Supra-inguinal fascia iliaca block in older-old patients for hip fractures: a retrospective study

Abstract Background: Pain management in hip fracture patients is of great importance for reducing postoperative morbidity and mortality. Multimodal techniques, including peripheral nerve blocks, are preferred for postoperative analgesia. Older-old hip fracture patients with high ASA scores are highly sensitive to the side effects of NSAIDs and opioids. Our aim was to investigate the effectiveness of the recently popularized Supra-Inguinal Fascia Iliaca Block (SIFIB) in this population. Methods: Forty-one ASA III-IV patients who underwent SIFIB + PCA (G-SIFIB) or PCA alone (Group Control: GC) after general anesthesia were evaluated retrospectively. In addition to 24-hour opioid consumption, Visual Analog Scale (VAS) scores, opioid-related side effects, block-related complications, and length of hospital stay were compared. Results: Twenty-two patients in G-SIFIB and 19 patients in GC were evaluated. The postoperative 24-hour opioid consumption was lower in G-SIFIB than in GC (p < 0.001). There was a statistically significant reduction in VAS scores at the postoperative 1st, 3rd, and 6th hours at rest (p < 0.001) and during movement (p < 0.001 for the 1st and 3rd hours, and p = 0.02 for the 6th hour) in G-SIFIB compared to GC. There was no difference in pain scores at the 12th and 24th hours postoperatively. While there was no difference between the groups in terms of other side effects, respiratory depression was significantly higher in GC than in G-SIFIB (p = 0.01). Conclusion: The SIFIB technique has a significant opioid-sparing effect and thus reduces opioid-related side effects in the first 24 hours after hip fracture surgery in older-old patients.

Role of calcium &/or vitamin D supplementation in preventing osteoporotic fracture in the elderly: A systematic review & meta-analysis

Background & objectives: Calcium and vitamin D, separately or in combination are usually prescribed to prevent fragility fractures in elderly population. However, there are conflicting results regarding the ideal dosage and overall efficacy obtained from randomized controlled trials (RCTs) conducted in the past. The objective of this study was to assess the fracture risk with the administration of calcium or vitamin D alone or in combination in elderly population (>60 yr). Methods: PubMed, Cochrane and Embase databases were searched to identify the studies from inception to February 2021 with keywords, ‘vitamin D’, ‘calcium’ and ‘fracture’ to identify RCTs. The trials with comparing vitamin D, calcium or combination with either no medication or placebo were included for final analyses. The data were extracted and the study quality was assessed by two reviewers. The principal outcome measure was fractures around hip joint and secondary outcomes assessed were vertebral and any other fracture. Results: Eighteen RCTs were considered for the final analysis. Neither calcium nor vitamin D supplementation was associated with risk of fractures around hip joint [risk ratio (RR) 1.56; 95% confidence interval (CI), 0.91 to 2.69, I2=28%; P=0.11]. In addition, the combined administration of calcium and vitamin D was also not associated with fractures around the hip joint in comparison to either no treatment or placebo. The incidence of vertebral (RR 0.95; 95% CI, 0.82 to 1.10, I2=0%; P=0.49) or any other fracture (RR 0.83; 95% CI 0.65 to 1.06, I2=0%; P=0.14) was not significantly associated with the administration of calcium and vitamin D either individually or in combination. Further subgroup analysis of the results did not vary with the dosage of calcium or vitamin D, dietary calcium intake sex, or serum 25-hydroxyvitamin D levels. Interpretation & conclusions: The present meta-analysis of RCTs on calcium, vitamin D or a combination of the two in comparison to no treatment or placebo did not support the routine administration protocol of calcium and vitamin D either alone or in combination to lower the risk of fractures in elderly population.

Effect of acupoint stimulation assisted anesthetics on the agitation during recovery and the levels of serum opioids and amyloid A in elderly patients after hip fracture surgery / 中国医师进修杂志

Objective:To investigate the effect of acupoint stimulation assisted anesthesia on the agitation during recovery and the levels of serum opioids (Opiorphin) and amyloid A (SAA) in elderly patients after hip fracture surgery.Methods:Eighty-six older patients who underwent hip fracture surgery in Shaoxing Second Hospital from February 2020 to September 2021 were randomly divided into the routine group and the research group, each with 43 patients. They were given acupoint sham stimulation and acupoint stimulation respectively, and the general indexes of the two groups, recovery quality, cognitive function and changes in serum Opiorphin and SAA levels were compared.Results:There were no differences in operation time, anesthesia time, recovery time and intraoperative blood transfusion between the two groups ( P>0.05). The dosage of remifentanil in the research group was significantly lower than that in the routine group: (270.64 ± 17.62) μg vs. (291.82 ± 23.34) μg, P<0.05. The incidence of agitation during the recovery period in the research group was significantly lower than that in the routine group: 13.95% (6/43) vs. 48.84% (21/43), P<0.05. The mini-mental state examination (MMSE) scores in the research group at 12, 24 and 48 h after operation were significantly higher than those in the routine group: (22.80 ± 2.04) scores vs. (19.31 ± 3.61) scores, (24.92 ± 2.44) scores vs. (21.49 ± 3.58) scores, (26.73 ± 2.57) scores vs. (24.23 ± 3.95) scores, there were statistical differences ( P<0.05). The serum Opiorphin level at 24 h after operation in the research group was higher than that in the routine group: (32.74 ± 8.57) mg/L vs. (25.40 ± 6.36) mg/L; and the SAA level was lower than that in the routine group: (157.36 ± 10.24) mg/L vs. (204.37 ± 15.56) mg/L, there were statistical differences ( P<0.05). Conclusions:Acupoint stimulation adjuvant anesthesia can reduce the occurrence of agitation during the recovery period of elderly patients with hip fracture, reduce the dosage of anesthetics, reduce postoperative cognitive impairment, regulate serum Opiorphin and SAA levels, and help early postoperative recovery.

The effect of fascia iliaca compartment block continuous analgesia in the early stage on early postoperative cognitive in patients with hip fractures / 中国医师进修杂志

Objective:To investigate the effect of fascial iliaca compartment block (FICB) continuous analgesia in the early stage after admission on early postoperative cognitive and motor function in elderly patients with hip fractures.Methods:A total of 80 elderly patients with hip fractures admitted toThe First Affiliated Hospital of Tsinghua University from June 2018 to June 2020 were selected and randomly divided into the control group and the observation group, with 40 cases in each group. The control group adopted the routine postoperative analgesia regimen, while the observation group adopted FICB analgesia immediately after admission to the hospital until before the operation. Postoperative analgesia pattern was consistent with that of the control group, and both groups were given postoperative analgesia for 48 h. The scores of visual analogue scale (VAS), mini mental state assessment scale (MMSE), Harris hip score (Harris) and surgical indexes, stress indexes and incidence of adverse reactions were compared between the two groups.Results:The levels of postoperative blood glucose, cortisol, angiotensin Ⅱin the observation group were lower than those in the control group: (5.21 ± 1.03) mmol/L vs. (7.03 ± 1.06) mmol/L, (643.08 ± 77.28) nmol/L vs. (747.96 ± 82.80) nmol/L, (41.03 ± 5.22) ng/L vs. (57.15 ± 8.16) ng/L, there were statistically differences ( P<0.05). The dosage of sufentanil in the observation group was lower than that in the control group: (27.48 ± 3.25) mg vs. (58.54 ± 4.86) mg, there was statistically difference ( P<0.05). The scores of VAS score at 12 h before surgery, 12 h and 48 h after surgery in the observation group were lower than those in the control group, and the scores of MMSE score were higher than those in the control group, there were statistically differences ( P<0.05). After the surgery, the Harris scores in the observation group was higher than that in the control group: (76.09 ± 6.11) scores vs. (65.62 ± 6.13) scores, there was statistically difference ( P<0.05). The incidence rate of postoperative cognitive dysfunction (POCD) in the observation group was lower than that in the control group: 2.5%(1/40) vs. 15.0%(6/40), there was statistically difference ( χ2 = 3.91, P<0.05). Conclusions:FICB continuou sanalgesic in the early stage after admission of elderly patients with hip fracture is satisfactory, which can effectively relieve postoperative pain, while the stress response is relatively mild, the recovery of postoperative cognitive function and hip function is good.

Study on home care needs and care resource integration expectations of elderly patients after hip fracture surgery: a mixed-method study / 中国实用护理杂志

Objective:To investigate the home care needs and home resource integration expectations of elderly patients after hip fracture surgery so as to provide health care guidance after discharge.Methods:A mixed study method of consistent parallel design was used to conduct semi-structured interviews in 15 elderly patients after hip fracture surgery. Meanwhile, convenient sampling method was used to select elderly patients after hip fracture surgery to conduct health survey with interRAI-HC(International Resident Assessment Instrument Home Care), and comprehensive data results were analyzed.Results:Through the analysis and induction of the interview data, two main themes were extracted: the diversification of home care needs and the lack of integration of home service resources. There were 25 health problems in the elderly after hip fracture surgery. Health problems mainly focus on ADL limitation, insufficient social activity, limited social interaction, clinical health problems (fall risk, malnutrition, pain, cardiovascular and respiratory problems, weakness, fatigue), etc.Conclusions:For elderly patients after hip fracture surgery, it is necessary to strengthen the rehabilitation guidance at discharge, integrate home care resources to provide diversified nursing services in the transitional stage, promote the formation and continuity of patients' rehabilitation behavior, and improve the clinical outcome of patients.

Perioperative mortality and morbidity of hip fractures among COVID-19 infected and non-infected patients: A systematic review and meta-analysis / 中华创伤杂志(英文版)

PURPOSE@#Hip fractures among elderly patients are surgical emergencies. During COVID-19 pandemic time, many such patients could not be operated at early time because of the limitation of the medical resources, the risk of infection and redirection of medical attention to a severe infective health problem.@*METHODS@#A search of electronic databases (PubMed, Medline, CINAHL, EMBASE and the Cochrane Central Register of Controlled Trials) with the keywords "COVID", "COVID-19″, "SARS-COV-2", "Corona", "pandemic", "hip fracture", "trochanteric fracture" and "neck femur fracture" revealed 64 studies evaluating treatment of hip fracture in elderly patients during COVID-19 pandemic time. The 30-day mortality rate, inpatient mortality rate, critical care/special care need, readmission rate and complications rate in both groups were evaluated. Data were analyzed using Review Manager (RevMan) V.5.3.@*RESULTS@#After screening, 7 studies were identified that described the mortality and morbidity in hip fractures in both COVID-19 infected (COVID-19 +) and non-infected (COVID-19 -) patients. There were significantly increased risks of 30-day mortality (32.23% COVID-19 + death vs. 8.85% COVID-19 - death) and inpatient mortality (29.33% vs. 2.62%) among COVID-19 + patients with odds ratio (OR) of 4.84 (95% CI: 3.13 - 7.47, p < 0.001) and 15.12 (95% CI: 6.12 - 37.37, p < 0.001), respectively. The COVID-19 + patients needed more critical care admission (OR = 5.08, 95% CI: 1.49 - 17.30, p < 0.009) and they remain admitted for a longer time in hospital (mean difference = 3.6, 95% CI: 1.74 - 5.45, p < 0.001); but there was no difference in readmission rate between these 2 groups. The risks of overall complications (OR = 17.22), development of pneumonia (OR = 22.25), and acute respiratory distress syndrome/acute respiratory failure (OR = 32.96) were significantly high among COVID-19 + patients compared to COVID-19 - patients.@*CONCLUSIONS@#There are increased risks of the 30-day mortality, inpatient mortality and critical care admission among hip fracture patients who are COVID-19 +. The chances of developing pneumonia and acute respiratory failure are more in COVID-19 + patients than in COVID-19 ‒ patients.

Reduction of Displaced Acetabular Fracture with Central Hip Dislocation using Vector Traction: A Case Report

@#Fracture-dislocations of the hip is the result of high-energy trauma which necessitates urgent reduction. Closed reduction is usually attempted first and if failed, open reduction is indicated and may require more than one surgical approach. However, there is also the option of managing it with vector traction. This case report details the treatment of a middle-aged gentleman who sustained a left hip central dislocation which was gradually reduced with vector traction prior to surgery and in doing so, diminished the risk of him developing several potentially debilitating complications known to be associated with surgical fixation of such injuries.

Pre-operative Factors Predicting Mortality in Six Months and Functional Recovery in Elderly Patients with Hip Fractures

@#Introduction: This study aimed to determine on-admission and perioperative factors predicting six-month mortality and functional recovery in Vietnamese patients with hip fracture. Materials and methods: Between April 2020 and July 2021, 118 patients participated in this prospective study. Patients’ data were collected from medical records. Harris hip score (HHS) was used to evaluate the functional recovery six months after fractures. The obtained data were analysed using a univariate and multivariate model. Results: The mean age of the participants was 79.5±9.4 years and 68.6% of the patients were female. The six-month mortality rate was 5.9% and independently associated with age (odds ratio (OR): 3.512, 95% confidence interval (CI) 1.538 – 8.019; P<0.001, patients aged >80 years vs those aged ≤80 years) and hypoproteinemia (OR: 2.859, 95% CI: 1.001 – 8.166, P=0.049). Among 111 survivors there were 66 (59.5%) of patients with a good functional recovery. Patients aged >80 years had a higher risk of poor functional outcome (OR: 3.167, 95% CI: 1.386 – 7.235, P: 0.006) compared to those aged ≤ 80 years. No significant correlations between other clinical (gender, body mass index, comorbidities, type of fractures or surgery, time until surgery) or laboratory parameters (anaemia, hyperglycemia, marked elevation of C reactive protein level, electrolyte abnormalities, elevated urea) and mortality or functional outcome were found. Conclusion: Advanced age is the most important factor affecting both mortality and functional outcome while hypoproteinemia is associated with a higher risk of mortality in elderly patients with hip fractures.

Clinical efficacy of the "3-2-1" surface positioning method assisted by proximal femoral anti-rotation nailing in the treatment of femoral subtrochanteric fractures / 中华骨科杂志

Objective:To investigate the clinical efficacy of proximal femoral nail anti-rotation (PFNA) assisted by the "3-2-1" surface positioning method in the treatment of femoral subtrochanteric fractures.Methods:A total of 97 patients with subtrochanteric fractures admitted to the Second Hospital of Fuzhou from January 2015 to December 2020 were retrospectively analyzed. They were divided into two groups according to whether the "3-2-1" surface positioning method (3 longitudinal axes, 2 preset incisions, and 1 auxiliary incision) was used. There were 44 patients in the surface positioning group, including 25 males and 19 females, aged 61.59±18.43 years (range, 22-90 years). According to the Seinsheimer classification, there were 13 cases of type II, 11 cases of type III, 6 cases of type IV, and 14 cases of type V. The mechanism of injury was low energy injury in 26 cases and high energy injury in 18 cases. There were 53 patients in the traditional positioning group, including 30 males and 20 females, aged 56.38±17.24 years (range, 24-90 years). According to the Seinsheimer classification, there were 9 cases of type II, 22 cases of type III, 9 cases of type IV, and 13 cases of type V. According to the mechanism of injury, there were 30 cases of low energy injury and 23 cases of high energy injury. The length of incision, operation time, and blood loss were recorded. At 1, 3, 6, and 12 months after operation, the anteroposterior and lateral X-ray films of the hip were taken to evaluate the imaging indicators (neck-shaft angle, anteroposterior and lateral displacement, and angulation), fracture healing, and complications (infection, malunion, loosening and breakage of the internal fixation, and periprosthetic fracture). The Harris hip score and EuroQol five dimensions questionnaire (EQ-5D) were evaluated.Results:All patients successfully completed the operation and were followed up for 15.12±1.54 months (range, 12-18 months). The operation time, incision length, dominant blood loss and hidden blood loss in the surface positioning group were 1.78(1.50, 2.00) h, 8(8, 9) cm, 300(200, 400) ml and 843(629, 1 130) ml, respectively, which were less than 2.10(1.69, 2.38) h, 10(9, 12) cm, 400(300, 500) ml and 1 030(954, 1 266) ml in the traditional positioning group, and the difference was statistically significant ( P<0.05). The neck-shaft angle in the surface positioning group was 135.54°±2.83°, which was larger than 132.33°±3.37° in the traditional positioning group, and the difference was statistically significant ( t=5.02, P<0.001). The anterolateral and lateral displacement and lateral image angle in the surface positioning group were 4.70±1.60 cm, 4.52±1.71 cm and 9.36°±2.94°, respectively, which were lower than 6.14±2.57 cm, 5.98±2.70 cm and 11.46°±4.68° in the traditional positioning group, and the difference was statistically significant ( P<0.05). One year after operation, the Harris hip score and EQ-5D score of the surface positioning group were 92(84, 99) points and 0.90(0.73, 1.00) points, respectively, which were higher than 88(74, 96) points and 0.81(0.72, 0.94) points of the traditional positioning group ( P<0.05). Conclusion:The "3-2-1" surface positioning method assisted PFNA internal fixation in the treatment of femoral subtrochanteric fracture can improve the quality of reduction, reduce intraoperative blood loss, and improve hip function and quality of life.

Treatment of infected nonunion after internal fixation of subtrochanteric fracture with a reconstruction stent of external fixation / 中华创伤骨科杂志

Objective:To evaluate the treatment of infected nonunion after internal fixation of subtrochanteric fracture with a reconstruction stent of external fixation.Methods:A retrospective study was conducted to analyze the data of 5 male patients with infected nonunion after internal fixation of subtrochanteric fracture who had been treated and completely followed up at The Great Wall Orthopaedics and Hand Surgery Hospital from January 2017 to October 2022. The patients were (30.0±13.5) years old. Seinsheimer fracture types: ⅢA (1 case), ⅢB (1 case), Ⅳ (2 cases), and Ⅴ (1 case); original internal fixation: intramedullary system (4 cases) and plate fixation (1 case); the Cierny-Mader anatomical classification: type Ⅳ (diffuse type) for all. After complete debridement at stage one, 2 or 3 hydroxyapatite (HA) coated screws were placed at both fracture ends from the lateral side of the femur for unilateral reconstruction external fixation. Next, a hybrid external fixation scaffold was added with a 1/3 ring at the sagittal position and 1 or 2 HA screws in 4 cases while unilateral reconstruction external fixation was constructed at both sides by inserting 2 HA screws into both fracture ends from the anterior femur at the sagittal position in 1 case. Antibiotic bone cement was used to fill bone defects of (3.8±1.8) cm. At 6 to 8 weeks after debridement when infection did not recur, antibiotic bone cement was removed before autogenous iliac bone grafting was performed in 3 patients and osteotomy bone transport in 2 patients. Infection control, bone union time, time for removal of external fixation stent, complications, Sanders hip function score and Paley bone outcome score were recorded.Results:The 5 patients were followed up for (23.4±8.1) months after surgery. Infection at the fracture ends was controlled after 1 time of debridement in 3 patients and after 2 times of debridement in 2 patients. The loosening HA screws were replaced twice due to infection at the proximal nail tract, and autologous bone grafting was performed at the opposite fracture ends in 1 case; no complications occurred in the other 4 cases. Bony union was achieved at the extended segment and fracture ends in all patients. The time for imaging union after bone reconstruction was (10.2±3.4) months. The time for wearing a stent of external fixation was (18.0±4.5) months. There was no recurrent infection or lingering infection. According to the Sanders hip function score at the last follow-up, 4 cases were excellent and 1 case was good; according to the Paley bone outcome score, the curative effect was excellent in all.Conclusion:Application of a reconstruction stent of external fixation combined with antibiotic bone cement can control infection at the first stage and conduct bone reconstruction at the second stage to successfully treat the infected nonunion and preserve the hip function after internal fixation of subtrochanteric fracture.

Morbilidad de pacientes operados de fractura de cadera / Morbidity of Patients Operated On For Hip Fracture

Introducción: La fractura de cadera en el anciano ha experimentado un incremento durante los últimos años como consecuencia del aumento de la expectativa de vida de la población. Cuba no está ajena a este fenómeno, por lo que es necesaria la preparación de todo el personal de salud para prevenir y tratar esta lesión traumática. Objetivo: Determinar la morbilidad de los pacientes con fractura de cadera. Métodos: Se realizó un estudio observacional descriptivo, en pacientes intervenidos quirúrgicamente en el Hospital Militar Dr. Joaquín Castillo Duany de Santiago de Cuba por presentar diagnóstico de fractura de cadera durante el período comprendido de enero 2013 a diciembre 2019. La muestra estuvo constituida por 69 pacientes. Se utilizó el porcentaje como medida resumen para el análisis. Resultados: La hipertensión arterial fue la comorbilidad más representada (58,0 por ciento). Prevaleció el tiempo quirúrgico medio (79,7 por ciento) y la infección de la herida quirúrgica fue la complicación más frecuente (23,5 por ciento). Conclusiones: Los pacientes operados de fractura de cadera presentan a la hipertensión arterial como la comorbilidad más representada. Prevalece el tiempo quirúrgico medio y las artroplastias tienen mayor grado de complejidad y dificultad para su colocación(AU)

Introduction: Hip fracture in the elderly has experienced an increase in recent years as a result of the increase in life expectancy of the population. Cuba is not immune to this phenomenon, so it is necessary to prepare all health personnel to prevent and treat this traumatic injury. Objective: To determine the morbidity of patients with hip fracture. Methods: A descriptive observational study was carried out from January 2013 to December 2019, in patients who underwent surgery at Dr. Joaquín Castillo Duany Military Hospital in Santiago de Cuba due to diagnosis of hip fracture. The sample consisted of 69 patients. The percentage was used as a summary measure for the analysis. Results: Arterial hypertension was the most represented comorbidity (58.0 percent). The average surgical time prevailed (79.7 percent) and the infection of the surgical wound was the most frequent complication (23.5 percent). Conclusions: Patients operated on due to hip fracture present arterial hypertension as the most represented comorbidity. The average surgical time prevails and the arthroplasties have higher degree of complexity and difficulty in their placement(AU)

Factores predisponentes asociados a la fractura de cadera en la región noroeste de la provincia de Villa Clara / Predisposing Factors Associated With Hip Fracture in the Northwest Region of Villa Clara Province

Introducción: La fractura de cadera es la causa más común de hospitalización en los servicios de urgencias de ortopedia. Objetivo: Describir los factores predisponentes asociados a la fractura de cadera en la región noroeste de la provincia de Villa Clara. Métodos: Se realizó un estudio descriptivo transversal en el período de noviembre de 2017 a diciembre de 2019, en la la región noroeste de la provincia de Villa Clara. La población en estudio estuvo integrada por 227 pacientes atendidos en el Hospital General Universitario Mártires del 9 de abril, del municipio Sagua la Grande, los cuales fueron ingresados en el servicio de Ortopedia y Traumatología por fractura de cadera. La muestra fue seleccionada mediante un muestreo no probabilístico y se tuvieron en cuenta los criterios de la investigación. Resultados: Según grupos de edad, predominaron las edades comprendidas entre 80-89 años en ambos sexos (42,7 por ciento), con mayor frecuencia entre las mujeres (45,3 por ciento) con respecto a los hombres (36,4 por ciento). Conclusiones: La caída de sus pies resultó ser el factor predominante asociado a la fractura de cadera en la región noroeste de la provincia de Villa Clara, con predominio en el sexo femenino. Esto sugiere la necesidad de desarrollar campañas de comunicación social para la población, dirigidas a la prevenciónde la fractura de cadera con un enfoque de género(AU)

Introduction: Hip fracture is the most common cause of hospitalization in orthopedic emergency services. Objective: To describe the predisposing factors associated with hip fracture in the northwestern region of the province of Villa Clara. Methods: A cross-sectional descriptive study was carried out from November 2017 to December 2019, in the northwestern region of Villa Clara province. A total of 227 patients participated; they were admitted to Mártires del 9 de abril General University Hospital, in Sagua la Grande municipality, and were treated in the Orthopedics and Traumatology service for hip fracture. Non-probabilistic sampling and the research criteria were taken into account for the selection. Results: According to age groups, the ages between 80-89 years prevailed in both sexes (42.7 percent), with higher frequency among women (45.3 percent) compared to men (36.4 percent). Conclusions: The fall from their feet"turned out to be the predominant factor associated with hip fracture in the northwest region of Villa Clara province, where the female sex predominated. This suggests the need to develop social communication campaigns for the population, aimed at the prevention of hip fracture with a gender approach(AU)

Abordaje rehabilitador de paciente con distrofia facioescapulohumeral y fractura de cadera / Rehabilitative Approach to a Patient with Facioscapulohumeral Dystrophy and Hip Fracture

La distrofia facioescapulohumeral es una miopatía progresiva de base genética, con gran variabilidad fenotípica. Se caracteriza por la progresión de cambios distróficos en la dirección cráneo-caudal con lesiones asimétricas de los músculos faciales, cintura escapular, hombros y piernas. Se expone este caso con el objetivo de demostrar la importancia de la rehabilitación en el manejo integral de pacientes con distrofia muscular y fractura de cadera. Se presenta el abordaje rehabilitador en una paciente con distrofia facioescapulohumeral y fractura de cadera tratada mediante artroplastia total de cadera. El tratamiento rehabilitador precoz contribuyó a mejorar el control del dolor y su recuperación funcional(AU)

Facioscapulohumeral dystrophy is a genetically based progressive myopathy (4q35), with great phenotypic variability. It is characterized by the progression of dystrophic changes in the craniocaudal direction with asymmetric lesions of the facial muscles, shoulder girdle, shoulders, and legs. We report the rehabilitation approach in a female patient with facioscapulohumeral dystrophy and hip fracture treated by total hip arthroplasty. A rehabilitation program was included and improvement in pain control and functionality was observed. Rehabilitation is a fundamental pillar in the comprehensive management of patients with muscular dystrophy and hip fracture(AU)

Anestesia espinal con bupivacaína más morfina en cirugía de urgencia de fractura intertrocantérica de cadera / Spinal anesthesia with bupivacaine plus morphine in urgent intertrochanteric hip fracture surgery

Introducción: La fractura de cadera en el anciano es una entidad frecuente y tiene gran incidencia en el mundo y en Cuba por el envejecimiento. Objetivo: Evaluar la eficacia de la anestesia espinal con bupivacaína más morfina en la cirugía de fractura intertrocantérica de cadera. Métodos: Se realizó un estudio clínico, experimental, no aleatorizado, prospectivo y de corte longitudinal en el Hospital Universitario Faustino Pérez Hernández de Matanzas de octubre de 2017 a octubre de 2019. El universo estuvo conformado por todos los pacientes quirúrgicos con fractura de cadera del hospital. La muestra se realizó por muestreo intencional, por 120 pacientes elegidos a criterio de los investigadores. Grupo control (B): Anestesia subaracnoidea con bupivacaína 0,5 por ciento 10 mg. Grupo estudio (M): Anestesia subaracnoidea con bupivacaína 0,5 por ciento 7 mg más 0,2 mg de morfina. Cada grupo estuvo integrado por 60 pacientes. Las variables analizadas fueron las siguientes: grupos de edades, género, estado físico, nivel de punción, tiempo de inicio del bloqueo motor, hipotensión arterial, uso de vasopresores y complicaciones secundarias a la técnica anestésica. Resultados: Predominó grupo de 84 y 90 años, género femenino y ASA III. La punción lumbar se realizó entre L3-L4. El tiempo de inicio del bloqueo motor fue 1,3 veces menor en el grupo M. Prevaleció la hipotensión arterial en el grupo B; y uso de vasopresores en ambos grupos. Predominó el prurito, grupo M, y la bradicardia, grupo B como complicaciones. Conclusiones: La asociación bupivacaína/morfina en anestesia espinal en adulto mayor para fractura de cadera proporciona mejores resultados sin complicaciones mayores(AU),

Introduction: Hip fracture in the elderly patient is a frequent entity with a high incidence worldwide and in Cuba due to aging. Objective: To assess the efficacy of spinal anesthesia with bupivacaine plus morphine in intertrochanteric hip fracture surgery. Methods: A clinical, experimental, nonrandomized, prospective, prospective and longitudinal study was carried out in Faustino Pérez Hernández University Hospital of Matanzas, from October 2017 to October 2019. The universe consisted of all surgical patients with hip fracture attended in the hospital. The sample was made by purposive sampling, consisting of 120 patients chosen at the discretion of the researchers. The control group (B) was administered subarachnoid anesthesia with 10 mg of bupivacaine 0.5 percent. The study group (M) was administered subarachnoid anesthesia with 7 mg of bupivacaine 0.5 percent. plus 0.2 mg of morphine. Each group consisted of 60 patients. The following variables were analyzed: age groups, gender, physical condition, puncture level, motor block onset time, arterial hypotension, use of vasopressors, and complications secondary to the anesthetic technique. Results: The predominant age group was 84 and 90 years old, together with female gender and ASA III. Lumbar puncture was performed between L3 and L4. The motor block onset time was 1.3 times shorter in the M group. Arterial hypotension prevailed in the B group; apart from the use of vasopressors in both groups. As complications, there was a predominance of pruritus in the M group and bradycardia in the B group. Conclusions: The association bupivacaine/morphine in spinal anesthesia for hip fracture among elderly adults provides better outcomes without major complications(AU)

Predictive values of neutrophil to lymphocyte ratio, monocyte to lymphocyte ratio and platelet to lym-phocyte ratio for delirium after hip fracture surgery in the elderly / 中华创伤骨科杂志

Objective:To explore the predictive values of neutrophil to lymphocyte ratio (NLR), monocyte to lymphocyte ratio (MLR) and platelet to lymphocyte ratio (PLR) for postoperative delirium in the elderly patients with hip fracture.Methods:The data of 1,278 elderly patients with hip fracture were analyzed retrospectively who had been admitted to Department of Orthopedics, The 7th Medical Center, General Hospital of Chinese People's Liberation Army from January 2012 to December 2018. There were 418 males and 860 females, with a median age of 81 (75, 90) years. There were 728 intertrochanteric fractures and 550 femoral neck fractures. The working characteristic curves (ROC) of NLR, MLR, and PLR used to predict postoperative delirium in the elderly patients with hip fracture were worked out to obtain the best cutoff points (sensitivity, specificity, and area under the curve) respectively. According to the best cutoff points, the NLR, MLR, and PLR were respectively divided into an increase group and a normal group. According to whether postoperative delirium occurred or not, the patients were divided into a delirium group and a delirium-free group. After univariable analysis was conducted to screen out the risk factors, binary logistic regression analysis was conducted of the factors with P<0.05 to determine the risk factors. Results:The median values of NLR, MLR and PLR in the 1,278 elderly patients with hip fracture at admission were 5.43 (3.87, 7.88), 0.40 (0.29, 0.54) and 158.40 (118.00, 222.50), respectively. Postoperative delirium occurred in 153 patients (12.0%). In the study of the predictive values of NLR, MLR, and PLR using ROC curves for postoperative delirium in the elderly patients with hip fracture, the best cutoff points (sensitivity, specificity, and area under the curve) for prediction were 7.613 (57.5%, 77.1%, 0.726), 0.512 (52.3%, 74.0%, 0.663), and 201.125 (68.6%, 73.3%, 0.751), respectively. The risk factors for postoperative delirium were increased NLR ( OR=2.046, 95% CI: 1.322 to 3.166, P<0.001), increased MLR ( OR=1.568, 95% CI: 1.039 to 2.367, P=0.032), and increased PLR ( OR=3.489, 95% CI: 2.290 to 5.317, P<0.001). Conclusion:As NLR≥7.613, MLR≥0.512 and PLR≥201.125 may be risk factors for postoperative delirium in elderly patients with hip fracture, NLR, MLR and PLR may have a positive value in prediction of postoperative delirium.

Clinical application progress of Nottingham Hip Fracture Score / 中国基层医药

Hip fracture is the most common traumatic disease in the older adult patients, and its incidence is rising year by year. There are various clinical scoring systems for predicting postoperative complications and mortality. However, most scoring systems are not suitable for predicting postoperative complications and mortality of hip fracture. This paper summarizes the establishment, calculation, application extension and clinical application of Nottingham Hip Fracture Score, and elaborates the clinical application of Nottingham Hip Fracture Score in hip fracture patients.

Methyl-CpG binding protein 2 is associated with the prognosis and mortality of elderly patients with hip fractures

ABSTRACT Objectives To investigate the expression level and clinical significance of Methyl-CpG binding Protein 2 (MECP2) in elderly patients with hip fractures. Methods This prospective observational study included 367 elderly patients with hip fractures between April 2016 and December 2018. All the patients were treated with internal fixation or joint replacement. In addition, 50 healthy elderly individuals were enrolled as healthy controls. The serum levels of MECP2 and inflammatory factors Interleukin (IL)-1β, IL-6, IL-8, and Tumor Necrosis Factor (TNF)-α was determined by enzyme-linked immunosorbent assay. Data on patients' basic characteristics and postoperative complications were collected. The Harris score was used to assess hip function at 1-month, 3-months, and 6-months after surgery. Patient quality of life was measured using the Barthel Index (BI) score 3-months after surgery. The 1-year mortality was analyzed using the Kaplan-Meier curve, and logical regression was used to analyze the risk factors for mortality. Results No significant differences were observed in the basic clinical characteristics of all patients. The serum MECP2 levels were remarkably high in patients with hip fractures and negatively correlated with serum IL-1β, IL-6, and TNF-α levels. Patients with higher MECP2 predicted higher dynamic Harris scores, lower postoperative complications, lower 1-year mortality, and higher BI scores. Logical regression showed that age was the only independent risk factor for postoperative 1-year mortality in elderly patients with hip fractures. Conclusion Lower MECP2 predicted poor prognosis and higher 1-year mortality in elderly patients with hip fractures.

Prevalencia de fracturas periprotésicas de fémur en una serie determinada de pacientes con reemplazo de cadera / Prevalence of periprosthetic femoral fractures in a selected series of hip replacement patients

Objetivo Determinar la prevalencia de fracturas periprotésicas en pacientes con antecedente de reemplazo de cadera que ingresaron a un servicio de ortopedia entre el 2010 al 2018. Materiales y métodos 709 pacientes fueron atendidos, pero solo 15 pacientes presentaron fracturas periprotésicas. Resultados La prevalencia de fracturas periprotésicas fue del 2.1% (IC 95%: 1.05; 3.17). La mayor parte de los casos se presentaron en el sexo femenino con un porcentaje de 53,3%, con edad promedio de 74.2 año. Las principales causas de fractura periprotésica fueron el trauma en la cadera por caída desde su propia altura. Solo el 12.12% presentaron alguna complicación local o sistémica. Conclusiones La prevalencia de fracturas periprotésicas fue menor del 3%; esta patología depende de distintos factores que se deben tener en cuenta al momento de realizar los procedimientos quirúrgicos.

Objective To determine the prevalence of periprosthetic fractures in patients with a history of hip replacement admitted to an orthopedic service between 2010 and 2018. Materials and methods 709 patients were seen, but only 15 patients had periprosthetic fractures. Results The prevalence of periprotic fractures was 2.1% (95% CI: 1.05; 3.17). The majority of cases occurred in females with a percentage of 53.3%, with an average age of 74.2 years. The main causes of periprotic fracture were hip trauma from falling from its own height. Only 12.12% presented some local or systemic complication. Conclusions The prevalence of periprosthetic fractures was less than 3%; this pathology depends on different factors that must be taken into account when performing surgical procedures.

Revisión narrativa: unidad de ortogeriatría, la propuesta para reducir los desenlaces adversos en adultos mayores con fracturas de cadera por fragilidad / Narrative review: Orthogeriatrics unit, the proposal to reduce adverse outcomes in older adults with fragility fractures

Introducción Las fracturas de cadera son un problema de salud pública debido a su asociación con altas tasas de mortalidad a un año, deterioro funcional y empeoramiento de la calidad de vida. Un enfoque multidisciplinario mejora los resultados de los pacientes adultos mayores con fracturas por fragilidad. Objetivo Realizar una revisión narrativa para evaluar la evidencia de las unidades de ortogeriatría como estrategia para reducir desenlaces adversos en adultos mayores con fracturas de cadera por fragilidad. Materiales y métodos Se realizó una búsqueda de la literatura en las siguientes bases de datos: PubMed,Cochrane y Scielo, con los términos: "hip fracture" or "fragility fracture" AND "multidisciplinary team" or "Geriatric co management" or AND "orthogeriatric" or "ortho-geriatric". Resultados El manejo por ortogeriatría reduce el tiempo de evaluación pre-quirúrgico, complicaciones postoperatorias y la estancia hospitalaria. La valoración interdisciplinaria ha demostrado ser eficaz para disminuir el deterioro funcional, la mortalidad intrahospitalaria, la mortalidad a los 30 días y el riesgo de institucionalización en comparación con otros modelos de atención. Estos factores impactan sobre la optimización de recursos disminuyendo los costos en salud. Conclusión Los servicios de ortogeriatría son el modelo ideal para tratar las fracturas de cadera por fragilidad en adultos mayores. En Colombia se deben implementar más unidades de ortogeriatría para mejorar la atención intrahospitalaria, crear programas de seguimiento y rehabilitación.

Introduction Hip fracture is a public health problem due to its association with high mortality rates at one year, functional decline and worsening of quality of life. A multidisciplinary approach improves outcomes for elderly patients with fragility fracture. Objective To carry out a narrative review to evaluate the evidence of orthogeriatric units as a strategy to reduce adverse outcomes in older adults with fragility hip fractures. Material and Methods A literature search was carried out in the following databases: PubMed, Cochrane and Scielo, with the terms: "hip fracture" or "fragility fracture" AND "multidisciplinary team" or "Geriatric co management" or AND "orthogeriatric" or "ortho-geriatric". Results Care by orthogeriatrics reduces pre-operative surgical time, postoperative complications and hospital stay. Interdisciplinary assessment has been shown to be effective in reducing functional decline, in-hospital mortality, 30-day mortality, and the risk of institutionalization compared to other models of care. These factors impact on the optimization of resources, reducing health costs. Conclusion Orthogeriatric services are the ideal model to treat fragility fractures in older adults. In Colombia, more orthogeriatric units should be implemented to improve in-hospital care, create follow-up and rehabilitation programs.