scholarly journals Acetabular fractures in the elderly: modern challenges and the role of conservative management

2021 ◽  
Author(s):  
Kunal Mohan ◽  
James M. Broderick ◽  
Hasnain Raza ◽  
Brendan O’Daly ◽  
Michael Leonard
Keyword(s):  
Conservative Management ◽  
Young Patients ◽  
Treatment Strategies ◽  
The Elderly ◽  
High Energy ◽  
Acetabular Fractures ◽  
Individualized Approach ◽  
Vulnerable Patient ◽  
Vulnerable Patient Group

Abstract Introduction  The incidence of acetabular fractures in the elderly population is ever increasing. While management of acetabular fractures in young patients following high-energy trauma is well described, treatment of the elderly patient subgroup is complex and requires a unique, individualized approach. A variety of treatment strategies including operative and non-operative approaches exists to manage this vulnerable patient group. Conservative management of acetabular fractures in the elderly continues to play an important role in treatment of both stable fracture patterns and those medically unfit for surgery. Aim  This review assessing the current literature was undertaken with the purpose of summarising the challenges of management in this at-risk cohort as well as quantifying the role and outcomes following conservative management in the elderly.  Conclusion Our recommendation is that conservative management of acetabular fractures in the elderly can be considered as a treatment option on a case-by-case basis accounting for patient, injury, and surgical factors. If it is to be pursued, we advise a multidisciplinary approach focused on early mobility, minimisation of risk and regular follow-up to optimise patient outcomes.

Blunt chest trauma in the elderly: an expert practice review

2019 ◽  
Vol 37 (2) ◽  
pp. 73-78
Author(s):  
Fraser Birse ◽  
Helen Williams ◽  
David Shipway ◽  
Edward Carlton
Keyword(s):  
Chest Trauma ◽  
The Elderly ◽  
Evidence Base ◽  
Spinal Fracture ◽  
Thoracic Injury ◽  
Common Mechanism ◽  
Vulnerable Patient ◽  
Practice Review ◽  
Vulnerable Patient Group ◽  
Expert Practice

Trauma in the elderly (>65 years) is an increasingly common presentation to the ED. A fall from standing height is the most common mechanism after which such patients present, and rib fracture is the most common non-spinal fracture. Thoracic injury in patients aged over 65 is associated with significant morbidity and mortality. There are currently no universally applied guidelines for assessment, investigation and management of such patients. In this expert practice review, we discuss the evidence base and options for clinical management in this vulnerable patient group.

scholarly journals Single versus separate implant fixation for concomitant ipsilateral femoral neck and shaft fractures: A systematic review

2019 ◽  
Vol 11 (2) ◽  
Author(s):  
Kunal Mohan ◽  
Prasad Ellanti ◽  
Helen French ◽  
Niall Hogan ◽  
Tom McCarthy
Keyword(s):  
Systematic Review ◽  
Femoral Neck ◽  
Young Patients ◽  
Treatment Strategies ◽  
High Energy ◽  
Current Evidence ◽  
Implant Fixation ◽  
High Energy Trauma ◽  
Shaft Fractures ◽  
Significant Difference

Concomitant ipsilateral femoral neck and shaft fractures are uncommon, occurring in 1-9% of femoral shaft fractures. While this injury typically occurs in young patients following high-energy trauma, little consensus has been established regarding the optimal fixation approach. A multitude of treatment strategies exist, with limited evidence as to which is more favorable. The aim of this study was to appraise current evidence, comparing management with either one single or separate devices for both fractures. A systematic review was undertaken in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies published between 1992 and 2018 comparing the rate of postoperative nonunion, malunion, delayed union, avascular necrosis, infection or reoperation between at least one method of single device fixation and one method of separate device fixation were included. Six non-randomized cohort studies assessing 173 patients were suitable for inclusion, each comparing single device cephalomedullary nail fixation of both fractures with a combination of devices. All patients presented following high-energy trauma, at a median age of 32 years. While low complication rate and favorable outcomes were found across both groups, no significant difference could be inferred between either treatment strategy. This injury continues to occur in the traditionally described patient group, and results in acceptable postoperative outcomes. A paucity of randomized studies limits the ability to recommend a single or separate device treatment approach, and as such prospective, randomized trials with adequately powered sample sizes are required to definitively compare surgical management strategies in this rare but complex injury.

scholarly journals Management of High-Energy Acetabular Fractures in the Elderly Individuals

2012 ◽  
Vol 3 (3) ◽  
pp. 95-106 ◽  
Author(s):  
Brian W. Hill ◽  
Julie A. Switzer ◽  
Peter A. Cole
Keyword(s):  
The Elderly ◽  
High Energy ◽  
Acetabular Fractures ◽  
Elderly Individuals

Refining the Role of Radiation Therapy in Pediatric Hodgkin Lymphoma

2012 ◽  
pp. 616-620
Author(s):  
Melissa M. Hudson ◽  
Louis S. Constine
Keyword(s):  
Radiation Therapy ◽  
Hodgkin Lymphoma ◽  
Young Patients ◽  
Treatment Strategies ◽  
Radiation Toxicity ◽  
Term Survival ◽  
Gonadal Dysfunction ◽  
Pediatric Hodgkin Lymphoma ◽  
Age Related

Overview: The role of radiation therapy in the treatment of pediatric Hodgkin lymphoma has continued to be refined, motivated by the desire to avoid disruption to normal tissue development and function and secondary carcinogenesis. Such progress has occurred in tandem with modifications of the multiagent chemotherapy regimens that have been used in place of or in combination with low-dose involved-field radiation that are also associated with dose-related risks of cardiopulmonary and gonadal dysfunction and leukemogenesis. Consequently, treatment strategies for young patients, who have an excellent prognosis of long-term survival, utilizes a risk-adapted approach that provides optimal efficacy for disease control whereas limiting toxicity associated with both radiation and chemotherapy. Because of the differences in age-related developmental status and gender-related sensitivity to chemotherapy and radiation toxicity, no single treatment approach is ideal for all pediatric patients. This manuscript summarizes results from published clinical trials with the goal of defining optimal treatment strategies for children and adolescents with Hodgkin lymphoma in regards to the use of radiation therapy.

scholarly journals Complex Ankle Fractures, Presentation of 3 Cases and Review of the Literature

2020 ◽  
pp. 1-6
Author(s):  
Montoya Saenz Rocio ◽  
Montoya Saenz Rocio ◽  
Carlos Cano ◽  
Marques Parrilla Carlos
Keyword(s):  
Soft Tissue ◽  
Elderly Population ◽  
Young Patients ◽  
Soft Tissue Injuries ◽  
The Elderly ◽  
High Energy ◽  
Ankle Fractures ◽  
Inherent Risk ◽  
Fixation Devices ◽  
Main Complication

Ankle fractures represent a significant percentage of all fractures, and there is currently an increased incidence, both among the elderly population with associated comorbidities and among young patients with high-energy traumas. These fractures have an inherent risk of complications. In this connection, it is crucial that we turn our attention to soft tissue injuries, with wound infection as the main complication in this category. The last objective of this study is to highlight the possible derived complications in complex ankle fractures, and to explain the advantages of the use of different fixation devices, through the presentation of three clinical cases treated in our center. We conclude in order to prevent or reduce the complications resulting from the direct surgical treatment of high-energy trauma in the distal end of the tibia, it is essential to properly manage the soft tissue based on the type of lesion and the characteristics of the patient.

scholarly journals Early Total Hip Replacement for Acetabular Fractures: Does Age Affect the Outcome?

2021 ◽  
pp. 116-125
Author(s):  
Hosam El-Din Yosry Mashal ◽  
Francesco M. Benazzo ◽  
Walid Mohammed Ewis ◽  
Moheb El-Din Ahmed Fadel ◽  
Tarek Ibrahim Abo ElNor ◽  
...  
Keyword(s):  
Hip Replacement ◽  
Functional Outcomes ◽  
Young Patients ◽  
The Elderly ◽  
Young Group ◽  
Elderly Group ◽  
Acetabular Fractures ◽  
Complication Rates ◽  
The Mean

Purpose: The aim of this study is to compare the functional outcomes and complication rates of early total hip replacement (THR) for acetabular fractures in the young versus the elderly populations, in a trial to reach a higher level of evidence to know whether to expand or limit the application of early THR to young patients. Methods: This was a multicenter retrospective comparative study that included patients who underwent early THR for an acetabular fracture in the period from February 2012 to December 2018 in one of three level one trauma centers. Patients were divided into an “elderly group” that included patients 65 years or older (seven males and seven females), and a “young group” that included patients younger than 65 years (11 males and three females). The mean period of follow up was 33.57 months (range 12-84). Results: The mean Harris Hip Score (HHS), at the final follow up, in the elderly group was 82.4 (range 75-92) while the mean HHS in the young group was 91.5 (range 72-100). The mean and median HHS in the young group were significantly higher than those in the elderly group. There was no statistically significant difference in the complication rate between the elderly and young patient groups. Conclusion: Significantly superior functional outcomes are expected from young patients managed with early THR for acetabular fractures compared to elderly patients, with comparable complication rates between both age groups. Therefore, there is more confidence to apply this procedure to younger patients when indicated.

Risks and Strategies to Avoid Approach-Related Complications During Operative Treatment of Pelvic Ring or Acetabular Fractures

2019 ◽  
Author(s):  
Markus Alexander Küper ◽  
Alexander Trulson ◽  
Christian Minarski ◽  
Fabian Stuby ◽  
Ulrich Stöckle ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Impact Energy ◽  
Geriatric Patients ◽  
Pelvic Ring ◽  
Young Patients ◽  
High Energy ◽  
Surgical Approaches ◽  
Acetabular Fractures ◽  
Anatomical Structures ◽  
High Energy Trauma

AbstractInjuries of the pelvic ring or the acetabulum are either to be found in young patients with high energy trauma mechanisms or in geriatric patients after simple falls with very low impact energy. The indication for surgical stabilization is given by the grade of instability. Exact knowledge of the different possible surgical approaches is essential for the planning of the surgical treatment. Both, knowledge of reachable anatomical structures and possible risks of the different approaches are important. In this review, we summarize the standard surgical approaches to the pelvic ring and to the acetabulum. We describe the reachable anatomical structures for each approach, approach-related pitfalls, and we focus on strategies to reduce approach-related complications.

Role of Leukocyte Count, Neutrophil Percentage, and C-Reactive Protein in the Diagnosis of Acute Appendicitis in the Elderly

2005 ◽  
Vol 71 (4) ◽  
pp. 344-347 ◽  
Author(s):  
Horng-Ren Yang ◽  
Yu-Chun Wang ◽  
Ping-Kuei Chung ◽  
Wei-Kung Chen ◽  
Long-Bin Jeng ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Leukocyte Count ◽  
Young Patients ◽  
The Elderly ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Neutrophil Percentage ◽  
Significant Difference ◽  
Leukocyte Counts

Leukocyte count, neutrophil percentage, and C-reactive protein (CRP) have been shown to give valuable information in the diagnosis of acute appendicitis. However, whether these laboratory tests have the same clinical applicability in the elderly as in young patients remains unclear. This retrospective study aimed to clarify the role of these tests in the diagnosis of acute appendicitis in patients aged 60 years or over. Eighty-five consecutive elderly patients underwent appendectomy for suspected acute appendicitis during a 30-month period. Histologically verified appendicitis was found in 77 of the 85 patients (90.6%). There was no significant difference in leukocyte counts or CRP values between patients with acute appendicitis and those with a normal appendix. The sensitivities of leukocyte count, neutrophil percentage, and CRP in the diagnosis of acute appendicitis were 71.4 per cent, 88.3 per cent, and 90 per cent, respectively, while the specificities were 37.5 per cent, 25 per cent, and 37.5 per cent, respectively. Of 77 patients with acute appendicitis, only two had all three tests simultaneously normal. In conclusion, patients with normal results in all three tests are highly unlikely to have acute appendicitis and should be evaluated with extra caution before surgery.

scholarly journals A case of successful conservative management of gallstone ileus

2019 ◽  
Vol 2019 (8) ◽  
Author(s):  
Sherif Monib ◽  
Mohamed Elkorety ◽  
Simon Thomson
Keyword(s):  
Small Intestine ◽  
Conservative Treatment ◽  
Bowel Obstruction ◽  
Conservative Management ◽  
Clinical Picture ◽  
Gallstone Ileus ◽  
The Elderly ◽  
Mechanical Bowel Obstruction ◽  
Uncommon Complication

Abstract Gallstone ileus is an uncommon complication of cholelithiasis but an established cause of mechanical bowel obstruction in the elderly. Perforation of the small intestine proximal to the obstructing gallstone is rare, only a handful of cases having been reported. Management is mainly surgical, but conservative treatment is occasionally appropriate. We report the case of an 86-year-old female who presented with a clinical picture of bowel obstruction, proven to be related to gallstone ileus which resolved spontaneously. We discuss the role of conservative management for this condition.

Smad7 attenuates TGF-β-mediated aging-related hypofunction of submandibular glands

2021 ◽  
pp. 153537022199343
Author(s):  
Minqi Hu ◽  
Wei Liu ◽  
Pingchuan Ma ◽  
Yingyi Wu ◽  
Honglin Li ◽  
...  
Keyword(s):  
Submandibular Gland ◽  
Interstitial Fibrosis ◽  
Treatment Strategies ◽  
Lymphocytic Infiltration ◽  
The Elderly ◽  
Salivary Flow ◽  
Pathological Process ◽  
Submandibular Glands ◽  
Restoration Strategies

Submandibular glands have essential functions in taste, mastication, swallowing, and digestion. Submandibular gland hypofunction is prevalent in the elderly, impairing the patients’ quality of life. Current clinical treatment strategies have not decelerated or reversed the pathological process of submandibular gland hypofunction. Therefore, novel restoration strategies should be explored. However, studies on the mechanism of aging-related submandibular gland hypofunction remain very limited. The role of the TGF-β/Smad pathway in fibrosis has been studied in other organs. Therefore, this study aimed to elucidate the role of TGF-β/Smad signaling in the aging-related submandibular gland hypofunction. The results showed that Smad7 knockout in mice decreased the salivary flow rate. H&E, Masson trichrome, and immunohistochemistry staining of MCP-1 and α-SMA showed that Smad7 knockout in mice resulted in lymphocytic infiltration, acinar cell atrophy, and interstitial fibrosis. The Western blotting of collagen I and III also confirmed extensive fibrosis. We then found that Smad7 depletion resulted in the TGF-β-mediated fibrosis via mir-21, mir-29, and np_5318, and NFκB-driven inflammation activation. This study confirmed the inhibitory role of Smad7 in the aging-related submandibular gland hypofunction. Therefore, it provided a promising treatment target for aging-related dysfunction and sialadenitis of submandibular gland.

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