Injury-International Journal of the Care of the Injured最新文献

{"title":"Readmission and mortality before and after introduction of orthogeriatric home visits: A retrospective cohort study in hip fracture patients","authors":"Anette Ekmann ,&nbsp;Thomas Giver Jensen ,&nbsp;Morten Tange Kristensen ,&nbsp;Troels Haxholdt Lunn ,&nbsp;Eckart Pressel ,&nbsp;Henrik Palm ,&nbsp;Charlotte Suetta ,&nbsp;Søren Overgaard ,&nbsp;Martin Aasbrenn","doi":"10.1016/j.injury.2024.111937","DOIUrl":"10.1016/j.injury.2024.111937","url":null,"abstract":"<div><h3>Introduction</h3><div>Orthogeriatric collaboration in hip fracture patients during admission is well established, however, orthogeriatric involvement after discharge is not common. The aim of this study was to explore the association of orthogeriatric home visits with 30-day and 120-day readmission and mortality in ≥ 65-year-old patients surgically treated for hip fractures.</div></div><div><h3>Materials and Methods</h3><div>A cohort of patients who underwent acute hip fracture surgery in an usual care period from January 2018 to December 2018 was compared with a cohort of patients in an intervention period from June 2020 to June 2021. During the intervention period, patients were offered orthogeriatric home visits at day 2 and 9 after discharge. The home visits were performed by orthogeriatric nurses, in close collaboration with geriatricians and orthopedic surgeons based in the local hospital. Readmission was defined as ≥ 12 h hospital stay, regardless of reason. For the main analysis, we applied Cox-regression models adjusted for age, sex, New Mobility Score, Cumulated Ambulation Score regained, cognitive function, Charlson Comorbidity Index, complications, medication, discharge destination and emergency department visits.</div></div><div><h3>Results</h3><div>In total, 292 patients were included during the usual care period, and 308 patients during the intervention period. Thirty- and 120-day readmission rates were 27.7 % and 41.4 % in the usual care cohort vs. 21.8 % and 35.1 % in the home visit cohort. Adjusted Hazard Ratios for readmission in the intervention cohort after 30 and 120 days were 0.67 (CI95 %: 0.48–0.93) and 0.71 (CI95 %: 0.54–0.93) respectively. Thirty- and 120-day mortality rates were 7.2 % and 20.9 % in the usual care cohort versus 5.8 % and 13.3 % in the intervention cohort. Adjusted Hazard Ratios for mortality in the intervention cohort after 30 and 120 days were 0.68 (CI95 %: 0.35–1.31) and 0.56 (CI95 %: 0.37–0.84) respectively.</div></div><div><h3>Conclusions</h3><div>In a period where hip fracture patients were offered two home visits after discharge, we observed lower 30- and 120- day readmission, and lower 120-day mortality, calling for more studies with a randomized design.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"55 12","pages":"Article 111937"},"PeriodicalIF":2.2,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142432589","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anteromedial cortical support reduction of intertrochanteric fractures–A review","authors":"Wenjun Xie ,&nbsp;Liu Shi ,&nbsp;Cheng Zhang ,&nbsp;Xueliang Cui ,&nbsp;Xiangxu Chen ,&nbsp;Tian Xie ,&nbsp;Sheng Zhang ,&nbsp;Hui Chen ,&nbsp;Yunfeng Rui","doi":"10.1016/j.injury.2024.111926","DOIUrl":"10.1016/j.injury.2024.111926","url":null,"abstract":"<div><div>The intertrochanteric fracture is a common fragility fracture typically resulting from low-energy falls. The functional outcome of intertrochanteric fractures is closely linked to the patient's underlying physical condition, intraoperative procedures, and postoperative complications. In terms of surgery, while timely surgery and appropriate internal fixation have demonstrated favorable outcomes, attention to intraoperative reduction is crucial. In recent years, there have been further developments in the evaluation of reduction of intertrochanteric fractures, particularly in the anteromedial cortical reduction, and these advances have been further scientifically elucidated in terms of their ability to provide stable fracture reduction and resist loss of reduction. In order to gain a comprehensive understanding of the anteromedial cortex theory, this article reviewed the anatomy, related theoretical progress, and controversies in recent years.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"55 12","pages":"Article 111926"},"PeriodicalIF":2.2,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142402493","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of children applying to emergency service after motor vehicle trauma","authors":"Selen Şimşek Pervane ,&nbsp;Halit Halil","doi":"10.1016/j.injury.2024.111925","DOIUrl":"10.1016/j.injury.2024.111925","url":null,"abstract":"<div><h3>Background</h3><div>Traffic accidents are significant causes of death and serious injury in children. Children's clinical findings are more subtle and there is a risk of faster deterioration. On the other hand, radiation sensitivity due to imaging is also high. These challenging factors highlight the importance of approaching pediatric trauma cases. In our study, we aimed to contribute to current approaches by examining the clinical course and profiles of children involved in traffic accidents. This study aimed to analyze the profiles and clinical courses of children involved in road traffic accidents.</div></div><div><h3>Methods</h3><div>Pediatric patients brought to our hospital due injuries from traffic accidents were retrospectively investigated.</div></div><div><h3>Results</h3><div>During the two-year period analyzed in the study, 605 child patients applied due to traffic accidents, accounting for 5.4 % of pediatric trauma cases. The majority of the children were between the ages of 12–17, with most accidents occurring in the summer. In total, 56.9 % were from in-vehicle traffic accidents, 36.7 % were from extra-vehicular traffic accidents, and 6.4 % were from motorcycle accidents. The imaging rate among the patients was 89 %, and 50.6 % had more than one tomography. More than half of the cases had no pathological findings, and only 6 % required hospitalization. Most cases were treated successfully with medical care, while 21.4 % needed interventional procedures, and 10 % received no treatment. The most common injuries were superficial skin lesions (11.1 %) and extremity fractures (10.2 %), with orthopedics being the most consulted department. Fractures were most common in the tibia and were more likely in motorcycle accidents than in-car accidents.</div></div><div><h3>Conclusion</h3><div>In-vehicle accidents were the most frequent type of accident, and children under 4 years old had a higher incidence of in-car accidents than other age groups. Males made up 60 % of the cases, with boys having higher rates of motorcycle and extra-vehicular accidents compared to girls. While most children had no injuries from the accidents, those who did generally recovered well with outpatient monitoring. On the other hand, 89 % of patients underwent imaging at a high rate.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"55 12","pages":"Article 111925"},"PeriodicalIF":2.2,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142432486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early kyphoplasty in the elderly patient","authors":"María Bragado González ,&nbsp;Silvia Santiago Maniega ,&nbsp;Jesús Crespo-Sanjuan ,&nbsp;Rubén Hernández Ramajo,&nbsp;Gregorio de Jesús Labrador Hernández,&nbsp;Francisco Ardura Aragón,&nbsp;David César Noriega González","doi":"10.1016/j.injury.2024.111757","DOIUrl":"10.1016/j.injury.2024.111757","url":null,"abstract":"<div><div>Prevalence of vertebral compression fractures is over 30 % in the elderly population. The ideal treatment for these fractures remains a subject of debate. The objective in this study is to compare the clinical outcomes of early kyphoplasty and conservative treatment in vertebral compression fractures.</div></div><div><h3>Materials and methods</h3><div>Observational retrospective study of 50 consecutive patients with acute vertebral compression fracture (25 patients treated by kyphoplasty and 25 treated by conservative therapy). Number and location of the fractures, radiographic assessment (Beck Index), symptoms duration, pain intensity (Visual Analog Scale -VAS), patient's functional capacity (Oswestry Disability Index – ODI) and analgesic use and dose were analysed. Both groups were followed for 1 year.</div></div><div><h3>Results</h3><div>Most of the patients in the sample were women with a mean age of 80,5 years old, both groups being comparable in age and sex (p=1 and p=1 respectively). The mean ASA score for kyphoplasty vs conservative was 2.6 vs 2.5 (p 0,54). VAS at initial diagnosis 8,50 vs 8,80 (p 0,405). VAS two months after initiation of the treatment 4,40 vs 2,40 (p 0,028), and VAS at one year follow-up was 1,80 vs 1,30 (p 0,216). ODI mean scores conservative vs kyphoplasty at initial diagnosis were 69,79 vs 74 (p 0,87) and two months later 31,60 vs15,40 (p 0,03). The mean Beck Index at the diagnosis conservative vs kyphoplasty was 59,20 % vs 61,50 % (p 0,68) and after 1 year 51,80 % vs 57,40 % (p 0,45). In the kyphoplasty group only 1 patient had to be hospitalised during 24 h. Cement leakage was detected in 2 patients without clinical repercussion. In the conservative group 5 patients had home help during their recovery and 3 went to nursing homes.</div></div><div><h3>Conclusion</h3><div>Kyphoplasty is a minimally invasive surgical procedure with hardly any complications. It offers a faster and greater pain relief to elderly patients than conservative treatment. Early treatment with kyphoplarty allows patients to walk in a short time (early wandering) after the fracture. This treatment avoids long periods of rest and loss of muscle mass. It is a surgical procedure that should be considered as part of the initial therapeutic choices for osteoporotic vertebral fractures.</div></div><div><h3>Level of evidence</h3><div>IV</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"55 ","pages":"Article 111757"},"PeriodicalIF":2.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142711219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Retrospective paired cohort study comparing internal fixation for undisplaced versus hemiarthroplasty for displaced femoral neck fracture in the elderly","authors":"José Cordero-Ampuero (Orthopaedic Surgeon) ,&nbsp;Ignacio Descalzo (Orthopaedic Resident) ,&nbsp;Pablo Fernández-Villacañas (Orthopaedic Resident) ,&nbsp;José Manuel Berdullas ,&nbsp;Ainhoa Hernández-Rodríguez ,&nbsp;Javier de Quadros ,&nbsp;Sergio Marcos-Aguilar ,&nbsp;Claudio Peix (Orthopaedic Surgeon)","doi":"10.1016/j.injury.2024.111674","DOIUrl":"10.1016/j.injury.2024.111674","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;div&gt;The debate continues regarding the best treatment for elderly patients with non-displaced femoral neck fractures (FNFs): internal fixation (IF) &lt;em&gt;vs&lt;/em&gt; hemiarthroplasty (HA). The Aim of the present study is to compare surgical insult, mortality, complications, and walking recovery after one year in patients older than 65 treated with cannulated screws or HA for FNFs.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Patients and methods&lt;/h3&gt;&lt;div&gt;Match-paired comparison of retrospective cohorts: 220 non-displaced FNFs treated with cannulated screws &lt;em&gt;vs&lt;/em&gt; 220 displaced FNFs treated with bipolar HA from 2013 to 2021. No differences were observed in age (82.1 ± 7.5 IF &lt;em&gt;vs&lt;/em&gt; 83±6.8 HA) (&lt;em&gt;p&lt;/em&gt; = 0.172), sex (74.6 % IF females &lt;em&gt;vs&lt;/em&gt; 74.6 % HA females) (&lt;em&gt;p&lt;/em&gt; = 0.912), year of intervention (&lt;em&gt;p&lt;/em&gt; = 0.638) and ASA scale (III in 55.5 % IF &lt;em&gt;vs&lt;/em&gt; 55.9 % HA) (IV in 21.8 % IF &lt;em&gt;vs&lt;/em&gt; 18.2 % HA) (&lt;em&gt;p&lt;/em&gt; = 0.726). Medical complications analyzed included respiratory and urinary infections, heart failure, myocardial infarction, stroke, pulmonary embolism, deep vein thrombosis, acute digestive bleeding.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Lower surgical aggression in IF: surgical time (&lt;em&gt;p&lt;/em&gt; &lt; 0.001), hemoglobin and hematocrit decrease (&lt;em&gt;p&lt;/em&gt; &lt; 0.001), need for transfusion (&lt;em&gt;p&lt;/em&gt; &lt; 0.001), hospital stay (&lt;em&gt;p&lt;/em&gt; &lt; 0.001).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Mortality&lt;/h3&gt;&lt;div&gt;higher in-hospital for hemiarthroplasties: 12 deaths (5.5 %) &lt;em&gt;vs&lt;/em&gt; 1 (0.5 %) (&lt;em&gt;p&lt;/em&gt; = 0.004) (RR=12, 1.5–91.5). No differences after 1 month (13 (6 %) in HA &lt;em&gt;vs&lt;/em&gt; 9 (4.1 %) in cannulated screws) and 1 year (33 (15 %) in HA &lt;em&gt;vs&lt;/em&gt; 35 (16 %) in IF).&lt;/div&gt;&lt;div&gt;Medical complications showed no significant differences (&lt;em&gt;p&lt;/em&gt; = 0.055).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Surgical complications&lt;/h3&gt;&lt;div&gt;No differences in surgical infections (5 HA (2.3 %) &lt;em&gt;vs&lt;/em&gt; 2 IF (0.9 %);&lt;em&gt;p&lt;/em&gt; = 0,253) or neurovascular injuries (3 HA (1,4 %) &lt;em&gt;vs&lt;/em&gt; 2 IF (0.9 %); &lt;em&gt;p&lt;/em&gt; = 1). HA: 10 dislocations (4.5 %), 11 periprosthetic fractures (5 %). Cannulated screws: 10 fixation failures (4.6 %), 9 non-unions (4.1 %), 16 ischemic necrosis of femoral head (7.3 %). Reoperation rate: 15/220 IF (6.8 %) and 8/220 HA (3.6 %) (&lt;em&gt;p&lt;/em&gt; = 0.134).&lt;/div&gt;&lt;div&gt;Functional results: No differences were detected (&lt;em&gt;p&lt;/em&gt; = 0.285): 111 osteosynthesis patients (50.45 %) and 99 HA (45 %) returned to their pre-fracture walking ability (&lt;em&gt;p&lt;/em&gt; = 0.322). There were also no differences between groups in those patients with worsening of walking status: 108 (49 %) osteosynthesis and 118 (53,6 %) prosthesis (&lt;em&gt;p&lt;/em&gt; = 0.412).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Cannulated screws in patients over 65 with non-displaced femoral neck fractures results in less surgical insult, lower in-hospital mortality, comparable medical and surgical complications, a similar re-operation rate, and functional outcomes equivalent to hemiarthroplasty.&lt;/div&gt;&lt;/di","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"55 ","pages":"Article 111674"},"PeriodicalIF":2.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142711746","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Serum levels of IL-6 and IL-10 on admission correlate with complications in elderly patients with hip fracture","authors":"Felícito García-Alvarez ,&nbsp;Álvaro Chueca-Marco ,&nbsp;Luis Martínez-Lostao ,&nbsp;María Aso-Gonzalvo ,&nbsp;Ruben Estella-Nonay ,&nbsp;Jorge Albareda","doi":"10.1016/j.injury.2024.111736","DOIUrl":"10.1016/j.injury.2024.111736","url":null,"abstract":"<div><h3>Objectives</h3><div>Ageing may cause a progressive pro-inflammatory environment and alter functionality of different immune-cell populations. The aim of the present study is to examine the influence of certain serum immunological parameters on hospitalization stay and complications in patients who have suffered a hip fracture.</div></div><div><h3>Patients and methods</h3><div>A prospective study was carried out with 87 patients (63 women) presenting with either trochanteric femoral fracture or Garden IV displaced subcapital fracture. The average age was 84.43 ± 9, ranging from 65 to 104 years old. Data regarding different comorbidities were recorded at the time of arrival. The morning after patient's admission peripheral blood samples were obtained and a series of immunological parameters were determined: leukocyte formula, platelets count, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), IL-6 and IL-10 levels, T-lymphocytes count, number of cells/mm3 and percentages of CD3, CD4, CD8, CD3-/CD16/56+ (NK cells), and CD³-/CD19+ (B cells).</div></div><div><h3>Results</h3><div>IL-6 serum levels presented a positive and significant correlation with higher levels of CRP (<em>p</em> &lt; 0.001), IL-10 (<em>p</em> = 0.002), and higher percentages of NK CD56+ cells (<em>p</em> = 0.046). IL-6 serum levels at hospitalization presented a positive and significant correlation with a longer hospitalization stay (<em>p</em> = 0.037). Hospitalization increased by 0.231 days for every 1 pg/mL above the IL-6 mean value (40.43 pg/mL). Lower serum IL-10 levels on admission were associated with the appearance of symptomatic urinary tract infection during hospitalization (<em>p</em> = 0.032). Higher number of CD19+ cells/mm³ presented a significant relationship with pneumonia (<em>p</em> = 0.018) and symptomatic urinary tract infection (<em>p</em> = 0.0019).</div></div><div><h3>Conclusions</h3><div>IL-6 serum levels on admission showed a positive and significant correlation with a longer hospitalization stay in elderly patients presenting with hip fracture. Lower levels of IL-10 in peripheral blood on admission were associated with symptomatic urinary tract infections. A higher number of CD19+ cells/mm³ was significantly associated with pneumonia and symptomatic urinary tract infection. These immunological variables on admission may serve as risk indicators of complications during hospitalization.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"55 ","pages":"Article 111736"},"PeriodicalIF":2.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141710721","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Time to surgery and 30-day mortality after hip fracture: An observational study of 29,695 patients reported to the Spanish National Hip Fracture Registry (SNHFR)","authors":"J. Sanz-Reig ,&nbsp;J Mas Martínez ,&nbsp;Concepción Cassinello Ogea ,&nbsp;J.I Gonzalez-Montalvo ,&nbsp;P. Saez-Lopez ,&nbsp;CM Verdu Roman ,&nbsp;C. Ojeda-Thies ,&nbsp;participants in the Spanish National Hip Fracture Registry","doi":"10.1016/j.injury.2024.111653","DOIUrl":"10.1016/j.injury.2024.111653","url":null,"abstract":"<div><h3>Introduction</h3><div>The aim of this study was to investigate the effect of time to surgery (TTS) on 30-day mortality in a cohort of patients from the Spanish National Hip Fracture Registry (SNHFR).</div></div><div><h3>Methods</h3><div>Retrospective study of a prospective database of hip fracture patients ≥ 75 years old between 2017 and 2019. Exclusion criterion was nonsurgical treatment. Association between TTS and 30-day mortality was assessed with a univariate analysis. Effect size was calculated using the probability of superiority. Regression analysis was performed to analyze the relationship between TTS and 30-day vital status. The ROC curve was used to evaluate the discrimination of mortality based on TTS.</div></div><div><h3>Results</h3><div>A total of 29,695 patients met the inclusion criteria. The median TTS was 53.8 h. Surgery within 48 h was performed in 51.8 % of cases. Patients with delay of surgery more than 2 days rather than within 2 days were more likely to present an ASA score above 2 (58.9 % vs. 41.1 %, <em>p</em> &lt; 0.001), less likely to achieve postoperative mobilization within 24 h (63 % vs. 67.4 %, <em>p</em> &lt; 0.001), more likely to develop pressure ulcers (10.7 % vs. 6.9 %, <em>p</em> &lt; 0.001), and had longer length of stay (10.7 days vs. 6.9 days, <em>p</em> &lt; 0.001). The overall 30-day mortality rate was 7.8 %. Median TTS was significantly higher in decedents (66 h) than in survivors (56.5 h). There were higher statistically significant differences in 30-day mortality between patients who underwent surgery after 2 days (7.5 %) and those who underwent surgery within 2 days (5.4 %). The 30-day mortality was 5.2 % in patients operated within 24 h and 9.2 % in patients operated more than 120 h. Probability of superiority value was 0.44. Area under the curve reached a value of 0.55.</div></div><div><h3>Conclusions</h3><div>The associations between TTS and 30-day mortality were weak. Hip fracture surgery performed within 2 days was significantly associated with remobilization on the day after the hip fracture, with fewer postoperative pressure ulcers and shorter hospital stays. Despite the weakness of the TTS and 30-day mortality association, there are benefits to consider if surgery is performed within 2 days. Our results suggest that patients should be fit for surgery as soon as possible.</div></div><div><h3>Level of evidence</h3><div>IV</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"55 ","pages":"Article 111653"},"PeriodicalIF":2.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142711995","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical and radiological factors related to dislocation in patients undergoing hip hemiarthroplasty for femoral neck fractures: A case-control study✰","authors":"Lorena Bellostas,&nbsp;Israel Rubio,&nbsp;Sarah Mills,&nbsp;Juan Carlos Rubio,&nbsp;Eduardo García-Rey","doi":"10.1016/j.injury.2024.111737","DOIUrl":"10.1016/j.injury.2024.111737","url":null,"abstract":"<div><h3>Introduction</h3><div>Dislocation rates are low in patients undergoing hemiarthoplasty (HA) for displaced femoral neck fractures (FNF); however, complications can be devastating. We hypothesize that patients sustaining HA dislocation have different comorbidities and surgical characteristics to those without.</div></div><div><h3>Materials and methods</h3><div>In this retrospective matched-control study, we identified 28 patients who sustained dislocation after HA. They were matched 1:2 based of sex and age to a cohort of patients undergoing HA without dislocation. We compared the pre-operative demographic and clinical data, surgical details, mortality and need for further revision or complications. The radiological analysis was performed by measuring the centre edge angle (CEA), acetabular index (AI), the femoral offset (FO), and the residual femoral neck (RFN) after surgery. The minimum follow-up for unrevised patients was one year (range, 1 to 4).</div></div><div><h3>Results</h3><div>19 (67 %) out of 28 patients in the study group needed further surgery. The 1-year mortality rate was 44 % in the study group and 14 % in the control group (<em>p</em> &lt; 0.001). A longer surgical delay (<em>p</em> &lt; 0.001), dementia and neuromuscular disorders, a greater CEA (mean cases = 46º and controls = 38º; <em>p</em> &lt; 0.001) and a shorter RFN (mean cases = 23.5 mm and controls = 28.4 mm; <em>p</em> = 0.04) was found in patients that suffered HA dislocation.</div></div><div><h3>Conclusions</h3><div>HA dislocation after FNF is a severe complication with high mortality rate and often require further surgery treatment. Dislocation was more frequent in patients with neuro-cognitive impairment, a longer surgical delay and a shorter femoral neck. Monitoring peri‑operative management and surgical technique may decrease the dislocation rate in this frail population.</div></div><div><h3>Level of evidence</h3><div>III</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"55 ","pages":"Article 111737"},"PeriodicalIF":2.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142712328","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of Early Axial Interfragmentary Motion on the Fracture Healing Environment: A Scoping Review","authors":"Griffin R. Rechter ,&nbsp;Ryan Tyler Anthony ,&nbsp;Justin Rennard ,&nbsp;James F. Kellam ,&nbsp;Stephen J. Warner","doi":"10.1016/j.injury.2024.111917","DOIUrl":"10.1016/j.injury.2024.111917","url":null,"abstract":"<div><h3>Purpose</h3><div>The initial interfragmentary motion (IFM) at a fracture site determines the mode of fracture healing. Understanding the impact of orthopaedic interventions on the fracture environment is essential to advancing our knowledge of fracture healing. The purpose of this scoping review is to analyze the orthopaedic literature to assess our understanding of the effects of early axial IFM on fracture healing outcomes.</div></div><div><h3>Methods</h3><div>PubMed, OVID, and Scopus databases were queried to identify all studies from inception until June 2023 assessing axial IFM on fracture healing outcomes in animal and human subjects. We collected information regarding the amount of IFM, osteotomy/fracture location, experimental methodology, and outcomes (histologic, biomechanical, and radiographic evidence of fracture healing) for each study. Data synthesis is presented as a narrative review of our findings.</div></div><div><h3>Results</h3><div>In total, 4,972 studies were identified. Fifteen studies were included, totaling 605 fractures/osteotomies. Of the included studies, 423 animal and 182 human subjects were examined. Nine studies investigated IFM at the tibia, four at the metatarsus, and two at the femur. The median time to analysis was nine weeks. The fracture gap size did not exceed 6 mm in any study. The range of IFM in tibias, metatarsi, and femurs was 0.3-2.0 mm, 0.1-2.4 mm, and 0.03-1.0 mm, respectively. No experiment using a femur model identified an association between early axial IFM and healing outcomes. All studies at the level of the tibia exhibited positive effects on callus formation with small-to-moderate axial IFM (mean 0.54, SD 0.30; range 0.2-0.9 mm). Most studies (9/13, 69.2%) found that early micromovement produced superior stiffness and biomechanical rigidity at the fracture site compared to absolute stability. While larger IFMs (mean 1.28, SD 0.70; range 0.25-2.4 mm) frequently led to a larger callus area, the callus quality and biomechanical strength of the callus was compromised.</div></div><div><h3>Conclusion</h3><div>The definitive range of axial IFM conducive to a favorable healing environment remains elusive. However, preliminary evidence suggests an association between small-to-moderate (mean 0.41, SD 0.32; range: 0.03- 1.0 mm) initial axial IFM for stimulating successful fracture healing. This review found that the cumulative evidence present in the literature is insufficient to determine a definite correlation between the early axial IFM and outcomes.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"55 12","pages":"Article 111917"},"PeriodicalIF":2.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142444742","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does surgical delay time affect mortality and functional outcomes in elderly patients with hip fractures?","authors":"P. Checa-Betegón ,&nbsp;A. Ramos-Fernández ,&nbsp;A. Martínez-García ,&nbsp;J. García-Coiradas ,&nbsp;J. Valle-Cruz","doi":"10.1016/j.injury.2024.111672","DOIUrl":"10.1016/j.injury.2024.111672","url":null,"abstract":"<div><h3>Introduction and objective</h3><div>Hip fracture in elderly population is a global health problem because of the high mortality and deterioration of functional status of the patients. The purpose of this study is to determine how surgical delay in elderly patients with hip fracture influences mortality and functional outcomes.</div></div><div><h3>Patients and methods</h3><div>An observational and retrospective study was designed. A total of 357 patients over 70 years of age with primary hip fracture were studied. Epidemiological characteristics and comorbidities were collected. Baseline functional status was assessed based on comorbidity, dependency degree and used of assistive devices. The patients were divided into three comparison groups based on the surgical delay time from hospital admission: group A (surgery ≤ 24 h), group B (surgery 24 - 48 h), and group C (&gt; 48 h). In-hospital mortality, 30-day after hospital discharge mortality, one-year mortality and postoperative complications were recorded. After two years of follow-up, a new clinical-functional assessment was conducted.</div></div><div><h3>Results</h3><div>Surgery was performed &lt; 24 h in 79 patients (22 %), between 24 and 48 h in 88 patients (25 %), and over 48 h in 190 patients (53 %). In-hospital mortality was 3.6 %, 30-day post-discharge mortality was 4.1 %, and one-year mortality was 14.8 %. One-year mortality was lower in patients with a surgical delay of more than 48 h (HR:0.36; 95 % CI (0.14–0.91), <em>p</em> = 0.03). We observed the same trend for in-hospital mortality (HR:0.32; 95 % CI (0.8–1.2), <em>p</em> = 0.10) and 30-day mortality (HR:0.96; 95 % CI (0.19–4.83), <em>p</em> = 0.96). Postoperative complications were reported in 34 % of patients in group A, 49 % of patients in group B, and 47 % of patients in group C (<em>p</em> = 0.067). 30 % of patients in group A, 30 % of patients in group B, and 37 % of patients in group C maintained autonomous mobility inside and outside the home after surgery (<em>p</em> = 0.001).</div></div><div><h3>Conclusion</h3><div>In our study, patients with longer surgical delays presented lower one-year mortality, but no differences were found in functional outcomes and complication rates. However, these findings should be interpreted with caution due to baseline differences between treatment groups and the limitations of the study. More studies with a higher level of evidence are needed in the future.</div></div><div><h3>Level of evidence</h3><div>IV</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"55 ","pages":"Article 111672"},"PeriodicalIF":2.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142712329","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}