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Morris H, Cameron C, Vanderboor C, Nguyen A, Londahl M, Harng Chong Y, Navarre P. Hip fractures in the older adult: orthopaedic and geriatric shared care model in Southland, New Zealand-a 5-year follow-up study. BMJ Open Qual 2023; 12:e002242. [PMID: 37783522 PMCID: PMC10565250 DOI: 10.1136/bmjoq-2022-002242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 09/11/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND Neck of femur fractures are common with associated high morbidity and mortality rates. National standards include provision of orthogeriatric care to any patient with a hip fracture. This study assessed the outcomes at 5 years following implementation of a collaborative orthogeriatric service at Southland Hospital in 2012. METHODS Retrospective data were collected for patients aged 65 years and older admitted with a fragility hip fracture. Data were collated for 2011 (preimplementation) and 2017 (postimplementation). Demographic data and American Society of Anesthesiologists (ASA) scores were recorded to ensure comparability of the patient groups. Length of stay, postoperative complications and 30-day and 1-year mortality were assessed. RESULTS 74 admissions with mean age at surgery of 84.2 years in 2011 and 107 admissions with mean age of 82.6 years in 2017. There was a higher proportion of ASA 2 and ASA 3 patients in 2017 compared with 2011 (p=0.036). The median length of stay in the orthopaedic ward was unchanged in the two cohorts but there was a shorter median length of stay by 6.5 days and mean length of stay by 11 days in 2017 in the rehabilitation ward (p<0.001 for both median and mean). Through logistic regression controlling for age, sex and ASA score, there was a reduction in the odds of having a complication by 12% (p<0.001). The study was too small to undertake statistical testing to calculate significant difference in overall 30-day and 1-year mortality between the groups. CONCLUSION The orthogeriatric service has reduced the frequency of complications and length of stay on the rehabilitation ward 5 years following implementation.
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Affiliation(s)
- Holly Morris
- Department of Trauma and Orthopaedics, Royal Derby Hospital, Derby, UK
| | - Claire Cameron
- Division of Health Sciences, University of Otago, Dunedin, New Zealand
| | - Christina Vanderboor
- Department of Trauma and Orthopaedics, Southland Hospital, Invercargill, Southland, New Zealand
| | - Anh Nguyen
- Department of Trauma and Orthopaedics, Royal National Orthopaedic Hospital London, London, UK
| | - Monica Londahl
- Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Yih Harng Chong
- Department of Older Person Health, Waitemata District Health Board, Takapuna, New Zealand
- Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Pierre Navarre
- Department of Trauma and Orthopaedics, Southland Hospital, Invercargill, Southland, New Zealand
- Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
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Raj S, Grover S, Bola H, Pradhan A, Fazal MA, Patel A. Dynamic hip screws versus cephalocondylic intramedullary nails for unstable extracapsular hip fractures in 2021: A systematic review and meta-analysis of randomised trials. J Orthop 2023; 36:88-98. [PMID: 36654796 PMCID: PMC9841034 DOI: 10.1016/j.jor.2022.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 12/15/2022] [Accepted: 12/29/2022] [Indexed: 01/09/2023] Open
Abstract
Background Extracapsular hip fractures comprise approximately half of all hip fractures and the incidence of hip fractures is exponentially increasing. Extramedullary fixation using a dynamic hip screw (DHS) has been the gold standard method of operative treatment for unstable extracapsular fractures, however, in recent years, intramedullary nails (IMN) have become a popular alternative. IMN versus DHS is continuously discussed and debated in literature. Therefore, the purpose of this systematic review and meta-analysis is to directly compare the peri- and post-operative outcomes of these two techniques to provide an up-to-date analysis of which method of fixation is superior. Methods The MEDLINE/PubMed, Embase and Web of Science Database were searched for eligible studies from 2008 to April 2022 that compared peri- and post-operational outcomes for patients undergoing IMN or DHS operations for fixation of unstable extracapsular hip fractures (PROSPERO registration ID:CRD42021228335). Primary outcomes included mortality rate and re-operation rate. Secondary outcomes included operation time, blood loss, transfusion requirement, complication, and failure of fixation rate. The risk of bias and quality of evidence were assessed using the Cochrane RoB 2.0 tool and GRADE analysis tool, respectively. Results Of the 6776 records identified, 22 studies involving 3151 patients were included in the final review. Our meta-analysis showed no significant differences between mortality rates (10 studies, OR 0.98; 95% CI 0.80 to 1.22, p = 0.88) or re-operation rates (10 studies, OR 1.03; 95% CI 0.64 to 1.64, p = 0.91) between the two procedures. There were also no significant differences found between complication rates (17 studies, OR 1.29; 95% CI 0.79 to 2.12, p = 0.31) and failure of fixation rates (14 studies, OR 1.32; 95% CI 0.74 to 2.38, p = 0.35). However, DHS operations had a significantly longer operation time (p < 0.0001) and blood loss (p < 0.00001) than IMN operations. Conclusion Overall, based on the outcomes assessed, this review has demonstrated that there is no significant difference in the post-operative outcomes for DHS vs IMN, however a significant difference exists in two of the intraoperative outcomes assessed in this review.
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Affiliation(s)
- Siddarth Raj
- GKT School of Medical Education, King's College London, London, UK
- University Hospital Coventry and Warwickshire, NHS Trust, Coventry, UK
| | - Sarika Grover
- GKT School of Medical Education, King's College London, London, UK
- University Hospital Coventry and Warwickshire, NHS Trust, Coventry, UK
| | - Harroop Bola
- Imperial College School of Medicine, Imperial College London, London, UK
| | | | - Muhammad Ali Fazal
- Department of Trauma and Orthopaedics, Royal Free London NHS Foundation Trust, London, UK
| | - Akash Patel
- Department of Trauma and Orthopaedics, Royal Free London NHS Foundation Trust, London, UK
- School of Medicine, University College London (UCL), London, UK
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Hernández-Pascual C, Santos-Sánchez JÁ, Hernández-Rodríguez J, Silva-Viamonte CF, Pablos-Hernández C, Villanueva-Martínez M, Mirón-Canelo JA. New Prognostic Factors in Operated Extracapsular Hip Fractures: Infection and GammaTScore. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11680. [PMID: 36141949 PMCID: PMC9517159 DOI: 10.3390/ijerph191811680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 09/12/2022] [Accepted: 09/14/2022] [Indexed: 06/16/2023]
Abstract
There is no universal postoperative classification of extracapsular hip fractures (ECFs). We wondered if infection (according to infection after fracture fixation criteria (IAFF)), immediate partial weight bearing (PWB) and/or the new GammaTScore tool could predict early cut-out. We also examined the correlation between GammaTScore and time to consolidation and studied long-term survival. This was a retrospective cohort study of low-energy complete ECFs operated with Gamma3T nailing in 2014 and fully monitoring, in patients aged over 65. Ten not distally locked cases, one late cut-out, one cut-through, one osteonecrosis and one pseudarthrosis were discarded. Patients were classified into early cut-out (7/204; 3.55%) and no early cut-out (197/204; 96.45%). There was a lower percentage of A2 fractures according to the AO Foundation/Orthopaedic Trauma Association classification (AO/OTA, 1997) in early cut-out. IAFF and only the GammaTScore reduction parameter were different for early cut-out, in opposition to immediate PWB, tip-to-apex distance (TAD) or the Baumgaertner-Fogagnolo classification. GammaTScore inversely correlated with consolidation (p < 0.01). Long-term survival time was not statistically significantly lower in the early cut-out group. Small sample of cases may limit our results. Apart from an important role of IAFF, GammaTScore would be useful for predicting consolidation, avoiding complications and reducing costs. Further studies are needed for reliability.
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Affiliation(s)
- Carlos Hernández-Pascual
- Department of Human Anatomy and Histology, Faculty of Medicine, Campus Miguel de Unamuno, Universidad de Salamanca, Avda, Alfonso X el Sabio s/n, 37007 Salamanca, Spain
- Department of Traumatology and Orthopaedic Surgery, Hospital Universitario de Salamanca, Pso. San Vicente 58-182, 37004 Salamanca, Spain
| | - José Ángel Santos-Sánchez
- Department of Biomedical and Diagnostic Sciences (Area of Radiology and Physical Medicine), Faculty of Medicine, Campus Miguel de Unamuno, Universidad de Salamanca, Avda, Alfonso X el Sabio s/n, 37007 Salamanca, Spain
| | - Jorge Hernández-Rodríguez
- Department of Biomedical and Diagnostic Sciences (Area of Radiology and Physical Medicine), Faculty of Medicine, Campus Miguel de Unamuno, Universidad de Salamanca, Avda, Alfonso X el Sabio s/n, 37007 Salamanca, Spain
| | - Carlos Fernando Silva-Viamonte
- Department of Statistics, Faculty of Medicine, Campus Miguel de Unamuno, Universidad de Salamanca, Avda, Alfonso X el Sabio s/n, 37007 Salamanca, Spain
| | - Carmen Pablos-Hernández
- Department of Geriatrics, Hospital Universitario de Salamanca, Pso. San Vicente 58-182, 37004 Salamanca, Spain
| | | | - José Antonio Mirón-Canelo
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Campus Miguel de Unamuno, Universidad de Salamanca, Avda, Alfonso X el Sabio s/n, 37007 Salamanca, Spain
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Dynamic hip screw with stabilization plate in unstable intertrochanteric fractures: a case series. CURRENT ORTHOPAEDIC PRACTICE 2022. [DOI: 10.1097/bco.0000000000001168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Wessels JO, Bjarnesen MP, Erichsen JL, Palm H, Gundtoft PH, Viberg B. Sliding hip screw vs intramedullary nail for AO/OTA31A1-A3: a systematic review and meta-analysis. Injury 2022; 53:1149-1159. [PMID: 35027220 DOI: 10.1016/j.injury.2021.12.034] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 12/17/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE to conduct a systematic review with consequent meta-analysis evaluating the best treatment for Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA) 31A1-A3 trochanteric fractures when comparing the sliding hip screw (SHS) to the intramedullary nail (IMN). The outcomes used for comparison are major complications (in total, as well as nonunion and infection specifically), mortality rates, functional outcomes and patient-reported outcome measures (PROM). MATERIALS AND METHODS Search strings for the Cochrane Library, CINAHL, Medline and Embase databases were developed with the help of a scientific librarian. Two authors screened the studies from the search string independently using Covidence.org and data extraction was performed similarly. Quality assessment was performed using the Cochrane Risk of Bias tool for randomised trials (ROB2) for RCT studies, and Cochrane Risk of Bias in Non-Randomised Studies - of Interventions (ROBINS-I) for non-RCT studies. Meta-analyses were performed using Log Risk Ratio as the primary effect estimate. RESULTS Of the 2,051 studies screened by the two authors, six RCTs and six non-RCTs were included in this meta-analysis, with a total of 10,402 patients. The results indicated no significant differences in total major complications, nonunion, infection or mortality between SHS and IMN treatments for AO/OTA 31A1, 31A2 and 31A3 trochanteric fractures. Due to a lack of compatible data, we were unable to perform a meta-analysis on function scores and PROM. However, there are trends that favour IMN for 31A1 and 31A2 fractures. CONCLUSION No significant difference between SHS and IMN was found in the meta-analysis in any of the examined AO/OTA fracture subtypes in terms of primary and secondary outcomes. When assessing function scores and PROM, we found trends favouring IMN for 31A1 and 31A2 fractures that should be explored further.
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Affiliation(s)
- Johanne Overgaard Wessels
- Department of Orthopaedic Surgery and Traumatology, Lillebaelt Hospital, University Hospital of Southern Denmark, Sygehusvej 24, 6000 Kolding, DK
| | - Mie Pilegaard Bjarnesen
- Department of Orthopaedic Surgery and Traumatology, Lillebaelt Hospital, University Hospital of Southern Denmark, Sygehusvej 24, 6000 Kolding, DK
| | - Julie Ladeby Erichsen
- Department of Orthopaedic Surgery and Traumatology, Lillebaelt Hospital, University Hospital of Southern Denmark, Sygehusvej 24, 6000 Kolding, DK
| | - Henrik Palm
- Department of Orthopaedic Surgery and Traumatology, Bispebjerg Hospital, DK
| | - Per Hviid Gundtoft
- Department of Orthopaedic Surgery and Traumatology, Lillebaelt Hospital, University Hospital of Southern Denmark, Sygehusvej 24, 6000 Kolding, DK
| | - Bjarke Viberg
- Department of Orthopaedic Surgery and Traumatology, Lillebaelt Hospital, University Hospital of Southern Denmark, Sygehusvej 24, 6000 Kolding, DK.
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Alm CE, Gjertsen JE, Basso T, Matre K, Rörhl S, Madsen JE, Frihagen F. Trochanteric stabilizing plate in the treatment of trochanteric fractures: a scoping review. Acta Orthop 2021; 92:733-738. [PMID: 34296661 PMCID: PMC8641671 DOI: 10.1080/17453674.2021.1954305] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - The trochanteric stabilizing plate (TSP) may be used as an adjunct to a sliding hip screw (SHS) in the treatment of trochanteric fractures to increase construct stability. We performed a scoping review of the literature to clarify when and how the TSP may be useful.Methods - A systematic search was performed in 5 databases and followed by a backwards-and-forwards citation search of the identified papers. 24 studies were included.Results - 6 biomechanical studies and 18 clinical studies were included in the review. The studies presented mainly low-level evidence. All studies were on unstable trochanteric fractures or fracture models. Due to the heterogeneity of methods and reporting, we were not able to perform a meta-analysis. In the biomechanical trials, the TSP appeared to increase stability compared with SHS alone, up to a level comparable with intramedullary nails (IMNs). We identified 1,091 clinical cases in the literature where a TSP had been used. There were 82 (8%) reoperations. The rate of complications and reoperations for SHS plus TSP was similar to previous reports on SHS alone and IMN. It was not possible to conclude whether the TSP gave better clinical results, when compared with either SHS alone or with IMN.Interpretation - The heterogeneity of methods and reporting precluded any clear recommendations on when to use the TSP, or if it should be used at all.
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Affiliation(s)
- Carl Erik Alm
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo;,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo;,Correspondence:
| | | | - Trude Basso
- Department of Orthopaedic Surgery, St Olav’s University Hospital, Trondheim
| | - Kjell Matre
- Department of Clinical Medicine, University of Bergen, Bergen
| | - Stephan Rörhl
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo
| | - Jan Erik Madsen
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo;,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo
| | - Frede Frihagen
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo;,Department of Orthopaedic Surgery, Østfold Hospital Trust, Grålum, Norway
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7
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Alm CE, Frihagen F, Dybvik E, Matre K, Madsen JE, Gjertsen JE. Implants for trochanteric fractures in Norway: the role of the trochanteric stabilizing plate-a study on 20,902 fractures from the Norwegian hip fracture register 2011-2017. J Orthop Surg Res 2021; 16:26. [PMID: 33413527 PMCID: PMC7792000 DOI: 10.1186/s13018-020-02163-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 12/15/2020] [Indexed: 12/31/2022] Open
Abstract
Background The trochanteric stabilizing plate (TSP) is used as an adjunct to the sliding hip screw (SHS) in unstable trochanteric and subtrochanteric fractures. We wanted to describe the choice of implant for trochanteric fractures with a focus on the TSP in Norway. Methods A total of 20,902 fractures from the Norwegian Hip Fracture Register treated surgically in 43 hospitals from 2011 to 2017 were included. Logistic regression analyses were performed to detect factors potentially influencing implant choice. Results The mean age was 83 years, and 15,137 (72%) were women. An SHS was used in 13,273 (63%) fractures, of them 4407 (33%) with a TSP. Fracture classification was the most important determinant of TSP. In cases where an SHS was used, the odds ratio (OR) for using a TSP was 14 for AO/OTA 31A2 fractures and 71 for AO/OTA 31A3 and subtrochanteric fractures, compared to AO/OTA 31A1 fractures. The probability of receiving a TSP was higher in urban, academic, and high-volume hospitals (OR 1.2 to 1.3) and lower in Central and Northern Norway (OR 0.3 to 0.7). The use of an intramedullary nail (IMN) (n = 7629 (36%)) was also to a degree decided by fracture classification (OR 1.8 to 5.3). However, hospital factors, with OR 0.1 to 0.4 for IMN in academic, urban, and high-volume hospitals and OR 1.5 to 2.6 outside South-Eastern Norway (all p < 0.001), were also important. Conclusions Fracture classification was the main determinant for TSP use. Any additional benefit from a TSP on postoperative fracture stability or clinical outcome needs to be clarified.
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Affiliation(s)
- Carl Erik Alm
- Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway. .,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Frede Frihagen
- Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway
| | - Eva Dybvik
- The Norwegian Hip Fracture Register, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Kjell Matre
- The Norwegian Hip Fracture Register, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine (K1), University of Bergen, Bergen, Norway
| | - Jan Erik Madsen
- Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Jan-Erik Gjertsen
- The Norwegian Hip Fracture Register, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine (K1), University of Bergen, Bergen, Norway
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