scholarly journals Outcomes after perioperative SARS-CoV-2 infection in patients with proximal femoral fractures: an international cohort study

BMJ Open ◽  
2021 ◽  
Vol 11 (11) ◽  
pp. e050830
Author(s):  
Keyword(s):  
Cohort Study ◽  
Femoral Fracture ◽  
Preoperative Diagnosis ◽  
Femoral Fractures ◽  
Risk Groups ◽  
Proximal Femoral Fracture ◽  
High Rate ◽  
Published Data ◽  
Proximal Femoral Fractures ◽  
Anaesthetic Care

ObjectivesStudies have demonstrated high rates of mortality in people with proximal femoral fracture and SARS-CoV-2, but there is limited published data on the factors that influence mortality for clinicians to make informed treatment decisions. This study aims to report the 30-day mortality associated with perioperative infection of patients undergoing surgery for proximal femoral fractures and to examine the factors that influence mortality in a multivariate analysis.SettingProspective, international, multicentre, observational cohort study.ParticipantsPatients undergoing any operation for a proximal femoral fracture from 1 February to 30 April 2020 and with perioperative SARS-CoV-2 infection (either 7 days prior or 30-day postoperative).Primary outcome30-day mortality. Multivariate modelling was performed to identify factors associated with 30-day mortality.ResultsThis study reports included 1063 patients from 174 hospitals in 19 countries. Overall 30-day mortality was 29.4% (313/1063). In an adjusted model, 30-day mortality was associated with male gender (OR 2.29, 95% CI 1.68 to 3.13, p<0.001), age >80 years (OR 1.60, 95% CI 1.1 to 2.31, p=0.013), preoperative diagnosis of dementia (OR 1.57, 95% CI 1.15 to 2.16, p=0.005), kidney disease (OR 1.73, 95% CI 1.18 to 2.55, p=0.005) and congestive heart failure (OR 1.62, 95% CI 1.06 to 2.48, p=0.025). Mortality at 30 days was lower in patients with a preoperative diagnosis of SARS-CoV-2 (OR 0.6, 95% CI 0.6 (0.42 to 0.85), p=0.004). There was no difference in mortality in patients with an increase to delay in surgery (p=0.220) or type of anaesthetic given (p=0.787).ConclusionsPatients undergoing surgery for a proximal femoral fracture with a perioperative infection of SARS-CoV-2 have a high rate of mortality. This study would support the need for providing these patients with individualised medical and anaesthetic care, including medical optimisation before theatre. Careful preoperative counselling is needed for those with a proximal femoral fracture and SARS-CoV-2, especially those in the highest risk groups.Trial registration numberNCT04323644

scholarly journals The Prognostic Value of Metabolic Profiling in Older Patients With a Proximal Femoral Fracture

2020 ◽  
Vol 11 ◽  
pp. 215145932096009
Author(s):  
Max P.L. van der Sijp ◽  
H. Eka D. Suchiman ◽  
Monica Eijk ◽  
Dina Vojinovic ◽  
Arthur H. P. Niggebrugge ◽  
...  
Keyword(s):  
Risk Score ◽  
Functional Recovery ◽  
Mortality Risk ◽  
Femoral Fracture ◽  
Patient Population ◽  
Prediction Accuracy ◽  
Prognostic Value ◽  
Femoral Fractures ◽  
Proximal Femoral Fracture ◽  
Proximal Femoral Fractures

Introduction: High mortality rates of approximately 20% within 1 year after treatment are observed for patients with proximal femoral fractures. This preliminary study explores the prognostic value of a previously constructed mortality risk score based on a set of 14 metabolites for the survival and functional recovery in patients with proximal femoral fractures. Materials and Methods: A prospective observational cohort study was conducted including patients admitted with a proximal femoral fracture. The primary outcome was patient survival, and the recovery of independence in activities of daily living was included as a secondary outcome. The mortality risk score was constructed for each patient and its prognostic value was tested for the whole population. Results: Data was available form 136 patients. The mean age of all patients was 82.1 years, with a median follow-up of 6 months. Within this period, 19.0% of all patients died and 51.1% recovered to their prefracture level of independence. The mortality score was significantly associated with mortality (HR, 2.74; 95% CI, 1.61-4.66; P < 0.001), but showed only a fair prediction accuracy (AUC = 0.68) and a borderline significant comparison of the mortality score tertile groups in survival analyses (P = 0.049). No decisive associations were found in any of the analyses for the functional recovery of patients. Discussion: These findings support the previously determined prognostic value of the mortality risk score. However, the independent prognostic value when adjusted for potential confounding factors is yet to be assessed. Also, a risk score constructed for this specific patient population might achieve higher accuracies for the prediction of survival and functional recovery. Conclusions: A modest prediction accuracy was observed for the mortality risk score in this population. More elaborate studies are needed to validate these findings and develop a tailored model for clinical purposes in this patient population.

scholarly journals The value of nonoperative versus operative treatment of frail institutionalized elderly patients with a proximal femoral fracture in the shade of life (FRAIL-HIP); protocol for a multicenter observational cohort study

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Pieter Joosse ◽  
◽  
Sverre A. I. Loggers ◽  
C. L. P. (Marc) Van de Ree ◽  
Romke Van Balen ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Femoral Fracture ◽  
Femoral Fractures ◽  
Proximal Femoral Fracture ◽  
Nonoperative Treatment ◽  
Proximal Femoral Fractures ◽  
Institutionalized Elderly ◽  
Time To Death ◽  
Observational Cohort

Abstract Background Proximal femoral fractures are strongly associated with morbidity and mortality in elderly patients. Mortality is highest among frail institutionalized elderly with both physical and cognitive comorbidities who consequently have a limited life expectancy. Evidence based guidelines on whether or not to operate on these patients in the case of a proximal femoral fracture are lacking. Practice variation occurs, and it remains unknown if nonoperative treatment would result in at least the same quality of life as operative treatment. This study aims to determine the effect of nonoperative management versus operative management of proximal femoral fractures in a selected group of frail institutionalized elderly on the quality of life, level of pain, rate of complications, time to death, satisfaction of the patient (or proxy) and the caregiver with the management strategy, and health care consumption. Methods This is a multicenter, observational cohort study. Frail institutionalized elderly (70 years or older with a body mass index < 18.5, a Functional Ambulation Category of 2 or lower pre-trauma, or an American Society of Anesthesiologists score of 4 or 5), who sustained a proximal femoral fracture are eligible to participate. Patients with a pathological or periprosthetic fractures and known metastatic oncological disease will be excluded. Treatment decision will be reached following a structured shared decision process. The primary outcome is quality of life (Euro-QoL; EQ-5D-5 L). Secondary outcome measures are quality of life measured with the QUALIDEM, pain level (PACSLAC), pain medication use, treatment satisfaction of patient (or proxy) and caregivers, quality of dying (QODD), time to death, and direct medical costs. A cost-utility and cost-effectiveness analysis will be done, using the EQ-5D utility score and QUALIDEM score, respectively. Non-inferiority of nonoperative treatment is assumed with a limit of 0.15 on the EQ-5D score. Data will be acquired at 7, 14, and 30 days and at 3 and 6 months after trauma. Discussion The results of this study will provide insight into the true value of nonoperative treatment of proximal femoral fractures in frail elderly with a limited life expectancy. The results may be used for updating (inter)national treatment guidelines. Trial registration The study is registered at the Netherlands Trial Register (NTR7245; date 10-06-2018).

scholarly journals PROXIMAL DISABILITY AND SPINAL DEFORMITY INDEX IN PATIENTS WITH PROXIMAL FEMUR FRACTURES

2015 ◽  
Vol 14 (4) ◽  
pp. 276-280
Author(s):  
Sylvio Mistro Neto ◽  
Marcelo Italo Risso Neto ◽  
Guilherme Rebechi Zuiani ◽  
Roberto Rossanez ◽  
Gabriel Gomes Freitas de Castro ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Spinal Deformity ◽  
Femoral Fracture ◽  
Strong Association ◽  
Femoral Fractures ◽  
Proximal Femoral Fracture ◽  
Proximal Femoral Fractures ◽  
Femur Fractures ◽  
Spinal Deformity Index

Objective : To evaluate the quality of life related to the spine in patients with proximal femoral fractures. Methods : Study conducted in a tertiary public hospital in patients with proximal femoral fractures caused by low-energy trauma, through the Oswestry Disability Index questionnaire to asses complaints related to the spine at the time of life prior to the femoral fracture. The thoracic and lumbar spine of patients were also evaluated applying the radiographic index described by Gennant (Spinal Deformity Index), which assesses the number and severity of fractures. Results : Seventeen subjects completed the study. All had some degree of vertebral fracture. Patients were classified in the categories of severe and very severe disability in the questionnaire about quality of life. It was found that the higher SDI, the better the quality of life. Conclusion : There is a strong association of disability related to the spine in patients with proximal femoral fracture, and this complaint must be systematically evaluated in patients with appendicular fracture.

Necrosis avascular

2020 ◽  
Vol 63 (2) ◽  
pp. 18-23
Author(s):  
Alejandro Jardón Gómez ◽  
Ana Cristina King ◽  
Carlos Pacheco Díaz
Keyword(s):  
Femoral Head ◽  
Avascular Necrosis ◽  
Femoral Fracture ◽  
Open Fracture ◽  
Clinical Presentation ◽  
Femoral Fractures ◽  
Proximal Femoral Fracture ◽  
Young Population ◽  
Steroid Use

The clinical presentation of a proximal femoral fracture is completely different between young and adult patients. Unlike closed proximal femoral fractures, the incidence of exposed fractures is found in the young population between 15 and 30 years of age. Osteonecrosis of the femoral head is one the complications we can find in this type of fractures. Avascular necrosis (AVN or osteonecrosis) is defined as the interruption of blood supply to the femoral head due to trauma, infectionalcohol or steroid use, resulting in bone necrosis, joint collapse and osteoarthrosis. The treatment will depend on the clinical presentation, age of the patient and when the diagnosis is made. This is a case report of a 16-year-old patient with a gunshot wound on the hip. Surgical cleansing and closed reduction plus internal fixation with a nail in the center of the spine were performed. A 3-year clinical and radiographic follow up was made, observing the evolution of the fracture and the subsequent avascular necrosis that the patient presented. Key words: Proximal femoral fracture; hip; avascular necrosis (AVN, osteonecrosis); open fracture; osteoarthritis.

scholarly journals The Mental Capacity Act 2005: review of mental capacity assessment in people with proximal femoral fracture

2010 ◽  
Vol 34 (7) ◽  
pp. 284-286 ◽  
Author(s):  
P. Guyver ◽  
P. Hindle ◽  
J. Harrison ◽  
N. Jain ◽  
M. Brinsden
Keyword(s):  
Staff Training ◽  
Femoral Fractures ◽  
Proximal Femoral Fracture ◽  
Mental Capacity ◽  
Clinical Implications ◽  
Proximal Femoral Fractures ◽  
Mental Capacity Act 2005 ◽  
Consent To Treatment ◽  
Mental Capacity Act ◽  
The Impact

Aims and methodTo ascertain whether patients with proximal femoral fractures were being correctly assessed in line with the Mental Capacity Act 2005. Fifty people admitted with proximal femoral fractures were audited to assess whether they had given consent to treatment in accordance with the Act. A Mental Capacity Act 2005 guidance and assessment form was then introduced accompanied by staff training. A re-audit was undertaken to assess the impact.ResultsThe initial audit showed that only one person (2%) had been properly assessed. The re-audit demonstrated that the use of the Mental Capacity Act 2005 assessment form ensured correct assessment.Clinical implicationsOur findings suggest the form is a useful tool in the documentation and assessment of an individual's capacity under the Mental Capacity Act.

A BIOMECHANICAL VALIDATION OF A NEW FEMORAL NECK FIXATION DYNAMIC HIP SCREW FOR PROXIMAL FEMORAL FRACTURE

2010 ◽  
Vol 22 (01) ◽  
pp. 53-59 ◽  
Author(s):  
Shih-Wei Lin ◽  
Jaw-Lin Wang
Keyword(s):  
Femoral Neck ◽  
Mechanical Test ◽  
Femoral Fractures ◽  
Vertical Displacement ◽  
Proximal Femoral Fracture ◽  
Dynamic Hip Screw ◽  
Fixation Strength ◽  
Proximal Femoral Fractures ◽  
Suitable Site ◽  
Hip Screw

High failure rates are expected in the treatment of osteoporotic proximal femoral fractures. A newly designed femoral neck locking dynamic hip screw has been developed to increase the fixation strength; a biomechanical examination was performed to prove its efficacy. Femoral surrogate specimens were used for the test. Unstable intertrochanteric fractures were created on specimens. Then these specimens were divided into two groups to test two different methods of fixation: (1) the conventional dynamic hip screw and (2) the new designed femoral neck fixation dynamic hip screw. For each specimen, the peak cyclic loading was 800 N, and a total of 20,000 cycles were applied. The vertical displacement, rotation around the long axis of lag screw, and the varus rotation around the center of femoral head between the two groups were compared at specific intervals. All the conventional dynamic hip screw constructs failed within 1000 cycles, while no gross mechanical failure was recorded for the femoral neck fixation dynamic hip construct even after 20,000 loading cycles. The mechanical test comparing the two constructs at the end of each 1000 loading cycles demonstrated that the femoral neck fixation dynamic hip screw construct is stronger than that of the conventional dynamic hip screw. For the fixation of proximal femoral fractures, the femoral neck fixation dynamic hip screw can provide a stronger support than what a conventional dynamic hip screw can do. At the same time, femoral neck can be a suitable site for the application of proximal locking screws.

The impact of antegrade intramedullary nailing start site using the SIGN nail in proximal femoral fractures: A prospective cohort study

Injury ◽  
2018 ◽  
Vol 49 (2) ◽  
pp. 323-327 ◽  
Author(s):  
Mohamed Mustafa Diab ◽  
Hao-Hua Wu ◽  
Edmund Eliezer ◽  
Billy Haonga ◽  
Saam Morshed ◽  
...  
Keyword(s):  
Cohort Study ◽  
Intramedullary Nailing ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Femoral Fractures ◽  
Start Site ◽  
Proximal Femoral Fractures ◽  
The Impact

Proximal Femoral Fractures in the Female Patient, a Controlled Trial: The Role of the Occupational Therapist and the Physiotherapist

1992 ◽  
Vol 55 (10) ◽  
pp. 397-400 ◽  
Author(s):  
Anita Burns ◽  
Kay Park
Keyword(s):  
Multidisciplinary Approach ◽  
Controlled Trial ◽  
Femoral Fractures ◽  
Proximal Femoral Fracture ◽  
Level Of Care ◽  
Proximal Femoral Fractures ◽  
Randomised Study ◽  
Shorten Hospital Stay ◽  
Intensive Physiotherapy

A randomised study was aimed at determining whether collaborative care of the proximal femoral fracture patient, by a multidisciplinary approach involving intensive physiotherapy and occupational therapy, could shorten hospital stay, improve personal independence at discharge and reduce the level of care needed after discharge.

scholarly journals The Bristol Hip View: Its Role in the Diagnosis and Surgical Planning and Occult Fracture Diagnosis for Proximal Femoral Fractures

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
J. Harding ◽  
T. J. S. Chesser ◽  
M. Bradley
Keyword(s):  
Femoral Fractures ◽  
Proximal Femoral Fracture ◽  
Proximal Femoral Fractures ◽  
Cross Sectional ◽  
Lateral Projection ◽  
Cross Sectional Imaging ◽  
Fracture Diagnosis ◽  
Occult Fractures ◽  
Sectional Imaging ◽  
Better Than

Aim. To evaluate whether a modified radiographic view of the femoral neck improves the diagnosis of occult proximal femoral.Materials and Methods. Prospective study of patients presenting with clinically suspected proximal femoral fractures or who underwent traditional plain radiographic views and the Bristol hip view (a 30-degree angled projection). Six blinded independent observers assessed the images for presence of a fracture, anatomical level, and displacement.Results. 166 consecutive patients presenting with the clinical diagnosis of a proximal femoral fracture, of which 61 sustained a fracture. Six of these were deemed occult due to negative plain and had proven fractures on subsequent cross-sectional imaging. The Bristol hip view demonstrated five of these six fractures. It performed better than the traditional lateral hip view to identify the injury. The Bristol hip view predicted correctly the fracture type and displacement in all cases and missed only one of the occult fractures.Conclusion. The Bristol hip view is more sensitive and clearer than a lateral projection for patients. It adds useful diagnostic information and performs better than the traditional views in occult fractures. Its use may prevent the need for further cross sectional imaging and subsequent surgical delay.

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