Hip Fractures

Objective: Whole-body vibration (WBV) is a potential therapy for age-related loss of musculoskeletal competence. Vibration has improved bone in animal models but human evidence is limited. Relative efficacy of low versus high intensity WBV is also unknown. Our goal was to observe the effect of brief low (LoWBV) and higher intensity WBV (HiWBV) on risk factors for hip fracture in postmenopausal women. Design: We utilized an 8-month randomized controlled trial design to examine the influence of twiceweekly LoWBV (15mins, 30Hz, 0.3g) or HiWBV (2x3mins, 12.5Hz, 1g) on anthropometrics, bone (whole body, hip, spine, forearm, heel), muscle (wall squat, chair rise), and balance (tandem walk, single leg stance). Physical activity, daily calcium and compliance were recorded. Effects were examined by repeated measures ANCOVA, controlling for age, height, weight, calcium, physical activity, compliance, and baseline values. Results: 47 women (71.5±9.0 years) completed the trial. There were no between-group differences in any measure at 8 months, but within-group effects were evident. Controls lost bone at the trochanter (-6%, p=0.03) and lumbar spine (-6.6%, p=0.02) while WBV groups did not. WBV subjects improved wall squat (up to 120%, p=0.004) and chair rise performance (up to 10.5%, p=0.05). Conclusions: 8 months of twice-weekly WBV may reduce bone loss at the hip and spine and improve lower extremity muscle function. These changes may translate to a decreased risk of falls and hip fracture.

There is increasing evidence that interventions with drugs affecting bone metabolism decrease the risk of hip fracture. The use of such agents is increasing in Europe, and there is a need to develop the strategies for optimum means of intervention. This paper assesses the impact of the increasing use of such agents on hip fracture outcome using several sets of assumptions. Since hip fractures occur largely after the age of 70 years, intervention directed at this age has a significant impact on hip fractures prevented. Indeed, the gains are greater if the effects of a 5-year treatment wear off once treatment has stopped. The targeting of intervention to those with the lowest values of bone mineral density increases the efficiency of intervention on hip fracture outcome by 70-1402, depending on the gradient of risk associited with decreasing bone mineral density.

There is increasing evidence that interventions with drugs affecting bone metabolism decrease the risk of hip fracture. The use of such agents is increasing in Europe, and there is a need to develop the strategies for optimum means of intervention. This paper assesses the impact of the increasing use of such agents on hip fracture outcome using several sets of assumptions. Since hip fractures occur largely after the age of 70 years, intervention directed at this age has a significant impact on hip fractures prevented. Indeed, the gains are greater if the effects of a 5-year treatment wear off once treatment has stopped. The targeting of intervention to those with the lowest values of bone mineral density increases the efficiency of intervention on hip fracture outcome by 70-1402, depending on the gradient of risk associited with decreasing bone mineral density.

Background: A hip fracture in older adulthood can result in function and mobility decline. The consequences are debilitating and place a great burden on patients, caregivers, and the health care system. Although inpatient rehabilitation programs have proven effective, the best practices for community-based rehabilitation required to maintain the gains in function and mobility post hospital discharge are currently unknown. Objective: The aim of this systematic review is to identify and evaluate the evidence on the effectiveness of community-based rehabilitation post hospital discharge interventions for older adults with cognitive impairment (CI) following a hip fracture, and to identify the physical recovery outcomes and measures used in previous studies. Methods: The methods outlined in the Cochrane Handbook for Systematic Reviews of Intervention were followed and findings were reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The search strategy included a combination of text words and subject headings relating to the concepts of CI, dementia, delirium, cognitive reserve, and hip fractures. For a study to be included in the review, it had to involve participants with CI who underwent hip fracture surgery, and consisted of an outpatient intervention that occurred in the participant's home or community. Peer-reviewed journal articles were identified by searching various databases. Two independent reviewers screened the titles and abstracts to determine which articles comprising of a rehabilitation intervention within a community setting prior to being included for a full article review. A data extraction form and an evidence and quality checklist were used during the full article data analysis and synthesis. A meta-analysis was not conducted due to heterogeneity of measures and outcomes. Results: The original search resulted in over 3000 articles. Of those, three studies satisfied the necessary criteria to be included in the systematic review. All studies included inpatient and outpatient physiotherapy, with some including a cognitive component, family education, and a discharge assessment. Conclusions: The findings from this review suggest that community-based rehabilitation post hospital discharge interventions show promising results towards improving various physical function outcomes, mobility, and activities of daily living for older adults with CI following a hip fracture. This review also demonstrates and discusses the current lack of outpatient rehabilitation interventions targeted towards older adults with CI post-hip fracture. Additionally, several substantive gaps that require attention to move this field forward are highlighted.

Fractures of the proximal humerus account for 4-5% of all fractures. Managing proximal humerus fractures operatively and non-operatively have their respective complications both short- and long-term. We present our experience using the Humelock hemiarthoplasty device for both primary and failed management of proximal humeral fractures. We present four different examples from ten cases that include a failure of internal fixation, a failure of intramedullary nailing, a complex case in a patient with multiple co-morbidities, and a failure of nonoperative management. The patients in our series had multiple injuries and the device allowed early mobilization and produced good results. We suggest that this device has a role in the failure of primary and secondary management of proximal humeral fractures in a district general hospital setting.

Objectives: Timely diagnosis of femoral neck stress fractures is important to prevent fracture completion and displacement. We hypothesize that an abbreviated magnetic resonance imaging (MRI) hip examination can diagnose femoral neck stress fractures and that femoral neck stress fractures are common in U.S. military recruits. Methods: We retrospectively reviewed abbreviated hip MRI examinations performed on active duty patients from November 1, 2013, to August 5, 2014. Patients were referred by primary care providers on the basis of high clinical suspicion. Study variables included presence and grade of femoral neck stress fractures. Results: 229 patients were evaluated with an abbreviated hip MRI. 43 patients (18.8%) were diagnosed with femoral neck stress fractures and 12 patients (5.2%) had bilateral femoral neck stress fractures. All femoral neck stress fractures were on the compressive side. Grading of stress fractures was as follows: 0 Grade I (0%), 8 Grade II (14.5%), 32 Grade III (58.2%), and 15 Grade IV (27.2%). Conclusions: An abbreviated MR hip examination can diagnose femoral neck stress fractures as well as additional pathologies that explain the patient's symptoms. Femoral neck stress fractures are common in U.S. military personnel.

We report on a rare case of pelvic ring injury with an overlapping pubic symphysis dislocation in a patient who was a pedestrian involved in a motor vehicle accident. She sustained a lateral compression pelvic ring injury with an overlapping pubic symphysis dislocation and a mildly displaced zone 2 sacral fracture. She was treated with open reduction and internal fixation of the pubic symphysis and a percutaneously inserted ilio-sacral screw for the sacral fracture. She recovered well and is asymptomatic at 9 months' follow-up. Only one case has been reported previously that was treated in a similar way. We review the literature, offer recommendations on management and propose a classification system for this injury.

Falls are a major problem in older adults. Many falls occur because of stumbling. The aim of the present study is to investigate stumbling reactions of older adults and to compare them with young adults. While subjects walked on a treadmill, a rigid obstacle unexpectedly obstructed the forward sway of the foot. In general, older adults used the same movement strategies as young adults ("elevating" and "lowering"). The electromyographic responses were categorized according to latencies: short-latency (about 45 ms, RP1), medium-latency (about 80 ms, RP2), and long-latency responses (about 110 ms, RP3; about 160 ms, RP4). Latencies of RP1 responses increased by about 6 ms and of RP2 by 10-19 ms in older adults compared with the young. Amplitudes of RP1 were similar for both age groups, whereas amplitudes of RP2-RP4 could differ. In the early-swing elevating strategy (perturbed foot directly lifted over the obstacle) older adults showed smaller responses in ipsilateral upperleg muscles (biceps femoris and rectus femoris). This was related to shorter swing durations, more shortened step distances, and more failures in clearing the obstacle. In parallel, RP4 activity in the contralateral biceps femoris was enhanced, possibly pointing to a higher demand for trunk stabilization. In the late-swing lowering strategy (foot placed on the treadmill before clearing the obstacle) older adults showed lower RP2-RP3 responses in most muscles measured. However, kinematic responses were similar to those of the young. It is concluded that the changes in muscular responses in older adults induce a greater risk of falling after tripping, especially in early swing.

Background Breast cancer survivors have an increased risk of bone fracture. But the risk among young patients with adjuvant therapies remains unknown. This population-based study is aimed to assess the incidence and risk of fracture among young (age of 20 to 39 years) breast cancer patients who received adjuvant therapies. Methods From January 2001 to December 2007, 5,146 newly diagnosed breast cancer patients were enrolled from the National Health Insurance Research Database (NHIRD) in Taiwan. Patients were observed for a maximum of 6 years to determine the incidence of newly onset fracture. Kaplan Meier and Cox regression analyses were used to evaluate the risk of fracture in young breast cancer patients who received adjuvant treatments. Results Of the total 5,146 young (age of 20 to 39 years) breast cancer patients, the Cox multivariate proportional hazards analysis showed that AIs, radiotherapy, and monoclonal antibodies were significantly associated with a high risk of fracture. Moreover, patients who received AIs for more than 180 days had a high hazard ratio (HR) of 1.77 (95% CI = 0.68-4.57), and patients who received more than four radiotherapy visits had a high HR of 2.54 (95% CI = 1.07-6.06). Under the site-specific analysis, young breast cancer patients who received AIs had the highest risk of hip fracture (HR = 8.520, 95% CI = 1.711-42.432, p < 0.04), whereas patients who received radiotherapy had the highest risk of vertebral fracture (HR = 5.512, 95% CI = 1.847-16.451, p < 0.01).

Background The impact of anesthetic choice on postopera-congestive heart failure, and postoperative change in mental the mortality and morbidity has not been determined with status. Numerous comorbid conditions were controlled for incertainty. dividually and by several comorbidity indices using logistic Methods: The authors evaluated the effect of type of anesthe-regression. sia on postoperative mortality and morbidity in a retrospective Results: General anesthesia was used in 6,206 patients cohort study of consecutive hip fracture patients, aged 60 yr or (65.8010) and regional anesthesia in 3,219 patients (3,078 spinal older, who underwent surgical repair at 20 US hospitals be-anesthesia and 141 epidural anesthesia). The 30-day mortality tween 1983 and 1993. The primary outcome was defined rate in the general anesthesia group was 4. 4O/o, compared with death within 30 days of the operative procedure. The secondary outcomes were postoperative 7-day mortality, postoperative myocardial infarction, postoperative pneumonia, postoperative This article is accompanied by an Editorial View. Please see: Baker SG: Randomized and nonrandomized clinical studies: Statistical considerations. ANESTHESIOLOGY 2000; 92: 928-50. 5.4% in the regional anesthesia group (unadjusted odds ratio = 0.80; 95% confidence interval = 0.66-0.97). However, the adjusted odds ratio for general anesthesia increased to 1.08 (0.84-1.38). The adjusted odds ratios for general anesthesia versus regional anesthesia for the 7-day mortality was 0.90 (0.59-1.39) and for postoperative morbidity outcomes were a. follows: myocardial infarction adjusted odds ratio = 1.17 (0.80-1.70); congestive heart fail= adjusted odds ratio = 1.04 (0.80-1.36); pneumonia: adjusted odds ratio = 1.21 (0.87-1.68); postoperative change in mental status: adjusted odds ratio = 1.08 (0.95-1.22). Conclusions: The authors were unable to demonstrate that regional anesthesia was associated with better outcome than was general anesthesia in this large observational study of eltype of anesthesia used should depend on factors other than any associated risks of mortality or morbidity.

BACKGROUND-The hemoglobin threshold at which postoperative red-cell transfusion is warranted is controversial. We conducted a randomized trial to determine whether a higher threshold for blood transfusion would improve recovery in patients who had undergone surgery for hip fracture. METHODS-We enrolled 2016 patients who were 50 years of age or older, who had either a history of or risk factors for cardiovascular disease, and whose hemoglobin level was below 10 g per deciliter after hip-fracture surgery. We randomly assigned patients to a liberal transfusion strategy (a hemoglobin threshold of 10 g per deciliter) or a restrictive transfusion strategy (symptoms of anemia or at physician discretion for a hemoglobin level of <8 g per deciliter). The primary outcome was death or an inability to walk across a room without human assistance on 60day follow-up. RESULTS-A median of 2 units of red cells were transfused in the liberal-strategy group and none in the restrictive-strategy group. The rates of the primary outcome were 35.2% in the liberalstrategy group and 34.7% in the restrictive-strategy group (odds ratio in the liberal-strategy group, 1.01; 95% confidence interval [CI], 0.84 to 1.22), for an absolute risk difference of 0.5 percentage points (95% CI, −3.7 to 4.7). The rates of in-hospital acute coronary syndrome or death were 4.3% and 5.2%, respectively (absolute risk difference, −0.9%; 99% CI, −3.3 to 1.6), and rates of death on 60-day follow-up were 7.6% and 6.6%, respectively (absolute risk difference, 1.0%; 99% CI, −1.9 to 4.0). The rates of other complications were similar in the two groups. CONCLUSIONS-A liberal transfusion strategy, as compared with a restrictive strategy, did not reduce rates of death or inability to walk independently on 60-day follow-up or reduce in-hospital morbidity in elderly patients at high cardiovascular risk. (Funded by the National Heart, Lung, and Blood Institute; FOCUS ClinicalTrials.gov number, NCT00071032.) In the United States, more than 17 million red-cell units are collected annually, and 15 million units are transfused. 1 Blood transfusions are frequently given to surgical patients and to the elderly. 2,3 Yet, the indications for postoperative transfusion have not been adequately

Introduction: Hip fractures occur 1.6 million times each year worldwide, with substantial associated mortality and losses of independence. At present, anaesthesia care for hip fracture surgery varies widely within and between countries, with general anaesthesia and spinal anaesthesia representing the 2 most common approaches. Limited randomised evidence exists regarding potential short-term or long-term differences in outcomes between patients receiving spinal or general anaesthesia for hip fracture surgery. Methods: The REGAIN trial (Regional vs General Anesthesia for Promoting Independence after Hip Fracture) is an international, multicentre, pragmatic randomised controlled trial. 1600 previously ambulatory patients aged 50 and older will be randomly allocated to receive either general or spinal anaesthesia for hip fracture surgery. The primary outcome is a composite of death or new inability to walk 10 feet or across a room at 60 days after randomisation, which will be assessed via telephone interview by staff who are blinded to treatment assignment. Secondary outcomes will be assessed by in-person assessment and medical record review for in-hospital end points (delirium; major inpatient medical complications and mortality; acute postoperative pain; patient satisfaction; length of stay) and by telephone interview for 60-day, 180-day and 365-day end points (mortality; disability-free survival; chronic pain; return to the prefracture residence; need for new assistive devices for ambulation; cognitive impairment). Ethics and dissemination: The REGAIN trial has been approved by the ethics boards of all participating sites. Recruitment began in February 2016 and will continue until the end of 2019. Dissemination plans include presentations at scientific conferences, scientific publications, stakeholder engagement efforts and presentation to the public via lay media outlets.

The aim of this prospective longitudinal study was to measure prospectively the bone mineral density (BMD) and anthropometric variables after a hip fracture. In particular, we studied changes in the BMD in both the injured and uninjured hips, and examined if the postoperative mortality rate and complications, including pseudarthrosis of the fracture and late segmental collapse of the head of the femur, could be predicted by early bone mass measurements. The bone mineral density and the body composition were measured with dual energy X-ray absorptiometry in 102 consecutive hip fracture patients, 31 men and 71 women, with a mean age of 74 and 79 years, respectively. All cases were operated on within 3 days. The measurements were undertaken within 10 days after the fracture, after 4 and after 12 months. The BMD of the hip fracture cases decreased, especially in the lower extremities where the patients lost 7%, during the first year after the fracture. The patients also lost lean body mass (5%) but gained fat (11%) during the same period. They lost significantly more bone mass in the fractured hip than in the uninjured hip (p < 0.05). No difference was found between those patients who survived and those who died within 2 years after their hip fracture in neither the initial measurement nor in the follow-up measurements. Also, we found no difference between those patients whose hip fracture healed and those who developed late segmental collapse or pseudarthrosis. In conclusion, osteoporotic hip fracture cases lose bone mass at an increased rate, especially in the fractured hip. Also, their soft tissue composition changes, gaining fat while losing muscle mass. Furthermore, it seems that early bone mineral measurements cannot predict postoperative failures or postoperative mortality.

BACKGROUND Postoperative acute kidney injury (AKI) is a cause of morbidity and mortality. Its diagnosis requires better markers than variations in diuresis or postoperative serum creatinine. OBJECTIVES The aim of this study was to evaluate the accuracy of Doppler renal resistive index for early detection of AKI after hip or knee arthroplasty. DESIGN A prospective observational study. SETTING A single-centre study in a university hospital. PATIENTS Fifty men and women older than 65 years, requiring hip or knee replacement with at least two perioperative AKI risk factors, including diabetes, arteritis, chronic heart or renal dysfunction, and prescription of angiotensin-converting enzyme (ACE) inhibitors. Exclusion criteria were poor abdominal echogenicity, arrhythmia, respiratory failure or agitation. INTERVENTION Renal resistive index was measured preoperatively and in the postanaesthesia care unit. RESULTS Sixteen patients presented with AKI in the postoperative period. Resistive index was increased in this group in both the preoperative [0.72 (0.69 to 0.73) vs. 0.66 (0.58 to 0.71); P ¼ 0.01] and postoperative periods [0.75 (0.71 to 0.75) vs. 0.67 (0.62 to 0.72); P ¼ 0.0001]. Resistive index evaluated by ROC curves and AUC to detect AKI was 0.862 [95% confidence interval (95% CI) 0.735 to 0.943]. The most accurate cutoff value was a postoperative resistive index of 0.705 (sensitivity ¼ 94%, specificity ¼ 71%, LRR ¼ 3.19 and LR-¼ 0.09). The grey area between 0.705 and 0.73, corresponding to the inconclusive zone, included 26% (13/50) of all the patients. CONCLUSION Postoperative resistive index appears to be effective for early detection of AKI after major orthopaedic surgery. Resistive index can be measured in the postoperative care unit in patients at risk of AKI.

Purpose To quantify the sensitivity and specificity of dual-energy computed tomographic (CT) virtual noncalcium images in the detection of nondisplaced hip fractures and to assess whether obtaining these images as a complement to bone reconstructions alters sensitivity, specificity, or diagnostic confidence. Materials and Methods The clinical research ethics board approved chart review, and the requirement to obtain informed consent was waived. The authors retrospectively identified 118 patients who presented to a level 1 trauma center emergency department and who underwent dual-energy CT for suspicion of a nondisplaced traumatic hip fracture. Clinical follow-up was the standard of reference. Three radiologists interpreted virtual noncalcium images for traumatic bone marrow edema. Bone reconstructions for the same cases were interpreted alone and then with virtual noncalcium images. Diagnostic confidence was rated on a scale of 1 to 10. McNemar, Fleiss κ, and Wilcoxon signed-rank te...

Hip fractures are associated with an in-hospital mortality rate of 7-14%. The criteria for postponing surgery and the effect of preoperative waiting time on mortality are a longstanding subject of debate. Current guidelines indicate that surgery for hip fracture should be performed within 24 hours of injury, previously 48 hours .

Low bone mineral density (BMD) gives an increased risk of fractures, which can lead to premature death. Can BMD of the wrist predict mortality? BMD consistent with osteopenia and osteoporosis gave a significantly increased risk of death for both men and women in a general population in Tromsø, Norway.

To improve understanding of survival among very elderly male patients with surgically repaired hip fractures, this study applied classification techniques to multiple chronic conditions (MCC) then modeled survival by latent class. Veterans Health Administration (VHA)&#39;s electronic medical records on male inpatients age 85-100 years (n=896) with hip fracture diagnosis and repair were used. MCC defined by Charlson and Elixhauser disorders, medications, demographic covariates, and 5 years follow-up survival were included. Latent Class Analysis (LCA) identified three classes based on patterns of MCC, medications, and demographic covariates: Low-comorbidity (16%), High-longevity (55%), and High-comorbidity (29%). Overall, survival censored at 5 years post-op averaged 717days. The Low-comorbidity group was more likely to be Hispanic, less disabled per VHA determination of eligibility for care, with less risk of postoperative emergency department (ED) visit, and taking no prescription m...

Given that different hospitals achieve different outcomes, optimal evaluation of treatment outcomes in the local community requires evaluation of many institutions in that area. We carried out a prospective multicenter cohort study in Kagoshima Prefecture to identify factors that contribute to deterioration in activities of daily living performance and patient mortality 1 year after surgical treatment of hip fractures. We prospectively enrolled 387 patients who underwent surgery for hip fractures in 33 registered facilities within a 6-month period from February to July 2007. Logistic regression analysis was carried out to identify factors that contribute to deterioration in activities of daily living performance and death within 1 year after surgery. An increased risk of Barthel Index (BI) deterioration was associated with increased age (P for trend = 0.003), worse pre-injury BI (P for trend = 0.021), trochanteric fractures (OR 2.07, 95% CI 1.31-3.27), worse BI at discharge (P for t...

To examine the determinants of postsurgery length of stay (LOS) and inpatient mortality in the United States (California and Massachusetts) and Canada (Manitoba and Quebec). Patient discharge abstracts from the Agency for Health Care Policy and Research Nationwide Inpatient Sample and from provincial health ministries. Descriptive statistics by state or province, pooled competing risks hazards models (which control for censoring of LOS and inpatient mortality data), and instrumental variables (which control for confounding in observational data) were used to analyze the effect of wait time for hip fracture surgery on postsurgery outcomes. DATA EXTRACTIONS: Data were extracted for patients admitted to an acute care hospital with a primary diagnosis of hip fracture who received hip fracture surgery, were admitted from home or the emergency room, were age 45 or older, stayed in the hospital 365 days or less, and were not trauma patients. The descriptive data indicate that wait times fo...

Objective: To explore and describe the consequences of an acute hip fracture as experienced by home-dwelling elderly people shortly after discharge from hospital. Design: Semi-structured interviews using the phenomenographic method. Subjects and setting: Eighteen subjects were interviewed in their own homes one month after discharge. Results: The interviewees described experiences of changes in their relation to the body, themselves, to others and to their whole life situation. These experiences were described as being limited in movement, having lost confidence in the body, becoming humble and grateful, respecting oneself and one&#39;s own needs, becoming more dependent on others, gaining more human contact and being treated in a friendly way by others, being secluded and trapped at home, feeling old, closer to death and having lost their zest for life, and taking one day at a time and being uncertain about the future. Conclusion: Experienced consequences of a hip fracture were mul...

Isolated avulsion fractures of the pelvic ring are rare and occur predominantly in adolescent athletes. Isolated fractures of the lesser trochanter are reported to be pathognomic for tumor diseases in adults. We present a case of a female patient with an isolated avulsion of the lesser trochanter after treatment by her chiropractor. After staging examination, we determine the diagnosis of a left-sided carcinoma of the mamma. Additional imaging shows multiple metastases in liver, spine and pelvis. Palliative therapy has started over the course of time. We suggest, on suspicion of a malignant metastatic process, further investigation.

Background Basicervical femoral neck fracture is a rare proximal femur fracture with a high implant failure rate. Biomechanical comparisons between cephalomedullary nails (CMNs) and dynamic hip screws (DHSs) under torsion loading are lacking. This study compared the biomechanical performance of three fixations for basicervical femoral neck fractures under torsion load during early ambulation. Methods The biomechanical study models used three fixations: a DHS, a DHS with an anti-rotation screw, and a short CMN. Finite element analysis was used to simulate hip rotation with muscle forces related to leg swing applied to the femur. The equivalent von Mises stress (EQV) on fixation, fragment displacement, and strain energy density at the proximal cancellous bone were monitored for fixation stability. Results The EQV of the short CMN construct (304.63 MPa) was comparable to that of the titanium DHS construct (293.39 MPa) and greater than that of the titanium DHS with an anti-rotation screw construct (200.94 MPa). The proximal fragment displacement in the short CMN construct was approximately 0.13 mm, the greatest among the constructs. The risk of screw cutout for the lag screw in short CMNs was 3.1-5.8 times greater than that for DHSs and DHSs with anti-rotation screw constructs. Conclusions Titanium DHS combined with an anti-rotation screw provided lower fragment displacement, stress, and strain energy density in the femoral head than the other fixations under torsion load. Basicervical femoral neck fracture treated with CMNs may increase the risk of lag screw cutout.

Introduction: Intertrochanteric fractures, which are one type of hip fracture, have been considered as a major public health issue in many nations. This study was carried out with the aim of comparing the rate of fusion between patients with intertrochanteric fractures treated with short sliding and non-sliding Gamma nail implants. Methods: This is a retrospective cross-sectional study performed in 2018 and 2019, and 47 patients with intertrochanteric fractures, who referred to Imam Hussein Hospital, and were treated using either sliding or non-sliding gamma nail implants were compared. The rates of bone fusion, fused union, and bone repairments were all assessed using radiography 1, 3, 7 and 12 months after the operation. Results: In the current survey, 68.6% of cases were treated with non-sliding gamma nail implants, while 31.4% were treated with sliding gamma nail implants. The mean period of bone fusion was 4.5 months in patients with non-sliding gamma nail implants and 5.5 mont...

Given the amount of time and resources invested in implementing quality programs in hospitals, few studies have investigated their clinical impact and what strategies could be recommended to enhance its effectiveness. To assess variations in clinical practice and explore associations with hospital- and department-level quality management systems. Multicenter, multilevel cross-sectional study. Seventy-three acute care hospitals with 276 departments managing acute myocardial infarction, deliveries, hip fracture, and stroke in seven countries. None. Predictor variables included 3 hospital- and 4 department-level quality measures. Six measures were collected through direct observation by an external surveyor and one was assessed through a questionnaire completed by hospital quality managers. Dependent variables included 24 clinical practice indicators based on case note reviews covering the 4 conditions (acute myocardial infarction, deliveries, hip fracture and stroke). A directed acycl...

Patient-reported experience measures are increasingly being used to routinely monitor the quality of care. With the increasing attention on such measures, hospital managers seek ways to systematically improve patient experience across hospital departments, in particular where outcomes are used for public reporting or reimbursement. However, it is currently unclear whether hospitals with more mature quality management systems or stronger focus on patient involvement and patient-centered care strategies perform better on patient-reported experience. We assessed the effect of such strategies on a range of patient-reported experience measures. We employed a cross-sectional, multi-level study design randomly recruiting hospitals from the Czech Republic, France, Germany, Poland, Portugal, Spain, and Turkey between May 2011 and January 2012. Each hospital contributed patient level data for four conditions/pathways: acute myocardial infarction, stroke, hip fracture and deliveries. The outco...

Purpose. There is a continuing need to improve the prediction of hip fractures to identify those at highest risk, enabling cost-effective use of preventative therapies. Methods. The aim of this work was to validate an innovative imaging biomarker for hip fracture by modelling the shape and texture of the proximal femur assessed from dual energy X-ray absorptiometry (DXA) scans. Scans used were acquired at baseline from elderly patients participating in a prospective, placebo-controlled fracture prevention study of the bisphosphonate, clodronate. 182 subjects who subsequently suffered a hip fracture were age, weight and height matched with two controls who did not suffer a fracture during a median 4year follow-up period. Logistic regression was used to test if variables were good predictors of fracture and adjust for bone mineral density (BMD). Results. Shape mode 2, reflecting variability in neck-shaft angle, neck width and the size of both trochanters, (0.81 (OR), 0.68-0.97 (CI), 0.024 (P)) and appearance mode 6, recording grey-level contrast, (1.33, 1.11-1.59, 0.002) were significant predictors of hip fracture and remained so after adjustment for BMD (shape mode 2 (0.77, 0.64-0.93, 0.006), appearance mode 6 (1.32, 1.10-1.59, 0.003)). Receiver Operating Curve analysis showed the combination of shape mode 2, appearance mode 6 and BMD was 3% better than any single predictor. Conclusion. Variables derived from shape and appearance models gave a prediction of fracture comparable to BMD and in combination with BMD gave an improvement in the prediction of hip fracture that could predict an additional 2000 hip fracture cases per year in the UK, potentially saving more than £20 million per year and 10,000 cases in the US.

Measurement of serum testosterone (T) levels is recommended in the evaluation of osteoporosis in older men and estradiol (E2) and sex hormone binding globulin (SHBG) levels are associated with the rate of bone loss and fractures, but the clinical utility of sex steroid and SHBG measurements for the evaluation of osteoporosis in men has not been examined. To evaluate whether measurements of T, E2 and/or SHBG are useful for the prediction of fracture risk or the rate of bone loss in older men, we analyzed longitudinal data from 5487 community-based men participating in the MrOS Study in the US, Sweden and Hong Kong. Serum T, E2 and SHBG levels were assessed at baseline; incident fractures were self-reported at 4 month intervals with radiographic verification (US), or ascertained via national health records (Sweden, Hong Kong). Rate of bone loss was assessed by serial measures of hip BMD. We used receiver operating characteristic (ROC) curves, net reclassification improvement (NRI) and...

Introduction. Hip fracture in geriatric patients has a substantial economic impact and represents a major cause of morbidity and mortality in this population. At our institution, a regional anesthesia program was instituted for patients undergoing surgery for hip fracture. This retrospective cohort review examines the effects of regional anesthesia (from mainly after July 2007) vs general anesthesia (mainly prior to July 2007) on morbidity, mortality and hospitalization costs. Methods. This retrospective cohort study involved data collection from electronic and paper charts of 308 patients who underwent surgery for hip fracture from September 2006 to December 2008. Data on postoperative morbidity, in-patient mortality, and cost of hospitalization (as estimated from data on hospital charges) were collected and analyzed. Seventy-three patients received regional anesthesia and 235 patients received general anesthesia. During July 2007, approximately halfway through the study period, a regional anesthesia and analgesia program was introduced. Results. The average cost of hospitalization in patients who received surgery for hip fracture was no different between patients who receive regional or general anesthesia ($16,789 + 631 vs $16,815 + 643, respectively, P = 0.9557). Delay in surgery and intensive care unit (ICU) admission resulted in significantly higher hospitalization costs. Age, male gender, African American race and ICU admission were associated with increased in-hospital mortality. In-hospital mortality and rates of readmission are not statistically different between the two anesthesia groups. Conclusions. There is no difference in postoperative morbidity, rates of rehospitalization, in-patient mortality or hospitalization costs in geriatric patients undergoing regional or general anesthesia for repair of hip fracture. Delay in surgery beyond 3 days and ICU admission both increase cost of hospitalization.

To understand the journey experienced by nursing home residents following hip fracture and impressions of an outreach rehabilitation program offered after their return home. A qualitative investigation was undertaken in parallel with a randomised controlled trial investigating the efficacy and cost utility of providing a hospital outreach rehabilitation program for older nursing home residents who have recently returned from hospital following hip fracture. Family members and nursing home staff of 28 (out of the first 30) participants (14 from intervention and 14 from control) agreed to participate in interviews and focus groups to provide information and perceptions of each person&#39;s journey. NVivo 10 qualitative data analysis software package was used to identify major themes (via open, then axial and finally selective coding). Both family members and staff described nursing home residents with dementia as receiving poor post-operative care from hospital staff who seemed unfami...

Introduction Physical inactivity is a costly and leading health risk factor. Engaging in moderate or more intense regular physical activity reduces premature mortality at the population level. Walking is a viable option for achieving the recommended level of physical activity. Yet, the sedentary lifestyle is trending. Determinants of physical activity may be personal, social or environmental. Health promotion endeavours aiming to enhance population-level physical activity are reported in the literature. However, a full range of factors influencing the development and implementation of sustainable indoor walking programmes is unclear. The current review protocol is aimed at describing a process of realist synthesis to uncover contexts, mechanisms and outcomes of indoor walking intervention programmes, which might reveal facilitators, constraints and barriers of planning, implementing and participating in indoor walking initiatives open for the members of the general public. Methods a...