Geriatric orthopaedic surgery & rehabilitation
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Geriatr Orthop Surg Rehabil · Sep 2011
High-energy proximal femur fractures in geriatric patients: a retrospective analysis of short-term complications and in-hospital mortality in 32 consecutive patients.
There is limited information in the literature on the outcomes and complications in elderly patients who sustain high-energy hip fractures. As the population ages, the incidence of high-energy geriatric hip fractures is expected to increase. The purpose of this study was to analyze the outcomes and complications in patients aged 65 years or older, who sustained a high-energy proximal femur fracture. ⋯ High-energy proximal femur fractures in elderly patients are not very common and are associated with a low in-hospital mortality rate of less than 10%, despite high rate of complications of nearly 70%. This selective cohort of patients requires a particular attention to respiratory management due to the high incidence of associated chest trauma.
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Geriatr Orthop Surg Rehabil · Jul 2011
A geriatric multidisciplinary and tailor-made hospital-at-home method in nursing home residents with hip fracture.
Nursing home residents represent a large proportion of patients hospitalized with hip fracture. Generally, residents do not achieve the same physical ability level as before their fracture and have an increased risk of death within few days after discharge. This study aims to compare 2 new approaches to geriatric intervention in residents with hip fracture. ⋯ A multidisciplinary and tailor-made geriatric intervention in nursing home residents has a positive effect on readmission rate and short-term mortality. Still, it is not obvious which part of the tailor-made intervention is most crucial.
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Geriatr Orthop Surg Rehabil · Mar 2011
A prospective review of hip fracture subtypes, surgical procedure, cognitive status, and analgesia use across 4 Australian hospitals.
To correlate analgesia use among patients with hip fracture requiring surgery with hip fracture subtype, cognitive status, and type of surgery in the postacute period. ⋯ Important differences in utilization of analgesia following hip fracture across readily defined clinical groups exist. Proactive pain management for those with cognitive impairment, certain hip fracture subtypes, and surgical procedures may enable early functional mobility and other activities.
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Geriatr Orthop Surg Rehabil · Mar 2011
Unique Aspects of the Elderly Surgical Population: An Anesthesiologist's Perspective.
Increasing life expectancies paired with age-related comorbidities have resulted in the continued growth of the elderly surgical population. In this group, age-associated changes and decreased physiological reserve impede the body's ability to maintain homeostasis during times of physiological stress, with a subsequent decrease in physiological reserve. This can lead to age-related physiological and cognitive dysfunction resulting in perioperative complications. ⋯ The type of anesthesia to be administered should be assessed on a case-by-case basis, with special consideration given to the health status of the patient, the type of operation being conducted, and the expertise of the anesthesiologist. Specifically addressed in this article are age-related cognitive issues such as postoperative cognitive dysfunction and postoperative delirium. Strategies are suggested for avoiding these pitfalls.
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Geriatr Orthop Surg Rehabil · Mar 2011
Biomechanical comparison of 2 different locking plate fixation methods in vancouver b1 periprosthetic femur fractures.
Locking plates are commonly used to treat fractures around a well-fixed femoral component. The optimal construct should provide sufficient fixation while minimizing soft-tissue dissection. The purpose of the current study was to determine whether plate length, working length, or bone mineral density affects survival of locking plate fixation for Vancouver type B1 periprosthetic hip fractures. ⋯ A shorter working length was not associated with increased failure rate. Lower bone mineral density was significantly associated with failure (P = .02). We concluded that long locked plates do not appear to offer a biomechanical advantage over short locking plates in terms of fixation survival, and that bone mineral density was a better predictor of failure than was the fixation construct type.