Midterm outcome after posterior stabilization of unstable Midthoracic spine fractures in the elderly

Abstract Background The evidence for the treatment of midthoracic fractures in elderly patients is weak. The aim of this study was to evaluate midterm results after posterior stabilization of unstable midthoracic fractures in the elderly. Methods Retrospectively, all patients aged ≥65 suffering from an acute unstable midthoracic fracture treated with posterior stabilization were included. Trauma mechanism, ASA score, concomitant injuries, ODI score and radiographic loss of reduction were evaluated. Posterior stabilization strategy was divided into short-segmental stabilization and long-segmental stabilization. Results Fifty-nine patients (76.9 ± 6.3 years; 51% female) were included. The fracture was caused by a low-energy trauma mechanism in 22 patients (35.6%). Twenty-one patients died during the follow-up period (35.6%). Remaining patients (n = 38) were followed up after a mean of 60 months. Patients who died were significantly older (p = 0.01) and had significantly higher ASA scores (p = 0.02). Adjacent thoracic cage fractures had no effect on mortality or outcome scores. A total of 12 sequential vertebral fractures occurred (35.3%). The mean ODI at the latest follow up was 31.3 ± 24.7, the mean regional sagittal loss of reduction was 5.1° (± 4.0). Patients treated with long segmental stabilization had a significantly lower rate of sequential vertebral fractures during follow-up (p = 0.03). Conclusion Unstable fractures of the midthoracic spine are associated with high rates of thoracic cage injuries. The mortality rate was rather high. The majority of the survivors had minimal to moderate disabilities. Thereby, patients treated with long segmental stabilization had a significantly lower rate of sequential vertebral body fractures during follow-up.

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Midterm Outcome after Posterior Stabilization of Unstable Midthoracic Spine Fractures in the Elderly

10.21203/rs.3.rs-104796/v1 ◽

2020 ◽

Author(s):

Ulrich J Spiegl ◽

Pia-Luise Hölbing ◽

Jan-Sven Jarvers ◽

Nicolas von der Höh ◽

Philipp Pieroh ◽

...

Keyword(s):

Vertebral Fractures ◽

The Elderly ◽

Trauma Mechanism ◽

Thoracic Cage ◽

Posterior Stabilization ◽

Concomitant Injuries ◽

Midterm Outcome ◽

Loss Of Reduction ◽

The Mean

Abstract Background: The evidence for the treatment of midthoracic fractures in elderly patients is weak. The aim of this study was to evaluate midterm results after posterior stabilization of unstable midthoracic fractures in the elderly.Methods: Retrospectively, all patients aged ≥65 suffering from an acute unstable midthoracic fracture treated with posterior stabilization were included. Trauma mechanism, ASA score, concomitant injuries, ODI score and radiographic loss of reduction were evaluated. Posterior stabilization strategy was divided into short-segmental stabilization (SSS) and long-segmental stabilization (LSS). Results: Fifty-nine patients (76.9 ± 6.3 years; 51% female) were included. The fracture was caused by a low-energy trauma mechanism in 22 patients (35.6%). Twenty-one patients died during the follow-up period (35.6%). Remaining patients (n=38) were followed up after a mean of 60 months. Patients who died were significantly older (p = 0.01) and had significantly higher ASA scores (p = 0.02). Adjacent thoracic cage fractures had no effect on mortality or outcome scores. A total of 12 sequential vertebral fractures occurred (35.3%). The mean ODI at the latest follow up was 31.3 ± 24.7, the mean regional sagittal loss of reduction was 5.1° (± 4.0). Patients treated with LSS had a significantly lower rate of sequential vertebral fractures during follow-up (p = 0.03). Conclusion: Unstable fractures of the midthoracic are associated with high rates of thoracic cage injuries. The mortality rate was rather high. The majority of the survivors had minimal to moderate disabilities. Thereby, patients treated with LSS had a significantly lower rate of sequential vertebral body fractures during follow-up.

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MO403ACUTE KIDNEY INJURY IN ELDERLY: EPIDEMIOLOGICAL, CLINICAL AND ETIOLOGICAL FEATURES

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab082.0057 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Mouna Malki abidi ◽

Rajaa Aoudia ◽

Soumaya Chargui ◽

Imen Gorsane ◽

Mouna Jerbi ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Renal Function ◽

Kidney Injury ◽

The Elderly ◽

Major Interest ◽

The Mean ◽

Renal Aging ◽

End Stage ◽

Iatrogenic Origin

Abstract Background and Aims Acute kidney injury (AKI) is common in the elderly due to physiologic renal aging and underlying pathologies. Few studies focused on AKI in Tunisian elderly. The aim of our study was to highlight the epidemiological, clinical, etiological, therapeutic, and progressive characteristics of AKI in elderly. Method We conducted a descriptive retrospective study of AKI in patients admitted to our department over a period of 04 years from 01/01/2014 to 31/12/2017. Results We collected 40 patients including 25 women and 15 men with a sex ratio of 1.66. The mean age was 74 [65-87] years. We noted the presence of pre-existing chronic kidney disease in 58% of cases, diabetes in 50% of cases and hypertension in 73% of cases. Polypharmacy was found in 40% of cases. AKI was symptomatic in 80% of cases and found on a routine check-up in 20% of cases. Mean creatinine was 612+/-334 µmol/l. AKI was pre-renal in 37% and parenchymal in 63% of cases. Iatrogenic origin was found in 33% of cases. Renal biopsy was performed for diagnostic purposes in 6 cases. Haemodialysis was necessary in 50% of cases. Etiopathogenic treatment was initiated in 73% of cases. Intra-hospital mortality was 10%, recovery of renal function (RF) was partial in 40 % of cases and total in 20 % of cases. Follow-up time was 16 +/- 23.2 months. And at the last news, recovery of renal function (RF) was partial in 7 cases and total in 10 cases, 6 patients kept a chronic renal failure (CRF), among them 3 cases had and end-stage of CRF. Conclusion AKI is a frequent pathology in the elderly and its severity is linked to mortality and the transition to chronicity. Iatrogenic causes are frequent and preventable in this population, hence the major interest of prevention.

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Development of Algorithm for Clinical Management of Sickle Cell Bone Disease: Evidence for a Role of Vertebral Fractures in Patient Follow-up

Journal of Clinical Medicine ◽

10.3390/jcm9051601 ◽

2020 ◽

Vol 9 (5) ◽

pp. 1601 ◽

Cited By ~ 1

Author(s):

Lucia De Franceschi ◽

Daniele Gabbiani ◽

Andrea Giusti ◽

Gianluca Forni ◽

Filippo Stefanoni ◽

...

Keyword(s):

Bone Density ◽

Sickle Cell ◽

Bone Disease ◽

Vertebral Fractures ◽

Cell Disease ◽

High Incidence ◽

The Mean

Sickle-cell disease (SCD) is a worldwide distributed hemoglobinopathy, characterized by hemolytic anemia associated with vaso-occlusive events. These result in acute and chronic multiorgan damage. Bone is early involved, leading to long-term disability, chronic pain and fractures. Here, we carried out a retrospective study to evaluate sickle bone disease (SBD) in a cohort of adults with SCD. We assessed bone density, metabolism and turnover. We also evaluated the presence of fractures and the correlation between SCD severity and skeletal manifestations. A total of 71 patients with SCD were analyzed. The mean age of population was 39 ± 10 years, 56% of which were females. We found osteoporosis in a range between 7% and 18% with a high incidence of vertebral fractures. LDH and AST were predictive for the severity of vertebral fractures, while bone density was not. Noteworthy, we identified -1.4 Standard Deviations T-score as the cutoff for detecting the presence of fractures in patients with SCD. Collectively our data allowed us to develop an algorithm for the management of SBD, which may be useful in daily clinical practice to early intersect and treat SBD.

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P1339ARTERIOVENOUS FISTULA AND BASILIC VEIN TRANSPOSITION IN ELDERLY PATIENTS ON HEMODIALYSIS: AN OBSERVATIONAL STUDY

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p1339 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Vinant Bhargava ◽

Priti Meena ◽

Ambrish Satwik ◽

Apurv Srivastava ◽

A K Bhalla ◽

...

Keyword(s):

Elderly Patients ◽

Vascular Access ◽

Elderly Population ◽

The Elderly ◽

Primary Patency ◽

New Delhi ◽

Secondary Patency ◽

Basilic Vein ◽

The Mean

Abstract Background and Aims With the increase in the line expectancy of chronic kidney disease in the older population (>60 years), the numbers requiring haemodialysis is progressively rising. The elderly population may be different from the younger in terms of non-suitable vessels for access creation, non-maturation, and vascular calcifications, and this may alter the outcomes of use of arteriovenous fistula (AVF). This study was conducted to analyse the outcomes of AVF in elderly patients (>60 years). Method Retrospective study was conducted in the Department of Nephrology at Sir Ganga Ram Hospital, New Delhi. Patients of more than 60 years of age in whom AVF was created from 1st January 2012 to 31st December 2016 were included in the study. Follow-up data of 3.5 years was analysed. The primary endpoint was to assess primary and secondary patency rates. Results A total of 300 patients were included in the study. The mean age was 63.8 years. Radiocephalic AVF (RCAVF) was the most common site of [69.8% (n = 210)], followed by brachiocephalic (BCAVF) in 25.2% (n = 75) and basilic vein transposition (BVT) in 5% (n = 15). At 12 months, overall survival of the AVF was 66.8%. At 42 months, the primary patency rate of RCAVF, BCAVF, and BVT was 50.6%, 52.6%, and 50.4% respectively. The commonest cause of access failure was thrombosis (20.4%) followed by non-maturation (9%). Vascular access abandonment was found least in BCAVF. Conclusion AVF remains the preferred vascular access for haemodialysis in the elderly population. Brachiocephalic AVF has higher primary and secondary patency rates. Thrombosis and failure of maturation are major concerns in the elderly AVF.

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Efficacy of HA Block Kyphoplasty for Old Osteoporotic Spine Fractures

Key Engineering Materials ◽

10.4028/www.scientific.net/kem.309-311.1371 ◽

2006 ◽

Vol 309-311 ◽

pp. 1371-1374

Author(s):

Taichi Nishimura ◽

Hiromi Matsuzaki ◽

Akihiro Okawa ◽

Masashi Oshima

Keyword(s):

Visual Analogue Scale ◽

Vertebral Fractures ◽

Neurological Disorder ◽

Analogue Scale ◽

Final Evaluation ◽

Spine Fractures ◽

Correction Loss ◽

Pulmonary Infarction ◽

The Mean

We have successfully treated osteoporotic spine fractures for about three years, by using transpedicular kyphoplasty with hydroxyapatite blocks (HA Block: PENTAX) (refer with: Fig. 1), The 13 patients, four men and nine women, ranged from 61 to 86 years in age (mean, 73 years). The mean Visual Analogue Scale (VAS) was 8.5 points before operation, improved to 2.7 points on the next day of operation, and improved significantly to 1.8 points at the final evaluation. The mean deformity rate (Anterior height / Posterior height x 100) was 66.3% before operation, but improved to 91.7% immediately after operation. At the time of follow-up, this rate was 78.6%, indicating that the correction loss was 13.1%. This procedure caused none of serious complications such as neurological disorder and pulmonary infarction. Kyphoplasty with HA blocks may be safe and effective in the treatment of chronic vertebral fractures.

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The benefit of atrial septal defect closure in the elderly patients

European Heart Journal ◽

10.1093/ehjci/ehaa946.2199 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

P.J Prochownik ◽

T Przewlocki ◽

B Sobien ◽

U Gancarczyk ◽

M Olszowska ◽

...

Keyword(s):

Elderly Patients ◽

Atrial Septal Defect ◽

Septal Defect ◽

Transcatheter Closure ◽

Color Doppler ◽

The Elderly ◽

Atrial Septal Defect Closure ◽

Exercise Tests ◽

The Mean

Abstract Objective Closure of the atrial septal defect in the elderly patients is controversial. The aim of the study was to evaluate the outcomes of transcatheter closure of secundum atrial septal defect (ASD) in elderly patients. Methods From a total of 650 pts with ASD who underwent transcatheter closure 120 pts over 60 years (70 F, 50 M) with a mean age of 66.7±18.1 (60–78) were analyzed. All patients had an isolated secundum ASD with a mean Qp:Qs: 2.79±1.8 (1.5–3.9). A symptom-limited treadmill exercise tests with respiratory gas exchange analysis and transthoracic color Doppler echocardiographic study as well as Quality of life (QoL) measured using the SF36 questionnaire (SF36q) were repeated in all pts before procedure and after 12 months of follow-up. Results The device was successfully implanted in all pts (procedure time 30.1±9.9 (10–59) minutes, fluoroscopy time 10.1±7.2 (6–40) minutes). There were no major complications. The defect echo diameter was 19.5±15.4 (12 - 34) mm. The mean balloon stretched diameter of ASD was 22.0±7.8 (14 - 36) mm. The diameter of the implanted devices ranged 16 - 38 mm. After 12 months of ASD closure, all the pts showed a significant improvement of exercise capacity parameters. Seven QoL parameters (except mental health) improved at 12 months follow up compared to their baseline data. The mean SF36q scale increased significantly in 96 (80.2%) pts of mean 41.6±26.1 (4–71). The right ventricular dimension decreased in 101 pts (84.2%) (Table 1). Conclusions Closure of ASD in elderly patients caused a significant clinical and hemodynamic improvement after percutaneous treatment, which is maintained to long-term follow-up what justified this procedure in old age. Funding Acknowledgement Type of funding source: None

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Prevalence of Vertebral Fractures in CTPA’s in Adults Aged 75 and Older and Their Association with Subsequent Fractures and Mortality

Geriatrics ◽

10.3390/geriatrics5030056 ◽

2020 ◽

Vol 5 (3) ◽

pp. 56

Author(s):

Llewelyn Jones ◽

Sukhdev Singh ◽

Chris Edwards ◽

Nimit Goyal ◽

Inder Singh

Keyword(s):

Vertebral Fracture ◽

Clinical Outcomes ◽

Computerized Tomography ◽

Fragility Fracture ◽

Vertebral Fractures ◽

Elderly Population ◽

Fragility Fractures ◽

The Elderly ◽

Overall Mortality

Identifying vertebral fractures is prudent in the management of osteoporosis and the current literature suggests that less than one-third of incidental vertebral fractures are reported. The aim of this study is to determine the prevalence of reported and unreported vertebral fractures in computerized tomography pulmonary angiograms (CTPA) and their relevance to clinical outcomes. All acutely unwell patients aged 75 or older who underwent CTPAs were reviewed retrospectively. 179 CTPAs were reviewed to identify any unreported vertebral fractures. A total of 161 were included for further analysis. Of which, 14.3% (23/161) were reported to have a vertebral fracture, however, only 8.7% (14/161) of reports used the correct terminology of ‘fracture’. On subsequent review, an additional 19.3% (31/161) were noted to have vertebral fractures. Therefore, the overall prevalence of vertebral fractures was 33.5% (54/161). A total of 22.2% (12/54) of patients with a vertebral fracture on CTPA sustained a new fragility fracture during the follow-up period (4.5 years). In comparison, a significantly lower 10.3% (11/107) of patients without a vertebral fracture developed a subsequent fragility fracture during the same period (p = 0.04). Overall mortality during the follow-up period was significantly higher for patients with vertebral fractures (68.5%, 37/54) as compared to those without (45.8%, 49/107, p = 0.006). Vertebral fractures within the elderly population are underreported on CTPAs. The significance of detecting incidental vertebral fractures is clear given the increased rates of subsequent fractures and mortality. Radiologists and physicians alike must be made aware of the importance of identifying and treating incidental, vertebral fragility fractures.

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Clinical and Etiological Characteristics of Epilepsy in the Elderly: A Hospital-Based Study from a Tertiary Care Referral Center of Niamey, Niger

Journal of Neurosciences in Rural Practice ◽

10.1055/s-0039-1700308 ◽

2019 ◽

Vol 10 (04) ◽

pp. 571-575

Author(s):

Hamid Assadeck ◽

Moussa Toudou-Daouda ◽

Zakaria Mamadou ◽

Mahadi Moussa-Konate ◽

Fatimata Hassane-Djibo ◽

...

Keyword(s):

Diagnostic Tests ◽

Tertiary Care ◽

The Elderly ◽

Tertiary Referral Center ◽

Referral Center ◽

Epilepsy In The Elderly ◽

Clonic Seizures ◽

The Mean

Abstract Objectives The aim of this study is to evaluate the management of epilepsy in the elderly at a tertiary referral center in Niger to obtain a comprehensive understanding to determine the intrahospital deficiencies to improve and to make recommendations in terms to improve the management of epilepsy in the elderly in Niger. Materials and Methods We conducted a retrospective study at the Neurology Outpatient Clinic of the National Hospital of Niamey (Niger) over a period of 5 years from May 2013 to May 2018, collecting all cases of patients aged 60 years or over diagnosed with epilepsy by neurologists. From the registers of consultation, we collected and analyzed for each patient the demographic, clinical, etiological, and therapeutic data, as well as the outcomes during follow-up visits. Results Of the 4,576 patients of all ages seen during the period of our study, we included 62 patients aged 60 years or over diagnosed with epilepsy with a hospital frequency of 1.35%. The mean age of patients was 65.82 ± 5.72 years (range: 60 and 83 years) with a predominance of the male sex (sex ratio at 1.6). Patients aged 60 to 64 years were the most represented (43.5%). Generalized tonic–clonic seizures were the most frequent (41.9%), followed by focal to bilateral tonic-clonic seizures (25.8%). All patients underwent electroencephalogram. Only 30 patients (48.4%) underwent brain imaging, and mainly brain computed tomography scan. The etiologies included poststroke epilepsy (25.8%), brain tumors (3.2%), cerebral toxoplasmosis (3.2%), and cerebral meningioma (1.6%). We found 41 cases (66.1%) of epilepsy without definite etiology and with an incomplete workup. Carbamazepine and phenobarbital were the only two antiepileptic drugs (AEDs) used. Conclusion The present study shows limited access to newer generation AEDs and diagnostic tests of epilepsy in Niger. Considerable efforts should be made to facilitate for people living with epilepsy the accessibility to diagnostic tests and the newer generation AEDs to improve the quality of epilepsy management in Niger.

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Percutaneous transpedicular vertebroplasty with calcium phosphate cement in the treatment of osteoporotic vertebral compression and burst fractures

Journal of Neurosurgery Spine ◽

10.3171/spi.2002.97.3.0287 ◽

2002 ◽

Vol 97 (3) ◽

pp. 287-293 ◽

Cited By ~ 24

Author(s):

Masato Nakano ◽

Norikazu Hirano ◽

Kousou Matsuura ◽

Hiroki Watanabe ◽

Hideki Kitagawa ◽

...

Keyword(s):

Back Pain ◽

Calcium Phosphate ◽

Pain Relief ◽

Vertebral Fractures ◽

Calcium Phosphate Cement ◽

Content Type ◽

Osteoporotic Vertebral Fractures ◽

The Mean ◽

Fine Print

Object. Osteoporotic vertebral fractures occasionally lead to late-onset collapse, kyphosis, persistent back pain, and disability. The authors describe a series of patients in whom they performed percutaneous vertebroplasty by using calcium phosphate cement (CPC) to obtain early pain relief and improve the integrity of the osteoporotic vertebral body (VB). Methods. Between August 2000 and February 2001, they performed 17 percutaneous transpedicular CPC-assisted vertebroplasty procedures in 16 patients who harbored thoracic or lumbar osteoporotic vertebral fractures. Following repositioning and curettage of the pathological soft tissues, CPC-assisted vertebroplasty was percutaneously performed in four patients with osteoporotic burst fracture and pseudarthrosis (Procedure A). In situ CPC-assisted vertebroplasty was performed in 12 patients with fresh vertebral compression fractures due to osteoporosis (Procedure B). Back pain and low-back pain were evaluated using a visual analog scale (VAS). The deformity index of the VB was measured on a lateral radiograph as the ratio of the VB's height (sum of measurements at anterior, middle, and posterior regions) to its longitudinal diameter. Based on VAS scores, pain was decreased in all patients immediately after surgery, and pain relief was maintained at the last follow up. The mean preoperative deformity index score of the VB was 1.43 in Procedure A and 1.67 in Procedure B; postoperatively scores improved to 1.59 and 1.93, respectively. At the 6-month follow-up examination, the mean deformity index score rebounded to 1.52 in Procedure A and 1.79 in Procedure B. Bone union was documented in all patients. Complications, such as a temporary respiratory insufficiency and a small amount of CPC leakage into the spinal canal, were observed in patients who underwent Procedure B. Conclusions. Percutaneous transpedicular CPC-assisted vertebroplasty is a minimally invasive procedure that provides early relief of pain and prevents vertebral collapse and pseudarthrosis in patients with osteoporotic vertebral fracture.

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Mid-term outcomes of tantalum cup– a single centre study

Arthroplasty ◽

10.1186/s42836-021-00099-z ◽

2021 ◽

Vol 3 (1) ◽

Author(s):

Rajesh Bawale ◽

Baseem Choudhry ◽

Srinivasa Samsani

Keyword(s):

Hip Arthroplasty ◽

Deep Infection ◽

Revision Hip Arthroplasty ◽

Trabecular Metal ◽

Level Of Evidence ◽

Porous Tantalum ◽

Midterm Outcome ◽

Cementless Cup ◽

The Mean

Abstract Introduction The cementless acetabular implants are commonly used in primary and revision hip arthroplasty. Reconstruction of acetabulum in case of bone defects can be challenging. The aims of this single center study are to review the mid-term outcomes of porous tantalum cups (TM) and evaluate complications. Methods The midterm outcome of a trabecular metal tantalum modular uncemented cup was evaluated in 59 hips in 58 patients. In our group, we had 23 males and 35 females. The mean age was 70.11 years (range, 30 to 87 years). Four patients were lost to follow-up and 13 died during the period without having further surgeries attributed to the hip arthroplasty. The remaining 41 patients (42 revision hip arthroplasties) had complete data available. Results The mean follow-up was 87 months, ranging from 24 to 144 months. Standard pelvic anteroposterior (AP) radiographs were used to assess and preoperatively classify acetabular defects as per Paprosky classification. The serial radiographs showed excellent stability, bone opposition and graft incorporation. Four patients had further surgeries. Two of these were due to infection (one superficial and one deep infection). One of the patients had washout and then removal of metal work, the other patient only had a washout and symptoms settled. One patient had vascular compromise and went for surgery to stem the bleeding. One patient had re-revision due to stem loosening and hence required surgery but the revision cup remained stable. We noted a 96% survival at an average of 7.2 years follow-up. Conclusion The mid-term results with the trabecular metal cementless cup appeared to be promising in both primary and revision hip arthroplasty, even in the presence of considerable bone loss which requires bone grafting and augments. Level of evidence IV.

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