Geriatric Orthopaedic Surgery & Rehabilitation最新文献

Background: Fragility hip fracture patients are often malnourished. Nutrition supplementation may help, but it is unclear if supplementation is impactful when considering outcomes. A systematic review of literature examining perioperative nutrition status for older adults experiencing a hip fracture was performed.

Methods: We searched Medline, CAB Abstracts and Embase (Ovid); Cochrane Library (Wiley); PubMed; Scopus; Global Index Medicus; Web of Science Core Collection; SPORTDiscus (EBSCO); and clinical trial registries ClinicalTrials.gov and WHO ICTRP from inception to April 2021, incorporating terminology related to nutritional interventions, fragility fractures, and postoperative outcomes. Two investigators reviewed citations for inclusion, extracted nutrition intervention criteria, and categorized hip fragility outcomes.

Results: Of 1792 citations, 90 articles underwent full-text screening, and 14 articles were included in the final sample. We identified nutritional interventions and 4 outcomes of interest. 8 studies (n = 649) demonstrated a mean difference of .78 days (CI .34-1.21) in length of stay (LOS) between the nutritional intervention and control groups. Rehabilitation ward stays were discussed in 2 studies demonstrating a non-statistically significant difference. 7 studies (n = 341) reported mortality rates; when pooled there was no statistically significant difference. 5 studies showed data for postoperative infections and 4 studies reported on postoperative urinary tract infections. Pooling of data found a statistically significant result (Relative Risk: .49 [.32, .75], P = .001) with low heterogeneity (I² = 27%). 4 studies reported urinary tract infections (n = 140) in the intervention group and (n = 121) in the control group with a non-statistically significant result. Grip strength was only reported in two studies but pooling of the data was non-statistically significant.

Conclusions: This systematic review highlighted the lack of consensus regarding the type of nutrition interventions available and impact on outcomes of interest including mortality, length of stay, infections, and grip strength for fragility hip fractures in older adults.

Introduction: Osteoporosis can affect the surgical outcomes of proximal humeral fractures in older people. Recently, the cortical bone thickness of the proximal humerus on plain radiograph has been proposed to reflect local osteoporosis of the proximal humerus; however, its effect on the surgical outcome of proximal humeral fractures remains unclear. The purpose of this study is to investigate the influence of cortical bone thickness on postoperative radiographic outcomes after osteosynthesis for proximal humeral fractures.

Materials and methods: We retrospectively identified 190 patients (≥50 years) who underwent osteosynthesis with an intramedullary nail or plate for proximal humeral fractures. The patients were categorized into 2 groups according to the cut-off value of an average proximal humerus cortical bone thickness of 6 mm on plain radiographs: patients with and without local osteoporosis. After propensity score matching, we compared the incidence of postoperative radiographic complications between the 2 groups. We also performed subgroup analyses of outcomes in a subgroup of patients who underwent intramedullary nailing and those who underwent plate fixation.

Results: Propensity score matching yielded 60 patients in each group. No significant difference in complication rates was observed between the 2 groups. However, in the intramedullary nailing subgroup, the incidence of reduction loss was significantly higher in patients with local osteoporosis than in those without local osteoporosis (51.7% vs 14.3%, P = .002).

Discussion: The proximal humeral cortical bone thickness had no significant effect on the overall radiographic outcome; however, reduction loss after intramedullary nailing was susceptible to local osteoporosis of the proximal humerus.

Conclusion: Our study suggests that plate fixation is advantageous in preventing postoperative reduction loss in patients with lower cortical bone thickness.

Background: Geriatric hip fractures are strongly correlated with increased morbidity. Even so, postoperative outcomes following surgical repair of hip fractures for patients with end stage renal disease lack extensive investigation. Chronic kidney disease (CKD) poses unique risks for surgical procedures as it has been associated with several complications. Little information is available regarding the outcomes of patients whose renal function decline necessitates dialysis usage. The purpose of this study was to compare post-surgical outcomes based on dialysis usage among CKD patients requiring hip fracture repair.

Materials and methods: We used the PearlDiver database to identify hip fracture repair patients diagnosed with stages 3, 4, and 5 CKD. We matched the populations according to patient characteristics and comorbidities. We then compared patient complication rates among dialyzed and non-dialyzed CKD patients following hip fracture repair at 30 days, 90 days, and 1 year following the procedure.

Results: Dialyzed patients were more likely to experience myocardial infarction within 30 days (P = .02) and 90 days (P = .002). Dialyzed patients suffered cardiac arrest at higher rates within the same time intervals (P = .02; P = .002). Furthermore, dialysis patients developed sepsis (P = .005) and pneumonia (P = .005) at higher rates within 30 days of operation. Dialysis patients did not have increased risk of blood transfusion within 30 days of the operation (P = .07).

Discussion: We found significant increases in myocardial infarction, cardiac arrest, pneumonia, and sepsis risk among dialyzed CKD patients. Blood transfusion risk failed to reach statistical significance. Our findings are consistent with previous research regarding CKD pathophysiology and associated perioperative outcomes.

Conclusion: Given the drastic decline of renal function among patients on dialysis, our findings may be attributable to decreased glomerular filtration rate in CKD as well as dialysis itself. Regardless, multidisciplinary collaboration should be employed when performing hip fracture repair on a patient who is actively undergoing hemodialysis.

Objective: To introduce the clinical features of and surgical techniques for a rare type of irreducible pertrochanteric femur fracture pattern with bisection of the lesser trochanter.

Methods: From January 2017 to December 2019, 357 patients with per/intertrochanteric femur fractures underwent surgery by closed reduction and internal fixation, of whom 12 patients were identified with rare preoperative imaging features, the lesser trochanter was almost equally bisected. The main fracture pathoanatomy of these cases included: The anterior fracture line passed along the intertrochanteric line to the medial lesser trochanter and bisected it into 2 equal parts from mid-level of the lesser trochanteric protrusion. The proximal part of the lesser trochanter connected to the head-neck fragment and attached by the psoas major tendon, while the distal part of the lesser trochanter connected to the femoral shaft and attached by the tendon of the iliac muscle. These fractures were irreducible by a closed maneuver and were reduced with limited assistance by some devices, and short intramedullary nails were used for fixation of these fractures.

Results: All patients were followed up for an average of 14.2 ± 2.1 months. Clinical fracture union occurred at an average of 10.8 ± 1.5 weeks, while radiographic union occurred at an average of 12.7 ± 1.2 weeks. No cut out of the helical blade was visible on radiographs. The average Parker-Palmer score was 6.9 ± 1.3 (range, 5-9) at the last follow up, including 8 cases rated as excellent, 2 as good and 2 as fair.

Conclusion: Two-part pertrochanteric femur fractures with bisection of the lesser trochanter have an irreducible fracture pattern with cortical locking and soft tissue incarceration. Soft tissue release and short cephalomedullary nail fixation for this fracture pattern provide stable fixation and allow early exercise. This treatment appears to have excellent outcomes in the short and medium terms.

Introduction: Sarcopenia is a prevalent risk factor for falls and fractures, and it affects the physical function and mortality of older people. The present study was performed to assess the prevalence of sarcopenia in patients who underwent rehabilitation after hip fracture surgery and to examine the association of sarcopenia with physical and cognitive function outcomes.

Methods: This case-control study involved 132 patients who were admitted to a convalescent rehabilitation ward at a single hospital after surgical treatment of hip fractures from April 2018 to March 2020. The skeletal muscle mass index was examined using whole-body dual-energy X-ray absorptiometry. The Asian Working Group for Sarcopenia 2019 diagnostic criteria were applied on admission. We compared the walking speed, Mini-Mental State Examination (MMSE) score, and Functional Independence Measure (FIM) score between the sarcopenia group and non-sarcopenia group on admission and on discharge.

Results: The prevalence of sarcopenia was 59.8%. In the non-sarcopenia group, the walking speed, MMSE score, FIM total score, FIM motor score, and FIM cognitive score were significantly lower on admission than those on discharge (P < .05). In the sarcopenia group, the walking speed, MMSE score, FIM total score, and FIM motor score were significantly lower on admission than those on discharge (P < .05); there was no significant difference in the FIM cognitive score between admission and discharge. On both admission and discharge, the MMSE score, FIM total score, FIM motor score, and FIM cognitive score were significantly better in the non-sarcopenia group than those in the sarcopenia group.

Conclusions: After postoperative rehabilitation of hip fractures in patients with and without sarcopenia, physical and cognitive function outcomes on discharge were significantly better than those on admission. Patients with sarcopenia had significantly worse physical and cognitive function outcomes than patients without sarcopenia both on admission and on discharge.

Introduction: Certain titanium alloy stems have been shown to be susceptible to failure at the neck with catastrophic trunnion failure. Failure has been particularly noted in the single wedge Accolade 1 stem design. Other stems also used this alloy including the anatomic designed Citation stem.

Methods: This case series details 3 catastrophic failures of the TMZF version of the Citation femoral stem.

Results: Each of these failures appear to be attributed to cyclical wear of the TMZF trunnion against the cobalt chromium femoral head. Wear resulted in ultimate implant failure and significant metal debris in the joint capsule at the time of revision surgery.

Discussion: While surgeons are aware of the risk of catastrophic failure for the Accolade 1 stem, failure may similarly happen in the TMZF Citation stem. Surgeons should monitor these implants with care and discuss the potential for trunnion failure with their patients.

Aims: To explore clinical characteristics, perioperative management and outcomes of Hip Fracture patients with advanced Chronic Kidney Disease (HF-aCKD) compared to the general Hip Fracture population without aCKD (HF-G) within a large volume tertiary hospital in Western Australia.

Methods: Retrospective chart review of patients admitted with hip fracture (HF) to a single large volume tertiary hospital registered on Australian and New Zealand Hip Fracture Registry (ANZHFR). We compared baseline demographic and clinical frailty scale (CFS) of HF-aCKD (n = 74), defined as eGFR < 30 mls/min/1.73 m², with HF-G (n = 452) and determined their outcomes at 120 days.

Results: We identified 74 (6.97%) HF patients with aCKD. General demographics were similar in HF-aCKD and HF-G populations. 120-days mortality for HF-aCKD was double that of HF-G population (34% vs 17%, P = .001). For dialysis patients, 120-days mortality was triple that of HF-G population (57%). Except for the fit category of HF-aCKD group, higher CFS was associated with higher 120-days mortality in both groups. Of all HF-aCKD patients, 96% had operative intervention and 48% received blood transfusion. There were no new starts to dialysis peri-operatively. Each point reduction in eGFR below 12 mL/min/1.73 m² was associated with 3% increased probability of death in hospital.

Conclusions: 120-days mortality was double in HF-aCKD and triple in HF-dialysis that of the HF-G within our institution. Clinical frailty scale can be useful in predicting mortality after HF in frail aCKD patients. High rate of blood transfusions was observed in HF-aCKD group. Further studies with larger HF-aCKD numbers are required to explore these associations in detail.

Introduction: Fragility fracture of the pelvis (FFP), generally involving Rommens and Hoffman classification type IVb (H-shaped) requires spinopelvic fixation (SPF). We report the clinical outcome of sacroiliac rod fixation (SIRF) for FFP type IVb in a case series.

Materials and methods: In this retrospective observational study, six patients (mean age, 80.3 years; range, 74-85 years) with FFP type IVb who underwent SIRF since October 2019 and could be followed up for ≥1 year postoperatively were included. All patients were injured in low-energy falls, a patient had a femoral neck fracture, and other had a humeral neck fracture and distal radius fracture.

Results: The mean (range) operative time was 135 (98-200) min, and mean blood loss was 103 (80-130) g. All patients achieved bone union in an average of 4.3 months. No implant failure or surgical site infection requiring reoperation occurred. No patient complained of iliac screw irritation or requested removal. One patient developed a T12 vertebral fracture at 3 weeks postoperatively. The mean final follow-up period was 17.8 months (13-22 months) and mean final modified Majeed Score (maximum 76 points as the items "work" and "sexual intercourse" were omitted for this study) was 71.7 (56-76).

Conclusions: SIRF is a less invasive surgical technique than SPF that uses only an S1 pedicle screw and iliac screw. SIRF using the "within ring" concept showed good clinical outcome in FFP type IVb.

Introduction: Hip fractures cause significant morbidity and mortality for geriatric patients, and incidence is increasing as the population ages. Following a primary hip fracture, up to 20% may suffer a contralateral hip fracture within 5 years despite fracture risk reduction measures, including fall prevention and osteoporosis pharmacologic treatment. The aim of this study is to assess whether insertion of the Femoral Neck System (Depuy Synthes, West Chester, PA) into the contralateral proximal femur may strengthen the bone and decrease the incidence of contralateral hip fractures.

Materials and methods: ScanIP, an image processing software was used to produce 3-dimensional models of a cadaver femur with the implanted device. Models were meshed and exported to Abaqus for finite element analysis to evaluate the device's ability to reduce stress in the proximal femur. Results were analyzed for element-wise volume and von-Mises stresses.

Results: The implant reduced peak stress and bone failure at all levels of bone quality. Specifically in osteoporotic bone, the implant decreased peak stress by 27%, proximal femur trabecular bone failure by 5% and cortical bone failure by 100% in the femoral neck.

Conclusions: Our results from computer generated finite element analyses indicate that the Femoral Neck System may strengthen an osteoporotic proximal femur in the event of a lateral fall. Further investigation with expanded finite element analysis and cadaveric biomechanical studies are needed to validate these results.