Geriatric Orthopaedic Surgery & Rehabilitation最新文献

{"title":"Which Factors Influence the Need for Inpatient Aftercare of Elderly Patients After Hospital Treatment for Proximal Humerus Fractures?","authors":"Bastian Mester, Raed Maali, Heinz-Lothar Meyer, Christina Polan, Stephanie Herbstreit, Monika Herten, Lars Becker, Marcel Dudda, Manuel Burggraf","doi":"10.1177/21514593251325365","DOIUrl":"10.1177/21514593251325365","url":null,"abstract":"<p><strong>Introduction: </strong>While epidemiology and treatment strategies of proximal humerus fractures have been well studied, post-hospital care is poorly analysed. Corresponding data is available in the context of hip fractures, but the evidence regarding proximal humerus fractures is weak. Aim of this study is to identify risk factors for institutionalisation required after discharge into inpatient aftercare for elderly patients treated for proximal humerus fractures.</p><p><strong>Materials and methods: </strong>For this retrospective single-centre investigation, n = 295 patients (age 70 (58,79) years, 63.7% female) admitted to hospital from home due to proximal humerus fractures were included and divided into two study groups: Patients being discharged home (<i>'Home'</i>) vs being discharged into aftercare (<i>'Aftercare'</i>). Differences regarding demographic and clinical data were analysed. Odds ratios (OR) of influencing factors (adjusted for age) were calculated by logistic regression analysis.</p><p><strong>Results: </strong>Increased age notably increased the likelihood for discharge of patients into 'Aftercare' (OR 1.09 [1.06;1.12] per year of life). Age-independent indicators for 'Aftercare' were higher ASA score (OR 2.16 per ASA point [1.37;3.49]; <i>P</i> < .001), anterior surgical approach (OR 6.05 [1.93,27.1]; <i>P</i> < .006), duration of surgery (OR 1.01 per min [1.00,1.02]; <i>P</i> < .012), non-surgical complications (OR 3.82 [1.60,9.49]; <i>P</i> < .003), length of stay (OR 1.12 per day [1.04,1.22]; <i>P</i> < .005), ICU stay (OR 3.15 [1.71,6.00]; <i>P</i> < .001) and reversely surgery (OR 0.39 [0.19,0.80]; <i>P</i> < .010).</p><p><strong>Conclusion: </strong>Increased Age and higher ASA score notably increase the likelihood for post-hospital discharge to an inpatient aftercare facility. Available literature in the context of hip fractures is confirmed. The results of this study may assist in identifying patients at risk and may serve as a stepstone in establishing a scoring system for elderly patients with proximal humerus fractures.</p>","PeriodicalId":48568,"journal":{"name":"Geriatric Orthopaedic Surgery & Rehabilitation","volume":"16 ","pages":"21514593251325365"},"PeriodicalIF":1.6,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11915286/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143659210","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":"Trends and Complications of Hip Fracture Fixation Among Early Career Orthopaedic Surgeons: An Analysis of the American Board of Orthopaedic Surgery Part II Oral Examination Database.","authors":"Teja Yeramosu, Lisa A Taitsman, Stephen L Kates","doi":"10.1177/21514593241291792","DOIUrl":"10.1177/21514593241291792","url":null,"abstract":"<p><strong>Background: </strong>Hip fractures are a major public health concern with a high mortality rate. Numerous risk factors for hip fracture have been identified, and efforts made to reduce complications and improve outcomes. This study aimed to assess recent trends in postoperative complications amongst early-career orthopaedic surgeons.</p><p><strong>Methods: </strong>This retrospective study analyzed surgical cases submitted to the American Board of Orthopaedic Surgery (ABOS) for the Part II Oral Examination from 2013 to 2022. The database includes patient demographics and medical and surgical complications. Current Procedural Terminology codes reflecting operative fixation for hip fracture were selected. Data was split into two cohorts: 2013-2016 and 2017-2020. Univariate and multivariable logistic regression analyses were used to identify significant differences between cohorts.</p><p><strong>Results: </strong>49,418 cases were analyzed. Compared to 2013-2016, 2017-2020 had a reduction in the overall medical complication rate (-1.49%, <i>P</i> = 0.0005), saw slight increases in congestive heart failure (+0.18%, <i>P</i> = 0.049), renal failure (+0.37%, <i>P</i> = 0.004), hypotension (+0.41%, <i>P</i> = 0.0007), and hypoxia (+0.41%, <i>P</i> = 0.0016). Minor decreases in myocardial infarction (-0.18%, <i>P</i> = 0.047) and pneumonia (-0.34%, <i>P</i> = 0.021) were noted. No differences occurred in confusion/delirium, deep vein thrombosis/pulmonary embolism, and mortality. There were no significant differences in overall surgical complications. The 90-day readmission rate increased with time (+1.17%, <i>P</i> < 0.0001). Multivariable logistic regression identified a decrease in the likelihood of overall medical complications (Odds Ratio (OR): 0.92 [0.89, 0.96]; <i>P</i> < 0.0001). Decreases were noted for the likelihood of myocardial infarction (OR: 0.81 [0.68, 0.98]; <i>P</i> = 0.031), pneumonia (OR: 0.87 [0.78, 0.97]; <i>P</i> = 0.013), fracture (OR: 0.80 [0.69, 0.92]; <i>P</i> = 0.002), and recurrent/persistent/uncontrolled pain (OR: 0.72 [0.56, 0.92]; <i>P</i> = 0.008). The likelihood of renal failure (OR: 1.18 [1.04, 1.34]; <i>P</i> = 0.009) and readmission increased (OR: 1.14 [1.07, 1.20]; <i>P</i> < 0.0001).</p><p><strong>Conclusion: </strong>This study found little change in postoperative complication patterns over the past decade. These findings suggest that more efforts are needed to improve hip fracture care and outcomes.</p>","PeriodicalId":48568,"journal":{"name":"Geriatric Orthopaedic Surgery & Rehabilitation","volume":"16 ","pages":"21514593241291792"},"PeriodicalIF":1.6,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11915309/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143659208","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":"Outcome of Conservative Treatment of Odontoid Fractures in Elderly Patients Over 80 Years Old.","authors":"Andrea Speldova, Josef Vcelak, Lukas F Mirchi, Lucie Sedova, Ondrej Seda","doi":"10.1177/21514593251315589","DOIUrl":"10.1177/21514593251315589","url":null,"abstract":"<p><strong>Introduction: </strong>The retrospective study evaluated the clinical and radiological outcomes of conservative treatment for type II odontoid C2 fractures in octogenerians. The study aimed to assess the clinical outcomes and quality of survival of patients treated using conservative methods. Additionally, the study sought to define radiological outcomes, fracture healing success and the development of complications in correlation with clinical outcomes.</p><p><strong>Materials and methods: </strong>Patients aged ≥80 with dens C2 fracture were fixed with a hard cervical collar for 6 weeks, followed by early mobilization. Patients showing delayed fracture healing on computed tomography (CT) scan were subsequently immobilized in a soft neck collar for additional 6 weeks. The follow-up CT scan was then performed with consequential rehabilitation. Patients with nonunion of the C2 on the follow-up CT scan and clinical symptoms were contraindicated for physical rehabilitation for cervical spine till next CT scan after another 12 weeks. Clinical and radiographic evaluations were performed during follow-up visits, with a median follow-up was 109 days, with the range extending from 1 day to 1 year.</p><p><strong>Results: </strong>In total, 33 patients were included in the study and were followed for 1 year. The 30-day mortality rate was 21.2%, and between 30 days and one year post-treatment, it was 18.2%. Mortality was higher during the study period in displaced fractures (>2 mm; 9 out of 16 patients died) compared to non-displaced fractures (≤2 mm; 4 out of 17 patients died). The Japanese Orthopaedic Association (JOA) score remained unchanged between admission (mean 16.9; SD ± 0.5) and the end of follow-up (mean 16.9; SD ± 0.5; <i>P</i> > 0.05), the Visual Analogue Scale (VAS) score showed improvement from values measured upon admission to the hospital (mean 7.97; SD ± 1.33) to values measured at the end of follow-up (mean 1.58; SD ± 1.62; <i>P</i> < 0.001) and the Neck Disability Index (NDI) showed a statistically significant difference between admission (mean 41.3; SD ± 14.92) and the end of follow-up (mean 14.29; SD ± 4.65; <i>P</i> < 0.001). The standard measurement of Posterior Atlantodental Interval (PADI) had an average value of 18.6 (range 16-22 mm) and primary bony union of odontoid fractures occurred in eleven cases (33.3%), while six patients (18.2%) had fibrous union with minimal clinical difficulties.</p><p><strong>Conclusion: </strong>This study demonstrates the safety and efficacy of conservative treatment for odontoid fractures in octogenerians and underscores the critical role of conservative management in a polymorbid elderly population.</p>","PeriodicalId":48568,"journal":{"name":"Geriatric Orthopaedic Surgery & Rehabilitation","volume":"16 ","pages":"21514593251315589"},"PeriodicalIF":1.6,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11898091/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143617662","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 Postoperative Ambulation Results in a Significant Increase in 90-Day Mortality in Surgically Treated Hip Fractures.","authors":"Robert S Wood, Maddie Vergun, Elizabeth Herrera, Jacqueline Krumrey","doi":"10.1177/21514593241308546","DOIUrl":"10.1177/21514593241308546","url":null,"abstract":"<p><strong>Introduction: </strong>Hip fractures in individuals aged 65 and older present a significant burden to patients, families, and health care systems. These fractures lead to increased morbidity, loss of autonomy in Activities of Daily Living (ADLs), prolonged hospitalization, and heightened mortality rates. Despite existing knowledge, there is a need for high-quality studies to understand mid- to long-term outcomes and the impact of postoperative variables on mortality.</p><p><strong>Methods: </strong>This retrospective matched case-control study analyzed patients who underwent operative management for hip fractures between August 1, 2021, and August 1, 2023, at a single Level II trauma center. Cases were defined as patients who expired between postoperative day 1 and ninety, while controls were patients alive at postoperative day 90. Cases and controls were matched by sex and age at the time of surgery. Patients over age 60, who underwent surgical treatment of a femoral neck or intertrochanteric fracture after receiving a preoperative block and were able to ambulate prior to their injury included. Cases and controls were matched based upon patient demographics including comorbidities. Major matched comorbidities were diabetes mellitus, hypertension, Chronic Obstructive Pulmonary Disease, and Coronary Artery Disease. A logistic regression was used to measure the association between in-hospital mobility and 90-day mortality.</p><p><strong>Results: </strong>The 90-day mortality rate was 9.5% (16/169). The mean age of participants was 85.7 years, with 62.5% female. No significant differences were found in hospital length of stay or operative time. However, 37.5% of cases were discharged on hospice compared to 3.1% of controls. Only 6.3% of cases ambulated in the hospital compared to 53.1% of controls (<i>P</i>-value <.001). Logistic regression indicated that the odds of death were 17 times higher in patients who did not walk during their hospital stay (OR: 17.0, 95% CI: 2.91-326.0, <i>P</i>-value: 0.01).</p><p><strong>Conclusions: </strong>This study highlights the critical importance of early postoperative mobilization in reducing 90-day mortality in hip fracture patients. The findings reveal that patients who ambulated during hospital admission had significantly lower mortality rates. These results suggest that early mobilization could serve as a strong protective factor against early postoperative mortality.</p>","PeriodicalId":48568,"journal":{"name":"Geriatric Orthopaedic Surgery & Rehabilitation","volume":"16 ","pages":"21514593241308546"},"PeriodicalIF":1.6,"publicationDate":"2025-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11808765/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143400378","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":"Trunk Muscle Cross-Sectional Areas at Hip Fractures and Their Association With Recovery of Postoperative Gait Ability: A Multicenter, Retrospective Cohort Study.","authors":"Kengo Kawanishi, Daisuke Fukuda, Masahiro Tsutsumi, Toshinori Miyashita, Naoya Katayama, Masaki Yokomori, Shinsuke Matsuzaki, Shintarou Kudo","doi":"10.1177/21514593241308536","DOIUrl":"10.1177/21514593241308536","url":null,"abstract":"<p><strong>Purpose: </strong>To determine the relationship between trunk muscle cross-sectional area (CSA) measured using trunk computed tomography at the time of injury and gait ability at discharge.</p><p><strong>Methods: </strong>This multicenter retrospective cohort study was performed in comprehensive rehabilitation units of four hospitals in Japan. The study included 442 patients with hip fractures who underwent surgery (bipolar hip arthroplasty or open reduction and internal fixation) and were hospitalized for treatment between January 2020 and January 2023. The main outcome measure was bilateral trunk muscle CSA (multifidus, erector spinae, psoas major, lateral abdominal muscles, and rectus abdominis). Participants who met the eligibility criteria were classified into two groups based on gait ability at the time of hospital discharge: those who maintained their gait ability (the maintenance group) and those who declined (the decline group).</p><p><strong>Results: </strong>The CSA of the multifidus muscle was 0.015 ± 0.005 (CSA/Weight/fourth lumbar vertebrae) and 0.013 ± 0.004 (CSA/Weight/fourth lumbar vertebrae) in the maintenance and decline groups, respectively, being significantly lower in the decline group (<i>P</i> = 0.028, effect size = 0.457). The CSA of the psoas major was 15.3 [13.1⁠-⁠18.0] (CSA/Weight/fourth lumbar vertebrae) and 13.4 [11.9⁠-⁠16.0] (CSA/Weight/fourth lumbar vertebrae) in the maintenance and decline groups, respectively, being significantly lower in the decline group (<i>P</i> = 0.020, effect size = 0.335).</p><p><strong>Conclusion: </strong>Smaller CSAs of the multifidus and psoas major muscles before injury were associated with decreased gait ability after hip fractures.</p>","PeriodicalId":48568,"journal":{"name":"Geriatric Orthopaedic Surgery & Rehabilitation","volume":"15 ","pages":"21514593241308536"},"PeriodicalIF":1.6,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11635865/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142819654","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":"Pre-Operative Direct Oral Anticoagulant Level Measurement Reduces Time to Surgery in Hip Fracture Patients.","authors":"Stephanie Su-Yin P'ng, Yue Wern Teh, Sophie Reynolds, Glenn Boardman, Christopher W Jones, Hannah Seymour","doi":"10.1177/21514593221142187","DOIUrl":"10.1177/21514593221142187","url":null,"abstract":"<p><strong>Introduction: </strong>The optimal management of patients taking DOAC medications in the perioperative trauma setting is based on limited evidence. Current guidelines recommend withholding DOAC medications 48-72 hours pre-operatively. The objective of this trial was to determine the utility of measuring DOAC levels prior to surgery, evaluate the safety of a cut-off level of <50 ng/mL and to compare the outcomes with time parameters.</p><p><strong>Materials and methods: </strong>We performed a cohort study of patients aged 50 years and older admitted with a hip fracture who underwent surgery between January 12 017 and December 31 2019. Primary outcome was time to surgery (TTS) in hours. Secondary outcomes include inpatient transfusion and thromboembolism rates and 30-day mortality.</p><p><strong>Results: </strong>1579 patients underwent operative management of their hip fracture. The mean TTS in the DOAC group was 33.0 hours. This was significantly longer when compared to patients not on anticoagulation whose mean TTS was 24.4hours (95% CI -13.78: -8.71, <i>P</i> value <.05). It was also significantly higher than patients on warfarin whose mean TTS was 26.4hours (95% CI -12.41: -4.18, <i>P</i> value <.05). There was no significant difference in the transfusion rate and 30-day mortality between the groups (X² = 2.086, df = 2, <i>P</i> value = .352)]. There was no significant difference in transfusion rates and 30-day mortality between the patients with a DOAC level <50 ng/mL compared with the patients not on any anticoagulation. There was no significant difference in 30-day mortality or transfusion rates between those patients on a DOAC operated within 48 hours compared with those operated after 48 hours (<i>P</i> value = .67).</p><p><strong>Discussion and conclusion: </strong>DOAC therapy delays surgery for patients with a hip fracture. Using a DOAC level <50 ng/mL is a safe level to proceed with surgery and reduces the TTS compared to following current guidelines. If DOAC levels are not available the data still supports operation at 48 hours.</p>","PeriodicalId":48568,"journal":{"name":"Geriatric Orthopaedic Surgery & Rehabilitation","volume":"15 ","pages":"21514593221142187"},"PeriodicalIF":1.6,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11629414/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142808314","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":"Functional Outcomes After Nonoperative Management in Older Adult Low-Energy Stable and Unstable Ankle Fractures: A Retrospective Review of 158 Patients.","authors":"Rebekah M Kleinsmith, Fernando A Huyke-Hernandez, Bailey R Abernathy, Andrew Sibley, Jordan Ammons, Lily Qian, Julie A Switzer, Naoko Onizuka","doi":"10.1177/21514593241307157","DOIUrl":"10.1177/21514593241307157","url":null,"abstract":"<p><strong>Background: </strong>There is ongoing debate regarding the optimal management of older adult ankle fractures. The purpose of this study was to describe baseline characteristics and functional outcomes including complications in older adult patients receiving nonoperative treatment for low-energy ankle fracture and compare the outcomes of those with unstable vs stable fracture patterns.</p><p><strong>Methods: </strong>Patients aged ≥65 from January 2012 to March 2019 that sustained an ankle fracture were identified. Those who had surgical treatment, age <65, high-energy trauma, bilateral ankle fractures, and patients without adequate follow-up (minimum 12 weeks) were excluded. Baseline demographics, injury characteristics, Charlson Comorbidity Index (CCI) score, and functioning regarding ambulatory status, living environment, and assistance personnel in the household were collected for all patients. The primary outcome of interest was retention of baseline ambulation, living environment, and assistance requirements at follow-up (>12 weeks). Pain improvement, radiographic changes, and adverse clinical events were also assessed.</p><p><strong>Results: </strong>A total of 158 patients were included with an average follow-up timeframe of 41.6 weeks. Eighty-six percent of patients (n = 136) retained their ambulatory status at long-term follow up. Most patients retained the same living environment (n = 145, 91.8%). Thirty-five patients (22.2%) required additional assistance long-term. Approximately 67.1% of the entire cohort retained all three functional metrics. Patients who experienced functional decline were older (77.8 vs 71.6, <i>P</i> < 0.001), had higher CCI (3.2 vs 1.6, <i>P</i> < 0.001), had a diagnosis of dementia or cognitive impairment (36.5% vs 3.8%, <i>P</i> < 0.001), had lower baseline functional status (ambulation, living environment, and assistance required; all <i>P</i> < 0.001), and had an unstable fracture pattern (<i>P</i> = 0.003).</p><p><strong>Conclusions: </strong>Understanding the functional outcomes of non-operative treatment in geriatric ankle fracture cases can contribute to a shared decision-making among healthcare providers, patients, and families.</p>","PeriodicalId":48568,"journal":{"name":"Geriatric Orthopaedic Surgery & Rehabilitation","volume":"15 ","pages":"21514593241307157"},"PeriodicalIF":1.6,"publicationDate":"2024-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11626655/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142802698","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":"Early Full Weight-Bearing Exercises to Improve Gait Function in Older Adult Patients Following Surgery for Distal Femoral Fractures.","authors":"Shin Watanabe, Kei Watanabe, Yasuharu Kinjo, Koushiro Imai, Mikio Muraoka","doi":"10.1177/21514593241304682","DOIUrl":"https://doi.org/10.1177/21514593241304682","url":null,"abstract":"<p><strong>Introduction: </strong>Postoperative rehabilitation for distal femur fracture generally requires gait exercises with weight-bearing restrictions. We aimed to determine whether full weight-bearing gait exercises immediately postoperatively effectively maintain walking ability in older adult patients with distal femur fractures.</p><p><strong>Methods: </strong>Patients diagnosed with distal femur fractures between April 2017 and March 2024 were retrospectively evaluated. Patients aged ≥75 years who had undergone surgical treatment were classified into full weight-bearing (FWB) and non-weight-bearing (NWB) groups, with FWB and NWB gait exercises starting immediately postoperatively. Patient background was evaluated in terms of age at time of surgery, sex, weight, cognitive function, and fracture type (AO classification). Postoperative outcomes were operative time, intraoperative blood loss, gait function, and postoperative complications. Two osteosynthesis conditions that allowed postoperative FWB were achievement of bony support through anatomical reduction of the medial femur and the use of adequate supplemental fixation to maintain reduction.</p><p><strong>Results: </strong>The study comprised 21 patients (1 man, 20 women; mean age, 87.2 [79-99] years). Extra- and intra-articular fractures were identified in 16 and 5 patients, respectively. The surgical procedures were lateral plating, double plating, and one-stage total knee arthroplasty in 16, 3, and 2 patients, respectively. There were 9 and 12 patients in the FWB and NWB groups, respectively, with no significant differences in patient background. The mean decrease in the Parker mobility score was 0.11 points (range, -3-2 points) in the FWB group vs 1.92 points (range, 0-3 points) in the NWB group, indicating that gait function was maintained in the FWB group (<i>P</i> = 0.0063). Two and 9 patients in the FWB and NWB groups, respectively, experienced complications (<i>P</i> = 0.017).</p><p><strong>Conclusion: </strong>Consideration should be given to treatment involving orthogeriatric care for older adults with distal femur fractures. Rehabilitation with FWB can preserve gait function and reduce postoperative complications.</p>","PeriodicalId":48568,"journal":{"name":"Geriatric Orthopaedic Surgery & Rehabilitation","volume":"15 ","pages":"21514593241304682"},"PeriodicalIF":1.6,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11605739/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142773869","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":"Low Rate of Teriparatide Supplementation for the Treatment of Osteoporotic Pelvic Fractures in Elderly Females.","authors":"David Novikov, Mary Grace Kelley, Michael S Kain, Paul Tornetta","doi":"10.1177/21514593241296396","DOIUrl":"10.1177/21514593241296396","url":null,"abstract":"<p><strong>Background: </strong>Osteoporotic pelvic fractures in the elderly lead to pain and immobility resulting in decreased quality of life and worsening frailty. Teriparatide has been shown to shorten time to fracture union, diminish pain, and improve mobilization. At our hospital, this medication is prescribed by an outpatient endocrinologist or geriatrician. We hypothesize that elderly female patients sustaining low energy lateral compression (LC) pelvic fractures are not given Teriparatide. This study reports rates of successful Teriparatide initiation and looks for areas of improvement.</p><p><strong>Materials and methods: </strong>A retrospective chart review of stable LC pelvic fractures admitted to a single urban academic level 1 trauma center from January 2012 to February 2021 was conducted. Females over 60 years old with stable LC pelvic fractures were included. Males and those aged less than 60 were excluded.</p><p><strong>Results: </strong>118 females with mean age of 79.1 ± 10.5 were included. Fourteen patients were not eligible for Teriparatide due to medical history, leaving 104 eligible patients. Twenty-eight patients (23.7%) had previous dual energy X-ray absorptiometry (DEXA) scans with mean T-scores of -3.14 ± 1.1 and 61% had Medicare insurance. Orthopaedic services recommended Teriparatide in 100% of cases. Geriatricians or endocrinologists documented evaluations for Teriparatide in 18 (17%), prescribed in 10 (9.6%), and initiated in 7 (6.7%) patients. Insurance type did not significantly differ among those that initiated Teriparatide and those that did not (<i>p-</i>0.10). Insurance did not approve the medication in 2 instances and in 1 instance it was discontinued at follow-up.</p><p><strong>Conclusion: </strong>Despite level 1 evidence of Teriparatide's benefit for elderly osteoporotic women with low energy LC pelvic fractures, we failed to initiate treatment in 93% of eligible patients. Barriers to initiation included low rates of medical evaluation for its use and failure of insurance coverage. There are opportunities for multidisciplinary collaboration to increase evaluation for and initiation of Teriparatide.</p><p><strong>Level of evidence: </strong>Cohort Retrospective (level III evidence).</p>","PeriodicalId":48568,"journal":{"name":"Geriatric Orthopaedic Surgery & Rehabilitation","volume":"15 ","pages":"21514593241296396"},"PeriodicalIF":1.6,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11585054/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142711366","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 1 mm Cerclage Cables in Surgical Treatment of Periprosthetic Femur Fractures.","authors":"Harrison S Brown, Bryce Wall, Simon C Mears, Benjamin M Stronach, Eric R Siegel, Jeffrey B Stambough","doi":"10.1177/21514593241302655","DOIUrl":"10.1177/21514593241302655","url":null,"abstract":"<p><strong>Introduction: </strong>1 mm cerclage cables have been introduced that can be placed under plates and hold reduction of periprosthetic femur fractures (PPFFx) around total hip arthroplasty (THA). Their utilization remains controversial due to the risk of nonunion secondary to periosteal stripping associated for their application. We compared surgical outcomes in patients with THA PPFFx treated with open reduction internal fixation (ORIF) and cables vs patients with PPFFx treated with ORIF without cables. We hypothesized that cable use would decrease hardware failure and nonunion rates.</p><p><strong>Materials & methods: </strong>We retrospectively reviewed 42 cases of PPFFx around THA performed from 2015 to 2021. Twenty-three PPFFx were treated with plate and 1 mm cerclage cables, and 19 PPFFx were treated with plate without cables. Primary surgical outcomes included hardware failure, nonunion, reoperation, and time to radiographic union.</p><p><strong>Results: </strong>There was no significant difference in nonunion rates: 9% in the cerclage cable group vs 16% in the plate-only group (<i>P</i> = .64). The average time to union was 6.0 months among 17 observed unions in the cerclage cable group, vs 8.0 months among 15 observed unions in the plate-only group, but this failed to reach significance (<i>P</i> = .12). There was no statistical difference in overall complication rates (13% cerclage vs 16% plate) requiring reoperation (<i>P</i> = 1.0).</p><p><strong>Discussion & conclusion: </strong>The utilization of 1 mm cerclage cables to hold reduction of PPFFx provides an easy method to hold fixation with a low overall complication rate and no significant differences in nonunion rate or time to union when compared to cases performed without cables.</p>","PeriodicalId":48568,"journal":{"name":"Geriatric Orthopaedic Surgery & Rehabilitation","volume":"15 ","pages":"21514593241302655"},"PeriodicalIF":1.6,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11585047/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142711367","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}