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Sample records for intertrochanteric hip fractures

  1. Reverse LISS plating for intertrochanteric Hip Fractures in elderly patients

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    Chen SB

    2010-07-01

    Full Text Available Abstract Background Fractures of the intertrochanteric hip are common and the treatment of unstable fractures generally requires an operative approach. In elderly patients, osteoporosis makes internal fixation problematic and frequently contributes to failed fixation and poor clinical results. We have attempted to apply the Less Invasive Stabilization System (LISS in reverse position for the repair of intertrochanteric hip fractures in elderly patients with osteoporotic bones. A retrospective review is presented of the cases of 28 elderly patients with stable and unstable fractures of the intertrochanteric hip treated using the reverse LISS. Methods We treated 28 elderly patients with a mean age of 82.3 years. According to the Evens classification, there were 2 Type I fractures, 2 Type II fractures, 3 Type III fractures, 13 Type IV fractures, 6 Type V fractures and 2 Type R fractures. All fractures were treated using the reverse LISS. Radiographic and clinical evidence of functional outcome and complications were evaluated. Results Mean perioperative blood loss was 92.4 milliliters (range 35 to 245 milliliters, and the mean postoperative hospital stay was 8.7 days (range 3 to 14 days. Complications included one minor wound hematoma. Radiographically, no collapses, screw cutouts, or head penetrations were seen. All surviving patients (28 of 28; 100 percent had uneventful fracture healing with union achieved by six months in all patients. Conclusions Use of the Reverse LISS plating for intertrochanteric hip fractures resulted in event-free fracture healing.

  2. Reliability of predictors for screw cutout in intertrochanteric hip fractures

    NARCIS (Netherlands)

    K.M.J. de Bruijn (Kirstin); D. den Hartog (Dennis); W.E. Tuinebreijer (Wim); G.R. Roukema (Gert)

    2012-01-01

    textabstractBackground: Following internal fixation of intertrochanteric hip fractures, tip apex distance, fracture classification, position of the screw in the femoral head, and fracture reduction are known predictors for screw cutout, but the reliability of these measurements is unknown. We invest

  3. Pseudoaneurysm of profunda femoris artery following dynamic hip screw fixation for intertrochanteric femoral fracture

    Institute of Scientific and Technical Information of China (English)

    Shailendra Singh; Sumit Arora; Ankit Thora; Ram Mohan; Sumit Sural; Anil Dhal

    2013-01-01

    Dynamic hip screw fixation is a commonly performed procedure for internal fixation of intertrochanteric femoral fractures.Arterial injury following the operative fixation is a rare but serious event.We present a patient who developed pseudoaneurysm of profunda femoris artery after internal fixation of intertrochanteric fracture with a dynamic hip screw.The diagnosis was confirmed by angiographic study and it was successfully treated by coil embolization.

  4. Fixation of a Periprosthetic Intertrochanteric Hip Fracture below a Birmingham Hip Resurfacing

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    J. Macdonald

    2014-01-01

    Full Text Available This case report involves a 56-year-old female (Mrs X with a traumatic intertrochanteric hip fracture with subtrochanteric extension below a previous Birmingham hip resurfacing. Periprosthetic fractures following hip resurfacing are usually subcapital and treated with a revision or conservative management. We present an unusual surgical problem with an interesting solution stabilising the fracture using a proximal femoral locking compression plate (LCP. Eight months following surgery the patient is able to walk pain free and there is good fixation and stability.

  5. Dynamic Hip Screw Compared to Condylar Blade Plate in the Treatment of Unstable Fragility Intertrochanteric Fractures

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    CK Yong

    2009-05-01

    Full Text Available Dynamic hip screw (DHS fixation is considered standard treatment for most intertrochanteric fractures. However, excessive sliding at the fracture site and medialisation of femoral shaft may lead in fixation failure. In contrast, fixed- angled 95° condylar blade plate (CBP has no effective dynamic capacity and causes little bone loss compared to DHS. We compared the outcome of 57consecutive unstable intertrochanteric fragility fractures treated with these two fixation methods. CBP instrumentation is more difficult requiring longer incision, operating time and higher surgeon- reported operative difficulty. The six month post-operative mortality rate is 16%. Post-operative Harris hip scores were comparable between the two methods. Limb length shortening more than 20 mm was 6-fold more common with DHS. In elderly patients with unstable intertrochanteric fragility fractures, fixed angled condylar blade plate appears to be a better choice than dynamic hip screws for preventing fixation failures.

  6. Posterior dislocation of hip with ipsilateral intertrochanteric fracture: A report of two cases

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    Rehan Ul Haq

    2016-01-01

    Full Text Available Posterior dislocations of the hip are known to be associated with fractures of the femoral head, neck, shaft, or posterior acetabular wall. However, its association with ipsilateral intertrochanteric fracture has only been anecdotally described in the English literature. We report two such cases managed by open reduction (OR of the hip and internal fixation (IF of the intertrochanteric fracture. The first case was a 26-year-old male who was managed by OR of the hip with IF of the intertrochanteric fracture with a dynamic hip screw and had a good functional result at 1-year followup. The second case was a 36-year-old female who was also managed by OR of the hip with IF of the head fragments with Herbert screw and IF of the intertrochanteric fracture with a dynamic condylar screw. The patient had a fair, functional result at 1-year followup. With the increase in high energy trauma, these fracture patterns have become more common, and there is an urgent need to review the existing classifications so that these fractures are better categorized, and treatment guidelines defined.

  7. Posterior dislocation of hip with ipsilateral intertrochanteric fracture: A report of two cases

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    Ul Haq, Rehan; Kumar, Jaswant; Dhammi, IK; Jain, Anil K

    2016-01-01

    Posterior dislocations of the hip are known to be associated with fractures of the femoral head, neck, shaft, or posterior acetabular wall. However, its association with ipsilateral intertrochanteric fracture has only been anecdotally described in the English literature. We report two such cases managed by open reduction (OR) of the hip and internal fixation (IF) of the intertrochanteric fracture. The first case was a 26-year-old male who was managed by OR of the hip with IF of the intertrochanteric fracture with a dynamic hip screw and had a good functional result at 1-year followup. The second case was a 36-year-old female who was also managed by OR of the hip with IF of the head fragments with Herbert screw and IF of the intertrochanteric fracture with a dynamic condylar screw. The patient had a fair, functional result at 1-year followup. With the increase in high energy trauma, these fracture patterns have become more common, and there is an urgent need to review the existing classifications so that these fractures are better categorized, and treatment guidelines defined. PMID:27746503

  8. Application of Richards Sliding Hip Screw in Treatment of Intertrochanteric Femoral Fractures

    Institute of Scientific and Technical Information of China (English)

    PING Jinzhong; SHEN Hongsheng; QIU Song

    2002-01-01

    @@ Richards Sliding Hip Screw is an effective method for the treatment of subtrochanteric and intertrochanteric femoral fractures. We applied the screw to treat the above- mentioned fractures from 1994 and obtained satisfying results in our hospital. All the cases were followed up. We reported it as follows.

  9. Trabecular Plate Loss and Deteriorating Elastic Modulus of Femoral Trabecular Bone in Intertrochanteric Hip Fractures

    Institute of Scientific and Technical Information of China (English)

    Ji Wang; Bin Zhou; Ian Parkinson; C. David L. Thomas; John G. Clement; Nick Fazzalari; X. Edward Guo

    2013-01-01

    Osteoporotic hip fracture is associated with significant trabecular bone loss, which is typically characterized as low bone density by dual-energy X-ray absorptiometry (DXA) and altered microstructure by micro-computed tomography (µCT). Emerging morphological analysis techniques, e.g. individual trabecula segmentation (ITS), can provide additional insights into changes in plate-like and rod-like trabeculae, two major micro-structural types serving different roles in determining bone strength. Using ITS, we evaluated trabecular microstructure of intertrochanteric bone cores obtained from 23 patients undergoing hip replacement surgery for intertrochanteric fracture and 22 cadaveric controls. Micro-finite element (µFE) analyses were performed to further understand how the abnormalities seen by ITS might translate into effects on bone strength. ITS analyses revealed that, near fracture site, plate-like trabeculae were seriously depleted in fracture patients, but trabecular rod volume was maintained. Besides, decreased plate area and rod length were observed in fracture patients. Fracture patients also showed decreased elastic moduli and shear moduli of trabecular bone. These results provided evidence that in intertrochanteric hip fracture, preferential loss of plate-like trabeculae led to more rod-like microstructure and deteriorated mechanical competence adjacent to the fracture site, which increased our understanding of the biomechanical pathogenesis of hip fracture in osteoporosis.

  10. SURGICAL MANAGEMENT OF INTERTROCHANTERIC FRACTURES : A STUDY USING DYNAMIC HIP SCREW AND PROXIMAL FEMORAL NAIL

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    Venkateswara Rao

    2015-08-01

    Full Text Available OBJECTIVES: The aim of this study was to compare the outcome of intertrochanteric fractures treated with Dynamic Hip Screw and Proximal Femoral nail. METHODS: This study was conducted on 80 cases of Intertrochanteric fractures of femur treated by a dynamic hip screw and proximal femoral nail. Patients were operated on standard fracture table under image intensifier control. RESULTS: The average age of the patient was 63.2 years. Most common mechanism of fracture was domestic fall. The unstable pattern was more common in old aged patients with higher grade of osteoporosis. The average blood loss was 240 and 320ml in PFN and DHS group respectively. In PFN there were more no. of radiation exposure intraoperatively. The average operating time for the patients treated with PFN was 100min as compared to 80 min in patients treated with DHS. No complications of non - union and infection. In the PFN group the amount of sliding on X - rays was less as compared to DHS. The patients treated with PFN started early ambulation as they had better Harris Hip Score in the early period (at 1 and 3 month. In the long term both the implant had almost similar functional outcomes. CONCLUSION: From the study, we concluded PFN is better alternative to DHS in management of intertrochanteric fractures but is technically difficult procedure and requires more expertise compared to DHS.

  11. Iatrogenic Injury of Profunda Femoris Artery Branches after Intertrochanteric Hip Screw Fixation for Intertrochanteric Femoral Fracture: A Case Report and Literature Review

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    Nikolaos Patelis

    2014-01-01

    Full Text Available A case of arterial rupture of the profunda femoris arterial branches, following dynamic hip screw (DHS fixation for an intertrochanteric femoral fracture, is presented. Bleeding is controlled by coil embolization, but, later on, the patient underwent orthopedic material removal due to an infection of a large femoral hematoma.

  12. Total hip replacement as primary treatment of unstable intertrochanteric fractures in elderly patients.

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    Sidhu, Amarjit Singh; Singh, Ajay Pal; Singh, Arun Pal; Singh, Sukhraj

    2010-08-01

    Fifty-three patients with A2.2 and A2.3 intertrochanteric fracture according to the Muller classification were treated with total hip replacement between April 2000 and February 2004. The average age of the patients was 77 years. Average follow-up period was 3.7 years. We studied postoperative complications, mortality rate, functional outcome using the Harris hip score, time to return to normal activities, and radiographic evidence of healing. Two patients died on the third and fifth postoperative days. Seven more patients died within one year. The Harris hip score at one month was 66 +/- 7 (mean +/- standard deviation); at three months 72 +/- 6; at one year 74 +/- 5; at three years 76 +/- 6 and in the 27 patients who completed five year follow-up it was 76 +/- 8. Mobilisation and weight-bearing was started immediately in the postoperative period. Average time taken to return to normal daily activities was 28 days (range 24-33). No loosening or infection of the implants was observed. Total hip arthroplasty is a valid treatment option for mobile and mentally healthy elderly patients with intertrochanteric fractures. This procedure offers quick recovery with little risk of mechanical failure, avoids the risks associated with internal fixation and enables the patient to maintain a good level of function immediately after surgery.

  13. Bone Marrow Stem Cells Added to a Hydroxyapatite Scaffold Result in Better Outcomes after Surgical Treatment of Intertrochanteric Hip Fractures

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    Joao Torres

    2014-01-01

    Full Text Available Introduction. Intertrochanteric hip fractures occur in the proximal femur. They are very common in the elderly and are responsible for high rates of morbidity and mortality. The authors hypothesized that adding an autologous bone marrow stem cells concentrate (ABMC to a hydroxyapatite scaffold and placing it in the fracture site would improve the outcome after surgical fixation of intertrochanteric hip fractures. Material and Methods. 30 patients were randomly selected and divided into 2 groups of 15 patients, to receive either the scaffold enriched with the ABMC (Group A during the surgical procedure, or fracture fixation alone (Group B. Results. There was a statistically significant difference in favor of group A at days 30, 60, and 90 for Harris Hip Scores (HHS, at days 30 and 60 for VAS pain scales, for bedridden period and time taken to start partial and total weight bearing (P<0.05. Discussion. These results show a significant benefit of adding a bone marrow enriched scaffold to surgical fixation in intertrochanteric hip fractures, which can significantly reduce the associated morbidity and mortality rates. Conclusion. Bone marrow stem cells added to a hydroxyapatite scaffold result in better outcomes after surgical treatment of intertrochanteric hip fractures.

  14. Integrity of the lateral femoral wall in intertrochanteric hip fractures: an important predictor of a reoperation

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    Palm, Henrik; Jacobsen, Steffen; Sonne-Holm, Stig;

    2007-01-01

    BACKGROUND: Reoperations after intertrochanteric fractures are often necessitated by fracture displacement following mobilization of the patient. The biomechanical complexity of the fracture, the position of the implant, and the patient's characteristics are known to influence postoperative outco...

  15. Minimally invasive percutaneous compression plating versus dynamic hip screw for intertrochanteric fractures: a randomized control trial

    Institute of Scientific and Technical Information of China (English)

    Cheng Qiang; Huang Wei; Gong Xuan; Wang Changdong; Liang Xi; Hu Ning

    2014-01-01

    Objective:Intertrochanteric femur fracture is a common injury in elderly patients.The dynamic hip screw (DHS) has served as the standard choice for fixation; however it has several drawbacks.Studies of the percutaneous compression plate (PCCP) are still inconclusive in regards to its efficacy and safety.By comparing the two methods,we assessed their clinical therapeutic outcome.Methods:Atotal of 121 elderly patients with intertrochanteric femur fractures (type AO/OTA 31.A 1-A2,Evans type 1) were divided randomly into two groups undergoing either a minimally invasive PCCP procedure or a conventional DHS fixation.Results:The mean operation duration was significantly shorter in the PCCP group (55.2 min versus 88.5 min,P<0.01).The blood loss was 156.5 ml±18.3 ml in the PCCP group and 513.2 ml±66.2 ml in the DHS group (P<0.01).Among the patients treated with PCCP,3.1% needed blood transfusions,compared with 44.6% of those that had DHS surgery (P<0.01).The PCCP group displayed less postoperative complications (P<0.05).The mean American Society of Anesthesiologists score and Harris hip score in the PCCP group were better than those in the DHS group.There were no significant differences in the mean hospital stay,mortality rates,or fracture healing.Conclusion:Due to several advantages,PCCP has the potential to become the ideal choice for treating intertrochanteric fractures (type AO/OTA 31.A1-A2,Evans type 1),particularly in the elderly.

  16. Integrity of the lateral femoral wall in intertrochanteric hip fractures: an important predictor of a reoperation

    DEFF Research Database (Denmark)

    Palm, Henrik; Jacobsen, Steffen; Sonne-Holm, Stig

    2007-01-01

    -six fractures of the lateral femoral wall occurred during the operative procedure itself. A fracture of the lateral femoral wall occurred in only 3% (three) of the 103 patients with an AO/OTA type-31-A1.1, A1.2, A1.3, or A2.1 intertrochanteric fracture compared with 31% (thirty-one) of the ninety......-nine with an AO/OTA type 31-A2.2 or A2.3 fracture (p fracture of the lateral femoral wall was found to be the main predictor for a reoperation after an intertrochanteric fracture. Consequently, we concluded that patients with preoperative or intraoperative fracture......BACKGROUND: Reoperations after intertrochanteric fractures are often necessitated by fracture displacement following mobilization of the patient. The biomechanical complexity of the fracture, the position of the implant, and the patient's characteristics are known to influence postoperative outcome...

  17. A STUDY OF PRIMARY CEMENTED BIPOLAR HEMIARTHROPLASTY OF HIP IN ELDERLY PATIENTS WITH OSTEOPOROTIC, UNSTABLE INTERTROCHANTERIC FRACTURE

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    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.

  18. Increased Fracture Collapse after Intertrochanteric Fractures Treated by the Dynamic Hip Screw Adversely Affects Walking Ability but Not Survival

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    Christian Fang

    2016-01-01

    Full Text Available In osteoporotic hip fractures, fracture collapse is deliberately allowed by commonly used implants to improve dynamic contact and healing. The muscle lever arm is, however, compromised by shortening. We evaluated a cohort of 361 patients with AO/OTA 31.A1 or 31.A2 intertrochanteric fracture treated by the dynamic hip screw (DHS who had a minimal follow-up of 3 months and an average follow-up of 14.6 months and long term survival data. The amount of fracture collapse and shortening due to sliding of the DHS was determined at the latest follow-up and graded as minimal (2 cm. With increased severity of collapse, more patients were unable to maintain their premorbid walking function (minimal collapse = 34.2%, moderate = 33.3%, severe = 62.8%, and p=0.028. Based on ordinal regression of risk factors, increased fracture collapse was significantly and independently related to increasing age (p=0.037, female sex (p=0.024, A2 fracture class (p=0.010, increased operative duration (p=0.011, poor reduction quality (p=0.000, and suboptimal tip-apex distance of >25 mm (p=0.050. Patients who had better outcome in terms of walking function were independently predicted by younger age (p=0.036, higher MMSE marks (p=0.000, higher MBI marks (p=0.010, better premorbid walking status (p=0.000, less fracture collapse (p=0.011, and optimal lag screw position in centre-centre or centre-inferior position (p=0.020. According to Kaplan-Meier analysis, fracture collapse had no association with mortality from 2.4 to 7.6 years after surgery. In conclusion, increased fracture collapse after fixation of geriatric intertrochanteric fractures adversely affected walking but not survival.

  19. Comparative study of the Ender method and Dynamic Hip Screw stabilization in the treatment of intertrochanteric fractures of the femur.

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    Walo, Roman; Semenowicz, Jacek; Grabowski, Marcin; Komarek, Marcin; Czuma, Przemysław

    2003-02-28

    Background. The aim of this retrospective study was to compare the results of two fixation devices (Ender rods in 118 patients and dynamic hip screw in 98 patients) for treatment of intertrochateric fractures of the hip. Material and methods. The two treatment groups were similar with respect to important preoperative variables such as age, coexisting disseases, bone quality and incidence of stable and unstable fractures. The following outcomes were assessed: quality of reduction, length of hospital stay, early mortality, reoperations, persistent pain at a knee or hip, decrease in range of motion of the knee and leg shortening. Results and conclusions. The subgroup analysis showed higher incidence of complications in patients with unstable type of fracture treated with Ender nailing. These complications included mainly valgus angulation and malrotation of the fracture, need for a secondary procedure due to loss of stabilization and knee pain. Intramedullary stabilization with Ender rods is not recommended in treatment of unstable intertrochanteric fractures of the femur.

  20. Treatment of unstable intertrochanteric fractures of the femur through hip arthroplasty in the elderly:A report of 56 cases

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    Chuan-lin DU

    2011-12-01

    Full Text Available Objective To investigate the treatment effect of hip arthroplasty for unstable intertrochanteric fractures of the femur in the elderly.Methods Fifty-six elderly patients(25 males and 31 females,aged 75 to 92 years with mean of 83 years with unstable intertrochanteric fractures hospitalized from January 2005 to June 2010 were involved in the present study.According to the Evan’s fracture classification,22 cases were classified as type III,24 as type IV,and 10 as type V.All the patients received bone-cement type hip arthroplasty,and the treatment effects,perioperative complications,and follow-up results were observed.Results The operation was completed successfully for all patients.The postoperative complications included,two cases of deep venous thrombosis,two cases of transient psychotic disorder,and two cases of pseudomembranous colitis,all of which,were cured via symptomatic treatment.Three patients have had complications with pulmonary embolism and two with fractures around the prosthesis four months after discharge.Two patients died of pulmonary infection and multiple organ failure,respectively.The Harris hip score were excellent for the 21 cases and good for 26 cases.The excellent and good rating was 83.9% after six months from operation.No joint infection or dislocation occurred during the follow-up period of 12 to 20 months(mean of 16 months.Conclusion Hip arthroplasty has been proven to be an effective treatment for unstable intertrochanteric fractures in the elderly with less surgery trauma and complications.It also allowed early ambulation and improved the quality of life of the patients.

  1. [Comparison of effects between two operating methods of treating intertrochanteric hip fracture with Gamma nail fixation].

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    Chen, Qin; Zhou, Zheng; Guan, Long

    2007-10-01

    To evaluate the surgical efficiency of treating the intertrochanteric hip fracture with the Gamma nail fixation and to compare two operating methods of the Gamma nail fixation. From August 2000 to August 2006, 69 patients (32 males, 37 females; age, 43-98 years;average, 72.3 years) with the intertrochanteric hip fracture but with no associated injury were treated with the Gamma nail fixation. The patients' average illness course was 5. 6 days (range, 3-14 days). Among the 69 patients, 36 were treated with the traditional method of the Gamma nail fixation (Group A) and 33 were treated with an improved method of the Gamma nail fixation (Group B). According to the Association for the Study of Internal Fixation (AO-ASIF) classification, in Group A, 5 patients had a disease of Type A1, 23 of Type A2, and 8 of Type A3; in Group B, 8 patients had a disease of Type A1, 21 of Type A2, and 4 of Type A3. The data from the two groups were analyzed, and the statistical analysis was made on the following aspects: incision length, operating time, intraoperative bleeding, X-ray exposure frequency, drainage amount, blood transfusion volume, postoperative infection of the lungs, superficial infection of the incision, duration of antibiotic use, standing with the walking stick after operation, complication due to internal fixation, healing time for the fracture, and the hip function recovery half a year after operation assessed with the Harris scoring system. All the 69 patients were followed up for 8-80 months (average, 42 months). We studied the indexes such as incision length, operating time, intraoperative bleeding, X-ray exposure frequency, drainage amount, and blood transfusion volum; above indexes in Group A were 9.5 +/- 4.7 cm, 85 +/- 35 min, 186.0 +/- 87.3 ml, 9.0 +/- 5.1 times, 102.7 +/- 49.8 ml, 325.0 +/- 169.5 ml; and those were 5.3 +/- 1.2 cm, 46 +/- 10 min, 65.0 +/- 26.0 ml, 3.0 +/- 2.1 times, 52.5 +/- 16.2 ml, 203.0 +/- 61.2 ml in Group B. The above indexes showed that

  2. COMPARATIVE STUDY BETWEEN PROXIMAL FEMORAL NAILING AND DYNAMIC HIP SCREW IN THE MANAGEMENT OF INTERTROCHANTERIC FRACTURES OF FEMUR

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    Penugonda Ravi Shankar

    2015-01-01

    Full Text Available AIMS AND OBJECTIVES : To determine the rate of union, complications, operative risks and functional outcomes in intertrochanteric fractures treated with DHS and PFN , To compare the results obtained and To compare the effectiveness of DHS and PFN in treatment of intertrochanteric fractures. RESULTS : In the present series of 24 cases of Intertrochanteric fractures were treated by proximal femoral nailing and dynamic hip screw, 12 cases in each. Out of 24 there were 13 male and 11 female. Minimum age was 36 years, maximum age 76 years with mean age of 59.25 years. Slip and fall accounted for 75% of cases. BOYD and GRIFFIN type II fracture accounted for 58.3% of cases. Mean duration of hospital stay was 26 days in both PFN and DHS groups. Length of incision was small 5 - 6cm in PFN group compared to 10 - 12cm in DHS group. Mean external blood loss 150ml in PFN group and 315 ml in DHS group. Mean time for full weight bearing was 11.5 weeks for PFN group and 14.3 weeks for DHS group. Radiological union was 12.3 weeks in PFN group and 15.5 weeks in DHS group. Good to excellent results were seen in 91.7% of cases in PFN group and 75% in DHS group. CONCLUSION : From the study, we consider PFN as better alternative to DHS in the treatment of intertrochanteric fractures but is technically difficult procedure and requires more expertise compared to DHS.As learning curve of PFN procedure is steep, with experience gained from each case operative time, radiation exposure and intraoperative complications can be reduced in each case of PFN

  3. A Biomechanical Study Comparing Helical Blade with Screw Design for Sliding Hip Fixations of Unstable Intertrochanteric Fractures

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    Qiang Luo

    2013-01-01

    Full Text Available Dynamic hip screw (DHS is a well-established conventional implant for treating intertrochanteric fracture. However, revision surgery sometimes still occurs due to the cutting out of implants. A helical blade instead of threaded screw (DHS blade was designed to improve the fixation power of the osteoporotic intertrochanteric fracture. In this study, the biomechanical properties of DHS blade compared to the conventional DHS were evaluated using an unstable AO/OTA 31-A2 intertrochanteric fracture model. Fifty synthetic proximal femoral bone models with such configuration were fixed with DHS and DHS blade in five different positions: centre-centre (CC, superior-centre (SC, inferior-center (IC, centre-anterior (CA, and centre-posterior (CP. All models had undergone mechanical compression test, and the vertical and rotational displacements were recorded. The results showed that DHS blade had less vertical or rotational displacement than the conventional DHS in CC, CA, and IC positions. The greatest vertical and rotational displacements were found at CP position in both groups. Overall speaking, DHS blade was superior in resisting vertical or rotational displacement in comparison to conventional DHS, and the centre-posterior position had the poorest performance in both groups.

  4. Lateral migration with telescoping of a trochanteric fixation nail in the treatment of an intertrochanteric hip fracture

    Institute of Scientific and Technical Information of China (English)

    Liu Wanjun; Wang Junqiang; Michael J.Weaver; Mark S.Vrahas; Zhou Dongsheng

    2014-01-01

    Background The trochanteric fixation nail (TFN) can be used to treat stable and unstable fractures of intertrochanteric hip fractures.We study the common lateral migration that occurs with telescoping of intertrochanteric hip fractures treated with TFN and identify the predictors and relationships to clinical outcomes.Methods Patient demographic information,fracture type (Arbeitsgemeinschaft für Osteosynthesefragen (AO)/Orthopaedic Trauma Association (OTA) classification),radiographic data,and clinical data were collected.Lateral migration with telescoping was measured.Statistical analyses were performed to determine which variables predicted lateral migration with telescoping.Patient outcome scores were recorded using the Modified Harris Hip Score (MHHS),Hip Outcome Score-Activity of Daily Living (HOS-ADL),and Visual Analog Scale for pain.Results Two hundred and twenty-three patients (67 males,156 females) fitted the radiographic and follow-up (average 24.6 months) criteria.The average age was 77.2 years.The average lateral migration with telescoping was 4.8 mm.Twenty-one patients (9.4%) had excessive lateral migration with telescoping (≥10 mm).The quality of calcar reduction (P=0.01) and unstable fracture patterns (P=0.006) were significant predictive factors of lateral migration with telescoping.The mean outcome scores (MHHS and HOS-ADL) were 80.1 points and 78.7 points,respectively.All subjects had no significant relationship to lateral migration with telescoping (P >0.05).Of all the patients who developed lateral migration with telescoping,only one required removal of the blade for hip pain and all patients went on to uneventful union at an average time of 4.5 months.Conclusions Lateral migration with telescoping is a common mechanical complication of intertrochanteric hip fracture treated with the TFN procedure.It was predicted by the quality of calcar reduction and fracture type.However,this did not affect stable fixation and fracture healing

  5. The Role of Radiographs and Office Visits in the Follow-Up of Healed Intertrochanteric Hip Fractures: An Economic Analysis.

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    Kempegowda, Harish; Richard, Raveesh; Borade, Amrut; Tawari, Akhil; Howenstein, Abby M; Kubiak, Erik N; Suk, Michael; Horwitz, Daniel S

    2016-12-01

    The purpose of this study was to evaluate the role and the necessity of radiographs and office visits obtained during follow-up of intertrochanteric hip injuries. Retrospective study. Two level I trauma centers. Four hundred sixty-five elderly patients who were surgically treated for an intertrochanteric fracture of the femur at 2 level I trauma centers between January 2009 and August 2014 were retrospectively identified from orthopaedic trauma databases. Analysis of all healed intertrochanteric hip fractures, including demographic characteristics, quality of reduction, time of healing, number of office visits, number of radiographs obtained, and each radiograph for fracture alignment, implant position or any pathological changes. The surgical fixation of 465 fractures included 155 short nails (33%), 232 long nails (50%), 69 sliding hip screw devices (15%), 7 trochanteric stabilizing plates (1.5%), and 2 proximal femur locking plates (0.5%). The average fracture healing time was 12.8 weeks and the average follow-up was 81.2 weeks. Radiographs of any patient obtained after the fracture had healed did not reveal any changes, including fracture alignment or implant position and hardware failure. In 9 patients, pathological changes, including arthritis (3), avascular necrosis (3), and ectopic ossification (3) were noted. The average number of elective office visits and radiographs obtained after the fracture had healed were 2.8 (range: 1-8) and 2.6 (range: 1-8), respectively. According to Medicare payments to the institution, these radiographs and office visits account for a direct cost of $360.81 and $192, respectively, per patient. The current study strongly suggests that there is a negligible role for radiographs and office visits during the follow-up of a well-healed hip fracture when there is documented evidence of radiographic and clinical healing with acceptable fracture alignment and implant position. Implementation of this simple measure will help in reducing

  6. Intertrochanteric Fracture After Hip Resurfacing Arthroplasty Managed with a Reconstruction Nail

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    Jason Chow

    2013-12-01

    Full Text Available Periprosthetic fractures after hip resurfacings are rare occurrences that can pose a challenge to orthopaedic surgeons. With hip resurfacings becoming more common, the prevalence of these fractures is likely to increase because these patients are usually younger and more active. We report a case of traumatic periprosthetic proximal femur fracture treated with a reconstruction intramedullary nail technique.

  7. The prognostic value of tip-to-apex distance (TAD index) in intertrochanteric fractures fixed by dynamic hip screw.

    Science.gov (United States)

    Sedighi, Ali; Sales, Jafar Ganjpour; Alavi, Sahar

    2012-11-01

    Intertrochanteric fractures (ITFs) are the most common type of fractures requiring surgical intervention. They also have the highest surgical mortality among orthopedic operations. Among the many different techniques used for fixation of this type of fracture, use of the Dynamic Hip Screw (DHS) has gained wide acceptance. This current study was designed to assess positive predictive value of tip-to-apex distance (TAD) index in the prognosis of patients treated with DHS. The study was designed according to a descriptive-analytic protocol, made up of 100 cases of ITFs caused by falling, treated in the Shohada Orthopedic Center, Tabriz, Iran. All patients underwent lateral and antero-posterior hip X-ray to measure TAD index. The cohort was followed for three months after DHS placement. Of a total of 100 cases (53 male, 47 female) with a mean age of 76.7 years (range 29-100 years), 43% had grade 4, 29% grade 3, 21% grade 5, 5% grade 2 and 2% grade 6 osteoporosis. The screw position was postero-inferior in 57%, central in 40% and superior in 3% of patients. Minimum and maximum TAD index were 20 and 28 mm, respectively. Mean TAD was 23.5 mm. There were no post-operative complications in 84% of cases. Screw failure was the most common complication in the remaining 16% of patients. The study shows a statistically significant correlation between TAD index and cut-off rate in patients with intertrochanteric fractures of femoral bone treated by DHS. This validates the use of TAD index in determining the prognosis of patients treated by DHS.

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

    DEFF Research Database (Denmark)

    Kristensen, Morten Tange

    2013-01-01

    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...... testing (P fracture type, day of TUG performance, and pain intensity....... Multivariate linear regression analyses (fracture type not included) showed that only greater age (B = 0.34), low prefracture function (B = 7.9), and experiencing moderate to severe pain (B = 8.7) were independently associated with having a poorer TUG score. CONCLUSIONS: Hip fracture-related pain primarily...

  9. Greater trochanteric fracture with occult intertrochanteric extension.

    Science.gov (United States)

    Reiter, Michael; O'Brien, Seth D; Bui-Mansfield, Liem T; Alderete, Joseph

    2013-10-01

    Proximal femoral fractures are frequently encountered in the emergency department (ED). Prompt diagnosis is paramount as delay will exacerbate the already poor outcomes associated with these injuries. In cases where radiography is negative but clinical suspicion remains high, magnetic resonance imaging (MRI) is the study of choice as it has the capability to depict fractures which are occult on other imaging modalities. Awareness of a particular subset of proximal femoral fractures, namely greater trochanteric fractures, is vital for both radiologists and clinicians since it has been well documented that they invariably have an intertrochanteric component which may require surgical management. The detection of intertrochanteric or cervical extension of greater trochanteric fractures has been described utilizing MRI but is underestimated with both computed tomography (CT) and bone scan. Therefore, if MRI is unavailable or contraindicated, the diagnosis of an isolated greater trochanteric fracture should be met with caution. The importance of avoiding this potential pitfall is demonstrated in the following case of an elderly woman with hip pain and CT demonstrating an isolated greater trochanteric fracture who subsequently returned to the ED with a displaced intertrochanteric fracture.

  10. Hip Fracture

    Science.gov (United States)

    Diseases and Conditions Hip fracture By Mayo Clinic Staff A hip fracture is a serious injury, with complications that can be life-threatening. The risk of hip fracture rises with age. Older people are at a ...

  11. Difference in the trajectory of change in bone geometry as measured by hip structural analysis in the narrow neck, intertrochanteric region, and femoral shaft between men and women following hip fracture.

    Science.gov (United States)

    Rathbun, Alan M; Shardell, Michelle; Orwig, Denise; Hebel, J Richard; Hicks, Gregory E; Beck, Thomas J; Magaziner, Jay; Hochberg, Marc C

    2016-11-01

    Prior studies have shown that women have declines in bone structure and strength after hip fracture, but it is unclear whether men sustain similar changes. Therefore, the objective was to examine sex differences in proximal femur geometry following hip fracture. Hip structural analysis was used to derive metrics of bone structure and strength: aerial bone mineral density, cross-sectional bone area (CSA), cortical outer diameter, section modulus (SM), and buckling ratio (BR) from dual-energy x-ray absorptiometry scans performed at baseline (within 22days of hospital admission), two, six, or twelve months after hip fracture in men and women (n=282) enrolled in the Baltimore Hip Studies 7th cohort. Weighted estimating equations were used to evaluate sex differences at the narrow neck (NN), intertrochanteric (IT), and femoral shaft (FS). Men had significantly different one year NN changes compared to women in CSA: -6.33% (-12.47, -0.20) vs. 1.37% (-3.31, 6.43), P=0.049; SM: -4.98% (-11.08, 1.10) vs. 3.94% (-2.51, 10.42), P=0.042; and BR: 7.50% (0.65, 14.36) vs. -1.20% (-6.41, 4.00), P=0.044. One year IT changes displayed similar patterns, but the sex differences were not statistically significant for CSA: -4.07% (-10.83, 2.67) vs. 0.41% (-3.41, 4.24), P=0.252; SM: -4.78% (-12.10, 5.53) vs. -0.31 (-4.74, 4.11), P=0.287; and BR: 4.59% (-0.65, 9.84) vs. 1.52% (-4.23, 7.28), P=0.425. Differences in FS geometric parameters were even smaller in magnitude and not significantly different by sex. Women generally experienced non-significant increases in bone tissue and strength following hip fracture, while men had structural declines that were statistically greater at the NN region. Reductions in the mechanical strength of the proximal femur after hip fracture could put men at higher risk for subsequent fractures of the contralateral hip. Copyright © 2016 Elsevier Inc. All rights reserved.

  12. Dynamic hip screw for femoral intertrochanteric fractures%动力髋螺钉内固定治疗股骨粗隆间骨折30例临床分析

    Institute of Scientific and Technical Information of China (English)

    王继夫; 朱伟秀; 轩林

    2008-01-01

    Objective To investigate the results of dynamic hip screw (DHS) intemal fixation for the treatment of femoral intertrochanteric fractures. Methods Thirty patients with femoral intertroehanteric fractures treated with DHS internal fixation were enrolled in the study. The classification of fracture, operative methods, postoperative treatment and therapeutic results were assessed. The mean follow-up period was one year. Results All the patients completed the follow-up. Fractures healed up without coxa vara, external rotation or shortening deformity of the lower extremity in all patients. Good hip joint function was obtained in 86.7% of the patients. Conclusion DHS internal fixation is an ideal method for the treatment of femoral intertrochanteric fractures.%目的 探讨应用动力髋螺钉(DHS)内固定治疗股骨粗隆间骨折的疗效.方法 对DHS内固定治疗30例股骨粗隆间骨折的分类、手术方法、术后处理及疗效进行评价,且平均随访12个月.结果 30例骨折愈合.无髋内翻、下肢外旋及短缩畸形,患髋关节功能优良率达86.7%,疗效肯定.结论 DHS内固定是治疗股骨粗隆间骨折的理想方法.

  13. 动力髋螺钉治疗老年股骨粗隆间骨折临床分析%Study on treatment of intertrochanteric fractures in aged patients with dynamic hip screw.

    Institute of Scientific and Technical Information of China (English)

    何斌; 赵光荣; 向秀根; 张绍伟; 沈力; 廖涛

    2012-01-01

    目的 探讨动力髋螺钉(DHS)治疗老年股骨粗隆间骨折的临床疗效.方法 2009年1月至2011年1月收治的54例老年股骨粗隆间骨折患者,采用动力髋螺钉DHS内固定治疗,评价其临床疗效.结果 随访6~18月,所有患者骨折均在术后3~8月愈合,参照Sanders髋关节创伤评分,优良率达88.9%,并发症发生率24.1%(13/54).结论 DHS治疗老年股骨粗隆间骨折临床疗效明显,可以早期功能锻炼,关节功能恢复满意,是老年股骨粗隆间骨折较为理想的治疗方法.%Objective To evaluate the therapeutic effects of treatment for intertrochanteric fractures in aged patients with dynamic hip screw. Methods Fifty four aged patients with intertrochanteric fractures( 17 males and 37 females, with an average age of 73. 8 years )were treated in this hospital during January 2009 to January 2011. All cases were followed up for 6 to 18 months ( with an average of 13 months ). Results All cases obtained bony union with average duration for fracture union of 4. 6 months( 3-8 months ). According to the criteria of Sanders'hip trauma scoring, the rate of excellent or good function recovery of hip joint was 88. 9% . The rate of postoperative complications was 24. 1 % ( 13/ 54 ). These complications were arrhythmia in 3 cases, lacunar infarction in 2 cases, postoperative psychiatric symptoms in 2 cases, hip varus deformity in 4 cases and fixation failure in 2 cases. Conclusions The application of dynamic hip screwT is one of effective medical device in treatment of intertrochanteric fractures in aged patients. It is worthy to be clinically applied particularly in primary hospitals.

  14. 微创动力髋螺钉内固定治疗股骨转子间骨折的护理%The nursing for treatment of the intertrochanteric fracture with minitraumatic dynamic hip screws

    Institute of Scientific and Technical Information of China (English)

    郑关伦; 钟小会; 杨益琼; 杨继录; 蒯娟; 李彤

    2012-01-01

    To promote successful rehabilitation after minimally invasive dynamic hip screw fixation of intertrochanteric fractures of the patients. Methods 68 cases of minimally invasive dynamic hip screw fixation of intertrochanteric fracture patients perioperative rehabilitation and care. Results Follow-up of 6 ~ 26 months, successful rehabilitation of the whole group, no nonunion and deformity. Conclusion Preoperative psychological nursing and the feasible rehabilitation program, early postoperative right limb and systemic functional rehabilitation exercise, guide early off-bed activities, is the key to successful rehabilitation of patients.%目的 促进微创动力髋螺钉内固定治疗股骨转子间骨折患者的术后顺利康复.方法 时68例微创动力髋螺钉内固定治疗股骨转子间骨折患者进行围手术期康复训练与护理.结果 随访6~26个月,全组顺利康复,未见骨折不愈合及畸形.结论 术前做好心理护理并制定切实可行的康复计划,术后早期正确地进行患肢及全身功能的康复锻炼,指导早期离床活动,是患者顺利康复的关键.

  15. Dynamic Hip Screw Fixation Combined of Oral Medicine Treating Intertrochanteric Fracture%动力髋螺钉固定术配合口服中药治疗高龄股骨粗隆间骨折

    Institute of Scientific and Technical Information of China (English)

    徐爱民

    2012-01-01

    目的:探讨采用动力髋螺钉(DHS)固定术配合口服中药治疗高龄股骨粗隆间骨折的方法和疗效.方法:对2004年1月—2009年1月收治的股骨粗隆间骨折患者进行手术治疗.其中男25例,女21例,年龄65~83岁,平均年龄73岁,采用动力髋螺钉(DHS)固定术.结果:1例病人术后3天出现患肢深静脉血栓,经活血、溶栓治疗后恢复.2例因其他疾病死亡,43例骨折均全部愈合,已恢复原来生活能力,无内固定物松动及髋内翻畸形等并发症.结论:动力髋螺钉(DHS)固定术配合口服中药治疗高龄股骨粗隆间骨折具有操作简单、时间短、固定可靠、损伤小、出血少、骨折愈合率高、并发症少等优点,是值得推广应用的手术方法[1].%Objective:To investigate the method and effect of the dynamic hip screw ( DHS )fixation of intertrochanteric fracture. Methods; During January 2004-January 2009, patients admitted because of intertrochanteric fractures were treated surgically, including 25 males and 21 females, aged 65 to 83 years old, mean age was 73, using dynamic hip screw ( DHS ) fixation. Results: 3 days after surgery, 1 case limb deep vein thrombosis occurs, the blood circulation restored after thrombolytic therapy. 2 patients died due to other diseases,43 cases of fracture were all healed and returned to the original capacity, no loosening of internal fixation, or complications such as varus deformity. Conclusion: The dynamic hip screw ( DHS ) fixation combined with oral medicine treatment of intertrochanteric fracture is simple, treatment course is short, fixed and reliable, with less damage, less bleeding, high fracture healing rate, fewer complications, and is worthy of promoting application for the surgical method[1].

  16. A STUDY ON SURGICAL MANAGEMENT OF INTERTROCHANTERIC AND SUBTROCHANTERIC FRACTURES OF FEMUR BY PROXIMAL FEMORAL NAIL

    Directory of Open Access Journals (Sweden)

    Kuppa Srinivas

    2015-01-01

    Full Text Available AIMS AND OBJECTIVES: To study the various fracture patte rns, mechanism of injury, operative difficulties encountered, result in terms of radiological union and ultimate functional outcome of intertrochanteric and subtrochanteric fractures of femur treated by proximal femoral nail. RESULTS: In the present study , 22 cases of subtrochanteric and intertrochanteric fractures of proximal femur treated by proximal femoral nail at Govt. General Hospital, Kurnool from August 2010 to July 2012 were included. Out of 22 cases, 18 were subtrochanteric and 4 were intertrochanteric fractures. In subtrochanteric fractures, seinsheimer type III were 44.4%,in intertrochanteric fractures evan’s unstable fractures were 75%. The mean age group was 45years with males 82%, right side femur were involved in 55%, road traffic accidents accounted for 55%, associated injuries found in 36%. Mean duration of hospital stay was 16.83 days, union was achieved in 86.6% with mean time for union was 12.75 weeks. Hip joint stiffness was found 23% and non - union in 4%. CONCLUSI ON: By the analysis of data collected in the present study, proximal femoral nail is an effective device in the management of complex proximal femoral fractures. It offers superior stabilization and good fracture union

  17. Treatment of AO/OTA 31-A3 intertrochanteric femoral fractures with a percutaneous compression plate

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    Fei Luo

    2014-01-01

    Full Text Available OBJECTIVE: AO/OTA 31-A3 intertrochanteric femoral fractures have completely different fracture line directions and biomechanical characteristics compared with other types of intertrochanteric fractures. The choice of the fixation method has been a focus of dispute among orthopedic trauma surgeons. The purpose of this study was to review the outcomes of these fractures treated with a percutaneous compression plate at our institute. METHOD: Seventeen patients with AO/OTA 31-A3 intertrochanteric femoral fractures were treated with a percutaneous compression plate at our institute from January 2010 to December 2011. The clinical data and imaging results were retrospectively analyzed. RESULTS: The medical complication of popliteal vein thrombosis occurred in one patient. Sixteen patients were followed up for 12 to 21 months. Two patients had malunion and mild pain. Fracture collapse occurred in two patients, with one having head penetration. These two patients had moderate pain. There were no occurrences of nonunion or reoperation. The mean Harris hip score obtained during the last follow-up was 84.1 (61-97. Patients with a poor quality of reduction were more likely to have pain results (p = 0.001. A trend existed toward the presence of a poor quality of reduction (p = 0.05 in patients with a collapse of fracture. Patients with poor preoperative mobility were more likely to have a lower Harris hip score (p = 0.000. CONCLUSION: The percutaneous compression plate is an alternative device for the treatment of AO/OTA 31-A3 intertrochanteric femoral fractures. Good fracture reduction and an ideal placement position of the neck screw are important in the success of the device.

  18. Safe and Effective Reduction Technique for Intertrochanteric Fracture with Ipsilateral Below-Knee Amputated Limb

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    Hironori Ochi

    2017-01-01

    Full Text Available The positioning of the patient on the fracture table is critical for the successful reduction and operative fixation of intertrochanteric hip fractures. However, this manipulation is challenging with patients who have undergone amputations of their legs. A 97-year-old man presented to the emergency department with symptom of right hip pain following a mechanical fall. He had a below-knee amputation on his right leg following a traffic accident as a 19-year-old and had a below-knee patellar tendon bearing prosthesis fitted to his lower limb for mobility. Radiographs of his pelvis revealed a displaced intertrochanteric fracture of the right side femur. The patient was positioned on a fracture table, as in the standard procedure. The method of inverting the traction boot to accommodate the flexed knee and stump described by Al-Harthy could be used to provide traction and rotational control. Internal fixation was performed using a short femoral nail. Postoperatively, the patient could walk with full weight bearing using a prosthesis on his affected limb. The method of inverting the traction boot to accommodate the flexed knee and stump can be used safely and effectively to achieve and maintain fracture reduction during fixation of intertrochanteric fractures for patients with a below-knee amputated limb.

  19. Treatment of stable and unstable intertrochanteric fractures with selfdynamisable internal fixator (concept of double dynamisation

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    Kostić Igor M.

    2015-01-01

    Full Text Available Bacground/Aim. Intertrochanteric fractures of the femur are the third most common fractures among all bone fractures. Today in everyday orthopedic practice a number of different methods of treatment of trochanteric fractures of the femur are applied. Despite the improvement in the development of new implants, the percentage of serious complications of the treatment of these fractures remains very high, varying from 10% to 20%. One of the most serious complications of internal fixation of intertrochanteric fractures is nonunion of fractures due to the lack of additional axial dynamisation of implants. The aim of this study was to determine the efficacy of double dynamisation in stable and unstable intertrochanteric fractures treatment using the self dynamisable internal fixator. Methods. During the period from 2000 to 2009 we analyzed the use of selfdynamisable internal fixator (SIF implant in the treatment of 247 patients with stable and unstable intertrochanteric fractures. Fracture types were classified according to the AO Fracture Classification/Orthopaedic Trauma Association Scheme. Salvati and Wilson scoring systems were used for functional assessment considering pain, walking ability and hip movements of operated patients. Results. Of the total number of treated patients, 134 were males and 113 females, aged 19 to 90 (average 49.6 years. More than a half of the patients were older than 50 years. Monitoring of the patients after the operation was carried out clinically and radiographically for a period of three to six months in all the patients, whereas a 2-year follow-up was conducted in 176 (71.2% patients. The average duration of surgery was 47 min, the average blood loss 145 mL, and the average fluoroscopy time was 16 sec (8-97 sec. The average time for union was 3.7 months (3-6.5 months. Double dynamisation (dynamisation along the neck and shaft of the femur was observed in 85 (34.4% patients, and was on average 4.3 mm (1.5-8 mm. All

  20. Related factors affecting prognostic function of hip joint in patients with femoral intertrochanteric fractures%影响股骨转子间骨折患者髋关节预后功能的相关因素

    Institute of Scientific and Technical Information of China (English)

    冯明利; 沈惠良; 雍宜民; 胡怀健

    2004-01-01

    Department of Orthopedics, Xuanwu Hospital, Capital University of Medical Sciences. A total of 121 patients including 67 males and 54 females between the ages of 47 and 91 years with intertrochanteric fractures admitted in hospital were reviewed.INTERVENTIONS: Measures were analyzed by univariance analysis. Quantitative data were processed with t test and qualitative data with x2 test. The parameters with P < 0. 05 were analyzed with Logistic regression.MAIN OUTCOME MEASURES: Age, sex, fracture types, therapeutic measure, reduction status, health evaluation of old traumatized patients (HEOTP), multi-injury and hip score.RESULTS: According to Harris' hip score (HHS), 31 cases were excellent,33 cases were fine, 47 cases were in middle level and 10 cases were bad. Univariance analysis manifested that age( t =4. 072, P =0. 001), therapeutic measure(X2 = 34. 43, P = 0. 000), reduction status(X2 = 16. 9, P =0. 000), HEOTP( t = 14.09, P =0. 000) and multi-injury(X2 =4. 109, P =0.037) were closely correlated with the prognosis of the femoral intertrochanteric fractures with a significant difference( P < 0. 05) . Logistic regression also showed that age ( r = - 0. 125 3, P = 0. 008 6), therapeutic measure( r= - 1. 747 8, P=0. 010 7), reduction status(r= -2. 083 9,P=0.002 9), HEOTP(r = -0.058 2, P=0.000 2), multi-injury(r=-4. 782 2, P =0. 010 2) were independent risk factors affecting hip score and prognosis of the femoral intertrochanteric fractures( P < 0.05).CONCLUSION: The function of hip suffering intertrochanteric fracture is obvious affected by age, therapeutic measure, reduction status, HEOTP and multi-injury.

  1. Treatment outcomes of intertrochanteric femur fractures treated with DLT™ nail

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    Mehmet Arıcan

    2015-12-01

    Full Text Available Objective: Intramedullary nails frequently use in proximal femur fractures. In this study, 49 patients with intertrochanteric fractures were evaluated clinical and radiological results treated with dyna locking trochanteric (DLT™ nail retrospectively. Methods: Twenty-two (44.9% patients were male and 27 (55.1% patients were female. Mean age was 74.29±1.98 (28-99 years and Followed up for a mean of 14.35±3.43 (9-24 months. Thirty-seven (75.6% of the fractures resulted from simple falls while 6 (12.2% caused from traffic accidents and 6 (12.2% fall down from height. There were 24 (49.0% left and 25 (51.0% right lower extremities fractured. According to Orthopaedic Trauma Association classification system; 21 (42.9%, 21 (42.9% and 7 (14.2% fractures were classified as 31A1, 31A2, and 31A3 respectively. One (2.0% patient had claviculae fracture, 3 (6.1% patients had radius distal fracture and 1 (2.0% patient had total knee arthroplasty. After surgery, X-ray was used for radiological results and functional outcomes were evaluated according to the Harris hip scoring system. Results: The average waiting time for the surgery was 2.02±0.18 (1-7 days and hospitalization time was 6.23±0.29 (4-15 days. Mean fracture healing time was 11.74±1.82 (8-15 weeks. Three patients had screw cut-out in the follow-up time and performed hemiarthroplasty. The average Harris hip score was 88.02±1.21 (42-97 points and included 29 (59.2% excellent cases, 17 (34.7% good and 3 (6.1% poor. Conclusion: DLT ™ nail is a safe and successful method because of low complication rates, and capability of detection.

  2. A Meta-analysis on comparing efficacy of percutaneous compression plate with dynamic hip screw in treating intertrochanteric hip fractures%经皮加压钢板与动力髋螺钉治疗股骨转子间骨折的Meta分析

    Institute of Scientific and Technical Information of China (English)

    顾家烨

    2016-01-01

    Objective To analyze the efficacy and safety of percutaneous compression plate (PCCP) with dynamic hip screw(DHS) in treating intertrochanteric hip fractures.Methods The domestic literatures related to clinical trials of treating intertrochanteric hip fractures with PCCP and DHS were collected by searching PubMed,OVID MEDLINE,the Chinese biomedical literature database,Wanfang database,Weipu database and CNKI in the years from 2000 to 2014.A Metaanalysis was performed using Stata 11.0 software.Results There were 12 literatures qualified including 1056 cases(506 cases in group PCCP and 550 cases in group DHS).Meta analysis showed that the patients in group PCCP had less operation time and blood loss during surgery,less major complications,shorter hospital stay and better recovery of hip joint function than those in group DHS (P<0.05).There were no differences in bone healing time and mortality after operation between two groups(P>0.05).Conclusion The efficacy of PCCP for treating intertrochanteric hip fractures is superior to that of DHS.%目的 分析经皮加压钢板(PCCP)和动力髋螺钉(DHS)治疗股骨转子间骨折的有效性和安全性.方法 检索PubMed、OVID MEDLINE、中国生物医学文献数据库、万方数据库、维普数据库和中国知网等2000-2014年PCCP和DHS治疗股骨转子间骨折的相关文献,采用Stata 11.0软件对其进行Meta分析.结果 本研究纳入12篇文献,共计1056例患者;其中,PCCP组506例,DHS组550例.Meta分析结果:与DHS组比较,PCCP组的手术用时短、术中出血少、术后主要并发症少、住院时间短、术后髋关节功能恢复较好(P<0.05);但两组骨折愈合时间和术后病死率并无统计学差异(P>0.05).结论 PCCP治疗股骨转子间骨折的临床疗效优于DHS.

  3. Internal fixation treatments for intertrochanteric fracture: a systematic review and meta-analysis of randomized evidence.

    Science.gov (United States)

    Yu, Jiajie; Zhang, Chao; Li, Ling; Kwong, Joey S W; Xue, Li; Zeng, Xiantao; Tang, Li; Li, Youping; Sun, Xin

    2015-12-11

    The relative effects of internal fixation strategies for intertrochanteric fracture after operation remain uncertain. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to address this important issue. We searched PubMed, EMBASE and CENTRAL for RCTs that compared different internal fixation implants in patients with intertrochanteric fracture at 6-month follow-up or longer. We ultimately included 43 trials enrolling 6911 patients; most trials were small in sample sizes and events. Their risk of bias was generally unclear due to insufficient reporting. Because of these, no statistically significant differences were present from most of the comparisons across all the outcomes, and no definitive conclusions can be made. However, a number of trials compared two commonly used internal fixation strategies, gamma nail (GN) and sliding hip screw (SHS). There is good evidence suggesting that, compared to SHS, GN may increase the risk of cut out (OR = 1.87, 95% CI, 1.08 to 3.21), re-operation (OR = 1.61, 95% CI, 1.02 to 2.53), intra-operative (OR = 3.14, 95% CI, 1.34 to 7.35) and later fractures (OR = 3.67, 95% CI, 1.37 to 9.83). Future randomized trials or observational studies that are carefully designed and conducted are warranted to establish the effects of alternative internal fixation strategies for intertrochanteric fracture.

  4. Fascia iliaca block associated only with deep sedation in high-risk patients, taking P2Y12 receptor inhibitors, for intramedullary femoral fixation in intertrochanteric hip fracture: a series of 3 cases.

    Science.gov (United States)

    Almeida, Carlos Rodrigues; Francisco, Emília Milheiro; Pinho-Oliveira, Vítor; Assunção, José Pedro

    2016-12-01

    We present a series of 3 cases in which the impact in outcome was, first of all, related to the capacity to offer early and safer treatment to some hip fracture high-risk patients using a fascia iliaca block (FIB; ropivacaine 0,5% 20 cc and mepivacaine 1,3% 15 cc, given 30 minutes before incision) associated only with deep sedation, contributing to better practice and outcome. All elderly patients were American Society of Anesthesiologists IV patients, under P2Y12 receptor inhibitors, suffering from an intertrochanteric fracture, and purposed for intramedullary femoral fixation (IMF). All patients have been managed successfully through a deep sedation using a low-dose infusion of propofol and bolus of fentanyl without face mask ventilation, supraglottic device placement, or endotracheal intubation after an FIB. Bispectral index was always greater than 75, and no CO2 retention or respiratory depression was present. No signs of pain or hemodynamic instability were observed. In these cases, surgery would be postponed if the choice was neuroaxial anesthesia, particularly because of P2Y12 receptor inhibitors' effect. FIB puncture site is distal to the fracture and incision site, but proximal local anesthetic migration through the interfascial planes allows for constant block of femoral nerve and lateral cutaneous of femur nerve and, less constantly, block of obturator. FIB may reduce the risk of perineural hematoma associated with several injections in nerve vicinity of different lumbar plexus branches. Frequently, indications for extramedullary or IMF are overlapping, but IMF is associated with less blood loss and may be managed using a low anesthetic depth if an FIB is done, increasing safety. This way, these less invasive surgical techniques combined with an adjusted anesthetic technique may have a crucial role in high-risk patients, particularly if taking P2Y12 receptor inhibitors. In these cases of IMF, surgical manipulation of sciatic and/or inferior subcostal

  5. A simple technique to position patients with bilateral above-knee amputations for operative fixation of intertrochanteric fractures of the femur: a case report

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    Dramis Asterios

    2010-11-01

    Full Text Available Abstract Introduction Intertrochanteric fractures of the femur are common fractures in the elderly, and management includes operative fixation after patient positioning on the fracture table. Patients with bilateral above-knee amputations are challenging in terms of positioning on the table. We describe a simple technique to overcome this special problem. Case presentation A 75-year-old wheelchair-bound Caucasian man with bilateral above-knee amputations presented to our hospital after a fall. Plain radiographs showed an intertrochanteric fracture of the femur, and operative fixation with a dynamic hip screw was planned. His positioning on the table posed a particular problem, and therefore we developed a technique to overcome this problem. Conclusion Positioning of patients for fixation of intertrochanteric fractures of the femur poses a particular problem that can be solved by using our simple technique.

  6. Pediatric Hip Fractures in California: Results from a Community-Based Hip Fracture Registry.

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    Prentice, Heather A; Paxton, Elizabeth W; Hunt, Jessica J; Grimsrud, Christopher D; Weiss, Jennifer M

    2017-01-01

    Hip fracture registries offer an opportunity to identify and to monitor patients with rare conditions and outcomes, including hip fractures in pediatric patients. To report patient demographics and surgical outcomes of pediatric patients treated surgically for hip fractures in a large integrated health care system. Pediatric patients (fracture) with hip fractures were identified between 2009 and 2012 using our health care system's hip fracture registry. Patient characteristics, type of fracture, surgical treatment, and short-term complications. Among 39 patients identified, 31 (79.5%) were male, and the median age was 15 years old (interquartile range: 11-17 years). Most patients were Hispanic (n = 17, 43.6%) or white (n = 14, 35.9%). There were 8 patients (20.5%) with 15 comorbidities. Delbet Type IV (intertrochanteric) fractures were the most common fracture type (n = 22, 56.4%), and fixation method was equally distributed between intramedullary, screw and sideplate, and screws (n = 12, 30.8% for each). Most surgeries were performed by medium-volume surgeons (n = 22, 56.4%) at medium- and high-volume hospitals (n = 37, 94.9%). Three 90-day readmissions (7.7%), 1 infection (2.6%), 1 malunion (2.6%), and 1 revision (2.6%) were observed in this cohort during the study period. In our series using registry data, hip fractures younger than age 21 years were more common in boys and Hispanic patients. Intertrochanteric fractures (Delbet Type IV) were the most frequently observed type in our community-based hip fracture registry. Short-term complications were infrequent.

  7. Hip fracture - discharge

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    ... this page: //medlineplus.gov/ency/patientinstructions/000168.htm Hip fracture - discharge To use the sharing features on this page, please enable JavaScript. Hip fracture surgery is done to repair a break in ...

  8. Hip fracture surgery

    Science.gov (United States)

    ... neck fracture repair; Trochanteric fracture repair; Hip pinning surgery; Osteoarthritis - hip ... You may receive general anesthesia for this surgery. This means you ... spinal anesthesia . With this kind of anesthesia, medicine is ...

  9. Lengthened-handle biotype total hip arthroplasty with spiral cerclage band for the treatment of aged patients with femoral intertrochanteric fracture%加长柄生物型人工全髋关节置换结合钛捆绑带治疗老年股骨粗隆间骨折

    Institute of Scientific and Technical Information of China (English)

    骆浩; 陈友浩; 张友; 谢鲤钟; 周继斌; 李章华; 刘忠厚

    2012-01-01

    Objective To investigate the clinical efficacy of treatment using lengthened-handle biotype total hip arthroplasty with spiral cerclage band on aged patients with femoral intertrochanteric fracture. Methods Twenty-three patients with femoral intertrochanteric fracture in our department from January 2006 to January 2011, treated with lengthened-handle biotype total hip arthroplasty with spiral cerclage band, were selected. The clinical efficacy and safety were evaluated. Results All the patients were followed up from 6 to 38 months. The function of the hip was graded with Harris system; excellent in 7 cases, good in 10 cases, fair in 5 cases, and poor in 1 case. The percentage of excellent and good was 73.91% and total patient satisfaction was 100%. No fracture deformity, artificial joint dislocation, infection, loosening, and down-place occurred. Conclusion For aged patients with femoral intertrochanteric fracture, lengthened-handle biotype total hip arthroplasty with spiral cerclaged band is a safe and efficient method.%目的 探讨钛捆绑带结合加长柄生物型人工全髋关节置换术治疗老年股骨粗隆间骨折的临床疗效.方法 对2006年1月至2011年1月收入我科的23例老年股骨粗隆间骨折患者,采用钛捆绑带结合加长柄生物型人工全髋关节置换术进行治疗,评价其临床疗效与安全性.结果 所有患者随访6月~38月,按Harris髋关节功能评定,优7例,良10例,中5例,差1例,优良率为73.91%,患者满意度100%;无骨折畸形、人工关节脱位、感染、假体松动、假体下沉等情况发生.结论 对老年股骨粗隆间骨折,钛捆绑带结合生物型假体行全髋关节置换术是一种安全有效的方法.

  10. Ipsilateral Traumatic Posterior Hip Dislocation, Posterior Wall and Transverse Acetabular Fracture with Trochanteric Fracture in an adult: Report of First Case

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    Skand Sinha

    2013-10-01

    Full Text Available Introduction: Posterior dislocation of the hip joint with associated acetabular and intertrochanteric fracture is a complex injury. Early recognition, prompt and stable reduction is needed of successful outcome. Case Report: 45 year old male patient presented with posterior dislocation of the hip with transverse fracture with posterior wall fracture of acetabulam and intertrochanteric fracture on the ipsilateral side. The complex fracture geometry was confirmed by CT scan. The patient was successfully managed by open reduction and internal fixation of intertrochanteric fracture was achieved with dynamic hip screw (DHS plate fixation followed by fixation of acetabular fracture with reconstruction plate. Conclusion: Hip dislocation combined with acetabular fracture is an uncommon injury; this article presents a unique case of posterior wall and transverse fractures of ipsilateral acetabulum with intertrochanteric fracture in a patient who sustained traumatic posterior hip dislocation. Early surgical intervention is important for satisfactory outcomes of such complex fracture-dislocation injuries. Keywords: Hip dislocation; acetabular fractures; intertrochanteric fracture; operative treatment.

  11. OUTCOME ANALYSIS OF PROXIMAL FEMORAL NAIL IN STABLE INTERTROCHANTERIC FEMUR FRACTURES

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    Suneet

    2015-02-01

    Full Text Available BACKGROUND: Proximal femoral nail is commonly recommended as treatment of choice for unstable and reverse oblique intertrochanteric fracture in view of superior biomechanics and prevention of varus collapse associated with Dynamic hip scre w. Although in stable fracture types DHS is still being preferred as the treatment modality of choice. Proximal femoral nail owing to better biomechanics , less complications can still be used as the method of choice in stable fracture pattern as well. The aim of this study is to evaluate the results of PFN nail in stable intertrochanteric fracture and include evaluation of the mean operative time , amount of blood loss , complications and functional status of the patient . MATERIALS AND METHODS : In this study 30 patients presented to Orthopedics Department Hamidia Hospital Bhopal with stable intertrochanteric fracture were treated with p roximal femoral nail. All patients were followed up for a period of 1 year and functional outcome assessment including amount of shortening , neck - shaft angle , Harris hip score was noted. RESULTS : At the time of final follow - up , all 30 patients showed union with average Harris hip score of 86.6 (range 62 - 94 . 14 patients had excellent score , 9 patients had good score , 5 patients ha d fair score and 2 patients had poor outcome . Mean neck shaft angle achieved post - reduction was 131.4 degrees and at final follow - up was 128.4 degrees. Limb length discrepancy was assessed in the final follow - up with average shortening of 5 mm and 4 patien ts had shortening above 1.5 cm. Average blood loss was 80 ml , the mean operative time was 65 minutes. Complications w ere seen in 3 cases with one case of local wound infection, one of screw cut - out and one of screw penetration. CONCLUSION : With proper tech nique PFN gives excellent results with less blood loss and shorter incision with less soft tissue trauma are added advantages which ultimately lead to less morbidity and

  12. INTERTAN髓内钉与滑动髋螺钉治疗老年性粗隆间和粗隆下骨折的临床效果比较%Clinical efficacy comparison of INTERTAN intramuscular nail and sliding hip screw in treatment of elderly intertrochanteric and subtrochanteric fractures

    Institute of Scientific and Technical Information of China (English)

    李雄辉; 钟涌; 刘阳灿

    2015-01-01

    Objective To study the clinical efficacy of INTERTAN intramuscular nail and sliding hip screw in treat-ment of elderly intertrochanteric and subtrochanteric fractures. Methods 80 patients with elderly intertrochanteric and subtrochanteric fractures treated in our hospital from January 2012 to January 2014 were selected,and were randomly divided into intramuscular nail group (40 cases) and hip screw group (40 cases).The bleeding volume,postoperative drainage volume,operation time of two groups was compared;visual analogue scale (VAS) after 3 and 6 months was sta-tistically analyzed. Results The operation time of two groups had no significant difference (P>0.05).The bleeding vol-ume,postoperative drainage volume in intramuscular nail group was less than that in hip screw group,the difference was significance (P0.05). Conclusion The efficacy of intramuscular nail in treatment of elderly intertrochanteric and subtrochanteric fractures is better than that of hip screw,the recovery and postoperative complications in two ways has no obvious difference.%目的:研究INTERTAN髓内钉与滑动髋螺钉(DHS)治疗老年性粗隆间和粗隆下骨折的效果。方法选取2012年1月~2014年1月在本院进行治疗的老年粗隆间和粗隆下骨折患者80例,按照随机数字表法分为髓内钉组40例和髋螺钉组40例。比较两组患者的术中出血量、术后引流量、手术时间等,术后3、6个月分别进行视觉模拟评分(VAS)。结果两组手术时间差异无统计学意义(P>0.05);髓内钉组术中出血量和术后引流量明显少于髋螺钉组,差异有统计学意义(P0.05)。结论髓内钉与髋螺钉治疗老年性粗隆间和粗隆下骨折,髓内钉方式优于髋螺钉方式,在术后恢复、并发症方面两种方式并无明显差异。

  13. Femoral Intertrochanteric Fracture With Spontaneous Lumbar Hernia: A Case Report

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    Luo

    2016-03-01

    Full Text Available Introduction The diagnosis of lumbar hernia can be easily missed, as it is a rare case to which most orthopedists are not exposed in their common clinical practice. Approximately 300 cases have been reported in the literature since it was first described by Barbette in 1672. Case Presentation A 76-year-old woman who had been diagnosed with a femoral intertrochanteric fracture was sent to our department. Physical examination revealed a smooth, soft, and movable mass, with no tenderness, palpable on her left flank, which had gradually increased during the last seven years and presented with a slight feeling of swelling. We initially misdiagnosed the case as a left lipoma combined with the femoral intertrochanteric fracture. However, after six hours, the patient presented with a sudden onset of nausea, vomiting, and abdominal distension. Afterward, computed tomography (CT examination confirmed that the mass was a spontaneous lumbar hernia. Conclusions A lumbar hernia may, on rare occasions, become incarcerated or strangulated, with the consequent complication of mechanical bowel obstruction. We suggest that a patient with a flank mass should always raise suspicions of a lumbar hernia.

  14. Femoral Intertrochanteric Fracture With Spontaneous Lumbar Hernia: A Case Report

    Science.gov (United States)

    Luo, Peng; HE, Xing-Wen; Chen, Qing-Yun; Hong, Hao; Yang, Lei

    2016-01-01

    Introduction The diagnosis of lumbar hernia can be easily missed, as it is a rare case to which most orthopedists are not exposed in their common clinical practice. Approximately 300 cases have been reported in the literature since it was first described by Barbette in 1672. Case Presentation A 76-year-old woman who had been diagnosed with a femoral intertrochanteric fracture was sent to our department. Physical examination revealed a smooth, soft, and movable mass, with no tenderness, palpable on her left flank, which had gradually increased during the last seven years and presented with a slight feeling of swelling. We initially misdiagnosed the case as a left lipoma combined with the femoral intertrochanteric fracture. However, after six hours, the patient presented with a sudden onset of nausea, vomiting, and abdominal distension. Afterward, computed tomography (CT) examination confirmed that the mass was a spontaneous lumbar hernia. Conclusions A lumbar hernia may, on rare occasions, become incarcerated or strangulated, with the consequent complication of mechanical bowel obstruction. We suggest that a patient with a flank mass should always raise suspicions of a lumbar hernia.

  15. Total hip arthroplasty following failed fixation of proximal hip fractures

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    Srivastav Shekhar

    2008-01-01

    Full Text Available Background: Most proximal femoral fractures are successfully treated with internal fixation but a failed surgery can be very distressing for the patient due to pain and disability. For the treating surgeon it can be a challenge to perform salvage operations. The purpose of this study was to evaluate the short-term functional outcome and complications of total hip arthroplasty (THA following failed fixation of proximal hip fracture. Materials and Methods: In a retrospective study, 21 hips in 20 patients (13 females and seven males with complications of operated hip fractures as indicated by either established nonunion or fracture collapse with hardware failure were analysed. Mean age of the patients was 62 years (range 38 years to 85 years. Nine patients were treated for femoral neck fracture, 10 for intertrochanteric (I/T fracture and two for subtrochanteric (S/T fracture of the hip. Uncemented THA was done in 11 cases, cemented THA in eight hip joints and hybrid THA in two patients. Results: The average duration of follow-up was four years (2-13 years. The mean duration of surgery was 125 min and blood loss was 1300 ml. There were three dislocations postoperatively. Two were managed conservatively and one was operated. There was one superficial infection and one deep infection. Only one patient required a walker while four required walking stick for ambulation. The mean Harris Hip score increased from 32 preoperatively to 79 postoperatively at one year interval. Conclusion: Total hip arthroplasty is an effective salvage procedure after failed osteosynthesis of hip fractures. Most patients have good pain relief and functional improvements inspite of technical difficulties and high complication rates than primary arthroplasty.

  16. Early results of reverse less invasive stabilization system plating in treating elderly intertrochanteric fractures: a prospective study compared to proximal femoral nail

    Institute of Scientific and Technical Information of China (English)

    YAO Chen; ZHANG Chang-qing; JIN Dong-xu; CHEN Yun-feng

    2011-01-01

    Background Intertrochanteric femur fracture is common in elderly population. Though multiple treatment options are available, the choice of implant remains controversial. The reverse less invasive stabilization system (LISS) plating was introduced for treatment of a patient with ipsilateral intertrochanteric and midshaft femoral fractures. The aim of this research was to compare such technique to intramedullary nailing (proximal femoral nail, PFN) for intertrochanteric fractures.Methods Fifty-six patients with an age of at least sixty-five years and an AO/OTA type-A1 or A2 fractures were included and divided into LISS and PFN treatment group. Background parameters, fracture and surgery details were documented. Follow-up time was at least 12 months. Radiology, complication, Harris Hip Score and Rapid Disability Rating Score (RDRS) were recorded to evaluate fixation status and hip function for each patient during follow-up.Results There was no significant difference between the two groups in surgical time ((48.0±8.6) minutes, vs.(51.8±10.8) minutes, P=0.3836) and intraoperative blood loss ((149.1±45.1) ml vs. (176.4±25.4) ml, P=0.0712). The LISS group had less postoperative haemoglobin (Hb) reduction ((10.2±4.5) g/L Hb, vs. (15.1~5.9) g/L Hb, P=0.0475). There was no complication observed in PFN group. All 31A1 type fracture in LISS group showed 100% maintenance of reduction. One nonunion with locking screw breakage and 2 varus union were found in the LISS group. Postoperative hip function was similar between the two groups.Conclusions Though reverse LISS plating may not be recommended as a routine fixation method for elderly unstable intertrochanteric fractures compared to PFN, it may possibly be reserved for rapid fixation and damage control in polytrauma patients and ORIF of subtrochanteric and reverse oblique intertrochanteric fractures.

  17. Outcomes of Four Different Surgical Techniques in the Treatment of Geriatric Intertrochanteric Femur Fractures

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    Altuğ Duramaz

    2014-12-01

    Full Text Available Aim: The aim of this study was to evaluate the suicide and intoxication cases between April 2011 and April 2013. Methods: One hundred eighty-two patients operated due to intertrochanteric femur fracture in our clinic were divided into four groups: hemiarthroplasty (HA, proximal femoral nail (PFN, sliding hip screw (SHC, and external fixator (EF groups. Time to surgery, comorbidities, anesthesia techniques, postoperative ambulation time, mortality rates and daily activity levels were compared. The patients were evaluated via outpatient follow-up and telephone interview. The Barthel index of activities of daily living was used for evaluation. Results: Patient distribution was: HA: 17 patients, PFN: 26 patients, SHC: 71 patients, and EF: 68 patients. The gender distribution (F/M and the mean age were: HA: 11/6, 83.4 years, PFN: 18/8, 81.2 years, SHC: 48/23, 82.1 years, and EF: 44/24, 84.5 years. There was no statistically significant difference between the groups in gender, comorbidities, anesthesia techniques, mean follow-up period, and Barthel index scores. In HA group, walking with double support duration was shorter (p=0.028. Conclusion: Elderly intertrochanteric femur fractures should be operated as soon as possible in order to prevent eventual complications preferably by regional anesthesia and internal fixation.

  18. 两种不同方法治疗老年人股骨粗隆间骨折疗效及对髋关节功能影响比较%Comparison of the effect and impact on hip function of two different methods in the treatment of elderly intertrochanteric fractures

    Institute of Scientific and Technical Information of China (English)

    徐卫东; 张凯

    2014-01-01

    Objective To compare the effect of anti-spin intramedullary nail and dynamic hip screw fixation in the treatment of elderly intertrochanteric fractures ,in order to investigate the clinical value of anti-spin intramedul-lary nail in elderly intertrochanteric fractures .Methods 160 elderly patients with intertrochanteric fractures were divided into the observation group and control group according to the random number table .The observation group received anti-spin intramedullary nail fixation , the control group received dynamic hip screw fixation .The fracture healing and hip function of two groups were compared .Results The operative time of the observation group was shor-ter than that of the control group ,and blood loss was less than the control group ,the differences were statistically sig-nificant(t=4.635,3.643,all P<0.05).The function,pain,deformity,range of motion and total scores of the obser-vation group were significantly higher than those of the control group ( t=4.433,4.364,4.865,3.876,3.645,all P<0.05).The postoperative hip function excellent rate of the observation group was 90.0%,which was significantly higher than 72.5%of the control group (χ2 =5.153,P<0.05).Conclusion Proximal femur intramedullary nail anti-rotation fixation in the treatment of elderly intertrochanteric femoral fractures has shorter operative time ,less blood loss,and postoperative hip function recovery is good ,it is worthy of promotion .%目的:通过比较不同内固定术在老年人股骨粗隆间骨折的临床疗效,探讨抗旋髓内钉内固定术在老年人股骨粗隆间骨折中的应用价值。方法选择160例老年股骨粗隆间骨折患者为研究对象,根据数字表法随机分为观察组(抗旋髓内钉内固定术)和对照组(动力髋螺钉内固定术)。比较两组患者治疗效果及髋关节功能恢复情况。结果观察组手术时间短于对照组,出血量少于对照组,差异均有统计学意义(t=4.635、3.643

  19. Bipolar hemiarthroplasty with a two-step osteotomy technique for unstable intertrochanteric fracture in senile patients

    Institute of Scientific and Technical Information of China (English)

    GU Gui-shan; LI Ying-hua; YANG Chen

    2013-01-01

    Objective:To introduce bipolar hemiarthroplasty with a two-step osteotomy technique and observe its clinical result for unstable intertrochanteric fractures in senile patients.Methods:Fifteen consecutive patients with unstable intertrochanteric fractures aged from 81 to 92 years with a mean of 85 years were treated in our hospital from August 2006 to October 2011 (Evans type Ⅲ in 4 cases,Evans type Ⅳ in 11 cases),who received bipolar hemiarthroplasty with a two-step osteotomy technique performed by a senior orthopedic surgeon through posterior approach under general anesthesia.All cases were evaluated by Zuckerman functional recovery score (FRS) and operative risk assessment software 1,based on the patients' physical and laboratory examinations preoperatively.The duration and blood loss have been recorded.There were 4 male cases (4 hips) and 11 female cases (11 hips).All prostheses consisted of Link SP Ⅱ femoral stem and bipolar femoral head.All patients were followed up for more than 1 year.Results:The average preoperative FRS,predictive value of operative morbidity and mortality were 83.7 (81.7-85.9),9.3% (7.3%-15.0%) and 3.5% (2.3%-4.2%),respectively.The average operation time was 50 minutes with a mean intraoperative blood loss of 310 ml.There were no operative or anesthetic complications or deaths within 30 days after operation.Sitting up was permitted 3 to 4 days,and partial weight bearing was allowed 5 to 7 days after operation.The average FRS was 79.3 at 30 days and 84.9 at 1 year postoperatively.Three patients died of unrelated causes (one due to myocardial infarction and the others due to cerebral hemorrhage during at least one-year follow-up).Conclusion:Bipolar hemiarthroplasty with a two-step osteotomy technique for unstable intertrochanteric fractures in the senile patients is a good choice for early ambulation and good hip function.

  20. Dynamic hip screw and Gamma nail fixation repair unstable intertrochanteric fracture:a three-dimensional finite element analysis%动力髋螺钉和Gamma钉置入固定不稳定股骨转子间骨折的三维有限元分析

    Institute of Scientific and Technical Information of China (English)

    黄晓微; 禹宝庆; 李泽湘; 敖荣广

    2015-01-01

    BACKGROUND:For unstable intertrochanteric fracture repair, there are two views:extramedul ary fixation or intramedul ary fixation. Theoretical y, intramedul ary fixation is in line with the principles of minimal y invasive, more mechanical and biological advantages. However, evidence-based medicine and related studies have shown that compared with the extramedul ary fixation, intramedul ary fixation did not reflect the proper theoretical advantage. OBJECTIVE:To compare the biomechanical performance of two kinds of internal fixation systems:dynamic hip screw and Gamma nail which commonly used in repair of intertrochanteric fractures by finite element method, and to evaluate the advantages and disadvantages of dynamic hip screw and Gamma nail in treatment of unstable intertrochanteric fracture. METHODS:Three-dimensional finite element model of human femur unstable intertrochanteric fractures (31-A2;AO fracture classification), and the three-dimensional finite element models of dynamic hip screw and Gamma nail were established respectively, and were fixed according to the requirement of orthopedic surgery. The reference load which the joint bearing was at the peak time in adult step state period with the body mass of 700 N was stimulated. The stress distribution of bone, bone-internal fixation model, nail or screw, the strain and deformation of fracture location on the surface of the bone and bone-internal fixation model, the stress distribution along the femur and the loading transfer condition along the internal fixator and the like were analyzed. RESULTS AND CONCLUSION:Dynamic hip screw and Gamma nail have good sliding compression features which could make the continuous and dynamical y axial compression of the fractured section. Under the load conditions, the displacement value of dynamic hip screw was larger. In the treatment of unstable intertrochanteric fracture, Gamma nail was stronger than dynamic hip screw. Two kinds of internal fixations al make the

  1. Medical Cost Analysis of the Osteoporotic Hip Fractures

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    Savaş Çamur

    2015-12-01

    Full Text Available Objective: Osteoporotic hip fractures decrease the life expectancy for 20% about 20-50% of the patients become permanently dependent in terms of walking for the rest of their life. Life expectancy is increasing in Turkey in the last 20 years. We investigated the impact of osteoporotic hip fractures which increase the morbidity and mortality on the national economy. Materials and Methods: A total of 81 patients admitted to our emergency department with the diagnosis of femur intertrochanteric fracture and femoral neck fracture between 2008 and 2012 were included in this study. We retrospectively evaluated the medical records and the medical costs of these patients from hospital information management system. Results: Of the 81 patients 32 (39.6% males and 49 (60.4% females meeting the inclusion criteria were included in this study. The mean age was 80.1 years (range, 61-103. Twenty-three (27.5% patients had femoral neck fracture and 58 (72.5% patients had intertrochanteric femur fracture. The mean length of hospital stay was 13.4 days in intertrochanteric femur fracture and 15.5 days in femoral neck fracture; average of the total days of hospitalization of all patients was 13.9 days. The average treatment cost per patient was 5,912.36 TL for intertrochanteric fractures, 5,753.00 TL for neck fractures, and 5,863.09 TL for the whole patient population. Conclusion: Hip fracture is a substantial cause of morbidity and mortality in elderly. Taking preventive measures before the fracture occurs may help to prevent this problem which has a high cost treatment and which is a substantial burden for the national economy.

  2. 人工股骨头置换与动力髋螺钉内固定治疗股骨粗隆间骨折的效果比较%Comparison of hip arthroplasty and internal fixation for the treatment of intertrochanteric fractures

    Institute of Scientific and Technical Information of China (English)

    熊秉刚; 谢文伟; 姚汉刚; 利盛成; 廖德允; 李再学; 黎明华; 苏厂尧

    2008-01-01

    Objective To compare the effect of hip artificial replacement and DHS internal fixation for the treatment of intertrochanteric fracture, and investigate the difference of the two method. Methods Eighty-six pa- tients with intertrochanterie fracture patients were treated with hip arthroplasty, and dynamic hip screw. The pa- tients were followed up for 6 months, and compared the operation rime, blood loss, postoperative complications, sur- vival rate, postoperative hip function score and lose situation. Results There was no significant difference in opera- tion time,blood loss,postoperative complications,in local symptoms hip varus deformation occured in the DHS inter- hal fixation because lag screw cut-our and the collapse of the medial cortex, hip and thigh pain oecured in artificial re- placement,hip function score dropped 9.5 % in DHS and 9.2% in artificial replacement. Conclusion For elderly patients, eomminuted fracture and osteoporosis, and other types of unstable intertrochanteric fracture patients, the primary purpose of surgery is to provide to patients more activities of the early conditions,so hip arthroplasty can be used to the treatment of intertrochanteric fracture,as a reasonable replacement surgery.%目的 通过对使用人工股骨头置换与动力髋螺钉(DHs)内固定治疗股骨粗隆间骨折的结果进行比较分析,探讨两者之间的差别.方法 86例高龄股骨粗隆间骨折患者,分别采用人工股骨头置换(半髋组)及DHS内固定方法(DHS组)治疗,经过6个月以上的随访,比较两组患者在手术时间、术中出血、术后并发症、累积生存情况、术后髋部功能评分及丢失情况等方面存在的差异.结果 两组患者在手术时间、术中出血、术后全身并发症等方面无明显差异.局部症状,DHS组出现了内固定穿出骨皮质以及内侧皮质塌陷所造成的髋内翻现象,而半髋组患者则出现髋部及大腿疼痛;DHS组髋关节综合评分下降9.5%,

  3. Laboratory nutritional parameters can predict one-year mortality in elderly patients with intertrochanteric fracture

    OpenAIRE

    Jun Lu

    2014-01-01

    "Objectives: The purpose of this study was to investigate the contributing value of nutrition related blood parameters to one-year mortality following intertrochanteric fracture surgery in a Chinese population over the age of 65. Methods: The nutritional status was evaluated by using admission serum albumin level and total lymphocyte count (TLC). One hundred and seventy-four intertrochanteric fracture patients were entered to this study for nutritional status assessment. Gender differences...

  4. Hip Fractures among Older Adults

    Science.gov (United States)

    ... online training for health care providers. Learn More Hip Fractures Among Older Adults Recommend on Facebook Tweet Share ... get older. What You Can Do to Prevent Hip Fractures You can prevent hip fractures by taking steps ...

  5. Surgical techniques for the fixation of trochanteric fracture compartments in hip arthroplasty for femoral intertrochanteric fractures%股骨转子间骨折人工关节置换术中转子部骨折固定技术的应用

    Institute of Scientific and Technical Information of China (English)

    储小兵; 刘富存; 童培建

    2015-01-01

    目的:探讨股骨转子间骨折人工关节置换术中转子部骨折固定的理想方式及选择依据。方法采用人工关节置换术治疗86例老年股骨转子间骨折患者。骨折按照 Evans-Jenson 分型,Ⅱ型2例,Ⅲ型22例,Ⅳ型45例,Ⅴ型17例。双极人工股骨头置换50例,全髋关节置换术36例。转子部骨折块采用金属线缆“双交叉法”捆绑固定46例,采用连接钛缆 GTR 接骨板固定技术28例,其他方法12例。结果手术成功78例,术后发生转子部骨折移位 5例(合并假体柄松动下沉 2例),关节脱位1例,假体深部感染1例,中毒性肠麻痹死亡1例。住院期间发生坠积性肺炎 2例,无坐骨神经损伤和严重的血栓栓塞并发症发生。 2例出院后失访,76例均获随访,时间3~79个月。 1例于术后2年死于急性心肌梗死,1例术后5个月死于脑溢血。末次随访时根据 Harris 髋关节功能判定标准,优52例,良13例,中9例,优良率为87.8% 。转子部骨折愈合时间3~8个月。结论老年人股骨转子间骨折采用人工关节置换治疗中,转子部骨折块的可靠固定对于术后开始进行康复训练的时间、行走步态和假体的使用寿命具有重要影响。%Objective To explore the ideal fixation techniques and selection criteria for trochanteric fracture frag-ments when treating intertrochanteric fractures of the femur by hip arthroplasty. Methods 86 cases of femoral inter-trochanteric fractures were undergone hip arthroplasties. According to Evans-Jenson classification,there were 2 cases with type Ⅱ fractures,22 with type Ⅲ,45 with type Ⅳ and 17 with type Ⅴ. 50 cases were received bipolar hemi-ar-throplasty and 36 cases were received total hip arthroplasty. Double cross binding fixation techniques with metal wires or cables were employed in 46 cases,cable-ready greater trochanteric reattachment fixation techniques in 28 cases,and other methods in 12 cases in treating femoral trochanteric

  6. 髋关节动力螺钉和股骨近端髓内钉-螺旋刀片固定股骨转子间骨折的效果比较%Therapeutic effect of dynamic hip screw versus proximal femoral nail anti-rotation blade for intertrochanteric fractures

    Institute of Scientific and Technical Information of China (English)

    陈生文

    2012-01-01

    BACKGROUND: Dynamic hip screw (DHS) is the gold standard for clinical fixation of intertrochanteric fractures, and achieves certain effect. But proximal femoral nail anti-rotation (PFNA) blade is a new modified proximal femoral fixation system, which is used to solve the deficiencies of previous fixation. OBJECTIVE: To compare the clinical effect of DHS and PFNA blade for intertrochanteric fractures. METHODS: Totally 76 patients with intertrochanteric fractures were selected including 36 cases treated with DHS and 40 cases with PFNA. All the patients received operative treatment with common operative route. RESULTS AND CONCLUSION: Incidence rate of medical complication and deformity rate of hip joint in the PFNA group were lower than those in the DSH group (P< 0.05). The excellent and good rate of the hip function recovery was 78% (28/36) in the DSH group, and which in the PFNA group was 82% (33/40). The results showed that both the two method of DHS and PFNA have good clinic curative effect for the treatment of intertrochanteric fractures, but the PFNA has the advantages of simple operation, less bleeding, and reliable fixation.%背景:髋关节动力螺钉是临床固定股骨转子间骨折的金标准,取得了一定的疗效,而股骨近端髓内钉-螺旋刀片是经过改进的新型股骨近端髓内固定系统,它的运用解决了以往内固定的不足.目的:比较髋关节动力螺钉和股骨近端髓内钉-螺旋刀片治疗股骨转子间骨折的疗效.方法:76例股骨转子间骨折患者,其中36例用髋关节动力螺钉固定,40例用股骨近端髓内钉-螺旋刀片固定,均采用常规手术入路.结果与结论:股骨近端髓内钉-螺旋刀片组的髋部畸形率及并发症发生率均低于髋关节动力螺钉组(P < 0.05),髋关节动力螺钉组髋关节功能恢复优良率达78%(28/36),股骨近端髓内钉-螺旋刀片组为82%(33/40).结果可见两组治疗股骨转子间骨折均有满意的临床疗效,但是股骨近

  7. Treatment of unstable intertrochanteric fractures of the femur through hip arthroplasty in the elderly: A report of 56 cases%人工股骨头置换治疗高龄不稳定粗隆间骨折56例分析

    Institute of Scientific and Technical Information of China (English)

    杜传林; 杨广左; 王宇; 杨泗华; 柴伟

    2011-01-01

    Objective To investigate the treatment effect of hip arthroplasty for unstable intertrochanteric fractures of the femur in the elderly. Methods Fifty-six elderly patients (25 males and 31 females, aged 75 to 92 years with mean of 83 years) with unstable intertrochanteric fractures hospitalized from January 2005 to June 2010 were involved in the present study. According to the Evan's fracture classification. 22 cases were classified as type Ⅲ. 24 as type IV, and 10 as type V. All the patients received bone-cement type hip arthroplasty. and the treatment effects, perioperative complications, and follow-up results were observed. Results The operation was completed successfully for all patients. The postoperative complications included, two cases of deep venous thrombosis, two cases of transient psychotic disorder, and two cases of pseudomembranous colitis, all of which, were cured via symptomatic treatment. Three patients have had complications with pulmonary embolism and two with fractures around the prosthesis four months after discharge. Two patients died of pulmonary infection and multiple organ failure, respectively. The Harris hip score were excellent for the 21 cases and good for 26 cases. The excellent and good rating was 83. 9 % after six months from operation. No joint infection or dislocation occurred during the follow-up period of 12 to 20 months (mean of 16 months). Conclusion Hip arthroplasty has been proven to be an effective treatment for unstable intertrochanteric fractures in the elderly with less surgery trauma and complications. It also allowed early ambulation and improved the quality of life of the patients.%目的 探讨人工股骨头置换治疗高龄患者不稳定股骨粗隆间骨折的疗效.方法 2005年1月-2010年6月收治的老年不稳定型股骨粗隆间骨折患者56例,其中男25例,女31例,年龄75~92岁,平均83岁.骨折Evans分型Ⅲ型22例,Ⅳ型24例,Ⅴ型10例.所有患者均施行骨水泥型人

  8. Comparative Effectiveness of INTERTAN Intramedullary Nail and Sliding Hip Screw in Treating Intertrochanteric or Subtrochanteric Fracture of Elderly Patients%INTERTAN髓内钉与滑动髋螺钉治疗老年性粗隆间和粗隆下骨折的临床比较

    Institute of Scientific and Technical Information of China (English)

    章暐; 邹剑

    2014-01-01

    目的:比较INTERTAN髓内钉与滑动髋螺钉(DHS)治疗老年性粗隆间和粗隆下骨折的手术疗效。方法自2010年1月至2012年1月,对120例股骨粗隆间或粗隆下骨折患者分别行INTERTAN髓内钉或DHS固定治疗,其中INTERTAN组67例,DHS组53例。记录手术时间、术中出血量、术后引流量;进行术后疼痛评估、Harris髋骨评分、SF-36生活质量评估;记录并发症情况。结果本组中共有111例(INTERTAN组64例、DHS组47例)患者完成随访。两组间的手术时间无显著差异。DHS组的平均失血量及术后引流量较大,与INTERTAN组相比存在明显差异。VAS疼痛评分中,INTERTAN组术后3 d的VAS评分要优于DHS组,存在统计学差异;但术后3个月及12个月的随访中无明显差异。在术后3个月及12个月后,两组的Harris 髋关节评分和SF-36生活质量评分没有统计学差异。结论 INTERTAN和DHS治疗股骨粗隆间或粗隆下骨折,术后疼痛、功能、并发症的结果无明显差异。%Objective To compare the surgical efficacy between INTERTAN intramedullary nail and sliding hip screw in treating intertrochanteric or subtrochanteric fracture of old people. Methods From Jan 2010 to Jan 2012, 120 patients with Intertrochanteric or subtrochanteric Fractures were treated by INTERTAN intramedullary nail ( n=67) and sliding hip screw (n=53). Operation time, bleeding volume, amount of drainage, visual analogue scale (VAS) pain score, Harris hip score, SF-36 score and complications were recorded at each time points. Results Among all the patients, 111 patients (INTERTAN group: 64 cases; DHS group: 47 cases) were followed up for more than 1 year successfully. Bleeding volume and amount of drainage in INTERTAN group were larger than in DHS group. VAS score in INTERTAN group 3 days after operation was better than in DHS group, and there was no difference between the two groups 3 and 12 months after operation. There was no

  9. Clinical Analysis of 65 Years of Age in Patients with Intertrochanteric Frac-tures of the Hip Joint Replacement and Internal Fixation%65岁以上股骨粗隆间骨折患者行髋关节置换和内固定术的临床分析

    Institute of Scientific and Technical Information of China (English)

    张登峰

    2015-01-01

    目的:探讨65岁以上股骨粗隆间骨折患者行髋关节置换和内固定术的临床疗效。方法选取60例2013年8月—2014年8月在该院接受治疗的65岁以上股骨粗隆间骨折患者,以随机方式将其平均分为两组,即对照组与观察组,对观察组患者实施髋关节置换术治疗,对对照组患者实施内固定术治疗。对比两组患者术后死亡率、并发症发生率、内置物松动率、髋部畸形率及髋关节功能评分等相关指标。结果术后观察组患者优良率为80.0%,对照组患者优良率为53.3%,观察组明显优于对照组,差异有统计学意义(P<0.05),观察组患者髋关节功能评分明显优于对照组,差异有统计学意义(P<0.05),但术后观察组患者死亡率显著高于对照组,差异有统计学意义(P<0.05);两组患者术后髋部畸形率、内科并发症发生率、内置物松动率,差异无统计学意义(P>0.05)。结论研究表明,内固定术与髋关节置换术治疗老年股骨粗隆间骨折患者均有其各自优势,需要对患者实际病情全面分析后才能决定所用治疗方法。%Objective To investigate the clinical efficacy of over 65 years in patients with intertrochanteric fractures hip replace-ment and internal fixation. Methods 60 August 2013 - August 2014 in our hospital treated 65 patients over the age of in-tertrochanteric fracture of the femur, in a random manner which were divided into two groups, namely the control group and the observation group, the observation group for patients with hip replacement therapy, patients in the control group on the implemen-tation of internal fixation. Comparison of postoperative mortality, morbidity, implant loosening, hip deformity and hip score and oth-er related indicators. Excellent results were observed in patients was 80.0%in the control group was 53.3%in patients with excel-lent observation group than the control group, P 0

  10. Fracture After Total Hip Replacement

    Science.gov (United States)

    ... osteolysis. Symptoms The most common symptoms of periprosthetic hip fracture include: • Pain around the hip or thigh • Swelling ... o en very painful, someone with a periprosthetic hip fracture will most likely go directly to the emergency ...

  11. Prevention of hip fractures.

    Science.gov (United States)

    Meunier, P J

    1993-11-30

    For a 50-year old Caucasian woman today, the risk of a hip fracture over her remaining life-time is about 17%. Tomorrow the situation will clearly be worse because the continuous increase in life expectancy will cause a three-fold increase in worldwide fracture incidence over the next 60 years. Through diagnostic bone mass measurements at the hip and assessment of biochemical parameters, a great deal has been learned in recent years about reduction of hip fracture risk. Preventive strategies are based on prevention of falls, use of hip protectors, and prevention of bone fragility. The latter includes the optimization of peak bone mass during childhood, postmenopausal estrogen replacement therapy, and also late prevention consisting in reversing senile secondary hyperparathyroidism, which plays an important role in the decrease of skeletal strength. This secondary hyperparathyroidism, which results from both vitamin D insufficiency and low calcium intake, is preventable with vitamin D3 and calcium supplements. They have recently been shown capable of providing effective prevention of hip fractures in elderly women living in nursing homes, with a reduction of about 25% in the number of hip fractures noted in a 3-year controlled study in 3,270 women (intention-to-treat analysis). In conclusion, it is never too early to reduce the risk of osteoporosis and never too late to prevent hip fractures.

  12. Treatment of osteoporotic intertrochanteric fractures by zoledronic acid injection combined with proximal femoral nail anti-rotation

    Institute of Scientific and Technical Information of China (English)

    Yong Li; Wen-Bo Zhao; De-Li Wang; Qing He; Qin Li; Fu-Xing Pei; Lei Liu

    2016-01-01

    Objective:To observe the clinical results of proximal femoral nail anti-rotation (PFNA) combined with zoledronic acid injection in the treatment of osteoporotic intertrochanteric fractures in the elderly.Methods:60 elderly patients with osteoporotic intertrochanteric fractures were diagnosed using a dual energy X-ray bone density instrument.Patients were randomly divided into treatment or control groups (30 cases in each group).Patients in both groups were treated by closed/open reduction and internal fixation using PFNA.In the treatment group,patients received one zoledronic phosphonic acid injection of 5 mg/100 ml via intravenous drip,in addition to 600 mg of Caltrate D (qd) and 0.25 μg of alpha ossification alcohol (qd).The control group received 600 mg of Caltrate D (qd) and 0.25 μg of alpha ossification alcohol (qd).The oral drugs were administered for 12 months.Bone pain relief was observed,and changes in the bone mineral density (BMD) of the lumbar and health-side hip were recorded.Clinical results were evaluated using the Visual Analogue Scale (VAS),Harris joint function score,and Osteoporosis Quality of Life Scale (OQOLS).Results:Compared with the control group,bone pain symptoms were significantly alleviated (p < 0.05) in the treatment group.In the treatment and control groups,both between-group and within-group differences in BMD were significantly increased in L1-4,femoral neck and trochanter (p < 0.05).No significant differences were found between the two groups in regard to the involved hip or the total rate of improvement at the end of the follow-up period,although cases in the treatment group had higher OQOLS scores than those of the controls (p =0.04).Cases in the treatment group healed more quickly than those in the control group [(13 ± 3.2) weeks vs (15 ± 4.6) weeks,p =0.02].During the follow-up period,cases in the treatment group had no new fractures,whereas 2 new cases of hip fracture and 2 cases of distal radial fractures were observed

  13. Comparative assessment of short term outcome of cementless prosthesis versus cemented femoral stem prosthesis in hip arthroplasty for elderly intertrochanteric fracture%生物型与骨水泥型人工髋关节置换治疗高龄转子间骨折早期疗效的比较

    Institute of Scientific and Technical Information of China (English)

    闫文龙; 杨小中; 张华; 张健

    2015-01-01

    Objective To compare the short-term clinical effect of the distal fixed prosthesis ( cementless prosthesis ) with cemented femoral stem prosthesis in hip arthroplasty for elderly intertrochanteric fracture .Methods Fifty-nine cases(54 cases followed-up) of unilateral intertrochanteric fracture in senile patients from Aug .2010 to Apr.2012 were retrospectively analyzed and randomly divided into 2 groups.In them,21 cases underwent hip ar-throplasty using the distal fixed prosthesis ( cementless group ) ,and the other 33 were treated with cemented hip ar-throplasty (cement group).The difference was compared in time of hospitalization , time of operation,blood loss, adverse effect,Harris scoring and radiological results .Results The average operation time were (42.3 ±7.2) mi-nutes in cementless group and (51.5 ±8.3) minutes in cement group,with significant difference (P0.05).Conclu-sion Hip arthroplasty using cementless prosthesis for treatment of elder patients with intertrochanteric fracture can a -chieve good short-term clinical effect alike cemented prosthesis .It helps reduce operative time ,blood loss and bone cement implantation syndrome during the operation .The medium and long term effect still needs further research . And preoperative evaluation on the shape and size of medullary cavity and the severity of osteoporosis is needed .%目的:比较远端固定生物型股骨假体与骨水泥型股骨假体行人工髋关节置换治疗高龄股骨转子间骨折的早期临床疗效。方法回顾性分析2010年8月~2012年4月在我院骨科行人工髋关节置换治疗的59例单侧股骨转子间骨折高龄患者的临床资料,实际随访54例。随机分成两组:生物固定组21例,骨水泥组33例。比较两组住院时间、手术时间、术中出血量、术后3d总失血量、术后并发症、Harris评分以及放射学效果。结果生物固定组手术时间、术中出血均明显少于骨水泥组;生物固定组术中、

  14. [Distal fixation prosthesis for unstable intertrochanteric fractures in elderly patients: a mid-term follow-up study].

    Science.gov (United States)

    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

  15. 动力髋螺旋刀系统与螺旋刀片抗旋髓内钉修复不稳定型股骨转子间骨折比较%Dynamic hip screw knife systemversus spiral blade anti-rotation intramedullary nail in the treatment of unstable intertrochanteric fractures

    Institute of Scientific and Technical Information of China (English)

    林勇; 林雪平; 阮张涛

    2015-01-01

    BACKGROUND:Anti-rotation intramedulary nail fixation for proximal femoral fractures replaces the femoral bearing axis, moves towards body axis relative to hip screw and dynamic ankle screw, enhances the anti-fatigue strength at the fracture site, supports the anti-varus and prevents the rotation of the proximal fracture site, and is suitable for the treatment of unstable fracture. OBJECTIVE:To comparatively observe the effects of dynamic hip screw knife system and minimaly invasive spiral blade anti-rotation intramedulary nail in the repair of unstable intertrochanteric fractures. METHODS: A total of 82 cases of unstable intertrochanteric fractures, who were treated in the Department of Orthopedics, First People’s Hospital of Shunde from January 2012 to January 2014, were selected in this study. The patients were equaly and randomly divided into two groups: dynamic hip screw knife system group and minimaly invasive spiral blade anti-rotation intramedulary nail group. Repair index, fracture healing time and the incidence of complications were compared between the two groups. RESULTS AND CONCLUSION:Healing time and repair index were significantly better in the minimaly invasive spiral blade anti-rotation intramedulary nail group than in the dynamic hip screw knife system group (P < 0.05). Complications appeared in five patients from the minimaly invasive spiral blade anti-rotation intramedulary nail group, with the incidence rate of 12%, and in ten patients from the dynamic hip screw knife system group, with the incidence rate of 24%. The incidence of complications was significantly lower in the minimaly invasive spiral blade anti-rotation intramedulary nail group than in the dynamic hip screw knife system group (P < 0.05). These data suggest that for patients with unstable intertrochanteric fracture, minimaly invasive spiral blade anti-rotation intramedulary nail can decrease the incidence of complications, elevate the safety of the repair method, and promote the

  16. 综合康复护理对股骨粗隆间骨折行DHS内固定术患者预后的影响%Effect of comprehensive rehabilitation interventions on the patients with intertrochanteric fracture of femur treated by dynamic hip screw internal fixation

    Institute of Scientific and Technical Information of China (English)

    钟巧艺; 陈思颖; 赵洁莲; 区海云; 何惠兰

    2011-01-01

    目的:探讨综合康复护理对股骨粗隆间骨折行动力髋螺钉(dynamic hip screw,DHS)内固定术患者预后的影响.方法:选择2008年9月-2009年9月本院收治的股骨粗隆间骨折行DHS内固定术的49例患者为对照组,选择2009年10月-2010年10月收治的58例患者为实验组.对照组给予常规护理,实验组采用综合康复护理,比较两组患者骨折愈合时间、住院时间、疗效及并发症的发生率.结果:实验组骨折愈合时间及住院时间短于对照组、疗效优于对照组、并发症的发生率低于对照组(均P<0.05).结论:股骨粗隆间骨折患者行DHS内固定术后采用综合康复护理,有利于缩短骨折愈合时间及住院时间,提高治疗效果,降低术后并发症的发生率,值得临床推广应用.%Objective To explore the influence of comprehenaive rehabilitation interventions on patients with intertrochanteric fracture of femur treated by DHS (dynamic hip screw) intemal fixation. Methods Forty-nine patients with intertrochanteric fracture of femur treated by DHS intemal fixation from September 2008 to September 2009 were selected as the control group. Fifty-eight patients with intertrochanteric fracture of femur treated by DHS intemal fixation from October 2009 to October 2010 were selected as the experimental group. The control group received conventional nuraing intervention, and the experimental group received comprehensive rehabilitation nursing interventions. Healing time, hospitalization time, clinical effect and incidence of complications were compared in the two groups. Results Hospitalization time, clinical effect in the experimental group was shorter than thoae in the control group; the clinical effect was better than that in the control Sroup; the incidence of complications was lower than that in the control group. Conclusion Comprehengive nursing intervention shortens healing time and hospitalization time, increases the therapy efficacy, and decreases the

  17. Internal fixations of proximal femoral nail antirotation versus that of dynamic hip screw for femoral intertrochanteric fracture%抗旋转型股骨近端髓内钉内固定与动力髋螺钉内固定治疗股骨转子间骨折的临床疗效对比观察

    Institute of Scientific and Technical Information of China (English)

    梁荣班; 赵佳; 卢珂恩; 谭宏昌

    2014-01-01

    Objective To explore and study the clinical effects of the internal fixations of proximal femoral nail antirotation(PFNA) and dynamic hip screw(DHS) for femoral intertrochanteric fracture.Methods 100 patients with femoral intertrochanteric fracture admitted into our hospital from April,2009 to April,2013 were selected as study objects and randomly and equally divided into two groups.50 patients (PFNA group) were treated by the internal fixation of PFNA,and the other 50 patients (DHS group) by the internal fixation of DHS.They were followed up for 9-18 months.The curative effects of both groups were observed and compared.Results The volumes of intraoperative bleeding and of the postoperative drainage were smaller and the postoperative weight-loading walking time and healing time were shorter in the PFNA group than in the DHS group.The Harris hip function scores were increased in both groups after the treatment; the hip function scores,motion ranges,and synthetic scores were increased more but the hip joint score of deformity less in the PFNA group than in the DHS group.The incidence of postoperative complications of the PFNA group was 6.0%,which was significantly lower than that of the DHS group (26.0%),with a statistical difference (P<0.05).Conclusions PFNA has better curative effects than DHS in the treatment of femoral intertrochanteric fracture and has greater comparative advantages in intraoperative bleeding volume,postoperative healing time,and weight-bearing walking time.Comparing with DHS treatment,PENA treatment causes fewer postoperative complications and recovers hip joint function better,so it can be the first treatment choice for patients with femoral intertrochanteric fracture.%目的 探究抗旋转型股骨近端髓内钉(PFNA)内固定与动力髋螺钉(DHS)内固定在股骨转子间骨折中的临床疗效.方法 选取自2009年4月至2013年4月我院收治的股骨转子间骨折患者100例,将其作为研究对

  18. Teriparatide Improves Fracture Healing and Early Functional Recovery in Treatment of Osteoporotic Intertrochanteric Fractures.

    Science.gov (United States)

    Huang, Tsan-Wen; Chuang, Po-Yao; Lin, Shih-Jie; Lee, Chien-Yin; Huang, Kuo-Chin; Shih, Hsin-Nung; Lee, Mel S; Hsu, Robert Wen-Wei; Shen, Wun-Jer

    2016-05-01

    Osteoporotic intertrochanteric fractures result in serious health problems and decrease health-related quality of life (HRQoL). Faster time-to-union is important for early return to daily activities and reduction of complications. Teriparatide has been shown to accelerate fracture healing, but the literature is sparse on this topic. The aim of this study is to assess whether teriparatide accelerates fracture healing.Between 2008 and 2014, patients with osteoporotic intertrochanteric fractures who underwent surgical interventions were enrolled in this retrospective cohort study. Group 1 included patients who were not on any osteoporosis medication prior to fracture and who postoperatively received only calcium and vitamin D; patients in Group 2 were not on any osteoporosis medication prior to fracture, and received teriparatide and calcium and vitamin D postoperatively. Patients in Group 3 were those who were on alendronate prior to fracture and postfracture received teriparatide as well as calcium and vitamin D. Demographics, time-to-union, HRQoL (short-form health survey [SF]-12 physical component summary [PCS] and SF-12 mental component summary [MCS]), morbidities, mortalities, and radiographic and functional outcomes between groups were compared.A total of 189 patients were enrolled in this study. There were 83 patients in Group 1, 47 patients in Group 2, and 59 patients in Group 3. A significantly shorter time-to-union was found in the teriparatide-treated groups (mean, 13.6, 12.3, and 10.6 weeks, respectively [P = 0.002]). With regard to SF-12 PCS, the scores were significantly better in teriparatide-treated groups at 3 months (mean, 19, 28, and 29, respectively [P = 0.002]) and 6 months (mean, 28, 37, and 38, respectively [P = 0.008]). Similar inter-group differences were noted when comparing the pain scores, the ability to get around the house, the ability to get out of the house, and the ability to go shopping at 3 and 6 months. Complications

  19. Influence of bone mineral density and hip geometry on the different types of hip fracture.

    Science.gov (United States)

    Li, Yizhong; Lin, Jinkuang; Cai, Siqing; Yan, Lisheng; Pan, Yuancheng; Yao, Xuedong; Zhuang, Huafeng; Wang, Peiwen; Zeng, Yanjun

    2016-01-01

    The aim of this study was to assess the influence of bone mineral density and hip geometry on the fragility fracture of femoral neck and trochanteric region. There were 95 menopausal females of age ≥ 50 years with fragility fracture of hip, including 55 cases of femoral neck fracture and 40 cases of trochanteric fracture. Another 63 non-fractured females with normal bone mineral density (BMD) were chosen as control. BMD, hip axis length, neck-shaft angle and structural parameters including cross surface area, cortical thickness and buckling ratio were detected and compared. Compared with control group, the patients with femoral neck fracture or trochanteric fractures had significantly lower BMD of femoral neck, as well as lower cross surface area and cortical thickness and higher buckling ratio in femoral neck and trochanteric region. There were no significant differences of BMD and structural parameters in the femoral neck fracture group and intertrochanteric fracture group. Hip axis length and neck-shaft angle were not significantly different among three groups. The significant changes of BMD and proximal femur geometry were present in the fragility fracture of femoral neck and trochanteric region. The different types of hip fractures cannot be explained by these changes.

  20. Comparison of migration behavior between single and dual lag screw implants for intertrochanteric fracture fixation

    Directory of Open Access Journals (Sweden)

    Katonis Pavlos G

    2009-05-01

    Full Text Available Abstract Background Lag screw cut-out failure following fixation of unstable intertrochanteric fractures in osteoporotic bone remains an unsolved challenge. This study tested if resistance to cut-out failure can be improved by using a dual lag screw implant in place of a single lag screw implant. Migration behavior and cut-out resistance of a single and a dual lag screw implant were comparatively evaluated in surrogate specimens using an established laboratory model of hip screw cut-out failure. Methods Five dual lag screw implants (Endovis, Citieffe and five single lag screw implants (DHS, Synthes were tested in the Hip Implant Performance Simulator (HIPS of the Legacy Biomechanics Laboratory. This model simulated osteoporotic bone, an unstable fracture, and biaxial rocking motion representative of hip loading during normal gait. All constructs were loaded up to 20,000 cycles of 1.45 kN peak magnitude under biaxial rocking motion. The migration kinematics was continuously monitored with 6-degrees of freedom motion tracking system and the number of cycles to implant cut-out was recorded. Results The dual lag screw implant exhibited significantly less migration and sustained more loading cycles in comparison to the DHS single lag screw. All DHS constructs failed before 20,000 cycles, on average at 6,638 ± 2,837 cycles either by cut-out or permanent screw bending. At failure, DHS constructs exhibited 10.8 ± 2.3° varus collapse and 15.5 ± 9.5° rotation around the lag screw axis. Four out of five dual screws constructs sustained 20,000 loading cycles. One dual screw specimens sustained cut-out by medial migration of the distal screw after 10,054 cycles. At test end, varus collapse and neck rotation in dual screws implants advanced to 3.7 ± 1.7° and 1.6 ± 1.0°, respectively. Conclusion The single and double lag screw implants demonstrated a significantly different migration resistance in surrogate specimens under gait loading simulation with

  1. Comparison of the effect of anatomical plate and dynamic hip screw for elderly patients with intertrochanteric fracture%解剖型钢板与髋动力螺钉治疗老年人股骨粗隆间骨折的疗效比较

    Institute of Scientific and Technical Information of China (English)

    沈俊玲

    2014-01-01

    Objective To compare the effect of anatomical plate and dynamic hip screw(DHS) for elderly patients with intertrochanteric fracture.Methods The clinical data of medical treatments for elderly patients with intertrochanteric fracture were retrospectively analyzed.36 cases received anatomical plate treatment were selected as observation group,and 34 cases received DHS were selected as control group.Results The operation time,intraoperative blood loss,postoperative length of stay(LOS) and the time of fracture healing in observation group were obviously shorter than those in control group(t =2.18,2.35,2.31,2.15,all P <0.05).In observation group,3 cases appeared postoperative complications,included 2 cases of pulmonary infection,and 1 case of varus deformity of hip joint.In control group,9 cases appeared postoperative complications,included 2 cases of pulmonary infection,4 cases of varus deformity of hip joint,2 cases of limb shortening deformity,and 1 case of deep venous thrombosis of lower extremity.The incidence rate of complication of the observation group was 8.33%,which was significantly lower than 26.47% of the control group (x2 =4.05,P < 0.05).The patients were followed up for 12 to 21 months after operation,average (16.7 ±4.2)months,the excellent and good rate of the function of postoperative hip joint in the observation group was 86.11%,which was significantly higher than 64.71% in the control group (x2 =4.36,P < 0.05).Conclusion Both anatomical plate and DHS have favorable effect on old patients with intertrochanteric fracture,and anatomical plate has advantages such as short operation time,a small amount of intraoperative bleeding,short postoperative LOS,short time of fracture healing,less postoperative complication,high excellent and good rate of the function of postoperative hip joint and etc,and it is preferably suitable for the comminuted fracture which cannot be cured by DHS.%目的 比较解剖型钢板与髋动力螺钉治疗老年人

  2. Interpretation of hip fracture patterns using areal bone mineral density in the proximal femur.

    Science.gov (United States)

    Hey, Hwee Weng Dennis; Sng, Weizhong Jonathan; Lim, Joel Louis Zongwei; Tan, Chuen Seng; Gan, Alfred Tau Liang; Ng, Jun Han Charles; Kagda, Fareed H Y

    2015-12-01

    Bone mineral density scans are currently interpreted based on an average score of the entire proximal femur. Improvements in technology now allow us to measure bone density in specific regions of the proximal femur. The study attempts to explain the pathophysiology of neck of femur (NOF) and intertrochanteric/basi-cervical (IT) fractures by correlating areal BMD (aBMD) scores with fracture patterns, and explore possible predictors for these fracture patterns. This is a single institution retrospective study on all patients who underwent hip surgeries from June 2010 to August 2012. A total of 106 patients (44 IT/basi-cervical, 62 NOF fractures) were studied. The data retrieved include patient characteristics and aBMD scores measured at different regions of the contralateral hip within 1 month of the injury. Demographic and clinical characteristic differences between IT and NOF fractures were analyzed using Fisher's Exact test and two-sample t test. Relationship between aBMD scores and fracture patterns was assessed using multivariable regression modeling. After adjusted multivariable analysis, T-Troc and T-inter scores were significantly lower in intertrochanteric/basi-cervical fractures compared to neck of femur fractures (P = 0.022 and P = 0.026, respectively). Both intertrochanteric/basi-cervical fractures (mean T.Tot -1.99) and neck of femur fractures (mean T.Tot -1.64) were not found to be associated with a mean T.tot less than -2.5. However, the mean aBMD scores were consistently less than -2.5 for both intertrochanteric/basi-cervical fractures and neck of femur fractures. Gender and calcium intake at the time of injury were associated with specific hip fracture patterns (P = 0.002 and P = 0.011, respectively). Hip fracture patterns following low energy trauma may be influenced by the pattern of reduced bone density in different areas of the hip. Intertrochanteric/basi-cervical fractures were associated with significantly lower T-Troc and T-Inter scores

  3. Influence of early postoperative complication on the operative results in elderly intertrochanteric fractured patients

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    Objective:Early complications were analyzed in those with Evans Ⅲ type of intertrochanteric fracture treated with operation or nonoperative approaches. Methods:59 cases with Evans Ⅲ type of intertrochanteric fracture between June, 1999 to July, 2006 were admitted in our department. 38 patients were complicated with cardiovascular diseases, such as hypertension and arrhythmia. All the cases were operated. Results:58 cases were operated successfully. One died of pulmonary interstitial fibrosis. Grade data of different age brackets indicated that early infective complications had apparent differences between the operation and the control group. Compared with the control group, the operation group had benefits such as fewer complications, especially the infective complications, and incidence of lower extremities venous thrombosis, and the results showed notable differences. Conclusion:In elderly patients with Evans Ⅲ type of intertrochanteric fracture, the incidence of pulmonary infection was the highest. Venous thrombosis in lower extremities was the most serious complication. So it will be helpful to perform the quadriceps femories function exercise. The postoperative effect is also related with the operation approach.

  4. Effects of Zoledronate on Mortality and Morbidity after Surgical Treatment of Hip Fractures

    Science.gov (United States)

    Cengiz, Ömer; Polat, Gökhan; Karademir, Gökhan; Tunç, Oytun Derya; Erdil, Mehmet; Tuncay, İbrahim; Şen, Cengiz

    2016-01-01

    We aimed to evaluate the effects of intertrochanteric femoral fractures on mortality, morbidity, and cost of zoledronate treatment in elderly patients treated by osteosynthesis. Based on Evans classification, 114 patients with unstable intertrochanteric femoral fractures were treated with osteosynthesis. After the surgical treatment of intertrochanteric fractures, the treatment group (M/F, 24/32; mean age, 76.7 ± SD years) received zoledronate infusion, and the control group (M/F, 20/38; mean age, 80.2 ± SD years) received placebo. Postoperative control visits were performed at 6-week, 3-month, 6-month, and 12-month time points. Functional level of patients was evaluated by the modified Harris hip score and Merle d'Aubigné hip score. By 12 months, the mean HHS in treatment and control groups was 81.93 and 72.9, respectively. For time of death of the patients, mortality was found to be 57.1% (16/28) on the first 3 months and 92.9% (26/28) on the first six months. The mortality rate in the treatment and control groups was 14.3% (8/56) and 34.5% (20/58), respectively. The use of zoledronic acid after surgical treatment of intertrochanteric femoral fractures in osteoporotic elderly patients is a safe treatment modality which helps to reduce mortality, improves functional outcomes, and has less side effects with single dose use per year. PMID:27092280

  5. Feasibility and Value of Radiographic Union Score Hip Fracture after Treatment with Intramedullary Nail of Stable Hip Fractures

    Science.gov (United States)

    Maiettini, Daniele; Bisaccia, Michele; Caraffa, Auro; Rinonapoli, Giuseppe; Piscitelli, Luigi; Bisaccia, Olga; Rollo, Giuseppe; Meccariello, Luigi; Ceccarini, Paolo; Rebonato, Alberto

    2016-01-01

    Introduction: Given the importance of fracture healing on patient outcome in clinical practice, it is critical to assess fracture healing. Aim: The aim of this study was to evaluate the feasibility of the Radiographic Union Score Hip fracture after treatment with intramedullary nail of stable hip fractures. Patients and Methods: We retrospectively collected the data from the clinical records of our institution of the 47 patientswho had undergone intertrochanteric hip fracture treatment using an intramedullary nail. Pain visual analogic score (VAS) was collected the same day that X-rays were taken. Plain hip X-rays were performed, in two radiographic views, at 40 and 90 days after the surgical procedure. The correlation between the RUSH and VAS score was evaluated. Results: Mean RUSH and VAS scores showed a strong statistical improvement between the 40 and 90 day follow-ups. RUSH value at 40 days fitted an inverse linear regression with VAS, p-value of 0.0063 and r2 of 0.15. At 90 days the regression between RUSH and VAS scores was not significant. Conclusion: RUSH could be proposed as an objective system to evaluate union in hip fractures treated with intramedullary nail. PMID:28077901

  6. Clinical Randomized Controlled Trials of Artificial Femoral Head Replacement and Dynamic Hip Screw Internal ;Fixation in Treatment of Senile Intertrochanteric Fracture%人工股骨头置换术与动力髋螺钉内固定术治疗老年转子间骨折的临床随机对照研究

    Institute of Scientific and Technical Information of China (English)

    汤岱; 李博

    2016-01-01

    目的:比较人工股骨头置换术与动力髋螺钉内固定术治疗老年转子间骨折的临床疗效,为临床选择合适的手术方式提供依据。方法选择符合标准的患者60例,按照入院先后顺序分为观察组和对照组各30例,观察组采用人工股骨头置换术,对照组采用动力髋螺钉内固定术,比较两者手术一般情况及术后髋关节恢复情况。结果两组患者伤后到手术时间差异无统计学意义(P>0.05);观察组患者手术时间、术中出血量及术后卧床时间均优于对照组,差异有统计学意义(P0.05);观察组髋关节功能优8例、良18例、中3例、差1例,优良率86.67%,对照组优3例、良17例、中4例、差6例,优良率为66.67%,差异有统计学意义( P0. 05);The operation time,intraoperative blood loss and postopera-tive bedrest time of the observation group were superior to the control group and there was significant difference in observation group compared to control group (P0. 05);The situation of hip joint function in ob-servation group was 8 excellent cases,18 good cases,3 medium cases and 1 poor case,the excellent and good rate was 86. 67%, while the control group was3,17,4,6,66. 67%respectively,the difference was statistically significant (P<0. 05). Conclusion Artificial femoral head replacement for senile in-tertrochanteric fracture has shorter operation time, less intraoperative blood loss, postoperative early weight bearing, low incidence of complications,and is beneficial to the hip joint function recovery.

  7. High mortality and poor morbidity after hip fracture in patients with previous vertebral fractures.

    Science.gov (United States)

    Ha, Yong-Chan; Baek, Ji-Hoon; Ko, Young-Bong; Park, Sang-Min; Song, Sang-Heon

    2015-09-01

    Although vertebral fracture in patients is a predictor of subsequent hip fracture, no study has assessed the mortality and functional outcome in hip fracture patients with previous vertebral fracture. Between September 2009 and December 2012, we evaluated 246 patients over 50-years-of-age diagnosed with femoral neck or intertrochanteric fractures who underwent surgery. The patients were categorized into two groups and two subgroups. Group Ia comprised 150 patients with previous vertebral fracture at the time of hip fracture. Group Ib comprised 96 patients with no vertebral fracture. Group IIa consisted of 76 patients fracture. Group IIb comprised 69 patients fracture. The mortality rate and functional outcome of osteoporotic hip fracture patients with and without vertebral fractures were compared. The cumulative mortality rate at 6 and 12 months post-fracture was 19 and 23 % in Group Ia and 6 and 7 % in Group Ib, respectively. In subgroup analysis, the cumulative mortality rate at 6 and 12 months was 13 and 17 % in Group IIa and 3 and 4 % in Group IIb, respectively. Shut-in patients at the final follow-up included 51 of 103 (49.5 %) patients in Group Ia and 19 of 83 (22.9 %) patients in Group Ib. In subgroup analysis, the shut-in patients included 18 of 58 (31.0 %) patients in Group IIa and 10 of 62 (16.1 %) patients in Group IIb. Previous vertebral fracture was associated with a poor functional outcome and increased mortality in patients with hip fracture.

  8. Social inequality and hip fracture

    DEFF Research Database (Denmark)

    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...

  9. Excess mortality following hip fracture

    DEFF Research Database (Denmark)

    Abrahamsen, B; van Staa, T; Ariely, R;

    2009-01-01

    Summary This systematic literature review has shown that patients experiencing hip fracture after low-impact trauma are at considerable excess risk for death compared with nonhip fracture/community control populations. The increased mortality risk may persist for several years thereafter, highlig...

  10. Knee-extension strength, postural control and function are related to fracture type and thigh edema in patients with hip fracture

    DEFF Research Database (Denmark)

    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...

  11. Effects of Hip Geometry on Fracture Patterns of Proximal Femur

    Directory of Open Access Journals (Sweden)

    Seyyed Morteza Kazemi

    2016-07-01

    Full Text Available Background: Some studies have previously shown that geometry of proximal femur can affect the probability of fracture and type of fracture. It happens since the geometry of the proximal femur determines how a force is applied to its different parts. In this study, we have compared proximal femur’s geometric characteristics in femoral neck (FNF, intertrochanteric (ITF and Subtrochanteric (STF fractures. Methods: In this study, 60 patients who had hip fractures were studied as case studies. They were divided into FNF, ITF and STF groups based on their fracture types (20 patients in each group. Patients were studied with x-ray radiography and CT scans. Radiological parameters including femoral neck length from lateral cortex to center of femoral head (FNL, diameter of femoral head (FHD, diameter of femoral neck (FND, femoral head neck offset (FHNO, neck-shaft angle (alpha, femoral neck anteversion (beta were measured and compared in all three groups. Results: Amount of FNL was significantly higher in STF group compared to FNF (0.011 while ITF and STF as well as FNT and ITF did not show a significant different. Also, FND in FNF group was significantly lower than the other two groups, i.e. ITF and STF. In other cases there were no instances of significant statistical difference. Conclusion: Hip geometry can be used to identify individuals who are at the risk of fracture with special pattern. Also, it is important to have more studies in different populations and more in men.

  12. Effects of Hip Geometry on Fracture Patterns of Proximal Femur

    Science.gov (United States)

    Kazemi, Seyyed Morteza; Qoreishy, Mohamad; Keipourfard, Ali; Sajjadi, Mohammadreza Minator; Shokraneh, Shahram

    2016-01-01

    Background: Some studies have previously shown that geometry of proximal femur can affect the probability of fracture and type of fracture. It happens since the geometry of the proximal femur determines how a force is applied to its different parts. In this study, we have compared proximal femur’s geometric characteristics in femoral neck (FNF), intertrochanteric (ITF) and Subtrochanteric (STF) fractures. Methods: In this study, 60 patients who had hip fractures were studied as case studies. They were divided into FNF, ITF and STF groups based on their fracture types (20 patients in each group). Patients were studied with x-ray radiography and CT scans. Radiological parameters including femoral neck length from lateral cortex to center of femoral head (FNL), diameter of femoral head (FHD), diameter of femoral neck (FND), femoral head neck offset (FHNO), neck-shaft angle (alpha), femoral neck anteversion (beta) were measured and compared in all three groups. Results: Amount of FNL was significantly higher in STF group compared to FNF (0.011) while ITF and STF as well as FNT and ITF did not show a significant different. Also, FND in FNF group was significantly lower than the other two groups, i.e. ITF and STF. In other cases there were no instances of significant statistical difference. Conclusion: Hip geometry can be used to identify individuals who are at the risk of fracture with special pattern. Also, it is important to have more studies in different populations and more in men. PMID:27517071

  13. [Meta-analysis of internal fixation versus hip replacement in the treatment of trochanteric fractures].

    Science.gov (United States)

    Dong, Jian-Bin; Wang, Zhi-Yong; Lu, Hao; Tian, Yuan; Wang, Xin-Rui; Zhang, Zhi-Qiang

    2015-03-01

    To compare the efficacy of internal fixation (including PFNA and PFN) versus hip replacement (including FHR or THA) in the treatment of trochanteric fractures in adults. Reports of studies using randomized controlled trials (RCT) to compare internal fixationg with hip replacement in the management of intertrochanteric fractures were retrieved (up to January 1, 2013) from the Cochrane Library, PUBMED Data, CNKI (China National Knowledge infrastructure), Elsevier, the Chinese Biomedical Database, Wanfang Data, and manually. Methodological quality of the trials was critically assessed, and relevant data were extracted. Statistical software RevMan 5.0 was used for data-analysis. Seven articles were included in the meta-analysis. The results showed that,compared internal fixation with hip replacement,there were statistical significance in the duration of surgery time [WMD = -2.66, 95% CI (-5.25,-0.06), P = 0.05], intra-operative blood loss [WMD = -24.20, 95% CI (-30.38, -18.02), P 0.05]. CON- CLUSION: Hip replacement (containing FHR or THA) for the treatment of intertrochanteric fractures is superior to internal fixa- tion in regards to the duration of surgery time, the mean duration of hosipital stays, mean post-operative down time, intra-opera- tive blood loss, the rate of post-operative good Harris scores. But there is not enough evidence to show any difference between hip replacement (containing THA or FHR) and internal fixation in regards to the rate of deep venous thrombosis. However, internal fixation for the treatment of intertrochanteric fractures is superior to hip replacement (containing FHR or THA) in regards to total complications rate.

  14. Infection in periprosthetic hip fractures.

    Science.gov (United States)

    Cabral, Rui

    2012-01-01

    Fracture around the acetabulum and femur in total hip arthroplasty is a possible complication, sometimes with difficult surgical solution, namely when a sepsis is present. Periprosthetic hip fractures were classified according to a modified Vancouver classification. We treated 112 patients (67 men and 45 women) with periprosthetic hip fractures: 105 femoral fractures (94%) and seven acetabular fractures (6%). Mean follow-up was 10.6 years. For Type A (seven cases - 7%), B1 (10 cases - 10%) or C (13 cases - 12%) fractures around well fixed femoral stems we only fixed the fractures. For Type B2 (17 cases - 16%), B3 (46 cases - 44%) and D (12 cases - 11%, with associated fractures, not contemplated in the Vancouver classification) we used an uncemented long femoral stem, fixation with metallic cables and cancellous bone allografts to fill the femoral bone loss. We observed a deep infection in three patients (2.7%), three early hip dislocations treated by closed reductions, two cases with asymptomatic trochanteric non-union and one femoral refracture. In the three infection cases we performed two-stage revision with cementless hip prosthesis, using an antibiotic-loaded cement hip spacer (three to eight months), a six weeks period of parenteral antibiotics and we performed articular aspiration before revision surgery. Until now, we did not observe any re-infection. It is very important to make an early diagnosis, isolate micro-organisms and ensure their antibiotic susceptibility. The surgery solution depends on the well fixed implants and periprosthetic osteolysis and articular instability.

  15. Preliminary effect of proximal femoral nail antirotation on emergency treatment of senile patients with intertrochanteric fracture

    Institute of Scientific and Technical Information of China (English)

    TANG Xin; LIU Lei; YANG Tian-fu; TU Chong-qi; WANG Guang-lin; FANG Yue; DUAN Hong; ZHANG Hui; PEI Fu-xing

    2010-01-01

    Objective: To retrospectively analyse the clinical outcome of emergency treatment of senile intertrochanteric fractures with proximal femoral nail antirotation (PFNA).Methods: From September 2008 to March 2009, 35 senile patients with intertrochanteric fracture, aged from 65 to 92 years with an average age of 76.5 years, were treated with PFNA within 24 hours after injury. There were 10 type Ⅰ fractures, 19 type Ⅱ and 6 type Ⅲ according to upgraded Evans-Jensen classification system. All patients were complicated with osteoporosis, and 19 patients had preexisting internal medical diseases. According to the rating scale of disease severity by the American Society of Anesthesiologists (ASA), there were 9 grade Ⅰ, 14 grade Ⅱ, 8 grade Ⅲ, and 4 grade Ⅳ.Results: The duration for operation ranged from 45 to 73 minutes with an average of 57.6 minutes. The volume of blood loss during operation ranged from 50 to 120 ml with an average of 77.5 ml. Patients could ambulate 2-4 days after operation (mean 3.5 days). Hospital stay was 4-7 days (mean 5.3 days). Full weight bearing time was 10-14 weeks (mean 12.8 weeks). During hospitalization period, there was no regional or deep infection, hypostatic pneumonia, urinary tract infection and bedsore except for 2 cases of urine retention. All cases were followed up with an average period of 12.3 months, and bone healing achieved within 15-18 weeks (mean 16.6 weeks). No complications such as delayed union, coxa vara or coxa valga, screw breakage or backout occurred and only 2 cases had trochanter bursitis because of thin body and overlong end of the antirotated nail. According to the Harris grading scale, the results were defined as excellent in 21 cases, good in 9 cases and fair in 5 cases, with the excellent and good rates of 85.7%.Conclusion: The emergency treatment of senile intertrochanteric fracture with proximal femoral nail antirotation has the advantages of minimal invasion, easy manipulation,less blood loss

  16. Pathogenesis of osteoporotic hip fractures.

    Science.gov (United States)

    McClung, Michael R

    2003-01-01

    Osteoporosis is characterized late in the course of the disease by an increased risk of fracture, particularly in the elderly. It occurs in both sexes, affecting approximately 8 million women and 2 million men aged > or = 50 years (1). While low bone density is a predictor of fractures, it is not the only determinant of fracture risk. Other factors include advanced age, altered bone quality, a personal or family history of falls, frailty, poor eyesight, debilitating diseases, and high bone turnover. A diet with sufficient calcium and vitamin D is important to minimize bone loss and, along with regular exercise, to maintain muscle strength. Bisphosphonates have been shown to reduce the risk of hip fracture. For elderly patients, the use of hip protectors may be used as a treatment of last resort. Regardless of the age of the patient, individual patient risk factors must be considered to target appropriate treatment and prevent fracture.

  17. Femoral Varus Osteotomy for Hip Instability after Traumatic Fracture Dislocations of the Hip Associated with Femoral Head Fractures: A Report of Two Cases

    Directory of Open Access Journals (Sweden)

    Shuichi Miyamoto

    2016-01-01

    Full Text Available Fracture of the femoral head and the acetabulum with traumatic dislocation of the hip is a severe injury representing various types and unfavorable outcome. We showed a 45-year-old man with Pipkin type-IV fracture and coxa valga. An immediate closed reduction was achieved followed by open reduction and internal fixation via a posterior approach 6 days later. However, dislocation occurred three times without traumatic events after three weeks. CT demonstrated no displacement of posterior fragments or implant failure. Femoral intertrochanteric varus osteotomy was performed to gain concentric stability and successfully resolved recurrent dislocation. Another 45-year-old woman with Pipkin type-IV fracture and coxa valga also underwent closed reduction initially and then continued conservative treatment. After eight weeks, when she started gait training, progressive pain became symptomatic. Persistent hip pain at weight bearing was not improved in spite of arthroscopic synovectomy and osteochondroplasty. Two years after injury, femoral intertrochanteric varus osteotomy was indicated and her refractory pain was resolved gradually. We suggest that femoral varus osteotomy should be considered for superolateral subluxation associated fracture dislocation of the hip in Pipkin type-IV and coxa valga.

  18. 应用锁定钢板治疗股骨转子间骨折%Treatment of intertrochanteric fracture with proximal femoral lock plate

    Institute of Scientific and Technical Information of China (English)

    李志洲; 徐衍斌; 王再欣; 于欣; 周凤吉; 季晓风

    2012-01-01

    Objective To evaluate retrospectively the effect for treatment of intertrochanteric comminuted fracture with lock plate. Methods A retrospective analysis was conduced to investigate 237 cases of intertrochanteric comminuted fracture which were treated with femoral lock plate from April 2007 to February 2010 , we evaluated the bone union time and hip function of the 210 patients whom were well followed up for average 12.5months (from 6 to 34months). Results This operation is easy to manage, with the advantage of stable fixation, the average union time was 21 weeks (range 12 to 32 weeks). Superficial vein thrombosis in 12 cases, decubitus ulcer in 3 cases, pneumonia in 4 cases, varus deformation in 2 cases were found, 10 patients were changed to hip arthroplasty surgery. The end results were 161 excellent, 18 good, based on Harris hip scale. Conclusion Excellent clinical effects can be achieved if the patients are treated correctly, femoral lock plate may be a better option for the treatment of intertrochanteric comminuted fracture.%目的 回顾分析锁定钢板治疗股骨转子间粉碎性骨折疗效.方法 2007 年4 月~ 2010年2月应用锁定钢板治疗237 例转子间粉碎性骨折患者,回顾分析其中210 例获得随访患者临床疗效,平均随访12.5 个月( 6~34月),观察骨折愈合时间,髋关节功能恢复情况.结果 平均骨折愈合时间21周(12~32 周),发生浅静脉血栓12例,褥疮3例,肺内感染4例,髋内翻2 例,改行人工关节置换10例.按照Harris 评分髋关节功能优161 例,良18 例,可19例,差12 例.结论 应用锁定钢板治疗转子间粉碎性骨折,手术操作简单,固定稳定,能够获得良好的临床疗效,是治疗转子间粉碎性骨折的较好选择.

  19. 骨质疏松高龄老人股骨粗隆间骨折 56例体会%Experience of senile intertrochanteric fracture caused by osteoporosis

    Institute of Scientific and Technical Information of China (English)

    石英杰; 李士春

    2003-01-01

    @@ INTRODUCTION Incidence of senile intertrochanteric fracture is increasing in present years and osteoporosis,diabetes,pulmonary diseases,cardiovascular diseases and other diseases are often complicated in senile patients,so the treatment is complicated.

  20. Comparative biomechanical study of reversed less invasive stabilization system and proximal femoral nail antirotation for unstable intertrochanteric fractures

    Institute of Scientific and Technical Information of China (English)

    Chen Ying; Liu Shouyao; Lin Peng; Wang Yunting; Wang Jinhui; Tao Jianfeng; Cai Rongrong

    2014-01-01

    Objective Unstable intertrochanteric fractures (ITFs) are mostly treated by proximal femoral nail antirotation (PFNA),Inter-Tan,Asian Hip,and other new internal fixation devices.But for complex unstable fractures,such as crushed lateral wall of the greater trochanter,the loss of fixation point on lateral wall slightly reduces the fixing effect.This study aimed to compare the biomechanical strengths between reversed less invasive stabilization system (LISS) and PFNA for treatment of unstable ITFs.Methods Forty synthetic femurs were used to simulate unstable ITFs in vitro and were fixed using the reversed LISS or PFNA.These fractures were divided into two groups depending on whether the lateral wall of the greater trochanter is intact or not (AO classification:31-A2.3 and 31-A3.3,respectively).The load-displacement of femur,stiffness,ultimate load,and cyclic fatigue resistance were detected using an incremental load test and a dynamic fatigue test through an MTS 858 test system.Results For both 31-A2.3 and 31-A3.3,the vertical sinking displacement (VSD) of the femoral head under 500 N load was insignificantly smaller after treatment with reversed LISS than with PFNA,and when the displacement was 5 mm,the femoral head bore insignificantly greater load.The fixation with reversed LISS resulted in greater axial stiffness of the femur but smaller ultimate load.During the same cycle in the dynamic fatigue test,the VSD was insignificantly smaller with the fixation of reversed LISS.Conclusion Reversed LISS and PFNA have similar biomechanical strength for unstable ITFs.This conclusion should be supported by additional large-size research on basic biomechanics and clinical application.This is the first comparative biomechanical study comparing reversed LISS and PFNA for unstable ITFs.

  1. Cephalomedullary fixation for femoral neck/intertrochanteric and ipsilateral shaft fractures: surgical tips and pitfalls

    Institute of Scientific and Technical Information of China (English)

    Kamal Bali; Nitesh Gahlot; Sameer Aggarwal; Vijay Goni

    2013-01-01

    Objective:Surgical management options for femoral shaft fracture and ipsilateral proximal femur fracture vary from single-implant to double-implant fixation.Cephalomedullary fixation in such fractures has relative advantages over other techniques especially because of less soft tissue dissection and immediate postoperative weight beating with accelerated rehabilitation.However,the surgery is technically demanding and there is a paucity of literature describing the surgical techniques for this fixation.The aim of the study was to describe the surgical technique of cephalomedullary fixation for femoral shaft fracture and ipsilateral proximal femur fracture.Methods:Sixteen cases (10 males and 6 females with a mean age of 41.8 years) ofipsilateral proximal femur and shaft fractures were treated by single-stage cephalomedullary fixation at tertiary level trauma center in northern India.The fractures were classified according to AO classification.An intraoperative record of duration of surgery as well as technical challenges unique to each fracture pattern was kept for all the patients.ResuRs:The most common proximal femoral pattern was AO B2.1 observed in 9 of our patients.The AO B2.3 fractures were seen in 4 patients while the AO A1.2 fractures in 3 patients.Four of the AO B2.1 and 2 of the AO B2.3 fractures required open reduction with Watson-Jones approach.The mean operative time was around 78 minutes,which tended to decrease as the surgical experience increased.There was only one case of malreduction,which required revision surgery.Conclusion:Combination of ipsilateral femoral shaft fracture and neck/intertrochanteric fracture is a difficult fracture pattern for trauma surgeons.Cephalomedullary nail is an excellent implant for such fractures but it requires careful insertion to avoid complications.Surgery is technically demanding with a definite learning curve.Nevertheless,a majority of these fractures can be surgically managed by singleimplant cephaiomedullary

  2. A CLINICAL STUDY OF PROXIMAL FEMUR LOCKING COMPRESSION PLATE (LCP - PF IN THE MANAGEMENT OF COMMUNITED INTERTROCHANTERIC AND SUBTROCHANTERIC FRACTURES OF THE FEMUR

    Directory of Open Access Journals (Sweden)

    Hari Babu

    2015-10-01

    Full Text Available Fractures of proximal femur and hip are relatively common injuries in elderly individuals . The incidence of peritrochanteric and intertrochanteric fracture is also increasing among young population, who sustain high energy trauma Rigid Internal fixation and early mobilization has been the standard method of treatment. A combination of orthopaedic surgery and early postoperative physiotherapy and ambulation is the best approach. The overall goal in the treatment of hip fractures is to return the patient to pre - morbid level of function. AIMS & OBJECTIVE : To analyse the anatomical and f unctional outcome of the treatment with LCP - Proximal femur. METHODOLOGY : The present study consists of 12 adult patients of peritrochanteric factures of femur satisfying the inclusion criteria , treated with Proximal Femoral Locking Compression Plate at S. V. R. R . Govt . General Hospital, Tirupati during the period of nov 2013 to Oct 2015. INCLUSION CRITERIA : Age >18years , comminuted trochanteric and sub trochanteric fractures , Signed written informed consent . EXCLUSION CRITERIA: Inter trochanteric fractures involving piriformis fossa , Compound fractures . Pathological fractures . Any displacement of a femoral neck fracture . A ssociated malignancy. RESULTS : Average age incidence in the present study was 62.7 years. , Predominantly males (75% were affected. , Most cases occurred after a fall 10 (50% cases which was statistically significant , Right side involvement was more common. , Average post - operative stay was 13.5 days. , Out of the 12 cases, evaluated using Salvati - Wilson scoring : 3 cases (25% had good, 8 cases (66.67% fair, 1 case (8.33% had poor score , Average weight bearing time was14.5 weeks , Average union rate was 19.45 weeks.

  3. Reduced cortical bone compositional heterogeneity with bisphosphonate treatment in postmenopausal women with intertrochanteric and subtrochanteric fractures.

    Science.gov (United States)

    Donnelly, Eve; Meredith, Dennis S; Nguyen, Joseph T; Gladnick, Brian P; Rebolledo, Brian J; Shaffer, Andre D; Lorich, Dean G; Lane, Joseph M; Boskey, Adele L

    2012-03-01

    Reduction of bone turnover with bisphosphonate treatment alters bone mineral and matrix properties. Our objective was to investigate the effect of bisphosphonate treatment on bone tissue properties near fragility fracture sites in the proximal femur in postmenopausal women with osteoporosis. The mineral and collagen properties of corticocancellous biopsies from the proximal femur were compared in bisphosphonate-naive (-BIS, n = 20) and bisphosphonate-treated (+BIS, n = 20, duration 7 ± 5 years) patients with intertrochanteric (IT) and subtrochanteric (ST) fractures using Fourier transform infrared imaging (FTIRI). The mean values of the FTIRI parameter distributions were similar across groups, but the widths of the parameter distributions tended to be reduced in the +BIS group relative to the -BIS group. Specifically, the widths of the cortical collagen maturity and crystallinity were reduced in the +BIS group relative to those of the -BIS group by 28% (+BIS 0.45 ± 0.18 versus -BIS 0.63 ± 0.28, p = 0.03) and 17% (+BIS 0.087 ± 0.012 versus -BIS 0.104 ± 0.036, p = 0.05), respectively. When the tissue properties were examined as a function of fracture morphology within the +BIS group, the FTIR parameters were generally similar regardless of fracture morphology. However, the cortical mineral:matrix ratio was 8% greater in tissue from patients with atypical ST fractures (n = 6) than that of patients with typical (IT or spiral ST) fractures (n = 14) (Atypical 5.6 ± 0.3 versus Typical 5.2 ± 0.5, p = 0.03). Thus, although the mean values of the FTIR properties were similar in both groups, the tissue in bisphosphonate-treated patients had a more uniform composition than that of bisphosphonate-naive patients. The observed reductions in mineral and matrix heterogeneity may diminish tissue-level toughening mechanisms.

  4. Correlation of hip fracture with other fracture types: Toward a rational composite hip fracture endpoint.

    Science.gov (United States)

    Colón-Emeric, Cathleen; Pieper, Carl F; Grubber, Janet; Van Scoyoc, Lynn; Schnell, Merritt L; Van Houtven, Courtney Harold; Pearson, Megan; Lafleur, Joanne; Lyles, Kenneth W; Adler, Robert A

    2015-12-01

    With ethical requirements to the enrollment of lower risk subjects, osteoporosis trials are underpowered to detect reduction in hip fractures. Different skeletal sites have different levels of fracture risk and response to treatment. We sought to identify fracture sites which cluster with hip fracture at higher than expected frequency; if these sites respond to treatment similarly, then a composite fracture endpoint could provide a better estimate of hip fracture reduction. Cohort study using Veterans Affairs and Medicare administrative data. Male Veterans (n=5,036,536) aged 50-99 years receiving VA primary care between 1999 and 2009 were included. Fractures were ascertained using ICD9 and CPT codes and classified by skeletal site. Pearson correlation coefficients, logistic regression and kappa statistics were used to describe the correlation between each fracture type and hip fracture within individuals, without regard to the timing of the events. 595,579 (11.8%) men suffered 1 or more fractures and 179,597 (3.6%) suffered 2 or more fractures during the time under study. Of those with one or more fractures, the rib was the most common site (29%), followed by spine (22%), hip (21%) and femur (20%). The fracture types most highly correlated with hip fracture were pelvic/acetabular (Pearson correlation coefficient 0.25, pfractures cluster with hip fractures within individuals at greater than expected frequency. If we observe similar treatment risk reductions within that cluster, subsequent trials could consider the use of a composite endpoint to better estimate hip fracture risk. Published by Elsevier Inc.

  5. Routine functional assessment for hip fracture patients

    DEFF Research Database (Denmark)

    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. Comparison and analysis of reoperations in two different treatment protocols for trochanteric hip fractures - postoperative technical complications with dynamic hip screw, intramedullary nail and Medoff sliding plate.

    Science.gov (United States)

    Paulsson, Johnny; Stig, Josefine Corin; Olsson, Ola

    2017-08-24

    In treatment of unstable trochanteric fractures dynamic hip screw and Medoff sliding plate devices are designed to allow secondary fracture impaction, whereas intramedullary nails aim to maintain fracture alignment. Different treatment protocols are used by two similar Swedish regional emergency care hospitals. Dynamic hip screw is used for fractures considered as stable within the respective treatment protocol, whereas one treatment protocol (Medoff sliding plate/dynamic hip screw) uses biaxial Medoff sliding plate for unstable pertrochanteric fractures and uniaxial Medoff sliding plate for subtrochanteric fractures, the second (intramedullary nail/dynamic hip screw) uses intramedullary nail for subtrochanteric fractures and for pertrochanteric fractures with intertrochanteric comminution or subtrochanteric extension. All orthopedic surgeries are registered in a regional database. All consecutive trochanteric fracture operations during 2011-2012 (n = 856) and subsequent technical reoperations (n = 40) were derived from the database. Reoperations were analysed and classified into the categories adjustment (percutaneous removal of the locking screw of the Medoff sliding plate or the intramedullary nail, followed by fracture healing) or minor, intermediate (reosteosynthesis) or major (hip joint replacement, Girdlestone or persistent nonunion) technical complications. The relative risk of intermediate or major technical complications was 4.2 (1.2-14) times higher in unstable pertrochanteric fractures and 4.6 (1.1-19) times higher in subtrochanteric fractures with treatment protocol: intramedullary nail/dynamic hip screw, compared to treatment protocol: Medoff sliding plate/dynamic hip screw. Overall rates of intermediate and major technical complications in unstable pertrochanteric and subtrochanteric fractures were with biaxial Medoff sliding plate 0.68%, with uniaxial Medoff sliding plate 1.4%, with dynamic hip screw 3.4% and with intramedullary nail 7.2%. The

  7. Clinical efficacy of locking compression plate fixation in treatment of femoral intertrochanteric fracture%锁定加压钢板治疗股骨转子间骨折21例临床分析

    Institute of Scientific and Technical Information of China (English)

    杨岭; 聂磊; 孙湖山

    2012-01-01

    Objective: To investigate the effects of locking compression plate fixation in treatment of intertrochanteric fracture. Methods: Twenty-one cases with femoral intertrochanteric fracture were treated with locking compression plate fixation. Results: The fractures of all cases were recovered after 3-6 months. The complications of nails breakage and internal fixation loosening were not found. The function recovery of hip joint were good and no clear lower limb shortening deformity. Excellent and good effects in 13 and 8 cases were confirmed according to Harris standard. Conclusions: Treatmment of femoral intertrochanteric fracture with locking compression plate fixation is easy to install and fix, which is an effective method of operation with shorter operative time, less bleeding and goog hip joint function recovery.%目的:观察锁定加压钢板治疗股骨转子间骨折的疗效.方法:应用锁定加压钢板治疗股骨转子间骨折21例.结果:21例患者3~ 6个月骨折均愈合,未出现断钉、内固定松动等并发症,无明显髋内翻和下肢短缩畸形;Harris评分为优11例,良8例,可2例.结论:锁定加压钢板治疗股骨转子间骨折具有容易安装、固定可靠、手术时间短、出血量少、髋关节功能恢复优良率高等特点,是一种有效的手术方法.

  8. Influence of Regional Difference in Bone Mineral Density on Hip Fracture Site in Elderly Females by Finite Element Analysis.

    Science.gov (United States)

    Lin, Z L; Li, P F; Pang, Z H; Zheng, X H; Huang, F; Xu, H H; Li, Q L

    2015-11-01

    Hip fracture is a kind of osteoporotic fractures in elderly patients. Its important monitoring indicator is to measure bone mineral density (BMD) using DXA. The stress characteristics and material distribution in different parts of the bones can be well simulated by three-dimensional finite element analysis. Our previous studies have demonstrated a linear positive correlation between clinical BMD and the density of three-dimensional finite element model of the femur. However, the correlation between the density variation between intertrochanteric region and collum femoris region of the model and the fracture site has not been studied yet. The present study intends to investigate whether the regional difference in the density of three-dimensional finite element model of the femur can be used to predict hip fracture site in elderly females. The CT data of both hip joints were collected from 16 cases of elderly female patients with hip fractures. Mimics 15.01 software was used to reconstruct the model of proximal femur on the healthy side. Ten kinds of material properties were assigned. In Abaqus 6.12 software, the collum femoris region and intertrochanteric region were, respectively, drawn for calculating the corresponding regional density of the model, followed by prediction of hip fracture site and final comparison with factual fracture site. The intertrochanteric region/collum femoris region density was [(1.20 ± 0.02) × 10(6)] on the fracture site and [(1.22 ± 0.03) × 10(6)] on the non-fracture site, and the difference was statistically significant (P = 0.03). Among 16 established models of proximal femur on the healthy side, 14 models were consistent with the actual fracture sites, one model was inconsistent, and one model was unpredictable, with the coincidence rate of 87.5 %. The intertrochanteric region or collum femoris region with lower BMD is more prone to hip fracture of the type on the corresponding site.

  9. Economic viability of geriatric hip fracture centers.

    Science.gov (United States)

    Clement, R Carter; Ahn, Jaimo; Mehta, Samir; Bernstein, Joseph

    2013-12-01

    Management of geriatric hip fractures in a protocol-driven center can improve outcomes and reduce costs. Nonetheless, this approach has not spread as broadly as the effectiveness data would imply. One possible explanation is that operating such a center is not perceived as financially worthwhile. To assess the economic viability of dedicated hip fracture centers, the authors built a financial model to estimate profit as a function of costs, reimbursement, and patient volume in 3 settings: an average US hip fracture program, a highly efficient center, and an academic hospital without a specific hip fracture program. Results were tested with sensitivity analysis. A local market analysis was conducted to assess the feasibility of supporting profitable hip fracture centers. The results demonstrate that hip fracture treatment only becomes profitable when the annual caseload exceeds approximately 72, assuming costs characteristic of a typical US hip fracture program. The threshold of profitability is 49 cases per year for high-efficiency hip fracture centers and 151 for the urban academic hospital under review. The largest determinant of profit is reimbursement, followed by costs and volume. In the authors’ home market, 168 hospitals offer hip fracture care, yet 85% fall below the 72-case threshold. Hip fracture centers can be highly profitable through low costs and, especially, high revenues. However, most hospitals likely lose money by offering hip fracture care due to inadequate volume. Thus, both large and small facilities would benefit financially from the consolidation of hip fracture care at dedicated hip fracture centers. Typical US cities have adequate volume to support several such centers.

  10. Facts and fiction in hip fracture treatment

    NARCIS (Netherlands)

    Embden, Daphne van

    2016-01-01

    As the number of hip fracture patients has increased dramatically over the years, the need for high quality, multidisciplinary and patient centred fracture treatment continues to grow. The first aim of this thesis is to provide better understanding of fracture patterns and classification in hip

  11. 高龄老人股骨粗隆间骨折手术前后的康复指导%Preoperative and postoperative rehabilitation guide to senile patients with intertrochanteric femoral fracture

    Institute of Scientific and Technical Information of China (English)

    2002-01-01

    @@ Along with social aging, incidence of senile intertrochanteric femoral fracture increases.We treated 106 cases of intertrochanteric femoral fracture from January 1988 to August 1999.In these cases, 46 cases received closed reduction DHS internal fixation therapy and gained good effects.

  12. sign hip construct: achieving hip fracture fixation without using an ...

    African Journals Online (AJOL)

    Objective: The aim of this study was to assess outcomes of using the SIGN Hip Construct (SHC) to achieve ... The majority (76%) of patients were ambulatory within. 3 days after the surgery. ... Conclusion: Using the SIGN Hip Construct, hip fracture fixation can be ... elderly has made stable reduction and internal fixation.

  13. Treatment of unstable femoral intertrochanteric fractures with locking proximal femoral plate%锁定接骨板治疗不稳定性股骨转子间骨折

    Institute of Scientific and Technical Information of China (English)

    侯振海; 施建国; 姚远; 叶虹; 郑隆宝; 倪志明; 姚军

    2009-01-01

    Objective To investigate the efficacy of locking proximal femoral plate (LPFP) in treatment of unstable femoral intertrochanteric fractures. Methods A total of 32 patients with unstable femoral intertrochanteric fractures were operated via Watson-Jones approach. According to the Evans classification, there were 16 patients with type Ⅲ fractures, 10 with type Ⅳ fractures and 6 with type Ⅴ fractures. The data of bone healing time and hip function scores according to Harris hip function score system were recorded for evaluating treatment outcomes. Results All the patients were followed up for an average 12.5 months, which showed fracture union within mean 10.4 weeks. There were no hip varus deformation, internal fixation failure and avaacular necrosis of femoral head, with total excellence rate of 84% according to Harris hip function score system. Conclusions LPFP is characterized by correspondence with configuration of proximal femur, stable fixation, less disturb to blood supply of femoral head, and hence is an effective treatment method for unstable femoral intertrochanteric fractures.%目的 总结股骨近端锁定接骨板(locking proximal femoral plate,LPFP)治疗不稳定性股骨转子间骨折的临床疗效. 方法股骨不稳定性转子间骨折32例,根据Evans分型:Ⅲ型16例,Ⅳ型10例,Ⅴ型6例.采用LPFP固定.观察骨折愈合情况,参照Harris髋关节评分系统评定术后患髋功能. 结果全部32例患者获得平均12.5个月随访,所有骨折均愈合.无髋内翻及内固定失败,无股骨头缺血性坏死.按Harris髋关节评分标准:优良率84%. 结论 LPFP具有符合股骨近端解剖形态、固定牢靠、对股骨头血供干扰小等优点,是一种较好的固定不稳定性股骨转子间骨折的内置物.

  14. [Intramedullary osteosynthesis in treating intertrochanteric fracture of the femur, based on our own experience using Gamma nails and Ender rods].

    Science.gov (United States)

    Bednarenko, Marcin; Kotela, Ireneusz; Zieńzuk, Witold; Korzec, Artur

    2008-01-01

    Intertrochanteric fractures have always posed an interdisciplinary medical problem. Most frequently it happens between 7th and 8th decades of life. The majority of them are due to osteoporosis. Both for a medical doctor and surgeon they face quite a challenge when it comes to treating a patient with a fracture of the proximal epiphysis of the femur. Recently, the outcome of the fracture treatment has improved greatly due to introduction of modern methods of intramedullary and periosteal fusion. In this study we present a possible utilization of Gamma nails, its advantages and disadvantages compared with the stabilisation achieved using Ender rods. We analyzed the outcome of treatment of 198 patients treated for intertrochanteric fractures of the femur. We present advantages and disadvantages of both methods of stabilization. We stress the importance of the correct reduction of the bone even if requiring opening. We also point to difficulties that accompany both types of stabilization. The final results reveal a considerably better outcome in patients treated using Gamma nails, especially if fractures were instable.

  15. Treatment of ipsilateral hip and femoral shaft fractures with reconstructive intramedullary interlocking nail

    Institute of Scientific and Technical Information of China (English)

    吴立东; 吴琼华; 严世贵; 潘志军

    2004-01-01

    Objective: To evaluate the results of reconstructive intramedullary interlocking nail in the treatment of ipsilateral hip and femoral shaft fractures. Methods: From August 1997 to November 2001, 13 patients were treated with the reconstructive intramedullary interlocking nail. Nine patients were associated with ipsilateral femoral neck fractures, three with ipsilateral intertrochanteric fractures, and one with subtrochanteric fracture. Results: The follow-up time was from 6 to 38 months with an average of 14 months. All the femoral shaft and hip fractures healed up well. There was no nonunion of the femoral neck, and only one varus malunion. No patient had avascular necrosis of the femoral head. The average healing time for femoral neck fracture was 4.6 months and for shaft fracture 5.8 months. The joint movement and other functions were fairly resumed. Conclusions: The reconstructive intramedullary interlocking nail, with less trauma, reliable fixation, and high rate of fracture healing, is an ideal method of choice in the treatment of ipsilateral hip and femoral shaft fractures.

  16. Hip fracture in hospitalized medical patients

    Directory of Open Access Journals (Sweden)

    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.

  17. Hip fracture: diagnosis, treatment, and secondary prevention.

    Science.gov (United States)

    LeBlanc, Kim Edward; Muncie, Herbert L; LeBlanc, Leanne L

    2014-06-15

    Hip fractures cause significant morbidity and are associated with increased mortality. Women experience 80% of hip fractures, and the average age of persons who have a hip fracture is 80 years. Most hip fractures are associated with a fall, although other risk factors include decreased bone mineral density, reduced level of activity, and chronic medication use. Patients with hip fractures have pain in the groin and are unable to bear weight on the affected extremity. During the physical examination, displaced fractures present with external rotation and abduction, and the leg will appear shortened. Plain radiography with cross-table lateral view of the hip and anteroposterior view of the pelvis usually confirms the diagnosis. If an occult hip fracture is suspected and plain radiography is normal, magnetic resonance imaging should be ordered. Most fractures are treated surgically unless the patient has significant comorbidities or reduced life expectancy. The consulting orthopedic surgeon will choose the surgical procedure. Patients should receive prophylactic antibiotics, particularly against Staphylococcus aureus, before surgery. In addition, patients should receive thromboembolic prophylaxis, preferably with low-molecular-weight heparin. Rehabilitation is critical to long-term recovery. Unless contraindicated, bisphosphonate therapy should be used to reduce the risk of another hip fracture. Some patients may benefit from a fall-prevention assessment.

  18. Treatment of intertrochanteric fractures of the femur withL.trapezoid compression plate and its mechanicalprinciples

    Institute of Scientific and Technical Information of China (English)

    2000-01-01

    Objective: To improve the results of the treatment of unstable types of intertrochanteric fractures of the femur (ITFF) by internal fixation. Methods: A L-trapezoid compression plate system (L-TCP) was designed and compared to the AO/ASIF angle plates of 95° and 130° (L-AP) with mechanical tests. An Evans Type Ⅲ model was made, the simulation electrical test with loading on single and both legs were done. The results demonstrated that the stability of the L-TCP fixation was significantly greater, and the stress concentration at the upper screw hole was relevantly smaller than that of L-AP. From June 1986 to June 1998, 82 patients of ITFF were treated with L-TCP fixation. The average age was 67.4 years old (26-91). Seventy-four of those fractures were unstable. Fifty-eight patients were treated with open reduction, and 24 cases were treated by closed reduction and limited open (only lateral aspect of upper femur was exposed) fixation with L-TCP under X-ray monitoring. Results: Sixty-six patients were followed up for 6-69months. Complications, including 3 wound infection, 1 non-union, 3 coxa varus and 2 implant breakage (9complications of 7 cases ), all occurred in the open reduction group. No complication was found in the dosed reduction group. Conclusions: In the treatment of ITFF, the results of closed reduction and limited open fixation with L-TCP is significantly better than that of open reduction and fully exposed fixation.

  19. Pressure ulcer risk in hip fracture patients

    NARCIS (Netherlands)

    Houwing, RH; Rozendaal, M; Wouters-Wesseling, W; Buskens, E; Keller, P; Haalboom, JRE

    2004-01-01

    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 wer

  20. Pressure ulcer risk in hip fracture patients

    NARCIS (Netherlands)

    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

  1. Progress of Surgical Treatment for Intertrochanteric Fracture of Femur%股骨粗隆间骨折的手术治疗进展

    Institute of Scientific and Technical Information of China (English)

    王文权

    2013-01-01

    股骨粗隆间骨折(IFF)是临床常见的髋部骨折,多见于老年人,治疗不当易引起髋内翻畸形,甚至严重影响行走.IFF的治疗有非手术和手术治疗两种方式,非手术治疗卧床时间长、并发症多、病死率高,目前应用已很少;手术治疗方法多,应用器械多,各有优缺点.该文从手术治疗的不同方法、器械阐述其优缺点及适应证,为临床IFF的手术治疗提供参考.%Intertrochanteric femoral fracturet( IFF ) is a common hip fracture in clinical, mostly seen in the elders,hip inward deformity can be caused if the treatment is not proper, which may even influence the walking ability in serious cases. IFF has nonoperative treatment and surgical treatment. At present the nonop-erative treatment application is very few due to the long time in bed, much complications, and high mortality; while there are various surgical treatments applying different devices, each with unique advantages and disadvantages. Here is to make a review on the pros and cons and indications of different surgical methods and devices, to provide references for the IFF surgery.

  2. Factors Affecting Postsurgery Hip Fracture Recovery

    Directory of Open Access Journals (Sweden)

    Sydney Wallace

    2014-12-01

    Full Text Available After hip fracture surgery, patients seldom return to their prefracture functional state and there is a 43% rate of mortality and institutionalisation of postsurgery hip fracture patients. A systematic literature review was conducted to identify preoperative, perioperative, postoperative, and psychosocial factors that may hinder postsurgery hip fracture patients from returning to previous functionality. Factors that were identified as being associated with postsurgical outcomes were age, muscle strength, prefracture living arrangements, number of daily medications taken, oxygen levels, fracture type and location, haemoglobin (Hb level, wait time prior to surgery, length of hospital stay (LOS, and dementia or depression.

  3. 人工股骨头置换术治疗老年人股骨粗隆间骨折疗效观察%Observation on the effect of prosthetic replacement for the management of intertrochanteric fractures in olderly patients

    Institute of Scientific and Technical Information of China (English)

    方成; 王怀波; 江涛; 李一奇

    2013-01-01

    目的 探讨人工股骨头置换术治疗老年股骨粗隆间骨折的方法与疗效.方法 应用人工股骨头置换治疗老年股骨粗隆间骨折24例.骨折按Evans分型,Ⅱ型4例,Ⅲ型16例,Ⅳ型4例.结果 24例患者术后平均下床时间为(6.0±2.2)d.随访6~27个月,平均12个月,无假体松动、感染.髋关节功能按Harris评分优良率为83.3%.结论 人工股骨头置换是治疗老年人股骨粗隆间骨折的有效手段,可明显减少卧床时间及并发症的发生.%Objective To explore the method and effect of prosthetic replacement for the management of intertrochanteric fracture in the elderly.Methods 24 elderly patients with intertrochanteric fracture were treated with prosthetic replacement.According to the Evans classification,there were 4 cases of Evans Ⅱ,16 Evans Ⅲ and 4 Evans Ⅳ.Results The mean time to ambulation following the surgery was (6.0 ± 2.2) days.No prosthetic loosening or infection were observed in the follow-up of 6 to 27 months(average 12 months).According to the Harris hip score,the excellent and good rate was 83.3%.Conclusion Prosthetic replacement is safe and effective for intertrochanteric fractures in elderly patients,which allows early ambulation and have a relatively low rate of complications.

  4. Comparison of hip geometry, strength, and estimated fracture risk in women with anorexia nervosa and overweight/obese women.

    Science.gov (United States)

    Bachmann, Katherine Neubecker; Fazeli, Pouneh K; Lawson, Elizabeth A; Russell, Brian M; Riccio, Ariana D; Meenaghan, Erinne; Gerweck, Anu V; Eddy, Kamryn; Holmes, Tara; Goldstein, Mark; Weigel, Thomas; Ebrahimi, Seda; Mickley, Diane; Gleysteen, Suzanne; Bredella, Miriam A; Klibanski, Anne; Miller, Karen K

    2014-12-01

    Data suggest that anorexia nervosa (AN) and obesity are complicated by elevated fracture risk, but skeletal site-specific data are lacking. Traditional bone mineral density (BMD) measurements are unsatisfactory at both weight extremes. Hip structural analysis (HSA) uses dual-energy X-ray absorptiometry data to estimate hip geometry and femoral strength. Factor of risk (φ) is the ratio of force applied to the hip from a fall with respect to femoral strength; higher values indicate higher hip fracture risk. The objective of the study was to investigate hip fracture risk in AN and overweight/obese women. This was a cross-sectional study. The study was conducted at a Clinical Research Center. PATIENTS included 368 women (aged 19-45 y): 246 AN, 53 overweight/obese, and 69 lean controls. HSA-derived femoral geometry, peak factor of risk for hip fracture, and factor of risk for hip fracture attenuated by trochanteric soft tissue (φ(attenuated)) were measured. Most HSA-derived parameters were impaired in AN and superior in obese/overweight women vs controls at the narrow neck, intertrochanteric, and femoral shaft (P ≤ .03). The φ(attenuated) was highest in AN and lowest in overweight/obese women (P fractures. Femoral geometry by HSA, hip BMD, and factor of risk for hip fracture attenuated by soft tissue are impaired in AN and superior in obesity, suggesting higher and lower hip fracture risk, respectively. Only attenuated factor of risk was associated with fragility fracture prevalence, suggesting that variability in soft tissue padding may help explain site-specific fracture risk not captured by BMD.

  5. Proximal femoral nail versus hemiarthroplasty for senile intertrochanteric fractures%PFN钉置入内固定与人工股骨头置换治疗高龄股骨转子间骨折的比较

    Institute of Scientific and Technical Information of China (English)

    邓海源

    2011-01-01

    ,bloodless volume, function of hip joint and complication were compared between PFNG and HEMG groups.RESULTS AND CONCLUSION: All operations of open reduction and internal fixation to intertrochanteric fractures in 62 cases of patients succeeded. ①Operative time was not remarkably different between PFNG and HEMG (P > 0.05). ②Bleeding volume,blood transfusion volume and time of getting out of bed was different (P < 0.05), which showed that operation wound was bigger in HEMG, but time of postoperative recovery was preponderant to PFNG.③Incidence rate of medical complications and deformities of the hip joint was different between PFNG and HEMG, which showed that HEMG was preponderant to PFNG in preventing postoperative medical complications and deformities of the hip joint. ④Harris score showed activity of hip joint in the near future in HEMG was preponderant to that in PFNG.

  6. Artificial Femoral Head Replacement in Treatment of 36 Patients with Osteoporotic Femoral Intertrochanteric Fracture%人工股骨头置换治疗骨质疏松性股骨粗隆间骨折36例

    Institute of Scientific and Technical Information of China (English)

    桑晓文; 杨利学; 谭龙旺; 孙智平; 张快强

    2014-01-01

    目的观察人工股骨头置换治疗骨质疏松性股骨粗隆间骨折的临床效果。方法对2008年1月-2013年6月收治的36例骨质疏松性股骨粗隆间骨折行加长柄双极骨水泥人工股骨头置换术,术后常规予鲑鱼降钙素联合钙剂抗骨质疏松治疗。结果术后Harris关节功能评分平均88分(68~94分),其中优18例,良13例,可4例,差1例,优良率为86.1%。2例术后活动后出现髋部轻度疼痛,1例下肢深静脉栓塞;本组均无髋关节脱位、假体周围再骨折、假体松动及下陷、大小粗隆骨折不愈合等并发症发生。结论人工股骨头置换术治疗骨质疏松性股骨粗隆间骨折可减少力学及内固定相关风险,且并发症少,效果良好。%Objective To observe the effect of artificial femoral head replacement in treatment of osteoporotic femoral inter-trochanteric fracture. Methods A total of 36 inpatients with osteoporotic femoral intertrochanteric fracture underwent long-stem ce-mented artificial femoral head replacement during January 2008 and June 2013, and routine salmon calcitonin combined with calcium of anti osteoporosis treatment was performed after operations. Results The postoperative Harris hip score was 88 (68-94), which included excellent in 18 cases, good in 13 cases, common in 4 cases and poor in 1 case, and the excellent and good rate was 86.1%. Two patients had postoperative hip mild pain after activity, and one patient had deep vein thrombosis of lower extremity, but there were no complications such as dislocation of hip joint, periprosthetic fracture, prosthesis loosening, subsidence and greater trochanteric fracture nonunion. Conclusion Artificial femoral head replacement in treatment of osteoporotic femoral intertrochanter-ic fracture can reduce the risks of mechanics and internal fixation with fewer complications and better effect.

  7. A simple technique to position patients with bilateral above-knee amputations for operative fixation of intertrochanteric fractures of the femur: a case report

    OpenAIRE

    Dramis Asterios; Desai Aravind; Aqil Adeel; Hossain Saqif

    2010-01-01

    Abstract Introduction Intertrochanteric fractures of the femur are common fractures in the elderly, and management includes operative fixation after patient positioning on the fracture table. Patients with bilateral above-knee amputations are challenging in terms of positioning on the table. We describe a simple technique to overcome this special problem. Case presentation A 75-year-old wheelchair-bound Caucasian man with bilateral above-knee amputations presented to our hospital after a fall...

  8. 股骨近端螺旋刀片抗旋髓内钉(PFNA)手术治疗中老年股骨转子间骨折48例体会%Clinical Effective Analysis of Treatment of Intertrochanteric Fractures with PFNA in 48 Middle and Aged Cases

    Institute of Scientific and Technical Information of China (English)

    鲁怡然; 梁朝革; 岳雄

    2013-01-01

    目的:总结股骨近端螺旋刀片抗旋髓内钉(PFNA)手术治疗中老年股骨转子间骨折的临床疗效。方法回顾性分析使用PFNA手术治疗中老年股骨转子间不同类型骨折患者48例。结果根据Harris髋关节功能评分,总体优良率85%,功能恢复接近伤前水平。结论用PFNA手术治疗中老年股骨转子间骨折,手术操作简便,缩短手术时间,降低长期卧床的并发症发生率,疗效满意。%Objective To evaluate the clinical results of treatment of intertrochanteric fractures with PFNA in middle and aged patients. Methods A retrospective analysis was performed on 48 patients with intertrochanteric femoral fractures were treated with PFNA. Results According to Harris hip joint function score, The total excellent and good rate of this treatment was 85%, and function of hips in patients were recovered to norma. Conclusion Intertrochanteric femoral fractures were treated successful y with the PFNA.The method has advantage of convenient procedure, less complication, excellent clinical results.

  9. Risk evaluation of failed internal fixation for intertrochanteric fracture%股骨转子间骨折内固定失败的风险评估

    Institute of Scientific and Technical Information of China (English)

    童培建; 吴寒松; 赵鹏; 杜文喜; 吴连国; 胡柏松; 王健; 储小兵

    2012-01-01

    -risk,mid-risk,and high-risk group.The rate of internal fixation failure was compared in the 3 groups.Results We found 42 cases which showed radiographic failures.The internal fixation failure directly related with advanced age,diabetes,severe osteoporosis,unstable type fracture,but not gender,hypertension,the abuse of alcohol and tobacco,use of glucocorticoid.Risk factors of internal fixation failure included diabetes,osteoporosis degree,and fracture stability.Failed intertrochanteric fracture fixation mainly occurred in the mid-risk and high-risk groups.Conclusion Severe osteoporosis,unstable fracture,diabetes are risk factors of failure of intertrochanteric fracture fixation.These factors will affect the quality of surgery.For the patient with intertrochanteric fractures in the low-risk groups,internal fixation should be the first choice for treatment.For the patients in the mid-risk and high-risk group,internal fixation should be applied cautiously.For the aged patients in high-risk groups,hip arthroplasty is a wise option.

  10. 人工关节置换术与内固定术治疗老年股骨粗隆间骨折的Meta分析%A Meta-analysis of arthroplasty versus internal fixation treatments of intertrochanteric fractures

    Institute of Scientific and Technical Information of China (English)

    郝耀; 向川

    2012-01-01

    [Objective]To compare arthroplasty and internal fixation treatments for intertrochanteric fractures by Meta-analysis.[Methods] The literature which had been published in English or Chinese from 1979 to 2011 on compare between arthroplasty and internal fixation treatments of intertrochanteric fractures were searched for on line.The clinical data were collected for comparing postoperative mortality,postoperative medical complications rate,postoperative hip deformity rate,postoperative loosening rate of internal fixation and postoperative Harris hip score.[Results] Arthroplasty treatment resulted in better postoperative Harris hip score than internal fixation (P < 0.01 ),but worse in postoperative mortality.There were no significant difference in other areas.[Conclusions] The arthroplasty treatment should be recommended for intertrochanteric fracture.%[目的]通过Meta分析比较人工关节置换术与内固定术在治疗股骨粗隆间骨折的疗效.[方法]检索1979年至2011年关于股骨粗隆间骨折采用人工关节置换术与内固定术治疗对照研究的中、英文文献,采用循证医学Meta分析对患者术后死亡率、术后内科并发症发生率、术后髋部畸形率、术后内固定物松动率及术后髋关节功能评分(Harris hip score)进行综合分析.[结果]Meta分析发现,与内固定手术相比,人工关节置换术在治疗股骨粗隆间骨折术后的髋关节功能评分中有明显优势(P<0.01),而人工关节置换组的术后死亡率却比内固定组高.在术后髋部畸形率,术后内科并发症发生率,术后内固定物松动率方面,二者无统计学差异.[结论]在治疗股骨粗隆间骨折的手术方式选择中,人工关节置换术较内固定术在术后髋关节功能评分方面优势明显.

  11. Laceration of a branch of the profunda femoris artery caused by a spike of the displaced lesser trochanter in an inter-trochanteric femoral fracture. A case report

    Directory of Open Access Journals (Sweden)

    Vito Potenza

    2016-01-01

    Conclusion: We believe that intertrochanteric femoral fractures with avulsed lesser trochanter are at risk for femoral vessel injuries caused by the displaced bone spike, and we advise meticulous clinical and laboratory monitoring pre- and post-operatively to prevent serious complications.

  12. Treatment of unstable intertrochanteric fractures with long-stem hemiarthroplasty in elderly ;patients%加长柄人工股骨头置换治疗高龄不稳定型股骨转子间骨折

    Institute of Scientific and Technical Information of China (English)

    聂治军; 常彦海

    2016-01-01

    Objective To evaluate the clinical effect of long-stem hemiarthroplasty in the treatment of unstable inter-trochanteric fractures in elderly patients. Methods Eighty-five elderly patients with unstable intertrochanteric frac-tures were treated with long-stem hemiarthroplasty. Harris hip score was used to evaluate the clinical efficacy. Re-sults All patients were followed up for 9 ~18 months. The hip joint function recovered well in those patients,and 3~6 months after surgery,the patients recovered the basic life skills. After hemiarthroplasty, no deep venous throm-bosis of lower limb, dislocation, prosthesis loosening, subsidence or rupture of the prosthesis, fracture of the prosthe-sis occurred. According to the Harris hip standard after 9 months postoperation, the excellent and good rate was 90. 83%. Conclusions Using long-stem hemiarthroplasty for treatment in the elderly patients with intertrochanteric fractures is a safe and effective method, but the long-term effect needs further observation.%目的:评价应用加长柄股骨头置换治疗高龄骨质疏松不稳定型转子间骨折的临床疗效。方法对85例高龄不稳定型股骨转子间骨折采用加长柄人工股骨头置换术,根据Harris髋关节评分评价临床疗效。结果患者均获得随访,时间9~18个月。患者髋关节功能均恢复良好,术后3~6个月基本恢复生活能力。术后随访均未出现下肢深静脉血栓、关节脱位、人工假体松动、下沉或断裂、假体周围骨折等并发症。术后9个月根据髋关节Harris评分优良率达90.83%。结论加长柄人工股骨头置换是治疗高龄不稳定型转子间骨折安全、有效的方法,但远期疗效尚需进一步随访观察。

  13. Celiac Disease in Women with Hip Fractures

    Science.gov (United States)

    LeBoff, Meryl S.; Cobb, Haley; Gao, Lisa Y.; Hawkes, William; Yu-Yahiro, Janet; Kolatkar, Nikheel S.; Magaziner, Jay

    2014-01-01

    Objective Celiac disease is associated with decreased bone density, however, the risk of fractures in celiac disease patients is unclear. We compared the prevalence of celiac disease between a group of women with hip fractures and a group of women undergoing elective joint replacement surgery and the association between celiac disease and vitamin D levels. Methods Two hundred eight community dwelling and postmenopausal women were recruited from Boston, MA (n=81) and Baltimore, MD (n=127). We measured tissue transglutaminase IgA by ELISA to diagnose celiac disease and 25-hydroxyvitamin D (25(OH)D) levels by radioimmunoassay in both women with hip fractures (n=157) and the control group (n=51), all of whom were from Boston. Subjects were excluded if they took any medications or had medical conditions that might affect bone. Results Median serum 25(OH)D levels were significantly lower (p< 0.0001) in the hip fracture cohorts compared to the elective joint replacement cohort (14.1 ng/ml vs. 21.3 ng/ml, respectively). There were no differences in the percentage of subjects with a positive tissue transglutaminase in the women with hip fractures versus the control group (1.91% vs. 1.61%, respectively). Conclusion Vitamin D levels are markedly reduced in women with hip fractures, however hip fracture patients did not show a higher percentage of positive tissue transglutaminase levels compared with controls. These data suggest that routine testing for celiac disease among hip fracture patients may not prove useful, although larger prospective studies among hip fracture subjects are needed. PMID:23732553

  14. Epidemiology of hip fracture: Worldwide geographic variation

    Directory of Open Access Journals (Sweden)

    Dinesh K Dhanwal

    2011-01-01

    Full Text Available Osteoporosis is a major health problem, especially in elderly populations, and is associated with fragility fractures at the hip, spine, and wrist. Hip fracture contributes to both morbidity and mortality in the elderly. The demographics of world populations are set to change, with more elderly living in developing countries, and it has been estimated that by 2050 half of hip fractures will occur in Asia. This review conducted using the PubMed database describes the incidence of hip fracture in different regions of the world and discusses the possible causes of this wide geographic variation. The analysis of data from different studies show a wide geographic variation across the world, with higher hip fracture incidence reported from industrialized countries as compared to developing countries. The highest hip fracture rates are seen in North Europe and the US and lowest in Latin America and Africa. Asian countries such as Kuwait, Iran, China, and Hong Kong show intermediate hip fracture rates. There is also a north-south gradient seen in European studies, and more fractures are seen in the north of the US than in the south. The factors responsible of this variation are population demographics (with more elderly living in countries with higher incidence rates and the influence of ethnicity, latitude, and environmental factors. The understanding of this changing geographic variation will help policy makers to develop strategies to reduce the burden of hip fractures in developing countries such as India, which will face the brunt of this problem over the coming decades.

  15. Primary total hip arthroplasty for acetabular fracture

    Institute of Scientific and Technical Information of China (English)

    WANG Zi-ming; SUN Hong-zhen; WANG Ai-min; DU Quan-yin; WU Siyu; ZHAO Yu-feng; TANG Ying

    2006-01-01

    Objective: To explore the operative indications and operative methods of primary total hip arthroplasty for acetabular fracture and to observe the clinical curative effect.Methods: We retrospectively summarized and analyzed the traumatic conditions, fracture types, complications,operative time, operative techniques, and short-term curative effect of 11 patients( 10 males and 1 female, with a mean age of 42. 4 years ) with acetabular fracture who underwent primary total hip arthroplasty.Results: The patients were followed up for 6-45 months ( mean = 28 months). Their average Harris score of postoperative hip joint was 78.Conclusion: Under strict mastery of indications,patients with acetabular fracture may undergo primary total hip arthroplasty, but stable acetabular components should be made.

  16. A new algorithm for hip fracture surgery

    DEFF Research Database (Denmark)

    Palm, Henrik; Krasheninnikoff, Michael; Holck, Kim

    2012-01-01

    Background and purpose Treatment of hip fracture patients is controversial. We implemented a new operative and supervision algorithm (the Hvidovre algorithm) for surgical treatment of all hip fractures, primarily based on own previously published results. Methods 2,000 consecutive patients over 50...... years of age who were admitted and operated on because of a hip fracture were prospectively included. 1,000 of these patients were included after implementation of the algorithm. Demographic parameters, hospital treatment, and reoperations within the first postoperative year were assessed from patient...... by reoperations was reduced from 24% of total hospitalization before the algorithm was introduced to 18% after it was introduced. Interpretation It is possible to implement an algorithm for treatment of all hip fracture patients in a large teaching hospital. In our case, the Hvidovre algorithm both raised...

  17. Hip Fracture Prevention: Cost-Effective Strategies

    OpenAIRE

    Peter Vestergaard; Lars Rejnmark; Leif Mosekilde

    2001-01-01

    The available literature on cost benefit, cost effectiveness and cost utility of different drug and non-drug regimens in preventing hip fractures was reviewed. The cost of a hip fracture and of the different treatment regimens varied considerably from one country to another. In primary prevention, potential savings only exceeded costs in women over the age of 70 years treated with hormonal replacement therapy (HRT). In the case of HRT, treating those with low bone mineral density levels (seco...

  18. The importance and the differences of bone morphogenetic proteins for osteoporotic hip fractures.

    Science.gov (United States)

    Dincel, V Ercan; Sepici-Dincel, Aylin

    2014-06-01

    Bone morphogenetic proteins (BMPs), major contributors to tissue repair, have become one of the most exciting fields in rheumatic and orthopaedic research. In our study we aimed to evaluate the relationship between osteoporotic hip fractures and the serum levels of BMPs to reveal their potential roles in the diagnosis of patients. The study group included 62 patients with osteoporotic hip fracture (Group 1; intertrochanteric fracture, Group 2; collum femoris fracture) and the control group. All fractures were due to low energy trauma, simple falls. For all subjects BMD measurements were in agreement for osteoporosis and no significant differences were observed between the two fracture groups. Biochemical markers; BMP-4 and BMP-7 (pg/mL) were determined by commercial Elisa kits from the serum samples. The mean and standard error values of serum samples for BMP-4 and BMP-7 in Group 1 (100.70 +/- 10.03, 74.41 +/- 6.31 respectively) and in Group 2 (112.34 +/- 11.52, 81.91 +/- 10.14 respectively) were not statistically different however for both groups only BMP-7 values increased statistically when compared to the control group. BMP-7 measurements may not only serve as potential biochemical markers for determining disease severity but also the increased levels, an osteogenic factor and bone stimulating agent in vivo, after trauma elevated levels are adaptive or protective and therefore may reduce the severity of the fracture.

  19. Management of osteoporosis in patients hospitalized for hip fractures

    OpenAIRE

    Ip, T. P.; Leung, J.; Kung, A. W. C.

    2010-01-01

    Hip fracture is associated with high morbidity, mortality, and economic burden worldwide. It is also a major risk factor for a subsequent fracture. A literature search on the management of osteoporosis in patients with hip fracture was performed on the Medline database. Only one clinical drug trial was conducted in patients with a recent hip fracture. Further studies that specifically address post-fracture management of hip fracture are needed. The efficacy of anti-osteoporosis medication in ...

  20. [Hip Fracture--Epidemiology, Management and Liaison Service. Risk factor for hip fracture].

    Science.gov (United States)

    Fujiwara, Saeko

    2015-04-01

    Many risk factors have been identified for hip fracture, including female, advanced age, osteoporosis, previous fractures, low body weight or low body mass index, alcohol drinking, smoking, family history of fractures, use of glucocorticoid, factors related to falls, and bone strength. The factors related to falls are number of fall, frail, post stroke, paralysis, muscle weakness, anti-anxiety drugs, anti-depression drugs, and sedatives. Dementia and respiratory disease and others have been reported to be risk factors for secondary hip fracture.

  1. Radiation exposure from fluoroscopy during fixation of hip fracture and fracture of ankle: Effect of surgical experience

    Directory of Open Access Journals (Sweden)

    Botchu Rajesh

    2008-01-01

    Full Text Available Background: Over the years, there has been a tremendous increase in the use of fluoroscopy in orthopaedics. The risk of contracting cancer is significantly higher for an orthopedic surgeon. Hip and spine surgeries account for 99% of the total radiation dose. The amount of radiation to patients and operating surgeon depends on the position of the patient and the type of protection used during the surgery. A retrospective study to assess the influence of the radiation exposure of the operating surgeon during fluoroscopically assisted fixation of fractures of neck of femur (dynamic hip screw and ankle (Weber B was performed at a district general hospital in the United Kingdom. Materials and Methods: Sixty patients with undisplaced intertrochanteric fracture were included in the hip group, and 60 patients with isolated fracture of lateral malleolus without communition were included in the ankle group. The hip and ankle groups were further divided into subgroups of 20 patients each depending on the operative experience of the operating surgeon. All patients had fluoroscopically assisted fixation of fracture by the same approach and technique. The radiation dose and screening time of each group were recorded and analyzed. Results: The radiation dose and screening time during fluoroscopically assisted fixation of fracture neck of femur were significantly high with surgeons and trainees with less than 3 years of surgical experience in comparison with surgeons with more than 10 years of experience. The radiation dose and screening time during fluoroscopically assisted fixation of Weber B fracture of ankle were relatively independent of operating surgeon′s surgical experience. Conclusion: The experience of operating surgeon is one of the important factors affecting screening time and radiation dose during fluoroscopically assisted fixation of fracture neck of femur. The use of snapshot pulsed fluoroscopy and involvement of senior surgeons could

  2. Total hip arthroplasty after previous fracture surgery.

    Science.gov (United States)

    Krause, Peter C; Braud, Jared L; Whatley, John M

    2015-04-01

    Total hip arthroplasty can be a very effective salvage treatment for both failed fracture surgery and hip arthritis that may occur after prior fracture surgery. The rate of complications is significantly increased including especially infection, dislocation, and loosening. Complications are more likely to occur after failed open reduction and internal fixation than after posttraumatic arthritis. Adequately ruling out infection before hip arthroplasty can be difficult. The best predictor of infection is a prior infection. Long-term outcomes can be comparable to outcomes in other conditions if complications are avoided.

  3. Femoral head fracture without hip dislocation

    Institute of Scientific and Technical Information of China (English)

    Aditya K Aggarwal; Ashwani Soni; Daljeet Singh

    2013-01-01

    Femoral head fractures without dislocation or subluxation are extremely rare injuries.We report a neglected case of isolated comminuted fracture of femoral head without hip dislocation or subluxation of one year duration in a 36-year-old patient who sustained a high energy trauma due to road traffic accident.He presented with painful right hip and inability to bear full weight on right lower limb with Harris hip score of 39.He received cementless total hip replacement.At latest follow-up of 2.3 years,functional outcome was excellent with Harris hip score of 95.Such isolated injuries have been described only once in the literature and have not been classified till now.The purpose of this report is to highlight the extreme rarity,possible mechanism involved and a novel classification system to classify such injuries.

  4. Hip fracture in hospitalized medical patients.

    Science.gov (United States)

    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 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.

  5. Zoledronic acid and clinical fractures and mortality after hip fracture

    DEFF Research Database (Denmark)

    Lyles, Kenneth W; Colón-Emeric, Cathleen S; Magaziner, Jay S

    2007-01-01

    BACKGROUND: Mortality is increased after a hip fracture, and strategies that improve outcomes are needed. METHODS: In this randomized, double-blind, placebo-controlled trial, 1065 patients were assigned to receive yearly intravenous zoledronic acid (at a dose of 5 mg), and 1062 patients were...... assigned to receive placebo. The infusions were first administered within 90 days after surgical repair of a hip fracture. All patients (mean age, 74.5 years) received supplemental vitamin D and calcium. The median follow-up was 1.9 years. The primary end point was a new clinical fracture. RESULTS...... in the two groups. CONCLUSIONS: An annual infusion of zoledronic acid within 90 days after repair of a low-trauma hip fracture was associated with a reduction in the rate of new clinical fractures and with improved survival. (ClinicalTrials.gov number, NCT00046254 [ClinicalTrials.gov].)....

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

    Energy Technology Data Exchange (ETDEWEB)

    Nachtrab, O. [Department of Radiology, The Robert Jones and Agnes Hunt Orthopaedic Hospital, Gobowen, Oswestry Shropshire SY10 7AG (United Kingdom); Cassar-Pullicino, V.N., E-mail: Victor.Pullicino@rjah.nhs.uk [Department of Radiology, The Robert Jones and Agnes Hunt Orthopaedic Hospital, Gobowen, Oswestry Shropshire SY10 7AG (United Kingdom); Lalam, R.; Tins, B.; Tyrrell, P.N.M.; Singh, J. [Department of Radiology, The Robert Jones and Agnes Hunt Orthopaedic Hospital, Gobowen, Oswestry Shropshire SY10 7AG (United Kingdom)

    2012-12-15

    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.

  7. Hip fracture fixation in a patient with below-knee amputation presents a surgical dilemma: a case report

    Directory of Open Access Journals (Sweden)

    Rethnam Ulfin

    2008-09-01

    Full Text Available Abstract Introduction Hip fracture fixation surgery in patients with below-knee amputations poses a challenging problem to the surgeon in terms of obtaining traction for reduction of the fracture. The absence of the foot and part of the leg in these patients makes positioning on the fracture table difficult. We highlight this difficult problem and suggest techniques to overcome it. Case presentation A 73-year-old man with bilateral below-knee amputations presented with a history of fall. Radiographs revealed an inter-trochanteric fracture of the femur. A dynamic hip screw fixation was planned for the fracture but the dilemma was on how to position the patient on the fracture table for the surgery. Special attention was needed in positioning the patient and in surgical fixation of the fracture. Conclusion Hip fracture fixation in patients with below-knee amputations poses a special problem in positioning for fracture reduction and fixation. In this case report, we share our experience and suggest techniques to use when encountering this difficult problem.

  8. [Clinical pathway for hip fracture patients].

    Science.gov (United States)

    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.

  9. Comparison of Locking Plate and PFNA for Intertrochanteric Fractures%锁定钢板与PFNA治疗股骨粗隆间骨折的对比分析

    Institute of Scientific and Technical Information of China (English)

    刘国龙; 窦庆寅; 韩同坤; 阳闽军

    2011-01-01

    Objective To compare the clinical effects of locking plate and PFNA in the treatment of intertrochanteric fractures. Methods A total of 138 cases of intertrochanteric fractures were treated with anatomical proximal femoral locking plate (locking plate group, n = 63) and modified proximal femoral intramedullary nails (PFNA group,n= 75) according to age and modified Evans classification. Perioperative indicators and degree of functional recovery of hip after surgery were compared between the two groups. Results All patients were followed up for 7-36 months. There were significant differences in cut size, amount of bleeding, reduction of neck shaft angle,and average healing time between locking plate group and PFNA group (P<0.05), but the differences in operation time and postoperative hip function were not significant between the two groups (P>0. 05). Conclusion PFNA is a better choice than proximal femoral anatomical locking plate in the treatment of intertrochanteric fractures due to smaller incisions,less blood loss and shorter time in bed.%目的 比较锁定钢板与改良股骨近端加锁髓内钉(PFNA)2种内固定方式治疗股骨粗隆间骨折的临床疗效.方法 根据不同年龄段和骨折分型,对138例股骨粗隆间骨折患者分别采用股骨近端解剖型锁定钢板(解剖型锁定钢板组,n=63)及PFNA(PFNA组,n=75)进行内固定.对2组围术期指标和术后髋关节功能恢复程度进行比较.结果 2组患者均获随访7~36个月.2组切口大小、出血量、颈干角减少、平均愈合时间比较,差异有统计学意义(P<0.05).2组骨折手术时间、术后髋关节功能比较,差异无统计学意义(P>0.05).结论 2种内固定方法 临床效果相当,但与股骨近端解剖型锁定钢板比较,PFNA创伤小、出血量少、卧床时间短.

  10. 骨水泥型人工股骨头置换治疗老年不稳定股骨转子间骨折%Curative effects using cemented artificial femoral head arthroplasty for unstable intertrochanteric fracture in elderly patients

    Institute of Scientific and Technical Information of China (English)

    吕浩; 荆珏华; 周云

    2013-01-01

    Objective To explore the clinical effect of artificial femoral head arthroplasty on unstable intertrochanteric fracture of femur in the elderly patients.Methods 17 cases of the femoral neck fractures in elderly patients was treated with bone cement prosthetic femoral head replacement and intertrochanteric reconstruction.The patients did earliest rehabilitation exercise after operation.Results The operation time was 55 ~ 95min,the intraoperative blood loss was 100 ~500 ml.1 case got involved deep vein thrombosis in lower limb.17 cases were followed up for 8 ~ 21 months.According to the final Harris hip function score,8 cases were excellent,6 good,2 fair,and 1 poor.Conclusions Cemented prosthetic femoral head replacement in the treatment of intertrochanteric femoral fractures can shorten the time in bed,reduce the complications,provide early stage of hip functional exercise to rehabilitation.The curative effect is reliable.%目的 探讨人工股骨头置换治疗老年不稳定股骨转子间骨折的临床效果.方法 对17例老年不稳定股骨转子间骨折患者行骨水泥型股骨头置换及转子间重建,术后早期进行功能锻炼.结果 手术时间55~95 min,术中出血量100~500 ml.1例术后出现下肢静脉血栓.17例均获随访,时间8~21个月.末次随访髋关节功能Harris评分:优8例,良6例,可2例,差1例.结论 应用骨水泥人工股骨头置换治疗不稳定股骨转子间骨折,可缩短患者卧床时间,减少并发症发生;早期进行患髋功能锻炼,有利于康复,且疗效可靠.

  11. UNSTABLE INTERTROCHANTERIC FRACTURE IN ELDERLY TREATED WITH CEMENTED BIPOLAR HEMIARTHROPLASTY AND TROCHANTERIC RECONSTRUCTION

    Directory of Open Access Journals (Sweden)

    Jagadeesh Kumar

    2015-06-01

    Full Text Available INTRODUCTION : Unstable inter - trochanteric fracture in the geriatric population is a common injury and is associated with poor bone quality, excessive collapse, loss of fixation, and cut - out of the lag screw, are the common problems of attempts to fix these fractures. Pr esent study is an attempt to evaluate the functional outcome of primary cemented bipolar hemiarthroplasty and trochanter reconstruction in these patients. MATERIALS AND METHOD S : This prospective study included 30 cases of elderly osteoporotic patients with mean age of 65.4 years who sustained comminuted inter - trochanteric femur fracture treated with cemented bipolar hemiarthroplasty& tension band wiring for greater trochanter rec onstruction. It is an essential technical step to avoid complication like abductor lurch gait. W e here describe a technique of reconstruction and fixation of greater trochanter using tension band wiring in figure of eight pattern. The patients were followe d up at six week, three month, six month and one year postoperatively and assessed using Harris Hip Score (HHS. RESULTS : The mean HHS score was was 85.6+SD 9.5 (range from 74 to 96. B y the end of one year. The main clinical measures were early post - opera tive full weight bearing, post - operative complication & functional outcome. The time to full weight bearing, the rate of post - operative complications & functional outcome was significantly better in cemented bipolar arthroplasty group . DISCUSSION : The chan ges in HHS up to six months periods are much greater which starts showing a stable trend thereafter. Fair to good scores were observed in all the patients. The purpose of its use was that while Harris Hip Score (HHS provides information on a multitude of factors. Superficial infection in 2 patients, anterior thigh pain in a patient, shortening less than 2cms in 2 patients, abductor lurch in a patient are the complications noted in post - operative period, but no patient required

  12. 股骨转子间六部分骨折分型产生机制的有限元分析%A finite element analysis of six-segment classification of femur intertrochanteric fracture

    Institute of Scientific and Technical Information of China (English)

    陈振沅; 李开南; 张之玺

    2015-01-01

    upper thigh-bone using software Super 93.The model consisted of 764 nodes and 531 units (including 306 compact bone units and 225 cancellous bone units).In this model,the stress distribution at the trochanter during human tumbling was analyzed by imitating adduction,abduction,adduction-intemal rotation and abduction-external rotation of the hip,as well as intense muscular contraction of gluteus medius,piriformis and iliopsoas during adduction-internal rotation of the hip.Results Analysis of stress nephogram showed that the stress was distributed mainly at the exterior cortical bone and spread to the inter-trochanteric part in simple hip adduction (two-part fracture) and distributed mainly at the interior cortical bone and spread to the inter-trochanteric part in simple hip abduction (two-part fracture).In adduction-internal rotation or abduction-external rotation of the hip,the stress was focused on the anterior and posterior walls of the greater trochanter and trochanteric part and spread to the exterior and interior cortical bone and the inter-trochanteric part (three-or four-part fracture).During intense muscular contraction of gluteus medius,piriformis and iliopsoas during adduction-internal rotation of the hip,the stress was focused on the anterior and posterior walls of the greater trochanter,lesser trochanter and trochanteric part and spread to the exterior and interior cortical bone and the inter-trochanteric part (five-or six-part fracture).Conclusions The six-segment classification of femur intertrochanteric fracture explains complex stress distributions after human falling.When combined with three-dimensional CT reconstruction,it is more intuitive than other classifications so that it can provide more definite surgical advice for different types of fracture.

  13. Zoledronic acid and clinical fractures and mortality after hip fracture

    DEFF Research Database (Denmark)

    Lyles, Kenneth W; Colón-Emeric, Cathleen S; Magaziner, Jay S

    2007-01-01

    BACKGROUND: Mortality is increased after a hip fracture, and strategies that improve outcomes are needed. METHODS: In this randomized, double-blind, placebo-controlled trial, 1065 patients were assigned to receive yearly intravenous zoledronic acid (at a dose of 5 mg), and 1062 patients were...... assigned to receive placebo. The infusions were first administered within 90 days after surgical repair of a hip fracture. All patients (mean age, 74.5 years) received supplemental vitamin D and calcium. The median follow-up was 1.9 years. The primary end point was a new clinical fracture. RESULTS......: The rates of any new clinical fracture were 8.6% in the zoledronic acid group and 13.9% in the placebo group, a 35% risk reduction with zoledronic acid (P=0.001); the respective rates of a new clinical vertebral fracture were 1.7% and 3.8% (P=0.02), and the respective rates of new nonvertebral fractures...

  14. Total Hip Arthroplasty in Failed Hip Fractures: A Case Series

    Directory of Open Access Journals (Sweden)

    Syed Shahid Noor

    2015-01-01

    Full Text Available Osteoporosis is epidemic in Asian countries. It is a major cause of fractures that orthopaedic surgeons deal in Pakistan, though proper epidemiological data is not available. Habiba U et al found that 75.3% of post menopausal women of Pakistan were predisposed to Osteoporosis; whereas Baig L has described an average T - score of -1.833±0.65 on bone mineral density calculation of post menopausal females of Pakistan. Osteoporotic hip fractures constitute a major cause of elderly mortality worldwide and recent figures supporting the idea that these patients have survival rates comparable to breast and thyroid cancer patients. Pakistan is a developing country with large burden of hip fractures. Patients living in remote areas are the ones which suffer more because of inadequate awareness, fear of surgical treatment and lack of availability of standard treatment. These patients are dealt by surgeons of various expertise and levels of experience. Lack of facilities in hospitals is well known and usage of sub-standard implant is a major cause of failure. Therefore these patients either because of their bone fragility or mal-treatment suffer frequently from failure of hip fracture surgeries. Being in a tertiary care centre we come across these types of cases very frequently. Six to eight such cases present to outpatient department of Liaquat National Hospital every month being referred from every part of the country. These patients may have been operated once, twice or even multiple times. Special attention is required to acquire an informative history from these cases and perform a comprehensive examination. Moreover previous records and radiographs provide invaluable information regarding cause of failure and deciding course of further treatment. We herein discuss few of the cases of failure of hip fractures which were treated by hip arthroplasty.

  15. Different Internal Fixation for Intertrochanteric Fractures in Elderly Patients%老年患者股骨粗隆间骨折内固定治疗

    Institute of Scientific and Technical Information of China (English)

    杨灵; 龙成; 徐巍; 刘跃洪; 汪红; 雷达

    2012-01-01

    目的 回顾分析不同内固定方式对老年股骨粗隆间骨折的临床疗效.方法 1999年3月-2009年5月采用内固定手术治疗121例股骨粗隆间骨折患者,根据内固定方式不同分为4组:动力髋螺钉(DHS;A组43例)、经皮加压钢板(PCCP;B组19例)、股骨近端髓内钉(PFN;C组27例)、Gamma钉(D组32例).4组患者年龄、骨折类型(Tronzo-Evans分型)等一般资料比较差异无统计学意义(P>0.05),具有可比性.记录手术时间、术中出血量及术后引流量、术中术后并发症、骨折临床愈合时间、术后髋关节功能恢复程度,比较评价各组临床疗效.结果 术后各组患者切口均Ⅰ期愈合,无伤口感染等早期并发症发生.患者均获随访,随访时间18~108个月,平均56.4个月.与A组比较,B、C、D组手术时间明显缩短,术中出血量及术后引流量减少,骨折愈合时间缩短,差异均有统计学意义(P<0.01),A组较差;B、C、D各组间两两比较差异无统计学意义(P> 0.05).术后并发症发生率A组较高,与其余各组比较差异有统计学意义(P<0.05).末次随访时各组髋关节功能Harris评分比较差异无统计学意义(P>0.05).结论 B、D组及C组3种手术方法在治疗老年患者股骨粗隆间骨折具有创伤小、并发症少等优势,与A组法比较更有利于老年患者术后康复,但应注意骨折的良好复位及内固定物位置.%Objective To compare clinical outcomes of four kinds of internal fixation for intertrochanteric fractures in elderly patients. Methods From March 1999 to May 2009, 121 elderly patients with intertrochanteric fractures were treated in our hospital. The surgical procedures included dynamic hip screw (DHS, group A, n=43), percutaneous compression plate (PCCP, group B,n=19), proximal femoral nail (PFN, group C, n=27) and Gamma nail (group D,n=32). The difference of patient age and fracture type in the four groups has no statistical significance (P > 0.05). The data

  16. Outcomes of osteoporotic trochanteric fractures treated with cement-augmented dynamic hip screw

    Directory of Open Access Journals (Sweden)

    Rakesh Kumar Gupta

    2012-01-01

    Full Text Available Background: Dynamic hip screw (DHS has been the standard treatment for stable trochanteric fracture patterns, but complications of lag screw cut out from a superior aspect, due to inadequate bone anchorage, occur frequently in elderly osteoporotic patients. Polymethylmethacrylate (PMMA has been used as an augmentation tool to facilitate fixation stability in cadaveric femora for biomechanical studies and in pathological fractures. However, there are very few reports on the utilization of PMMA cement to prevent these complications in fresh intertrochanteric fractures. A prospective study was conducted to evaluate the outcome and efficacy of PMMA augmented DHS in elderly osteoporotic patients with intertrochanteric fractures. Materials and Methods: The study included 64 patients (AO type31-A2.1 in eight, A2.2 in 29, A2.3 in 17 patients, and 31-A3.1 in five, A3.2 in three, and A3.3 in two patients with an average age of 72 years (60 − 94 years of which 60 were available for final followup. PMMA augmentation of DHS was performed in all cases by injecting PMMA cement into the femoral head with a custommade gun designed by the authors. The clinical outcome was rated as per the Salvati and Wilson scoring system at the time of final followup of one year. Results were graded as excellent (score > 31, good (score 24 − 31, fair (score 16 − 23, and poor (score < 16. Results: Fracture united in all patients and the average time to union was 13.8 weeks (range 12 − 16 weeks. At an average followup of 18 months (range 12 − 24 months, no incidence of varus collapse or superior screw cut out was observed in any of the patients in spite of weightbearing ambulation from the early postoperative period. There was no incidence of avascular necrosis (AVN or cement penetration into the joint in our series. Most of the patients were able to regain their prefracture mobility status with a mean hip pain score of 8.6. Conclusion: Cement augmentation of DHS appears

  17. 股骨近端防旋髓内钉治疗老年人髋部骨折疗效的多因素分析%Multivariate analysis of geriatric intertrochanteric fractures treated with proximal femoral nail antirotation (PFNA)

    Institute of Scientific and Technical Information of China (English)

    纪泉; 高凡; 文良元; 薛庆云; 黄公怡

    2012-01-01

    Objective To investigate the clinical and functional outcome of the proximal femoral nail antirotation (PFNA) in the treatment of geriatric intertrochanteric fractures and analylze various factors affecting the prognosis. Methods All of 76' patients with intertrochanteric fractures treated with PFNA were included. Patients' general health, injury mechanism, fracture pattern, operation time, intraoperative blood loss, perioperative complications, bone healing and evaluation of the operated hip joint were reviewed. Results The incidence of superficial infection occurred 2.6% (n=2),cerebrocardiovascular accidents 3.9%(n=3),postoperative pneumonia was 6.6%(n=5), geriatric delirium 15.8%(n=12),postoperative deep venous thrombosis 5.3%(n=4), upper peptic tract hemorrhage 2.6%(n=2).Multivariate analysis indicated that age, fracture stability, ASA score was the predictors of postoperative hip function (P =0.032,P =0.032,P =0.038) while gender, early operation and operation time was not statistically correlated with hip joint function (P >0.05).Conclusion PFNA is a suitable and less invasive procedure for geriatric intertrochanteric fractures via stable fixation and early rehabilitation but the complication incidence is relatively high. Age, fracture stability and ASA score may be related to the postoperative hip joint function.%目的 研究股骨近端防旋髓内钉(PFNA)治疗老年股骨粗隆间骨折的疗效,并分析影响预后的因素.方法 76例股骨粗隆间骨折患者接受PFNA内固定治疗,记录患者一般情况、骨折类型、手术时间、术中出血量、围手术期并发症,患侧髋关节Harris评分.结果 术后并发症发生率:表浅软组织感染2.6%(2例),心脑血管意外3.9%(3例),肺炎6.6%(5例),老年谵妄15.8%(12例),术后DVT5.3%(4例),应激性溃疡2.6%(2例).多因素回归分析显示年龄、骨折稳定性(股骨内后侧皮质)、ASA评分是骨折愈合后髋关节功能的预测因子(P =0.032,P =0.032,P

  18. Effectiveness of treatment of transtrochanteric fractures with Dynamic Hip Screws using minimally invasive access☆

    Science.gov (United States)

    de Abreu, Eduardo Lima; Sena, Caroline Brum; Saldanha Rodrigues Filho, Sergio Antonio

    2016-01-01

    Objective To analyze the short-term results from treating unstable intertrochanteric fractures with Dynamic Hip Screws (DHS), using a minimally invasive route, focusing on the functional aspects and complication and mortality rates of the method. Methods This was a prospective longitudinal study on 140 patients who underwent fixation of transtrochanteric fractures with the DHS system with a lateral minimally invasive access in the hip, between January and December 2013. The patients were evaluated pre and postoperatively (after six months of follow-up) by means of the Parker and Palmer mobility score. Women comprised 65.7% of the sample, and 54.3% of the fractures were on the right side. The patients’ mean age was 80 years, ranging from 60 to 93 years. Results We observed an overall decrease in the mobility score and an increase in the degree of dependence over the short term. However, we encountered only two deaths in the study sample and there were no cases of infection or nonunion. Conclusion Despite the efficacy of the treatment with DHS, with high rates of fracture consolidation and a low mortality rate, we noted that the patients still showed significant functional limitation at the follow-up six months after the operation. PMID:27069880

  19. 动力髋螺钉及药物治疗老年性股骨转子间骨折%The treatment of senile osteoporotic intertrochanteric fractures with DHS internal fixation and drugs

    Institute of Scientific and Technical Information of China (English)

    崔树森

    2012-01-01

    Objective To evaluate the clinical efficacy of dynamic hip screw (DHS) for the treatment of senile osteoporotic intertrochanteric fractures. Methods Retrospectively analysis of X-ray results and limb function of 56 patients with senile osteoporotic intertrochanteric fractures, who were treated with DHS combined with salmon calcitonin, alfacalcidol, ,nd calcium tablets. Results After following up for more than 12 months, the post-operative function of the hips were: excellent in 46 cases, good in 5 cases, fair in 4 cases, and poor in 1 case, according to Parker's hip function score. The excellent-good rate was 91.1%. Conclusion DHS is strong enough in structure, and is good for fracture healing. Combination of salmon calcitonin, alfacalcidol,,nd calcium tablets is helpful for prevention of osteoporosis, fracture healing, and reduction of complications.%目的 探讨应用DHS及药物治疗老年骨质疏松性股骨转子间骨折的治疗效果.方法 回顾性分析56例老年骨质疏松性转子间骨折经DHS内固定术及鲑鱼降钙素、阿法骨化醇、维D咀嚼钙片联合治疗前后的X线片、肢体功能.结果 经12个月以上随访,按Parker髋关节功能评分标准评价术后功能恢复情况:优46例,良5例,可4例,差1例.优良率为91.1%.结论 DHS结构坚强,有利于骨折愈合.鲑鱼降钙素、阿法骨化醇、维D咀嚼钙片联合应用有利于预防骨质疏松,促进骨折的愈合,降低手术并发症的发生率.

  20. Mortality analysis in hip fracture patients

    DEFF Research Database (Denmark)

    Foss, N B; Kehlet, H

    2005-01-01

    Patients with hip fractures are usually frail and elderly with a 30-day mortality in excess of 10% in European series. Perioperative morbidity is often multifactorial in nature, and unimodal interventions will not necessarily decrease mortality. The purpose of this prospective study was to analys...

  1. Short time-frame from first to second hip fracture in the Funen County Hip Fracture Study

    DEFF Research Database (Denmark)

    Nymark, T; Lauritsen, Jens; Ovesen, O

    2006-01-01

    Hip fracture patients represent a frail group of elderly with increased morbidity and mortality. The aim of this study was to evaluate the occurrence and distribution of a second hip fracture in the time interval between the first and the second hip fracture....

  2. Effects of two different methods in the treatment of unstable intertrochanteric fractures in elderly patients%两种内固定术治疗老年股骨粗隆间不稳定性骨折的疗效

    Institute of Scientific and Technical Information of China (English)

    刘建军

    2014-01-01

    Objective To compare the clinical effects of proximal femoral nail anti‐rotation (PFNA ) and dy‐namic hip screw (DHS) fixation in the treatment of unstable intertrochanteric fractures in elderly patient and their impacts on hip joint function .Methods A total of 80 patients with intertrochanteric fractures were divided into ob‐servation group and control group according to random number table .Patients in observation group were treated with PFNA fixation ,and patients in control group were treated with DHS fixation .Surgical situation ,healing of fracture and hip joint function of the two groups were compared .Results (1)The operative time and bleeding volume of ob‐servation group was less than control group (t=2 .890 and 2 .922 ,P<0 .05) .(2)The function ,pain ,deformity ,range of motion and total scores of observation group were significantly higher than control group (P<0 .05) .Of observa‐tion group ,the postoperative hip joint function excellent rate was 90 .0% ,significantly higher than the 72 .5% of con‐trol group (χ2 =4 .021 ,P<0 .05) .Conclusion The treatment of PFNA fixation in intertrochanteric factures in elder‐ly patents might be with advantages of shorter operative time ,less blood loss ,and fine recovery of postoperative hip joint function ,which could be worthy of promotion .%比较抗旋髓内钉(PFNA)与动力髋螺钉(DHS)内固定术治疗老年股骨粗隆间骨折的临床疗效及对髋关节功能的影响。方法根据随机数字表法将80例股骨粗隆间骨折患者分为观察组和对照组,观察组采用PFNA内固定术治疗,对照组采用DHS内固定术治疗。比较两组患者手术情况、骨折愈合情况及髋关节功能。结果(1)观察组患者手术时间短于对照组,出血量少于对照组,差异有统计学意义( t=2.890、2.922,P<0.05);(2)观察组功能、疼痛、畸形、运动范围及总分均显著高于对照组,

  3. Microinvasive surgery for the treatment of intertrochanteric fractures in the elderly%高龄老年股骨粗隆间骨折微创手术治疗

    Institute of Scientific and Technical Information of China (English)

    耿立杰; 江涛; 张哓立; 孙玮

    2011-01-01

    Objective To explore the clinical efficacy of microinvasive surgery for the treatment of intertrochanteric fracture in the elderly. Methods Seventy-three elder intertrochanteric fracture patients treated with intracavity screws in the proximal femur from May 2006 to October 2009 were collected, including 14 males and 59 fema' s, with mean age of 80 years old. Three patients were in fracture type I, 31 in type II, 34 in type III, and 5 in type VI, respectively, according to Evans calcification. All patients were followed up after operation. The functions of hip joint were evaluated with Harris scores. The overall satisfactions of patients were recorded. Results Sixty-one patients were followed up for 10-36 months, with a mean of 18 months. The walking ability of eighteen patients recovered to pre-operation level in 1 year. Thirty-one patients could not walk independently and needed crutches. Eight patients could only stay on the bed without hip pain. Four patients were with hip pain and deformity of the diseased knee joint. The post-operation Harris score showed that the hip function was excellent in 18 patients, good in 31 patients, fare in 8 patients, and bad in 4 patients. The excellent and good rate was 80. 1%. Conclusion Microinvasive surgery is an effective treatment to elder intertrochanteric fracture patients.%目的 探讨微创手术方法治疗老年人粗隆间骨折的临床疗效.方法 2006年5月-2009年10月,我们应用股骨近端髓内钉微创手术方法治疗80岁以上高龄老年股骨粗隆间骨折73例,其中男14例,女59例,平均年龄86.5岁,根据Evans分型:Ⅰ型3例,Ⅱ型31例,Ⅲ型34例,Ⅵ型5例.术后定期随访,术后髋关节按Harris评分对髋关节功能进行评估;记录患者对手术效果的整体满意度.结果 61例获得10~36个月随访,平均18月.其中18例术后1年内恢复术前行走功能水平;31例不能独立行走,需要扶拐下地行走;8例不能下地,只能在

  4. Increasing incidence of hip fracture in Chiang Mai, Thailand.

    Science.gov (United States)

    Wongtriratanachai, Prasit; Luevitoonvechkij, Sirichai; Songpatanasilp, Thawee; Sribunditkul, Siripoj; Leerapun, Taninnit; Phadungkiat, Sompant; Rojanasthien, Sattaya

    2013-01-01

    Hip fracture is a major health problem in Thailand. This study attempted to examine the incidence, related factors, and trends of hip fracture in Chiang Mai, Thailand. All hip fracture data among patients aged 50 yr or older were collected from hospitals in Chiang Mai, Thailand from August 1, 2006 to July 3, 2007. Data from the 1997 Chiang Mai hip fracture study were used for comparison. In the study period, 690 hip fractures were reported: 203 males and 487 females (male to female ratio was 1 to 2.4), with a mean age of 76.7 yr. The estimated cumulative incidence was 181.0 per 100,000, and the adjusted incidence was 253.3 (males: 135.9; females: 367.9). A simple fall was the most common mechanism (79%) of fracture, and 80% of the hip fractures occurred in patients aged 70 yr or older. The highest incidence of hip fracture was observed in patients older than 85 yr (1239). At 6 mo postfracture, most patients (61%) used a walking aid. Compared with the 1997 data, hip fracture incidence had increased by an average of 2% per yr, and the incidence of hip fracture had increased significantly from August 1, 2006 to July 31, 2007, especially in patients older than 75 yr. In patients older than 84 yr, the incidence increased by a factor of 2. Urgent strategies for the prevention and treatment of osteoporosis, and hence hip fracture, are needed.

  5. Schizophrenia, antipsychotics and risk of hip fracture

    DEFF Research Database (Denmark)

    Sørensen, Holger J; Jensen, Signe O W; Nielsen, Jimmi

    2013-01-01

    -morbidity, antipsychotics (IRR=1.19; 95% CI 1.15-1.24), antidepressant (IRR=1.18; 95% CI 1.16-1.20), anticholinergics (IRR=1.29; 95% CI 1.22-1.36), benzodiazepines (IRR=1.06; 95% CI 1.04-1.08) and corticosteroids (IRR=1.44; 95% CI 1.36-1.53) were significant predictors. In 556 persons with schizophrenia and hip fracture...

  6. 股骨转子间骨折与股骨远端骨折的可视化仿真手术研究%Visualized simulative surgery for intertrochanteric and distal fractures of the femur

    Institute of Scientific and Technical Information of China (English)

    王丹; 金丹; 裴国献; 王义生; 夏磊; 鲍苏苏; 谢叻

    2014-01-01

    Objective To study the application of three-dimensional (3D) models of femoral intertrochanteric and distal fractures in visualized simulative surgery.Methods Enrolled in this study were a male patient (45 years old) with right femoral intertrochanteric fracture and a female patient (34 years old) with left femoral distal fracture.Their original image data of 64-slice spiral CT were obtained.Using adaptive region growing algorithm,the serial CT images were segmented and automatically extracted for 3D reconstruction of the femur and its anatomically related structures with a self-designed program.The model was then processed with Freeform Modeling System for image modification and smoothing.Next Computer Aided Design (CAD) software Unigraphics NX4.0 and Freeform Modeling System V9.0 were used to develop dynamic hip screw system,femoral retrograde intramedullary nailing system and less invasive stable system.With the assistance of GHST SDK and PHANTOM software,preoperative simulative surgery for femoral fractures was performed on the basis of the established femoral model.Results The reconstructed 3D model clearly and freely demonstrated the 3D images of the femoral structures,the intertrochanteric fracture with dynamic hip plate fixation,the femoral distal fracture with AO LISS plating and retrograde intramedullary nailing.During the simulative surgery for femoral fractures,the GHOST SDK system allowed effective application of the virtual surgical instruments.The use of PHANTOM software produced a surgical experience highly resembling that from an actual operation.The whole process from the start of model establishment till the finish of internal fixation lasted 1.2 hours for the femoral intertrochanteric fracture and 1.5 hours for the femoral distal fracture.Conclusion Since the visualized simulative surgery for femoral intertrochanteric and distal fractures on the 3D model can familiarize surgeons with the 3D structures of the fracture,it has a great value in

  7. Hip Fracture. A Nine-Year Study.

    Directory of Open Access Journals (Sweden)

    Horacio Suárez Monzón

    2007-08-01

    Full Text Available Background: Recent studies in Cuba stated that a great number of hip fractures are caused due to accidental falls constituting an important health problem in the third age. Objective: To characterize the behaviour of hip fractures from 1997 to 2005 in Cienfuegos Province. Methods: An observational longitudinal descriptive and prospective study was carried out to all patients treated for hip fracture from 1997 to 2005 in the University Hospital ¨Dr. Gustavo Aldereguía Lima¨ in Cienfuegos city. Variable such as age, sex, and topographical diagnosis, and surgical modality, scale of disability, comorbidity, complications, lethality, and second time of admission were taken into account and collected in the analyzed period of time and in specific clinical records elaborated for this purpose. Results: 13,7 per cent of the orthopaedic complications were registered being significantly lower in regard with previous studies in similar contexts. 62 per cent of the assisted patients could get back their initial scale of disability. Conclusions: The results obtained showed the level of experience reached by the specialists using the new technologies at the surgical act.

  8. Hip Hemiarthroplasty for Femoral Neck Fractures Using the Modified ...

    African Journals Online (AJOL)

    The patients had good hip abduction postoperatively. In addition ... Key words: Femoral neck fractures, hip hemiarthroplasty, ... the overall blood loss at surgery and morbidity after surgery, ... Their clinical and demographic features were noted.

  9. Percutaneous pelvic osteotomy and intertrochanteric varus shortening osteotomy in nonambulatory GMFCS level IV and V cerebral palsy patients: preliminary report on 30 operated hips.

    Science.gov (United States)

    Canavese, Federico; Gomez, Horacio; Kaelin, André; Ceroni, Dimitri; de Coulon, Geraldo

    2013-01-01

    This study evaluated the outcome of severe cerebral palsy patients (Gross Motor Function Classification System level IV and V) treated by simultaneous percutaneous pelvic osteotomy and intertrochanteric varus shortening osteotomy for hip subluxation or dislocation between 2002 and 2011. Twenty-four patients (30 hips) with an average age of 9.4 years (5-16.5) were reviewed at a mean follow-up of 35.9 months (6-96). Percutaneous pelvic osteotomy lasted on average 30 min/patient per side (25-40) and was always performed through a skin incision of 2-3 cm. The migration percentage and acetabular angle were assessed on plain radiographs. The mean Reimers' migration percentage improved from 67.1% (42-100) preoperatively to 7.7% (0-70) at the last follow-up and the mean acetabular angle improved from 31.8° (22-48) to 15.7° (5-27). Five patients presented complications: one redislocation, one bone graft dislodgement, and three with avascular necrosis of the femoral head. This study should be considered as a pilot study. These results indicate that this combined approach is an effective, reliable, and minimally invasive alternative method for the treatment of spastic dislocated hips in severe cerebral palsy patients with an outcome similar to standard techniques reported in the literature.

  10. 老年人髋部骨折后低钠血症%HYPONATREMIA FOR THE ELDER PEOPLE AFTER HIP FRACTURE

    Institute of Scientific and Technical Information of China (English)

    李志; 梁忆; 赵昌平; 张学斌; 宋朝晖

    2012-01-01

    目的 探讨老年人髋部骨折后低钠血症的发生及相关因素.方法 选择2010年6月-2011年6月新鲜髋部骨折患者(年龄≥70岁)67例,其中股骨颈骨折25例,股骨粗隆间骨折42例.入院后第1、3天查血生化,观察血清电解质情况,记录内科并发症,探讨低钠血症的发生率和相关因素.结果 67例患者中有38例发生低钠血症,其中股骨颈骨折10例,粗隆间骨折28例.股骨粗隆间骨折比股骨颈骨折患者低钠血症的发生率要高,差异有统计学意义.低钠血症的发生与高血压病、肺部疾病和糖尿病的发生无明显相关性.结论 老年人髋部骨折后常发生低钠血症,粗隆间骨折患者的发生率高于股骨颈骨折的患者,但与高血压病、肺部疾病和糖尿病等内科并发症无明显相关性.%Objective To investigate the relevant factors of hyponatremia for the elder people after hip fractures. Methods From June 2010 to June 2011,67 patients ( age≥70 years ) with fresh hip fractures were chosen, of these, 25 cases were femoral neck fractures and 42 cases were intertrochanteric fractures. The blood biochemistry was done to observe electrolyte circumstances at 1 day and 3 days after admission. Medical complications of the patients were recorded in order to observe the impact of hyponatremia. Results Thirty eight patients sustained hyponatremia in all the 67 patients, in which 10 cases were femoral neck fractures and 28 cases were intertrochanteric fractures. There was significant statistical difference in the incidence of hyponatremia between patients with femoral neck fractures and intertrochanteric fractures. There was no significant correlation between hyponatremia and medical complications such as hypertension, lung disease, diabetes and so on. Conclusion Hyponatremia often occues in elderly patients with hip fractures, and especially in patients with intertrochanteric fractures, but there are no significant correlations between

  11. Off-hours admission and quality of hip fracture care

    DEFF Research Database (Denmark)

    Kristiansen, Nina Sahlertz; Kristensen, Pia Kjær; Nørgård, Bente Mertz

    2016-01-01

    OBJECTIVE: Higher risks of adverse outcomes have been reported for patients admitted acutely during off-hours. However, in relation to hip fracture, the evidence is inconsistent. We examined whether time of admission influenced compliance with performance measures, surgical delay and 30-day...... mortality in patients with hip fracture. DESIGN: Cohort study. SETTING: Data from The Danish Multidisciplinary Hip Fracture Registry linked with data from Danish National Registries. PARTICIPANTS: Danish patients undergoing hip fracture surgery, aged >65 years, admitted 1 March 2010 to 30 November 2013 (N...

  12. Does bone mineral density affect hip fracture severity?

    Science.gov (United States)

    Spencer, Simon J; Blyth, Mark J G; Lovell, Frances; Holt, Graeme

    2012-06-01

    The association between hip fracture and reduced bone mineral density is well documented, with reduced bone mineral density predisposing to fracture. However, it is unknown whether an association exists between the magnitude of bone density lost and the severity of the hip fracture sustained. One hundred forty-two patients (96 women, 46 men) with a mean age of 74 years (range, 49-92 years) who sustained a hip fracture following a simple ground-level fall and were treated for this injury were reviewed. All patients had undergone dual-energy x-ray absorptiometry bone scanning of the contralateral hip and lumbar spine. Fractures were classified as intra- or extracapsular or subtrochanteric and then subclassified by degree of severity as simple (stable) or multifragmentary (unstable) fracture patterns.Although a low hip bone mineral density (T- or Z score fracture (P=.025) compared with other fracture types, no association existed between bone mineral density and the severity of the resultant hip fracture. Although an association exists between bone mineral density and the risk of fragility fractures, the results of the current study suggest that the severity of hip fractures does not follow this correlation. Therefore, no assumption can be made about bone mineral density of the proximal femur based on the severity of the fracture observed on plain radiographs. Copyright 2012, SLACK Incorporated.

  13. Treatment of long unstable femoral intertrochanteric fractures with locking plate and cable rope%锁定钢板及缆绳联合治疗老年长段粗隆骨折

    Institute of Scientific and Technical Information of China (English)

    杨玉宝; 阚金庆; 高忠礼; 李林

    2012-01-01

    目的:探讨锁定钢板和缆绳治疗老年长段粗隆间骨折的临床疗效.方法:自2004年6月至2010年6月治疗26例老年长段粗隆间骨折,男16例,女10例;年龄50~65岁,平均(58.23±4.45)岁.车祸伤22例,其中10例合并其他复合伤;坠落伤4例.Evans分型:I型21(顺转子型),其中Ia型8例,Ib型10例,Ic型2例,Id型1例;Hrd型(逆转子型)5例.26例中均采用锁定钢板及缆绳固定治疗,髋关节功能根据Harris评分.结果:26例均获得随访,时间9~18个月,平均15个月.手术顺利,术后7~14d下地无负重功能锻炼,6周逐渐负重功能锻炼,12周后逐渐完全负重.髋关节功能Harris评分,疼痛(39.79±6.54)分,功能(31.08±9.45)分,畸形及活动(3.85±0.46)分,总分(77.31±13.97)分;结果优10例,良13例,可3例.结论:锁定钢板及缆绳适合治疗老年长段涉及粗隆Evans分型的各种类型骨折,尤其是骨质疏松患者取得较好临床效果.%Objective: To investigate clinical effect of long unstable femoral intertrochanteric fractures with locking plate and cable rope. Methods: From June 2004 to June 2010, twenty-six elderly patients with long unstable femoral intertrochanteric fractures were treated locking plate and cable rope fixation, included 16 males and 10 females with an average age of (58.23?4.45) years ranging from 50 to 65 years. There were 22 cases for traffic accident, 10 of them for traffic accident with other injury; 4 cases for falling injury. According to Evans classification, 21 cases were in type I, among them 8 in type la, 10 in type Ib, 2 in type Ic, 1 in type Id; the other 5 cases were type Hrd. Hip function scores were recorded to evaluate the treatment outcomes by Harris hip function score system. Results: Twenty-six cases were followed-up for 9 to 18 months (means 15 months). The operations were successful. All the patients received functional training for walking without weight loading from 7 to 14 days after operation , and walking

  14. [Investigate progress of intraoperative periprosthetic fracture of total hip arthroplasty].

    Science.gov (United States)

    Cong, Yu; Zhao, Jian-ning

    2011-02-01

    One of the complications of total hip arthroplasty is intraoperative periprosthetic fracture. Periprosthetic fracture is divided into acetabular fracture and femoral fracture. Risk factors for intraoperative periprosthetic fracture include use of minimally invasive techniques, press-fit cementless stems, revision operations and osteoporosis. It has been recognized that treatment of intraoperative periprosthetic fractures should be based on the classification of the Vancouver system for intraoperative fractures.

  15. Contralateral hip fractures and other osteoporosis-related fractures in hip fracture patients: Incidence and risk factors. An observational cohort study of 1,229 patients

    NARCIS (Netherlands)

    A.J.H. Vochteloo (Anne); B.L. Borger van der Burg (Boudewijn); M.L. Röling (Maarten); D.H.-J. van Leeuwen (Diederik); P. van den Berg (Peter); 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)

    2012-01-01

    textabstractPurpose: To report risk factors, 1-year and overall risk for a contralateral hip and other osteoporosis-related fractures in a hip fracture population. Methods: An observational study on 1,229 consecutive patients of 50 years and older, who sustained a hip fracture between January 2005

  16. The association between hip fracture and hip osteoarthritis: A case-control study

    Directory of Open Access Journals (Sweden)

    Englund Martin

    2010-11-01

    Full Text Available Abstract Background There have been reports both supporting and refuting an inverse relationship between hip fracture and hip osteoarthritis (OA. We explore this relationship using a case-control study design. Methods Exclusion criteria were previous hip fracture (same side or contralateral side, age younger than 60 years, foreign nationality, pathological fracture, rheumatoid arthritis and cases were radiographic examinations were not found in the archives. We studied all subjects with hip fracture that remained after the exclusion process that were treated at Akureyri University Hospital, Iceland 1990-2008, n = 562 (74% women. Hip fracture cases were compared with a cohort of subjects with colon radiographs, n = 803 (54% women to determine expected population prevalence of hip OA. Presence of radiographic hip OA was defined as a minimum joint space of 2.5 mm or less on an anteroposterior radiograph, or Kellgren and Lawrence grade 2 or higher. Possible causes of secondary osteoporosis were identified by review of medical records. Results The age-adjusted odds ratio (OR for subjects with hip fracture having radiographic hip OA was 0.30 (95% confidence interval [95% CI] 0.12-0.74 for men and 0.33 (95% CI 0.19-0.58 for women, compared to controls. The probability for subjects with hip fracture and hip OA having a secondary cause of osteoporosis was three times higher than for subjects with hip fracture without hip OA. Conclusion The results of our study support an inverse relationship between hip fractures and hip OA.

  17. Comparison of nail-plate fixation and Ender's nailing for intertrochanteric fractures.

    Science.gov (United States)

    Hall, G; Ainscow, D A

    1981-02-01

    Two comparable groups of patients with fractures of the trochanteric region of the femur were studied. One hundred and sixty-five fractures had been fixed with conventional nail-plates and 132 with Ender's nails. Ender's nails gave superior results in the treatment of trochanteric fractures. The operation was quicker and less traumatic than that using conventional nail-plates and both the mortality rate and the time in hospital were reduced. More patients in the group with Ender's nails who were initially independent returned to an independent existence.

  18. Subtrochanteric fractures in bisphosphonate-naive patients

    DEFF Research Database (Denmark)

    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...... incident subtrochanteric fractures with those sustaining other hip fractures. Subjects were bisphosphonate-naive or had a bisphosphonate washout period of 6-24 months and subsequently received an annual infusion of zoledronic acid 5 mg or placebo after low-trauma hip-fracture repair. In total, 2,127 men...... and women were included. Of the qualifying hip fractures, 5.2% were subtrochanteric, 54.8% femoral neck, 33.0% intertrochanteric, and 7.1% other (generally complex fractures of mixed type). Significant baseline (pre-hip fracture) differences were seen between index hip-fracture types, with the percentage...

  19. Orthogeriatric Service Reduces Mortality in Patients With Hip Fracture

    DEFF Research Database (Denmark)

    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 p......, and ASA score. Future trials should include frail patients with other fracture types who can benefit from orthogeriatrics.......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...

  20. Prevalence of dementia in elderly patients with hip fracture.

    Science.gov (United States)

    Yiannopoulou, Konstantina G; Anastasiou, Ioannis P; Ganetsos, Theodore K; Efthimiopoulos, Petros; Papageorgiou, Sokratis G

    2012-01-01

    Hip fractures occur commonly and are a cause of disability for older adults and lead to increased dependence and requirements for social support. Dementia is one of the possible risk factors for falling and hip fracture, a potential source for complications during surgery and during the postoperative period, difficulties in rehabilitation and a risk factor for hip fracture reccurence. However, in previous studies of hip fracture patients, cognitive status has not been formally assessed during the inpatient stay and diagnosis was based only on previous history. Additionally, no previous studies have compared prevalence of dementia between elderly patients with hip fracture and patients with other surgical pathology. Our aim was to define whether dementia was more prevalent in older subjects with hip fracture than in other elderly patients undergoing surgery. In this study, we prospectively assessed all patients aged 68 and older admitted to our hospital for hip fracture surgery during a one year period and compared them with age and gender matched patients attending other surgical departments. 80 hip fracture patients and 80 controls were assessed for dementia. Dementia was common in both groups, presumably reflecting the advanced mean age of both groups and cognitive deterioration due to hospitalization-status. Dementia was significantly higher in the hip fracture group (85%) compared to the control group (61.5%; p=0.002). Dementia is very common in older patients admitted for surgery to a general hospital and extremely common in those with hip fracture. It seems that dementia is under diagnosed in elderly hospitalised patients. Our data confirm that dementia is a major risk factor for hip fracture in the elderly.

  1. Low-trauma fractures indicate increased risk of hip fracture in frail older people.

    Science.gov (United States)

    Chen, Jian Sheng; Cameron, Ian D; Simpson, Judy M; Seibel, Markus J; March, Lyn M; Cumming, Robert G; Lord, Stephen R; Sambrook, Philip N

    2011-02-01

    This study aims to investigate the risk of subsequent fractures after low-trauma fracture in frail older people. A total of 1412 elderly residents (mean age 86.2 years, SD 7.0 years, female 77%) were recruited from aged care facilities in Australia. Residents were assessed and then followed for any fracture for 2 years and hip fractures for at least 5 years. Residents with and without a newly acquired fracture in the first 2 years were compared for risk of subsequent hip fracture. Residents with a nonhip fracture in the first 2 years had an increased risk of subsequent hip fracture for about 2.5 years, whereas those with a hip fracture had a similar risk over the whole period compared with those with no fracture. During these 2.5 years, 60, 28, and 6 subsequent hip fractures occurred in the nonfracture group (n = 953), the nonhip fracture group (n = 194), and the hip fracture group (n = 101), respectively, resulting in the probability of subsequent hip fracture of 8.0%, 19.9%, and 10.4%, respectively. Compared with the nonfracture group, the hazard ratio (HR) was 2.82 [95% confidence interval (CI) 1.73-4.59; p < .001] for the nonhip fracture group and 1.48 (95% CI 0.63-3.49, p = .37) for the hip fracture group after adjusting for age, sex, residence type, calcaneal broadband ultrasound attenuation, fracture history, weight, lower leg length, immobility, cognitive function, and medications. Frail institutionalized older people with newly acquired fractures are at increased risk of subsequent hip fracture for the next few years. Accordingly, despite their advanced age, they are a high-priority target group to investigate interventions that might reduce the risk of hip fracture.

  2. A mechanical model for predicting the probability of osteoporotic hip fractures based in DXA measurements and finite element simulation

    Directory of Open Access Journals (Sweden)

    López Enrique

    2012-11-01

    Full Text Available Abstract Background Osteoporotic hip fractures represent major cause of disability, loss of quality of life and even mortality among the elderly population. Decisions on drug therapy are based on the assessment of risk factors for fracture, from BMD measurements. The combination of biomechanical models with clinical studies could better estimate bone strength and supporting the specialists in their decision. Methods A model to assess the probability of fracture, based on the Damage and Fracture Mechanics has been developed, evaluating the mechanical magnitudes involved in the fracture process from clinical BMD measurements. The model is intended for simulating the degenerative process in the skeleton, with the consequent lost of bone mass and hence the decrease of its mechanical resistance which enables the fracture due to different traumatisms. Clinical studies were chosen, both in non-treatment conditions and receiving drug therapy, and fitted to specific patients according their actual BMD measures. The predictive model is applied in a FE simulation of the proximal femur. The fracture zone would be determined according loading scenario (sideway fall, impact, accidental loads, etc., using the mechanical properties of bone obtained from the evolutionary model corresponding to the considered time. Results BMD evolution in untreated patients and in those under different treatments was analyzed. Evolutionary curves of fracture probability were obtained from the evolution of mechanical damage. The evolutionary curve of the untreated group of patients presented a marked increase of the fracture probability, while the curves of patients under drug treatment showed variable decreased risks, depending on the therapy type. Conclusion The FE model allowed to obtain detailed maps of damage and fracture probability, identifying high-risk local zones at femoral neck and intertrochanteric and subtrochanteric areas, which are the typical locations of

  3. Acute cognitive dysfunction after hip fracture

    DEFF Research Database (Denmark)

    Bitsch, M S; Foss, N B; Kristensen, B B;

    2006-01-01

    BACKGROUND: Patients undergoing hip fracture surgery often experience acute post-operative cognitive dysfunction (APOCD). The pathogenesis of APOCD is probably multifactorial, and no single intervention has been successful in its prevention. No studies have investigated the incidence of APOCD after......, fourth and seventh post-operative days with the Mini Mental State Examination (MMSE) score. RESULTS: Thirty-two per cent of patients developed a significant post-operative cognitive decline, which was associated with several pre-fracture patient characteristics, including age and cognitive function......, but also the number of peri-operative transfusions. The development of APOCD was also associated with impaired post-operative rehabilitation and an increased length of stay. APOCD was associated with the development of a major medical complication in 35% of all patients. In 65% of patients developing APOCD...

  4. Hidden blood loss after surgery for hip fracture

    DEFF Research Database (Denmark)

    Foss, Nicolai Bang; Kehlet, H

    2006-01-01

    Our aim was to determine the total blood loss associated with surgery for fracture of the hip and to identify risk factors for increased blood loss. We prospectively studied 546 patients with hip fracture. The total blood loss was calculated on the basis of the haemoglobin difference, the number ...

  5. Thiazide diuretics and the risk for hip fracture

    NARCIS (Netherlands)

    M. van de Klift (Marjolein); C.E.D. de Laet (Chris); R.M.C. Herings (Ron); Th. Stijnen (Theo); H.A.P. Pols (Huib); B.H.Ch. Stricker (Bruno); M.W.C.J. Schoofs (Marlette); A. Hofman (Albert)

    2003-01-01

    textabstractBACKGROUND: Since most hip fractures are related to osteoporosis, treating accelerated bone loss can be an important strategy to prevent hip fractures. Thiazides have been associated with reduced age-related bone loss by decreasing urinary calcium excretion. OBJECTIVE: To examine the ass

  6. Decreasing incidence of hip fracture in the Funen County, Denmark

    DEFF Research Database (Denmark)

    Nymark, Tine; Lauritsen, Jens; Ovesen, Ole

    2006-01-01

    Hip fracture incidence rates are high, and increase with increasing age. Previous studies have predicted a continued increase in both crude and age-standardized rates.......Hip fracture incidence rates are high, and increase with increasing age. Previous studies have predicted a continued increase in both crude and age-standardized rates....

  7. Feasibility of progressive strength training shortly after hip fracture surgery

    DEFF Research Database (Denmark)

    Overgaard, Jan; Kristensen, Morten T

    2013-01-01

    To investigate the feasibility of a 6-wk progressive strength-training programme commenced shortly after hip fracture surgery in community-dwelling patients.......To investigate the feasibility of a 6-wk progressive strength-training programme commenced shortly after hip fracture surgery in community-dwelling patients....

  8. Fear of falling in older patients after hip fracture

    NARCIS (Netherlands)

    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

  9. External validation of the discharge of hip fracture patients score

    NARCIS (Netherlands)

    Vochteloo, Anne J. H.; Flikweert, Elvira R.; Tuinebreijer, Wim E.; Maier, Andrea B.; Bloem, Rolf M.; Pilot, Peter; Nelissen, Rob G. H. H.

    This paper reports the external validation of a recently developed instrument, the Discharge of Hip fracture Patients score (DHP) that predicts discharge location on admission in patients living in their own home prior to hip fracture surgery. The DHP (maximum score 100 points) was applied to 125

  10. Comparison of the Lag Screw Placements for the Treatment of Stable and Unstable Intertrochanteric Femoral Fractures regarding Trabecular Bone Failure.

    Science.gov (United States)

    Celik, Talip; Mutlu, Ibrahim; Ozkan, Arif; Kisioglu, Yasin

    2016-01-01

    Background. In this study, the cut-out risk of Dynamic Hip Screw (DHS) was investigated in nine different positions of the lag screw for two fracture types by using Finite Element Analysis (FEA). Methods. Two types of fractures (31-A1.1 and A2.1 in AO classification) were generated in the femur model obtained from Computerized Tomography images. The DHS model was placed into the fractured femur model in nine different positions. Tip-Apex Distances were measured using SolidWorks. In FEA, the force applied to the femoral head was determined according to the maximum value being observed during walking. Results. The highest volume percentage exceeding the yield strength of trabecular bone was obtained in posterior-inferior region in both fracture types. The best placement region for the lag screw was found in the middle of both fracture types. There are compatible results between Tip-Apex Distances and the cut-out risk except for posterior-superior and superior region of 31-A2.1 fracture type. Conclusion. The position of the lag screw affects the risk of cut-out significantly. Also, Tip-Apex Distance is a good predictor of the cut-out risk. All in all, we can supposedly say that the density distribution of the trabecular bone is a more efficient factor compared to the positions of lag screw in the cut-out risk.

  11. Comparison of the Lag Screw Placements for the Treatment of Stable and Unstable Intertrochanteric Femoral Fractures regarding Trabecular Bone Failure

    Directory of Open Access Journals (Sweden)

    Talip Celik

    2016-01-01

    Full Text Available Background. In this study, the cut-out risk of Dynamic Hip Screw (DHS was investigated in nine different positions of the lag screw for two fracture types by using Finite Element Analysis (FEA. Methods. Two types of fractures (31-A1.1 and A2.1 in AO classification were generated in the femur model obtained from Computerized Tomography images. The DHS model was placed into the fractured femur model in nine different positions. Tip-Apex Distances were measured using SolidWorks. In FEA, the force applied to the femoral head was determined according to the maximum value being observed during walking. Results. The highest volume percentage exceeding the yield strength of trabecular bone was obtained in posterior-inferior region in both fracture types. The best placement region for the lag screw was found in the middle of both fracture types. There are compatible results between Tip-Apex Distances and the cut-out risk except for posterior-superior and superior region of 31-A2.1 fracture type. Conclusion. The position of the lag screw affects the risk of cut-out significantly. Also, Tip-Apex Distance is a good predictor of the cut-out risk. All in all, we can supposedly say that the density distribution of the trabecular bone is a more efficient factor compared to the positions of lag screw in the cut-out risk.

  12. [Treatment of anemia in hip fracture surgery].

    Science.gov (United States)

    García Pascual, E

    2015-06-01

    Repairing hip fractures is one of the most common surgical procedures and has greater morbidity and mortality. This procedure is also a process that involves a greater need for blood products. Numerous factors influence morbidity, mortality and the use of blood products: patient age, concomitant diseases and drug treatments that change hemostasis and hemorrhaging (preoperative, intraoperative and postoperative), which are usually significant. On top of all this is the presence in a high percentage of cases of preoperative anemia, which can have one or more causes. It is therefore essential to establish an appropriate management of perioperative anemia and optimize the transfusion policy. The aim of this review is to briefly analyze the epidemiology of hip fractures as well as establish a basis for treating perioperative anemia and transfusion policies, proposing guidelines and recommendations for clinical management based on the most current studies. Copyright © 2015 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  13. Effects of depression and antidepressant medications on hip fracture

    Science.gov (United States)

    Cheng, Bi-Hua; Chen, Pau-Chung; Yang, Yao-Hsu; Lee, Chuan-Pin; Huang, Ko-En; Chen, Vincent C.

    2016-01-01

    Abstract This study was conducted to investigate the effects of depression and antidepressant medications on hip fracture. The database of the Taiwan National Health Insurance with medical records of more than 1,000,000 individuals was searched for patients who had hip fracture with or without depression from 1998 to 2009. Patients with the following conditions were excluded: hip fracture due to cancer or traffic accidents, hip fracture that occurred before the diagnosis of depression, and use of antidepressants before the diagnosis of depression. A matched cohort of 139,110 patients was investigated, including 27,822 (17,309 females; 10,513 males) with depression and 111,288 (69,236 females; 42,052 males) without depression (1:4 randomly matched with age, sex, and index date). Among these patients, 232 (158 females and 74 males) had both hip fracture and depression, and 690 (473 females and 217 males) had hip fracture only. The Cox proportional-hazards regression method was used to determine the effect of depression on hip fracture. The hazard ratio (HR) for each clinical parameter was calculated after adjusting for confounders including sex, age, Charlson comorbidity index, urbanization, osteoporosis, and antidepressants. Results showed that patients with major depressive disorder had a 61% higher incidence of hip fracture than those without depression (HR 1.61, 95% confidence interval [CI] 1.19–2.18, P = 0.002). The risk of hip fracture for patients with less severe depressive disorder (dysthymia or depressive disorder, not otherwise specified) was not statistically higher than that of patients with no depression (HR 1.10, 95% CI = 0.91–1.34, P = 0.327). Among the patients with depression, females had a 49% higher incidence for hip fracture than males (HR 1.49, 95% CI 1.30–1.72, P < 0.001). The incidence of hip fracture also increased with age and Charlson comorbidity index scores. Analyses of both all (139,110) patients and only patients (27,822) with

  14. Proximal femoral bone geometry in osteoporotic hip fractures in Thailand.

    Science.gov (United States)

    2015-01-01

    A number of different bone geometries have been reported to be correlated with osteoporosis, bone mineral density and fractures. Those correlations are used for diagnosis, treatment and prediction of fracture risk in osteoporosis cases. However there have been no studies of significant bone parameters predicting osteoporosis and hip fracture in Thailand To evaluate the correlation between geometric parameters of the proximal femur and both the Singh index and bone mineral density as well as to investigate the relationship between those two metrics and osteoporotic hip fracture in the Thai population. Forty-four Thai patients with osteoporotic hip fractures andforty-five healthy Thai people matched for age and gender were included in the present study. Bone mineral density and bone geometry from plain hip radiographs of non-fracture sites in the fracture group and proximal femur radiographs of the same site in the healthy group were measured That data were analyzed to determine levels of correlation. Bone geometries were also analyzed to determine hip fracture predictive capacity. Correlation between the Singh index and bone mineral density was significant (p hip fracture (p = 0.014 and p = 0.035, respectively). Each 1 mm reduction in the width of the femoral medial neck cortex increased the osteoporotic hip fracture risk by a factor of 2.7 (OR = 0.37, 95% CI = 0.15-0.93). In the Thai population, bone geometry from plain radiographs can help predict the risk of osteoporotic hip fracture. Osteoporosis is correlated with a low Singh index value. The width of the femoral medial neck cortex is a reliable predictor of hip fracture risk.

  15. Experiences of well-being and suffering after hip fracture

    DEFF Research Database (Denmark)

    Rasmussen, Birgit; Uhrenfeldt, Lisbeth

    Background: Dependency and limited functional ability is common when older people fracture their hip. Experiences of well-being seem to be important during recovery and when living with a hip fracture as a balancing of suffering. Evidence exists that self-confidence is important during...... rehabilitation and when managing in everyday life after hip fracture. Identifying the meaning of a hip fracture in older people can provide a deeper understanding of what matters during rehabilitation and when managing in everyday life. Aim: To aggregate, appraise, interpret and synthesize findings from...... qualitative studies of lived experiences of well-being and suffering within one year after discharge with hip fracture. Method: Following the methodology of the Joanna Briggs Institute, a three-step literature search strategy was developed. Initially, a structured search was performed in the databases CINAHL...

  16. PFNAⅡ治疗股骨转子间及转子下骨折的临床研究%Clinical study of PFNA Ⅱ in the treatment of femoral intertrochanteric fracture and subtrochanteric fracture

    Institute of Scientific and Technical Information of China (English)

    于博凡; 陈光; 刘涛; 程应全; 王伟

    2014-01-01

    目的 探讨PFNAⅡ系统在治疗股骨转子间及转子下骨折的疗效.方法 应用PFNAⅡ内固定治疗系统对68例股骨转子间及转子下骨折的患者进行治疗.结果 随访6~ 24个月,平均12.3个月,骨折全部愈合.根据Harris评分:优54例,良9例,中2例,优良率95.6%.结论 PFNAⅡ对股骨转子间及转子下骨折的治疗具有微创、操作简便、术后并发症少的特点,值得推广.%Objective To analyze the effect of PFNA on femoral intertrochanteric fracture and subtrochanteric fracture.Methods The internal fixation treatment system of PFNA Ⅱ was applied to 68 patients with intertrochanteric fracture and subtrochanteric fracture.Results The 68 patients were followed up for an average of 12.3 months (6-24 months).All the factures were healed.According to the Harris rating system,54 cases turned out to be excellent,9 cases were good and 2 cases were fair.The excellent rate was 95.6%.Conclusions PFNA Ⅱ is minimally invasive,easy and convenient to operate.It is a good internal fixation method with less complications to treat femoral intertrochanteric fracture and subtrochanteric fracture.

  17. Red Flags Are Missed in the Prevention of Hip Fractures: Baseline Results of the Zurich Hip Fracture Trial

    Science.gov (United States)

    From January 2005 to December 2007, we recruited 173 patients age 65 and older with acute hip fracture and a Folstein mini mental score of at least 15 into an ongoing double-blind RCT with vitamin D. 69% of hip fracture patients were admitted from home and 31% from institutions, 79% were women. Mean...

  18. Hip fractures. Epidemiology, risk factors, falls, energy absorption, hip protectors, and prevention

    DEFF Research Database (Denmark)

    Lauritzen, J B

    1997-01-01

    on the hip. Women with hip fractures have a lower body weight compared with controls, and they may also have less soft tissue covering the hip even when adjusted for body mass index, indicating a more android body habitus. Experimental studies show that the passive energy absorption in soft tissue covering...

  19. Femoral neck non-union treatment by valgus intertrochanteric osteotomy

    Science.gov (United States)

    Schwartsmann, Carlos Roberto; Spinelli, Leandro de Freitas; Yépez, Anthony Kerbes; Boschin, Leonardo Carbonera; Silva, Marcelo Faria

    2015-01-01

    ABSTRACT OBJECTIVE : The purpose of this study was to evaluate the performance of valgus intertrochanteric osteotomy in femoral neck non-union. METHODS : Forty-two patients with femoral neck fractures with non-union treated using Pauwels' intertrochanteric osteotomy were reviewed. Demographics, time elapsed between fracture and surgery, follow--up, osteosynthesis used, Garden's classification, limb shortening, and x-rays were evaluated. RESULTS : Twenty-two men and 20 women were reviewed. The youngest patient was 18 years old and the oldest 65 years old, with a mean age of 42.4 years (±11.2). The minimum follow-up was 2 years, with a mean of 10.2 years. The average time elapsed between initial fracture and osteotomy was 6.5 months. Twel-ve cases were neglected femoral neck fractures. Nineteen patients were classified as Garden III, and 23 patients as Garden IV. After valgus osteotomy, non-union healing was observed in 38 patients (38/42; 90.4%). Healing of thirty-seven cases of pseudoarthrosis were obtained after the first-attempt osteotomy, and one case required two operations for healing. The osteotomy failed in four cases. Conside-ring the healed osteotomies, good to excellent functional results were achieved in 80.9% (34/42) of the patients. Total hip replacement was subsequently performed in 14.2% (6/42) of the patients for unfavoura-ble outcomes (two for cutting out, two for osteonecrosis, and two for osteoarthritis). CONCLUSIONS : Valgus intertrochanteric osteotomy has a high success rate in archiving healing in femoral neck non-union with good functional results. It is a biological and effective method. Level of Evidence IV, Therapeutic Study. PMID:27057146

  20. Incidence and socioeconomic burden of hip fractures in Italy

    Directory of Open Access Journals (Sweden)

    A. Angeli

    2011-09-01

    Full Text Available Objectives: The aim of this study was to evaluate the trend of the incidence and costs of hip fractures in Italy. Methods: The incidence of hip fractures after 45 years of age in both females and males during the years 1999-2002 was obtained by analyzing the Italian Ministry of Health national hospitalization database, according to the diagnosis codes of International Classification of Diseases, Clinical Modification, 9° edition (IDC-9-CM that indicate femoral fracture. We have computed all direct costs sustained by the National Health Service for hospitalization and treatment of hip fractures on the basis of the value of the Diagnosis Related Groups (DRG referring to hip fractures. The expenses of rehabilitation and indirect expenses were based on estimates. Results: In 2002, more than 86,000 hip fractures were registered in Italy in male and female patients over 45 years old, with 9% progression compared to 1999; 77% were female and 80% were over 75 years of age. In 2002 the direct costs of hospitalization, in the patients over 65 years alone, were almost 400 milion euros, with an increase of 15% as compared to 1999. Considering also estimated rehabilitation costs, social aid and indirect costs, we estimate that hip fractures due to age-related osteoporosis created over a billion euros in expenses in 2002. Conclusions: Preventive intervention regarding the risk of hip fracture in elderly patients is urgent.

  1. Clinical experience in the treatments of femoral intertrochanteric fracture in seniors with PFNA%PFNA治疗老年股骨粗隆间骨折临床疗效分析

    Institute of Scientific and Technical Information of China (English)

    商建磊; 封吉亮

    2013-01-01

    Objective To sum up the clinical effect and complications in curing femoral intertrochanteric fracture with proximal femoral nail anti-rotation(PFNA,for short). Methods 24 cases of femoral intertrochanteric fracture undergone PFNA treatment were retrospectively analyzed. Operation time, blood loss, postoperative complications and time of fracture union et al were observed and statistic data of joint function scores was made. Results Mean operating time was 76 minutes and mean bleeding volume during operation was 84.7mL.Deep venous thrombosis, infection, breaking nail and incising head of femur with helical cutting edges et al.appeared in no patients.1 case of hypovolemic shock after the operation and 2 cases of shortening deformity of coxa vara appeared.All got bony healing and the average healing time was 14 weeks.The hip-joint function scores showed that results were excellence in 18 cases,good in 4 cases,medium in 1case,and poor in 1 case. Conclusion PFNA had some advantages in treatments of femoral intertrochanteric fracture,such as seniors high fixation strength, slight injury and good biomechanical characteristics,but the hidden blood loss needed to be paid more attentionduring the perioperative period in the clinical application.%目的探讨股骨近端抗旋髓内钉(PFNA)治疗老年股骨粗隆间骨折的临床效果及并发症。方法将我院收治的老年股骨粗隆间骨折患者48例作为临床研究对象,随机分为治疗组和对照组,各24例,治疗组给予PFNA手术治疗,对照组给予DHS治疗,观察两组患者的手术时间、术中出血量、术后并发症、骨折愈合时间等,统计关节功能评分情况。结果两组手术时间、术中出血量比较,差异具有统计学意义(P<0.01);所有患者随访中均未出现下肢深静脉血栓、感染、断钉、螺旋刀片切割股骨头等,术后出现低血容量性休克1例,出现髋内翻短缩畸形2例,所有患

  2. Increased cortical porosity in women with hip fracture.

    Science.gov (United States)

    Sundh, D; Nilsson, A G; Nilsson, M; Johansson, L; Mellström, D; Lorentzon, M

    2017-05-01

    Hip fractures cause increased mortality and disability and consume enormous healthcare resources. Only 46% of hip fracture patients have osteoporosis at the total hip according to dual-energy X-ray absorptiometry (DXA) measurement. Cortical porosity increases with ageing and is believed to be important for bone strength. To investigate whether older women with hip fracture have higher cortical porosity than controls, and if so whether this difference is independent of clinical risk factors and areal bone mineral density (aBMD). From an ongoing population-based study, we identified 46 women with a prevalent X-ray-verified hip fracture and 361 control subjects without any fractures. aBMD was measured with DXA. High-resolution peripheral quantitative computed tomography was used to measure bone microstructure at the standard (ultradistal) site and at 14% (distal) of the tibial length. Women with a previous hip fracture had lower aBMD at the femoral neck (-11.8%) and total hip (-14.6%) as well as higher cortical porosity at the ultradistal (32.1%) and distal (29.3%) tibia compared with controls. In multivariable logistic regression analysis, with adjustment for covariates (age, height, weight, smoking, calcium intake, physical activity, walk time, oral glucocorticoids, parental hip fracture, rheumatoid arthritis, previous fall, current bisphosphonate treatment and femoral neck aBMD), cortical porosity at the ultradistal [odds ratio per standard deviation increase (95% confidence interval) 2.61 (1.77-3.85)] and distal [1.57 (1.12-2.20)] sites was associated with prevalent hip fracture. Cortical porosity was associated with prevalent hip fracture in older women independently of femoral neck aBMD and clinical risk factors. © 2017 The Authors. Journal of Internal Medicine published by John Wiley & Sons Ltd on behalf of Association for Publication of The Journal of Internal Medicine.

  3. Peripheral nerve blocks for hip fractures.

    Science.gov (United States)

    Guay, Joanne; Parker, Martyn J; Griffiths, Richard; Kopp, Sandra

    2017-05-11

    Various nerve blocks with local anaesthetic agents have been used to reduce pain after hip fracture and subsequent surgery. This review was published originally in 1999 and was updated in 2001, 2002, 2009 and 2017. This review focuses on the use of peripheral nerves blocks as preoperative analgesia, as postoperative analgesia or as a supplement to general anaesthesia for hip fracture surgery. We undertook the update to look for new studies and to update the methods to reflect Cochrane standards. For the updated review, we searched the following databases: the Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 8), MEDLINE (Ovid SP, 1966 to August week 1 2016), Embase (Ovid SP, 1988 to 2016 August week 1) and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (EBSCO, 1982 to August week 1 2016), as well as trial registers and reference lists of relevant articles. We included randomized controlled trials (RCTs) involving use of nerve blocks as part of the care provided for adults aged 16 years and older with hip fracture. Two review authors independently assessed new trials for inclusion, determined trial quality using the Cochrane tool and extracted data. When appropriate, we pooled results of outcome measures. We rated the quality of evidence according to the GRADE Working Group approach. We included 31 trials (1760 participants; 897 randomized to peripheral nerve blocks and 863 to no regional blockade). Results of eight trials with 373 participants show that peripheral nerve blocks reduced pain on movement within 30 minutes of block placement (standardized mean difference (SMD) -1.41, 95% confidence interval (CI) -2.14 to -0.67; equivalent to -3.4 on a scale from 0 to 10; I(2) = 90%; high quality of evidence). Effect size was proportionate to the concentration of local anaesthetic used (P mobilization after surgery (mean difference -11.25 hours, 95% CI -14.34 to -8.15 hours; I(2) = 52%; moderate quality of evidence). One trial

  4. Early total hip arthroplasty for severe displaced acetabular fractures

    Institute of Scientific and Technical Information of China (English)

    YANG Shu-hua; ZHANG Yu-kun; XU Wei-hua; LI Jin; LIU Guo-hui; YANG Cao; LIU Yong; TIAN Hong-tao

    2006-01-01

    Objective : To investigate the effect of early total hip arthroplasty for severe displaced acetabular fractures.Methods: Total hip arthroplasty was performed on 17 cases of severe fracture of the acetabulum from 1997 to 2003. The mean follow-up was 2.1 years (1-6 years) and the average period from fracture to operation was 8 days (5-21 day). The average age of the patients was 53 years (26-69 years).Results: At the final follow-up the Harris hip score averaged 82(69-100) points and 15 cases have got a good outcome. There was one case of heterotopic bone formation. There were no radiographic evidences of late loosening of the prosthesis. One patient had severe central displacement of the cup.Conclusions: In patients with severe displaced acetabular fractures, particularly in elderly patients, early total hip arthroplasty is probably an alternative efficient way to achieve a painless and stable hip.

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

    Science.gov (United States)

    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. Older peoples' lived experiences after hip fracture

    DEFF Research Database (Denmark)

    Rasmussen, Birgit; Uhrenfeldt, Lisbeth

    add to the load of wellbeing-challenges after HF. Evidence-based knowledge in order to address the wellbeing of older people and the challenges they meet in changing times after HF is needed for professionals. Aim To explore the support older people with HF may need to optimize their wellbeing during...... changes in their daily life. Method A PhD study is initiated conducting a systematic review; establishing a steering-group with hospital and community representatives in order to clarify organizational needs in a homecare setting; developing a phenomenological-hermeneutic study design guided......Background Older people's hip fracture (HF) may occur due to osteoporosis, impaired balance or other health problems. For the individual, the experience of changes in wellbeing and/or changes in a recent active everyday-life; new health problems such as dependency, pain and a fear of falling may...

  7. Physical Activity and Hip Fracture Disability: A Review

    Science.gov (United States)

    Marks, Ray

    2011-01-01

    Objective. The present paper examines pertinent literature sources published in the peer-reviewed English language between 1980 and November 1, 2010 concerning hip fractures. The aim was to highlight potential intervention points to offset the risk of incurring a hip fracture and its attendant disability. Methods. An in-depth search of the literature using the key terms: disability, epidemiology, hip fracture, prevention, and risk factors was conducted, along with data from the author's research base detailing the disability associated with selected hip fracture cases. All articles that dealt with these key topics were reviewed, and relevant data were tabulated and analyzed. Results. Hip fractures remain an important but potentially preventable public health problem. Among the many related remediable risk factors, low physical activity levels are especially important. Related determinants of suboptimal neuromuscular function also contribute significantly to hip fracture disability. Conclusion. Physical activity participation can help to reduce the prevalence and excess disability of hip fractures and should be encouraged. PMID:21584248

  8. [Delirium prevention and treatment in elderly hip fracture].

    Science.gov (United States)

    Robles, María José; Formiga, Francesc; Vidán, M Teresa

    2014-04-22

    The fracture of the proximal femur or hip fracture in the elderly usually happens after a fall and carries a high morbidity and mortality. One of the most common complications during hospitalization for hip fracture is the onset of delirium or acute confusional state that in elderly patients has a negative impact on the hospital stay, and prognosis, worsening functional ability, cognitive status and mortality. Also the development of delirium during hospitalization increases health care costs. Strategies to prevent and treat delirium during hospitalization for hip fracture have been less studied. In this context, this paper aims to conduct a review of the literature on strategies that exist in the prevention and treatment of delirium in elderly patients with hip fracture.

  9. OCCURRENCE AND INCIDENCE OF THE 2ND HIP FRACTURE

    DEFF Research Database (Denmark)

    SCHRODER, HM; Petersen, KK; ERLANDSEN, M

    1993-01-01

    During a 16-year period, 256 second hip fractures were found in 3898 persons 40 years of age and older who had a previous hip fracture. Ninety-two percent of the second fractures were contra-lateral, and 68% of these were the same type as the first. Thus, 62% of the femoral neck and 72......% of the trochanteric fractures were preceded by a contra-lateral fracture of the same type. The mean interval between fractures was 3.3 years, and there was no significant difference between genders or among fracture types. The risk of the first fracture was 1.6 per 1000 men per year and 3.6 per 1000 women......, and for the second fracture 15 per 1000 men per year and 22 per 1000 women. This increase was highly significant for both genders, especially for men....

  10. Perioperative nursing care of elderly patients with intertrochanteric fracture%高龄股骨粗隆间骨折围手术期护理

    Institute of Scientific and Technical Information of China (English)

    孙琳琳

    2011-01-01

    目的 总结高龄股骨粗隆间骨折围手术期的护理措施,降低围手术期的并发症.方法 本组65例高龄股骨粗隆间骨折患者,均患有不同程度的冠心病、糖尿病、高血压等老年性疾病,待患者能够耐受麻醉及手术时行手术治疗,非手术患者行皮肤牵引.指导患者功能锻炼,预防感染、消肿、营养支持治疗.结果 手术后第10天因多脏器功能衰竭死亡1例,术后第5天并发脑血栓形成1例,围手术期内发生肺栓塞1例,肺部感染1例,压疮1例.结论 高龄股骨粗隆间骨折患者需完善围手术期的护理工作,预防并发症,提高机体的抗手术打击能力,才能减少并发症、后遗症,降低死亡率.%Objective To explore the clinical nursing intervention for the elderly with intertrochanteric fracture and preventive measures for complications during perioperative. Methods Sixty - five patients with intertrochanteric fractures were treated. All the patients suffered from different degree coronary heart disease, diabetes, hypertension geriatric diseases and so on. All the patients endured the anesthesia and operation. Non - operation patients were treated with traditional skin traction. The patients were guided to do the exercise effectively to prevent wound infection, reduce the swelling, and have better nutrition support. Results One case died of MODs 10 days after surgery, brain thrombus occurred in 1 case 5 days after surgery, pulmonary embolism occurred in 1 case during perioperative, pulmonary infection occurred in 1 case, and bedsore occurred in 1 case.Conclusion The elderly patient with intertrochanteric fracture should actively complete nursing intervention to reduce the complications and improve the ability of enduring the anesthesia and operation. It can reduce complications, sequelea, and mortality.

  11. Application of 3D printing fracture models in treatment of intertrochanteric fracture%3D打印骨折模型在股骨转子间骨折治疗中的应用

    Institute of Scientific and Technical Information of China (English)

    冒锋涌; 姚庆强; 郑朋飞; 谭立文; 刘帅; 张翔; 顾强荣; 徐燕; 王黎明

    2016-01-01

    the surgery and 15 did not.CT scanning was performed for the patients in 3D printing model group.Their anatomical data of.Dicom form were reconstructed into the.STL form data through M3D software.The 3D printing model was constructed using fused deposition modeling (FDM) technique.The length and diameter of the main screw and blade were measured based on the 3D printing prototyping before surgical planning.The 2 groups were compared in terms of operation time,intraoperative blood loss,postoperative drainage volume,hospital stay and Harris hip score at the final follow-up.Results No significant differences were found in the 3D printing model between surgical planning and actual operation in the respects of diameter of main PFNA screw (9.42 ± 0.64 mm versus 9.58 ± 0.76 mm),length of main PFNA screw (177.50±12.90 mm versus 178.33±20.34 mm),or length of blade (84.58±5.94 mm versus 85.42 ±5.57 mm) (P > 0.05).The 27 patients obtained an average follow-up of 12.4 months (from 10 to 16 months).The operation time (47.8 ± 5.1 min),intraoperative blood loss (101.6 ± 3.9 mL) and postoperative drainage volume (47.3 ± 5.9 mL) in the 3D printing model group were significantly less than those in the conventional group (61.1 ±7.5 min,122.3 ±9.8 mL and 58.6 ±6.3 mL,respectively) (P < 0.05).There were no significant differences between the 2 groups in hospital stay or Harris hip score at the final follow-up (P >0.05).Both groups obtained fine fracture union.No varus deformation of the hip joint or failure of implants was observed during the follow-up period.Conclusion 3D printing technique can manufacture an accurate model of intertrochanteric fracture,which may play an important role in improving efficiency and accuracy of reduction and PFNA fixation.

  12. The effects of liberal versus restrictive transfusion thresholds on ambulation after hip fracture surgery

    DEFF Research Database (Denmark)

    Foss, Nicolai B; Kristensen, Morten Tange; Jensen, Pia Søe;

    2009-01-01

    BACKGROUND: Perioperative anemia leads to increased morbidity and mortality and potentially inhibits rehabilitation after hip fracture surgery. As such, the optimum transfusion threshold after hip fracture surgery is unknown. PATIENTS AND METHODS: A total of 120 elderly, cognitively intact hip...

  13. Evaluation of Osteoporosis in Patients with Hip Fracture - Original Investigation

    Directory of Open Access Journals (Sweden)

    Firuzan Altın

    2007-03-01

    Full Text Available Aim: The aim of this study is to determine the state of osteoporosis and treatment in patients with osteoporotic hip fracture. Patients and Methods: 39 patients enrolled in this study that were above 50 years with an atraumatic hip fracture and operated in 1. and 2. Department of Orthopedics and Traumatology. Istanbul Training and Research Hospital, in our study (31 women, 8 men we investigate patients about risk factors of osteoporosis, before and after fracture severity of osteoporosis, treatment of osteoporosis. Patients who are younger than 50 years, and immobilized for long time, have pathological fracture, hip fracture is 2 cm distal than minor trochanter; are taken out from our study. Results: There is not significant difference between type of fracture, age, sex and risk factors. Before fractured 5 patients were diagnosed as osteoporosis and only 4 of them had been using antiresorptive, vitamin D, and calcium preparats. 36 patients that we studied never examined and treated for osteoporosis. All patients participating in study were informed about osteoporosis. Each patient was asked to apply for physical therapy and rehabilitation department with result of lumber and femoral bone mineral density measurement. Conclusion: Patients who had recent osteoporotic fractures must be treated to prevent new fracture. Orthopedic doctors should care osteoporosis and a new fracture risk as a serious important complication of osteoporotic hip fracture. (From the World of Osteoporosis 2007;13:11-4

  14. Missed opportunities for prevention of hip fracture in older patients

    Directory of Open Access Journals (Sweden)

    Dubljanin-Raspopović Emilija

    2012-01-01

    Full Text Available Background/Aim. Osteoporotic fractures are a major cause of morbidity in the population. Therefore, fracture prevention strategies should be a major concern, and one of the priorities in the primary health care system. The aim of the study was to assess fracture and fall risk factors, and fracture risk level in patients with acute hip fracture, and to evaluate if there had been adequate osteoporosis treatment prior to fracture in this group of patients. Methods. Fracture and fall risk factors were assessed in 342 patients, ≥ 65 years old, hospitalized due to acute hip fracture at the Clinic for Orthopedic Surgery and Traumatology, Clinical Centre of Serbia in a 12-month period. Fall risk factors were assessed with the Fracture Risk Assessment (FRAX® algorithm, and patients were classified in respect to fracture risk level. Results. Hip fracture occurred in the majority of the patients in the high risk group (74.2%, where no additional bone mineral density testing was needed. Less than 10% of the patients had a diagnosis of osteoporosis before injury, while less than 2% were treated. Cognitive impairment (95.3%, visual impairment (58.2%, lower index of daily activities (51.8%, and depression (47.1% were the most frequently observed fall risk factors. Conclusion. The results of our investigation reveal insufficient identification of clinical fracture risk factors in the primary care setting, inadequate treatment of osteoporosis and, consequently, ineffective prevention of hip fractures in the geriatric population. The introduction of FRAX® into clinical practice enables more effective acknowledgment of patients with elevated fracture risk, even if bone density measurement is not available. The results of this study have a special significance for everyday clinical practice, because they impose a need for reviewing the existing approaches to osteoporosis prevention, and precise definiment of hip prevention strategies.

  15. Post-operative rounds by anaesthesiologists after hip fracture surgery

    DEFF Research Database (Denmark)

    Foss, N B; Christensen, D S; Krasheninnikoff, M

    2006-01-01

    Efforts to optimize the peri-operative care of hip fracture patients through multidisciplinary intervention have focused on orthopaedic-geriatric liaisons, which have not resulted in significant outcome changes. The early phase of rehabilitation could potentially be optimized through...

  16. Proximal femoral nail antirotation for treatment of intertrochanteric fractures: an analysis of 112 patients%股骨近端防旋髓内钉治疗老年股骨转子间骨折112例

    Institute of Scientific and Technical Information of China (English)

    李慧武; 孙月华; 史定伟; 唐坚; 俞超; 龚伟华; 朱振安; 王友; 戴尅戎

    2011-01-01

    -energy injury in 15.The Salvati-Wilson score was used to evaluate the hip function postoperatively.Results Ninety patients received 12-24 months follow-up (average 18.6 months).The Salvati-Wilson score was (29.98 ± 5.18 ) points.The result was excellent in 41 patients,good in 40,fair in 6 and poor in 3,with excellenct rate of 90%.The introduction of the nail in operation was difficult in 22 patients,of which 3 patients suffered femoral cortex rupture.Displacement or separation of the fracture segments occurred in 34 patients and distal locking difficulty in nine during the screw blade tapping process.Local complications included hip pain in 21 patients,thigh pain in 4,apparent coxa vara in 2 and delayed healing in 7.There were no cutting-out or femoral shaft fractures no matter what type of Singh index was.The systemic complications included cardiovascular and cerebrovascular disease in one patient,pulmonary infection in four,deep vein embolism in one and perineum congestion or swelling in seventeen.Conclusion PFNA is effective in treating intertrochanteric fractures especially osteoporotic fractures,but delayed healing of the fractures and the mismatch between the intramedullary nail and the proximal femoral morphology remain to be addressed.

  17. Focal osteoporosis defects play a key role in hip fracture.

    Science.gov (United States)

    Poole, Kenneth E S; Skingle, Linda; Gee, Andrew H; Turmezei, Thomas D; Johannesdottir, Fjola; Blesic, Karen; Rose, Collette; Vindlacheruvu, Madhavi; Donell, Simon; Vaculik, Jan; Dungl, Pavel; Horak, Martin; Stepan, Jan J; Reeve, Jonathan; Treece, Graham M

    2017-01-01

    Hip fractures are mainly caused by accidental falls and trips, which magnify forces in well-defined areas of the proximal femur. Unfortunately, the same areas are at risk of rapid bone loss with ageing, since they are relatively stress-shielded during walking and sitting. Focal osteoporosis in those areas may contribute to fracture, and targeted 3D measurements might enhance hip fracture prediction. In the FEMCO case-control clinical study, Cortical Bone Mapping (CBM) was applied to clinical computed tomography (CT) scans to define 3D cortical and trabecular bone defects in patients with acute hip fracture compared to controls. Direct measurements of trabecular bone volume were then made in biopsies of target regions removed at operation. The sample consisted of CT scans from 313 female and 40 male volunteers (158 with proximal femoral fracture, 145 age-matched controls and 50 fallers without hip fracture). Detailed Cortical Bone Maps (c.5580 measurement points on the unfractured hip) were created before registering each hip to an average femur shape to facilitate statistical parametric mapping (SPM). Areas where cortical and trabecular bone differed from controls were visualised in 3D for location, magnitude and statistical significance. Measures from the novel regions created by the SPM process were then tested for their ability to classify fracture versus control by comparison with traditional CT measures of areal Bone Mineral Density (aBMD). In women we used the surgical classification of fracture location ('femoral neck' or 'trochanteric') to discover whether focal osteoporosis was specific to fracture type. To explore whether the focal areas were osteoporotic by histological criteria, we used micro CT to measure trabecular bone parameters in targeted biopsies taken from the femoral heads of 14 cases. Hip fracture patients had distinct patterns of focal osteoporosis that determined fracture type, and CBM measures classified fracture type better than a

  18. Incidence of Hip Fractures among Iranian Elderly Population

    Directory of Open Access Journals (Sweden)

    A Moayyeri

    2004-03-01

    Full Text Available Hip fracture, the most dramatic complication of osteoporosis, constitutes a serious health problem of the elderly, with great socioeconomic consequences. Hip fracture epidemiology has been studied by many investigators. Until now, there are no reported studies in Iran regarding this issue. We studied hip fractures that occurred in Iran in 2003 and compared the findings with those of other countries. Data used were obtained from the Iranian Multicenter Study on Accidental Injuries, a large-scale population-based study conducted in 9 provinces across the country. The study was conducted by the Ministry of Health and Medical Education and continued for 135 days (4.5 months in all centers, beginning in a date between 15 June 2003 and 15 July 2003 for each center. A total of 1482 new cases of hip fracture (1079 male, 403 female were recorded during the study period. The crude annual incidence of hip fracture (per 100000 person-years was 59.8 in men and 23.5 in women. The incidence rates increased exponentially after the age of 60 in both genders and nearly tripled after each decade. In comparison with hip fracture incidence rates of other countries, Iranian rates are considerably lower than other Asian, European, and American countries. The reasons for this low incidence rate remain uncertain. With increase in life span, rapid economic development and aging of the population, hip fracture will become a major health problem in Iran and studies are needed to increase awareness of osteoporosis and to monitor the epidemiology of hip fractures.

  19. Three-dimensional finite element analysis of unstable intertrochanteric fracture in different fixation ways%不稳定股骨转子间骨折不同内固定方式的三维有限元分析

    Institute of Scientific and Technical Information of China (English)

    陈少明; 邱玉金; 卢斌; 杨志强; 王宝九; 冯振东

    2016-01-01

    优缺点,可以根据需要选择合适的内固定装置。%BACKGROUND:The morphological and mechanical transfers of unstable intertrochanteric fractures were complicated, so it is difficult to analyze the biomechanical characteristicsof the common experimental methods in a comprehensive way. Moreover, the high cost, long cycle and poor repeatability of common tests limit its application in biomechanics. OBJECTIVE:To analyze the biomechanical characteristics of unstable intertrochanteric fracture in different fixation ways by three-dimensional finite element analysis. METHODS:Intertrochanteric fracture locking dynamic hip fixation model (C1), Gamma nail fixation model (C2) and proximal femoral anatomical locking plate model (C3) were established. The distal end of the femur was fixed, and subjected to the hip reaction force of 2800 N and abduction muscle strength of 1 200 N. Three-dimensional finite element analysis was used to analyze the stress distribution, stress concentration and maximum displacement of unstable intertrochanteric fracture in three different fixation ways. RESULTS AND CONCLUSION:(1) Stress: the anterolateral stress and anteromedial stress of C3 were the maximum. Posterolateral stress and posteromedial stress ofC3 were the minimum. There were significant differences among the three groups (alP< 0.05). (2) Stress of fracture space: significant differences in anterolateral stress, anteromedial stress, posterolateral stress and posteromedial stress were determined in C1, C2 and C3 (P< 0.05). Anterolateral stress of C3 was significantly less than anterolateral stresses of C1 and C2 (P< 0.05). Anteromedial stress of C3 was significantly less than that of C1 and C2 (P< 0.05). Posterolateral stress of C1 was significantly larger than that of C2 and C3 (P<0.05). Posteromedial stress of C1 was significantly larger than that of C2 (P< 0.05). Posteromedial stress of C3 was significantly less than that of C1 and C2 (P< 0.05). (3) Significant differences

  20. Distinct Cognitive Trajectories in the First Year After Hip Fracture

    NARCIS (Netherlands)

    Beishuizen, Sara J. E.; van Munster, Barbara C.; de Jonghe, Annemarieke; Abu-Hanna, Ameen; Buurman, Bianca M.; de Rooij, Sophia E.

    ObjectivesChange in cognitive functioning is often observed after hip fracture. Different patterns, with both improvement and decline, are expected, depending on premorbid cognitive functioning and events that occur during hospitalization. These patterns are unknown and important for older hip

  1. 三种手术方法治疗老年股骨粗隆间骨折的比较研究%The comparative study of three kinds of surgical method treatments of senile intertrochanteric fractures

    Institute of Scientific and Technical Information of China (English)

    王黎明; 邱冠军; 张伟东; 曲洪雪

    2011-01-01

    [ Objective] To investigate the therapeutic effects of three kinds of treatment method on femoral intertrochanteric fractures. [ Method] We retrospectively reviewed the clinical and radiological records of 133 patients with femoral intertrochanteric fracture using three different treatments:unilateral external fixtion apparatus(group A,n =41),dynamic hip screw(group B,n = 47), internal fixation of locked plate (group C,n =45) ,who were treated in our hospital from January 2004 to December 2009. The union of fracture and weight loading time, the incidence of complications, the opetation time, the average length of stay, the functional evaluation of hip joint (the rates of excellent and good results) were compared and the curative effects were analyzed for different methods. [Result] All the patients were followed up for 16 months (range,8 to 31 months). The union of fracture time had no statistical significance(P>0.05), but weight loading time and incidence of complications had statistical significance a-mong the three groups (P<0.05). Among the three groups,the incision length,operation time,blood loss and drainage in group A were less than those in other two groups. According to the Harris hip functional standard score,there were significant diference between group C and each of other two groups ( P < 0.05 ). [ Conclusion ] The internal fixation of locked plate is a good choice for treating femoral intertrochanteric fracture. The earlier weight loading,the better recovery of hip joint function,the fewer complications were fonnd in internal fixation of locked plate group.%[目的]分析单边外固定支架、DHS与锁定钢板治疗股骨粗隆间骨折的疗效.[方法]2004年1月~2009年12月,采用单边外固定支架、DHS、锁定钢板内同定3种方法治疗133例股骨粗隆间骨折患者.采用回顾性方法,分析临床资料及疗效.其中单边外固定支架固定治疗(A组)41例,DHS内固定治疗(B组)47例,

  2. Factors affecting functional prognosis of patients with hip fracture

    DEFF Research Database (Denmark)

    Kristensen, M T

    2011-01-01

    . 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......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...... 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...

  3. Caffeine and the risk of hip fracture: the Framingham Study.

    Science.gov (United States)

    Kiel, D P; Felson, D T; Hannan, M T; Anderson, J J; Wilson, P W

    1990-10-01

    Caffeine increases urinary calcium output and has been implicated as a risk factor for osteoporosis. The authors examined the effect of caffeine on hip fracture risk in 3,170 individuals attending the 12th (1971-1973) Framingham Study examination. Coffee and tea consumption, age, Framingham examination number, weight, smoking, alcohol consumption, and estrogen use were used to evaluate hip fracture risk according to caffeine intake. Hip fractures occurred in 135 subjects during 12 years of follow-up. Fracture risk over each 2-year period increased with increasing caffeine intake (one cup of coffee = one unit of caffeine, one cup of tea = 1/2 unit of caffeine). For intake of 1.5-2.0 units per day, the adjusted relative risk (RR) of fracture was not significantly elevated compared with intake of one or less units per day. Consumption of greater than or equal to 2.5 units per day significantly increased the risk of fracture. Overall, intake of greater than two cups of coffee per day (four cups of tea) increased the risk of fracture. In summary, hip fracture risk was modestly increased with heavy caffeine use, but not for intake equivalent to one cup of coffee per day. Since caffeine use may be associated with other behaviors that are, themselves, risk factors for fracture, the association may be indirect. Further studies should be performed to confirm these findings.

  4. TIP APEX DISTANCE OF INTRAMEDULLARY DEVICES AS A PREDICTOR OF CUT-OUT FAILURE IN TREATMENT OF PERITROCHANTERIC ELDERLY HIP FRACTURES

    Directory of Open Access Journals (Sweden)

    Purushotham K

    2017-02-01

    Full Text Available BACKGROUND A Tip-Apex Distance (TAD of greater than 25 mm has been shown to be an accurate predictor of lag screw cut-out when Sliding Hip Screws (SHS are used to treat Peritrochanteric (PT fractures. The purpose of this study was to determine, which factors, including TAD correlated with successful clinical outcomes of PT hip fractures surgically treated with intramedullary devices. MATERIALS AND METHODS A total of 72 patients were included in this retrospective study. TAD values were radiographically analysed at a mean follow up of 13 months. This was correlated with limited functional status and rate of revision for implant failure or inability to achieve fracture union. Only 62 patients had adequate follow up to fracture union or definitive failure. RESULTS There were 36 intertrochanteric fractures and 26 subtrochanteric fractures. Overall, 5 patients (9.8% went on to experience lag screw cut out. The average TAD of patients who did not cut-out was 18 mm compared to 38 mm for those who did (p=0.012. All patients who cut-out had IT fractures. CONCLUSION The percentage of cut-outs correlated clinically to both the severity of IT fractures and the TAD. Using a cut-off of 25 mm, there was a statistically significant difference in the incidence of lag screw cut-out (p<0.001. As in sliding hip screw, surgeons should strive for a TAD less than 25 mm when using IM devices in the treatment of PT hip fractures to help avoid lag screw cut-out.

  5. Anemia on Admission Is an Independent Predictor of Long-Term Mortality in Hip Fracture Population

    Science.gov (United States)

    Zhang, Licheng; Yin, Pengbin; Lv, Houchen; Long, Anhua; Gao, Yuan; Zhang, Lihai; Tang, Peifu

    2016-01-01

    Abstract Anemia is a disputable factor for long-term mortality in hip fracture population in previous studies. Previous studies indicated that the level of hemoglobin (Hb) might fluctuate due to various factors, such as comorbidities and in-hospital interventions, and the changing level of Hb, may lead to discordance diagnosis of anemia and thus to the conflicting conclusions on prognostic value of anemia. So in this study, we aim to compare factors affecting the diagnosis of anemia at different time-points, admission, postoperation, and discharge, and to determine which the time point is most suitable for mortality prediction. This prospective cohort study included 1330 hip fracture patients from 1 January 2000 to 18 November 2012. Hb levels at 3 different time points, such as admission, postoperation, and discharge, were collected and used to stratify the cohort into anemia and nonanemia groups. Candidate factors including commodities, perioperative factors, blood transfusion, and other in-hospital interventions were collected before discharge. Logistic regression analyses were performed to detect risk factors for anemia for the 3 time points separately. Kaplan–Meier and multivariate Cox regression analyses were used to evaluate the association between anemia and 2-year mortality. Factors affecting the diagnosis of anemia were different for the 3 time points. Age, female sex, American Society of Anesthesiologists score (ASA), and intertrochanteric fracture were associated with admission anemia, while surgical procedure, surgical duration, blood transfusion, blood loss during the operation, and drainage volume were major risk factors for postoperation anemia. Cox proportional-hazards regression analysis suggested that the risk of all-cause mortality was higher in the anemia group on admission (1.680, 95%CI: 1.201–2.350, P anemia varied at different time points, and therapy interventions would greatly affect the status of postoperation and discharge anemia in

  6. Hip axis length is a FRAX- and bone density-independent risk factor for hip fracture in women.

    Science.gov (United States)

    Leslie, William D; Lix, Lisa M; Morin, Suzanne N; Johansson, Helena; Odén, Anders; McCloskey, Eugene V; Kanis, John A

    2015-05-01

    Bone mineral density (BMD) measurement from dual-energy X-ray absorptiometry (DXA) is widely used to assess skeletal strength in clinical practice, but DXA instruments can also measure biomechanical parameters related to skeletal shape. The objective of the study was to determine whether DXA-derived hip geometry measures provide information on fracture prediction that is independent of hip fracture probability determined from the fracture risk assessment tool (FRAX) algorithm. This was a retrospective registry study using BMD results for Manitoba, Canada. Women aged 40 years and older with baseline hip DXA, derived hip geometry measures, and FRAX scores (n = 50 420) participated in the study. Hospitalized hip fracture (n = 1020) diagnosed during 319 137 person-years of follow-up (median 6.4 y) was measured. Among the hip geometry measures, hip axis length (HAL) showed a consistent association with hip fracture risk when adjusted for age [hazard ratio (HR) 1.30 per SD increase, 95% confidence interval (CI) 1.22-1.38], and this was unaffected by further adjustment for BMD or FRAX score. Adjusted for FRAX score with BMD, there was a significant effect of increasing HAL quintile on hip fracture risk (linear trend P hip geometry measurements are associated with incident hip fracture risk, but many do not confer significant independent predictive information. HAL was found to predict hip fractures when adjusted for BMD or FRAX score and may be of clinical value in refining hip fracture risk.

  7. Validity of bone mineral density and WHO fracture risk assessment thresholds in hip fractures.

    Science.gov (United States)

    Shahla, Ahmad

    2011-09-01

    Hip fractures are common and serious consequence of osteoporosis. Bone mineral density (BMD) measurement and the World Health Organization (WHO) fracture risk assessment tool are considered to predict the hip osteoporotic fractures. In this study, their sensitivities in hip fracture cases are evaluated. BMD and WHO probability of fracture risk were determined in 71 hip fractures ≥ 50 years of old. Totally, 65% of patients had ≤-2.5 BMD T score. 81% of patients had above the upper interventional threshold of WHO fracture risk probability model. Sensitivities were low in 50-59 year age group with progression in older age groups. Results of BMD T score and fracture risk probabilities were not significant between men and women. There were 23% and 49% sensitivities of less than or equal to -2.5 T score in the 50-59 and 60-69 year age groups with a 31% sensitivity of greater than 3% probability of hip fracture risk in the 50-59 year age group, both of which were not valid for predicting hip fracture risk.

  8. Determinants of outcome in hip fracture patient care

    NARCIS (Netherlands)

    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. Severe Vitamin D Deficiency in Swiss Hip Fracture Patients

    Science.gov (United States)

    Background: Based on evidence for fall and fracture prevention, most clinical guidelines for the prevention of hip fractures recommend 800 IU vitamin D per day. This dose shifted 25(OH)D levels in previous studies to between 60-100 nmol/l. Aim: As a direct test of clinical guideline practice in Swi...

  10. Evaluation of a simplified hip structure analysis method for the prediction of incident hip fracture events.

    Science.gov (United States)

    Khoo, B C C; Lewis, J R; Brown, K; Prince, R L

    2016-01-01

    Many attempts have been made to improve the predictive ability of areal bone mineral density (aBMD) which integrates bone mass and area. The addition of an extra variable derived from the hip dual-energy X-ray (DXA) image TR_σ, which describes distribution of mass within the scanned area of the trochanter, improved prediction of 15-year hip fracture probability in elderly women. Two-dimensional DXA imaging of the proximal femur to produce an aBMD is a clinically useful predictor of future fracture risk. Further analysis of the DXA image to produce an eight-variable hip structure analysis (Beck HSA) has been developed to improve understanding of structural factors determining hip bone strength at each of three proximal femur sites, the narrow femoral neck (NN), intertrochanter (TR) and shaft (S). Recently, data on four measurements derived from the currently used eight Beck HSA variables were used to capture population variation in bone structure at each site. These include two previously used variables, the localised aBMD and the sub-periosteal width (W) applying to 5-mm sections (at each sites), and two new variables, standard deviation of normalised mineral-mass projection profile distribution (σ), and displacement between centre-of-mineral mass and geometric centre-of-mineral mass of projection profile (δ). Using a cohort of 1159 women, mean baseline age 75, who sustained 139 hip fractures over 15 years, we determined whether these measures significantly improved 15-year hip fracture prediction compared to current approach utilising age and total hip aBMD. To describe the most parsimonious model for hip fracture risk prediction, the 12 base measures (4 from each site), total hip aBMD and age were evaluated in stepwise logistic regression models. The final model included TR_σ, total hip aBMD and age and provided improved utility for hip fracture prediction compared to total hip aBMD and age alone (C-statistic 0.73 vs. 0.69, P = 0.009 and net

  11. Hidden blood loss after surgery for hip fracture

    DEFF Research Database (Denmark)

    Foss, Nicolai Bang; Kehlet, H

    2006-01-01

    with aspirin, intra-operative hypotension and gastro-intestinal bleeding or ulceration were all independent predictors of blood loss. We conclude that total blood loss after surgery for hip fracture is much greater than that observed intra-operatively. Frequent post-operative measurements of haemoglobin......Our aim was to determine the total blood loss associated with surgery for fracture of the hip and to identify risk factors for increased blood loss. We prospectively studied 546 patients with hip fracture. The total blood loss was calculated on the basis of the haemoglobin difference, the number...... of transfusions and the estimated blood volume. The hidden blood loss, in excess of that observed during surgery, varied from 547 ml (screws/ pins) to 1473 ml (intramedullary hip nail and screw) and was significantly associated with medical complications and increased hospital stay. The type of surgery, treatment...

  12. Hidden blood loss after surgery for hip fracture

    DEFF Research Database (Denmark)

    Foss, N B; Kehlet, H

    2006-01-01

    Our aim was to determine the total blood loss associated with surgery for fracture of the hip and to identify risk factors for increased blood loss. We prospectively studied 546 patients with hip fracture. The total blood loss was calculated on the basis of the haemoglobin difference, the number...... of transfusions and the estimated blood volume. The hidden blood loss, in excess of that observed during surgery, varied from 547 ml (screws/ pins) to 1473 ml (intramedullary hip nail and screw) and was significantly associated with medical complications and increased hospital stay. The type of surgery, treatment...... with aspirin, intra-operative hypotension and gastro-intestinal bleeding or ulceration were all independent predictors of blood loss. We conclude that total blood loss after surgery for hip fracture is much greater than that observed intra-operatively. Frequent post-operative measurements of haemoglobin...

  13. Progress in research on intramedullary fixation for intertrochanteric fractures%股骨转子间骨折髓内钉固定相关问题的研究进展

    Institute of Scientific and Technical Information of China (English)

    虎群盛; 姜自伟; 黄枫

    2016-01-01

    Intertrochanteric fractures are common in clinic.With biomechanical advantages of short force arm,central fixation and conformity with the femur biomechanical structure,intramedullary nailing is the most common treatment for intertrochanteric fractures.However,there are unresolved disputes over clinical issues like insertion point,neck screw position,main nail length and distal interlocking screws.The present review summarizes the progress in the intramedullary fixation of intertrochanteric fracture and discusses the related issues.%股骨转子间骨折是临床常见骨折.具有中心内固定、力臂短及符合股骨生物力学结构的髓内钉固定是目前股骨转子间骨折最常用的治疗方法.但是在入钉点、头颈钉位置、主钉长度及远端交锁螺钉等方面还存在一些尚未解决的问题.本文对股骨转子间骨折的髓内钉固定研究进展作一综述,并对上述相关问题进行讨论.

  14. The risk of major and any (non-hip) fragility fracture after hip fracture in the United Kingdom : 2000-2010

    NARCIS (Netherlands)

    Gibson-Smith, D; Klop, C; Elders, P J M; Welsing, P M J; van Schoor, N; Leufkens, H G M; Harvey, N C; van Staa, T P; de Vries, F

    2014-01-01

    UNLABELLED: The risk of a subsequent major or any fracture after a hip fracture and secular trends herein were examined. Within 1 year, 2.7 and 8.4% of patients sustained a major or any (non-hip) fracture, which increased to 14.7 and 32.5% after 5 years. Subsequent fracture rates increased during th

  15. The risk of major and any (non-hip) fragility fracture after hip fracture in the United Kingdom : 2000-2010

    NARCIS (Netherlands)

    Gibson-Smith, D; Klop, C; Elders, P J M; Welsing, P M J; van Schoor, N; Leufkens, H G M; Harvey, N C; van Staa, T P; de Vries, F

    UNLABELLED: The risk of a subsequent major or any fracture after a hip fracture and secular trends herein were examined. Within 1 year, 2.7 and 8.4% of patients sustained a major or any (non-hip) fracture, which increased to 14.7 and 32.5% after 5 years. Subsequent fracture rates increased during

  16. Failure cause and treatment countermeasure of internal fixation on femoral intertrochanteric fracture%股骨粗隆间骨折内固定失效原因分析及对策

    Institute of Scientific and Technical Information of China (English)

    任周奎; 吕应文; 余定华; 于金华

    2011-01-01

    目的 探讨股骨粗隆间骨折内固定失效原因及治疗对策.方法 回顾总结我院2003~2009年行手术治疗的123例股骨粗隆间骨折病例,按Evans分型,分析各型骨折内固定失效原因,内固定方式与内固定失效类型及发生率情况.结果 123例均得到随访,有23例骨折内固定失效,其中稳定型骨折内固定失效5例,不稳定型骨折内固定失效18例;发生率为18.69%.失效类型:髋内翻、股骨颈短缩、内固定物断裂导致骨折畸形.不稳定型骨折内固定失效发生率远高于稳定性骨折,而钉板系统内固定失效发生率远高于髓内系统.钉板系统中近端解剖钢板内固定失效发生率高于动力髋螺钉(DHS).结论 对各类型骨折特点认识不够从而导致内固定方式选择不当;骨质疏松症患者术后过早负重;术者操作不当.%Objective To discuss the failure cause and treatment countermeasure of internal fixation on femoral intertrochanteric fracture. Methods Clinical data of 123 patients with femoral intertrochanteric fracture ad mitted into our hospital from 2003 to 2009 were retrospectiverly collected , analyzing the failure causes of operation , methods of inlernal fixation ,failure types of internal fixalion and failure incidence of inlernal fixalion , Results All the patients were followed up for 1.5 to 36(mean,24. 3) months. Totally 23 patients didn't achieve good internal fixation , with the failure rate of 18. 69% . The types of failure included coxa vara deformity , short femoral neck ,fixity breakage. The failure incidence of inlernal fixation in unstable fracture pafienls was higher than that of stable fracture palienls , and the failure incidence of inlernal fixation in screw -plate system was higher lhan that of intramedul lary system. While for the screw-plate system,the failure incidence at internal fixation in the distal anatomical plate was higher than that of dynamic hip screw . Conclusion The internal fixalion

  17. Patient characteristics and outcomes of a hip fracture and concomitant fracture compared with hip fracture alone: results from a United Kingdom teaching hospital.

    Science.gov (United States)

    Ong, Terence; Anand, Varun; Tan, Wei; Quah, Edmund; Moran, Chris; Sahota, Opinder

    2016-04-01

    A proportion of patients sustaining hip fractures present with a concomitant fracture. We aimed to evaluate the relationship between patient characteristics and clinical outcomes, in those with a hip and concomitant fracture compared with those sustaining a hip fracture alone from a clinical service registry. Cross-sectional study using data obtained from a clinical service registry (Nottingham Hip Fracture Database) on patients aged 50 and above who suffered a hip fracture between 1/1/2003 and 31/12/2012. Data was collected on patient demographics, fracture information and healthcare outcomes. 7338 patients of which 75 % were female (mean age 82 (SD 9.4), had a hip fracture with 334 (4.6 %) patients having a concomitant fracture. The majority (58 %) were distal radius or proximal humeral fractures. Only females (p = 0.002), those taking three or fewer medications (p = 0.018) and those on long term steroids (p = 0.048) were more likely to suffer a concomitant fracture. There was no difference in mortality, rates of postoperative complication, intensive care unit or care home admission between both groups. Patients with a concomitant fracture have a 16 % longer average length of stay in hospital (mean difference 1.16; 95 % CI 1.07-1.25, p fractures have similar patient characteristics, except gender, polypharmacy and long term steroid use; and outcomes to those presenting with hip fracture alone, except a longer average inpatient stay.

  18. Risk Factors for Hip Fracture in Japanese Older Adults

    Directory of Open Access Journals (Sweden)

    Takashi Yamashita

    2012-09-01

    Full Text Available Risk factors for hip fracture in Japanese older populations are understudied compared with Western countries arguably due to the relatively lower prevalence rates in Japan. Nationally representative data from the Nihon University Japanese Longitudinal Study of Aging were analyzed using logistic regression to examine possible risk factors of hip fractures, separately for older women (n = 2,859 and older men (n = 2,108. Results showed that older Japanese women with difficulty bending their knees (OR = 1.9, with diabetes (OR = 1.7 times, and/or with more activity of daily living limitations (OR = 1.1 had higher risks of hip fracture. Older Japanese men with difficulty bending their knees (OR = 2.6, who use more external prescription drugs (OR = 1.9, and with cancer (OR = 2.0 times had higher risks of hip fracture. Further considerations of gender- and culture-specific factors along with the identified risk factors may provide insights into future intervention programs for hip fracture in Japanese older populations.

  19. InterTAN髓内钉治疗股骨转子间骨折术中主钉置入困难的原因分析%Pitfalls in implantation of InterTAN for intertrochanteric femur fracture

    Institute of Scientific and Technical Information of China (English)

    高翔; 李杰; 姜勇; 宫富良; 范钦波; 范继峰; 李元城

    2015-01-01

    Objective To investigate the intraoperative technical difficulties in the implantation of InterTAN for intertrochanteric femur fracture and their countermeasures.Methods A retrospective study was conducted of the 496 patients with intertrochanteric femur fracture who had been treated with InterTAN intramedullary nails from September 2008 to August 2013 at our department.They were 172 men and 324 women, aged from 32 to 87 years at the time of fracture (average, 69.2 years).According to the AO classification, 29 cases were type 31-A1, 315 cases type 31-A2 and 152 cases type 31-A3.Intraoperative difficulties in implantation of InterTAN intramedullary nails were analyzed and countermeasures were proposed.Results We identified intraoperative technical difficulties in implantation of the main nail in the following situations: in 21 patients who had anatomic variation in femoral shaft (excessive anterior or lateral skewing), in 5 obese patients in one of whom iatrogenic fracture occurred;in 3 elderly patients, and in 17 patients with hard reduction in one of whom iatrogenic fracture occurred during the locking of a distal screw.Conclusions To deal with the difficulties in implantation of InterTAN for intertrochanteric femur fracture we propose the following 4 countermeasures: 1.Anteroposterior and lateral radiographs of the full length of the injured femur are necessary for preoperative determination of presence or absence of anatomical variations so that implantation can be adjusted during surgery.2.Vertical trajectory and sufficient reaming in the medullar canal of the proximal femur are important to reduce the possibility of iatrogenic fracture, particularly in obese patients.3.Violent hammering is prohibited and full reaming is recommended in the elderly whose bone is fragile.4.For the cases where hard fracture reduction is predicted by the preoperative evaluation, the strategy of open reduction and fixation with dynamic hip screws seems more rational or should be

  20. Clinical Study on Effect of Osteoking (恒古骨伤愈合剂) in Preventing Postoperational Deep Venous Thrombosis in Patients with Intertrochanteric Fracture

    Institute of Scientific and Technical Information of China (English)

    ZHAO Hong-bin; HU Min; ZHENG Hong-yu; LIANG Hong-suo; ZHU Xiao-song

    2005-01-01

    Objective: To evaluate the effect of Osteoking (恒古骨伤愈合剂) in preventing postoperational deep venous thrombosis (DVT) in patients with intertrochanteric fracture (ITF). Methods: With prospective and randomized controlled clinical design adopted, 62 patients with ITF after operation were assigned into 2 groups, the tested group and the control group, Osteoking (25 ml every other day) and SanchiDifference of round length of thighs and shanks between two sides were measured on the 10th day and Doppler ultrasonic examination on the fractured leg was carried out. Results: The occurrence rate of DVT in the tested goup was 9.4%, which was lower than that in the control group (30.0%, P<0.05). All the difference of round lengths, either that of the thigh or the shank, was less in the tested group than that in the control group, showing statistical significance ( P<0.05 ). Conclusion: Osteoking has a satisfactory effect in preventing postoperational DVT in patients with ITF.

  1. PRIMARY CEMENTED BIPOLAR HEMIARTHROPLASTY WITH TROCHANTERIC AND CALCAR RECONSTRUCTION IN UNSTABLE INTERTROCHANTERIC FRACTURES IN ELDERLY: A PROSPECTIVE STUDY

    Directory of Open Access Journals (Sweden)

    Pandu Ranga Vital

    2015-09-01

    Full Text Available INTRODUCTION : To avoid the complications and morbidity associated with attempted Osteosynthesis of the so called Unstable inter - trochanteric fractures in the elderly population, Primary Cemented Bipolar hemiarthroplasty been around for over three decades now. But, hardly any emphasis been given over the technical aspects to i mprove the functional outcome. Present study is one such, following reconstructive attempts ( O f primary cemented bipolar hemiarthroplasty with trochanter and calcar reconstruction in the elderly population to reduce the risk of unstable Hemiarthroplasty. MATERIALS AND METHODS: This prospective study included 20 cases of elderly patients with mean age of 73.5 years (Age range 66 to 82 yr who sustained multifragmentary/communited inter - trochanteric femur fracture treated with Primary cemented bipolar hemiar throplasty with trochanteric and calcar reconstruction to emphasize the importance of restoration soft tissue tension to reduce the risk of unstable Hemiarthroplasty. Essential Technical steps include Figure of eight / multiple wire loop technique of recons truction ( with or without K ‘wires of greater trochanter/ abductor mechanism and calcar reconstruction either by wiring Lesser trochanteric fragment and or insertion of cortical piece of bone graft (medially under the collar of the prosthesis harvested f rom head and neck fragment. The patients were followed up at six week, three month, six month and one year postoperatively and assessed using Harris Hip Score (HHS. RESULTS: The mean HHS score was 85 (range 69 to 91 at the end of one year. The main clini cal measures were early post - operative full weight bearing, post - operative complication & functional outcome. The time to full weight bearing, the rate of post - operative complications & functional outcome was significantly better in cemented bipolar arthro plasty group. CONCLUSION: The authors strongly believe that primary cemented bipolar

  2. Anaemia impedes functional mobility after hip fracture surgery

    DEFF Research Database (Denmark)

    Foss, N.B.; Kristensen, M.T.; Kehlet, H.

    2008-01-01

    BACKGROUND: the impact of anaemia on the outcome after a hip fracture surgery is controversial, but anaemia can potentially decrease the physical performance and thereby impede post-operative rehabilitation. We therefore conducted a prospective study to establish whether anaemia affected functional...... mobility in the early post-operative phase after a hip fracture surgery. PATIENTS AND METHODS: four hundred and eighty seven consecutive hip fracture patients, treated according to a well-defined multimodal rehabilitation programme with a uniform, liberal transfusion threshold, were studied. Hb...... integrating the type of surgery, medical complications and prefracture function showed that anaemia at the time of the physiotherapy session was an independent risk factor for not being able to walk on the third post-operative day [OR 0.41 (0.14-0.73) P = 0.002]. CONCLUSION: anaemia impedes functional...

  3. Morbidity and Mortality in Jeju Residents over 50-Years of Age with Hip Fracture with Mean 6-Year Follow-Up: A Prospective Cohort Study

    National Research Council Canada - National Science Library

    Lee, Sung-Rak; Ha, Yong-Chan; Kang, Hyun; Park, Yong-Geun; Nam, Kwang Woo; Kim, Sang-Rim

    2013-01-01

    This prospective cohort study was performed to estimate the morbidity and mortality with 790 patients over 50-yr of age that sustained a femoral neck or intertrochanteric fracture from 2002 to 2006...

  4. Complications of total hip arthroplasty: periprosthetic fractures of the acetabulum.

    Science.gov (United States)

    Chitre, Amol; Wynn Jones, Henry; Shah, Nikhil; Clayson, Anthony

    2013-12-01

    Periprosthetic fractures of the acetabulum are a rare but potentially disastrous complication of total hip arthroplasty. Such fractures occur either as early perioperative complications or late complications when they are associated with either significant trauma or as a result of the loss of the structural integrity of the bone supporting the prosthesis, such as aseptic osteolysis. The incidence of such fractures appears to be increasing with the increased use of uncemented acetabular components. This article explores the current literature on the epidemiology, etiology, and classification of periprosthetic acetabular fractures as well as offering potential treatment strategies.

  5. Survival and Functional Outcomes after Hip Fracture among Nursing Home Residents

    National Research Council Canada - National Science Library

    Cho, Hong Man; Lee, Kyujung; Min, Woongbae; Choi, Yong Suk; Lee, Hyun Suk; Mun, Hyoung Jin; Shim, Hye Young; Lee, Da Geon; Yoo, Mi Joung

    2016-01-01

    .... Despite the fact that this is a high-risk group vulnerable to hip fractures, no study has yet been conducted in Korea on hip fracture incidence rates and prognoses among patients residing at nursing homes...

  6. Complications and institutionalization are almost doubled after second hip fracture surgery in the elderly patient

    NARCIS (Netherlands)

    T.J. van der Steenhoven; B. Staffhorst (Bas); S.K. van de Velde (Samuel); R.G.H.H. Nelissen (Rob); M.H.J. Verhofstad (Michiel)

    2015-01-01

    markdownabstractAbstract Purpose To determine patient and hip fracture characteristics, early postoperative complication rate and need for institutionalization at time of discharge from the hospital in patients treated for a second, contralateral hip fracture. Methods During a

  7. Economic evaluation of osteoporosis liaison service for secondary fracture prevention in postmenopausal osteoporosis patients with previous hip fracture in Japan.

    Science.gov (United States)

    Moriwaki, K; Noto, S

    2017-02-01

    A model-based cost-effectiveness analysis was performed to evaluate the cost-effectiveness of secondary fracture prevention by osteoporosis liaison service (OLS) relative to no therapy in patients with osteoporosis and a history of hip fracture. Secondary fracture prevention by OLS is cost-effective in Japanese women with osteoporosis who have suffered a hip fracture.

  8. Outcome after osteosynthesis of hip fractures in nonagenarians

    Directory of Open Access Journals (Sweden)

    de Leur K

    2013-12-01

    Full Text Available Kevin de Leur,1 Jos P A M Vroemen,1 Dagmar I Vos,1 Leon Elmans,2 Lijckle van der Laan1 1Department of Surgery, 2Orthopedics, Amphia Hospital, Breda, The Netherlands Background: Hip fractures in the elderly population are associated with high morbidity and mortality. However, there is still a lack of information on mortality and loss of independence in extremely elderly people with a hip fracture. Objective: To study functional outcomes and mortality after osteosynthesis of hip fractures in very old patients in our clinic. Patients and methods: Hospital charts of all patients over 90 years old who were operated for a hip fracture between January 2007 and December 2011 were reviewed. Outcome measures were mortality, preoperative and postoperative mobility, and loss of independence. Results: A total of 149 patients were included; 132 (89% women, median age 93.5±2.45 years. Thirty-six (24% patients were classified as American Society of Anesthesiologists (ASA grade 2, 104 (70% as ASA grade 3, and nine (6% as ASA grade 4. The Charlson comorbidity index (CCI score was 2 or less in 115 (77% patients and 34 (23% patients scored 3 or more points. Short-term survival was 91% and 77% at 30 days and 3 months, respectively. Long-term survival was 64%, 42%, and 18% at 1, 3, and 5 years after surgery, respectively. Survival was significantly better in patients with lower ASA scores (P=0.005. No significant difference in survival was measured between patients according to CCI score (P=0.13. Fifty-one percent of patients had to be accommodated in an institution with more care following treatment, and 57% were less mobile after osteosynthesis of a hip fracture. Conclusion: Our study shows that short-term mortality rates in very elderly patients with a hip fracture are high and there is no clear predictive value for mortality. ASA classification is the best predictive value for overall mortality. A large proportion of these patients lost their independence after

  9. A comprehensive hip fracture program reduces complication rates and mortality

    DEFF Research Database (Denmark)

    Pedersen, Susanne Juhl; Moltke, Finn Borgbjerg; Schousboe, B.

    2008-01-01

    OBJECTIVES: To evaluate the rate of postoperative complications, length of stay, and 1-year mortality before and after introduction of a comprehensive Multidisciplinary fast-track treatment and care program for hip fracture patients (the optimized program). DESIGN: Retrospective chart review...... with historical control. SETTING: Orthopedic ward (110 beds) at a university hospital (700 beds). PARTICIPANTS: Five hundred thirty-five consecutive patients aged 40 and older (94% >= 60) hospitalized for hip fracture between January 1, 2003, and March 3 1, 2004. Three hundred and thirty-six patients (70.3%) were...... tract infection (P mortality was 23% in the control group versus 12% in the intervention...

  10. Total hip arthroplasty with cementless cup after acetabular fracture

    Directory of Open Access Journals (Sweden)

    Marcelo Alfonso Lugones

    2012-12-01

    Full Text Available Background Acetabular fractures are a common cause of degenerative hip arthritis. The incidence of post-traumatic osteoarthritis has been reported between 12% and 57% and avascular necrosis of the femoral head may occur in 2% to 40% after posterior fracture dislocation. The fracture is often caused by major trauma in road accidents, at work or during sports, and patients usually present for total hip replacement (THR at an earlier age than the general arthritic population. We describe and analyze our patients with uncemented acetabular reconstruction in post-traumatic arthritis and compare them with THR in non-traumatic arthritis. Methods We retrospectively evaluated 19 patients who underwent uncemented acetabular reconstruction due to post-traumatic arthritis secondary to acetabular fracture. Results The average age at the time of arthroplasty was 52.2 years (19-83. The age at the time of fracture was 47.9 years (16-81. The average time between the acetabular fracture and THR was 52.4 months (4-360. The average follow-up was 4.25 years. No acetabular component loosening or infections were seen in either group. The Harris Hip Score at an average follow-up of 4.25 years was 89.3 (57-99. The follow-up in the control group with non-traumatic arthritis was 4.9 years, and the Harris Hip Score was 94.1 points (78-100. There were no significant difference in the Harris Hip Score between groups (p = 0.24. Conclusion Uncemented acetabular reconstruction in post-traumatic arthritis secondary to acetabular fracture is a more difficult procedure than routine arthroplasty in patient with non-traumatic arthritis. In the short-term there are no clinical or radiographic differences in THR with uncemented acetabular cups in post-traumatic arthritis patients compared to patients with non-traumatic arthritis.

  11. Is mortality after hip fracture associated with surgical delay or admission during weekends and public holidays?

    DEFF Research Database (Denmark)

    Daugaard, Cecilie Laubjerg; Jørgensen, Henrik L; Riis, Troels

    2012-01-01

    Hip fractures are associated with high mortality, but the cause of this is still not entirely clear. We investigated the effect of surgical delay, weekends, holidays, and time of day admission on mortality in hip fracture patients.......Hip fractures are associated with high mortality, but the cause of this is still not entirely clear. We investigated the effect of surgical delay, weekends, holidays, and time of day admission on mortality in hip fracture patients....

  12. Arthroscopic removal of intraarticular fragments following fracture dislocation of the hip

    Directory of Open Access Journals (Sweden)

    Bagaria Vaibhav

    2008-01-01

    Full Text Available We report here a case of posterior dislocation of hip with fracture of posterior lip of acetabulum, with retained fracture fragments after a successful closed reduction. The fractured fragments were removed by arthroscopy of the hip. The technique of hip arthroscopy used in removing the fragments is discussed.

  13. The incidence of symptomatic venous thromboembolism following hip fractures with or without surgery in Taiwan

    Directory of Open Access Journals (Sweden)

    Cheng-Han Lee

    2015-12-01

    Conclusions: The incidence of symptomatic VTE after hip fractures is low in Taiwan. Patients rarely received pharmacological thromboprophylaxis following hip fractures. Universal thromboprophylaxis for patients experiencing hip fractures was not necessary in Taiwan, but it should be considered in high-risk populations.

  14. Zoledronic Acid in Reducing Clinical Fracture and Mortality after Hip Fracture

    DEFF Research Database (Denmark)

    Lyles, Kenneth W; Colón-Emeric, Cathleen S; Magaziner, Jay S

    2007-01-01

    BACKGROUND: Mortality is increased after a hip fracture, and strategies that improve outcomes are needed. METHODS: In this randomized, double-blind, placebo-controlled trial, 1065 patients were assigned to receive yearly intravenous zoledronic acid (at a dose of 5 mg), and 1062 patients were...... assigned to receive placebo. The infusions were first administered within 90 days after surgical repair of a hip fracture. All patients received supplemental vitamin D and calcium. The median follow-up was 1.9 years. The primary end point was a new clinical fracture. RESULTS: The rates of any new clinical...... infusion of zoledronic acid within 90 days after repair of a low-trauma hip fracture was associated with a reduction in the rate of new clinical fractures and improved survival. (ClinicalTrials.gov number, NCT00046254.)....

  15. Risk-factors for surgical delay following hip fracture.

    Science.gov (United States)

    Sanz-Reig, J; Salvador Marín, J; Ferrández Martínez, J; Orozco Beltrán, D; Martínez López, J F

    To identify pre-operative risk factors for surgical delay of more than 2 days after admission in patients older than 65 years with a hip fracture. A prospective observational study was conducted on 180 hip fractures in patients older than 65 years of age admitted to our hospital from January 2015 to April 2016. The data recorded included, patient demographics, day of admission, pre-fracture comorbidities, mental state, level of mobility and physical function, type of fracture, antiaggregant and anticoagulant medication, pre-operative haemoglobin value, type of treatment, and surgical delay. The mean age of the patients was 83.7 years. The mean Charlson Index was 2.8. The pre-fracture baseline co-morbidities were equal or greater than 2 in 70% of cases. Mean timing of surgery was 3.1 days. At the time of admission, 122 (67.7%) patients were fit for surgery, of which 80 (44.4%) underwent surgery within 2 days. A Charlson index greater than 2, anticoagulant therapy, and admission on Thursday to Saturday, were independently associated with a surgical delay greater than 2 days. The rate of hip fracture patients undergoing surgery within 2 days is low. Risk factors associated to surgical delay are non-modifiable. However, their knowledge should allow the development of protocols that can reduce surgical delay in this group of patients. Copyright © 2017 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.

  16. Geriatric hip fracture management: keys to providing a successful program.

    Science.gov (United States)

    Basu, N; Natour, M; Mounasamy, V; Kates, S L

    2016-10-01

    Hip fractures are a common event in older adults and are associated with significant morbidity, mortality and costs. This review examines the necessary elements required to implement a successful geriatric fracture program and identifies some of the barriers faced when implementing a successful program. The Geriatric Fracture Center (GFC) is a treatment model that standardizes the approach to the geriatric fracture patient. It is based on five principles: surgical fracture management; early operative intervention; medical co-management with geriatricians; patient-centered, standard order sets to employ best practices; and early discharge planning with a focus on early functional rehabilitation. Implementing a geriatric fracture program begins with an assessment of the hospital's data on hip fractures and standard care metrics such as length of stay, complications, time to surgery, readmission rates and costs. Business planning is essential along with the medical planning process. To successfully develop and implement such a program, strong physician leadership is necessary to articulate both a short- and long-term plan for implementation. Good communication is essential-those organizing a geriatric fracture program must be able to implement standardized plans of care working with all members of the healthcare team and must also be able to foster relationships both within the hospital and with other institutions in the community. Finally, a program of continual quality improvement must be undertaken to ensure that performance outcomes are improving patient care.

  17. Risk of hip fracture after osteoporosis fractures. 451 women with fracture of lumbar spine, olecranon, knee or ankle

    DEFF Research Database (Denmark)

    Lauritzen, J B; Lund, B

    1993-01-01

    In a follow-up study during 1976-1984, the risk of a subsequent hip fracture was investigated in women aged 60-99 years, hospitalized for the following fractures: lumbar spine (n 70), olecranon (n 52), knee (n 129) and ankle (n 200). Follow-up ranged from 0 to 9 years. Observation time of the 4...... different fractures were 241, 180, 469, and 779, person-years, respectively. In women aged 60-79 years with one of the following fractures the relative risk of a subsequent hip fracture was increased by 4.8 (lumbar spine), 4.1 (olecranon), 3.5 (knee) and 1.5 (ankle). The relative risk of hip fracture showed...

  18. Multifunctional External Fixator for the Treatment of Femoral Intertrochanteric Fracture%多功能外固定支架治疗老年股骨粗隆间骨折

    Institute of Scientific and Technical Information of China (English)

    李祥春; 刘太福; 唐书建

    2011-01-01

    early complications. Follow-up was done to all the patients for 5 to 14 months, averaging 9 months. X-ray showed all fractures healed, and the healing time ranged from 11 to 24 weeks with an average of 17 weeks. No varus or leg shortening or other complications occurred. Three months after surgery, based on the Harris hip score for functional evaluation, there were 18 excellent cases, 7 good cases and 3 poor cases with a excellent and good rate of 89. 3%. Mild pin tract infection was detected in 7 patients, moderate in 5, and severe in 2 with a total pin tract infection rate of 50%. Two patients with diabetes suffering from severe pin tract infection recovered by local medication and antibiotics, but the infection reoccurred repeatedly till the healing nails were taken. No bone infection of ulcers occurred, and the existing complications were not aggravated. Conclusion Treatment of intertrochanteric fractures with multifunctional external fixator is minimally invasive, simple, and consistent with biomechanical principles, which can promote early activities out of bed and early fracture healing for the patients.

  19. Periprosthetic femoral fracture within two years after total hip replacement:

    DEFF Research Database (Denmark)

    Thien, T. M.; Chatziagorou, G.; Garellick, G.;

    2014-01-01

    BACKGROUND: We used the Nordic Arthroplasty Register Association database to evaluate whether age, sex, preoperative diagnosis, fixation, and implant design influence the risk of revision arthroplasty due to periprosthetic fracture within two years from operation of a primary total hip replacemen...

  20. Dementia and delirium, the outcomes in elderly hip fracture patients

    NARCIS (Netherlands)

    Mosk, C.A. (Christina A.); Mus, M. (Marnix); Vroemen, J.P.A.M. (Jos P. A. M.); T. van der Ploeg (Tjeerd); D.I. Vos (Dagmar); Elmans, L.H.G.J. (Leon H. G. J.); L. van der Laan (Lyckle)

    2017-01-01

    textabstractBackground: Delirium in hip fractured patients is a frequent complication. Dementia is an important risk factor for delirium and is common in frail elderly. This study aimed to extend the previous knowledge on risk factors for delirium and the consequences. Special attention was given to

  1. Electrocardiographic abnormalities in patients admitted for hip fracture

    NARCIS (Netherlands)

    Goslings, J C; Schafroth, M U; de Rooij, S E J A; Jansen, S.; Koster, R.W.; de Lange, F.J.; van der Velde, N

    2014-01-01

    BACKGROUND: Several risk factors for falls and hip fractures have been recognised, but controversy still exists regarding the importance of rhythm and conduction abnormalities as potentially modifiable risk factors for recurrent falls. The aim of this study was to determine the prevalence of

  2. Comprehensive evaluation of intramedullary fixation and extramedullary fixation in the treatment of unstable femoral intertrochanteric fractures%髓内与髓外系统骨钉置入治疗不稳定股骨转子间骨折的综合效果评价

    Institute of Scientific and Technical Information of China (English)

    李岩; 王东; 孙海钰; 刘亮; 栗树伟

    2013-01-01

    BACKGROUND:Nowadays, the internal fixation materials for the clinical treatment of unstable femoral intertrochanteric fractures are broadly divided into two categories:intramedul ary fixation system and extramedul ary fixation system. However, the effects of the treatments usual y lack of macro evaluation. OBJECTIVE:To compare the effect of intramedul ary fixation system and extramedul ary internal fixation system in the treatment of unstable femoral intertrochanteric fractures. METHODS:217 patients with unstable femoral intertrochanteric fracture (Evans typing: Ⅲ type to Ⅴ type and R type) were treated by using intramedul ary fixation system and extramedul ary internal fixation system:18 cases were treated with dynamic condylar screw, 67 cases were treated with dynamic hip screw, 43 cases were treated with reconstruction nail, 72 cases were treated with proximal femoral anti-rotation blade nail, and 17 cases were treated with new generation of antegrade interlocking intramedul ary nail. The operative time, length of incision, blood loss, time in bed, fracture healing time, complications and Harris hip score were analyzed and compared. RESULTS AND CONCLUSION:In the aspects of operative time, blood loss, time in bed, complications and Harris hip score, the intramedul ary fixation system was superior to extramedul ary internal fixation system. But there were significant differences in the aspects of length of incision and fracture healing time between two methods. The results showed that the treatment of unstable femoral intertrochanteric fractures by using intramedul ary fixation system was better than the extramedul ary internal fixation system, as the intramedul ary fixation system could effectively shorten the operative time and reduce blood loss. This stable and reliable fixation enables patients to take early postoperative functional exercise, and could significantly shorten the time in bed and reduce the incidence of complications and it is conducive to

  3. The risk of second hip fracture is decreased with compliant and persistent use of bisphosphonates

    DEFF Research Database (Denmark)

    Hansen, Louise; Vestergaard, Peter; Petersen, Karin Dam

    on the medical assumption that 50% of additional hip fractures may be prevented with compliant and persistent use of alendronate in five years following the initial fracture. RESULTS: In the no treatment arm, the average cost was EUR 16,233 and 0.32 hip fractures per woman, and in the alendronate treatment arm...... the average cost was EUR 13,395 and 0.17 hip fractures per woman. The incremental cost-effectiveness ratio (ICER) resulted in a cost saving of EUR 18,623 per prevented hip fracture. In the alendronate treatment arm, the average cost and effect was EUR 5,631 and 0.16 hip fractures per man. The no treatment arm...... the first month after fracture and does not normalise until 15 years later. Fracture prevention programs have focused on identifying patients at risk of secondary low energy trauma fractures. The secondary prevention programs for fractures begin immediately after the first fracture, through identification...

  4. Acute periprosthetic fractures of the acetabulum after total hip arthroplasty.

    Science.gov (United States)

    Potty, Anish G; Corona, Jacqueline; Manning, Blaine T; Le, Amanda; Saleh, Khaled J

    2014-01-01

    Although periprosthetic fractures of the acetabulum are relatively uncommon after total hip arthroplasty, a variety of patient-, surgeon-, and implant-related risk factors can contribute to the occurrence of this serious complication. These risk factors, combined with the increased use of cementless acetabular cups, will likely result in an increased prevalence of these fractures in the future. By better understanding the risk factors, classification schemes, and treatment options for periprosthetic fractures of the acetabulum, orthopaedic surgeons can achieve better outcomes for their patients.

  5. Meta analysis of artificial joint replacement and internal fixation in treatment of elderly femoral intertrochanteric fractures%人工关节置换术与内固定术治疗老年股骨粗隆间骨折的Meta分析

    Institute of Scientific and Technical Information of China (English)

    王涛

    2015-01-01

    目的:探讨老年股骨粗隆间骨折采用人工关节置换术与内固定术治疗的Meta分析。方法:1980-2014年老年股骨粗隆间骨折治疗文献1000例,采用Meta方法对不同治疗方案预后展开对比。结果:人工髋关节置换300例,术后内科并发症率3.3%,术后髋关节畸形率3.3%,内固定物松动率2.7%。内固定组分别为3.3%、3.2%、2.7%,经Meta分析,差异无统计学意义(P>0.05)。人工股骨头置换组分别为3%、3%、2%,与内固定比较,差异无统计学意义(P>0.05)。人工髋关节置换组死亡率5%,内固定组2.7%,人工股骨头置换组0%,人工髋关节置换组高于内固定组(P<0.05)。人工股骨头置换组低于内固定组(P<0.05)。结论:老年股骨粗隆间骨折采用人工关节置换术与内固定术Meta分析结果显示,采人工股骨头置换术,效果更为明显,可显著改善预后,保障患者生存质量。%Objective:To explore the Meta analysis of artificial joint replacement and internal fixation in treatment of elderly femoral intertrochanteric fractures.Methods:1000 cases of literature about the treatment of intertrochanteric fractures in elderly from 1980 to 2014 were selected and the prognosis of different treatment options were compared through Meta analysis.Results:300 cases had hip replacement and the postoperative medical complications was 3.3%,the postoperative hip deformity rate was 3.3% ,the implant loosening rate was 2.7% and the internal fixation group were 3.3% ,3.2% ,2.7% ,there was no significant difference through Meta analysis(P>0.05).The hemiarthroplasty group were 3%,3%,2%,there was no differences compared with the fixation group(P>0.05).The mortality of the hip replacement group was 5% and that of the internal fixation group was 2.7%, that of the hemiarthroplasty group was 0%,and that of the hip replacement group was higher than that of the internal fixation group(P <0.05).That of the

  6. A meta-analysis of arthroplasty versus internal fixation treatment of intertrochanteric fracture in the elderly%人工髋关节置换术与内固定术治疗老年股骨粗隆间骨折的META分析

    Institute of Scientific and Technical Information of China (English)

    向川; 郝耀; 杨宇君; 孙剑; 秦迎泽; 卫小春

    2013-01-01

    [Objective] To compare arthroplasty and internal fixation treatment for intertrochanteric fracture in the elderly by meta-analysis.[Method] The literature published in English or Chinese from 1979 to 2011 on compare between arthroplasty and internal fixation treatment of intertrochanteric fracture were searched and analysed.Five English papers and nine Chinese ones were eligibly included in this meta-analysis.The clinical data of the 14 papers were collected for comparing postoperative morality,postoperative medical complications rate,postoperative hip deformity rate,postoperative loosening rate of implantation and postoperative Harris hip score.[Result] Arthroplasty led to better result in postoperative Harris hip score than internal fixation (P < 0.000 01),but worse result in postoperative mortality (P < 0.01).There were no significant differences in other index.[Conclusion] Arthroplasty and internal fixation play different roles in treatment of intertrochanteric fracture.%[目的]通过Meta分析比较人工髋关节置换术(包括股骨头置换术、全髋关节置换术)与内固定术治疗老年人股骨粗隆间骨折的疗效.[方法]检索1979年1月~2011年1月关于股骨粗隆间骨折采用人工关节置换术与内固定术治疗对照研究的文献(共14篇),采用循证医学Meta分析对患者术后死亡率、术后内科并发症发生率、术后髋部畸形率、术后内置物松动率及术后髋关节功能评分(Harris hip score)进行综合分析.[结果]Meta分析发现,人工股骨头置换术后的髋关节功能评分明显优于内固定术(P<0.000 01),但人工髋关节置换术(股骨头置换术+全髋关节置换术)的术后死亡率却比内固定组高(P<0.01).在术后髋部畸形率、内科并发症发生率、内置物松动率方面,则均无明显统计学差异.[结论]治疗老年股骨粗隆间骨折,人工髋关节置换术与内固定术在不同评价指标的比较中各有优劣,临床可根据患

  7. Risk Factors for Hip Fracture in Older Home Care Clients

    Science.gov (United States)

    Poss, Jeff; Cook, Richard J.; Byrne, Kerry; Hirdes, John P.

    2009-01-01

    Background Little information is available on hip fracture risks among community-dwelling persons receiving home care. Our aim was to identify risk factors for hip fracture from health information routinely collected for older home care clients. Methods This was a cohort study involving secondary analysis of data on 40,279 long-stay (>60 days) home care clients aged 65 and older in Ontario, Canada; occurrence of hip fracture as well as potential risk factor information were measured using the Resident Assessment Instrument (RAI)/Minimum Data Set–Home Care assessment instrument. Results In all, 1,003 clients (2.5%) had hip fracture on follow-up assessment. Older (85+ vs 65–74, relative risk [95% confidence interval]: 0.52 [0.43–0.64]) clients are at increased risk; males are at reduced risk [0.60 (0.51–0.70)]. Other risk factors include osteoporosis (1.19 [1.03–1.36]), falls (1.31 [1.15–1.49]), unsteady gait (1.18 [1.03–1.36]), use of ambulation aide (1.39 [1.21–1.59]), tobacco use (1.42, [1.13–1.80]), severe malnutrition (2.61 [1.67–4.08]), and cognitive impairment (1.30 [1.12–1.51]). Arthritis (0.86 [0.76–0.98]) and morbid obesity (0.34 [0.16–0.72]) were associated with reduced risk. Males and females demonstrated different risk profiles. Conclusions Important risk factors for hip fracture can be identified from routinely collected data; these could be used to identify at-risk clients for further investigation and prevention strategies [22]. PMID:19196903

  8. Intraoperative Hypothermia During Surgical Fixation of Hip Fractures.

    Science.gov (United States)

    Frisch, Nicholas B; Pepper, Andrew M; Jildeh, Toufic R; Shaw, Jonathan; Guthrie, Trent; Silverton, Craig

    2016-11-01

    Hip fractures are common orthopedic injuries and are associated with significant morbidity/mortality. Intraoperative normothermia is recommended by national guidelines to minimize additional morbidity/mortality, but limited evidence exists regarding hypothermia's effect on orthopedic patients. The purpose of this study was to determine the incidence of intraoperative hypothermia in patients with operatively treated hip fractures and evaluate its effect on complications and outcomes. Retrospective chart review was performed on clinical records from 1541 consecutive patients who sustained a hip fracture and underwent operative fixation at the authors' institution between January 2005 and October 2013. A total of 1525 patients were included for analysis, excluding those with injuries requiring additional surgical intervention. Patient demographic data, surgery-specific data, postoperative complications, length of stay, and 30-day readmission were recorded. Patients with a mean intraoperative temperature less than 36°C were identified as hypothermic. Statistical analysis with univariate and multivariate logistic regression modeling evaluated associations with hypothermia and effect on complications/outcomes. The incidence of intraoperative hypothermia in operatively treated hip fractures was 17.0%. Hypothermia was associated with an increase in the rate of deep surgical-site infection (odds ratio, 3.30; 95% confidence interval, 1.19-9.14; P=.022). Lower body mass index and increasing age demonstrated increased association with hypothermia (P=.004 and P=.005, respectively). To the authors' knowledge, this is the first and largest study analyzing the effect of intraoperative hypothermia in orthopedic patients. In patients with hip fractures, the study's findings confirm evidence found in other surgical specialties that hypothermia may be associated with an increased risk of deep surgical-site infection and that lower body mass index and increasing age are risk factors

  9. Prediction of early mortality following hip fracture surgery in frail elderly : The Almelo Hip Fracture Score (AHFS)

    NARCIS (Netherlands)

    Nijmeijer, W. S.; Folbert, E. C.; Vermeer, M.; Slaets, J. P.; Hegeman, J. H.

    2016-01-01

    Background: Hip fractures are common in the elderly and have a high risk of early mortality. Identification of patients at high risk of early mortality could contribute to enhanced quality of care. A simple scoring system is essential for preoperative identification of patients at high risk of early

  10. Geographic Variation in Hip Fracture Among United States Long-Stay Nursing Home Residents

    Science.gov (United States)

    Banerjee, Geetanjoli; Zullo, Andrew R.; Berry, Sarah D.; Lee, Yoojin; McConeghy, Kevin; Kiel, Doug P.; Mor, Vincent

    2016-01-01

    Introduction Despite high rates of hip fracture among United States (US) nursing home (NH) residents, little is known about geographic variation in hip fracture incidence. We used nationally representative data to identify geographic variation in hip fracture among US NH residents. Design and setting Retrospective cohort study using Part A claims for a 100% of Medicare enrollees in 15,289 NHs linked to NH minimum data set and Online Survey, Certification, and Reporting databases. Participants A total of 891,085 long-stay (continuous residence of ≥100 days) NH residents ≥65 years old. Measurements Medicare Part A claims documenting a hip fracture. Mean incidence rates of hip fracture for long-stay NH residents were calculated for each state and US Census Division from 2007 to 2010. Results The age-, sex-, and race-adjusted incidence rate of hip fracture ranged from 1.49 hip fractures/100 person-years (Hawaii) to 3.60 hip fractures/100 person-years (New Mexico), with a mean of 2.38 (standard deviation 0.43) hip fractures/100 person-years. The mean incidence of hip fracture was 1.7-fold greater in the highest quintile than the lowest. Conclusions We observed modest US state and regional variation in hip fracture incidence among long-stay NH residents. Future studies should assess whether state policies or NH characteristics explain the variation. PMID:27461867

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

    Science.gov (United States)

    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.

  12. Radial and humeral fractures as predictors of subsequent hip, radial or humeral fractures in women, and their seasonal variation

    DEFF Research Database (Denmark)

    Lauritzen, J B; Schwarz, Peter; McNair, P;

    1993-01-01

    Hip fractures are common in elderly women, and early risk assessment of future hip fractures is relevant in relation to prevention. We studied the predictive value of radial and humeral fractures in women. The influence of weather conditions on the risk was also studied. Women aged 20-99 years wi...

  13. Are Hip-Specific Items Useful in a Quality of Life Questionnaire for Patients with Hip Fractures?

    Science.gov (United States)

    Yao, Kai-Ping Grace; Lee, Hsin-Yi; Tsauo, Jau-Yih

    2009-01-01

    Researchers measure the significance of hip fracture by the patient's impairment. The patient's quality of life (QOL) is usually also substantially affected. However, there is no specific quality of life (QOL) questionnaire for patients with hip fractures. This study was designed to determine whether adding a new set of specific questions about…

  14. Prevalent vertebral fractures on chest CT: higher risk for future hip fracture.

    Science.gov (United States)

    Buckens, Constantinus F; de Jong, Pim A; Mali, Willem P; Verhaar, Harald J; van der Graaf, Yolanda; Verkooijen, Helena M

    2014-02-01

    Subclinical or undiagnosed vertebral fractures on routine chest computed tomography (CT) may be useful for detecting patients at increased risk of future hip fractures who might benefit from preventive interventions. We investigated whether prevalent vertebral fractures on routine chest CT are associated with future hip fractures. From a source population of 5679 patients ≥40 years old undergoing chest CT in one of three Dutch hospitals between 2002 and 2005, patients hospitalized for hip fractures (n = 149) during a median follow-up of 4.4 years were identified. Following a case-cohort design, a random sample of 576 patients was drawn from the source population and added to the cases. In this group, the presence and severity of vertebral fractures was determined using semiquantitative vertebral fracture assessment and multivariate case-cohort appropriate Cox modeling. We found that cases were older (69 versus 63 years) and more often female (48% versus 38%) than the source population. Compared with those with no fracture, patients with any vertebral fracture had triple the risk of future hip fracture (age- and gender-adjusted hazard ratio [HR] = 3.1, 95% confidence interval [CI] 2.1-4.7). This HR rose to 3.8 (CI 2.6-5.6) if mild fractures were discounted. Future fracture risk increased significantly with increasing severity of vertebral fracture status: from mild (HR = 2.4, CI 1.5-3.7) and moderate (HR = 4.8, CI 2.5-9.2) to severe (HR = 6.7, CI 2.9-15.5). The same was true for having higher cumulative fracture grades: 1 to 3 (HR = 2.7, CI 1.8-4.1), 4 to 6 (HR = 4.8, CI 2.2-10.5), or ≥7 (HR = 11.2, CI 3.7-34.6). In conclusion, prevalent vertebral fractures on routine clinical chest CT are associated with future hip fracture risk. © 2014 American Society for Bone and Mineral Research.

  15. Proximal femoral locking plate treatment of intertrochanteric fractures in older adults%股骨近端锁定板治疗老年人股骨粗隆间骨折

    Institute of Scientific and Technical Information of China (English)

    田学林; 朱冬承

    2014-01-01

    目的:探讨股骨近端锁定板治疗老年人股骨粗隆间骨折的疗效。方法选取我院老年人股骨粗隆间骨折患者88例为研究对象,对照组采取常规内固定,观察组采取股骨近端锁定板内固定,比较两组疗效。结果观察组治疗总有效率为95.45%;对照组治疗总有效率为68.18%。结论股骨近端锁定板治疗老年人股骨粗隆间骨折具有很好的临床效果,能有效促进患者恢复,提高其生活质量。%Objective To explore the proximal femoral locking plate curative effect for the treatment of intertrochanteric fractures in older adults. Methods Selected from 88 cases of patients with intertrochanteric fractures in older adults as the research object,control group,take regular internal fixation group take the proximal femoral locking plate internal fixation,compared two groups of therapeutic effect. Results Observation treatment group the total effective rate was 95.45%; The control group total effective rate was 68.18%. Conclusion Proximal femoral locking plate treatment of intertrochanteric fractures in older adults have very good clinical effect,can effectively promote the patient recover,improve the quality of life.

  16. Central dislocation of the hip secondary to insufficiency fracture

    Directory of Open Access Journals (Sweden)

    Moe Thaya

    2010-03-01

    Full Text Available We present a case report of a 45-year old man who sustained a central dislocation of the hip secondary to an insufficiency fracture of the acetabulum. At the time of presentation he was on alendronate therapy for osteoporosis which had been previously investigated. CT scanning of the pelvis was useful for pre-operative planning which confirmed collapse of the femoral head but no discontinuity of the pelvis. The femoral head was morcellized and used as bone graft for the acetabular defect and an uncemented total hip replacement was performed.

  17. Hip and pelvic fractures and sciatic nerve injury

    Institute of Scientific and Technical Information of China (English)

    蒋电明; 余学东; 安洪; 梁勇; 梁安霖

    2002-01-01

    Objective: To investigate the influence of hip and pelvic fracture, especially acetabular fracture complicated by sciatic nerve injury on clinical features and prognosis of sciatic nerve injury. Methods: From January 1987 to January 2000, 17 patients (14 male and 3 female) who had hip and pelvic fractures complicated by sciatic nerve injury were treated with operative reduction and internal fixation and followed up from 10 months to 5 years. The average age was 38 years (ranging 23-56 years). The left extremities were involved in 11 patients and the right in 6. Twelve patients underwent primary exploration and neurolysis and 5 patients underwent secondary operation. Results: Preoperatively, 8 patients were treated with large doses of oral narcotics to control their severe sciatic pain. Three of the 8 patients underwent patient-controlled analgesia and epidural analgesia. After operation, excellent and good rates of reduction and functional recovery of sciatic nerve were 94.1% and 88% respectively. Four patients still had sciatic pain and 2 patients failed to recover. Sciatic nerve function improved within 3-6 months after surgery in 11 patients. Conclusions: Hip and pelvic fractures can result in sciatic nerve injury, especially common peroneal nerve injury and prognosis is poor. Open reduction and internal fixation combined with nerve exploration and neurolysis should be used as early as possible for severe sciatic pain.

  18. Application of calcitonin for the treatment of unstable intertrochanteric fractures in elderly patients%降钙素在老年不稳定型股骨转子间骨折应用

    Institute of Scientific and Technical Information of China (English)

    陈宝; 陈国俊; 龚遂良; 黄成龙; 范顺武

    2014-01-01

    Objective To compare the clinical outcomes between proximal femoral nail antirotation (PFNA) combined with salmon calcitonin and PFNA only for the treatment of unstable intertrochanteric fractures in elderly patients.Methods From January 2009 to December 2011,120 elderly patients with intertrochanteric fracture were randomly divided into two groups:calcitonin group and control group.Patients in calcitonin group were treated with PFNA combined with salmon calcitonin,while patients in control group were treated with PFNA only.According to Evans-Jensen classification,60 patients in calcitonin group (28 males and 32 females,with an average age of 75.1 years) were divided into 20 cases of type Ⅱ A,32 cases of type Ⅱ B and 8 type Ⅲ.Sixty patients in control group (27 males and 33 females,with an average age of 74.9 years) were divided into 22 cases of type Ⅱ A,32 cases of type Ⅱ B and 6 type Ⅲ.Bone healing was assessed with X-ray and bone mineral density (BMD) was measured by dual energy X-ray absorptiometry.Harris hip and SF-12 score,complications,adverse effect of salmon calcitonin and subsequent fragility fractures were evaluated postoperatively.Results One-hundred and thirteen patients were followed up for at least 2 years.In 6 months after surgery,there were 4 cases of delayed healing in control group.However,all fractures were healed in 12 months after surgery.No significant difference was found between the two groups in BMD preoperatively.The changes in BMD were significantly different between the two groups in 6 months,1 year and 2 years after surgery.No significant difference was found between the two groups in Harris hip and 1-year SF-12 score while the 2-year SF-12 score was significantly different between the two groups.There was 1 patient in calcitonin group who suffered from subsequent fragility fracture in 3 months after surgery,while there was 6 patients in control group during 13 to 23 months postoperatively.Conclusion PFNA combined with

  19. Meaningful improvement in gait speed in hip fracture recovery.

    Science.gov (United States)

    Alley, Dawn E; Hicks, Gregory E; Shardell, Michelle; Hawkes, William; Miller, Ram; Craik, Rebecca L; Mangione, Kathleen K; Orwig, Denise; Hochberg, Marc; Resnick, Barbara; Magaziner, Jay

    2011-09-01

    To estimate meaningful improvements in gait speed observed during recovery from hip fracture and to evaluate the sensitivity and specificity of gait speed changes in detecting change in self-reported mobility. Secondary longitudinal data analysis from two randomized controlled trials Twelve hospitals in the Baltimore, Maryland, area. Two hundred seventeen women admitted with hip fracture. Usual gait speed and self-reported mobility (ability to walk 1 block and climb 1 flight of stairs) measured 2 and 12 months after fracture. Effect size-based estimates of meaningful differences were 0.03 for small differences and 0.09 for substantial differences. Depending on the anchor (stairs vs walking) and method (mean difference vs regression), anchor-based estimates ranged from 0.10 to 0.17 m/s for small meaningful improvements and 0.17 to 0.26 m/s for substantial meaningful improvement. Optimal gait speed cutpoints yielded low sensitivity (0.39-0.62) and specificity (0.57-0.76) for improvements in self-reported mobility. Results from this sample of women recovering from hip fracture provide only limited support for the 0.10-m/s cut point for substantial meaningful change previously identified in community-dwelling older adults experiencing declines in walking abilities. Anchor-based estimates and cut points derived from receiver operating characteristic curve analysis suggest that greater improvements in gait speed may be required for substantial perceived mobility improvement in female hip fracture patients. Furthermore, gait speed change performed poorly in discriminating change in self-reported mobility. Estimates of meaningful change in gait speed may differ based on the direction of change (improvement vs decline) or between patient populations. © 2011, Copyright the Authors. Journal compilation © 2011, The American Geriatrics Society.

  20. Periprosthetic fracture of the acetabulum after total hip arthroplasty.

    Science.gov (United States)

    Peterson, C A; Lewallen, D G

    1996-08-01

    Eleven patients who had sustained a periprosthetic fracture of the acetabulum at a mean of 6.2 years (range, one month to thirteen years) after a total hip arthroplasty were managed at our institution between 1985 and 1991. Five patients had a fracture of the medial wall; three, a fracture of the posterior column; two, a transverse fracture; and one, a fracture of the anterior column. Six fractures were displaced by two millimeters or more. Eight fractures were caused by blunt trauma or a fall, and three occurred spontaneously. A fracture was classified as type 1 if the acetabular component was clinically and radiographically stable (eight patients) and as type 2 if the component was unstable (three patients). One patient, who had a displaced type-2 fracture of the posterior column, died of an associated intrapelvic vascular injury. The other two patients who had a type-2 fracture were managed with revision of the acetabular component without supplemental plate fixation, immediately after the diagnosis of the fracture. The eight patients who had a type-1 fracture initially were managed with limitation of weight-bearing or modification of activity; in six of these patients, the fracture united without additional treatment. The ten surviving patients were followed for a mean of sixty-two months after the fracture. Eight of these patients-including four in whom a type-1 fracture had united after non-operative treatment-had a revision of the acetabular component because of pain, loosening, or non-union by the time of the most recent follow-up. Two patients (one of whom had a type-1 fracture and the other, a type-2 fracture) had multiple revisions of the acetabular component; both had supplemental internal fixation with a plate. All ten patients ultimately had a stable, functioning prosthesis. We conclude that periprosthetic acetabular fractures are associated with a poor prognosis with regard to the survival of the acetabular component but that it is possible to

  1. Risk Factors for Hip Fractures in Elderly Patients

    Directory of Open Access Journals (Sweden)

    Erhan Bayram

    2014-09-01

    Full Text Available Aim: In this study, we aimed to determine the risk factors for hip fractures in elderly patients in order to contribute to efforts to reduce the incidence of hip fractures. Methods: We evaluated 54 patients aged 79.12±8.83 (range: 55-95 years, who presented to our emergency department due to hip fractures (Group 1 and 52 hospitalized patients aged 69.04±7.66 (range: 60-83 years, without a hip fracture (Group 2. We compare the groups in terms of neuropathy symptom score (NSS, neurological impairment score (NIS, accompanying diseases, foot deformities, dermal and nail problems, body mass index (BMI, osteoporosis, and use of walking aid devices. Results: The mean BMI score was 24.81±3.67 and 27.67±4.86 in Group 1 and in Group 2, respectively. The difference was statistically significant (p=0.001. The mean NSS and NIS in Group 1 was 2.87±2.89 and 2.06±1.17, respectively, while the mean NSS was 1.83±2.84 and NIS was 0.6±0.82 in group 2. The two scores were higher in group 1 than in Group 2, however, the difference in NISs between the groups was statistically significant (p<0.001. In Group 1, the number of patients smoking or drinking alcohol was higher than in Group 2, but the difference was not significant (p=0.37, p=0.324. There were no significant relationship between foot deformities and hip fractures. The number of patients with osteoporosis and those using walking aid devices was significantly higher in Group 1 than in Group 2 (p=0.007, p<0.001. Conclusion: In this study including a limited number of patients, we determined that a low BMI score, osteoporosis, and use of walking aid device are the risk factors for hip fractures. (The Me­di­cal Bul­le­tin of Ha­se­ki 2014; 52: 187-90

  2. Age Related Incidence and Early Outcomes of Hip Fractures: A Prospective Cohort Study of 1177 patients

    OpenAIRE

    Shenoy Ravikiran; Eranki Vivek; Pillai Anand; Hadidi Mahar

    2011-01-01

    Abstract Introduction Associated with the increase in the aging population, there is an increase in the incidence of hip fractures worldwide. Outcome following such fractures is affected by age of the patient. This study aims to assess the incidence and early outcome of hip fractures, comparing between different age groups. Methods Data of hip fractures collected over a period of five years was analysed. Patients were divided into three groups, group A (patients under the age of 64), group B ...

  3. 老年人股骨转子间骨折保守治疗的疗效分析%Therapeutic effects of conservative treatment of intertrochanteric fracture in the elderly

    Institute of Scientific and Technical Information of China (English)

    文良元; 金祎; 申剑; 纪权; 张启维; 高凡; 黄公怡

    2008-01-01

    Objective To analyze therapeutic effects of conservative treatment and the causes of malunion of intertrochanteric fracture in elderly patients, and try to find the way to deal with the problems. Methods Fifteen cases aged 75 to 101 years with intertroehanterie fracture treated conservatively were included. Their average age was 88.8 years. All fractures were classified according to Evens-Jensen. Because of the medical complication or other reasons, they were conservatively treated by methods of traction, wearing shoes et al. X-ray examination was taken at regular time and their final functions were assessed. Results Two cases were died 1-3 months after admission, and the fractures were only partially healed. The remaining thirteen cases got complete healing. Among the fifteen cases, the deformity did not happen in 4 cases of IA without fixation and 1 case of IIB with bone traction. All others got the deformity of varus, shorting and external rotation in different degree, which interfered the lower extremity motor function. Conclusions The fracture position not kept and fixed satisfactorily during treatment would lead to more joint deformity and deteriorated hip joint function for the displaced intertroehanterie fractures in elderly patients.%目的 分析老年人股骨转子间骨折保守治疗及骨折畸形愈合的具体原因,探讨避免或减轻骨折畸形愈合的对策. 方法 随访15例老年转子间骨折保守治疗病例,年龄75~101岁,平均88.8岁,骨折类型按Evens-Jensen分型,入院后因内科并存症或其他原因未手术而行骨折保守治疗,分别采取皮牵引、骨牵引、穿"丁"字鞋或仅卧床制动,定期拍X线片观察骨折愈合情况和最终的活动功能. 结果 2例患者在入院后1~3个月死亡,骨折仅部分愈合,其余患者骨折均完全愈合.15例患者中,4例IA型骨折和严格骨折牵引的1例ⅡB型骨折未出现畸形愈合,其余患者未能严格同定和制

  4. Treatment of intertrochanteric fractures fractures with the proximal femoral nail antirotation%股骨近端防旋髓内钉治疗股骨转子间骨折

    Institute of Scientific and Technical Information of China (English)

    尚宪平; 王小岗; 银保

    2011-01-01

    Objective To explore the clinical outcome of intertrochanteric fractures with the proximal femoral nail anti-rotation ( PFNA). Methods Twenty-two patients for intertochanteric fractures of the femur were treated with the proximal femoral nail anti-rotation from March 2009 to March 2011. The fractures were reducted with closed reduction technique and fixed with the proximal femoral nail anti-rotation . Results The mean operative time was 65 min (50 ~ 90min). The mean operative blood loss was 270ml (150 ~ 500ml). Reaming in 6 cases andunreaming in 16 cases during operative procedure . With static distal locking nail in 18 cases and without distal locking nail in 4 cases . The median time to partical weight-bearing was 9d(6 - 24d). The mean duration of follow up was 9. 5 months (6 ~ 13months). The wound healing was smoothly in 22 patients. The average time of fracture heaking was5. 2 months (4 ~ 8months). The postoperative function was recovered to premorbid status in all patients. One patient occurred the migration of cut-out of lag screw postoperatively. One patient suffered varus deformity in 13° due to the lateral entrying pointof the main nail . Conclusion The proximal femoral nail anti-rotation can fixed intertrochanteric fractures safely . With a mina-mally invasive,shorter operative time ,less bleeding, anti-rotation capability, can be an early postoperative functional exercise,less complications,is the treatment of intertrochanteric fractures as a good way.%目的 探讨股骨近端防旋髓内钉(PFNA)治疗股骨转子间骨折的临床疗效.2009年3月~2011年3月,采用股骨近端防旋髓内钉治疗股骨转子间骨折患者22例.骨折采用闭合复位,股骨近端防旋髓内钉固定术.结果 平均手术时间65min(50~90min).术中平均失血量270ml( 150~ 500ml).6例患者术中须扩髓即可放入主钉,16例患者术中无须扩髓即可放入主钉,18例患者静力交锁远端螺钉,4例患者未交锁远端螺钉.

  5. The clinical observation of three different internal fixations in treating elderly stable femoral intertrochanteric fracture%3种不同方式内固定治疗老年稳定型股骨粗隆间骨折的临床疗效观察

    Institute of Scientific and Technical Information of China (English)

    文皓; 丁雪勇; 徐希彦

    2015-01-01

    Objective To compare the clinical efficacy of locking plate (LCP),dynamic hip screw (DHS)and proximal femo-ral nail (PFNA)internal fixation in the treatment of elderly stable femoral intertrochanteric fracture.Methods A total of 60 pa-tients with stable stable intertrochanteric fractures in elderly patients were randomly divided randomly into proximal femoral LCP fixation group (group A),the DHS fixation group (group B)and PFNA fixation group (group C).The operative time,blood loss, postoperative complications and postoperative weight-bearing time were analyzed among three different groups.Results There were significant difference in blood loss,postoperative weight-bearing time,operative time among three different groups (P < 0.05 ). Group C was significantly better than the group A(P <0.05).Two cases of hip varus deformity,one case of crew loosening and su-perficial infection were appeared among group A.One case of hip varus deformity occurred in group B.One case of suffered refrac-ture occurred in group C.Conclusion LCD fixation,fixation with DHS and PFNA fixation are effective treatment for stable femoral intertrochanteric fracture in the elderly patients.%目的:探讨锁定钢板(LCP)固定、动力髋螺钉(DHS)内固定和股骨近端髓内钉(PFNA)内固定治疗老年股骨粗隆间骨折的疗效。方法选择老年稳定型股骨粗隆间骨折患者60例,随机分至股骨近端 LCP 固定组(A 组)、DHS 内固定组(B 组)和 PFNA 固定组(C 组),对3组患者手术时间、出血量、术后负重时间及并发症发生情况进行分析和比较。结果A 组、B 组、C组与在术中出血量、术后负重时间及手术时间的比较具有统计学意义(P <0.05)。C 组优良率显著优于 A 组(P <0.05)。A 组出现2例髋内翻,1例断钉、退钉,1例浅表感染;B 组出现1例髋内翻;C 组出现1例股骨转子间再骨折。结论LCP 固定、DHS 内固定和 PFNA 均为老年稳定型股骨粗隆间骨折的有效治疗方式。

  6. Analysis of Clinical Effect of Lateral Position and Supine Position Under the Proximal Femoral Intramedullary Nail in Treatment of Femoral Intertrochanteric Fracture%侧卧位与平卧位下股骨近端防旋髓内钉治疗股骨转子间骨折的临床效果分析

    Institute of Scientific and Technical Information of China (English)

    孙秀钦

    2015-01-01

    目的:探讨侧卧位与平卧位下股骨近端防旋髓内钉(PFNA)治疗肥胖患者股骨转子间骨折的疗效。方法回顾性分析59例应用PFNA内固定治疗股骨转子间骨折患者的临床资料,随机分为侧卧位组和平卧位组,比较两组患者的手术时间、术中出血量、转子顶端切口长度、骨折愈合时间及髋关节Harris评分等。结果侧卧位组患者手术时间、转子顶端切口长度短于平卧位组,差异有统计学意义(P<0.05),侧卧位组患者术中出血量少于平卧位组,差异有统计学意义(P<0.05),两组患者骨折愈合时间、髋关节Harris评分等比较差异均无统计学意义(P>0.05)。结论侧卧位行PFNA治疗肥胖患者股骨转子间骨折,降低了手术难度,缩短了手术时间和手术切口长度,减少了术中出血量,较平卧位行PFNA治疗肥胖患者股骨转子间骨折有明显优势。%Objective The paper explores the curative effects of proximal femur nail anti-rotation (PFNA) on obese patients’ intertrochanteric fracture in lateral position and horizontal position.MethodsThe paper makes a retrospective analysis on the clinical data of 59 cases applying PFNA internal ifxation for the treatment of intertrochanteric facture, and divides the cases into the lateral position group and the horizontal position group randomly to compare the two groups in terms of duration of operation,blood loss during operation, incision length on trochanter top, facture healing time and Harris hip score.Results Lateral position group’s duration of operation and incision length on trochanter top are signiifcantly shorter than those of horizontal position group, of which the difference shows the statistical significance (P0.05). Conclusion The horizontal-position PFNA for obese patients’ intertrochanteric fracture decreases operation dififculty, shortens operation time and length of surgical incision and reduces blood loss

  7. Educational Inequalities in Post-Hip Fracture Mortality: A NOREPOS Study.

    Science.gov (United States)

    Omsland, Tone K; Eisman, John A; Naess, Øyvind; Center, Jacqueline R; Gjesdal, Clara G; Tell, Grethe S; Emaus, Nina; Meyer, Haakon E; Søgaard, Anne Johanne; Holvik, Kristin; Schei, Berit; Forsmo, Siri; Magnus, Jeanette H

    2015-12-01

    Hip fractures are associated with high excess mortality. Education is an important determinant of health, but little is known about educational inequalities in post-hip fracture mortality. Our objective was to investigate educational inequalities in post-hip fracture mortality and to examine whether comorbidity or family composition could explain any association. We conducted a register-based population study of Norwegians aged 50 years and older from 2002 to 2010. We measured total mortality according to educational attainment in 56,269 hip fracture patients (NORHip) and in the general Norwegian population. Both absolute and relative educational inequalities in mortality in people with and without hip fracture were compared. There was an educational gradient in post-hip fracture mortality in both sexes. Compared with those with primary education only, the age-adjusted relative risk (RR) of mortality in hip fracture patients with tertiary education was 0.82 (95% confidence interval [CI] 0.77-0.87) in men and 0.79 (95% CI 0.75-0.84) in women. Additional adjustments for Charlson comorbidity index, marital status, and number of children did not materially change the estimates. Regardless of educational attainment, the 1-year age-adjusted mortality was three- to fivefold higher in hip fracture patients compared with peers in the general population without fracture. The absolute differences in 1-year mortality according to educational attainment were considerably larger in hip fracture patients than in the population without hip fracture. Absolute educational inequalities in mortality were higher after hip fracture compared with the general population without hip fracture and were not mediated by comorbidity or family composition. Investigation of other possible mediating factors might help to identify new targets for interventions, based on lower educational attainment, to reduce post-hip fracture mortality.

  8. A long-term follow-up of 221 hip fracture patients in southeastern Finland: analysis of survival and prior or subsequent fractures.

    Science.gov (United States)

    Lüthje, Peter; Helkamaa, Teemu; Kaukonen, Juha-Pekka; Nurmi-Lüthje, Ilona; Kataja, Matti

    2012-01-01

    To analyze the type and effect of prior and subsequent fractures in a hip fracture cohort. Hip fracture patients (n=221) were followed for a mean of 8 years and all prior and subsequent fractures were studied. Incidence of the first fracture and subsequent fractures according to sex, age group, and time between the first and the index hip fracture were measured. The absolute fracture risk was measured in the study subjects and in the age groups hip fracture patients had sustained previous fractures. In men, these were mostly ankle or hip fractures, and in women, wrist fractures. Of the subjects, 24% suffered a subsequent fracture, which in both sexes was usually a second hip fracture. At the end of the 8-year follow-up, 74% of the patients had died. The observed absolute fracture risk was 7% at one year and 24% at 5 years. In women, excess mortality was lowest during the first 4.8 years after the index hip fracture among patients with one fracture. However, it was highest among women with two fractures. In men, excess mortality was lowest among those with two fractures and highest among those with ≥3 fractures. There were no differences between the genders in sustaining subsequent fractures. The fracture risk subsequent to hip fracture was similar in both genders. Patients with prior hip fractures had the worst survival rate. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  9. 股骨粗隆间骨折PFNA内固定的治疗体会%Treatment of PFNA internal fixation for intertrochanteric fracture of femur

    Institute of Scientific and Technical Information of China (English)

    武广林

    2015-01-01

    Objective To study the treatment of Proximal Femoral Nail Antirotation internal fixation in the treatment of intertrochanteric fracture of femur,analyze the treatment methods and strategies.Methods 40 patients with intertrochanteric fracture of femur received in ous hospital from January 2012 to January 2014 were selected. According to admission number, they were randomly divided into two groups, that is the observation group and the control group, 20 cases in each group.On the basis of conventional treatment, the observation group was treated with PFNA internalfixation. Conventional physical therapy and drug therapy were given to the control group.To observe and analyze the clinical treatment of the two groups of patients, the treatment effect of the two groups of patients.Results after treatment 5~24 months follow-up, the observation group cured 19 cases, the excellent and good rate was 95%; the control group cured 17 cases, the excellent rate was 85%. The excellent and good rate of the observation group was significantly higher than that in the control group, the difference was statistically significant (P<0.05).ConclusionPFNA internal fixation treatment is a relatively perfect and advanced treatment method, especially for the elderly patients with osteoporosis, the treatment effect is significant, worthy of clinical promotion.%目的:探讨股骨粗隆间骨折股骨近端防旋转髓内钉(Proximal Femoral Nail Antirotation,PFNA)内固定的治疗体会,分析治疗方法和对策。方法选取2012年1月到2014年1月于本院就诊的股骨粗隆间骨折患者40例,将患者按照入院编号,随机分为两组,观察组和对照组患者各20例,在常规治疗的基础上,给予观察组患者PFNA内固定的医疗手段进行治疗;给予对照组患者常规物理治疗和药物治疗,观察和分析两组患者临床治疗现象,比较两组患者的治疗效果。结果通过治疗后5至24个月

  10. Osteoporotic Hip Fractures: The Burden of Fixation Failure

    Directory of Open Access Journals (Sweden)

    J. M. Broderick

    2013-01-01

    Full Text Available Osteoporotic hip fractures are a major cause of morbidity and mortality in the elderly. Furthermore, reduced implant anchorage in osteoporotic bone predisposes towards fixation failure and with an ageing population, even low failure rates represent a significant challenge to healthcare systems. Fixation failure in fragility fractures of the hip ranges from 5% in peritrochanteric fractures through to 15% and 41% in undisplaced and displaced fractures of the femoral neck, respectively. Our findings, in general, support the view that failed internal fixation of these fragility fractures carries a poor prognosis: it leads to a twofold increase in the length of hospital stay and a doubling of healthcare costs. Patients are more likely to suffer a downgrade in their residential status upon discharge with a consequent increase in social dependency. Furthermore, the marked disability and reduction in quality of life evident before salvage procedures may persist at long-term followup. The risk, of course, for the elderly patient with a prolonged period of decreased functioning is that the disability becomes permanent. Despite this, however, no clear link between revision surgery and an increase in mortality has been demonstrated in the literature.

  11. Osteoporotic hip fractures: the burden of fixation failure.

    Science.gov (United States)

    Broderick, J M; Bruce-Brand, R; Stanley, E; Mulhall, K J

    2013-01-01

    Osteoporotic hip fractures are a major cause of morbidity and mortality in the elderly. Furthermore, reduced implant anchorage in osteoporotic bone predisposes towards fixation failure and with an ageing population, even low failure rates represent a significant challenge to healthcare systems. Fixation failure in fragility fractures of the hip ranges from 5% in peritrochanteric fractures through to 15% and 41% in undisplaced and displaced fractures of the femoral neck, respectively. Our findings, in general, support the view that failed internal fixation of these fragility fractures carries a poor prognosis: it leads to a twofold increase in the length of hospital stay and a doubling of healthcare costs. Patients are more likely to suffer a downgrade in their residential status upon discharge with a consequent increase in social dependency. Furthermore, the marked disability and reduction in quality of life evident before salvage procedures may persist at long-term followup. The risk, of course, for the elderly patient with a prolonged period of decreased functioning is that the disability becomes permanent. Despite this, however, no clear link between revision surgery and an increase in mortality has been demonstrated in the literature.

  12. Fracture of the ceramic epiphysis in hip arthroplasty.

    Science.gov (United States)

    Toni, A; Terzi, S; Sudanese, A; Zappoli, F A; Giunti, A

    1996-01-01

    Between November 1985 and October 1993, a total of 694 ceramic-ceramic hip arthroplasties were implanted; up until 1987 the alumina used in the first 82 cases was Ostalox, produced by IMEC of Caravaggio, characterized by poor control of the size of the crystals; after 1987 Biolox alumina of the Feldmhule company was used in 612 cases. Fracture of the ceramic head occurred in 2 cases; in both patients ceramic was of the Ostalox type, meaning a 2.4% incidence of fracture; up until the present none of the 612 Biolox heads has presented this complication.

  13. Machine Learning Principles Can Improve Hip Fracture Prediction

    DEFF Research Database (Denmark)

    Kruse, Christian; Eiken, Pia; Vestergaard, Peter

    2017-01-01

    Apply machine learning principles to predict hip fractures and estimate predictor importance in Dual-energy X-ray absorptiometry (DXA)-scanned men and women. Dual-energy X-ray absorptiometry data from two Danish regions between 1996 and 2006 were combined with national Danish patient data.......89 [0.82; 0.95], but with poor calibration in higher probabilities. A ten predictor subset (BMD, biochemical cholesterol and liver function tests, penicillin use and osteoarthritis diagnoses) achieved a test AUC of 0.86 [0.78; 0.94] using an "xgbTree" model. Machine learning can improve hip fracture...... prediction beyond logistic regression using ensemble models. Compiling data from international cohorts of longer follow-up and performing similar machine learning procedures has the potential to further improve discrimination and calibration....

  14. Modeling climate effects on hip fracture rate by the multivariate GARCH model in Montreal region, Canada

    Science.gov (United States)

    Modarres, Reza; Ouarda, Taha B. M. J.; Vanasse, Alain; Orzanco, Maria Gabriela; Gosselin, Pierre

    2014-07-01

    Changes in extreme meteorological variables and the demographic shift towards an older population have made it important to investigate the association of climate variables and hip fracture by advanced methods in order to determine the climate variables that most affect hip fracture incidence. The nonlinear autoregressive moving average with exogenous variable-generalized autoregressive conditional heteroscedasticity (ARMA X-GARCH) and multivariate GARCH (MGARCH) time series approaches were applied to investigate the nonlinear association between hip fracture rate in female and male patients aged 40-74 and 75+ years and climate variables in the period of 1993-2004, in Montreal, Canada. The models describe 50-56 % of daily variation in hip fracture rate and identify snow depth, air temperature, day length and air pressure as the influencing variables on the time-varying mean and variance of the hip fracture rate. The conditional covariance between climate variables and hip fracture rate is increasing exponentially, showing that the effect of climate variables on hip fracture rate is most acute when rates are high and climate conditions are at their worst. In Montreal, climate variables, particularly snow depth and air temperature, appear to be important predictors of hip fracture incidence. The association of climate variables and hip fracture does not seem to change linearly with time, but increases exponentially under harsh climate conditions. The results of this study can be used to provide an adaptive climate-related public health program and ti guide allocation of services for avoiding hip fracture risk.

  15. Dementia and delirium, the outcomes in elderly hip fracture patients

    Science.gov (United States)

    Mosk, Christina A; Mus, Marnix; Vroemen, Jos PAM; van der Ploeg, Tjeerd; Vos, Dagmar I; Elmans, Leon HGJ; van der Laan, Lijckle

    2017-01-01

    Background Delirium in hip fractured patients is a frequent complication. Dementia is an important risk factor for delirium and is common in frail elderly. This study aimed to extend the previous knowledge on risk factors for delirium and the consequences. Special attention was given to patients with dementia and delirium. Methods This is a retrospective cohort study performed in the Amphia Hospital, Breda, the Netherlands. A full electronic patient file system (Hyperspace Version IU4: Epic, Inc., Verona, WI, USA) was used to assess data between January 2014 and September 2015. All patients presented were aged ≥70 years with a hip fracture, who underwent surgery with osteosynthesis or arthroplasty. Patients were excluded in case of a pathological or a periprosthetic hip fracture, multiple traumatic injuries, and high-energy trauma. Patient and surgical characteristics were documented. Postoperative outcomes were noted. Delirium was screened using Delirium Observation Screening Scale and dementia was assessed from medical notes. Results Of a total of 566 included patients, 75% were females. The median age was 84 years (interquartile range: 9). Delirium was observed in 35%. Significant risk factors for delirium were a high American Society of Anesthesiology score, delirium in medical history, functional dependency, preoperative institutionalization, low hemoglobin level, and high amount of blood transfusion. Delirium was correlated with a longer hospital stay (P=0.001), increased association with complications (PPatients with dementia (N=168) had a higher delirium rate (57.7%, Ppatients with (34.0%) and without dementia (26.3%). Conclusion Elderly patients with a hip fracture are vulnerable for delirium, especially when the patient has dementia. Patients who underwent an episode of delirium were at increased risk for adverse outcomes. PMID:28331300

  16. Changing trends in the epidemiology of hip fracture in Spain

    Science.gov (United States)

    Azagra, R.; López-Expósito, F.; Martin-Sánchez, JC.; Aguyé, A.; Moreno, N.; Cooper, C.; Díez-Pérez, A.; Dennison, EM.

    2016-01-01

    Summary Temporal trends in hip fracture incidence have recently been reported in some developed countries. Such data in Spain has previously been incomplete; this study reports the stratified incidence of hip fractures in people over 65 in Spain during the last 14 years. Introduction The main objective is to establish whether temporal trends in hip fracture incidence in Spain exist. Methods Ecological study with data from hospital discharges nationwide. The study includes patients aged ≥ 65 years during a 14-year period (1997-2010). The analysis compares two periods of four years: 1997-2000 (P1) and 2007-2010 (P2). Results There were 119,857 fractures in men and 415,421 in women. Comparing periods (P1 vs P2), over ten years the crude incidence rate/100,000 inhabitant/year increased an average of 2.3%/year in men and 1.4% in women. After adjustment, the rate increased an average of 0.4%/year in men (p<0.0001), but decreased 0.2%/year in women (p<0.0001). In men younger than 85, the decrease was not significant except in 70-74 years and from 80 years the adjusted rate increases significantly (p<0.0001). In women under 80 years of age, the decrease in adjusted rate was significant, there was no change in 80-84 years and the adjusted rate increased significantly in individuals 85 years and older (p<0.0001). Mortality rates declined by 22% in both sexes and the index of overaging population rises 30.1% in men and 25.2% in women. Conclusions This study supports other international studies by showing changes in the incidence of hip fractures after age-population adjustment, which denotes a decrease in the younger age groups and among women and shows an increase in both groups over 85 years. The increase in the crude incidence rate of hip fracture in Spain reflects changes in population structure. PMID:24322478

  17. Dementia and delirium, the outcomes in elderly hip fracture patients.

    Science.gov (United States)

    Mosk, Christina A; Mus, Marnix; Vroemen, Jos Pam; van der Ploeg, Tjeerd; Vos, Dagmar I; Elmans, Leon Hgj; van der Laan, Lijckle

    2017-01-01

    Delirium in hip fractured patients is a frequent complication. Dementia is an important risk factor for delirium and is common in frail elderly. This study aimed to extend the previous knowledge on risk factors for delirium and the consequences. Special attention was given to patients with dementia and delirium. This is a retrospective cohort study performed in the Amphia Hospital, Breda, the Netherlands. A full electronic patient file system (Hyperspace Version IU4: Epic, Inc., Verona, WI, USA) was used to assess data between January 2014 and September 2015. All patients presented were aged ≥70 years with a hip fracture, who underwent surgery with osteosynthesis or arthroplasty. Patients were excluded in case of a pathological or a periprosthetic hip fracture, multiple traumatic injuries, and high-energy trauma. Patient and surgical characteristics were documented. Postoperative outcomes were noted. Delirium was screened using Delirium Observation Screening Scale and dementia was assessed from medical notes. Of a total of 566 included patients, 75% were females. The median age was 84 years (interquartile range: 9). Delirium was observed in 35%. Significant risk factors for delirium were a high American Society of Anesthesiology score, delirium in medical history, functional dependency, preoperative institutionalization, low hemoglobin level, and high amount of blood transfusion. Delirium was correlated with a longer hospital stay (P=0.001), increased association with complications (Pdelirium rate (57.7%, Pdelirium, especially when the patient has dementia. Patients who underwent an episode of delirium were at increased risk for adverse outcomes.

  18. 改良股骨近端锁定板内固定治疗股骨粗隆间合并粗隆下骨折的疗效观察%Curative Effect Observation of the Modified Proximal Femoral Locking Plate Internal Fixation in the Treatment of Intertrochanteric Combined Subtrochanteric Fracture

    Institute of Scientific and Technical Information of China (English)

    董必成; 李朝军; 尹东武; 杨利; 白虎荣; 冯文顺; 李小健

    2015-01-01

    Objective:To investigate the curative effect observation of the modified proximal femoral locking plate internal fixation in the treatment of intertrochanteric combined subtrochanteric fracture.Method:The clinical data of 18 patients with intertrochanteric combined subtrochanteric fracture in our hospital from January 2009 to May 2015 were retrospectively analyzed.They were treated with the modified proximal femoral locking plate internal fixation,and the treatment effect was observed.Result:The operation time of the group was 80-120 min,the intraoperative bleeding was 400-800 mL,the average was 510 mL.All patients were healed by first intention,during a mean 14(6 to 18 months) months following-up,the fracture were healed.The postoperative functional recovery of hip joint in the follow-up according to Harris score standard,excellent in 10 cases,good in 4 cases,fair in 4 cases,the excellent and good rate was 77.8%.Conclusion:The clinical effect of the modified proximal femoral locking plate internal fixation in the treatment of intertrochanteric combined subtrochanteric fracture is reliable,fracture anatomical reduction,stable internal fixation, high fracture healing rate and less complications,is worthy of clinical popularization and application.%目的:探讨改良股骨近端锁定板内固定治疗股骨粗隆间合并粗隆下骨折的疗效观察。方法:回顾性分析本院2009年1月-2015年5月治疗的18例股骨粗隆间合并粗隆下骨折患者的临床资料,所有患者均采用改良股骨近端锁定板内固定进行治疗,观察其治疗效果。结果:本组手术时间80~120 min,术中出血400~800 mL,平均510 mL。所有患者切口Ⅰ期愈合,随访6~18个月,平均14个月骨折愈合。本次随访髋关节术后功能恢复根据Harris评分标准,评定优10例,良4例,可4例,优良率为77.8%。结论:改良股骨近端锁定板内固定治疗股骨粗隆间合并粗隆下骨折临床效果可靠,骨

  19. 解剖型锁定钢板固定治疗累及股骨干的转子间或转子下骨折%Treating femoral intertrochanteric and subtrochanteric fractures combined with femoral shaft fractures using anatomic locking plate

    Institute of Scientific and Technical Information of China (English)

    王少林; 谭祖键; 周明全; 吴钢; 张胜利; 龙祥明

    2012-01-01

    Objective To evaluate clinical efficacy of treating femoral intertrochanteric and subtrochanteric fractures combined with femoral shaft fractures using anatomic locking plate.Methods From January 2009 to June 2011,we treated 72 cases of femoral intertrochanteric and subtrochanteric fractures combined with femoral shaft fractures using anatomic locking plate.Sixty-four cases were followed up.There were 50 males and 14 female,with an average age of 42.8 years (range,21-79).All patients suffered from closed femoral unilateral fractures.The interval between injury and surgery was 2 h-16 d (average,4.6 d).All patients were followed up at regular interval.During the follow-up period,clinical and radiographic data were recorded.The clinical efficacy was evaluated with Harris hip function score.Results The mean operative time was 65 min (range,45-120 min); the mean blood loss was 210 ml (range,50-650 ml).All patients began to walk with crutches 3-35 d after surgery.During the follow-up period,no infection,deep vein thrombosis,screwed cut-out and implant failure occurred in all patients.Coxa vara with shortening deformity was noted in 2 cases,solid bone union was found in all the cases.The mean time of fracture healing was 5.2 months (range,3.6-10.5 months).According to Harris hip score,45 cases were classified as excellent,14 as good and 5 as fair,with excellent and good rate being 92.19% (59/64).Conclusion Anatomic locking plate fixation provides stable fixation,with a high union rate and a minimal complication rate in treatment of intertrochanteric and subtrochanteric fractures combined with femoral shaft fracture.%目的 评价采用解剖型锁定钢板固定治疗累及股骨干的转子间或转子下骨折的临床疗效.方法 2009年1月至2011年6月,采用解剖型锁定钢板固定治疗累及股骨干的转子间或转子下骨折者72例,64例患者获得随访.男50例,女14例;年龄21~79岁,平均42.8岁.所有患者均为股骨单侧闭

  20. Use of DXA-Based Structural Engineering Models of the Proximal Femur to Discriminate Hip Fracture

    Science.gov (United States)

    Yang, Lang; Peel, Nicola; Clowes, Jackie A; McCloskey, Eugene V; Eastell, Richard

    2011-01-01

    Several DXA-based structural engineering models (SEMs) of the proximal femur have been developed to estimate stress caused by sideway falls. Their usefulness in discriminating hip fracture has not yet been established and we therefore evaluated these models. The hip DXA scans of 51 postmenopausal women with hip fracture (30 femoral neck, 17 trochanteric, and 4 unspecified) and 153 age-, height-, and weight-matched controls were reanalyzed using a special version of Hologic’s software that produced a pixel-by-pixel BMD map. For each map, a curved-beam, a curved composite-beam, and a finite element model were generated to calculate stress within the bone when falling sideways. An index of fracture risk (IFR) was defined over the femoral neck, trochanter, and total hip as the stress divided by the yield stress at each pixel and averaged over the regions of interest. Hip structure analysis (HSA) was also performed using Hologic APEX analysis software. Hip BMD and almost all parameters derived from HSA and SEM were discriminators of hip fracture on their own because their ORs were significantly >1. Because of the high correlation of total hip BMD to HSA and SEM-derived parameters, only the bone width discriminated hip fracture independently from total hip BMD. Judged by the area under the receiver operating characteristics curve, the trochanteric IFR derived from the finite element model was significant better than total hip BMD alone and similar to the total hip BMD plus bone width in discriminating all hip fracture and femoral neck fracture. No index was better than total hip BMD for discriminating trochanteric fractures. In conclusion, the finite element model has the potential to replace hip BMD in discriminating hip fractures. PMID:18767924

  1. High reliability of an algorithm for choice of implants in hip fracture patients

    DEFF Research Database (Denmark)

    Palm, Henrik; Posner, Eva; Ahler-Toftehøj, Hans-Ulrik;

    2013-01-01

    Hip fracture treatment is controversial, with high complication rates. An algorithm for hip fracture surgery has shown reduced reoperation rates, but choice of implant is based on the commonly used fracture classifications, which were previously evaluated to be unreliable. The purpose of this study...... was to investigate the reliability of the algorithm....

  2. The incidence of hip fractures in Norway -accuracy of the national Norwegian patient registry

    DEFF Research Database (Denmark)

    Høiberg, Mikkel; Gram, Jeppe; Hermann, Pernille;

    2014-01-01

    Background: Hip fractures incur the greatest medical costs of any fracture. Valid epidemiological data are important to monitor for time-dependent changes. In Norway, hip fractures are registered in the Norwegian Patient Registry (NPR), but no published national validation exists. The aim...

  3. Femoral head fractures: hemiarthroplasty or total hip arthroplasty?

    Science.gov (United States)

    Ullmark, Gösta

    2014-10-02

    Most femoral neck fractures are osteoporotic fractures in the elderly. The one-year mortality after neck fracture in this group is 24%.For hemiarthroplasty (HA) the bipolar heads have a risk reduction for reoperation due to acetabular erosion compared with monoblock heads. Surprisingly, the bipolar head had an increased reoperation risk for dislocation, infection and for periprosthetic fracture.Total hip arthroplasty (THA) after fracture has a four-fold raised risk for dislocation compared with THA after osteoarthritis. A larger head on the same neck (head to neck ratio) results in a theoretically larger range of movement and hence less risk for dislocation. The dual mobility bearing has, theoretically, the largest range of movement and good clinical results.Functional results are better for THA compared with HA. Arthroplasty for fracture has much better results compared with arthroplasty after a failed internal fixation; the risk for reoperation is more than doubled for the latter.A Swedish hip arthroplasty register study found a 20-fold higher risk for periprosthetic fracture when comparing uncemented HA with matt cemented HA. Also a polished cemented stem had 13½-fold higher risks compared with a matt.The mortality during the first day after surgery is higher for cemented compared with uncemented arthroplasties, but lower after one week, one month and one year. Analysing the time points together resulted in no difference.A matt cemented THA with a maximum head size, maybe dual mobility, has the best results, and is also for the low-demanding elderly.

  4. Dementia and delirium, the outcomes in elderly hip fracture patients

    Directory of Open Access Journals (Sweden)

    Mosk CA

    2017-03-01

    Full Text Available Christina A Mosk,1 Marnix Mus,1 Jos PAM Vroemen,1 Tjeerd van der Ploeg,2 Dagmar I Vos,1 Leon HGJ Elmans,3 Lijckle van der Laan1 1Department of Surgery, Amphia Hospital, Breda, 2Department of Public Health, Erasmus MC–University Medical Center, Rotterdam, 3Department of Orthopedic Surgery, Amphia Hospital, Breda, the Netherlands Background: Delirium in hip fractured patients is a frequent complication. Dementia is an important risk factor for delirium and is common in frail elderly. This study aimed to extend the previous knowledge on risk factors for delirium and the consequences. Special attention was given to patients with dementia and delirium.Methods: This is a retrospective cohort study performed in the Amphia Hospital, Breda, the Netherlands. A full electronic patient file system (Hyperspace Version IU4: Epic, Inc., Verona, WI, USA was used to assess data between January 2014 and September 2015. All patients presented were aged ≥70 years with a hip fracture, who underwent surgery with osteosynthesis or arthroplasty. Patients were excluded in case of a pathological or a periprosthetic hip fracture, multiple traumatic injuries, and high-energy trauma. Patient and surgical characteristics were documented. Postoperative outcomes were noted. Delirium was screened using Delirium Observation Screening Scale and dementia was assessed from medical notes.Results: Of a total of 566 included patients, 75% were females. The median age was 84 years (interquartile range: 9. Delirium was observed in 35%. Significant risk factors for delirium were a high American Society of Anesthesiology score, delirium in medical history, functional dependency, preoperative institutionalization, low hemoglobin level, and high amount of blood transfusion. Delirium was correlated with a longer hospital stay (P=0.001, increased association with complications (P<0.001, institutionalization (P<0.001, and 6-month mortality (P<0.001. Patients with dementia (N=168 had a

  5. Can Hip Fracture Prediction in Women be Estimated beyond Bone Mineral Density Measurement Alone?

    Science.gov (United States)

    Geusens, Piet; van Geel, Tineke; van den Bergh, Joop

    2010-01-01

    The etiology of hip fractures is multifactorial and includes bone and fall-related factors. Low bone mineral density (BMD) and BMD-related and BMD-independent geometric components of bone strength, evaluated by hip strength analysis (HSA) and finite element analysis analyses on dual-energy X-ray absorptiometry (DXA) images, and ultrasound parameters are related to the presence and incidence of hip fracture. In addition, clinical risk factors contribute to the risk of hip fractures, independent of BMD. They are included in the fracture risk assessment tool (FRAX) case finding algorithm to estimate in the individual patient the 10-year risk of hip fracture, with and without BMD. Fall risks are not included in FRAX, but are included in other case finding tools, such as the Garvan algorithm, to predict the 5- and 10-year hip fracture risk. Hormones, cytokines, growth factors, markers of bone resorption and genetic background have been related to hip fracture risk. Vitamin D deficiency is endemic worldwide and low serum levels of 25-hydroxyvitamin D [25(OH)D] predict hip fracture risk. In the context of hip fracture prevention calculation of absolute fracture risk using clinical risks, BMD, bone geometry and fall-related risks is feasible, but needs further refinement by integrating bone and fall-related risk factors into a single case finding algorithm for clinical use. PMID:22870438

  6. Subtrochanteric fractures in bisphosphonate-naive patients: results from the HORIZON-recurrent fracture trial.

    Science.gov (United States)

    Adachi, Jonathan D; Lyles, Kenneth; Boonen, Steven; Colón-Emeric, Cathleen; Hyldstrup, Lars; Nordsletten, Lars; Pieper, Carl; Recknor, Chris; Su, Guoqin; Bucci-Rechtweg, Christina; Magaziner, Jay

    2011-12-01

    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 incident subtrochanteric fractures with those sustaining other hip fractures. Subjects were bisphosphonate-naive or had a bisphosphonate washout period of 6-24 months and subsequently received an annual infusion of zoledronic acid 5 mg or placebo after low-trauma hip-fracture repair. In total, 2,127 men and women were included. Of the qualifying hip fractures, 5.2% were subtrochanteric, 54.8% femoral neck, 33.0% intertrochanteric, and 7.1% other (generally complex fractures of mixed type). Significant baseline (pre-hip fracture) differences were seen between index hip-fracture types, with the percentage of patients with extreme mobility problems being twofold higher in patients with index subtrochanteric fracture (9.9%) compared to other patients. The distribution of hip-fracture types was similar between the treatment groups at baseline. No patients with index subtrochanteric fractures and six patients with other qualifying hip fractures reported prior bisphosphonate use. Only one further subtrochanteric fracture occurred in each treatment group over an average 2-year patient follow-up. Subtrochanteric fractures are not uncommon in bisphosphonate-naive patients. Extreme difficulties with mobility may be a unique risk factor predisposing to development of incident subtrochanteric fractures rather than other types of hip fracture. In patients with recent hip fracture who received zoledronic acid therapy, the incidence of new subtrochanteric fractures was too small to draw any meaningful conclusions.

  7. Inflammatory markers and risk of hip fracture in older white women: the study of osteoporotic fractures.

    Science.gov (United States)

    Barbour, Kamil E; Lui, Li-Yung; Ensrud, Kristine E; Hillier, Teresa A; LeBlanc, Erin S; Ing, Steven W; Hochberg, Marc C; Cauley, Jane A

    2014-09-01

    Hip fractures are the most devastating consequence of osteoporosis and impact 1 in 6 white women leading to a two- to threefold increased mortality risk in the first year. Despite evidence of inflammatory markers in the pathogenesis of osteoporosis, few studies have examined their effect on hip fracture. To determine if high levels of inflammation increase hip fracture risk and to explore mediation pathways, a case-cohort design nested in a cohort of 4709 white women from the Study of Osteoporotic Fractures was used. A random sample of 1171 women was selected as the subcohort (mean age 80.1 ± 4.2 years) plus the first 300 women with incident hip fracture. Inflammatory markers interleukin-6 (IL-6) and soluble receptors (SR) for IL-6 (IL-6 SR) and tumor necrosis factor (TNF SR1 and TNF SR2) were measured, and participants were followed for a median (interquartile range) of 6.3 (3.7, 6.9) years. In multivariable models, the hazard ratio (HR) of hip fracture for women in the highest inflammatory marker level (quartile 4) was 1.64 (95% confidence interval [CI], 1.09-2.48, p trend = 0.03) for IL-6 and 2.05 (95% CI, 1.35-3.12, p trend hip fracture was 1.51 (95% CI, 1.07-2.14) and 1.42 (95% CI, 0.87-2.31) compared with women with zero to one marker(s) in the highest quartile (p trend = 0.03). After individually adjusting for seven potential mediators, cystatin-C (a biomarker of renal function) and bone mineral density (BMD) attenuated HRs among women with the highest inflammatory burden by 64% and 50%, respectively, suggesting a potential mediating role. Older white women with high inflammatory burden are at increased risk of hip fracture in part due to poor renal function and low BMD. © 2014 American Society for Bone and Mineral Research.

  8. Observaiton on clinical effetc applicatoin of anit -osteopo rosis treatment with intramedullary nail in treatment of femoral intertrochanteric fractures in elderly patient's%高龄股骨粗隆间骨折应用髓内钉结合抗骨质疏松治疗的效果观察

    Institute of Scientific and Technical Information of China (English)

    晏万述; 于德洋; 谢东方

    2015-01-01

    Objective:To investigate the application of anti osteoporosis treatmentwith intramedullary nail in treatment of femoral inter-trochanteric fractures in the elderly patient's clinical effect.Methods:Our hospital 70 cases of elderly patients with femoral intertrochan-teric fracture were divided into observation group and control group.Given to the control group of patients with intramedullary nails in the treatment, the patients in observation group were given intramedullary nailinternal fixation combined with anti osteoporosis treatment, pa-tients were followed up for 1 years.Results:preoperative hip joint function were compared between the two groups ( Harris score) there was no significant difference (P>0.05), after 1 years observation of hip function score was significantly higher than that of the control group patients (P<0.05), the observation group of patients with postoperative complication rate was 11.4%, significantly lower than the control 28.6%groups of patients (P<0.05).Conclusion :The application of anti osteoporosis therapy combined with intramedul-lary nail in treatment offemoral intertrochanteric fractures in the elderly patients,might have a significant clinical effect, high safety.%目的:探讨应用抗骨质疏松治疗结合髓内钉内固定治疗高龄股骨粗隆间骨折患者的临床效果。方法:将我院收治的70例高龄股骨粗隆间骨折患者平均分为观察组和对照组。给予对照组患者髓内钉内固定治疗,给予观察组患者髓内钉内固定结合抗骨质疏松治疗,术后随访1年。结果:术前比较2组患者的髋关节功能评分( Harris)不存在明显差异( P>0.05),术后1年观察组患者的髋关节功能评分明显高于对照组患者(P<0.05),术后观察组患者的并发症发生率为11.4%,明显低于对照组患者的28.6%( P<0.05)。结论:应用抗骨质疏松治疗结合髓内钉内固定治疗高龄股骨粗隆间骨折患者

  9. DHS与PFNA治疗老年股骨转子间骨折疗效比较%Curative effects of using DHS and PFNA for intertrochanteric fracture in the elderly

    Institute of Scientific and Technical Information of China (English)

    朱定川; 刘雷; 高峰

    2013-01-01

    Objective To discuss and compare the curative effects of using dynamic hip screw (DHS) and proximal femoral nail anti-rotation blade ( PFNA) for iniertrochanteric fracture in the elderly. Methods Among 59 elderly persons with intertrochanteric fracture, who were treated in our department from 2006 to 2012, DHS internal fixation was adopted for 28 persons and PFNA internal fixation for the rest 31 persons. A comparison was made to evaluate curative effect of them. Results A follow-up survey was conducted among 56 of them for 12 to 18 months (averagely 16.7 months). There was no loosing, breaking, exposure nor falling off in terms of the status of internal fixation. For DHS treatment group, the surgery lasted for 107 to 15 3 minutes, during which the amount of bleeding was 200 ~ 300 mL. It took 6 to 8 weeks for them restore to the extent that they were capable of walking, and it took 12 to 20 weeks to cure the fracture. For PFNA group,the surgery lasted for 45 to 115 minutes, during which the amount of bleeding was 120 to 230 mL. It took 5 to 7 days for them restore to the extent that they were capable of walking, and it took 6 to 8 weeks to cure the fracture. The difference of two groups in duration of surgery,amount of bleeding and the time of walking exercises were of a significant meaning. Conclusion The conclusion is that both DHS and PFNA are effective methods to treat intertrochanteric fracture in the elderly. For those with PFNA therapy,the surgery could be finished in a shorter time with less amount of bleeding and smaller trauma; and it was possible for them to walk and heal over earlier. It could effectively avoid complication arising from long-term bed.%目的 探讨对比老年患者股骨转子间骨折使用动力髋螺钉(DHS)与股骨近端螺旋刀片抗旋髓内钉(PFNA)治疗的相关疗效.方法 2006年至20012年在我科收治的59例老年股骨转子间骨折患者中,对28例老年股骨转子间骨折患者应用DHS内固定,31例老年

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

    Science.gov (United States)

    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

  11. Association between timing of zoledronic acid infusion and hip fracture healing

    DEFF Research Database (Denmark)

    Colón-Emeric, C; Nordsletten, L; Olson, S

    2010-01-01

    Patients in the Health Outcomes and Reduced Incidence with Zoledronic Acid Once Yearly (HORIZON) Recurrent Fracture Trial were assessed for evidence of delayed hip fracture healing. No association was observed between zoledronic acid (ZOL) and delayed healing. We conclude that ZOL has no clinically...... evident effect on fracture healing, even when the drug is infused in the immediate postoperative period. INTRODUCTION: Intravenous zoledronic acid 5 mg (ZOL) given after a hip fracture reduces secondary fracture rates and mortality. It has been postulated that bisphosphonates may affect healing if given...... soon after a fracture. We sought to determine whether the timing of ZOL infusion affected the risk of delayed hip fracture healing. METHODS: In the HORIZON Recurrent Fracture Trial, patients were randomized within 90 days of a low-trauma hip fracture to receive either once-yearly ZOL (n¿=¿1...

  12. The risk factors that effect the prognosis in fractures of the hip

    OpenAIRE

    Ozturk, Irfan

    2004-01-01

    There is still some controversy and problems about the treatment of hip fractures in elderly people. In addition to success of surgical technique, low postoperative morbidity and mortality rates also have to be the aim of the therapy. In elderly people whose hips are fractured, there is a high rate of postoperative mortality and medical problems. For this reason preoperative evaluation of hip fractured patients must be well recognized. There are so many "risk evaluation schedules" present in ...

  13. The risk factors that effect the prognosis in fractures of the hip

    OpenAIRE

    Ozturk, Irfan

    2004-01-01

    There is still some controversy and problems about the treatment of hip fractures in elderly people. In addition to success of surgical technique, low postoperative morbidity and mortality rates also have to be the aim of the therapy. In elderly people whose hips are fractured, there is a high rate of postoperative mortality and medical problems. For this reason preoperative evaluation of hip fractured patients must be well recognized. There are so many "risk evaluation schedules" p...

  14. Hip fracture epidemiological trends, outcomes, and risk factors, 1970–2009

    Directory of Open Access Journals (Sweden)

    Ray Marks

    2009-12-01

    Full Text Available Ray MarksCity University of New York and Columbia University, New York, NY, USAAbstract: Hip fractures – which commonly lead to premature death, high rates of morbidity, or reduced life quality – have been the target of a voluminous amount of research for many years. But has the lifetime risk of incurring a hip fracture decreased sufficiently over the last decade or are high numbers of incident cases continuing to prevail, despite a large body of knowledge and a variety of contemporary preventive and refined surgical approaches? This review examines the extensive hip fracture literature published in the English language between 1980 and 2009 concerning hip fracture prevalence trends, and injury mechanisms. It also highlights the contemporary data concerning the personal and economic impact of the injury, plus potentially remediable risk factors underpinning the injury and ensuing disability. The goal was to examine if there is a continuing need to elucidate upon intervention points that might minimize the risk of incurring a hip fracture and its attendant consequences. Based on this information, it appears hip fractures remain a serious global health issue, despite some declines in the incidence rate of hip fractures among some women. Research also shows widespread regional, ethnic and diagnostic variations in hip fracture incidence trends. Key determinants of hip fractures include age, osteoporosis, and falls, but some determinants such as socioeconomic status, have not been well explored. It is concluded that while more research is needed, well-designed primary, secondary, and tertiary preventive efforts applied in both affluent as well as developing countries are desirable to reduce the present and future burden associated with hip fracture injuries. In this context, and in recognition of the considerable variation in manifestation and distribution, as well as risk factors underpinning hip fractures, well-crafted comprehensive, rather

  15. Feasibility of Progressive Strength Training Implemented in the Acute Ward after Hip Fracture Surgery

    DEFF Research Database (Denmark)

    Kronborg, Lise; Bandholm, Thomas; Palm, Henrik;

    2014-01-01

    IMPORTANCE: Patients with a hip fracture lose more than 50% knee-extension strength in the fractured limb within one week of surgery. Hence, immediate progressive strength training following hip fracture surgery may be rational, but the feasibility unknown. OBJECTIVE: To examine the feasibility...... of in-hospital progressive strength training implemented in the acute ward following hip fracture surgery, based on pre-specified criteria for feasibility. DESIGN, SETTING AND PATIENTS: A prospective cohort study conducted in an acute orthopedic hip fracture unit at a university hospital. A consecutive...... sample of 36 patients, 18 with a cervical and 18 with a trochanteric hip fracture (27 women and 9 men, mean (SD) age of 79.4 (8.3) years) were included between June and December 2012. INTERVENTION: A daily (on weekdays) program of progressive knee-extension strength training for the fractured limb, using...

  16. Room for improvement in the treatment of hip fractures in Denmark

    DEFF Research Database (Denmark)

    Egerod, Ingrid; Rud, Kirsten; Specht, Kirsten;

    2010-01-01

    INTRODUCTION: Treatment of hip fractures has evolved since the introduction of fast-track surgical programs in the late 1990s. The aim of our study was to describe the quality of treatment and care related to fast-track hip fracture surgery in Denmark by external audit of patient records. MATERIAL...... AND METHODS: This was a national multicenter audit of hospital charts from each hospital treating ≥ 50 hip fracture patients per year (n = 594). RESULTS: The study demonstrated significant variability in treatment and care of patients with hip fractures among the regions of Denmark. Pain management...

  17. A comparison of hip fracture incidence rates among elderly in Sweden by latitude and sunlight exposure.

    Science.gov (United States)

    Nilson, Finn; Moniruzzaman, Syed; Andersson, Ragnar

    2014-03-01

    Research has shown that hip fracture risk increases with latitude; hypothetically due to reduced sunlight exposure and its effect on bone quality. Sweden, with large differences in latitude and UV radiation, is ideal to study in order to analyse the association between latitude and UV radiation on age- and sex-specific hip fracture rates among elderly. Aggregated (2006-2008) age- and sex-specific hip fracture data was obtained for each Swedish municipality as well as the municipality's latitudinal coordinates and aggregated (2006-2008) UV radiation levels. Pearson correlations were calculated between hip fracture incidence rates, latitude and UV radiation. Independent t tests were calculated on tertile-categorized latitudinal data in order to investigate the difference in hip fracture risk between these categories. Statistically significant correlations were seen in all groups between hip fracture incidence rates and latitude as well as UV radiation. The independent t tests showed that this correlation was mainly due to high incidence rates in high latitude municipalities. Statistically significant correlations are seen between hip fracture incidence rates and latitude as well as UV radiation in Sweden and the northern parts of Sweden have an increased risk of hip fractures compared to the middle and southern parts. To our knowledge this is the first study using a national discharge register that shows this relationship and provides a starting point for further research to investigate why populations in northern Sweden have a higher risk of hip fractures compared to other Swedish regions.

  18. Intramedullary fixation of a femoral shaft fracture with preservation of an existing hip resurfacing prosthesis.

    Science.gov (United States)

    Bilkhu, A; Sisodia, G; Chakrabarty, G; Muralikuttan, K P

    2015-04-01

    Femoral neck fractures have been reported as a cause for failure in patients with a hip resurfacing arthroplasty. However, the incidence and management of fractures of the femoral shaft with an ipsilateral hip resurfacing arthroplasty is relatively absent in current literature. Although, the gold standard for the fixation of a closed femoral shaft fracture is with the use of an intramedullary nail, this can be a challenge in the presence of a hip resurfacing arthroplasty. We describe the case of anterograde intramedullary nail fixation for a femoral shaft fracture in a patient with an ipsilateral hip resurfacing arthroplasty in situ.

  19. 锁定加压钢板与DHS治疗股骨转子间骨折的对比研究%Comparative study of treatment of the femoral intertrochanteric fractures with locking compression Plate and DHS

    Institute of Scientific and Technical Information of China (English)

    罗福昌; 彭建强; 蔡汉周; 周经颖; 李中檀

    2008-01-01

    目的 探讨锁定加压钢板与DHS治疗股骨转子间骨折的疗效及适应证.方法 使用锁定加压钢板与DHS治疗股骨转子间骨折共102例,并对其在手术时间、术中出血量、术后引流、Parker髋关节功能评分、并发症等方而进行比较.结果 锁定加压钢板组在手术时间、手术期出血量、术后切口引流量、并发症等均较DHS组少,DHS组早期活动和负重时间明显早于锁定加压钢板组.结论 锁定加压钢板治疗股骨转子间骨折适用于所有类型的股骨转子间骨折,对于骨质疏松、粉碎性骨折患者尤为适合.DHS治疗股骨转子间骨折具有固定可靠、患者可早期活动和负重的优点,适用于Ⅰ、Ⅱ型股骨转子间骨折.%Objective To evaluate the effect and indications in the treatment of the femoral intertro-chanteric fractures with locking compression plate add DHS. Methods Treated femoral intertrochanteric fractures with locking compression plate and DHS for 102 cases at the same period, and its operation time, blood loss,the drainage volum,Parkerhip function score,complication in the 2 groups were compared. Results The group of locking compression plate in the blood loss, operation time, complication and the drainage volum were less than the group of DHS,the group of DHS in the early activities were more early than the group of locking compression plate. Conclusion Treatment of the femoral intertrochantefic fractures with locking compression plate is suitable treatment for all types of femoral intertroehanterie fractures, which is especially suitable treatment for the syntripsis and osteoporosis. Treatment of the femoral intertrochanteric fractures with DHS has the advantages of reliable fixation and early activities,which is suitable treatment for the types of Ⅰ and Ⅱ.

  20. 经皮加压钢板在治疗股骨转子间骨折中的应用%Percutaneous compression plate for the treatment of intertrochanteric fractures

    Institute of Scientific and Technical Information of China (English)

    陈滨; 程光齐; 冯宇; 张磊; 王涵韬

    2010-01-01

    Objective To discuss the value of percutaneous compression plate (PCCP) in treating intertrochanteric fractures. Methods A retrospective study was done on 57 patients with intertrochanteric fractures treated by PCCP from January 2008 to January 2009 to evaluate the operative effect.Results All the fractures were healed in 11-15 weeks after the operation, with no incision infection, hematoma, internal fixation failure or fracture collapse. Two surgical incisions were for 2 cm, with no blood transfusion found in any patient. According to Harris score, the postoperative excellent rate reached 92.6%. Conclusion PCCP can attain similar effect wiht DHS and now is the choice of treatment in treating intertrochanteric fracture in the elderly patients.%目的 探讨采用经皮加压钢板(percutaneous compression plate,PCCP)治疗股骨转子间骨折的手术疗效.方法 对2008年1月-2009年1月间行PCCP固定治疗的57例股骨转子间骨折患者进行分析,评价其手术疗效.结果 所有患者骨折均于术后11~15周内愈合.术后无一例发生伤口感染、血肿形成、内固定失败和骨折端塌陷.手术切口均为2个约2 cm皮肤切口.术后无一例患者输血.术后髋关节评分优良率达93%.结论 PCCP微创固定手术能获得与经典的动力髋螺钉(DHS)内固定手术类似的疗效,同时在损伤程度、固定理念等方面优于DHS.PCCP是目前治疗老年股骨转子间骨折的第一选择.

  1. Study of Hip Fracture Risk using Tree Structured Survival Analysis

    Directory of Open Access Journals (Sweden)

    Lu Y

    2003-01-01

    Full Text Available In dieser Studie wird das Hüftfraktur-Risiko bei postmenopausalen Frauen untersucht, indem die Frauen in verschiedene Subgruppen hinsichtlich dieses Risikos klassifiziert werden. Frauen in einer gemeinsamen Subgruppe haben ein ähnliches Risiko, hingegen in verschiedenen Subgruppen ein unterschiedliches Hüftfraktur-Risiko. Die Subgruppen wurden mittels der Tree Structured Survival Analysis (TSSA aus den Daten von 7.665 Frauen der SOF (Study of Osteoporosis Fracture ermittelt. Bei allen Studienteilnehmerinnen wurde die Knochenmineraldichte (BMD von Unterarm, Oberschenkelhals, Hüfte und Wirbelsäule gemessen. Die Zeit von der BMD-Messung bis zur Hüftfraktur wurde als Endpunkt notiert. Eine Stichprobe von 75% der Teilnehmerinnen wurde verwendet, um die prognostischen Subgruppen zu bilden (Trainings-Datensatz, während die anderen 25% als Bestätigung der Ergebnisse diente (Validierungs-Datensatz. Aufgrund des Trainings-Datensatzes konnten mittels TSSA 4 Subgruppen identifiziert werden, deren Hüftfraktur-Risiko bei einem Follow-up von im Mittel 6,5 Jahren bei 19%, 9%, 4% und 1% lag. Die Einteilung in die Subgruppen erfolgte aufgrund der Bewertung der BMD des Ward'schen Dreiecks sowie des Oberschenkelhalses und nach dem Alter. Diese Ergebnisse konnten mittels des Validierungs-Datensatzes reproduziert werden, was die Sinnhaftigkeit der Klassifizierungregeln in einem klinischen Setting bestätigte. Mittels TSSA war eine sinnvolle, aussagekräftige und reproduzierbare Identifikation von prognostischen Subgruppen, die auf dem Alter und den BMD-Werten beruhen, möglich. In this paper we studied the risk of hip fracture for post-menopausal women by classifying women into different subgroups based on their risk of hip fracture. The subgroups were generated such that all the women in a particular subgroup had relatively similar risk while women belonging to two different subgroups had rather different risks of hip fracture. We used the Tree Structured

  2. 鲑鱼降钙素鼻喷剂对老年股骨转子间骨折术后康复的临床研究%Clinical study of salmon calcitonin nasal spray on senile femoral intertrochanteric fracture after

    Institute of Scientific and Technical Information of China (English)

    陈方经; 欧阳跃平; 苟三怀; 刘岩; 徐盛明; 叶添文; 史国栋

    2011-01-01

    目的 研究鲑鱼降钙素鼻喷剂对老年人股骨转子间骨折内固定术后的临床疗效.方法 采用完全随机对照的前瞻性临床研究方法,将入组的60例股骨转子间骨折老年患者分为两组,试验组行内固定手术并给予鲑鱼降钙素鼻喷剂及钙尔奇D治疗,对照组行内固定手术及钙尔奇D治疗.观察两组术后1、2,3、4周疼痛视觉模拟评分(VAS)、术后3个月骨折愈合及患髋关节功能情况.结果 鲑鱼降钙素鼻喷剂能明显减轻患者术后疼痛(P<0.001).术后3个月试验组骨折愈合率(89.3%)高于对照组(65.5%),P<0.05.术后3个月试验组患侧Harris髋关节功能评分优于对照组(P<0.05).结论 鲑鱼降钙素鼻喷剂具有一定的减轻老年股骨转子间骨折患者术后疼痛的作用,有助于促进骨折愈合及术后髋关节功能康复.%Objective To observe the efficacy of salmon calcitonin nasal spray on patients of senile femoral intertrochsnteric fracture after internal fixation surgery. Methods Using a fully randomized controlled research method, 60 cases of senile femoral intertrochanteric fracture were divided into two groups, 30 cases in experimental group were given salmon calcitonin nasal spray and Caltrate D and 30 cases in control group were given Caltrate D. The visual analogue scale(VAS) scores were evaluated in four weeks after surgery. The fracture healing and the function of hip were assessed after 3 weeks. Results Salmon calcitonin was effected for the patients reducing pain after internal fixation of femoral intertrochanteric fractures than the patients of the control group (P<0.001), the fracture healing rates in the experimental group and the control group were 89.3% and 65.5%respectively at 3 months, the difference has statistically significance(P<0.05). The experimental group is higher in Harris hip score than the control group (P<0.05). Conclusions Salmon calcitonin nasal spray can reduce postoperative pain in

  3. Effects of Teriparatide Compared with Risedronate on Recovery After Pertrochanteric Hip Fracture

    DEFF Research Database (Denmark)

    Aspenberg, Per; Malouf, Jorge; Tarantino, Umberto;

    2016-01-01

    BACKGROUND: Osteoporosis drugs might affect fracture-healing. We therefore studied the effects of teriparatide in comparison with risedronate on recovery after pertrochanteric hip fractures. METHODS: The study was a randomized, multicenter, active-controlled, 78-week trial comparing teriparatide ...

  4. A critical review of the long-term disability outcomes following hip fracture

    National Research Council Canada - National Science Library

    Dyer, Suzanne M; Crotty, Maria; Fairhall, Nicola; Magaziner, Jay; Beaupre, Lauren A; Cameron, Ian D; Sherrington, Catherine

    2016-01-01

    .... Studies were identified through PubMed and Scopus searches and contact with experts. Cohort studies of hip fracture patients reporting outcomes 3 months post-fracture or longer were included for review...

  5. Does Early Functional Outcome Predict 1-year Mortality in Elderly Patients With Hip Fracture?

    National Research Council Canada - National Science Library

    Dubljanin-Raspopović, Emilija; Marković-Denić, Ljiljana; Marinković, Jelena; Nedeljković, Una; Bumbaširević, Marko

    2013-01-01

    ... fractures.A total of 228 consecutive patients (average age, 77.6 ± 7.4 years) with hip fractures who met the inclusion criteria were enrolled in an open, prospective, observational cohort study...

  6. Hip resurfacing femoral neck fracture influenced by valgus placement.

    Science.gov (United States)

    Anglin, Carolyn; Masri, Bassam A; Tonetti, Jérôme; Hodgson, Antony J; Greidanus, Nelson V

    2007-12-01

    Femoral neck fracture is the most common short-term concern after hip resurfacing arthroplasty. Currently, there is little basis to decide between neutral and valgus placement. We loaded 10 notched cadaveric femur pairs to failure; one side was implanted at 0 degrees relative to the femoral neck and the other at 10 degrees valgus. All 20 were dual-energy X-ray absorptiometry-scanned. Failure load correlated with bone mineral density. Valgus placement increased the fracture load by an average of 28% over neutral for specimens with normal bone mineral density but had no effect on fracture load in specimens with low bone mineral density. For specimens with normal bone mineral density (typical of patients undergoing resurfacing arthroplasty), neutral-valgus placement had a greater effect than bone mineral density, explaining 54% of the fracture load variance. Component placement greater than 10 degrees valgus is likely undesirable because this can lead to an increase in component size and a greater likelihood of notching. To reduce fracture risk, we recommend placing the femoral component in valgus and selecting patients with higher bone mineral density.

  7. 股骨近端防旋髓内钉微创内固定治疗股骨转子间骨折%Treatment of intertrochanteric fractures with proximal femoral nail anti-rotation

    Institute of Scientific and Technical Information of China (English)

    徐荣华; 霍维玲; 赵耀; 郭含军

    2015-01-01

    目的:探讨股骨近端防旋髓内钉(PFNA)微创治疗股骨转子间骨折的临床疗效。方法采取闭合复位PFNA 微创内固定治疗48例股骨转子间骨折患者。结果48例均获随访,时间6~24个月。术后6个月所有患者均获得骨性愈合,无髋内翻、螺旋刀片切割股骨头、骨不连、内固定断裂等并发症发生。疗效按 Harris评分标准评定:优37例,良9例,可2例,优良率95.8%。结论PFNA 具有创伤小、固定牢靠、并发症少、防旋、防切割等特点,是治疗股骨转子间骨折的有效方法。%Objective To evaluate the clinical and radiographic results in intertrochanteric fractures treated with prox-imal femoral nail anti-rotation(PFNA).Methods 48 cases of intertrochanteric fractures were reduced with closed reduction technique and fixed with PFNA.Results The patients were followed up for 6 ~24 months and all fractures were healed in 6 months postoperatively.No Coxa vara,cut-out of lag screw,pseudoarthrosis or implant failure was recorded.According to the Harris standard:the results were excellent in 37 cases,good in 9 and fair in 2,the rate of excellent and good was 95.8%.Conclusions PFNA has the advantages of less surgical trauma,less loss of reduc-tion,less complications,more stable fixation,anti-rotation,anti-cutout.So it is a useful device in the treatment of femoral intertrochanteric fracture.

  8. Direct costs of osteoporosis and hip fracture: an analysis for the Mexican healthcare system.

    Science.gov (United States)

    Clark, P; Carlos, F; Barrera, C; Guzman, J; Maetzel, A; Lavielle, P; Ramirez, E; Robinson, V; Rodriguez-Cabrera, R; Tamayo, J; Tugwell, P

    2008-03-01

    This study reports the direct costs related to osteoporosis and hip fractures paid for governmental and private institutions in the Mexican health system and estimates the impact of these entities on Mexico. We conclude that the economic burden due to the direct costs of hip fracture justifies wide-scale prevention programs for osteoporosis (OP). To estimate the total direct costs of OP and hip fractures in the Mexican Health care system, a sample of governmental and private institutions were studied. Information was gathered through direct questionnaires in 275 OP patients and 218 hip fracture cases. Additionally, a chart review was conducted and experts' opinions obtained to get accurate protocol scenarios for diagnoses and treatment of OP with no fracture. Microcosting and activity-based costing techniques were used to yield unit costs. The total direct costs for OP and hip fracture were estimated for 2006 based on the projected annual incidence of hip fractures in Mexico. A total of 22,233 hip fracture cases were estimated for 2006 with a total cost to the healthcare system of US$ 97,058,159 for the acute treatment alone ($4,365.50 per case). We found considerable differences in costs and the way the patients were treated across the different health sectors within the country. Costs of the acute treatment of hip fractures in Mexico are high and are expected to increase with the predicted increment of life expectancy and the number of elderly in our population.

  9. Hip fracture epidemiological trends, outcomes, and risk factors, 1970–2009

    Science.gov (United States)

    Marks, Ray

    2010-01-01

    Hip fractures – which commonly lead to premature death, high rates of morbidity, or reduced life quality – have been the target of a voluminous amount of research for many years. But has the lifetime risk of incurring a hip fracture decreased sufficiently over the last decade or are high numbers of incident cases continuing to prevail, despite a large body of knowledge and a variety of contemporary preventive and refined surgical approaches? This review examines the extensive hip fracture literature published in the English language between 1980 and 2009 concerning hip fracture prevalence trends, and injury mechanisms. It also highlights the contemporary data concerning the personal and economic impact of the injury, plus potentially remediable risk factors underpinning the injury and ensuing disability. The goal was to examine if there is a continuing need to elucidate upon intervention points that might minimize the risk of incurring a hip fracture and its attendant consequences. Based on this information, it appears hip fractures remain a serious global health issue, despite some declines in the incidence rate of hip fractures among some women. Research also shows widespread regional, ethnic and diagnostic variations in hip fracture incidence trends. Key determinants of hip fractures include age, osteoporosis, and falls, but some determinants such as socioeconomic status, have not been well explored. It is concluded that while more research is needed, well-designed primary, secondary, and tertiary preventive efforts applied in both affluent as well as developing countries are desirable to reduce the present and future burden associated with hip fracture injuries. In this context, and in recognition of the considerable variation in manifestation and distribution, as well as risk factors underpinning hip fractures, well-crafted comprehensive, rather than single solutions, are strongly indicated in early rather than late adulthood. PMID:20463818

  10. Team management of the elderly patient with hip fracture.

    Science.gov (United States)

    Pryor, G A; Myles, J W; Williams, D R; Anand, J K

    1988-02-20

    The management of 200 consecutive patients with hip fracture by a joint hospital and community team in Peterborough has shown that over half the patients could be discharged considerably earlier than is usual. The patients are cared for at home by the hospital-at-home nursing service and generally need much less nursing care than patients treated conventionally. In the first 10 months of the scheme 733 inpatient bed-days were saved and the average hospital stay of patients discharged home was reduced from 22.0 to 14.6 days.

  11. 骨水泥型双极股骨头假体应用于高龄不稳定股骨转子间骨折16例%Cemented bipolar hemiprosthesis arthoplasty for 16 senile patients with unstable intertrochanteric fractures

    Institute of Scientific and Technical Information of China (English)

    朱光明; 徐耀增; 耿德春; 王现彬

    2009-01-01

    选择苏州大学附属第一医院骨科自2006-07/2008-11行骨水泥型双极股骨头假体置换治疗高龄不稳定股骨转子间骨折患者16例,男5例,女11例;平均年龄84岁.其中,5例获得随访.假体采用北京蒙太因公司骨水泥型双极股骨头假体,置换后常规抗生素治疗5-7d,并给予镇痛、抗凝等药物.平均随访时间14个月,1例于置换10个月后因肺心病死亡,3例存在异位骨化,随访期间均未见假体松动、脱位现象.髋关节功能按Harris评分,优3例,良9例,可3例,差0例,优良率为80%.结果提示骨水泥型双极人工股骨头置换治疗高龄不稳定股骨转子间骨折是积极、有效的,但应严格掌握手术适应证.%From July 2006 to November 2008,16 patients with unstable intertrochanteric fractures were treated with cemented bipolar hemiprosthesis arthroplasty, including 5 males and 11 females, at a mean age of 84 years (range, 78-92 years) in the First Affiliated Hospital of Soochow University. Of them, 15 patients were followed with mean time of 14 months. The cemented bipolar hemiprosthesis was purchased from Beijing Montagne. The patients received 5-7 days of antibiotics following arthroplasty in addition to medicine of anticoagulation and analgesia. 1 case died of pulmonary heart disease 10 months after the operation and 3 cases had heterotopic ossification. There was no prosthesis loosening or dislocation. According to Harris hip scores, 3 cases were rated as excellent, 9 good, 3 fair, and 0 poor; the excellent and good rate was 80%. Results show that cemented bipolar hemiprosthesis arthroplasty is effective in treating elderly unstable intertrochanteric fractures, but operation indications require more attention.

  12. Hip fracture risk estimation based on principal component analysis of QCT atlas: a preliminary study

    Science.gov (United States)

    Li, Wenjun; Kornak, John; Harris, Tamara; Lu, Ying; Cheng, Xiaoguang; Lang, Thomas

    2009-02-01

    We aim to capture and apply 3-dimensional bone fragility features for fracture risk estimation. Using inter-subject image registration, we constructed a hip QCT atlas comprising 37 patients with hip fractures and 38 age-matched controls. In the hip atlas space, we performed principal component analysis to identify the principal components (eigen images) that showed association with hip fracture. To develop and test a hip fracture risk model based on the principal components, we randomly divided the 75 QCT scans into two groups, one serving as the training set and the other as the test set. We applied this model to estimate a fracture risk index for each test subject, and used the fracture risk indices to discriminate the fracture patients and controls. To evaluate the fracture discrimination efficacy, we performed ROC analysis and calculated the AUC (area under curve). When using the first group as the training group and the second as the test group, the AUC was 0.880, compared to conventional fracture risk estimation methods based on bone densitometry, which had AUC values ranging between 0.782 and 0.871. When using the second group as the training group, the AUC was 0.839, compared to densitometric methods with AUC values ranging between 0.767 and 0.807. Our results demonstrate that principal components derived from hip QCT atlas are associated with hip fracture. Use of such features may provide new quantitative measures of interest to osteoporosis.

  13. Anabolic steroids for rehabilitation after hip fracture in older people

    Directory of Open Access Journals (Sweden)

    Vaqas Farooqi

    Full Text Available ABSTRACT BACKGROUND: Hip fracture occurs predominantly in older people, many of whom are frail and undernourished. After hip fracture surgery and rehabilitation, most patients experience a decline in mobility and function. Anabolic steroids, the synthetic derivatives of the male hormone testosterone, have been used in combination with exercise to improve muscle mass and strength in athletes. They may have similar effects in older people who are recovering from hip fracture. OBJECTIVES: To examine the effects (primarily in terms of functional outcome and adverse events of anabolic steroids after surgical treatment of hip fracture in older people. METHODS: Search methods: We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialized Register (10 September 2013, the Cochrane Central Register of Controlled Trials (CENTRAL (The Cochrane Library, 2013 Issue 8, MEDLINE (1946 to August Week 4 2013, EMBASE (1974 to 2013 Week 36, trial registers, conference proceedings, and reference lists of relevant articles. The search was run in September 2013. Selection criteria: Randomized controlled trials of anabolic steroids given after hip fracture surgery, in inpatient or outpatient settings, to improve physical functioning in older patients with hip fracture. Data collection and analysis: Two review authors independently selected trials (based on predefined inclusion criteria, extracted data and assessed each study's risk of bias. A third review author moderated disagreements. Only very limited pooling of data was possible. The primary outcomes were function (for example, independence in mobility and activities of daily living and adverse events, including mortality. MAIN RESULTS: We screened 1290 records and found only three trials involving 154 female participants, all of whom were aged above 65 years and had had hip fracture surgery. All studies had methodological shortcomings that placed them at high or unclear risk of bias. Because of this high

  14. Prefracture functional level evaluated by the New Mobility Score predicts in-hospital outcome after hip fracture surgery

    DEFF Research Database (Denmark)

    Kristensen, Morten T; Foss, Nicolai Bang; Ekdahl, Charlotte

    2010-01-01

    Clinicians need valid and easily applicable predictors of outcome in patients with hip fracture. Adjusting for previously established predictors, we determined the predictive value of the New Mobility score (NMS) for in-hospital outcome in patients with hip fracture....

  15. 髓外固定与髓内固定系统应用于临床分组治疗股骨粗隆间骨折对比分析与评价%Comparative Analysis and Evaluation on Medullary External Fixation and Intramedullary Fixation System Applied in Treating Intertrochanteric Fracture by Clinical Grouping

    Institute of Scientific and Technical Information of China (English)

    蒙向铖; 覃小武; 韦东; 李林峰

    2015-01-01

    Objective To compare and analyze and evaluate the clinical efficacy of external fixation and intramedullary fixation in the treatment of patients with femoral intertrochanteric fracture. Methods Seventy two patients with femoral intertrochanteric fracture were divided into two groups with 36 cases in each group according to different methods of operation. Patients in Group A underwent external system internal fixation of open reduction locking plate medullary (proximal femoral locking plate) treatment, while those in Group B underwent closed reduction or intramedullary system internal fixation treatment of open reduction proximal femoral nail anti-rotation (PFNA).Clinical efficacies on patients in two groups were compared, and the analysis and evaluation were made. Results The comparisons in the operation duration, bleeding amount and hip joint function before and after treatment were not significantly different (P > 0.05).But the complication rate of patients in Group B (8.33%) was lower than that of patients in Group A (19.44%), and the inter-group via statistical analysis satisfied P < 0.05, and the differences were significant. Conclusion External medullary fixation and intramedullary fixation system on patients with femoral intertrochanteric fracture deliver better efficacies, but the incidence of postoperative complications of intramedullary fixation system was significantly lower, suitable operation method should be chosen in clinical treatment according to conditions of patient to get best efficacies.%目的:研究股骨粗隆间骨折患者行髓外固定与髓内固定的临床疗效并进行对比分析与评价。方法将72例股骨粗隆间骨折患者按手术方式的不同分为两组,各36例,A组患者行切开复位锁定钢板髓外系统内固定(股骨近端锁定板)治疗, B组患者行闭合复位或切开复位股骨近端防旋髓内钉(PFNA)髓内系统内固定治疗,对比两组患者临床疗效并进行分析与

  16. Effect of PFNA fixation combined with salmon calcitonin in the treatment of senile femoral intertrochanteric fracture and the influence on bone mineral density%PFNA固定联合鲑鱼降钙素治疗老年股骨粗隆间骨折的效果及对骨密度的影响

    Institute of Scientific and Technical Information of China (English)

    应挺君

    2015-01-01

    目的:研究股骨近端防旋髓内钉(PFNA)内固定与鲑鱼降钙素(SCT)联合治疗老年股骨粗隆间骨折的效果及其对骨密度(BMD)的影响。方法将老年股骨粗隆间骨折患者82例随机分成SCT组与对照组,各41例。两组均行PFNA内固定术,对照组术后应用钙尔奇D600,SCT组在对照组的基础上加用SCT,比较两组的手术时间、术中出血量、术后住院时间及骨折愈合时间等手术指标,随访比较两组手术前后Harris评分、视觉模拟评分(VAS)、BMD以及髋关节功能。结果 SCT组的住院时间与骨折愈合时间明显短于对照组,VAS降低较对照组明显(P0.05)。结论 PFNA内固定治疗老年股骨粗隆间骨折具有显著效果,配合SCT治疗可提高BMD,促进骨折愈合,改善患者的生活质量。%Objective To investigate the efficacy of PFNA fixation combined with salmon calcitonin (SCT) in the treat-ment of senile femoral intertrochanteric fracture and the effects on bone mineral density (BMD). Methods 82 cases of senile femoral intertrochanteric fracture patients were randomly divided into SCT group and control group, with 41 cas-es in each group. Both groups underwent PFNA fixation, the control group received caltrate D600 treatment, SCT group received SCT on the basis of the control group, the surgical indexes such as operative time, blood loss, hospitai stay time and bone healing time of the two groups were compared, the Harris score, VAS score, BMD and hip function be-fore and after surgery of the two groups were followed and compared. Results The hospital stay time and bone healing time in SCT group was significantly shorter than the control group, and the VAS reduction was significantly better than the control group (P0.05). Conclusion PFNA fixation in the treatment of senile femoral intertrochanteric fracture has a signif-icant effect, combined with salmon calcitonin can improve BMD, promote healing and improve

  17. Study on the effect of different treatment on intertrochanteric fracture%不同治疗方式治疗转子间骨折的效果研究

    Institute of Scientific and Technical Information of China (English)

    黄超

    2016-01-01

    Objective:To investigate the clinical effect of different treatment on intertrochanteric fractures.Methods:120 elderly patients with femoral bone intertrochanteric fractures were selected.They were divided into three groups according to the principle of random double blind,with 40 cases in each group.A group were treated with extramedullary fixation system method;B group were treated with intramedullary fixation system therapy;C group were treated with artificial femoral head replacement surgery. Results:The surgery bleeding,operation time,safety and recovery effects of patients in C group were significantly better than in the other two groups(P<0.05).Conclusion:Artificial femoral head replacement surgery treated on patients with intertrochanteric fractures has high safety,rapidly recovery and significantly treatment effect.%目的:探讨不同治疗方式治疗转子间骨折的临床效果。方法:收治老年股骨头转子间骨折患者120例,按照双盲随机原则将其分成3组,各40例。A组采用髓外固定系统治疗法;B组采用髓内固定系统治疗法,C组采用人工股骨头置换手术治疗。结果:C组患者在手术出血情况、手术耗时、安全性和恢复效果方面均显著优于其他两组(P<0.05)。结论:在治疗转子间骨折的患者时采用人工股骨头置换手术进行治疗,具有安全性高、恢复快、效果显著的优点。

  18. Martial arts fall training to prevent hip fractures in the elderly.

    NARCIS (Netherlands)

    Groen, B.E.; Smulders, E.; Kam, D. de; Duysens, J.E.J.; Weerdesteijn, V.G.M.

    2010-01-01

    Hip fractures are a common and serious consequence of falls. Training of proper fall techniques may be useful to prevent hip fractures in the elderly. The results suggested that martial arts fall techniques may be trainable in older individuals. Better performance resulted in a reduced impact force.

  19. Interrater Reliability of the 6-Minute Walk Test in Women With Hip Fracture

    DEFF Research Database (Denmark)

    Larsen, Camilla Marie; Overgaard, Jan; Holtze, Steffen

    2016-01-01

    of the 6MWT in individuals with hip fracture. Methods: Two senior physical therapy students independently examined a convenience sample of 20 participants in a randomized order. Their assessments were separated by 2 days and followed the guidelines of the American Thoracic Society. Hip fracture...

  20. Prediction of postoperative morbidity, mortality and rehabilitation in hip fracture patients

    DEFF Research Database (Denmark)

    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....

  1. Exposure to antiepileptic drugs and the risk of hip fracture: a case-control study

    DEFF Research Database (Denmark)

    Tsiropoulos, Ioannis; Andersen, Morten; Nymark, Tine

    2008-01-01

    PURPOSE: To investigate whether the use of antiepileptic drugs (AEDs) increases the risk of hip fracture. METHODS: We performed a case-control study using data from the Funen County (population 2004: 475,000) hip fracture register. Cases (n = 7,557) were all patients admitted to county hospitals ...

  2. Martial arts fall training to prevent hip fractures in the elderly.

    NARCIS (Netherlands)

    Groen, B.E.; Smulders, E.; Kam, D. de; Duysens, J.E.J.; Weerdesteijn, V.G.M.

    2010-01-01

    Hip fractures are a common and serious consequence of falls. Training of proper fall techniques may be useful to prevent hip fractures in the elderly. The results suggested that martial arts fall techniques may be trainable in older individuals. Better performance resulted in a reduced impact force.

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

    DEFF Research Database (Denmark)

    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...

  4. Quality of life after hip fracture in the elderly : A systematic literature review

    NARCIS (Netherlands)

    Peeters, C.M.M.; Visser, E.; van de Ree, C.L.P.; Gosens, T.; den Oudsten, B.L.; de Vries, J.

    2016-01-01

    Background With an increasing ageing population, hip fractures have become a major public health issue in the elderly. It is important to examine the health status (HS) and health-related quality of life (HRQOL) of the elderly faced with the epidemic of hip fractures. Objective To provide an

  5. Mortality in British hip fracture patients, 2000-2010 : a population-based retrospective cohort study

    NARCIS (Netherlands)

    Klop, Corinne; Welsing, Paco M J; Cooper, Cyrus; Harvey, Nicholas C; Elders, Petra J M; Bijlsma, Johannes W J; Leufkens, Hubert G M|info:eu-repo/dai/nl/075255049; de Vries, Frank|info:eu-repo/dai/nl/303546670

    BACKGROUND: Data on recent trends in mortality after hip fracture are scarce. Aims were therefore to examine secular trends in all-cause and cause-specific mortality post hip fracture and to compare this to the general population from 2000 to 2010. METHODS: Population-based cohort study within the

  6. Preoperative factors associated with red blood cell transfusion in hip fracture patients

    DEFF Research Database (Denmark)

    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...

  7. Fascia iliaca compartment blockade for acute pain control in hip fracture patients

    DEFF Research Database (Denmark)

    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....

  8. Risk factors for failure to return to the pre-fracture place of residence after hip fracture: a prospective longitudinal study of 444 patients

    NARCIS (Netherlands)

    A.J.H. Vochteloo (Anne); S.T. Vliet-Koppert; A.B. Maier (Andrea); W.E. Tuinebreijer (Wim); M.R. de Vries (Mark); R.M. Bloem (Rolf); R.G.H.H. Nelissen (Rob); P. Pilot (Peter)

    2012-01-01

    textabstractIntroduction: Long-term place of residence after hip fracture is not often described in literature. The goal of this study was to identify risk factors, known at admission, for failure to return to the pre-fracture place of residence of hip fracture patients in the Wrst year after a hip

  9. Risk factors for failure to return to the pre-fracture place of residence after hip fracture: a prospective longitudinal study of 444 patients

    NARCIS (Netherlands)

    A.J.H. Vochteloo (Anne); S.T. Vliet-Koppert; A.B. Maier (Andrea); W.E. Tuinebreijer (Wim); M.R. de Vries (Mark); R.M. Bloem (Rolf); R.G.H.H. Nelissen (Rob); P. Pilot (Peter)

    2012-01-01

    textabstractIntroduction: Long-term place of residence after hip fracture is not often described in literature. The goal of this study was to identify risk factors, known at admission, for failure to return to the pre-fracture place of residence of hip fracture patients in the Wrst year after a hip

  10. ASYMMETRICAL BILATERAL HIP DISLOCATION WITH SEGMENTAL FRACTURE FEMUR: AN UNUSUAL CASE REPORT AND LITERATURE REVIEW

    Directory of Open Access Journals (Sweden)

    Ramesh

    2015-01-01

    Full Text Available Bilateral traumatic hip dislocation is rarely seen. A unique case is presented, consisting of asymmetric bilateral hip dislocation with associated segmental fracture femur, resulting from fall from bus. This case represents an unusual, severe combination of injuries resulting from the fall from bus under influence of alcohol. Traumatic hip dislocation represents a true orthopaedic emergency . Given the severity of associated complications, every effort should be made to ensure pr ompt diagnosis and immediate therapy. We report our experience in the management of this complex injury pattern and review the pertinent literature on this subject. Keywords: Bilateral hip dislocation , Asymmetric hip dislocation , Segmental femur fracture , Closed reduction , Fall from bus .

  11. Ageism perceived by the elderly in Taiwan following hip fracture.

    Science.gov (United States)

    Huang, Yueh-Fang; Liang, Jersey; Shyu, Yea-Ing Lotus

    2014-01-01

    This qualitative, longitudinal study explored the feelings about and responses to discrimination experiences related to perceived ageism of older persons following hip fracture. Five male and six female hip-fractured elderly patients were sampled from a medical center in northern Taiwan. Semi-structured questionnaires were used to explore participants' experiences of and responses to ageism-related experiences. Data were collected in face-to-face interviews during home visits at 1, 3, 6, and 12 months after discharge from hospital, between June 2007 and December 2008. Textual data of participants' responses were analyzed by directed content analysis. All participants experienced ageism. In first 3 months after discharge, participants' main perceived ageism was positive because of their dependency and feeling overprotected by others. From 3 months to 1 year after discharge, other ageism experiences emerged: isolated because of physical restrictions and neglected. Furthermore, participants' responses were divided into two categories: disregard and tolerance of ageism, or becoming more independent because of ageism. The elderly participants considered that the influences of positive ageism in the early months after discharge reduced their autonomy and deprived them of power. This response to ageism was temporary; over time the participants tried to regain autonomy by overcoming their dependency and improving their physical functioning.

  12. Benzodiazepines and risk of hip fractures in older people: a review of the evidence.

    Science.gov (United States)

    Cumming, Robert G; Le Couteur, David G

    2003-01-01

    A hip fracture epidemic is occurring in developed countries in association with population aging. The increasing number of people with a hip fracture has major implications for clinicians and health service managers. More importantly, a hip fracture is a devastating event in the life of an older person, as it often leads to loss of independence and death. Identification of risk factors for hip fracture is an essential first step towards prevention. The use of psychotropic medications is an established risk factor for hip fracture. The purpose of this article is to systematically review epidemiological studies of the relationship between use of benzodiazepines and risk of hip fracture and, then, to see how the findings of these studies fit with what is known about the pharmacology of benzodiazepines. Eleven primary epidemiological studies were identified. The results of these studies were not consistent; however, the inconsistency appeared to be almost entirely explained by research design. The studies that did not show an association between increased hip fracture risk and benzodiazepine use were nearly all hospital-based case-control studies, a type of study that often lacks validity because of the difficulty of finding an appropriate control group. After excluding the hospital-based case-control studies, all but one of the remaining seven studies found that use of benzodiazepines was associated with an increased risk of hip fracture that varied between 50% and 110%. The only higher quality study that did not find an association between benzodiazepine use and hip fracture was also the only study conducted entirely in nursing homes. There was no evidence that the risk of hip fracture differed between short- and long-acting benzodiazepines. People using higher doses of benzodiazepines and those who had recently started using benzodiazepines were at the highest risk of hip fracture. In very old people, there was some preliminary evidence that benzodiazepines that

  13. Geographic Variation in Osteoporotic Hip Fracture Incidence: The Growing Importance of Asian Influences in Coming Decades

    Directory of Open Access Journals (Sweden)

    D. K. Dhanwal

    2010-01-01

    Full Text Available Studies over the last few decades have demonstrated geographic variation in the incidence of hip fracture across continents and among different parts of the same region. This paper studies the epidemiology of hip fracture worldwide, with special emphasis on the geographic variation among Asian countries. Using the Pubmed database, keywords that were employed included hip fracture, incidence rate, geographic variation, osteoporosis, and epidemiology. Articles were chosen based on the basis of (1 focus: studies that were said to specifically focus on geographic variation in hip fracture from different continents with a focus on Asia; (2 language: studies that were in English; (3 methods: studies that used statistical tests to examine hip fracture incidence rates. The highest hip fracture rates are seen in Scandinavian countries and the US and the lowest in African countries. Fracture rates are intermediate in Asian populations. Among different ethnic populations, the highest fracture rates are seen in Caucasians and the lowest in blacks. There is also a north-south gradient, particularly in Europe, where more hip fractures occur in North Europe compared to the South.

  14. Delayed cementless total hip arthroplasty for neglected dislocation of hip combined with complex acetabular fracture and deficient bone stock

    Directory of Open Access Journals (Sweden)

    Gavaskar Ashok S

    2012-12-01

    Full Text Available 【Abstract】Total hip arthroplasty (THA for an un-treated acetabular fracture is technically challenging and the long-term result is not so favorable. A 45-year-old fe-male patient with untreated column and comminuted poste-rior wall fracture of the acetabulum was treated in our insti-tution by reconstruction of the posterior wall using iliac strut autograft and plate stabilization of the posterior col-umn with cancellous grafting and cementless THA in a single stage. At 3 years’ follow-up, the patient was independently mobile without limb length discrepancy. Radiological evalu-ation showed well integrated components and bone grafts. No evidence of aseptic loosening or osteolysis was found. This report aims to emphasize that bony acetabular recon-struction allows the use of primary hip components, which improves prosthesis longevity and preserves bone stock for a future revision. Key words: Acetabulum; Fractures, bone; Hip dislocation; Arthroplasty, replacement, hip

  15. Texture analysis of clinical radiographs using radon transform on a local scale for differentiation between post-menopausal women with and without hip fracture

    Science.gov (United States)

    Boehm, Holger F.; Körner, Markus; Baumert, Bernhard; Linsenmaier, Ulrich; Reiser, Maximilian

    2011-03-01

    Osteoporosis is a chronic condition characterized by demineralization and destruction of bone tissue. Fractures associated with the disease are becoming an increasingly relevant issue for public health institutions. Prediction of fracture risk is a major focus research and, over the years, has been approched by various methods. Still, bone mineral density (BMD) obtained by dual-energy X-ray absorptiometry (DXA) remains the clinical gold-standard for diagnosis and follow-up of osteoporosis. However, DXA is restricted to specialized diagnostic centers and there exists considerable overlap in BMD results between populations of individuals with and without fractures. Clinically far more available than DXA is conventional x-ray imaging depicting trabecular bone structure in great detail. In this paper, we demonstrate that bone structure depicted by clinical radiographs can be analysed quantitatively by parameters obtained from the Radon Transform (RT). RT is a global analysis-tool for detection of predefined, parameterized patterns, e.g. straight lines or struts, representing suitable approximations of trabecular bone texture. The proposed algorithm differentiates between patients with and without fractures of the hip by application of various texture-metrics based on the Radon-Transform to standard x-ray images of the proximal femur. We consider three different regions-of-interest in the proximal femur (femoral head, neck, and inter-trochanteric area), and conduct an analysis with respect to correct classification of the fracture status. Performance of the novel approach is compared to DXA. We draw the conclusion that performance of RT is comparable to DXA and may become a useful supplement to densitometry for the prediction of fracture risk.

  16. Education, marital status, and risk of hip fractures in older men and women: the CHANCES project.

    Science.gov (United States)

    Benetou, V; Orfanos, P; Feskanich, D; Michaëlsson, K; Pettersson-Kymmer, U; Ahmed, L A; Peasey, A; Wolk, A; Brenner, H; Bobak, M; Wilsgaard, T; Schöttker, B; Saum, K-U; Bellavia, A; Grodstein, F; Klinaki, E; Valanou, E; Papatesta, E-M; Boffetta, P; Trichopoulou, A

    2015-06-01

    The role of socioeconomic status in hip fracture incidence is unclear. In a diverse population of elderly, higher education was found to be associated with lower, whereas living alone, compared to being married/cohabiting, with higher hip fracture risk. Educational level and marital status may contribute to hip fracture risk. The evidence on the association between socioeconomic status and hip fracture incidence is limited and inconsistent. We investigated the potential association of education and marital status with hip fracture incidence in older individuals from Europe and USA. A total of 155,940 participants (79 % women) aged 60 years and older from seven cohorts were followed up accumulating 6456 incident hip fractures. Information on education and marital status was harmonized across cohorts. Hip fractures were ascertained through telephone interviews/questionnaires or through record linkage with registries. Associations were assessed through Cox proportional hazard regression adjusting for several factors. Summary estimates were derived using random effects models. Individuals with higher education, compared to those with low education, had lower hip fracture risk [hazard ratio (HR) = 0.84, 95 % confidence interval (CI) 0.72-0.95]. Respective HRs were 0.97 (95 % CI 0.82-1.13) for men and 0.75 (95 % CI 0.65-0.85) for women. Overall, individuals living alone, especially those aged 60-69 years, compared to those being married/cohabiting, tended to have a higher hip fracture risk (HR = 1.12, 95 % CI 1.02-1.22). There was no suggestion for heterogeneity across cohorts (P heterogeneity > 0.05). The combined data from >150,000 individuals 60 years and older suggest that higher education may contribute to lower hip fracture risk. Furthermore, this risk may be higher among individuals living alone, especially among the age group 60-69 years, when compared to those being married/cohabiting.

  17. The Bristol Hip View: Its Role in the Diagnosis and Surgical Planning and Occult Fracture Diagnosis for Proximal Femoral Fractures

    Directory of Open Access Journals (Sweden)

    J. Harding

    2013-01-01

    Full Text Available Aim. To evaluate whether a modified radiographic view of the femoral neck improves the diagnosis of occult proximal femoral. Materials and Methods. Prospective study of patients presenting with clinically suspected proximal femoral fractures or who underwent traditional plain radiographic views and the Bristol hip view (a 30-degree angled projection. Six blinded independent observers assessed the images for presence of a fracture, anatomical level, and displacement. Results. 166 consecutive patients presenting with the clinical diagnosis of a proximal femoral fracture, of which 61 sustained a fracture. Six of these were deemed occult due to negative plain and had proven fractures on subsequent cross-sectional imaging. The Bristol hip view demonstrated five of these six fractures. It performed better than the traditional lateral hip view to identify the injury. The Bristol hip view predicted correctly the fracture type and displacement in all cases and missed only one of the occult fractures. Conclusion. The Bristol hip view is more sensitive and clearer than a lateral projection for patients. It adds useful diagnostic information and performs better than the traditional views in occult fractures. Its use may prevent the need for further cross sectional imaging and subsequent surgical delay.

  18. USING TRABECULAR METAL AUGMENTS FOR TOTAL HIP REPLACEMENT IN PATIENTS AFTER ACETABULAR FRACTURES

    Directory of Open Access Journals (Sweden)

    R. M. Tikhilov

    2011-01-01

    Full Text Available The authors presented the experience of treatment of two patients with hip arthritis after acetabular fracture. Both patients were treated with total hip replacement. During the operation, to manage posterior-superior bone defects of the acetabulum, augments of trabecular metal were used. Pain and limitation of motions in hip were indications for operative treatment. After a year of follow up there was no pain in hip; also recovery of motion and improved quality of life were observed.

  19. Incidence and direct hospitalisation costs of hip fractures in Vilnius, capital of Lithuania, in 2010

    Directory of Open Access Journals (Sweden)

    Tamulaitiene Marija

    2012-07-01

    Full Text Available Abstract Background Few epidemiological data on hip fractures were previously available in Lithuania. The aim of this study was to estimate the incidence and hospital costs of hip fractures in Vilnius in 2010. Methods Data were collected from the medical charts of all patients admitted to hospitals in Vilnius (population, 548,835 due to new low-energy trauma hip fracture, during 2010. The estimated costs included ambulance transportation and continuous hospitalisation immediately after a fracture, which are covered by the Lithuanian healthcare system. Results The incidence of new low-energy trauma hip fractures was 252 (308 women and 160 men per 100,000 inhabitants of Vilnius aged 50-years or more. There was an exponential increase in the incidence with increasing age. The overall estimated cost of hip fractures in Vilnius was 1,114,292 EUR for the year 2010. The greatest part of the expenditure was accounted for by fractures in individuals aged 65-years and over. The mean cost per case was 2,526.74 EUR, and cost varied depending on the treatment type. Hip replacement did not affect the overall mean costs of hip fracture. The majority of costs were incurred for acute (53% and long-term care (35% hospital stays, while medical rehabilitation accounted for only 12% of the overall cost. The costs of hip fracture were somewhat lower than those found in other European countries. Conclusion The data on incidence and costs of hip fractures will help to assess the importance of interventions to reduce the number of fractures and associated costs.

  20. Risk Factors for Hip Fracture in Older Men: The Osteoporotic Fractures in Men Study (MrOS).

    Science.gov (United States)

    Cauley, Jane A; Cawthon, Peggy M; Peters, Katherine E; Cummings, Steven R; Ensrud, Kristine E; Bauer, Douglas C; Taylor, Brent C; Shikany, James M; Hoffman, Andrew R; Lane, Nancy E; Kado, Deborah M; Stefanick, Marcia L; Orwoll, Eric S

    2016-10-01

    Almost 30% of hip fractures occur in men; the mortality, morbidity, and loss of independence after hip fractures are greater in men than in women. To comprehensively evaluate risk factors for hip fracture in older men, we performed a prospective study of 5994 men, primarily white, age 65+ years recruited at six US clinical centers. During a mean of 8.6 years of 97% complete follow-up, 178 men experienced incident hip fractures. Information on risk factors including femoral neck bone mineral density (FNBMD) was obtained at the baseline visit. Cox proportional hazards models were used to calculate the hazard ratio (HR) with 95% confidence intervals; Fine and Gray models adjusted for competing mortality risk. Older age (≥75 years), low FNBMD, currently smoking, greater height and height loss since age 25 years, history of fracture, use of tricyclic antidepressants, history of myocardial infarction or angina, hyperthyroidism or Parkinson's disease, lower protein intake, and lower executive function were all associated with an increased hip fracture risk. Further adjustment for competing mortality attenuated HR for smoking, hyperthyroidism, and Parkinson's disease. The incidence rate of hip fracture per 1000 person-years (PY) was greatest in men with FNBMD T-scores hip fracture at rates of 14.52 versus 0.88 per 1000 PY in men age hip fracture. Many of these assessments can easily be incorporated into routine clinical practice and may lead to improved risk stratification. © 2016 American Society for Bone and Mineral Research. © 2016 American Society for Bone and Mineral Research.

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

    DEFF Research Database (Denmark)

    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 preliminary prefracture New Mobility Score (NMS), age and fracture type as independent predictors of in-hospital outcome after hip fracture surgery....

  2. Coffee, tea, and the risk of hip fracture: a meta-analysis.

    Science.gov (United States)

    Sheng, J; Qu, X; Zhang, X; Zhai, Z; Li, H; Liu, X; Li, H; Liu, G; Zhu, Z; Hao, Y; Qin, A; Dai, K

    2014-01-01

    The present meta-analysis shows no clear association between coffee consumption and the risk of hip fractures. There was a nonlinear association between tea consumption and the risk of hip fracture. Compared to no tea consumption, drinking 1-4 cups of tea daily was associated with a lower risk of hip fracture. Prospective cohort and case-control studies have suggested that coffee and tea consumption may be associated with the risk of hip fracture; the results have, however, been inconsistent. We conducted a meta-analysis to assess the association between coffee and tea consumption and the risk of hip fracture. We performed systematic searches using MEDLINE, EMBASE, and OVID until February 20, 2013, without limits of language or publication year. Relative risks (RRs) with 95% confidence intervals (CI) were derived using random-effects models throughout all analyses. We conducted categorical, dose-response, heterogeneity, publication bias, and subgroup analyses. Our study was based on 195,992 individuals with 9,958 cases of hip fractures from 14 studies, including six cohort and eight case-control studies. The pooled RRs of hip fractures for the highest vs. the lowest categories of coffee and tea consumption were 0.94 (95% CI 0.71-1.17) and 0.84 (95% CI 0.66-1.02), respectively. For the dose-response analysis, we found evidence of a nonlinear association between tea consumption and the risk of hip fracture (p(nonlinearity) risk of hip fracture by 28% (0.72; 95% CI 0.56-0.88 for 1-2 cups/day), 37% (0.63; 95% CI 0.32-0.94 for 2-3 cups/day), and 21% (0.79; 95% CI 0.62-0.96 for 3-4 cups/day). We found no significant association between coffee consumption and the risk of hip fracture. A nonlinear association emerged between tea consumption and the risk of hip fracture; individuals drinking 1-4 cups of tea per day exhibited a lower risk of hip fractures than those who drank no tea. The association between 5 daily cups of tea, or more, and hip fracture risk should be

  3. Does hip osteoarthritis have a protective effect against proximal femoral fractures? A retrospective study.

    Science.gov (United States)

    Calderazzi, Filippo; Groppi, Giulia; Ricotta, Agostino; Ceccarelli, Francesco

    2014-01-01

    The inverse relationship between proximal femoral fracture incidence and hip osteoarthritis remains controversial. However, femoral neck fractures rarely occur in patients with hip osteoarthritis, suggesting a protective effect of osteoarthritis. We sought to determine if the severity of osteoarthritis influenced fracture type. We examined the radiographs of 190 consecutive patients treated at our institution after hip trauma. They were divided into three groups according to the outcome of the trauma: femoral neck fracture; trochanteric fracture; and no fracture. We then analysed the severity of osteoarthritis within these groups. No relationship between the grade of hip osteoarthritis and the presence of a proximal femoral fracture was found. However, the grade of osteoarthritis was related both to the outcome of the trauma (posteoarthritis of the hip had a three-fold increased likelihood of trochanteric fracture compared to femoral neck fracture. Osteoarthritis does not protect against proximal femoral fractures, but strongly affects the location of the fracture in the proximal femur, increasing the possibility of a trochanteric location.

  4. Bone bruise, lipohemarthrosis, and joint effusion in CT of non-displaced hip fracture

    Energy Technology Data Exchange (ETDEWEB)

    Geijer, Mats (Center for Medical Imaging and Physiology, Skaane University Hospital, Lund University, Lund (Sweden)), Email: mats@geijer.info; Dunker, Dennis; Collin, David; Goethlin, Jan H. (Department of Radiology, Sahlgrenska University Hospital, Moelndal (Sweden))

    2012-03-15

    Background. A suspected occult hip fracture after normal radiography is not uncommon in an elderly person after a fall. Despite a lack of robust validation in the literature, computed tomography (CT) is often used as secondary imaging. Purpose. To assess the frequency and clinical utility of non-cortical skeletal and soft tissue lesions as ancillary fracture signs in CT diagnosis of occult hip fractures. Material and Methods. All fracture signs (cortical and trabecular fractures, bone bruise, joint effusion, and lipohemarthrosis) were recorded in 231 hip low-energy trauma cases with CT performed after normal or equivocal radiography in two trauma centers. Results. There were no fracture signs in 110 patients. Twelve of these had a joint effusion. In 121 patients with 46 cervical hip fractures and 75 trochanteric fractures one or more fracture signs were present. Cortical fractures were found in 115 patients. Bone bruise was found in 119 patients, joint effusion in 35, and lipohemarthrosis in 20 patients. Conclusion. Ancillary signs such as bone bruise and lipohemarthrosis can strengthen and sometimes indicate the diagnosis in CT of occult hip fractures. Joint effusion is a non-specific sign

  5. Bone bruise, lipohemarthrosis, and joint effusion in CT of non-displaced hip fracture.

    Science.gov (United States)

    Geijer, Mats; Dunker, Dennis; Collin, David; Göthlin, Jan H

    2012-03-01

    A suspected occult hip fracture after normal radiography is not uncommon in an elderly person after a fall. Despite a lack of robust validation in the literature, computed tomography (CT) is often used as secondary imaging. To assess the frequency and clinical utility of non-cortical skeletal and soft tissue lesions as ancillary fracture signs in CT diagnosis of occult hip fractures. All fracture signs (cortical and trabecular fractures, bone bruise, joint effusion, and lipohemarthrosis) were recorded in 231 hip low-energy trauma cases with CT performed after normal or equivocal radiography in two trauma centers. There were no fracture signs in 110 patients. Twelve of these had a joint effusion. In 121 patients with 46 cervical hip fractures and 75 trochanteric fractures one or more fracture signs were present. Cortical fractures were found in 115 patients. Bone bruise was found in 119 patients, joint effusion in 35, and lipohemarthrosis in 20 patients. Ancillary signs such as bone bruise and lipohemarthrosis can strengthen and sometimes indicate the diagnosis in CT of occult hip fractures. Joint effusion is a non-specific sign.

  6. Geographic variation in secondary fracture prevention after a hip fracture during 1999-2013: a UK study.

    Science.gov (United States)

    Shah, A; Prieto-Alhambra, D; Hawley, S; Delmestri, A; Lippett, J; Cooper, C; Judge, A; Javaid, M K

    2017-01-01

    Fragility fractures of the hip have a major impact on the lives of patients and their families. This study highlights significant geographical variation in secondary fracture prevention with even the highest performing regions failing the majority of patients despite robust evidence supporting the benefits of diagnosis and treatment. The purpose of the study is to describe the geographic variation in anti-osteoporosis drug therapy prescriptions before and after a hip fracture during 1999-2013 in the UK. We used primary care data (Clinical Practice Research Datalink) to identify patients with a hip fracture and primary care prescriptions of any anti-osteoporosis drugs prior to the index hip fracture and up to 5 years after. Geographic variations in prescribing before and after availability of generic oral bisphosphonates were analysed. Multivariable logistic regression models were adjusted for gender, age and body mass index (BMI). Thirteen thousand sixty-nine patients (76 % female) diagnosed with a hip fracture during 1999-2013 were identified. Eleven per cent had any anti-osteoporosis drug prescription in the 6 months prior to the index hip fracture. In the 0-4 months following a hip fracture, 5 % of patients were prescribed anti-osteoporosis drugs in 1999, increasing to 51 % in 2011 and then decreasing to 39 % in 2013. The independent predictors (OR (95 % CI)) of treatment initiation included gender (male 0.42 (0.36-0.49)), BMI (0.98 per kg/m(2) increase (0.97-1.00)) and geographic region (1.29 (0.89-1.87) North East vs. 0.56 (0.43-0.73) South Central region). Geographic differences in prescribing persisted over the 5-year follow-up. If all patients were treated at the rate of the highest performing region, then nationally, an additional 3214 hip fracture patients would be initiated on therapy every year. Significant geographic differences exist in prescribing of anti-osteoporosis drugs after hip fracture despite adjustment for potential confounders

  7. A Biomechanical Approach to Assessing Hip Fracture Risk

    Science.gov (United States)

    Ellman, Rachel

    2009-01-01

    Bone loss in microgravity is well documented, but it is difficult to quantify how declines in bone mineral density (BMD) contribute to an astronaut's overall risk of fracture upon return. This study uses a biomechanical approach to assessing hip fracture risk, or Factor of Risk (Phi), which is defined as the ratio of applied load to bone strength. All long-duration NASA astronauts from Expeditions 1-18 were included in this study (n=25), while crewmembers who flew twice (n=2) were treated as separate subjects. Bone strength was estimated based on an empirical relationship between areal BMD at the hip, as measured by DXA, and failure load, as determined by mechanical testing of cadaver femora. Fall load during a sideways fall was calculated from a previously developed biomechanical model, which takes into account body weight, height, gender, and soft tissue thickness overlying the lateral aspect of the hip that serves to attenuate the impact force. While no statistical analyses have been performed yet, preliminary results show that males in this population have a higher FOR than females, with a post- flight Phi of 0.87 and 0.36, respectively. FOR increases 5.1% from preflight to postflight, while only one subject crossed the fracture "threshold" of Phi = 1, for a total of 2 subjects with a postflight Phi > 1. These results suggest that men may be at greater risk for hip fracture due largely in part to their relatively thin soft tissue padding as compared to women, since soft tissue thickness has the highest correlation (R(exp 2)= .53) with FOR of all subject-specific parameters. Future work will investigate changes in FOR during recovery to see if baseline risk levels are restored upon return to 1-g activity. While dual x-ray absorptiometry (DXA) is the most commonly used clinical measure of bone health, it fails to provide compartment-specific information that is useful in assessing changes to bone quality as a result of microgravity exposure. Peripheral

  8. A Biomechanical Approach to Assessing Hip Fracture Risk

    Science.gov (United States)

    Ellman, Rachel

    2009-01-01

    Bone loss in microgravity is well documented, but it is difficult to quantify how declines in bone mineral density (BMD) contribute to an astronaut's overall risk of fracture upon return. This study uses a biomechanical approach to assessing hip fracture risk, or Factor of Risk (Phi), which is defined as the ratio of applied load to bone strength. All long-duration NASA astronauts from Expeditions 1-18 were included in this study (n=25), while crewmembers who flew twice (n=2) were treated as separate subjects. Bone strength was estimated based on an empirical relationship between areal BMD at the hip, as measured by DXA, and failure load, as determined by mechanical testing of cadaver femora. Fall load during a sideways fall was calculated from a previously developed biomechanical model, which takes into account body weight, height, gender, and soft tissue thickness overlying the lateral aspect of the hip that serves to attenuate the impact force. While no statistical analyses have been performed yet, preliminary results show that males in this population have a higher FOR than females, with a post- flight Phi of 0.87 and 0.36, respectively. FOR increases 5.1% from preflight to postflight, while only one subject crossed the fracture "threshold" of Phi = 1, for a total of 2 subjects with a postflight Phi > 1. These results suggest that men may be at greater risk for hip fracture due largely in part to their relatively thin soft tissue padding as compared to women, since soft tissue thickness has the highest correlation (R(exp 2)= .53) with FOR of all subject-specific parameters. Future work will investigate changes in FOR during recovery to see if baseline risk levels are restored upon return to 1-g activity. While dual x-ray absorptiometry (DXA) is the most commonly used clinical measure of bone health, it fails to provide compartment-specific information that is useful in assessing changes to bone quality as a result of microgravity exposure. Peripheral

  9. Predictors of not regaining basic mobility after hip fracture surgery

    DEFF Research Database (Denmark)

    Hulsbæk, Signe; Larsen, Rikke Faebo; Troelsen, Anders

    2015-01-01

    cohort study 274 hip fracture patients were included. Patients with compromised ability to exercise were excluded leaving 167 patients for analysis. Patient demographics, functional level, method of operation, post-operative hemoglobin and the completion of physiotherapy was registered. Basic mobility...... was assessed by the Cumulated Ambulation Score. Multivariate logistic regression was performed. RESULTS: Age >80 years (OR = 7.5), low prefracture functional level (OR = 3.0), not completed the physiotherapy on first post-operative day (OR = 4.6) and hemoglobin ... (OR = 5.8) were significant predictors of not regaining basic mobility within the fifth post-operative day (p values: 0.04 - 80 years (OR = 4.3), prefracture functional level (OR = 7.0) and not completed the physiotherapy...

  10. [Hip fracture, antiplatelet drugs treatment and postoperative complications].

    Science.gov (United States)

    Reguant, F; Martínez, E; Gil, B; Prieto, J C; del Milagro Jiménez, L; Arnau, A; Bosch, J

    2013-11-01

    To assess the incidence of postoperative complications, blood transfusions and survival at one month, in the old patients operated for hip fracture undergoing chronic treatment with antiplatelet drugs. Two hundred twenty three patients operated for hip fracture were studied retrospectively, separated into 3 groups: patients who received acetylsalicylic acid (group I), patients who were given 100mg/day of acetylsalicylic acid or 300mg/day of triflusal (group II) and patients receiving>100mg/day of acetylsalicylic acid, or>300mg/day of triflusal or thienopyridines (group III). Surgery was delayed for 4 days in patients in group III. Demographic, biological, clinical and treatment characteristics, postoperative complications and survival at one month were recorded. Patients in group III were older and sustain worse general health status. Patients with a higher transfusion requirement were those of group II (73.8%) (P=0.192), who also showed a higher percentage of anaemia on admission. Severe cardiovascular complications were experienced by 5.4% of group III patients, 4.8% of group II patients and 2.1% of group I patients. Patients from group III presented a significant amount of respiratory complications (P=0.007). Our results suggest that delaying surgery for 4 days in patients treated with clopidogrel can be associated to an increase in postoperative respiratory complications and severe adverse cardiovascular events, without increasing the tranfusional index, hospital stay, mortality, and without complications related to neuraxial anaesthesia. Copyright © 2013 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Published by Elsevier España. All rights reserved.

  11. Machine Learning Principles Can Improve Hip Fracture Prediction.

    Science.gov (United States)

    Kruse, Christian; Eiken, Pia; Vestergaard, Peter

    2017-04-01

    Apply machine learning principles to predict hip fractures and estimate predictor importance in Dual-energy X-ray absorptiometry (DXA)-scanned men and women. Dual-energy X-ray absorptiometry data from two Danish regions between 1996 and 2006 were combined with national Danish patient data to comprise 4722 women and 717 men with 5 years of follow-up time (original cohort n = 6606 men and women). Twenty-four statistical models were built on 75% of data points through k-5, 5-repeat cross-validation, and then validated on the remaining 25% of data points to calculate area under the curve (AUC) and calibrate probability estimates. The best models were retrained with restricted predictor subsets to estimate the best subsets. For women, bootstrap aggregated flexible discriminant analysis ("bagFDA") performed best with a test AUC of 0.92 [0.89; 0.94] and well-calibrated probabilities following Naïve Bayes adjustments. A "bagFDA" model limited to 11 predictors (among them bone mineral densities (BMD), biochemical glucose measurements, general practitioner and dentist use) achieved a test AUC of 0.91 [0.88; 0.93]. For men, eXtreme Gradient Boosting ("xgbTree") performed best with a test AUC of 0.89 [0.82; 0.95], but with poor calibration in higher probabilities. A ten predictor subset (BMD, biochemical cholesterol and liver function tests, penicillin use and osteoarthritis diagnoses) achieved a test AUC of 0.86 [0.78; 0.94] using an "xgbTree" model. Machine learning can improve hip fracture prediction beyond logistic regression using ensemble models. Compiling data from international cohorts of longer follow-up and performing similar machine learning procedures has the potential to further improve discrimination and calibration.

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

    DEFF Research Database (Denmark)

    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......-centre placebo-controlled double-blinded randomised clinical trial was performed to test the hypothesis on patients undergoing surgery for extra-capsular hip fractures. For reasons outside the control of the investigators, the trial was stopped before reaching the 120 included patients as planned in the protocol.......7) in the TXA group. The 90-day mortality was 27.2% (n = 9) in the TXA group and 10.2% (n = 4) in the placebo group (p = 0.07). We were not able to ascertain a reliable cause of death in these patients. DISCUSSION: TXA significantly reduced TBL in extra-capsular hip fractures, but concerns regarding its safety...

  13. Hip and fragility fracture prediction by 4-item clinical risk score and mobile heel BMD: a women cohort study

    Directory of Open Access Journals (Sweden)

    Thulesius Hans

    2010-03-01

    Full Text Available Abstract Background One in four Swedish women suffers a hip fracture yielding high morbidity and mortality. We wanted to revalidate a 4-item clinical risk score and evaluate a portable heel bone mineral density (BMD technique regarding hip and fragility fracture risk among elderly women. Methods In a population-based prospective cohort study we used clinical risk factors from a baseline questionnaire and heel BMD to predict a two-year hip and fragility fracture outcome for women, in a fracture preventive program. Calcaneal heel BMD was measured by portable dual X-ray laser absorptiometry (DXL and compared to hip BMD, measured with stationary dual X-ray absorptiometry (DXA technique. Results Seven women suffered hip fracture and 14 women fragility fracture/s (at hip, radius, humerus and pelvis among 285 women; 60% having heel BMD ≤ -2.5 SD. The 4-item FRAMO (Fracture and Mortality Index combined the clinical risk factors age ≥80 years, weight Conclusions In a follow-up study we identified high risk groups for hip and fragility fracture with our plain 4-item risk model. Increased fracture risk was also related to decreasing heel BMD in calcaneal bone, measured with a mobile DXL technique. A combination of high FRAMO Index, prior fragility fracture, and very low BMD restricted the high risk group to 11%, among whom most hip fractures occurred (71%. These practical screening methods could eventually reduce hip fracture incidence by concentrating preventive resources to high fracture risk women.

  14. A comparison of bone density and bone morphology between patients presenting with hip fractures, spinal fractures or a combination of the two.

    Science.gov (United States)

    Crilly, Richard G; Cox, Lizebeth

    2013-02-22

    Currently it is uncertain how to define osteoporosis and who to treat after a hip fracture. There is little to support the universal treatment of all such patients but how to select those most in need of treatment is not clear. In this study we have compared cortical and trabecular bone status between patients with spinal fractures and those with hip fracture with or without spinal fracture with the aim to begin to identify, by a simple clinical method (spine x-ray), a group of hip fracture patients likely to be more responsive to treatment with current antiresorptive agents. Comparison of convenience samples of three groups of 50 patients, one with spinal fractures, one with a hip fracture, and one with both. Measurements consist of bone mineral density at the lumbar spine, at the four standard hip sites, number, distribution and severity of spinal fractures by the method of Genant, cortical bone thickness at the infero-medial femoral neck site, femoral neck and axis length and femoral neck width. Patients with spinal fractures alone have the most deficient bones at both trabecular and cortical sites: those with hip fracture and no spinal fractures the best at trabecular bone and most cortical bone sites: and those with both hip and spinal fractures intermediate in most measurements. Hip axis length and neck width did not differ between groups. The presence of the spinal fracture indicates poor trabecular bone status in hip fracture patients. Hip fracture patients without spinal fractures have a bone mass similar to the reference range for their age and gender. Poor trabecular bone in hip fracture patients may point to a category of patient more likely to benefit from therapy and may be indicated by the presence of spinal fractures.

  15. Incidence and socioeconomic burden of hip fractures in Italy: extension study 2003-2005

    Directory of Open Access Journals (Sweden)

    G. Guglielmi

    2011-06-01

    Full Text Available Objectives: we aimed to analyze incidence and costs of hip fractures in Italy. Methods: we analyzed the Italian Ministry of Health national hospitalization and DRGs databases concerning fractures occurred in people ≥65 between 2003 and 2005. We have estimated incidence and direct costs sustained by the National Health Service for hospitalization and treatment of hip fractures on the basis of the value of the Diagnosis Related Groups (DRGs referring to hip fractures. The expenses of rehabilitation and indirect costs were based on regional estimations. Results: between 2003 and 2005 we registered almost 90,000 hospital admissions per year (corresponding to 75,000 patients because of hip fractures in people aged ≥65. Women accounted for the majority of hospital admissions due to hip fractures (78.0%; n=214,519. Among women, 84.3% of fractures (n=180,861 occurred in patients ≥75, which is known to be the age group with the highest prevalence of osteoporosis. Hospitalizations of both men and women showed an increasing trend across all the examined period. Hospital costs increased up to 467 million euros in 2005, while rehabilitation costs rose up to 531 million in the same year. Conclusions: hip fractures in the Italian population are increasing and represent a major public health challenge.

  16. Multidisciplinary osteoporosis management of post low-energy trauma hip-fracture patients.

    Science.gov (United States)

    Skorupski, Nicole; Alexander, Ivy M

    2013-01-01

    The purpose of this article is to increase awareness of osteoporosis incidence in patients with hip fracture among providers and allied health professionals, to increase osteoporosis recognition and treatment in post hip-fracture patients, and to provide guidance on how to improve continuity of care and collaboration between members of the multidisciplinary healthcare team. Recent evidence from the literature is reviewed to identify effective management strategies for post low-energy trauma hip-fracture patients and prevention of future osteoporotic fracture, regardless of osteoporosis diagnosis prior to the initial fracture. Despite the availability of accurate screening technologies and highly efficacious antiosteoporosis medications, implementation of these measures for low-energy trauma hip-fracture patients remains critically low. This is because of a number of factors including hesitancy to integrate care across specialty lines, lack of reliable referral systems, and resistance to change. There is also a lack of recognition of the connection between low-energy trauma hip fracture and osteoporosis by many healthcare professionals. All members of the multidisciplinary care team are called to action to adopt osteoporosis evaluation and treatment strategies that research has shown to be effective on a larger scale in the post hip-fracture setting. ©2012 The Author(s) Journal compilation ©2012 American Association of Nurse Practitioners.

  17. The role of sarcopenia in the risk of osteoporotic hip fracture.

    Science.gov (United States)

    Oliveira, A; Vaz, C

    2015-10-01

    Several common age-related mechanisms and factors influence muscle and bone, affecting functionality of both tissues. Sarcopenia is closely linked with osteoporosis, and their combined effect may exacerbate negative health outcomes. Fall-related fractures are some of the most serious consequences of these two systemic pathologies, with hip fracture being a major complication affecting osteoporotic and sarcopenic elderly. This work aims to review the literature on the current state of knowledge about the relations between sarcopenia and osteoporosis and to present the association between sarcopenia and osteoporosis and the risk of hip fracture. A literature search was performed in PubMed and Scopus databases for articles with the predefined terms "sarcopenia," "muscular atrophy," "femoral fractures," "hip fractures," "osteoporosis," and "bone density." There is a growing and significant interest being directed to sarcopenia and associated risk for osteoporotic hip fracture, but there still is a notorious heterogeneity in the methodology and cohort size of the available studies. Collectively, most of the studies herein analyzed indicate that sarcopenia could be a predictor of risk for hip fracture. The simultaneous evaluation of sarcopenia and osteoporosis may be of importance in identifying those patients in higher risk of suffering an osteoporotic hip fracture and who could benefit from preventive or therapeutic interventions, or both.

  18. Subgroup variations in bone mineral density response to zoledronic acid after hip fracture.

    Science.gov (United States)

    Magaziner, Jay S; Orwig, Denise L; Lyles, Kenneth W; Nordsletten, Lars; Boonen, Steven; Adachi, Jonathan D; Recknor, Chris; Colón-Emeric, Cathleen S; Mesenbrink, Peter; Bucci-Rechtweg, Christina; Su, Guoqin; Johnson, Rasheeda; Pieper, Carl F

    2014-12-01

    Minimizing post-fracture bone loss is an important aspect of recovery from hip fracture, and determination of factors that affect bone mineral density (BMD) response to treatment after hip fracture may assist in the development of targeted therapeutic interventions. A post hoc analysis of the HORIZON Recurrent Fracture Trial was done to determine the effect of zoledronic acid (ZOL) on total hip (TH) and femoral neck (FN) BMD in subgroups with low-trauma hip fracture. A total of 2127 patients were randomized (1:1) to yearly infusions of ZOL 5 mg (n = 1065) or placebo (n = 1062) within 90 days of operation for low-trauma hip fracture. The 1486 patients with a baseline and at least one post-baseline BMD assessment at TH or FN (ZOL = 745, placebo = 741) were included in the analyses. Percentage change from baseline in TH and FN BMD was assessed at months 12 and 24 and compared across subgroups of hip fracture patients. Percentage change from baseline in TH and FN BMD at months 12 and 24 was greater (p 6 weeks post-surgery; and for TH and FN BMD in patients with a history of one or more prior fractures. All interactions were limited to the first 12 months after treatment with none observed for the 24-month comparisons. (Clinical trial registration number NCT00046254.) © 2014 American Society for Bone and Mineral Research.

  19. Postoperative Treatment of Pain after Hip Fracture in Elderly Patients with Dementia

    DEFF Research Database (Denmark)

    Jensen-Dahm, Christina; Palm, Henrik; Gasse, Christiane

    2016-01-01

    BACKGROUND/AIMS: Prior studies have shown that patients with dementia are at risk of receiving insufficient treatment for pain after a hip fracture. We therefore hypothesized that elderly hip fracture patients with dementia received less postoperative pain treatment than those without dementia....... METHOD: All patients (age ≥65 years) who had been operated on for a hip fracture in the Copenhagen University Hospital region in 2009 were included. Data about analgesic use for the first 72 h after surgery were acquired from the hospitals' electronic medication system and linked with information about...

  20. A COMPARITIVE STUDY OF CLINICO-RADIOLOGICAL OUTCOME: DHS VERSES PFLCP IN INTERTROCHANTRIC FRACTURES OF FEMUR

    Directory of Open Access Journals (Sweden)

    Vanamali B

    2015-11-01

    Full Text Available INTRODUCTION: There have been many case series advocating the potential benefits of PFLCP for fixation of intertrochanteric fractures. But these studies are lacking in terms of guidelines regarding the type of fractures in which PFLCP has an upper hand over the gold standard implant that is the DHS. Moreover there have been very few control studies comparing these two implants. Therefore, we performed a case control study to assess: (1 If PFLCP offers better functional results and fewer complications than dynamic hip screws (DHS? (2 Which kind of extracapsular femoral fractures would benefit from PFLCP fixation? PATIENTS AND METHODS: A total of 60 patients with intertrochanteric femoral fractures were recruited. Thirty patients underwent PFLCP fixation, and thirty patients underwent DHS fixation. Patient information, type of fracture, functional level (as assessed by Harris hip score, bone union, and implant complications were compared for the two treatment groups. RESULTS: The Mean duration for union in PFLCP group was 17 Weeks (12-24 weeks. The Mean duration for union in DHS group was 16 Weeks (12-28 weeks. Although there were better functional results (Harris Hip Score in PFLCP group when compared to DHS group the difference was not statistically significant (P value= 0.06 in our study. The complications like fracture of the lateral cortex, shortening >2cm, rotational deformity, varus mal-union screw cut off phenomenon, plate lift off were more in DHS group when compared to PFLCP. CONCLUSION: We conclude that there was no major difference between DHS and PFLCP for stable intertrochanteric fractures and PFLCP is a better alternative in fixing osteoporotic and unstable intertrochanteric fractures. Further large case control studies are needed in this regard.

  1. Cortical thickness mapping to identify focal osteoporosis in patients with hip fracture.

    Directory of Open Access Journals (Sweden)

    Kenneth E S Poole

    Full Text Available BACKGROUND: Individuals with osteoporosis are predisposed to hip fracture during trips, stumbles or falls, but half of all hip fractures occur in those without generalised osteoporosis. By analysing ordinary clinical CT scans using a novel cortical thickness mapping technique, we discovered patches of markedly thinner bone at fracture-prone regions in the femurs of women with acute hip fracture compared with controls. METHODS: We analysed CT scans from 75 female volunteers with acute fracture and 75 age- and sex-matched controls. We classified the fracture location as femoral neck or trochanteric before creating bone thickness maps of the outer 'cortical' shell of the intact contra-lateral hip. After registration of each bone to an average femur shape and statistical parametric mapping, we were able to visualise and quantify statistically significant foci of thinner cortical bone associated with each fracture type, assuming good symmetry of bone structure between the intact and fractured hip. The technique allowed us to pinpoint systematic differences and display the results on a 3D average femur shape model. FINDINGS: The cortex was generally thinner in femoral neck fracture cases than controls. More striking were several discrete patches of statistically significant thinner bone of up to 30%, which coincided with common sites of fracture initiation (femoral neck or trochanteric. INTERPRETATION: Femoral neck fracture patients had a thumbnail-sized patch of focal osteoporosis at the upper head-neck junction. This region coincided with a weak part of the femur, prone to both spontaneous 'tensile' fractures of the femoral neck, and as a site of crack initiation when falling sideways. Current hip fracture prevention strategies are based on case finding: they involve clinical risk factor estimation to determine the need for single-plane bone density measurement within a standard region of interest (ROI of the femoral neck. The precise sites of focal

  2. [Hip Fracture--Epidemiology, Management and Liaison Service. Prevention of the secondary hip fractures utilizing the regional post-referral treatment plan].

    Science.gov (United States)

    Matsushita, Mutsumi

    2015-04-01

    Fragility fracture can result in a series of fractures, with the need for the prevention of secondary hip fractures seen as increasingly pertinent in Japan. In 2006, regional post-referral treatment plans for femoral neck fracture came into effect in Japan, but treatment of fracture and prevention of secondary fracture were fragmented. Patient education about prevention included on explanation forms were commenced, but the levels of discharge prescription for osteoporosis medications did not indicate an improvement. We evaluated a fracture liaison service for post-referral treatment plans for femoral neck fracture, by registering rehabilitation-stage hospitals and surveying data over a six-month period about whether there was prescription of osteoporosis medications on discharge, and the varieties of medication prescribed.

  3. Association of the presence of bone bars on radiographs and hip fracture in postmenopausal Caucasian women.

    Science.gov (United States)

    Sarver, D B; Lopez-Ben, R; Morgan, S L; Rehder, D; Duke, J N; Fineberg, N; Pitt, M J

    2012-09-01

    To determine whether the presence of bone bars (BB) identified on anteroposterior hip radiographs are more prevalent in patients that have had a hip fracture as compared to patients without a fracture. Ninety-two Caucasian women with a unilateral proximal femur fracture were retrospectively evaluated and randomly selected using radiology database records to comprise the investigational group. Ninety-eight age-matched Caucasian women without hip fracture were selected as a control group. Anteroposterior hip radiographs were evaluated for the presence of BBs by two musculoskeletal radiologists. Chi-square tests were used to assess whether fractures were more prevalent in patients with BB than those without BB. The patient population was comprised Caucasian women with a mean age of 79.8 ± 6.4 years in the control group and 79.9 ± 6.6 years in the investigational group. Regardless of the reader, BB were identified in a significantly higher percentage of women with a fracture (75 versus 39%, p fracture. BB are associated with hip fracture. Their presence is a trigger for requesting a dual-energy x-ray absorptiometry (DXA) examination to confirm or refute a diagnosis of low bone mineral density (BMD) and a subsequent increased risk of fracture. Copyright © 2012 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

  4. Quality of life after hip fracture in the elderly: A systematic literature review.

    Science.gov (United States)

    Peeters, Charles M M; Visser, Eva; Van de Ree, Cornelis L P; Gosens, Taco; Den Oudsten, Brenda L; De Vries, Jolanda

    2016-07-01

    With an increasing ageing population, hip fractures have become a major public health issue in the elderly. It is important to examine the health status (HS) and health-related quality of life (HRQOL) of the elderly faced with the epidemic of hip fractures. To provide an overview of reported HS and HRQOL in elderly patients with a hip fracture. A systematic literature search was performed in Embase, Medline, Web of Science, Scopus, CINAHL, Cochrane, PsycINFO, Pubmed, and Google Scholar in July 2014. Studies which reported the HS or HRQOL based on standardised questionnaires in patients older than 65 years with a hip fracture were considered eligible for inclusion. After inspecting the 2725 potentially eligible studies, 49 fulfilled the inclusion criteria. All included studies were randomised controlled trials or prospective cohort studies. The methodological quality of the studies was moderate. Patients' functioning on the physical, social, and emotional domains were affected after a hip fracture. The HS and HRQOL of the majority of patients recovered in the first 6 months after fracture. However, their HS did not return to prefracture level. Mental state, prefracture functioning on physical and psychosocial domains, comorbidity, female gender, nutritional status, postoperative pain, length of hospital stay, and complications were factors associated with HS or HRQOL. Treatment with total hip arthroplasty or hemi-arthroplasty provided better HS than treatment with internal fixation with displaced femoral neck fractures. Supportive psychotherapy in "low-functioning" patients, (home) rehabilitation programmes and nutritional supplementation appeared to have beneficial effects on HS. Optimizing nutrition intake, (home) rehabilitation programmes, and the possibility for psychological counselling in patients with difficulties in the psychosocial dimensions would be recommended after hip fracture surgery. Besides HS questionnaires like EQ-5D and SF-36, adequate

  5. A vast increase in the use of CT scans for investigating occult hip fractures

    Energy Technology Data Exchange (ETDEWEB)

    Jordan, Robert, E-mail: Robert.jordan@doctors.org.uk; Dickenson, Edward, E-mail: edwarddickenson@doctors.org.uk; Westacott, Daniel, E-mail: dan_westacott@hotmail.com; Baraza, Njalalle, E-mail: njaleb@Doctors.Org.Uk; Srinivasan, Kuntrapka, E-mail: bijusri@Yahoo.Co.Uk

    2013-08-15

    Background: Early diagnosis in neck of femur fractures has been shown to improve outcome. The National Institute for Clinical Excellence recommends if an occult hip fracture is suspected then an MRI should be performed and if not available within 24 h a CT should be considered. At our centre, emergency MRI is rarely available and so CT is commonly used. Objectives: Our study aims to analyse the trends in CT use over a five year period for the diagnosis of neck of femur fractures. Methods: Both the number of patients with a hip fracture and those undergoing a CT hip to diagnose an occult injury were identified across two district general hospitals between 2006–2007 and 2010–2011. The time from initial radiograph to CT and initial radiograph to operation were calculated. Results: In 2006–2007, of 547 hip fractures, 20 CT hips were performed and 6 reported as a fractured neck of femur (30%). In 2010–2011, of 499 hip fractures, 239 CT hips were performed and 65 fractures were recognised (27%). The mean time from radiograph until CT scan was 2.0 days in 2007 and 3.2 days in 2011, which was a statistically significant difference (p < 0.001). For those diagnosed using a CT scan the mean time from admission X-ray to surgery was 1.2 days in 2007 and 3.6 days in 2011. Conclusion: Clinicians are becoming increasingly reliant on CT for the diagnosis of hip fractures with our data suggesting further imaging is one factor that can delay time to diagnosis and theatre.

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

    Directory of Open Access Journals (Sweden)

    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

  7. Clinical study on effect of proxima l femoraln ail antirotation (PFNA) in treatment of intertrochanteric fracture and subtrochanteric fracture of femur in elderly patients%应用PFNA治疗高龄老人股骨粗隆间及粗隆下骨折的临床研究

    Institute of Scientific and Technical Information of China (English)

    刘贵秋; 李晓波; 李文波

    2014-01-01

    目的:观察应用PFNA来治疗超过80岁以上老人股骨粗隆间及粗隆下骨折的治疗效果。方法:收集2011年8月~2014年2月期间来我院采取PFNA方法治疗股骨粗隆间及粗隆下骨折的80岁以上高龄患者36例。均采用手术治疗,主要包括手术前的准备、手术过程中的方法和手术之后的治疗,对应用PFNA的疗效进行分析。结果:经过3个月~2年观察骨折愈合、无内固定物断裂、骨折不愈合、畸形愈合等并发症。结论:应用PFNA治疗股骨粗隆间和粗隆下骨折具有出血少、内固定牢固、术后髋关节恢复满意等优点,尤其适合高龄老人患者,是疗效好的治疗方法。%Objective:To evaluate the clinical results of PFNA( the Proximal Femoral Nail Antirotation) internal fixation for the treat-ment of patients over 80 years old who suffered from comminute intertrochanteric fracture and Subtrochanteric fracture of femur.Methods:36 cases of elderly intertrochanteric fracture and Subtrochanteric fracture of femur treated with PFNA in our hospital from August 2011 to February 2014 were selected and analyzed in this study.The perfect treating methods including preparation before operation and care after the treatment were taken.Proximal femoral nail anti-rotation was analyzed.Results:All patients were followed up for 3 months~2 years and all fractures were healed.No complications such as bone nonunion,coxa vara,or malunion occurred were found.Conclusion:Since PFNA fixation had advantages of less interference with blood circulation at the fracture ends,little osseous destruction,simple operation, less blood loss,stable fixation and few postoperative complications,it might be an effective treatment for femoral intertrochanteric fracture and Subtrochanteric fracture in senile patients.

  8. Does achieving the best practice tariff improve outcomes in hip fracture patients? An observational cohort study

    National Research Council Canada - National Science Library

    Oakley, B; Nightingale, J; Moran, CG; Moppett, IK

    2017-01-01

      Objectives To determine if the introduction of the best practice tariff (BPT) has improved survival of the elderly hip fracture population, or if achieving BPT results in improved survival for an individual...

  9. Comparing prophylactic effect of phenylephrine and ephedrine on hypotension during spinal anesthesia for hip fracture surgery

    Directory of Open Access Journals (Sweden)

    Rahman Abbasivash

    2016-01-01

    Conclusion: At the doses of ephedrine and phenylephrine administered in this trial, phenylephrine was better to prevent hypotension during hip fracture surgery with spinal anesthesia. Higher frequency of hypotension was observed in the ephedrine group.

  10. Prospective comparison of the anterior and lateral approach in hemiarthroplasty for hip fractures: a study protocol

    National Research Council Canada - National Science Library

    Max P L van der Sijp; Inger B Schipper; Stefan B Keizer; Pieta Krijnen; Arthur HP Niggebrugge

    2017-01-01

    .... The aim of this study is to compare postoperative complications, hip function and patient mobility after hemiarthroplasty via the anterior or lateral approach following a displaced femoral neck fracture...

  11. Patient Perspectives on Engagement in Recovery after Hip Fracture: A Qualitative Study

    National Research Council Canada - National Science Library

    Joanie Sims-Gould; Sarah Stott-Eveneshen; Lena Fleig; Megan McAllister; Maureen C. Ashe

    2017-01-01

    .... 50 community-dwelling older adults recovering from a recent (3-12 months) hip fracture (32 women, 18 men) participated in telephone interviews using a semistructured format at 6 and 12 months after recruitment into the study...

  12. Pilot case-control investigation of risk factors for hip fractures in the urban Indian population

    Directory of Open Access Journals (Sweden)

    Malhotra Nidhi

    2010-03-01

    Full Text Available Abstract Background Despite the reported high prevalence of osteoporosis in India, there have been no previous studies examining the risk factors for hip fracture in the Indian population. Methods We carried out a case control investigation comprising 100 case subjects (57 women and 43 men admitted with a first hip fracture into one of three hospitals across New Delhi. The 100 controls were age and sex matched subjects who were either healthy visitors not related to the case patients or hospital staff. Information from all subjects was obtained through a questionnaire based interview. Results There was a significant increase in the number of cases of hip fracture with increasing age. There were significantly more women (57% than men (43%. Univariate analysis identified protective effects for increased activity, exercise, calcium and vitamin supplements, almonds, fish, paneer (cottage cheese, curd (plain yogurt, and milk. However, tea and other caffeinated beverages were significant risk factors. In women, hormone/estrogen therapy appeared to have a marginal protective effect. For all cases, decreased agility, visual impairment, long term medications, chronic illnesses increased the risk of hip fracture. The multivariate analysis confirmed a protective effect of increased activity and also showed a decrease in hip fracture risk with increasing body mass index (odds ratio (OR 0.024, 95% confidence interval (CI 0.006-0.10 & OR 0.81, 95% CI 0.68-0.97 respectively. Individuals who take calcium supplements have a decreased risk of hip fracture (OR 0.076; CI 0.017-0.340, as do individuals who eat fish (OR 0.094; CI 0.020-0.431, and those who eat paneer (OR 0.152; 0.031-0.741. Tea drinkers have a higher risk of hip fracture (OR 22.8; 95% CI 3.73-139.43. Difficulty in getting up from a chair also appears to be an important risk factor for hip fractures (OR 14.53; 95% CI 3.86-54.23. Conclusions In the urban Indian population, dietary calcium, vitamin D

  13. Inflammatory Markers and the Risk of Hip and Vertebral Fractures in Men: the Osteoporotic Fractures in Men (MrOS).

    Science.gov (United States)

    Cauley, Jane A; Barbour, Kamil E; Harrison, Stephanie L; Cloonan, Yona K; Danielson, Michelle E; Ensrud, Kristine E; Fink, Howard A; Orwoll, Eric S; Boudreau, Robert

    2016-12-01

    Cytokines play major roles in regulating bone remodeling, but their relationship to incident fractures in older men is uncertain. We tested the hypothesis that men with higher concentrations of pro-inflammatory markers have a higher risk of fracture. We used a case-cohort design and measured inflammatory markers in a random sample of 961 men and in men with incident fractures including 120 clinical vertebral, 117 hip, and 577 non-spine fractures; average follow-up 6.13 years (7.88 years for vertebral fractures). We measured interleukin (IL)-6, C-reactive protein (CRP), tumor necrosis factor alpha (TNFα), soluble receptors (SR) of IL-6 (IL-6SR) and TNF (TNFαSR1 and TNFαSR2), and IL-10. The risk of non-spine, hip, and clinical vertebral fracture was compared across quartiles (Q) of inflammatory markers using Cox proportional hazard models with tests for linear trend. In multivariable-adjusted models, men with the highest (Q4) TNFa cytokine concentrations and their receptors had a 2.0-4.2-fold higher risk of hip and clinical vertebral fracture than men with the lowest (Q1). Results were similar for all non-spine fractures, but associations were smaller. There was no association between CRP and IL-6SR and fracture. Men in the highest Q of IL-10 had a 49% lower risk of vertebral fracture compared with men in Q1. Among men with ≥3 inflammatory markers in the highest Q, the hazard ratio (HR) for hip fractures was 2.03 (95% confidence interval [CI] 1.11-3.71) and for vertebral fracture 3.06 (1.66-5.63). The HRs for hip fracture were attenuated by 27%, 27%, and 15%, respectively, after adjusting for appendicular lean mass (ALM), disability, and bone density, suggesting mediating roles. ALM also attenuated the HR for vertebral fractures by 10%. There was no association between inflammation and rate of hip BMD loss. We conclude that inflammation may play an important role in the etiology of fractures in older men. © 2016 American Society for Bone and Mineral Research.

  14. Traumatic fracture-dislocation of the hip following rugby tackle: a case report

    Directory of Open Access Journals (Sweden)

    Venkatachalam Santosh

    2009-12-01

    Full Text Available Abstract Posterior fracture-dislocation of hip is uncommonly encountered in rugby injuries. We report such a case in an adult while playing rugby. The treating orthopaedician can be caught unaware and injuries in such sports can be potentially misdiagnosed as hip sprains. Immediate reduction of the dislocation was performed in theatres. The fracture was fixed with two lag screws and a neutralization plate. This led to early rehabilitation and speedy recovery with return to sporting activities by 12 months.

  15. Value of routine blood tests for prediction of mortality risk in hip fracture patients

    DEFF Research Database (Denmark)

    Mosfeldt, Mathias; Pedersen, Ole B; Riis, Troels

    2012-01-01

    There is a 5- to 8-fold increased risk of mortality during the first 3 months after a hip fracture. Several risk factors are known. We studied the predictive value (for mortality) of routine blood tests taken on admission.......There is a 5- to 8-fold increased risk of mortality during the first 3 months after a hip fracture. Several risk factors are known. We studied the predictive value (for mortality) of routine blood tests taken on admission....

  16. Frequent manual repositioning and incidence of pressure ulcers among bedbound elderly hip fracture patients

    OpenAIRE

    Rich, Shayna E.; Margolis, David; Shardell, Michelle; Hawkes, William G; Miller, Ram R.; Amr, Sania; Baumgarten, Mona

    2010-01-01

    Frequent manual repositioning is an established part of pressure ulcer (PU) prevention, but there is little evidence for its effectiveness. This study examined the association between repositioning and PU incidence among bedbound elderly hip fracture patients, using data from a 2004–2007 cohort study in nine Maryland and Pennsylvania hospitals. Eligible patients (n=269) were age≥65 years, underwent hip fracture surgery, and were bedbound at index study visits (during the first five days of ho...

  17. Change of residence and functional status within three months and one year following hip fracture surgery

    DEFF Research Database (Denmark)

    Ariza-Vega, Patrocinio; Jiménez-Moleón, José Juan; Kristensen, Morten Tange

    2014-01-01

    PURPOSE: To study the recovery of patients in terms of 18 activities of daily living and change of residence within the year following a hip fracture. METHOD: This prospective cohort study was carried out in a trauma service of an acute hospital in southern Spain including 159 patients with a hip...

  18. Functional Recovery of Older Hip-Fracture Patients after Interdisciplinary Intervention Follows Three Distinct Trajectories

    Science.gov (United States)

    Tseng, Ming-Yueh; Shyu, Yea-Ing L.; Liang, Jersey

    2012-01-01

    Purpose To assess the effects of an interdisciplinary intervention on the trajectories of functional recovery among older patients with hip fracture during 2 years after hospitalization. Design and Methods In a randomized controlled trial with 24-month follow-up, 162 patients [greater than or equal to]60 years were enrolled after hip-fracture…

  19. High hip fracture risk in men with severe aortic calcification - MrOS study

    Science.gov (United States)

    Szulc, Pawel; Blackwell, Terri; Schousboe, John T.; Bauer, Douglas C.; Cawthon, Peggy; Lane, Nancy E.; Cummings, Steven R.; Orwoll, Eric S.; Black, Dennis M.; Ensrud, Kristine E.

    2013-01-01

    A significant link between cardiovascular disease and osteoporosis is established in postmenopausal women, but data in men are scarce. We tested the hypothesis that greater severity of abdominal aortic calcification (AAC) was associated with an increased risk of non-spine fracture in 5994 men aged ≥65 years. AAC wasassessed on 5400 baseline lateral thoraco-lumbar radiographs using a validated visual semi-quantitative score. Total hip bone mineral density (BMD) was measured using dual energy X-ray absorptiometry. Incident non-spine fractures were centrally adjudicated. After adjustment for age, BMI, total hip BMD, fall history, prior fracture, smoking status, co-morbidities, race and clinical center, the risk of non-spine fracture (n=805) was increased among men with higher AAC (HR Q4 (AAC score ≥9) vs Q1 (0-1): 1.36, 96%CI: 1.10-1.68). This association was due to an increased risk of hip fracture (n=178) among men with higher AAC (HR Q4 vs Q1: 2.33, 95%CI: 1.41-3.87). By contrast, the association between AAC and the risk of non-spine-non-hip fracture was weaker and not significant (HR Q4 vs Q1: 1.22, 95%CI: 0.96-1.55). The findings regarding higher AAC and increased risk of fracture were not altered in additional analyses accounting for degree of trauma, estimated glomerular filtration rate, presence of lumbar vertebral fractures (which may bias AAC assessment), preexisting cardiovascular disease, ankle brachial index or competing risk of death. Thus, in this large cohort of elderly men, greater AAC was independently associated with an increased risk of hip fracture, but not with other non-spine fractures. These findings suggest that AAC assessment may be a useful method for identification of older men at high risk of hip fracture. PMID:23983224

  20. A computer-assisted systematic quality monitoring method for cervical hip fracture radiography

    Directory of Open Access Journals (Sweden)

    Mats Geijer

    2016-12-01

    Full Text Available Background A thorough quality analysis of radiologic performance is cumbersome. Instead, the prevalence of missed cervical hip fractures might be used as a quality indicator. Purpose To validate a computer-based quality study of cervical hip fracture radiography. Material and Methods True and false negative and positive hip trauma radiography during 6 years was assessed manually. Patients with two or more radiologic hip examinations before surgery were selected by computer analysis of the databases. The first of two preoperative examinations might constitute a missed fracture. These cases were reviewed. Results Out of 1621 cervical hip fractures, manual perusal found 51 (3.1% false negative radiographic diagnoses. Among approximately 14,000 radiographic hip examinations, there were 27 (0.2% false positive diagnoses. Fifty-seven percent of false negative reports were occult fractures, the other diagnostic mistakes. There were no significant differences over the years. Diagnostic sensitivity was 96.9% and specificity 99.8%. Computer-assisted analysis with a time interval of at least 120 days between the first and the second radiographic examination discovered 39 of the 51 false negative reports. Conclusion Cervical hip trauma radiography has high sensitivity and specificity. With computer-assisted analysis, 76% of false negative reports were found.

  1. Frequency of Osteoporosis and Osteopenia According To Bone Mineral Density of Proximal Femur Subregions in Normal and Osteopenic Postmenopausal Women With Respect to Total Hip Bone

    Directory of Open Access Journals (Sweden)

    Murat Ersöz

    2002-09-01

    Full Text Available In this study 29 normal (mean age: 65.6 ± 5.1 years and 33 osteopenic (mean age: 67.6 ± 4.9 years postmenopausal women according to total bone mineral density (BMD of the hip were evaluated for BMD values of subregions of proximal femur. The percentages for osteoporosis and osteopenia with respect to subregions were 13.8% and 58.6% for femoral neck and 20.7% and 41.4% for Ward’s triangle in normal group. In trochanteric and intertrochanteric measurements there were no T scores below –2.5 but 17.2% of the subjects were osteopenic with regard to trochanteric and 6.9% were osteopenic due to intertrochanteric BMD values. The percentages for osteoporosis and osteopenia with respect to subregion measurements were 57.6% and 42.4% for femoral neck, 60.6% and 36.4% for Ward’s triangle, 3% and 78.8% for trochanteric, 9.1% and 87.9% for intertrochanteric regions in osteopenic group according to total hip values. Knowing that hip fracture risk is increasing 2-3 fold for 1 standart deviation decrease from the young adult mean value for all subregions and knowing the relation between cervical hip fractures and BMD values of Ward’s triangle and femoral neck and the relation between intertrochanteric fractures and trochanteric BMD values, it is recommended to evaluate the BMD values of subregions of the hip besides the total hip values in daily practice.

  2. Organizational Factors and Long-Term Mortality after Hip Fracture Surgery. A Cohort Study of 6143 Consecutive Patients Undergoing Hip Fracture Surgery

    DEFF Research Database (Denmark)

    Lund, Caterina A; Møller, Ann M; Wetterslev, Jørn

    2014-01-01

    OBJECTIVE: In hospital and health care organizational factors may be changed to reduce postoperative mortality. The aim of this study is to evaluate a possible association between mortality and 'length of hospital stay', 'priority of surgery', 'time of surgery', or 'surgical delay' in hip fracture......, anaesthetic and surgical procedures were retrieved. PARTICIPANTS: 6143 patients aged more than 65 years undergoing hip fracture surgery. MAIN OUTCOME MEASURES: All-cause mortality. RESULTS: The one year mortality was 30% (28-31%, 95% Confidence interval (CI)). In a multivariate model 'length of hospital stay...

  3. Schizophrenia, antipsychotics and risk of hip fracture: a population-based analysis.

    Science.gov (United States)

    Sørensen, Holger J; Jensen, Signe O W; Nielsen, Jimmi

    2013-08-01

    In a nationwide study using linkage of Danish hospital registers we examined predictors of hip fracture (ICD-10: S72) in 15,431 patients with schizophrenia (ICD-10: F20 or ICD-8: 295) and 3,807,597 population controls. Shorter education, disability pension, lifetime alcohol abuse, somatic co-morbidity, antipsychotics (IRR=1.19; 95% CI 1.15-1.24), antidepressant (IRR=1.18; 95% CI 1.16-1.20), anticholinergics (IRR=1.29; 95% CI 1.22-1.36), benzodiazepines (IRR=1.06; 95% CI 1.04-1.08) and corticosteroids (IRR=1.44; 95% CI 1.36-1.53) were significant predictors. In 556 persons with schizophrenia and hip fracture (matched to 1:3 to schizophrenia controls without hip fracture), antipsychotic polypharmacy predicted hip fracture. Analyses among antipsychotic monotherapy patients showed no differential effect of individual antipsychotics. A dose-response relationship of hip fracture and lifetime antipsychotics consumption was found (IRR=1.13 95% CI 1.07-1.19) and both prolactin-increasing and non-prolactin-increasing antipsychotics contributed to the effect. In conclusion, several factors, including complex psychopharmacological treatment, contribute in the prediction of hip fracture in large populations. Preventive strategies should focus attention to severely ill patients with high likelihood of a receiving complex psychopharmacologic treatment and high doses of antipsychotics.

  4. The Benefits of Streamlined Hip Fracture Management in a Regional Hospital.

    Science.gov (United States)

    Mow, T C; Lukeis, Jen; Sutherland, A G

    2017-06-01

    Hip fracture is an increasingly common injury in the growing elderly population. The morbidity and mortality associated with this injury can be reduced by minimizing delays to surgical treatment. We describe the impact of a regional hospital service redesign project that utilized the principles of smart simplicity, a management strategy that lays emphasis on collaboration to achieve desired goals. Prior to the redesign, patients with hip fractures were taking an average of 72 hours for surgical treatment. A hip fracture working group was created to examine closely the process of hip fracture care, and a single key performance indicator (KPI) of "surgery within 48 hours" was adopted. This allowed identification of processes that could be clarified and streamlined, with the agreement of relevant stakeholders, in the creation of a new hip fracture pathway. In the first 3 months of the pathway's implementation, 16 of 18 patients had surgery within 48 hours of presentation. In a 6-month follow-up audit after 2 years of implementation, 36 of 39 patients were treated within 48 hours. This was significantly different to the time to surgery seen in the 12 months prior to the redesign (P KPI has allowed a significant culture shift in the treatment of hip fractures in our institution in the months following its institution. Collaborative, multidisciplinary collaboration has facilitated a higher standard of care and demonstrated significant cost benefit.

  5. Height and Risk of Hip Fracture: A Meta-Analysis of Prospective Cohort Studies.

    Science.gov (United States)

    Xiao, Zhihong; Ren, Dong; Feng, Wei; Chen, Yan; Kan, Wusheng; Xing, Danmou

    2016-01-01

    The association between height and risk of hip fracture has been investigated in several studies, but the evidence is inconclusive. We therefore conducted this meta-analysis of prospective cohort studies to explore whether an association exists between height and risk of hip fracture. We searched PubMed and EMBASE, Web of Science, and the Cochrane Library for studies of height and risk of hip fracture up to February 16, 2016. The random-effects model was used to combine results from individual studies. Seven prospective cohort studies, with 7,478 incident hip fracture cases and 907,913 participants, were included for analysis. The pooled relative risk (RR) was 1.65 (95% confidence interval (CI): 1.26-2.16) comparing the highest with the lowest category of height. Result from dose-response analysis suggested a linear association between height and hip fracture risk (P-nonlinearity = 0.0378). The present evidence suggests that height is positively associated with increased risk of hip fracture. Further well-designed cohort studies are needed to confirm the present findings in other ethnicities.

  6. Improvements in hip fracture incidence counterbalanced by the rise of other fracture types: data from Spain 2000-2010.

    Science.gov (United States)

    Cirera, Eva; Pérez, Katherine; Santamariña-Rubio, Elena; Novoa, Ana M; Olabarria, Marta

    2014-12-01

    In recent years, the incidence of injury in older people has increased. The aim of this study is to address the hypothesis that this increase is due to an increase in the incidence of some injuries that, while less common than hip fractures, are sufficient jointly to counteract the decrease or stabilisation in hip fracture rates observed in most countries. We performed a descriptive study of trends using data from the National Hospital Discharge Register. We included individuals 65 years and older who were discharged from a Spanish hospital during the period 2000-2010 with at least one injury diagnosis in the primary diagnosis field on the discharge form. The dependent variables were the following injury groups, classified using the Barell Matrix: hip fracture, shoulder and upper arm fractures, forearm and elbow fractures, thoracic fractures, lower leg and ankle fractures, and TBI type 1 internal injury. Incidence rates were calculated per 100,000 inhabitants (data from National Statistics Institute) and stratified by sex and age group. Trends, in terms of Annual Percent Change (APC), were assessed using Poisson Regression with discharge year as the independent variable. Hip fracture continues to be the most important injury type in older people. Thoracic fractures and TBI internal injuries are more common in men, while fractures in the upper extremities are more common in women. All injuries increased in frequency with age, except lower leg and ankle fractures, which decreased. While a secular decreasing trend in hip fracture was noted, the incidences of fractures of the shoulder and upper arm, forearm and elbow, and lower leg and ankle, as well as of TBI type 1 internal injuries have increased steadily. Although hip fracture continue to be the most common type of injury in older people, this study has allowed identifying other types of injury that are becoming increasingly common. These trends are driving paradigm changes in the burden of injuries requiring

  7. Can experts in acetabular fracture care determine hip stability after posterior wall fractures using plain radiographs and computed tomography?

    Science.gov (United States)

    Davis, Adrian T; Moed, Berton R

    2013-10-01

    Hip stability status after a posterior wall acetabular fracture involving 20%-50% of the posterior wall is difficult to determine. However, noted experts have professed that hip stability can be accurately determined by careful review of high-quality anteroposterior and oblique plain radiographs and a computed tomography scan. The objective of this investigation was to evaluate the interobserver and intraobserver reliabilities and accuracies in determining hip stability status by fellowship-trained orthopedic traumatologists expert in acetabular fracture care using these studies. Reliability and validation study. Level 1 trauma center. Fifteen patients with isolated unilateral posterior wall (OTA 62-A1) acetabular fractures involving 20%-50% of the posterior acetabular wall and known clinical outcome had undergone dynamic stress fluoroscopy under anesthesia to determine hip stability. High-quality anteroposterior and oblique plain radiographs and axial computed tomography images of 15 fractures involving 20%-50% of the posterior acetabular wall were reviewed in random order by 4 fellowship-trained orthopedic traumatologists specializing in acetabular fracture care in 2 separate sessions. The second session occurred after a minimum 1-month washout period. Determination of hip stability status was made for each fracture at the 2 time points based on the images along with any history of dislocation of the hip at the time of injury. These determinations were compared with the findings of examination under anesthesia, which served as the gold standard. Measurement of agreement using the Kappa statistic. Although intraobserver reliability was good (0.65), interobserver reliability was poor (0.12). In addition, percent correct was only 53% (32/60) for the initial reading and only 52% (31/60) for the second. For the initial reading, sensitivity and specificity were 100% (28/28) and 13% (4/32), respectively. For the second reading, the sensitivity and specificity were 57

  8. Increased risk for early periprosthetic fractures after uncemented total hip replacement

    DEFF Research Database (Denmark)

    Solgaard, Søren; Kjersgaard, Anne Grete

    2014-01-01

    INTRODUCTION: The purpose of this study was to describe a new type of proximal periprosthetic fracture occurring within the first six weeks after total hip arthroplasty and to analyse possible causes of a rising incidence. MATERIAL AND METHODS: Patient files and radiographs from 2,408 uncemented...... hip replacements were analysed and patients with a periprosthetic split fracture reaching from the calcar to the medial femoral shaft below the lesser trochanter were included. RESULTS: A total of 28 fractures in 2,408 uncemented primary hip replacements were included. Almost all fractures were seen...... in women. No correlation with diagnosis, age, body mass index, operation time, operative technique or implant position could be demonstrated, but a possible correlation with post-operative mobilisation and pain treatment was observed. Trainees had more fractures than experienced surgeons (non...

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

    LENUS (Irish Health Repository)

    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.

  10. Systematic review of the association between climate and hip fractures

    Science.gov (United States)

    Román Ortiz, Carmen; Tenías, José María; Estarlich, Marisa; Ballester, Ferran

    2015-10-01

    This study aims to systematically review epidemiological studies that evaluate the relationship between meteorology and the incidence of hip fracture (HF). After a search in Scopus, PubMed, and Embase, two independent authors assessed the relevance of studies and extracted data for description. From each study, we extracted the geographic and temporal scope, design, study variables (meteorological and related to HF), statistical analysis, and estimated associations. Of a total of 134 works, 20 studies were selected. All use an ecological design but one case-crossover. Most studies have been conducted in northern latitudes. The analysis methodology did not take into account the temporal structure of the data in 10 studies (regression and linear correlations); the rest used Poisson regression (7) and ARIMA model (3). Most studies showed significant positive associations with rainfall, especially in the form of snow: HF relative risk (RR) on days with precipitation vs. days without precipitation that ranged from 1.14 (95 % confidence interval (CI)1.04 to 1.24) to 1.60 (95 % CI 1.06 to 2.41), the temperature, with RR by one degree Celsius decline from 1.012 (95 % CI 1.004 to 1.020) to 1.030 (95 % CI 1.023 to 1.037), and wind (3) RR FC windiest days vs. calm days: 1.32 (95 % CI 1.10 to 1.58) to 1.35 (95 % CI 0.88 to 2.08). This review shows that analytic methods are very heterogeneous and poorly adapted to the temporary nature of the data. Studies confirm a certain seasonality, with more fractures in winter and meaningful relationships with meteorological conditions typical of this season.

  11. Differences in the trajectory of bone mineral density change measured at the total hip and femoral neck between men and women following hip fracture.

    Science.gov (United States)

    Rathbun, Alan M; Shardell, Michelle; Orwig, Denise; Hebel, J Richard; Hicks, Gregory E; Beck, Thomas; Hochberg, Marc C; Magaziner, Jay

    2016-01-01

    Research has not examined changes in bone mineral density (BMD) between men and women following hip fracture. The aim was to evaluate sex differences in BMD following hip fracture. Men experienced significant declines in BMD, while not statistically greater than women, underscoring the necessity for better osteoporosis care in men. Each year in the USA, approximately 260,000 older adults experience a hip fracture. Women experiencing hip fracture have excess decline in BMD in the year following fracture compared to expected decrements due to aging, but few studies have assessed sex differences in the sequelae of hip fracture. Thus, our objective was to examine sex differences in BMD change in the year after hip fracture. The sample (n = 286) included persons enrolled in the Baltimore Hip Studies 7th cohort, a study that matched (1:1) men and women experiencing hip fracture. Weighted estimating equations that accounted for missing data and selective survival were used to estimate sex differences in 12-month total hip (TH) and femoral neck (FN) BMD changes. Men had larger average adjusted percent decline in TH and FN BMD. Adjusted 12-month decreases at the FN showed a statistically significant decline of -4.60% (95% confidence interval [CI] -7.76%, -0.20%) in men and an insignificant change of -1.62% (95% CI -4.57%, 1.32%) in women. Yet, the difference in change between men and women was not statistically significant (P = 0.17). The estimated sex differences for TH BMD loss were smaller in magnitude. There is evidence of significant BMD loss among men at the FN in the year after hip fracture. Although not statistically greater than women, these clinically significant findings highlight the need for improved osteoporosis care among men prior to and after hip fracture.

  12. Fibrosis markers, hip fracture risk, and bone density in older adults.

    Science.gov (United States)

    Barzilay, J I; Bůžková, P; Kizer, J R; Djoussé, L; Ix, J H; Fink, H A; Siscovick, D S; Cauley, J A; Mukamal, K J

    2016-02-01

    We examined whether blood levels of two markers of fibrosis (transforming growth factor beta one (TGF-β1) and procollagen type III N-terminal propeptide (PIIINP)) are related to hip fracture risk and to bone mineral density (BMD). TGF-β1 levels were associated with lower hip fracture risk in women and with lower BMD in men. PIIINP levels were not associated with either outcome. TGF-β1 serves several roles in bone formation and resorption. A consequence of TGF-β1 activation is the production of PIIINP, a marker of collagen III deposition. Here, we explore whether these two biomarkers are related to incident hip fracture and bone mineral density (BMD) and whether their associations are modified by systemic inflammation, as measured by C-reactive protein (CRP) levels. Participants were from the Cardiovascular Health Study (mean age 78 years; mean follow-up 8.3 years). We included 1681 persons with measured levels of TGF-β1 (149 hip fractures) and 3226 persons with measured levels of PIIINP (310 hip fractures). Among women, higher TGF-β1 levels were associated with lower hip fracture risk (HR, per doubling, 0.78 [95 % CI 0.61, 0.91]). Among men, TGF-β1 levels were associated with hip fracture risk in a non-linear manner, but among those with elevated CRP levels, doubling was associated with increased risk of fracture (HR 2.22 [1.20, 4.08]) (p = 0.02, interaction between low and high CRP and TGF-β1 on fracture risk). TGF-β1 levels had no significant association with total hip or total body BMD in women but were significantly associated with lower BMD in men. There were no associations of PIIINP levels with hip fracture risk or BMD in men or women. TGF-β1 levels appear to be associated with bone-related phenotypes in a sex-specific manner. The reasons for these differences between men and women regarding TGF-β1 levels and hip fracture risk and bone density require further investigation.

  13. Excess mortality in men compared with women following a hip fracture. National analysis of comedications, comorbidity and survival

    DEFF Research Database (Denmark)

    Kannegaard, Pia Nimann; van der Mark, Susanne; Eiken, Pia

    2010-01-01

    to the general population regardless of age. The aim of this study was to assess excess mortality following hip fracture and, if possible, identify reasons for the difference between mortality for the two genders. METHODS: this is a nationwide register-based cohort study presenting data from the National......INTRODUCTION: osteoporosis is a common disease, and the incidence of osteoporotic fractures is expected to rise with the growing elderly population. Immediately following, and probably several years after a hip fracture, patients, both men and women, have a higher risk of dying compared...... fracture patients than female hip fracture patients despite men being 4 years younger at the time of fracture. Both male and female hip fracture patients were found to have an excess mortality rate compared to the general population. The cumulative mortality at 12 months among hip fracture patients...

  14. Osteoporosis in Japan: factors contributing to the low incidence of hip fracture.

    Science.gov (United States)

    Fujita, T

    1994-01-01

    Hip fracture incidence seems to be lower in Japan than in many Western countries, but the difference is apparently becoming smaller with progressive Westernization of the Japanese lifestyle and nutritional habits. Nutrition cannot explain the lower incidence of hip fracture. A lower calcium intake prevails in Japan. Genetic differences in body build, including a lower center of gravity, better motor function and agility, well developed hip musculature and small but more fracture-resistant bones secondary to a difference in life- and work-style may contribute to fewer falls and a lower fracture rate among Japanese than among their Western counterparts. Such traditional lifestyle habits as sitting directly on the floor are rapidly decreasing, and time will tell how much of the low incidence of hip fracture in Japan can be explained by lifestyle and how much by genetic and other factors. The Japanese women who now enjoy a low hip fracture incidence led a hard physical life when they were young. This may be a lesson to the young of future generations in how to avoid bone fractures when they are old. Bone health may be achieved by enjoying life through sports or even the tea ceremony in place of the hard physical work of their ancestors, which is gradually disappearing.

  15. Risk factors for hip fracture. MEDOS study: results of the Toulouse Centre.

    Science.gov (United States)

    Ribot, C; Tremollieres, F; Pouilles, J M; Albarede, J L; Mansat, M; Utheza, G; Bonneu, M; Bonnissent, P; Ricoeur, C

    1993-01-01

    The development of preventive strategies for hip fractures requires better identification of risk factors. The MEDOS study was designed to study prospectively the incidence of hip fracture in 14 centres from six countries and characterise risk factors. At one centre (Toulouse), data were gathered from questionnaires completed by 386 cases of hip fracture aged over 50 years and 848 age- and sex-matched controls over a 12-month period. Of the 935 variables of the MEDOS questionnaire, 235, grouped into 56 items, were statistically analysed. Odds ratios (and 95% confidence intervals) were estimated for each variable from a multiple stepwise logistic regression model. The population comprised 19.2% men and 80.8% women, with a mean age of 80 +/- 8.8 years; 80% were living in an urban area and 76% with their family. Of the 17 significant variables, moderate excess weight and a high nutritional intake of calcium were associated with a decreased risk of hip fracture. Loss of autonomy, a higher height than normal (> 1SD), and a history of previous fractures significantly increased the risk of fracture. Interestingly, all these variables accounted for only 18% of the risk of hip fracture.

  16. The use of MRI and CT in Imaging Occult Hip Fractures

    Directory of Open Access Journals (Sweden)

    Obadă B.

    2014-11-01

    Full Text Available Diagnosis of hip fractures is particularly important due to the high dependence on the integrity of this structure for people to function in their daily lives. Left unrecognized, patients face increasing morbidity and mortality as time from the original injury lengthens. A delay of just 2 days in surgical treatment for an acute hip fracture doubles mortality. In addition, an unrecognized non-displaced fracture may displace, requiring surgery of much higher risk. This may be part of the reason that the most frequent lawsuit against Emergency Physicians is for missed orthopedic injury. We reviewed the use of MRI and CT for occult hip fractures (OHF detection at a major urban trauma unit. Our study is a retrospective review. Inclusion criteria: all patients presenting to the Emergency Clinical Hospital of Constanta with a suspected, posttraumatic, occult hip fracture, over a 5 years period were included. All patients had negative initial radiographs and underwent further imaging with either CT or MRI. A total of 185 cases meeting the inclusion criteria were identified. 72 occult hip fractures were detected with both imaging modalities. Although MRI certainly enables greater image detail, in our experience both modalities are able to provide satisfactory fracture characterization. The choice of imaging should be determined by availability and indication. MRI provides superior imaging of soft tissue but is less sensitive for degenerative changes in presence of bone edema.

  17. 髓内固定与钉板固定治疗股骨粗隆间骨折的疗效比较%A comparison study of intramedullary fixation and screw-plate fixation treatment on intertrochanteric fracture

    Institute of Scientific and Technical Information of China (English)

    孔祥安; 董力军; 金韡

    2014-01-01

    目的:对比观察两种方法(髓内固定系统和钉板固定系统)治疗股骨粗隆间骨折的临床疗效,为临床推广作出指导。方法选择53例股骨粗隆间骨折患者为研究对象,按手术方法分为髓内组和钉板组,髓内组采用髓内固定系统治疗,钉板组采用钉板固定系统治疗,比较两组患者术中、术后的各项指标以及治疗后的临床疗效。结果①两组患者术中、术后各项指标的比较:髓内组术中、术后各项指标均优于钉板组,其结果比较差异有统计学意义(P<0.05);②两组患者临床疗效的比较:髓内组的优良率为88.89%,钉板组的优良率为88.57%,其结果比较差异无统计学意义( P>0.05)。结论髓内固定系统和钉板固定系统治疗股骨粗隆间骨折的临床疗效均较好,但髓内固定系统具有切口小、出血少和恢复快等优势。%Objective To explore two different internal fixation methods ,intramedullary fixation system and screw -plate fixation system for the treatment of intertrochanteric fractures ,in order to direct the clinical application .Methods From Jan.2007 to May 2013,53 cases of intertrochanteric fractures were retrospectively studied ,and the patients were divided into two groups:the intramedullary fixation group and the screw-plate fixation group .Procedure related index and postoperative recover situation of the two groups were compared .Results ①Procedure related index in the intramedullary fixation group were better than those of the screw -plate fixation group with a statistically signifi-cant difference(P0.05).Conclusion Both of the two treatment methods for intertrochanteric fractures can get excellent clinical efficacy .However,the intramedullary fixation system has advantages in smaller surgical injury ,less blood loss and faster recovery ,which is worth clinical application .

  18. Nursing of Intertrochanteric Fracture with Osteoporosis by Proximal Femoral Locking Compression Plate%骨质疏松性股骨转子间骨折患者锁定加压钢板固定治疗的护理

    Institute of Scientific and Technical Information of China (English)

    王秀

    2011-01-01

    Objective To evaluate the nursing measures of intertrochanteric fracture and osteoporosis by proximal femoral locking compression plate.Methods Twenty-nine patients with the intertrochanteric fracture and osteoporosis by proximal femoral locking compression plate were reviewed for the psychological nursing, dietary nursing and effects of rehabilitation and training before and after treatment from February 2006 through October 2009.Results The postoperative follow ranged from 6 to 36 months(mean 18.31±6.43 months).The postoperative ambulation ranged from 3 to 15 days(mean 9.00±2.42 days).The time of fracturehealing ranged from 12-30 weeks(mean 14.85±2.21 weeks).Deep vein thrombosis of the lower extremity and minor coax vara occurred in one ant two patients respectively.The good and excellent rate of postoperative function was 93.10% according to Sander's standard.Conclusion Proximal femoral locking compression plate is effective for the intertrochanteric fracture with osteoporosis, which has the advantages of minimal invasiveness and little blood loss.It is especially suitable for elder patients.Positive psychological interventions, proper rehabilitation, routine follow up, and anti- osteoporosis treatment play essential roles in lessening bed time and improving the postoperative life quality.%目的 探讨骨质疏松性股骨转子间骨折患者股骨近端锁定加压钢板内固定手术前后的护理措施.方法 回顾性总结2006年2月至2009年10月29例采用股骨近端锁定加压钢板内固定手术治疗骨质疏松性股骨转子间骨折患者的心理护理、饮食护理、术前后康复训练及效果.结果 29例患者术后随访6~36个月,平均(18.31±6.43)个月.术后离床时间3~15 d,平均(9.00±2.42)d;骨折愈合时间12~30周,平均(14.85±2.21)周.出现下肢深静脉血栓1例,轻度髋内翻2例.按照Sander评分标准,优良率为93.10%.结论 股骨近端锁定加压钢板是治疗骨质疏松性股骨转子间

  19. 健康教育对老年股骨粗隆间骨折患者褥疮发生率的影响%Health education for elderly patients with intertrochanteric fractures the incidence of pressure ulcers

    Institute of Scientific and Technical Information of China (English)

    康瑞芳

    2013-01-01

    目的:探讨健康教育对老年股骨粗隆间骨折患者褥疮发生率的影响。方法:将我院88例老年股骨粗隆间骨折患者,按治疗的先后顺序将其随机分为对照组、观察组。对照组给予常规护理,观察组在常规护理的基础上加用系统健康教育,调查两组患者对其疾病相关知识的知晓情况,并将褥疮发生的情况进行统计比较。结果:观察组患者在宣教后其对疾病相关知识的知晓情况提高,与对照组比较,差异有统计学意义(P<0.05);观察患者褥疮发生率明显低于对照组,两者间比较,差异有统计学意义(P<0.01)。结论:对老年股骨粗隆间骨折患者实施系统健康教育能够提高患者预防褥疮依从性及重视程度,从而降低其褥疮发生率,提高患者生活质量。%Objective:Explore health education for elderly patients with intertrochanteric fractures the incidence of pressure ulcers. Method:Our hospital 88 cases of elderly patients with intertrochanteric fractures, according to the order of treatment were randomly divided into control group and observation group. Control group received routine care, observation group in the conventional care system based on the use of health education, the survey groups were aware of their disease-related knowledge of the situation and the situation of bedsores statistical comparisons. Results:The patients in the mission after their awareness of knowledge related to disease situation improved, compared with the control group, the difference was statistical y significant (P<0.05);observed in patients with pressure ulcers was significantly lower than the control group, between the two, the difference statistical y significant (P<0.01). Conclusion:Intertrochanteric fractures in elderly patients with the implementation of the system of health education can improve patient compliance and prevention of bedsores degree of at ention, thereby reducing their

  20. 健康教育对老年股骨粗隆间骨折患者褥疮发生率的影响%Health education for elderly patients with intertrochanteric fractures the incidence of pressure ulcers

    Institute of Scientific and Technical Information of China (English)

    康瑞芳

    2013-01-01

    Objective:Explore health education for elderly patients with intertrochanteric fractures the incidence of pressure ulcers. Method:Our hospital 88 cases of elderly patients with intertrochanteric fractures, according to the order of treatment were randomly divided into control group and observation group. Control group received routine care, observation group in the conventional care system based on the use of health education, the survey groups were aware of their disease-related knowledge of the situation and the situation of bedsores statistical comparisons. Results:The patients in the mission after their awareness of knowledge related to disease situation improved, compared with the control group, the difference was statistical y significant (P<0.05); observed in patients with pressure ulcers was significantly lower than the control group, between the two, the difference statistical y significant (P<0.01). Conclusion:Intertrochanteric fractures in elderly patients with the implementation of the system of health education can improve patient compliance and prevention of bedsores degree of at ention, thereby reducing their incidence of pressure ulcers, improve patient quality of life.%目的:探讨健康教育对老年股骨粗隆间骨折患者褥疮发生率的影响。方法:将我院88例老年股骨粗隆间骨折患者,按治疗的先后顺序将其随机分为对照组、观察组。对照组给予常规护理,观察组在常规护理的基础上加用系统健康教育,调查两组患者对其疾病相关知识的知晓情况,并将褥疮发生的情况进行统计比较。结果:观察组患者在宣教后其对疾病相关知识的知晓情况提高,与对照组比较,差异有统计学意义(P<0.05);观察患者褥疮发生率明显低于对照组,两者间比较,差异有统计学意义(P<0.01)。结论:对老年股骨粗隆间骨折患者实施系统健康教育能够提高患者预防褥疮依从性及重视程

  1. 鲑鱼降钙素促进老年转子间骨折愈合的疗效观察%Efficacy Observation of Salmon Calcitonin for Femoral Intertrochanteric Fractures Healing in Elderly Patients

    Institute of Scientific and Technical Information of China (English)

    谭美云; 郭杏; 税巍; 王远辉; 张忠杰

    2011-01-01

    目的:观察鲑鱼降钙素促进老年转子问骨折愈合的疗效.方法:将40例老年患者随机分为2组:治疗组20例,肌肉注射鲑鱼降钙素;对照组20例,在相同的部位肌肉注射等量注射用生理盐水.自术后第1天开始,2组均连续用药3个月.用药后的第1、3个月复查X线片,观察骨痂生长情况.治疗前和治疗后3个月检测患者腰椎(L4)骨密度(BMD)及血清钙、磷、碱性磷酸酶等浓度.结果:所有患者均得到随访.术后第1、3个月x线评估发现,治疗组比同时期对照组的骨痂生成量多.治疗后3个月,治疗组腰椎(L4)BMD明显高于对照组(P0.05),治疗组碱性磷酸酶明显高于对照组(P<0.05).治疗组1例出现恶心、呕吐等胃肠道症状,2例出现面颈部潮红.结论:鲑鱼降钙素能显著促进老年转子间骨折的愈合.%OBJECTIVE: To observe the therapeutic efficacy of salmon calcitonin for femoral intertrochanteric fractures healing in elderly patients. METHODS: A total of 40 elderly patients with femoral intertrochanteric fractures were randomly divided into 2 groups. 20 cases in treatment group received intramuscular injection of salmon calcitonin and 20 cases in control group received equal dose of normal saline at the same site. Both groups were given medicine after operation for 3 months. The X-ray plate of 2 groups was examined at 1 and 3 months after treatment to investigate the condition of bony callus. The BMD of the lumbar spine at LA, the concentration of serum calcium, serum phosphorus and alkaline phosphate were measured before treament and 3 months after treatment. RESULTS: All patients were followed up. The X-ray plate showed that the bony callus in treatment group was more abundant than in control group at 1 and 3 months after treatment. 3 months after treatment, the BMD of the lumbar spine at L4 in treatment group was significantly higher than in control group (P<0.05). The concentration of serum calcium in treatment group was

  2. Fall scenarios In causing older women's hip fractures.

    Science.gov (United States)

    Hägvide, Mona-Lisa; Larsson, Tore J; Borell, Lena

    2013-01-01

    Falls and fall-related injuries among older women constitute a major public health problem with huge costs for the society and personal suffering. The aim of this study was to describe and illustrate how a number of circumstances, conceptualized as a scenario, that were related to the individual, the environment, and the ongoing occupation contributed to a fall that led to a hip fracture among women. The sample included 48 women over 55 years old. Interviews were conducted during home visits and the analysis provided a descriptive picture of circumstances in the shape of a scenario related to the risk of falling. A number of scenarios were developed based on the data and named to provide an understanding of the interplay between the individual, the environment, and the ongoing occupation at the time of the fall. By applying the concept of a scenario, occupational therapists can increase the awareness of fall risks among older people, and are relevant also for interior designers, architects, and town planners to consider when designing the local environment as well as furniture and other objects.

  3. Inter-Rater Reliability and Agreement of the 6-Minute Walk Test in Women With Hip Fracture

    DEFF Research Database (Denmark)

    Larsen, Camilla Marie; Overgaard, Jan; Tange Kristensen, Morten

    MWT in individuals with hip fractures. Methods: Two senior physiotherapy students independently examined (randomized order) a convenient sample of 20 participants; their assessments were separated by two days, and testing followed instructions from the American Thoracic Society(1). Hip pain...

  4. Hip fractures and pain following proton therapy for management of prostate cancer

    Energy Technology Data Exchange (ETDEWEB)

    Valery, Raul; Mendenhall, Nancy P.; Nichols, Romaine C. Jr.; Henderson, Randal; Morris, Christopher G.; Su, Zhong; Li, Zuofeng; Hoppe, Bradford S. [Univ. of Florida Proton Therapy Inst., Univ. of Florida Coll. of Medicine, Jacksonville (United States)], e-mail: bhoppe@floridaproton.org; Mendenhall, William M. [Dept. of Radiation Oncology, Coll. of Medicine, Univ. of Florida, Gainesville (United States); Williams, Christopher R. [Dept. of Surgery, Univ. of Florida Coll. of Medicine, Jacksonville (United States)

    2013-04-15

    Background: Proton therapy (PT) for prostate cancer reduces rectal and bladder dose, but increases dose to the femoral necks. We assessed the risk of hip fracture and pain in men treated with PT for prostate cancer. Material and methods: From 2006 to 2008, 382 men were treated for prostate cancer and evaluated at six-month intervals after PT for toxicities at Univ. of Florida Proton Therapy Institute (UFPTI). The WHO Fracture Risk Assessment Tool (FRAX) generated annual hip-fracture risk for the cohort. The WHO FRAX tool was utilized to generate the expected number of patients with hip fractures and the observed-to-expected ratio; confidence intervals and p-value were generated with the mid-P exact test. Univariate analysis of hip pain as a function of several prognostic factors was accomplished with Fisher's exact test. Results. Median follow-up was four years (range, 0.1-5.5 years). Per FRAX, 3.02 patients were expected to develop a hip fracture without PT. Three PT patients actually developed fractures for a rate of 0.21 fractures per 100 person-years of follow-up. There was an observed-expected ratio of 0.99 (p-value not significant). Forty-eight patients (13%) reported new pain in the hip during follow-up; three required prescription analgesics. Conclusion. PT for prostate cancer did not increase hip-fractures in the first four years after PT compared to expected rates in untreated men.

  5. Occupational physical demand and risk of hip fracture in older women.

    Science.gov (United States)

    Palumbo, Aimee J; Michael, Yvonne L; Burstyn, Igor; Lee, Brian K; Wallace, Robert

    2015-08-01

    Hip fractures are leading causes of disability, morbidity and mortality among older women. Since physical activity helps maintain physical functioning and bone mineral density, occupational physical demand may influence fracture risk. This study investigates the association of occupational physical demand with hip fracture incidence among women. The Women's Health Initiative Observational Study is a multiethnic cohort of 93,676 postmenopausal women, 50-79 years of age at enrolment, enrolled from 1994 to 1998 at 40 geographically diverse clinical centres throughout the USA. Outcomes including hip fractures were assessed annually and up to 3 jobs held since age 18 years were reported by each woman. Occupational physical demand levels were assigned for each job through linkage of occupational titles with Standard Occupational Codes and the Occupational Information Network. Average, cumulative and peak physical demand scores both before and after menopause and throughout women's work life were estimated. Women were followed through 2010 for an average of 11.5 years; 1834 hip fractures occurred during this time. We did not observe an overall association of occupational physical demand with subsequent risk of hip fracture after adjusting for age, race/ethnicity, birth region and education. Previous research on occupations and hip fracture risk in women is inconclusive. This study was able to take critical risk periods into account and control for confounding factors in a large cohort of older women to show that overall occupational physical demand neither increases nor decreases risk of hip fracture later in life. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  6. Postoperative pain after hip fracture is procedure specific

    DEFF Research Database (Denmark)

    Foss, Nicolai; Palm, H; Kehlet, H

    2009-01-01

    . Patients were stratified into four groups according to surgical procedure: screws or pins, arthroplasty, dynamic hip screw (DHS), and intra-medullary hip screw (IMHS). RESULTS: Cumulated pain levels were significantly different between surgical procedures both for hip flexion (P=0.002) and for walking (P=0...

  7. High hip fracture risk in men with severe aortic calcification: MrOS study.

    Science.gov (United States)

    Szulc, Pawel; Blackwell, Terri; Schousboe, John T; Bauer, Douglas C; Cawthon, Peggy; Lane, Nancy E; Cummings, Steven R; Orwoll, Eric S; Black, Dennis M; Ensrud, Kristine E

    2014-04-01

    A significant link between cardiovascular disease and osteoporosis is established in postmenopausal women, but data for men are scarce. We tested the hypothesis that greater severity of abdominal aortic calcification (AAC) was associated with an increased risk of nonspine fracture in 5994 men aged ≥ 65 years. AAC was assessed on 5400 baseline lateral thoracolumbar radiographs using a validated visual semiquantitative score. Total hip bone mineral density (BMD) was measured using dual-energy X-ray absorptiometry. Incident nonspine fractures were centrally adjudicated. After adjustment for age, body mass index (BMI), total hip BMD, fall history, prior fracture, smoking status, comorbidities, race, and clinical center, the risk of nonspine fracture (n=805) was increased among men with higher AAC (hazard ratio [HR] quartile 4 [Q4] [AAC score ≥ 9] versus quartile 1 [Q1] [0-1], 1.36; 96% confidence interval [CI], 1.10-1.68). This association was due to an increased risk of hip fracture (n=178) among men with higher AAC (HR Q4 versus Q1, 2.33; 95% CI, 1.41-3.87). By contrast, the association between AAC and the risk of nonspine, nonhip fracture was weaker and not significant (HR Q4 versus Q1, 1.22; 95% CI, 0.96-1.55). The findings regarding higher AAC and increased risk of fracture were not altered in additional analyses accounting for degree of trauma, estimated glomerular filtration rate, presence of lumbar vertebral fractures (which may bias AAC assessment), preexisting cardiovascular disease, ankle brachial index, or competing risk of death. Thus, in this large cohort of elderly men, greater AAC was independently associated with an increased risk of hip fracture, but not with other nonspine fractures. These findings suggest that AAC assessment may be a useful method for identification of older men at high risk of hip fracture.

  8. Effect of Implementing a Discharge Plan on Functional Abilities of Geriatric Patients with Hip Fractures

    Science.gov (United States)

    AL Khayya, Hatem; El Geneidy, Moshera; Ibrahim, Hanaa; Kassem, Mohamed

    2016-01-01

    Hip fracture is considered one of the most fatal fractures for elderly people, resulting in increased morbidity and mortality and impaired functional capacity, particularly for basic and instrumental activities of daily living. The aim of this study was to determine the effect of implementing a discharge plan on functional abilities of geriatric…

  9. Clostridium perfringens infection complicating periprosthetic fracture fixation about the hip: successful treatment with early aggressive debridement.

    LENUS (Irish Health Repository)

    Baker, Joseph F

    2012-07-13

    Periprosthetic fracture and infection are both challenges following hip arthroplasty. We report the case of an 87 year old female who underwent open reduction and internal fixation of a periprosthetic femoral fracture. Her post-operative course was complicated by infection with Clostridium perfringens. Early aggressive antibiotic treatment and surgical debridement were successful, and allowed retention of the original components.

  10. Association between timing of zoledronic acid infusion and hip fracture healing

    DEFF Research Database (Denmark)

    Colón-Emeric, C; Nordsletten, L; Olson, S

    2011-01-01

    Patients in the Health Outcomes and Reduced Incidence with Zoledronic Acid Once Yearly (HORIZON) Recurrent Fracture Trial were assessed for evidence of delayed hip fracture healing. No association was observed between zoledronic acid (ZOL) and delayed healing. We conclude that ZOL has no clinical...

  11. Implementing, Adapting, and Validating an Evidence-Based Algorithm for Hip Fracture Surgery

    DEFF Research Database (Denmark)

    Ban, I.; Palm, H.; Birkelund, Lasse;

    2014-01-01

    Reoperations are common after surgical treatment of hip fractures but may be reduced by optimal choice of implant based on fracture classification. We hypothesized that implementing a surgical treatment algorithm was possible in our hospital and would result in a reduced reoperation rate....

  12. Imaging of ceramic liner fractures in total hip arthroplasty: the value of CT

    Energy Technology Data Exchange (ETDEWEB)

    Endo, Yoshimi; Mintz, Douglas N. [Hospital for Special Surgery, Department of Radiology and Imaging, New York, NY (United States); Renner, Lisa; Schmidt-Braekling, Tom; Boettner, Friedrich [Hospital for Special Surgery, Adult Reconstruction and Joint Replacement Division, New York, NY (United States)

    2015-08-15

    Fracture of a ceramic liner of a total hip arthroplasty is rare and is radiographically occult if not displaced. We report on two patients in whom ceramic liner fracture was radiographically occult but was diagnosed on subsequent CT scan through appropriate windowing. (orig.)

  13. The epidemic of Hip fractures: Are we on the right track?

    NARCIS (Netherlands)

    K.A. Hartholt (Klaas); C. Oudshoorn (Christian); S.M. Zielinski (Stephanie); P.T.P.W. Burgers (Paul); M.J.M. Panneman (Martien); E.F. van Beeck (Ed); P. Patka (Peter); T.J.M. van der Cammen (Tischa)

    2011-01-01

    textabstractBackground: Hip fractures are a public health problem, leading to hospitalization, long-term rehabilitation, reduced quality of life, large healthcare expenses, and a high 1-year mortality. Especially older adults are at greater risk of fractures than the general population, due to the

  14. On prevention of second hip fracture surgery : epidemiological and biomechanical aspects of elastomer femoroplasty

    NARCIS (Netherlands)

    Steenhoven, Timothy Jason van der

    2014-01-01

    Demographic changes will result in a tidal wave of hip fractures in the growing group of frail octo- and nonagenarian citizens. These osteoporotic fractures are a major burden to the patients’ quality of life. Despite all preventive measures, predominantly focusing on osteoporosis medication, the

  15. Incidence of hip fracture in Barranquilla, Colombia, and the development of a Colombian FRAX model.

    Science.gov (United States)

    Jaller-Raad, J J; Jaller-Char, J J; Lechuga-Ortiz, J A; Navarro-Lechuga, E; Johansson, H; Kanis, J A

    2013-07-01

    A FRAX model for Colombia was released June 30, 2010. This article describes the data used to develop the Colombian FRAX model and illustrates its features compared to other countries. Hip fracture cases aged 50 years or more who were referred to all hospitals serving the city of Barranquilla were identified prospectively over a 3-year period (2004-2006). Age- and sex-stratified hip fracture incidence rates were computed using the 2005 census. Present and future numbers of hip fracture cases in Colombia were calculated from the age- and sex-specific incidence and the national population demography. Mortality rates for 1999 were extracted from nationwide databases and used to estimate hip fracture probabilities. For other major fractures (clinical vertebral, forearm, and humerus), incidence rates were imputed, using Swedish ratios for hip to other major osteoporotic fracture, and used to construct the FRAX model. Incidence of hip fracture increased with age, more markedly in women than in men. Over all ages, the female to male ratio was 1.7. By extrapolation, there were estimated to be 7,902 new hip fracture cases (2,673 men, 5,229 women) in Colombia in 2010, which was predicted to increase to 22,720 cases (7,568 men, 15,152 women) in 2035. The 10-year probability of hip or major fracture was increased in patients with a clinical risk factor, lower BMI, female gender, a higher age, and a decreased BMD T score. The remaining lifetime probability of hip fracture at the age of 50 years was 2.5 and 4.7 % in men and women, respectively, which were lower than rates in a Mexican population (3.8 and 8.5 %, respectively) and comparable with estimates for Venezuela (2.4 and 7.5 %, respectively). The FRAX tool is the first country-specific fracture-prediction model available in Colombia. It is based on the original FRAX methodology, which has been externally validated in several independent cohorts. Despite some limitations, the strengths make the Colombian FRAX tool a good

  16. Older Male Physicians Have Lower Risk of Trochanteric but Not Cervical Hip Fractures

    Directory of Open Access Journals (Sweden)

    Hsiu-Nien Shen

    2015-02-01

    Full Text Available Background: Osteoporosis is pathophysiologically related to trochanteric fractures, and this condition is more preventable by lifestyle modifications than cervical fractures. We investigated whether older physicians, who are health-conscious people, are at a lower risk of hip fractures because of fewer trochanteric fractures. Methods: Data regarding older (≥65 years physicians (n = 4303 and matched non-medical persons (control were retrieved from Taiwan’s National Health Insurance claims. All of the subjects were obtained from NHIRD with index dates from 1 January 2000 to 31 December 2008. Cox proportional hazard and competing risk regression models were established to estimate the hazard ratio (HR of hip fracture associated with older physicians. Results: The incidence rates of trochanteric fractures were lower in older physicians than in controls (1.73 and 3.07 per 1000 person-years, respectively, whereas the rates of cervical fractures were similar between the two groups (2.45 and 2.12 per 1000 person-years, respectively. Older physicians yielded 46% lower hazard of trochanteric fractures than controls (adjusted HR 0.54, 95% confidence interval 0.37–0.79; by contrast, hazards of cervical fractures were comparable between the two groups. The HRs estimated from the competing risk models remained unchanged. Conclusions: Our findings indicated that health risk awareness may pose a significant preventive effect on trochanteric hip fractures.

  17. Effects of proximal femoral nail combining anti-osteoporotic drugs on elderly patients of unstable femoral intertrochanteric fractures%股骨近端带锁髓内钉联合抗骨质疏松药物治疗高龄不稳定型股骨粗隆间骨折的疗效观察

    Institute of Scientific and Technical Information of China (English)

    李煜明; 孙强; 王黎明; 蒋纯志; 徐杰

    2014-01-01

    bone mineral density ( by DEXA) was 0.46~0.82 g/cm2 ,and the average value was 0.64 ±0.16 g/cm2 , which was diagnosed as severe osteoporosis .The severe damaged bone was filled with Wright artificial implants .Early rehabilitation training of hip , CPM-assisted therapy , and the standard anti -osteoporosis treatment which included the sequential medication of salmon calcitonin and zoledronic acid , together with calcium and Vitamin D , were recommended postoperatively .Results The patients were successfully operated without postoperative complications such as wound infection ect ..62 cases were graded as excellent , 22 cases as good , six cases as fair and two cases as poor according to the hip-functional scoring method of Parker .The overall satisfaction rate was 91.3%.All the patients had been followed up for more than 12 months.The fracture healing had been demonstrated by X -rays 12 to 18 weeks (average 14.5w) after the operation.Slightly backward releasing of the rotary screws had been observed in three patients .Conclusion Because of the reliable fixation , minimal invasion and being conducive to healing , PFN with anti-osteoporosis therapy has been proved as a safe and effective method for treatment of the unstable femoral intertrochanteric fractures in the elderly patients with osteoporosis .

  18. Dynamic finite element analysis of unstable intertrochanteric fractures fixed with PFNA-Ⅱ%PFNA-Ⅱ治疗不稳定型股骨转子间骨折的动态有限元研究

    Institute of Scientific and Technical Information of China (English)

    姜自伟; 虎群盛; 黄枫; 郑晓辉; 赵京涛; 周琦石

    2016-01-01

    目的:采用有限元方法动态分析亚洲型股骨近端防旋髓内钉(PFNA-Ⅱ)治疗不稳定型股骨转子间骨折后不同阶段的生物力学性能,为临床上合理使用 PFNA-Ⅱ提供理论依据。方法建立 PFNA-Ⅱ固定 Evans-JensenⅣ型股骨转子间骨折模型,通过调整骨折端的接触关系和去除 PFNA-Ⅱ模拟骨折愈合和取出内固定后的情况,利用有限元计算各模型的应力峰值和生物力学稳定性,并与正常股骨模型进行比较。结果 PFNA-Ⅱ固定 Evans-Jensen Ⅳ型股骨转子间骨折后的应力集中位于螺旋刀片与主钉的交界部位,骨折愈合后内固定应力峰值上升。取出内固定后股骨颈区域的应力明显上升,骨骼稳定性下降。结论在股骨转子间骨折愈合后为避免内固定断裂应去除 PFNA-Ⅱ,但需要注意防范股骨颈骨折的风险。%Objective To explore the dynamic biomechanical properties of unstable intertrochanteric fracture fixed with proximal femoral nail antirotation Ⅱ(PFNA-Ⅱ)through finite element analysis,and therefore to provide theoretical foundation for clinic application.Methods Finite element model of Evans IV intertrochanteric fracture fixed by PFNA-Ⅱwas developed.We simulated the conditions of fracture union and internal fixation removal by adjusting the contact relation-ship of fractures and taking out of PFNA-Ⅱ.Stress peak and biomechanical stability of models were compared with normal femur model through finite element analysis.Results The highest stress concentration area of fixation models was located in the caudal passage of the blade through the nail.After fracture union,the stress of internal fixation increased.After in-ternal fixation was removed,the stress of femoral neck increased significantly and the stability decreased.Conclusions In order to avoid internal fixation rupture after fracture union,PFNA-Ⅱ should be removed,meanwhile the risk of femoral neck fracture requires

  19. Potential Impact of Benzodiazepine Use on the Rate of Hip Fractures in Five Large European Countries and the United States

    OpenAIRE

    2012-01-01

    Benzodiazepine use increases the risk of falls and has been associated with an increased risk of hip fractures. Our aim was to estimate the possible population impact of the use of benzodiazepines on the rate of hip fracture in France, Germany, Italy, Spain, the United Kingdom, and the United States. We conducted a literature review to estimate the pooled relative risk (RR) for hip fractures and use of benzodiazepines. Prevalence rates of benzodiazepine use in 2009 were calculated for each co...