Fracture Care Research Articles

Survivorship and Outcomes of Hip Arthroplasty for Elective Care Versus Fracture in Patients Who Have Solid Organ Transplant: Lung Transplant Patients Do Worse.

With continued improvement in patient outcomes following solid organ transplant (SOT), more SOT recipients may benefit from hip arthroplasty. This study sought to compare the perioperative complications and survivorship of SOT recipients undergoing hip arthroplasty for elective care versus for fracture. A single-institution retrospective review yielded 95 hip arthroplasty procedures (80 patients) performed between August 2016 and May 2023 with a mean follow-up of 35 months. The most common SOT was liver (47%), followed by kidney (31%) and lung (23%). Cases with an elective indication (69 hips) were compared to those with traumatic indications (26 hips). Perioperative complications and patient survivorship were compared between groups and by transplant type. Patient mortality at one year was 19.2% for the fracture group compared to 1.4% for the elective group (P = 0.006). For elective care, lung transplant recipients had a higher incidence of postoperative mortality at final follow-up (27%) when compared to the liver (7%) and renal (0%) (P = 0.044). Hospital length of stay was less in the elective group (2.7 ± 3.1 versus 16.3 ± 21.2 days, P = 0.002), and more elective patients were discharged to home (85 versus 42%, P < 0.001), but there was no difference in the rate of 90-day hospital readmission (P = 0.91) or orthopaedic complication (13 versus 12%, P = 1.0). For fracture care, a preoperative surgical delay greater than 48 hours was more frequently observed for lung compared to liver transplant recipients (83 versus 13%, P = 0.010). Recipients of SOT undergoing hip arthroplasty for fracture experience longer hospitalizations and increased 1-year mortality compared to elective cases with a similar rate of orthopaedic complications and hospital readmissions. When evaluating by SOT type, lung transplant patients may have increased surgical delays for fracture care and postoperative mortality for elective care.

Patients Residing in Areas of Increased Social Vulnerability Are at an Increased Risk for Prolonged Length of Stay and Mortality After Hip Fracture Surgery

Introduction: Patients undergoing hip fracture surgery face notable risks of postoperative morbidity and mortality, and racial and socioeconomic disparities in outcomes exist. This study examined the effect of social vulnerability on outcomes after hip fracture surgery using the CDC's Social Vulnerability Index (SVI). Methods: A retrospective study of 464 patients undergoing hip fracture surgery at a single institution from July 2020 to June 2023 was conducted. Demographics, comorbidities, time to surgery, length of stay (LOS), and postoperative outcomes were compared between patients with low versus high social vulnerability. SVI was calculated based on patient's zip code of residence. The 50th percentile of national SVI scores was used to divide patients into low and high vulnerability groups. Univariate and multivariable analyses were done to compare patient characteristics and outcomes between the groups. The primary outcome of interest was 1-year postoperative mortality. Results: No notable differences were observed in demographics, comorbidities, or procedure performed between the groups. Patients with increased social vulnerability had a higher rate of mortality within 1 year (low vulnerability: 12.2 vs. high vulnerability: 24.0%, P = 0.005) and a shorter time to mortality (340.7 vs. 138.9 days, P &lt; 0.001). Patients with higher social vulnerability had longer LOS (β = 1.12, 95% CI: 0.35-1.88, P = 0.004), were 2.37 times more likely to experience mortality within 1 year (OR = 2.37, 95% CI: 1.30-4.27, P = 0.004), and 1.75 times more likely to experience mortality at any time (OR = 1.75, 95% CI: 1.01-2.99, P = 0.045). Conclusion: Patients residing in areas of increased social vulnerability were more likely to experience a longer LOS, and more likely to die within 1 year, or at any time after undergoing hip fracture surgery, when compared with those living less socially vulnerable regions. These findings highlight the need for interventions aimed at addressing social factors within hip fracture care pathways to mitigate socioeconomic disparities in patient outcomes.

Criteria to clear polytrauma patients with traumatic brain injury for safe definitive surgery (

Optimizing treatment strategies in polytrauma patients is a key focus in trauma research and timing of major fracture care remains one of the most actively discussed topics. Besides physiologic factors, associated injuries, and injury patterns also require consideration. For instance, the exact impact and relevance of traumatic brain injury on the timing of fracture care have not yet been fully investigated. In this retrospectively cohort study at a level one trauma center, patients requiring trauma team activations from 2015 to 2020 were screened. Patients with an injury severity score >16 and at least one body region requiring operative fixation were included. Patients who underwent their first definitive surgery <24 h were stratified as group SDS (Safe Definitive Surgery) and >24 h as group DFC (Delayed Fracture Care). Outcomes were early mortality (<72 h), SIRS and sepsis, timing to first definitive surgery and completed reconstruction, total number of surgeries, and factors influencing the surgical strategy (e.g., unstable physiology). Odds ratios for treatment strategies and influencing factors were calculated using the Fisher`s exact test with conditional maximum likelihood estimate. From a total of 901 patients screened, 239 were included in the analyzes (Group DFC: 151, Groups SDS: 88). Groups did not significantly differ regarding early mortality, SIRS and sepsis. Group SDS had a significantly lower mean number of operations (4.3 vs. 5.3; p = 0.037) and a significantly shorter mean time until completion of reconstructive operations (10 days vs. 15 days; p = 0.013). Unstable physiology and intracranial trauma sequelae with the necessity for neurosurgical interventions (NSI) were identified as most significant factors for delaying definitive fracture care (OR: 2.85; 95 % CIs: 1.56 to 5.33 and OR: 5.59; 95 % CIs: 1.63 to 29.85), while the presence of intracranial bleeding (IB) without NSI did not have a significant influence (OR: 1.21; 95 % CIs: 0.63 to 2.34). The necessity of NSI and unstable physiology are highly relevant factors for delaying definitive fracture care in polytrauma patients, while the presence of IB without NSI had less impact. In this cohort, early definitive fracture care in physiologically stable patients without NSI, was not associated with increased patient morbidity.

Comparing total medical costs of surgical treatment versus nonoperative care for femoral neck fractures among Alzheimer's disease patients: A retrospective cohort study

Comparing total medical costs of surgical treatment versus nonoperative care for femoral neck fractures among Alzheimer's disease patients: A retrospective cohort study

Scottish Open Fractures of Tibia (SOFT) audit; a multi-centre retrospective review of ortho-plastic management of tibial shaft fractures at major trauma centres (MTCs) in Scotland.

Open fractures of the tibia are associated with significant complications, for which attempts have been made to standardise and optimise their management. In the UK, this standard is the British Orthopaedic Association Standards for Trauma (BOAST) guidelines. The Scottish Open Fracture of Tibia (SOFT) Audit is a national review of open tibial shaft fractures across all four Scottish Trauma Networks, which aims to provide a definite review of ortho-plastic care for open tibial shaft fractures in Scotland. A retrospective audit of all adult patients who sustained open tibial shaft fractures in Scotland from June 2021 to June 2023 was performed. The primary outcome measure was compliance with BOAST guidelines. Secondary outcome measures included infection, return to theatre, soft-tissue failure, and amputation. 196 open tibial shaft fractures were identified. Common complications included infection (24%), return to theatre (17%), soft-tissue failure (9.7%) and amputation (7.1%). Complete compliance with BOAST guidelines was documented in 8.8% of cases. Significant variation was seen between geographical regions of Scotland. No significance was seen between compliance to BOAST guidelines and any of the secondary outcome measures. Multivariate analysis identified Grade 3 Gustilo-Anderson injuries as significantly associated with post-operative infection, post-operative infection significantly associated with return to theatre, and return to theatre significantly associated with soft-tissue failure and/or amputation. This study demonstrates in Scotland there is scope for improvement in cohesion with national guidance including timing of antibiotic delivery, combined ortho-plastics approach, and soft-tissue cover within 72h of definitive fixation.

Management of a Right Tibial Proximal Third Open Comminuted Fracture: Surgical Disarticulation of Right Stifle Joint in a 1-Year-Old Hen Pigeon (Columba livia domestica)

Traumatic pelvic limb fractures in pet birds are rare and primarily result from trauma. Avian bones are fragile and prone to fragmentation due to various natural and anthropogenic events. This case report describes the diagnosis, anesthesia protocol, surgical management, post-operative care, and remarkable outcome of a right tibial comminuted fracture in a one-year-old hen pigeon (Columba livia domestica). A one-year-old hen pigeon was presented to the Veterinary Teaching Hospital, University of Jos, Nigeria, with a broken right pelvic limb after being attacked by a young lad. The attack occurred 30 minutes prior to presentation. Clinical examination revealed extensive tissue damage including an open wound with a complete fracture and bone fragment at the proximal third of the right tibia, accompanied by hemorrhages, tenderness, pale ocular mucous membranes, and lethargy. The impact of the attack was the primary cause of the comminuted fracture. Due to logistical constraints and the patient's critical condition, pre-operative radiographic imaging was not feasible. A definitive diagnosis of right tibial proximal third open comminuted fracture was readily made based on the gross tissue damage. Following standard aseptic protocol, stifle disarticulation was performed under local anesthesia to alleviate the bird's excruciating pain. Local anesthesia was achieved with 10mg lidocaine hydrochloride via local infiltration at the stifle. Due to the bird's critical condition, local anesthesia was preferred over general anesthesia. A 5mm stab skin incision was made distal to the right stifle, followed by blunt dissection of the musculature and disarticulation at the tibiofemoral joint. 5mm musculature distal to the stifle was transected and the skin was routinely sutured with size 3/0 silk suture. Post-operative care included injectable amoxicillin, piroxicam, and iron dextran administration, along with alternative-day wound dressing. Skin sutures were removed eight days post-surgery. The pigeon made a remarkable recovery, regaining balance and flying comfortably. Post-recovery imaging was not feasible as all arrangements made with the client following the bird's recovery ultimately fell through. To our knowledge, this case represents the first reported instance of a comminuted tibial fracture in a pigeon managed with stifle disarticulation. The successful outcome of this case proves stifle disarticulation to be an effective treatment option for complex fractures in birds, underscoring the importance of innovative strategies, prompt surgical intervention and addressing a significant gap in the literature. At the time of this report, the pet bird is currently nesting and brooding its eggs. Keywords: Hen pigeon, Comminuted tibial fracture, Proximal third, Stifle disarticulation.

Difficulty in financing fracture care in south-western Nigeria: a prospective cohort study of predictors and recommendations for improvement

BackgroundBone fractures remain a significant global public health issue despite preventive measures, leading to substantial health and economic consequences. Effective treatment options are difficult to access in most sub-Saharan African countries, leading to reliance on unqualified practitioners and resulting in serious complications that worsen poverty. In Nigeria, the main challenge is the need for out-of-pocket payment for healthcare, which is the primary method of health financing. However, anecdotal evidence suggests that some patients find it easier to finance their fracture care than others. This study aimed to identify the factors that predict difficult fracture-care financing among patients treated operatively for long-bone fractures (LBFs) in southwestern Nigeria.MethodsThe study collected socio-demographic and clinical data on 690 consecutive adult patients with LBFs treated with SIGN nails between July 2014 and June 2024 at a mission teaching hospital in southwestern Nigeria. A literature review and preliminary interviews were conducted with patients, caregivers, and hospital staff to understand potential risk factors for difficult fracture-care financing. The patients were divided into two cohorts – easy fracture-care financing (EF) and difficult fracture-care financing (DF) – based on their promptness in paying the in-patient care bills. Potential risk factors for DF identified in the initial univariate analysis were entered as covariates into a binary logistic regression to determine the significant predictors of DF.ResultsThe mean age of the patients was 45.1 years (SD = 17.52). The DF cohort comprised 321 (46.5%) patients. Significant predictors of DF included younger age (p = 0.018), male gender (p = 0.002), lack of formal education or low level of education (p < 0.001), residence in the hospital city (p < 0.001), absence of health insurance (p = 0.013), lack of extended family support (p < 0.001), previous traditional bone setting treatment (p = 0.005), concomitant injury (p = 0.017), and a post-operative hospital stay longer than one week (p = 0.036).ConclusionsThe findings suggest that improving people’s socioeconomic status through job creation, women’s empowerment, reduction of gender inequality, higher education, comprehensive health insurance coverage, and stronger family bonds, as well as preventive strategies to reduce the occurrence and severity of injuries, can improve fracture-care financing in low-resource settings.

Do Patient-Answered Versus Caregiver-Answered Patient-Reported Outcomes Differ in Pediatric Upper Extremity Fracture Care?

Patient-reported outcomes in children can be assessed using self-report or caregiver proxy-report; however, self-reported and proxy-reported outcomes often vary between respondents, a phenomenon called cross-informant variance. This phenomenon has not been studied in pediatric fracture care. This study compares self-reported and proxy-reported patient-reported outcomes in children being treated for upper extremity fractures. Children aged 8 to 17 with upper extremity fractures completed pediatric self-report questionnaires and their caregivers completed parent proxy-report questionnaires composed of items from three Patient-Reported Outcomes Measurement Information System (PROMIS) domains (Physical Function-Upper Extremity, Psychological Stress Experiences, and Pain-Interference). Mean patient and caregiver T-scores for each domain were compared using paired T-tests. Correlation between scores was assessed using scatterplots and Pearson correlation coefficient. Agreement between child and caregiver T-scores was assessed using Bland-Altman plots. One hundred child-caregiver dyads were included. Patients' mean age was 12.3 years, and 68% were male. Statistically significant differences were found between mean patient and caregiver T-scores in all PROMIS domains. Caregivers overestimated patient pain and psychological stress and underestimated upper extremity function. However, only the disagreement in the Pain-Interference domain met the threshold of clinical significance, a difference of three or more T-score points. Bland-Altman analysis revealed proportional bias in the Psychological Stress Experiences and Pain-Interference domains. With higher T-scores, caregivers tended to overestimate psychological stress to a greater extent but tended toward agreement with their children for pain. This study identified cross-informant variance between children and caretakers in the setting of pediatric upper extremity fractures. Although notable differences were observed in all PROMIS domains included, only one met the level of clinical significance, suggesting that not all domains are equally susceptible to child-caretaker disagreement. As patient-reported outcomes become more used in pediatric settings, the possibility of cross-informant variance must be considered when choosing to use self-report or proxy-report instruments. Level III.

Trends in management of odontoid fractures 2010–2021

Background ContextOdontoid fractures are relatively common. However, the literature is unclear how these fractures are best managed in many scenarios. As such, care is varied and poorly characterized. PurposeTo investigate the trends and predictive factors of surgical versus nonsurgical treatment and anterior versus posterior stabilization of odontoid fractures. Study Design/SettingRetrospective database cohort study. Patient SampleAdult patients with odontoid fractures between 2010 and 2021. Outcome MeasuresYearly trends and predictors of odontoid fracture management. MethodsAdult patients with odontoid fractures were abstracted from the large, national, administrative M161Ortho Pearldiver dataset. For operative versus nonoperative care of odontoid fractures, yearly rates were determined (since 2016 based on coding limitations). For anterior versus posterior stabilization, yearly rates were determined (2010-2021). Univariate and multivariable analyses were performed for both sets of comparisons. ResultsFor assessment of nonsurgical versus surgical management from 2016 to 2021, a total of 42,754 patients with odontoid fracture were identified, of which surgical intervention was done for 7.9%. Predictive factors of surgical intervention included being managed by a neurosurgeon (OR:1.29), being from Midwest United States (OR:1.35 relative to West), male sex (OR:1.20), and decreasing age (OR: 0.82 per decade) (p<0.001 for each). Of those undergoing surgical intervention, 33.6% had anterior surgery while 66.4% had posterior surgery (anterior surgery decreased from 36.4% in 2010 to 27.2% in 2021, p<0.001). Predictive factors of undergoing anterior versus posterior approach include having a neurosurgeon surgeon (OR:1.98), being from the Southern (OR:1.61 relative to Northeast), and having Medicare insurance (OR: 1.31) (p<0.001 for each). ConclusionsThe overall rate of surgery for odontoid fractures has remained similar over the past years. Of those undergoing surgery, less are being done from anterior. While these decisions were predicted by some clinical factors, both also correlated with non-clinical factors suggesting room for more consistent algorithms.

Language Preference, Surgical Wait Time, and Outcomes Among Older Adults With Hip Fracture

Patients with a non-English language preference served within English-dominant health care settings are at increased risk of adverse events that may be associated with communication barriers and inequitable access to care. To investigate the association of non-English language preference with surgical wait time and postoperative outcomes in older patients undergoing hip fracture repair. This population-based, retrospective cohort study was conducted using linked databases to measure surgical wait time and postoperative outcomes among older adults (aged ≥66 years) in Ontario, Canada, who underwent hip fracture surgery between January 1, 2017, and December 31, 2022. Propensity-based overlap weighting accounting for baseline patient characteristics was used to compare primary and secondary outcomes. Non-English language preference. The primary outcome was surgical delay beyond 24 hours. Secondary outcomes included time to surgery, surgical delay beyond 48 hours, postoperative medical complications, length of stay, discharge destination, 30-day mortality, and 30-day hospital readmission. Among 35 238 patients who underwent hip fracture surgery, 28 815 individuals (81.8%) were English speakers (mean [SD] age, 84.4 [8.0] years; 19 965 female [69.3%]) and 6423 individuals (18.2%) were non-English speakers (mean [SD] age, 85.5 [7.0] years; 4556 female [70.9%]). The median (IQR) wait time for surgery was similar for English (24 [16-41] hours) and non-English (25 [16-42] hours) speakers. There was no significant difference in surgical delay beyond 24 hours between English-speaking and non-English-speaking patients (3321 patients [51.7%] vs 14 499 patients [50.3%]; adjusted relative risk [aRR], 1.00; 95% CI, 0.98-1.03). Compared with English speakers, patients with a non-English language preference had increased risk of delirium (4207 patients [14.6%] vs 1209 patients [18.8%]; aRR, 1.10; 95% CI, 1.03-1.17), myocardial infarction (150 patients [0.5%] vs 43 patients [0.7%]; aRR, 1.52; 95% CI, 1.04-2.22), longer length of stay (median [IQR], 10 [6-17] vs 11 [7-20] days; aRR per 1-day increase, 1.11; 95% CI, 1.06-1.15), and more frequent discharge to a nursing home (1814 of 26 673 patients surviving to discharge [6.8%] vs 413 of 5903 patients surviving to discharge [7.0%]; aRR, 1.13; 95% CI, 1.01-1.27). In this study of older adults with hip fracture, non-English language preference was associated with increased risk of delirium, myocardial infarction, longer length of stay, and discharge to a nursing home. These findings suggest inequities in hip fracture care for patients with a non-English language preference.

Conjoint effect of post-discharge physical exercise and co-managed care on health outcomes of older patients with hip fracture in China: A post-hoc factorial analysis

ObjectivesThe study aimed to explore the effects of post-discharge physical exercise combined with co-managed care on health the outcomes of older patients with hip fracture. MethodsBased on a completed non-randomised controlled trial which evaluated a co-managed care of patients aged 65 years and above with hip fracture, provided by orthopedists and geriatricians within an acute setting, a retrospective post-hoc factorial analysis was further conducted. The analysis observed the health outcomes of older patients with post-discharge physical exercise combined with co-managed care within hospitals compared to those had either post-discharge physical exercise or co-managed care. The collected data included demographics, clinical characteristics, and follow-up information about post-discharge physical exercises and health outcomes at one-month, four-month, and one-year after admission. The health outcomes comprised the cumulative mortality, complications, ambulatory ability (Fracture Mobility Score), and quality of life (the five-level EuroQol five-dimensional questionnaire) at each follow-up visit. ResultsPatients who having the conjoint interventions benefited more reduction of one-year mortality (RR 0.59, 95 %CI: 0.38, 0.80) but no reduction of complications (RR 0.70, 95 %CI: 0.43, 1.14) than each single intervention. Ambulance ability (at one-year follow-up) and quality of life (at four-month follow-up) of patients who having the conjoint interventions were observed a significant improvement against each single intervention. ConclusionThe conjoint intervention with co-managed care and post-discharge physical exercise might contribute more to the quality improvement of hip fracture care in a long run.

Avoiding “a piece of paper on the wall that everyone ignores”: A qualitative study on the barriers for implementing open fracture guidelines

BackgroundOrtho-plastic evidence-based clinical guidelines for open fractures have demonstrated to standardise care and improve outcomes for patients admitted following lower extremity trauma. Despite its benefits, very few countries have introduced such guidance. The aim of this study was to explore the attitudes, barriers and limitations to the development and implementation of guidelines for lower limb open fractures MethodsTwelve renowned orthopaedic and plastic surgeons, based in countries with no guidelines at present, underwent semi-structured interviews. A qualitative appraisal was conducted using reflexive thematic analysis methodology. Systematic coding led to the development and refinement of themes to address the research question. ResultsIndividualistic decision-making, reliance on multidisciplinary interpersonal relationships, and the presence of immobile determinants of open fracture care emerged as three themes that define how patients are currently managed in settings with no guidelines in place. Although guidelines can potentially improve care by presenting evidence-based recommendations, introducing audit practices, establishing pathways for multidisciplinary collaboration, and enhancing effective leadership; if barriers to the implementation are not considered, they may end up as a “piece of paper on the wall that everyone ignores” ConclusionsThis study is the first to explore the challenges of introducing ortho-plastic guidelines for open extremity trauma. The themes presented describe the status quo in settings with no such protocols in place, establishing the foundation for future initiatives aiming to provide a practical strategy to aid the development and introduction of clinical guidelines for open lower limb fractures.

Time to surgical treatment for hip fracture care.

Studies have demonstrated beneficial outcomes associated with timely surgical treatment of hip fracture. Subsequently, practice recommendations changed with 24-48 h as the recommended time for surgery from admission; however, recent data on timing of hip fracture surgery and how this impacts outcomes are lacking. This retrospective cohort study included patients who had a primary diagnosis of hip fracture and underwent a subsequent surgical repair within 3 days of admission (Premier Healthcare claims 2006-2021 data). The primary exposure of interest was time from hip fracture diagnosis to surgery (categorized as 0-1 day, 2 days, and 3 days). Outcomes included any major complication, mortality, and intensive care unit (ICU) admission. Mixed-effects models measured the association between timing of surgery and outcomes. We report odds ratios (OR) and 95% confidence intervals. Among 501,267 surgical hip fracture patients, 26.0%, 56.0%, and 18.1% of patients received surgery on days 0-1, 2, and 3, respectively. The median ages were 83, 84, and 84 years old, and there were 73.3%, 72.2%, and 68.8% female in each group respectively. Compared with repair on day 0-1, hip fracture surgical treatment on day 2 or day 3 was associated with increased odds of major complications (OR 1.06, 95% CI 1.03-1.08 and OR 1.17, 95% CI 1.13-1.2), mortality (OR 1.08, 95% CI 1.02-1.14 and OR 1.2, 95% CI 1.12-1.28), and ICU admission (OR 1.06, 95% CI 1.04-1.09 and OR 1.36, 95% CI 1.32-1.4) after adjusting major comorbidities; all p < 0.001. Despite the publication of society guidelines in 2015, most fracture patients still received surgery on day 2 or day 3 of admission and were associated with worse outcomes. Balancing optimization of clinical factors with timing of surgery can be challenging, and further research is needed. Nonetheless, our findings reiterate the importance of timely surgical intervention.

The impact of obesity on pediatric orthopedic polytrauma patients

Objectives: The effect of obesity on fracture care and management in the adult population has been well documented in the literature; there is a scarcity of evidence-based research reporting the impact of obesity on pediatric orthopedic polytrauma patients. The aim of this study was to objectively investigate the impact of obesity on pediatric orthopedic polytrauma patients to optimize care and fracture management. Methods: A single-center retrospective cohort study of pediatric polytrauma patients aged 2–18 years old admitted to a level 1 trauma center was conducted over three years. Patients were categorized based on their body mass index (BMI). A logistic regression model was used to identify significant variables between the study groups. Results: A total of 60 patients were included in the analysis and divided into normal weight group (n = 36) and overweight/obese group (n = 24). A trend of lower injury severity score (ISS) was observed in the overweight/obese group compared to the normal weight group. Non-orthopedic injuries, including head, chest, and abdominal injuries, were found to be less in the overweight/obese group. Higher rates of spine and extremity fractures were reported in the overweight/obese group, as well as the need for surgical fixation (P = 0.05). No specific differences in complications, outcome, or discharge facility were found between the two groups. Conclusion: The paradoxical association between BMI and ISS/non-orthopedic injuries, in contrast to spine and extremity fractures, reflects the complex relationship between obesity and polytrauma patterns. Large multi-center prospective studies are needed to predict clinical outcomes in pediatric orthopedic polytrauma patients.

Disparities in management of symptomatic osteoporotic vertebral compression fractures: a nationwide multidisciplinary survey

SummaryThis nationwide multidisciplinary survey found dissatisfaction among physicians with current osteoporotic vertebral compression fracture care, revealing significant disparities in diagnosis, treatment, and follow-up practices. Issues include poor communication and differing guidelines. Improving interdisciplinary collaboration and standardized care strategies is essential for better patient outcomes.PurposeThis survey aims to assess current preferred care practices for symptomatic osteoporotic vertebral compression fractures (OVCF) in the Netherlands, focusing on guideline adherence, identifying knowledge gaps, and clarifying consensus and collaboration across medical disciplines in OVCF treatment.MethodsThis cross-sectional study was conducted via Qualtrics (Provo, UT) using a self-administered online survey distributed to 238 general practitioners and physicians in orthopedics, traumatology, internal medicine, rheumatology, and geriatrics working at 51 hospitals in the Netherlands. The survey, conducted in Dutch, included 36 multiple-choice and two open questions and was accessible via an anonymous email link or QR code. General practitioners received additional questions specific to their role. Data was anonymized, stored securely, and analyzed using descriptive statistics in Microsoft Excel and SPSS (Version 24). Open-ended responses were coded and categorized. The survey was conducted prior to the publication of the updated Federation of Medical Specialists guidelines in 2024.ResultsPhysicians across various disciplines uniformly expressed dissatisfaction with current OVCF care. The survey highlighted significant disparities in diagnosis, treatment, and follow-up practices. A lack of communication between primary and secondary care providers and differing guidelines further complicate OVCF management. These issues point to considerable variation in clinical practice and gaps in interdisciplinary collaboration.ConclusionAddressing the identified issues requires fostering interdisciplinary collaboration and creating cohesive care strategies. Ensuring access to diagnostic resources in both primary and secondary care and establishing coordinated care models promises more structured and standardized treatment. These steps are crucial for enhancing patient outcomes in OVCF management.

Efficacy of Fragility Fracture Integrated Rehabilitation Management in Older Adults With Hip Fractures: A Randomized Controlled Trial With 1-Year Follow-Up

ObjectivesComprehensive multidisciplinary rehabilitation has been proven to benefit patients recovering from hip fracture surgery, enhancing postoperative outcomes. However, challenges persist in delivering such rehabilitation due to health care system limitations and inadequate policies. This study aimed to evaluate the clinical effectiveness of Fragility Fracture Integrated Rehabilitation Management (FIRM) in comparison to a conventional rehabilitation after hip fracture surgery. DesignA parallel-group, single-blind, multicenter randomized clinical trial. Setting and ParticipantsThree in-hospital rehabilitation settings; 203 hip fracture surgery patients aged 65 years and older were randomized and followed up for 1 year. MethodsThe main outcome assessed ambulatory function, using the Koval and Functional Ambulation Category (FAC) scales. Functional outcomes were evaluated upon rehabilitation admission, discharge, and during follow-up at 3, 6, and 12 months post-surgery. The prevalence of independent ambulation and recovery to prefracture ambulatory status at each follow-up time point were analyzed. ResultsThe FIRM group demonstrated superior improvements in Koval and FAC scores, along with most secondary outcomes during the 1-year follow-up. Significant changes from baseline to 12 months were observed in Koval scores [mean difference, −4.13 (95% CI, −4.56 to −3.70) vs −3.22 (95% CI, −3.86 to −2.61), P = .016] and FAC scores [mean difference, 3.37 (95% CI, 3.01 to 3.72) vs 2.56 (95% CI, 2.10 to 3.02), P = .006]. At the 12-month follow-up point, this group also showed higher rates of independent ambulation [53 (76.8%) vs 28 (56.0%), P = .016] and recovery to prefracture ambulatory status [56 (81.2%) vs 31 (62.0%), P = .020] than the conventional group. Conclusions and ImplicationsThe FIRM demonstrated superior effectiveness compared with conventional rehabilitation in improving ambulation and other functional outcomes in older adults with hip fracture. This finding provides valuable insights for managing comprehensive multidisciplinary postoperative care for hip fractures in South Korea and beyond.

Surgeon Alignment With Clinical Practice Guidelines: A Qualitative Analysis of Treatment of Distal Radius Fractures.

Clinical practice guidelines (CPGs) are developed to guide physicians in providing consistent high-quality care. Despite availability of evidence-based guidelines for the treatment of distal radius fractures, prior work suggests many patients receive treatment that is misaligned with the CPG. We sought to explore barriers and facilitators of guideline-aligned care for distal radius fractures. We conducted semistructured interviews of a purposive sample of surgeons who treat distal radius fractures. Our interview guide was based on the Theoretical Domains Framework (TDF). Interviews were transcribed and coded using a deductive analytical approach within the 14 TDF domains. Belief statements underlying similar codes were developed to describe barriers and facilitators of guideline-aligned care. A content analysis was performed to count the frequency of each TDF domain. We interviewed 14 surgeons. The most common TDF domains were beliefs about consequences (110), knowledge (49), and social influences (29). Belief statements representative of barriers of concordance to the CPGs included, "I am more likely to deviate from the CPGs when the CPGs differ from my professional opinion," which was coded under beliefs about consequences. Similar belief statements were created for each theme within TDF domains. Decision-making for patients with distal radius fractures is driven by beliefs about consequences, knowledge, and social influences. Strategies to address these beliefs in other fields such as including patient factors in a further structured shared decision-making process, developing implementation toolkits as part of the CPG development process, and implementing payment programs may improve CPG alignment.

Unveiling Factors Influencing Mortality in Irish Hip Fracture Patients: A Comprehensive Five-Year Analysis

BackgroundHip fractures impose a substantial healthcare burden, contributing to increased morbidity, disability, and mortality. The Irish Hip Fracture Standards (IHFS) were officially employed in 2017, providing specialized pathways for hip fracture care to improve patient outcomes. This study evaluated the performance of our unit regarding hip fracture care and analyzed individual outcome parameters. MethodsData spanning 5 years (2015 to 2019) preceding the COVID-19 era were extracted from our hip fracture repository. Patients aged 60 years and more were included. The dataset integrated demographic information and outcomes, validating mortality events using the Irish death events registry. Mortality rates were measured cumulatively and at various time intervals. There were 1,685 hip fractures treated during the study timeframe; average patient age was 78 years, with women constituting 68% of the cohort. ResultsThe one-year mortality rate was 20.8% (n = 350). Adverse outcomes were observed in older patients, men, and those who had higher American Society of Anesthesiologists scores. Patients adhering to IHFS 1 (P ≤ 0.05) and IHFS 2 (P ≤ 0.05) exhibited improved outcomes. Our institution displayed lower compliance rates with IHFS 1 and 2 when compared to standards 3 to 6, with the latter standards showing no notable impact on mortality outcomes. ConclusionsWhile our unit’s hip fracture care outcomes align well with national averages, resource constraints hinder full compliance with IHFS 1 and 2, emphasizing the need for targeted resource allocation in areas with the greatest impact on outcomes.

Injury Characteristics and Frailty Patterns in Older Patients Admitted with Hip Fractures in an Irish Hospital

Abstract Background The Irish Hip Fracture Database (IHFD) has played a crucial role in improving hip fracture care over the last ten years. However, the IHFD does not include detailed data on the nature of the injury leading to hip fracture. In this study we examined the characteristics of the injuries leading to hip fractures and their relationship with frailty. Methods We conducted a retrospective chart review of all hip fracture patients aged over 60 years old admitted to an acute orthopaedic floor in a tertiary hospital from May 2023 to May 2024. Patients under 60 years old, and those with periprosthetic fractures were excluded. Delirium was based on a composite of clinical diagnosis and/or a 4AT score ≥ 4. Frailty was quantified using the IFHD Frailty Index. The relationships between various injury characteristics were examined with Student T test and χ square. Results The study included 168 patients, 73.8% female, mean age was 80.1±11.2 years. Of these, 91.1 % were fragility fractures and 4.8% were atraumatic. Indoor falls accounted for 67.9% of cases. Assault led to hip fracture in 5.4% (n=9) of all fractures and 17.0% (n=8) of outdoor fractures. Frailty Index was higher in those with fragility fracture vs. non fragility fracture (0.19 vs. 0.10, p&amp;lt;0.003), as well as in those with indoor vs. outdoor fractures (0.21 vs 0.16, p&amp;lt;0.001). Indoor fractures were significantly associated with delirium (p=0.012), frailty index (p&amp;lt;0.001), and age (p=0.016). Conclusion The great majority of hip fractures were fragility fractures occurring indoors. Patients who suffer hip fractures indoors are frailer and more likely to develop delirium. These findings underscore the importance of targeted falls prevention strategies for frail older adults, including optimizing the home environment and reducing hazards within the home. The number of hip fractures due to assault deserves further examination.

Single-Plate versus Dual-Plate Utilization for Treatment of Humeral Shaft Fractures: A Retrospective Clinical Series

Objectives Dual plating is the current standard of care for displaced distal humerus fractures and even some metadiaphyseal humeral fractures. Single plate fixation is the current standard of care for humeral shaft fractures when performing open reduction and internal fixation (ORIF). A role may exist for dual plating of humeral shaft fractures. This study aims to compare clinical outcomes of single versus dual-plating when performing ORIF procedures on humeral shaft fractures. Methods A retrospective study of 143 patients (81 females, 62 males; mean age 47.3) who sustained humeral shaft fractures (Arbeitsgemeinschaft für Osteosynthesefragen/Orthopedic Trauma Association (AO/OTA) type 12A, B, and C) and received either dual or single plating via ORIF between March 2010 and May 2022. Of the 143 patients, 79 (55%) received single plating, while 64 (45%) received dual plating. To account for possible confounders, we collected data on patient characteristics, mechanism of injury, and intra-surgical variables. Primary outcome measurements compared radiographical x-ray imaging (3-months, 6-months, and 12-months), complications, and visual analog scale (VAS) score. Results There was no statistically significant difference between VAS scores, union rates, post operative radial nerve injury, infections, or hardware failure for primary surgical outcomes. Patients were allowed to bear weight as tolerated more quickly in the dual-plating group. An association was observed between the usage of dual plates and osteoporosis. Conclusion In conclusion, we found dual-plate fixation for ORIF of humerus fractures to be not statistically significantly different compared to single plate fixation. Dual-plating has satisfactory radiograph and clinical outcomes compared to conventional single-plate fixation. While we are not advocating for the routine use of dual-plating, the results of our study suggest that the use of dual-plating produces similar outcomes when compared to single-plating for ORIF of a humerus shaft fracture.