Fracture Patients Research Articles

Effectiveness of a co-management program with internal medicine on hip fracture patients at a regional hospital in northwest Spain. Co-inter-Monf study.

Hip fractures represent a serious public health problem with a high burden of mortality, morbidity, and resource use. Co-management has proven to enhance the clinical outcomes of hip fracture patients hospitalized in various settings. This study aims to evaluate whether the previously observed benefits of co-management can be achieved when such a program is implemented in a rural-based district hospital. A prospective, single-center observational study was conducted on hip fracture patients hospitalized for hip fracture. Patients were either co-managed by an internal medicine specialist with part-time dedication or not co-managed. The study was conducted in a rural hospital located in Galicia, Northwestern Spain, which serves a population of 45,000. A total of 207 patients were included in the study, of whom 97 received co-management. The majority of the patients who were co-managed were female (69.1%) and had a median age of 88years (interquartile range 83-92). The study showed a high burden of comorbidity with a median Charlson index of 6 points, along with high prevalence rates of dementia (46%), functional disability (50%), and chronic anticoagulant therapy (25%). Despite no differences in age, sex, or preadmission cognitive or functional status, the study found lower 30-day postdischarge mortality in co-managed patients (9.3%) compared with the 110 controls (20.0%, p = 0.049). The prevalence of osteoporosis treatment, both calcium/vitamin D (87.8% vs. 60.7%, p < 0.001) and bisphosphonates/denosumab/teriparatide (42.4% vs. 15.7%, p < 0.001), was higher in the co-managed patients at 30days after discharge. No differences were observed between the two groups in terms of in-hospital mortality and length of stay. The implementation of internal medicine co-management for hip fracture patients resulted in enhanced outcomes, particularly in the reduction of mortality within 30days of discharge as well as in the prevalence of osteoporosis treatment.

Evaluation of using grip strength and hand muscle cross-sectional area to predict secondary fractures post distal radius fracture

SummaryGrip strength measurement, as a surrogate of sarcopenia diagnosis, effectively predicts secondary fracture risk in distal radius fracture patients. This simple tool enhances clinical practice by identifying high-risk patients for targeted interventions, potentially preventing or reversing functional decline and recurrent fractures.PurposeTo evaluate grip strength and hand muscle cross-sectional area as predictors of secondary fracture risk in patients with a history of distal radius fracture (DRF), serving as surrogates of the diagnosis of sarcopenia.MethodsA retrospective cohort study of 745 DRF patients was analyzed with their grip strength data using Cox proportional hazards regression, receiver operating characteristic analysis, and Kaplan–Meier analysis to predict secondary fracture risk over an average of 12 years. Hand muscle cross-sectional area was similarly analyzed.ResultsPatients with a history of DRF were predicted to have a 4.1% higher likelihood of experiencing a secondary fracture per kilogram reduction in their grip strength (p < 0.008), independent of age and sex. Patients were categorized as high-risk (≤ 16 kg), moderate-risk (17–24 kg), or low–risk (≥ 25 kg) (p < 0.001). High-risk patients showed a 2.2-fold (95% CI = 1.55–3.17) higher recurrent fracture risk compared to low-risk patients. Cumulative secondary fracture probabilities of the high-risk group patients at 5, 10, and 15 years were estimated to be 16%, 30%, and 54%, respectively.ConclusionsGrip strength measurement, as a surrogate of sarcopenia diagnosis, effectively predicts secondary fracture risk in patients with DRF. This simple tool could improve clinical practice by identifying high-risk patients for targeted interventions to prevent recurrent fractures or even reverse functional decline.

Low-Demand Cemented Femoral Stem Designs and Revision Risk Following the Hemiarthroplasty Treatment of Geriatric Hip Fracture.

Cemented fixation is recommended in the hemiarthroplasty treatment of geriatric femoral neck fractures. Certain cemented stems have similarly designed "low-demand" counterparts, but it is unclear whether they yield comparable clinical outcomes. The purpose of this study was to evaluate the revision risk associated with two low-demand stems, Summit Basic (DePuy Synthes) and Versys LD/Fx (Zimmer Biomet), in comparison to their standard counterparts, Summit (DePuy Synthes) and Versys Advocate (Zimmer Biomet). Using our U.S. integrated healthcare system's Hip Fracture Registry, we identified patients aged ≥60 years who were treated with one of these four cemented hemiarthroplasty devices (2009-2022). Low-demand stems were compared with standard stems on the basis of aseptic revision rates (primary outcome measure) as well as periprosthetic fracture and 90-day complications (secondary outcome measures). Multivariable Cox proportional hazards regression was used to adjust for potential confounders. Overall, there were 9,828 cemented hemiarthroplasties (69.0% female, 78.9% White), including 3,713 low-demand stems and 6,115 standard stems. In the adjusted analysis, low-demand stems were associated with a higher risk of aseptic revision compared with standard designs (hazard ratio [HR] 1.53, 95%CI 1.06-2.22, P = 0.024). This difference was driven primarily by a higher risk of periprosthetic fracture in the low-demand stems (HR 3.40, 95%CI 1.54-7.51, P = 0.003). Similar findings were observed when separately comparing Summit Basic with Summit and Versys LD/Fx to Versys Advocate, and when restricting to procedures performed by experienced total hip arthroplasty surgeons. In this study of 9,828 hip fracture patients treated with cemented hemiarthroplasty, low-demand stems were associated with a higher risk of aseptic revision as compared with their standard counterparts. Further research is required to determine the features of the low-demand stems which could be contributing to this finding, as well as the circumstances under which usage of low-demand stems could still be justified based on cost.

Prediction Models for Postoperative Pneumonia in Elderly Hip Fracture Patients: A Systematic Review and Critical Appraisal.

Although several models have been developed to predict postoperative pneumonia in elderly hip fracture patients, no systematic review of the model quality and clinical applicability has been reported. To systematically review and critically appraise existing models for postoperative pneumonia in elderly hip fracture patients. Systematic review and meta-analysis. 10 databases were systematically searched from inception to April 15, 2024, updated on August 26. Two reviewers independently performed literature selection, information extraction and quality assessment. A narrative synthesis was employed to summarise the characteristics of the models. Meta-analysis was performed using Stata 17.0. 13 studies containing 25 models were included. The prevalence of pneumonia was 9.62% (95% CI: 7.62%-11.62%). Age (53.8%), hypoproteinemia (46.2%), chronic obstructive pulmonary disease (COPD, 30.8%), gender (30.8%), activity of daily living score (ADL, 30.8%) and American Society of Anesthesiologists (ASA, 30.8%) score were the top six predictors. All models reported area under curve (AUC: 0.617-0.996). 9 studies (69.2%) used the Hosmer-Lemeshow (H-L) test, calibration curves, or Brier scores to evaluate the calibration. 5 studies (38.5%) performed internal validation, 4 studies (30.8%) performed external validation. All studies had a high risk of bias due to single sample source, inappropriate data processing, inadequate model evaluation, and negligence of calibration and validation. 10 studies (76.9%) had good applicability. Prediction models for postoperative pneumonia in elderly hip fracture patients are still in the developing stage. The validation and evaluation of existing models are poor. Future studies should focus on robust external validation and updating. Additionally, the Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis + artificial intelligence (TRIPOD+AI) statement should be followed. Prediction models are effective in discriminating postoperative pneumonia in elderly hip fracture patients, but further external validation and adjustment are still warranted.

Combining systemic inflammation biomarkers with traditional prognostic factors to predict surgical site infections in elderly hip fracture patients: a risk factor analysis and dynamic nomogram development

BackgroundSystemic inflammation biomarkers have been widely shown to be associated with infection. This study aimed to construct a nomogram based on systemic inflammation biomarkers and traditional prognostic factors to assess the risk of surgical site infection (SSI) after hip fracture in the elderly.MethodsData were retrospectively collected from patients over 60 with acute hip fractures who underwent surgery and were followed for more than 12 months between June 2017 and June 2022 at a tertiary referral hospital. Biomarkers were calculated from peripheral venous blood collected on admission. The Centers for Disease Control and Prevention (CDC) definition of SSI was applied, with SSI identified through medical and pathogen culture records during hospitalization and routine postoperative telephone follow-ups. Multivariable logistic regression identified independent risk factors for SSI and developed predictive nomograms. Model stability was validated using an external set of patients treated from July 2022 to June 2023.ResultsA total of 1430 patients were included in model development, with 41 cases (2.87%) of superficial SSI and 6 cases (0.42%) of deep SSI. Multivariable analysis identified traditional prognostic factors older age (OR = 1.08, 95% CI 1.04–1.12), ASA class III-IV (OR = 2.46, 95% CI 1.32–4.56), surgical delay ≥ 6 days (OR = 3.59, 95% CI 1.36–9.47), surgical duration > 180 min (OR = 2.72, 95% CI 1.17–6.35), and systemic inflammation biomarkers Platelet-to-lymphocyte ratio (PAR) ≥ 6.6 (OR = 2.25, 95% CI 1.17–4.33) and Systemic Immune-Inflammation Index (SII) ≥ 541.1 (OR = 2.24, 95% CI 1.14–4.40) as independent predictors of SSI. Model’s stability was proved by internal validation, and external validation with 307 patients, and an online dynamic nomogram (https://brooklyn99.shinyapps.io/DynNomapp/) was generated.ConclusionsThis study combined systemic inflammatory biomarkers and developed an online dynamic nomogram to predict SSI in elderly hip fracture patients, which could be used to guide early screening of patients with high risk of SSI and provide a reference tool for perioperative management.

Cognitive Behavioural Therapy to Optimize Post-Operative Recovery (COPE): a randomized controlled feasibility trial in extremity fracture patients

BackgroundOutcomes following surgery to operatively manage extremity fractures are variable, and up to two-thirds of patients report chronic post-surgical pain. Preliminary evidence suggests that psychotherapy directed at improving coping skills and reducing somatic vigilance may improve outcomes among fracture patients. The objective of this pilot study was to test the feasibility and acceptability of a randomized controlled trial comparing an online cognitive behavioural therapy (CBT) program versus usual care in patients with an operatively managed open or closed extremity fracture.MethodsWe conducted a single-centre internal pilot study over a 10-month period in patients with at least one operatively managed open or closed fracture of the appendicular skeleton. Participants were randomized to an online CBT program or usual care and followed for 12 months. The goals of our pilot study were to determine an acceptable rate of recruitment, the degree to which participants randomized to CBT were compliant with treatment, the site investigator’s ability to adhere to study protocol and data collection procedures, and our ability to achieve high follow-up rates. Feasibility criteria were evaluated using a graded “traffic light” approach, in which “green light” indicates moving forward with the definitive trial, “yellow light” indicates proceeding with modifications to the protocol and trial procedures, and “red light” indicates a definitive trial is not feasible without significant protocol and trial procedure modifications.ResultsWe enrolled 94 participants over 10 months, which resulted in a “yellow light” for recruitment. Participant compliance with completion of the online CBT program received a “yellow light”, with 60% of participants who were randomized to CBT completing all seven modules. However, 40% of participants in the CBT-arm withdrew from the program, resulting in a “red light”. Adherence with the study protocol activities at baseline was relatively high (88%) which resulted in a “yellow light”. Follow-up was 85% (80 of 94) at 12 months, resulting in a “yellow light”.ConclusionsThese results suggest feasibility of a definitive, multi-centre trial to compare CBT versus usual care in the management of persistent post-operative pain in fracture patients despite the pilot phase identifying some challenges with enrollment timelines, compliance with the CBT program, and participant follow-up. For the definitive trial, we will expand participant recruitment to additional centres and implement strategies to optimize participant engagement and compliance with the CBT program and follow-up.Trial registrationClincialTrials.gov (NCT04274530). Registered February 18, 2020, https://classic.clinicaltrials.gov/ct2/show/NCT04274530.

PENERAPAN TERAPI PROGRESSIVE MUSCLE RELAXATION TERHADAP NYERI AKUT PRE OPERASI FRACTURE NECK FEMUR

Fractures or breaks in the continuity of bone structure are a major problem in the health sector. Tissue damage causes several typical clinical manifestations, namely pain. If not treated immediately, it can cause immobilization of the individual to carry out self-care activities. This study aims to determine the application of progressive muscle relaxation therapy to acute pain in preoperative patients with left femoral neck fractures in the Agung Wilis Accident Surgery Room, Blambangan Hospital. The research design used a case study of nursing care for femoral neck fracture patients with acute pain and carried out assessment, diagnosis, action planning, implementation and evaluation. Data collection methods through interviews and direct observation. The results of Mrs. N complained of pain from a femoral neck fracture, pain like being stabbed in the thigh area radiating to the pelvis on a scale of 7, the pain seemed to come and go. Interventions are given to reduce pain levels with progressive muscle relaxation. The evaluation revealed a change in the scale before therapy was given, namely a pain scale of 7 to 5. It can be concluded that the application of progressive muscle relaxation can be an alternative in treating pain in fracture sufferers.

The Predictive Value of Multifidus Degeneration in Osteoporotic Vertebral Compression Fracture Patients with Kyphosis Deformity.

Osteoporotic vertebral compression fracture (OVCF) causes pain, kyphosis and neurological damage, which significantly affect patients' quality of life. Patients with OVCF are often elderly and have severe osteoporosis, which makes preoperative symptom more serious, postoperative recovery worse and the incidence of postoperative complications high. The paraspinal muscles have been well studied in adult spinal deformities, but there is no conclusive evidence that their findings can be applied to OVCF. The purpose of this study was to evaluate the associations between multifidus (MF) parameters including fat infiltration (FI), relative functional sectional area (rFCSA), relative gross cross-sectional area (rGCSA) and the sagittal parameters, symptom score, and postoperative complications. To figure out the potential associations between multifidus muscle (MF) degeneration and patients' quality of life (QoL), sagittal parameters and mechanical complications in osteoporotic vertebral compression fracture (OVCF) patients with kyphosis deformity. Retrospective cohort study PATIENT SAMPLE: OVCF patients with kyphosis deformity who underwent corrective surgery between 2008 to 2021. MF fat infiltration (MFFI), relative functional cross-sectional area (MFrFCSA), MF relative gross cross-sectional area (MFrGCSA), VAS, ODI, JOA, SRS-22, preoperative, postoperative and last-follow up spine sagittal parameters, postoperative mechanical complications. The study included 108 OVCF patients with kyphosis deformity who underwent corrective surgery and were followed for two years. MRI were performed preoperatively to evaluate the paraspinal muscle morphology, including MF fat infiltration (MFFI), relative functional cross-sectional area (MFrFCSA), and MF relative gross cross-sectional area (MFrGCSA). VAS, ODI, JOA, and SRS-22 were conducted preoperatively. Preoperative, postoperative and last-follow up spine sagittal parameters were recorded, as well as sagittal balance, loss of correction results and improvement and deterioration of sagittal parameters. The occurrence of postoperative mechanical complications, including adjacent segment disease, screw loosening, proximal junctional kyphosis, and distal junctional problem were recorded. We analyzed the relationship between MF degeneration and the above parameters. Strong crrelation was observed in VAS and MFFI(rr=0.597,p=0.000),MF rFCSA(RR=-0.520,p=0.001) and MF rGCSA(RR=-0.461,p=0.005), as well as ODI and MF rFCSA(RR=-0.336, p=0.042). Preoperatively, strong correlations were observed between MF rFCSA and LL(rr=-0.320,p=0.010),TLK(RR=-0.271,p=0.026),TK(rr=-0.251,p=0.048).MF rGCSA and LL(rr=-0.259, p=0.039),TLK(rr=-0.247, p=0.043),TK(rr=-0.273, p=0.030),GK(rr=-0.381, p=0.002) were also strongly correlated. Our study showed strong correlations between MF FI and TLK loss(rr=0.406, p=0.003),TK loss(rr=0.332, p=0.045);MF rGCSA and SVA loss(rr =-0.367, p=0.050),TPA loss(rr =-0.404, p=0.030);MF rGCSA and TPA loss(rr =-0.401, p=0.031),MF FI and GK loss(rr =0.397, p=0.027). MF FI was significantly higher in the complication-presence group(p=0.045). Multifidus degeneration is significantly associated with QoL, sagittal parameters and mechanical complications in OVCF patients with kyphosis deformity. The pathological changes of paravertebral muscles should be included in the surgical strategy and postoperative paravertebral muscle rehabilitation should be adopted to improve the clinical outcomes of OVCF patients.

Is the Rate of Early mobilization in Hip fracture patients using Alfentanil Better than standard opioid analgesia (REHAB)? A protocol for a prospective cohort study.

The primary aim of this study is to compare mobility status of patients receiving oral oxycodone with those receiving subcutaneous alfentanil as analgesic methods prior to mobilization to help physiotherapy compliance after hip fracture surgery. The secondary aims are to assess postoperative pain, health-related quality of life, in-hospital length of stay, total use of analgesia over postoperative days 1 and 2 (POD 1 and POD 2), complication rates within 30 days, and 30-day mortality rates. A single-centre, prospective cohort study of 64 patients will be undertaken. Patients undergoing surgery for femoral neck fractures at the study centre will be recruited. Patients with a hip fracture meeting the inclusion/exclusion criteria will be enrolled on admission. Patients who have been administered oral oxycodone will be compared to those prescribed alfentanil for pain prior to mobilization with physiotherapists on POD 1 and POD 2. Which drug a patient receives is reliant of the prescriptions given by the medical team, and in current practice this varies at approximately 50:50. Mobilization will be defined as the ability to stand on and weightbear both feet with or without assistance. Visual analogue scale pain scores, mobility status, and total analgesia use will be assessed on POD 1 and POD 2. EuroQol five-dimension health questionnaire scores, complication rates, and mortality rates will be assessed up to 30 days following surgery (POD 1, 2, 7, and 30). This study will help to build a wider protocol aiming to improve early mobilization after hip fracture surgery. The results of this study will provide pain scores and mobility status which will either support use of subcutaneous alfentanil as the standard analgesic modality prior to physiotherapy sessions, or highlight its limitations compared to the standard oral oxycodone. Secondary outcomes will also help to assess if early mobilization improves outcomes compared to delayed mobilization.

Comparative analysis of general and regional anesthesia applications in geriatric hip fracture surgery.

This study compares the outcomes of general anesthesia (GA) and regional anesthesia (RA) in geriatric hip fracture surgery to determine optimal anesthesia strategies for this population. A comprehensive literature review was conducted, analyzing studies comparing GA and RA in elderly patients undergoing hip fracture surgery. Studies encompassed various designs, including randomized controlled trials, cohort studies, and meta-analyses. Key analytical techniques included comparative analysis of intraoperative complications, postoperative outcomes, mortality rates, and physiological impacts. GA was associated with higher risks of intraoperative cardiovascular events, respiratory depression, and postoperative complications such as cognitive dysfunction and delirium. In contrast, RA demonstrated superior outcomes in pain management, early mobilization, and reduced incidences of complications like postoperative nausea and vomiting. RA also correlated with shorter hospital stays and lower mortality rates within the first 30 days post-surgery. RA emerges as a preferable choice for geriatric hip fracture surgery, offering improved safety profiles, enhanced recovery trajectories, and better postoperative cognitive outcomes compared to GA. These findings underscore the importance of anesthesia selection in optimizing surgical outcomes and patient safety in elderly populations. Future research should focus on prospective trials to validate these results and refine anesthesia protocols tailored to elderly hip fracture patients.

Feasibility within-subject RCT of neuromuscular electrical stimulation; an Intervention to Maintain and improve neuroMuscular function during period of Immobility (IMMI).

Neuromuscular electrical stimulation (NMES) is a potentially effective intervention to improve outcomes after a fragility fracture, but its feasibility in this group has not been established. A feasibility study was conducted in two phases: 1) in the hospital only, and 2) hospital, rehabilitation centres, and participants' homes. Patients with fragility fracture were randomised to receive NMES for 6weeks/discharge either to the right or left leg, with the other leg serving as control. Patients who had no mobility issues had contraindications to NMES and were unable to give consent were excluded. NMES was applied to quadriceps and tibialis anterior muscles for 30min, 3days/week. Sessions were progressed to achieve 60min, 5-7days/week. Feasibility outcomes included participant characteristics, recruitment rate, tolerability, and number of NMES sessions. Clinical outcomes included muscle strength, and ADL at six months. Overall, 1052 patients were identified, of whom 113 (11%) were eligible, and 29 (3%) were recruited (median Clinical Frailty Score 3, median Barthel ADL score 93/100). The recruitment rate was 0.45/week in phase 1 and 0.9/week in phase 2. Fifty-three percent achieved the target of 24 NMES sessions. However, 5/29 withdrew due to intolerance of NMES. Leg muscle strength improved in both treated and untreated legs, with marginally greater improvement observed in the tibialis anterior of treated legs. Although it would be feasible to evaluate the specific effect of NMES in fragility fracture patients in a multi-centre trial using home-based NMES, this would be possible only in a minority of mildly frail fragility fracture patients with little premorbid disability.

Early Mobilization and Predictors of Delayed Disposition for Geriatric Hip Fractures.

To evaluate the effect of perioperative variables including PT and walking distance on length of stay (LOS) in hip fracture patients. Design: A retrospective review. Single level I trauma center. Patients ≥ 65 years of age with hip fractures (OTA/AO 31-A and 31-B) between 2017-2020 were included. Patients were excluded if they were treated nonoperatively, suffered periprosthetic fracture or were not admitted under the hip fracture protocol. Admission and perioperative variables including time to surgery and number of postoperative days (PODs) without a documented PT session during the first three PODs were assessed for correlation with increased total hospital length of stay and postoperative length of stay. There were 301 patients included (234 (77.7%) female) with an average age of 84.4 years (± 8.1 years). Median total LOS was 5 [IQR, 3-7] days and 4 [IQR 3-6] days after surgical fixation. 37% of hip fractures had a delay in discharge. 95% of patients were discharged to a rehabilitation facility. The highest percentage of days with no PT session occurred on Saturdays and Sundays with 43% and 34% on POD#1 respectively; 40% and 33% on POD#2 and 26% and 30% POD#3; p = 0.0004. In multivariate analysis longer total LOS was associated with time to surgery greater than 24 hours (AOR 5.6; 95% CI, 1.8-17.4; p<0.0030), major complication (AOR 8.26; 95% CI, 2.8-20.0; p<0.0014), discharge to subacute rehab (AOR 5.6; 95% CI, 3.0-10.5; p<0.0001) and walking less than five feet or not receiving PT (among patients with no assistance required as pre-hospital ambulatory status) (AOR 6.0; 95% CI, 2.3-15.3; p<0.02). Longer LOS after surgery was associated with major complication (AOR 11.2; 95% CI, 3.1-39.8; p<0.0002), discharge to subacute rehab (AOR 5.0; 95% CI, 2.7-9.1; p<0.0001) and walking less than five feet or no PT (AOR 4.8; 95% CI, 2.0-11.5; p<0.01). Emphasis should be placed on minimizing complications while maximizing postoperative PT and early ambulation in the acute postoperative period given the demonstrated association between inadequate mobilization and delayed disposition, especially if surgical fixation occurs surrounding the weekend or holiday. Level III.

The Role of Mindfulness Decompression Therapy in Managing Acute Stress Disorder in Traumatic Fracture Patients.

Traumatic fractures are common orthopedic injuries with higher incidence globally, leading to acute stress disorder (ASD). Therefore, this study aimed to analyze the clinical outcomes of mindfulness-based stress reduction (MBSR) therapy in patients with traumatic bone fractures suffering from ASD. This study included 135 patients who underwent trauma and fracture treatment at The 305th Hospital of the PLA between August 2021 and August 2023. Based on their participation in MBSR therapy, they were categorized into a conventional group (n = 62) and a combined group (n = 73). We comparatively analyzed the ASD Scale (ASDS), Self-Rating Anxiety Scale (SAS), Self-Rating Depression Scale (SDS), Self-Rating Sleep Status Scale (SRSS), and World Health Organization Quality of Life (WHOQOL) measurement-BREF (WHOQOL-BREF) scores between these two experimental groups. Furthermore, we assessed the incidence of ASD after treatment between these two groups. There were no significant differences in gender, age, body mass index, education, income, type of expense, trauma type, marital status, fracture site, diabetes status, hypertension status, and the pain visual analog scale (VAS) score, activities of daily living (i.e., modified Barthel index) score, and Social Support Rating Scale score between the two experimental groups (p > 0.05). Moreover, no significant differences were found in the prevalence of ASDS before treatment between these two groups (p > 0.05). However, after treatment, the ASDS score was significantly lower in the combined group than in the conventional group (p < 0.05). Furthermore, post-management analysis revealed that the incidence rate of ASD was 24.19% in the conventional group and 8.22% in the combined group. Moreover, the incidence of ASD was significantly lower in the combined group compared to the conventional group (p < 0.05). Before intervention, the difference in the SAS or SDS between patients was not statistically significant (p > 0.05). However, following treatment, the SAS and SDS scores of patients were significantly lower in the combined group than in the conventional group (p < 0.05). Similarly, after treatment, the SRSS scores of patients were substantially lower in the combined group than in the conventional group (p < 0.05). Furthermore, the WHOQOL-BREF score of patients was significantly greater in the combined group than in the conventional group (p < 0.05). MBSR therapy can significantly alleviate ASD in trauma and fracture patients. Furthermore, this approach can alleviate the incidence of ASD and reduce anxiety, depression, and negative emotions in patients. These positive effects collectively improve sleep quality and overall well-being of patients.

Clinical and Functional Outcomes of Peri-Implant Fractures Associated with Short Proximal Femur Nails: Prevention Strategies and Key Insights.

Background: Hip fractures are prevalent among the elderly and impose a significant burden on healthcare systems due to the associated high morbidity and costs. The increasing use of intramedullary nails for hip fracture fixation has inadvertently introduced risks; these implants can alter bone elasticity and create stress concentrations, leading to peri-implant fractures. The aim of this study is to investigate the outcomes of peri-implant hip fractures, evaluate the potential causes of such fractures, determine the type of treatment provided, assess the outcomes of said treatments, and establish possible improvement strategies. Methods: We conducted a retrospective observational study on 33 patients with peri-implant hip fractures (PIFs) who underwent surgical management at Río Hortega University Hospital from 2010 to 2022. The collected data included demographics, initial fracture characteristics, the peri-implant fracture classification, implant details, surgical outcomes, functional scores, and complications. Functional capacity was evaluated using the Parker Mobility Score (PMS). Results: The cohort (91% female, mean age 87.6 years) included 34 peri-implant fractures. The mean time from the initial fracture to the PIF was 47.2 months (nine patients developed PIFs within 2 months). Most fractures (76%) were managed with implant removal and the insertion of a long intramedullary nail, with cement augmentation in 31% of cases. The mean surgical time was 102 min, and the average hospital stay was 9.6 days. Postoperative complications occurred in 27%, with a perioperative mortality rate of 9%. Functional capacity showed a significant decline, with an average PMS loss of 4.16 points. Mortality at one year post-PIF was 36%, rising to 83% at five years. Radiographic consolidation was observed in 72% of cases at an average of 6.04 months, though 24% of patients died before consolidation. Statistically significant correlations were found for PMS pre-index fracture (PMS1: r = 0.354, p < 0.05), pre-PIF (PMS2: r = 0.647, p < 0.001), and post-PIF (PMS3: r = 0.604, p < 0.001). Conclusions: Peri-implant hip fractures present complex challenges due to their surgical difficulty and impact on patient mobility and survival. Successful management requires individualized treatment based on fracture type, implant positioning, and patient factors. These findings underscore the need for preventive measures, particularly in implant choice and techniques like overlapping and interlocking constructs, to minimize the secondary fracture risk.

Risk factors and characteristics of preoperative heart failure in elderly patients with hip fracture and the influence of anemia on prognosis

BackgroundPatients with preoperative acute heart failure (AHF) after hip fracture in the elderly have a worse prognosis. We aim to investigate the characteristics, risk factors and postoperative complications of elderly patients with hip fracture complicated with preoperative AHF. We also looked at the effect of the severity of anemia at admission on the prognosis of the above people.MethodsA retrospective study of hip fracture patients (aged ≥ 65) admitted to the Department of Geriatric Orthopaedics, Third Hospital, Hebei Medical University, was conducted from January 2018 to October 2020. We used univariate and multivariate logistic regression to assess risk factors for preoperative AHF. The Kaplan–Meier survival curve shows the relationship between the severity of anemia on admission and all-cause mortality in elderly hip fracture patients with preoperative AHF.ResultsOut of the 1092 patients, 503 had preoperative AHF and the incidence of it in hip fracture patients was 46.1%. Age, coronary artery disease, chronic atrial fibrillation, Age-Adjusted Charlson Comorbidity Index (ACCI), admission anemia, admission albumin < 40 g/dl, and admission C-reactive protein (CRP) were all significantly different between those with AHF and those without. Multivariate logistic regression analysis revealed that age ≥ 80 years (OR 1.740, 95% CI 1.309–2.313), coronary artery disease (OR 1.417, 95% CI 1.017–1.975), chronic atrial fibrillation (OR 4.010, 95% CI 1.757–9.152), admission anemia (OR 1.433, 95% CI 1.051–1.953) are the independent risk factors for preoperative AHF in elderly patients with hip fracture (p < 0.05). The HF group exhibited a higher incidence of postoperative complications, such as anemia, arrhythmia, NOAF (new‐onset atrial fibrillation), AIS (acute ischemic stroke), electrolyte disturbance and hypoproteinemia. The moderate-to-severe anemia group had a higher incidence of postoperative complications, including deep vein thrombosis of the lower limbs, NOAF, and hypoproteinemia, as well as all-cause mortality.ConclusionOlder patients combined with admission anemia, coronary artery disease, chronic atrial fibrillation are more likely to have preoperative AHF after hip fracture. For such patients, early and effective identification and strengthening perioperative management can avoid the occurrence of adverse events. For patients with moderate and severe anemia at admission, timely intervention is recommended to reduce postoperative complications and mortality.

Reasons for declining to participate in a trial of online cognitive behavioural therapy following orthopaedic trauma: A mixed methods study.

The timely enrollment of study participants is critical to the success of clinical trials. Understanding factors that contribute to patients' decision to participate in trials involving online cognitive behavioural therapy for pain management should prove helpful to optimize the design of study protocols. Fracture patients from an orthopaedic clinic who declined to participate in the Cognitive behavioural therapy to Optimize Post-operative rEcovery (COPE) trial were asked to complete a Research Participation Questionnaire that asked them about their previous experiences with clinical research and mental health therapy and their reasons for declining to participate in the COPE trial. At the end of the questionnaire, a subset of participants was offered the opportunity to participate in a telephone interview to further discuss why they declined to participate in the COPE trial. Sixty-four patients who declined to participate in the COPE trial completed the questionnaire and twenty of these participants agreed to take part in a telephone interview (31%). Twenty-two participants (34%) had previous experience with clinical research and six participants (9%) had received cognitive behavioural therapy (CBT) in the past. Excessive time commitment (41%) was the most commonly selected reason for not participating in the COPE trial, followed by a disinclination to participate in clinical research (19%). Four themes emerged from the interviews with participants: 1) belief that they could overcome mental health challenges after their fracture without external help; 2) belief that CBT might be helpful for some fracture patients, but not for themselves; 3) preference for online or in-person CBT; and 4) concerns regarding time commitment. To maximize enrollment, trials exploring the role of psychotherapy in recovery from orthopedic trauma should optimize time commitment of psychotherapy. Providing information in the patient consent process regarding evidence for psychotherapy and recovery from orthopedic trauma may also prove helpful in promoting patient enrollment.

Comprehensive radiographic grading system and clinical outcomes of canine tibial avulsion fractures in dogs.

The tibial apophysis is a separate center of ossification in the proximal tibia of skeletally immature dogs. Because it is made of cartilage during development, it is prone to fractures (avulsions) and other tensile-related injuries. One prior veterinary study proposed a classification system for proximal tibial apophyseal fractures, but this study did not include fractures that involved the proximal tibial physis or metaphysis, which have been described in human classification systems. The objectives of the study reported here were (1) to characterize and establish a radiographic grading system of proximal tibial apophyseal fractures in dogs, (2) to investigate the intra- and interobserver agreements of the proposed grading system, and (3) to identify associations between fracture types and patient signalment, surgical fixation, and clinical outcomes. This is a retrospective and observational study where images were assessed twice in a randomized order at least two weeks apart by three observers. The most frequent fracture configurations were type 1 (33/49, 67.3%) and type 5 (13/49, 26.5%), followed by type 4 (2/49, 4%) and type 2 (1/49, 2%). A fracture configuration type 3 was not identified. Dogs with a concurrent fibular fracture were associated with type 4 and 5 tibial avulsion fractures (P<.01). The intraobserver agreement for observers 1 and 2 was kappa ≥0.88, and for observer 3, kappa=0.63. In conclusion, this study introduces an enhanced classification system for tibial apophyseal fractures in dogs, demonstrating substantial to moderate intraobserver reliability and moderate to modest interobserver agreement.

Predictors of Venous Thromboembolism Following Geriatric Distal Femur Fracture Fixation: Are These Patients at Higher Risk Compared With Hip Fracture Patients?

Venous thromboembolism (VTE) following injury and subsequent fixation of a distal femur fracture (DFFx) is associated with considerable morbidity. However, the incidence of VTE, associated factors, and the relative risk compared with hip fracture (HFx) fixation remains poorly characterized. Retrospective cohort study using the PearlDiver M165 database to identify geriatric patients who underwent DFFx and HFx fixation. Clinical risk factors of VTE within 90 days of DFFx and the risk modification associated with enoxaparin (Lovenox) and direct oral anticoagulants (DOACs) relative to aspirin/nonprescription agents were characterized. To determine the odds of VTE following fixation of DFFx relative to HFx, a matched comparison based on age, sex, and Elixhauser Comorbidity Index was done. Of 24,358 DFFx patients, 1684 (6.9%) developed VTE. Independent risk factors included a prior VTE (odds ratio [OR] 28.76), displaced DFFx morphologies (condylar [OR 5.44], and supracondylar without intracondylar extension [OR 3.96] and with extension [OR 3.75]), active cancer (OR 2.11), coagulopathy disorder (OR 1.15), and younger age (OR 1.03) (P < 0.05 for all). Lovenox and DOAC were both associated with reduced odds of VTE (OR 0.40 and OR 0.61, respectively) (P < 0.05 for both). Relative to HFx patients, DFFx patients demonstrated heightened odds of VTE (OR 1.25) (P < 0.001). This study identified a relatively high rate of VTE, 6.9% within 90 days, following surgical management of DFFx and heightened odds of VTE relative to HFx patients. Various factors demonstrated a notable association with increased odds of VTE, although both Lovenox and DOACs may be effective therapeutic options for risk mitigation.

Frailty index predicts adverse short- and long-term outcomes in older adults with rib fractures.

Older adults with rib fractures pose an increasing clinical and financial burden on healthcare. Identifying and addressing the increased risk of adverse outcomes has been a key objective in geriatric co-management of surgical patients. The Comprehensive Geriatric Assessment-based Frailty Index (FI-CGA) is a useful predictor of complications and mortality in older adults, but its value in rib fracture management remains unclear. This study investigates the association between FI-CGA and short- and long-term outcomes of older adults with rib fractures. Rib fracture patients ≥65 years, with a FI-CGA score available, were retrospectively identified from a single level-I trauma center between 2018 and 2022. FI-CGA scores were categorized as pre-frail (<0.20), mild frailty (0.20-0.29), moderate frailty (0.30-0.39), and severe frailty (≥0.40). Outcome measures included mortality up to two years, length of stay (LOS), complications, and 30-day readmission. 288 patients were included for analysis (57 pre-frail; 66 mildly frail; 61 moderately frail; 104 severely frail). Compared to the pre-frail group, only severely frail patients were at higher risk of 90-day (OR 5.71 [CI 1.29 - 52.67]) and 1-year mortality (OR 6.66 [CI 2.18 - 27.37]), while 2-year mortality was higher in mild (OR 3.77 [CI 1.30 - 12.57]), moderate (OR 4.28 [CI 1.46 - 14.51]) and severe (OR 6.42 [CI 2.43 - 20.11]) frailty groups. Hospital (p=0.183) and ICU LOS (p=0.131) was similar across groups. Severely frail patients were at risk of pneumonia (OR 3.50 [CI 0.95 - 19.48]) and delirium (OR 4.16 [CI 1.33 - 17.40]), while other complications were similar between groups (p=0.679). Adjusted proportional hazard ratios for mortality were significantly higher for moderate frailty (HR 1.99 [CI 1.02 - 3.89]) and severe frailty (HR 2.66 [CI 1.10 - 3.73]). FI-CGA was also a significant predictor if used per 0.01 point (HR 1.03 [CI 1.01 - 1.04)]) and per 0.1 point (HR 1.29 [CI 1.12 - 1.47]). FI-CGA can identify vulnerable rib fracture patients at risk of in-hospital complications, and short- and long-term mortality. Continuous FI-CGA scores provide a granular and individualized risk assessment. In severely frail patients with rib fractures, FI-CGA may assist in aligning treatment with individual patients' needs and goals of care.

Quality of Life after Open versus Closed Treatment for Mandibular Condylar Fractures

Objective: To compare the quality of life after surgical management with closed reduction and internal fixation (CRIF) versus open reduction and internal fixation (ORIF) for mandibular condylar fractures. Methodology: This analytical observational study was carried out between January 2024 to June 2024, at the Department of Oral and Maxillofacial Surgery, Jinnah Postgraduate Medical Centre, Karachi, focusing on patients with mandibular condylar fractures. The study assessed their quality of life using the General Oral Health Assessment Index (GOHAI) Questionnaire, with scores ranging from 1 to 3, where 1 denoted "Always," 2 indicated "Sometimes," and 3 represented "Never." Quality of life scores were categorized as high (34-36), medium (31-33), or low (&lt;30) based on the GOHAI results. Results: In this study there were 66.7% neglected patients had high quality of life, 15.4% had moderate, and 27.3% had low GOHAI, (p=0.084). Further, there were only 16.7% patient close reduction management had high quality of life, 5 (38.5%) had moderate, and 545.5% had low GOHAI. According to open reduction management, there were 83.3% patients had high quality of life, 61.5% had moderate, and 45.5% had low GOHAI, (p=0.157). Conclusion: Factors such as age, gender, neglected type, and treatment modality did not significantly affect the post-operative quality of life. However, mandibular fracture patients who underwent surgical treatment with open reduction technique, as assessed by the GOHAI parameter, experienced a high quality of life.