344-348.].

The role of parathyroid hormone (PTH) and vitamin D in falls and hip fracture type

BACKGROUND

Fragility fractures of the hip are associated with high morbidity and mortality, and represent a rather devastating consequence of osteoporosis. Hip fractures are traditionally investigated as a whole, although it has been recently implied that distinct pathogenic mechanisms may lead either to trochanteric or subcapital fractures.

AIMS

To investigate whether differences exist by hip fracture type with respect to serum 25(OH)D (vitamin D) and parathyroid hormone (PTH) levels, in addition to epidemiological and demographic data, including history of falls.

METHODS

The inclusion criteria were met by 116 patients [48 men and 68 women; mean age 80.8 ± 8.5 (range 62-94) years]. Patients were analyzed according to hip fracture type, history of falls, and vitamin D and PTH status.

RESULTS

Older age, recurrent falls, serum levels of PTH > 65 pg/ml, and severe vitamin D deficiency were found to be associated with trochanteric fractures. Additionally, older age, female gender, PTH > 65 pg/ml, and severe vitamin D deficiency were related to recurrent falls. Meanwhile, patients with absence of PTH response to low vitamin D levels, were not repeated fallers and suffered mostly from subcapital fractures.

DISCUSSION AND CONCLUSION

Elevated PTH levels predispose both to falls and trochanteric fractures, while vitamin D-deficient patients with normal PTH levels are mostly related to subcapital fractures. It is thereby indicated that different pathophysiological processes lie behind subcapital and trochanteric fractures. A better understanding of these mechanisms may assist in the development of prevention strategies for individuals recognized at risk for falls and either type of hip fracture.

The Increase of Osteoporotic Hip Fractures and Associated One-Year Mortality in Poland: 2008-2015

INTRODUCTION

Hip fractures are a worldwide public health issue associated with significant mortality. Previous Polish studies reported an increasing trend in the number of hip fractures for both men and women, although lower than most other European countries.

MATERIALS AND METHODS

The Polish National Database was analyzed to examine osteoporotic hip fractures in the population aged 50 and over. Hip fracture incidence, rate, one-year mortality, and postoperative length of hospitalization were analyzed using the national health system data. Hospital discharge registry ICD-10 codes were reviewed from 2008 to 2015.

RESULTS

The incidence of hip fractures increased in both women and men by 19.4% and 14.2%, respectively. The female to male fracture ratio was 2.46. Mean postoperative hospitalization decreased from 13.6 to 11.2 days. The one-year mortality ranged between 30.45% to 32.8% for men and 26.2% to 28% for women. Of note, women aged 80-89 had the highest one-year mortality, 50.7%-55.4% after femoral neck fracture and 53%-58.5% after a pertrochanteric fracture.

CONCLUSIONS

Hip fractures in Poland are increasingly more prevalent in the aging population. The unfavorable trends observed in this study indicate higher annual mortality after hip fracture, compared with other European countries.

Nonunion and Reoperation After Internal Fixation of Proximal Femur Fractures: A Systematic Review

Nonunion after fixation of a proximal femur fracture is associated with increased disability, pain, and cost to both patient and health care system. Understanding the effect of fixation method and fracture pattern on healing is important to optimize healing. The authors evaluated surgical healing, nonunion rate, and reoperation rate after internal fixation of proximal femur fracture, especially since the year 2000. They performed a systematic review of all published records from PubMed, Embase, and the Cochrane Review system. The burden of proximal femoral fracture extends beyond acute disability, as it carries a high risk of long-term morbidity and mortality. Choice of fixation method for high-risk fractures is critical to reduce nonunion and reoperation rates. [Orthopedics. 2019; 42(2):e162-e171.].

Nutrition and Inflammation Influence 1-Year Mortality of Surgically Treated Elderly Intertrochanteric Fractures: A Prospective International Multicenter Case Series

Introduction:

Hip fracture is a common and devastating event in older adults causing increased dependence, comorbidity, and mortality. Since new surgical techniques have not significantly improved the mortality rate, a better understanding of patient risk factors could improve the treatment algorithm and outcomes. This prospective study aimed to document the 1-year survival rate of patients with intertrochanteric fracture treated surgically in Latin America and to investigate risk factors associated with 1-year mortality.

Patients and Methods:

Between January 2013 and March 2015, 199 patients were prospectively enrolled. Inclusion criteria were aged 60 years or older, isolated intertrochanteric fracture (AO/OTA 31-A), and time to surgery within 10 days after injury. The follow-up period was 1 year. The association between mortality and patient demographics, comorbidity, surgical details, and preoperative laboratory parameters was assessed using log-rank tests.

Results:

Twenty patients died by 365 days after surgery (including 5 that died within 30 days of surgery) resulting in a 1-year survival rate of 89.8% (95% confidence interval = 84.6-93.3). The 1-year mortality was significantly associated with age (≥85 years old, P = .032), existing comorbidity (P = .002), preinjury mobility level (P = .026), mental state (Mini-Mental State Examination > 23, P = .040), low preoperative plasma albumin level (P = .007), and high preoperative blood C-reactive protein level (CRP; P = .012). At the 1-year follow-up, patients on average did not regain their preinjury hip function and mobility, although the self-assessed quality of life was equal or better than before the injury.

Discussion:

As a prospective study, the current patient population had clear inclusion and exclusion criteria and was relatively homogeneous. The resulting associations between 1-year postoperative mortality and preoperative hypoalbuminemia and preoperative elevated CRP level are therefore especially notable. Previously identified risk factors such as male gender and time to surgery showed no significant association with 1-year mortality—the overall favorable condition of the current population or the lack of statistical power maybe responsible for this observation.

Conclusion:

The current results showed that under the condition of optimal surgical treatment and low surgery-related complication, preinjury health status as indicated by the blood level of albumin and CRP has a direct and significant impact on 1-year mortality rate.

Short-Term Outcomes of Interdisciplinary Hip Fracture Rehabilitation in Frail Elderly Inpatients

Objective

To investigate short-term outcomes of an interdisciplinary rehabilitation program for elderly inpatients who underwent surgical treatment for hip fractures.

Methods

This is a prospective cohort study of fifty older inpatients who were admitted to a geriatric rehabilitation unit. Clinical and functional outcomes were assessed at admission, at discharge, and one month postdischarge.

Results

Patients mean age was 84.1 ± 4.7 years. Proportions of study population with risk factors of frailty were cognitive impairment (64%), Charlson comorbidity index > 1 (72%), and protein malnutrition (59.2%). Before fracture, Barthel median was 90 (IQR 85, 100), and functional ambulation classification (FAC) score was ≥ 4 for 90% of study participants. One month after concluding rehabilitation, Barthel median was 80, 1 month postdischarge FAC ≥ 4 – prefracture FAC ≥ 4 mean change was – 8% (95% CI, -21.5%, 3.4%), and average for gait speed was 0.48 ± 0.18 m/s (95% CI, 0.43, 0.54). Significant correlation was found between admission Barthel score and 1 month postdischarge Barthel score (ρ= 0.27, p=0.05), and between prefracture FAC score and FAC score 1 month postdischarge (ρ = 0.57, p = 0.05). According to regression analysis, age, cognitive status, prefracture Barthel, prefracture FAC, type of surgery, and length of stay were associated with short-term recovery outcomes.

Conclusion

An early interdisciplinary rehabilitation management was insufficient to recover prefracture functional status. Future studies should investigate the best therapeutic strategies to optimize functional recovery, according to clinical and prefracture frail conditions of these patients.

Age-specific 1-year mortality rates after hip fracture based on the populations in mainland China between the years 2000 and 2018: a systematic analysis

We used statistical approaches to calculate 1-year mortality rates and reveal the relationship between age and the 1-year mortality rate after hip fracture based on data from mainland China between the years 2000 and 2018.

INTRODUCTION

Data on the 1-year mortality rates after hip fracture in mainland China remain limited and localized. We aimed to analyze the 1-year mortality rates and reveal the variations in 1-year mortality by age after hip fracture based on data from mainland China.

METHODS

We searched PubMed, EMBASE, Cochrane Library, CNKI, Wanfang, and CBM-SinoMed for all relevant articles in English or Chinese to estimate the 1-year mortality rates after hip fracture in mainland China. A random-effects meta-analysis model was fitted to pool the overall 1-year mortality rates. A multilevel mixed-effects meta-regression model was developed. Based on the final model, the age-specific 1-year mortality rates after hip fracture in mainland China were generated.

RESULTS

The pooled estimate of the 1-year mortality rate was 13.96% after hip fracture (95% CI 12.26 to 15.86%), 17.47% after femoral intertrochanteric fracture (95% CI 14.29 to 21.20%), and 9.83% after femoral neck fracture (95% CI 6.96 to 13.72%) between the years 2000 and 2018. We found that the 1-year mortality rates ranged from 2.65% (95% CI 1.76 to 3.99%) in those aged 50~54 years to 28.91% (95% CI 24.23 to 34.30%) in those aged 95~99 years after hip fracture; ranged from 1.73% (95% CI 0.58 to 4.99%) in those aged 50~54 years to 50.11% (95% CI 46.03% to 53.97%) in those aged 95~99 years after femoral intertrochanteric fracture; and ranged from 1.66% (95% CI 1.31 to 2.11%) in those aged 60~64 years to 37.71% (95% CI 27.92 to 48.63%) in those aged 95~99 years after femoral neck fracture.

CONCLUSION

In this systematic review and meta-analysis, we calculated the 1-year mortality rate after hip fracture in mainland China and found that this rate was lower than that in most countries. We also estimated the age-specific mortality rates for different age groups after hip fracture. These findings will be beneficial for the prevention and treatment of hip fracture in mainland China.

Assessment of quality of life using the EQ-5D-3L instrument for hospitalized patients with femoral fracture in Brazil

BACKGROUND

Quality of life has become a key outcome in assessing the effectiveness of treatments and interventions in health.

METHODS

Accordingly, this research study aimed to measure quality of life using the EQ-5D-3L instrument for patients from the Jamil Haddad National Institute of Traumatology and Orthopedics (Instituto Nacional de Traumatologia e Ortopedia Jamil Haddad - INTO) with femoral fractures, hospitalized between 11/2015 and 10/2016.

RESULTS

A total of 165 orthopedic trauma patients with femoral fractures, aged 18 years or older, who were hospitalized and operated upon in the INTO were assessed. The assessment instruments were applied at admission and in the first and second follow-up visits to the outpatient clinic. Most study subjects were women and older than 60 years. Proximal femoral fracture was the most commonly found fracture. The Visual Analog Scale (VAS) assessments over the study period showed an increasing gain in self-assessed quality of life. Similarly, the EQ-5D-3L showed significant improvements in quality of life assessed in the five dimensions of the instrument: mobility, self-care, usual activities, pain/discomfort and anxiety/depression.

CONCLUSION

This type of assessment may help in decision-making and cost-utility assessments related to orthopedic trauma.

Physiotherapy following fragility fractures

Physiotherapy can play a vital role in the pathway of care of people after fragility fracture and includes interventions of early mobilisation and prescription of structured exercise programmes for maximising functional recovery and reducing the risk of falls and further fractures. Although the optimal nature of physiotherapist interventions after hip and vertebral fracture requires further investigation in large-scale trials, evidence supports the prescription of high-intensity and extended exercise interventions. This article will overview interventions in the acute and chronic phases after hip fractures, interventions after vertebral fracture and the role of physiotherapy in the prevention of further fractures.

A case series of patients change in mobility following a hip fracture

INTRODUCTION

Hip fractures are common in the elderly population. It is currently believed that patients can expect to lose a level of mobility following a hip fracture. The aim of this study was to compare the pre- and post-treatment mobility of patients treated in our institution who had suffered a fracture neck of femur and identify the factors that could predict pre-operatively those patients who would suffer a deterioration in mobility after treatment.

METHODS

Patients admitted to a large UK teaching hospital with a surgically treated neck of femur fracture were included between 2 April 2011 and 31 March 2014. Patient's mobility was assessed on admission and at 1 year following surgery.

RESULTS

There were a total of 615 patients alive at 1 year. There were 142 males and 473 females with a mean age of 82.1 (range 47-100). On admission, 338 (55.0%) mobilised independently 52.2% had no change in their pre-fracture mobility at 1 year following their treatment. Age, a lower AMTS, a higher ASA and living in residential care were significant risk factors for not regaining their pre-fracture mobility. Sex and type of fracture were not associated with change in mobility.

CONCLUSION

It is commonly stated that patients lose one level of mobility following a hip fracture. This case series demonstrates that over 50% of patients can expect to have the same level of mobility at 1 year post-surgery as they did previously.

Hip osteoarthritis as a predictor of the fracture pattern in proximal femur fractures

INTRODUCTION

Several authors have suggested a correlation between the fracture patterns of proximal femur fractures and the degree of hip osteoarthritis (HOA), but the current evidence to support this are insufficient. The aim of our study was to demonstrate whether there is an association between the grade of HOA and fracture pattern observed, in patients presenting with a fragility fracture of the proximal femur.

MATERIALS AND METHODS

We contacted a retrospective review of all patients presenting to our institution with fragility fractures involving the proximal femur, between March 2012 and October 2013. Pathological fractures, high-energy injuries and patients with less than one year of follow-up were excluded from further analysis. Admission radiographs and severity of HOA were assessed according to Kellgren and Lawrence scale (minimal: Grades 1-2; severe: Grades 3-4). Fractures were classified according to AO/OTA classification.

RESULTS

A total of 1003 patients (725 females; 1003 fractures) met the inclusion criteria, having a mean age of 81.5 (46-106 years). With regards to fracture classification, 417 (41.6%) fractures were classified as extracapsular and 586 (58.4%) as intracapsular. A total of 939 (93.9%) patients presented with minimal HOA, whilst 61 (6.1%) of the patients presented with severe HOA. Of the 61 patients presenting with severe HOA, 42 patients (68.9%) sustained a 31A-interthrocanteric fracture and 19 patients (31.1%) sustained a 31B-intracapsular fracture. Regarding the patients presenting with minimal HOA (832 patients in total), 323 patients (38.8%) sustained 31A-intertrochanteric fracture and 509 patients (61.2%) sustained a 31B-intracapsular fracture. Patients presenting with severe HOA were found to have a statistically significant chance to present with an extracapsular fracture (p<0.01).

CONCLUSIONS

The degree of HOA is related to the fracture pattern in patients presenting following simple mechanical falls. More specifically, higher grades of HOA are associated with extracapsular fracture patterns, whereas lower grades of HOA are associated with intracapsular fracture patterns.

Extent and Morbidity of Lateralization of a Trochanteric Fixation Nail Blade

This study examined the incidence and risk factors associated with lateral helical blade migration and trochanteric pain with the trochanteric fixation nail. A retrospective review was performed of 141 cases of pertrochanteric femur fracture treated with a trochanteric fixation nail at a level I trauma center over a period of 42 months. Exclusion criteria included follow-up of less than 60 days, preexisting osteonecrosis of the femoral head, and prophylactic trochanteric fixation nail treatment. Patient demographics, operative findings, and radiographic findings were recorded. Medical records were reviewed to identify symptomatic hardware. Overall, 27 patients (19.1%) were symptomatic, and 3 (2.1%) required revision surgery for blade prominence. Of the patients, 42 (30%) had lateralization of greater than 1 cm, and 16 of these (38.1%) were symptomatic (P<.02). A risk factor for lateralization was AO classification, with 46.1% of type A2 fractures showing lateralization of greater than 1 cm. The quality of calcar reduction nearly reached statistical significance, and 44.8% of patients who had inadequate reduction had lateralization of greater than 1 cm compared with 26.4% of patients who had adequate reduction (P=.054). Lateralization of greater than 1 cm was directly associated with the presence of symptoms (P<.001) and removal of hardware because of trochanteric pain (P=.007). Multivariate analysis showed that increasing tip-apex distance, inadequate calcar reduction, and greater fracture severity were predictive of excessive lateralization of greater than 1 cm. Nearly 20% of patients had lateral hip pain associated with cephalomedullary fixation. Final lateralization of the helical blade of greater than 1 cm was a very strong predictor of symptoms. During preoperative counseling, surgeons should caution patients about this relatively frequent and likely underreported complication. [Orthopedics. 2017; 40(5):e886-e891.].