Dataset Information

Injury specific trauma registry: Outcomes of a prospective cohort with proximal femur fractures.

ABSTRACT:

Background

The elderly population is prone to hip fractures, and treating such patients to achieve good outcomes can be challenging. Collection of outcomes data can support clinicians to modify their treatment protocols and improve outcomes over time. The aim of this study is to compare different surgical procedures in patients with neck of femur and intertrochanteric fractures in terms of clinical, functional and radiological outcomes using injury-specific outcome scores.

Methods

The study data was derived from the existing single-center, prospective orthopaedic trauma registry initiated from July 2015. Functional, clinical and radiological outcomes were assessed using Modified Harris Hip Score and The Radiographic Union Score for Hip. Mean radiological outcome scores was compared by Mann-Whitney U test and deaths by Chi-square and Odds ratio.

Results

Of the total 138 patients, 53 (38%) were neck of femur and 85 (62%) Intertrochanteric fractures with fall as leading cause of injury. At 12 months follow-up, modified Harris Hip Score showed 67% excellent-good results in both dynamic hip screw (N?=?6) and total hip replacement (N?=?3) followed by 50% in intramedullary nail (N?=?2). Hemiarthroplasty has fair-poor outcomes with significantly higher deaths as compared to other procedure groups (p?=?0.016). Radiological outcomes showed non-significant trend towards better outcomes in dynamic hip screw as compared to intramedullary nail (p?=?0.08).

Conclusion

Our 12 months follow-up data suggest that dynamic hip screw and total hip replacement have better clinical, functional outcomes followed by intramedullary nail. Hemiarthroplasty has fair-poor clinical and functional outcomes with significantly higher deaths as compared to other procedure groups.

SUBMITTER: Ahmad T

PROVIDER: S-EPMC6642254 | biostudies-literature | 2019 Sep

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Injury specific trauma registry: Outcomes of a prospective cohort with proximal femur fractures.

Ahmad Tashfeen T Muhammad Zehra Abdul ZA Habib Ahmed A

Annals of medicine and surgery (2012) 20190711

<h4>Background</h4>The elderly population is prone to hip fractures, and treating such patients to achieve good outcomes can be challenging. Collection of outcomes data can support clinicians to modify their treatment protocols and improve outcomes over time. The aim of this study is to compare different surgical procedures in patients with neck of femur and intertrochanteric fractures in terms of clinical, functional and radiological outcomes using injury-specific outcome scores.<h4>Methods</h4 ...[more]

PMID: 31360461

Similar Datasets

Project description:We have characterised 997 hip fracture patients from a representative 45 Spanish hospitals, and followed them up prospectively for up to 4 months. Despite suboptimal surgical delays (average 59.1 hours), in-hospital mortality was lower than in Northern European cohorts. The secondary fracture prevention gap is unacceptably high at 85%.PurposeTo characterise inpatient care, complications, and 4-month mortality following a hip or proximal femur fracture in Spain.MethodsDesign: prospective cohort study. Consecutive sample of patients ??50 years old admitted in a representative 45 hospitals for a hip or proximal femur fragility fracture, from June 2014 to June 2016 and followed up for 4 months post-fracture. Patient characteristics, site of fracture, in-patient care (including secondary fracture prevention) and complications, and 4-month mortality are described.ResultsA total of 997 subjects (765 women) of mean (standard deviation) age 83.6 (8.4) years were included. Previous history of fracture/s (36.9%) and falls (43%) were common, and 10-year FRAX-estimated major and hip fracture risks were 15.2% (9.0%) and 8.5% (7.6%) respectively. Inter-trochanteric (44.6%) and displaced intra-capsular (28.0%) were the most common fracture sites, and fixation with short intramedullary nail (38.6%) with spinal anaesthesia (75.5%) the most common procedures. Surgery and rehabilitation were initiated within a mean 59.1 (56.7) and 61.9 (55.1) hours respectively, and average length of stay was 11.5 (9.3) days. Antithrombotic and antibiotic prophylaxis were given to 99.8% and 98.2% respectively, whilst only 12.4% received secondary fracture prevention at discharge. Common complications included delirium (36.1 %) and kidney failure (14.1%), with in-hospital and 4-month mortality of 2.1% and 11% respectively.ConclusionsDespite suboptimal surgical delay, post-hip fracture mortality is low in Spanish hospitals. The secondary fracture prevention gap is unacceptably high at >?85%, in spite of virtually universal anti-thrombotic and antibiotic prophylaxis.

Project description:Proximal femur fractures represent a major healthcare problem in the aging society. High rates of post-operative infections are linked to risk factors that seem to affect local microcirculation. Patterns and time courses of alterations in microcirculation have, however, not been previously investigated. The aim of this prospective cohort study was to evaluate perioperative changes in microcirculation after trochanteric femur fractures using non-invasive laser-Doppler spectrophotometry to analyze how oxygen saturation (SO2), hemoglobin content (Hb) and blood flow changed before and after surgery, and how these parameters were altered by implant type, gender, smoking, diabetes and age. Measurements were separately recorded for nine locations around the greater trochanter in 2, 8, and 15 mm depths, before surgery and 8, 24, 48 h, 4, 7, and 12 days after surgery in 48 patients. Three implants were compared: Dynamic Hip Screw, Gamma3 Nail, and Percutaneous Compression Plate. Surgery resulted in significant differences between the healthy and injured leg in SO2, Hb and flow. Each parameter showed comparable values for both legs prior to surgery. Significantly higher values in SO2 and flow were registered in women compared to men before and after surgery. Smoking caused significant increases in SO2, Hb, and flow only in the superficial layer of the skin after surgery. Diabetes decreased blood flow at 2 and 8 mm depth and increased SO2 at 8 and 15 mm depth after surgery. Age revealed a significant negative correlation with flow. The ability to increase the flow rate after surgery decreased with age. Comparison of implants indicated the minimally invasive implant PCCP altered microcirculation less than the DHS or the Gamma3 nail. Overall, the proximal femur fracture alone did not alter local skin microcirculation significantly in a way comparable to the effect caused by surgery. In conclusion, microcirculation after proximal femur fractures is highly affected by surgery, gender, smoking, diabetes, age and implant in ways specified in this study.

Project description:INTRODUCTION:Treatment of fractures in the elderly population is a clinical challenge due partly to the presence of comorbidities. In a Geriatric Fracture Centre (GFC), patients are co-managed by a geriatrician in an attempt to improve clinical outcomes and reduce morbidity and mortality. Until now the beneficial effect of orthogeriatric co-management has not been definitively proven. The primary objective of this study is to determine the effect of GFC on predefined major adverse events related to a hip fracture compared to usual care centres (UCC). The secondary objectives include assessments in quality of life, patient-reported outcomes and cost-effectiveness. METHODS AND ANALYSIS:Two hundred and sixty-six elderly patients diagnosedwith hip fracture and planned to be treated with osteosynthesis or endoprosthesis in either a GFC or UCC study site will be recruited, 133 per type of centre. All procedures and management will be done according to the site's standard of care. Study-related visits will be performed at the following time points: preoperative, intraoperative, discharge from the orthopaedic/trauma department, discharge to definite residential status, 12 weeks and 12 months postsurgery. Data collected include demographics, residential status, adverse events, patient-reported outcomes, fall history, costs and resources related to treatment. The risk of major adverse events at 12 months will be calculated for each centre type; patient-reported outcomes will be analysed by mixed effects regression models to estimate differences in mean scores between baseline and follow-ups whereas cost-effectiveness will be assessed using the incremental cost-effectiveness ratio. ETHICS AND DISSEMINATION:Ethics approval for this study was granted from the local Ethics Committees or Institutional Review Board from each of the participating sites prior to patient enrolment. The results of this study will be published in peer-reviewed journals and presented at different conferences. TRIAL REGISTRATION NUMBER:ClinicalTrials.gov: NCT02297581; pre-results.

Project description:BackgroundTotal hip arthroplasty (THA) is the treatment of choice for posttraumatic arthritis with failed internal fixation for hip fractures. However, the postoperative prognosis is not clear.Questions/purposesThe primary aim of the study is to report the postoperative outcome, prognosis, and complication rates of total hip arthroplasty in posttraumatic hip arthritis after failed internal fixation of fractures around the hip. The secondary aim of the study is to report results among different fracture types around the hip.Patients and methodsWe enrolled salvage THA patients after failed internal fixation of fractures around the hip and matched control patients undergoing primary THA for hip osteoarthritis. Subgroup analysis was performed to compare the postoperative outcomes, prognosis, and complication rates of salvage THA in posttraumatic hip arthritis after failed internal fixation of different fracture types around the hip.ResultsA total of 315 THAs (105 salvage THAs and 210 primary THAs) were analyzed. Patients with salvage THA had a longer operative time, lower postoperative hemoglobin (Hb) level, more Hb drop (2.2 ± 1.4 vs. 1.7 ± 1.2 gm/dl, p = 0.002), and delayed ambulation. The salvage THA group also had a higher dislocation rate within 2 months after salvage THA (9.5% vs. 1.9%, p = 0.002), reoperation rate (10.5% vs. 3.8%, p = 0.019, including debridement, open and closed reduction under sedation, revision surgery, surgical fixation for periprosthetic fractures), and revision rate (5.7% vs. 0.5%, p = 0.003) than patients undergoing primary THA. Patients who had failed fixation for acetabular fractures were younger and tended to recover well. Patients with previous intertrochanteric fracture had the longest operative time, more hip pain (83.8%, p = 0.022) and more complications.ConclusionSalvage THA in posttraumatic hip arthritis after failed internal fixation required a longer operative time and led to more blood loss and postoperative complications. The dislocation, reoperation, and revision rates after salvage THA were higher than those after primary THA. Patients with salvage THA after failed internal fixation for intertrochanteric fractures were the most susceptible to more complications compared to those with femoral neck fracture or acetabular fracture. Level of Evidence level III.

Project description:BackgroundSeveral strategies for the treatment of pathologic proximal femur fractures are practiced but treatment outcomes have not been rigorously compared.Questions/purposesMajor variations in the use of intramedullary fixation, extramedullary/plate-screw fixation, and endoprosthetic reconstruction techniques for pathologic proximal femur fractures in patients with skeletal metastases are reported. The clinical and surgical variables that influence this choice differ among treating surgeons. To characterize the technique preferences and to identify areas of consensus regarding specific clinical presentations, we administered an online survey to the Musculoskeletal Tumor Society (MSTS) membership. We also tested whether responses correlated with the respondents' years in practice and asked about the indications for wide tumor resection and the role of tumor debulking and adjuvant cementation.MethodsA 10-minute, web-based survey was sent via email to 244 MSTS members. The survey queried participants' musculoskeletal oncology training and experience and presented case scenarios illustrating different combinations of four variables that influence decision-making: cancer type, estimated patient survival, fracture displacement, and anatomic region of involvement.ResultsForty-one percent (n = 98) of MSTS members completed the survey. Intramedullary nail fixation (IMN; 45%) and proximal femur resection and reconstruction (34%) were the most commonly recommended techniques followed by long-stem cemented hemiarthroplasty/cemented hemiarthroplasty (15%) and open reduction and internal fixation (7%). Most respondents (56%) recommended use of cementation with IMN. Differences of opinion on recommended treatment were associated with variations in cancer type, fracture displacement, and anatomic region of involvement.ConclusionsOur online survey showed a trend among MSTS members for selecting IMN and arthroplasty-related techniques to treat pathologic fractures of the proximal femur, but major differences in preferred operative technique exist. Prospective studies are needed to develop consistent, evidence-based treatment recommendations.

Dataset Information

Injury specific trauma registry: Outcomes of a prospective cohort with proximal femur fractures.

Background

Methods

Results

Conclusion

Publications

Injury specific trauma registry: Outcomes of a prospective cohort with proximal femur fractures.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets