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Schoeneberg C, Heuser L, Rascher K, Lendemans S, Knobe M, Eschbach D, Buecking B, Liener U, Neuerburg C, Pass B, Schmitz D. The Geriatrics at Risk Score (GeRi-Score) for mortality prediction in geriatric patients with proximal femur fracture - a development and validation study from the Registry for Geriatric Trauma (ATR-DGU). Osteoporos Int 2023; 34:879-890. [PMID: 36892634 DOI: 10.1007/s00198-023-06719-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 03/01/2023] [Indexed: 03/10/2023]
Abstract
UNLABELLED This study developed an easy-to-use mortality prediction tool, which showed an acceptable discrimination and no significant lack of fit. The GeRi-Score was able to predict mortality and could distinguish between mild, moderate and high risk groups. Therefore, the GeRi-Score might have the potential to distribute the intensity of medical care. PURPOSE Several mortality-predicting tools for hip fracture patients are available, but all consist of a high number of variables, require a time-consuming evaluation and/or are difficult to calculate. The aim of this study was to develop and validate an easy-to-use score, which depends mostly on routine data. METHODS Patients from the Registry for Geriatric Trauma were divided into a development and a validation group. Logistic regression models were used to build a model for in-house mortality and to obtain a score. Candidate models were compared using Akaike information criteria (AIC) and likelihood ratio tests. The quality of the model was tested using the area under the curve (AUC) and the Hosmer-Lemeshow test. RESULTS 38,570 patients were included, almost equal distributed to the development and to the validation dataset. The AUC was 0.727 (95% CI 0.711 - 0.742) for the final model, AIC resulted in a significant reduction in deviance compared to the basic model, and the Hosmer-Lemeshow test showed no significant lack of fit (p = 0.07). The GeRi-Score predicted an in-house mortality of 5.3% vs. 5.3% observed mortality in the development dataset and 5.4% vs. 5.7% in the validation dataset. The GeRi-Score was able to distinguish between mild, moderate and high risk groups. CONCLUSIONS The GeRi-Score is an easy-to-use mortality-predicting tool with an acceptable discrimination and no significant lack of fit. The GeRi-Score might have the potential to distribute the intensity of perioperative medical care in hip fracture surgery and can be used in quality management programs as benchmark tool.
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Affiliation(s)
- Carsten Schoeneberg
- Department of Orthopedic and Emergency Surgery, Alfried Krupp Hospital, Hellweg 100, 45276, Essen, Germany.
| | - Laura Heuser
- Department of Orthopedic and Emergency Surgery, Alfried Krupp Hospital, Hellweg 100, 45276, Essen, Germany
| | | | - Sven Lendemans
- Department of Orthopedic and Emergency Surgery, Alfried Krupp Hospital, Hellweg 100, 45276, Essen, Germany
| | - Matthias Knobe
- Medical Faculty, University of Zurich, Zurich, Switzerland
- Medical Faculty, RWTH Aachen University Hospital, 52074, Aachen, Germany
| | - Daphne Eschbach
- Center for Orthopedics and Trauma Surgery, University Hospital Giessen and Marburg, Marburg, Germany
| | - Benjamin Buecking
- Department for Trauma Surgery, Klinikum Hochsauerland, Arnsberg, Germany
| | - Ulrich Liener
- Department of Orthopedics and Trauma Surgery, Marienhospital, Stuttgart, Germany
| | - Carl Neuerburg
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU, Munich, Germany
| | - Bastian Pass
- Department of Orthopedic and Emergency Surgery, Alfried Krupp Hospital, Hellweg 100, 45276, Essen, Germany
| | - Daniel Schmitz
- Department of Trauma, Orthopedic and Hand Surgery, Marienhospital Bottrop, Bottrop, Germany
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Aigner R, Buecking B, Hack J, Schwenzfeur R, Eschbach D, Einheuser J, Schoeneberg C, Pass B, Ruchholtz S, Knauf T. Effect of Direct Oral Anticoagulants on Treatment of Geriatric Hip Fracture Patients: An Analysis of 15,099 Patients of the AltersTraumaRegister DGU®. Medicina (B Aires) 2022; 58:medicina58030379. [PMID: 35334555 PMCID: PMC8951459 DOI: 10.3390/medicina58030379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 02/22/2022] [Accepted: 02/27/2022] [Indexed: 11/16/2022] Open
Abstract
Background and Objectives: The increased use of direct oral anticoagulants (DOACs) results in an increased prevalence of DOAC treatment in hip fractures patients. However, the impact of DOAC treatment on perioperative management of hip fracture patients is limited. In this study, we describe the prevalence of DOAC treatment in a population of hip fracture patients and compare these patients with patients taking vitamin K antagonists (VKA) and patients not taking anticoagulants. Materials and Methods: This study is a retrospective analysis from the Registry for Geriatric Trauma (ATR-DGU). The data were collected prospectively from patients with proximal femur fractures treated between January 2016 and December 2018. Among other factors, anticoagulation was surveyed. The primary outcome parameter was time-to-surgery. Further parameters were: type of anesthesia, surgical complications, soft tissue complications, length of stay and mortality. Results: In total, 11% (n = 1595) of patients took DOACs at the time of fracture, whereas 9.2% (n = 1325) were on VKA therapy. During the study period, there was a shift from VKA to DOACs. The time-to-surgery of patients on DOACs and of patients on VKA was longer compared to patients who did not take any anticoagulation. No significant differences with regard to complications, type of anesthesia and mortality were found between patients on DOACs compared to VKA treatment. Conclusion: An increased time-to-surgery in patients taking DOACs and taking VKA compared to non-anticoagulated patients was found. This underlines the need for standardized multi-disciplinary orthopedic, hematologic and ortho-geriatric algorithms for the management of hip fracture patients under DOAC treatment. In addition, no significant differences regarding complications and mortality were found between DOAC and VKA users. This demonstrates that even in the absence of widely available antidotes, the safe management of geriatric patients under DOACs with proximal femur fractures is possible.
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Affiliation(s)
- Rene Aigner
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg, 35039 Marburg, Germany; (R.A.); (J.H.); (D.E.); (J.E.); (S.R.)
| | - Benjamin Buecking
- Department for Trauma Surgery, Klinikum Hochsauerland, 59821 Arnsberg, Germany;
| | - Juliana Hack
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg, 35039 Marburg, Germany; (R.A.); (J.H.); (D.E.); (J.E.); (S.R.)
| | - Ruth Schwenzfeur
- Working Committee on Geriatric Trauma Registry of the German Trauma Society, 80538 München, Germany;
| | - Daphne Eschbach
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg, 35039 Marburg, Germany; (R.A.); (J.H.); (D.E.); (J.E.); (S.R.)
| | - Jakob Einheuser
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg, 35039 Marburg, Germany; (R.A.); (J.H.); (D.E.); (J.E.); (S.R.)
| | - Carsten Schoeneberg
- Department of Orthopedic and Emergency Surgery, Alfried Krupp Hospital, 45131 Essen, Germany; (C.S.); (B.P.)
| | - Bastian Pass
- Department of Orthopedic and Emergency Surgery, Alfried Krupp Hospital, 45131 Essen, Germany; (C.S.); (B.P.)
| | - Steffen Ruchholtz
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg, 35039 Marburg, Germany; (R.A.); (J.H.); (D.E.); (J.E.); (S.R.)
| | - Tom Knauf
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg, 35039 Marburg, Germany; (R.A.); (J.H.); (D.E.); (J.E.); (S.R.)
- Correspondence: ; Tel.: +49-6421-58-63174; Fax: +49-6421-58-66721
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Knauf T, Buecking B, Geiger L, Hack J, Schwenzfeur R, Knobe M, Eschbach D, Ruchholtz S, Aigner R. The Predictive Value of the “Identification of Seniors at Risk” Score on Mortality, Length of Stay, Mobility and the Destination of Discharge of Geriatric Hip Fracture Patients. Clin Interv Aging 2022; 17:309-316. [PMID: 35386750 PMCID: PMC8979564 DOI: 10.2147/cia.s344689] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 03/10/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose The German Society for Geriatrics recommends the “ISAR” questionnaire as a screening tool for patients ≥70 for geriatric screening in emergency rooms. Although the ISAR-score is collected routinely in the “AltersTraumaRegister DGU®” (ATR-DGU), to date less is known about the predictive value of the “ISAR”-score in geriatric trauma patients. Patients and Methods Currently, 84 clinics participate in the ATR-DGU. This evaluation is limited to the subgroup of proximal femur fractures from 2016–2018. Patients ≥70 years, who underwent surgery for a hip fracture are included in the ATR-DGU. In this evaluation, the influence of the “ISAR”-score on mortality, length of stay, mobility and the destination of discharge was examined. Results Overall 10,098 patients were included in the present study. The median age was 85 years (interquartile range (IQ) 80–89 years). According to the ISAR-score 80.6% (n=8142) of the patients were classified as geriatric patients (cut off “ISAR”-score ≥2 points). These group of patients had a length of stay of 16 days (IQ10.1–22.1) compared to the non-geriatric patient cohort showing a length of stay of 15 days (IQ10.1–20.1). Patients showing an ISAR-score ≥2 had an increased risk of being discharged to a nursing home (OR 8.25), not being able to walk (OR 12.52) and higher risk of mortality (OR 3.45). Conclusion The “ISAR”-score shows predictive power for the length of stay, mobility, hospital mortality and discharge after hospital in the collective of geriatric trauma patients. It therefore seems suitable as a screening tool for geriatric trauma patients in the emergency department and should be considered in this context.
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Affiliation(s)
- Tom Knauf
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg, Marburg, Germany
- Correspondence: Tom Knauf, Tel +49-6421-58-63174, Fax +49-6421-58-66721, Email
| | - Benjamin Buecking
- Department for Trauma Surgery, Klinikum Hochsauerland, Arnsberg, Germany
| | - Lukas Geiger
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg, Marburg, Germany
| | - Juliana Hack
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg, Marburg, Germany
| | - Ruth Schwenzfeur
- Working Committee on Geriatric Trauma Registry of the German Trauma Society (DGU), München, Germany
| | - Matthias Knobe
- Department of Orthopaedic and Trauma Surgery, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Daphne Eschbach
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg, Marburg, Germany
| | - Steffen Ruchholtz
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg, Marburg, Germany
| | - Rene Aigner
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg, Marburg, Germany
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Hack J, Buecking B, Strauch L, Lenz J, Knauf T, Ruchholtz S, Oberkircher L. Self-rated health status and activities of daily living in the first 12 months after fragility fractures of the pelvis-a prospective study on 134 patients. Osteoporos Int 2022; 33:161-168. [PMID: 34463843 PMCID: PMC8758624 DOI: 10.1007/s00198-021-06104-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 08/16/2021] [Indexed: 11/10/2022]
Abstract
The aim of this study was to evaluate changes in activities of daily living and self-reported health status in the first year after fragility fractures of the pelvis. We found out that these fractures lead to a significant, long-lasting deterioration of both parameters, comparable with hip fractures. PURPOSE The aim of this prospective study was to evaluate the development and to identify influencing factors in activities of daily living (ADL) and self-reported health status (HS) in the first year after fragility fractures of the pelvis (FFP). METHODS A total of 134 patients with FFP ≥ 60 years were included. ADL were measured using the Barthel index (BI) and the IADL scale pre-fracture, at 6 weeks, 6 months, and 12 months. HS was evaluated using the EQ-5D questionnaire at 6 weeks, 6 months, and 12 months. Multiple regression analysis and hierarchical linear models were applied to identify influencing factors in ADL and HS. RESULTS The BI was 95 pre-fracture, 75 at 6 weeks (p < 0.001), 80 at 6 months (p = 0.178), and 80 at 12 months (p = 0.149). The IADL was 6 pre-fracture, 3 at 6 weeks (p < 0.001), 4 at 6 months (p = 0.004), and 4 at 12 months (p = 0.711). The EQ-5D index was 0.70 at 6 weeks, 0.788 at 6 months (p = 0.158), and 0.788 at 12 months (p = 0.798). Significant influencing factors in the multiple regression analysis were pre-fracture nursing care level for all scores; pre-fracture mobility for BI; and pre-fracture IADL, ASA score, and age for IADL. Significant influencing factors in the hierarchical linear model were pre-fracture nursing care level for all scores; pre-fracture IADL, ASA score, age, and time for IADL; and pre-fracture mobility, sex, and time for the EQ-5D. CONCLUSION Our results confirm that FFP lead to a significant, long-lasting deterioration in ADL and HS, comparable with hip fractures.
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Affiliation(s)
- Juliana Hack
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg GmbH, Baldingerstrasse, 35043, Marburg, Germany.
| | - Benjamin Buecking
- Center for Orthopaedics, Trauma Surgery and Geriatric Traumatology, DRK-Kliniken Nordhessen, Kassel, Germany
| | - Lukas Strauch
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg GmbH, Baldingerstrasse, 35043, Marburg, Germany
| | - Julia Lenz
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg GmbH, Baldingerstrasse, 35043, Marburg, Germany
| | - Tom Knauf
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg GmbH, Baldingerstrasse, 35043, Marburg, Germany
| | - Steffen Ruchholtz
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg GmbH, Baldingerstrasse, 35043, Marburg, Germany
| | - Ludwig Oberkircher
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg GmbH, Baldingerstrasse, 35043, Marburg, Germany
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Knauf T, Eschbach D, Buecking B, Knobe M, Barthel J, Rascher K, Ruchholtz S, Aigner R, Schoeneberg C. Open Reduction in Subtrochanteric Femur Fractures Is Not Accompanied by a Higher Rate of Complications. ACTA ACUST UNITED AC 2021; 57:medicina57070659. [PMID: 34199013 PMCID: PMC8305416 DOI: 10.3390/medicina57070659] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 06/17/2021] [Accepted: 06/23/2021] [Indexed: 11/16/2022]
Abstract
Backgroundand Objectives: Hip fractures are among the most typical geriatric fractures. Subtrochanteric fractures are considered difficult to treat, and, to date, there is no consensus on the optimal surgical treatment. Materialisand Methods: We analyzed data from the Registry for Geriatric Trauma, which includes patients ≥ 70 years old with hip fractures or periprosthetic fractures requiring surgery (21,734 patients in 2017-2019). For this study, we analyzed only the subgroup of patients with a subtrochanteric fracture. We analyzed the difference between closed and open surgical methods on a range of outcomes, including mortality, mobility, length of acute hospital stay, and the need for surgical revisions. Results: A total of 506 patients with subtrochanteric fractures were analyzed in this study. The median age was 85 years (interquartile range of 81-89). About 21.1% (n = 107) were operated on with a closed technique, 73.3% (n = 371) with open reduction without using a cerclage, and 5.53% (n = 28) with open reduction with the additional use of one or more cerclage wires. A total of 3.56% (n = 18) of the patients had complications requiring operative revision, most commonly soft tissue interventions (open vs. closed reduction-3.26% vs. 4.67%) (p = 0.687). Patients treated with open reduction were significantly more mobile 7 days after surgery (p = 0.008), while no significant effects on mortality (p = 0.312), length of hospital stay (p = 0.968), or surgical complications (p = 0.687) were found. Conclusion: Proper reduction is the gold standard practice for successful union in subtrochanteric fractures. This study shows that open reduction is not associated with a higher complication rate but does lead to increased mobility 7 days after operation. Therefore, in case of doubt, a good reduction should be aimed for, even using open techniques.
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Affiliation(s)
- Tom Knauf
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg, 35039 Marburg, Germany; (D.E.); (J.B.); (S.R.); (R.A.)
- Correspondence: ; Tel.: +49-6421-58-63174; Fax: +49-6421-58-66721
| | - Daphne Eschbach
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg, 35039 Marburg, Germany; (D.E.); (J.B.); (S.R.); (R.A.)
| | - Benjamin Buecking
- Center for Orthopaedics and Trauma Surgery, DRK-Kliniken Nordhessen, 34121 Kassel, Germany;
| | - Matthias Knobe
- Department of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital, 6004 Lucerne, Switzerland;
| | - Juliane Barthel
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg, 35039 Marburg, Germany; (D.E.); (J.B.); (S.R.); (R.A.)
| | | | - Steffen Ruchholtz
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg, 35039 Marburg, Germany; (D.E.); (J.B.); (S.R.); (R.A.)
| | - Rene Aigner
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg, 35039 Marburg, Germany; (D.E.); (J.B.); (S.R.); (R.A.)
| | - Carsten Schoeneberg
- Department of Orthopedic and Emergency Surgery, Alfried Krupp Hospital, 45131 Essen, Germany;
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Knauf T, Jensen KO, Hack J, Barthel J, Althaus H, Buecking B, Aigner R, Knobe M, Ruchholtz S, Eschbach D. Type of underlying fracture after the surgical treatment of geriatric trauma patients has no effect on mortality during intensive care treatment. Geriatr Gerontol Int 2020; 20:1120-1125. [PMID: 33155420 DOI: 10.1111/ggi.14053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 07/23/2020] [Accepted: 09/14/2020] [Indexed: 11/27/2022]
Abstract
AIM Due to demographic change, the number of geriatric patients is still rising. Although hip fractures are the subject of current research, little is known about the remaining geriatric trauma entities. The aim of this study was to collect data of the age-related traumatological intensive care unit (ICU) population, its underlying diagnosis, and the influence on mortality and length of stay in the ICU. METHODS Geriatric trauma patients (aged ≥65 years) treated postoperatively in our surgical ICU were included in this retrospective observational study covering the period 2013-2017. In addition to the underlying fracture entities, patient characteristics, such as age, sex, Charlson Comorbidity Index, length of stay and mortality, were collected to identify possible independent predictive factors for mortality in the ICU using multivariate analysis. RESULTS During the observation period, 805 (60.5%) patients met the inclusion criteria. 47.6% of the patients suffered from a proximal femoral fracture. The total mortality rate during the stay in the ICU was 7.5%. Significant predictive factors for mortality in the ICU were Charlson Comorbidity Index (P < 0.001) and length of stay (P < 0.001). The different fracture types themselves were not a significant risk factor for mortality (P = 0.862). CONCLUSION Patients with proximal femoral fractures account for approximately half of the patients in intensive care. The mortality rate of these patients is no higher than that in geriatric trauma patients with other fractures. The progression is essentially influenced by the patient's comorbidities. Nowadays, the focus shifts from trauma care to the therapy of concomitant diseases. Nevertheless, this cohort, when adequately treated, shows a comparatively low mortality rate. Geriatr Gerontol Int 2020; 20: 1120-1125.
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Affiliation(s)
- Tom Knauf
- Center for Orthopedics and Trauma Surgery, University Hospital Giessen and Marburg, Marburg, Germany
| | - Kai Oliver Jensen
- Center of Trauma Surgery, University Hospital Zuerich, Zürich, Switzerland
| | - Juliana Hack
- Center for Orthopedics and Trauma Surgery, University Hospital Giessen and Marburg, Marburg, Germany
| | - Juliane Barthel
- Center for Orthopedics and Trauma Surgery, University Hospital Giessen and Marburg, Marburg, Germany
| | - Hannah Althaus
- Center for Orthopedics and Trauma Surgery, University Hospital Giessen and Marburg, Marburg, Germany
| | - Benjamin Buecking
- Center for Orthopedics and Trauma Surgery, DRK-Kliniken Nordhessen, Kassel, Germany
| | - Rene Aigner
- Center for Orthopedics and Trauma Surgery, University Hospital Giessen and Marburg, Marburg, Germany
| | - Matthias Knobe
- Department of Orthopedic Trauma, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Steffen Ruchholtz
- Center for Orthopedics and Trauma Surgery, University Hospital Giessen and Marburg, Marburg, Germany
| | - Daphne Eschbach
- Center for Orthopedics and Trauma Surgery, University Hospital Giessen and Marburg, Marburg, Germany
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Schoeneberg C, Knobe M, Babst R, Friess T, Volland R, Hartwig E, Schmidt W, Lendemans S, Buecking B. [120-day follow-up after proximal femoral fractures-first results from the Geriatric Trauma Registry DGU®]. Unfallchirurg 2020; 123:375-385. [PMID: 31598740 DOI: 10.1007/s00113-019-00730-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Geriatric trauma centers which are certified to the status of a Geriatic Trauma Center DGU® based on the criteria catalogue as outlined by the German Trauma Society (DGU), are required to participate in the Geriatric Trauma Register (ATR-DGU) for quality management and outcome analyses. The evaluation is pseudoanonymous and includes data on all treated hip fracture patients over 70 years old. This has been in regular use since 2016. This study analyzed the postoperative evaluation of gait, mortality, quality of life, hospital readmission and treatment of osteoporosis after 120 days. METHODS A voluntary retrospective data evaluation of the ATR-DGU 120-day follow-up from 2017 was carried out. Written consent for the analysis and publication of the data was obtained from six clinics that already participated in the follow-up. The primary target parameters were mortality rate, readmission and revision rates, gait quality, osteoporosis treatment and quality of life according to EQ-5D-3L. The patient data were completely pseudonymized and a descriptive analysis was carried out. RESULTS In this study 957 patients from the 6 hospitals were included. The average age was 84.5 years (±6.8 years). The mortality rate during the acute treatment phase was 5%. The 120-day follow-up could be evaluated in 412 patients, 10% of these required hospital readmission due to complications oft he same fracture and of these 6% required revision surgery. The mortality rate at 120 days was 12%. In 54% of the patients the fracture led to deterioration of mobility and 49% of patients received osteoporosis treatment after 120 days. The results of the EQ-5D-3L at 120 days revealed improvement as compared to the values on postoperative day 7; however, the preoperative status with respect to mobility and quality of life could not be regained. CONCLUSION Despite the clear advantages of interdisciplinary treatment, the results are still limited concerning mobilization and quality of life. Further analysis of causative and influencing factors is necessary.
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Affiliation(s)
- Carsten Schoeneberg
- Klinik für Orthopädie und Unfallchirurgie, Alfried Krupp Krankenhaus, Hellweg 100, 45276, Essen, Deutschland.
| | - Matthias Knobe
- Klinik für Unfall- und Wiederherstellungschirurgie, Universitätsklinikum RWTH, Aachen, Deutschland.,Klinik für Orthopädie und Unfallchirurgie, Luzerner Kantonsspital, Luzern, Schweiz
| | - Reto Babst
- Klinik für Orthopädie und Unfallchirurgie, Luzerner Kantonsspital, Luzern, Schweiz
| | - Thomas Friess
- Projektkoordination AltersTraumaZentrum DGU®, Herne, Deutschland
| | - Ruth Volland
- AUC, Akademie der Unfallchirurgie GmbH, München, Deutschland
| | - Erich Hartwig
- Klinik für Orthopädie und Unfallchirurgie, ViDia Kliniken Karlsruhe Standort Diakonissenkrankenhaus, Karlsruhe, Deutschland
| | - Wolfgang Schmidt
- Klinik für Unfallchirurgie, Sportorthopädie und Kindertraumatologie, Klinikum Garmisch-Partenkirchen, Garmisch-Partenkirchen, Deutschland
| | - Sven Lendemans
- Klinik für Orthopädie und Unfallchirurgie, Alfried Krupp Krankenhaus, Hellweg 100, 45276, Essen, Deutschland
| | - Benjamin Buecking
- Zentrum für Orthopädie und Unfallchirurgie, Universitätsklinikum Gießen und Marburg GmbH, Standort Marburg, Marburg, Deutschland.,DRK-Kliniken Nordhessen, Klinik für Orthopädie, Unfallchirurgie und Alterstraumatologie, Kassel, Deutschland
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Balzer-Geldsetzer M, Buecking B, Ruchholtz S, Kis B, Dodel R, Hessmann P. Association between longitudinal clinical outcomes in patients with hip fracture and their pre-fracture place of residence. Psychogeriatrics 2020; 20:11-19. [PMID: 30920108 DOI: 10.1111/psyg.12450] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 01/05/2019] [Accepted: 02/24/2019] [Indexed: 01/15/2023]
Abstract
BACKGROUND Clinical outcomes of patients with proximal femoral fracture within 1 year after hospitalization are presented. In particular, associations between the patients' clinical status and their pre-fracture residence were evaluated (community-dwelling vs nursing home). METHODS Patients aged ≥60 years with proximal femoral fractures were included in a prospective, single-centre observational study and followed for 12 months. Patients' clinical status at baseline was compared to their health status at follow-up 12 months later. Several standardized questionnaires were used to evaluate the patients' functional and cognitive capacity (e.g. Lawton Instrumental Activities of Daily Living Scale, Barthel Index, and Mini-Mental State Examination), mobility (timed up-and-go test, Tinetti Test, and Harris Hip Score), quality of life (EuroQol-5 Dimensions index and EuroQol Visual Analogue Scale), and psychological status (Geriatric Depression Scale). RESULTS This study included 402 patients (mean age: 81.3 ± 8.2 years, 72% women). Patients stayed in hospital for 13.7 ± 6.1 days on average. The comparison of patients' clinical status at baseline and at 12-month follow-up revealed that the Mini-Mental State Examination and Charlson Comorbidity Index remained unchanged (P = 0.527 and P = 0.705), the level of depression (Geriatric Depression Scale) significantly decreased (P < 0.001), and quality of life (EuroQol-5 Dimensions index) diminished (P < 0.001). Although patients' mobility increased after 12 months (P < 0.001 for timed up-and-go test and Harris Hip Score), their functional capacity was significantly reduced (P < 0.001 for Barthel Index and Lawton Instrumental Activities of Daily Living Scale). Nursing home residents showed a significantly higher impairment at baseline than community-dwelling individuals and less improvement in functional and cognitive tests at 12-month follow-up. CONCLUSIONS Clinical outcomes after hip fracture are significantly associated with patients' pre-fracture residence status. Place of residence as well as functional and cognitive status on admission may lead to differences in functional recovery and affect therapeutic and rehabilitative decision-making.
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Affiliation(s)
- Monika Balzer-Geldsetzer
- University Hospital Essen, Geriatric Centre Haus Berge, Contilia GmbH, Germany.,Department of Neurology, Philipps-University Marburg, Giessen, Germany
| | - Benjamin Buecking
- Department of Trauma, Hand and Reconstructive Surgery, Philipps-University Marburg, Germany
| | - Steffen Ruchholtz
- Department of Trauma, Hand and Reconstructive Surgery, Philipps-University Marburg, Germany
| | - Bernhard Kis
- Department of Psychiatry and Psychotherapy, University Medical Center, Goettingen, Germany
| | - Richard Dodel
- University Hospital Essen, Geriatric Centre Haus Berge, Contilia GmbH, Germany.,Department of Neurology, Philipps-University Marburg, Giessen, Germany
| | - Philipp Hessmann
- Department of Psychiatry and Psychotherapy, University Medical Center, Goettingen, Germany
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Knauf T, Hack J, Barthel J, Eschbach D, Schoeneberg C, Ruchholtz S, Buecking B, Aigner R. Medical and economic consequences of perioperative complications in older hip fracture patients. Arch Osteoporos 2020; 15:174. [PMID: 33157555 PMCID: PMC7647988 DOI: 10.1007/s11657-020-00843-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 10/16/2020] [Indexed: 02/07/2023]
Abstract
UNLABELLED Patients suffering from complications during inpatient treatment after hip fracture surgery are associated with a worse mid-term outcome. While surgically treatable complications only delay the healing process, internal complications seem to worsen the outcome in the long run. All complications come with significant increased costs during the hospital stay. PURPOSE Due to the demographic changes, the importance of hip fractures is still increasing nowadays. Not only surgical but also medical complications represent a major challenge in the treatment of those patients. Nevertheless, only few is known about the functional, medical, and economic consequences of complications. METHODS A total of 402 hip fracture patients ≥ 60 years were observed prospectively at a German university hospital. Complications were assessed during the inpatient stay and classified by Clavien and Dindo. Afterwards their influence on acute care costs was examined as well as their influence on the mortality, health-related quality of life (HRQL) (EQ5D), functional capacities (Barthel index), and mobility (Tinetti score) in the follow-up periods of 6 and 12 months. RESULTS Complications that required surgical revision/treatment (type III) were associated with an increased 6 months' mortality, while type II and IV complications did not influence mortality after 6 and 12 months. Six months after surgery, HRQL, Barthel score, and Tinetti score were reduced in patients suffering from all different types of complications. After 12 months however, HRQL, Barthel score, and Tinetti score following type II and IV complications remained reduced, while the scores improved in patients suffering from type III complication. All types of complications led to significantly increased acute care costs. CONCLUSIONS The results of the present study emphasize the crucial role of perioperative complications in older patients with hip fractures. Therefore, special attention has to be given to the prevention of those complications, e.g., with orthogeriatric treatment models, which have been shown to be effective in the reduction of complications.
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Affiliation(s)
- Tom Knauf
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg GmbH, Baldingerstraße 1, 35043, Marburg, Germany.
| | - Juliana Hack
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg GmbH, Baldingerstraße 1, 35043, Marburg, Germany
| | - Juliane Barthel
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg GmbH, Baldingerstraße 1, 35043, Marburg, Germany
| | - Daphne Eschbach
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg GmbH, Baldingerstraße 1, 35043, Marburg, Germany
| | - Carsten Schoeneberg
- Department of Orthopedic and Emergency Surgery, Alfried Krupp Hospital, Alfried-Krupp-Straße 21, 45131, Essen, Germany
| | - Steffen Ruchholtz
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg GmbH, Baldingerstraße 1, 35043, Marburg, Germany
| | - Benjamin Buecking
- Center for Orthopaedics and Trauma Surgery, DRK-Kliniken Nordhessen, Hansteinstraße 29, 34121, Kassel, Germany
| | - Rene Aigner
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg GmbH, Baldingerstraße 1, 35043, Marburg, Germany
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10
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Schoeneberg C, Friess T, Buecking B, Krinner S, Lendemans S, Schumacher J. [Online survey for assessment of geriatric early rehabilitation complex treatment in geriatric trauma centers of the DGU by the medical services of the health funds]. Unfallchirurg 2019; 123:368-374. [PMID: 31451842 DOI: 10.1007/s00113-019-00715-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Orthogeriatric co-management of proximal femoral fractures has been proven to effectively reduce mortality rates. This involves extending resources in hospitals treating these patients as well as dealing with the possibility of prolonged periods of hospitalization. The increase in costs of orthogeriatric co-management are best illustrated by the implementation of geriatric early rehabilitation complex treatment. In view of the problems concerning billing this complex treatment, an online survey was carried among certified geriatric trauma centers of the German Trauma Society (DGU®). METHODS Based on a trauma-geriatric consensus 20 questions were formulated by the Academy of Trauma Surgery (AUC) as an online questionnaire and sent to all 75 certified geriatric trauma centers. Apart from a description of the results, a subanalysis based on the figures presented by the case closing departments (geriatrics or trauma surgery) was included. The questions covered a 2-year period of experiences from 2016 to 2018. RESULTS A total of 26 of the 75 certified geriatric trauma centers participated (35%). A continuous increase in cost analysis evaluations by the medical services of the health funds was observed. A rise from 38% in 2016 to 45% in 2018 was seen. An analogous rejection trend from 16% to 24% during this period was evident as well. Subanalysis revealed significantly higher cost evaluation by the medical services of the health funds and cost rejection rates if trauma departments were the case closing disciplines. CONCLUSION The online survey revealed significantly higher assessment and rejection rates when compared to other hospital services. This could prove potentially detrimental to the future of orthogeriatric co-management.
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Affiliation(s)
- Carsten Schoeneberg
- Klinik für Orthopädie und Unfallchirurgie, Alfried Krupp Krankenhaus, Hellweg 100, 45276, Essen, Deutschland.
| | - Thomas Friess
- Projektkoordination AltersTraumaZentrum DGU®, Herne, Deutschland
| | - Benjamin Buecking
- Zentrum für Orthopädie und Unfallchirurgie, Universitätsklinikum Gießen und Marburg GmbH, Standort Marburg, Marburg, Deutschland
| | | | - Sven Lendemans
- Klinik für Orthopädie und Unfallchirurgie, Alfried Krupp Krankenhaus, Hellweg 100, 45276, Essen, Deutschland
| | - Jens Schumacher
- Klinik für Orthopädie und Unfallchirurgie, Innere Medizin, Städtisches Klinikum Dessau, Dessau, Deutschland
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Hack J, Buecking B, Aigner R, Oberkircher L, Knauf T, Ruchholtz S, Eschbach D. What are the influencing factors in self-rated health status after hip fracture? A prospective study on 402 patients. Arch Osteoporos 2019; 14:92. [PMID: 31435743 DOI: 10.1007/s11657-019-0642-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 08/12/2019] [Indexed: 02/03/2023]
Abstract
UNLABELLED Health status (HS) and influencing factors in HS were evaluated six and 12 months after hip fracture. One-third of the patients did not reach their pre-fracture HS within 1 year. HS before fracture and fall risk could, inter alia, be identified as influencing factors. PURPOSE From a patient's perspective, regaining pre-fracture health status (HS) is one of the most important factors concerning the outcome after hip fracture. The aim of this study was to evaluate the HS and particularly to identify influencing factors in HS 6 and 12 months after hip fracture. METHODS A total of 402 patients with hip fractures aged 60 years and older were included. HS was evaluated using the EQ-5D questionnaire pre-fracture and at 6 and 12 months after surgery. Multivariate regression analysis was performed to identify influencing factors in HS at 6 and 12 months. Afterwards, the results in the EQ-5D index were dichotomized into worse and equal/better results than before fracture, and a multivariate logistic regression analysis was performed for the dichotomized variables at 6 and 12 months. RESULTS The EQ-5D index decreased from 0.71 before the fracture to 0.60 at 6 months (p < 0.001) and increased slightly to 0.63 at 12 months (p = 0.328). A high pre-fracture EQ-5D index was associated with not reaching the pre-fracture EQ-5D index, and a high Tinetti score at hospital discharge was associated with reaching the pre-fracture EQ-5D index at 6 and 12 months. A high ASA score was an influencing factor behind a lower EQ-5D index than before the fracture at 6 months. CONCLUSIONS Hip fractures constitute a deep and long-lasting drop in the patients' HS. Early and intensive physiotherapy and individualized rehabilitation programmes regarding a patient's living situation before the fracture seem to be essential to improve HS.
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Affiliation(s)
- Juliana Hack
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg GmbH, Marburg, Germany.
| | - Benjamin Buecking
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg GmbH, Marburg, Germany
| | - Rene Aigner
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg GmbH, Marburg, Germany
| | - Ludwig Oberkircher
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg GmbH, Marburg, Germany
| | - Tom Knauf
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg GmbH, Marburg, Germany
| | - Steffen Ruchholtz
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg GmbH, Marburg, Germany
| | - Daphne Eschbach
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg GmbH, Marburg, Germany
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12
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Knauf T, Buecking B, Hack J, Barthel J, Bliemel C, Aigner R, Ruchholtz S, Eschbach D. Development of the Barthel Index 5 years after hip fracture: Results of a prospective study. Geriatr Gerontol Int 2019; 19:809-814. [PMID: 31264331 DOI: 10.1111/ggi.13723] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 05/21/2019] [Accepted: 05/26/2019] [Indexed: 12/12/2022]
Abstract
AIM The importance of proximal femoral fractures is increasing due to demographic change. Despite appropriate care, these are associated with poor results. We are still lagging behind, and require information on the long-term functional outcome of these patients and the predictive factors involved. METHODS Between 2009 and 2011, 402 patients aged >60 years with hip fractures were included in this prospective observational study. Patients were assessed with the Barthel Index before fracture, at discharge, and 6 months, 1 year and 5 years after surgery. In addition, a variety of parameters (sex, age, fracture type, American Society of Anesthesiologists classification, Mini-Mental State Examination, housing situation, occurrence of complications during inpatient stay and type of care) were collected to identify the possible independent predictive factors using multivariate analysis. RESULTS The lowest Barthel Index was found at discharge (66 ± 24) for patients from an acute hospital. The Barthel Index improved within the first 6 months (86 ± 21) and decreased afterwards. The factors associated with a significantly higher point loss of the Barthel Index in the multivariate analysis were age (P-value 0.020), pre-fracture Barthel Index, (P ≤ 0.001), Mini-Mental State Examination (P ≤ 0.001) and type II complications (P = 0.001). The other values showed no significant influence on the Barthel Index. CONCLUSIONS The present results showed that patients after a hip fracture have a great rehabilitation potential within the first 6 months after the event. More attention should be paid to type II complications and the occurrence of cognitive impairment. Both seem to be a surrogate parameter for the frailty of the patients. Geriatr Gerontol Int 2019; 19: 809-814.
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Affiliation(s)
- Tom Knauf
- Center for Orthopedics and Trauma Surgery, University Hospital Giessen and Marburg, Marburg, Germany
| | - Benjamin Buecking
- Center for Orthopedics and Trauma Surgery, University Hospital Giessen and Marburg, Marburg, Germany
| | - Juliana Hack
- Center for Orthopedics and Trauma Surgery, University Hospital Giessen and Marburg, Marburg, Germany
| | - Juliane Barthel
- Center for Orthopedics and Trauma Surgery, University Hospital Giessen and Marburg, Marburg, Germany
| | - Christopher Bliemel
- Center for Orthopedics and Trauma Surgery, University Hospital Giessen and Marburg, Marburg, Germany
| | - Rene Aigner
- Center for Orthopedics and Trauma Surgery, University Hospital Giessen and Marburg, Marburg, Germany
| | - Steffen Ruchholtz
- Center for Orthopedics and Trauma Surgery, University Hospital Giessen and Marburg, Marburg, Germany
| | - Daphne Eschbach
- Center for Orthopedics and Trauma Surgery, University Hospital Giessen and Marburg, Marburg, Germany
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13
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Rasche P, Nitsch V, Rentemeister L, Coburn M, Buecking B, Bliemel C, Bollheimer LC, Pape HC, Knobe M. The Aachen Falls Prevention Scale: Multi-Study Evaluation and Comparison. JMIR Aging 2019; 2:e12114. [PMID: 31518273 PMCID: PMC6715018 DOI: 10.2196/12114] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 11/16/2018] [Accepted: 01/23/2019] [Indexed: 01/13/2023] Open
Abstract
Background Fall risk assessment is a time-consuming and resource-intensive activity. Patient-driven self-assessment as a preventive measure might be a solution to reduce the number of patients undergoing a full clinical fall risk assessment. Objective The aim of this study was (1) to analyze test accuracy of the Aachen Falls Prevention Scale (AFPS) and (2) to compare these results with established fall risk assessment measures identified by a review of systematic reviews. Methods Sensitivity, specificity, and receiver operating curves (ROC) of the AFPS were calculated based on data retrieved from 2 independent studies using the AFPS. Comparison with established fall risk assessment measures was made by conducting a review of systematic reviews and corresponding meta-analysis. Electronic databases PubMed, Web of Science, and EMBASE were searched for systematic reviews and meta-analyses that reviewed fall risk assessment measures between the years 2000 and 2018. The review of systematic reviews was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement. The Revised Assessment of Multiple SysTemAtic Reviews (R-AMSTAR) was used to assess the methodological quality of reviews. Sensitivity, specificity, and ROC were extracted from each review and compared with the calculated values of the AFPS. Results Sensitivity, specificity, and ROC of the AFPS were evaluated based on 2 studies including a total of 259 older adults. Regarding the primary outcome of the AFPS subjective risk of falling, pooled sensitivity is 57.0% (95% CI 0.467-0.669) and specificity is 76.7% (95% CI 0.694-0.831). If 1 out of the 3 subscales of the AFPS is used to predict a fall risk, pooled sensitivity could be increased up to 90.0% (95% CI 0.824-0.951), whereas mean specificity thereby decreases to 50.0% (95% CI 0.42-0.58). A systematic review for fall risk assessment measures produced 1478 articles during the study period, with 771 coming from PubMed, 530 from Web of Science, and 177 from EMBASE. After eliminating doublets and assessing full text, 8 reviews met the inclusion criteria. All were of sufficient methodological quality (R-AMSTAR score ≥22). A total number of 9 functional or multifactorial fall risk assessment measures were extracted from identified reviews, including Timed Up and Go test, Berg Balance Scale, Performance-Oriented Mobility Assessment, St Thomas’s Risk Assessment Tool in Falling Elderly, and Hendrich II Fall Risk Model. Comparison of these measures with pooled sensitivity and specificity of the AFPS revealed a sufficient quality of the AFPS in terms of a patient-driven self-assessment tool. Conclusions It could be shown that the AFPS reaches a test accuracy comparable with that of the established methods in this initial investigation. However, it offers the advantage that the users can perform the self-assessment independently at home without involving trained health care professionals.
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Affiliation(s)
- Peter Rasche
- Institute of Industrial Engineering and Ergonomics, Department of Mechanical Engineering, RWTH Aachen University, Aachen, Germany
| | - Verena Nitsch
- Institute of Industrial Engineering and Ergonomics, Department of Mechanical Engineering, RWTH Aachen University, Aachen, Germany
| | - Lars Rentemeister
- Department of Orthopaedic Trauma, University of Aachen Medical Center, RWTH Aachen University, Aachen, Germany
| | - Mark Coburn
- Klinik für Anästhesiologie, University of Aachen Medical Center, RWTH Aachen University, Aachen, Germany
| | - Benjamin Buecking
- Center for Orthopaedics and Trauma Surgery, University Hospital of Giessen and Marburg, Marburg, Germany
| | - Christopher Bliemel
- Center for Orthopaedics and Trauma Surgery, University Hospital of Giessen and Marburg, Marburg, Germany
| | - Leo Cornelius Bollheimer
- Department of Geriatrics, University of Aachen Medical Center, RWTH Aachen University, Aachen, Germany
| | - Hans-Christoph Pape
- Department of Orthopaedic Trauma, University of Zurich Medical Center, University of Zurich, Zurich, Switzerland
| | - Matthias Knobe
- Department of Orthopaedic Trauma, University of Aachen Medical Center, RWTH Aachen University, Aachen, Germany
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14
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Eschbach D, Buecking B, Kivioja H, Fischer M, Wiesmann T, Zettl R, Oberkircher L, Barthel J, Aigner R, Ruchholtz S, Bliemel C. One year after proximal or distal periprosthetic fracture of the femur -two conditions with divergent outcomes? Injury 2018; 49:1176-1182. [PMID: 29729819 DOI: 10.1016/j.injury.2018.04.025] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 03/27/2018] [Accepted: 04/23/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Arthroplasty of the hip and knee is 1 of the 20 most frequent operations in Germany. Periprosthetic fracture is one of the most feared complications following primary or revision arthroplasty. Present publication aims to analyse differences between patients with periprosthetic fracture around total knee arthroplasty (PFTKA) and patients with periprosthetic fracture around total hip arthroplasty (PFTHA) concerning demographics, clinical course, complications and return to pre-fracture mobility. METHODS Prospective single-centre observation study of periprosthetic femoral fractures with stable implants. Present subgroup analysis includes patients with PFTKA and PFTHA. All patients were treated with polyaxial angular stable plates using two standardized techniques: a minimally invasive percutaneous distal insertion technique and a mini-open technique. Data collection included implant- and operation-related information as well as demographics, clinical course, complications and return to pre-fracture mobility. Data were collected during a 12-month follow-up. RESULTS We were able to analyse the data of 73 patients. The PFTKA group had 37 patients with a mean age of 76 ± 10 years; 88% were female. After 1 year, 3 patients in this cohort had died; 68% of survivors had reached their pre-fracture mobility; 22% had undergone operative revisions for various reasons. The PFTHA cohort included 36 patients with a mean age of 80 ± 13 years, 72% were female. After 1 year, 9 patients had died in this cohort, 42% of survivors had reached their pre-fracture mobility. Non-operative complications occurred for 16% in the PFTKA group and 64% in the PFTHA group (p < 0.001). 11% had undergone operative revisions for various reasons, among them, two cases of nonunion but no primary infection. CONCLUSION On average, compared to the PFTHA patients, PFTKA patients were younger, underwent significantly lower rates of non-operative complications, had a tendency towards lower mortality, and returned to pre-fracture mobility at higher rates, although they tended to have more revisions when compared to treatment for PFTHA. Overall, when periprosthetic fractures of the femur were treated using polyaxial locking plate osteosynthesis, patients showed very low rates of nonunion and no primary infection.
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Affiliation(s)
- D Eschbach
- Center for Orthopedics and Trauma Surgery, University Hospital Giessen and Marburg, Marburg, Germany.
| | - B Buecking
- Center for Orthopedics and Trauma Surgery, University Hospital Giessen and Marburg, Marburg, Germany
| | - H Kivioja
- Center for Orthopedics and Trauma Surgery, University Hospital Giessen and Marburg, Marburg, Germany
| | - M Fischer
- Center for Orthopedics and Trauma Surgery, University Hospital Giessen and Marburg, Marburg, Germany
| | - T Wiesmann
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Giessen and Marburg, Marburg, Germany
| | - R Zettl
- Department of Orthopaedic and Trauma Surgery, Kantonsspital Frauenfeld, 8500, Frauenfeld, Switzerland
| | - L Oberkircher
- Center for Orthopedics and Trauma Surgery, University Hospital Giessen and Marburg, Marburg, Germany
| | - J Barthel
- Center for Orthopedics and Trauma Surgery, University Hospital Giessen and Marburg, Marburg, Germany
| | - R Aigner
- Center for Orthopedics and Trauma Surgery, University Hospital Giessen and Marburg, Marburg, Germany
| | - S Ruchholtz
- Center for Orthopedics and Trauma Surgery, University Hospital Giessen and Marburg, Marburg, Germany
| | - C Bliemel
- Center for Orthopedics and Trauma Surgery, University Hospital Giessen and Marburg, Marburg, Germany
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Rasche P, Mertens A, Brandl C, Liu S, Buecking B, Bliemel C, Horst K, Weber CD, Lichte P, Knobe M. Satisfying Product Features of a Fall Prevention Smartphone App and Potential Users' Willingness to Pay: Web-Based Survey Among Older Adults. JMIR Mhealth Uhealth 2018; 6:e75. [PMID: 29588268 PMCID: PMC5893889 DOI: 10.2196/mhealth.9467] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 02/16/2018] [Accepted: 02/23/2018] [Indexed: 01/15/2023] Open
Abstract
Background Prohibiting falls and fall-related injuries is a major challenge for health care systems worldwide, as a substantial proportion of falls occur in older adults who are previously known to be either frail or at high risk for falls. Hence, preventive measures are needed to educate and minimize the risk for falls rather than just minimize older adults’ fall risk. Health apps have the potential to address this problem, as they enable users to self-assess their individual fall risk. Objective The objective of this study was to identify product features of a fall prevention smartphone app, which increase or decrease users’ satisfaction. In addition, willingness to pay (WTP) was assessed to explore how much revenue such an app could generate. Methods A total of 96 participants completed an open self-selected Web-based survey. Participants answered various questions regarding health status, subjective and objective fall risk, and technical readiness. Seventeen predefined product features of a fall prevention smartphone app were evaluated twice: first, according to a functional (product feature is implemented in the app), and subsequently by a dysfunctional (product feature is not implemented in the app) question. On the basis of the combination of answers from these 2 questions, the product feature was assigned to a certain category (must-be, attractive, one-dimensional, indifferent, or questionable product feature). This method is widely used in user-oriented product development and captures users’ expectations of a product and how their satisfaction is influenced by the availability of individual product features. Results Five product features were identified to increase users’ acceptance, including (1) a checklist of typical tripping hazards, (2) an emergency guideline in case of a fall, (3) description of exercises and integrated workout plans that decrease the risk of falling, (4) inclusion of a continuous workout program, and (5) cost coverage by health insurer. Participants’ WTP was assessed after all 17 product features were rated and revealed a median monthly payment WTP rate of €5.00 (interquartile range 10.00). Conclusions The results show various motivating product features that should be incorporated into a fall prevention smartphone app. Results reveal aspects that fall prevention and intervention designers should keep in mind to encourage individuals to start joining their program and facilitate long-term user engagement, resulting in a greater interest in fall risk prevention.
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Affiliation(s)
- Peter Rasche
- Institute of Industrial Engineering and Ergonomics, Department of Mechanical Engineering, RWTH Aachen University, Aachen, Germany
| | - Alexander Mertens
- Institute of Industrial Engineering and Ergonomics, Department of Mechanical Engineering, RWTH Aachen University, Aachen, Germany
| | - Christopher Brandl
- Institute of Industrial Engineering and Ergonomics, Department of Mechanical Engineering, RWTH Aachen University, Aachen, Germany
| | - Shan Liu
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - Benjamin Buecking
- Hand and Reconstructive Surgery, Department of Trauma, University Hospital of Giessen and Marburg, Marburg, Germany
| | - Christopher Bliemel
- Hand and Reconstructive Surgery, Department of Trauma, University Hospital of Giessen and Marburg, Marburg, Germany
| | - Klemens Horst
- Department of Orthopaedic Trauma, University of Aachen Medical Center, RWTH Aachen University, Aachen, Germany
| | - Christian David Weber
- Department of Orthopaedic Trauma, University of Aachen Medical Center, RWTH Aachen University, Aachen, Germany
| | - Philipp Lichte
- Department of Orthopaedic Trauma, University of Aachen Medical Center, RWTH Aachen University, Aachen, Germany
| | - Matthias Knobe
- Department of Orthopaedic Trauma, University of Aachen Medical Center, RWTH Aachen University, Aachen, Germany
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16
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Hack J, Eschbach D, Aigner R, Oberkircher L, Ruchholtz S, Bliemel C, Buecking B. Medical Complications Predict Cognitive Decline in Nondemented Hip Fracture Patients-Results of a Prospective Observational Study. J Geriatr Psychiatry Neurol 2018; 31:84-89. [PMID: 29562811 DOI: 10.1177/0891988718760240] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The aim of this study was to identify factors that are associated with cognitive decline in the long-term follow-up after hip fractures in previously nondemented patients. METHODS A consecutive series of 402 patients with hip fractures admitted to our university hospital were analyzed. After exclusion of all patients with preexisting dementia, 266 patients were included, of which 188 could be examined 6 months after surgery. Additional to several demographic data, cognitive ability was assessed using the Mini-Mental State Examination (MMSE). Patients with 19 or less points on the MMSE were considered demented. Furthermore, geriatric scores were recorded, as well as perioperative medical complications. Mini-Mental State Examination was performed again 6 months after surgery. RESULTS Of 188 previously nondemented patients, 12 (6.4%) patients showed a cognitive decline during the 6 months of follow-up. Multivariate regression analysis showed that age ( P = .040) and medical complications ( P = .048) were the only significant independent influencing factors for cognitive decline. CONCLUSIONS In our patient population, the incidence of dementia exceeded the average age-appropriate cognitive decline. Significant independent influencing factors for cognitive decline were age and medical complications.
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Affiliation(s)
- Juliana Hack
- 1 Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg GmbH, Marburg, Germany
| | - Daphne Eschbach
- 1 Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg GmbH, Marburg, Germany
| | - Rene Aigner
- 1 Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg GmbH, Marburg, Germany
| | - Ludwig Oberkircher
- 1 Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg GmbH, Marburg, Germany
| | - Steffen Ruchholtz
- 1 Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg GmbH, Marburg, Germany
| | - Christopher Bliemel
- 1 Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg GmbH, Marburg, Germany
| | - Benjamin Buecking
- 1 Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg GmbH, Marburg, Germany
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Aigner R, Buecking B, Hack J, Eschbach D, Oberkircher L, Ruchholtz S, Bliemel C. Pre-fracture hospitalization is associated with worse functional outcome and higher mortality in geriatric hip fracture patients. Arch Osteoporos 2017; 12:32. [PMID: 28349470 DOI: 10.1007/s11657-017-0327-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 03/16/2017] [Indexed: 02/03/2023]
Abstract
UNLABELLED Hip fractures are common in elderly people. Despite great progress in surgical care, the outcomes of these patients remain disappointing. This study determined pre-fracture hospital admission as a prognostic variable for inferior functional outcomes and increased mortality rates in the perioperative phase and in the first postoperative year. PURPOSE The influence of a pre-fracture hospitalization on outcomes in hip fracture patients has not yet been investigated. METHODS Four hundred two patients who were surgically treated for hip fracture were prospectively enrolled. Patients with a hospital stay within the last 3 months prior to a hip fracture were compared to patients without a pre-fracture hospitalization. Postoperative functional outcomes and mortality rates were compared between groups at the time of hospital discharge and additionally at the six- and twelve-month follow-up appointments. A multivariate regression analysis was performed. RESULTS A pre-fracture hospitalization was reported by 67 patients (17%). In 63% of cases, patients were admitted due to non-surgical, general medical conditions. In 37% of cases, patients were treated due to a condition related to a surgical subject. In the multivariate analysis, pre-fracture hospitalization was an independent risk factor for reduced values on the Barthel Index at 6 months after surgery (B, -9.918; 95%CI of B, -19.001--0.835; p = 0.032) and on the Tinetti Test at 6 months (B, -2.914; 95%CI of B, -1.992--0.047; p = 0.047) and 12 months after surgery (B, -4.680; 95%CI of B, -8.042--1.319; p = 0.007). Pre-fracture hospitalization was additionally associated with increased mortality rates at 6 months (OR 1.971; 95%CI 1.052-3.693; p = 0.034) and 12 months after surgery (OR 1.888; 95%CI 1.010-9.529; p = 0.046). CONCLUSIONS Hip fracture patients with a recent pre-fracture hospital admission are at a substantial risk for inferior functional outcomes and increased mortality rates not only in the perioperative phase but also in the first postoperative year. As a simple dichotomous variable, pre-fracture hospitalization might be a suitable tool for future geriatric hip fracture screening instruments.
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Affiliation(s)
- Rene Aigner
- Center for Orthopaedics and Trauma Surgery, University Hospital Marburg, Baldingerstrasse, 35043, Marburg, Germany
| | - Benjamin Buecking
- Center for Orthopaedics and Trauma Surgery, University Hospital Marburg, Baldingerstrasse, 35043, Marburg, Germany
| | - Juliana Hack
- Center for Orthopaedics and Trauma Surgery, University Hospital Marburg, Baldingerstrasse, 35043, Marburg, Germany
| | - Daphne Eschbach
- Center for Orthopaedics and Trauma Surgery, University Hospital Marburg, Baldingerstrasse, 35043, Marburg, Germany
| | - Ludwig Oberkircher
- Center for Orthopaedics and Trauma Surgery, University Hospital Marburg, Baldingerstrasse, 35043, Marburg, Germany
| | - Steffen Ruchholtz
- Center for Orthopaedics and Trauma Surgery, University Hospital Marburg, Baldingerstrasse, 35043, Marburg, Germany
| | - Christopher Bliemel
- Center for Orthopaedics and Trauma Surgery, University Hospital Marburg, Baldingerstrasse, 35043, Marburg, Germany.
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Buecking B, Eschbach D, Knobe M, Oberkircher L, Balzer-Geldsetzer M, Dodel R, Sielski R, Doering B, Ruchholtz S, Bliemel C. Predictors of noninstitutionalized survival 1 year after hip fracture: A prospective observational study to develop the Marburg Rehabilitation Tool for Hip fractures (MaRTHi). Medicine (Baltimore) 2017; 96:e7820. [PMID: 28906363 PMCID: PMC5604632 DOI: 10.1097/md.0000000000007820] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Hip fractures are frequent fractures in geriatric patients. These fractures have great socioeconomic implications because of the significantly higher risk of mortality and institutionalization. The aim of this study was to develop a prognostic tool to predict survival without institutionalization within 1 year after hip fracture.A total of 402 hip fracture patients aged >60 years (84% community-dwelling) were included in a prospective observational cohort study. Multiple regression analyses determined independent predictors for noninstitutionalized 1-year survival. Finally, the Marburg Rehabilitation Tool for Hip fractures (MaRTHi) was developed based on these independent predictors.Of the 312 patients who were followed up for 1 year, 168 (54%) survived noninstitutionalized, 104 (33%) died, and 40 (13%) lived in nursing homes. Independent predictors for patients' noninstitutionalized survival included the American Society of Anesthesiologists (ASA) score [ASA 1 or 2: odds ratio (OR) = 7.828; 95% confidence interval (CI) = 2.496-24.555 and ASA 3: OR = 8.098; 95% CI = 2.982-21.993 compared with ASA 4 or 5], the Mini Mental State Examination upon admission to the hospital (OR = 7.365; 95% CI = 2.967-18.282 for 27-30 compared with 0-10), patients' age (OR = 2.814; 95% CI = 1.386-5.712 for 75-89 y and OR = 2.520; 95% CI = 0.984-6.453 for 90-99 y compared with 60-74 ys), and prefracture EQ-5D (OR = 2.163; 95% CI = 1.119-4.179 for EQ-5D >0.80 compared with <0.60). The area under the receiver-operating characteristic curve was 0.756 (95% CI = 0.703-0.809), and the sensitivity analysis yielded a MaRTHi score that ranged from 0 to 12 points.The MaRTHi score is the first instrument to predict noninstitutionalized survival with only 4 variables. In addition to 3 well-known factors influencing outcome (age, comorbidities, and cognitive ability), prefracture health-related quality of life was identified as an independent predictor of noninstitutionalized survival. Further studies must be conducted to validate the MaRTHi score and define cutoff scores. Health-related quality of life seems to be an important patient-reported outcome measurement and may play a role in determining patient prognosis.
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Affiliation(s)
- Benjamin Buecking
- Center of Orthopedics and Trauma Surgery, University Hospital Giessen and Marburg, Location Marburg
| | - Daphne Eschbach
- Center of Orthopedics and Trauma Surgery, University Hospital Giessen and Marburg, Location Marburg
| | - Matthias Knobe
- Department of Orthopedic Trauma, University of Aachen Medical Center
| | - Ludwig Oberkircher
- Center of Orthopedics and Trauma Surgery, University Hospital Giessen and Marburg, Location Marburg
| | | | - Richard Dodel
- Department of Neurology, University Hospital Giessen and Marburg, Marburg
| | - Robert Sielski
- Department of Clinical Psychology and Psychotherapy, Philipps University Marburg, Germany
| | - Bettina Doering
- Department of Clinical Psychology and Psychotherapy, Philipps University Marburg, Germany
| | - Steffen Ruchholtz
- Center of Orthopedics and Trauma Surgery, University Hospital Giessen and Marburg, Location Marburg
| | - Christopher Bliemel
- Center of Orthopedics and Trauma Surgery, University Hospital Giessen and Marburg, Location Marburg
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Schoeneberg C, Hussmann B, Wesemann T, Pientka L, Vollmar MC, Bienek C, Steinmann M, Buecking B, Lendemans S. [Challenges of implementing a geriatric trauma network : A regional structure]. Unfallchirurg 2017; 121:313-320. [PMID: 28717977 DOI: 10.1007/s00113-017-0385-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND At present, there is a high percentage and increasing tendency of patients presenting with orthogeriatric injuries. Moreover, significant comorbidities often exist, requiring increased interdisciplinary treatment. These developments have led the German Society of Trauma Surgery, in cooperation with the German Society of Geriatrics, to establish geriatric trauma centers. METHODS As a conglomerate hospital at two locations, we are cooperating with two external geriatric clinics. In 2015, a geriatric trauma center certification in the form of a conglomerate network structure was agreed upon for the first time in Germany. For this purpose, the requirements for certification were observed. Both structure and organization were defined in a manual according to DIN EN ISO 9001:2015. RESULTS Between 2008 and 2016, an increase of 70% was seen in geriatric trauma cases in our hospital, with a rise of up to 360% in specific diagnoses. The necessary standards and regulations were compiled and evaluated from our hospitals. After successful certification, improvements were necessary, followed by a planned re-audit. These were prepared by multiprofessional interdisciplinary teams and implemented at all locations. CONCLUSIONS A network structure can be an alternative to classical cooperation between trauma and geriatric units in one clinic and help reduce possible staffing shortage. Due to the lack of scientific evidence, future evaluations of the geriatric trauma register should reveal whether network structures in geriatric trauma surgery lead to a valid improvement in medical care.
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Affiliation(s)
- Carsten Schoeneberg
- Klinik für Unfallchirurgie und Orthopädie, Alfried Krupp Krankenhaus Essen Steele, Hellweg 100, 45276, Essen, Deutschland.
| | - Bjoern Hussmann
- Klinik für spezielle Unfallchirurgie, Alfried Krupp Krankenhaus Essen Rüttenscheid, Essen, Deutschland
| | - Thomas Wesemann
- Zentrum für Altersmedizin und Geriatrische Rehabilitation, Marien Hospital Wattenscheid, Katholisches Klinikum Bochum, Bochum, Deutschland
| | - Ludger Pientka
- Zentrum für Altersmedizin und Geriatrische Rehabilitation, Marien Hospital Wattenscheid, Katholisches Klinikum Bochum, Bochum, Deutschland
| | - Marie-Christin Vollmar
- Zentrum für Altersmedizin, St. Elisabeth-Krankenhaus Niederwenigern, Katholische Kliniken Ruhrhalbinsel, Hattingen, Deutschland
| | - Christine Bienek
- Zentrum für Altersmedizin, St. Elisabeth-Krankenhaus Niederwenigern, Katholische Kliniken Ruhrhalbinsel, Hattingen, Deutschland
| | - Markus Steinmann
- Qualitäts- und Risikomanagement, Alfried Krupp Krankenhaus Essen Steele und Rüttenscheid, Essen, Deutschland
| | - Benjamin Buecking
- Zentrum für Orthopädie und Unfallchirurgie, Universitätsklinikum Gießen und Marburg GmbH, Standort Marburg, Marburg, Deutschland
| | - Sven Lendemans
- Klinik für Unfallchirurgie und Orthopädie, Alfried Krupp Krankenhaus Essen Steele, Hellweg 100, 45276, Essen, Deutschland.,Klinik für spezielle Unfallchirurgie, Alfried Krupp Krankenhaus Essen Rüttenscheid, Essen, Deutschland
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Bliemel C, Buecking B, Hack J, Aigner R, Eschbach DA, Ruchholtz S, Oberkircher L. Urinary tract infection in patients with hip fracture: An underestimated event? Geriatr Gerontol Int 2017. [PMID: 28621029 DOI: 10.1111/ggi.13077] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM Urinary tract infections (UTI) represent a common perioperative complication among elderly patients with hip fracture. To determine the impact of UTI on the perioperative course of elderly patients with hip fractures, a prospective study was carried out. METHODS A total of 402 surgically-treated geriatric hip fracture patients were consecutively enrolled at a level 1 trauma center. On admission, all patients received an indwelling urinary catheter. Clinically symptomatic patients were screened more closely for UTI. Patients diagnosed with UTI were compared with asymptomatic patients. Outcomes in both patient groups were measured using in-hospital mortality, overall length of hospital stay, wound infection, functional results and mobility at discharge. Multivariate regression analysis was carried out to control for influencing factors. RESULTS A total of 97 patients (24%) sustained a UTI during in-hospital treatment. UTI were independently associated with inferior functional outcomes as assessed by the Barthel Index (β = -0.091; P = 0.031), Timed Up and Go test (β = 0.364; P = 0.001) and Tinetti test (β = -0.169; P = 0.001) at discharge. Additionally, length of hospital stay was significantly longer for patients with a UTI diagnosis (β = 0.123; P = 0.029) after controlling for all other variables. No differences were observed in the rate of wound infection (odds ratio 1.185; P = 0.898) or in-hospital mortality (P < 0.997). CONCLUSIONS Patients with UTI seem to be at risk of inferior functional outcomes. In addition to an early detection of symptomatic UTI and a targeted antibiotic therapy, perioperative care should focus on preserving functional ability to protect these patients from further loss of independence and prolonged clinical courses. Geriatr Gerontol Int 2017; 17: 2369-2376.
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Affiliation(s)
- Christopher Bliemel
- Center for Orthopedics and Trauma Surgery, University Hospital Marburg, Marburg, Germany
| | - Benjamin Buecking
- Center for Orthopedics and Trauma Surgery, University Hospital Marburg, Marburg, Germany
| | - Juliana Hack
- Center for Orthopedics and Trauma Surgery, University Hospital Marburg, Marburg, Germany
| | - Rene Aigner
- Center for Orthopedics and Trauma Surgery, University Hospital Marburg, Marburg, Germany
| | | | - Steffen Ruchholtz
- Center for Orthopedics and Trauma Surgery, University Hospital Marburg, Marburg, Germany
| | - Ludwig Oberkircher
- Center for Orthopedics and Trauma Surgery, University Hospital Marburg, Marburg, Germany
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Aigner R, Hellige R, Knippel S, Oberkircher L, Ruchholtz S, Buecking B. Internal fixation of acetabular fractures in an older population using the TIMI approach - Midterm results of a prospective study. Injury 2017; 48:890-896. [PMID: 28216064 DOI: 10.1016/j.injury.2017.02.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 12/03/2016] [Accepted: 02/02/2017] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The incidence of geriatric acetabular fractures continues to increase due to demographic changes. In the elderly, anterior column fractures are common, and standard approaches are associated with a considerable risk for surgery-associated complications. Therefore, a minimally invasive approach was developed in our department. The aim of this study was to examine early and mid-term results regarding the use of this novel two-incision minimally invasive (TIMI) approach in patients aged over 55 years with acetabular fractures. METHODS From July 2007 to April 2014, 47 patients aged over 55 years were treated via the TIMI approach; these patients were included in the present prospective study. The patients' characteristics, data, and early phase of care were assessed during acute care. A radiological evaluation comprised pre- and postoperative CT scans and x-rays, including Judet views at follow-up. Follow-up examinations were performed after 6 and 24 months and comprised a clinical and radiological examination and an evaluation of hip function (Harris Hip Score) and health-related quality of life (EQ-5D). RESULTS The mean age of the patients was 74±11years, with a gender ratio of 35/12 (m/f). The average operation time was 93±30min, and perioperative blood loss amounted to 858±463ml. In total, five (11%) complications associated with the operative procedure occurred, and revision surgery was necessary in three patients. We observed no wound infections, abdominal wall hernias or cases of heterotopic ossification in our sample. The Harris Hip Score at six months after surgery was 81, and it slightly improved to 84 after 24 months. The mean EQ5D index was 0.91 at six months after surgery and 0.92 at 24 months after surgery. CONCLUSION The TIMI approach represents a valuable alternative to the ilioinguinal and modified Stoppa approach for the treatment of acetabular fractures located in the anterior column, which are often observed in geriatric patients. LEVEL OF EVIDENCE Therapeutic Level II (Prospective cohort study).
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Affiliation(s)
- Rene Aigner
- Center for Orthopedics and Trauma Surgery, University Hospital Giessen and Marburg GmbH, Location Marburg, Germany.
| | - Ralf Hellige
- Center for Orthopedics and Trauma Surgery, University Hospital Giessen and Marburg GmbH, Location Marburg, Germany
| | - Sabine Knippel
- Center for Orthopedics and Trauma Surgery, University Hospital Giessen and Marburg GmbH, Location Marburg, Germany
| | - Ludwig Oberkircher
- Center for Orthopedics and Trauma Surgery, University Hospital Giessen and Marburg GmbH, Location Marburg, Germany
| | - Steffen Ruchholtz
- Center for Orthopedics and Trauma Surgery, University Hospital Giessen and Marburg GmbH, Location Marburg, Germany
| | - Benjamin Buecking
- Center for Orthopedics and Trauma Surgery, University Hospital Giessen and Marburg GmbH, Location Marburg, Germany
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Hack J, Buecking B, Lopez CL, Ruchholtz S, Kühne CA. Vorausverfügungen im klinischen Alltag. Unfallchirurg 2017; 120:153-161. [DOI: 10.1007/s00113-016-0308-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
BACKGROUND Geriatric traumatology is increasing in importance due to the demographic transition. In cases of fractures close to large joints it is questionable whether primary joint replacement is advantageous compared to joint-preserving internal fixation. OBJECTIVE The aim of this study was to describe the importance of prosthetic joint replacement in the treatment of geriatric patients suffering from frequent periarticular fractures in comparison to osteosynthetic joint reconstruction and conservative methods. MATERIAL AND METHODS A selective search of the literature was carried out to identify studies and recommendations concerned with primary arthroplasty of fractures in the region of the various joints (hip, shoulder, elbow and knee). RESULTS The importance of primary arthroplasty in geriatric traumatology differs greatly between the various joints. Implantation of a prosthesis has now become the gold standard for displaced fractures of the femoral neck. In addition, reverse shoulder arthroplasty has become an established alternative option to osteosynthesis in the treatment of complex proximal humeral fractures. Due to a lack of large studies definitive recommendations cannot yet be given for fractures around the elbow and the knee. Nowadays, joint replacement for these fractures is recommended only if reconstruction of the joint surface is not possible. CONCLUSION The importance of primary joint replacement for geriatric fractures will probably increase in the future. Further studies with larger patient numbers must be conducted to achieve more confidence in decision making between joint replacement and internal fixation especially for shoulder, elbow and knee joints.
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Affiliation(s)
- B Buecking
- Zentrum für Orthopädie und Unfallchirurgie, Universitätsklinikum Gießen und Marburg GmbH,Standort Marburg, Baldingerstraße, 35043, Marburg, Deutschland.
| | - D Eschbach
- Zentrum für Orthopädie und Unfallchirurgie, Universitätsklinikum Gießen und Marburg GmbH,Standort Marburg, Baldingerstraße, 35043, Marburg, Deutschland
| | - C Bliemel
- Zentrum für Orthopädie und Unfallchirurgie, Universitätsklinikum Gießen und Marburg GmbH,Standort Marburg, Baldingerstraße, 35043, Marburg, Deutschland
| | - M Knobe
- Klinik für Unfall- und Wiederherstellungschirurgie, Universitätsklinikum der RWTH Aachen, Aachen, Deutschland
| | - R Aigner
- Zentrum für Orthopädie und Unfallchirurgie, Universitätsklinikum Gießen und Marburg GmbH,Standort Marburg, Baldingerstraße, 35043, Marburg, Deutschland
| | - S Ruchholtz
- Zentrum für Orthopädie und Unfallchirurgie, Universitätsklinikum Gießen und Marburg GmbH,Standort Marburg, Baldingerstraße, 35043, Marburg, Deutschland
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Bliemel C, Oberkircher L, Bockmann B, Petzold E, Aigner R, Heyse TJ, Ruchholtz S, Buecking B. Impact of cement-augmented condylar screws in locking plate osteosynthesis for distal femoral fractures - A biomechanical analysis. Injury 2016; 47:2688-2693. [PMID: 27773369 DOI: 10.1016/j.injury.2016.10.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 10/16/2016] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Compromised bone quality and the need for early mobilization continue to lead to implant failure in elderly patients with distal femoral fractures. The cement augmentation of screws might facilitate improving implant anchorage. The aim of this study was to analyse the impact of cement augmentation of the condylar screws on implant fixation in a human cadaveric bone model. MATERIAL AND METHODS Ten pairs of osteoporotic femora (mean age: 90 years, range: 84-99 years) were used. A 2-cm gap osteotomy was created in the metaphyseal region to simulate an unstable AO/OTA 33-A3 fracture. All specimens were treated with a polyaxial locking plate. Specimens randomly assigned to the augmented group received an additional cement augmentation of the condylar screws using bone cement. A servohydraulic testing machine was used to perform incremental cyclic axial loading using a load-to-failure mode. RESULTS All specimens survived at least 800N of axial compressive force. The mean compressive forces leading to failure were 1620N (95% CI: 1382-1858N) in the non-augmented group and 2420N (95% CI: 2054-2786N) in the group with cement-augmented condylar screws (p=0.005). Deformation with cutting out of the condylar screws and condylar fracture were the most common reasons for failure in both groups. Whereas axial stiffness was comparable between both osteosyntheses (p=0.508), significant differences were observed for the plastic deformation of the constructs (p=0.014). CONCLUSION The results of the present study showed that the cement augmentation of the condylar screws might be a promising technique for the fixation of distal femoral fractures in elderly patients with osteoporotic bones.
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Affiliation(s)
- Christopher Bliemel
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg, Location Marburg, Germany.
| | - Ludwig Oberkircher
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg, Location Marburg, Germany.
| | - Benjamin Bockmann
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg, Location Marburg, Germany.
| | - Eric Petzold
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg, Location Marburg, Germany.
| | - Rene Aigner
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg, Location Marburg, Germany.
| | - Thomas Jan Heyse
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg, Location Marburg, Germany.
| | - Steffen Ruchholtz
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg, Location Marburg, Germany.
| | - Benjamin Buecking
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg, Location Marburg, Germany.
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Eschbach D, Kirchbichler T, Wiesmann T, Oberkircher L, Bliemel C, Ruchholtz S, Buecking B. Nutritional intervention in cognitively impaired geriatric trauma patients: a feasibility study. Clin Interv Aging 2016; 11:1239-1246. [PMID: 27672318 PMCID: PMC5026212 DOI: 10.2147/cia.s109281] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Background Most studies focusing on improving the nutritional status of geriatric trauma patients exclude patients with cognitive impairment. These patients are especially at risk of malnutrition at admission and of worsening during the perioperative fasting period. This study was planned as a feasibility study to identify the difficulties involved in including this high-risk collective of cognitively impaired geriatric trauma patients. Patients and methods This prospective intervention study included cognitively impaired geriatric patients (Mini–Mental State Examination <25, age >65 years) with hip-related fractures. We assessed Mini Nutritional Assessment (MNA), Nutritional Risk Screening (NRS 2002), body mass index, calf circumference, American Society of Anesthesiologists’ classification, and Braden Scale. All patients received parenteral nutritional supplementation of 800 kcal/d for the 96-hour perioperative period. Serum albumin and pseudocholinesterase were monitored. Information related to the study design and any complications in the clinical course were documented. Results A total of 96 patients were screened, among whom eleven women (median age: 87 years; age range: 74–91 years) and nine men (median age: 82 years; age range: 73–89 years) were included. The Mini–Mental State Examination score was 9.5 (0–24). All patients were manifestly undernourished or at risk according to MNA and NRS 2002. The body mass index was 23 kg/m2 (13–30 kg/m2), the calf circumference was 29.5 cm (18–34 cm), and the mean American Society of Anesthesiologists’ classification status was 3 (2–4). Braden Scale showed 18 patients at high risk of developing pressure ulcers. In all, 12 patients had nonsurgical complications with 10% mortality. Albumin as well as pseudocholinesterase dropped significantly from admission to discharge. The study design proved to be feasible. Conclusion The testing of MNA and NRS 2002 was feasible. Cognitively impaired trauma patients proved to be especially at risk of malnutrition. Since 96 hours of parenteral nutrition as a crisis intervention was insufficient, additional supplementation could be considered. Laboratory and functional outcome parameters for measuring successive supplementation certainly need further evaluations involving randomized controlled trials.
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Affiliation(s)
- D Eschbach
- Center for Orthopedics and Trauma Surgery
| | | | - T Wiesmann
- Department of Anaesthesiology and Critical Care, University of Marburg, Marburg, Germany
| | | | - C Bliemel
- Center for Orthopedics and Trauma Surgery
| | | | - B Buecking
- Center for Orthopedics and Trauma Surgery
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Eschbach D, Kirchbichler T, Oberkircher L, Knobe M, Juenemann M, Ruchholtz S, Buecking B. Management of malnutrition in geriatric trauma patients: results of a nationwide survey. Eur J Trauma Emerg Surg 2016; 42:553-558. [DOI: 10.1007/s00068-016-0698-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 06/16/2016] [Indexed: 10/21/2022]
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Knobe M, Giesen M, Plate S, Gradl-Dietsch G, Buecking B, Eschbach D, van Laack W, Pape HC. The Aachen Mobility and Balance Index to measure physiological falls risk: a comparison with the Tinetti POMA Scale. Eur J Trauma Emerg Surg 2016; 42:537-545. [DOI: 10.1007/s00068-016-0693-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 05/30/2016] [Indexed: 11/29/2022]
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Bliemel C, Sielski R, Doering B, Dodel R, Balzer-Geldsetzer M, Ruchholtz S, Buecking B. Pre-fracture quality of life predicts 1-year survival in elderly patients with hip fracture-development of a new scoring system. Osteoporos Int 2016; 27:1979-87. [PMID: 26733375 DOI: 10.1007/s00198-015-3472-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 12/17/2015] [Indexed: 10/22/2022]
Abstract
UNLABELLED Hip fractures are common in elderly people. Despite great progress in surgical care, the outcome of patients with hip fracture remains disappointing. This study determined four prognostic factors (lower ASA score, higher pre-fracture EQ-5D index, higher MMSE score, and female gender) to predict 1-year survival in patients with hip fracture. INTRODUCTION This study determined the prognostic factors for 1-year survival in patients with hip fracture. Based on these predictors, a scoring system was developed for use upon patients' admission to the hospital. METHODS Hip fracture patients, aged ≥60 years, were prospectively enrolled. Upon admission, patients' sociodemographic data, type of fracture, American Society of Anesthesiologists (ASA) score, health-related quality of life scores (EQ-5D index) and Mini-Mental State Examination (MMSE) scores were recorded, among other parameters. Correlational analysis was performed on all potential variables to identify relevant predictor variables of 1-year survival. Univariate regression analysis was performed on all selected variables, followed by a multivariate analysis for variables that were significant in the univariate analysis. The final score was developed by converting the β-coefficients of each variable from the multivariate analysis into a scoring system. RESULTS For 391 hip fracture patients, complete data were available at the time of the 1-year follow-up. In multivariate regression analysis, independent predictors of 1-year survival were lower ASA score, higher pre-fracture EQ-5D index, higher MMSE score, and female gender. The different variables were weighted according to their β-coefficient to build the prognostic score, which ranged from 0 to 10 points. The ROC curve for 1-year mortality after hip fracture showed an area under the curve of 0.74 (R (2) = 0.272; 95 % CI 0.68-0.79; p < 0.001). CONCLUSIONS With only four instruments, the new score represents a useful tool for estimating 1-year survival in elderly patients with hip fractures. At present, the score is limited due to a lack of validation. A validation study is currently underway to prove its reliability.
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Affiliation(s)
- C Bliemel
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg, Baldingerstrasse, 35043, Marburg, Germany.
| | - R Sielski
- Department of Clinical Psychology and Psychotherapy, Philipps-University, Marburg, Germany
| | - B Doering
- Department of Clinical Psychology and Psychotherapy, Philipps-University, Marburg, Germany
| | - R Dodel
- Department of Neurology, University Hospital Giessen and Marburg, Marburg, Germany
| | - M Balzer-Geldsetzer
- Department of Neurology, University Hospital Giessen and Marburg, Marburg, Germany
| | - S Ruchholtz
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg, Baldingerstrasse, 35043, Marburg, Germany
| | - B Buecking
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg, Baldingerstrasse, 35043, Marburg, Germany
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Bliemel C, Lechler P, Oberkircher L, Colcuc C, Balzer-Geldsetzer M, Dodel R, Ruchholtz S, Buecking B. Effect of Preexisting Cognitive Impairment on In-Patient Treatment and Discharge Management among Elderly Patients with Hip Fractures. Dement Geriatr Cogn Disord 2016; 40:33-43. [PMID: 25896170 DOI: 10.1159/000381334] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/02/2015] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To examine the influence of cognitive impairment on the functional outcomes and complication rates of patients with hip fracture during in-patient treatment. METHODS A total of 402 patients who were surgically treated for hip fractures were consecutively enrolled at a single trauma center. The patients were grouped according to their results on the Mini-Mental State Examination (MMSE), i.e., ≥20 points (group I) and ≤19 points (group II). Complication and in-hospital mortality rates as well as postoperative functional outcomes according to the Barthel Index (BI) were compared between the groups. A multivariate regression analysis was performed to control for additional factors. RESULTS 33% of the patients had MMSE scores ≤19 points. The complication rates were similar between the groups (p > 0.05). Likewise, the overall in-hospital mortality rates were similar between the patients in group I (4.5%) and those in group II (9.8%; β = 0.218, p < 0.740). Functional outcomes, as assessed by the BI, were lower in group II (β = -0.266, p < 0.001). The patients in group II were transferred to a rehabilitation clinic less frequently (52.3 vs. 76.0%, p < 0.001). CONCLUSIONS Patients with lower MMSE scores are at a higher risk for poorer functional outcomes. Perioperative care should focus on the preservation of functional abilities to protect these patients from an additional loss of independence and disadvantageous clinical course.
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Affiliation(s)
- Christopher Bliemel
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Giessen and Marburg, Marburg, Germany
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Hack J, Buecking B, Lopez CL, Ruchholtz S, Kühne CA. [Living will, durable power of attorney and legal guardianship in the trauma surgery routine : Data from a geriatric trauma center]. Z Gerontol Geriatr 2015; 49:721-726. [PMID: 26608036 DOI: 10.1007/s00391-015-0981-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Revised: 08/04/2015] [Accepted: 10/22/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Due to the increasing number of elderly patients, trauma surgeons are often confronted with end-of-life treatment decisions. Advance directives can help reduce the lack of clarity in those situations. OBJECTIVES The aim of this study was to identify the presence of living wills, durable power of attorney, legal guardianship and appointment of guardianship in the geriatric trauma center of a university hospital. MATERIALS AND METHODS The data of all patients treated in our geriatric trauma center from 01/01/2013 to 03/31/2014 were analyzed regarding the presence of a living will, durable power of attorney, legal guardianship and appointment of guardianship as well as the procedure of documenting those items. RESULTS Out of 181 patients, 63 % (n = 114) had one or more of these documents. Most frequently used was the durable power of attorney in 33 % (n = 59), followed by a living will in 27 % (n = 48), legal guardianship in 20 % (n = 37) and appointment of guardianship in 7 % (n = 12). The existence of those documents was recorded in 88 % (n = 100) of patients within 24 h after admission; documentation in the medical records was found in 58 % (n = 66). CONCLUSION A large proportion of patients had one or more of the documents named above. In this respect, standardized documentation of advance directives in the medical record is an important issue for all persons involved.
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Affiliation(s)
- J Hack
- Zentrum für Orthopädie und Unfallchirurgie, Universitätsklinikum Gießen und Marburg GmbH, Standort Marburg, 35043, Marburg, Deutschland
| | - B Buecking
- Zentrum für Orthopädie und Unfallchirurgie, Universitätsklinikum Gießen und Marburg GmbH, Standort Marburg, 35043, Marburg, Deutschland
| | - C L Lopez
- Klinik für Visceral-, Thorax- und Gefäßchirurgie, Universitätsklinikum Gießen und Marburg GmbH, Standort Marburg, 35043, Marburg, Deutschland
| | - S Ruchholtz
- Zentrum für Orthopädie und Unfallchirurgie, Universitätsklinikum Gießen und Marburg GmbH, Standort Marburg, 35043, Marburg, Deutschland
| | - C A Kühne
- Zentrum für Orthopädie und Unfallchirurgie, Universitätsklinikum Gießen und Marburg GmbH, Standort Marburg, 35043, Marburg, Deutschland.
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Boese CK, Buecking B, Bliemel C, Ruchholtz S, Frink M, Lechler P. The effect of osteoarthritis on functional outcome following hemiarthroplasty for femoral neck fracture: a prospective observational study. BMC Musculoskelet Disord 2015; 16:304. [PMID: 26475144 PMCID: PMC4609155 DOI: 10.1186/s12891-015-0767-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2015] [Accepted: 10/08/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The influence of pre-existing radiographic osteoarthritis on the functional outcome of elderly patientents with displaced intracapsular fractures of the femoral neck treated by hemiarthroplasty is unclear. METHODS We prospectively examined the impact of pre-existing osteoarthritis on the functional outcome of 126 elderly patients with displaced intracapsular fracture of the femoral neck treated by hemiarthroplasty. RESULTS The mean age of the cohort was 82.7 years. At 12 months, we observed no statistically significant differences in the Harris hip score (p = 0.545), the timed up and go test (p = 0.298), the Tinetti test (p = 0.381) or the Barthel Index (p = 0.094) between patients with Kellgren and Lawrence grades 3 or 4 osteoarthritis, and patients with grades 0 to 2 changes. Furthermore, there were no differences in complication or revision rates. CONCLUSIONS Our findings challenge the hypothesis that pre-existing osteoarthritis is a contraindication to hemiarthroplasty in elderly patients with femoral neck fracture.
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Affiliation(s)
- Christoph Kolja Boese
- Department of Trauma, Hand and Reconstructive Surgery, University of Giessen and Marburg, Baldinger Straße, 35043, Marburg, Germany.
- Department of Orthopaedic and Trauma Surgery, University Hospital of Cologne, Joseph-Stelzmann-Straße 9, 50931, Cologne, Germany.
| | - Benjamin Buecking
- Department of Trauma, Hand and Reconstructive Surgery, University of Giessen and Marburg, Baldinger Straße, 35043, Marburg, Germany.
| | - Christopher Bliemel
- Department of Trauma, Hand and Reconstructive Surgery, University of Giessen and Marburg, Baldinger Straße, 35043, Marburg, Germany.
| | - Steffen Ruchholtz
- Department of Trauma, Hand and Reconstructive Surgery, University of Giessen and Marburg, Baldinger Straße, 35043, Marburg, Germany.
| | - Michael Frink
- Department of Trauma, Hand and Reconstructive Surgery, University of Giessen and Marburg, Baldinger Straße, 35043, Marburg, Germany.
| | - Philipp Lechler
- Department of Trauma, Hand and Reconstructive Surgery, University of Giessen and Marburg, Baldinger Straße, 35043, Marburg, Germany.
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Abstract
BACKGROUND Reconstruction of the femoral offset reportedly improves outcome following total hip arthroplasty, but little is known of its influence following hip fractures. We aimed to establish the effect of the femoral offset on the medium-term functional outcome in elderly patients who had sustained trochanteric fractures requiring proximal femoral nailing. PATIENTS AND METHODS We measured the rotation corrected femoral offset (FORC) and relative femoral offset (FORL) on plain anteroposterior radiographs of the hip in 188 patients (58 male, 130 female) with a trochanteric fracture who underwent proximal femoral nailing at our institution. The primary outcome measure was the Harris hip score (HSS) 6 and 12 months postoperatively; the Barthel index was assessed as a secondary outcome. RESULTS The mean FORC after surgery was 58 mm (±11 mm), while the mean FORL was 1.21 (±0.22). At final follow up, we found significant inverse relationships (Spearman's rank correlation coefficient, ρ) between FORC and FORL and the functional outcome assessed by the HSS (FORC: ρ = -0.207, p = 0.036; FORL: ρ = -0.247, p = 0.012), and FORL and the Barthel index (FORC: ρ = -147, p = 0.129; FORL: ρ = -0.192, p = 0.046). A consistent trend was observed after adjustment for confounding variables. CONCLUSIONS Our results underline the biomechanical importance of the femoral offset for medium-term outcomes in elderly patients with trochanteric fractures. In contrast with the published findings on total hip arthroplasty, we found an inverse correlation between functional outcome and the extent of the reconstructed femoral offset. LEVEL OF EVIDENCE Level I - Prognostic study.
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Affiliation(s)
- Benjamin Buecking
- Center for Orthopaedics and Trauma Surgery, University of Giessen and Marburg, Marburg, Germany
| | - Christoph Kolja Boese
- Center for Orthopaedics and Trauma Surgery, University of Giessen and Marburg, Marburg, Germany; Department of Orthopaedic and Trauma Surgery, University Hospital of Cologne, Cologne, Germany
| | - Vinzenz Seifert
- Center for Orthopaedics and Trauma Surgery, University of Giessen and Marburg, Marburg, Germany
| | - Steffen Ruchholtz
- Center for Orthopaedics and Trauma Surgery, University of Giessen and Marburg, Marburg, Germany
| | - Michael Frink
- Center for Orthopaedics and Trauma Surgery, University of Giessen and Marburg, Marburg, Germany
| | - Philipp Lechler
- Center for Orthopaedics and Trauma Surgery, University of Giessen and Marburg, Marburg, Germany.
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Knobe M, Gradl G, Buecking B, Gackstatter S, Sönmez TT, Ghassemi A, Stromps JP, Prescher A, Pape HC. Locked minimally invasive plating versus fourth generation nailing in the treatment of AO/OTA 31A2.2 fractures: A biomechanical comparison of PCCP(®) and Intertan nail(®). Injury 2015; 46:1475-82. [PMID: 25997559 DOI: 10.1016/j.injury.2015.05.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Accepted: 05/01/2015] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Locked minimally invasive plating and fourth generation nailing potentially could reduce the complication rate in the treatment of trochanteric femur fractures by its rotational stability and providing better lateral cortical support. The purpose of this study was (1) to compare the biomechanical properties of the Percutaneous compression plate (PCCP) and the Intertan nail (IT) with regards to implant failure and (2) to assess dynamic stability coefficients in an unstable AO/OTA 31A2.2 fracture model. METHODS In paired femurs, a standardised unstable trochanteric femur fracture was induced by an oscillating saw. The fractures were stabilised by either the PCCP (Orthofix, McKinney, TX, USA) or the IT (Smith & Nephew, Memphis, TN, USA). All femurs were loaded with 300N, followed by an increase in load until failure using 300N each time (2000 cycles each, 0.5Hz). After every load step the samples were assessed visually and radiographically. We measured migration and performed a survival analysis. RESULTS 16 fractures were induced in 8 paired human specimens (mean age: 84 years, 61-100 years). The mean stiffness (PCCP vs. IT: 249±124N/mm vs. 273±153N/mm; p=0.737) was comparable. The IT proved superior to the PCCP with regard to the number of cycles reached before failure occurred (PCCP vs. IT: 12,691±4733 vs. 15,313±4875 cycles; p=0.023). Except for a higher axial migration of the IT at failure point (PCCP vs. IT: 1.3mm vs. 4.3mm; p=0.028) there were no differences between the intra- and extramedullary implants, not even in terms of rotational stability along the femoral neck axis. A fracture of the femoral neck caused test abortion in both implants in most cases. CONCLUSION This study showed a superiority of the IT compared with the PCCP with regards to number of cycles achieved under sequential load increases for unstable trochanteric femur fractures. The stiffness was comparable. Both implants showed a high rotational stability and a support of the lateral wall. STUDY TYPE Biomechanical study.
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Affiliation(s)
- Matthias Knobe
- Department of Orthopaedic Trauma, University of Aachen Medical Center, Aachen, Germany.
| | - Gertraud Gradl
- Department of Orthopaedic Trauma, University of Aachen Medical Center, Aachen, Germany.
| | - Benjamin Buecking
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Gießen and Marburg GmbH, Campus Marburg, Marburg, Germany.
| | - Stefan Gackstatter
- Department of Orthopaedic Trauma, University of Aachen Medical Center, Aachen, Germany.
| | - Tolga Taha Sönmez
- Department of Oral and Maxillofacial Surgery, University of Aachen Medical Center, Aachen, Germany.
| | - Alireza Ghassemi
- Department of Oral and Maxillofacial Surgery, University of Aachen Medical Center, Aachen, Germany.
| | - Jan-Philipp Stromps
- Department of Plastic Surgery, Reconstructive and Hand Surgery, University of Aachen Medical Center, Aachen, Germany.
| | - Andreas Prescher
- Department of Molecular and Cellular Anatomy, University of Aachen Medical Center, Aachen, Germany.
| | - Hans-Christoph Pape
- Department of Orthopaedic Trauma, University of Aachen Medical Center, Aachen, Germany.
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Bockmann B, Buecking B, Franz D, Zettl R, Ruchholtz S, Mohr J. Mid-term results of a less-invasive locking plate fixation method for proximal humeral fractures: a prospective observational study. BMC Musculoskelet Disord 2015; 16:160. [PMID: 26141352 PMCID: PMC4491200 DOI: 10.1186/s12891-015-0618-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 06/24/2015] [Indexed: 12/02/2022] Open
Abstract
Background The optimal treatment for proximal humeral fractures remains under debate. In this article, we report the mid-term results of patients who underwent the less-invasive implantation of a polyaxial locking plate for displaced proximal humeral fractures. Methods This study included patients who were treated with a polyaxial locking plate via an anterolateral deltoid split approach from May 2008 to December 2011. We evaluated outcome parameters after a minimum follow-up period of 2.5 years (median 4.5 years, follow-up rate 62 %) including the age- and gender-dependent Constant score, the activities of daily living score, and the visual analog scale for both pain and subjective shoulder function. Results Of the 140 patients who underwent surgery, 114 were included in the follow-up and 71 completed the questionnaire. Fifteen patients (21 %) exhibited 2-fragment fractures, and 56 patients (79 %) exhibited 3- and 4-part fractures. The Constant score improved significantly (4.5 years: 70 ± 21, p < 0.001) between the first two follow-ups (6 weeks: 35 ± 14, 6 months: 56 ± 18, p < 0.001), and also between 6 months and 4.5 years post-surgery. At the final follow-up, the activities of daily living score had not reached pre-fracture levels (before trauma: 27 ± 5, 4.5 years: 20 ± 8, p < 0.001). A multivariate analysis showed that age has a more significant influence on the final outcome than fracture morphology or gender. Conclusion Although the less-invasive surgical procedure is a feasible treatment option in proximal humeral fractures with acceptable complications and considerable improvement during the first six months, a lengthy recovery time is required. The majority of our patients did not become pain-free or reach pre-fracture activity levels.
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Affiliation(s)
- Benjamin Bockmann
- Center for Orthopedics and Trauma Surgery, University Hospital Giessen and Marburg, Location Marburg, Baldingerstrasse, 35043, Marburg, Germany.
| | - Benjamin Buecking
- Center for Orthopedics and Trauma Surgery, University Hospital Giessen and Marburg, Location Marburg, Baldingerstrasse, 35043, Marburg, Germany.
| | - Daniel Franz
- Center for Orthopedics and Trauma Surgery, University Hospital Giessen and Marburg, Location Marburg, Baldingerstrasse, 35043, Marburg, Germany.
| | - Ralph Zettl
- Center for Orthopedics and Trauma Surgery, University Hospital Giessen and Marburg, Location Marburg, Baldingerstrasse, 35043, Marburg, Germany.
| | - Steffen Ruchholtz
- Center for Orthopedics and Trauma Surgery, University Hospital Giessen and Marburg, Location Marburg, Baldingerstrasse, 35043, Marburg, Germany.
| | - Juliane Mohr
- Department of Trauma Surgery, Otto-von-Guericke University, Leipziger Strasse 44, 39120, Magdeburg, Germany.
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Buecking B, Boese CK, Bergmeister VA, Frink M, Ruchholtz S, Lechler P. Functional implications of femoral offset following hemiarthroplasty for displaced femoral neck fracture. Int Orthop 2015; 40:1515-21. [PMID: 26130280 DOI: 10.1007/s00264-015-2828-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 05/13/2015] [Indexed: 11/25/2022]
Abstract
PURPOSE Inadequate reconstruction of femoral offset after total hip arthroplasty (THA) is associated with unfavourable outcomes, but its importance following hemiarthroplasty for displaced femoral neck fracture is unknown. METHODS Our study examined the correlation between reconstructed femoral offset and functional outcome 12 months after post traumatic hemiarthroplasty in 126 prospectively enrolled elderly patients. Rotation-corrected femoral offset (FORC), relative femoral offset (FORL) and contralateral femoral offset (FOC) were measured on anteroposterior radiographs. The Harris Hip Score (HHS) was the primary outcome measure; the timed up and go (TUG) test and Lawton instrumental activities of daily living (IADL) score were secondary outcomes. Correlations were sought using the Spearman correlation coefficient (r). Sample size was calculated using an Altman nomogram, with the power set at 80 %, the significance level of 0.05 and a standardised difference of 0.75. RESULTS The mean reconstructed FORC was 41 mm (17-67 mm) and showed a linear relationship and excellent correlation with the FOC. At 12 months, we found a significant positive correlation between FORC and HHS (r = 0.303, p = 0.025) and IADL (r = 0.325, p = 0.013), but not TUG (r = -0.026, p = 0.863). These findings were confirmed by bivariate and multivariate correlation between FORL and functional outcome parameters. CONCLUSIONS We found a clinically relevant relationship between femoral offset and functional outcome after hemiarthroplasty in elderly patients, comparable with that of THA, for treating osteoarthritis.
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Affiliation(s)
- Benjamin Buecking
- Department of Trauma, Hand and Reconstructive Surgery, University of Marburg, Marburg, Germany
| | - Christoph Kolja Boese
- Department of Orthopaedic and Trauma Surgery, University Hospital of Cologne, Cologne, Germany
| | - Verena Anna Bergmeister
- Department of Trauma, Hand and Reconstructive Surgery, University of Marburg, Marburg, Germany
| | - Michael Frink
- Department of Trauma, Hand and Reconstructive Surgery, University of Marburg, Marburg, Germany
| | - Steffen Ruchholtz
- Department of Trauma, Hand and Reconstructive Surgery, University of Marburg, Marburg, Germany
| | - Philipp Lechler
- Department of Trauma, Hand and Reconstructive Surgery, University of Marburg, Marburg, Germany.
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Oberkircher L, Schubert N, Eschbach DA, Bliemel C, Krueger A, Ruchholtz S, Buecking B. Prehospital Pain and Analgesic Therapy in Elderly Patients with Hip Fractures. Pain Pract 2015; 16:545-51. [PMID: 25865847 DOI: 10.1111/papr.12299] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Revised: 01/30/2015] [Accepted: 02/10/2015] [Indexed: 12/01/2022]
Abstract
INTRODUCTION As a part of aging, hip fractures are becoming more common. The connection between increased pain and a poor outcome has previously been shown. Therefore, even in prehospital situations, analgesic therapy appears to be reasonable. We established a prospective study with 153 patients to evaluate the patients' pain levels during the prehospital phase of treatment and prehospital analgesic therapy. METHODS We performed a prospective study on 153 patients the age of 60 years or older in a University hospital setting between 2010 and 2011 who suffered hip fracture. Analgesics given and the type of medical staff that was involved were documented. Pain was measured using the NRS upon initial contact of the medical staff and upon admission to our emergency department. RESULTS Initial pain level evaluated by EMS (emergency medical service) was 6.8 (SD = 2.7). Twenty-two percent of the patients reported an NRS of 10 as the highest value following their injury. Forty-three of 153 patients (28%) received analgesics. The mean initial pain score for those 43 patients who did receive pain medication was 7.0 (SD = 2.6). However, this score dropped to a mean of 2.8 (SD = 1.4) upon hospital arrival (P < 0.001). The patients who did not receive pain medication had an initial pain score of 4.5 (SD = 1.9). Upon admission to the hospital, this score decreased to a mean of 4.0 (SD = 1.7, P = 0.092). CONCLUSION Only a minority of patients with hip fractures received prehospital analgesia. The administration of prehospital analgesia was associated with significant pain relief.
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Affiliation(s)
- Ludwig Oberkircher
- Department of Trauma, Hand and Reconstructive Surgery, Philipps University, Marburg, Germany
| | - Natalie Schubert
- Department of Trauma, Hand and Reconstructive Surgery, Philipps University, Marburg, Germany
| | | | - Christopher Bliemel
- Department of Trauma, Hand and Reconstructive Surgery, Philipps University, Marburg, Germany
| | - Antonio Krueger
- Department of Trauma, Hand and Reconstructive Surgery, Philipps University, Marburg, Germany
| | - Steffen Ruchholtz
- Department of Trauma, Hand and Reconstructive Surgery, Philipps University, Marburg, Germany
| | - Benjamin Buecking
- Department of Trauma, Hand and Reconstructive Surgery, Philipps University, Marburg, Germany
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Bockmann B, Buecking B, Eschbach DA, Franz D, Ruchholtz S, Mohr J. Fixation of the greater tuberosity in proximal humeral fractures: FiberWire® or wire cerclage? Acta Orthop Belg 2015; 81:9-16. [PMID: 26280848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Proximal humeral fractures remain a surgical challenge, and scientific discussions are commonly focused on their ideal treatment. One possible treatment involves the use of an angle stable plate osteosynthesis. However, which material can most feasibly be used to attach the greater tuberosity to the implant remains unknown. In two prospective, non-randomized trials, we compared the results of a FiberWire® and a wire cerclage. A total of 104 patients with 3- and 4-part fractures were included in this examination. In 25 cases, the greater tuberosity was fixated with a FiberWire®, size 2, while 79 cases received a wire cerclage. Plate osteosynthesis was constantly performed via the anterolateral delta-split approach using the NCB®-PH-plate by Zimmer®. The patients were followed clinically at discharge, 6 weeks and 6 months postoperatively and were examined for relevant complications. Age and gender were equally distributed in both groups. Concerning the follow-up after 6 weeks, a significant benefit concerning shoulder function was observed in the FiberWire®-group (wire cerclage: 39.20±11.85, 95% CI 32.37-44.56, FiberWire®: 45.84±16.80, 95% CI 28.34-61.56: p=0.049). After 6 months, the difference between the groups was not significant (wire cerclage: 58.13±18.73, 95% CI 50.25-72.40, FiberWire®: 68.85±23.10, 95% CI 46.83-99.53: p=0.06).
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Boese CK, Buecking B, Schwarting T, Debus F, Ruchholtz S, Bliemel C, Frink M, Lechler P. The influence of pre-existing radiographic osteoarthritis on functional outcome after trochanteric fracture. International Orthopaedics (SICOT) 2015; 39:1405-10. [DOI: 10.1007/s00264-014-2663-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Accepted: 12/29/2014] [Indexed: 11/28/2022]
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Bliemel C, Buecking B, Mueller T, Wack C, Koutras C, Beck T, Ruchholtz S, Zettl R. Distal femoral fractures in the elderly: biomechanical analysis of a polyaxial angle-stable locking plate versus a retrograde intramedullary nail in a human cadaveric bone model. Arch Orthop Trauma Surg 2015; 135:49-58. [PMID: 25388863 DOI: 10.1007/s00402-014-2111-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Indexed: 02/09/2023]
Abstract
INTRODUCTION Compromised bone quality and the need for early mobilization still lead to high rates of implant failure in geriatric patients with distal femoral fractures. With the newest generation of polyaxial locking plates and the proven retrograde femoral nails today two minimally invasive surgical procedures have been established. Indications for both procedures overlap. This study attempts to define the strength and failure mode of both surgical procedures. MATERIALS AND METHODS A standardized fracture model was established to simulate an unstable AO/OTA 33-A3 fracture. Eight pairs of human cadaver femora (mean age 79 years, range 63-100 years) with compromised bone quality were used. Osteosyntheses with eight retrograde femoral nails and eight locking plates were randomly performed. A materials testing machine (Instron 5566) was used to perform cyclic stress tests according to a standardized loading protocol, up to a maximum load of 5,000 N. RESULTS All specimens survived loading of at least 2,500 N. Three nail and one plate construct survived a maximum load of 5,000 N. The mean compressive force leading to failure was 4,400 N (CI 4,122-4,678 N) for nail osteosynthesis and 4,429 N (CI 3,653-5,204 N) for plate osteosynthesis (p = 0.943). Proximal cutting out of the osteosynthesis was the most common reason for interruption in the nail and plate osteosyntheses. Significant differences between the retrograde femoral nail and plate osteosyntheses were seen under testing conditions for plastic deformation and stiffness of the constructs (p = 0.002 and p = 0.001, respectively). CONCLUSION Based on our results, no statements regarding the superiority of either of the devices can be made. Even though the load to failure values for both osteosyntheses were much higher than the loads experienced during normal walking; however, because only axial loading was applied, it remains unclear whether both osteosyntheses meet the estimated requirements for postoperative full weight-bearing for an average heavy patient with a distal femoral fracture.
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Affiliation(s)
- Christopher Bliemel
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Giessen and Marburg, Location Marburg, Baldingerstrasse, 35043, Marburg, Germany,
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Abstract
BACKGROUND AND PURPOSE The effect of continuous exposure of a driver's bones and muscles to vibration and G forces to years of automobile racing and the effect on overall health have not yet been examined in detail. The goal of this study was to investigate via questionnaire the musculoskeletal injuries and influencing parameters in 130 amateur and 7 professional race car drivers. MATERIALS AND METHODS A questionnaire, translated in English and German, was used to investigate the parameters that influence the racing performance and the character of resulting injuries. RESULTS This investigation involved 137 drivers (133 men and 4 women) with a mean age of 42 years (standard deviation = 15). Approximately half of the drivers had < 10 years of experience in auto racing (49%). The drivers mainly complained about pains in the lumbar (n = 36; 26%), shoulder (n = 27; 20%), and neck regions (n = 25; 18%). The driver's posture and the comfort of the seat were statistically significant for causing lower back and upper legs pains. The race duration was relevant to neck and shoulder discomfort. CONCLUSION The high incidence of musculoskeletal injuries in race car driving indicates the need for further improvements. Elimination of driver complaints about pain in the spine and upper extremities can be achieved through technical development, as already accomplished in Formula One racing.
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Affiliation(s)
- Christos Koutras
- Department of Trauma, Hand and Reconstructive Surgery, University of Giessen and Marburg, Marburg, Germany.
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Oberkircher L, Born S, Struewer J, Bliemel C, Buecking B, Wack C, Bergmann M, Ruchholtz S, Krüger A. Biomechanical evaluation of the impact of various facet joint lesions on the primary stability of anterior plate fixation in cervical dislocation injuries: a cadaver study. J Neurosurg Spine 2014; 21:634-9. [DOI: 10.3171/2014.6.spine13523] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Injuries of the subaxial cervical spine including facet joints and posterior ligaments are common. Potential surgical treatments consist of anterior, posterior, or anterior-posterior fixation. Because each approach has its advantages and disadvantages, the best treatment is debated. This biomechanical cadaver study compared the effect of different facet joint injuries on primary stability following anterior plate fixation.
Methods
Fractures and plate fixation were performed on 15 fresh-frozen intact cervical spines (C3–T1). To simulate a translation-rotation injury in all groups, complete ligament rupture and facet dislocation were simulated by dissecting the entire posterior and anterior ligament complex between C-4 and C-5. In the first group, the facet joints were left intact. In the second group, one facet joint between C-4 and C-5 was removed and the other side was left intact. In the third group, both facet joints between C-4 and C-5 were removed. The authors next performed single-level anterior discectomy and interbody grafting using bone material from the respective thoracic vertebral bodies. An anterior cervical locking plate was used for fixation. Continuous loading was performed using a servohydraulic test bench at 2 N/sec. The mean load failure was measured when the implant failed.
Results
In the group in which both facet joints were intact, the mean load failure was 174.6 ± 46.93 N. The mean load failure in the second group where only one facet joint was removed was 127.8 ± 22.83 N. In the group in which both facet joints were removed, the mean load failure was 73.42 ± 32.51 N. There was a significant difference between the first group (both facet joints intact) and the third group (both facet joints removed) (p < 0.05, Kruskal-Wallis test).
Conclusions
In this cadaver study, primary stability of anterior plate fixation for dislocation injuries of the subaxial cervical spine was dependent on the presence of the facet joints. If the bone in one or both facet joints is damaged in the clinical setting, anterior plate fixation in combination with bone grafting might not provide sufficient stabilization; additional posterior stabilization may be needed.
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Affiliation(s)
| | - Sebastian Born
- Departments of 1Trauma, Hand, and Reconstructive Surgery and
| | - Johannes Struewer
- 2Orthopedics and Rheumatology, Philipps University of Marburg, University Hospital Giessen and Marburg, Marburg, Germany
| | | | | | - Christina Wack
- Departments of 1Trauma, Hand, and Reconstructive Surgery and
| | - Martin Bergmann
- Departments of 1Trauma, Hand, and Reconstructive Surgery and
| | | | - Antonio Krüger
- Departments of 1Trauma, Hand, and Reconstructive Surgery and
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Buecking B, Struewer J, Waldermann A, Horstmann K, Schubert N, Balzer-Geldsetzer M, Dodel R, Bohl K, Ruchholtz S, Bliemel C. What determines health-related quality of life in hip fracture patients at the end of acute care?--a prospective observational study. Osteoporos Int 2014; 25:475-84. [PMID: 23783644 DOI: 10.1007/s00198-013-2415-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Accepted: 06/03/2013] [Indexed: 12/30/2022]
Abstract
UNLABELLED Hip fractures are associated with reduced health-related quality of life (HrQoL). We found pre-existing need of care or limited function, cognitive impairment, and depression to be independent factors associated with lower HrQoL during the postsurgical period. In contrast, joint replacement was associated with better HrQoL compared to internal fixation. Patients' treatment should be focused on functional recovery and treatment of depression. INTRODUCTION The aim of the study was to identify independent factors that were correlated with health-related quality of life (HrQoL) after hip fracture. METHODS A total of 402 patients with a mean age of 81 years suffering from a hip fracture were included in this prospective, observational cohort study. HrQoL (determined by the EuroQol instrument) was measured at admission and at discharge from an acute care hospital. Independent factors correlated with HrQoL at discharge and changes from pre-fracture to discharge were determined using multivariate analyses. The influence of antidepressants was evaluated by an ANOVA with repeated measurements. RESULTS Need of care prior to fracture was the most important determinant of EQ-5D index at discharge (ß = -0.359, p = 0.003). Additionally, low Mini Mental Status Examination (MMSE) was associated with a lower EQ-5D index at discharge (MMSE 0-9: ß = -0.238, p <0.001; MMSE 10-19: ß = -0.294, p <0.001) and a greater decrease in EQ-5D during hospitalisation (MMSE 10-19: ß = 0.281, p <0.001), while joint replacement (compared to internal fixation) was associated with a higher EQ-5D index (ß = 0.188, p = 0.002) and a lower decrease in the index (ß = -0.216, p = 0.003). EQ VAS values at discharge were correlated with pre-fracture Barthel Index (ß = 0.253, p <0.001) and Geriatric Depression Scale scores (ß = -0.135, p = 0.026). Depressive patients on antidepressants demonstrated less of a decrease in the EQ-5D index compared to patients not receiving medication (F = 2.907, p = 0.090). CONCLUSIONS Acute care of hip fracture patients should be focused on functional recovery and treatment of depression. When the preferred surgical strategy is unclear, joint replacement should be considered.
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Affiliation(s)
- B Buecking
- Department of Trauma, Hand and Reconstructive Surgery, University of Giessen and Marburg GmbH, Baldingerstrasse, 35043, Marburg, Germany,
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Buecking B, Eschbach D, Koutras C, Kratz T, Balzer-Geldsetzer M, Dodel R, Ruchholtz S. Re-admission to Level 2 unit after hip-fracture surgery - Risk factors, reasons and outcome. Injury 2013; 44:1919-25. [PMID: 23791011 DOI: 10.1016/j.injury.2013.05.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2012] [Revised: 03/07/2013] [Accepted: 05/21/2013] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Hip fractures are common geriatric fractures with increasing incidence. Treatment of these fractures is still associated with high rates of complications and poor outcome. Data concerning unexpected re-admission to a Level 2 unit after an initial inconspicuous postoperative course are limited. We aimed to identify causes and associated risk factors for admission as well as impact of re-admission on acute care and short-term outcome. PATIENTS AND METHODS Patients over 60 years of age with hip fractures were included in this prospective single-centre observational study. Patients with polytrauma or malignancy-associated fractures were excluded. Age, gender, fracture type, pre-fracture residential, physical and cognitive status, recording to the American Society of Anesthesiologists (ASA) score, Barthel Index (BI) and Mini-Mental State Examination (MMSE) were recorded on admission. Date, type of surgery and operation time were evaluated. Postoperatively, the prevalence of and reasons for unexpected re-admission to the Level 2 unit and patients' outcome were measured. Parameters were hospital mortality, BI at discharge, length of stay in hospital and type of discharge. Univariate and multivariate analyses were performed to identify risk factors for admission to the Level 2 unit and influence on patients' outcome. RESULTS Out of 402 included patients, 48 (12%) were re-admitted to the Level 2 unit. The most frequent reasons were non-surgical (n=38), such as respiratory failure (n=12), cardiovascular diseases (n=8) and acute renal failure (n=5). Ten patients were re-admitted due to a revision surgery of the hip. We identified two independent risk factors for readmission: male gender (odds ratio (OR)=2.38, confidence interval (95% CI)=1.10-5.15, p=0.027) and type of fracture, especially femoral neck fracture (OR=7.40, 95% CI=2.39-23.26, p=0.001). Patients who were re-admitted to the Level 2 unit had a higher mortality (β=2.09, OR=8.07, 95% CI=2.44-26.75, p=0.001), an increase in hospital stay (β=7.0, 95% CI 5.2-8.7, p<0.001) and a lower functional outcome (BI, β=-17, 95% CI=-23 to -10, p<0.001). CONCLUSION Unexpected admission to the Level 2 unit in the post-surgical period is a frequent phenomenon in geriatric hip-fracture patients. Males and femoral neck fracture patients seem to be especially endangered. Although the majority of reasons for admissions were not immediately life-threatening illnesses, they had a substantial negative impact on patients' outcome. This emphasises the importance of careful handling of this frail patient population.
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Affiliation(s)
- Benjamin Buecking
- Department of Trauma, Hand and Reconstructive Surgery, University of Giessen and Marburg, Baldingerstrasse, 35043 Marburg, Germany.
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Bohl K, Buecking B, Struewer J, Waldermann A, Horstmann K, Schubert N, Balzer-Geldsetzer M, Dodel R, Ruchholtz S. Welche Faktoren beeinflussen die gesundheitsbezogene Lebensqualität bei Patienten mit Hüftfraktur während der Versorgung in der Akutklinik. Gesundheitswesen 2013. [DOI: 10.1055/s-0033-1354217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Bliemel C, Buecking B, Struewer J, Piechowiak EI, Ruchholtz S, Krueger A. Detection of pulmonary cement embolism after balloon kyphoplasty : should conventional radiographs become routine? Acta Orthop Belg 2013; 79:444-450. [PMID: 24205776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Fatal pulmonary cement embolism is the worst complication after balloon kyphoplasty. Therefore the authors conducted a prospective study about the use of postoperative plain radiographs of the chest as a screening tool for the detection of pulmonary cement embolism. More specifically, they tried to determine its incidence. Postoperative AP and lateral plain radiographs of the chest confirmed this diagnosis in only one out of 94 patients (1%). Systematic use of CT would probably have led to a higher incidence. To the authors' knowledge this is the only study assessing the incidence of pulmonary cement embolism after balloon kyphoplasty. Computed tomography confirmed the diagnosis in the single patient affected , but she remained asymptomatic. Given the low incidence, routine postoperative plain radiographs of the chest do not seem to be indicated in asymptomatic patients, although the radiation exposure is low. Reasonable suspicion (dyspnea, peroperative findings via image amplifier) warrants computed tomography for confirmation of the diagnosis.
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Affiliation(s)
- Christopher Bliemel
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Giessen and Marburg, Location Marburg, Germany.
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Bliemel C, Oberkircher L, Eschbach DA, Struewer J, Ruchholtz S, Buecking B. [Surgical treatment of proximal femoral fractures--a training intervention?]. Z Orthop Unfall 2013; 151:180-8. [PMID: 23619652 DOI: 10.1055/s-0032-1328395] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Proximal femoral fractures are common in the elderly. Surgical and postoperative complications are of major importance in this population. Numerous factors affecting the treatment results could be identified so far. The effect of surgeons' experience in terms of educational status is not entirely clarified yet. The aim of the present study was to analyse the effect of surgeons' educational status on the outcome in proximal femoral fractures. Therefore treatment results were compared in terms of individual surgeons' experience. Furthermore, the surgical education concept of our department was evaluated. MATERIAL AND METHODS At a national trauma centre, patients of at least 60 years of age with proximal femoral fractures were prospectively screened. Patient-specific parameters like Barthel index, ASA score, Charlson score, patients' age and type of fracture were collected at the time of hospital admission. During the in-hospital stay type of fracture treatment, surgery time, number of blood transfusions, perioperative complications, duration of in-hospital stay as well as in-hospital mortality were recorded. Results were analysed for osteosynthesis and prosthesis depending on the surgeons' educational status. Four different groups of surgeons were distinguished (inexperienced senior house officer; experienced senior house officer; specialist in orthopaedics and accident surgery; specialist in orthopaedics and accident surgery with an additional qualification for special accident surgery). RESULTS 402 patients with coxal femoral fractures could be included into the study. 160 patients (40 %) sustained complications of different severity. In-hospital mortality was shown to be 6.2 %. Separate consideration of osteosynthesis and prosthesis revealed no difference between the four groups of surgeons regarding mortality rate, number of blood transfusions and in-hospital stay. In terms of cutting/suture time consultants with a further specialisation in trauma surgery were significantly faster. CONCLUSION Apart from cutting/suture time, surgeons' educational status had no statistically significant impact on the rate of complications, rate of blood transfusions, hospital mortality and in-hospital stay. It can be presumed that surgical education according to our educational concept has no negative effects on treatment quality of patients with proximal femoral fractures. Differences in cutting/suture time give a hint for the additional expense that is connected with surgical education.
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Affiliation(s)
- C Bliemel
- Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Marburg.
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Buecking B, Timmesfeld N, Riem S, Bliemel C, Hartwig E, Friess T, Liener U, Ruchholtz S, Eschbach D. Early orthogeriatric treatment of trauma in the elderly: a systematic review and metaanalysis. Dtsch Arztebl Int 2013; 110:255-62. [PMID: 23667392 PMCID: PMC3647136 DOI: 10.3238/arztebl.2013.0255] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Accepted: 01/11/2013] [Indexed: 11/27/2022]
Abstract
BACKGROUND More than 125,000 hip fractures occur in Germany every year, with a one-year mortality of about 25%. To improve treatment outcomes, models of cooperation between trauma surgery and geriatrics have been developed. Their benefit has not yet been unequivocally demonstrated. METHODS We systematically searched the Medline database and the Cochrane Library for prospective randomized controlled trials in which the treatment of elderly patients with fractures by the trauma surgery service alone was compared with preoperatively initiated collaborative treatment by the trauma surgery and geriatric services ("orthogeriatric" treatment). We investigated three treatment outcome variables--length of hospital stay, in-hospital mortality, and one-year mortality--in a metaanalysis. RESULTS The five trials of hip fracture treatment that met the selection criteria all had relatively small study populations and a high risk of bias. The outcomes with respect to hospital stay differed greatly among trials (I(2): 88.5%), and geriatric intervention was not found to have any statistically significant effect (0.06 days, 95% confidence interval [CI]: -3.74 to 3.62 days). The relative risk of dying in the hospital was 0.66 for orthogeriatric treatment (95% CI: 0.28-1.55, p = 0.34), and the hazard ratio for one-year mortality was 0.79 in favor of orthogeriatric treatment (95% CI: 0.57 to 1.10, p = 0.17). A metaanalysis of functional outcomes was not possible. CONCLUSION Only a few randomized controlled trials of early orthogeriatric treatment have been performed, and these trials are of limited quality. Due to low case numbers, a benefit from interdisciplinary orthogeriatric treatment could not clearly be demonstrated. Further trials are needed.
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Affiliation(s)
- Benjamin Buecking
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Gießen and Marburg GmbH, Campus Marburg, Germany.
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Eschbach DA, Oberkircher L, Bliemel C, Mohr J, Ruchholtz S, Buecking B. Increased age is not associated with higher incidence of complications, longer stay in acute care hospital and in hospital mortality in geriatric hip fracture patients. Maturitas 2012; 74:185-9. [PMID: 23218684 DOI: 10.1016/j.maturitas.2012.11.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Revised: 11/09/2012] [Accepted: 11/11/2012] [Indexed: 11/15/2022]
Abstract
The number of agile patients in the 10th decade with a strong need for postoperative mobility will increase in the following decades. The present prospective study sought to prove if very old patients with hip-related fractures are disadvantaged according to incidence of complications, length of ICU and in-hospital stay, and in-hospital mortality. We included 402 patients, age 60 years and older, with hip related fractures. Operative treatment consisted of osteosynthesis or endoprothesis. ASA score, body mass index, Charlson Comorbidity Index, Barthel Index and Mini-Mental-Status were documented. We noted length of in-hospital stay and ICU stay as well as readmission to ICU and complications, including their dispersal according to Clavien-Dindo Classification. After univariate analysis, a multivariate analysis was performed. The examined cohorts were 85 patients aged 60-74 years, 253 75-90 years old and 64 >90 year old patients. In-hospital periods (13-14 days) mean stay on ICU (2 days) and frequency of readmission on ICU did not significantly differ statistically. Most complications were grade II, with comparable frequency and modality, displaying no significant difference throughout age-related groups (p=0.461). In-hospital mortality showing significance (p=0.014) only between 75-89 (4.4%) and >90-year-old (12.5%) cohort. Nevertheless, according to multivariate analysis, including the common risk factors, increased age was not an independent risk factor for dying (p=0.132). Patients at an advanced age with hip-related fractures showed neither a prolonged in-hospital nor ICU stay. There was no significant relation of advanced age to number and type of complications.
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Affiliation(s)
- D-A Eschbach
- Department of Trauma, Hand and Reconstructive Surgery, University of Giessen and Marburg GmbH, Marburg, Germany.
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Buecking B, Wack C, Oberkircher L, Ruchholtz S, Eschbach D. Do concomitant fractures with hip fractures influence complication rate and functional outcome? Clin Orthop Relat Res 2012; 470:3596-606. [PMID: 22707068 PMCID: PMC3492635 DOI: 10.1007/s11999-012-2419-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2011] [Accepted: 05/24/2012] [Indexed: 01/31/2023]
Abstract
BACKGROUND Owing to the aging population, the incidence of hip fractures is increasing. While concomitant fractures are not uncommon, it is unclear how they influence subsequent function. QUESTIONS/PURPOSES Therefore, we determined (1) the incidence, type and treatment of concomitant fractures accompanying hip fractures, (2) the length of hospital stay, (3) the impact of concomitant fractures on mortality and complication rate, and (4) patients' function. METHODS We retrospectively reviewed 402 patients older than 60 years with hip fractures. We recorded the presence of concomitant fractures and their treatment. We analyzed the duration of hospital stays, in-hospital mortality, perioperative complications, and function. We recorded function with the Barthel Index, Harris hip score, and timed up and go test. For this study we followed patients 1 year. RESULTS Twenty-two patients (5%) had concomitant fractures, the most frequent being proximal humeral fractures (n = 8) and distal radius fractures (n = 6). Patients without and with concomitant fractures had similar lengths of hospitalization (mean, 14 days; 95% CI, 13-15 days), in-hospital mortality (5% with concomitant fractures, 6% without concomitant fractures), and incidence of complications (41% versus 40%). Function at discharge and last followup were similar in both groups. CONCLUSION The most frequent concomitant fractures were typical osteoporotic fractures (radial and humeral fractures). Concomitant fractures did not influence length of hospitalization, in-hospital mortality, complication rate, and function. Hip fracture and comorbidities predicted the incidence of complications and patients' function. LEVEL OF EVIDENCE Level II, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Benjamin Buecking
- Department of Trauma, Hand and Reconstructive Surgery, University of Giessen and Marburg GmbH, Baldingerstrasse, 35043 Marburg, Germany.
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Buecking B, Bliemel C, Struewer J, Eschbach D, Ruchholtz S, Müller T. Use of the Gamma3™ nail in a teaching hospital for trochanteric fractures: mechanical complications, functional outcomes, and quality of life. BMC Res Notes 2012; 5:651. [PMID: 23176260 PMCID: PMC3534554 DOI: 10.1186/1756-0500-5-651] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Accepted: 11/21/2012] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Trochanteric fractures are common fractures in the elderly. Due to characteristic demographic changes, the incidence of these injuries is rapidly increasing. Treatment of these fractures is associated with high rates of complications. In addition, the long-term results remain poor, with high morbidity, declines in function, and high mortality. Therefore, in this study, complication rates and patients' outcomes were evaluated after fixation of geriatric trochanteric fractures using the Gamma3™ nail. METHODS Patients aged 60 years old or older, with pertrochanteric and subtrochanteric femoral fractures, were included. Patients with polytrauma or pathological fractures were excluded. Age, sex, and fracture type were collected on admission. In addition, data were recorded concerning the surgeon (resident vs. consultant), time of operation, and local or systemic perioperative complications. Complications were also collected at the 6- and 12-month follow-ups after trauma. Barthel Index, IADL, and EQ-5D measurements were evaluated retrospectively on admission, as well as at discharge and during the follow-up. RESULTS Ninety patients were prospectively included between April 2009 and September 2010. The patients' average age was 81 years old, and their average ASA score was 3. The incision/suture time was 53 min (95% CI 46-60 min). Hospital mortality was 4%, and overall mortality was 22% at the 12-month follow-up. Eight local complications occurred (4 haematomas, 1 deep infection, 1 cutting out, 1 irritation of the iliotibial tract, 1 periosteosynthetic fracture). The incidence of relevant systemic complications was 6%. Forty-two percent of the patients were operated on by residents in training, without significant differences in duration of surgery, complication rate, or mortality rate. The Barthel Index (82 to 71, p < .001), IADL (4.5 to 4.3, p = .0195) and EQ-5-D (0.75 to 0.66, p = .068) values did not reach pre-fracture levels during the follow-up period of 12 months. CONCLUSION The results showed a relatively low complication rate using the Gamma3™ nail, even if the nailing was performed by residents in training. The high mortality, declines in function, and low quality of life could probably be attributed to pre-existing conditions, such as physical status.In summary, the Gamma3™ nail seems to be a useful implant for the nailing of trochanteric fractures, although further studies are necessary comparing different currently available devices.
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Affiliation(s)
- Benjamin Buecking
- Department of Trauma, Hand, and Reconstructive Surgery, University of Giessen and Marburg GmbH, Location Marburg, Baldingerstrasse, Marburg, 35043, Germany
| | - Christopher Bliemel
- Department of Trauma, Hand, and Reconstructive Surgery, University of Giessen and Marburg GmbH, Location Marburg, Baldingerstrasse, Marburg, 35043, Germany
| | - Johannes Struewer
- Department of Trauma, Hand, and Reconstructive Surgery, University of Giessen and Marburg GmbH, Location Marburg, Baldingerstrasse, Marburg, 35043, Germany
| | - Daphne Eschbach
- Department of Trauma, Hand, and Reconstructive Surgery, University of Giessen and Marburg GmbH, Location Marburg, Baldingerstrasse, Marburg, 35043, Germany
| | - Steffen Ruchholtz
- Department of Trauma, Hand, and Reconstructive Surgery, University of Giessen and Marburg GmbH, Location Marburg, Baldingerstrasse, Marburg, 35043, Germany
| | - Thorben Müller
- Department of Trauma, Hand, and Reconstructive Surgery, University of Giessen and Marburg GmbH, Location Marburg, Baldingerstrasse, Marburg, 35043, Germany
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