Impact of concomitant injuries in geriatric patients with proximal femur fracture

Aims The impact of concomitant injuries in patients with proximal femoral fractures has rarely been studied. To date, the few studies published have been mostly single-centre research focusing on the influence of upper limb fractures. A retrospective cohort analysis was, therefore, conducted to identify the impact and distribution of concomitant injuries in patients with proximal femoral fractures. Methods A retrospective, multicentre registry-based study was undertaken. Between 1 January 2016 and 31 December 2019, data for 24,919 patients from 100 hospitals were collected in the Registry for Geriatric Trauma. This information was queried and patient groups with and without concomitant injury were compared using linear and logistic regression models. In addition, we analyzed the influence of the different types of additional injuries. Results A total of 22,602 patients met the inclusion criteria. The overall prevalence of a concomitant injury was 8.2% with a predominance of female patients (8.7% vs 6.9%; p < 0.001). Most common were fractures of the ipsilateral upper limb. Concomitant injuries resulted in prolonged time-to-surgery (by 3.4 hours (95 confidence interval (CI) 2.14 to 4.69)) and extended length of stay in hospital by 2.2 days (95% CI 1.74 to 2.61). Mortality during the admission was significantly higher in the concomitant injury group (7.4% vs 5.3%; p < 0.001). Additionally, walking ability and quality of life were reduced in these patients at discharge. More patients were discharged to a nursing home instead of their own home compared to patients without additional injuries (25.8% vs 30.3%; p < 0.001). Conclusion With a prevalence of 8.2%, the appearance of a concomitant injury is common in elderly patients with hip fracture. These patients are at a greater risk for death during the admission, longer hospital stays, and delayed surgery. This knowledge is clinically important for all who are involved in the treatment of proximal femur fractures. Cite this article: Bone Joint J 2021;103-B(9):1526–1533.

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Geriatric Proximal Femur Fractures During the Covid-19 Pandemic - Fewer Cases, But More Comorbidities

Geriatric Orthopaedic Surgery & Rehabilitation ◽

10.1177/21514593211009657 ◽

2021 ◽

Vol 12 ◽

pp. 215145932110096

Author(s):

Christina Polan ◽

Heinz-Lothar Meyer ◽

Manuel Burggraf ◽

Monika Herten ◽

Paula Beck ◽

...

Keyword(s):

Nursing Home ◽

Elderly Patients ◽

Proximal Femur ◽

Minor Trauma ◽

Proximal Femur Fractures ◽

Femur Fractures ◽

Number Of Patients ◽

Group 2 ◽

The Impact ◽

Group 1

Background: The COVID-19 pandemic is challenging healthcare systems worldwide. This study examines geriatric patients with proximal femur fractures during the COVID-19 pandemic, shifts in secondary disease profile, the impact of the pandemic on hospitalization and further treatment. Methods: In a retrospective monocentric study, geriatric proximal femur fractures treated in the first six months of 2020 were analyzed and compared with the same period of 2019. Pre-traumatic status (living in a care home, under supervision of a legal guardian), type of trauma, accident mechanism, geriatric risk factors, associated comorbidities, time between hospitalization and surgery, inpatient time and post-operative further treatment of 2 groups of patients, aged 65-80 years (Group 1) and 80+ years (Group 2) were investigated. Results: The total number of patients decreased (70 in 2019 vs. 58 in 2020), mostly in Group 1 (25 vs. 16) while the numbers in Group 2 remained almost constant (45 vs. 42). The percentage of patients with pre-existing neurological conditions rose in 2020. This corresponded to an increase in patients under legal supervision (29.3%) and receiving pre-traumatic care in a nursing home (14.7%). Fractures were mostly caused by minor trauma in a home environment. In 2020, total number of inpatient days for Group 2 was lower compared to Group 1 (p = 0.008). Further care differed between the years: fewer Group 1 patients were discharged to geriatric therapy (69.6% vs. 25.0%), whereas in Group 2 the number of patients discharged to a nursing home increased. Conclusions: Falling by elderly patients is correlated to geriatric comorbidities, consequently there was no change in the case numbers in this age group. Strategic measures to avoid COVID-19 infection in hospital setting could include reducing the length of hospital stays by transferring elderly patients to a nursing home as soon as possible and discharging independent, mobile patients to return home.

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Role of cephalomedullary nail in proximal femur fractures

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20173154 ◽

2017 ◽

Vol 3 (5) ◽

pp. 929

Author(s):

Nishant Kumar ◽

Dhruv Sharma ◽

Kuljit Kumar

Keyword(s):

Hip Fractures ◽

Proximal Femur ◽

Femoral Fractures ◽

Public Health Problem ◽

Major Public Health Problem ◽

Cephalomedullary Nail ◽

Proximal Femur Fractures ◽

Femur Fractures ◽

Bending Loads ◽

Cephalomedullary Nails

Background: Hip fractures are recognized to be a major public health problem. Key determinants of hip fractures include age, osteoporosis, and falls. In these determinants socioeconomic status, have not been well explored. Under eccentric loading, high bending loads occur, leading to failure of the osteosynthetis anchorage at the center of the femoral head.The introduction of the reconstruction nail has broadened the indications for the intramedullary fixation of difficult femoral fractures. The operative technique is however complicated. Some technical difficulties encountered during its use are presented together with guidance to allow these problems to be avoided.Methods: This Study had included 47 cases which were operated by single surgeon and use of different implant (cephalomedullary nail) was randomized irrespective of fracture types and pattern. This study was done over a period of 12 months (October 2013 to October 2014) with 1 month, 3 months, 6 months, 12 months follow up. At every visit patient were assessed as per Oxford hip score. Type of implant used was PFNA, Intertan, Sirus Nail.Results: The mean age of the patients was 65.68 (±13.55) years. Severe pain was observed among majority of the patients at one month (70.2%) which became mild (40.4%) and moderate (34%) at 3 months. Very mild pain was found in 36.2% patients at 6 months and in 61.7% at 12 months. The limping was all the time among all the patients at one month. However, the limping was found often in 46.8% at 3 months and sometimes in 57.4% at 6 months and 53.2% at 12 months. The hip score was found to be severe among all the patients at one month. However, moderate to severe hip was in 46.8% patients at 3 months, mild to moderate was in 57.4% at 6 months and satisfactory joint function was in 68.1% at 12 months. The comparison of Hip score according to long or short nail at one 3, 6 and 12 months showed no difference. Conclusions: Cephalomedullary nails with adequate technique so that the lag screws by purchase in the centre-centre or posterior-inferior quadrant combines the benefit of sliding hip screw as well as intramedullary implants. So we recommend the use of cephalomedullary nails in proximal femur fractures especially the unstable fractures.

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The Mental Capacity Act 2005: review of mental capacity assessment in people with proximal femoral fracture

The Psychiatrist ◽

10.1192/pb.bp.109.026757 ◽

2010 ◽

Vol 34 (7) ◽

pp. 284-286 ◽

Cited By ~ 5

Author(s):

P. Guyver ◽

P. Hindle ◽

J. Harrison ◽

N. Jain ◽

M. Brinsden

Keyword(s):

Staff Training ◽

Femoral Fractures ◽

Proximal Femoral Fracture ◽

Mental Capacity ◽

Clinical Implications ◽

Proximal Femoral Fractures ◽

Mental Capacity Act 2005 ◽

Consent To Treatment ◽

Mental Capacity Act ◽

The Impact

Aims and methodTo ascertain whether patients with proximal femoral fractures were being correctly assessed in line with the Mental Capacity Act 2005. Fifty people admitted with proximal femoral fractures were audited to assess whether they had given consent to treatment in accordance with the Act. A Mental Capacity Act 2005 guidance and assessment form was then introduced accompanied by staff training. A re-audit was undertaken to assess the impact.ResultsThe initial audit showed that only one person (2%) had been properly assessed. The re-audit demonstrated that the use of the Mental Capacity Act 2005 assessment form ensured correct assessment.Clinical implicationsOur findings suggest the form is a useful tool in the documentation and assessment of an individual's capacity under the Mental Capacity Act.

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Proximal Femur Locking Plate: An Alternative Implant For Unstable Proximal Femoral Fractures.

IOSR Journal of Dental and Medical Sciences ◽

10.9790/0853-1604070714 ◽

2017 ◽

Vol 16 (04) ◽

pp. 07-14

Author(s):

Harindra Himanshu ◽

Mani Bhushan Prasad ◽

Ajay Kumar Verma ◽

Lal Bahadur Manjhi

Keyword(s):

Proximal Femur ◽

Locking Plate ◽

Femoral Fractures ◽

Proximal Femoral Fractures

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The impact of antegrade intramedullary nailing start site using the SIGN nail in proximal femoral fractures: A prospective cohort study

Injury ◽

10.1016/j.injury.2017.11.020 ◽

2018 ◽

Vol 49 (2) ◽

pp. 323-327 ◽

Cited By ~ 7

Author(s):

Mohamed Mustafa Diab ◽

Hao-Hua Wu ◽

Edmund Eliezer ◽

Billy Haonga ◽

Saam Morshed ◽

...

Keyword(s):

Cohort Study ◽

Intramedullary Nailing ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Femoral Fractures ◽

Start Site ◽

Proximal Femoral Fractures ◽

The Impact

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The impact of polyethylene abrasion on the occurrence of periprosthetic proximal femoral fractures in patients with total hip arthroplasty

European Journal of Trauma and Emergency Surgery ◽

10.1007/s00068-019-01222-1 ◽

2019 ◽

Author(s):

Dirk Zajonz ◽

Nora Lang ◽

Cathleen Pönick ◽

Melanie Edel ◽

Robert Möbius ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Femoral Fractures ◽

Proximal Femoral Fractures ◽

Total Hip ◽

The Impact

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Functional outcomes of reverse distal femoral locking plate in the extra capsular fractures of proximal femur

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20191046 ◽

2019 ◽

Vol 5 (3) ◽

pp. 417

Author(s):

Jaspreet Singh ◽

Harpal Singh Selhi ◽

Rahul Gupta ◽

Gurleen Kaur

Keyword(s):

Proximal Femur ◽

Functional Outcomes ◽

Locking Plate ◽

Femoral Fractures ◽

Delayed Union ◽

Bony Union ◽

Proximal Femoral Fractures ◽

Superficial Infection ◽

Non Union ◽

Wound Breakdown

Background: The optimal management of unstable proximal femoral fractures is controversial. In this prospective study, the functional outcomes of reverse distal femoral locking plate for the treatment of comminuted unstable proximal femoral fractures were assessed. Objectives were to study the functional outcomes of reverse locking plate in extra-capsular fractures of the proximal femur, with respect to quality of reduction, time to bony union, mobility achieved, complications of the procedure, secondary procedures performed (if any) and delayed complications like implant breakage, delayed union, non-union.Methods: 17 patients with unstable proximal femoral fractures were assessed and managed with reverse distal femur plates, and evaluated with X-ray, physical examination, Palmer and Parker mobility score.Results: Union was achieved in all the patients, with average time to union 6.43±1.18 months (range 3-12 months). There was one loosening of implant and wound breakdown, which was managed conservatively. One case of loosening of proximal screws was there, but the fracture united in 9 months with some varus angulation. Superficial infection occurred in one patient, which healed after debridement and IV antibiotics.Conclusions: Taking into consideration the simple surgical technique, good healing rate and minimum complications, it is strongly recommended to use reverse locked distal femoral plates for the management of proximal femoral fractures and further in lean patients, sum-muscular MIPPO should be attempted.

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Mortality Following Distal Femur Fractures Versus Proximal Femur Fractures in Elderly Population: The Impact of Best Practice Tariff

Cureus ◽

10.7759/cureus.10744 ◽

2020 ◽

Author(s):

Islam Mubark ◽

Amr Abouelela ◽

Ahmed Genena ◽

Abdallah Al Ghunimat ◽

Islam Sarhan ◽

...

Keyword(s):

Proximal Femur ◽

Best Practice ◽

Elderly Population ◽

Distal Femur ◽

Proximal Femur Fractures ◽

Femur Fractures ◽

The Impact

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Proximal femoral nail- outcome and complications: a prospective study of 125 cases of proximal femoral fractures

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20173673 ◽

2017 ◽

Vol 3 (5) ◽

pp. 973 ◽

Cited By ~ 1

Author(s):

B. L. Chopra ◽

Krishan Kumar ◽

B. L. Khajotia ◽

Ravindra Bhambu ◽

Sunil Bhatiwal ◽

...

Keyword(s):

Prospective Study ◽

Proximal Femur ◽

Femoral Fractures ◽

The Elderly ◽

Reoperation Rate ◽

Proximal Femoral Nail ◽

Common Source ◽

Proximal Femoral Fractures ◽

Femoral Nail ◽

A Prospective Study

Background: Fractures of the proximal femur are relatively common injuries in adults and common source of morbidity and mortality among the elderly. Fractures of the proximal femur include trochantric and subtrochantric fractures. The present study was designed to evaluate and analyze the role of proximal femoral nail (PFN) in the treatment of proximal femoral fractures.Methods: It was a prospective study on 125 cases of proximal femoral fractures. The fractures were classified according to AO classification. Salvati and Wilson Score were used for functional assessment.Results: In this study at 6 months follow up, union was achieved in 123 cases, open reduction was performed in 11% of cases (14 cases). Technical and mechanical complications were noted in 21% cases (27 cases). Reoperation rate was 4% (Five cases). According to Salvati and Wilson scoring system excellent results were seen in 36% of cases (45 cases), good results in 46% cases (58 cases), fair result in 13% cases (16 cases) and poor results in 5% cases (6 cases). Conclusions: It is concluded from our study that proximal femoral nailing is an attractive and suitable implant for Proximal Femoral Fractures and its use in unstable intertrochantric fractures is very encouraging.

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Gamma 3 U-Blade lag screws in patients with trochanteric femur fractures: are rotation control lag screws better than others?

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-019-1427-z ◽

2019 ◽

Vol 14 (1) ◽

Cited By ~ 2

Author(s):

Jehyun Yoo ◽

Sangmin Kim ◽

Junyoung Choi ◽

Jihyo Hwang

Keyword(s):

Femoral Fractures ◽

Walking Ability ◽

Fixation Failure ◽

Neck Shaft Angle ◽

Lag Screw ◽

Femur Fractures ◽

Significant Difference ◽

Shaft Angle ◽

Sliding Distance ◽

Screw Group

Abstract Background Intramedullary hip nails may be classified as blades or screws depending on the type of lag screw used. Recently, a combination of lag screw types with a U-clip insertion has also been used. The purpose of this study was to evaluate the clinical and radiological outcomes of these new screw types. Methods A total of 185 patients with trochanteric femoral fractures (age ≥ 65 years) who underwent surgery with intramedullary nails were selected. Surgeries with InterTrochanteric/SubTrochanteric (ITST), Proximal Femoral Nail Antirotation (PFNA), and Gamma 3 U-Blade lag screws were performed between January 2011 and June 2016. The AO/OTA classification, presence of a basicervical fracture type on 3D-CT, BMI, BMD, reduction quality, position of the lag screw, TAD (tip apex distance) of the lag screw, sliding distance of the lag screw, varus change (neck shaft angle), radiological union period, fixation failure and functional outcome as determined by walking ability were analyzed. Results There were 3/60 (5.0%) cases of fixation failure in the ITST group, all caused by cut-out; 4/57 (7.0%) in the PFNA II group: 3 caused by cut-through and 1 by metal fracture; 1/68 (1.5%) in the Gamma 3 U-Blade lag screw group (P = 0.301). In each group, the sliding distance of the lag screw showed a significant difference (P = 0.017), whereas significant sliding over 10 mm showed no statistically significant results. Conclusion There was only one (1.5%) case of fixation failure in the Gamma 3 U-Blade lag screw group. The sliding distance of the U-Blade was found to be in the middle, between the PFNA II (shorter) and ITST (longer) implants. The new rotational control lag screw seems to be comparable to other screw types.

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