Medical management of hip fractures and the role of the orthogeriatrician

2012 ◽  
Vol 22 (4) ◽  
pp. 261-273 ◽  
Author(s):  
Abhaya Gupta
Keyword(s):  
Hip Fracture ◽  
Hip Fractures ◽  
Evidence Based ◽  
Effective Management ◽  
Vulnerable Group ◽  
Management Guidelines ◽  
Operative Complications ◽  
Orthopaedic Ward ◽  
Time Of Admission

SummaryPublished literature shows that evidence-based medical care can improve hip fracture outcomes. The orthogeriatrician plays a key role in providing this care, in collaboration with surgical and multidisciplinary professionals, managing pre-operative conditions and post-operative complications that may affect functional recovery, and ensuring co-ordinated effective management of hip fractures right from admission to discharge. Several management guidelines are available for this vulnerable group of elderly patients. Recent UK guidelines recommend that, from time of admission, hip fracture patients should be offered a formal acute orthogeriatric or orthopaedic ward-based ‘Hip Fracture Programme’, which includes orthogeriatric assessment as an essential key component.

The Role of General Practitioners in Migraine Management

Cephalalgia ◽  
2008 ◽  
Vol 28 (2_suppl) ◽  
pp. 1-8 ◽  
Author(s):  
M Lantéri-Minet
Keyword(s):  
Medical Education ◽  
General Practitioners ◽  
Patient Expectations ◽  
Diagnostic Tools ◽  
Effective Management ◽  
Over The Counter ◽  
Management Guidelines ◽  
Treatment Regimens ◽  
Satisfactory Outcome

General practitioners (GPs) play a pivotal role in managing migraine and ensuring that patients have a positive first experience when seeking treatment. A large proportion of migraineurs do not consult a GP, preferring to rely on over-the-counter remedies to reduce pain and disability. For those who do consult, receiving a satisfactory outcome at their first consultation is important for ensuring subsequent effective management of their migraine. If patient expectations are not met at their first visit (prescribed treatment is ineffective or GP does not empathize with their suffering), patients may not return for further consultation. There remains a need to improve migraine diagnosis and treatment, and GPs require continuing medical education and neurologist support to ensure that they are providing the best migraine treatments and outcomes. More widespread use of diagnostic tools, standardized management guidelines and individualized treatment regimens will help GPs successfully manage both migraine symptoms and patient expectations.

Potential role of FRAX analysis in postmenopausal women with osteopenia

Open Medicine ◽  
2011 ◽  
Vol 6 (2) ◽  
pp. 185-189
Author(s):  
Aleksandar Dimić ◽  
Stojanovic Sonja ◽  
Nedovic Jovan ◽  
Stankovic Aleksandra ◽  
Stamenkovic Bojana ◽  
...  
Keyword(s):  
Hip Fracture ◽  
High Risk ◽  
Postmenopausal Women ◽  
Hip Fractures ◽  
Potential Role ◽  
Osteoporotic Fractures ◽  
Significant Negative Correlation ◽  
Mineral Density ◽  
Fracture Development

AbstractEarly diagnosis of osteoporosis and estimation of subjects that are at high risk for fracture, is neccesary for osteoporosis treatment. Dual-energy X-ray absorptometry (DXA) is a modern method for bone mineral density (BMD) evaluation. However, along BMD, clinical risk factors may significantly influence fracture development. Therefore, FRAX algorithm was designed for the assessment of a ten-year risk for serious osteoporotic fractures (SOF), as well as hip fractures. In the current study, we tried to evaluate the possible lumbal spine and hip BMD influence on ten year risk for SOF and hip fractures and potential role of FRAX in predicting the therapy in postmenopausal women with osteopenia. We performed the study on 385 postmenopausal women. According to the DXA measurements, at the lumbal (L) spine (L1–L4) and hip (femor neck), patients were then classified as normal, osteopenic, or osteoporotic. BMD evaluation included the L spine and the hip (subgroup 1), and only on the L spine (subgroup 2). By filling up the FRAX questionnaire, a ten-year risk for SOF fracture and hip fracture was calculated. BMD evaluation, in complete patient’s group and in subgroup 1, resulted in the highest number of osteoporosis (61.04%, 48.08%, retrospectively), while ospeopenia was a main finding in subgroup 2. In the subgroup 1, a high risk for SOF and hip fracture was detected in 16.45% and with high risk for hip fracture in 11.38% subjects. In subgroup 2, only high risk for hip fracture was observed in 3.16% subjects, indicating the active medicament treatment. Simultaneously, correlation of BMD results with FRAX values for SOF and hip fracture, showed significant negative correlation (p<0.001). Obtained results showed significant role of femur neck BMD evaluation in predicting the future factors, which may, together with FRAX analysis, improve the therapy approach in postmenopausal women with ospeopenia.

scholarly journals Identifying Disparities in the Management of Hip Fractures Within Europe: A Comparison of 3 Health-Care Systems

2019 ◽  
Vol 10 ◽  
pp. 215145931987294 ◽  
Author(s):  
Cliodhna E. Murray ◽  
Andreas Fuchs ◽  
Heide Grünewald ◽  
Owen Godkin ◽  
Norbert P. Südkamp ◽  
...  
Keyword(s):  
Health Care ◽  
Hip Fracture ◽  
Hip Fractures ◽  
Care Pathway ◽  
Health Care Systems ◽  
Standards Of Care ◽  
Evidence Based ◽  
Care Hospital ◽  
Care Systems ◽  
The Uk

Introduction: This study investigates the management of hip fractures in a German maximum care hospital and compares these data to evidence-based standard and practice in 180 hospitals participating in the UK National Hip Fracture Database (NHFD) and 16 hospitals participating in the Irish Hip Fracture Database (IHFD). This is the first study directly comparing the management of hip fractures between 3 separate health-care systems within Europe. Methods: Electronic medical data were collected retrospectively describing the care pathway of elderly patients with a hip fracture admitted to a large trauma unit in the south of Germany “University Hospital Freiburg” (UHF). The audit evaluated demographics, postoperative outcome, and the adherence to the 6 “Blue Book” standards of care. These data were directly compared with the data from the UK NHFD and the IHFD acquired from 180 and 16 hospitals, respectively. Results: At 36 hours, 95.8% of patients had received surgery in UHF, compared to 71.5% in the NHFD and 58% of patients in the IHFD. The rate of in-hospital mortality was 4.7% compared to 7.1% in the NHFD and 5% in the IHFD. The mean average acute length of stay was 13.4 days compared to 16.4 days in the NHFD and 20 days in the IHFD. Reoperation rates are 3.3% compared to 1% in the NHFD and 1.1% in the IHFD; 50.5% of patients were discharged on bone protection medication, compared to 47% in the IHFD and 79.3% in the UK NHFD. Discussion: Despite uniformly acknowledged evidence-based treatment guidelines, the management of hip fractures remains heterogeneous within Europe. Conclusion: These data show that different areas of the hip fracture care pathway in Germany, England, and Ireland, respectively, show room for improvement in light of the growing socioeconomic burden these countries are expected to face.

scholarly journals Hip fracture treatment in Norway

2020 ◽  
Vol 1 (10) ◽  
pp. 644-653
Author(s):  
Cato Kjærvik ◽  
Eva Stensland ◽  
Hanne Sigrun Byhring ◽  
Jan-Erik Gjertsen ◽  
Eva Dybvik ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Femoral Neck ◽  
Hip Fractures ◽  
Best Practice ◽  
Treatment Guidelines ◽  
Treatment Recommendations ◽  
Femoral Neck Fractures ◽  
Evidence Based ◽  
Fracture Treatment ◽  
One Year

Aims The aim of this study was to describe variation in hip fracture treatment in Norway expressed as adherence to international and national evidence-based treatment guidelines, to study factors influencing deviation from guidelines, and to analyze consequences of non-adherence. Methods International and national guidelines were identified and treatment recommendations extracted. All 43 hospitals routinely treating hip fractures in Norway were characterized. From the Norwegian Hip Fracture Register (NHFR), hip fracture patients aged > 65 years and operated in the period January 2014 to December 2018 for fractures with conclusive treatment guidelines were included (n = 29,613: femoral neck fractures (n = 21,325), stable trochanteric fractures (n = 5,546), inter- and subtrochanteric fractures (n = 2,742)). Adherence to treatment recommendations and a composite indicator of best practice were analyzed. Patient survival and reoperations were evaluated for each recommendation. Results Median age of the patients was 84 (IQR 77 to 89) years and 69% (20,427/29,613) were women. Overall, 79% (23,390/29,613) were treated within 48 hours, and 80% (23,635/29,613) by a surgeon with more than three years’ experience. Adherence to guidelines varied substantially but was markedly better in 2018 than in 2014. Having a dedicated hip fracture unit (OR 1.06, 95%CI 1.01 to 1.11) and a hospital hip fracture programme (OR 1.16, 95% CI 1.06 to 1.27) increased the probability of treatment according to best practice. Surgery after 48 hours increased one-year mortality significantly (OR 1.13, 95% CI 1.05 to 1.22; p = 0.001). Alternative treatment to arthroplasty for displaced femoral neck fractures (FNFs) increased mortality after 30 days (OR 1.29, 95% CI 1.03 to 1.62)) and one year (OR 1.45, 95% CI 1.22 to 1.72), and also increased the number of reoperations (OR 4.61, 95% CI 3.73 to 5.71). An uncemented stem increased the risk of reoperation significantly (OR 1.23, 95% CI 1.02 to 1.48; p = 0.030). Conclusion Our study demonstrates a substantial variation between hospitals in adherence to evidence-based guidelines for treatment of hip fractures in Norway. Non-adherence can be ascribed to in-hospital factors. Poor adherence has significant negative consequences for patients in the form of increased mortality rates at 30 and 365 days post-treatment and in reoperation rates. Cite this article: Bone Joint Open 2020;1-10:644–653.

scholarly journals Operative Trends in the Treatment of Hip Fractures and the Role of Arthroplasty

2018 ◽  
Vol 9 ◽  
pp. 215145931876063 ◽  
Author(s):  
Luis Grau ◽  
Spencer Summers ◽  
Dustin H. Massel ◽  
Samuel Rosas ◽  
Alvin Ong ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Total Hip Arthroplasty ◽  
Hip Fractures ◽  
Hip Arthroplasty ◽  
Perioperative Complications ◽  
The United States ◽  
Medical Comorbidities ◽  
Total Hip ◽  
Fracture Population

Introduction: There is a projected exponential increase in the number of hip fractures in the United States. Trends in patient demographics and the role of total hip arthroplasty (THA) and its associated outcomes following hip fractures surgery have not been well studied. Methods: Patients with proximal femur fractures between 1990 and 2007 were identified in the National Hospital Discharge Survey database. Demographics, comorbidities, perioperative complications, and discharge status for patients undergoing THA, hemiarthroplasty, or internal fixation were examined. Multivariable regression was performed to determine independent risk factors for perioperative complications. Results: Between 1990 and 2007, there was a statistically significant increase in patient age, adverse events, medical comorbidities, surgical complications, medical complications, and nonroutine discharge across all surgical treatment modalities. In the same time period, the utilization of THA for all fracture types decreased significantly. Discussion: Total hip arthroplasty was found to be an independent risk factor for perioperative complications. Orthopedic surgeons should be aware that the hip fracture population continues to get older, with more medical comorbidities and are at higher risk for perioperative complications. Conclusion: Total hip arthroplasty is associated with a higher rate of perioperative complications in the hip fracture population.

scholarly journals Improving Hip Fracture Care in Ireland: A Preliminary Report of the Irish Hip Fracture Database

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Prasad Ellanti ◽  
Breda Cushen ◽  
Adam Galbraith ◽  
Louise Brent ◽  
Conor Hurson ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Hip Fractures ◽  
Preliminary Report ◽  
Older Persons ◽  
International Standards ◽  
Standards Of Care ◽  
Age Group ◽  
Web Based ◽  
Fracture Care ◽  
Orthopaedic Ward

Introduction. Hip fractures are common injuries in the older persons, with significant associated morbidity and mortality. The Irish Hip Fracture Database (IHFD) was implemented to monitor standards of care against international standards.Methods. The IHFD is a clinically led web-based audit. We summarize the data collected on hip fractures from April 2012 to March 2013 from 8 centres.Results. There were 843 patients with the majority being (70%) female. The 80–89-year age group accounted for the majority of fractures (44%). Most (71%) sustained a fall at home. Intertrochanteric fractures (40%) were most common. Only 28% were admitted to an orthopaedic ward within 4 hours. The majority (97%) underwent surgery with 44% having surgery within 36 hours. Medical optimization (35%) and lack of theatre space (26%) accounted for most of the surgical delay. While 29% were discharged home, 33% were discharged to a nursing home or other long-stay facilities. There was a 4% in-hospital mortality rate.Conclusions. Several key areas in both the database and aspects of patient care needing improvement have been highlighted. The implementation of similar databases has led to improved hip fracture care in other countries and we believe this can be replicated in Ireland.

scholarly journals Haemoglobin and transfusions in elderly patients with hip fractures: the effect of a dedicated orthogeriatrician

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Marco Quaranta ◽  
Luca Miranda ◽  
Francesco Oliva ◽  
Filippo Migliorini ◽  
Gabriela Pezzuti ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Hip Fracture ◽  
Blood Loss ◽  
Elderly Patients ◽  
Hip Fractures ◽  
Length Of Hospital Stay ◽  
Primary Objective ◽  
Post Surgery ◽  
Stay Time ◽  
Orthopaedic Ward

Abstract Background Hip fractures are common in elderly patients, in whom it is important to monitor blood loss; however, unnecessary transfusions should be avoided. The primary objective of this study was to assess whether the employment of a dedicated orthogeriatrician in an Orthopaedic Department allows to optimise the clinical conditions of patients, influencing blood loss and consequently the number of transfusions. The secondary objective was to determine whether the influence of the orthogeriatrician differs according to the type of surgical treatment. Methods A total of 620 elderly patients treated for hip fracture were included in the study. These patients were divided into two groups according to the presence or not of the orthogeriatrician. For each patient, age, sex, comorbidities, type of fracture, surgical treatment, length of hospital stay, time from hospitalisation and surgery, time from surgery to discharge, haemoglobin (Hb) values (admission, 24h post-surgery, lowest Hb reached, discharge) and the number of transfusions were recorded. Results Regardless of the surgical procedure performed, in patients managed by the orthogeriatrician, the Hb at discharge was significantly higher (p = 0.003). In addition to the highest Hb at discharge, in patients who underwent hemiarthroplasty, the number of transfusions per patient is significantly reduced (p = 0.03). Conclusion The introduction of the orthogeriatrician in an orthopaedic ward for the management of elderly patients treated for hip fracture allows to discharge the patients with higher Hb values, reducing the risk of anemisation and the costs related to possible re-admission.

scholarly journals Rehabilitation guidance for hip fracture patients during the COVID-19 pandemic using chat software: A new model

2021 ◽  
pp. 1-6
Author(s):  
Shuai-Shuai Gao ◽  
Yan-Jun Wang ◽  
Guo-Xun Zhang ◽  
Wen-Ting Zhang
Keyword(s):  
Hip Fracture ◽  
Hip Fractures ◽  
The Elderly ◽  
Social Software ◽  
Harris Hip Score ◽  
Control Group ◽  
Observation Group ◽  
New Model ◽  
Complications And Mortality

BACKGROUND: Hip fractures are serious fractures for the elderly. The rehabilitation of patients with hip fractures has been greatly affected by the coronavirus disease 2019 (COVID-19) pandemic. OBJECTIVE: We have piloted a new model for tracking patients and providing rehabilitation guidance that uses WeChat. The purpose of this study is to explore the role of chat software in rehabilitation guidance for hip fracture patients during COVID-19. METHODS: Patients treated for hip fractures from February 1 to April 30, 2020 were randomly divided into a control group and an observation group. The control group was given conventional discharge guidance, while the observation group also followed up the patients using WeChat to guide the exercise. Satisfaction, the Harris Hip Score, complications and the mortality of the two groups after discharge were compared. RESULTS: The incidence of complications and mortality in the observation group were significantly lower than in the control group: p= 0.022 and p= 0.048, respectively. The Harris Hip Score and satisfaction were significantly better than the control group’s: p= 0.000 and p= 0.007, respectively. CONCLUSION: During the COVID-19 pandemic, it is very helpful to use WeChat software or other social software with similar functions (such as WhatsApp and Facebook) to guide the rehabilitation of hip fractures.

scholarly journals Integrated Fragility Hip Fracture Program: A Model for High Quality Care

2020 ◽  
Vol 15 (8) ◽  
pp. 461-467 ◽  
Author(s):  
Jensa C Morris ◽  
Anne Moore ◽  
Joseph Kahan ◽  
Marc Shapiro ◽  
Jinlei Li ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Length Of Stay ◽  
Adverse Effects ◽  
Clinical Outcomes ◽  
Hip Fractures ◽  
Quality Care ◽  
Multidisciplinary Care ◽  
Care Physician ◽  
Evidence Based ◽  
Fragility Hip Fracture

BACKGROUND: Hip fractures are a significant cause of morbidity and mortality among elderly patients. Coordinated multidisciplinary care is required to optimize medical outcomes. OBJECTIVE: To determine the effect of the implementation of standardized, evidence-based protocols on clinical outcomes and mortality in patients with fragility hip fractures. INTERVENTIONS: A multidisciplinary group was convened to define best practices in fragility hip fracture care and implement a fragility hip fracture clinical protocol at Yale-New Haven Hospital. Clinical outcomes in 2015, prior to program initiation, were compared with 2018, after the program was well established. MAIN OUTCOMES AND MEASURES: Measured outcomes included 30-day mortality, blood transfusion utilization, adverse effects of drugs, venous thromboembolic complications, sepsis, myocardial infarction, mechanical surgical fixation complications during the index admission, length of stay, 30-day readmission, unexpected return to the operating room (OR) and time to the OR. RESULTS: The implementation of the Integrated Fragility Hip Fracture Program was associated with significant reductions in 30-day mortality from 8.0% in 2015 to 2.8% in 2018 (P = .001). Significant reductions were also seen in use of blood transfusions (46.6% to 28.1%; P < .001), adverse effects of drugs (4.0% to 0%; P < .001), length of stay (5.12 to 4.47 days; P = .004), unexpected return to the OR (5.1% to 0%; P < .001), and time to the OR <24 hours (41.8% to 55.0%, P = .001). CONCLUSIONS: An Integrated Fragility Hip Fracture Program using multidisciplinary care, physician and nursing engagement, evidence-based protocols, data tracking with feedback, and accountability can reduce mortality and improve clinical outcomes in patients with hip fractures.

scholarly journals Systematic Review on the Functional Status of Elderly Hip Fracture Patients using Katz Index of Activity of Daily Living (Katz ADL) Score

2020 ◽  
Vol 15 (2) ◽  
Author(s):  
Sharkawi MA ◽  
Zulfarina SM ◽  
Aqilah-SN SMZ ◽  
Isa NM ◽  
Sabarul AM ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Hip Fractures ◽  
Daily Living ◽  
Elderly Population ◽  
Evidence Based ◽  
Activity Of Daily Living ◽  
Inclusion Criteria ◽  
Katz Index ◽  
One Year ◽  
Careful Screening

Hip fractures cases are common in elderly population. After a hip fracture, around 80% of patients were unable to carry out at least one independent activity of daily living (ADL). This review attempted to provide an evidence-based literature on ADL of elderly hip fracture patients. A computerised literature search using Medline (OVID) and Scopus databases were conducted to identify relevant studies on ADL of elderly hip fracture patients that was assessed with Katz ADL score. Only articles that fulfilled the inclusion criteria were included in this review. Initial search identified 314 potentially relevant articles but after careful screening, only 5 full-text articles were selected for the present review. Three studies showed an increase dependent level of the patients’ ADL after hip fractures. Two studies showed not more than half of the patients were unable to regain their pre-fracture ADL level after one year of hip fracture incidence. Feeding/eating showed the highest independent activity while bathing was the lowest independent activity among patients. In conclusion, elderly hip fracture patients have declined ADL with the risk that they may never regain their pre-fracture ADL level.

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