Preoperative Ascorbic Acid Levels in Proximal Femur Fracture Patients Have No Postoperative Clinical Impact, While Ascorbic Acid Levels upon Discharge Have a Major Effect on Postoperative Outcome

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.

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P16 An audit of elderly patients with a femoral fracture: is the quality of care received by patients affected by where in the femur the fracture occurs?

BJS Open ◽

10.1093/bjsopen/zrab032.015 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

Author(s):

O A Javed ◽

M J Khan ◽

Y Abbas ◽

S Pillai ◽

K Hristova ◽

...

Keyword(s):

Risk Assessment ◽

Elderly Patients ◽

Bone Health ◽

Nutritional Assessment ◽

Femur Fracture ◽

Femoral Fractures ◽

Neck Of Femur ◽

Femur Fractures ◽

Neck Of Femur Fracture ◽

Health Review

Abstract Introduction Elderly patients with femoral fractures are often frail and require a multidisciplinary approach to optimise medical care, rehabilitation and prevention of further injury. Previously, neck of femur fracture patients were the focus of such an approach, but NICE and BOAST guidelines emphasise extending this care to other elderly trauma patients. Methods A retrospective analysis of 43 patients over 60 years old at Gloucestershire Hospitals NHS Foundation Trust in 2019 with a femoral fracture other than a neck of femur fracture. BOAST guideline standards were surgery within 36 hours, orthogeriatric assessment within 72 hours, a documented ceiling of treatment, falls risk assessment, bone health review, nutritional assessment and physiotherapy review. Results Our study showed worse outcomes in all standards for patients with femoral shaft, distal femur and periprosthetic femur fractures compared to neck of femur fractures: surgery within 36 hours (63.9% vs. 66%); orthogeriatric assessment within 72 hours (32.6% vs. 91.9%); falls risk assessment (76.7% vs. 99.6%); bone health review (41.9% vs. 99.7%); nutritional assessment (55.8% vs. 99.6%); physiotherapy review (97.7% vs. 98.9%). The group also had worse outcomes for average length of stay (19 days vs. 14 days) and 30 day mortality (9.3% vs. 8.6%). Discussion Our study showed a discrepancy in care received by elderly patients with femoral fractures other than neck of femur. We will introduce a proforma for all femoral fractures, present our findings to orthogeriatric, bone health and physiotherapy teams to involve them in the care of such patients and re-audit following these recommendations.

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Mini nutritional assessment and nutritional risk screening are good tools for nutritional screening in hospitalized elderly patients

Clinical Nutrition ESPEN ◽

10.1016/j.clnesp.2021.09.171 ◽

2021 ◽

Vol 46 ◽

pp. S602

Author(s):

A.A.R. Almendra ◽

V.A. Leandro-Merhi ◽

J.L.B.D. Aquino

Keyword(s):

Elderly Patients ◽

Nutritional Assessment ◽

Mini Nutritional Assessment ◽

Nutritional Risk ◽

Nutritional Screening ◽

Risk Screening ◽

Hospitalized Elderly ◽

Hospitalized Elderly Patients ◽

Nutritional Risk Screening

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To assess the role of VIT. D3 in proximal femur Fracture in elderly patients

International Journal of Orthopaedics Sciences ◽

10.22271/ortho.2018.v4.i4e.42 ◽

2018 ◽

Vol 4 (4) ◽

pp. 444-448

Author(s):

Dr. Surendra Kumar ◽

Dr. Shashank Tomar ◽

Dr. Sanjay Chaudhary ◽

Dr. Ashok Yadav ◽

Dr. Anil Yadav

Keyword(s):

Elderly Patients ◽

Proximal Femur ◽

Femur Fracture ◽

Proximal Femur Fracture

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Factors in Pulmonary Embolus Diagnosis via CT Pulmonary Angiogram in Patients Undergoing Repair of Proximal Femur Fractures

The Open Orthopaedics Journal ◽

10.2174/1874325001812010236 ◽

2018 ◽

Vol 12 (1) ◽

pp. 236-251

Author(s):

Peter Moriarty ◽

Heather Moriarty ◽

Michael Maher ◽

James Harty

Keyword(s):

Pulmonary Artery ◽

Proximal Femur ◽

Femur Fracture ◽

Main Pulmonary Artery ◽

Fracture Repair ◽

Proximal Femur Fracture ◽

Pulmonary Emboli ◽

Proximal Femur Fractures ◽

Femur Fractures ◽

D Dimer

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.

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In-hospital care, complications, and 4-month mortality following a hip or proximal femur fracture: the Spanish registry of osteoporotic femur fractures prospective cohort study

Archives of Osteoporosis ◽

10.1007/s11657-018-0515-8 ◽

2018 ◽

Vol 13 (1) ◽

Cited By ~ 10

Author(s):

Daniel Prieto-Alhambra ◽

Carlen Reyes ◽

Miguel Sanz Sainz ◽

Jesús González-Macías ◽

Luis Gracia Delgado ◽

...

Keyword(s):

Cohort Study ◽

Prospective Cohort Study ◽

Proximal Femur ◽

Prospective Cohort ◽

Hospital Care ◽

Femur Fracture ◽

Proximal Femur Fracture ◽

Femur Fractures

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Proximal femur fractures - effect of preoperative mental status of patients on postoperative mobility of patients

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20185057 ◽

2018 ◽

Vol 5 (1) ◽

pp. 27

Author(s):

Sandeep Krishna Avulapati ◽

Senthil Kumar Mahalingam ◽

T. Munirathnam ◽

Jagadeesh Gudaru ◽

Deepak Kaki

Keyword(s):

Mental Status ◽

Proximal Femur ◽

Femur Fracture ◽

Proximal Femur Fracture ◽

Mobility Patterns ◽

Mental Test Score ◽

Proximal Femur Fractures ◽

Femur Fractures ◽

Postoperative Mobility ◽

Abbreviated Mental Test

Background: 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.Methods: This is a retrospective study, carried out during the period of 14th March, 2016 to 14th 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.Results: 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.Conclusions: 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.

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Structural Parameters of Proximal Femur in Evaluation of Its Strength

N N Priorov Journal of Traumatology and Orthopedics ◽

10.32414/0869-8678-2014-1-77-81 ◽

2014 ◽

pp. 77-81

Author(s):

S. S. Rodionova ◽

A. N. Torgashin ◽

E. I. Solod ◽

N. S. Morozova ◽

A. K. Morozov ◽

...

Keyword(s):

Cross Section ◽

Proximal Femur ◽

Femur Fracture ◽

Structural Parameters ◽

Comparative Assessment ◽

Proximal Femur Fracture ◽

Bone Thickness ◽

Linear Discriminant ◽

Femur Fractures ◽

Axial Moment

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.

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Proximal femur fracture in older patients - rehabilitation and clinical outcome

Age and Ageing ◽

10.1093/ageing/32.1.74 ◽

2003 ◽

Vol 32 (1) ◽

pp. 74-80 ◽

Cited By ~ 48

Author(s):

F. Roder

Keyword(s):

Clinical Outcome ◽

Proximal Femur ◽

Older Patients ◽

Femur Fracture ◽

Proximal Femur Fracture

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Effect of music on clinical outcome after hip fracture operations (MCHOPIN): study protocol of a multicentre randomised controlled trial

BMJ Open ◽

10.1136/bmjopen-2021-049706 ◽

2021 ◽

Vol 11 (12) ◽

pp. e049706

Author(s):

Victor X Fu ◽

Johannes Jeekel ◽

Esther M M Van Lieshout ◽

Detlef Van der Velde ◽

Leonie J P Slegers ◽

...

Keyword(s):

Hip Fracture ◽

Postoperative Complications ◽

Length Of Stay ◽

Clinical Outcome ◽

Proximal Femur ◽

Postoperative Delirium ◽

Femur Fracture ◽

Proximal Femur Fracture ◽

Music Intervention ◽

Randomised Controlled

BackgroundPatients undergoing proximal femur fracture surgery are at high risk of postoperative complications, with postoperative delirium occurring in 25%–40% of patients. Delirium has profound effects on patient outcome and recovery, the patient’s family, caregivers and medical costs. Perioperative music has a beneficial effect on eliciting modifiable risk factors of delirium. Therefore, the aim of this trial was to evaluate the effect of perioperative recorded music on postoperative delirium in patients with proximal femur fracture undergoing surgery.Methods and analysisThe Music on Clinical Outcome after Hip Fracture Operations study is an investigator-initiated, multicentre, randomised controlled, open-label, clinical trial. Five hundred and eight patients with proximal femur fracture meeting eligibility criteria will be randomised to the music intervention or control group with concealed allocation in a 1:1 ratio, stratified by hospital site. The perioperative music intervention consists of preselected lists totalling 30 hours of music, allowing participants to choose their preferred music from these lists (classical, jazz and blues, pop and Dutch). The primary outcome measure is postoperative delirium rate. Secondary outcome measures include pain, anxiety, medication requirement, postoperative complications, hospital length of stay and 30-day mortality. A 90-day follow-up will be performed in order to assess nursing home length of stay, readmission rate and functional ability to perform daily living activities. Furthermore, the cost and cost-effectiveness of the music intervention will be assessed. Data will be analysed according to an intention-to-treat principle.Ethics and disseminationThe study protocol has been approved by the Medical Research Ethics Committee Erasmus MC on 8 October 2018 (MEC-2018–110, NL64721.078.18). The trial will be carried out following the Declaration of Helsinki principles, Good Clinical Practice guidelines and Dutch Medical Research Involving Human Subjects Act. Research data will be reported following Consolidated Standards of Reporting Trials guidelines and study results will be published in a peer-reviewed journal.Trial registration numberNTR7036.

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