The Widowhood Effect on Mortality in Older Patients with Hip Fracture.

Objective: Widowed people have increased mortality than married people of the same age, a phenomenon known as the widowhood effect. This study aimed to investigate whether this effect exists in older patients with hip fracture. Methods: Using our own hip fracture database, a total of 1101 hip fracture patients were consecutively included from January 2014 to December 2021. Marital status was stratified as married (n = 793) and widowed (n = 308). Patients survival status was obtained from medical records or telephone follow-ups, and the outcomes were all-cause mortality at 30 days, 1 year and at latest follow-up. Univariate and multivariate Cox proportional hazard models were used to assess the association between marital status and mortality, and subgroup analyses according to sex were also conducted. Results: Compared with married patients, widowed patients were more likely to be older, female and intertrochanteric fracture, and were less likely to be urban area, smoking, drinking, and surgical treatment (P < 0.05). After a median follow-up of 37.1 months, the 30-day mortality was 4.3% (n = 47), 1-year mortality was 19.3% (n = 178), and total mortality was 34.2% (n = 376). Multivariate Cox analysis showed that widowed marital status remained an independent risk factor for 1-year mortality (HR = 1.437, 95% CI: 1.054-1.959, P = 0.022), and total mortality (HR = 1.296, 95% CI: 1.038-1.618, P = 0.022), whereas this association was not found in 30-day mortality (HR = 1.200, 95% CI: 0.607-2.376, P = 0.599). Moreover, subgroup analyses also found that the widowhood effect on mortality was present in both male and female. Conclusion: Widowed marital status seems to be an independent risk factor for long-term mortality in older patients with hip fracture.

Muscular Calf Vein Thrombosis Is Associated With Increased 30-Day Mortality But Not 90-Day Mortality in Older Patients With Hip Fracture.

Calf deep vein thrombosis (DVT) is common in patients with hip fractures. However, studies on whether calf DVT has an impact on the prognosis are limited. This retrospective cohort study explored the association between calf DVT and 30-day and 90-day all-cause mortality in older patients with hip fractures. A total of 564 consecutive patients who underwent ultrasound examination were identified from our hip fracture database and categorized into patients with calf DVT (axial DVT, muscular DVT) and no DVT. Of these, 86 patients (15.2%) had ultrasound-confirmed calf DVT, including 66 patients with muscular DVT, and 20 patients with axial DVT. The 30-day and 90-day all-cause mortality were 2.5% and 6.0%, respectively. Multivariate Cox analysis showed that calf DVT was significantly associated with an increased risk of 30-day mortality (hazard ratio [HR] 3.21, 95% confidence interval [CI] 1.05 to 9.84, p = 0.04), but this risk relationship did not persist at 90-day follow-up (HR 1.59, 95% CI 0.69 to 3.71, p = 0.28). When calf DVT was further categorized, muscular DVT remained an independent risk factor for 30-day mortality (HR 3.95, 95% CI 1.18 to 13.15, p = 0.03), whereas this relationship was not found in axial DVT (HR 1.79, 95% CI 0.21 to 15.02, p = 0.59). In conclusion, calf DVT, especially muscular calf DVT but not axial DVT, is independently associated with an increased risk of 30-day mortality in older patients with hip fracture, but this risk relationship did not persist at 90-day follow-up.

Association Between Monocyte Count and Preoperative Deep Venous Thrombosis in Older Patients with hip Fracture: A Retrospective Study.

PURPOSE: To analyze the relationship between monocyte count and preoperative deep venous thrombosis (DVT) in older patients with hip fracture. METHODS: Consecutive older patients with hip fracture undergoing surgery were included from January 2014 to December 2021. Monocyte count was measured on admission, and Doppler ultrasonography was performed for DVT screening prior to surgery. Univariate and multivariate logistic regression analyses were used to assess the association between monocyte count and DVT. RESULTS: A total of 674 patients were finally included, and 128 patients (19.0%) were diagnosed with preoperative DVT. Patients with DVT exhibited a higher monocyte count than patients without DVT [0.55 (0.43-0.72) × 109/L versus 0.49 (0.38-0.63) × 109/L, P = 0.007]. Multivariate logistic regression analysis showed that a high monocyte count (> 0.6 × 109/L) was independently associated with a higher risk of DVT (OR = 1.705, 95% CI: 1.121-2.593, P = 0.013), and for every 0.1 × 109/L increase in monocyte count, the risk of DVT increased by 8.5% (OR = 1.085, 95% CI: 1.003-1.174, P = 0.041). Other risk factors associated with DVT included intertrochanteric fracture (OR = 1.596, 95% CI: 1.022-2.492, P = 0.040), and elevated fibrinogen level (OR = 1.236, 95% CI: 1.029-1.484, P = 0.023). CONCLUSION: A high monocyte count is associated with an increased risk of DVT in older patients with hip fracture. Future studies should evaluate the potential role of monocyte in the prevention and treatment of thrombosis.

[Case-control study on calcaneal traction and external fixator fixation of fractional delayed surgery for type C Pilon Fracture].

OBJECTIVE: To compare clinical effects of calcaneal traction and external fixator fixation of fractional delayed surgery in treating type C Pilon fractures. METHODS: From January 2012 to December 2017, clinical data of 45 patients with tibial Pilon fractures were respectively analyzed. There were 24 patients in traction group, including 16 males and 8 females, aged from 21 to 57 years old with an average age of (38.6 ±10.5) years old; 18 patients caused by falling down, 6 patients caused by traffic accident; 15 patients on the left side and 9 patients on the right side; according to AO/OTA classification, 3 patients classified type C1, 9 patients classified type C2 and 12 patients classified type C3; treated by calcaneal traction on the first stage, and open reduction and internal fixation on the second stage. There were 21 patients in external fixation group, including 15 males and 6 females, aged from 19 to 58 years old with an average age of (37.8 ±11.2) years old; 17 patients caused by falling down, 4 patients caused by traffic accident; 11 patients on the left side and 10 patients on the right side; according to AO/OTA classification, 2 patients classified type C1, 8 patients classified type C2 and 11 patients classified type C3; treated by external fixator on the first stage, and open reduction and internal fixation on the second stage. All patients were closed fracture. Preoperative waiting time, hospital stays, operative time, postoperative complications, fracture reduction and healing time between two groups were compared, VAS score was used to evaluate relief of pain before internal fixation on the second stage, Burwell-Charnley radiological evaluation criteria was applied to evaluate fracture reduction after internal fixation, AOFAS score was used to evaluate recovery of ankle joint function. RESULTS: There were no statistical difference in operative time, following-up time and fracture healing time between two groups. VAS score before internal fixation in traction group was 3.73± 0.87, while in external fixation group was 2.67±0.69, there was statistical difference between two groups. Preoperative waiting time, and hospital stays in traction group were (9.20±1.40) d ,(12.30±3.60) d; while in external fixation group were (7.60± 1.50) d ,(10.80±2.60) d; and had significant difference between two groups. There was no difference in complications between two groups. According to Burwell-Charnley radiological evaluation criteria, 20 patients obtained anatomical reduction, and 4 patients received normal reduction in traction group; 18 patients obtained anatomical reduction, and 3 patients received normal reduction in external fixation group; while without difference between two groups. There was no difference between two groups in AOFAS score. CONCLUSION: For type C Pilon fractures, one-stage calcaneus traction or temporary external fixation also could achieve temporary fixation and provide better soft tissue conditions for the second stage internal fixation, and could receive better ankle joint function after internal fixation. The operation of calcaneus traction is simple, while external fixation may be increase the number of operation times, but external fixation has more advantages in reducing preoperative pain, shortening preoperative waiting days and hospitalization time than traction.