Orthogeriatric Combined Management of Elderly Patients With Proximal Femoral Fracture: Results of a 1-Year Follow-Up

Introduction: According to the expected demographical changes, the number of elderly trauma patients will increase exponentially over the next decades. Different models of an interdisciplinary orthogeriatric care have been developed. But there is only limited evaluation of their benefit without clear and evidence-based results. In 2011, we monitored the results of our orthogeriatric combined management by conducting a 1-year follow-up. Methods: We treated 231 patients presenting a proximal femoral fracture on our orthogeriatric ward. We obtained the epidemiological data and the geriatric assessments from all these patients. One year after discharge, we sent them a written questionnaire. Primary end points were the mortality and the functional outcome, measured by Barthel score, the requirement of care, and the residential status. Results: One hundred sixty-seven (72%) of the 231 patients completed the follow-up. The average age at admission was 81.5 years (70-99 years). The mortality rate was 2.4% during hospital stay and 31.4% after 1 year. The average Barthel score was 44 points at the time of admission, 55 points at discharge, and 72 points after 1 year. Forty-five percent of the patients were in requirement of care at the time of their admission. At the 1-year follow-up, 63% of the patients had some form of care, thus showing an increase of 18%. At the moment of the fracture, 77% of the patients were living in their own home and 23% in a nursing home. After 1 year, the surviving patients show nearly unchanged conditions (75% own home vs 25% nursing home). Eighty-six percent of the patients coming from their own home were able to continue living there independently. Conclusion: The orthogeriatric care is successful in reducing the short-time mortality without showing any effect on 1-year mortality. But the surviving patients seem to benefit from an improved functional outcome.

Download Full-text

Necrosis avascular

Studies in the Economic History of Southern Africa ◽

10.22201/fm.24484865e.2020.63.2.03 ◽

2020 ◽

Vol 63 (2) ◽

pp. 18-23

Author(s):

Alejandro Jardón Gómez ◽

Ana Cristina King ◽

Carlos Pacheco Díaz

Keyword(s):

Femoral Head ◽

Avascular Necrosis ◽

Femoral Fracture ◽

Open Fracture ◽

Clinical Presentation ◽

Femoral Fractures ◽

Proximal Femoral Fracture ◽

Young Population ◽

Steroid Use

The clinical presentation of a proximal femoral fracture is completely different between young and adult patients. Unlike closed proximal femoral fractures, the incidence of exposed fractures is found in the young population between 15 and 30 years of age. Osteonecrosis of the femoral head is one the complications we can find in this type of fractures. Avascular necrosis (AVN or osteonecrosis) is defined as the interruption of blood supply to the femoral head due to trauma, infectionalcohol or steroid use, resulting in bone necrosis, joint collapse and osteoarthrosis. The treatment will depend on the clinical presentation, age of the patient and when the diagnosis is made. This is a case report of a 16-year-old patient with a gunshot wound on the hip. Surgical cleansing and closed reduction plus internal fixation with a nail in the center of the spine were performed. A 3-year clinical and radiographic follow up was made, observing the evolution of the fracture and the subsequent avascular necrosis that the patient presented. Key words: Proximal femoral fracture; hip; avascular necrosis (AVN, osteonecrosis); open fracture; osteoarthritis.

Download Full-text

PP038 NUTRIENT STATUS IN NURSING HOME RESIDENTS - A ONE-YEAR FOLLOW-UP STUDY

Clinical Nutrition Supplements ◽

10.1016/s1744-1161(10)70115-0 ◽

2010 ◽

Vol 5 (2) ◽

pp. 37-38

Author(s):

R. Kaiser ◽

K. Winning ◽

D. Volkert ◽

T. Bertsch ◽

S. Lesser ◽

...

Keyword(s):

Nursing Home ◽

Nursing Home Residents ◽

Nutrient Status ◽

Follow Up Study ◽

One Year

Download Full-text

Intermediate care in nursing home after hospital admission: a randomized controlled trial with one year follow-up

BMC Research Notes ◽

10.1186/1756-0500-7-889 ◽

2014 ◽

Vol 7 (1) ◽

pp. 889 ◽

Cited By ~ 7

Author(s):

Jo Herfjord ◽

Torhild Heggestad ◽

Håkon Ersland ◽

Anette Ranhoff

Keyword(s):

Randomized Controlled Trial ◽

Nursing Home ◽

Hospital Admission ◽

Controlled Trial ◽

Intermediate Care ◽

Randomized Controlled ◽

One Year

Download Full-text

P099: Extending the trimodal distribution of death; trauma patients die at increased rates after discharge. Linking trauma registry data to vital statistics and hospital datasets identifies opportunities to save life

CJEM ◽

10.1017/cem.2020.305 ◽

2020 ◽

Vol 22 (S1) ◽

pp. S100-S100

Author(s):

J. French ◽

C. Somayaji ◽

D. Dutton ◽

S. Benjamin ◽

P. Atkinson

Keyword(s):

Mortality Rate ◽

Cause Of Death ◽

Causes Of Death ◽

Trauma Registry ◽

Vital Statistics ◽

Trauma Patients ◽

Age Group ◽

Post Discharge ◽

One Year

Introduction: The New Brunswick Trauma Registry is a database of injury admissions from eight hospitals throughout the province. Data tracks individuals in-hospital. By linking this information with vital statistics, we are able to observe outcomes post-discharge and can model health outcomes for participants. We want to know how outcomes for trauma patients compare with the general population post discharge. Methods: Using data from 2014-15, we followed over 2100 trauma registry observations for one year and tracked mortality rate per 1,000 people by age-group. We also compared the outcomes of this group to all Discharge Abstract Database (DAD) entries in the province (circa. 7500 total). We tracked mortality in-hospital, at six months, and one year after discharge. We truncated age into groups aged 40-64, 65-84, and 85 or older. Results: In-hospital mortality among those in the trauma registry is approximately 20 per 1,000 people for those age 40-64, 50 per 1,000 people for those aged 65-84, and 150 per 1,000 people aged 85 or older. For the oldest age group this is in line with the expected population mortality rate, for the younger two groups these estimates are approximately 2-4 times higher than expected mortality. The mortality at six-month follow-up for both of the younger groups remains higher than expected. At one-year follow-up, the mortality for the 65-84 age group returns to the expected population baseline, but is higher for those age 40-64. Causes of death for those who die in hospital are injury for nearly 50% of observations. After discharge, neoplasms and heart disease are the most common causes of death. Trends from the DAD are similar, with lower mortality overall. Of note, cardiac causes of death account for nearly as many deaths in the 6 months after the injury in the 40 -64 age group as the injury itself. Conclusion: Mortality rates remain high upon discharge for up to a year later for some age groups. Causes of death are not injury-related. Some evidence suggests that the injury could have been related to the eventual cause of death (e.g., dementia), but questions remain about the possibility for trauma-mitigating care increasing the risk of mortality from comorbidities. For example, cardiac death, which is largely preventable, is a significant cause of death in the 40-64 age group after discharge. Including an assessment of Framingham risk factors as part of the patients rehabilitation prescription may reduce mortality.

Download Full-text

Mortality and One-Year Functional Outcome in Elderly and Very Old Patients with Severe Traumatic Brain Injuries: Observed and Predicted

Behavioural Neurology ◽

10.1155/2015/845491 ◽

2015 ◽

Vol 2015 ◽

pp. 1-7 ◽

Cited By ~ 12

Author(s):

Cecilie Røe ◽

Toril Skandsen ◽

Unn Manskow ◽

Tiina Ader ◽

Audny Anke

Keyword(s):

Functional Outcome ◽

Brain Injuries ◽

Clinical Information ◽

Unfavorable Outcome ◽

Old Patients ◽

Very Old ◽

Severe Tbi ◽

One Year ◽

Very Old Patients

The aim of the present study was to evaluate mortality and functional outcome in old and very old patients with severe traumatic brain injury (TBI) and compare to the predicted outcome according to the internet based CRASH (Corticosteroid Randomization After Significant Head injury) model based prediction, from the Medical Research Council (MRC).Methods.Prospective, national multicenter study including patients with severe TBI ≥65 years. Predicted mortality and outcome were calculated based on clinical information (CRASH basic) (age, GCS score, and pupil reactivity to light), as well as with additional CT findings (CRASH CT). Observed 14-day mortality and favorable/unfavorable outcome according to the Glasgow Outcome Scale at one year was compared to the predicted outcome according to the CRASH models.Results.97 patients, mean age 75 (SD 7) years, 64% men, were included. Two patients were lost to follow-up; 48 died within 14 days. The predicted versus the observed odds ratio (OR) for mortality was 2.65. Unfavorable outcome (GOSE < 5) was observed at one year follow-up in 72% of patients. The CRASH models predicted unfavorable outcome in all patients.Conclusion.The CRASH model overestimated mortality and unfavorable outcome in old and very old Norwegian patients with severe TBI.

Download Full-text

Impact of avolition and cognitive impairment on functional outcome in first-episode schizophrenia-spectrum disorder: a prospective one-year follow-up study

Schizophrenia Research ◽

10.1016/j.schres.2016.01.004 ◽

2016 ◽

Vol 170 (2-3) ◽

pp. 318-321 ◽

Cited By ~ 20

Author(s):

Wing Chung Chang ◽

Christy Lai Ming Hui ◽

Sherry Kit Wa Chan ◽

Edwin Ho Ming Lee ◽

Eric Yu Hai Chen

Keyword(s):

Cognitive Impairment ◽

Functional Outcome ◽

Spectrum Disorder ◽

First Episode ◽

Schizophrenia Spectrum Disorder ◽

Follow Up Study ◽

Schizophrenia Spectrum ◽

One Year ◽

First Episode Schizophrenia

Download Full-text

Early experience and patient-reported outcomes of 503 INFINITY total ankle arthroplasties

The Bone & Joint Journal ◽

10.1302/0301-620x.103b7.bjj-2020-2058.r2 ◽

2021 ◽

Vol 103-B (7) ◽

pp. 1270-1276

Author(s):

David N. Townshend ◽

Andrew J. F. Bing ◽

Timothy M. Clough ◽

Ian T. Sharpe ◽

Andy Goldberg ◽

...

Keyword(s):

Functional Outcome ◽

Early Experience ◽

Outcome Data ◽

Patient Specific ◽

Patient Specific Instrumentation ◽

Significant Difference ◽

Patient Reported ◽

The Mean ◽

One Year

Aims This is a multicentre, non-inventor, prospective observational study of 503 INFINITY fixed bearing total ankle arthroplasties (TAAs). We report our early experience, complications, and radiological and functional outcomes. Methods Patients were recruited from 11 specialist centres between June 2016 and November 2019. Demographic, radiological, and functional outcome data (Ankle Osteoarthritis Scale, Manchester Oxford Questionnaire, and EuroQol five-dimension five-level score) were collected preoperatively, at six months, one year, and two years. The Canadian Orthopaedic Foot and Ankle Society (COFAS) grading system was used to stratify deformity. Early and late complications and reoperations were recorded as adverse events. Radiographs were assessed for lucencies, cysts, and/or subsidence. Results In all, 500 patients reached six-month follow-up, 420 reached one-year follow-up, and 188 reached two-year follow-up. The mean age was 67.8 years (23.9 to 88.5). A total of 38 patients (7.5%) presented with inflammatory arthritis. A total of 101 (20.0%) of implantations used patient-specific instrumentation; 167 patients (33.1%) underwent an additional procedure at the time of surgery. A total of seven patients died of unrelated causes, two withdrew, and one was lost to follow-up. The mean follow-up was 16.2 months (6 to 36). There was a significant improvement from baseline across all functional outcome scores at six months, one, and two years. There was no significant difference in outcomes with the use of patient-specific instrumentation, type of arthritis, or COFAS type. Five (1.0%) implants were revised. The overall complication rate was 8.8%. The non-revision reoperation rate was 1.4%. The 30-day readmission rate was 1.2% and the one-year mortality 0.74%. Conclusion The early experience and complications reported in this study support the current use of the INFINITY TAA as a safe and effective implant in the treatment of end-stage ankle arthritis. Cite this article: Bone Joint J 2021;103-B(7):1270–1276.

Download Full-text

Pelvic Osteosarcoma: Resection and Reconstruction Using a Customised Plate

New Medical Innovations and Research ◽

10.31579/jnmir.2021/002 ◽

2021 ◽

Vol 2 (1) ◽

pp. 01-06

Author(s):

Zeineb Alaya

Keyword(s):

Case Report ◽

Neoadjuvant Chemotherapy ◽

Functional Outcome ◽

Medical History ◽

Pelvic Ring ◽

Pelvic Bone ◽

Reconstruction Surgery ◽

One Year ◽

Made In

Introduction Primitive bone tumours of the pelvis represent a considerable challenge for carcinologic surgeons. Resections made in the acetabular zone could disrupt the continuity of the pelvic ring. The morbidity that comes after such a procedure requires a reconstruction surgery in order to improve the functional outcome. In this aim, multiple techniques have been reported. Case report We report the case of a 23-year-old male with no medical history diagnosed with a right pelvic bone osteosarcoma located in Enneking zones I and II. He first underwent neoadjuvant chemotherapy followed by a large resection of the whole bone. A reconstruction was then made using a vascularized fibular autologous graft and stabilized by a long customized lombo-femoral plate. Recovery of walking was possible using crutches. No recurrence was note at one year follow-up. Conclusion Malignant primitive tumours of the pelvis threaten the vital and functional prognoses of patients. It is now possible to perform conservative resections in more than 80% of case without compromising the survival of patients or their functional outcome.

Download Full-text

Functional outcome after open reduction and internal fixation for traumatic diastasis of the pubic symphysis a one year follow-up study

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20163548 ◽

2016 ◽

Vol 2 (4) ◽

pp. 256

Author(s):

B. L. S. Kumar Babu ◽

Biju Ravindran

Keyword(s):

Internal Fixation ◽

Functional Outcome ◽

Open Reduction ◽

High Energy ◽

Walking Distance ◽

Early Weight Bearing ◽

Dual Plating ◽

Pubic Diastasis ◽

One Year

Background: Pubic diastasis often results in anteroposterior compression (APC) injuries based on Young and Burgess classification. It is caused due to high-energy trauma and of much clinical importance is given when coexists with urogenital and neurological complications with hemodynamic instability. Open reduction and internal fixation with plating facilitates early mobilisation with better results and is the preferable mode of stabilisation. We evaluated the clinical and functional outcome of such patients in a one-year follow-up period.Methods: In our study, we included 20 patients with APC II injuries who underwent an open reduction by single or dual plating technique by the Pfannenstiel approach, were followed for one year.Results: Among 20 patients, 14 patients (70%) were operated with single superior plating, six patients (30%) were performed with dual plating, i.e., both superior and anterior plating. Among 20 patients, two patients (10%) were operated for primary arthrodesis with double plating. Only one among 20 (5%) had implant failure due to early weight bearing and were re-operated with primary arthrodesis with plating. Results were analysed based on a scoring system which includes five criteria such as anterior pelvic pain, dyspareunia and sexual dysfunction, ability to sit, gait abnormalities and walking distance. Among 20 patients ten patients (50%) had excellent results, six patients (30%) had good results, two patients (10%) had fair results, two patients (10%) had poor results.Conclusions: Open reduction and internal fixation of traumatic pubic diastasis in type II APC injuries with single or dual plating had given better results and early functional recovery.

Download Full-text