Hip Fracture

Orthopaedic Department, Peterborough and Stamford NHS Foundation Trust, Peterborough PE3 6DA.
BMJ (online) (Impact Factor: 17.45). 08/2006; 333(7557):27-30. DOI: 10.1136/bmj.333.7557.27
Source: PubMed
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    • "Most hip fractures are fragility fractures occurring in old individuals (Parker and Johansen, 2006). These fractures require surgical stabilization (Parker and Handoll, 2010; Parker and Stockton, 2001). "
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    ABSTRACT: Fourth generation composite femurs (4GCFs, models #3406 and #3403) simulate femurs of males <80 years with good bone quality. Since most hip fractures occur in old women with fragile bones, concern is raised regarding the use of standard 4GCFs in biomechanical experiments. In this study the stability of hip fracture fixations in 4GCFs was compared to human cadaver femurs (HCFs) selected to represent patients with hip fractures. Ten 4GCFs (Sawbones, Pacific Research Laboratories, Inc., Vashon, WA, USA) were compared to 24 HCFs from seven females and five males >60 years. Proximal femur anthropometric measurements were noted. Strain gauge rosettes were attached and femurs were mounted in a hip simulator applying a combined subject-specific axial load and torque. Baseline measurements of resistance to deformation were recorded. Standardized femoral neck fractures were surgically stabilized before the constructs were subjected to 20,000 load-cycles. An optical motion tracking system measured relative movements. Median (95% CI) head fragment migration was 0.8mm (0.4 to 1.1) in the 4GCF group versus 2.2mm (1.5 to 4.6) in the cadaver group (p=0.001). This difference in fracture stability could not be explained by observed differences in femoral anthropometry or potential overloading of 4GCFs. 4GCFs failed with fracture-patterns different from those observed in cadavers. To conclude, standard 4GCFs provide unrealistically stable bone-implant constructs and fail with fractures not observed in cadavers. Until a validated osteopenic or osteoporotic composite femur model is provided, standard 4GCFs should only be used when representing the biomechanical properties of young healthy femurs. Copyright © 2014 Elsevier Ltd. All rights reserved.
    Journal of Biomechanics 10/2014; 47(16). DOI:10.1016/j.jbiomech.2014.10.025 · 2.75 Impact Factor
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    • "The majority of patients following hip fracture are treated operatively to obtain pain relief, hasten mobility, and minimize complications. The indications of conservative treatment after hip fracture in previous reported studies were patients with impacted femoral neck fracture, minimally symptomatic following late diagnosis of hip fracture, already bed-ridden, and significant medical co-morbidity (5-8). "
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    ABSTRACT: Although many studies have assessed mortality and morbidity of conservative treatment after hip fracture in elderly patients, the mortality of conservative treatment done because of economic burden is unclear. Among 451 patients diagnosed with displaced hip fracture during 3 yr, 28 patients (Group I) were enrolled as conservative treatment. Fifty-six patients matched in age, gender, ASA score, and diagnosis (Group II) who had undergone surgical treatment were used as the control group. The causal factors of non-operative treatment and mortality rate and functional recovery were evaluated according to the causal factors of patients with surgical procedure. Ten patients (36%) in Group I involved medical problems and 18 (64%) by economic burdens. The cumulative mortality rate over 3, 6, 12, and 24 months was 54%, 61%, 64%, and 82% in Group I and 9%, 11%, 14%, and 21% in Group II, respectively. At the latest follow-up, all five patients in Group I displayed a nonfunctional ambulatory state, whereas only seven of 44 patients in Group II were in a nonfunctional ambulatory state. Non-surgical treatment following hip fracture that is done because of the economic burden is associated with substantially high mortality and serious functional loss.
    Journal of Korean medical science 09/2013; 28(9):1378-81. DOI:10.3346/jkms.2013.28.9.1378 · 1.27 Impact Factor
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    • "The thirty day mortality after hip fracture surgery was reported to be 5-10% [9], which was higher than that reported in the present study (2.17%). The reason for the discrepancy in mortality is unclear. "
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    ABSTRACT: The preoperative coexisting chronic systemic illness, delay in surgery, gender, and age were considered as risk factors for the complications after hip fracture surgery. The wider range of surgical delay and immobility-related pulmonary morbidity may affect postoperative complications and mortality. This study examined the risk factors for morbidity and mortality following the hip fracture surgery. The patient data was collected retrospectively. The consecutive 506 patients with hip fracture surgery, aged 60 years or older, were included. The patients' age, gender, preexisting diseases, American Society of Anesthesiologists (ASA) classification, delay in surgical repair, duration of surgical procedure, and methods of anesthesia were noted. The thirty-day postoperative complications were reviewed, and cardiac complications, pulmonary complications, delirium, and death were recorded. The data was analyzed for postoperative complications and risk factors. Atelectasis was associated with postoperative pulmonary complications. Male gender and age ≥ 80 years were associated with an increased incidence of postoperative delirium. ASA classification 3 was associated with death. A delay in surgery was not associated with any complications. Preexisting diseases and methods of anesthesia did not affect mortality and postoperative complications. The results suggest that a delay in surgery did not affect the postoperative complications and morbidity.
    Korean journal of anesthesiology 06/2013; 64(6):505-10. DOI:10.4097/kjae.2013.64.6.505
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