scholarly journals Hip fracture—great steps forward but we still need better evidence. A commentary on NICE CG124 and QS16 on fractured neck of femur

2018 ◽  
Vol 47 (5) ◽  
pp. 630-632 ◽  
Author(s):  
Roger H Jay ◽  
Daniel Hipps
Keyword(s):  
Hip Fracture ◽  
Fractured Neck Of Femur ◽  
Neck Of Femur

scholarly journals Predictors of direct home discharge following fractured neck of femur

2017 ◽  
Vol 99 (6) ◽  
pp. 444-451 ◽  
Author(s):  
O Salar ◽  
PN Baker ◽  
DP Forward ◽  
BJ Ollivere ◽  
N Weerasuriya ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Trauma Centre ◽  
Fractured Neck Of Femur ◽  
Neck Of Femur ◽  
Mental Test Score ◽  
Hip Fracture Surgery ◽  
Home Discharge ◽  
Walking Aids ◽  
Major Trauma Centre ◽  
Alternative Location

INTRODUCTION Direct home discharge (DHD) following hip fracture surgery represents a challenging proposition. The aim of this study was to identify factors influencing the discharge destination (home vs alternative location) for patients admitted from their own home with a fractured neck of femur. METHODS A retrospective cohort study of prospectively collected major trauma centre data was performed, identifying 10,044 consecutive hip fracture admissions between 2000 and 2012. RESULTS Two-thirds of the patients (n=6,742, 67%) were admitted from their own home. Half of these (n=3,509, 52%) returned directly to their own home while two-fifths (n=2,640, 39%) were discharged to an alternative location; 593 (9%) died. The following were identified as independent variables associated with a higher likelihood of DHD: younger patients, female sex, an abbreviated mental test score of 10, absence of certain co-morbidities, cohabiting, walking independently outdoors, no use of walking aids, no assistance required with basic activities of daily living and intracapsular fracture. CONCLUSIONS Identifying those at risk of being discharged to an alternative location following admission from home on the basis of identified preoperative indices could assist in streamlining the postoperative care phase. Pre-emptive action may help increase the numbers of patients discharged directly home and reduce the number requiring additional rehabilitation prior to discharge home with its associated socioeconomic effect.

scholarly journals Standardised Warfarin Reversal Expedites Time to Theatre for Fractured Neck of Femur Surgery and Improves Mortality Rates: A Matched Cohort Study

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Thomas S. Moores ◽  
Benjamin D. Chatterton ◽  
Matthew J. Walker ◽  
Phillip J. Roberts
Keyword(s):  
Cohort Study ◽  
Hip Fracture ◽  
Length Of Stay ◽  
Nearest Neighbour ◽  
Fractured Neck Of Femur ◽  
Neck Of Femur ◽  
The United Kingdom ◽  
Before And After ◽  
Warfarin Reversal ◽  
Guideline Group

Background. This study aims to evaluate outcomes for warfarinised hip fracture patients and compare them with a matched nonwarfarinised group, before and after the introduction of national hip fracture guidelines in the United Kingdom. Methods. A retrospective cohort study of 1743 hip fracture patients was undertaken. All patients admitted taking warfarin were identified. These patients were then matched to nonwarfarinised patients using nearest neighbour propensity score matching, accounting for age, sex, hip fracture type, and Nottingham Hip Fracture Score. A pre-guideline group (no standardised warfarin reversal regimen) and a post-guideline group (standardised regimen) were identified. Outcomes assessed included time to INR less than 1.7, time to theatre, length of stay, and 30-day and 1-year mortality. Results. Forty-six warfarinised hip fracture patients were admitted in the pre-guideline group (mean age 80.5, F:M 3:1) and 48 in the post-guideline group (mean age 81.2 years, F:M 3:1). Post-guideline patients were reversed to a safe operative INR level within 18 hours of admission, decreasing the time to first dose vitamin K (p<0.001). 70% of warfarinised patients were operated upon within 36 hours, compared to 19.6% with no regimen (p<0.05). After anticoagulation reversal protocol, thirty-day mortality decreased from 15.2% to 8.3% and 1-year mortality from 43.5% to 33% for warfarinised patients, which is comparable to nonwarfarinised matched patients. There was no significant change in the length of stay pre- and post-guideline for both groups of patients. Conclusions. Proactive anticoagulant management and expedient surgery reduces morbidity and mortality when managing this surgically challenging subset of hip fracture patients.

scholarly journals Improving Administration of Fascia-iliaca Blocks for Patients With a Fractured Neck of Femur by Clinical Audit

2021 ◽  
Author(s):  
Isaac Okereke ◽  
Sridhar Rao Sampalli
Keyword(s):  
Hip Fracture ◽  
Older People ◽  
Femur Fracture ◽  
Fractured Neck Of Femur ◽  
Neck Of Femur ◽  
Analgesic Effects ◽  
Femur Fractures ◽  
Anaesthetic Agents ◽  
Number Of Patients ◽  
Neck Of Femur Fracture

Abstract BackgroundHip fracture is the most common serious injury in older people. It is also the most common reason for older people to need emergency anaesthesia and surgery, and the commonest cause of death following an accident. A FICB is the injection of anaesthetic agents into the fascia- iliaca compartment with the effect of blocking the lumbar plexus via an anterior approach. FICB is clinically safe and efficient and provides consistent analgesic effects irrespective of the performing doctor's experience of frailty fractures of the proximal femur.Methods Data from the National Hip Fracture Database (NHFD) for all patients admitted with a neck of femur fracture between October 2018 and May 2019 was interrogated and audited. Results of this audit were discussed in the department of Trauma & Orthopaedics' and the Trust's mortality review meetings. Teaching sessions were held for doctors and filling out of the neck of femur fracture proforma to detail administration or not of FICB and a valid reason when the later occurred was encouraged. A re-audit was carried out in May 2020 where a retrospective study of patients admitted with a neck of femur fracture over six months from October 2019 to April 2020 was done to assess improvement in compliance rates of administration of fascia iliaca blocks.Results We noted a statistically significant increase in the number of patients who got a fascia iliaca block on presentation with a fractured neck of the femur from after our second audit (p<0.00001). There were no complications associated with the administration of FICB to patients with neck of femur fractures. ConclusionThis study showed that clinical processes could be improved through audits, staff education and by employing the use of proformas to ensure compliance.

scholarly journals Adherence to guidelines regarding total hip replacement for fractured neck of femur

2016 ◽  
Vol 98 (6) ◽  
pp. 422-424 ◽  
Author(s):  
A Fishlock ◽  
C Scarsbrook ◽  
R Marsh
Keyword(s):  
Hip Fracture ◽  
Total Hip Replacement ◽  
Hip Replacement ◽  
Best Practice ◽  
Treatment Strategies ◽  
National Average ◽  
Fractured Neck Of Femur ◽  
Neck Of Femur ◽  
Total Hip ◽  
American Society

Introduction In 2011 the National Institute for Health and Care Excellence (NICE) published guidelines suggesting that clinicians offer total hip replacement (THR) to patients with displaced intracapsular hip fractures who could walk independently outside with no aids or one stick, who are not cognitively impaired and are ASA (American Society of Anesthesiologists) grade ≤2. They also stated that best practice is operating within 36 hours of presentation. This audit aimed to determine whether Scarborough Hospital was following these guidelines and compared the results with the national average. Methods Two years of data (January 2012 – December 2013) were collected retrospectively from Scarborough Hospital’s hip fracture database on all patients presenting with an intracapsular hip fracture. Data were analysed to determine whether patients who had a THR fulfilled NICE criteria. Furthermore, patients with hemiarthroplasties who were eligible for THRs were identified. Finally, the time to surgery was calculated to examine whether patients receiving THRs waited longer than patients receiving hemiarthroplasties. Results In 2012, 48.6% of all eligible patients received a THR while in 2013 the figure was 55.9%. These percentages are much higher than the national average. However, 36 (53.7%) of the 67 patients who received a THR did not fulfil all the NICE criteria, mainly owing to high ASA grade. The mean time from presentation to theatre for THR was 8 hours and 37 minutes longer for THR patients than for hemiarthroplasty in 2012. This difference was reduced to 2 hours and 12 minutes in 2013. Conclusions Small general hospitals can meet and even exceed the standards regarding treatment strategies for hip factures. However, there is still room for improvement. Departmental training may be useful in achieving this aim. The anaesthetic team should be involved at the earliest opportunity, to help optimise patients preoperatively and determine whether patients listed for THR with higher ASA grades are suitable for this surgery.

scholarly journals The Nottingham Hip Fracture Score as a predictor of early discharge following fractured neck of femur

2011 ◽  
Vol 41 (3) ◽  
pp. 322-326 ◽  
Author(s):  
I. K. Moppett ◽  
M. D. Wiles ◽  
C. G. Moran ◽  
O. Sahota
Keyword(s):  
Hip Fracture ◽  
Early Discharge ◽  
Fractured Neck Of Femur ◽  
Neck Of Femur

scholarly journals Admission and treatment at a weekend is not associated with worse outcomes for patients admitted with fractured neck of femur

Trauma ◽  
2018 ◽  
Vol 21 (4) ◽  
pp. 288-294
Author(s):  
Asef Al-Ani ◽  
Matthew Bence ◽  
Alexander D. Liddle ◽  
Barry Ferris
Keyword(s):  
Hip Fracture ◽  
Hip Fractures ◽  
Weekend Effect ◽  
Specific Reference ◽  
Confounding Factors ◽  
Fractured Neck Of Femur ◽  
Neck Of Femur ◽  
Unmeasured Confounding ◽  
Risk Of Death ◽  
Developed World

Introduction The weekend effect is a reported phenomenon whereby patients admitted at a weekend are found to have worse outcomes than those admitted during the week. The causes are not well understood, but may have implications for the planning of medical workforces throughout the developed world. Although the magnitude of the weekend effect is reduced whenknown confounding factors are adjusted for, there are likely to be substantial residual unmeasured confounding factors. It remains unclear how much effect exists in comparable patients. The aim of this study was to determine whether the presence of a weekend effect could be detected for the patients admitted with hip fracture to our unit and to quantify this effect if detected. Methods All hip fracture patients admitted to our unit over a five-year period were examined. All patients had their details entered onto the National Hip Fracture Database which was investigated to compare inpatient, 30-day, 120-day and 365-day mortality with specific reference to day of admission and operative treatment. Results Two thousand one hundred and thirty fractured neck of femur patients were admitted from 2011 to 2016. We found no difference in mortality in being admitted or treated at the weekend or weekday; however, patients operated upon on a Tuesday had a statistically significant higher risk of death (OR 2.813, 95% CI 1.336–5.992, p = 0.006). The reasons for this are unclear. Conclusions In our unit there is no evidence of a weekend effect for hip fractures.

scholarly journals Nutritional status in elderly female hip fracture patients: comparison with an age-matched home living group attending day centres

2001 ◽  
Vol 85 (6) ◽  
pp. 733-740 ◽  
Author(s):  
M. Lumbers ◽  
S. A. New ◽  
S. Gibson ◽  
M. C. Murphy
Keyword(s):  
Hip Fracture ◽  
Vitamin C ◽  
Glutathione Peroxidase ◽  
Glutathione Peroxidase Activity ◽  
Plasma Albumin ◽  
Fractured Neck Of Femur ◽  
Neck Of Femur ◽  
Fracture Group ◽  
Home Living ◽  
Living Group

Fractured neck of femur occurs mostly in the older female population and is generally caused by falls. Malnutrition has been postulated as a factor that increases the tendency to suffer falls. Nutritional status of older female hospital patients admitted for emergency surgery for fractured neck of femur recruited (n 75), was compared with an age-matched independent-living group of females attending one of three local day centres (n 50). Dietary assessment was undertaken using three consecutive 24 h dietary recalls and, in the hip fracture group, completed menu cards were used as memory prompts. Data concerning key lifestyle characteristics were obtained using a face-to-face administered questionnaire. Blood samples were taken to determine levels of plasma albumin, transferrin, C-reactive protein (CRP), cholesterol, vitamin C, Se, Zn and total antioxidant status. Haemolysate samples were analysed for Se-dependent glutathione peroxidase activity. There were no significant differences in age between the two groups, but the hip fracture patients had lower mean values for body weight (59.6 v. 67.5 kg; p = 0.005), mindex (weight/demispan) (83· v. 94.4 kg/m; P < 0·0001), calculated BMI (24·1 v. 27·5 kg/m2P<0·0001), mid-upper arm circumference; 27·1 v. 31·3 cm, p = 0.001) and triceps skinfold thickness; 17·0 v. 18.9 mm, p = 0·005) than the home-living group. The hip fracture patients had lower intakes of energy (4·3 v. 5·4 MJ, p = 0·001), fat (p = 0·025), carbohydrate (p = 0·002), protein (p = 0·006), thiamine (p = 0·017), vitamin B6 (p = 0·001), calcium (p = 0·01), K (p = 0·001), Mg (p = 0·001), P (p = 0·001), Fe (p = 0·007), Se (p = 0·008) and NSP (p = 0·001). Mean intakes of both groups were below the estimated average requirement for energy and below the reference nutrient intakes for folate, Ca, vitamin D, Mg, K, Se and Zn. In a high percentage of the hip fracture group the dietary intake of particular nutrients fell below the lower reference nutrient intake for Se (73 %), Mg (54 %) and Fe (19 %). As expected, the fracture patients had reduced plasma albumin (P<0·0001) and increased CRP (P<0·001) values. They had higher plasma vitamin C levels (P<0·001) and lower cholesterol levels (p = 0.04) than the day centre attendees. There were no significant differences in plasma levels of Se, Zn, transferrin or haemolysate glutathione peroxidase activity between the two groups. However, there was evidence of under-nutrition in both groups as key anthropometric values were low, plasma nutrient and metabolite levels were below the standard reference ranges and many individuals had low dietary intakes for specified nutrients.

scholarly journals 739 The Management and Outcomes of Patients with Fractured Neck of Femur During The COVID-19 Pandemic; A District General Hospital Experience

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
P Lancaster ◽  
S Selvarajan ◽  
K Dasari
Keyword(s):  
Hip Fracture ◽  
Length Of Stay ◽  
District General Hospital ◽  
Mortality Rates ◽  
Discharge Destination ◽  
Fractured Neck Of Femur ◽  
Neck Of Femur ◽  
Vulnerable Patients ◽  
Secondary Outcomes ◽  
The Uk

Abstract Background The UK announced a “lockdown” in response to COVID-19 on 23/03/2020, despite this NHS England did not anticipate a significant decrease in hip fracture cases. Early data from Europe had shown mortality rates of up to 30.4% in patients who develop COVID-19 and a hip fracture. Method Prospective study of patients presenting with a hip fracture between 23/03/2020 and 18/05/2020. Primary outcomes were 30-day mortality and COVID-19 status. Secondary outcomes were length of stay, discharge destination and readmission. Results 50 patients identified, mean age 82. 49 patients underwent operation, 34 (69.4%) within 48 hours of admission. 14 Patients (28%) tested positive for COVID-19 within 30 days. 30-day mortality was 10% (n = 5). 2 patients who died were COVID-19 positive. Mean length of stay was 12.3 days. 7 patients (14%) re-admitted within 30 days, 4 with COVID-19. Conclusions Despite extra strain on the hospital, we believe we achieved good outcomes for this cohort. Compared to previous NHFD data we decreased our length of stay and time to operation. 30-day mortality increased (8.4% in 2018) but we believe this to be expected in vulnerable patients during a pandemic. We hope to take lessons we have learnt during the pandemic into the post-pandemic era.

Seasonality of Hip Fracture and Haemorrhagic Disease of the Newborn

1993 ◽  
Vol 38 (2) ◽  
pp. 37-40 ◽  
Author(s):  
A.S. Douglas
Keyword(s):  
United States ◽  
Vitamin D ◽  
Hip Fracture ◽  
The United States ◽  
Fractured Neck Of Femur ◽  
Neck Of Femur ◽  
Death Rates ◽  
Seasonal Rhythms ◽  
Admission Data ◽  
Haemorrhagic Disease

The objective is to examine and compare the seasonalities offractured neck of femur and haemorrhagic disease of the newborn. The data are from two sources. Admissions for fractured neck of femur in Scotland over five years (1983–87) are examined by age, sex, mortality, operative intervention and source of admission. Data from the United States (1927–36) are examined for infant death rates from suspected haemorrhagic disease of the newborn 3–14 days after birth. The sine curves are examined. The rhythms, while not identical, have similarities. The peaks are in January-February and the troughs in July-August. Amongst hip fractures the peak is one month earlier and the seasonal excess around 20–25 per cent in both conditions. Rickets, haemorrhagic disease of the newborn and fractured neck of femur have comparable seasonal rhythms. Vitamin D regulates the systhesis of the vitamin K dependent bone protein osteocalcin, which is functionally abnormal in postmenopausal women. This may be a significant factor in the seasonal variation of hip fracture.

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