scholarly journals 601 The Effect of the COVID-19 Pandemic on Hip Fracture Mortality in The South West of England

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
C Spolton-Dean ◽  
B Kent ◽  
T Ball ◽  
R Middleton ◽  
C Marusza ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Perioperative Mortality ◽  
Neck Of Femur ◽  
Significant Drop ◽  
Data Set ◽  
Urgent Surgery ◽  
Significant Difference ◽  
Neck Of Femur Fracture ◽  
Hip Fracture Mortality ◽  
Post Hoc

Abstract Aim High perioperative mortality rates in surgical patients suffering concomitant COVID-19 infection have contributed to a fall in elective and urgent surgery. However, data and debate have centred around post hoc infected cases, without the context of the rest of the surgical cohort, and without comparable historical control groups. We aimed to address this by studying patients with a neck of femur fracture. This common condition has a stable incidence with good prospective data collected routinely for the National Hip Fracture Database (NHFD). Method We analysed NHFD data for all hospitals within our region over a 3-month period, covering the height of the first outbreak and compared this with the same months in 2019. Results The incidence of hip fracture was stable (463 in 2019, 448 in 2020). 30-day mortality was 6.26% in 2019 and 7.14% in 2020 (p = 0.595). In the second cohort, 14 patients tested positive for COVID-19 perioperatively. Of these, 3 died (21%) compared to 29 who tested negative (p < 0.001). Mean time to operation reduced by 1.90 hours, with a significant drop in patients waiting over 36 hours (190 to 85, p < 0.001). There were no significant differences between gender, ASA grade or pre-operative AMTS. Conclusions We have confirmed high perioperative mortality for those with COVID-19 infection but have not shown a statistically significant difference in overall mortality from hip fracture during the initial phase of the pandemic. We argue from this data set that the hypothetical risk of surgery during this pandemic may have been overestimated.

Occult Bilateral Hip Fracture Secondary to Seizure: A Case Report and Literature Review

2007 ◽  
Vol 6 (2) ◽  
pp. 75-76
Author(s):  
J Fingleton ◽  
Keyword(s):  
Case Report ◽  
Hip Fracture ◽  
Functional Outcomes ◽  
Femur Fracture ◽  
Delayed Diagnosis ◽  
Review Of The Literature ◽  
Diagnostic Challenge ◽  
Neck Of Femur ◽  
Acute Medicine ◽  
Neck Of Femur Fracture

Seizures are a common presenting complaint in acute medicine and post-ictal patients can pose a diagnostic challenge. Approximately 1% of patients presenting after a seizure will have sustained a fracture. Delayed diagnosis is common and can lead to worse functional outcomes. A case of occult bilateral neck of femur fracture secondary to seizure is presented together with a review of the literature.

480 Preoperative Templating in Hip Hemiarthroplasty Improves Femoral Offset and Function

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
S Saleem ◽  
S Parikh ◽  
T Parratt ◽  
M Loeffler
Keyword(s):  
Clinical Outcomes ◽  
Fracture Dislocation ◽  
Neck Of Femur ◽  
Hip Hemiarthroplasty ◽  
Preoperative Templating ◽  
Percentage Difference ◽  
Group Data ◽  
Significant Difference ◽  
Neck Of Femur Fracture ◽  
And Function

Abstract The use of preoperative templating for hip hemiarthroplasty increases the likelihood of successfully restoring offset. This study sought to identify whether templating improves radiographic and clinical outcomes in this group. Data belonging to all patients that underwent hip hemiarthroplasty between March 2018 and March 2019 were collected. The patients were grouped based on whether or not their preoperative images were templated. Radiographs were studied retrospectively to calculate preoperative and postoperative offset and LLD for each patient. The clinical outcomes that were measured included the rate of periprosthetic fracture, dislocation and contra-lateral neck of femur fracture for each group. Data was analysed by SPSS. There were 208 patients of which 72 were templated and 136 not templated. The percentage difference between the preoperative and postoperative offset was lower in the templated group (p < 0.05). There was no significant difference in radiographic LLD between the two groups. There was no significant difference in the clinical outcomes between the two groups. A significantly closer restoration to the original offset was achieved with preoperative templating, which is likely to improve function in this group. There were no significant differences in the other clinical outcomes between the two groups.

scholarly journals Improving Administration of Fascia-iliaca Blocks for Patients With a Fractured Neck of Femur by Clinical Audit

2021 ◽  
Author(s):  
Isaac Okereke ◽  
Sridhar Rao Sampalli
Keyword(s):  
Hip Fracture ◽  
Older People ◽  
Femur Fracture ◽  
Fractured Neck Of Femur ◽  
Neck Of Femur ◽  
Analgesic Effects ◽  
Femur Fractures ◽  
Anaesthetic Agents ◽  
Number Of Patients ◽  
Neck Of Femur Fracture

Abstract BackgroundHip fracture is the most common serious injury in older people. It is also the most common reason for older people to need emergency anaesthesia and surgery, and the commonest cause of death following an accident. A FICB is the injection of anaesthetic agents into the fascia- iliaca compartment with the effect of blocking the lumbar plexus via an anterior approach. FICB is clinically safe and efficient and provides consistent analgesic effects irrespective of the performing doctor's experience of frailty fractures of the proximal femur.Methods Data from the National Hip Fracture Database (NHFD) for all patients admitted with a neck of femur fracture between October 2018 and May 2019 was interrogated and audited. Results of this audit were discussed in the department of Trauma & Orthopaedics' and the Trust's mortality review meetings. Teaching sessions were held for doctors and filling out of the neck of femur fracture proforma to detail administration or not of FICB and a valid reason when the later occurred was encouraged. A re-audit was carried out in May 2020 where a retrospective study of patients admitted with a neck of femur fracture over six months from October 2019 to April 2020 was done to assess improvement in compliance rates of administration of fascia iliaca blocks.Results We noted a statistically significant increase in the number of patients who got a fascia iliaca block on presentation with a fractured neck of the femur from after our second audit (p<0.00001). There were no complications associated with the administration of FICB to patients with neck of femur fractures. ConclusionThis study showed that clinical processes could be improved through audits, staff education and by employing the use of proformas to ensure compliance.

scholarly journals 174 SARS-Cov-2 Increases The 30-Day Mortality in Hip Fracture Patients. A UK District Hospital’s Experience

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
U Oduoza ◽  
G Mamarelis ◽  
R Chekuri ◽  
R Estfan ◽  
A Greer
Keyword(s):  
Hip Fracture ◽  
Mortality Rate ◽  
Demographic Data ◽  
University Hospital ◽  
Neck Of Femur ◽  
Exact Test ◽  
Fisher's Exact Test ◽  
Significant Difference ◽  
Fisher’S Exact Test ◽  
Mortality Ratio

Abstract Introduction Coronavirus disease 2019 (COVID-19) is a worldwide pandemic with a case mortality ratio of approximately 6.4%. Hip fracture patients are vulnerable if contracting COVID-19. Evidence is lacking regarding the mortality rate of hip fracture patients admitted during the COVID-19 pandemic. Method Retrospective review of all patients admitted to Southend University Hospital from March – April 2020. Demographic data (age, BMI, gender, co-morbidities) along with diagnosis of COVID-19 (clinical + (radiology +/- microbiology positive) and operative characteristics (time to operation, length of stay, ASA grading, Nottingham Hip Fracture Score), blood tests. Primary outcome was 30-day mortality rate in COVID-19 positive/negative patients who had hip fracture. Results 41 patients were included in the study of which 37 had a COVID-19 swab. Overall mortality in the group was 22%. Eleven patients tested positive for COVID-19. There was a statistically significant difference in mortality between those testing positive compared to those testing negative (54.5% versus 7,69% respectively, Fisher’s exact test, p = 0.004) and when comparing those who had an operation and tested positive for COVID-19 against those who had an operation and tested negative (37.5% versus 4,34% respectively, Fisher’s exact test, p = 0.043). Conclusions COVID-19 increases the 30-day mortality in neck of femur fracture patients.

scholarly journals The Abbreviated Mental Test Score; Is There a Need for a Contemporaneous Update?

2021 ◽  
Vol 12 ◽  
pp. 215145932110010
Author(s):  
Kizzie A. Peters ◽  
Thomas J. Howe ◽  
Daniel Rossiter ◽  
Kirsty J. Hutchinson ◽  
Philip A. Rosell
Keyword(s):  
New York ◽  
Hip Fracture ◽  
Test Score ◽  
Terrorist Attack ◽  
Neck Of Femur ◽  
Mental Test ◽  
Mental Test Score ◽  
Significant Difference ◽  
Abbreviated Mental Test ◽  
Memorable Event

Introduction: Designed in 1972 the Abbreviated Mental Test Score (AMTS) is widely used to assess a cognition on hospital admission. The Nottingham Hip Fracture Score uses this in predicting morbidity/mortality in neck of femur fracture. The consequences of misappropriating cognitive impairment could have lasting implications. Questions about the monarchy or World War One and Two may be inappropriate for today’s diverse society. Materials and Methods: 100 patients were questioned during routine fracture clinic appointments. Patients were asked: In what year did WWII start? Who is the current monarch? Please state a memorable event in your lifetime that you would not expect another person of the same age to forget. Two-tailed Z-tests were performed between the observed proportions and those from the original AMTS validation study. Results: Only 47% (n = 47) were able to correctly answer the year in which WW2 started. A statistically significant difference when compared to the upper and lower limits from the original study (z = -4.191, p < .001.). Significance was not seen in the second question, with 97% (n-97) identifying the monarch correctly. 51% (n = 51) of participants suggested the terrorist attack on the World Trade Centre in New York as an alternative memorable event. Discussion: Some hospitals now use the 4 “A”s Test (4-AT) as a screening tool for delirium. Without amendments to the Nottingham Hip Fracture Score, AMTS use is likely to continue in orthogeriatric patients. Over time there will be a need for the AMTS to be reviewed so that it remains a true assessment of cognition. Its limitations regarding language and culture is widely acknowledged and several validated variants have been published in the literaure. Conclusions: We highlight a potential future issue with the AMTS and raise considerations for the development of an alternative question to better meet the needs of the orthogeriatric population.

scholarly journals Incidental hip fracture in an outpatient clinic: the importance of patient-centred assessment

2018 ◽  
Vol 10 (2) ◽  
pp. 176 ◽  
Author(s):  
Lloyd David Hughes ◽  
Gavin Love
Keyword(s):  
Hip Fracture ◽  
Hip Fractures ◽  
Outpatient Clinic ◽  
Older Patients ◽  
Femur Fracture ◽  
Comorbid Conditions ◽  
Diagnostic Challenge ◽  
Neck Of Femur ◽  
Neck Of Femur Fracture

ABSTRACT Although many patients presenting with hip fractures have classic symptoms, other patients may present atypically with referred knee pain and reasonably unremarkable clinical examination following initial presentation. Older patients commonly have comorbid conditions such as arthritis, stroke and dementia that can complicate history and examination, making the diagnosis of subtle fractures difficult. Multimorbidity represents an important diagnostic challenge to both primary and secondary care. This case study discusses a 90-year-old lady who was found to have an old right neck of femur fracture after attendance at an geriatric outpatient clinic for a discussion about anticoagulation, after GP referral.

The impact of COVID-19 on 30-day mortality in patients with neck of femur fractures

2020 ◽  
Vol 1 (7) ◽  
pp. 326-329 ◽  
Author(s):  
James E. Archer ◽  
Siddhant Kapoor ◽  
Danielle Piper ◽  
Abdulrahman Odeh
Keyword(s):  
Hip Fracture ◽  
Femur Fracture ◽  
Early Mobilization ◽  
Early Assessment ◽  
Optimal Care ◽  
Neck Of Femur ◽  
Hip Fracture Surgery ◽  
Femur Fractures ◽  
Neck Of Femur Fracture ◽  
The Impact

Aims The COVID-19 pandemic presents a significant threat to patients with neck of femur fractures. The 30-day mortality for these patients has gradually been reducing in the UK due to a multitude of inputs aimed at improving their outcomes. We provided an early assessment of 30-day mortality in neck of femur fracture patients who contracted COVID-19. Methods We identified 18 patients who were admitted from three acute hospital sites who underwent an operation for a neck of femur fracture and were diagnosed with COVID-19 between 25 March and 25 April 2020. We collected information on their age, American Association of Anesthesiologists (ASA) grade, diagnosis, surgical procedure, complications, and 30-day mortality. Results Our study identified 18 patients who were all diagnosed with a positive swab result during the postoperative period. Female patients made up two-thirds of the patient cohort and the mean age of patients was 82 years (55 to 101). In all, ten patients sustained intracapsular fractures with eight sustaining extracapsular fractures. The 30-day mortality in this group of patients was 22.2% as compared to 4% 30-day mortality in those without COVID-19. Conclusion Our results show a 30-day mortality of 22.2%, which is higher than the national average provided by the 2019 National Hip Fracture Database report. However, while 30-day mortality has increased in those patients with COVID-19, this should not impact upon the provision of hip fracture surgery as it provides significant benefits to the patient such as pain relief and early mobilization. However, the information presented in this study should form an important part of the informed consent process for surgery. A multidisciplinary approach is crucial in ensuring optimal care for this complex patient group. Cite this article: Bone Joint Open 2020;1-7:326–329.

OUTCOME COMPARISON OF TREATMENT BASICERVICAL NECK OF FEMUR FRACTURE USING HEMIARTHROPLASTY VERSUS DYNAMIC HIP SCREW

2021 ◽  
Vol 5 (6) ◽  
Author(s):  
Manpreet Singh ◽  
Anurag Dhaker ◽  
Pradeep Kumar Mundotiya
Keyword(s):  
Femur Fracture ◽  
Age Groups ◽  
Clinical Score ◽  
Dynamic Hip Screw ◽  
Neck Of Femur ◽  
Medical College ◽  
Significant Difference ◽  
Outcome Comparison ◽  
Hip Screw ◽  
Neck Of Femur Fracture

Background: The present study was conducted to compare outcome of hemiarthroplasty with dynamic hip screw for basicervical neck of femur fracture. Methods: Hospital based, randomized prospective, comparative interventional study conducted on Basicervical neck of femur fracture cases attending with orthopaedics department of S.M.S. Medical College and Hospital, Jaipur (Rajasthan, India) Results: As per the post operative complications in Hemiarthroplasty and DHS groups respectively, no significant difference was observed among the group. As per the age groups clinical score (merle's d aubigne), at 6m and 12 m Group H was better than group D. As per average functional outcome at 3,6 ,12months. Score improved with the time. Conclusion: We concluded that Hemiarthroplastymay allow better restoration of function and should be favoured for treatment of fracture neck of femur in patients that meet the indications for surgery whenever the technical competence and facilities exist. Keywords: Femur, Hemiarthroplasty, DHS

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