Femoral Fracture Patients Research Articles

Effect of Age on the Patterns of Traumatic Femoral Fractures: Seven Years of Experience at a Regional Tertiary Hospital

ObjectiveFemoral fractures are a common cause of mortality and functional loss, mainly among older people, and there are few studies about the age in relation to traumatic femoral fractures. The aim of this study was to investigate the effect of age on the patterns of traumatic femoral fractures in patients presenting to our regional tertiary hospital.MethodsThe records of 2020 patients who presented with traumatic femoral fractures between 2013 and 2019 were retrospectively reviewed. The patients' clinical and radiographic records were reviewed. Univariate and multivariable logistic regression were used to identify independent risk factors for associated injuries and complications.ResultsThe patients were divided into a child group (CH group, n = 342) aged under 18 years, a young adult group (YA group, n = 484) aged 18–60 years, and an older people group (OP group, n = 1194) aged 60 years and over. There were significant differences among the three groups in several indexes, such as sex ratio (χ 2 = 301.699, p < 0.001), osteoporosis (χ 2 = 375.463, p < 0.001), injury time of day (χ 2 = 114.913, p < 0.001), injury cause (χ 2 = 748.187, p < 0.001), injury location (χ 2 = 490.153, p < 0.001), fracture side (χ 2 = 57.000, p < 0.001), fracture site (χ 2 = 806.650, p < 0.001), associated injuries (χ 2 = 322.921, p < 0.001), coma after injury (χ 2 = 147.814, p < 0.001), non‐surgery‐related complications (χ 2 = 7.895, p = 0.019), and surgery‐related complications (χ 2 = 82.186, p < 0.001). The YA group had a significantly higher percentage of patients with surgery‐related complications than the OP group. The OP group had a higher frequency of non‐surgery‐related complications than the YA group and CH group. The most common non‐surgery‐related complications were pneumonia (7.1%) in the OP group and deep venous thrombosis (6.4%) in the YA group. Multivariable logistic regression showed that young adults, high‐energy injury, outdoors, coma after injury, and fracture sites except for the proximal region were independent risk factors for associated injuries. Older age, male, and fracture site except for the proximal region were independent risk factors for complications.ConclusionsTraumatic femoral fractures are mostly the result of low‐energy trauma and predominantly affect the proximal site of the femur among older people. A higher rate of shaft fractures, fractures occurring outdoors, and associated injuries were observed among young adults and children than among older people.

Distal femur: nail plate combination and the linked construct.

Operative fixation of distal femur fractures in patients with osteoporotic bone can be challenging. Treatment with either lateral locking plate or retrograde intramedullary nail alone may not provide adequate fixation to allow for early mobilization. Rather, fixation using the nail plate combination (NPC) to treat distal femur fractures in the elderly may offer improved biomechanical stability to achieve immediate weight-bearing, especially in the setting of complex fracture patterns and osteoporosis. Here, we describe the rationale, step-by-step technique, and outcome following 2 cases: 1 patient treated with a true NPC procedure using retrograde intramedullary nail and standard locking plate, as well as a NPC procedure using a novel locking attaching washer plate.

Outcome study of proximal femur fracture in patients having cardiac diseases

To assess the outcome of fracture in patients with cardiac diseases, evaluate delay in surgery &amp; study the quality of life post hospital discharge. A prospective review of the medical records of 32 cases who underwent surgery at Dayanand Medical college &amp; Hospital, Ludhiana was performed. Patients were selected with proximal femur fracture having cardiac diseases after fulfilling the inclusion and exclusion criteria. After taking detailed history and examination, the patients were followed up after 4-6 weeks and 3-4 months. A detailed structured performa was filled and functional assessment was done using HHS. We had final follow up of all 32 patients which were included in the study managed by PFN. Modified HHS was accessed at 4-6 weeks and 3-4 months and found to be 41.19 (SD =12.89) &amp; 64.66 (SD =13.35) respectively. No mortality was observed during the follow up. Presence of cardiac comorbidities increased the chances of hip fracture and poor HHS was observed among the patients in the study. Although no significant difference on HHS was observed among the subtypes of cardiac diseases. Most common cause of delay in surgery was the use of antiplatelet agents and delay in surgery affected the HHS significantly in a way that more the delay, poor was the HHS. Presence of comorbidities like hypertension, diabetes mellitus decreased the mean HHS. Occurrence of complications also affected the HHS. More the complications, poor was the HHS. Patients with hip fracture with a diagnosis of CVD, have greater risk of hip fracture with longer length of hospital stay and hence higher cost per hospital stay. Presence of more comorbidities along with CVD shows a significant association in the functional outcome.

Proximal femur fractures in patients taking anti-coagulants: has anything changed?

With an ever-ageing population, the incidence of hip fractures is increasing worldwide. Increasing age is not just associated with increasing fractures but also increasing comorbidities and polypharmacy.Consequently, a large proportion of patients requiring hip fracture surgery (HFS) are also prescribed antiplatelet and anti-coagulant medication. There remains a clinical conundrum with regards to how such medications should affect surgery, namely with regards to anaesthetic options, timing of surgery, stopping and starting the medication as well as the need for reversal agents.Herein, we present the up-to-date evidence on HFS management in patients taking blood-thinning agents and provide a summary of recommendations based on the existing literature.

Polypharmacy and medication related falls risk in orthogeriatric femoral fracture patients Polypharmacy and medication related falls risk in orthogeriatric femoral fracture patients

Aim: To reportpolypharmacy rates and identify specific medications that increase falls riskin orthogeriatric femoral fracture patients. Method: A retrospectivesub-analysis, using the electronic medical records of patients admitted with a minimaltrauma femoral fracture to a tertiary teaching hospital during a 12-monthperiod was undertaken. Specific medications associated with falls risk wereclassified under three specific groups: benzodiazepines, tricyclicantidepressants (TCAs), and non-benzodiazepine hypnotics. Results: A sample of 131patients was included in the audit. Of these, 99 patients (75.6%) were reportedto be taking five or more medications prior to their falls related admission.From this, 49 patients (37.4%) were taking ten or more medications. One in fivepatients were found to be taking specified falls risk medications prior toadmission, primarily benzodiazepines (75.8%). Conclusion: Orthogeriatricpatients admitted to hospital with a femoral fracture following a minimaltrauma fall were commonly taking five or more medications prior to admission.Over a third of patients that were reported to take ten or more pre-admissionmedications were taking specified falls risk medications. This highlights theneed for medication-reviews and de-prescribing, particularly focusing on fallsrisk medications, to reduce incidence of falls and minimal trauma fractures inhigh risk patients

An Overview of Rate of Infection and Mortality in Femur Fracture Patients and its Fixation during Covid-19 Pandemic

Aim: To observe the workload of fractures of the femur (shaft and distal femur) and their fixations along with complications in terms of infection and mortality at our hospital during COVID 19 pandemic. Study design: Prospective study. Place and duration of study: Dept of Orthopaedic, Ghurki Trust Teaching Hospital, Lahore from 01-03-2020 to 31-07-2020 Methodology: One hundred and thirty-one diagnosed patients with femur fracture (shaft and distal) during pandemic period of COVID were enrolled. Demographic data included (age, sex, implant type, surgical site infection (SSI) and mortality).Since study was done during COVID-19 pandemic, positivity of COVID symptoms was noted as yes/ no on data collection proforma. Results: There were 105 (80.15%) males while 26 (19.84%) were females with mean age was 39.20±13.02 years. Majority of the surgical interventions were done based on Intramedullary nailing 74.05%, the second prevalent surgeries were done on AO external fixation 8.4%. Infection rate was observed in 7(5.32%) patients. No mortality was seen in any of the cases. Four infected cases were observed after intramedullary nailing procedure, two from AO external fixation and one after locking plate. Conclusion: There is no significant higher complication rate due to COVID-19 pandemic to patients whom femur fracture fixation was done. None of admitted patient suffered COVID-19 symptoms during hospitalization. It was only pointless fear about orthopaedic intervention during this interval. Key words: COVID-19, Femur, Infection

Primary fibular grafting combined with double plating in distal femur fractures in elderly patients

PurposeTo report functional and radiological outcomes of using primary fibular graft together with double plating in distal femoral fractures in the elderly.MethodsA retrospective study on 30 elderly patients with comminuted distal femoral fractures managed by primary fibular grafting and double plating through an anterior midline approach has been conducted. Only isolated distal femoral fractures type 33-A3, 33-C2, and 33-C3 were included. The patient’s mean age was 75.3 years. Evaluation included operative time, blood loss, time to union, knee range of motion, Sanders scoring, and presence of complications.ResultsThe average follow-up period was 26.6 months. Mean intraoperative blood loss was 401 ml, and mean operative time was 216 min. All patients had a knee range of motion (90–120°) during follow-up. Time for union ranged from 16 to 23 weeks with a mean of 18.4 weeks, with no cases of non-union. A total of 22 patients (73.3%) showed excellent functional outcomes, and the remaining eight (26.7%) showed good functional outcomes according to the Sanders scoring system. Only two cases (6.6%) had superficial wound infections managed conservatively. No post-operative deformity, loss of reduction, or implant failure was observed until the end of follow-up period.ConclusionPrimary fibular grafting combined with double plating of comminuted distal femur fractures in patients above 70 years is an effective technique with higher rates of union and lower re-operation rates compared to other fixation modalities.

Effect of Ultrasound-Guided Fascia Iliac Compartment Block on Serum NLRP3 and Inflammatory Factors in Patients with Femoral Intertrochanteric Fracture.

Objective To investigate the effects of ultrasound-guided fascia iliac compartment block (FICB) on patients' postoperative pain and inflammatory factors as well as nucleotide-binding domain and leucine-rich repeat (NLR) family, pyrin domain-containing 3 (NLRP3) in femoral intertrochanteric fracture. Methods This single-blind randomized controlled study included 231 patients with femoral intertrochanteric fracture treated in our hospital from January 2017 to December 2020. All patients were randomized into two groups, the FICB group (n = 116) and the general anesthesia group (control group, n = 115). The serum NLRP3 levels and inflammatory factors were evaluated. The heart rate (HR), mean arterial pressure (MAP), and SpO2 values were recorded. Pain condition was measured by the visual analogue scale (VAS) score. Harris score was performed for positive hip function. Results The values of HR and MAP were significantly lower after anesthesia induction in FICB groups compared with the control group. However, no significant difference was found for SpO2. Compared with the control group, the VAS scores within 72 h after surgery were all markedly lower in the FICB group than in the control group and showed no significant difference at 1 week after surgery. The levels of NLRP3 and interleukin 6 (IL-6) were significantly lower in FICB patients at 1 h, 6 h, 24 h, 48 h, and 72 h after surgery compared with the control group. Tumor necrosis factor-α (TNF-α) showed a significant lower level in the FICB group at 1 h and 6 h after surgery, and significant lower levels of C-reactive protein (CRP) were found at 1 h and 24 h after surgery compared with the control group. Positive correlation was found between NLRP3 and IL-6, as well as CRP and VAS scores after 1 h of the surgery. No significant difference was found for both Harris score and postoperative complications between the two groups. Conclusion Fascia iliac compartment block could reduce the postoperative pain, which might be associated with the decrease of the serum levels of NLRP3, CRP, IL-6, and TNF-α in femoral intertrochanteric fracture patients.

Functional and Radiological Outcomes of Unstable Proximal Femur Fractures Fixed With Anatomical Proximal Locking Compression Plate.

IntroductionPeritrochanteric fractures are the most frequent fractures of the proximal femur that accounts for nearly half of all proximal femur fractures. They are a major cause of disability in the elderly. The aim is to study the functional and radiological outcome of unstable proximal femur fractures fixed with proximal femur locking compression plate (PF-LCP) and its complications. Unstable proximal femur fracture patients operated with proximal femur locking compression plate were followed up functionally by Harris Hip Score and radiologically by neck-shaft angle measure.Materials and methodsA retrospective analysis of 30 patients with unstable peritrochanteric fractures treated with PF-LCP in the first-level trauma center was conducted between 2015 and 2019. Stable peritrochanteric, pediatric and open fractures, and polytrauma were excluded. As a mid-term follow-up, functional and radiological outcomes were assessed at six weeks, three months, six months, and 12 months. Data was analyzed using a chi-square test, and results were compared with available western literature. ResultsThirty patients with unstable peritrochanteric fractures operated between 2015 and 2019, complying with our inclusion criteria, were analyzed. All patients were operated by the same surgeon and were available for a mid-term follow-up (12 months). Mean radiological union time was 12.5+/-2 weeks, with 24 patients achieving union between 10-15 weeks, three patients had union little more than 15 weeks. Two patients had non-union and required re-surgery. Functional results were assessed in the 30 patients available for follow-up using Harris Hip Score. Excellent results were seen in 17, good in seven, fair in three, and poor in three patients.ConclusionsThe choice of implant used to manage unstable peritrochanteric fractures has always been a debatable subject in our orthopedic fraternity. In our study, we used the anatomic, fixed-angle plates in peritrochanteric fractures and obtained significant functional and radiological outcomes over a midterm follow-up. We recommend PF-LCP as a good, stable alternative in the treatment of peritrochanteric femoral fractures. We consider that fracture pattern and extent in the proximal femur have a definite influence in determining the implant of choice. It provides good-to-excellent bone healing with reduced complications and better biomechanical stability.

Risk factors for development of Atypical Femoral Fractures in patients on long-term oral Bisphosphonate therapy

Risk factors for development of Atypical Femoral Fractures in patients on long-term oral Bisphosphonate therapy

Comparison of functional outcomes and complications of cemented vs uncemented total hip arthroplasty in the elderly neck of femur fracture patients: A systematic review and meta-analysis

PurposeThe neck of femur fractures in the elderly is a global concern. These fractures impair the quality of living and add to morbidity and mortality. A Multitude of treatment options for the same. This systematic review focuses on evaluating outcomes between cemented and uncemented total hip replacement in the elderly population with neck of femur fractures. Material and methodsThe search was conducted in databases PubMed, Embase, Scopus, open grey, and Cochrane following PRISMA guidelines. The studies fulfilling the inclusion criteria were included, scrutinized for data analysis, and also quality appraisal of all the included studies was conducted to be included in this article. ResultsA total of 7 studies were included (2 RCT, 5 retrospective studies) comprising 1171 THRs. Data analysis showed a higher HHS in cemented compared to uncemented(p < 0.001). The uncemented group had a significantly higher rate of revision, dislocation, and periprosthetic fracture compared to cemented group(p < 0.001). However, VAS score, loosening rates, and heterotopic ossification were similar in both statistically insignificant groups. ConclusionChoosing between cemented and uncemented techniques had been a controversy with lesser data due to higher morbidity and mortality. This systematic review provides information regarding functional outcomes and complications in both groups. The cemented group had better outcomes and lesser complications which should be preferred in elderly patients as the conclusion of this study. However, a larger RCT with better follow-up is still required. Level of evidenceLevel I, systematic review and meta-analysis.

Validation and algorithmic audit of a deep learning system for the detection of proximal femoral fractures in patients in the emergency department: a diagnostic accuracy study

Proximal femoral fractures are an important clinical and public health issue associated with substantial morbidity and early mortality. Artificial intelligence might offer improved diagnostic accuracy for these fractures, but typical approaches to testing of artificial intelligence models can underestimate the risks of artificial intelligence-based diagnostic systems. We present a preclinical evaluation of a deep learning model intended to detect proximal femoral fractures in frontal x-ray films in emergency department patients, trained on films from the Royal Adelaide Hospital (Adelaide, SA, Australia). This evaluation included a reader study comparing the performance of the model against five radiologists (three musculoskeletal specialists and two general radiologists) on a dataset of 200 fracture cases and 200 non-fractures (also from the Royal Adelaide Hospital), an external validation study using a dataset obtained from Stanford University Medical Center, CA, USA, and an algorithmic audit to detect any unusual or unexpected model behaviour. In the reader study, the area under the receiver operating characteristic curve (AUC) for the performance of the deep learning model was 0·994 (95% CI 0·988-0·999) compared with an AUC of 0·969 (0·960-0·978) for the five radiologists. This strong model performance was maintained on external validation, with an AUC of 0·980 (0·931-1·000). However, the preclinical evaluation identified barriers to safe deployment, including a substantial shift in the model operating point on external validation and an increased error rate on cases with abnormal bones (eg, Paget's disease). The model outperformed the radiologists tested and maintained performance on external validation, but showed several unexpected limitations during further testing. Thorough preclinical evaluation of artificial intelligence models, including algorithmic auditing, can reveal unexpected and potentially harmful behaviour even in high-performance artificial intelligence systems, which can inform future clinical testing and deployment decisions. None.

780 IMPROVING NUTRITIONAL SUPPORT FOR POST-SURGICAL FEMUR FRACTURE PATIENTS AT ST MARY’S HOSPITAL, LONDON

Abstract Introduction Malnutrition represents a common complication in femur fracture patients and is primarily caused by poor dietary intake. Malnutrition is associated with poor clinical outcomes, and is the strongest independent risk factor for recurrent femur fracture. High protein oral nutrition supplements (ONS) have been associated with improved clinical outcomes after femur fracture, including reduced complications, length of hospital stay, mortality and bone mineral density loss, and increases in functional status and quality of life (Volkert, Beck, Cederholm et al., Clinical Nutrition, 38, 10–47)). Accordingly, the European Society for Clinical Nutrition and Metabolism (ESPEN) advocates the use of ONS with all femur fracture patients in hospital. Aim To improve nutritional support for post-surgical femur fracture patients at St Mary’s Hospital, London. Methods We plan to carry out three PDSA cycles to evaluate whether two separate interventions are effective in increasing the prescription rate of ONS in post-surgical femur patients. Each PDSA cycle included all patients who underwent surgical treatment for femur fracture during a one month period. Results ‘Cycle 1’ included 18 patients (mean age: 84.6 years; range: 68–98 years) treated in March 2021. ONS were prescribed in 11% (2/18) post-surgical femur fracture patients. ‘Intervention 1’ comprised a dietician-led presentation during the Geriatric department weekly teaching session on 17/05/21. ‘Cycle 2’ data will be collected one month after ‘Intervention 1’. Conclusion ‘Cycle 1’ results revealed low rates of ONS prescriptions for post-surgical femur patients. We anticipate higher ONS prescription rates following ‘Intervention 1’. We believe that doctors’ and dieticians’ awareness of the importance of nutritional support for post-surgical femur fracture patients is key to the success of this quality improvement project.

PEMBERIAN RELAKSASI BENSON TERHADAP PENURUNAN NYERI PASIEN POST OPERASI FRAKTUR FEMUR DI RUMAH SAKIT UMUM DAERAH MEURAXA BANDA ACEH

Pain in postoperative Femur Fracture patients must be addressed immediately because it has an impact on the patient's healing process, because it can affect psychological and physiological conditions. Benson relaxation is one of the methods that can reduce pain, this technique is able to reduce the activity of the sympathetic nerves that control pain, causing a feeling of calm and comfort and will affect the decrease in pain intensity. The purpose of this study was to determine the effect of Benson Relaxation on reducing pain intensity in post-femoral fracture surgery patients at Meuraxa Hospital Banda Aceh in 2019. The method used in this study was a quasi-experimental pre test and post test one group, the number of samples in this study was 14 respondents. Consecutive sampling sampling technique. The time of this research was carried out on June 04 to July 22, 2019. The data were processed using paired t-test and Independent t-test statistical tests. The results of the study used paired t-test statistical tests. It shows that there is a significant difference in pain intensity before and after Benson Relaxation in postoperative femur fracture patients with p value 0.000 (P &lt; 0.05), and the results of the study using the Independent t-test statistic test showed that there was a significant difference in pain intensity between the experimental group and the experimental group. control group of postoperative Femur Fracture patients with p value 0.010 (P &lt; 0.05), so it can be concluded that there is a significant effect on pain intensity after Benson Relaxation in postoperative Femur Fracture patients. It is hoped that patients and nurses can apply the Benson Relaxation Technique after Fracture surgery.

20 Incidence of Acute Kidney Injury in Neck of Femur Fracture Patients During the COVID-19 Pandemic in Princess Royal Hospital, Telford

AimPatients undergoing surgical repair of neck-of-femur (NOF) fractures are at higher risk of acute kidney injury (AKI). NICE and BOAST have published guidelines to help prevent the occurrence of AKI, including adequate fluid resuscitation pre- and post-operatively. An audit was conducted during the COVID-19 pandemic to explore whether the department was adhering to NICE guidelines.MethodAKI was defined, as per NICE Clinical Knowledge Summaries, as an increase in serum creatinine levels by 26 µmol/L or greater. Data was collected prospectively starting from December 2020 to February 2021 in the Princess Royal Hospital during the COVID-19 pandemic. All patients with NOFs were included and data on sex, age, comorbidities, and type of surgery were collected.ResultsIn total, 32 patients were included in the audit with an average age of 82 years; of these, eleven patients had dynamic hip screws and eighteen patients had hemiarthroplasties. Five patients had chronic kidney disease, six patients had previous myocardial infarctions and thirteen patients had hypertension. Two patients (6.3%) were found to have an AKI post-surgery with increased creatinine levels of 27 and 28 µmol/L. Both had hypertension and underwent hemiarthroplasties.ConclusionsComplications such as AKIs are reversible and preventable. Especially during the COVID-19 pandemic such complications can increase morbidity and mortality of patients suffering from NOF leading to longer hospital stays. The low rate of AKI following NOF repair in our Department of Trauma and Orthopaedic is attributable to adherence to NICE and BOAST fluid resuscitation guidelines.

54 A Novel, Cost-Effective and Easily Reproducible Simulation Method for Teaching Fascia Iliaca Blocks Significantly Improves Peri-Operative Administration Rates in Neck of Femur Fracture Patients

Despite high-level evidence supporting early fascia iliaca block (FIB) administration in patients sustaining neck of femur (NOF) fractures, administration remains suboptimal, restricted primarily by limited training opportunities. We present a novel, cost-effective and easily reproducible simulation session designed to teach the landmark technique during the Covid-19 pandemic.A simulation mannequin was used with four absorbent swabs, two banana skins and a clear dressing were applied to the inguinal region to recreate the “two-pop” texture of the landmark technique. Ten participants attended, limited by social distancing. A 1 (poor) to 5 (excellent) feedback sheet was handed to all participants for the five domains of content, delivery, interaction, usefulness, and quality of the practical skills session, with opportunities for qualitative feedback. The FIB administration rates in all NOF fracture patients between August -October 2019, before the simulation session, were statistically compared to November-December 2020, following it.All participants gave a 5/5 (excellent) rating for all five domains, confirming good acceptability amongst practitioners. In the time period before the session, 9/29 NOF fracture patients received a FIB, improving to 18/31 patients following it (p = 0.042; two-tailed Fisher’s exact test), a statistically significant increase in administration. The average cost per participant for the single-use materials in the session was £1.56, whereas the multiple-use items costed £7.88 per participant.Adoption of this novel, cost-effective and widely reproducible simulation method is deemed highly useful and acceptable by a diverse range of healthcare professionals, resulting in a statistically significant increase in FIB administration in NOF fracture patients.

Low body mass index is a risk factor for increased post-operative mortality and poor functional improvement in distal femur fractures among patients aged over 65: A multicentre (TRON) study

BackgroundDistal femur fractures have been reported to have a mortality rate comparable to hip fractures, but the risk is still unknown. Recent studies have reported that low body mass index (BMI) is a risk factor for mortality in the elderly. We investigated the efficacy of low BMI for predicting the risk of mortality in distal femur fractures in patients aged over 65 within 18 months after injury and its impact on postoperative clinical outcomes and mortality. MethodsData from patients followed for more than six months were obtained from our trauma research group's database. We investigated risk factors for increased mortality using Cox proportional hazards models. We divided the analysed cases into low (<18.5 kg/m2) and high (>18.5 kg/m2) BMI groups. We adjusted the background characteristics of the groups by patient matching, and evaluated the postoperative mortality, complication rate, and knee society score (KSS). ResultsWe identified 216 patients, including 58 (26.9%) with low BMI values. Low BMI was an independent risk factor for mortality in all models (Hazard Ratio: 2.9, p = 0.011). The overall survival rate of the low BMI group at 18 months was significantly lower than that of the high BMI group (70.7% vs. 89.1%; p = 0.003). The complication rates of the low BMI and high BMI groups were not significantly different (33.3% vs. 22.2%; p = 0.283). The mean KSS values at 3, 6, and 12 months in the low BMI group was significantly worse than that in the high BMI group (78.7 ± 16.2 vs. 84.8 ± 13.1; p = 0.035, 82.2 ± 16.9 vs. 89.7 ± 8.9; p = 0.005, 86.4 ± 13.0 vs. 91.4 ± 8.4; p = 0.020, respectively). ConclusionsOur study indicated that low BMI was independent associated with increased mortality and impaired postoperative functional recovery in distal femur fractures of the elderly patients.

The effect of COVID-19 on perioperative morbidity and mortality in the neck of femur fracture patients

The effect of COVID-19 on perioperative morbidity and mortality in the neck of femur fracture patients

Effect of Combining Operating Room Nursing Based on Clinical Quantitative Assessment with WeChat Health Education on Postoperative Complications and Quality of Life of Femoral Fracture Patients Undergoing Internal Fixation.

Objective To explore the effect of combining operating room nursing based on clinical quantitative assessment with WeChat health education on postoperative complications and quality of life (QOL) of femoral fracture patients undergoing internal fixation. Methods Ninety femoral fracture patients treated in our hospital (July 2018 to July 2021) were chosen as the research objects and split into the control group (routine intervention) and the study group (combination of operating room nursing based on clinical quantitative assessment and WeChat health education) according to the nursing intervention modes, with 45 cases each. After nursing, the postoperative complications and QOL of patients were compared between the two groups. Results No statistical between-group differences in general data were observed (P > 0.05); the hospital stay, weight-bearing time, and fracture healing time were obviously shorter in the study group than in the control group (P < 0.05); 1 d after surgery, the VAS pain status was not significantly different between the two groups (P > 0.05), and 2 d and 3 d after surgery, the VAS scores were significantly lower in the study group than in the control group (P < 0.05); 1 d after surgery, the Harris scores of patients in the two groups were close and did not present statistical difference (P > 0.05), and 8 weeks after surgery, the Harris score was significantly higher in the study group than in the control group (P < 0.05); the scores on self-care agency such as self-concept, self-care skills, sense of self-care responsibility, and health knowledge level were significantly higher in the study group than in the control group (P < 0.05); compared with the control group, the probability of occurring incision infection, lung infection, pressure sore, swelling and pain, and other complications was significantly lower in the study group (P < 0.05). Conclusion Implementing operating room nursing based on clinical quantitative assessment combined with WeChat health education to femoral fracture patients undergoing internal fixation can effectively improve their postoperative clinical indicators, reduce their postoperative pain sensation and complication incidence, and effectively promote the joint motion range, which is conducive to enhancing their self-care agency and QOL.

Risk of complications during the treatment of proximal femoral fractures in patients in the age aspect

<h3>ЦЕЛЬ ИССЛЕДОВАНИЯ</h3> Изучение связи между когнитивными нарушениями у пациентов с переломами проксимального отдела бедренной кости (ППОБК) и риском развития осложнений в возрастном аспекте. <h3>МАТЕРИАЛ И МЕТОДЫ</h3> Проанализированы данные 86 пациентов, лечившихся по поводу ППОБК в период с марта по май 2020 г. (44% женщин и 42% мужчин, средний возраст 65,2±6,3 года). Всем пациентам при поступлении была проведена оценка когнитивных функций при помощи Монреальской шкалы оценки когнитивных функций (Montreal Cognitive Assessment) — МОКА-тест (2004), по результатам которого сформированы две группы: 1-я — 40 (46,5%) пациентов с когнитивными нарушениями, 2-я группа — 46 (53,5%) пациентов без когнитивных нарушений. <h3>РЕЗУЛЬТАТЫ</h3> Выявлена достоверно (<i>p</i>&lt;0,05) более высокая частота развития осложнений у пациентов, имеющих когнитивные расстройства (15 случаев; 37,5%) в сравнении с группой больных с сохранной когнитивной функцией (5 случаев; 10,9%). При анализе частоты возникновения отдельных осложнений в исследуемых группах выявлены статистически достоверные различия по частоте развития инфекционно-гнойных осложнений, миграции металлоконструкций и замедления консолидации, развития контрактур: такие виды осложнений возникали чаще в 1-й группе пациентов. Вероятно, это связано с поведенческими особенностями исследуемой группы пациентов, выявленными при анализе когнитивных нарушений у пациентов с ППОБК. <h3>ЗАКЛЮЧЕНИЕ</h3> Пациенты с ППОБК, страдающие старческими когнитивными дисфункциями, чаще подвержены осложнениям, чем больные с сохранной когнитивной функцией (37,5% против 10,9% соответственно), что существенно усложняет течение основного заболевания и ухудшает прогноз у лиц пожилого и старческого возраста.