Fracture Patients Research Articles

Readmission and mortality before and after introduction of orthogeriatric home visits: A retrospective cohort study in hip fracture patients

IntroductionOrthogeriatric collaboration in hip fracture patients during admission is well established, however, orthogeriatric involvement after discharge is not common. The aim of this study was to explore the association of orthogeriatric home visits with 30-day and 120-day readmission and mortality in ≥ 65-year-old patients surgically treated for hip fractures. Materials and MethodsA cohort of patients who underwent acute hip fracture surgery in an usual care period from January 2018 to December 2018 was compared with a cohort of patients in an intervention period from June 2020 to June 2021. During the intervention period, patients were offered orthogeriatric home visits at day 2 and 9 after discharge. The home visits were performed by orthogeriatric nurses, in close collaboration with geriatricians and orthopedic surgeons based in the local hospital. Readmission was defined as ≥ 12 h hospital stay, regardless of reason. For the main analysis, we applied Cox-regression models adjusted for age, sex, New Mobility Score, Cumulated Ambulation Score regained, cognitive function, Charlson Comorbidity Index, complications, medication, discharge destination and emergency department visits. ResultsIn total, 292 patients were included during the usual care period, and 308 patients during the intervention period. Thirty- and 120-day readmission rates were 27.7 % and 41.4 % in the usual care cohort vs. 21.8 % and 35.1 % in the home visit cohort. Adjusted Hazard Ratios for readmission in the intervention cohort after 30 and 120 days were 0.67 (CI95 %: 0.48–0.93) and 0.71 (CI95 %: 0.54–0.93) respectively. Thirty- and 120-day mortality rates were 7.2 % and 20.9 % in the usual care cohort versus 5.8 % and 13.3 % in the intervention cohort. Adjusted Hazard Ratios for mortality in the intervention cohort after 30 and 120 days were 0.68 (CI95 %: 0.35–1.31) and 0.56 (CI95 %: 0.37–0.84) respectively. ConclusionsIn a period where hip fracture patients were offered two home visits after discharge, we observed lower 30- and 120- day readmission, and lower 120-day mortality, calling for more studies with a randomized design.

Machine Learning for Treatment Management Prediction in Laryngeal Fractures

ObjectivesLaryngeal fractures are rare but potentially life-threatening traumas. Complications, such as airway obstruction and disrupted laryngeal anatomy, associate with significant morbidity. Early identification of at-risk patients and optimal management remain crucial for improved outcomes. Recently, machine learning (ML) has attained great attention as a unique and novel technique for evaluating complex non-linear relationships between multiple observations to create a predictive model with greater accuracy. This study aimed to demonstrate the potential of ML in predicting airway and surgical management of laryngeal fracture patients and identify key contributing parameters for the predictive performance of the ML models. MethodsThe ML models were developed using a patient series managed at the Helsinki University Hospital during 2005–2019. The developed models were further evaluated independently using a different cohort collected from the same institution between 1995–2004. ResultsThe ML showed a weighted area under curve (AUC) of 0.93 and accuracy of 0.86 following training for airway management. Likewise, for treatment approach, weighted AUC was 0.85 and accuracy 0.78. Injury type, Schaefer-Fuhrman grade (SF gr), age at incident, cause of injury, and fracture of the cricoid, in decreasing order of significance, were the most prominent features for the model's predictive performance for airway management. Similarly, our model identified SF gr, fracture of the cricoid, injury type, age at incident, and cause of injury as the most significant predictors for surgical treatment approach. ConclusionsThe proposed prediction of management approach by an ML technique can provide accurate predictions and thus aid clinicians in administering early and personalized interventions. The model may serve as a supporting tool in recognizing at-risk patients and in timely decision making. Further independent external validation is warranted for model generalizability.

Posterior Hip Pericapsular Block (PHPB) with pericapsular nerve group (PENG) block for hip fracture: a case series

BackgroundPain after total hip arthroplasty (THA) for femoral neck fracture (FNF) can be severe, potentially leading to serious complications. PENG block has become an optional local analgesic strategy in hip fracture surgery, but it cannot provide effective pain relief for the posterior capsule of the hip joint. Therefore, we modified the traditional sacral plexus nerve block and named it Posterior Hip Pericapsule Block (PHPB) to complement the blockade of the relevant nerves innervating the posterior hip capsule region. Thereby, we detail the analgesic effect of PHPB combined with PENG block on five hip fracture patients and the effect on their hip motor function.MethodsThis case series was conducted from December 2023 to February 2024. We performed ultrasound-guided PHPB combined with PENG block on five patients with hip fractures. Numerical Rating Scale (NRS) pain scores at rest and maximum NRS pain scores during limb movement of the five patients were recorded within 48 h after surgery. Their hip flexion, abduction, adduction, keen flexion and quadriceps muscle strength were also recorded. Serious postoperative complications, including wound infection, hematoma formation, or nerve injury, were recorded.ResultsThey experienced effective pain control within 48 h postoperatively, with NRS pain scores at rest decreasing from 3.0 (3.0, 4.5) to 0.0 (0.0, 1.0) and maximum NRS pain scores during limb movement from 8.0 (7.5, 8.5) to 1.0 (0.5, 2.0). They can autonomously perform hip flexion, abduction, adduction, and knee flexion within 48 h postoperatively without any signs of movement disorders or quadriceps muscle weakness. No severe postoperative complications, such as wound infections, hematoma formation or nerve damage, were observed in any of the patients.ConclusionsUltrasound-guided PENG block combined with PHPB provided effective analgesia for hip fracture patients in the perioperative period. It maintained hip joint motor function and quadriceps muscle strength within 24 h after THA.

A qualitative study of older adults: The difficulties and needs of returning home after hip fractures

BackgroundFalls and consequent fractures are an increasing problem among older adults, with low rates of return to previous functional condition and a substantial risk of subsequent falls. This scenario points to the need for an improved response to this population's needs. ObjectiveTo define the difficulties and needs felt by older adults with hip fractures when returning home. MethodsThis was a descriptive and exploratory qualitative study. Semi-structured interviews were conducted with hip fracture patients who had been submitted to surgery and who were treated at a hospital in the central region of Portugal. Bardin's content analysis was used to analyze the data. Content analysis was carried out with the support of MAXQDA® Analytic pro 2022 software. ResultsThe analysis of the results of the 15 interviews yielded three categories related to the difficulties perceived by hip fracture patients on returning home: functional limitations; pain; and emotional management. Regarding the needs felt, the following categories emerged: resources/help with activities of daily living; capacity-building for the return home; and information. ConclusionsThe needs and difficulties of older adults with hip fractures on returning home are multiple and variable. Knowledge of these aspects can significantly enhance the standardized actions of nurses in this area of intervention, contributing to the improvement of continuity of care and ensuring a safe transition.

Who breaks their hip? A decade of traumatic hip fracture data

Aims & objectivesHip fractures lead to significant morbidity, mortality, and healthcare costs, particularly in elderly populations. Understanding the mechanisms underlying these fractures is crucial for developing targeted prevention strategies and counseling patients. MethodsThe National Electronic Injury Surveillance System (NEISS) was utilized to identify a cohort of 25,068 hip fractures from 2013 to 2022. The inclusion criteria mandated classification as a lower trunk fracture and explicit mention of hip fracture in the narrative. Patient age, race, sex, incident location, the time of year, and associated consumer products were compared using 95% confidence intervals and Chi-Squared tests of independence. ResultsA total of 25,068 hip fracture patients were included in this study. Females were more likely to fracture their hip (P < .001) representing 68.4% (95% CI 67.8%–69.0%) of all fractures. Patients were most likely to injure themselves at home (P < .001), accounting for 62.0 % (95% CI 61.4%–62.6%) of fractures. Falls to the floor represented 36.0 % (95% CI 35.4%–36.6%) of fractures, while fractures related to beds, stairs, and chairs emerged as other prevalent mechanisms at 11.2% (95% CI 10.8%–11.6%), 7.9% (95% CI 7.5%–8.2%), and 5.4% (95% CI 5.1%–5.7%), respectively. In the 50–60 age group, stairs present a prominent risk, representing 12.4% (95% CI 10.6%–14.5%) of fractures. Younger individuals suffered fractures most commonly due to high energy activities, such as falls from ladders, bicycles, and stairs (P < .001). ConclusionWhile falls remain the chief cause of hip fractures, many of these injuries stem from overlooked mechanisms. The heightened risk associated with falls from beds and chairs in the elderly, stair-related injuries in middle-aged individuals, and high-force modalities in younger people, highlights the necessity for tailored preventive measures. Providers should counsel their patients on risk reduction measures within the home, while Medicare and other insurers must work to expand coverage for these same measures.

Real-world mobility recovery after hip fracture: secondary analyses of digital mobility outcomes from four randomized controlled trials.

The main focus of rehabilitation following hip fracture is to regain mobility. To estimate the progression of real-world mobility the first year after hip fracture using digital mobility outcomes. An exploratory, prospective cohort study with pooled data from four previously conducted clinical trials. We combined data from the Trondheim Hip Fracture Trial and Eva-Hip Trial in Trondheim, Norway, and the PROFinD 1 and PROFinD 2 trials in Stuttgart and Heidelberg, Germany, resulting in a sample of 717 hip fracture patients aged ≥65years. Each of the trials assessed mobility using body-fixed sensors (activPAL) at three time points, collectively providing observations across the entire first year post-surgery. The following 24-h DMOs were calculated: total walking duration (minutes), maximum number of steps within a walking bout, and number of sit-to-stand-to-walk transfers. Continuous 1-year progression of the median, the 25th percentile, and the 75th percentile were estimated using quantile regression models with splines. The dataset contained 5909 observation days. The median daily total walking duration increased until 36weeks post-surgery reaching 40min; daily maximum number of steps within a walking bout increased during the first eight weeks and then stabilized at less than 100 steps; daily sit-to-stand-to-walk transfers reached a plateau after 6 weeks with less than 40 transfers. The three DMOs progressed differently and attained plateau levels at varying times during the first year after hip fracture, indicating that these Digital Mobility Outcomes provide complementary information about different aspects of mobility recovery.

Hip Fracture Management in a Major Trauma Centre: The Impact of 'Smart Phrase' Integration Into Electronic Clerking on Culture and Adherence to Guidelines.

The National Institute for Health and Care Excellence (NICE) introduced guidelines in 2011 for the management of hip fractures in patients over the age of 65. NICE CG124 recommended different procedures depending on the demographics of the patient and fracture pattern. In terms of compliance in 2019, Addenbrooke's Hospital (ADH) was found to be in line with the national average, although room for improvement was noted. The aim of this study was to identify and address areas of substantial non-compliance at ADH. A total of 1636 patients who sustained a hip fracture between 2017 and 2020 and who subsequently underwent surgery at ADH were retrospectively analysed. We collected data from the National Hip Fracture Database (NHFD), digital medical records, and digital imaging systems. We then amended the clerking proforma by adding a 'smart phrase' and re-analysed another 543 patients who attended ADH following hip fracture between 2021 and 2022, using the same data collection methods. From 2017-2020, total adherence to CG124, Section 1.6, was 76.04%. Our results demonstrated that 56.43% of all hip fracture patients indicated for total hip arthroplasty (THA) did not have documented consideration for the procedure. In 2021-22, following the addition of our 'smart phrase,' we made to the clerking proforma, total adherence improved to 87.43%, with only 42.11% of THA-indicated patients lacking documented consideration of the procedure, down from 65.41% in 2020. The use of our smart phrase decreased during the follow-up without a corresponding drop in compliance. In January 2023, NICE CG124 underwent changes, rendering our ADH changes outdated. However, we have demonstrated that we can increase NICE guideline compliance by standardising and encouraging formal documentation of the decision-making process. As electronic patient record (EPR) systems become more widespread, we have shown how 'smart phrases' can be used to generate change and increase compliance, even over a short period of time.

A clinical assessment of preperitoneal packing adequacy for pelvic fracture bleeding control

BackgroundThis study aimed to objectively assess the laparotomy pads to potential hemorrhage sites proximity in pelvic fracture patients who underwent post-pre peritoneal packing (PPP) CT scans with packs in situ. MethodsThe CT scans of 19 patients were assessed to measure the distance between laparotomy pads and predetermined pelvic anatomical landmarks. ResultsA total of 38 measurements showed that the median pack-to-point distance for the sacroiliac joint was 2.7 cm (IQR, 2.1–4.0), for the common iliac artery 4.1 cm (IQR, 3.2–5.0), for the external iliac artery 0 cm (IQR, 0.0–0.2), for the internal iliac artery 0.1 cm (IQR, 0–0.7), and for the iliac bifurcation 2.0 cm (IQR, 1.7–3.9). There were 60 % direct contact measurements for the iliac arteries. ConclusionThis study shows that with adequately executed PPP a reasonable proximity of laparotomy packs to the potential bleeding sites to provide tamponade for arresting hemorrhage may be achieved.

Clinical significance and underlying mechanism of long non-coding RNA SNHG12 in lower extremity deep venous thrombosis.

D-dimer is widely used in the diagnosis of deep vein thrombosis (DVT), but the specificity is low. The study examined the diagnostic value of long non-coding RNA (lncRNA) SNHG12 in DVT, and preliminarily discussed its mechanism. SNHG12 levels were detected in 200 elderly fracture patients via RT-qPCR, including 38 DVTs. Logistic regression analysis and receiver operating characteristic (ROC) curve were applied for diagnostic value evaluation. HUVECs were used for function study. Cell proliferation, migration, apoptosis, release of inflammatory cytokines, and adhesion factors were detected. Student's t test and one-way ANOVA were applied for data comparison between two or among three or more groups. Correlation analysis of indicators was completed via Pearson's correlation analysis. Bioinformatics analysis predicted the target miRNAs and genes of SNHG12, with GO and KEGG for the function enrichment. It was found that SNHG12 was at low expression in DVT patients, and negatively correlated with D-dimer concentration (r = -0.535). SNHG12 and D-dimer were independent influence factors related to the development of DVT. SNHG12 and D-dimer combination had the best performance in DVT diagnosis. In HUVECs, SNHG12 promoted cell proliferation and migration and restricted the release of inflammatory cytokines and adhesion factors, but these influences were counteracted by miR-424-5p. A total of 208 overlapping target genes of miR-424-5p were identified, and their function was enriched in cellular cycle and senescence. PI3K-Akt signaling pathway was the most significant pathway based on KEGG results. In conclusion, SNHG12 had good diagnostic potential for DVT combined with D-dimer. SNHG12 maintains vascular endothelial cell function by acting as a competitive endogenous RNA (ceRNA) for miR-424-5p.

‘NOF Said’: enhancing perioperative management of hip fracture patients in Royal Victoria Hospital Belfast

‘NOF Said’: enhancing perioperative management of hip fracture patients in Royal Victoria Hospital Belfast

Diagnostic value of fibrinogen in lower extremity deep vein thrombosis caused by rib fracture: A retrospective study.

Objectives: To investigate the diagnostic value of fibrinogen (FIB) in patients with rib fractures complicated by lower extremity deep venous thrombosis (DVT).Methods: Analyzing data from 493 patients at Shijiazhuang Third Hospital, FIB levels at 24, 48, and 72h post-injury were compared between DVT and non-DVT groups.Results: DVT group had elevated FIB levels at all times (p < .001). FIB at 24h showed highest AUC, particularly in patients with BMI <28.Conclusion: In conclusion, measuring FIB at 24h post-injury enhances DVT detection in rib fracture patients, with potential BMI-related variations.

Relation of Mandibular Canal Discontinuity and IAN Paresthesia in Operated Cases of Mandibular Fracture.

Mandibular fractures are common in maxillofacial trauma, often requiring surgical intervention for optimal recovery. One critical concern during such procedures is the potential for nerve damage, specifically involving the mandibular canal. This study aims to investigate whether the presence of postoperative mandibular canal discontinuity is associated with an increased risk of nerve damage. A retrospective analysis was conducted on a cohort of 72 postoperative mandibular fracture patients. In total, 58 patients had entire mandibular canal continuity, while 14 showed discontinuity. Clinical records and follow-up data were examined to assess the occurrence of nerve injury. Statistical analysis was performed to determine the significance of any correlation. Of the 14 patients with mandibular canal discontinuity, 9 (64.28%) exhibited paresthesia. In patients where mandibular canal continuity was maintained, 5 (8.62%) patients reported paresthesia. These results suggest a higher incidence of paresthesia in patients with mandibular canal discontinuity, albeit with a small sample size. Notably, only 3 patients in the discontinuity group did not show any sign of improvement, while the remaining patients in both groups demonstrated complete recovery in 6 months of follow-up period. The findings suggest a potential link between mandibular canal discontinuity and an increased risk of paresthesia in postoperative mandibular fracture patients. It is hypothesized that discontinuity may lead to nerve compression, irritation, or direct damage during healing. The observed complete recovery in most patients, including those with paresthesia, highlights the potential for the nervous system to repair itself over a period of time. However, further studies with larger sample sizes are warranted to establish a more definitive correlation. This study provides preliminary evidence that mandibular canal discontinuity may contribute to a higher incidence of paresthesia in postoperative mandibular fracture patients. Clinicians should be cautious when addressing mandibular fractures to minimize the risk of nerve damage, particularly in cases involving canal discontinuity. The encouraging trend of complete recovery among the majority of patients suggests a positive prognosis for nerve healing.

The Functional Outcome of Patients Treated with Proximal Femoral Nail (Pfn) for Sub Trochanteric Femur Fracture in Ayyub Teaching Hospital, Abbottabad

Sub-trochanteric femur fractures are challenging for orthopedic surgeons to fix owing to their location and associated consequences. Different intramedullary and extra-medullary implant stabilization techniques have been explored with varying degrees of effectiveness. Objective: To assess the functional outcomes of proximal femoral nail in patients treated for sub-trochanteric femur fracture. Methods: This cross-sectional study investigated 28 patients of sub trochanteric femur fracture treated with proximal femoral nail in Orthopedic Unit of Ayub Teaching Hospital, Abbottabad from January 2021 to March 2024. Patients aged≥20 years who suffered from sub-trochanteric femur fracture and fit for surgery were included. All the patients were immobilized before surgery. Skin traction was applied and prepared for surgery. Postoperative outcome was assessed using the Harris hip score. Results: The overall mean age was 56 ± 10.8 years. Out of 28 cases, there were 18 (64.3%) male and 12 (35.7%) female. The overall mean of hospital duration was 14 ± 4.6 days. The majority of patients were 41-60 years old. Postoperative independence of ambulation was assessed in each patient after three, five, and six months. After 5 months, only two patients were unable to move around unassisted. Based on the Harris Hip Score, the incidence of exceptional, good, and fair outcomes was 6 (21.4%), 5 (17.9%), and 17 (60.7%) respectively. Conclusion: It was concluded that sub-trochanteric femur fractures can be treated with a proximal femoral implant, which offers advantages in terms of increased stability, quick disposition and minimal exposure.

Introduction of A Proforma to Improve Communication to General Practitioners from an Acute Orthogeriatric Service

Abstract Background The National Office of Clinical Audit Irish Hip Fracture Standards 5 and 6 advise “patients with hip fracture should have their bone health assessed to determine their need for therapy to prevent future osteoporotic fractures” and “hip fracture patients should receive a specialist falls assessment and intervention to prevent further falls”. Ideally, these assessments should be communicated clearly via discharge summaries to avoid omission or duplication of treatment. Methods An admission proforma for an acute orthogeriatric service assessing inpatients with fragility fractures was developed. We retrospectively audited orthogeriatric patients’ discharge summaries prior and post introduction of the proforma. Patients who had atraumatic fractures were appropriately excluded from audit on their falls assessment. Results The total number of patients was 98. There were 70 patients in the pre-orthogeriatric proforma group and 28 patients in the post-orthogeriatric proforma group. The average age was 80.34 (SD 8.78). There were 55 females. The average length of stay was 18.08 days (SD 10.49). In the pre-orthogeriatric proforma group a falls assessment was reported in the discharge summary for 85.29% (n=58), bone protection; 60% (n=42). In the post-orthogeriatric proforma group a falls assessment was reported in the discharge summary for; 96.15% (n=25), bone protection; 61% (n=17). 100% of patients included had a bone protection plan: IV Zoledronic acid for 56 patients, denosumab for 26 patients, DEXA for 4 patients, virtual follow-up for 8 patients, onward specialty referral for 2. One patient was from overseas and for follow-up locally. Conclusion An orthogeriatric proforma may improve communication of falls assessment and bone protection plans in discharge summaries. Despite 100% of patients having a bone protection plan, there was a discrepancy of this in the discharge summaries. A dedicated orthogeriatric intern would ensure communication is accurate. This could avoid potential duplication or omission of prescribing of anti-resorptive treatment.

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.

Estimating Patient Eligibility And Benefit Of Intravenous Zolendronic Acid In Hip Fracture Patients: A Service Evaluation

Abstract Background Low trauma hip fractures are serious and carry an estimated re-fracture rate of 10.6%, leading increased morbidity, mortality and healthcare cost. Intravenous Zolendronic Acid (IVZ) administration following hip fracture reduces re-fracture risk by approximately 23% and is recommended yearly for three years by National Osteoporosis Guidelines Group (NOGG) 2021. However, a significant treatment gap remains with only one-fifth of patients receiving IVZ pre-discharge, due to implementation challenges, such as suboptimal Vitamin D levels and lack of resources for yearly infusions. Recently published consensus guidelines offer practical advice as to how to overcome these barriers. This service evaluation estimates the proportion of hip fracture patients eligible for IVZ; as well as the re-fracture rate, prior to the introduction of a local IVZ pathway. Methods Approval from local Quality and Patient Safety Department was received. Low trauma hip fracture patients were identified from the local Orthogeriatric database (October 2019 to January 2021). Hospital electronic laboratory and radiology software were used to identify renal function on discharge and evidence of further fractures (at six months, 1 year and 3 years). Subjects were deemed potentially eligible for IVZ if they had an estimated glomerular filtration rate (eGFR) of ≥50 mls/min (a proxy for calculated creatinine clearance ≥30mls/min in this patient cohort). Results Of 463 subjects, 384 (82.9%) had an eGFR ≥50. Re-fracture data was collected for 263 eligible subjects. Seventeen (6.5%) re-fractured within six months, 21 (8%) re-fractured within a year and 45 (17.1%) re-fractured at any stage post discharge. Conclusion IVZ treatment is the most efficacious secondary fracture prevention post-hip fracture, and most patients are eligible for this treatment. Implementing IVZ pathways for hip fracture patients may significantly reduce re-fracture rate, however expansion of resources allocated to Orthogeriatrics and Fracture Liaison teams is required to successfully implement inpatient pathways and ongoing care.

Perioperative Management Of Diabetes Mellitus In Older Hip Fracture Patients

Abstract Background Hip fracture is one of the most serious injuries sustained by older adults worldwide, associated with increased morbidity and almost 25% mortality at one year. Pre-existing comorbidity worsens prognosis, e.g. hip fracture patients with Diabetes Mellitus (DM) have increased mortality rates, worse functional outcomes, and higher post-operative complications rates. Perioperative blood glucose optimisation may improve outcomes, however this can be challenging due to periods of fasting and reduced intake, as well as complications such as infection. Local guidelines for the peri-operative management of DM have been developed and are sign-posted in our hip fracture integrated admission document. This audit aimed to compare current practice with those recommended in local guidance. Methods Since 1st January 2024, 31 hip fracture patients aged ≥65 years with DM have been admitted. Charts were available on twenty patients, and hence reviewed. Results Of 20 patients, four were on insulin; 13 on metformin; four on sulphonylureas; five on SGLT2 inhibitors; and six on DPP4 inhibitors. No intraoperative hypoglycemic events nor episodes of Diabetic Ketoacidosis were documented; however, ketones were not checked in the majority of patients during admission. Eleven (55%) had HbA1C either done in the previous six months or during admission. Blood Sugar Levels were checked on admission in 9/20 (45%). The protocol was followed in only one patient on insulin; and 5/13 metformin patients. The protocol was followed in all Sulphonylurea prescriptions, and in 4/5 SGLT2 inhibitor prescriptions, however these medications were not held by the Orthopaedic team, rather by nursing staff while the patient was fasting pre-operatively. Conclusion This audit demonstrates poor adherence to local guidance on peri-operative management of diabetes, particularly perioperative insulin adjustments. We aim to develop an educational intervention (including group teaching, plus distribution of flashcards and posters) for Orthopaedic SHOs and interns and re-audit in the coming months.

Examining Post Hip Fracture Bone Protection At 30 days After Admission To An Irish Hospital

Abstract Background The Irish Hip Fracture Database (IHFD) includes a national standard of bone assessment during the acute episode of care. Furthermore, IV Zoledronic Acid (IVZ) is now recommended after hip fracture to provide longer term bone protection. It is not known however, how many patients commence appropriate bone therapy, by 30 days after admission. This audit aimed to examine commencement of bone protection medication for hip fracture patients across one acute hospital and its associated rehabilitation sites. Methods A retrospective audit was conducted. Consecutive patients admitted between December 2022 and December 2023, with hip fracture to a single acute hospital were included. Patients that did not meet IHFD inclusion criteria, were excluded. Patients were contacted in-person or by telephone by a physiotherapist to ask about bone-protection medication at 30 days after hip fracture admission, as part of a broader follow-up. Results A total of 146 patients were included for follow-up at 30 days after hip fracture admission. Of these patients, n=13 (9%) had died within this time and n=7 were not contactable at 30 days. A further n=8 (5%) did not receive bone-health follow-up. Only n= 3 patients contacted were not started on bone medication because it was contraindicated. While it is known that many patients were given IVZ as inpatients, it was not possible to determine this information accurately from patient report or current information recorded in the IHFD. Conclusion Most participants were administered bone protection medication by day 30 post hip fracture admission, however in some cases this was difficult to determine. The process of conducting the audit has improved commencement and recording of specific medication, in particular IVZ. The introduction of long-term outcomes into the IHFD should facilitate our hospital to benchmark our bone protection coverage nationally.

Irish Hip Fracture Database Frailty Index Predicts Delirium Incidence and Length of Stay in Older Adults Admitted with Hip Fractures

Abstract Background The Irish Hip Fracture Database (IHFD) Frailty Index was developed with the National Office for Clinical Audit has been shown to predict adverse outcomes in older adults with fractures in retrospective review of national data. Here we examined the tool prospectively in clinical practice and its ability to predict delirium and length of stay. Methods We prospectively collected data on all hip fracture patients admitted to an acute orthopaedic floor from October 2022 to May 2024. Patients aged &amp;lt; 60 years or those with atypical femoral or peri-prosthetic fractures were excluded. The 21-item frailty index was applied to all eligible patients. Delirium diagnosis was based on a composite of clinical diagnosis and a 4AT score ≥ 4. Regression analysis was used to examine the relationship between delirium and length of stay with Frailty Index, age and sex. Results A total of 260 patients were included in the study, of whom 72% were female. The mean age was 80 ± 10 years, and 7.7% were nursing home residents. Additionally, 24.2% of patients were discharged directly home, while 40.3% were discharged to rehabilitation. Delirium developed in 24.6% of patients, and 24.9% of patients had a LOS exceeding 30 days. Higher frailty index scores were significantly associated with both LOS (p = 0.001) and delirium (p = 0.013) in both unadjusted and adjusted analyses. There was no significant association between age or sex and LOS or delirium in adjusted analysis. Conclusion The IHFD Frailty Index facilitates a pro-active risk stratification that is based on comorbidities and functional status. IHFD Frailty index independently predicted delirium and length of stay while age did not. Further studies integrating this tool into everyday practice in the care of older patients with hip fractures is warranted.

Association Between Serum Albumin And Lower Limb Ultrasound Muscle Thickness in Older Patients Admitted with Hip Fracture

Abstract Background Sarcopenia is an important geriatric syndrome that is common in older patients admitted to the hospital with hip fracture. Nutritional status is known to be associated with sarcopenia in the general population, but less is known about this association in hospitalised hip fracture patients, especially when considering biochemical nutritional biomarkers. Our aim was to contribute evidence in this regard. Methods We recruited patients over the age of 75 years admitted to a hospital with hip fracture. During admission, we measured muscle thickness (MT) of the rectus femoris (contralateral to the fracture) using ultrasonography (Sonosite M-Turbo). All patients had serum albumin measured on admission, and in a subsample we were able to measure body mass index (BMI). We performed bivariate correlation between serum albumin and MT, and linear regression models were computed to assess how MT was predicted by albumin, controlling for age, sex, and BMI. Results 69 patients were recruited, mean age 87.8 years (SD 6.3; minimum 76, maximum 103), and 79.7% were women. Mean MT was 1.19 cm (SD 0.36). Serum albumin was available in 68 patients (mean 3.30 g/dl, SD 0.36), and BMI was available in 41 patients (mean 25.4 kg/m2, SD 4.0). The correlation between serum albumin and MT was statistically significant (Pearson’s coefficient = 0.263, p = 0.030). After controlling for age and sex in n = 68, albumin was the only significant predictor of MT (Beta = 0.275, p = 0.036). When adding BMI to the model in n = 41, albumin was the only significant predictor of MT (Beta = 0.364, p = 0.026). Conclusion Serum albumin was independently predictive of MT in hospitalised hip fracture patients. Serum albumin may be a useful biochemical nutritional biomarker of risk of sarcopenia in this population, and further research is required to confirm this biologically plausible observation.