RESUMEN
Background and Objectives: Appropriate timing of surgery for periprosthetic femoral fractures (PFFs) in geriatric patients remains unclear. Data from a large international geriatric trauma register were analyzed to examine the outcome of patients with PFF with respect to the timing of surgical stabilization. Materials and Methods: The Registry for Geriatric Trauma of the German Trauma Society (Deutsche Gesellschaft für Unfallchirurgie (DGU)) (ATR-DGU) was analyzed. Patients treated surgically for PFF were included in this analysis. As outcome parameters, in-house mortality rate and mortality at the 120-day follow-up as well as mobility, the EQ5D index score and reoperation rate were analyzed in relation to early (<48 h) or delayed (≥48 h) surgical stabilization. Results: A total of 1178 datasets met the inclusion criteria; 665 fractures were treated with osteosynthesis (56.4%), and 513 fractures were treated by implant change (43.5%). In contrast to the osteosynthesis group, the group with implant changes underwent delayed surgical treatment more often. Multivariate logistic regression analysis of mortality rate (p = 0.310), walking ability (p = 0.239) and EQ5D index after seven days (p = 0.812) revealed no significant differences between early (<48 h) and delayed (≥48 h) surgical stabilization. These items remained insignificant at the follow-up as well. However, the odds of requiring a reoperation within 120 days were significantly higher for delayed surgical treatment (OR: 1.86; p = 0.003). Conclusions: Early surgical treatment did not lead to decreased mortality rates in the acute phase or in the midterm. Except for the rate of reoperation, all other outcome parameters remained unaffected. Nevertheless, for most patients, early surgical treatment should be the goal, so as to achieve early mobilization and avoid secondary nonsurgical complications. If early stabilization is not possible, it can be assumed that orthogeriatric co-management will help protect these patients from further harm.
Asunto(s)
Fracturas del Fémur , Anciano , Fracturas del Fémur/epidemiología , Fracturas del Fémur/cirugía , Fémur , Fijación Interna de Fracturas , Humanos , Sistema de Registros , Reoperación , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
BACKGROUND: The COVID 19 pandemic is a major challenge to all social systems, particularly the healthcare system. Within an international study, German Trauma Centres DGU and Geriatric Trauma Centres DGU have been questioned about their situation. METHOD: The questionnaire was translated from English into German and sent to all contacts. The evaluation was performed descriptively. RESULTS: 71 of 692 centres participated in this study. Government instructions to avoid elective treatments have been adhered to by 68% of the hospitals, and the remaining performed only urgent elective treatments. There was also a decline in the number of traumatological patients. In more than 90% of the hospitals, only 0â-â4% of all patients treated for proximal femur fracture were tested positive for COVID-19. It appears that 84% of these hospitals have or will have financial deficits. Almost all hospitals were organised and ready to fight the pandemic with their personal and/or infrastructural resources they possess. CONCLUSION: Our questionnaire shows that the pandemic had an enormous effect on Trauma Centres DGU and Geriatric Trauma Centres DGU. The hospitals expect financial losses. Almost all the hospitals have provided personal and infrastructural resources to be used in the fight against the pandemic with a better outcome in Germany in comparison with international standards.
Asunto(s)
COVID-19 , Pandemias , Anciano , Alemania/epidemiología , Humanos , Pandemias/prevención & control , Sistema de Registros , SARS-CoV-2 , Centros TraumatológicosRESUMEN
AIM: Urinary tract infections (UTI) represent a common perioperative complication among elderly patients with hip fracture. To determine the impact of UTI on the perioperative course of elderly patients with hip fractures, a prospective study was carried out. METHODS: A total of 402 surgically-treated geriatric hip fracture patients were consecutively enrolled at a level 1 trauma center. On admission, all patients received an indwelling urinary catheter. Clinically symptomatic patients were screened more closely for UTI. Patients diagnosed with UTI were compared with asymptomatic patients. Outcomes in both patient groups were measured using in-hospital mortality, overall length of hospital stay, wound infection, functional results and mobility at discharge. Multivariate regression analysis was carried out to control for influencing factors. RESULTS: A total of 97 patients (24%) sustained a UTI during in-hospital treatment. UTI were independently associated with inferior functional outcomes as assessed by the Barthel Index (ß = -0.091; P = 0.031), Timed Up and Go test (ß = 0.364; P = 0.001) and Tinetti test (ß = -0.169; P = 0.001) at discharge. Additionally, length of hospital stay was significantly longer for patients with a UTI diagnosis (ß = 0.123; P = 0.029) after controlling for all other variables. No differences were observed in the rate of wound infection (odds ratio 1.185; P = 0.898) or in-hospital mortality (P < 0.997). CONCLUSIONS: Patients with UTI seem to be at risk of inferior functional outcomes. In addition to an early detection of symptomatic UTI and a targeted antibiotic therapy, perioperative care should focus on preserving functional ability to protect these patients from further loss of independence and prolonged clinical courses. Geriatr Gerontol Int 2017; 17: 2369-2376.
Asunto(s)
Catéteres de Permanencia/efectos adversos , Fracturas de Cadera/complicaciones , Fracturas de Cadera/cirugía , Resultado del Tratamiento , Catéteres Urinarios/efectos adversos , Infecciones Urinarias/complicaciones , Anciano , Anciano de 80 o más Años , Femenino , Mortalidad Hospitalaria , Humanos , Tiempo de Internación , Masculino , Limitación de la Movilidad , Estudios Prospectivos , Infección de HeridasRESUMEN
INTRODUCTION: As a part of aging, hip fractures are becoming more common. The connection between increased pain and a poor outcome has previously been shown. Therefore, even in prehospital situations, analgesic therapy appears to be reasonable. We established a prospective study with 153 patients to evaluate the patients' pain levels during the prehospital phase of treatment and prehospital analgesic therapy. METHODS: We performed a prospective study on 153 patients the age of 60 years or older in a University hospital setting between 2010 and 2011 who suffered hip fracture. Analgesics given and the type of medical staff that was involved were documented. Pain was measured using the NRS upon initial contact of the medical staff and upon admission to our emergency department. RESULTS: Initial pain level evaluated by EMS (emergency medical service) was 6.8 (SD = 2.7). Twenty-two percent of the patients reported an NRS of 10 as the highest value following their injury. Forty-three of 153 patients (28%) received analgesics. The mean initial pain score for those 43 patients who did receive pain medication was 7.0 (SD = 2.6). However, this score dropped to a mean of 2.8 (SD = 1.4) upon hospital arrival (P < 0.001). The patients who did not receive pain medication had an initial pain score of 4.5 (SD = 1.9). Upon admission to the hospital, this score decreased to a mean of 4.0 (SD = 1.7, P = 0.092). CONCLUSION: Only a minority of patients with hip fractures received prehospital analgesia. The administration of prehospital analgesia was associated with significant pain relief.
Asunto(s)
Analgésicos/uso terapéutico , Fracturas de Cadera/complicaciones , Dolor/tratamiento farmacológico , Dolor/etiología , Anciano , Anciano de 80 o más Años , Depresión/diagnóstico , Depresión/psicología , Servicios Médicos de Urgencia , Femenino , Evaluación Geriátrica , Humanos , MMPI , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Estudios RetrospectivosRESUMEN
Proximal humeral fractures remain a surgical challenge, and scientific discussions are commonly focused on their ideal treatment. One possible treatment involves the use of an angle stable plate osteosynthesis. However, which material can most feasibly be used to attach the greater tuberosity to the implant remains unknown. In two prospective, non-randomized trials, we compared the results of a FiberWire® and a wire cerclage. A total of 104 patients with 3- and 4-part fractures were included in this examination. In 25 cases, the greater tuberosity was fixated with a FiberWire®, size 2, while 79 cases received a wire cerclage. Plate osteosynthesis was constantly performed via the anterolateral delta-split approach using the NCB®-PH-plate by Zimmer®. The patients were followed clinically at discharge, 6 weeks and 6 months postoperatively and were examined for relevant complications. Age and gender were equally distributed in both groups. Concerning the follow-up after 6 weeks, a significant benefit concerning shoulder function was observed in the FiberWire®-group (wire cerclage: 39.20±11.85, 95% CI 32.37-44.56, FiberWire®: 45.84±16.80, 95% CI 28.34-61.56: p=0.049). After 6 months, the difference between the groups was not significant (wire cerclage: 58.13±18.73, 95% CI 50.25-72.40, FiberWire®: 68.85±23.10, 95% CI 46.83-99.53: p=0.06).
Asunto(s)
Hilos Ortopédicos , Fijación Interna de Fracturas/instrumentación , Fracturas del Hombro/cirugía , Actividades Cotidianas , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Fracturas del Hombro/fisiopatología , Articulación del Hombro/fisiopatologíaRESUMEN
INTRODUCTION: Patients with Parkinson's disease (PD) have a heightened risk of sustaining hip fractures due to disturbed balance and gait insecurity. This study aims to determine the impact of PD on the perioperative course and medium-term functional outcome of patients with hip fractures. MATERIALS AND METHODS: A total of 402 hip fracture patients, aged ≥60 years, were prospectively enrolled. On admission, the American Society of Anesthesiologists score, Mini-Mental Status Examination, and Barthel Index (BI), among other scales, were documented. The Hoehn and Yahr scale was used to assess the severity of PD. The functional outcome was assessed by performance on the BI, Tinetti test (TT), and Timed Up and Go test (TUG) at discharge and at the 6-month follow-up. Additionally, the length of hospitalization, perioperative complications, and discharge management were documented. A multivariate regression analysis was performed to control for influencing factors. RESULTS: A total of 19 patients (4.7%) had a concomitant diagnosis of PD. The functional outcome (BI, TT, and TUG) was comparable between groups (all p > 0.05). Grade II (52.6 vs. 26.1%; OR = 4.304, p = 0.008) and IV complications (15.8 vs. 4.4%; OR = 7.785, p = 0.012) occurred significantly more often among PD patients. While the diagnosis of PD was associated with a significantly longer mean length of hospital stay (ß = 0.119, p = 0.024), the transfer from acute hospital care showed no significant difference (p = 0.246). Patients with an additional diagnosis of PD had inferior results in BI at the 6-month follow-up (p = 0.038). CONCLUSION: PD on hospital admission is not an independent risk factor for in-hospital mortality or an inferior functional outcome at hospital discharge. However, patients with PD are at risk for specific complications and longer hospitalization at the time of transfer from acute care so as for reduced abilities in activities of daily living in the medium term.
Asunto(s)
Cuidados Críticos/estadística & datos numéricos , Fracturas de Cadera , Enfermedad de Parkinson , Anciano , Anciano de 80 o más Años , Fracturas de Cadera/complicaciones , Fracturas de Cadera/epidemiología , Fracturas de Cadera/cirugía , Humanos , Persona de Mediana Edad , Enfermedad de Parkinson/complicaciones , Enfermedad de Parkinson/epidemiología , Estudios Prospectivos , Resultado del TratamientoRESUMEN
STUDY DESIGN: Biomechanical cadaver study. OBJECTIVE: The aim of the present study was to evaluate 2 different methods with respect to height restoration and preservation in a cadaver model under cyclic loading. SUMMARY OF BACKGROUND DATA: Standard balloon kyphoplasty (BKP) represents a well-established treatment opportunity for osteoporotic vertebral compression fractures. BKP was developed to restore vertebral height and improve sagittal alignment. Its use has grown significantly over the last 2 decades. In contrast, distinct biomechanical data are missing. Within the last few years, several alternative techniques with regard to height restoration have emerged, such as radiofrequency kyphoplasty (RFK). METHODS: Twenty-five vertebral bodies of 2 female cadavers with secured osteoporosis were examined. Standardized vertebral wedge compression fractures were created. Afterward, 2 groups were randomly assigned: 12 vertebral bodies were treated with BKP and 13 vertebral bodies by RFK under a preload of 100 N. Then the vertebral bodies underwent cyclic loading (100,000 cycles, 100 to 600 N, 5 Hz). Anterior, central, and posterior vertebral body heights were evaluated by CT scans. RESULTS: Anterior height was reduced after fracture 6.3 mm (SD 3) for the BKP group and 7.2 mm (SD 3) in the RFK group (P>0.1). After treatment, the difference in the initial anterior height was 4.5 mm (SD 2) for the BKP group and 4.7 mm (SD 3) for the RFK group (P>0.1). After cyclic loading, the difference was 5.3 mm (SD 3) for the BKP group and 5.2 mm (SD 3) for the RFK group (P>0.1). The average cement volume used was 8.7 mL (SD 1) for the BKP group and 4.8 mL (SD 2) for the RFK group (P<0.0001). CONCLUSIONS: On the basis of our results, the unipedicular RFK in osteoporotic compression fractures might represent a promising alternative for the clinical setting.