A Case of Fragility Fracture of the Pelvis Initially Diagnosed as Osteoarthritis of the Hip.
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SUBMITTER: Ogawa R
PROVIDER: S-EPMC9160669 | biostudies-literature | 2022 Aug
REPOSITORIES: biostudies-literature
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A Case of Fragility Fracture of the Pelvis Initially Diagnosed as Osteoarthritis of the Hip.
Ogawa Ryo R Nishiwaki Toru T Yanagimoto Shigeru S Imabayashi Hideaki H Oya Akihito A
Arthroplasty today 20220530
We present the case of a 58-year-old woman who presented with anterior groin pain, initially diagnosed with hip osteoarthritis (OA), scheduled for total hip arthroplasty, and subsequently diagnosed with an occult fragility fracture of the pelvis (FFP) by preoperative computed tomography (CT) examination. We diagnosed the patient with pre-existing hip OA and a bilateral sacrum and left pubic tubercle fracture that exacerbated the groin pain. We operated on the FFP followed by simultaneous bilater ...[more]
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Project description:Acute hip pain following total hip arthroplasty (THA) could have numerous causes to include stress fracture of the pelvis. Stress fractures of the pelvis are rare and have been reported to involve the medial wall and the pubic ramus. A unique case is presented demonstrating the clinical presentation and management of an acute stress fracture of ilium and anterior column following a THA.A 72-year-old man underwent an uncomplicated right THA. He was noted to have femoral head resorption and thin osteoporotic bone intraoperatively. He initially did well postoperatively and ambulating without pain or assistive devices. Within 1 month of surgery, he returned with acute right hip pain without any traumatic event. Radiographs showed migration of the acetabular component and computed tomography scan confirmed a fracture through the ilium. The patient underwent revision surgery, where the fracture was reduced and internal fixation was achieved with a reconstruction plate and acetabular cage construct. At 9 months postoperatively, the patient remained pain-free with full weight bearing and with stable radiographs.Elderly patients who undergo THA may have low bone mineral density. These patients can develop stress fractures in their pelvis after surgery. These fractures may involve the medial wall, posterior column, or posterior wall. In patients who develop atraumatic pain postoperatively, it is important to consider for potential stress fractures of the ilium and evaluate appropriately with imaging. In these cases, revision surgery can be necessary to provide fixation of the stress fracture.
| S-EPMC5553846 | biostudies-other
Project description:IntroductionCognitive function is an important factor that affects functional recovery after hip fracture (HipFx) surgery. The literature on the pathophysiology of dementia in HipFx patients is scarce. We performed a differential diagnosis of dementia in HipFx patients using clinical and brain MRI findings.MethodsThis is a prospective study in which brain MRI was evaluated for patients with HipFx for research purposes. One-hundred-and-five HipFx patients (85 females and 20 males) who underwent surgery and were subsequently able to undergo brain MRI at our hospital were evaluated. The mean age was 84 years. The presence of dementia was determined based on clinical findings and whether the patient meets its diagnostic criteria according to the International Classification of Diseases 10th Edition (ICD-10). The differential diagnosis of dementia was made based on brain MRI findings and the dementia diagnostic flow chart published in the Clinical Practice Guideline for Dementia 2017 (Japanese Society of Neurology). The Voxel-based Specific Regional Analysis System for Alzheimer's Disease (VSRAD) advance 2 diagnostic software was used to evaluate atrophy of the para-hippocampal gyrus.ResultsFifty-six (53%) patients were clinically diagnosed with dementia according to the ICD-10 criteria. The MRI findings were diverse: Alzheimer's disease (AD)-type, asymptomatic multiple ischemic cerebral lesions, past symptomatic cerebral infarction or cerebral hemorrhage, Binswanger's disease (BW)-type, chronic subdural hematoma, disproportionately enlarged subarachnoidal hydrocephalus (DESH), and their combinations thereof. A combination of MRI and clinical findings of dementia patients demonstrated the following distribution of dementia subtypes: AD (n = 20), vascular dementia (n = 33), AD and BW vascular dementia (n = 3).ConclusionThis study revealed that the brain MRI findings of HipFx patients were diverse. Although vascular dementia is found to be common in this particular population, this could be an incidental finding. Further study is warranted to clarify the specificity of our findings by increasing the number of patients, setting the control, and investigating whether dementia subtypes affect postoperative gait acquisition and fall risk.
| S-EPMC8982891 | biostudies-literature
Project description:The aim of this work is to apply an integrated systems approach to understand the biological underpinnings of hip osteoarthritis that culminates in the need for total joint replacement (TJR). This study is a feasibility pilot that integrates functional genomics data from diseased and non-diseased tissues of OA patients who have undergone TJR. For each tissue, we characterised epigenetic marks (methylation), gene transcription (RNASeq) and expression (quantitative proteomics). We also generated genotype data on the HumanCoreExome array for each individual. This data is part of a pre-publication release.
2018-05-14 | PXD006673 | Pride
Project description:Geriatric patients with hip fractures often experience overlap in problems related to nutrition, including undernutrition, sarcopenia, and frailty. Such problems are powerful predictors of adverse responses, although few healthcare professionals are aware of them and therefore do not implement effective interventions. This review aimed to summarize the impact of undernutrition, sarcopenia, and frailty on clinical outcomes in elderly individuals with hip fractures and identify successful strategies that integrate nutrition and rehabilitation. We searched PubMed (MEDLINE) and Cochrane Central Register of Controlled Trials (CENTRAL) for relevant literature published over the last 10 years and found that advanced interventions targeting the aforementioned conditions helped to significantly improve postoperative outcomes among these patients. Going forward, protocols from advanced interventions for detecting, diagnosing, and treating nutrition problems in geriatric patients with hip fractures should become standard practice in healthcare settings.
| S-EPMC7762043 | biostudies-literature
Project description:Objective: The evaluation of the disease severity in hip osteoarthritis (OA) patients being currently based on subjective instruments. It would be of interest to develop more objective instruments, for example based on gait analysis. The aims of this study were to explore if pelvis-thorax coordination parameters could be valuable instrument outcomes to achieve this evaluation by assessing their reliability, discriminant capacity and responsiveness. Methods: Three groups of subjects; healthy, hip OA patients with severe disease (defined as indication to surgery), hip OA patients with less severe disease (no indication to surgery) were included. Hip OA patients with severe disease were evaluated before and 6 months after surgery. Subjects had to perform a gait analysis at comfortable speed, and pelvis-thorax coordination was evaluated. The correlations with clinical and structural parameters, as well as reliability, discriminant capacities and responsiveness, were assessed. Results: The pelvis-thorax coordination in the coronal plane during walking was correlated to clinical and to structural severity in hip OA patients (R 2 = 0.13). The coronal plane coordination allowed to discriminate healthy subjects from all hip OA patients (sensibility = 0.86; specificity = 0.59). Moreover, when comparing OA patients only, coronal plane coordination allows to discriminate patients with indication of surgery from those with no indication of surgery (sensibility = 0.72; specificity = 0.72). Moreover, the pelvis-thorax coordination demonstrated an excellent reliability and a good responsiveness. Conclusion: Changes in the pelvis-thorax coordination might refer to different mechanisms, from analgesia to motor control plasticity, and might be a possible explanation for the weak correlation between structure and symptoms in hip OA patients. Moreover, such parameter might be used as an objective outcome in hip OA clinical trials. Clinical Trials Registration: www.ClinicalTrials.gov, identifier: NCT02042586 and NCT01907503.
| S-EPMC6990408 | biostudies-literature
Project description:The incidence of fragility fractures of the pelvis is rising. Whereas the treatment for FFP type I, III, and IV is clear, the optimal treatment for FFP type II remains a topic of discussion. Traditionally these fractures have been treated conservatively. However, there is a shift toward early surgical stabilization with percutaneous screw fixation to reduce pain and promote mobility in an already frail patient population. High-quality evidence, however, is lacking. Therefore, a randomized clinical trial was designed to compare conservative management to early percutaneous screw fixation in patients with type II fragility fractures. This is a monocenter randomized controlled trial. All patients with a FFP type II are screened for inclusion. After obtaining informed consent, patients are randomized between conservative management and surgical stabilization. Conservative management consists of early mobilization under guidance of physiotherapy and analgesics. Patients randomized for surgical treatment are operated on within 72 h using percutaneous screw fixation. The primary endpoint is mobility measured by the DEMMI score. Secondary endpoints are other dimensions of mobility, pain levels, quality of life, mortality, and morbidity. The total follow-up is 1 year. The required sample size is 68. The present study aims to give certainty on the potential benefit of surgical treatment. Current literature on this topic remains unclear. According to the volume of FFP at the study hospital, we assume that the number of patients needed for this study is gathered within 2 years. ClinicalTrials.gov NCT04744350. Registered on February 8, 2021.
| S-EPMC11287941 | biostudies-literature
Project description:ObjectiveTo determine the effectiveness of Fragility Fracture Integrated Rehabilitation Management (FIRM) on mobility, activity of daily living and cognitive functioning in elderly with hip fracture.MethodsA randomized control trial was conducted at Seoul National University Bundang Hospital, South Korea from August 2017 to January 2018. Patients of both genders with the age 65-95 years, diagnosed cases of hip fracture specifically fractures neck of femur, intertrochanteric, subtrochantric, patients who got bipolar hemiarthroplasty, total hip replacement arthroplasty, reduction and internal fixation were included in this study. A total of n=39 sample was collected through non probability convenience sampling technique and randomly divided into Fragility Integrated Rehabilitation Management (FIRM) group (n=20) and Conventional Physical therapy (CPT) group (n=19). The data was collected through KOVAL for walking ability, modified barthal index (MBI) for behaviors related to activities of daily living (ADLS) and mini mental status examination (MMSE) for cognitive functions at baseline on 2nd postoperative day and after 10th FIRM session on 15th postoperative day.ResultsThe mean age of study participants was 82.07±6.00 years. The post intervention comparison did not show any significant difference (p>0.05) in walking ability, overall ADLs and cognitive functioning. But FIRM group showed significant improvement in stair climbing {0(5) ver. 2(7.5), p=0.049} and ambulation or walker use {8(5) ver. 2(4), p=0.037}, as compared to CPT group.ConclusionBoth groups improved in indoor mobility with walker and crutches as well as activities of daily living. But FIRM showed more improving ambulation with walker and stair climbing. While cognitive functioning was observed only in FIRM group.
| S-EPMC7372678 | biostudies-literature
Project description:BackgroundRehabilitation in hospital is effective in reducing mortality after hip fracture. However, there is uncertainty over optimal in-hospital rehabilitation treatment ingredients, and the generalizability of trial findings to subgroups of patients systematically excluded from previous trials. The aim of this study is to determine the feasibility of a randomized controlled trial which aims to assess the clinical- and cost-effectiveness of adding a stratified care intervention to usual care designed to improve outcomes of acute rehabilitation for all older adults after hip fracture.MethodsThis is a protocol for a single site, feasibility and pilot, pragmatic, parallel group (allocation ratio 1:1) randomised controlled assessor-blind STRATIFY trial (Structured Tailored Rehabilitation AfTer HIp FragilitY Fracture). Adults aged 60 years or more, surgically treated for hip fracture following low energy trauma (fragility fracture), who are willing to provide consent or by consultee declaration (depending on capacity), are eligible. Individuals who experienced in-hospital hip fracture will be excluded. Screening, consent/assent, baseline assessment (demographics, patient reported outcome measures or PROMs [health related quality of life, activities of daily living, pain, falls related self-efficacy], and resource use), and randomization will take place within the first four days post-admission. Participants will then be offered usual care, or usual care plus STRATIFY intervention during their hospital stay. The STRATIFY intervention includes 1) a web-based algorithm to allocate participants to low- medium- or high-risk subgroups; and 2) matched interventions depending on subgroup allocation. The low-risk subgroup will be offered a self-management review, training in advocacy, and a self-managed exercise programme with support for progression, in addition to usual care (1-hour 40 minutes therapist time above usual care). The medium-risk subgroup will be offered education, a goal-orientated mobility programme (with carer training, as available and following carer consent), and early enhanced discharge planning, in addition to usual care (estimated 2-hours 15 minutes therapist time above usual care). The high-risk subgroup will be offered education, enhanced assessment, orientation, and a goal-orientated activities of daily living programme (with carer training, as available and following carer consent), in addition to usual care (estimated 2-hours 45minutes therapist time above usual care). All STRATIFY subgroup treatment interventions are specified using the Rehabilitation Treatment Specification System (RTSS) for treatment theory development and replication. Follow-up PROM data collection, RESOURCE USE alongside readmissions and mortality, will be collected on discharge and 12-weeks post-randomisation. Intervention acceptability will be determined by semi-structured interviews with participants, carers, and therapists at the end of the intervention.DisseminationThe trial findings will be disseminated to patients and the public, health professionals and researchers through publications, presentations and social media channels.Trial registrationThe trial has been registered at clinicaltrials.gov (NCT06014554).
| S-EPMC11651604 | biostudies-literature
Project description:This study demonstrates real-world effectiveness of teriparatide in reducing the risk of hip and other fragility fractures. Fracture incidence significantly decreased as adherence and persistence increased for any clinical, vertebral, nonvertebral, and hip fractures among patients who were observed for 2 years after teriparatide initiation.IntroductionExamine the relationship of treatment adherence and persistence to teriparatide with hip and other fractures.MethodsTruven MarketScan Research Databases, 2004 through 2014, provided teriparatide users ≥18 years old with continuous coverage 12 months pre- and 24 months post-teriparatide prescription. Adherence (medication possession ratio, MPR) groups were defined as high (≥0.80), medium (0.50 ≤ MPR < 0.80), and low (<0.50). Persistence, allowing for ≤90-day gaps between prescriptions, was defined as 1-6, 7-12, 13-18, and 19-24 months. Fracture incidence was summarized and compared by using ANOVA and logistic regression models; the effects of adherence were examined with Cox proportional hazard models with time-dependent covariates for teriparatide exposure.ResultsAmong 14,284 teriparatide subjects, mean age was 68.4 years, 89.8% were female, and 29.6% had a fracture in the previous year; these characteristics were similar across MPR and persistence groups. The effects of adherence and persistence to teriparatide were statistically significant (P < .001) for all fracture types except wrist (P ≥ .125). By logistic regression, high vs low adherence was associated with reduced risk for any (OR = 0.67; P < .001); vertebral (OR = 0.64; P < .001); nonvertebral (OR = 0.71; P < .001); and hip fractures (OR = 0.52; P < .001) and longer (19-24 months) vs shorter persistence (1-6 months) was associated with reduced risk for any (OR = 0.63, P < .001); vertebral (OR = 0.56, P < .001); nonvertebral (OR = 0.69, P < .001); and hip fractures (OR = 0.48, P < .001). Cox models revealed a significantly reduced risk between high and low adherence for any (OR = 0.69, P < .001); vertebral (OR = 0.60, P < .001); nonvertebral (OR = 0.77, P < .001); and hip fractures (OR = 0.55, P < .001).ConclusionFracture incidence significantly decreased as persistence and adherence to teriparatide increased.
| S-EPMC5306167 | biostudies-literature
Project description:Using the nationwide health insurance claims database in Japan, we estimated total annual medical expenditures for fragility hip fracture across the population at 329.2 billion yen (2.99 billion US dollars). Long-term care expenditures were not included. Fragility hip fracture imposes a considerable health economic burden on society in Japan.PurposeFragility hip fracture imposes a substantial health economic burden on society globally. We aimed to estimate medical expenditures for fragility hip fracture using the nationwide health insurance claims database in Japan.MethodsWe included adults aged 60 and over without prior hip fracture who were admitted for fragility hip fracture (i.e., femoral neck or extracapsular) between October 2014 and October 2015 (13 months). Fragility hip fracture was identified through newly assigned disease codes for fracture and procedure codes associated with the fracture. As a proxy for medical expenditures per patient, incremental payments were calculated (i.e., the difference between the total payments 6 months before and after fragility hip fracture). The total payments included health insurance reimbursements and copayments for inpatient and outpatient services. Long-term care expenditures were not included in this study.ResultsWe identified 142,361 individuals (28,868 male and 113,493 female) with fragility hip fracture. Mean medical expenditures for fragility hip fracture per patient were 2,550,000 yen (¥) (23,180 US dollars [$]; ¥110 = $1) in male and ¥2,494,000 ($22,670) in female patients, respectively. Total annual medical expenditures for fragility hip fracture across the population were 329.2 billion yen (2.99 billion US dollars): 67.96 billion yen (620 million US dollars) in male and 261.24 billion yen (2.37 billion US dollars) in female patients, respectively.ConclusionThis is the first study to estimate medical expenditures for hip fracture using the nationwide health insurance claims database, which represents almost all health insurance claims in Japan. Fragility hip fracture inflicts a considerable health economic burden on society in Japan.
| S-EPMC9001568 | biostudies-literature