ABSTRACT
A 59-year-old woman presented with worsening bilateral hip pain for 6 months. She had been receiving hemodialysis for 12 years.
Subject(s)
Amyloidosis/diagnostic imaging , Amyloidosis/etiology , Bone Diseases/diagnostic imaging , Bone Diseases/etiology , Renal Dialysis/adverse effects , Amyloidosis/surgery , Bone Diseases/surgery , Diagnosis, Differential , Female , Hip Joint/diagnostic imaging , Hip Joint/surgery , Humans , Middle Aged , Pain/etiology , RadiographyABSTRACT
The Affordable Care Act currently requires hospitals to report 30-day readmission rates for certain medical conditions. It has been suggested that surveillance will expand to include hip and knee surgery-related readmissions in the future. To ensure quality of care and avoid penalties, readmissions related to hip fractures require further investigation. The goal of this study was to evaluate factors associated with 30-day hospital readmission after hip fracture at a level I trauma center. This retrospective cohort study included 1486 patients who were 65 years or older and had a surgical procedure performed to treat a femoral neck, intertrochanteric, and/or subtrochanteric hip fracture during an 8-year period. Analysis of these patients showed a 30-day readmission rate of 9.35% (n=139). Patients in the readmission group had a significantly higher rate of pre-existing diabetes and pulmonary disease and a longer initial hospital length of stay. Readmissions were primarily the result of medical complications, with only one-fourth occurring secondary to orthopedic surgical failure. Pre-existing pulmonary disease (odds ratio [OR], 1.885; 95% confidence interval [CI], 1.305-2.724), initial hospitalization of 8 days or longer (OR, 1.853; 95% CI, 1.223-2.807), and discharge to a skilled nursing facility (OR, 1.586; 95% CI, 1.043-2.413) were determined to be predictors of readmission. Accordingly, patient management should be consistently geared toward optimizing chronic disease states while concomitantly working to minimize the duration of initial hospitalization and decrease readmission rates
Subject(s)
Hip Fractures/epidemiology , Patient Readmission/statistics & numerical data , Aged , Aged, 80 and over , Female , Hip Fractures/surgery , Humans , Male , Registries , Retrospective Studies , Risk Factors , Rural Population , Tertiary Care Centers/statistics & numerical data , Time Factors , Trauma Centers/statistics & numerical data , United States , West Virginia/epidemiologyABSTRACT
Periprosthetic fracture and infection are dreaded complications after total hip arthroplasty. We present the case of a 50-year-old man who suffered an early postoperative Vancouver B1 periprosthetic fracture, which was further complicated by concurrent infection after open reduction and internal fixation. We report the novel use of an antibiotic-impregnated cement coated locking plate during the staged treatment of concomitant periprosthetic fracture and chronic total hip arthroplasty infection. At 1-year follow-up, the patient is pain free and ambulating independently with full range of motion.
Subject(s)
Anti-Bacterial Agents/administration & dosage , Arthroplasty, Replacement, Hip/adverse effects , Bone Cements , Prosthesis-Related Infections/therapy , Anti-Bacterial Agents/therapeutic use , Cementation , Fracture Fixation, Internal/adverse effects , Hip Joint/physiopathology , Hip Joint/surgery , Humans , Male , Middle Aged , Periprosthetic Fractures/complications , Periprosthetic Fractures/surgery , Prosthesis-Related Infections/complications , Range of Motion, Articular , Recovery of Function , Treatment OutcomeSubject(s)
Acetabulum/surgery , Arthroplasty, Replacement, Hip/methods , Fracture Fixation, Internal/methods , Fractures, Comminuted/surgery , Osteogenesis Imperfecta/surgery , Acetabulum/diagnostic imaging , Acetabulum/injuries , Blood Loss, Surgical/prevention & control , Bone Plates , Female , Fractures, Comminuted/complications , Fractures, Comminuted/diagnostic imaging , Humans , Intraoperative Care/methods , Middle Aged , Osteogenesis Imperfecta/complications , Osteogenesis Imperfecta/physiopathology , Range of Motion, Articular , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
Retrograde femoral nailing is a widely used treatment for fractures involving the distal third of the femur. Angular malunion of these fractures after retrograde intramedullary nailing is a known complication. We report our surgical technique and experience using blocking screws to aid in reduction and augment the stability of the fixation when using a retrograde intramedullary nail for distal femoral fractures.
