Geriatric Orthopaedic Surgery & Rehabilitation最新文献

Introduction: Hip fractures can be divided into intracapsular(ICF) and extracapsular(ECF) fractures. Preoperative pain management of hip fractures is important and complex. Fascia Iliaca Compartment Block(FICB) is proven effective in reducing pain. The effectiveness may vary depending on the location of the hip fracture, given the complex nerve innervation of the hip joint. To our knowledge, the difference in effect of pre-operative FICB across the various types of hip fractures has not yet been investigated. This study compared pre-operative pain management with FICB in ICF and ECF patients.

Methods: This retrospective, single center cohort study included patients(>50 years) with ICF or ECF and preoperative FICB. Numeric Rating Scale(NRS) scores at 2 time points after FICB were compared, adjusting for baseline NRS, potential confounding by prehospital opioid use and time interval between FICB and NRS-score. Also preoperative opioids use 24 hours after FICB was compared.

Results: 183 patients were included; 94 ICF and 89 ECF patients. Both groups had comparable demographics(age and gender) and baseline characteristics, except for pre-injury home opioid use, which was significantly higher in the ECF patient group. NRS score before FICB-administration was 4.610(SD1.634; ICF) and 4.870(SD1.746;ECF P = 0.302) and did not differ between groups. NRS scores decreased significantly after FICB, with no significant difference between the groups: ICF: 2.900(SD1.522) and 2.360(SD1.574) and ECF 2.920(SD1.817;P = 0.834) and 2.960(SD1.938;P = 0.093) for the first and second NRS scores after FICB respectively. There was no confounding or effect modification. Opioid use in the first 24hrs after FICB was not significantly different in both groups.

Conclusion: There was no statistically significant difference in preoperative pain relief provided by FICB in patients with intracapsular or extracapsular hip fractures. The FICB had great value as a regional pain block at the emergency department for both types of frail hip fracture patients.

Background: Hip fractures in older adults are associated with significant morbidity and mortality. Nocturia is a common but under-recognized symptom in this population and may contribute to increased nighttime fall risk. This study aimed to examine the relationship between nocturia severity and nighttime falls among older adults with hip fractures and to evaluate associated clinical and biochemical factors.

Methods: This retrospective observational study included 491 patients aged ≥55 years who underwent surgery for hip fractures between 2019 and 2024. Data were obtained from medical records and a structured questionnaire administered prior to hospital discharge or during follow-up. Patients were categorized into three nocturia groups: none, moderate (1 void/night), and severe (≥2 voids/night). Demographic, clinical, and laboratory parameters (including electrolytes and renal function) were analyzed. Univariate comparisons and multivariate logistic regression were performed to identify independent factors associated with nighttime falls.

Results: Overall, 76.8% of patients reported at least one nocturnal void, and 44.2% had severe nocturia. Nighttime fall incidence increased with nocturia severity (20.4% in the non-nocturia group, 37.3% in moderate, and 40.6% in severe; P < .001). In multivariate analysis, male sex (OR = 1.56, 95% CI: 1.04-2.35), lower serum potassium (OR = 0.58, 95% CI: 0.36-0.94), moderate nocturia (OR = 3.17, 95% CI: 1.70-5.93), severe nocturia (OR = 3.94, 95% CI: 2.21-7.04), and lower serum calcium (OR = 0.65, 95% CI: 0.45-0.93) were independently associated with nighttime falls. Age, renal function, and serum sodium were not significant factors.

Conclusions: Nocturia, particularly at moderate and severe levels, is independently associated with nighttime falls in older adults with hip fractures. Male sex and mild disturbances in potassium and calcium were also associated with the occurrence of nighttime falls. Our results highlight the importance of incorporating nocturia assessment and basic biochemical screening into comprehensive fall-risk evaluation and prevention strategies in geriatric orthopedic care.

Introduction: Femoral head specimens are often sent for histopathology after geriatric femoral neck fractures in patients with past history of malignancies. However, the cost-effectiveness of this practice is unclear and the clinical impact and effect on patient management has yet to be ascertained.

Methods: This is a retrospective review of all femoral head histopathology specimens registered in our center from 2003 to 2023. Patients <65 years of age were excluded from the study. Patient demographics were analyzed. Clinical notes and radiographic information were retrieved for all cases with positive histopathological findings to delineate any history of (1) atraumatic fractures, (2) prodromal pain and (3) radiological suspicion of pathological fractures. Any changes in subsequent management were also identified and analyzed.

Result: From the 1431 cases, the average age was 81.9 ± 7.91 years-old, with 986 females (68.9%). There has been a rising trend of femoral head biopsies over the past 20 years. Only 45 cases had a positive histological diagnosis (3.14%). Among which, 37 of them had radiological features of malignancy (82.2%). Thirty-five cases did not have a history of trauma prior to the fracture (77.8%) and 29 out of 44 cases had documented prodromal pain (64.4%). For the positive cases, just over half (26/45) experienced a change in the subsequent management plan. Majority of cases were managed by palliative intent with adjunctive radiotherapy or bisphosphonate therapy alone. Cost analysis showed the direct cost of pathological examination to be $395.78 USD per case, with an average of $12,585 per positive case. Only 1.8% of femoral neck biopsies were of clinical significance with change in management plans.

Conclusion: There is a low positive yield of femoral head biopsies with minimal change in management. Clinical history and radiological features can guide clinicians on the need for femoral head histopathology examinations.

Background: Despite advances in surgical care, disparities in functional recovery and mortality following hip fracture directly relate to racial, ethnic, and economic factors. Without a comprehensive method to model patients' diverse socioeconomic factors, researchers rely on proxies such as race and insurance status. The Distressed Community Index (DCI) score is a validated means of holistically estimating a patient's socioeconomic status, incorporating variables including community median income, unemployment, housing vacancies, education, business growth, and poverty rates.

Methods: The 2012-2014 100% Medicare Standard Analytical Files was queried, identifying patients surgically treated for isolated hip fractures. Individual socio-economic status was determined by linking residential ZIP codes with the DCI score. The study cohort was divided into 5 distinct tiers based on the DCI score: [0-20] (prosperous), [21-40] (comfortable), [41-60] (mid-tier), [61-80] (at risk), and >80 (distressed). Multi-variate logistic regression analyses were used to assess the impact of increasing DCI score on 90-day complications, readmissions, and mortality.

Results: A total of 364 074 patients met inclusion criteria. Patients with lower DCI scores were more likely to receive care at teaching hospitals (13.1%) in urban settings (97.6%) than the Distressed tier (8.7% and 73.6%, respectively). The distressed group was at a significantly higher risk of urinary tract infections (OR 1.12; P < 0.001), pneumonia (OR 1.18; P < 0.001), and pressure ulcers (OR 1.09; P < 0.001). Patients in the distressed group were more likely to have emergency department visits (OR 1.12; P < 0.001) and had higher odds of mortality (OR 1.14; P < 0.001). With elevated DCI score there were lower rates of readmission (OR 0.91-0.95; P < 0.001) but this was not significant in the DCI >80 group.

Conclusions: Patients living in ZIP codes with high DCI score had higher risks of post-operative complications, including death, after hip fracture surgery. Integration of the DCI score into clinical practice may help to mitigate adverse outcomes in this vulnerable patient population.

Aim: Hip fractures in older adults often result in decreased mobility and independence. This study aimed to identify critical balance skills that distinguish different activity levels following fracture, using sub-items of the Berg Balance Scale (BBS).

Methods: This retrospective cross-sectional study analyzed the medical records of 252 older adults (mean age 79.8 ± 8.8 years) with hip fractures. Participants were classified into Independent (n = 90), House-bound (n = 92), and Chair-bound (n = 70) groups based on the Japanese Bedriddenness Rank (BR). Decision tree analysis was performed using BBS sub-items as predictors of activity level.

Results: Key discriminators between activity levels were identified: "360° Turning" and "Sit to Stand" differentiated the Independent from the House-bound groups, while "Reaching Forward While Standing" and "Standing Unsupported" distinguished the House-bound from Chair-bound groups. Model accuracy was 81.9% (AUC 0.894) for Independent vs House-bound and 83.3% (AUC 0.910) for House-bound vs Chair-bound groups.

Discussion: Our results offer a novel, evidence-based approach to tailoring rehabilitation strategies for hip fracture patients. By focusing on these critical balance skills, patient functional outcomes may improve, ultimately enhancing quality of life in older adults following hip fracture.

Introduction: Prophylactic surgery for symptomatic incomplete atypical femoral fractures (SIAFFs) has demonstrated favorable outcomes. However, concerns remain regarding surgical intervention for a fracture that has not yet completed. This retrospective study aimed to evaluate the efficacy of conservative treatment using teriparatide (TPTD) as a conservative treatment for SIAFF.

Methods: This retrospective study reviewed 30 cases with SIAFF who underwent conservative treatment between November 2012 and September 2019. The diagnosis of SIAFF was based on the criteria established by the Task Force of the American Society for Bone and Mineral Research(ASBMR). The treatment protocol included (1) discontinuation of bisphosphonates, (2) use of 2 crutches or a four-point walker, (3) daily subcutaneous TPTD injection until pain subsided, and (4) monthly radiographic follow-up. Radiographs and bone scans were used to assess bone union, and follow-up continued for up to 2 years from protocol initiation. Comparisons between the successful and failed treatment groups were performed using the Student's t-test for continuous variables and Fisher's exact test for categorical variables.

Results: The mean age was 72.6 years (range, 55-87) and all patients were female. 13 cases involved the diaphyseal region and 17 involved the subtrochanteric region. The average duration of TPTD treatment was 6.5 months (range, 3-12), and the average follow-up was 45.5 months (range, 19-84) after the final injection. The mean SIAFF severity score was 9.5 (range, 7-11). Symptom-free bone union was achieved in 23 of 30 cases (76.7%). Five cases (4 with worsening pain, 1 with radiographic progression) underwent prophylactic intramedullary nailing, and 2 cases progressed to complete fracture and were treated with intramedullary nailing.

Conclusion: The result of this study suggests that the conservative treatment with teriparatide injection may be a potentially effective option for patients with SIAFF.

Purpose: Post-acute care (PAC) plays a key role in recovery following hip fractures. The aim of the study is to examine the factors affecting the achievement of the minimal important change (MIC) in older patients with hip fractures.

Methods: This retrospective cohort study included 228 patients who underwent surgical interventions for hip fractures and received subsequent PAC between 2020 and 2021. Data on demographics, medical history, and lifestyle habits were collected. Outcomes were measured using the Barthel Index, Numeric Rating Scale (NRS), and Harris Hip Score (HHS). Univariate and multivariate regression analyses were conducted to identify predictors of achieving the MIC.

Results: After treatment, significant improvements were observed in the Barthel Index (from 41.45 to 65.15, P < 0.001), NRS (from 5.03 to 2.52, P < 0.001), and HHS (from 29.35 to 63.68, P < 0.005). The MIC for the Barthel Index, NRS, and HHS were determined to be 6.20, 0.92, and 6.69, respectively. Dementia (odds ratio [OR] = 3.77, 95% confidence interval [CI] = 1.51-9.44, P = 0.005), age above 80 years (OR = 2.80, 95% CI = 1.15-6.84, P = 0.024), and heart failure (OR = 4.21, 95% CI = 1.34-13.23, P = 0.014) served as significant predictors of failure to achieve the MIC with the Barthel Index. For HHS, Diabetes mellitus was the only significant predictor of failure to achieve the MIC (OR = 4.32, 95% CI = 1.00-18.62, P = 0.050).

Conclusions: This study highlights major improvements in the Barthel Index, NRS, and HHS among older patients receiving PAC after hip fractures, along with a quantifiable MIC. Dementia is a robust predictor of failure to achieve the MIC with the Barthel Index, and advanced age, heart failure, and diabetes mellitus are key factors for optimizing recovery.

Background: To evaluate the clinical efficacy of PFNA in treating intertrochanteric fractures in super-elderly patients.

Methods: This study included patients aged over 90 years admitted to the orthopedic department of our hospital with intertrochanteric fractures between January 2021 and December 2023. The patients were categorized into two groups: the surgical group, which received treatment with PFNA, and the conservative group, which underwent tibial tubercle skeletal traction. PSM was additionally applied to control for confounding biases. Comparisons were conducted between the two groups concerning VAS scores at 1 week and 3 months post-admission, fracture healing time, complication rates, HHS, and SF-36 at the final follow-up, as well as 1-year survival rates.

Results: A total of 112 patients were enrolled, including 36 in the surgical group and 76 in the conservative group. After performing 1:1 PSM on baseline characteristics such as gender, age, BMI, bone density, Evans-Jensen classification, ASA grade, and CCI, 32 pairs of data were obtained, with 32 patients in the surgical group and 32 in the conservative group. Follow-up results indicated that the surgical group experienced faster pain relief, shorter fracture healing times, and lower incidence rates of most complications. Additionally, the HHS and SF-36 scores at the final follow-up were higher in the surgical group, and the one-year survival rate was also greater than that of the conservative group (P < 0.05).

Conclusion: For super-elderly patients with relatively good physical conditions who suffer from intertrochanteric fractures, the use of PFNA fixation, compared to conservative treatment, can achieve better limb function, a lower incidence of complications, and a higher survival rate.

Background: To evaluate the incidence rate of urinary tract infection (UTI) and postoperative urinary retention (POUR) in the initial indwelling urinary catheter (IIC) and intraoperative indwelling urinary catheter (IOC) groups of hip fracture patients who had undergone either fracture fixation or hemiarthroplasty operation within 48 hours.

Methods: Between June 2023 and October 2024, 110 patients who met the eligible criteria were enrolled in this study. We prospectively randomized all patients into the IOC (n = 55) and IIC (n = 55) groups. The postoperative incidence of UTI and POUR was compared between the two groups and evaluated 24 h postoperatively.

Results: The incidence of UTI was significantly higher in the IIC group (23.6%) than in the IOC group (9.1%) (P = .039). However, the incidence of POUR was not significantly different between the groups (16.4% vs 9.1%; P = .252).

Conclusion: For hip fracture patients undergoing early surgery within 48 h, intraoperative urinary catheterization significantly reduced the incidence of POUR, while the incidence of UTI did not differ significantly between the groups.