Mortality and functional outcomes of fragility fractures of the pelvis by fracture type with conservative treatment: a retrospective, multicenter TRON study

2021 ◽  
Author(s):  
Toshifumi Omichi ◽  
Yasuhiko Takegami ◽  
Katsuhiro Tokutake ◽  
Yuki Saito ◽  
Osamu Ito ◽  
...  
Keyword(s):  
Conservative Treatment ◽  
Functional Outcomes ◽  
Fragility Fractures ◽  
Fracture Type

scholarly journals Too Cool? Hip Fracture Care and Maintaining Body Temperature

2020 ◽  
Vol 11 ◽  
pp. 215145932094947
Author(s):  
James Arkley ◽  
Suhib Taher ◽  
Ján Dixon ◽  
Gemma Dietz-Collin ◽  
Stacey Wales ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Temperature Control ◽  
Functional Outcomes ◽  
Surgical Site Infections ◽  
Fragility Fractures ◽  
Perioperative Period ◽  
Readmission Rates ◽  
Comprehensive Review ◽  
Fracture Care ◽  
Increase Risk

Introduction: Patients with hip fractures can become cold during the perioperative period despite measures applied to maintain warmth. Poor temperature control is linked with increasing complications and poorer functional outcomes. There is generic evidence for the benefits of maintaining normothermia, however this is sparse where specifically concerning hip fracture. We provide the first comprehensive review in this population. Significance: Large studies have revealed dramatic impact on wound infection, transfusion rates, increased morbidity and mortality. With very few studies relating to hip fracture patients, this review aimed to capture an overview of available literature regarding hypothermia and its impact on outcomes. Results: Increased mortality, readmission rates and surgical site infections are all associated with poor temperature control. This is more profound, and more common, in older frail patients. Increasing age and lower BMI were recognized as demographic factors that increase risk of hypothermia, which was routinely identified within modern day practice despite the use of active warming. Conclusion: There is a gap in research related to fragility fractures and how hypothermia impacts outcomes. Inadvertent intraoperative hypothermia still occurs routinely, even when active warming and cotton blankets are applied. No studies documented temperature readings postoperatively once patients had been returned to the ward. This is a point in the timeline where patients could be hypothermic. More studies need to be performed relating to this area of surgery.

Displaced fragility fractures of proximal humerus in elderly patients affected by severe comorbidities: percutaneous fixation and conservative treatment

2013 ◽  
Vol 25 (4) ◽  
pp. 447-452 ◽  
Author(s):  
Massimo Innocenti ◽  
Christian Carulli ◽  
Roberto Civinini ◽  
Fabrizio Matassi ◽  
Massimiliano Tani ◽  
...  
Keyword(s):  
Conservative Treatment ◽  
Elderly Patients ◽  
Proximal Humerus ◽  
Fragility Fractures ◽  
Percutaneous Fixation

Significance of Kinetotherapy in Rehabilitation Treatment of Osteoporosis

2013 ◽  
Author(s):  
Petru A. Pop ◽  
Liviu Lazar ◽  
Florin M. Marcu
Keyword(s):  
Conservative Treatment ◽  
Physical Inactivity ◽  
Fragility Fractures ◽  
Future Research ◽  
Mineral Density ◽  
Treatment Of Osteoporosis ◽  
Rehabilitation Treatment ◽  
Quality Life ◽  
Recovery Treatment ◽  
Support Devices

Osteoporosis is a systemic skeleton disease, characterized by a low bone mass and micro-architectural deterioration of bone tissue with consecutive increasing of fragile bones and susceptibility of fractures. Risk facture, advanced ages, family history, rheumatoid arthritis, low calcium intake, physical inactivity, and low body weight can lead to this condition. The aim of treatment in osteoporosis is to grow-up the bone mineral density of the skeleton and to increase resorption of formed bone, used diverse methods as medications, conservative measures, weight reduction, physical and occupational therapy, mechanical support devices and surgery. This paper presents a balneal-conservative treatment applied to 82 patients diagnosed with osteoporosis from Rehabilitation Clinical Hospital of Felix Spa in 2011–2012, which has combined with a kinetotherapy and medication treatment. The complex rehabilitation treatment involves balneal-physical-kinetic recovery treatment that must be periodical repeated every six months, while the subjects themselves at home followed the kinetotherapy with drugs between balneal-treatments at hospital. The significance of rehabilitation treatment for the osteoporosis patients is to rise both functional and independence level, and improving their quality life. DEXA, Qualeffo-41 Test, fragility fractures, difference of height patients, using the statistical analysis have performed the evaluation of trial. These results emphasized the efficiency of balneal-rehabilitation treatment with main accent on respect the kinetotherapy applied the osteoporosis patients. The future research will be focused upon the implementation of vibration therapy with balneal-conservative treatment on patients with osteoporosis to reduce the therapy time and improving the quality patients life.

scholarly journals Conservative Treatment Versus Repair Deltoid in SER Type IV Equivalent Ankle Fracture

2018 ◽  
Vol 3 (2) ◽  
pp. 2473011418S0000
Author(s):  
Chamnanni Rungprai
Keyword(s):  
Conservative Treatment ◽  
Functional Outcomes ◽  
Ankle Fracture ◽  
Deltoid Ligament ◽  
Medial Side ◽  
Type Iv ◽  
Sf 36 ◽  
Fibular Fixation ◽  
Return To Activity

Category: Trauma Introduction/Purpose: There remains a controversy to repair deltoid ligament in SER type IV equivalence of acute ankle fracture. Some surgeons prefer conservative treatment with casting while others prefer to repair deltoid ligament after distal fibular fixation. However, there is a little evidence to report comparative outcomes between the two methods. There remains a controversy to repair deltoid ligament in SER type IV equivalence of acute ankle fracture. Some surgeons prefer conservative treatment with casting while others prefer to repair deltoid ligament after distal fibular fixation. However, there is a little evidence to report comparative outcomes between the two methods. The purpose of this study was to report clinical and functional outcomes including complications between the two methods. Methods: A prospective, randomized collected data of 41 consecutive patients who were diagnosed with SER type IV equivalence acute ankle fracture and underwent either conservative treatment (20 patients) or deltoid repair (21 patients) between 2015 and 2017. A minimum follow up to be included in the study was 6 months (mean, 13.2 months; range, 6 to 30 months). The primary outcome was visual analogue scale (VAS), Short Form-36 (SF-36); physical and mental component scores, and FAAM; ADL and Sport. Pre- and post-operative SF-36, FAAM, and pain (Visual Analog Scale) were obtained and compared between the two groups using independent t-test. The secondary outcomes were time to return to activity of daily living, sports, work, and complications. Results: There were 41 patients (30 male and 11 female) with mean age of 29.7 years (range, 18-70 years) and mean BMI of 26.7 kg/m2 (range, 18.3-33.6 kg/m2). Both methods demonstrated significant improvement of post-operative functional outcomes (FAAM, SF-36, and VAS (p < 0.05 all)) compared to pre-operative period; however, there was no significant different between the two groups. Functional outcomes between casting and deltoid repair groups were time to return to activity of daily living (10.4 vs 11.7 weeks), works (12.1 vs 12.9 weeks), sport (25.9 vs 23.7 weeks), weight bearing medial clear space (2.9 vs 3.9 mm), and complications included medial side ankle pain (57 vs 15%) and painful scar (0 vs 15%) for cast and deltoid repair respectively. Conclusion: Both casting and deltoid repair were demonstrated significant improvement in terms of functional outcomes as measured with the FAAM, SF-36, and VAS in patients with SER IV equivalent ankle fracture. Although there was no significant difference of functional outcome in short term of follow-up, deltoid repair group was better in term of medial side ankle pain and lesser medial clear space widening.

scholarly journals Indications and results of osteosynthesis for proximal humerus fragility fractures in elderly patients

2020 ◽  
Vol 12 (1) ◽  
Author(s):  
Luigi Murena ◽  
Gianluca Canton ◽  
Chiara Ratti ◽  
Bramir Hoxhaj ◽  
Gioia Giraldi ◽  
...  
Keyword(s):  
Conservative Treatment ◽  
Full Text ◽  
Elderly Population ◽  
Proximal Humerus ◽  
Surgical Techniques ◽  
Fragility Fractures ◽  
The Elderly ◽  
Postoperative Rehabilitation ◽  
Rehabilitation Protocols ◽  
Clinical Conditions

Proximal humerus fractures (PHF) are common injuries in the elderly population. Conservative treatment is indicated for undisplaced and stable fractures, which account for almost 80% of the cases. More complex fracture patterns might need surgery, with a wide variety of indication criteria and surgical techniques described in the literature. Surgical treatment should be reserved for patients in good clinical conditions, autonomous in daily living activities and able to adhere to postoperative rehabilitation protocols. In the elderly population with severe osteoporosis, cognitive impairment and clinical comorbidities, the risk of surgical failures is high. In these patients, the choice between surgical and conservative treatment, as well as for the type of procedure, is even more difficult, with no general consensus in the literature. Final indication is usually conditioned by surgeon’s experience and preference. Two independent reviewers (B.H and G.G) independently extracted studies on proximal humeral fractures. All selected studies were screened independently (B.H and G.G) based on title and abstract. Then the full text of any article that either judged potentially eligible was acquired and reviewed again. Any disagreement was resolved by discussing the full text manuscripts. Aim of the present paper is to review the literature about indications and results of osteosynthesis for proximal humerus fragility fractures in the elderly population.

scholarly journals Does Surgical Repair Benefit Pipkin Type I Femoral Head Fractures?: A Systematic Review and Meta-Analysis

Life ◽  
2022 ◽  
Vol 12 (1) ◽  
pp. 71
Author(s):  
Sung Huang Laurent Tsai ◽  
Wei-Che Tai ◽  
Tsai-Sheng Fu ◽  
Eric H. Tischler ◽  
Rafa Rahman ◽  
...  
Keyword(s):  
Systematic Review ◽  
Decision Making ◽  
Femoral Head ◽  
Conservative Treatment ◽  
Clinical Outcomes ◽  
Functional Outcomes ◽  
Open Reduction ◽  
Meta Analysis ◽  
Fragment Excision

Background: Femoral head fractures are rare injuries with or without traumatic dislocations. The management of these fractures is crucial to prevent the development of severe complications and to achieve optimal functional outcomes. Wide treatment options for Pipkin 1 femoral head fractures range from fragment excision, fixation following open reduction with internal fixation, or conservative treatment such as close reduction alone after fracture dislocation. However, the best decision making remains controversial not only due to lack of large trials, but also inconsistent results reported. Therefore, we aim to compare the operative with nonoperative outcomes of Pipkin type 1 patients. Patients and Methods: We systemically searched MEDLINE, EMBASE, Cochrane library, In-Process & Other Non-Indexed Citations to identify studies assessing outcomes of Pipkin type 1 patients after conservative treatment, and open reduction with excision or fixation. Data on comparison of clinical outcomes of each management were extracted including arthritis, heterotopic ossification (HO), avascular necrosis (AVN), and functional scores (Thompson Epstein, Merle’ d Augine and Postel Score). We performed a meta-analysis with the available data. Results: Eight studies (7 case series and 1 RCT) were included in this study. In a pooled analysis, the overall rate of arthritis was 37% (95% CI, 2–79%), HO was 20% (95% CI, 2–45%), and AVN was 3% (95% CI, 0–16%). In comparison of management types, the excision group reached the best functional outcomes including Thompson Epstein Score (poor to worse, 9%; 95% CI, 0–27%) and Merle d’ Aubigne and Postel Score (poor to worse, 18%; 95% CI, 3–38%); ORIF group had the highest AVN rate (11%; 95% CI, 0–92%); conservative treatment had the highest arthritis rate (67%; 95% CI: 0–100%) and lowest HO rate (2%; 95% CI, 0–28%). Discussion: This meta-analysis demonstrates that different procedures lead to various clinical outcomes: fragment excision may achieve better function, conservative treatment may result in a higher arthritis rate, while ORIFs may have a higher AVN rate. These findings may assist surgeons in tailoring their decision-making to specific patient profiles. Future RCTs with multicenter efforts are needed to validate associations found in this study. Level of Evidence: II, systematic review and meta-analysis.

scholarly journals The incidence of clinical fractures in adults aged 50 years and older in Spain

2020 ◽  
Vol 4 (2) ◽  
Author(s):  
Carmen Gomez-Vaquero ◽  
Lidia Valencia ◽  
Joan M Nolla ◽  
Dolors Boquet ◽  
Silvia Martínez Pardo ◽  
...  
Keyword(s):  
Emergency Department ◽  
Fragility Fractures ◽  
Reference Population ◽  
Fracture Incidence ◽  
Validation Sample ◽  
Fracture Type ◽  
Entire Sample ◽  
Clinical Fractures ◽  
Validation Technique ◽  
Age And Sex

Abstract Objective The aim of this study was to quantify the incidence of all clinical fractures, including traumatic and fragility fractures, in patients aged 50 years and older, and to describe their distribution by fracture location, sex and age. Methods The incidence of clinical fractures at 10 hospitals in Catalonia, with a reference population of 3 155 000 inhabitants, was studied. For 1 week, from 30 May to 5 June 2016, we reviewed the discharge reports of the Traumatology section of the Emergency Department to identify all fractures diagnosed in patients ≥50 years of age. As a validation technique, data collection was carried out for 1 year at one of the centres, from 1 December 2015 to 30 November 2016. The fracture incidence, including the 95% CI, was estimated for the entire sample and grouped by fracture type, location, sex and age. Results A total of 283 fractures were identified. Seventy per cent were in women, with a mean age of 72 years. The overall fracture incidence was 11.28 per 1000 person-years (95% CI: 11.10, 11.46), with an incidence of traumatic and fragility fractures of 4.15 (95% CI: 4.04, 4.26) and 7.13 per 1000 person-years (95% CI: 6.99, 7.28), respectively. The incidence of fractures observed in the validation sample coincided with that estimated for the whole of Catalonia. The most common fragility fractures were of the hip, forearm, humerus and vertebrae. Conclusion The results of this study are the first to estimate the incidence of clinical fragility fractures in Spain, grouped by location, age and sex.

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