1
|
Mounisamy P, Suresh H, Chandrashekar S, D U, Jeyaraman N, Jeyaraman M, Muthu S. Medial cortical reduction does not influence outcomes in geriatric intertrochanteric femur fractures treated with proximal femoral nail. World J Orthop 2025; 16:106862. [PMID: 40290611 PMCID: PMC12019145 DOI: 10.5312/wjo.v16.i4.106862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2025] [Revised: 03/23/2025] [Accepted: 04/11/2025] [Indexed: 04/17/2025] Open
Abstract
BACKGROUND In intertrochanteric fractures, the positive medial cortex support reduction is considered to provide a non-anatomical buttress that helps in controlled collapse. AIM To analyze the concept of medial cortical reduction (MCR) and its clinical and radiological association in geriatric intertrochanteric femur fractures. METHODS Geriatric patients who presented with AO/OTA 31A1 and 31A2 femur fractures and treated with proximal femoral nailing between July 2021 and June 2023 were include in this prospective cohort study. Based on the degree of MCR, they were divided into positive, neutral, or negative MCR groups. The demographic baseline characteristics, postoperative radiographic femoral neck-shaft angle and neck length were analyzed at 6, 12 and 24 weeks post-surgery. Functional outcomes such as modified Harris Hip Score (HHS) and time to full-weight bearing were also analyzed. RESULTS 47 patients (Male: Famale 35:12) with mean age of 65.8 ± 4.2 years were included in this study. Twenty-two cases had neutral support, nine had negative support, and sixteen had positive support in the medial cortex post-operatively. Baseline characteristics of the three groups were comparable. No significant differences were found in the femur neck length and femur neck-shaft angle changes post-surgery between the groups. The modified HHS was not found to be significant between the groups (P = 0.883) as that of the time to full weight bearing (P = 0.789). CONCLUSION The type of reduction achieved based on medial cortical alignment does not affect the femur neck length shortening or varus collapse. Future randomized controlled trials are needed to validate the findings noted in the study.
Collapse
Affiliation(s)
- Prabu Mounisamy
- Department of Orthopaedics, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry 605006, India
| | - Hanoop Suresh
- Department of Orthopaedics, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry 605006, India
| | - Sushma Chandrashekar
- Department of Orthopaedics, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry 605006, India
| | - Udayakumar D
- Department of Orthopaedics, Sri Manakula Vinayagar Medical College and Hospital, Puducherry 605107, India
| | - Naveen Jeyaraman
- Department of Orthopaedics, ACS Medical College and Hospital, Dr MGR Educational and Research Institute, Chennai 600077, Tamil Nadu, India
- Department of Orthopaedics, Orthopaedic Research Group, Coimbatore 641045, Tamil Nadu, India
| | - Madhan Jeyaraman
- Department of Orthopaedics, ACS Medical College and Hospital, Dr MGR Educational and Research Institute, Chennai 600077, Tamil Nadu, India
- Department of Orthopaedics, Orthopaedic Research Group, Coimbatore 641045, Tamil Nadu, India
| | - Sathish Muthu
- Department of Orthopaedics, Orthopaedic Research Group, Coimbatore 641045, Tamil Nadu, India
- Central Research Laboratory, Meenakshi Medical College Hospital and Research Institute, Meenakshi Academy of Higher Education and Research, Chennai 600078, Tamil Nadu, India
| |
Collapse
|
2
|
Hecht GA, Senden R, Marcellis R, Mertes M, Willems P, Meijer K, Poeze M, Blokhuis TJ. Early Postoperative Gait Analysis in Elderly Patients Following Hip Fracture Surgery. SENSORS (BASEL, SWITZERLAND) 2025; 25:1888. [PMID: 40293021 PMCID: PMC11945655 DOI: 10.3390/s25061888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2025] [Revised: 02/26/2025] [Accepted: 03/14/2025] [Indexed: 04/30/2025]
Abstract
Hip fractures in elderly patients significantly reduce independence and quality of life. Early postoperative gait performance remains poorly understood, particularly regarding differences between surgical treatments, such as proximal femur nailing and hemiarthroplasty. Identifying gait alterations early in rehabilitation could optimize clinical interventions. This prospective observational cohort study included 40 elderly patients hospitalized after acute hip fracture surgery. Relative peak force and step duration were assessed using the ambulant pressure biofeedback system during postoperative mobilization. Additionally, three-dimensional gait analysis evaluated spatiotemporal parameters and sagittal plane kinematics of the hip, knee, and ankle. Results demonstrated significant improvements in median peak force (45.32% to 70.00%, (p < 0.001)) and median step duration (2.96 s to 137 s, (p < 0.001)) at the end of the hospitalization period. No significant differences in step duration and peak force were observed between the different surgical procedures, proximal femur nail, and hemiarthroplasty. Three-dimensional gait analysis showed significantly reduced hip extension during terminal stance in the operated leg compared to the healthy leg. These findings highlight the utility of biofeedback systems for monitoring early rehabilitation progress and emphasize the importance of 3D gait analysis in identifying early postoperative gait deficits. Targeted interventions during hospitalization could enhance functional recovery and improve patient outcomes.
Collapse
Affiliation(s)
- Gereon Anton Hecht
- Department of Trauma Surgery, Maastricht University Medical Centre (MUMC+), 6229 HX Maastricht, The Netherlands
| | - Rachel Senden
- Department of Physical Therapy, Maastricht University Medical Centre (MUMC+), 6229 HX Maastricht, The Netherlands
| | - Rik Marcellis
- Department of Physical Therapy, Maastricht University Medical Centre (MUMC+), 6229 HX Maastricht, The Netherlands
| | - Matthias Mertes
- Department of Trauma Surgery, Maastricht University Medical Centre (MUMC+), 6229 HX Maastricht, The Netherlands
| | - Paul Willems
- Department of Nutrition and Movement Sciences, Maastricht University, 6211 LK Maastricht, The Netherlands
| | - Kenneth Meijer
- Department of Nutrition and Movement Sciences, Maastricht University, 6211 LK Maastricht, The Netherlands
- School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, 6211 LK Maastricht, The Netherlands
| | - Martijn Poeze
- Department of Trauma Surgery, Maastricht University Medical Centre (MUMC+), 6229 HX Maastricht, The Netherlands
- School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, 6211 LK Maastricht, The Netherlands
| | - Taco J. Blokhuis
- Department of Trauma Surgery, Maastricht University Medical Centre (MUMC+), 6229 HX Maastricht, The Netherlands
- School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, 6211 LK Maastricht, The Netherlands
| |
Collapse
|
3
|
Vesseur MAM, Quaedvlieg L, Schotanus MGM, Most J, Bouwman LH, van Vugt R, Boonen B. Zuyderland Hip Inference for Survival and Lifetime Expectancy (ZHISLE) following hip fracture surgery: validation of the model that demonstrated good predictive power. Hip Int 2025; 35:214-219. [PMID: 39772998 DOI: 10.1177/11207000241312306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2025]
Abstract
PURPOSE Proximal femoral fractures are common within the elderly population and are associated with a high risk of mortality and reduced quality of life. Hemiarthroplasty or osteosynthesis (extramedullary or intramedullary) is the primary treatment option for these fractures. However, within this fragile patient population many comorbidities, among others dementia, are seen. Therefore, predicting patients with a high mortality risk after surgery may lead to adopting alternative treatment options with less risks. This paper proposes a new model to distinguish patients with high postoperative mortality risk with adequate follow-up time in combination with a wide set of useful and available variables. METHODS Patients treated with hemiarthroplasty or osteosynthesis for proximal femoral fractures were studied, with a follow-up period of 6 months. Patients who died within this follow-up period were compared to survivors, and predicting variables were assessed in logistic regression: The Zuyderland Hip Inference for Survival and Lifetime Expectancy (ZHISLE). The model was validated internally against a held-out dataset. Furthermore, the model performance was compared against the Almelo Hip Fracture Score (AHFS) on the same sample. RESULTS Out of 2463 patients undergoing surgical treatment for proximal femoral fractures, 415 (16.8%) died within 183 days. Predictors for early mortality included old age, male sex, high heartbeat, KATZ-ADL and GFI scores, C-reactive protein and urea concentrations and low albumin concentration. Our model showed satisfactory predictive and discriminatory power (ROC curve = 0.81). Internal validation was good (ROC in validation dataset = 0.81), and better than the AHFS (ROC = 0.57). CONCLUSIONS The ZHISLE model demonstrates good predictive power concerning mortality risk for old patients with a proximal femoral fracture. The model could benefit patients by indicating if a conservative, non-invasive policy might be a better option for those patients.
Collapse
Affiliation(s)
- Maud A M Vesseur
- Multidisciplinary Trauma Unit, Zuyderland Medical Center, Heerlen, The Netherlands
- Department of Orthopaedic Surgery, Zuyderland Medical Center, Sittard-Geleen, The Netherlands
- Faculty of Science and Engineering, STEM Graduate School Maastricht University, Maastricht, The Netherlands
| | - Lars Quaedvlieg
- Department of Finance, Artificial Intelligence, Zuyderland Medical Center, Sittard-Geleen, The Netherlands
| | - Martijn G M Schotanus
- Department of Orthopaedic Surgery, Zuyderland Medical Center, Sittard-Geleen, The Netherlands
- School of Care and Public Health Research Institute, Faculty of Health, Medicine and Life Science, Maastricht University, Maastricht, The Netherlands
| | - Jasper Most
- Department of Orthopaedic Surgery, Zuyderland Medical Center, Sittard-Geleen, The Netherlands
| | - Lee H Bouwman
- Faculty of Science and Engineering, STEM Graduate School Maastricht University, Maastricht, The Netherlands
- Department of Surgery, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Raoul van Vugt
- Multidisciplinary Trauma Unit, Zuyderland Medical Center, Heerlen, The Netherlands
- Department of Surgery, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Bert Boonen
- Multidisciplinary Trauma Unit, Zuyderland Medical Center, Heerlen, The Netherlands
- Department of Orthopaedic Surgery, Zuyderland Medical Center, Sittard-Geleen, The Netherlands
| |
Collapse
|
4
|
Tang W, Wang Y, He Y, Liu B, Yuan R, Zhou Y, Huang H. Effect of early rehabilitation on hospital stay and postoperative complications in elderly hip fracture patients: a prospective cohort study. J Orthop Surg Res 2025; 20:84. [PMID: 39849613 PMCID: PMC11755951 DOI: 10.1186/s13018-024-05354-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2024] [Accepted: 12/10/2024] [Indexed: 01/25/2025] Open
Abstract
BACKGROUND Hip fractures in the elderly are a major global public health concern, with incidence projected to rise as populations age. Rehabilitation is critical to recovery after hip fracture surgery, but the ideal timing for initiation remains uncertain. While early rehabilitation, within 48 h post-surgery, is associated with better outcomes, its specific impact on hospital stay duration and postoperative complications is not yet conclusively established. AIM This study aims to evaluate the effects of initiating rehabilitation within 48 h after hip fracture surgery on hospital length of stay and postoperative complications, compared to rehabilitation started one-week post-surgery in elderly patients. It is hypothesized that early rehabilitation will significantly reduce hospital stays and decrease the rate of postoperative complications. METHODS In this prospective cohort study, patients aged 65 and older are divided into early rehabilitation (within 48 h) and delayed rehabilitation (after one week) groups. Data will be collected using electronic medical records (EMR), standardized clinical tools (Barthel Index, Timed Up and Go), and patient-reported outcome measures (SF-36, EQ-5D). Statistical analyses will include t-tests and chi-square tests for outcome comparison, with multiple regression adjusting for potential confounders such as age, gender, and comorbidities.
Collapse
Affiliation(s)
- Wen Tang
- Department of Orthopedics Center, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang City, 421001, Hunan Province, China
| | - Yiqi Wang
- School of Nursing, University of South China, Hengyang City, 421001, Hunan Province, China
| | - Yulian He
- Department of Orthopedics Center, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang City, 421001, Hunan Province, China
| | - Bo Liu
- Department of Orthopedics Center, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang City, 421001, Hunan Province, China
| | - Runzhi Yuan
- Department of Orthopedics Center, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang City, 421001, Hunan Province, China
| | - Yanhui Zhou
- Nursing Department, The First Affiliated Hospital, Hengyang Medical School, University of South China, No.69 Chuanshan Road, Shigu District, 421001, Hengyang City, Hunan Province, China.
| | - Huayong Huang
- Department of Emergency Medicine Center, The First Affiliated Hospital, Hengyang Medical School, University of South China, No.69 Chuanshan Road, Shigu District, 421001, Hengyang City, Hunan Province, China.
| |
Collapse
|
5
|
Jia S, Liu W, Zhang M, Wang L, Ren C, Feng C, Zhang T, Lv H, Hou Z, Zou W, Zhang Y, Tong W, Wang J, Chen W. Insufficient Mechanical Loading Downregulates Piezo1 in Chondrocytes and Impairs Fracture Healing Through ApoE-Induced Senescence. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2024; 11:e2400502. [PMID: 39418070 PMCID: PMC11633519 DOI: 10.1002/advs.202400502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 08/10/2024] [Indexed: 10/19/2024]
Abstract
Insufficient mechanical loading impairs fracture healing; however, the underlying mechanisms remain unclear. Increasing evidence indicates that Piezo1 plays an important role in fracture healing, although the effect of Piezo1 on the endochondral ossification of chondrocytes has been overlooked. This study reports that mechanical unloading down-regulates the expression of Piezo1 in chondrocytes and leads to fracture nonunion. Single-cell sequencing of calluses revealed that specific deletion of Piezo1 in chondrocytes upregulated the expression of apolipoprotein E (ApoE) in hypertrophic chondrocytes, resulting in delayed cartilage-to-bone transition due to enhanced chondrocyte senescence. Based on these results, an injectable and thermosensitive hydrogel is developed, which released an ApoE antagonist in situ at the fracture site. This hydrogel effectively attenuated chondrocyte senescence and, thus, promoted cartilage-to-bone transition as well as the fracture healing process. Overall, this data provide a new perspective on the activity of chondrocytes in fracture healing and a new direction for the treatment of fracture nonunion caused by insufficient mechanical loading.
Collapse
Affiliation(s)
- Siming Jia
- Department of Orthopaedic Surgery, NHC Key Laboratory of Intelligent Orthopaedic EquipmentHebei Medical University Third HospitalShijiazhuangHebei050051China
- Hebei Medical University Clinical Medicine Postdoctoral Station (Hebei Medical University Third Hospital)ShijiazhuangHebei050051China
| | - Weijian Liu
- Department of OrthopaedicsUnion HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhanHubei430022China
| | - Mo Zhang
- Hebei Medical University Clinical Medicine Postdoctoral Station (Hebei Medical University Third Hospital)ShijiazhuangHebei050051China
- School of PharmacyKey Laboratory of Innovative Drug Development and EvaluationHebei Medical UniversityShijiazhuang050017China
| | - Lijun Wang
- Hainan Institute of Regenerative Orthopedics and Sports Medicine, Hainan Academy of Medical Sciences and School of Basic MedicineHainan Medical UniversityHainan570000China
- Key Laboratory of RNA Innovation, Science and Engineering, CAS Center for Excellence in Molecular Cell Science, Shanghai Institute of Biochemistry and Cell Biology, University of Chinese Academy of SciencesChinese Academy of SciencesShanghai200031China
| | - Chuan Ren
- Department of Orthopaedic Surgery, NHC Key Laboratory of Intelligent Orthopaedic EquipmentHebei Medical University Third HospitalShijiazhuangHebei050051China
| | - Chen Feng
- Department of Orthopaedic Surgery, NHC Key Laboratory of Intelligent Orthopaedic EquipmentHebei Medical University Third HospitalShijiazhuangHebei050051China
| | - Tao Zhang
- Department of Orthopaedic Surgery, NHC Key Laboratory of Intelligent Orthopaedic EquipmentHebei Medical University Third HospitalShijiazhuangHebei050051China
| | - Hongzhi Lv
- Department of Orthopaedic Surgery, NHC Key Laboratory of Intelligent Orthopaedic EquipmentHebei Medical University Third HospitalShijiazhuangHebei050051China
| | - Zhiyong Hou
- Department of Orthopaedic Surgery, NHC Key Laboratory of Intelligent Orthopaedic EquipmentHebei Medical University Third HospitalShijiazhuangHebei050051China
| | - Weiguo Zou
- Hainan Institute of Regenerative Orthopedics and Sports Medicine, Hainan Academy of Medical Sciences and School of Basic MedicineHainan Medical UniversityHainan570000China
- Key Laboratory of RNA Innovation, Science and Engineering, CAS Center for Excellence in Molecular Cell Science, Shanghai Institute of Biochemistry and Cell Biology, University of Chinese Academy of SciencesChinese Academy of SciencesShanghai200031China
| | - Yingze Zhang
- Department of Orthopaedic Surgery, NHC Key Laboratory of Intelligent Orthopaedic EquipmentHebei Medical University Third HospitalShijiazhuangHebei050051China
| | - Wei Tong
- Department of OrthopaedicsUnion HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhanHubei430022China
| | - Juan Wang
- Department of Orthopaedic Surgery, NHC Key Laboratory of Intelligent Orthopaedic EquipmentHebei Medical University Third HospitalShijiazhuangHebei050051China
| | - Wei Chen
- Department of Orthopaedic Surgery, NHC Key Laboratory of Intelligent Orthopaedic EquipmentHebei Medical University Third HospitalShijiazhuangHebei050051China
| |
Collapse
|
6
|
Söderberg J, Sallfeldt E, Ribom E, Urell C. Cross-cultural adaptation and test-retest reliability assessment of a Swedish version of the exercise adherence rating scale in patients after shoulder surgery. Ann Med 2024; 56:2409962. [PMID: 39351706 PMCID: PMC11445904 DOI: 10.1080/07853890.2024.2409962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 06/19/2024] [Accepted: 06/25/2024] [Indexed: 10/04/2024] Open
Abstract
BACKGROUND Adherence to prescribed home exercise is an important predictor for the long-term effectiveness of exercise therapy and therefore important to evaluate. The Exercise Adherence Rating Scale (EARS) is a valid and reliable tool to assess exercise adherence behavior, but it is not translated into Swedish. This study aimed to translate EARS into Swedish and to explore the psychometric properties in terms of test-retest reliability, internal consistency as well and possible floor-/ceiling effects. MATERIALS AND METHODS A translation and cultural adaptation process followed international guidelines and resulted in EARS-Sv. A total of 30 patients who had undergone shoulder surgery were included in the study and filled out EARS-Sv at two different time points. The test-retest reliability was evaluated through the weighted kappa coefficient and Intraclass Correlation Coefficient (ICC). Cronbach's alpha was used to assess internal consistency. Floor-/ceiling effects were calculated. RESULTS The test-retest reliability of the questionnaire was good with ICC (0.79, CI 95%) and moderate with weighted kappa-coefficient (MD= 0.58). Cronbach's alpha was considered good (0.88). A ceiling effect was registered in all 6 items of EARS-Sv. CONCLUSION EARS-Sv has moderate to good test-retest reliability and good internal consistency in patients who have undergone shoulder surgery.
Collapse
Affiliation(s)
- Johanna Söderberg
- Department of Surgical Sciences, Orthopedics, Uppsala University, Uppsala, Sweden
| | - Ellen Sallfeldt
- Department of Surgical Sciences, Orthopedics, Uppsala University, Uppsala, Sweden
| | - Eva Ribom
- Department of Surgical Sciences, Orthopedics, Uppsala University, Uppsala, Sweden
| | - Charlotte Urell
- Department of Women’s and Children’s Health, Physiotherapy, Uppsala University, Uppsala, Sweden
| |
Collapse
|
7
|
Changsuphan S, Srisatidnarakul B, DeVon HA. RHD-HA-9: A scale for nurses to assess readiness for hospital discharge in older adults following hip arthroplasty-development and psychometric testing. BELITUNG NURSING JOURNAL 2024; 10:670-679. [PMID: 39601030 PMCID: PMC11586610 DOI: 10.33546/bnj.3583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2024] [Revised: 09/19/2024] [Accepted: 10/27/2024] [Indexed: 11/29/2024] Open
Abstract
Background Designing an instrument to assess discharge readiness post-hip surgery is essential due to trends showing poor patient outcomes, such as pain management issues, mobility challenges, and insufficient home support. A structured assessment tool would help ensure patients are better prepared for recovery, reducing the risk of complications and readmission. Objective To develop and test the psychometric properties of the Readiness for Hospital Discharge Scale (RHD-HA-9) for hip arthroplasty. Methods Items were generated from a comprehensive literature review and individual, face-to-face interviews with experts and patients. A cross-sectional study was conducted across four tertiary governmental hospitals to evaluate the psychometric properties of the scale. Data were collected from a total of 200 older adults who had undergone hip arthroplasty between June 2020 and February 2021. Exploratory Factor Analysis (EFA) was performed on data from 100 older adults to identify the underlying factor structure, followed by Confirmatory Factor Analysis (CFA) on a separate 100-patient dataset to validate the model. The questionnaire's internal consistency, corrected item-total correlations, inter-rater reliability, construct, concurrent, and predictive validity were assessed. Results The RHD-HA-9 included nine items, categorized into two factors: the physical performance of hip function and barriers to physical activity. EFA and CFA confirmed these factors, explaining 62% of the total variance. Model fit indices were acceptable (CFI = 0.97, TLI = 0.96, SRMR = 0.04), though RMSEA was 0.12. Chi-square was significant (χ2 = 0.056, df = 24, p <0.001). The scale showed excellent internal consistency (Cronbach's α = 0.89) and stability (ICC = 0.94). ROC analysis identified a cutoff of 9.5, with a sensitivity of 90.7%, specificity of 70.6%, and AUC of 0.89. Conclusion The RHD-HA-9 demonstrated strong psychometric properties for assessing discharge readiness in older adults following hip arthroplasty. It identifies patients who need additional support during their transition home. Nurses can use this tool to accurately assess patient needs and implement effective post-discharge care, thereby enhancing patient outcomes.
Collapse
Affiliation(s)
| | | | - Holli A. DeVon
- School of Nursing, University of California, Los Angeles, USA
| |
Collapse
|
8
|
Lormans P, Loos PJ, Vanbrabant S, Quetin P, Huybrechts X, Ghekiere O. Hip Fracture in the Sportive Adult: Case Report of Complete Functional Recovery After Removal of Hardware. J Sport Rehabil 2024; 33:683-686. [PMID: 39293791 DOI: 10.1123/jsr.2023-0338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 05/17/2024] [Accepted: 07/04/2024] [Indexed: 09/20/2024]
Abstract
CONTEXT Pertrochanteric hip fractures in sportive young adults are mainly caused by a high-energy trauma and treated in the same way as in the older population, using an osteosynthesis immediately followed by a rehabilitation program for several months. The current standard is not to remove osteosynthesis material, similar to the case of older patients. CASE PRESENTATION A 45-year-old male cyclist experienced a right pertrochanteric femoral fracture, treated with cephalomedullary nails. After 9 months of adequate rehabilitation, weakness of the quadriceps musculature and functional complaints persisted, objectified through an isokinetic strength test and a significantly reduced score on the Hip Disability and Osteoarthritis Outcome Score questionnaire. The patient was unable to return to his previous level of cycling performance. MANAGEMENT AND OUTCOME After exclusion of structural bone complications, nerve injury, and central sensitization, the functional complaints and strength deficiency were hypothesized to be related to the osteosynthesis material. Therefore, the hardware was removed 9 months after the first surgery, and the rehabilitation was continued for another 20 weeks. Very soon after the removal of the hardware, the functional complaints disappeared with a remarkable improvement of the Hip Disability and Osteoarthritis Outcome Score. The isokinetic strength test showed complete recovery of muscle strength 20 weeks after osteosynthesis removal, and preinjury cycling performance values were obtained 9 months posthardware removal. CONCLUSION Despite an adequate rehabilitation following a hip fracture, sporty young adults may fail to reach their previous level of functioning. Osteosynthesis removal may be indicated in this sportive population to reach complete muscle strength and functional recovery. The management of hip fractures in the sportive young adult and the identification of patients who may benefit from removal of the hardware require more research.
Collapse
Affiliation(s)
- Pieter Lormans
- Department of Physical Medicine and Rehabilitation, Jessa Ziekenhuis, Hasselt, Belgium
| | - Pieter-Jan Loos
- Department of Physical Medicine and Rehabilitation, Jessa Ziekenhuis, Hasselt, Belgium
| | - Stefanie Vanbrabant
- Department of Physiotherapy, Jessa Ziekenhuis, Hasselt, Belgium
- Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | - Philippe Quetin
- Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | - Xavier Huybrechts
- Department of Physical Medicine and Rehabilitation, Jessa Ziekenhuis, Hasselt, Belgium
| | - Olivier Ghekiere
- Department of Radiology, Jessa Ziekenhuis, Hasselt, Belgium
- Faculty of Medicine and Life Sciences, Cardiology and Organ Systems, Hasselt University, Diepenbeek, Belgium
| |
Collapse
|
9
|
Adulkasem N, Chotiyarnwong P, Vanitcharoenkul E, Unnanuntana A. Ambulation recovery prediction after hip fracture surgery using the Hip Fracture Short-Term Ambulation Prediction tool. J Rehabil Med 2024; 56:jrm40780. [PMID: 39482980 PMCID: PMC11541808 DOI: 10.2340/jrm.v56.40780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Accepted: 10/02/2024] [Indexed: 11/03/2024] Open
Abstract
OBJECTIVE To develop models for predicting postoperative ambulation recovery at 3 months following fragility hip fracture surgery. DESIGN Cross-sectional study. SUBJECTS Fragility hip fracture patients aged ≥ 50 years who underwent operative treatment and completed a 3-month follow-up. METHODS Potential predictors were collected from eligible patients, while ambulation at 3 months after injury was assessed using the modified functional ambulation classification. These factors were used to develop the Hip Fracture Short-Term Ambulation Prediction, consisting of 2 models: Model 1 for postoperative ambulation and Model 2 for preinjury status recovery. RESULTS Among the 275 patients, 55 (20.0%) achieved good ambulation, and 59 (21.5%) returned to their preinjury status at 3 months. Age, preinjury ambulatory status, and discharge ambulatory status were identified as significant predictors of 3-month postoperative ambulation. The tool presented (Models 1 and 2) showed strong performance (area under the curve of 0.86 and 0.85, respectively) and good internal validity. CONCLUSIONS Age, preinjury ambulatory status, and discharge ambulatory status significantly predict postoperative ambulation and preinjury status recovery at 3 months after fragility hip fracture surgery. The tool presented may aid clinicians in identifying patients who could benefit from targeted rehabilitation interventions during this crucial period.
Collapse
Affiliation(s)
- Nath Adulkasem
- Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Pojchong Chotiyarnwong
- Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Ekasame Vanitcharoenkul
- Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Aasis Unnanuntana
- Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
| |
Collapse
|
10
|
Padilla-Rojas LG, Tamayo-Cosio J, Garín-Zertuche DE, Rojas-Herrera CA, Vallejo L, Leal JA, Soarez-Hungria JO, Caiero MT, Tabares-Neyra H, González Roig JL, Giordano V. Trauma center rehabilitation systems in Latin America. OTA Int 2024; 7:e332. [PMID: 39114374 PMCID: PMC11301634 DOI: 10.1097/oi9.0000000000000332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 12/21/2023] [Accepted: 01/30/2024] [Indexed: 08/10/2024]
Abstract
Trauma is a leading cause of mortality and morbidity worldwide with high rates of disability in survivors. With improvements in care, rehabilitation of the trauma patient is a cornerstone to reducing sequelae. A lack of well-established hospital rehabilitation units and standardized protocols for managing posttraumatic injuries is a common problem in Latin American countries. Future studies should seek to understand the barriers and gaps in care so that consensus and ultimately best practice guidelines can be developed and included in rehabilitation programs throughout trauma centers in Latin America.
Collapse
Affiliation(s)
- Luis G. Padilla-Rojas
- Mexican Federation of Orthopaedic and Traumatology FEMECOT International Committee Chair, Metropolitana de Guadalajara University, Puerta de Hierro Hospital, Guadalajara, Jal. México
| | - Johnatan Tamayo-Cosio
- Director of CORE Rehabilitation and Physiotherapy Center, Professor Madrid School of Osteopathy Campus Mexico, Guadalajara, México
| | - Darío E. Garín-Zertuche
- Mexican Federation of Orthopaedic and Traumatology FEMECOT President, Autónoma de Baja Californa University. Angeles Hospital, Tijuana, BCN, México
| | | | - Linda Vallejo
- Mayor Mederi University Hospital, Police Hospital, San José Infantil Hospital, Bogotá, Colombia
| | - Jaime A. Leal
- Mayor Mederi University Hospital, La Samaritana University Hospital, Bogotá, Colombia
| | | | - Marcelo T. Caiero
- Instituto de Ortopedia e Traumatologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil
| | - Horacio Tabares-Neyra
- Cuban Orthopedics and Traumatology Society President, Head of the Surgical Department of the Center for Research in Longevity, Aging and Health (CITED), La Havana, Cuba
| | | | - Vincenzo Giordano
- Serviço de Ortopedia e Traumatologia Prof. Nova Monteiro, Hospital Municipal Miguel Couto, Rio de Janeiro, Brazil
- Ortopedia, Clínica São Vicente, Rede D’or São Luiz, Rio de Janeiro, Brazil
| |
Collapse
|
11
|
Mahmood I, Maqbool HF, Raza A, Iqbal N, Dehghani-Sanij AA. Gait dynamic stability evaluation in patients undergoing hip joint fractures - tools to measure rehabilitation effectiveness. Biomed Phys Eng Express 2024; 10:045050. [PMID: 38861944 DOI: 10.1088/2057-1976/ad567b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 06/11/2024] [Indexed: 06/13/2024]
Abstract
A hip joint fracture includes a break in the thigh (femur) or coxa bone near the pelvis. During fracture healing, stability and weight bearing by the affected limb are key indicators to measure patients' improvement. Conventionally, the rehabilitation effectiveness is monitored through clinical examinations, patients' feedback, and few studies also reported instrumented gait evaluations. A gap remains there to numerically quantify the recovery in patients' stability and weight bearing in response to rehabilitation therapies. This study introduces Nyquist and Bode (N&B) methods to analyse the instrumented gait signals further and evaluate gait stability in hip fracture patients during weight loading and unloading transitions. The centre of pressure (CoP) data was recorded using force plates for conditions: coxa hip fracture (HC), femur hip fracture (HF), and normal hip joint (NH). The time rate of CoP signals illustrated two major impulses during the loading and unloading phases which were modelled in time and frequency domains. The frequency models were further analysed by applying N&B methods and stability margins were computed for both impaired and healthy conditions. Results illustrated a significant decrease (Kruskal-Wallis's test, p < 0.001) in the intralimb walking stability of both fracture conditions. Further, Spearman's correlation between CoP velocities of fractured and intact limbs illustrated significant interlimb dependencies to maintain walking stability (p < 0.001) during weight loading and unloading transitions. Overall, the HF impairment illustrated the least intralimb walking stability and relatively greater interlimb dependencies. Clinically, these methods and findings are important to measure the recovery in patients undergoing rehabilitation after a hip joint or other lower limb impairments.
Collapse
Affiliation(s)
- Imran Mahmood
- Mechanical, Mechatronics and Manufacturing Engineering Department, University of Engineering and Technology Lahore, Faisalabad Campus, Pakistan
| | - Hafiz Farhan Maqbool
- Mechanical, Mechatronics and Manufacturing Engineering Department, University of Engineering and Technology Lahore, Faisalabad Campus, Pakistan
| | - Anam Raza
- Department of Zoology, Government College University, Faisalabad, Pakistan
| | - Nadeem Iqbal
- Department of Computer Science, Abdul Wali Khan University, Mardan, Pakistan
| | | |
Collapse
|
12
|
Giordano V, Pires RE, de Faria LPG, Temtemples I, Macagno T, Freitas A, Joeris A, Giannoudis PV. Doctor, When Should I Start Walking? Revisiting Postoperative Rehabilitation and Weight-Bearing Protocols in Operatively Treated Acetabular Fractures: A Systematic Review and Meta-Analysis. J Clin Med 2024; 13:3570. [PMID: 38930099 PMCID: PMC11204460 DOI: 10.3390/jcm13123570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 05/29/2024] [Accepted: 06/07/2024] [Indexed: 06/28/2024] Open
Abstract
Background and Objectives: Management of acetabular fractures is aimed at anatomically reducing and fixing all displaced or unstable fractures, as the accuracy of fracture reduction has been demonstrated to strongly correlate with clinical outcomes. However, there is a noticeable gap in the literature concerning the perioperative and postoperative care of patients with acetabular fractures, which ultimately can be potential risk factors for adverse outcomes and permanent disabilities. This study aimed to systematically review the available literature regarding rehabilitation practices, including weight-bearing protocols, across time points in surgically treated acetabular fracture patients and correlate these practices with functional outcomes. Methods: We systematically reviewed the Medline and PubMed databases and the Cochrane Central Register of Controlled Trials in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The inclusion criteria were studies with adult patients (19+ years), publications from the last 10 years, articles focusing on rehabilitation or mentioning any aspect related to rehabilitation (such as weight-bearing or muscle training), and describing the surgical management of acute, isolated acetabulum fractures. Specific information was collected, including the fracture classification, time to surgery, surgical approach, surgical time, blood loss, fixation strategy, quality of reduction, postoperative rehabilitation protocol, complication rate, type(s) of complication, and outcome measurement(s). The choice(s) of surgical approach, surgical time, blood loss, and fixation strategy were stratified based on the fracture classification. The complication rate and type(s) of complication were calculated for all studies. Fractures were classified based on the Letournel classification. Results: A total of 494 articles were identified from the initial search, of which 22 (1025 patients) were included in the final review. The most common rehabilitation protocol favored isometric quadriceps and abductor strengthening exercises starting on the first postoperative day, with passive hip movement at 1-3 days postoperatively and active hip movement ranging from the first postoperative day to 4 weeks postoperatively. Partial weight-bearing with a walker or a pair of crutches was permitted from 1 to 12 weeks after surgery, and full weight-bearing was allowed depending on the patient's general condition and fracture healing state (generally at the end of 3 months). In only three studies did the patients start bearing weight in the early postoperative period (≤1 week). Meta-regression analysis was not performed due to the discrepancy between studies that reported a weight-bearing protocol ≤1 week and >1 week postoperatively. Conclusions: Our study suggests that an accelerated postoperative rehabilitation protocol, including early permissive weight-bearing, does not appear to increase the risk of loss of reduction or the rate of complications after surgical treatment of acetabular fractures. However, a proper meta-analysis was not possible, and the heterogeneity of the included studies did not allow us to conclude anything about the potential biomechanical and clinical benefits nor the negative effects related to this rehabilitation regimen in terms of functional results. There is an inconsistent use of PROMs for objectively calculating the effect size of the accelerated protocol compared with restricted weight-bearing regimes. We pose the need for higher-level evidence to proof our hypothesis.
Collapse
Affiliation(s)
- Vincenzo Giordano
- Serviço de Ortopedia e Traumatologia Prof. Nova Monteiro, Hospital Municipal Miguel Couto, Rio de Janeiro 22430-160, Brazil; (L.P.G.d.F.); (I.T.)
| | - Robinson Esteves Pires
- Departamento do Aparelho Locomotor, Escola de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte 30130-100, Brazil;
| | - Luiz Paulo Giorgetta de Faria
- Serviço de Ortopedia e Traumatologia Prof. Nova Monteiro, Hospital Municipal Miguel Couto, Rio de Janeiro 22430-160, Brazil; (L.P.G.d.F.); (I.T.)
| | - Igor Temtemples
- Serviço de Ortopedia e Traumatologia Prof. Nova Monteiro, Hospital Municipal Miguel Couto, Rio de Janeiro 22430-160, Brazil; (L.P.G.d.F.); (I.T.)
| | - Tomas Macagno
- Hospital Sirio Libanés, Buenos Aires C1419, Argentina;
| | - Anderson Freitas
- HOME—Hospital Ortopédico e Medicina Especializada, Brasília 70200-730, Brazil;
| | - Alexander Joeris
- Clinical Science, AO Innovation Translation Center, 8600 Dübendorf, Switzerland;
| | - Peter V. Giannoudis
- Department of Trauma & Orthopaedic Surgery, School of Medicine, University of Leeds, Leeds LS2 9LU, UK;
| |
Collapse
|
13
|
Chiang YW, Chang YJ, Huang HJ, Hsieh CP, Lu YH. Does post acute care reduce the mortality of octogenarian and nonagenarian patients undergoing hip fracture surgery? BMC Geriatr 2024; 24:322. [PMID: 38589787 PMCID: PMC11000408 DOI: 10.1186/s12877-024-04936-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 03/30/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND With the increasing number of elderly individuals worldwide, a greater number of people aged 80 years and older sustain fragility fracture due to osteopenia and osteoporosis. METHODS This retrospective study included 158 older adults, with a median age of 85 (range: 80-99) years, who sustained hip fragility fracture and who underwent surgery. The patients were divided into two groups, one including patients who joined the post-acute care (PAC) program after surgery and another comprising patients who did not. The mortality, complication, comorbidity, re-fracture, secondary fracture, and readmission rates and functional status (based on the Barthel index score, numerical rating scale score, and Harris Hip Scale score) between the two groups were compared. RESULTS The patients who presented with fragility hip fracture and who joined the PAC rehabilitation program after the surgery had a lower rate of mortality, readmission rate, fracture (re-fracture and secondary fracture), and complications associated with fragility fracture, such as urinary tract infection, cerebrovascular accident, and pneumonia (acute coronary syndrome, out-of-hospital cardiac arrest, or in-hospital cardiac arrest. CONCLUSIONS PAC is associated with a lower rate of mortality and complications such as urinary tract infection, bed sore, and pneumonia in octogenarian and nonagenarian patients with hip fragility fracture.
Collapse
Affiliation(s)
- Yu-Wei Chiang
- Department of Orthopedics, Changhua Christian Hospital, No. 135, Nanxiao St., Changua City, Changhua County, 500054, Taiwan R.O.C
| | - Yu-Jun Chang
- Big Data Center, Changhua Christian Hospital, No. 135, Nanxiao St., Changua City, Changhua County, 500054, Taiwan R.O.C
| | - Hui-Jen Huang
- Department of Nursing, Changhua Christian Hospital, No. 135, Nanxiao St., Changua City, Changhua County, 500054, Taiwan R.O.C
| | - Cheng-Pu Hsieh
- Department of Orthopedics, Changhua Christian Hospital, No. 135, Nanxiao St., Changua City, Changhua County, 500054, Taiwan R.O.C
- Orthopedics & Sports Medicine Laboratory, Changhua Christian Hospital, No. 135, Nanxiao St., Changua City, Changhua County, 500054, Taiwan R.O.C
- Department of Post-Baccalaureate Medicine, National Chung Hsing University, No. 145 Xingda Rd., South District, Taichung, 40227, Taiwan R.O.C
| | - Yueh-Hsiu Lu
- Department of Orthopedics, Changhua Christian Hospital, No. 135, Nanxiao St., Changua City, Changhua County, 500054, Taiwan R.O.C..
- Institute of Biomedical Sciences, National Chung Hsing University, No. 145 Xingda Rd., South District, Taichung, 40227, Taiwan R.O.C..
| |
Collapse
|
14
|
Holzer KJ, Bartosiak KA, Calfee RP, Hammill CW, Haroutounian S, Kozower BD, Cordner TA, Lenard EM, Freedland KE, Tellor Pennington BR, Wolfe RC, Miller JP, Politi MC, Zhang Y, Yingling MD, Baumann AA, Kannampallil T, Schweiger JA, McKinnon SL, Avidan MS, Lenze EJ, Abraham J. Perioperative mental health intervention for depression and anxiety symptoms in older adults study protocol: design and methods for three linked randomised controlled trials. BMJ Open 2024; 14:e082656. [PMID: 38569683 PMCID: PMC11146368 DOI: 10.1136/bmjopen-2023-082656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 03/18/2024] [Indexed: 04/05/2024] Open
Abstract
INTRODUCTION Preoperative anxiety and depression symptoms among older surgical patients are associated with poor postoperative outcomes, yet evidence-based interventions for anxiety and depression have not been applied within this setting. We present a protocol for randomised controlled trials (RCTs) in three surgical cohorts: cardiac, oncological and orthopaedic, investigating whether a perioperative mental health intervention, with psychological and pharmacological components, reduces perioperative symptoms of depression and anxiety in older surgical patients. METHODS AND ANALYSIS Adults ≥60 years undergoing cardiac, orthopaedic or oncological surgery will be enrolled in one of three-linked type 1 hybrid effectiveness/implementation RCTs that will be conducted in tandem with similar methods. In each trial, 100 participants will be randomised to a remotely delivered perioperative behavioural treatment incorporating principles of behavioural activation, compassion and care coordination, and medication optimisation, or enhanced usual care with mental health-related resources for this population. The primary outcome is change in depression and anxiety symptoms assessed with the Patient Health Questionnaire-Anxiety Depression Scale from baseline to 3 months post surgery. Other outcomes include quality of life, delirium, length of stay, falls, rehospitalisation, pain and implementation outcomes, including study and intervention reach, acceptability, feasibility and appropriateness, and patient experience with the intervention. ETHICS AND DISSEMINATION The trials have received ethics approval from the Washington University School of Medicine Institutional Review Board. Informed consent is required for participation in the trials. The results will be submitted for publication in peer-reviewed journals, presented at clinical research conferences and disseminated via the Center for Perioperative Mental Health website. TRIAL REGISTRATION NUMBERS NCT05575128, NCT05685511, NCT05697835, pre-results.
Collapse
Affiliation(s)
- Katherine J Holzer
- Department of Anesthesiology, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
| | - Kimberly A Bartosiak
- Department of Orthopaedics, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
| | - Ryan P Calfee
- Department of Orthopaedics, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
| | - Chet W Hammill
- Department of Surgery, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
| | - Simon Haroutounian
- Department of Anesthesiology, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
| | - Benjamin D Kozower
- Department of Surgery, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
| | - Theresa A Cordner
- Department of Anesthesiology, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
| | - Emily M Lenard
- Department of Psychiatry, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
| | - Kenneth E Freedland
- Department of Psychiatry, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
| | - Bethany R Tellor Pennington
- Department of Anesthesiology, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
| | - Rachel C Wolfe
- Department of Pharmacy, Barnes-Jewish Hospital, St Louis, Missouri, USA
| | - J Philip Miller
- Institute for Informatics, Data Science and Biostatistics, Washington University School of Medicine in Saint Louis, St. Louis, Missouri, USA
| | - Mary C Politi
- Department of Surgery, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
| | - Yi Zhang
- Department of Psychiatry, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
| | - Michael D Yingling
- Department of Psychiatry, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
| | - Ana A Baumann
- Department of Surgery, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
| | - Thomas Kannampallil
- Department of Anesthesiology, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
- Institute for Informatics, Data Science and Biostatistics, Washington University School of Medicine in Saint Louis, St. Louis, Missouri, USA
| | - Julia A Schweiger
- Department of Psychiatry, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
| | - Sherry L McKinnon
- Department of Anesthesiology, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
| | - Michael S Avidan
- Department of Anesthesiology, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
| | - Eric J Lenze
- Department of Psychiatry, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
| | - Joanna Abraham
- Department of Anesthesiology, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
- Institute for Informatics, Data Science and Biostatistics, Washington University School of Medicine in Saint Louis, St. Louis, Missouri, USA
| |
Collapse
|
15
|
Patel N, Golwala P. Hip Abductor Muscle Strength Recovery: A Comparison Between Joint Replacement Surgery and Internal Fixation Surgery. Cureus 2024; 16:e59120. [PMID: 38803789 PMCID: PMC11128942 DOI: 10.7759/cureus.59120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2024] [Indexed: 05/29/2024] Open
Abstract
Introduction Proximal femoral fractures are common fractures of the hip that are considered a major healthcare concern globally; these include subtrochanteric, intertrochanteric, and the neck of the femur fractures. Internal fixation surgery and joint replacement surgery are the two most common intervention techniques used to treat these fractures. Consequently, weakness in the hip abductor muscle post-surgery may lead to implant loosening, necessitating revision of the surgery. In light of this, this study aimed to compare hip abductor strength recovery outcomes between joint replacement surgery and internal fixation surgery. Methodology A comparative study was performed over six months at the Department of Orthopaedics and Physiotherapy. Based on the inclusion and exclusion criteria and anticipating potential dropouts, a total of 56 patients were included in the study, and their hip abductor strength was measured using a sphygmomanometer. The patients were classified into two groups: Group A or Group B as per the type of hip surgery. Group A included 29 patients who underwent joint replacement surgeries involving either cemented or uncemented total hip arthroplasty (THA) or hip hemiarthroplasty (HHA). Group B comprised 27 patients who were operated on using either proximal femoral nail (PFN) or dynamic hip screw (DHS). Results The cohort consisted of 36 males and 20 females, with a mean age of 51.71 years. The overall mean value of hip abductor muscle strength at postoperative day (POD) three in the internal fixation group was 65.06 ±5.98, which progressed to 107.51 ±24.76 after six months; in the joint replacement surgery group, it was 70.03 ±12.46 at POD three, which progressed to 113.11 ±21.27 after six months. The age-wise distribution demonstrated that the patients in the age group of 18-50 years demonstrated progressive results: from 65.33 ±4.9 at POD three to 105.95 ±22.71 after six months in the internal fixation group; from 66.82 ±7.72 at POD three to 109.59 ±22.54 after six months in the joint replacement group. Moreover, patients aged above 50 years showed progression from 64.80 ±6.98 at POD three to 103.33 ±27.30 after six months in the internal fixation group, and from 69.58 ±14.75 at POD three to 108.22 ±20.62 after six months in the joint replacement group. Conclusions Our findings revealed that joint replacement surgery resulted in greater improvements in the hip abductor muscle strength compared to internal fixation surgery in the immediate postoperative period and during follow-ups. Additionally, younger patients exhibited better strength-related outcomes in comparison to the elderly population regardless of the type of surgery.
Collapse
Affiliation(s)
- Niketa Patel
- Department of Physiotherapy, College of Physiotherapy, Sumandeep Vidyapeeth Deemed to be University, Pipariya, Vadodara, IND
| | - Paresh Golwala
- Department of Orthopaedics, Sumandeep Vidyapeeth Deemed to be University, Pipariya, Vadodara, IND
| |
Collapse
|
16
|
Guerra S, Ellmers T, Turabi R, Law M, Chauhan A, Milton-Cole R, Godfrey E, Sheehan KJ. Factors associated with concerns about falling and activity restriction in older adults after hip fracture: a mixed-methods systematic review. Eur Geriatr Med 2024; 15:305-332. [PMID: 38418713 PMCID: PMC10997732 DOI: 10.1007/s41999-024-00936-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 01/02/2024] [Indexed: 03/02/2024]
Abstract
PURPOSE To investigate factors contributing to concerns about falling and activity restriction in the community among older adults who had a hip fracture. METHODS A mixed method systematic review with a convergent segregated approach. We searched Medline, Embase, PsycInfo, PEDRo, CINAHL and the Cochrane library. Results were synthesised narratively considering physical, psychological, environmental, care, and social factors and presented in tables. Critical appraisal was completed in duplicate. RESULTS We included 19 studies (9 qualitative, 9 observational, 1 mixed methods) representing 1480 individuals and 23 factors related to concerns about falling and activity restriction. Physical factors included falls history, comorbidities, balance, strength, mobility and functionality. Psychological factors included anxiety and neuroticism scores, perceived confidence in/control over rehabilitation and abilities, and negative/positive affect about the orthopaedic trauma, pre-fracture abilities and future needs. Environmental factors included accessibility in the home, outdoors and with transport. Social and care factors related to the presence or absence of formal and informal networks, which reduced concerns and promoted activity by providing feedback, advice, encouragement, and practical support. CONCLUSION These findings highlight that to improve concerns about falling and activity restriction after hip fracture, it is important to: improve physical and functional abilities; boost self-confidence; promote positive affect; involve relatives and carers; increase access to clinicians, and; enhance accessibility of the home, outdoors and transport. Most factors were reported on by a small number of studies of varying quality and require replication in future research.
Collapse
Affiliation(s)
- Stefanny Guerra
- Department of Population Health Sciences, School of Life Course and Population Sciences, Kings College London, London, UK.
- Bone and Joint Health, Blizard Institute, Queen Mary University of London, London, UK.
| | - Toby Ellmers
- Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK
| | - Ruqayyah Turabi
- Department of Population Health Sciences, School of Life Course and Population Sciences, Kings College London, London, UK
| | - Magda Law
- Department of Population Health Sciences, School of Life Course and Population Sciences, Kings College London, London, UK
| | - Aishwarya Chauhan
- Department of Population Health Sciences, School of Life Course and Population Sciences, Kings College London, London, UK
| | - Rhian Milton-Cole
- Department of Population Health Sciences, School of Life Course and Population Sciences, Kings College London, London, UK
| | - Emma Godfrey
- Department of Population Health Sciences, School of Life Course and Population Sciences, Kings College London, London, UK
| | - Katie J Sheehan
- Department of Population Health Sciences, School of Life Course and Population Sciences, Kings College London, London, UK
- Bone and Joint Health, Blizard Institute, Queen Mary University of London, London, UK
| |
Collapse
|
17
|
Alito A, Fenga D, Portaro S, Leonardi G, Borzelli D, Sanzarello I, Calabrò RS, Milone D, Tisano A, Leonetti D. Early hip fracture surgery and rehabilitation. How to improve functional quality outcomes. A retrospective study. Folia Med (Plovdiv) 2023; 65:879-884. [PMID: 38351775 DOI: 10.3897/folmed.65.e99513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 01/27/2023] [Indexed: 02/16/2024] Open
Abstract
INTRODUCTION Hip fractures are one of the major disability causes associated with a high morbidity and mortality rate. Early surgery and stable fixation could be associated with better pain control, possibly lower mortality rates, and early recovery of autonomy.
Collapse
|
18
|
Cedeno-Veloz BA, Casadamon-Munarriz I, Rodríguez-García A, Lozano-Vicario L, Zambom-Ferraresi F, Gonzalo-Lázaro M, Hidalgo-Ovejero ÁM, Izquierdo M, Martínez-Velilla N. Effect of a Multicomponent Intervention with Tele-Rehabilitation and the Vivifrail© Exercise Programme on Functional Capacity after Hip Fracture: Study Protocol for the ActiveFLS Randomized Controlled Trial. J Clin Med 2023; 13:97. [PMID: 38202104 PMCID: PMC10779784 DOI: 10.3390/jcm13010097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 12/19/2023] [Accepted: 12/21/2023] [Indexed: 01/12/2024] Open
Abstract
INTRODUCTION Hip fractures are the most common fracture leading to hospitalization and are associated with high costs, mortality rates and functional decline. Although several guidelines exist for preventing new fractures and promoting functional recovery, they tend to focus on osteoporosis treatment and do not take into account the complexity of frailty in older adults and geriatric syndromes, which are important factors in individuals at risk of suffering from frailty fractures. Moreover, most health systems are fragmented and are incapable of providing appropriate management for frail and vulnerable individuals who are at risk of experiencing fragility fractures. Multicomponent interventions and physical exercise using tele-rehabilitation could play a role in the management of hip fracture recovery. However, the effectiveness of exercise prescription and its combination with a comprehensive geriatric assessment (CGA) is still unclear. METHODS This randomized clinical trial will be conducted at the Hospital Universitario de Navarra (Pamplona, Spain). A total of 174 older adults who have suffered a hip fracture and fulfil the criteria for inclusion will be randomly allocated to either the intervention group or the control group. The intervention group will receive a multicomponent intervention consisting of individualized home-based exercise using the @ctive hip app for three months, followed by nine months of exercise using Vivifrail. Additionally, the intervention group will receive nutrition intervention, osteoporosis treatment, polypharmacy adjustment and evaluation of patient mood, cognitive impairment and fear of falling. The control group will receive standard outpatient care according to local guidelines. This research aims to evaluate the impact of the intervention on primary outcome measures, which include changes in functional status during the study period based on the Short Physical Performance Battery. DISCUSSION The findings of this study will offer valuable insights into the efficacy of a comprehensive approach that considers the complexity of frailty in older adults and geriatric syndromes, which are important factors in individuals at risk of suffering from frailty fractures. This study's findings will contribute to the creation of more effective strategies tailored to the requirements of these at-risk groups.
Collapse
Affiliation(s)
- Bernardo Abel Cedeno-Veloz
- Navarre University Hospital (HUN), Irunlarrea 3, 31008 Pamplona, Navarra, Spain; (I.C.-M.); (A.R.-G.); (L.L.-V.); (F.Z.-F.); (M.G.-L.); (N.M.-V.)
- Navarrabiomed, Institute for Health Research of Navarra (IDISNA), Irunlarrea 3, 31008 Pamplona, Navarra, Spain;
- Department of Health Sciences, Public University of Navarre, Av Cataluña s/n, 31006 Pamplona, Navarra, Spain
| | - Irache Casadamon-Munarriz
- Navarre University Hospital (HUN), Irunlarrea 3, 31008 Pamplona, Navarra, Spain; (I.C.-M.); (A.R.-G.); (L.L.-V.); (F.Z.-F.); (M.G.-L.); (N.M.-V.)
| | - Alba Rodríguez-García
- Navarre University Hospital (HUN), Irunlarrea 3, 31008 Pamplona, Navarra, Spain; (I.C.-M.); (A.R.-G.); (L.L.-V.); (F.Z.-F.); (M.G.-L.); (N.M.-V.)
| | - Lucia Lozano-Vicario
- Navarre University Hospital (HUN), Irunlarrea 3, 31008 Pamplona, Navarra, Spain; (I.C.-M.); (A.R.-G.); (L.L.-V.); (F.Z.-F.); (M.G.-L.); (N.M.-V.)
- Navarrabiomed, Institute for Health Research of Navarra (IDISNA), Irunlarrea 3, 31008 Pamplona, Navarra, Spain;
- Department of Health Sciences, Public University of Navarre, Av Cataluña s/n, 31006 Pamplona, Navarra, Spain
| | - Fabricio Zambom-Ferraresi
- Navarre University Hospital (HUN), Irunlarrea 3, 31008 Pamplona, Navarra, Spain; (I.C.-M.); (A.R.-G.); (L.L.-V.); (F.Z.-F.); (M.G.-L.); (N.M.-V.)
- Navarrabiomed, Institute for Health Research of Navarra (IDISNA), Irunlarrea 3, 31008 Pamplona, Navarra, Spain;
- Department of Health Sciences, Public University of Navarre, Av Cataluña s/n, 31006 Pamplona, Navarra, Spain
- CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Av Monforte de Lemos 3-5, Pabellón 11, Planta 0, 28029 Madrid, Spain
| | - María Gonzalo-Lázaro
- Navarre University Hospital (HUN), Irunlarrea 3, 31008 Pamplona, Navarra, Spain; (I.C.-M.); (A.R.-G.); (L.L.-V.); (F.Z.-F.); (M.G.-L.); (N.M.-V.)
| | - Ángel María Hidalgo-Ovejero
- Department of Orthopaedics Clinics and Traumatology, University Hospital of Navarre (HUN), 31008 Pamplona, Navarra, Spain;
| | - Mikel Izquierdo
- Navarrabiomed, Institute for Health Research of Navarra (IDISNA), Irunlarrea 3, 31008 Pamplona, Navarra, Spain;
- Department of Health Sciences, Public University of Navarre, Av Cataluña s/n, 31006 Pamplona, Navarra, Spain
- CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Av Monforte de Lemos 3-5, Pabellón 11, Planta 0, 28029 Madrid, Spain
| | - Nicolás Martínez-Velilla
- Navarre University Hospital (HUN), Irunlarrea 3, 31008 Pamplona, Navarra, Spain; (I.C.-M.); (A.R.-G.); (L.L.-V.); (F.Z.-F.); (M.G.-L.); (N.M.-V.)
- Navarrabiomed, Institute for Health Research of Navarra (IDISNA), Irunlarrea 3, 31008 Pamplona, Navarra, Spain;
- Department of Health Sciences, Public University of Navarre, Av Cataluña s/n, 31006 Pamplona, Navarra, Spain
- CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Av Monforte de Lemos 3-5, Pabellón 11, Planta 0, 28029 Madrid, Spain
| |
Collapse
|
19
|
Shelke S, Ambade R, Shelke A. From Conservative Measures to Surgical Interventions, Treatment Approaches for Cubital Tunnel Syndrome: A Comprehensive Review. Cureus 2023; 15:e51262. [PMID: 38288228 PMCID: PMC10823195 DOI: 10.7759/cureus.51262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 12/29/2023] [Indexed: 01/31/2024] Open
Abstract
Cubital tunnel syndrome (CuTS) is a neuropathic condition characterized by the compression or irritation of the ulnar nerve at the elbow, resulting in a wide spectrum of symptoms ranging from pain and numbness to muscle weakness and impaired hand function. This comprehensive review delves into the diverse landscape of CuTS treatment approaches, emphasizing the importance of early intervention. The review explores how these strategies aim to alleviate symptoms and enhance patient well-being by beginning with conservative measures encompassing rest, splinting, medications, physical therapy, and lifestyle adjustments. Non-surgical medical interventions, including nerve gliding exercises, ultrasound-guided nerve injections, and orthotic devices, are considered alternative therapies for symptom relief. Surgical interventions, such as decompression procedures and emerging techniques, are discussed in detail, highlighting their indications and expected outcomes. Throughout this review, the critical role of patient-centered care is underscored, emphasizing the need for tailored treatment plans that respect individual preferences and goals. Recognizing the unique nature of each CuTS case, shared decision-making between patients and healthcare providers is advocated, ensuring that interventions align with specific patient needs. As research advances, promising developments in diagnosis, surgical techniques, and drug therapies offer hope for more effective management of CuTS, paving the way for improved symptom relief and enhanced nerve function.
Collapse
Affiliation(s)
- Saurabh Shelke
- Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Ratnakar Ambade
- Orthopaedic Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Aditi Shelke
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| |
Collapse
|
20
|
Zabawa L, Choubey AS, Drake B, Mayo J, Mejia A. Dementia and Hip Fractures: A Comprehensive Review of Management Approaches. JBJS Rev 2023; 11:01874474-202312000-00002. [PMID: 38079493 DOI: 10.2106/jbjs.rvw.23.00157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
» The elderly population is the fastest growing demographic, and the number of dementia cases in the United States is expected to double to 10 million by 2050.» Patients with dementia are at 3× higher risk of hip fractures and have higher morbidity and mortality after hip fractures.» Hip fracture patients with dementia benefit from early analgesia and timely surgical fixation of fracture.» Early and intensive inpatient rehabilitation is associated with improved postoperative outcomes in patients with dementia.» Coordination of care within a "orthogeriatric" team decreases mortality, and fracture liaison services show potential for improving long-term outcomes in hip fracture patients with dementia.
Collapse
Affiliation(s)
- Luke Zabawa
- Department of Orthopaedics, University of Illinois at Chicago, Chicago, Illinois
| | - Apurva S Choubey
- Department of Orthopaedics, University of Illinois at Chicago, Chicago, Illinois
| | - Brett Drake
- Department of Orthopaedics, University of Illinois at Chicago, Chicago, Illinois
| | - Joel Mayo
- University of Illinois College of Medicine, Chicago, Illinois
| | - Alfonso Mejia
- Department of Orthopaedics, University of Illinois at Chicago, Chicago, Illinois
| |
Collapse
|
21
|
Dong W, Lisitano LSJ, Marchand LS, Reider LM, Haller JM. Weight-bearing Guidelines for Common Geriatric Upper and Lower Extremity Fractures. Curr Osteoporos Rep 2023; 21:698-709. [PMID: 37973761 DOI: 10.1007/s11914-023-00834-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/03/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE OF REVIEW The purpose of this review paper is to summarize current weight-bearing guidelines for common geriatric fractures, around weight-bearing joints, of the upper and lower extremities. RECENT FINDINGS There is an increasing amount of literature investigating the safety and efficacy of early weight-bearing in geriatric fractures, particularly of the lower extremity. Many recent studies, although limited, suggest that early weight-bearing may be safe for geriatric distal femur and ankle fractures. Given the limited data pertaining to early weight-bearing in geriatric fractures, it is difficult to establish concrete weight-bearing guidelines in this population. However, in the literature available, early weight-bearing appears to be safe and effective across most injuries. The degree and time to weight-bearing vary significantly based on fracture type and treatment method. Future studies investigating postoperative weight-bearing protocols should focus on the growing geriatric population and identify methods to address specific barriers to early weight-bearing in these patients such as cognitive impairment, dependence on caregivers, and variations in post-acute disposition.
Collapse
Affiliation(s)
- Willie Dong
- Department of Orthopaedic Surgery, University of Utah, 590 Wakara Way, Salt Lake City, UT, 84108, USA
| | - Leonard S J Lisitano
- Department of Orthopaedic Surgery, University of Utah, 590 Wakara Way, Salt Lake City, UT, 84108, USA
| | - Lucas S Marchand
- Department of Orthopaedic Surgery, University of Utah, 590 Wakara Way, Salt Lake City, UT, 84108, USA
| | - Lisa M Reider
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Justin M Haller
- Department of Orthopaedic Surgery, University of Utah, 590 Wakara Way, Salt Lake City, UT, 84108, USA.
| |
Collapse
|
22
|
Unnanuntana A, Kuptniratsaikul V, Srinonprasert V, Charatcharoenwitthaya N, Kulachote N, Papinwitchakul L, Wattanachanya L, Chotanaphuti T. A multidisciplinary approach to post-operative fragility hip fracture care in Thailand - a narrative review. Injury 2023; 54:111039. [PMID: 37757673 DOI: 10.1016/j.injury.2023.111039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 08/21/2023] [Accepted: 09/08/2023] [Indexed: 09/29/2023]
Abstract
INTRODUCTION Appropriate care and rehabilitation following surgery for fragility hip fractures in older adults is associated with better outcomes and a greater likelihood of achieving pre-injury functioning. Clinical guidelines specifically for the post-operative care and rehabilitation of patients with hip fractures are scarce; as such, country-specific protocols benchmarked against established guidelines are essential given the wide variation in cultures and beliefs, clinical practice and diverse healthcare systems in Asia. We aimed to provide clinically relevant recommendations for post-operative fragility hip fracture care and rehabilitation to improve patient outcomes and prevent subsequent fractures in Thailand. METHODS A targeted literature review was conducted to identify key evidence on various elements of post-hip fracture care and rehabilitation. Further discussions at a meeting and over email correspondence led to the development of the recommendations which amalgamate available evidence with the clinical experience of the multidisciplinary expert panel. RESULTS Our recommendations are categorized by one period domain - acute post-operative period, and five major domains during the post-operative period - rehabilitation, optimization of bone health, prevention of falls, nutritional supplementation, and prophylaxis for venous thromboembolism. A multidisciplinary approach should be central to the rehabilitation process with the involvement of orthopedists, geriatricians/internists, physiatrists, physical and occupational therapists, endocrinologists, pharmacists and nursing staff. Other key components of our recommendations which we believe contribute to better functional outcomes in older patients undergoing hip fracture surgery include comprehensive pre-operative assessments, early surgery, goal setting for recovery and rehabilitation, early mobilization, medication optimization, tailored exercise plans, adequate coverage with analgesia, assessment and appropriate management of osteoporosis with due consideration of the fracture risk, fall prevention plans, and nutritional assessment and support. Patients and their caregivers should be a part of the recovery process at every step, and they should be counseled and educated appropriately, particularly on the importance of adherence to their rehabilitation plan. CONCLUSION We have provided guidance on the critical domains of clinical care in the post-operative setting to optimize patient outcomes and prevent fracture recurrence. Our recommendations for post-operative care and rehabilitation of older adults with hip fracture can serve as a framework for hospitals across Thailand.
Collapse
Affiliation(s)
- Aasis Unnanuntana
- Department of Orthopedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok 10700, Thailand.
| | - Vilai Kuptniratsaikul
- Department of Rehabilitation Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Varalak Srinonprasert
- Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Natthinee Charatcharoenwitthaya
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
| | - Noratep Kulachote
- Department of Orthopedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | | | - Lalita Wattanachanya
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Chulalongkorn University and Excellence Center for Diabetes, Hormone and Metabolism, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Thanainit Chotanaphuti
- Department of Orthopedics, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| |
Collapse
|
23
|
Suljevic O, Schwarze UY, Okutan B, Herber V, Lichtenegger H, Freudenthal-Siefkes JE, Weinberg AM, Sommer NG. Does early post-operative exercise influence bone healing kinetics? Preclinical evaluation of non-critical sized femur defect healing. Bone 2023; 176:116869. [PMID: 37562662 DOI: 10.1016/j.bone.2023.116869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 07/27/2023] [Accepted: 08/07/2023] [Indexed: 08/12/2023]
Abstract
Physical exercise is a well-known modality for maintaining healthy locomotor mechanism. A detailed preclinical research on physical exercise effect on bone healing kinetics could help to improve the rehabilitation process after fracture treatment and bone remodeling. Our aim was to evaluate the effect of early post-operative exercise effect on bone microstructural changes in a rat model. Twenty Sprague Dawley male rats underwent bi-cortical 1.6 mm hole drilling in both femur diaphysis, after which (n = 10) underwent continuous treadmill training (TR) over two weeks, while the other group of rats (n = 10) was assigned to non-training (NT) control group. New bone formation labeling was performed by subcutaneous fluorochrome injections at day 5, 14 and 31. In vivo micro-computed tomography (μCT) scans were performed once a week during the 6-week post-operative period. Ten animals (five from each group) were euthanized at 3rd week while remaining animals were euthanized at 6th week. Femur samples were extracted and underwent ex vivo μCT and histological evaluation, while serum was used for evaluating alkaline phosphatase (ALP). μCT data demonstrated increased volume and surface of newly formed bone in defect area of TR group. Bone volume/Tissue volume (BV/TV) ratio and number of osteocytes showed an increase in TR group after 3-week period. Fluorochrome distances were increased between day 5 and 14 within the training group. Serum ALP level increased in both groups over 3- and 6-weeks. Post-operative exercise increases the bone healing kinetics and stimulates the new bone formation during and after the training protocol has ended.
Collapse
Affiliation(s)
- Omer Suljevic
- Department of Orthopedics and Traumatology, Medical University of Graz, Graz 8036, Austria.
| | - Uwe Y Schwarze
- Department of Orthopedics and Traumatology, Medical University of Graz, Graz 8036, Austria; Department of Dentistry and Oral Health, Division of Oral Surgery and Orthodontics, Medical University of Graz, 8036 Graz, Austria.
| | - Begüm Okutan
- Department of Orthopedics and Traumatology, Medical University of Graz, Graz 8036, Austria.
| | - Valentin Herber
- Department of Orthopedics and Traumatology, Medical University of Graz, Graz 8036, Austria; Department of Dentistry and Oral Health, Division of Oral Surgery and Orthodontics, Medical University of Graz, 8036 Graz, Austria; Department of Oral Surgery, University Center for Dental Medicine, University of Basel, Basel 4058, Switzerland.
| | - Helga Lichtenegger
- Department of Material Science and Process Engineering, University of Natural Resources and Life Sciences, Vienna 1180, Austria.
| | | | - Annelie-M Weinberg
- Department of Orthopedics and Traumatology, Medical University of Graz, Graz 8036, Austria.
| | - Nicole G Sommer
- Department of Orthopedics and Traumatology, Medical University of Graz, Graz 8036, Austria.
| |
Collapse
|
24
|
Ta CN, Lurie B, Mitchell B, Howard R, Onodera K, Harkin W, Ouillette R, Kent WT. Ambulation Distance Within 72 Hours after Surgical Management Is a Predictor of 90-Day Ambulatory Capacity in Elderly Patients with Hip Fracture. J Am Acad Orthop Surg Glob Res Rev 2023; 7:01979360-202308000-00012. [PMID: 37607250 PMCID: PMC10445784 DOI: 10.5435/jaaosglobal-d-23-00079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 06/30/2023] [Indexed: 08/24/2023]
Abstract
INTRODUCTION The inability to mobilize after surgical intervention for hip fractures in the elderly is established as a risk factor for greater morbidity and mortality. Previous studies have evaluated the association between the timing and distance of ambulation in the postoperative acute care phase with postoperative complications. The purpose of this study was to evaluate the association between ambulatory distance in the acute postoperative setting and ambulatory capacity at 3 months. METHODS Patients aged 65 and older who were ambulatory at baseline and underwent surgical intervention for hip fractures from 2014 to 2019 were retrospectively reviewed. Consistent with previous literature, patients were divided into two groups: those who were able to ambulate 5 feet within 72 hours after surgical fixation (early ambulatory) and those who were not (minimally ambulatory). RESULTS One hundred seventy patients (84 early ambulatory and 86 minimally ambulatory) were available for analysis. Using a multivariable ordinal logistic regression model, variables found to be statistically significant predictors of ambulatory status at 3 months were the ability to ambulate five feet in 72 hours (P < 0.0001), ambulatory distance at discharge (P = 0.012), and time from presentation to surgery (P = 0.039). Patients who were able to ambulate 5 feet within 72 hours had 9 times the odds of being independent ambulators rather than a lower ambulatory class (cane, walker, and nonambulatory). Pertrochanteric fractures were less likely than femoral neck fractures to independently ambulate at 3 months (17.2% vs. 42.3%; P = 0.0006). DISCUSSION Ambulating 5 feet within 72 hours after hip fracture surgery is associated with an increased likelihood of independent ambulation at 3 months postoperatively. This simple and clear goal may be used to help enhance postoperative mobility and independence while providing a metric to guide therapy and help counsel patients and families.
Collapse
Affiliation(s)
- Canhnghi N. Ta
- From the University of California San Diego, Arbor Drive, San Diego, CA (Dr. Ta, Dr. Mitchell, Dr. Howard, Dr. Onodera, and Dr. Kent); the University of Nevada Las Vegas, Las Vegas, NV (Dr. Lurie); the Rush University, Chicago, IL (Dr. Harkin); and the UCLA Health, Santa Monica, CA (Dr. Ouillette)
| | - Benjamin Lurie
- From the University of California San Diego, Arbor Drive, San Diego, CA (Dr. Ta, Dr. Mitchell, Dr. Howard, Dr. Onodera, and Dr. Kent); the University of Nevada Las Vegas, Las Vegas, NV (Dr. Lurie); the Rush University, Chicago, IL (Dr. Harkin); and the UCLA Health, Santa Monica, CA (Dr. Ouillette)
| | - Brendon Mitchell
- From the University of California San Diego, Arbor Drive, San Diego, CA (Dr. Ta, Dr. Mitchell, Dr. Howard, Dr. Onodera, and Dr. Kent); the University of Nevada Las Vegas, Las Vegas, NV (Dr. Lurie); the Rush University, Chicago, IL (Dr. Harkin); and the UCLA Health, Santa Monica, CA (Dr. Ouillette)
| | - Roland Howard
- From the University of California San Diego, Arbor Drive, San Diego, CA (Dr. Ta, Dr. Mitchell, Dr. Howard, Dr. Onodera, and Dr. Kent); the University of Nevada Las Vegas, Las Vegas, NV (Dr. Lurie); the Rush University, Chicago, IL (Dr. Harkin); and the UCLA Health, Santa Monica, CA (Dr. Ouillette)
| | - Keenan Onodera
- From the University of California San Diego, Arbor Drive, San Diego, CA (Dr. Ta, Dr. Mitchell, Dr. Howard, Dr. Onodera, and Dr. Kent); the University of Nevada Las Vegas, Las Vegas, NV (Dr. Lurie); the Rush University, Chicago, IL (Dr. Harkin); and the UCLA Health, Santa Monica, CA (Dr. Ouillette)
| | - Will Harkin
- From the University of California San Diego, Arbor Drive, San Diego, CA (Dr. Ta, Dr. Mitchell, Dr. Howard, Dr. Onodera, and Dr. Kent); the University of Nevada Las Vegas, Las Vegas, NV (Dr. Lurie); the Rush University, Chicago, IL (Dr. Harkin); and the UCLA Health, Santa Monica, CA (Dr. Ouillette)
| | - Ryan Ouillette
- From the University of California San Diego, Arbor Drive, San Diego, CA (Dr. Ta, Dr. Mitchell, Dr. Howard, Dr. Onodera, and Dr. Kent); the University of Nevada Las Vegas, Las Vegas, NV (Dr. Lurie); the Rush University, Chicago, IL (Dr. Harkin); and the UCLA Health, Santa Monica, CA (Dr. Ouillette)
| | - William T. Kent
- From the University of California San Diego, Arbor Drive, San Diego, CA (Dr. Ta, Dr. Mitchell, Dr. Howard, Dr. Onodera, and Dr. Kent); the University of Nevada Las Vegas, Las Vegas, NV (Dr. Lurie); the Rush University, Chicago, IL (Dr. Harkin); and the UCLA Health, Santa Monica, CA (Dr. Ouillette)
| |
Collapse
|
25
|
Konda SR, Esper GW, Meltzer-Bruhn AT, Ganta A, Egol KA. Hip Fracture Care during COVID-19: Evolution through the Pandemic. Cureus 2023; 15:e42696. [PMID: 37654921 PMCID: PMC10465306 DOI: 10.7759/cureus.42696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2023] [Indexed: 09/02/2023] Open
Abstract
INTRODUCTION The purpose of this epidemiologic study was to analyze the care provided by our institution to middle-aged and geriatric hip fracture patients throughout the pandemic to examine for any differences compared to pre-pandemic care and across the pandemic stages. METHODS Consecutive patients >55 years old treated for hip fractures at our institution between October 2014 and January 2022 were analyzed for demographics, coronavirus disease 2019 (COVID-19) and vaccination status at admission, injury characteristics, hospital quality measures, and outcomes. Patients were divided into three separate cohorts: Pre-COVID-19 (PRECOV), COVID-19 Pre-Vaccine (PREVAX), and COVID-19 Post-Vaccine (POSTVAX). A sub-analysis removed COVID-19-positive patients across the study period. Comparative analyses were conducted. RESULTS A total of 2,633 hip fracture patients were included. For the overall cohort, there was no difference in the rate of inpatient deaths between the PRECOV, PREVAX, and POSTVAX cohorts (p=0.278). PRECOV had a significantly lower 30-day mortality rate compared to PREVAX or POSTVAX (p=0.012). Differences in complication rates for surgical site infection, urinary tract infection, and anemia (p<0.01 for all) were seen between cohorts. PRECOV had the longest length of hospital stay (p<0.01). PREVAX patients required more ICU level of care (p<0.01). When removing COVID-19-positive patients, all three cohorts had similar inpatient (p=0.872) and 30-day mortality rates (p=0.130). CONCLUSION The care of patients treated for hip fractures did not change throughout the pandemic at our institution. The elevated mortality rate due to the effects of COVID-19 seen in the pre-vaccine cohort decreased over time as the understanding of COVID-19 improved and the vaccine was introduced. We recommend continuation of the same hip fracture care protocols as used pre-pandemic.
Collapse
Affiliation(s)
- Sanjit R Konda
- Orthopedic Surgery, Jamaica Hospital Medical Center, New York, USA
- Orthopedic Surgery, NYU (New York University) Langone Health, New York, USA
| | - Garrett W Esper
- Orthopedic Surgery, NYU (New York University) Langone Health, New York, USA
| | - Ariana T Meltzer-Bruhn
- Medical School, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, USA
- Orthopedic Surgery, NYU (New York University) Langone Health, New York, USA
| | - Abhishek Ganta
- Orthopedic Surgery, Jamaica Hospital Medical Center, New York, USA
- Orthopedic Surgery, NYU (New York University) Langone Health, New York, USA
| | - Kenneth A Egol
- Orthopedic Surgery, NYU (New York University) Langone Health, New York, USA
- Orthopedic Surgery, Jamaica Hospital Medical Center, New York, USA
| |
Collapse
|
26
|
Rimayanti MU, Taylor NF, Shields N, Prendergast LA, O'Halloran PD. Health Professionals can Sustain Proficiency in Motivational Interviewing With a Moderate Amount of Training: An Intervention Fidelity Study. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2023; 44:105-111. [PMID: 37366578 DOI: 10.1097/ceh.0000000000000522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
INTRODUCTION Motivational interviewing (MI) proficiency may erode quickly, limiting its effectiveness. We examined whether health professionals completing a 2-day workshop, with 3 to 5 hours of personalized coaching, and twice-yearly group reflections sustained proficiency for the duration of a hip fracture rehabilitation trial and whether intervention was implemented as intended. METHODS A fidelity study was completed as part of a process evaluation of the trial that tested whether physical activity increased among hip fracture patients randomly allocated to receive MI (experimental) compared with dietary advice (control) over ten 30-minute sessions. Twelve health professionals (none were proficient in MI before trial commencement) delivered the intervention for up to 952 days. Two hundred experimental sessions (24% of all sessions, 83 patients) were randomly selected to evaluate proficiency using the MI Treatment Integrity scale; along with 20 control sessions delivered by four dietitians. Linear mixed-effects regression analyses determined whether proficiency was sustained over time. Dose was assessed from all experimental sessions ( n = 840, 98 patients). RESULTS Intervention was implemented as intended; 82% of patients received at least eight 30-minute sessions. All motivational interviewers were proficient, whereas dietitians did not inadvertently deliver MI. Time had no effect on MI proficiency (est < 0.001/d, P = .913, 95% CI, -0.001 to 0.001). DISCUSSION MI proficiency was sustained in a large trial over 2.6 years by completing a 2-day workshop, 3 to 5 hours of personalized coaching, and twice-yearly group reflections, even for those without previous experience; further research needs to establish the maximum duration of training effectiveness.
Collapse
Affiliation(s)
- Made Utari Rimayanti
- Ms. Rimayanti: PhD Candidate, School of Allied Health, Human Services, and Sport, La Trobe University, Victoria, Australia. Prof. Taylor: Professor of Allied Health, School of Allied Health, Human Services, and Sport, La Trobe University, Victoria, Australia. Prof. Shields: Research Director, Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Victoria, Australia. Prof. Prendergast: Deputy Dean of the School of Computing, Engineering and Mathematical Sciences, La Trobe University, Victoria, Australia. A/Prof. O'Halloran: Associate Professor of Living Well, School of Psychology and Public Health, La Trobe University, Victoria, Australia
| | | | | | | | | |
Collapse
|
27
|
Gadhvi C, Bean D, Rice D. A systematic review of fear of falling and related constructs after hip fracture: prevalence, measurement, associations with physical function, and interventions. BMC Geriatr 2023; 23:385. [PMID: 37353752 PMCID: PMC10288814 DOI: 10.1186/s12877-023-03855-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 02/28/2023] [Indexed: 06/25/2023] Open
Abstract
BACKGROUND Hip fracture is a common and debilitating injury amongst older adults. Fear of falling (FoF) and related constructs (balance confidence and falls efficacy) may impede rehabilitation after hip fracture. An updated systematic review to synthesize existing literature on FoF after hip fracture is needed. This review focussed on four research questions: In the hip fracture population: (1) What is the prevalence of FoF?; (2) What FoF assessment tools are validated? (3) What is the relationship between FoF and physical function?; (4) What interventions are effective for reducing FoF? METHODS A systematic search was undertaken in EBSCO Health, Scopus and PsychINFO in January 2021 (and updated December 2022) for articles on FoF after hip fracture. Data in relation to each research question was extracted and analysed. The quality of the studies was appraised using the 'Risk of Bias Tool for Prevalence Studies', 'COSMIN Risk of Bias checklist for Patient-reported outcome measures', modified version of the 'Appraisal Tool for Cross-sectional studies', and the 'Cochrane Risk of Bias 2' tools for each research question, respectively. RESULTS 36 studies (37 articles) with 5099 participants were included (mean age 80.2 years and average 78% female). Prevalence rates for FoF after hip fracture ranged between 22.5% and 100%, and prevalence tended to decrease as time progressed post hip fracture. The 'Falls Efficacy Scale - International' (FES-I) and 'Fear of Falling Questionnaire - Revised' (FFQ-R) were found to be reliable, internally consistent, and valid tools in hip fracture patients. FoF after hip fracture was consistently associated with measures of physical function including balance, gait speed, composite physical performance measures and self-reported function. Ten of 14 intervention studies were considered high risk of bias. Exercise-based interventions with or without a psychological component were not effective in reducing FoF after hip fracture compared to a control condition. CONCLUSION FoF is prevalent after hip fracture and is consistently associated with poorer physical function. Only two instruments (FES-I and FFQ-R) have been validated for measuring FoF in the hip fracture population. However, there remains a need for larger, higher quality randomised controlled trials targeting FoF after hip fracture in order to guide clinical practice. TRIAL REGISTRATION PROSPERO registration: CRD42020221836.
Collapse
Affiliation(s)
- Chandini Gadhvi
- Health & Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
- Allied Health - Physiotherapy, Te Whatu Ora Health New Zealand - Te Toka Tumai, Auckland, New Zealand
| | - Debbie Bean
- Health & Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand.
- Department of Anaesthesiology & Perioperative Medicine, Te Whatu Ora Health New Zealand - Waitematā, Auckland, New Zealand.
| | - David Rice
- Health & Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
- Department of Anaesthesiology & Perioperative Medicine, Te Whatu Ora Health New Zealand - Waitematā, Auckland, New Zealand
| |
Collapse
|
28
|
López-Martín N, Escalera-Alonso J, Thuissard-Vasallo IJ, Andreu-Vázquez C, Bielza-Galindo R. [Result of the update of the clinical pathway for hip fracture in the elderly at a university hospital in Madrid]. Rev Esp Geriatr Gerontol 2023; 58:61-67. [PMID: 36804952 DOI: 10.1016/j.regg.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/13/2022] [Accepted: 01/18/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND AND OBJECTIVES Orthogeriatric management with clinical pathways (CP) in hip fracture (HF) has been shown to be superior to other models. We studied whether updating the CP, through prioritization of admission and surgery, improvement in the prevention and treatment of delirium, management of anticoagulants and antiplatelet agents and the use of perioperative peripheral nerve block, modifies surgical delay, stay, readmissions, mortality, suffering delirium and functional status at discharge. MATERIAL AND METHOD A retrospective observational study of unicenter cohorts of 468 patients with HF, 220 from 2016 (old VC) and 248 from 2019 (new VC). The variables are: intervention in the first 48hours, surgical delay (hours), stay (days), stay less than 15 days, delirium, functional loss at discharge (Barthel prefracture scale less Barthel scale at discharge), readmission at one month, and mortality at admission, month and year. RESULTS Median age: 87.0 [interquartile range 8.0], mostly women (76.7%). Significantly, with the new VC, there was a greater number of patients operated on in the first 48hours (27,7% vs 36,8% p=0.036), less surgical delay (72.5 [47,5-110,5] vs 64.0 [42,0-88,0] p<0.001), shorter stay (10,0 [7,0-13,0] vs 8,0 [6,0-11,0] p<0.001), greater number of discharges in 15 days (78,2% vs 91,5% p<0.001), lower delirium (54,1% vs 43,5% p=0.023). No significant changes in readmissions, functional loss at discharge, mortality at admission, 3 months or year. CONCLUSIONS Updating the VC brings benefits to the patient (less surgical delay, equal functional status at discharge with fewer days of admission) and benefits in management (lower admission) without modifying mortality.
Collapse
Affiliation(s)
- Néstor López-Martín
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, España.
| | - Javier Escalera-Alonso
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, España
| | - Israel John Thuissard-Vasallo
- Facultad de Ciencias Biomédicas y de la Salud, Departamento de Medicina, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, España
| | - Cristina Andreu-Vázquez
- Facultad de Ciencias Biomédicas y de la Salud, Departamento de Medicina, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, España
| | - Rafael Bielza-Galindo
- Sección de Geriatría, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, España
| |
Collapse
|
29
|
Howell DF, Malmgren Fänge A, Rogmark C, Ekvall Hansson E. Rehabilitation Outcomes Following Hip Fracture of Home-Based Exercise Interventions Using a Wearable Device-A Randomized Controlled Pilot and Feasibility Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3107. [PMID: 36833801 PMCID: PMC9967499 DOI: 10.3390/ijerph20043107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 02/07/2023] [Accepted: 02/09/2023] [Indexed: 06/18/2023]
Abstract
Although hip fractures are common and severe, there is insufficient evidence concerning which type of rehabilitation is most beneficial. The primary aim of this three-armed pilot study was to investigate any difference in outcome after hip fractures between and within groups in terms of balance, everyday activities, and health-related quality of life (HRQoL) following different home rehabilitation interventions. Further aims were to study feasibility and to suggest, if necessary, adjustments to the protocol for a future full randomized controlled trial (RCT). In total, 32 persons were included in this study. The intervention groups underwent the HIFE program with or without an inertial measurement unit, while the control group underwent standard rehabilitation. Within- and between-groups differences in outcomes and feasibility outcomes in terms of recruitment and retention rates were analyzed, and the ability to collect primary and secondary outcomes was assessed. Balance, measured as postural sway, showed no significant improvement in any group. All three groups improved in functional balance (p = 0.011-0.028), activity of daily living (p = 0.012-0.027), and in HRQoL (p = 0.017-0.028). There were no other significant changes within or between the groups. The recruitment rate was 46%, the retention rate was 75%, and the ability to collect outcome measures was 80% at baseline and 64% at follow-up. Based on the results, it is possible to, after adjusting the protocol, conduct a full RCT.
Collapse
Affiliation(s)
| | - Agneta Malmgren Fänge
- Department of Health Sciences, Faculty of Medicine, Lund University, P.O. Box 157, 22100 Lund, Sweden
| | - Cecilia Rogmark
- Department of Orthopedics, Skane University Hospital, Lund University, 21428 Malmö, Sweden
| | - Eva Ekvall Hansson
- Department of Health Sciences, Faculty of Medicine, Lund University, P.O. Box 157, 22100 Lund, Sweden
| |
Collapse
|
30
|
El Miedany Y, Hasab El Naby MM, Abu-Zaid MH, Mahran S, Eissa M, Saber HG, Tabra SA, Ibrahim RA, Galal S, Elwakil W. Post-fracture care program in Egypt: merging subsequent fracture prevention and improving patients’ outcomes—an initiative by the Egyptian Academy of Bone Health. EGYPTIAN RHEUMATOLOGY AND REHABILITATION 2023. [DOI: 10.1186/s43166-023-00173-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
Abstract
Abstract
Background
Despite the associated high prevalence of morbidity and mortality, osteoporotic fragility fractures remain underdiagnosed and undertreated. Furthermore, those who sustain a fragility fracture are at imminent risk of sustaining subsequent fractures. Post-fracture care (PFC) programs are systematic, coordinated care programs that recognize, evaluate, and manage older adults who sustained a fragility fracture with the goal of managing all the risk factors and preventing succeeding fractures.
Main text
This work was carried out to outline the PFC program adopted in Egypt and its applicability in standard clinical practice. A review of literature was conducted to identify an evidence-informed PFC strategies and protocols, which outlines the optimal manner to manage older adults living with fragility fractures. The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) checklist was used to guide the reporting of this review. Based on this, a PFC integrated model of care based on a patient-centered approach has been developed aiming to optimize the outcomes.
Conclusion
This manuscript described the integrated model of care adopted in Egypt to provide care for older adults presenting with fragility fractures. This will pave the way to standardize patient identification and management. Additionally, to prevent occurrence of subsequent fractures and to enhance equity of care for patients with fragility fracture and osteoporosis, expansion of such service to rural and remote areas is highly recommended.
Collapse
|
31
|
Effect of distal interlocking of a cephalomedullary femoral nail on peri-implant fractures: A sawbone biomechanical analysis. Injury 2022; 53:3894-3898. [PMID: 36229244 DOI: 10.1016/j.injury.2022.09.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 08/28/2022] [Accepted: 09/23/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND A large proportion of hip fractures involve inter-trochanteric fractures which are managed by cephalomedullary nails. There is ongoing debate about the advantages and disadvantages of locked versus unlocked long cephalomedullary femoral nails in the treatment of intertrochanteric fractures. The objectives of our study are to evaluate the biomechanical effects of a distal interlocking bolt on the type of peri-implant fractures in a healed intertrochanteric fracture with long cephalomedullary nail fixation. METHODS 20 femoral sawbone specimens were prepared with the TFN-ADVANCED Proximal Femoral Nailing System (TFNA) and divided into 2 groups: locked and unlocked. The specimens were subjected to axial loading force until failure. Compressive forces, strain and fracture patterns were compared between the 2 groups. RESULTS There was no significant difference in the mean load to failure of the unlocked specimens compared to locked specimens. However, there was significant difference in the mean compressive stress at the time of failure with the unlocked specimen (1.79±0.17 MPa) compared to the locked group (1.92±0.05 MPa) (p < 0.05). Video review analysis showed unlocked specimens consistently having basi-cervical type peri-implant fractures while locked specimens showed complex, compound fractures of the head-neck region with 2 or more fracture propagation points. CONCLUSION Distal-locked long cephalomedullary nails in a healed intertrochanteric fracture model are able to tolerate higher compressive stress at the point of failure but demonstrate more complex peri-implant fracture patterns in the femoral head-neck region as compared to unlocked specimens.
Collapse
|
32
|
Rimayanti MU, Taylor NF, O'Halloran PD, Shields N. Gently steering - the mechanism of how motivational interviewing supported walking after hip fracture: A qualitative study. PEC INNOVATION 2022; 1:100078. [PMID: 37213730 PMCID: PMC10194110 DOI: 10.1016/j.pecinn.2022.100078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 08/19/2022] [Accepted: 08/22/2022] [Indexed: 05/23/2023]
Abstract
Objective To explore how older adults perceive motivational interviewing influences their walking and physical activity after hip fracture. Methods Qualitative study using an interpretive description framework. Twenty-four participants aged ≥65 years living in the community after hip fracture were interviewed. Participants had received at least 8 sessions of motivational interviewing via telephone. Semi-structured interviews were transcribed verbatim and coded inductively by two researchers independently. All authors discussed findings and themes observed through the researchers' lens and mapped them to the Medical Research Council's framework for process evaluation. Results Motivational interviewing was described as a nuanced and subtle intervention that guided participants through their journey of recovery. Three themes described possible mechanisms of how motivational interviewing might work: connection, checking in and confidence. In the context of recovering from hip fracture psychologically and physically, a strong connection with clinicians, along with weekly checking in, were perceived to build participants' confidence to walk after hip fracture. Conclusion This study provided insight on participant perceptions of how motivational interviewing might work to support walking after hip fracture. Innovation The addition of motivational interviewing to rehabilitation is a novel way of building confidence to walk for people recovering from hip fracture.
Collapse
Affiliation(s)
- Made U. Rimayanti
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, VIC, Australia
- Corresponding author.
| | - Nicholas F. Taylor
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, VIC, Australia
- Allied Health Clinical Research Office, Eastern Health, Box Hill, VIC, Australia
| | - Paul D. O'Halloran
- School of Psychology and Public Health, La Trobe University, Bundoora, VIC, Australia
| | - Nora Shields
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, VIC, Australia
| |
Collapse
|
33
|
Muacevic A, Adler JR, Gachake AA, Chitale NV, Phansopkar P. Rehabilitation Towards Functional Independence in a Patient With Intertrochanteric Fracture and Paraplegia: A Case Report. Cureus 2022; 14:e32689. [PMID: 36686125 PMCID: PMC9847962 DOI: 10.7759/cureus.32689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 12/19/2022] [Indexed: 12/23/2022] Open
Abstract
Traumatic spinal cord injury (SCI) causes significant neurological deficits that adversely affect the quality of life of patients and caregivers. Patients with SCI present with the symptoms of weakness and loss of sensations in the limbs. Motor deficits may occur in the form of paraplegia, hemiplegia, or quadriplegia. Patients remain immobilized for a prolonged period which may lead to complications like muscle wasting, atrophy, joint stiffness, contractures, bed sores, and osteoporosis. Patients are prone to fractures owing to osteoporosis. The fractures may occur even due to trivial trauma. Our case report presents the case of a 45-year-old male patient who is already diagnosed with paraplegia having a history of SCI one-and-a-half years ago. He has recent history of intertrochanteric (IT) fracture that occurs during the transfer from bed to wheelchair. Admitted to the hospital with a complaint of a popping sound along with low back pain. Further investigation and management were started.
Collapse
|
34
|
Wu W, Zhang Y, Zhang Y, Peng B, Xu W. Clinical Effectiveness of Home-Based Telerehabilitation Program for Geriatric Hip Fracture Following Total Hip Replacement. Orthop Surg 2022; 15:423-431. [PMID: 36448261 PMCID: PMC9891946 DOI: 10.1111/os.13521] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 08/08/2022] [Accepted: 08/24/2022] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE To compare the effectiveness of a six-month home-based telerehabilitation based on the Internet-based rehabilitation management system coupled with conventional outpatient care in elderly patients with hip fractures following total hip replacement (THR). METHODS Elderly patients (aged over 65 years) with first hip fractures who underwent THR between March 2018 and September 2018 in Tianjin Hospital were enrolled in this study. Patients were divided into two groups: telerehabilitation group (n = 43) and telephone group (n = 42). A Internet-based telerehabilitation management system was established and applied on patients in the telerehabilitation group. For patients in the telephone group, the rehabilitation intervention was administered through conventional outpatient care (telephone along with outpatient follow-up). Data from the Harris hip scale (HHS), functional independence measure (FIM), self-rating anxiety scale (SAS), and postoperative complications at 1, 3, and 6 months after surgery were collected and compared between the two groups. RESULTS A total of 85 elderly patients completed the 6-month follow-up assessment. Results showed that the HHS score was significantly higher in the telerehabilitation group than in the telephone group at 1 month (66.35 ± 4.63 vs 63.48 ± 4.49), 3 months (76.33 ± 4.52 vs 71.81 ± 3.84), and 6 months (84.23 ± 3.13 vs 77.29 ± 4.95) after surgery (P < 0.001). The FIM score was significantly higher in the telerehabilitation group than in the telephone group at 1 month (89.00 ± 5.63 vs 73.35 ± 8.70), 3 months (100.16 ± 4.56 vs 92.81 ± 5.17), and 6 months (111.70 ± 3.13 vs 98.64 ± 5.12) after surgery (P < 0.001). The SAS score was significantly lower in the telerehabilitation group than in the telephone group at 1 month (42.40 ± 3.07 vs 46.21 ± 3.53), 3 months (36.77 ± 2.26 vs 40.24 ± 1.66), and 6 months (29.26 ± 1.63 vs 33.81 ± 2.62) after surgery (P < 0.001). The overall complication rate was significantly lower in the telerehabilitation group than in the telephone group (14% vs 40.5%) (P < 0.05). CONCLUSION Internet-based rehabilitation management system can not only promote the physical rehabilitation of patients, but also play a positive role in psychological rehabilitation and the prevention of complications, which provides new ideas and methods for clinical rehabilitation.
Collapse
Affiliation(s)
- Wei‐yong Wu
- Department of OrthopaedicsTianjin HospitalTianjinChina
| | | | | | - Bing Peng
- Department of OrthopaedicsTianjin HospitalTianjinChina
| | - Wei‐guo Xu
- Department of OrthopaedicsTianjin HospitalTianjinChina
| |
Collapse
|
35
|
Kim HS, Lee JE, Choi RJ, Kim CH. Impact of concomitant upper-extremity injuries in patients with hip fractures: a systematic review and meta-analysis. Arch Orthop Trauma Surg 2022:10.1007/s00402-022-04608-w. [PMID: 36074171 DOI: 10.1007/s00402-022-04608-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 08/29/2022] [Indexed: 11/02/2022]
Abstract
INTRODUCTION Combined hip and upper-extremity fractures raise clinical concerns because upper-extremity fractures may hinder early mobilization, thereby affecting rehabilitation and mortality. This systematic review and meta-analysis aimed to evaluate the effects of combined upper-extremity and hip fractures on rehabilitation and mortality. MATERIALS AND METHODS We systematically searched MEDLINE, Embase, and the Cochrane Library for studies published before March 20, 2022, that evaluated the impact of concomitant upper-extremity injuries in geriatric patients with hip fractures. The pooled analysis identified differences in the (1) length of hospital stay, (2) discharge destination, and (3) mortality rates between the isolated and combined hip fracture groups. RESULTS A total of 217,233 patients with isolated hip fractures (n = 203,816) and combined hip and upper-extremity fractures (n = 13,417) from 12 studies were analyzed. The average length of hospital stay was significantly longer in the combined upper-extremity fracture group than in the isolated hip fracture group (mean difference = 1.67 days; 95% confidence interval [CI] 0.63-2.70; P = 0.002). Patients in the combined upper limb fracture group were less likely to be discharged directly home (odds ratio [OR] = 0.64; 95% CI 0.52-0.80; P < 0.001) and showed significantly higher 30-day mortality (OR = 1.44; 95% CI 1.32-1.58; P < 0.001). The mortality rate after 30 days was not significantly different between the two groups. CONCLUSIONS Concomitant upper-extremity fractures have debilitating effects on rehabilitation and early mortality in geriatric patients with hip fractures. Therefore, more focus should be placed on the early ambulation of patients with hip fractures and simultaneous upper limb fractures to promote rehabilitation and alleviate the public health burden. LEVEL OF EVIDENCE III meta-analysis.
Collapse
Affiliation(s)
- Han Soul Kim
- Department of Orthopedic Surgery, Gachon University Gil Medical Center, Namdong-gu, Incheon, Republic of Korea
| | - Jung Eun Lee
- Department of Orthopedic Surgery, Gachon University Gil Medical Center, Namdong-gu, Incheon, Republic of Korea
| | - Rak Jun Choi
- Department of Orthopedic Surgery, Gachon University Gil Medical Center, Namdong-gu, Incheon, Republic of Korea
| | - Chul-Ho Kim
- Department of Orthopedic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102 Heukseok-ro, Dongjak-ku, Seoul, 06973, Republic of Korea.
| |
Collapse
|
36
|
Phruetthiphat OA, Paiboonrungroj S, Satravaha Y, Lawanprasert A. The effect of CKD on intertrochanteric fracture treated with proximal femoral nail anti-rotation: A 7-year study. J Orthop 2022; 32:151-155. [PMID: 35733927 DOI: 10.1016/j.jor.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 05/24/2022] [Accepted: 06/02/2022] [Indexed: 11/27/2022] Open
Abstract
Background Intertrochanteric fracture is one of the most burdensome osteoporotic fractures in the elderly. Chronic kidney disease is associated with sarcopenia, especially in its advanced stages and, thus may impact functional status. Combining an intertrochanteric fracture with advanced CKD may diminish results after surgical fixation. This study aims to distinguish whether CKD affects the result of intertrochanteric fracture fixation in terms of mechanical and functional outcomes. Methods A retrospective study reviews all intertrochanteric fractures treated with PFNA fixation from 2012 to 2018. 445 patients were classified into 5 stages of CKD and divided by eGFR = 90 ml/min/1.73 m2 into CKD and non-CKD group and by eGFR = 30 ml/min/1.73 m2 into advanced CKD and non-advanced CKD group. The primary outcome was one year Harris Hip Score (HHS). Secondary outcomes were medical complications, surgical complications, and a 1-year mortality rate. Results Harris Hip Scores (HHS) were not different between non-CKD and CKD groups (eGFR <90 mL/min/1.73 m2). However, there was a difference between non-advanced CKD and advanced CKD groups (eGFR <30 mL/min/1.73 m2) (p < 0.001). Medical complications were not different, except for sepsis in CKD stage 5 compared with stage 1 (p = 0.023). Even though AO/OTA types were more severe in the advanced CKD group, surgical complications and 1-year mortality were not different. Conclusion Advanced stage CKD treated with PFNA fixation is associated with lower functional outcomes at one year. Sepsis is more prone to occur after surgery in CKD stage 5. Level of evidence Level III; Retrospective cohort study.
Collapse
Affiliation(s)
| | | | - Yodhathai Satravaha
- Department of Orthodontics, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | | |
Collapse
|
37
|
Chintalapudi N, Agarwalla A, Bortman J, Lu J, Basmajian HG, Amin NH, Liu JN. Liposomal Bupivacaine Associated with Cost Savings during Postoperative Pain Management in Fragility Intertrochanteric Hip Fractures. Clin Orthop Surg 2022; 14:162-168. [PMID: 35685981 PMCID: PMC9152892 DOI: 10.4055/cios21024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 04/22/2021] [Accepted: 04/22/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Intertrochanteric hip fractures are among the most common and most expensive diagnoses in the Medicare population. Liposomal bupivacaine is a novel preparation of a commonly used analgesic agent that, when used intraoperatively, decreases narcotic requirements and hospital length of stay and increases the likelihood of discharge to home. The purpose of this investigation was to determine whether there was an economic benefit to utilizing intraoperative liposomal bupivacaine in patients with fragility intertrochanteric hip fractures in comparison to a group of patients who did not receive liposomal bupivacaine. METHODS This is a retrospective observational study performed at two academic medical centers. Fifty-six patients with intertrochanteric hip fractures treated with cephalomedullary nail implant who received standard hip fracture pain management protocol were compared to a cohort of 46 patients with intertrochanteric hip fractures who received additional intraoperative injections of liposomal bupivacaine. All other standards of care were identical. A cost analysis was completed including the cost of liposomal bupivacaine, operating room costs, and discharge destination. Statistical significance was set at p < 0.05. RESULTS Although the length of hospital stay was similar between the two groups (3.2 days vs. 3.8 days, p = 0.08), patients receiving intraoperative liposomal bupivacaine had a lower likelihood of discharge to a skilled nursing facility (84.8% vs. 96.4%, p = 0.002) and a longer operative time (73.4 minutes vs 67.2 minutes, p = 0.004). The cost-benefit analysis indicated that for an investment of $334.18 in the administration of 266 mg of liposomal bupivacaine, there was a relative saving of $1,323.21 compared to the control group. The benefit-cost ratio was 3.95, indicating a $3.95 benefit for each $1 spent in liposomal bupivacaine. CONCLUSIONS Despite the increased initial cost, intraoperative use of liposomal bupivacaine was found to be a cost-effective intervention due to the higher likelihood of discharge to home during the postoperative management of patients with intertrochanteric hip fractures.
Collapse
Affiliation(s)
| | - Avinesh Agarwalla
- Department of Orthopedic Surgery, Westchester Medical Center, Westchester, NY, USA
| | | | - Joana Lu
- Department of Orthopaedic Surgery, Pomona Valley Hospital Medical Center, Pomona Valley, CA, USA
| | - Hrayr G. Basmajian
- Department of Orthopaedic Surgery, Pomona Valley Hospital Medical Center, Pomona Valley, CA, USA
| | - Nirav H. Amin
- Department of Orthopaedic Surgery, Pomona Valley Hospital Medical Center, Pomona Valley, CA, USA
| | - Joseph N. Liu
- Department of Orthopedic Surgery, Loma Linda Medical Center, Loma Linda, CA, USA
| |
Collapse
|
38
|
Queiroz RD, Borger RA, Heitzmann LG, Fingerhut DJP, Saito LH. Fraturas intracapsulares do colo femoral no idoso. Rev Bras Ortop 2022; 57:360-368. [PMID: 35785116 PMCID: PMC9246523 DOI: 10.1055/s-0041-1736473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 05/18/2021] [Indexed: 11/17/2022] Open
Abstract
Currently, intracapsular femoral neck fracture (IFNF) is still a great challenge for orthopedists. In spite of the progress that has been made, a high mortality rate persists in the first year, especially in Brazil, where there is no awareness that such fractures in elderly patients should be treated as a medical emergency. The present article seeks to provide an update on the preoperative, surgical, and postoperative approaches.
Collapse
Affiliation(s)
- Roberto Dantas Queiroz
- Serviço de Ortopedia e Traumatologia, Hospital do Servidor Público Estadual de São Paulo, Instituto de Assistência Médica ao Servidor Público Estadual (Iamspe), São Paulo, SP, Brasil
| | - Richard Armelin Borger
- Serviço de Ortopedia e Traumatologia, Hospital do Servidor Público Estadual de São Paulo, Instituto de Assistência Médica ao Servidor Público Estadual (Iamspe), São Paulo, SP, Brasil
| | - Lourenço Galizia Heitzmann
- Serviço de Ortopedia e Traumatologia, Hospital do Servidor Público Estadual de São Paulo, Instituto de Assistência Médica ao Servidor Público Estadual (Iamspe), São Paulo, SP, Brasil
| | - David Jeronimo Peres Fingerhut
- Serviço de Ortopedia e Traumatologia, Hospital do Servidor Público Estadual de São Paulo, Instituto de Assistência Médica ao Servidor Público Estadual (Iamspe), São Paulo, SP, Brasil
| | - Luiz Henrique Saito
- Serviço de Ortopedia e Traumatologia, Hospital do Servidor Público Estadual de São Paulo, Instituto de Assistência Médica ao Servidor Público Estadual (Iamspe), São Paulo, SP, Brasil
| |
Collapse
|
39
|
Kweon SH, Park JS, Park BH. Sarcopenia and Its Association With Change of Bone Mineral Density and Functional Outcome in Old-Aged Hip Arthroplasty Patients. Geriatr Orthop Surg Rehabil 2022; 13:21514593221092880. [PMID: 35603232 PMCID: PMC9118409 DOI: 10.1177/21514593221092880] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 12/21/2021] [Accepted: 12/27/2021] [Indexed: 12/03/2022] Open
Abstract
This study aimed to investigate the relationship between sarcopenia and change in bone mineral density (BMD) and functional outcome in hip arthroplasty patients. Methods: Among the 221 patients who had undergone hip arthroplasty, 147 patients were enrolled. All patients were divided into 2 groups according to presence of sarcopenia. Bone mineral density (BMD) at hospitalization and 1-year after surgery and Barthel index was measured at the time of before injury, hospitalization, 3 months and 1-year after surgery. Results: BMD at hospitalization showed .627 ± .082 (g/cm2) in Sarcopenia and .726 ± .059 (g/cm2) in Non-sarcopenia at femur (total) site (P < .001), .531 ± .085 (g/cm2) vs .629 ± .057 (g/cm2) at femur neck site (P=.002), .715 ± .084 (g/cm2) vs .807 ± .058 (g/cm2) at lumbar (L1-L4) site (P < .001). BMD at 1-year follow-up period, Sarcopenia showed .626 ± .082 (g/cm2) and Non-sarcopenia showed .725 ± .060 (g/cm2) at femur (total) site (P < .001), .530 ± .085 (g/cm2) vs .629 ± .058 (g/cm2) at femur neck site (P < .001), .715 ± .084 (g/cm2) vs .806 ± .058 (g/cm2) at lumbar (L1-L4) site (P < .001). Change of BMD showed −.01 ± .25% for Sarcopenia and −.15 ± .47% for Non-sarcopenia in femur (total) site (P=.089), −.08 ± .63% vs −.01 ± 1.01% in femur neck site (P = .058), .00 ± .09% vs −.12 ± .33% for each group in lumbar (L1-L4) site (P = .052). Barthel index score showed 79.94 ± 5.66 for Sarcopenia and 84.74 ± 5.36 for Non-sarcopenia at pre-injury status (P < .001), 33.89 ± 4.94 vs 33.87 ± 5.36 at the time of hospitalization (P = .977), 57.42 ± 7.19 vs 60.06 ± 5.39 at 3 months follow up (P = .015), 73.86 ± 5.94 vs 80.71 ± 4.81 for each group at 1-year follow up (P < .001). Conclusions: Our study found that the sarcopenia showed lower BMD than the non-sarcopenia, but there was no significant difference of BMD change in the follow-up period. In addition, the sarcopenia showed poor functional results at all points except at the time of hospitalization.
Collapse
Affiliation(s)
- Suc-Hyun Kweon
- Department of Orthopedic Surgery, School of Medicine, WonkwangUniversityHospital, Iksan, Korea
| | - Jin Sung Park
- Department of Orthopedic Surgery, School of Medicine, WonkwangUniversityHospital, Iksan, Korea
| | - Byung Ha Park
- Department of Orthopedic Surgery, School of Medicine, WonkwangUniversityHospital, Iksan, Korea
| |
Collapse
|
40
|
Fujikawa T, Takahashi S, Shinohara N, Mashima N, Koda M, Takahashi H, Yasunaga Y, Sankai Y, Yamazaki M, Miura K. Early Postoperative Rehabilitation Using the Hybrid Assistive Limb (HAL) Lumbar Type in Patients With Hip Fracture: A Pilot Study. Cureus 2022; 14:e22484. [PMID: 35371681 PMCID: PMC8943782 DOI: 10.7759/cureus.22484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2022] [Indexed: 11/27/2022] Open
Abstract
Objective: To extend life expectancy after surgery, patients with hip fractures need to improve their mobility quickly through postoperative rehabilitation. Voluntary hip joint motion supported by the hybrid assistive limb (HAL) lumbar type, an exoskeleton robot suit characterized by its ability to detect the wearer’s intentions through the bioelectrical signals and assist hip extension motions at an optimal timing, may be effective to improve mobility in patients with hip joint dysfunction after surgery. We aimed to introduce rehabilitation using the HAL lumbar type in the early period after hip fracture surgery. Methods: Patients who underwent internal fixation for hip fracture at a single institution were prospectively enrolled. They received early postoperative rehabilitation (forward and backward bending of the lumbar spine, pelvic tilt forward and backward, standing up, and squatting) using the HAL lumbar type (six times a week for 15 min per session). Five-times-sit-to-stand (FTSS) and timed-up-and-go (TUG) tests were conducted at baseline before HAL rehabilitation (pre-HAL) and after the HAL rehabilitation (post-HAL) intervention. Results: We enrolled 14 patients (one man, 13 women) in this study. There were no adverse events, and all patients were able to complete the entire rehabilitation program. Post-HAL FTSS showed significant improvement compared with pre-HAL and had a large effect size of 1.81 (95% CI = 0.93 to 2.66) and sufficient power. Conclusions: Robotic rehabilitation with HAL lumbar type could be introduced without adverse events, even in the early postoperative period following surgery for hip fracture. Further study is needed to develop an appropriate rehabilitation protocol using the HAL lumbar type.
Collapse
|
41
|
Orwig DL, Abraham DS, Hochberg MC, Gruber-Baldini A, Guralnik JM, Cappola AR, Golden J, Hicks GE, Miller RR, Resnick B, Shardell M, Sterling RS, Bajracharya R, Magaziner J. Sex Differences in Recovery Across Multiple Domains Among Older Adults With Hip Fracture. J Gerontol A Biol Sci Med Sci 2021; 77:1463-1471. [PMID: 34555162 PMCID: PMC9255694 DOI: 10.1093/gerona/glab271] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Hip fractures are a public health problem among older adults, but most research on recovery after hip fracture has been limited to females. With growing numbers of hip fractures among males, it is important to determine how recovery outcomes may differ between the sexes. METHODS 168 males and 171 females were enrolled within 15 days of hospitalization with follow-up visits at 2, 6, and 12 months postadmission to assess changes in disability, physical performance, cognition, depressive symptoms, body composition, and strength, and all-cause mortality. Generalized estimating equations examined whether males and females followed identical outcome recovery assessed by the change in each outcome. RESULTS The mean age at fracture was similar for males (80.4) and females (81.4), and males had more comorbidities (2.5 vs 1.6) than females. Males were significantly more likely to die over 12 months (hazard ratio 2.89, 95% confidence interval: 1.56-5.34). Changes in outcomes were significantly different between males and females for disability, gait speed, and depressive symptoms (p < .05). Both sexes improved from baseline to 6 months for these measures, but only males continued to improve between 6 and 12 months. There were baseline differences for most body composition measures and strength; however, there were no significant differences in change by sex. CONCLUSIONS Findings confirm that males have higher mortality but suggest that male survivors have continued functional recovery over the 12 months compared to females. Research is needed to determine the underlying causes of these sex differences for developing future prognostic information and rehabilitative interventions.
Collapse
Affiliation(s)
- Denise L Orwig
- Address correspondence to: Denise L. Orwig, PhD, Department of Epidemiology and Public Health, University of Maryland School of Medicine, 660 West Redwood Street, Suite 200, Baltimore, MD 21201, USA. E-mail:
| | - Danielle S Abraham
- Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, USA
| | - Marc C Hochberg
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, USA
| | - Ann Gruber-Baldini
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, USA
| | - Jack M Guralnik
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, USA
| | - Anne R Cappola
- Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, USA
| | - Justine Golden
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, USA
| | - Gregory E Hicks
- Department of Physical Therapy, University of Delaware, Newark, USA
| | - Ram R Miller
- Novartis Institutes for BioMedical Research, Cambridge, Massachusetts, USA
| | - Barbara Resnick
- Department of Organizational Systems and Adult Health, University of Maryland School of Nursing, Baltimore, USA
| | - Michelle Shardell
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, USA
| | - Robert S Sterling
- Department of Orthopedics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Rashmita Bajracharya
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, USA
| | - Jay Magaziner
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, USA
| |
Collapse
|
42
|
Wang L, Chen W, Kang FB, Zhang YH, Qi LL, Zhang YZ. Blood transfusion practices affect CD4 + CD25 + FOXP3 + regulatory T cells/T helper-17 cells and the clinical outcome of geriatric patients with hip fracture. Aging (Albany NY) 2021; 13:21408-21420. [PMID: 34470917 PMCID: PMC8457583 DOI: 10.18632/aging.203479] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 07/17/2021] [Indexed: 05/01/2023]
Abstract
Hip fracture (HF) is common among older individuals and associated with high mortality, poor vitality and functional impairment. HF patients suffer whole body immunological changes and that lead to severe consequences, including immobilization, physical impairment and a high risk of complications. The objective of this study was to decipher the pattern of dynamic immunological changes, especially in two major T cell subsets, CD4+ CD25+ FOXP3+ regulatory T (Treg) cells and T helper-17 (Th17) cells, and their balance, during the hospital stay and to observe whether blood transfusion could influence these cells and clinical patietns' prognosis. In this study, ninety-eight consecutive HF patients were initially enrolled, and finally fifty-one patients qualified for the study, and correlation analysis of their clinical parameters was carried out to predict the meaning of their distribution in clinical practice. Our results showed that the frequency of Tregs gradually decreased, while the frequency of Th17 cells slowly increased in HF patients who received blood transfusion. The Treg frequency was inversely correlated with the level of hemoglobin (Hb), and Th17 cell frequency was positively related to fluctuations in Hb levels in HF patients after trauma. HF patients with a better prognosis and survival time showed decreased a Treg frequency and a decreased Treg/Th17 ratio. Transfusion helped reverse the imbalance in the frequencies of Tregs and Th17 cells and the Treg/Th17 ratio and especially contributed to a better outcome in HF patients with moderate-to-severe anemia. In conclusion, a higher frequency of peripheral blood Tregs and a higher Treg/Th17 ratio may be associated with unfavorable outcomes in HF patients, and blood transfusion may benefit moderate-to-severe HF patients rebalance their immune response.
Collapse
Affiliation(s)
- Ling Wang
- Department of Orthopedic Oncology, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, PR China
- Department of Orthopedic Research Center, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, PR China
| | - Wei Chen
- Department of Orthopedic Trauma, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, PR China
| | - Fu-Biao Kang
- The Liver Disease Center of PLA, The 980th Hospital of PLA Joint Logistics Support Force, Shijiazhuang 050082, PR China
| | - Ya-Hui Zhang
- Department of Orthopedic Trauma, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, PR China
| | - Li-Li Qi
- Department of Pathogenic biology, Hebei Medical University, Shijiazhuang, Hebei, PR China
| | - Ying-Ze Zhang
- Department of Orthopedic Research Center, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, PR China
- Department of Orthopedic Trauma, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, PR China
| |
Collapse
|
43
|
Terzis N, Salonikidis K, Apostolara P, Roussos N, Karzis K, Ververidis A, Drosos G. Can the exercise-based and occupational therapy improve the posture, strength, and mobility in elderly Greek subjects with hip fracture? A non-randomized control trial. J Frailty Sarcopenia Falls 2021; 6:57-65. [PMID: 34131602 PMCID: PMC8173532 DOI: 10.22540/jfsf-06-057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2021] [Indexed: 11/03/2022] Open
Abstract
Objectives The effects of a rehabilitation program on static balance, mobility, and strength of lower limbs in elderly fallers operated after a hip fracture and non-operated were studied. Methods Ninety-one elderly (>65 years) were divided in two groups, the Operated Group (OG, 43 fallers) and the Non-Operated Group (NOG, 48 fallers). Posture during bipedal stance (30s), mobility (Up-and-Go, Falls Efficacy Scale, Berg Balance Scale) and isokinetic strength of several muscular groups in both limbs were evaluated before and after a rehabilitation intervention, consisting in 20 sessions (3 sessions/week) including kinesiotherapy and occupational therapy. Results After intervention, the average velocity of Center of Pressure displacement decreased significantly for OG and NOG (p<0.005). Similarly, all other variables describing static balance, mobility (p<0.05) and isokinetic strength (p<0.005) were improved significantly for both groups. Conclusions The applied intervention led to improvement in static balance, mobility, and strength of lower limbs after hip fracture. Physical and Rehabilitation Medicine physicians should prescribe evidence-based rehabilitation protocols in elderly fallers because they could show just as remarkable improvements as non-operated patients when the program is carefully designed.
Collapse
Affiliation(s)
- Nikolaos Terzis
- Medical School, Department of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Konstantinos Salonikidis
- Laboratory of Neuromechanics, Department of Physical Education and Sport Science at Serres, Aristotle University of Thessaloniki, Serres, Greece
| | | | | | | | - Athanasios Ververidis
- Medical School, Department of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Georgios Drosos
- Medical School, Department of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| |
Collapse
|
44
|
Khwaja A, Mahoney W, Johnson J, Trompeter A, Lowe J. Biomechanics of periprosthetic femur fractures and early weightbearing. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 31:861-869. [PMID: 33852066 DOI: 10.1007/s00590-021-02969-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 04/01/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE The incidence of periprosthetic fractures is expected to rise increase by 4.6% every 10 years between 2015 and 2060. There are few large series examining optimal fixation constructs or the influence of early ambulation on outcome. The purpose of this narrative review is to investigate the published biomechanical considerations for periprosthetic fracture fixation, with specific consideration of early postoperative weightbearing. METHODS A literature review was performed to identify fracture incidences, etiology, and current trends in weightbearing after fixation. Benefits of early weightbearing, current constructs, and biomechanics are reviewed. RESULTS The limited data available support medical benefits and increased union rates with early mobilization. Optimal fixation constructs are not agreed upon, but mechanical studies suggest that dual implant constructs can support physiologic weightbearing loads. CONCLUSION Further clinical trials are required to investigate fracture union and hardware complications in dual implant construct.
Collapse
Affiliation(s)
- Ansab Khwaja
- Department of Orthopaedics, University of Arizona, 1625 N Campbell Avenue, Tucson, AZ, 85719, USA.
| | - William Mahoney
- Department of Orthopaedics, University of Arizona, 1625 N Campbell Avenue, Tucson, AZ, 85719, USA
| | - Jay Johnson
- Department of Orthopaedics, University of Arizona, 1625 N Campbell Avenue, Tucson, AZ, 85719, USA.,Banner University Medical Group, Banner Health System Phoenix, Phoenix, AZ, USA
| | | | - Jason Lowe
- Department of Orthopaedics, University of Arizona, 1625 N Campbell Avenue, Tucson, AZ, 85719, USA.,Banner University Medical Group, Banner Health System Phoenix, Phoenix, AZ, USA
| |
Collapse
|