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Polo TOB, Fonseca-Santos JM, Momesso GAC, da Silva WPP, Barbosa S, Santos AMDS, Silva MC, Garcia VG, Theodoro LH, Faverani LP. Single intraoperative infrared laser optimized bone repair in rat femoral osteotomies with experimentally induced osteoporosis. Lasers Med Sci 2023; 38:87. [PMID: 36935455 DOI: 10.1007/s10103-023-03746-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 03/06/2023] [Indexed: 03/21/2023]
Abstract
This study aimed to evaluate the effect of infrared laser (IRL) on bone repair in ovariectomized rats subjected to femoral osteotomies. Of 32 rats, half underwent bilateral ovariectomy (OVX) and the other half underwent sham ovariectomy (SHAM). A period of 3 months was defined to observe the presence of osteoporosis. The rats were subjected to osteotomies in the femurs and then fixed with a miniplate and 1.5-mm system screws. Thereafter, half of the rats from both SHAM and OVX groups were not irradiated, and the other half were irradiated by IRL using the following parameters: wavelength, 808 nm; power, 100 mW; 60 s for each point; 6 J/point; and a total of 5 points of bone gap. All animals were euthanized 60 days after surgery. The femur gap was scanned using micro-computed tomography (micro-CT). The samples were then examined under a confocal laser microscope to determine the amounts of calcein and alizarin red. The slides were stained with alizarin red and Stevenel's blue for histometric analysis. In the micro-CT analysis, the OVX groups had the lowest bone volume (P < 0.05). When the laser was applied to the OVX groups, bone turnover increased (P < 0.05). New bone formation (NBF) was comparable between SHAM and OVX/IR (P > 0.05) groups; however, it was less in the OVX groups (P < 0.05). In conclusion, the results encourage the use of IRL intraoperatively as it optimizes bone repair, mainly in animals with low bone mineral density.
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Affiliation(s)
- Tárik Ocon Braga Polo
- School of Dentistry, São Paulo State University (UNESP), Araçatuba, São Paulo, Brazil
| | | | - Gustavo Antonio Correa Momesso
- School of Dentistry, São Paulo State University (UNESP), Araçatuba, São Paulo, Brazil
- Department of Implantology, University of Santo Amaro, Unisa, São Paulo, SP, Brazil
| | | | - Stefany Barbosa
- School of Dentistry, São Paulo State University (UNESP), Araçatuba, São Paulo, Brazil
| | | | - Mirela Caroline Silva
- School of Dentistry, São Paulo State University (UNESP), Araçatuba, São Paulo, Brazil
| | - Valdir Gouveia Garcia
- Diagnosis and Surgery Department, School of Dentistry, São Paulo State University (UNESP), 1193 José Bonifácio Street, Araçatuba, São Paulo, 16015-050, Brazil
| | - Letícia Helena Theodoro
- Diagnosis and Surgery Department, School of Dentistry, São Paulo State University (UNESP), 1193 José Bonifácio Street, Araçatuba, São Paulo, 16015-050, Brazil
| | - Leonardo P Faverani
- Diagnosis and Surgery Department, School of Dentistry, São Paulo State University (UNESP), 1193 José Bonifácio Street, Araçatuba, São Paulo, 16015-050, Brazil.
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Dakhil S, Saltvedt I, Benth JŠ, Thingstad P, Watne LO, Bruun Wyller T, Helbostad JL, Frihagen F, Johnsen LG, Taraldsen K. Longitudinal trajectories of functional recovery after hip fracture. PLoS One 2023; 18:e0283551. [PMID: 36989248 PMCID: PMC10057789 DOI: 10.1371/journal.pone.0283551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 03/01/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND There is limited evidence regarding predictors of functional trajectories after hip fracture. We aimed to identify groups with different trajectories of functional recovery the first year after hip fracture, and to determine predictors for belonging to such groups. METHODS This longitudinal study combined data from two large randomized controlled trials including patients with hip fracture. Participants were assessed at baseline, four and 12 months. We used the Nottingham Extended Activities of Daily Living (NEADL) as a measure of instrumental ADL (iADL) and Barthel Index for personal ADL (pADL). A growth mixture model was estimated to identify groups of patients following distinct trajectories of functioning. Baseline characteristics potentially predicting group-belonging were assessed by multiple nominal regression. RESULTS Among 726 participants (mean age 83.0; 74.7% women), we identified four groups of patients following distinct ADL trajectories. None of the groups regained their pre-fracture ADL. For one of the groups identified in both ADL outcomes, a steep decline in function was shown the first four months after surgery, and none of the groups showed functional recovery between four and 12 months after surgery. CONCLUSIONS No groups regained their pre-fracture ADL. Some of the patients with relatively high pre-fracture function, had a steep ADL decline. For this group there is a potential for recovery, but more knowledge and research is needed in this group. These findings could be useful in uncovering groups of patients with different functioning after a hip fracture, and aid in discharge planning.
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Affiliation(s)
- Shams Dakhil
- Oslo Delirium Research Group, Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ingvild Saltvedt
- Department of Geriatric Medicine, St. Olav University Hospital, Trondheim, Norway
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Jūratė Šaltytė Benth
- Institute of Clinical Medicine, Campus Ahus, University of Oslo, Oslo, Norway
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
| | - Pernille Thingstad
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Leiv Otto Watne
- Oslo Delirium Research Group, Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Torgeir Bruun Wyller
- Oslo Delirium Research Group, Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Jorunn L Helbostad
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Frede Frihagen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Orthopaedic Surgery, Østfold Hospital Trust, Grålum, Norway
| | - Lars Gunnar Johnsen
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Orthopedic Trauma Unit, Department of Orthopedic Surgery, St. Olav University Hospital, Trondheim, Norway
| | - Kristin Taraldsen
- Department of Rehabilitation Science and Health Technology, OsloMet, Oslo Metropolitan University, Oslo, Norway
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Steenhuis S, Hofstra G, Portrait F, Amankour F, Koolman X, van der Hijden E. The potential risk of using historic claims to set bundled payment prices: the case of physical therapy after lower extremity joint replacement. BMC Health Serv Res 2022; 22:1061. [PMID: 35986285 PMCID: PMC9392222 DOI: 10.1186/s12913-022-08410-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 07/30/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
One of the most significant challenges of implementing a multi-provider bundled payment contract is to determine an appropriate, casemix-adjusted total bundle price. The most frequently used approach is to leverage historic care utilization based on claims data. However, those claims data may not accurately reflect appropriate care (e.g. due to supplier induced demand and moral hazard effects). This study aims to examine variation in claims-based costs of post-discharge primary care physical therapy (PT) utilization after total knee and hip arthroplasties (TKA/THA) for osteoarthritis patients.
Methods
This retrospective cohort study used multilevel linear regression analyses to predict the factors that explain the variation in the utilization of post-discharge PT after TKA or THA for osteoarthritis patients, based on the historic (2015–2018) claims data of a large Dutch health insurer. The factors were structured as predisposing, enabling or need factors according to the behavioral model of Andersen.
Results
The 15,309 TKA and 14,325 THA patients included in this study received an average of 20.7 (SD 11.3) and 16.7 (SD 10.1) post-discharge PT sessions, respectively. Results showed that the enabling factor ‘presence of supplementary insurance’ was the strongest predictor for post-discharge PT utilization in both groups (TKA: β = 7.46, SE = 0.498, p-value< 0.001; THA: β = 5.72, SE = 0.515, p-value< 0.001). There were also some statistically significant predisposing and need factors, but their effects were smaller.
Conclusions
This study shows that if enabling factors (such as supplementary insurance coverage or co-payments) are not taken into account in risk-adjustment of the bundle price, they may cause historic claims-based pricing methods to over- or underestimate appropriate post-discharge primary care PT use, which would result in a bundle price that is either too high or too low. Not adjusting bundle prices for all relevant casemix factors is a risk because it can hamper the successful implementation of bundled payment contracts and the desired changes in care delivery it aims to support.
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The effect of postoperative weight-bearing status on mortality rate following proximal femoral fractures surgery. Arch Orthop Trauma Surg 2022; 142:947-953. [PMID: 33417019 DOI: 10.1007/s00402-020-03721-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 12/06/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Proximal femur fractures are associated with an increased mortality rate in the elderly. Early weight-bearing presents as a modifiable factor that may reduce negative postoperative outcomes and complications. As such, we aimed to compare non-weight-bearing, partial-weight-bearing and full weight-bearing cohorts, in terms of risk factors and postoperative outcomes and complications. METHODS We retrospectively reviewed our database to identify the three cohorts based on the postoperative weight-bearing status the day of surgery from 2003 to 20014. We collected data on numerous risk factors, including age, cerebrovascular accident (CVA), pulmonary embolism (PE), surgical fixation method and diagnosis type. We also collected data on postoperative outcomes, including the number of days of hospitalization, pain levels, and mortality rate. We performed a univariate and multivariate analysis; P < 0.05 was the significant threshold. RESULTS There were 186 patients in the non-weight-bearing group, 127 patients in the partial-weight-bearing group and 1791 patients in the full weight-bearing group. We found a significant difference in the type of diagnosis between cohorts (P < 0.001 in univariate, P < 0.001 in multivariate), but not in fixation type (P < 0.001 in univariate, but P = 0.76 in multivariate). The full weight-bearing group was diagnosed most with pertrochanteric fracture, 48.0%, and used Richard's nailing predominantly. Finally, we found that age was not a significant determinant of mortality rate but only weight-bearing cohort (P = 0.13 vs. P < 0.001, respectively). CONCLUSION We recommend early weight-bearing, which may act to decrease the mortality rate compared to non-weight-bearing and partial weight-bearing. In addition, appropriate expectations and standardizations should be set since age and type of diagnosis act as significant predictors of weight-bearing status.
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Hershkovitz A, Frenkel Rutenberg T. Are extracapsular and intracapsular hip-fracture patients two distinct rehabilitation subpopulations? Disabil Rehabil 2021; 44:4761-4766. [PMID: 33984250 DOI: 10.1080/09638288.2021.1919214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE To assess whether intracapsular and extracapsular hip fracture patients in a post-acute rehabilitation setting differ in their background characteristics and whether fracture type affects rehabilitation outcome. METHODS A retrospective cohort study. OUTCOME MEASURES Functional Independence Measure (FIM), motor FIM (mFIM), mFIM effectiveness, length of stay (LOS), and discharge destination. Various tests assessed associations (the Mann-Whitney U, the chi-square, logistic regression), population differences (t-test), and independent predictors of discharge FIM score (multiple linear regression model). RESULTS Six hundred and eighty-seven patients completed the rehabilitation program. The intracapsular hip fracture patient group was characterized by significantly higher percentages of males, higher education levels, and living with a caregiver compared with the extracapsular hip fracture patient group. Intracapsular hip fracture patients were younger, had longer latency time from fracture to surgery, exhibited higher functional levels on admission and upon discharge, higher cognitive function and shorter rehabilitation time than extracapsular hip fracture patients. Both study groups possessed similar comorbidities, rehabilitation achievements, and discharge destination. Regression analyses showed that the fracture type was not associated with discharge FIM score, nor with the probability of achieving a favorable functional gain. CONCLUSIONS Post-acute extracapsular and intracapsular hip fracture patients are demographically and clinically two distinct subpopulations. Nevertheless, given additional time, extracapsular hip fracture patients will attain similar functional achievements as intracapsular hip fracture patients.Implications for rehabilitationPost-acute extracapsular and intracapsular hip fracture patients are demographically and clinically two distinct subpopulations.Given additional time, extracapsular hip fracture patients can attain similar functional achievements as intracapsular hip fracture patients.
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Affiliation(s)
- Avital Hershkovitz
- Beit Rivka Geriatric Rehabilitation Center, Petach Tikva, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tal Frenkel Rutenberg
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Orthopedics, Rabin Medical Center, Petach Tikva, Israel
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Polo TOB, Momesso GAC, Silva WPP, Santos AMDS, Fonseca-Santos JM, da Cruz NC, Barão VAR, Garcia VG, Theodoro LH, Faverani LP. Is an anodizing coating associated to the photobiomodulation able to optimize bone healing in ovariectomized animal model? JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY B-BIOLOGY 2021; 217:112167. [PMID: 33667733 DOI: 10.1016/j.jphotobiol.2021.112167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 01/10/2021] [Accepted: 02/23/2021] [Indexed: 10/22/2022]
Abstract
This in vivo study investigated whether the bioactivity of anodizing coating, produced by plasma electrolytic oxidation (PEO), on mini-plate in femur fracture could be improved with the association of photobiomodulation (PBM) therapy. From the 20 ovariectomized Wistar female rats, 8 were used for model characterization, and the remaining 12 were divided into four groups according to the use of PBM therapy by diode laser (808 nm; power: 100 mW; energy: 6.0 J; energy density: 212 J/cm2; power density: 3.5 W/cm2) and the type of mini-plate surface (commercially pure titanium mini-plate -cpTi- and PEO-treated mini-plate) as follow: cpTi; PEO; cpTi/PBM; and PEO/PBM. After 60 days of surgery, fracture healing underwent microstructural, bone turnover, histometric, and histologic adjacent muscle analysis. Animals of groups with PEO and PBM showed greater fracture healing than cpTi control group under histometric and microstructural analysis (P < 0.05); however, bone turnover was just improved in PBM's groups (P < 0.05). there was no difference between cpTi and PEO without PBM (P > 0.05). Adjacent muscle analysis showed no metallic particles or muscle alterations in all groups. PEO and PBM are effective strategies for bone repair in fractures, however their association does not provide additional advantages.
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Affiliation(s)
- Tárik Ocon Braga Polo
- Department of Diagnosis and Surgery, Aracatuba School of Dentistry, São Paulo State University (UNESP), Araçatuba, São Paulo, Brazil
| | - Gustavo Antônio Correa Momesso
- Department of Diagnosis and Surgery, Aracatuba School of Dentistry, São Paulo State University (UNESP), Araçatuba, São Paulo, Brazil
| | - William Phillip Pereira Silva
- Department of Diagnosis and Surgery, Aracatuba School of Dentistry, São Paulo State University (UNESP), Araçatuba, São Paulo, Brazil
| | - Anderson Maikon de Souza Santos
- Department of Diagnosis and Surgery, Aracatuba School of Dentistry, São Paulo State University (UNESP), Araçatuba, São Paulo, Brazil
| | - João Matheus Fonseca-Santos
- Department of Diagnosis and Surgery, Aracatuba School of Dentistry, São Paulo State University (UNESP), Araçatuba, São Paulo, Brazil
| | - Nilson Cristino da Cruz
- Technological Plasma Laboratory (LaPTec), Experimental Campus of Sorocaba, São Paulo State University (UNESP), Sorocaba, São Paulo, Brazil
| | - Valentim A R Barão
- Department of Prosthodontics and Periodontology, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
| | - Valdir Gouveia Garcia
- Department of Diagnosis and Surgery, Aracatuba School of Dentistry, São Paulo State University (UNESP), Araçatuba, São Paulo, Brazil
| | - Letícia Helena Theodoro
- Department of Diagnosis and Surgery, Aracatuba School of Dentistry, São Paulo State University (UNESP), Araçatuba, São Paulo, Brazil
| | - Leonardo P Faverani
- Department of Diagnosis and Surgery, Aracatuba School of Dentistry, São Paulo State University (UNESP), Araçatuba, São Paulo, Brazil.
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Abstract
Hip fracture is a leading cause of profound morbidity in individuals aged 65 years and older, ranking in the top 10 causes of loss of disability-adjusted life-years for older adults. Worldwide, the number of people with hip fracture is expected to rise significantly due to the aging population and other factors. Physical therapist management is recommended within medical, surgical, and multidisciplinary clinical practice guideline (CPGs) and is considered to be the standard of care in rehabilitation for people with hip fracture. The goal of this CPG was to review the evidence relevant to physical therapist management and to provide evidence-based recommendations for physical therapy diagnosis, prognosis, intervention, and assessment of outcome in adults with hip fracture. J Orthop Sports Phys Ther 2021;51(2):CPG1-CPG81. doi:10.2519/jospt.2021.0301.
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Wahlsten LR, Smedegaard L, Brorson S, Gislason G, Palm H. Living settings and cognitive impairment are stronger predictors of nursing home admission after hip fracture surgery than physical comorbidities A nationwide Danish cohort study. Injury 2020; 51:2289-2294. [PMID: 32622625 DOI: 10.1016/j.injury.2020.06.041] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 05/13/2020] [Accepted: 06/24/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Sustaining a hip fracture is a life changing event for many elderlies. While doctors and researchers tend to be preoccupied with mortality and complication rates, patients are more concerned by other aspects e.g. loss of independence and ability to remain in their own home. This study aimed to i) determine age-stratified one-year event rates of admission to nursing home after discharge, and ii) identify risk factors associated with nursing home admission. METHODS Community dwelling patients aged 60-100 years undergoing their first hip fracture surgery in 2005 - 2015 were identified in nationwide administrative registries. Outcome was admission to nursing home within one year of discharge. To assess risk factors, we performed age-stratified cumulative incidence curves and multivariate cause specific cox regression models adjusted for age, sex, social factors, and comorbidities. RESULTS A total of 53,157 patients were included. One-year risk increased with advancing age from 3.2% of patients aged 60 to 69, up to 22.4% in the eldest group aged 90-100 years. Living alone and dementia were strong risk factors HR 9.22 [95% CI 5.60-15.18, p = <0.0001] and HR 6.73 [95% CI 4.80- 9.44, p = 0.0001] respectively for patients aged 60 to 69 years, the effect decreased with higher age down to HR 2.75 [95% CI 2.12- 3.57, p = <0.0001] and HR 2.15 [95% CI 1.88- 2.46, p = <0.0001] for patients ≥ 90 years. Other important risk factors were pre-injury home care, Parkinson's disease and depression. Surprisingly, physical comorbidities i.e. kidney disease, chronic obstructive pulmonary disease, diabetes and cancer did not increase the risk of nursing home admission. CONCLUSION Future initiatives aimed to reduce loss of independence and nursing home admission, among patients with first time hip fracture, should devote attention to living settings and cognitive impairment rather than physical comorbidity.
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Affiliation(s)
- Liv Riisager Wahlsten
- Department of Orthopaedics, Copenhagen University Hospital Herlev-Gentofte, Hospitalsvej 1, 2900 Hellerup, Denmark.
| | - Lærke Smedegaard
- Department of Cardiology, Research 1, Copenhagen University Hospital Herlev-Gentofte, Hospitalsvej 6 3.sal, 2900 Hellerup, Denmark
| | - Stig Brorson
- Department of Orthopaedic Surgery, Zealand University Hospital, Lykkebækvej 1, 4600 Køge, Denmark
| | - Gunnar Gislason
- Department of Cardiology, Research 1, Copenhagen University Hospital Herlev-Gentofte, Hospitalsvej 6 3.sal, 2900 Hellerup, Denmark
| | - Henrik Palm
- Department of Orthopaedics, Copenhagen University Hospital Bispebjerg, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark
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Ucpunar H, Camurcu Y, Çöbden A, Sofu H, Kis M, Demirel H. Comparative evaluation of postoperative health status and functional outcome in patients treated with either proximal femoral nail or hemiarthroplasty for unstable intertrochanteric fracture. J Orthop Surg (Hong Kong) 2020; 27:2309499019864426. [PMID: 31354039 DOI: 10.1177/2309499019864426] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE This study aimed to compare functional recovery and change in morbidity status from the preoperative levels among patients who underwent two different surgical treatments for unstable intertrochanteric fracture. METHODS This retrospective comparative study enrolled 140 patients (aged >80 years) who were referred to two hospitals. Of these, 64 were treated using proximal femoral nail (PFN) and 76 were treated using hemiarthroplasty (HA). To evaluate functional recovery, primary outcome measures were cumulative illness rating scale (CIRS) score to evaluate changes in morbidity status, activity of daily living (ADL) index, and mobility scores. RESULTS The proportion of patients who experienced increased CIRS scores in the HA group was higher at the 3-month follow-up (p = 0.02) but similar at the 6-month follow-up (p = 0.2) in comparison to the PFN group. Treatment with HA, American Society of Anesthesiologists scores of 3-4, and lower, preoperative ADL indexes were the major predictors of increased postoperative CIRS score. Impaired ambulatory ability and the need for walking aids were significantly higher in the PFN group at the 3-month follow-up (p = 0.01 and p = 0.02, respectively) but similar at the 6-month follow-up with respect to the HA group. PFN treatment and high patient body mass index were the major predictors of decreased ambulatory ability at postoperative 3 months. CONCLUSION HA has several advantages, including early mobilization and decreased dependency. However, it is associated with greater blood loss, a higher need for blood transfusion, and longer surgical duration than PFN, all of which are predisposing factors for significantly higher risk of reduced CIRS scores.
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Affiliation(s)
- Hanifi Ucpunar
- 1 Department of Orthopedics and Traumatology, Faculty of Medicine, Erzincan University, Erzincan, Turkey
| | - Yalkin Camurcu
- 1 Department of Orthopedics and Traumatology, Faculty of Medicine, Erzincan University, Erzincan, Turkey
| | - Adem Çöbden
- 2 Department of Orthopedics and Traumatology, Sivas Numune State Hospital, Merkez/Sivas, Turkey
| | - Hakan Sofu
- 3 Department of Orthopedics and Traumatology, Altinbas University Medicalpark Bahçelievler Hospital
| | - Mehmet Kis
- 2 Department of Orthopedics and Traumatology, Sivas Numune State Hospital, Merkez/Sivas, Turkey
| | - Huseyin Demirel
- 2 Department of Orthopedics and Traumatology, Sivas Numune State Hospital, Merkez/Sivas, Turkey
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Mellner C, Hedström M, Hommel A, Sköldenberg O, Eisler T, Mukka S. The Sernbo score as a predictor of 1-year mortality after hip fracture: a registry study on 55,716 patients. Eur J Trauma Emerg Surg 2020; 47:2043-2048. [PMID: 32363412 PMCID: PMC8629894 DOI: 10.1007/s00068-020-01375-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 04/10/2020] [Indexed: 12/04/2022]
Abstract
Purpose Patients sustaining a hip fracture have a high mortality rate during the first postoperative year and the Sernbo score may stratify patients into a high, intermediate and low risk of death during this period. We assessed its predictive properties on patients from the National Swedish Hip Fracture Register. Patients and methods 55,716 hip fracture patients, 69% women older than 65 years at surgery (registered between 2010 and 2015) with complete Sernbo scores and mortality data were studied. Receiver-operating characteristics analyses (ROC) were used. Validation of Sernbo score was performed. Results The overall 1-year mortality rate was 26%—and 17%, 27.4% and 55.6% in the low, intermediate and high-risk groups, respectively. The ROC analysis indicated a predictive ability of the Sernbo score, with an AUC of 0.69 (CI 0.68–0.69). Conclusion In this registry-based study, the easy-to-use Sernbo scoring system proved to be appropriate and useful way to identify hip fracture patients with a high-risk mortality during the first postoperative year. Electronic supplementary material The online version of this article (10.1007/s00068-020-01375-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Carl Mellner
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden.
| | - Margareta Hedström
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - Ami Hommel
- Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, Sweden
| | - Olof Sköldenberg
- Department of Clinical Sciences at Danderyd Hospital (KIDS), Division of Orthopaedics, Karolinska Institutet, Stockholm, Sweden
| | - Thomas Eisler
- Department of Clinical Sciences at Danderyd Hospital (KIDS), Division of Orthopaedics, Karolinska Institutet, Stockholm, Sweden
| | - Sebastian Mukka
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
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Hip fractures - Treatment and functional outcome. The development over 25 years. Injury 2018; 49:2209-2215. [PMID: 30366830 DOI: 10.1016/j.injury.2018.10.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Accepted: 10/08/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Nearly 18,000 individuals suffer from hip fracture in Sweden each year. The choice in operation method for femoral neck fractures has changed over the years as well as the overall management. Functional outcome after hip fracture is affected by several factors and the overall functional level for old people in Sweden has improved over the last decades. OBJECTIVE To describe and analyse the functional outcome and choice of operation method for hip fracture patients between 1988 and 2012. PATIENTS AND METHODS All patients with cervical or trochanteric hip fracture treated at Lund University Hospital from 1988 until 2012 were collected from the National Quality Register for hip fracture patients, RIKSHÖFT. Patients younger than 50 years and those with pathological fractures were excluded. Data regarding patient characteristics, fracture type, operation method and housing, walking ability and use of walk aids prefracture and at 4-months follow-up was retrieved and analysed. RESULTS For this study 8723 patients were included with a mean age of 81.6 (men 79.3, women 82.5). The mean age significantly increased over the period studied. Sliding hip screw dominates as method of choice for the trochanteric fractures. For the cervical fractures there is a clear shift from osteosynthesis to arthroplasty. There is a significant decrease in functional outcome at follow-up compared to prefracture. No significant trend change can be seen over 25 years. Functional outcome are worse for the patients with trochanteric fracture. CONCLUSION Although there have been changes in operation methods for hip fractures and the management has developed, our study does not show any effect on functional outcome over a 25-year period. The medical condition of these patients with increasing age seems to counteract efforts to improve the care.
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Åhman R, Siverhall PF, Snygg J, Fredrikson M, Enlund G, Björnström K, Chew MS. Determinants of mortality after hip fracture surgery in Sweden: a registry-based retrospective cohort study. Sci Rep 2018; 8:15695. [PMID: 30356058 PMCID: PMC6200788 DOI: 10.1038/s41598-018-33940-8] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 10/06/2018] [Indexed: 11/27/2022] Open
Abstract
Surgery for hip fractures is associated with high mortality and morbidity. The causes of poor outcome are not fully understood and may be related to other factors than the surgery itself. The relative contributions of patient, surgical, anaesthetic and structural factors have seldom been studied together. This study, a retrospective registry-based cohort study of 14 932 patients undergoing hip fracture surgery in Sweden from 1st of January 2014 to 31st of December 2016, aimed to identify important predictors of mortality post-surgery. The independent predictive power of our included variables was examined using Cox proportional hazards modeling with all-cause mortality at longest follow-up as the outcome. Twelve independent variables were considered as interrelated ‘exposures’ and their individual adjusted effect within a single model were evaluated. Kaplan-Meier curves were also generated. Crude mortality rates were 8.2% at 30 days (95% CI 7.7–8.6%) and 23.6% at 365 days (95% CI 22.9–24.2%). Of the 12 factors entered into the Cox regression analysis, age (aHR1.06, p < 0.001), male gender (aHR 1.45, p < 0.001), ASA-PS-class (ASA 1&2 reference; ASA 3 aHR 2.12; ASA 4 aHR 4.79; ASA 5 aHR 12.57 respectively, p < 0.001) and PACU-LOS (aHR 1.01, p < 0.001) were significantly associated with mortality at longest follow-up (up to 3 years). University hospital status was protective (aHR 0.83, p < 0.001) in the same model. Age, gender and ASA-PS-class were strong predictors of mortality after surgery for hip fractures in Sweden. University hospital status and length of stay in the postoperative care unit were also identified as modifiable risk factors after multivariable adjustment and require confirmation in future studies.
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Affiliation(s)
- Rasmus Åhman
- Department of Anaesthesia and Intensive Care, Department of Medical and Health Sciences, Linköping University, Linköping, S-58185, Sweden.
| | - Pontus Forsberg Siverhall
- Department of Anaesthesia and Intensive Care, Department of Medical and Health Sciences, Linköping University, Linköping, S-58185, Sweden
| | - Johan Snygg
- Department of Anaesthesia and Intensive Care, Sahlgrenska University Hospital, 41345, Gothenburg, Sweden
| | - Mats Fredrikson
- Department of Clinical and Experimental Medicine, Faculty of Medicine and Health, Linköping University, S-58185, Linköping, Sweden
| | - Gunnar Enlund
- Department of Anaesthesia and Intensive Care, Uppsala University Hospital, 78185, Uppsala, Sweden
| | - Karin Björnström
- Department of Anaesthesia and Intensive Care, Department of Medical and Health Sciences, Linköping University, Linköping, S-58185, Sweden
| | - Michelle S Chew
- Department of Anaesthesia and Intensive Care, Department of Medical and Health Sciences, Linköping University, Linköping, S-58185, Sweden
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13
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Bisphosphonate Use After Hip Fracture in Older Adults: A Nationwide Retrospective Cohort Study. J Am Med Dir Assoc 2017; 18:515-521. [PMID: 28238673 DOI: 10.1016/j.jamda.2016.12.083] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 12/29/2016] [Accepted: 12/30/2016] [Indexed: 11/21/2022]
Abstract
OBJECTIVES The aim of this study was to investigate the association between bisphosphonate use and the risk of new fracture in a nationwide cohort of individuals with previous hip fractures, with emphasis on individuals above 80 years of age. DESIGN, SETTING, AND PARTICIPANTS From a nationwide cohort with hip fracture (2006-2012) (n = 93, 601), each individual prescribed bisphosphonates after hip fracture (n = 5845) was matched with up to three individuals not prescribed bisphosphonates, resulting in a cohort of 21,363 individuals. MAIN OUTCOME MEASURE A new hip fracture. RESULTS During a mean follow-up period of 2.98 (range, 0.02-8) years, 4581 fractures occurred in the cohort. Before the initiation of bisphosphonate therapy, individuals later prescribed bisphosphonates had an increased risk of hip fracture (multivariable adjusted odds ratio [OR], 2.63; 95% confidence interval [CI], 2.23-3.24) compared with controls. In the period after bisphosphonate therapy initiation, individuals prescribed bisphosphonates had a lower risk of hip fracture (multivariable adjusted hazard ratio [HR], 0.76; 95% CI, 0.65-0.90) compared with controls. Similar effects were seen after the initiation of bisphosphonates in individuals aged more than 80 years (HR, 0.79; 95% CI, 0.62-0.99). In contrast, the initiation of bisphosphonate therapy did not influence the risk of injurious falls not resulting in fracture (HR, 0.95; 95% CI, 0.86-1.05). CONCLUSION Bisphosphonate use was associated with a decreased risk of hip fracture in this nationwide cohort of older men and women, with similar risk reductions in individuals older than 80 years.
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14
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Bea JW, Thomson CA, Wallace RB, Wu C, Seguin RA, Going SB, LaCroix A, Eaton C, Ockene JK, LaMonte MJ, Jackson R, Jerry Mysiw W, Wactawski-Wende J. Changes in physical activity, sedentary time, and risk of falling: The Women's Health Initiative Observational Study. Prev Med 2017; 95:103-109. [PMID: 27932054 PMCID: PMC5289299 DOI: 10.1016/j.ypmed.2016.11.025] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 10/28/2016] [Accepted: 11/24/2016] [Indexed: 12/22/2022]
Abstract
Falling significantly affects quality of life, morbidity, and mortality among older adults. We sought to evaluate the prospective association between sedentary time, physical activity, and falling among post-menopausal women aged 50-79years recruited to the Women's Health Initiative Observational Study between 1993 and 1998 from 40 clinical centers across the United States. Baseline (B) and change in each of the following were evaluated at year 3 (Y3) and year 6 (Y6; baseline n=93,676; Y3 n=76,598; Y6 n=75,428): recreational physical activity (MET-h/wk), sitting, sleeping (min/day), and lean body mass by dual energy X-ray absorptiometry (subset N=6475). Falls per year (0, 1, 2, ≥3) were assessed annually by self-report questionnaire and then dichotomized as ≤1 and ≥2falls/year. Logistic regression models were adjusted for demographics, body mass index, fall history, tobacco and alcohol use, medical conditions, and medications. Higher baseline activity was associated with greater risk of falling at Y6 (18%; p for trend <0.0001). Increasing sedentary time minimally decreased falling (1% Y3; 2% Y6; p<0.05). Increasing activity up to ≥9MET-h/wk. (OR: 1.12, 95% CI: 1.03-1.22) or maintaining ≥9MET-h/wk. (OR: 1.20, 95% CI: 1.13-1.29) increased falling at Y3 and Y6 (p for trend <0.001). Adding lean body mass to the models attenuated these relationships. Physically active lifestyles increased falling among post-menopausal women. Additional fall prevention strategies, such as balance and resistance training, should be evaluated to assist post-menopausal women in reaching or maintaining levels of aerobic activity known to prevent and manage several chronic diseases.
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Affiliation(s)
- Jennifer W Bea
- University of Arizona, Cancer Center, 1515 N. Campbell Ave., Tucson, AZ 85724, United States.
| | - Cynthia A Thomson
- University of Arizona, 3950 S Country Club Rd., Suite 330, Tucson, AZ 85714, United States
| | - Robert B Wallace
- University of Iowa, 145 N Riverside Dr., Iowa City, IA 52242, United States
| | - Chunyuan Wu
- Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, M3-A410, Seattle, WA 98109, United States
| | - Rebecca A Seguin
- Cornell University, Savage Hall, Room 412, Ithaca, NY 14853, United States
| | - Scott B Going
- University of Arizona, 3950 S Country Club Rd., Suite 330, Tucson, AZ 85714, United States
| | - Andrea LaCroix
- University of California, San Diego, 9500 Gilman Dr., #0725, La Jolla, CA 92093, United States
| | - Charles Eaton
- Brown University, 111 Brewster Street, Pawtucket, RI 02860, United States
| | - Judith K Ockene
- University of Massachusetts, 55 Lake Ave North, S7-746, Worcester, MA 01655, United States
| | - Michael J LaMonte
- University at Buffalo, State University of New York, 273 Farber Hall, Buffalo, NY 14214, United States
| | - Rebecca Jackson
- Ohio State University, 376 W 10th Avenue, Suite 205, Columbus, OH 43210, United States
| | - W Jerry Mysiw
- Ohio State University, 2050 Kenny Road, Columbus, OH 43221, United States
| | - Jean Wactawski-Wende
- University at Buffalo, State University of New York, 410 Kimball Hall, Buffalo, NY 14214, United States
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15
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Hektoen LF, Saltvedt I, Sletvold O, Helbostad JL, Lurås H, Halsteinli V. One-year health and care costs after hip fracture for home-dwelling elderly patients in Norway: Results from the Trondheim Hip Fracture Trial. Scand J Public Health 2016; 44:791-798. [PMID: 28929932 DOI: 10.1177/1403494816674162] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIM The aim of this study was to estimate the one-year health and care costs related to hip fracture for home-dwelling patients aged 70 years and older in Norway, paying specific attention to the status of the patients at the time of fracture and cost differences due to various patient pathways after fracture. METHODS Data on health and care service provision were extracted from hospital and municipal records and from national registries; data on unit costs were collected from the municipalities, hospital administrations and previously published studies. Four different patient pathways were identified and the total costs for subgroups of patients according to age, sex, fracture type and instrumental activity of daily living at fracture incidence were calculated. Descriptive statistics were used to identify cost estimates. RESULTS The mean total one-year costs per patient were EUR 68,376 and the costs for patients alive one year after hip fracture were EUR 71,719. The patients' age and pre-fracture functional status contributed most to the total cost. CONCLUSIONS On average, care costs accounted for more than 50% of the total cost; even for patients with good functional status before hip fracture, care costs accounted for 40% of the total cost compared with hospital costs of 38%. To reduce the financial costs of hip fractures in the care sector, the results point to the importance of preventive programmes to reduce the risk of hip fracture, but also to the importance of comprehensive geriatric care in the initial phase after a hip fracture.
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Affiliation(s)
- Liv Faksvåg Hektoen
- 1 Faculty of Health Sciences, Department of Physiotherapy, Oslo and Akershus University College of Applied Sciences, Norway
| | - Ingvild Saltvedt
- 2 St Olav Hospital, Trondheim University Hospital, Norway.,3 Department of Neuroscience, Norwegian University of Science and Technology, Norway
| | - Olav Sletvold
- 2 St Olav Hospital, Trondheim University Hospital, Norway.,3 Department of Neuroscience, Norwegian University of Science and Technology, Norway
| | - Jorunn L Helbostad
- 3 Department of Neuroscience, Norwegian University of Science and Technology, Norway
| | - Hilde Lurås
- 4 Health Services Research Centre, Akershus University Hospital, Norway.,5 Institute of Clinical Medicine, Campus Ahus, University of Oslo, Norway
| | - Vidar Halsteinli
- 2 St Olav Hospital, Trondheim University Hospital, Norway.,6 Department of Public Health and General Practice, Norwegian University of Science and Technology, Norway
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16
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Abstract
Background and purpose - Pre-fracture functional level has been shown to be a consistent predictor of rehabilitation outcomes in older hip fracture patients. We validated 4 overall pre-fracture functional level assessment instruments in patients aged 65 or more, used the prediction of outcome at 4 months post-fracture, and assessed cutoff values for decision making in treatment and rehabilitation. Patients and methods - 165 consecutive patients with acute primary hip fracture were prospectively included in the study. Pre-fracture Barthel-20, Barthel-100, cumulated ambulation score, and new mobility score were scored immediately after admission. Outcome defined as mortality, residential status, and independent walking ability was assessed at 4 months. Results - 3 of the assessment instruments, namely Barthel-20, Barthel-100, and new mobility score, correlated with outcome at 4 months post-fracture and were valid predictors. Thresholds were estimated. We found no evidence that Barthel-100, with its finer granularity, performs better than Barthel-20 as a predictor. Interpretation - Our findings indicate that pre-fracture scores of Barthel-20 and new mobility score have predictive ability, and further investigation of usage for guidance of clinical and rehabilitation decisions concerning hip fracture patients is warranted.
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Affiliation(s)
- Tonny J Pedersen
- Rehabilitation Department, OUH Odense University Hospital, Svendborg Hospital; ,Institute of Public Health, University of Southern Denmark; ,Correspondence:
| | - Jens M Lauritsen
- Orthopaedic Department, OUH Odense University Hospital; ,Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
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17
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Prestmo A, Saltvedt I, Helbostad JL, Taraldsen K, Thingstad P, Lydersen S, Sletvold O. Who benefits from orthogeriatric treatment? Results from the Trondheim hip-fracture trial. BMC Geriatr 2016; 16:49. [PMID: 26895846 PMCID: PMC4761133 DOI: 10.1186/s12877-016-0218-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Accepted: 02/03/2016] [Indexed: 11/10/2022] Open
Abstract
Background Hip fracture patients are heterogenous. Certain patient characteristics are associated with poorer prognosis, but less is known about differences in response to treatment among subgroups. The Trondheim Hip Fracture trial found beneficial effects on mobility and function from comprehensive geriatric care (CGC) compared to traditional orthopaedic care (OC). The aim of this study was to explore differences in response to CGC among subgroups in this trial. Methods Secondary analysis of the complete dataset from Trondheim Hip Fracture Trial, a randomised controlled trial including 397 home-dwelling older adults (≥70 years) with a hip fracture. Subgroups were age (over/under 80 years), gender, fracture type (intra-/extracapsular), and pre-fracture instrumental ADL (i-ADL) (defined as over/under 45 on the Nottingham Extended ADL scale). Dependent variables were mobility (Short Physical Performance Battery), personal ADL (p-ADL) (Barthel Index), i-ADL (Nottingham Extended ADL scale), cognition (Mini-Mental Status Examination), four and 12 months after hip fracture. Data were analysed by linear mixed models with interactions (treatment, time, and subgroup), reporting treatment effects being clinically and statistically significant within and between subgroups. Results Analyses within subgroups showed beneficial effects of CGC on mobility and i-ADL either at four or twelve months in all subgroups except for males, extra-capsular fractures and patients with impaired pre-fracture i-ADL. Beneficial effect on p- ADL was found in patients < 80 years, intra-capsular fractures and patients with impaired pre-fracture i-ADL. Effects on cognition were found in patients < 80 years and men. The interaction analyses showed that CGC had statistically significant better treatment effect on i-ADL for younger participants at four months (p = 0.004), on p-ADL both at four (p = 0.037) and twelve months (p = 0.045) and mobility at twelve months (p = 0.021), for participants with intracapsular as compared to extracapsular fractures, and on i-ADL at twelve months for participants with higher pre-fracture function (p = 0.012). Conclusion Contrary to our hypothesis that the most vulnerable patients would benefit the most from CGC, we found the intervention effect was most pronounced in younger, female participants with higher pre-fracture i-ADL function. Trial rigistration ClinicalTrials.gov registration number: NCT00667914. Electronic supplementary material The online version of this article (doi:10.1186/s12877-016-0218-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anders Prestmo
- Department of Neuroscience, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Department of Geriatrics, St Olav Hospital, University Hospital of Trondheim, Trondheim, Norway
| | - Ingvild Saltvedt
- Department of Neuroscience, Norwegian University of Science and Technology (NTNU), Trondheim, Norway. .,Department of Geriatrics, St Olav Hospital, University Hospital of Trondheim, Trondheim, Norway.
| | - Jorunn L Helbostad
- Department of Neuroscience, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Clinic of Clinical Services, St Olav Hospital, University Hospital of Trondheim, Trondheim, Norway
| | - Kristin Taraldsen
- Department of Neuroscience, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Pernille Thingstad
- Department of Neuroscience, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Stian Lydersen
- Regional Centre for Child and Youth Mental Health and Child Welfare, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Olav Sletvold
- Department of Neuroscience, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Department of Geriatrics, St Olav Hospital, University Hospital of Trondheim, Trondheim, Norway
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18
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Hommel A, Bååth C. A national quality registers as a tool to audit items of the fundamentals of care to older patients with hip fractures. Int J Older People Nurs 2015; 11:85-93. [DOI: 10.1111/opn.12101] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 06/08/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Ami Hommel
- Department of Health Sciences; Lund University; Lund Sweden
- Department of Orthopedics; Skåne University Hospital; Lund Sweden
| | - Carina Bååth
- Department of Health Sciences; Karlstad University; Karlstad Sweden and Country Council of Varmland, Sweden
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19
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Zhong L, Mahmoudi E, Giladi AM, Shauver M, Chung KC, Waljee JF. Utilization of Post-Acute Care Following Distal Radius Fracture Among Medicare Beneficiaries. J Hand Surg Am 2015; 40:2401-9.e8. [PMID: 26527599 PMCID: PMC5079469 DOI: 10.1016/j.jhsa.2015.08.026] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 08/21/2015] [Accepted: 08/21/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To examine the utilization and cost of post-acute care following isolated distal radius fractures (DRFs) among Medicare beneficiaries. METHODS We examined utilization of post-acute care among Medicare beneficiaries who experienced an isolated DRF (n = 38,479) during 2007 using 100% Medicare claims data. We analyzed the effect of patient factors on hospital admission following DRF and the receipt of post-acute care delivered by skilled nursing facilities, inpatient rehabilitation facilities, home health care agencies, and outpatient occupational therapy/physical therapy for the recovery of DRF. RESULTS In this cohort of isolated DRF patients, 1,694 (4.4%) were admitted to hospitals following DRF, and 20% received post-acute care. Women and patients with more comorbid conditions were more likely to require hospital admission. The utilization of post-acute care was higher among women, patients who resided in urban areas, and patients of higher socioeconomic status. The average cost per patient of post-acute care services from inpatient rehabilitation facilities and skilled nursing facilities ($15,888/patient) was significantly higher than the average cost other aspects of DRF care and accounted for 69% of the total DRF-related expenditure among patients who received inpatient rehabilitation. CONCLUSIONS Sociodemographic factors, including sex, socioeconomic status, and age, were significantly correlated with the use of post-acute care following isolated DRFs, and post-acute care accounted for a substantial proportion of the total expenditures related to these common injuries among the elderly. Identifying patients who will derive the greatest benefit from post-acute care can inform strategies to improve the cost efficiency of rehabilitation and optimize scarce health care resources. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic III.
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Affiliation(s)
- Lin Zhong
- Department of Surgery, University of Michigan Health System, Ann Arbor, MI, United States
| | - Elham Mahmoudi
- Section of Plastic Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor, MI, United States
| | - Aviram M. Giladi
- Section of Plastic Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor, MI, United States
| | - Melissa Shauver
- Department of Surgery, University of Michigan Health System, Ann Arbor, MI, United States
| | - Kevin C. Chung
- Section of Plastic Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor, MI, United States
| | - Jennifer F. Waljee
- Section of Plastic Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor, MI, United States
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20
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Gregersen M, Borris LC, Damsgaard EM. Blood Transfusion and Overall Quality of Life After Hip Fracture in Frail Elderly Patients—The Transfusion Requirements in Frail Elderly Randomized Controlled Trial. J Am Med Dir Assoc 2015; 16:762-6. [DOI: 10.1016/j.jamda.2015.03.022] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Revised: 03/20/2015] [Accepted: 03/24/2015] [Indexed: 11/25/2022]
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21
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Nordström P, Michaëlsson K, Hommel A, Norrman PO, Thorngren KG, Nordström A. Geriatric Rehabilitation and Discharge Location After Hip Fracture in Relation to the Risks of Death and Readmission. J Am Med Dir Assoc 2015; 17:91.e1-7. [PMID: 26297621 DOI: 10.1016/j.jamda.2015.07.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 07/02/2015] [Accepted: 07/02/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To investigate the effects of geriatric rehabilitation on short-term risk of death and readmission after a hip fracture were investigated in a nationwide cohort. In addition, the association of discharge location (nursing home or patient's home) with the short-term risk of death was assessed. DESIGN, SETTING, AND PARTICIPANTS The cohort consisted of 89,301 individuals at least 50 years of age, with a first hip fracture registered in the Swedish quality register RIKSHÖFT, the years 2004-2012. MEASURES Short-term risk of death and readmission to hospital after discharge was compared at 8 hospitals, where most patients received inpatient care in geriatric wards, and those treated at 71 regular hospitals. RESULTS The risks of death within 30 days of admission were 7.1% in patients admitted to geriatric ward hospitals and 7.4% in those treated at regular hospitals (multivariable-adjusted hazard ratio [HR] 0.91, 95% CI 0.85-0.97), whereas the odds of readmission within 30 days of discharge were 8.7% and 9.8%, respectively (multivariable-adjusted odds ratio 0.86, 95% CI 0.81-0.91). The risk of death was influenced by discharge location and inpatient length of stay (LOS). Thus, for patients discharged to short-term nursing homes with a LOS of at most 10 days, each additional day of LOS reduction increased the risk of death within 30 days of discharge by 13% (HR 1.13, 95% CI 1.08-1.18). This association was reduced in patients discharged to permanent nursing homes (HR 1.04, 95% CI 1.02-1.07), and not significant in those discharged to their own home (OR 1.00, 95% CI 0.91-1.10). CONCLUSION The risks of death and readmission were lower in patients with hip fracture who received care in hospitals with geriatric wards. The risk of death after discharge increased with shorter LOS, especially in patients discharged to short-term nursing homes.
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Affiliation(s)
- Peter Nordström
- Department of Community Medicine and Rehabilitation, Geriatrics, Umeå University, Umeå, Sweden.
| | - Karl Michaëlsson
- Department of Surgical Sciences, Orthopedics Section, Uppsala University, Uppsala, Sweden
| | - Ami Hommel
- Department of Clinical Sciences, Orthopedics, Lund University, Lund, Sweden
| | - Per Ola Norrman
- Department of Clinical Sciences, Orthopedics, Lund University, Lund, Sweden
| | | | - Anna Nordström
- Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, Umeå, Sweden
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22
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Al-Ani AN, Cederholm T, Sääf M, Neander G, Blomfeldt R, Ekström W, Hedström M. Low bone mineral density and fat-free mass in younger patients with a femoral neck fracture. Eur J Clin Invest 2015; 45:800-6. [PMID: 26036839 DOI: 10.1111/eci.12472] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 05/29/2015] [Indexed: 01/01/2023]
Abstract
BACKGROUND Reduced bone mineral density (BMD) together with muscle wasting and dysfunction, that is sarcopenia, emerges as a risk factor for hip fracture. The aim of this study was to examine body composition and BMD and their relationship with trauma mechanisms in young and middle-aged patients with femoral neck fracture. MATERIALS AND METHODS Altogether, 185 patients with femoral neck fracture aged 20-69 were included. BMD, body composition and fat-free mass index (FFMI) were determined by dual-X-ray absorptiometry (DXA), and trauma mechanisms were registered. RESULTS Ninety per cent of the whole study population had a femoral neck BMD below the mean for age. In the young patients (< 50 years), 27% had a Z-score of BMD ≤ -2 SD. More than half of the middle-aged patients (50-69 years) had osteopenia, that is T-score -1 to -2.5, and 35% had osteoporosis, that is T-score < -2.5, at the femoral neck. Patients with low-energy trauma, sport injury or high-energy trauma had a median standardised BMD of 0.702, 0.740 vs. 0.803 g/cm(2) (P = 0.03), and a median FFMI of 15.9, 17.7 vs. 17.5 kg/m(2) (P < 0.001), respectively. FFMI < 10th percentile of an age- and gender-matched reference population was observed in one-third. CONCLUSIONS A majority had low BMD at the femoral neck, and one-third had reduced FFMI (i.e. sarcopenia). Patients with fracture following low-energy trauma had significantly lower femoral neck BMD and FFMI than patients with other trauma mechanisms. DXA examination of both BMD and body composition could be of value especially in those with low-energy trauma.
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Affiliation(s)
- Amer N Al-Ani
- Division of Orthopaedics, Department of Clinical Science Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, Huddinge, Stockholm, Sweden
| | - Tommy Cederholm
- Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden.,Department of Geriatric Medicine, Uppsala University Hospital, Uppsala, Sweden
| | - Maria Sääf
- Department of Molecular Medicine and Surgery, Endocrine and Diabetes Unit, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Gustaf Neander
- Division of Orthopaedics, Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
| | - Richard Blomfeldt
- Karolinska Instistutet, Department of Clinical Science and Education, Orthopaedic Unit, Söder hospital, Stockholm, Sweden
| | - Wilhelmina Ekström
- Department of Molecular Medicine and Surgery, Section of Orthopaedics and Sports Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Margareta Hedström
- Division of Orthopaedics, Department of Clinical Science Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, Huddinge, Stockholm, Sweden
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23
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A comparison of outcomes and dislocation rates using dual articulation cups and THA for intracapsular femoral neck fractures. Hip Int 2014; 23:22-6. [PMID: 23397197 DOI: 10.5301/hip.2013.10632] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/05/2012] [Indexed: 02/04/2023]
Abstract
Total hip arthroplasty for intracapsular femoral neck fractures (FNF) is associated with a greater risk of dislocation. Dual articulation systems in this group of patients may provide better implant stability and a reduced dislocation rate. The aim of our study was to investigate FNF patients treated with dual articulation cups (DAC) and conventional THA and compare their clinical results at four months and one year after surgery. Our study compared femoral neck fracture patients treated with either DAC or conventional THA during two different time periods. Before surgery and during follow-up, the patients answered questions regarding their mobility, pain and usage of walking aids. Additionally at four-month and one-year follow-ups EQ-5D and HOOS questionnaires were applied for those patients qualifying for functional and quality of life analysis. Out of 125 femoral neck fracture patients 58 were treated with DAC and 67 with conventional THA. At four months and one year follow-up the HOOS and EQ-5D results did not differ significantly between DAC and conventional THA. Five hips in the THA group were revised for recurrent dislocation and two had a single dislocation. One year after surgery, the functional result of DAC and conventional THA are comparable but DAC have a lower risk of dislocation.
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Hulsbæk S, Larsen RF, Troelsen A. Predictors of not regaining basic mobility after hip fracture surgery. Disabil Rehabil 2014; 37:1739-44. [PMID: 25350664 DOI: 10.3109/09638288.2014.974836] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Regaining basic mobility after hip fracture surgery is a milestone in the in-hospital rehabilitation. The aims were to investigate predictors for not regaining basic mobility at the fifth post-operative day and at discharge after undergoing hip fracture surgery. METHOD In a prospective cohort study 274 hip fracture patients were included. Patients with compromised ability to exercise were excluded leaving 167 patients for analysis. Patient demographics, functional level, method of operation, post-operative hemoglobin and the completion of physiotherapy was registered. Basic mobility was assessed by the Cumulated Ambulation Score. Multivariate logistic regression was performed. RESULTS Age >80 years (OR = 7.5), low prefracture functional level (OR = 3.0), not completed the physiotherapy on first post-operative day (OR = 4.6) and hemoglobin <6 mmol/L measured on first post-operative day (OR = 5.8) were significant predictors of not regaining basic mobility within the fifth post-operative day (p values: 0.04 - <0.0001). Predictors of not regaining basic mobility at discharge were: Age >80 years (OR = 4.3), prefracture functional level (OR = 7.0) and not completed the physiotherapy on first post-operative day (OR = 3.3) (p values: 0.009-<0.0001). CONCLUSIONS This study shows that patients undergoing hip fracture surgery, who are not able to complete physiotherapy on first post-operative day, are at a greater risk of not regaining basic mobility during hospitalization. This highlights the importance of physiotherapy as part of the interdisciplinary treatment. IMPLICATIONS FOR REHABILITATION Regaining abilities in basic mobility after hip fracture surgery is a primary goal of rehabilitation during hospitalization in the acute ward. The following factors are indentified to predict patients not regaining their previous level of basic mobility: Age >80 years, low prefracture functional level, patients not being able to complete the physiotherapy on the first post-operative day and hemoglobin value <6 mmol/l on the first post-operative day. In future strategies, the findings regarding both modifiable and unmodifiable factors, can be used to conduct early planning of discharge and to take actions in relation to patients who are at a risk of not regaining basic mobility.
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Affiliation(s)
- Signe Hulsbæk
- Department of Physiotherapy, Køge Hospital , Køge , Denmark and
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Karni S, Bentur N, Ratzon N. Participation and Quality of Life of Cognitively Impaired Older Women in Israel Following Hip Fractures. Occup Ther Int 2014; 21:91-7. [DOI: 10.1002/oti.1365] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Revised: 12/29/2013] [Accepted: 12/30/2013] [Indexed: 11/09/2022] Open
Affiliation(s)
| | - Netta Bentur
- Myers-JDC-Brookdale Institute; Israel
- Tel-Aviv University; Occupational Therapy, Tel-Aviv; Israel
| | - Nava Ratzon
- Tel-Aviv University; Occupational Therapy, Tel-Aviv; Israel
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Rastogi A, Arun GR, Singh V, Singh A, Singh AK, Kumaraswamy V. In vitro comparison of resistance to implant failure in unstable trochanteric fractures fixed with intramedullary single screw versus double screw device. Indian J Orthop 2014; 48:306-12. [PMID: 24932039 PMCID: PMC4052032 DOI: 10.4103/0019-5413.132524] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The purpose of this study was to compare the resistance of intramedullary single screw device (Gamma nail) and double screw device proximal femoral nail (PFN) in unstable trochanteric fractures in terms of the number of cycles sustained, subsidence and implant failure in an axial loading test in cadaveric femora. MATERIALS AND METHODS The study was conducted on 18 dry cadaveric femoral specimens, 9 of these were implanted with a Gamma nail and 9 with PFN. There was no significant difference found in average dual energy X-ray absorptiometry value between both groups. The construct was made unstable (AO type 31A3.3) by removing a standard sized posteromedial wedge. These were tested on a cyclic physiological loading machine at 1 cycle/s with a load of 200 kg. The test was observed for 50,000 loading cycles or until implant failure, whichever occurred earlier. Peak displacements were measured and analysis was done to determine construct stiffness and gap micromotion in axial loading. RESULT It was observed that there was statistically significant difference in terms of displacement at the fracture gap and overall construct stiffness of specimens of both groups. PFN construct group showed a mean subsidence of 1.02 mm and Gamma nail construct group showed mean subsidence of 2.36 mm after cycling. The average stiffness of Gamma nail group was 62.8 ± 8.4 N/mm which was significantly lower than average stiffness of the PFN group (80.4 ± 5.9 N/mm) (P = 0.03). In fatigue testing, 1 out of 9 PFN bone construct failed, while 5 of 9 Gamma nail bone construct failed. CONCLUSION When considering micromotion (subsidence) and incidence of implant/screw failure, double screw device (PFN) had statistically significant lower micromotion across the fracture gap with axial compression and lower incidence of implant failure. Hence, double screw device (PFN) construct had higher stability compared to single screw device (GN) in an unstable trochanteric fracture femur model.
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Affiliation(s)
- Amit Rastogi
- Department of Orthopaedics, Institute of Medical Sciences, Varanasi, India
| | - GR Arun
- Department of Orthopaedics, Institute of Medical Sciences, Varanasi, India,Address for correspondence: Dr. GR Arun, Room No. 56, New Doctors Hostel, BHU, Varanasi - 221 005, Uttar Pradesh, India. E-mail:
| | - Vakil Singh
- Department of Metallurgical Engineering, Institute of Technology, BHU, Varanasi, India
| | - Anant Singh
- Department of Orthopaedics, Institute of Medical Sciences, Varanasi, India
| | - Ashutosh K Singh
- Department of Orthopaedics, Mayo Institute of Medical Sciences, Barabanki, Uttar Pradesh, India
| | - Vinay Kumaraswamy
- Department of Orthopaedics, Institute of Medical Sciences, Varanasi, India
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Al-Ani AN, Neander G, Samuelsson B, Blomfeldt R, Ekström W, Hedström M. Risk factors for osteoporosis are common in young and middle-aged patients with femoral neck fractures regardless of trauma mechanism. Acta Orthop 2013; 84:54-9. [PMID: 23343373 PMCID: PMC3584603 DOI: 10.3109/17453674.2013.765639] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE There have been few prospective studies examining young and middle-aged patients with hip fracture. We therefore investigated background data, risk factors, and the trauma mechanism in young and middle-aged patients with femoral neck fracture. PATIENTS AND METHODS 185 patients, 27 young (20-49 years old) and 158 middle-aged (50-69 years old) were prospectively included in a multicenter study lasting 3 years. Background data and risk factors for osteoporosis and fracture were obtained, and the type of injury was classified as low-energy trauma, high-energy trauma, or sports injury. RESULTS In the young age group, the fracture occurred because of low-energy trauma in two-fifths of patients and because of sport injury in two-fifths of patients. The rest occurred because of high-energy trauma. The corresponding proportions for the middle-aged group were four-fifths, one tenth, and one tenth (p < 0.001). There was a higher proportion of men (19/27) in the young group than in the middle-aged group (69/158) (p = 0.001). One fifth of the young patients were smokers as compared to two-fifths in the middle-age group (p = 0.04). One quarter of the patients reported high-volume alcohol drinking, with no difference between the two groups. Furthermore, three-quarters of the young patients and four-fifths of the middle-aged patients had one or more risk factors for osteoporosis and fracture. INTERPRETATION A minority of patients in each age group had high-energy trauma as the cause of their femoral neck fracture. Lifestyle factors and other non-trauma-related risk factors appear to have been important contributors to the occurrence of femoral neck fracture in both age groups.
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Affiliation(s)
- Amer N Al-Ani
- Institute of Clinical Science, Intervention and Technology (CLINTEC), Department of Orthopaedics, Karolinska University Hospital
| | - Gustaf Neander
- Clinical Sciences, Department of Orthopaedics, Danderyd Hospital;
| | - Bodil Samuelsson
- Clinical Sciences, Department of Orthopaedics, Danderyd Hospital;
| | - Richard Blomfeldt
- Section of Orthopaedics, Department of Clinical Science and Education, Södersjukhuset
| | - Wilhelmina Ekström
- Department of Molecular Medicine and Surgery, Section of Orthopaedics and Sports Medicine, Karolinska University Hospital; 2,3,4 Karolinska Institutet, Stockholm, Sweden.
| | - Margareta Hedström
- Institute of Clinical Science, Intervention and Technology (CLINTEC), Department of Orthopaedics, Karolinska University Hospital
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Identifying clinically relevant groups of hip fracture patients at risk of adverse outcomes by using classification tree analysis. Int J Orthop Trauma Nurs 2013. [DOI: 10.1016/j.ijotn.2012.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Fisher AA, Srikusalanukul W, Davis MW, Smith PN. Clinical profiles and risk factors for outcomes in older patients with cervical and trochanteric hip fracture: similarities and differences. J Trauma Manag Outcomes 2012; 6:2. [PMID: 22333003 PMCID: PMC3295722 DOI: 10.1186/1752-2897-6-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2011] [Accepted: 02/15/2012] [Indexed: 02/08/2023]
Abstract
Background Data on clinical characteristics and outcomes in regard to hip fracture (HF) type are controversial. This study aimed to evaluate whether clinical and laboratory predictors of poorer outcomes differ by HF type. Methods Prospective evaluation of 761 consecutively admitted patients (mean age 82.3 ± 8.8 years; 74.9% women) with low-trauma non-pathological HF. Clinical characteristics and short-term outcomes were recorded. Haematological, renal, liver and thyroid status, C-reactive protein, cardiac troponin I, serum 25(OH) vitamin D, PTH, leptin, adiponectin and resistin were determined. Results The cervical compared to the tronchanteric HF group was younger, have higher mean haemoglobin, albumin, adiponectin and resistin and lower PTH levels (all P < 0.05). In-hospital mortality, length of hospital stay (LOS), incidence of post-operative myocardial injury and need of institutionalisation were similar in both groups. Multivariate analysis revealed as independent predictors for in-hospital death in patient with cervical HF male sex, hyperparathyroidism and lower leptin levels, while in patients with trochanteric HF only hyperparathyroidism; for post-operative myocardial injury dementia, smoking and renal impairment in the former group and coronary artery disease (CAD), hyperparathyroidism and hypoleptinaemia in the latter; for LOS > 20 days CAD, and age > 75 years and hyperparathyroidism, respectively. Need of institutionalisation was predicted by age > 75 years and dementia in both groups and also by hypovitaminosis D in the cervical and by hyperparathyroidism in the trochanteric HF. Conclusions Clinical characteristics and incidence of poorer short-term outcomes in the two main HF types are rather similar but risk factors for certain outcomes are site-specific reflecting differences in underlying mechanisms.
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Affiliation(s)
- Alexander A Fisher
- Department of Geriatric Medicine, The Canberra Hospital, PO Box 11, Woden, ACT 2606, Australia.
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Hedman AMR, Strömberg L, Grafström M, Heikkilä K. Hip fracture patients’ cognitive state affects family members’ experiences - a diary study of the hip fracture recovery. Scand J Caring Sci 2010; 25:451-8. [DOI: 10.1111/j.1471-6712.2010.00848.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Kristensen MT, Foss NB, Ekdahl C, Kehlet H. Prefracture functional level evaluated by the New Mobility Score predicts in-hospital outcome after hip fracture surgery. Acta Orthop 2010; 81:296-302. [PMID: 20450426 PMCID: PMC2876830 DOI: 10.3109/17453674.2010.487240] [Citation(s) in RCA: 111] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Clinicians need valid and easily applicable predictors of outcome in patients with hip fracture. Adjusting for previously established predictors, we determined the predictive value of the New Mobility score (NMS) for in-hospital outcome in patients with hip fracture. PATIENTS AND METHODS We studied 280 patients with a median age of 81 (interquartile range 72-86) years who were admitted from their own homes to a special hip fracture unit. Main outcome was the regain of independence in basic mobility, defined as. independence in getting in and out of bed, sitting down and standing up from a chair, and walking with an appropriate walking aid. The Cumulated Ambulation score was used to evaluate basic mobility. Predictor variables were NMS functional level before fracture, age, sex, fracture type, and mental and health status. RESULTS Except for sex, all predictor variables were statistically significant in univariate testing. In multiple logistic regression analysis, only age, NMS functional level before fracture, and fracture type were significant. Thus, patients with a low prefracture NMS and/or an intertrochanteric fracture would be 18 and 4 times more likely not to regain independence in basic mobility during the hospital stay, respectively, than patients with a high prefracture level and a cervical fracture, respectively. The model was statistically stable and correctly classified 84% of cases. INTERPRETATION The NMS functional level before fracture, age, and fracture type facilitate prediction of the in-hospital rehabilitation potential after hip fracture surgery.
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Affiliation(s)
| | - Nicolai B Foss
- Anesthesiology, Hvidovre Hospital, Copenhagen University
| | - Charlotte Ekdahl
- Division of Physical Therapy, Health Sciences Center, Lund UniversitySweden
| | - Henrik Kehlet
- Section of Surgical Pathophysiology, Rigshospitalet, Copenhagen UniversityDenmark
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Modeling the Length of the Care Episode after Hip Fracture: Does the Type of Fracture Matter? Scand J Surg 2009; 98:169-74. [DOI: 10.1177/145749690909800308] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background and Aims: Hip fractures are common events that require intensive operative hospital care and a lengthy rehabilitation. The effect of hip fracture type on successful rehabilitation is not well known. The aim of this study is to model and compare the length of the care episodes between intra- and extracapsular hip fractures in Finland. Material and Methods: 15544 hip fracture patients living at home in Finland 1998–2001 were followed using register-based data. Patient characteristics, outcomes, and length of stay (LOS) distributions were analyzed using a Bayesian nonparametric multilayer perceptron (MLP) network model. Results: Mortality was similar in intra- and extracapsular hip fractures. Patients were more likely to need long-term care after extracapsular hip fracture. The average LOS at the surgical ward was similar for intra- and extracapsular fractures (1.7 weeks), but there was a considerable difference for the total inpatient LOS between the groups (5.2 weeks vs. 6.9 weeks). Intracapsular fractures had a simple unimodal LOS distribution, whereas the LOS distribution for the extracapsular fractures was multimodal with two clear peaks. Patients with more comorbidities required a longer LOS. Conclusions: The causes for differences in LOS between fracture types were most likely due to the different surgical methods and rehabilitation practices for the fracture types. As national guidelines suggest similar rehabilitation for all hip fracture patients, there is a need for early and aggressive rehabilitation of patients with extracapsular fractures, including full-weight bearing for all but selected patients.
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Frihagen F. On the diagnosis and treatment of femoral neck fractures. ACTA ORTHOPAEDICA. SUPPLEMENTUM 2009; 80:1-26. [PMID: 19919380 DOI: 10.1080/17453690610046611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Rydholm Hedman AM, Heikkilä K, Grafström M, Strömberg L. Hip fractures and cognitive state: patient outcomes and proxies’ perceptions of the rehabilitation period. Int J Older People Nurs 2008; 3:178-86. [DOI: 10.1111/j.1748-3743.2008.00131.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Hagino T, Ochiai S, Wako M, Sato E, Maekawa S, Hamada Y. Comparison of the prognosis among different age groups in elderly patients with hip fracture. Indian J Orthop 2008; 42:29-32. [PMID: 19823651 PMCID: PMC2759581 DOI: 10.4103/0019-5413.38577] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The outcome of treatment of hip fractures in different age groups in the elderly population is largely unknown. Hence, we stratified elderly patients with hip fracture into age groups and compared the prognosis in various age groups. MATERIALS AND METHODS Among 459 patients with hip fracture treated at our hospital from 1997, 430 patients aged 65 years or above at the time of injury were studied. The patients comprised 98 males and 332 females and the ages at injury ranged from 65 to 103 years (mean 83.4 years). There were 167 cases of femoral neck fracture and 263 cases of trochanteric fractures. Surgery was performed in 383 cases, while 47 cases were treated conservatively. The subjects were classified by age into young-old for those aged 65-74 years (group A, n = 55), middle-old for those aged 75-84 years (group B, n = 172), old-old for those aged 85-94 (group C, n = 180), and oldest-old for those aged 95 years or above (group D, n = 23). The functional and survival prognosis at discharge in each group was investigated. RESULTS Numbers of patients who were ambulatory at discharge among those ambulatory before injury were 43 of 49 (87.8%) in group A, 113 of 152 (74.3%) in group B, 86 of 138 (62.3%) in group C, and 5 of 14 (35.7%) in group D, showing worse recovery of walking ability as age advanced. Among those ambulatory before injury, 42 patients in group A, 139 patients in group B, 130 patients in group C, and 12 patients in group D underwent surgery and of these patients, 38 patients (90.5%) in group A, 109 patients (78.4%) in group B, 83 patients (63.8%) in group C, and 5 patients (41.7%) in group D were ambulatory at discharge. On the other hand, the numbers of patients who were ambulatory at discharge among those receiving conservative treatment were 5 of 7 (71.4%) in group A, 4 of 13 (30.8%) in group B, 3 of 8 (37.5%) in group C, and 0 of 2 (0%) in group D, showing better walking ability in surgical patients than in conservatively treated patients even in the elderly. There were two in-hospital deaths in group B, 11 in group C, and two in group D. Five of the 15 deaths were inoperable cases due to poor performance status at admission. CONCLUSION Walking ability at discharge and survival prognosis worsened as age advanced. On the other hand, since surgical cases achieved better walking ability than conservatively treated cases, efforts should be made to achieve better functional prognosis even in the old-olds, including surgery together with early ambulation and rehabilitation.
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Affiliation(s)
- Tetsuo Hagino
- Department of Orthopaedic Surgery, National Hospital Organization, Kofu National Hospital, Yamanashi, Japan.
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Penrod JD, Litke A, Hawkes WG, Magaziner J, Koval KJ, Doucette JT, Silberzweig SB, Siu AL. Heterogeneity in Hip Fracture Patients: Age, Functional Status, and Comorbidity. J Am Geriatr Soc 2007; 55:407-13. [PMID: 17341244 DOI: 10.1111/j.1532-5415.2007.01078.x] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To examine unidentified heterogeneity in hip fracture patients that may predict variation in functional outcomes. DESIGN Observational, longitudinal, multisite cohort study. SETTING Three separate cohorts from five hospitals in the metropolitan New York area and eight hospitals in Baltimore. PARTICIPANTS Two thousand six hundred ninety-two hip fracture patients treated at one of 13 hospitals and followed for 6 months postfracture. MEASUREMENTS A mobility measure with three categories (independent (walks independently or with a device), limited independence (needs human assistance or supervision to walk 150 feet or one block or able only to walk indoors), and unable to walk) was developed for use with all three cohorts. A similar measure was developed for the other activities of daily living (ADLs): bathing, dressing, feeding, and using the toilet. Cluster analysis was used to form homogenous groups of patients based on baseline demographic characteristics, comorbid conditions, and baseline mobility and ADL independence. RESULTS Seven homogeneous subgroups were identified based on prefracture age, health, and functional status, with measurably different 6-month functional outcomes. At least 90% of patients could be correctly classified into the seven groups using simple decision rules about age, ADLs, and dementia status at baseline. Dementia was the only comorbid condition that segmented the groups. CONCLUSION The heterogeneous hip fracture population can be grouped into homogenous patient clusters based on prefracture characteristics. Differentially targeting services and interventions to these subgroups may improve functional status outcomes.
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Affiliation(s)
- Joan D Penrod
- Program of Research in Serious Physical and Mental Illness, Bronx VA Medical Center, New York, New York 10468, USA.
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Endres HG, Dasch B, Lungenhausen M, Maier C, Smektala R, Trampisch HJ, Pientka L. Patients with femoral or distal forearm fracture in Germany: a prospective observational study on health care situation and outcome. BMC Public Health 2006; 6:87. [PMID: 16594996 PMCID: PMC1526725 DOI: 10.1186/1471-2458-6-87] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2005] [Accepted: 04/04/2006] [Indexed: 11/13/2022] Open
Abstract
Background Distal radius and proximal femoral fractures are typical injuries in later life, predominantly due to simple falls, but modulated by other relevant factors such as osteoporosis. Fracture incidence rates rise with age. Because of the growing proportion of elderly people in Western industrialized societies, the number of these fractures can be expected to increase further in the coming years, and with it the burden on healthcare resources. Our study therefore assessed the effects of these injuries on the health status of older people over time. The purpose of this paper is to describe the study method, clinical parameters of fracture patients during hospitalization, mortality up to one and a half years after discharge in relation to various factors such as type of fracture, and to describe changes in mobility and living situation. Methods Data were collected from all consecutive patients (no age limit) admitted to 423 hospitals throughout Germany with distal radius or femoral fractures (57% acute-care, femoral and forearm fractures; 43% rehabilitation, femoral fractures only) between January 2002 and September 2003. Polytrauma and coma patients were excluded. Demographic characteristics, exact fracture location, mobility and living situation, clinical and laboratory parameters were examined. Current health status was assessed in telephone interviews conducted on average 6–7 months after discharge. Where telephone contact could not be established, at least survival status (living/deceased/date of death) was determined. Results The study population consisted of 12,520 femoral fracture patients (86.8% hip fractures), average age 77.5 years, 76.5% female, and 2,031 forearm fracture patients, average age 67.6 years, 81.6% female. Women's average age was 6.6 (femoral fracture) to 10 years (forearm fracture) older than men's (p < 0.0001). Only 4.6% of femoral fracture patients experienced changes in their living situation post-discharge (53% because of the fracture event), although less than half of subjects who were able to walk without assistive devices prior to the fracture event (76.7%) could still do so at time of interview (34.9%). At time of interview, 1.5% of subjects were bed-ridden (0.2% before fracture). Forearm fracture patients reported no change in living situation at all. Of the femoral fracture patients 119 (0.95%), and of the forearm fracture patients 3 (0.15%) died during hospital stay. Post-discharge (follow-up one and a half years) 1,463 femoral fracture patients died (19.2% acute-care patients, 8.5% rehabilitation patients), but only 60 forearm fracture patients (3.0%). Ninety percent of femoral fracture deaths happened within the first year, approximately 66% within the first 6 months. More acute-care patients with a pertrochanteric fracture died within one year post-discharge (20.6%) than patients with a cervical fracture (16.1%). Conclusion Mortality after proximal femoral fracture is still alarmingly high and highest after pertrochanteric fracture. Although at time of interview more than half of femoral fracture patients reported reduced mobility, most patients (96%) attempt to live at home. Since forearm fracture patients were on average 10 years younger than femoral fracture patients, forearm fractures may be a means of diagnosing an increased risk of later hip fractures.
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Affiliation(s)
- Heinz G Endres
- Department of Medical Informatics, Statistics and Epidemiology, Ruhr University Bochum, D-44801 Bochum, Germany
| | - Burkhard Dasch
- Department of Medical Informatics, Statistics and Epidemiology, Ruhr University Bochum, D-44801 Bochum, Germany
| | - Margitta Lungenhausen
- Department of Pain Management, BG-Kliniken Bergmannsheil, Ruhr University Bochum, D-44789 Bochum, Germany
| | - Christoph Maier
- Department of Pain Management, BG-Kliniken Bergmannsheil, Ruhr University Bochum, D-44789 Bochum, Germany
| | - Rüdiger Smektala
- Department of Surgery, Knappschaftskrankenhaus Bochum-Langendreer, Ruhr University Bochum, D-44892 Bochum, Germany
| | - Hans J Trampisch
- Department of Medical Informatics, Statistics and Epidemiology, Ruhr University Bochum, D-44801 Bochum, Germany
| | - Ludger Pientka
- Department of Geriatrics, Ruhr University Bochum, Marienhospital Herne, D-44627 Herne, Germany
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