scholarly journals Management of Warfarin Anticoagulation in Patients with Fractured Neck of Femur

2011 ◽  
Vol 2011 ◽  
pp. 1-5 ◽  
Author(s):  
Feras Ashouri ◽  
Wissam Al-Jundi ◽  
Akash Patel ◽  
Jitendra Mangwani
Keyword(s):  
Vitamin K ◽  
Hip Fractures ◽  
National Policy ◽  
District General Hospital ◽  
Pharmacological Therapy ◽  
Fractured Neck Of Femur ◽  
Neck Of Femur ◽  
Time To Surgery ◽  
Group A ◽  
Group B

Background. Most orthopaedic units do not have a policy for reversal of anticoagulation in patients with hip fractures. The aim of this study was to examine the current practice in a district general hospital and determine difference in the time to surgery, if any, with cessation of warfarin versus cessation and treatment with vitamin K. Methods. A retrospective review of the case notes between January 2005 and December 2008 identified 1797 patients with fracture neck of femur. Fifty seven (3.2%) patients were on warfarin at the time of admission. Patients were divided into 2 groups (A and B). Group A patients (16/57; 28%) were treated with cessation of warfarin only and group B patients (41; 72%) received pharmacological therapy in addition to stopping warfarin. Time to surgery between the two groups was compared. Results. The mean INR on admission was 2.9 (range 1.7–6.5) and prior to surgery 1.4 (range 1.0–2.1). Thirty eight patients received vitamin K only and 3 patients received fresh frozen plasma and vitamin K. The average time to surgery was 4.4 days in group A and 2.4 days in group B. The difference was statistically significant (P<.01). Conclusion. Reversal of high INR is important to avoid significant delay in surgery. There is a need for a national policy for reversing warfarin anticoagulation in patients with hip fractures requiring surgery. Vitamin K is safe and effective for anticoagulation reversal in hip fracture patients.

Hypercoagulable State in the Watanabe Heritable Hyperlipidemic Rabbit, an Animal Model for the Progression of Atherosclerosis

1989 ◽  
Vol 61 (01) ◽  
pp. 140-143 ◽  
Author(s):  
Yoshitaka Mori ◽  
Hideo Wada ◽  
Yutaka Nagano ◽  
Katsumi Deguch ◽  
Toru Kita ◽  
...  
Keyword(s):  
Vitamin K ◽  
Fibrinogen Level ◽  
Plasma Cholesterol ◽  
Age Groups ◽  
Clotting Factor ◽  
Clotting Factors ◽  
Group A ◽  
Hyperlipidemic Rabbit ◽  
Group B ◽  
Progression Of Atherosclerosis

SummaryBlood coagulation in a strain of rabbits designated as Watanabe heritable hyperlipidemic (WHHL) rabbits was examined. The activities of vitamin K-dependent clotting factors, contact factors and clotting factor VIII (F VIII) and the fibrinogen level were significantly higher in WHHL rabbits than in normolipidemic rabbits (all age groups). Values for vitamin Independent clotting factor were already higher at 2 months of age. Contact factors and fibrinogen levels increased age after 5 to 8 months. F VIII increased between 5 and 8 months and then decreased. At 2 months of age, WHHL rabbits were divided into two groups. Group A was fed standard rabbit chow and group B standard rabbit chow containing 1% probucol. Probucol prevented the progression of atherosclerosis in group B in the absence of a significant reduction in plasma cholesterol level. F VIII and fibrinogen levels were statistically decreased in all rabbits at all ages in group B (P<0.05). These differences in clotting factors between the two groups were most obvious at 8 months (P<0.02).We conclude that vitamin K-dependent clotting factors may increase with hyperlipemia and that increases in F VIII and fibrinogen may be closely related to the progression of throm- boatherosclerosis.

scholarly journals Hip Fractures in Centenarians: Has Care Improved in the National Hip Fracture Database Era?

2017 ◽  
Vol 8 (3) ◽  
pp. 161-165 ◽  
Author(s):  
Alastair G. Dick ◽  
Dominic Davenport ◽  
Mohit Bansal ◽  
Therese S. Burch ◽  
Max R. Edwards
Keyword(s):  
Hip Fracture ◽  
Length Of Stay ◽  
Hip Fractures ◽  
District General Hospital ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Retrospective Case ◽  
Time To Surgery ◽  
Surgery Mortality ◽  
Hospital Acquired

Introduction: The number of centenarians in the United Kingdom is increasing. An associated increase in the incidence of hip fractures in the extreme elderly population is expected. The National Hip Fracture Database (NHFD) initiative was introduced in 2007 aiming to improve hip fracture care. There is a paucity of literature on the outcomes of centenarians with hip fractures since its introduction. The aim of this study is to report our experience of hip fractures in centenarians in the era since the introduction of the NHFD to assess outcomes in terms of mortality, time to surgery, length of stay, and complications. Methods: A retrospective case note study of all centenarians managed for a hip fracture over a 7-year period at a London district general hospital. Results: We report on 22 centenarians sustaining 23 hip fractures between 2008 and 2015. Twenty-one fractures were managed operatively. For patients managed operatively, in-hospital, 30-day, 3-month, 6-month, 1-year, 2-year, 3-year, and 5-year cumulative mortalities were 30%, 30%, 39%, 50%, 77%, 86%, 95%, and 100%, respectively. In-hospital mortality was 100% for those managed nonoperatively. Mean time to surgery was 1.6 days (range: 0.7-6.3 days). Mean length of stay on the acute orthopedic ward was 23 days (range: 2-51 days). Seventy-one percent had a postoperative complication most commonly a hospital-acquired pneumonia or urinary tract infection. Conclusion: Compared to a series of centenarians with hip fractures prior to the introduction of the NHFD, we report a reduced time to surgery. Mortality and hospital length of stay were similar.

scholarly journals Changing management of suspected appendicitis in the laparoscopic era

2010 ◽  
Vol 92 (1) ◽  
pp. 65-68 ◽  
Author(s):  
Fayyaz Akbar ◽  
Mansoor Yousuf ◽  
Richard J Morgan ◽  
Andrew Maw
Keyword(s):  
Lower Abdominal Pain ◽  
Laparoscopic Group ◽  
District General Hospital ◽  
Laparoscopic Appendicectomy ◽  
Suspected Appendicitis ◽  
Increasing Trend ◽  
Group A ◽  
Patient Groups ◽  
Group B ◽  
Diagnostic Outcomes

INTRODUCTION The aims of this study were to examine the trends in performance of open and laparoscopic appendicectomy at a district general hospital, and to compare the diagnostic outcomes in the two patient groups. PATIENTS AND METHODS Data were collected prospectively from patients undergoing an open or laparoscopic procedure for cted appendicitis in an 8-year period between January 2000 and December 2007. RESULTS A total of 1700 patients (873 women, 827 men) with a median age of 24 years underwent surgery for suspected appendicitis in the study period. There were 1357 patients (group A) who underwent an open procedure for presumed appendicitis (610 women and 747 men [F:M ratio, 1:1.2]). There were 343 patients (group B) who underwent laparoscopy with or without laparoscopic appendicectomy (82 men and 261 women [F:M ratio, 1:0.31]). Over the study period, there was an increasing trend towards the performance of laparoscopic procedures for suspected appendicitis, increasing from 4% to 39% of the total per year. In group A, 1172 (86%) patients had appendicular pathology, while the appendix was normal histologi-cally in 178 (13%). Other pathologies were diagnosed intra-operatively in 1%. In group B, 193 patients (56%) had appendicular pathology while in 150 (44%) the appendix was normal. In the subgroup with a normal appendix, 56 patients (37%) had another cause for their symptoms identified. CONCLUSIONS Laparoscopic appendicectomy is increasingly being performed. Laparoscopy is often used as a diagnostic tool in general surgical patients, particularly women, with lower abdominal pain. In effect, these patients are undergoing diagnostic laparoscopy, with or without appendicectomy. This has resulted in a lower positive appendicectomy rate, but a higher yield of diagnoses other than appendicitis, in the laparoscopic group. Overall appendicectomy rates, however, have remained unchanged.

scholarly journals 799 Do Not Attempt Cardiopulmonary Resuscitation Decisions in Neck of Femur Fractures – Is Documentation Adequate?

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
T Williamson ◽  
K Hughes ◽  
M Osborne-Grinter ◽  
V Philip ◽  
G Dall ◽  
...  
Keyword(s):  
Cardiopulmonary Resuscitation ◽  
District General Hospital ◽  
Healthcare Team ◽  
Power Of Attorney ◽  
Fractured Neck Of Femur ◽  
Neck Of Femur ◽  
Care Plans ◽  
Femur Fractures ◽  
Senior Clinician ◽  
Grade 3

Abstract Introduction ‘Do not attempt cardiopulmonary resuscitation’ (DNACPR) documentation is essential to communicate decisions regarding ceilings of care for patients to the clinical team. Patients admitted to hospital with a fractured neck of femur (#NOF) are often elderly with multiple comorbidities, and so robust and clear anticipatory care plans are especially indicated. Method All patients admitted to a large district general hospital in Scotland with a #NOF over a three-week period between 23/10/2020 and 12/11/2020 were identified prospectively and included in this audit. Patients’ demographic information, DNACPR status and the quality of their DNACPR documentation was recorded. Results 20 patients (85% Female, 15% Male) were identified and included. Median ASA grade was 3, with 77.8% of patients ASA grade 3 or 4. 63.2% of patients had DNACPR documentation in place, all of which were ASA grade 3 or above. Most DNACPR documentation had patient information clearly identifiable (91.7%), was completed preoperatively (90.9%), and involved either the patient or appropriate relative or power of attorney (91.6%). However, only 75% of patients’ documentation had the rationale for the DNACPR decision documented and only 25% of DNACPR decisions were reviewed by a senior clinician within 72 hours. No DNACPR decisions were documented as having been communicated to the wider healthcare team. Conclusions DNACPR documentation is a crucial for anticipatory care planning in #NOF patients. This audit shows improvement is needed in documenting whether decisions have been reviewed by senior clinicians, and if they have been communicated to the wider healthcare team.

scholarly journals Outcome of management of intracapsular fracture neck of femur in young adult patients

2020 ◽  
Vol 8 (12) ◽  
pp. 4456
Author(s):  
Sakib Arfee ◽  
Asma Jabeen ◽  
Akib Arfee ◽  
Adnan Aadil Arfee
Keyword(s):  
Young Adult ◽  
Adult Patients ◽  
Intracapsular Fracture ◽  
Neck Of Femur ◽  
Medical College ◽  
Fracture Neck Of Femur ◽  
High Incidence ◽  
Group A ◽  
Group B

Background: Almost four centuries back fracture neck of femur was described, but till today this fracture is unsolved, though situation has largely improved from the days of Sir Astley Cooper, who had said “I have never met one in whom union had taken place”. High incidence of complications with this fracture even in modern day show that we still have not found way to treat this fracture appropriately and its treatment remains a challenging problem. The objective of the study was to assess the final outcome of management of intracapsular fracture neck of femur in young adult patients after internal fixation.Methods: This study has been conducted at Orthopedic Department of Government Medical College and hospital, Jammu from 2018 to 2020. 30 young adult patients with fractures neck of femur treated with CCS (27 patients) and DHS (3 patients) after taking informed consent were selected for the study.Results: 30 young adult patients in age group of 18-60 years, constituted this study. 27 patients were treated with closed reduction and internal fixation with CCS (group A) and 3 patients were treated with DHS (group B). 3 patients were lost to the follow up, all of them from group A.Conclusions: DHS appears to be more forgiving implant than CCS in fracture neck of femur in young adult patients. However number in this group is very small and hence larger studies are needed. In fixation with CCS anatomical reduction of fracture, proper screw placement is the most important criterion for achieving better results.

TP6.2.3 Abnormal liver function tests: A helpful diagnostic test and a predictor of severity in acute appendicitis

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Muwaffaq Telfah ◽  
Mathew Mason ◽  
Marianne Hollyman ◽  
Hamish Noble ◽  
David Mahon ◽  
...  
Keyword(s):  
Liver Function ◽  
Acute Appendicitis ◽  
Hospital Stay ◽  
District General Hospital ◽  
Liver Function Tests ◽  
Average Hospital ◽  
Function Tests ◽  
Group A ◽  
Negative Appendicectomy ◽  
Group B

Abstract Aim: Acute appendicitis (AA) is the commonest surgical emergency worldwide. The diagnosis usually is clinical but imaging and bloods tests are helpful. The study aims to establish the role of abnormalities in liver function tests (LFTs) in the diagnosis and in predicting the severity of AA. Methods Retrospective, observational study performed in district general hospital between June 2018 and June 2019. Patients with abdominal pain and appendicectomy (excluding children &lt;16 years with isolated ALP rise) were categorized into two groups based on presence (Group-A) or absence (Group-B) of abnormal LFTs. Demographics data, diagnosis and severity of appendicitis, hospital stay and postoperative complications were analysed. Results Two hundred and seventy nine patients were included: Group-A (n = 146, mean age 37.5 years, M: F 1.3/1.0) and Group-B (n = 133, mean age 29.7 years, M:F 1.0/1.8). Appendicitis occurred in 85.6% of Group-A (125/146) and in 62.4% (83/133) of Group-B with positive predictive value 85.6%. The appendix was normal in 14.4% of Group-A (21/146) and in 37.6% of Group-B (50/133) with specificity of 70%. Laparotomy was required in 6.1% in Group-A (9/146) compared to 1.5% in Group-B (2/133). Average hospital stay was 4.7 days (range: 1-21) in Group-A versus 2.7 days (range 1-14) in Group-B. Readmission rate due to a postoperative complication was 16.4% in Group-A (24/146) compared to 6% in Group-B (8/ 133). Conclusion: Deranged LFTs is an additional diagnostic tool in AA and a good predictor of its severity. This may help to decrease the negative appendicectomy rate and guide surgeon in the decision-making process.

scholarly journals The impact of pre-operative echocardiograms on time to surgery in patients with fractured neck of femur

2013 ◽  
Vol 11 (8) ◽  
pp. 660-661
Author(s):  
Gopikanthan Manoharan ◽  
Thomas Moores ◽  
Natalie Parrott ◽  
Rohit Singh
Keyword(s):  
Fractured Neck Of Femur ◽  
Neck Of Femur ◽  
Time To Surgery ◽  
The Impact

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 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.

scholarly journals 940 Neck of Femur Fracture Management and Outcomes during COVID-19: Overview of the Results from a District General Hospital in Wales

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
J Waterman ◽  
U Jayaraju ◽  
J Nadimi ◽  
D Morgan
Keyword(s):  
Hip Fractures ◽  
District General Hospital ◽  
Mortality Rates ◽  
Neck Of Femur ◽  
Fourfold Increase ◽  
Retrospective Data Analysis ◽  
Fracture Management ◽  
Orthopaedic Community ◽  
Neck Of Femur Fracture ◽  
The Impact

Abstract Introduction The COVID-19 pandemic has delivered significant challenges to the Orthopaedic community. Our study aims to assess the impact of COVID-19 on the management and outcomes of patient’s presenting with Hip Fractures to our DGH. Method Retrospective data analysis was performed on a cohort of hip fracture patients who presented to our DGH before the COVID-19 pandemic (23/03/2019 to 05/05/2019) and were compared to those who presented during the COVID-19 pandemic (23/03/2020 to 05/05/2020). Minimum follow up was 30 days postoperatively. Results 38 patients with hip fractures presented to our unit in the pre-COVID-19 period compared to 27 patients in the COVID-19 period. Total time from presentation to discharge, during COVID-19, demonstrated a 70.23% decrease when compared to the pre-COVID cohort. 30-day Mortality rates were higher in the COVID-19 cohort. Conclusions During the COVID-19 pandemic our time to theatre and discharge of hip fractures has seen an improvement, with time to discharge decreasing by 70.23%. Comparison of our mortality rates has seen a fourfold increase likely influenced by the detrimental effects of COVID-19. Further work and larger numbers are required to see the true impact of COVID-19 on the management and outcomes of hip fractures in our DGH.

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