Incidence Of Femoral Fractures Research Articles

Periprosthetic Femoral Fractures in Total Hip Arthroplasty

Objective: This study aimed to analyze the occurrence of periprosthetic fractures (PPFs) in patients who underwent total hip arthroplasty. Methods: The researchers conducted a retrospective review of 447 patients (494 hips) who received a hip replacement with an ESOP stem. The average follow-up period was 12.33 ± 5.2 years. The study population comprised 248 men with 276 hips and 203 women with 220 hips, with a mean age of 65.7 ± 11.6 years. Results: We found 42 PPFs, 15 of them taking place intraoperatively. Regarding the postoperative fractures, 3 of them happened during the first month and the rest of them afterward. There were 3 deaths directly related to the PPF episode. We found a higher risk of fractures among the female, population older than 65 years, and among those with total hip arthroplasty following hip fracture. This population showed a higher incidence of complications and mortality rate. The cumulative percentage probability of periprosthetic femoral fracture was 3.2% (95% confidence interval, 2-5.6) at 10 years, and 10.3% (95% confidence interval, 7-20) at 20 years after surgery. Conclusions: Our findings indicate that periprosthetic femoral fracture incidence increases significantly after the first decade. The use of modular stems did not modify this behavior, similar to other nonmodular or anatomical stems.

Special aspects of total hip arthroplasty in patients with proximal femur pseudarthrosis

IntroductionThe rate of proximal femur fractures (PFF) in the structure of musculoskeletal system injuries among all fractures of long bones ranges from 3.9 to 18%. According to Russian Ministry of Health 2020 data, the incidence of femoral fractures in Russia was up to 61 cases per 100,000 population (90,000 per year); and femoral neck fractures incidence was 4 times higher among people over 75 years of age. The choice of surgical technique and the fixator used depend on many factors, such as fracture location and its nature, the age of the patient, comorbidities, and the quality of bone tissue. Internal osteosynthesis, is the current treatment method of choice for extra-articular proximal femur fracture, but every treatment method has its limitations. a significant number of complications caused by technical errors, vicious union or nonunion with the subsequent development of false joints, the development of femoral head aseptic necrosis, which leads to coxarthrosis and persistent pain syndrome. To solve the above-described problems, it is necessary to use a conversion surgery - total hip replacement. Objectiveslong-term analysis of the results of total hip replacement in patients with proximal femur pseudarthrosis. MethodsThe study was based on clinical and laboratory data analysis and on the results of total hip arthroplasty (THA) in 45 patients aged 56–84 years (mean age 68.3), including 32 (71.1%) women and 13 (26.1%) men. 12 patients initially received conservative treatment, and 33 patients received initial surgical treatment using various metal osteosynthesis procedures. The time from osteosynthesis or from the moment of injury to admission to the hospital for hip arthroplasty ranged from 12 to 30 months. All patients, before conversion arthroplasty and after discharge, were repeatedly invited to the clinical diagnostic department for a clinical examination and for assessment using rating scales. 3, 6 and 12 months after the surgery, pain syndrome and patient quality of life were assessed using the following questionnaire scales: Harris Hip Score, MOS SF-36, VAS. The maximum follow-up period ranged from 12 to 60 months. ResultsBased on the results obtained, patients of all 4 groups after conversion arthroplasty noted a significant quality of life improvement, a decrease in pain severity and functional results improvement. This was probably due to the presence of a severe limitation of range of movements in the joint, intense pain, absence of support ability of the extremity, as well as low operative efficacy expectations.In 1 (2%) patient, acute PJI was diagnosed in the early postoperative period, followed by sepsis and death.In 4 patients (9%) the result was considered unsatisfactory. At 1 year of follow-up after surgery, they complained of pain and claudication in the operated joint.3 (6%) patients underwent reduction of dislocation. ConclusionsStrict adherence to the recommended treatment algorithm for patients with proximal femur pseudarthrosis made it possible to achieve good treatment results in 90% of surgically treated patients. An important step in the treatment of this patients is a careful preoperative planning with thorough assessment of bone tissue quality and muscles condition in the proximal femur area, allowing to choose the optimal endoprosthesis components.

Mendelian-randomization study revealed causal relationship between nonalcoholic fatty liver disease and osteoporosis/fractures.

Patients with nonalcoholic fatty liver disease (NAFLD) are reported to have a higher risk of osteoporosis/fractures; however, the causal relationship remains unclear. Publicly available genome-wide association studies (GWASs) were used for Mendelian randomization (MR) analysis. GWASs of NAFLD and fractures were obtained from the FinnGen Consortium. GWASs of bone mineral density (BMD) were derived from a meta-analysis. GWASs of obesity, diabetes, liver function, and serum lipid-related metrics were used to clarify whether the accompanying NAFLD symptoms contributed to fractures. Moreover, two additional GWASs of NAFLD were applied. A causal association was not observed between NAFLD and BMD using GWASs from the FinnGen Consortium. However, a causal relationship between NAFLD and femoral neck-BMD (FN-BMD), a suggestive relationship between fibrosis and FN-BMD, and between NAFLD and osteoporosis were identified in replication GWASs. Genetically proxied body mass index (BMI), high-density lipoprotein (HDL), and hip circumference increased the likelihood of lower limb fractures. The waist-to-hip ratio decreased, whereas glycated hemoglobin (HbA1C) and homeostasis model assessment of β-cell function (HOMA-B) increased the risk of forearm fractures. Low-density lipoprotein (LDL) reduced, whereas HbA1C increased the incidence of femoral fractures. Alkaline phosphatase (ALP) raised the risk of foot fractures. However, after a multivariate MR analysis (adjusted for BMI), all the relationships became insignificant. NAFLD caused reduced BMD, and genetically predicted HDL, LDL, HbA1C, HOMA-B, ALP, hip circumference, and waist-to-hip ratio causally increased the risk of fractures. BMI may mediate causal relationships. Larger GWASs are required to verify this finding.

Relationship between menopausal hormone therapy and incidence of fractures in postmenopausal women

Objective Long-term protective effects of menopausal hormone therapy (MHT) at fractures with different doses and components are controversial. We analyzed the effect of MHT on the incidence of spine and femur fractures according to MHT type, age at commencement, duration and dose of hormones in Korean women. Method This retrospective study evaluated propensity score-matched patients with MHT from the Korean National Health Insurance Service database. Among women aged ≥50 years with menopause between 2004 and 2007, spine and femur fracture incidence until 2017 was analyzed in 36,446 women who had received MHT for >1 year. Estrogen–progesterone therapy (EPT), estrogen-only therapy (ET) or tibolone therapy was conducted. Results EPT significantly lowered the incidence of spine and femur fractures with a conventional dose, but not with a low dose. Tibolone significantly decreased the incidence of spine fractures in women aged 50–59 years when used for >5 years, and the incidence of femur fractures in women older than 60 years when used for >3 years. ET significantly lowered the risk of femur fractures when estradiol was used for >5 years. Conclusion In menopausal women, all MHT including conventional-dose EPT, ET and tibolone tended to lower the incidence of fractures. The effects, however, varied with the type of fracture and type of MHT.

IMPACT OF COVID-19 ON THE PROFILE, SEASONALITY AND INCIDENCE OF FEMUR FRACTURE CASES IN BRAZILIAN YOUNG ADULTS

To compare the incidence of femur fractures (ICD S72) in patients aged 15 to 49 in Brazil, in the period before (March to December 2019) and during the COVID-19 pandemic (March to December 2020), based on data from DATASUS, as well as to assess the impact of social isolation on the incidence and demographic profile of affected individuals. An ecological study with data from individuals aged 15 to 49 who had a femur fracture before and during the COVID-19 pandemic, extracted from the DATASUS database. We calculated the incidence and demographic profile of femur fractures and the type of hospitalization. There was a significant increase in the incidence of femur fractures among individuals aged 15 - 49 in Brazil during the period of social isolation due to COVID-19. The incidence was 165/100,000 inhabitants during the pandemic and 163/100,000 inhabitants in the same period of 2019 (main increase observed in the 15 - 34 age group and decline in the 35 - 49 age group). The North and Northeast regions showed an increase in the incidence of femur fractures and an increase in emergency hospitalizations related to this condition. On the other hand, there was a decrease in incidence in the Central-West region and in the type of hospitalization described as elective. We conclude that during the COVID-19 pandemic in Brazil there has been an increase in femur fractures in young adults, which may be related to the failure of social isolation measures.

Femoral fractures and abuse in children under 36 months old: a Swiss case series.

Abuse should be suspected in infant femoral fractures without significant trauma, especially if the child is non-ambulatory. Review the epidemiological and radiological characteristics of femoral fractures in children under 36 months old to identify those potentially related to child abuse. Cases involving 102 patients presenting with 103 femoral fractures between January 1990 and December 2020 were investigated, paying close attention to mechanisms of injury, fracture patterns, and their possible relations to child abuse. The annual incidence of femoral fractures in patients under 36 months old was estimated at 24.6 per 100 000; the incidence in infants under 13 months was significantly higher than among children between 13 and 36 months old. Most infants under 13 months suffered from transverse or oblique metaphyseal/diaphyseal fractures (93.2%), whereas 67.8% of older children presented with spiral shaft fractures. Data confirmed child abuse in 4.9% of all patients (one with bilateral fractures); femoral fractures were incompatible with their reported mechanisms of injury in 31 patients (30.4%), whereas 12 fractures (11.8%) occurred in unexplained circumstances. More than 50% of femoral fractures occurred with low-energy trauma. The difference in patterns according to patients' ages suggested different mechanisms of trauma in ambulatory and non-ambulatory infants. Confirmed abuses and unclear or inconsistent mechanisms of trauma, raised potential total child abuse cases to 47.1% of our cohort. Level of evidence: Level IV.

Hemochromatosis Genetic Variants and Musculoskeletal Outcomes: 11.5-Year Follow-Up in the UK Biobank Cohort Study.

The iron overload disorder hemochromatosis is primarily caused by the homozygous HFE p.C282Y variant, but the scale of excess related musculoskeletal morbidity is uncertain. We estimated hemochromatosis-genotype associations with clinically diagnosed musculoskeletal outcomes and joint replacement surgeries in the UK Biobank community cohort. A total of 451,143 European ancestry participants (40 to 70 years at baseline) were followed in hospital records (mean 11.5-years). Cox proportional hazards models estimated HFE p.C282Y and p.H63D associations with incident outcomes. Male p.C282Y homozygotes (n = 1294) had increased incidence of osteoarthritis (n = 52, hazard ratio [HR]: 2.12 [95% confidence interval, CI: 1.61 to 2.80]; p = 8.8 × 10-8), hip replacement (n = 88, HR: 1.84 [95% CI: 1.49 to 2.27]; p = 1.6 × 10-8), knee replacement (n = 61, HR: 1.54 [95% CI: 1.20 to 1.98]; p = 8.4 × 10-4), and ankle and shoulder replacement, compared to males with no HFE mutations. Cumulative incidence analysis, using Kaplan-Meier lifetable probabilities demonstrated 10.4% of male homozygotes were projected to develop osteoarthritis and 15.5% to have hip replacements by age 75, versus 5.0% and 8.7% respectively without mutations. Male p.C282Y homozygotes also had increased incidence of femoral fractures (n = 15, HR: 1.72 [95% CI: 1.03 to 2.87]; p = 0.04) and osteoporosis (n = 21, HR: 1.71 [95% CI: 1.11 to 2.64]; p = 0.02), although the latter association was limited to those with liver fibrosis/cirrhosis diagnoses. Female p.C282Y homozygotes had increased incidence of osteoarthritis only (n = 57, HR: 1.46, [95% CI: 1.12 to 1.89]; p = 0.01). Male p.C282Y/p.H63D compound heterozygotes experienced a modest increased risk of hip replacements (n = 234, HR: 1.17 [95% CI: 1.02 to 1.33], p = 0.02), but this did not pass multiple testing corrections. In this large community cohort, the p.C282Y homozygote genotype was associated with substantial excess musculoskeletal morbidity in males. Wider HFE genotype testing may be justified, including in orthopedic clinics serving higher HFE variant prevalence populations. © 2023 The Authors. JBMR Plus published by Wiley Periodicals LLC. on behalf of American Society for Bone and Mineral Research.

The Watson Extraction System for removal of well-fixed femoral stems: A retrospective review of 10 cases

BackgroundRevision of well-fixed cementless femoral stems is a challenging and time-consuming aspect of revision hip arthroplasty. The Watson Extraction System (WES) is a novel, size-specific 3-D fabricated instrument that mimics the outer geometry of the implanted femoral stem. The device acts to cut circumferentially around the stem as it is impacted into place, effectively disrupting the bone-implant interface. MethodsThis is a retrospective review assessing the experience of 3 fellowship-trained adult reconstruction surgeons who used the WES to extract 10 well-fixed femoral stems during rTHA between 11/7/2020 and 11/7/2022. Outcomes and measures included: ability to remove the stem without a femoral osteotomy, femoral stem extraction time, incidence of femoral fracture, stem type used for reconstruction, blood loss, total surgical time, post-operative complications. ResultsNo femoral osteotomies were required. The mean time for stem extraction was 7 min (range, 2–13), and there were 2 (20%) intra-operative femoral fractures. The stem type utilized for reconstruction included: 4 (40%) modular, tapered style stems, 3 (30%) antibiotic spacers, 2 (20%) primary style stems, and 1 (10%) ream and broach proximally porous stem. The mean blood loss was 425 ml (range, 200–800), total surgical time was 160 min (range, 107–232), and duration of follow-up was 7 months (range, 2–22 months). ConclusionThe WES may mitigate the need for femoral osteotomy, reduce femoral stem extraction and overall intraoperative time, and decrease blood loss in rTHA. Further, reduced bone loss with use of this device may permit final reconstruction with a primary style stem.

Knee Pain After Retrograde Intramedullary Nailing with Surgical Implant Generation Network of Femur Shaft Fractures at Public Hospitals in Bahir Dar City, Ethiopia: Analysis of 6-Months Follow-Up Results.

The incidence of femur fractures in young and elderly people has increased, particularly in countries with limited resources like Ethiopia. Intra-medullary nailing (IM) has been an effective and cost-effective method of treating long bone shaft fractures, but it can lead to complications such as knee pain. This study aimed to evaluate knee pain and its associated factors following retrograde intramedullary nailing for femur fractures. The study followed 110 patients diagnosed with femur fractures and treated with retrograde SIGN Standard Nail or Fin Nail from January 2020 to December 2022 at two hospitals in Ethiopia. The patients were followed up for at least 6 months, and data were collected from medical charts, patient interviews, and phone calls to patients who did not attend the follow-up appointment. Binary logistic regression analysis was used to identify factors associated with knee pain. The study showed that 40 patients reported knee pain at 6-months follow-up, making a prevalence of 36.4%. Factors significantly associated with knee pain were a time of injury to nailing (AOR=4.23, 95% CI: 1.28-13.92), use of a screw to the medial cortex (AOR=9.30, 95% CI: 2.90-12.74), and fracture site (AOR= 2.67, 95% CI: 14.01-7.03). Specifically, the longer the time from injury to nailing, the higher the risk of knee pain. The use of a longer screw to the medial cortex and a fracture site were also positively associated with knee pain. This study concludes that although retrograde intramedullary nail fixation is an effective method for femur fractures, it often results in knee pain. Approximately 4 of 10 patients suffered from knee pain in this study. Avoiding delayed surgical management and minimizing the use of prominent metalwork may reduce knee pain.

THE CHANGING FACE OF FEMORAL FRAGILITY FRACTURES: INCIDENCE; FRACTURE PATTERNS; AND MANAGEMENT

The purpose of this study was to determine whether there have been changes in the complexity of femoral fragility fractures presenting to our Dunedin Orthopaedic Department, New Zealand, over a period of ten years.Patients over the age of 60 presenting with femoral fragility fractures to Dunedin Hospital in 2009 −10 (335 fractures) were compared with respect to demographic data, incidence rates, fracture classification and treatment details to the period 2018-19 (311 fractures). Pathological and high velocity fractures were excluded.The gender proportion and average age (83.1 vs 83.0 years) was unchanged. The overall incidence of femoral fractures in people over 60 years in our region fell by 27% (p<0.001). Intracapsular fractures (31 B1 and B2) fell by 29% (p=0.03) and stable trochanteric fractures by 56% (p<0.001). The incidence of unstable trochanteric fractures (31A2 and 31A3) increased by 84.5% from 3.5 to 6.4/10,000 over 60 years (p = 0.04). The proportion of trochanteric fractures treated with an intramedullary (IM) nail increased from 8% to 37% (p <0.001). Fewer intracapsular fractures were treated by internal fixation (p<0.001) and the rate of acute total hip joint replacements increased from 13 to 21% (p=0.07). The incidence of femoral shaft fractures did not change significantly with periprosthetic fractures comprising 70% in both cohorts.While there has been little difference in the numbers there has been a decrease in the incidence of femoral fragility fractures likely due to the increasing use of bisphosphonates. However, the incidence of unstable trochanteric fractures is increasing. This has led to the increased use of IM nails which are increasingly used for stable fractures as well.The increasing complexity of femoral fragility fractures is likely to have an impact on implant use, theatre time and cost.

Trends in neck of femur fracture incidence in EU15+ Countries from 1990-2017

BackgroundNeck of femur fractures (NOFF) pose significant socio-economic costs to society with a high degree of morbidity and mortality. Its incidence rate has been collated within the Global Burden of Disease (GBD) database; however, to date, no comparison across countries has been reported. MethodsNOFF age-standardised incidence rates (ASIR) per 100,000 population were extracted from the GBD database for European Union (EU) 15+ countries over the period 1990 to 2017. Joinpoint regression analysis of the data identified trends in ASIR and associated estimated annual percentage changes (EAPC). These were analysed by specified timeframe, country and gender. ResultsOf the 19 EU15+ countries, 11 (58%) had overall increases in NOFF ASIRs in 2017 compared to 1990. The median ASIRs were 240/100,000 and 322/100,000 for males and females, respectively, in 1990. By 2017, this had increased to 259/100,000 and 325/100,000, respectively. Females consistently had relatively higher NOFF ASIRs with a median gender fracture gap of 62/100,000 in 2017. Males had a higher percentage change in increasing ASIRs, with a smaller percentage change in decreasing ASIRs for all included countries. The highest national ASIRs was observed in Australia, followed by Finland and Belgium. Conversely the Mediterranean countries demonstrated the lowest ASIRs, closely followed by the USA. ConclusionDespite significant advances in primary and secondary hip fracture prevention strategies over the 28-year study period, significant increases in NOFF ASIRs among most EU15+ countries were observed, especially with respect to gender.

OR01-1 Proximal Femur Fracture Incidence by Sex among Older US Asian/Pacific Islander Adults and non-Hispanic White Adults

Abstract Background The burden of proximal femur (hip) fractures is high in older adults and contributes to substantial mortality. Numerous studies also document racial/ethnic differences in hip fracture incidence, lower among US Asian compared to non-Hispanic White (NH-White) adults. These data have informed base population factors used for fracture risk calculation; for US Asian compared to NH-White populations, ratios of 0.50 and 0.64 have been used for women and men, respectively. In this study, we examined age-adjusted and age-specific incidences of hip fracture in a contemporary population of older US adults and compared findings in Asian and NH-White women and men. Methods Among adults age ≥50 years who were members of a large US healthcare system during 2010-2019, we identified Asian/Pacific Islander (Asian/PI) and NH-White adults based on self-reported race/ethnicity data. Incident hip fractures were identified during follow-up from 2010 to 2021 (censoring at hip fracture, death, or membership end) based on (1) initial principal/primary hospital diagnosis of femoral neck or pertrochanteric fracture or (2) secondary hospital diagnosis with hip fracture repair procedure(s). The incidence of hip fracture (per 100,000 person-years) by sex and age and overall age-standardized incidence (using the 2010 US Census) were reported with [95% confidence intervals]. To compare sex-specific fracture rates between Asian/PI and NH-White adults, Poisson models were fitted, adjusting for age (5-year age categories). Results Among 203,116 Asian/PI and 645,384 NH-White women, we identified 1,436 and 15,214 hip fractures, and among 174,594 Asian/PI and 573,693 NH-White men, we identified 582 and 7051 hip fractures during follow-up, respectively. The age-adjusted incidence of hip fracture was 136 [129-143] and 297 [292-302] per 100,000 person-years for Asian/PI and NH-White women and 54 [49-58] and 149 [145-153] per 100,000 person-years for Asian/PI and NH-White men, respectively. By 5-year age group, hip fracture incidence increased from 4, 40, to 1113 per 100,000 person-years for Asian/PI women and 7, 29, to 528 per 100,000 person-years for Asian/PI men ages 50-54, 65-69, to 85+ years, respectively. These estimates were lower than that observed in respective NH-White women (range 19, 140, to 2068 per 100,000 person-years) and NH-White men (range 22, 85, and 1381 per 100,000 person-years). The age-adjusted relative risk (risk ratio) of fracture comparing Asian/PI to NH-White women was 0.44 [0.41-0.46] and comparing Asian/PI to NH-White men was 0.35 [0.33-0.39]. Conclusion Hip fracture incidence in Asian/PI women and men is 56% and 65% lower than that observed in NH-White women and men. These findings indicate that racial/ethnic differences in proximal femur fracture persist in contemporary aggregate populations of older US Asian/PI adults compared to NH-White adults. However, given the known and increasing heterogeneity of the US Asian/PI population, future studies should examine whether these risk ratios vary by Asian/PI ethnic subgroups. Presentation: Saturday, June 11, 2022 11:30 a.m. - 11:45 a.m.

Daylight savings time transition and the incidence of femur fractures in the older population: a nationwide registry-based study.

BackgroundDaylight Savings Time (DST) transition is known to cause sleep disruption, and thus may increase the incidence of injuries and accidents during the week following the transition. The aim of this study was to assess the incidence of femur fractures after DST transition.MethodsWe conducted retrospective population-based register study. All Finnish patients 70 years or older who were admitted to hospital due to femur fracture between 1997 and 2020 were gathered from the Finnish National Hospital Discharge Register. Negative binomial regression with 95% confidence intervals (CI) was used to evaluate the incidence of femur fractures after DST transition.ResultsThe data included a total of 112,658 femur fractures during the study period between 1997 and 2020, with an annual mean (SD) of 4,694 (206) fractures. The incidence of femur fractures decreased at the beginning of the study period from 968 to 688 per 100,000 person-years between 1997 and 2007. The weekly mean of femur fractures remained lower during the summer (from 130 to 150 per 100,000 person-weeks) than in winter (from 160 to 180 per 100,000 person-weeks). Incidence rate ratio for the Monday following DST transition was 1.10 (CI [0.98–1.24]) in spring and 1.10 (CI [0.97–1.24]) in fall, and for the whole week 1.07 (CI [1.01–1.14]) in spring and 0.97 (CI [0.83–1.13]) in fall.ConclusionWe found weak evidence that the incidence of femur fractures increases after DST transition in the spring.

12 Trends in Neck of Femur Fracture Incidence in EU15+ Countries From 1990–2017

Abstract Background Neck of femur fractures (NOFF) pose significant socio-economic costs to society with a high degree of morbidity and mortality. Its incidence rate has been collated within the Global Burden of Disease (GBD) database; however, to date, no comparison across countries has been reported. Method NOFF age-standardised incidence rates (ASIR) per 100,000 population were extracted from the GBD database for European Union (EU) 15+ countries over the period 1990 to 2017. Joinpoint regression analysis of the data identified trends in ASIR and associated estimated annual percentage changes (EAPC). These were analysed by specified timeframe, country, and gender. Results Of the 19 EU15+ countries, 11 (58%) had overall increases in NOFF ASIRs in 2017 compared to 1990. The median ASIRs were 240/100,000 and 322/100,000 for males and females, respectively, in 1990. By 2017, this had increased to 259/100,000 and 325/100,000, respectively. Females consistently had relatively higher NOFF ASIRs with a median gender fracture gap of 62/100,000 in 2017. Males had a higher percentage change in increasing ASIRs, with a smaller percentage change in decreasing ASIRs for all included countries. The highest national ASIRs was observed in Australia, followed by Finland and Belgium. Conversely the Mediterranean countries demonstrated the lowest ASIRs, closely followed by the USA. Conclusions Despite significant advances in primary and secondary hip fracture prevention strategies over the 28-year study period, significant increases in NOFF ASIRs among most EU15+ countries were observed, especially with respect to gender.

Metabolic bone disease and fracture risk after gastric bypass and sleeve gastrectomy: comparative analysis of a multi-institutional research network.

Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) are the two most performed bariatric procedures. Multiple studies have investigated the metabolic bone complications after bariatric surgery, but there is a paucity of data comparing bone health after RYGB and SG. To compare the rates of major fractures and osteoporosis after Roux-en-Y gastric bypass and sleeve gastrectomy. Data from TriNetX multi-institutional research network that includes data from multiple health care organizations in the USA was analyzed at West Virginia University. We conducted a retrospective cohort study using TriNetX, a federated multi-institutional research network. We identified patients who underwent RYGB or SG. Primary outcome was the rate of major fractures at 3 years after the procedure. Other outcomes includedthe rate of spine fracture, femur fracture, osteoporosis, and vitamin D deficiency at follow-up. In unmatched analysis, patients with SG were less likely to have major fractures or an osteoporosis diagnosis than RYGB patients at 3 years after the procedure (P < .05). After propensity-score matching, similar results were noted; patients with SG were less likely to have major fractures than RYGB patients at 3 years after procedure (2.85% versus 3.66%, risk ratio [RR]: .78, 95% confidence interval [CI]: .71-.85), and a lower rate of osteoporosis diagnosis was noted in the SG group. High rates of vitamin D deficiency were noted in both cohorts. The incidence of spine fractures was significantly lower in the SG group than in the RYGB group (.76% versus 1.18%, RR: .65, 95% CI: .54-.77). Similarly, the incidence of femur fracture was significantly lower after SG (RR: .62, 95% CI: .44-.88). Female sex, higher age, smoking history, and diabetes were independently associated with osteoporosis diagnosis during follow-up (all P values <.05). Our analyses showed that RYGB is associated with a higher risk of osteoporosis, vitamin D deficiency, and osteoporotic fractures. Thus, in patients with a higher baseline osteoporotic risk, SG may be preferred option; however, further studies are needed.

Incidence of femoral fractures in children and adolescents in Finland and Sweden between 1998 and 2016: A binational population-based study.

Femoral fractures in children have significant impact for patients, family, and trauma resources as they usually require hospitalization and surgical treatment. The aim of this study was to determine the incidence and trends of femoral fractures among children and adolescents hospitalized between 1998 and 2016 in Finland and Sweden. All patients younger than 17 years of age in Finland and Sweden with a femoral fracture treated surgically between 1998 and 2016 were included in the study. Data were collected from National Hospital Discharge Registries. Patients were classified by gender and age into four groups. The annual incidences per 100,000 were calculated using annual mid-year population census data obtained from the Official Statistics of Finland and Sweden. In total, 6410 patients younger than 17 years of age diagnosed with femoral fracture were included in this study. The total incidence per 100,000 femoral fractures was 13.3 in Finland and 11.0 in Sweden. The incidence of femoral fractures decreased during the study period in all age groups, except for teenage Finnish girls. Most of the fractures were located in femoral shaft. Fractures of the upper and distal femur were rare. Male predominance was detected in all age groups older than 1 year. The incidence of femoral fractures decreased in all age groups except in teenage Finnish girls. Majority of femoral fractures were located in femoral shaft with male predominance. In children younger than 1 year of age, female predominance was found.

Variações sazonais na incidência de fraturas do fêmur no estado do Rio Grande do Sul, sul do Brasil

Abstract Introduction Femoral fractures are a major cause of morbidity and mortality, mainly among older people. Objective To examine the effect of seasonality on hospitalizations due to femur fracture among people residing in the Rio Grande do Sul state, southern Brazil, from 2008 to 2019. Methods Ecological study based on secondary data from the SUS Hospital Information System (SIH/SUS). A total of 74,374 reports of hospital admissions was considered. The generalized additive model (GAM) approach was employed to assess the seasonality of the time series, with stratification by sex and age groups and considering the monthly average number of events of femoral fractures per day as a dependent variable. Results A considerably higher incidence of femoral fractures in women aged 70 years or more was described. Among people aged less than 50 years, there is not an apparent seasonal effect. Men aged 70 years or older and women aged 50 years or older have a higher frequency of hospitalizations due to femur fractures in the colder months. Conclusion Among older people, more femoral fractures occurred during the winter compared to summer. This supports findings from other studies, although reasons for this seasonal variation are uncertain. The knowledge of these seasonal variations can help to plan the health care in the public health system.

COMPARATIVE STUDY OF HEMIREPLACEMENT ARTHROPLASTY WITH BIPOLAR PROSTHETIC AND PROXIMAL FEMORAL NAIL (PFN) IN UNSTABLE INTERTROCHANTERIC FRACTURE OF FEMURE: INTERVENTIONAL PROSPECTIVE RANDOMIZED STUDY

Background: Intertrochanteric femur fracture incidence has increased due to increased life expectancy and osteoporosis.&#x0D; Methods- The present study was prospectively carried out in 60 consecutive patients of Fracture Intertrochanter Femur and treated with Hemiarthroplasty with Cemented Bipolar Prosthesis and Proximal Femoral Nail.&#x0D; Results: The age of the patients in present study was in range of 60 - 80 years. There was a preponderance of female in present study in both groups. The mean duratioin of surgery in the Bipolar group (91.24±9.21Minutes) was much More That In PFN (53.12 ±6.02Minutes) Group. All patients of Bipolar group was discharged between 4 to 9 days and in PFN group 4 to 12 days after surgery. The average harris hip score in PFN group is 87.32±4.13 and in Bipolar group is 85.02±7.92. Final functional outcome were better in PFN group (P value 0.01) than by Bipolar group and significant.&#x0D; Conclusion: The outcomes of the stable fractures treated with either Bipolar or PFN were similar. Unstable comminuted fractures treated with Bipolar showed significantly better outcomes with all patients having good results.&#x0D; Keywords: Hip Arthroplasty, PFN, Complication

The impact of COVID-19 on the epidemiologic characteristics of traumatic fractures: A systematic review of recent literature.

The aim of this study was to evaluate whether COVID-19-related period of societal restrictions and nationwide in 2020 were associated with a significant change in types and frequency of traumatic fractures. A systematic review of recent literature on epidemiologic characteristics of traumatic fractures during the outbreak of COVID-19 was conducted. Multiple databases of PubMed, EMBASE, Cochrane library, and Web of Science were searched, and articles comparing incidence for traumatic fractures before and after of COVID-19 outbreak were Results: From 8 published studies which had been reported from July 2020 to September 2020, a total of 9305 patients were identified. The study period of each study included varied from January 24 to May 22 in 2020. There was a significant decrease in the total number of trauma cases during lockdown by 3229 cases (pre-lockdown n = 6267 and lockdown n = 3038), amounting to a decrease by a pooled percentage of 51.6% (P = 0.012). The incidence of hand and tibia fractures decreased while the incidence of femoral fracture significantly increased during COVID-19 outbreak (P < 0.001). There was no significant difference in the fracture frequency for all other skeletal areas (P > 0.05). Evidence suggests that there was a significant decrease in the overall number of traumatic fractures during the COVID-19-related period of societal restrictions and lockdown. Proportions of most fractured areas were not significantly influenced by the state of emergency, except for femoral fractures, which had occurred more often during this state. Care must be taken, while developing contingency plans for reallocating resources during the COVID-19 pandemic, not to assume that all trauma presentations will decrease. Evidence from this study has suggested there was a significant decrease in the overall number of traumatic fractures during the COVID-19-related period of societal restrictions and lockdown. Proportions of most fractured areas were not significantly influenced by the state of emergency, except for femoral fractures which had occurred more often during this state. Level III, Diagnostic Study.

COMPARATIVE STUDY OF HEMIREPLACEMENT ARTHROPLASTY WITH BIPOLAR PROSTHETIC AND PROXIMAL FEMORAL NAIL (PFN) IN UNSTABLE INTERTROCHANTERIC FRACTURE OF FEMURE: INTERVENTIONAL PROSPECTIVE RANDOMIZED STUDY

Background: Intertrochanteric femur fracture incidence has increased due to increased life expectancy and osteoporosis. Management of these fractures in elderly is challenging due to difficult anatomical reduction, poor bone quality and osteoporosis. Internal fixation in these cases usually involves prolonged bed rest to prevent implant failure which leads higher complication such as deep vein thrombosis, pneumonia pulmonary embolism, bed sores, increased morbidity.&#x0D; Methods: The present study was prospectively carried out in 60 consecutive patients of Fracture Intertrochanter Femur and treated with Hemiarthroplasty with Cemented Bipolar Prosthesis and Proximal Femoral Nail.&#x0D; Results: The average harris hip score in PFN group is 88.21±4.36 and in Bipolar group is 85.21±8.12. Final functional outcome were better in PFN group (P value 0.02) than by Bipolar group and significant.&#x0D; Conclusion: The outcomes of the stable fractures treated with either Bipolar or PFN were similar. Unstable comminuted fractures treated with Bipolar showed significantly better outcomes with all patients having good results.&#x0D; Keywords: Hip arthroplasty, PFN, Complication