Geriatric Orthopaedic Surgery & Rehabilitation最新文献

{"title":"Fracture Type Modifies the Prognostic Impact of Acute Kidney Injury on In-Hospital Mortality after Hip Fracture Surgery in Elderly Patients: A Retrospective Cohort Study with Risk Stratification.","authors":"Ozan Altun, Erdi Özdemir, Osman Çömez, Yılmaz Ergişi, Uygar Daşar, Muhammed Nadir Yalçın","doi":"10.1177/21514593261461131","DOIUrl":"10.1177/21514593261461131","url":null,"abstract":"<p><strong>Introduction: </strong>In-hospital mortality following hip fracture surgery remains a significant outcome in elderly patients, yet perioperative determinants - particularly those modifiable during hospitalization - are incompletely characterized. Whether the prognostic impact of acute kidney injury (AKI) on in-hospital mortality differs according to fracture type has not been previously examined.</p><p><strong>Materials and methods: </strong>This retrospective cohort study included 342 patients aged ≥65 years who underwent surgical treatment for hip fracture at a tertiary referral center between January 2018 and January 2022. The primary outcome was in-hospital mortality. Independent predictors were identified using multivariable logistic regression. Model performance was assessed by ROC analysis, Hosmer-Lemeshow calibration testing, and bootstrap internal validation with 1000 iterations. A simple additive risk score was derived from the final model. Interaction analysis evaluated whether fracture type modified the association between AKI and mortality.</p><p><strong>Results: </strong>In-hospital mortality occurred in 29 of 342 patients (8.5%). Independent predictors were postoperative AKI (OR 5.46, 95% CI 2.20-13.51), lower preoperative serum albumin (OR per 1 g/dL increase 0.38, 95% CI 0.18-0.78), and lower admission oxygen saturation (OR per 1% increase 0.86, 95% CI 0.77-0.95). The model demonstrated acceptable discrimination (AUC = 0.766, 95% CI 0.655-0.877). A three-variable additive risk score stratified mortality from 3.4% (score 0) to 39.1% (score 2-3). Interaction analysis revealed that fracture type significantly modified the prognostic impact of AKI (interaction p = 0.016), with a substantially stronger effect in extracapsular fractures (OR 14.3, 95% CI 4.0-50.0) than intracapsular fractures (OR 1.32, 95% CI 0.30-5.88).</p><p><strong>Conclusions: </strong>Postoperative AKI, hypoalbuminemia, and reduced admission oxygen saturation independently predict in-hospital mortality after hip fracture surgery. The mortality risk conferred by AKI is substantially greater in extracapsular fractures, highlighting the need for fracture-type-specific perioperative vigilance and early renal protection strategies.</p>","PeriodicalId":48568,"journal":{"name":"Geriatric Orthopaedic Surgery & Rehabilitation","volume":"17 ","pages":"21514593261461131"},"PeriodicalIF":1.8,"publicationDate":"2026-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13380693/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148521580","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Proximal and Distal Femoral Fracture. A Longitudinal Retrospective Survival Analysis.","authors":"David Briz, Carmen da Casa, José M de Haro, Carmen Pablos, Alfonso González-Ramírez, Juan F Blanco","doi":"10.1177/21514593261466312","DOIUrl":"10.1177/21514593261466312","url":null,"abstract":"<p><strong>Background: </strong>Osteoporotic fractures represent a major public health problem, particularly in older adults. Distal femur fractures, although less frequent, have also been associated with substantial mortality, with rates approaching those of hip fractures. However, direct comparisons between both entities remain limited and heterogeneous, and it is unclear whether distal femur fractures carry a comparable prognostic burden.</p><p><strong>Methods: </strong>We conducted a retrospective observational cohort study including surgically treated patients aged ≥65 years with proximal or distal femoral fractures between 2013 and 2019. Distal fracture cases were compared with a proximal femoral fracture cohort. Cases were identified using ICD codes and validated through clinical record review. The primary outcome was all-cause mortality at 30, 90, and 365 days after surgery. Survival was analyzed using Kaplan-Meier curves, compared with the log-rank test. Cox proportional hazards models were used to assess the association between fracture type and mortality, adjusting for relevant clinical variables.</p><p><strong>Results: </strong>A total 234 proximal and 74 distal femoral fractures patients were included. One-year mortality was similar between groups (27.4% vs. 35.6%, p=0.176). However, mortality was significantly higher in distal fractures at 30 days (16.2% vs. 7.7%, p = 0.031) and 90 days (24.3% vs. 14.1%, p = 0.039). Kaplan-Meier analysis showed significant differences at 30 and 90 days but not at 365 days. In multivariable Cox regression, fracture type was not independently associated with mortality, while rurality was associated with lower mortality.</p><p><strong>Conclusion: </strong>Although distal femoral fractures were associated with higher short- and mid-term mortality, fracture type was not an independent predictor of mortality after multivariable adjustment. Rurality emerged as an independent predictor of survival, warranting further investigation. These findings suggest that distal femur fractures may require a similar level of clinical attention.</p>","PeriodicalId":48568,"journal":{"name":"Geriatric Orthopaedic Surgery & Rehabilitation","volume":"17 ","pages":"21514593261466312"},"PeriodicalIF":1.8,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13373426/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148473563","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Corrigendum to \"Rate of Osteoporosis Evaluation and Treatment Following Kyphoplasty in Patients With Vertebral Compression Fractures: A Retrospective Study and Review of the Literature\".","authors":"","doi":"10.1177/21514593261453503","DOIUrl":"https://doi.org/10.1177/21514593261453503","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.1177/21514593251332463.].</p>","PeriodicalId":48568,"journal":{"name":"Geriatric Orthopaedic Surgery & Rehabilitation","volume":"17 ","pages":"21514593261453503"},"PeriodicalIF":1.8,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13376457/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148580808","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence and Related Risk Factors of Pulmonary Complications After Spinal Fusion Surgery: A Retrospective Nationwide Inpatient Sample Database Study.","authors":"Yue Wang, Yu-Dong Liao, Yuheng Zhang, Cong-Rui Liao, Jian-Ting Chen","doi":"10.1177/21514593261468051","DOIUrl":"10.1177/21514593261468051","url":null,"abstract":"<p><strong>Background: </strong>Postoperative pulmonary complications (PPCs) are common surgical complications and have a significant cost impact. However, the incidence, risk factors, and cost burden of US health care associated with PPCs after spine fusion surgery have not been comprehensively analyzed through large national databases.</p><p><strong>Methods: </strong>A retrospective analysis utilized the Nationwide Inpatient Sample (NIS) database from 2010 to 2019. Adult patients (≥18 years) undergoing spinal fusion were identified via ICD-9-CM/ICD-10-CM procedural codes. PPCs-defined as pneumonia, acute respiratory failure (ARF), pulmonary embolism, or pulmonary edema-were identified by diagnostic codes. Multivariate and stratified logistic regression analyses examined overall and subtype-specific risk factors.</p><p><strong>Results: </strong>Among 812,609 patients, 17,121 (2.11%) developed PPCs, including 9,591 (1.18%) with ARF, 7,376 (0.91%) with pneumonia, 2,159 (0.27%) with pulmonary embolism, and 553 (0.07%) with pulmonary edema. The overall PPCs' rate increased from 2014 to 2019, driven primarily by rising ARF incidence. Patients with PPCs had longer hospital stays (9 vs. 3 days), higher total charges ($197,994 vs. $85,233), and greater in-hospital mortality (5.82% vs. 0.08%, all P < 0.001). Multivariate analysis identified advanced age (≥75: OR = 1.86), multiple comorbidities (OR = 10.98), pulmonary circulation disorders (OR = 11.38), continuous trauma ventilation (OR = 13.34), and septicemia (OR = 14.34) as high-risk factors. Stratified analyses revealed distinct risk profiles: impaired pulmonary reserve and frailty were associated with pneumonia and ARF; venous thromboembolism risk factors with pulmonary embolism; and cardiac, renal, and fluid-related disorders with pulmonary edema. Protective factors included female sex (OR = 0.70), elective admission (OR = 0.32), lumbar fusion (OR = 0.76), and private insurance (OR = 0.89).</p><p><strong>Conclusion: </strong>PPCs after spinal fusion are increasing, primarily due to rising ARF rates. These complications exhibit clinically distinct risk profiles that support subtype-specific assessment and individualized prevention strategies targeting pulmonary reserve, thromboembolic risk, and cardiopulmonary vulnerability.</p>","PeriodicalId":48568,"journal":{"name":"Geriatric Orthopaedic Surgery & Rehabilitation","volume":"17 ","pages":"21514593261468051"},"PeriodicalIF":1.8,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13354916/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148425406","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unicompartmental Knee Arthroplasty for Medial Osteoarthritis in Patients Aged 75 Years and Older: A Comparative Study Evaluating Patient Outcomes With Mobile-Bearing and Fixed-Bearing Prostheses.","authors":"Bin Wang, Gang Ji, Xue Wang, Shoujiang Han, Xiaokang Gao, Wei Liu, Yaqing Li, Guobin Liu","doi":"10.1177/21514593261467163","DOIUrl":"10.1177/21514593261467163","url":null,"abstract":"<p><strong>Objective: </strong>Unicompartmental knee arthroplasty (UKA) offers potential advantages over total knee arthroplasty, but evidence regarding its efficacy in patients aged over 75 years remains limited. This comparative study evaluates clinical outcomes following UKA in patients aged ≥75 years and compares mobile-bearing (MB) versus fixed-bearing (FB) prostheses in this population.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of 189 consecutive patients aged ≥75 years who underwent UKA for medial compartment osteoarthritis (June 2021-December 2022). The cohort comprised 118 MB and 71 FB prostheses. Demographic data, perioperative complications, and patient-reported outcome measures (Knee Society Score [KSS], Oxford Knee Score [OKS], Visual Analogue Scale [VAS] for pain, and Forgotten Joint Score-12 [FJS-12]) were collected preoperatively and at minimum 12-month follow-up. Wilcoxon signed-rank and Mann-Whitney U tests were used for within- and between-group comparisons, respectively.</p><p><strong>Results: </strong>Mean follow-up was 25 months (range, 12-36 months), with no losses or deaths. Significant improvements occurred across all outcomes. Median KSS clinical score improved from 30.00 to 91.00 (P < 0.001); KSS functional from 25.00 to 70.00 (P < 0.001); OKS from 40.00 to 18.00 (P < 0.001); and VAS pain from 6.00 to 1.00 (P < 0.001). One patient (0.5%) experienced a minor cardiac event; no revisions, infections, or bearing complications occurred. No significant differences were observed between MB and FB groups for any outcome measure, including FJS-12 (median 100 both groups; P = 0.359).</p><p><strong>Conclusion: </strong>UKA provides significant, clinically meaningful improvements in pain and function for patients aged ≥75 years with medial compartment osteoarthritis, with low complication rates and excellent joint awareness. Both MB and FB prostheses yield equivalent outcomes. Advanced age alone should not contraindicate UKA.</p>","PeriodicalId":48568,"journal":{"name":"Geriatric Orthopaedic Surgery & Rehabilitation","volume":"17 ","pages":"21514593261467163"},"PeriodicalIF":1.8,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13346832/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148425505","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postoperative Sleep Disorders in Elderly THA Patients: Phenotypes, Risk Factors, and Perioperative Rehabilitation Strategies: A Single-Center Retrospective Observational Study.","authors":"Jinqiang Chen, Bin Ma, Kunpeng Fu, Hui Zhang, Yang Yu, Xiaoli Zhang, Zhenhu Wang","doi":"10.1177/21514593261466334","DOIUrl":"10.1177/21514593261466334","url":null,"abstract":"<p><strong>Purpose: </strong>Sleep disorder is a frequent postoperative complication after total hip arthroplasty (THA). This study aimed to characterize sleep disorder phenotypes, identify associated risk factors, and explore the relationships between sleep disturbance patterns and clinical outcomes in elderly patients aged ≥70 years.</p><p><strong>Materials and methods: </strong>A single-center retrospective analysis included 892 primary THA patients between January 2021 and December 2024. Sleep disorders were assessed via a validated 12-item questionnaire and diagnosed according to the International Classification of Sleep Disorders, 2nd Edition. Visual analog scale (VAS) pain scores and length of hospital stay (LOS) were extracted and stratified by different groups. All patients finished a minimum 6-month postoperative follow-up.</p><p><strong>Results: </strong>78.3% of patients had postoperative sleep disturbances (median 6 weeks, range 4-8 weeks). Primary insomnias (72.1%) dominated, with adjustment sleep disorder (41.5%) most common; secondary insomnias (27.9%) linked to comorbidities (19.7%) and drugs (8.2%). Elderly patients had 83.5% incidence and 3.2-fold higher risk of persistent disturbances versus non-elderly patients (<i>p</i><0.001). Patients with sleep maintenance difficulties or non-restorative sleep tended to present with higher VAS (<i>p</i><0.001) and longer LOS (<i>p</i><0.001) significantly.</p><p><strong>Discussion: </strong>Pain (38.6%), psychological stress (29.4%), and intrinsic factors (16.2%) were most commonly associated with sleep disturbances. Elderly patients were more vulnerable to comorbidity-related and environmental sleep disruptors. Differences in clinical indicators were observed between patients receiving personalized perioperative management and those under routine care.</p><p><strong>Conclusions: </strong>Adjustment sleep disorder is the most common postoperative sleep phenotype in THA patients. Pain, psychological factors, and intrinsic characteristics are key drivers. In addition, patients with difficulty in staying asleep and non-restorative sleep are associated with higher pain scores and prolonged LOS. Elderly patients are high-risk for persistent sleep disturbances and inferior recovery outcomes. These findings suggest potential directions for patient-centered perioperative management, while relevant associations need further verification.</p>","PeriodicalId":48568,"journal":{"name":"Geriatric Orthopaedic Surgery & Rehabilitation","volume":"17 ","pages":"21514593261466334"},"PeriodicalIF":1.8,"publicationDate":"2026-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13338542/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148406444","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperative GNRI Predicts Postoperative Constipation after Fixation of Extracapsular Hip Fractures in Older Adults.","authors":"Lan Guo, Youwei Tian, Ying Liu, Yanan Fu, Zhanbei Ma, Chong Nan","doi":"10.1177/21514593261466327","DOIUrl":"10.1177/21514593261466327","url":null,"abstract":"<p><strong>Background: </strong>Postoperative constipation (POC) is common in older adults after hip fracture surgery and may be influenced by perioperative care and nutritional status. Serum albumin is an imperfect nutrition marker, whereas the Geriatric Nutritional Risk Index (GNRI) combines albumin with body weight and may better reflect nutritional reserve. The association between preoperative GNRI and POC after fixation of AO/OTA 31-A extracapsular hip fractures remains unclear. We evaluated the association of preoperative GNRI with POC and compared discrimination with other preoperative markers.</p><p><strong>Methods: </strong>We conducted a single-center retrospective cohort study of patients aged ≥65 years undergoing proximal femoral nail fixation for AO/OTA 31-A extracapsular hip fractures. POC was defined as no spontaneous bowel movement for ≥3 postoperative days or laxative/enema use within 72 hours. Multivariable logistic regression adjusted for age, sex, BMI, diabetes, prior stroke/TIA, Parkinson's disease, time to first mobilization (≥48 h), and total opioid dose (morphine-equivalent dose, MED). Discrimination was assessed using ROC AUC; analyses were complete-case.</p><p><strong>Results: </strong>Among 230 patients, 152 (66%) developed POC. In the expanded model, higher GNRI was associated with lower odds of POC (adjusted OR 0.86 per 1-unit increase, 95% CI 0.81-0.91; P<0.001). Higher BMI (OR 1.18, 95% CI 1.05-1.33; P=0.005), mobilization ≥48 h (OR 2.43, 95% CI 1.22-4.83; P=0.011), and opioid exposure (OR 1.52, 95% CI 1.24-1.85; P<0.001) were associated with higher odds. Model AUC increased from 0.758 to 0.822 after adding perioperative factors. In single-marker ROC analyses, GNRI showed modest discrimination for POC (AUC 0.724, 95% CI 0.650-0.789), higher than serum albumin (AUC 0.689), BMI (AUC 0.539), and age (AUC 0.545).</p><p><strong>Conclusions: </strong>POC was common after fixation of AO/OTA 31-A extracapsular hip fractures in older adults. Preoperative GNRI provided prognostic information, and perioperative variables further improved discrimination. GNRI may help identify patients who could benefit from proactive bowel management, opioid-sparing strategies, and early mobilization.</p>","PeriodicalId":48568,"journal":{"name":"Geriatric Orthopaedic Surgery & Rehabilitation","volume":"17 ","pages":"21514593261466327"},"PeriodicalIF":1.8,"publicationDate":"2026-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13333044/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148392153","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Trauma-specific Frailty Index Identifies Orthopaedic Trauma Patients at Risk for Stepdown Admission, Skilled Nursing Facility Discharge, and Prolonged Hospitalization.","authors":"William A Crites, Benjamin E Jevnikar, Samuel K Gerak, Anish Gangavaram, Ronak J Mahatme, Shawn A Moore, Richard T Laughlin","doi":"10.1177/21514593261461121","DOIUrl":"10.1177/21514593261461121","url":null,"abstract":"<p><strong>Objectives: </strong>To compare the Trauma-Specific Frailty Index (TSFI) with an institutional Perioperative Geriatric Score (PGS) for predicting postoperative level of care, discharge disposition, and length of stay in older adults undergoing operative fixation of lower-extremity fractures.</p><p><strong>Methods: </strong>Design: Retrospective cohort study. Setting: Two hospitals within a single academic health system: an urban level I and a suburban level III trauma center. Patient Selection Criteria: Patients aged ≥65 years who underwent operative fixation of lower-extremity fractures between January 1 and June 30, 2025; nonoperative fractures and encounters lacking primary outcome data were excluded. Frailty was measured with the TSFI (0-1 deficit-accumulation index). Perioperative risk was measured with an institutional PGS combining vasopressor use, blood loss, cardiac comorbidity, case duration, and delay to surgery. Outcome Measures and Comparisons: Primary outcomes were postoperative level of care, discharge disposition, and hospital length of stay; 90-day readmission and mortality were secondary. Multivariable regression adjusted for age, sex, body mass index, and fracture type.</p><p><strong>Results: </strong>Among 248 patients (median age, 78 years; 64.1% female), higher TSFI values were associated with stepdown admission (odds ratio [OR] 2.43; 95% confidence interval [CI], 1.13-5.21), intensive care unit admission (OR 2.79; 95% CI, 1.16-6.70), discharge to a skilled nursing facility (OR 1.96; 95% CI, 1.11-3.47), and longer length of stay (OR 1.61; 95% CI, 1.19-2.17). The PGS showed weaker associations, reaching significance only for intensive care unit admission (OR 1.16; 95% CI, 1.07-1.26). Ninety-day readmission and mortality were too infrequent for reliable estimates.</p><p><strong>Conclusions: </strong>The TSFI outperformed an institutional perioperative geriatric triage score in predicting postoperative care escalation and discharge disposition in lower-extremity fracture patients. Incorporation of frailty assessment into orthopaedic trauma workflows may improve risk stratification, counseling, and resource planning.</p>","PeriodicalId":48568,"journal":{"name":"Geriatric Orthopaedic Surgery & Rehabilitation","volume":"17 ","pages":"21514593261461121"},"PeriodicalIF":1.8,"publicationDate":"2026-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13305790/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148346966","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of 95-Degree Angled Blade Plate With Distal Femoral Fractures in Patients Over 65-Years Old of Age.","authors":"Serdar Demiroz, Cengiz Erdemir, Kaya Memisoglu, Serdar Ertan, Mesut Uysal, Erdal Işık, Cumhur Cevdet Kesemenli","doi":"10.1177/21514593261463835","DOIUrl":"10.1177/21514593261463835","url":null,"abstract":"<p><strong>Background: </strong>The aim of this study was to evaluate patients over 65 years old treated with an angled blade plate (ABP) for distal femoral fractures and determine if the use of ABP was reasonable in this specific population who are prone to complications.</p><p><strong>Methods: </strong>Consecutive patients with distal femoral fracture who had undergone open reduction and internal fixation with ABP plate between January 2010 and December 2023 were retrospectively analyzed. Medical records were reviewed for age, sex, follow-up, injury characteristics, fracture pattern, and complications, such as malunion, non-union and infection. Clinical evaluation of patients was performed using the international Knee Documentation Committee (IKDC) score.</p><p><strong>Results: </strong>Twenty-one (18 female; 85.7%) patients were included, with a median (range) age of 78.5 (65-92) years. Mean follow-up was 17 months. Four of the patients sustained high-energy trauma fractures and the remainder fractured because of a simple fall; five were admitted due to the nonunion and three because of complications related to intramedullary nail. Most (85%) had periprosthetic fracture. Only 2/21 (9.5%) had nonunion and implant failure and were revised again with ABP and iliac crest autograft. Furthermore, only 1 (4.8%) with superficial infection needed surgical debridement in the early postoperative period. After a minimum of 12 months follow up the mean IKDC score was 37 (range 21-72).</p><p><strong>Conclusion: </strong>ABP appears to be a reliable device for the treatment of distal femoral fractures in patients over 65 years, including those with osteoporotic and periprosthetic fractures, and non-unions, with a 90% union rate.</p>","PeriodicalId":48568,"journal":{"name":"Geriatric Orthopaedic Surgery & Rehabilitation","volume":"17 ","pages":"21514593261463835"},"PeriodicalIF":1.8,"publicationDate":"2026-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13309640/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148346955","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Back to the Future? Institutional Learning Curves and Intraoperative Fracture Rates Associated With Adoption of a Cemented Composite Beam Stem for Hemiarthroplasty.","authors":"Orla Hennessy, Kieran Field, Sean O Flynn, Darren Dahly, Fiachra E Rowan, Eoghan Pomeroy, Terence Murphy, May S Cleary","doi":"10.1177/21514593261461094","DOIUrl":"10.1177/21514593261461094","url":null,"abstract":"<p><strong>Background: </strong>Hemiarthroplasty remains the gold standard for hip fracture care in displaced intracapsular fractures. There is now substantial evidence that uncemented femoral stems are associated with higher risk of perioperative fractures. Cemented composite beam (CCB) stems offer some of the lowest overall rates of perioperative fracture risk, but are not widely used in the Irish system, and concern regarding the use of new implants and associated learning curves can act as a barrier to change.</p><p><strong>Objectives: </strong>We aim to assess our units experience transitioning to a cemented composite beam (CCB) and the associated learning curve and technical pitfalls.</p><p><strong>Design: </strong>Retrospective, single centre, single blind review identified the first 140 cases of CCB stems.</p><p><strong>Methods: </strong>Post-operative radiographs on all cases were assessed for perioperative fracture and stems were classed as being varus or valgus if the stem alignment was >3 degrees from the anatomical axis. A cemented taper slip (CTS) stem, which was in use for over 10 years in the unit, provided a control group.</p><p><strong>Results: </strong>Following introduction, higher odds of malalignment were experienced with the CCB stem (OR 2.19, 1.09-4.55 p<0.031), relative to CTS. However, compared to overall rate of malalignment in the CTS group (9.3%), the learning curve for the CCB stem was short, with rates of malalignment returning to in line with our control CTS cohort within 46 cases (Cases 1-46 32% malaligned, cases 47-92 10.86% malaligned, cases 93-138 4.34% malaligned). There was no increased risk of periprosthetic fracture demonstrated with introduction of the new stem.</p><p><strong>Conclusions: </strong>We have shown a relatively short learning curve associated with transitioning to a CCB stem for fragility fracture hemiarthroplasty. We highlight some of the early technical issues experienced and corrected.</p>","PeriodicalId":48568,"journal":{"name":"Geriatric Orthopaedic Surgery & Rehabilitation","volume":"17 ","pages":"21514593261461094"},"PeriodicalIF":1.8,"publicationDate":"2026-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13272853/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148279312","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}