Geriatric orthopaedic surgery & rehabilitation
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Geriatr Orthop Surg Rehabil · Sep 2017
ReviewHip Fractures in Elderly People: Surgery or No Surgery? A Systematic Review and Meta-Analysis.
Increasing numbers of patients with hip fractures also have advanced comorbidities. A majority are treated surgically. However, a significantly increasing percentage of medically unfit patients with unacceptably high risk of perioperative death are treated nonoperatively. Important questions about patients' prefracture quality of life (QOL) and future perspectives should be asked before considering different treatment options to assess what kind of treatment is advisable in frail elderly high-risk patients with a hip fracture. ⋯ This systematic review and meta-analysis demonstrated that only a few studies with small number of patients comparing NOM with OM were published. A significantly higher 30-day and 1-year mortality was revealed in nonoperatively treated hip fracture patients. No data were found examining (HR)QOL and costs. Further work is needed to enable shared decision-making and to initiate NOM in frail elderly patients with advanced comorbidity and limited life expectancy.
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Geriatr Orthop Surg Rehabil · Sep 2017
Hip Fractures in Centenarians: Has Care Improved in the National Hip Fracture Database Era?
The number of centenarians in the United Kingdom is increasing. An associated increase in the incidence of hip fractures in the extreme elderly population is expected. The National Hip Fracture Database (NHFD) initiative was introduced in 2007 aiming to improve hip fracture care. There is a paucity of literature on the outcomes of centenarians with hip fractures since its introduction. The aim of this study is to report our experience of hip fractures in centenarians in the era since the introduction of the NHFD to assess outcomes in terms of mortality, time to surgery, length of stay, and complications. ⋯ Compared to a series of centenarians with hip fractures prior to the introduction of the NHFD, we report a reduced time to surgery. Mortality and hospital length of stay were similar.
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Geriatr Orthop Surg Rehabil · Sep 2017
Multimodal Pain Management in Older Elective Arthroplasty Patients.
Pain management after elective arthroplasty in older adults is complicated due to the risk of undertreatment of postoperative pain and potential adverse effects from analgesics, notably opioids. Using combinations of analgesics has been proposed as potentially beneficial to achieve pain control with lower opioid doses. ⋯ A multimodal approach to pain control demonstrated no benefit over traditional postoperative analgesia in elective arthroplasty patients, but with significantly higher amounts of opioid consumed. This poses a potential risk regarding tolerability in frail older adults and results in increased drug costs.
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Geriatr Orthop Surg Rehabil · Sep 2017
Preoperative Factors Influencing Decision Between Hemiarthroplasty and Total Hip Arthroplasty in Femoral Neck Fractures in Indian Patients-Retrospective Single-Center Study.
The percentage of elderly population is increasing worldwide, with increasing incidence of femoral neck fractures. An increasing trend of arthroplasty for femoral neck fracture is observed. We aim to retrospectively analyze the preoperative factors that seem to influence the decision between hemiarthroplasty and total hip arthroplasty for managment of the same. ⋯ We conclude that preinjury functional independency of a patient is an important decisive factor in the choice between hemiarthroplasty and total hip arthroplasty. In addition to other factors including age and comorbidity pattern, scoring methods for preinjury functional status of patient could aid in decision-making. Early optimization, early surgery, and faster rehabilitation help the patients to achieve their preinjury functional status.