scholarly journals Delirium after hip hemiarthroplasty for proximal femoral fractures in elderly patients: risk factors and clinical outcomes

2019 ◽  
Vol Volume 14 ◽  
pp. 427-435 ◽  
Author(s):  
Louis de Jong ◽  
Veronique van Rijckevorsel ◽  
Jelle W. Raats ◽  
Taco M.A.L. Klem ◽  
Tjallingius M. Kuijper ◽  
...  
Keyword(s):  
Risk Factors ◽  
Elderly Patients ◽  
Clinical Outcomes ◽  
Femoral Fractures ◽  
Proximal Femoral Fractures ◽  
Hip Hemiarthroplasty

scholarly journals Longitudinal Study on Functional and Cognitive Outcomes in Patients with Postoperative Delirium after Femoral Fracture

2019 ◽  
Author(s):  
Monika Balzer-Geldsetzer ◽  
Benjamin Buecking ◽  
Steffen Ruchholtz ◽  
Bernhard Kis ◽  
Richard Dodel ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Elderly Patients ◽  
Hospital Stay ◽  
Clinical Outcomes ◽  
Postoperative Delirium ◽  
Femoral Fractures ◽  
Cognitive Capacity ◽  
Cognitive State ◽  
Multiple Logistic Regression ◽  
Proximal Femoral Fractures

Abstract Background Proximal femoral fractures are frequent injuries of elderly people and are often associated with declines in physical function and high rates of morbidity and mortality. A severe and frequent complication after hip surgery is postoperative delirium (POD), potentially associated with poorer clinical outcomes. We hypothesized that elderly patients with POD after hip fracture showed significantly worse clinical outcomes within one year after the fracture, compared to patients not suffering from POD. Additionally, relevant predictors of POD were evaluated. Methods Patients with proximal femoral fractures aged ≥ 60 years were included in a prospective, single-center observational study in Germany and followed up for 12 months. POD was evaluated by daily application of the Confusion Assessment Method (CAM) during the acute hospital stay. A variety of standardized instruments were used to evaluate patients’ functional and cognitive capacity, mobility, quality of life (HrQoL), depression, pain, etc., at baseline, discharge, and follow-up. A multiple logistic regression analysis was conducted to determine socio-demographic and clinical predictors of POD. Results Among 402 included patients (mean age: 81.3 ± 8.2 years), 184 (45.8%) developed POD (mean duration: 6.5 ± 4.4 days). At baseline, POD patients were significantly older, more often institutionalized, cognitively and physically more impaired, reported lower HrQoL, and had significantly more complications during the hospital stay. Multiple logistic regression analyses explained 22% of the variance, while prolonged intensive care unit stays, level of pain after surgery, and diminished pre-operative physical and cognitive state were significant predictors of POD. In-hospital mortality and overall mortality after 12 months were significantly higher in POD patients. Twelve months after the fracture, POD was significantly associated with diminished mobility, HrQoL, cognitive and functional capacity, and higher risk of falls. Conclusions Pain management is an important and controllable variable during hospital stay and should be a specific focus of the postoperative period, especially in functionally and cognitively impaired patients. Since patients with POD showed significantly worse clinical outcomes at discharge and 12 months post-fracture, prevention and effective treatment of POD should be of high priority in elderly patients with hip fractures.

Clinical outcomes of proximal femoral fractures treated with a novel carbon fiber-reinforced polyetheretherketone intramedullary nail

Injury ◽  
2020 ◽  
Vol 51 (3) ◽  
pp. 678-682 ◽  
Author(s):  
Kazuma Takashima ◽  
Ichiro Nakahara ◽  
Keisuke Uemura ◽  
Hidetoshi Hamada ◽  
Wataru Ando ◽  
...  
Keyword(s):  
Carbon Fiber ◽  
Clinical Outcomes ◽  
Intramedullary Nail ◽  
Femoral Fractures ◽  
Proximal Femoral Fractures ◽  
Fiber Reinforced ◽  
Carbon Fiber Reinforced

scholarly journals Incidence and Clinical Outcomes of Hip Fractures Involving Both the Subcapital Area and the Trochanteric or Subtrochanteric Area

2019 ◽  
Vol 2019 ◽  
pp. 1-4
Author(s):  
Takayuki Tani ◽  
Hiroaki Kijima ◽  
Natsuo Konishi ◽  
Hitoshi Kubota ◽  
Shin Yamada ◽  
...  
Keyword(s):  
Femoral Neck ◽  
Clinical Outcomes ◽  
Failure Rate ◽  
Femoral Fractures ◽  
Prosthetic Replacement ◽  
Proximal Femoral Fractures ◽  
Posterior Aspect ◽  
Anterior Aspect ◽  
Area Classification

Purpose. Proximal femoral fractures involving both the subcapital area and the trochanteric or subtrochanteric area have rarely been reported, but they are not uncommon. However, few studies have reported the incidence or clinical outcomes of such fractures. This study investigated such fractures.Methods. In area classification, the proximal femur is divided into 4 areas by 3 boundary planes: the first plane is the center of femoral neck; the second plane is the border between femoral neck and femoral trochanter; and the third plane links the inferior borders of greater and lesser trochanters. A fracture only in the first area is classified as a Type 1 fracture; one in the first and second areas is classified as a Type 1-2 fracture. Therefore, proximal femoral fractures involving both the subcapital area and the trochanteric area are classified as Type 1-2-3, and those involving both the subcapital area and the subtrochanteric area are classified as Type 1-2-3-4. In this study, a total of 1042 femoral proximal fractures were classified by area classification, and the treatment methods and the failure rates were investigated only for Types 1-2-3 and 1-2-3-4 cases. The failure rate was defined as the incidence of internal fixator cut-out or telescoping >10 mm.Results. Types 1-2-3 and 1-2-3-4 fractures accounted for 1.72%. Surgical treatment was performed for 89%. Of these, 56% underwent osteosynthesis, but the failure rate was 33%. The other patients (44%) underwent prosthetic replacement. Fracture lines of all these fractures were present along trochanteric fossa to intertrochanteric fossa in posterior aspect and just below the femoral head in anterior aspect.Conclusion. Fracture involving the subcapital area to the trochanteric or subtrochanteric area was found in approximately 2%. In patients for whom prosthetic replacement was selected, good results were obtained. However, 1/3 of patients who underwent osteosynthesis had poor results.

Treatment and outcomes of Vancouver type B periprosthetic femoral fractures

2020 ◽  
Vol 102-B (3) ◽  
pp. 293-300
Author(s):  
Hanlong Zheng ◽  
Hangyu Gu ◽  
Hongyi Shao ◽  
Yong Huang ◽  
Dejin Yang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Postoperative Complications ◽  
Conservative Treatment ◽  
Internal Fixation ◽  
Clinical Outcomes ◽  
Femoral Fractures ◽  
Harris Hip Score ◽  
Type B ◽  
Periprosthetic Femoral Fractures

Aims Vancouver type B periprosthetic femoral fractures (PFF) are challenging complications after total hip arthroplasty (THA), and some treatment controversies remain. The objectives of this study were: to evaluate the short-to-mid-term clinical outcomes after treatment of Vancouver type B PFF and to compare postoperative outcome in subgroups according to classifications and treatments; to report the clinical outcomes after conservative treatment; and to identify risk factors for postoperative complications in Vancouver type B PFF. Methods A total of 97 consecutive PPFs (49 males and 48 females) were included with a mean age of 66 years (standard deviation (SD) 14.9). Of these, 86 patients were treated with surgery and 11 were treated conservatively. All living patients had a minimum two-year follow-up. Patient demographics details, fracture healing, functional scores, and complications were assessed. Clinical outcomes between internal fixation and revisions in patients with or without a stable femoral component were compared. Conservatively treated PPFs were evaluated in terms of mortality and healing status. A logistic regression analysis was performed to identify risk factors for complications. Results In surgically treated patients, all fractures united and nine complications were identified. The mean postoperative Visual Analogue Scale (VAS) for pain was 1.5 (SD 1.3), mean Parker Mobility Score (PMS) was 6.5 (SD 2.4), and mean Harris Hip Score (HHS) was 79.4 (SD 16.2). Among type B2 and type B3 fractures, patients treated with internal fixation had significantly lower PMS (p = 0.032) and required a longer time to heal (p = 0.012). In conservatively treated patients, one-year mortality rate was 36.4% (4/11), and two patients ultimately progressed to surgery. Young age (p = 0.039) was found to be the only risk factor for complications. Conclusion The overall clinical outcome among Vancouver type B PFF was satisfactory. However, treatment with internal fixation in type B2 and B3 fractures had a significantly longer time to heal and lower mobility than revision cases. Conservative treatment was associated with high rates of early mortality and, in survivors, nonunion. This probably reflects our selection bias in undertaking surgical intervention. In our whole cohort, younger patient age was a risk factor for postoperative complications in Vancouver type B PFF. Cite this article: Bone Joint J 2020;102-B(3):293–300

scholarly journals Risk factors for intramedullary nail breakage in proximal femoral fractures: a 10-year retrospective review

2017 ◽  
Vol 99 (2) ◽  
pp. 145-150 ◽  
Author(s):  
NA Johnson ◽  
C Uzoigwe ◽  
M Venkatesan ◽  
V Burgula ◽  
A Kulkarni ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pathological Fracture ◽  
Treatment Options ◽  
Young Patients ◽  
Femoral Fractures ◽  
Subtrochanteric Fracture ◽  
Proximal Femur Fracture ◽  
Bony Union ◽  
Proximal Femoral Fractures ◽  
Asa Score

INTRODUCTION Intramedullary nailing is a common treatment for proximal femoral fractures. Fracture of the nail is a rare but devastating complication that exposes often frail patients to complex revision surgery. We investigated which risk factors predict nail failure. METHODS We reviewed all cases of nail breakage seen over a 10-year period in a single busy trauma unit; 22 nail fractures were seen in 19 patients. Comparison was made with a group of 209 consecutive patients who underwent intramedullary fixation of a proximal femur fracture with no nail breakage over a 2-year period. RESULTS In the fractured nail group, mean age was 70.4 years (range 55–88 years).The mean time to fracture was 10 months (range 2.5–23 months). Logistical regression was used to show that low American Society of Anesthesiologists (ASA) score, subtrochanteric fracture and pathological fracture were independent risk factors for nail fracture. CONCLUSIONS Young patients with a low ASA score are at highest risk of nail breakage. We advise close follow-up of patients with these risk factors until bony union has been achieved. In addition, there may be merit in considering other treatment options, such as proximal femoral replacement, especially for those with pathological fracture with a good prognosis.

The Effect of Time-to-Surgery on Outcome in Elderly Patients with Proximal Femoral Fractures

2007 ◽  
Vol 79 (2) ◽  
Author(s):  
Rüdiger Smektala ◽  
Burghard Dasch ◽  
Helmut Endres ◽  
Michael Lungenhausen ◽  
Christoph Mayer ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Femoral Fractures ◽  
Proximal Femoral Fractures ◽  
Time To Surgery
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