Geriatric orthopaedic surgery & rehabilitation
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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.
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Geriatr Orthop Surg Rehabil · Jun 2017
Comparison of Postoperative Outcomes in Elderly Patients With a Do-Not-Resuscitate Order Undergoing Elective and Nonelective Hip Surgery.
Emergency hip surgery generally has worse outcomes than elective hip surgery, even when adjusted for patient and surgical factors. Do-not-resuscitate (DNR) status patients are typically at higher perioperative risk and undergo a narrow range of surgical procedures. We aimed to compare the outcomes after hip surgery of differing degrees of urgency in this cohort. ⋯ For patients with DNR status, both emergent and non-emergent hip surgery carries high mortality, greatly exceeding rates predicted for that patient by American College of Surgeons NSQIP risk calculators. Morbidity rates and patterns for patients with DNR status are also similar in emergency and nonemergency groups. These data may be useful in discussing risk and obtaining adequately informed consent in DNR patients undergoing hip surgery.
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Geriatr Orthop Surg Rehabil · Mar 2017
Outcome and 2-Year Survival Rate in Elderly Patients With Lateral Compression Fractures of the Pelvis.
Osteoporotic pelvic ring fractures are a rising problem for surgeons in industrialized countries. There is no evidence-based treatment strategy especially for lateral compression (LC) fractures involving the sacrum. The aim of this study was to evaluate and compare outcome and survival rate of nonoperative and operative treatment strategies for lateral compression fractures. ⋯ Elderly patients display a high rate and variety of complications and mortality in the aftermath of lateral compression fractures of the pelvis. Although a significantly higher 2-year survival rate for operatively treated patients was found, this study cannot give proof of superior position for operative treatment. Due to lacking data for alternative treatment algorithms especially for fracture-related immobilized patients, we recommended operative treatment with the aim to reduce complications related to prolonged bed rest and ensure early mobilization.