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.

Fracturas por epilepsia en el hospital Víctor Lazarte Echegaray / Epilepsy Fractures at Víctor Lazarte Echegaray Hospital

Introducción: Las convulsiones pueden producir una tensión muscular significativa capaz de fracturar el hueso. Se halló que el aumento significativo en la incidencia de fracturas se encuentra dentro del grupo de edad entre 45 a 64 años, lo que demuestra que los epilépticos no solo son más vulnerables a las fracturas, sino que tienen un comienzo de fractura más precoz. Las medidas de prevención comprenden suplementos de calcio, vitamina D, densitometría ósea y tratamiento con bifosfonatos, que deben reforzarse en pacientes con epilepsia que tienen riesgo de osteoporosis. Objetivo: Presentar casos de fracturas extracapsular e intracapsular de la cadera por convulsiones epilépticas, atendidos en el hospital Víctor Lazarte Echegaray, Trujillo, Perú, en el periodo comprendido entre 2013 y 2019. Presentación de los casos: Se reporta dos casos de fractura de cadera por convulsiones epilépticas, uno con fractura del acetábulo e iliaco izquierdo y otro a nivel del cuello femoral y subtrocantérica. Conclusiones: Las personas con convulsiones epilépticas poseen un mayor peligro de fracturas, por consiguiente se recomienda a los médicos que maximicen su conciencia sobre las fracturas relacionadas a convulsiones, en especial a pacientes con dolor postictal, debido a que los síntomas pueden ser inespecíficos y una mala interpretación puede impedir la rehabilitación(AU)

Introduction: Seizures can produce significant muscle tension capable of fracturing the bone. The significant increase in the incidence of fractures was found to be within the age group between 45 and 64 years, which shows that epileptics are not only more vulnerable to fractures, but also have earlier fracture onset. Prevention measures include calcium supplements, vitamin D, bone densitometry, and bisphosphonate treatment that should be reinforced in patients with epilepsy who are at risk for osteoporosis. Objective: To present cases of hip fractures due to epileptic seizures, treated at Víctor Lazarte Echegaray Hospital, Trujillo, Peru, from 2013 to 2019. Case report: Cases of hip fracture due to epileptic seizures have been reported, one with fracture of the acetabulum and left iliac and another at the level of the femoral and subtrochanteric neck. Conclusions: Individuals with epileptic seizures have greater risk of fractures, it is recommended that physicians maximize their awareness of seizure-related fractures, especially in patients with postictal pain, since the symptoms can be nonspecific and misinterpretation can prevent rehabilitation(AU)

Fascitis necrotizante como complicación de una osteosíntesis de fractura medial de cadera. Presentación de un caso / Necrotizing fasciitis. Complication of osteosynthesis in medial hip fracture. Case presentation

Introducción: La fascitis necrotizante es un cuadro infrecuente que provoca una alta morbimortalidad. La comunicación de esta entidad asociada a una osteosíntesis de cadera con tornillos canulados es inusual. Se describe el caso de un paciente con múltiples comorbilidades tratado por una fractura medial de cadera mediante una osteosíntesis con tornillos canulados. El paciente ingresó con un cuadro de shock séptico. Requirió cirugía de urgencia con fasciotomía amplia y limpieza quirúrgica más desbridamiento extenso de tejido necrótico. Esta presentación hace hincapié en la importancia de reconocer las principales manifestaciones de esta enfermedad. El diagnóstico es fundamentalmente clínico y requiere de una alta sospecha para instaurar un tratamiento precoz. Conclusión: A pesar de su baja frecuencia y los escasos reportes relacionados con cirugías ortopédicas, es importante tener en cuenta esta entidad como una posible complicación de la cirugía. Nivel de Evidencia: IV

Introduction: Necrotizing fasciitis is an infrequent pathology with a high morbidity and mortality. The report of this entity in relation to hip osteosynthesis with cannulated screws is unusual. The aim of this study is to present a case of necrotizing fasciitis as a complication of hip surgery. A case about a patient with multiple comorbidities treated for a femoral neck fracture with osteosynthesis with cannulated screws is described. The patient was admitted to the emergency department of our hospital suffering from septic shock. He required emergency surgical treatment with a wide fasciotomy and a surgical toilet plus extensive debridement of necrotic tissue. The case report emphasizes the importance of recognizing the main manifestations of this disease. The diagnosis is fundamentally clinical and requires high suspicion to establish treatment early. Conclusion: Despite its low frequency and reporting in relation to orthopedic surgeries, it is important to consider this entity as a possible complication of surgery. Necrotizing fasciitis is characterized by its rapid and torpid evolution. Early debridement has been shown to decrease mortality and is the best treatment along with antibiotic therapy. Level of Evidence: IV

Lesiones ortopédicas asociadas a fractura de cadera / Orthopedic injuries associated with hip fracture

Resumen: Introducción: La información que demuestra lesiones ortopédicas al mismo tiempo que fractura de cadera es escasa. Nuestro objetivo es determinar si existe relación entre el tipo de lesiones ortopédicas asociadas en pacientes con fractura de cadera y sus variables demográficas, el trazo de fractura y el mecanismo de lesión. Material y métodos: Diseño transversal, descriptivo y retrospectivo. Se revisaron los casos con fracturas de cadera y que tuvieran alguna lesión ortopédica asociada del 01 de Noviembre de 2012 al 31 de Octubre de 2016. Resultados: Se incluyeron 103 pacientes, de los cuales 61.2% fueron mujeres; media de edad 64 ± 21 años. Los mayores de 65 años representaron 59% (n = 61/103), 61.2% tuvieron fractura pertrocantérica (AO/OTA tipo 31-A1 a A3) (n = 63), el resto de cuello (AO/OTA tipo 31-B1 a B3) (n = 40); 21.4% tuvieron dos o más lesiones asociadas a fractura de cadera (n = 22). Las lesiones asociadas en mujeres fueron las de radio distal, mientras que en hombres fueron las del acetábulo, pelvis u otras. No hubo diferencias en cuanto a sexo, edad, mecanismo de lesión o número de lesiones asociadas dependiendo de la clasificación AO de la fractura de cadera. Discusión: Existe un número considerable de lesiones asociadas en fracturas de cadera, independientemente de la edad, el sexo o localización.

Abstract: Introduction: There Is little information showing orthopedic injuries at the same time as a hip fracture. Our objective is to determine if there is association between the type of orthopedic injuries associated in patients with hip fractures and their demographic variables, fracture pattern and mechanism of injury. Material and methods: Transversal design, descriptive and retrospective. We reviewed cases with hip fractures and had an associated orthopedic lesion from November 01, 2012 to October 31, 2016. Results: We included 103 patients, of whom women 61.2%; average age 64 ± 21 years. Over 65 years old accounted for 59% (n = 61/103), 61.2% had Perthrocanteric fracture (AO/OTA type 31-A1 to A3) (n = 63), the rest of the neck (AO/OTA type 31-B1 to B3) (n = 40); 21.4% had two or more injuries associated with hip fracture (n = 22). The lesions associated with women were those of distal radio, while in males were those of the acetabulum, pelvis or others. There were No differences in sex, age, injury mechanism or number of associated injuries depending on the AO classification of the hip fracture. Discussion: There is a significant number of injuries associated with hip fractures regardless of age, sex, or location.

Rescate de osteosíntesis intertrocantéricas y subtrocantéricas fallidas con un reemplazo articular: Técnica y resultados de una serie de 61 casos / Rescue of failed inter- and subtrochanteric osteosynthesis with a joint replacement. Technique and results of a series of 61 cases

Introducción: El objetivo de este estudio fue revisar los aspectos técnicos de la artroplastia de cadera como rescate de una osteosíntesis fallida de una fractura intertrocantérica o subtrocantérica, y evaluar los resultados funcionales y las complicaciones en una serie consecutiva de 61 casos. Materiales y Métodos: Sesenta y un pacientes fueron sometidos a una artroplastia de cadera como rescate de una osteosíntesis fallida de una fractura intertrocantérica o subtrocantérica. La edad promedio era de 76 años (rango 50-93). Treinta y cuatro casos (56%) fueron tratados inicialmente con un tornillo deslizante de cadera; 8 (13%), con un DCS; 2 (3%), con clavos de Ender y 17 (28%), con un clavo de fémur proximal (corto o largo). Cincuenta y cinco (90%) fueron rescatadas con una artroplastia total y 6 (10%), con una hemiartroplastia. Se utilizaron tallos no cementados en 17 casos (28%) y cementados en 44 (72%). El largo del tallo fue estándar en 12 pacientes y de revisión en 49 casos. Resultados: El HHS mejoró de 47 (rango 32-54) antes de la cirugía a 84 (rango 67-93) al año posoperatorio. Siete pacientes (11,5%) presentaron complicaciones: 3 (4,9%) fracturas femorales periprotésicas, 2 (3,2%) luxaciones, 1 (1,6%) infección y 1 (1,6%) hematoma de la herida. Conclusiones: La artroplastia de cadera se presenta como un método eficaz para el rescate de las osteosíntesis fallidas de fracturas intertrocantéricas y subtrocantéricas. El dolor y la capacidad funcional mejoran significativamente en la mayoría de los pacientes. Sin embargo, es un procedimiento más demandante y con más complicaciones asociadas que el de una artroplastia de cadera primaria. Nivel de Evidencia: IV

Introduction: The aim of this study was to review technical issues of hip arthroplasty after a failed proximal femur fixation, as well as to evaluate results and complications associated with this procedure. Methods: Sixty-one hip arthroplasties after a failed intertrochanteric or subtrochanteric fixation were performed. Average age of patients was 76 years (range 50-93). Thirty-four patients (56%) were originally treated with a dynamic hip screw, 8 (13%) with a DCS, 2 (3%) with Ender nail and 17 (28%) with proximal femoral nail. Fifty-five patients (90%) were treated with total hip arthroplasty and 6 (10%) with hemiarthroplasty. Uncemented stem was used in 17 patients (28%) and a cemented stem in 44 (72%). A standard length stem was used in 12 patients, and a long stem in 49 cases. Results: The HHS improved from 47 (range 32-54) before surgery to 84 (range 67-93) at one-year follow-up. Seven patients (11.5%) had complications: 3 (4.9%) periprosthetic femoral fractures, 2 (3.2%) dislocations, one (1.6%) wound hematoma, and one (1.6%) deep infection. Conclusions: Hip arthroplasty after a failed fixation of an intertrochanteric or subtrochanteric fracture is an effective method. Pain and functional outcomes improve significantly in most patients. However, it is a more technically challenging procedure and causes more complications than primary hip replacement. Level of Evidence: IV

Functionality, comorbidity, complication & surgery of hip fracture in older adults by age distribution

SUMMARY BACKGROUND Hip fractures may be the greatest complication secondary to osteoporotic disorder. The objective of this study was to determine the influence of age distribution in the functionality, comorbidity, complications and surgical features of older adults with hip fractures. METHODS A prospective cohort study was carried out from 2013 to 2014. A sample of 557 adults over 75 years old with osteoporotic hip fractures was recruited from the Orthogeriatric Unit of the León University Hospital (Spain). Age distributions of 75-84, 85-90 and >90 years old were considered. Firstly, sociodemographic data, fracture type and hospital staying days were collected. Secondly, baseline functionality (Barthel index), ambulation, cognitive impairment and comorbidities were described. Thirdly, surgical intervention, urgency, type, American Association of Anesthesiologists (ASA) scores, non-surgical cause, and baseline pharmacologic treatments were determined. Finally, complications and features at hospital discharge were observed. RESULTS The age ranges did not show any statistically-significant differences (P<.05; R2=.000-.005) for gender, fracture type, or number of hospital staying days. Statistically-significant differences (P<.05; R2=.011-.247) between age groups were observed for Barthel index, cognitive impairment, dementia, osteoporosis, Parkinson's disease, aortic stenosis, surgery type, ASA-score, non-surgical cause, benzodiazepines, antidementia, anti-osteoporosis, insulin, pharmacologic treatments, renal function alteration, heart failure, destination and ambulation features. All other measurements did not show statistically-significant differences (P>.05; R2=.000-.010). CONCLUSION Age distributions greater than 75 years old may determine the functionality, comorbidities, surgical features, baseline pharmacologic treatments, complications and features at hospital discharge for older adults who suffer a hip fracture.

RESUMO CONTEXTO As fraturas do quadril podem ser a maior complicação secundária à doença osteoporótica. O objetivo deste estudo foi determinar a influência da distribuição etária na funcionalidade, comorbidade, complicações e características cirúrgicas de idosos com fratura de quadril. MÉTODOS Um estudo prospectivo de coorte foi realizado de 2013-2014. Uma amostra de 557 adultos mais velhos, com mais de 75 anos, com fratura de quadril osteoporótica foi recrutada na Unidade Ortogeriátrica do Hospital Universitário de León (Espanha). As distribuições de idade de 75-84, 85-90 e >90 anos foram consideradas. Em primeiro lugar, foram coletados dados sociodemográficos, tipo de fratura e dias de permanência hospitalar. Em segundo lugar, foram descritas funcionalidades de base (índice Barthel), ambulação, comprometimento cognitivo e comorbidades. Em terceiro lugar, determinaram-se a intervenção cirúrgica, a urgência, o tipo, os resultados da Associação Americana de Anestesiologistas (ASA), a causa não cirúrgica e os tratamentos farmacológicos iniciais. Finalmente, foram observadas complicações e características na alta hospitalar. RESULTADOS As faixas etárias não mostraram diferenças estatisticamente significativas (P <,05; R2 = ,000-,005) para sexo, tipo de fratura ou dias de permanência hospitalar. Foram apresentadas diferenças estatisticamente significativas (P <,05; R2 = ,011-,247) para o índice de Barthel, comprometimento cognitivo, demência, osteoporose, doença de Parkinson, estenose aórtica, tipo de cirurgia, pontuação ASA, causa não cirúrgica, benzodiazepínicos, antidementia, antiosteoporose, insulina, tratamentos farmacológicos, alteração da função renal, insuficiência cardíaca, destino e características de ambulação entre grupos etários. O restante das medidas não apresentou diferença estatisticamente significativa (P> 0,05; R2 = ,000-,010). CONCLUSÃO As distribuições de idade após 75 anos podem determinar a funcionalidade, comorbidades, características cirúrgicas, tratamentos farmacológicos de base, complicações e características na alta hospitalar de adultos mais velhos que sofrem fratura de quadril.

Frecuencia de complicaciones en pacientes mayores de 60 años con fractura de cadera / Frequency of complications in patients older than 60 years with hip fracture

Resumen: Introducción: Según indican las cifras del INEGI 2009, una de cada 12 mujeres mexicanas y uno de cada 20 hombres mayores de 65 años sufre una fractura de cadera. Se estima que en el año 2050 ésta alcance 110,055 pacientes. Las fracturas por estrés del cuello femoral son más frecuentes en mujeres y comprenden de 5 a 10%. Existe un alto número de pacientes con complicaciones de fractura de cadera secundario a múltiples factores, los cuales poco se han estudiado y esto limita su prevención. Material y métodos: Se realizó un estudio retrospectivo, observacional y transversal de los pacientes de la tercera edad con fractura de cadera entre Enero y Diciembre de 2016 mediante recopilación de datos sociodemográficos: edad, sexo, dirección, además de tipo de fractura, tipo de manejo, diagnóstico principal: CIE 10 S72 fractura de cadera, procedimiento realizado, días de estancia intrahospitalaria, intervención quirúrgica realizada y lugar de destino posterior al alta de la unidad. Resultados: El género más afectado fue el femenino. Las principales complicaciones se correlacionan con delirium, considerando el promedio de estancia hospitalaria de un día por los resultados arrojados, se afirma que las estancias hospitalarias son relativamente cortas en comparación con otro tipo de fracturas. Al igual que en la literatura internacional, la fractura transtrocantérica es el principal tipo de fractura; sin embargo, en cuanto al manejo quirúrgico el de mayor prevalencia fue la hemiartroplastía tipo Thompson seguido de reducción cerrada y fijación interna con colocación de sistema DHS.

Abstract: Introduction: According to Figures from INEGI 2009, indicate that one in 12 Mexican women and one in 20 men over 65 will suffer a hip fracture. Is expected to reach 110,055 patients in the year 2050. Femoral neck stress fractures are more common in women and consist of 5 to 10%. There is a high number of patients with hip fracture complications, secondary to multiple factors which have been little studied and this limits its prevention. Material and methods: A retrospective, observational and transversal study in senior citizens between January and December 2016 with hip fracture was conducted. Through collection of demographic data: age, sex, address, as well as type of fracture, type of management, primary diagnosis: ICD 10 S72 fracture of hip, hospital stay, surgery carried out and place of destination subsequent to discharge from the unit. Results: The most affected gender was female. Within the main complications it correlates with delirium considering the average hospital stay of one day thrown outcomes, says that hospital stays are relatively short compared to other types of fractures. As in the international literature, the Transtrochanteric fracture is the main type of fracture; However in terms of surgical management of higher prevalence was hemiarthroplasty type Thompson followed by closed reduction internal fixation with DHS system placement.

Optimización perioperatoria del paciente anciano con fractura osteoporótica de cadera / Perioperative care of older patients with hip fractures

The number of osteoporotic fractures is increasing along with population aging. Most patients with these type of fractures are older than 65 years, with multiple chronic conditions and different degrees of disability. Hip fracture is the most relevant osteoporotic fracture due to its frequency, costs, severity and complications. Multidisciplinary management is of the utmost importance to obtain good therapeutic results. We herein review the management of this fracture. Orthogeriatric joint management should be incorporated in fragility fracture treatment. We contribute with general recommendations for the perioperative management, which can be homologated for the management of older patients with other type of fragility fractures.

Morbimortalidad en Pacientes con Diagnóstico de Fractura de Cadera Atendidos en el Hospital de Especialidades José Carrasco Arteaga, 2015 / Morbidity and Mortality of Patients Diagnosed with Hip Fracture at José Carrasco Arteaga Specialties Hospital. 2015

INTRODUCCIÓN: La incidencia de fractura de cadera en el Ecuador se estima en 314 casos por 100.000 habitantes al año. El objetivo del presente estudio fue establecer la incidencia y factores de riesgo asociados a morbimortalidad en pacientes con diagnóstico de fractura de cadera. MÉTODO: Estudio retrospectivo y analítico de cohorte que estudió la incidencia y riesgo asociado a morbimortalidad. Se incluyeron todos los pacientes diagnosticados con fractura de cadera que fueron tratados en el Hospital de Especialidades José Carrasco Arteaga durante el año 2015. Para el análisis se utilizó la estadística básica descriptiva, chi-cuadrado y análisis de riesgo relativo con un intervalo de confianza al 95% (p: <0.05) para determinar significancia estadística. RESULTADOS: Se estudiaron 81 pacientes. Las complicaciones más frecuentes fueron: infección del sitio quirúrgico (13.58 %), neumonía (12.34 %) y fallo de osteosíntesis (9.87 %). La mortalidad general fue de 32.1 %. Los pacientes con dos o más complicaciones tuvieron casi dos veces más riesgo de fallecimiento (RR: 2.94; IC ­ 95 %: 1.78 ­ 4.85; p: 0.016), similar a lo observado en los pacientes con infección de la herida quirúrgica y/u osteomielitis (RR: 2.76; IC- 95 %: 1.60 ­ 4.79; p: 0.001) y en aquellos con diagnóstico de TEP (RR: 2.72; IC ­ 95 %: 1.48 ­ 4.97; p: 0.055). No se determinó asociación estadísticamente significativa entre la presencia de comorbilidades y desarrollo de complicaciones o fallecimiento. CONCLUSIÓN: El desarrollo de al menos una complicación duplica el riesgo de mortalidad y es aún mayor en los pacientes complicados con infección de la herida, osteomielitis y/o TEP; la presencia de dos o más complicaciones determina un riesgo 2 veces mayor de fallecimiento.(AU)

BACKGROUND: The incidence of hip fractures in Ecuador is around 314/100.000 people per year. The aim of this study was to establish the incidence and risk factors associated to morbidity and mortality in patients diagnosed with hip fracture. METHODS: This is a retrospective analytic-cohort research, it studied incidence and associated risks to morbidity and mortality. Patients diagnosed with hip fracture and treated at José Carrasco Arteaga Hospital during 2015 were included. Basic descriptive statistics, chi-square and relative risk (with 95% confidence interval) were used to analyze data. P value under 0.05 was used to determine statistical significance. RESULTS: 81 patients were part of the study. Most common complications were: surgical site infection (13.58 %), pneumonia (12.34 %) and osteosynthesis failure (9.87 %). General mortality reached 32.1 %. Patients with 2 or more complications had near double risk of death (RR: 2.94; 95 % - CI: 1.78 ­ 4.85; p: 0.016) as observed in those with surgical site infections or osteomyelitis (RR: 2.76; 95 % - CI: 1.60 ­ 4.79; p: 0.001) and in patients diagnosed with pulmonary embolism (RR: 2.72; 95 % - CI: 1.48 ­ 4.97; p: 0.055). Statistically significant association was not determined between presence of comorbidities and death or complications. CONCLUSION: Development of at least one complication after hip fracture duplicates death risk and is even higher in those patients with surgical site infections, osteomyelitis and/or pulmonary embolism; presence of two or more complications increased risk of death twice. (AU)

Factores asociados a la fractura de cadera en el hospital clinicoquirúrgico Dr. Salvador Allende / Factors associated to hip fracture in Dr Salvador Allende clinical and surgical hospital

Introducción: La fractura de cadera es una de las principales causas de ingreso en ancianos y la misma está asociada a varios factores de riesgo.Objetivo: Determinar los factores asociados a la fractura de cadera en pacientes mayores de 65 años en el Hospital Dr. Salvador Allende. Método: Se realizó, en el 2013, un estudio epidemiológico observacional analítico de casos y controles. Los casos fueron los pacientes con fractura de cadera. Se consideraron variables demográficas y clínicas seleccionadas. Se emplearon métodos estadísticos descriptivos y la razón de ventajas para estimar el riesgo así como regresión logística para valorar los factores de confusión. Resultados: El estudio incluyó 196 casos y 392 controles. Las variables asociadas con fractura de cadera fueron: edad (OR: 1,9; IC 95 por ciento: 1,3-2,9; p= 0,001); color de la piel (OR: 4,2; IC 95 por ciento: 2,3 - 7,6; p= 0,000); APP de: fractura de cadera (OR: 4,1; IC 95 por ciento: 1,5- 11.1; p= 0,005); de caídas (OR: 2,2; IC 95 por ciento: 1,1 - 4,3; p= 0,020); de HTA (OR: 2,6; IC 95 por ciento: 1,7 - 4,1; p= 0,000); consumo actual de: antihipertensivos (OR: 4,4; IC 95 por ciento: 1,5 - 12,8; p= 0,007), y antianginosos (OR: 0,1; IC 95 por cientro: 0,1 - 0,9; p= 0,027). Conclusiones: La edad, el color de la piel, los antecedentes de fractura de cadera, de caídas, de hipertensión arterial y el consumo actual de antihipertensivos son las variables que se asociaron con riesgo aumentado de fracturas. El consumo de antianginosos se comportó como factor protector(AU)

Introduction: Hip fracture is one of the main causes of hospitalization in the elderly and is associated to several risk factors. Objective: To determine the factors associated to hip fractures in patients aged over 65 years in Dr Salvador Allende hospital. Methods: A case-control, analytical, observational and epidemiological study was carried out in 2013 in patients with hip fracture. Selected demographic and clinical variables were taken into consideration. Summary statistical methods and odds ratio were used to estimate risk, and the logistic regression to assess the confounding factors. Results: The study included 196 cases and 392 controls. The variables associated to hip fracture were age OR: 1.9; 95 percent CI: 1.3-2.9; p= 0.001); race (OR: 4,2; 95 percent CI: 2.3-7.6; p= 0.000); APP of hip fracture (OR: 4.1; IC 95 percent: 1.5-11.1; p= 0.005) of falls (OR: 2.2; 95 percent CI: 1.1-4.3; p= 0.020); blood hypertension (OR: 2.6; 95 percent CI: 1.7-4.1; p= 0.000); present consumption of antihypertensive drugs (OR: 4.4; 95 percent CI: 1.5-12.8; p= 0.007), and antiangina drugs (OR: 0.1; 95 percent CI: 0.1-0.9; p= 0.027). Conclusions: Age, race, history of hip fracture, falls, blood hypertension, and present consumption of antihypertensive drugs are the variables statistically associated to increased risk of hip fractures. The consumption of anti-angina drugs acts as protective factor(AU)

Levosimendan as a treatment for acute renal failure associated with cardiogenic shock after hip fracture / Levosimendana como tratamento para insuficiência renal aguda associada a choque cardiogênico após fratura de quadril

Abstract Inotropic drugs are part of the treatment of heart failure; however, inotropic treatment has been largely debated due to the increased incidence of adverse effects and increased mortality. Recently levosimendan, an inotropic positive agent, has been proved to be effective in acute heart failure, reducing the mortality and improving cardiac and renal performance. We report the case of a 75-year-old woman with history of heart and renal failure and hip fracture. Levosimendan was used in preoperative preparation as an adjuvant therapy, to improve cardiac and renal function and to allow surgery.

Resumo Fármacos inotrópicos fazem parte do tratamento de insuficiência cardíaca; no entanto, o tratamento com inotrópicos tem sido amplamente debatido devido ao aumento da incidência de efeitos adversos e da mortalidade. Recentemente, levosimendana, um agente inotrópico positivo, provou ser eficaz na insuficiência cardíaca aguda, reduz a mortalidade e melhora o desempenho cardíaco e renal. Relatamos o caso de uma paciente de 75 anos, com história de insuficiência cardíaca e renal e fratura de quadril. Levosimendana foi usada na preparação do pré-operatório como terapia adjuvante para melhorar a função cardíaca e renal e permitir a cirurgia.

Características de las fracturas de fémur proximal / Characteristics of proximal femoral fractures

Introducción: Las fracturas de cadera ocurren en la cabeza, el cuello y la región intertrocantérica. El tratamiento obedece al tipo, la localización, la edad del paciente y las comorbilidades. Objetivo: Describir las características y los factores relacionados con las fracturas de cadera en pacientes atendidos en el Hospital de San José de Bogotá entre enero del 2014 y junio del 2016. Métodos: Estudio serie de casos. Se incluyó a adultos con fractura primaria e historia clínica completa. Se excluyó a aquellos con antecedente de manejo quirúrgico de fractura de fémur proximal ipsolateral y las fracturas patológicas. La información se obtuvo de las historias clínicas. Resultados: Se incluyó a 96 pacientes, 66,7% mujeres, mediana de edad 81 an˜ os (RIC 29-93 an˜ os), con comorbilidades (69,8%) como hipertensión arterial (58,3%), enfermedad coronaria (16,7%), diabetes mellitus (8,3%), consumo de tabaco (9,4%), Alzheimer (14,6%) y osteoporosis (4,2%). La fractura más común fue la intertrocantérica (69,8%) teniendo como origen la caída de su altura (93,8%). El tratamiento más frecuente fue osteosíntesis (50%) seguida por artroplastia (43,8%). El clavo céfalo-medular largo fue el más utilizado en osteosíntesis (77,1%). Las complicaciones principales fueron muerte postoperatoria en el 5,2%, aflojamiento y reintervenciones en el 3,1%, úlceras por presión, neumonía, tromboembolismo pulmonar y fracturas periimplante en el 2,1%. Conclusiones: La fractura de cadera es una patología común en pacientes ancianos, se relaciona con alta morbimortalidad. Es imprescindible un manejo temprano de esta patología, así como contar con programas de prevención.

Introduction: Hip fractures may occur in the femoral head, neck or intertrocantheric line. Treatment is based on, type and location of the fracture and patient's age and comorbidities. Objective: To describe hip fracture characteristics and risk factors in patients seen at Hospital de San José of Bogotá between January 2014 and June 2016. Methods: A case series study. Adults with primary fractures and a complete medical record were included. Those with prior surgical management of ipsilateral proximal femoral and pathologic fractures were excluded. Data collection was based on clinical records. Results: 96 patients were included, 66.7% females, mean age 81 years (IQR 29 ­ 93 years), and comorbidities such as hypertension (58.3%), coronary artery disease (16.7%), diabetes mellitus (8.3%), tobacco smoking (9.4%), Alzheimer's (14.6%) and osteoporosis (4.2%) present in 69.8%. Intertrochanteric fracture (69.8%) caused by a fall from own height (93.8%) was the commonest fracture. The most widely used treatment was fixation (50%) followed by arthroplasty (43.8%). Osteosynthesis by an intramedullary long proximal femoral nail was the most common fixation method used (77.1%). Major complications were postoperative mortality (5.2%), component loosening and reoperations (3.1%), pressure ulcers, pneumonia, pulmonary thromboembolism and periprosthetic fractures in 2.1%. Conclusions: Hip fractures associated with significant morbidity and mortality are common in elders. It is essential to provide timely treatment and to count on prevention programs regarding this pathology.

Morbimortalidad anestésica y sus factores de riesgo en pacientes con fractura de cadera / Anesthetic morbidity and mortality and risk factors in patients with hip fracture

Introducción: el envejecimiento poblacional condiciona incremento de la fractura de cadera y tratamiento quirúrgico consecuente. Objetivos: describir la morbimortalidad anestésica y sus factores de riesgo en pacientes con fractura de cadera. Métodos: se realizó estudio analítico longitudinal prospectivo en el Servicio de Anestesiología y Reanimación del Hospital Universitario Manuel Ascunce Domenech de Camagüey, de agosto de 2012 a agosto de 2013. El universo fue de 235 pacientes con fractura de cadera bajo intervención quirúrgica. La muestra quedó conformada por similar número de pacientes (población objetivo). Los datos fueron recogidos a propósito de la investigación con las variables de interés y procesados en SPSS. Se emplearon métodos de análisis estadístico univariado y multivariado. Resultados: las complicaciones intraoperatorias más frecuentes fueron hipotensión arterial y sangrado, mientras que en el posoperatorio fueron náuseas y vómitos, hipotensión arterial e isquemia miocárdica. Los valores de Odds ratio mostraron que los factores asociados a esas complicaciones fueron la presencia de anemia, evaluación ASA-III, momento quirúrgico mayor de 24 h, hipertensión arterial, cardiopatía isquémica y sangrado intraoperatorio. La mortalidad por tromboembolismo pulmonar fue escasa y el análisis de regresión logística determinó que los factores de mayor riesgo fueron laringoespasmo, hipertensión transoperatoria y evaluación ASA-III. Conclusiones: la morbilidad estuvo mediada por factores relacionados con las comorbilidades y estado general del paciente, el momento de la cirugia y las incidencias perioperatorias. La mortalidad fue dada por tromboembolismo pulmonar, con factores de riesgo asociados a eventos perioperatorios y estado del paciente(AU)

Introduction: Population aging conditions increased hip fracture and subsequent surgical treatment. Objectives: To describe the anesthetic morbidity and mortality and their risk factors in patients with hip fracture. Methods: A prospective, longitudinal, analytic, study was carried out in the Department of Anesthesiology of Manuel Ascunce Domenech University Hospital of Camagüey, from August 2012 to August 2013. The sample group was 235 patients with hip fracture and under surgical intervention. The sample was made up by the similar number of patients (target population). Data collection was performed on purpose of the research with the variable of interest and processed in SPSS. Univariate and multivariate methods of statistical analysis were used. Results: The most frequent intraoperative complications were hypotension and bleeding, while in the postoperative period there was a manifestation of nausea and vomits, hypotension and myocardial ischemia. Odds ratio values showed that the factors associated with these complications were the presence of anemia, ASA-III assessment, higher surgical time of 24 hours, hypertension, ischemic heart disease and intraoperative bleeding. Mortality for pulmonary embolism was low and logistic regression analysis determined that the major risk factors were laryngospasm, intraoperative hypertension, and ASA-III assessment. Conclusions: morbidity was mediated by factors related to comorbidities and the general condition of the patient, the time of surgery and the perioperative incidents. Mortality manifested due to pulmonary embolism, with risk factors associated with perioperative events and the patient's condition(AU)

Fracturas alrededor de una osteosíntesis extramedular previa de fémur proximal: una solución simple para un problema complejo / Fractures around a previous proximal femur fixation: a simple solution to a complex problem

El número de fracturas de cadera en pacientes ancianos aumenta proporcionalmente al incremento de la expectativa de vida. Por lo tanto, no resulta infrecuente hallar una fractura de fémur, distal a un implante de osteosíntesis extramedular (clavo compresivo deslizante o clavo placa de ángulo fijo) previamente colocado en fracturas intertrocantérica o subtrocantérica de cadera, pese a la tasa de mortalidad anual comunicada del 30-50 % en los pacientes con fractura de cadera. Ante dicha situación, hemos utilizado un clavo endomedular retrógrado asociado a la extracción, de forma percutánea, de los tornillos del implante previo. Se presentan ocho casos de fracturas periosteosíntesis en pacientes con una edad promedio de 85.6 años (5 mujeres y 3 hombres) y un tiempo promedio desde la osteosíntesis de fémur proximal hasta la fractura periosteosíntesis de 3.5 años. El seguimiento fue de 36 meses y se evaluaron la movilidad y el dolor posoperatorios. Se logró la consolidación de la fractura en todos los casos. Dicho procedimiento nos ha resultado una técnica eficaz, se puede lograr una fijación estable sin agregar morbilidad debido a la posibilidad de solapar los dos implantes y disminuir el potencial riesgo de una nueva fractura interimplantes.

The number of hip fractures in the elderly elevates as life expectancy increases. Therefore it is not infrequent to observe a femur fracture, distal to a previous proximal femur fixation (dynamic hip screw or fixed angle plate) used in intertrochanteric femur fractures, despite the reported annual mortality rate of 30-50% in patients with a femoral fracture. Given this situation, we used a retrograde intramedullary nail together with the percutaneous removal of previously implanted screws. We present eight cases of peri-osteosynthesis fractures in patients with an average age of 85.6 years (5 women and 3 men) and an average time from the proximal femur fixation to the new fracture of 3.5 years. The follow-up was 36 months and postoperative motion and pain were evaluated. Consolidation of the fracture was achieved in all cases. We found this technique effective; it was possible to achieve a stable fixation without adding morbidity due to the possibility of overlapping two implants, thus reducing the potential risk of a new fracture between implants.

Survival and Functional Outcomes after Hip Fracture among Nursing Home Residents

Following the implementation of a long-term care insurance system for the elderly in Korea, many nursing homes have been established and many more patients than ever before have been living at nursing homes. Despite the fact that this is a high-risk group vulnerable to hip fractures, no study has yet been conducted in Korea on hip fracture incidence rates and prognoses among patients residing at nursing homes. We recently studied 46 cases of hip fracture in nursing homes; more specifically, we investigated the most common conditions under which fractures occur, and examined the degree of recovery of ambulatory ability and the mortality within 1 yr. Among those who had survived after 1 yr, the number of non-functional ambulators increased from 8 hips before hip fracture to 19 hips at final post-fracture follow-up. These individuals showed poor recovery of ambulatory ability, and the number who died within one year was 11 (23.9%), a rate not significantly different from that among community-dwelling individuals. It was evident that hip-joint-fracture nursing home residents survived for similar periods of time as did those dwelling in the community, though under much more uncomfortable conditions. The main highlight of this report is that it is the first from Korea on nursing home residents' ambulatory recovery and one-year mortality after hip fracture. The authors believe that, beginning with the present study, the government should collect and evaluate the number of hips fractured at nursing facilities in order to formulate criteria that will help to enable all patients to select safer and better-quality nursing facilities for themselves or their family members.

Preoperative Incidence of Deep Vein Thrombosis after Hip Fractures in Korean

BACKGROUND: The purpose of the current study was to investigate the incidence of preoperative deep vein thrombosis (DVT) after hip fractures in Korea. METHODS: In this prospective study, we enrolled 152 Korean geriatric patients who had suffered hip fractures due to a simple fall and were hospitalized between January 2013 and December 2013. There were 52 male and 100 female patients, and their mean age was 78.2 years. There were 96 trochanteric fractures and 56 femoral neck fractures. All patients were examined for DVT: 26 by ultrasonography and 126 by computed tomography venography. The patients having DVT underwent inferior vena cava filter insertion before the surgical intervention. RESULTS: Preoperatively, none of the patients had any signs or symptoms of DVT; however, 4 patients were identified as having asymptomatic DVT. The overall incidence of DVT was 2.6% (4/152). The mean time to arrival at emergency room after injury was 32.6 hours. Mean time elapsed to undergo surgery after hospitalization was 24.9 hours. The average time to hospitalization after injury was 237 hours for patients with DVT versus 27.5 hours for patients without DVT. DVT developed within 72 hours in two of the 137 patients (1.4%) and after 72 hours in two of the remaining 15 patients (13.3%) hospitalized. CONCLUSIONS: While the preoperative incidence of DVT after hip fractures was relatively low (2.6%) in the Korean geriatric population, we confirmed that getting no treatment within 72 hours after injury increased the incidence of DVT. Thus, we conclude from this study that a workup for DVT should be considered in cases where admission or surgery has been delayed for more than 72 hours after injury.

Síndromes geriátricos en pacientes con fractura de cadera no reciente en una unidad de primer nivel de atención médica / Geriatric syndromes in patients with a non-recent hip fracture seen at a primary health care unit

Objetivo: Identificar la frecuencia de síndromes geriátricos en pacientes que sufrieron fractura de cadera no reciente en una unidad de primer nivel de atención médica en el estado de Puebla, México. Material y métodos: Estudio transversal realizado en 376 pacientes que sufrieron fractura de cadera no reciente, a los que se les evaluó la presencia de síndromes geriátricos. Incluimos variables demográficas, incontinencia urinaria, polifarmacia, trastornos del sueño, estado nutricional, así como depresión y autonomía. La depresión y autonomía fueron evaluadas por las escalas de Yesavage y Katz. Utilizamos estadística descriptiva. Resultados: Fueron un total de 376 pacientes, 219 (58%) femeninos, 157 (42%) masculinos; edad promedio 72.57, (65-95, ± 7.08) años, 98.7% presentó al menos un síndrome geriátrico. La depresión se detectó en 303 (80.9%), la polifarmacia se observó en 282 (75%), en cuanto a los trastornos del sueño se encontraron en 262 (69.7%), las caídas se encontraron en 63 (16.8%), la incontinencia urinaria en 19 (5.1%), en cuanto a la obesidad en 15 (4%) y pérdida de la autonomía en 3 (0.8%). Conclusión: 98.7% padecen por lo menos un síndrome geriátrico, el género femenino es el más afectado, el síndrome más frecuente es depresión, seguida de polifarmacia, trastorno del sueño, caídas, incontinencia urinaria, obesidad y pérdida de la autonomía.

Objective: To identify the frequency of geriatric syndromes in patients with a non-recent hip fracture seen at a primary health care unit in the state of Puebla, Mexico. Material and methods: Cross-sectional study conducted in 376 patients with a non-recent hip fracture screened for geriatric syndromes. We included demographic variables, urinary incontinence, polypharmacy, sleep disorder, nutritional status, depression and autonomy. The two latter were assessed using the Yesavage geriatric depression scale and the Katz index. We used descriptive statistics. Results: The total number of patients was 376; 219 (58%) were females and 157 (42%) were males; mean age was 72.57 years (65-95 ± 7.08), and 98.7% had at least one geriatric syndrome. Depression was detected in 303 (80.9%), 282 (75%) were on polypharmacy, 262 (69.7%) had sleep disorders, 63 (16.8%) had experienced falls, 19 (5.1%) had urinary incontinence, 15 (4%) were obese, and 3 (0.8%) had loss of autonomy. Conclusion: 98.7% of the patients had at least one geriatric syndrome; females were the most affected sex; depression was the most frequent syndrome, followed by polypharmacy, sleep disorders, falls, urinary incontinence, obesity and loss of autonomy.