Proximal femur fracture in older patients - rehabilitation and clinical outcome

BackgroundPatients undergoing proximal femur fracture surgery are at high risk of postoperative complications, with postoperative delirium occurring in 25%–40% of patients. Delirium has profound effects on patient outcome and recovery, the patient’s family, caregivers and medical costs. Perioperative music has a beneficial effect on eliciting modifiable risk factors of delirium. Therefore, the aim of this trial was to evaluate the effect of perioperative recorded music on postoperative delirium in patients with proximal femur fracture undergoing surgery.Methods and analysisThe Music on Clinical Outcome after Hip Fracture Operations study is an investigator-initiated, multicentre, randomised controlled, open-label, clinical trial. Five hundred and eight patients with proximal femur fracture meeting eligibility criteria will be randomised to the music intervention or control group with concealed allocation in a 1:1 ratio, stratified by hospital site. The perioperative music intervention consists of preselected lists totalling 30 hours of music, allowing participants to choose their preferred music from these lists (classical, jazz and blues, pop and Dutch). The primary outcome measure is postoperative delirium rate. Secondary outcome measures include pain, anxiety, medication requirement, postoperative complications, hospital length of stay and 30-day mortality. A 90-day follow-up will be performed in order to assess nursing home length of stay, readmission rate and functional ability to perform daily living activities. Furthermore, the cost and cost-effectiveness of the music intervention will be assessed. Data will be analysed according to an intention-to-treat principle.Ethics and disseminationThe study protocol has been approved by the Medical Research Ethics Committee Erasmus MC on 8 October 2018 (MEC-2018–110, NL64721.078.18). The trial will be carried out following the Declaration of Helsinki principles, Good Clinical Practice guidelines and Dutch Medical Research Involving Human Subjects Act. Research data will be reported following Consolidated Standards of Reporting Trials guidelines and study results will be published in a peer-reviewed journal.Trial registration numberNTR7036.

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Preoperative Ascorbic Acid Levels in Proximal Femur Fracture Patients Have No Postoperative Clinical Impact, While Ascorbic Acid Levels upon Discharge Have a Major Effect on Postoperative Outcome

Journal of Clinical Medicine ◽

10.3390/jcm9010066 ◽

2019 ◽

Vol 9 (1) ◽

pp. 66

Author(s):

Katharina Hill-Mündel ◽

Johannes Schlegl ◽

Hans Konrad Biesalski ◽

Sabrina Ehnert ◽

Steffen Schröter ◽

...

Keyword(s):

Ascorbic Acid ◽

Clinical Outcome ◽

Elderly Patients ◽

Proximal Femur ◽

Nutritional Assessment ◽

Femur Fracture ◽

Mini Nutritional Assessment ◽

Nutritional Risk ◽

Proximal Femur Fracture ◽

Femur Fractures

Proximal femur fractures show a high prevalence in elderly patients and are associated with an elevated risk of multimorbidity and early mortality. Recovery is impaired by malnutrition and oxidative stress, which is affected by antioxidants such as ascorbic acid (AA). This study monitored AA levels during hospitalization of patients with a proximal femur to investigate the influence of AA status to the clinical outcome. AA levels of 25 elderly patients with a proximal femur fracture were measured during hospitalization using high performance liquid chromatography. Plasma samples were collected preoperatively, on the first day after surgery, on the third day after surgery and on the day of discharge. Nutritional Risk Screening 2002 (NRS) and Mini Nutritional Assessment (MNA) were assessed to evaluate the nutritional status. In patients with proximal femoral fractures, preoperative AA concentrations were significantly lower compared to elderly patients without an acute fracture. A significant decrease of 33.8% in AA plasma level was measured on the day after surgery with a significant recovery up to the time of discharge. The preoperative AA status did not have any significant effect on clinical outcome. However, inadequate AA levels (<50 µmol/L) upon discharge significantly increased the incidence and the severity of postoperative complications. These results indicate that the AA status upon discharge has a greater impact on clinical outcome than assumed, and therefore, AA supplementation during hospitalization should be considered.

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Mortality Rates of Proximal Femur Fracture Patients Through a Worldwide Pandemic: Preliminary Results of the Spanish HIP-COVID Observational Study

SSRN Electronic Journal ◽

10.2139/ssrn.3576799 ◽

2020 ◽

Author(s):

Josep Maria Muñoz Vives ◽

Montsant Jornet-Gibert ◽

J. Cámara-Cabrera ◽

Pedro L. Esteban ◽

Laia Brunet ◽

...

Keyword(s):

Observational Study ◽

Proximal Femur ◽

Femur Fracture ◽

Mortality Rates ◽

Proximal Femur Fracture ◽

Preliminary Results

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Patient Positioning for Proximal Femur Fracture Fixation: a Review of Best Practices

Current Reviews in Musculoskeletal Medicine ◽

10.1007/s12178-021-09710-x ◽

2021 ◽

Author(s):

Khushdeep S. Vig ◽

Curtis Adams ◽

Joseph R. Young ◽

Eric Perloff ◽

Casey M. O’Connor ◽

...

Keyword(s):

Best Practices ◽

Proximal Femur ◽

Fracture Fixation ◽

Femur Fracture ◽

Patient Positioning ◽

Proximal Femur Fracture

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Early mortality in hip fracture patients admitted during first wave of the COVID-19 pandemic in Northern Italy: a multicentre study

Journal of Orthopaedics and Traumatology ◽

10.1186/s10195-021-00577-9 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Dante Dallari ◽

Luigi Zagra ◽

Pietro Cimatti ◽

Nicola Guindani ◽

Rocco D’Apolito ◽

...

Keyword(s):

Hip Fracture ◽

Mortality Rate ◽

Multicentre Study ◽

Proximal Femur ◽

Femur Fracture ◽

Northern Italy ◽

Proximal Femur Fracture ◽

Time To Surgery ◽

Fracture Management ◽

The Mean

Abstract Background Treatment of hip fractures during the coronavirus disease 2019 (COVID-19) pandemic has posed unique challenges for the management of COVID-19-infected patients and the maintenance of standards of care. The primary endpoint of this study is to compare the mortality rate at 1 month after surgery in symptomatic COVID-positive patients with that of asymptomatic patients. A secondary endpoint of the study is to evaluate, in the two groups of patients, mortality at 1 month on the basis of type of fracture and type of surgical treatment. Materials and methods For this retrospective multicentre study, we reviewed the medical records of patients hospitalised for proximal femur fracture at 14 hospitals in Northern Italy. Two groups were formed: COVID-19-positive patients (C+ group) presented symptoms, had a positive swab for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and received treatment for COVID-19; COVID-19-negative patients (C− group) were asymptomatic and tested negative for SARS-CoV-2. The two groups were compared for differences in time to surgery, survival rate and complications rate. The follow-up period was 1 month. Results Of the 1390 patients admitted for acute care for any reason, 477 had a proximal femur fracture; 53 were C+ but only 12/53 were diagnosed as such at admission. The mean age was > 80 years, and the mean American Society of Anesthesiologists (ASA) score was 3 in both groups. There was no substantial difference in time to surgery (on average, 2.3 days for the C+ group and 2.8 for the C− group). As expected, a higher mortality rate was recorded for the C+ group but not associated with the type of hip fracture or treatment. No correlation was found between early treatment (< 48 h to surgery) and better outcome in the C+ group. Conclusions Hip fracture in COVID-19-positive patients accounted for 11% of the total. On average, the time to surgery was > 48 h, which reflects the difficulty of maintaining normal workflow during a medical emergency such as the present pandemic and notwithstanding the suspension of non-urgent procedures. Hip fracture was associated with a higher 30-day mortality rate in COVID-19-positive patients than in COVID-19-negative patients. This fact should be considered when communicating with patients and/or their family. Our data suggest no substantial difference in hip fracture management between patients with or without COVID-19 infection. In this sample, the COVID-19-positive patients were generally asymptomatic at admission; therefore, routine screening is recommended. Level of evidence Therapeutic study, level 4.

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