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Feng C, Wu H, Qi Z, Wei Y, Yang B, Yin H, Yan S, Wang L, Yu Y, Xie J, Xing X, Tu S, Zhang H. Association of preoperative frailty with the risk of postoperative delirium in older patients undergoing hip fracture surgery: a prospective cohort study. Aging Clin Exp Res 2024; 36:16. [PMID: 38294584 PMCID: PMC10830592 DOI: 10.1007/s40520-023-02692-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 12/31/2023] [Indexed: 02/01/2024]
Abstract
OBJECTIVE This study aimed to explore the correlation between preoperative frailty and the risk of postoperative delirium (POD) in older patients undergoing hip fracture surgery. METHODS In total, 148 patients with hip fractures who were admitted to Tsinghua Changgung Hospital (Beijing, China) between January 2022 and January 2023 were involved in this study. Preoperative frailty scales were assessed, of which the CAM scale was postoperatively administered every morning and evening on days 1, 2, 3, 5, and 7. Binary logistic regression analysis was conducted to determine the correlation between preoperative frailty and the risk of POD. RESULTS Among 148 older patients with hip fractures, 71 (48.0%) were identified as preoperative frail and 77 (52.0%) as non-frail. The overall incidence of POD on day 7 was 24.3% (36/148), and preoperative frailty was associated with a significantly higher risk of POD compared with non-frailty (42.3% vs. 7.8%, P < 0.001). The binary logistic regression analysis revealed that preoperative frailty was noted as an independent risk factor for the risk of POD in older patients undergoing hip fracture surgery (P = 0.002). CONCLUSION Preoperative frailty increased the risk of POD in older patients undergoing hip fracture surgery. DISCUSSION Preoperative assessment of frailty in geriatric hip surgery can timely identify potential risks and provide interventions targeting frailty factors to reduce the incidence of POD in older patients undergoing hip fracture surgery. The findings suggested that preoperative frailty could increase the risk of POD in older patients undergoing hip fracture surgery. Further research is necessary to determine whether perioperative interventions aimed at enhancing frailty can mitigate the risk of POD and improve prognosis in older patients undergoing hip fracture surgery.
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Affiliation(s)
- Chunyu Feng
- School of Clinical Medicine, Tsinghua University, Beijing, China
- Department of Anesthesiology, Beijing Tsinghua Changgung Hospital, No.168 Litang Road, Changping District, Beijing, 102218, China
| | - Haotian Wu
- School of Clinical Medicine, Tsinghua University, Beijing, China
- Department of Anesthesiology, Beijing Tsinghua Changgung Hospital, No.168 Litang Road, Changping District, Beijing, 102218, China
| | - Ziheng Qi
- School of Clinical Medicine, Tsinghua University, Beijing, China
- Department of Anesthesiology, Beijing Tsinghua Changgung Hospital, No.168 Litang Road, Changping District, Beijing, 102218, China
| | - Yuzhi Wei
- School of Clinical Medicine, Tsinghua University, Beijing, China
- Department of Anesthesiology, Beijing Tsinghua Changgung Hospital, No.168 Litang Road, Changping District, Beijing, 102218, China
| | - Bo Yang
- School of Clinical Medicine, Tsinghua University, Beijing, China
- Department of Anesthesiology, Beijing Tsinghua Changgung Hospital, No.168 Litang Road, Changping District, Beijing, 102218, China
| | - Haolin Yin
- School of Clinical Medicine, Tsinghua University, Beijing, China
- Department of Anesthesiology, Beijing Tsinghua Changgung Hospital, No.168 Litang Road, Changping District, Beijing, 102218, China
| | - Siyi Yan
- School of Clinical Medicine, Tsinghua University, Beijing, China
- Department of Anesthesiology, Beijing Tsinghua Changgung Hospital, No.168 Litang Road, Changping District, Beijing, 102218, China
| | - Lu Wang
- School of Clinical Medicine, Tsinghua University, Beijing, China
- Department of Plastic Surgery, Beijing Tsinghua Changgung Hospital, No.168 Litang Road, Changping District, Beijing, 102218, China
| | - Yangyang Yu
- Department of Orthopedic, Beijing Tsinghua Changgung Hospital, No.168 Litang Road, Changping District, Beijing, 102218, China
| | - Juanjuan Xie
- Department of Orthopedic, Beijing Tsinghua Changgung Hospital, No.168 Litang Road, Changping District, Beijing, 102218, China
| | - Xueyan Xing
- Department of Anesthesiology, Beijing Tsinghua Changgung Hospital, No.168 Litang Road, Changping District, Beijing, 102218, China
| | - Shumin Tu
- Department of Anesthesiology, Beijing Tsinghua Changgung Hospital, No.168 Litang Road, Changping District, Beijing, 102218, China
| | - Huan Zhang
- School of Clinical Medicine, Tsinghua University, Beijing, China.
- Department of Anesthesiology, Beijing Tsinghua Changgung Hospital, No.168 Litang Road, Changping District, Beijing, 102218, China.
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Nadaph MI, Meng C, Wu X. Clinical applications of skin traction technique with adjustable tension in treatment of large area skin defects. BMC Musculoskelet Disord 2023; 24:556. [PMID: 37415122 DOI: 10.1186/s12891-023-06628-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 06/12/2023] [Indexed: 07/08/2023] Open
Abstract
OBJECTIVE To explore the clinical applications of the adjustable skin traction technique in the treatment of large area skin defects. RESEARCH DESIGN A prospective study. BACKGROUND The skin is the largest organ of the human body and skin tissue exposed to external environment which makes it vulnerable to damage. There are many reasons for skin defects such as trauma, infection, burns, scars, tumors resection, inflammation, pigmented nevus, etc. Skin traction is the application of pulling force to the trunk or extremities for immobilization, fracture reduction and deformity correction. This technique accurately controls skin expansion which is safe, convenient and accelerates wound healing. METHODS A prospective study was conducted on 80 patients suffered from large area skin defects in the department of orthopedics, the first affiliated hospital of Zhengzhou University from September 2019 to January 2023. There were 40 patients in the experimental group who underwent skin traction. In contrast, 40 people in the control group underwent skin flaps or skin grafts without skin traction. The inclusion criteria include large area skin defects, normal peripheral skin & blood supply, normal vital organs, no severe coagulation dysfunction etc. Male & female with and without skin traction are 22 & 18 and 25 & 15 respectively. The skin traction device used was a hook and single rod type. The skin defect area was approximately 15 cm × 9-43 cm × 10 cm. RESULTS Postoperatively, the experimental group with traction showed 2 cases of skin infection, 1 case of skin necrosis and 3 cases of inflammation recurrence. In contrast, the control group without traction showed 8 cases of skin infection, 6 cases of skin necrosis and 10 cases of inflammation recurrence. Skin infection (P = 0.04), skin necrosis (P = 0.02) and inflammatory response (P = 0.03) represented significant differences between two groups. There was also a significant difference in hospitalization costs (P = 0.001). CONCLUSION Skin traction has huge clinical applications including a shorter hospital stay, faster wound healing, lower hospitalization cost, high satisfaction rate, and a fair skin appearance after surgery. It is an effective method of treating skin and musculoskeletal defects.
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Affiliation(s)
- Md Israil Nadaph
- Department of Orthopedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Chong Meng
- Department of Orthopedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xuejian Wu
- Department of Orthopedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
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Kheiri S, Akbari Aghdam H, Motififard M, Gharib Gashteh Shahi N, Saleki Mehrjardi M, Rezaei T. The effect of skin traction on pain relief in patients with isolated intertrochanteric fractures, a randomized clinical trial. BMC Musculoskelet Disord 2023; 24:25. [PMID: 36631801 PMCID: PMC9834036 DOI: 10.1186/s12891-023-06135-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 01/05/2023] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Hip fractures are common in elderly patients. The surgery is usually delayed due to underlying conditions, and pain control is crucial while the patient is cleared for surgery. In this randomized controlled trial (RCT) study, we hypothesized that the application of skin traction in patients with intertrochanteric fracture does not significantly change the Visual Analogue Score (VAS) of pain. METHODS This is a prospective, single institution, parallel randomized controlled trial. Two hundred and twenty-nine patients with isolated intertrochanteric fractures were enrolled in the study. Patients with neurologic issues, drug addiction, scars or swelling, or vascular issues at the site of skin traction application were excluded from the study. Patients were divided into two groups: group A included 97 patients, and group B included 95 patients. Skin traction was applied for group A, while only a soft pillow was put beneath the patients' knees in the other group. The VAS score was measured after the diagnosis, two hours before the operation, and 24 h after the surgery. The morphine dosage administered per day was documented for both groups. RESULTS After excluding patients with postoperative delirium, 154 patients (55 males and 99 females) with isolated intertrochanteric fractures (69 right-sided and 85 left-sided), and a mean age of 70 ± 10 remained in the study. There were no significant differences between the two groups regarding age, gender, and mean time from injury to admission (P > .05). The mean VAS score measures and morphine dosage administered per day were not significantly different between the two groups (P > .05). Both groups experienced significant pain relief 24 h postoperatively (P < .001). CONCLUSION Pre-operative skin traction application affected neither the patients' VAS scores nor the mean morphine dosage per day in patients with isolated intertrochanteric fractures. Our data does not support the routine application of pre-operative skin traction in patients with intertrochanteric fractures. TRIAL REGISTRATION The project was registered in the Iranian Registry of Clinical Trials (registration reference: IRCT20180729040636N3, registration date: 01/07/2020). LEVEL OF EVIDENCE: 1
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Affiliation(s)
- Sara Kheiri
- Isfahan University of Medical Sciences, Isfahan, Iran.
| | | | | | | | | | - Tayebe Rezaei
- Isfahan University of Medical Sciences, Isfahan, Iran
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Kobayashi T, Akiyama T, Mawatari M. Predictors of preoperative deep vein thrombosis in hip fractures: A systematic review and meta-analysis. J Orthop Sci 2023; 28:222-232. [PMID: 34593286 DOI: 10.1016/j.jos.2021.08.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 08/25/2021] [Accepted: 08/27/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND The predictors of preoperative deep vein thrombosis (DVT) in patients with hip fractures remain unclear. Therefore, this study describes the results of a systematic review and meta-analysis of relevant peer-reviewed literature on this topic. METHODS We searched PubMed, Google Scholar, Cochrane Library, Web of Science, and MEDLINE for articles published in English on the predictors of preoperative DVT in hip fractures. We calculated pooled odds ratios (OR) or mean differences (MD) for the DVT groups as compared with the non-DVT groups for each variable, including gender, age, body mass index, injury side, current smoking status, time from injury to admission, time from injury to surgery, fracture type, hypertension, arrhythmia, coronary artery disease, diabetes, stroke, kidney disease, liver disease, lung disease, malignancy, rheumatoid arthritis, D-dimer, fibrinogen, activated partial thromboplastin time, prothrombin time, thrombin time, hemoglobin, albumin, total cholesterol, and triglycerides. RESULTS We included 9 studies involving 3,123 Asian patients with hip fractures (DVT, n = 570; non-DVT, n = 2,553). Being female (OR = 1.27; 95% confidence interval [CI] 1.04-1.56; p = 0.02), being of advanced age (MD = 1.63; 95% CI 0.80-2.47; p = 0.0001), having a longer time from injury to admission (MD = 0.80; 95% CI 0.48-1.12; p < 0.00001), having a longer time from injury to surgery (MD = 2.20; 95% CI 1.53-2.88; p < 0.00001), and the presence of kidney disease (OR = 1.76; 95% CI 1.04-2.96; p = 0.03) were correlated with a high risk of DVT. However, we found no significant differences between the two groups in the other predictors. CONCLUSIONS Evidence indicates that being female, being of advanced age, having a longer time from injury to admission, having a longer time from injury to surgery, and having kidney disease are significantly correlated with a high risk of preoperative DVT in Asian patients with hip fracture. Further investigations with patients of other ethnicities are required.
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Affiliation(s)
- Takaomi Kobayashi
- Department of Orthopaedic Surgery, Imari-Arita Kyoritsu Hospital, 860 Ninosekou Arita-Town Nishimatsuura-Gun, Saga 849-4141, Japan; Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga 849-8501, Japan.
| | - Takayuki Akiyama
- Department of Orthopaedic Surgery, Imari-Arita Kyoritsu Hospital, 860 Ninosekou Arita-Town Nishimatsuura-Gun, Saga 849-4141, Japan; Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga 849-8501, Japan
| | - Masaaki Mawatari
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga 849-8501, Japan
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Kobayashi T, Ureshino H, Morimoto T, Sonohata M, Mawatari M. Pain relief differentiated according to the length of time that preoperative skin traction was carried out for hip fractures: A systematic review and meta-analysis. Int J Orthop Trauma Nurs 2021; 43:100886. [PMID: 34416406 DOI: 10.1016/j.ijotn.2021.100886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 08/04/2021] [Accepted: 08/08/2021] [Indexed: 10/20/2022]
Abstract
AIM Conduct a systematic review and meta-analysis pertaining to pain relief differentiated by time within 24 h of preoperative skin traction for hip fracture. METHOD PubMed, Google Scholar, Cochrane Library, Web of Science, and MEDLINE were searched for relevant articles published in the English language on comparison of pain relief between preoperative skin traction and no traction for hip fracture. RESULTS Five studies involving 413 patients with hip fractures (skin traction, n = 207; no traction, n = 206) were included. The visual analog scale (VAS) score within 1 h postadmission in the skin traction group was significantly smaller than that in the no traction group. In contrast, there was no significant difference in the VAS scores of the two groups at 4-6 h postadmission. CONCLUSIONS Evidence indicates that preoperative skin traction for hip fracture can provide pain relief within 1 h postadmission, but not at 4-6, 12, and 24 h postadmission. Accordingly, alternative preoperative pain relief methods for hip fractures should be carefully considered.
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Affiliation(s)
- Takaomi Kobayashi
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan.
| | - Hiroshi Ureshino
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Tadatsugu Morimoto
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Motoki Sonohata
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Masaaki Mawatari
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
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Sammut R, Attard M, Mangion D, Trapani J. The effectiveness of skin traction in reducing pain in adults with a hip fracture: A systematic review. Int J Orthop Trauma Nurs 2021; 43:100880. [PMID: 34481147 DOI: 10.1016/j.ijotn.2021.100880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 04/22/2021] [Accepted: 05/15/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Femoral fractures are associated with high mortality and morbidity, including pain. Skin traction may be used pre-operatively as an adjunct to analgesia to decrease pain. OBJECTIVE To evaluate the effects on pain of the use of pre-operative skin traction in adults with a fracture of the proximal femur. RESEARCH QUESTION Is the use of pre-operative skin traction effective in reducing pain in adults with proximal femoral fractures? METHOD A systematic review was conducted based on a search of PubMed, CINAHL Complete, MEDLINE Complete, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews. The keywords 'preoperative', 'skin traction', 'hip fractures' and 'pain' were used. Randomised controlled trials published in English between April 2011 and November 2020 were included and appraised using the Cochrane Risk of Bias tool. RESULTS Five articles met the inclusion criteria; all were randomised controlled trials. The results confirm those of earlier reviews: skin traction does not significantly decrease pain and analgesia use. The quality of the evidence available is weak. CONCLUSION There is no strong evidence for the routine pre-operative use of skin traction in adults with a hip fracture. As the quality of the evidence is weak, further high-quality research on this topic is warranted.
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Affiliation(s)
- Roberta Sammut
- Faculty of Health Sciences, University of Malta, Msida, MSD 2080, Malta.
| | | | | | - Josef Trapani
- Department of Nursing, Faculty of Health Sciences, University of Malta, Malta
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