Hip Fractures In Elderly Population Research Articles

Dysphagia is associated with increased mortality risk after hip fracture surgery.

This study aims to explore the prevalence of dysphagia, as well as mortality associated with dysphagia in the elderly population receiving surgical treatment for a hip fracture. A retrospective cohort study was completed at an academic level 1 tertiary care center. Patients older than or equal to 65 admitted with a hip fracture diagnosis from January 2015 to December 2020 (n = 617) were included. The main outcome was the prevalence of dysphagia and association with mortality. Secondary analysis included timing of dysphagia and contributions to mortality. Fifty-six percent of patients had dysphagia, and the mortality rates were higher in patients with dysphagia (8.9%) versus those without dysphagia (2.6%), chi-square p = 0.001, and odds ratio 3.69 (CI 1.6-8.5). Mortality rates in patients with acute dysphagia were also higher (12.4%) than those with chronic dysphagia (5%) and chi-squared p = 0.02. Mortality rates in patients with a perioperative dysphagic event (13.9%) were higher than those with non-perioperative dysphagia (4%) and chi-squared p = 0.001. Mortality rates in patients who had acute perioperative dysphagia (21.2%) were higher than those with chronic dysphagia that presented perioperatively (6.8%) and chi-squared p = 0.006. This study demonstrates high rates of dysphagia in the elderly hip fracture population and a significant association between dysphagia and mortality. Timing and chronicity of dysphagia were relevant, as patients with acute perioperative dysphagia had the highest mortality rate. Unlike other identified risk factors, dysphagia may be at least partially modifiable. More research is needed to determine whether formal evaluation and treatment of dysphagia lowers mortality risk.

Perioperative use of tranexamic acid in elderly patients undergoing hemiarthroplasty for neck of femur fractures: Is it worth using in every patient? An updated systematic review and Meta-analysis

Hemiarthroplasty becomes the procedure of choice for hip fracture in elderly population with blood loss as its complication. Tranexamic acid (TXA) has been used with no systematic review conducted to evaluate its efficacy and safety. The PRISMA guidelines were followed to conduct literature screening and selection. Main outcomes were extracted for qualitative analysis and quantitative analysis. Blood loss level and haemoglobin drop was significantly reduced in TXA group as compared to the control group. TXA is also deemed as protective factor for transfusion requirement. TXA use may be considered in every patient undergoing hemiarthroplasty procedure unless absolute contraindication exists.

Predictive Value of the C-Reactive Protein to Albumin Ratio in 30-Day Mortality after Hip Fracture in Elderly Population: A Retrospective Observational Cohort Study.

C-reactive protein (CRP) to Albumin ratio (CAR) has been used in multiple clinical settings to predict early mortality. However, there is a lack of evidence on the predictive role of CAR in 30-day mortality after a hip fracture. The purpose of this study was to establish a potential association between CAR and 30-day mortality and to assess if the CAR Receiving Operating Characteristics curve (ROC) can be a reliable predictor of early mortality. We retrospectively reviewed the charts of 676 patients (>65 years) treated for hip fracture between 2006 and 2018. All hip fractures were included. Treatment strategies included closed reduction and internal fixation, open reduction and internal fixation, hemiarthroplasty, or total joint arthroplasty. Statistical analysis included T-test, Pearson correlation for CAR and other markers, ROC curves and area under the curve, Youden Model, and Odds Ratio. The 30-day mortality rate analysis showed that higher preoperative levels of CAR were associated with higher early mortality. When analyzing the area under the ROC curve (AUROC) for 30-day mortality, the reported value was 0.816. The point of the ROC curve corresponding to 14.72 was considered a cut-off with a specificity of 87% and a sensibility of 40.8%. When analyzing values higher than 14.72, the 30-day mortality rate was 17.9%, whilst, for values lower than 14.72, the 30-day mortality rate was 1.8%. Patients older than 65 years affected by a hip fracture with increased preoperative levels of CAR are associated with higher 30-day mortality. Despite a moderate sensibility, considering the low cost and the predictivity of CAR, it should be considered a standard predictive marker.

Peripheral Nerve Block and Peri-operative Neurocognitive Disorders in Older Patients With Hip Fractures: A Systematic Review With Meta-analysis.

Poor pain control and opioid use are risk factors for perioperative neurocognitive disorders (PND). The peripheral nerve block (PNB) can reduce pain and opioid consumption. This systematic review aimed to investigate the effects of PNB on PND in older patients with hip fractures. The PubMed, Cochrane Central Registers of Controlled Trial, Embase and ClinicalTrials.gov databases were searched from inception until November 19, 2021 for all randomized controlled trials (RCTs) comparing PNB with analgesics. The quality of the selected studies was assessed according to Version 2 of the Cochrane tool for assessing the risk of bias in RCTs. The primary outcome was the incidence of PND. Secondary outcomes included pain intensity and the incidence of postoperative nausea and vomiting. Subgroup analyses were based on population characteristics, type and infusion method of local anesthetics, and type of PNB. Eight RCTs comprising 1015 older patients with hip fractures were included. Compared with analgesics, PNB did not reduce the incidence of PND in the elderly hip fracture population comprising patients with intact cognition and those with pre-existing dementia or cognitive impairment (risk ratio [RR] = .67; 95% confidence interval [CI] = .42 to 1.08; P = .10; I2 = 64%). However, PNB reduced the incidence of PND in older patients with intact cognition (RR = .61; 95% CI = .41 to .91; P = .02; I2 = 0%). Fascia iliaca compartment block, bupivacaine, and continuous infusion of local anesthetics were found to reduce the incidence of PND. PNB effectively reduced PND in older patients with hip fractures and intact cognition. When the study population included patients with intact cognition and those with pre-existing dementia or cognitive impairment, PNB showed no reduction in the incidence of PND. These conclusions should be confirmed with larger, higher-quality RCTs.

A Description of Novel Uses of Hip Protectors in an Elderly Hip Fracture Population: A Technical Report.

Hip fractures are a significant cause of morbidity and mortality in the elderly population. The number of hip fractures is set to increase significantly by 2050 as the global population ages. The costs associated with hip fracture patients are significant due to prolonged hospitalisation and rehabilitation.Hip protectors have been advocated as a strategy to reduce the risk of hip fractures in a high-risk population. Evidence suggests that hip protectors are a cost-effective method for reducing the risk of hip fractures. There have, however, been issues with adherence with wearing hip protectors amongst patients and healthcare staff.Despite prevention strategies, many patients continue to present with hip fractures. Many of these patients have cognitive impairment or experience peri-operative delirium. This can cause issues with patients' interference with the operative wound and presents a significant burden to the healthcare team with the need for increased wound monitoring and care in the post-operative period. Applying a well-fitted hip protector provides a substantial additional barrier to protect the surgical wound. Hip fracture surgical wounds can be difficult to manage in these patients and our standard post-operative protocol is to apply compression dressings in this group of patients. We have found that a well-fitted hip protector can provide adequate compression to the surgical site.We describe a brief technical report on a novel use of hip protectors in providing wound security in the agitated patient post-operatively as well as a method of providing compression to the surgical wound site.

Development and Clinical Validation of a Rehabilitation Platform for Hip Fracture in Elderly Population

Hip fracture is one of the most common traumatisms associated with falls in the elderly, severely affecting the patient's mobility and independence. In recent years, the use of robotic technology has proven to be effective in gait rehabilitation, especially for neurological disorders. However, there is a lack of research validating these devices for hip fracture in elderly patients. This paper presents the design and evaluation of a novel assistive platform for hip rehabilitation, SWalker, aimed at improving the rehabilitation of this condition. Functional validation of the SWalker platform was carried out with five healthy elderly subjects and two physiotherapists. Clinical validation was conducted with 34 patients with hip fracture. The control group ( [Formula: see text], age = 86.38±6.16 years, 75% female) followed conventional therapy, while the intervention group ( [Formula: see text], age = 86.80±6.32 years, 90% female) was rehabilitated using SWalker. The functional validation of the device reported good acceptability (System Usability Scale >85). In the clinical validation, the control group required 68.09±27.38 rehabilitation sessions compared to 22.60±16.75 in the intervention group ( [Formula: see text]). Patients in the control group needed 120.33±53.64 days to reach ambulation, while patients rehabilitated with SWalker achieved that stage in 67.11±51.07 days ( [Formula: see text]). FAC and Tinetti indexes presented a larger improvement in the intervention group when compared with the control group ( [Formula: see text] and [Formula: see text], respectively). The SWalker platform can be considered an effective tool to enhance autonomous gait and shorten rehabilitation therapy in elderly hip fracture patients. This result encourages further research on robotic rehabilitation platforms for hip fracture.

Relationship between skin and urine colonization and surgical site infection in the proximal femur fracture: a prospective study.

Antibiotic prophylaxis is routinely used in the surgical management of proximal femur fractures. The role of bacterial colonization of the skin and urine in the development of deep surgical site infections (SSI) is yet to be elucidated. This study aimed to evaluate the role of previous skin and urine colonization in the development of deep SSI after a proximal femoral fracture surgery. We conducted a prospective observational study in 326 patients > 64years old, who were scheduled to surgery. Cultures from skin samples of the surgical site and from urine were performed prior to the procedure, and cefazoline was administered as prophylaxis. Skin microbiota was isolated in 233 (71.5%) cases; 8 (2.5%) samples were positive for other bacteria, and 85 (26%) were negative. Of 236 urine samples, 168 were negative or contaminated (71.2%), and 68 (28.8%) were positive, being 58/236 for Enterobacterales (24.6%). Acute deep SSI were diagnosed in nine out of 326 patients (2.7%), and two (22%) were infected by Gram-negative bacilli. Of the 9 cases, normal skin microbiota was isolated in 7 (78%), and the remaining twowere negative. Seven cases had negative or contaminated urine cultures, and the one with E. coli did not correlate with SSI bacteria. In our elderly hip fracture population, most patients harbored normal skin microbiota, and Enterobacterales urine cultures were positive in one-quarter of cases. There was no relationship between skin colonization, urine culture, and deep SSI. We therefore do not believe that our patients would benefit from modifying the current antibiotic prophylaxis.

Resuscitation in hip fractures: The practicality and clinical effectiveness of pre-operative resuscitation of patients with hip fracture using blood products

IntroductionThis study aimed to determine the practicality and estimate the effect of administering pre-operative blood product resuscitation to a consecutive, prospectively recruited cohort of 100 patients admitted to a single centre with a hip fracture with all other treatment unchanged. Method100 patients aged 65 years or over admitted acutely to our unit with unilateral fractured femoral neck during the study period were included in this study, regardless of cognitive function. Patients were excluded only if there were relevant medical comorbidities or consent was declined. Each patient was resuscitated with a single unit of packed red cells in the immediate perioperative period in addition to standard care. The primary outcome was to establish the feasibility of the study protocol employed in using blood products to resuscitate eligible patients and recording reasons for any failures to include eligible patients. Additional data regarding mortality at 30 days following injury, subsequent blood product use, any transfusion related adverse reactions and total blood product use was measured. ResultsWe were able to show that it is safe and practicable to deliver blood as an early resuscitative strategy in the frail elderly hip fracture population. The mortality rate of the study cohort was 3%. No adverse reaction was observed in any of the 99 patients given blood as a result of the resuscitation strategy and no morbidity was seen that could be attributed to the effect of giving blood. The total amount of blood received by comparable cohorts in the study period and the two preceding years were similar. ConclusionsThe study suggests that in the hip fracture population it is both practical and beneficial to move away from reactive transfusion regimens, and instead centre efforts instead on optimal resuscitation at the initial presentation.

Incidence and costs of hip fractures in elderly Italian population: first regional-based assessment.

We aimed at evaluating the burden of hip fractures in elderly Italian population at the regional level. We analyzed national hospitalizations records 2007-2014 to compute standardized hospitalizations rates (SHR) due to hip fractures per 10,000 inhabitants at the regional level and average annual percent change (AAPC), along with related costs. Hip fractures occurred in people over 65years increased from 89,601 to 94,525 over 8years. The overall increase in the number of hospitalizations is attributable only to people aged ≥85. Actually, in the 65-74 and 74-84 age groups, totalhospitalizations decreased from 13,396 to 12,268 and from 40,733 to 37,786 respectively, while they increased from 35,472 to 44,471 in people aged ≥85 (women = 28,605 and men = 6,867 in 2007; women = 34,636 and men = 9,835 in 2014). Almost 50% of hip fractures were found to have been experienced by patients aged 85 or older in 2014 (with women ≥ 85 representing 36.6% of total fractures), in accordance with the higher prevalence of osteoporosis in this age group. Fractures increase in people aged ≥ 85 was two-folds higher in males (AAPC: + 5.0%; P > 0.05) than in females (AAPC: + 2.6%; P > 0.05). Increases in the number of hospitalizations and related costs were observed for all the regions, with the only exception of Lazio (AAPC: - 4.6%; P < 0.05) and Friuli Venezia Giulia (hip fractures AAPC: - 1.9%; P < 0.05). The most significant increases in hip fractures and related costs were recorded in Calabria (+ 2.7%), Campania (+ 2.2%), and Lombardia (+ 2.0%). At the national level, SHR per 10,000 inhabitants due to hip fractures decreased in all three examined age groups (65-74, 75-84, and ≥ 85), both in males and females during the 8-year period (P < 0.05). This reduction was confirmed also when looking at the regional dataset, with few exceptions concerning female population (AAPC not statistically significant). When looking at the SHR per 10,000 inhabitants for the entire nation, we recorded a decreasing trend also in females aged 85years old and over but not in males ≥ 85. Actually, men aged ≥ 85 showed increased HR per 10,000 in 10 regions out of 20. Direct hospitalization and rehabilitation costs increased in all the regions over the 8-year period (although at different rates), except for Friuli Venezia Giulia (where costs decreased from 21 to 19 million Euros) and Lazio (from 107 to 87 million Euros). Lombardia and Piemonte were the regions spending the highest amount of money to treat hip fractures in elderly people (151 and 95 million Euros in the year 2014, respectively). Hip fractures in the elderly population remain a major public health issue in all Italian regions, especially in people aged 85years old and over, although the problem is starting to become more controlled compared with the past. Women represent the majority of hip fractures, but the highest increasing rate has been observed in men. Pilot projects at regional level targeting elderly people at higher risk of fractures and treatment compliance are needed.

AB138. 211. A study of vitamin D levels in a frail elderly hip fracture population and a comparative non-frail elderly population

AB138. 211. A study of vitamin D levels in a frail elderly hip fracture population and a comparative non-frail elderly population

An interprofessional collaboration between nurses and speech therapists to detect dysphagia early in an elderly hip fracture population

The International Journal of Integrated Care (IJIC) is an online, open-access, peer-reviewed scientific journal that publishes original articles in the field of integrated care on a continuous basis.IJIC has an Impact Factor of 5.120 (2020 JCR, received in June 2021)

Does achieving the best practice tariff improve outcomes in hip fracture patients? An observational cohort study

ObjectivesTo determine if the introduction of the best practice tariff (BPT) has improved survival of the elderly hip fracture population, or if achieving BPT results in improved survival for an...

One year survival in patients undergoing surgical repair for hip fractures in elderly population

One year survival in patients undergoing surgical repair for hip fractures in elderly population

Cephalomedullary fixation for intertrochanteric fractures: an operative technical tip

Intertrochanteric fracture is the most common hip fractures in elderly population. Cephalomedullary fixation, including proximal femoral nail antirotation (PFNA) and gamma nail, is commonly used in the treatment of intertrochanteric fractures. One of difficulties encountered in operation is insertion of the guide wire to femoral head. The guide wire would always bend and flow superiorly away from femoral calcar, and the lag screw and helical blade will follow the track and get into superior part of femoral head, not into femoral calcar. Here, we are presenting a surgical technique to direct the guide wire to right track. When guide wire just passed the tack hole of the nail, the rod of nail was slightly tapped down further to allow the superior border of the tack hole to touch the guide wire. Therefore, the superior border of the tack hole can be used as presser to prevent the wire from deviating upward. Through this way, the lag screw and helical blade get a good purchase that docked at femoral calcar. After that, the rod of nail was pulled back a little to make the wire in the middle of the tack hole, which can facilitate the insertion of the PFNA blade or lag screw. Our experience demonstrated that this surgical technique reduced the intraoperative risk for patients.

Basis of bone strength vs. bone fragility: A review of determinants of age-related hip fracture risk

The burden of hip fractures in elderly population has been growing worldwide. A particular focus has been directed towards identifying persons at high risk of fracture. However, bone mineral density (BMD), which is currently used in clinical settings as an indicator of risk of age-related fracture, cannot explain all fracture cases in the elderly. In fact, the risk of hip fractures in the elderly is associated with numerous bone features that degrade bone strength. This review focuses on complexity of bone features that could account for increased bone fragility in advanced age. Besides a decrease in BMD, various macroscopic and microscopic structural parameters, as well as the material of which the bone is composed, are subject to age-related changes. Therefore, in order to have a more thorough assessment of the fracture risk, it is essential to provide integrative approaches that combine BMD measure with other relevant bone features.

A nationwide seven-year trend of hip fractures in the elderly population of Taiwan

To investigate the recent longitudinal trend of hip fractures (including cervical and trochanteric fractures) in Taiwan's elderly population (≥ 65 years), a nationwide descriptive epidemiological study was conducted using the database of the Bureau of National Health Insurance from 1996 through 2002. Frequencies and incidences of hip fracture by gender, fracture site, and age group were estimated, and the 7-year incidence trend was further evaluated. The results showed that a total of 75,482 hip fractures occurred during the study period with an incidence rate of 57.54 per 10,000 per year. Overall incidence significantly increased by 30% ( p < 0.0001), from 49.56 to 64.37 per 10,000 per year during the 7-year study period. The increase in rates was greater in males (36%) than in females (22%). The average female-to-male ratio was 1.76, lower than those in many countries. In females, the annual incidence of cervical fracture was higher than that of trochanteric fractures throughout the 7 years, while the incidence of trochanteric fractures was higher than cervical fractures each year in males ( p < 0.0001). The average annual incidence of patients older than 85 years was 9.9 times higher than that of aged 65 to 69 years in females and 7.9 times in males. Development and implementation of public health strategies for hip fractures should more focus on these subgroups in Taiwan's rapidly aging society.

Prospective Randomized Clinical Trial Comparing Hemiarthroplasty to Total Hip Arthroplasty in the Treatment of Displaced Femoral Neck Fractures: Winner of the Dorr Award

The Displaced Femoral (neck fracture) Arthroplasty Consortium for Treatment and Outcomes study is a prospective, multicenter randomized clinical trial comparing hemiarthroplasty to total hip arthroplasty (THA) in the treatment of displaced femoral neck fractures in previously independent patients. Primary outcomes were measured at 6, 12, and 24 months with the Short Form-36 (SF-36), Western Ontario and McMaster Osteoarthritis Index (WOMAC), and the Harris Hip Score and the Timed “Up & Go” Test. Forty subjects were enrolled. At 24 months, THA patients had significantly less pain on the SF-36 subscale than hemiarthroplasty patients (54.8 ± 7.9 vs 44.7 ± 10.5, P = .04) and scored significantly better on the SF-36 mental health subscale (54.9 ± 9.4 vs 40.9 ± 10.3, P = .006). Total hip arthroplasty patients also had superior WOMAC function scores (81.8 ± 10.2 vs 65.1 ± 18.1, P = .03). Significant differences in outcomes, without a significantly greater incidence of complications, suggest THA is a valuable treatment option for the active elderly hip fracture population.

A pilot investigation of the efficacy of falls risk assessment tools and prevention strategies in an elderly hip fracture population

summary Background The importance of reducing the number of falls was highlighted by the UK National Service Framework for Older People [Department of Health, 2001]. In response falls risk assessment tools have been developed and implemented into clinical practice. However their predictive accuracy is generally unsubstantiated. Aims The study aimed to investigate the predictive accuracy of the Fall Risk Assessment Scale for the Elderly (FRASE) and St. Thomas's Risk Assessment Tool (STRATIFY) and determine if falls prevention strategies reduced the number of falls in hip fracture patients. Design A quasi-experimental design compared the incidence of falls between retrospective ( n =30) and prospective ( n =60) groups of hip fracture patients admitted to an acute NHS hospital. Receiver Operator Characteristic (ROC) calculated the predictive accuracy of both FRASE and STRATIFY in identifying the fall risk status of the sample. Also the inter-rater reliability of the two tools was tested. Results Inter-rater reliability for both FRASE and STRATIFY was high with correlation coefficients of 0.964 and 0.836, respectively, and p values of 0.001. Two patients fell in the prospective group and 3 in the retrospective group. There was no significant difference in the number of falls between the groups with the p value being 0.204. Both FRASE and STRATIFY were found to have poor predictive accuracy with ROC scores of 0.560 and 0.629, respectively, for the prospective group. The tools also demonstrated poor predictive accuracy with the retrospective group with a ROC score of 0.370 for FRASE and 0.463 for STRATIFY. Conclusions and relevance Although the study demonstrated good inter-rater reliability of both tools the level of predictive accuracy was poor. Both tools were demonstrated to over predict the risk of patients falling. At face value it would appear preferable for a tool to over predict risk of falling rather than under predicting, however this must be viewed in the context of finite resources. It is recommended that further research is needed to manipulate the threshold level for risk of falling with both tools and to ascertain if the inclusion of extrinsic factors would improve their predictive accuracy.

Standardised Assessment: A Comparison of the Community Dependency Index and the Barthel Index with an Elderly Hip Fracture Population

The Community Dependency Index (CDI) is a standardised outcome measure of independence in self-care activities, based upon the Barthel Index, for the assessment of disabled and elderly people living in the community. The operational definitions take account of the influence that the environment has on a person's ability to carry out activities of daily living. This paper reports the results of a longitudinal study of two groups of community-dwelling elderly people who had sustained a hip fracture. The inter-rater reliability of the CDI was assessed, the agreement between the CDI and the Barthel Index was assessed and the sensitivity to change over time of the two measures was compared. The CDI was found to be equally as sensitive to a change in overall scores as the Barthel Index but tended to give lower scores. This trend has important implications for its use as an outcome measure of independence in activities of daily living following trauma.

The impact of continuing education on patient outcomes in the elderly hip fracture population.

As the health care system is oriented to provide service with finite dollars, nursing educators are being asked to demonstrate how continuing education for staff improves patient outcomes. The purpose of this study was to evaluate the impact of an orthopedic-geriatric continuing education program for nurses on the elderly patient who had sustained a hip fracture. A significant difference was found between the control and experimental unit patients with respect to time to first ambulation and length of stay on the orthopedic unit.