scholarly journals Clinical Practice Guideline for Postoperative Rehabilitation in Older Patients With Hip Fractures

2021 ◽  
Vol 45 (3) ◽  
pp. 225-259
Author(s):  
Kyunghoon Min ◽  
Jaewon Beom ◽  
Bo Ryun Kim ◽  
Sang Yoon Lee ◽  
Goo Joo Lee ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Hip Fracture ◽  
Hip Fractures ◽  
Multidisciplinary Approach ◽  
Evaluation Method ◽  
Relevant Literature ◽  
Cochrane Library ◽  
Postoperative Phase ◽  
Postoperative Rehabilitation ◽  
Post Surgery

Objective The incidence of hip fractures is increasing worldwide with the aging population, causing a challenge to healthcare systems due to the associated morbidities and high risk of mortality. After hip fractures in frail geriatric patients, existing comorbidities worsen and new complications are prone to occur. Comprehensive rehabilitation is essential for promoting physical function recovery and minimizing complications, which can be achieved through a multidisciplinary approach. Recommendations are required to assist healthcare providers in making decisions on rehabilitation post-surgery. Clinical practice guidelines regarding rehabilitation (physical and occupational therapies) and management of comorbidities/complications in the postoperative phase of hip fractures have not been developed. This guideline aimed to provide evidence-based recommendations for various treatment items required for proper recovery after hip fracture surgeries. Methods Reflecting the complex perspectives associated with rehabilitation post-hip surgeries, 15 key questions (KQs) reflecting the complex perspectives associated with post-hip surgery rehabilitation were categorized into four areas: multidisciplinary, rehabilitation, community-care, and comorbidities/complications. Relevant literature from four databases (PubMed, EMBASE, Cochrane Library, and KoreaMed) was searched for articles published up to February 2020. The evidence level and recommended grade were determined according to the grade of recommendation assessment, development, and evaluation method. Results A multidisciplinary approach, progressive resistance exercises, and balance training are strongly recommended. Early ambulation, weigh-bearing exercises, activities of daily living training, community-level rehabilitation, management of comorbidities/complication prevention, and nutritional support were also suggested. This multidisciplinary approach reduced the total healthcare cost. Conclusion This guideline presents comprehensive recommendations for the rehabilitation of adult patients after hip fracture surgery.

scholarly journals The association of fracture risk in atrial fibrillation patients and long-term anticoagulant therapy category: a systematic review and meta-analysis

PeerJ ◽  
2021 ◽  
Vol 9 ◽  
pp. e10683
Author(s):  
Jun Chen ◽  
Lingchun Lyu ◽  
Jiayi Shen ◽  
Chunlai Zeng ◽  
Cheng Chen ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Systematic Review ◽  
Hip Fracture ◽  
Fracture Risk ◽  
Hip Fractures ◽  
Observational Studies ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Hip Fracture Risk ◽  
Significant Difference

Objective Our study aimed to assess the risk of all fractures and hip fractures in patients with atrial fibrillation (AF) who took non-vitamin K antagonist oral anticoagulants (NOACs) compared to warfarin. Methods We searched PubMed, Embase, and Cochrane Library and Clinical Trials.gov Website. Reviewed related researches up to January 31, 2020, to identify studies with more than 12 months of follow-up data. The protocol for this systematic review and meta-analysis has been registered in the International Prospective Register of Systematic Reviews (PROSPERO Number: CRD42020156893). Results We included five RCT studies, and five observational studies that contained a total of 326,846 patients in our meta-analysis. Our meta-analysis showed that patients taken NOACs had no significant all fracture risk (RR = 0.91, 95% CI [0.81–1.01]) and hip fracture risk (RR = 0.92, 95% CI [0.82–1.03]) compared with those taken warfarin. Subanalysis showed that the risk of all fractures and hip fractures treated by NOACs were significant lower compared with warfarin in observational studies compared with RCT studies. Also, a subanalysis across the duration of anticoagulation showed the NOACs users have lower all fracture risk than warfarin users when the duration of anticoagulation ≤2 years (RR = 0.89, 95% CI [0.80–0.99]). Further analysis, significant lower all fracture risk in the rivaroxaban therapy (RR = 0.81; 95% CI [0.76–0.86]) compared with warfarin but no statistical significance in hip fracture. There were no significant difference of all fracture risk and hip fracture risk in dabigatran, apixaban, and edoxaban therapy compared with warfarin. Conclusion The meta-analysis demonstrated that NOACs associated with a significantly lower all fracture risk compared with warfarin when the duration of anticoagulation more than 2 years. Rivaroxaban users had lower risk of all fracture than warfarin users in AF patients. But there was no evidence to verify apixaban, edoxaban, and dabigatranin could decrease all fracture and hip fracture risk compared with warfarin.

scholarly journals Observation on the risk of falling and self-efficacy in elderly patients with hip fracture

2019 ◽  
Vol 3 (4) ◽  
Author(s):  
Zongyou Mou ◽  
Ke Song ◽  
Jinquan Guo
Keyword(s):  
High School ◽  
Hip Fracture ◽  
Elderly Patients ◽  
Hip Fractures ◽  
Self Efficacy ◽  
School Education ◽  
High School Education ◽  
Risk Of Falling ◽  
Post Surgery ◽  
Number Of Patients

Objectives:To study the risk of falling and self-efficacy in elderly patients with hip fracture. Methodology: Forty elderly patients with hip fractures that were caused by falling were admitted into our hospital from April 2018 to April 2019, and were enrolled into this study. All patients were assessed by using the Morse Fall Scale (MFS) and Falls Efficacy Scale(FES).The basic situation of the patients with hip fractures caused by falling and the scores of MFS and FES before and after falling were evaluated. Results: Results showed that the number of patients with femoral neck fractures accounted for 70% out of all patients, and the number of patients with intertrochanteric fractures accounted for the remaining30%of the patients. The number of patients with academic qualification below primary school is 16, the number of patients with middle high school education is 11 and the number of patients with high school education and above is 13. Slipping is the cause of hip fracture that accounted for the most in patients, followed by outing activities, whereas least patients with hip fractures was caused by falling in nursing home. There were 29 patients’ whoused crutches or walking aids and this number was more than that of those who required the devices. After the MFS and FES analyses, the results (scores of MFS and FES) showed that the risk before the fall was lower. In contrast, the risk of fracture and post-surgery after the fall was greatly increased. Conclusion: The elderly patients with hip fractures were found to have increased risk of falling and thus, these patients require good care.

scholarly journals Outcome of nonoperative treatment for hip fractures in elderly patients: A systematic review of recent literature

2020 ◽  
Vol 28 (2) ◽  
pp. 230949902093684
Author(s):  
Seung-Ju Kim ◽  
Hyun-Soo Park ◽  
Dong-Woo Lee
Keyword(s):  
Hip Fracture ◽  
Elderly Patients ◽  
Health Care Providers ◽  
Hip Fractures ◽  
Fragility Fractures ◽  
Nonoperative Treatment ◽  
Cochrane Library ◽  
Care Providers ◽  
Nonsurgical Management ◽  
Tract Infections

Many studies have shown that surgical management still leads to the best outcomes in elderly patients with hip fractures, with some studies showing non-inferiority of nonsurgical management as compared to surgery in fragility fractures. Evidence-based guidelines on whether to operate on these patients are lacking. A systematic literature search was conducted regarding outcomes of nonoperatively treated hip fractures in elderly patients with various comorbidities. A structured literature review of multiple databases (PubMed, Web of Science, EMBASE, and Cochrane library) referenced articles from 2000 to 2020. A total of 596 patients from 11 published studies were identified. Mean age was 83.3 years. Overall 328 (69.7%) complications occurred in 470 patients with nonsurgical treatment. Pneumonia and urinary tract infections were the most common complications which occurred in 53 (16.1%) and 46 (14.0%) patients, respectively. Hip fracture patients who were treated nonoperatively had a higher in-hospital (17.1% vs. 4.4%; p < 0.001), 30-day (31.4% vs. 10.2%; p < 0.001), and 1-year (48.5% vs. 19.9%; p < 0.001) mortality compared to a matched group of operatively treated patients ( n = 1464). Of the 110 patients whose reported cause of death was nonoperative care, 44 (40%) was due to pneumonia. Patients with nonoperative treatment following hip fracture were associated with substantially higher complication and mortality compared with patients who were treated operatively. Our study will help health-care providers and caregivers to enable more informed decision-making for families and patients confronted with a hip fracture.

Self-Efficacy Care Program for Older Adults Receiving Hip-Fracture Surgery

2021 ◽  
pp. 105477382110014
Author(s):  
Shu-Fen Su ◽  
Shu-Ni Lin ◽  
Chia-Sui Chen
Keyword(s):  
Older Adults ◽  
Hip Fracture ◽  
Hip Fractures ◽  
Self Efficacy ◽  
Short Form ◽  
Care Program ◽  
Control Group ◽  
Hip Fracture Surgery ◽  
Post Surgery ◽  
Fracture Surgery

Hip fractures decrease older adults’ physical activity and quality of life (QoL). However, no current self-efficacy care programs are managed by clinical nurses, and thus no studies have measured their effects on self-care self-efficacy (SCSE). Hence, this quasi-experimental study determined the effectiveness of a self-efficacy care program (SECP) in 104 older adults receiving hip-fracture surgery who were divided into intervention and control groups. The Strategies Used by People to Promote Health and Short Form-36 were administered pre-surgery and at 1 and 3-month intervals post-surgery. The SCSE and QoL of the SECP group were significantly better than the control group at 1- and 3-month follow-ups post-surgery. Both groups’ QoL decreased at one-month post-surgery but increased by 3-months post-surgery. The SECP group had higher psychological QoL than the control group post-surgery. This intervention increased the SCSE and QoL of older adults with hip fractures and improved post-operative care.

scholarly journals Is hip fracture surgery safe for patients on antiplatelet drugs and is it necessary to delay surgery? A Systematic Review and Meta-analysis

2020 ◽  
Author(s):  
Zhanyu Yang ◽  
Jiangdong Ni ◽  
Ze Long ◽  
Letian Kuang ◽  
Yongquan Gao ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Antiplatelet Therapy ◽  
Hip Fractures ◽  
Meta Analysis ◽  
Platelet Aggregation Inhibitors ◽  
Early Surgery ◽  
Cochrane Library ◽  
Transfusion Rate ◽  
Hip Fracture Surgery ◽  
Keywords Hip

Abstract Background: Hip fractures are common and account for a large proportion of orthopaedic surgical admissions in elderly patients. However, determining the timing for surgery has been controversial for patients who develop with hip fractures while on antiplatelet treatment. Methods: Computerized databases for studies published from the inception date to January 2020, including the Cochrane Library, PubMed (Medline), EMBASE, Web of Science TM , ClinicalTrials, ClinicalKey and Google Scholar, were searched using the keywords “Hip AND Fracture”, “Antiplatelet”, “Antithrombocyte”, “Platelet aggregation inhibitors”, “Aspirin”, “Plavix”, and “Clopidogrel”. Results: In total, 2328 initial articles were identified. Twenty-four studies with 5423 participants were ultimately included in our analysis. Early surgery was associated with an increased transfusion rate in the antiplatelet group compared to the non-antiplatelet group (OR = 1.21; 95% CI, 1.01 to 1.44; p = 0.03). Early surgery for hip fracture patients on antiplatelet therapy was associated with a greater decrease in haemoglobin compared to delayed surgery (WMD = 0.75; 95% CI, 0.50 to 1.00; p < 0.001). However, early surgery appeared to decrease the length of hospitalization (WMD = -6.05; 95% CI, -7.06 to -5.04; p < 0.001) and mortality (OR = 0.43; 95% CI, 0.23 to 0.79; p = 0.006). Conclusion: It is unnecessary to delay surgery to restore platelet function when patients with hip fractures receive antiplatelet therapy. Furthermore, early surgery can significantly reduce mortality and hospital stay, which is conducive to patient recovery. Future randomized trials should determine whether the results are sustained over time.

scholarly journals Clinical Practice Guidelines on Ordering Echocardiography Before Hip Fracture Repair Perform Differently from One Another

2020 ◽  
Vol 16 (S2) ◽  
pp. 378-382
Author(s):  
Eric Swart ◽  
Chris Adair ◽  
Rachel B. Seymour ◽  
Madhav A. Karunakar
Keyword(s):  
Clinical Practice ◽  
Hip Fracture ◽  
Hip Fractures ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
European Society ◽  
Operative Management ◽  
Fracture Repair ◽  
British Society ◽  
Fragility Hip Fracture

Abstract Background Osteoporotic hip fractures typically occur in frail elderly patients with multiple comorbidities, and repair of the fracture within 48 h is recommended. Pre-operative evaluation sometimes involves transthoracic echocardiography (TTE) to screen for heart disease that would alter peri-operative management, yet TTE can delay surgery and is resource intensive. Evidence suggests that the use of clinical practice guidelines (CPGs) can improve care. It is unclear which guidelines are most useful in hip fracture patients. Questions/Purposes We sought to evaluate the performance of the five commonly used CPGs in determining which patients with acute fragility hip fracture require TTE and to identify common features among high-performing CPGs that could be incorporated into care pathways. Patients and Methods We performed a retrospective study of medical records taken from an institutional database of osteoporotic hip fracture patients to identify those who underwent pre-operative TTE. History and physical examination findings were recorded; listed indications for TTE were compared against those given in five commonly used CPGs: those from the American College of Cardiology/American Heart Association (ACC/AHA), the British Society of Echocardiography (BSE), the European Society of Cardiology and the European Society of Anaesthesiology(ESC/ESA), the Association of Anaesthetists of Great Britain and Ireland (AAGBI), and the Scottish Intercollegiate Guidelines Network (SIGN). We then calculated the performance (sensitivity and specificity) of the CPGs in identifying patients with TTE results that had the potential to change peri-operative management. Results We identified 100 patients who underwent pre-operative TTE. Among those, the patients met criteria for TTE 32 to 66% of the time, depending on the CPG used. In 14% of those receiving TTE, the test revealed new information with the potential to change management. The sensitivity of the CPGs ranged from 71% (ESC/ESA and AAGBI) to 100% (ACC/AHA and SIGN). The CPGs’ specificity ranged from 37% (BSE) to 74% (ESC/ESA). The more sensitive guidelines focused on a change in clinical status in patients with known disease or clinical concern regarding new-onset disease. Conclusions In patients requiring fixation of osteoporotic hip fractures, TTE can be useful for identifying pathologies that could directly change peri-operative management. Our data suggest that established CPGs can be safely used to identify which patients should undergo pre-operative TTE with low risk of missed pathology.

scholarly journals Graduated compression stockings in hip fractures

2012 ◽  
Vol 94 (7) ◽  
pp. 463-467 ◽  
Author(s):  
A Alsawadi ◽  
M Loeffler
Keyword(s):  
Venous Thromboembolism ◽  
Hip Fracture ◽  
Hip Fractures ◽  
Literature Search ◽  
Significant Risk ◽  
Sufficient Evidence ◽  
Cochrane Library ◽  
Reference List ◽  
Compression Stockings ◽  
Graduated Compression Stockings

INTRODUCTION Hip fractures are the most common cause of acute admissions to orthopaedics and in the UK approximately 70,000–75,000 hip fractures occur annually. Hip fractures carry a significant risk of developing a venous thromboembolism. The National Institute for Health and Clinical Excellence (NICE) estimated that the risk of developing a venous thromboembolism in patients with hip fractures who do not receive thromboprophylaxis is 43%. In their recent guidelines, NICE recommended that combined mechanical and pharmacological thromboprophylaxis should be offered to patients undergoing hip fracture surgery and mechanical prophylaxis should be commenced at admission. The aim of this review was to search for available evidence that could support using graduated compression stockings combined with low molecular weight heparin (LMWH) in hip fracture patients. METHODS NICE guidelines and the reference list of the guidance were reviewed and a thorough literature search was performed on main electronic databases (MEDLINE®, Embase™ and the Cochrane Library). RESULTS A literature search was unable to find sufficient evidence to support the use of graduated compression stockings combined with LMWH in hip fracture settings. The guidelines are critically reviewed and the available evidence discussed. CONCLUSIONS The evidence supporting these recommendations is very limited and there is considerable concern regarding the safety and efficacy of the mechanical devices used in thromboprophylaxis. Further studies are needed urgently before specific guidelines can be agreed confidently for patients with hip fractures.

scholarly journals Haemoglobin and transfusions in elderly patients with hip fractures: the effect of a dedicated orthogeriatrician

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Marco Quaranta ◽  
Luca Miranda ◽  
Francesco Oliva ◽  
Filippo Migliorini ◽  
Gabriela Pezzuti ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Hip Fracture ◽  
Blood Loss ◽  
Elderly Patients ◽  
Hip Fractures ◽  
Length Of Hospital Stay ◽  
Primary Objective ◽  
Post Surgery ◽  
Stay Time ◽  
Orthopaedic Ward

Abstract Background Hip fractures are common in elderly patients, in whom it is important to monitor blood loss; however, unnecessary transfusions should be avoided. The primary objective of this study was to assess whether the employment of a dedicated orthogeriatrician in an Orthopaedic Department allows to optimise the clinical conditions of patients, influencing blood loss and consequently the number of transfusions. The secondary objective was to determine whether the influence of the orthogeriatrician differs according to the type of surgical treatment. Methods A total of 620 elderly patients treated for hip fracture were included in the study. These patients were divided into two groups according to the presence or not of the orthogeriatrician. For each patient, age, sex, comorbidities, type of fracture, surgical treatment, length of hospital stay, time from hospitalisation and surgery, time from surgery to discharge, haemoglobin (Hb) values (admission, 24h post-surgery, lowest Hb reached, discharge) and the number of transfusions were recorded. Results Regardless of the surgical procedure performed, in patients managed by the orthogeriatrician, the Hb at discharge was significantly higher (p = 0.003). In addition to the highest Hb at discharge, in patients who underwent hemiarthroplasty, the number of transfusions per patient is significantly reduced (p = 0.03). Conclusion The introduction of the orthogeriatrician in an orthopaedic ward for the management of elderly patients treated for hip fracture allows to discharge the patients with higher Hb values, reducing the risk of anemisation and the costs related to possible re-admission.

scholarly journals Predictors of poor functional outcomes and mortality in patients with hip fracture: a systematic review

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Bang Yu Xu ◽  
Shi Yan ◽  
Lian Leng Low ◽  
Farhad Fakhrudin Vasanwala ◽  
Sher Guan Low
Keyword(s):  
Systematic Review ◽  
Hip Fracture ◽  
Grip Strength ◽  
Hip Fractures ◽  
Functional Outcomes ◽  
Medical Condition ◽  
Hand Grip Strength ◽  
Adverse Outcomes ◽  
Cochrane Library ◽  
Hand Grip

Abstract Background Hip fracture is an important and prevalent medical condition associated with adverse outcomes. The aim of this article is to systematically review and summarise the predictors of poor functional outcomes and mortality for patients with hip fractures. Methods We conducted a systemic literature search using PubMed, EMBASE and Cochrane Library. We included English peer-reviewed cohort studies that examined predictors of poor functional outcomes (such as independence in Activities of Daily Living) and mortality for patients with hip fracture published in the past 15 years (from 1 Jan 2004 up to 30 May 2019). Two independent researchers evaluated the articles for eligibility. Consensus on the eligibility was sought and a third researcher was involved if there was disagreement. A standardised form was used to extract relevant data. The Newcastle-Ottawa Scale (NOS) was used to assess the quality of the included studies. Results We retrieved 4339 and included 81 articles. We identified two emerging predictors of poor functional outcomes and mortality for patients with hip fractures: low hand grip strength and frailty in line with an emerging concept of “physical performance”. The predictors identified in this systematic review can be grouped into 1) medical factors, such as presence of co-morbidities, high American Society of Anesthesiologists (ASA) grade, sarcopenia, 2) surgical factors including delay in operation (e.g. > 48 h), type of fracture s, 3) socio-economic factors which include age, gender, ethnicity, and 4) system factors including lower case-volume centers. Conclusions This systematic review identified multiple significant predictors of poor functional outcomes and mortality, with the hand grip strength and frailty being important emerging predictors in the most recent literature. These predictors would further inform healthcare providers of their patients’ health status and allow for early intervention for modifiable predictors.

The role of digital health for post-surgery care of older patients with hip fracture: a scoping review (Preprint)

2021 ◽  
Author(s):  
Jing Zhang ◽  
Yufeng Ge ◽  
Minghui Yang ◽  
Rebecca Ivers ◽  
Ruth Webster ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Older People ◽  
Integrated Care ◽  
Scoping Review ◽  
Digital Health ◽  
Health Interventions ◽  
Cochrane Library ◽  
Post Surgery ◽  
Care For Older People

BACKGROUND Digital health interventions have the potential to improve the integration of health care at all system levels. Hip fracture is a serious injury for older people and integrated post-surgery care for hip fracture is vital for good recovery. OBJECTIVE The aim of this study was to understand and characterise digital health interventions used for hip fracture post-surgery care, and further to examine the extent to which of these digital health interventions address the six domains of the World Health Organisation (WHO) integrated care for older people framework. METHODS A scoping review was conducted, by searching the literature from English and Chinese electronic databases and trial registries, including Medline, EMBASE, ProQuest, PsycINFO, The Cochrane library, CINAHL, Open Science Framework, Clinicaltrials.gov, VIP, China National Knowledge of Infrastructure (CNKI) and Wanfang. Keywords used in the English database included hip fracture, post-surgery care and digital health interventions, while Chinese keywords included “Kuan Bu Gu Zhe (hip fracture)”, “Shu Hou Kang Fu (post-surgery care)” and “Shu Zi Jian Kang (digital health)”. Interventional, observational, qualitative studies as well as case reports and study reports were included in this study. We used a combined framework, the WHO integrated care for older people and WHO digital health intervention classifications, to support data synthesis. RESULTS A total of 4,542 articles were identified, of which 39 studies were included in the analysis. We identified only six randomised controlled trials. Digital health interventions were mainly used to help doctors provide clinical care and facilitate service delivery between the patients, caregivers and health providers. No studies focused on health workforce, financial policy or the development of infrastructure. The primary users of digital health interventions were limited to healthcare providers and patients, with no studies involving healthcare managers or the use of data services to support the data collection, management, use and exchange. From the post-surgery care perspective, most digital health interventions focused on physical therapy, bone protection and falls prevention. The functionalities of digital health interventions were mainly limited to health education or promotion and providing remote services. There were limited interventions implemented in low-and middle-income countries. CONCLUSIONS There are opportunities to expand the use of digital health for post-surgery care of hip fracture patients, but this requires a stronger evidence base, including high-quality larger-scale studies, more focus on application in resource-constrained settings, expanding to more users and capabilities of interventions, and exploring the role of digital health for the integrated care model to mitigate health system challenges.

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