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1.
Article in Chinese | WPRIM | ID: wpr-1027103

ABSTRACT

Objective:To explore the clinical effectiveness of a self-designed robot reduction system for femoral intertrochanteric fractures.Methods:A retrospective study was conducted to analyze the 57 patients with intertrochanteric fracture who had been treated at Department of Orthopedics, The Fourth Affiliated Central Hospital of Tianjin Medical University from June 2022 to February 2023. The patients were divided into a robot group (using the self-designed robot reduction system to assist intramedullary nailing) and a traction bed group (using a traction bed to assist intramedullary nailing) based on their fracture reduction method. The robot group: 31 patients, 11 males and 20 females, with an age of (78.7±9.3) years; 16 left and 15 right sides; 17 cases of type 31-A1, 12 cases of type 31-A2 and 2 cases of type 31-A3 by the AO/OTA classification. The traction bed group: 26 patients, 12 males and 14 females, with an age of (78.7±7.7) years; 13 left and 13 right sides; 16 cases of type 31-A1, 9 cases of type 31-A2 and 1 cases of type 31-A3 by the AO/OTA classification. The 2 groups were compared in terms of reduction and operation time, intraoperative blood loss, fluoroscopy frequency, reduction quality, and VAS and Harris score at preoperation, 1 week and 6 months postoperation.Results:The 2 groups were comparable due to insignificant differences in their preoperative general data ( P>0.05). The robot group was significantly better than the traction bed group in reduction time [(4.4±2.2) min versus (9.4±3.2) min], operation time [(29.0±13.5) min versus (49.3±13.3) min], intraoperative blood loss [(76.5±30.5) mL versus (115.0±38.4) mL], fluoroscopy frequency [(10.2±2.6) times versus (14.8±3.2) times], and good/excellent rate of reduction [80.6% (25/31) versus 50.0% (13/26)] ( P<0.05). All patients were followed up for (6.8±0.3) months. Respectively, the VAS scores at preoperation and 6 months postoperation was (6.2±1.3) and (2.4±0.8) points for the robot group, and (6.3±1.3) and (2.7±0.8) points for the traction bed group, showing no statistically significant differences between the 2 groups ( P>0.05). However, the VAS score was (3.3±1.2) points for the robotic group and (4.8±1.5) points for the traction bed group at 1 week postoperation, showing a statistically significant difference between the 2 groups ( P<0.001). Respectively, the Harris scores at preoperation and 6 months postoperation were (35.3±3.0) and (88.7±3.4) points for the robot group, and (35.6±2.9) and (87.2±3.5) points for the traction bed group, showing no statistically significant differences between the 2 groups ( P>0.05). However, the Harris score was (57.3±3.7) points for the robotic group and (46.7±2.8) points for the traction bed group at 1 week postoperation, showing a statistically significant difference between the 2 groups ( P<0.05). The patient satisfaction rates in the robot and traction bed groups were 96.8% (30/31) and 92.3% (24/26), respectively, showing no statistically significant difference ( P>0.05). Conclusion:Our self-designed robot reduction for femoral intertrochanteric fractures can effectively shorten reduction and operation time, reduce bleeding and fluoroscopy frequency, and enhance anatomical reduction.

2.
Chinese Journal of Orthopaedics ; (12): 161-168, 2024.
Article in Chinese | WPRIM | ID: wpr-1027703

ABSTRACT

Objective:To explore the efficacy of long intramedullary nails versus short intramedullary nails in the treatment of AO/OTA 31-A3 intertrochanteric fractures.Methods:A retrospective analysis was conducted on 60 patients with AO/OTA 31-A3 intertrochanteric femur fractures treated between March 2019 and August 2022. The patients were randomly divided into two groups (the long nail group and the short nail group). Thirty-four patients were treated with long intramedullary nails, including 16 males and 18 females, aged 68.41±17.84 years old (range 31-96 years). Twenty-six patients were treated with short intramedullary nails, including 13 males and 13 females, aged 72.23±13.97 years old (range 31-90 years). The causes of injury, fracture classification (AO/OTA classification), intraoperative blood loss, operation time, fracture healing time, imaging indexes (fracture reduction quality, postoperative neck trunk angle, and medial support), Harris score of the hip joint at the last follow-up, one-year mortality rates and complications were compared between the two groups.Results:The follow-up time was 24.26±6.67 months in the long nail group and 24.31±5.60 months in the short nail group, and the general information of the two groups were comparable. Between the long nail and short nail group, the intraoperative blood loss was 281.47±235.28 ml vs. 121.92±84.14 ml and the operation time was 110.44±24.63 min vs. 81.15±28.54 min with significant differences ( P<0.05). While the length of hospital stay was 12.35±4.81 d vs. 10.89±4.30 d, the good rate of fracture reduction was 55.9% vs. 61.53%, the fracture healing time was 120.44±16.43 d vs. 128.07±18.33 d, the presence rate of medial support was 67.6% vs. 79.4%, and the excellent rate of Harris score was 65.4% vs. 65.4% with no significant difference between the two groups ( P>0.05). One-year mortality rates was 5.3% vs. 7.1% and complications was 11.7% vs. 15.4% with no significant difference between the two groups ( P>0.05). Conclusion:Both long intramedullary nails and short intramedullary nails are effective in the treatment of AO/OTA 31-A3 intertrochanteric femur fractures. However, surgical time and intraoperative blood loss was less in the short nail group.

3.
Chinese Journal of Geriatrics ; (12): 50-55, 2024.
Article in Chinese | WPRIM | ID: wpr-1028246

ABSTRACT

Objective:To analyze the value of the modified 5-factor frailty index in assessing postoperative complications and mortality in elderly hip fracture patients.Methods:In this retrospective study, clinical data were collected of hip fracture patients aged 60 years and above surgically treated at Beijing Luhe Hospital affiliated to Capital Medical University between January 2015 and December 2019.Patients' group assignment was based on whether the modified frailty index score was ≤1 or ≥2, and a post-surgery follow-up was conducted for survival at 30 days, 1 year, 2 years, and 4 years, which was analyzed by the Kaplan-Meier method.Multivariate Cox regression analysis was used to identify factors affecting death in elderly patients.Results:A total of 1 208 patients were included, with 890 in the group with the index score ≤1 and 318 in the group with the index score ≥2.There was no difference in mortality at 30 days(1.6% or 14/890 vs.1.9% or 6/318, P=0.707), 1-year(11.3% or 99/874 vs.11.6% or 36/310, P=0.917), 2-years(19.7% or 168/852 vs.24.3% or 73/300, P=0.099)and 4-years(44.0% or 238/541 vs.51.5% or 106/206, P=0.071). The incidence of postoperative complications in the group with the score ≥2 was higher(14.8% or 47/318 vs.9.7% or 86/890, P=0.012), including the incidence of stroke(6.3% or 20/318 vs.1.8% or 16/890, P<0.001)and the incidence of postoperative pneumonia(6.0% or 19/318 vs.3.1% or 28/890, P=0.029), and the differences were statistically significant.Multivariate Cox regression analysis showed that age, being female, the Charlson comorbidity index score and low hemoglobin at admission were risk factors for 1-year, 2-year and 4-year mortality post-surgery(all P<0.05), while the modified frailty index score had no correlation with postoperative mortality. Conclusions:A modified frailty index ≥2 is predictive of increased risk of postoperative pneumonia and stroke in patients with hip fractures, but is not correlated with the risk of postoperative mortality.

4.
Chinese Journal of Geriatrics ; (12): 251-256, 2024.
Article in Chinese | WPRIM | ID: wpr-1028269

ABSTRACT

Older patients with hip fractures often experience moderate to severe pain, which can increase the risk of complications during surgery and hinder early postoperative mobility and rehabilitation.To address this, peripheral nerve blocks have been suggested as a method for perioperative pain management in these patients.This article aims to provide an overview of the neural innervation of the hip joint, the techniques used for peripheral nerve blocks in hip fracture surgeries, and their impact on postoperative complications and recovery in older patients.Current evidence suggests that peripheral nerve blocks may have a positive effect on the prognosis of older patients with hip fractures.However, further high-quality clinical studies are required to validate these findings.

5.
International Journal of Surgery ; (12): 207-211, 2024.
Article in Chinese | WPRIM | ID: wpr-1018116

ABSTRACT

Femoral intertrochanteric fracture is one of the common types of fractures in the elderly. With the general improvement of medical and living standards, the number of elderly people is increasing, and the problem of osteoporosis has also become relatively prominent. Therefore, low violence can usually cause fractures in this area of the elderly, which has a significant negative impact on the quality of life of elderly patients. With the further development of medical technology and internal fixation materials, the emergence of proximal femoral nail antirotation(PFNA) has greatly improved the treatment effect of femoral intertrochanteric fractures in elderly patients. However, with the increasing number of patients treated, internal fixation failures have gradually been reported. In recent years, proximal femoral biomimetic intramedullary nail(PFBN) has been reported to have good clinical efficacy. Therefore, this article mainly elaborates on the theoretical basis, design characteristics, biomechanics, and clinical efficacy research of PFBN, providing more reference for the clinical treatment of femoral intertrochanteric fractures in elderly patients in the future.

6.
Tianjin Medical Journal ; (12): 97-101, 2024.
Article in Chinese | WPRIM | ID: wpr-1020978

ABSTRACT

Objective To investigate the relationship between perioperative nutritional risk and venous thromboembolism(VTE)in patients with hip fracture.Methods A total of 379 patients with unilateral hip fracture due to fall or sprain who underwent elective surgery were selected and divided into the non-VTE group(246 cases)and the VTE group(133 cases)according to whether or not VTE occurred during perioperative period.Basic information,surgical and anesthesia records,nutritional risk related indicators,inflammatory indicators and outcome indicators of patients were collected.Multiple Logistic regression was used to analyze the independent influencing factors of perioperative VTE.Receiver operating characteristics(ROC)curves were used to assess the ability to discriminate independent factors,and DeLong test was used to compare area under the curve(AUC).Results Compared with the non-VTE group,the proportion of patients in the VTE group was older,complicated with hypertension,the time to visit hospital more than 2 days,received(hollow/intramedullary nail)internal fixation,perioperative blood transfusion,ASA gradeⅢtoⅣ,and higher nutritional risk screening Table(NRS)-2002 scores on admission and higher postoperative neutrophil/lymphocyte ratio(NLR).Nutritional prognosis index(PNI),hemoglobin(Hb)and prealbumin(PA)at admission and after operation were lower in the VTE group than those in the non-VTE group(P<0.01).Multivariate Logistic regression analysis showed that PNI was decreased,NRS-2002 scores and PA were increased,and the time of visit hospital was>2 days after internal fixation.American College of Anesthesiologists(ASA)gradesⅢ-Ⅳwere independent risk factors for perioperative VTE of hip fracture(P<0.05).ROC curve analysis showed that the AUC(95%CI)of NRS-2002 at admission was 0.739(0.692-0.783),and that of PNI at admission was 0.720(0.672-0.765),both of which were better than other influencing factors(P<0.01).Conclusion NRS-2002 and PNI are good predictors of perioperative VTE in patients with hip fracture.

7.
Adv Rheumatol ; 64: 8, 2024. tab
Article in English | LILACS-Express | LILACS | ID: biblio-1550007

ABSTRACT

Abstract Background Hip fractures in the older adults lead to increased morbidity and mortality. Although a low bone mineral density is considered the leading risk factor, it is essential to recognize other factors that could affect the risk of hip fractures. This study aims to evaluate the contribution of clinical characteristics, patient-reported outcomes, and muscle and aerobic capacity for hip fractures in community-dwelling older adults. Methods This is a retrospective cohort study with real world-data from subjects ≥ 60 years old attending an outpatient clinic in Minas Gerais, Brazil, from May 1, 2019, to August 22, 2022. Data about clinical characteristics (multimorbidity, medications of long-term use, sedative and or tricyclic medications, number of falls), patient-reported outcomes (self-perception of health, self-report of difficulty walking, self-report of vision problems, and self-report of falls) and muscle and aerobic capacity (calf circumference, body mass index, and gait speed) were retrieved from an electronic health record. The association of each potential risk factor and hip fracture was investigated by a multivariable logistic regression analysis adjusted for age and sex. Results A total of 7,836 older adults were included with a median age of 80 years (IQR 72-86) and 5,702 (72.7%) were female. Hip fractures occurred in 121 (1.54%) patients. Multimorbidity was associated with an increased risk of hip fracture (OR = 1.12, 95%CI 1.06-1.18) and each episode of fall increased the chance of hip fracture by 1.7-fold (OR = 1.69, 95%CI 1.52-1.80). Patient-reported outcomes associated with increased fracture risk were regular or poor self-perception of health (OR = 1.59, 95%CI 1.06-2.37), self-report of walking difficulty (OR = 3.06, 95%CI 1.93-4.84), and self-report of falls (OR = 2.23, 95%CI 1.47-3.40). Body mass index and calf circumference were inversely associated with hip fractures (OR = 0.91, 95%CI 0.87-0.96 and OR = 0.93, 95%CI 0.88-0.97, respectively), while slow gait speed increased the chance of hip fractures by almost two-fold (OR = 1.80, 95%CI 1.22-2.66). Conclusion Our study reinforces the importance of identified risk factors for hip fracture in community-dwelling older adults beyond bone mineral density and available fracture risk assessment tools. Data obtained in primary care can help physicians, other health professionals, and public health policies to identify patients at increased risk of hip fractures.

8.
Einstein (São Paulo, Online) ; 22: eGS0493, 2024. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1564510

ABSTRACT

ABSTRACT Objective To describe and analyze the aspects regarding the cost and length of stay for elderly patients with bone fractures in a tertiary reference hospital. Methods A cross-sectional retrospective study using data obtained from medical records between January and December 2020. For statistical analysis, exploratory analyses, Shapiro-Wilk test, χ2 test, and Spearman correlation were used. Results During the study period, 156 elderly patients (62.2% women) with bone fractures were treated. The main trauma mechanism was a fall from a standing height (76.9%). The most common type of fracture in this sample was a transtrochanteric fracture of the femur, accounting for 40.4% of cases. The mean length of stay was 5.25 days. The total cost varied between R$2,006.53 and R$106,912.74 (average of R$15,695.76) (updated values). The mean daily cost of hospitalization was R$4,478.64. A positive correlation was found between the length of stay and total cost. No significant difference in cost was observed between the two main types of treated fractures. Conclusion Fractures in the elderly are frequent, resulting in significant costs. The longer the hospital stay for treatment, the higher the total cost. No correlation was found between total cost and number of comorbidities, number of medications used, and the comparison between the treatment of transtrochanteric and femoral neck fractures.

9.
Rev. Bras. Ortop. (Online) ; 59(2): 284-296, 2024. tab, graf
Article in English | LILACS | ID: biblio-1565393

ABSTRACT

Abstract Objectives This study evaluated pain intensity in elderly subjects with hip fractures admitted to the emergency sector and undergoing preoperative pericapsular nerve group (PENG) block. Additionally, the degree of tolerable hip flexion was assessed. Methods A prospective, randomized, and controlled clinical trial with parallel groups. The control group consisted of elderly subjects with hip fractures undergoing standardized intravenous systemic analgesia. The intervention group consisted of elderly patients with hip fractures undergoing PENG block and standardized systemic analgesia. The groups were evaluated at rest and during movement using the Pain Assessment in Advanced Dementia (PAINAD) scale. We determined pain intensity and reduction, in addition to the degree of tolerable flexion of the fractured hip. All patient assessments occurred before the medication or block administration and at 45 minutes, 12, 24, and 36 hours postmedication or block. Results Preoperatively and 24 hours after PENG block, elderly subjects with hip fracture showed a significant reduction in pain at rest or movement compared to control patients (p< 0.05), with 60% of patients assessed at rest demonstrating desirable pain reduction (≥50%) and only 13.3% of the control group achieving the desired pain reduction. During movement, after undergoing PENG block, 40% of subjects demonstrated the desired pain reduction and no patient from the control group. The intervention group also showed a significant improvement in the tolerable hip flexion group (p< 0.05). Conclusion Preoperative PENG block in elderly subjects with hip fractures admitted to the emergency sector provided a significant reduction in pain compared with the control group.


Resumo Objetivos Este estudo avaliou a intensidade da dor em idosos acometidos por fratura do quadril internados no setor de emergência e submetidos ao Pericapsular Nerve Group (PENG) block no pré-operatório. Ademais, o grau de flexão tolerável do quadril foi avaliado. Métodos Ensaio clínico, prospectivo, aleatorizado e controlado em grupos paralelos. O grupo controle consiste em idosos com fratura do quadril, submetidos à analgesia sistêmica endovenosa padronizada. O grupo intervenção consiste em idosos com fratura do quadril submetidos ao PENG block e analgesia sistêmica padronizada. Os grupos foram avaliados em repouso e durante o movimento pela escala de dor Pain Assessment in Advance Dementia (PAINAD). Aferiram-se intensidade da dor e redução álgica, assim como o grau de flexão tolerável do quadril fraturado. Todos os pacientes foram avaliados previamente à administração de medicação ou bloqueio e aos 45 minutos, 12, 24 e 36 horas pós-medicação ou bloqueio. Resultados No pré-operatório e 24 horas após o PENG block, idosos com fratura do quadril apresentaram redução significativa da dor em repouso ou movimento em comparação com o controle (p< 0,05), com 60% dos pacientes avaliados em repouso, demonstrando a redução álgica desejável de ≥ 50% e apenas 13,3% do grupo controle com redução álgica desejável. Durante o movimento, após o PENG block, 40% demonstraram redução álgica desejada e nenhum paciente do grupo controle apresentou a redução desejada. Verificou-se, também, no grupo intervenção a melhora significativa da flexão tolerável do quadril (p < 0,05). Conclusão O PENG block no pré-operatório de idosos com fratura do quadril, internados no setor de emergência, proporcionou redução significativa da dor em comparação ao grupo controle.


Subject(s)
Humans , Aged , Aged, 80 and over , Pain , Hip Fractures/surgery , Hip Fractures/diagnostic imaging , Analgesia , Anesthesia, Conduction , Nerve Block
10.
Rev. Bras. Ortop. (Online) ; 59(1): 88-92, 2024. tab, graf
Article in English | LILACS | ID: biblio-1559602

ABSTRACT

Abstract Objective: Hip fractures in older adults have the highest impact on the patient's health. These injuries result in many complications, reducing functional capability, quality of life, and life expectancy. This study aimed to provide more epidemiological data on the outcomes of these fractures in nonagenarians from a large city treated at a tertiary hospital. Methods: This study consisted of medical record reviews and interviews. Results: In this study, 76 patients underwent 82 surgeries. The mean age of the patients was 92.5 years. Ninety percent of the subjects were female. The patients spent 10.4 days in hospital. Surgery occurred on average 2.3 days after hospitalization. Regarding fractures, 46 were trochanteric (56%), and 34 affected the femoral neck (41.5%). Forty-one surgeries used the short proximal femoral nail (50%), and 18 were partial hip replacements (22%). During hospitalization, 46 patients (55%) had no complications, excluding episodes of delirium, and seven patients (9%) died. Forty-two subjects completed the one-year postoperative follow-up period, with 56% alive and 44% dead. Conclusions: Treating hip fractures in older patients is challenging. Our goal must focus on helping these subjects receive the quickest and least aggressive treatment possible and start mobilization early. We hope the data presented in this study can lead to a better understanding of the characteristics of our nonagenarian population with hip fractures and seek the best possible treatment for them.


Resumo Objetivo: As fraturas de quadril em idosos são as que mais impactam na saúde do paciente e estão associadas a muitas complicações, levando a redução da capacidade funcional, da qualidade de vida e da expectativa de vida. O nosso trabalho visa trazer mais dados epidemiológicos sobre os desfechos dessas fraturas em nonagenários em uma grande cidade atendidos em um hospital terciário. Métodos: O trabalho foi realizado através de revisão de prontuários e entrevistas. Resultados: Foram realizadas 82 cirurgias em 76 pacientes nesse período. A média de idade foi de 92,5 anos, 90% eram mulheres e ficaram 10,4 dias internados. A cirurgia foi realizada em média 2,3 dias após a internação. Do total, 46 fraturas foram trocantéricas (56%) e 34 do colo do fêmur (41,5%). Foram realizadas 41 cirurgias com a técnica da haste cefalomedular curta (50%) e 18 artroplastias parcial de quadril (22%). Durante a internação, 46 pacientes (55%) não apresentaram complicações, excluindo episódios de delirium, e 7 pacientes (9% dos casos) evoluíram para óbito. 42 pacientes já fecharam 1 ano após cirurgia: 56% estão vivos e 44% evoluíram para óbito. Conclusões: O tratamento de fraturas de quadril em pacientes idosos é desafiador. O nosso objetivo deve estar focado em ajudar esses idosos a receber um tratamento rápido e menos agressivo possível e a mobilizar precocemente. Esperamos que, com os dados apresentados nesse trabalho, possamos entender melhor acerca das características da nossa população nonagenária vítimas de fratura de quadril e buscar o melhor tratamento possível para esses pacientes.


Subject(s)
Humans , Male , Female , Aged, 80 and over , Indicators of Morbidity and Mortality , Hip Injuries/surgery , Hip Injuries/rehabilitation , Nonagenarians
11.
Rev. colomb. anestesiol ; 51(4)dic. 2023.
Article in English | LILACS-Express | LILACS | ID: biblio-1535701

ABSTRACT

Introduction Hip fracture is one of the main causes of morbidity and mortality among the elderly population. In Colombia there is a shortage of scientific literature on the perioperative management of this population of patients. Objective To describe the perioperative management of hip fracture patients at a tertiary university hospital in Cali, Colombia. Methods An observational study was conducted with relational scope of a historical cohort of patients with hip fracture who underwent surgical management between January 2018 and June 2022. A non-probability sampling method was used and contingency tables were designed aimed at describing the relationship between the patients' characteristics and the postoperative outcomes. Results 235 patients were included, of which 57 % were males. The mean age was 79 years and 49.8 % were classified as ASA III or higher. Spinal anesthesia was the most commonly used technique in 63.4 % of the cases. The most frequent outcomes were delirium in 17.9 %, and acute kidney failure in 6.8 %. 83.4 % of the patients underwent surgery within 48 hours of admission to the emergency department and intra-hospital mortality was 2.6 %. Conclusions The results of this study provide relevant information to identify opportunities for improvement and their implementation, such as the reduction in the time elapsed until surgical management and the development of care protocols in the region.


Introducción: La fractura de cadera es una de las principales causas de morbimortalidad en la población adulta mayor. En Colombia hay un déficit en la literatura científica acerca del manejo perioperatorio de esta población de pacientes. Objetivo: Describir el manejo perioperatorio de pacientes con fractura de cadera en un hospital universitario de alto nivel de complejidad de Cali, Colombia. Métodos: Se realizó un estudio observacional con alcance relacional de una cohorte histórica de pacientes con fractura de cadera, que recibieron manejo quirúrgico entre enero de 2018 y junio de 2022. Se hizo un muestreo no probabilístico y se diseñaron tablas de contingencia con el propósito de describir relaciones entre las características y los desenlaces posoperatorios. Resultados: Se incluyeron 235 pacientes de los cuales el 57 % fueron hombres. La mediana de edad fue de 79 años y el 49,8 % tenían una clasificación ASA III o mayor. La anestesia espinal fue la técnica más utilizada en el 63,4 %. Los desenlaces más frecuentes fueron el delirio en el 17,9 %, y la falla renal aguda en el 6,8 %. El 83,4 % de los pacientes fueron intervenidos quirúrgicamente antes de las 48 horas desde el ingreso a urgencias y la mortalidad intrahospitalaria fue del 2,6 %. Conclusiones: Los resultados de este estudio brindan información relevante que permite la implementación de oportunidades de mejora como disminución en los tiempos hasta el manejo quirúrgico y el desarrollo de protocolos de atención en la región.

12.
Rev. cienc. salud (Bogotá) ; 21(3): [1-11], 20230901.
Article in Spanish | LILACS | ID: biblio-1510564

ABSTRACT

Introducción: durante el postoperatorio por cirugía de cadera, el delírium es la complicación más frecuente en los pacientes ancianos, con una alta incidencia y prevalencia, la cual lleva a una alta morbimortalidad en ellos. Objetivo: identificar los factores asociados con delírium en pacientes ancianos durante su posto-peratorio de cirugía por fractura de cadera. Materiales y métodos: se realizó un estudio observacional analítico de corte retrospectivo con pacientes hospitalizados por el grupo de Ortogeriatría en el Hospital Universitario San Ignacio en Bogotá (Colombia), entre enero de 2017 y septiembre de 2020. Resultados: se incluyeron 210 personas, en quienes se documentó una incidencia de delírium del 28.57 %. En el análisis bivariado, las variables con asociación estadísticamente significativa fueron edad, dependencia, demencia previa, malnutrición, polifarmacia y tipo de anestesia. Sin embargo, en el análisis multivariado, las dos variables con asociación estadísticamente significativa fueron edad (OR: 1.05; IC95 %: 1.01-1.10; p = 0.014) y demencia (OR: 2.83; IC95 %: 1.28-6.27; p = 0.010). Conclusión: las variables asociadas con delírium reportadas en el estudio concuerdan con la literatura ya publicada. Esto abre las puertas a futuras investigaciones no solo para identificar nuevos o más factores asociados, sino también para adoptar medidas en conjunto con los programas de ortogeriatría, a fin de intervenir estos factores y, de esta manera, poder disminuir la incidencia y prevalencia del delírium y, por ende, su morbimortalidad.


Introduction: Post-operative delirium after hip surgery is the most common complication among the elderly, with a high incidence and prevalence, which leads to high morbidity and mortality rates among them. Objective: To identify the main factors associated with post-operative delirium after hip surgery among older adults. Materials and methods: a retrospective analytical observational study was conducted using data from patients hospitalized by the Orthogeriatric group at the San Ignacio University Hospital in Bogotá, Colombia, between January 2017 and September 2020. Results: 210 people were included in the study, with a documented incidence of delirium of 28.57% was documented. In the bivariate analysis, the variables with a statistically significant association with delirium were age, dependency, previous dementia, malnutrition, polypharmacy, and type of anesthesia used in the procedure. Nonetheless, in a multivariate analysis, the two variables with a statistically significant association were age (OR: 1.05; 95%CI: 1.01-1.10; p = 0.014) and dementia (OR: 2.83; 95% CI: 1.28-6.27; p = 0.010). Conclusion: the variables associated with postoperative delirium reported in our study align with the existing literature. This opens doors to future research not only to identify new or more risk factors, but also to adopt measures, jointly with the Orthogeriatric programs, to intervene such factors so that the incidence and prevalence of delirium can be reduced, and therefore, reduce the morbidity and mortality among the elderly.


Introdução: o delirium no pós-operatório de cirurgia de quadril é a complicação mais frequente em pacientes idosos, com alta incidência e prevalência, o que leva a alta morbimortalidade nos mesmos e, assim, o objetivo deste estudo foi identificar os fatores associados ao delirium em pacientes idosos no pós-operatório de cirurgia de fratura de quadril. Materiais e métodos: foi realizado um estudo observacional analítico retrospectivo com pacientes internados pelo grupo de Ortogeriatria do Hospital Universitário San Ignacio, em Bogotá, Colômbia, entre janeiro de 2017 e setembro de 2020. Resultados: foram incluídas 210 pessoas, nas quais foi documentado incidência de delirium de 28,57%. Na análise bivariada, as variáveis com associação estatisticamente significativa foram idade, dependência, demência prévia, desnutrição, polifarmácia e tipo de anestesia. Porém, na análise multivariada, as duas variáveis com associação estatisticamente significativa foram idade (or: 1,05; Ic 95% 1,01-1,10; p: 0,014) e demência (or: 2,83; Ic 95% 1,28-6,27, p: 0,010). Conclusão: as variáveis associadas ao delirium relatadas em nosso estudo concordam com a literatura publicada anteriormente. Isso abre as portas para pesquisas futuras não só para identificar novos ou mais fatores associados, mas também para adotar medidas em conjunto com programas de ortogeriatria para poder intervir nesses fatores e, assim, reduzir a incidência e prevalência de delirium e, portanto, a morbimortalidade


Subject(s)
Humans , Frail Elderly
13.
Rev. méd. Chile ; 151(9)sept. 2023.
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1565706

ABSTRACT

Introducción: Las fracturas osteoporóticas, especialmente de cadera y columna, conllevan una significativa morbimortalidad, y el riesgo de fractura de cadera aumenta en un 50% tras una fractura previa. A nivel global y en Chile, persiste una baja tasa de tratamiento de la osteoporosis post fractura. La iniciativa "Capture the Fracture" de la International Osteoporosis Foundation propone prácticas óptimas, incluyendo Servicios de Enlace Post Fractura (FLS); sin embargo, en Chile, sólo existen dos FLS, ambos en el sector privado. Objetivo: Este estudio busca implementar el primer FLS en el ámbito público, específicamente en el Hospital Clínico Dra. Eloísa Díaz de La Florida. La metodología se basa en el Modelo Lógico, enfatizando la relevancia del recurso humano, especialmente una enfermera coordinadora. Resultados: Los resultados identifican el problema, recursos necesarios, acciones clave y metas a corto, mediano y largo plazo. Factores externos como el entorno hospitalario y colaboración con programas existentes se consideran. Se presenta un esquema gráfico del Modelo Lógico y se proponen indicadores de evaluación. Discusión: Es relevante abordar las fracturas por fragilidad como un problema de salud pública y en cuanto a esto, se destaca la aceptación de nuestro proyecto para su implementación por parte de las autoridades hospitalarias. Se espera que esta iniciativa inspire a otros centros de salud pública en Chile a implementar servicios similares, contribuyendo a cerrar la brecha de tratamiento y mejorar la calidad de vida de los pacientes.


Introduction: Osteoporotic fractures, especially of the hip and spine, entail significant morbidity and mortality, with a 50% increased risk of hip fracture following a prior fracture. Globally - and in Chile, a low rate of post-fracture osteoporosis treatment persists. The International Osteoporosis Foundation's "Capture the Fracture" initiative advocates optimal practices, including Fracture Liaison Services (FLS); however, in Chile, there are only two FLS, both in the private healthcare system. Objective: This study aims to implement the first FLS in the public domain, specifically at the Dra. Eloísa Díaz Clinical Hospital, at Santiago. The methodology is based on the Logic Model, emphasizing the importance of human resources, especially a coordinating nurse. Results: The findings identify the problem, necessary resources, key actions, and short, medium, and long-term goals. External factors such as the hospital environment and collaboration with existing programs are considered. A graphical representation of the Logic Model is presented, along with proposed evaluation indicators. Discussion: Addressing fragility fractures as a public health issue is pertinent, and hospital authorities' acceptance of our project for implementation is highlighted. This initiative is anticipated to inspire other public health centers in Chile to implement similar services, contributing to closing the treatment gap and enhancing patients' quality of life.

14.
An. Fac. Med. (Perú) ; 84(2)jun. 2023.
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1447200

ABSTRACT

Introducción. Las fracturas de cadera son un conjunto de patologías frecuentes en los adultos mayores frágiles, con impacto negativo sobre la funcionalidad. Objetivo. Determinar las características clínicas, funcionales, mentales y sociales basados en la evaluación geriátrica integral. Métodos. Se evaluó a 445 pacientes, la comorbilidad se midió con el índice de Charlson, el estado funcional basal con el índice de Barthel y la escala de Lawton y Brody, el estado mental con el cuestionario de Pfeiffer, el delirio mediante el Confusion Assessment Method y la evaluación social con la Escala Sociofamiliar de Gijón. Las variables categóricas se presentaron como valor absoluto y porcentaje, y las continuas como media y desviación estándar. Resultados. El sexo femenino representó el 71,5%, el promedio de edad en mujeres fue de 81,58 años y en varones de 82,58 años. El deterioro visual fue 48,8% y el auditivo fue 46,1%. El 46,0% tuvieron más de una comorbilidad. 30,3% era independiente para actividades básicas, así como 90,3% de mujeres y 64,3% de hombres fueron dependientes para actividades instrumentales. El deterioro cognitivo estuvo presente en el 53,5% de los pacientes y delirio el 20,4%. En la segunda semana fueron operados 30,5% y en la tercera 21,6%. La mortalidad fue de 2,7% durante la hospitalización. Conclusión. Las características más frecuentes fueron de una octogenaria, con deterioro visual/auditivo, sin comorbilidad, pero pluripatológica, con dependencia leve para actividades básicas de vida diaria y deterioro cognitivo en entorno social de riesgo.


Introduction. Hip fractures are a group of frequent pathologies in frail older adults, with a negative impact on functionality. Objective. To determine the clinical, functional, mental, and social characteristics based on the comprehensive geriatric assessment. Methods. 445 patients were evaluated, comorbidity was measured with the Charlson index, baseline functional state with the Barthel index and the Lawton and Brody scale, mental state with the Pfeiffer questionnaire, delirium using the Confusion Assessment Method and social assessment with the Gijón Socio-Family Scale. Categorical variables were presented as absolute value and percentage and continuous variables as mean and standard deviation. Results. The female sex represented 71.5%, the average age in women was 81.58 years and in men 82.58 years. Visual impairment was 48.8% and hearing impairment 46.1%. 46% had more than one comorbidity. 30.3% were independent for basic activities, as well as 90.3% of women and 64.3% of men were dependent for instrumental activities. Cognitive impairment was present in 53.5% and delirium developed in 20.4%. In the second week, 30.5% were operated and in the third, 21.6%. Mortality was 2.7% during hospitalization. Conclusion. the most frequent characteristics were of an octogenarian, with visual / auditory deterioration, without comorbidity, but multipathological, with slight dependence for basic activities of daily living and cognitive deterioration in a risky social environment.

15.
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1559918

ABSTRACT

Introducción: El aumento de la fractura de cadera durante los últimos años se ha convertido en un problema socioeconómico y sanitario a nivel mundial. Objetivo: Modificar cuatro instrumentos del sistema de clavos dinamic hip screw para su uso en la instalación hospitalaria. Métodos: Se trabajó junto con electromedicina provincial para efectuar la innovación tecnológica. Se modificaron cuatro instrumentos del sistema de clavos dinamic hip screw para operar pacientes adultos con diagnóstico de fracturas de cadera en enero 2020. Resultados: Se elaboraron los siguientes instrumentos: soporta clavo tipo a, soporta clavo tipo b, "macho" para hacer rosca y atornillador para ajustar el medidor del fresador del cuello. Conclusiones: Las modificaciones a los cuatro instrumentos del sistema de clavos dinamic hip screw significaron un importante ahorro de recursos para la institución hospitalaria.


Introduction: The increase in hip fracture in recent years makes it a worldwide socio-economic and health problem. Objective: To modify four instruments of the dynamic hip screw nail system for its use in a hospital facility. Methods: The work was implemented together with the provincial electromedicine unit in order to carry out technological innovations. Four instruments of the dynamic hip screw nail system were modified to operate adult patients with a diagnosis of hip fractures. Results: The following instruments were developed: supports nail type a, supports nail type b, "male" to make screw thread and screwdriver to adjust the milling maching meter of the neck. Conclusions: The modifications to the four instruments of the dynamic hip screw nail system meant a significant saving of resources for the hospital.

16.
Rev. Bras. Ortop. (Online) ; 58(3): 507-513, May-June 2023. tab, graf
Article in English | LILACS | ID: biblio-1449817

ABSTRACT

Abstract Objective To evaluate the biomechanical capacity of two forms of fixation for Pipkin type-II fractures, describing the vertical fracture deviation, the maximum and minimum principal stresses, and the Von Mises equivalent stress in the syntheses used. Materials and Methods Two internal fasteners were developed to treat Pipkin type-II fractures through finite elements: a 3.5-mm cortical screw and a Herbert screw. Under the same conditions, the vertical fracture deviation, the maximum and minimum principal stresses, and the Von Mises equivalent stress in the syntheses used were evaluated. Results The vertical displacements evaluated were of 1.5mm and 0.5mm. The maximum principal stress values obtained in the upper region of the femoral neck were of 9.7 KPa and 1.3 Kpa, and the minimum principal stress values obtained in the lower region of the femoral neck were of-8.7 KPa and -9.3 KPa. Finally, the peak values for Von Mises stress were of 7.2 GPa and 2.0 GPa for the fixation models with the use of the 3.5-mm cortical screw and the Herbert screw respectively. Conclusion The fixation system with the Herbert screw generated the best results in terms of reduction of vertical displacement, distribution of the maximum principal stress, and the peak Von Mises equivalent stress, demonstrating mechanical superiority compared to that of the 3.5-mm cortical screw in the treatment of Pipkin type-II fractures.


Resumo Objetivo Avaliar a capacidade biomecánica de duas formas de fixação de fraturas tipo II de Pipkin descrevendo o desvio da fratura no sentido vertical, as tensões máxima e mínima principais, e a tensão equivalente de Von Mises nas sínteses utilizadas. Materiais e Métodos Dois fixadores internos foram desenvolvidos para tratar a fratura tipo II de Pipkin por meio de elementos finitos: parafuso cortical de 3,5 mm e parafuso de Herbert. Sob as mesmas condições, foram avaliados o desvio da fratura no sentido vertical, as tensões máxima e mínima principais, e a tensão equivalente de Von Mises nas sínteses utilizadas. Resultados Os deslocamentos verticais avaliados foram de 1,5 mm e 0,5 mm. Os valores de tensão máxima obtidos na região superior do colo femoral foram de 9,7 KPa e 1,3 KPa, e os valores de tensão mínima obtidos na região inferior do colo femoral foram de -8,7KPa e -9,3 KPa. Por fim, os valores de pico da tensão equivalente de Von Misesforam de 7,2 GPa e2,0 GPa paraosmodelos de fixação com o uso do parafuso cortical de 3,5 mm e do parafuso de Herbert, respectivamente. Conclusão Osistema de fixação com parafuso de Herbert gerou os melhores resultados em termos de redução do deslocamento vertical, distribuição da tensão máxima e do pico da tensão equivalente de Von Mises, o que demonstra sua superioridade mecânica comparada à do parafuso cortical de 3,5 mm no tratamento da fratura tipo II de Pipkin.


Subject(s)
Humans , Bone Screws , Femur Head/surgery , Hip Fractures/surgery
17.
Salud UNINORTE ; 39(1)abr. 2023.
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1536834

ABSTRACT

El proceso de atención en enfermería (PAE) es un método sistemático y organizado que requiere de un entrenamiento específico, tener conocimientos y habilidades prácticas que proporcionan las herramientas para brindar cuidado abordando las dimensiones de forma holística a partir de una interacción directa con el paciente, la familia y el entorno social. Se presenta el PAE de una persona mayor, femenina, de 65 años de edad, con pluripatologías: síndrome purpúrico, monoparesia de miembro inferior derecho y síndrome convulsivo, reintervenida quirúrgicamente de un reemplazo de cadera derecha. Se plantea el PAE y sus cinco etapas: valoración, diagnóstico, planeación, ejecución y evaluación; siguiendo la valoración por dominios. El plan de cuidados se realiza con el enfoque de mapa de cuidados en la situación quirúrgica, diagnóstico NANDA International, lnc. La evaluación de intervenciones NIC (Nursing Interventions Classification) y resultados NOC (Nursing Outcomes Classification).


The Nursing Care Process (NCP) is a systematic and organized method that requires specific training, knowledge and practical skills that provide the tools needed to provide care by addressing the dimensions holistically from direct interaction with the patient, the family and social environment. Te NCP of a 65-year-old female elderly person with multiple pathologies; purpuric syndrome, right lower limb monoparesis and convulsive syndrome, who underwent surgery for a right hip replacement is presented. The Nursing Care Process (NCP) and its five stages are proposed: assessment, diagnosis, Outcomes/ Planning, Implementation and evaluation; following the valuation by domains. The care plan was carried out with the care map approach, NANDA Internacional Inc. Te evaluation of NIC (Nursing Interventions Classification) interventions and NOC (Nursing Outcomes Classification) results.

18.
Chinese Journal of Traumatology ; (6): 111-115, 2023.
Article in English | WPRIM | ID: wpr-970981

ABSTRACT

PURPOSE@#Long proximal femoral nail anti-rotation (PFNA-II) is a preferred implant in recent years for fixation of pertrochanteric fractures, especially in osteoporotic patients. The purpose of this study is to prospectively investigate the effect of distal locking in long PFNA-II fixation of stable intertrochanteric fractures.@*METHODS@#A total of 58 patients with isolated stable intertrochanteric fractures and treated in our hospital during the study period of 2017-2019 by distal locked or unlocked long PFNA-II fixation were included in this study. Patients who had multiple injuries or open fractures were excluded. There were 40 female and 18 male patients, with 33 affecting the left side and 25 the right side. Of them, 31 belonged to the distal locked group (group A) and 27 to the unlocked group (group B). Surgical procedures and implants used in both groups were similar except for the distal locking of the nails. General data (age, gender, fracture side, etc.) showed no significant difference between two groups (all p > 0.05). The intraoperative parameters like operative time, radiation exposure and follow-up parameters like functional and radiological outcomes were recorded and compared. Statistical tests like the independent samples t-test Fischer's exact and Chi-square test were used to analyze association.@*RESULTS@#The distribution of the fractures according to AO/OTA classification and 31A1.2 type of intertrochanteric fractures were most common in our study. All the included fractures united and the average functional outcome in both groups were good and comparable at the end of one year. The operative time (mL, 107.1 ± 12.6 vs. 77.0 ± 12.0, p < 0.001) and radiation exposure (s, 78.6 ± 11.0 vs. 40.3 ± 9.3, p < 0.001) were significantly less among the patients in group B. Fracture consolidation, three months after the operative procedures, was seen in a significantly greater proportion of patients in group B (92.6% vs. 67.7%, p = 0.025). Hardware irritation because of distal locking bolt was exclusively seen in group A, however this was not statistically significant (p = 0.241).@*CONCLUSION@#We conclude that, in fixation of stable intertrochanteric fractures by long PFNA-II nail, distal locking not only increases the operative time and radiation exposure but also delays the fracture consolidation and increases the chances of hardware irritation, and hence is not required.


Subject(s)
Humans , Male , Female , Fracture Fixation, Intramedullary/methods , Bone Nails , Treatment Outcome , Retrospective Studies , Hip Fractures/etiology , Femoral Fractures/etiology
19.
Article in Chinese | WPRIM | ID: wpr-981751

ABSTRACT

OBJECTIVE@#To retrospectively study medium term follow up outcomes effects of effect of bio-lengthend stem hemiarthroplasty in the treatment of unstable osteoporotic intertrochanteric fractures in elderly patients.@*METHODS@#Total of 32 elderly patients with the osteoporotic intertrochanteric fractures were treated with bio-lengthend stem hemiarthroplasty from Jan. 2016 to Jan. 2019 including 14 males and 22 females, aged from 85 to 95 years old with an average of (89.5±4.5) years old. According to classification of Evans, there were 12 cases with type Ⅲ, 11 with type Ⅳ and 9 with type Ⅳ. The time from injury to operation ranged from 0.5 to 9 days with an average of (4.5±3.9) days. The operation time, blood loss and postoperative complications were analyzed. Functional outcome was assessed by Parker Palmer mobility score(PPMS) and Harris hip score.@*RESULTS@#Four patients died within one year after operation, and the mortality was 12.5%. The follow up time for the rest 28 patients ranged from 24 to 60 months with an average of (28.5±4.5) months. The mean operative time was (54.2±22.5) min;the mean blood loss (hidden blood loss+obvious blood loss) was (450±140) ml;the first weight bearing was (3.35±1.35) days. No perioperative death occurred. PPMS were(6.63±1.25), (6.94±1.18), (7.11±0.83), (7.32±1.11) and Harris scores were(67.85±6.19), (71.42±5.57), (73.41±5.62), (77.32±5.24) respectively at 1, 3, 6 months and the final follow-up after operation. There were no significant difference in PPMS and Harris score at 1, 3, 6 months after operation and the final follow-up(P>0.05). There were no complications such as joint dislocation and prosthesis loosening occure at the final follow-up.@*CONCLUSION@#On the premise of strictly mastering the case selection criteria, the bio-lengthend stem hemiarthroplasty in the treatment of unstable osteoporotic intertrochanteric fractures in elderly patients has a satisfied medium term follow-up outcomes. It can restore hip function in the early stage and improve the quality of life of patients.


Subject(s)
Male , Female , Humans , Aged , Aged, 80 and over , Arthroplasty, Replacement, Hip , Hemiarthroplasty , Quality of Life , Retrospective Studies , Treatment Outcome , Hip Fractures/surgery , Osteoporotic Fractures/surgery
20.
Singapore medical journal ; : 721-727, 2023.
Article in English | WPRIM | ID: wpr-1007302

ABSTRACT

INTRODUCTION@#Postoperative day 1 (POD 1) mobilisation is a key clinical indicator for the fragility hip fracture surgery population. This study aimed to evaluate the current trends of POD 1 mobilisation at our institution and to review the relationships between early mobilisation and outcomes of early functional recovery, length of stay (LOS) and discharge destination.@*METHODS@#In this preliminary observational study, data pertaining to demographics, premorbid function, health status, injury and surgical factors, POD 1 mobilisation status and clinical outcomes of interest were retrieved from eligible patients. Patients who attained POD 1 ambulation formed the early ambulation (EA) group, while the remaining patients formed the delayed ambulation (DA) group. Data were analysed for any significant difference between the groups.@*RESULTS@#One hundred and fifteen patients were included in the analysis. The rate of patients achieving at least sitting out of bed on POD 1 was 80.0% (n=92), which was comparable to the data available from international hip fracture audit databases. There were 55 (47.8%) patients in the EA group and 60 (52.5%) patients in the DA group. The EA group was approximately nine times more likely to achieve independence in ambulation at discharge compared to the DA group (adjusted odds ratio 9.20, 95% confidence interval 1.50-56.45; P = 0.016). There were observed trends of shorter LOS and more proportion of home discharge in the EA group compared to the DA group (P > 0.05).@*CONCLUSION@#This is the first local study to offer benchmark of the POD 1 mobilisation status for this population. Patients who attained POD 1 ambulation had better early functional recovery.


Subject(s)
Humans , Early Ambulation , Patient Discharge , Tertiary Care Centers , Hip Fractures/surgery , Physical Therapy Modalities , Length of Stay
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