Persistent pain and depression after hip fracture strongly correlate with poor outcomes

2015 ◽  
Vol 6 (4) ◽  
pp. 399-404 ◽  
Author(s):  
G. Pidemunt ◽  
D. Pérez-Prieto ◽  
A. Ginés-Cespedosa ◽  
J. Suils-Ramon ◽  
L. Puig-Verdié ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Persistent Pain ◽  
Poor Outcomes

scholarly journals Peripheral IL-6 Levels but not Sarcopenia Are Predictive of 1-Year Mortality After Hip Fracture in Older Patients

2020 ◽  
Vol 75 (10) ◽  
pp. e130-e137
Author(s):  
Paloma Bermejo-Bescós ◽  
Sagrario Martín-Aragón ◽  
Alfonso José Cruz-Jentoft ◽  
Ana Merello de Miguel ◽  
María-Nieves Vaquero-Pinto ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Muscle Mass ◽  
Older Patients ◽  
Primary Outcome Measure ◽  
First Year ◽  
Increased Risk ◽  
European Working ◽  
Cutoff Points ◽  
Poor Outcomes ◽  
Definition Of

Abstract Background Sarcopenic patients may have an increased risk of poor outcomes after a hip fracture. The objective of this study was to determine whether sarcopenia and a set of biomarkers were potential predictors of 1-year-mortality in older patients after a hip fracture. Methods About 150 patients at least 80 years old were hospitalized for the surgical treatment of a hip fracture. The primary outcome measure was the death in the first year after the hip fracture. Sarcopenia was defined at baseline by having both low muscle mass (bioimpedance analysis) and handgrip and using the updated European Working Group on Sarcopenia in Older People (EWGSOP2) definition of probable sarcopenia. Janssen’s (J) and Masanés (M) cutoff points were used to define low muscle mass. Results Mortality 1 year after the hip fracture was 11.5%. In univariate analyses, baseline sarcopenia was not associated with mortality, using neither of the muscle mass cutoff points: 5.9% in sarcopenic (J) versus 12.4% in non-sarcopenic participants (p = .694) and 16% in sarcopenic (M) versus 9.6% in non-sarcopenic participants (p = .285). Probable sarcopenia (EWGSOP2) was not associated with mortality. Peripheral levels of IL-6 at baseline were significantly higher in the group of participants who died in the year after the hip fracture (17.14 ± 16.74 vs 11.42 ± 7.99 pg/mL, p = .026). TNF-α peripheral levels had a nonsignificant trend to be higher in participants who died. No other biomarker was associated with mortality. Conclusions Sarcopenia at baseline was not a predictor of 1-year mortality in older patients after a hip fracture. IL-6 was associated with a higher risk of mortality in these patients, regardless of sarcopenia status.

scholarly journals Role of Arthroscopy in Ankle Fracture Surgery

2019 ◽  
Vol 7 (11_suppl6) ◽  
pp. 2325967119S0045
Author(s):  
Jae Hoon Ahn
Keyword(s):  
Internal Fixation ◽  
Ankle Fracture ◽  
Postoperative Outcome ◽  
Persistent Pain ◽  
Ankle Arthroscopy ◽  
Ankle Fractures ◽  
Definitive Treatment ◽  
Syndesmosis Injury ◽  
Poor Outcomes

The ankle arthroscopy is widely used as an essential tool for the various ankle disorders. The use of arthroscopy has also been tried for the treatment of acute ankle fractures, in the hope of improving the postoperative outcome. It was initially thought that the properly reduced ankle fractures had generally acceptable outcomes, with a reported rate of 81% good to excellent results. However further investigation and longer term follow-up has shown more mixed and less encouraging results. Some patients have persistent pain and poor outcomes following open reduction and internal fixation (ORIF), although the cause of poor outcome is not clearly understood. It may be secondary to intra-articular injuries at the time of fracture, which occur in up to 88% of fractures. Ankle arthroscopy at the time of ORIF has been proposed to address these intraarticular injuries. Arthroscopy-assisted reduction and percutaneous screw fixation for syndesmosis injury has been performed as well by some surgeons. However the effectiveness of true arthroscopic reduction and internal fixation compared with ORIF for ankle fractures has yet to be determined, in spite of the advantages such as limited exposure, preservation of blood supply, and improved visualization of the pathology. Postoperative chronic pain and arthrofibrosis after ankle fracture are another good indication for ankle arthroscopy, which can be performed at the time of implant removal. In conclusion, the ankle arthroscopy is a safe adjunctive procedure for the treatment of ankle fractures. It can be performed as well for the evaluation and management of syndesmotic injury, and for persistent pain following the definitive treatment of ankle fractures.

scholarly journals Utility of Geriatric Assessment in the Projection of Early Mortality Following Hip Fracture in the Elderly Patients

2018 ◽  
Vol 9 ◽  
pp. 215145931881397 ◽  
Author(s):  
Aunaly Palmer ◽  
Lisa A. Taitsman ◽  
May J. Reed ◽  
Bala G. Nair ◽  
Itay Bentov
Keyword(s):  
Hip Fracture ◽  
Hip Fractures ◽  
Demographic Data ◽  
Geriatric Medicine ◽  
The Elderly ◽  
Energy Mechanism ◽  
Intraoperative Hypotension ◽  
Short Term Mortality ◽  
The Mean ◽  
Poor Outcomes

Hip fractures result in significant morbidity and mortality in elders. Indicators of frailty are associated with poor outcomes. Commonly used frailty tools rely on motor skills that cannot be performed by this population. We determined the association between the Charlson Comorbidity Score (CCS), intraoperative hypotension (IOH), and a geriatric medicine consult index (GCI) with short-term mortality in hip fracture patients. A retrospective cohort study was conducted at a single institution over a 2-year period. Patients aged 65 years and older who sustained a hip fracture following a low-energy mechanism were identified using billing records and our orthopedic fracture registry. Medical records were reviewed to collect demographic data, fracture classification and operative records, calculation of CCS, intraoperative details including hypotension, and assessments recorded in the geriatric consult notes. The GCI was calculated using 30 dichotomous variables contained within the geriatric consult note. The index, ranging from 0 to 1, included markers for physical and cognitive function, as well as medications. A higher GCI score indicated more markers for frailty. One hundred eight patients met inclusion criteria. Sixty-four (59%) were females and the average age was 77.3 years. Thirty-five (32%) patients sustained femoral neck fractures, and 73 (68%) patients sustained inter-/pertrochanteric hip fractures. The 30-day mortality was 6%; the 90-day mortality was 13%. The mean GCI was 0.30 in the 30-day survivor group as compared to 0.52 in those who died. The mean GCI was 0.28 in patients who were alive at 90 days as compared to 0.46 in those who died. In contrast, the CCS and IOH were not associated with 30- or 90-day mortality. In our older hip fracture patients, an index calculated from information routinely obtained in the geriatric consult evaluation was associated with 30- and 90-day mortality, whereas the CCS and measures of IOH were not.

scholarly journals Early mobility after fragility hip fracture: a mixed methods embedded case study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Lynn Haslam-Larmer ◽  
Catherine Donnelly ◽  
Mohammad Auais ◽  
Kevin Woo ◽  
Vincent DePaul
Keyword(s):  
Hip Fracture ◽  
Healthcare Provider ◽  
Functional Decline ◽  
Healthcare Providers ◽  
Early Mobility ◽  
Fragility Hip Fracture ◽  
Increased Risk ◽  
Poor Outcomes ◽  
Embedded Case Study

Abstract Background Following a hip fracture up to 60% of patients are unable to regain their pre-fracture level of mobility. For hospitalized older adults, the deconditioning effect of bedrest and functional decline has been identified as the most preventable cause of ambulation loss. Recent studies demonstrate that this older adult population spends greater than 80% of their time in bed during hospitalization, despite being ambulatory before their fracture. We do not fully understand why there continues to be such high rates of sedentary times, given that evidence demonstrates functional decline is preventable and early mobility recommendations have been available for over a decade. Methods A descriptive mixed method embedded case study was selected to understand the phenomenon of early mobility after fragility hip fracture surgery. In this study, the main case was one post-operative unit with a history of recommendation implementation, and the embedded units were patients recovering from hip fracture repair. Data from multiple sources provided an understanding of mobility activity initiation and patient participation. Results Activity monitor data from eighteen participants demonstrated a mean sedentary time of 23.18 h. Median upright time was 24 min, and median number of steps taken was 30. Qualitative interviews from healthcare providers and patients identified two main categories of themes; themes external to the person and themes unique to the person. We identified four factors that can influence mobility; a patient’s pre-fracture functional status, cognitive status, medical unpredictability, and preconceived notions held by healthcare providers and patients. Conclusions There are multi-level factors that require consideration with implementation of best practice interventions, namely, systemic, healthcare provider related, and patient related. An increased risk of poor outcomes occurs with compounding multiple factors, such as a patient with low pre-fracture functional mobility, cognitive impairment, and a mismatch of expectations. The study reports several variables to be important considerations for facilitating early mobility. Communicating mobility expectations and addressing physical and psychological readiness are essential. Our findings can be used to develop meaningful healthcare provider and patient-centred interventions to address the risks of poor outcomes.

Impact of place of residence, frailty and other factors on rehabilitation outcomes post hip fracture

2020 ◽  
Author(s):  
Stephanie Low ◽  
Edmund Wee ◽  
Michael Dorevitch
Keyword(s):  
Hip Fracture ◽  
Residential Care ◽  
Functional Independence Measure ◽  
Inpatient Rehabilitation ◽  
Functional Independence ◽  
Community Dwelling ◽  
Hip Fracture Surgery ◽  
Rehabilitation Outcomes ◽  
Poor Outcomes ◽  
Fracture Surgery

Abstract Background Following hip fracture surgery, patients from residential care are frequently excluded from inpatient rehabilitation. We aimed to assess the impact of place of residence and other factors such as frailty on rehabilitation outcomes after hip fracture surgery. Methods Retrospective cohort study. Outcome measures included Functional Independence Measure efficiency, discharge destination and recovery of pre-fracture mobility. Univariable and multivariable linear or logistic regression analyses were performed. Setting One general rehabilitation and two geriatric evaluation and management wards in a large public tertiary teaching hospital. Participants A total of 844 patients who underwent inpatient rehabilitation after hip fracture surgery from 2010 to 2018. Results There were 139 (16%) patients from residential care. Being from residential care was not an independent predictor of poor outcomes. Premorbid frailty (Clinical Frailty Scale) was the strongest independent predictor of poorer Functional Independence Measure efficiency, inability to recover pre-fracture mobility and return to community dwelling. Dementia and delirium were also independently predictive of poor outcomes across all measures. Age > 90 years was independently predictive of inability to recover pre-fracture mobility and return to community dwelling. Conclusion Being from residential care is not independently associated with poor outcomes following inpatient rehabilitation after hip fracture surgery and should not be the basis for excluding these patients from rehabilitation. Major predictors of poorer outcomes include premorbid frailty, dementia, delirium and age > 90 years. If able and motivated, those with potentially reversible functional limitations should be given the opportunity to participate in inpatient rehabilitation as even small gains can have a significant impact on quality of life.

GERIATRIC SYNDROMES IN OLDER SURGICAL PATIENTS: A LITERATURE REVIEW

2013 ◽  
pp. 1-6
Author(s):  
P.J . McRae ◽  
A.M. MUDGE ◽  
N.M. PEEL ◽  
P.J. WALKER
Keyword(s):  
Hip Fracture ◽  
Literature Review ◽  
Usual Care ◽  
Observational Studies ◽  
Surgical Patients ◽  
Geriatric Syndromes ◽  
Admission Screening ◽  
Older Inpatients ◽  
Poor Outcomes ◽  
Type Of Surgery

With the ageing of the population, surgical wards are caring for an increased proportion of olderpatients. Geriatric syndromes are common in older hospitalised medical and hip fracture patients and areimportant predictors of poor outcomes in these groups, however the extent of presenting and hospital acquiredgeriatric syndromes in other older inpatients is less clear. This systematic literature review aimed to identify theproportion of patients aged 60 or older, cared for in usual-care surgical wards, who presented with and/ordeveloped geriatric syndromes. Observational studies in English were identified through searches in CINAHLand Medline databases from 1985-2012. Studies of hip fracture patients and those requiring surgical intensivecare (eg cardiac surgery) were excluded. The review included 25 studies. The majority of studies reported on theincidence of post-operative delirium, which ranged from 2% to 51% and varied with the type of surgery. Theprevalence of depression at pre-admission screening varied from 9% to 29%. No studies reported on functionaldecline. Estimates of falls, malnutrition, pressure ulcers and urinary incontinence were limited by the smallnumber of studies. These findings indicate the need for further studies to improve the understanding of geriatricsyndromes in older surgical patients in usual-care wards.

Persistent Pain in Frail Older Adults After Hip Fracture Repair

2004 ◽  
Vol 52 (12) ◽  
pp. 2062-2068 ◽  
Author(s):  
Cynthia Herrick ◽  
Karen Steger-May ◽  
David R. Sinacore ◽  
Marybeth Brown ◽  
Kenneth B. Schechtman ◽  
...  
Keyword(s):  
Older Adults ◽  
Hip Fracture ◽  
Persistent Pain ◽  
Fracture Repair ◽  
Frail Older Adults

scholarly journals Improvement in ADLs during a Nursing Home Stay for Older Adults with Stroke, Joint Replacement or Hip Fracture

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 912-912
Author(s):  
Warona Mathuba ◽  
Brian Downer ◽  
Rachel Deer
Keyword(s):  
Older Adults ◽  
Hip Fracture ◽  
Acute Care ◽  
Joint Replacement ◽  
Patient Characteristics ◽  
The Elderly ◽  
Fee For Service ◽  
Data Set ◽  
Indwelling Catheters ◽  
Poor Outcomes

Abstract Regularly assessing the health and function of older adults who are in the hospital is important for preventing poor outcomes. Such information may also be useful in post-acute care settings, such as skilled nursing facilities (SNFs) to identify older adults who are high risk for poor outcomes. This study had two objectives: Map items from the Acute Care for the Elderly (ACE) Tracker to items from the Minimum Data Set (MDS). (2) Examine the association between ACE Tracker items and improvement in activities of daily living (ADLs) during a SNF stay. We identified Medicare fee-for-service beneficiaries admitted to a SNF within 3 days of hospital discharge for a hip fracture (n=118,790), joint replacement (n=245,845), or stroke (n=64,153). Items from the ACE Tracker were matched to patients’ first MDS assessment. The first and last MDS assessments were used to calculate a total score for self-performance on seven ADLs. Multivariable logistic regression models were used to identify patient characteristics associated with the odds for improvement in ADL function. Severe ADL limitations at admission and greater hours of physical and occupational therapy were associated with significantly higher odds of ADL improvement. Cognitive impairment, vision limitations, indwelling catheters, and unhealed pressure ulcers were associated with significantly lower odds of ADL improvement. The characteristics associated with improved ADL function were similar between patients with joint replacement, hip fracture, and stroke. Many of the health and functional characteristics routinely measured in hospital settings are also collected in SNFs and are associated with improvement in ADL function.

Quick Reference: Chapter 1: The Musculoskeletal System: The Hand and Upper Extremity

2000 ◽  
Vol 5 (5) ◽  
pp. 4-5
Keyword(s):  
Dorsal Column ◽  
Persistent Pain ◽  
Illness Behavior ◽  
Abnormal Illness Behavior ◽  
Organ Systems ◽  
Spinal Cord Dorsal ◽  
Objective Basis ◽  
Dorsal Column Stimulation ◽  
Underlying Pathology

Abstract Spinal cord (dorsal column) stimulation (SCS) and intraspinal opioids (ISO) are treatments for patients in whom abnormal illness behavior is absent but who have an objective basis for severe, persistent pain that has not been adequately relieved by other interventions. Usually, physicians prescribe these treatments in cancer pain or noncancer-related neuropathic pain settings. A survey of academic centers showed that 87% of responding centers use SCS and 84% use ISO. These treatments are performed frequently in nonacademic settings, so evaluators likely will encounter patients who were treated with SCS and ISO. Does SCS or ISO change the impairment associated with the underlying conditions for which these treatments are performed? Although the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) does not specifically address this question, the answer follows directly from the principles on which the AMA Guides impairment rating methodology is based. Specifically, “the impairment percents shown in the chapters that consider the various organ systems make allowance for the pain that may accompany the impairing condition.” Thus, impairment is neither increased due to persistent pain nor is it decreased in the absence of pain. In summary, in the absence of complications, the evaluator should rate the underlying pathology or injury without making an adjustment in the impairment for SCS or ISO.

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