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Sample records for fractures patients aged

  1. Sociomedical sequels and quality of life in patients of old age group with proximal femoral fractures

    T. A. Raskina

    2014-01-01

    Full Text Available The sociomedical significance of osteoporosis is determined by its sequels (vertebral and peripheral skeletal fractures that are responsible for high mortality and disability rates among persons in the old age group and accordingly for high material costs in the health care system.Objective: to study sociomedical sequels and quality of life in patients with proximal femoral fractures in the old age group.Subjects and methods. 956 patients with osteoporotic fractures were followed up. Major social sequels were traced in the patients 6, 12, and 24 months after femur fractures in relation to treatment options.Results. There were 10 (8.0% and 78 (66.7% bedridden patients in the surgical and medical treatment groups, respectively. Twenty four months after fracture, recovery of function was noted in 72 (57.6% and 32 (27.35% patients receiving surgical and medical treatment, respectively.Conclusion. The findings suggest that immediate and late sequels in patients with proximal femoral fractures depend on a treatment option.

  2. Comparison of the prognosis among different age groups in elderly patients with hip fracture

    Hagino Tetsuo

    2008-01-01

    Full Text Available Background: The outcome of treatment of hip fractures in different age groups in the elderly population is largely unknown. Hence, we stratified elderly patients with hip fracture into age groups and compared the prognosis in various age groups. Materials and Methods: Among 459 patients with hip fracture treated at our hospital from 1997, 430 patients aged 65 years or above at the time of injury were studied. The patients comprised 98 males and 332 females and the ages at injury ranged from 65 to 103 years (mean 83.4 years. There were 167 cases of femoral neck fracture and 263 cases of trochanteric fractures. Surgery was performed in 383 cases, while 47 cases were treated conservatively. The subjects were classified by age into young-old for those aged 65-74 years (group A, n = 55, middle-old for those aged 75-84 years (group B, n = 172, old-old for those aged 85-94 (group C, n = 180, and oldest-old for those aged 95 years or above (group D, n = 23. The functional and survival prognosis at discharge in each group was investigated. Results: Numbers of patients who were ambulatory at discharge among those ambulatory before injury were 43 of 49 (87.8% in group A, 113 of 152 (74.3% in group B, 86 of 138 (62.3% in group C, and 5 of 14 (35.7% in group D, showing worse recovery of walking ability as age advanced. Among those ambulatory before injury, 42 patients in group A, 139 patients in group B, 130 patients in group C, and 12 patients in group D underwent surgery and of these patients, 38 patients (90.5% in group A, 109 patients (78.4% in group B, 83 patients (63.8% in group C, and 5 patients (41.7% in group D were ambulatory at discharge. On the other hand, the numbers of patients who were ambulatory at discharge among those receiving conservative treatment were 5 of 7 (71.4% in group A, 4 of 13 (30.8% in group B, 3 of 8 (37.5% in group C, and 0 of 2 (0% in group D, showing better walking ability in surgical patients than in conservatively treated

  3. Role of BMI and age in predicting pathologic vertebral fractures in newly diagnosed multiple myeloma patients: A retrospective cohort study.

    Chen, Yi-Lun; Liu, Yao-Chung; Wu, Chia-Hung; Yeh, Chiu-Mei; Chiu, Hsun-I; Lee, Gin-Yi; Lee, Yu-Ting; Hsu, Pei; Lin, Ting-Wei; Gau, Jyh-Pyng; Hsiao, Liang-Tsai; Chiou, Tzeon-Jye; Liu, Jin-Hwang; Liu, Chia-Jen

    2018-04-01

    Vertebral fractures affect approximately 30% of myeloma patients and lead to a poor impact on survival and life quality. In general, age and body mass index (BMI) are reported to have an important role in vertebral fractures. However, the triangle relationship among age, BMI, and vertebral fractures is still unclear in newly diagnosed multiple myeloma (NDMM) patients. This study recruited consecutive 394 patients with NDMM at Taipei Veterans General Hospital between January 1, 2005 and December 31, 2015. Risk factors for vertebral fractures in NDMM patients were collected and analyzed. The survival curves were demonstrated using Kaplan-Meier estimate. In total, 301 (76.4%) NDMM patients were enrolled in the cohort. In the median follow-up period of 18.0 months, the median survival duration in those with vertebral fractures ≥ 2 was shorter than those with vertebral fracture BMI BMI ≥ 24.0 kg/m 2 (adjusted RR, 2.79; 95% CI, 1.44-5.43). In multivariable logistic regression, BMI BMI ≥ 24.0 kg/m 2 (adjusted OR, 6.05; 95% CI, 2.43-15.08). Among age stratifications, patients with both old age and low BMI were at a greater risk suffering from increased vertebral fractures, especially in patients > 75 years and BMI BMI. Elder patients with low BMI should consider to routinely receive spinal radiographic examinations and regular follow-up. Copyright © 2017 John Wiley & Sons, Ltd.

  4. Auckland City Hospital's Ortho-Geriatric Service: an audit of patients aged over 65 with fractured neck of femur.

    Wimalasena, Bodhi; Harris, Roger

    2016-07-01

    The aims of this audit were to collect the Minimum Data Set outlined by the Australia New Zealand Hip Fracture Registry (ANZHFR), assess patient characteristics, analyse process of care, and evaluate how this compares to NICE guidelines for hip fracture care, as well as to Auckland Hospital data from 2007. Retrospective case record audit of patients with fractured neck of femur aged 65 years and over admitted under Orthopaedics over a 4-month period in 2013. Ninety-one patients were audited; mean age was 83 years, 68% were female. Both inpatient and 30-day mortality was 5%. 120-day mortality was 15%. Seventy-six percent of patients were admitted from ED within the national health target prescribed period of 6 hours. Only one patient was treated non-surgically. Eighty-six percent had surgery within 48 hours of admission. Eighty-two percent of patients had rehabilitation and treatment by Older People's Health. Of those living at home pre-fracture, 76% returned home on discharge. Thirty-seven percent of patients were able to walk unaided prior to hip fracture, but only 1% on discharge. Average overall length of stay was 22 days. Bisphosphonates were prescribed for 56% of patients. Compared to 2007, Auckland City Hospital has demonstrated a significant improvement in the rate of provision of timely surgery for hip fracture patients. Most patients are receiving the guideline recommended fracture-specific surgical interventions. The assessment and treatment of osteoporosis needs further attention.

  5. Routine functional assessment for hip fracture patients

    Pedersen, Tonny J; Lauritsen, Jens M

    2016-01-01

    Background and purpose - Pre-fracture functional level has been shown to be a consistent predictor of rehabilitation outcomes in older hip fracture patients. We validated 4 overall pre-fracture functional level assessment instruments in patients aged 65 or more, used the prediction of outcome at 4...... months post-fracture, and assessed cutoff values for decision making in treatment and rehabilitation. Patients and methods - 165 consecutive patients with acute primary hip fracture were prospectively included in the study. Pre-fracture Barthel-20, Barthel-100, cumulated ambulation score, and new...... investigation of usage for guidance of clinical and rehabilitation decisions concerning hip fracture patients is warranted....

  6. Prevalence of protein-energy malnutrition in hospital patients over 75 years of age admitted for hip fracture.

    Drevet, S; Bioteau, C; Mazière, S; Couturier, P; Merloz, P; Tonetti, J; Gavazzi, G

    2014-10-01

    One percent of falls in over-75 years old cause hip fracture (HF). Protein-energy malnutrition (PEM) is associated with falls and fracture. PEM screening and perioperative nutritional management are recommended by the European Society of Parenteral and Enteral Nutrition, yet data on nutritional status in elderly HF patients are sparse. The Mini Nutritional Assessment (MNA) score is presently the most effective screening tool for PEM in over-75 years old. The principal objective of the present study was to determine the prevalence on MNA of PEM in patients aged over 75 years admitted for HF. Secondary objectives were to identify factors associated with PEM and its role as a factor of evolution. A prospective observational epidemiological study included 50 patients aged over 75 years admitted for HF in an 8-bed orthopedic surgery department with a geriatric follow-up unit. PEM was defined by MNApatients was 86.1 years (range, 77-94 years). Prevalence of PEM was 28%; a further 58% of patients were at risk for PEM. PEM was associated with elevated CIRS-G (Ppatients aged over 75 years, supporting longer hospital stay. MNA is a diagnostic gold standard, not to be replaced by albuminemia or body-mass index in this perioperative clinical situation. Given the present economic stakes relating to geriatric trauma patients' hospital stay, it is essential to prevent, diagnose and treat PEM in elderly subjects. Level IV; prospective cohort study. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  7. Isolated rib fractures in geriatric patients

    Elmistekawy, Elsayed M.; Hammad, Abd Almohsen M.

    2007-01-01

    Introduction: The goal of this study was to investigate the short-term outcomes in patients older than 60 years with isolated rib fractures and admitted to emergency hospital. Materials and Methods: This study included patients who were 60 years old or more and sustained blunt chest injury and had isolated rib fractures. The following data were obtained from the medical records: age, gender, number of fracture ribs, side of fracture ribs, mechanism and nature of injury, preexisting medical...

  8. Mortality in patients with pelvic fractures

    Hauschild, Oliver; Strohm, Peter C; Culemann, Ulf

    2008-01-01

    hospitals were evaluated for age, gender, Injury Severity Score (ISS), Hannover Polytrauma Score (PTS), fracture type (using Tile's classification), peripelvic soft tissue injury, need for emergency measures, mortality, cause of death, and need for operative stabilization. We compared the patients...

  9. Risk factors of avascular necrosis of the femoral head and fixation failure in patients with valgus angulated femoral neck fractures over the age of 50 years.

    Song, Hyung Keun; Choi, Ho June; Yang, Kyu Hyun

    2016-12-01

    The aim of our study was to identify the risk factors for avascular necrosis of the femoral head (AVN) and fixation failure (FF) after screw osteosynthesis in patients with valgus angulated femoral neck fractures. We conducted a retrospective study of 308 patients (mean age, 72.5 years, range, 50-97 years), with a mean follow-up of 21.4 months (range, 12-64 months). The risk for failure in treatment (FIT) associated with patient- and fracture-related factors was evaluated by logistic regression analyses. FIT was identified in 32 cases (10.3%): 22 cases (7.1%) of AVN and 10 cases (3.2%) of FF. Initial valgus tilt>15° (p=0.023), posterior tilt>15° (p=0.012), and screw sliding distance (p=0.037) were significantly associated with FIT. FIT occurred in 7 patients (5.2%) with B1.2.1 fractures and 17 patients (48.6%) with B1.1.2 fractures (p15° (B1.1.2) compared to patients with 15° are reasonable candidates for primary arthroplasty due to high risk of FIT. Copyright © 2016 Elsevier Ltd. All rights reserved.

  10. Logistic regression analysis of factors associated with avascular necrosis of the femoral head following femoral neck fractures in middle-aged and elderly patients.

    Ai, Zi-Sheng; Gao, You-Shui; Sun, Yuan; Liu, Yue; Zhang, Chang-Qing; Jiang, Cheng-Hua

    2013-03-01

    Risk factors for femoral neck fracture-induced avascular necrosis of the femoral head have not been elucidated clearly in middle-aged and elderly patients. Moreover, the high incidence of screw removal in China and its effect on the fate of the involved femoral head require statistical methods to reflect their intrinsic relationship. Ninety-nine patients older than 45 years with femoral neck fracture were treated by internal fixation between May 1999 and April 2004. Descriptive analysis, interaction analysis between associated factors, single factor logistic regression, multivariate logistic regression, and detailed interaction analysis were employed to explore potential relationships among associated factors. Avascular necrosis of the femoral head was found in 15 cases (15.2 %). Age × the status of implants (removal vs. maintenance) and gender × the timing of reduction were interactive according to two-factor interactive analysis. Age, the displacement of fractures, the quality of reduction, and the status of implants were found to be significant factors in single factor logistic regression analysis. Age, age × the status of implants, and the quality of reduction were found to be significant factors in multivariate logistic regression analysis. In fine interaction analysis after multivariate logistic regression analysis, implant removal was the most important risk factor for avascular necrosis in 56-to-85-year-old patients, with a risk ratio of 26.00 (95 % CI = 3.076-219.747). The middle-aged and elderly have less incidence of avascular necrosis of the femoral head following femoral neck fractures treated by cannulated screws. The removal of cannulated screws can induce a significantly high incidence of avascular necrosis of the femoral head in elderly patients, while a high-quality reduction is helpful to reduce avascular necrosis.

  11. Hip fracture in hospitalized medical patients.

    Zapatero, Antonio; Barba, Raquel; Canora, Jesús; Losa, Juan E; Plaza, Susana; San Roman, Jesús; Marco, Javier

    2013-01-08

    The aim of the present study is to analyze the incidence of hip fracture as a complication of admissions to internal medicine units in Spain. We analyzed the clinical data of 2,134,363 adults who had been admitted to internal medicine wards. The main outcome was a diagnosis of hip fracture during hospitalization.Outcome measures included rates of in-hospital fractures, length of stay and cost. A total of 1127 (0.057%) admittances were coded with an in-hospital hip fracture. In hospital mortality rate was 27.9% vs 9.4%; p patients with a hip fracture (20.7 days vs 9.8 days; p hip-fracture patients (6927€ per hospitalization vs 3730€ in non fracture patients). Risk factors related to fracture were: increasing age by 10 years increments (OR 2.32 95% CI 2.11-2.56), female gender (OR 1.22 95% CI 1.08-1.37), admission from nursing home (OR 1.65 95% CI 1.27-2.12), dementia (1.55 OR 95% CI1.30-1.84), malnutrition (OR 2.50 95% CI 1.88-3.32), delirium (OR 1.57 95% CI 1.16-2.14), and anemia (OR 1.30 95%CI 1.12-1.49). In-hospital hip fracture notably increased mortality during hospitalization, doubling the mean length of stay and mean cost of admission. These are reasons enough to stress the importance of designing and applying multidisciplinary plans focused on reducing the incidence of hip fractures in hospitalized patients.

  12. Isolated rib fractures in geriatric patients

    Elmistekawy Elsayed

    2007-01-01

    Full Text Available Introduction: The goal of this study was to investigate the short-term outcomes in patients older than 60 years with isolated rib fractures and admitted to emergency hospital. Materials and Methods: This study included patients who were 60 years old or more and sustained blunt chest injury and had isolated rib fractures. The following data were obtained from the medical records: age, gender, number of fracture ribs, side of fracture ribs, mechanism and nature of injury, preexisting medical conditions, complications, admission to intensive care unit (ICU, need for mechanical ventilation, length of ICU and hospital stay and mortality. Results: For the study, 39 patients who were 60 years old or more and admitted to the hospital because of isolated rib fractures were enrolled. There were 28 males (71.7% and 11 females (28.3% with mean age of (66.84 ± 4.7 years. No correlation was found between comorbidities and hospital outcomes except in those who were diabetic (P-value = 0.005 and those with chronic lung disease (P-value = 0.006. Pulmonary complications were the most frequent complications encountered in those patients. Pulmonary complications were: lung contusion in 8 patients (20.5% and pulmonary infection in 6 patients (15.8%. Conclusion: Elderly patients sustaining blunt chest trauma had significant morbidity and potential for mortality.

  13. [Clinical pathway for hip fracture patients].

    Sáez López, Pilar; Sánchez Hernández, Natalia; Paniagua Tejo, Sonsoles; Valverde García, José Antonio; Montero Díaz, Margarita; Alonso García, Noelia; Freites Esteve, Alfonso

    2015-01-01

    Hip fracture in the elderly often occurs in patients with high co-morbidity. Effective management requires a comprehensive and multidisciplinary approach. To evaluate the effect of a quality improvement intervention in the detection and treatment of complications in elderly patients admitted for hip fracture. A comparative study was conducted between two groups of patients admitted for hip fracture prior to 2010, and after a quality improvement intervention in 2013. The intervention consisted of implementing improved multidisciplinary measures in accordance with recent scientific evidence. The degree of compliance of the implemented measures was quantified. Patients admitted due to hip fracture in 2010 (216 patients) and 2013 (196 patients) were similar in age, sex, Barthel Index, and a reduced Charlson Index, although there were more comorbidities in 2013. After implementation of the protocols, the detection of delirium, malnutrition, anemia, and electrolyte disturbances increased. A larger number of patients in 2013 were precribed intravenous iron (24% more) and osteoporosis treatment (61.3% more). The average stay was reduced by 45.3% and surgical delay by 29.4%, achieving better functional efficiency. The implementation of a clinical pathway in geriatric patients with hip fracture is useful to detect and treat complications at an early stage, and to reduce pre-operative and overall stay, all without a negative clinical or functional impact. Copyright © 2014 SEGG. Published by Elsevier Espana. All rights reserved.

  14. HIP FRACTURES IN THE ELDERLY PATIENT

    Franci Koglot

    2001-11-01

    Full Text Available Background. Hip fractures are typical of the ageingpopulation. They represent a severe trauma for the elderlypatient due to significant impact on life quality and morbidity.We analyzed the characteristics of patients with hip fractures,the methods and success of treatment. In conclusion, theimportance of continuous team approach and surgical treatmentwithin 24 hours are stressed. Methods. We retrospectively evaluated patients admitted forfemoral neck and intertrochanteric fractures between 1994–1999. The incidence of these fractures, patient age and sex, comorbidity,methods of treatment, hospital stay and success oftreatment with regard to ambulatory status were established.Results. 662 patients were treated in the above mentioned period,yielding a 1‰ annual incidence for the choosen population.The mean patient age was 76 years; there were 426 female(64% and 236 male patients (36%. 336 patients (51%had a history of accompanying disease, in 73 patients (11%additional fractures were diagnosed. 30 patients (4.5% weretreated conservatively, 632 (95.5% underwent surgery. Themean hospital stay length was 17 days. Success of treatmentwas evaluated as good in 441 patients (67%, satisfactory in112 patients (17% and poor in 78 patients (12%. 31 patients(5% died during hospital admission. Conclusions. Patients with hip fractures represent 10% of allin-hospital trauma patients; with hospital stays twice as longas average trauma patients and considering the financial demandsof surgical treatment they are a challenge in traumawards organization and management in the Slovenian environment.Here as well as abroad the number of these patientsis increasing, along with their mean age and co-morbidity. Itis evident that hip fractures, regardless the way of treatment,implicate a partial or complete loss of ambulancy and henceloss of life-quality in one-third of patients. We advise early aspossible surgery –within 24 h– where not absolutely

  15. Survival of 534 incisors after intra-alveolar root fracture in patients aged 7-17 years

    Cvek, M.; Tsilingaridis, G.; Andreasen, Jens Ove

    2008-01-01

    The purpose of the study was to evaluate and assess the survival rate of 534 root fractured teeth, including factors that may affect the survival rate but were not included in previous long-term studies. Location of fracture was registered as in the cervical, cervical/middle, middle and apical on...

  16. Studies on hip fracture patients : effects of nutrition and rehabilitation

    Flodin, Lena

    2015-01-01

    Hip fracture in the elderly is a serious condition associated with increased mortality. Survivors experience an increase in morbidity and disability that affect their independence and quality of life; the outcome for patients with dementia is particularly poor. Many hip fracture patients have signs of malnutrition already on admission and this patient group has been shown to have a lower body mass index (BMI) than aged-matched controls. A catabolic state develops following hip fracture, chara...

  17. Fracture, aging and disease in bone

    Ager, J.W.; Balooch, G.; Ritchie, R.O.

    2006-02-01

    From a public health perspective, developing a detailed mechanistic understanding of the well-known increase in fracture risk of human bone with age is essential. This also represents a challenge from materials science and fracture mechanics viewpoints. Bone has a complex, hierarchical structure with characteristic features ranging from nanometer to macroscopic dimensions; it is therefore significantly more complex than most engineering materials. Nevertheless, by examining the micro-/nano-structural changes accompanying the process of aging using appropriate multiscale experimental methods and relating them to fracture mechanics data, it is possible to obtain a quantitative picture of how bone resists fracture. As human cortical bone exhibits rising ex vivo crack-growth resistance with crack extension, its fracture toughness must be evaluated in terms of resistance-curve (R-curve) behavior. While the crack initiation toughness declines with age, the more striking finding is that the crack-growth toughness declines even more significantly and is essentially absent in bone from donors exceeding 85 years in age. To explain such an age-induced deterioration in the toughness of bone, we evaluate its fracture properties at multiple length scales, specifically at the molecular and nanodimensions using pico-force atomic-force microscopy, nanoindentation and vibrational spectroscopies, at the microscale using electron microscopy and hard/soft x-ray computed tomography, and at the macroscale using R-curve measurements. We show that the reduction in crack-growth toughness is associated primarily with a degradation in the degree of extrinsic toughening, in particular involving crack bridging, and that this occurs at relatively coarse size-scales in the range of tens to hundreds of micrometers. Finally, we briefly describe how specific clinical treatments, e.g., with steroid hormones to treat various inflammatory conditions, can prematurely damage bone, thereby reducing its

  18. Opioids, antiepileptic and anticholinergic drugs and the risk of fractures in patients 65 years of age and older: a prospective population-based study.

    Nurminen, Janne; Puustinen, Juha; Piirtola, Maarit; Vahlberg, Tero; Lyles, Alan; Kivelä, Sirkka-Liisa

    2013-05-01

    in men, the concomitant use of two or more benzodiazepines or two or more antipsychotics is associated with an increased risk of fracture(s). Potential associations between the concomitant use of drugs with central nervous system effects and fracture risk have not been studied. the purpose was to describe the gender-specific risk of fractures in a population aged 65 years or over associated with the use of an opioid, antiepileptic or anticholinergic drug individually; or, their concomitant use with each other; or the concomitant use of one of these with a psychotropic drug. this study was part of a prospective, population-based study performed in Lieto, Finland. Information about fractures in 1,177 subjects (482 men and 695 women) was confirmed with radiology reports. at 3 years of follow-up, the concomitant use of an opioid with an antipsychotic was associated with an increased risk of fractures in men. During the 6-year follow-up, the concomitant use of an opioid with a benzodiazepine was also related to the risk of fractures for males. No significant associations were found for females. the concomitant use of an opioid with an antipsychotic, or with a benzodiazepine may increase the risk of fractures in men aged 65 years and older.

  19. Importance of a patient-centred approach in ensuring quality of post-fracture rehabilitation for working aged people: A qualitative study of therapists' and patients' perspectives.

    Lindahl, Marianne; Teljigović, Sanel; Heegaard Jensen, Lars; Hvalsoe, Berit; Juneja, Hemant

    2016-01-01

    Quality in rehabilitation is important for recovery and return to work for people at working age, who sustain fractures, but there is limited information about what constitutes quality in rehabilitation. To identify factors that therapists and patients define as quality in the rehabilitation process for working population after simple or multiple fractures. The study is a qualitative study based on grounded theory approach with semi-structured interviews conducted individually or in focus groups. Seven patients with fractures, 15 physiotherapists and eight occupational therapists from hospitals, municipalities and private practice were included in the study. Grounded theory was used to analyze data and develop a theory about quality in the rehabilitation process. Partnership was identified as the core category with continuity of rehabilitation and patient-centred approach as its dimensions. Themes in the patient-centred approach were Biopsychosocial understanding and Professionalism. The patient's perceived control enhanced when the therapist addressed the whole situation, especially return to work. Therapist's individual considerations and patient's involvement in decisions about the therapeutic methods had the same effect. Quality in rehabilitation was enhanced in all its dimensions namely structure, process and outcome when therapists used the patient-centred approach and addressed the patient's overall situation.

  20. PSYCHIATRIC EVALUATION OF LIMB FRACTURE PATIENTS

    CHAUDHURY, S; JOHN, TR; KUMAR, A; SINGH, HARCHARAN

    2002-01-01

    The study included 70 consecutive patients with fracture of the lower and upper limbs each and an equal number of age and sex matched normal control subjects. All the subjects were screened using the General Health Questionnaire (GHQ), the Michigan Alcoholism Screening Test (MAST), Carroll Rating Scale for Depression (CRSD), State-Trait Anxiety Inventory (STAI), Impact of Events Scale (IES), Fatigue Scale (FS) and the Perceived Stress Questionnaire (PSQ). Probable “Psychiatric cases” identifi...

  1. Survival times of patients with a first hip fracture with and without subsequent major long-bone fractures.

    Angthong, Chayanin; Angthong, Wirana; Harnroongroj, Thos; Naito, Masatoshi; Harnroongroj, Thossart

    2013-01-01

    Survival rates are poorer after a second hip fracture than after a first hip fracture. Previous survival studies have included in-hospital mortality. Excluding in-hospital deaths from the analysis allows survival times to be evaluated in community-based patients. There is still a lack of data regarding the effects of subsequent fractures on survival times after hospital discharge following an initial hip fracture. This study compared the survival times of community-dwelling patients with hip fracture who had or did not have a subsequent major long-bone fracture. Hazard ratios and risk factors for subsequent fractures and mortality rates with and without subsequent fractures were calculated. Of 844 patients with hip fracture from 2000 through 2008, 71 had a subsequent major long-bone fracture and 773 did not. Patients who died of other causes, such as perioperative complications, during hospitalization were excluded. Such exclusion allowed us to determine the effect of subsequent fracture on the survival of community-dwelling individuals after hospital discharge or after the time of the fracture if they did not need hospitalization. Demographic data, causes of death, and mortality rates were recorded. Differences in mortality rates between the patient groups and hazard ratios were calculated. Mortality rates during the first year and from 1 to 5 years after the most recent fracture were 5.6% and 1.4%, respectively, in patients with subsequent fractures, and 4.7% and 1.4%, respectively, in patients without subsequent fractures. These rates did not differ significantly between the groups. Cox regression analysis and calculation of hazard ratios did not show significant differences between patients with subsequent fractures and those without. On univariate and multivariate analyses, age fracture. This study found that survival times did not differ significantly between patients with and without subsequent major long-bone fractures after hip fracture. Therefore, all

  2. Orthogeriatric Service Reduces Mortality in Patients With Hip Fracture

    Stenqvist, Charlotte; Madsen, Christian Medom; Riis, Troels

    2016-01-01

    INTRODUCTION: Orthogeriatric service has been shown to improve outcomes in patients with hip fracture. The purpose of this study is to evaluate the effect of orthogeriatrics at Bispebjerg University Hospital, Denmark. The primary outcome is mortality inhospital and after 1, 3, and 12 months...... for patients with hip fracture. The secondary outcome is mortality for home dwellers and nursing home inhabitants. MATERIALS AND METHODS: This is a retrospective clinical cohort study with an historic control group including all patients with hip fracture admitted from 2007 to 2011. Patients with hip fracture...... = .009) after orthogeriatrics. However, when adjusting for age, gender, and American Society of Anaesthesiologists (ASA) score in a multivariate analysis, including all patients with hip fracture, we find significantly reduced mortality inhospital (odds ratio [OR] 0.35), after 30 [OR 0.66] and 90 days...

  3. Factors affecting functional prognosis of patients with hip fracture

    Kristensen, M T

    2011-01-01

    to just one or two single factors. The current article reviews important factors affecting the functional prognosis, and clinicians are encouraged to include all factors potentially influencing the outcome of patients with hip fracture in their individualised treatment and rehabilitation plan. Especially......Having a hip fracture is considered one of the most fatal fractures for elderly people, resulting in impaired function, and increased morbidity and mortality. This challenges clinicians in identifying patients at risk of worse outcome, in order to optimise and intensify treatment in these patients....... A variety of factors such as age, prefracture function and health status, fracture type, pain, anaemia, muscle strength, and the early mobility level have been shown to influence patient outcome. Thus, the outcome of patients with hip fracture is considered multi-factorial, and can therefore not be related...

  4. Subtrochanteric fractures in bisphosphonate-naive patients

    Adachi, Jonathan D; Lyles, Kenneth; Boonen, Steven

    2011-01-01

    Our purpose was to characterize the risks of osteoporosis-related subtrochanteric fractures in bisphosphonate-naive individuals. Baseline characteristics of patients enrolled in the HORIZON-Recurrent Fracture Trial with a study-qualifying hip fracture were examined, comparing those who sustained ...

  5. Cardiovascular Risk Factor Analysis in Patients with a Recent Clinical Fracture at the Fracture Liaison Service

    Caroline E. Wyers

    2014-01-01

    Full Text Available Patients with a low bone mineral density have an increased risk of cardiovascular diseases (CVD and venous thromboembolic events (VTE. The aim of our retrospective chart review was to investigate the prevalence of CVD, VTE, hypertension (HT, and diabetes mellitus type 2 (DM2 in patients with a recent clinical fracture visiting the Fracture Liaison Service (FLS. Out of 3057 patients aged 50–90 years, 1359 consecutive patients, who agreed and were able to visit the FLS for fracture risk evaluation, were included (71.7% women; mean age 65.2 yrs. Based on medical history, 29.9% had a history of CVD (13.7%, VTE (1.7%, HT (14.9%, and DM2 (7.1% or a combination. Their prevalence increased with age (21% in patients aged 50–59 years to 48% in patients aged >80 years and was higher in men than in women (36% versus 27%, but independent of bone mineral density and fracture type. Careful evaluation of medical history with respect to these risk factors should be performed in patients with a recent clinical fracture before starting treatment with medications that increase the risk of VTE or cardiovascular events, such as raloxifene, strontium ranelate, or NSAIDs.

  6. Biologic disease-modifying anti-rheumatic drugs and the risk of non-vertebral osteoporotic fractures in patients with rheumatoid arthritis aged 50 years and over.

    Roussy, J-P; Bessette, L; Bernatsky, S; Rahme, E; Lachaine, J

    2013-09-01

    Prevention of bone mineral density loss in rheumatoid arthritis (RA) has been associated with use of biologic disease-modifying anti-rheumatic drugs (DMARDs). However, in this study, we could not demonstrate a reduction in the risk of non-vertebral fractures. Additional research is required to clarify the impact of biologic DMARDs on fracture risk in RA. Small studies have suggested biologic DMARDs preserve bone mineral density at 6-12 months. Our objective was to determine the association between biologic DMARD use and the risk of non-vertebral osteoporotic fractures in RA subjects aged ≥50 years. A nested case-control study was conducted using Quebec physician billing and hospital discharge data. RA subjects were identified from International Classification of Disease-9/10 codes in billing and hospitalisation data and followed from cohort entry until the earliest of non-vertebral osteoporotic fracture, death, or end of study period. Controls were matched to cases (4:1 ratio) on age, sex, and date of cohort entry. Biologic DMARD exposure was defined as being on treatment for ≥180 days pre-fracture (index). Conditional logistic regression was used, adjusting for indicators of RA severity, comorbidity, drugs influencing fracture risk, and measures of health care utilisation. Over the study period, 1,515 cases were identified (6,023 controls). The most frequent fracture site was hip/femur (42.3%). In total, 172 subjects (49 cases and 123 controls) were exposed to biologic DMARDs. The median duration of exposure was 735 (interquartile range (IQR), 564) and 645 (IQR, 903) days in cases and controls, respectively. We were unable to demonstrate an association between biologic DMARDs and fracture risk (odds ratio, 1.03; 95% confidence interval, 0.42-2.53). RA duration significantly increased the fracture risk. Despite the positive impact of biologic DMARDs on bone remodelling observed in small studies, we were unable to demonstrate a reduction in the risk of non

  7. Femoral neck shortening in adult patients under the age of 55 years is associated with worse functional outcomes: Analysis of the prospective multi-center study of hip fracture outcomes in China (SHOC).

    Slobogean, Gerard P; Stockton, David J; Zeng, Bing-Fang; Wang, Dong; Ma, Baotong; Pollak, Andrew N

    2017-08-01

    Young femoral neck fracture patients require surgical fixation to preserve the native hip joint and accommodate increased functional demands. Recent reports have identified a high incidence of fracture shortening and this may have negative functional consequences. We sought to determine if fracture shortening is associated with poor functional outcome in young femoral neck fracture patients. One hundred and forty-two patients with femoral neck fractures age 18-55 were recruited in this prospective cohort study across three Level 1 trauma hospitals in Mainland China. Patient-reported and objective functional outcomes were measured with the Harris Hip Score (HHS), Timed Up and Go (TUG), and SF-36 Physical Component Summary (SF-36 PCS) at 12 months. Radiographic fracture shortening was measured along the long axis of the femoral neck and corrected for magnification. Severe shortening was defined as ≥10mm. The primary analysis measured associations between severe radiographic shortening and HHS at one-year post-fixation. One hundred and two patients had complete radiographic and functional outcomes available for analysis at one year. The mean age of participants was 43.7±10.8years and 53% were male. Fifty-five percent of fractures were displaced and 37% were vertically orientated (Pauwels Type 3). The mean functional outcome scores were: HHS 90.0±10.8, TUG 12.0±5.1s, and PCS 48.5±8.6. Severe shortening occurred in 13% of patients and was associated with worse functional outcome scores: HHS mean difference 9.9 (p=0.025), TUG mean difference 3.2s (p=0.082), and PCS mean difference 5.4 (p=0.055). Severe shortening is associated with clinically important decreases in functional outcome as measured by HHS following fixation of young femoral neck fractures, occurring in 13% of patients in this population. The principle of fracture site compression utilized by modern constructs may promote healing; however, excessive shortening is associated with worse patient

  8. Pressure ulcer risk in hip fracture patients

    Houwing, R. H.; Rozendaal, M; Wouters-Wesseling, W; Buskens, E.; Keller, P; Haalboom, JRE

    Hip fracture patients have a high risk of pressure ulcers (PU). We followed 121 hip fracture patients for the development of pressure ulcers and evaluated a risk assessment tool for sensitivity and specificity. More than half of the patients presented with PU, mostly stage I. Risk factors for PU

  9. Hip Fracture-Related Pain Strongly Influences Functional Performance of Patients With an Intertrochanteric Fracture Upon Discharge From the Hospital

    Kristensen, Morten Tange

    2013-01-01

    .7 seconds to perform the TUG. No significant differences were observed in baseline characteristics or pain medication given for patients with a cervical versus an intertrochanteric fracture (P ≥ .22), but patients with an intertrochanteric fracture presented more often with moderate to severe pain during......OBJECTIVE: To examine whether functional performance upon hospital discharge is influenced by pain in the region of the hip fracture or related to the fracture type. DESIGN: Prospective observational study. SETTING: A 20-bed orthopedic hip fracture unit. PATIENTS: Fifty-five cognitively intact...... patients (20 men and 35 women; ages 75.8 ± 10 years), 33 with a cervical hip fracture and 22 with an intertrochanteric hip fracture, all of whom were allowed to bear full weight after surgery. METHODS: All patients were evaluated upon discharge from the hospital to their own homes at a mean of 10 ± 6 days...

  10. Importance of patient-centered approach in ensuring quality of post-fracture rehabilitation for working aged people

    Lindahl, Marianne Pia; Teljigovic, Sanel; Jensen, Lars Heegaard

    2016-01-01

    therapists from hospitals, municipalities and private practice were included in the study. Grounded theory was used to analyze data and develop a theory about quality in the rehabilitation process. RESULTS: Partnership was identified as the core category with continuity of rehabilitation and patient...

  11. Early age fracture properties of microstructurally-designed mortars

    Di Bella, Carmelo; Michel, Alexander; Stang, Henrik

    2017-01-01

    This paper compares the fracture properties as well as crack initiation and propagation of real and equivalent mortars. The development of the elastic modulus, tensile strength, and fracture energy at different hydration stages were determined by inverse analysis of load-displacement curves...... the two mortars. At early age, the moisture content has a considerable influence on the tensile strength and the fracture energy....

  12. Femur Neck Fracture in a Young Marfan Syndrome Patient.

    Kwon, Yong-Uk; Kong, Gyu-Min; Park, Jun-Ho

    2016-12-01

    Marfan syndrome is an autosomal dominant and could decrease bone mineral density. So patients with Marfan syndrome could vulnerable to trauma in old ages. We present the first report, to the best of our knowledge, of a rare fracture of the femoral neck with a minor traumatic history in a juvenile Marfan syndrome patient whose physis is still open. Although the patient is young, her bone mineral density was low and the geometry of femur is changed like old ages. The femur neck fracture in children is very rare and only caused by high energy trauma, we concluded that the Marfan syndrome makes the bone weaker in young age and preventative medications to avoid fractures in younger Marfan syndrome patients are necessary in early ages.

  13. A systematic review of undisplaced femoral neck fracture treatments for patients over 65 years of age, with a focus on union rates and avascular necrosis.

    Xu, Dan-Feng; Bi, Fang-Gang; Ma, Chi-Yuan; Wen, Zheng-Fa; Cai, Xun-Zi

    2017-02-10

    It remains unclear whether conservative treatment should be used to treat the common undisplaced femoral neck fractures that develop in the elderly. Herein, we systematically review the rates of union and avascular necrosis after conservative and surgical treatment of undisplaced femoral neck fractures. We searched the EMBASE, PubMed, OVID, Cochrane Library, Web of Science, and Scopus databases for randomized controlled trials or observational studies that assessed the outcomes of conservative or surgical treatments of undisplaced femoral neck fractures. No language or publication year limitation was imposed. Statistical analyses were performed with the aid of the chi-squared test. We evaluated the quality of each publication and the risk of bias. Twenty-nine studies involving 5071 patients were ultimately included; 1120 patients were treated conservatively and 3951 surgically. The union rates were 68.8% (642/933) and 92.6% (635/686) in the former and latter groups, respectively (p avascular necrosis rate in the conservatively treated group was 10.3% (39/380), while it was 7.7% (159/2074) in the surgically treated group (p = 0.09). Surgery to treat undisplaced femoral neck fractures was associated with a higher union rate and a tendency toward less avascular necrosis than conservative treatment.

  14. The influence of renal dialysis and hip fracture sites on the 10-year mortality of elderly hip fracture patients

    Hung, Li-Wei; Hwang, Yi-Ting; Huang, Guey-Shiun; Liang, Cheng-Chih; Lin, Jinn

    2017-01-01

    Abstract Hip fractures in older people requiring dialysis are associated with high mortality. Our study primarily aimed to evaluate the specific burden of dialysis on the mortality rate following hip fracture. The secondary aim was to clarify the effect of the fracture site on mortality. A retrospective cohort study was conducted using Taiwan's National Health Insurance Research Database to analyze nationwide health data regarding dialysis and non-dialysis patients ≥65 years who sustained a first fragility-related hip fracture during the period from 2001 to 2005. Each dialysis hip fracture patient was age- and sex-matched to 5 non-dialysis hip fracture patients to construct the matched cohort. Survival status of patients was followed-up until death or the end of 2011. Survival analyses using multivariate Cox proportional hazards models and the Kaplan-Meier estimator were performed to compare between-group survival and impact of hip fracture sites on mortality. A total of 61,346 hip fracture patients were included nationwide. Among them, 997 dialysis hip fracture patients were identified and matched to 4985 non-dialysis hip fracture patients. Mortality events were 155, 188, 464, and 103 in the dialysis group, and 314, 382, 1505, and 284 in the non-dialysis group, with adjusted hazard ratios (associated 95% confidence intervals) of 2.58 (2.13–3.13), 2.95 (2.48–3.51), 2.84 (2.55–3.15), and 2.39 (1.94–2.93) at 0 to 3 months, 3 months to 1 year, 1 to 6 years, and 6 to 10 years after the fracture, respectively. In the non-dialysis group, survival was consistently better for patients who sustained femoral neck fractures compared to trochanteric fractures (0–10 years’ log-rank test, P fractures was better than that of patients with trochanteric fractures only within the first 6 years post-fracture (0–6 years’ log-rank, P fracture patients. Survival outcome was better for non-dialysis patients with femoral neck fractures compared to those with

  15. Elderly patients with maxillofacial trauma: study of mandibular condyle fractures.

    Nogami, Shinnosuke; Yamauchi, Kensuke; Yamashita, Toshio; Kataoka, Yoshihiro; Hirayama, Bunichi; Tanaka, Kenko; Takahashi, Tetsu

    2015-02-01

    The aim of this study was to investigate the trends and characteristic features of mandibular condyle fractures in elderly patients in terms of etiology, patterns, and treatment modalities. Records of 201 patients aged 65 years and older, who were treated for maxillofacial fractures at the Department of Oral and Maxillofacial Surgery, Kyushu Dental University, and Tohoku University from January 2002 to December 2013, were retrospectively analyzed. Patient records and radiographs were examined, with the following information: relevant medical history, cause of fracture, the presence and state of premolars and molars in the maxilla and mandible, number and location of mandible fracture, and method of treatment. As for the state of premolars and molars, premolars or molars in the mandible in contact with the maxilla were regarded as contacted. A fall was responsible for the majority of the fractures (173/201). With condyle fractures, there was a significant difference between the contacted and non-contacted group in regard to incidence. Furthermore, there was a significantly greater number of cases with symphysis and condyle combination fractures in the non-contacted group (70.9%) than in the contacted group (51.9%). As for the method of treatment, arthrocentesis was the most commonly employed. The present findings suggest that contacted molars in the maxilla and mandible have an influence on condyle fractures in elderly individuals. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  16. Excess of all-cause mortality after a fracture in type 2 diabetic patients

    Martinez-Laguna, D; Nogues, Xavier; Abrahamsen, B

    2017-01-01

    Post-fracture mortality in type 2 diabetes mellitus (T2DM) patients has been poorly studied. We report an absolute and relative excess all-cause mortality following a fracture in these patients compared to non-diabetic patients. INTRODUCTION: T2DM and osteoporotic fractures are independently...... ≥50 years old T2DM patients registered in SIDIAP in 2006-2013 and two diabetes-free controls matched on age, gender, and primary care center were selected. Study outcome was all-cause mortality following incident fractures. Participants were followed from date of any fracture (AF), hip fracture (HF...... associated with a reduced lifespan, but it is unknown if T2DM confers an excess post-fracture mortality compared to non-diabetic fracture patients. We report post-fracture all-cause mortality according to T2DM status. METHODS: This is a population-based cohort study using data from the SIDIAP database. All...

  17. Comparison of outcomes following uncemented hemiarthroplasty and dynamic hip screw in the treatment of displaced subcapital hip fractures in patients aged greater than 70 years.

    El-Abed, Kaldoun

    2012-02-03

    As health care costs increase, evaluating treatment methods in femoral neck fractures to determine the most effective treatment paradigm will become increasingly important. The current study compared two methods of treatment in similar cohorts of displaced femoral neck fractures. One hundred and twenty two patients were randomly assigned to two groups: In Group A, 62 patients were treated with a hemiarthroplasty. In group B, 60 patients were treated with dynamic screw fixation. Patients were evaluated at a minimum 3 year follow-up. Using the Matta functional hip score, 42% of group A and 70% of group B had good to excellent results. This difference was significant (p = 0.004). A significant agreement between physician assessment using the Matta score, and patient perception of outcome using the SF-36 scale was demonstrated (r = 0.64). No statistical difference between groups for revision surgery existed. Both physician based and patient based outcome scores favour retention and internal fixation of the femoral head in this cohort of patients at a short-term follow-up.

  18. Hip fracture in hospitalized medical patients

    Zapatero Antonio

    2013-01-01

    Full Text Available Abstract Background The aim of the present study is to analyze the incidence of hip fracture as a complication of admissions to internal medicine units in Spain. Methods We analyzed the clinical data of 2,134,363 adults who had been admitted to internal medicine wards. The main outcome was a diagnosis of hip fracture during hospitalization. Outcome measures included rates of in-hospital fractures, length of stay and cost. Results A total of 1127 (0.057% admittances were coded with an in-hospital hip fracture. In hospital mortality rate was 27.9% vs 9.4%; p  Conclusions In-hospital hip fracture notably increased mortality during hospitalization, doubling the mean length of stay and mean cost of admission. These are reasons enough to stress the importance of designing and applying multidisciplinary plans focused on reducing the incidence of hip fractures in hospitalized patients.

  19. An evaluation of flexible intramedullary nail fixation in femoral shaft fractures in paediatric age group.

    Kumar, Sanjay; Roy, Sandip Kumar; Jha, Amrish Kumar; Chatterjee, Debdutta; Banerjee, Debabrata; Garg, Anant Kumar

    2011-06-01

    Sixty-two femoral shaft fractures in 60 patients treated by elastic intramedullary nailing with mean age of the patients being 9.2 years (range 5 years to 12 years) and average follow-up of 15 months (range 7 months to 60 months) are evaluated. Twenty-eight fractures were fixed with titanium elastic nail while 34 fractures were fixed with Enders nail. There were 40 midshaft fractures, 18 proximal femoral and 4 were fractures of distal third. Fracture patterns were transverse in 35, short oblique in 14 cases and 13 were spiral fractures. Mean age of union in this series was 17 weeks (range 12 weeks to 28 weeks). Ten cases had complications, 5 had nail tip irritation, 3 varus or valgus malalignment and 2 had delayed union. In this series, we did not have any non-union, refracture, limb length discrepancy or any major infection. The result demonstrates 100% union rate irrespective of the age, weight and height of the patient. Regardless of the site of fracture and their pattern, it united every time with elastic nail fixation. We did not find and mismatch in the results of fractures stabilised with titanium elastic nail with that of elastic stainless steel nail.

  20. Frequency of extradural haematoma in patients with linear skull fracture

    Aurangzeb, A.; Afridi, E.A.K.; Khan, S.A.

    2015-01-01

    Apparently normal looking patients after traumatic brain injury can have serious neurological deterioration, and one of the common causes of such deterioration is extradural haematomas. This study was conducted to determine the frequency of extradural hematoma and common types of trauma leading to it among patients presenting with skull fracture due to head injury. Methods: This cross-sectional study was conducted in the department of Neurosurgery Ayub Medical College, Abbottabad from June 2011 to June 2012. All patients who were suspected to have Skull fracture on X-ray skull, during the study period, were included in study after informed consent and later on CT-Scan brain was done to see for extradural hematoma. Findings were recorded on a predesigned proforma including demographic data, radiological findings and the type of head trauma. Results: Out of 114 patients 85 (74.5%) were males and 29 (225.4%) were females. Age ranged from 2 to 70 years (18.23 ± 16.5 years). Among these patients the most important cause of head injury was fall from height in 65(57%), followed by road traffic accidents in 39 (34.2%), and assault in 10 (8.8%) patients. The most common site of fracture was parietal in 49 (43%) of patients, followed by frontal bone in 28 (24.6%) of patients, occipital bone in 24 (21.1%) of patients, and temporal bone in 23 (20.2%) of patients. Frequency of extradural hematoma among linear skull fracture was in 34 (29.8%) patients. Extradural hematoma was most common with parietotemporal linear skull fractures (73.5%). Conclusion: Extradural haematoma occurs commonly with linear skull fractures, so patients with linear skull fracture should be properly evaluated with CT brain. (author)

  1. Incidence of fractures in patients with multiple sclerosis: the Danish National Health Registers

    Bazelier, Marloes T; de Vries, Frank; Bentzen, Joan

    2012-01-01

    Background: Patients with multiple sclerosis (MS) are potentially at high risk of fracture due to falls and osteoporosis. Objective: To estimate incidence rates of fractures in MS patients, stratified by fracture type, sex and age, and to compare these rates with controls. Methods: The case...... population consisted of all patients with an accepted diagnosis of MS in the Danish MS Registry (1949-2007). Data were linked to the National Hospital Discharge Register (1977-2007). Patients with MS (n = 11,157) were 1: 6 matched by year of birth, gender, calendar time and region to persons without MS...... (controls). Incidence rates of fracture were estimated as the number of fractures per 1000 person-years. Incidence rate ratios (IRRs) were calculated by dividing fracture rates in MS patients by fracture rates in controls. Results: Among patients with MS, the incidence rate of any fracture yielded 22.8 per...

  2. Postoperative hemoglobin level in patients with femoral neck fracture

    Nagra, Navraj; van Popta, Dmitri; Whiteside, Sigrid; Holt, Edward

    2018-01-01

    Objective: The aim of this study was to analyze the changes of hemoglobin levels in patients undergoing fixation for femoral neck fracture.Methods: Peroperative hemoglobin levels of patients who underwent either dynamic hip screw (DHS) fixation (n=74; mean age: 80 years) or hip hemiarthroplasty (n=104; mean age: 84 years) for femoral neck fracture was monitored.Results: There was a statistically and clinically significant mean drop of 31.1 g/L between the preoperative (D0) and postoperative D...

  3. CT findings in patient with skull fractures

    Jo, Han Gi; Suh, Won Hyuck [Korea University College of Medicine, Seoul (Korea, Republic of)

    1988-12-15

    CT scan has been inevitable method for patient with head trauma. CT scans of 94 cases, which were confirmed skull fracture by plain film, were reviewed for better and useful dealing of CT. The results were as follows: 1. Car accident was the most frequent cause of head injury. 2. No evidence of intracranial abnormality in CT scan of skull fractures on plane film was 45.7%, and alert mentality was 46.8% of skull fracture on skull fracture on simple film. 3. Detection rate on CT scan to skull fractures was 27.7%, but detection rate to depression fractures of skull fracture was 70.2%. 4. Mortality rate of patients with skull fracture was 10.6%. 5. Associated CT findings were pneumocephalus on CT scan 3.2%, contusion of edema 4.2%, epidural hematoma 16.0%, subdural hematoma 17.0%, subdural hygroma 2.1%, intracerebral hemorrhage 4.9%, and subarachnoid hemorrhage 2.0%.

  4. Spatial distribution of the human enamel fracture toughness with aging.

    Zheng, Qinghua; Xu, Haiping; Song, Fan; Zhang, Lan; Zhou, Xuedong; Shao, Yingfeng; Huang, Dingming

    2013-10-01

    A better understanding of the fracture toughness (KIC) of human enamel and the changes induced by aging is important for the clinical treatment of teeth cracks and fractures. We conducted microindentation tests and chemical content measurements on molar teeth from "young" (18 ≤ age ≤ 25) and "old" (55 ≤ age) patients. The KIC and the mineral contents (calcium and phosphorus) in the outer, the middle, and the inner enamel layers within the cuspal and the intercuspal regions of the crown were measured through the Vickers toughness test and Energy Dispersive X-Ray Spectroscopy (EDS), respectively. The elastic modulus used for the KIC calculation was measured through atomic force microscope (AFM)-based nanoindentation tests. In the outer enamel layer, two direction-specific values of the KIC were calculated separately (direction I, crack running parallel to the occlusal surface; direction II, perpendicular to direction I). The mean KIC of the outer enamel layer was lower than that of the internal layers (penamel layer, old enamel has a lower KIC, II and higher mineral contents than young enamel (penamel surface becomes more prone to cracks with aging partly due to the reduction in the interprismatic organic matrix observed with the maturation of enamel. Copyright © 2013 Elsevier Ltd. All rights reserved.

  5. High prevalence of simultaneous rib and vertebral fractures in patients with hip fracture.

    Lee, Bong-Gun; Sung, Yoon-Kyoung; Kim, Dam; Choi, Yun Young; Kim, Hunchul; Kim, Yeesuk

    2017-02-01

    The purpose was to evaluate the prevalence and location of simultaneous fracture using bone scans in patients with hip fracture and to determine the risk factors associated with simultaneous fracture. One hundred eighty two patients with hip fracture were reviewed for this study. Clinical parameters and bone mineral density (BMD) of the lumbar vertebra and femoral neck were investigated. To identify acute simultaneous fracture, a bone scan was performed at 15.4±4.1days after hip fracture. The prevalence and location of simultaneous fracture were evaluated, and multivariate logistic regression analysis was performed to determine the risk factors. Simultaneous fracture was observed in 102 of 182 patients, a prevalence of 56.0%. Rib fracture was the most common type of simultaneous fracture followed by rib with vertebral fracture. The BMD of the lumbar vertebra was significantly lower in patients with simultaneous fracture (p=0.044) and was identified as an independent risk factor (odds ratio: OR 0.05, 95% confidence interval: CI 0.01-0.57). The prevalence of simultaneous fracture was relatively high among patients with hip fracture, and BMD was significantly lower in patients with simultaneous fracture than in patients without it. Surgeons should be aware of the possibility of simultaneous fracture in patients with hip fracture. Copyright © 2016 Elsevier Ltd. All rights reserved.

  6. Tibial Fractures in Alpine Skiing and Snowboarding in Finland: A Retrospective Study on Fracture Types and Injury Mechanisms in 363 Patients.

    Stenroos, A; Pakarinen, H; Jalkanen, J; Mälkiä, T; Handolin, L

    2016-09-01

    Alpine skiing and snowboarding share the hazards of accidents accounting for tibial fractures. The aim of this study was to evaluate the fracture patterns and mechanisms of injury of tibial fractures taking place in downhill skiing and snowboarding. All patients with tibial fracture due to alpine skiing or snowboarding accident treated in four trauma centers next to the largest ski resorts in Finland were analyzed between 2006 and 2012. The hospital records were retrospectively reviewed for data collection: equipment used (skis or snowboard), age, gender, and mechanism of injury. Fractures were classified according to AO-classification. There were 342 skiing and 30 snowboarding related tibial fractures in 363 patients. Tibial shaft fracture was the most common fracture among skiers (n = 215, 63%), followed by proximal tibial fractures (n = 92, 27%). Snowboarders were most likely to suffer from proximal tibial fracture (13, 43%) or tibial shaft fracture (11, 37%). Snowboarders were also more likely than skiers to suffer complex AO type C fractures (23% vs 9%, p jumping (46%). The most important finding was the relatively high number of the tibial plateau fractures among adult skiers. The fracture patterns between snowboarding and skiing were different; the most common fracture type in skiers was spiral tibial shaft fracture compared to proximal tibial fractures in snowboarders. Children had more simple fractures than adults. © The Finnish Surgical Society 2016.

  7. Increased Mortality in Elderly Patients with Sarcopenia and Acetabular Fractures.

    Deren, Matthew E; Babu, Jacob; Cohen, Eric M; Machan, Jason; Born, Christopher T; Hayda, Roman

    2017-02-01

    Sarcopenia is a condition of clinically relevant loss of muscle mass and function. Acetabular fractures in elderly patients are common and difficult to treat. This study aimed to determine if sarcopenia is common in elderly patients with acetabular fractures and correlates with lower-energy mechanisms of injury, higher rates of complications, and higher mortality than patients with normal muscle mass. The Rhode Island Hospital Trauma Database was queried for patients who were ≥60 years of age from 2005 to 2014 using the International Classification of Diseases, Ninth Revision, code for closed acetabular fracture, 808.0. Charts were retrospectively reviewed for demographic data, operative intervention, mechanism of injury, mortality, comorbidities, and other factors. Computed tomography (CT) was used to determine the muscle cross-sectional area and to calculate the skeletal muscle index. The database revealed 192 patients coded for acetabular fracture; of these, 181 were correctly diagnosed. Ninety-nine patients had recorded body mass index (BMI) and adequate CT scans to measure the skeletal muscle index. Forty-two patients (42.4%) had sarcopenia, and 57 patients (57.6%) did not have sarcopenia. There were no significant differences in demographic characteristics between the groups with the exception of BMI and sex. BMI was higher in patients who did not have sarcopenia (31.7 kg/m) than it was in patients with sarcopenia (23.6 kg/m) (p sarcopenia at 76.2% (32 of 42 patients) than in patients without sarcopenia at 50.9% (29 of 57 patients). Fractures in patients without sarcopenia were associated with a higher-energy mechanism of injury in 78.9% of cases compared with 52.4% of cases of patients with sarcopenia (p = 0.005). Sarcopenia was significantly associated (p = 0.0419) with increased 1-year mortality (28.6%) compared with the absence of sarcopenia (12.3%). This association was even stronger if in-hospital mortality was excluded (p = 0.00074). Finally

  8. Osteoporosis management in older patients who experienced a fracture

    Oertel MJ

    2016-08-01

    Full Text Available Mark J Oertel,1 Leland Graves,1 Eyad Al-Hihi,2 Vincent Leonardo,3 Christina Hopkins,2 Kristin DeSouza,2 Rajib K Bhattacharya1 1Division of Endocrinology, Metabolism and Genetics, Department of Medicine, 2Department of Internal Medicine, 3Department of Enterprise Analytics, University of Kansas Medical Center, Kansas City, KS, USA Background: Fractures in older patients are common, morbid, and associated with increased risk of subsequent fractures. Inpatient and outpatient management and treatment of fractures can be costly. With more emphasis placed on quality care for Medicare beneficiaries, we studied if patients were receiving proper screening for osteoporosis and treatment after diagnosis of fracture. This study aims to determine if adequate screening and treatment for osteoporosis occurs in the postfracture period.Methods: A retrospective analysis of Medicare beneficiaries aged 67 years or older was gathered from a single institution in both inpatient and outpatient visits. Based on International Classification of Diseases ninth revision codes, primary diagnosis of fractures of neck and trunk, upper limb, and lower limb were obtained in addition to current procedural terminology codes for fracture procedures. We studied patients who had been screened for osteoporosis with a bone mineral study or received osteoporosis treatment after their fracture.Results: Medicare beneficiaries totaling 1,375 patients were determined to have an inclusion fracture between June 1, 2013 and November 30, 2014. At the time of our analysis on December 1, 2014, 1,219 patients were living and included in the analysis. Of these patients, 256 (21.0% either received osteoporosis testing with bone mineral density or received treatment for osteoporosis. On sex breakdown, 208/820 (25.4% females received proper evaluation or treatment of osteoporosis in comparison to 48/399 (12.0% males. This is in comparison to the Centers for Medicare and Medicaid Services’ national

  9. Magnetic Resonance Enhancement Patterns at the Different Ages of Symptomatic Osteoporotic Vertebral Compression Fractures

    You, Ja Yeon; Lee, Joon Woo; Kim, Jung Eun; Kang, Heung Sik [Dept. of Radiology, Seoul National University Bundang Hospital, Seongnam (Korea, Republic of)

    2013-06-15

    To investigate the magnetic resonance (MR) enhancement patterns of symptomatic osteoporotic vertebral compression fracture (VCF) according to the fracture age, based on the successful single-level percutaneous vertebroplasty (PVP) cases. The study included 135 patients who underwent contrast-enhanced MR imaging and successful PVP from 2005 to 2010 due to a single- level osteoporotic VCF. Two radiologists blinded to the fracture age evaluated the MR enhancement patterns in consensus. The MR enhancement patterns were classified according to the enhancing proportion to the vertebral height and the presence or extent of a non-enhancing cleft within the enhancing area on sagittal plane. The Fisher' exact test, Kruskal-Wallis test and Mann-Whitney U test were performed to assess the differences in the MR enhancement patterns according to the fracture age. Symptomatic VCFs show variable MR enhancement patterns in all fracture ages. A diffuse enhancing area can be seen in not only the hyperacute and acute VCFs but also the chronic symptomatic VCFs. Symptomatic VCFs having a segmental enhancing area were all included in the hyperacute or acute stage. Most symptomatic osteoporotic VCFs had a non-enhancing cleft in the enhanced vertebral body (128/135, 94.8%). There was no statistical difference of the enhancement pattern according to the fracture age. Symptomatic VCFs show variable MR enhancement patterns in all fracture ages. The most common pattern is a non-enhancing cleft within a diffuse enhanced vertebra.

  10. Magnetic Resonance Enhancement Patterns at the Different Ages of Symptomatic Osteoporotic Vertebral Compression Fractures

    You, Ja Yeon; Lee, Joon Woo; Kim, Jung Eun; Kang, Heung Sik

    2013-01-01

    To investigate the magnetic resonance (MR) enhancement patterns of symptomatic osteoporotic vertebral compression fracture (VCF) according to the fracture age, based on the successful single-level percutaneous vertebroplasty (PVP) cases. The study included 135 patients who underwent contrast-enhanced MR imaging and successful PVP from 2005 to 2010 due to a single- level osteoporotic VCF. Two radiologists blinded to the fracture age evaluated the MR enhancement patterns in consensus. The MR enhancement patterns were classified according to the enhancing proportion to the vertebral height and the presence or extent of a non-enhancing cleft within the enhancing area on sagittal plane. The Fisher' exact test, Kruskal-Wallis test and Mann-Whitney U test were performed to assess the differences in the MR enhancement patterns according to the fracture age. Symptomatic VCFs show variable MR enhancement patterns in all fracture ages. A diffuse enhancing area can be seen in not only the hyperacute and acute VCFs but also the chronic symptomatic VCFs. Symptomatic VCFs having a segmental enhancing area were all included in the hyperacute or acute stage. Most symptomatic osteoporotic VCFs had a non-enhancing cleft in the enhanced vertebral body (128/135, 94.8%). There was no statistical difference of the enhancement pattern according to the fracture age. Symptomatic VCFs show variable MR enhancement patterns in all fracture ages. The most common pattern is a non-enhancing cleft within a diffuse enhanced vertebra.

  11. Risk of falling in patients with a recent fracture

    Willems Gittie

    2007-06-01

    Full Text Available Abstract Background Patients with a history of a fracture have an increased risk for future fractures, even in short term. The aim of this study was to assess the number of patients with falls and to identify fall risk factors that predict the risk of falling in the first three months after a clinical fracture. Methods Prospective observational study with 3 months of follow-up in a large European academic and regional hospital. In 277 consenting women and men aged ≥ 50 years and with no dementia and not receiving treatment for osteoporosis who presented to hospital with a clinical fracture, fall risk factors were assessed according to the guidelines on fall prevention in the Netherlands. Follow-up information on falls and fractures was collected by monthly telephone interview. Incidence of falls and odds ratio's (OR, with 95% confidence intervals were calculated. Results 512 consecutive patients with a fracture were regarded for analysis, 87 were not eligible for inclusion and 137 patients were excluded. No follow-up data were available for 11 patients. Therefore full analysis was possible in 277 patients. A new fall incident was reported by 42 patients (15%, of whom five had a fracture. Of the 42 fallers, 32 had one new fall and 10 had two or more. Multivariate analysis in the total group with sex, age, ADL difficulties, urine incontinence and polypharmacy showed that sex and ADL were significant fall risk factors. Women had an OR of 3.02 (95% CI 1.13–8.06 and patients with ADL-difficulties had an OR of 2.50 (95% CI 1.27–4.93. Multivariate analysis in the female group with age, ADL difficulties, polypharmacy and presence of orthostatic hypotension indicated that polypharmacy was the predominant risk factor (OR 2.51; 95% CI: 1.19 – 5.28. The incidence of falls was 35% in women with low ADL score and polypharmacy compared to 15% in women without these risk factors (OR 3.56: CI 1.47 – 8.67. Conclusion 15% of patients reported a new fall

  12. Characterization of fracture toughness of epoxy resin after hygrothermal aging

    Quispe, Gustavo Q.

    2013-07-01

    Characterization of fracture toughness of epoxy resin after hygrothermal ageing Gustavo Quino Quispe The aim of this work is to characterize the e ects of hygrothermal aging in the plain strain fracture toughness of the epoxy system composed by cycloaliphatic epoxy resin and diglycidyl ether of bisphenol-A (DGEBA). For this, after having been under hygrothermal aging in a climatic chamber, epoxy samples were studied using ASTM D5045 fracture toughness test, and micrography and roughness measurements of the fracture surface. It is reported a rapid decrease of GIc and KIc during the rst 2 days. Moreover, a numerical model [13] was used to simulate and see with more detail the water absorption in the aged samples. From that, it was observed the heterogeneous distribution of water. Accordingly, it was proposed that the results should be correlated with the water content at the vicinity of the crack tip. Consequently, it was possible to obtain, by quasi-static simulations, the ideal load-displacement curves of crack propagation in the heterogeneous samples. Finally, another contribution of this work is the study of the fracture surface, that gives a clue of the relationship among the fracture energy, the appearance of microcracks in the fracture surface, and the roughness (Ra).

  13. Gender-specific hip fracture risk in community-dwelling and institutionalized seniors age 65 years and older.

    Finsterwald, M; Sidelnikov, E; Orav, E J; Dawson-Hughes, B; Theiler, R; Egli, A; Platz, A; Simmen, H P; Meier, C; Grob, D; Beck, S; Stähelin, H B; Bischoff-Ferrari, H A

    2014-01-01

    In this study of acute hip fracture patients, we show that hip fracture rates differ by gender between community-dwelling seniors and seniors residing in nursing homes. While women have a significantly higher rate of hip fracture among the community-dwelling seniors, men have a significantly higher rate among nursing home residents. Differences in gender-specific hip fracture risk between community-dwelling and institutionalized seniors have not been well established, and seasonality of hip fracture risk has been controversial. We analyzed detailed data from 1,084 hip fracture patients age 65 years and older admitted to one large hospital center in Zurich, Switzerland. In a sensitivity analysis, we extend to de-personalized data from 1,265 hip fracture patients from the other two large hospital centers in Zurich within the same time frame (total n = 2,349). The denominators were person-times accumulated by the Zurich population in the corresponding age/gender/type of dwelling stratum in each calendar season for the period of the study. In the primary analysis of 1,084 hip fracture patients (mean age 85.1 years; 78% women): Among community-dwelling seniors, the risk of hip fracture was twofold higher among women compared with men (RR = 2.16; 95% CI, 1.74-2.69) independent of age, season, number of comorbidities, and cognitive function; among institutionalized seniors, the risk of hip fracture was 26% lower among women compared with men (RR = 0.77; 95% CI: 0.63-0.95) adjusting for the same confounders. In the sensitivity analysis of 2,349 hip fracture patients (mean age 85.0 years, 76% women), this pattern remained largely unchanged. There is no seasonal swing in hip fracture incidence. We confirm for seniors living in the community that women have a higher risk of hip fracture than men. However, among institutionalized seniors, men are at higher risk for hip fracture.

  14. EPIDEMIOLOGICAL PROFILE OF PATIENTS WITH TRAUMATIC SPINAL FRACTURE

    MATEUS BERGAMO LOMAZ

    Full Text Available ABSTRACT Objective: To analyze the epidemiological profile of patients with spinal fractures and the characteristics of the population at risk attended at a university hospital. Methods: The study population is composed of 202 patients diagnosed and treated for vertebral fracture due to trauma. The variables were correlated with each other and the correlations with p<0.05 were considered statistically significant. Results: The ratio of incidence of trauma between the sexes was 3:1 for males. The mean age was 37 years and the age group with the highest incidence was between 20 and 39 years. Traffic accidents were the most frequent mechanism (51.2% and secondly, falls (33.2%. There was a statistical correlation between trauma mechanisms to age group and region of the spine. The first lumbar vertebra (L1 fracture alone accounted for 21.5% of all cases studied associated with the fall mechanism. Spinal cord injury was recorded in 33.7% of the individuals in the sample. A total of 57.3% of the patients were submitted to surgical treatment and 41.7% to the conservative treatment. The mean hospitalization time was 15 days. Conclusions: Spinal fractures are important determinants of morbidity and mortality in the population with a major impact on economically active individuals, especially males. They are directly associated to traffic accidents in the young population and to falls in the higher age brackets. Primary prevention of trauma is the main mechanism for change in this scenario.

  15. Effects of Nutritional Status on 6-Month Outcome of Hip Fractures in Elderly Patients

    Miu, Ka Ying Doris; Lam, Pui Shan

    2017-01-01

    Objective To identify the prevalence of malnutrition in elderly hip fracture and to investigate the relationship between hip fracture patients and malnutrition on functional recovery and mortality. Methods All hip fracture patients age >65 years admitted to a rehabilitation unit were recruited from July 2015 to June 2016. Nutritional status was assessed by Mini-Nutritional Assessment Short-Form (MNA-SF) within 72 hours of admission. Patients were reassessed at 6 months for functional status a...

  16. Secondary hyperparathyroidism and mortality in hip fracture patients compared to a control group from general practice

    Madsen, Christian Medom; Jørgensen, Henrik Løvendahl; Lind, Bent

    2012-01-01

    INTRODUCTION: Previously, little attention has been paid as to how disturbances in the parathyroid hormone (PTH)-calcium-vitamin D-axis, such as secondary hyperparathyroidism (SHPT), relate to mortality amongst hip fracture patients. This study aimed to (1) determine if SHPT is associated......) (age=70 years) admitted to a Danish university hospital. The hip fracture patients were prospectively enrolled in a dedicated hip fracture database. Each hip fracture patient was exactly matched according to age and sex with two controls randomly chosen from a control population of 21,778 subjects who...

  17. Early Age Fracture Mechanics and Cracking of Concrete

    Østergaard, Lennart

    2003-01-01

    . The reasons are the increased autogenous deformation, the high rate of heat evolution and a higher brittleness of these concretes. Due to these adverse mechanisms the interest in the full description of the behavior of early age concrete has increased dramatically in the last two or three decades. Almost all...... the fictitious crack model and the aim has been experimentally to determine the fracture mechanical properties related to this model. The results provide interesting and important insight into the development of the fracture properties in early age. It is found that the characteristic length has moments of low...... values in early age, which means that the cracking sensibility is higher at those time points. The possible influence of time-dependent effects in the fracture mechanical properties on the cracking behavior in early age has also been investigated. The reason for this has been the known fact...

  18. Risk Factors of the Hip Fractures in Elderly Patients

    Ali Reza Nik-Tab'e

    2001-12-01

    Full Text Available Objective: The hip fractures are the most frequent cause of traumatic death after the age of 75 years, occurring more frequently in women that will make a negative impact of the patient's life style. The purpose of this research was to evaluate the risk factors of the hip fractures in elderly hospitalized in centers of education and treatment of Kerman and Rafsanjan cities in 1998-2000. Methods and Materials & Methods: This study was a descriptive method of sampling during 27 months (from 19 April 1998 to 21 July 2000 in hospitalized patients of orthopedic wards of Ali ebne Abitaleb hospital of Rafsanjan and Shahid bahonar hospital of Kerman. 257 patients who were afflicted with hip fracture were evaluated by a questionnaire with 20 statements (risk factors of hip fractures that was used to recorded information about this study: This risk factors were including age, sex, type of fracture, osteoporosis, milk consumption, muscle atrophy, environmental hazards, body mass index diseases, diabetes, previous fracture, smoking, antidepressant and anti convulsion drugs, heart disease, low mobility and activity perception disorders, age of menopause, impaired visual and nonuse external hip protector (padding. Results: The results of this study showed that many of above risk factors were effective (>50% than others. These factors were including environmental hazards (81.7%, muscle atrophy (72.8%, previous fractures (52.1%, low mobility and activity (70.8%, low milk consumption (100%, low BMI (79.8%, osteoporosis (52.1% and nonuse external hip protector (100%. Conclusion: The results of this study recommend that environmental hazards of elderly should be modified (e.g. well lighted, stair case with secure hand rail to prevent from falling Exercise and faradic current prevent muscle atrophy and improve physical fitness, muscle strength, balance and coordination. Treatment of impaired visual is important because risk of falling is decreased. Regular load

  19. [Nutritional status in elderly patients with a hip fracture].

    Pérez Durillo, F T; Ruiz López, M D; Bouzas, P R; Martín-Lagos, A

    2010-01-01

    Undernutrition is very common in elderly patients with a hip fracture. Malnutrition is associated with increased risk of complications after surgery. Few data exist about the presence of nutritional risk in these patients. The aim of this study was to evaluate the prevalence of undernutrition and the nutritional risk in elderly patients with a hip fracture admitted to a hospital. A cross sectional study assessing the nutritional status of 80 patients with hip fracture (mean age 80 years) was carried out. Functional capacity, anthropometric measurements, biochemical markers and dietary intake were evaluated. The Mini Nutritional Assessment test has been used to detect nutritional risk. 8.8% of patients were undernourished. 43.7% at risk of malnutrition and 47.5% well-nourished according to MNA test. If only BMI was considered the prevalence of malnutrition was 5%. Energy and micronutrient intake was low and could contribute to the development of complications after surgery. Our study shows a high prevalence of nutritional risk in elderly patients with a hip fracture. The inclusion of MNA in the preoperative evaluation could contribute to a better nutritional intervention during their stay in the hospital and to provide specific dietary advices to avoid malnutrition after surgery.

  20. Maxillofacial fractures among patients attended at Muhimbili ...

    Objective: To determine the pattern of occurrence, types, and treatment and prognosis of patients with maxillofacial fractures at the dental school of the Muhimbili University College of Health SciencesNational Hospital, Dar es Salaam, Tanzania. Methodology: ... comprised of 25 (accounting for 21.3%) of the cases (p<0.001).

  1. Low evaluation rate for osteoporosis among patients presenting with a rib fracture.

    Kim, Whang; Gong, Hyun Sik; Lee, Seung Hoo; Park, Jin Woo; Kim, Kahyun; Baek, Goo Hyun

    2017-12-01

    This study in a regional hospital setting found a low evaluation rate for osteoporosis among patients presenting with a rib fracture. Increased emphasis or education for osteoporosis evaluation may be necessary in case of rib fractures. Rib fractures from a low-energy trauma are common in the elderly, and a history of rib fracture has been reported to increase the risk for a subsequent osteoporotic fracture. The purpose of this study was to evaluate how many of the patients presenting with an isolated rib fracture were being evaluated for osteoporosis and the risk for a subsequent fracture. We retrospectively reviewed all patients aged 50 years or older who were diagnosed with a rib fracture between January 2011 and April 2016 at a regional tertiary care university hospital near Seoul, South Korea. We excluded those who had been treated for osteoporosis or those with other concomitant fractures or fractures from a motor vehicle accident or cancer. We evaluated the frequency of dual energy X-ray absorptiometry (DXA) scan examinations in these patients. There were 231 patients with isolated rib fractures (132 men and 99 women). The mean age was 65 years. Rib fractures were most commonly diagnosed at the emergency department and most of the patients were referred to the department of thoracic surgery for follow-up evaluations. Of these 231 patients, 29 (12%) had DXA examinations after the injury, and only 9 (4%) of them did so within 6 months. Physicians specializing in orthopedic surgery, family medicine, internal medicine, rehabilitation medicine, and emergency medicine were ordering the examination. This study in a regional hospital setting found a low evaluation rate for osteoporosis among patients presenting with a rib fracture. This study suggests that increased emphasis or education for osteoporosis evaluation may be necessary for physicians who are often referred to for care of rib fractures.

  2. Quality in rehabilitation after a working age person has sustained a fracture

    Lindahl, Marianne; Hvalsoe, Berit; Poulsen, Jeppe Rosengaard

    2013-01-01

    Research in quality of rehabilitation has mostly concerned patients with chronic diseases, but the aim of the present study was to investigate what constitutes good quality in rehabilitation after a person has sustained a fracture at working age, from both patients' and therapists' perspectives....

  3. The risk of fracture in incident multiple sclerosis patients

    Bazelier, Marloes T; Bentzen, Joan; Vestergaard, Peter

    2012-01-01

    Patients with multiple sclerosis (MS) may be at increased risk of fractures owing to osteoporosis and falling.......Patients with multiple sclerosis (MS) may be at increased risk of fractures owing to osteoporosis and falling....

  4. Postoperative hemoglobin level in patients with femoral neck fracture.

    Nagra, Navraj S; Van Popta, Dmitri; Whiteside, Sigrid; Holt, Edward M

    2016-01-01

    The aim of this study was to analyze the changes of hemoglobin levels in patients undergoing fixation for femoral neck fracture. Peroperative hemoglobin levels of patients who underwent either dynamic hip screw (DHS) fixation (n=74; mean age: 80 years) or hip hemiarthroplasty (n=104; mean age: 84 years) for femoral neck fracture was monitored. There was a statistically and clinically significant mean drop of 31.1 g/L between the preoperative (D0) and postoperative Day 5 Hb levels (pmeasurement, DHS patients had lower hemoglobin values over hemiarthroplasty patients (p=0.046). The decrease in hemoglobin in the first 24-hour postoperative period (D0 to Day 1) is an underestimation of the ultimate lowest value in hemoglobin found at Day 2. Relying on the Day 1 hemoglobin level could be detrimental to patient care. We propose a method of predicting patients likely to be transfused and recommend a protocol for patients undergoing femoral neck fracture surgery to standardize postoperative hemoglobin monitoring.

  5. Frequency of ipsilateral femoral neck fractures in patients with ...

    Background: Ipsilateral associated femoral neck and shaft fractures are reported to occur in 2.5-6% of all femoral shaft fractures. Objective: To establish the frequency of ipsilateral femoral neck fractures amongst all patients presenting with femoral shaft fractures in Mulago Hospital. Methodology: This was a descriptive ...

  6. Do clinical characteristics and outcome in nonagenarians with a hip fracture differ from younger patients?

    Vochteloo, Anne J.H.; Borger van der Burg, Boudewijn L.S.; Tuinebreijer, Wim E.; de Vries, Mark R.; Niggebrugge, Arthur H.P.; Bloem, Rolf M.; Maier, Andrea B.; Nelissen, Rob G.H.H.; Pilot, Peter

    Aim: To compare clinical characteristics and outcome of nonagenarian hip fracture patients with younger patients aged 65-89years. Methods: This was a cohort follow-up study of admissions for a hip fracture between 2005-2010 (mean follow up of 3.5years) in two teaching hospitals in the Netherlands;

  7. High inter-tester reliability of the new mobility score in patients with hip fracture

    Kristensen, M.T.; Bandholm, T.; Foss, N.B.

    2008-01-01

    OBJECTIVE: To assess the inter-tester reliability of the New Mobility Score in patients with acute hip fracture. DESIGN: An inter-tester reliability study. SUBJECTS: Forty-eight consecutive patients with acute hip fracture at a median age of 84 (interquartile range, 76-89) years; 40 admitted from...

  8. [Application of anterior percutaneous screw fixation in treatment of odontoid process fractures in aged people].

    Luo, Peng; Dou, Hai-cheng; Ni, Wen-fei; Huang, Qi-shan; Wang, Xiang-yang; Xu, Hua-zi; Chi, Yong-long

    2011-03-01

    To explore the efficacy of anterior percutaneous screw fixation in the treatment of odontoid process fractures in aged people. From February 2001 to April 2009, 15 elderly patients with odontoid fracture were treated with anterior percutaneous screw fixation,including 13 males and 2 females; the average age was 69.3 years (ranged, 60 to 86 years). According to Anderson classification, there were 10 patients with type II fractures (type II A in 7 cases, type II B in 3 cases, based on Eysel and Roosen classification), 4 patients with shallow type III fractures, 1 patient with deep type III fractures. Thirteen patients were fresh fractures, 2 patients were obsolete fractures. All patients had varying degrees of neck or shoulder pain, and limit activity of neck. There were 4 patients with neural symptoms including 2 grade D and 2 grade C according to Frankel classification. All the patients were followed up and were assessed by radiology. Clinical examination included neck activity, neurological function and the degree of neck pain. Radiology examinations including anteroposterior, lateral, open mouth position and flexion-extension radiographs of cervical vertebra were performed. After surgery, all patients were followed up,and the duration ranged from 6 to 60 months (averaged 31.3 months). Two patients died of other diseases during the follow-up period (18 and 22 months after surgery respectively). All patients got satisfactory results, and all screws were in good position. As the screw was too long, esophagus was compressed by screw tail in one case. One case showed fibrous union, 12 cases had achieved solid bony union, 2 cases showed nonunion without clinical symptoms. The rotation of neck in 3 cases was mildly limited,the neck function of the remaining patients were normal. Four patients with symptoms nerve injuries improved after operation (Frankel E in 3 cases, Frankel D in 1 case). The symptom of neck pain had a significant improvement after surgery (P process

  9. Locking plates in distal humerus fractures: study of 43 patients

    Gupta Rakesh Kumar

    2013-08-01

    Full Text Available 【Abstract】Objective: The treatment of multi-fragmentary, intraarticular fractures of the distal humerus is difficult, even in young patients with bone of good quality. Small distal fragment, diminished bone mineral quality and increased trauma-associated joint destruction make stable joint reconstruction more problematic. The anatomically preshaped locking plates allow angular stable fixation for these complex fractures. We evaluated functional results of patients treated with open reduction and internal fixation with distal humerus locking plates for complex distal hu-merus fractures. Methods: Forty-three consecutive patients with ar-ticular fractures of the distal humerus were treated by open reduction and internal fixation with AO distal humerus plate system and locking reconstruction plates. Forty patients were available for the final outcome analysis. According to AO/ASIF classification, there were 2 cases of type A2, 4 cases of type A3, 1 case of type B1, 1 case of type B2, 14 cases of type C1, 7 cases of type C2 and 11 cases of type C3. Open reduction with triceps splitting technique was used in all patients. The clinical and radiographic follow-up was performed and outcome measures included pain assessment, range of motion, and Mayo elbow performance score. Results: Forty patients were available for the final outcome analysis. There were 29 males and 11 females with an average age of 38.4 years (18-73 years. Clinical and ra-diological consolidation of the fracture was observed in all cases at an average of 11.6 weeks (9-14 weeks. The average follow-up was 12 months (10-18 months. Using the Mayo elbow performance score the results obtained were graded as excellent or good results in 33 patients (82.5%. One pa-tient had superficial infection, and 4 had myositis ossificans. There were no cases of primary malposition or secondary displacement, implant failure or ulnar neuropathy. Conclusion: Anatomically preshaped distal humerus locking

  10. Elastic nailing of tibia shaft fractures in young children up to 10 years of age.

    Heo, Jeong; Oh, Chang-Wug; Park, Kyeong-Hyeon; Kim, Joon-Woo; Kim, Hee-June; Lee, Jong-Chul; Park, Il-Hyung

    2016-04-01

    Although tibia shaft fractures in children usually have satisfactory results after closed reduction and casting, there are several surgical indications, including associated fractures and soft tissue injuries such as open fractures. Titanium elastic nails (TENs) are often used for pediatric tibia fractures, and have the advantage of preserving the open physis. However, complications such as delayed union or nonunion are not uncommon in older children or open fractures. In the present study, we evaluated children up to 10 years of age with closed or open tibial shaft fractures treated with elastic nailing technique. A total of 16 tibia shaft fractures treated by elastic nailing from 2001 to 2013 were reviewed. The mean patient age at operation was 7 years (range: 5-10 years). Thirteen of 16 cases were open fractures (grade I: 4, grade II: 6, grade IIIA: 3 cases); the other cases had associated fractures that necessitated operative treatments. Closed, antegrade intramedullary nailing was used to insert two nails through the proximal tibial metaphysis. All patients were followed up for at least one year after the injury. Outcomes were evaluated using modified Flynn's criteria, including union, alignment, leg length discrepancies, and complications. All fractures achieved union a mean of 16.1 weeks after surgery (range: 11-26 weeks). No patient reported knee pain or experienced any loss of knee or ankle motion. There was a case of superficial infection in a patient with grade III open fracture. Three patients reported soft tissue discomfort due to prominent TEN tips at the proximal insertion site, which required cutting the tip before union or removing the nail after union. At the last follow-up, there were no angular or rotational deformities over 10° in either the sagittal or coronal planes. With the exception of one case with an overgrowth of 15 mm, no patient showed shortening or overgrowth exceeding 10mm. Among final outcomes, 15 were excellent and 1 was

  11. Age-related hip fractures in men: clinical spectrum and short-term outcomes.

    Poór, G; Atkinson, E J; Lewallen, D G; O'Fallon, W M; Melton, L J

    1995-01-01

    Clinical spectrum, treatment and short-term outcomes were assessed among the 131 Rochester, Minnesota, men who contracted an initial hip fracture due to moderate trauma during 1978-89. Three-fourths of falls leading to hip fracture occurred indoors with little seasonality, and 91% of fractures were in men 65 years of age or older. The ratio of cervical to intertrochanteric femur fractures was 1.4:1, and there was a tendency toward more neurological conditions among the patients with cervical fractures. Hemiarthroplasty and total hip replacement were mostly performed for cervical fractures, while internal fixation was preferred for intertrochanteric fractures. In-hospital mortality was 11.5%, and the 30-day case fatality rate was 16.0%. Age and postoperative deterioration of mental status significantly increased the risk of early death, the latter even after adjustment in a multivariate model, while comorbidity had a suggestive but not statistically significant influence on mortality. More than half the men were discharged to nursing homes, and 79% of the patients who survived at 1 year resided in nursing homes or intermediate care facilities or were attended by home care. Only 41% of survivors recovered their prefracture level of functioning and nearly 60% of patients limped and required a cane or walker. After implementation of the prospective payment system in 1984, the length of hospital stay was reduced, but there was no change in early mortality rates, in the duration of physical therapy following fracture or in attendance at nursing homes. The results of this population-based study demonstrate the strong impact of hip fractures on short-term outcomes in men.

  12. Vertebral Compression Fracture in a Patient with Hyperthyroidism

    Ayhan Kul

    2016-12-01

    Full Text Available Osteoporosis in men is an important public health problem, and its prevalence is increasing as the population ages. Although it is traditionally considered as a women’s health issue, osteoporosis-related mortality and morbidity rates are higher in men. Although the lifetime risk of the hip fracture is lower in men than women, men are twice as likely to die after a hip fracture. All men diagnosed with osteoporosis should be evaluated for secondary causes of bone loss, such as hypogonadism, the use of corticosteroid, smoking, excessive alcohol consumption, low calcium intake, vitamin D deficiency and hypothyroidism. Here, we aimed to present a male patient in whom osteoporotic a vertebral fracture was detected and who was diagnosed with hyperthyroidism.

  13. Age, Sex, and Dose Effects of Nonbenzodiazepine Hypnotics on Hip Fracture in Nursing Home Residents.

    Dore, David D; Zullo, Andrew R; Mor, Vincent; Lee, Yoojin; Berry, Sarah D

    2018-04-01

    The Food and Drug Administration recommends a reduced dose of nonbenzodiazepine hypnotics in women, yet little is known about the age-, sex-, and dose-specific effects of these drugs on risk of hip fracture, especially among nursing home (NH) residents. We estimated the age-, sex-, and dose-specific effects of nonbenzodiazepine hypnotics on the rate of hip fracture among NH residents. Case-crossover study in US NHs. A total of 691 women and 179 men with hip fracture sampled from all US long-stay NH residents. Measures of patient characteristics were obtained from linked Medicare and the Minimum Data Set (2007-2008). The outcome was hospitalization for hip fracture with surgical repair. We estimated rate ratios (RRs) and 95% confidence intervals (CIs) from conditional logistic regression models for nonbenzodiazepine hypnotics (vs nonuse) comparing 0 to 29 days before hip fracture (hazard period) with 60 to 89 and 120 to 149 days before hip fracture (control periods). We stratified analyses by age, sex, and dose. The average RR of hip fracture was 1.7 (95% CI 1.5-1.9) for any use. The RR of hip fracture was higher for residents aged ≥90 years vs <70 years (2.2 vs 1.3); however, the CIs overlapped. No differences in the effect of the hypnotic on risk of hip fracture were evident by sex. Point estimates for hip fracture were greater with high-dose versus low-dose hypnotics (RR 1.9 vs 1.6 for any use), but these differences were highly compatible with chance. The rate of hip fracture in NH residents due to use of nonbenzodiazepine hypnotics was greater among older patients than among younger patients and, possibly, with higher doses than with lower doses. When clinicians are prescribing a nonbenzodiazepine hypnotic to any NH resident, doses of these drugs should be kept as low as possible, especially among those with advanced age. Copyright © 2017 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

  14. Profile and procedures for fractures among 1323 fracture patients from the 2010 Yushu earthquake, China.

    Kang, Peng; Tang, Bihan; Liu, Yuan; Liu, Xu; Shen, Yan; Liu, Zhipeng; Yang, Hongyang; Zhang, Lulu

    2016-11-01

    The injuries caused by earthquakes are often complex and of various patterns. Our study included all fracture inpatients from the Yushu earthquake (1323 in total), to learn more about the incidence and distribution of fractures during earthquakes. A retrospective study of the clinical characteristics of hospitalized fracture patients after the 2010 Yushu earthquake was conducted from December 20 to 25, 2010.We reviewed medical records of hospitalized patients who had been evacuated from the Yushu earthquake area between April 14 and June 15, 2010, from 57 hospitals, and also reviewed more than 100 documents assembled from daily medical rescue and disease prevention reports submitted by the frontline rescue organizations. In total, 78.0% of fracture patients were admitted to the hospital within 3 days after the earthquake. There were 1323 patients who presented with 1539 fractures. The most common fracture occurred in the lower limbs, followed by spinal, pelvic, and shoulder-upper limb fractures. The end of the thoracic vertebra and the lumbar vertebra were the high-risk sites for vertebral fractures. A total of 38 patients became paraplegic. A 2-level spatial clustering was detected among the 193 patients presenting with 2 fractures. Analysis profiles of the injuries and clinical features of patients with earthquake-related fractures will positively impact rescue efforts and the treatment of fracture injuries caused by possible future natural disasters. We should assemble orthopedic-related medications and surgical equipment, and allocate them promptly after a major earthquake. Copyright © 2016 Elsevier Inc. All rights reserved.

  15. The risk of fractures among patients with cirrhosis or chronic pancreatitis.

    Bang, Ulrich Christian; Benfield, Thomas; Bendtsen, Flemming; Hyldstrup, Lars; Beck Jensen, Jens-Erik

    2014-02-01

    Cirrhosis and chronic pancreatitis (CP) are accompanied by inflammation and malnutrition. Both conditions can have negative effects on bone metabolism and promote fractures. We evaluated the risk of fractures among patients with CP or cirrhosis and determined the effect of fat malabsorption on fracture risk among patients with CP. We performed a retrospective cohort study using the Danish National Patient Register to identify patients diagnosed with CP or cirrhosis. We analyzed data collected from January 1, 1995, to December 31, 2010, on 20,769 patients (35.5% women with cirrhosis and 11,972 patients (33.5% women) with CP. Each patient was compared with 10 age- and sex-matched controls. We also assessed the risk of fractures among patients with CP who received pancreatic enzyme substitution (PES) for fat malabsorption. During the study period, bone fractures occurred in 3954 patients with cirrhosis and 2594 patients with CP. The adjusted hazard ratio (HR) for any fracture was 2.4 in patients with cirrhosis (95% confidence interval [CI], 2.2-2.5) and 1.7 in patients with CP (95% CI, 1.6-1.8). The relative risk of low-trauma fractures was highest among individuals younger than 50 years old. Alcohol as an etiology was associated with an increased risk of fracture compared with patients with nonalcoholic cirrhosis (HR, 2.4 vs 1.5; P risk of fractures than other CP patients (HR, 0.8; 95% CI, 0.7-0.9). However, increasing the duration of treatment with PES was associated with an increased risk of fracture. Patients, especially younger patients, with cirrhosis or CP have an increased risk of fractures of all types. Copyright © 2014 AGA Institute. Published by Elsevier Inc. All rights reserved.

  16. [Characteristics of falls producing hip fracture in an elderly population. Differences according to age and gender].

    Formiga, F; Ruiz, D; López-Soto, A; Duaso, E; Chivite, D; Pérez-Castejón, J M

    2006-01-01

    The majority of hip fractures are produced because of a fall. We examined the characteristics associated with falls causing hip fracture in elderly patients. Characteristics of falls owing to hip fracture were analyzed in 410 consecutive patients admitted in 6 hospitals during the 2004. We evaluated the location, time and the possible cause of fall: intrinsic risk factor, extrinsic or combined. We evaluated 316 women (77%) and 94 men, mean age 81.9 years. Previous to the hip fracture, the mean BI was 77.5. The mean value of falls during the last year was 1.9. Previously to the fall that caused hip fracture, we found that 24% of the patients had fallen repeatedly (more than two falls). Usually falls were at home (68%) and during daytime (80%). In 45% of patients an intrinsic risk factor was considered the most likely cause, in 33% an extrinsic risk factor and in 22% a combination. The majority of falls owing to hip fracture in elderly people happen in daytime, at home and due to intrinsic risk factors. Efforts to identify elderly people at risk of fall should be stressed in order to establish preventive measures.

  17. Clinical Utility of Chest Computed Tomography in Patients with Rib Fractures CT Chest and Rib Fractures

    Chapman, Brandon C.; Overbey, Douglas M.; Tesfalidet, Feven; Schramm, Kristofer; Stovall, Robert T.; French, Andrew; Johnson, Jeffrey L.; Burlew, Clay C.; Barnett, Carlton; Moore, Ernest E.; Pieracci, Fredric M.

    2016-01-01

    Background Chest CT is more sensitive than a chest X-ray (CXR) in diagnosing rib fractures; however, the clinical significance of these fractures remains unclear. Objectives The purpose of this study was to determine the added diagnostic use of chest CT performed after CXR in patients with either known or suspected rib fractures secondary to blunt trauma. Methods Retrospective coho...

  18. Cementless Stem for Femoral Neck Fractures in a Patient's 10th Decade of Life: High Rate of Periprosthetic Fractures.

    Kabelitz, Method; Fritz, Yannick; Grueninger, Patrick; Meier, Christoph; Fries, Patrick; Dietrich, Michael

    2018-01-01

    Subsidence of cementless femoral stems in hemiarthroplasty (HA) and increased fracture rates are ongoing concerns of orthopedic surgeons when treating fractures in very old patients. Additionally, bone cement implantation syndrome may result in perioperative cardiac or pulmonary complications, especially in older patients, leading to morbidity and mortality. This study was performed to analyze possible subsidence and intraoperative fractures in a cohort of very old patients treated with cementless stems. We retrospectively analyzed a consecutive cohort of patients aged ≥90 years with femoral neck fractures treated by uncemented HA and an anterior minimally invasive approach. Immediate full-weight bearing was allowed postoperatively. Pelvic radiographs were examined for subsidence immediately postoperatively and 6 weeks later. We treated 109 patients (74% women; mean age, 93 years; range, 90-102 years) by HA from January 2010 to March 2016. The 30-day mortality rate was 16%, and the morbidity rate was 47%. There were 11 (12%) intraoperative fractures: 8 (Vancouver B 2 ) had to be addressed immediately during the primary operation, while 3 (1 Vancouver B 1 and 2 Vancouver A G ) were treated conservatively. One periprosthetic femoral fracture (Vancouver B 1 ) was documented during follow-up. In 17 patients, subsidence of >2.0 mm (median, 3.9 mm; range, 2.5-9.0 mm) was documented. Early subsidence was low in this very old cohort treated with an uncemented stem and not showing a periprosthetic fracture. The risk of intraoperative periprosthetic fractures was high. The use of uncemented implants in osteoporotic bone continues to be an intervention with high risk and should only be performed by experienced surgeons. Level III, Therapeutic study.

  19. Determinants of time to surgery for patients with hip fracture.

    Zeltzer, Justin; Mitchell, Rebecca J; Toson, Barbara; Harris, Ian A; Close, Jacqueline

    2014-09-01

    Guidelines for hip fracture care suggest that patients with hip fracture should undergo surgery on the day of or day after admission to hospital. This study examined factors affecting time to surgery for hip fracture extracted from existing administrative datasets in New South Wales (NSW), Australia. A retrospective analysis of patients with hip fracture aged 65 years and over undergoing surgical intervention in NSW public hospitals between 1 July 2000 and 30 June 2011. A multinomial logistic model was used to identify factors impacting on time to surgery from 1 July 2006 to 30 June 2011. A total of 49,317 hip fracture procedures were recorded during 2000-2001 to 2010-2011. Sixty-four per cent of patients received operative treatment on the day of or day after admission. Co-morbidity, type of surgical procedure and day of presentation all impacted significantly on time to surgery. Fourteen per cent required an inter-hospital transfer prior to receiving operative intervention. Transferred patients were 2.6 (95% confidence interval (CI): 2.31-2.85) times more likely to wait 2-4 days and 3.2 times more likely to wait 5 or more days (95% CI: 2.77-3.76) for surgery compared with patients presenting to an operating hospital. Significant variation exists between hospitals in the time to surgery that is not solely explained by measures of case mix or geography. Opportunities exist to consider other factors contributing to this variation and to ensure timely access to surgical intervention in the future. © 2014 Royal Australasian College of Surgeons.

  20. Fragility non-hip fracture patients are at risk.

    Gosch, M; Druml, T; Nicholas, J A; Hoffmann-Weltin, Y; Roth, T; Zegg, M; Blauth, M; Kammerlander, C

    2015-01-01

    Fragility fractures are a growing worldwide health care problem. Hip fractures have been clearly associated with poor outcomes. Fragility fractures of other bones are common reasons for hospital admission and short-term disability, but specific long-term outcome studies of non-hip fragility fractures are rare. The aim of our trial was to evaluate the 1-year outcomes of non-hip fragility fracture patients. This study is a retrospective cohort review of 307 consecutive older inpatient non-hip fracture patients. Patient data for analysis included fracture location, comorbidity prevalence, pre-fracture functional status, osteoporosis treatments and sociodemographic characteristics. The main outcomes evaluated were 1-year mortality and post-fracture functional status. As compared to the expected mortality, the observed 1-year mortality was increased in the study group (17.6 vs. 12.2 %, P = 0.005). After logistic regression, three variables remained as independent risk factors for 1-year mortality among non-hip fracture patients: malnutrition (OR 3.3, CI 1.5-7.1), Charlson comorbidity index (CCI) (OR 1.3, CI 1.1-1.5) and the Parker Mobility Score (PMS) (OR 0.85, CI 0.74-0.98). CCI and PMS were independent risk factors for a high grade of dependency after 1 year. Management of osteoporosis did not significantly improve after hospitalization due to a non-hip fragility fracture. The outcomes of older non-hip fracture patients are comparable to the poor outcomes of older hip fracture patients, and appear to be primarily related to comorbidities, pre-fracture function and nutritional status. The low rate of patients on osteoporosis medications likely reflects the insufficient recognition of the importance of osteoporosis assessment and treatment in non-hip fracture patients. Increased clinical and academic attention to non-hip fracture patients is needed.

  1. Management of nonunion after an old - neglected ankle fracture in diabetic patient; case report

    Tudor M. Gavrilă

    2016-11-01

    Full Text Available Ankle fractures represent 9% of fractures. Even if it is a relatively usual fracture, the presence of diabetes makes treatment more difficult and rate of complications is higher than in the rest of population. The incidence of ankle fractures increased in the last half century. Many studies from SUA, England, Sweden and Finland suggest that the epidemiology of ankle fractures continues to change as populations age, up to the age 60 of years in men and above age of 50 years in women. Two-thirds of fractures are isolated malleolar fractures, bimalleolar fractures occur in one-fourth of patients and trimaleolar fractures occur in the rest of them. We present a case of 60 years old women with non-insulin dependent diabetes for 22 years who sustained a fracture of ankle. Her first presentation at doctor was after 4 months after injury and surgical treatment occurred after 8 months after the injury. She was operated using an external fixator. Despite the fact the treatment was delayed, the evolution of lesion was good and patient could regained normal gate.

  2. Sites, frequencies, and causes of self-reported fractures in 9,720 rheumatoid arthritis patients: a large prospective observational cohort study in Japan.

    Ochi, Kensuke; Furuya, Takefumi; Ikari, Katsunori; Taniguchi, Atsuo; Yamanaka, Hisashi; Momohara, Shigeki

    2013-01-01

    Sites, frequencies, and causes of self-reported fractures in Japanese patients with rheumatoid arthritis (RA) were evaluated in a prospective, observational cohort study. The incidence and cause of fracture differ by anatomical site, sex, and age. These differences may be considered in establishing custom strategies for preventing fractures in RA patients in the future. The literature contains limited data describing the details of fractures at different skeletal sites in patients with RA. We evaluated the details of fractures in Japanese RA patients on the basis of our Institute of Rheumatology Rheumatoid Arthritis cohort study in 9,720 RA patients (82 % women; mean age, 56 years) who were enrolled from 2000 to 2010. The details of fractures were obtained through biannual patient self-report questionnaires. Over a mean duration of 5.2 years, 1,317 patients (13.5 %) reported 2,323 incident fractures comprising 563 (24.2 %) clinical vertebral fractures and 1,760 (75.8 %) nonvertebral fractures. Rib fractures were the most common fractures in men, followed by clinical vertebral and hip fractures; the most common fractures in women were clinical vertebral fractures, followed by rib, foot, and hip fractures. There was a significant difference between sexes in the rates of rib, clavicle, shoulder, and ankle fractures. Spontaneous event was the primary cause of clinical vertebral fracture (65.4 %), whereas falls were the primary cause of upper extremity (76.5 %) and lower extremity (57.8 %) fractures. Rates of clinical vertebral and hip fractures increased, while those of rib and foot fractures decreased with increasing age. Incidence of falls, as causes of nonvertebral fractures, also increased in older age groups. Our results suggest that the causes of fractures may differ depending on anatomical site and that prevention of falls may be the most effective way to reduce upper and lower extremity fractures, especially in older patients with RA.

  3. Risk factors for fractures in patients with rheumatoid arthritis (preliminary results of the multicenter program «Osteoporosis in rheumatoid arthritis: Diagnosis, risk factors, fractures, treatment»

    Marina Mikhailovna Podvorotova

    2013-01-01

    Full Text Available In patients with rheumatoid arthritis (RA, bone fractures occur 1.5-2 times more frequently than in the population. They often lead to reduced quality of life, to disability and death in the patients. It should be noted that risk factors (RFs for fractures have not been studied on a sufficient sample in Russia; there are no recommendations on the prevention of fractures in this category of patients. Objective: to compare groups of RA patients with and without a history of fractures to further identify possible RFs for fractures. Subjects and methods. The trial included 254 patients aged 18 to 85 years, diagnosed with RA, from the database of the multicenter program «Osteoporosis in rheumatoid arthritis: Diagnosis, risk factors, fractures, treatment», who had been followed up in 2010 to 2011. The patients were divided into two groups: 1 101 (39.8% patients with a history of low-trauma fractures and 2 153 (60.2% patients without a history of fractures. In Group 1, the patients were older than in Group 2 (mean age 59.8 and 56.1 years, respectively. Menopause was recorded in 88.1 and 77.8% of cases, respectively. The groups differed in the duration of RA an average of 15.5 and 11.5 years, respectively Results. The fractures in the history were associated with the use of glucocorticoids (GC, their higher cumulative dose and use duration. In Group 1 patients, the bone mineral density (BMD was lower in all study skeleton portions and more frequently corresponded to osteoporosis. RA complications, such as amyloidosis and osteonecrosis, were more common in the patients with a history of fractures. Conclusion. In RA patients, the most likely RFs of fractures are age, the long-term intake of large-dose GC, low BMD, the severe course of RA, and the presence of its complications.

  4. Detection of neurological deficits by computed tomography in sacral fracture patients

    Nakai, Daisuke; Numazaki, Shin; Katsumura, Tetsu; Tamaru, Tomohiko; Sugiyama, Mitsugi; Nakamura, Jun-ichiro; Saitoh, Tomoyuki

    2006-01-01

    The purpose of this study is to evaluate the correlation between sacral fractures and neurological deficits as complications. From November 2002 to February 2005, 12 patients (15 fractures) were found to have sacral fractures without other spinal injuries or brain injuries and were evaluated by plain CT scans immediately after trauma. This group included 6 males and 6 females, whose age ranged from 17 to 67 years with mean of 39.9±17.4. All patients were classified according to AO (Arbeitsgemeinschaft fuer Osteosynthesefragen) classification (pelvic ring fracture) and Denis's classification. Displacements of sacral fractures were evaluated by plain CT scans for all patients. We defined displacements using the key slice in CT scans that included the first foramen in the sacrum. Five cases, including 2 with bi-lateral sacral fractures, were complicated with neurological deficits. There was one case with a neurological deficit of 7 Type B fractures (14%) and 4 cases with neurological deficits of 5 Type C fractures (80%) in the AO classification. There were 6 fractures with neurological deficits of 12 Zone II fractures (50%) and one fracture with neurological deficits of one Zone III fractures (100%) in Denis's classification. There was a significant correlation between the extent in the displacement of the sacral fractures and neurological deficits. For more than 3 mm displacements in the medial or lateral or anterior directions, neurological deficits increased significantly. In emergency medicine, it is difficult to evaluate the neurological findings of patients with impaired consciousness. Our evaluation using CT scan is valuable as a predictor of neurological deficits and for an optimal reduction in sacral fractures in patients with in impaired consciousness. (author)

  5. Cervical spine fractures in elderly patients with hip fracture after low-level fall: an opportunity to refine prehospital spinal immobilization guidelines?

    Boland, Lori L; Satterlee, Paul A; Jansen, Paul R

    2014-02-01

    Conventional prehospital spine-assessment approaches based on low index of suspicion and mechanism of injury (MOI) result in the liberal application of spinal immobilization in trauma patients. A painful distracting injury (DI), such as a suspected hip fracture, historically has been a sufficient condition for immobilization, even in an elderly patient who suffers a simple fall from standing and exhibits no other risk factors for spinal injury. Because the elderly are at increased risk of hip fracture from low-level falls, and are also particularly susceptible to the discomfort and morbidity associated with immobilization, the prevalence of cervical spine (c-spine) fracture in this patient population was examined. Hospital billing records were used to identify all cases of traumatic femur fracture in Minnesota (USA) in 2010-2011. Concurrent diagnosis and external cause codes were used to estimate the prevalence of c-spine fracture by age and MOI. Among 1,394 patients with femur fracture, 23 (1.7%) had a c-spine fracture. When the MOI was a fall from standing or sitting height and the patient age was ≥ 65, the prevalence dropped to 0.4% (2/565). The prevalence was similar when the definition of hip fracture additionally included pelvis fractures (0.5%; 11/2,441). Eight of the 11 patients with c-spine fracture had diagnosis codes indicative of criteria other than the DI that likely would have resulted in immobilization (eg, head injury and compromised mental status). C-spine fracture is extremely rare in elderly patients who sustain hip fracture as a result of a low-level fall, and appears to be accompanied frequently by other known predictors of spinal injury besides DI. More research is needed to determine whether conservative use of spinal immobilization may be warranted in elderly patients with hip fracture after low-level falls when the only criteria for immobilization is the distracting hip injury.

  6. Clinical Utility of Chest Computed Tomography in Patients with Rib Fractures CT Chest and Rib Fractures.

    Chapman, Brandon C; Overbey, Douglas M; Tesfalidet, Feven; Schramm, Kristofer; Stovall, Robert T; French, Andrew; Johnson, Jeffrey L; Burlew, Clay C; Barnett, Carlton; Moore, Ernest E; Pieracci, Fredric M

    2016-12-01

    Chest CT is more sensitive than a chest X-ray (CXR) in diagnosing rib fractures; however, the clinical significance of these fractures remains unclear. The purpose of this study was to determine the added diagnostic use of chest CT performed after CXR in patients with either known or suspected rib fractures secondary to blunt trauma. Retrospective cohort study of blunt trauma patients with rib fractures at a level I trauma center that had both a CXR and a CT chest. The CT finding of ≥ 3 additional fractures in patients with ≤ 3 rib fractures on CXR was considered clinically meaningful. Student's t-test and chi-square analysis were used for comparison. We identified 499 patients with rib fractures: 93 (18.6%) had CXR only, 7 (1.4%) had chest CT only, and 399 (79.9%) had both CXR and chest CT. Among these 399 patients, a total of 1,969 rib fractures were identified: 1,467 (74.5%) were missed by CXR. The median number of additional fractures identified by CT was 3 (range, 4 - 15). Of 212 (53.1%) patients with a clinically meaningful increase in the number of fractures, 68 patients underwent one or more clinical interventions: 36 SICU admissions, 20 pain catheter placements, 23 epidural placements, and 3 SSRF. Additionally, 70 patients had a chest tube placed for retained hemothorax or occult pneumothorax. Overall, 138 patients (34.5%) had a change in clinical management based upon CT chest. The chest X-ray missed ~75% of rib fractures seen on chest CT. Although patients with a clinical meaningful increase in the number of rib fractures were more likely to be admitted to the intensive care unit, there was no associated improvement in pulmonary outcomes.

  7. Determinants of prevalent vertebral fractures and progressive bone loss in long-term hemodialysis patients.

    Mares, Jan; Ohlidalova, Kristina; Opatrna, Sylvie; Ferda, Jiri

    2009-01-01

    Skeletal fractures are common in hemodialysis (HD) patients. However, consensus regarding technique and site of bone examination has not been reached in HD patients. Seventy-two patients (44% females) aged 65 (1.4) years, treated with HD for 43 (4.6) months were examined with quantitative computed tomography and 53 of them re-examined after 1 year. Bone mineral density (BMD) of lumbar spine was established separately for cortical and trabecular bone, prevalent vertebral fractures were determined. Data are given as mean (standard error). At least one vertebral fracture was discovered in 15 (21%) patients. In a logistic regression model, fractures were best predicted by cortical BMD: OR 0.96 (CI 0.94, 0.99), p multiple regression analysis, time on dialysis was found to be independently correlated to cortical BMD (R = 0.35, p decrement may impose an increased risk of fractures on long-term dialysis patients.

  8. Economic burden of illness among US patients experiencing fracture nonunion

    Wu N

    2013-03-01

    Full Text Available Ning Wu,1 Yuan-chi Lee,1 Daniel Segina,2 Hallie Murray,3 Teresa Wilcox,1 Luke Boulanger1 1United BioSource Corporation, Lexington, MA, USA; 2Department of Orthopaedics, Holmes Regional Trauma Center, Melbourne, FL, USA; 3Biomet Spine and Bone Healing Technologies, Parsippany, NJ, USA Objectives: To compare economic outcomes in a real-world study of patients with fracture nonunion receiving non-invasive electrical bone growth stimulation (EBGS, low-intensity pulsed ultrasound stimulation (LIPUS, or other non-stimulation fracture management interventions (No-stim. Methods: Medical and pharmacy claims from a US commercially-insured population were analyzed to select adult patients newly diagnosed with a fracture nonunion between July 2006 and September 2009. The date of initial nonunion diagnosis was set as the index date. Three cohorts were constructed based on the first treatment prescribed post index date: EBGS, LIPUS, or No-stim. Baseline demographics, clinical characteristics, and health care costs 9 months before and 1 year after the index date were assessed. Multivariate regression analyses were performed to compare health care costs between cohorts in the post index period. Results: 11,628 patients (mean age 45.4 years; 45.7% males with a fracture nonunion were identified within the three treatment groups (EBGS: 29.5%, LIPUS: 12.3%, and No-stim: 58.2%. In the post-index period, EBGS patients were significantly less likely to receive fracture-related treatments when compared to the LIPUS (33.6% vs 42.2%, P < 0.01 and the No-stim (33.6% vs 60.3%, P < 0.01 cohorts. Additionally, after adjusting for demographic and clinical characteristics, the EBGS cohort had significantly lower predicted health care-associated costs 1 year post index date when compared to the LIPUS (mean: $21,632 vs $23,964, P < 0.01 and the No-stim (mean: $21,632 vs $23,843, P < 0.01 cohorts. Furthermore, the predicted fracture-related costs (FRC of EBGS patients were also

  9. Affective functioning after delirium in elderly hip fracture patients.

    Slor, Chantal J; Witlox, Joost; Jansen, René W M M; Adamis, Dimitrios; Meagher, David J; Tieken, Esther; Houdijk, Alexander P J; van Gool, Willem A; Eikelenboom, Piet; de Jonghe, Jos F M

    2013-03-01

    Delirium in elderly patients is associated with various long-term sequelae that include cognitive impairment and affective disturbances, although the latter is understudied. For a prospective cohort study of elderly patients undergoing hip fracture surgery, baseline characteristics and affective and cognitive functioning were assessed preoperatively. During hospital admission, presence of delirium was assessed daily. Three months after hospital discharge, affective and global cognitive functioning was evaluated again in patients free from delirium at the time of this follow-up. This study compared baseline characteristics and affective functioning between patients with and without in-hospital delirium. We investigated whether in-hospital delirium is associated with increased anxiety and depressive levels, and post-traumatic stress disorder (PTSD) symptoms three months after discharge. Among 53 eligible patients, 23 (43.4%) patients experienced in-hospital delirium after hip fracture repair. Patients who had experienced in-hospital delirium showed more depressive symptoms at follow-up after three months compared to the 30 patients without in-hospital delirium. This association persisted in a multivariate model controlling for age, baseline cognition, baseline depressive symptoms, and living situation. The level of anxiety and symptoms of PTSD at follow-up did not differ between both groups. This study suggests that in-hospital delirium is associated with an increased burden of depressive symptoms three months after discharge in elderly patients who were admitted to the hospital for surgical repair of hip fracture. Symptoms of depression in patients with previous in-hospital delirium cannot be fully explained by persistent (sub)syndromal delirium or baseline cognitive impairment.

  10. Results of operative fixation of unstable ankle fractures in geriatric patients.

    Pagliaro, A J; Michelson, J D; Mizel, M S

    2001-05-01

    It is widely accepted that operative fixation of unstable ankle fractures yields predictably good outcomes in the general population. The current literature, however reports less acceptable results in the geriatric population age 65 years and older. The current study analyzes the outcome of the surgical treatment of unstable ankle fractures in patients at least 65 years old. Twenty three patient over 65 years old were surgically treated after sustaining 21 (91%) closed and 2 (9%) open grade II unstable ankle fractures. Fractures were classified according to the Danis-Weber and Lauge-Hansen schemes. Fracture type was predominantly Weber B (21/23, 91%), or supination external rotation stage IV (21/23, 91%). Fracture union rate was 100%. There were three significant complications including a lateral wound dehiscence with delayed fibular union in an open fracture dislocation, and two below knee amputations, neither of which was directly related to the fracture treatment. There were three minor complications; one superficial wound infection and two cases of prolonged incision drainage, all of which resolved without further surgical intervention. Complications were associated with open fractures and preexisting systemic disease. These results indicate that open reduction and internal fixation of unstable ankle fractures in geriatric patients is an efficacious treatment regime that with results that are comparable to the general population.

  11. SPECT of aged backache patients

    Ito, Shigehiko; Nishikimi, Junzo; Mizuno, Naokado; Watanabe, Kentaro; Kondo, Masaki; Ozaki, Satoshi; Urasaki, Tetsuya; Muro, Toshiyuki [Prefectural Tajimi Hospital, Gifu (Japan)

    1995-12-01

    Single photon emission computed tomography (SPECT) using {sup 99m}Tc-HMDP was performed on 53 middle-aged or elderly patients (male 20, female, 33; age range, 40-80 years old) with lumbago, i.e., 25 patients with lumbar spondylosis, 15 with lumbar degenerative spondylolisthesis, 4 with spondylolytic spondylolisthesis, 3 with compression fracture, 3 with pulurent spondylitis, 2 with spondylous osteoporosis, and 1 with spinal osteodesmosis. {sup 99m}Tc-HMDP (740 MBq) was intravenously injected and regular SPECT was performed at 3 hours. Gamma camera was performed for about 10 seconds with 5deg intervals, and 36 steps (180deg) of collection was completed after about 6 minutes. The radioisotope accumulation, the presence or absence of sthenia, and its site were evaluated. Forty-seven (88.7%) patients showed excessive accumulation, i.e., 40 (75.5%) in peripheral vertebral osteophyte, 31 (58.5%) in vertebral articulations, and 10 (18.9%) in whole vertebral body. Significantly increased bilateral excessive accumulation was admitted in the vertebral articulations of sliding disc in degenerative spondylolisthesis. SPECT is considered useful in understanding the pathophysiology of degenerative lumber diseases. (S.Y.).

  12. SPECT of aged backache patients

    Ito, Shigehiko; Nishikimi, Junzo; Mizuno, Naokado; Watanabe, Kentaro; Kondo, Masaki; Ozaki, Satoshi; Urasaki, Tetsuya; Muro, Toshiyuki

    1995-01-01

    Single photon emission computed tomography (SPECT) using 99m Tc-HMDP was performed on 53 middle-aged or elderly patients (male 20, female, 33; age range, 40-80 years old) with lumbago, i.e., 25 patients with lumbar spondylosis, 15 with lumbar degenerative spondylolisthesis, 4 with spondylolytic spondylolisthesis, 3 with compression fracture, 3 with pulurent spondylitis, 2 with spondylous osteoporosis, and 1 with spinal osteodesmosis. 99m Tc-HMDP (740 MBq) was intravenously injected and regular SPECT was performed at 3 hours. Gamma camera was performed for about 10 seconds with 5deg intervals, and 36 steps (180deg) of collection was completed after about 6 minutes. The radioisotope accumulation, the presence or absence of sthenia, and its site were evaluated. Forty-seven (88.7%) patients showed excessive accumulation, i.e., 40 (75.5%) in peripheral vertebral osteophyte, 31 (58.5%) in vertebral articulations, and 10 (18.9%) in whole vertebral body. Significantly increased bilateral excessive accumulation was admitted in the vertebral articulations of sliding disc in degenerative spondylolisthesis. SPECT is considered useful in understanding the pathophysiology of degenerative lumber diseases. (S.Y.)

  13. Aging and Fracture of Human Cortical Bone and Tooth Dentin

    Ager, Joel; Koester, Kurt J.; Ager III, Joel W.; Ritchie, Robert O.

    2008-05-07

    Mineralized tissues, such as bone and tooth dentin, serve as structural materials in the human body and, as such, have evolved to resist fracture. In assessing their quantitative fracture resistance or toughness, it is important to distinguish between intrinsic toughening mechanisms which function ahead of the crack tip, such as plasticity in metals, and extrinsic mechanisms which function primarily behind the tip, such as crack bridging in ceramics. Bone and dentin derive their resistance to fracture principally from extrinsic toughening mechanisms which have their origins in the hierarchical microstructure of these mineralized tissues. Experimentally, quantification of these toughening mechanisms requires a crack-growth resistance approach, which can be achieved by measuring the crack-driving force, e.g., the stress intensity, as a function of crack extension ("R-curve approach"). Here this methodology is used to study of the effect of aging on the fracture properties of human cortical bone and human dentin in order to discern the microstructural origins of toughness in these materials.

  14. Low-density lipoprotein cholesterol is associated with fracture risk in diabetes patients - a nested case-control study

    Starup-Linde, Jakob; Gregersen, Søren; Vestergaard, Peter

    2014-01-01

    available for an analysis of patient characteristics, co-morbidities, biochemical parameters and drug usage. Results: Patient age at the time of diabetes diagnosis, a diagnosis of previous fracture, an alcohol related diagnosis, total cholesterol level, and the usage of antidepressants, antiepileptics...... and insulin all increased the odds of fracture. Low-density lipoprotein cholesterol (LDL) levels decreased the odds of fracture, where the level of 3.04-5.96 mmol/l was optimal with regard to fracture risk. Conclusion: LDL may add to the understanding of fractures in diabetes patients and it may be added...

  15. Assessment of fracture risk in a cohort of Egyptian female Systemic Lupus erythematosus patients

    Eman A. Hafez

    2018-04-01

    Full Text Available Aim of the work: To assess the fracture risk in a cohort of Egyptian systemic lupus erythematosus (SLE females in correlation to some disease variables. Patients and methods: Seventy female SLE patients ≥40 years old were enrolled with detailed history taking, assessment of disease activity and damage index. Measurement of Serum calcium, phosphorus and alkaline phosphatase, bone mineral density (BMD by dual emission X-ray absorptiometry (DEXA at lumbar spine (LS and femoral neck (FN, serum osteocalcin level and World Health Organization (WHO fracture risk assessment tool (FRAX®. Results: 20% of the patients had LS osteoporosis, 35.7% LS osteopenia, 8.6% FN osteoporosis, and 42.9% FN osteopenia. Ten-year risk of major and hip fractures was high in SLE patients evidenced by FRAX-Major ≥20% in 10% of patients, and FRAX-Hip ≥3% in 27.1% of patients. Serum osteocalcin level was significantly decreased in SLE patients with lower BMD than those with normal BMD, and significantly decreased in patients with osteoporosis than those with osteopenia. A significant negative correlation was found between osteocalcin level and age of patients, disease duration, disease activity and damage index scores, current intravenous pulse and cumulative steroids, immunosuppressants, anticoagulants, but there was a positive correlation with antimalarials and calcium supplements. Conclusion: Ten-year risk of major and hip fractures was high in SLE patients. Increasing age, disease duration, high anti-DNA titres, higher disease activity and damage index were associated with a higher fracture risk. FRAX predicted fractures among SLE patients with normal and low bone mass not just those with frank osteoporosis. Physicians should be alerted to the higher risk of future fractures in SLE patients for periodic monitoring. Keywords: Systemic lupus erythematosus, Bone mineral density, Osteoporosis, Fracture risk, Fracture risk assessment tool

  16. Factors with independent influence on the 'timed up and go' test in patients with hip fracture

    Kristensen, Morten Tange; Foss, Nicolai Bang; Kehlet, Henrik

    2009-01-01

    an intertrochanteric fracture (B = 7), performing TUG with a walker (B = 15), and performing TUG in the later postoperative period (B = 0.39) were independently associated with having a poorer TUG score. CONCLUSIONS: These preliminary normative reference values of TUG performances in patients with hip fracture can...... be used as references, to which individuals can expect to perform. Multivariate testing suggests that clinicians should use age, pre-fracture function, fracture type and walking-aid specific data when interpreting the TUG test results. Physiotherapists should be aware of this if TUG scores are to be used...

  17. A retrospective study of eyeball rupture in patients with or without orbital fracture.

    Chen, Xiang; Yao, Yi; Wang, Fengxiang; Liu, Tiecheng; Zhao, Xiao

    2017-06-01

    To summarize the clinical features of eyeball rupture with or without orbital fracture and explore the differences between them.In all, 197 patients were observed, and the following data were recorded: sex, age, time of injury, place of injury, cause of trauma, zone of eye injury, intraocular content prolapse, surgical methods and the therapeutic process, visual acuity after injury, and the final best corrected visual acuity. The results were analyzed for statistically significant differences.There was no significant difference (P > .05) in the age, sex, or cause of injury. Patients with eyeball rupture with fracture had poorer vision than did those in the simple eyeball rupture group; eyeball rupture with fracture also had a higher probability of enucleation.In this study, the clinical results show that prognosis of eyeball rupture with orbital fracture is worse than that of eyeball rupture without orbital fracture.

  18. High fall incidence and fracture rate in elderly dialysis patients.

    Polinder-Bos, H A; Emmelot-Vonk, M H; Gansevoort, R T; Diepenbroek, A; Gaillard, C A J M

    2014-12-01

    Although it is recognised that the dialysis population is ageing rapidly, geriatric complications such as falls are poorly appreciated, despite the many risk factors for falls in this population. The objective of this study was to determine the incidence, complications and risk factors for falls in an elderly dialysis population. A one-year observational study of chronic dialysis patients aged ≥ 70 years. At baseline, patient characteristics were noted and during follow-up the vital parameters and laboratory values were recorded. Patients were questioned weekly about falls, fall circumstances and consequences by trained nurses. 49 patients were included with a median age of 79.3 years (70-89 years). During follow-up 40 fall accidents occurred in 27 (55%) patients. Falls resulted in fractures in 15% of cases and in hospital admissions in 15%. In haemodialysis (HD) patients, the mean systolic blood pressure (SBP) before HD was lower in fallers compared with non-fallers (130 vs. 143 mmHg). Several patients in the lower blood pressure category received antihypertensive medication. For every 5 mmHg lower SBP (before HD) the fall risk increased by 30% (hazard ratio (HR) 1.30, 95% CI 1.03-1.65, p = 0.03). Furthermore, fall risk increased by 22% for every 10 pmol/l rise of parathyroid hormone (HR 1.22, 95% CI 1.06-1.39, p = 0.004). Elderly dialysis patients have a high incidence of falls accompanied by a high fracture rate. Given the high complication rate, elderly patients at risk of falling should be identified and managed. Reduction of blood pressure-lowering medication might be a treatment strategy to reduce falls.

  19. Factors influencing period from surgery to discharge in patients with femoral trochanteric fractures

    Shinoda, Soichiro; Mutsuzaki, Hirotaka; Watanabe, Arata; Morita, Hidetaka; Kamioka, Yumiko

    2017-01-01

    [Purpose] The purpose of this study was to investigate factors influencing the period from surgery to discharge in patients with femoral trochanteric fractures. [Subjects and Methods] Sixty patients with femoral trochanteric fractures were investigated retrospectively. Based on the mean period from surgery to discharge (85.6 ± 26.6 days), the patients were divided into two groups: an under-85-day group (range, 29–78 days) and an over-85-day group (87–128 days). Age, gender, fracture type, pre...

  20. Cervical hip fractures do not occur in arthrotic joints. A clinicoradiographic study of 256 patients.

    Dretakis, E K; Steriopoulos, K A; Kontakis, G M; Giaourakis, G; Economakis, G; Dretakis, K E

    1998-08-01

    We studied endogenic factors for the occurrence of cervical hip fractures in 256 patients. 230 underwent hemiarthroplasty, and 26 were treated with internal fixation or without surgery. The condition of the fractured hip and of the ipsilateral knee, as well as the mobility of the patient before the fracture, were studied in all 256 patients. The removed femoral heads were examined, photographed and radiographs were taken with sensitive film. The acetabulum and the femoral head were macroscopically normal in all 230 cases and there was no radiographic evidence of arthrosis. 64% of the patients were fully mobile before the fracture, 34% were mobile with the aid of a cane and 2% were dependent. In 88%, the ipsilateral knee was normal both clinically and radiographically, and in 12%, there was moderate arthrosis. When comparing the mobility before the fracture and the condition of the ipsilateral hip and knee in 100 patients having a cervical fracture with 100 patients having a trochanteric fracture matched for age and sex, we found that a normal hip joint was sine qua non while a normal ipsilateral knee and a fully mobile individual were important additional conditions for the occurrence of a cervical hip fracture, instead of a trochanteric one, after a fall in an elderly person.

  1. Celiac Disease Does Not Influence Fracture Risk in Young Patients with Type 1 Diabetes

    Reilly, Norelle R; Lebwohl, Benjamin; Mollazadegan, Kaziwe; Michaëlsson, Karl; Green, Peter HR; Ludvigsson, Jonas F

    2015-01-01

    Objectives To examine the risk of any fractures in patients with both type 1 diabetes (T1D) and celiac disease (CD) vs patients with T1D only. Study design We performed a population-based cohort study. We defined T1D as individuals aged ≤30 years who had a diagnosis of diabetes recorded in the Swedish National Patient Register between 1964–2009. Individuals with CD were identified through biopsy report data between 1969–2008 from any of Sweden’s 28 pathology departments. Some 958 individuals had both T1D and CD and were matched for sex, age and calendar period with 4,598 reference individuals with T1D only. We then used a stratified Cox regression analysis, where CD was modeled as a time-dependent covariate, to estimate the risk of any fractures and osteoporotic fractures (hip, distal forearm, thoracic and lumbar spine, and proximal humerus) in patients with both T1D and CD compared with that in patients with T1D only. Results During follow-up, 12 patients with T1D and CD had a fracture (1 osteoporotic fracture). CD did not influence the risk of any fracture (adjusted Hazard Ratio=0.77; 95%CI=0.42–1.41) or osteoporotic fractures (adjusted Hazard Ratio=0.46; 95%CI=0.06–3.51) in patients with T1D. Stratification for time since CD diagnosis did not affect risk estimates. Conclusion Having a diagnosis of CD does not seem to influence fracture risk in young patients with T1D. Follow-up in this study was, however, too short to ascertain osteoporotic fractures which traditionally occur in old age. PMID:26589343

  2. Vertebral artery injury in patients with isolated transverse process fractures.

    Bonney, Phillip A; Burks, Joshua D; Conner, Andrew K; Glenn, Chad A; Baker, Cordell M; Cheema, Ahmed A; Archer, Jacob B; Buster, Bryan E; Albrecht, Roxie M; Bohnstedt, Bradley N

    2017-07-01

    We sought to assess the rate of CTA-diagnosed vertebral artery injury in patients with isolated transverse process fractures, with and without extension into the transverse foramen, in the blunt-trauma population served by our hospital. We queried our universities trauma registry between January 2009 and July 2014 for ICD-9 codes pertaining to cervical spine fractures. Of 330 patients identified, 45 patients had fractures limited to the transverse process and were selected for the study population. For each patient identified, demographics, injury mechanism, imaging reports, angiography findings, and treatments were recorded. In total, 69 fractures were identified in 45 patients. Of the 45 patients, 15 (33%) had transverse process fractures at multiple cervical levels. 23/45 (51%) patients had at least one fracture extending into TF. Four patients with transverse process fractures and one patient without transverse process fractures were diagnosed with vertebral artery injury by CT angiogram (17.4% vs. 4.5%, p=0.35). The number of transverse process fractures in patients with VAI was greater than those without VAI (3.0 vs. 1.4, p<0.001). None of the 30 patients with any one-level TPF (with or without extension into TF) was diagnosed with VAI (p=0.003). None of 17 patients with isolated C7-level TPFs were diagnosed with VAI (p=0.15). The incidence of cervical VAI was greater in patients with multiple-level TPFs than in patients with single-level TPFs. While patients with a single, isolated TPF have a low probability of VAI, patients with numerous TPF fractures may benefit from CTA. Copyright © 2017 Elsevier Ltd. All rights reserved.

  3. Intertrochanteric fractures in elderly high risk patients treated with Ender nails and compression screw

    Gangadharan Sidhartha

    2010-01-01

    Full Text Available Background: Ender and Simon Weidner popularized the concept of closed condylocephlic nailing for intertrochanteric fractures in 1970. The clinical experience of authors revealed that Ender nailing alone cannot provide secure fixation in elderly patients with osteoporosis. Hence we conducted a study to evaluate the efficacy of a combined fixation procedure using Ender nails and a cannulated compression screw for intertrochanteric fractures. Materials and Methods: 76 patients with intertrochanteric fractures were treated using intramedullary Ender nails and cannulated compression screw from January 2004 to December 2007. The mean age of the patients was 80 years (range 70-105 years.Using the Evan′s system of classification 49 were stable and 27 unstable fractures. Inclusion criteria was high risk elderly patients (age > 70 years with intertrochanteric fracture. The exclusion criteria included patients with pressure sores over the trochanteric region. Many patients had pre-existing co-morbidities like diabetes mellitus, hypertension, COPD, ischemic heart disease, CVA and coronary artery bypass surgery. The two Ender nails of 4.5mm each were passed across the fracture site into the proximal neck. This was reinforced with a 6.5 mm cannulated compression screw passed from the sub trochanteric region, across the fracture into the head. Results: The mean follow-up was 14 months (range 9-19 months Average time to fracture union was 10 weeks (range 6-16 weeks. The mean knee ROM was 130o (± 5o. There was no case of nail penetration into hip joint. In five cases with advanced osteoporosis there was minimal migration of Ender nails distally. Conclusions: The Ender nailing combined with compression screw fixation in cases of intertrochanteric fractures in high risk elderly patients could achieve reliable fracture stability with minimal complications.

  4. National trends of incidence, treatment, and hospital charges of isolated C-2 fractures in three different age groups.

    Kukreja, Sunil; Kalakoti, Piyush; Murray, Richard; Nixon, Menarvia; Missios, Symeon; Guthikonda, Bharat; Nanda, Anil

    2015-04-01

    Incidence of C-2 fracture is increasing in elderly patients. Patient age also influences decision making in the management of these fractures. There are very limited data on the national trends of incidence, treatment interventions, and resource utilization in patients in different age groups with isolated C-2 fractures. The aim of this study is to investigate the incidence, treatment, complications, length of stay, and hospital charges of isolated C-2 fracture in patients in 3 different age groups by using the Nationwide Inpatient Sample (NIS) database. The data were obtained from NIS from 2002 to 2011. Data on patients with closed fractures of C-2 without spinal cord injury were extracted using ICD-9-CM diagnosis code 805.02. Patients with isolated C-2 fractures were identified by excluding patients with other associated injuries. The cohort was divided into 3 age groups: 80 years. Incidence, treatment characteristics, inpatient/postoperative complications, and hospital charges (mean and total annual charges) were compared between the 3 age groups. A total of 10,336 patients with isolated C-2 fractures were identified. The majority of the patients were in the very elderly age group (> 80 years; 42.3%) followed by 29.7% in the 65- to 80-year age group and 28% in age group. From 2002 to 2011, the incidence of hospitalization significantly increased in the 65- to 80-year and > 80-year age groups (p age group (p = 0.287). Overall, 21% of the patients were treated surgically, and 12.2% of the patients underwent nonoperative interventions (halo and spinal traction). The rate of nonoperative interventions significantly decreased over time in all age groups (p age groups had a greater risk of inpatient/postoperative complications, nonroutine discharges, and longer hospitalization. The mean hospital charges were significantly higher in older age groups (p age groups. Simultaneously, there has been a steadily decreasing trend in the preference for nonoperative

  5. Osteoporosis and fall risk in patients with fragility fractures

    van Helden, SH; Nieuwenhuijzen-Kruseman, AC; Dinant, G; Pijpers, E; ten Broeke, R; Brink, PR; GEUSENS, Piet

    2005-01-01

    Low BMD and fall risk are well-documented risk factors for fractures. The prevalence of both risk factors has only scarcely been reported in the same population of patients with recent clinical fractures. Methods : 261 consecutive patients (women and men of 50 years and older) admitted to the hospital with a recent clinical fracture were included and had extensive evaluation of bone mineral density (BMD) and fall risk (135 patients with fracture of the upper limb, 94 of the lower limb, 12 of...

  6. Pelvic fracture in the patient with multiple injuries: factors and lesions associated with mortality.

    Martínez, Fernando; Alegret, Núria; Carol, Federico; Laso, M Jesús; Zancajo, Juanjo; García, Esteban; Ros, Vanesa

    2018-01-01

    The main objective of this study was to identify demographic, clinical, analytical factors or injuries associated with 30-day mortality in patients with pelvic fractures. Prospective observational study of patients with multiple injuries including pelvic fractures between January 2009 and January 2017. We recorded demographic, clinical, and laboratory data on arrival at the emergency department; type of pelvic fracture; treatments; associated lesions; and 30-day mortality. Univariable and multivariable models were used to analyze the data. A total of 2061 multiple-injury patients were attended; 118 had pelvic fractures. Fifteen of the patients with pelvic fractures (12.7%) died within 30 days. Arterial blood pressure on admission was less than 90 mm Hg in 23.7%, heart rate was over 100 beats per minute in 41.52%, lactic acid level was 20 mg/dL or higher in 67.6%, and base excess of -6 or less was recorded for 26.3%. The mean Injury Severity Score was 20 points. Angiographic embolization was required in 80.6% and preperitoneal packing in 3.4%. The main associated lesions were rib fractures (35.6%), hemo-pneumothorax (31.3%), spinal injuries (35.6%), and head injuries (30%). The 6 independent variables associated with risk of death in multiple-injury patients with pelvic fractures are age, female sex, complex fractures (Tile type C), lactic acid level of 20 mg/dL or more, base excess of -6 or less, and bowel perforation.

  7. Malnutrition in hip fracture patients: an intervention study.

    Olofsson, Birgitta; Stenvall, Michael; Lundström, Maria; Svensson, Olle; Gustafson, Yngve

    2007-11-01

    To investigate whether a nutritional intervention in older women and men with femoral neck fracture had an effect on postoperative complications during hospitalization and on nutritional status at a four-month follow-up. The design was a randomized controlled trial. The present study sample consisted of 157 patients aged 70 years and above with femoral neck fracture. The nutritional intervention included, among other things, a nutritional journal to detect nutrition deficiencies and protein-enriched meals for at least four days postoperatively. Further, at least two nutritional and protein drinks were served each day during the whole hospitalization and other factors that would influence the patient's nutrition were also considered and dealt with. Postoperative complications were registered and patients were assessed using the Mini Nutritional Assessment (MNA) scale, including body mass index (BMI), on admission and at a four-month follow-up. Malnutrition was common and low MNA scores were associated with postoperative complications such as delirium and decubitus ulcers. There were significantly fewer days of delirium in the intervention group, seven patients in the intervention group developed decubitus ulcers vs. 14 patients in the control group and the total length of hospitalization was shorter. There were no detectable significant improvements regarding nutritional parameters between the intervention and the control group at the four-month follow-up but men improved their mean BMI, body weight and MNA scores in both the intervention and the control groups while women deteriorated in both groups. Malnutrition was common among older people with hip fractures admitted to hospital. The nutritional intervention might have contributed to the patients suffering fewer days with delirium, fewer decubitus ulcers and shorter hospitalization but did not improve the long-term nutritional status, at least not in women. This nutritional intervention, which was included in a

  8. [Conventional X-Rays of Ankle Joint Fractures in Older Patients are Not Always Predictive].

    Jubel, A; Faymonville, C; Andermahr, J; Boxberg, S; Schiffer, G

    2017-02-01

    Background: Ankle fractures are extremely common in the elderly, with an incidence of up to 39 fractures per 100,000 persons per year. We found a discrepancy between intraoperative findings and preoperative X-ray findings. It was suggested that many relevant lesions of the ankle joint in the elderly cannot be detected with plain X-rays. Methods: Complete data sets and preoperative X-rays of 84 patients aged above 60 years with ankle fractures were analysed retrospectively. There were 59 women and 25 men, with a mean age of 69.9 years. Operation reports and preoperative X-rays were analysed with respect to four relevant lesions: multifragmentary fracture pattern of the lateral malleolus, involvement of the medial malleolus, posterior malleolar fractures and bony avulsion of anterior syndesmosis. Sensitivity, specificity, positive predictive value, negative predictive value, accuracy and prevalence were calculated. Results: The prevalence of specific ankle lesions in the analyzed cohort was 24 % for the multifragmentary fracture pattern of the lateral malleolus, 38 % for fractures of the medial malleolus, 25 % for posterior malleolar fractures and 22.6 % for bony avulsions of the anterior syndesmosis. Multifragmentary fracture patterns of the lateral malleolus (sensitivity 0 %) and bony avulsions of the anterior syndesmosis (sensitivity 5 %) could not be detected in plain X-rays of the ankle joint at all. Fractures of the medial malleolus and involvement of the dorsal tibial facet were detected with a sensitivity of 96.8 % and 76.2 %, respectively, and specificity of 100 % in both cases. Conclusions: This study confirms that complex fracture patterns, such as multifragmentary involvement of the lateral malleolus, additional fracture of the medial malleolus, involvement of the dorsal tibial facet or bony avulsion of the anterior syndesmosis are common in ankle fractures of the elderly. Therefore, CT scans should be routinely considered for primary

  9. [Malnutrition as a prognostic factor in elderly patients with hip fractures].

    Montero Pérez-Barquero, Manuel; García Lázaro, Milagros; Carpintero Benítez, Pedro

    2007-05-19

    Hip fracture occurs frequently in elderly patients, with devastating effects on the quality of life due to the high financial burden and the high mortality rate in patients with this condition. Malnutrition is prevalent in the elderly and it can negatively influence patients' recovery from hip fracture. Our proposal was to assess the relationship between malnutrition and the recovery of patients with hip fracture. A total of 110 patients with hip fractures who were admitted to the orthopedic unit at the Reina Sofía Hospital were reassessed one year after discharge. A prospective cohort design and logistic regression analysis was used. Mean age was 81.4, and 80% of patients were women. After one year 19.7% of patients had died. A multivariate analysis showed a significant relationship between a poor functional recovery and age (odds ratio [OR] = 1.19), caloric malnutrition (OR = 290), protein malnutrition (OR = 125); and there was a significant relationship between being confined to bed and a worse situation before fracture (OR = 10.02); caloric malnutrition (OR = 9.57) and protein malnutrition (OR = 15.23). Caloric and protein malnutrition were associated with a worse functional recovery in elderly patients with hip fracture.

  10. Lower limb fractures in adult patients with residua of poliomyelitis ...

    Few studies have been published in the literature regarding fractures of limbs in patients with poliomyelitis. We have conducted a retrospective study from 1992 to 2004 in order to present our data on fractures of lower limbs in adult patients with residua of poliomyelitis. During the thirteen-year period under study, only eight ...

  11. Compression fractures in patients undergoing spinal manipulative therapy

    Haldeman, S.; Rubinstein, S M

    Increasing numbers of elderly patients are currently seeking chiropractic care. One condition commonly seen in the elderly is osteoporosis of the spine, which carries with it the risk of compression fractures. We present four cases in which patients were noted to have compression fractures following

  12. Fear of falling in older patients after hip fracture

    Visschedijk, Johannes Hermanus Maria (Jan)

    2016-01-01

    FoF is possibly one of the most important factors in patients after hip fracture, with a substantial impact on the final results of the rehabilitation process. Moreover, patients with hip fracture who rehabilitate in a SNF with high rates of comorbidity and complications, may have even worse

  13. An analysis of postoperative hemoglobin levels in patients with a fractured neck of femur

    Navraj S. Nagra; Dmitri van Popta; Sigrid Whiteside; Edward M. Holt

    2016-01-01

    Objectives: The aim of this study was to analyze the changes in hemoglobin level and to determine a suitable timeline for post-operative hemoglobin monitoring in patients undergoing fixation of femoral neck fracture. Patients and methods: Patients who underwent either dynamic hip screw (DHS) fixation (n = 74, mean age: 80 years) or hip hemiarthroplasty (n = 104, mean age: 84 years) for femoral neck fracture were included into the study. The hemoglobin level of the patients was monitored pe...

  14. Predictors for perioperative blood transfusion in elderly patients with extra capsular hip fractures treated with cephalo-medullary nailing

    M. Ali Fazal

    2018-02-01

    Conclusion: Patient age, ASA grade, preoperative haemoglobin and length of nail are reliable predictors for perioperative blood transfusion in extra capsular hip fractures in elderly patients treated with cephalo-medullary nailing and reinforce a selective transfusion policy.

  15. Femoral Neck Stress Fractures in Children Younger Than 10 Years of Age.

    Boyle, Matthew J; Hogue, Grant D; Heyworth, Benton E; Ackerman, Kathryn; Quinn, Bridget; Yen, Yi-Meng

    2017-03-01

    Femoral neck stress fractures are rare in healthy children, with only 9 cases previously reported. The present article reviews our institutional experience with femoral neck stress fractures in children younger than 10 years of age, to highlight the unique features of this condition. We undertook a retrospective review of clinical records of patients who had been treated at our institution for an idiopathic femoral neck stress fracture between 2000 and 2014. To focus on children rather than adolescents, the World Health Organization's definition of adolescent as a person between 10 and 19 years of age was used; we thereby limited our analysis to patients younger than 10 years of age. The study included 6 patients (3 males, 3 females) treated for an idiopathic femoral neck stress fracture, with a mean age at diagnosis of 7.7 years (range, 5.2 to 8.9 y). All patients presented with a limp, which worsened with activity and had persisted for a mean of 5 weeks (range, 2 to 9 wk). None of the patients had experienced an increase in activity level or sporting volume before symptom onset. On examination, 3 patients experienced pain with terminal hip flexion and 3 patients demonstrated pain-free hip range of motion. Plain radiography demonstrated inferior femoral neck cortical disruption, suggesting a compression-type stress fracture mechanism. The diagnosis was confirmed by cross-sectional imaging in all cases. All patients were initially treated with 6 to 8 weeks of non-weight-bearing followed by 4 to 6 weeks of partial weight-bearing, leading to complete healing in 4 patients. Two patients demonstrated incomplete healing and were managed with spica casting for an additional 6 weeks. Our case series illustrates the unique features of this rare condition in children, with a history and examination profile distinct from those of adolescents and adults. Compliance with weight-bearing restrictions is difficult in this population and hip spica casting may be required to permit

  16. Radiation-induced femoral neck fracture in patients cured of cervical carcinoma

    Lukowska, K; Zomer-Drozda, J; Kielbinska, S [Instytut Onkologii, Warsaw (Poland)

    1976-01-01

    In the years 1948-1967 8275 patients with cervical carcinoma in various grades of progression were treated at the Institute of Oncology in Warsaw by radiotherapy from external fields. Five-year survival without signs of recurrence was obtained in 4204 cases, 3863 of them were irradiated from external fields with X-rays under conventional conditions, while 341 received Co/sup 60/ radiotherapy. In 43 patients treated with X-rays and radium and regarded as cured radiological evidence of femoral neck fracture was obtained. These patients account for 1.1% of all cured patients. In the group treated with Co/sup 60/ radiation in only 1 case femoral neck fracture was observed (0.3%). In the group of cured patients with femoral neck fracture the method of irradiation from external fields, the age, clinical course, radiological appearance of radiation-induced changes and the method of fracture management were analysed.

  17. Bilateral iatrogenic maxillary fractures after dental treatment in two aged horses

    Widmer, A; Fürst, A; Bettschart-Wolfensberger, R; Makara, M; Geyer, H; Kummer, M

    2010-01-01

    This clinical report describes two horses with bilateral maxillary fractures following dental treatment. The fractures occurred during dental treatment by a veterinarian, and both had rostral, transverse, and complete bilateral maxillary fractures with instability and minimal displacement. The fractures were repaired using bilateral intraoral wiring with the patients under general anesthesia. The postoperative period was without complications and the fractures healed as expected. Maxillary fr...

  18. Femoral Geometry in Male Patients with Atraumatic Hip Fracture - Original Investigation

    Gülten Tan

    2007-03-01

    Full Text Available Aims: Hip fracture is the most serious complication of osteoporosis and the most disabling type of fracture. In this study, we aimed to compare femoral geometry in hip fractured male patients aged more than 65 years old with age matched controls. Patients and Methods: 20 male patients with a history of nontraumatic hip fracture and 19 age-matched healthy controls were included in this study. Bone mineral density of neck and trochanter of hip were measured by DEXA. In addition to BMD, an experienced radiologist measured proximal femur geometric parameters potentially involved in bone strength. Results: Mean BMDs of trochanteric region were not significantly different between groups, but mean BMDs of neck region were statistically significantly lower in the hip fractured group. Neck shaft angle and femur shaft width were the geometric parameters found to be significantly higher in the hip fractured group. The correlation between femur geometric and the anthropometric measurements was present only in the kontrol group. Conclusion: We concluded that besides femur geometric measurements, correlation between these measurements might be an important factors for the fracture risk. (From the World of Osteoporosis 2007;13:15-8

  19. Outcome in hip fracture patients related to anemia at admission and allogeneic blood transfusion: An analysis of 1262 surgically treated patients

    A.J.H. Vochteloo (Anne); B.L. Borger van der Burg (Boudewijn); B. Mertens (Bart); A.H.P. Niggebrugge (Arthur); M.R. de Vries (Mark); W.E. Tuinebreijer (Wim); R.M. Bloem (Rolf); R.G.H.H. Nelissen (Rob); P. Pilot (Peter)

    2011-01-01

    textabstractBackground: Anemia is more often seen in older patients. As the mean age of hip fracture patients is rising, anemia is common in this population. Allogeneic blood transfusion (ABT) and anemia have been pointed out as possible risk factors for poorer outcome in hip fracture patients.

  20. The number of displaced rib fractures is more predictive for complications in chest trauma patients.

    Chien, Chih-Ying; Chen, Yu-Hsien; Han, Shih-Tsung; Blaney, Gerald N; Huang, Ting-Shuo; Chen, Kuan-Fu

    2017-02-28

    Traumatic rib fractures can cause chest complications that need further treatment and hospitalization. We hypothesized that an increase in the number of displaced rib fractures will be accompanied by an increase in chest complications. We retrospectively reviewed the trauma registry between January 2013 and May 2015 in a teaching hospital in northeastern Taiwan. Patients admitted with chest trauma and rib fractures without concomitant severe brain, splenic, pelvic or liver injuries were included. The demographic data, such as gender, age, the index of coexistence disease, alcohol consumption, trauma mechanisms were analyzed as potential predictors of pulmonary complications. Pulmonary complications were defined as pneumothorax, hemothorax, flail chest, pulmonary contusion, and pneumonia. In the 29 months of the study period, a total of 3151 trauma patients were admitted to our hospital. Among them, 174 patients were enrolled for final analysis. The most common trauma mechanism was road traffic accidents (58.6%), mainly motorbike accidents (n = 70, 40.2%). Three or more displaced rib fractures had higher specificity for predicting complications, compared to three or more total rib fractures (95.5% vs 59.1%). Adjusting the severity of chest trauma using TTSS and Ribscore by multivariable logistic regression analysis, we found that three or more rib fractures or any displaced rib fracture was the most significant predictor for developing pulmonary complication (aOR: 5.49 95% CI: 1.82-16.55). Furthermore, there were 18/57 (31.6%) patients with fewer than three ribs fractures developed pulmonary complications. In these 18 patients, only five patients had delayed onset complications and four of them had at least one displaced rib fracture. In this retrospective cohort study, we found that the number of displaced or total rib fractures, bilateral rib fractures, and rib fractures in more than two areas were associated with the more chest complications. Furthermore

  1. Affective functioning after delirium in elderly hip fracture patients

    Slor, C.J.; Witlox, J.; Jansen, R.W.M.M.; Adamis, D.; Meagher, D.J.; Tieken, E.; Houdijk, A.P.J.; van Gool, W.A.; Eikelenboom, P.; de Jonghe, J.F.M.

    2013-01-01

    ABSTRACT Background: Delirium in elderly patients is associated with various long-term sequelae that include cognitive impairment and affective disturbances, although the latter is understudied. Methods: For a prospective cohort study of elderly patients undergoing hip fracture surgery, baseline

  2. One-year health and care costs after hip fracture for home-dwelling elderly patients in Norway: Results from the Trondheim Hip Fracture Trial

    Hektoen, Liv Faksvåg; Saltvedt, Ingvild; Sletvold, Olav; Helbostad, Jorunn L.; Lurås, Hilde; Halsteinli, Vidar

    2016-01-01

    Aim: The aim of this study was to estimate the one-year health and care costs related to hip fracture for home-dwelling patients aged 70 years and older in Norway, paying specific attention to the status of the patients at the time of fracture and cost differences due to various patient pathways after fracture. Methods: Data on health and care service provision were extracted from hospital and municipal records and from national registries; data on unit costs were collected from the municipal...

  3. When Should Abdominal Computed Tomography Be Considered in Patients with Lower Rib Fractures?

    Jeroukhimov, Igor; Hershkovitz, Yehuda; Wiser, Itay; Kessel, Boris; Ayyad, Mohammed; Gatot, Inbar; Shapira, Zahar; Jeoravlev, Svetlana; Halevy, Ariel; Lavy, Ron

    2017-05-01

    Lower rib fractures are considered as a marker of intra-abdominal organ injury. Abdominal computed tomography (CT) is the "gold standard" examination for patients with lower rib fractures. However, the reported incidence of concomitant intra-abdominal injuries (IAI) is 20%-40%. The purpose of this study was to evaluate the incidence of intra-abdominal organ injuries in blunt trauma patients with lower rib fractures. Medical charts and radiology reports of patients with lower rib (from the 8th to 12th rib) fractures admitted to our center during a 6-year period were retrospectively reviewed. Patients were divided into two groups. Group I included patients with intra-abdominal injury (IAI) diagnosed either by CT or on urgent laparotomy, and Group II included those with normal abdominal CT scans. Data included demographics, mechanism of injury, laboratory tests, radiology results including number and location of fractured ribs, and incidence of IAI. Overall 318 patients were included in the study. Fifty-seven patients (17.9%) had 71 IAIs compared with 265 (82.1%) patients with no IAI. Logistic regression identified age younger than 55 years (relative risk [RR] = 7.2; 95% confidence interval [CI] 3.1-16.8; p = 0.001), bilateral rib fractures (RR = 3.9; 95% CI 1.1-13.5; p = 0.03) and decreased levels of hematocrit (RR = 2.4; 95% CI 1.2-4.8; p = 0.016) as independent risk factors for the presence of IAI. Abdominal CT should be considered in blunt trauma patients with lower rib fractures who are younger than 55 years of age and have bilateral rib fractures and decreased levels of hematocrit on admission. Copyright © 2016 Elsevier Inc. All rights reserved.

  4. Osteoporosis among hospitalized patients with proximal femoral fractures in Assiut University Trauma Unit, Egypt.

    Farouk, Osama; Mahran, Dalia G; Said, Hatem G; Alaa, Mohamed M; Eisa, Amr; Imam, Hisham; Said, G Z

    2017-12-01

    The study was done to investigate osteoporosis prevalence in 275 hip fracture admissions at the Trauma Unit of Assiut University Hospitals and associated factors, which are understudied in our locality. Prevalence was 74.9%. Female sex, older age, low body mass index, and fall on the ground were associated with osteoporosis. This study aims to identify osteoporosis prevalence in hip fracture admissions at the Trauma Unit of Assiut University Hospitals and to study the independent correlates of osteoporosis-related fracture. A prospective cross-sectional study was carried out in 275 hip fracture patients admitted to the Trauma Unit of Assiut University Hospitals from January through December 2014 of both sexes aged 50 years and older. Exclusion criteria were polytrauma, major accidents, and history of chronic conditions and long-term medication associated with osteoporosis risk increase and bilateral hip fractures. For every patient, weight, height, and bone mineral density by dual-energy x-ray absorptiometry (DEXA) were recorded. Tests of significance for non-parametric data were used. The questionnaire included sociodemographic characteristics, dietary habits, lifestyle factors such as smoking and physical activity, and female obstetric and gynecological factors. Mean age was 70.82 ± 11.02 SD; 51.6% were males and 8.4% were obese. Fall on ground was in 81.1% of fractures. Osteoporosis (femoral neck T score ≤ -2.5 SD) prevalence was 74.9%. By univariable analysis, significant correlates were female gender, older age, normal BMI, and fall on the ground. Milk and cheese daily intake was significantly associated with lower prevalence of osteoporosis. In a multivariable logistic regression model, female sex, older age, low BMI, and fall on the ground were associated with osteoporosis. Osteoporosis prevalence is high among hip fracture patients and associated with female sex, increase in age, low BMI, and fall on ground. Strategies to prevent osteoporosis are

  5. Most patients regain prefracture basic mobility after hip fracture surgery in a fast-track programme

    Kristensen, Morten Tange; Kehlet, Henrik

    2012-01-01

    Treatment of patients with hip fracture has improved over the past decade. Still, some patients do not regain independent mobility within their primary hospital stay even if they follow a multimodal fast-track surgical programme. The aim of the present article was to examine the validity of the p......Treatment of patients with hip fracture has improved over the past decade. Still, some patients do not regain independent mobility within their primary hospital stay even if they follow a multimodal fast-track surgical programme. The aim of the present article was to examine the validity...... of the preliminary prefracture New Mobility Score (NMS), age and fracture type as independent predictors of in-hospital outcome after hip fracture surgery....

  6. Identifying Fracture Types and Relative Ages Using Fluid Inclusion Stratigraphy

    Dilley, Lorie M.; Norman, David; Owens, Lara

    2008-06-30

    Enhanced Geothermal Systems (EGS) are designed to recover heat from the subsurface by mechanically creating fractures in subsurface rocks. Understanding the life cycle of a fracture in a geothermal system is fundamental to the development of techniques for creating fractures. Recognizing the stage of a fracture, whether it is currently open and transmitting fluids; if it recently has closed; or if it is an ancient fracture would assist in targeting areas for further fracture stimulation. Identifying dense fracture areas as well as large open fractures from small fracture systems will also assist in fracture stimulation selection. Geothermal systems are constantly generating fractures, and fluids and gases passing through rocks in these systems leave small fluid and gas samples trapped in healed microfractures. Fluid inclusions trapped in minerals as the fractures heal are characteristic of the fluids that formed them, and this signature can be seen in fluid inclusion gas analysis. Our hypothesis is that fractures over their life cycle have different chemical signatures that we can see in fluid inclusion gas analysis and by using the new method of fluid inclusion stratigraphy (FIS) the different stages of fractures, along with an estimate of fracture size can be identified during the well drilling process. We have shown with this study that it is possible to identify fracture locations using FIS and that different fractures have different chemical signatures however that signature is somewhat dependent upon rock type. Open, active fractures correlate with increase concentrations of CO2, N2, Ar, and to a lesser extent H2O. These fractures would be targets for further enhancement. The usefulness of this method is that it is low cost alternative to current well logging techniques and can be done as a well is being drilled.

  7. Mandibular fractures: a comparative analysis between young and adult patients in the southeast region of Turkey

    Serhat Atilgan

    2010-02-01

    Full Text Available OBJECTIVE: The purpose of this study was to review and compare the differences between mandibular fractures in young and adult patients. MATERIAL AND METHODS: Patients treated at the Oral and Maxillofacial Department of Dicle University during a five-year period between 2000 and 2005 were retrospectively evaluated with respect to age groups, gender, etiology, localization and type of fractures, treatment methods and complications. RESULTS: 532 patients were included in the study, 370 (70% males and 162 (30% females, with a total of 744 mandibular fractures. The mean age of young patients was 10, with a male-female ratio of 2:1. The mean age of adult patients was 28, with a male-female ratio of 3:1. The most common causes of injury were falls (65% in young patients and traffic accidents (38% in adults. The most common fracture sites were the symphysis (35% and condyle (36% in young patients, and the symphysis in adults (36%. Mandibular fractures were generally treated by arch bar and maxillomandibular fixation in both young (67% and adult (39% patients, and 43% of the adult patients were treated by open reduction and internal fixation. CONCLUSION: There was a similar gender, monthly and type of treatment distribution in both young and adult patients in the southeast region of Turkey. However, there were differences regarding age, etiology and fracture site. These findings between young and adult patients are broadly similar to those from other studies. Analysis of small differences may be an important factor in assessing educational and socioeconomic environments.

  8. Determinants of outcome in hip fracture patient care

    Vochteloo, Anne Jochem Hendrik

    2013-01-01

    In this thesis, clinical and functional outcomes of a large cohort of hip fracture patients are described, with regards to anemia, blood transfusion, concomitant fractures, loss of mobility and place of residence. Secondly, risk factors for poor outcome, both in a clinical and a functional

  9. Diagnostic strategies in patients with high fracture risk

    Malgo, F.

    2018-01-01

    This thesis describes the results of data collected from patients who were referred to our Fracture Liaison Service in a 2-year time period for screening for increased fracture risk, and also describes the results of our clinical studies performed using the impact microindentation technique, a new

  10. The risk of fracture in patients with multiple sclerosis: The UK general practice research database

    Bazelier, Marloes T; van Staa, Tjeerd; Uitdehaag, Bernard Mj

    2011-01-01

    Patients with multiple sclerosis (MS) may be at an increased risk of fracture owing to a greater risk of falling and decreased bone mineral density when compared with the general population. This study was designed to estimate the relative and absolute risk of fracture in patients with MS. We...... were used to derive adjusted hazard ratios (HRs) for fracture associated with MS. Time-dependent adjustments were made for age, comorbidity, and drug use. Absolute 5- and 10-year risks of fracture were estimated for MS patients as a function of age. Compared with controls, MS patients had an almost...... threefold increased risk of hip fracture [HR = 2.79,95% confidence interval (CI) 1.83-4.26] and a risk of osteoporotic fracture that was increased 1.4-fold (HR = 1.35,95% CI 1.13-1.62). Risk was greater in patients who had been prescribed oral/intravenous glucocorticoids (GCs; HR = 1.85, 95% CI 1...

  11. Low Levels of Hemoglobin at Admission Are Associated With Increased 30-Day Mortality in Patients With Hip Fracture

    Praetorius, Katrine; Madsen, Christian M; Abrahamsen, Bo

    2016-01-01

    INTRODUCTION: Previous smaller studies suggest that anemia is a risk factor for mortality in patients with hip fracture. The purpose of this investigation was to assess the correlation between hemoglobin at admission with 30-day mortality following a hip fracture in a large-scale study. PATIENTS...... AND METHODS: From January 1996 to December 2012, all patients with hip fracture (>60 years of age) admitted to Bispebjerg Hospital, Copenhagen, were identified from a local hip fracture database. We excluded conservatively treated patients and patients who died preoperatively. RESULTS: Seven thousand four...... hundred twenty-one consecutive patients with hip fracture were identified. Of those 7319 had a hemoglobin measurement on admission and were thus eligible for further analysis. Mean hemoglobin for patients alive at 30 days was 7.6 (standard deviation [SD]: 1.0) and for deceased patients 7.4 (SD: 1.1), P...

  12. Factors influencing period from surgery to discharge in patients with femoral trochanteric fractures

    Shinoda, Soichiro; Mutsuzaki, Hirotaka; Watanabe, Arata; Morita, Hidetaka; Kamioka, Yumiko

    2017-01-01

    [Purpose] The purpose of this study was to investigate factors influencing the period from surgery to discharge in patients with femoral trochanteric fractures. [Subjects and Methods] Sixty patients with femoral trochanteric fractures were investigated retrospectively. Based on the mean period from surgery to discharge (85.6 ± 26.6 days), the patients were divided into two groups: an under-85-day group (range, 29–78 days) and an over-85-day group (87–128 days). Age, gender, fracture type, presence of lesser trochanteric displacement, discharge destination, and walking ability were investigated. The relationship between these factors and the period from surgery to discharge was analyzed with logistic regression analysis. [Results] Age and lesser trochanteric displacement were significantly higher in the over-85-day group, and walking ability before fracture and at discharge were significantly lower in the over-85-day group. Logistic regression analysis showed that lesser trochanteric displacement and age were predictors of the length from surgery to discharge. Lesser trochanteric displacement were observed in 87.5% of these. Immediate displacement after surgery occurred in 57.8% of lesser trochanteric fractures, while 26.3% displaced 1 to 3 weeks after surgery. [Conclusion] This study revealed that lesser trochanteric displacement, higher age, and lower walking ability before fracture and at discharge were associated with longer hospitalizations in patients with femoral trochanteric fractures. Lesser trochanteric displacement were observed in 87.5% of lesser trochanteric fractures. These displacements occurred within 3 weeks after surgery in 84.1% of cases. PMID:29200639

  13. Season of birth and the risk of hip fracture in danish men and women aged 65+

    Abrahamsen, Bo; Heitmann, Berit L; Eiken, Pia Agnete

    2012-01-01

    calculated fracture rates and relative risks. The analysis covered 541,109 men and 691,522 women. In women, we observed a small but statistically significant difference between fracture rates by season of birth for all age intervals expect the youngest (age 65-69). A similar pattern was seen in men...... an epidemiological analysis of hip fracture rates as a function of season of birth, age, and sex. We retrieved information on all hip fractures in the 9-year period between 1997 and 2005 in all men and women aged 65-95, excluded hip fractures that occurred in current and recent prednisolone users, and subsequently......, but this was only statistically significant in the two oldest age groups (age 85-89 and 90-95). These findings suggest that vitamin D availability in the first and second trimester of intrauterine life could have a small but lasting impact on bone health and the risk of osteoporotic fractures. Further studies...

  14. Increased fracture risk assessed by fracture risk assessment tool in Greek patients with Crohn's disease.

    Terzoudis, Sotirios; Zavos, Christos; Damilakis, John; Neratzoulakis, John; Dimitriadi, Daphne Anna; Roussomoustakaki, Maria; Kouroumalis, Elias A; Koutroubakis, Ioannis E

    2013-01-01

    The World Health Organization has recently developed the fracture risk assessment tool (FRAX) based on clinical risk factors and bone mineral density (BMD) for evaluation of the 10-year probability of a hip or a major osteoporotic fracture. The aim of this study was to evaluate the use of the FRAX tool in Greek patients with inflammatory bowel disease (IBD). FRAX scores were applied to 134 IBD patients [68 Crohn's disease (CD); 66 ulcerative colitis (UC)] who underwent dual-energy X-ray absorptiometry scans at the femoral neck and lumbar spine during the period 2007-2012. Calculation of the FRAX scores, with or without BMD, was made through a web-based probability model used to compute individual fracture probabilities according to specific clinical risk factors. The median 10-year probability of a major osteoporotic fracture for IBD patients based on clinical data was 7.1%, and including the BMD was 6.2%. A significant overestimation with the first method was found (P = 0.01). Both scores with and without BMD were significantly higher in CD patients compared with UC patients (P = 0.02 and P = 0.005, respectively). The median 10-year probability of hip fracture based on clinical data was 0.8%, and including the BMD was 0.9%. The score with use of BMD was significantly higher in CD compared with UC patients (P = 0.04). CD patients have significantly higher FRAX scores and possibly fracture risk compared with UC patients. The clinical FRAX score alone seems to overestimate the risk of osteoporotic fracture in Greek IBD patients.

  15. A 72-year-old patient with bilateral Maisonneuve fractures

    Thomas Dienstknecht

    2012-07-01

    Full Text Available Maisonneuve fractures result from a disruption of the medial ankle structures and a proximal fibular fracture. Patient complaints can be misleading and there is a significant rate of delayed diagnosed injuries. We present a case of bilateral Maisonneuve fractures after a fall due to a syncopal collapse. A precise clinical examination led to this rare diagnosis. The injuries were treated with syndesmotic screw fixation, removal of hardware followed after 6 weeks. The patient was asymptomatic at threemonths follow up. Patients with bilateral injuries undergoing standard surgical treatment can gain full recovery, but high suspicion in clinical examination is needed to detect this uncommon bilateral injury.

  16. Fear of falling in patients with hip fractures: prevalence and related psychological factors.

    Visschedijk, Jan; van Balen, Romke; Hertogh, Cees; Achterberg, Wilco

    2013-03-01

    To determine the prevalence of fear of falling (FoF) in patients after a hip fracture, to investigate the relation with time after fracture, and to assess associations between FoF and other psychological factors. Cross-sectional study performed between September 2010 and March 2011 in elderly patients after a hip fracture. Ten postacute geriatric rehabilitation wards in Dutch nursing homes. A total of 100 patients aged ≥65 years with a hip fracture admitted to a geriatric rehabilitation ward. FoF and related concepts such as falls-related self-efficacy, depression, and anxiety were measured by means of self-assessment instruments. Of all patients, 36% had a little FoF and 27% had quite a bit or very much FoF. Scores on the Falls Efficacy Scale-International were 30.6 in the first 4 weeks after hip fracture, 35.6 in the second 4 weeks, and 29.4 in the period ≥8 weeks after fracture. In these 3 periods, the prevalence rates of FoF were 62%, 68%, and 59%, respectively. Significant correlations were found between FoF and anxiety (P falls-related self-efficacy. During rehabilitation, FoF is greatest in the second 4 weeks after hip fracture. More studies are needed to explore the determinants of FoF and develop interventions to reduce FoF and improve outcome after rehabilitation. Copyright © 2013. Published by Elsevier Inc.

  17. High inter-tester reliability of the new mobility score in patients with hip fracture

    Kristensen, M.T.; Bandholm, T.; Foss, N.B.

    2008-01-01

    OBJECTIVE: To assess the inter-tester reliability of the New Mobility Score in patients with acute hip fracture. DESIGN: An inter-tester reliability study. SUBJECTS: Forty-eight consecutive patients with acute hip fracture at a median age of 84 (interquartile range, 76-89) years; 40 admitted from...... their own home and 8 from nursing homes to an acute orthopaedic hip fracture unit at a university hospital. METHODS: The New Mobility Score, which evaluates the prefracture functional level with a score from 0 (not able to walk at all) to 9 (fully independent), was assessed by 2 independent physiotherapists...... the prefracture functional level in patients with acute hip fracture Udgivelsesdato: 2008/7...

  18. [Osteoarthritic changes in hip joint in patients with fractures of femoral neck].

    Kravtsov, Vladimir; Saranga, Dan; Kidron, Debora

    2013-06-01

    Fractures of proximal femur are common among elderly people. They are associated with considerable morbidity and mortality. Identification of etiopathogenetic factors associated with fractures might facilitate prevention. Osteoporosis is commonly present in the heads of femurs. The prevalence of osteoarthritic changes in hip joints is controversial. Some authorities report low prevalence and even speculate on the protective effect of osteoarthritis against fractures. The goal of the study was to examine the association between osteoarthritic changes (radiologic and histologic) and fractures of the neck of the femur. The patient population included 41 patients undergoing replacement of femoral head for subcapital fracture; their ages ranged from 61 - 93 years of age. Radiologic criteria for osteoarthritis included: (a)narrowing of joint space (b) subchondral sclerosis (c) deformation of head of femur (d) subchondra cysts and (e] osteophytes. Osteoarthritic changes, usually mild, were present in 22 (54%) patients, regardless of age and gender The frequency of radioLogical changes was similar to the general population. HistoLogic findings included subchondral fibrosis and subchondral cysts. Mild subchondral fibrosis was present in 78% of cases. The findings support lack of association between osteoarthritic changes in hip joint and fracture of proximal femur, without a protective effect.

  19. Four quadrant parallel peripheral screw fixation for displaced femoral neck fractures in elderly patients

    Bhava RJ Satish

    2013-01-01

    Conclusion: Closed reduction and cannulated cancellous screw fixation gives satisfactory functional results in large group of elderly patients. The four quadrant parallel peripheral (FQPP screw fixation technique gives good stability, allows controlled collapse, avoids fixation failure and achieves predictable bone healing in displaced femoral neck fracture in patients ≥50 years of age.

  20. Epidemiology of distal radius fractures in polytrauma patients and the influence of high traumatic energy transfer.

    Ferree, Steven; van der Vliet, Quirine M J; Nawijn, Femke; Bhashyam, Abhiram R; Houwert, Roderick M; Leenen, Luke P H; Hietbrink, Falco

    2018-03-01

    For several extremity fractures differences in morphology, incidence rate and functional outcome were found when polytrauma patients were compared to patients with an isolated injury. This is not proven for distal radius fractures (DRF). Therefore, this study aimed to analyse fracture morphology in relation to energy transfer in both poly- and mono-trauma patients with a DRF. This was a retrospective cohort study. All patients aged 16 years and older with a DRF were included. Patients with an Injury Severity Score of 16 or higher were classified as polytrauma patients. Injuries were defined as high or low energy. All DRFs were classified using the AO/OTA fracture classification system. A total of 830 patients with a DRF were included, 12% were polytrauma. The incidence rate of DRF in polytrauma patients was 3.5%. Ipsilateral upper extremity injury was found in >30% of polytrauma and high-energy monotrauma patients, compared to 5% in low-energy monotrauma patients. More type C DRF were found in polytrauma and high-energy monotrauma patients versus low-energy monotrauma patients. Operative intervention rates for all types of DRF were similar for polytrauma and high-energy monotrauma patients. Non-union rates were higher in polytrauma patients. Higher energy mechanisms of injury, in polytrauma and high-energy monotrauma patients, were associated with more severe complex articular distal radius fractures and more ipsilateral upper extremity injuries. Polytrauma and high-energy monotrauma patient have a similar fracture morphology. However, polytrauma patients have in addition to more injured body regions also more non-union related interventions than high-energy monotrauma patients. Copyright © 2018 Elsevier Ltd. All rights reserved.

  1. Quality of life in old patients with proximal femoral fractures

    T A Raskina

    2012-01-01

    Full Text Available Objective: to study quality of life in Kemerovo old patients with proximal femoral fractures. Patients and methods. Quality of life in osteoporotic fractures was analyzed in 219 patients (173 women and 46 men who had sustained the injury in January 2004 to December 2008. Results. In the patients with hip fractures, the lowest (41.94+31.16 scores values were recorded by the physical functioning scale reflecting the degree to which their health limited the performance of physical exercises (self-service, walking, going upstairs, weight carriage, etc.. The role functioning and life activity scales showed the highest values (50.96+19.04 and 51.44+26.51 scores, respectively. The mean value of the physical component scale was 46.42+28.26 scores. That of the psychological component scale was 49.56+19.55 scores. Conclusion. The patients with proximal femoral fractures were found to have lower scores on all SF-36 dimensions.

  2. Hip fracture in hospitalized medical patients

    Zapatero Antonio; Barba Raquel; Canora Jesús; Losa Juan E; Plaza Susana; San Roman Jesús; Marco Javier

    2013-01-01

    Abstract Background The aim of the present study is to analyze the incidence of hip fracture as a complication of admissions to internal medicine units in Spain. Methods We analyzed the clinical data of 2,134,363 adults who had been admitted to internal medicine wards. The main outcome was a diagnosis of hip fracture during hospitalization. Outcome measures included rates of in-hospital fractures, length of stay and cost. Results A total of 1127 (0.057%) admittances were coded with an in-hosp...

  3. Incidence rate of mild traumatic brain injury among patients who have suffered from an isolated limb fracture: Upper limb fracture patients are more at risk.

    Jodoin, Marianne; Rouleau, Dominique M; Charlebois-Plante, Camille; Benoit, Benoit; Leduc, Stéphane; Laflamme, G-Yves; Gosselin, Nadia; Larson-Dupuis, Camille; De Beaumont, Louis

    2016-08-01

    This study compares the incidence rate of mild traumatic brain injury (mild TBI) detected at follow-up visits (retrospective diagnosis) in patients suffering from an isolated limb trauma, with the incidence rate held by the hospital records (prospective diagnosis) of the sampled cohort. This study also seeks to determine which types of fractures present with the highest incidence of mild TBI. Retrospective assessment of mild TBI among orthopaedic monotrauma patients, randomly selected for participation in an Orthopaedic clinic of a Level I Trauma Hospital. Patients in the remission phase of a limb fracture were recruited between August 2014 and May 2015. No intervention was done (observational study). Standardized semi-structured interviews were conducted with all patients to retrospectively assess for mild TBI at the time of the fracture. Emergency room related medical records of all patients were carefully analyzed to determine whether a prospective mild TBI diagnosis was made following the accident. A total of 251 patients were recruited (54% females, Mean age=49). Study interview revealed a 23.5% incidence rate of mild TBI compared to an incidence rate of 8.8% for prospective diagnosis (χ(2)=78.47; plimb monotrauma (29.6%; n=42/142) are significantly more at risk of sustaining a mild TBI compared to lower limb fractures (15.6%; n=17/109) (χ(2)=6.70; p=0.010). More specifically, patients with a proximal upper limb injury were significantly more at risk of sustaining concomitant mild TBI (40.6%; 26/64) compared to distal upper limb fractures (20.25%; 16/79) (χ(2)=7.07; p=0.008). Results suggest an important concomitance of mild TBI among orthopaedic trauma patients, the majority of which go undetected during acute care. Patients treated for an upper limb fracture are particularly at risk of sustaining concomitant mild TBI. Copyright © 2016 Elsevier Ltd. All rights reserved.

  4. Trauma patient adverse outcomes are independently associated with rib cage fracture burden and severity of lung, head, and abdominal injuries.

    Dunham, C Michael; Hileman, Barbara M; Ransom, Kenneth J; Malik, Rema J

    2015-01-01

    We hypothesized that lung injury and rib cage fracture quantification would be associated with adverse outcomes. Consecutive admissions to a trauma center with Injury Severity Score ≥ 9, age 18-75, and blunt trauma. CT scans were reviewed to score rib and sternal fractures and lung infiltrates. Sternum and each anterior, lateral, and posterior rib fracture was scored 1 = non-displaced and 2 = displaced. Rib cage fracture score (RCFS) = total rib fracture score + sternal fracture score + thoracic spine Abbreviated Injury Score (AIS). Four lung regions (right upper/middle, right lower, left upper, and left lower lobes) were each scored for % of infiltrate: 0% = 0; ≤ 20% = 1, ≤ 50% = 2, > 50% = 3; total of 4 scores = lung infiltrate score (LIS). Of 599 patients, 193 (32%) had 854 rib fractures. Rib fracture patients had more abdominal injuries (p fractures (p = 0.0028) and death or need for mechanical ventilation ≥ 3 days (Death/Vdays ≥ 3) (p rib fracture patients, Glasgow Coma Score 3-12 or head AIS ≥ 2 occurred in 43%. A lung infiltrate or hemo/pneumothorax occurred in 55%. Thoracic spine injury occurred in 23%. RCFS was 6.3 ± 4.4 and Death/Vdays ≥ 3 occurred in 31%. Death/Vdays ≥ 3 rates correlated with RCFS values: 19% for 1-3; 24% for 4-6; 42% for 7-12 and 65% for ≥ 13 (p rib fracture score (p = 0.08) or number of fractured ribs (p = 0.80). Rib fracture patients have increased risk for truncal injuries and adverse outcomes. Adverse outcomes are independently associated with rib cage fracture burden. Severity of head, abdominal, and lung injuries also influence rib fracture outcomes.

  5. Increased Oxidative Stress Response in Granulocytes from Older Patients with a Hip Fracture May Account for Slow Regeneration

    Zhiyong Wang

    2014-01-01

    Full Text Available Proximal femur fracture, a typical fracture of the elderly, is often associated with morbidity, reduced quality of life, impaired physical function and increased mortality. There exists evidence that responses of the hematopoietic microenvironment to fractures change with age. Therefore, we investigated oxidative stress markers and oxidative stress-related MAPK activation in granulocytes from the young and the elderly with and without fractured long bones. Lipid peroxidation levels were increased in the elderly controls and patients. Aged granulocytes were more sensitive towards oxidative stress induced damage than young granulocytes. This might be due to the basally increased expression of SOD-1 in the elderly, which was not further induced by fractures, as observed in young patients. This might be caused by an altered MAPK activation. In aged granulocytes basal p38 and JNK activities were increased and basal ERK1/2 activity was decreased. Following fracture, JNK activity decreased, while ERK1/2 and p38 activities increased in both age groups. Control experiments with HL60 cells revealed that the observed p38 activation depends strongly on age. Summarizing, we observed age-dependent changes in the oxidative stress response system of granulocytes after fractures, for example, altered MAPK activation and SOD-1 expression. This makes aged granulocytes vulnerable to the stress stimuli of the fracture and following surgery.

  6. Elderly patient's mortality and morbidity following trochanteric fracture. A prospective study of 100 cases.

    Mnif, H; Koubaa, M; Zrig, M; Trabelsi, R; Abid, A

    2009-11-01

    Trochanteric fractures are a major source of mortality, morbidity and functional impairment in the elderly. Morbidity is closely related to the degree of instability and comminution and is substantially influenced by the quality of reduction and internal fixation. Advanced age and associated co-morbidities are two decisive factors of mortality secondary to trochanteric fracture. This prospective study examined the epidemiological profile of trochanteric fractures and assessed mortality and morbidity with the aim of establishing management guidelines and improving prevention strategies. One hundred patients were included; 60% were male. Mean age was 76 years (range, 60-96 yrs). One, or more than one, co-morbidities were present in 68% of cases. The fractures were caused by a simple fall in 90% of cases. Fractures were classified according to the criteria of Ramadier and the ones of Ender. Sixty-five percent of these fractures were unstable. A dynamic hip screw was systematically used as the standard means of internal fixation. Anatomic and functional results were analyzed in 82 patients (18 had died within the first year following fracture occurrence). Mean follow-up period was 24 months (range, 12-36 months). Bone healing was achieved in 96% of cases. There were numerous postoperative complications (four cases of thromboembolism, fourteen immobility-related complications, two infections, six secondary displacement combined to loss of fixation, four non-unions, and nine malunions). At 2 years follow-up, 28 patients had died. Mortality was strongly correlated with older age (over 90 years), associated co-morbidity and fracture instability. Good functional outcomes (72%) correlated with younger age (60-74 years), fracture stability, adequate reduction and internal fixation. In stable trochanteric fractures, osteosynthesis by dynamic screw-plate is more effective than alternative techniques (blade-plate, nail-plate, Ender nail or even trochanteric nail). In unstable

  7. Number of rib fractures thresholds independently predict worse outcomes in older patients with blunt trauma.

    Shulzhenko, Nikita O; Zens, Tiffany J; Beems, Megan V; Jung, Hee Soo; O'Rourke, Ann P; Liepert, Amy E; Scarborough, John E; Agarwal, Suresh K

    2017-04-01

    There have been conflicting reports regarding whether the number of rib fractures sustained in blunt trauma is associated independently with worse patient outcomes. We sought to investigate this risk-adjusted relationship among the lesser-studied population of older adults. A retrospective review of the National Trauma Data Bank was performed for patients with blunt trauma who were ≥65 years old and had rib fractures between 2009 and 2012 (N = 67,695). Control data were collected for age, sex, injury severity score, injury mechanism, 24 comorbidities, and number of rib fractures. Outcome data included hospital mortality, hospital and intensive care unit durations of stay, duration of mechanical ventilation, and the occurrence of pneumonia. Multiple logistic and linear regression analyses were performed. Sustaining ≥5 rib fractures was associated with increased intensive care unit admission (odds ratio: 1.14, P rib fractures was associated with an increased incidence of pneumonia (odds ratio: 1.32, P rib fractures was associated with increased mortality (odds ratio: 1.51, P rib fractures is a significant predictor of worse outcomes independent of patient characteristics, comorbidities, and trauma burden. Copyright © 2016 Elsevier Inc. All rights reserved.

  8. Serum vitamin E concentrations among highly functioning hip fracture patients are higher than in nonfracture controls.

    D'Adamo, Christopher R; Shardell, Michelle D; Hicks, Gregory E; Orwig, Denise L; Hochberg, Marc C; Semba, Richard D; Yu-Yahiro, Janet A; Ferrucci, Luigi; Magaziner, Jay S; Miller, Ram R

    2011-03-01

    Malnutrition after hip fracture is common and associated with poor outcomes and protracted recovery. Low concentrations of vitamin E have been associated with incident decline in physical function among older adults and may, therefore, be particularly important to functionally compromised patients hip fracture patients. Serum concentrations of α-tocopherol and γ-tocopherol, the 2 major forms of vitamin E, were assessed in 148 female hip fracture patients 65 years or older from the Baltimore Hip Studies cohort 4 around the time of fracture (baseline) and at 2, 6, and 12 month postfracture follow-up visits (recovery). It was hypothesized that mean concentrations of both forms of vitamin E among these hip fracture patients would be lowest at the baseline visit and increase at each study visit during the year after fracture. Linear regression and generalized estimating equations were used to assess changes in vitamin E concentrations after adjustment for covariates and to determine predictors of vitamin E concentrations at baseline and throughout recovery. It was also hypothesized that vitamin E concentrations shortly after hip fracture would be lower than those in nonfracture controls after adjustment for covariates. To evaluate this hypothesis, linear regression was used to perform adjusted comparisons of baseline vitamin E concentrations among Baltimore Hip Studies cohort 4 participants to 1076 older women without history of hip fracture from the Women's Health and Aging Study I, Invecchiare in Chianti Study, and the National Health and Nutrition Examination Surveys. Mean α-tocopherol was lowest at baseline, and time from fracture to blood draw was positively associated with baseline α-tocopherol (P = .005). Mean γ-tocopherol did not change appreciably throughout the year after fracture, although it fluctuated widely within individuals. Serum concentrations of α-tocopherol and γ-tocopherol were highest among the hip fracture population after adjustment (P hip

  9. Rib fractures in coronary bypass patients: radionuclide detection

    Greenwald, L.V.; Baisden, C.E.; Symbas, P.N.

    1983-01-01

    Sternal retraction can cause the first rib to be fractured posteriorly, injuring the brachial plexus. The authors conducted bone scans of 24 consecutive open-heart surgery patients and found an unexpectedly high number of rib fractures which in all but one case had not been seen on the chest radiograph. Bone scans are recommended whenever there is unexplained non-incisional pain in a patient who has undergone sternal retraction

  10. Risk of vertebral compression fractures in multiple myeloma patients

    Anitha, D.; Thomas, Baum; Jan, Kirschke S.; Subburaj, Karupppasamy

    2017-01-01

    Abstract The purpose of this study was to develop and validate a finite element (FE) model to predict vertebral bone strength in vitro using multidetector computed tomography (MDCT) images in multiple myeloma (MM) patients, to serve as a complementing tool to assess fracture risk. In addition, it also aims to differentiate MM patients with and without vertebral compression fractures (VCFs) by performing FE analysis on vertebra segments (T1?L5) obtained from in vivo routine MDCT imaging scans....

  11. Methodology for identifying patients at high risk for osteoporotic fracture.

    Westfall, G; Littlefield, R; Heaton, A; Martin, S

    2001-09-01

    Osteoporotic fractures are associated with significant morbidity, mortality, and health care costs. The purpose of this paper is to present and validate a mathematical model that managed care organizations can apply to administrative claims data to help locate members at risk for osteoporotic fracture and estimate future fracture rates. Using known risk factors from previous clinical studies, 92,000 members of a large Midwest health plan were placed in 1 of 4 risk categories based on historical claims markers: demographic/lifestyle (age, sex, smoking, alcoholism); steroid use; medical history (previous osteoporotic fracture, ordinary bone fracture, osteoporosis diagnosis, bone mineral density test); or steroid use with medical history. Logistic regression was used to assign a probability of fracture for the 4 groups over the next 2 years. These predictions were compared with actual fracture rates, and refined models were produced. The models were then validated by applying them to current data and comparing the predicted fracture rate for each group to known results. The model predicted that 1.26% of the study members would experience osteoporotic fracture over the next 2 years; the actual result was 1.27%. Within the 4 risk groups, the predicted fracture rates were lower than the actual rates for the demographic risk group (0.87% predicted vs 0.97% actual) and higher than the actual rates for the steroid use (1.78% predicted vs 1.58% actual), medical history (5.90% predicted vs 4.94% actual), and the steroid use with medical history groups (7.80% predicted vs 6.42% actual). The application of this risk model to an administrative claims database successfully identified plan members at risk for osteoporotic fracture.

  12. Analysis of the characteristics of patients with open tibial fractures of Gustilo and Anderson type III

    Frederico Carlos Jaña Neto

    2016-04-01

    Full Text Available OBJECTIVE: To analyze the characteristics of patients with Gustilo-Anderson Type III open tibial fractures treated at a tertiary care hospital in São Paulo between January 2013 and August 2014. METHODS: This was a cross-sectional retrospective study. The following data were gathered from the electronic medical records: age; gender; diagnosis; trauma mechanism; comorbidities; associated fractures; Gustilo and Anderson, Tscherne and AO classifications; treatment (initial and definitive; presence of compartment syndrome; primary and secondary amputations; MESS (Mangled Extremity Severity Score index; mortality rate; and infection rate. RESULTS: 116 patients were included: 81% with fracture type IIIA, 12% IIIB and 7% IIIC; 85% males; mean age 32.3 years; and 57% victims of motorcycle accidents. Tibial shaft fractures were significantly more prevalent (67%. Eight patients were subjected to amputation: one primary case and seven secondary cases. Types IIIC (75% and IIIB (25% predominated among the patients subjected to secondary amputation. The MESS index was greater than 7 in 88% of the amputees and in 5% of the limb salvage group. CONCLUSION: The profile of patients with open tibial fracture of Gustilo and Anderson Type III mainly involved young male individuals who were victims of motorcycle accidents. The tibial shaft was the segment most affected. Only 7% of the patients underwent amputation. Given the current controversy in the literature about amputation or salvage of severely injured lower limbs, it becomes necessary to carry out prospective studies to support clinical decisions.

  13. Assessment of radiological vertebral fractures in HIV-infected patients: clinical implications and predictive factors.

    Gazzola, L; Savoldi, A; Bai, F; Magenta, A; Dziubak, M; Pietrogrande, L; Tagliabue, L; Del Sole, A; Bini, T; Marchetti, G; d'Arminio Monforte, A

    2015-10-01

    The aim of this study was to evaluate the clinical impact of including lateral spine X-ray in the screening of bone diseases in HIV-positive patients. A total of 194 HIV-positive patients underwent dual-energy X-ray absorptiometry (DEXA), lateral spine X-ray and bone biochemical analysis. Vertebral fractures were identified using a morphometric analysis of X-rays and classified using the semiquantitative scoring system of Genant et al. For each patient, a spine deformity index (SDI) score was calculated by summing the grades of vertebral deformities. Reductions in vertebral body height of > 25% were considered vertebral fractures, and those Risk factors associated with vertebral fractures were evaluated by univariate and multivariate analysis. Vertebral fractures were detected in 24 patients (12.4%) and vertebral deformities in 17 patients (8.7%); 153 patients (78.9%) did not show any vertebral deformity. Among patients with fractures, only two with SDI > 10 reported lumbar pain; the remaining were asymptomatic. Patients over 50 years old showed a higher prevalence of vertebral fracture [24.4% versus 11.8% in patients 41-50 years old (P = 0.05) and 1.9% in patients ≤ 40 years old (P = 0.04)]. No significant increase in the prevalence according to bone mineral density (BMD) reduction was observed, and 70% of fractures were diagnosed in nonosteoporotic patients. Older age [adjusted odds ratio 1.09; 95% confidence interval (CI) 1.03-1.13; P = 0.001] and steroid use (adjusted odds ratio 3.64; 95% CI 1.29-10.3; P = 0.01) were independently associated with vertebral fracture; no association was found with HIV- or highly active antiretroviral therapy (HAART)-related variables. A prevalence of vertebral fractures of 12.4% was observed in our HIV-positive cohort. Given that two-thirds of fractures occurred in nonosteoporotic patients, spine X-ray may be considered in patients at increased risk, irrespective of BMD; that is, in elderly patients

  14. Rib fractures in trauma patients: does operative fixation improve outcome?

    Majak, Peter; Næss, Pål A

    2016-12-01

    Renewed interest in surgical fixation of rib fractures has emerged. However, conservative treatment is still preferred at most surgical departments. We wanted to evaluate whether operative treatment of rib fractures may benefit severely injured patients. Several studies report a reduction in mechanical ventilation time, ICU length of stay (LOS), hospital LOS, pneumonia, need for tracheostomy, pain and costs in operatively treated patients with multiple rib fractures compared with patients treated nonoperatively. Although patient selection and timing of the operation seem crucial for successful outcome, no consensus exists. Mortality reduction has only been shown in a few studies. Most studies are retrospective cohort and case-control studies. Only four randomized control trials exist. Conservative treatment, consisting of respiratory assistance and pain control, is still the treatment of choice in the vast majority of patients with multiple rib fractures. In selected patients, operative fixation of fractured ribs within 72 h postinjury may lead to better outcome. More randomized control trials are needed to further determine who benefits from surgical fixation of rib fractures.

  15. Practical use of bone scan in patients with an osteoporotic vertebral compression fracture.

    Jun, Deuk Soo; An, Byoung Keun; Yu, Chang Hun; Hwang, Kyung Hoon; Paik, Je Won

    2015-02-01

    Rib fractures are one of main causes of chest or flank pain when related to an osteoporotic vertebral compression fracture (OVCF). The authors investigated the incidence and risk factors of rib fracture in 284 patients with OVCF using bone scans and evaluated the feasibility as to whether bone scans could be utilized as a useful screening tool. Hot uptake lesions on ribs were found in 122 cases (43.0%). The factors analyzed were age, sex, number and locations of fractured vertebrae, BMD, and compression rates as determined using initial radiography. However, no statistical significances were found. In 16 cases (5.6%), there were concurrent multiple fractures of both the thoracic and lumbar spines not detected by single site MRI. Sixty cases (21.1%) of OVCF with the a compression rate of less than 15% could not be identified definitely by initial plain radiography, but were confirmed by bone scans. It is concluded that a bone scan has outstanding ability for the screening of rib fractures associated with OVCF. Non-adjacent multiple fractures in both thoracic and lumbar spines and fractures not identified definitely by plain radiography were detected on bone scans, which provided a means for determining management strategies and predicting prognosis.

  16. [Is Mapuche ethnicity a risk factor for hip fracture in aged?].

    Sapunar, Jorge; Bravo, Paulina; Schneider, Hermann; Jiménez, Marcela

    2003-10-01

    Ethnic factors are involved in the risk for osteoporosis and hip fracture. To assess the effect of Mapuche ethnicity on the risk of hip fracture. A case control study. Cases were subjects over 55 years of age admitted, during one year, for hip fracture not associated to major trauma or tumors. Controls were randomly chosen from other hospital services and paired for age with cases. The magnitude of the association between ethnicity and hip fracture was expressed as odds ratio in a logistic regression model. In the study period, 156 cases with hip fracture were admitted. The proportion of subjects with Mapuche origin was significantly lower among cases than controls (11.8 and 26.5% respectively, p Mapuche ethnicity was associated with hip fracture with an odds radio of 0.14 (p = 0.03, 95% CI 0.03-0.8). In this sample, Mapuche ethnicity is a protective factor for hip fracture.

  17. The management of ankle fractures in patients with diabetes.

    Wukich, Dane K; Kline, Alex J

    2008-07-01

    Patients with diabetes mellitus have higher complication rates following both open and closed management of ankle fractures. Diabetic patients with neuropathy or vasculopathy have higher complication rates than both diabetic patients without these comorbidities and nondiabetic patients. Unstable ankle fractures in diabetic patients without neuropathy or vasculopathy are best treated with open reduction and internal fixation with use of standard techniques. Patients with neuropathy or vasculopathy are at increased risk for both soft-tissue and osseous complications, including delayed union and nonunion. Careful soft-tissue management as well as stable, rigid internal fixation are crucial to obtaining a good outcome. Prolonged non-weight-bearing and subsequently protected weight-bearing are recommended following both operative and nonoperative management of ankle fractures in patients with diabetes.

  18. Posthospital Discharge Medical Care Costs and Family Burden Associated with Osteoporotic Fracture Patients in China from 2011 to 2013

    Zhao Xie

    2015-01-01

    Full Text Available Objectives. This study collected and evaluated data on the costs of outpatient medical care and family burden associated with osteoporosis-related fracture rehabilitation following hospital discharge in China. Materials and Methods. Data were collected using a patient questionnaire from osteoporosis-related fracture patients (N = 123 who aged 50 years and older who were discharged between January 2011 and January 2013 from 3 large hospitals in China. The survey captured posthospital discharge direct medical costs, indirect medical costs, lost work time for caregivers, and patient ambulatory status. Results. Hip fracture was the most frequent fracture site (62.6%, followed by vertebral fracture (34.2%. The mean direct medical care costs per patient totaled 3,910¥, while mean indirect medical costs totaled 743¥. Lost work time for unpaid family caregivers was 16.4 days, resulting in an average lost income of 3,233¥. The average posthospital direct medical cost, indirect medical cost, and caregiver lost income associated with a fracture patient totaled 7,886¥. Patients’ ambulatory status was negatively impacted following fracture. Conclusions. Significant time and cost of care are placed on patients and caregivers during rehabilitation after discharge for osteoporotic fracture. It is important to evaluate the role and responsibility for creating the growing and inequitable burden placed on patients and caregivers following osteoporotic fracture.

  19. Comparing the Incidence of Falls/Fractures in Parkinson's Disease Patients in the US Population.

    Linda Kalilani

    Full Text Available Patients with Parkinson's disease (PD may experience falls and/or fractures as a result of disease symptoms. There are limited data available from long-term studies estimating the incidence of falls/fractures in patients with PD. The objective was to compare the incidence rate of falls/fractures in PD patients with non-PD patients in a US population. This was a retrospective study using a US-based claims database (Truven Health MarketScan® that compared the incidence rate of falls/fractures in PD subjects with non-PD subjects. The study period included the 12 months prior to index date (defined as earliest PD diagnosis [International Classification of Diseases, Ninth Revision, Clinical Modification code 332.0] and a postindex period to the end of data availability. Fractures were defined by inpatient/outpatient claims as a principal or secondary diagnosis and accompanying procedure codes during the postindex period. Incidence rates and 95% CIs for falls/fractures were calculated as the number of events per 10,000 person-years of follow-up using negative binomial or Poisson regression models. Twenty-eight thousand two hundred and eighty PD subjects were matched to non-PD subjects for the analysis (mean [SD] age, 71.4 [11.8] years; 53% male. A higher incidence rate (adjusted for comorbidities and medications of all fall/fracture cases and by fall and fracture types was observed for PD subjects versus non-PD subjects; the overall adjusted incidence rate ratio comparing PD to non-PD subjects was 2.05; 95% CI, 1.88-2.24. The incidence rate of falls/fractures was significantly higher in subjects with PD compared with non-PD subjects in a US population.

  20. Fracture following lower limb lengthening in children: a series of 58 patients.

    Launay, F; Younsi, R; Pithioux, M; Chabrand, P; Bollini, G; Jouve, J-L

    2013-02-01

    Fracture is one of the main complications following external fixator removal used in cases of progressive lower limb lengthening; rates as high as 50% are found in the literature. The aim of this study was to determine the factors influencing this complication. One hundred and eleven cases of lower limb lengthening were performed in 58 patients (40 femurs and 71 tibias). The mean age at surgery was 10.1years old. Lengthening was performed in all cases with an external fixator alone, associated in 39.6% of cases with intramedullary nailing. The patients were divided into three groups according to disease etiology (congenital, achondroplasia and other). The fractures were classified according to the Simpson classification. Twenty fractures were recorded (18%). Sixteen fractures were found in patients with congenital disease, four with achondroplasia and none in the group of other etiologies. The fracture was more often in the femur (27.5%) than in the tibia (12.7%). The rate of fracture is influenced by different factors depending on the etiology of disease. In congenital diseases, the fracture rate is higher when there is lengthening of more than 15% of the initial length and a delay between surgery and the beginning of lengthening of less than 7days. In patients with achondroplasia, the influence of a relative percentage of lengthening is less important than in those with congenital disease. However, to avoid fractures, lengthening should not be started in children under the age of nine. Moreover, lengthening should begin at least 7days after the fixator has been placed. Retrospective. Level IV. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

  1. Pre-hospital dietary intake correlates with muscle mass at the time of fracture in older hip fractured patients

    Riccardo eCalvani

    2014-11-01

    Full Text Available Background. Failure to meet an adequate dietary intake is involved in the pathogenesis of sarcopenia and osteoporosis, which in turn increase the risk for falls and fractures, respectively. Older people with hip fracture are often protein-malnourished at hospitalization. Whether low protein-energy intake is associated with muscle atrophy in hip fractured patients is presently unknown. This information is necessary for the development of novel strategies to manage this especially vulnerable patient population. The aim of this study was therefore to explore the relationship between dietary intake and muscle mass in older hip fractured patients.Methods. Analyses were conducted in hip fractured elderly admitted to an orthopedic and trauma surgery ward (University Hospital. Muscle mass was estimated by bioelectrical impedance analysis within 24 h from admission. Dietary information was collected via 24-h dietary recall and nutrient intakes calculated by a nutrition software.Results. Among 62 hip fractured patients (mean age 84.6±7.6 years, 84% women, the average energy intake was 929.2±170.3 Kcal/day, with higher values reported by men (1.046.8±231.4 Kcal/day relative to women (906.5±148.3 Kcal/day; p=0.01. Absolute and normalized protein intake was 50.0±13.5 g/day and 0.88±0.27 g/kg (body weight/day, respectively, with no gender differences. A positive correlation was determined between total energy intake and muscle mass (r=0.384; p=0.003. Similarly, protein and leucine consumption was positively correlated with muscle mass (r=0.367 and 0.311, respectively; p=0.005 for both.Conclusions. A low intake of calories, protein and leucine is associated with reduced muscle mass in hip fractured elderly. Given the relevance of sarcopenia as a risk factor for adverse outcomes in this patient population, our findings highlight the importance of a comprehensive dietary assessment for the detection of nutritional deficits predisposing to or aggravating

  2. Comprehensive care program for elderly patients over 65 years with hip fracture.

    Fernández-Moyano, A; Fernández-Ojeda, R; Ruiz-Romero, V; García-Benítez, B; Palmero-Palmero, C; Aparicio-Santos, R

    2014-01-01

    To report the health outcomes of a multidisciplinary care program for patients over 65 years with hip fracture. We have developed a care coordination model for the comprehensive care of hip fracture patients. It establishes what, who, when, how and where orthopedists, internists, family physicians, emergency, intensive care, physiotherapists, anesthetists, nurses and workers social intervene. All elderly patients over 65 years admitted with the diagnosis of hip fracture (years 2006 to 2010) were retrospectively evaluated. One thousand episodes of hip fracture, corresponding to 956 patients, were included. Mean age was 82 years and mean stay 6.7 days. This was reduced by 1.14 days during the 5 years of the program. A total of 85.1% were operated on before 72 yours, and 91.2% during the program. Incidence of surgical site infection was 1.5%. In-hospital mortality was 4.5%, (24.2% at 12 months). Readmissions at one years was 14.9%. Independence for basic activity of daily living was achieved by 40% of the patients. This multidisciplinary care program for hip fracture patients is associated with positive health outcomes, with a high percentage of patients treated early (more than 90%), reduced mean stay (less than 7 days), incidence of surgical site infections, readmissions and inpatient mortality and at one year, as well as adequate functional recovery. Copyright © 2012 Elsevier España, S.L. All rights reserved.

  3. Total elbow arthroplasty in distal humerus fracture in patients older than 65 years.

    Gerardo Gallucci

    2016-05-01

    Full Text Available Objective To report the clinical-functional results of the treatment of humeral distal fractures with a total elbow prosthesis in patients older than 65 years old. Material and methods This retrospective paper was performed in two surgical centers. Criteria inclusion were: patients with humeral distal fractures, > 65 years, operated on with Coonrad-Morrey prostheses, and with a follow-up of  >1 year. Twenty-one patients were included. Twenty were women with an average age of 79 years old. According to AO classification, 13 fractures were type C3, 7 C2 and 1 A2. All patientes were operated on without desinsertion of the extensor mechanism. Average follow-up was 40 months. Results Flexo-extension was 123-17°, with a total arc of mobility of 106° (80 % of the contralateral side. Pain according to AVE was 1. The MEPI was 83 points: 8 patients had excellent results, 11 good, 1 regular and 1 bad. Average DASH score was 24 points. Conclusion Treatment of humeral distal fractures with total elbow arthoplasty in patients older than 65 years old, may lead to a good option of treatment, but indications must be limited to patients with complex fractures, bad bone quality, with osteoporosis and low functional demands.

  4. High frequency of vertebral fracture and low bone quality in patients with rheumatoid arthritis-Results from TOMORROW study.

    Okano, Tadashi; Inui, Kentaro; Tada, Masahiro; Sugioka, Yuko; Mamoto, Kenji; Wakitani, Shigeyuki; Koike, Tatsuya; Nakamura, Hiroaki

    2017-05-01

    Osteoporosis is one of the complications in patients with rheumatoid arthritis (RA). In this study, we researched the morbidity of existing vertebral fractures and the risk factors for vertebral fractures in patients with RA. This study included 413 participants, 208 patients with RA, and 205 age- and sex-matched controls without RA. Clinical data, radiographic assessment of vertebral fracture from T4 to L4 in thoracic and lumber spine, bone mineral density (BMD), and bone metabolic markers (BMM) were analyzed. Vertebral fractures were observed more frequently, severe and multiple in patients with RA. In the logistic regression analysis, age (adjusted odds ratios (OR): 1.07, 95% confidence interval (CI): 1.04-1.09) and RA (adjusted OR: 1.72, 95% CI: 1.04-2.83) were risk factors for existing vertebral fracture. Moreover, two bone matrix-related markers, undercarboxylated osteocalcin (ucOC) (adjusted OR: 1.68, 95% CI: 1.02-2.78), and urinary pentocidine (adjusted OR: 2.51, 95% CI: 1.48-4.24) were associated with existing vertebral fracture. High frequent, multiple, and severe vertebral fractures were found in patients with RA compared to the controls. Low bone quality might be the cause of the frequent prevalence of vertebral fracture in patients with RA.

  5. Evaluation of a multidisciplinary rehabilitation programme for elderly patients with hip fracture: A prospective cohort study

    Wing-Hoi Cheung

    2017-12-01

    Full Text Available Objective: To investigate the effectiveness and cost of an 18-month multi-disciplinary Comprehensive Fragility Fracture Management Program (CFFMP for fragility hip fracture patients. Design: Prospective cohort study. Patients: Elderly patients with hip fracture were recruited at their first postoperative follow-up in 2 district hospitals. The intervention group comprised patients from the hospital undergoing CFFMP, and the control group comprised patients from another hospital undergoing conventional care. CFFMP provided geri-orthopaedic co-management, physician consultations, group-exercise and vibration-therapy. Timed-up-and-go test (TUG, Elderly Mobility Scale (EMS, Berg Balance Scale (BBS and fall risk screening (FS were used to assess functional performance. Incidences of falls and secondary fractures, the cost of the programme and related healthcare resources were recorded. Results: A total of 76 patients were included in the intervention group (mean age 77.9 years ((standard deviation; SD 6.1 and 77 in the control group (79.9 (SD 7.2, respectively. The re-fracture rate in the control group (10.39% was significantly higher than in the intervention group (1.32% (p = 0.034. The intervention group improved significantly in TUG, EMS and FS after a 1-year programme. The overall healthcare costs per patient in the intervention and control groups were US$22,450 and US$25,313, respectively. Conclusion: Multi-disciplinary CFFMP is effective, with reduced overall cost, reduced length of hospital stay and reduced secondary fracture rate. The rehabilitation community service favours rehabilitation and improved quality of life of hip fracture patients.

  6. [The role of malnutrition and other medical factors in the evolution of patients with hip fracture].

    García Lázaro, M; Montero Pérez-Barquero, M; Carpintero Benítez, P

    2004-11-01

    As the population progressively ages, hip fractures have become increasingly common and are associated with high morbidity and mortality and a pronounced decline in functional status. Hip fractures frequently occur in elderly patients with a high rate of comorbidity and polymedication. Patients hospitalised with hip fractures often display signs of protein malnutrition and may develop medical complications requiring intrahospital care. These factors, more than simply surgical ones, unfavourably influence the vital status and functional outcome of these patients. For this reason, it is necessary to improve the management of pre-existing conditions during hospitalisation, assess and treat malnutrition and prevent medical complications to achieve optimal outcomes for these patients. With this objective, we believe that care should be provided by multidisciplinary teams in close partnership with internists.

  7. Clinical assessment tools identify functional deficits in fragility fracture patients

    Ames TD

    2016-05-01

    Full Text Available Tyler D Ames,1 Corinne E Wee,1 Khoi M Le,1 Tiffany L Wang,1 Julie Y Bishop,2 Laura S Phieffer,2 Carmen E Quatman2 1The Ohio State University College of Medicine, 2Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, USA Purpose: To identify inexpensive, noninvasive, portable, clinical assessment tools that can be used to assess functional performance measures that may put older patients at risk for falls such as balance, handgrip strength, and lumbopelvic control.Patients and methods: Twenty fragility fracture patients and 21 healthy control subjects were evaluated using clinical assessment tools (Nintendo Wii Balance Board [WBB], a handheld dynamometer, and an application for the Apple iPod Touch, the Level Belt that measure functional performance during activity of daily living tasks. The main outcome measurements were balance (WBB, handgrip strength (handheld dynamometer, and lumbopelvic control (iPod Touch Level Belt, which were compared between fragility fracture patients and healthy controls.Results: Fragility fracture patients had lower scores on the vertical component of the WBB Torso Twist task (P=0.042 and greater medial–lateral lumbopelvic sway during a 40 m walk (P=0.026 when compared to healthy controls. Unexpectedly, the fracture patients had significantly higher scores on the left leg (P=0.020 and total components (P=0.010 of the WBB Single Leg Stand task as well as less faults during the left Single Leg Stand task (P=0.003.Conclusion: The clinical assessment tools utilized in this study are relatively inexpensive and portable tools of performance measures capable of detecting differences in postural sway between fragility fracture patients and controls. Keywords: fall risk, geriatric fracture, Nintendo Wii Balance Board, Level Belt, fragility fracture

  8. Evaluation of sarcopenia in patients with distal radius fractures.

    Roh, Young Hak; Koh, Young Do; Noh, Jung Ho; Gong, Hyun Sik; Baek, Goo Hyun

    2017-12-01

    Sarcopenia is more prevalent in patients with distal radius fracture (DRF) than in age- and sex-matched controls. Lower appendicular mass index in men and weaker grip strength in both men and women increase the likelihood of DRF. Sarcopenia is a core component of physical frailty that predisposes older people to falls and negatively impacts the activities of daily living. The objectives of this study were to compare the prevalence of sarcopenia in patients with DRF with that in age- and sex-matched controls without DRF; and evaluate the association between sarcopenia and the occurrence of DRF. We prospectively recruited 132 patients over 50 years of age who sustained DRF due to fall and 132 age- and sex-matched controls without DRF. A definition of sarcopenia was based on the consensus of the Asian Working Group for Sarcopenia. Sarcopenic components including appendicular lean body mass, grip strength, and gait speed were compared between the two groups. Other factors assessed for the occurrence of DRF were age, gender, body mass index (BMI), lumbar, and hip bone mineral density (BMD) values. A conditional logistic regression analysis was conducted to evaluate the associations between sarcopenia and the occurrence of DRF. A total of 39 (30%) of 132 DRF patients were sarcopenic, whereas 23 (17%) of the 132 controls were within the sarcopenic criteria (p = 0.048). The patient group had significantly lower lean body mass and weaker grip strength than those of the control group. However, there was no significant difference in gait speed between the two groups. According to regression analysis, lower appendicular mass index in men was associated with an increased incidence of DRF (odds ratio [OR] = 0.84, 95% confidence interval [CI] = 0.72, 0.95) while weaker grip strength and lower total hip BMD values were associated with the occurrence of DRF in both men (OR = 0.77, 95% CI = 0.63, 0.92; and OR = 0.79, 95% CI = 0.64, 0.94, respectively) and women (OR

  9. Unstable intertrochanteric femur fractures in geriatric patients treated with the DLT trochanteric nail.

    Temiz, Aytun; Durak, Aslihan; Atici, Teoman

    2015-07-01

    To evaluate clinical-functional and radiological results of geriatric patients with unstable intertrochanteric femur fracture treated with intramedullary nail. Thirty-two patients treated with intramedullary nail (DLT trochanteric nail) due to unstable intertrochanteric femur fractures were reviewed retrospectively. Fractures 31-A2 and 31-A3 (AO classification) were evaluated. Operation time, blood loss, and blood transfusion requirements, hospitalization period, time to fracture union were evaluated and perioperative and postoperative complications were recorded. According to the modified Baumgaertner criteria fracture reduction was analyzed radiologically, and nail tip-apex distance was measured. Femoral neck-shaft angle was also evaluated. Harris Hip Score for clinical evaluation and Kyo criteria for walking capacity were used. The mean age was 72 years (65-81), mean follow up time was 18.3 months (12-26). Nineteen patients had type 31-A2 and 13 had type 31-A3 fractures. Mean operation time was 36.3min (25-45), blood loss 185.9ml (100-250). Blood transfusion was required in 7 patients. The average hospitalization duration was 6 days (4-14) while the time to surgery from admission was 2.9 days (2-6). Radiologically, in 21 of the cases fracture reduction was well (65.6%), acceptable in 9 (28.1%), and poor in 2 (6.3%). In early postoperative period, the mean collo-diaphyseal angle was 129.1° (120-140°), mean tip-apex distance was 15.5mm (10-27). The mean Harris Hip Score was 63.4 (38-90). Two patients (6.3%) had excellent, 21 patients (65.6%) had good, 7 patients (21.8%) had moderate, and 2 patients (6.3%) had poor results. Walking capacity in the last follow-up in 20 of the cases (62.5%) was pre-fracture level. While complications were observed in seventeen patients (53.1%) (5 superficial wound infections, 5 fractures of the greater trochanter, 3 cases of secondary varus angulation and 4 cases of heterotopic ossification) none of them required additional surgery

  10. Fragility Hip Fractures in Elderly Patients in Bhubaneswar, India (2012-2014): A Prospective Multicenter Study of 1031 Elderly Patients.

    Dash, Sunil K; Panigrahi, Ranajit; Palo, Nishit; Priyadarshi, Ashok; Biswal, Manas

    2015-03-01

    Elderly patients with hip fracture constitute Single Largest Group of Emergency Orthopaedics Admissions. In 2050, 6.26 million hip fractures worldwide, approximately 50%, will occur in Asia. Only small number of reports on incidence of hip fractures in the Asian population exist. India lacks data registry for fragility hip fractures, therefore, the magnitude and standard of patient care are not known. A prospective multicenter study was conducted from January 2012 to April 2014 to describe population-based longitudinal trends, namely, age-specific incidence, fracture type, timing of presentation, kilometers traveled, timing of surgery, hospital stay, man hours lost, pressure ulcers, weight bearing, 30-day return, 3-month mortality, and so on, of fragility hip fractures. A total of 1031 patients were included with 59.7% females and 40.3% of male patients, with a female-male ratio of 1.5:1. Commonest mode: Falls 45%. 56.4% IT fractures. 66.2%patients operated, Operative/Conservative Ratio of 2.8:1. Patients travel a mean distance of 86.4 kilometers for quality treatment. Of the patients, 85.9 % presented late due to ignorance and misguiding quack practice. Incidence of delayed surgery was 69.3%. Persistent electrolytes imbalance and hyperglycemia normalized in 81.2% by second or third postoperative day. The man hours lost was 157.85 hours/person. Medical complications was more (90%) in patients who had delays in surgeries and presentation. Mortality rate was 6.2 %. Patients travel long for quality treatment, most of them are misguided, present late with significant complications and sufferings, and their pockets half drained depriving them off best treatment. Early presentation and operation have better prognosis and rehabilitation, facilitates early return to work, and independence. Increased pressure sores, infections, hospital stay, treatment cost, depression, and mortality are directly related to delays in surgeries and presentation. Estimated losses according to

  11. Early and late fracture following extensive limb lengthening in patients with achondroplasia and hypochondroplasia.

    Kitoh, H; Mishima, K; Matsushita, M; Nishida, Y; Ishiguro, N

    2014-09-01

    Two types of fracture, early and late, have been reported following limb lengthening in patients with achondroplasia (ACH) and hypochondroplasia (HCH). We reviewed 25 patients with these conditions who underwent 72 segmental limb lengthening procedures involving the femur and/or tibia, between 2003 and 2011. Gender, age at surgery, lengthened segment, body mass index, the shape of the callus, the amount and percentage of lengthening and the healing index were evaluated to determine predictive factors for the occurrence of early (within three weeks after removal of the fixation pins) and late fracture (> three weeks after removal of the pins). The Mann‑Whitney U test and Pearson's chi-squared test for univariate analysis and stepwise regression model for multivariate analysis were used to identify the predictive factor for each fracture. Only one patient (two tibiae) was excluded from the analysis due to excessively slow formation of the regenerate, which required supplementary measures. A total of 24 patients with 70 limbs were included in the study. There were 11 early fractures in eight patients. The shape of the callus (lateral or central callus) was the only statistical variable related to the occurrence of early fracture in univariate and multivariate analyses. Late fracture was observed in six limbs and the mean time between removal of the fixation pins and fracture was 18.3 weeks (3.3 to 38.4). Lengthening of the tibia, larger healing index, and lateral or central callus were related to the occurrence of a late fracture in univariate analysis. A multivariate analysis demonstrated that the shape of the callus was the strongest predictor for late fracture (odds ratio: 19.3, 95% confidence interval: 2.91 to 128). Lateral or central callus had a significantly larger risk of fracture than fusiform, cylindrical, or concave callus. Radiological monitoring of the shape of the callus during distraction is important to prevent early and late fracture of lengthened

  12. The effect of lower limb rehabilitation gymnastics on postoperative rehabilitation in elderly patients with femoral shaft fracture

    Yang, Si-Dong; Ning, Sheng-Hua; Zhang, Li-Hong; Zhang, Ying-Ze; Ding, Wen-Yuan; Yang, Da-Long

    2016-01-01

    Abstract The purpose of this study was to explore the effect of lower limb rehabilitation gymnastics on postoperative rehabilitation in elderly patients with femoral shaft fracture after undergoing intramedullary nail fixation surgery. We collected medical records of elderly patients aged???60 years with femoral shaft fracture between 03/2010 and 03/2015 in Longyao County Hospital. Totally, 160 patients were identified and divided into the intervention group (n = 80) and the control group (n ...

  13. Age-specific incidence of hip fracture in the elderly: a healthy decline.

    Green, C

    2012-02-01

    Hip fractures in the elderly are an important source of morbidity and mortality. The predicted increase in the number of hip fractures due to the increasing elderly population has not been universally observed. The purpose of this study was to examine the incidence of hip fractures over a twenty year period to determine if this rise is occurring in our region. All hip fractures from the unit over 20 years were identified. Population data for those over 65 in the catchment area of our hospital was acquired. The rate of fractures occurring each year relative to the population was determined. The results were split into age groups. There was a strong correlation between the population rise and number of fractures (p = 0.77). But there was no significant difference in the rate of fracture over time (p = 0.41). However, the average age at which fracture occurred increased by two years. In addition we show the overall trend in the rate of fractures decreases in the younger age groups and increases in the older age groups. Therefore, the predicted rapid increase in rate is not occurring. This probably reflects the strengthening of the economy in Ireland from the 1930\\'s onwards, leading to a healthier population.

  14. Evaluating recovery following hip fracture: a qualitative interview study of what is important to patients.

    Griffiths, Frances; Mason, Victoria; Boardman, Felicity; Dennick, Katherine; Haywood, Kirstie; Achten, Juul; Parsons, Nicholas; Griffin, Xavier; Costa, Matthew

    2015-01-06

    To explore what patients consider important when evaluating their recovery from hip fracture and to consider how these priorities could be used in the evaluation of the quality of hip fracture services. Semistructured interviews exploring the experience of recovery from hip fracture at two time points-4 weeks and 4 months postoperative hip fixation. Two approaches to analysis: thematic analysis of data specifically related to recovery from hip fracture; summarising the participant's experience overall. 31 participants were recruited, of whom 20 were women and 12 were cognitively impaired. Mean age was 81.5 years. Interviews were provided by 19 patients, 14 carers and 8 patient/carer dyad; 10 participants were interviewed twice. Single major trauma centre in the West Midlands of the UK. Stable mobility (without falls or fear of falls) for valued activities was considered most important by participants who had some prefracture mobility and were able to articulate what they valued during recovery. Mobility was important for managing personal care, for day-to-day activities such as shopping and gardening, and for maintenance of mental well-being. Some participants used assistive mobility devices or adapted to their limitations. Others maintained their previous limited function through increased care provision. Many participants were unable to articulate what they valued as hip fracture was perceived as part of their decline with age. The fracture and problems from other health conditions were an inseparable part of one health experience. Prefracture mobility, adaptations to reduced mobility before or after fracture, and whether or not patients perceive themselves to be declining with age influence what patients consider important during recovery from hip fracture. No single patient-reported outcome measure could evaluate quality of care for all patients following hip fracture. General health-related quality of life tools may provide useful information within

  15. Supine vs decubitus lateral patient positioning in vertebral fracture assessment.

    Paggiosi, Margaret Anne; Finigan, Judith; Peel, Nicola; Eastell, Richard; Ferrar, Lynne

    2012-01-01

    In vertebral fracture assessment (VFA), lateral scans are obtained with the patient positioned supine (C-arm densitometers) or lateral decubitus (fixed-arm densitometers). We aimed to determine the impact of positioning on image quality and fracture definition. We performed supine and decubitus lateral VFA in 50 postmenopausal women and used the algorithm-based qualitative method to identify vertebral fractures. We compared the 2 techniques for the identification of fractures (kappa analysis) and compared the numbers of unreadable vertebrae (indiscernible endplates) and vertebrae that were projected obliquely (Wilcoxon matched-pairs signed-rank test). The kappa score for agreement between the VFA techniques (to identify women with vertebral fractures) was 0.84 (95% confidence interval [CI]: 0.68-0.99), and for agreement with fracture assessments made from radiographs, kappa was 0.76 (95% CI: 0.57-0.94) for both supine and decubitus lateral VFA. There were more unreadable vertebrae with supine lateral (48 vertebrae in supine lateral compared with 14 in decubitus lateral; p=0.001), but oblique projection was less common (93 vertebrae compared with 145 in decubitus lateral; p=0.002). We conclude that there were significantly different projection effects with supine and decubitus lateral VFA, but these differences did not influence the identification of vertebral fractures in our study sample. Copyright © 2012 The International Society for Clinical Densitometry. Published by Elsevier Inc. All rights reserved.

  16. Proximal Humerus Fractures: Evaluation and Management in the Elderly Patient

    Grawe, Brian

    2018-01-01

    Introduction: Proximal humerus fractures are common in the elderly. The evaluation and management of these injuries is often controversial. The purpose of this study is to review recent evidence and provide updated recommendations for treating proximal humerus fractures in the elderly. Methods: A literature review of peer-reviewed publications related to the evaluation and management of proximal humerus fractures in the elderly was performed. There was a focus on randomized controlled trials and systematic reviews published within the last 5 years. Results: The incidence of proximal humerus fractures is increasing. It is a common osteoporotic fracture. Bone density is a predictor of reduction quality and can be readily assessed with anteroposterior views of the shoulder. Social independence is a predictor of outcome, whereas age is not. Many fractures are minimally displaced and respond acceptably to nonoperative management. Displaced and severe fractures are most frequently treated operatively with intramedullary nails, locking plates, percutaneous techniques, or arthroplasty. Discussion: Evidence from randomized controlled trials and systematic reviews is insufficient to recommend a treatment; however, most techniques have acceptable or good outcomes. Evaluation should include an assessment of the patient’s bone quality, social independence, and surgical risk factors. With internal fixation, special attention should be paid to medial comminution, varus angulation, and restoration of the calcar. With arthroplasty, attention should be paid to anatomic restoration of the tuberosities and proper placement of the prosthesis. Conclusion: A majority of minimally displaced fractures can be treated conservatively with early physical therapy. Treatment for displaced fractures should consider the patient’s level of independence, bone quality, and surgical risk factors. Fixation with percutaneous techniques, intramedullary nails, locking plates, and arthroplasty are all

  17. "I struggle to count my blessings": recovery after hip fracture from the patients' perspective.

    Bruun-Olsen, Vigdis; Bergland, Astrid; Heiberg, Kristi Elisabeth

    2018-01-19

    Recovery outlooks of physical functioning and quality of life after hip fracture have not changed significantly over the past 25 years. Previous research has mainly dealt with causalities and acute treatment, while the recovery process from the patients' perspective has been less comprehensively described. Expanded knowledge of what the patients consider important in their recovery process may have important consequences for how these patients are treated in the future and thereby on future patient outcomes. The aim presently is therefore to explore how elderly patients with hip fracture enrolled in an ongoing RCT have experienced their recovery process. The study was qualitative in design. Eight frail elderly in recovery after hip fracture (aged 69-91) were interviewed in their home four months after their fracture. The interviews covered issues related to their experiences of facilitators and barriers throughout the different stages in the recovery process. The patients were already enrolled in an ongoing randomized controlled trial, examining the effects of habitual functional training during their short term stays at nursing homes. The patients were chosen strategically according to age, gender, and participation in rehabilitation. The interviews were recorded, transcribed and subjected to a method of systematic text condensation inspired by Giorgi's phenomenological method. The results revealed that the patients' experiences of the recovery process fell into three main themes: "Feeling vulnerable", "A span between self-reliance and dependency" and "Disruption from a normal life". The feeling of gloominess and vulnerability persisted throughout. Being in recovery was also experienced as a tension between self-reliance and dependency; a disrupted life where loss of mobility and the impact of age was profoundly present. Being in recovery after hip fracture was experienced as a life breaking event. Based on these findings, increased focus on individualized

  18. Predictors of mortality subsequent to a fracture in diabetes mellitus patients

    Jakob eStarup-Linde

    2015-04-01

    Full Text Available Background: Type-1 and type-2 Diabetes Mellitus (DM is associated with an increased fracture risk and possibly an increased risk of death following a fracture.Aim: To investigate the association between diabetes related drugs and mortality following a fracture. Methods: A nested case-control study was conducted. Cases were patients with DM who died following a fracture; controls were DM patients not dying after a fracture. We identified DM patients using the Danish National Hospital Discharge Register (1977-2011 and included information on date of DM diagnosis, date of fracture and comorbidities. From the Danish Cause of Death Register the date of death was collected (2008-2011. From the Central Region of Jutland, Denmark, medication use was collected (2008-2011. Analysis was performed by unconditional logistic regression.Results: 2,621 diabetes patients with a fracture following the diabetes diagnosis and with information on medication use were included. Of these 229 died. In a multivariate analysis, statin use (n= 1,106 (42% statin users, odds ratio (OR = 0.60, 95 % confidence interval, p=0.012 decreased the risk of dying subsequent to a fracture. Male gender (OR=1.57, p=0.005, increasing age (OR=1.08, p<0.001, a diagnosis of retinopathy (OR=2.12, p=0.008, heart failure (OR= 1.68, p=0.004 and use of glucocorticoids (OR=2.22, p=0.001 were associated with an increased risk of death. None of the antidiabetics; biguanides, glucagon-like receptor agonists, β-cell stimulants, glitazones, and insulin were associated with mortality.Conclusion: Co-morbidity reflected by late onset complications, heart failure and glucocorticoid use was associated with an increased risk of mortality subsequent to a fracture. Statin use may reduce mortality subsequent to a fracture in diabetes patients. Clinical trials are needed to determine whether diabetes patients with a fracture should initiate statin treatment.

  19. Patients with eating disorders. A high-risk group for fractures

    Vestergaard, Peter; Emborg, C.; Stoving, R.K.

    2003-01-01

    PURPOSE: To analyze fracture risk and bone mineral density in patients with eating disorders (anorexia nervosa, bulimia nervosa, and other eating disorders). DESIGN: Clinical overview. FINDINGS: Bone mineral density is decreased and fracture risk increased in patients with anorexia nervosa....... In patients with bulimia nervosa, bone mineral is only marginally decreased and fracture risk marginally increased. In patients with other eating disorders (eating disorders not otherwise specified), bone mineral density is decreased and fracture risk increased. CONCLUSIONS: Fracture risk is increased...

  20. Complications of ankle fracture in patients with diabetes.

    Chaudhary, Saad B; Liporace, Frank A; Gandhi, Ankur; Donley, Brian G; Pinzur, Michael S; Lin, Sheldon S

    2008-03-01

    Ankle fractures in patients with diabetes mellitus have long been recognized as a challenge to practicing clinicians. Complications of impaired wound healing, infection, malunion, delayed union, nonunion, and Charcot arthropathy are prevalent in this patient population. Controversy exists as to whether diabetic ankle fractures are best treated noninvasively or by open reduction and internal fixation. Patients with diabetes are at significant risk for soft-tissue complications. In addition, diabetic ankle fractures heal, but significant delays in bone healing exist. Also, Charcot ankle arthropathy occurs more commonly in patients who were initially undiagnosed and had a delay in immobilization and in patients treated nonsurgically for displaced ankle fractures. Several techniques have been described to minimize complications associated with diabetic ankle fractures (eg, rigid external fixation, use of Kirschner wires or Steinmann pins to increase rigidity). Regardless of the specifics of treatment, adherence to the basic principles of preoperative planning, meticulous soft-tissue management, and attention to stable, rigid fixation with prolonged, protected immobilization are paramount in minimizing problems and yielding good functional outcomes.

  1. Treatment of Medial Malleolus or Pure Deltoid Ligament Injury in Patients with Supination-External Rotation Type IV Ankle Fractures.

    Wang, Xu; Zhang, Chao; Yin, Jian-Wen; Wang, Chen; Huang, Jia-Zhang; Ma, Xin; Wang, Cheng-Wei; Wang, Xue

    2017-02-01

    To investigate the effect of internal fixation on postoperative ankle function in patients with supination-external rotation type IV ankle fractures, including medial malleolus fractures and deltoid ligament injury. Between January 2012 and June 2014, patients with medial structure injuries were enrolled in this study and assigned to the medial malleolus fracture group or the deltoid ligament group. The surgical procedures for the two groups were documented. The follow-up endpoint was the time point when the steel plate or screw was removed from the lateral ankle. The Olerud-Molander ankle scoring system was used to assess ankle function. A total of 84 patients with supination-external rotation type IV ankle fractures had complete medical records and were included in this study. The average age of the patients was 44.16 years (range, 15-75). The patient sample included 39 males and 45 females. Overall, 49 patients (19 males and 30 females) suffered a medial malleolus fracture. The average age of these patients was 40.20 years (range, 15-75). Patients with a posterior malleolar fracture fragment >25% of the articular surface accounted for 81.6% (40 patients) of these patients. Overall, 35 patients (20 males and 15 females) experienced a deltoid ligament injury. The average age of these patients was 44.21 years (range, 17-73). Patients with a posterior malleolar fracture fragment >25% of the articular surface accounted for 11.5% (four patients) of these patients. Open reduction was performed in patients with medial malleolus fractures, and two 4.0-mm cannulated screws were used to fixate the posterior malleolus and the medial malleolus. The suture-anchor technique was used to repair the ligaments in patients with deltoid ligament injuries. The follow-up endpoint was the time point when the steel plate and screws were removed from the lateral ankle in patients. The average follow-up period was 13.4 months (range, 11-17). The Olerud-Molander ankle scoring system was

  2. Soft-plastic brace for lower limb fractures in patients with spinal cord injury.

    Uehara, K; Akai, M; Kubo, T; Yamasaki, N; Okuma, Y; Tobimatsu, Y; Iwaya, T

    2013-04-01

    Retrospective study at a rehabilitation center. Patients with spinal cord injury, even if they are wheelchair users, sometimes suffer from fractures of the lower limb bones. As their bones are too weak to have surgery, and because a precise reduction is not required for restoration, such patients are often indicated for conservative treatment. This case series study investigated the use of a hinged, soft-plastic brace as a conservative approach to treating fractures of the lower extremities of patients with spinal cord injury. National Rehabilitation Center, Japan. Fifteen patients (male, n=10; female, n=5; average age, 52.7 years) with 19 fractures of the femur or the tibia who were treated with a newly-developed hinged, soft-plastic brace were studied. All of them used wheelchairs. We analyzed the time taken for fracture union and for wearing orthotics, degree of malalignment, femorotibial angle and side effects. The fractures in this series were caused by relatively low-energy impact. The average time taken for fracture union was 80.1 (37-189) days, and the average amount of time spent wearing orthotics was 77.9 (42-197) days. On final X-ray imaging, the average femorotibial angle was 176.9° (s.d. ±8.90), and 15° of misalignment in the sagittal plane occurred in one patient. A hinged, soft-plastic brace is a useful option as a conservative approach for treating fractures of the lower extremities in patients with spinal cord injury.

  3. Comparison in bone turnover markers during early healing of femoral neck fracture and trochanteric fracture in elderly patients

    Shota Ikegami

    2009-10-01

    Full Text Available Healing of fractures is different for each bone and bone turnover markers may reflect the fracture healing process. The purpose of this study was to determine the characteristic changes in bone turnover markers during the fracture healing process. The subjects were consecutive patients with femoral neck or trochanteric fracture who underwent surgery and achieved bone union. There were a total of 39 patients, including 33 women and 6 men. There were 18 patients (16 women and 2 men with femoral neck fracture and 21 patients (17 women and 4 men with trochanteric fracture. Serum bone-specific alkaline phosphatase (BAP was measured as a bone formation marker. Urine and serum levels of N-terminal telopeptide of type I collagen (NTX, as well as urine levels of C-terminal telopeptide of type I collagen (CTX and deoxypyridinoline (DPD, were measured as markers of bone resorption. All bone turnover markers showed similar changes in patients with either type of fracture, but significantly higher levels of both bone formation and resorption markers were observed in trochanteric fracture patients than in neck fracture patients. BAP showed similar levels at one week after surgery and then increased. Bone resorption markers were increased after surgery in patients with either fracture. The markers reached their peak values at three weeks (BAP and urinary NTX, five weeks (serum NTX and DPD, and 2-3 weeks (CTX after surgery. The increase in bone turnover markers after hip fracture surgery and the subsequent decrease may reflect increased bone formation and remodeling during the healing process. Both fractures had a similar bone turnover marker profile, but the extent of the changes differed between femoral neck and trochanteric fractures.

  4. Comparison in bone turnover markers during early healing of femoral neck fracture and trochanteric fracture in elderly patients.

    Ikegami, Shota; Kamimura, Mikio; Nakagawa, Hiroyuki; Takahara, Kenji; Hashidate, Hiroyuki; Uchiyama, Shigeharu; Kato, Hiroyuki

    2009-10-10

    Healing of fractures is different for each bone and bone turnover markers may reflect the fracture healing process. The purpose of this study was to determine the characteristic changes in bone turnover markers during the fracture healing process. The subjects were consecutive patients with femoral neck or trochanteric fracture who underwent surgery and achieved bone union. There were a total of 39 patients, including 33 women and 6 men. There were 18 patients (16 women and 2 men) with femoral neck fracture and 21 patients (17 women and 4 men) with trochanteric fracture. Serum bone-specific alkaline phosphatase (BAP) was measured as a bone formation marker. Urine and serum levels of N-terminal telopeptide of type I collagen (NTX), as well as urine levels of C-terminal telopeptide of type I collagen (CTX) and deoxypyridinoline (DPD), were measured as markers of bone resorption. All bone turnover markers showed similar changes in patients with either type of fracture, but significantly higher levels of both bone formation and resorption markers were observed in trochanteric fracture patients than in neck fracture patients. BAP showed similar levels at one week after surgery and then increased. Bone resorption markers were increased after surgery in patients with either fracture. The markers reached their peak values at three weeks (BAP and urinary NTX), five weeks (serum NTX and DPD), and 2-3 weeks (CTX) after surgery. The increase in bone turnover markers after hip fracture surgery and the subsequent decrease may reflect increased bone formation and remodeling during the healing process. Both fractures had a similar bone turnover marker profile, but the extent of the changes differed between femoral neck and trochanteric fractures.

  5. Radioisotopic and Radiological Evaluation in Patient with Stress Fracture

    Ko, Kwang Seop; Kim, Jai Young; Kang, Sung Koo; Kim, So Yon; Lee, Gwon Jun

    1987-01-01

    The stress fracture is a disease caused by and abnormal stress to the normal bone with constant, repeated pull. Early detection of stress fracture plays an important role in treatment and prevention of its complication. Bone scintigraphy was performed to evaluate 18 patients with stress fracture of the lower extremities from May, 1985 to April, 1987, in the Department of Internal Medicine of National Police Hospital. The results were as follows: 1) Seventeen of the 18 cases showed positive bone scans at the initial study performed from 1 week to 5 months after the onset of symptom. 2) Ten of the 18 patients had findings of stress fracture at the initial X-ray film. Two out of 8 negative case revealed positive findings in the follow-up studies. 3) The bone scans in the 2 cases taken 5 months after the onset of symptom; the one showed only slightly increased radio uptake, the other showed no abnormal findings. In conclusion, bone scanning is a more sensitive indicator of early stress fracture than radiologic study, The healing phase is characterized by a gradual decline in radioactivity at the fracture site in concordance with subsidence of symptom.

  6. Bilateral impacted femoral neck fracture in a renal disease patient ...

    Spontaneous bilateral femoral neck facture in a renal disease patient is not common. We report a case of 47-year-old female patient with chronic renal failure and on regular hemodialysis for the past 5 years who sustained bilateral impacted femoral neck fracture without history of trauma and injury and refused any surgical ...

  7. Affective functioning after delirium in elderly hip fracture patients

    Slor, Chantal J.; Witlox, Joost; Jansen, René W. M. M.; Adamis, Dimitrios; Meagher, David J.; Tieken, Esther; Houdijk, Alexander P. J.; van Gool, Willem A.; Eikelenboom, Piet; de Jonghe, Jos F. M.

    2013-01-01

    Delirium in elderly patients is associated with various long-term sequelae that include cognitive impairment and affective disturbances, although the latter is understudied. For a prospective cohort study of elderly patients undergoing hip fracture surgery, baseline characteristics and affective and

  8. Effect of Thermal Aging and Test Temperatures on Fracture Toughness of SS 316(N) Welds

    Dutt, B. Shashank; Babu, M. Nani; Shanthi, G.; Moitra, A.; Sasikala, G.

    2018-03-01

    The effect of thermal aging and test temperatures on fracture toughness (J 0.2) of SS 316(N) weld material has been studied based on J-R curve evaluations. The aging of the welds was carried out at temperatures 370, 475 and 550 °C and for durations varying from 1000 to 20,000 h. The fracture toughness (J-R curve) tests were carried out at 380 and 550 °C for specimens after all aging conditions, including as-weld condition. The initiation fracture toughness (J 0.2) of the SS 316(N) weld material has shown degradation after 20,000-h aging durations and is reflected in all the test temperatures and aging temperatures. The fracture toughness after different aging conditions and test temperatures, including as-weld condition, was higher than the minimum specified value for this class of welds.

  9. Degradation of impact fracture during accelerated aging of weld metal on microalloyed steel

    Vargas-Arista, B.; Hallen, J. M.; Albiter, A.; Angeles-Chavez, C.

    2008-01-01

    The effect of accelerated aging on the toughness and fracture of the longitudinal weld metal on an API5L-X52 line pipe steel was evaluated by Charpy V-notch impact test, fracture analysis and transmission electron microscopy. Aging was performed at 250 degree centigrade for 100 to 1000 h. The impact results indicated a significant reduction in the fracture energy and impact toughness as a function of aging time, which were achieved by the scanning electron microscope fractography that showed a decrease in the vol fraction of microvoids by Charpy ductile failure with the aging time, which favored the brittle fracture by transgranular cleavage. The minimum vol fraction of microvoids was reached at 500 h due to the peak aged. The microstructural analysis indicated the precipitation of transgranular iron nano carbides in the aged specimens, which was related to the deterioration of toughness and change in the ductile to brittle behavior. (Author) 15 refs

  10. Risk of fracture with thiazolidinediones: an individual patient data meta-analysis

    Marloes T Bazelier

    2013-02-01

    Full Text Available Background: The use of thiazolidinediones (TZDs has been associated with increased fracture risks. Our aim was to estimate the risk of fracture with TZDs in three different healthcare registries, using exactly the same study design, and to perform an individual patient data meta-analysis of these three studies. Methods: Population-based cohort studies were performed utilizing the British General Practice Research Database (GPRD, the Dutch PHARMO Record Linkage System, and the Danish National Health Registers. In all three databases, the exposed cohort consisted of all patients (aged 18+ with at least one prescription of antidiabetic (AD medication. Cox proportional hazards models were used to estimate hazard ratios (HRs of fracture. The total period of follow-up for each patient was divided into periods of current exposure and past exposure, with patients moving between current and past use.Results: In all three registries, the risk of fracture was increased for women who were exposed to TZDs: HR 1.48 [1.37-1.60] in GPRD, HR 1.35 [1.15-1.58] in PHARMO and HR 1.22 [1.03-1.44] in Denmark. Combining the data in an individual patient data meta-analysis resulted, for women, in a 1.4-fold increased risk of any fracture for current TZD users versus other AD drug users (adj. HR 1.44 [1.35-1.53]. For men, there was no increased fracture risk (adj. HR 1.05 [0.96-1.14]. Risks were increased for fractures of the radius/ulna, humerus, tibia/fibula, ankle and foot, but not for hip/femur or vertebral fractures. Current TZD users with more than 25 TZD presciptions ever before had a 1.6-fold increased risk of fracture compared with other AD drug users (HR 1.59 [1.46-1.74].Conclusion: In this study, we consistently found a 1.2- to 1.5-fold increased risk of fractures for women using TZDs, but not for men, across three different healthcare registries. TZD users had an increased risk for fractures of the extremities, and risks further increased for prolonged users

  11. Epidemiology of fractures of the proximal third of the femur in elderly patients

    Daniel Daniachi

    2015-08-01

    Full Text Available ABSTRACTOBJECTIVE: This was an epidemiological study on fractures of the proximal third of the femur in elderly patients who were treated at a teaching hospital in the central region of São Paulo. METHODS: The subjects were patients over the age of 60 years who were attended over a 1-year period. A questionnaire seeking basic sociodemographic data and information on comorbidities presented and medications used was drawn up. The circumstances of the fractures and their characteristics, the treatment instituted and the intra-hospital mortality rate were evaluated. RESULTS: The 113 patients included in the study presented a mean age of 79 years. The ratio between the sexes was three women to each man. Only 30.4% of the patients reported having osteoporosis and only 0.9% had had treatment for the disease. Low-energy trauma was the cause of 92.9% of the fractures. Femoral neck fractures accounted for 42.5% of the fractures and trochanteric fractures, 57.5%. Five patients did not undergo operations; 39 underwent joint replacement; and 69 underwent osteosynthesis. The mean length of hospital stay was 13.5 days and the mean length of waiting time until surgery was 7 days. The intra-hospital mortality rate was 7.1%. CONCLUSION: The patients attended at this institution presented an epidemiological profile similar to what is found in the Brazilian literature. Chronic kidney failure is a significant factor with regard to intra-hospital mortality. Preventive measures such as early diagnosis and treatment of osteoporosis and regular physical activity practices were not implemented.

  12. Epidural analgesia in patients with traumatic rib fractures

    Duch, P; Møller, M H

    2015-01-01

    BACKGROUND: Traumatic rib fractures are a common condition associated with considerable morbidity and mortality. Observational studies have suggested improved outcome in patients receiving continuous epidural analgesia (CEA). The aim of the present systematic review of randomised controlled trials...... (RCTs) was to assess the benefit and harm of CEA compared with other analgesic interventions in patients with traumatic rib fractures. METHODS: We performed a systematic review with meta-analysis and trial sequential analysis (TSA). Eligible trials were RCTs comparing CEA with other analgesic...... interventions in patients with traumatic rib fractures. Cumulative relative risks (RRs) and mean differences (MDs) with 95% confidence intervals (CIs) were estimated, and risk of systematic and random errors was assessed. The predefined primary outcome measures were mortality, pneumonia and duration...

  13. LOW-TRAUMATIC FRACTURES IN PATIENTS WITH ENDOGENOUS HYPERCORTISOLISM. PREDICTORS AND RISK FACTORS, THE IMPACT ON QUALITY OF LIFE

    Zh E Belaya

    2013-12-01

    Full Text Available The objective of this study was to investigate the prevalence of low traumatic fractures, the factors influencing fractures in endogenous Cushing’s syndrome (CS of various etiologies and their contributions into functional abilities and quality of life in patients with CS. Materials and methods: the retrospective data of patients, who had received treatment due to endogenous CS, (2001-2011, was evaluated. All enrolled patients underwent standard spinal radiographs in lateral positions of the vertebrae Th4-L4. Recent low traumatic non-vertebral fractures were recorded in the medical cards. Bone mineral density (BMD was measured by DXA GE Lunar Prodigy. Serum samples on octeocalcin (OC, carboxyterminal cross-linked telopeptide of type I collagen (CTx, latenight cortisol in serum were assayed by electrochemiluminescence (ECLIA. 24h urinary free cortisol (24hUFC was measured by an immunochemiluminescence assay (extraction with diethyl ether. Functional assessment was performed using «chair rising», «up and go» and «tandem» tests. Universal pain assessment tool (verbal descriptor scale, Wong-Baker facial grimace scale, activity tolerance scale, EQ-5D and ECOS-16 questionnaires were given to patients and they self-reported their conditions. Results: Among 215 patients, 178 were females and 37 males, median age 35 (Q25-Q75 27-48; 88patients (40,9% had low traumatic fractures, including vertebral fractures in 76 cases (in 60 cases multiple vertebral fractures and non-vertebral fractures in 27 cases (17 patients had rib fractures, 3 -fractures of metatarsal bones, 2 fractures of radius, 2 fractures of tibia and fibula, 1 humerus, 1 breastbone; 1 hip fracture. Patients with fractures had higher 24hUFC, late-night cortisol in serum, lower OC, Total Hip BMD, but did not differ in age, BMI, CTx or etiology of CS. After applying the logistic regression analysis (adjusted for sex, age, BMI, BMD, OC, the main predictor of fractures was late-night serum

  14. Treatment cost of patients with maxillofacial fractures at the University Hospital in Mostar 2002-2006.

    Jurić, Mario; Novakovic, Josip; Carapina, Mirela; Kneiević, Ervin

    2010-03-01

    The aim of this study was to establish the costs structure of medical treatment for the patients with maxillofacial fractures, to perform a treatment cost evaluation, describe the factors which considerably influence the costs and discover the ways of achieving financial savings in treated patients. The study group consisted of patients with maxillofacial fractures who were admitted and treated at the Department of Maxillofacial Surgery of the University Hospital Mostar in the period from January 2002 until December 2006. Data for the study were collected from the patients' databases, case histories and data obtained on the basis of individual payments for the treatment that was collected by Finance Department of the University Hospital of Mostar Most patients in this study were men (83%), of average age 34 +/- 19 years. Zygomatic bone fracture was the commonest injury. Open surgical procedure was performed in 84.7% of treated cases. The costs for the open procedure were considerably higher than conservative treatment. Medication cost made up a total of 37.9% and cost of hospital accommodation 27.3% out of total hospital charge. Cost reduction in treated patients with maxillofacial fractures should be achieved through protocols of urgent treatment of maxillofacial trauma patients immediately after sustaining an injury and with earlier discharge of the patients when postoperative complications are not expected.

  15. A Radiographic Study on the Associations of Age and Prevalence of Vertebral Fractures with Abdominal Aortic Calcification in Japanese Postmenopausal Women and Men

    Jun Iwamoto

    2010-01-01

    Full Text Available The purpose of the present study was to determine the associations of age and history of non- and low-traumatic fractures with the severity of abdominal aortic calcification in Japanese postmenopausal women and men. Four hundred and one Japanese persons (24 men and 377 postmenopausal women, mean age: 73.8 years for whom thoracic and lumbar spine radiographs had been obtained to evaluate their posture prior to patient participation in a fall-prevention exercise program were enrolled. The associations of sex, age, history of hip fracture, prevalence of vertebral fracture, and spondylosis grade (the Nathan degree with the severity of abdominal aortic calcification (length of calcification, as evaluated according to the number of vertebral bodies were analyzed. Nine subjects (2.2% had a history of hip fracture, and 221 (55.1% had at least one prevalent vertebral fracture. Two hundred and sixty-seven subjects (66.6% had first-degree spondylosis. Age and the number of prevalent vertebral fractures, but not sex, history of hip fracture, or spondylosis grade, were significantly associated with the severity of abdominal aortic calcification. The present study confirmed that age and the number of vertebral fractures were associated with the severity of abdominal aortic calcification in Japanese postmenopausal women and men.

  16. Mortality and morbidity in elderly patients with fracture neck of femur treated by hemi arthroplasty

    Ahmad, I.

    2006-01-01

    To determine mortality and morbidity in elderly patients with fracture neck of femur treated by hemiarthroplasty (Austin Moore Prosthesis) during one year postoperatively. During the study period, all patients with fracture neck of femur, who were 65 years of age or above and treated by Austin Moore Prosthesis (AMP), were included. The patients were followed for one year at intervals of 2 weeks, 4 weeks, 6 months, and one year. All surviving patients were assessed for complications, both general and mechanical, related to the implant. The mortality and morbidity were compared for various age subgroups, and in patients with and without systemic co-morbidities.Chi square test was applied to see the significance of results. The total number of patients was 46 with average age of 70 years. Male to female ratio was 1:2. There were 70% patients who had one or more associated systemic disease. The mortality at 2 weeks was 4.3%, 17.4% at 6 months and 26% at one year. The overall dislocation rate was 4.3%. Two patients had infection and 17.4% patients had thigh pain at one year. The mortality and morbidity was high in patients with systemic comorbidities, and those above 70 years of age, but this was statistically not significant (p value >0.05). The functional assessment of surviving patients at one year was graded as excellent or good in 76.4% of patients. (author)

  17. Optimal age of commencing and discontinuing thiazide therapy to protect against fractures

    Kruse, C; Eiken, P; Vestergaard, P

    2016-01-01

    subjects. Ten-year crude and adjusted age-grouped hazard ratios (HRs) of fracture occurrence were stratified by age of commencing thiazides compared to non-exposure. Separate analyses were done on Anatomical Therapeutic Chemical Classification System (ATC) codes C03AA and C03AA + C03AB compiled. Ten...... occurrence. INTRODUCTION: The purpose of this study was to retrospectively examine the optimal age for commencing and discontinuing thiazide therapy to protect from osteoporotic fractures. METHODS: A population-based, retrospective matched cohort study was done using national data of 2.93 million Danish......-year crude HRs of fracture occurrence for discontinuing vs. continuing thiazides were estimated and stratified by age for the two groups. RESULTS: For C03AB alone (97.1 % of thiazide prescriptions), adjusted 10-year HRs of fracture occurrence were significantly increased for thiazide commencement after age...

  18. Lidocaine patches reduce pain in trauma patients with rib fractures.

    Zink, Karen A; Mayberry, John C; Peck, Ellen G; Schreiber, Martin A

    2011-04-01

    Rib fracture pain is notoriously difficult to manage. The lidocaine patch is effective in other pain scenarios with an excellent safety profile. This study assesses the efficacy of lidocaine patches for treating rib fracture pain. A prospectively gathered cohort of patients with rib fracture was retrospectively analyzed for use of lidocaine patches. Patients treated with lidocaine patches were matched to control subjects treated without patches. Subjective pain reports and narcotic use before and after patch placement, or equivalent time points for control subjects, were gathered from the chart. All patients underwent long-term follow-up, including a McGill Pain Questionnaire (MPQ). Twenty-nine patients with lidocaine patches (LP) and 29 matched control subjects (C) were analyzed. During the 24 hours before patch placement, pain scores and narcotic use were similar (LP 5.3, C 4.6, P = 0.19 and LP 51, C 32 mg morphine, P = 0.17). In the 24 hours after patch placement, LP patients had a greater decrease in pain scores (LP 1.2, C 0.0, P = 0.01) with no change in narcotic use (LP -8.4, C 0.5-mg change in morphine, P = 0.25). At 60 days, LP patients had a lower MPQ pain score (LP 7.7, C 12.2, P rib fracture pain. Lidocaine patches resulted in a sustained reduction in pain, outlasting the duration of therapy.

  19. Diagnostic accuracy of ultrasound in upper and lower extremity long bone fractures of emergency department trauma patients.

    Frouzan, Arash; Masoumi, Kambiz; Delirroyfard, Ali; Mazdaie, Behnaz; Bagherzadegan, Elnaz

    2017-08-01

    Long bone fractures are common injuries caused by trauma. Some studies have demonstrated that ultrasound has a high sensitivity and specificity in the diagnosis of upper and lower extremity long bone fractures. The aim of this study was to determine the accuracy of ultrasound compared with plain radiography in diagnosis of upper and lower extremity long bone fractures in traumatic patients. This cross-sectional study assessed 100 patients admitted to the emergency department of Imam Khomeini Hospital, Ahvaz, Iran with trauma to the upper and lower extremities, from September 2014 through October 2015. In all patients, first ultrasound and then standard plain radiography for the upper and lower limb was performed. Data were analyzed by SPSS version 21 to determine the specificity and sensitivity. The mean age of patients with upper and lower limb trauma were 31.43±12.32 years and 29.63±5.89 years, respectively. Radius fracture was the most frequent compared to other fractures (27%). Sensitivity, specificity, positive predicted value, and negative predicted value of ultrasound compared with plain radiography in the diagnosis of upper extremity long bones were 95.3%, 87.7%, 87.2% and 96.2%, respectively, and the highest accuracy was observed in left arm fractures (100%). Tibia and fibula fractures were the most frequent types compared to other fractures (89.2%). Sensitivity, specificity, PPV and NPV of ultrasound compared with plain radiography in the diagnosis of upper extremity long bone fractures were 98.6%, 83%, 65.4% and 87.1%, respectively, and the highest accuracy was observed in men, lower ages and femoral fractures. The results of this study showed that ultrasound compared with plain radiography has a high accuracy in the diagnosis of upper and lower extremity long bone fractures.

  20. Pathologic fracture of the distal radius in a 25-year-old patient with a large unicameral bone cyst.

    Massen, Felix; Baumbach, Sebastian; Volkmer, Elias; Mutschler, Wolf; Grote, Stefan

    2014-06-13

    Distal radius fractures (DRF) are often referred to as osteoporosis indicator fractures as their incidence increases from age 45. In the group of young adults, distal radius fractures normally result from high-energy trauma. Wrist fractures in young patients without adequate trauma thus raise suspicion of a pathologic fracture. In this report we present the case of a fractured unicameral bone cyst (UBC) at the distal radius in a young adult.To the author's best knowledge, this is the first detailed report in an UBC at the distal radius causing a pathologic DRF in an adult patient. A 25-year-old otherwise healthy male presented to our Emergency Department after a simple fall on his right outstretched hand. Extended diagnostics revealed a pathologic, dorsally displaced, intra-articular distal radius fracture secondary to a unicameral bone cyst occupying almost the whole metaphysis of the distal radius. To stabilize the fracture, a combined dorsal and volar approach was used for open reduction and internal fixation. A tissue specimen for histopathological examination was gathered and the lesion was filled with an autologous bone graft harvested from the ipsilateral femur using a reamer-irrigator-aspirator (RIA) system. Following one revision surgery due to an intra-articular step-off, the patient recovered without further complications. Pathologic fractures in young patients caused by unicameral bone cysts require extended diagnostics and adequate treatment. A single step surgical treatment is reasonable if fracture and bone cyst are treated appropriately. Arthroscopically assisted fracture repair may be considered in intra-articular fractures or whenever co-pathologies of the carpus are suspected.

  1. The gender- and age-specific 10-year and lifetime absolute fracture risk in Tromso, Norway

    Ahmed, Luai A.; Schirmer, Henrik; Bjornerem, Ashild; Emaus, Nina; Jorgensen, Lone; Stormer, Jan; Joakimsen, Ragnar M.

    2009-01-01

    Aim of this study is to estimate the gender- and age-specific 10-year and lifetime absolute risks of non-vertebral and osteoporotic (included hip, distal forearm and proximal humerus) fractures in a large cohort of men and women. This is a population-based 10 years follow-up study of 26,891 subjects aged 25 years and older in Tromso, Norway. All non-vertebral fractures were registered from 1995 throughout 2004 by computerized search in radiographic archives. Absolute risks were estimated by life-table method taking into account the competing risk of death. The absolute fracture risk at each year of age was estimated for the next 10 years (10-year risk) or up to the age of 90 years (lifetime risk). The estimated 10-year absolute risk of all non-vertebral fracture was higher in men than women before but not after the age of 45 years. The 10-year absolute risk for non-vertebral and osteoporotic fractures was over 10%, respectively, in men over 65 and 70 years and in women over 45 and 50 years of age. The 10-year absolute risks of hip fractures at the age of 65 and 80 years were 4.2 and 18.6% in men, and 9.0 and 24.0% in women, respectively. The risk estimates for distal forearm and proximal humerus fractures were under 5% in men and 13% in women. The estimated lifetime risks for all fracture locations were higher in women than men at all ages. At the age of 50 years, the risks were 38.1 and 24.8% in men and 67.4 and 55.0% in women for all non-vertebral and osteoporotic fractures, respectively. The estimated gender- and age-specific 10-year and lifetime absolute fracture risk were higher in Tromso than in other populations. The high lifetime fracture risk reflects the increased burden of fractures in this cohort

  2. Influence of the preparation design and artificial aging on the fracture resistance of monolithic zirconia crowns.

    Mitov, Gergo; Anastassova-Yoshida, Yana; Nothdurft, Frank Phillip; von See, Constantin; Pospiech, Peter

    2016-02-01

    The aim of this study was to evaluate the fracture resistance and fracture behavior of monolithic zirconia crowns in accordance with the preparation design and aging simulation method. An upper first molar was prepared sequentially with three different preparation designs: shoulderless preparation, 0.4 mm chamfer and 0.8 mm chamfer preparation. For each preparation design, 30 monolithic zirconia crowns were fabricated. After cementation on Cr-Co alloy dies, the following artificial aging procedures were performed: (1) thermal cycling and mechanical loading (TCML): 5000 cycles of thermal cycling 5℃-55℃ and chewing simulation (1,200,000 cycles, 50 N); (2) Low Temperature Degradation simulation (LTD): autoclave treatment at 137℃, 2 bar for 3 hours and chewing simulation; and (3) no pre-treatment (control group). After artificial aging, the crowns were loaded until fracture. The mean values of fracture resistance varied between 3414 N (LTD; 0.8 mm chamfer preparation) and 5712 N (control group; shoulderless preparation). Two-way ANOVA analysis showed a significantly higher fracture loads for the shoulderless preparation, whereas no difference was found between the chamfer preparations. In contrast to TCML, after LTD simulation the fracture strength of monolithic zirconia crowns decreased significantly. The monolithic crowns tested in this study showed generally high fracture load values. Preparation design and LTD simulation had a significant influence on the fracture strength of monolithic zirconia crowns.

  3. Decision to take osteoporosis medication in patients who have had a fracture and are 'high' risk for future fracture: a qualitative study.

    Sale, Joanna E M; Gignac, Monique A; Hawker, Gillian; Frankel, Lucy; Beaton, Dorcas; Bogoch, Earl; Elliot-Gibson, Victoria

    2011-05-09

    Patients' values and preferences are fundamental tenets of evidence-based practice, yet current osteoporosis (OP) clinical guidelines pay little attention to these issues in therapeutic decision making. This may be in part due to the fact that few studies have examined the factors that influence the initial decision to take OP medication. The purpose of our study was to examine patients' experiences with the decision to take OP medication after they sustained a fracture. A phenomenological qualitative study was conducted with outpatients identified in a university teaching hospital fracture clinic OP program. Individuals aged 65+ who had sustained a fragility fracture within 5 years, were 'high risk' for future fracture, and were prescribed OP medication were eligible. Analysis of interview data was guided by Giorgi's methodology. 21 patients (6 males, 15 females) aged 65-88 years participated. All participants had low bone mass; 9 had OP. Fourteen patients were taking a bisphosphonate while 7 patients were taking no OP medications. For 12 participants, the decision to take OP medication occurred at the time of prescription and involved minimal contemplation (10/12 were on medication). These patients made their decision because they liked/trusted their health care provider. However, 4/10 participants in this group indicated their OP medication-taking status might change. For the remaining 9 patients, the decision was more difficult (4/9 were on medication). These patients were unconvinced by their health care provider, engaged in risk-benefit analyses using other information sources, and were concerned about side effects; 7/9 patients indicated that their OP medication-taking status might change at a later date. Almost half of our older patients who had sustained a fracture found the decision to take OP medication a difficult one. In general, the decision was not considered permanent. Health care providers should be aware of their potential role in patients

  4. Decision to take osteoporosis medication in patients who have had a fracture and are 'high' risk for future fracture: A qualitative study

    Hawker Gillian

    2011-05-01

    Full Text Available Abstract Background Patients' values and preferences are fundamental tenets of evidence-based practice, yet current osteoporosis (OP clinical guidelines pay little attention to these issues in therapeutic decision making. This may be in part due to the fact that few studies have examined the factors that influence the initial decision to take OP medication. The purpose of our study was to examine patients' experiences with the decision to take OP medication after they sustained a fracture. Methods A phenomenological qualitative study was conducted with outpatients identified in a university teaching hospital fracture clinic OP program. Individuals aged 65+ who had sustained a fragility fracture within 5 years, were 'high risk' for future fracture, and were prescribed OP medication were eligible. Analysis of interview data was guided by Giorgi's methodology. Results 21 patients (6 males, 15 females aged 65-88 years participated. All participants had low bone mass; 9 had OP. Fourteen patients were taking a bisphosphonate while 7 patients were taking no OP medications. For 12 participants, the decision to take OP medication occurred at the time of prescription and involved minimal contemplation (10/12 were on medication. These patients made their decision because they liked/trusted their health care provider. However, 4/10 participants in this group indicated their OP medication-taking status might change. For the remaining 9 patients, the decision was more difficult (4/9 were on medication. These patients were unconvinced by their health care provider, engaged in risk-benefit analyses using other information sources, and were concerned about side effects; 7/9 patients indicated that their OP medication-taking status might change at a later date. Conclusions Almost half of our older patients who had sustained a fracture found the decision to take OP medication a difficult one. In general, the decision was not considered permanent. Health care

  5. Risk factors for fragility fracture in Seremban district, Malaysia: a comparison of patients with fragility fracture in the orthopedic ward versus those in the outpatient department.

    Keng Yin Loh; King Hock Shong; Soo Nie Lan; Lo, Wan-Yi; Shu Yuen Woon

    2008-01-01

    Osteoporosis is a silent disease and becomes clinically significant in the presence of fragility fracture. Identifying risk factors that are associated with osteoporosis in the community is important in reducing the incidence of fragility fracture. The aim of this study is to identify risk factors associated with fragility fracture in the Seremban District of Malaysia. This is a population comparison study between orthopedic ward patients and outpatients attending a community health clinic for 6 months. Epidemiological data and the possible risk factors for osteoporosis were collected by direct interview. This study demonstrates that advancing age, low body weight, smoking, lack of regular exercise, low consumption of calcium containing foods, and using bone depleting drugs (steroids, thyroid hormone, and frusemides) are major risk factors for fragility fracture. Most of these risk factors are modifiable through effective lifestyle intervention.

  6. Physical activity in middle-aged women and hip fracture risk: the UFO study.

    Englund, U; Nordström, P; Nilsson, J; Bucht, G; Björnstig, U; Hallmans, G; Svensson, O; Pettersson, U

    2011-02-01

    In a population-based case-control study, we demonstrate that middle-aged women who were active with walking or in different physical spare time activities were at lower risk of later sustaining a hip fracture compared to more sedentary women. In middle-aged women participating in the Umeå Fracture and Osteoporosis (UFO) study, we investigated whether physical activity is associated with a subsequent decreased risk of sustaining a hip fracture. The UFO study is a nested case-control study investigating associations between bone markers, lifestyle, and osteoporotic fractures. We identified 81 female hip fracture cases that had reported lifestyle data before they sustained their fracture. Each case was compared with two female controls who were identified from the same cohort and matched for age and week of reporting data, yielding a total cohort of 237 subjects. Mean age at baseline was 57.2 ± 5.0 years, and mean age at fracture was 65.4 ± 6.4 years. Conditional logistic regression analysis with adjustments for height, weight, smoking, and menopausal status showed that subjects who were regularly active with walking or had a moderate or high frequency of physical spare time activities (i.e. berry/mushroom picking and snow shovelling) were at reduced risk of sustaining a hip fracture (OR 0.14; 95% CI; 0.05-0.53 for walking and OR 0.19; 95% CI; 0.08-0.46, OR 0.17, 95% CI; 0.05-0.64 for moderate and high frequency of spare time activities, respectively) compared to more sedentary women. An active lifestyle in middle age seems to reduce the risk of future hip fracture. Possible mechanisms may include improved muscle strength, coordination, and balance resulting in a decreased risk of falling and perhaps also direct skeletal benefits.

  7. Dislocation of total hip replacement in patients with fractures of the femoral neck.

    Enocson, Anders; Hedbeck, Carl-Johan; Tidermark, Jan; Pettersson, Hans; Ponzer, Sari; Lapidus, Lasse J

    2009-04-01

    Total hip replacement is increasingly used in active, relatively healthy elderly patients with fractures of the femoral neck. Dislocation of the prosthesis is a severe complication, and there is still controversy regarding the optimal surgical approach and its influence on stability. We analyzed factors influencing the stability of the total hip replacement, paying special attention to the surgical approach. We included 713 consecutive hips in a series of 698 patients (573 females) who had undergone a primary total hip replacement (n = 311) for a non-pathological, displaced femoral neck fracture (Garden III or IV) or a secondary total hip replacement (n = 402) due to a fracture-healing complication after a femoral neck fracture. We used Cox regression to evaluate factors associated with prosthetic dislocation after the operation. Age, sex, indication for surgery, the surgeon's experience, femoral head size, and surgical approach were tested as independent factors in the model. The overall dislocation rate was 6%. The anterolateral surgical approach was associated with a lower risk of dislocation than the posterolateral approach with or without posterior repair (2%, 12%, and 14%, respectively (p replacement in patients with femoral neck fractures.

  8. Analysis of facial bone fractures: An 11-year study of 2,094 patients

    Hwang Kun

    2010-01-01

    Full Text Available Purpose: The medical records of these patients were reviewed and analysed to determine the clinical characteristics and treatment of facial bone fractures. Patients and Methods: This is a retrospective study of 2,094 patients with facial bone fractures from various accidents that were treated at the Inha University Hospital from 1996 to 2007. Results: The most common age group was the third decade of life (29%. Males were more common than females (3.98:1. The most common aetiology was violent assault or nonviolent traumatic injury (49.4%. The most common isolated fracture site was the nasal bone (37.7%, followed by the mandible (30%, orbital bones (7.6%, zygoma (5.7%, maxilla (1.3% and the frontal bone (0.3%. The largest group with complex fractures included the inferior region of the orbital floor and zygomaticomaxilla (14%. Closed reduction was performed in 46.3% of the cases while 39.7% of the cases required open reduction. For open reductions, the most commonly used soft-tissue approach was the intraoral approach (32.3%. The complication rate was 6.4% and the most common complication was hypoesthesia (68.4% followed by diplopia (25.6%. Conclusion: Long-term collection of epidemiological data regarding facial fractures and concomitant injuries is important for the evaluation of existing preventive measures and useful in the development of new methods of injury prevention and treatment.

  9. Impact of the Holocaust on the Rehabilitation Outcome of Older Patients Sustaining a Hip Fracture.

    Mizrahi, Eliyahu H; Lubart, Emilia; Heymann, Anthony; Leibovitz, Arthur

    2017-04-01

    Holocaust survivors report a much higher prevalence of osteoporosis and fracture in the hip joint compared to those who were not Holocaust survivors. To evaluate whether being a Holocaust survivor could affect the functional outcome of hip fracture in patients 64 years of age and older undergoing rehabilitation. A retrospective cohort study compromising 140 consecutive hip fracture patients was conducted in a geriatric and rehabilitation department of a university-affiliated hospital. Being a Holocaust survivor was based on registry data. Functional outcome was assessed by the Functional Independence Measure (FIM)TM at admission and discharge from the rehabilitation ward. Data were analyzed by t-test, chi-square test, and linear regression analysis. Total and motor FIM scores at admission (P = 0.004 and P = 0.006, respectively) and total and motor FIM gain scores at discharge (P = 0.008 and P = 0.004 respectively) were significantly higher in non-Holocaust survivors compared with Holocaust survivors. A linear regression analysis showed that being a Holocaust survivor was predictive of lower total FIM scores at discharge (β = -0.17, P = 0.004). Hip fracture in Holocaust survivors showed lower total, motor FIM and gain scores at discharge compared to non-Holocaust survivor patients. These results suggest that being a Holocaust survivor could adversely affect the rehabilitation outcome following fracture of the hip and internal fixation.

  10. Improved Outcomes Associated with the Liberal Use of Thoracic Epidural Analgesia in Patients with Rib Fractures.

    Jensen, Courtney D; Stark, Jamie T; Jacobson, Lewis L; Powers, Jan M; Joseph, Michael F; Kinsella-Shaw, Jeffrey M; Denegar, Craig R

    2017-09-01

    Each year, more than 150,000 patients with rib fractures are admitted to US trauma centers; as many as 10% die. Effective pain control is critical to survival. One way to manage pain is thoracic epidural analgesia. If this treatment reduces mortality, more frequent use may be indicated. We analyzed the patient registry of a level II trauma center. All patients admitted with one or more rib fractures (N = 1,347) were considered. Patients who were not candidates for epidural analgesia (N = 382) were eliminated. Mortality was assessed with binary logistic regressions. Across the total population, mortality was 6.7%; incidence of pneumonia was 11.1%; mechanical ventilation was required in 23.8% of patients, for an average duration of 10.0 days; average stay in the hospital was 7.7 nights; and 49.7% of patients were admitted to the ICU for an average of 7.2 nights. Epidural analgesia was administered to 18.4% of patients. After matching samples for candidacy, patients who received epidurals were 3.7 years older, fractured 2.6 more ribs, had higher injury severity scores, and were more likely to present with bilateral fractures, flail segments, pulmonary contusions, hemothoraces, and pneumothoraces. Despite greater injury severity, mortality among these patients was lower (0.5%) than those who received alternative care (1.9%). Controlling for age, injury severity, and use of mechanical ventilation, epidural analgesia predicted a 97% reduction in mortality. Thoracic epidural analgesia associates with reduced mortality in rib fracture patients. Better care of this population is likely to be facilitated by more frequent reliance on this treatment. © 2016 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

  11. Comprehensive geriatric care for patients with hip fractures: a prospective, randomised, controlled trial.

    Prestmo, Anders; Hagen, Gunhild; Sletvold, Olav; Helbostad, Jorunn L; Thingstad, Pernille; Taraldsen, Kristin; Lydersen, Stian; Halsteinli, Vidar; Saltnes, Turi; Lamb, Sarah E; Johnsen, Lars G; Saltvedt, Ingvild

    2015-04-25

    Most patients with hip fractures are characterised by older age (>70 years), frailty, and functional deterioration, and their long-term outcomes are poor with increased costs. We compared the effectiveness and cost-effectiveness of giving these patients comprehensive geriatric care in a dedicated geriatric ward versus the usual orthopaedic care. We did a prospective, single-centre, randomised, parallel-group, controlled trial. Between April 18, 2008, and Dec 30, 2010, we randomly assigned home-dwelling patients with hip-fractures aged 70 years or older who were able to walk 10 m before their fracture, to either comprehensive geriatric care or orthopaedic care in the emergency department, to achieve the required sample of 400 patients. Randomisation was achieved via a web-based, computer-generated, block method with unknown block sizes. The primary outcome, analysed by intention to treat, was mobility measured with the Short Physical Performance Battery (SPPB) 4 months after surgery for the fracture. The type of treatment was not concealed from the patients or staff delivering the care, and assessors were only partly masked to the treatment during follow-up. This trial is registered with ClinicalTrials.gov, number NCT00667914. We assessed 1077 patients for eligibility, and excluded 680, mainly for not meeting the inclusion criteria such as living in a nursing home or being aged less than 70 years. Of the remaining patients, we randomly assigned 198 to comprehensive geriatric care and 199 to orthopaedic care. At 4 months, 174 patients remained in the comprehensive geriatric care group and 170 in the orthopaedic care group; the main reason for dropout was death. Mean SPPB scores at 4 months were 5·12 (SE 0·20) for comprehensive geriatric care and 4·38 (SE 0·20) for orthopaedic care (between-group difference 0·74, 95% CI 0·18-1·30, p=0·010). Immediate admission of patients aged 70 years or more with a hip fracture to comprehensive geriatric care in a dedicated

  12. Risk factors associated with outcomes of hip fracture surgery in elderly patients.

    Kim, Byung Hoon; Lee, Sangseok; Yoo, Byunghoon; Lee, Woo Yong; Lim, Yunhee; Kim, Mun-Cheol; Yon, Jun Heum; Kim, Kye-Min

    2015-12-01

    Hip fracture surgery on elderly patients is associated with a high incidence of morbidity and mortality. The aim of this study is to identify the risk factors related to the postoperative mortality and complications following hip fracture surgery on elderly patients. In this retrospective study, the medical records of elderly patients (aged 65 years or older) who underwent hip fracture surgery from January 2011 to June 2014 were reviewed. A total of 464 patients were involved. Demographic data of the patients, American Society of Anesthesiologists physical status, preoperative comorbidities, type and duration of anesthesia and type of surgery were collected. Factors related to postoperative mortality and complications; as well as to intensive care unit admission were analyzed using logistic regression. The incidence of postoperative mortality, cardiovascular complications, respiratory complications and intensive care unit (ICU) admission were 1.7, 4.7, 19.6 and 7.1%, respectively. Postoperative mortality was associated with preoperative respiratory comorbidities, postoperative cardiovascular complications (P bedridden state (P elderly patients undergoing hip fracture surgery.

  13. Influence of ageing, inclusions and voids on ductile fracture ...

    Unknown

    The strain hardening capacity has a marked effect on void size, and is an indicator of fracture .... a model of ductile failure based on the concept that the critical step in the .... Ashby M F, Gandhi C and Taplin D M R 1979 Acta Metal. 27. 699.

  14. Vertebral fractures in patients with rheumatoid arthritis treated with corticosteroids

    Lems, W. F.; Jahangier, Z. N.; Jacobs, J. W.; Bijlsma, J. W.

    1995-01-01

    To examine the relationship between roentgenological deformities of the vertebral column and clinical manifestations of vertebral fractures in patients with RA, treated with glucocorticosteroids (Cs). In all outpatients of Utrecht University Hospital with RA, who were currently using Cs (n = 52),

  15. Multiple maxillofacial fractures in a patient undergoing orthodontic ...

    A multi-disciplinary team approach for the management of maxillofacial fractures in patients undergoing orthodontic treatment with fixed appliances is suggested. Orthodontic treatment with surgical involvement has been found to improve both facial aesthetics and occlusal function. Key words: Maxillofacial, trauma, ...

  16. Androgen deprivation therapy and fracture risk in Chinese patients with prostate carcinoma.

    Chi-Ho Lee

    Full Text Available Androgen deprivation therapy (ADT increases fracture risk in men with carcinoma of the prostate, but little is known about the fracture risk for different types of ADT. We studied the fracture risk amongst Chinese patients with carcinoma of the prostate prescribed different ADT regimens.This was a single-centered observational study that involved 741 patients with carcinoma of the prostate from January 2001 to December 2011.After a median follow-up of 5 years, 71.7% of the study cohort received ADT and the incidence rate of fracture was 8.1%. Multivariable Cox regression analysis revealed that use of ADT was significantly associated with risk of incident fracture (Hazard Ratio [HR] 3.60; 95% Confidence Interval [95% CI] 1.41-9.23; p = 0.008, together with aged >75 years and type 2 diabetes. Compared with no ADT, all three types of ADT were independently associated with the risk of incident fracture: anti-androgen monotherapy (HR 4.47; 95% CI 1.47-13.7; p = 0.009, bilateral orchiectomy ± anti-androgens (HR 4.01; 95% CI 1.46-11.1; p = 0.007 and luteinizing hormone-releasing hormone agonists ± anti-androgens (HR 3.16; 95% CI 1.18-8.43; p = 0.022. However, there was no significant difference in the relative risks among the three types of ADT.Fracture risk increases among all types of ADT. Clinicians should take into account the risk-benefit ratio when prescribing ADT, especially in elderly patients with type 2 diabetes.

  17. Association Between Dabigatran vs Warfarin and Risk of Osteoporotic Fractures Among Patients With Nonvalvular Atrial Fibrillation.

    Lau, Wallis C Y; Chan, Esther W; Cheung, Ching-Lung; Sing, Chor Wing; Man, Kenneth K C; Lip, Gregory Y H; Siu, Chung-Wah; Lam, Joanne K Y; Lee, Alan C H; Wong, Ian C K

    2017-03-21

    The risk of osteoporotic fracture with dabigatran use in patients with nonvalvular atrial fibrillation (NVAF) is unknown. To investigate the risk of osteoporotic fracture with dabigatran vs warfarin in patients with NVAF. Retrospective cohort study using a population-wide database managed by the Hong Kong Hospital Authority. Patients newly diagnosed with NVAF from 2010 through 2014 and prescribed dabigatran or warfarin were matched by propensity score at a 1:2 ratio with follow-up until July 31, 2016. Dabigatran or warfarin use during the study period. Risk of osteoporotic hip fracture and vertebral fracture was compared between dabigatran and warfarin users using Poisson regression. The corresponding incidence rate ratio (IRR) and absolute risk difference (ARD) with 95% CIs were calculated. Among 51 496 patients newly diagnosed with NVAF, 8152 new users of dabigatran (n = 3268) and warfarin (n = 4884) were matched by propensity score (50% women; mean [SD] age, 74 [11] years). Osteoporotic fracture developed in 104 (1.3%) patients during follow-up (32 dabigatran users [1.0%]; 72 warfarin users [1.5%]). Results of Poisson regression analysis showed that dabigatran use was associated with a significantly lower risk of osteoporotic fracture compared with warfarin (0.7 vs 1.1 per 100 person-years; ARD per 100 person-years, -0.68 [95% CI, -0.38 to -0.86]; IRR, 0.38 [95% CI, 0.22 to 0.66]). The association with lower risk was statistically significant in patients with a history of falls, fractures, or both (dabigatran vs warfarin, 1.6 vs 3.6 per 100 person-years; ARD per 100 person-years, -3.15 [95% CI, -2.40 to -3.45]; IRR, 0.12 [95% CI, 0.04 to 0.33]), but not in those without a history (0.6 vs 0.7 per 100 person-years; ARD per 100 person-years, -0.04 [95% CI, 0.67 to -0.39]; IRR, 0.95 [95% CI, 0.45 to 1.96]) (P value for interaction, <.001). Among adults with NVAF receiving anticoagulation, the use of dabigatran compared with warfarin was associated with a

  18. Facial Fractures.

    Ghosh, Rajarshi; Gopalkrishnan, Kulandaswamy

    2018-06-01

    The aim of this study is to retrospectively analyze the incidence of facial fractures along with age, gender predilection, etiology, commonest site, associated dental injuries, and any complications of patients operated in Craniofacial Unit of SDM College of Dental Sciences and Hospital. This retrospective study was conducted at the Department of OMFS, SDM College of Dental Sciences, Dharwad from January 2003 to December 2013. Data were recorded for the cause of injury, age and gender distribution, frequency and type of injury, localization and frequency of soft tissue injuries, dentoalveolar trauma, facial bone fractures, complications, concomitant injuries, and different treatment protocols.All the data were analyzed using statistical analysis that is chi-squared test. A total of 1146 patients reported at our unit with facial fractures during these 10 years. Males accounted for a higher frequency of facial fractures (88.8%). Mandible was the commonest bone to be fractured among all the facial bones (71.2%). Maxillary central incisors were the most common teeth to be injured (33.8%) and avulsion was the most common type of injury (44.6%). Commonest postoperative complication was plate infection (11%) leading to plate removal. Other injuries associated with facial fractures were rib fractures, head injuries, upper and lower limb fractures, etc., among these rib fractures were seen most frequently (21.6%). This study was performed to compare the different etiologic factors leading to diverse facial fracture patterns. By statistical analysis of this record the authors come to know about the relationship of facial fractures with gender, age, associated comorbidities, etc.

  19. Incidence of Symptomatic Vertebral Fractures in Patients After Percutaneous Vertebroplasty

    Hierholzer, Johannes; Fuchs, Heiko; Westphalen, Kerstin; Baumann, Clemens; Slotosch, Christine; Schulz, Rudolf

    2008-01-01

    The aim of this study was to evaluate the incidence of secondary symptomatic vertebral compression fractures (VCFs) in patients previously treated by percutaneous vertebroplasty (VTP). Three hundred sixteen patients with 486 treated VCFs were included in the study according to the inclusion criteria. Patients were kept in regular follow-up using a standardized questionairre before, 1 day, 7 days, 6 months, and 1 year after, and, further on, on a yearly basis after VTP. The incidence of secondary symptomatic VCF was calculated, and anatomical distribution with respect to previous fractures characterized. Mean follow-up was 8 months (6-56 months) after VTP. Fifty-two of 316 (16.4 %) patients (45 female, 7 male) returned for treatment of 69 secondary VCFs adjacent to (35/69; 51%) or distant from (34/69; 49%) previously treated levels. Adjacent secondary VCF occurred significantly more often compared to distant secondary VCF. Of the total 69 secondary VCFs, 35 of 69 occurred below and 27 of 69 above pretreated VCFs. Of the 65 sandwich levels generated, in 7 of 65 (11%) secondary VCFs were observed. Secondary VCF below pretreated VCF occurred significantly earlier in time compared to VCF above and compared to sandwich body fractures. No major complication occurred during initial or follow-up intervention. We conclude that secondary VCFs do occur in individuals after VTP but the rate found in our study remains below the level expected from epidemiologic studies. Adjacent fractures occur more often and follow the cluster distribution of VCF as expected from the natural history of the underlying osteoporosis. No increased rate of secondary VCF after VTP was observed in this retrospective analysis. In accordance with the pertinent literature, short-term and also midterm clinical results are encouraging and provide further support for the usefulness and the low complication rate of this procedure as an adjunct to the spectrum of pain management in patients with severe

  20. An analysis of postoperative hemoglobin levels in patients with a fractured neck of femur.

    Nagra, Navraj S; van Popta, Dmitri; Whiteside, Sigrid; Holt, Edward M

    2016-10-01

    The aim of this study was to analyze the changes in hemoglobin level and to determine a suitable timeline for post-operative hemoglobin monitoring in patients undergoing fixation of femoral neck fracture. Patients who underwent either dynamic hip screw (DHS) fixation (n = 74, mean age: 80 years) or hip hemiarthroplasty (n = 104, mean age: 84 years) for femoral neck fracture were included into the study. The hemoglobin level of the patients was monitored perioperatively. Analysis found a statistically and clinically significant mean drop in hemoglobin of 31.1 g/L over time from pre-operatively (D0) to day-5 post-operatively (p hemoglobin values over hemiarthroplasty patients (p = 0.046). The decrease in hemoglobin in the first 24-h post-operative period (D0 to day-1) is an underestimation of the ultimate lowest value in hemoglobin found at day-2. Relying on the day-1 hemoglobin could be detrimental to patient care. We propose a method of predicting patients likely to be transfused, and recommend a protocol for patients undergoing femoral neck fracture surgery to standardize postoperative hemoglobin monitoring. Level IV Prognostic study. Copyright © 2016 Turkish Association of Orthopaedics and Traumatology. Production and hosting by Elsevier B.V. All rights reserved.

  1. CT of peroneal tendon injury in patients with calcaneal fractures

    Rosenberg, Z.S.; Feldman, F.; Singson, R.D.

    1986-01-01

    Injury to the peroneal tendons is a major complication of intraarticular calcaneal fractures. Heretofore, the injury has been difficult to diagnose by routine imaging modalities. However, CT studies of 24 intraarticular calcaneal fractures revealed evidence of peroneal tendon injury in 22 cases. The pathologic conditions included lateral displacement, subluxation, dislocation, and impingement on the tendons by bony fragments, hematomas, and scar tissue. Patients studied 6-12 months after injury had CT evidence consistent with clinical symptoms of peroneal tenosynovitis. Since peroneal tendon injury is surgically correctable, it should be differentiated from other known and more obvious complications, of calcaneal fractures. CT therefore serves as a valuable, noninvasive tool in evaluating these otherwise nonvisualized soft tissue structures in the immediate posttraumatic period as well as during long-term follow up

  2. Use of Pressure-Redistributing Support Surfaces among Elderly Hip Fracture Patients across the Continuum of Care: Adherence to Pressure Ulcer Prevention Guidelines

    Baumgarten, Mona; Margolis, David; Orwig, Denise; Hawkes, William; Rich, Shayna; Langenberg, Patricia; Shardell, Michelle; Palmer, Mary H.; McArdle, Patrick; Sterling, Robert; Jones, Patricia S.; Magaziner, Jay

    2010-01-01

    Purpose: To estimate the frequency of use of pressure-redistributing support surfaces (PRSS) among hip fracture patients and to determine whether higher pressure ulcer risk is associated with greater PRSS use. Design and Methods: Patients (n = 658) aged [greater than or equal] 65 years who had surgery for hip fracture were examined by research…

  3. A case report of a completely displaced stress fracture of the femoral shaft in a middle-aged male athlete - A precursor of things to come?

    Larsen, Peter; Elsoe, Rasmus; Rathleff, Michael S

    2016-05-01

    Displaced stress fractures of the femoral shaft are very uncommon. The proportion of middle-aged and older age groups participating in long-distance running, triathlon and other high intensity sports is increasing. As a consequence stress fracture of the femoral shaft may be on the rise in the future. The patient was 43 years old male caucasian triathlete. The authors met the patient after he was admitted with a displaced femoral shaft fracture. The fracture occurred during running at the national championship in ½ Ironman. The patient reported that his symptoms had gradually developed over the last month before the fracture with pain localized anterior to the thigh. The patient interpreted the symptoms as local muscle damage. A clinical examination was conducted by a physiotherapist and the symptoms were interpreted as a simple muscle injury in the quadriceps. When presented with a patient with non-traumatic, diffuse anterior thigh pain in an individual of this age, who is participating in high-level endurance running; clinicians should consider the possibility that the cause of the symptoms may be a femoral shaft stress fracture. Copyright © 2015 Elsevier Ltd. All rights reserved.

  4. Estimation of fracture toughness of cast stainless steels during thermal aging in LWR systems

    Chopra, O.K.

    1991-06-01

    A procedure and correlations are presented for predicting the change in fracture toughness of cast stainless steel components due to thermal aging during service in light water rectors (LWRs) at 280--330 degrees C (535--625 degrees F). The fracture toughness J-R curve and Charpy-impact energy of aged cast stainless steels are estimated from known mineral in formation. Fracture toughness of a specific cast stainless steel is estimated from the extent and kinetics of thermal embrittlement. The extent of thermal embrittlement is characterized by the room-temperature ''normalized'' Charpy-impact energy. A correlation for the extent of embrittlement at ''saturation,'' i.e., the minimum impact energy that would be achieved for the material after long-term aging, is given in terms of a material parameter, Φ, which is determined from the chemical composition. The fracture toughness J-R curve for the material is then obtained from correlations between room-temperature Charpy-impact energy and fracture toughness parameters. Fracture toughness as a function of time and temperature of reactor service is estimated from the kinetics of thermal embrittlement, which is determined from chemical composition. A common ''lower-bound'' J-R curve for cast stainless steels with unknown chemical composition is also defined for a given material specification, ferrite content, and temperature. Examples for estimating impact strength and fracture toughness of cast stainless steel components during reactor service are describes. 24 refs., 39 figs., 2 tabs

  5. Risks of all-cause and site-specific fractures among hospitalized patients with COPD

    Liao, Kuang-Ming; Liang, Fu-Wen; Li, Chung-Yi

    2016-01-01

    Abstract Patients with chronic obstructive pulmonary disease (COPD) have a high prevalence of osteoporosis. The clinical sequel of osteoporosis is fracture. Patients with COPD who experience a fracture also have increased morbidity and mortality. Currently, the types of all-cause and site-specific fracture among patients with COPD are unknown. Thus, we elucidated the all-cause and site-specific fractures among patients with COPD. A retrospective, population-based, cohort study was conducted u...

  6. Comparing fracture healing disorders and long-term functional outcome of polytrauma patients and patients with an isolated displaced midshaft clavicle fracture

    Ferree, Steven; Hietbrink, Falco; van der Meijden, Olivier A J; Verleisdonk, Egbert Jan M M; Leenen, Luke P.H.; Houwert, Roderick M.

    2017-01-01

    Background Although clavicle fractures are a common injury in polytrauma patients, the functional outcome of displaced midshaft clavicle fractures (DMCFs) in this population is unknown. Our hypothesis was that there would be no differences in fracture healing disorders or functional outcome in

  7. Timed up & go test score in patients with hip fracture is related to the type of walking aid

    Kristensen, Morten T; Bandholm, Thomas; Holm, Bente

    2009-01-01

    Kristensen MT, Bandholm T, Holm B, Ekdahl C, Kehlet H. Timed Up & Go test score in patients with hip fracture is related to the type of walking aid. OBJECTIVE: To determine the relationship between Timed Up & Go (TUG) test scores and type of walking aid used during the test, and to determine...... the feasibility of using the rollator as a standardized walking aid during the TUG in patients with hip fracture who were allowed full weight-bearing (FWB). DESIGN: Prospective methodological study. SETTING: An acute orthopedic hip fracture unit at a university hospital. PARTICIPANTS: Patients (N=126; 90 women......, 36 men) with hip fracture with a mean age +/- SD of 74.8+/-12.7 years performed the TUG the day before discharge from the orthopedic ward. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The TUG was performed with the walking aid the patient was to be discharged with: a walker (n=88) or elbow...

  8. The effect of aging on the fracture characteristics and ductility of self-compacting concrete

    Beygi, Morteza H.A.; Kazemi, Mohammad T.; Nikbin, Iman M.; Vaseghi Amiri, Javad

    2014-01-01

    Highlights: • Fracture properties of SCC were obtained using two different methods. • Results showed with increase of age the fracture toughness increases. • As SCC becomes older, brittleness number is almost doubled. • The Size effect curve showed SCC brittleness increases with increase of age. - Abstract: Good knowledge of fracture parameters and cracking behavior of self-compacting concrete (SCC) from early ages until the SCC becomes mature plays an important role in design of SCC structure and also in evaluation of durability and consequently prevention of damage. In this paper, variation of fracture parameters and corresponding ductility behavior of SCC at different ages (e.g. 3 days, 7 days, 28 days and 90 days) for SCC mixes with w/c ratios of 0.45 and 0.65 have been experimentally studied. To do so, three-point bending tests were carried out on 120 notched beams. Then, size effect method (SEM) and work of fracture method (WFM) were applied to interpret the results. The results of analyses indicated that as the concrete is aging from 3 days to 90 days: (a) fracture energies from SEM (G f ) and WFM (G F ) are increased: (b) effective size of the process zone (C f ) in SEM and characteristic length (L ch ) in WFM are considerably decreased indicating increase of concrete brittleness: (c) fracture surface of concrete passing through the aggregate is increased which is attributed to strength improvement of hardened cement paste and aggregate–paste transition zone: (d) fracture toughness is significantly increased: (e) brittleness number is almost doubled. Also, the ratio of G F /G f , which is applied for calibration of numerical models of cracking at different ages, is equal to 2.70

  9. Potential Benefits of Rib Fracture Fixation in Patients with Flail Chest and Multiple Non-flail Rib Fractures.

    Qiu, Meiguang; Shi, Zhanjun; Xiao, Jun; Zhang, Xuming; Ling, Shishui; Ling, Hao

    2016-12-01

    The purpose of this study is to evaluate the potential benefits of rib fracture fixation in patients with flail chest and multiple non-flail rib fractures versus conventional treatment modalities. A retrospective reviewed study compared 86 cases which received surgical treatment between June 2009 and May 2013 to 76 cases which received conservative treatment between January 2006 and May 2009. The patients were divided into the flail chest ( n  = 38) and multiple non-flail rib fracture groups ( n  = 124). In the flail chest group, the mechanical ventilation time, ICU monitoring time, tracheostomies, thoracic deformity, and impaired pulmonary function and return to full-time employment were compared. In the multiple non-flail rib fracture group, fracture healing, visual analog scale (VAS) pain score, inpatient length of stay, atelectatic, pulmonary complications, and normal activity-returning time were compared. Patients in the flail chest operative fixation group had significantly shorter ICU stay, decreased ventilator requirements, fewer tracheostomies, less thoracic deformity and impaired pulmonary function, and more returned to full-time employment. Patients in the multiple non-flail rib fracture operative fixation had shorter hospital stay, less pain, earlier return to normal activity, more fracture healing, less atelectasis, and fewer pulmonary infections. This study demonstrates the potential benefits of surgical stabilization of flail chest and multiple non-flail rib fractures with plate fixation. When compared with conventional conservative management, operatively managed patients demonstrated improved clinical outcomes.

  10. Fracture of the temporal bone in patients with traumatic brain injury

    Secchi, Myrian Marajó Dal

    2012-01-01

    Full Text Available Introduction: The fractures in the temporal bone are lesions that are observed in patients with traumatic brain injury (TBI. The computed tomography of high-resolution (CT allows evaluating the fracture and the complications. Objective: Evaluate patients with TBI and temporal bone fracture. Way of study: Retrospective study. Method: Were evaluated 28 patients interned by TBI with clinical evidence and/or radiologic from temporal bone fractures. Results: The age ranged from 3 to 75 years. The most affected side was the right side 50% (n=14, left side 36% (n=10 and both sides 14% (n=4. The etiology of the trauma was the falling 25% (n=7, accidents with motorcycles and bicycles 21% (n=6, physical aggression 14% (n=4, running over 11% (n=3, fall of object 4% (n=1 and other causes 25% (n=7. The clinical signs were: Otorrhagia 78%, otalgia 11% (n=3, otorrhea 7% (n=2, facial paralysis 7% (n=2 and hearing loss 7% (n=2. The otoscopic findings: otorrhagia 57% (n=16, laceration of external auditory canal 36% (n=10, hemotympanum 11% (n=3, normal 7% (n=2 and Battle signal 7% (n=2. The findings for CT of skull were: with no alterations 54% (n=15 and temporal fracture 7% (n=2 and the CT of temporal bones were: line of fracture 71% (n=20, opacification of the mastoid 25% (n=7, glenoid cavity air 14% (n=1, dislocation of the ossicular chain 7% (n=2 and veiling of the middle ear 4% (n=1. Conclusion: Patients with TBI must be submitted to the otorhinolaryngological evaluation and imaging, for the early diagnosis of the complications and treatment.

  11. Early interdisciplinary hospital intervention for elderly patients with hip fractures : functional outcome and mortality

    Francisco José Tarazona-Santabalbina

    2012-01-01

    Full Text Available OBJECTIVES: Hip fractures are associated with high levels of co-morbidity and mortality. Orthogeriatric units have been shown to be effective with respect to functional recovery and mortality reduction. The aim of this study is to document the natural history of early multidisciplinary intervention in elderly patients with hip fractures and to establish the prognostic factors of mortality and walking ability after discharge. METHODS: This observational, retrospective study was performed in an orthogeriatric care unit on patients aged >70 years with a diagnosis of hip fracture between 2004 and 2008. This study included 1363 patients with a mean age of 82.7 + 6.4 years. RESULTS: On admission to the unit, the average Barthel score of these patients was 77.2 + 27.8 points, and the average Charlson index score was 2.14 + 2.05. The mean length of stay was 8.9 + 4.26 days, and the readmission rate was 2.3%. The in-hospital mortality rate was 4.7%, and the mortality rates at one, six, and 12 months after discharge were 8.7%, 16.9%, and 25.9%, respectively. The Cox proportional hazards model estimated that male sex, Barthel scale, heart failure, and cognitive impairment were associated with an increased risk of death. With regard to functionality, 63.7% of the patients were able to walk at the time of discharge, whereas 77.4% and 80.1% were able to walk at one month and six months post-discharge, respectively. The factors associated with a worse functional recovery included cognitive impairment, performance status, age, stroke, Charlson score, and delirium during the hospital stay. CONCLUSIONS: Early multidisciplinary intervention appears to be effective for the management of hip fracture. Age, male sex, baseline function, cognitive impairment and previous comorbidities are associated with a higher mortality rate and worse functional recovery.

  12. A comparison study of pelvic fractures and associated abdominal injuries between pediatric and adult blunt trauma patients.

    Swaid, Forat; Peleg, Kobi; Alfici, Ricardo; Olsha, Oded; Givon, Adi; Kessel, Boris

    2017-03-01

    Pelvic fractures are a marker of severe injury, mandating a thorough investigation for the presence of associated injuries. Anatomical and physiological differences between adults and children may lead to a different impact of pelvic fractures on these populations. The purpose of this study is to compare pelvic fractures between pediatric and adult blunt trauma victims, mainly regarding their severity and associated intraabdominal injuries. A retrospective study involving blunt trauma patients suffering pelvic fractures, according to the records of the Israeli National Trauma Registry. Patients included children, aged 0-14years, and adults between 15 and 64years. The presence and severity of associated injuries were assessed. Overall, 7621 patients aged 0-64years were identified with pelvic fractures following blunt trauma. The incidence of pelvic fractures in children was (0.8%), as compared to 4.3% in adults, p 25. Adults sustained significantly more moderate to severe pelvic fractures (AIS≥3) than children (26.7% vs. 17.4%, psplenic and hepatic injuries (p=0.026, p=0.0004, respectively). Among children, a similar correlation was not demonstrated. Adults involved in blunt trauma are more likely to sustain pelvic fractures, and these are generally more severe fractures, as compared to children suffering from blunt trauma. Nonetheless, mortality rates were found similar in both groups. The only associated injury with statistically significant difference in incidence among the two groups was rectal injury. In adults, but not in children, higher grade pelvic fractures correlated with more severe concomitant splenic or hepatic injuries. The level of evidence for this study is III (3). Copyright © 2016 Elsevier Inc. All rights reserved.

  13. Endodontics and the ageing patient.

    Johnstone, M; Parashos, P

    2015-03-01

    Patients are living longer and the rate of edentulism is decreasing. Endodontic treatment is an essential part of maintaining the health and well-being of the elderly. Retention of natural teeth improves the quality of life and the overall health and longevity of ageing patients. Also, teeth that might be otherwise extracted may be strategically valuable to retain a prosthesis, and elderly patients are more likely to have medical complications that may prevent dental extractions from being safely performed. The technical goals of endodontic treatment in the elderly are the same as those for younger patients. However, the pulpo-dentinal complex undergoes calcific changes over time, which may pose challenges for the clinician. The purposes of this review are to discuss age changes in the pulp and the challenges posed by diagnosing, treatment planning and treating the elderly endodontic patient. © 2015 Australian Dental Association.

  14. Acetabular Fracture

    Chad Correa

    2017-09-01

    Full Text Available History of present illness: A 77-year-old female presented to her primary care physician (PCP with right hip pain after a mechanical fall. She did not lose consciousness or have any other traumatic injuries. She was unable to ambulate post-fall, so X-rays were ordered by her PCP. Her X-rays were concerning for a right acetabular fracture (see purple arrows, so the patient was referred to the emergency department where a computed tomography (CT scan was ordered. Significant findings: The non-contrast CT images show a minimally displaced comminuted fracture of the right acetabulum involving the acetabular roof, medial and anterior walls (red arrows, with associated obturator muscle hematoma (blue oval. Discussion: Acetabular fractures are quite rare. There are 37 pelvic fractures per 100,000 people in the United States annually, and only 10% of these involve the acetabulum. They occur more frequently in the elderly totaling an estimated 4,000 per year. High-energy trauma is the primary cause of acetabular fractures in younger individuals and these fractures are commonly associated with other fractures and pelvic ring disruptions. Fractures secondary to moderate or minimal trauma are increasingly of concern in patients of advanced age.1 Classification of acetabular fractures can be challenging. However, the approach can be simplified by remembering the three basic types of acetabular fractures (column, transverse, and wall and their corresponding radiologic views. First, column fractures should be evaluated with coronally oriented CT images. This type of fracture demonstrates a coronal fracture line running caudad to craniad, essentially breaking the acetabulum into two halves: a front half and a back half. Secondly, transverse fractures should be evaluated by sagittally oriented CT images. By definition, a transverse fracture separates the acetabulum into superior and inferior halves with the fracture line extending from anterior to posterior

  15. Femoral nerve block versus intravenous fentanyl in adult patients with hip fractures - a systematic review

    Flávia Vieira Guimarães Hartmann

    Full Text Available Abstract Background: Hip fractures configure an important public health issue and are associated with high mortality taxes and lose of functionality. Hip fractures refer to a fracture occurring between the edge of the femoral head and 5 cm below the lesser trochanter. They are common in orthopedic emergencies. The number of proximal femoral fractures is likely to increase as the population ages. The average cost of care during the initial hospitalization for hip fracture can be estimated about US$ 7,000 per patient. Femoral fractures are painful and need immediate adequate analgesia. Treating pain femoral fractures is difficult because there are limited numbers of analgesics available, many of which have side effects that can limit their use. Opiates are the most used drugs, but they can bring some complications. In this context, femoral nerve blocks can be a safe alternative. It is a specific regional anesthetic technique used by doctors in emergency medicine to provide anesthesia and analgesia of the affected leg. Objective: To compare the analgesic efficacy of intravenous fentanyl versus femoral nerve block before positioning to perform spinal anesthesia in patients with femoral fractures assessed by Pain Scales. Methods: A systematic review of scientific literature was conducted. Studies described as randomized controlled trials comparing femoral nerve block and traditional fentanyl are included. Two reviewers (MR and FH independently assessed potentially eligible trials for inclusion. The methodology assessment was based on the tool developed by the Cochrane Collaboration for assessment of bias for randomized controlled trials. The Cochrane Library, Pubmed, Medline and Lilacs were searched for all articles published, without restriction of language or time. Results: Two studies were included in this review. Nerve blockade seemed to be more effective than intravenous fentanyl for preventing pain in patients suffering from a femoral fracture

  16. Computed tomography fluoroscopy-guided placement of iliosacral screws in patients with unstable posterior pelvic fractures

    Iguchi, Toshihiro; Ogawa, Ken-Ichi; Doi, Takeshi; Munetomo, Kazuo; Miyasho, Koji; Hiraki, Takao; Kanazawa, Susumu; Ozaki, Toshifumi

    2010-01-01

    The purpose of this study was to evaluate retrospectively the safety and effectiveness of the computed tomography (CT) fluoroscopy-guided placement of iliosacral screws in patients with unstable posterior pelvic fractures. Six patients (four women and two men; mean age 55.8 years; range 35-77 years) with unstable posterior pelvic fractures underwent iliosacral screw placement under CT fluoroscopy guidance between November 2007 and August 2008. Unstable pelvic ring injury (AO types B and C) was the indication for this procedure. In all the six patients except one, CT fluoroscopy-guided placement had been technically successful. In one patient, a second screw had been inserted, with a tilt to the caudal site, and slightly advanced into the extrasacral body; afterward, it could be exchanged safely for a shorter screw. Five patients and one patient underwent placement of two screws and one screw, respectively. The mean duration of the procedure was 15.0 min (range 9-30 min) per screw; the duration was 12.3 min and 18.2 min for the first and second screws, respectively. No complications requiring treatment occurred during or after the procedure. The mean clinical and radiologic follow-up period was 14 months (range 6-21 months). All pelvic injuries had healed satisfactorily, without complication, and all patients are now doing well clinically and can walk. CT fluoroscopy-guided placement of iliosacral screws is a safe and effective treatment in patients with unstable posterior pelvic fractures. (orig.)

  17. Assessment and management of rib fracture pain in geriatric population: an ode to old age.

    Wardhan, Richa

    2013-10-01

    Pain management for traumatic rib fractures has been described in literature, but there is paucity of data when it comes to acute pain management in the elderly, let alone pain resulting from traumatic rib fractures. This article focuses on challenges of assessment of pain in elderly patients and the various options available for pain management including utilization of nerve blocks. Nerve blocks are instrumental in treating rib fracture pain along with utilization of opioids and nonopioids thus formulating a multimodal approach to pain management. The goal is to devise a proper pain management regimen for geriatric patients with rib fractures to decrease the morbidity and mortality associated with it. Developing institutional protocols is one step forward towards quality care for such patients.

  18. Sarcopenia in patients with hip fracture: A multicenter cross-sectional study.

    Steihaug, Ole Martin; Gjesdal, Clara Gram; Bogen, Bård; Kristoffersen, Målfrid Holen; Lien, Gunhild; Ranhoff, Anette Hylen

    2017-01-01

    Sarcopenia is prevalent in older persons and is a risk factor for falls, fractures, and mortality. The aim of this study was to determine a) the feasibility of determining sarcopenia in patients with acute hip fracture, b) the prevalence of sarcopenia and c) associations of sarcopenia with nutritional status and comorbidities. A multicenter cross-sectional study on sarcopenia in male and female patients with acute hip fracture. Participants were previously ambulatory and living in the community. Sarcopenia was assessed postoperatively with muscle mass estimated by anthropometry using triceps skinfold, arm circumference, height, weight and sex. Grip strength was measured by Jamar dynamometer and pre-fracture mobility was by self-report using the New Mobility Score. Out of 282 patients, 202 were assessed for sarcopenia of whom 74 (37%) were diagnosed as sarcopenic. Sarcopenia was associated with age, odds ratio (OR) 1.4 per 5 years, 95% confidence interval (CI) [1.1, 1.8], ASA Physical Status Classification System score, OR 2.3 per point, 95% CI [1.3, 4.3] and number of medications at discharge, OR 1.2 per medication, 95% CI [1.0, 1.3] and inversely associated with BMI, OR 0.8, 95% CI [0.7, 0.9] and serum albumin, OR 0.9, 95% CI [0.8,1.0]. Thirty-seven percent of assessed subjects were diagnosed with sarcopenia. Our data demonstrates that the prevalence of sarcopenia is associated with older age, malnutrition and comorbidities. Determining sarcopenia at the bedside was feasible in postoperative hip fracture patients by using grip strength, estimation of muscle mass by anthropometry and self-reported mobility.

  19. Sarcopenia in patients with hip fracture: A multicenter cross-sectional study.

    Ole Martin Steihaug

    Full Text Available Sarcopenia is prevalent in older persons and is a risk factor for falls, fractures, and mortality. The aim of this study was to determine a the feasibility of determining sarcopenia in patients with acute hip fracture, b the prevalence of sarcopenia and c associations of sarcopenia with nutritional status and comorbidities.A multicenter cross-sectional study on sarcopenia in male and female patients with acute hip fracture. Participants were previously ambulatory and living in the community. Sarcopenia was assessed postoperatively with muscle mass estimated by anthropometry using triceps skinfold, arm circumference, height, weight and sex. Grip strength was measured by Jamar dynamometer and pre-fracture mobility was by self-report using the New Mobility Score.Out of 282 patients, 202 were assessed for sarcopenia of whom 74 (37% were diagnosed as sarcopenic. Sarcopenia was associated with age, odds ratio (OR 1.4 per 5 years, 95% confidence interval (CI [1.1, 1.8], ASA Physical Status Classification System score, OR 2.3 per point, 95% CI [1.3, 4.3] and number of medications at discharge, OR 1.2 per medication, 95% CI [1.0, 1.3] and inversely associated with BMI, OR 0.8, 95% CI [0.7, 0.9] and serum albumin, OR 0.9, 95% CI [0.8,1.0].Thirty-seven percent of assessed subjects were diagnosed with sarcopenia. Our data demonstrates that the prevalence of sarcopenia is associated with older age, malnutrition and comorbidities. Determining sarcopenia at the bedside was feasible in postoperative hip fracture patients by using grip strength, estimation of muscle mass by anthropometry and self-reported mobility.

  20. Sarcopenia in patients with hip fracture: A multicenter cross-sectional study

    Gjesdal, Clara Gram; Bogen, Bård; Kristoffersen, Målfrid Holen; Lien, Gunhild; Ranhoff, Anette Hylen

    2017-01-01

    Background Sarcopenia is prevalent in older persons and is a risk factor for falls, fractures, and mortality. The aim of this study was to determine a) the feasibility of determining sarcopenia in patients with acute hip fracture, b) the prevalence of sarcopenia and c) associations of sarcopenia with nutritional status and comorbidities. Methods A multicenter cross-sectional study on sarcopenia in male and female patients with acute hip fracture. Participants were previously ambulatory and living in the community. Sarcopenia was assessed postoperatively with muscle mass estimated by anthropometry using triceps skinfold, arm circumference, height, weight and sex. Grip strength was measured by Jamar dynamometer and pre-fracture mobility was by self-report using the New Mobility Score. Results Out of 282 patients, 202 were assessed for sarcopenia of whom 74 (37%) were diagnosed as sarcopenic. Sarcopenia was associated with age, odds ratio (OR) 1.4 per 5 years, 95% confidence interval (CI) [1.1, 1.8], ASA Physical Status Classification System score, OR 2.3 per point, 95% CI [1.3, 4.3] and number of medications at discharge, OR 1.2 per medication, 95% CI [1.0, 1.3] and inversely associated with BMI, OR 0.8, 95% CI [0.7, 0.9] and serum albumin, OR 0.9, 95% CI [0.8,1.0]. Conclusions Thirty-seven percent of assessed subjects were diagnosed with sarcopenia. Our data demonstrates that the prevalence of sarcopenia is associated with older age, malnutrition and comorbidities. Determining sarcopenia at the bedside was feasible in postoperative hip fracture patients by using grip strength, estimation of muscle mass by anthropometry and self-reported mobility. PMID:28902873

  1. Osteoporosis, identification and treatment in fracture patients : An essential part of fracture management in elderly patients

    de Klerk, Gijsbert

    2017-01-01

    Osteoporosis is a major health problem increasing the risk of sustaining a fragility fracture. The golden standard for diagnosing osteoporosis is the measurement of bone mineral density (BMD) with Dual Energy X-ray (DXA). The Dutch consensus on diagnosing osteoporosis is the screening of all

  2. Predictive factors of hospital stay, mortality and functional recovery after surgery for hip fracture in elderly patients.

    Pareja Sierra, T; Bartolomé Martín, I; Rodríguez Solís, J; Bárcena Goitiandia, L; Torralba González de Suso, M; Morales Sanz, M D; Hornillos Calvo, M

    Due to its high prevalence and serious consequences it is very important to be well aware of factors that might be related to medical complications, mortality, hospital stay and functional recovery in elderly patients with hip fracture. A prospective study of a group of 130 patients aged over 75 years admitted for osteoporotic hip fracture. Their medical records, physical and cognitive status prior to the fall, fracture type and surgical treatment, medical complications and functional and social evolution after hospitalization were evaluated. Patients with greater physical disability, more severe cognitive impairment and those who lived in a nursing home before the fracture had worse functional recovery after surgery. Treatment with intravenous iron to reduce transfusions reduced hospital stay and improved walking ability. Infections and heart failure were the most frequent medical complications and were related to a longer hospital stay. The prescription of nutritional supplements for the patients with real indication improved their physical recovery after the hip fracture CONCLUSIONS: Evaluation of physical, cognitive and social status prior to hip fracture should be the basis of an individual treatment plan because of its great prognostic value. Multidisciplinary teams with continuous monitoring of medical problems should prevent and treat complications as soon as possible. Intravenous iron and specific nutritional supplements can improve functional recovery six months after hip fracture. Copyright © 2017 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.

  3. Evaluation of Severity Score in Patients with Lower Limb and Pelvic Fractures Injured in Motor Vehicle Front-Impact Collisions.

    Gokalp, Mehmet Ata; Hekimoglu, Yavuz; Gozen, Abdurrahim; Guner, Savas; Asirdizer, Mahmut

    2016-12-01

    BACKGROUND Lower limb and pelvic injuries and fractures occur at a very high incidence in motor vehicle accidents. In this study, the characteristics (e.g., body side, bone location, and fracture severity) of lower limb and pelvic fractures that occurred during front-impact collisions were correlated with the injured patients' sex, age, and position in the vehicle. MATERIAL AND METHODS We retrospectively evaluated 191 patients (136 males, 55 females) who were injured in motor vehicle accidents, specifically in frontal collisions. RESULTS This study revealed that most of lower limb and pelvic fractures occurred in males (71.2%; p=.000), 19-36 years old (55.5%; p=.000), small vehicles (86.4%; p=.000), and rear seat passengers (49.2%; p=.000). Fractures most commonly occurred in the left side of the body (46.6%; p=.000) and upper legs (37.7%; p=.000). Severity scores were higher (2.76) in males than females (2.07). No statistically significant was found in severity scores of patients and other personal characteristics and fracture features of patients with lower limb and pelvic fractures who were injured in a vehicle during front-impact collisions (p>0.05). CONCLUSIONS The results of this study will be useful for the automobile industry, forensics and criminal scientists, and for trauma research studies.

  4. Change of Charpy impact fracture behavior of precracked ferritic specimens due to thermal aging in sodium

    Hu, W.L.

    1985-12-01

    A series of tests were conducted to evaluate the effect of sodium on the impact fracture behavior of precracked Charpy specimens made of HT-9 weldment. One set of samples was precracked prior to sodium aging and the other set was precracked after aging in sodium. Both set of specimens exhibited the same DBTT. Samples precracked prior to sodium exposure, however, showed a 40% reduction in the upper shelf energy (USE) as compared to the set precracked after aging. The results suggest that the fracture toughness of the material may be reduced if an existing crack was soaked in sodium at elevated temperature for a period of time

  5. Incidence of traumatic long-bone fractures requiring in-hospital management: a prospective age- and gender-specific analysis of 4890 fractures.

    Meling, Terje; Harboe, Knut; Søreide, Kjetil

    2009-11-01

    Musculoskeletal trauma represents a considerable global health burden; however, reliable population-based incidence data are lacking. Thus, we prospectively investigated the age- and sex-specific incidence patterns of long-bone fractures in a defined population. A 4-year prospective study of all long-bone fractures in a defined Norwegian population was carried out. The demographic data, as well as data on fracture type and location and mode of treatment were collected using recognised classification (e.g., AO/OTA - Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association; Gustilo-Anderson (GA) for open fractures). Age- and sex-adjusted incidences were calculated using population statistics. During the study period, 4890 long-bone fractures were recorded. The overall incidence per 100,000 per year was 406 with a 95% confidence interval (95%CI) of 395-417. The age-adjusted incidence for those lower than that for those >or=16 years (427; 95%CI: 414-440). The overall male incidence (337; 95%CI: 322-355) was lower than the female (476; 95%CI: 459-493), but the male:female ratio was 2:1 among those or=50 years. The upper limb fractures had an overall incidence of 159 (95%CI: 152-166), whereas the lower limb fracture incidence was 247 (95%CI: 238-256). Open fractures occurred in 3%, with an incidence of 13 (95%CI: 11-15). Paediatric fractures were more likely to be treated conservatively with only 8% requiring internal fixation, compared to 56% internal fixation in those >or=16 years of age. An increase in the use of angular stable plates occurred during the study period. This prospectively collected study of long-bone fractures in a defined population recognises age- and gender-specific fracture patterns. Boys predominate in the younger age group for which treatment is basically conservative. In the senior population, women and operative treatment predominate.

  6. Fractures and alcohol abuse - patient opinion of alcohol intervention

    Pedersen, Bolette; Alva-Jørgensen, Peter; Raffing, Rie

    2011-01-01

    PURPOSE: To clarify patient opinions about alcohol intervention in relation to surgery before investigating the effect in a Scandinavian multi-centre randomized trial. MATERIAL AND METHODS: A qualitative study. Thirteen consecutive alcohol patients with fractures participated after informed consent....... They were interviewed during their hospital stay. The number of participants was based on the criteria of data-saturation. The analysis followed the applied qualitative framework model aimed at evaluation of specific participant needs within a larger overall project. RESULTS: All patients regarded alcohol...

  7. Early coordinated rehabilitation in acute phase after hip fracture - a model for increased patient participation.

    Asplin, Gillian; Carlsson, Gunnel; Zidén, Lena; Kjellby-Wendt, Gunilla

    2017-10-17

    Studies have shown that patients with hip fracture treated in a Comprehensive Geriatric Care (CGC) unit report better results in comparison to orthopaedic care. Furthermore, involving patients in their healthcare by encouraging patient participation can result in better quality of care and improved outcomes. To our knowledge no study has been performed comparing rehabilitation programmes within a CGC unit during the acute phase after hip fracture with focus on improving patients' perceived participation and subsequent effect on patients' function. A prospective, controlled, intervention performed in a CGC unit and compared with standard care. A total of 126 patients with hip fracture were recruited who were prior to fracture; community dwelling, mobile indoors and independent in personal care. Intervention Group (IG): 63 patients, mean age 82.0 years and Control Group (CG): 63 patients mean age 80.5 years. coordinated rehabilitation programme with early onset of patient participation and intensified occupational therapy and physiotherapy after hip fracture surgery. The primary outcome measure was self-reported patient participation at discharge. Secondary outcome measures were: TLS-BasicADL; Bergs Balance Scale (BBS); Falls Efficacy Scale FES(S); Short Physical Performance Battery (SPPB) and Timed Up and Go (TUG) at discharge and 1 month and ADL staircase for instrumental ADL at 1 month. At discharge a statistically significant greater number of patients in the IG reported higher levels of participation (p < 0.05) and independence in lower body hygiene (p < 0.05) and dressing (p < 0.001). There were however no statistically significant differences at discharge and 1 month between groups in functional balance and confidence, performance measures or risk for falls. This model of OT and PT coordinated inpatient rehabilitation had a positive effect on patients' perceived participation in their rehabilitation and ADL at discharge but did not appear to

  8. Associations of vitamin D deficiency with postoperative gait and mortality among patients with fractures of the proximal femur

    David Nicoletti Gumieiro

    2015-04-01

    Full Text Available OBJECTIVE: To assess whether serum vitamin D concentration is associated with gait status and mortality among patients with fractures of the proximal femur, six months after suffering the fracture.METHODS: Consecutive patients aged ≥65 years with fractures of the proximal femur, who were admitted to the orthopedics and traumatology ward of our service between January and December 2011, were prospectively evaluated. Clinical, radiological, epidemiological and laboratory analyses were performed, including vitamin D. The patients underwent surgery and were followed up as outpatients, with return visits 15, 30, 60 and 180 days after discharge, at which the outcomes of gait and mortality were evaluated.RESULTS: Eighty-eight patients were evaluated. Two of them were excluded because they presented oncological fractures. Thus, 86 patients of mean age 80.2 ± 7.3 years were studied. In relation to serum vitamin D, the mean was 27.8 ± 14.5 ng/mL, and 33.7% of the patients presented deficiency of this vitamin. In relation to gait, univariate and multivariate logistic regression showed that vitamin D deficiency was not associated with gait recovery, even after adjustment for gender, age and type of fracture (OR: 1.463; 95% CI: 0.524-4.088; p = 0.469. Regarding mortality, Cox regression analysis showed that vitamin D deficiency was not related to its occurrence within six months, even in multivariate analysis (HR: 0.627; 95% CI: 0.180-2.191; p = 0.465.CONCLUSION: Serum vitamin D concentration was not related to gait status and/or mortality among patients with fractures of the proximal femur, six months after suffering the fracture.

  9. Perineal hygiene in patients with pelvic fractures.

    Hossain, Mohammad A; Pearce, Rachel; Bircher, Martin D

    2008-08-01

    At the tertiary referral Orthopaedic Unit of St. Georges Hospital, it was noted that there was an unacceptably high number of soiled perinea in patients transferred from Base Hospitals. This not only exposed the patients to increased infection [Jepsen O. The effectiveness of preoperative skin preparations: an integrated review of the literature. AORN J 1993;58:477-82; and Nix D, Ermer-Seltun J. A review of perineal skin care protocols and skin barrier product use. Ostomy Wound Manage 2004;50:59-67] but was also undignified and unacceptable for them. We decided to audit the problem with a view to finding out why this was happening and to improve the situation. A 2-year study was carried out over three distinct phases (phase 1: February-June 2004, phase 2: July-November 2004, phase 3: February-November 2005). Observations of soiling were recorded in a questionnaire by the surgeon prior to surgery. Key system and clinical guidelines were implemented during the second phase, and the audit process was repeated. The percentage of clean perinea in phase 1 was 32%, phase 2 68% and phase 3 99.5% indicating a clear improvement in the overall system.

  10. Can paramedics use FRAX (the WHO Fracture Risk Assessment Tool) to help GPs improve future fracture risk in patients who fall? Protocol for a randomised controlled feasibility study.

    Clarke, Shane; Bradley, Rachel; Simmonds, Bethany; Salisbury, Chris; Benger, Jonathan; Marques, Elsa; Greenwood, Rosemary; Shepstone, Lee; Robinson, Maria; Appleby-Fleming, John; Gooberman-Hill, Rachael

    2014-09-03

    Currently identification, and therefore, management of patients at risk of osteoporotic fracture in the UK is suboptimal. As the majority of patients who fracture have fallen, it follows that people who fall can usefully be targeted in any programme that aims to reduce osteoporotic fracture. Targeting vulnerable patients who are likely to benefit from intervention may help shift the management of fracture prevention into primary care, away from emergency departments. Paramedics who attend to patients who have fallen may be well placed to assess future fracture risk, using the Fracture Risk Assessment Tool (FRAX) and communicate that information directly to general practitioners (GPs). This feasibility study takes the form of a pragmatic, randomised controlled trial aimed at exploring and refining issues of study design, recruitment, retention, sample size and acceptability preceding a large-scale study with fracture as the end point. Patients (aged >50) who fall, call an ambulance, are attended by a study paramedic and give verbal consent will be asked FRAX and fall questions. Patients who subsequently formally consent to participation will be randomised to control (usual care) or intervention groups. Intervention will constitute transmission of calculated future fracture risk to the patients' GP with suitable, evidence-based recommendations for investigation or treatment. 3 months after the index fall, data (proportion of patients in each group undergoing investigation or starting new treatment, quality of life and health economic) will be collected and analysed using descriptive statistics. A nested qualitative study will explore issues of acceptability and study design with patients, paramedics and GPs. This protocol was approved by NRES Committee South Central Oxford C in October 2012. Research Ethics Committee ref.12/SC/0604. The study findings will be disseminated through peer-reviewed journals, conference presentations and local public events. A publication

  11. The Effect of Creep Aging on the Fatigue Fracture Behavior of 2524 Aluminum Alloy

    Wenke Li; Lihua Zhan; Lingfeng Liu; Yongqian Xu

    2016-01-01

    Normal temperature tensile and fatigue tests were adopted to test the mechanical performance and fatigue life of 2524 aluminum alloy under the three states of T3, artificial aging, and creep aging, and scanning electron microscope and transmission electron microscope were also used to observe the fatigue fracture morphology and aging precipitation features of the alloy under the above three states. Results showed that the alloy treated by creep aging can obtain higher fatigue life, but that t...

  12. High risk of early periprosthetic fractures after primary hip arthroplasty in elderly patients using a cemented, tapered, polished stem

    Brodén, Cyrus; Mukka, Sebastian; Muren, Olle; Eisler, Thomas; Boden, Henrik; Stark, André; Sköldenberg, Olof

    2015-01-01

    Background and purpose Postoperative periprosthetic femoral fracture (PPF) after hip arthroplasty is associated with considerable morbidity and mortality. We assessed the incidence and characteristics of periprosthetic fractures in a consecutive cohort of elderly patients treated with a cemented, collarless, polished and tapered femoral stem (CPT). Patients and methods In this single-center prospective cohort study, we included 1,403 hips in 1,357 patients (mean age 82 (range 52–102) years, 72% women) with primary osteoarthritis (OA) or a femoral neck fracture (FNF) as indication for surgery (367 hips and 1,036 hips, respectively). 64% of patients were ASA class 3 or 4. Hip-related complications and need for repeat surgery were assessed at a mean follow-up time of 4 (1–7) years. A Cox regression analysis was used to evaluate risk factors associated with PPF. Results 47 hips (3.3%) sustained a periprosthetic fracture at median 7 (2–79) months postoperatively; 41 were comminute Vancouver B2 or complex C-type fractures. The fracture rate was 3.8% for FNF patients and 2.2% for OA patients (hazard ratio (HR) = 4; 95% CI: 1.3–12). Patients > 80 years of age also had a higher risk of fracture (HR = 2; 95% CI: 1.1–4.5). Interpretation We found a high incidence of early PPF associated with the CPT stem in this old and frail patient group. A possible explanation may be that the polished tapered stem acts as a wedge, splitting the femur after a direct hip contusion. Our results should be confirmed in larger, registry-based studies, but we advise caution when using this stem for this particular patient group. PMID:25280133

  13. Influence of Aging Conditions on Fatigue Fracture Behaviour of 6063 Aluminum Alloy

    Rafiq Ahmed Siddiqui

    2001-12-01

    Full Text Available Aluminum - Magnesium - Silicon (Al-Mg-Si 6063 alloy was heat-treated using under aged, peak aged and overage temperatures. The numbers of cycles required to cause the fatigue fracture, at constant stress, was considered as criteria for the fatigue resistance. Moreover, the fractured surface of the alloy at different aging conditions was evaluated by optical microscopy and the Scanning Electron Microscopy (SEM. The SEM micrographs confirmed the cleavage surfaces with well-defined fatigue striations. It has been observed that the various aging time and temperature of the 6063 Al-alloy, produces different modes of fractures. The most suitable age hardening time and temperature was found to be between 4 to 5 hours and to occur at 460 K. The increase in fatigue fracture property of the alloy due to aging could be attributed to a vacancy assisted diffusion mechanism or due to pinning of dislocations movement by the precipitates produced during aging. However, the decrease in the fatigue resistance, for the over aged alloys, might be due to the coalescence of precipitates into larger grains.

  14. Bone Parameters and Risk of Hip and Femur Fractures in Patients on Hemodialysis

    Hazzan, Azzour D.; Jhaveri, Kenar D.; Ma, Lin; Lacson, Eduardo

    2016-01-01

    Background and objectives Patients on hemodialysis have a high rate of hip fractures. In this study, we performed a contemporary analysis of mineral and bone parameters and their relationship to hip and femur fracture risk. Design, setting, participants, & measurements Patients on hemodialysis treated between 2000 and 2013 in Fresenius Medical Care North America facilities were included. Predictors were on the basis of data as of December 31 of each baseline year and time-averaged values of selected laboratory parameters and medication doses throughout the year. Four period cohorts were constructed from baseline years: 2000, 2003, 2006, and 2009. Follow-up for each cohort was ≤3 years. Results The incidence of hip and femur fractures remained generally unchanged (P=0.40), except among patients who were white and >65 years of age, in whom the rate decreased significantly over the 14-year period (P<0.01). Results from combined multivariable models indicated that the lowest quartiles of time–averaged intact parathyroid hormone were independently associated with higher hip fracture risk (intact parathyroid hormone =181–272 pg/ml: hazard ratio, 1.20; 95% confidence interval [95% CI], 1.03 to 1.41 and intact parathyroid hormone <181 pg/ml: hazard ratio, 1.20; 95% CI, 1.01 to 1.44; referent third quartile, 273 to <433 pg/ml). The lowest quartile of time–averaged serum calcium was also associated with higher risk (calcium <8.7 mg/dl; hazard ratio, 1.17; 95% CI, 1.00 to 1.37) compared with the referent third quartile of 9.1 to <9.5 mg/dl. Conclusions We found an association between lower levels of intact parathyroid hormone and serum calcium and greater risk for hip and femur fractures among patients on hemodialysis. These findings support additional research toward elucidating long-term safety of treatment approaches for hyperparathyroidism in patients with ESRD. PMID:27026521

  15. Management of Femoral Shaft Fractures with Elastic Titanium Nails in Pediatric Patients

    Yunus Güzel

    2016-06-01

    Full Text Available Objective: The aim of this study was to evaluate the func­tional and radiological results of the application of intra­medullary fixation with elastic titanium nails in unstable femoral fractures and to determine the factors affecting these results. Methods: A total of 32 patients aged 4-17 years treated with intramedullary elastic nails for a femoral diaphysis fracture between 2001 and 2014 were included. The frac­ture was left side in 12 cases, right side in 18 and bilateral in 2. The fracture pattern was determined as fragmented in 11 cases, short oblique in 11, transverse in 8 and spi­ral in 4. The same surgical technique and postoperative care was applied to all the patients. Sagittal and coronal angle measurements were made from postoperative and follow-up anterior-posterior and lateral radiographs. The mean follow-up period was 54 months (12-156 months. Positive union criteria were accepted as pain-free weight-bearing and callus bridging in at least 3 cortices seen on direct radiographs. Results: Union was achieved in all except one patient. They were able to return to previous activities with full knee and hip joint range of movement. Radiologically, the mean time to union was determined as 9 weeks (range, 6-16 weeks. Limb shortness was determined in 5 (14% patients. No significant association was detected be­tween shortness and fracture pattern. No varus or valgus angulation of >10˚ was determined in any patient. Conclusion: Application of titanium elastic nails in pe­diatric femoral diaphysis fractures is a comfortable, eco­nomic, and reliable method which is allows early weight-bearing.

  16. Occurrence of secondary fracture around intramedullary nails used for trochanteric hip fractures: a systematic review of 13,568 patients.

    Norris, Rory; Bhattacharjee, Dhritiman; Parker, Martyn J

    2012-06-01

    A sliding hip screw (SHS) is currently the treatment of choice for trochanteric hip fractures, largely due to the low incidence of complications. An alternative treatment is the use of intramedullary proximal femoral nails. Unfortunately these implants have been associated with a risk of later fracture around the implant. The aim of this study was to see if any improvements have been made to the current intramedullary nails, to reduce the incidence of secondary fracture around the distal tip of the nail. We analysed data related to 13,568 patients from 89 studies, focusing on the incidence of post operative secondary femoral shaft fracture following the use of intramedullary nails in the fixation of trochanteric hip fractures. The overall reported incidence of secondary fracture around the nail was 1.7%. The incidence of fracture has reduced in the 3rd generation Gamma nails when compared to the older Gamma nail (1.7% versus 2.6%, p value 0.03). However, the incidence of secondary fracture in the 3rd generation Gamma nails is still significantly higher than the other brands of short nail (1.7% versus 0.7%, p value 0.0005). Long nails had a slight tendency towards a lower risk of fracture although the difference was not statistically significant (1.1% versus 1.7%, p value 0.28). There was a significantly lower risk of fracture for those nails with a biaxial fixation as opposed to uniaxial fixation (0.6% versus 1.9%, p value fracture around a proximal femoral nail is one of the most significant of fracture healing complications, and this study suggests that continuing design changes to this method of fixation has reduced the risk of this complication occurring. Copyright © 2011 Elsevier Ltd. All rights reserved.

  17. Improved 1-year mortality in elderly patients with a hip fracture following integrated orthogeriatric treatment.

    Folbert, E C; Hegeman, J H; Vermeer, M; Regtuijt, E M; van der Velde, D; Ten Duis, H J; Slaets, J P

    2017-01-01

    To improve the quality of care and reduce the healthcare costs of elderly patients with a hip fracture, surgeons and geriatricians collaborated intensively due to the special needs of these patients. After treatment at the Centre for Geriatric Traumatology (CvGT), we found a significant decrease in the 1-year mortality rate in frail elderly patients compared to the historical control patients who were treated with standard care. The study aimed to evaluate the effect of an orthogeriatric treatment model on elderly patients with a hip fracture on the 1-year mortality rate and identify associated risk factors. This study included patients, aged 70 years and older, who were admitted with a hip fracture and treated in accordance with the integrated orthogeriatric treatment model of the CvGT at the Hospital Group Twente (ZGT) between April 2008 and October 2013. Data registration was carried out by several disciplines using the clinical pathways of the CvGT database. A multivariate logistic regression analysis was used to identify independent risk factors for 1-year mortality. The outcome measures for the 850 patients were compared with those of 535 historical control patients who were managed under standard care between October 2002 and March 2008. The analysis demonstrated that the 1-year mortality rate was 23.2 % (n = 197) in the CvGT group compared to 35.1 % (n = 188) in the historical control group (p malnutrition (OR 2.01), physical limitations in activities of daily living (OR 2.35), and decreasing Barthel Index (BI) (OR 0.96). After integrated orthogeriatric treatment, a significant decrease was seen in the 1-year mortality rate in the frail elderly patients with a hip fracture compared to the historical control patients who were treated with standard care. The most important risk factors for 1-year mortality were male gender, increasing age, malnutrition, physical limitations, increasing BI, and medical conditions. Awareness of risk factors that

  18. Validation of the IOF quality of life questionnaire for patients with wrist fracture

    Lips, P.T.A.M.; Jameson, K.; Bianchi, M.L.; Goemaere, S.; Boonen, S.; Reeve, J.; Stepan, J.; Johnell, O.; van Schoor, N.M.; Dennison, E.; Kanis, J.A.; Cooper, C.

    2010-01-01

    Introduction: Wrist fracture causes pain and decreased physical, social and emotional function. The International Osteoporosis Foundation has developed a specific questionnaire to assess quality of life in patients with wrist fracture. This questionnaire, including 12 questions, was validated in a

  19. Percutaneous Cement-Augmented Screws Fixation in the Fractures of the Aging Spine: Is It the Solution?

    Sébastien Pesenti

    2014-01-01

    Full Text Available Introduction. Management of elderly patients with thoracolumbar fractures is still challenging due to frequent osteoporosis and risk of screws pull-out. The aim of this study was to evaluate results of a percutaneous-only procedure to treat these fragile patients using cement-augmented screws. Methods. 12 patients diagnosed with a thoracolumbar fracture associated with an important loss of bone stock were included in this prospective study. Surgical procedure included systematically a percutaneous osteosynthesis using cemented fenestrated screws. When necessary, additional anterior support was performed using a kyphoplasty procedure. Clinical and radiographic evaluations were performed using CT scan. Results. On the whole series, 15 fractures were diagnosed and 96 cemented screws were inserted. The difference between the pre- and postoperative vertebral kyphosis was statistically significant (12.9° versus 4.4°, P=0.0006. No extrapedicular screw was reported and one patient was diagnosed with a cement-related pulmonary embolism. During follow-up period, no infectious complications, implant failures, or pull-out screws were noticed. Discussion. Aging spine is becoming an increasing public health issue. Management of these patients requires specific attention due to the augmented risk of complications. Using percutaneous-only screws fixation with cemented screw provides satisfactory results. A rigorous technique is mandatory in order to achieve best outcomes.

  20. Role of MRI in hip fractures, including stress fractures, occult fractures, avulsion fractures

    Nachtrab, O.; Cassar-Pullicino, V.N.; Lalam, R.; Tins, B.; Tyrrell, P.N.M.; Singh, J.

    2012-01-01

    MR imaging plays a vital role in the diagnosis and management of hip fractures in all age groups, in a large spectrum of patient groups spanning the elderly and sporting population. It allows a confident exclusion of fracture, differentiation of bony from soft tissue injury and an early confident detection of fractures. There is a spectrum of MR findings which in part is dictated by the type and cause of the fracture which the radiologist needs to be familiar with. Judicious but prompt utilisation of MR in patients with suspected hip fractures has a positive therapeutic impact with healthcare cost benefits as well as social care benefits.

  1. Do schizophrenia patients age early?

    Shivakumar, Venkataram; Kalmady, Sunil V; Venkatasubramanian, Ganesan; Ravi, Vasanthapuram; Gangadhar, Bangalore N

    2014-08-01

    The etiopathogenesis of schizophrenia is poorly understood. Within the proposed "neurodegeneration paradigm", observations have been put forth for "accelerated aging" in this disorder. This proposition is largely based on the neuroscience research that demonstrates progressive changes in brain as well as other systemic abnormalities supportive of faster aging process in patients with this disorder. In this review, we have summarized the literature related to the concept of early aging in schizophrenia. These studies include P300 abnormalities & visual motion discrimination, neuroimaging findings, telomere dynamics as well as neuropathology of related brain regions. We also propose a role of vitamin D, neuroimmunological changes and elevated oxidative stress as well as mitochondrial dysfunction in addition to the above factors with 'vitamin-D deficiency' as the central paradox. Put together, the evidence supporting early aging in schizophrenia is compelling and this requires further systematic studies. Copyright © 2014 Elsevier B.V. All rights reserved.

  2. Mexican patients with HIV have a high prevalence of vertebral fractures

    José Antonio Mata-Marín

    2018-04-01

    Full Text Available Low bone mineral density (BMD and fragility fractures are common in individuals infected with HIV, who are undergoing antiretroviral therapy (ART. In high-income countries, dual energy X-ray absorptiometrry is typically used to evaluate osteopenia or osteoporosis in HIV infected individuals. However, this technology is unavailable in low and-middle income countries, so a different approach is needed. The aim of this study was to use X-ray scans of the spine to determine the prevalence of and associated risk factors for vertebral fractures in HIV-infected patients in a tertiary-care hospital in Mexico. We conducted a cross-sectional study of outpatients who were >40 years old and receiving ART at the Hospital de Infectología, La Raza National Medical Center in Mexico City, Mexico. We used semi-quantitative morphometric analysis of centrally digitized X-ray images to assess vertebral deformities in the spine. Anterior, middle and posterior vertebral heights were measured, and height ratios were calculated. For each vertebral body, fractures were graded on the basis of height ratio reductions, and a spine deformity index’ (SDI value was calculated by summing the grades of the vertebral deformities: An SDI>1 was indicative of a vertebral fracture. We included 104 patients, 87% of whom were men. The median age was 49 years [interquartile range (IQR 42-52]. Themost common stage of HIV infection, as defined by the Centers for Disease Control,was B2 in 40 (39% of patients. Forty seven (45% patients were on ART regimens that included protease inhibitors (PIs and 100 (96% being treated with tenofovir. The median time of ART was 6.5 years (IQR1.6-9.0. Of the 104 patients in our study, 83 (80% had undetectable viral load, as assessed by HIV-1 RNA levels, 32 (31% showed evidence of a previous fracture, 4 (4% were co-infected with hepatitis C virus, and 57 (55% had a history of corticosteroid treatment. The prevalence of vertebral fractures was 25%, 95

  3. Impact of admissions for bone fractures on the dependency ratio of adults over 65 years of age in Southern Spain.

    Calero-García, Maria José; Ortega, Ana Raquel; Navarro, Elena; Jimenez, Carmen; Calero, María Dolores

    2012-01-01

    Hospital admission for acute illness, as in the case of bone fractures, means for some elderly people a loss of autonomy, not always associated with the illness causing hospitalization. The factors and/or modulators contributing to this situation have not been sufficiently studied. The aim of this study was to describe the characteristics of hospitalized elderly patients diagnosed with bone fractures, after surgery is carried out, and to establish the associated variables to their cognitive and functional dependency at discharge. The outcomes show that functional deterioration significantly correlates (positively) to anxiety self-control at discharge and knowledge about the therapy at discharge and inversely (negatively), to the patient's age, polypharmacy, and length of inpatient stay until surgery. From our outcomes we conclude the need to design and apply actions leading toward a reduction of the pre-surgery inpatient stay, immediate mobilization programs as well as training and information about therapeutic procedures. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  4. Histomorphometrical analysis on the effects of two therapeutic ultrasound intensities on fracture healing in aged rats

    Jeronimo Rafael Skau

    Full Text Available Introduction Experimental studies conducted in young animals show that therapeutic ultrasound (TUS has been successfully used to shorten the healing time of bone fractures. However, they were not found in the literature, studies comparing the effect of different intensities of UST in aged animals. Objective To test the efficacy of intensity 1.0 W/cm2 and of 0.5 W/cm2 in the consolidation of experimental fracture of the tibia from aged Wistar rats. Materials and methods Three groups of 15 month old rats were submitted to a midshaft osteotomy of the tibia and then, the hind member was immobilized with a metal splint and plaster of Paris, wrapping the knee and ankle joint. One group (L, received ultrasound at 0.5 W/cm2; the other group (I, were exposed to ultrasound at 1.0 W/cm2. One control group (C, did not receive the ultrasound. Fifteen animals (five from each group were euthanatized at the end of the first week and fifteen (five from each group at the end of the third week. The progress of the fracture healing was performed for each group by morphometric analysis of histological sections of the fracture region. Results and conclusion The results showed that fractures treated with ultrasound at 1.0 W/cm2 healed significantly faster than did the fractures treated with ultrasound at 0.5 W/cm2 and the control.

  5. Municipal resources and patient outcomes through the first year after a hip fracture.

    Ruths, Sabine; Baste, Valborg; Bakken, Marit Stordal; Engesæter, Lars Birger; Lie, Stein Atle; Haugland, Siren

    2017-02-16

    Hip fractures represent major critical events for older people, and put huge demands on economic and personnel resources. Most hip fracture patients are in need of postoperative rehabilitation services. Through the Coordination Reform, the municipalities in Norway were given increased responsibility for community-based treatment and rehabilitation after surgery. The purpose of this study was to examine associations between municipal resources and patient outcomes through the first year after a hip fracture, focusing on survival and health-related quality of life. We conducted a nationwide cohort study on people experiencing a hip fracture in 2011-2012 in Norway, with a 1-year follow-up. We obtained data on date of hip fracture, demographics, total morbidity (ASA) score, health-related quality of life (EQ-5D-3 L), date of death if applicable, municipality of residence (Norwegian Hip Fracture Register), date of hospital readmission due to complications (Norwegian Patient Register), and information on municipalities' characteristics (Municipality-State-Reporting). The study population comprised 15,757 patients, mean age 80.8 years, 68.6% women. All-cause mortality was 8.6% at 30 days, and 25.3% at 12 months. Mortality was lower in the municipalities with the highest overall staff time for rehabilitation. A high proportion of the population aged 80+, was associated with low rates of self-reported anxiety/depression 12 months after surgery, as well as higher general health scores (EQ-5D VAS). There were no other differences in outcome according to rehabilitation resources, when comparing municipalities with the highest and lowest staffing. The study revealed no substantial impact of municipal resources on survival and health-related quality of life through the first year after a hip fracture. To evaluate major organizational changes and allocate resources according to best practice, there is a need to monitor health outcomes and use of resources over time through

  6. Locking plate fixation in distal metaphyseal tibial fractures: series of 79 patients

    Gupta, Rakesh K.; Rohilla, Rajesh Kumar; Sangwan, Kapil; Singh, Vijendra; Walia, Saurav

    2009-01-01

    Open reduction and internal fixation in distal tibial fractures jeopardises fracture fragment vascularity and often results in soft tissue complications. Minimally invasive osteosynthesis, if possible, offers the best possible option as it permits adequate fixation in a biological manner. Seventy-nine consecutive adult patients with distal tibial fractures, including one patient with a bilateral fracture of the distal tibia, treated with locking plates, were retrospectively reviewed. The 4.5-...

  7. Atypical metatarsal fracture in a patient on long term bisphosphonate therapy

    Pavan Pradhan

    2012-01-01

    Full Text Available A 24 years old female of cushing disease had undergone adrenelectomy. She was put on alendronate and steroid. After six and a half years she developed pathological fracture subtrochanteric femur. The patient was treated with proximal femoral nailing and the fracture united. 2 years later she developed pain right foot. She was diagnosed as transverse fracture of fifth metatarsal. We report this rare case of atypical metatarsal fracture in a patient on long term bisphosphonate therapy.

  8. Predictors for perioperative blood transfusion in elderly patients with extra capsular hip fractures treated with cephalo-medullary nailing.

    Fazal, M Ali; Bagley, Caroline; Garg, Parag

    2018-02-01

    The aim of our study was to determine predictive factors and requirement for perioperative blood transfusion in elderly patients with extra capsular hip fractures treated with cephalo-medullary device. Seventy-nine patients with extra capsular hip fractures treated with cephalo-medullary nailing were included in the study. Age, sex, ASA grade, timing of surgery, preoperative and postoperative haemoglobin, length of hospital stay, fracture type, number of units transfused and 30-day mortality were recorded. The mean age was 82.3 years. Forty-seven patients underwent a short nail and 32 patients a long nail; 53.4% patients required blood transfusion postoperatively. Transfusion was required in 71.8% of the long nails (p  0.05). Length of hospital stay in non-transfusion group was 13 days and in transfusion group was 19 days (p  0.05). Thirty-day mortality in patients needing blood transfusion was 5% and in non-transfusion group was 3.7% (p > 0.05). Patient age, ASA grade, preoperative haemoglobin and length of nail are reliable predictors for perioperative blood transfusion in extra capsular hip fractures in elderly patients treated with cephalo-medullary nailing and reinforce a selective transfusion policy. Copyright © 2017 Daping Hospital and the Research Institute of Surgery of the Third Military Medical University. Production and hosting by Elsevier B.V. All rights reserved.

  9. Insufficiency Fractures After Pelvic Radiotherapy in Patients With Prostate Cancer

    Igdem, Sefik; Alco, Guel; Ercan, Tuelay; Barlan, Metin; Ganiyusufoglu, Kuersat; Unalan, Buelent; Turkan, Sedat; Okkan, Sait

    2010-01-01

    Purpose: To assess the incidence, predisposing factors, and clinical characteristics of insufficiency fractures (IF) in patients with prostate cancer, who received pelvic radiotherapy as part of their definitive treatment. Methods and Materials: The charts of 134 prostate cancer patients, who were treated with pelvic radiotherapy between 1998 and 2007 were retrospectively reviewed. IF was diagnosed by bone scan and/or CT and/or MRI. The cumulative incidence of symptomatic IF was estimated by actuarial methods. Results: Eight patients were identified with symptomatic IF after a median follow-up period of 68 months (range, 12-116 months). The 5-year cumulative incidence of symptomatic IF was 6.8%. All patients presented with lower back pain. Insufficiency fracture developed at a median time of 20 months after the end of radiotherapy and was managed conservatively without any need for hospitalization. Three patients were thought to have metastatic disease because of increased uptake in their bone scans. However, subsequent CT and MR imaging revealed characteristic changes of IF, avoiding any further intervention. No predisposing factors for development of IF could be identified. Conclusions: Pelvic IF is a rare complication of pelvic radiotherapy in prostate cancer. Knowledge of pelvic IF is essential to rule out metastatic disease and prevent unnecessary treatment, especially in a patient cohort with high-risk features for distant spread.

  10. Mutiple Spontaneous Rib Fractures in Patient with Cushing's Syndrome.

    Lee, Hyun Jung; Je, Ji Hye; Seo, Ji Hye; Na, Young Ju; Yoo, Hye Jin

    2014-11-01

    Glucocorticoid (GC) excess, including Cushing's syndrome, is a common cause of secondary osteoporosis. Thirty to fifty percent of Cushing's syndrome patients experience non-traumatic fractures, which is often the presenting manifestation of Cushing's syndrome. However, there have been rare cases of Cushing's syndrome diagnosed only based upon bone manifestations. We describe a case of Cushing's syndrome that was diagnosed in a 44-year-old woman who initially visited our hospital due to multiple non-traumatic rib fractures. She did not exhibit any other manifestations of Cushing's syndrome such as moon face, buffalo hump or abdominal striae. Initially, we evaluated her for bone metastases from a cancer of unknown origin, but there was no evidence of metastatic cancer. Instead, we found a left adrenal incidentaloma. As a result of the hormone study, she was diagnosed as having Cushing's syndrome. Interestingly, her bony manifestation of Cushing's syndrome, which was evident in the bone scan and bone mineral densitometry, completely recovered after a left adrenalectomy. Therefore, the possibility of Cushing's syndrome as a cause of secondary osteoporosis should be considered in young patients with non-traumatic multiple fractures, with or without any other typical features of Cushing's syndrome.

  11. FRAIL Questionnaire Screening Tool and Short-Term Outcomes in Geriatric Fracture Patients.

    Gleason, Lauren Jan; Benton, Emily A; Alvarez-Nebreda, M Loreto; Weaver, Michael J; Harris, Mitchel B; Javedan, Houman

    2017-12-01

    There are limited screening tools to predict adverse postoperative outcomes for the geriatric surgical fracture population. Frailty is increasingly recognized as a risk assessment to capture complexity. The goal of this study was to use a short screening tool, the FRAIL scale, to categorize the level of frailty of older adults admitted with a fracture to determine the association of each frailty category with postoperative and 30-day outcomes. Retrospective cohort study. Level 1 trauma center. A total of 175 consecutive patients over age 70 years admitted to co-managed orthopedic trauma and geriatrics services. The FRAIL scale (short 5-question assessment of fatigue, resistance, aerobic capacity, illnesses, and loss of weight) classified the patients into 3 categories: robust (score = 0), prefrail (score = 1-2), and frail (score = 3-5). Postoperative outcome variables collected were postoperative complications, unplanned intensive care unit admission, length of stay (LOS), discharge disposition, and orthopedic follow-up after surgery. Thirty-day outcomes measured were 30-day readmission and 30-day mortality. Analysis of variance (1-way) and Kruskal-Wallis tests were used to compare continuous variables across the 3 FRAIL categories. Fisher exact tests were used to compare categorical variables. Multiple regression analysis, adjusted by age, sex, and Charlson index, was conducted to study the association between frailty category and outcomes. FRAIL scale categorized the patients into 3 groups: robust (n = 29), prefrail (n = 73), and frail (n = 73). There were statistically significant differences between groups in terms of age, comorbidity, dementia, functional dependency, polypharmacy, and rate of institutionalization, being higher in the frailest patients. Hip fracture was the most frequent fracture, and it was more frequent as the frailty of the patient increased (48%, 61%, and 75% in robust, prefrail, and frail groups, respectively). The American

  12. Psychotropic drugs and the risk of fractures in old age: a prospective population-based study.

    Nurminen, Janne; Puustinen, Juha; Piirtola, Maarit; Vahlberg, Tero; Kivelä, Sirkka-Liisa

    2010-07-06

    There is evidence that the use of any psychotropic and the concomitant use of two or more benzodiazepines are related to an increased risk of fractures in old age. However, also controversial results exist. The aim was to describe associations between the use of a psychotropic drug, or the concomitant use of two or more of these drugs and the risk of fractures in a population aged 65 years or over. This study was a part of a prospective longitudinal population-based study carried out in the municipality of Lieto, South-Western Finland. The objective was to describe gender-specific associations between the use of one psychotropic drug [benzodiazepine (BZD), antipsychotic (AP) or antidepressant (AD)] or the concomitant use of two or more psychotropic drugs and the risk of fractures in a population 65 years or over. Subjects were participants in the first wave of the Lieto study in 1990-1991, and they were followed up until the end of 1996. Information about fractures confirmed with radiology reports in 1,177 subjects (482 men and 695 women) during the follow-up was collected from medical records. Two follow-up periods (three and six years) were used, and previously found risk factors of fractures were adjusted as confounding factors separately for men and women. The Poisson regression model was used in the analyses. The concomitant use of two or more BZDs and the concomitant use of two or more APs were related to an increased risk of fractures during both follow-up periods after adjusting for confounding factors in men. No similar associations were found in women. The concomitant use of several BZDs and that of several APs are associated with an increase in the risk of fractures in older men. Our findings show only risk relations. We cannot draw the conclusion that these drug combinations are causes of fractures.

  13. [Vitamin D and calcium supplementation in elderly patients with hip fracture].

    Salamon, Antal; Toldy, Erzsébet; Biró, Csaba; Mátrai, Ákos; Balassa, Tibor; Lőcsei, Zoltán

    2017-10-01

    Vitamin D plays an important role in maintaining calcium and bone metabolism, a risk factor of osteoporosis, fall and fracture in old age. Reduction in D-vitamin levels associated with compensatory increased level of parathyroid hormone causes significant loss of bone matrix, so substitutions of vitamin D and calcium are very important. Many authors publish their recommended doses used for prevention of hip fracture during the last years. Some authors are satisfied only with vitamin D supplementation while others have better experiences with vitamin D and calcium substitution. On the other hand, some metaanalyses give contradictory results and propose further investigations. It is important to consider the patients' eating habits and lifestyle as well as the risk of cardiovascular and other chronic diseases. Further trials should be done in different age groups in order to examine the effects of different doses of vitamin D without and with calcium to make a final decision. Orv Hetil. 2017; 158(43): 1699-1707.

  14. OUTCOME OF UNCEMENTED UNIPOLAR HEMIARTHROPLASTY IN FRACTURE NECK OF FEMUR, IN GERIATRIC PATIENTS IN RELATION TO BONE QUALITY

    Mehraj Din

    2015-09-01

    Full Text Available BACKGROUND: Osteoporosis plays an important role in pathogenesis of fracture neck of femur in mobile elderly. Hemiarthroplasty is most common mode of management of femoral neck fractures in elderly in developing world. We report the outcome of uncemented hemiarthropl asty in elderly patients with a femoral neck fracture in relation to bone quality of patient as estimated by Dual energy x ray absorptiometry (DEXA scan. MATERIALS AND METHODS: 75 uncemented hemiarthroplasties for femoral neck fractures were performed in elderly patients more than 70 years of age between August 2008 and April 2012. The clinical, radiological results and bone mineral density of 65 hips in 65 patients who could be followed up were analyzed. For all cases Austin Moore prosthesis was implanted . RESULTS: The mean age of the patients was 79.96±7.21 years ( 7 1 to 96 years. 44 patients were women and 21 were men. Average duration of follow - up was 18.59±11.53 months ( R ange 4 to 44 months. The mean Harris Hip Score in patients with osteopenia was 80 .29±13.29 and in patients with osteoporosis it was 79.96 ± 11.67 at the time of the last follow - up. There was no significant difference in mean Harris hi p score in osteoporotic and non - osteoporotic patient’s p value 0.923. Out of 65 patients whose results were assessed in our study 48 patients (73.8% had osteoporosis and 17 patients (26.1% had Osteopenia. None of the patients in our study had a normal bone density. The mean T Score as measured on DEXA scan was - 3.74±1.57. CONCLUSION: Uncemented hemiarthro plasty for elderly patients more than 70 years of age with a femoral neck fracture showed satisfactory short - term results with no relationship to the bone quality

  15. Incidence of fractures among epilepsy patients: a population-based retrospective cohort study in the General Practice Research Database.

    Souverein, Patrick C; Webb, David J; Petri, Hans; Weil, John; Van Staa, Tjeerd P; Egberts, Toine

    2005-02-01

    To compare the incidence of various fractures in a cohort of patients with epilepsy with a reference cohort of patients not having epilepsy. Patients were included in the epilepsy cohort if they had at least one diagnosis of epilepsy in their medical history and had sufficient evidence of "active" epilepsy (use of antiepileptic drugs, diagnoses) after the practice was included in the General Practice Research Database (GPRD). Two reference patients were sampled for each patient with epilepsy from the same practice. Primary outcome was the occurrence of any fracture during follow-up. Poisson regression analysis was used to estimate incidence density ratios (IDRs). The study population comprised 40,485 and 80,970 patients in the epilepsy and reference cohorts, respectively. The median duration of follow-up was approximately 3 years. The overall incidence rate in the epilepsy cohort was 241.9 per 10,000 person-years. This rate was about twice as high as that in reference cohort: age- and sex-adjusted IDR, 1.89 (95% CI, 1.81-1.98). When comparing IDRs among the different groups of fractures, the highest relative-risk estimate was found for hip and femur fractures (adjusted IDR, 2.79; 95% CI, 2.41-3.24). IDRs were consistently elevated across age and sex groups and across fracture subtypes. The overall risk of fractures was nearly twice as high among patients with epilepsy compared with the general population. The relative fracture risk was highest for hip and femur. Further study is necessary to elucidate whether this elevated risk is due to the disease, the use of antiepileptic drugs, or both.

  16. First Quantification of Calcium Intake from Calcium-Dense Dairy Products in Dutch Fracture Patients (The Delft Cohort Study

    Peter van den Berg

    2014-06-01

    Full Text Available Recommendations for daily calcium intake from dairy products are variable and based on local consensus. To investigate whether patients with a recent fracture complied with these recommendations, we quantified the daily dairy calcium intake including milk, milk drinks, pudding, yoghurt, and cheese in a Dutch cohort of fracture patients and compared outcomes with recent data of a healthy U.S. cohort (80% Caucasians. An observational study analyzed dairy calcium intakes of 1526 female and 372 male Dutch fracture patients older than 50. On average, participants reported three dairy servings per day, independently of age, gender or population density. Median calcium intake from dairy was 790 mg/day in females and males. Based on dairy products alone, 11.3% of women and 14.2% of men complied with Dutch recommendations for calcium intake (adults ≤ 70 years: 1100 mg/day and >70 years: 1200 mg/day. After including 450 mg calcium from basic nutrition, compliance raised to 60.5% and 59.1%, respectively, compared to 53.2% in the U.S. cohort. Daily dairy calcium intake is not associated with femoral neck bone mineral density (BMD T-scores or WHO Fracture Assessment Tool (FRAX risk scores for major fracture or hip fracture. However, when sub analyzing the male cohort, these associations were weakly negative. The prevalence of maternal hip fracture was a factor for current fracture risks, both in women and men. While daily dairy calcium intake of Dutch fracture patients was well below the recommended dietary intake, it was comparable to intakes in a healthy U.S. cohort. This questions recommendations for adding more additional dairy products to preserve adult skeletal health, particularly when sufficient additional calcium is derived from adequate non-dairy nutrition.

  17. First quantification of calcium intake from calcium-dense dairy products in Dutch fracture patients (the Delft cohort study).

    van den Berg, Peter; van Haard, Paul M M; van den Bergh, Joop P W; Niesten, Dieu Donné; van der Elst, Maarten; Schweitzer, Dave H

    2014-06-23

    Recommendations for daily calcium intake from dairy products are variable and based on local consensus. To investigate whether patients with a recent fracture complied with these recommendations, we quantified the daily dairy calcium intake including milk, milk drinks, pudding, yoghurt, and cheese in a Dutch cohort of fracture patients and compared outcomes with recent data of a healthy U.S. cohort (80% Caucasians). An observational study analyzed dairy calcium intakes of 1526 female and 372 male Dutch fracture patients older than 50. On average, participants reported three dairy servings per day, independently of age, gender or population density. Median calcium intake from dairy was 790 mg/day in females and males. Based on dairy products alone, 11.3% of women and 14.2% of men complied with Dutch recommendations for calcium intake (adults ≤ 70 years: 1100 mg/day and >70 years: 1200 mg/day). After including 450 mg calcium from basic nutrition, compliance raised to 60.5% and 59.1%, respectively, compared to 53.2% in the U.S. cohort. Daily dairy calcium intake is not associated with femoral neck bone mineral density (BMD) T-scores or WHO Fracture Assessment Tool (FRAX) risk scores for major fracture or hip fracture. However, when sub analyzing the male cohort, these associations were weakly negative. The prevalence of maternal hip fracture was a factor for current fracture risks, both in women and men. While daily dairy calcium intake of Dutch fracture patients was well below the recommended dietary intake, it was comparable to intakes in a healthy U.S. cohort. This questions recommendations for adding more additional dairy products to preserve adult skeletal health, particularly when sufficient additional calcium is derived from adequate non-dairy nutrition.

  18. One-Year Outcome of Geriatric Hip-Fracture Patients following Prolonged ICU Treatment

    Daphne Eschbach

    2016-01-01

    Full Text Available Purpose. Incidence of geriatric fractures is increasing. Knowledge of outcome data for hip-fracture patients undergoing intensive-care unit (ICU treatment, including invasive ventilatory management (IVM and hemodiafiltration (CVVHDF, is sparse. Methods. Single-center prospective observational study including 402 geriatric hip-fracture patients. Age, gender, the American Society of Anesthesiologists (ASA classification, and the Barthel index (BI were documented. Underlying reasons for prolonged ICU stay were registered, as well as assessed procedures like IVM and CVVHDF. Outcome parameters were in-hospital, 6-month, and 1-year mortality and need for nursing care. Results. 15% were treated > 3 days and 68% 3d cohort were significantly increased (p=0.001. Most frequent indications were cardiocirculatory pathology followed by respiratory failure, renal impairment, and infection. 18% of patients needed CVVHDF and 41% IVM. In these cohorts, 6-month mortality ranged > 80% and 12-month mortality > 90%. 100% needed nursing care after 6 and 12 months. Conclusions. ICU treatment > 3 days showed considerable difference in mortality and nursing care needed after 6 and 12 months. Particularly, patients requiring CVVHDF or IVM had disastrous long-term results. Our study may add one further element in complex decision making serving this vulnerable patient cohort.

  19. High intertester reliability of the cumulated ambulation score for the evaluation of basic mobility in patients with hip fracture

    Kristensen, Morten Tange; Andersen, Lene; Bech-Jensen, Rie

    2009-01-01

    OBJECTIVE: To examine the intertester reliability of the three activities of the Cumulated Ambulation Score (CAS) and the total CAS, and to define limits for the smallest change in basic mobility that indicates a real change in patients with hip fracture. DESIGN: An intertester reliability study....... SETTING: An acute 20-bed orthopaedic hip fracture unit. SUBJECTS: Fifty consecutive patients with a median age of 83 (25-75% quartile, 68-86) years. INTERVENTIONS: The CAS, which describes the patient's independency in three activities - (1) getting in and out of bed, (2) sit to stand from a chair, and (3...

  20. Fracture risk in patients with type 2 diabetes mellitus and possible risk factors: a systematic review and meta-analysis

    Moayeri A

    2017-04-01

    Full Text Available Ardeshir Moayeri,1 Mahmoud Mohamadpour,2 Seyedeh Fatemeh Mousavi,3 Ehsan Shirzadpour,2 Safoura Mohamadpour,3 Mansour Amraei4 1Department of Anatomy, 2Department of Biochemistry, Faculty of Medicine, 3Department of Epidemiology, Prevention of Psychosocial Injuries Research Center, 4Department of Physiology, Faculty of Medicine, Ilam University of Medical Sciences, Ilam, Iran Aim: Patients with type 2 diabetes mellitus (T2DM have an increased risk of bone fractures. A variable increase in fracture risk has been reported depending on skeletal site, diabetes duration, study design, insulin use, and so on. The present meta-analysis aimed to investigate the association between T2DM with fracture risk and possible risk factors.Methods: Different databases including PubMed, Institute for Scientific Information, and Scopus were searched up to May 2016. All epidemiologic studies on the association between T2DM and fracture risk were included. The relevant data obtained from these papers were analyzed by a random effects model and publication bias was assessed by funnel plot. All analyses were done by R software (version 3.2.1 and STATA (version 11.1.Results: Thirty eligible studies were selected for the meta-analysis. We found a statistically significant positive association between T2DM and hip, vertebral, or foot fractures and no association between T2DM and wrist, proximal humerus, or ankle fractures. Overall, T2DM was associated with an increased risk of any fracture (summary relative risk =1.05, 95% confidence interval: 1.04, 1.06 and increased with age, duration of diabetes, and insulin therapy.Conclusion: Our findings strongly support an association between T2DM and increased risk of overall fracture. These findings emphasize the need for fracture prevention strategies in patients with diabetes. Keywords: diabetes mellitus, fractures, bone, osteoporosis, risk factors, meta-analysis

  1. Fracture Incidence and Characteristics in Young Adults Aged 18 to 49 Years: A Population-Based Study.

    Farr, Joshua N; Melton, L Joseph; Achenbach, Sara J; Atkinson, Elizabeth J; Khosla, Sundeep; Amin, Shreyasee

    2017-12-01

    Although fractures in both the pediatric and, especially, the elderly populations have been extensively investigated, comparatively little attention has been given to the age group in between. Thus, we used the comprehensive (inpatient and outpatient) data resources of the Rochester Epidemiology Project to determine incidence rates for all fractures among young adult (age range, 18 to 49 years) residents of Olmsted County, Minnesota, in 2009 to 2011, and compared the distribution of fracture sites and causes in this young adult cohort with those for older residents aged 50 years or older. During the 3-year study period, 2482 Olmsted County residents aged 18 to 49 years experienced 1 or more fractures. There were 1730 fractures among 1447 men compared with 1164 among 1035 women, and the age-adjusted incidence of all fractures was 66% greater among the men (1882 [95% confidence interval 1793-1971] versus 1135 [95% CI 1069-1201] per 100,000 person-years; p age ≥50 years who sustained a fracture in 2009 to 2011. Younger residents (aged 18 to 49 years), when compared with older residents (aged ≥50 years), had a greater proportion of fractures of the hands and feet (40% versus 18%) with relatively few fractures observed at traditional osteoporotic fracture sites (14% versus 43%). Vertebral fractures were still more likely to be the result of moderate trauma than at other sites, especially in younger women. In conclusion, whereas pediatric and elderly populations often fracture from no more than moderate trauma, young adults, and more commonly men, suffer fractures primarily at non-osteoporotic sites due to more significant trauma. © 2017 American Society for Bone and Mineral Research. © 2017 American Society for Bone and Mineral Research.

  2. Estimation of fracture toughness of cast stainless steels during thermal aging in LWR systems

    Chopra, O.K. (Argonne National Lab., IL (USA))

    1991-06-01

    A procedure and correlations are presented for predicting the change in fracture toughness of cast stainless steel components due to thermal aging during service in light water rectors (LWRs) at 280--330{degrees}C (535--625{degrees}F). The fracture toughness J-R curve and Charpy-impact energy of aged cast stainless steels are estimated from known mineral in formation. Fracture toughness of a specific cast stainless steel is estimated from the extent and kinetics of thermal embrittlement. The extent of thermal embrittlement is characterized by the room-temperature normalized'' Charpy-impact energy. A correlation for the extent of embrittlement at saturation,'' i.e., the minimum impact energy that would be achieved for the material after long-term aging, is given in terms of a material parameter, {Phi}, which is determined from the chemical composition. The fracture toughness J-R curve for the material is then obtained from correlations between room-temperature Charpy-impact energy and fracture toughness parameters. Fracture toughness as a function of time and temperature of reactor service is estimated from the kinetics of thermal embrittlement, which is determined from chemical composition. A common lower-bound'' J-R curve for cast stainless steels with unknown chemical composition is also defined for a given material specification, ferrite content, and temperature. Examples for estimating impact strength and fracture toughness of cast stainless steel components during reactor service are describes. 24 refs., 39 figs., 2 tabs.

  3. Do instability markers predict satisfactory reduction and requirement for later surgery in emergency department patients with wrist fracture?

    Winayak, Amar; Gossat, Alyza; Cooper, Jenny; Ritchie, Peter; Lim, Wei; Klim, Sharon; Kelly, Anne-Maree

    2018-02-01

    Research suggests that the presence of instability markers in patients with displaced distal radial fractures is associated with poorer outcome. Our aims were to determine whether the presence of previously defined instability markers could predict the likelihood of successful ED reduction and requirement for a secondary procedure after ED reduction. Retrospective cohort study performed by medical record review. Adult ED patients coded as having an isolated wrist fracture and having fracture reduction in ED were eligible for inclusion. Data collected included demographics, history of osteoporosis, mechanism of injury, radiological features on X-rays and performance of a secondary procedure. Outcomes of interest were the rate of successful fracture reduction in ED (against defined radiological criteria), the rate of secondary procedures and the association between the number of defined instability risk factors and successful reduction and performance of a secondary surgical procedure. Analysis was by χ 2 test, receiver operating characteristic curve, logistic regression analyses. Three hundred and nineteen patients were studied; median age 62 years, 77% female. Sixty-five per cent of patients had satisfactory fracture reduction in ED (95% CI 59%-70%). Eighty-six patients underwent a secondary procedure to reduce/stabilise their fracture (28%, 95% CI 23%-33%). Younger age, lack of satisfactory ED reduction and increased number of instability factors were independently predictive of the performance of a secondary procedure. Instability risk factors are common in patients with wrist fractures requiring reduction in ED. The number of instability factors is not a strong predictor of the performance of secondary procedures. © 2017 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  4. Fracture mechanics evaluation for the cast duplex stainless steel after thermal aging

    Urata, Shigeru [Kansai Electric Power Co., Inc., Osaka (Japan)

    1998-12-31

    For the primary coolant piping of PWRs in Japan, cast duplex stainless steel which is excellent in terms of strength, corrosion resistance, and weldability has conventionally been used. The cast duplex stainless steel contains the ferrite phase in the austenite matrix and thermal aging after long term service is known to change its material characteristics. It is considered appropriate to apply the methodology of elastic plastic fracture mechanics for an evaluation of the integrity of the primary coolant piping after thermal aging. Therefore, we evaluated the integrity of the primary coolant piping for an initial PWR plant in Japan by means of elastic plastic fracture mechanics. The evaluation results show that the crack will not grow into an unstable fracture and the integrity of the piping will be secured, even when such through wall crack length is assumed to equal the fatigue crack growth length for a service period of up to 60 years. (author)

  5. Physeal Fractures in Foals.

    Levine, David G; Aitken, Maia R

    2017-08-01

    Physeal fractures are common musculoskeletal injuries in foals and should be included as a differential diagnosis for the lame or nonweightbearing foal. Careful evaluation of the patient, including precise radiographic assessment, is paramount in determining the options for treatment. Prognosis mostly depends on the patient's age, weight, and fracture location and configuration. Copyright © 2017 Elsevier Inc. All rights reserved.

  6. The Determinants of Costs and Length of Stay for Hip Fracture Patients

    Castelli, Adriana; Daidone, Silvio; Jacobs, Rowena; Kasteridis, Panagiotis; Street, Andrew David

    2015-01-01

    Background and Purpose An ageing population at greater risk of proximal femoral fracture places an additional clinical and financial burden on hospital and community medical services. We analyse the variation in i) length of stay (LoS) in hospital and ii) costs across the acute care pathway for hip fracture from emergency admission, to hospital stay and follow-up outpatient appointments. Patients and Methods We analyse patient-level data from England for 2009/10 for around 60,000 hip fracture cases in 152 hospitals using a random effects generalized linear multi-level model where the dependent variable is given by the patient’s cost or length of stay (LoS). We control for socio-economic characteristics, type of fracture and intervention, co-morbidities, discharge destination of patients, and quality indicators. We also control for provider and social care characteristics. Results Older patients and those from more deprived areas have higher costs and LoS, as do those with specific co-morbidities or that develop pressure ulcers, and those transferred between hospitals or readmitted within 28 days. Costs are also higher for those having a computed tomography (CT) scan or cemented arthroscopy. Costs and LoS are lower for those admitted via a 24h emergency department, receiving surgery on the same day of admission, and discharged to their own homes. Interpretation Patient and treatment characteristics are more important as determinants of cost and LoS than provider or social care factors. A better understanding of the impact of these characteristics can support providers to develop treatment strategies and pathways to better manage this patient population. PMID:26204450

  7. [Demographic features and difficulties in rehabilitation in patients referred to hand rehabilitation unit for phalangeal fractures].

    Sahin, Füsun; Yücel, Serap Dalgiç; Yilmaz, Figen; Ergöz, Ernur; Kuran, Banu

    2006-01-01

    We evaluated demographic and occupational features of patients with phalangeal fractures of the hand, etiologies and types of injuries, and the results of rehabilitation. The study included 91 fingers of 62 patients (54 males, 8 females; mean age 28+/-13 years; range 4 to 59 years) who were referred to our hand rehabilitation unit for phalangeal fractures. Demographic features, the cause and localization of injury, the type of surgery, time from surgery to rehabilitation, and the follow-up period were determined. At the end of rehabilitation, range of motion (ROM) of the phalangeal joint and total ROM of the injured fingers were assessed using the Strickland-Glogovac rating system. A great majority of injuries were caused by work accidents, followed by sport injuries and falls occurring in students. Sixty patients (96.8%) were right-handed. The fractures occurred in the dominant hand in 29 patients (46.8%). The majority of patients (n=45) were primary school graduates. The most common mechanism of injury was accidents related to heavy work machinery (n=18). The most commonly injured finger and the phalanx were the third finger (n=25, 27.5%) and the proximal phalanx (n=59, 56.7%), respectively. Only 27 patients (43.6%) had a sufficient follow-up with a mean of 79.7+/-46.6 days (range 30 to 254 days). Following rehabilitation, the mean ROM and the total ROM were 45.0+/-22.9 degrees and 63.3+/-16.1 degrees for the injured joint and the thumb, and 31.3+/-22.5 degrees and 122+/-60.3 degrees for the injured joint and the other fingers, respectively. Our data provide important insight into appropriate treatment and rehabilitation of phalangeal fractures, in particular, shortcomings in the treatment and follow-up.

  8. Risks of all-cause and site-specific fractures among hospitalized patients with COPD

    Liao, Kuang-Ming; Liang, Fu-Wen; Li, Chung-Yi

    2016-01-01

    Abstract Patients with chronic obstructive pulmonary disease (COPD) have a high prevalence of osteoporosis. The clinical sequel of osteoporosis is fracture. Patients with COPD who experience a fracture also have increased morbidity and mortality. Currently, the types of all-cause and site-specific fracture among patients with COPD are unknown. Thus, we elucidated the all-cause and site-specific fractures among patients with COPD. A retrospective, population-based, cohort study was conducted utilizing the Taiwan Longitudinal Health Insurance Database. Patients with COPD were defined as those who were hospitalized with an International Classification of Diseases, Ninth Revision, Clinical Modification code of 490 to 492 or 496 between 2001 and 2011. The index date was set as the date of discharge. The study patients were followed from the index date to the date when they sought care for any type of fracture, date of death, date of health insurance policy termination, or the last day of 2013. The types of fracture analyzed in this study included vertebral, rib, humeral, radial and ulnar/wrist, pelvic, femoral, and tibial and fibular fractures. The cohort consisted of 11,312 patients with COPD. Among these patients, 1944 experienced fractures. The most common site-specific fractures were vertebral, femoral, rib, and forearm fractures (radius, ulna, and wrist) at 32.4%, 31%, 12%, and 11.8%, respectively. The adjusted hazard ratios of fracture were 1.71 [95% confidence interval (95% CI) = 1.56–1.87] for female patient with COPD and 1.50 (95% CI = 1.39–1.52) for patients with osteoporosis after covariate adjustment. Vertebral and hip fractures are common among patients with COPD, especially among males with COPD. Many comorbidities contribute to the high risk of fracture among patients with COPD. PMID:27749576

  9. An outcomes assessment of intra-articular calcaneal fractures, using patient and physician's assessment profiles.

    Kennedy, J G

    2012-02-03

    Thirty-six patients with intra-articular displaced calcaneal fractures were examined to determine both physician- and patient-based outcomes. Three groups were selected. Group A was treated with open reduction and internal fixation, group B was treated with open reduction internal fixation and supplemental bone graft augmentation and the patients in group C were treated with plaster cast immobilisation and no formal operative treatment. All cohorts were well matched for age, sex and severity of injury. Patients were evaluated using both the American Foot and Ankle Society Scoring System (AFASS) and the short form 36 (SF-36). Minimum time to follow up was 4 years. No significant difference was observed between the three groups with regards to pain and functional outcomes using the AFASS score (P>0.05). No difference was observed between the three groups using the SF-36 score (P>0.1). A statistically significant difference was observed, using radiological criteria, between both groups A and B when compared to the non-operative group C. The rate of wound infection in groups A and B was 31.5%. No correlation was found between the SF-36 score and the AFASS score. No correlation was found between the radiological score and either the SF-36 or the AFASS score. This study has found that the conservative treatment of calcaneal fractures can produce satisfactory outcomes with lower morbidity than surgically treated fractures.

  10. Tranexamic acid reduces blood loss in patients with extracapsular fractures of the hip

    Tengberg, P T; Foss, N B; Palm, H

    2016-01-01

    AIMS: We chose unstable extra-capsular hip fractures as our study group because these types of fractures suffer the largest blood loss. We hypothesised that tranexamic acid (TXA) would reduce total blood loss (TBL) in extra-capsular fractures of the hip. PATIENTS AND METHODS: A single...

  11. High incidence of osteoporosis and fractures in an aging post-polio population.

    Mohammad, Ausaf F

    2009-01-01

    Since the polio epidemic in Ireland in the 1950s, most polio survivors are approaching into the 6th and 7th decade of their lives. There is little data about bone density and risk of fractures in these patients. In 2006, we undertook an audit of post-polio patients attending rheumatology and neurology outpatient clinics in a university teaching hospital. Our aim was to determine the prevalence of osteoporosis (OP), falls and fractures and to evaluate the association of bone density with other potential contributing factors to OP.

  12. A new measurement for posterior tilt predicts reoperation in undisplaced femoral neck fractures: 113 consecutive patients treated by internal fixation and followed for 1 year

    Palm, Henrik; Gosvig, Kasper; Krasheninnikoff, Michael

    2009-01-01

    BACKGROUND AND PURPOSE: Preoperative posterior tilt in undisplaced (Garden I-II) femoral neck fractures is thought to influence rates of reoperation. However, an exact method for its measurement has not yet been presented. We designed a new measurement for posterior tilt on preoperative lateral...... radiographs and investigated its association with later reoperation. PATIENTS AND METHODS: A consecutive series of 113 patients, > or = 60 years of age with undisplaced (Garden I-II) femoral neck fractures treated with two parallel implants, was assessed regarding patient characteristics, radiographs...... and able to predict reoperation in patients with undisplaced (Garden I-II) femoral neck fractures....

  13. Fractures in patients with anorexia nervosa, bulimia nervosa, and other eating disorders--a nationwide register study.

    Vestergaard, Peter; Emborg, Charlotte; Støving, René K; Hagen, Claus; Mosekilde, Leif; Brixen, Kim

    2002-11-01

    To study fracture risk in patients with anorexia nervosa (AN), bulimia nervosa (BN), or eating disorders not otherwise specified (EDNOS). Cohort study including all Danes diagnosed with AN (n = 2,149), BN (n = 1,294), or EDNOS (n = 942) between 1977 and 1998. Each patient was compared with three randomly drawn age- and gender-matched control subjects. Fracture risk was increased in AN after diagnosis compared to controls (incidence rate ratio: 1.98, 95% CI: 1.60-2.44), but not before. The increased fracture risk persisted more than 10 years after diagnosis. A significant increase in fracture risk was found before diagnosis in BN (1.31, 95% CI: 1.04-1.64), with a trend towards an increase after diagnosis (1.44, 95% CI: 0.93-2.22). EDNOS patients had a significant increase in fracture risk before (1.39, 95% CI: 1.06-1.81) and after diagnosis (1.77, 95% CI: 1.25-2.51). The increased fracture risk many years after diagnosis indicates permanent skeletal damage. Copyright 2002 by Wiley Periodicals, Inc.

  14. Atrial fibrillation in fracture patients treated with oral bisphosphonates

    Abrahamsen, B; Eiken, P; Brixen, K

    2009-01-01

    OBJECTIVES: To determine if patients receiving oral bisphosphonates are at excess risk of atrial fibrillation (AF), stroke and myocardial infarction. DESIGN: Register-based restricted cohort study. SETTING: National Hospital Discharge Register and National Prescriptions Database (1995-2005). SUBJ......OBJECTIVES: To determine if patients receiving oral bisphosphonates are at excess risk of atrial fibrillation (AF), stroke and myocardial infarction. DESIGN: Register-based restricted cohort study. SETTING: National Hospital Discharge Register and National Prescriptions Database (1995...... to adherence. There was no increased risk of ischaemic stroke and an increased risk of myocardial infarction was not significant after adjustment for comorbidity. CONCLUSIONS: The increased occurrence of AF in fracture patients who are users of oral bisphosphonates should be attributed to targeting...

  15. Orbital fractures treated in Auckland from 2010-2015: review of patient outcomes.

    Anand, Lanit; Sealey, Christopher

    2017-07-07

    The purpose of this study was to review patient outcomes from surgical reconstruction of isolated orbital fractures, performed by the Auckland District Health Board (ADHB) Oral and Maxillofacial Surgery service (OMFS), from 2010 to 2015. In particular, we wished to assess titanium as an orbital reconstructive material and compare outcomes with the international literature. Hospital records for 103 adults (>18 years old) who underwent repair of isolated orbital fractures by the OMFS department at Middlemore Hospital, between 2010 and 2015, were reviewed. Information collected included patient characteristics, cause of injury, type of reconstruction material used and post-operative complications. Patients were then followed up by means of a verbal telephone questionnaire. The majority of patients were male in the 18-30 year age group, with interpersonal violence being the leading cause of injury. Titanium was the preferred choice of reconstructive material. Seven patients required return to theatre to resolve post-operative complications. Sixty-four patients could be contacted by telephone (12 months to six years follow-up). Thirty patients, who could not be contacted by telephone, did attend clinic follow-up and were assessed from their hospital records (minimum of one month follow-up). Ten patients could not be contacted by telephone and had not attended clinic follow-up. Problems with diplopia, paraesthesia and cosmesis were within complication rates reported in the literature. Patients with isolated orbital fractures, treated by the Oral and Maxillofacial Surgery Department in Auckland from 2010-2015, were reviewed. Titanium was the most commonly used reconstructive material and proved to be well tolerated. Complication rates were within international norms.

  16. Subtrochanteric stress fractures in patients on oral bisphosphonate therapy: an emerging problem.

    Murphy, Colin G

    2012-01-31

    The emergence of a new variant of subtrochanteric stress fractures of the femur, affecting patients on oral bisphosphonate therapy, has only recently been described. This fracture is often preceded by pain and distinctive radiographic changes (lateral cortical thickening), and associated with a characteristic fracture pattern (transverse fracture line and medial cortical spike). A retrospective review (2007-2009) was carried out for patients who were taking oral bisphosphonates and who sustained a subtrochanteric fracture after a low velocity injury. Eleven fractures were found in 10 patients matching the inclusion criteria outlined. All were females, and taking bisphosphonates for a mean of 43 years. Five of the 10 patients mentioned prodromal symptoms, for an average of 9.4 months before the fracture. Although all fractures were deemed low velocity, 5 of 11 were even atraumatic. Two patients had previously sustained contralateral subtrochanteric fractures. Plain radiographs of two patients showed lateral cortical thickening on the contralateral unfractured femur; the bisphosphonate therapy was stopped and close surveillance was started. Patients taking oral bisphosphonates may be at risk of a new variant of stress fracture of the proximal femur. Awareness of the symptoms is the key to ensure that appropriate investigations are undertaken.

  17. Serum vitamin E concentrations among highly functioning hip fracture patients are higher than in nonfracture controls

    D’Adamo, Christopher R.; Shardell, Michelle D.; Hicks, Gregory E.; Orwig, Denise L.; Hochberg, Marc C.; Semba, Richard D.; Yu-Yahiro, Janet A.; Ferrucci, Luigi; Magaziner, Jay S.; Miller, Ram R.

    2011-01-01

    Malnutrition after hip fracture is common and associated with poor outcomes and protracted recovery. Low concentrations of vitamin E have been associated with incident decline in physical function among older adults and may, therefore, be particularly important to functionally compromised patients hip fracture patients. Serum concentrations of α-tocopherol and γ-tocopherol, the 2 major forms of vitamin E, were assessed in 148 female hip fracture patients 65 years or older from the Baltimore H...

  18. Effects of Nutritional Status on 6-Month Outcome of Hip Fractures in Elderly Patients.

    Miu, Ka Ying Doris; Lam, Pui Shan

    2017-12-01

    To identify the prevalence of malnutrition in elderly hip fracture and to investigate the relationship between hip fracture patients and malnutrition on functional recovery and mortality. All hip fracture patients age >65 years admitted to a rehabilitation unit were recruited from July 2015 to June 2016. Nutritional status was assessed by Mini-Nutritional Assessment Short-Form (MNA-SF) within 72 hours of admission. Patients were reassessed at 6 months for functional status and place of residence. Length of hospital stay, in-patient mortality rate, and 6-month mortality rate were also recorded. There were 218 patients recruited. The mean age was 83.5±7.5 years. According the MNA-SF, 46 (21.1%) were well nourished, 115 (52.6%) were at risk of malnutrition, and 57 (26.1%) were malnourished. Malnourished individuals were significantly older, had lower Mini-Mental State Examination score and albumin level, were functionally more dependent and were more likely to reside in elderly care facility. A higher proportion of elderly care residents were at-risk or were malnourished on admission, discharge and at 6 months. Functional recovery was slower in the malnourished group. In-patient mortality was higher in malnourished individuals compared to those at risk of malnourishment and well-nourished individuals. The prevalence of malnutrition is high and is associated with poor functional recovery and elderly care placement. Residents of elderly care facilities are especially at risk due a higher prevalence of malnourishment. Health authorities are encouraged to evaluate the dietetic component in elderly care facilities and initiate nutrition supplementation in their planning of healthcare resources.

  19. A personalized snack-based intervention for hip fracture patients: development, feasibility and acceptability.

    Price, Rosemary J G; McMurdo, Marion E T; Anderson, Annie S

    2006-04-01

    Undernutrition is common in older people admitted to hospital with hip fracture. Oral supplementation with sip feeds may be provided but compliance is a major problem. To develop a personalized snack-based intervention for practical implementation in hip fracture patients and to assess feasibility, adherence, acceptability and cost. Twenty-three older hip fracture patients with a mean age (SD) 84.1 (6.3) were provided with three between-meal snacks daily for 4 weeks following surgery. Dietary counselling, assessment of acceptability and feasibility were undertaken and costs of intervention calculated. Sixteen of the 23 participants recruited completed the study. Mean estimated energy derived from the snacks provided 26% of daily energy requirements. Monitoring adherence proved problematic and stocktakes highlighted discrepancies. Although several participants reported that they did not usually eat between meals, overall the intervention was acceptable to participants. The cost of implementation was 21.29 UK pounds per participant per week. Although it proved feasible, practical difficulties were encountered with implementation and adherence due to timing. A more appropriate time to deliver such an intervention may be after the acute phase is over and patients are back home. The costs compared favourably with the alternative of providing sip feeds.

  20. Are first rib fractures a marker for other life-threatening injuries in patients with major trauma? A cohort study of patients on the UK Trauma Audit and Research Network database.

    Sammy, Ian Ayenga; Chatha, Hridesh; Lecky, Fiona; Bouamra, Omar; Fragoso-Iñiguez, Marisol; Sattout, Abdo; Hickey, Michael; Edwards, John E

    2017-04-01

    First rib fractures are considered indicators of increased morbidity and mortality in major trauma. However, this has not been definitively proven. With an increased use of CT and the potential increase in detection of first rib fractures, re-evaluation of these injuries as a marker for life-threatening injuries is warranted. Patients sustaining rib fractures between January 2012 and December 2013 were investigated using data from the UK Trauma Audit and Research Network. The prevalence of life-threatening injuries was compared in patients with first rib fractures and those with other rib fractures. Multivariate logistic regression was performed to determine the association between first rib fractures, injury severity, polytrauma and mortality. There were 1683 patients with first rib fractures and 8369 with fractures of other ribs. Life-threatening intrathoracic and extrathoracic injuries were more likely in patients with first rib fractures. The presence of first rib fractures was a significant predictor of injury severity (Injury Severity Score >15) and polytrauma, independent of mechanism of injury, age and gender with an adjusted OR of 2.64 (95% CI 2.33 to 3.00) and 2.01 (95% CI 1.80 to 2.25), respectively. Risk-adjusted mortality was the same in patients with first rib fractures and those with other rib fractures (adjusted OR 0.97, 95% CI 0.79 to 1.19). First rib fractures are a marker of life-threatening injuries in major trauma, though they do not independently increase mortality. Management of patients with first rib fractures should focus on identification and treatment of associated life-threatening injuries. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) [year]. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  1. Outcome in hip fracture patients related to anemia at admission and allogeneic blood transfusion: an analysis of 1262 surgically treated patients

    Vochteloo Anne JH

    2011-11-01

    Full Text Available Abstract Background Anemia is more often seen in older patients. As the mean age of hip fracture patients is rising, anemia is common in this population. Allogeneic blood transfusion (ABT and anemia have been pointed out as possible risk factors for poorer outcome in hip fracture patients. Methods In the timeframe 2005-2010, 1262 admissions for surgical treatment of a hip fracture in patients aged 65 years and older were recorded. Registration was prospective from 2008 on. Anemic and non-anemic patients (based on hemoglobin level at admission were compared regarding clinical characteristics, mortality, delirium incidence, LOS, discharge to a nursing home and the 90-day readmission rate. Receiving an ABT, age, gender, ASA classification, type of fracture and anesthesia were used as possible confounders in multivariable regression analysis. Results The prevalence of anemia and the rate of ABT both were 42.5%. Anemic patients were more likely to be older and men and had more often a trochanteric fracture, a higher ASA score and received more often an ABT. In univariate analysis, the 3- and 12-month mortality rate, delirium incidence and discharge to a nursing home rate were significantly worse in preoperatively anemic patients. In multivariable regression analysis, anemia at admission was a significant risk factor for discharge to a nursing home and readmission Conclusions This study has demonstrated that anemia at admission and postoperative anemia needing an ABT (PANT were independent risk factors for worse outcome in hip fracture patients. In multivariable regression analysis, anemia as such had no effect on mortality, due to a rescue effect of PANT. In-hospital, 3- and 12-month mortality was negatively affected by PANT, with the main effect in the first 3 months postoperatively.

  2. Characteristics of bone turnover in the long bone metaphysis fractured patients with normal or low Bone Mineral Density (BMD.

    Christoph Wölfl

    Full Text Available The incidence of osteoporotic fractures increases as our population ages. Until now, the exact biochemical processes that occur during the healing of metaphyseal fractures remain unclear. Diagnostic instruments that allow a dynamic insight into the fracture healing process are as yet unavailable. In the present matched pair analysis, we study the time course of the osteoanabolic markers bone specific alkaline phosphatase (BAP and transforming growth factor β1 (TGFβ1, as well as the osteocatabolic markers crosslinked C-telopeptide of type-I-collagen (β-CTX and serum band 5 tartrate-resistant acid phosphatase (TRAP5b, during the healing of fractures that have a low level of bone mineral density (BMD compared with fractures that have a normal BMD. Between March 2007 and February 2009, 30 patients aged older than 50 years who suffered a metaphyseal fracture were included in our study. BMDs were verified by dual energy Xray absorptiometry (DXEA scans. The levels of BTMs were examined over an 8-week period. Osteoanabolic BAP levels in those with low levels of BMD were significantly different from the BAP levels in those with normal BMD. BAP levels in the former group increased constantly, whereas the latter group showed an initial strong decrease in BAP followed by slowly rising values. Osteocatabolic β-CTX increased in the bone of the normal BMD group constantly, whereas these levels decreased significantly in the bone of the group with low BMD from the first week. TRAP5b was significantly reduced in the low level BMD group. With this work, we conduct first insights into the molecular biology of the fracture healing process in patients with low levels of BMD that explains the mechanism of its fracture healing. The results may be one reason for the reduced healing qualities in bones with low BMD.

  3. Fracture resistance of zirconia-based implant abutments after artificial long-term aging.

    Alsahhaf, Abdulaziz; Spies, Benedikt Christopher; Vach, Kirstin; Kohal, Ralf-Joachim

    2017-02-01

    To investigate the survival rate, fracture strength, bending moments, loading to fracture and fracture modes of different designs of zirconia abutments after dynamic loading with thermocycling, and compare these values to titanium abutments. A total of 80 abutment samples were divided into 5 test groups of 16 samples in each group. The study included the following groups, "Group 1" CAD/CAM produced all-zirconia abutments, "Group 2" titanium abutments, "Group 3" zirconia-abutments adhesively luted to a titanium base, "Group 4" prefabricated all-zirconia abutments and "Group 5" zirconia-abutments glass soldered to a titanium base. Half the number of samples in each group was exposed to 1.2 million loading cycles (5-years simulation) in the chewing simulator. The samples that survived the artificial aging were later tested for fracture strength in a universal testing machine. The remaining 8 samples of the group were directly tested for fracture strength. All samples exposed to the 5-years artificial aging survived except of six samples in one group (Group 1). The surviving samples were later fracture tested in the universal testing machine. The bending moments (Ncm) values were as follow: Exposed groups: "Group 1" 94.5Ncm; "Group 2" 599.2Ncm; "Group 3" 477.5Ncm; "Group 4" 314.4Ncm; "Group 5" 509.4Ncm. Non-exposed groups: "Group 1" 269.3Ncm; "Group 2" 474.2Ncm; "Group 3" 377.6Ncm; "Group 4" 265.4Ncm; "Group 5" 372.4Ncm. Except in Group 1, the values were higher in the exposed groups, although, statistically there was no difference (p>0.05). The one-piece ZrO2-abutment group (Group 1 and Group 4) exhibited lower values, while the two-piece ZrO2-abutment groups (Group 3 and Group 5) showed similar values and fracture modes like the titanium abutment group. The titanium abutment group showed the highest values of bending moments among all groups. The implant-abutment connection area appeared to influence the bending moment value and the fracture mode of the tested

  4. Role of bone mineral density in predicting morphometric vertebral fractures in patients with HIV infection.

    Porcelli, T; Gotti, D; Cristiano, A; Maffezzoni, F; Mazziotti, G; Focà, E; Castelli, F; Giustina, A; Quiros-Roldan, E

    2014-09-01

    This study investigated the bone of HIV patients both in terms of quantity and quality. It was found that HIV-infected patients did fracture independently of the degree of bone demineralization as in other forms of secondary osteoporosis. We aimed to determine the prevalence of vertebral fractures (VFs) in HIV patients who were screened by bone mineral density (BMD) and to explore possible factors associated with VFs. This is a cross-sectional study that included HIV-infected patients recruited in the Clinic of Infectious and Tropical Diseases and that underwent BMD measurement by dual-energy X-ray absorptiometry (DXA) at the lumbar spine and hip (Lunar Prodigy, GE Healthcare). For the assessment of VFs, anteroposterior and lateral X-ray examinations of the thoracic and lumbar spines were performed and were centrally digitized. Logistic regression models were used in the statistical analysis of factors associated with VFs. One hundred thirty-one consecutive patients with HIV infection (93 M, 38 F, median age 51 years; range, 36-75) underwent BMD measurement: 25.2 % of patients showed normal BMD, while 45 % were osteopenic and 29.7 % osteoporotic. Prevalence of low BMD (osteopenia and osteoporosis) was higher in females as compared to males (90 vs 69 %) with no significant correlation with age and body mass index. VFs occurred more frequently in patients with low BMD as compared to patients with normal BMD (88.5 vs. 11.4 %; p osteoporosis (43 vs. 46 %; p = 0.073). VFs were significantly associated with older age and previous AIDS events. These results suggest a BMD patients at risk of skeletal fragility and, therefore, good candidates for morphometric evaluation of spine X-ray in line with other forms of secondary osteoporosis with impaired bone quality.

  5. Association of QCT Bone Mineral Density and Bone Structure With Vertebral Fractures in Patients With Multiple Myeloma.

    Borggrefe, Jan; Giravent, Sarah; Thomsen, Felix; Peña, Jaime; Campbell, Graeme; Wulff, Asmus; Günther, Andreas; Heller, Martin; Glüer, Claus C

    2015-07-01

    Computed tomography (CT) is used for staging osteolytic lesions and detecting fractures in patients with multiple myeloma (MM). In the OsteoLysis of Metastases and Plasmacell-infiltration Computed Tomography 2 study (OLyMP-CT) study we investigated whether patients with and without vertebral fractures show differences in bone mineral density (BMD) or microstructure that could be used to identify patients at risk for fracture. We evaluated whole-body CT scans in a group of 104 MM patients without visible osteolytic lesions using an underlying lightweight calibration phantom (Image Analysis Inc., Columbia, KY, USA). QCT software (StructuralInsight) was used for the assessment of BMD and bone structure of the T11 or T12 vertebral body. Age-adjusted standardized odds ratios (sORs) per SD change were derived from logistic regression analyses, and areas under the receiver operating characteristics (ROC) curve (AUCs) analyses were calculated. Forty-six of the 104 patients had prevalent vertebral fractures (24/60 men, 22/44 women). Patients with fractures were not significantly older than patients without fractures (mean ± SD, 64 ± 9.2 versus 62 ± 12.3 years; p = 0.4). Trabecular BMD in patients with fractures versus without fractures was 169 ± 41 versus 192 ± 51 mg/cc (AUC = 0.62 ± 0.06, sOR = 1.6 [1.1 to 2.5], p = 0.02). Microstructural variables achieved optimal discriminatory power at bone thresholds of 150 mg/cc. Best fracture discrimination for single microstructural variables was observed for trabecular separation (Tb.Sp) (AUC = 0.72 ± 0.05, sOR = 2.4 (1.5 to 3.9), p Rarefaction of the trabecular network due to plasma cell infiltration and osteoporosis can be measured. Deterioration of microstructural measures appear to be of value for vertebral fracture risk assessment and may indicate early stages of osteolytic processes not yet visible. © 2014 American Society for Bone and Mineral Research.

  6. Active commuting reduces the risk of wrist fractures in middle-aged women-the UFO study.

    Englund, U; Nordström, P; Nilsson, J; Hallmans, G; Svensson, O; Bergström, U; Pettersson-Kymmer, U

    2013-02-01

    Middle-aged women with active commuting had significantly lower risk for wrist fracture than women commuting by car/bus. Our purpose was to investigate whether a physically active lifestyle in middle-aged women was associated with a reduced risk of later sustaining a low-trauma wrist fracture. The Umeå Fracture and Osteoporosis (UFO) study is a population-based nested case-control study investigating associations between lifestyle and fragility fractures. From a cohort of ~35,000 subjects, we identified 376 female wrist fracture cases who had reported data regarding their commuting habits, occupational, and leisure physical activity, before they sustained their fracture. Each fracture case was compared with at least one control drawn from the same cohort and matched for age and week of reporting data, yielding a total of 778 subjects. Mean age at baseline was 54.3 ± 5.8 years, and mean age at fracture was 60.3 ± 5.8 years. Conditional logistic regression analysis with adjustments for height, body mass index, smoking, and menopausal status showed that subjects with active commuting (especially walking) were at significantly lower risk of sustaining a wrist fracture (OR 0.48; 95 % CI 0.27-0.88) compared with those who commuted by car or bus. Leisure time activities such as dancing and snow shoveling were also associated with a lower fracture risk, whereas occupational activity, training, and leisure walking or cycling were unrelated to fracture risk. This study suggests that active commuting is associated with a lower wrist fracture risk, in middle-aged women.

  7. Fracture mechanics evaluation of cast duplex stainless steel after thermal aging

    Tujikura, Y.; Urata, S.

    1999-01-01

    For the primary coolant piping of PWRs in Japan, cast duplex stainless steel, which is excellent in terms of strength, corrosion resistance and weldability, has conventionally been used. Cast duplex stainless steel contains the ferrite phase in the austenite matrix, and thermal aging after long-term service is known to decrease fracture toughness. Therefore, we evaluated the integrity of the primary coolant piping for an initial PWR plant in Japan by means of elastic plastic fracture mechanics. The evaluation results show that the crack will not grow into an unstable fracture and the integrity of the piping will be secure, even when such through-wall crack length is assumed to be as large as the fatigue crack length grown for a service period of up to 60 years. (orig.)

  8. Fracture mechanics evaluation of cast duplex stainless steel after thermal aging

    Tujikura, Y.; Urata, S. [Kansai Electr. Power Co., Inc., Osaka (Japan). General Office of Nucl. and Fossil Power Production

    1999-07-01

    For the primary coolant piping of PWRs in Japan, cast duplex stainless steel, which is excellent in terms of strength, corrosion resistance and weldability, has conventionally been used. Cast duplex stainless steel contains the ferrite phase in the austenite matrix, and thermal aging after long-term service is known to decrease fracture toughness. Therefore, we evaluated the integrity of the primary coolant piping for an initial PWR plant in Japan by means of elastic plastic fracture mechanics. The evaluation results show that the crack will not grow into an unstable fracture and the integrity of the piping will be secure, even when such through-wall crack length is assumed to be as large as the fatigue crack length grown for a service period of up to 60 years. (orig.)

  9. Modified Creatinine Index and the Risk of Bone Fracture in Patients Undergoing Hemodialysis: The Q-Cohort Study.

    Yamada, Shunsuke; Taniguchi, Masatomo; Tokumoto, Masanori; Yoshitomi, Ryota; Yoshida, Hisako; Tatsumoto, Narihito; Hirakata, Hideki; Fujimi, Satoru; Kitazono, Takanari; Tsuruya, Kazuhiko

    2017-08-01

    Hemodialysis patients are at increased risk for bone fracture and sarcopenia. There is close interplay between skeletal muscle and bone. However, it is still unclear whether lower skeletal muscle mass increases the risk for bone fracture. Cross-sectional study and prospective longitudinal cohort study. An independent cohort of 78 hemodialysis patients in the cross-sectional study and 3,030 prevalent patients undergoing maintenance hemodialysis prospectively followed up for 4 years. Skeletal muscle mass measured by bioelectrical impedance analysis (BIA) and modified creatinine index, an estimate of skeletal muscle mass based on age, sex, Kt/V for urea, and serum creatinine level. Bone fracture at any site. In the cross-sectional study, modified creatinine index was significantly correlated with skeletal muscle mass measured by BIA. During a median follow-up of 3.9 years, 140 patients had bone fracture. When patients were divided into sex-specific quartiles based on modified creatinine index, risk for bone fracture estimated by a Fine-Gray proportional subdistribution hazards model with all-cause death as a competing risk was significantly higher in the lower modified creatinine index quartiles (Q1 and Q2) compared to the highest modified creatinine index quartile (Q4) as the reference value in both sexes (multivariable-adjusted HRs for men were 7.81 [95% CI, 2.63-23.26], 5.48 [95% CI, 2.08-14.40], 2.24 [95% CI, 0.72-7.00], and 1.00 [P for trend creatinine index; no data for residual kidney function and fracture sites and causes. Modified creatinine index was correlated with skeletal muscle mass measured by BIA. Lower modified creatinine index was associated with increased risk for bone fracture in male and female hemodialysis patients. Copyright © 2017 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

  10. Prospective study of ankle and foot fractures in elderly women

    Yadagiri Surender Rao

    2015-01-01

    Full Text Available The epidemiology of ankle fractures in old people is changing as time passes on. The incidence of ankle fractures increases with advancing age. The study conducted was among a rural popula-tion which comprised of 68 women (32 women with ankle fractures & 36 women with foot fractures. Patients studied were in the age group more than 50 years. The study highlights the etiological & risk factors for fractures of ankle & foot. The commonest ankle fracture was the lateral malleolar fracture & the commonest foot fracture was the 5th Metatarsal fracture. Diabetes is a risk factor which increases the occurrence of ankle and foot injuries.

  11. Trajectory of social isolation following hip fracture: an analysis of the English Longitudinal Study of Ageing (ELSA) cohort.

    Smith, Toby O; Dainty, Jack R; MacGregor, Alex

    2018-01-01

    social isolation is defined as a lack of meaningful and sustained communication or interactions with social networks. There is limited understanding on the prevalence of social isolation and loneliness in people following hip fracture and no previous understanding of how this changes over time. to determine the prevalence and trajectory of social isolation and loneliness before a hip fracture, during the recovery phase and a minimum of 2 years post-hip fracture in an English population. data were from the English Longitudinal Study of Ageing (ELSA) cohort (2004/5-2014/15). The sample comprised of 215 participants who had sustained a hip fracture. Measures of social isolation and loneliness were analysed through multilevel modelling to determine their trajectories during three-time intervals (pre-fracture; interval at hip fracture and recovery; minimum 2 years post-fracture). The prevalence of social isolation and loneliness were determined pre- and post-fracture. prevalence of social isolation was 19% post-hip fracture and loneliness 13% post-hip fracture. There was no statistically significant change in social isolation pre-fracture compared to a minimum of 2 years post-fracture (P = 0.78). Similarly, there was no statistically significant change in loneliness pre-fracture compared to a minimum of 2 years post-fracture (P = 0.12). this analysis has determined that whilst social isolation and loneliness do not change over time following hip fracture, these remain a significant problem for this population. Interventions are required to address these physical and psychological health needs. This is important as they may have short and longer term health benefits for people post-hip fracture. © The Author 2017. Published by Oxford University Press on behalf of the British Geriatrics Society.All rights reserved. For permissions, please email: journals.permissions@oup.com

  12. The clinical significance of adjacent rib involvement on MRI in patients with acute osteoporotic compression fractures of the thoracic spine

    Kim, Hyun Joo; Kim, Jae Hyun; Kwon, Kui Hyang; Choi, Deuk Lin; Goo, Dong Erk; Suh, You Sung; Bae, Won Kyung

    2012-01-01

    The purpose of this study was to evaluate the significance of the presence of adjacent rib involvement in osteoporotic compression fractures. All the patients with acute osteoporotic compression fractures of the thoracic spine on thoracic spine MRI that presented to our clinic between September 2003 and January 2010 were retrospectively reviewed. All the vertebrae were divided into two groups: those that showed signal intensity change in the rib adjacent to the compression fracture and those that did not. We compared the results between the two groups to determine if there were differences in the degree of osteoporosis, the compression fracture level and the age of patients between the two groups. We calculated the degree of correlation between the MRI and the bone scan images of these patients. We also reviewed whether percutaneous vertebroplasty relieved symptoms or not. Signal intensity changes were found in the adjacent rib(s) in 12 of the 60 patients and in 14 of the 94 levels (the total number of levels). The MRI and bone scan showed significant correlation (p < 0.001). There was a statistically significant difference in the incidence of pain at the one month outpatient follow up between the two groups (p = 0.0215). The radiologist should comment on the presence or absence of adjacent rib involvement when reporting on the thoracic spine MRI of patients suffering from osteoporotic compression fractures in order to more accurately determine prognosis

  13. The clinical significance of adjacent rib involvement on MRI in patients with acute osteoporotic compression fractures of the thoracic spine

    Kim, Hyun Joo; Kim, Jae Hyun; Kwon, Kui Hyang; Choi, Deuk Lin; Goo, Dong Erk; Suh, You Sung [Soonchunhyang Univ. Seoul Hospital/Soonchunhyang Univ. College of Medicine, Seoul (Korea, Republic of); Bae, Won Kyung [Soonchunhyang Univ. Cheonan Hospital/Soonchunhyang Univ. College of Medicine, Cheonan (Korea, Republic of)

    2012-05-15

    The purpose of this study was to evaluate the significance of the presence of adjacent rib involvement in osteoporotic compression fractures. All the patients with acute osteoporotic compression fractures of the thoracic spine on thoracic spine MRI that presented to our clinic between September 2003 and January 2010 were retrospectively reviewed. All the vertebrae were divided into two groups: those that showed signal intensity change in the rib adjacent to the compression fracture and those that did not. We compared the results between the two groups to determine if there were differences in the degree of osteoporosis, the compression fracture level and the age of patients between the two groups. We calculated the degree of correlation between the MRI and the bone scan images of these patients. We also reviewed whether percutaneous vertebroplasty relieved symptoms or not. Signal intensity changes were found in the adjacent rib(s) in 12 of the 60 patients and in 14 of the 94 levels (the total number of levels). The MRI and bone scan showed significant correlation (p < 0.001). There was a statistically significant difference in the incidence of pain at the one month outpatient follow up between the two groups (p = 0.0215). The radiologist should comment on the presence or absence of adjacent rib involvement when reporting on the thoracic spine MRI of patients suffering from osteoporotic compression fractures in order to more accurately determine prognosis.

  14. Fracture Strength of Aged Monolithic and Bilayer Zirconia-Based Crowns

    Deborah Pacheco Lameira

    2015-01-01

    Full Text Available The purpose of this study was to evaluate the effect of design and surface finishing on fracture strength of yttria-tetragonal zirconia polycrystal (Y-TZP crowns in monolithic (1.5 mm thickness and bilayer (0.8 mm zirconia coping and 0.7 mm porcelain veneer configuration after artificial aging. Bovine incisors received crown preparation and Y-TZP crowns were manufactured using CAD/CAM technique, according to the following groups (n=10: Polished monolithic zirconia crowns (PM; Glazed monolithic zirconia crowns (GM; Bi-layer crowns (BL. Crowns were cemented with resin cement, submitted to artificial aging in a chewing simulator (2.5 million cycles/80 N/artificial saliva/37°C, and tested for fracture strength. Two remaining crowns referring to PM and GM groups were submitted to a chemical composition analysis to measure the level of yttrium after aging. One-way ANOVA and Tukey’s test (P=.05 indicated that monolithic zirconia crowns presented similar fracture strength (PM=3476.2 N ± 791.7; GM=3561.5 N ± 991.6, which was higher than bilayer crowns (2060.4 N ± 810.6. There was no difference in the yttrium content among the three surfaces evaluated in the monolithic crowns. Thus, monolithic zirconia crowns present higher fracture strength than bilayer veneered zirconia after artificial aging and surface finishing does not affect their fracture strength.

  15. Isolated Transverse Sacrum Fracture: A Case Report

    Cemil Kavalci

    2011-01-01

    Full Text Available Sacral fracture commonly results from high-energy trauma. Most insufficiency fractures of the sacrum are seen in women after the age of 70. Fractures of the sacrum are rare and generally combined with a concomitant pelvic fracture. Transverse sacral fractures are even less frequent which constitute only 3–5% of all sacral fractures. This type of fractures provide a diagnostic challenge. We report a unique case of isolated transverse fracture of sacrum in a young man sustained low-energy trauma. The patient presented to our emergency department after several hours of injury, and diagnosed by clinical features and roentgenogram findings.

  16. High-resolution-cone beam tomography analysis of bone microarchitecture in patients with acromegaly and radiological vertebral fractures.

    Maffezzoni, Filippo; Maddalo, Michele; Frara, Stefano; Mezzone, Monica; Zorza, Ivan; Baruffaldi, Fabio; Doglietto, Francesco; Mazziotti, Gherardo; Maroldi, Roberto; Giustina, Andrea

    2016-11-01

    Vertebral fractures are an emerging complication of acromegaly but their prediction is still difficult occurring even in patients with normal bone mineral density. In this study we evaluated the ability of high-resolution cone-beam computed tomography to provide information on skeletal abnormalities associated with vertebral fractures in acromegaly. 40 patients (24 females, 16 males; median age 57 years, range 25-72) and 21 healthy volunteers (10 females, 11 males; median age 60 years, range: 25-68) were evaluated for trabecular (bone volume/trabecular volume ratio, mean trabecular separation, and mean trabecular thickness) and cortical (thickness and porosity) parameters at distal radius using a high-resolution cone-beam computed tomography system. All acromegaly patients were evaluated for morphometric vertebral fractures and for mineral bone density by dual-energy X-ray absorptiometry at lumbar spine, total hip, femoral neck, and distal radius. Acromegaly patients with vertebral fractures (15 cases) had significantly (p acromegaly patients did not have significant differences in bone density at either skeletal site. Patients with acromegaly showed lower bone volume/trabecular volume ratio (p = 0.003) and mean trabecular thickness (p acromegaly. High-resolution cone-beam computed tomography at the distal radius may be useful to evaluate and predict the effects of acromegaly on bone microstructure.

  17. The outcomes of patients newly admitted to nursing homes after hip fracture.

    Kiel, D P; Eichorn, A; Intrator, O; Silliman, R A; Mor, V

    1994-08-01

    The outcomes of elderly, hospitalized patients discharged to nursing homes after hip fracture were examined. For 2624 hip fracture patients admitted to any of 43 proprietary nursing homes between 1984 and 1988, admission assessments were examined in relation to 1-month outcomes. Mean patient age was 82 +/- 7 y; 85% of the sample were female. Within 1 month after discharge, 24% had returned home, 12% had been rehospitalized, 3% had died, and 61% remained in the nursing home. Characteristics significantly associated with morality included disorientation, functional dependency, neurologic diagnoses, and use of cardiac medications, antidepressants, or narcotics. Rehospitalization was significantly associated with age, gender, living with someone, being ambulatory, and functional dependency. Returning home was associated with younger age, living with someone, being ambulatory, and having no disorientation, functional dependency, or psychiatric or neurologic diagnoses, nor any pressure sores. Better-functioning persons and those with social support returned home; physically and cognitively impaired persons and those taking narcotics, cardiac medications, or antidepressants were likely to die; and younger men, those with social support, those with functional dependency, and those who were free of disorientation were more likely to be rehospitalized.

  18. The Incidence of Atypical Femoral Fractures in Patients with Rheumatic Disease: Yamagata Prefectural Committee of Atypical Femoral Fractures (YamaCAFe) Study.

    Takakubo, Yuya; Ohta, Daichi; Ishi, Masaji; Ito, Juji; Oki, Hiroharu; Naganuma, Yasushi; Uno, Tomohiro; Sasaki, Akiko; Akabane, Takeru; Dairaku, Katsuyuki; Goto, Shinichi; Goto, Yasuo; Kanauchi, Yumiko; Kobayashi, Shinji; Nakajima, Taku; Masuda, Keiji; Matsuda, Michiharu; Mura, Nariyuki; Takenouchi, Kenji; Tsuchida, Hiroyuki; Onuma, Yasushi; Shibuya, Junichirou; Seino, Mitsuyoshi; Yamaguchi, Osamu; Hiragami, Ken; Urayama, Yasuhiro; Furukawa, Takashi; Okuda, Shouta; Ogura, Ken; Nakamura, Takeshi; Sasaki, Kan; Konta, Tsuneo; Takagi, Michiaki

    2017-08-01

    Atypical femoral fractures (AFFs) have been reported to occur with minimal or spontaneous subtrochanteric and femoral shaft fractures with a characteristic transverse pattern, compared with typical femoral fractures in young patients with high-energy trauma. AFFs are related to long-term use of bisphosphonates (BPs), glucocorticoids and rheumatic diseases. We have estimated a blind analysis of AFFs in rheumatic patients receiving BPs and glucocorticoids ordinary over a long time in all Yamagata prefectural area through radiographic examination. The 123 AFFs including suspected cases over six years were collected and reviewed by two independent orthopedic surgeons. We found 86 patients with a total of 99 AFFs between 2009 and 2014 (1.43 cases/100,000 person/year). Of these 99 AFFs, 11 were in 8 rheumatic patients including three patients with bilateral AFFs. The incidence of AFFs in rheumatic patients had trend to increase from 2012. The mean age of all 8 patients was 54.9 years. All 8 patients received BPs and 7/8 received prednisolone (PSL). The mean dose of PSL was 14 mg/day. Compared to patients with unilateral AFFs, those with bilateral AFFs in rheumatic patients were on a higher dose of PSL (20 mg/day vs. 7 mg/day) and had less femoral neck-shaft angle (129° vs. 136°, p rheumatic patients showed a trend to increase from 2012 to 2014 in Yamagata prefecture. Careful management of AFFs is of particular importance in rheumatic patients who have taken high doses of PSL and have small femoral neck-shaft angle.

  19. Sliding hip screw versus IM nail in reverse oblique trochanteric and subtrochanteric fractures. A study of 2716 patients in the Norwegian Hip Fracture Register.

    Matre, Kjell; Havelin, Leif Ivar; Gjertsen, Jan-Erik; Vinje, Tarjei; Espehaug, Birgitte; Fevang, Jonas Meling

    2013-06-01

    Intramedullary nailing is commonly recommended as the treatment of choice for transverse/reverse oblique trochanteric (AO/OTA type A3=intertrochanteric) and subtrochanteric fractures. However, only to a limited extent is this approach supported by superior results in well designed clinical trials, and the sliding hip screw (SHS) is still a frequently used implant for these fractures. The aim of the present study was to compare IM nails and SHS in the treatment of transverse/reverse oblique trochanteric and subtrochanteric fractures using data from the Norwegian Hip Fracture Register (NHFR). Data on 2716 operations for acute transverse/reverse oblique trochanteric or subtrochanteric fractures were collected from the NHFR from 2005 to 2010. Surgeons reported patient characteristics and details from initial surgery and reoperations, and patients answered questionnaires about pain, satisfaction, and quality of life (EQ-5D) 4, 12, and 36 months postoperatively. Reoperation rates were calculated using Kaplan-Meier analyses. Primary outcome measures were pain (Visual Analogue Scale (VAS)), satisfaction (VAS), quality of life (EQ-5D), and reoperation rates at one year. The treatment groups were similar regarding age, gender, ASA-class, cognitive impairment, and preoperative EQ-5Dindex score. At one year reoperation rates were 6.4% and 3.8% for SHS and IM nails, respectively (p=0.011). Patients treated with SHS also had slightly more pain (VAS 30 vs. 27, p=0.037) and were less satisfied (VAS 31 vs. 36, p=0.003) compared to patients treated with IM nail. There was no statistically significant difference in the EQ-5Dindex score, but the mobility was significantly better for the IM nail group. 12 months postoperatively patients with transverse/reverse oblique trochanteric and subtrochanteric fractures operated with a SHS had a higher reoperation rate compared to those operated with an IM nail. Small differences regarding pain, satisfaction, quality of life, and mobility were

  20. Patient information comes of age.

    Murphy, Jeannette

    2017-12-01

    This virtual issue (VI) has been assembled to coincide with the 8th Annual Patient Information Conference 2013 organised by the UK Patient Information Forum (PiF). The conference theme 'Information and support - a service in its own right' is a response to policy documents and initiatives in both Scotland and England which signal the coming of age of patient/consumer information. The VI consists of a collection of open access articles and addresses the question 'What can health science librarians do to ensure that the public are able to find, appraise and use health information?' This material provides research evidence, and examples of the types of initiatives librarians have undertaken to make information a health and care service in its own right. Two recurrent messages are that health science librarians need to form partnerships with healthcare providers and they have a role to play in improving health literacy skills. © 2013 The authors. Health Information and Libraries Journal © 2013 Health Libraries Group.

  1. Incidence and Imaging Findings of Costal Cartilage Fractures in Patients with Blunt Chest Trauma: A Retrospective Review of 1461 Consecutive Whole-Body CT Examinations for Trauma.

    Nummela, Mari T; Bensch, Frank V; Pyhältö, Tuomo T; Koskinen, Seppo K

    2018-02-01

    Purpose To assess the incidence of costal cartilage (CC) fractures in whole-body computed tomographic (CT) examinations for blunt trauma and to evaluate distribution of CC fractures, concomitant injuries, mechanism of injury, accuracy of reporting, and the effect on 30-day mortality. Materials and Methods Institutional review board approval was obtained for this retrospective study. All whole-body CT examinations for blunt trauma over 36 months were reviewed retrospectively and chest trauma CT studies were evaluated by a second reader. Of 1461 patients who underwent a whole-body CT examination, 39% (574 of 1461) had signs of thoracic injuries (men, 74.0% [425 of 574]; mean age, 46.6 years; women, 26.0% [149 of 574]; mean age, 48.9 years). χ 2 and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. Interobserver agreement was calculated by using Cohen kappa values. Results A total of 114 patients (men, 86.8% [99 of 114]; mean age, 48.6 years; women, 13.2% [15 of 114]; mean age, 45.1 years) had 221 CC fractures. The incidence was 7.8% (114 of 1461) in all whole-body CT examinations and 19.9% (114 of 574) in patients with thoracic trauma. Cartilage of rib 7 (21.3%, 47 of 221) was most commonly injured. Bilateral multiple consecutive rib fractures occurred in 36% (41 of 114) versus 14% (64 of 460) in other patients with chest trauma (OR, 3.48; 95% CI: 2.18, 5.53; P chest trauma with CC fractures (13%, 15 of 114) versus patients with chest trauma without CC fractures (4%, 18 of 460) (OR, 3.72; 95% CI: 1.81, 7.64; P = .0001), as well as aortic injuries (n = 4 vs n = 0; P = .0015; OR, unavailable). Kappa value for interobserver agreement in detecting CC fractures was 0.65 (substantial agreement). CC fractures were documented in 39.5% (45 of 114) of primary reports. The 30-day mortality of patients with CC fractures was 7.02% (eight of 114) versus 4.78% (22 of 460) of other patients with chest trauma (OR, 1.50; 95% CI: 0.65, 3.47; P = .3371). Conclusion

  2. A STUDY OF PRIMARY CEMENTED BIPOLAR HEMIARTHROPLASTY OF HIP IN ELDERLY PATIENTS WITH OSTEOPOROTIC, UNSTABLE INTERTROCHANTERIC FRACTURE

    Maheshwar

    2015-08-01

    Full Text Available BACKGROUND: Intertrochanteric fractures are a major cause of morbidity and mortality in geriatric population. Osteoporosis contributes significantly to the comminution and instability in such fractures. Internal fixations in unstable intertrochanteric fractures are a ssociated with high rates of implant failures and gross restriction of hip movements. This study was undertaken to evaluate the efficacy of cemented bipolar hemiart h roplasty in elderly patients with osteoporotic, unstable intertrochanteric fractures. PATIE NTS AND METHODS: 52 patients aged above 60 years with unstable, comminuted intertrochanteric fractures with Singh’s index < 4 were operated with primary cemented bipolar hemireplacement arthroplasty. All the patients were mobilized early with full weight b earing in the post - operative period as permitted. 50 patients were evaluated for the functional outcome with Harris Hip score. RESULTS: The average age of patients was 65 years with female predominance (64%. Left side (56% was commonly involved and the c ommonest mode of injury was due to a trivial fall at home. Hypertension (30% was the commonest co - morbid condition. Limb shortening was the commonest complication (8%. The mean ± S.D. of the Harris Hip score was 85.6 ± 10.59 with a range from 56 to 96. Resul ts were excellent in 62%, good in 22%, fair in 12% and poor in 4% of cases. CONCLUSION: Elderly osteoporotic patients with comminuted, unstable intertrochanteric fractures have an increased prevalence of unsatisfactory functional results with conventional internal fixation devices. Primary cemented bipolar hemiarthroplasty with anatomical reconstruction of the trochanters allows early mobilization, improved functional outcome with relatively low incidence of associated complications.

  3. Initial non-weight-bearing therapy is important for preventing vertebral body collapse in elderly patients with clinical vertebral fractures

    Kishikawa Y

    2012-04-01

    Full Text Available Yoichi KishikawaKishikawa Orthopaedic Clinic, Saga City, Saga, JapanPurpose: The aim of the present conventional observational study was to compare the clinical outcomes of initial non-weight-bearing therapy and conventional relative rest therapy among elderly patients with clinical vertebral fractures.Methods: In total, 196 consecutive patients with clinical vertebral fractures (mean age: 78 years who were hospitalized for treatment between January 1999 and March 2007 were analyzed. Initial non-weight-bearing therapy consisted of complete bed rest allowing rolling on the bed without any weight-bearing to the spine for 2 weeks, followed by rehabilitation wearing a soft brace. The indications for initial non-weight-bearing therapy were vertebral fracture involving the posterior portion of the vertebral body at the thoraco-lumbar spine, mild neurological deficit, instability of the fracture site, severe pain, multiple vertebral fractures arising from trauma, malalignment at the fracture site, and mild spinal canal stenosis caused by the fracture. Patients who met the indication criteria were treated with initial non-weight-bearing therapy (n = 103, while the other patients were treated with conventional relative rest (n = 93. All the patients were uniformly treated with intramuscular elcatonin to relieve pain. The primary endpoint was progression of the vertebral fracture. The secondary endpoints included bony union and subjective back pain. The follow-up period was 12 weeks.Results: Compared with the conventional relative rest group, the collapse rate of the anterior and posterior portions of the vertebral body was significantly smaller in the initial non-weight-bearing group. The bony union rate was 100% in the initial non-weight-bearing group and 97% in the conventional relative rest group. The number of patients who experienced back pain was significantly lower in the initial non-weight-bearing group than in the conventional relative rest

  4. Pressure ulcers are associated with 6-month mortality in elderly patients with hip fracture managed in orthogeriatric care pathway.

    Magny, Emmanuelle; Vallet, Helene; Cohen-Bittan, Judith; Raux, Mathieu; Meziere, Antony; Verny, Marc; Riou, Bruno; Khiami, Frédéric; Boddaert, Jacques

    2017-08-29

    Despite orthogeriatric management, 12% of the elderly experienced PUs after hip fracture surgery. PUs were significantly associated with a low albumin level, history of atrial fibrillation coronary artery disease, and diabetes. The risk ratio of death at 6 months associated with pressure ulcer was 2.38 (95% CI 1.31-4.32%, p = 0.044). Pressure ulcers in hip fracture patients are frequent and associated with a poor outcome. An orthogeriatric management, recommended by international guidelines in hip fracture patients and including pressure ulcer prevention and treatment, could influence causes and consequences of pressure ulcer. However, remaining factors associated with pressure ulcer occurrence and prognostic value of pressure ulcer in hip fracture patients managed in an orthogeriatric care pathway remain unknown. From June 2009 to April 2015, all consecutive patients with hip fracture admitted to a unit for Post-operative geriatric care were evaluated for eligibility. Patients were included if their primary presentation was due to hip fracture and if they were ≥ 70 years of age. Patients were excluded in the presence of pathological fracture or if they were already hospitalized at the time of the fracture. In our unit, orthogeriatric principles are implemented, including a multi-component intervention to improve pressure ulcer prevention and management. Patients were followed-up until 6 months after discharge. Five hundred sixty-seven patients were included, with an overall 14.4% 6-month mortality (95% CI 11.6-17.8%). Of these, 67 patients (12%) experienced at least one pressure ulcer. Despite orthogeriatric management, pressure ulcers were significantly associated with a low albumin level (RR 0.90, 95% CI 0.84-0.96; p = 0.003) and history of atrial fibrillation (RR 1.91, 95% CI 1.05-3.46; p = 0.033), coronary artery disease (RR 2.16, 95% CI 1.17-3.99; p = 0.014), and diabetes (RR 2.33, 95% CI 1.14-4.75; p = 0.02). A pressure ulcer was associated

  5. COMPARATIVE ANALYSIS OF TREATMENT OUTCOMES IN PATIENTS WITH TYPES B AND C PYLON FRACTURES

    V. V. Khominets

    2017-01-01

    Full Text Available Objective — to develop and implement improved approaches to the diagnosis and tactics of surgical treatment in patients with fractures of the distal tibia metaepiphysis.Material and methods. The study included 126 patients with fractures of distal tibia metaepiphysis of «B» and «C» types who underwent internal fixation with plates in 2005–2012. The authors analyzed surgical treatment outcomes within the period from 2.5 to 9 years (average of 5.7–2.3 years of postoperative follow up. Average age of patients was 23.4±2.1 years. Patients were divided into the main group (64 patients and the comparison group (62 patients. In the comparison group, traditional approaches to diagnosis and surgical treatment were used, including standard clinical examination and X-rays of the affected ankle in two views and the median access to the distal tibia metaepiphysis. In the main group, a specially elaborated algorithm for selection of optimal surgical tactics was utilized basing on the improved diagnostics program. Clinical and functional data were assessed by Foot and Ankle Outcome Score (FAOS and SF-36 Health Survey. Roentgenological assessment was done by X-rays and CT scans. Statistical significance of the differences was evaluated by Wald-Wolfowitz and Fisher tests.Results. Improved approaches to the tactics of surgical treatment in patients with pylon fractures of «B» and «C» types allowed to reduce the incidence of unsatisfactory anatomical and functional outcomes from 43.5% to 28.1%. The number of satisfactory and good outcomes increased by 4.7% and 10.7% respectively after application of improved therapeutic and diagnostic approaches.Conclusion. Proposed improved approaches to verification of severe intraarticular fractures of the distal tibia metabiphysis allowed to increase the informative value of the diagnostic procedures and to avoid discrepancies between preand intraoperative assessment of fracture type by classifications of M

  6. Perioperative mortality in hip fracture patients treated with cemented and uncemented hemiprosthesis: a register study of 11,210 patients.

    Talsnes, Ove; Vinje, Tarjei; Gjertsen, Jan Erik; Dahl, Ola E; Engesæter, Lars B; Baste, Valborg; Pripp, Are Hugo; Reikerås, Olav

    2013-06-01

    Adverse events associated with the use of bone cement for fixation of prostheses is a known complication. Due to inconclusive results in studies of hip fracture patients treated with cemented and uncemented hemiprostheses, this study was initiated. Our study is based on data reported to the Norwegian Hip Fracture Register on 11,210 cervical hip fractures treated with hemiprostheses (8,674 cemented and 2,536 uncemented). Significantly increased mortality within the first day of surgery was found in the cemented group (relative risk 2.9, 95 % confidence interval 1.6-5.1, p=0.001). The finding was robust giving the same results after adjusting for independent risk factors such as age, sex, cognitive impairment and comorbidity [American Society of Anesthesiologists (ASA) score]. For the first post-operative day the number needed to harm was 116 (one death for every 116 cemented prosthesis). However, in the most comorbid group (ASA worse than 3), the number needed to harm was only 33. We found increased mortality for the cemented hemiprosthesis the first post-operative day compared to uncemented procedures. This increased risk is closely related to patient comorbidity estimated by the patient's ASA score.

  7. CORRELATION BETWEEN TIME UNTIL SURGICAL TREATMENT AND MORTALITY AMONG ELDERLY PATIENTS WITH FRACTURES AT THE PROXIMAL END OF THE FEMUR.

    Arliani, Gustavo Gonçalves; da Costa Astur, Diego; Linhares, Glauber Kazuo; Balbachevsky, Daniel; Fernandes, Hélio Jorge Alvachian; Dos Reis, Fernando Baldy

    2011-01-01

    The primary aim of this study was to analyze the possible association between delay in receiving surgical treatment and mortality among elderly patients with fractures at the proximal end of the femur. 269 patients with fractures at the proximal end of the femur (femur neck and intertrochanteric fractures) who were treated surgically at Hospital São Paulo, UNIFESP, São Paulo, between January 2003 and December 2007, were studied. The following attributes were analyzed and compared with the literature relating to this subject: sex, age, type of fracture, classification of the fracture, affected side, synthesis used, trauma mechanism, length of hospitalization, waiting time for surgery, associated comorbidities, hemogram on admission, type of anesthesia, need for blood transfusion, day of the week and season of the year of the fracture. The study showed that higher mortality correlated with higher numbers of clinical comorbidities, longer hospitalization and use of general anesthesia during the surgery. There was no association between the time spent waiting for surgery and mortality.

  8. Thoracolumbar spine fractures in the geriatric fracture center : early ambulation leads to good results on short term and is a successful and safe alternative compared to immobilization in elderly patients with two-column vertebral fractures

    Weerink, L B M; Folbert, E C; Kraai, M; Smit, R S; Hegeman, J H; van der Velde, D

    INTRODUCTION: Thoracolumbar spine fractures are common osteoporotic fractures among elderly patients. Several studies suggest that these fractures can be treated successfully with a nonoperative management. The aim of this study is to evaluate the conservative treatment of elderly patients with a

  9. Risk of pneumonia in patients with isolated minor rib fractures: a nationwide cohort study.

    Ho, Sai-Wai; Teng, Ying-Hock; Yang, Shun-Fa; Yeh, Han-Wei; Wang, Yu-Hsun; Chou, Ming-Chih; Yeh, Chao-Bin

    2017-01-13

    Isolated minor rib fractures (IMRFs) after blunt chest traumas are commonly observed in emergency departments. However, the relationship between IMRFs and subsequent pneumonia remains controversial. This nationwide cohort study investigated the association between IMRFs and the risk of pneumonia in patients with blunt chest traumas. Nationwide population-based cohort study. Patients with IMRFs were identified between 2010 and 2011 from the Taiwan National Health Insurance Research Database. Non-traumatic patients were matched through 1:8 propensity-score matching according to age, sex, and comorbidities (namely diabetes, hypertension, cardiovascular disease, asthma and chronic obstructive pulmonary disease (COPD)) with the comparison cohort. We estimated the adjusted HRs (aHRs) by using the Cox proportional hazard model. A total of 709 patients with IMRFs and 5672 non-traumatic patients were included. The primary end point was the occurrence of pneumonia within 30 days. The incidence of pneumonia following IMRFs was 1.6% (11/709). The aHR for the risk of pneumonia after IMRFs was 8.94 (95% CI=3.79 to 21.09, ppneumonia following IMRFs. In the IMRF group, presence of single or two isolated rib fractures was associated with an increased risk of pneumonia with aHRs of 3.97 (95% CI 1.09 to 14.44, ppneumonia following IMRFs is low, patients with two isolated rib fractures were particularly susceptible to pneumonia. Physicians should focus on this complication, particularly in elderly patients and those with COPD. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  10. Preoperative cerebrospinal fluid cytokine levels and the risk of postoperative delirium in elderly hip fracture patients

    2013-01-01

    Background Aging and neurodegenerative disease predispose to delirium and are both associated with increased activity of the innate immune system resulting in an imbalance between pro- and anti-inflammatory mediators in the brain. We examined whether hip fracture patients who develop postoperative delirium have altered levels of inflammatory mediators in cerebrospinal fluid (CSF) prior to surgery. Methods Patients were 75 years and older and admitted for surgical repair of an acute hip fracture. CSF samples were collected preoperatively. In an exploratory study, we measured 42 cytokines and chemokines by multiplex analysis. We compared CSF levels between patients with and without postoperative delirium and examined the association between CSF cytokine levels and delirium severity. Delirium was diagnosed with the Confusion Assessment Method; severity of delirium was measured with the Delirium Rating Scale Revised-98. Mann–Whitney U tests or Student t-tests were used for between-group comparisons and the Spearman correlation coefficient was used for correlation analyses. Results Sixty-one patients were included, of whom 23 patients (37.7%) developed postsurgical delirium. Concentrations of Fms-like tyrosine kinase-3 (P=0.021), Interleukin-1 receptor antagonist (P=0.032) and Interleukin-6 (P=0.005) were significantly lower in patients who developed delirium postoperatively. Conclusions Our findings fit the hypothesis that delirium after surgery results from a dysfunctional neuroinflammatory response: stressing the role of reduced levels of anti-inflammatory mediators in this process. Trial registration The Effect of Taurine on Morbidity and Mortality in the Elderly Hip Fracture Patient. Registration number: NCT00497978. Local ethical protocol number: NL16222.094.07. PMID:24093540

  11. Concomitant upper limb fractures and short-term functional recovery in hip fracture patients: does the site of upper limb injury matter?

    Di Monaco, Marco; Castiglioni, Carlotta; Vallero, Fulvia; Di Monaco, Roberto; Tappero, Rosa

    2015-05-01

    The aim of this study was to evaluate functional recovery in a subgroup of hip fracture patients who sustained a simultaneous fracture at the upper limb, taking into account the site of upper limb injury. Of 760 patients admitted consecutively to the authors' rehabilitation hospital because of a fall-related hip fracture, 700 were retrospectively investigated. Functional outcome was assessed using Barthel Index scores. In 49 of the 700 patients, a single fall resulted in both a hip fracture and a fracture of either wrist (n = 34) or proximal humerus (n = 15). The patients with concomitant shoulder fractures had lower median Barthel Index scores after rehabilitation (70 vs. 90, P = 0.003), lower median Barthel Index effectiveness (57.1 vs. 76.9, P = 0.018), and prolonged median length of stay (42 vs. 36 days, P = 0.011) than did the patients with isolated hip fractures. Significant differences persisted after adjustment for six potential confounders. The adjusted odds ratio for achieving a Barthel Index score lower than 85 was 6.71 (95% confidence interval, 1.68-26.81; P = 0.007) for the patients with concomitant shoulder fractures. Conversely, no prognostic disadvantages were associated with concomitant wrist fractures. Data show a worse functional recovery and a prolonged length of stay in the subgroup of hip fracture patients who sustained a concomitant fracture at the proximal humerus, but not at the wrist.

  12. Knee-extension strength, postural control and function are related to fracture type and thigh edema in patients with hip fracture

    Kristensen, Morten T; Bandholm, Thomas; Bencke, Jesper

    2008-01-01

    BACKGROUND: Post-surgery thigh edema, loss of knee-extension strength, and reduced physical performance are common following a hip fracture. It is not known if knee-extension strength and physical performance are related to the edema and fracture type. The aim of this study was to examine...... the influence of fracture type and post-surgery edema on physical performances in patients with hip fracture. METHODS: Fifteen women and five men admitted from their own home to an acute orthopedic hip fracture unit were examined. Ten had cervical and ten had intertrochanteric fractures. Correlations between...... fracture type and thigh edema in the fractured limb (% non-fractured) to physical performances of basic mobility, postural control (sway), and isometric knee-extension strength were examined. All measures, except those of basic mobility, were conducted at the time of discharge, 8.5 days post...

  13. Complete Remodeling After Conservative Treatment of a Severely Angulated Odontoid Fracture in a Patient With Osteogenesis Imperfecta: A Case Report.

    Colo, Dino; Schlösser, Tom P C; Oostenbroek, Hubert J; Castelein, René M

    2015-09-15

    Case report. This is the first case report describing successful healing and remodeling of a traumatic odontoid fracture that was dislocated and severely angulated in a patient with osteogenesis imperfecta who was treated conservatively. Osteogenesis imperfecta (OI) is a rare genetic disorder resulting in a low bone mass and bone fragility, predisposing these patients to fractures that often occur at a young age. Although any bone in the body may be involved, odontoid fractures are uncommon in this population. Because of a very high fusion rate, conservative management is accepted as a safe and efficient treatment of fractures of the odontoid in children. Several authors, however, recommend surgical treatment of patients who have failure of conservative treatment and have severe angulation or displacement of the odontoid. A 5-year-old female, diagnosed with OI type I, presented with neck pain without any neurological deficits after falling out of a rocking chair backward, with her head landing first on the ground. Computed tomography confirmed a type III odontoid fracture without dislocation and she was initially treated with a rigid cervical orthosis. At 1 and 2 months of follow-up, progressive severe angulation of the odontoid was observed but conservative treatment was maintained as the space available for the spinal cord was sufficient and also considering the patient's history of OI. Eight months postinjury, she had no clinical symptoms and there was osseous healing of the fracture with remodeling of the odontoid to normal morphology. Even in patients with OI, severely angulated odontoid fractures might have the capacity for osseous healing and complete remodeling under conservative treatment. 5.

  14. frequency of ipsilateral femoral neck fractures in patients

    Background: Ipsilateral associated femoral neck and shaft fractures are reported to occur in 2.5-6% of all femoral shaft ... nailing of the shaft fracture, which makes treatment of the neck ... chest, spine), while the other had maxillofacial injuries.

  15. Subtrochanteric and Distal Femur Fractures in a Patient with ...

    This study reports the surgical management for this rare case and the treatment ... car accident and presented closed femoral shaft fracture associated with a ... to fix the distal femur fracture, enhancing the construction stability [Figures 4 and 5].

  16. Effect of aging time and aging temperature on fatigue and fracture behavior of 6063 aluminum alloy under seawater influence

    Siddiqui, R.A.; Abdul-Wahab, S.A.; Pervez, T.

    2008-01-01

    This paper describes experimentally the effect of seawater corrosion, aging time, and aging temperature on the fatigue resistance property of 6063 aluminum alloy. The 6063 aluminum alloy that was used for the study was heat treated and soaked in seawater for different intervals of time between 2 and 30 weeks. It was found that the maximum fatigue resistance property in the 6063 aluminum alloy was observed when aged between 7 and 9 h and heat treated at temperatures between 160 o C and 200 o C. Generally at constant load, the results indicated that the number of cycles to fail the 6063 aluminum alloy decreased with increasing the soaking time in seawater. Moreover, fracture surfaces were considered and studied under a scanning electron microscope (SEM). The results showed that the brittle fracture pattern tended to occur with the increase in aging time and temperature. The fatigue striations were observed very clearly at low and peak aging temperature. The increase in the fatigue resistance property with aging time was linked with the vacancies assisted diffusion mechanism and also by the hindering of dislocation movement by impure atoms

  17. Comparative Analysis of the Paravertebral Analgesic Pump Catheter with the Epidural Catheter in Elderly Trauma Patients with Multiple Rib Fractures.

    Shapiro, Brian S; Wasfie, Tarik; Chadwick, Mathew; Barber, Kimberly R; Yapchai, Raquel

    2017-04-01

    Presently, trauma guidelines recommend epidural analgesia as the optimal modality of pain relief from rib fractures. They are not ideally suited for elderly trauma patients and have disadvantages including bleeding risk. The paravertebral analgesic pump (PVP) eliminates such disadvantages and includes ease of placement in the trauma setting. This study compares pain control in patients treated by EPI versus PVP. This is a retrospective, historical cohort study comparing two methods of pain management in the trauma setting. Before 2010, patients who had epidural catheters (EPI) placed for pain control were compared with patients after 2010 in which the PVP was used. All patients had multiple rib fractures as diagnosed by CT scan. Analysis was adjusted for age, number of fractures, and comorbid conditions. Multiple linear regression analysis was conducted to compare average reported pain. A total of 110 patients, 31 PVP and 79 epidural catheters, were included in the study. Overall mean age was 65 years. The mean Injury Severity Score was 12.0 (EPI) and 11.1 (PVP). Mean number rib fractures was 4.29 (EPI) and 4.71 (PVP). PVP was associated with a 30 per cent greater decrease in pain than that seen with EPI (6.0-1.9 vs 6.4-3.4). After controlling for age, Injury Severity Score, and number of rib fractures, there were no differences in intensive care unit or total length of stay (P = 0.35) or in pain score (3.76 vs 3.56, P = 0.64). In conclusion, the PVP compares well with epidural analgesia in older trauma patients yet is safe, well tolerated, and easily inserted.

  18. Cough-induced rib fractures.

    Hanak, Viktor; Hartman, Thomas E; Ryu, Jay H

    2005-07-01

    To define the demographic, clinical, and radiological features of patients with cough-induced rib fractures and to assess potential risk factors. For this retrospective, single-center study, we identified all cases of cough-induced rib fractures diagnosed at the Mayo Clinic in Rochester, Minn, over a 9-year period between January 1, 1996, and January 31, 2005. Bone densitometry data from patients' medical records were analyzed, and T scores were used to classify patients into bone density categories. The mean +/- SD age of the 54 study patients at presentation was 55+/-17 years, and 42 patients (78%) were female. Patients presented with chest wall pain after onset of cough. Rib fracture was associated with chronic cough (> or =3 weeks' duration) in 85% of patients. Rib fractures were documented by chest radiography, rib radiography, computed tomography, or bone scan. Chest radiography had been performed in 52 patients and revealed rib fracture in 30 (58%). There were 112 fractured ribs in 54 patients. One half of patients had more than one fractured rib. Right-sided rib fractures alone were present in 17 patients (26 fractured ribs), left-sided in 23 patients (35 fractured ribs), and bilateral in 14 patients (51 fractured ribs). The most commonly fractured rib on both sides was rib 6. The fractures were most common at the lateral aspect of the rib cage. Bone densitometry was done in 26 patients and revealed osteopenia or osteoporosis in 17 (65%). Cough-induced rib fractures occur primarily in women with chronic cough. Middle ribs along the lateral aspect of the rib cage are affected most commonly. Although reduced bone density is likely a risk factor, cough-induced rib fractures can occur in the presence of normal bone density.

  19. Preferences of older patient regarding hip fracture rehabilitation service configuration: A feasibility discrete choice experiment.

    Charles, Joanna M; Roberts, Jessica L; Din, Nafees Ud; Williams, Nefyn H; Yeo, Seow Tien; Edwards, Rhiannon T

    2018-05-14

    As part of a wider feasibility study, the feasibility of gaining older patients' views for hip fracture rehabilitation services was tested using a discrete choice experiment in a UK context. Discrete choice experiment is a method used for eliciting individuals' preferences about goods and services. The discrete choice experiment was administered to 41 participants who had experienced hip fracture (mean age 79.3 years; standard deviation (SD) 7.5 years), recruited from a larger feasibility study exploring a new multidisciplinary rehabilitation for hip fracture. Attributes and levels for this discrete choice experiment were identified from a systematic review and focus groups. The questionnaire was administered at the 3-month follow-up. Participants indicated a significant preference for a fully-qualified physiotherapist or occupational therapist to deliver the rehabilitation sessions (β = 0·605, 95% confidence interval (95% CI) 0.462-0.879), and for their rehabilitation session to last less than 90 min (β = -0.192, 95% CI -0.381 to -0.051). The design of the discrete choice experiment using attributes associated with service configuration could have the potential to inform service implementation, and assist rehabilitation service design that incorporates the preferences of patients.

  20. Prediction of postoperative morbidity, mortality and rehabilitation in hip fracture patients: the cumulated ambulation score

    Foss, Nicolai Bang; Kristensen, Morten Tange; Kehlet, Henrik

    2006-01-01

    fracture patients with an independent walking function admitted from their own home. Rehabilitation followed a well-defined multimodal rehabilitation regimen and discharge criteria. MAIN OUTCOME MEASURE: Admission tests with a new mobility score to assess prefracture functional mobility and a short mental......OBJECTIVE: To validate the cumulated ambulation score as an early postoperative predictor of short-term outcome in hip fracture patients. DESIGN: Prospective, descriptive study. SETTING: An orthopaedic hip fracture unit in a university hospital. PATIENTS: Four hundred and twenty-six consecutive hip...... of short-term postoperative outcome after hip fracture surgery....

  1. Bone scan as a screening test for missed fractures in severely injured patients.

    Lee, K-J; Jung, K; Kim, J; Kwon, J

    2014-12-01

    In many cases, patients with severe blunt trauma have multiple fractures throughout the body. These fractures are not often detectable by history or physical examination, and their diagnosis can be delayed or even missed. Thus, screening test fractures of the whole body is required after initial management. We performed this study to evaluate the reliability of bone scans for detecting missed fractures in patients with multiple severe traumas and we analyzed the causes of missed fractures by using bone scan. A bone scan is useful as a screening test for fractures of the entire body of severe trauma patients who are passed the acute phase. We reviewed the electronic medical records of severe trauma patients who underwent a bone scan from September 2009 to December 2010. Demographic and medical data were compared and statistically analyzed to determine whether missed fractures were detected after bone scan in the two groups. A total of 382 patients who had an injury severity score [ISS] greater than 16 points with multiple traumas visited the emergency room. One hundred and thirty-one patients underwent bone scan and 81 patients were identified with missed fractures by bone scan. The most frequent location for missed fractures was the rib area (55 cases, 41.98%), followed by the extremities (42 cases, 32.06%). The missed fractures that required surgery or splint were most common in extremities (11 cases). In univariate analysis, higher ISS scores and mechanism of injury were related with the probability that missed fractures would be found with a bone scan. The ISS score was statistically significant in multivariate analysis. Bone scan is an effective method of detecting missed fractures among patients with multiple severe traumas. Level IV, retrospective study. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  2. Sarcopenia in patients with hip fracture: A multicenter cross-sectional study

    Steihaug, Ole Martin; Gjesdal, Clara Gram; Bogen, Bård Erik; Kristoffersen, Målfrid Holen; Lien, Gunhild; Ranhoff, Anette Hylen

    2017-01-01

    Background: Sarcopenia is prevalent in older persons and is a risk factor for falls, fractures, and mortality. The aim of this study was to determine a) the feasibility of determining sarcopenia in patients with acute hip fracture, b) the prevalence of sarcopenia and c) associations of sarcopenia with nutritional status and comorbidities. Methods: A multicenter cross-sectional study on sarcopenia in male and female patients with acute hip fracture. Participants were previously ambulatory a...

  3. The Risk of Fractures Among Patients With Cirrhosis or Chronic Pancreatitis

    Bang, Ulrich Christian; Benfield, Thomas; Bendtsen, Flemming

    2014-01-01

    BACKGROUND & AIMS: Cirrhosis and chronic pancreatitis (CP) are accompanied by inflammation and malnutrition. Both conditions can have negative effects on bone metabolism and promote fractures. We evaluated the risk of fractures among patients with CP or cirrhosis and determined the effect of fat...... individuals younger than 50 years old. Alcohol as an etiology was associated with an increased risk of fracture compared with patients with nonalcoholic cirrhosis (HR, 2.4 vs 1.5; P

  4. Patients with rett syndrome sustain low-energy fractures

    Roende, Gitte; Ravn, Kirstine; Fuglsang, Kathrine

    2011-01-01

    We present the first case-control study addressing both fracture occurrence and fracture mechanisms in Rett syndrome (RTT). Two previous studies have shown increased fracture risk in RTT. This was also our hypothesis regarding the Danish RTT population. Therefore, we investigated risk factors...

  5. Deep vein thrombosis in bilateral lower extremities after hip fracture: a retrospective study of 463 patients

    Zhang BF

    2018-04-01

    Full Text Available Bin-Fei Zhang,* Xing Wei,* Hai Huang, Peng-Fei Wang, Ping Liu, Shuang-Wei Qu, Jia-Hao Li, Hu Wang, Yu-Xuan Cong, Yan Zhuang, Kun Zhang Department of Orthopedic Trauma, Hong-Hui Hospital, Xi’an Jiaotong University College of Medicine, Beilin District, Xi’an, Shaanxi, China *These authors contributed equally to this work Objective: To investigate the incidences of deep vein thrombosis (DVT before and after operation in inpatients with hip fractures in both lower extremities.Patients and methods: We collected the clinical data of 463 patients with lower extremities fractures who presented at Xi’an Honghui Hospital between July 1, 2014, and October 31, 2016 and met all the inclusion criteria. Doppler ultrasonography was used to diagnose DVT. The patients were examined preoperatively and postoperatively and divided into the thrombosis and non-thrombosis group according to the ultrasonographic findings. We divided the DVT cases into central, peripheral, and mixed thromboses.Results: The incidence of preoperative DVT was 34.98%, and the prevalence of DVT on the uninjured side was 13.60%. This composition ratio increased to 57.23% postoperatively, and the prevalence of DVT on the uninjured side was 25.05%. Age (odds ratio [OR], 1.03; 95% CI: 1.01–1.04; P=0.002, venous thrombosis at admission (OR, 4.05; 95% CI, 2.30–7.13; P=0.000, and the days between the fracture and the operation (OR, 1.10; 95% CI, 1.02–1.20; P=0.020 were the independent risk factors of preoperative DVT. Coronary heart disease (OR, 1.85; 95% CI: 1.18–2.89; P=0.007, venous thrombosis at admission (OR, 22.35; 95% CI: 6.78–73.60; P=0.000, days between fracture and operation (OR, 1.06; 95% CI: 1.01–1.11; P=0.021, and blood loss (OR, 1.002; 95% CI: 1.000–1.003; P=0.014 were independent risk factors of postoperative DVT.Conclusion: The actual incidence of DVT after hip fracture may be underestimated. The incidences of preoperative and postoperative DVTs and the incidence

  6. Spontaneous rib fractures.

    Katrancioglu, Ozgur; Akkas, Yucel; Arslan, Sulhattin; Sahin, Ekber

    2015-07-01

    Other than trauma, rib fracture can occur spontaneously due to a severe cough or sneeze. In this study, patients with spontaneous rib fractures were analyzed according to age, sex, underlying pathology, treatment, and complications. Twelve patients who presented between February 2009 and February 2011 with spontaneous rib fracture were reviewed retrospectively. The patients' data were evaluated according to anamnesis, physical examination, and chest radiographs. The ages of the patients ranged from 34 to 77 years (mean 55.91 ± 12.20 years), and 7 (58.4%) were male. All patients had severe cough and chest pain. The fractures were most frequently between 4th and 9th ribs; multiple rib fractures were detected in 5 (41.7%) patients. Eight (66.7%) patients had chronic obstructive pulmonary disease, 2 (16.7%) had bronchial asthma, and 2 (16.7%) had osteoporosis. Bone densitometry revealed a high risk of bone fracture in all patients. Patients with chronic obstructive pulmonary disease or bronchial asthma had been treated with high-dose steroids for over a year. Spontaneous rib fracture due to severe cough may occur in patients with osteoporosis, chronic obstructive pulmonary disease, or bronchial asthma, receiving long-term steroid therapy. If these patients have severe chest pain, chest radiography should be performed to check for bone lesions. © The Author(s) 2015.

  7. Consequences of quality of reduction on osteosynthesis complications and quality of life in elderly patients with subtrochanteric fracture.

    Codesido-Vilar, P; Mejía-Casado, A; Riego-Fernández, J; Rodriguez-Casas, N; García-Cabanas, S; Rivas-Felice, J; García-Quevedo, L

    2018-05-18

    To compare results in terms of orthopaedic complications and quality of life in elderly patients with subtrochanteric fracture treated with intramedullary nailing according to fracture reduction status. A prospective cohort study including 90 elderly patients with subtrochanteric fractures of the femur treated with a cephalomedullary nail, with a minimum 1-year follow up. The inclusion criteria were: aged 60 years or older, without severe cognitive dysfunction and independent ambulatory capability before the fracture. We defined 3different groups in relation to fracture reduction status: good, acceptable and poor, according to modified criteria from Baumgartner et al. We compared clinical and surgical characteristics and healthy quality of life, social function and mobility according to the EQ-5D, Jensen Index and Mobility Score of Parker and Palmer questionnaires. We found differences in time to union, better in the good reduction group (P=.002); need for open reduction, more frequent in the good reduction group (P<.001), and in postoperative complications, more frequent in the poor reduction group (P=.001). We found no significant differences between the 3groups regarding scores in quality of life, social function and mobility. Reduction in subtrochanteric fractures in older people is key to obtaining better clinic and surgical results, improving time to union and decreasing surgical complications. Exposure of the focus fracture seems to be a safe manoeuvre. Quality of life had substantially deteriorated n these patients, but a there was a tendency, although not statistically significant, for it to improve in patients after good surgical reduction. Copyright © 2018 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.

  8. P2Y12 Receptor Antagonist, Clopidogrel, Does Not Contribute to Risk of Osteoporotic Fractures in Stroke Patients

    Jørgensen, Niklas R; Schwarz, Peter; Iversen, Helle K

    2017-01-01

    Background: Stroke is a leading cause of mortality and morbidity. It is associated with excessive bone loss and risk of fracture in stroke patients is high. The P2Y12R antagonist and platelet inhibitor, clopidogrel, is widely used for secondary prevention after a stroke. However, recent studies...... have shown that clopidogrel has negative effects on bone and that long-term clopidogrel use is associated with increased fracture risk. The purpose of the current study was therefore to investigate the association of clopidogrel treatment with risk of fractures in stroke and TIA patients.......Methods:The study was a cohort study including all subjects who were prescribed clopidogrel between 1996 and 2008 in Denmark (n= 77,503). Age- and gender matched controls (n= 232,510) were randomly selected from the background population. The study end-points were occurrence of stroke or TIA and occurrence...

  9. Outcome of management of distal radius fractures in ...

    Background and Purpose: Distal radial fractures are common fractures of postmenopausal age group patients. They are often called fractures of osteoporosis. These fractures are considered to be one of the commonest minor injuries to cause major morbidity in the community. A lot of patient who need surgery, fail to afford ...

  10. Risk Prediction of New Adjacent Vertebral Fractures After PVP for Patients with Vertebral Compression Fractures: Development of a Prediction Model

    Zhong, Bin-Yan; He, Shi-Cheng; Zhu, Hai-Dong; Wu, Chun-Gen; Fang, Wen; Chen, Li; Guo, Jin-He; Deng, Gang; Zhu, Guang-Yu; Teng, Gao-Jun

    2017-01-01

    PurposeWe aim to determine the predictors of new adjacent vertebral fractures (AVCFs) after percutaneous vertebroplasty (PVP) in patients with osteoporotic vertebral compression fractures (OVCFs) and to construct a risk prediction score to estimate a 2-year new AVCF risk-by-risk factor condition.Materials and MethodsPatients with OVCFs who underwent their first PVP between December 2006 and December 2013 at Hospital A (training cohort) and Hospital B (validation cohort) were included in this study. In training cohort, we assessed the independent risk predictors and developed the probability of new adjacent OVCFs (PNAV) score system using the Cox proportional hazard regression analysis. The accuracy of this system was then validated in both training and validation cohorts by concordance (c) statistic.Results421 patients (training cohort: n = 256; validation cohort: n = 165) were included in this study. In training cohort, new AVCFs after the first PVP treatment occurred in 33 (12.9%) patients. The independent risk factors were intradiscal cement leakage and preexisting old vertebral compression fracture(s). The estimated 2-year absolute risk of new AVCFs ranged from less than 4% in patients with neither independent risk factors to more than 45% in individuals with both factors.ConclusionsThe PNAV score is an objective and easy approach to predict the risk of new AVCFs.

  11. Risk Prediction of New Adjacent Vertebral Fractures After PVP for Patients with Vertebral Compression Fractures: Development of a Prediction Model

    Zhong, Bin-Yan; He, Shi-Cheng; Zhu, Hai-Dong [Southeast University, Department of Radiology, Medical School, Zhongda Hospital (China); Wu, Chun-Gen [Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Department of Diagnostic and Interventional Radiology (China); Fang, Wen; Chen, Li; Guo, Jin-He; Deng, Gang; Zhu, Guang-Yu; Teng, Gao-Jun, E-mail: gjteng@vip.sina.com [Southeast University, Department of Radiology, Medical School, Zhongda Hospital (China)

    2017-02-15

    PurposeWe aim to determine the predictors of new adjacent vertebral fractures (AVCFs) after percutaneous vertebroplasty (PVP) in patients with osteoporotic vertebral compression fractures (OVCFs) and to construct a risk prediction score to estimate a 2-year new AVCF risk-by-risk factor condition.Materials and MethodsPatients with OVCFs who underwent their first PVP between December 2006 and December 2013 at Hospital A (training cohort) and Hospital B (validation cohort) were included in this study. In training cohort, we assessed the independent risk predictors and developed the probability of new adjacent OVCFs (PNAV) score system using the Cox proportional hazard regression analysis. The accuracy of this system was then validated in both training and validation cohorts by concordance (c) statistic.Results421 patients (training cohort: n = 256; validation cohort: n = 165) were included in this study. In training cohort, new AVCFs after the first PVP treatment occurred in 33 (12.9%) patients. The independent risk factors were intradiscal cement leakage and preexisting old vertebral compression fracture(s). The estimated 2-year absolute risk of new AVCFs ranged from less than 4% in patients with neither independent risk factors to more than 45% in individuals with both factors.ConclusionsThe PNAV score is an objective and easy approach to predict the risk of new AVCFs.

  12. [Close reduction combined with minimally invasive percutaneous plate osteosynthesis for proximal and distal tibial fractures: a report of 56 patients].

    Liu, Yin-Wen; Kuang, Yong; Gu, Xin-Feng; Zheng, Yu-Xin; Li, Zhi-Qiang; Wei, Xiao-En; Zhang, Ming-Cai; Zhan, Hong-Sheng; Shi, Yin-yu

    2013-03-01

    To evaluate the clinical effects of close reduction combined with minimally invasive percutanous plate osteosynthesis (MIPPO) for proximal and distal tibial fractures. From March 2007 to December 2010, 56 patients with proximal and distal tibial fractures were treated with close reduction combined with MIPPO technique. There were 39 males and 17 females,aged from 22 to 67 years with an average of 41.3 years. Left fracture was in 25 cases and right fracture was in 31 cases; proximal tibial fracture was in 15 cases and distal tibial fractures was in 41 cases; 34 cases caused by fall down and 22 cases caused by road accident. The mean time from injury to operation was 1.7 d. Clinical manifestation included pain, swelling of leg with limitation of activity. According to the standard of Johner-Wruhs, clinical effects were evaluated. The mean operative time was 46 min in 56 patients. All fractures obtained satisfactory reduction and the location of plate was good. Incisions healed with one-stage and no superficial or deep infection was found. All the patients were followed up from 8 to 23 months with an average of 14.2 months. Only one fracture complication with delayed union,and after auto grafting with ilium bone,the fracture got union. Other 55 cases obtained bone healing in 15 to 20 weeks after operation and no internal fixation failure was found. The time of walking was 4-6 months after operation,without limping at 7 months after operation. Both lower extremities were symmetrical and the function of knee and ankle got complete recovery. According to the criteria of Johner-Wruhs score,46 cases obtained excellent results,9 good and 2 fair. Treatment of proximal and distal tibial fractures with close reduction and MIPPO technique can not only preserve soft tissue,simplify operative procedure and decrease wound, but also can obtain rigid internal fixation and guarantee early function exercises of knee and ankle joints. The method has the advantages of less soft tissue

  13. Oral hygiene of hospitalised older patients with lower limb fracture.

    Ewan, Victoria; Newton, Julia L; Rushton, Steven; Walls, Angus W G

    2016-11-01

    good oral hygiene is important for eating, talking and improved quality of life, and is part of basic patient care, but there are few observational studies in hospitalised older patients. The aim of this study is to investigate dental plaque load in older patients over time in hospital. we examined the mouths of 93 patients with lower limb fracture prospectively at day 1, 7 and 14 after admission in a Newcastle upon Tyne Hospital. We assessed dental and denture plaque load, dry mouth symptoms and tooth number, along with demographic and frailty variables. We used univariate generalised linear modelling and mixed effects models to investigate associations between increased plaque and patient characteristics. in dentate patients, plaque score increased with time in hospital (P = 0.007, odds ratio (OR): 1.02; 95% confidence of interval (CI): 1.01-1.04). Frailty (P = 0.015, OR: 1.19; 95% CI: 1.04-1.37), dementia (P < 0.001, OR: 4.30; 95% CI: 2.03-9.12), residence in an institution (P < 0.001, OR: 4.61; 95% CI: 2.18-9.74), decreased mobility (P = 0.013, OR: 0.97; 95% CI: 0.96-0.99), but not Charlson comorbidity index (P = 0.102, OR: 1.08; 95% CI: 0.99-1.19), were associated with increased plaque scores at every time point. oral hygiene deteriorated in dentate patients in hospital. Plaque scores were significantly higher in patients who were more likely to be dependent on others for their oral hygiene. © The Author 2016. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  14. Four Weeks in a Single-Leg Weight-Bearing Hip Spica Cast is Sufficient Treatment for Isolated Femoral Shaft Fractures in Children Aged 1 to 3 Years.

    Jaafar, Sami; Sobh, Ali; Legakis, Julie E; Thomas, Ronald; Buhler, Kelsey; Jones, Eric T

    2016-01-01

    Hip spica casting regimens for the treatment of femoral shaft fractures in a pediatric population aged 1 to 3 years vary. Patient charts were reviewed to determine if there are any clinical differences between 3 and 4 weeks in an ambulatory single-leg hip spica (SLHS) cast versus 6 to 8 weeks in a standard double-leg, non-weight-bearing hip spica cast. The medical records of 109 patients with femoral shaft fractures treated with a hip spica casting from January 1, 2008 to December 31, 2011 were examined. After exclusions, 94 patients were eligible for inclusion in the study. Patient records were assessed, noting age, weight, type of cast, time in cast, and complications. All casts were applied by senior pediatric orthopaedic surgeons at a single institution. Two groups were evaluated: 59 patients in the SLHS group and 35 in the double-leg hip spica group. The 2 groups were demographically similar with an average age of 2 years, 70.2% of patients were male, 45.7% were black, and 35.1% were white. The average time to cast removal was 4.1 weeks for the single-leg group and 5.3 weeks for the double-leg group (Pshaft fractures in patients less than 4 years old can be treated in a weight-bearing SLHS casts for approximately 4 weeks with fewer alignment and skin complications. Level III-clinical retrospective comparative study.

  15. Geriatric Trauma Patients With Cervical Spine Fractures due to Ground Level Fall: Five Years Experience in a Level One Trauma Center.

    Wang, Hao; Coppola, Marco; Robinson, Richard D; Scribner, James T; Vithalani, Veer; de Moor, Carrie E; Gandhi, Raj R; Burton, Mandy; Delaney, Kathleen A

    2013-04-01

    It has been found that significantly different clinical outcomes occur in trauma patients with different mechanisms of injury. Ground level falls (GLF) are usually considered "minor trauma" with less injury occurred in general. However, it is not uncommon that geriatric trauma patients sustain cervical spine (C-spine) fractures with other associated injuries due to GLF or less. The aim of this study is to determine the injury patterns and the roles of clinical risk factors in these geriatric trauma patients. Data were reviewed from the institutional trauma registry of our local level 1 trauma center. All patients had sustained C-spine fracture(s). Basic clinical characteristics, the distribution of C-spine fracture(s), and mechanism of injury in geriatric patients (65 years or older) were compared with those less than 65 years old. Furthermore, different clinical variables including age, gender, Glasgow coma scale (GCS), blood alcohol level, and co-existing injuries were analyzed by multivariate logistic regression in geriatric trauma patients due to GLF and internally validated by random bootstrapping technique. From 2006 - 2010, a total of 12,805 trauma patients were included in trauma registry, of which 726 (5.67%) had sustained C-spine fracture(s). Among all C-spine fracture patients, 19.15% (139/726) were geriatric patients. Of these geriatric patients 27.34% (38/139) and 53.96% (75/139) had C1 and C2 fractures compared with 13.63% (80/587) and 21.98% (129/587) in young trauma patients (P geriatric trauma patients 13.67% (19/139) and 18.71% (26/139) had C6 and C7 fractures compared with 32.03% (188/587) and 41.40% (243/587) in younger ones separately (P geriatric patients had sustained C-spine fractures due to GLF with more upper C-spine fractures (C1 and C2). Only 3.2% of those had positive blood alcohol levels compared with 52.9% of younger patients (P geriatric patients due to GLF had intracranial pathology (ICP) which was one of the most common co

  16. Effect of oral taurine on morbidity and mortality in elderly hip fracture patients: a randomized trial

    van Stijn, Mireille F. M.; Bruins, Arnoud A.; Vermeulen, Mechteld A. R.; Witlox, Joost; Teerlink, Tom; Schoorl, Margreet G.; de Bandt, Jean Pascal; Twisk, Jos W. R.; van Leeuwen, Paul A. M.; Houdijk, Alexander P. J.

    2015-01-01

    Hip fracture patients represent a large part of the elderly surgical population and face severe postoperative morbidity and excessive mortality compared to adult surgical hip fracture patients. Low antioxidant status and taurine deficiency is common in the elderly, and may negatively affect

  17. Prediction of postoperative morbidity, mortality and rehabilitation in hip fracture patients

    Foss, Nicolai B; Kristensen, Morten T; Kehlet, Henrik

    2006-01-01

    To validate the cumulated ambulation score as an early postoperative predictor of short-term outcome in hip fracture patients.......To validate the cumulated ambulation score as an early postoperative predictor of short-term outcome in hip fracture patients....

  18. Paratrooper's ankle fracture: posterior malleolar fracture.

    Young, Ki Won; Kim, Jin-su; Cho, Jae Ho; Kim, Hyung Seuk; Cho, Hun Ki; Lee, Kyung Tai

    2015-03-01

    We assessed the frequency and types of ankle fractures that frequently occur during parachute landings of special operation unit personnel and analyzed the causes. Fifty-six members of the special force brigade of the military who had sustained ankle fractures during parachute landings between January 2005 and April 2010 were retrospectively analyzed. The injury sites and fracture sites were identified and the fracture types were categorized by the Lauge-Hansen and Weber classifications. Follow-up surveys were performed with respect to the American Orthopedic Foot and Ankle Society ankle-hindfoot score, patient satisfaction, and return to preinjury activity. The patients were all males with a mean age of 23.6 years. There were 28 right and 28 left ankle fractures. Twenty-two patients had simple fractures and 34 patients had comminuted fractures. The average number of injury and fractures sites per person was 2.07 (116 injuries including a syndesmosis injury and a deltoid injury) and 1.75 (98 fracture sites), respectively. Twenty-three cases (41.07%) were accompanied by posterior malleolar fractures. Fifty-five patients underwent surgery; of these, 30 had plate internal fixations. Weber type A, B, and C fractures were found in 4, 38, and 14 cases, respectively. Based on the Lauge-Hansen classification, supination-external rotation injuries were found in 20 cases, supination-adduction injuries in 22 cases, pronation-external rotation injuries in 11 cases, tibiofibular fractures in 2 cases, and simple medial malleolar fractures in 2 cases. The mean follow-up period was 23.8 months, and the average follow-up American Orthopedic Foot and Ankle Society ankle-hindfoot score was 85.42. Forty-five patients (80.36%) reported excellent or good satisfaction with the outcome. Posterior malleolar fractures occurred in 41.07% of ankle fractures sustained in parachute landings. Because most of the ankle fractures in parachute injuries were compound fractures, most cases had to

  19. Locking plate fixation in distal metaphyseal tibial fractures: series of 79 patients.

    Gupta, Rakesh K; Rohilla, Rajesh Kumar; Sangwan, Kapil; Singh, Vijendra; Walia, Saurav

    2010-12-01

    Open reduction and internal fixation in distal tibial fractures jeopardises fracture fragment vascularity and often results in soft tissue complications. Minimally invasive osteosynthesis, if possible, offers the best possible option as it permits adequate fixation in a biological manner. Seventy-nine consecutive adult patients with distal tibial fractures, including one patient with a bilateral fracture of the distal tibia, treated with locking plates, were retrospectively reviewed. The 4.5-mm limited-contact locking compression plate (LC-LCP) was used in 33 fractures, the metaphyseal LCP in 27 fractures and the distal medial tibial LCP in the remaining 20 fractures. Fibula fixation was performed in the majority of comminuted fractures (n = 41) to maintain the second column of the ankle so as to achieve indirect reduction and to prevent collapse of the fracture. There were two cases of delayed wound breakdown in fractures fixed with the 4.5-mm LC-LCP. Five patients required primary bone grafting and three patients required secondary bone grafting. All cases of delayed union (n = 7) and nonunion (n = 3) were observed in cases where plates were used in bridge mode. Minimally invasive plate osteosynthesis (MIPO) with LCP was observed to be a reliable method of stabilisation for these fractures. Peri-operative docking of fracture ends may be a good option in severely impacted fractures with gap. The precontoured distal medial tibial LCP was observed to be a better tolerated implant in comparison to the 4.5-mm LC-LCP or metaphyseal LCP with respect to complications of soft tissues, bone healing and functional outcome, though its contour needs to be modified.

  20. Antiresorptive treatment, when initiated after a first hip fracture, may not protect of a second contralateral episode in elderly population: A study with 685 patients.

    Besalduch, M; Carrera, I; Gómez-Masdeu, M; De Caso, J

    2016-04-01

    Osteoporosis predisposes for a higher risk of hip fracture and its treatment is frequently underprescribed. Our purpose was to assess the relation between having a second hip fracture and receiving osteoporosis treatment. Also to assess the relation between this second fracture and using central nervous system drugs or being institutionalised. We reviewed all the patients that were admitted to our hospital with an osteoporotic proximal femoral fracture between September 2009 and February 2011. We identified 685 patients, 74 of which presented a contralateral fracture. We evaluated if they were receiving osteoporosis treatment or taking any medication that could affect the central nervous system and if they were institutionalised. A 10.8% of patients had a second fracture and the mean time between the two of them was 20 months (1-122). There was a clear female predominance (76.35%). The mean age at occurrence of the primary fracture was 83.02 years and 85 for the second. A 90.8% did not follow any type of osteoporosis medication before the first fracture. A 50.9% did not receive central nervous system drugs and 79.1% lived at home at the time of the first fracture. 12.8% of the patients that did not follow the osteoporosis treatment, had a contralateral fracture, 3% more than those that did follow some kind of treatment, but this difference was not significant (p=0.2). We identified a similar number of patients undergoing osteoporotic treatment as registered in literature. There was no significant difference between suffering a second hip fracture and following osteoporosis treatment, using psychotropic drugs or being institutionalised. Copyright © 2016 Elsevier Ltd. All rights reserved.

  1. Use of orthodontic brackets for intermaxillary fixation for management of mandibular fracture in a pediatric patient

    Rajeev Pandey; Anit Khatri; Rajat Gupta; Nitin Bhagat

    2017-01-01

    Fracture of mandible is relatively less common in pediatric population when compared to adults. Management of pediatric mandibular fracture is a very complex issue and requires accurate and early treatment. Although the general principles of treatment remain the same as adult but various factors which influence the choice of management: age, dentition status, site involved, amount of displacement, number of fractures, and socioeconomic status. This case report describes a conservative way of ...

  2. Photoelastic stress analysis assisted evaluation of fracture toughness in hydrothermally aged epoxies

    G. Pitarresi

    2014-10-01

    Full Text Available The present work has investigated the fracture toughness of a model DGEBA epoxy system subject to Hidro-Thermal aging. A Photoelastic Stress Analysis technique has been implemented, showing the evolution of stresses arising throughout the water uptake process due to the non-uniform swelling of the material. Gravimetric and Dynamic Mechanical Thermal Analyses have further complemented the characterization, showing the onset of plasticization effects with aging. The correlation of all previous characterizations has allowed to conclude that an increase of KIC fracture toughness is obtained at the fully saturated condition. In particular Photoelasticity has also revealed the onset of relevant swelling induced stresses during the first stages of water absorption, leading to an increase of fracture toughness due to compressive stresses settling near the crack tip. A stress free condition is instead reestablished at the later stages of absorption, suggesting that the increased toughness of the saturated material is an effect of the modifications induced by aging on the polymer structure.

  3. Screening for postoperative delirium in patients with acute hip fracture: Assessment of predictive factors.

    Koskderelioglu, Asli; Onder, Ozlem; Gucuyener, Melike; Altay, Taskin; Kayali, Cemil; Gedizlioglu, Muhtesem

    2017-06-01

    The aim of the present study was to estimate the incidence and risk factors of delirium during the early postoperative period after hip fracture surgery. Furthermore, we investigated the accuracy of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) for detection and assessment of delirium in orthopedic patients. We consecutively recruited patients aged 65 years or older undergoing hip fracture surgery. The presence of delirium was determined daily by two of the authors according to the CAM-ICU criteria. A further evaluation was made with the reference standard Diagnostic and Statistical Manual of Mental Disorders Fourth Edition criteria for delirium. Their cognitive function was evaluated with the Mini-Mental State Examination, and possible depressive mood with the Beck Depression Inventory. Baseline characteristics, as well as the American Society of Anesthesiologists classification and clinical outcomes, were analyzed for a correlation with accompanying delirium. Among 109 patients, 20 (18.3%) were diagnosed with delirium. The concurrent validity of CAM-ICU was good (kappa = 0.84). Specificity was 98.9%, and sensitivity was 80%. Multivariate regression analysis showed that Mini-Mental State Examination (P = 0.001; odds ratio 0.75, 95% confidence interval 0.65-0.86) and Beck Depression Inventory scores (P = 0.001; odds ratio 1.13, 95% confidence interval 1.05-1.22) correlated with the occurrence of delirium. The present results show that CAM-ICU is highly sensitive and specific to identify delirium in hip fracture patients in the postoperative period. Among all of the risk factors, cognitive impairment and depressive mood were strongly associated with postoperative delirium. We suggest that a preoperative assessment of cognition and depression might be useful for identifying patients with a higher risk of postoperative delirium. Geriatr Gerontol Int 2017; 17: 919-924. © 2016 Japan Geriatrics Society.

  4. Association between l-thyroxine treatment, GH deficiency, and radiological vertebral fractures in patients with adult-onset hypopituitarism.

    Mazziotti, G; Mormando, M; Cristiano, A; Bianchi, A; Porcelli, T; Giampietro, A; Maffezzoni, F; Serra, V; De Marinis, L; Giustina, A

    2014-06-01

    In this study, we aimed at evaluating the association between radiological vertebral fractures and levo-thyroxine (l-T4) replacement doses in adult patients with hypopituitarism. Cross-sectional study. We studied 74 adult hypopituitary patients (males, 43; females, 31; mean age, 57 years; and range, 23-79) with central hypothyroidism treated with l-T4 (median daily dose: 1.1  μg/kg). All patients also had severe GH deficiency (GHD) and 38 of them were replaced with recombinant GH. Vertebral fractures were assessed by a quantitative morphometric analysis performed on thoracic and lumbar spine lateral X-ray. Radiological vertebral fractures were found in 23 patients (31.1%) in association with untreated GHD (P=0.02), higher serum free T4 levels (P=0.03), a higher daily dose of l-T4 (P=0.005), and a longer duration of hypopituitarism (P=0.05). When GHD was treated, the prevalence of vertebral fractures was more frequent (P=0.03) in patients receiving high l-T4 doses (third tertile: >1.35  μg/kg per day) as compared with patients who were treated with lower drug doses (first tertile: hypopituitarism. © 2014 European Society of Endocrinology.

  5. Is there an association between body temperature and serum lactate levels in hip fracture patients?

    Murtuza, F; Farrier, A J; Venkatesan, M; Smith, R; Khan, A; Uzoigwe, C E; Chami, G

    2015-10-01

    Introduction Hyperlactataemia is associated with adverse outcomes in trauma cases. It is thought to be the result of anaerobic respiration during hypoperfusion. This produces much less energy than complete aerobic glycolysis. Low body temperature in the injured patient carries an equally poor prognosis. Significant amounts of energy are expended in maintaining euthermia. Consequently, there may be a link between lactate levels and dysthermia. Hyperlactataemia may be indicative of inefficient energy production and therefore insufficient energy to maintain euthermia. Alternatively, significant amounts of available oxygen may be sequestered in thermoregulation, resulting in anaerobic respiration and lactate production. Our study investigated whether there is an association between lactate levels and admission body temperature in hip fracture patients. Furthermore, it looked at whether there is a difference in the mean lactate levels between hip fracture patients with low (37.5°C) body temperature on admission, and for patients who have low body temperature, whether there is a progressive rise in serum lactate levels as body temperature falls. Methods The admission temperature and serum lactate of 1,162 patients presenting with hip fracture were recorded. Patients were divided into the euthermic (body temperature 36.5-37.5°C), the pyrexial (>37.5°C) and those with low body temperature (body temperature were compared. Results There was a significant difference in age between the three body temperature groups (p=0.007). The pyrexial cohort was younger than the low body temperature group (mean: 78 vs 82 years). Those with low body temperature had a higher mean lactate level than the euthermic (2.2mmol/l vs 2.0mmol/l, p=0.03). However, there was no progressive rise in serum lactate level as admission temperature fell. Conclusions The findings suggest that in hip fracture patients, the body attempts initially to maintain euthermia, incurring an oxygen debt. This would

  6. Bone fractures among postmenopausal patients with endocrine-responsive early breast cancer treated with 5 years of letrozole or tamoxifen in the BIG 1-98 trial

    Rabaglio, M; Sun, Z; Price, K N

    2009-01-01

    of letrozole or tamoxifen in the BIG 1-98 trial who received at least some study medication (median follow-up 60.3 months). Bone fracture information (grade, cause, site) was collected every 6 months during trial treatment. RESULTS: The incidence of bone fractures was higher among patients treated......BACKGROUND: To compare the incidence and timing of bone fractures in postmenopausal women treated with 5 years of adjuvant tamoxifen or letrozole for endocrine-responsive early breast cancer in the Breast International Group (BIG) 1-98 trial. METHODS: We evaluated 4895 patients allocated to 5 years...... with letrozole [228 of 2448 women (9.3%)] versus tamoxifen [160 of 2447 women (6.5%)]. The wrist was the most common site of fracture in both treatment groups. Statistically significant risk factors for bone fractures during treatment included age, smoking history, osteoporosis at baseline, previous bone...

  7. Demographics and outcome of metatarsal fractures

    Cakir, H.; van Vliet-Koppert, S. T.; van Lieshout, E. M. M.; de Vries, M. R.; van der Elst, M.; Schepers, T.

    2011-01-01

    Although metatarsal fractures are amongst the most common injuries of the foot, this is the first study on outcome after metatarsal fractures. All consecutive patients with metatarsal fractures treated between January 2006 and September 2008 were re-evaluated. Patients aged 16 to 75 were sent a

  8. Fracture of fusion mass after hardware removal in patients with high sagittal imbalance.

    Sedney, Cara L; Daffner, Scott D; Stefanko, Jared J; Abdelfattah, Hesham; Emery, Sanford E; France, John C

    2016-04-01

    As spinal fusions become more common and more complex, so do the sequelae of these procedures, some of which remain poorly understood. The authors report on a series of patients who underwent removal of hardware after CT-proven solid fusion, confirmed by intraoperative findings. These patients later developed a spontaneous fracture of the fusion mass that was not associated with trauma. A series of such patients has not previously been described in the literature. An unfunded, retrospective review of the surgical logs of 3 fellowship-trained spine surgeons yielded 7 patients who suffered a fracture of a fusion mass after hardware removal. Adult patients from the West Virginia University Department of Orthopaedics who underwent hardware removal in the setting of adjacent-segment disease (ASD), and subsequently experienced fracture of the fusion mass through the uninstrumented segment, were studied. The medical records and radiological studies of these patients were examined for patient demographics and comorbidities, initial indication for surgery, total number of surgeries, timeline of fracture occurrence, risk factors for fracture, as well as sagittal imbalance. All 7 patients underwent hardware removal in conjunction with an extension of fusion for ASD. All had CT-proven solid fusion of their previously fused segments, which was confirmed intraoperatively. All patients had previously undergone multiple operations for a variety of indications, 4 patients were smokers, and 3 patients had osteoporosis. Spontaneous fracture of the fusion mass occurred in all patients and was not due to trauma. These fractures occurred 4 months to 4 years after hardware removal. All patients had significant sagittal imbalance of 13-15 cm. The fracture level was L-5 in 6 of the 7 patients, which was the first uninstrumented level caudal to the newly placed hardware in all 6 of these patients. Six patients underwent surgery due to this fracture. The authors present a case series of 7

  9. Scaphoid fractures in children

    Gajdobranski Đorđe

    2014-01-01

    Full Text Available Introduction. Scaphoid fractures are rare in childhood. Diagnosis is very difficult to establish because carpal bones are not fully ossified. In suspected cases comparative or delayed radiography is used, as well as computerized tomography, magnetic resonance imaging, ultrasound and bone scintigraphy. Majority of scaphoid fractures are treated conservatively with good results. In case of delayed fracture healing various types of treatment are available. Objective. To determine the mechanism of injury, clinical healing process, types and outcome of treatment of scaphoid fractures in children. Methods. We retrospectively analyzed patients with traumatic closed fracture of the scaphoid bone over a ten-year period (2002-2011. The outcome of the treatment of “acute” scaphoid fracture was evaluated using the Mayo Wrist Score. Results. There were in total 34 patients, of mean age 13.8 years, with traumatic closed fracture of the scaphoid bone, whose bone growth was not finished yet. Most common injury mechanism was fall on outstretched arm - 76% of patients. During the examined period 31 children with “acute” fracture underwent conservative treatment, with average immobilization period of 51 days. Six patients were lost to follow-up. In the remaining 25 patients, after completed rehabilitation, functional results determined by the Mayo Wrist Score were excellent. Conclusion. Conservative therapy of “acute” scaphoid fractures is an acceptable treatment option for pediatric patients with excellent functional results.

  10. A randomized, controlled comparison of home versus institutional rehabilitation of patients with hip fracture.

    Kuisma, Raija

    2002-08-01

    To compare ambulation outcomes between home and institutional rehabilitation of patients with hip fracture. Randomized controlled clinical equivalence trial. The Queen Elizabeth Hospital in Hong Kong. Eighty-one patients with hip fracture. Study group patients (40) were discharged directly home from the acute hospital and visited by a physiotherapist an average of 4.6 times. The control group subjects (41) were discharged to a rehabilitation centre for further treatment lasting on average 36.2 days (SD 14.6) and they received physiotherapy daily. Ambulation ability measured on a categorical scale. The mean age of the subjects was 75 years (SD 8.3 years). Females comprised 60% of all the subjects and majority were retired or home makers. Both groups of patients improved in their ambulation ability during their rehabilitation period but neither group achieved their pre-ambulatory status by the time of completion of the study. The study group achieved significantly higher ambulation scores (p institution-based rehabilitation.

  11. Hip Fracture

    ... hip fractures in people of all ages. In older adults, a hip fracture is most often a result of a fall from a standing height. In people with very weak bones, a hip fracture can occur simply by standing on the leg and twisting. Risk factors The rate of hip fractures increases substantially with ...

  12. [Clinical analysis of LPFP, PFNA and BPH in treating femoral intertrochanteric fractures in elderly patients].

    Zhu, Li-Jun; Li, Xiao-Fei; Liu, Chao; Lyu, Cheng-Yu

    2017-07-25

    To evaluate the clinical results of locking proximal femur plate(LPFP), proximal femoral nail antirotation(PFNA) and bipolar hemiarthroplasty(BPH) in the treatment of femoral intertrochanteric fractures in elderly patients. Retrospective analysis of the 86 elderly patients with femoral intertrochanteric fractures during June 2011 and August 2016 were enrolled in this study. The patients were divided into 3 groups: 26 cases in LPFP group included 10 males and 16 females with an average age of (72.54±4.78) years old, 5 cases of type II of Evans, 12 cases of type III and 9 cases of type IV; 39 cases in PFNA group included 17 males and 22 females with an average age of 74.41±5.65, 11 cases of type II, 18 cases of type III and 10 cases of type IV; 21 cases in BPH group included 9 males and 12 females with an average age of 76.23±6.97, 1 case of type II, 10 cases of type III and 10 cases of type IV. The data of three groups were collected for statistical analysis on the following aspects: operation time, intraoperative blood loss, the length of hospital stay, postoperative complications and Harris score of the hip joint function. The wound healed well and no complication occurred. Eighty-four cases were follow-up, while 2 cases were lost, the follow-up rate was 97.6%. The patients were followed up for 22 to 41 months with an average of 26.3 months. For comparison of operation time and time of the hospital stay, BPH group was shorter than the LPFP and PFNA group( F =19.782, 21.981, P BPH group was less blood loss than the LPFP and PFNA group( F =12.976, P 0.05). For comparison of the postoperative complications, LPFP group was higher than BHP and PFNA group( F =30.976, P 0.05). For comparison of the Harris score of the hip joint at 1 year after operation, BPH and PFNA group were both higher than LPFP group( F =19.692, P BPH and PFNA group ( t =4.971, P >0.05). For elder patient with femoral intertrochanteric fracture, BPH could be the best optional for the shorter

  13. Spinal cord injuries related to cervical spine fractures in elderly patients: factors affecting mortality.

    Daneshvar, Parham; Roffey, Darren M; Brikeet, Yasser A; Tsai, Eve C; Bailey, Chris S; Wai, Eugene K

    2013-08-01

    Spinal cord injuries (SCIs) related to cervical spine (C-spine) fractures can cause significant morbidity and mortality. Aggressive treatment often required to manage instability associated with C-spine fractures is complicated and hazardous in the elderly population. To determine the mortality rate of elderly patients with SCIs related to C-spine fractures and identify factors that contribute toward a higher risk for negative outcomes. Retrospective cohort study at two Level 1 trauma centers. Thirty-seven consecutive patients aged 60 years and older who had SCIs related to C-spine fractures. Level of injury, injury severity, preinjury medical comorbidities, treatment (operative vs. nonoperative), and cause of death. Hospital medical records were reviewed independently. Baseline radiographs and computed tomography or magnetic resonance imaging scans were examined to permit categorization according to the mechanistic classification by Allen and Ferguson of subaxial C-spine injuries. Univariate logistic regression analyses were performed to identify factors related to in-hospital mortality and ambulation at discharge. There were no funding sources or potential conflicts of interest to disclose. The in-hospital mortality rate was 38%. Respiratory failure was the leading cause of death. Preinjury medical comorbidities, age, and operative versus nonoperative treatment did not affect mortality. Injury level at or above C4 was associated with a 7.1 times higher risk of mortality compared with injuries below C4 (p=.01). Complete SCI was associated with a 5.1 times higher risk of mortality compared with incomplete SCI (p=.03). Neurological recovery was uncommon. Apart from severity of initial SCI, no other factor was related to ambulatory disposition at discharge. In this elderly population, neurological recovery was poor and the in-hospital mortality rate was high. The strongest risk factors for mortality were injury level and severity of SCI. Although each case of SCI

  14. Motor function and activities of daily living capacity of patients with fractures sustained during the Wenchuan earthquake.

    Zhang, Jin-Long; He, Hong-Chen; Lin, Hai-Dan; Luo, Qing-Lu; Xia, Lu; Li, Sha-Sha; He, Cheng-Qi

    2011-05-01

    On the afternoon of May 12, 2008, a 8.0-magnitude earthquake hit Sichuan Province, a mountainous region in Western China, killing about 70 000 people and leaving over 18 000 missing. What about the survivors motor functions and activities of daily living (ADL) capacity, especially for fractures? We need the data to guide the rehabilitation for the seismic wounded and it's important to collect the data for the future. We study the survivors to understand the motor functions and ADL capacity of patients with fractures sustained in the Wenchuan earthquake, to provide a basis for rehabilitation and treatment. We used the Manual Muscle Testing method to evaluate muscle strength, the joint angle scale to measure joint range of motion (ROM), and the Barthel index to evaluate the activities of daily living status. SPSS 13.0 software was used to analyze the data and the results were tested using one-way analysis of variance (ANOVA). The number of seismic wounded amounted to 487; 81.1% of patients had fractures. Most of the injured had fractures in multiple regions (53.9% of all fracture patients), followed by fractures of the upper limb (34.0% of patients); cranial fractures were rare (2.3%). Totally 82.0% had restricted range of motion, 23.5% had decreased muscle force, and 72.2% of the patients had restricted activities of daily living capacities. With time the activities of daily living capacity of female increased (P 0.05). The difference between the patients' ages and ADL capacities did not reach statistical significance (P > 0.05), nor was there a significant difference between their ages and the numbers of days in hospital (P > 0.05). Fractures were the main issue in the seismic wounded, many of them had reductions in the ROM, muscle force and ADL capacities. The physicians involved in rehabilitation should pay greater attention to muscle force exercises, joint mobilization, and occupational therapy during the early phases post disaster.

  15. Patient survival and surgical re-intervention predictors for intracapsular hip fractures.

    González Quevedo, David; Mariño, Iskandar Tamimi; Sánchez Siles, Juan Manuel; Escribano, Esther Romero; Granero Molina, Esther Judith; Enrique, David Bautista; Smoljanović, Tomislav; Pareja, Francisco Villanueva

    2017-08-01

    Choosing between total hip replacement (THR) and partial hip replacement (PHR) for patients with intracapsular hip fractures is often based on subjective factors. Predicting the survival of these patients and risk of surgical re-intervention is essential to select the most adequate implant. We conducted a retrospective cohort study on mortality of patients over 70 years with intracapsular hip fractures who were treated between January 2010 and December 2013, with either PHR or THR. Patients' information was withdrawn from our local computerized database. The age-adjusted Charlson comorbidity index (ACCI) and American Society of Anesthesiologists (ASA) score were calculated for all patients. The patients were followed for 2 years after surgery. Survival and surgical re-intervention rates were compared between the two groups using a Multivariate Cox proportional hazard model. A total of 356 individuals were included in this study. At 2 years of follow-up, 221 (74.4%) of the patients with ACCI score≤7 were still alive, in contrast to only 20 (29.0%) of those with ACCI score>7. In addition, 201 (76.2%) of the patients with ASA score≤3 were still alive after 2 years, compared to 30 (32.6%) of individuals with ASA >3. Patients with the ACCI score>7, and ASA score>3 had a significant increase in all-cause 2-year mortality (adjusted hazard ratio of 3.2, 95% CI 2.2-4.6; and 3.12, 95% CI 2.2-4.5, respectively). Patients with an ASA score>3 had a quasi-significant increase in the re-intervention risk (adjusted hazard ratio 2.2, 95% CI 1.0-5.1). The sensitivity, specificity, positive predictive value and negative predictive values of ACCI in predicting 2-year mortality were 39.2%, 91.1%, 71%, and 74.4%, respectively. On the other hand, the sensitivity, specificity, positive predictive value and negative predictive values of ASA score in predicting 2-year mortality were 49.6%, 79.1%, 67.4%, and 76.1%, respectively. Both ACCI and ASA scales were able to predict the 2-year

  16. The economic burden of fracture patients with osteoporosis in western China.

    Qu, B; Ma, Y; Yan, M; Wu, H-H; Fan, L; Liao, D-F; Pan, X-M; Hong, Z

    2014-07-01

    To study the cost of osteoporotic fracture in China, we performed a prospective study and compared the costs of the disease in referral patients with fractures in three of the most common sites. Our results indicated that the economic burden of osteoporotic fracture to both Chinese patients and the nation is heavy. This paper aims to study the cost of osteoporotic fracture in China and thus to provide essential information about the burden of this disease to individuals and society. This prospective observational data collection study assessed the cost related to hip, vertebral, and wrist fracture 1 year after the fracture based on a patient sample consisting of 938 men and women. Information was collected using patient records, registry sources, and patient interviews. Both direct medical, direct non-medical, and indirect non-medical costs were considered. The annual total costs were highest in hip fracture patients (renminbi, RMB 27,283 or USD 4,330, with confidence interval (RMB 25715, 28851)), followed by patients with vertebral fracture (RMB 21,474 or USD 3,409, with confidence interval (RMB 20082, 22866)) and wrist fracture (RMB 8,828 or USD 1,401, with confidence interval (RMB 7829, 9827)). The direct medical care costs averaged approximately RMB 17,007 per year per patient, of which inpatient costs, drugs, and investigations accounted for the majority of the costs. Nonmedical direct costs were much less compared to direct healthcare costs and averaged approximately RMB 1,846. These results indicate that the economic burden of osteoporotic fracture to both Chinese patients and China was heavy, and the proportion of the costs in China demonstrated many similar features and some significant differences compared to other countries.

  17. Social inequality and hip fracture

    Harvey, N. C.; Hansen, L.; Judge, A.

    2015-01-01

    Social inequality appears to be increasing in many countries. We explored whether risk of hip fracture was associated with markers of inequality and whether these relationships changed with time, using data from Danish Health Registries. Methods: All patients 60 years or older with a primary hip...... fracture (ICD10: S720, S721, S722 and S729) were identified from 1 January 1995 to 31 December 2011. Hip fracture patients were matched 1:1 on age, gender and year of fracture to a non-hip fracture control. An individual's education attainment was defined as basic, secondary or higher, and their income...

  18. Warfarinized Patients with Proximal Femoral Fractures: Survey of UK Clinical Practice.

    Starks, Ian; Cooke, Stephen; Docker, Charles; Raine, Andrew

    2009-06-01

    In an aging population, anticoagulation in patients with musculoskeletal injuries is increasingly prevalent. The North American literature indicates an absence of consensus concerning the most appropriate management for this group. We aim to test the hypothesis that there is a lack of consensus in the UK regarding the perioperative management of patients with hip fractures on long-term warfarin therapy. A representative group of 400 consultant orthopedic surgeons was surveyed by postal questionnaire regarding their policy on the reversal of anticoagulation in warfarinized patients with hip fractures. The consultants contacted were selected to represent a geographical spread throughout the UK. There were 159 respondents (40% response rate), of which 79% (126) had a trauma commitment. 95 (75%) of these had a protocol for the reversal of anticoagulation prior to surgery. The commonest method used was to simply withhold warfarin and wait (70%). Other methods included FFP (16%), and low-dose (23%) and high-dose (14%) vitamin K. Some respondents used more than onemethod. Although nearly all respondents preferred an INR < 2.0 prior to surgery, 55% preferred an INR < 1.5. Hip fracture in the presence of long-term warfarin use is associated with significantly increased morbidity. This problem is likely to increase. Our results demonstrate variation in approach throughout the UK with regard to warfarin reversal and the acceptable INR at which to operate in this group of patients. We propose that low-dose vitamin K is considered more widely as a safe and effective method of warfarin reversal in this group.

  19. Analysis of patients ≥65 with predominant cervical spine fractures: Issues of disposition and dysphagia

    Lisa M Poole

    2017-01-01

    Full Text Available Background: Cervical spine fractures occur in 2.6% to 4.7% of trauma patients aged 65 years or older. Mortality rates in this population ranges from 19% to 24%. A few studies have specifically looked at dysphagia in elderly patients with cervical spine injury. Aims: The aim of this study is to evaluate dysphagia, disposition, and mortality in elderly patients with cervical spine injury. Settings and Design: Retrospective review at an the American College of Surgeons-verified level 1 trauma center. Methods: Patients 65 years or older with cervical spine fracture, either isolated or in association with other minor injuries were included in the study. Data included demographics, injury details, neurologic deficits, dysphagia evaluation and treatment, hospitalization details, and outcomes. Statistical Analysis: Categorical and continuous data were analyzed using Chi-square analysis and one-way analysis of variance, respectively. Results: Of 136 patients in this study, 2 (1.5% had a sensory deficit alone, 4 (2.9% had a motor deficit alone, and 4 (2.9% had a combined sensory and motor deficit. Nearly one-third of patients (n = 43, 31.6% underwent formal swallow evaluation, and 4 (2.9% had a nasogastric tube or Dobhoff tube placed for enteral nutrition, whereas eight others (5.9% had a gastrostomy tube or percutaneous endoscopic gastrostomy tube placed. Most patients were discharged to a skilled nursing unit (n = 50, 36.8%, or to home or home with home health (n = 48, 35.3%. Seven patients (5.1% died in the hospital, and eight more (5.9% were transferred to hospice. Conclusion: Cervical spine injury in the elderly patient can lead to significant consequences, including dysphagia and need for skilled nursing care at discharge.

  20. COMPLEX TREATMENT OF PATIENT WITH MULTIPLE FRACTURES OF THE VERTEBRAE IN THE THORACIC SPINE

    S. V. Vissarionov

    2012-01-01

    Full Text Available The authors presented an example of a complex treatment of pediatric patient with multiple fractures of the vertebrae in the thoracic spine. The child was operated on the burst fracture of a Th5 vertebra. Due to the presence of vertebral compression fractures Th8 a course of conservative treatment by the orthosis in hyperextension brace. Follow-up was 15 months.

  1. Non union of an epiphyseal fibular fracture in a pediatric patient.

    Mirmiran, Roya; Schuberth, John M

    2006-01-01

    There are few reports on delayed or nonunion in the pediatric ankle fracture. The authors present a case of a nonunion of a mid-epiphyseal fracture of the distal fibula, described as a type 7 pediatric fracture. Both the occurrence of this injury pattern and a nonunion has not been reported in the same patient. Operative reduction of the nonunion resulted in a satisfactory outcome.

  2. [Prevalence of osteoporosis, estimation of probability of fracture and bone metabolism study in patients with newly diagnosed prostate cancer in the health area of Lugo].

    Miguel-Carrera, Jonatan; García-Porrua, Carlos; de Toro Santos, Francisco Javier; Picallo-Sánchez, Jose Antonio

    2018-03-01

    To study the prevalence of osteoporosis and fracture probability in patients diagnosed with prostate cancer. Observational descriptive transversal study. SITE: Study performed from Primary Care of Lugo in collaboration with Rheumatology and Urology Services of our referral hospital. Patients diagnosed with prostate cancer without bone metastatic disease from January to December 2012. Epidemiologic, clinical, laboratory and densitometric variables involved in osteoporosis were collected. The likelihood of fracture was estimated by FRAX ® Tool. Eighty-three patients met the inclusion criteria. None was excluded. The average age was 67 years. The Body Mass Index was 28.28. Twenty-five patients (30.1%) had previous osteoporotic fractures. Other prevalent risk factors were alcohol (26.5%) and smoking (22.9%). Eighty-two subjects had vitamin D below normal level (98.80%). Femoral Neck densitometry showed that 8.9% had osteoporosis and 54% osteopenia. The average fracture risk in this population, estimated by FRAX ® , was 2.63% for hip fracture and 5.28% for major fracture. Cut level for FRAX ® major fracture value without DXA >5% and ≥7.5% proposed by Azagra et al. showed 24 patients (28.92%) and 8 patients (9.64%) respectively. The prevalence of osteoporosis in this population was very high. The more frequent risk factors associated with osteoporosis were: previous osteoporotic fracture, alcohol consumption, smoking and family history of previous fracture. The probability of fracture using femoral neck FRAX ® tool was low. Vitamin D deficiency was very common (98.8%). Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

  3. Value of lateral blood pool imaging in patients with suspected stress fractures of the tibia.

    Mohan, Hosahalli K; Clarke, Susan E M; Centenara, Martin; Lucarelli, Amanda; Baron, Daniel; Fogelman, Ignac

    2011-03-01

    To critically evaluate the use of lateral blood pool imaging in athletes with lower limb pain and with a clinical suspicion of stress fracture. Two experienced nuclear medicine physicians evaluated 3-phase bone scans using 99mTc-methylene diphosphonate performed in 50 consecutive patients referred from a specialist sports injury clinic for suspected tibial stress fracture. The vascularity to the tibia as seen on the blood pool (second phase) images in the anterior/posterior views was compared with the lateral/medial view assessments. Stress fractures were presumed to be present when on the delayed images (third phase) there was a focal or fusiform area of increased tracer uptake involving the tibial cortex. Shin splints which are a recognized cause of lower limb pain in athletes mimicking stress fracture were diagnosed if increased tracer uptake was seen extending along the posterior tibial surface with no significant focal or fusiform area of uptake within this. Inter-reviewer agreement for the assessment of vascularity was also assessed using Cohen's Kappa scores. Twenty-four stress fractures in 24 patients and 66 shin splints in 40 patients were diagnosed. In 18 patients stress fracture and shin splints coexisted. In 10 patients no tibial pathology was identified. Of the 24 patients diagnosed with stress fractures, lateral/medial blood pool imaging was superior in the assessment of blood pool activity (P tibial stress fractures, lateral views of the tibia provide the optimal method for evaluation of vascularity. Prospective studies with quantitative or semi-quantitative assessment of skeletal vascularity could provide supplementary information relating to the pathophysiology of stress fractures, for example, the time scale of vascular changes after a tibial stress fracture, and potentially could have clinical relevance as to the assessment of the severity of stress fractures and their prognosis.

  4. Local approach on mixed-mode ductile fracture of an aged stainless steel 316L

    Jeon, K.L.; Marini, B.

    1993-01-01

    In the frame of the structural integrity of the fast breeder reactor vessel, the local approach of fracture is applied to the ductile crack initiation under mixed-mode I+II loading for a 316L type stainless steel thermally aged for 1000 hours at 700 deg C. Experimental and numerical tests are performed on axisymmetric notched specimens, compact tension specimens and disymmetric four-point bend specimens. From elastoplastic finite element analyses, the damage variables are evaluated with various models: the Beremin model, the McClintock model, the Guennouni-Francois model and the Lemaitre model. The critical values of damage variable obtained on simple tensile specimens and axisymmetric notched specimens are used for the prediction of crack initiation under mixed-mode loading. The damage variable at crack initiation seems to be rather dependent on the fracture mode related to the stress triaxiality and the brittle fracture of banded ferrite of the aged material. The results are compared with those of the J values at crack initiation. (author). 9 ref., 2 figs

  5. Humeral fractures due to low-energy trauma: an epidemiological survey in patients referred to a large emergency department in Northern Italy.

    Pedrazzoni, M; Abbate, B; Verzicco, I; Pedrazzini, A; Benatti, M; Cervellin, G

    2015-01-01

    This survey describes the epidemiology of approximately 1800 low-energy humeral fractures seen in a large emergency department in Northern Italy over 7 years (2007-2013), highlighting the differences from previous Italian studies. The purpose of this study was to determine the incidence of humeral fractures due to low-energy trauma in patients 40 years of age or older referred to a large Emergency Department (Parma, Northern Italy) in a 7-year period (2007-2013). All humeral fractures referred to the emergency department of the Academic Hospital of Parma (the main hospital in the province with a catchment area of approximately 345,000) were retrieved from the hospital database using both ICD-9CM codes and text strings. The diagnosis of humeral fracture due to low-energy trauma was confirmed by medical records and X-ray reports, after exclusion of injuries due to a clear-cut high-energy trauma or cancer. The query identified 1843 humeral fractures (1809 first fractures), with a clear predominance in women (78 %). Fractures of the proximal humerus represented the large majority of humeral fractures (more than 85 %), with an incidence progressively increasing with age (more than 60-fold in women and 20-fold in men). Simultaneous fractures (hip in particular) were frequent especially after 85 years of age (1 out of 8 cases). When compared to other Italian studies, the incidence of humeral fractures was significantly lower than that derived from discharge data corrected for hospitalization rate (standardized rate ratio 0.74; p energy humeral fractures in Italy. Our results partly differ from previous Italian studies based on indirect estimations.

  6. High perceived caregiver burden for relatives of patients following hip fracture surgery

    Ariza-Vega, Patrocinio; Ortiz-Piña, Mariana; Kristensen, Morten Tange

    2018-01-01

    treatment strategies such as the support and training of the caregivers in patient handling during hospital stay could be carried out to reduce caregiver burden. Implications for rehabilitation The main caregiver of a hip fracture patient is usually a woman who is the daughter of the patient, and reducing...... her burden of care should be included as one of the objectives of rehabilitation treatment. The caregivers of hip fracture patients must be considered as part of the treatment during the patient's recovery period, and patient handling training should be provided to the caregivers of hip fracture......PURPOSE: To determine the profile of the main informal caregivers, the evolution of the caregiver burden, and the influencing factors of caregiver burden at 1-year after hip fracture surgery. METHODS: In this prospective cohort study, a total of 172 informal caregivers of patients were interviewed...

  7. [Distal fixation prosthesis for unstable intertrochanteric fractures in elderly patients: a mid-term follow-up study].

    Zhang, Zhan-feng; Min, Ji-kang; Zhong, Jian-ming; Wang, Dan

    2016-06-01

    To explore mid-term follow up results of distal fixation prosthesis in treating unstable intertrochanteric fractures in elderly patients. From May 2008 to March 2014,58 elderly patients with unstable intertrochanteric were treated with distal fixation prosthesis, among them, there were 15 males and 43 females aged from 75 to 87 years old with an average of 83.2 years old. Fracture were classified according to Evans classification, 39 cases were type I c and 19 cases were type I d. Surgical risk was evaluated before operation, 9 patients were performed total hip arthroplasty and 49 patients were performed prosthetic replacement hip joint function of patients with different age period, Evans classificaton, prothesis type, fixation method were evaluated respectively by using Harris score. Fifty-six patients were followed up from 13 to 36 months with an average of 21.6 months. Harris score was 83.51 ± 6.40, 5 cases got excellent results, 38 cases good and 13 cases moderate. Harris score of patients aged from 75 to 80 years old was 88.64 ± 2.35, 81.64 ± 6.40 in patients aged more than 80 years old, and had significant differences between two groups; Harris score in patients with type Evans I c was 83.64 ± 6.53, and 83.11 ± 6.08 in type Evans I d, while there was no significant differences between two groups. There was no obvious meaning in Harris score between patients with tension band (83.63 ± 6.15) and without tension band (82.41 ± 6.57). There was no significant meaning in Harris score between patients with normal distal fixation prosthesis (83.34 ± 6.43) and femoral moment reconstruction distal fixation prosthesis (83.92 ± 6.51). There was 1 patient occurred hip joint dislocation on the operative side and re-dislocation after manual reduction, then received open reduction. Two patients occurred femoral osteolysis without clinical symptoms, and treated conservative treatment. Artificial joint replacement for unstable intertrochanteric fractures in elderly

  8. Ten-year incident osteoporosis-related fractures in the population-based Canadian Multicentre Osteoporosis Study - comparing site and age-specific risks in women and men.

    Prior, Jerilynn C; Langsetmo, Lisa; Lentle, Brian C; Berger, Claudie; Goltzman, David; Kovacs, Christopher S; Kaiser, Stephanie M; Adachi, Jonathan D; Papaioannou, Alexandra; Anastassiades, Tassos; Towheed, Tanveer; Josse, Robert G; Brown, Jacques P; Leslie, William D; Kreiger, Nancy

    2015-02-01

    Population-based incident fracture data aid fracture prevention and therapy decisions. Our purpose was to describe 10-year site-specific cumulative fracture incidence by sex, age at baseline, and degree of trauma with/without consideration of competing mortality in the Canadian Multicentre Osteoporosis Study adult cohort. Incident fractures and mortality were identified by annual postal questionnaires to the participant or proxy respondent. Date, site and circumstance of fracture were gathered from structured interviews and medical records. Fracture analyses were stratified by sex and age at baseline and used both Kaplan-Meier and competing mortality methods. The baseline (1995-97) cohort included 6314 women and 2789 men (aged 25-84 years; mean±SD 62±12 and 59±14, respectively), with 4322 (68%) women and 1732 (62%) men followed to year-10. At least one incident fracture occurred for 930 women (14%) and 247 men (9%). Competing mortality exceeded fracture risk for men aged 65+years at baseline. Age was a strong predictor of incident fractures especially fragility fractures, with higher age gradients for women vs. men. Major osteoporotic fracture (MOF) (hip, clinical spine, forearm, humerus) accounted for 41-74% of fracture risk by sex/age strata; in women all MOF sites showed age-related increases but in men only hip was clearly age-related. The most common fractures were the forearm for women and the ribs for men. Hip fracture incidence was the highest for the 75-84 year baseline age-group with no significant difference between women 7.0% (95% CI 5.3, 8.9) and men 7.0% (95% CI 4.4, 10.3). There are sex differences in the predominant sites and age-gradients of fracture. In older men, competing mortality exceeds cumulative fracture risk. Copyright © 2014 Elsevier Inc. All rights reserved.

  9. The Effect of Creep Aging on the Fatigue Fracture Behavior of 2524 Aluminum Alloy

    Wenke Li

    2016-09-01

    Full Text Available Normal temperature tensile and fatigue tests were adopted to test the mechanical performance and fatigue life of 2524 aluminum alloy under the three states of T3, artificial aging, and creep aging, and scanning electron microscope and transmission electron microscope were also used to observe the fatigue fracture morphology and aging precipitation features of the alloy under the above three states. Results showed that the alloy treated by creep aging can obtain higher fatigue life, but that treated by artificial aging is lower than T3; T3 alloy is mainly dominated by GPB region. Meanwhile, the crystal boundary displays continuously distributed fine precipitated phases; after artificial aging and creep aging treatment, a large amount of needle-shaped S′ phases precipitate inside the alloy, while there are wide precipitated phases at the crystal boundary. Wide precipitation free zones appear at the crystal boundary of artificial-aging samples, but precipitation free zones at the alloy crystal boundary of creep aging become narrower and even disappear. It can be seen that creep aging can change the precipitation features of the alloy and improve its fatigue life.

  10. Penile fracture in a patient with stuttering priapism | Badmus | West ...

    Penile fracture commonly results from trauma of sexual intercourse or masturbation. It is common in the Middle East and America, but rare in Nigeria and sub-Sahara Africa. We present a case of penile fracture, an uncommon urologic emergency, complicating priapism, another urologic emergency; precipitated in an ...

  11. Comparing fracture healing disorders and long-term functional outcome of polytrauma patients and patients with an isolated displaced midshaft clavicle fracture.

    Ferree, Steven; Hietbrink, Falco; van der Meijden, Olivier A J; Verleisdonk, Egbert Jan M M; Leenen, Luke P H; Houwert, Roderick M

    2017-01-01

    Although clavicle fractures are a common injury in polytrauma patients, the functional outcome of displaced midshaft clavicle fractures (DMCFs) in this population is unknown. Our hypothesis was that there would be no differences in fracture healing disorders or functional outcome in polytrauma patients with a DMCF compared with patients with an isolated DMCF, regardless of the treatment modality. A retrospective cohort study of patients (treated at our level I trauma center) with a DMCF was performed and a follow-up questionnaire was administered. Polytrauma patients, defined as an Injury Severity Score ≥16, and those with an isolated clavicle fracture were compared. Fracture healing disorders (nonunion and delayed union) and delayed fixation rates were determined. Functional outcome was assessed by the Quick Disability of the Arm, Shoulder, and Hand questionnaire. A total of 152 patients were analyzed, 71 polytrauma patients and 81 patients with an isolated DMCF. Questionnaire response of 121 patients (80%) was available (mean, 53 months; standard deviation, 22 months). No differences were found between polytrauma patients and those with an isolated DMCF with regard to nonunion (7% vs. 5%, respectively), delayed union (4% vs. 4%), and delayed fixation rate (13% vs. 13%). Polytrauma patients had an overall worse functional outcome, regardless of initial nonoperative treatment or delayed operative fixation. Polytrauma patients had a similar nonunion and delayed fixation rate but had an overall worse functional outcome compared with patients with an isolated DMCF. For polytrauma patients, a wait and see approach can be advocated without the risk of decreased upper extremity function after delayed fixation. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  12. Indications for surgical stabilization of rib fractures in patients without flail chest: surveyed opinions of members of the Chest Wall Injury Society.

    Pieracci, Fredric M; Agarwal, Suresh; Doben, Andrew; Shiroff, Adam; Lottenberg, Larwence; Whitbeck, Sarah Ann; White, Thomas W

    2018-02-01

    There are currently no evidence-based indications for surgical stabilization of rib fractures (SSRF) in patients without flail chest. The purpose of this survey was to identify patients for whom there is relative equipoise (operative vs. non-operative) in order to assist in designing a randomized clinical trial. Members of the Chest Wall Injury Society were sent an online survey, in which 18 patient scenarios were presented. The baseline patient had ≥ three displaced, contiguous fractures and had no other contraindications for surgery. This default scenario was then varied based upon patient age, degree of traumatic brain injury (TBI), fracture series location, and number of abnormal pulmonary physiologic variables (oxygen requirement, respiratory rate, incentive spirometry ability, cough, and numeric pain score). Thirty respondents provided a total of 540 answers. Overall, the majority of responses were in favor of SSRF (n = 413, 84.1%). Furthermore, the vast majority of responses indicated that some degree of pulmonary compromise was necessary to recommend SSRF (n = 44, 90.4%), with ≥ two abnormal parameters being the most common threshold (n = 156, 31.8%). Decision to recommend SSRF varied significantly by number of abnormal clinical variables, age, and degree of TBI, but not by fracture series location. Patients aged 85 years old and those with moderate TBI were the least likely to be recommended for SSRF, regardless of abnormal pulmonary physiologic variables. The most appropriate cutoff for equipoise appeared to be a patient aged 21-79 years old, with no or mild TBI, ≥ two abnormal pulmonary parameters, and regardless of fracture location (44.8% consensus for SSRF). SSRF was recommended for most patients with non-flail, displaced rib fractures. However, this recommendation was contingent upon patient age, degree of TBI, and pulmonary clinical status. Results of this survey may be used to inform inclusion criteria for a future randomized

  13. Fracture mechanics assessment of thermal aged nuclear piping based on the Leak-Before-Break concept

    Chen, Mingya, E-mail: chenmingya@cgnpc.com.cn [Suzhou Nuclear Power Research Institute, Suzhou, Jiangsu Province (China); Yu, Weiwei [Suzhou Nuclear Power Research Institute, Suzhou, Jiangsu Province (China); Qian, Guian [Paul Scherrer Institute, Nuclear Energy and Safety Department, Villigen PSI (Switzerland); Wang, Rongshan; Lu, Feng; Zhang, Guodong; Xue, Fei; Chen, Zhilin [Suzhou Nuclear Power Research Institute, Suzhou, Jiangsu Province (China)

    2016-05-15

    Highlights: • The effects of thermal aging on crack unstable tearing are studied. • The critical size of crack unstable tearing is calculated by different methods. • The critical failure models are compared. • The conservatism of J–T diagram is shown. - Abstract: The Leak-Before-Break (LBB) concept has been accepted to design the primary piping system of the pressurized water reactor (PWR). Due to thermal aging of long term operation, the cast stainless steels (CSSs) which are used for the primary piping of PWR, suffer a significant loss of fracture toughness, and as a consequence the safety margin of the thermal aged pipe decreases. Therefore, the aged piping should be analyzed and validated by the LBB concept. In this paper, elastic–plastic fracture mechanics (EPFM) assessments of the thermal aged piping are presented according to the LBB concept. The critical break size of crack unstable tearing is calculated by the EPFM method. The crack driving force diagram (J–a diagram), the stability assessment diagram (J–T diagram) and a numerical method are applied to calculate the critical crack size of crack break. The effects of thermal aging on the plastic limit load, J–T diagram, critical crack size of the EPFM and the critical failure mode are studied. The results show that the thermal aging effect decreases the maximum allowed J-integral at a certain ductile tearing modulus by more than 50% and it increases the flow stress and plastic limit load by 11.78%. The results based on the J–T diagram are about 40% conservative than those based on the direct numerical method for the high loading case. For the thermal aged piping, it is important to consider the competition failure modes between plastic collapse and unstable ductile tearing.

  14. Fascia iliaca compartment blockade for acute pain control in hip fracture patients

    Foss, Nicolai B; Kristensen, Billy B; Bundgaard, Morten

    2007-01-01

    Hip fracture patients are in severe pain upon arrival at the emergency department. Pain treatment is traditionally based on systemic opioids. No study has examined the effect of fascia iliaca compartment blockade (FICB) in acute hip fracture pain management within a double-blind, randomized setup....

  15. Preoperative factors associated with red blood cell transfusion in hip fracture patients

    Madsen, Christian Medom; Jørgensen, Henrik Løvendahl; Norgaard, Astrid

    2014-01-01

    Red blood cell (RBC) transfusion is a frequently used treatment in patients admitted with a fractured hip, but the use remains an area of much debate. The aim of this study was to determine preoperative factors associated with the risk of receiving a red blood cell transfusion in hip fracture...

  16. Fear of Falling in Patients With Hip Fractures: Prevalence and Related Psychological Factors

    Visschedijk, J.; Van Balen, R.; Hertogh, C.M.P.M.; Achterberg, W.

    2013-01-01

    Objective: To determine the prevalence of fear of falling (FoF) in patients after a hip fracture, to investigate the relation with time after fracture, and to assess associations between FoF and other psychological factors. Design: Cross-sectional study performed between September 2010 and March

  17. Population-based studies on risk of fracture in patients with neurological disorders

    Pouwels, S.

    2014-01-01

    Introduction Patients with neurological disorders may be at an increased risk of fracture via multiple causal pathways, including increases in the risk of falls, changes in bone mineral density and quality of bone microarchitecture. Risk of fracture may be increased by the disease itself, by

  18. Follow-up for osteoporosis in older patients three years after a fracture

    Schurink, M.; Hegeman, J. H.; Kreeftenberg, H. G.; ten Duis, H. J.

    Background: Recently a Fracture and Osteoporosis outpatient clinic (FO clinic) was set up at the University Medical Centre Groningen (UMCG) with the aim to optimise case-finding of osteoporosis in older patients with a low-energy fracture. To provide a diagnostic setting before the start of our FO

  19. Increased rate of osteoporosis, low lean mass, and fragility fractures in COPD patients: association with disease severity.

    Graumam, R Q; Pinheiro, M M; Nery, L E; Castro, C H M

    2018-03-21

    A very high rate of osteoporosis, fractures, and low lean mass was observed in patients with chronic obstructive pulmonary disease (COPD). Disease severity was associated with bone and muscle adverse outcomes, while age ≥ 63.5 years old, low lean mass, higher iPTH, and a T-score below - 2.5 were all associated with higher risk of fracture. Osteoporosis is frequently neglected in patients with COPD. We aimed at evaluating the rate of osteoporosis, fractures, and low lean mass in patients with COPD. Ninety-nine patients with COPD (53 women, 64.5 ± 9.6 years old, and 46 men, 65.9 ± 8.0 years old) underwent bone densitometry (DXA) with body composition analyses. Healthy individuals (N = 57) not exposed to tobacco matched by sex, age, and body mass index (BMI) were used as controls. Spirometry, routine laboratory workout, and conventional thoracolumbar radiography surveying for vertebral deformities were performed in all patients. Osteoporosis was found in 40.4% of the COPD patients against only 13.0% of the healthy controls (p = 0.001). Vertebral fractures were seen in 24.4% of the men and 22.0% of the women with COPD. Disease severity (GOLD 3 and 4) was significantly associated with higher risk of vitamin D deficiency (p = 0.032), lower BMD (both men and women at all sites), higher frequency of osteoporosis (in women at all sites), lower skeletal mass index, and higher rate of low lean mass (in both men and women) than healthy controls and COPD patients with milder disease (GOLD 1 and 2). Age was a main predictor of vertebral fractures (OR = 1.164 (1.078-9.297); p lean mass were associated with FEV 1% lean mass, high iPTH, and low bone mass were all significantly associated with fractures in COPD patients.

  20. Risk Factors for Pneumonia in Ventilated Trauma Patients with Multiple Rib Fractures

    Park, Hyun Oh; Kang, Dong Hoon; Moon, Seong Ho; Yang, Jun Ho; Kim, Sung Hwan; Byun, Joung Hun

    2017-01-01

    Background: Ventilator-associated pneumonia (VAP) is a common disease that may contribute to morbidity and mortality among trauma patients in the intensive care unit (ICU). This study evaluated the associations between trauma factors and the development of VAP in ventilated patients with multiple rib fractures. Methods: We retrospectively and consecutively evaluated 101 patients with multiple rib fractures who were ventilated and managed at our hospital between January 2010 and De...

  1. Clinical Analysis for the Correlation of Intra-abdominal Organ Injury in the Patients with Rib Fracture

    Park, Seongsik

    2012-01-01

    Background Although it is rare for the fracture itself to become a life threatening injury in patients suffering from rib fracture, the lives of these patients are occasionally threatened by other associated injuries. Especially, early discovery of patients with rib fracture and intra-abdominal organ injury is extremely important to the prognosis. This study analyzed the link between rib fracture and intra-abdominal injury to achieve improved treatment. Materials and Methods Among trauma pati...

  2. PROXIMAL DISABILITY AND SPINAL DEFORMITY INDEX IN PATIENTS WITH PROXIMAL FEMUR FRACTURES

    Sylvio Mistro Neto

    2015-12-01

    Full Text Available Objective : To evaluate the quality of life related to the spine in patients with proximal femoral fractures. Methods : Study conducted in a tertiary public hospital in patients with proximal femoral fractures caused by low-energy trauma, through the Oswestry Disability Index questionnaire to asses complaints related to the spine at the time of life prior to the femoral fracture. The thoracic and lumbar spine of patients were also evaluated applying the radiographic index described by Gennant (Spinal Deformity Index, which assesses the number and severity of fractures. Results : Seventeen subjects completed the study. All had some degree of vertebral fracture. Patients were classified in the categories of severe and very severe disability in the questionnaire about quality of life. It was found that the higher SDI, the better the quality of life. Conclusion : There is a strong association of disability related to the spine in patients with proximal femoral fracture, and this complaint must be systematically evaluated in patients with appendicular fracture.

  3. Combined three-part humeral anterior fracture-dislocation and humeral shaft fracture treated with one-stage long stem shoulder hemiarthroplasty in an active elderly patient

    Herzberg Guillaume

    2017-01-01

    Full Text Available Introduction: Injuries combining a humeral head fracture-dislocation and a shaft fracture of the ipsilateral humerus are very rare. They should be separated from extended fractures of the humeral head to the shaft [1]. Case report: We present the case of an active 84-year-old man who sustained a three-part fracture-dislocation of the proximal humerus combined with a long spiral humeral middle third diaphyseal fracture, after a ski fall. We were unable to find a similar case in the literature. He was treated with a long stem hemiarthroplasty, associated with screw osteosynthesis of the long spiral shaft fracture. The result after 30 months of follow-up was excellent, with good shoulder range of motion, good bone integration of the prosthesis and uneventful healing of the fracture. Conclusion: This treatment allowed this intrepid elderly patient to recover a normal quality of life, including driving his car and to return to skiing.

  4. A clinico-radiologic study of bony remodeling of the fractured condyles in children

    Cho, Jeong Shin; Park, Chang Seo

    1995-01-01

    Bony remodeling pattern of condyle fractures in children are different from in adult for growing of condyle, also might affect treatment and prognosis of the condyle fracture. Subjects of this clinical and radiologic study were 26 temporomandibular joints diagnosed as condyle fracture in 23 patients under 15 years old age, They were treated with conservative method at Dental Hospital of Yonsei University from Jan., 1986 to Oct., 1994. Bony remodeling related with fracture pattern was evaluated. The results obtained are as follows: 1. The ratio of male to female in patients with condyle fracture was 1 : 0.9 and the difference of sex ratio was not noted. Comparing with preschool-age group and school-age group, age frequency was higher in preschool-age group (83%). 2. Fallen down (54%) was the most frequent cause of condyle fractures. Traffic accident and slip down were followed. 3. The most common clinical sign of condyle fractures was tenderness to palpation (19 cases). Mouth opening limitation (17 cases), swelling (7 cases), malocclusion (3 cases) were next in order. 4. According to sites of condyle fractures, unilateral fractures were in 20 patients and bilateral fractures in 3 patients, therefore total 23 patients-26 cases of condyle fracture were observed. According to fracture distribution, condyle fractures were in 10 patients (44%). Condyle fractures with symphysis fracture (9 patients, 39%), condyle fractures with ascending ramus fracture (2 patients, 9%), condyle fracture with mandibular body fracture (1 patient, 4%), and condyle fractures with mandibular angle fracture (1 patient, 4%) were followed. 5. In displacement pattern of fractured fragment of mandibular condyle, displacement (17 cases, 66%) was most common. Dislocation (5 cases, 19%) and deviation (4 cases, 15%) were next in order. 6. During the observation period of fractured condyles, remodeling patterns of fracture sites related with articular fossa were observed with usual congealer shape in 23

  5. A clinico-radiologic study of bony remodeling of the fractured condyles in children

    Cho, Jeong Shin; Park, Chang Seo [Department of Dentistry, The Graduate School, Yonsei University, Seoul (Korea, Republic of)

    1995-08-15

    Bony remodeling pattern of condyle fractures in children are different from in adult for growing of condyle, also might affect treatment and prognosis of the condyle fracture. Subjects of this clinical and radiologic study were 26 temporomandibular joints diagnosed as condyle fracture in 23 patients under 15 years old age, They were treated with conservative method at Dental Hospital of Yonsei University from Jan., 1986 to Oct., 1994. Bony remodeling related with fracture pattern was evaluated. The results obtained are as follows: 1. The ratio of male to female in patients with condyle fracture was 1 : 0.9 and the difference of sex ratio was not noted. Comparing with preschool-age group and school-age group, age frequency was higher in preschool-age group (83%). 2. Fallen down (54%) was the most frequent cause of condyle fractures. Traffic accident and slip down were followed. 3. The most common clinical sign of condyle fractures was tenderness to palpation (19 cases). Mouth opening limitation (17 cases), swelling (7 cases), malocclusion (3 cases) were next in order. 4. According to sites of condyle fractures, unilateral fractures were in 20 patients and bilateral fractures in 3 patients, therefore total 23 patients-26 cases of condyle fracture were observed. According to fracture distribution, condyle fractures were in 10 patients (44%). Condyle fractures with symphysis fracture (9 patients, 39%), condyle fractures with ascending ramus fracture (2 patients, 9%), condyle fracture with mandibular body fracture (1 patient, 4%), and condyle fractures with mandibular angle fracture (1 patient, 4%) were followed. 5. In displacement pattern of fractured fragment of mandibular condyle, displacement (17 cases, 66%) was most common. Dislocation (5 cases, 19%) and deviation (4 cases, 15%) were next in order. 6. During the observation period of fractured condyles, remodeling patterns of fracture sites related with articular fossa were observed with usual congealer shape in 23

  6. Role of MRI in the diagnosis and management of patients with clinical scaphoid fracture.

    Tibrewal, Saket; Jayakumar, Prakash; Vaidya, Sujit; Ang, Swee Chai

    2012-01-01

    The American College of Radiologists (ACR) recognises the value of magnetic resonance imaging (MRI) as the investigation of choice in patients with a clinically suspected scaphoid fracture but normal plain radiographs. The Royal College of Radiologists (RCR) in the UK produces no similar guidelines, as evidenced by the inconsistent management of such cases in hospitals around the UK. In discussion with our musculoskeletal radiologists, we implemented new guidelines to standardise management of our patients and now report our findings. A consecutive series of 137 patients referred to the orthopaedic department with clinically suspected scaphoid fracture but normal series of plain radiographs were prospectively followed up over a two-year period. We implemented the use of early MRI for these patients and determined its incidence of detected scaphoid injury in addition to other occult injuries. We then prospectively examined results of these findings on patient management. Thirty-seven (27%) MRI examinations were normal with no evidence of a bony or soft-tissue injury. Soft-tissue injury was diagnosed in 59 patients (43.4%). Of those, 46 were triangular fibrocartilage complex (TFCC) tears (33.8%) and 18 were intercarpal ligament injuries (13.2 %). Bone marrow oedema with no distinct fracture was discovered in 55 cases (40.4%). In 17 (12.5%) cases, this involved only the scaphoid. In the remainder, it also involved the other carpal bones or distal radius. Fracture(s) were diagnosed on 30 examinations (22.0%). MRI should be regarded as the gold standard investigation for patients in whom a scaphoid fracture is suspected clinically. It allows the diagnosis of occult bony and soft-tissue injuries that can present clinically as a scaphoid fracture; it also helps exclude patients with no fracture. We believe that there is a need to implement national guidelines for managing occult scaphoid fractures.

  7. Fracture-dislocation at C6-C7 level with Quadriplegia after Traditional Massage in a Patient with Ankylosing Spondylitis: A Case Report.

    Abilash, Kak; Mohd, Qmq; Ahmad, Zah; Towil, Basir

    2017-07-01

    Ankylosing spinal disorders (ASD) tend to result in fractures and/or dislocations after minor trauma because of the altered biomechanical properties. The relative risk of traumatic vertebral fractures in patients with ankylosing spondylitis has been estimated as three times higher than in the general population. These spine traumas, which are located at cervical level in 81% of patients with ankylosing spondylitis, are complicated by neurological lesions in 65% of patients, due to the high inherent instability of these fractures. Traditional massage is an ancient practice in many parts of Asia. It has many benefits that are currently recognized world-wide. However, it can be dangerous and even lethal if practised without adequate knowledge and skill. We report a case of C6-C7 fracture-dislocation with complete neurology and neurogenic shock in a middle aged man with undiagnosed ankylosing spondylitis.

  8. Fracture-dislocation at C6-C7 level with Quadriplegia after Traditional Massage in a Patient with Ankylosing Spondylitis: A Case Report

    Abilash KAK

    2017-07-01

    Full Text Available Ankylosing spinal disorders (ASD tend to result in fractures and/or dislocations after minor trauma because of the altered biomechanical properties. The relative risk of traumatic vertebral fractures in patients with ankylosing spondylitis has been estimated as three times higher than in the general population. These spine traumas, which are located at cervical level in 81% of patients with ankylosing spondylitis, are complicated by neurological lesions in 65% of patients, due to the high inherent instability of these fractures. Traditional massage is an ancient practice in many parts of Asia. It has many benefits that are currently recognized world-wide. However, it can be dangerous and even lethal if practised without adequate knowledge and skill. We report a case of C6-C7 fracture-dislocation with complete neurology and neurogenic shock in a middle aged man with undiagnosed ankylosing spondylitis.

  9. Medical Complications Predict Cognitive Decline in Nondemented Hip Fracture Patients-Results of a Prospective Observational Study.

    Hack, Juliana; Eschbach, Daphne; Aigner, Rene; Oberkircher, Ludwig; Ruchholtz, Steffen; Bliemel, Christopher; Buecking, Benjamin

    2018-03-01

    The aim of this study was to identify factors that are associated with cognitive decline in the long-term follow-up after hip fractures in previously nondemented patients. A consecutive series of 402 patients with hip fractures admitted to our university hospital were analyzed. After exclusion of all patients with preexisting dementia, 266 patients were included, of which 188 could be examined 6 months after surgery. Additional to several demographic data, cognitive ability was assessed using the Mini-Mental State Examination (MMSE). Patients with 19 or less points on the MMSE were considered demented. Furthermore, geriatric scores were recorded, as well as perioperative medical complications. Mini-Mental State Examination was performed again 6 months after surgery. Of 188 previously nondemented patients, 12 (6.4%) patients showed a cognitive decline during the 6 months of follow-up. Multivariate regression analysis showed that age ( P = .040) and medical complications ( P = .048) were the only significant independent influencing factors for cognitive decline. In our patient population, the incidence of dementia exceeded the average age-appropriate cognitive decline. Significant independent influencing factors for cognitive decline were age and medical complications.

  10. Comprehensive care of elderly patients with hip fracture: the orthogeriatric model

    Carlo Frondini

    2013-04-01

    Full Text Available Introduction: Hip fractures in the elderly are a major source of morbidity and mortality. Interdisciplinary hospital care models proposed for the treatment of these patients include consultant teams, integrated orthopedic-geriatric care, and comprehensive geriatric-led care settings. A prospective interventional cohort study was conducted in 4 public hospitals in the Emilia-Romagna Region of Italy to compare the outcomes of these different care models. This report presents the preliminary results obtained with an orthogeriatric model in one of these centers, a large teaching hospital in Bologna. Materials and methods: Beginning in February 2008, all patients older than 75 years admitted to the University of Bologna’s Sant’Orsola-Malpighi Hospital for hip fractures were cared for in an orthogeriatric unit. The unit consisted of 10 beds in the orthopedic ward that were managed by a geriatric specialist and a multidisciplinary team, which met daily and included an orthopedic surgeon, a physiatrist, a nurse case-manager, staff nurses, a physical therapist, and a social worker. The management protocol included a thorough geriatric work-up to identify comorbidities and risk factors, systematic assessment and prevention of pain and acute disorientation, early verticalization and moblization, postacute rehabilitation therapy, family support, and regular follow-up after discharge. Preliminary results were compared with those achieved in the same orthopedic ward prior to the creation of the Orthogeriatric Unit. Results: During 2008, 226 elderly patients (mean age 86.2 + 5.5 years, 73.4% of whom were women, were admitted to the Orthogeriatric Unit for hip fractures. The mean Charlson comorbidity index of this cohort was 3.0 + 1.8. Half the patients had Activity of Daily Living scores < 4, and cognitive impairment was common (mean score on Short Portable Mental Status Questionnaire: 5.9 + 3.2. Compared with figures obtained in the hospital

  11. Depression and young age impact on hip fracture subsequent to stroke: A population-based cohort study.

    Yeh, Hui-Fang; Hsu, Yao-Chun; Clinciu, Daniel L; Tung, Heng-Hsin; Yen, Yung-Chieh; Kuo, Hung-Chang

    2018-06-03

    The purpose of this study is to identify whether depression and other associated factors in stroke are related to subsequent hip fracture. There are very few studies that focus on depression and demographic impact on subsequent hip fracture after a stroke. This a retrospective cohort study design. The Taiwan Longitudinal Health Insurance Database between 1997 and 2010 was used. Two stroke patient cohorts were analysed: (1) depression within 1 year after newly diagnosed strokes; (2) without depression within 1 year after newly diagnosed strokes. Demographic characteristics, comorbidities, and hip fracture were compared using the Fine and Gray regression model for subdistribution hazard ratios. Patients with depression showed a higher risk of hip fracture (95% CI, 0.99-1.66). Depression was associated with increased risk of hip fracture for patients below 50 years old (95% CI, 1.45-7.34). Comorbidities and gender showed no significant correlation with hip fracture risk in the depressed or nondepressed groups. Poststroke depression was a significant contributor to hip fracture in patients who suffered strokes and had more negative impact on the younger population, regardless of the gender and presence of comorbidities. © 2018 John Wiley & Sons Australia, Ltd.

  12. Comparison of surgical complications of intertrochanteric hip fractures between non-osteoporotic and osteoporotic patients

    Azhar, M.S.; Nasab, M.H.K.; Saravi, M.S.

    2013-01-01

    Objective: To determine the role of bone quality in post-treatment complications among patients of intertrochanteric fracture. Methods: The cross-sectional descriptive study was done on 61 patients who presented with intertrochanteric hip fractures to two affiliated hospitals of Mazandaran University of Medical Science, Sari, Iran between February 2009 and December 2010. All the patients went through open reduction and internal fixation using 4-hole dynamic hip screw. The patients were followed up from 2 to 60 months. Data was analysed using SPSS 18. Results: The final rate of malunion, nail protrusion and mortality was 8.3% (n=3), 5.6% (n=2) and 8.4% (n=3) respectively. There was no significant difference between osteoporatic (n=36; 59%) and non-osteoporatic (n=25; 41%) groups regarding the surgical complications of intertrochanteric hip fracture. Conclusion: The quality of bone made no significant difference among patients who were treated for intertrochanteric fracture. (author)

  13. Do intramedullary implants improve survival in elderly patients with trochanteric fractures? A retrospective study.

    Vermesan, D; Prejbeanu, R; Poenaru, D V; Petrescu, H; Apostol, E; Inchingolo, F; Dipalma, G; Abbinante, A; Caprio, M; Potenza, M A; Cagiano, R; Malcangi, G; Inchingolo, A D; Haragus, H

    2015-01-01

    There is currently no consensus regarding superiority of the intramedullary fixation over the sliding hip screw. Regional variation remains high and not backed up by solid evidence. Given these premises we aimed to analyze weather implant preference can influence the postoperative survival. Secondary objectives were determining the trend for implant choice and confounding factors associated with intramedullary nails compared to sliding hip screws. Retrospective data was obtained from patient charts with the main diagnosis of extracapsular/ trochanteric fractures, corresponding to ICD S72.1 codes. Between 2008-2012, 441 patients underwent osteosynthesis with a dynamic hip screw and 155 with intramedullary nail respectively. The living status was determined by comparing the patient identification number against the national population evidence records. The lifetable shows similar survival for both implants over the 5 year period. The yearly mortality was 19.4% for the dynamic hip screw and 21.8% for the intramedullary implant respectively, even though the later were used predominantly in older patients. This age difference is significant according to both parametric and non-parametric tests whereas duration of hospital stay are similar. We found a clear increase in the proportion of intramedullary implants, for a total of 11.2% over the 5 year period. There is no difference for the one year mortality and overall survival between sliding screw plates and intramedullary constructs. A clear increase in the use of intramedullary implants for trochanteric fractures was observed. This is even more apparent for older ages, presumably due to an higher surgeon confidence with the biomechanical stability of the intramedullary constructs.

  14. Atypical Femur Fractures in Patients Treated with Bisphosphonates: Identification, Management, and Prevention

    Judith Sarah Bubbear

    2016-10-01

    Full Text Available Osteoporosis is a common condition with significant health care costs. First-line therapy is with bisphosphonates, which have proven anti-fracture efficacy. Around 10 years after the introduction of bisphosphonates reports began to be published of atypical femoral fractures (AFFs that may be associated with this therapy. These fractures are associated with significant morbidity although lower mortality than the more common osteoporotic neck-of-femur fractures. A case definition has been described to allow identification of this class of fracture. Further work has established a high relative risk of AFFs in patients treated with bisphosphonates, but a low absolute risk in comparison to that of osteoporotic fractures. Proposed pathological mechanisms include low bone turnover states leading to stress/insufficiency fractures. Clinicians should be aware of the risk of AFFs and in particular the high rate of prodromal thigh/groin pain that warrants investigation in a patient receiving a bisphosphonate. If an incomplete fracture is diagnosed then bisphosphonate therapy needs to be stopped and prophylactic surgery may be considered. Due to these rare side effects patients on bisphosphonates require regular review, and this is particularly advised after 5 years of oral or 3 years of intravenous therapy.

  15. User's manuals of probabilistic fracture mechanics analysis code for aged piping, PASCAL-SP

    Itoh, Hiroto; Nishikawa, Hiroyuki; Onizawa, Kunio; Kato, Daisuke; Osakabe, Kazuya

    2010-03-01

    As a part of research on the material degradation and structural integrity assessment for aged LWR components, a PFM (Probabilistic Fracture Mechanics) analysis code PASCAL-SP (PFM Analysis of Structural Components in Aging LWR - Stress Corrosion Cracking at Welded Joints of Piping) has been developed. This code evaluates the failure probabilities at welded joints of aged piping by a Monte Carlo method. PASCAL-SP treats stress corrosion cracking (SCC) and fatigue crack growth in piping, according to the approaches of NISA and JSME FFS Code. The development of the code has been aimed to improve the accuracy and reliability of analysis by introducing new analysis methodologies and algorithms considering the latest knowledge in the SCC assessment and fracture criteria of piping. In addition, the accuracy of flaw detection and sizing at in-service inspection and residual stress distribution were modeled based on experimental data and introduced into PASCAL-SP. This code has been developed for a cross-check use by the regulatory body in Japan. In addition to this, this code can also be used for a research purpose by researchers in academia and industries. This report provides the user's manual and theoretical background of the code. (author)

  16. Initiation of anti-osteoporotic therapy in patients with recent fractures: a nationwide analysis of prescription rates and persistence

    Roerholt, C; Eiken, P; Abrahamsen, Bo

    2009-01-01

    initiation within 1 year was highest after spine fracture: 39.6% of women began therapy in 2004 compared with 19.5% in 1997. In men, 16.5% began therapy in 2004 vs. 8.0% in 1997. Following hip fracture, 9.2% of women and 4.1% of men began therapy in 2004 vs. 3.4% and 0.7% in 1997, respectively. Median...... or weekly alendronate obtaining treatment durations equalling those of the licensing trials. INTRODUCTION: Reducing the societal fracture burden remains challenging due to failure to treat fragility fractures and non-compliance with treatment. METHODS: We used national registers to identify patients born...... persistence (years) was 2.8 for daily alendronate, 3.8 for weekly alendronate, 2.5 for etidronate and 4.7 for raloxifene. The risk of discontinuing or changing therapy increased with age. CONCLUSIONS: Prescription rates for anti-osteoporotic medication are very low, especially in hip fracture and in men...

  17. Identification of risk factors for neurological deficits in patients with pelvic fractures

    Schmal, Hagen; Hauschild, Oliver; Culemann, Ulf

    2010-01-01

    This multicenter register study was performed to define injury and fracture constellations that are at risk to develop pelvic associated neural lesions. Data of 3607 patients treated from 2004 to 2009 for pelvic fractures were evaluated for neurological deficits depending on Tile classification......, pelvic injury configuration, and treatment.In 223 patients (6.5%), neurological lesions were diagnosed on the day of discharge from the hospital. The degree of instability of the pelvic fracture correlated with occurrence of nerve lesions. Rate of neurological dysfunction increased from 1.5% in type...... A fractures to 14.4% in type C fractures (PPatients sustaining complex pelvic trauma (7.85%) suffered from significantly more neurological...

  18. Standardization of spedalized medical care to patients with shin fractures in multifield city hospital

    R. M. Tikhilov

    2013-01-01

    Full Text Available The aim of the investigation was development of science-based recommendations for increasing efficiency of operative treatment of adult patients with shin fractures in multiprofile city hospital. Investigation was made in Saint-Petersburg Alexandrovskiy City Hospital. Clinical material was presented by official hospital reports, individual medical documentation and results of direct survey of patients treated in this hospital in period 1999-2010 years. All patients had follow up treatment in outpatient department of this hospital. Information was completed following federal and local laws. Recommendations for standardization of modern specialized medical care of patients with shin fractures, based on methods of internal fixation, were performed. We took into consideration possibilities of conventional and minimally invasive fixation of closed and open fractures including politrauma injuries. Models of patients with shin fractures depending on method of internal fixation and list of basic diagnostic procedures and treatment were formed. Operations classifier of internal shin fractures fixation was developed. This classifier includes calculation of hospital costs in process of specialized medical care considering actual correction coefficients. Calculation of each surgical procedure component was performed. List and composition of instrument sets and expense materials for such operations were formed. Analisis of organizational, medico-technological, economica aspect and expert evaluation of clinical results of different methods of long bones fractures fixation have provided conceptual approach to treatment standardization. On this base we have developed medico-economical standards of long bones fractures treatment in city multiprofile hospital.

  19. Ankle fractures have features of an osteoporotic fracture.

    Lee, K M; Chung, C Y; Kwon, S S; Won, S H; Lee, S Y; Chung, M K; Park, M S

    2013-11-01

    We report the bone attenuation of ankle joint measured on computed tomography (CT) and the cause of injury in patients with ankle fractures. The results showed age- and gender-dependent low bone attenuation and low-energy trauma in elderly females, which suggest the osteoporotic features of ankle fractures. This study was performed to investigate the osteoporotic features of ankle fracture in terms of bone attenuation and cause of injury. One hundred ninety-four patients (mean age 51.0 years, standard deviation 15.8 years; 98 males and 96 females) with ankle fracture were included. All patients underwent CT examination, and causes of injury (high/low-energy trauma) were recorded. Mean bone attenuations of the talus, medial malleolus, lateral malleolus, and distal tibial metaphysis were measured on CT images. Patients were divided into younger age (fractures than the younger age group. With increasing age, bone attenuations tended to decrease and the difference of bone attenuation between the genders tended to increase in the talus, medial malleolus, lateral malleolus, and distal tibial metaphysis. Ankle fracture had features of osteoporotic fracture that is characterized by age- and gender-dependent low bone attenuation. Ankle fracture should not be excluded from the clinical and research interest as well as from the benefit of osteoporosis management.

  20. [Effect of different anesthetic methods on postoperative outcomes in elderly patients undergoing hip fracture surgery].

    Wei, B; Zhang, H; Xu, M; Li, M; Wang, J; Zhang, L P; Guo, X Y; Zhao, Y M; Zhou, F

    2017-12-18

    To investigate the effect of general or regional anesthesia on postoperative cardiopulmonary complications and inpatient mortality after hip fracture surgery in elderly patients. A retrospective analysis was conducted according to the medical records of 572 elderly patients with hip fractures admitted to our hospital from January 1, 2005 to December 31, 2014. The age, gender, preoperative comorbidities, length of preoperative bedridden time, mechanism of injury, surgical types, anesthetic methods, major postoperative complications and inpatient mortality were recorded. Multivariate Logistic regression analysis was applied to analyze the impact of different anesthetic methods on inpatient mortality in these patients. Of the 572 patients, 392 (68.5%) received regional anesthesia. Inpatient death occurred in 8 (8/572, mortality: 1.4%), including 5 cases of RA group (5/392, mortality: 1.3%) and 3 cases of GA group (3/180, mortality: 1.7%). There was no statistically significant difference between the two groups in inpatient mortality (P>0.05). Multiple Logistic regression analysis showed that gender (odds ratio: 0.18, 95% CI: 0.03-1.05, P=0.057), age (odds ratio: 1.22, 95% CI: 1.07-1.38, P=0.002), preoperative pulmonary comorbidities (odds ratio: 12.09, 95% CI: 2.28-64.12, P=0.003) and surgical types (odds ratio: 9.36, 95% CI: 1.34-64.26, P=0.024) were risk factors for inpatient mortality. Postoperative cardiovascular complications occurred in 36 patients (36/572, morbidity: 6.3%), with 19 patients in RA group (19/392, morbidity: 4.8%),and 17 patients in GA group (17/180, morbidity: 9.4%). Multiple Logistic regression analysis showed that age (odds ratio: 1.13, 95% CI: 1.07-1.19, Pbedridden time (odds ratio: 1.11, 95% CI: 1.04-1.18, P=0.003) and anesthetic methods (odds ratio: 5.86, 95% CI: 2.98-11.53, Pelderly patients. Regional anesthesia is associated with a lower risk of pulmonary complications after surgical procedure compared with general anesthesia.

  1. Merkel cells carcinoma of the aged patient

    Levy, A.; Assouline, A.; Mazeron, J.J.; Chargari, C.; Krzisch, C.

    2009-01-01

    The carcinoma at Merkel cells is a rare and aggressive skin cancer, principally of the aged adult. The surgery is the fundamental treatment. The interest of the adjuvant radiotherapy is discussed for the aged patient. In the limits of this retrospective analysis, the postoperative radiotherapy appeared to bring a similar benefit as for younger patients. (N.C.)

  2. Fibroblast Growth Factor-23, Sclerostin, and Bone Microarchitecture in Patients With Osteoporotic Fractures of the Proximal Femur: A Cross-sectional Study.

    Herlyn, Philipp K E; Cornelius, Norina; Haffner, Dieter; Zaage, Franziska; Kasch, Cornelius; Schober, Hans-Christof; Mittlmeier, Thomas; Fischer, Dagmar-C

    2016-01-01

    This cross-sectional observational cohort study was designed to simultaneously investigate bone microarchitecture and serum markers of bone metabolism in elderly osteoporotic patients experiencing a trochanteric or femoral neck fracture. Special emphasis was put on renal function, sclerostin and fibroblast growth factor-23 (FGF-23). Eighty-two patients (median age: 84 years; 49 trochanteric fractures) scheduled for emergency surgery due to an osteoporotic fracture participated. Bone specimens for ex vivo microcomputed X-ray tomography were sampled during surgery. Blood samples for laboratory workup were collected before surgery (t0) and 1 day afterward (t1). Fifty-eight patients consented to dual-energy X-ray absorptiometry scanning of the lumbar spine and/or contralateral femoral neck after recovery during the in-patient stay. Samples were grouped according to the site of fracture. Regression coefficients were controlled for age and/or estimated glomerular filtration rate (eGFR), if appropriate. Patients experiencing a femoral neck fracture presented with better preserved renal function (eGFR) and lower C-terminal fragment of fibroblast growth factor-23 (cFGF-23) concentrations compared to those with trochanteric fractures. By contrast, serum sclerostin was similar at both time points and did not differ between groups. Age-adjusted correlation analysis revealed negative associations between eGFR and cFGF-23 determined at t1 (R=-0.34; ptrochanteric and femoral neck fractures, respectively. Our study provides evidence that not only an age-related decline of renal function but also the type of skeletal injury may contribute to the circulating concentrations of cFGF-23. Copyright © 2016 The International Society for Clinical Densitometry. Published by Elsevier Inc. All rights reserved.

  3. Reliability, validity, and responsiveness of the Western Ontario and McMaster Universities Osteoarthritis Index for elderly patients with a femoral neck fracture.

    Burgers, Paul T P W; Poolman, Rudolf W; Van Bakel, Theodorus M J; Tuinebreijer, Wim E; Zielinski, Stephanie M; Bhandari, Mohit; Patka, Peter; Van Lieshout, Esther M M

    2015-05-06

    The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) has been extensively evaluated in groups of patients with osteoarthritis, yet not in patients with a femoral neck fracture. This study aimed to determine the reliability, construct validity, and responsiveness of the WOMAC compared with the Short Form-12 (SF-12) and the EuroQol 5D (EQ-5D) questionnaires for the assessment of elderly patients with a femoral neck fracture. Reliability was tested by assessing the Cronbach alpha. Construct validity was determined with the Pearson correlation coefficient. Change scores were calculated from ten weeks to twelve months of follow-up. Standardized response means and floor and ceiling effects were determined. Analyses were performed to compare the results for patients less than eighty years old with those for patients eighty years of age or older. The mean WOMAC total score was 89 points before the fracture in the younger patients and increased from 70 points at ten weeks to 81 points at two years postoperatively. In the older age group, these scores were 86, 75, and 78 points. The mean WOMAC pain scores before the fracture and at ten weeks and two years postoperatively were 92, 76, and 87 points, respectively, in the younger age group and 92, 84, and 93 points in the older age group. Function scores were 89, 68, and 79 points for the younger age group and 84, 71, and 73 points for the older age group. The Cronbach alpha for pain, stiffness, function, and the total scale ranged from 0.83 to 0.98 for the younger age group and from 0.79 to 0.97 for the older age group. Construct validity was good, with 82% and 79% of predefined hypotheses confirmed in the younger and older age groups, respectively. Responsiveness was moderate. No floor effects were found. Moderate to large ceiling effects were found for pain and stiffness scales at ten weeks and twelve months in younger patients (18% to 36%) and in the older age group (38% to 53%). The WOMAC showed good

  4. Improving consent in patients undergoing surgery for fractured neck of femur.

    Thiruchandran, Gajendiran; McKean, Andrew R; Rudran, Branavan; Imam, Mohamed A; Yeong, Keefai; Hassan, Abdel

    2018-05-02

    Background Neck of femur fractures and their subsequent operative fixation are associated with high rates of perioperative morbidity and mortality. Consenting in this setting is suboptimal with the Montgomery court ruling changing the perspective of consent. This quality improvement project assessed the adequacy of consenting against British Orthopaedic Association-endorsed guidance and implemented a series of changes to improve the documentation of risks associated with surgery for fractured neck of femur. Methods Seventy consecutive patients who underwent any operative fixation of a neck of femur fracture were included over a 6-month period at a single centre. Patients unable to consent or without electronic notes were excluded. Consent forms were analysed and the documented potential risks or complications associated with surgery were compared to British Orthopaedic Association-endorsed guidance. A series of changes (using the plan, do study, act (PDSA) approach) was implemented to improve the adequacy of consent. Results Documentation of four out of 12 potential risks or complications was recorded in <50% of cases for patients with intracapsular fractures (n=35), and documentation of seven out of 12 potential risks or complications was recorded in <50% of cases for patients with extracapsular fractures (n=35). Re-audit following raising awareness and attaching consent guidance showed 100% documentation of potential risks or complications in patients with intracapsular and extracapsular fractures (n=70). A neck of femur fracture-specific consent form has been implemented which will hopefully lead to sustained improvement. Conclusions Consenting patients with fractured neck of femur for surgery in the authors' unit was suboptimal when compared to British Orthopaedic Association-endorsed consent guidance. This project has shown that ensuring such guidance is readily available has improved the adequacy of consent. The authors hope that introduction of a neck of

  5. Complex tibial fractures are associated with lower social classes and predict early exit from employment and worse patient-reported QOL: a prospective observational study of 46 complex tibial fractures treated with a ring fixator.

    Elsoe, Rasmus; Larsen, Peter; Petruskevicius, Juozas; Kold, Søren

    2018-04-01

    The long-term outcomes following complex fractures of the tibia are reported to carry a risk of knee pain, malalignment, articular injury and post-traumatic osteoarthritis. The main objective of this study was to account for the patient-reported quality of life (QOL) 12 months after ring fixator removal in patients with a complex tibial fracture. Secondary objectives included a review of the socio-economic characteristics of the patient group and the rate of return to work in the study period. A prospective follow-up study was conducted of 60 patients with complex fractures of the tibia treated with ring external fixation. Patient-reported outcomes, radiological outcomes and socio-economic status including employment status of the patients were obtained 12 months after frame removal. Forty-six patients completed the assessment 12 months after frame removal (77%). The mean age of the patient at the time of fracture was 54.6 years (range 31-86). There were 19 males and 27 females. At 12 months after frame removal, the mean EQ5D-5L index was 0.66 (CI 0.60-0.72). The mean EQ5D-5L VAS was 69 (CI 61-76). When this was compared to the established reference population from Denmark, the study population showed a significantly worse EQ5D-5L index. The majority of patients (87%) were in the lower social classes suggesting a higher degree of social deprivation in the study population. Twenty-seven per cent of patients who were employed prior to injury had returned to employment at approximately 19 months following fracture. The onset of post-traumatic osteoarthritis was present in the knee joint in 29% of patients following a proximal intra-articular fracture, whereas osteoarthritis was present at the ankle joint in 35% of patients following a distal intra-articular fracture 12 months after frame removal. This study indicates that at 12 months after frame removal there are poorer patient-reported QOL as when compared to reference populations. Furthermore, this study

  6. Study of Aging-Induced Degradation of Fracture Resistance of Alloy 617 Toward High-Temperature Applications

    Singh, Aditya Narayan; Moitra, A.; Bhaskar, Pragna; Sasikala, G.; Dasgupta, Arup; Bhaduri, A. K.

    2017-07-01

    For the Alloy 617, the effect of aging on the fracture energy degradation has been investigated after aging for different time periods at 1023 K (750 °C). A sharp reduction in impact energy (by 55 pct vis-à-vis the as-received material) after 1000 hours of aging, as evaluated from room-temperature Charpy impact tests, has been observed. Further aging up to 10,000 hours has led to a degradation of fracture energy up to 78 pct. Fractographic examinations using scanning electron microscopy (SEM) have revealed a change in fracture mode from fibrous-ductile for the un-aged material to intergranular mode for the aged one. The extent of intergranular fracture increases with the increasing aging time, indicating a tendency of the material to undergo grain boundary embrittlement over long-term aging. Analysis of the transmission electron microscopy (TEM) micrographs along with selected area diffraction (SAD) patterns for the samples aged at 10,000 hours revealed finely dispersed γ' precipitates of size 30 to 40 nm, rich in Al and Ti, along with extensive precipitation of M23C6 at the grain boundaries. In addition, the presence of Ni3Si of size in the range of 110 to 120 nm also has been noticed. The extensive precipitation of M23C6 at the grain boundaries have been considered as a major reason for aging-induced embrittlement of this material.

  7. A qualitative study of Functioning, Disability, and Rehabilitation of patients after hip fracture surgery

    Ehlers, Monica Milter

    2013-01-01

    A qualitative study of functioning, disability, and rehabilitation of patients after hip fracture surgery Monica Milter Ehlers PhD student, MSc in Nursing Merete Bender Bjerrum* PhD, MA, Associate Professor Claus Vinther Nielsen* Professor, PhD, MD, Specialist in Clinical Social Medicine...... *Department of Public Health, Aarhus University Introduction Hip fractures cause the greatest consumption of bed days in Danish hospitals. The need for rehabilitation of hip fracture patients older than 65 years is increasing because of a growing number of elderly people in Denmark. Rehabilitation of hip...... fracture patients consists primarily of muscle training and daily mobilisation. Patients' functioning, disability, and involvement in their rehabilitation process have not been investigated in scientific studies. Aims To establish a specific research-based knowledge for functioning, disability...

  8. [Ankle injuries without fracture in children. Prospective study with magnetic resonance in 116 patients].

    Launay, F; Barrau, K; Petit, P; Jouve, J-L; Auquier, P; Bollini, G

    2008-09-01

    Appropriate assessment of ankle injuries in children and adolescents is a common emergency room problem. Many imaging techniques have been proposed, but with no consensus on the reality of anatomic lesions in ankles free of fractures, complicating the therapeutic decision. We analyzed the lesions observed with magnetic resonance imaging (MRI) in a large number of acute ankles in children. This prospective study was conducted in a pediatric emergency room. The study population included all children aged eight to 15 years who presented an isolated injury of the ankle without fracture on the plain x-ray. History taking and physical examination were standardized. MRI was performed within three days of the initial physical examination. All the radiographic documents were examined by an experienced radiologist blinded to the results of the physical examination. During the study period, 116 patients were included. One hundred two MRI series were examined. Minor ligament injury was noted in 20 patients and ligament tear in five, including three with a closed distal tibial growth plate. Minor bone injury was noted in 42 patients and fracture in seven. None of these fractures were visible on the plain x-ray, even after knowledge of the MRI. Injuries were more frequent in boys. Injuries were more frequent when the pain was localized on the lateral aspect of the ankle and when there was an edema. Despite an abundant literature on ankle sprains, prospective studies are scarce in the pediatric population. We have found that MRI is particularly well-adapted for children because it allows a complete examination of anatomic lesions involving the bone or ligaments without the inconveniences of injections, pain, or radiation. Our clinical and imaging findings show that ankle sprains are real in children. We were however unable to identify any clinical factors predictive of ligament and/or bone injury. Other studies should be conducted to better understand the nosological context of

  9. A Pronounced Inflammatory Activity Characterizes the Early Fracture Healing Phase in Immunologically Restricted Patients

    Hoff, Paula; Gaber, Timo; Strehl, Cindy; Jakstadt, Manuela; Hoff, Holger; Schmidt-Bleek, Katharina; Lang, Annemarie; Röhner, Eric; Huscher, Dörte; Matziolis, Georg; Burmester, Gerd-Rüdiger; Schmidmaier, Gerhard; Perka, Carsten; Duda, Georg N.; Buttgereit, Frank

    2017-01-01

    Immunologically restricted patients such as those with autoimmune diseases or malignancies often suffer from delayed or insufficient fracture healing. In human fracture hematomas and the surrounding bone marrow obtained from immunologically restricted patients, we analyzed the initial inflammatory phase on cellular and humoral level via flow cytometry and multiplex suspension array. Compared with controls, we demonstrated higher numbers of immune cells like monocytes/macrophages, natural killer T (NKT) cells, and activated T helper cells within the fracture hematomas and/or the surrounding bone marrow. Also, several pro-inflammatory cytokines such as Interleukin (IL)-6 and Tumor necrosis factor α (TNFα), chemokines (e.g., Eotaxin and RANTES), pro-angiogenic factors (e.g., IL-8 and Macrophage migration inhibitory factor: MIF), and regulatory cytokines (e.g., IL-10) were found at higher levels within the fracture hematomas and/or the surrounding bone marrow of immunologically restricted patients when compared to controls. We conclude here that the inflammatory activity on cellular and humoral levels at fracture sites of immunologically restricted patients considerably exceeds that of control patients. The initial inflammatory phase profoundly differs between these patient groups and is probably one of the reasons for prolonged or insufficient fracture healing often occurring within immunologically restricted patients. PMID:28282868

  10. Low bone mineral density is not related to failure in femoral neck fracture patients treated with internal fixation

    Viberg, Bjarke; Ryg, Jesper; Overgaard, Søren

    2014-01-01

    the importance of low bone mineral density (BMD). Patients and methods - 140 consecutive patients (105 females, median age 80) treated with IF had a dual-energy X-ray absorptiometry (DXA) scan of the hip performed median 80 days after treatment. The patients' radiographs were evaluated for fracture displacement......, implant positioning, and quality of reduction. From a questionnaire completed during admission, 2 variables for comorbidity and walking disability were chosen. Primary outcome was low hip BMD (amount of mineral matter per square centimeter of hip bone) compared to hip failure (resection, arthroplasty...

  11. Management of penile fractures

    Ghilan, Abdulelah M. M.; Al-Asbahi, Waleed A.; Alwan, Mohammed A.; Al-Khanbashi, Omar M.; Ghafour, Mohammed A.

    2008-01-01

    Objective was to present our experience with surgical and conservative management of penile fracture. This prospective study was carried out in the Urology and Nephrology Center, at Al-Thawra General and Teaching Hospital, Sana'a, Yemen from June 2003 to September 2007 and included 30 patients presenting with penile fracture. Diagnosis was made clinically in all our patients. Six patients with simple fracture were treated conservatively while 24 patients with more severe injuries were operated upon. Patient's age ranged from 24-52 years (mean 31.3 years) 46.7% of patients were under the age of 30 years and 56.7% were unmarried. Hard manipulation of the erect penis for example during masturbation was the most frequent mechanism of fracture in 53.3% of patients. Solitary tear was found in 22 patients and bilateral corporal tears associated with urethral injury were found in 2 patients. Corporal tears were saturated with synthetic absorbable sutures and urethral injury was repaired primarily. All operated patients described full erection with straight penis except 3 of the 8 patients who were managed by direct longitudinal incision, in whom mild curvature during erection was observed. The conservatively treated patients described satisfactory penile straightness and erection. The optimal functional and cosmetic results are achieved following immediate surgical repair of penis fracture. Good results can also be obtained in some selected patients with conservative management. (author)

  12. Traumatic Fracture in a patient of Osteopoikilosis with review of literature

    Rohan Bansal

    2013-04-01

    Full Text Available Introduction: Osteopoikilosis or osteopathia condensans disseminata is a rare hereditary autosomal dominant sclerosing bone dysplasia. Patients are usually asymptomatic and the diagnosis is usually made incidentally on radiographs which show presence of symmetric, multiple, well defined, small ovoid areas of increased radiodensity clustered in peri-articular osseous regions with propensity for epiphyseal and metaphyseal involvement. There are no increased risks of pathological fracture in a case of osteopoikilosis and traumatic fracture healing in a case of osteopoikilosis is similar to fracture occurring in other normal patients. Case Report: A 34 years male, electrician came with history of accidental fall from height while working in office leading to development of pain and swelling over left lower leg and ankle diagnosed with Ruedi-Allgower classification type I pilon fracture(without fibula fracture no distal neuro-vascular deficit. Patient was offered surgical treatment in form of open reduction and internal fixation of tibial fracture by plate osteosynthesis using antero-medial approach , showed complete union and was followed up for eight months. Conclusion: Osteopoikilosis has a benign course and it should always be kept as a possible differential diagnosis for osteoblastic metastasis to avoid diagnositic dilemma. Diagnosis can be settled by routine x-rays ( for type ,extent and site of lesions, bones affected, clinical features of patient , histopathology and other systemic or pre-existing conditions. Keywords: Fracture , Osteopoikilosis , union, Pilon, Osteoblastic metastasis

  13. Acute flexor tendon injury following midshaft radius and ulna fractures in a paediatric patient

    James Williams

    2018-06-01

    Full Text Available Delayed rupture of the extensor and flexor tendons are recognised complications of distal radius fractures. However, acute flexor tendon rupture in the context of forearm fractures is rare. A twelve-year-old female sustained midshaft fractures of the radius and ulna. Intra-operatively the flexor pollicis longus (FPL was found to be stripped from its musculotendinous junction at the level of the fracture fragment. The ruptured tendon was repaired using a modified Krackow technique at the time of fracture fixation. The repair was protected in plaster of Paris prior to referral to the paediatric hand clinic. The patient made a full recovery. Flexor tendon injury is a rare but potentially devastating consequence of acute forearm fractures. High energy trauma, significant volar angulation of the fracture fragment and clinical signs of flexor tendon injury should raise suspicion of this injury. A high index of suspicion in conjunction with repeat clinical examination of flexor tendon function should be performed before opting for closed management or intramedullary nailing in paediatric patients. Keywords: Acute, Flexor, Tendon, Fracture, Radius, Paediatric

  14. Middle-term follow-up results of Pipkin type IV femoral head fracture patients treated by reconstruction plate and bioabsorbable screws

    Shan-Xi Wang

    2018-06-01

    Full Text Available Purpose: To investigate the mid-term curative effects of the treatment of Pipkin type IV femoral head fractures using a reconstruction plate and bioabsorbable screws and provide the evidence for clinical practice. Methods: From February 2010 to September 2014, 21 patients with Pipkin type IV femoral head fractures were treated surgically. There were 13 males and 8 females with an average age of 41.1 years (range, 20–65 years. The causes of the fractures included traffic accidents (13 cases, falls from a height (four cases, heavy lifting injuries (three cases, and sport injury (one case. All patients were followed up with radiography and three-dimensional reconstruction computed tomography and other checks and any complications were actively managed. Closed reduction of fracture-dislocation of the hip was attempted under general anesthesia using the Kocher-Langenbeck approach. Femoral head fractures were treated with internal fixation or excision based on the size of the fracture fragments, whereas acetabular fractures were fixed with a reconstruction plate and screws following anatomic reduction. Results: The incisions healed by primary intention in all patients after surgery, without any infection, deep venous thrombosis, or other complications. All 21 patients were followed up for 36–76 months, with an average follow-up duration of 49 months. Postoperative imaging data showed that all dislocations and fractures were anatomically reduced, and bony union of the fractures was achieved. Heterotopic ossification was found in four patients, post-traumatic osteoarthritis in three, and avascular necrosis of the femoral head in two. At the final follow-up, the assessment of hip joint function according to the Thompson-Epstein scoring scale was excellent in 10 cases, good in six cases, fair in three cases, and poor in two cases. The rate of excellent and good functional outcomes was 76.1%. Conclusion: The mid-term curative effects of a

  15. [Trochanteric femoral fractures].

    Douša, P; Čech, O; Weissinger, M; Džupa, V

    2013-01-01

    At the present time proximal femoral fractures account for 30% of all fractures referred to hospitals for treatment. Our population is ageing, the proportion of patients with post-menopausal or senile osteoporosis is increasing and therefore the number of proximal femoral fractures requiring urgent treatment is growing too. In the age category of 50 years and older, the incidence of these fractures has increased exponentially. Our department serves as a trauma centre for half of Prague and part of the Central Bohemia Region with a population of 1 150 000. Prague in particular has a high number of elderly citizens. Our experience is based on extensive clinical data obtained from the Register of Proximal Femoral Fractures established in 1997. During 14 years, 4280 patients, 3112 women and 1168 men, were admitted to our department for treatment of proximal femoral fractures. All patients were followed up until healing or development of complications. In the group under study, 82% were patients older than 70 years; 72% of those requiring surgery were in their seventies and eighties. Men were significantly younger than women (pfractures were 2.3-times more frequent in women than in men. In the category under 60 years, men significantly outnumbered women (pfractures were, on the average, eight years older than the patients with intertrochanteric fractures, which is a significant difference (pTrochanteric fractures accounted for 54.7% and femoral neck fractures for 45.3% of all fractures. The inter-annual increase was 5.9%, with more trochanteric than femoral neck fractures. There was a non-significant decrease in intertrochanteric (AO 31-A3) fractures. On the other hand, the number of pertrochanteric (AO 31-A1+2) fractures increased significantly (pfractures were treated with a proximal femoral nail; a short nail was used in 1260 and a long nail in 134 of them. A dynamic hip screw (DHS) was employed to treat 947 fractures. Distinguishing between pertrochanteric (21-A1

  16. Use of orthodontic brackets for intermaxillary fixation for management of mandibular fracture in a pediatric patient

    Rajeev Pandey

    2017-01-01

    Full Text Available Fracture of mandible is relatively less common in pediatric population when compared to adults. Management of pediatric mandibular fracture is a very complex issue and requires accurate and early treatment. Although the general principles of treatment remain the same as adult but various factors which influence the choice of management: age, dentition status, site involved, amount of displacement, number of fractures, and socioeconomic status. This case report describes a conservative way of management of moderately displaced mandibular fracture with the help of closed reduction achieved using intermaxillary fixation (IMF with help of elastics using orthodontic brackets. A 9-year-old male child was treated for body of mandible fracture using this technique. The IMF was removed after 3 weeks and adequate bone union was demonstrated clinically and radiographically.

  17. [Application of immunomodulators in the treatment of mandibular fractures in elderly patients with incomplete secondary adentia].

    Abramov, A V; Parfenov, S A; Belov, V G; Parfenov, Iu A

    2014-01-01

    The aim of the work was to study the experience of using complex pharmacotherapy in the treatment of mandibular fractures in elderly patients with incomplete secondary periodontitis, which were divided into two groups. In the first group, patients (n = 46; average age 69.0 ± 3.6) were treated using the authors' original device combined with application of antimicrobial MetrogilDenta gel onto gums two times a day during ten days. Patients in the second group (n = 52; average age 61.0 ± 3.1) were treated with the same device combined with (i) application of MetrogilDenta antimicrobial gel onto gums two times a day during ten days, (ii) application of 1.5 ml of Cycloferon 5% liniment by cotton pellet for 20 min during the same 10 days (30 minutes after the antimicrobial gel), and (iii) intramuscular injections of 6 mg of synthetic immunomodulator Polyoxidonium once a day for 3 days, then once every two days (for a total of 17 days). It is established that the use of the combination of interferon inducers of immunomodulator group--Cycloferon in the form of liniment and synthetic immunomodulator Polyoksidonium together with MetrogilDenta antimicrobial gel--led to the most pronounced regression of inflammatory and destructive processes in periodontal tissues (in 7.1%, đ = 0.05), optimized the state of local immunity of the oral cavity, and normalized microflora in periodontal pockets in elderly patients with incomplete secondary adentia.

  18. Atraumatic Occult Odontoid Fracture in Patients with Osteoporosis-Associated Thoracic Kyphotic Deformity: Report of a Case and Review of the Literature

    Kanji Mori

    2015-01-01

    Full Text Available Anderson type II odontoid fractures are reported to be the most common injury of the odontoid process in patients over the age of 65. However, atraumatic occult Anderson type III odontoid fractures have been rarely described and remain a diagnostic challenge. In the present report, we illustrate a 78-year-old female with osteoporosis-associated marked thoracic kyphotic deformity who developed atraumatic Anderson type III occult odontoid fracture and raise awareness of this condition. Anteroposterior and lateral standard radiographs of cervical spine failed to disclose odontoid fracture. Magnetic resonance imaging demonstrated intensity changes of the axis. Subsequent computed tomography clearly demonstrated Anderson type III odontoid fracture. Conservative treatment achieved complete bone union without neurological deteriorations. At 3-year follow-up, the patient was doing well without neurological and radiological deteriorations. Even if the patients have no traumatic event, we have to keep odontoid fractures in our mind as one of the differential diagnoses when we encounter elderly patients with neck pain, especially in patients with osteoporosis-associated marked thoracic kyphotic deformity.