Geriatric Orthopaedic Surgery & Rehabilitation最新文献

{"title":"Accuracy of the ACS-NSQIP Risk Calculator, Nottingham Hip Fracture Score and CRP/Albumin Ratio in Predicting Adverse Postoperative Outcomes in the Hip Fracture Surgery: A Lithuanian Single-Centre Prospective Study.","authors":"Povilas Masionis, Rokas Bobina, Simonas Utkus, Raminta Martinaitytė, Valentinas Uvarovas, Igoris Šatkauskas","doi":"10.1177/21514593251352336","DOIUrl":"10.1177/21514593251352336","url":null,"abstract":"<p><p><b>Objective:</b> As the global population ages, hip fracture importance will increase. The high postoperative mortality and morbidity necessitate tools for accurate risk assessment to aid surgical decisions and inform patients and families. This study aimed to compare and validate ACS NSQIP, Nottingham hip fracture risk calculators, and C reactive protein/albumin ratio in predicting complications and 30 day mortality. <b>Methods:</b> 583 patients over the 65 years old who sustained hip fracture from simple fall and underwent surgical treatment for hip fracture were included in prospective study. Each patient was evaluated by ACS NSQIP and Nottingham hip fracture risk calculators and C reactive protein/albumin ratio was calculated from preoperative values. Patients were followed up for 30 days and all the complications were recorded. <b>Results:</b> ACS NSQIP and Nottingham hip fracture score showed AUC of .724 and .731 respectively. C reactive protein/albumin ratio performed less and showed AUC of .623 that is defined as poor predictor for 30 day mortality. Furthermore, in terms of predicting any complication, ACS NSQIP showed AUC of .645, Nottingham hip fracture score of .611 and C reactive protein/albumin ratio of .594. Nottingham hip fracture score than compared to ACS NSQIP yielded lower average of mortality rates (5.4% compared to 7.9%) in contrast of study findings of 8.1%. None of the ACS NSQIP scale predictive complication showed acceptable performance. When adjusted for fracture type, Nottingham hip fracture score showed .858 AUC in predicting 30 day mortality in femoral neck fractures. <b>Conclusions:</b> We recommend Nottingham fracture risk calculator use for 30 day mortality risk assessment in femoral neck fractures. In hip fractures combined-none of models showed strong discrimination. In our cohort C reactive protein/albumin ratio showed poor prognostic values in terms of mortality and complications.</p>","PeriodicalId":48568,"journal":{"name":"Geriatric Orthopaedic Surgery & Rehabilitation","volume":"16 ","pages":"21514593251352336"},"PeriodicalIF":1.6,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12198540/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144508928","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 Indicators for 1-year Mortality in Elderly Individuals Following Hip Fracture Surgery Under A Multidisciplinary Team Co-Management Model: A Single-Centre Retrospective Observational Study.","authors":"Yucheng Gao, Shaoyang Zhou, Wang Gao, Yuanwei Zhang, Liu Shi, Tian Xie, Chuwei Tian, Hui Chen, Yunfeng Rui","doi":"10.1177/21514593251356135","DOIUrl":"10.1177/21514593251356135","url":null,"abstract":"<p><strong>Background: </strong>Elderly patients have an impaired functional state and multiple comorbidities, resulting in poor postoperative rehabilitation ability and high rates of disability and mortality. However, little evidence exists on mortality predictors for geriatric hip fractures within the context of the multidisciplinary team co-management model. This study aimed to investigate the incidence and explore preoperative indicators of 1-year mortality following hip fractures in the elderly under this model.</p><p><strong>Methods: </strong>A total of 439 elderly patients (130 men and 309 women) surgically treated for hip fractures under the multidisciplinary team co-management model between January 2018 and June 2021were included. Data regarding demographics, health state-related variables, injury- and admission-related variables, and preoperative laboratory test results were collected from medical records. Univariate and multivariate logistic regression analyses were used to identify preoperative indicators for 1-year mortality.</p><p><strong>Results: </strong>A total of 49 patients died within 1 year of hip fracture surgery between January 2018 and June 2021, with an accumulated mortality rate of 11.16%. In univariate analysis, 14 items were found to be significant. In the multivariable logistic regression model, age >85 years, body mass index <21.0 kg/m², time from injury to admission >9.5 h, preoperative haemoglobin <117 g/L, serum albumin <33.9 g/L, lactate dehydrogenase >292 U/L, and blood urea nitrogen >8.5 mmol/L were the independent preoperative indicators for 1-year mortality after surgery in elderly patients with hip fracture under the multidisciplinary team co-management model.</p><p><strong>Conclusions: </strong>This study establishes a novel set of preoperative predictors for 1-year mortality in geriatric hip fracture patients managed under an MDT model, distinct from previous investigations focusing on postoperative interventions. The identified indicators enable early risk stratification, facilitating timely preoperative optimization. These findings underscore the prognostic value of integrating clinical and biochemical markers before surgery, warranting validation in multicenter prospective studies. Further prospective studies should be conducted to elucidate these associations and assess the effectiveness of targeted measures.</p>","PeriodicalId":48568,"journal":{"name":"Geriatric Orthopaedic Surgery & Rehabilitation","volume":"16 ","pages":"21514593251356135"},"PeriodicalIF":1.6,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12198578/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144508929","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":"Dual Construct for Very Low Periprosthetic Distal Femur Fracture-Case Series and Extensile Medial Parapatellar Single Incision Approach.","authors":"Wei Cheong Eu, Jade Pei Yuik Ho, Elizabeth Gar Mit Chong, Jeffrey Jaya Raj, Kunalan G","doi":"10.1177/21514593251352332","DOIUrl":"10.1177/21514593251352332","url":null,"abstract":"<p><strong>Background: </strong>Owing to the increasing number of arthroplasty cases performed annually and an aging population with longer life expectancy, periprosthetic fractures have become more common. Very low distal femur periprosthetic fractures (PPDFF) are rare and still underreported. Due to the osteopenia bone quality at metaphysis and complex fracture pattern, fixation stability could decline over time especially with single-plate fixation, even with weight-bearing restriction. Dual construct, a newer fixation strategy, not only ensures the most stable fixation but also allows immediate weight bearing in this frail geriatric group. This study aims to demonstrate any change in fracture alignment 1 year after immediate weight-bearing practice post-surgery and to report the fracture union and functional outcomes with the newer dual construct technique.</p><p><strong>Method: </strong>All Type III Su Classification very low PPDFFs with surgery performed from 2020 to 2023 were reviewed. All surgeries were performed using an extensile medial parapatellar single-incision approach. Either dual plate (DPC) or nail-plate construct (NPC) was performed. Immediate weight bearing was allowed from Day 1 post-surgery. Radiographs were assessed for malunion or non-union. Patients were evaluated for pain, stiffness, functional activity in the WOMAC score, range of knee motion and complications.</p><p><strong>Results: </strong>Six were performed with DPC and another two with NPC. All patients had union at 8.0 weeks and consolidation at 35 weeks. The differences in LDFA and PDFA were only 1.4° and 1.2°. Post-surgery knee flexion was at a mean of 100°, with a mean WOMAC score of 32 points and Parker Mobility Score of 8. There was no change in ambulatory status and no postoperative complication despite the longer operative time, a mean of 172 min.</p><p><strong>Conclusion: </strong>A dual construct by dual-plating or nail-plate combination in very low PPDFF ensures fracture fixation stability with early union and allows safe, immediate postoperative weight-bearing as tolerated in older adults.</p>","PeriodicalId":48568,"journal":{"name":"Geriatric Orthopaedic Surgery & Rehabilitation","volume":"16 ","pages":"21514593251352332"},"PeriodicalIF":1.6,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12179451/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144477409","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":"Risk Factors for Readmission Following Elderly Low Energy Pelvis Fractures.","authors":"Sean Thomas, Avinaash Korrapati, Brendan O'Leary, Cooper Haaland, Alexandra K Schwartz, William T Kent","doi":"10.1177/21514593251350498","DOIUrl":"10.1177/21514593251350498","url":null,"abstract":"<p><strong>Introduction: </strong>Fragility fractures of the pelvis (FFP) are associated with loss of mobility and significant mortality in elderly patients. The purpose of this study was to assess the 60-day readmission rates following FFP and to identify what factors may predict readmission.</p><p><strong>Methods: </strong>Six hundred thirty-one patients over 65 years of age presenting for FFP to a level 1 trauma center between 2010 and 2022 were reviewed. The chi-square test of independence and logistic regression were performed to identify factors associated with readmission.</p><p><strong>Results: </strong>One hundred and thirty-six patients met inclusion criteria. Of these, 31 (23%) returned to the Emergency Department (ED) within 60 days of discharge and 16 (12%) were readmitted. Chronic obstructive pulmonary disease (COPD) (OR = 3.30, <i>P</i> = .01), discharge home instead of to a skilled nursing facility (SNF) (OR = 2.75, <i>P</i> = .01), discharge home from the ED instead of admission to the hospital (OR = 2.95, <i>P</i> = .009), and an American Society of Anesthesiologists (ASA) score ≥4 (OR = 5.14, <i>P</i> = .03) were all associated with return to the ED. Patients who were able to ambulate in the ED were less likely to be admitted to the hospital (OR = 0.05, <i>P</i> < .001) and more likely to return to the ED within 60 days (OR = 4.52, <i>P</i> = .03).</p><p><strong>Conclusion: </strong>Return to the ED and readmission following FFP is common, with an incidence of 23% and 12% in our cohort. Patients who were not admitted as an inpatient after their initial presentation, and patients who were discharged home instead of to a SNF, both had a higher risk of repeat presentation within 60 days of discharge. Additionally, ambulation by patients in the ED may provide false reassurance, as these patients were less likely to be admitted as an inpatient, but more likely to subsequently return within 60 days.</p>","PeriodicalId":48568,"journal":{"name":"Geriatric Orthopaedic Surgery & Rehabilitation","volume":"16 ","pages":"21514593251350498"},"PeriodicalIF":1.6,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12177243/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144334230","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":"Comparing Intramedullary Nails versus Dynamic Hip Screws in the Treatment of Intertrochanteric Hip Fractures on Post-operative Rehabilitation Outcomes - A Systematic Review and Meta-Analysis.","authors":"Chantal Backman, Ashley Lam, Rosie Papp, Aurelie Tonjock Kolle, Franciely Daina Engel, Wenshan Li, Soha Shah, Colleen Webber, Peter Tanuseputro, Marie-Cecile Domecq, Steve Papp","doi":"10.1177/21514593251350490","DOIUrl":"10.1177/21514593251350490","url":null,"abstract":"<p><strong>Objective: </strong>We conducted a systematic review and meta-analysis to compare post-operative rehabilitation outcomes between two common treatments in patients who have suffered an intertrochanteric hip fracture: intramedullary nails vs dynamic hip screws.</p><p><strong>Methods: </strong>We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Web of Science up to August 10, 2022. The inclusion criteria were defined as Population: adults (>18 years old); Interventions/Comparators: intramedullary nails and dynamic hip screws; Outcomes: function, quality of life and survival; and Study type: randomized controlled trials and non-randomized studies. A meta-analysis was performed, and the fixed-effect model was selected to pool the data for homogeneous studies (I² < 50%) and the random effect model was selected for heterogeneity I²>50%. The <i>P</i>-value of less than 0.05 was considered statistically significant. A narrative synthesis was conducted on the remaining outcomes with insufficient data (ie, missing means, or standard deviations).</p><p><strong>Results: </strong>108 studies were included in the review. 42 studies had outcomes that were included in the meta-analysis. There were modest differences after sensitivity analysis for the Parker mobility score mean difference (MD) = 0.70, 95% CI [0.12, 1.28], T = 3.11, df = 5, <i>P</i> = 0.03, and Harris hip score (MD = 0.94, 95% CI [0.34, 1.54], T = 3.54, df = 9, <i>P</i> = 0.006) favoring the nails. There were no statistically significant differences in the Functional Independence Measure (FIM) (MD = -2.50, 95% CI [-6.46, 1.45], Z = 1.24, <i>P</i> = 0.22), the Barthel Index (MD = 2.66, 95% CI [-7.60, 12.92], T = 1,12, df = 2, <i>P</i> = 0.38), the generic quality of life (MD = 0.04, 95% CI [-0.08, 0.17], Z = 0.70, <i>P</i> = 0.49), the health-related quality of life (MD = -0.14, 95% CI [-3.57, 3.28], Z = 0.08, <i>P</i> = 0.93) or mortality (1.00, 95% CI [0.96, 1.03], Z = 0.16, <i>P</i> = 0.87) outcomes.</p><p><strong>Conclusion: </strong>This review showed some differences in functional outcomes in the treatment of intertrochanteric fractures favoring intramedullary nails over dynamic hip screws. There were no differences between the groups for quality of life and mortality outcomes. The narrative synthesis showed additional outcomes that warrant further investigations.</p>","PeriodicalId":48568,"journal":{"name":"Geriatric Orthopaedic Surgery & Rehabilitation","volume":"16 ","pages":"21514593251350490"},"PeriodicalIF":1.6,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12174732/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144327286","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":"Delayed Deep Femoral Artery Injury Secondary to Migrated Lesser Trochanter Fragment After Intertrochanteric Fracture Fixation: A Case Report and Updated Literature Review.","authors":"Slavko Čičak, Josip Kocur, Vedran Farkaš, Petra Čičak, Stjepan Ištvanić, Marko Lovrić, Marko Perić, Nenad Koruga, Tomislav Ištvanić","doi":"10.1177/21514593251351188","DOIUrl":"10.1177/21514593251351188","url":null,"abstract":"<p><strong>Background: </strong>With the increasing elderly population and prevalence of osteoporosis, geriatric intertrochanteric fragility fractures pose a major challenge to orthopedic practice. These fractures have a significant impact on patient outcomes, with a reported mortality rate of 13.3% within 30 days and 24.5% within one year.</p><p><strong>Case presentation: </strong>This report presents a rare case of delayed iatrogenic deep femoral artery (DFA) injury due to progressive displacement of the lesser trochanter following intertrochanteric fracture fixation. An 87-year-old female patient developed significant thigh swelling and pain 33 days postoperatively. Imaging confirmed migration of the lesser trochanter fragment, leading to DFA injury and active bleeding.</p><p><strong>Discussion: </strong>Through a comprehensive literature review, we explore the incidence, diagnostic modalities, and management of vascular injuries associated with pertrochanteric fracture fixation. We emphasize the importance of identifying significantly displaced lesser trochanter fragments (>1 cm) preoperatively, as they markedly increase the risk of DFA injury. While debate continues over routine fragment fixation, our case suggests that surgical fixation may be beneficial in selected patients with large displacements to prevent vascular complications. Early CT angiography is highlighted as a crucial non-invasive diagnostic tool for timely detection and intervention in these high-risk cases.</p><p><strong>Conclusion: </strong>This case underscores the need for careful postoperative monitoring and early intervention to optimize patient outcomes. As PFFs become more prevalent, further research is essential to improve geriatric orthopedic care.</p>","PeriodicalId":48568,"journal":{"name":"Geriatric Orthopaedic Surgery & Rehabilitation","volume":"16 ","pages":"21514593251351188"},"PeriodicalIF":1.6,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12174772/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144327287","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":"Surgical Timing and Postoperative Outcomes in Distal Femur Fractures: Does Early Intervention Matter?","authors":"Naoko Onizuka, Gabriel Alain, Samuel Farmer, Catherine C Quatman-Yates, Carmen E Quatman","doi":"10.1177/21514593251350516","DOIUrl":"10.1177/21514593251350516","url":null,"abstract":"<p><strong>Introduction: </strong>Distal femur fractures are the second most common femoral fragility fractures in older adults, with postoperative mortality rates similar to or exceeding those of hip fractures. While early surgery has been shown to improve outcomes in hip fracture patients, its impact on distal femur fractures remains unclear. This study examines the relationship between surgical timing and postoperative outcomes in distal femur fracture patients.</p><p><strong>Methods: </strong>This retrospective cohort study utilized the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database to identify patients aged 65 and older who underwent surgery for distal femur fractures between 2015 and 2022. Patients were categorized into early (within 1 day), intermediate (between 1-2 days), and delayed (>2 days) surgery groups. The primary outcome was 30-day mortality. Secondary outcomes included postoperative complications, length of hospital stay (LOS), and hospital readmission rates. Multivariate logistic regression was performed to adjust for potential confounders.</p><p><strong>Results: </strong>A total of 4500 cases met the inclusion criteria, with 67% undergoing surgery within one day, 20% within 1-2 days, and 13% after more than two days. After adjustment for baseline characteristics, early surgery was not associated with a significant reduction in 30-day mortality (OR: 1.00, 95% CI: 0.57-1.83, <i>P</i> = 0.99). However, the risk of urinary tract infections (UTIs) was significantly lower in the early surgery group (adjusted OR: 0.61, 95% CI: 0.43-0.88, <i>P</i> = 0.01). No significant differences were observed for other major complications.</p><p><strong>Conclusions: </strong>Unlike in hip fractures, early surgery did not significantly impact mortality or most postoperative complications in distal femur fracture patients. However, it was associated with a reduced risk of UTIs. These findings suggest that surgical timing may be less critical than preoperative optimization and comprehensive perioperative care in improving outcomes for this population.</p>","PeriodicalId":48568,"journal":{"name":"Geriatric Orthopaedic Surgery & Rehabilitation","volume":"16 ","pages":"21514593251350516"},"PeriodicalIF":1.6,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12174680/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144327288","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":"Transfusion Risk Factors in Low-Energy Pelvic Fractures: A Retrospective Cohort Study.","authors":"Hieronim Kołodziejczyk, Filip Brzeszczyński, Oktawiusz Bończak","doi":"10.1177/21514593251351557","DOIUrl":"10.1177/21514593251351557","url":null,"abstract":"<p><strong>Introduction: </strong>The management of low-energy pelvic fractures poses a multifaceted challenge in orthopedic and geriatric care. With an increasing prevalence of patients taking new oral anticoagulant medications, it is unclear, which patients with pelvis fractures will have a significant life threatening bleed. The aim of this study was to assess the main risk factors leading to blood transfusion and longer hospital stay in patients with low-energy pelvic fractures.</p><p><strong>Materials and methods: </strong>This single center retrospective observational study was performed with reference to STROBE guidelines. Demographic data, bleeding risk factors as well as blood transfusion rates were recorded. Initially, a univariate regression analysis was performed to analyze factors associated with blood transfusion. Significant variables were selected and a multidimensional predictive model was built based on variables that showed a significant relationship with the transfusion occurrence.</p><p><strong>Results: </strong>In total 167 patients were included in the study, there were 24 male and 143 female patients. The number of patients requiring blood transfusion was 20 (12%). Following univariate analysis, in final multivariate regression model, the only variable factors predicting the need for blood transfusion were low hemoglobin level on first hospital assessment (9.85 g/dl in transfused group vs 12 g/dl in non-transfused group, OR: 0.364, <i>P</i> < 0.005). First control hemoglobin check after 24 hours was also a significant predictor of transfusion (8.45 g/dl in transfused group vs 11.20 in non-transfused group, OR: 0.347, <i>P</i> < 0.005). The area under curve analysis for ROC showed good predictive accuracy for blood transfusion in patients with low haemoglobin level on first assessment (AUC = 0.9) and for first control haemoglobin (AUC = 0.88).</p><p><strong>Conclusions: </strong>We suggest that all patients following low energy pelvic fractures have a haemoglobin level assessment in the emergency department. Patients with initial haemoglobin <10 g/dl should be considered for hospital admission and repeat blood tests within the first 24 hours.</p>","PeriodicalId":48568,"journal":{"name":"Geriatric Orthopaedic Surgery & Rehabilitation","volume":"16 ","pages":"21514593251351557"},"PeriodicalIF":1.6,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12166246/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144303359","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":"Perioperative Hyperglycemia is an Independent Risk Factor for Venous Thromboembolism Events After Operative Treatment of Geriatric Femur Fractures.","authors":"Zachary J Herman, Christopher J Como, Romano Sebastiani, Ryan Gilbert, Audrey Chang, Gele B Moloney","doi":"10.1177/21514593251342423","DOIUrl":"10.1177/21514593251342423","url":null,"abstract":"<p><strong>Introduction: </strong>Geriatric femur fractures occur in complex hosts that pose significant challenges in perioperative management, with venous thromboembolism (VTE) as a well described complication. Hyperglycemia, prevalent in the perioperative period, has been implicated in increasing thrombotic risk. However, data on its impact on outcomes following femur fracture fixation in the elderly population remains limited.</p><p><strong>Methods: </strong>A retrospective cohort analysis was conducted on adults >60 years old undergoing operative fixation for femur fractures between January 2017 and December 2019. Demographic information, comorbidities, and outcomes were collected from electronic medical records.</p><p><strong>Results: </strong>Six hundred and fourteen patients met inclusion criteria. The average age was 78.7 years (30.3% male; 25.0% with diabetes mellitus (DM) diagnosis). Patients with postoperative glucose ≥180 mg/dL had significantly higher rates of pulmonary embolism (PE) and VTE within 90 days, and glucose ≥180 mg/dL was an independent predictor for these events. Those with a DM diagnosis had higher rates of sepsis but not PE, VTE, or other complications compared to those without DM.</p><p><strong>Conclusion: </strong>Acute perioperative hyperglycemia, regardless of DM diagnosis, is an independent risk factor for VTE and PE following geriatric femur fracture fixation. Strict glucose control in the postoperative period may improve outcomes in this patient population.</p>","PeriodicalId":48568,"journal":{"name":"Geriatric Orthopaedic Surgery & Rehabilitation","volume":"16 ","pages":"21514593251342423"},"PeriodicalIF":1.6,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12163271/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144303358","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 Reality of Physical Restraint Implementation During Hospitalization in Older Patients With Hip Fractures.","authors":"Sho Fujita, Takehiro Michikawa, Takumi Taniguchi, Takayuki Hirono, Keigo Sato, Soya Kawabata, Takao Tobe, Risa Tobe, Mitsuhiro Morita, Shigeki Yamada, Nobuyuki Fujita","doi":"10.1177/21514593251343499","DOIUrl":"10.1177/21514593251343499","url":null,"abstract":"<p><strong>Introduction: </strong>Hip fractures, which result in a high rate of complications and mortality, are a major public health concern in aging societies. Physical restraint for older patients with hip fractures may be employed to ensure safety, continue medical treatment, and minimize the risk of harm to oneself or others. This study aimed to investigate the current practices of physical restraint use among hip fracture patients across 2 acute-care hospitals, as well as uncover factors associated with physical restraint in patients with hip fracture.</p><p><strong>Methods: </strong>We retrospectively reviewed all patients aged ≥65 years who underwent surgery for hip fractures at two institutions. Physical restraint was applied in accordance with institutional guidelines, following thorough assessments by physicians and nurses and obtaining informed consent from the patient or their family. When we examined the independent associations of physical restraint during hospitalization, the Poisson regression models were used to estimate the relative risks (RRs) and 95% confidence intervals (CIs).</p><p><strong>Results: </strong>In total, 463 older patients with hip fractures were assessed. Among the included patients, 118 (25.5%) were subjected to physical restraint. Multivariable analysis revealed that 85 years or older (RR, 1.8; CI: 1.1-3.0), a BMI below 18.5 (RR, 1.8; CI: 1.4-2.5), dementia (RR, 2.3; CI: 1.7-3.1), stroke (RR, 1.5; CI: 1.1-2.0), impairment in physical function (RR, 3.1; CI: 1.2-8.3), and administration of antipsychotics (RR, 1.6; CI: 1.0-2.4) were significantly associated with the implementation of physical restraint.</p><p><strong>Conclusions: </strong>This retrospective study provided real-world data regarding the use of physical restraint in older patients with hip fractures. Patients with older age, low BMI, dementia, stroke, impaired physical function, and administration of antipsychotics may be at high risk for the use of physical restraints. To minimize the use of physical restraints, future research for further data collection will be essential.</p>","PeriodicalId":48568,"journal":{"name":"Geriatric Orthopaedic Surgery & Rehabilitation","volume":"16 ","pages":"21514593251343499"},"PeriodicalIF":1.6,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12123103/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144200569","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}