Hyponatraemia in Hip Fracture Patients

2002 ◽  
Vol 47 (5) ◽  
pp. 115-116 ◽  
Author(s):  
E. McPherson ◽  
R. A. Dunsmuir
Keyword(s):  
Hip Fracture ◽  
Hip Fractures ◽  
Retrospective Review ◽  
Surgical Intervention ◽  
Close Monitoring ◽  
Neck Of Femur ◽  
Before And After

We performed a retrospective review of hyponatraemia in patients with hip fractures, before and after surgery. All patients admitted with fractures of the neck of femur who had a surgical intervention to deal with the fracture were included. Results were determined using two definitions for hyponatraemia. The incidence of preoperative and post-operative hyponatraemia were both 2.8% if hyponatraemia was defined as [Na]<130mmol/l. No cases of hyponatraemia were found pre-operatively when hyponatraemia was defined as [Na]<125mmol/l. Using this definition the post operative incidence of hyponatraemia was 0.93%. The incidence of hyponatraemia in this group of patients is small. However the potentially severe affects of hyponatraemia warrant close monitoring of these patients and the establishment of methods to prevent this problem from occurring.

scholarly journals Standardised Warfarin Reversal Expedites Time to Theatre for Fractured Neck of Femur Surgery and Improves Mortality Rates: A Matched Cohort Study

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Thomas S. Moores ◽  
Benjamin D. Chatterton ◽  
Matthew J. Walker ◽  
Phillip J. Roberts
Keyword(s):  
Cohort Study ◽  
Hip Fracture ◽  
Length Of Stay ◽  
Nearest Neighbour ◽  
Fractured Neck Of Femur ◽  
Neck Of Femur ◽  
The United Kingdom ◽  
Before And After ◽  
Warfarin Reversal ◽  
Guideline Group

Background. This study aims to evaluate outcomes for warfarinised hip fracture patients and compare them with a matched nonwarfarinised group, before and after the introduction of national hip fracture guidelines in the United Kingdom. Methods. A retrospective cohort study of 1743 hip fracture patients was undertaken. All patients admitted taking warfarin were identified. These patients were then matched to nonwarfarinised patients using nearest neighbour propensity score matching, accounting for age, sex, hip fracture type, and Nottingham Hip Fracture Score. A pre-guideline group (no standardised warfarin reversal regimen) and a post-guideline group (standardised regimen) were identified. Outcomes assessed included time to INR less than 1.7, time to theatre, length of stay, and 30-day and 1-year mortality. Results. Forty-six warfarinised hip fracture patients were admitted in the pre-guideline group (mean age 80.5, F:M 3:1) and 48 in the post-guideline group (mean age 81.2 years, F:M 3:1). Post-guideline patients were reversed to a safe operative INR level within 18 hours of admission, decreasing the time to first dose vitamin K (p<0.001). 70% of warfarinised patients were operated upon within 36 hours, compared to 19.6% with no regimen (p<0.05). After anticoagulation reversal protocol, thirty-day mortality decreased from 15.2% to 8.3% and 1-year mortality from 43.5% to 33% for warfarinised patients, which is comparable to nonwarfarinised matched patients. There was no significant change in the length of stay pre- and post-guideline for both groups of patients. Conclusions. Proactive anticoagulant management and expedient surgery reduces morbidity and mortality when managing this surgically challenging subset of hip fracture patients.

scholarly journals 63 Impact of an Orthogeriatric Service on Osteoporosis Management in HIP Fracture Patients

2019 ◽  
Vol 48 (Supplement_4) ◽  
pp. iv13-iv17
Author(s):  
Homaira Amini ◽  
Kevin Ong ◽  
Edward Strivens
Keyword(s):  
Vitamin D ◽  
Hip Fracture ◽  
Hip Fractures ◽  
Odds Ratio ◽  
Diagnosis Of Osteoporosis ◽  
Osteoporosis Management ◽  
Minimal Trauma ◽  
Tertiary Teaching ◽  
Before And After ◽  
New Diagnosis

Abstract Background Osteoporosis which is now treatable is the major risk factor for hip fractures in the elderly. Having a hip fracture increases morbidity and mortality. Hip fractures are costly. Incidence increases with age. Aims To examine how introduction of an orthogeriatric service (OGS) improves osteoporosis management. Method A dedicated OGS was established in the orthopaedic unit in an Australian tertiary teaching hospital in July 2014. Retrospective analyses were undertaken to compare osteoporosis diagnosis and treatment rates in patients ≥ 65 years old presenting with minimal trauma hip fractures (MTHF) before and after the OGS was established. Results 1. 108 MTHF (mean age 81 years) and 107 MTHF (mean age 82 years) were admitted in 2014 respectively before and after the OGS was established. 2. New osteoporosis diagnoses increased by 27%, new calcium &/or vitamin D prescription increased by 17% and new antiresorptive treatment increased by 30%, after the OGS was established. 3. The odds ratio for receiving a new diagnosis of osteoporosis post MTHF with the OGS compared to pre-OGS was 4.4 (2.1 – 9.0), p&lt;0.0001. 4. The odds ratio for initiating new antiresorptive treatment post fractured NOF with OGS compared to pre-OGS was 6.2 (3.0 – 12.7), p&lt;0.0001. 5. Rates of new diagnoses of osteoporosis and initiation of antiresorptive treatments with the OGS were not affected by age or gender. Conclusion 1. Introduction of a dedicated OGS improved osteoporosis diagnoses and initiation of antiresorptive treatments. 2. Patients who received a new diagnosis of osteoporosis and/or started on antiresorptive treatment were also likely to be prescribed calcium and/or vitamin D supplements as well. 3. There did not appear to be any age or gender bias towards giving more new diagnoses of osteoporosis and/or more new antiresorptive treatments with a dedicated OGS. 4. These results may be useful for benchmarking and comparison purposes.

Causes of in-hospital mortality after hip fractures in the elderly

2019 ◽  
Vol 30 (2) ◽  
pp. 204-209 ◽  
Author(s):  
Hannah Groff ◽  
Michael M Kheir ◽  
Jaiben George ◽  
Ibrahim Azboy ◽  
Carlos A Higuera ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Hip Fracture ◽  
Hospital Mortality ◽  
Hip Fractures ◽  
Surgical Intervention ◽  
Multiorgan Failure ◽  
Pathologic Fracture ◽  
The Elderly ◽  
Opioid Use ◽  
Type Of Anaesthesia

Objectives: Although there are numerous studies reporting early mortality after hip fracture, the incidence and aetiology of in-hospital mortality following hip fractures is largely unknown. This study aimed to determine the causes and the incidence of in-hospital mortality in patients with a hip fracture who received surgical treatment. Methods: This was a multi-institutional retrospective study identifying 2464 consecutive patients >65 years of age who were treated for a hip fracture from 2000 to 2016 at 2 institutions. Revision surgeries were excluded. An electronic query followed by manual chart review was performed to collect patient demographics, Charlson comorbidity index (CCI), type of anaesthesia, and cause of death. Results: The overall in-hospital mortality rate for patients undergoing surgical intervention for an acute hip fracture was 3.0% (75/2464). The most common causes of death in descending order were: respiratory failure ( n = 26), cardiac failure ( n = 13), multiorgan failure ( n = 6), septic shock ( n = 6), pulmonary embolism ( n = 5), end stage renal disease ( n = 5) and others ( n = 14). In-hopsital mortality was associated with older age ( p = 0.001) and higher CCI scores ( p = 0.001). There was no association with gender ( p = 0.165), type of anaesthesia ( p = 0.497), extracapsular versus intracapsular fracture ( p = 0.627), pathologic versus non-pathologic fracture (0.799), or body mass index ( p = 0.781). Conclusion: This study demonstrated that hip fracture patients are at relatively high risk of in-hospital mortality following surgical intervention with a high proportion of patients succumbing to respiratory failure. The findings compel us to investigate strategies that can minimize mortality related to respiratory failure in this patient population such as minimising opioid use, early mobilisation, and implementing greater respiratory monitoring.

scholarly journals Admission and treatment at a weekend is not associated with worse outcomes for patients admitted with fractured neck of femur

Trauma ◽  
2018 ◽  
Vol 21 (4) ◽  
pp. 288-294
Author(s):  
Asef Al-Ani ◽  
Matthew Bence ◽  
Alexander D. Liddle ◽  
Barry Ferris
Keyword(s):  
Hip Fracture ◽  
Hip Fractures ◽  
Weekend Effect ◽  
Specific Reference ◽  
Confounding Factors ◽  
Fractured Neck Of Femur ◽  
Neck Of Femur ◽  
Unmeasured Confounding ◽  
Risk Of Death ◽  
Developed World

Introduction The weekend effect is a reported phenomenon whereby patients admitted at a weekend are found to have worse outcomes than those admitted during the week. The causes are not well understood, but may have implications for the planning of medical workforces throughout the developed world. Although the magnitude of the weekend effect is reduced whenknown confounding factors are adjusted for, there are likely to be substantial residual unmeasured confounding factors. It remains unclear how much effect exists in comparable patients. The aim of this study was to determine whether the presence of a weekend effect could be detected for the patients admitted with hip fracture to our unit and to quantify this effect if detected. Methods All hip fracture patients admitted to our unit over a five-year period were examined. All patients had their details entered onto the National Hip Fracture Database which was investigated to compare inpatient, 30-day, 120-day and 365-day mortality with specific reference to day of admission and operative treatment. Results Two thousand one hundred and thirty fractured neck of femur patients were admitted from 2011 to 2016. We found no difference in mortality in being admitted or treated at the weekend or weekday; however, patients operated upon on a Tuesday had a statistically significant higher risk of death (OR 2.813, 95% CI 1.336–5.992, p = 0.006). The reasons for this are unclear. Conclusions In our unit there is no evidence of a weekend effect for hip fractures.

scholarly journals 67 Reducing Delays to Operative Management of Anti-Coagulated Patients With Hip Fractures

2020 ◽  
Vol 49 (Supplement_1) ◽  
pp. i18-i20
Author(s):  
J Ensanullah ◽  
B Shah ◽  
M Fertleman
Keyword(s):  
Hip Fracture ◽  
Hip Fractures ◽  
Heart Valves ◽  
Guideline Implementation ◽  
Operative Management ◽  
National Guidelines ◽  
Improvement Project ◽  
Before And After ◽  
Surgery Timing ◽  
The Uk

Abstract Introduction In the UK, the gold-standard treatment of a hip fracture is surgical fixation within 36 hours. Reduced delay to surgery has been shown to minimise the risk of complications. Locally, frequent delays to surgery were observed in patients taking long-term anticoagulation. There are no national guidelines regarding anticoagulation reversal and surgery timing in patients with hip fractures, and doctors are often unfamiliar with increasingly prevalent Direct Oral Anti-coagulants (DOACs). This quality improvement project aimed to reduce delays to surgery in anti-coagulated patients with hip fractures. Methods A guideline was formulated following literature review and consultation with a Consultant Ortho-geriatrician, Orthopaedic Surgeon and Haematologist. Retrospective casenote audit was conducted including 3-month period before and after implementation. The new guideline was disseminated in poster form. Due to the observation that delays in receiving INR results resulted in reversal delay, patient’s on warfarin were recommended to receive 5 mg IV Vitamin K prior to receiving INR results. The INR was rechecked after 6 hours, and if less than 1.6, surgery could proceed. Those on DOACs could undergo surgery 24 hours after the last dose providing eGFR &gt;30, and after 48 hours if eGFR &lt;30. Exclusions were those anti-coagulated for metallic heart valves or recent venous thromboembolism. Results In the 3 months prior to guideline implementation, 71 patients had a hip fracture; 15 were anti-coagulated. Of these, 8 patients were delayed due to their anticoagulation. Repeat audit after implementation, included 46 patients with a hip fracture over the 3-month period; 7 were anti-coagulated. None were delayed due to anticoagulation (p &lt; 0.05). Conclusions This improvement project describes formulation of a simple protocol with evidence from the literature and local expert opinion in order to reduce unnecessary delays in anti-coagulated patients with hip fractures.

SO072INCIDENCE OF FRACTURES BEFORE AND AFTER DIALYSIS INITIATION AMONG INCIDENT DIALYSIS PATIENTS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Ken Iseri ◽  
Juan Jesus Carrero ◽  
Marie Evans ◽  
Li Felländer-Tsai ◽  
Hans Berg ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Incidence Rate ◽  
Hip Fractures ◽  
Temporal Pattern ◽  
Incidence Rates ◽  
Fracture Incidence ◽  
Dialysis Initiation ◽  
Dialysis Patients ◽  
Initiation Of Dialysis ◽  
Before And After

Abstract Background and Aims The incidence of fractures is markedly higher in dialysis patients than in pre-dialysis patients, but it is not clear to what extent the initiation of dialysis as such is associated with accelerated fracture incidence or if fracture rates are already increasing prior to dialysis start among incident dialysis patients. Here we investigated the temporal pattern of occurrence of a first major osteoporotic fracture (MOF) among incident dialysis patients in the pre-dialysis period and in the period following dialysis initiation. Method We analyzed data from Swedish Renal Registry (SRR) and identified 9041 incident dialysis patients (2005 -2015; age 67 years, 67% men). We identified all first MOF (MOFfirst) in hip, spine, humerus and forearm during 12 months before and after dialysis initiation. Using flexible parametric hazard models and Fine-Gray analysis accounting for competing risk of death and renal transplantation, we estimated adjusted fracture incidence rates and predictors of MOFfirst. Results During the whole follow-up period, there were 361 fractures including 196 hip fractures. The crude incidence rate of MOFfirst (n=157) before dialysis initiation was 17/1000 patient-years and after initiation of dialysis the incidence rate of MOFfirst increased to 24/1000 patient-years. Overall the adjusted MOFfirst incidence rates increased from 6 months before initiation of dialysis, fluctuated, and stabilized at a higher rate than that of the baseline rate after 12 months. The adjusted hip fracture rate rose steeply 3 months before dialysis initiation, declined 3 months after dialysis initiation, fluctuated, and then became stabilized. On the contrary, the adjusted incidence rates of other fractures, i.e., non-hip fractures, appeared to be stable all the time, before as well as after initiation of dialysis. Female gender, higher age and previous history of MOF had a negative impact on fracture incidence rates before and after dialysis initiation. Conclusion We conclude that the incidence of MOFfirst is increasing already from 6 months prior to dialysis initiation among incident dialysis patients, and that there is a further increase following dialysis initiation. For hip fracture, which was the most common MOF, the temporal pattern of incidence rates was compressed to a high risk period lasting from 3 months before to 3 months after dialysis initiation, underlining the need of increased attention to prevent hip fractures in incident dialysis patients during this critical period.

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.

scholarly journals Demographic Study of Hip Fractures in the Maltese Islands

2018 ◽  
Vol 9 ◽  
pp. 215145931876477 ◽  
Author(s):  
Mark Bugeja ◽  
Simon Aquilina ◽  
Charles Farrugia ◽  
Ivan Esposito
Keyword(s):  
Socioeconomic Status ◽  
Hip Fracture ◽  
Hospital Stay ◽  
Low Socioeconomic Status ◽  
Hip Fractures ◽  
Surgical Intervention ◽  
Average Delay ◽  
Public Health Burden ◽  
Maltese Islands ◽  
The Impact

Introduction: Despite hip fractures being a great public health burden, only few studies have analyzed the relationship between hip fracture incidence and socioeconomic status. Many studies found an association; however, results are in part conflicting. Objective: To analyze the impact of regional-level socioeconomic status on the incidence of hip fractures in the Maltese Islands. Method: All individuals older than 50 years who presented to the acute care hospitals in Malta and Gozo with low-energy hip fractures between December 1, 2015, and November 30, 2016, were selected. Data on individual demographics, hip fracture type, surgical intervention, and hospital stay were collected. The percentage of hip fracture and socioeconomic status of each region in the Maltese Islands were calculated. These were then analyzed for any statistical association. Results: A moderate negative correlation ( r = −0.5987, N = 454, P < .05) was found between the socioeconomic status and the incidence of hip fracture in each region. There was 5.9% (n = 27) mortality rate posed by these hip fractures. The average duration of hospital stay was 14 days, with an average delay to surgical intervention of 2 days. Conclusion: Despite the Maltese Islands having a small population (429 344 people) and a free universal national health service, our results show that districts with low socioeconomic status had a higher incidence of hip fracture. Further studies using individual socioeconomic data and longer duration are required.

scholarly journals Hip Fracture Trends in America Between 2009 and 2016

2020 ◽  
Vol 11 ◽  
pp. 215145932092958
Author(s):  
Ethan A. Remily ◽  
Nequesha S. Mohamed ◽  
Wayne A. Wilkie ◽  
Ashwin K. Mahajan ◽  
Nirav G. Patel ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Hip Fractures ◽  
Complication Rate ◽  
Smoking Status ◽  
High Morbidity ◽  
Neck Of Femur ◽  
Lengths Of Stay ◽  
Common Diagnosis ◽  
Tract Infections ◽  
Deep Vein

Background: Hip fractures are a common condition associated with high morbidity and mortality. In this study, we assess (1) yearly incidences, (2) demographic factors, (3) postoperative outcomes, (4) primary diagnoses, and (5) primary procedures. Materials and Methods: The National Inpatient Sample was queried for patients admitted with hip fractures from 2009 to 2016 (n = 2 761 850). Variables analyzed were age, sex, race, obesity status, Charlson Comorbidity Index, smoking status, osteoporosis status, lengths of stay (LOS), discharge dispositions, charges, costs, mortalities, inpatient complications, primary and secondary diagnoses, and primary procedures. Results: From 2009 to 2016, the overall gross number of hip fractures decreased ( P < .001). At the conclusion of the study, more patients were male, obese, and smokers, while fewer had a diagnosis of osteoporosis ( P < .001 for all). Mean LOS significantly decreased ( P < .001), while charges and costs increased ( P < .001 for both). Both mortality and the overall complication rate decreased ( P < .001 for both). Specifically, complications that decreased included myocardial infarctions, deep vein thromboses, pulmonary emboli, pneumoniae, hematomas/seromas, urinary tract infections, and transfusions ( P < .001 for all). Complications that increased included cardiac arrests, respiratory failures, mechanical complications, and sepsis ( P < .001 for all). The most common diagnosis was “closed fracture of intertrochanteric section of neck of femur.” The procedure performed most often was “open reduction of fracture with internal fixation, femur.” Conclusion: An increasing number of males and smokers have sustained hip fractures, although fewer patients with osteoporosis experienced these injuries. A decreasing overall complication rate may indicate improving perioperative courses for hip fracture patients. However, several shortcomings still exist and can be improved to further decrease negative outcomes.

scholarly journals Hip fracture litigation: A 10-year review of NHS Litigation Authority data and the effect of national guidelines

2017 ◽  
Vol 99 (1) ◽  
pp. 17-21 ◽  
Author(s):  
R Fanous ◽  
S Sabharwal ◽  
A Altaie ◽  
CM Gupte ◽  
P Reilly
Keyword(s):  
Hip Fracture ◽  
Hip Fractures ◽  
Best Practice ◽  
Clinical Excellence ◽  
Freedom Of Information ◽  
National Guidelines ◽  
Delay In Diagnosis ◽  
Significant Difference ◽  
Before And After ◽  
The Uk

We present a review evaluating all litigation claims relating to hip fractures made in a 10-year period between 2005 and 2015. Data was obtained from the NHS Litigation Authority through a freedom of information request. All claims relating to hip fractures were reviewed. During the period analysed, 216 claims were made, of which 148 were successful (69%). The total cost of settling these claims was in excess of £5 million. The introduction of a best-practice tariff by the Department of Health in 2010 was designed to improve the quality of care for hip fracture patients. This was followed by guidance from the National Institute for Health and Clinical Excellence in 2011 and the British Orthopaedic Association in 2012. We analysed claims submitted before and after these guidelines were introduced and no significant difference in the number of claims was noted. The most common cause for litigation was a delay in diagnosis, which accounted for 86 claims in total (40%). Despite the presence of these guidelines and targets, there has not been a significant reduction in the number of claims or an improvement in diagnostic accuracy. This may be due to an increasing level of litigation in the UK but we must also question whether we are indeed providing best-practice care to our hip fracture patients and whether these guidelines need further review.

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