Spontaneous Fractured Neck of Femur in Rheumatoid Arthritis: Absence of Radiographic Changes on Initial X-Ray

1985 ◽  
Vol 30 (3) ◽  
pp. 178-180 ◽  
Author(s):  
T. Pullar ◽  
J. Parker ◽  
H. A. Capell
Keyword(s):  
Rheumatoid Arthritis ◽  
Fractured Neck Of Femur ◽  
Neck Of Femur ◽  
X Ray ◽  
Radiographic Changes

scholarly journals Another fractured neck of femur: do we need a lateral X-ray?

2011 ◽  
Vol 84 (1001) ◽  
pp. 413-417 ◽  
Author(s):  
B Almazedi ◽  
C D Smith ◽  
D Morgan ◽  
G Thomas ◽  
G Pereira
Keyword(s):  
Fractured Neck Of Femur ◽  
Neck Of Femur ◽  
X Ray

scholarly journals The use of computed tomography in identifying radiologically occult hip fractures in the elderly

2014 ◽  
Vol 96 (3) ◽  
pp. 234-237 ◽  
Author(s):  
S Heikal ◽  
P Riou ◽  
L Jones
Keyword(s):  
Computed Tomography ◽  
Hip Fractures ◽  
Historical Review ◽  
The Elderly ◽  
Acetabular Fractures ◽  
Fractured Neck Of Femur ◽  
Neck Of Femur ◽  
X Ray ◽  
Magnetic Resonance Imaging Mri ◽  
Occult Hip Fractures

Introduction Fractured neck of femur (NOF) is a cause of significant morbidity and mortality. Approximately 4% of patients with an initial normal hip x-ray in the emergency department (ED) will in fact have an occult fracture. In cases where there is ongoing clinical suspicion of NOF fracture despite a normal hip x-ray, alternative imaging should be used. Although available evidence supports the use of magnetic resonance imaging (MRI) for this, it is often not readily accessible from the ED. In our department, it is common practice to request computed tomography (CT). Methods A historical review was undertaken of all patients who presented between October 2007 and January 2011 who had CT requested by ED staff. Patients included in the study were those who presented following low impact trauma in whom fractured NOF was suspected despite a normal x-ray. Results Of the 65 included patients, fractures (pelvic and hip) were identified in 38 patients on CT. Fractured NOFs were found in 13 patients. Acetabular fractures were found in nine patients, five of whom required further orthopaedic management. One patient went on to have MRI to confirm the diagnosis of an impacted NOF fracture, suspected both on x-ray and CT. Further review was undertaken of the medical notes of discharged patients to identify any who reattended or required further imaging. No such cases were found. Conclusions This review has shown the use of CT to be a practical approach to improving the care of patients with occult hip fractures.

Trial of Aspirin and RA 233 in Prevention of Post-operative Deep Vein Thrombosis

1973 ◽  
Vol 30 (01) ◽  
pp. 018-024 ◽  
Author(s):  
Edward H. Wood ◽  
Colin R.M. Prentice ◽  
D. Angus McGrouther ◽  
John Sinclair ◽  
George P. McNicol
Keyword(s):  
Deep Vein Thrombosis ◽  
Controlled Trial ◽  
Oral Anticoagulants ◽  
Antithrombotic Agent ◽  
Fractured Neck Of Femur ◽  
Neck Of Femur ◽  
Vein Thrombosis ◽  
Effective Prophylaxis ◽  
Deep Vein ◽  
Calf Vein

SummaryAlthough the oral anticoagulants provide effective prophylaxis against postoperative deep vein thrombosis following fracture of neck of femur there is a need for an antithrombotic agent which needs less laboratory control and does not cause haemorrhagic complications. It has been suggested that drugs causing inhibition of platelet function may fulfil these requirements. A controlled trial was carried out in which aspirin, RA 233, or a combination of these drugs was compared with a placebo in the prevention of post-operative deep vein thrombosis. In thirty patients undergoing surgery for fractured neck of femur the incidence of post-operative calf vein thrombosis, as detected by 125I-fibrinogen scanning, was not significantly different between the untreated and treated groups.

102 Peer Teaching in Hip Fracture: Responding to the Medical Needs of Surgical Patients and Educational Needs of Junior Doctors

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
N Jones ◽  
J Francis ◽  
R Parikh ◽  
M Shaath
Keyword(s):  
Metastatic Cancer ◽  
Vascular Complications ◽  
Educational Programme ◽  
Junior Doctors ◽  
Fractured Neck Of Femur ◽  
Neck Of Femur ◽  
Teaching Programme ◽  
Medical Needs ◽  
Strongly Agree ◽  
Case Based

Abstract Introduction Fractured Neck of Femur (FNOF) patients are complex. A mortality project identified topics for a peer-led teaching programme. Method Eight bite-sized case-based sessions were devised, to provide a framework to approach the following topics: Anaemia, delirium/dementia, ECG abnormalities, metastatic cancer, osteoporosis, renal disease, respiratory disease, and vascular complications. Attendees were asked to complete pre- and post- teaching programme questionnaires using a Likert Scale to indicate agreement with statements relating to the topic areas chosen (1=strongly disagree and 5=strongly agree). Result Pre-programme questionnaire: respondents were neutral (average 3.04) when asked whether topic areas were currently “well managed”. Attendees lacked confidence, indicating preparedness as neutral (average 3.35). Trainees agreed that they would benefit from teaching (average 4.56). Post-programme questionnaire: increased confidence was reported when considering preparedness (average 4.3). Attendees felt the teaching programme was “accessible” and the “topics well-chosen”. 100% of attendees regarded the teaching as ‘excellent’ or ‘very-good’. Conclusions Matching patient needs to an educational programme is important. The “bite-sized” nature of the programme paired with case-based learning increased confidence. A peer-led teaching programme is a positive response to themes emerging from morbidity and mortality reviews.

scholarly journals AB0267 BODY COMPOSITION IN PATIENTS WITH RHEUMATOID ARTHRITIS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1432.2-1432
Author(s):  
N. Toroptsova ◽  
O. Dobrovolskaya ◽  
N. Demin ◽  
L. Shornikova
Keyword(s):  
Rheumatoid Arthritis ◽  
Body Composition ◽  
Muscle Mass ◽  
Dual Energy ◽  
X Ray ◽  
T Score ◽  
Osteosarcopenic Obesity ◽  
The Mean ◽  
Total Fat ◽  
Appendicular Muscle Mass

Background:Rheumatoid arthritis (RA) is a complex inflammatory disease that modifies body composition. Using the dual-energy x-ray absorptiometry (DXA) in RA patients could be a method for body composition changes detection.Objectives:To study the body composition using DXA in patients with RA.Methods:The study involved 79 women with RA, median age 60 [55; 65] years. The bone mineral density (BMD) was measured by dual-energy x-ray absorptiometry using «Discovery A» (Hologic, USA). Assessment of body composition was carried out, using the program «Whole body». Sarcopenia (SP) was diagnosed as a decrease in appendicular mass index (AMI) <6.0 kg/m2. Osteoporosis (OP) was diagnosed as a decrease in T-score <-2.5 SD. Osteosarcopenia was determined when T-score was <-1.0 SD, AMI was <6.0 kg/m2, osteosarcopenic obesity - T-score was <-1.0 SD, AMI was <6.0 kg/m2and total fat was >35%.Results:The mean duration of RA was 9 [3; 11] years. The mean body mass index (BMI) was 27.6±4.8 kg/m2. Disease activity score in 28 joints-erythrocyte sedimentation rate was 4.5±1.3 points for the group. 39 (49.3%) patients used oral glucocorticoids continuously. Appendicular muscle mass and AMI were on average 17.8±3.0 kg and 6.8±1.0 kg/m2, respectively. AMI <6 kg/m2was detected in 20 (25.3%) patients. 56 (70.9%) women with RA had total fat > 35%, while only 22 (27.8%) of women with RA had obesity according to BMI (BMI >30 kg/m2). Isolated OP was found in 13 (16.5%), osteosarcopenia in 7 (8.9%) and osteosarcopenic obesity in 13 (16.5%) patients RA. No cases with isolated sarcopenia or sarcopenic obesity were detected. Only 3 (3.8%) patients did not have appendicular muscle mass, AMI and BMD decrease and overfat or obesity.Conclusion:About 97% women with RA had abnormal body composition phenotype: 16,5% - OP, 8.9% -osteosarcopenia, 16,5% - osteosarcopenic obesity and 54,4% - overfat.Disclosure of Interests:None declared

scholarly journals Management of Warfarin Anticoagulation in Patients with Fractured Neck of Femur

2011 ◽  
Vol 2011 ◽  
pp. 1-5 ◽  
Author(s):  
Feras Ashouri ◽  
Wissam Al-Jundi ◽  
Akash Patel ◽  
Jitendra Mangwani
Keyword(s):  
Vitamin K ◽  
Hip Fractures ◽  
National Policy ◽  
District General Hospital ◽  
Pharmacological Therapy ◽  
Fractured Neck Of Femur ◽  
Neck Of Femur ◽  
Time To Surgery ◽  
Group A ◽  
Group B

Background. Most orthopaedic units do not have a policy for reversal of anticoagulation in patients with hip fractures. The aim of this study was to examine the current practice in a district general hospital and determine difference in the time to surgery, if any, with cessation of warfarin versus cessation and treatment with vitamin K. Methods. A retrospective review of the case notes between January 2005 and December 2008 identified 1797 patients with fracture neck of femur. Fifty seven (3.2%) patients were on warfarin at the time of admission. Patients were divided into 2 groups (A and B). Group A patients (16/57; 28%) were treated with cessation of warfarin only and group B patients (41; 72%) received pharmacological therapy in addition to stopping warfarin. Time to surgery between the two groups was compared. Results. The mean INR on admission was 2.9 (range 1.7–6.5) and prior to surgery 1.4 (range 1.0–2.1). Thirty eight patients received vitamin K only and 3 patients received fresh frozen plasma and vitamin K. The average time to surgery was 4.4 days in group A and 2.4 days in group B. The difference was statistically significant (P<.01). Conclusion. Reversal of high INR is important to avoid significant delay in surgery. There is a need for a national policy for reversing warfarin anticoagulation in patients with hip fractures requiring surgery. Vitamin K is safe and effective for anticoagulation reversal in hip fracture patients.

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