Geriatric Orthopaedic Surgery & Rehabilitation最新文献

Background: To estimate 5-year mortality after major upper-extremity fractures in adults aged ≥65 years and to identify clinical and fracture-related factors associated with mortality.

Methods: We conducted a retrospective single-center study of adults aged ≥65 years who presented between 2014 and 2020 with a suspected major upper-extremity fracture. Fracture diagnoses were confirmed on archived radiographs and analyzed by index diagnosis and by anatomic region. Candidate factors included age, sex, comorbidity burden (age-adjusted Charlson Comorbidity Index [aCCI] categories), presence of concomitant fractures outside the upper extremity, injury mechanism (low- vs high-energy), upper-extremity fracture multiplicity, and treatment type (operative vs nonoperative). Five-year mortality was the primary outcome.

Results: A total of 1,240 patients were included (median age 73 years; 67.3% female) with a median follow-up of 6.0 years. Five-year mortality was 28.2% (95% CI 25.7-30.8). Mortality differed by fracture location, lowest after wrist-region fractures (especially distal radius) and highest after arm-region fractures (especially humeral shaft). Mortality increased with age and was higher in men. Concomitant fractures outside the upper extremity and greater comorbidity burden were associated with higher mortality, with a stepwise gradient across aCCI categories (2-3, 4-5, and ≥6). Injury mechanism, upper-extremity fracture multiplicity, and treatment type were not significantly associated with 5-year mortality.

Conclusions: In older adults with major upper-extremity fractures, long-term mortality is substantial and is most strongly associated with baseline vulnerability-especially comorbidity burden-the presence of concomitant fractures outside the upper extremity, and fracture location. Larger multicenter studies incorporating standardized frailty and functional measures are needed to confirm these associations and to inform care pathways for high-risk patients.

Introduction: Falls can be detrimental for older adults, causing hip fracture that result in disability and increased risk of mortality. This study aimed to investigate the temporal distribution of falls among the geriatric patients with hip fractures and compare the characteristics of falls occurring at different times and locations.

Methods: This cross-sectional study analyzed 801 older adults with hip fractures from falls. We collected data on fall timing (day vs night), location (indoor vs outdoor), and patient characteristics, including demographics, handgrip strength, BMI, and the Charlson Comorbidity Index (CCI). The primary analysis investigated the association between these clinical characteristics and the specific circumstances of the fall.

Results: This study encompassed 801 hip fracture patients, with 560 women (70%) and 241 men (30%), and a median age of 81 years. Among these patients, 546 (68.3%) experienced falls during the daytime, while 255 (31.7%) fell at night. Furthermore, 577 (74.9%) hip fractures occurred indoors, with 193 (25.1%) falls taking place outdoors. The analysis revealed that patients with lower handgrip strength and BMI were significantly more susceptible to nighttime falls compared to daytime falls. Furthermore, patients who fell indoors exhibited notably higher CCI scores, along with lower BMI, handgrip strength, and pre-fracture ADL, in comparison to those who fell outdoors.

Conclusions: Our findings indicate that falls during the daytime were more prevalent among geriatric hip fracture patients in Taiwan compared to nighttime falls. Moreover, we observed that more frail patients were relatively susceptible to falling indoors and at night, emphasizing the potential clinical value for clinicians to take proactive measures in fall prevention.

Aim: The aim of this study was to investigate whether or not spinopelvic parameters alone affect the mechanism of formation and type of hip fracture. A secondary aim was to examine the impact on the formation mechanism of many factors that have been previously determined in the epidemiology of hip fractures.

Material and method: The data of 200 patients who presented because of a hip fracture were retrospectively examined. The data included age, gender, body mass index, affected side and Singh Index (SI), and the measurements taken on radiographs of pelvic incidence, pelvic tilt, sacral slope, and lumbar lordosis values. The hip fractures were categorised into two groups: femoral neck and pertrochanteric.

Results: The 100 patients in Group 1 (femoral neck) comprised 64 females and 36 males with a mean age of 75.4 ± 10.9 years, and the 100 patients in Group 2 (pertrochanteric) comprised 70 females and 30 males with a mean age of 77.6 ± 11.1 years. In Group 1, the mean values measured were pelvic incidence: 49.9 ± 11.6, pelvic tilt: 12.25 ± 7.68, sacral slope: 37.7 ± 10.1, and lumbar lordosis: 49.6 ± 13.2. In Group 2, these values were pelvic incidence: 57.2 ± 14.2, pelvic tilt: 15.62 ± 9.72, sacral slope: 41.6 ± 11.5, and lumbar lordosis: 55 ± 14.5. These values were statistically significantly higher in the pertrochanteric group than in the femoral neck group (P < 0.05).

Conclusion: This study demonstrated that pelvic incidence and related spinopelvic parameters are associated with hip fracture morphology. Patients with pertrochanteric fractures had significantly higher pelvic parameter values compared with those with femoral neck fractures, suggesting that increased pelvic incidence may predispose to pertrochanteric fractures.

Background: Dementia is widely recognized as a factor that influences the outcomes of total knee arthroplasty (TKA). However, recent studies have not fully elucidated the effects of dementia on perioperative medical and surgical complications, as well as in-hospital resource utilization. The objective of this study is to evaluate the specific impact of dementia on perioperative outcomes in elderly patients undergoing TKA.

Methods: Data on elderly patients undergoing TKA were extracted from the National Inpatient Sample database (2010-2019). Patients were categorized into a dementia group and a non-dementia group. Propensity score matching (PSM) was employed to control for differences in demographics, hospital characteristics, and comorbidities. Multivariate logistic regressions were conducted to evaluate perioperative outcomes.

Results: From 2010 to 2019, a group of 344,200 patients undergoing TKA was identified, among whom 6761 individuals (2.0%) were diagnosed with dementia. Following PSM, dementia remained an independent predictor for several perioperative outcomes, including urinary tract infection (aOR = 2.001, 95%CI = 1.561-2.564, P < 0.0001), pneumonia (aOR = 2.043, 95%CI = 1.244-3.355, P = 0.005), postoperative delirium (aOR = 5.854, 95%CI = 4.418-7.758, P < 0.0001), acute hemorrhagic anemia (aOR = 1.229, 95%CI = 1.128-1.340, P < 0.0001), prolonged hospital stay (aOR = 1.966, 95%CI = 1.785-2.165, P < 0.0001), and increased total healthcare charges (aOR = 1.122, 95%CI = 1.037-1.215, P = 0.004).

Conclusion: Dementia is independently associated with an increased risk of perioperative complications after TKA, underscoring the importance of tailored perioperative care for elderly patients with dementia.

Background: Femoral neck fractures are a significant source of morbidity and mortality in older adults. This study compared demographics, outcomes and complications between the following treatment options: Open Reduction and Internal Fixation (ORIF), Total Hip Arthroplasty (THA) and Hemiarthroplasty (HA).

Methods: This was a population-based study using the Centers for Medicare & Medicaid Services dataset from 2017-2021. A total of 67,759 isolated hip fracture patients were analyzed. Multivariate regression analyses adjustmented for age, comorbidities and hospital volume. Outcomes were compared using odds ratios (OR) with 95% confidence intervals (CI).

Results: ORIF patients were the oldest (36.7% aged 85+), while THA patients were younger (18.6% aged 65-69). Females predominated for overall fracture incidence (66.9%-81.8%). HA patients had significantly higher risks of discharge mortality OR = 1.51 (95% CI 1.24, 1.83), deep venous thrombosis OR = 1.31 (95% CI 1.07, 1.60), cardiac arrest OR = 1.85 (95% CI 1.33, 2.57), pulmonary embolism OR = 1.76 (95% CI 1.38, 2.36), acute kidney injury OR = 1.32 (95% CI 1.24, 1.40) and overall infection compared to ORIF. THA and HA patients were associated with lower odds of rehab discharge (OR = 0.65 and OR = 0.90, respectively). THA was linked to shorter hospital stays (4.3 days) but an increased pulmonary embolism risk OR = 2.39 (95% CI 1.17, 4.88).

Conclusions: For femoral neck fractures, ORIF had the lowest complication rates. Hemiarthroplasty posed the highest complication risks, including mortality and thromboembolic events. THA appeared better suited for healthier individuals, with shorter hospital stays but higher rates of pulmonary embolism. Complication profiles vary significantly across fixation methods for femoral neck fractures. Individualized surgical planning is essential to balance risks and optimize outcomes for femoral neck fracture patients. There may be an opportunity to more carefully scrutinize surgical decision making for femoral neck fractures that would otherwise be treated with either ORIF or HA.

Background: Total hip arthroplasty (THA) significantly improves the quality of life of patients with end-stage osteoarthritis. Dementia, which is prevalent in geriatric THA recipients, is correlated with several adverse outcomes. This study further investigated the impact of dementia on perioperative outcomes (complications, mortality, skilled nursing facilities [SNFs] transfer, total cost, and length of hospital stay [LOS]) in geriatric patients undergoing elective THA.

Methods: This study retrospectively analysed data from patients aged 65 years and older who underwent elective THA in the Nationwide inpatient sample (NIS) database from 2010 to 2019. Propensity score matching (PSM) was applied to reduce potential selection bias arising from differences in demographic and comorbidity factors. The Wilcoxon rank test (for continuous data) and Chi‒square test (for categorical data) were used to assess demographic characteristics, comorbidities, LOS, total hospital costs, and in-hospital mortality; logistic regression analysis was employed to determine the influence of dementia on adverse outcomes.

Results: 376 323 elective geriatric THA patient samples from the NIS database were included, with an overall dementia prevalence of 2.05%. Adverse outcomes following elective THA in patients with dementia included deep vein thrombosis, acute myocardial infarction, acute anaemia, cardiac arrest, urinary retention, urinary tract infection, acute renal failure, pneumonia, respiratory failure, invasive mechanical ventilation, postoperative delirium, gastrointestinal bleeding, mechanical loosening, broken internal joint prosthesis, dislocation, other prosthesis-related complications, wound rupture/unhealed, transfusion, prolonged LOS, increased total cost, and discharge to SNFs.

Conclusion: In elective geriatric THA patients, dementia is independently associated with significantly higher risks of perioperative complications and greater healthcare resource utilization, underscoring the need for enhanced perioperative monitoring and multidisciplinary care for this vulnerable group.

Objective: This study aimed to evaluate the efficacy of visual health education (VHE) intervention in the perioperative management of older adults undergoing percutaneous kyphoplasty (PKP) for osteoporotic vertebral fractures (OVFs).

Methods: A prospective cohort of 96 patients (aged ≥65 years) scheduled for primary PKP between June 2024 and January 2025 were enrolled. Participants were allocated to a control group (n = 46) receiving conventional verbal education or an intervention group (n = 50) receiving VHE via instructional videos. The VHE program encompassed disease-specific knowledge, surgical procedures, and postoperative rehabilitation. Outcome measures included sleep quality (PSQI), anxiety (SAS), blood pressure stability, patient satisfaction, and anti-osteoporosis medication adherence.

Results: The VHE group demonstrated significant improvements across all perioperative metrics compared to controls. Preoperative sleep quality was superior (PSQI: 7.85 ± 2.16 vs 15.63 ± 3.62, P < 0.001), anxiety levels were lower (SAS: 30.62 ± 3.48 vs 55.68 ± 3.95, P < 0.001), and patient satisfaction at discharge was higher (100% vs 95.7%, P < 0.001). The intervention group also exhibited better medication adherence at 6-month follow-up (76% vs 28.3%, P < 0.001) and more stable preoperative blood pressure (systolic BP: 152.8 ± 5.9 vs 178.4 ± 7.1 mmHg, P < 0.001).

Conclusion: Disease-specific visual health education significantly enhances perioperative experiences, improves psychological well-being, stabilizes physiological parameters, and promotes long-term treatment adherence in older OVF patients undergoing PKP. This approach represents a valuable adjunct to standard perioperative care, with the potential to reduce complications and improve overall clinical outcomes.

Introduction: Bisphosphonate medications reduce the risk of osteoporotic fragility fractures; however, prolonged use increases the risk of atypical femur fractures (AFF). As the population ages and the burden of osteoporosis rises, the relative incidence of AFFs is expected to grow. Current expert guidelines recommend discontinuing bisphosphonates and initiating alternative anti-fracture therapies (AFT), such as denosumab, teriparatide, or raloxifene, following an AFF to support skeletal health and reduce future fracture risk. However, it is unclear which patients receive these medications after an AFF. This study aims to identify demographics associated with the initiation of alternate osteoporosis therapies following an AFF.

Methods: We conducted a retrospective cohort study using data from the TriNetX Registry to identify patients who were on bisphosphonate therapy that had an AFF. The primary outcome was initiation of teriparatide, denosumab, or raloxifene within one year after AFF. We compared patient demographics and baseline characteristics between those initiated on AFT after an AFF and those who were not. Pairwise comparisons of proportions were performed between the groups using two-proportion Z-tests with Bonferroni correction to account for multiple comparisons.

Results: We identified 784 patients with AFFs following bisphosphonate use. 71 patients (9.5%) were initiated on AFT following the index fracture. Teriparatide (83.1%) was the most commonly prescribed AFT, followed by denosumab (21.9%), then raloxifene (≤14.1%). Patients initiated on AFT were more likely to have a previous fragility fracture (66.2% vs 45.2%, P < 0.001). Other patient demographics assessed did not show any significant differences.

Discussion and conclusion: Despite expert recommendations, AFT was initiated in only a small percentage of patients following AFFs. These findings highlight a significant care gap in secondary fracture prevention and underscore the need for a multidisciplinary approach, including coordination between endocrinology, orthopaedics, and primary care, to improve adherence to post-fracture osteoporosis management guidelines.

Purpose: Fracture Liaison Services (FLS) have been developed as a coordinated, multidisciplinary programs designed to improve the identification and management of patients with fragility fractures, including hip fractures. This study aims to evaluate the impact of coordinator based FLS on medical treatment compliance and mortality in patients following hip fracture. Specifically, it seeks to evaluate the impact of routine follow-up post discharge on these outcomes.

Methods: Comparative retrospective cohort of following hip fracture patients for one year after surgery. First group with the complete FLS treatment and protocol and second group with partial FLS protocol without the routine clinical follow-up after discharge. Main clinical outcomes were osteoporosis medication compliance and morality rates.

Results: 347 participants, 182 (52.4%) without a coordinator follow-up and 165 (47.6%) with a coordinator follow-up. Patients with coordinator follow-up had better medication compliance 1 year following hip fracture (77% vs 39%). First year mortality rate was 11% and 13% accordingly without statistical significance.

Conclusion: This study found that patients in an FLS with coordinator follow-up had better clinical outcomes, receiving more timely medication recommendations and showing higher treatment adherence, highlighting the value of coordinated follow-up in long-term care.