Novel Conservative Approach to High Surgical Risk Frail Proximal Femur Fractures

One of the major impacts following a neck of femur fracture is pain. Most patients (nearly all) undergo an operation. This usually includes the frailest terminal patients and deemed a palliative procedure to reduce ongoing pain. The operation comes with risks and can reduce life expectancy in these patients and result in prolonged hospital admission, delirium, and postoperative complications. This case highlights a novel approach to managing the frailest end-of-life patients that does not require them to undergo a conventional operation. The case resulted in a quick discharge from hospital and for the patient and family to maximise the time out of hospital, with a reduced analgesic burden and a peaceful passing away. We feel that this could be an alternative, more humane option for such patients.

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P16 An audit of elderly patients with a femoral fracture: is the quality of care received by patients affected by where in the femur the fracture occurs?

BJS Open ◽

10.1093/bjsopen/zrab032.015 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

Author(s):

O A Javed ◽

M J Khan ◽

Y Abbas ◽

S Pillai ◽

K Hristova ◽

...

Keyword(s):

Risk Assessment ◽

Elderly Patients ◽

Bone Health ◽

Nutritional Assessment ◽

Femur Fracture ◽

Femoral Fractures ◽

Neck Of Femur ◽

Femur Fractures ◽

Neck Of Femur Fracture ◽

Health Review

Abstract Introduction Elderly patients with femoral fractures are often frail and require a multidisciplinary approach to optimise medical care, rehabilitation and prevention of further injury. Previously, neck of femur fracture patients were the focus of such an approach, but NICE and BOAST guidelines emphasise extending this care to other elderly trauma patients. Methods A retrospective analysis of 43 patients over 60 years old at Gloucestershire Hospitals NHS Foundation Trust in 2019 with a femoral fracture other than a neck of femur fracture. BOAST guideline standards were surgery within 36 hours, orthogeriatric assessment within 72 hours, a documented ceiling of treatment, falls risk assessment, bone health review, nutritional assessment and physiotherapy review. Results Our study showed worse outcomes in all standards for patients with femoral shaft, distal femur and periprosthetic femur fractures compared to neck of femur fractures: surgery within 36 hours (63.9% vs. 66%); orthogeriatric assessment within 72 hours (32.6% vs. 91.9%); falls risk assessment (76.7% vs. 99.6%); bone health review (41.9% vs. 99.7%); nutritional assessment (55.8% vs. 99.6%); physiotherapy review (97.7% vs. 98.9%). The group also had worse outcomes for average length of stay (19 days vs. 14 days) and 30 day mortality (9.3% vs. 8.6%). Discussion Our study showed a discrepancy in care received by elderly patients with femoral fractures other than neck of femur. We will introduce a proforma for all femoral fractures, present our findings to orthogeriatric, bone health and physiotherapy teams to involve them in the care of such patients and re-audit following these recommendations.

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Bilateral pathological neck of femur fractures associated with low grade splenic marginal zone lymphoma: Case report, and review of the literature

International Journal of Diagnostic Imaging ◽

10.5430/ijdi.v1n2p47 ◽

2014 ◽

Vol 1 (2) ◽

pp. 47

Author(s):

F Fallahi ◽

A Waton ◽

M Mansha ◽

W Cope ◽

H O’Brien ◽

...

Keyword(s):

Marginal Zone ◽

Marginal Zone Lymphoma ◽

Low Grade ◽

Splenic Marginal Zone Lymphoma ◽

Pathological Fractures ◽

Neck Of Femur ◽

Femur Fractures ◽

Clinical Literature ◽

Current Guidance ◽

Neck Of Femur Fracture

We report a case involving a 64 year old lady with bilateral pathological fractures of the neck of the femur secondary to Low Grade Splenic Marginal Zone Lymphoma, a pathology that has not previously been described in clinical literature. This particular case also highlights the value of the diagnosis and management of patients presenting with subtle and unusual symptoms, and supports the current guidance of the National Institute for Health and Care Excellence regarding the investigation of patients with suspected pathological neck of femur fracture.

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Comparison of functional outcomes between cemented and uncemented bipolar hemiarthroplasty for intracapsular neck femur fractures

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20200743 ◽

2020 ◽

Vol 6 (2) ◽

pp. 333

Author(s):

Harpreet Singh ◽

Tej S. Rudani ◽

Malay P. Gandhi ◽

Aliasgar J. Rampurwala

Keyword(s):

Excellent Result ◽

The Elderly ◽

Bipolar Hemiarthroplasty ◽

Neck Of Femur ◽

Femur Fractures ◽

Uncemented Hemiarthroplasty ◽

Duration Of Surgery ◽

The Mean ◽

Neck Of Femur Fracture ◽

Uncemented Group

Background: The neck of femoral fracture is common and leading fracture in orthopaedic practice. The older age group and female are more to prone to develop this fracture.Methods: A prospective, clinical observational, analytical comparative study was undertaken in the department of Orthopaedics of Geetanjali Medical College and Hospital in Udaipur, Rajasthan from January 2018 to June 2019. 52 adult patients with neck of femur fracture, 26 patients in each group. Results: In our study, the mean age was 77.72 years. Female preponderance was seen in our study. In our study mean duration of surgery in uncemented group was 65.78 minutes and mean duration of surgery in cemented group was 79.89 minutes. The mean total HHS in our patient was 86.63 with standard deviation of 6.18. Mean HHS for cemented group was 86 and for uncemented group was 87.23. We found 20 excellent result and 27 good results (35.71% and 51.92% respectively). We also found 5 fair result (12.37%). There were 2 complications, both in cemented group, one had post-operative dislocation and other had a cement reaction.Conclusions: Both cemented and uncemented hemiarthroplasty are equally good options in the treatment of femoral neck fractures in the elderly. However, it is to be noted that the duration of surgery & complications, were both less in the uncemented group as compared to cemented hemiarthroplasty group in our study.

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

10.21203/rs.3.rs-502228/v1 ◽

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.

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The effect of time to surgery in neck of femur fracture patients with ASA Grade of 3 and above

Hip International ◽

10.1177/1120700020972025 ◽

2020 ◽

pp. 112070002097202

Author(s):

Hiba Khan ◽

Al-Achraf Khoriati ◽

Stefan Lazic ◽

Jack Navein ◽

Ritesh Sharma ◽

...

Keyword(s):

High Risk ◽

Femur Fracture ◽

Mortality Rates ◽

Time Frame ◽

Neck Of Femur ◽

Time To Surgery ◽

Femur Fractures ◽

American Society ◽

Neck Of Femur Fracture ◽

The Impact

Introduction: Hip fractures are an important cause of morbidity and mortality. Early surgery has been shown to reduce mortality rates and surgical complications. The American Society of Anesthesiologists (ASA) grade is a widely used tool to assess preoperative health of patients. This study aims to assess is whether delay in surgical time has a greater impact on the mortality rates for high risk patients. Method: Retrospective study using the National Hip Fracture Database (NHFD) of 4883 neck of femur fracture patients. Time of surgery, ASA grade, reason for delay and mortality at 120 days was analysed, using statistical analysis software. Results: There was a significant increase in mortality ( p < 0.001) with increasing ASA grade. Surgical delays of more than 36 hours increased mortality by 2.9%. The impact of delaying surgery became more pronounced as the ASA grade increased. ASA 3 and above had an optimum time to surgery of between 12 and 24 hours giving the statistically significant lowest mortality rate ( p = 0.004). Discussion: Surgical delay beyond the 36-hour target for surgery has a greater impact on mortality for patients with higher ASA grades. The effect is most profound in the high-risk ASA grade 5 patients with delayed patients showing a 37.5% increase in mortality in this group. This would imply that by prioritising this higher risk group and operating on it within a specific time frame there would be a subsequent fall in mortality associated with neck of femur fractures.

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1671 The Effect Of COVID-19 On the Management and Outcome of Neck of Femur Fractures in A District General Hospital - A Comparative Study

British Journal of Surgery ◽

10.1093/bjs/znab259.1066 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

P Linardatou Novak ◽

B Davies ◽

A Bacon ◽

A MacDowell

Keyword(s):

Length Of Stay ◽

Femur Fracture ◽

Average Length ◽

Multidisciplinary Care ◽

District General Hospital ◽

Neck Of Femur ◽

Time To Surgery ◽

Average Length Of Stay ◽

Femur Fractures ◽

Neck Of Femur Fracture

Abstract Aim We wanted to see how the virus has impacted the management and outcome of our neck of femur fracture patients during Spring 2020. Method We performed a retrospective study of all neck of femur fracture patients presenting to our hospital from 23rd March 2020 (start of official lockdown in UK) until the end of May 2020 and compared them to patients presenting in the same time period in 2019. We recorded patient demographics, COVID-19 swab results, time to surgery, length of stay, transfers between wards, and 30-day mortality rates. Results We identified 75 patients in 2020 compared to 88 in 2019. Average length of stay was 11.4 days compared to 14.3 a year earlier. Mean time to surgery was 32.3 hours compared to 31.6 in 2019. The 30-day mortality increased significantly from 5.7% (5/88) in 2019 to 16% (12/75) in 2020 (p < 0.05) From 73 patients tested for COVID-19, 3 had a positive swab. Of these, 2 died. During their admission, 14 patients were transferred to 3 or more wards; in this group, 30-day mortality was 42.9% (6/14). Conclusions There has been a significant increase in 30-day mortality during COVID-19. Despite maintaining our time to surgery and reducing overall length of stay, we saw an increase in mortality, associated with multiple ward transfers rather than a high number of COVID-19 positive swab cases. Changes in pathways and wards configurations led to some patients requiring multiple transfers. This can cause difficulties in coordinated, multidisciplinary care for patients with NOF Fractures.

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Acetabular erosion after hemiarthroplasty

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20175140 ◽

2017 ◽

Vol 4 (1) ◽

pp. 53

Author(s):

Venkatesh Kumar N. ◽

Arvind Kumar S. M. ◽

Vinayagamoorthy . ◽

Sairamakrishnan S.

Keyword(s):

Functional Activity ◽

Activity Level ◽

Clinical Activity ◽

Bipolar Hemiarthroplasty ◽

Neck Of Femur ◽

Femur Fractures ◽

Ucla Score ◽

Cemented Bipolar Hemiarthroplasty ◽

Neck Of Femur Fracture ◽

Acetabular Erosion

Background: Neck of femur fractures are one of the devastating injuries in the old age. Their incidence is on the rise causing immense stress on the society. One of the most commonly done procedure is bipolar hemiarthroplasty. In our study we have evaluated the acetabular erosion after hemiarthroplasty, in neck of femur fracture patients after a minimum period of 2 years and have tried to correlate it with activity level of the patient.The aim of the study were early detection of acetabular erosion; to assess the functional outcome after minimum of 2 years after hemiarthroplasty by modified UCLA score; to correlate the functional activity level and radiological acetabular erosion.Methods: This is a retrospective radiological and clinical study. The post hemiarthroplasty plain radiographs, showing AP view of hip joint taken in the Department of Radiodiagnosis, PSGIMS&R will be studied along with activity level assessment. By Convenient sampling method, all the patients undergone cemented bipolar hemiarthroplasty, for fracture neck of femur after minimum of 2 years were assessed both radiologically and clinically. Functional activity level was assessed by Modified UCLA scoring system.Results: By this study we suggest an easy and effective way of evaluating acetabular erosion and clinical activity. There is significant increase in acetabular erosion as the duration after surgery increases. Conclusions: By this study we suggest an easy and effective way of evaluating acetabular erosion and clinical activity. There is significant increase in acetabular erosion as the duration after surgery increases. The clinical activity is by and large not significantly altered as the erosion progress at mid-term follow up.

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

Bone & Joint Open ◽

10.1302/2046-3758.17.bjo-2020-0066.r1 ◽

2020 ◽

Vol 1 (7) ◽

pp. 326-329 ◽

Cited By ~ 1

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.

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P134 Under the weather: The Meteorological correlation in Orthopaedic Trauma and within Hertfordshire

BJS Open ◽

10.1093/bjsopen/zrab032.133 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

Author(s):

M Vella-Baldacchino ◽

J Hanrahan ◽

S Islam ◽

R Sofat ◽

Martinique Vella-Baldacchino

Keyword(s):

Weather Conditions ◽

Local Area ◽

Meteorological Factor ◽

Weather Data ◽

Neck Of Femur ◽

Activity Data ◽

Femur Fractures ◽

Trauma Service ◽

Ankle Trauma ◽

Neck Of Femur Fracture

Abstract Background The paper aims to understand the effect of meteorological factors on the number of referrals and volume of trauma operating cases within our local area. Method Trauma data was analysed in our database: (eTrauma), a digital clinical platform that co-ordinates all admissions and: trauma theatre activity. Data consisted of number of referrals per day, patient: age, mechanism of injury and type of orthopaedic injury. Weather data was: gathered from a local weather station which: records daily weather observations. Results 1160 consultations wereanalysed, 779 required an operative intervention. Neck of femur fractures: and ankle trauma were the two most common cause of trauma, accounting for 27% and 15% respectively. Neck of femur fracture pathology were not significantly correlated with any meteorological factor studied. On the contrary, ankle trauma were the only injuries significantly correlating with temperature (p < 0.03) and due point (p < 0.04). Conclusion Weather has no effect on neck of femur fractures, the most common trauma pathology treated in our department. In all seasons allocated specific trauma lists for the latter should be arranged irrelevant of the weather conditions. We identified the days receiving highest referral rate, using this data to shape the future on call trauma service.

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The Neck of Femur Fracture in an Elderly Patient with Schizophrenia and Parkinsonism Managed with Dual Mobility Total Hip Replacement – A Rare Case Report

Journal of Orthopaedic Case Reports ◽

10.13107/jocr.2021.v11.i06.2246 ◽

2021 ◽

Vol 11 (6) ◽

Author(s):

Neetin P. Mahajan ◽

Lalkar Laxman Gadod ◽

Ajay S. Chandanwale ◽

Prasanna Kumar G. S ◽

Mrugank Narvekar ◽

...

Keyword(s):

Total Hip Replacement ◽

Hip Replacement ◽

Femur Fracture ◽

Dual Mobility Cup ◽

Neck Of Femur ◽

Dual Mobility ◽

Total Hip ◽

Femur Fractures ◽

The Right ◽

Neck Of Femur Fracture

Introduction: Neck of femur fractures is the most common fractures in elderly people as they present with osteoporosis. There is a higher chance of proximal femur fracture in a schizophrenic patient as there is a loss of bone mineral density due to a drug-induced increase in the level of prolactin and immobility. Patients with Parkinson’s disease were at higher risk for the development of hip fractures due to gait disturbances and instability. Case Report: A 63-year-old male patient presented with complaints of the right arm pain, swelling, deformity of the right arm, and difficulty in extending the wrist for 3 days. The patient had a history of falls and trauma to the left arm at home. X-ray right arm showed distal one-third spiral humerus fracture for which intramedullary nailing was done. X-ray of the pelvis with both hips showed right neck of femur fracture with associated greater trochanter (GT) fracture. We managed with total hip replacement using a dual mobility cup and tension band wiring for GT fracture. Postoperatively, the patient has a good range of motion at the hip. The functional outcome is good as per Harris’s hip score. Conclusion: Neck femur fractures in elderly patients with associated comorbidities such as schizophrenia and parkinsonism are best managed with total hip replacement using a dual mobility cup. It avoids the risk of dislocation in high-risk patients and prevents secondary procedures. Careful clinical and radiological examination of the pelvis is very essential even in asymptomatic patients with a history of trauma to prevent delayed diagnosis of these types of fractures in patients with schizophrenia and parkinsonism. Keywords: Neck of femur fracture, Parkinsonism, schizophrenia, dual mobility cup, total hip replacement.

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