Fracturas del extremo superior del fémur por fragilidad. Principios del comanejo / Fractures of The Upper End of the Femur Due to Fragility. Co-Management Principles

Introducción: El rápido crecimiento de la población geriátrica va aparejado al aumento de fracturas por fragilidad. Ello crea la necesidad de un programa integral para el tratamiento del paciente anciano con fracturas por fragilidad y del extremo superior del fémur. Los modelos de comanejo ortogeriátrico son empleados en muchos países. Objetivo: Presentar los distintos modelos de atención ortogeriátrica y analizar el modelo de comanejo de pacientes geriátricos con fracturas por fragilidad, principalmente la fractura del extremo superior del fémur. Métodos: Se realizó una búsqueda en la base de datos PubMed de trabajos publicados entre los años 2010-2020 con los términos: modelos de atención ortogeriátrica, comanejo de pacientes ortopédicos geriátricos, comanejo de fracturas por fragilidad y comanejo ortogeriátrico en fracturas del extremo superior de fémur. Conclusiones: El modelo de comanejo de las fracturas por fragilidad y de fémur proximal da como resultado una estadía hospitalaria más corta, tasas de reingreso y de complicaciones más bajas y una tasa de mortalidad menor a la esperada, por lo cual ofrece muchos beneficios para pacientes, médicos y sistema de salud(AU)

Introduction: The rapid growth of the geriatric population is coupled with the increase in fragility fractures. This creates the need for a comprehensive program for the treatment of the elderly patient with fragility fractures and fractures of the upper end of the femur. Orthogeriatric co-management models are used in many countries. Objective: To present the different models of orthogeriatric care and to analyze the model of co-management of geriatric patients with fragility fractures, mainly fractures of the upper end of the femur. Methods: A search was made in the PubMed database of works published in the years 2010-2020 with the terms orthogeriatric care models, co-management of geriatric orthopedic patients, co-management of fragility fractures and co-management orthogeriatric in fractures of the upper end of the femur. Conclusions: The co-management model for fragility and proximal femur fractures results in a shorter hospital stay, lower readmission and complication rates, and a lower-than-expected mortality rate, thus offering many benefits for patients, doctors and health system(AU)

Comparison of femoral neck geometric parameters between Chinese and Japanese females / 中南大学学报(医学版)

OBJECTIVES@#Femoral neck fracture is the most serious osteoporotic fractures that is responsible for high medical costs and high mortality. Femoral neck geometric parameters (FNGPs) are important parameters that reflect the geometrical characteristics of femoral neck, and are closely related to the strength of femoral neck and the risk of fragility fracture.There are differences in the incidence of femoral neck fractures among races. However, whether there is difference in FNGPs among races is unknown.Therefore, this study aims to compare the differences in FNGPs between Chinese and Japanese females.@*METHODS@#This study was a cross-sectional study, in which 3 859 healthy females aged 10-86 (45.7±17.1) years old were recruited from Changsha City of Hunan Province and surrounding areas. The weight and height were measured and recorded, and the body mass index (BMI) was calculated. A dual energy X-ray absorptiometry (DXA) bone densitometer was used to measure femoral neck projective bone area (BA) and bone mineral density (BMD). FNGPs were calculated using the BMD and BA, which included the outer diameter (OD), cross-sectional area (CSA), cortical thickness (CT), endocortical diameter (ED), buckling ratio (BR), section modulus (SM), cross-sectional moment of inertia (CSMI), and compression strength index (CSI). The data of FNGPs in Japanese females was collected from literature. These subjects were grouped by 10-year age. The mean and standard deviation of height, weight, BMI, femoral neck BMD, and FNGPs of each group were calculated. The model with the best goodness-of-fit was selected from various mathematical regression models to analyze the distribution trend and the best fitting curve of FNGPs with age. The differences in FNGPs between Chinese and Japanese females were analyzed by using age-corresponding mean fitting curve for paired t-test, and the relative change rates of FNGPs were compared.@*RESULTS@#The mean values of FNGPs were significantly different among different years old healthy females (all P<0.01). The mean values of OD, CSA, CT, SM, and CSMI in femoral neck were high at 30 to 39 years old, and then they were gradually decreased with age. The CSI reached its peak at 20-29 years old, and it was decreased gradually after 30 years old. ED and BR were at a low level before 40 years old, they were gradually increased after 40 years old, and reached the maximum average value at 80-86 years old. The variations in FNGPs with age were fitted with the best goodness-of-fit by applying the cubic regression model and the determination coefficients of regression equations (R2: 0.062-0.404) were significant (all P<0.01). The distribution trend of FNGPs with age varied with the indices, among which CSA, CT, SM, CSMI and CSI were increased with age before 35 years old, and then they were decreased with age; BR was at a low level in the early stage, and then it was increased with age after about 40 years. There were significant differences in the fitting curves of FNGPs related to age between Chinese and Japanese females (all P<0.01). The fitting curves of OD, ED, BR and SM in Chinese females were significantly higher than those in Japanese females (all P<0.01), while those of CSA and CT in Chinese females were significantly lower than those in Japanese females (all P<0.01). Before the age of 50, the curves of CSMI and CSI of Chinese females were significantly higher than those of Japanese females (all P<0.01), while after the age of 60 the situation was reversed (all P<0.01). Except for SM and CSI, there were significant differences in the rate of OD, CSA, CT, ED, BR and CSMI with age (all P<0.01). By the age of 80 years old, the rates of change in OD, ED, and BR with the age in Chinese females were increased by 0.91%,3.94%, and 47.5%, respectively, while those in Japanese females were increased by 8.57%, 15.8% and 85.3%, respectively；the rates of change of CSA, CT, and CSMI with the age in Chinese females were declined 28.0%, 29.6%, and 25.2%, respectively, while those in Japanese females were declined 29.9%, 36.2%, and 10.9%, respectively. There were significant difference in the rates of change in FNGPs with the age between Chinese and Japanese females (all P<0.01).@*CONCLUSIONS@#The study reveals the variation of FNGPs with age in Chinese, and confirms that there are racial differences in FNGPs between Chinese and Japanese females, which may be one of the important reasons for the difference in the incidence of femoral neck fracture between Chinese and Japanese females.

Trends in surgical treatment of femoral neck fractures in the elderly / Tendências no tratamento cirúrgico das fraturas do colo do fêmur em idosos

ABSTRACT Objective To analyze recent demographic and medical billing trends in treatment of femoral neck fracture of American elderly patients. Methods The American College of Surgeons National Surgical Quality Improvement Program database was analyzed from 2006 to 2015, for patients aged 65 years and older, using the Current Procedural Terminology codes 27130, 27125, 27235, and 27236. Patient demographics, postoperative complications, and frequency of codes were compared and analyzed over time. Our sample had 17,122 elderly patients, in that, 70% were female, mean age of 80.1 years (standard deviation±6.6 years). Results The number of cases increased, but age, gender, body mass index, rates of diabetes and smoking did not change over time. Open reduction internal fixation was the most commonly billed code, with 9,169 patients (53.6%), followed by hemiarthroplasty with 5,861 (34.2%) patients. Combined estimated probability of morbidity was 9.8% (standard deviation±5.2%), and did not change significantly over time. Postoperative complication rates were similar between treatments. Conclusion Demographics and morbidity rates in femoral neck fractures of elderly patients did not change significantly from 2006 to 2015. Open reduction internal fixation was the most common treatment followed by hemiarthroplasty.

RESUMO Objetivo Analisar tendências recentes demográficas e de faturamento médico no tratamento de fraturas do colo do fêmur em idosos americanos. Métodos O banco de dados National Surgical Quality Improvement Program, do American College of Surgeons, foi analisado de 2006 a 2015, para pacientes com idade igual ou superior a 65 anos, usando os códigos de Current Procedural Terminology 27130, 27125, 27235 e 27236. Dados demográficos dos pacientes, complicações pós-operatórias e frequência de códigos foram comparados e analisados ao longo do tempo. A amostra teve 17.122 pacientes geriátricos, sendo 70% do sexo feminino, com média de idade de 80,1 anos (desvio padrão±6,6 anos). Resultados O número de casos aumentou no período, mas idade, gênero, índice de massa corporal e taxas de diabetes e tabagismo não mudaram ao longo do tempo. A fixação interna de redução aberta foi o código faturado mais comum, com 9.169 pacientes (53,6%), seguido por artroplastia parcial do quadril, com 5.861 (34,2%) pacientes. A probabilidade estimada combinada de morbidade foi de 9,8% (desvio padrão±5,2%) e não mudou significativamente ao longo do tempo. As taxas de complicações pós-operatórias foram semelhantes entre os tratamentos. Conclusão Os dados demográficos e as taxas de morbidade relacionadas às fraturas geriátricas do colo do fêmur não apresentaram mudança significativa entre 2006 e 2015. A redução aberta e a fixação interna foram as opções de tratamento mais comuns, seguidas da artroplastia parcial do quadril.

Influencia de la polución ambiental en la incidencia de fractura de cuello femoral / Influence of enviromental pollution on the femoral neck fracture incidence

It has been shown that there is an association between air pollution and cardiovascular mortality. In bone pathology, studies show that air pollution is associated with a risk of developing osteoporosis and osteoporotic fracture associated with MP2.5 and nitrogen dioxide (NO2 ). The aim of our study was to determine whether or not there is an association between air pollution and osteoporotic disease, associating the incidence of femoral neck fracture in individuals aged 50 years or more and the contamination present in the several cities. Our results showed no statistically significant association between air pollution, evaluated using PM10 and PM2.5 as indicators, and the average annual incidence of osteoporotic hip fracture, comparing the most polluted cities and the less polluted cities of Chile

Fracturas vertebrales, osteoporosis y vitamina D en la posmenopausia: Estudio en 555 mujeres en Chile / Vertebral fractures, osteoporosis and vitamin D levels in Chilean postmenopausal women

Background: Approximately one-third of vertebral fractures can be clinically diagnosed. Aim: To study the frequency of vertebral fractures in postmenopausal women. Patients and methods: We recruited 555 postmenopausal women from Santiago, Chile, aged 55-84 years, who manifested interest in their bone health. All were healthy by self-declaration and by general clinical and laboratory tests and had not taken any bone-active therapy. They all underwent a spine and femoral neck (FN) densitometry and a digital lateral spine X-ray from T4 to L4 was obtained. PTH, calcidiol, and other parameters of calcium metabolism were also measured. Results: Overall, 142 of 478 patients with a complete study (29.7 percent) had at least one vertebral fracture. The proportion of women with fractures increased with age. A T score below -2.5 in the spine and hip was found in 32 percent and 14 percent of women, respectively. The proportion of women with spinal opeoporosis doubled between ages 55-70 and remained constant afterwards. In contrast, at the femoral neck, this proportion increased progressively reaching 53.3 percent at age 80-85. However, 56 percent of patients with vertebral fractures did not have densitometric osteoporosis in any location. Calcidiol levels were 16.8±6.8 ng/mL. With a cutoff point of 17 ng/mL, 47.5 percent of the patients had hypovitaminosis D. There was no association between calcidiol levels and vertebral fractures or bone density at the spine or femoral neck. Patients with fractures differed from those without fractures in that they had significantly lower bone density at the spine and hip and were older (p <0.001). However they did not differ in weight, body mass index, or calcidiol levels. Conclusions: Thirty percent of postmenopausal women in this series had a vertebral fractures. Osteoporosis and vitamin D deficiency were also common. Most vertebral fractures were observed in women without osteoporosis by densitometric criteria.

Criterio para el tratamiento de las fracturas transcervicales del fémur. Revisión epidemiológica / Criteria for treatment of transcervical fractures of the femur. An epidemiologic review

Se presenta una serie retrospectiva de 324 pacientes con fractura de la cadera; 279 con edad promedio de 75 años se trataron con diversas prótesis y 45 con edad promedio de 55, se trataron con osteosíntesis

Incidencia de fractura de cuello de femur (FCF): área sur y sur oriente de Santiago / Incidence of femoral collar fracture in the souther area of Santiago Chile

La Osteoporosis ha emergido como verdadera epidemia. Su principal consecuencia es el aumento de fracturas en los ancianos. Con el fin de conocer las tasas de incidencia de la fractura más grave, la de cuello de fémur, se revisaron los egresos de los Hospitales Barros Luco-Trudeau y Sótero del Río. En una población de 1.582.823 beneficiarios, se encontraron, en los años 1984 y 1985, 312 casos, lo que da una tasa de incidencia de 9.8 pacientes por 100.000 habitantes por año. Los mayores de 45 años tenían una tasa de 45 comparada con 1,1 de los individuos menores. Las mujeres presentan 1,5 veces más Fracturas de Cuello de Fémur que los hombres. En mayores de 45 años las tasas aumentan constantemente con la edad. Comparadas con tasas inglesas, las chilenas tienen 1/6 y los hombres 1/3 de FCF. Concluimos que la FCF es propia de los individuos mayores, preferentemente de sexo femenino. Comparada con tasas inglesas nuestras tasas son significativamente menores

Fracturas del cuello del femur en los ninos / Fractures of the neck of the femur in children

Se revisa la experiencia obtenida en el tratamiento de las fracturas del extremo proximal del femur en los ninos. Se analizaron las historias clinicas y los estudios radiologicos de 43 casos tratados en el Hospital Universitario Pediatrico de La Misericordia de Bogota, en los ultimos 20 anos y 5 casos, tratados y controlados personalmente por el autor desde julio de 1982 hasta julio de 1987. Se siguio la clasificacion establecida por Delbet, en 4 grupos: Tipo I transepifisiarias: 3 casos (6.25%); Tipo II Transcervicales: 17 casos (35.41%); Tipo III cervico-trocantericas: 18 casos (37.5%); Tipo IV Intertrocantericas: 10 casos (20.83%). Los resultados obtenidos se analizaron, siguiendo los criterios establecidos por Ratliff y en general, se consideran similares a los encontrados por la mayoria de los autores que se han ocupado de este tema. La frecuencia con que se presentan estas fracturas, continua siendo baja (aproximadamente 2.5 por ano) lo cual aun hace valida la premisa establecida por Blount en 1955, segun la cual "las verdaderas fracturas del extremo proximal del femur son tan raras que nadie tiene suficiente experiencia con ellas". Los metodos de tratamiento no se han modificado significativamente con el transcurso de los anos y la aparicion de la necrosis osea avascular, la gran responsable de los malos resultados, se encuentra relacionada principalmente con el grado de desplazamiento inicial de las fracturas.