scholarly journals Structural Parameters of Proximal Femur in Evaluation of Its Strength

Author(s):  
S. S. Rodionova ◽  
A. N. Torgashin ◽  
E. I. Solod ◽  
N. S. Morozova ◽  
A. K. Morozov ◽  
...  

Comparative assessment of software HAS for Hologic densitometer was performed in two groups of osteoporotic patients (mean age 60.4 years) with and without proximal femur fractures. The area of cross-section, cross-section moment of inertia, axial moment of section resistance, cortical bone thickness and coefficient of bending were assessed in three zones of the femur (narrow part of the neck, intertrochanteric and diaphyseal zones). Results of linear discriminant analysis showed that totality of 9 out of 15 geometric parameters assessed by that program enabled with 100% probability to differentiate patients with and without fractures and gave the background to introduce that method into clinical practice for timely detection of patients with high risk of proximal femur fracture.

2014 ◽  
Vol 21 (1) ◽  
pp. 77-81
Author(s):  
S. S Rodionova ◽  
A. N Torgashin ◽  
E. I Solod ◽  
N. S Morozova ◽  
A. K Morozov ◽  
...  

Comparative assessment of software HAS for Hologic densitometer was performed in two groups of osteoporotic patients (mean age 60.4 years) with and without proximal femur fractures. The area of cross-section, cross-section moment of inertia, axial moment of section resistance, cortical bone thickness and coefficient of bending were assessed in three zones of the femur (narrow part of the neck, intertrochanteric and diaphyseal zones). Results of linear discriminant analysis showed that totality of 9 out of 15 geometric parameters assessed by that program enabled with 100% probability to differentiate patients with and without fractures and gave the background to introduce that method into clinical practice for timely detection of patients with high risk of proximal femur fracture.


2018 ◽  
Vol 12 (1) ◽  
pp. 236-251
Author(s):  
Peter Moriarty ◽  
Heather Moriarty ◽  
Michael Maher ◽  
James Harty

Background:As imaging technology improves small Pulmonary Emboli (PE) of debatable clinical relevance are increasingly detected leading to higher numbers of patients receiving anticoagulation. Although PE are an important cause of morbidity and mortality in patients undergoing repair of proximal femur fractures, this cohort of patients are at increased falls risk and are therefore largely unsuitable for long term anticoagulant therapy.Objective:1. To review sequential Computed Tomography Pulmonary Angiograms (CTPA) performed in patients who underwent repair of proximal femur fractures at our institution. 2. To establish the perioperative CT imaging performed.Design:A retrospective cross sectional study of all patients undergoing proximal femur fracture repair at a single tertiary referral.Methods:The theatre database was interrogated to reveal all patients undergoing proximal femur fracture repair over a 28 month period from 01/01/12 to 07/04/14 inclusive. This was cross-referenced with the Picture Archiving Communication System (PACS) to establish all imaging undertaken in the perioperative period. CTPA studies performed within the time period of 1 week prior to and 6 months post proximal femur fixation were included. CTPA studies and reports were assessed for quality and findings. D-Dimer results, if performed within 72 hours of the CTPA study, were recorded.Results:1388 patients underwent neck of femur fracture repair in the 28-month study period. Of this cohort 71 CTPA studies were performed in 71 patients (5.2%) with a mean age of 77.8 years (range 38 - 100). 53 (74.6%) of studies were negative for embolus and 17 (23.9%) studies revealed clot in a pulmonary artery (1 saddle embolus, 2 main pulmonary artery emboli, 7 lobar vessel emboli, 2 segmental artery emboli, 5 subsegmental emboli). Overall PE detection rate was 1.2% of our total study population. In all 71 studies, Houndsfield Unit (HU) in the main pulmonary artery (PA) was >200; which is considered to be of satisfactory quality to assess for segmental pulmonary emboli. 32% of patients had D Dimer levels performed, however no relationship with presence of PE on CTPA was demonstrated.Conclusion:The rate of positive CTPA studies in patients undergoing proximal femur fracture repair is 23.9% in our patient population, comparing favorably to published data. This is likely to reflect good compliance with prevention measures at ward level. D-Dimer results are unreliable for PE prediction.


Author(s):  
Sandeep Krishna Avulapati ◽  
Senthil Kumar Mahalingam ◽  
T. Munirathnam ◽  
Jagadeesh Gudaru ◽  
Deepak Kaki

<p class="abstract"><strong>Background:</strong> In the elderly population, proximal femur fractures are most common which can result in increase of morbidity and mortality. Pre and postoperative mobility patterns, also depends upon the Mental Status of the patient. Incidence of Mental health disorders of patient can increases with age and co morbidities. The aim of the study was to evaluate the effect and relationship of preoperative mental status, on postoperative mobility in proximal femur fracture patients. On null hypothesis; there exists no co-relation between pre-operative mental status on pre and postoperative mobility those had surgery for proximal femur fractures.</p><p class="abstract"><strong>Methods:</strong> This is a retrospective study, carried out during the period of 14<sup>th</sup> March, 2016 to 14<sup>th</sup> March, 2017 at BIRRD (T) Hospital. All the patients who underwent proximal femur fracture surgeries were included in the study. Patients were evaluated for Abbreviated Mental Score Test pre-operatively. Mobility patterns were before injury and after surgery evaluated in patients with proximal femur fractures. Postoperatively patients were followed up to one year.<strong></strong></p><p class="abstract"><strong>Results:</strong> 50 patients were included into the study, where 12 patients could not present to follow-up due to various reasons, thus we have complete data of 38 patients. There is significant reduction in mobility status of individuals i.e. from 6.18 (preoperative pre fracture mobility) to 5.36 (postoperative mobility). Average abbreviated mental test score is 7.55. There exists a correlation between the variables.</p><p class="abstract"><strong>Conclusions:</strong> Null hypothesis remains rejected. There is statistically significant relationship between the variables (pre and postoperative mobility, and abbreviated mental test score), which appears to be positive correlation.</p>


2019 ◽  
Vol 9 (1) ◽  
pp. 66
Author(s):  
Katharina Hill-Mündel ◽  
Johannes Schlegl ◽  
Hans Konrad Biesalski ◽  
Sabrina Ehnert ◽  
Steffen Schröter ◽  
...  

Proximal femur fractures show a high prevalence in elderly patients and are associated with an elevated risk of multimorbidity and early mortality. Recovery is impaired by malnutrition and oxidative stress, which is affected by antioxidants such as ascorbic acid (AA). This study monitored AA levels during hospitalization of patients with a proximal femur to investigate the influence of AA status to the clinical outcome. AA levels of 25 elderly patients with a proximal femur fracture were measured during hospitalization using high performance liquid chromatography. Plasma samples were collected preoperatively, on the first day after surgery, on the third day after surgery and on the day of discharge. Nutritional Risk Screening 2002 (NRS) and Mini Nutritional Assessment (MNA) were assessed to evaluate the nutritional status. In patients with proximal femoral fractures, preoperative AA concentrations were significantly lower compared to elderly patients without an acute fracture. A significant decrease of 33.8% in AA plasma level was measured on the day after surgery with a significant recovery up to the time of discharge. The preoperative AA status did not have any significant effect on clinical outcome. However, inadequate AA levels (<50 µmol/L) upon discharge significantly increased the incidence and the severity of postoperative complications. These results indicate that the AA status upon discharge has a greater impact on clinical outcome than assumed, and therefore, AA supplementation during hospitalization should be considered.


2019 ◽  
Vol 2019 ◽  
pp. 1-5
Author(s):  
S. Craig Morris ◽  
Priyantha L. Wickramanayake ◽  
Peter J. Wilton ◽  
Jonathan L. Allen

Traumatic hip dislocations are potentially devastating injuries, especially in young patients, and require emergent orthopedic treatment. Given the significant amount of energy required to cause these injuries, a high index of suspicion is necessary to identify related injuries. The associated injuries, direction of dislocation, and time between injury and reduction represent the known prognostic factors, based on limited available research. Intrapelvic hip dislocations represent an uncommon variant of the traumatic hip dislocation, with all previously reported cases involving ipsilateral proximal femur fractures. We present a case of intrapelvic femoral head dislocation without an associated proximal femur fracture, as well as the maneuvers used to treat the patient via a closed reduction.


2020 ◽  
Author(s):  
Josep Maria Muñoz Vives ◽  
Montsant Jornet-Gibert ◽  
J. Cámara-Cabrera ◽  
Pedro L. Esteban ◽  
Laia Brunet ◽  
...  

Author(s):  
Khushdeep S. Vig ◽  
Curtis Adams ◽  
Joseph R. Young ◽  
Eric Perloff ◽  
Casey M. O’Connor ◽  
...  

BMJ Open ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. e039960
Author(s):  
Michael Blauth ◽  
Alexander Joeris ◽  
Elke Rometsch ◽  
Kathrin Espinoza-Rebmann ◽  
Pannida Wattanapanom ◽  
...  

ObjectiveThe aim of this study was to determine the effect of treatment in geriatric fracture centres (GFC) on the incidence of major adverse events (MAEs) in patients with hip fractures compared with usual care centres (UCC). Secondary objectives included hospital-workflow and mobility-related outcomes.DesignCohort study recruiting patients between June 2015 and January 2017. Follow-up was 1 year.SettingInternational (six countries, three continents) multicentre study.Participants281 patients aged ≥70 with operatively treated proximal femur fractures.InterventionsTreatment in UCCs (n=139) or GFCs (n=142), that is, interdisciplinary treatment including regular geriatric consultation and daily physiotherapy.Outcome measuresPrimary outcome was occurrence of prespecified MAEs, including delirium. Secondary outcomes included any other adverse events, time to surgery, time in acute ward, 1-year mortality, mobility, and quality of life.ResultsPatients treated in GFCs (n=142) had a mean age of 81.9 (SD, 6.6) years versus 83.9 (SD 6.9) years in patients (n=139) treated in UCCs (p=0.013) and a higher mean Charlson Comorbidity Index of 2.0 (SD, 2.1) versus 1.2 (SD, 1.5) in UCCs (p=0.001). More patients in GFCs (28.2%) experienced an MAE during the first year after surgery compared with UCCs (7.9%) with an OR of 4.56 (95% CI 2.23 to 9.34, p<0.001). Analysing individual MAEs, this was significant for pneumonia (GFC: 9.2%; UCC: 2.9%; OR, 3.40 (95% CI 1.08 to 10.70), p=0.027) and delirium (GFC: 11.3%; UCC: 2.2%, OR, 5.76 (95% CI 1.64 to 20.23), p=0.002).ConclusionsContrary to our study hypothesis, the rate of MAEs was higher in GFCs than in UCCs. Delirium was revealed as a main contributor. Most likely, this was based on improved detection rather than a truly elevated incidence, which we interpret as positive effect of geriatric comanagement.Trial registration numberClinicalTrials.gov: NCT02297581.


2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Dante Dallari ◽  
Luigi Zagra ◽  
Pietro Cimatti ◽  
Nicola Guindani ◽  
Rocco D’Apolito ◽  
...  

Abstract Background Treatment of hip fractures during the coronavirus disease 2019 (COVID-19) pandemic has posed unique challenges for the management of COVID-19-infected patients and the maintenance of standards of care. The primary endpoint of this study is to compare the mortality rate at 1 month after surgery in symptomatic COVID-positive patients with that of asymptomatic patients. A secondary endpoint of the study is to evaluate, in the two groups of patients, mortality at 1 month on the basis of type of fracture and type of surgical treatment. Materials and methods For this retrospective multicentre study, we reviewed the medical records of patients hospitalised for proximal femur fracture at 14 hospitals in Northern Italy. Two groups were formed: COVID-19-positive patients (C+ group) presented symptoms, had a positive swab for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and received treatment for COVID-19; COVID-19-negative patients (C− group) were asymptomatic and tested negative for SARS-CoV-2. The two groups were compared for differences in time to surgery, survival rate and complications rate. The follow-up period was 1 month. Results Of the 1390 patients admitted for acute care for any reason, 477 had a proximal femur fracture; 53 were C+ but only 12/53 were diagnosed as such at admission. The mean age was > 80 years, and the mean American Society of Anesthesiologists (ASA) score was 3 in both groups. There was no substantial difference in time to surgery (on average, 2.3 days for the C+ group and 2.8 for the C− group). As expected, a higher mortality rate was recorded for the C+ group but not associated with the type of hip fracture or treatment. No correlation was found between early treatment (< 48 h to surgery) and better outcome in the C+ group. Conclusions Hip fracture in COVID-19-positive patients accounted for 11% of the total. On average, the time to surgery was > 48 h, which reflects the difficulty of maintaining normal workflow during a medical emergency such as the present pandemic and notwithstanding the suspension of non-urgent procedures. Hip fracture was associated with a higher 30-day mortality rate in COVID-19-positive patients than in COVID-19-negative patients. This fact should be considered when communicating with patients and/or their family. Our data suggest no substantial difference in hip fracture management between patients with or without COVID-19 infection. In this sample, the COVID-19-positive patients were generally asymptomatic at admission; therefore, routine screening is recommended. Level of evidence Therapeutic study, level 4.


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