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1.
Rev. Col. Bras. Cir ; 49: e20223054, 2022. tab, graf
Article in English | LILACS | ID: biblio-1365396

ABSTRACT

ABSTRACT Objective: to evaluate the relationship between 25(OH)D3 levels and fatal outcome in patients over 60 years of age undergoing surgical repair of hip fractures. Methods: prospective cohort of patients undergoing surgical repair of hip fractures. At admission, 25(OH)D3 levels were measured, among other parameters. Patients were followed for at least 1 year, and incident mortality was recorded. Results: 209 patients were included in the study, with a mean age of 79.5 ± 7.6 years among survivors and 80.7 ± 8.2 years among those who died in the first postoperative year (p=0.346). The 25(OH)D3 levels of survivors were significantly higher than those of patients who died (p=0.003). After adjusting for confounding variables, 25(OH)D3 levels below 12.5ng/mL were significant risk factors regardless of mortality (adjusted OR: 7.6; 95% CI: 2.35 to 24.56). Conclusions: our data show that serum 25(OH)D3 levels below 12.5ng/mL significantly and independently increased the risk of mortality in the first year after surgical repair of low-energy hip fracture in patients over 60 years of age in the geographic region where this study was conducted. Low albumin also showed a significant association with mortality in these patients. All other factors had no significant associations.


RESUMO Objetivo: avaliar a relação entre os níveis de 25(OH)D3 e o desfecho fatal em pacientes acima de 60 anos submetidos a correção cirúrgica de fratura de quadril. Métodos: coorte prospectiva de pacientes submetidos a correção cirúrgica de fraturas de quadril. À admissão, foram medidos os níveis de 25(OH)D3, entre outros parâmetros. Os pacientes foram acompanhados por, pelo menos, um ano e a mortalidade foi registrada. Resultados: foram incluídos 209 pacientes no estudo, com média de idade de 79,5 ± 7,6 anos entre os sobreviventes e 80,7 ± 8,2 anos entre os que morreram no primeiro ano de pós-operatório (p=0,346). Os níveis de 25(OH)D3 dos sobreviventes foram significativamente maiores do que os dos pacientes que morreram (p=0,003). Após o ajuste para variáveis de confusão, níveis de 25(OH)D3 abaixo de 12,5ng/mL foram fator de risco significativo, independentemente da mortalidade (OR ajustado 7,6; IC 95% 2,35 24,56). Conclusões: níveis séricos de 25(OH)D3 abaixo de 12,5ng/mL aumentaram significativa e independentemente o risco de morte no primeiro ano após o reparo cirúrgico de fratura de quadril de baixa energia em pacientes com mais de 60 anos de idade na região geográfica onde este estudo foi realizado. A albumina baixa também teve associação significativa com a mortalidade nesses pacientes. Todos os outros fatores não tiveram associações significativas.


Subject(s)
Humans , Aged , Aged, 80 and over , Vitamin D Deficiency/complications , Hip Fractures/surgery , Vitamin D , Prospective Studies , Risk Factors , Cohort Studies , Middle Aged
2.
Rev. cuba. ortop. traumatol ; 35(1): e347, 2021. ilus
Article in Spanish | LILACS, CUMED | ID: biblio-1289553

ABSTRACT

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)


Subject(s)
Humans , Adult , Middle Aged , Seizures/etiology , Hip Fractures/surgery , Hip Fractures/complications , Peru , Arthroplasty/methods , Acetabulum/surgery
3.
Rev. medica electron ; 43(1): 2838-2857, tab
Article in Spanish | LILACS, CUMED | ID: biblio-1156779

ABSTRACT

RESUMEN Introducción: la fractura de cadera es una de las causas más frecuentes de cirugía traumatológica. La selección del material de osteosíntesis constituye el objetivo fundamental en el tratamiento quirúrgico, lo que puede influir en el nivel de validismo alcanzado. Objetivo: evaluar el nivel de validismo en los pacientes intervenidos quirúrgicamente, con diferentes implantes según los diferentes tipos de fracturas del extremo proximal de fémur. Atendidos en el Hospital Provincial Clínico Quirúrgico "Comandante Faustino Pérez Hernández" de la provincia de Matanzas. Materiales y métodos: se realizó un estudio prospectivo, longitudinal donde se estudiaron todos aquellos pacientes con fractura de cadera. En el periodo comprendido desde el 1er de enero del 2016 al 31 de diciembre del 2017. Resultados: predominó el sexo femenino con un 60 % y el grupo de edades de 70 a 79 años para ambos sexos. Prevaleció la fractura extracapsular en un 74 %. El material de osteosíntesis más representado fue el clavo intramedular Gt y en las intracapsulares la prótesis simple. El tiempo quirúrgico se comportó con un tiempo menor a 2 h y el egreso antes de los 5 días. El 48,2 % de los pacientes fueron evaluados de bueno según nivel de validismo alcanzado posterior al tratamiento aplicado. Conclusiones: la fractura de cadera es propia de pacientes adultos mayores que sobrepasan los 65 años. La intervención quirúrgica de urgencia con una adecuada selección del método de osteosíntesis, disminuye un serio problema de salud en el contexto médico, social y epidemiológico cubano (AU).


ABSTRACT Introduction: hip fracture is one of the most frequent indications of trauma surgery. The choice of the osteosynthesis material is the main objective in the surgical treatment, which can influence the level of validity achieved. Objective: to assess the level of validism in patients who underwent surgery with different implants according to the different types of fracture of the proximal end of the femur in the Provincial Surgical Clinical Hospital Comandante Faustino Pérez Hernández of the province of Matanzas. Materials and methods: A prospective, longitudinal study was carried out in all patients with hip fracture in the period from January 1st 2016 to December 31st 2017. Results: female sex (60%) and the 70-79 age group for both sexes (36%) predominated. The extracapsular fracture prevailed with 74%. The most represented osteosynthesis material was the Gt intramedullary nail, and the simple prosthesis in the intracapsular ones. Surgical time was less than 2 hours and the patients were discharged before the 5th day. 48.2% of patients were evaluated as good according to the level of validism achieved after the applied treatment. Conclusions: hip fracture is proper of elder adult people aged more than 65 years. The emergency surgical intervention with an adequate choice of the osteosynthesis method, reduces a serious health problem in the Cuban epidemiological, social and medical context (AU).


Subject(s)
Humans , Aged , Population Dynamics , Fracture Fixation, Internal/methods , Hip Fractures/surgery , Prospective Studies , Longitudinal Studies
4.
Article in Chinese | WPRIM | ID: wpr-888352

ABSTRACT

OBJECTIVE@#To explore the influencing factors of perioperative blood transfusion in the treatment of elderly femoral intertrochanteric fractures with proximal femoral nail antirotation(PFNA).@*METHODS@#The clinical data of 109 elderly patients with intertrochanteric fractures who received PFNA treatment from July 2018 to January 2020 were retrospectively analyzed. Both pelvic hip X-rays and CT plain scans were performed before surgery. All patients were diagnosed by X-ray and CT plain scan of pelvis and hip before operation. Through the statistical analysis of the basic data of patients before and during operation, the risk factors of perioperative blood transfusion were explored.@*RESULTS@#Logistic regression analysis showed that age (@*CONCLUSION@#Age, fracture type, diabetes history, and preoperative hemoglobin are independent risk factors for perioperative blood transfusion in the treatment of elderly intertrochanteric fractures with PFNA. The older the patient, the history of diabetes, the more unstable the fracture, and the lower preoperative hemoglobin, the more likely it is to require a blood transfusion, which may provide a reference for clinical perioperative blood transfusion decisions.


Subject(s)
Aged , Blood Transfusion , Bone Nails , Fracture Fixation, Intramedullary/adverse effects , Hip Fractures/surgery , Humans , Retrospective Studies , Risk Factors , Treatment Outcome
5.
Article in Chinese | WPRIM | ID: wpr-888327

ABSTRACT

OBJECTIVE@#To develop a universal screwdriver for sealing the end of the central hole of the femoral interlocking intramedullary nail, so as to shorten the operation time of the tail cap implantation of the intramedullary nail and improve the accuracy of implantation.@*METHODS@#Total 77 patients with intertrochanteric fractures underwent femoral interlocking intramedullary nail (FIIN) surgery from June 2018 to June 2019. There were 28 males and 49 females, aged 55 to 80 (76.22± 7.32) years old, and course of disease was 20 to 40 h. All patients were divided into universal screwdriver group (39 cases) and ordinary screwdriver group (38 cases) according to whether the self-developed universal screw was applicable during the operation. The blood loss during tail cap implantation, the time of tail cap implantation, the success rate of one-time implantation, and the postoperative curative effect were compared between two groups.@*RESULTS@#All patients were followed up for 12 to 36 months, with an average of(20.00±6.38) months. The bleeding volume and the time of tail cap implantation in the universal screwdriver group were significantly lower thanthose in the ordinary screwdriver group (@*CONCLUSION@#The universal screwdriver is easy to operate during the operation when using the cap of the femoral intramedullary nail, the operation time is shortened, the amount of bleeding is reduced, and the treatment effect is satisfactory.


Subject(s)
Aged , Aged, 80 and over , Bone Nails , Female , Femoral Fractures , Fracture Fixation, Intramedullary , Fracture Healing , Hip Fractures/surgery , Humans , Male , Retrospective Studies , Treatment Outcome
6.
Article in Chinese | WPRIM | ID: wpr-888325

ABSTRACT

OBJECTIVE@#To investigate the effect of parecoxib sodium preemptive analgesia on pain and stress response after surgery in elderly hip fracture patients.@*METHODS@#The clinical data of 70 elderly patients with hip fracture treated in our hospital from October 2017 to October 2019 were prospectively analyzed. According to different analgesic patterns, 35 cases were randomly divided into experimental group, aged 65 to 86(78.5±9.1) years, 21 males and 14 females, including 18 femoral neck fractures and 17 femoral intertrochanteric fractures. There were 35 cases in control group, aged 66 to 88 (80.6±8.1) years, 18 males, and 17 females, including 20 cases of femoral neck fractures and 15 cases of intertrochantericfractures. The visual analogue scale (VAS) at 4 h, 12 h, 24 h, 48 h, and 72 h after surgery, the incidence of delirium and stress indicators of malondialdehyde (MDA), superoxide dismutase (SOD), cortisol (COR), and epinephrise (E) postoperatively in the two groups were observed.@*RESULTS@#At 4 h, 12 h, 24 h, 48 h after surgery, the VAS score of experimental group was lower than that of the control group, and the difference was statistically significant (@*CONCLUSION@#The advanced analgesic application of parecoxib sodium can significantly reduce the postoperative stress response of elderly hip fracture patients, enhance the postoperative analgesic effect, reduce the incidence of postoperative delirium, and improve the quality of rehabilitation of patients.


Subject(s)
Aged , Analgesia , Female , Hip Fractures/surgery , Humans , Isoxazoles , Male , Pain , Prospective Studies , Treatment Outcome
7.
Article in Chinese | WPRIM | ID: wpr-888324

ABSTRACT

OBJECTIVE@#To analyze the influence of preoperative serum nutritional indexes and postoperative nutritional guidance on 1-year mortality in elderly patients with hip fracture.@*METHODS@#From January 2015 to December 2017, 396 elderly patients with hip fracture were included in the study, including 267 females and 129 males, aged 68 to 80(75.48±2.62) years; the course of disease was 2 to 10 (6.12±1.35) days;all patients were followed up for 1-year, and were divided into death group and survival group according to whether the patients died or not. Multivariate logistic regression model was used to analyze the influencing factors of 1 year mortality.@*RESULTS@#Duringthe follow-up, 4 patients lost contact and were treated as shedding, among which 67 patients died and 325 patients survived. The age, male patients, patients with more than three basic diseases, American Society of Anesthesiologists grade Ⅲ-Ⅳ and patients with postoperative complications in the death group were significantly higher than those in the survival group (all @*CONCLUSION@#Advanced age, male and multiple underlying diseases were independent risk factors for 1-year mortality in elderly patients with hip fracture, while higher preoperative nutritional level and routine nutritional guidance were protective factors.


Subject(s)
Aged , Female , Hip Fractures/surgery , Humans , Logistic Models , Male , Postoperative Complications , Postoperative Period , Retrospective Studies , Risk Factors
8.
Article in Chinese | WPRIM | ID: wpr-888323

ABSTRACT

OBJECTIVE@#To investigate the application of tranexamic acid in the treatment of intertrochanteric fracture.@*METHODS@#From January 2017 to October 2019, 100 patients with intertrochanteric fracture were randomly divided into observation group (48 cases) and control group(52 cases). All patients received the same surgical treatment. The control group was given tranexamic acid 20 minutes before operation, and 15 mg/kg diluted in 250 ml sodium chloride injection, intravenous drip;the observation group was given tranexamic acid 0.5 g dissolved in 20 ml normal saline injected into femoral bone marrow cavity for local treatment on the basis of the control group. The blood loss, operation time and postoperative hospital stay were compared between two groups. Hematocrit, hemoglobin, D-dimer and fibrinogen levels were analyzed before and after operation, and the incidence of thrombotic complications was observed.@*RESULTS@#The total blood loss, dominant blood loss, hidden blood loss and postoperative drainage volume of the observation group were significantly lower than those of the control group (@*CONCLUSION@#Tranexamic acid combined with systemic and local application has important clinical significance in reducing perioperative blood lossand blood cell loss in patients with intertrochanteric fracture, and has good safety.


Subject(s)
Antifibrinolytic Agents/therapeutic use , Blood Loss, Surgical , Femur , Hip Fractures/surgery , Humans , Postoperative Hemorrhage , Tranexamic Acid , Treatment Outcome
9.
Article in Chinese | WPRIM | ID: wpr-921916

ABSTRACT

OBJECTIVE@#To investigate the effect of femoral offset (FO) on the postoperative functional results of proximal femoral nail antirotation (PFNA) in femoral trochanteric fractures.@*METHODS@#From May 2017 to June 2019, 112 patients receiving PFNA were analyzed, X-ray and CT examination of both hips were performed before operation, and X-ray examination of both hips of pelvis was performed on the first day after operation. Among them, 71 patients showed bilateral FO difference≤ 5 mm on positive X-ray film (group A), and 41 patients showed bilateral FO difference>5 mm (group B). There was no significant difference between two groups in gender, age, operative side, course of disease, Harris score of preoperative hip joint, preoperativeFO(@*RESULTS@#Patients in both groups were followed up for 12 months after surgery, and all patients reached the healing criteria. The difference of Harris score of the hip joint at 6 and 12 months after surgery was statistically significant (@*CONCLUSION@#In the treatment of trochanteric fractures with PFNA, the greater the difference of FO between the two sides, the worse the postoperative function of the patients. The appropriate FO(the difference of FO between the two sides ≤5 mm) can improve the postoperative function of the patients.


Subject(s)
Bone Nails , Femoral Fractures , Fracture Fixation, Intramedullary , Hip Fractures/surgery , Humans , Retrospective Studies , Treatment Outcome
10.
Article in Chinese | WPRIM | ID: wpr-921915

ABSTRACT

OBJECTIVE@#To study the prognosis and complications of proximal femoral nail antirotation(PFNA) in the treatment of elderly intertrochanteric fracture.@*METHODS@#From January 2016 to November 2019, 127 cases of femoral intertrochanteric fracture were treated with PFNA, including 51 males and 76 females. The average age was 81.39±8.16 (range from 60 to 98). According to Evans classification, the numbers of cases of typeⅠa, typeⅠb, typeⅠc, typeⅠd and typeⅡwere 10, 46, 48, 16 and 7, respectively. Based on the AO /OTA classification, there were 10 cases of type 31-A1.2, 84 of type 31- A1.3, 17 of type 31-A2.2, 9 of type 31-A2.3, and 7 of type 31-A3. Preoperative and the final follow up, function of hip joint of patients treatedwith the PFNA were evaluated by harris hip score, and the postoperative complications were observed.@*RESULTS@#No incision infection occurred in all patients after PFNA. In this research, 4 cases failed in internal fixation, three of them underwent artificial femoral head replacement;5 cases died within one year after operation;2 cases had multiple embolizations of pulmonary artery branches, which recovered after anticoagulation treatment. There were 48 cases complicated with pneumonia, among which 9 cases had pulmonary inflammation before operation;27 cases with pleural effusion, 3 cases with acute heart failure, 3 cases with acute renal insufficiency, except one case died of pneumonia, pleural effusion, hypoproteinemia and respiratory failure during hospitalization, the other patients recovered after treatment. All 119 patients were followed up for 6 to 36 months, with an average of (17.01±6.03) months, Harris hip score increased from 8.96±5.40 preoperation to 83.57±8.92 at the final follow-up (@*CONCLUSION@#PFNA is a recommended option for the treatment of senile patients with intertrochanteric fracture. However, there were a lot of complications when femoral intertrochanteric fractures happened in aged patients, especially prevention and treatment of pulmonary embolism, promptly corrected low hemoglobin and low albumin, and reduce complications.


Subject(s)
Aged , Aged, 80 and over , Bone Nails , Female , Fracture Fixation, Intramedullary/adverse effects , Hip Fractures/surgery , Humans , Male , Retrospective Studies , Treatment Outcome
11.
Article in Chinese | WPRIM | ID: wpr-921914

ABSTRACT

OBJECTIVE@#To explore the effect of metabolic syndrome on 15 days postoperative adverse events of femoral intertrochanteric fractures with internal fixation.@*METHODS@#From January 2011 to June 2019, 986 elderly patients with intertrochanteric fracture were treated with internal fixation, including 312 males and 674 females, with an average age of(77.71± 7.58) years old. And there were 97 patients with metabolic syndrome and 889 patients without metabolic syndrome. Through the electronic medical record system, the patient's age, gender, fracture type, cause of trauma, body mass index, smoking history, preoperative comorbidities, preoperative bloodtransfusion, operation timing, ASA classification, anesthesia method, internal fixation type, operation duration, and 15 days postoperative adverse events, which include surgical site infection, acute heart failure, acute respiratory failure, pulmonary infection, acute renal failure, DVT, embolism in important organs, urinary tract infection, death, and blood transfusion after surgery were collected. The differences of preoperative and intraoperative baseline datas and 15 days postoperative adverse events between the two groups were compared and analyzed by t text or univariate @*RESULTS@#There were statistical differences in age, body mass index, history of cardiac insufficiency, history of COPD, history of renal insufficiency, operation timing, ASA classification, operation duration, surgical site infection, acute heart failure, DVT, urinary tract infection and blood transfusion between two groups (@*CONCLUSION@#Elderly patients with intertrochanteric fracture with metabolic syndrome had higher postoperative surgical site infection rate, DVT incidence rate, urinary tract infection rate, and postoperative blood transfusion rate. Therefore, the orthopedic treatment team should give more attentionand optimize the treatment plan during the perioperative period with the cooperation of internal physician and anesthesiologist.


Subject(s)
Aged , Aged, 80 and over , Bone Nails , Female , Fracture Fixation, Internal/adverse effects , Fracture Fixation, Intramedullary/adverse effects , Hip Fractures/surgery , Humans , Male , Metabolic Syndrome/complications , Retrospective Studies , Treatment Outcome
12.
Article in Chinese | WPRIM | ID: wpr-921913

ABSTRACT

OBJECTIVE@#To compare the clinical efficacy of femoral head replacement and internal fixation in the treatment of unstable intertrochanteric fractures in the elderly.@*METHODS@#Retrospective analysis of 70 cases of unstable intertrochanteric fractures treated from January 2016 to January 2019 and meeting the inclusion and exclusion criteria, 39 cases were fixed with closed reduction and new proximal femoral intramedullary nail(InterTAN), and 31 cases were treated with open trochanter reconstruction and artificial femoral head replacement. The operation time, intraoperative bleeding, hospital stay, weight bearing time, postoperative complication rate and hip function recovery (Harris score) were compared between two groups.@*RESULTS@#All cases were followed up for 12 to 24 months. There were no significant differences in intraoperative bleeding and hospital stay between the two groups (@*CONCLUSION@#InterTAN and femoral head replacement can treat unstable intertrochanteric fractures in the elderly, but femoral head replacement can move down early, improve the quality of life at the end of life, reduce postoperative complications and facilitate the treatment of coexisting diseases in internal medicine.


Subject(s)
Aged , Bone Nails , Femoral Fractures , Femur Head , Fracture Fixation, Internal , Fracture Fixation, Intramedullary , Hip Fractures/surgery , Humans , Quality of Life , Retrospective Studies , Treatment Outcome
13.
Article in Chinese | WPRIM | ID: wpr-921899

ABSTRACT

OBJECTIVE@#To compare clinical efficacy of intramedullary nail fixation following two-step closed reduction or limited open reduction for femoral subtrochanteric fractures.@*METHODS@#Forty six patients with femoral subtrochanteric fractures were analyzed retrospectively from January 2014 to April 2020. Twenty four patients which including 16 males and 8 females, aged from 34 to 91 years old with an average of (55.42±18.25) years old, were treated with two step closed reduction and intramedullary nail fixation on supine position. Twenty-two patients which including 15 males and 7 females, aged from 33 to 87 years old with an average of (56.31±14.77) years old, were performed limited open reductionand intramedullary nail fixation. Operation time, intraoperative blood loss, complications and fracture healing time were recorded and compared between two groups. Postoperative Harris hip score at 8 months was applied to evalaute joint function.@*RESULTS@#All patients were successfully complete operation without incision infection. All patients were followed up from 8 to 36 months with an average of (18.2± 6.1) months. Introperation blood loss, operation time in closed reduction group were (157.92±51.07) ml, (82.08±13.43) min respectively, while in limited open reduction group were (230.91±87.88) ml, (92.73±12.79) min respectively; while there were statistical difference between two groups (@*CONCLUSION@#Femoral subtrochanteric fractures could be effectively treated by both methods. Two-step closed reduction and intramedullary nail fixation may be more advantageous in less tissue damage, shorter operation time and less intraoperative bleeding.


Subject(s)
Adult , Aged , Aged, 80 and over , Bone Nails , Female , Femoral Fractures , Fracture Fixation, Intramedullary , Fracture Healing , Hip Fractures/surgery , Humans , Male , Middle Aged , Retrospective Studies , Treatment Outcome
14.
Chinese Medical Journal ; (24): 1720-1725, 2021.
Article in English | WPRIM | ID: wpr-887614

ABSTRACT

BACKGROUND@#Geriatric hip fracture patients receiving clopidogrel are a surgical challenge. In China, most of these patients undergo delayed surgical treatment after clopidogrel withdrawal for at least 5 to 7 days. However, delayed surgery is associated with increased complications and mortality in the older adults. This retrospective paralleled comparison study investigated the safety of early surgery for geriatric hip fracture patients within 5 days of clopidogrel withdrawal.@*METHODS@#Acute hip fracture patients (≥65 years) who were hospitalized in the orthogeriatric co-management ward of Beijing Jishuitan Hospital between November 2016 and April 2018 were retrospectively reviewed. Sixty patients taking clopidogrel before injury and discontinued  0.050). The percentages of patients with coronary heart disease (61.7% vs. 18.3%; P  0.050). There was no significant difference in perioperative complications, and 30-day and 1-year mortality rates between the groups.@*CONCLUSIONS@#Early hip fracture surgery is safe for elderly patients within 5 days of clopidogrel withdrawal, without increased perioperative blood loss, transfusion requirement, complications, and mortality compared with patients not taking antiplatelet drugs.


Subject(s)
Aged , Case-Control Studies , Clopidogrel/therapeutic use , Hip Fractures/surgery , Humans , Platelet Aggregation Inhibitors/adverse effects , Retrospective Studies , Ticlopidine/adverse effects
15.
Article in English | WPRIM | ID: wpr-880635

ABSTRACT

OBJECTIVES@#To screen the risk factors for predicting venous thromboembolism (VTE) risk after hip fracture in the elderly, to establish a prediction model based on these factors, and to analyze its prediction efficacy.@*METHODS@#A total of 52 hip fracture patients over 60 years old with VTE admitted to the Department of Orthopaedic Trauma, Xiangya Hospital, Central South University from March 2017 to April 2019 were selected as a thrombus group, and another 52 hip fracture patients over 60 years old without VTE were selected as a control group. The differences of hospitalization data and examination results between the 2 groups were compared. Logistic regression model was used to explore the influence of risk factors on VTE risk after hip fracture in the elderly and construct the prediction model based on these factors. The receiver operating characteristic curve was used to analyze the predictive effectiveness of model, Hosmer-lemeshow goodness of fit test was used to evaluate the fitting degree of prediction model.@*RESULTS@#Univariate analysis showed that injury-admission interval, Caprini score, WBC count, platelet count, neutrophil count, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, systemic immune-inflammatory index (SII), and fibrinogen in the thrombus group were higher than those in the control group (all @*CONCLUSIONS@#SII, Caprini score, and injury-admission interval are independent predictors of VTE after hip fracture in the elderly. The prediction model based on these 3 factors has a good efficacy on the prediction of VTE risk, and could provide important reference for the prevention, management, and treatment of VTE after hip fracture in the elderly.


Subject(s)
Aged , Hip Fractures/surgery , Humans , Middle Aged , ROC Curve , Retrospective Studies , Risk Assessment , Risk Factors , Venous Thromboembolism/etiology
16.
Article in Chinese | WPRIM | ID: wpr-879426

ABSTRACT

OBJECTIVE@#To analyze the short-term prognosis of elderly patients with hip fracture after operation, and to explore the main factors affecting the recovery of daily life function.@*METHODS@#From November 2015 to November 2016, 130 elderly patients with hip fracture were analyzed, including 43 males and 87 females, aged from 60 to 95 (77.54±8.49) years. The death, fall and complications were recorded 3 months after operation. The daily life function of the patients was followed up 3 months after operation with the functional recovery of daily life scale (FRS). T-test, analysis of variance and single factor linear regression analysis were used to analyze the general clinical data. The factors with @*RESULTS@#Among 130 patients, 7 died (5.4%), 4 fell (3.1%), 103 (79.2%) had postoperative complications, and the FRS score of 123 patients was 65.92±22.79. The results showed that gender, age, fracture site, pre fracture Basel rating, frailty index, postoperative hospital stay and total number of postoperative complications had significant differences in the recovery of daily life function (@*CONCLUSION@#The short term rehabilitation level of elderly patients with hip fracture after operation is poor. Basel rating before fracture, frailty index, postoperative hospital stay and total number of postoperative complications may be related risk factors affecting the recovery of daily life function of patients after operation.


Subject(s)
Activities of Daily Living , Aged , Female , Hip Fractures/surgery , Humans , Length of Stay , Male , Postoperative Complications , Postoperative Period , Risk Factors
17.
Article in Spanish | LILACS, BINACIS | ID: biblio-1353984

ABSTRACT

Objetivos: El tratamiento de elección para las fracturas femorales periprotésicas Vancouver B3 aún no está definido. Por este motivo, nos propusimos analizar la tasa de complicaciones de la técnica de injerto óseo impactado con un vástago cementado cuando se utiliza para tratar estas fracturas. Materiales y métodos: Estudiamos retrospectivamente 33 fracturas femorales periprotésicas B3 tratadas con la técnica de injerto óseo impactado operados entre 2000 y 2016, analizando la tasa de complicaciones. La mediana de seguimiento fue de 75 meses (RIC 36-111). La mediana de edad fue de 78 años (RIC 74-83). La mediana del defecto óseo femoral fue 3 (RIC 3-3) según la clasificación de la Endo-Klinik. Se realizó un análisis de regresión múltiple para determinar los factores de riesgo asociados a complicaciones, las variables incluidas fueron: cantidad de cirugías previas, diámetro de la nueva cabeza femoral y defecto óseo femoral. Resultados: Se realizó una cirugía de revisión en dos etapas en cuatro pacientes. Se registraron cinco fallas asépticas del implante y dos luxaciones en toda la serie. El análisis de regresión lineal multivariable mostró una asociación significativa entre el grado del defecto óseo femoral Endo-Klinik y la tasa de complicaciones (p = 0,04). Conclusión: La reconstrucción femoral con la técnica de injerto óseo impactado para tratar fracturas periprotésicas Vancouver B3 provocó una alta tasa de complicaciones. Nivel de Evidencia: IV


Aims: Because the gold standard for the treatment of Vancouver type B3 periprosthetic femoral fractures (PFFs) is yet to be defined, we sought to analyze the complication rate of the impaction bone grafting (IBG) technique with a cemented stem for the treatment of this fractures. Materials and methods: We retrospectively studied 33 B3 PFFs treated with the IBG technique oper-ated between 2000 and 2016, analyzing the complication rate. The median follow-up was 75 months (interquartile range [IQR], 36-111). The median age was 78 years (IQR, 74-83). The median grade of EndoKlinik femoral bone defect was 3 (IQR, 3-3). Weperformed a multiple regression analysis to determine risk factors for complications, including the following variables: number ofprevious surgeries, femoral head diameter, and femoral bone defect. Results: As for infection outcomes, 2-stage revision surgerywas performed in 4 patients. We registered 5 implant failures and 2 dislocations in the whole series. Multiple regression analysisshowed a significant association between the grade of EndoKlinik femoral bone defect and complication rate (P=0.04). Conclu-sion: Femoral reconstruction with the IBG technique evidenced a high complication rate for the treatment of B3 PFF. Level of Evidence: IV


Subject(s)
Postoperative Complications , Reoperation , Bone Transplantation , Treatment Outcome , Arthroplasty, Replacement, Hip , Periprosthetic Fractures/surgery , Hip Fractures/surgery
18.
Article in Spanish | LILACS, BNUY, UY-BNMED | ID: biblio-1142103

ABSTRACT

Introducción: Las fracturas ipsilaterales proximales de fémur ocurren en el 1 al 9% de las fracturas diafisarias. Existen múltiples tratamientos propuestos para dicha asociación lesional. El objetivo de este trabajo es revisar los diferentes métodos de tratamiento propuestos, y comparar sus resultados funcionales y principales complicaciones. Materiales y Métodos: Se utilizaron los buscadores electrónicos: PubMed, Lilacs, Cochrane y Ovid SP. La búsqueda llegó a un total de 1829 trabajos, de los cuales se seleccionaron 21 según criterios de inclusión y exclusión. Discusión: No existe un consenso acerca de cuál es el mejor método de fijación para esta asociación lesional. Esta ocurre en pacientes jóvenes por un mecanismo axial de alta energía cinética y la opción elegida debe buscar la reducción anatómica de la fracturas proximales de fémur. Las complicaciones como la pseudoartrosis de cuello femoral y la necrosis avascular son de difícil manejo en este grupo etario. Conclusión: Las fracturas ipsilaterales proximales y diafisarias de fémur son lesiones que presentan un problema diagnóstico y terapéutico. Hay un subdiagnóstico de las mismas y no existe un implante ideal, ni un consenso de cual es el mejor método de fijación.


Introduction: Ipsilateral proximal femoral fractures ocurred in 1 to 9% of femoral shaft fractures. There are multiple treatments proposed for these injuries. The objetive of the present work is revise the different treatment options and compare their functional results and main complications Materials and methods: A comprehensive literature search was carried out using: Pubmed, Lilacs, Cochrane and OVID SP. Initially there were identified a total of 1829 studies. Only 21 studies remained after inclusion and exclusion were applied. Discussion: There is no consensus about which is the best fixation option for these injuries. These occurred in young patients as a result of a high energy axial trauma, and the selected treatment must achieve anatomic reduction of the proximal femoral fracture. Complications such as femoral neck no-union and avascular necrosis are difficult to manage at this age. Conclusion: Ipsilateral proximal and shaft femoral fractures present diagnostic and therapeutic problems. There is an underdiagnosis of these injuries, and there is no ideal implant or consensus on which is the best fixation method.


Introdução: As fraturas proximais ipsilaterais do fêmur ocorrem em 1 a 9% das fraturas diafisárias. Existem vários tratamentos propostos para essa associação lesional. O objetivo deste trabalho é rever os diferentes métodos de tratamento propostos, e comparar os seus resultados funcionais e principais complicações. Materiais e Métodos: Foram utilizados os buscadores eletrônicos: Pubmed, Lilacs, Cochrane e Ovid SP. A busca chegou a um total de 1829 trabalhos, dos quais foram selecionados 21 segundo critérios de inclusão e exclusão. Discussão: Não há consenso sobre qual é o melhor método de fixação para esta associação lesional. Esta ocorre em pacientes jovens por um mecanismo axial de alta energia cinética e a opção escolhida deve procurar a redução anatômica da fratura proximal do fêmur. Complicações como a pseudoartrose do pescoço femoral e a necrose avascular são de difícil manejo neste grupo etário. Conclusão: As fraturas ...(SUPRIMIR LO PRECEDENTE)Conclusão: As fracturas ipsilaterais proximais e diafisárias do fémur são lesões que apresentam um problema diagnóstico e terapêutico. Há um subdiagnóstico das mesmas e não existe um implante ideal, nem um consenso de qual é o melhor método de fixação.


Subject(s)
Humans , Bone Nails/adverse effects , Bone Plates/adverse effects , Bone Screws/adverse effects , Femoral Neck Fractures/surgery , Fracture Fixation, Internal/methods , Hip Fractures/surgery , Treatment Outcome , Fracture Fixation, Internal/adverse effects
19.
Rev. medica electron ; 42(6): 2512-2529, nov.-dic. 2020. tab
Article in Spanish | LILACS, CUMED | ID: biblio-1150034

ABSTRACT

RESUMEN Introducción: el tratamiento ideal en las fracturas estables del extremo proximal de fémur lo constituye el Sistema Dinámico de cadera. Objetivo: Evaluar la efectividad de su uso en dichas fracturas. Diseño metodológico: se realizó un estudio observacional, descriptivo, de tipo longitudinal de los pacientes intervenidos quirúrgicamente por fractura del extremo proximal de fémur en el Hospital Provincial José Ramón López Tabrane, de Matanzas en el periodo comprendido entre enero del 2013 y diciembre del 2015, quedando la muestra constituida por 128 pacientes. Resultados: encontramos un predominio de las femeninas (60%) y el grupo de edades más representado el de 70 a 79 años con 50 pacientes. Predominaron las fracturas extracapsulares con 122 pacientes, siendo dentro de la variedad del DHS la placa de 130 grados la más usada en 81% de los casos. Se operó el 78 % de los pacientes antes de las 2 horas, presentando 12 complicaciones locales, dentro de las cuales resaltó el colapso de la fractura con 4 pacientes. El 70 % de los pacientes apoyó antes de las 12 semanas, presentando 33 % de fallecidos en el primer año de operado. El 92 % de los pacientes fueron evaluados de bien al final de los resultados. Conclusiones: el Sistema Dinámico de Cadera constituye el método de osteosíntesis ideal en fracturas estables con muy buenos resultados funcionales y con temprana indicación de carga de peso; recomendamos su uso en las fracturas estables del extremo proximal de fémur por sus buenos resultados (AU).


SUMMARY Introduction: the ideal treatment for stable fractures of the proximal end of the femur is the Dynamic Hip System. Objective: to evaluate the effectiveness of its use in such fractures. Methodological design: a longitudinal, descriptive, observational study of patients operated on for fractures of the proximal end of the femur was carried out at the José Ramón López Tabrane Provincial Hospital, Matanzas, between January 2013 and December 2015. The sample consisted of 128 patients. Results: we found a predominance of females (60%) and the most represented age group was 70-79 years old with 50 patients. Extracapsular fractures predominated with 122 patients, being within the DHS variety the 130 degree plate the most used in 81% of the cases. Seventy-eight percent of the patients were operated before 2 hours, presenting 12 local complications, among which the collapse of the fracture stood out with 4 patients. Seventy percent of the patients supported before 12 weeks, presenting 33% of deaths in the first year of surgery. Ninety-two percent of the patients were evaluated as being well at the end of the results. Conclusions: The Dynamic Hip System constitutes the ideal method of osteosynthesis in stable fractures with very good functional results and with early indication of weight load;we recommend its use in stable fractures of the proximal end of the femur because of its good results (AU).


Subject(s)
Humans , Male , Female , Aged , Femoral Fractures/rehabilitation , Hip Fractures/rehabilitation , Surgical Procedures, Operative/methods , Incidence , Frail Elderly , Fracture Fixation, Internal/methods , Hip Fractures/surgery , Hip Fractures/diagnosis
20.
Rev. Assoc. Med. Bras. (1992) ; 66(10): 1417-1422, Oct. 2020. tab, graf
Article in English | SES-SP, LILACS, SES-SP | ID: biblio-1136157

ABSTRACT

SUMMARY OBJECTIVE: Determine good recovery practices for ambulation of octogenarian women after hospital discharge after being operated on for hip fracture. METHODS: Prospective study during the second half of 2019, with 192 women (85.95 ± 5.1 years) with hip fracture. A medical history, fracture types, complications, surgical treatment, and assessment of the level of ambulation were recorded before and after six months of hospital discharge. RESULTS: 100 patients lived in the family home and 92 in an institutional center, 68.2% provided pertrochanteric fracture and a total of 3.7 comorbidities, all of them received spinal anesthesia and were admitted an average of 11.4 days. After six months, the patients showed a significant loss of functional independence with respect to the situation prior to the fracture, both for the ability to wander and for activities of daily living. It is noteworthy that the worst prognosis in the recovery of ambulation has to do with intermediate levels of ambulation and that the functional level of departure influences to a lesser extent than the place where they perform the recovery. CONCLUSIONS: Age is a factor that influences the recovery of hip fracture, but there are other influential factors since patients who remain in the family home have a better functional prognosis than those who recover in institutionalized centers, after six months of hospital discharge.


RESUMO OBJETIVO: Determinar boas práticas para a recuperação da ambulação de octogenárias posterior à alta hospitalar após cirurgia por fratura da pelve. METODOLOGIA: Um estudo prospectivo realizado no segundo semestre de 2019 com 192 mulheres (85,95 ± 5,1 anos) com fratura da pelve. O histórico médico, tipo de fratura, complicações, tratamento cirúrgico, e avaliação do nível de ambulação foram registrados antes da alta hospitalar e após seis meses. RESULTADOS: De todas as pacientes, 100 viviam com a família e 92 em alguma instituição, 68.2% tinham fratura peritrocantérica e uma média de 3,7 comorbidades; todas receberam anastesia espinhal e ficaram internadas por 11,4 dias em média. Após seis meses, as pacientes apresentaram uma perda significativa da independência funcional em relação à situação anterior à fratura, tanto em relação à capacidade de ambulação e atividades cotidianas. É importante ressaltar que o prognóstico negativo em relação à recuperação da ambulação está relacionado a níveis intermediários de ambulação e que o nível funcional de saída tem menor influência do que o local onde a recuperação é feita. CONCLUSÃO: A idade é um fator que influencia a recuperação de fraturas da pelve. Porém, há outros fatores com influência, já que as pacientes que ficam com familiares têm um prognostico funcional melhor do que aquelas que se recuperam em instituições, após seis meses da alta hospitalar.


Subject(s)
Humans , Female , Aged , Walking , Hip Fractures/surgery , Self Care , Activities of Daily Living , Prospective Studies , Recovery of Function
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