Beyond Hip Fractures: Other Fragility Fractures’ Associated Mortality, Functional and Economic Importance: A 2-year-Follow-up.

Background Hip fractures are well researched in orthogeriatric literature. Equivalent investigations for fragility-associated periprosthetic and periosteosynthetic femoral, ankle joint, pelvic ring, and rib fractures are still rare. The purpose of this study was to evaluate mortality, functional outcome, and socioeconomic parameters associated to the upper-mentioned fragility fractures prospectively in a 2-year follow-up. Methods Over the course of a year, all periprosthetic and periosteosynthetic femoral fractures (PPFF), ankle joint fractures (AJ), pelvic ring fractures (PR), and rib fractures (RF), that were treated on a co-managed orthogeriatric ward, were assessed. Parker Mobility Score (PMS), Barthel Index (BI), place of residence, and care level were recorded. After 2 years, patients and/or relatives were contacted by mailed questionnaires or phone calls in order to calculate mortality and reevaluate the mentioned parameters. Results Follow-up rate was 77.7%, assessing 87 patients overall. The relative mortality risk was significantly increased for PR (2.9 (95% CI: 1.5–5.4)) and PPFF (3.5 (95% CI: 1.2–5.8)) but not for RF (1.5 (95% CI: 0.4–2.6)) and AJ (2.0 (95% CI: 0.0–4.0)). Every fracture group except AJ showed significantly higher BI on average at follow-up. PMS was, respectively, reduced on average for PR and RF insignificantly, but significantly for PPFF and AJ in comparison to pre-hospital values. 10.0–27.3% (each group) of patients had to leave their homes permanently; care levels were raised in 30.0–61.5% of cases. Discussion This investigation provides a perspective for further larger examinations. PR and PPFF correlate with significant increased mortality risk. Patients suffering from PPFF, PR, and RF were able to significantly recover in their activities of daily living. AJ and PPFF conclude in significant reduction of PMS after 2 years. Conclusion Any fragility fracture has its impact on mortality, function, and socioeconomic aspects and shall not be underestimated. Despite some fractures not being the most common, they are still present in daily practice.

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External Fixator in Elderly Patients with Hip Fractures

Nepal Orthopaedic Association Journal ◽

10.3126/noaj.v3i1.9319 ◽

2013 ◽

Vol 3 (1) ◽

pp. 11-13

Author(s):

Shilu Shrestha ◽

Bibek Banskota ◽

Tarun Rajbhandary ◽

Babukaji Shrestha ◽

Jwala Raj Pandey ◽

...

Keyword(s):

Elderly Patients ◽

Local Anesthesia ◽

Hip Fractures ◽

External Fixator ◽

Early Mobilization ◽

Fragility Fractures ◽

The Elderly ◽

Harris Hip Score ◽

Average Delay

Introduction: Fragility fractures around the hip are common in the elderly and are associated with significant morbidity and mortality. Early stabilization and mobilization reduces mortality associated with prolonged recumbence. In patients who are not fi t for general anesthesia, external fixation under local anesthesia will help early mobilization. Methods: A retrospective study of hip fractures treated between 2002 to 2009 was undertaken. Out of 242 hip fractures, 13 patients with inter-trochanteric fractures had undergone external fixator application under local anesthesia. There were 9 females and 4 males; five were on right side and 8 on left side. As per the system of American Society of Anesthesiologists (ASA), 10 were of grade III, 2 of grade IV and 1 of grade E. The age of the patient ranged from 60 to 92 years (average 80 years). The average delay in surgery was 8.2 days for cases presenting soon after the injury. Results: Follow up was done at 6 weeks, 3 months and 6 months with the average follow up of 4.7 months. All the fractures (n=13) united and the average time to radiological union was 3 months. Three patients had grade I pin tract infection which was easily controlled with local care. The average Harris hip score at final follow-up was 92. Conclusion: External fixator can be a valuable tool for the treatment of hip fractures in high risk elderly patients with concomitant medical co-morbidities. DOI: http://dx.doi.org/10.3126/noaj.v3i1.9319 Nepal Orthopedic Association Journal 2013 Vol.3(1): 11-13

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Fractures’ associated mortality risk in orthogeriatric inpatients: a prospective 2-year survey

European Geriatric Medicine ◽

10.1007/s41999-020-00392-1 ◽

2020 ◽

Author(s):

Andreas Wiedl ◽

Stefan Förch ◽

Annabel Fenwick ◽

Edgar Mayr

Keyword(s):

Upper Extremity ◽

Mortality Risk ◽

Cox Regression ◽

Age Groups ◽

Fragility Fractures ◽

Pairwise Comparisons ◽

Death Rates ◽

Relative Mortality ◽

Fracture Types

Abstract Purpose The most common osteoporotic fragility fractures are hip, vertebral and upper extremity fractures. An association with increased mortality is widely described with their occurrence. Fracture-specific associated death rates were determined in a 2-year follow-up for patients treated on an orthogeriatric ward. These were compared amongst each other, examined for changes with age and their impact on the relative mortality risk in relation to the corresponding population. Methods We assessed all patients that were treated in the course of a year on an orthogeriatric ward and suffered from the following injuries: hip (HF), vertebral (VF) and upper extremity fractures (UEF). In a 2-year follow-up it was possible to determine the month of death in the case of the patient’s decease. Pairwise comparisons of the three fracture type death rates were performed through Cox-Regression. We stratified the fracture-dependent absolute mortality and age-specific mortality risk (ASMR) for age groups 71–80, 81–90 and 91–95. Results Overall, we assessed 240 patients with HF, 96 with VF and 127 with UEF over the span of a year. 1- and 2-year-mortality was: HF: 29.6% a.e. 42.9%, VF: 29.2% a.e. 36.5%, UEF: 20.5% a.e 34.6%. Pairwise comparisons of these mortality values revealed no significant differences. In association with HF and VF, we observed a significant increase of 2-year mortality for the oldest compared to the youngest patients (HF: 60.4% vs. 22.5%; p = 0.028) (VF 70% vs. 14.3%; p = 0.033). The analogue comparison for UEF revealed no relevant difference in age-dependent mortality (40.9% vs. 31.1%; p = 0.784). Common for all fracture types ASMR’s were more elevated in the younger patients and decreased with higher age. Conclusion The fracture-related mortality in the 2-year follow-up was comparable. We observed a reduction of relative mortality risk in the oldest patients. While a direct influence of fracture on mortality must be supposed, we support the thesis of the fracture rather being an indicator of higher susceptibility of timely death.

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Incidence, Risk-Factors and Associated Mortality of Complications in Orthogeriatric Co-Managed Inpatients

Geriatric Orthopaedic Surgery & Rehabilitation ◽

10.1177/2151459321998314 ◽

2021 ◽

Vol 12 ◽

pp. 215145932199831

Author(s):

Andreas Wiedl ◽

Stefan Förch ◽

Annabel Fenwick ◽

Edgar Mayr

Keyword(s):

Risk Factors ◽

Mortality Risk ◽

Kidney Injury ◽

Fragility Fractures ◽

Incidence Risk ◽

Relevant Risk Factor ◽

Thrombotic Complications ◽

Tract Infections ◽

Diverse Groups

Introduction: Pneumonia, thromboembolic and ischemic events, urinary tract infections (UTI), delirium and acute kidney injury (AKI) are common complications during the treatment of fragility fractures. In a 2 years-follow-up we determined the according incidence and risk factors of these and other complications in orthogeriatric inward patients, as well as the respective associated mortality. Methods: All patients treated on an orthogeriatric co-managed ward over the course of a year were included. Besides injury, therapy and geriatric assessment parameters, we evaluated the inward incidence of common complications. In a 2 years-follow-up the associated death rates were aquired. SPSS (IBM) was used to determine the importance of risk factors predisposing to the respective occurrence of a complication and accordingly determine it’s impact on the patients’ 1- and 2-years-mortality. Results: 830 orthogeriatric patients were initially assessed with a remaining follow-up cohort of 661 (79.6%). We observed very few cases of thrombosis (0.6%), pulmonary embolism (0.5%), apoplex (0.5%) and myocardial infarction (0.8%). Pneumonia was seen in 42 (5.1%), UTI in 85 (10.2%), delirium in 186 (22.4%) and AKI in 91 (11.0%) patients. Consistently ADL on admission was found to be a relevant risk factor in the development of each complication. After adjustment only AKI showed a significant increased mortality risk of 1.60 (95%CI:1.086-2.350). Discussion: In our fracture-independent assessment of complications in the orthogeriatric treatment of inward patients we’ve seen very rare cases of cardiac and thrombotic complications. Typical fragility-fracture associated common events like pneumonia, UTI, delirium and AKI were still more incidental. No complication except AKI was associated to significant increased mortality risk. Conclusions: The relevance of orthogeriatric care in prevention and outcome of inward complications seems promising, needing still more controlled studies, evaluating not just hip fracture patients but more diverse groups. Consensus is needed in the scholar evaluation of orthogeriatric complications.

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Trans-sacral bar osteosynthesis provides low mortality and high mobility in patients with fragility fractures of the pelvis

Scientific Reports ◽

10.1038/s41598-021-93559-0 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Daniel Wagner ◽

Miha Kisilak ◽

Geoffrey Porcheron ◽

Sven Krämer ◽

Isabella Mehling ◽

...

Keyword(s):

Quality Of Life ◽

Length Of Stay ◽

Pelvic Ring ◽

Fragility Fractures ◽

Total Length ◽

Management Protocol ◽

Operative Revision ◽

At Home

AbstractOperative treatment of osteoporosis-associated fragility fractures of the pelvis (FFP) and the sacrum is advocated with immobilizing or longstanding pain, fracture progression and displacement. We analyzed clinical outcomes regarding mobility, quality of life, and mortality of patients with FFP treated with trans-sacral bar (TB) osteosynthesis through S1. Demographics, clinical data, and operation-related data of patients with an FFP treated with TB were acquired from chart review. We assessed mortality, quality of life (EQ-5D), mobility, and residential status at follow-up. Seventy-nine females and six males with a median age of 78.0 years (IQR 73–84) were included, median follow-up was 3.2 years. Medical complications during hospitalization occurred in 28%. Operative revision was carried out in 15% of patients. One-year survival was 90.4%, this was associated with shorter preoperative and total length of stay in hospital (p 0.006 and 0.025, respectively). At follow-up, 85% lived at home and 82% walked with or without walking aid. Higher EQ-5D was reached with higher mobility status and living at home (p < 0.001 and < 0.001, respectively). TB osteosynthesis is an adequate and reliable method for fixation of FFP in the posterior pelvic ring to ensure timely mobilization. Shorter preoperative and total length of stay had lower mortality rates, advocating a standardized management protocol to limit time delay to operative therapy. Patients treated with TB osteosynthesis had low 1-year mortality of less than 10%.

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Fracture progression in fragility fractures of the pelvis: A case report

Trauma ◽

10.1177/14604086211015065 ◽

2021 ◽

pp. 146040862110150

Author(s):

Roos HE Kolk ◽

Sverre AI Loggers ◽

Jelle P van der List ◽

Ditmar Schakenraad ◽

Linda de Nooij ◽

...

Keyword(s):

Case Report ◽

Surgical Intervention ◽

Pelvic Ring ◽

Fragility Fractures ◽

Unstable Fracture ◽

Recurrent Pain ◽

Invasive Treatment ◽

Additional Imaging ◽

Posterior Ring

Introduction Fragility fractures of the pelvis (FFP) are becoming increasingly common as our population ages. Usually treated conservatively the concept of fracture progression is little recognized but can have important consequences for the patient if missed. Case report A patient with a FFP presented with increase of pain after initial conservative treatment. Additional imaging revealed extensive fracture progression resulting in an unstable pelvic ring, requiring surgical intervention. Most FFPs are currently treated conservatively. However, initially stable FFPs can progress into more unstable fracture patterns that may require invasive treatment. Conclusion Physicians should be aware of fracture progression and concomitant posterior ring fractures in case of prolonged or recurrent pain or mobilization difficulties. Careful follow-up and awareness might help to prevent or treat debilitation in an early phase and improve outcomes.

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Economic Impact of Osteoporosis Related Hip Fractures in Bahrain. A Systematic Review.

The Open Public Health Journal ◽

10.2174/1874944502114010332 ◽

2021 ◽

Vol 14 (1) ◽

pp. 332-335

Author(s):

Mir Sadat-Ali

Keyword(s):

Middle East ◽

Economic Impact ◽

United Arab Emirates ◽

Hip Fractures ◽

Financial Burden ◽

Femoral Fractures ◽

Fragility Fractures ◽

Published Data ◽

Cochrane Central Register ◽

Prevalence Of Osteoporosis

Background: Fragility fractures are common due to osteoporosis and there is very limited data on hip fractures from the Middle East in general and Kingdom of Bahrain in particular. The aim of this paper is to review the published data of femoral fractures in the Middle East and extrapolate the financial burden of osteoporosis related hip fractures in Bahrain and suggest some course of action for the region in controlling the fragility fractures. Methods: An extensive search was performed on published studies on hip fracture from 1990 to 2020 by a Medline, EMBASE the Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews and the Science Citation Index, Bahrain Medical Bulletin, Qatar Medical J, Oman with the key words: Osteoporosis, osteopenia, fragility hip fractures. The inclusion criterion was studies published during 1990-2020 describing the prevalence of osteoporosis and proximal hip fractures in patients with ≥50 years, from the Kingdom of Bahrain, Saudi Arabia, State of Kuwait, Sultanate of Oman, United Arab Emirates, State of Kuwait, Iraq, Iran, Turkey and the State Hashemite Kingdom of Jordan. Based on the fractures per 1000, an average was taken and extrapolated for the Kingdom of Bahrain and direct and indirect costs were assessed. Results: A total of 19 studies were selected for analysis from 10 countries. The average prevalence of postmenopausal osteoporosis was 29.37±6.97% (Range 20.2 to 38.5). In these 10 countries, 252.411 million people live, with an average of 28.56% suffering from osteoporosis. A total of 72.088 million are at risk of having a fragility fracture. The prevalence of fragility fractures of the proximal femur in six countries means prevalence is 4.41/1000. With this average, it is extrapolated that femoral fractures due to osteoporosis costs Bahrain yearly a total of BD 5.31 million. Conclusion: The prevalence of Osteoporosis is going to increase in Bahrain as the population is aging. This will further increase the economic impact of taking care of elderly patients with osteoporosis and related fractures. Early intervention to diagnose and treat this aging population will reduce the cost and save lives.

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67 How Well is Osteoporosis Checked for and Treated in Those Admitted with Fragility Fractures on General Medical Call?

Age and Ageing ◽

10.1093/ageing/afz103.36 ◽

2019 ◽

Vol 48 (Supplement_3) ◽

pp. iii17-iii65

Author(s):

Muhammad Ridhwaan Salehmohamed ◽

Sarah O'Riordan ◽

Rachael Doyle ◽

Clodagh O'Dwyer

Keyword(s):

Vitamin D ◽

Hip Fractures ◽

Fragility Fractures ◽

Osteoporosis Treatment ◽

Vitamin D Supplementation ◽

Retrospective Audit ◽

History Of ◽

Recommended Guidelines ◽

Time Of Admission

Abstract Background Patients suffering a fragility fracture should be assessed and considered for treatment for osteoporosis according to current guidelines. This retrospective audit set out to assess if diagnosis and treatment of osteoporosis occurred appropriately in those admitted to a Model 2 Hospital with non-hip fractures on general medical call under all specialities. Methods All patients, admitted with fragility fractures, between January and June 2018, were included. Hip fracture patients treated through a separate ortho-geriatric rehab pathway were excluded. Data including source of admission, length of stay, type of fracture, investigations, treatments initiated or planned, were identified from patient’s records and collated using excel statistical analysis. Results From a total of 64 fracture admissions, 38 cases were non-Hip fractures. 34% (n=13) male, average age was 84 and 40% (n=15) patient had a history of previous fracture. Once admitted 68.4% (n=26), 60.5% (n=23) and 50.0% (n=19) had Vitamin D level, Bone profile and Serum Protein Electrophoresis checked respectively. Three patients passed away. 37% (n=13/35) of patients had a DXA scan performed either during or after their admission, all of whom were diagnostic for osteoporosis. 50% (n=19/38) were on Vitamin D at time of admission while 77% (n=27/35) were discharged on Vitamin D supplementation. 8% (n=3/38) were on osteoporosis treatment at time of admission while 31% (n=11/35) were discharged on, or had a plan in place for, osteoporosis treatment. Conclusion Investigation for and management of osteoporosis in patients admitted with fragility fractures are not being adhered to as per recommended guidelines. A new pathway under the supervision of a newly appointed c/RANP is being developed, in line with osteoporosis guidelines as a result, with a view to re audit and better follow-up of these patients.

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Impact of intraoperative femoral fractures in primary hip arthroplasty: a comparative study with a mid-term follow-up

Hip International ◽

10.1177/1120700019849911 ◽

2019 ◽

Vol 30 (5) ◽

pp. 544-551

Author(s):

Thomas Ferbert ◽

Ayham Jaber ◽

Nathan Gress ◽

Gerhard Schmidmaier ◽

Tobias Gotterbarm ◽

...

Keyword(s):

Patient Satisfaction ◽

Functional Outcome ◽

Hip Arthroplasty ◽

Femoral Fractures ◽

Harris Hip Score ◽

Control Group ◽

Fracture Group ◽

Stem Revision ◽

Score Improvement

Background: Intraoperative femoral fractures (IFF) during primary total hip arthroplasty (THA) pose a major clinical challenge, and data on mid-term implant performance, functional outcome and patient satisfaction is limited. Methods: 50 patients who sustained IFFs during primary THA were retrospectively reviewed. A control group of patients who received a primary THA without complications was matched according to gender, age, body mass index and indication for THA. Both groups were followed-up for a minimum duration of 2 years. Average follow-up duration was 5.6 years (range 2–11.8 years) for the fracture group and 6 years (range 4.1–8.3 years) for the control group respectively. The following parameters were assessed and compared: stem revision, Harris Hip Score improvement, pain scale improvement, WOMAC, Tegner Score, UCLA, SF-36, forgotten joint score and patient satisfaction. Results: There were no stem revisions in the fracture group and 1 stem revision in the control group. Stem survival was 100% and 98.1% respectively ( p = 0.447). The mean improvement in Harris hip score was 35.3 and 44.8 respectively. Significantly lower Harris Hip score improvement ( p = 0.021) and patient satisfaction ( p = 0.01) were observed in the fracture group. All other acquired parameters did not show significant differences. Conclusion: Intraoperative fractures of the proximal femur are a relevant complication that does not lead to higher revision rates but might worsen the functional outcome and negatively impact patient satisfaction in mid-term follow-up even if treated appropriately.

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Delayed onset acute massive haemothorax after traumatic rib fractures-A Case Report

Journal of Anaesthesia and Critical Care Reports ◽

10.13107/jaccr.2021.v07i02.175 ◽

2021 ◽

Vol 7 (2) ◽

Keyword(s):

Road Traffic ◽

Pelvic Ring ◽

Rib Fractures ◽

Organ Injury ◽

Old Irish ◽

Multiple Rib Fractures ◽

Pelvic Fixation ◽

Chest X Ray ◽

High Level

Rib fractures are common injuries that frequently necessitate intensive care admission for pain management, respiratory support, in addition to managing possible complications. The most common complications of rib fractures are pain, haemothorax, pneumothorax, pulmonary contusions and lacerations, vascular injuries, and intra-abdominal organ injury. After a high impact road traffic accident, a polytrauma 26-year-old Irish gentleman presented with right-sided posterior rib series fractures (from 8th to 12th rib), lung contusion, hepatic laceration, pelvic ring crush injury and urinary bladder disruption. Resuscitation and emergency management including suprapubic catheterisation and external pelvic fixation were performed successfully. Although complications of multiple rib fractures were excluded clinically and radiologically on admission, the patient developed acute massive haemothorax 5 days after the primary injury which has been managed appropriately. This incident raises the concern that haemothoraces and pneumothoraces can occur late after the original injury and high level of suspicion associated with follow-up chest x-ray images are essential in patients with rib fractures. Keywords: Polytrauma, Rib fracture, Haemothorax.

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Emergency Department Admission and Mortality Rate for Suicidal Behavior

Crisis ◽

10.1027/0227-5910/a000282 ◽

2014 ◽

Vol 35 (6) ◽

pp. 406-414 ◽

Cited By ~ 10

Author(s):

Raimondo Maria Pavarin ◽

Angelo Fioritti ◽

Francesca Fontana ◽

Silvia Marani ◽

Alessandra Paparelli ◽

...

Keyword(s):

Emergency Department ◽

Metropolitan Area ◽

Suicidal Behavior ◽

Mortality Risk ◽

Illicit Drugs ◽

Attempted Suicide ◽

Cox Model ◽

Emergency Department Admission ◽

Completed Suicide

Background: The international literature reports that for every completed suicide there are between 8 and 22 visits to an Emergency Department (ED) for attempted suicide/suicidal behavior. Aims: To describe the characteristics of admission to emergency departments (EDs) for suicide-related presenting complaints in the metropolitan area of Bologna; to estimate the risk for all-cause mortality and for suicide; to identify the profiles of subjects most at risk. Method: Follow-up of patients admitted to the EDs of the metropolitan area of Bologna between January 2004 and December 2010 for attempted suicide. A Cox model was used to evaluate the association between sociodemographic variables and the general mortality risk. Results: We identified 505 cases of attempted suicide, which were more frequent for female subjects, over the weekend, and at night (8:00 p.m./8:00 a.m.). The most used suicide methods were psychotropic drugs, sharp or blunt objects, and jumping from high places. In this cohort, 3.6% of subjects completed suicide (4.5% of males vs. 2.9% of females), 2.3% within 1 year of the start of follow-up. The most common causes of death were drug use and hanging. In the multivariate analysis, those who used illicit drugs 24 hr prior to admission to the ED (hazard ratio [HR] = 3.46, 95% CI = 1.23–9.73) and patients who refused the treatment (HR = 6.74, 95% CI = 1.86–24.40) showed an increased mortality risk for suicide. Conclusion: Deliberate self-harm patients presenting to the ED who refuse treatment represent a specific target group for setting up dedicated prevention schemes.

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