Geriatric orthopaedic surgery & rehabilitation
-
Geriatr Orthop Surg Rehabil · Jan 2021
Developing a Simpler Prognosticating Tool: Comparing the Combined Assessment of Risk Encountered in Surgery Score with Deyo-Charlson Comorbidity Index and The American Society of Anesthesiologists Physical Status Score in Predicting 2 years Mortality after Hip Fracture Surgery.
Background: The use of risk stratification tools in identifying high-risk hip fracture patients plays an important role during treatment. The aim of this study was to compare our locally derived Combined Assessment of Risk Encountered in Surgery (CARES) score with the the American Society of Anesthesiologists physical status (ASA-PS) score and the Deyo-Charlson Comorbidity Index (D-CCI) in predicting 2-year mortality after hip fracture surgery. Methods and Material: A retrospective study was conducted on surgically treated hip fracture patients in a large tertiary hospital from Jan 2013 through Dec 2015. ⋯ A CARES score of 23, attributable primarily to pre-surgical morbidities and poor health of the patient, was identified as the statistical threshold for "high" risk of 2-year mortality. Conclusion: The CARES score is a viable risk predictor for 2-year mortality following hip fracture surgery and is comparable to the D-CCI in predictive capability. Our results support the use of a simpler yet clinically relevant CARES in prognosticating mortality following hip fracture surgery, particularly when information on the pre-existing comorbidities of the patient is not immediately available.
-
Geriatr Orthop Surg Rehabil · Jan 2021
Biomechanical Evaluation of Extramedullary Versus Intramedullary Reduction in Unstable Femoral Trochanteric Fractures.
The failure rate of operations involving the cephalomedullary nail technique for unstable femoral trochanteric fractures is 3-12%. Changing the reduction strategy may improve the stability. This study aimed to confirm whether reducing the proximal fragment with the medial calcar contact, as opposed to utilizing an intramedullary reduction, would improve the stability of such fractures. ⋯ As opposed to the "Intramedullary" reduction pattern, the biomechanical properties of the "Extramedullary" reduction pattern improved stability during testing and decreased sliding.
-
Geriatr Orthop Surg Rehabil · Jan 2021
Outcomes of COVID-19 Negative Hip Fracture Patients During the Acute and Subacute Pandemic.
To better elucidate how the COVID-19 pandemic has affected the operatively treated geriatric hip fracture population and how the health care system adapted to pandemic dictated procedures. ⋯ This is the first study to compare the effect of the acute and subacute phases of the pandemic on uninfected hip fracture patients. In the age of COVID-19, to provide the best care for the vulnerable geriatric orthopedic populations, the healthcare system must adopt new protocols. We should still aim to promote prompt surgical care when indicated. It is important to ensure adequate resource availability, such as OR time and staff so that hip fracture patients may continue to receive rapid access to surgery. A multidisciplinary approach remains the key to the management of fragility hip fracture patients during the pandemic.
-
Geriatr Orthop Surg Rehabil · Jan 2020
The Epidemiology of Fractures and Muskulo-Skeletal Traumas During COVID-19 Lockdown: A Detailed Survey of 17.591 Patients in a Wide Italian Metropolitan Area.
On 9 March 2020 the Italian Government declared a national lockdown to curb the spread of Covid-19. The aim of our study was to analyze the effects of such intervention on the traumatological emergency service, with particular emphasis on variations in trauma incidence and patients' characteristics. ⋯ The lockdown reduced the pressure on the Health System in at least 2 ways: directly, by curbing viral transmission and indirectly, by more than halving the ED trauma visits. Nonetheless, we observed an increased proportion of traumas in older patients, requiring hospitalizations, while the rate of less-severe cases decreased. This analysis may raise awareness of the effects of a lockdown on trauma services and may be helpful for those ones around the world who are now facing the emergency.
-
Geriatr Orthop Surg Rehabil · Jan 2020
Utilization of an Orthopedic Hood as Personal Protective Equipment for Intubation of Coronavirus Patients: a Brief Technical Report.
The novel coronavirus disease (COVID-19) has afflicted millions of people worldwide since its first case was reported in December 2019. Personal protective equipment (PPE) has been tailored accordingly, but as of April 2020, close to 10 000 health care workers in the United States have contracted COVID-19 despite wearing recommended PPE. As such, standard guidelines for PPE may be inadequate for the health care worker performing high-risk aerosolizing procedures such as endotracheal intubation. In this brief technical report, we describe the integration of an orthopedic hood cover as an item for full barrier protection against COVID-19 transmission. ⋯ Modification of existing PPE may provide protection for health care workers during high-risk aerosolizing procedures such as endotracheal intubation. Although the integration of this medical equipment meets the immediate needs of an escalating crisis, further innovation is on the horizon. More research is needed to confirm the safety of modified PPE.