Functional Outcome In Elderly Patients Research Articles

An evaluation of functional outcome in elderly patients with proximal humeral fractures treated conservatively

Aim: The relationship between radiological data and the clinical outcomes in elderly patients with incomplete proximal humeral fractures treated conservatively is limited and controversial in the literature. We aimed to report the short-to-mid-term results of the radiological data and functional outcome in these patients. Methods: A total of 114 patients over 65 years of age, diagnosed with unilateral isolated incomplete proximal displaced humerus fractures, and treated conservatively, were recruited in the study. Demographic characteristics, radiological data and clinical scores of all patients were recorded. Fractures were classified according to the Neer classification. Functional evaluation of patients was performed via Quick-Disabilities of Arm, Shoulder, and Hand (Quick-DASH) and Visual Analog Scale (VAS). Results: Mean VAS and Quick-DASH scores of the patients were 3.6 (1.4) and 34.5(13.7), respectively, both of which changed significantly as the number of the parts of fracture increased (P=0.02 and P=0.04, respectively). The VAS and the Quick-DASH scores were significantly higher in females (P=0.02 and P=0.03, respectively), similar among the smokers (P=0.58 and P=0.41, respectively), and significantly higher in diabetic and osteoporotic patients (P<0.001 and P=0.39, respectively). Conclusion: Functional outcomes after conservative follow-up in patients over 65 years of age with incomplete proximal humerus fractures are good in most patients. Therefore, conservative treatment can be an option regardless of the fracture type in elderly patients with incomplete proximal humeral fractures.

Evaluation of Austin Moore prosthesis in the femur neck fracture management: Retrospective study

Introduction: Femoral neck fractures have been considered unsolvable fractures ‘in the older era of orthopedics due to the high rate of associated complications, which include non-union and avascular necrosis of the femoral head, among others. The aim of the study was to assess the functional outcome following the use of Austin Moore prosthesis in the elderly population and to substantiate the use of AMP in modern-day orthopedic practice. Materials and Methods: A total of 40 patients were included in the study. The patients who were more than 60 years of age, those were not having any major hip surgery or problem before the fracture; all those who were treated with Austin prosthesis were included in the study. Results: The patients were graded as excellent, good, fair, and poor depending on the functional outcome of the study based on each of the criteria for the assessment of the hip. The score range from 30 to 95 in the present study. Good to excellent results were obtained in around 45% of patients, satisfactory results were obtained in 30% and the poor result was obtained in 25% patients. Conclusion: Hemiarthroplasty with Austin Moore Prosthesis for fracture neck of femur gives fairly good long term functional outcome in elderly patients. Patients are, for the most part, without pain. Even if there, pain is usually not disabling and doesn‘t affect routine ambulation, except when the prosthesis is loose or there is acetabular erosion. These complications are the exception rather than the norm.

Mortality, complications and long-term functional outcome in elderly patients with fragility fractures of the acetabulum

BackgroundEarly operative treatment of acetabulum fractures in geriatric patients has been suggested to reduce pain and allow for earlier mobilization. The aim of this study was to determine mortality, complications and functional outcome after operative and non-operative treatment.MethodsPatients aged ≥60 years with operative treatment of low-energy fragility fracture of the acetabulum from 2009 to 2016 and a follow-up of at least 24 months were identified. The patients were contacted by phone and a modified Merle d’Aubigné score was obtained. If patients or their relatives were not available for follow-up, mortality data was assessed using a national social insurance database.ResultsOne hundred seventy-six patients (mean age 78, SD 10 years; 73 female) were available for analysis of mortality data. At final follow-up (68 months, SD 26, range, 24 to 129), 99/176 patients (56.3%) had deceased. One-year-mortality was 25.0% and 2-year mortality 35.8%. Type of treatment (non-operative vs. operative) did not affect mortality at 1 and 2 years (p = .65 and p = .10). Hospital-acquired infections were observed in 31/176 cases (17.6%), thromboembolic events and delirium in 6 patients (3.4%). In-hospital mortality was 5.7%. Patients who underwent operative treatment were more likely to have an in-hospital infection (p = .02) but less likely to sustain thromboembolic events (p = .03).The mean hospital stay was 14 days (SD 10 days, range, 1 to 66). Patients with operative treatment were longer hospitalized than patients with non-operative treatment (p < .001).The rate of secondary conversions to THA was 12.4%, this was not affected by initial treatment.The mean modified Merle d’Aubigné Score of those patients available for a final follow-up (n = 47; follow-up 56 months, SD 28, range, 24 to 115) was 14/18 points, SD 3 (range 7 to 18). Functional results at final follow-up between operatively and non-operatively treated patients were without difference.ConclusionsAll-cause mortality and in-hospital complications are high among geriatric patients with low-energy fractures of the acetabulum even when treated operatively. Secondary conversion rates to THA are similar to those seen in younger patients. Mid-term functional outcome in those surviving is fair.

Cognitive and Functional Outcomes in Elderly Patients with Post-Stroke Delirium

Cognitive and Functional Outcomes in Elderly Patients with Post-Stroke Delirium

Functional Outcome of Elderly Patients Treated for Odontoid Fracture: A Multicenter Study.

Retrospective multicenter study. Analysis of impact of conservative and surgical treatments on functional outcome of geriatric odontoid fractures. Treatment of odontoid fractures in aged population is still debatable. One hundred fourty-seven consecutive odontoid fractures in elderly patients were classified according to Anderson-D'Alonzo and Roy-Camille classifications. Philadelphia type collar was always positioned and kept as a treatment whenever acceptable. Halo-vest, anterior screw fixation, C1-C2 posterior arthrodesis, and occipito-cervical fixation were the other treatments adopted. Conservative or surgical treatment strategy was more significantly influenced by antero-posterior displacement (< or >5 mm) and by surgeon decision. On admission ASA, modified Rankin scale (mRS-pre) and Charlson Comorbidity Index (CCI) were assessed. Modified Rankin scale (mRS-post), Neck Disability Index (NDI), and Smiley Webster Pain Scale (SWPS) were administered 12 to 15 months after treatment to estimate functional outcome in terms of general disability, neck-related disability, and ability to return to work/former activity. Risk of treatment crossover was calculated considering factors affecting outcome. Fracture healing process in terms of fusion-stability, no fusion-stability, no fusion-no stability was evaluated at 12 months through a cervical computed tomography (CT) scan. Dynamic cervical spine x-rays were obtained whether necessary. No fusion-stability was considered an adequate treatment goal in our geriatric population. Chi square/Fisher exact test and logistic regression were performed for statistical anal. Overall 67 patients were treated conservatively whereas 80 underwent surgery. Collar was adopted in 45 patients, while anterior odontoid fixation and C1-C2 posterior arthrodesis were preferred for 30 patients each. 79.8% of patients showed good outcomes according to NDI. No significant differences were observed between patients of 65 to 79 years and more than or equal to 80 years (P = 0.81). CCI greatly correlated with mRS-post, with higher indexes in 68.8% of cases characterized by good outcomes (P = 0.05). mRS-pre correlated with NDI (P < 0.000001) and mRS-post (P = 0.04). CCI, mRS-pre, and surgery were associated with worse NDI, while both C1-C2 posterior arthrodesis and occipito-cervical stabilization were associated with worse mRS-post, respectively in 40% and 30% of cases. Younger patients had a higher risk of treatment crossover. mRS-pre and CCI provided two independent predictive values respectively for functional outcome and post-treatment disability. Compared with conservative immobilizations, surgery revealed no advantages in the elderly in terms of functional outcome. 3.

Does adding an integrated physical therapy and neuromuscular electrical stimulation therapy to standard rehabilitation improve functional outcome in elderly patients with pneumonia? A randomised controlled trial

Objective: To compare the effects of an integrated programme of physical and electrical therapy to standard rehabilitation to improve physical and functional performance in elderly patients with pneumonia. Design: Randomized clinical trial. The study was registered in the ClinicalTrial.gov website (identifier: NCT02515565). Setting: University Hospital. Subjects: In total, 185 elderly patients with pneumonia were eligible for the study, of which 95 were finally randomized. Interventions: Patients were randomized to a control group which received the standard treatment or to an intervention group which received additionally an integrated programme of physical and electrical therapy. Main measures: Demographic and clinical information was acquired. Pulmonary function, length of hospital stay, handgrip strength, independence levels and comorbidities were assessed as descriptive outcomes. The main outcome measure was functional and physical performance, evaluated with the short physical performance battery. Secondary outcome measures were respiratory symptoms including dyspnoea, fatigue and cough. Results: Mean age of patients was 74.92 (11.03) years in the intervention group and 72.53 (9.24) years in the control group. Significant between groups differences (P < 0.05) were found in short physical performance battery chair stand test (2.17 (0.97) vs. 0.58 (0.61)) and total score (5.91 (3.61) vs. 4.15 (3.15)). The intervention group showed better performance than the control group in both cases. Fatigue (32.04 (18.58) vs. 46.22 (8.90)) and cough (18.84 (2.47) vs. 17.40 (3.67)) showed higher improvement in the intervention group, and significant differences were observed between the groups. Conclusion: An integrated programme of physical and electrical therapy during hospitalization improves physical and functional performance in patients with pneumonia.

Prestroke sarcopenia and functional outcomes in elderly patients who have had an acute stroke: A prospective cohort study.

The association between prestroke sarcopenia and functional outcomes in patients who have had a stroke has not, to our knowledge, been evaluated to date. We aimed to investigate the prevalence of prestroke sarcopenia, and determine whether prestroke sarcopenia is associated with functional outcomes in elderly patients who have suffered an acute stroke. We assessed prestroke sarcopenia in elderly patients with acute stroke using the SARC-F questionnaire. Patients were divided into two groups according to their SARC-F score: non-sarcopenia (SARC-F score <4) and prestroke sarcopenia (SARC-F score ≥4). The study endpoint was the modified Rankin Scale score at 3 mo after the stroke (0-3, good outcome; 4-6, poor outcome). The Mann-Whitney U-test, Pearson χ2 test, Fisher exact test, and logistic regression were used in the statistical analyses. Of the 152 patients (81 men; median age [interquartile range]: 76 [11] y) enrolled, the prevalence rate of prestroke sarcopenia was 18% (27 patients). These 27 patients showed poor functional outcome at 3 mo after the stroke (50% versus 12%, prestroke sarcopenia versus nonsarcopenia; P < 0.001). After adjusting for variables, prestroke sarcopenia was an independent predictor of poor functional outcome at 3 mo after stroke (odds ratios: 7.39, 95% confidence interval: 1.47-37.21, P = 0.02). Prestroke sarcopenia is an independent predictor of functional outcome at 3 mo after a stroke. Our findings highlight the importance of detecting prestroke sarcopenia in elderly patients with acute stroke.

Long-term functional outcome after a low-energy hip fracture in elderly patients

BackgroundThe incidence of hip fractures is increasing. Elderly patients with a hip fracture frequently present with comorbidities, which are associated with higher mortality rates. Clinical studies regarding long-term functional outcome and mortality in hip fractures are rare. The aim of this study was to analyse the functional outcome and the mortality rate after a follow-up of 5 years in elderly patients with a hip fracture.Materials and MethodsThis combined retrospective and cross-sectional study included patients aged 65 years or older with a low energy hip fracture who underwent surgery in the Maastricht University Medical Center+, the Netherlands. Data such as demographics and mortality rates were retrospectively collected and functional outcome (i.e. mobility, pain, housing conditions and quality of life) was assessed by a questionnaire.ResultsTwo hundred and sixteen patients were included in this study (mean age 82.2, SD ± 7.5). No significant differences were found in pain before hip fracture and after 1-year and 5-year follow-ups. Long-term functional outcome deteriorated after a hip fracture, with a significant increase in the use of walking aids (p < 0.001), a significant decrease of patients living in a private home (p < 0.001), and a low physical quality of life (SF-12 PCS = 27.1). The mortality incidences after 30-day, 1-year and 5-year follow-ups were 7.9%, 37.0% and 69.4%, respectively.ConclusionLong-term functional outcome in elderly patients with hip fractures significantly deteriorated, with an increased dependency for mobility and housing conditions and a decreased physical quality of life. In addition, hip fractures are associated with high mortality rates at the 5-year follow-up.Level of evidenceLevel III, a retrospective cohort study.

Type II odontoid fracture in elderly patients treated conservatively: is fracture healing the goal?

Analysis of functional outcome of elderly patients with type II odontoid fractures treated conservatively in relation to their radiological outcome. A total of 50 geriatric patients with type II odontoid fractures were treated with Aspen/Vista collars. On admission, each patient was assessed assigning ASA score, modified Rankin Scale (mRS-pre) and Charlson Comorbidity Index (CCI). From 12-15months after treatment, functional evaluations were performed employing a second modified Rankin Scale (mRS-post) together with Neck Disability Index (NDI) and Smiley-Webster pain scale (SWPS). Radiological outcome was evaluated through dynamic cervical spine X-rays at 3months and cervical spine CT scans 6months after treatment. Three different conditions were identified: stable union, stable non-union and unstable non-union. Surgery was preferred whenever a fracture gap > 2mm, an antero-posterior displacement > 5mm, an odontoid angulation > 11° or neurological deficits occurred. Among the 50 patients, 24 reached a stable union, while 26 a stable non-union. Comparing the two groups, no differences in ASA (p = 0.60), CCI (p = 0.85) and mRS-pre (p = 0.14) were noted. Similarly, no differences in mRS-post (p = 0.96), SWPS (p = 0.85) and NDI (p = 0.51) were observed between patients who reached an osseous fusion and those with a stable fibrous non-union. No effects of age, sex, ASA, mRS-pre, fracture dislocation and radiological outcome were discovered on functional outcome. At logistic regression analysis, female sex and high values of CCI emerged associated with worse NDI. In geriatric type II odontoid fractures, pre-injury clinical status and comorbidities overcome imaging in determining post-treatment level of function. Hard collar immobilization led to a favourable functional outcome with mRS-post, NDI and SWPS values diffusely encouraging whatever a bony union or a fibrous non-union was obtained. These slides can be retrieved under Electronic Supplementary Material.

Sleep and Intensive Care Unit-Acquired Weakness in Critically Ill Older Adults.

Older adults in the intensive care unit (ICU) often experience sleep disturbances, which may stem from life-threatening illness, the ICU environment, medications/sedation, or psychological stress. Two complementary endocrinological responses occur as a result of compromised sleep and consequently could exacerbate ICU-acquired weakness: a decrease in anabolic hormones leading to decreased protein synthesis and an increase in catabolic hormones leading to increased protein degradation. Age-associated decreases in anabolic hormones, such as insulin-like growth factor 1, testosterone, and growth hormone, may inhibit protein synthesis. Likewise, age-associated increases in insulin resistance, glucocorticoids, and myostatin can stimulate muscle atrophy and further reduce protein synthesis. Thus, perhaps, sleep promotion in the ICU may attenuate muscle atrophy among critically ill older adults who are at risk for ICU-acquired weakness and subsequent functional decline. The aim of this study was to discuss the hypothesized theoretical underpinnings of the relationship between sleep disturbances and ICU-acquired weakness among critically ill older adults. A search of research literature published from 1970 to 2018 and indexed in MEDLINE, Embase, CINAHL, and Ovid was undertaken, and relevant sources were selected to build an informed discussion. Nurses must be mindful of secondary sleep disturbances that occur throughout the acute phase of critical illness and their probable links to ICU-acquired weakness. Targeted interventions to promote functional outcomes in elderly patients should consider this relationship. Improved sleep may have the potential to decrease the severity of muscle atrophy and ICU-acquired weakness. Future research must explore this hypothesis and the underlying mechanisms of the association between sleep disturbances and ICU-acquired weakness in critically ill older adults.

Comparing outcomes in cemented vs uncemented hemiarthroplasty in femoral neck fractures

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; The optimal treatment choice for femoral neck fractures is often debated. In this study, we aimed to compare the functional outcome in elderly patients who underwent either cemented or uncemented hemiarthroplasty in our department.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This prospective study included patients who were scheduled to undergo hemiarthroplasty for femoral neck fracture in the Department of Orthopedics, Dr DY Patil University School of Medicine, Navi Mumbai. Two study groups were made. One group had patients who underwent uncemented hemiarthroplasty and the second group had patients who underwent cemented hemiarhtroplasty. Surgery related information was collected from the operative notes of the surgeon. Post-operative complications, Visual Analogue Scale (VAS) scores and Harris Hip Score (HHS) were noted during the follow up period.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; There were 30 patients in the uncemented group and 31 in the cemented group. All the baseline demographic and clinical variables were similar in both the study groups. Mean intraoperative blood loss and operative time was significantly higher among the patients who underwent cemented hemiarthroplasty as compared to uncemented group. Mean VAS score at the first month and sixth month follow up was significantly higher among patients in the uncemented group as compared to cemented group. Functional outcome was not signicantly different according to the HHS performed 6 months post-operatively.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Patients in the cemented group had a higher intra-operative blood loss and longer operative time. However, the pain score on the VAS were significantly lower at first and sixth month follow up. Functional outcomes were not significantly different between the two study groups.&lt;/p&gt;&lt;p&gt; &lt;/p&gt;

Long-term oncologic and functional outcomes after robot-assisted partial nephrectomy in elderly patients.

The aim of this study was to assess the long-term oncologic and functional outcomes in elderly patients having undergone robot-assisted partial nephrectomy (RAPN) for renal cancer (RC). Sixty-one patients out of 323 who underwent RAPN for localized RC between July 2009 and March 2016 in our high-volume robotic surgery center (>800 procedures/year), had 70 years or more. Inclusion criteria of the study were age ≥70 years; pathological confirmed RCC and ASA Score ≤3. All patients were stratified according to PADUA classification system in three groups: <7 points, 8-9 points, >10 points. Trifecta was defined as a warm ischemia time (WIT) less then 25 min, negative surgical margins and no perioperative complications. A total of 52 patients were included; median follow-up was 47 months. Median age was 74 yrs. (IQR 72-76.5). Complication rate was 15.4%. Trifecta failure was associated to PADUA Score (P=0.02), and tumor diameter (P=0.04). Renal function was altered in 10 (19.2%) patients before surgery and at last follow-up in 11 (21.1%) patients (CKD stage>2) The DFS, OS and CSS were 89.33%, 90.06% and 94.4%, respectively. In a high-volume center, robot-assisted approach is feasible and safe in surgical fit elderly patients with good long-term oncologic outcomes.

Management of full thickness rotator cuff tears in the elderly: a systematic review protocol.

The objective of this review is to synthesize the best available evidence on the effectiveness of non-surgical and surgical treatment on the clinical and functional outcomes of elderly patients with full thickness rotator cuff tear.

Mid-Term Functional Outcome after Volar Locking Plate Fixation of Distal Radius Fractures in Elderly Patients.

The volar locking plate is frequently used in the fixation of unstable distal radius fractures, but despite this there is a paucity of mid to long term outcome studies. The purpose of this study was to investigate the mid-term functional outcomes of elderly patients treated with a volar locking plate for unstable distal radius fractures. Thirty-two patients with a mean age of 74.1 (range, 65-85) years were followed for a mean of 39.1 (range, 30-81) months. Patients with follow-up periods of < 24 months were excluded from this study to investigate the mid-term clinical outcomes. The Mayo wrist score (MWS), grip strength and wrist range of motion were retrospectively reviewed at 12 months, 24 months and the latest follow-up (mean 39.1 months). Osteoarthritis status according to the system of Knirk and Jupiter was assessed at 24 months. Significant improvements in MWS and grip strength were observed between 12 and 24 months but not between 24 months and the final follow-up. There was no significant difference in wrist range of motion between 12 and 24 months. The MWS of 14 patients with radiographic signs of osteoarthritis was not significantly different from that of 18 patients without radiographic signs of osteoarthritis. Elderly patients treated with the volar locking plate showed improved MWS and grip strength postoperatively after 12 months. Improvement in grip strength was slower than range of motion.

Functional Outcomes of Elderly Patients With Nonoperatively Treated Acetabular Fractures That Meet Operative Criteria.

To report functional outcomes of displaced acetabular fractures treated nonoperatively in the geriatric patient population. Retrospective case series. Two Level I trauma centers. Twenty-seven patients 60 years of age or older who sustained displaced acetabular fractures during an 11-year period. Nonoperative treatment. Primary outcome measurements were Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores and Short Form 8 (SF-8) scores. Secondary outcome measurements were conversion to open reduction and internal fixation or total hip arthroplasty and 1-year mortality. Twenty-six patients completed the WOMAC and SF-8 surveys. The overall WOMAC score was 12.9 ± 15.6 (range, 0-59.4). The average physical SF-8 was 51.1 ± 8.7 (range, 30.4-58.6), and the average mental SF-8 was 55 ± 6.2 (range, 30.4-58.6). The 1-year mortality rate was 24%. Conversion of treatment occurred in 15% of patients. Elderly patients with fracture patterns that would qualify for operative treatment in younger healthy patients had surprisingly good outcome scores when treated nonoperatively. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Significant increase in acute subdural hematoma in octo- and nonagenarians: surgical treatment, functional outcome, and predictors in this patient cohort.

OBJECTIVE Acute subdural hematoma (aSDH) is a common disease increasing in prevalence given the demographic growth of the aging population. Yet, the benefit of surgical treatment for aSDH and the subsequent functional outcome in elderly patients (age ≥ 80 years) remain unclear. Therefore, the aims of this study were to evaluate the incidence of aSDH in patients 80 years or older, determine overall functional outcome, identify predictors of an unfavorable or favorable outcome, and establish specific risk factors for seizures. METHODS The authors retrospectively analyzed patients 80 years and older who presented with isolated aSDH in the past 10 years at their institution. The following parameters were assessed: baseline characteristics, clinical status on admission and 24 hours after surgery, and clinical course. Functional outcome was assessed at discharge and the 3-month follow-up (FU). RESULTS In the period from January 2007 to December 2016, 165 patients with aSDH were admitted to the authors' institution. Sixty-eight patients (41.2%) were 80 years old or older, and the mean age overall was 85 years (range 80-96 years). The incidence of aSDH in the elderly had significantly increased over past decade, with more than 50% of patients admitted to our institution for aSDH now being 80 years or older. The overall mortality rate was 28% at discharge and 48% at the FU. Independent predictors of an unfavorable outcome at discharge were a GCS score ≤ 8 at 24 hours after operation (p < 0.001) and pneumonia (p < 0.02). At the FU, a GCS score ≤ 8 at 24 hours after operation (p < 0.001) and cumulative comorbidities (≥ 5; p < 0.05) were significant independent predictors. All patients with more than 6 comorbidities had died by the FU. Surgical treatment in comatose compared to noncomatose patients had statistically significant, higher mortality rates at discharge and the FU. Still, 23% of the comatose patients and more than 50% of the noncomatose patients had a favorable outcome at the FU (p = 0.06). CONCLUSIONS The number of octo- and nonagenarians with aSDH significantly increased over the last decade. These patients can achieve a favorable outcome, especially those with a noncomatose status and fewer than 5 comorbidities. Surgical and nonsurgical treatment of octo- and nonagenarians during and after discharge should be optimized to increase clinical improvement.

140 - Early Ambulation Decreases Length of Hospital Stay, Perioperative Complications, and Improves Functional Outcomes in Elderly Patients Undergoing Surgery for Correction of Adult Degenerative Scoliosis

140 - Early Ambulation Decreases Length of Hospital Stay, Perioperative Complications, and Improves Functional Outcomes in Elderly Patients Undergoing Surgery for Correction of Adult Degenerative Scoliosis

Early Ambulation Decreases Length of Hospital Stay, Perioperative Complications and Improves Functional Outcomes in Elderly Patients Undergoing Surgery for Correction of Adult Degenerative Scoliosis.

Ambispective cohort review. To examine the effects of early mobilization on patient outcomes, complications profile, and 30-day readmission rates. Prolonged immobilization after surgery can result in functional decline and an increased risk of hospital-associated complications. We conducted an ambispective study of 125 elderly patients (>65 years) undergoing elective spinal surgery for correction of adult degenerative scoliosis. We identified all unplanned readmissions within 30 days of discharge. Unplanned readmissions were defined to have occurred as a result of either a surgical or a nonsurgical complication. "Days of immobility" was defined as the number of days until a patient moved out of bed beyond a chair. Patients in the top and bottom quartiles were dichotomized into "early ambulators" and "late ambulators", respectively. Early ambulators were ambulatory within 24 hours of surgery, whereas late ambulators were ambulatory at a minimum of 48 hours after surgery. Complication rates, duration of hospital stay, and 30-day readmission rates were compared between early ambulators and late ambulators. Baseline characteristics were similar between both cohorts. Compared with patients with a longer duration of immobility (i.e., late ambulators), the prevalence of at least one perioperative complication was significantly lower in the early ambulators cohort (30% vs. 54%, P = 0.06). The length of inhospital stay was 34% shorter in the early ambulators cohort (5.33 days vs. 8.11 days, P = 0.01). Functional independence was superior in the early ambulators cohort, with the majority of patients discharged directly home after surgery compared with late ambulators (71.2% vs. 22.0%, P = 0.01). Early ambulation after surgery significantly reduces the incidence of perioperative complications, shortens duration of inhospital stay, and contributes to improved perioperative functional status in elderly patients. Even a delay of 24 hours to ambulation is associated with higher complication rates and inferior functional outcomes. 3.

Low risk of ischaemic stroke in hyperhomocysteinaemia

Whether elevated serum homocysteine concentrations (ie, hyperhomocysteinaemia) are a risk factor for ischaemic stroke and if normalising hyperhomocysteinaemia might reduce stroke risk are controversial issues. Hyperhomocysteinaemia can be primary (ie, hereditary) or secondary (ie, due to vitamin B12 deficiency, diabetes, etc). The effect of both primary and secondary hyperhomocysteinaemia on putative stroke risk is debated. One study 1 Wang W Gao C Yu C et al. No association between elevated total homocysteine levels and functional outcome in elderly patients with acute cerebral infarction. Front Aging Neurosci. 2017; 9: 70 Crossref PubMed Scopus (13) Google Scholar has shown that hyperhomocysteinaemia is an independent risk factor for ischaemic stroke, whereas other studies have reached different conclusions. 2 Pang H Han B Fu Q Zong Z Association of high homocysteine levels with the risk stratification in hypertensive patients at risk of stroke. Clin Ther. 2016; 38: 1184-1192 Summary Full Text Full Text PDF PubMed Scopus (20) Google Scholar , 3 Toole JF Malinow MR Chambless LE et al. Lowering homocysteine in patients with ischemic stroke to prevent recurrent stroke, myocardial infarction, and death: the Vitamin Intervention for Stroke Prevention (VISP) randomized controlled trial. JAMA. 2004; 291: 565-575 Crossref PubMed Scopus (1212) Google Scholar , 4 Bønaa KH Njølstad I Ueland PM et al. Homocysteine lowering and cardiovascular events after acute myocardial infarction. N Engl J Med. 2006; 354: 1578-1588 Crossref PubMed Scopus (1264) Google Scholar , 5 Lonn E Yusuf S Arnold MJ et al. Homocysteine lowering with folic acid and B vitamins in vascular disease. N Engl J Med. 2006; 354: 1567-1577 Crossref PubMed Scopus (1527) Google Scholar In The Lancet Neurology, J David Spence and colleagues 6 Spence D Yi Q Hankey GJ B Vitamins in stroke prevention: time to reconsider. Lancet Neurology. 2017; 16: 750-760 Summary Full Text Full Text PDF PubMed Scopus (81) Google Scholar advocate the use of B vitamins (folic acid, vitamin B12, and vitamin B6) to normalise hyperhomocysteinaemia for the prevention of ischaemic stroke. Their Personal View raises concerns about arguments in favour of normalising hyperhomocysteinaemia. B vitamins in stroke prevention: time to reconsiderB vitamin therapy lowers plasma total homocysteine concentrations, and might be a beneficial intervention for stroke prevention; however, cyanocobalamin (a form of vitamin B12) can accelerate decline in renal function and increase the risk of cardiovascular events in patients with impaired renal function. Although early trials did not show benefit in reduction of stroke, these results might have been due to harm in participants with impaired renal function. In patients with diabetic nephropathy, cyanocobalamin is harmful, whereas B vitamins appear to reduce cardiovascular events in study participants with normal renal function. Full-Text PDF

Comparision of functional outcome in elderly patients with inter trochanteric fracture: Dynamic hip screw vs proximal femoral nail

Introduction: The conservative approach has high complication rate. The common problems of prolonged immobilization, decubitus ulcers, U.T.I, joint contractures, pneumonia, and thrombo-embolism contribute to the high mortality rate. The increased incidence of varus deformity and shortening results in poor function. Methodology: This was a retrospective study carried out in department of orthopaedics, MIMS, mandya. The material for the present study was obtained from the patients visiting for follow-up in out-patient department with the diagnosis of intertrochanteric fracture femur who had undergone operative treatment between 2014 and 2015 ( 6 months elucidated after surgery at this visit)were de-identified and analysed. Results: Comparision of clinical, radiological and functional outcomes between group DHS and group PFN were presented in the Table-2 and Table-3. No patients had wound problems, union problems and screw out in both the groups. In the group DHS, 6 patient had shortening, 5 patients had restricted range of motion and collapse radiologically in 6 patients. In the group PFN, 2 patient had shortening, 2 patients had restricted range of motion and collapse radiologically in 2 patients. Conclusion: PFN group had statistically significant improvement with respect to harris hip scoring and PCS, MCS of SF-12 health survey.