scholarly journals Pilot multi-centre randomised trial of the impact of pre-operative focused cardiac ultrasound on mortality and morbidity in patients having surgery for femoral neck fractures (ECHONOF-2 pilot)

Anaesthesia ◽  
2017 ◽  
Vol 73 (4) ◽  
pp. 428-437 ◽  
Author(s):  
D. J. Canty ◽  
J. Heiberg ◽  
Y. Yang ◽  
A. G. Royse ◽  
S. Margale ◽  
...  
Keyword(s):  
Femoral Neck ◽  
Randomised Trial ◽  
Femoral Neck Fractures ◽  
Cardiac Ultrasound ◽  
Mortality And Morbidity ◽  
Focused Cardiac Ultrasound ◽  
The Impact

Finite element analysis of the impact of screw insertion distal to the trochanter minor on the risk of iatrogenic subtrochanteric fracture

2018 ◽  
Vol 232 (8) ◽  
pp. 807-818 ◽  
Author(s):  
Ersin Sensoz ◽  
Fatih Mehmet Özkal ◽  
Volkan Acar ◽  
Ferit Cakir
Keyword(s):  
Finite Element ◽  
Femoral Neck ◽  
Screw Fixation ◽  
Subtrochanteric Fracture ◽  
Femoral Neck Fractures ◽  
Cannulated Screws ◽  
Screw Insertion ◽  
Subtrochanteric Fractures ◽  
Trochanter Minor ◽  
The Impact

Iatrogenic subtrochanteric fractures are rarely encountered after cannulated screw fixation of femoral neck fractures; however, when they do occur, there can be several complications. Many orthopedic surgeons have concerns about the potential for iatrogenic subtrochanteric fractures after screw fixation distal to the trochanter minor; therefore, some surgeons are typically reluctant to perform this procedure. This study focused on the risk of an iatrogenic subtrochanteric fracture after treating femoral neck fractures with cannulated screws. The main purpose of the study was to understand iatrogenic subtrochanteric fractures and evaluate the effects on these fractures of an inverted triangular–shaped configuration for placement of the cannulated screws. A femur bone with an femoral neck fracture at a 40° incline to the horizontal plane was generated along with a representation of a three-dimensional finite element model, and three inverted triangular–shaped configurations for placement of the cannulated screws were investigated using finite element analyses. Statistical results indicated that the occurrence risk of ISF increases when the screw is located distal to the trochanter minor. Moreover, the risk of occurrence of intertrochanteric fracture increases when the screw is located medial to the trochanter minor because of local concentrated stress on the surface of the screw canals. To avoid the vulnerability of the subtrochanteric region, it was found that proximal placement of the screws using the inverted triangular–shaped configuration could yield better results. In addition, the results of this study provide suggestions on improved screw configurations.

scholarly journals One-year results of the pilot multicentre randomised trial of preoperative focused cardiac ultrasound in hip fracture surgery

2019 ◽  
Vol 47 (2) ◽  
pp. 207-208 ◽  
Author(s):  
David J Canty ◽  
Johan Heiberg ◽  
Yang Yang ◽  
Alistair G Royse ◽  
Swaroop Margale ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Randomised Trial ◽  
Cardiac Ultrasound ◽  
Focused Cardiac Ultrasound ◽  
Hip Fracture Surgery ◽  
One Year ◽  
Fracture Surgery

scholarly journals Secondary Prevention of Hip Fragility Fractures During the COVID-19 Pandemic: Service Evaluation of “MRS BAD BONES” (Preprint)

2020 ◽  
Author(s):  
Alastair Stephens ◽  
Hannah Rudd ◽  
Emilia Stephens ◽  
Jayne Ward
Keyword(s):  
Vitamin D ◽  
Femoral Neck ◽  
Secondary Prevention ◽  
Fragility Fractures ◽  
Femoral Neck Fractures ◽  
Fisher Exact Test ◽  
Calcium Supplements ◽  
Dexa Scan ◽  
Retrospective Audit ◽  
The Impact

BACKGROUND Management of osteoporosis is an important consideration for patients with femoral neck fractures due to the morbidity and mortality it poses. The input of orthogeriatric teams is invaluable in coordinating secondary fragility fracture prevention. The COVID-19 pandemic resulted in the rapid restructuring of health care teams and led to the redeployment of orthogeriatricians. OBJECTIVE This study aimed to determine the impact COVID-19 had on the secondary prevention of fragility fractures among patients with femoral neck fractures, and to optimize management in this population. METHODS A retrospective audit was conducted of patients with femoral neck fractures before and after the lockdown in response to the COVID-19 pandemic in the United Kingdom. A reaudit was conducted following the development of our new mnemonic, “MRS BAD BONES,” which addressed key factors in the assessment and management of osteoporosis: <i>m</i>edication review, <i>r</i>heumatology/renal advice, smoking cessation; <i>b</i>lood tests, <i>a</i>lcohol limits, <i>D</i>EXA (dual energy X-ray absorptiometry) scan; <i>b</i>one-sparing medications, <i>o</i>rthogeriatric review, <i>n</i>utrition, <i>e</i>xercise, supplements. The Fisher exact test was used for comparison analyses between each phase. RESULTS Data for 50 patients were available in each phase. The orthogeriatric team reviewed 88% (n=44) of patients prelockdown, which fell to 0% due to redeployment, before recovering to 38% (n=19) in the postintervention period. The lockdown brought a significant drop in the prescription of vitamin D/calcium supplements from 81.6% (n=40) to 58.0% (n=29) (<i>P</i>=.02); of bone-sparing medications from 60.7% (n=17) to 18.2% (n=4) (<i>P</i>=.004), and DEXA scan requests from 40.1% (n=9) to 3.6% (n=1) (<i>P</i>=.003). Following the implementation of our mnemonic, there was a significant increase in the prescription of vitamin D/calcium supplements to 85.7% (n=42) (<i>P</i>=.003), bone-sparing medications to 72.4% (n=21) (<i>P</i>&lt;.001), and DEXA scan requests to 60% (n=12) (<i>P</i>&lt;.001). CONCLUSIONS The redeployment of the orthogeriatric team, due to the COVID-19 pandemic, impacted the secondary prevention of fragility fractures in the study population. The “MRS BAD BONES” mnemonic significantly improved management and could be used in a wider setting. CLINICALTRIAL

The Impact of Focused Cardiac Ultrasound Performed by Pediatric Intensivists

2019 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
João Rato ◽  
Cristina Camilo ◽  
Leonor Boto ◽  
Joana Rios ◽  
Francisco Abecasis ◽  
...  
Keyword(s):  
Cardiac Ultrasound ◽  
Focused Cardiac Ultrasound ◽  
The Impact

scholarly journals Community care: A factor that affects mortality and morbidity after femoral neck fractures

Injury Extra ◽  
2007 ◽  
Vol 38 (4) ◽  
pp. 131-132
Author(s):  
Y.H.K. Lodhi ◽  
I. Ibrahim ◽  
A. Zubairy ◽  
C. Charalombos
Keyword(s):  
Femoral Neck ◽  
Community Care ◽  
Femoral Neck Fractures ◽  
Mortality And Morbidity

scholarly journals Randomised trial of the fascia iliaca block versus the ‘3-in-1’ block for femoral neck fractures in the emergency department

2014 ◽  
Vol 32 (9) ◽  
pp. 685-689 ◽  
Author(s):  
Paul Reavley ◽  
Alan A Montgomery ◽  
Jason E Smith ◽  
Simon Binks ◽  
Judith Edwards ◽  
...  
Keyword(s):  
Emergency Department ◽  
Femoral Neck ◽  
Randomised Trial ◽  
Femoral Neck Fractures ◽  
Fascia Iliaca Block

scholarly journals Rehabilitation Strategies for Patients with Femoral Neck Fractures in Sarcopenia: A Narrative Review

2020 ◽  
Vol 9 (10) ◽  
pp. 3115
Author(s):  
Marianna Avola ◽  
Giulia Rita Agata Mangano ◽  
Gianluca Testa ◽  
Sebastiano Mangano ◽  
Andrea Vescio ◽  
...  
Keyword(s):  
Physical Therapy ◽  
Femoral Neck ◽  
Cognitive Rehabilitation ◽  
Femoral Neck Fractures ◽  
Postoperative Rehabilitation ◽  
Randomized Controlled ◽  
New Methods ◽  
Rehabilitation Protocols ◽  
Neck Fracture ◽  
The Impact

Sarcopenia is defined as a syndrome characterized by progressive and generalized loss of skeletal muscle mass and strength. It has been identified as one of the most common comorbidities associated with femoral neck fracture (FNF). The aim of this review was to evaluate the impact of physical therapy on FNF patients’ function and rehabilitation. The selected articles were randomized controlled trials (RCTs), published in the last 10 years. Seven full texts were eligible for this review: three examined the impact of conventional rehabilitation and nutritional supplementation, three evaluated the effects of rehabilitation protocols compared to new methods and a study explored the intervention with erythropoietin (EPO) in sarcopenic patients with FNF and its potential effects on postoperative rehabilitation. Physical activity and dietary supplementation are the basic tools of prevention and rehabilitation of sarcopenia in elderly patients after hip surgery. The most effective physical therapy seems to be exercise of progressive resistance. Occupational therapy should be included in sarcopenic patients for its importance in cognitive rehabilitation. Erythropoietin and bisphosphonates could represent medical therapy resources.

scholarly journals Increased perioperative mortality for femoral neck fractures in patients with coronavirus disease 2019 (COVID-19): experience from the United Kingdom during the first wave of the pandemic

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Esther Victoria Wright ◽  
Omar Musbahi ◽  
Abhinav Singh ◽  
Naresh Somashekar ◽  
Christopher P. Huber ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Femoral Neck ◽  
Clinical Care ◽  
Multidisciplinary Care ◽  
The Elderly ◽  
Femoral Neck Fractures ◽  
Perioperative Mortality ◽  
The United Kingdom ◽  
Using Data ◽  
The Impact

Abstract Background The coronavirus disease 19 (COVID-19) pandemic has presented modern healthcare with an unprecedented challenge. At the peak of the pandemic, trauma and orthopaedic services at our institutions undertook internal restructuring, diverting resources to frontline medical care. Consequently, we sought to assess the impact on the elderly and comorbid patients presenting with femoral neck fractures, with a particular focus on 30-day mortality, length of stay, multidisciplinary team involvement and departmental structuring. Method A retrospective analysis of patients presenting with femoral neck fractures at three separate West London NHS Trusts was undertaken between March 11, 2020, to April 30, 2020. Length of stay, 30-day mortality and adherence to parameters constituting the best care evidence-based practice tariffs were compared between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positive and negative patients. A similar comparison was also conducted between our cohort and the equivalent period in 2018 using data from the National Hip Fracture Database. Results A total of 68 patients presenting with femoral neck fractures were identified, mean age 81 (range 38–98), 73% female. There were 10 confirmed/suspected cases of COVID-19 on admission and a further seven confirmed as inpatients. The 30-day mortality within our cohort was 11.76% compared to 6% nationally in 2018 (p = 0.045). Orthogeriatric reviews occurred within 72 h in 71% of cases compared to 88% in the equivalent 2018 period. Within the cohort, mean length of stay was 17.13 days (SD 5.6, range 8-27 days) for SARS-CoV-2 positive patients compared to 10 days (SD 8.7, range 1–53 days) for negative patients (p < 0.05). Thirty-two patients (47%) required increased packages of care on discharge or rehabilitation. Conclusions The increase in 30-day mortality for SARS-CoV-2 positive patients presenting with femoral neck fractures is multifactorial, resulting from a combination of the direct effects of COVID-19 pneumonia as well as changes to the delivery of orthopaedic services. The provision of multidisciplinary care was directly affected by staff redeployment, particularly reorganisation of orthogeriatric services and lack of continuity of ward based clinical care. Our experiences have re-directed efforts towards the management of theatre teams, patient services and staffing, should we be faced with either a resurgence of COVID-19 or a future pandemic.

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