Comminuted Patella Fracture in Elderly Patients: A Systematic Review and Case Report

Objectives: To review comminuted patella fracture in the elderly patients and examine the surgical options to avoid complications such as fixation failure and poor functional outcome. To provide an example of mesh augmentation in comminuted patella fracture in the elderly patients. Data Sources: A literature review was conducted by the authors independently using Ovid, Medline, Cochrane, PubMed, and Clinical Key in English. We aimed to review data on patients older than 65 with comminuted patella fracture. Search conducted between July and December 2015. Study Selection: Search terms included patella fracture, elderly, and fixation failure. Abstracts were included if they were a case report, cohort series, or randomized control trial. Further inclusion criteria were that they were available in full text and included patient age(s), operative details, follow-up, and outcome discussion. Data Extraction: Each study was assessed according to its level of evidence, number of patients, age of patients, fracture patterns described, complications of treatment, and results summarized. Data Synthesis: Paucity of data and heterogeneity of studies limited statistical analysis. Data are presented as a review table with the key points summarized. Conclusion: In patella fracture, age >65 years and comminuted fracture pattern are predictors of increased fixation failure and postoperative stiffness, warranting special consideration. There is a trend toward improved functional outcomes when augmented fixation using mesh or plates is used in this group. Further level 1 studies are required to compare and validate new treatment options and compared them to standard surgical technique of tension band wire construct.

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Beyond the guidelines management of juvenile idiopathic arthritis: a case report of a girl with polyarticular disease refractory to multiple treatment options and Leri Weill syndrome

BMC Pediatrics ◽

10.1186/s12887-021-02494-6 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Vana Vukić ◽

Ana Smajo ◽

Mandica Vidović ◽

Rudolf Vukojević ◽

Miroslav Harjaček ◽

...

Keyword(s):

Juvenile Idiopathic Arthritis ◽

Case Report ◽

Treatment Options ◽

Janus Kinase ◽

Musculoskeletal Symptoms ◽

Multiple Treatment ◽

Number Of Patients ◽

Systemic Glucocorticoids ◽

Inflammatory Drugs ◽

Anti Inflammatory

Abstract Background The last two decades brought new treatment options and high quality guidelines into the paediatric rheumatologic practice. Nevertheless, a number of patients still present a diagnostic and therapeutic challenge due to combination of vague symptoms and unresponsiveness to available treatment modalities. Case presentation We report a case of sixteen years old girl suffering from polyarticular type of juvenile idiopathic arthritis refractory to multiple treatment options. She first presented at the age of 4 with swelling and contractures of both knees. Her symptoms were initially unresponsive to nonsteroidal anti-inflammatory drugs and progressed despite treatment with intraarticular and systemic glucocorticoids and methotrexate. Throughout the years, she received several biologics together with continuous administration of nonsteroidal anti-inflammatory drugs and disease modifying anti-rheumatic drugs as well as intraarticular and systemic glucocorticoids in disease flares. However, none of this options provided a permanent remission, so various other modalities, as well as other possible diagnoses were constantly being considered. Eventually she became dependent on a daily dose of systemic glucocorticoids. In 2018, the treatment with Janus kinase inhibitor tofacitinib was initiated, which led to gradual amelioration of musculoskeletal symptoms, improvement of inflammatory markers and overall well-being, as well as to the weaning of systemic glucocorticoids. As the swelling of the wrists subsided for the first time in many years, Madelung’s deformity was noticed, first clinically, and later radiographically as well. Genetic analysis revealed short-stature homeobox gene deficiency and confirmed the diagnosis of Leri Weill syndrome. Conclusions This case report emphasizes the need for reporting refractory, complicated cases from everyday clinical practice in order to build-up the overall knowledge and share experience which is complementary to available guidelines. Individual reports of difficult to treat cases, especially when additional diagnoses are involved, can be helpful for physicians treating patients with common rheumatological diseases such as juvenile idiopathic arthritis.

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The Relationship between Smoking and Sublingual Varices in the Elderly

Oman Medical Journal ◽

10.5001/omj.2021.94 ◽

2021 ◽

Vol 36 (4) ◽

pp. e288-e288

Author(s):

Niusha Barzideh ◽

Arezoo Alaee ◽

Arash Azizi

Keyword(s):

Older Adults ◽

Cigarette Smoking ◽

Elderly Patients ◽

Varicose Veins ◽

The Elderly ◽

Control Group ◽

Case Group ◽

Chi Square ◽

Number Of Patients ◽

And Control

Objectives: We investigated the existence of any connection between smoking and sublingual varices (SLV) in the older population. Methods: This case-control study was conducted in 2019 on adults > 65 years old at Kahrizak Charity Nursing Home, Alborz, Iran. We conducted clinical examination and inspection of 222 elderly patients. Both the case group and control group contained the same number of patients (n = 111). SLV were classified as grade 0 (few or none visible) and grade 1 (moderate or severe). The case group included patients with SLV and the control group consisted of those older adults without SLV and who were matched with the case group based on age, gender, blood pressure, denture wearing, and varicose veins in their legs. Cigarette smoking habits were investigated in both groups. Smokers were considered those who smoked at least one cigarette per day for more than six months. Chi-square and odds ratio (OR) were used to statistically analyze the exposure of participants to smoking in both groups. Results: Among 222 participants, 21.6% and 5.4% were smokers in the case and control groups, respectively. The results of our data analysis revealed that SLV were significantly associated with smoking (p < 0.001, OR = 4). Conclusions: Elderly patients with SLV are more likely to be cigarette smokers. Therefore, cigarette smoking cessation programs are recommended for older adults in society.

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Coronary artery disease in the elderly

Reviews in Clinical Gerontology ◽

10.1017/s0959259899009120 ◽

1999 ◽

Vol 9 (1) ◽

pp. 13-21 ◽

Cited By ~ 2

Author(s):

SK Glen ◽

NA Boon

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Elderly Patients ◽

Treatment Guidelines ◽

Treatment Options ◽

The Elderly ◽

Elderly Subjects ◽

Younger Patients ◽

Artery Disease ◽

Morbid Conditions

Coronary artery disease is extremely common among elderly people and accounts for half of all deaths in those who are more than 65 years old. Although the condition is essentially the same as that encountered in younger patients, the management of coronary artery disease in elderly subjects can be difficult because the anticipated benefits and risks of the various treatment options are often altered by the presence of co-morbid conditions. Moreover, the results of the major outcome studies that underpin most treatment guidelines may not be relevant to the needs of many elderly patients for several reasons.

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Evaluation of the Meniscal repair in Bucket handle. Systematic review

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967118s00209 ◽

2018 ◽

Vol 6 (12_suppl5) ◽

pp. 2325967118S0020

Author(s):

Damián Bustos ◽

Lucas Marangoni ◽

Pablo Bertiche ◽

Javier Núñez ◽

Iván Bitar ◽

...

Keyword(s):

Systematic Review ◽

Treatment Options ◽

Meniscal Repair ◽

Level Of Evidence ◽

Meniscal Lesions ◽

Number Of Patients ◽

Bibliographic Search ◽

Rate Of Failure ◽

Bucket Handle

Introduction: Faced with a bucket meniscal lesion we have two treatment options. A frequently practiced option is to remove the bucket handle, another is to repair it. Generally, they are associated with ligament injuries. In this context, it has been shown that meniscal repair has a good result, but the evolution of isolated meniscal repairs is not entirely clear. The purpose of this systematic review is to determine the results after the repair of bucket handle injuries. Materials and Methods: A bibliographic search of the computerized database was carried out pubmed. Eight articles were included according to the inclusion and exclusion criteria. The results of interest included, level of evidence, number of patients, follow-up, average age, surgical technique,% cure,% failure, complications, associated injuries and average time from injury to surgical repair. Results: The works studied, on average, 43 patients, with ages between 16 and 33 years making 341 patients. The follow-up period was focused on 58 months. The percentage of cure varies from 52% to 98%. Conclusion: The isolated repair of this type of meniscal lesions has a good overall evolution associated with a low rate of failure and complications Level of evidence: IV Type of study systematic review

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Early Outcomes of 3D Printed Total Talus Arthroplasty

Foot & Ankle Specialist ◽

10.1177/1938640019873536 ◽

2019 ◽

Vol 13 (5) ◽

pp. 372-377 ◽

Cited By ~ 3

Author(s):

Daniel J. Scott ◽

John Steele ◽

Amanda Fletcher ◽

Selene G. Parekh

Keyword(s):

Treatment Option ◽

Treatment Options ◽

Case Series ◽

Level Of Evidence ◽

Ankle Motion ◽

Motion Data ◽

Number Of Patients ◽

3D Printed ◽

Radiographic Alignment

Background. Patients with talar avascular necrosis (AVN) have limited treatment options to manage their symptoms. Historically, surgical options have been limited and can leave patients with little ankle motion and have high failure rates. The use of custom 3D printed total talar replacements (TTRs) has arisen as a treatment option for these patients, possibly allowing better preservation of hindfoot motion. We hypothesized that patients undergoing TTR will demonstrate a statistically significant improvement in Foot and Ankle Outcome Score (FAOS) at 1 year after surgery. Methods. We retrospectively reviewed 15 patients who underwent a TTR over a 2-year period. Patient outcomes were reviewed, including age, sex, comorbidities, etiology of talar pathology, number and type of prior surgeries, radiographic alignment, FAOS and Visual Analog Scale (VAS) score, and range of motion. Data analysis was performed with Student t-tests and multivariate regression. Results. FAOSs and VAS scores showed statistically significant improvements postoperatively as compared with preoperative scores. There was a statistically significant decrease in VAS pain scores from 7.0 preoperatively to 3.6 (P < .001). Average follow-up was 12.8 months. With the number of patients available, there was no statistically significant change in radiographic alignment parameters postoperatively as compared with preoperatively (P values ranged from .225 to .617). Conclusion. Our hypothesis that these patients show statistically significant improvements in FAOSs at 1 year was confirmed. TTR represents an exciting treatment option for patients with talar AVN, though longer-term follow-up is needed. Level of Evidence: Level IV: Case series

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Valproic Acid-Induced Myoclonus in a Demented Patient: A Case Report

Case Reports in Medicine ◽

10.1155/2009/392091 ◽

2009 ◽

Vol 2009 ◽

pp. 1-3 ◽

Cited By ~ 3

Author(s):

Tina M. Gardner ◽

Rehan Aziz ◽

Sunanda Muralee ◽

Rajesh R. Tampi

Keyword(s):

Valproic Acid ◽

Case Report ◽

Elderly Patients ◽

Psychiatric Disorders ◽

Early Onset ◽

The Elderly ◽

Demented Patient ◽

Behavioral Disturbances ◽

Neuropsychiatric Complications

Valproic acid and its derivatives are now commonly used to treat various psychiatric disorders in the elderly. Data indicates that the elderly patients are more susceptible to developing neuropsychiatric complications when treated with these medications. In this report, we describe the case of a 66-year-old woman with early-onset, Alzheimer's type dementia, who developed myoclonus when treated with a valproic acid preparation for behavioral disturbances associated with the dementia.

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Supportive Care Considerations for Older Adults With Cancer

Journal of Clinical Oncology ◽

10.1200/jco.2014.55.3065 ◽

2014 ◽

Vol 32 (24) ◽

pp. 2627-2634 ◽

Cited By ~ 38

Author(s):

Arash Naeim ◽

Matti Aapro ◽

Rashmi Subbarao ◽

Lodovico Balducci

Keyword(s):

Elderly Patients ◽

Supportive Care ◽

Chronic Conditions ◽

Treatment Options ◽

The Elderly ◽

Strongly Correlated ◽

Lifestyle Management ◽

Patients With Cancer ◽

Age Appropriate

The treatment of cancer presents specific concerns that are unique to the growing demographic of elderly patients. Because the incidence of cancer is strongly correlated with aging, the expansion of supportive care and other age-appropriate therapies will be of great importance as the population of elderly patients with cancer increases in the coming years. Elderly patients are especially likely to experience febrile neutropenia, complications from chemotherapy-induced nausea, anemia, osteoporosis (especially in patients diagnosed with breast or prostate cancer), depression, insomnia, and fatigue. These issues are often complicated by other chronic conditions related to age, such as diabetes and cardiac disease. For many patients, symptoms may be addressed both through lifestyle management and pharmaceutical approaches. Therefore, the key to improving quality of life for the elderly patient with cancer is an awareness of their specific needs and a familiarity with emergent treatment options.

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Pathologic and Clinical Characteristics of Elderly Patients With Breast Cancer: A Retrospective Analysis of a Multicenter Study (Anatolian Society of Medical Oncology)

International Surgery ◽

10.9738/intsurg-d-13-00010 ◽

2014 ◽

Vol 99 (1) ◽

pp. 2-7 ◽

Cited By ~ 4

Author(s):

Ali İnal ◽

Tulay Akman ◽

Sebnem Yaman ◽

Selcuk Cemil Ozturk ◽

Caglayan Geredeli ◽

...

Keyword(s):

Breast Cancer ◽

Retrospective Study ◽

Elderly Patients ◽

Older Patients ◽

The Elderly ◽

Lymph Node Involvement ◽

Axillary Lymph ◽

Breast Cancer Patients ◽

Number Of Patients ◽

Er Positive

Abstract There is very little information about breast cancer characteristics, treatment choices, and survival among elderly patients. The purpose of this multicenter retrospective study was to examine the clinical, pathologic, and biologic characteristics of 620 breast cancer patients age 70 years or older. Between June 1991 and May 2012, 620 patients with breast cancer, recruited from 16 institutions, were enrolled in the retrospective study. Patients had smaller tumors at diagnosis; only 15% of patients had tumors larger than 5 cm. The number of patients who had no axillary lymph node involvement was 203 (32.7%). Ninety-three patients (15.0%) had metastatic disease at diagnosis. Patients were characterized by a higher fraction of pure lobular carcinomas (75.3%). The tumors of the elderly patients were also more frequently estrogen receptor (ER) positive (75.2%) and progesterone receptor (PR) positive (67.3%). The local and systemic therapies for breast cancer differed according to age. An association between age and overall survival has not been demonstrated in elderly patients with breast cancer. In conclusion, the biologic behavior of older patients with breast cancer differs from younger patients, and older patients receive different treatments.

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Perioperative pain management in elderly patients with а proximal femoral fracture: evidence review

Pain medicine ◽

10.31636/pmjua.v4i4.2 ◽

2020 ◽

Vol 4 (4) ◽

pp. 42-49

Author(s):

Anastasiia Romanenko ◽

Юрій Кучин ◽

Катерина Бєлка ◽

Ігор Токар

Keyword(s):

Hip Fracture ◽

Pain Management ◽

Elderly Patients ◽

Femoral Fracture ◽

Adverse Drug Events ◽

Perioperative Period ◽

The Elderly ◽

Proximal Femoral Fracture ◽

Nerve Blocks ◽

Number Of Patients

The purpose of this article is to compare different methods of analgesia during perioperative period in elderly patients with а proximal femoral fracture. The incidence of hip fracture is high and also rises with the age, for example, In Great Britain, number of patients with a hip fracture will be approximately 100 000 in 2033, and it’s also associated with significant healthcare financing. Nevertheless, effective pain management is a big challenge for clinicians because of considerable problems in geriatric patients, including age, physiological changes in the elderly, preexisting comorbidities, cognitive impairment, high risk of delirium, problems with rehabilitation and probability of an independent life [12]. Opioids are still the main option for hip fracture pain management, despite differences in pharmacokinetics and pharmacodynamics in elderly patients, which are correlated with high frequency of side effects. Opioid-related adverse drug events are associated with worse patient outcomes such as morbidity, mortality and length of stay increase. Therefore, peripheral nerve blocks as part of multimodal analgesic technique can provide more effective pain control after hip fracture. Comprehensive literature searches focus on the use of peripheral nerves blocks as preoperative analgesia, as postoperative analgesia or as a supplement to general anesthesia for hip fracture surgery.

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Hemodynamic evaluation of elderly patients during laparoscopic cholecystectomy

Revista do Colégio Brasileiro de Cirurgiões ◽

10.1590/0100-6991e-20181659 ◽

2018 ◽

Vol 45 (2) ◽

Author(s):

LUIZ PAULO JACOMELLI RAMOS ◽

RODRIGO BARCELLOS ARAÚJO ◽

MARIA DO CARMO VALENTE CASTRO ◽

MARIA ROBERTA MENEGUETTI SERAVALLI RAMOS ◽

JOSÉ ANTONIO CUNHA-E-SILVA ◽

...

Keyword(s):

Blood Pressure ◽

Laparoscopic Cholecystectomy ◽

Ejection Fraction ◽

Elderly Patients ◽

The Elderly ◽

Statistical Correlation ◽

Hemodynamic Changes ◽

Number Of Patients ◽

Elective Laparoscopic Cholecystectomy ◽

The Mean

ABSTRACT Objective: to demonstrate hemodynamic changes during laparoscopic cholecystectomy in elderly patients with trans-esophageal echocardiography. Methods: we studied 31 elderly patients (aged 60 years or older), ASA I or II, who underwent elective laparoscopic cholecystectomy under general, standardized anesthesia, with cardiovascular parameters measured using transesophageal echocardiography at three different times: before the pneumoperitoneum (T1), after CO2 insufflation (T2) and at deflation (T3). We statistically evaluated changes in systolic, diastolic and mean blood pressure, heart rate, cardiac output and index, and ejection fraction. Results: although small, only the diastolic blood pressure (DBP) and ejection fraction (EF) variations were statistically significant. The mean ± standard deviation of DBP in mmHg at the different times were: T1=67.5±10.3; T2=73.6±12.4; and T3=66.7±9.8. And for EF, in percentage (%) they were: T1=66.7±10.4; T2=63.2±9.9; and T3=68.1±8.4. There was no statistical correlation between hemodynamic variations, age and number of patients’ comorbidities. Conclusion: laparoscopic cholecystectomy causes few hemodynamic changes that are well tolerated by the majority of the elderly patients; prior impairment of ventricular function represents a threat in elderly patients during surgery; there appears to be a lower hemodynamic effect caused by the pneumoperitoneum than by the patient’s positioning in a reverse Trendelemburg during surgery.

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