Geriatric Orthopaedic Surgery & Rehabilitation最新文献

{"title":"Outcomes of Tibiotalocalcaneal (TTC) Nailing in Ankle Fractures in Diabetic Patients with Charcot Neuroarthropathy.","authors":"Sayed Mohamed Elgoyoushi, Ahmed Nabawy Morrah, Ahmed Mahmoud Kholeif, Ahmad Amr Elbadry","doi":"10.1177/21514593251328896","DOIUrl":"https://doi.org/10.1177/21514593251328896","url":null,"abstract":"<p><p><b>Background:</b> Ankle arthrodesis, traditionally used for Charcot arthropathy or failed fracture fixation, has evolved to include techniques such as tibiotalocalcaneal (TTC) nailing and tibiotalar arthrodesis. These methods offer advantages like smaller incisions and minimal disruption of the fracture site's biology. This approach is particularly beneficial for diabetic patients, who are prone to vascular complications, diabetic foot ulcers, and infections. Early weight-bearing with implants like TTC nails is especially advantageous for patients with poor bone stock or soft tissue quality. <b>Objective:</b> This study aimed to evaluate the clinical and radiographic outcomes of TTC nailing in ankle fractures among diabetic patients with Charcot arthropathy. <b>Methods</b> <b>:</b> This prospective study included 84 diabetic patients with unstable, displaced ankle fractures and Charcot neuroarthropathy who underwent TTC nailing from October 2022 to June 2024. Primary outcomes were complication rates and functional outcomes, while secondary outcomes included time to weight-bearing and bone union rates. The Foot and Ankle Outcome Score (FAOS) was used to assess functional improvement. <b>Results:</b> At six months postoperatively, FAOS scores were classified as excellent in 54 patients (64.3%), good in 24 patients (28.6%), and poor in 6 patients (7.1%). The mean preoperative FAOS score improved significantly from 19.9 ± 3.81 to 72.6 ± 11.66 at six months (<i>P</i> < 0.001). Union was achieved in 63 patients (75%), delayed union occurred in 15 patients (17.9%), and non-union occurred in 6 patients (7.1%). No significant correlations were found between final FAOS scores and age, body mass index, diabetes duration, or HbA1c levels. Furthermore, postoperative complications included wound infections, which were categorized into superficial and deep infections. Superficial infections occurred in 6 patients (7.1%), characterized by localized erythema and mild discharge around the surgical site. Deep infections, on the other hand, were observed in 3 patients (3.6%), involving deeper tissues and requiring more aggressive management, including hardware removal after achieving complete bone consolidation. Advanced postoperative deformity was noted in 6 patients (7.1%), likely due to the underlying Charcot arthropathy and its associated instability. <b>Conclusion:</b> TTC nailing is a reliable and effective treatment for ankle fractures in diabetic patients with Charcot neuroarthropathy, offering good clinical and functional outcomes with a low complication rate. <b>Level of Evidence:</b> III.</p>","PeriodicalId":48568,"journal":{"name":"Geriatric Orthopaedic Surgery & Rehabilitation","volume":"16 ","pages":"21514593251328896"},"PeriodicalIF":1.6,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12033558/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144035346","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":"Outcomes of Headed and Headless Cannulated Screws Fixation in Nondisplaced Femoral Neck Fracture.","authors":"Ko-Ta Chen, Hsien-Tsung Lu, Chian-Her Lee, Meng-Huang Wu","doi":"10.1177/21514593251330580","DOIUrl":"https://doi.org/10.1177/21514593251330580","url":null,"abstract":"<p><strong>Background: </strong>The incidence of femoral neck fracture is increasing as society ages. Different types of cannulated screws can be used for internal fixation of femoral neck fractures, but no screw selection protocol has been determined to reduce the risk of operation failure. This retrospective study aimed to elucidate differences in outcomes between using cannulated compression screws and headless compression screws for fixation in nondisplaced femoral neck fractures.</p><p><strong>Methods: </strong>Adults aged 18 years and older with non-displaced femoral neck fracture, admitted between February 2016 and January 2022, and received fixation using three screws in an inverted triangle configuration were selected for this retrospective study. After exclusions, patients were separated into four groups based on using different combinations of headed cannulated compression screws and headless compression screws. Postoperative computerized tomography or magnetic resonance imaging was used to evaluate operation failure, defined as nonunion or avascular necrosis of the femoral head.</p><p><strong>Results: </strong>After exclusions, 153 patients (median age 75.0, range 65.0-85.0) with majority of females (69.9%) were included. While the combination of one cannulated compression screw (CCS) and two headless compression screws (HCS) did not achieve statistical significance compared to other screw configurations (<i>P</i> = 0.073), it still demonstrated the lowest rate of operative failure (0.0%). Age was identified as the only significant factor associated with operative failure (adjusted OR: 1.10; 95% CI: 1.03-1.17; <i>P</i> = 0.004).</p><p><strong>Conclusions: </strong>No significant differences are found in outcomes between different combinations of cannulated headed compression screws and headless compression screws in an inverted triangle configuration for fixation of non-displaced femoral neck fractures.</p>","PeriodicalId":48568,"journal":{"name":"Geriatric Orthopaedic Surgery & Rehabilitation","volume":"16 ","pages":"21514593251330580"},"PeriodicalIF":1.6,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12032461/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144054748","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":"Does Patient Health Literacy Affect Patient Reported Outcome Measure Completion Method in Orthopaedic Patients?","authors":"Timothy J Trotter, David B Bumpass, Simon C Mears, Eric R Siegel, Jeffrey B Stambough","doi":"10.1177/21514593251331539","DOIUrl":"10.1177/21514593251331539","url":null,"abstract":"<p><strong>Introduction: </strong>PROMIS® Computer Adaptive Testing (CAT) is a testing tool for tracking patient-reported outcome measures (PROM) with a goal to improve individual and population outcomes. Patients' health literacy (HL) may affect how they are able to complete PROM. We hypothesized that patients with low HL were less likely both to complete surveys and to do so via online patient portal (OPP).</p><p><strong>Methods: </strong>A retrospective cohort study of 3926 orthopaedic patients in a rural state was performed. Completion rate and completion method both were subjected to log-binomial regressions with patient demographics and HL as predictor variables.</p><p><strong>Results: </strong>PROM surveys were completed by 2166 (55.2%) of patients, including 512 completed via OPP and 1654 completed via in-clinic tablet (ICT). Compared to high HL patients, low HL patients had a 23% higher non-completion rate, and low HL completers were 63% less likely to use OPP. Age and gender had significant (<i>P</i> < 0.05) associations with completion method, but not completion rate, whereas Area Deprivation Index (ADI) had significant associations with both. Compared to White patients, Black patients had a 25% higher non-completion rate, and Black completers were 49% less likely to use OPP.</p><p><strong>Discussion: </strong>Our analysis shows that health literacy, demographics, and socioeconomic status affect both whether and how patients fill out PROM surveys. Patients with low HL were less likely to complete PROM surveys, and less likely to use the OPP when they did.</p><p><strong>Conclusion: </strong>Our results demonstrate that patients' health literacy, demographics, and socioeconomic status affect both whether they complete their PROMIS® CAT and what method they complete it with. Additional efforts should be made to understand these factors, accommodate patients, and facilitate accurate and complete PROM responses, especially in hospitals that serve diverse and socioeconomically disadvantaged patients.</p>","PeriodicalId":48568,"journal":{"name":"Geriatric Orthopaedic Surgery & Rehabilitation","volume":"16 ","pages":"21514593251331539"},"PeriodicalIF":1.6,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11967209/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143781553","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":"Rate of Osteoporosis Evaluation and Treatment Following Kyphoplasty in Patients With Vertebral Compression Fractures: A Retrospective Study and Review of the Literature.","authors":"Christian Benedict, Avani A Chopra, Michaela Pitcher, Noel Jeansonne, Edward Fox","doi":"10.1177/21514593251332463","DOIUrl":"10.1177/21514593251332463","url":null,"abstract":"<p><strong>Background: </strong>Lifetime risk of an osteoporotic fracture is 50% for women and 20% for men. Of these fractures, vertebral compression fractures (VCF) are the most common. While surgery plays a crucial role in managing these fractures, preventative measures are also critical when addressing the risk of osteoporotic VCFs. Although many recent guidelines recommend osteoporosis evaluation and treatment for patients with VCFs, the true proportion of patients who undergo an osteoporosis workup following their kyphoplasty procedure is unknown. The aim of this study is to assess the frequency of osteoporosis screening and treatment in patients who undergo a kyphoplasty procedure to correct a vertebral fragility fracture.</p><p><strong>Methods: </strong>This study utilized the TriNetX Research Network, a database containing de-identified patient information. Using this database, we identified patients from 89 institutions with non-traumatic VCFs and VCFs that resulted from low-energy trauma who subsequently underwent a kyphoplasty procedure. We then analyzed any follow-up osteoporosis treatment or screening they received.</p><p><strong>Results: </strong>A total of 3371 patients were identified to have undergone kyphoplasty to treat a VCF for the first time. To our knowledge, this is the largest study of its kind to date. Among these patients, 71.3% never had a DEXA scan or prior medical treatment for osteoporosis within 2 years before their kyphoplasty procedure. Additionally, 56.1% of all patients with VCFs treated with kyphoplasty for the first time were never screened or treated for osteoporosis in the two years preceding and 1 year following the procedure.</p><p><strong>Conclusion: </strong>Our results suggest that only 15.2% of patients with a vertebral fragility fracture secondary to decreased bone density are screened and treated for osteoporosis. Despite existing guidelines recommending osteoporosis evaluation and treatment for patients with VCFs, our findings highlight missed opportunities for intervention. Improving the implementation of existing screening protocols and increasing awareness among healthcare providers could reduce VCF-associated morbidity and mortality.</p>","PeriodicalId":48568,"journal":{"name":"Geriatric Orthopaedic Surgery & Rehabilitation","volume":"16 ","pages":"21514593251332463"},"PeriodicalIF":1.6,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11970096/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143796703","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":"Lag Screw Design Is a Predictor for Cut-Out Complication After Intertrochanteric Femur Fracture Treatment in Elderly. A Comparative Analysis.","authors":"Aytek Hüseyin Çeliksöz, Nusret Köse, Akın Turgut, Erol Gökturk","doi":"10.1177/21514593251328929","DOIUrl":"10.1177/21514593251328929","url":null,"abstract":"<p><p><b>Background:</b> Hip fractures are common in older adults and are associated with significant morbidity and mortality. Surgical fixation with intramedullary devices, such as proximal femoral nails (PFN), is a common treatment method. However, complications such as implant cut-out remain a challenge despite advancements in implant designs. The objective of this study was to evaluate the clinical experience with different PFN designs and lag screws and to compare implant cut-out rates. Additionally, the study aimed to identify the most important factors that could prevent complications and predict cut-out. <b>Methods:</b> This retrospective study included 145 patients with trochanteric fractures who had undergone surgical treatment with PFN devices between January 2015 and December 2018. Patients younger than 65 years, those with pathological fractures, ipsilateral pelvic and knee fractures, subtrochanteric fractures, and multiple traumas were excluded. Radiographs were evaluated to determine osteoporosis, fracture type, implant type, fracture reduction quality, early and late neck shaft angle (NSA), lag screw position in the femoral head, tip-apex distance (TAD), and cut-out. Fractures were classified according to the AO/OTA classification system, and the quality of fracture reduction was assessed using the Baumgaertner classification. The Cleveland method was used to record the location of the screw/blade within the head. <b>Results:</b> The study compared the implant features of four different PFN devices, including Double lag screw PFN, Wedge wing lag screw PFN nail, Helical blade PFN, and Integrated Dual Screw PFN. The statistical analysis indicated that early and late NSA, TAD, Reduction quality of fracture, Cleveland index, and the difference between PFN types were risk factors for Cut-out. (<i>P</i> ≤ .001). Patients with helical blade PFN had a significantly higher rate of cut-out compared to other PFN devices. Univariate and multivariate regression analyses identified the Cleveland Index, fracture reduction quality (<i>P</i> ≤ .001), TAD, and early and late NSA as significant predictors for cut-out complications (<i>P</i> ≤ .001). Patients with poor Cleveland Index, poor fracture reduction quality, low TAD, and low NSA had a higher risk of cut-out (<i>P</i> ≤ .001). <b>Conclusion:</b> In conclusion, careful consideration of patient and surgical factors, including implant design and placement, is crucial in minimizing the risk of complications such as cut-out.</p>","PeriodicalId":48568,"journal":{"name":"Geriatric Orthopaedic Surgery & Rehabilitation","volume":"16 ","pages":"21514593251328929"},"PeriodicalIF":1.6,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11960184/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143765485","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":"Advantages of Distal Unlocked Proximal Femoral Nails in the Treatment of Stable Intertrochanteric Fractures in Geriatric Patients: A Single-Center Comparative Randomized Study.","authors":"Sönmez Sağlam, Omer Ersen, Harun Yasin Tüzün, Cemil Yıldız","doi":"10.1177/21514593251327910","DOIUrl":"10.1177/21514593251327910","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to investigate the effect of omitting a distal locking screw in intramedullary nailing of stable intertrochanteric femur fractures on clinical outcomes.</p><p><strong>Methods: </strong>Ninety-six patients over 65 years old with stable pertrochanteric fractures (AO/OTA 31-A1 and A2) treated with short/intermediate proximal femoral nails (PFNA-II) were randomly assigned into two groups: Group 1 (distal locked) and Group 2 (distal unlocked). Comparative analyses were conducted on operative time, total fluoroscopy time, blood loss, incision length, complications, and functional outcomes.</p><p><strong>Results: </strong>The mean operative time was significantly shorter in Group 2 (35.73 ± 7.62 minutes) compared to Group 1 (47.40 ± 9.96 minutes) (<i>P</i> < 0.001). Fluoroscopy time was also shorter in Group 2 (45.92 ± 6.08 seconds) compared to Group 1 (54.02 ± 5.94 seconds) (<i>P</i> < 0.001). Incision length was reduced in Group 2 (9.21 ± 1.41 centimeters) compared to Group 1 (12.96 ± 1.68 centimeters) (<i>P</i> < 0.001). Blood loss was lower in Group 2 (187.50 ± 32.00 milliliters) than in Group 1 (208.65 ± 49.12 milliliters) (<i>P</i> < 0.05). There were no significant differences between the groups in fracture union time, hospital stay, fracture union weeks, or postoperative blood transfusion rates.</p><p><strong>Conclusions: </strong>Proximal femoral nailing without distal locking offers shorter operative times, reduced fluoroscopy exposure, and lower blood loss and complications, making it a viable option for treating stable intertrochanteric fractures.</p>","PeriodicalId":48568,"journal":{"name":"Geriatric Orthopaedic Surgery & Rehabilitation","volume":"16 ","pages":"21514593251327910"},"PeriodicalIF":1.6,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11954384/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755261","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":"Influence of Preoperative Nutritional Status on Surgical Outcomes of Arthroplasty in Geriatric Femoral Neck Fractures.","authors":"Sarbhjit Singh Lakha Singh, Khanchana Devi Theveraja, Jade Pei Yuik Ho, Sangitaa P Palaniappan, Sanjay Raj Subramaniam, Sarbhan Singh Lakha Singh, Kunalan Ganthel","doi":"10.1177/21514593251327914","DOIUrl":"10.1177/21514593251327914","url":null,"abstract":"<p><strong>Background: </strong>Patients with geriatric neck of femur (NOF) fractures often have multiple medical conditions and compromised baseline nutrition, impacting arthroplasty outcomes. Indicators like BMI, albumin, hemoglobin, urea, creatinine, CRP, and HbA1c influence nutritional status and postoperative results. This study evaluates the impact of preoperative nutrition on surgical outcomes, including postoperative complications, mobility, and pain scores in geriatric femoral neck fractures.</p><p><strong>Methods: </strong>A retrospective study of 141 geriatric patients with NOF fractures admitted to Kuala Lumpur General Hospital between 2022-2023, treated operatively, was conducted. Associations of age, gender, ethnicity, BMI, education, smoking status, comorbidity, pre-fracture mobility, American Society of Anesthesiologists (ASA) level, and perioperative nutritional parameters with post-surgical complications, mobility, and WOMAC scores 1-year post-surgery were analyzed using logistic regression.</p><p><strong>Results: </strong>Higher BMI (AOR = 1.21, 95% CI: 1.07-1.42, <i>P</i> = 0.03) and ASA levels ≥2 (AOR = 2.53, 95% CI: 1.30-4.91, <i>P</i> = 0.01) were significant predictors of post-surgical complications. Abnormal hematological variables, including hemoglobin (AOR = 1.78, 95% CI: 1.45-2.45, <i>P</i> < 0.001), urea (AOR = 1.35, 95% CI: 1.15-1.60, <i>P</i> = 0.002), creatinine (AOR = 1.20, 95% CI: 1.00-1.52, <i>P</i> = 0.04), and HbA1c (AOR = 1.40, 95% CI: 1.25-1.67, <i>P</i> = 0.004), were also associated with complications. BMI (AOR = 1.12, 95% CI: 1.06-1.30, <i>P</i> = 0.049) and abnormal hematological variables, including hemoglobin (AOR = 1.99, 95% CI: 1.05-2.70, <i>P</i> = 0.003), urea (AOR = 1.58, 95% CI: 1.06-1.95, <i>P</i> = 0.006), creatinine (AOR = 1.21, 95% CI: 1.09-1.38, <i>P</i> = 0.048), and HbA1c (AOR = 1.98, 95% CI: 1.25-2.57, <i>P</i> = 0.002), were significant predictors of reduced post-surgical mobility. No significant factors were associated with WOMAC scores at 1 year.</p><p><strong>Conclusion: </strong>Preoperative nutritional status significantly impacts outcomes in geriatric patients undergoing arthroplasty for femoral neck fractures. Comprehensive preoperative nutritional assessments are essential for improving postoperative outcomes.</p>","PeriodicalId":48568,"journal":{"name":"Geriatric Orthopaedic Surgery & Rehabilitation","volume":"16 ","pages":"21514593251327914"},"PeriodicalIF":1.6,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11952030/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755262","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":"Fracture-Related Infection of the Proximal Femur - Diagnostics and Treatment.","authors":"Moritz Riedl, Josina Straub, Nike Walter, Susanne Baertl, Florian Baumann, Volker Alt, Markus Rupp","doi":"10.1177/21514593251324768","DOIUrl":"10.1177/21514593251324768","url":null,"abstract":"<p><strong>Purpose: </strong>With the aging population and rising life expectancy the incidence of trauma-related injuries, particularly proximal femur fractures, is expected to increase. Complications such as fracture-related infections (FRI) significantly impede the healing process and pose substantial risks to patients. Despite advancements in understanding, diagnosing, and treating FRI, challenges persist in achieving optimal outcomes. This review addresses the significance of FRI following proximal femur fractures, emphasizing diagnostic methodologies and therapeutic modalities to enhance clinical care.</p><p><strong>Findings: </strong>Notably, a consensus definition for FRI has been established, providing clarity for accurate diagnosis. Diagnostic criteria encompass confirmatory and suggestive elements, facilitating precise identification of FRI. Therapeutic strategies for FRI in proximal femur fractures include a spectrum of surgical and antimicrobial approaches. Surgical interventions, ranging from debridement with implant retention over implant removal/exchange to staged conversions to arthroplasty, are tailored based on fracture stability, individual patient factors, and infection characteristics. The intricate decision-making process is elucidated, highlighting the importance of individualized treatment plans and multidisciplinary collaboration. Antimicrobial therapy plays a pivotal role in FRI management, with empirical regiments targeting common pathogens and local delivery systems offering sustained antibiotic release. Microbiological analysis and collaboration with infectious disease specialists should guide antimicrobial treatment and ensure optimal therapy efficacy.</p><p><strong>Conclusion: </strong>Managing FRI following proximal femur fractures requires a tailored, multidisciplinary approach. Treatment strategies should be guided by diagnostic precision, patient-specific considerations, and collaboration among surgical, infectious disease, and clinical teams. Implementing comprehensive therapeutic approaches is essential for mitigating the impact of FRI and improving patient outcomes.</p>","PeriodicalId":48568,"journal":{"name":"Geriatric Orthopaedic Surgery & Rehabilitation","volume":"16 ","pages":"21514593251324768"},"PeriodicalIF":1.6,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11948549/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143732524","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":"Current Care and Barriers to Optimal Care of People With Hip Fracture: A Survey of Hospitals in New South Wales, Australia.","authors":"Danielle Ní Chróinín, Zsolt J Balogh, Jennifer Smith, Glen Pang, Jessica Wragg, Magnolia Cardona","doi":"10.1177/21514593251327551","DOIUrl":"10.1177/21514593251327551","url":null,"abstract":"<p><strong>Background: </strong>Fragility hip fractures are a common and often devastating event, and a shared care approach between orthopaedics and geriatrics can improve patient, health service and quality of care outcomes. The aim of this cross-sectional survey, administered to all hospitals caring for patients with acute hip fracture, in New South Wales (NSW), Australia, was to establish current models of care (e.g. shared care or other), and barriers and facilitators of best care.</p><p><strong>Methods: </strong>A combination of quantitative and free-text data was collected. In total, 30/36 (83%) hospitals responded, with representation from all 15 state local health districts.</p><p><strong>Results: </strong>Overall, 21/30 had a formal orthopedic surgery/geriatric medicine shared care model; orthopaedic surgery admission with routine (ortho)geriatrician input was commonest (13/21). Multiple barriers to optimal hip fracture care were identified along the various stages of the national guideline-recommended care pathway. Common barriers reported included staffing deficits (for pain assessment, fascia iliaca block administration) and gaps in service structure (lack of specialist services for refracture prevention). Multidisciplinary meetings were in place to enable best care and to promote team communication, but were impeded by absence of relevant team members (8/16). Free-text themes of enablers of good practice included clear escalation and hand-over processes, multidisciplinary communication strategies, and guideline-aligned clinical pathways.</p><p><strong>Conclusion: </strong>Moving forward, addressing common barriers such as staffing and knowledge deficits, and harnessing enablers of good practice such as multidisciplinary communication and support, combined with effective implementation strategies, are likely to optimize care for patients with hip fracture.</p>","PeriodicalId":48568,"journal":{"name":"Geriatric Orthopaedic Surgery & Rehabilitation","volume":"16 ","pages":"21514593251327551"},"PeriodicalIF":1.6,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11926827/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143693959","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 Impact of Attribution Training on Emotional and Functional Recovery in Elderly Patients Undergoing Total Knee Arthroplasty: A Single-Center Randomized Controlled Trial.","authors":"Xuan Chen, Fengjiao Yu","doi":"10.1177/21514593251326042","DOIUrl":"10.1177/21514593251326042","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to explore the effects of attribution training on postoperative negative emotions, attributional styles, and knee joint function in elderly patients who have undergone total knee arthroplasty (TKA).</p><p><strong>Methods: </strong>A total of 76 elderly patients who underwent TKA were selected and randomly divided into an intervention group and a control group in this prospective randomized controlled study. All patients received routine postoperative care, while the intervention group also underwent eight sessions of attribution training intervention, each lasting 60 minutes. The Hamilton Anxiety Scale (HAMA) and Hamilton Depression Scale (HAMD), Attributional Style Questionnaire (ASQ) scores and Hospital for Special Surgery (HSS) knee joint function scores between the two groups before and after the intervention were compared.</p><p><strong>Results: </strong>The study revealed that after the intervention, the intervention group exhibited lower scores on the HAMA and the HAMD compared to the control group, a difference that was statistically significant (<i>P</i> < 0.05). Additionally, the intervention group scored significantly higher on the ASQ for positive events and demonstrated better knee joint function compared to the control group (<i>P</i> < 0.05).</p><p><strong>Conclusion: </strong>The results of the study indicate that attribution training can effectively enhance psychological resilience and rehabilitation adherence in elderly patients post-TKA, thereby promoting functional recovery of the knee joint. This suggests that attribution training can play a crucial role in optimizing postoperative care.</p>","PeriodicalId":48568,"journal":{"name":"Geriatric Orthopaedic Surgery & Rehabilitation","volume":"16 ","pages":"21514593251326042"},"PeriodicalIF":1.6,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11915294/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143659205","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}