Prediction of survival, second fracture, and functional recovery following the first hip fracture surgery in elderly patients

Risk factors for subsequent fractures in hip fracture patients: a nested case-control study

BACKGROUND

The risk factors for subsequent fractures following an initial hip fracture are not entirely understood. This study examined the clinical characteristics of hip fracture patients to identify potential risk factors associated with a higher risk of experiencing subsequent fractures.

METHODS

We conducted a nested case-control study using data from the Chinese PLA General Hospital Hip Fracture Cohort between January 2008 and March 2022. The cases were individuals who experienced subsequent fractures following an initial hip fracture. Each case was matched with up to 2 controls who did not develop subsequent fractures. Important clinical factors were compared across groups, including traditional fracture risk factors and potential risk factors (e.g., comorbidities, falls risk, physical impairment, calcium or vitamin D use, and anti-osteoporosis medications). Conditional logistic regression analyses were used to evaluate the impact of these clinical features as potential risk factors for subsequent fractures.

RESULTS

A total of 96 individuals who suffered from subsequent fractures were matched with 176 controls. The median time between the initial hip fracture and the subsequent fracture was 2.1 years. The overall proportion of patients receiving anti-osteoporosis treatment after initial hip fracture was 25.7%. In the multivariable regression analysis, living in a care facility (OR = 3.78, 95%CI: 1.53-9.34), longer hospital stays (OR = 1.05, 95%CI: 1.00-1.11), and falls after discharge (OR = 7.58, 95%CI: 3.37-17.04) were associated with higher odds of subsequent fractures.

CONCLUSIONS

This study showed that living in a care facility, longer hospital stays, and falls after discharge may be independent risk factors for repeat fractures following an initial hip fracture. These findings could be used to identify and manage patients at high risk of subsequent fractures.

Systematic review and meta-analysis of preoperative predictors for early mortality following hip fracture surgery

Hip fractures are a global health problem with a high postoperative mortality rate. Preoperative predictors for early mortality could be used to optimise and personalise healthcare strategies. This study aimed to identify predictors for early mortality following hip fracture surgery. Cohort studies examining independent preoperative predictors for mortality following hip fracture surgery were identified through a systematic search on Scopus and PubMed. Predictors for 30-day mortality were the primary outcome, and predictors for mortality within 1 year were secondary outcomes. Primary outcomes were analysed with random-effects meta-analyses. Confidence in the cumulative evidence was assessed using the GRADE criteria. Secondary outcomes were synthesised narratively. Thirty-three cohort studies involving 462,699 patients were meta-analysed. Five high-quality evidence predictors for 30-day mortality were identified: age per year (OR: 1.06, 95% CI: 1.04-1.07), ASA score ≥ 3 (OR: 2.69, 95% CI: 2.12-3.42), male gender (OR: 2.00, 95% CI: 1.85-2.18), institutional residence (OR: 1.81, 95% CI: 1.31-2.49), and metastatic cancer (OR: 2.83, 95% CI: 2.58-3.10). Additionally, six moderate-quality evidence predictors were identified: chronic renal failure, dementia, diabetes, low haemoglobin, heart failures, and a history of any malignancy. Weak evidence was found for non-metastatic cancer. This review found relevant preoperative predictors which could be used to identify patients who are at high risk of 30-day mortality following hip fracture surgery. For some predictors, the prognostic value could be increased by further subcategorising the conditions by severity.

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.

The Association Between Red Cell Distribution Width (RDW) and All-Cause Mortality in Elderly Patients with Hip Fractures: A Retrospective Cohort Study

Background

Red cell distribution width (RDW) may be related to the prognosis of hip fractures. The purpose of this study was to evaluate the association between (RDW) and all-cause mortality in elderly hip fractures.

Materials and Methods

Elderly patients aged ≥65 years who had a hip fracture were screened between January 1, 2015, and September 30, 2019. The age, gender of patients and other demographics, as well as history of allergy, injury mechanism, underlying illnesses at the time of admission, fracture classification, time from admission to operation, RDW, operation time, blood loss, infusion, transfusion, treatment strategy, and length in hospital stay and follow-up and other clinical characteristics were collected. Linear and nonlinear multivariate Cox regression models were used to identify the association between RDW and mortality in these patients. Analyses were performed using EmpowerStats and the R software.

Results

A total of 2587 patients were included in this retrospective cohort study. The mean follow-up period was 38.92 months. A total of 873 (33.75%) patients died due to all-cause mortality. The RDW was linearly associated with mortality in elderly patients with hip fractures. Linear multivariate Cox regression models showed that RDW was associated with mortality (hazard ratio [HR]=1.03, 95% confidence interval [CI]:1.02-1.05, P < 0.0001) after adjusting for confounding factors. The mortality risk increased by 3% when RDW increased by 1 fL.

Conclusion

RDW is associated with mortality in elderly patients with hip fractures, and RDW could be considered a predictor of mortality risk.

Registration

ChiCTR2200057323.

Ambulation Distance Within 72 Hours after Surgical Management Is a Predictor of 90-Day Ambulatory Capacity in Elderly Patients with Hip Fracture

INTRODUCTION

The inability to mobilize after surgical intervention for hip fractures in the elderly is established as a risk factor for greater morbidity and mortality. Previous studies have evaluated the association between the timing and distance of ambulation in the postoperative acute care phase with postoperative complications. The purpose of this study was to evaluate the association between ambulatory distance in the acute postoperative setting and ambulatory capacity at 3 months.

METHODS

Patients aged 65 and older who were ambulatory at baseline and underwent surgical intervention for hip fractures from 2014 to 2019 were retrospectively reviewed. Consistent with previous literature, patients were divided into two groups: those who were able to ambulate 5 feet within 72 hours after surgical fixation (early ambulatory) and those who were not (minimally ambulatory).

RESULTS

One hundred seventy patients (84 early ambulatory and 86 minimally ambulatory) were available for analysis. Using a multivariable ordinal logistic regression model, variables found to be statistically significant predictors of ambulatory status at 3 months were the ability to ambulate five feet in 72 hours (P < 0.0001), ambulatory distance at discharge (P = 0.012), and time from presentation to surgery (P = 0.039). Patients who were able to ambulate 5 feet within 72 hours had 9 times the odds of being independent ambulators rather than a lower ambulatory class (cane, walker, and nonambulatory). Pertrochanteric fractures were less likely than femoral neck fractures to independently ambulate at 3 months (17.2% vs. 42.3%; P = 0.0006).

DISCUSSION

Ambulating 5 feet within 72 hours after hip fracture surgery is associated with an increased likelihood of independent ambulation at 3 months postoperatively. This simple and clear goal may be used to help enhance postoperative mobility and independence while providing a metric to guide therapy and help counsel patients and families.

Prognostic factors and prediction model for 1-year mortality after proximal humeral fracture

The goal was to investigate if patient characteristics can be used to predict 1-year post-fracture mortality after proximal humeral fracture (PHF). A clinical prediction model showed that the combination of 6 pre-fracture characteristics demonstrated good predictive properties for mortality within 1 year of PHF.

INTRODUCTION

Proximal humeral fractures (PFH) are the third most common major non-vertebral osteoporotic fractures in older persons and result in an increased mortality risk. The aim of this study was to investigate if patient characteristics can be used to predict 1-year post-fracture mortality.

METHODS

Retrospective study with 261 patients aged 65 and older who were treated for a PHF in University Hospitals Leuven between 2016 and 2018. Baseline variables including demographics, residential status, and comorbidities were collected. The primary outcome was 1-year mortality. A clinical prediction model was developed using LASSO regression and validated using split sample and bootstrapping methods. The discrimination and calibration were evaluated.

RESULTS

Twenty-seven (10.3%) participants died within 1-year post-PHF. Pre-fracture independent ambulation (p < 0.001), living at home at time of fracture (p < 0.001), younger age (p = 0.006), higher BMI (p = 0.012), female gender (p = 0.014), and low number of comorbidities (p < 0.001) were predictors for 1-year survival. LASSO regression identified 6 stable predictors for a prediction model: age, gender, Charlson comorbidity score, BMI, cognitive impairment, and pre-fracture nursing home residency. The discrimination was 0.891 (95% CI, 0.833 to 0.949) in the training sample, 0.878 (0.792 to 0.963) in the validation sample and 0.756 (0.636 to 0.876) in the bootstrapping samples. A similar performance was observed for patients with and without surgery. The developed model demonstrated good calibration.

CONCLUSIONS

The combination of 6 pre-fracture characteristics demonstrated good predictive properties for mortality within 1 year of PHF. These findings can guide PHF treatment decisions.

An analysis of cost and complications for patients sustaining a second, contralateral hip fracture within 1 year

INTRODUCTION

Hip fractures are an increasingly common occurrence among the aging population. With increased life expectancy and advancements in medicine, patients sustaining a hip fracture are at an increasing risk of sustaining a contralateral hip fracture. Efforts are being made to better understand the environment of these hip fractures so that secondary prevention clinics and guidelines can be made to help prevent recurrent osteoporotic hip fractures. The estimated incidence of a contralateral hip fracture varies from 2 to 10% and is reportedly associated with a higher incidence of complications. Previous studies evaluating contralateral hip fractures compared a single cohort of patients sustaining a second hip fracture with patients who sustained only one hip fracture. We aimed to investigate the overall complications and associated costs as it relates to a patients first hip fracture and contrast this to the same patient's contralateral, second hip fractures.

METHODS

We performed a retrospective review of all patients in our health systems electronic database who were found to have surgically treated hip fractures between January 2004 and July 2019. Patients with surgically treated hip fractures (CPT Codes: 27235, 27236, 27245, 27244), who sustained a second contralateral hip fracture were included. Medical complications within 30 days of either procedure (such as pneumonia, UTI, altered mental status and others), length of stay, orthopedic complications (such as wound complications, infection, hardware failure, nonunion), type of implants, costs, comorbidities, and ASA Class as well as Mortality were reviewed.

RESULTS

A total of 4,870 hip fractures were identified during the study period where 137 (2.8%) patients sustained a second hip fracture, and 47 (0.9%) of which were sustained within the first year after their index hip fracture. There was no statistical difference in length of stay (p = 0.68), medical (p>0.99) or orthopedic complications (p>0.99) between patients first and second hip fractures. There was an increased incidence of cognitive impairment with the second hip fracture (P = 0.0002). For patients that underwent operative treatment of a second hip fracture, the total cost of care was higher for the second surgery (mean difference 757. 38 USD) however the difference wasn't statistically significant (p = 0.31). The overall 1-year mortality rate was 14.9 percent.

CONCLUSIONS

Our study demonstrates there is no statistical difference between the first and second surgery regarding length of stay, medical or orthopedic complications and cost.

Mortality following hip fracture: Trends and geographical variations over the last SIXTY years

INTRODUCTION

The management of hip fractures has advanced on all aspects from prevention pre-operatively, specialised hip fracture units, early operative intervention and rehabilitation. This is in line with the appropriate recognition over the past years of an important presentation with significant mortality and socioeconomic consequences of ever increasing incidence in an aging population. It is therefore imperative to continue to gather data on the incidence and trends of hip fractures to guide future management planning of this important presentation.

METHODS

A review of all articles published on the outcome after hip fracture over a twenty year period (1999-2018) was undertaken to determine any changes that had occurred in the demographics and mortality over this period. This article complements and expands upon the findings of a previous article by the authors assessing a four decade period (1959 - 1998) and attempts to present trends and geographical variations over sixty years.

RESULTS

The mean age of patients sustaining hip fractures continues to be steadily increasing at approximately just over 1 year of age for every 5-year time period. The mean age of patients sustaining hip fractures increased from 73 years (1960s) to 81 years (2000s) to 82 years (2010s). Over the six decade period one-year mortality has reduced from an overall mean of 27% (1960s) to 20% (2010s). The proportion of female hip fractures has decreased from 84% (1960s) to 70% (2010s). There is a decreasing trend in the proportion of intracapsular fractures from 54% (1970s) to 49% (2000s) and 48% (2010s).

CONCLUSION

Our study indicates that significant progress has been made with preventative planning, medical management, specialised orthogeriatric units and surgical urgency all playing a role in the improvements in mean age of hip fracture incidence and reduction in mortality rates. While geographical variations do still exist there has been an increase in the study of hip fractures globally with results now being published from more widespread institutions indicating appropriate increased attention and commitment to an ever-increasing presentation.

Impact of Dementia on Long-Term Hip Fracture Surgery Outcomes: An Electronic Health Record Analysis

OBJECTIVE

Older adults with dementia are at higher risk for sustaining hip fracture and their long-term health outcomes after surgery are usually worse than those without dementia. Widespread adoption of electronic health records (EHRs) may allow hospitals to better monitor long-term health outcomes in patients with dementia after hospitalization. This study aimed to (1) estimate how dementia influences discharge location, mortality, and readmission 180 days and 1 year after hip fracture surgery in older adults, and (2) demonstrate the feasibility of using selection-bias reduced EHR data for research and long-term health outcomes monitoring.

DESIGN

Retrospective observational cohort study using EHRs.

SETTING AND PARTICIPANTS

A cohort of 1171 patients over age 65 years who had an initial hip fracture surgery between October 2015 and December 2018 was extracted from EHRs of one health system; 376 of these patients had dementia.

METHODS

Logistic regression was applied to estimate influences of dementia on discharge disposition and Cox proportional hazards model for mortality. The Fine and Gray regression model was used to analyze readmission, accounting for the competing risk of death. To reduce selection bias in EHRs, inverse probability of treatment weighting using propensity scores was implemented before modeling.

RESULTS

Dementia had significant impacts on all outcomes: being discharged to facilities [odds ratio (OR) = 2.11, 95% confidence interval (CI) 1.19-3.74], 180-day mortality [hazard ratio (HR) = 1.69, 95% CI 1.20-2.38], 1-year mortality (HR = 1.78, 95% CI 1.33-2.38), 180-day readmission (HR = 1.62, 95% CI 1.39-1.89), and 1 year readmission (HR = 1.39, 95% CI 1.21-1.58).

CONCLUSIONS AND IMPLICATIONS

Dementia was a significant risk factor for worse long-term outcomes. The inverse probability of treatment weighting approach can be used to reduce selection bias in EHR data for research and monitoring long-term health outcomes in the target population. Such monitoring could foster collaborations with post-acute and long-term health care services to improve recovery outcomes in patients with dementia after hip fracture surgery.

RELATION OF FEMUR FRACTURES LOCATION WITH CLINICAL OUTCOMES IN ELDERLY PATIENTS

Objectives

This study was designed to investigate the possible relationship between the anatomical location of the PFF (head-neck fractures) and the demographic features, comorbidities, and risk factors of elderly patients.

Methods

233 patients aged 65 years and over, who were admitted to the emergency department with a diagnosis of proximal femur fracture were included in this study.

Results

Most patients (59.6%) had a trochanteric fracture. The incidence of trochanteric fractures had a statistically significant positive correlation with age. Falls at ground level were found to be highly associated with trochanteric fractures (92,8%). At least one complication was observed in 57 (41,0%) cases and 31 (22,3%) died in one year, of the patients with trochanteric fractures. Comorbidity was not related to fracture location statistically. Fall ground level (p = 0.013), complication rate (73.7%; p <0.001), and Charlesen comorbidity index (p = 0.019) were statistically significantly associated with death. The logistic regression analysis of variables determined that only the quantity of comorbidities may be related to femoral neck fractures (p = 0.047).

Conclusion

Female patients with trochanteric fractures were found to be older than male patients. Fall ground level, mortality, and complications were more frequently seen in patients with trochanteric fractures. Level of Evidence II, Retrospective study.

Risk factors of mortality and second fracture after elderly hip fracture surgery in Shanghai, China

INTRODUCTION

Hip fracture is one of the leading causes of death and disability in the elderly. We analyzed the risk factors of mortality and second fracture within 2 years after hip fracture surgery in elderly Chinese patients.

MATERIALS AND METHODS

A total of 613 elderly patients after hip fracture surgery were selected, including 181 males and 432 females, and the patients were followed for at least 24 months. Information about patients and surgery was collected from medical records. Information on death, secondary fracture, and postoperative activities of daily living (ADL) was obtained by telephone follow-up. Cox regression was performed to identify risk factors associated with mortality and second fracture, measured by hazard ratio (HR).

RESULTS

The 1-year and 2-year mortality rates after hip fracture were 13.4% and 20.7%, respectively. The second fracture rate within 2 years was 9.5%. Male gender (HR 1.51, P = 0.035), increased age (HR 1.07, P < 0.001), preoperative hypoalbuminemia (HR 1.79, P = 0.004), preoperative pneumonia (HR 2.60, P = 0.005) and poor ADL (P = 0.048) were independent risk factors for 2-year mortality, while high preoperative hemoglobin (HR 0.98, P = 0.002), high preoperative eGFR (HR 0.99, P = 0.031), high preoperative LVEF (HR 0.92, P = 0.048) were protective factors for 2-year mortality. Poor ADL (P = 0.002) was the independent risk factor for second fracture within 2 years.

CONCLUSIONS

The 2-year mortality rate and second fracture rate after hip fracture in elderly remained high, which was related to old age and complications exists. Postoperative rehabilitation and improving ADL were very important to reduce mortality and second fracture.

What is the most fixable intramedullary implant for basicervical fracture and transcervical shear fracture? - A finite element study

Objective

The objectives of this study are 1) to biomechanically compare six different intramedullary fixations for basicervical fracture (AO 31-B3, Type 2 in area classification) and transcervical shear fracture (AO 31-B2.3, Type 1-2 in area classification) using the finite element (FE) method, and 2) to investigate the effects of two different unstable fracture types on fixation.

Methods

FE models of two different types of proximal femoral fractures are constructed from CT scan images of a patient with osteoporosis. The fracture models are fixed with a short femoral nail with a single lag screw, short femoral nail with a single blade, and short femoral nail with double lag screws, and then fixed with long femoral nails for each of the three nail types. Subsequently, the maximum loads during walking and stair climbing, as well as the minimum principal strain and compressive failure elements are calculated to assess the fixation of each implant.

Results

In both fracture types, the long nail with double lag screws show the smallest volume of compressive failure elements (basicervical fracture, 2 mm3; transcervical shear fracture, 217 mm3). In all types of implants, the volume of the compressive failure elements is larger in the transcervical shear fracture than in the basicervical fracture. A similar trend is observed for the minimum principal strain (compressive strain).

Conclusion

The present study shows that a long nail with double lag screws is the most fixative intramedullary nail device for basicervical fracture and transcervical shear fracture in any condition. Furthermore, it is shown that transcervical shear fracture is considerably more unstable than basicervical fracture.

Morbidity and mortality of fragility proximal humerus fractures: a retrospective cohort study of patients presenting to a level one trauma center

PURPOSE

Fragility fractures are a significant source of morbidity and have high associated mortality. Identifying risk factors for poor outcomes is essential for guiding treatment and for setting expectations for patients and their families. Although fragility hip fractures have been abundantly explored, there is a paucity of information regarding proximal humerus fractures (PHFs).

METHODS

We retrospectively review the electronic medical records of 379 patients who presented to a level 1 trauma center with a PHF secondary to a fall. Patient demographics, handedness, comorbidities, treatment, imaging data, follow-up data, and death date (if applicable) were recorded.

RESULTS

Our cohort consisted of 279 females and 100 males with an average age of 71.4 years. Distribution of injuries was 178 left, 141 right, and 7 bilateral. Compared with handedness, 179 were ipsilateral, 141 were contralateral, and 59 were unknown. A total of 81.3% of injuries were treated nonoperatively, whereas 18.7% were managed surgically. One-year mortality was 17.4%, and 2-year mortality was 24.0%.Males demonstrated a 2.28 increased risk of 1-year mortality (P = .004). Patients who died within 1 year of fracture had significantly higher Charlson comorbidity index scores (P < .0001) and age (P = .0003). Risk of death was significantly lower in patients who underwent surgery compared with those who were treated nonoperatively (P = .01). Patients who used an assist device before fracture had 4.2 increased risk of 1-year mortality (P < .0001). Patients who presented from nursing homes or assisted living had a 2.1 increased risk of 1-year mortality (P = .02). Patients with severe liver disease had a 5.5 increased risk of 1-year mortality (P < .0001), and those with metastatic cancer had a 13.7 increased risk of 1-year mortality (P < .0001). Bilateral fractures, side of injury in relation to handedness, rehospitalization, Neer classification, and PCP follow-up within 30 days were not associated with increased mortality.

CONCLUSIONS

Increased understanding risk factors for mortality after PHF will allow for more informed patient discussions regarding treatment outcomes and risk of death. Our data suggest that mortality at 1 year for fragility PHF is universally high regardless of risk factors. This risk is increased in patients who are older, functionally limited, or who have medical comorbidities. Our data demonstrate the importance of medical optimization of patients with a fragility PHF and underscore the importance of fall prevention in high-risk patients.

Risk factors for a second nonsimultaneous hip fracture in a prospective cohort study

INTRODUCTION

The risk factors for a second nonsimultaneous hip fracture are unclear, and in general, it is empirically assumed that they are similar to those associated with the first hip fracture. We aimed to determine the incidence of a second hip fracture and define the characteristics of the patients sustaining the event in a prospective cohort study in a Spanish population.

MATERIALS AND METHODS

We conducted a multicentric, prospective cohort study in a representative sample of 45 hospitals from 15 autonomic regions in Spain. In total, the study included 994 patients. One hundred and one patients presented a nonsimultaneous contralateral hip fracture, constituting the intervention group. The remaining 893 patients presenting with a hip fracture formed the control group. The main outcome measures of this study were sociodemographic characteristics of the patient, comorbid conditions, and baseline and postfracture clinical outcomes (inpatient complications and acute mortality).

RESULTS

The key fracture risk factors were a history of fragility fractures, the need for assistance when walking outdoors and a history of falls. There were no associations between the groups in any of the common fragility risk factors, including rheumatoid arthritis, secondary osteoporosis, or steroid consumption. The results showed that patients suffering a nonsimultaneous hip fracture had an increased risk of mortality after discharge compared with the control group.

CONCLUSION

A nonsimultaneous second hip fracture leads to a near-significant increase in four-month mortality. In our study, this fracture was associated with a history of falls, prior fragility fractures, and the need for a walking aid.

Relationship between pressure ulcer risk and sarcopenia in patients with hip fractures

OBJECTIVE

Pressure ulcer (PU) is a frequent complication of hip fractures. PUs can develop at any time after a hip fracture but most appear within 2-4 days after surgery. The purpose of this study was to investigate the association between hip fractures due to sarcopenia and the risk of PUs in patients with hip fracture.

METHOD

Between March 2017 and March 2019, patients aged ≥65 years of age with hip fractures were included in this retrospective cohort study. PU risk assessment according to the Braden Scale was performed within the first few hours after arrival at hospital. Skeletal muscle mass index (SMI) and hand grip strength were evaluated for a diagnosis of sarcopenia.

RESULTS

Of the 289 patients admitted to the study institution, 180 patients were finally enrolled in the study (129 females; 51 males). In male patients, as SMI increased, so too did the Braden Scale score, which was statistically significant (p=0.02). However, there was no statistically significant difference between SMIs and Braden Scale scores in female patients (p=0.304). In male patients, there was no statistically significant difference between hand grip strength and Braden Scale score (p=0.251). However, in female patients, as hand grip strength increased, so too did the Braden Scale score; this was also statistically significant (p=0.041).

CONCLUSION

In this study, decreased muscle mass and muscle weakness in patients with hip fractures were associated with increased PU risk as measured by Braden Scale scores in both males and females.

Single vs Dual-site service reconfiguration during Covid-19 pandemic - A tertiary care centre experience in hip fractures and a Scoping review

Aims and objectives

The Covid-19 pandemic has had an unprecedented effect on surgical practice and healthcare delivery globally. We compared the impact of the care pathways which segregate Covid-19 Positive and Negative patients into two geographically separate sites, on hip fracture patients in our high-volume trauma center in 3 distinct eras - the pre-pandemic period, against the first Covid-19 wave with dual-site service design, as well as the subsequent surge with single-site service delivery. In addition, we sought to invoke similar experiences of centres worldwide through a scoping literature review on the current evidence on "Dual site" reconfigurations in response to Covid-19 pandemic.

Methods

We prospectively reviewed our hip fracture patients throughout the two peaks of the pandemic, with different service designs for each, and compared the outcomes with a historic service provision. Further, a comprehensive literature search was conducted using several databases for articles discussing Dual-site service redesign.

Results

In our in-house study, there was no statistically significant difference in mortality of hip fracture patients between the 3 periods, as well as their discharge destinations. With dual-site reconfiguration, patients took longer to reach theatre. However, there was much more nosocomial transmission with single-site service, and patients stayed in the hospital longer. 24 articles pertaining to the topic were selected for the scoping review. Most studies favour dual-site service reorganization, and reported beneficial outcomes from the detached care pathways.

Conclusion

It is safe to continue urgent as well as non-emergency surgery during the Covid-19 pandemic in a separate, geographically isolated site.

Incidence of Subsequent Hip Fracture and Mortality in Elderly Patients: A Multistate Population-Based Cohort Study in Eastern Spain

Osteoporotic hip fractures in older people may confer an increased risk of subsequent hip fractures and death. The aim of this study was to estimate the cumulative incidence of both recurrent hip fracture and death in the Valencia region. We followed a cohort of 34,491 patients aged ≥65 years who were discharged alive from Valencia Health System hospitals after an osteoporotic hip fracture between 2008 and 2015, until death or end of study (December 31, 2016). Two Bayesian illness-death models were applied to estimate the cumulative incidences of recurrent hip fracture and death by sex, age, and year of discharge. We estimated 1-year cumulative incidences of recurrent hip fracture at 2.5% in women and 2.3% in men, and 8.3% and 6.6%, respectively, at 5 years. Cumulative incidences of total death were 18.3% in women and 28.6% in men at 1 year, and 51.2% and 69.8% at 5 years. One-year probabilities of death after recurrent hip fracture were estimated at 26.8% and 43.8%, respectively, and at 57.3% and 79.2% at 5 years. Our analysis showed an increasing trend in the 1-year cumulative incidence of recurrent hip fracture from 2008 to 2015, but a decreasing trend in 1-year mortality. Male sex and age at discharge were associated with increased risk of death. Women showed higher incidence of subsequent hip fracture than men although they were at the same risk of recurrent hip fracture. Probabilities of death after recurrent hip fracture were higher than those observed in the general population. © 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).

Muscle density is an independent risk factor of second hip fracture: a prospective cohort study

BACKGROUND

Patients with a first hip fracture are at high risk of fracturing their other hip. Despite this, preventive therapy is often not given. Because little is known about specific risk factors of a second hip fracture, we investigated the association with areal bone mineral density (aBMD), muscle size, and density. We also investigated whether muscle parameters predict the risk of a contralateral fracture independently of aBMD.

METHODS

Three groups were included, one without hip fracture (a subcohort of the China Action on Spine and Hip Status study), one with a first, and one with a second hip fracture. Subjects with fractures were recruited from the longitudinal Chinese Second Hip Fracture Evaluation (CSHFE). Computed tomography scans of CSHFE patients, which were obtained immediately following their first fracture, were used to measure cross-sectional area and density of the gluteus maximus (G.MaxM) and gluteus medius and minimus (G.Med/MinM) muscles. Computed tomography X-ray absorptiometry was used to measure aBMD of the contralateral femur. Median follow-up time to second fracture was 4.5 years. Cox proportional hazards models were used to compute hazard ratios (HR) of second hip fracture risk in subjects with a first hip fracture. Multivariate logistic regressions were used to compare odds ratios (OR) for the risk of a first and second hip fracture.

RESULTS

Three hundred and one participants (68.4 ± 6.1 years, 64% female) without and 302 participants (74.6 ± 9.9 years, 71% female) with a first hip fracture were included in the analysis. Among the latter, 45 (79.2 ± 7.1 years) sustained a second hip fracture. ORs for first hip fracture were significant for aBMD and muscle size and density. ORs for a second fracture were smaller by a factor of 3 to 4 and no longer significant for femoral neck (FN) aBMD. HRs for predicting second hip fracture confirmed the results. G.Med/MinM density (HR, 1.68; CI, 1.20-2.35) and intertrochanter aBMD (HR, 1.62; CI, 1.13-2.31) were the most significant. FN aBMD was not significant. G.Med/MinM density remained significant for predicting second hip fracture after adjustment for FN (HR, 1.66; Cl, 1.18-2.30) or total hip aBMD (HR, 1.50; 95% Cl, 1.04-2.15).

CONCLUSIONS

Density of the G.Med/MinM muscle is an aBMD independent predictor of the risk of second hip fracture. Intertrochanteric aBMD is a better predictor of second hip fracture than FN and total hip aBMD. These results may trigger a paradigm shift in the assessment of second hip fracture risk and prevention strategies.

Preoperative and perioperative factors are related to the early postoperative Barthel Index score in patients with trochanteric fracture

Previous studies have shown that preoperative factors predict the postoperative Barthel Index score in patients with trochanteric fractures, while there is less evidence on the effects of perioperative factors on the prediction. This study aimed to assess the effects of preoperative and perioperative factors on the early postoperative Barthel Index score in patients with trochanteric fractures. Consecutive 288 patients aged ≥60 years with trochanteric fractures who could independently walk before injury were included. Patients were grouped according to the Barthel Index score measured after 2 weeks of surgery; the cut-off value was 20 points. Two logistic regression models were created to assess the effects of preoperative (model 1: dementia, walking ability before injury, and nutrition status) and perioperative (model 2: independent variables in model 1, reduction quality, and basic mobility function) factors on the Barthel Index score. Sensitivity and specificity were used to assess the predicative accuracy of the models. Poor preoperative (model 1: χ2 = 34.626, P < 0.01) and perioperative (model 2: χ2 = 43.956, P < 0.01) characteristics were significantly related to lower Barthel Index score. Sensitivity and specificity were similar between the models (model 1: 83.3% and 38.9% and model 2: 82.2% and 42.6%, respectively). Both preoperative and perioperative factors were significantly related to the early postoperative Barthel Index score after trochanteric fracture. However, only minimal increase in predictive accuracy was observed when perioperative predictors were analyzed along with preoperative factors. Both baseline characteristics and basic postoperative mobility should be considered when treating patients with trochanteric fractures.

Development and internal validation of a machine-learning-developed model for predicting 1-year mortality after fragility hip fracture

Background

Fragility hip fracture increases morbidity and mortality in older adult patients, especially within the first year. Identification of patients at high risk of death facilitates modification of associated perioperative factors that can reduce mortality. Various machine learning algorithms have been developed and are widely used in healthcare research, particularly for mortality prediction. This study aimed to develop and internally validate 7 machine learning models to predict 1-year mortality after fragility hip fracture.

Methods

This retrospective study included patients with fragility hip fractures from a single center (Siriraj Hospital, Bangkok, Thailand) from July 2016 to October 2018. A total of 492 patients were enrolled. They were randomly categorized into a training group (344 cases, 70%) or a testing group (148 cases, 30%). Various machine learning techniques were used: the Gradient Boosting Classifier (GB), Random Forests Classifier (RF), Artificial Neural Network Classifier (ANN), Logistic Regression Classifier (LR), Naive Bayes Classifier (NB), Support Vector Machine Classifier (SVM), and K-Nearest Neighbors Classifier (KNN). All models were internally validated by evaluating their performance and the area under a receiver operating characteristic curve (AUC).

Results

For the testing dataset, the accuracies were GB model = 0.93, RF model = 0.95, ANN model = 0.94, LR model = 0.91, NB model = 0.89, SVM model = 0.90, and KNN model = 0.90. All models achieved high AUCs that ranged between 0.81 and 0.99. The RF model also provided a negative predictive value of 0.96, a positive predictive value of 0.93, a specificity of 0.99, and a sensitivity of 0.68.

Conclusions

Our machine learning approach facilitated the successful development of an accurate model to predict 1-year mortality after fragility hip fracture. Several machine learning algorithms (eg, Gradient Boosting and Random Forest) had the potential to provide high predictive performance based on the clinical parameters of each patient. The web application is available at www.hipprediction.com. External validation in a larger group of patients or in different hospital settings is warranted to evaluate the clinical utility of this tool.

Trial registration

Thai Clinical Trials Registry (22 February 2021; reg. no. TCTR20210222003).

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-03152-x.

Autonomy of the elderly after a hip fracture surgery in a subsaharan country

Purpose: The aim of this study was to assess the impact of surgery on autonomy in the elderly after a fracture of the proximal femur; and the factors associated with its alteration. Materials and methods: A prospective longitudinal study was performed on 66 patients aged at least 90 years treated for a fracture of the proximal femur between 2008 and 2017. Physical autonomy was assessed using the Katz scale Results: After the surgical management, the previous level of autonomy was found progressively increasing in 9.1% at 1 month, 17.5% in the 3rd month, 23.5% in the 6th month and 22% at 1 year ( P value <0.001). The factors associated with the deterioration in patient autonomy one month postoperatively were as follows: late admission ( P = 0.02), a period of verticalization greater than 15 days ( P = 0.02), at least one complication of decubitus ( P = 0.004), anemia ( P = 0.02) and an ASA score ≥ 2 ( P = 0.05). The comparison of the autonomy between hip fixation and hip prosthetic replacement did not show a significant difference in the first postoperative month ( P = 0.83). Conclusion: Even at over 90 years of age, surgery can significantly restore previous autonomy. The early admission and management of patients, the prevention of complications in the decubitus position, the early rise after surgery and the management of anemia are key points in restoring physical autonomy.

Impact of bisphosphonates and comorbidities on initial hip fracture prognosis

The aim of this study is to investigate the impact of bisphosphonate treatment on the prognosis of patients with initial hip fracture. Patients aged fifty years and older with initial hip fracture were identified from the Taiwan National Health Insurance Research Database between 2002 and 2011. A multi-state model was established to evaluate the transition between "first to second hip fracture", "first hip fracture to death", and "second hip fracture to death". Transition probability and cumulative hazards were used to compare the prognosis of initial hip fracture in a bisphosphonate treated cohort versus non-treated cohort. In addition, Deyo-Charlson comorbidities, both vertebral and non-vertebral fractures, and cataracts were also included for analysis. After 10-year follow-up, there is decreased cumulative transition probability for both second hip fracture and mortality after both first and second hip fracture in the bisphosphonate treated cohort. Multivariable, transition-specific time-dependent Cox model revealed that bisphosphonate treatment significantly reduced risk for second hip fracture in the first 5 years of the treatment (HR 0.88; 95% CI 0.79-0.99; P: 0.034), first hip fracture mortality (HR 0.88; 95% CI 0.83-0.93; P < 0.001), and second hip fracture mortality in the first 2 years of the treatment (HR 0.78; 95% CI 0.65-0.95; P = 0.011). Female sex, both vertebral and non-vertebral fractures, cataracts, dementia in the first 2 years, and DM with complication were all significantly associated with risk of a second hip fracture. Cerebrovascular disease and hemiplegia comorbidities had less risk of a second hip fracture. The risk of mortality after both first and second hip fracture was significantly associated with congestive heart failure, renal disease, myocardial infarction, and moderate to severe liver disease. Our study demonstrated that bisphosphonate treatment and strict management of comorbidities after the initial hip fracture significantly decrease the risk for a second hip fracture and mortality.

Very Distal Femoral Periprosthetic Fractures: Replacement Versus Fixation: A Systematic Review

OBJECTIVES

To synthesize all-cause reoperations and complications data as well as secondary clinical and functional outcomes, after the management of very distal femur periprosthetic fractures (vDFPFs) in a geriatric patient population with either a distal femoral locking plate (DFLP) or distal femoral replacement (DFR).

DATA SOURCES

MEDLINE, Embase, and Web of Science were searched for English language articles from inception to March 16, 2020, in accordance to the PRISMA guidelines.

STUDY SELECTION

Studies reporting the management of vDFPFs in adults older than 65 years with either a DFLP or DFR were included. To ensure this review solely focused on very distal femoral periprosthetic fractures, only fractures of the following classifications were included: (1) Lewis and Rorabeck type II or III, (2) Su and Associates' Classification of Supracondylar Fractures of the Distal Femur type III, (3) Backstein et al type F2, and/or (4) Kim et al type II or III.

DATA EXTRACTION

Three reviewers independently extracted data from the included studies. Study validity was assessed using the methodological index for nonrandomized studies (MINORS), a quality assessment tool for nonrandomized controlled studies in surgery.

DATA SYNTHESIS

Twenty-five studies with 649 vDFPFs were included for analysis. There were 440 knees in the DFLP group (mean age range: 65.9-88.3 years) and 209 knees in the DFR group (mean age range: 71.0-84.8 years). Because of the literature's heterogeneity, the data were qualitatively synthesized.

CONCLUSIONS

vDFPFs in the elderly treated with DFR underwent fewer reoperations relative to DFLP (0%-45% vs. 0%-77%, respectively). Time to weight-bearing was observably shorter in DFR studies relative to DFLP studies. Functional outcomes and postoperative range of motion indicated a trend for DFLP knees to outperform DFR knees. Future research should include prospective studies and cost-effectiveness evaluations to better understand the utility of DFR for these fractures.

LEVEL OF EVIDENCE

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

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.

Mortality profile after 2 years of hip fractures in elderly patients treated with early surgery

BACKGROUND

In geriatric age group, hip fractures tend to become a major public health hazard. Due to this high occurrence, there is a need to develop standardized, effective, and multidisciplinary management for treatment. These elderly patients have excessive mortality that can extend ahead of the time of recovery. Early surgery after hip fractures has lead to a notable reduction in mortality rates. Still, it is considerably high as compared to other fractures.

METHODS

266 patients of >65 years who were operated within 72 h hours in a tertiary level health care centre for hip fractures were included. They were evaluated with X-rays and grade of Singh's index was noted. Mortality rates and the factors associated with it such as age, sex, co morbidities (using Charlson's co morbidity Index/CCI) were evaluated after 2 year follow up.

RESULTS

The overall 2-year mortality reported in our study population was 11.2%. It was broadly lower as compared to most of the other studies. It was 6.3% in females as compared to 18.1% in males. While it was reported to be only 6% in 65-74 years of age, it was 25% in patients who were 85 years and above. 76.6% of the patients had Singh's index of ≤ grade 3 showing osteoporosis. The patients with Low Charlson's score showed only 4.2% mortality while those with high Charlson's score showed 25.5% mortality.

CONCLUSION

It was concluded that Mortality among elderly patients after early surgery after osteoporotic hip fractures is quite significant. The factors for improvement in long term survival post-hip fracture may include changing treatment patterns, increasing life expectancy and early surgery. Increase in age, female sex, and high CCI Scores were major risk factors of mortality after hip fractures in a 2-year follow-up period.

Clinical prediction model for postoperative ambulatory ability outcomes in patients with trochanteric fractures

INTRODUCTION

Regaining independent ambulatory ability is one of the primary goals of treatment in patients with trochanteric fractures. This study aimed to develop and evaluate the discriminative accuracy of a clinical prediction model for ambulatory ability outcomes 3 months after surgery for trochanteric fractures.

METHODS

This retrospective cohort study included 346 patients treated with intramedullary nailing for trochanteric fractures who had independent ambulatory ability before their injury. Multiple regression models with preoperative and postoperative factors were used to predict ambulatory ability outcomes at 3 months. A clinical prediction model (CPM) was created based on a decision tree developed using a chi-square automatic interaction detector technique.

RESULTS

Three months after surgery, 263 (76.0%) and 83 (24.0%) patients regained and lost independent ambulatory ability, respectively. Univariate analysis showed that the Barthel index (BI) total score at 2 weeks predicted the ambulatory ability outcome at 3 months with good discriminative accuracy (area under the receiver operating characteristic curve [AUROC]: 0.819; 95% confidence interval [CI]: [0.769, 0.868], cut-off value: 22.5; sensitivity: 69.5%; specificity: 82.3%). Multiple logistic regression analysis showed that preoperative factors (residence before injury, diagnosis of dementia, and serum albumin at admission) and postoperative factors (BI total score at 2 weeks) predicted ambulatory ability outcomes at 3 months (AUROC: 0.710; 95%CI: [0.636, 0.783]; sensitivity: 91.3%; specificity: 41.8%). The CPM with the BI total score at 2 weeks (≤10; 10<, ≤50; >50 points) and dementia status (present; absent) had a moderate discriminative accuracy (AUROC: 0.676; 95%CI: [0.600, 0.752]; sensitivity: 94.7%; specificity: 40.5%).

CONCLUSIONS

We developed a CPM with moderate accuracy to predict ambulatory ability outcomes in patients 3 months after surgery for trochanteric fractures. Our results demonstrate the importance of the BI score measured soon after surgery and dementia status for the prediction of postoperative ambulation.

The importance of maternal pregnancy vitamin D for offspring bone health: learnings from the MAVIDOS trial

Optimisation of skeletal mineralisation in childhood is important to reduce childhood fracture and the long-term risk of osteoporosis and fracture in later life. One approach to achieving this is antenatal vitamin D supplementation. The Maternal Vitamin D Osteoporosis Study is a randomised placebo-controlled trial, the aim of which was to assess the effect of antenatal vitamin D supplementation (1000 IU/day cholecalciferol) on offspring bone mass at birth. The study has since extended the follow up into childhood and diversified to assess demographic, lifestyle and genetic factors that determine the biochemical response to antenatal vitamin D supplementation, and to understand the mechanisms underpinning the effects of vitamin D supplementation on offspring bone development, including epigenetics. The demonstration of positive effects of maternal pregnancy vitamin D supplementation on offspring bone development and the delineation of underlying biological mechanisms inform clinical care and future public-health policies.

Predictive Model of Gait Recovery at One Month after Hip Fracture from a National Cohort of 25,607 Patients: The Hip Fracture Prognosis (HF-Prognosis) Tool

The aim of this study was to develop a predictive model of gait recovery after hip fracture. Data was obtained from a sample of 25,607 patients included in the Spanish National Hip Fracture Registry from 2017 to 2019. The primary outcome was recovery of the baseline level of ambulatory capacity. A logistic regression model was developed using 40% of the sample and the model was validated in the remaining 60% of the sample. The predictors introduced in the model were: age, prefracture gait independence, cognitive impairment, anesthetic risk, fracture type, operative delay, early postoperative mobilization, weight bearing, presence of pressure ulcers and destination at discharge. Five groups of patients or clusters were identified by their predicted probability of recovery, including the most common features of each. A probability threshold of 0.706 in the training set led to an accuracy of the model of 0.64 in the validation set. We present an acceptably accurate predictive model of gait recovery after hip fracture based on the patients’ individual characteristics. This model could aid clinicians to better target programs and interventions in this population.

The role of having children for the incidence of and survival after hip fracture - A nationwide cohort study

BACKGROUND

Childless older women have a higher risk of sustaining a hip fracture than mothers. Several biological mechanisms linking parity to bone health among women have been proposed but it remains unclear whether a similar association exists among men. Adult children may also support their ageing parents with hip fracture, thereby potentially increasing survival chances.

AIM

To investigate how having children is related to the incidence of and survival after hip fracture among Swedish men and women over the age of 70.

METHODS

This nation-wide cohort study is based on data from several administrative population registers and a clinical hip fracture register. During 2013 to 2017, we estimated multivariable-adjusted incidence rate ratios to examine the association between number of children and incidence of first hip fracture and hazard ratios to examine survival after first hip fracture.

RESULTS

More than two million individuals were followed for hip fracture incidence and 45,991 patients for survival. Women had a higher risk of sustaining a hip fracture, but men had substantially higher mortality than women. Adjusting for education, comorbidity level, and further covariates, having children was associated with a lower risk of sustaining a hip fracture and a longer survival after hip fracture.

CONCLUSIONS

Older childless individuals may constitute risk groups for both the incidence of and mortality after hip fracture. Mechanisms linking parity to hip fracture risk are likely complex and not limited to biological mechanisms related to pregnancy, childbirth, or breastfeeding among women.

Implementing a hip fracture registry and financial incentive program to enhance best practice in hip fracture care in Western Australia

Hip fracture is a common injury in older adults that causes significant morbidity and mortality. Older adults who sustain a hip fracture are at a higher risk of institutionalisation, reduced mobility and subsequent falls and, consequently, have increased rates of morbidity and mortality. Quality improvement strategies that address gaps in hip fracture care are needed to ensure best practice and improve health outcomes for older adults.

Associations between Hip Fracture Operation Waiting Time and Complications in Asian Geriatric Patients: A Taiwan Medical Center Study

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

Bone mineral density and trabecular bone score in elderly type 2 diabetes Southeast Asian patients with severe osteoporotic hip fractures

INTRODUCTION

Studies show trabecular bone score (TBS) may provide information regarding bone quality independent of bone mineral density (BMD) in type 2 diabetes (DM2) patients. We analyzed our Southeast Asian severe osteoporotic hip fracture patients to study these differences.

METHODS

We conducted a retrospective cross-sectional analysis of subjects admitted to Changi General Hospital, Singapore with severe osteoporotic hip fractures from 2014-2017 who had BMD performed. Electronic records were reviewed and subjects were classified as having diabetes according to the WHO 2019 criteria. DM2 patients were classified according to their HbA1c into well controlled (HbA1c < 7%) and poorly controlled (HbA1c ≥ 7%) DM2.

RESULTS

Elderly patients with hip fractures present with average femur neck T scores at the osteoporotic range, however those with DM2 had higher BMD and TBS values compared to non DM2 patients. These differences were statistically significant in elderly women-poorly controlled elderly DM2 women with hip fracture had the highest total hip T-score (-2.57 ± 0.86) vs (-2.76 ± 0.96) in well controlled DM2 and (-3.09 ± 1.01) in non DM2 women with hip fracture, p < 0.001. In contrast, TBS scores were lower in poorly controlled DM2 women with hip fracture compared to well controlled DM2 women with hip fracture (1.22 ± 0.11) vs (1.24 ± 0.09), but these were still significantly higher compared to non DM2 women with hip fracture (1.19 ± 0.10), p < 0.001. In elderly men with hip fractures, univariate analysis showed no statistically significant differences in TBS or hip or LS BMD between those with poorly controlled DM2, well controlled DM2 and non DM2. The differences in TBS and BMD remained significant in all DM2 women with hip fractures even after adjustments for potential confounders. Differences in TBS and BMD in poorly controlled DM2 men with hip fractures only became significant after accounting for potential confounders. However, upon inclusion of LS BMD into the multivariate model these differences were attenuated and remained significant only between elderly women with well controlled DM2 and non DM2 women with hip fractures.

CONCLUSIONS

Elderly patients with DM2 and severe osteoporosis present with hip fractures at a higher BMD and TBS values compared to non DM2 patients. These differences were significant after adjustment for confounders in all DM2 women and poorly controlled DM2 men with hip fractures, TBS differences were attenuated with the inclusion LS BMD. Further studies are needed to ascertain differences in BMD and TBS in older Southeast Asian DM2 patients with variable glycemic control and severe osteoporosis.

Independent factors associated with long-term functional outcomes in patients with a proximal femoral fracture: A systematic review

INTRODUCTION

The current understanding of prognostic factors of functional recovery after a proximal femoral fracture is limited, and enhancements could improve the prognostic accuracy and target subgroups for additional care strategies. This systematic review aims to identify all studied factors with an independent prognostic value for the long-term functional recovery of patients with a proximal femoral fracture.

MATERIALS AND METHODS

Observational studies with multivariate analyses on prognostic factors of long-term functional outcome after proximal femoral fractures were obtained through an electronic search performed on November 9, 2018.

RESULTS

In the 31 included articles, thirteen prognostic factors were studied by at least two independent studies and an additional ten by only one study. Age, comorbidity, functionality and cognition were factors for which the majority of studies indicated a significant effect. The majority of studies which included sex as a factor found no significant effect. The level of evidence for the remaining factors was deemed too low to be conclusive on their relevance for long-term functional outcome.

CONCLUSION

The identified factors showed overlap with prognostic factors of short-term functional outcomes and mortality. The validity and applicability of prognostic models based on these factors may be of interest for future research.

Placental volume at 11 weeks is associated with offspring bone mass at birth and in later childhood: Findings from the Southampton Women's Survey

OBJECTIVES

To investigate associations between placental volume (PV) at 11 weeks' gestation and offspring bone outcomes at birth, 6 years and 8 years.

METHODS

3D ultrasound scanning was used to assess 11 week PV in a subset (n = 236) of the Southampton Women's Survey (a prospective mother-offspring cohort). Maternal anthropometric measures and lifestyle information were obtained pre-pregnancy and at 11 weeks' gestation. Offspring dual-energy x-ray absorptiometry scanning was performed within 2 weeks postnatally and at 6 and 8 years. Linear regression was used to assess associations between PV and bone outcomes, adjusting for offspring age at DXA and sex, and maternal age, height, smoking status, walking speed and triceps skinfold thickness. β are SD change in bone outcome per SD change in PV.

RESULTS

In adjusted models, 11 week PV was positively associated with bone area (BA) at all time points, with evidence of persisting associations with increasing childhood age (birth: n = 80, β = 0.23 [95%CI = 0.03, 0.42], 6 years: n = 110, β = 0.17 [-0.01, 0.36], 8 years: n = 85, β = 0.13 [-0.09, 0.36]). Similar associations between 11 week PV and bone mineral content (BMC) were observed. Associations with size-corrected bone mineral content were weaker at birth but strengthened in later childhood (birth: n = 78, β = 0.07 [-0.21, 0.35], 6 years: n = 107, β = 0.13 [-0.08, 0.34], 8 years: n = 71, β = 0.19 [-0.05, 0.43]).

CONCLUSIONS

11 week PV is associated with DXA bone measures at birth, with evidence of persisting associations into later childhood. Further work is required to elucidate the contributions of placental morphology and function to gestational influences on skeletal development.

Sequential Bilateral Hip Fractures in Elderly Patients

Purpose

To evaluate the incidence and presentation of osteoporotic sequential bilateral hip fractures (SBHF) in Center for Joint Disease, Chonnam National University Hwasun Hospital as there are limited studies with variable results reported in Korea.

Materials and Methods

Records of 507 patients aged >60 years old presenting with osteoporotic hip fractures between 2009 and 2015 were retrospectively reviewed to document the occurrence and presentation of sequential hip fractures; mean post-treatment follow-up was 48 months. Additionally, any correlations between sequential fractures and initial fracture and risk factors were assessed. Bone mineral density (BMD) was measured before and after sequential hip fracture for comparison.

Results

There were 246 femoral neck (Group A) and 261 intertrochanteric (Group B) fractures. The cumulative incidence of SBHF was 8.2% (42 patients total; 29 in Group A and 13 in Group B). Average interval of SBHF for Group A and Group B were 37.4 months and 29.9 months, respectively. There was significant correlation between the initial fracture type and sequential fractures, particularly the trochanteric and subgroup of those with neck fractures. Hypertension as a co-morbidity and female sex have been identified as risk factors for SBHF. No significant findings were noted regarding BMD and risk factors in both groups.

Conclusion

The clinical presentations of SBHF noted here concur with other worldwide studies and may guide efforts to develop relevant programs to prevent SBHF.

Epidemiology and risk factors for contralateral proximal femur fracture: a single center retrospective cohort study on 1022 patients

Summary.

BACKGROUND AND AIM OF THE WORK

Given the high impact of proximal femur fractures (PFFs) on elderly patients and healthcare systems, the burden of contralateral PFFs might be overlooked. Aim of the study is to analyze the epidemiology and risk factors of contralateral proximal femur fractures. Secondary aim is to detect mortality rate differences in first and contralateral PPF.

METHODS

A population of 1022 patients admitted for proximal femur fractures in a single center was studied. Prevalence at admission as well as incidence of contralateral PFF during a 18 to 36 months follow-up was recorded. Epidemiology of contralateral PFF was studied recording number of events, time to second fracture and fracture type. Mortality at 1-year was recorded for all patients and compared between first and second PFF patients. Comorbidities, pharmacotherapy, BMI, MNA and SPMSQ were studied as possible risk factors.

RESULTS

Prevalence and incidence of contralateral PFFs were 9.4% and 6.5% respectively. Median time to second fracture was 12 months. One-year mortality of contralateral PFFs was significantly lower (20.5% vs 25.1%, p 0.003) than first PFF. Contralateral fracture patients had a significantly lower BMI and a significantly lower proportion of malnourished patients.

CONCLUSIONS

The incidence and prevalence of contralateral PFFs is relevant. Mortality of contralateral PFFs results to be lower than first PFF. Patients with higher BMI and malnourished patients have a lower risk of contralateral PFF.

Prognostic factors for discharge to home and residing at home 12 months after hip fracture: an Anoia hip study

OBJECTIVES

Hip fracture is often associated with loss of physical function and institutionalization. The aim of this study is to describe the prognostic factors for discharge to home and residing there 12 months after a hip fracture.

METHODS

A prospective study that includes patients aged ≥ 69 years that live at home before the fracture, admitted from June 1st, 2010, to May 31st, 2013. We registered the demographic data, presurgical function and cognitive assessment, surgical waiting time, type of fracture and complications during hospitalization.

RESULTS

We included 273 patients (mean age 84.8 ± 6.1 years; 80% women), 130 (47.6%) were discharged directly to their own home. The predictors of discharge to home were a lower Geriatrics Dementia Scale score (OR 1.42; 95% CI 1.17-1.71; p < 0.001), a higher Barthel Index score at discharge (OR 1.07; 95% CI 1.05-1.10; p < 0.001) and a longer hospital stay (OR 1.14; 95% CI 1.02-1.27; p = 0.019). At 12 months, 169 (63.5%) were still residing at home. Predictors of residing at home 12 months after the hip fracture were age (OR 1.07; 95% CI 1.02-1.12; p = 0.010), the discharge Barthel Index score (OR 0.96; 95% CI 0.94-0.98; p < 0.001), the Geriatrics Dementia Scale score (OR 1.27; 95% CI 1.05-1.52; p = 0.013), the surgical waiting time (OR 3.42; 95% CI 1.077-10.89; p = 0.037) and Charlson comorbidity index (OR 1.27; 95% CI 1.05-1.55; p = 0.016).

CONCLUSION

Prognostic factors for discharging to home and remaining there 12 months after a hip fracture are those that reflect a better health condition prior to the fracture and better functionality at the hospital discharge for 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.

Association between longitudinal clinical outcomes in patients with hip fracture and their pre-fracture place of residence

BACKGROUND

Clinical outcomes of patients with proximal femoral fracture within 1 year after hospitalization are presented. In particular, associations between the patients' clinical status and their pre-fracture residence were evaluated (community-dwelling vs nursing home).

METHODS

Patients aged ≥60 years with proximal femoral fractures were included in a prospective, single-centre observational study and followed for 12 months. Patients' clinical status at baseline was compared to their health status at follow-up 12 months later. Several standardized questionnaires were used to evaluate the patients' functional and cognitive capacity (e.g. Lawton Instrumental Activities of Daily Living Scale, Barthel Index, and Mini-Mental State Examination), mobility (timed up-and-go test, Tinetti Test, and Harris Hip Score), quality of life (EuroQol-5 Dimensions index and EuroQol Visual Analogue Scale), and psychological status (Geriatric Depression Scale).

RESULTS

This study included 402 patients (mean age: 81.3 ± 8.2 years, 72% women). Patients stayed in hospital for 13.7 ± 6.1 days on average. The comparison of patients' clinical status at baseline and at 12-month follow-up revealed that the Mini-Mental State Examination and Charlson Comorbidity Index remained unchanged (P = 0.527 and P = 0.705), the level of depression (Geriatric Depression Scale) significantly decreased (P < 0.001), and quality of life (EuroQol-5 Dimensions index) diminished (P < 0.001). Although patients' mobility increased after 12 months (P < 0.001 for timed up-and-go test and Harris Hip Score), their functional capacity was significantly reduced (P < 0.001 for Barthel Index and Lawton Instrumental Activities of Daily Living Scale). Nursing home residents showed a significantly higher impairment at baseline than community-dwelling individuals and less improvement in functional and cognitive tests at 12-month follow-up.

CONCLUSIONS

Clinical outcomes after hip fracture are significantly associated with patients' pre-fracture residence status. Place of residence as well as functional and cognitive status on admission may lead to differences in functional recovery and affect therapeutic and rehabilitative decision-making.

Pre-fracture medication use as a predictor of 30-day mortality in hip fracture patients: an analysis of 141,201 patients

PURPOSE

To evaluate the predictive value of pre-fracture medication usage on 30-day mortality following a hip fracture.

METHODS

Information on age, sex, fracture type, time of death and Charlson co-morbidity index (CCI) was collected from the Danish National Patient Registry on all patients above 60 years, sustaining a hip fracture during the period January 1995 to December 2013. Information on drug usage was obtained from the Danish National Prescription Database. Hazard ratios were calculated with 30-day mortality as the outcome. A univariate and 3 multivariate analyses were conducted with increasing adjustments, starting with age, sex and fracture type, adding co-morbidity and dose in the latter.

RESULTS

141,201 patients were included and a total of 12 drugs/drug groups were identified for analysis. Increased mortality was evident in all analyses for antiarrhythmics, beta blockers, proton pump inhibitors, loop diuretics, opioids, acetaminophen and for psycholeptics. For ACE-inhibitors, increased mortality was found in all analyses, except after adjustment for co-morbidity and dose. For thiazide diuretics, a significantly reduced mortality was evident in all but the univariate analyses while NSAIDs and statins were associated with a significantly reduced mortality in all analyses. For calcium channel blockers, an insignificant decrease was found after adjustment for dose. Further analysis showed a dose-response relationship for all drugs except ACE-inhibitors and calcium channel blockers.

CONCLUSION

The study shows a correlation between pre-fracture usage of certain drugs and 30 day mortality after a hip fracture.

Secondary Fracture Prevention: Consensus Clinical Recommendations from a Multistakeholder Coalition

Osteoporosis-related fractures are undertreated, due in part to misinformation about recommended approaches to patient care and discrepancies among treatment guidelines. To help bridge this gap and improve patient outcomes, the American Society for Bone and Mineral Research assembled a multistakeholder coalition to develop clinical recommendations for the optimal prevention of secondary fracture among people aged 65 years and older with a hip or vertebral fracture. The coalition developed 13 recommendations (7 primary and 6 secondary) strongly supported by the empirical literature. The coalition recommends increased communication with patients regarding fracture risk, mortality and morbidity outcomes, and fracture risk reduction. Risk assessment (including fall history) should occur at regular intervals with referral to physical and/or occupational therapy as appropriate. Oral, intravenous, and subcutaneous pharmacotherapies are efficacious and can reduce risk of future fracture. Patients need education, however, about the benefits and risks of both treatment and not receiving treatment. Oral bisphosphonates alendronate and risedronate are first-line options and are generally well tolerated; otherwise, intravenous zoledronic acid and subcutaneous denosumab can be considered. Anabolic agents are expensive but may be beneficial for selected patients at high risk. Optimal duration of pharmacotherapy is unknown but because the risk for second fractures is highest in the early post-fracture period, prompt treatment is recommended. Adequate dietary or supplemental vitamin D and calcium intake should be assured. Individuals being treated for osteoporosis should be reevaluated for fracture risk routinely, including via patient education about osteoporosis and fractures and monitoring for adverse treatment effects. Patients should be strongly encouraged to avoid tobacco, consume alcohol in moderation at most, and engage in regular exercise and fall prevention strategies. Finally, referral to endocrinologists or other osteoporosis specialists may be warranted for individuals who experience repeated fracture or bone loss and those with complicating comorbidities (eg, hyperparathyroidism, chronic kidney disease). © 2019 American Society for Bone and Mineral Research.

One-year mortality after hip fracture surgery and prognostic factors: a prospective cohort study

Older adult patients with hip fractures are 3-4 times more likely to die within one-year after surgery than general population. The study aimed to identify independent predictive factors associated with one-year mortality after hip fracture surgery. A prospective prognostic cohort study was performed. All patients aged ≥65 years, consecutively admitted in three Italian hospitals with a diagnosis of fragility hip fracture were included. Patients with periprosthetic or pathological fractures were excluded. Multivariate analysis was used to determine variables that significantly increased the risk of one-year mortality and Receiver operating characteristic (ROC) curve analysis to assess their predictive capacity on the outcome.1083 patients fulfilled the inclusion criteria and the one-year follow-up was reached in 728 patients. The 16.6% of patients died within one-year after surgery. At the multivariate analysis, advancing age (OR = 1.094, 95% CI = 1.057-1.132), higher baseline Charlson Index (OR = 1.257, 95% CI = 1.114-1.418) and Activities of Daily Living scores (OR = 1.259, 95% CI = 1.143-1.388), presence of hospital-acquired pressure ulcers (PUs) (OR = 1.579, 95% CI = 1.002-2.489) and lack recovery of ambulation (OR = 1.736, 95% CI = 1.115-2.703), were found to be independent predictive factors of one-year mortality after surgery. The area under the ROC curve of the model was 0.780 (CI95% 0.737-0.824) for one-year mortality in elderly hip fractures patients. Early ambulation and careful long-term follow-up, with attention to frailty in elderly people, should be promoted.

Predictors of poor functional outcomes and mortality in patients with hip fracture: a systematic review

Background

Hip fracture is an important and prevalent medical condition associated with adverse outcomes. The aim of this article is to systematically review and summarise the predictors of poor functional outcomes and mortality for patients with hip fractures.

Methods

We conducted a systemic literature search using PubMed, EMBASE and Cochrane Library. We included English peer-reviewed cohort studies that examined predictors of poor functional outcomes (such as independence in Activities of Daily Living) and mortality for patients with hip fracture published in the past 15 years (from 1 Jan 2004 up to 30 May 2019). Two independent researchers evaluated the articles for eligibility. Consensus on the eligibility was sought and a third researcher was involved if there was disagreement. A standardised form was used to extract relevant data. The Newcastle-Ottawa Scale (NOS) was used to assess the quality of the included studies.

Results

We retrieved 4339 and included 81 articles. We identified two emerging predictors of poor functional outcomes and mortality for patients with hip fractures: low hand grip strength and frailty in line with an emerging concept of “physical performance”. The predictors identified in this systematic review can be grouped into 1) medical factors, such as presence of co-morbidities, high American Society of Anesthesiologists (ASA) grade, sarcopenia, 2) surgical factors including delay in operation (e.g. > 48 h), type of fracture s, 3) socio-economic factors which include age, gender, ethnicity, and 4) system factors including lower case-volume centers.

Conclusions

This systematic review identified multiple significant predictors of poor functional outcomes and mortality, with the hand grip strength and frailty being important emerging predictors in the most recent literature. These predictors would further inform healthcare providers of their patients’ health status and allow for early intervention for modifiable predictors.

Functional Trajectories Before and After Major Surgery in Older Adults

OBJECTIVES

We hypothesized that distinct sets of functional trajectories can be identified in the year before and after major surgery, with unique transition probabilities from pre to postsurgical functional trajectories, and that outcomes would be better among participants undergoing elective versus nonelective surgery.

BACKGROUND

Major surgery is common and can be highly morbid in older persons. The relationship between the course of disability (ie, functional trajectory) before and after surgery in older adults has not been well-studied for most operations.

METHODS

Prospective cohort study of 754 community-living persons 70 years or older. The analytic sample included 250 participants who underwent their first major surgery during the study period.

RESULTS

Before surgery, 4 functional trajectories were identified: no disability (n = 60, 24.0%), and mild (n = 84, 33.6%), moderate (n = 73, 29.2%), and severe (n = 33, 13.2%) disability. After surgery, 4 functional trajectories were identified: rapid (n = 39, 15.6%), gradual (n = 76, 30.4%), partial (n = 70, 28.0%), and little (n = 57, 22.8%) improvement. Rapid improvement was seen for n = 31 (51.7%) participants with no disability before surgery, but was uncommon among those with mild disability (n = 8, 9.5%) and was not observed in the moderate and severe trajectory groups. For participants with mild to moderate disability before surgery, gradual improvement (n = 46, 54.8%) and partial improvement (n = 36, 49.3%) were most common. Most participants with severe disability (n = 27, 81.8%) before surgery exhibited little improvement. Outcomes were better for participants undergoing elective versus nonelective surgery.

CONCLUSIONS

Functional prognosis in the year after major surgery is highly dependent on premorbid function.

Pronostic factors of good functionality at 12 months of a hip fracture. Maluc Anoia study

BACKGROUND

Hip fracture usually occurs in frail elderly patients and is associated with an important morbi-mortality in the first year. The objective of the study is to describe the prognostic factors that would allow maintaining functionality at 12 months.

METHOD

From June 1, 2010 to May 31, 2013, all patients older than 69 years with hip fracture due to bone fragility admitted to the Geriatric Acute Unit of our hospital were included. We define as functional maintenance those patients who have lost between 0-15 points in the Barthel Index with respect to the previous to the fracture. Prospective study of bivariate data analysis for related and multivariate prognostic factors for predictive predictors.

RESULTS

271 patients were included, of them, 146 (54.8%), maintained functionality at 12 months and 122 (45.2%) no. Patients who maintain functional status are younger: average age 83.4 vs 85.80 years (P=.002); with better scores in the indexes of: Lawton prior to fracture 4.42 vs 2.40 (P<.001) and Barthel at discharge 34.2 vs. 27.1 (P=.002). There are also differences in the score of the "Geriatric Dementia Scale" 2.59 vs. 3.13 (P=.009), in the score of the "American Society Anesthesiologist"<II 62.2% vs 37.8% (P=0.006) and have presented less delirium during hospitalization 4.7% vs 35.3% (P=.002). In the multivariate analysis they maintained statistical significance, age OR: 1.044 (95% CI: 1.002-1.088) (P=.04) and the Lawton Index OR: 0.869 (95% CI: 0.804-0.940) (P <.001).

CONCLUSIONS

Prognostic factors of functional maintenance at 12 months are age and the ability to perform instrumental activities of daily life.

Pre- and Perioperative Risk Factors of Post Hip Fracture Surgery Walking Failure in the Elderly

Introduction:

Osteoporotic hip fractures are a major problem. They increase mortality, morbidity, and functional decline. Recovery of ambulatory status is an essential prerequisite for older adults living in a normal environment. The main objective of this study was to investigate walking failure at 3 to 6 months after hip fracture surgery with the aim of identifying pre- and perioperative risk factors associated with it.

Methods:

A total of 120 participants (>65 years) were recruited following hip fracture surgery at a teaching hospital. Walking status was assessed on average 4.4 ± 1.3 months after hip fracture surgery and compared with prefracture walking status. The participants were divided into 2 groups according to walking status (group 1: ambulatory; group 2: nonambulatory) and risk factors associated with a failure to walk were determined using binominal logistic regression analysis.

Results:

The rate of recovery to prefracture ambulatory status was about 18.3% and 25% of participants could not walk at all. Risk factors for not being able to walk at all included poor prefracture ambulatory status and living at a long care facility as nonmodifiable factors, whereas a shorter length of stay before surgery and having a longer total hospitalization periods were modifiable factors.

Conclusion:

Walking recovery after hip fracture surgery was very poor at 3 to 6 months after hip fracture surgery. Based on our findings, older adults living in a long care facility should be provided their medical and functional needs through professional health-care providers and systematic health delivery systems. The therapeutic management for underlying diseases affecting surgery should precede unconditional early surgery. Older adults hospitalized during longer periods should be focused on their functional care.

Prenatal influences on bone health in children

INTRODUCTION

Optimising bone health might reduce the burden of both fractures in childhood and fragility fractures in later life. A number of maternal dietary and non-dietary factors have been identified that might influence offspring bone health and represent targets for intervention.

AREAS COVERED

This article will outline the accrual of bone mineral throughout the life course and how observational and intervention studies have shown that maternal diet, in particular maternal calcium and 25-hydroxyvitamin D [25(OH)D] status, and lifestyle are associated with offspring bone mineralization. Studies examining the effects of maternal micronutrient supplementation on offspring bone mineral density (BMD) will also be discussed.

EXPERT COMMENTARY

There is a wealth of observational evidence relating maternal diet to offspring BMD. However, high quality randomized controlled trials, such as the ongoing MAVIDOS study, are needed before these findings can be definitively translated into public health advice.

Influence of mobilization and weight bearing on in-hospital outcome in geriatric patients with hip fractures

INTRODUCTION

Early recovery of mobilization after a fracture of the hip is associated with improved long-term ability to walk, lower complication rates, and mortality. In this context, early mobilization and full weight bearing are favorable. The aim of this study was (1) to analyze the influence of time between operation and first mobilization on in-hospital outcome and (2) the influence of early mobilization, full weight bearing, and ASA on pain, mobility of the hip, and ability to walk during the in-hospital phase of recovery.

METHODS

This is a retrospective in-hospital study of 219 patients aged 70 years or older who were treated with surgery after a hip fracture. Data were collected by a review of medical records. The outcomes were mortality, complications, length of stay, and the Merle d'Aubigné score which evaluates pain, mobility of the hip, and ability to walk. Factors were sought in bivariate and multivariate analyses.

RESULTS

A shorter time between operation and first mobilization was significantly associated with lower in-hospital mortality and complications. Early mobilization (within 24 h after the operation) and full weight bearing had no influence on pain, mobility of the hip, and ability to walk as well as length of stay in our cohort. Fracture type and treatment influenced mobility of the hip, while age as well as physical health status affected the ability to walk.

DISCUSSION

Patients with femoral neck fractures, respectively after total hip arthroplasty, had less pain and showed better mobility of the hip and ability to walk during hospitalization than patients with trochanteric fractures; these results were irrespective of early vs. late mobilization and full vs. partial weight bearing. Foremost, a shorter time between operation and first mobilization is associated with lower complication and mortality rates.