Surgery For Proximal Femur Fracture Research Articles

Safety of urgent surgery for the patients with proximal femur fracture treated with platelet aggregation inhibitors: a propensity-score matching analysis.

To compare the various perioperative outcomes in an urgent surgery setting among patients with proximal femur fracture (PFF) who received platelet aggregation inhibitors (PAIs) and those who did not. We retrospectively reviewed the data of 1,838 patients who underwent surgery for PFF between January 2011 and January 2021. We conducted 1:1 propensity-score matching and compared the perioperative outcomes, including operation time, postoperative complications, hospital stay, mortality, and variables related to bleeding risk (e.g., number of transfusion profiles, hemoglobin levels, and laboratory data, including coagulation battery). Of the 492 patients who were treated with PAIs, 484 were 1:1 matched to the untreated control group. The PAI group showed shorter operation time than the matched control group (72.3min for PAI vs. 77.7min for control; P = 0.041), and the control group showed more pulmonary thromboembolism (0.2% for PAI vs 1.7% for control; P = 0.046) than the PAI group. The other complications and length of hospital stay, mortality rate, transfusion profile, and the laboratory test (except preoperative international normalized ratio, INR) showed no significant difference between the groups. Subgroup analyses of the patients treated with only aspirin (aspirin: 306, matched control: 306), only clopidogrel (clopidogrel: 100, matched control: 100), and others who were treated with dual anticoagulation (dual anticoagulation: 78, matched control: 78) showed no significant differences in perioperative outcomes among the groups. The patients who were treated with PAI could undergo PFF surgery safely without delay, which led to no significant difference in operation time, postoperative complication risk, perioperative blood transfusion, and variables related to bleeding risk. Therefore, we believe that it is unnecessary to delay surgery for patients with PFF who receive PAI.

COMPARATIVE STUDY OF ERECTOR SPINAE PLANE BLOCK VERSUS SYSTEMIC ANALGESIA FOR INTERLOCKING NAIL IN INTERTROCHANTERIC FRACTURE OF FEMUR: A RANDOMIZED CONTROLLED INTERVENTIONAL STUDY

Objective: The geriatric population is prone to multiple comorbidities, and their fragile bones and unsteadiness make them susceptible to fractures, commonly observed in the wrist and proximal end of the femur. Internal fixation of fractures under central neuraxial block allows for early mobilization. However, the presence of comorbidities in elderly patients puts them at higher risk for anesthesia and surgery.
 Methods: To manage postoperative pain following surgery for proximal femur fracture, opioid-sparing multimodal analgesia techniques are employed. Regional anesthesia techniques such as fascia iliaca block, femoral nerve block, and quadratuslumborum block are utilized as part of a multimodal approach. Pain is subjective, and the inability to communicate does not negate the need for appropriate pain relief.
 Results: Postoperative pain, if poorly managed, can result in complications, prolonged recovery, and chronic pain with reduced quality of life. Effective pain relief enhances patient satisfaction, reduces hospital stays and costs. Inadequate pain control activates the sympathetic nervous system, increases hormonal response, and contributes to adverse events. Opioids, though common, pose risks and adverse effects.
 Conclusion: The erector spinae plane block (ESPB) is a safe and easy-to-perform technique for postoperative pain management. It involves ultrasound-guided deposition of local anesthetic, allowing effective spread. Previous studies have shown its effectiveness for thoracic pain relief. This study evaluated lumbar ESPB and compared it with systemic analgesics in terms of ease of positioning and postoperative pain control.

Association Between Pelvic Bone Computed Tomography-Derived Body Composition and Patient Outcomes in Older Adults With Proximal Femur Fracture.

To investigate the association between pelvic bone computed tomography (CT)-derived body composition and patient outcomes in older adult patients who underwent surgery for proximal femur fractures. We retrospectively identified consecutive patients aged ≥ 65 years who underwent pelvic bone CT and subsequent surgery for proximal femur fractures between July 2018 and September 2021. Eight CT metrics were calculated from the cross-sectional area and attenuation of the subcutaneous fat and muscle, including the thigh subcutaneous fat (TSF) index, TSF attenuation, thigh muscle (TM) index, TM attenuation, gluteus maximus (GM) index, GM attenuation, gluteus medius and minimus (Gmm) index, and Gmm attenuation. The patients were dichotomized using the median value of each metric. Multivariable Cox regression and logistic regression models were used to determine the association between CT metrics with overall survival (OS) and postsurgical intensive care unit (ICU) admission, respectively. A total of 372 patients (median age, 80.5 years; interquartile range, 76.0-85.0 years; 285 females) were included. TSF attenuation above the median (adjusted hazard ratio [HR], 2.39; 95% confidence interval [CI], 1.41-4.05), GM index below the median (adjusted HR, 2.63; 95% CI, 1.33-5.26), and Gmm index below the median (adjusted HR, 2.33; 95% CI, 1.12-4.55) were independently associated with shorter OS. TSF index (adjusted odds ratio [OR], 6.67; 95% CI, 3.13-14.29), GM index (adjusted OR, 3.45; 95% CI, 1.49-7.69), GM attenuation (adjusted OR, 2.33; 95% CI, 1.02-5.56), Gmm index (adjusted OR, 2.70; 95% CI, 1.22-5.88), and Gmm attenuation (adjusted OR, 2.22; 95% CI, 1.01-5.00) below the median were independently associated with ICU admission. In older adult patients who underwent surgery for proximal femur fracture, low muscle indices of the GM and gluteus medius/minimus obtained from their cross-sectional areas on preoperative pelvic bone CT were significant prognostic markers for predicting high mortality and postsurgical ICU admission.

Quality of life and cost-effectiveness analysis of topical tranexamic acid and fibrin glue in femur fracture surgery

BackgroundWe assessed quality of life (QoL) of patients undergoing surgery for proximal femur fracture and performed a cost-effectiveness analysis of haemostatic drugs for reducing postoperative bleeding.MethodsWe analysed data from an open, multicentre, parallel, randomized controlled clinical trial (RCT) that assessed the efficacy and safety of tranexamic acid (TXA group) and fibrin glue (FG group) administered topically prior to surgical closure, compared with usual haemostasis methods (control group).For this study we conducted a cost-effectiveness analysis of these interventions from the Spanish Health System perspective, using a time horizon of 12 months. The cost was reported in $US purchasing power parity (USPPP). We calculated the incremental cost-effectiveness ratio (ICER) per QALY (quality-adjusted life-year).ResultsWe included 134 consecutive patients from February 2013 to March 2015: 42 patients in the TXA group, 46 in the FG group, and 46 in the control group. Before the fracture, EuroQol visual analogue scale (EQ-VAS) health questionnaire score was 68.6. During the 12 months post-surgery, the intragroup EQ-VAS improved, but without reaching pre-fracture values.There were no differences between groups for EQ-VAS and EuroQol 5 dimensions 5 levels (EQ-5D-5L) health questionnaire score, nor in hospital stay costs or medical complication costs. Nevertheless, the cost of one FG treatment was significantly higher (399.1 $USPPP) than the cost of TXA (12.9 $USPPP) or usual haemostasis (0 $USPPP).When comparing the cost-effectiveness of the interventions, FG was ruled out by simple dominance since it was more costly (13,314.7 $USPPP) than TXA (13,295.2 $USPPP) and less effective (utilities of 0.0532 vs. 0.0734, respectively). TXA compared to usual haemostasis had an ICER of 15,289.6 $USPPP per QALY).ConclusionsThere were no significant differences between the intervention groups in terms of postoperative changes in QoL. However, topical TXA was more cost-effective than FG or usual haemostasis.Trial registrationClinicalTrials.gov: NCT02150720. Date of registration 30/05/2014. Retrospectively registered.

Cumulated ambulation score as predictor of postoperative mobility in patients with proximal femur fractures.

The cumulated ambulation score (CAS) has been developed as an index for evaluating mobility in the early postoperative period. This study aimed to estimate the association between CAS and independent ambulation after surgery for proximal femur fractures. This retrospective cohort study included 223 elderly patients who underwent surgery for proximal femur fractures and had independent ambulation before the injury. Multivariable logistic regression analyses with cognitive impairment, pre-injury Barthel index, and CAS as the test variables were used to predict independent ambulation at 2weeks (model 1) and 3months (model 2) postoperatively. We established scoring systems based on the modeling results. The number of patients with independent ambulation at 2weeks and 3months postoperatively was 115 and 169, respectively. Univariate analysis showed that the CAS was significantly associated with independent ambulation at 2weeks and 3months postoperatively. Multivariable analysis showed that models 1 and 2 had good predictive accuracies, with areas under the receiver-operating characteristic curve of 0.855 and 0.868, respectively. Among the explanatory variables, only the CAS in model 2 was not significantly associated with the postoperative ambulatory ability. Scoring systems for both models 1 and 2 also had good predictive accuracies, with cut-off scores of 3.5 for model 1 and 9.5 for model 2. The CAS predicted independent ambulation at 2weeks postoperatively; however, this relationship was limited at 3months postoperatively. Therefore, the CAS may help estimate independent ambulation at discharge from an acute-care hospital.

Lumbar Erector Spinae Plane Block at L3 Level for Managing Post-operative Pain in Patients Undergoing Surgery for Proximal Femur Fractures.

Ultrasound guided erector spinae plane block (ESPB) has been widely used at thoracic level. There has been a recent interest in utilising ESPB at lumbar level. Available literature is in the form of case reports. In this series involving 10 cases with proximal femur fractures, we have described unilateral ultrasound guided lumbar ESPB at L3 level for managing postoperative analgesia with continuous local anaesthetic infusion for 48 hours. The visual analogue scale score was always below 4, and there were no adverse effect or complications due to the block.

Proximal femur fractures - effect of preoperative mental status of patients on postoperative mobility of patients

<p class="abstract"><strong>Background:</strong> In the elderly population, proximal femur fractures are most common which can result in increase of morbidity and mortality. Pre and postoperative mobility patterns, also depends upon the Mental Status of the patient. Incidence of Mental health disorders of patient can increases with age and co morbidities. The aim of the study was to evaluate the effect and relationship of preoperative mental status, on postoperative mobility in proximal femur fracture patients. On null hypothesis; there exists no co-relation between pre-operative mental status on pre and postoperative mobility those had surgery for proximal femur fractures.</p><p class="abstract"><strong>Methods:</strong> This is a retrospective study, carried out during the period of 14<sup>th</sup> March, 2016 to 14<sup>th</sup> March, 2017 at BIRRD (T) Hospital. All the patients who underwent proximal femur fracture surgeries were included in the study. Patients were evaluated for Abbreviated Mental Score Test pre-operatively. Mobility patterns were before injury and after surgery evaluated in patients with proximal femur fractures. Postoperatively patients were followed up to one year.<strong></strong></p><p class="abstract"><strong>Results:</strong> 50 patients were included into the study, where 12 patients could not present to follow-up due to various reasons, thus we have complete data of 38 patients. There is significant reduction in mobility status of individuals i.e. from 6.18 (preoperative pre fracture mobility) to 5.36 (postoperative mobility). Average abbreviated mental test score is 7.55. There exists a correlation between the variables.</p><p class="abstract"><strong>Conclusions:</strong> Null hypothesis remains rejected. There is statistically significant relationship between the variables (pre and postoperative mobility, and abbreviated mental test score), which appears to be positive correlation.</p>

Outcome Following Surgery for Proximal FemurFractures in Centenarians

Outcome Following Surgery for Proximal FemurFractures in Centenarians

Analysis of Perioperative Complications of Surgery for Proximal Femur Fracture in Elderly Patients Older than 75 Years

Background: In elderly patients with femoral neck fracture, functional recovery is affected largely by preoperative underlying diseases and postoperative complications. The present study was designed to analyze the relationship between preoperative underlying diseases and perioperative complications of surgery for proximal femur fracture. Methods: The study involved 86 patients aged 75 years or older, who underwent surgery for proximal femur fracture. Each patient was examined for the presence of preoperative underlying diseases and preoperative biochemical test data. Moderate and severe complications, which were life-threatening and necessitated treated, were investigated during the perioperative period. A retrospective analysis was conducted on the relationship of preoperative underlying diseases and preoperative biochemical data with the moderate or severe complications that developed during the perioperative period. Results: Eighty-one patients developed a preoperative underlying disease, with hypertension being most frequent (42 cases). Complications during the perioperative period were observed in 58 patients, with anemia develops most frequently (23 cases). Moderate or severe complications during the perioperative period were observed in 16 patients, and infection was the most frequent complication (8 cases). In the statistical analysis, a significant difference in the incidence of moderate or severe perioperative complications was observed only in the users of anticoagulants/antiplatelet drugs. Discussion: Patients of preoperative use of anticoagulants/antiplatelet drugs should be closely managed medically so that perioperative medical complications can be managed.

Improving consent in patients undergoing surgery for proximal femur fractures through the introduction of ‘consent cards’ for junior doctors

s / International Journal of Surgery 10 (2012) S53–S109 S57 ABSTRACTS questionnaire was administered at follow up. The median follow up period was 209.5 days. Results: 85% of those responding had returned to sport, with 50% making a full return to their previous standard. The mean improvement in Oxford Score following surgery was 12.3. The improvement in Oxford Score, age and gender had an influence on return to sport. Conclusions: Return to sport is a useful outcome measure, but not in isolation. Athletes wishing to return to sport following shoulder stabilisation can expect good outcomes provided they comply with the rehabilitation protocol. Psychology plays a large role in a patient's decision to return to sport. 0274: A COMPARISON OF CONSENT: PROXIMAL FEMUR FRACTURES VERSUS ELECTIVE TOTAL HIP REPLACEMENT Simon Humphry, Efstratios Gerakopoulos. Gloucestershire Royal Hospital,

Individual nutrition therapy and exercise regime: a controlled trial of injured, vulnerable elderly (INTERACTIVE trial).

BackgroundProximal femoral fractures are amongst the most devastating consequences of osteoporosis and injurious accidental falls with 25–35% of patients dying in the first year post-fracture. Effective rehabilitation strategies are evolving however, despite established associations between nutrition, mobility, strength and strength-related functional outcomes; there has been only one small study with older adults immediately following fragility fracture where a combination of both exercise and nutrition have been provided. The aim of the INTERACTIVE trial is to establish whether a six month, individualised exercise and nutrition program commencing within fourteen days of surgery for proximal femur fracture, results in clinically and statistically significant improvements in physical function, body composition and quality of life at an acceptable level of cost and resource use and without increasing the burden of caregivers.Methods and DesignThis randomised controlled trial will be performed across two sites, a 500 bed acute hospital in Adelaide, South Australia and a 250 bed acute hospital in Sydney, New South Wales. Four hundred and sixty community-dwelling older adults aged > 70 will be recruited after suffering a proximal femoral fracture and followed into the community over a 12-month period. Participants allocated to the intervention group will receive a six month individualised care plan combining resistance training and nutrition therapy commencing within 14 days post-surgery. Outcomes will be assessed by an individual masked to treatment allocation at six and 12 months. To determine differences between the groups at the primary end-point (six months), ANCOVA or logistic regression will be used with models adjusted according to potential confounders.DiscussionThe INTERACTIVE trial is among the first to combine nutrition and exercise therapy as an early intervention to address the serious consequence of rapid deconditioning and weight loss and subsequent ability to regain pre-morbid function in older patients post proximal femoral fracture. The results of this trial will guide the development of more effective rehabilitation programs, which may ultimately lead to reduced health care costs, and improvements in mobility, independence and quality of life for proximal femoral fracture sufferers.Trial registrationAustralian Clinical Trials Registry: ACTRN12607000017426.

Outcome following surgery for proximal femur fractures in patients with recent myocardial infarction

The mortality following surgery in patients with a recent MI is high. Standard advice is to wait for a minimum of 6 months. In urgent situations, this may not be possible. From Jan 2003 to Aug 2004, 10 patients were admitted with fracture neck of femur and a recent MI proven by ECG changes or raised troponin. There were 7 females. The mean age was 79.5 yrs (59–95yrs). The premorbid mobility and co-morbidities were noted. Echocardiography was done in all patients preoperatively to assess the cardiac function. All patients were seen by physicians and anaesthetist pre-operatively. The mean time from infarction to operation was 11.5 days (3–23 days). The patients underwent either Thompsons hemiarthroplasty or DHS. The anaesthetic was performed by a consultant. Most patients received spinal anaesthesia (7/9). The anaesthetic records could not be found for 1 patient. 6 patients died within a month and 1 patient died within 6 month of operation. Despite thorough preoperative work-up and consultant anaesthesia, the mortality following surgery for proximal femur fractures in patients with recent myocardial infarction is 70% at 6 months. To our knowledge, there are no published mortality figures for this situation. This is much higher than the reported mortality following proximal femur fracture.

Rehabilitation after proximal femur fracture surgery in the oldest old

Lieberman D, Lieberman D. Rehabilitation after proximal femur fracture surgery in the oldest old. Arch Phys Med Rehabil 2002;83:1360-3. Objective: To assess the course and results of rehabilitation after proximal femur fracture (PFF) in patients 85 years of age or older, compared with younger elderly patients, with an emphasis on functional status. Design: Prospective cohort study. Setting: A rehabilitation geriatric ward in a tertiary university hospital in southern Israel. Participants: The study group included 127 elderly patients 85 years of age or older who were hospitalized for rehabilitation following surgery for PFF. The comparison group was comprised of 297 patients aged 75 to 84 years who were hospitalized for the same indication in the same time period. Interventions: Not applicable. Main Outcome Measures: Functional studies by FIM™ instrument, mental status by the Folstein Mini-Mental State Examination, Geriatric Depression Screening (GDS) scale, length of rehabilitation, and complications and mortality during rehabilitation. Results: Compared with patients aged 75 to 84 years, the older study group was in a worse mental state (P=.00005), even though the groups did not differ in their GDS scores. There were no significant differences between the groups in rehabilitation length of stay, in the rate of most postoperative complications, or in death rates during rehabilitation. FIM values before PFF, at the beginning of rehabilitation and at its end, and the difference between the beginning and end of rehabilitation were lower in the older group (P<.00001 for all tests). Conclusions: From the functional standpoint, rehabilitation after PFF surgery is much less successful in the 85+ age group than in the 75-to-84 age group but did not differ in its duration, rates of most complications, or mortality. Nonetheless, a significant percentage of patients in this age group have successful rehabilitation so they should not be deprived the chance. © 2002 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

Registration of Complications in Operative Treatment of Proximal Femoral Fractures in the Elderly

Surgery of proximal femur fractures can give rise to a high rate of postoperative complications and morbidity. In order to evaluate the results of proximal femoral surgery and to improve treatment in the elderly, we performed a prospective study between 1996 and 1998, scoring complications according to a special system used at our institute. Patients: 268 patients (220 women; 82%), mean age 81 years (range 24–97 years), underwent surgery for proximal femoral fractures during a 2-year period. Results: 172 complications (64%) occurred in 116 patients. Complications included pressure score (13.4%), urinary tract infection (8.5%), problems due to implantation of the osteosynthesis (8.5%), pneumonia (7.8%), minor wound infection (4.9%), urine retention (3.3%), deep venous thrombosis (0.7%), and myocardial infarction (0.4%). Mean hospital stay was 31 days (range 3–196 days). During this time, eleven of 268 patients died (mortality 4.1%). An error in management was seen in 30% of all complications, and technical errors in 21%. In 49% the complications was due to the patient's general health. Conclusions: Surgery for proximal femur fractures is accompanied by complications in many patients, and especially in the elderly. Indeed, the patients in our study were elderly, and their poor general health accounted for nearly half of the complications encountered. The registration of complications may lead to new management/surgical protocols to prevent such complications in the near future.