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@#children with femur fractures. This study compares the outcomes of spica cast application, in terms of quality of fracture reduction and hospital charges when performed in operating theatre versus outpatient clinics at a local institution. Materials and Methods: A total of 93 paediatric patients, aged between 2 months to 8 years, who underwent spica casting for an isolated femur fracture between January 2008 and March 2019, were identified retrospectively. They were separated into inpatient or outpatient cohort based on the location of spica cast application. Five patients with metaphyseal fractures and four with un-displaced fractures were excluded. There were 13 and 71 patients in the outpatient and inpatient cohort respectively who underwent spica casting for their diaphyseal and displaced femur fractures. Variables between cohorts were compared. Results: There were no significant differences in gender, fracture pattern, and mechanism of injury between cohorts. Spica casting as inpatients delayed the time from assessment to casting (23.55 ± 29.67h vs. 6.75 ± 4.27h, p<0.05), increased average hospital stay (41.2 ± 31.1h vs. 19.2 ± 15.0h, p<0.05) and average hospital charges (US$1857.14 vs US$775.49, p<0.05). Excluding the un-displaced fractures, there were no significant differences in the period of cast immobilisation and median follow-up length. Both cohorts had a similar proportion of unacceptable reduction and revision casting rate. Conclusion: Both cohorts presented similar spica casting outcomes of fracture reduction and follow-up period. With spica cast application in operating theatre reporting higher hospital charges and prolonged hospital stay, the outpatient clinic should always be considered for hip spica application.
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Objective To investigate the causes and prognosis of conservative treatment for hip fracture in the elderly. Methods The 47 elderly patients undergoing conservative treatment for hip fracture were recruited and retrospectively analyzed in our hospital from July 2014 to June 2017. The causes of conservative treatment and corresponding therapeutic methods were analyzed ,and hip joint function ,complications ,survival situation at 12-36 months after fracture were followed up. Results A total of 47 hip fracture patients aged(80.0 ± 7.2)years(range ,63-92 years)with 25 females and 22 males included 30 cases with femoral neck fractures and 17 cases with intertrochanteric fractures.Details of prognosis of treatments in all (100% )patients followed for 12-36 months after fracture were as follows :(1 ) In treatment methods ,43 patients were treated with bed-rest immobilization after discharge from hospital and 4 patients were rehospitalized for surgery due to pain and intolerance of long-term bedridden. (2)There were 40 patients with three comorbidities or more , accounting for 85.1% of the total.11 cases had surgical contraindications.27 cases choose conservative treatment due to the high risk of surgery.9 cases gave up surgery due to psychological or economic reasons. (3)In complications and death ,complications were found in 43(91.5% ,43/47)patients with conservative treatment ,including pneumonia(37.2% ,16/43 cases ,)and bedsore(51.2% ,22/43 cases). (4)In fracture healing and hip joint function ,among the 43 patients receiving conservative treatment , hip fractures were not healed in 31 patients ,and fractures were malunited in 12 patients. Hip Harris score was poor in 31 cases and fair in 12 cases. The mortality rate within 1 year after fracture is high in the elderly hip fracture patients with conservative treatment and complication incidence rates are also high.Most of them have poor function recovery of hip joint ,and clinical results are not good. Conclusions The elderly hip fracture patients with conservative treatment have a high rate of complications and mortality within 1 year after fracture.Most of them have poor hip joint function recovery.
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Objective To investigate the risk assessment ,prevention and management for perioperative stroke in elderly patients with hip fractures. Methods A total of 179 patients aged 65 years and older were admitted to our department due to hip fracture. In managements of perioperative stroke ,the preoperative risk assessment and the management of stroke ,identifying the risk population for stroke prevention ,controlling risk factors of the preoperative stroke ,intraoperative monitoring , postoperative treatment ,etc.were studied retrospectively.The incidence of perioperative stroke was recorded and analyzed. Results Of 179 patients with hip fracture ,overviews of diagnosis and treatment were as follows.Twenty-four (24/179 ,13.41% ) cases did not receive operative treatments.Head and neck CT angiography(CTA)-showed severe stenosis or occlusion of intracranial artery and internal carotid artery were in 9(5.03% ,9/179)patients ,of whom the 5(2.79% ,5/179) cases underwent cerebrovascular digital subtraction angiography (DSA ) ,balloon dilation and stent implantation ,then received the operation for hip fracture 10 days later ,finally were discharged uneventfully.1 (0.56% ,1/179 ) patient underwent orthopaedic surgery due to the results of DSA showing no indication of interventional therapy ,and was discharged unevenfully.3 (1.68% ,3/179 ) patients refused to receive the further DSA examination or interventional therapy ,strongly demanded for orthopaedic surgery and would take the surgical risk ,and were discharged uneventfully.2(1.12% , 2/179)patients were found to have cerebral aneurysm diagnosed by CTA and DSA ,and underwent surgery for hipfracture without special treatment.2(1.12% ,2/179)patients were diagnosed as new occurrence of cerebral infarction before the operation ,and received head and carotid stenting at the department of cerebrovascular surgery ,followed by combined antithrombotic therapy of aspirin , clopidogrel and low molecular weight heparin for 4 weeks ,then underwent orthopaedic surgery for hip fracture.2 (1.12% ,2/179 ) patients were diagnosed as new cerebral infarction after orthopaedic surgery ,then were transferred to the department of neurology for treatment. Conclusions The thorough preoperative risk assessment and management of stroke ,reasonable perioperative antiplatelet and anticoagulation therapy ,intense intraoperative monitoring and active postoperative complications management make it possible for high-risk and new ischemic stroke patients with hip fractures to receive early orthopaedic treatment.
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Objective To observe the clinical efficacy of umbilicus application withDa Huang (Rheum Officinale) during 5-7 a.m. in treating senile constipation after hip fracture.Method Fifty-nine elderly patients with constipation after hip fracture were randomized into a treatment group of 30 cases and a control group of 29 cases. The treatment group was intervened by umbilicus application withDa Huang (Rheum Officinale) during 5-7 a.m, while the control group was by umbilicus application withDa Huang (Rheum Officinale) at any time but avoiding 5-7 a.m. period. After a treatment course, the therapeutic efficacy was evaluated based on bowel movement frequency and shape of stool, and the two groups were compared with each other.Result The total effective rate and markedly-effective rate were respectively 93.3% and 70.0% in the treatment group versus 82.8% and 37.9% in the control group. The between-group difference in the total effective rate was statistically insignificant (P>0.05); there was a significant difference in comparing the markedly-effective rate between the two groups (P<0.01).Conclusion Umbilicus application withDa Huang (Rheum Officinale) during 5-7 a.m. is an effective method in treating senile constipation after hip fracture.
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@# Objective To investigate the effects of mindfulness behavior training on mood states and quality of life in old patients post fixation for hip fracture. Methods Patients were randomly divided into experiment group (n=30) and control group (n=30). The control group received routine rehabilitation, while the experiment group received mindfulness practice therapy in addition. They were evaluated with Profile of Mood States (POMS), Short Form of Health Survey (SF-36), and Mindful Attention Awareness Scale (MAAS) before and 5 weeks after treatment. Results There was no difference in the scores of POMS, MAAS and SF-36 before treatment (P>0.05). The scores of MAAS and SF-36, the subscores of tension-anxiety, depression-dejection, fatigue-inertia and vigor-activity of POMS improved more in the experiment group than in the control group (P<0.05). Conclusion Mindfulness behavior training can improve the mood state and quality of life of old patients post fixation for hip fracture.