scholarly journals Medial Calcar Comminution and Intramedullary Nail Failure in Unstable Geriatric Trochanteric Hip Fractures

Medicina ◽  
2021 ◽  
Vol 57 (4) ◽  
pp. 338
Author(s):  
Seth M. Tarrant ◽  
David Graan ◽  
Drew J. Tarrant ◽  
Raymond G. Kim ◽  
Zsolt J. Balogh
Keyword(s):  
Multivariate Analysis ◽  
Hip Fractures ◽  
Health Resources ◽  
Fracture Morphology ◽  
Trauma Centre ◽  
Short Version ◽  
Trochanteric Fractures ◽  
Technical Factors ◽  
Definition Of ◽  
Fracture Stability

Background and Objectives: An increasing global burden of geriatric hip fractures is anticipated. The appropriate treatment for fractures is of ongoing interest and becoming more relevant with an aging population and finite health resources. Trochanteric fractures constitute approximately half of all hip fractures with the medial calcar critical to fracture stability. In the management of unstable trochanteric fractures, it is assumed that intramedullary nails and longer implants will lead to less failure. However, the lack of power, inclusion of older generation femoral nails, and a variable definition of stability complicate interpretation of the literature. Materials and Methods: Between January 2012 and December 2017, a retrospective analysis of operatively treated geriatric trochanteric hip fracture patients were examined at a Level 1 Trauma Centre. The treatment was with a long and short version of one type of trochanteric nail. Unstable trochanteric fractures with medial calcar comminution were examined (AO31A2.3, 2.3 & 3.3). The length of the medial calcar loss, nail length, demographics, fracture morphology, and relevant technical factors were examined in univariate and multivariate analysis using competing risk regression analysis. The primary outcome was failure of fixation with post-operative death the competing event and powered to previously reported failure rates. Results: Unstable patterns with medial calcar comminution loss constituted 617 (56%) of operatively treated trochanteric fractures. Failure occurred in 16 (2.6%) at a median post-operative time of 111 days (40–413). In univariate and multivariate analysis, only younger age was a significant predictor of failure (years; SHR: 0.91, CI 95%: 0.86–0.96, p < 0.001). Nail length, medial calcar loss, varus reduction, and other technical factors did not influence nail failure. Conclusions: In a cohort of unstable geriatric trochanteric hip fractures with medial calcar insufficiency, only younger patient age was predictive of nail failure. Neither the length of the medial calcar fragment or nail was predictive of failure.

scholarly journals Hip fractures among the elderly in Kyoto, Japan: a 10-year study

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Maki Asada ◽  
Motoyuki Horii ◽  
Kazuya Ikoma ◽  
Tsuyoshi Goto ◽  
Naoki Okubo ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Femoral Neck ◽  
Incidence Rate ◽  
Acute Care ◽  
Hip Fractures ◽  
Age Groups ◽  
The Elderly ◽  
Femoral Neck Fractures ◽  
Age Group ◽  
Trochanteric Fractures

Abstract Summary In Kyoto Prefecture, Japan, the number of hip fractures increased during 2013–2017 compared to 2008–2012. However, the estimated overall incidence rate increased only in femoral neck fractures in men aged ≥75 and women aged ≥85. Purpose The incidence rate of hip fractures in Japan has plateaued or decreased. We investigated the annual hip fracture occurrences in Kyoto Prefecture, Japan, from 2008 to 2017. Methods Patients aged 65 years and above who sustained hip fractures between 2008 and 2017 and were treated at one of the participating 11 hospitals were included. The total number of beds in these institutions was 3701, accounting for 21.5% of the 17,242 acute-care beds in Kyoto Prefecture. The change in incidence rate was estimated utilizing the population according to the national census conducted in 2010 and 2015. Results The total number of hip fractures was 10,060, with 47.5% femoral neck fractures and 52.5% trochanteric fractures. A decrease in number was seen only in trochanteric fractures in the group of 75- to 84-year-old women. The population-adjusted numbers of femoral neck fractures showed a significant increase in all age groups in men, whereas in women, there was an increase in femoral neck fractures in the ≥85 group and trochanteric fractures in the age group 65–74, and a decrease in trochanteric fractures in the age group 75–84. The estimated change in incidence rate showed an increase in femoral neck fractures in men aged ≥75 and women aged ≥85. Conclusion In Kyoto Prefecture, the number of hip fractures increased in the second half of the study period (2013–2017) compared to the first half (2008–2012). However, the incidence rate had not increased, except in femoral neck fractures in men aged ≥75 and women aged ≥85.

scholarly journals Redefining lumbar spinal stenosis as a developmental syndrome: an MRI-based multivariate analysis of findings in 709 patients throughout the 16- to 82-year age spectrum

2018 ◽  
Vol 29 (6) ◽  
pp. 654-660 ◽  
Author(s):  
Sameer Kitab ◽  
Bryan S. Lee ◽  
Edward C. Benzel
Keyword(s):  
Multivariate Analysis ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Structural Changes ◽  
Age Cohorts ◽  
Age Related ◽  
Management Approaches ◽  
Definition Of ◽  
Lumbar Spinal ◽  
Lower Lumbar

OBJECTIVEUsing an imaging-based prospective comparative study of 709 eligible patients that was designed to assess lumbar spinal stenosis (LSS) in the ages between 16 and 82 years, the authors aimed to determine whether they could formulate radiological structural differences between the developmental and degenerative types of LSS.METHODSMRI structural changes were prospectively reviewed from 2 age cohorts of patients: those who presented clinically before the age of 60 years and those who presented at 60 years or older. Categorical degeneration variables at L1–S1 segments were compared. A multivariate comparative analysis of global radiographic degenerative variables and spinal dimensions was conducted in both cohorts. The age at presentation was correlated as a covariable.RESULTSA multivariate analysis demonstrated no significant between-groups differences in spinal canal dimensions and stenosis grades in any segments after age was adjusted for. There were no significant variances between the 2 cohorts in global degenerative variables, except at the L4–5 and L5–S1 segments, but with only small effect sizes. Age-related degeneration was found in the upper lumbar segments (L1–4) more than the lower lumbar segments (L4–S1). These findings challenge the notion that stenosis at L4–5 and L5–S1 is mainly associated with degenerative LSS.CONCLUSIONSIntegration of all the morphometric and qualitative characteristics of the 2 LSS cohorts provides evidence for a developmental background for LSS. Based on these findings the authors propose the concept of LSS as a developmental syndrome with superimposed degenerative changes. Further studies can be conducted to clarify the clinical definition of LSS and appropriate management approaches.

Fracture morphology of AO/OTA 31-A trochanteric fractures: A 3D CT study with an emphasis on coronal fragments

Injury ◽  
2017 ◽  
Vol 48 (2) ◽  
pp. 277-284 ◽  
Author(s):  
Jae-Woo Cho ◽  
William T. Kent ◽  
Yong-Cheol Yoon ◽  
Youngwoo Kim ◽  
Hyungon Kim ◽  
...  
Keyword(s):  
Fracture Morphology ◽  
3D Ct ◽  
Trochanteric Fractures

Influence of Fracture Stability on Early Patient Mortality and Reoperation After Pertrochanteric and Intertrochanteric Hip Fractures

2015 ◽  
Vol 29 (12) ◽  
pp. 538-543 ◽  
Author(s):  
Mellick J. Chehade ◽  
Tania Carbone ◽  
Danny Awward ◽  
Anita Taylor ◽  
Corinna Wildenauer ◽  
...  
Keyword(s):  
Hip Fractures ◽  
Fracture Stability

Blood loss in trochanteric fractures: multivariate analysis comparing dynamic hip screw and Gamma nail

Injury ◽  
2017 ◽  
Vol 48 ◽  
pp. S44-S47 ◽  
Author(s):  
Mario Ronga ◽  
Daniele Bonzini ◽  
Marco Valoroso ◽  
Giuseppe La Barbera ◽  
Jacopo Tamini ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Blood Loss ◽  
Gamma Nail ◽  
Dynamic Hip Screw ◽  
Trochanteric Fractures ◽  
Hip Screw

scholarly journals Difficulties in Establishing “Truth” Conditions in the Assessment of Addictive Smartphone Use in Young Adults

2021 ◽  
Vol 19 (1) ◽  
pp. 358
Author(s):  
Javier García-Manglano ◽  
Claudia López-Madrigal ◽  
Charo Sádaba-Chalezquer ◽  
Cecilia Serrano ◽  
Olatz Lopez-Fernandez
Keyword(s):  
Assessment Tools ◽  
Smartphone Addiction ◽  
Short Version ◽  
Behavioral Addictions ◽  
Negative Consequences ◽  
Truth Conditions ◽  
Spanish Speaking ◽  
Scale Range ◽  
Smartphone Use ◽  
Definition Of

The smartphone revolution has placed powerful, multipurpose devices in the hands of youth across the globe, prompting worries about the potential negative consequences of these technologies on mental health. Many assessment tools have been created, seeking to classify individuals into problematic and non-problematic smartphone users. These are identified using a cutoff value: a threshold, within the scale range, at which higher scores are expected to be associated with negative outcomes. Lacking a clinical assessment of individuals, the establishment of this threshold is challenging. We illustrate this difficulty by calculating cutoff values for the Short Version of the Smartphone Addiction Scale (SAS-SV) in 13 Spanish-speaking samples in 11 countries, using common procedures (i.e., reliability, validity, ROC methodology). After showing that results can be very heterogeneous (i.e., they lead to diverse cutoff points and rates of addiction) depending on the decisions made by the researchers, we call for caution in the use of these classifications, particularly when researchers lack a clinical definition of true addiction—as is the case with most available scales in the field of behavioral addictions—which can cause an unnecessary public health alert.

scholarly journals Determination and optimization of ideal patient candidacy for anterior odontoid screw fixation

2021 ◽  
Vol 12 ◽  
pp. 170
Author(s):  
Brian Fiani ◽  
Thao Doan ◽  
Claudia Covarrubias ◽  
Jennifer Shields ◽  
Manraj Sekhon ◽  
...  
Keyword(s):  
Screw Fixation ◽  
Odontoid Process ◽  
Soft Tissue Injuries ◽  
Patient Characteristics ◽  
Fracture Morphology ◽  
Bibliographic Databases ◽  
Spinal Stabilization ◽  
Odontoid Fractures ◽  
Fracture Stability ◽  
Final Selection

Background: Odontoid process fractures are one of the most common spine fractures, especially in patients over age 70. There is still much controversy over the ideal candidate for anterior odontoid screw fixation (AOSF), with outcomes affected by characteristics such as fracture morphology, nonideal body habitus, and osteoporosis. Therefore, this systematic review seeks to discuss the optimal criteria, indications, and adverse postoperative considerations when deciding to pursue AOSF. Methods: This investigation was conducted from experiential recall and article selection performed using the PubMed electronic bibliographic databases. The search yielded 124 articles that were assessed and filtered for relevance. Following the screening of titles and abstracts, 48 articles were deemed significant for final selection. Results: AOSF is often utilized to treat Type IIB odontoid fractures, which has been shown to preserve atlantoaxial motion, limit soft-tissue injuries/blood loss/vertebral artery injury/reduce operative time, provide adequate osteosynthesis, incur immediate spinal stabilization, and allow motion preservation of C1 and C2. However, this technique is limited by patient characteristics such as fracture morphology, transverse ligament rupture, remote injuries, short neck or inability to extend neck, barrel chested, and severe spinal kyphosis, in addition to adverse postoperative outcomes such as dysphagia and vocal cord paralysis. Conclusion: Due to the fact that odontoid fractures have a significant morbidity in elderly population, treatment with AOSF is generally recommended for this population with higher risk for nonoperative fusion. Considerations should be made to achieve fracture stability and fusion, while lowering the risk for operative and postoperative complications.

scholarly journals Tight versus standard blood pressure control on the incidence of myocardial infarction and stroke: An observational retrospective cohort study in the general ambulatory setting

2020 ◽  
Author(s):  
Bumsoo Park ◽  
Katarzyna Budzynska ◽  
Nada Almasri ◽  
Sumaiya Islam ◽  
Fanar Alyas ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Blood Pressure ◽  
Multivariate Analysis ◽  
Heart Association ◽  
Pressure Control ◽  
Ambulatory Setting ◽  
Stroke Incidence ◽  
Independent Risk Factors ◽  
Definition Of

Abstract Background: The 2017 American College of Cardiology and American Heart Association guideline defined hypertension as blood pressure (BP) ≥ 130/80 mmHg compared to the traditional definition of ≥ 140/90 mmHg. This change raised much controversy. We conducted this study to evaluate incidences of myocardial infarction (MI) and stroke comparing tight (TBPC) and standard BP control (SBPC). Methods: The data were collected and analyzed in 2018. We retrospectively identified hypertensive patients for 1 year at our institution who were classified by BP rate across 3 years into 2 groups of TBPC (< 130 mmHg) and SBPC (130-139 mmHg). We compared the incidence of new MI and stroke between the 2 groups across a 2-year follow-up. Multivariate analysis was done to identify independent risk factors. Results: Of 5640 study patients, the TBPC group showed significantly less incidence of stroke compared to the SBPC group. No differences were found in MI incidence between the 2 groups. Multivariate analysis showed that increased age independently increased the incidence of both MI and stroke, and TBPC independently decreased the incidence of stroke but not of MI. Conclusions: Our observational study suggests that TBPC may be beneficial in less stroke incidence compared to SBPC but it didn’t seem to affect the incidence of MI. Our study is limited by its retrospective design with potential confounders.

scholarly journals Predictors of in-hospital mortality post hip fracture in Ireland 2013-2017

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
H Ferris ◽  
L Brent ◽  
J Martin ◽  
P Crowley ◽  
T Coughlan
Keyword(s):  
Multivariate Analysis ◽  
Hip Fracture ◽  
Hospital Mortality ◽  
Hip Fractures ◽  
Best Practice ◽  
Secondary Analysis ◽  
Specific Reference ◽  
Ageing Population ◽  
The Republic ◽  
Organisational Factors

Abstract Background Hip fractures are associated with considerable mortality, morbidity and healthcare expenditure. There are approximately 3,500 hip fractures in Ireland per annum with this figure set to increase considerably over the coming years due to the ageing population. Internationally, mortality following hip fracture is approximately 10% at 1 month and 30% at 1 year, with less than half of survivors regaining their preoperative level of function. The authors aimed to identify the determinants of in-hospital mortality post hip fracture in the Republic of Ireland 2013-2017, with specific reference to the Irish Hip Fracture Standards. Methods A secondary analysis of 15,603 patients in the Irish hip fracture database was conducted. Results 31% (n = 4,769) were male and 69% (n = 10,807) were female. Mean age for males was 75 years (SD 13.5) and 79 years for females (SD 10.5). The largest proportion of hip fractures occurred in the 80-89 age category, with 72.3% (n = 4,600) of these being female. Median in-hospital mortality was 4.7% (n = 711) (Range 2.7-6.2). Univariate logistic regression revealed 11 statistically significant predictors of in-hospital mortality; however, only 4 remained statistically significant on multivariate analysis [mobilised day of/after surgery (OR 1.46, 95% CI 1.25-1.70, p &lt; 0.000), pre-fracture mobility (OR 0.84, 95% CI 0.79-0.89, p &lt; 0.000), gender (OR 0.56, 95% CI 0.41-0.76, p &lt; 0.000) and age (OR 1.05, 95% CI 1.03-1.06, p &lt; 0.000)]. Conclusions Older males with poor pre-fracture mobility who were not mobilised the day of/after surgery had the highest risk of in-hospital mortality. The ability to be mobilised on the day of/after surgery is a good composite measure of both patient and organisational factors in hip fracture care. This research supports the inclusion of mobilisation on the day of/after surgery as a new formal best practice standard. Key messages Patients not mobilised on the day of/after surgery are 46% more likely to die in hospital. In-hospital mortality of 4.7% in Ireland is comparable internationally. None of the IHFSs significantly influenced in-hospital mortality after multivariate analysis, but may well affect other outcomes such as ability to return home.

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