Geriatric Orthopaedic Surgery & Rehabilitation最新文献

{"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}

{"title":"Percutaneous Treatment of Geriatric Distal Tibia and Fibula Fractures With a Poor Soft Tissue Envelope - A Case Series.","authors":"Pedram Rajabifard, Joshua Booth, Samuel Hookway, Richard Kjar, Nathan Donovan, Anton Lambers","doi":"10.1177/21514593261446750","DOIUrl":"10.1177/21514593261446750","url":null,"abstract":"<p><strong>Purpose: </strong>Geriatric distal tibia and fibula fractures are typically treated with open reduction and internal fixation (ORIF) or prolonged cast immobilisation. These methods predispose to wound complications and delayed weight-bearing. Percutaneous fixation can offer a stable construct allowing for early weight-bearing while minimising wound complications. This case series details the management and outcomes of patients over 65 with distal tibia and fibula fractures and poor soft tissue envelope treated with percutaneous fixation.</p><p><strong>Methods: </strong>A prospective observational study was conducted at two Victorian orthopaedic units, identifying patients over 65 years of age who underwent percutaneous distal tibia or fibula fracture fixation. Patient selection considered soft tissue quality and overall health. Antegrade tibial intramedullary nails and retrograde percutaneous screws were used. Surgery proceeded without delay for swelling or anticoagulation cessation. Clinical notes and radiographs were analysed for premorbid health, mobility status, injury mechanism and classification, fixation methods, post-operative mobility, and treatment complications.</p><p><strong>Results: </strong>The study identified 13 ankles in 11 patients (average age 82) across two sites. Fractures included 4 trimalleolar, 5 bimalleolar, 1 lateral malleolar, and 3 distal tibia and fibula diaphyseal. Three fractures were open. Median time to operation was 3 days. Six patients were allowed immediate weight-bearing as tolerated. Median post-operative stay was 5 days. One deep infection required removal of a suture-button syndesmosis device and two minor wound breakdowns (distant to surgical site) were managed non-operatively with dressings.</p><p><strong>Conclusion: </strong>Percutaneous distal tibia and fibula fracture fixation appears to be a viable alternative to ORIF in geriatric patients with poor soft tissue envelope, potentially offering reduced complications and earlier mobilisation.</p><p><strong>Level of evidence: </strong>Level IV.</p>","PeriodicalId":48568,"journal":{"name":"Geriatric Orthopaedic Surgery & Rehabilitation","volume":"17 ","pages":"21514593261446750"},"PeriodicalIF":1.8,"publicationDate":"2026-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13287419/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148320013","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":"Predictive Performance of Frailty Indices for Complications and Functional Recovery After Distal Radius Fracture Surgery in Patients Aged ≥65 years.","authors":"Ekrem Özdemir, Fatih Emre Topsakal, Nasuhi Altay, Ayşe Güzin Özdemir","doi":"10.1177/21514593261461137","DOIUrl":"10.1177/21514593261461137","url":null,"abstract":"<p><strong>Background: </strong>Distal radius fractures (DRFs) are the most common upper-extremity fractures in older adults. Frailty may modulate postoperative risk, but the comparative prognostic value of widely used frailty indices in DRF surgery is unclear.</p><p><strong>Objective: </strong>To compare the 5-item modified Frailty Index (mFI-5), Clinical Frailty Scale (CFS), and Charlson Comorbidity Index (CCI) for predicting complications and functional outcomes after DRF surgery in patients ≥65 years, and to assess whether machine learning (ML) enhances risk stratification.</p><p><strong>Methods: </strong>We retrospectively analyzed 562 patients (mean age 75.1±4.9 years; 71.7% female) undergoing open reduction and internal fixation (67.1%), closed reduction percutaneous pinning (21.2%), or external fixation (11.7%), with ≥12 months of follow-up. Preoperative mFI-5, CFS, and CCI were collected. The primary endpoint was any postoperative complication (composite of surgical site infection, wound dehiscence, loss of reduction, tendon injury, nonunion/malunion, hardware failure, reoperation, 30-/90-day readmission, venous thromboembolism, and complex regional pain syndrome). Functional outcomes were DASH, PRWE, grip strength, and return to activities of daily living (ADLs). Logistic and Cox regression were used. Exploratory ML models (random forest, gradient boosting) employed 5-fold cross-validation, an 80/20 train-test split, and isotonic calibration.</p><p><strong>Results: </strong>Over 17.9±4.5 months, 195 of 562 patients (34.8%) developed ≥1 complication. mFI-5 ≥2 was associated with higher complication rates (38.2% vs 31.9%) and worse 6-month disability (DASH 55.4 vs 44.5; PRWE 47.9 vs 36.4; all p<0.001). CFS ≥4 predicted lower 12-month grip strength recovery (67.8% vs 74.1%) and reduced ADL return (65.9% vs 78.6%). Discrimination for complications was modest (AUCs: mFI-5 0.552; CFS 0.534; CCI 0.507). ML substantially improved performance (gradient boosting AUC 0.878; random forest AUC 0.812) with superior calibration.</p><p><strong>Conclusions: </strong>mFI-5, CFS, and CCI are associated with postoperative complications and functional recovery after DRF surgery but have limited individual discriminative power. ML-based multivariable models achieve markedly better risk stratification and may support more accurate preoperative counseling and personalized perioperative management.</p>","PeriodicalId":48568,"journal":{"name":"Geriatric Orthopaedic Surgery & Rehabilitation","volume":"17 ","pages":"21514593261461137"},"PeriodicalIF":1.8,"publicationDate":"2026-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13272859/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148279315","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 Effect of Hospital Trauma Level on Odds of Non-home Discharge from Hospital Following Dens Fracture.","authors":"Andrew Ni, Doha Hussien, Abhi Rashiwala, Victoria Vargas, Nasa Xu, Jason McCartney, Ralph Zachary Garza","doi":"10.1177/21514593261460566","DOIUrl":"10.1177/21514593261460566","url":null,"abstract":"<p><strong>Introduction: </strong>Dens fractures are cervical spine injuries with high morbidity and mortality in the elderly. Many patients require discharge to rehabilitation facilities or skilled nursing care, which impacts patient recovery, healthcare system resource allocation, and prognosis. This study evaluated the effect of trauma center level designation on discharge disposition in patients with dens fractures.</p><p><strong>Materials and methods: </strong>We conducted a retrospective study using data from a Texas State Trauma Registry from 2020 to 2022. Patient demographics, injury characteristics, and outcomes were queried in patients with dens fractures. Discharge home was defined as home discharge with or without home health services. Non-home discharge (NHD) was defined as discharge to another facility. Differences in discharge disposition were analyzed using adjusted binary and multinomial logistic regressions with 95% confidence intervals. Baseline characteristics were analyzed with chi-square and Kruskal-Wallis tests with post-hoc Dunn test for pairwise comparisons.</p><p><strong>Results: </strong>A total of 904 patients were included. After excluding patients who died during hospitalization or were discharged to locations not included in the analysis (e.g., against medical advice, jail, or psychiatric facilities), 433 (52.9%) patients were discharged home while 385 (47.1%) patients had a NHD. Patients treated at level II trauma centers were almost twice as likely to have a NHD compared to patients who were treated at a level I (OR=1.98; 95% CI, 1.39-2.83; p<0.001). Lower-level trauma centers combined (levels II to IV) also had higher odds of a NHD compared to patients who were treated at a level I trauma center (OR=2.03, 95% CI, 1.47-2.79; p<0.001). These findings remained significant when patients discharged from the ED without inpatient admission were excluded (OR=1.52; 95% CI, 1.08-2.14; p=0.016).</p><p><strong>Discussion: </strong>Patients with dens fractures treated at Level I trauma centers were significantly more likely to undergo home discharge than those treated at lower-level centers. Trauma center level may play an important role in discharge outcomes for this high-risk population. Further research is needed to identify specific practices contributing to this difference in discharge disposition.</p>","PeriodicalId":48568,"journal":{"name":"Geriatric Orthopaedic Surgery & Rehabilitation","volume":"17 ","pages":"21514593261460566"},"PeriodicalIF":1.8,"publicationDate":"2026-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13260780/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148254058","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":"Clinical Utility and Safety of Bone Cement Augmentation in Intramedullary Nailing for Proximal Femur Fractures: A Multicenter Prospective Observational Study.","authors":"Masahiro Matsumoto, Hyonmin Choe, Naomi Kobayashi, Kazuyoshi Yamamoto, Kousuke Matsuo, Hiroyuki Makita, Daisuke Enomoto, Yuta Hieda, Yutaka Inaba","doi":"10.1177/21514593261441131","DOIUrl":"10.1177/21514593261441131","url":null,"abstract":"<p><strong>Introduction: </strong>Proximal femur fractures are common in older adults and are associated with high morbidity and mortality. Bone cement augmentation during intramedullary nailing has been reported to improve implant stability; however, its clinical utility and safety in Japan remain unclear.</p><p><strong>Materials and methods: </strong>This multicenter prospective observational study included patients aged ≥45 years who underwent intramedullary nailing for trochanteric or basicervical femoral fractures between May 1, 2021, and July 31, 2023. Cement augmentation was applied exclusively to patients aged ≥60 years. Femoral neck fractures were excluded. Patients were treated with cement augmentation (CA group) or without augmentation (N group). The primary outcome was screw cut-out within 6 months postoperatively. Secondary outcomes included sliding distance (>5 mm), reoperation, nonunion, postoperative infection, and other complications. Group comparisons were performed using two-sided statistical tests with p < 0.05 considered significant.</p><p><strong>Results: </strong>A total of 300 patients were analyzed (CA, n=97; N, n=203; mean age 86.8 years). No cut-out occurred in the CA group, whereas four cases (1.9%) occurred in the N group (p = 0.12). Sliding distance >5 mm was observed in 2 patients (2.0%) in the CA group and 12 patients (5.9%) in the N group (p = 0.108). Postoperative complications occurred in 2 patients (2.1%) in the CA group and 12 patients (5.9%) in the N group (p = 0.12). No cement-related adverse events were observed.</p><p><strong>Conclusions: </strong>Cement augmentation during intramedullary nailing was safe and showed numerically lower rates of cut-out and excessive sliding compared with non-augmented fixation. Although statistical significance was not reached, these findings suggest a potential clinical role in elderly patients at high risk of fixation failure. Randomized controlled trials are warranted.</p>","PeriodicalId":48568,"journal":{"name":"Geriatric Orthopaedic Surgery & Rehabilitation","volume":"17 ","pages":"21514593261441131"},"PeriodicalIF":1.8,"publicationDate":"2026-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13250425/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148228677","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":"Predicting 90-Day Mortality After Geriatric Hip Fracture Using Combined Preoperative and Perioperative Risk Factors.","authors":"Murat Erem, Cihan Unyilmaz, Sinem Erem, Savas Yildirim, Esref Selcuk, Mert Ozcan, Cem Copuroglu","doi":"10.1177/21514593261456505","DOIUrl":"10.1177/21514593261456505","url":null,"abstract":"<p><strong>Background: </strong>Hip fractures in the elderly are associated with high 90-day mortality rates. Most existing predictive models rely solely on preoperative variables. This study aimed to develop two parallel risk score models integrating preoperative and perioperative factors to predict 90-day mortality.</p><p><strong>Methods: </strong>Medical records of patients aged ≥65 years who underwent hip fracture surgery at our institution between January 2018 and December 2024 were retrospectively reviewed. <b>Five preoperative risk factors were evaluated: Prognostic Nutritional Index <40, age ≥85 years, ≥4 comorbidities, surgical delay >5 days, and intracapsular fracture.</b> The >5-day surgical delay threshold was determined empirically through receiver operating characteristic analysis, as the conventional 48-hour cut-off lacked discriminative capacity in this cohort where 86.8% of patients exceeded it. Model performance was assessed using logistic regression and receiver operating characteristic analysis.</p><p><strong>Results: </strong>Of 388 patients enrolled, 387 constituted the analytical sample (60 deaths). The 90-day mortality rate was 15.5%. Individually, each factor showed weak to moderate discrimination. <b>The preoperative five-factor score achieved an AUC of 0.722, and the combined six-factor score - which additionally incorporates ICU stay ≥5 days - achieved an AUC of 0.737.</b> Each unit score increase raised mortality odds approximately 2.68-fold. In patients scoring ≥4, mortality exceeded 50%. The Hosmer-Lemeshow test confirmed adequate calibration for both models.</p><p><strong>Conclusion: </strong>A two-stage scoring approach combining admission-available and postoperative variables demonstrated acceptable discrimination and calibration for 90-day mortality <b>prediction in elderly hip fracture patients, supporting its use as a practical risk stratification tool at both preoperative and postoperative clinical decision points.</b></p>","PeriodicalId":48568,"journal":{"name":"Geriatric Orthopaedic Surgery & Rehabilitation","volume":"17 ","pages":"21514593261456505"},"PeriodicalIF":1.8,"publicationDate":"2026-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13219819/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148139411","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}