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GERONTOLOGY AND GERIATRICS (125 journals)                     

Showing 1 - 122 of 122 Journals sorted alphabetically
Activities, Adaptation & Aging     Hybrid Journal   (Followers: 6)
Advances in Alzheimer's Disease     Open Access   (Followers: 8)
Advances in Geriatrics     Open Access   (Followers: 4)
Advances in Gerontology     Partially Free   (Followers: 9)
Advances in Parkinson's Disease     Open Access   (Followers: 2)
Age and Ageing     Hybrid Journal   (Followers: 106)
Aging & Mental Health     Hybrid Journal   (Followers: 40)
Aging and Cancer     Open Access   (Followers: 2)
Aging and Health Research     Open Access   (Followers: 1)
Aging Clinical and Experimental Research     Hybrid Journal   (Followers: 3)
Aging Medicine     Open Access   (Followers: 1)
Aging, Neuropsychology, and Cognition     Hybrid Journal   (Followers: 41)
Alzheimer's & Dementia     Hybrid Journal   (Followers: 50)
Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring     Open Access   (Followers: 5)
Alzheimer's & Dementia: Translational Research & Clinical Interventions     Open Access   (Followers: 5)
American Journal of Alzheimer's Disease and Other Dementias     Hybrid Journal   (Followers: 21)
American Journal of Geriatric Psychiatry     Hybrid Journal   (Followers: 19)
Anales en Gerontología     Open Access  
Angewandte GERONTOLOGIE Appliquée     Full-text available via subscription  
Annual Review of Gerontology and Geriatrics     Hybrid Journal   (Followers: 14)
Arthritis und Rheuma     Hybrid Journal  
Australasian Journal On Ageing     Hybrid Journal   (Followers: 12)
Australian Ageing Agenda     Full-text available via subscription   (Followers: 5)
B&G Bewegungstherapie und Gesundheitssport     Hybrid Journal   (Followers: 2)
Biogerontology     Hybrid Journal   (Followers: 1)
BMC Geriatrics     Open Access   (Followers: 17)
Canadian Geriatrics Journal     Open Access   (Followers: 6)
Canadian Journal on Aging     Hybrid Journal   (Followers: 17)
Clinical Gerontologist     Hybrid Journal   (Followers: 3)
Clinics in Geriatric Medicine     Full-text available via subscription   (Followers: 6)
Current Geriatrics Reports     Hybrid Journal   (Followers: 1)
Current Gerontology and Geriatrics Research     Open Access   (Followers: 11)
Dementia and Geriatric Cognitive Disorders     Full-text available via subscription   (Followers: 36)
Dementia and Geriatric Cognitive Disorders Extra     Open Access   (Followers: 19)
Drugs & Aging     Full-text available via subscription   (Followers: 10)
European Geriatric Medicine     Full-text available via subscription   (Followers: 3)
European Journal of Ageing     Hybrid Journal   (Followers: 16)
European Review of Aging and Physical Activity     Open Access   (Followers: 11)
Experimental Aging Research: An International Journal Devoted to the Scientific Study of the Aging Process     Hybrid Journal   (Followers: 2)
Experimental Gerontology     Hybrid Journal   (Followers: 5)
Frontiers in Aging Neuroscience     Open Access   (Followers: 22)
Gait & Posture     Hybrid Journal   (Followers: 17)
Generations     Full-text available via subscription   (Followers: 3)
Geriatric Care     Open Access   (Followers: 4)
Geriatric Medicine in General Practice     Full-text available via subscription   (Followers: 8)
Geriatric Orthopaedic Surgery Rehabilitation     Open Access   (Followers: 5)
Geriatrics     Open Access   (Followers: 3)
Geriatrics & Gerontology International     Hybrid Journal   (Followers: 12)
Geriatrie up2date     Hybrid Journal  
Geriatrie-Report : Forschung und Praxis in der Altersmedizin     Full-text available via subscription  
Gerodontology     Hybrid Journal   (Followers: 2)
Gerokomos     Open Access   (Followers: 1)
Geron     Full-text available via subscription  
Gerontologia     Open Access  
Gerontology     Full-text available via subscription   (Followers: 22)
Gerontology & Geriatrics Education     Hybrid Journal   (Followers: 8)
Gerontology and Geriatric Medicine     Open Access   (Followers: 5)
GeroPsych: The Journal of Gerontopsychology and Geriatric Psychiatry     Hybrid Journal   (Followers: 5)
GeroScience : Official Journal of the American Aging Association (AGE)     Hybrid Journal   (Followers: 8)
Global Journal of Geriatrics Nursing     Open Access   (Followers: 4)
Hip International     Hybrid Journal  
I Advance Senior Care     Full-text available via subscription  
Immunity & Ageing     Open Access   (Followers: 9)
Innovation in Aging     Open Access   (Followers: 1)
International Journal of Ageing and Later Life     Open Access   (Followers: 1)
International Journal of Aging and Human Development     Full-text available via subscription   (Followers: 11)
International Journal of Alzheimer's Disease     Open Access   (Followers: 8)
JMIR Aging     Open Access  
Journal for Healthcare Quality     Hybrid Journal   (Followers: 28)
Journal of Adult Protection, The     Hybrid Journal   (Followers: 16)
Journal of Aging and Environment     Hybrid Journal   (Followers: 4)
Journal of Aging and Health     Hybrid Journal   (Followers: 28)
Journal of Angiogenesis Research     Open Access   (Followers: 2)
Journal of Applied Gerontology     Hybrid Journal   (Followers: 18)
Journal of Elder Abuse & Neglect     Hybrid Journal   (Followers: 6)
Journal of Frailty & Aging     Hybrid Journal  
Journal of Geriatric Cardiology     Open Access   (Followers: 3)
Journal of Geriatric Mental Health     Open Access   (Followers: 6)
Journal of Geriatric Oncology     Hybrid Journal   (Followers: 2)
Journal of Geriatric Physical Therapy     Hybrid Journal   (Followers: 14)
Journal of Geriatrics     Open Access   (Followers: 1)
Journal of Geriatrics and Palliative Care     Open Access   (Followers: 5)
Journal of Gerontological Social Work     Hybrid Journal   (Followers: 14)
Journal of Mid-life Health     Open Access  
Journal of Military and Veterans Health     Full-text available via subscription   (Followers: 7)
Journal of Parkinsonism and Restless Legs Syndrome     Open Access   (Followers: 2)
Journal of Parkinson’s Disease and Alzheimer’s Disease     Open Access   (Followers: 1)
Journal of Prevention of Alzheimer's Disease     Hybrid Journal   (Followers: 1)
Journal of Religion Spirituality & Aging     Hybrid Journal   (Followers: 7)
Journal of Social Work in End-of-Life & Palliative Care     Hybrid Journal   (Followers: 22)
Journal of the American Geriatrics Society     Hybrid Journal   (Followers: 68)
Journal of the Indian Academy of Geriatrics     Open Access   (Followers: 4)
Maturitas     Hybrid Journal   (Followers: 10)
Medycyna Wieku Podeszłego (Geriatric Medicine)     Open Access  
Mortality: Promoting the interdisciplinary study of death and dying     Hybrid Journal   (Followers: 9)
Neurodegenerative Diseases     Full-text available via subscription   (Followers: 1)
Neuroembryology and Aging     Full-text available via subscription   (Followers: 1)
NOVAcura     Hybrid Journal  
npj Aging and Mechanisms of Disease     Open Access   (Followers: 1)
npj Parkinson's Disease     Open Access   (Followers: 4)
Nursing Older People     Full-text available via subscription   (Followers: 9)
OA Elderly Medicine     Open Access  
Paediatrics & Child Health in General Practice     Full-text available via subscription   (Followers: 5)
Palliative Care & Social Practice     Open Access   (Followers: 3)
Parkinson's Disease     Open Access   (Followers: 12)
Pathobiology of Aging & Age-related Diseases     Open Access  
Physical & Occupational Therapy in Geriatrics     Hybrid Journal   (Followers: 56)
Quality in Ageing and Older Adults     Hybrid Journal   (Followers: 44)
Quality of Life Research     Hybrid Journal   (Followers: 20)
RASP - Research on Ageing and Social Policy     Open Access   (Followers: 4)
Revista Española de Geriatría y Gerontología     Full-text available via subscription  
Senex: Yaşlılık Çalışmaları Dergisi / Senex: Journal of Aging Studies     Open Access  
The Aging Male     Hybrid Journal   (Followers: 2)
The Gerontologist     Hybrid Journal   (Followers: 23)
The Journals of Gerontology : Series A     Hybrid Journal   (Followers: 22)
Topics in Geriatric Rehabilitation     Hybrid Journal   (Followers: 15)
Translational Medicine of Aging     Open Access  
Work, Aging and Retirement     Open Access   (Followers: 4)
Working with Older People     Hybrid Journal   (Followers: 40)
Zeitschrift fur Gerontologie und Geriatrie     Hybrid Journal   (Followers: 1)
Zeitschrift für Gerontopsychologie und -psychiatrie     Full-text available via subscription   (Followers: 1)
Zeitschrift für Palliativmedizin     Hybrid Journal  


Similar Journals
Journal Cover
Geriatric Orthopaedic Surgery Rehabilitation
Number of Followers: 5  

  This is an Open Access Journal Open Access journal
ISSN (Print) 2151-4585 - ISSN (Online) 2151-4593
Published by Sage Publications Homepage  [1174 journals]
  • Impact of a Secondary Prevention Program for Fragility Fractures at the
           Orthogeriatric Clinical Care Center at the Fundación Santa Fe de Bogotá,

    • Authors: Carlos M. Olarte, Ana M. López, Jonathan Tihanyi Feldman, Andrés Libos Zabala, Diana C. Morales, Aldo F. Patiño, Rodrigo F. Pesantez, Julián E. Salavarrieta, Valentina Sanint
      Abstract: Geriatric Orthopaedic Surgery & Rehabilitation, Volume 13, Issue , January-December 2022.
      Introduction:The presence of a fragility fracture increases the risk of new fractures. The timely and prompt initiation of treatment for osteoporosis can reduce the incidence of new fractures, for which adherence to management is a determining factor. The main objective of the study was to characterize the secondary prevention program for fragility hip fractures in patients older than 65 years, determine adherence to treatment and its effect on the appearance of new fractures in the established follow-up period.Materials and Methods:A descriptive retrospective cohort study was carried out. Patients older than 65 years with a fragility hip fracture treated by an Orthogeriatric Clinical Care Center between May 2014 and April 2020 who completed a one-year follow-up were included.Results:A final sample of 290 patients was obtained (226 women and 64 men) with an average age of 82.27 years. It was found that 84.5% of patients received indications to start osteoporotic management prior to hospital discharge and only 35.2% started the treatment in the first 6 postoperative months. 16.6% (n = 48) of patients presented a new fracture, with no significant difference between those who started their osteoporosis treatment in a timely manner. Out of the 48 patients, 5 patients (10.4%) met therapeutic failure criteria.Discussion:Most patients (84.5%) received indications for starting osteoporotic treatment before hospital discharge, nevertheless 35.2% started it during the first 6 postoperative months. 16.6% of patients presented a new fracture during follow up, of which only five met therapeutic failure criteria.Conclusions:No significant differences were found between the presence of new fractures and early initiation of osteoporotic management. However, literature shows that prompt and timely osteoporotic treatment reduces the incidence of new fractures, thus measures must be implemented to strengthen the adherence and surveillance of patients to the indicated treatment.
      Citation: Geriatric Orthopaedic Surgery & Rehabilitation
      PubDate: 2022-08-11T06:42:38Z
      DOI: 10.1177/21514593221118182
      Issue No: Vol. 13 (2022)
  • Disseminated Zoster Involving the Whole Body in an Immunocompetent Patient
           Complaining of Left Leg Radiating Pain and Weakness: A Case Report and
           Literature Review

    • Authors: Young-Seok Moon, Wan-Jae Cho, Youn-Sung Jung, Jun-Seok Lee
      Abstract: Geriatric Orthopaedic Surgery & Rehabilitation, Volume 13, Issue , January-December 2022.
      IntroductionDisseminated herpes zoster is defined as at least 20 skin lesions in multiple dermatomes. In particular, it has been reported mainly in patients with immunological defects. To our knowledge, there is no reported case of disseminated zoster in a non-immunocompromised patient with leg radiating pain and weakness.Case presentationA 74-year-old man visited our hospital with left leg radiating pain and left hip pain. He had no underlying disease other than hypertension. Neurologic examination revealed radiating pain on the L4 dermatome of the left leg. The muscle power was grade 3 for the hip flexor and knee extensor, and grade 4 for the ankle dorsiflexor and big toe dorsiflexor of the left leg. There were no sensory changes or skin lesions on his left leg. Herniation of the nucleus pulposus of the lumbar spine was suspected and lumbar magnetic resonance imaging (MRI) was performed. However, no pathologic lesions were seen on lumbar MRI. On the third day of hospitalization, erythematous patches and vesicles were observed on the head, face, ear, neck, trunk, back, and both lower extremities. Herpes zoster infection was confirmed by polymerase chain reaction analysis. Treatment was performed with 250 mg of intravenous acyclovir every 8 hours for 6 days and 62.5 mg of intravenous methylprednisolone for 4 days. On the 13th day of hospitalization, the skin lesions and left leg radiating pain and weakness improved.ConclusionWe report the first case of disseminated herpes zoster involving the whole body in a non-immunocompromised patient complaining of left leg radiating pain and weakness. After treatment, both the patient’s radiating pain and weakness improved.
      Citation: Geriatric Orthopaedic Surgery & Rehabilitation
      PubDate: 2022-08-11T03:14:33Z
      DOI: 10.1177/21514593221119619
      Issue No: Vol. 13 (2022)
  • Hip Fracture Care in Parkinson Disease: A Retrospective Analysis of 1,239

    • Authors: Fernando A. Huyke-Hernández, Sotirios A. Parashos, Lisa K. Schroder, Julie A. Switzer
      Abstract: Geriatric Orthopaedic Surgery & Rehabilitation, Volume 13, Issue , January-December 2022.
      IntroductionCompared to other patients, Parkinson disease (PD) patients may experience suboptimal outcomes after hip fracture. The purpose of this study was to describe and compare characteristics and outcomes of hip fracture patients with PD to those without PD.MethodsThis retrospective cohort study included all patients admitted for hip fracture within a large healthcare system between July 1, 2017 and June 30, 2019. Demographics, injury characteristics, Charlson Comorbidity Index (CCI), treatment characteristics, and outcomes including complications, readmissions, and mortality were extracted. Patients with PD were compared to those without PD. Chi-square tests, two-sample t-tests, and Fisher exact tests were conducted to identify group differences.ResultsA total of 1239 patients were included (4.0% PD and 96.0% non-PD). PD patients were mostly male (59.2%) compared to mostly female non-PD patients 69.4%, P < .001). PD patients on average had a higher CCI (2.3 vs 1.7, P = .040) and more frequently had dementia (42.9% vs 26.7%, P = .013). No PD patients were discharged home without additional assistance compared to 8.1% of patients without PD. More PD patients were discharged to a skilled nursing facility (SNF) than non-PD patients (65.3% vs 48.2%, P = .021). Only 22.4% of PD patients were previously prescribed osteoporosis medication, and only 16.3% were referred for osteoporosis follow-up after fracture. In-house complications, readmissions, and mortality up to 1 year were comparable between groups (P>.191).ConclusionsOutcomes between PD patients and non-PD patients were mostly equivalent, but more PD patients required discharge to a higher-level care environment compared to non-PD patients. Although PD seems to be a risk factor for hip fracture regardless of age and sex, most patients had not undergone proper screening or preventative treatment for osteoporosis. These results emphasize the need for early bone health evaluation, multidisciplinary collaboration, and care coordination in preventing and treating hip fractures in PD.
      Citation: Geriatric Orthopaedic Surgery & Rehabilitation
      PubDate: 2022-08-08T04:37:22Z
      DOI: 10.1177/21514593221118225
      Issue No: Vol. 13 (2022)
  • A Novel Osteoporosis Screening Protocol to Identify Orthopedic Surgery
           Patients for Preoperative Bone Health Optimization

    • Authors: Elliot Chang, Brian Nickel, Neil Binkley, James Bernatz, Diane Krueger, Alec Winzenried, Paul A. Anderson
      Abstract: Geriatric Orthopaedic Surgery & Rehabilitation, Volume 13, Issue , January-December 2022.
      IntroductionOsteoporosis is highly prevalent in elective orthopedic surgery. While preoperative bone health optimization decreases osteoporosis-related complications, there is an unmet need to establish who may benefit from preoperative dual-energy x-ray absorptiometry (DXA). This study assesses a novel, simple screening protocol to identify orthopedic surgical patients for preoperative DXA.Materials/MethodsThis retrospective cohort study included 628 patients undergoing total knee, hip, or shoulder arthroplasty or thoracolumbar spine fusion. Inclusion criteria were ≥40 years undergoing primary elective surgery. Screening criteria defining who should obtain DXA due to high osteoporosis risk included: female ≥65, male ≥70, fracture history when ≥50 years, or FRAX major osteoporotic fracture risk (without bone mineral density [BMD]-adjustments) ≥8.4%. Osteoporosis was defined by World Health Organization criteria [T-score ≤ −2.5], clinical National Osteoporosis Foundation (NOF) criteria [T-score ≤ −2.5, elevated BMD-adjusted FRAX risk, or prior hip/spine fracture], and modified clinical criteria [NOF criteria simplified to include any non-traumatic prior fracture and FRAX without BMD].ResultsThe study included 100 TKAs, 100 THAs, 251 TSAs, and 177 spine fusions, average age 65.6 ± 9.8. DXA was available for 209 patients. Screening criteria recommending DXA was met by 362 patients. For those with DXA, screening sensitivity was .96 (CI: .78 to .99) and specificity was .19 (CI: .14 to .25) for identifying T-score osteoporosis. Similar sensitivity of .99 (CI: .91 to .99) and specificity of .61 (CI: .56 to .66) were found for modified clinical osteoporosis. For modified clinical osteoporosis, 192 patients with osteoporosis met criteria (true pos.), 1 patient with osteoporosis did not meet criteria (false neg.), 170 patients without osteoporosis met criteria (false pos.), and 265 patients without osteoporosis did not meet criteria (true neg.).Discussion/ConclusionA simple screening protocol identifies orthopedic surgical candidates at risk of T-score or clinical osteoporosis for preoperative DXA with high sensitivity.
      Citation: Geriatric Orthopaedic Surgery & Rehabilitation
      PubDate: 2022-08-07T04:52:36Z
      DOI: 10.1177/21514593221116413
      Issue No: Vol. 13 (2022)
  • Intramedullary Nail or Primary Arthroplasty' A System Review and
           Meta-Analysis on the Prognosis of Intertrochanteric Femoral Fractures
           Based on Randomized Controlled Trials

    • Authors: Zhaojun Wang, Fei Gu, Shizhuang Xu, Yang Yue, Kefu Sun, Wei Nie
      Abstract: Geriatric Orthopaedic Surgery & Rehabilitation, Volume 13, Issue , January-December 2022.
      IntroductionThere is no consensus regarding the superiority between intramedullary nailing and primary arthroplasty in the management of intertrochanteric femoral fractures. This systematic review was performed to investigate and compare the clinical efficacy of intertrochanteric femoral fractures treated with these 2 methods.Materials and methodsWe systematically searched PubMed, Embase, Cochrane, Web of science core collection and for randomized controlled trials which compared the clinical outcomes of intertrochanteric fractures treated with either intramedullary nails or primary arthroplasty. Relevant data of the postoperative complications, reoperations, mortality and functional assessment, were pooled and presented graphically.ResultsA total of 6 trials with 427 participants were identified and included in the analyses. The pooled estimates suggested these 2 techniques have comparable risks in terms of overall complications (pooled risk ratio [RR] .80; 95% confidence interval [CI] .43 to 1.43; I2 = 79.94%), the rate of patients with orthopedic complications (RR .71, 95% CI .40 to 1.27; I2 = .00%), reoperations (RR 1.33, 95% CI .48 to 3.71; I2 = .00%), the overall mortality (RR .52; 95%CI .26 to 1.02; I2 = 31.35%) and 1-year mortality (RR .67; 95%CI .38 to 1.19; I2 = .00%). Primary arthroplasty associated with higher HHS at 3 months postoperatively (MD -21.95, 95% CI -28.29 to −15.60; I2 = 70.44%). While the difference was not significant at 6 months (MD 2.32, 95% CI -1.55 to 6.18; I2 = .00%), and even reversed at 12 months postoperatively (MD 13.02, 95% CI 8.14 to 17.90; I2 = 73.42%).ConclusionsMeta-analytic pooling of current evidences demonstrated that primary arthroplasty is related to a better early functional recovery at the early stage postoperatively, but the long-term result tends to favor to intramedullary nailing. The differences in overall complications, the rate of patients with orthopedic complications, reoperations, overall and 1-year mortality did not reach a significant level.
      Citation: Geriatric Orthopaedic Surgery & Rehabilitation
      PubDate: 2022-08-06T02:05:46Z
      DOI: 10.1177/21514593221118212
      Issue No: Vol. 13 (2022)
  • Mortality Rates in Femoral Neck Fractures Treated With Arthroplasty in
           South Africa

    • Authors: Jacobus D. Jordaan, Marilize C Burger, Shafique Jakoet, Muhammad Ahmed Manjra, Johan Charilaou
      Abstract: Geriatric Orthopaedic Surgery & Rehabilitation, Volume 13, Issue , January-December 2022.
      ObjectivesTo investigate the mortality rate for neck of femur fractures treated with arthroplasty at a tertiary level unit in South Africa and to evaluate the effect of known risk factors for mortality in neck of femur fractures treated with arthroplasty in the South African context.DesignRetrospective cohort study. The main outcome was to determine mortality rates during in hospital stay, at 3 months, 6 months 1 year post surgery. The secondary outcome was to determine factors influencing mortality at 30 days, 6 months and 12 months post-surgery.ResultsMortality rate was 3.3% in hospital, 5.6% at 30 days and 26.7% at 1 year. Age>79, ASA score>3, and cementing of the femur had statistically increased mortality risk (P < .001). Average length of hospital stay was 12.3 ± 5.1 days (range 3.0-41.0 days) with 73% of patients discharged back to pre-hospital home.ConclusionMortality rates after femur neck fracture arthroplasty in South Africa are slightly higher at 1 year compared to international data. However, the rates are comparably low during hospital stay, 30 day and at 6 months post-surgical intervals.
      Citation: Geriatric Orthopaedic Surgery & Rehabilitation
      PubDate: 2022-08-03T05:02:43Z
      DOI: 10.1177/21514593221117309
      Issue No: Vol. 13 (2022)
  • Bone/Muscle Interaction as a Good Biomarker for Lifespan and Quality

    • Authors: Arben Boshnjaku, Ermira Krasniqi
      Abstract: Geriatric Orthopaedic Surgery & Rehabilitation, Volume 13, Issue , January-December 2022.

      Citation: Geriatric Orthopaedic Surgery & Rehabilitation
      PubDate: 2022-08-03T02:17:15Z
      DOI: 10.1177/21514593221111646
      Issue No: Vol. 13 (2022)
  • Metastatic Ceruminous Adenoid Cystic Carcinoma of the Lumbar Spine Causing
           Neurological Compromise: A Case Report

    • Authors: Yi-Wei Shen, Yi Yang, Hao Liu, Zhong-Jie Zhou, Tao Li
      Abstract: Geriatric Orthopaedic Surgery & Rehabilitation, Volume 13, Issue , January-December 2022.
      BackgroundCeruminous glands are modified apocrine glands of the external auditory canal (EAC). Malignant tumours within the ceruminous glands are extremely rare, and the most common histological type is adenoid cystic carcinoma (ADCC), which has high recurrence and metastasis risks. Although a few cases of metastatic ADCC from other head and neck glands have been reported, metastatic ADCC originating from the ceruminous gland are extremely rare.Case presentationWe present an unusual case of spinal metastases of ADCC from ceruminous glands. A 61-year-old woman complaining of low back pain and both lower limbs pain was referred to our department. The primary ceruminous tumour was resected 26 years ago and recurred 6 years later, which was treated by radiotherapy. Three years ago, she presented with low back pain and was diagnosed as multiple lungs and bone metastases. The patient underwent tumour excision, decompression and fusion. The biopsy revealed metastatic ADCC. The symptoms were alleviated after surgery.ConclusionsADCC of EAC is a pernicious malignant tumour that is characterized by slow-growing patterns and a high predisposition to recurrence and metastasis. Differential diagnoses of ADCC and benign tumours in the EAC are challenging, particularly at early stages. We report a rare case of ceruminous ADCC with a prolonged clinical history as well as spinal metastasis and highlight the significance of regular follow-ups for patients undergoing tumour excision in the EAC.
      Citation: Geriatric Orthopaedic Surgery & Rehabilitation
      PubDate: 2022-07-16T09:21:50Z
      DOI: 10.1177/21514593221111357
      Issue No: Vol. 13 (2022)
  • Comparison Between Femoral Neck Systems and Cannulated Cancellous Screws
           in Treating Femoral Neck Fractures: A Meta-Analysis

    • Authors: Peng Tian, Lan Kuang, Zhi-jun Li, Gui-jun Xu, Xin Fu
      Abstract: Geriatric Orthopaedic Surgery & Rehabilitation, Volume 13, Issue , January-December 2022.
      BackgroundWe performed a meta-analysis to compare the efficacy and safety of the femoral neck system (FNS) with cannulated cancellous screws (CCSs) in treating femoral neck fractures (FNFs) in controlled clinical trials.MethodsEligible scientific articles published prior to September 2021 were retrieved from the PubMed, Web of Science, Springer, ScienceDirect and Cochrane Library databases. The statistical analysis was performed with RevMan 5.1.ResultsSeven retrospective studies met the inclusion criteria. Meta-analysis showed that there were significant differences in perioperative blood loss, the postoperative Harris score, healing time, fluoroscopy frequency, total complications, femoral head necrosis, femoral neck shortening and screw cutout. No significant differences were found regarding operation time, length of hospital stay or nonunion between the two groups.ConclusionCompared with CCSs, the FNS showed better clinical efficacy and fewer complications in treating FNFs. Due to the limited quality and data of the currently available evidence, more high-quality randomized controlled trials are needed.
      Citation: Geriatric Orthopaedic Surgery & Rehabilitation
      PubDate: 2022-07-06T05:22:00Z
      DOI: 10.1177/21514593221113533
      Issue No: Vol. 13 (2022)
  • The Impact of the Fascia Iliaca Block Beyond Perioperative Pain Control in
           Hip Fractures: A Retrospective Review

    • Authors: David J. Houserman, Jesse A. Raszewski, Brandi Palmer, Bhakti Chavan, Abby Sferrella, Melody Campbell, Steven Santanello
      Abstract: Geriatric Orthopaedic Surgery & Rehabilitation, Volume 13, Issue , January-December 2022.
      BackgroundGeriatric hip fractures are common injuries that are associated with high morbidity and mortality. Adequate pain control remains a challenge as the altered physiology in elderly patients makes use of traditional analgesics challenging. The use of regional anesthetics, specifically the fascia iliaca compartment block (FICB), in the perioperative period has been shown to decrease opioid use in this population. This study aimed to investigate the effect the FICB had on pain control, length of stay, readmissions, and complications in a 30-day postoperative period.MethodsThis was a retrospective cohort study comparing patients who sustained hip fractures; one cohort (110 patients) received a preoperative fascia iliaca block with continuous infusion (FICB), whereas the other cohort (110 patients) did not receive a block (NO-FICB). Both cohorts were from level II trauma centers. Data were collected between 2016 and 2019. Descriptive statistics was performed to describe and summarize the data. Bivariate analysis was performed using chi-square test, with 2 tailed P-values ≤ .05 were considered statistically significant.ResultsThe FICB group had a lower length of stay (3.9 days vs 4.8 days; P < .001), and lower pain scores on post-operative days 2 and 3 (P = .019). There was no difference in time from admission to surgery (P = .112) or narcotic use between cohorts (P = .304). However, the FICB group was more likely to discharge to a skilled nursing facility (P=.002), and more likely to be readmitted within 30 days (P = .047). There were no differences in medical complications or mortality between the 2 groups.ConclusionsThe primary study endpoint, length of stay, was found to be significantly shorter in the patients who underwent the FICB vs the group who did not undergo the FICB. Pain scores on POD2 and POD3 were lower in patients who received a FICB. This study adds to the body of evidence that the FICB is an effective addition to a multimodal pain pathway.Level of EvidenceLevel III Evidence – Retrospective Cohort Study
      Citation: Geriatric Orthopaedic Surgery & Rehabilitation
      PubDate: 2022-06-30T11:43:53Z
      DOI: 10.1177/21514593221099107
      Issue No: Vol. 13 (2022)
  • The Definition of the Term “Orthogeriatric Infection” for
           Periprosthetic Joint Infections

    • Authors: Nike Walter, Markus Rupp, Susanne Bärtl, Claus Uecker, Volker Alt
      Abstract: Geriatric Orthopaedic Surgery & Rehabilitation, Volume 13, Issue , January-December 2022.
      IntroductionIn the background of the aging population, an increase of geriatric patients with specific age-related co-morbidities has already been seen over the years for proximal femur fractures in orthopaedic surgery as well as other medical disciplines. However, the geriatric aspect has not been well recognized in periprosthetic joint infection (PJI) patients so far. Therefore, this paper seeks to provide an overview on the co-morbidities of PJI patients with respect to the definition of geriatric patients.Material and methodsIn this single-center retrospective study, patients treated between 2007 and 2020 for PJI were included (n = 255). Patients were defined as geriatric according to the consensus definition criteria of the Federal Working Group of Clinical Geriatric Facilities e.V., the German Society for Geriatrics e.V. and the German Society for Gerontology and Geriatrics e.V. based on age (≤70 years), geriatric multimorbidity and the Barthel index (≤30).ResultsApplying the criteria defined 184 of the 255 (72.2%) PJI patients as geriatric infection patients. Regarding geriatric comorbidity, incontinence was most prevalent (38.1%), followed by immobility (25.6%). Comparing the geriatric infection patients with those classified as non-geriatric (n = 71) revealed that geriatric patients had a longer hospital stay and spent more days in the intensive care unit (ICU). Also, the amputation rate and the 5-year mortality rate was significantly increased (n = 15, 8.2% vs n = 1, 1.4%, P = .007 and n = 24, 13.0% vs n = 5, 7.0%, P = .005). The Barthel index showed a significant correlation with mortality (r = −.22, P = .011).DiscussionWe propose to use the term orthogeriatric infection patients in those cases in order to focus treatment not only on the orthopaedic infections but also on the important geriatric aspects.ConclusionThe inclusion of geriatric physicians into the multidisciplinary team approach for PJI patients might be beneficial.
      Citation: Geriatric Orthopaedic Surgery & Rehabilitation
      PubDate: 2022-06-30T09:51:53Z
      DOI: 10.1177/21514593221111649
      Issue No: Vol. 13 (2022)
  • Comparison of Femoral Nerve Block and Fascia Iliaca Block for Proximal
           Femoral Fracture in the Elderly Patient: A Meta-analysis

    • Authors: Xiao-dan Li, Chao Han, Wen-li Yu
      Abstract: Geriatric Orthopaedic Surgery & Rehabilitation, Volume 13, Issue , January-December 2022.
      IntroductionPain management modalities after proximal femoral fracture are variable and have been studied extensively. Regional anesthesia, specifically femoral nerve (FNB) and fascia iliaca compartment blocks (FICB), can be used to provide analgesia preoperatively.MethodsSystematic searches of all related literature were conducted in the Medline, Embase, and Cochrane Central Register of Controlled Trials databases. Randomized controlled trials (RCTs) of proximal femoral fractures were included. The pain scores at different time points, opioid requirement in 24 h, mean arterial pressure, time for spinal anesthesia, patient satisfaction, and incidence of side effects between the 2 groups were extracted throughout the study.ResultsFifteen RCTs including 1240 patients met the inclusion criteria. The present meta-analysis indicated that compared with FNB, FICB could decrease the visual analog scale (VAS) scores at 4 h after surgery (P < .05). The incidence of side effects (nausea, vomiting, and sedation) was lower in the FNB group (P < .05). Compared to the FICB, no significant difference was found at any other observed time point. Additionally, no difference was found in opioid requirement at 24 h, mean arterial pressure, time for spinal anesthesia, or patient satisfaction (P> .05).ConclusionsFICB demonstrates a reduction in VAS score at 4 while FNB decreases the risk of several adverse events. More high-quality RCTs are necessary for proper comparison of the efficacy and safety of FNB and FICB.
      Citation: Geriatric Orthopaedic Surgery & Rehabilitation
      PubDate: 2022-06-27T11:10:13Z
      DOI: 10.1177/21514593221111647
      Issue No: Vol. 13 (2022)
  • Efficacy and Safety of Posterior Long-Segment Fixation Versus Posterior
           Short-Segment Fixation for Kummell Disease: A Meta-Analysis

    • Authors: Yikang Yu, Hanbing Zeng, Enpin Guo, Binbin Tang, Yuan Fang, Lianguo Wu, Chao Xu, Yi Peng, Bin Zhang, Zhen Liu
      Abstract: Geriatric Orthopaedic Surgery & Rehabilitation, Volume 13, Issue , January-December 2022.
      PurposePosterior short-segment fixation (SSF) and long-segment fixation (LSF) are two methods for the treatment of Kummell disease, but the safety and effectiveness of these two surgical methods still lack adequate medical evidence. This study aimed to evaluate the two methods.MethodsDatabase searches for randomized controlled trials, case-control studies, and cohort studies of posterior SSF and posterior LSF in the treatment of Kummell disease were performed. After the document quality was evaluated with the Newcastle-Ottawa Quality Assessment Scale, a meta-analysis was carried out.ResultsMeta-analysis revealed that the operation time and intraoperative blood loss in the LSF group were higher than those in the SSF group [MD = −18.17, 95% CI (−30.31, −6.03), z = 2.93, P = .003; MD = −82.07, 95% CI (−106.91, −57.24], z = 6.48, P < .00001). The postoperative last follow-up local kyphosis angle in the SSF group was greater than that in the LSF group (MD = 3.18, 95% CI [.56, 5.81], z = 2.38, P = .02), and there were no significant differences in perioperative complications, bone cement leakage rate, incidence of adverse events during follow-up, postoperative follow-up visual analog scale, postoperative Oswestry dysfunction index, and postoperative immediate local kyphosis angle between the two groups (P> .05).ConclusionSSF and LSF are effective and safe for the treatment of Kummell disease. SSF can reduce the operation time and intraoperative bleeding; LSF can better maintain the long-term stability of kyphosis. The methods should be evaluated by clinicians according to the individual situation of the patients.
      Citation: Geriatric Orthopaedic Surgery & Rehabilitation
      PubDate: 2022-06-13T05:29:48Z
      DOI: 10.1177/21514593221107509
      Issue No: Vol. 13 (2022)
  • Efficacy of Oral Nutritional Supplements in Patients Undergoing Surgical
           Intervention for Hip Fracture

    • Authors: Itay Ashkenazi, Dani Rotman, Nissan Amzalleg, Nadav Graif, Amal Khoury, Tomer Ben-Tov, Ely Steinberg
      Abstract: Geriatric Orthopaedic Surgery & Rehabilitation, Volume 13, Issue , January-December 2022.
      Introduction: Malnutrition is considered a risk factor among geriatric individuals with hip fracture, affecting functional healing and recovery, increasing healthcare spending, and associated with high mortality. In this study, we sought to evaluate the clinical efficacy of oral nutritional supplements in geriatric patients undergoing surgery for hip fracture. Material and Methods: We retrospectively analyzed data of 1625 consecutive patients who underwent fixation or arthroplasty for hip fracture in a tertiary medical center between 2017 and 2020. Patients who had no available albumin or body mass index levels were excluded. The study group is of patients who received an advanced formula in the form of an oral nutritional supplement (ONS), and the control group of patients that received no ONS. Peri- and postoperative complications, readmissions, short-term mortality, and albumin levels were compared between the 2 groups. Results: The final cohort included 1123 patients, 298 in the study group and 825 controls, with a follow-up of at least 1-year. Provision of the advanced enriched formula was not associated with 30-day, 90-day, or 1-year mortality (P = .62, P = .52, and P = .72, respectively) or any perioperative complications, such as 30-day or 90-day readmission (P = .37 and P = .1, respectively), revision surgery of any cause (P = .35), and postoperative infection rates (P = .73). Albumin levels on admission and the minimum albumin levels during hospitalization were similar between the groups, but they were significantly higher in the study group before discharge (33.42 g/L vs. 32.79 g/L, P = .01). Discussion: The use of an ONS was not associated with reduced perioperative complications or mortality, although it did affect nutritional status, as indicated by increased albumin levels, a known marker of nutritional status. Conclusions. While current findings do not support ONS use to minimize major postoperative complication after hip fracture surgery, further long-term study is warranted to evaluate subjective and functional outcomes associated with improved nutritional status.
      Citation: Geriatric Orthopaedic Surgery & Rehabilitation
      PubDate: 2022-05-20T02:58:24Z
      DOI: 10.1177/21514593221102252
      Issue No: Vol. 13 (2022)
  • Sarcopenia and Its Association With Change of Bone Mineral Density and
           Functional Outcome in Old-Aged Hip Arthroplasty Patients

    • Authors: Suc-hyun Kweon, Jin sung Park, Byung Ha Park
      Abstract: Geriatric Orthopaedic Surgery & Rehabilitation, Volume 13, Issue , January-December 2022.
      AimThis study aimed to investigate the relationship between sarcopenia and change in bone mineral density (BMD) and functional outcome in hip arthroplasty patients. Methods: Among the 221 patients who had undergone hip arthroplasty, 147 patients were enrolled. All patients were divided into 2 groups according to presence of sarcopenia. Bone mineral density (BMD) at hospitalization and 1-year after surgery and Barthel index was measured at the time of before injury, hospitalization, 3 months and 1-year after surgery. Results: BMD at hospitalization showed .627 ± .082 (g/cm2) in Sarcopenia and .726 ± .059 (g/cm2) in Non-sarcopenia at femur (total) site (P < .001), .531 ± .085 (g/cm2) vs .629 ± .057 (g/cm2) at femur neck site (P=.002), .715 ± .084 (g/cm2) vs .807 ± .058 (g/cm2) at lumbar (L1-L4) site (P < .001). BMD at 1-year follow-up period, Sarcopenia showed .626 ± .082 (g/cm2) and Non-sarcopenia showed .725 ± .060 (g/cm2) at femur (total) site (P < .001), .530 ± .085 (g/cm2) vs .629 ± .058 (g/cm2) at femur neck site (P < .001), .715 ± .084 (g/cm2) vs .806 ± .058 (g/cm2) at lumbar (L1-L4) site (P < .001). Change of BMD showed −.01 ± .25% for Sarcopenia and −.15 ± .47% for Non-sarcopenia in femur (total) site (P=.089), −.08 ± .63% vs −.01 ± 1.01% in femur neck site (P = .058), .00 ± .09% vs −.12 ± .33% for each group in lumbar (L1-L4) site (P = .052). Barthel index score showed 79.94 ± 5.66 for Sarcopenia and 84.74 ± 5.36 for Non-sarcopenia at pre-injury status (P < .001), 33.89 ± 4.94 vs 33.87 ± 5.36 at the time of hospitalization (P = .977), 57.42 ± 7.19 vs 60.06 ± 5.39 at 3 months follow up (P = .015), 73.86 ± 5.94 vs 80.71 ± 4.81 for each group at 1-year follow up (P < .001). Conclusions: Our study found that the sarcopenia showed lower BMD than the non-sarcopenia, but there was no significant difference of BMD change in the follow-up period. In addition, the sarcopenia showed poor functional results at all points except at the time of hospitalization.
      Citation: Geriatric Orthopaedic Surgery & Rehabilitation
      PubDate: 2022-05-16T09:23:15Z
      DOI: 10.1177/21514593221092880
      Issue No: Vol. 13 (2022)
  • Management of Haemarthrosis in Patients On Oral Anticoagulants

    • Authors: James Dalrymple, Andrew Davies, Alexandra Biggs, Shahil Rajcoomar, Ian Gill
      Abstract: Geriatric Orthopaedic Surgery & Rehabilitation, Volume 13, Issue , January-December 2022.
      AimsOur aim was to investigate the management of patients who were admitted to hospital with an acute haemarthrosis whilst taking oral anticoagulants, and highlight the outcomes of different management strategies.MethodsA retrospective review was performed of all orthopaedic admissions over a 42-month period (January 2015–July 2018) to the Orthopaedic Department of a London District General Hospital. All patients admitted with a spontaneous joint haemarthrosis and concomitant use of oral anticoagulants was identified. Anonymised data was placed on a secure trust database.FindingsA total of 31 patients were included. 22 patients (71%) had their anticoagulant temporarily held during admission. 9 patients (32%) had their anticoagulation reversed with 10 mg of vitamin K. 5 patients had their haemarthrosis aspirated either on admission or during their hospital stay. The overall mean length of stay in patients with a haemarthrosis was 7.0 days. The mean length of stay in patients who had their anticoagulation held was 8.6 days. In contrast, patients who continued taking their anticoagulation were found to have an average length of stay of 2.3 days. No patients suffered a thrombotic event in the 60 days following discharge. No adverse events were recorded following joint aspiration.ConclusionThere is currently no consensus on the management of haemarthrosis in patients on oral anticoagulants. Continuing the anticoagulants did not increase length of hospital stay. Further research may focus on assessing the effect of management adjuncts on patient outcomes and their cost effectiveness to aid the development of local and/or national guidelines.
      Citation: Geriatric Orthopaedic Surgery & Rehabilitation
      PubDate: 2022-05-11T01:20:09Z
      DOI: 10.1177/21514593221076966
      Issue No: Vol. 13 (2022)
  • Treatment Algorithm of Periprosthetic Femoral Fracturens

    • Authors: Nicola Mondanelli, Elisa Troiano, Andrea Facchini, Roberta Ghezzi, Martina Di Meglio, Nicolò Nuvoli, Giacomo Peri, Pietro Aiuto, Giovanni Battista Colasanti, Stefano Giannotti
      Abstract: Geriatric Orthopaedic Surgery & Rehabilitation, Volume 13, Issue , January-December 2022.
      Introduction. The ever-expanding indications for total hip arthroplasty are leading to more implants being placed in younger as well as in older patients with high functional demand. Also, prolonged life expectancy is contributing to an overall increment of periprosthetic femoral fractures. The Vancouver classification has been the most used for guiding the surgeon choice since its proposal in 1995. Fractures occurring over a hip femoral implant can be divided into intra-operative and post-operative PFFs, and their treatment depends on factors that may severely affect the outcome: level of fracture, implant stability, quality of bone stock, patients’ functional demand, age and comorbidities, and surgeon expertise. There are many different treatment techniques available which include osteosynthesis and revision surgery or a combination of both. The goals of surgical treatment are patients’ early mobilization, restoration of anatomical alignment and length with a stable prosthesis and maintenance of bone stock. Significance. The aim of this review is to describe the state-of-the-art treatment and outcomes in the management of PFFs. We performed a systematic literature review of studies reporting on the management of PFFs around hip stems and inter-prosthetic fractures identifying 45 manuscripts eligible for the analysis. Conclusions. PFFs present peculiar characteristic that must be considered and special features that must be addressed. Their management is complex due to the extreme variability of stem designs, the possibility of having cemented or uncemented stems, the difficulty in identifying the “real” level of the fracture and the actual stability of the stem. As a result, the definition of a standardized treatment is unlikely, thereby high expertise is fundamental for the surgical management of PPFs, so this kind of fractures should be treated only in specialized centres with both high volume of revision joint arthroplasty and trauma surgery.
      Citation: Geriatric Orthopaedic Surgery & Rehabilitation
      PubDate: 2022-05-10T11:53:05Z
      DOI: 10.1177/21514593221097608
      Issue No: Vol. 13 (2022)
  • Peri-Articular Injection of Tranexamic Acid Reduce Blood Loss and
           Transfusion Requirement During Total Knee Arthroplasty: A Meta-analysis

    • Authors: Yue Liu, Duo Shan, Peng Tian, Zhi-jun Li, Gui-jun Xu, Xin Fu
      Abstract: Geriatric Orthopaedic Surgery & Rehabilitation, Volume 13, Issue , January-December 2022.
      BackgroundThe aim of this meta-analysis was to evaluate the efficacy and safety of peri-articular injection of tranexamic acid (TXA) during total knee arthroplasty (TKA) from clinical controlled trials.MethodEligible scientific articles published prior to October 2021 were retrieved from the PubMed, Springer, ScienceDirect and Cochrane Library databases. The statistical analysis was performed with RevMan 5.1.Result2 RCTs and 3 non-RCTs met the inclusion criteria. Meta-analysis showed significant differences in terms of hemoglobin reduction (MD = −1.04, 95% CI: −1.33 to −.76, P < .00001), total blood loss (MD = −342.80.70, 95% CI: −437.52 to −248.08, P < .00001), drainage volume (MD = −297.24, 95% CI: −497.26 to −97.23, P = .004) and blood transfusion rate (OR = .30, 95% CI: .14 to .62, P = .001) were found in the control group. No postoperative infection and deep venous thrombosis were found between 2 groups.ConclusionPeri-articular injection of TXA can effectively decrease perioperative blood loss and blood transfusion rate without increasing the incidence of postoperative complications during TKA.
      Citation: Geriatric Orthopaedic Surgery & Rehabilitation
      PubDate: 2022-05-09T11:17:42Z
      DOI: 10.1177/21514593221101264
      Issue No: Vol. 13 (2022)
  • COVID-19 Is Associated With a 4 Fold Increase in 30-day Mortality Risk in
           Hip Fracture Patients in the United Kingdom: A Systematic Review and

    • Authors: Saleem Mastan, Ghazal Hodhody, Mohammed Sajid, Rayaz Malik, Charalambos Panayiotou Charalambous
      Abstract: Geriatric Orthopaedic Surgery & Rehabilitation, Volume 13, Issue , January-December 2022.
      BackgroundHip fracture in elderly patients is associated with a significant mortality which may be worsened by COVID-19 infection.ObjectiveTo undertake a systematic review and meta-analysis of studies assessing the effect of COVID-19 infection and mortality rates in hip fracture patients in the United Kingdom (UK) during the first surge of the pandemic.DesignA systematic literature search of 9 online databases was undertaken independently by 2 reviewers using the Cochrane methodology for systematic reviews. Eligibility criteria were any study of an adult population with a hip fracture that assessed the relationship between COVID-19 infection and 30-day mortality in the UK. Meta-analysis was conducted using a random-effects model.ResultsOut of 309 identified articles, 10 studies reporting on 2448 hip fracture patients met the inclusion criteria. Meta-analysis showed that the estimated mortality rate in patients with laboratory confirmed COVID-19 infection was 32.5% (95% CI= 28.3 to 37.0) compared to 8.6% (95% CI= 6.3 to 11.6) in COVID-19 negative patients. Meta-analysis of 9 comparative studies showed a significantly higher mortality in patients with laboratory confirmed COVID-19 infection as compared to patients without (RR=3.937, 95% CI= 2.867 to 5.406, P
      Citation: Geriatric Orthopaedic Surgery & Rehabilitation
      PubDate: 2022-05-07T08:59:48Z
      DOI: 10.1177/21514593221099375
      Issue No: Vol. 13 (2022)
  • The Short-Term Changes of the Sagittal Spinal Alignments After Acute
           Vertebral Compression Fracture Receiving Vertebroplasty and Their
           Relationship With the Change of Bathel Index in the Elderly

    • Authors: Wen-Chin Su, Wen-Tien Wu, Cheng-Huan Peng, Tzai-Chiu Yu, Ru-Ping Lee, Jen-Hung Wang, Kuang-Ting Yeh
      Abstract: Geriatric Orthopaedic Surgery & Rehabilitation, Volume 13, Issue , January-December 2022.
      IntroductionFragility vertebral compression fractures (VCFs) are of major concern due to aging populations worldwide, which may occur after a fall from standing or due to severe osteoporosis, impacting greatly the life quality of the elderly. This study thus determined the factors independently associated with poor functional recovery from a new VCF and changes in sagittal spinal alignment after vertebroplasty in elderly patients with osteoporosis.Materials and MethodsThe data were collected from patients older than 70 years and diagnosed with a new VCF. Logistic regression analysis was performed to determine factors independently associated with function and radiographic status.ResultsWe enrolled 8 male and 34 female patients with a mean age of 80.74 ± 8.31 years between January and July 2020. Compared with preoperative data, post-vertebroplasty lumbar sagittal alignments and functional scores improved significantly, and function recovered gradually over 12 weeks. Climbing stairs was the most influential performance indicator at the beginning of the recovery process. At each postoperative follow-up, changes in the C7-sacrum sagittal vertical axis exhibited an influence on functional recovery. Male patients were better able to move from a chair to a bed at the 2-week postoperative follow-up, and positive changes in the spino-sacral angle led to improved function in terms of stair climbing at the 6-week postoperative follow-up.ConclusionsVertebroplasty seemed to be effective for functional recovery related to sagittal spinal alignment improvement of the elderly with VCFs during postoperative 12 weeks, which may be a critical stage for the recovery for their life activities. The recovery rate for stair climbing after vertebroplasty was slower than for the other functional performance indicators in our study. In addition, if a patient was unable to demonstrate a marked improvement in sagittal alignment, they were likely to have ongoing impaired function and a poor prognosis after surgery.
      Citation: Geriatric Orthopaedic Surgery & Rehabilitation
      PubDate: 2022-05-06T08:10:44Z
      DOI: 10.1177/21514593221100238
      Issue No: Vol. 13 (2022)
  • Establishment and Validation of a Nomogram for the Risk of New Vertebral
           Compression Fractures After Percutaneous Vertebroplasty in Patients With
           Osteoporotic Vertebral Compression Fractures: A Retrospective Study

    • Authors: FuCheng Bian, GuangYu Bian, YongSheng An, DaYong Wang, JinHui Fang
      Abstract: Geriatric Orthopaedic Surgery & Rehabilitation, Volume 13, Issue , January-December 2022.
      PurposeNew vertebral compression fractures(NVCFs) after minimally invasive surgery in patients with osteoporotic vertebral compression fracture (OVCF) is a challenging issue worldwide. Predicting the occurrence of NVCFs is key to addressing such questions. Therefore, we aimed to investigate the risk factors for patients who developed NVCFs after undergoing surgical treatment and establish a nomogram model to reduce the occurrence of NVCFs.MethodsThis study is a retrospective analysis that collected the general characteristics and surgical features of patients who underwent surgical treatment at 2 central institutions between January 2017 and December 2020. Patients were divided into training and testing sets based on the presence or absence of NVCFs. Independent risk factors for NVCFs were obtained in the training set of patients, and then a nomogram model was constructed. Internal and external validation of the nomogram model was performed using the consistency index (C index), receiver operating characteristic curve(ROC), calibration curves, and decision curve analysis (DCA).ResultsA total of 562 patients were included in this study. Patients from the first center were used for nomogram construction and internal validation, and patients from the second center were used as an external validation population. Multivariate regression analysis showed that age, Hounsfield unit (Hu) value, cement leakage, and thoracolumbar (TL) junction fracture were independent risk factors for NVCFs after minimally invasive surgery. The C index was .85, and the validation of internal and external validation shows that the predicted values of the established model is in good agreement with the actual values.ConclusionsIn this study, 4 independent risk factors were obtained by regression analysis, and a nomogram model was constructed to guide clinical work. The application of this model can help surgeons to make more accurate judgments to prevent the occurrence of NVCFs.
      Citation: Geriatric Orthopaedic Surgery & Rehabilitation
      PubDate: 2022-05-04T06:00:51Z
      DOI: 10.1177/21514593221098620
      Issue No: Vol. 13 (2022)
  • Use of the Locking Attachment Plate for Internal Fixation of
           Periprosthetic Femur Fractures

    • Authors: Bryce Wall, Jeffrey B Stambough, Steven M. Cherney, Simon C Mears
      Abstract: Geriatric Orthopaedic Surgery & Rehabilitation, Volume 13, Issue , January-December 2022.
      IntroductionThe locking attachment plate (LAP) can be added to a locking compression plate (LCP) to allow the fixation of locking screws bicortically around a femoral implant. We aimed to examine surgical and fracture characteristics associated with healing for periprosthetic femur fractures (PPFFx) treated with constructs employing LAP fixation. We hypothesize that the addition of an LAP provides stable peri-implant fixation.Materials &MethodsWe retrospectively reviewed a consecutive series of 28 PPFFx surgically treated with LCP-LAP constructs by 4 surgeons from 2015-2020. Fractures were classified and grouped using the Vancouver Classification System and included 12 B1, 2 B2, 11 C fractures, and 3 fractures around other stemmed implants. Primary outcome measures included hardware failure such as screw pullout, broken screws, and plate fracture. Clinical complications including infection, non-union, malunion, and reoperation were recorded.ResultsNo LAP failures, screw pullout, or broken screws were observed. Two fractured plates (7.1%) occurred in patients with Vancouver C fracture types. Overall complication rate was 17.9% and included 3 non-unions, 1 deep infection, and 1 implant loosening with painful hardware, each requiring reoperation. Differences were observed between unions and nonunions for total number of screws (12.4 vs 14.7, P = .005) and number of locking screws used (8.04 vs 11.3, P = .03).ConclusionThe LAP provides adequate fixation and low failure rates where fixation is required around a well-fixed stem. When failures occur, it is from plate breakage and not due to failure of fixation at the area of plate-stem overlap.
      Citation: Geriatric Orthopaedic Surgery & Rehabilitation
      PubDate: 2022-05-04T04:07:42Z
      DOI: 10.1177/21514593221100417
      Issue No: Vol. 13 (2022)
  • Progressive Resistance Training Program Characteristics in Rehabilitation
           Programs Following Hip Fracture: A Meta-Analysis and Meta-Regression

    • Authors: Ailar Ramadi, Victor E Ezeugwu, Sydnie Weber, Martha Funabashi, Camila Astolphi Lima, Monica Rodrigues Perracini, Lauren A Beaupre
      Abstract: Geriatric Orthopaedic Surgery & Rehabilitation, Volume 13, Issue , January-December 2022.
      Introduction: Older adults often experience incomplete recovery after a hip fracture. Rehabilitation programs with progressive resistance training are associated with improved functional recovery. This systematic review and meta-analysis with meta-regression a) evaluated resistance training characteristics reported in hip fracture rehabilitation programs, b) performed meta-analysis of resistance training impact on strength (primary outcome), gait and physical activity (secondary outcomes), and c) explored resistance training program characteristics associated with improved outcomes using meta-regression. Materials and Methods: Medline, EMBASE, CINAHLPLUS, and Web of Science Core Collection databases were searched (January2000–February2021). Randomized controlled trials including progressive resistance training rehabilitation programs after hip fracture surgery in adults ≥50 years old were included. Meta-analyses and exploratory meta-regression were performed. Results: Meta-analysis showed significant increases in strength (10 trials-728 participants; Standardized Mean Difference (SMD) [95%CI]; .40 [.02, .78]) immediately following program completion in intervention relative to control participants. Meta-analysis on 5 trials (n = 384) with extended follow up found no significant group differences (SMD = .47 [-.28, 1.23]) in strength. Center-based relative to home-based programs were associated with significantly greater improvements in strength (P < .05) as were programs where resistance training intensity was prescribed using one-repetition maximum relative to other exercise prescription methods (P < .05). In gait meta-analysis (n = 10 trials-704 participants), gait speed in intervention participants immediately after the program was significantly higher than control (SMD = .42 [.08, .76]) but this finding was not maintained in extended follow-up (n = 5 trials-240 participants; SMD = .6 [-.26, .38]). Higher resistance training intensity was associated with significant improvements in gait speed (P < .05). No meta-analysis was performed for the 3 heterogeneous studies reporting physical activity. Discussion: Progressive resistance training improved muscle strength and gait speed after hip fracture surgery in adults ≥50years old immediately after the program ended, but the longer-term impact may be more limited. Conclusions: Higher resistance training intensity and center-based programs may be associated with more improvement, but require further research.
      Citation: Geriatric Orthopaedic Surgery & Rehabilitation
      PubDate: 2022-05-02T05:20:30Z
      DOI: 10.1177/21514593221090799
      Issue No: Vol. 13 (2022)
  • Encouragement for Further Study of Tranexamic Acid Administration for
           Sacroiliac Joint Fusion Surgery

    • Authors: Ryan S. Beyer, Matthew J. Hatter, Daniel Streetman
      Abstract: Geriatric Orthopaedic Surgery & Rehabilitation, Volume 13, Issue , January-December 2022.
      TO THE EDITOR: We read with great interest the article by Huynh et al.regarding the association between tranexamic acid (TXA) and blood loss in patients undergoing surgical treatment for hip fracture (Huynh PAN, Miller M, Will R. Intravenous Tranexamic Acid Decreases Blood Transfusions and Blood Loss for Patients with Surgically Treated Hip Fractures. Geriatric Orthopedic Surg Rehabil. 2021). The authors illustrated, via retrospective chart review of 505 patients who were surgically treated for hip fractures, that patients administered TXA had statistically significant decreases in perioperative blood loss and reduced relative risk of transfusion. Huynh et al. reported no statistically significant increases in thromboembolic events in patients given TXA. Mechanistically, TXA is a synthetic anti-fibrinolytic that competitively inhibits the plasminogen activation pathway. By preventing activated plasmin from de-stabilizing the fibrin matrix, TXA promotes clot formation. Given the anti-fibrinolytic effects of TXA, concerns in the literature exist regarding its use being associated with increased risk for thromboembolic events. However, it is important to note the complication profile associated with TXA is minimal, as elucidated by Brown et al., specifically finding that no patients who were administered TXA perioperatively experienced a thromboembolic event (or at least, there were no reports of thromboembolism or any other adverse events). While administration of TXA may theoretically increase the risk for thrombosis, Brown et al. showed this does not seem to occur in spinal laminectomy and fusion with posterior instrumentation. Similarly, in a systematic review of the literature describing TXA use in intracranial tumor resection, this study revealed a statistically significant reduction in the need for intraoperative blood transfusion in patients administered TXA. Upon consideration of postoperative outcomes, no significant increase in complication rate was found. This evidence in the existing literature on TXA use in orthopedic, spinal, and cranial neurosurgery exemplifies the wide potential of TXA for reducing blood loss with minimal complications in surgical procedures, especially involving the craniospinal axis.
      Citation: Geriatric Orthopaedic Surgery & Rehabilitation
      PubDate: 2022-04-29T09:37:55Z
      DOI: 10.1177/21514593221098606
      Issue No: Vol. 13 (2022)
  • Comparison of Unipedicular and Bipedicular Percutaneous Kyphoplasty for
           Kummell’s Disease

    • Authors: Dan Pan, Dayong Chen
      Abstract: Geriatric Orthopaedic Surgery & Rehabilitation, Volume 13, Issue , January-December 2022.
      Objective:To compare the clinical efficacy of unipedicular and bipedicular percutaneous kyphoplasty (PKP) for Kummell’s disease.Methods:A retrospective study was performed to review 40 patients with stage I and II Kummell’s disease who underwent PKP in our hospital from January 2015 to June 2018. Based on the transpedicular approach of PKP, those patients were randomly divided into unipedicular group (n = 19) and bipedicular group (n = 21). Operative time, bone cement injection volume and cement leakage rate were compared in the two groups. Pre- and post-operative visual analogue score (VAS), local kyphotic angle and average vertebral height were also evaluated.Results:All patients underwent surgery successfully. Compared with preoperative condition, VAS was significantly decreased at 1 day after operation and the last follow-up in both groups (P < .05), and local kyphotic angle and average vertebral height were restored markedly (P < .05). Operative time of both groups had no significant difference (P> .05). Bone cement injection volume was larger in bipedicular group (P < .05). At 1 day after operation and the last follow-up, the local kyphotic angle and average vertebral height in bipedicular group were restored better than those in unipedicular group (P < .05). There were 4 cases of cement leakage in both groups, with leakage rates of 21.1% and 19.0%, respectively, and the difference was not significant (P> .05).Conclusion:Both unipedicular and bipedicular PKP are effective for treating patients with stage I and II Kummell’s disease, while postoperative pain relief and imaging results in bipedicular group were better than those in unipedicular group.
      Citation: Geriatric Orthopaedic Surgery & Rehabilitation
      PubDate: 2022-04-29T07:45:47Z
      DOI: 10.1177/21514593221099264
      Issue No: Vol. 13 (2022)
  • Epidemiology of Fragility Pubic Ramus Fractures in the United States

    • Authors: Nishant Suneja, Ryan M Kong, Olivia C Tracey, Zachary Mallon, Eric H. Tischler
      Abstract: Geriatric Orthopaedic Surgery & Rehabilitation, Volume 13, Issue , January-December 2022.
      IntroductionPrevious studies illustrate significant increases in pelvic fracture incidence; however, there is a paucity of information on the incidence of osteoporotic pelvic ring injuries based on large-scale examinations of geographically and ethnically diverse populations. This study addresses the epidemiology of osteoporotic pubic ramus fractures in the United States and details differences in incidence rates with respect to age, gender, and race.Materials and MethodsNational Electronic Injury Surveillance System (NEISS) data between 2002 and 2019 was gathered for individuals aged 60 and above presenting to U.S. emergency departments with ramus fractures. Incidence rates for ramus injuries were calculated using adjusted U.S. Census Bureau estimates of population. Fracture incidences were calculated for age, gender, and race strata.ResultsThe overall incidence rate of pubic ramus fractures in the United States between 2002 and 2019 was 13.47 per 1,000,000 people 60 years and older (95% confidence limit: 9.92-17.01). The incidence of pubic ramus fractures for females in the US was 21.71 (16.08-27.34). Rates of ramus fracture increased overall (P < .001) and for both genders between the ages of 60 and 100, though the rate increase was significantly greater in females than in males (P < .001). In terms of race, incidence was highest Asian females and lowest in Native American and Pacific Islander men.Discussion/Conclusion: As the first national study addressing the epidemiology of ramus injuries in the United States, this work reveals these injuries comprise a significant fracture risk in the elderly. In addition, it highlights gender and ethnic strata that are more susceptible to these injuries.
      Citation: Geriatric Orthopaedic Surgery & Rehabilitation
      PubDate: 2022-04-23T07:51:38Z
      DOI: 10.1177/21514593221097274
      Issue No: Vol. 13 (2022)
  • The Covid 19 Pandemic Effect on the Epidemiology of Thoracolumbar
           Fractures Presenting to the Emergency Department in Patients Above 65
           years Old

    • Authors: Raphael Lotan, Ilia Prosso, Lev klatzkin, Oded Hershkovich
      Abstract: Geriatric Orthopaedic Surgery & Rehabilitation, Volume 13, Issue , January-December 2022.
      IntroductionStudies investigating the Covid-19 Pandemic’s orthopedic aspects are accumulating, including reports on a 10-33% decrease in hip fracture incidence alongside shorter times to surgery. Osteoporotic vertebral compression fractures (VCF) have not yet been discussed. This study evaluated the effect of the Covid-19 pandemic’s first wave on VCF in the elderly.MethodA retrospective cohort of elderly patients diagnosed with VCF between 2018-19 (Pre-Covid-19 pandemic) to 2020.ResultsThe cohort included 172 patients above 65 years with VCF during 2018-2020. Patients’ age and gender were similar between the two study groups. We found a higher proportion of high-energy VCF during 2020 (10.5% vs 6.7%). Incidence of recurrent fractures was 7.5 times higher during 2020 (5.3% vs .7%, P =.06), and significantly higher rates of Ankylosing Spondylitis or Diffuse Idiopathic Skeletal Hyperostosis in 2020 (7.9% vs 1.5%, P=.04). VCF ED admission rates were similar, with 60% treated conservatively. Admitted patients underwent more surgeries in 2020 (66.7% vs 60%, P =.71) and a tendency towards Precoutaneus Balloon Kyphoplasty (BKP) + fixation compared with BKP alone (15.8% in 2020 vs 7.5% in 2018-19, P =.29). RR for BKP + fixation vs BKP alone was 1.95, suggesting higher odds for a more complex surgery during the Covid-19 pandemic. The complication rate was significantly higher during 2020 (18.4% vs 3.7%, P
      Citation: Geriatric Orthopaedic Surgery & Rehabilitation
      PubDate: 2022-04-23T05:02:44Z
      DOI: 10.1177/21514593221098828
      Issue No: Vol. 13 (2022)
  • Comparison of Highly Intensive Home-Based Post-acute Care to Inpatient
           Program for Patients With Fragility Fractures After Surgery

    • Authors: Min-Chang Lee, Lin-Chung Woung, Jau-Yih Tsauo, Shih-Liang Shih, Hung-Ming Chen, Da-Chen Chu, Sheng-Jean Huang
      Abstract: Geriatric Orthopaedic Surgery & Rehabilitation, Volume 13, Issue , January-December 2022.
      IntroductionEvidence suggests that patients with fragility fractures would benefit from post-acute care (PAC); however, they have been subjected to varying PAC programs. This study aimed to compare the effectiveness of home-based PAC (HPAC) to inpatient PAC (IPAC) programs for patients with fragility fractures in Taiwan.Materials and methodsThis is a retrospective study that reviewed the medical records of patients who received HPAC or IPAC within three weeks after hip, knee, or spine fragility fractures in the Taipei City Hospital from September 1, 2017, to August 31, 2018.ResultsThe mean age (78.9 ± 10.8 years) showed significant difference between the HPAC (age = 80.6 ± 11.1, n = 83) and the IPAC (age = 78.2 ± 10.6, n = 185) groups (P = .049). After PAC, both HPAC and IPAC groups showed improvement on Barthel index, numerical pain rating scale, and Harris hip score (all P < .001). Patients in the HPAC group displayed greater improvement than the IPAC group on Barthel Index for activities of daily living (ADLs) by 5.8 (95% confidence interval, 3.0 to 8.5). The IPAC group had a significant longer length of PAC than the HPAC group (12.4 ± 3.0 vs. 11.1 ± 2.7, P < .001).ConclusionBoth PAC programs could significantly improve functional performance and reduce pain in patients with fragility fractures. Patients treated in the HPAC group had better ADLs, and less length of PAC.
      Citation: Geriatric Orthopaedic Surgery & Rehabilitation
      PubDate: 2022-04-23T01:18:30Z
      DOI: 10.1177/21514593221081376
      Issue No: Vol. 13 (2022)
  • Intramedullary Nailing for Atypical Femoral Fracture With Lateral Bowing:
           Does Medial Gap Matter'

    • Authors: Keong-Hwan Kim, Gill Song
      Abstract: Geriatric Orthopaedic Surgery & Rehabilitation, Volume 13, Issue , January-December 2022.
      IntroductionWhen performing intramedullary nailing for atypical femoral fractures (AFF), especially in lateral bowing femurs, a medial opening wedge-shaped gap in the fracture site may occur after nailing. We intended to analyse and compare clinical outcomes according to the medial gap in AFF cases after intramedullary nailing. Materials and Methods: Of the 38 consecutive patients with complete AFF treated by intramedullary nailing, 22 patients (all female, mean age of 76.5 years [range, 62–87]) available for follow-up for more than 12 months were included. According to the size of the medial gap, the patients were divided into 2 groups: large and small medial gaps. Comparative analysis was performed between groups in terms of patient, fracture characteristics and post-operative clinical outcomes. Results: There was no significant difference in bone union time between the 2 groups (5.4 months vs 5.6 months, P = .628). When comparing the amount of change in the hip–knee–ankle angle after the surgery with reference to the contralateral side, there was a significant difference between the 2 groups (−4.4° [femoral straightening and relatively changed to a more valgus pattern, that is, in cases of varus alignment, towards neutral alignment] vs .5°, P = .002). There was no significant difference in leg length discrepancy between the 2 groups (4.1 mm vs 3.2 mm, P = .674). In terms of functional outcomes, there was no significant difference in the recovery of ambulatory ability (ΔKoval grade: post-operative Koval grade–pre-operative Koval grade, 0 vs .1, P = .771). Conclusion: Even if the medial gap occurs following intramedullary nailing in AFF, post-operative clinical outcomes seem to be acceptable. However, if previous total knee arthroplasty is performed and neutral alignment is maintained, care should be taken as the occurrence of the gap may result in lower limb malalignments.
      Citation: Geriatric Orthopaedic Surgery & Rehabilitation
      PubDate: 2022-04-20T06:39:19Z
      DOI: 10.1177/21514593211070130
      Issue No: Vol. 13 (2022)
  • Pre-Operative Medications as a Predictor for Post-Operative Complications
           Following Geriatric Hip Fracture Surgery

    • Authors: Christopher L. McDonald, Brian H. Cohen, Giancarlo Medina Pérez, Jacob M. Modest, Eren O. Kuris, Christopher Born
      Abstract: Geriatric Orthopaedic Surgery & Rehabilitation, Volume 13, Issue , January-December 2022.
      BackgroundFragility hip fractures are a common orthopedic injury seen in Emergency Departments, with variable outcomes that can range from average to devastating. Currently, few reliable metrics to predict which patients will suffer post-operative complications exist. The aim of this study was to determine if the number and type of pre-operative medications can help predict post-operative complications.MethodsA prospectively collected database of hip fracture patients was retrospectively reviewed. Patients with isolated greater trochanteric fractures, periprosthetic fractures, or re-fractures were excluded. Pre-operative baseline characteristics as well as number and type of post-operative complications were reviewed. Any complication within 6 months of surgery and complications that could be directly attributable to the surgical procedure within 2 years of surgery were examined. Major complications (return to the operating room, deep infection, pulmonary, cardiac, and hematologic) and minor medical complications were assessed. A multivariate regression model was performed to identify independent risk factors.ResultsThree-hundred ninety-one patients were included. A majority were aged 80–90 and female, and lived at home prior to presentation. Overall, 33.7% of patients suffered a complication within a 2-year follow-up period. Mortality rates were 5.4%, 10.0%, and 14.9% over 30 days, 1 year, and 2 years, respectively. After assessing this relationship while controlling for age, sex, injury type, pre-operative residence, ambulatory status, ASA score, and CCI score, the relationship remained significant for both an increased number of complications (P = .048) and a higher likelihood of having a complication (P = .008). Cardiovascular (P = .003), pulmonary (P = .001), gout (P = .002), or diabetes (P = .042) medications were associated with a higher likelihood for experiencing a complication.ConclusionsOur study suggests that there is a strong and linear relationship between the number and type of pre-operative medications taken and risk of post-operative complications. This exists for up to 8 medications, at which point further increase does not contribute to an increased risk of complication. This relationship exists even after controlling for confounding variables and can be used by surgeons to better counsel patients and families regarding their specific risk for suffering perioperative complications.
      Citation: Geriatric Orthopaedic Surgery & Rehabilitation
      PubDate: 2022-04-14T11:44:46Z
      DOI: 10.1177/21514593221091062
      Issue No: Vol. 13 (2022)
  • Risk Factors of Frailty in Patients with Distal Radius Fractures

    • Authors: Jeong-Hyun Kang, Seok Woo Hong
      Abstract: Geriatric Orthopaedic Surgery & Rehabilitation, Volume 13, Issue , January-December 2022.
      AimThe aim of this study was to determine risk factors for the incidence of frailty in patients with distal radius fractures (DRFs).MethodsIn total, 116 patients (mean age, 66.3 ± 7.7 years) with DRFs were recruited. The participants were categorized into two groups, “frail” and “non-frail,” according to the presence or absence of frailty, respectively. The areal bone mineral densities (aBMDs) of the total hip, femoral neck, and lumbar spine were measured using dual-energy x-ray absorptiometry. The participants’ levels of resilience, depression, anxiety, nutritional intake, oral health-related quality of life, and social support were evaluated by self-reported questionnaires. The participants’ grip strength, gait speed, number of teeth present in their oral cavities, circumference of their upper arms and calves, and serum levels of vitamin D were also assessed.ResultsThe participants in the “frail” group seemed to have lower aBMDs and muscle function and mass than those in the “non-frail” group. There were significant differences in grip strength, calf circumference, gait speed, and aBMD of the total hip, femoral neck, and lumbar spine between the groups. There were also significant differences in the levels of resilience and depression between the groups. A multivariate logistic regression analyses demonstrated that levels of sarcopenia, malnutritional status, and aBMDs of the total hip and femoral neck had significant relationships with the development of frailty in patients with DRFs.ConclusionsAn interdisciplinary approach involving the management of osteoporosis, sarcopenia, oral health, social relationships, and psychological support would be required for the proper management of DRF patients in preventing frailty.
      Citation: Geriatric Orthopaedic Surgery & Rehabilitation
      PubDate: 2022-04-14T11:39:15Z
      DOI: 10.1177/21514593221094736
      Issue No: Vol. 13 (2022)
  • Standardized Preoperative Pathways Determining Preoperative Echocardiogram
           Usage Continue to Improve Hip Fracture Quality

    • Authors: Garrett Esper, Utkarsh Anil, Sanjit Konda, David Furgiuele, Jonah Zaretsky, Kenneth Egol
      Abstract: Geriatric Orthopaedic Surgery & Rehabilitation, Volume 13, Issue , January-December 2022.
      IntroductionThe purpose of this study was to assess the hospital quality measures and outcomes of operative hip fracture patients before and after implementation of an anesthesiology department protocol assigning decision for a preoperative transthoracic echocardiogram (TTE) to the hospitalist co-managing physician.Materials and MethodsDemographics, injury details, hospital quality measures, and outcomes were reviewed for a consecutive series of patients presenting to our institution with an operative hip fracture. In May of 2019, a new protocol assigning the responsibility to indicate a patient for preoperative TTE was mandated to the co-managing hospitalist at the institution. Patients were split into pre-protocol and post-protocol cohorts. Linear regression modeling and comparative analyses were conducted with a Bonferroni adjusted alpha as appropriate.ResultsBetween September 2015 and June 2021, 1002 patients presented to our institution and were diagnosed with a hip fracture. Patients in the post-protocol cohort were less likely to undergo a preoperative echocardiogram, experienced a shorter time (days) to surgery, shorter length of stay, an increase in amount of home discharges, and lower complication risks for urinary tract infection and acute blood loss anemia as compared to those in the pre-protocol cohort. There were no differences seen in inpatient or 30-day mortality. Multivariable linear regression demonstrated a patient’s comorbidity profile (Charlson Comorbidity Index (CCI)) and their date of presentation (pre- or post-protocol), were both associated with (P
      Citation: Geriatric Orthopaedic Surgery & Rehabilitation
      PubDate: 2022-04-14T10:36:06Z
      DOI: 10.1177/21514593221094730
      Issue No: Vol. 13 (2022)
  • Novel Approach to Identify Patients With the Most to Gain From New
           Treatment Options Intended to Prevent Fragility Fractures

    • Authors: Norbert Suhm, Simon K. Gratza
      Abstract: Geriatric Orthopaedic Surgery & Rehabilitation, Volume 13, Issue , January-December 2022.

      Citation: Geriatric Orthopaedic Surgery & Rehabilitation
      PubDate: 2022-04-14T07:06:34Z
      DOI: 10.1177/21514593221076620
      Issue No: Vol. 13 (2022)
  • Effects of Perioperative Fascia Iliaca Compartment Block on Postoperative
           Pain and Hip Function in Elderly Patients With Hip Fracture

    • Authors: Chao Hao, Chao Li, Ruiqi Cao, Yike Dai, Chongyang Xu, Lifeng Ma, Ai Guo, Haomiao Yu
      Abstract: Geriatric Orthopaedic Surgery & Rehabilitation, Volume 13, Issue , January-December 2022.
      PurposePain management is a challenging issue in elderly patients with hip fracture. Despite the accepted clinical outcomes following hip surgery, pain and prolonged recovery time are the most difficult consequences associated with the rehabilitation process. The purpose of this study was to evaluate pain relief and functional improvement associated with the Fascia Iliaca Compartment Block (FICB) during the perioperative period of elderly patients with hip fracture.Patients and methodsThis study included 120 elderly patients with hip fracture, who were admitted to our institution between January 2019 and December 2020. The participants were subsequently randomly divided into the routine analgesia (RA) and fascia iliaca compartment block (FICB) groups. Inter-group differences were compared via VAS scores at rest and during movement, Harris hip scores (HHS), presence of complications, adverse events after surgery, and length of hospital stay.ResultsThe FICB group VAS scores at rest at 6 hour, 1 and 3 days, and 1 week after surgery were significantly lower than the RA group (P < .05). Moreover, the FICB group VAS scores with movement were markedly lower at 6 hour, 1 and 3 days, as well as 1 and 2 weeks after surgery (P < .05). The HHS of the FICB and RA groups were (53.41±8.63) and (40.02±9.61), respectively, on the seventh day after surgery, and the difference was statistically significant (P < .05). The incidence of postoperative complications and adverse events in the FICB group were not statistically different from the RA group. The average hospital stay of the FICB group was 2.12 days shorter than the RA group, but the difference did not reach statistical significance (P = .13).ConclusionFICB provides superior analgesic effect both at rest and with movement, along with rapid short-term recovery of hip function following surgery in elderly patients with hip fracture, without increasing postoperative complications or adverse events.
      Citation: Geriatric Orthopaedic Surgery & Rehabilitation
      PubDate: 2022-04-14T02:24:07Z
      DOI: 10.1177/21514593221092883
      Issue No: Vol. 13 (2022)
  • Is the Posterior Approach With Posterior locking compression plate and
           Anterior Allograft Useful and Safe in the Treatment of Periprosthetic
           Humeral Fractures Following Reverse Total Shoulder Arthroplasty'

    • Authors: Giovanni Vicenti, Giuseppe Solarino, Massimiliano Carrozzo, Filippo Simone, Guglielmo Ottaviani, Davide Bizzoca, Giacomo Zavattini, Domenico Zaccari, Claudio Buono, Biagio Moretti
      Abstract: Geriatric Orthopaedic Surgery & Rehabilitation, Volume 13, Issue , January-December 2022.
      IntroductionAs the reverse total shoulder arthroplasty (RTSA) surgery has dramatically increased in the last few decades, many complications have followed through. The periprosthetic fracture, at the moment, is still a subject of debate in the orthopedic world. In this monocentric study, along with a literature review of periprosthetic humeral fractures, we would present our institutional experience with the treatment of periprosthetic humeral fractures with a posterior humeral approach, posterior cortex plate fixation, anterior strut allograft, screws, and cerclage wires.Materials and MethodsOur study consisted in a prospective monocentric study based on 18 patients, with a mean age of 75.3 years (range 64–88), all following a reverse shoulder total arthroplasty (RTSA). Postoperative follow-ups were taken at 1, 6, and 12 months with objective measurement of shoulder motion and strength, while clinical outcome measures were assessed using the American Shoulder and Elbow Surgeons (ASES score) and visual analog scale (VAS) for pain. Together with that, we performed a literature review focused on the management of periprosthetic humeral fractures after shoulder arthroplasty.ResultsAll fractures consolidated without complication at a mean 4.2 months (range 3–6). At final follow-up, the average active shoulder flexion was 88° (range 62–129°), active abduction 73° (range 52–91°) and active external rotation 22° (range 3–56°). The average ASES score was 73 (range 59–97), while average VAS score was 1.1 (range 0–3).DiscussionSurgical treatment of periprosthetic humeral fractures following a shoulder arthroplasty remains a hard challenge for every surgeon, and their treatment must consider fracture’s location, displacement, and local bone quality.ConclusionsThe posterior approach with a posterior plate placement and anterior strut allograft, which is appliable only in case of a B or C type fracture according to Worland classification, could be a good treatment option for periprosthetic humeral fractures.
      Citation: Geriatric Orthopaedic Surgery & Rehabilitation
      PubDate: 2022-04-11T12:05:49Z
      DOI: 10.1177/21514593221080961
      Issue No: Vol. 13 (2022)
  • Surgical and Pharmacological Management of Periprosthetic Atypical Femoral
           Fractures: A Narrative Literature Review

    • Authors: Elisa Troiano, Tiziano Giacché, Andrea Facchini, Nicholas Crippa Orlandi, Matteo Cacioppo, Marco Saviori, Vanna Bottai, Francesco Muratori, Nicola Mondanelli, Stefano Giannotti
      Abstract: Geriatric Orthopaedic Surgery & Rehabilitation, Volume 13, Issue , January-December 2022.
      IntroductionAn increasing number of patients is annually undergoing total hip arthroplasty (THA), and a significant proportion of these patients are elderly and consequently at a higher risk of complications because of age, osteoporosis, and medical comorbidities. Periprosthetic femoral fractures (PFFs) are one of the worst complications of THA associated with high rates of unfavorable prognosis. Besides, in the last decade, a new independent disease entity called “atypical femoral fracture” (AFF) has been identified and defined by the American Society for Bone and Mineral Research (ASBMR) task force. Some PFFs present clinical history and radiographic aspect consistent with an AFF, meeting the ASBMR criteria for the diagnosis of AFF except that PFFs by themselves are an exclusion criterion for AFF. However, there is an increasing number of published studies suggesting that periprosthetic atypical femoral fractures (PAFFs) exist and should not be excluded by definition.SignificanceNowadays, although there is an increasing interest in PAFFs, there are still very few studies published on the topic and a lack of consensus regarding their treatment. This narrative literature review aims to introduce this new emerging topic to a wider readership describing the characteristics of PAFFs and the state-of-the-art in their management.ConclusionsMany authors agree that PAFFs should be considered as a subgroup of PFFs that have atypical characteristics; they also show a significant correlation with prolonged bisphosphonate use. A correct diagnosis is paramount for proper treatment of the disease that requires both surgical and medical actions to be taken.
      Citation: Geriatric Orthopaedic Surgery & Rehabilitation
      PubDate: 2022-04-11T02:08:19Z
      DOI: 10.1177/21514593221090392
      Issue No: Vol. 13 (2022)
  • Proton Pump Inhibitors and the Risk of Early Aseptic Loosening in Hip and
           Knee Arthroplasty

    • Authors: Iskandar Tamimi, Pablo Carnero, David Bautista, David Gonzalez, Pablo Rodrigo, María Jose. Bravo, Abel Gómez, Faleh Tamimi, David Garcia de Quevedo
      Abstract: Geriatric Orthopaedic Surgery & Rehabilitation, Volume 13, Issue , January-December 2022.
      IntroductionThe use of proton pump inhibitors (PPIs) has been associated with a higher risk of osteoporotic fractures and non-unions rates. However, the relation between the use of PPIs and the development of aseptic loosening in arthroplasty procedures has not been studied. The objective of this study is to analyze the relation between the use of PPIs, and the risk of early aseptic loosening in total knee arthroplasty (TKA) and total hip arthroplasty (THA).Materials and methodsA nested case-control study was conducted on patients who were subjected THA or TKA in our center between 2010 and 2014. Cases were patients subjected to revision surgery due to early aseptic loosening during the study period. Cases were matched with controls who did not require any type of revision surgery by type of joint replacement (THA/TKA), gender, age (+/− 2 years), and follow-up time (±6 months). Odds Ratios were adjusted to potential confounders.ResultsThe crude and adjusted ORs (95% CI) of undergoing revision surgery for aseptic loosening following primary total knee arthroplasty or total hip arthroplasty, were 6.25 (2.04–19.23) and 6.10 (1.71–21.73), respectively, for any use PPIs compared with non-users. Crude and adjusted ORs, were 11.6 (2.93–45.88) and 17.1 (2.41–121.66), respectively, for patients with a Proportion of Days Covered (PDC) for PPIs
      Citation: Geriatric Orthopaedic Surgery & Rehabilitation
      PubDate: 2022-04-11T02:03:18Z
      DOI: 10.1177/21514593221091664
      Issue No: Vol. 13 (2022)
  • Orthogeriatric Multidisciplinary Co-Management Across Acute and
           Rehabilitation Care Improves Length of Stay, Functional Outcomes and
           Complications in Geriatric Hip Fracture Patients

    • Authors: Dennis King Hang Yee, Tak-Wing Lau, Christian Fang, Kathine Ching, Jake Cheung, Frankie Leung
      Abstract: Geriatric Orthopaedic Surgery & Rehabilitation, Volume 13, Issue , January-December 2022.
      IntroductionAs the global number of geriatric hip fracture cases continues to proliferate, a newly developed orthogeriatric co-management multidisciplinary care model has been implemented since November 2018 to meet further increases in demand. Our objective was to evaluate the effectiveness of the new pathway in improving the clinical outcomes of fragility hip fractures.MethodsThe data of geriatric hip fracture patients from 1 April 2018 till 30 October 2018 was collected as the conventional orthopaedic care model (pre-orthogeriatric care model) to compare with data from the orthogeriatric co-management model, 1 Feb 2019 till 31 August 2019. Clinical outcomes were analyzed between the groups, with the efficiency of the programme reflected in the total length of stay in acute and convalescent hospitals.Results194 patients were recruited to the conventional group and 207 were recruited to the orthogeriatric group, 290 patients (72.3%) were female. The mean (SD) patient age was 84.2 (7.9) years. The median length of stay in the acute and rehabilitation hospitals decreased by 1 day and 2 days, respectively (P=.001). The orthogeriatric group was associated with a higher Modified Barthel Index score on discharge from the rehabilitation hospital and more patients in the orthogeriatric collaboration group received osteoporosis medication prescription within one year after the index fracture. There was no difference in the 28-days unplanned readmission rate, complication rate, mortality rate or Elderly Mobility Scale scores on discharge from the rehabilitation hospital between the two groups.ConclusionOrthogeriatric collaboration has been proven to be effective in terms of a decreased length of stay in both the acute and the rehabilitation hospitals.
      Citation: Geriatric Orthopaedic Surgery & Rehabilitation
      PubDate: 2022-04-11T01:59:37Z
      DOI: 10.1177/21514593221085813
      Issue No: Vol. 13 (2022)
  • Proximal Branching of the Anterior Tibial Artery From the Popliteal Artery
           Increases the Risk of Vascular Injury During Total Knee Arthroplasty: A
           Retrospective Analysis Using Preoperative Magnetic Resonance Imaging and
           Intraoperative Findings

    • Authors: Yuya Kimura, Tsuneari Takahashi, Ryusuke Ae, Katsushi Takeshita
      Abstract: Geriatric Orthopaedic Surgery & Rehabilitation, Volume 13, Issue , January-December 2022.
      IntroductionArterial injury following total knee arthroplasty (TKA) can be life-threatening. There are some anatomical variations in the popliteal artery (PA) and its branches. In most cases, the PA branches into the anterior tibial artery (ATA) and posterior tibial artery (PTA), which are usually distal to the height of tibial resection in TKA. However, some cases show that the PA branches into the ATA and PTA proximal to the height of tibial resection in TKA. This study aimed to assess the distance from the posterior cortex of the proximal tibia to the anterior wall of the PA or ATA at the height of the tibial cut line, during TKA in the distal and proximal branch groups.Methods129 patients (6 patients in the proximal branch group and 123 patients in the distal branch group) were enrolled for this study. For prediction of the distance from the posterior cortex of the proximal tibia to the anterior wall of the PA or ATA, preoperative sagittal and coronal magnetic resonance images and postoperative radiographs were evaluated.ResultsThe distance between the posterior cortex of the proximal tibia and the anterior wall of the PA or ATA at the height of the tibial cut line was 1.8 ± 1.1 mm in the proximal branch group and 6.1 ± 2.6 mm in the distal branch group, which was significantly closer in the proximal group (P < .05).DiscussionThe rate of proximal branching was 4.7%. This study clarified that the proximal branching of the ATA from PA significantly decreased the distance between the posterior cortex of the proximal tibia and the anterior wall of the artery.ConclusionsThe proximal branch group has a high risk for arterial injury as the artery may be close to the saw, and appropriate retraction should be performed.
      Citation: Geriatric Orthopaedic Surgery & Rehabilitation
      PubDate: 2022-04-11T01:54:15Z
      DOI: 10.1177/21514593221082785
      Issue No: Vol. 13 (2022)
  • CORRIGENDUM to “Toe Clearance Rehabilitative Slippers for Older Adults
           With Fall Risk: A Randomized Controlled Trial”

    • Abstract: Geriatric Orthopaedic Surgery & Rehabilitation, Volume 13, Issue , January-December 2022.

      Citation: Geriatric Orthopaedic Surgery & Rehabilitation
      PubDate: 2022-04-07T01:02:52Z
      DOI: 10.1177/21514593221092834
      Issue No: Vol. 13 (2022)
  • CalTAD is the Key Evaluation Tool for Measurement of Cephalic Fixation
           Position for Predicting Cut-Out in Geriatric Intertrochanteric Fracture
           Patients with Internal Fixations after Achieving Acceptable Reduction

    • Authors: Yun-fa Yang, Jian-wen Huang, Xiao-sheng Gao
      Abstract: Geriatric Orthopaedic Surgery & Rehabilitation, Volume 13, Issue , January-December 2022.
      ObjectiveTo discover the key evaluation tool of the cephalic fixation position for predicting implant failures in geriatric intertrochanteric fracture (ITF) patients treated with internal fixations after achieving an acceptable reduction.MethodsWe measured the geriatric ITF patients undergoing single-screw cephalomedullary nailing (CMN) fixation surgery after obtaining the acceptable reduction (including anatomical reduction and positive medial cortex support reduction) in our treatment group between September 2016 and March 2020 by using four kinds of cephalic fixation position evaluation tools including Cleveland zone system, Parker’s ratio index, tip–apex distance (TAD), calcar-referenced TAD (CalTAD), and analyzed which were the key evaluation tools for measurement of cephalic fixation position for prediction of implant failures in geriatric ITF patients with internal fixations.ResultsSeventy-four ITF patients treated with single-screw CMN fixation after obtaining the acceptable reduction were enrolled in this study. Of the 74 patients, nine cases were observed with implant failures. There were six cases of cut-out and three of pending cut-out. We found that TAD (odds ratio (OR)=1.149; 95% confidence interval (CI), 1.00–1.32; P=.046) and CalTAD (OR=1.140; 95% CI, 1.00–1.30; P=.037) were risk factors for implant failures by univariate analysis, while only CalTAD (OR=1.200; 95% CI, 1.032–1.395; P=.018) was the independent risk factor for implant failures by multivariate analysis. The Kappa coefficient (κ) of CalTAD was .976 (95% CI, .966–.984) by ICC analysis. The ROC analysis showed that the best cut-off value of CalTAD was 23.76 mm with a sensitivity of 77.8% and specificity of 72.3% (area under the curve, AUC =.775; P = .001).ConclusionsCalTAD is the key evaluation tool for measurement of cephalic fixation position for predicting implant failures in geriatric ITF patients treated with single-screw CMN after obtaining the acceptable reduction.
      Citation: Geriatric Orthopaedic Surgery & Rehabilitation
      PubDate: 2022-03-29T07:10:10Z
      DOI: 10.1177/21514593221083820
      Issue No: Vol. 13 (2022)
  • Timing of Surgery for Hip Fracture in Patients on Direct Oral
           Anti-coagulants: A Population-Based Cohort Study

    • Authors: En Lin Goh, Swathikan Chidambaram, Suprabha Rai, Angela Kannan, Sambandam Anand
      Abstract: Geriatric Orthopaedic Surgery & Rehabilitation, Volume 13, Issue , January-December 2022.
      BackgroundIn patients with hip fracture on direct oral anti-coagulants (DOACs), timely surgery is important in optimising outcomes but the safety of early surgery is unclear. This study aims to evaluate the timing of surgery on peri- and post-operative outcomes in patients with hip fracture on DOAC therapy.MethodsSingle-centre, retrospective, population-based cohort study of patients on DOAC therapy compared to standard care with low-molecular-weight heparin (LMWH) undergoing surgery for hip fracture. Data obtained: patient demographics, fracture classification, American Society of Anaesthesiologists (ASA) classification, time to surgery, procedure performed, type of DOAC, timing of last DOAC dose, use of reversal agents or pro-coagulants and length of stay. Outcomes assessed: pre- and post-operative haemoglobin levels, incidence of blood transfusion, major haemorrhage, venous thromboembolism (VTE) and death within 30 days of surgery.ResultsA total of 755 patients were included. Compared to standard treatment, DOAC use was associated with a similar change in pre- and post-operative haemoglobin levels (P = .90), risk of blood transfusion (RR: 1.04, 95% CI: .70–1.54, P = .84), haemorrhage (RR: 1.51, 95% CI: .53-4.28, P = .44), VTE (RR: .92, 95% CI: .12–7.20, P = .94) and mortality (RR: 1.85, 95% CI: .89–3.84, P = .10), all of which were independent of the timing of surgery.ConclusionThis study builds on growing evidence that surgery for hip fracture in patients on DOAC therapy is not associated with an excessive risk of haemorrhage, irrespective of the timing of surgery. Timely surgical fixation of the hip fracture in this population is indicated in the absence of other risk factors for haemorrhage.
      Citation: Geriatric Orthopaedic Surgery & Rehabilitation
      PubDate: 2022-03-26T11:31:21Z
      DOI: 10.1177/21514593221088405
      Issue No: Vol. 13 (2022)
  • Current Practice of Italian Association of Revision Surgery Members in the
           Treatment of Unified Classification System Type B Periprosthetic Femoral
           Fracture Around Hip Arthroplasty: A Cross-Sectional Survey

    • Authors: Antonio Capone, Pietro Cavaliere, Antonio Campacci, Christian Carulli, Giovanni Pignatti, Filippo Randelli, Bruno Marelli, Paolo Esopi, Stefano Congia, Giuseppe Marongiu
      Abstract: Geriatric Orthopaedic Surgery & Rehabilitation, Volume 13, Issue , January-December 2022.
      IntroductionPeriprosthetic femoral fracture around hip arthroplasty are growing in the world, nevertheless management and treatment options for fractures “around the stem” are still debated due to lack of high-level studies.Materials and methodA 85-item survey were fill out by 40 Italian Orthopedic Surgeon member of SIOT (Società Italiana di Ortopedia e Traumatologia) and AIR (Associazione Italiana Riprotesizzazione) to assess their current opinion in the management of type B periprosthetic femoral fractures. Responses were summarized using proportions, and further stratified by practice type, case volume, surgeon age, and fellowship training.ResultsVancouver/UCS fracture classification showed a good interobserver agreement (k value = .76). ORIF were the treatment of choice for UCS type B1 fractures (100%), revision stem for B2 (85%) and B3 (100%). Locked plates were preferred to cable plate and cerclage without a plate for B1 fractures (50% vs 40% vs 10%); revision with modular stem was preferred to monoblock stem for B2 fractures (50% vs 35%) and B3 (75% vs 15%). Responders tended to postpone at 1-month weight-bearing in patients with B1 fractures. Regarding postoperative pharmacological treatment there was absolute lack of consensus.DiscussionThe primary finding of our survey confirmed the preference of ORIF for B1 fractures and stem revision for B2 and B3 fractures. However, there is no definitive operative technique for all UCS B fractures. Surgeons tended to favor locked plating over cable plating, although only slightly. This general lack of consensus coincides with the inconclusive evidence that currently exists in the literature, which demonstrates both favorable and unfavorable outcomes for both techniquesConclusionsThe absence of complete homogeneity among participants showed the need for prospective randomized studies to set up stronger guidelines for classification, management, surgical treatment, rehabilitation, and pharmacological support of periprosthetic femoral fractures.
      Citation: Geriatric Orthopaedic Surgery & Rehabilitation
      PubDate: 2022-03-24T07:21:16Z
      DOI: 10.1177/21514593221080341
      Issue No: Vol. 13 (2022)
  • Postoperative Pneumonia in Geriatric Patients With a Hip Fracture:
           Incidence, Risk Factors and a Predictive Nomogram

    • Authors: Xin Zhang, Zhi-long Shen, Xu-Zhou Duan, Qi-Rong Zhou, Jie-fu Fan, Jie Shen, Fang Ji, Da-ke Tong
      Abstract: Geriatric Orthopaedic Surgery & Rehabilitation, Volume 13, Issue , January-December 2022.
      ObjectivesTo evaluate the incidence and risk factors of postoperative pneumonia (POP) in geriatric patients with a hip fracture after surgery, to design a predictive nomogram, and to validate the accuracy of the nomogram.DesignRetrospective study.SettingA tertiary hospital affiliated to a medical university.Patients/ParticipantsWe retrospectively studied 1285 surgical-treated geriatric patients with a hip fracture from April 2010 to April 2018.InterventionSurgical treatment was performed on the patients of this study. The procedure methods were classified as: total hip arthroplasty, hemiarthroplasty, percutaneous fixation, intramedullary nail fixation, and plate/screw fixation.Main Outcome MeasurementThe primary interest of end point of this study is the development of POP during the postoperative period. The postoperative period in this study was defined as the time from 24 hours after surgery to discharge. The diagnostic criteria for pneumonia were set according to the guidelines built by the Infectious Diseases Society of America and the American Thoracic Society (Guidelines for the Management of Adults with Hospital-Acquired, Ventilator-Associated, and Healthcare-Associated Pneumonia, 2005). Potential variables for developing POP were identified using logistic regression analyses initially and were further selected via the method of LASSO. Then the independent risk factors were identified by multivariable regression analyses. A predictive nomogram was built based on the multiple regression model, and the calibration abilities of the nomogram was measured by Harrel C-index, calibration plot and Hosmer–Lemeshow test, respectively. Decision curve analysis was carried out to assess the net benefit due to threshold probability and an on-line questionnaire survey was conducted among the clinicians to assess the applicability of the nomogram coherently.ResultsOf the 1285 patients, 70 (5.4%) developed POP. COPD, number of comorbidities, ASA classification>2, preoperative dependent functional status and cognitive impairment were identified as independent risk factors of POP. The nomogram built based on the results showed good accordance between the predicted probabilities and the observed frequency. The decision curve analysis confirmed the clinical utility of the nomogram when the threshold probabilities were between 5% and 65% due to the net benefit, while the results of on-line questionnaire among 200 clinicians showed that 91.5% of the participants had a mental threshold of intervention between 5-50%.Conclusion(1). COPD, number of comorbidities, ASA classification>2, preoperative dependent functional status and cognitive impairment are independent risk factors for POP. (2). The nomogram built in this study has a good accordance between the predictive risk and the observational incidence. The results of decision curve and questionnaire among clinicians show well applicability of the nomogram.
      Citation: Geriatric Orthopaedic Surgery & Rehabilitation
      PubDate: 2022-03-23T03:35:51Z
      DOI: 10.1177/21514593221083824
      Issue No: Vol. 13 (2022)
  • Management of Severe Scoliosis with Pulmonary Arterial Hypertension: A
           Single-Center Retrospective Case Series Study

    • Authors: Qiang Li, Fei Zeng, Tao Chen, Mengqiu Liang, Xue Lei, Yijian Liang, Chuandong Zheng, He Huang
      Abstract: Geriatric Orthopaedic Surgery & Rehabilitation, Volume 13, Issue , January-December 2022.
      AimsTo determine the impact of anesthesia encountered and to optimize the treatment of perioperative pulmonary arterial hypertension (PAH) in an effort to improve perioperative management and reduce complications.MethodsWe conducted a retrospective analysis of scoliosis patients with PAH who underwent scoliosis surgery.ResultsDuring this period, we identified a total of 22 patients. Their mean age was 22.18 ± 2.11 years. 16 PAH patients (72.72%) received PAH-specific treatment. Only Propofol-based TIVA was used intraoperatively. During the procedure, pulmonary artery catheters and PICCO catheters were placed in all patients to monitor intraoperative and postoperative mPAP, MAP, PRVI and SRVI. During tracheal intubation and intraoperative awake testing, mPAP generally tended to increase in all patients. 6 patients (27.27%) received intraoperative PAH-Specific therapy. All patients received oral sildenafil (75-100 mg/d orally), and 9 patients received postoperative oral sildenafil combined with nebulized iloprost (20 μg/d); intravenous treprostinil (2 ng/kg/min started and titrated to 10-17.5 ng/kg/min); or bosentan (250 mg/d) postoperatively. 7 patients (31.82%) reported postoperative complications, including 2 cases of respiratory failure requiring reintubation, 1 case of right heart failure, 2 cases of superficial surgical site infection, 1 case of fluid and electrolyte and acid-base imbalances, 2 cases of pneumonia and 1 case of pulmonary oedema with fluid overload. Two patients developed more than 1 postoperative complication. No in-hospital death occurred.ConclusionsThe anesthetic management of scoliosis patients with PAH is important task that, like its own surgery, relies on the input of the multidisciplinary team for its success. Close monitoring, optimization of systemic blood pressure, pain control, oxygenation and ventilation, avoidance of exacerbating factors, and the use of vasopressors and pulmonary vasodilators when necessary are essential elements of management.
      Citation: Geriatric Orthopaedic Surgery & Rehabilitation
      PubDate: 2022-03-19T12:39:12Z
      DOI: 10.1177/21514593221080279
      Issue No: Vol. 13 (2022)
  • Comparison of Hard and Soft Cervical Collars for the Management of
           Odontoid Peg Fractures in the Elderly

    • Authors: Nichola Coleman, Hoi-Ying H. Chan, Veronique Gibbons, Joseph F Baker
      Abstract: Geriatric Orthopaedic Surgery & Rehabilitation, Volume 13, Issue , January-December 2022.
      IntroductionOdontoid peg fractures (OF) are the most common cervical spine fracture in the elderly. This retrospective analysis aimed to compare the outcomes of older patients with OF who had been managed non-operatively with either a hard or soft cervical collar.Materials and MethodsWe analysed the retrospective data of the clinical and radiographic records of patients 60 years or older who presented over a 10-year period with OF and were treated non-operatively with a cervical collar. Mortality was the primary outcome measure with mechanism of injury, complications, and fracture healing secondary measures.Results45 patients (hard collar n = 22; soft collar n = 23) were included with comparable demographics for frailty and co-morbidities in each group; age was significantly higher in the soft collar group (80.6 vs 86.4 years; P = .0065). Associated injuries and complications were not significantly different overall, or when Type II fractures were separately analysed (P = .435 associated injuries, P = .121 complications). All-cause mortality was greater in the soft collar group (30-day mortality hard: 0%, soft: 9%; 1-year mortality hard: 18%, soft: 48% P = .035). However, once corrected for age, this proved not to reach significance (P = .333) in any fracture type. Non-union was common (77%) but was not significantly different (hard = 70%; soft = 87%; P = .419).DiscussionConsistent with other reports, non-union rates remained substantial regardless of which collar was used. After controlling for age, there was no difference in all-cause mortality between elderly patients treated with a hard or soft cervical collar for odontoid peg fractures.ConclusionsSoft collars appear suitable for the treatment of odontoid peg fractures in the elderly without compromising outcome. Larger cohort analyses will help confirm this finding.
      Citation: Geriatric Orthopaedic Surgery & Rehabilitation
      PubDate: 2022-03-18T07:25:57Z
      DOI: 10.1177/21514593211070263
      Issue No: Vol. 13 (2022)
  • Risk Factors for Postoperative Pneumonia in the Elderly Following Hip
           Fracture Surgery: A Systematic Review and Meta-Analysis

    • Authors: Sang Hee Lee, Ki Uk Kim
      Abstract: Geriatric Orthopaedic Surgery & Rehabilitation, Volume 13, Issue , January-December 2022.
      Introduction: Pneumonia is a serious complication following hip fracture surgery in older people. However, the prevalence and risk factors of postoperative pneumonia (POP) are not well-established. This study identified pre- and peri-operative factors associated with the development of POP following hip fracture surgery.Methods: We searched the Cochrane library, PubMed, and Embase databases for relevant articles published up to June 2021. Studies involving older patients who underwent hip fracture surgery were considered if they detailed the demographic or surgical characteristics of the participants. For all analyses, the pooled odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated.Results: A total of 24 studies (288819 participants) were included. The overall prevalence of POP following hip fracture surgery was 5.0%. There were 36 risk factors for POP, and the meta-analysis included the five most common: delayed surgery (OR: 1.84, 95% CI: 1.29-2.63), low serum albumin (OR: 2.34, 95% CI: .82-6.73), chronic respiratory diseases (OR: 2.42, 95% CI: 1.82-3.24), increased age (OR: 1.25, 95% CI:1.11-1.40), and male sex (OR: 2.22, 95% CI: 2.00-2.47).Conclusions: The prevalence of POP was 5.0% following hip fracture surgery in the elderly. Older age, male sex, chronic respiratory diseases, delayed surgery, and low serum albumin were significant risk factors. Clinicians treating hip fracture patients must remain be aware of these risk factors.
      Citation: Geriatric Orthopaedic Surgery & Rehabilitation
      PubDate: 2022-03-14T11:33:32Z
      DOI: 10.1177/21514593221083825
      Issue No: Vol. 13 (2022)
  • Refracture After Removal of the PFNA in a Healed Intertrochanteric Femoral
           Fracture: Case Report

    • Authors: Jin-Woo Jin, Hyeon-Soo Kim, Min-Jae Jang
      Abstract: Geriatric Orthopaedic Surgery & Rehabilitation, Volume 13, Issue , January-December 2022.
      Hardware removal in a healed intertrochanteric fracture in elderly, which is not a routine procedure, should be needed in the case of irritable hardware. The reports of refracture after hardware removal can be seen as sparse in current literature, which are focused to secondary femoral neck fracture after removal of the lag screw or blade. We experienced a case of the intertrochanteric refracture and varus collapse after the PFNA removal in a healed fracture, treated with valgus trochanteric osteotomy and angled blade plate fixation. The PFNA is an innovative device for the treatment of the trochanteric fracture; however, the complications after removal never end. Therefore, the removal from healed fracture in elderly who have osteoporosis should not be recommended unless intractable pain had persisted.
      Citation: Geriatric Orthopaedic Surgery & Rehabilitation
      PubDate: 2022-03-12T10:40:24Z
      DOI: 10.1177/21514593221074179
      Issue No: Vol. 13 (2022)
  • Risk Factors for Perioperative Hidden Blood Loss After Intertrochanteric
           Fracture Surgery in Chinese Patients: A Meta-Analysis

    • Authors: Tao Wang, Junfei Guo, Zhiyong Hou
      Abstract: Geriatric Orthopaedic Surgery & Rehabilitation, Volume 13, Issue , January-December 2022.
      Study DesignA meta-analysisIntroductionTo perform a meta-analysis to explore the risk factors of perioperative hidden blood loss (HBL) in the treatment of intertrochanteric fracture for Chinese patients.SignificanceAn extensive search of the literature was performed in the English databases of PubMed, Embase, and Cochrane Library and the Chinese databases of CNKI and WAN FANG (up to July 2021). We collected factors including demographic data and surgical factors. Data analysis was conducted with RevMan 5.3 and STATA 12.0.ResultsFinally, we collected 7 studies including 1377 patients in the final analysis. In our study, female patients (P
      Citation: Geriatric Orthopaedic Surgery & Rehabilitation
      PubDate: 2022-03-11T06:38:04Z
      DOI: 10.1177/21514593221083816
      Issue No: Vol. 13 (2022)
  • We Must Consider a Growing Opioid Epidemic in Older People

    • Authors: Murray A J Hudson, Louis J Koizia, Michael B Fertleman
      Abstract: Geriatric Orthopaedic Surgery & Rehabilitation, Volume 13, Issue , January-December 2022.

      Citation: Geriatric Orthopaedic Surgery & Rehabilitation
      PubDate: 2022-03-09T06:31:08Z
      DOI: 10.1177/21514593221083823
      Issue No: Vol. 13 (2022)
  • Barriers and Enablers to Early Identification, Referral and Access to
           Geriatric Rehabilitation Post-Hip Fracture: A Theory-Based Descriptive
           Qualitative Study

    • Authors: Chantal Backman, Anne Harley, Steve Papp, Veronique French-Merkley, Paul E Beaulé, Stéphane Poitras, Johanna Dobransky, Janet E Squires
      Abstract: Geriatric Orthopaedic Surgery & Rehabilitation, Volume 13, Issue , January-December 2022.
      BackgroundGeriatric hip fracture patients often experience gaps in care including variability in the timing and the choice of an appropriate setting for rehabilitation following hip fracture surgery. Many guidelines recommend standardized processes, including timely access of no later than day 6 to rehabilitation services. A pathway for early identification, referral and access to geriatric rehabilitation post-hip fracture was created to facilitate the implementation. The study aimed to describe the barriers and enablers prior to the implementation of this pathway.MethodsWe conducted a qualitative descriptive study consisting of semi-structured interviews with geriatric hip fracture patients (n = 8), caregivers (n = 1), administrators (n = 12) and clinicians (n = 17) in 2 orthopaedics units and a geriatric rehabilitation service. Responses were analysed using a systematic approach, and overarching themes describing the barriers and enablers were identified.ResultsThe clinicians’ and administrators’ top barriers to implementation of the pathway were competing demands (n = 24); lack of bed availability, community resources and funding (n = 19); and the need for extended hours and increased staff (n = 16). The top 3 enablers were clear communication with patients (n = 27), awareness of the benefits of geriatric rehabilitation (n = 24) and the need for education and resources to properly use the pathway (n = 15). Common barriers among patients and caregivers included lack of care coordination, overcoming some of their own specific challenges during their transition, gaps in the information they received before discharge, not knowing what questions to ask and lack of resources. Despite these barriers, patients were generally pleased with their transition from the hospital to geriatric rehabilitation.ConclusionWe identified and described key barriers and enablers to early identification, referral and access to geriatric rehabilitation post-hip fracture. These influencing factors provide a basis for the development of a standardized pathway aimed at improving access to rehabilitative care for geriatric hip fracture patients.
      Citation: Geriatric Orthopaedic Surgery & Rehabilitation
      PubDate: 2022-03-04T09:53:38Z
      DOI: 10.1177/21514593211047666
      Issue No: Vol. 13 (2022)
  • Review of Postoperative Delirium in Geriatric Patients After Hip Fracture

    • Authors: Anita M. Albanese, Noyan Ramazani, Natasha Greene, Laura Bruse
      Abstract: Geriatric Orthopaedic Surgery & Rehabilitation, Volume 13, Issue , January-December 2022.
      IntroductionPostoperative delirium (POD) is a serious complication occurring in 4–53.3% of geriatric patients undergoing surgeries for hip fracture. Incidence of hip fractures is projected to grow 11.9% from 258,000 in 2010 to 289,000 in 2030 based on 1990 to 2010 data. As prevalence of hip fractures is projected to increase, POD is also anticipated to increase.SignficancePostoperative delirium remains the most common complication of emergency hip fracture surgery leading to high morbidity and mortality rates despite significant research conducted regarding this topic. This study reviews literature from 1990 to 2021 regarding POD in geriatric hip fracture management.ResultsPotentially modifiable and non-modifiable risk factors for developing POD include, but are not limited to, male gender, older age, multiple comorbidities, specific comorbidities (dementia, cognitive impairment, diabetes, vision impairment, and abnormal blood pressure), low BMI, preoperative malnutrition, low albumin, low hematocrit, blunted preoperative cytokines, emergency surgery, time to admission and surgery, preoperative medical treatment, polypharmacy, delirium-inducing medications, fever, anesthesia time, and sedation depth and type. Although the pathophysiology remains unclear, the leading theories suggest neurotransmitter imbalance, inflammation, and electrolyte or metabolic derangements as the underlying cause of POD. POD is associated with increased length of hospital stay, cost, morbidity, and mortality. Prevention and early recognition are key factors in managing POD. Methods to reduce POD include utilizing interdisciplinary teams, educational programs for healthcare professionals, reducing narcotic use, avoiding delirium-inducing medications, and multimodal pain control.ConclusionWhile POD is a known complication after hip fracture surgery, further exploration in prevention is needed. Early identification of risk factors is imperative to prevent POD in geriatric patients. Early prevention will enhance delivery of health care both pre- and post-operatively leading to the best possible surgical outcome and better quality of life after hip fracture treatment.
      Citation: Geriatric Orthopaedic Surgery & Rehabilitation
      PubDate: 2022-03-04T09:53:38Z
      DOI: 10.1177/21514593211058947
      Issue No: Vol. 13 (2022)
  • Cracking the Hip: Does Protocol Matter' A Retrospective Cohort Study
           Investigating the Effect of Protocol Implementation

    • Authors: Amelia R Levi, Marine Coste, Ethan Warshowsky, Neil V Shah, Nishant Suneja, Jeffrey M. Schwartz, Valery Roudnitsky
      Abstract: Geriatric Orthopaedic Surgery & Rehabilitation, Volume 13, Issue , January-December 2022.
      IntroductionApproximately 300 000 hip fractures occur annually in the USA in patients>65 years old. Early intervention is key in reducing morbidity and mortality. Our institution implemented a collaborative hip fracture protocol, streamlining existing processes to reduce time to OR (TTO) and hospital length of stay (LOS). Our aim was to determine if this protocol improved these outcomes.Study DesignWe conducted a retrospective cohort study using our level-1 trauma center’s trauma registry, comparing outcomes for patients>60 years old with isolated hip fractures pre-and post-hip protocol implementation in May 2018. Our primary outcomes were TTO and in-hospital mortality. Secondary outcomes included LOS and postoperative complications. Univariate analysis was done using chi-square and T-test.ResultsWe identified 176 patients with isolated hip fractures: 69 post- and 107 pre-protocol. Comparing post- to pre-protocol, TTO decreased by 18hrs (39 vs 57h; P = .013) and patients had fewer postoperative complications (9 vs 23%; P = .016) despite post-protocol patients being more likely to have diabetes (42 vs 27%, P < .05), elevated BMI (22 vs 25; P < .001), and to be current smokers (9 vs 2%; P < .05). LOS and in-hospital mortality also decreased (11 vs 20d; P = .312, 4.3 vs 7.5%; P = .402). Post-protocol patients were more likely to go to the OR within 24hrs of presentation (39 vs 16%; P < .001) and to go straight from ED to OR (32 vs 4%; P < .001).ConclusionTTO, LOS, and postoperative complications for isolated hip fracture patients were lower post-protocol. Though not all statistically significant, this trend indicates that the protocol was helpful in improving hip fracture outcomes but may require further improvement and institution-wide education.
      Citation: Geriatric Orthopaedic Surgery & Rehabilitation
      PubDate: 2022-02-27T01:22:05Z
      DOI: 10.1177/21514593221076614
      Issue No: Vol. 13 (2022)
  • Risk Factors of Postoperative Delirium in Elderly Patients With
           Intertrochanteric Fracture: An Age-Stratified Retrospective Analysis of
           2307 Patients

    • Authors: Tao Wang, Junfei Guo, Zhiyong Hou, Yingze Zhang
      Abstract: Geriatric Orthopaedic Surgery & Rehabilitation, Volume 13, Issue , January-December 2022.
      BackgroundPostoperative delirium (POD) is a serious and common complication of intertrochanteric fracture (IF). However, the risk factors for POD remain debated. The purpose of this study was to explore risk factors for POD after IF surgery in elderly patients by age-stratified analysis.MethodsA total of 2307 patients who underwent IF surgery in our hospital between Jan. 2017 and Nov. 2020 were included. 128 patients suffering from POD were regarded as the delirium group (DG) and the other patients as the normal group (NG). Univariate and multivariate analyses were conducted.ResultsIn our study, the occurrence of POD after IF surgery in elderly patients was 5.55% (128 of 2307). The results of univariate and multivariate analysis showed that advanced age and patients with a history of dementia were identified as the risk factors for POD. Age-stratified analysis showed different comorbidities influencing POD at different stages of age. Additionally, POD markedly increased along with age. Moreover, compared with younger than 70 years in male patients and younger than 80 years in female patients, patients over the age of 70 for males and over the age of 80 for females had a higher rate of POD.ConclusionsAdvanced age and patients with a history of dementia were independent risks of delirium after IF surgery in both univariate and multivariate analyses. 70 years old in male patients and 80 years old in female patients may be the cut-off values for a significantly increased rate of POD. Preoperative measures should be taken to lower the incidence of POD.Level of EvidencePrognostic Level III.
      Citation: Geriatric Orthopaedic Surgery & Rehabilitation
      PubDate: 2022-02-25T04:47:03Z
      DOI: 10.1177/21514593221081779
      Issue No: Vol. 13 (2022)
  • Is Dual Mobility Total Hip Arthroplasty Surgery More Aggressive than
           Hemiarthroplasty when Treating Femoral Neck Fracture in the Elderly' A
           Multicentric Retrospective Study on 302 Hips

    • Authors: Marco Rotini, Luca Farinelli, Leonardo Natalini, Federico De Rosa, Rocco Politano, Marco Cianforlini, Emanuele Pacetti, Roberto Procaccini, Fabiana Magrini Pasquinelli, Antonio Gigante
      Abstract: Geriatric Orthopaedic Surgery & Rehabilitation, Volume 13, Issue , January-December 2022.
      IntroductionBipolar hemiarthroplasty (BHA) and total hip arthroplasty (THA) are validated treatments for displaced femoral neck fractures (DFNFs). BHA seldomly needs conversion to THA, but the latter has higher dislocation rate in FNFs. Dual Mobility THA offers a reduced dislocation rate and eliminates the risk of conversion. This study looks for differences between BHA and DMTHA in terms of surgical time, blood loss and transfusion, dislocation rate, mortality, and thromboembolic events.Material and MethodsAll patients were ≥75yo. Recorded data included use of anticoagulant/antiplatelet drugs, ASA, operative time, intra-operative complications, pre/post-operative hemoglobin values, transfusions, hospitalization time, DVT/PE, glomerular filtration rate, Charlson Comorbidity Index (CCI), dislocation at 60 days, and mortality at 30 days and 6 months. A secondary analysis compared the subgroups in different age range (75–85 and ≥ 86yo).ResultsIn the cohort of 302 DFNF (93 BHA and 209 DMTHA) differences in mean age, CCI, and ASA score were significant. Once divided by age, the subgroups resulted comparable in terms of age and CCI, with no significant difference. A significant difference in surgical times showed DMTHA being an average 12 minutes longer than BHA. Significant was the ΔHB in the DMTHA subgroup which resulted lower compared to the BHA one. Difference in mean number of post-operative transfusion were not statistically significant.ConclusionsFrom our data, DMTHA did not lead to an increase in mortality, morbidity, bleeding, or dislocation rate when compared to BHA and could be considered as treatment of choice for DFNFs especially in healthy and active patients.
      Citation: Geriatric Orthopaedic Surgery & Rehabilitation
      PubDate: 2022-02-24T06:34:16Z
      DOI: 10.1177/21514593221081375
      Issue No: Vol. 13 (2022)
  • Thickness of the Subcutaneous Fat as a Risk Factor for Surgical Site
           Infection Following Fragility Hip Fracture Surgery

    • Authors: Tal Frenkel Rutenberg, Rotem Markman, Ran Rutenberg, Efrat Daglan, Tomer Rubin, Shai Shemesh
      Abstract: Geriatric Orthopaedic Surgery & Rehabilitation, Volume 13, Issue , January-December 2022.
      IntroductionSurgical site infection (SSI) following fragility hip fracture (FHF) surgery is associated with increased morbidity and mortality.SignificancePrediction of patients at risk for SSI is fundamental. We aimed to determine whether subcutaneous radiographic fat measurement (SRM) is associated with increased SSI risk.MethodsA retrospective case-control comparison of SRMs at 3 locations around the hip. Patients diagnosed with SSI in the first post-operative year were matched with age, gender, surgical year, Charlsons’ co-morbidity index score, and surgical type controls, not diagnosed with SSI, at a 1:2 ratio. Measurements included the distance between (1) the sourcil to skin surface (SS), (2) the tip of the greater trochanter to skin surface (TGTS), and (3) the most prominent lateral aspect of the greater trochanter to skin surface.Results1430 patients were operated during the study period, of whom 45 patients presented with a diagnosis of SSI and compared to 90 controls. Infections occurred 27.4 ( ± 24.8) days following surgery. SRM significantly differed between groups, and all were higher in the study group; SS, 86.8 ± 25.5 cm vs 74.2 ± 15.3 cm; TGTS, 59.8 ± 26.3 cm vs 47.0 ± 15.8 cm; and LGTS, 45.4 ± 25.1 cm vs 33.2 ± 15.1 cm (P = .003, .004, and .004, respectively). Intraclass correlation coefficients (intra-rater) were high for all measurements (.999 for all). Intraclass correlation coefficients (inter-rater) for SS, TGTS and LGTS were high, .749 (.663.815), .792 (.719.847) and .817 (.751.866), respectively.ConclusionsSRMs were found to be a valid and reproducible tool for predicting high risk of SSI in geriatric patients sustaining FHFs.Level of EvidenceIII.
      Citation: Geriatric Orthopaedic Surgery & Rehabilitation
      PubDate: 2022-02-23T08:21:25Z
      DOI: 10.1177/21514593221080272
      Issue No: Vol. 13 (2022)
  • Efficacy of Supercapsular Percutaneously-Assisted Total Hip Arthroplasty
           in the Elderly With Femoral Neck Fractures: A Meta-analysis

    • Authors: Fulong Zhao, Yang Xue, Xuefei Wang, Yunjia Zhan
      Abstract: Geriatric Orthopaedic Surgery & Rehabilitation, Volume 13, Issue , January-December 2022.
      IntroductionSupercapsular Percutaneously-Assisted Total Hip (SuperPATH) approach is a novel minimally invasive surgical technique for total hip arthroplasty (THA). This meta-analysis was conducted to evaluate the outcomes following THA via the SuperPATH approach in elderly patients with femoral neck fractures (FNFs), compared with those via traditional surgical approaches.MethodsEligible studies were retrieved through searching 7 electronic databases and manually screening related references. Objectives were surgical-related parameters, functional outcomes, and incidence of postoperative complications.Results9 comparative studies were included. Pooled results suggested that at the cost of longer operative time (WMD: 14.25, 95% CI: 3.25 to 25.25), the SuperPATH technique was superior to traditional approaches regarding incision length (WMD: −4.51, 95% CI: −6.46 to −2.56), intraoperative blood loss (WMD: −80.47, 95% CI: −122.36 to −38.57), and hospital stays (WMD: −3.35, 95% CI: −5.05 to −1.65). SuperPATH groups exhibited significantly increased Harris Hip Scores within 1 month after surgery (7d, WMD: 9.85, 95% CI: 6.40 to 13.30; 14d, WMD: 10.68, 95% CI: 8.29 to 13.08; 1 month, WMD: 6.17, 95% CI: 3.56 to 8.78) and had a reduced incidence of overall complications (OR: .19, 95% CI: .09 to .41). No significant differences were found between the 2 groups regarding postoperative pain relief.ConclusionElderly patients with FNFs are potential candidates for THA treatment via the SuperPATH technique, which is associated with improved surgical outcomes, better short-term functional recovery, and lower risk of total complications as compared to traditional approaches. Additional studies are needed to further confirm our conclusions and validate the long-term efficacy of SuperPATH.
      Citation: Geriatric Orthopaedic Surgery & Rehabilitation
      PubDate: 2022-02-16T01:13:24Z
      DOI: 10.1177/21514593221074176
      Issue No: Vol. 13 (2022)
  • ‘XX’–Sacroplasty: A Novel Technique for Management of “H-Type”
           Sacral Insufficiency Fractures

    • Authors: Raphael Lotan, Oded Hershkovich, Yigal Bronstein, Joel Finkelstein
      Abstract: Geriatric Orthopaedic Surgery & Rehabilitation, Volume 13, Issue , January-December 2022.
      ObjectiveExamine the feasibility, safety, and results of a novel sacral percutaneous injection technique (“XX”) addressing both the vertical and horizontal aspects of sacral insufficiency fractures (SIF).MethodsProspective cohort study. Eight consecutive SIF patients with immobility and pain investigated using CT and nuclear imaging confirmed “H"-type fracture. Demographics, pain level, and ambulation status were recorded. The long-term quality of life was evaluated using the ODI questionnaire and pain VAS scores. Sacroplasty procedures in prone positioning using fluoroscopy were used to insert 2 bone trochars through the S1 pedicles and 2 trochars through the sacral ale aiming toward the SIJ, thus forming 2 “X” trochar formations. Balloon kyphoplasty was done through the trocars, and PMM was injected. Postoperative ambulation and VAS were recorded.ResultsAverage age was 81.5 years (±3.4 years). The time from presenting symptoms to hospital admission was 2 days to 4 months. All patients were significantly limited with ambulation. None had a neurologic compromise. Sacroplasty was performed with 2 cases that required additional lumbar kyphoplasty. The mean operative time was 54 min (±14). The average exposure was 19 mGy (±12 mGy). Two patients had cement leaks. CT and X-rays revealed good cement filling of the fractures sacral alae and body of S1. The average postoperative hospitalization was 10 days. All patients reported postoperatively pain relief immediately and were able to walk better. Follow-up time was 17 ± 12 months. Follow-up VAS was 2.7 (±2) and ODI was 57.3% (±21%).Conclusion“XX” technique showed good outcomes for patients with higher complexity SIF, using the same principles as for lumbar VPL/KPL, and was found to be safe and effective.
      Citation: Geriatric Orthopaedic Surgery & Rehabilitation
      PubDate: 2022-02-04T04:00:21Z
      DOI: 10.1177/21514593211049671
      Issue No: Vol. 13 (2022)
  • Early Weight Bearing after Distal Femur Fracture Fixation

    • Authors: Brendan M. Striano, Phillip T. Grisdela, Shay Shapira, Marilyn Heng
      Abstract: Geriatric Orthopaedic Surgery & Rehabilitation, Volume 13, Issue , January-December 2022.
      ObjectivesTo assess outcomes following early weight bearing after distal femur fracture fixation with locked lateral plating.DesignRetrospective cohort studySettingTwo Level 1 Academic Trauma Centers.Patients/ParticipantsPatients 18 years and older with distal femur fractures treated with locked lateral platingInterventionEarly full weight bearing (defined as less than 30 days from date of surgery) versus restricted post-operative weight bearingMain Outcome MeasurementsComposite complication comprising malunion, nonunion, surgical site infection, re-admission, or deathResults270 distal femur fractures were reviewed, with 165 meeting inclusion criteria. 21 patients had been allowed early full weight bearing. Fractures were divided into two groups based on when full weight bearing was allowed post-operatively. The two groups had similar fractures as determined by the distribution of AO distal femur fracture and Su periprosthetic femur fracture classifications. The early weight bearing group was significantly older and more comorbid. Despite being older, more comorbid, and allowed early full weight bearing on their fracture fixation construct, there was no difference in the rate of composite complications between groups.ConclusionOur data contributes to the small, but growing body of literature that has found no increased rate of fracture related complications in surgically treated distal femur fractures allowed early post-operative weight bearing.Level of EvidenceTherapeutic Level III Study.
      Citation: Geriatric Orthopaedic Surgery & Rehabilitation
      PubDate: 2022-01-27T07:47:55Z
      DOI: 10.1177/21514593211070128
      Issue No: Vol. 13 (2022)
  • Osteochondroma Arising From the Inferior Articular Process of the Lumbar
           Spine in a Geriatric Patient: A Case Report and Literature Review

    • Authors: Guang-Xun Lin, Hua-Jian Wu, Chien-Min Chen, Gang Rui, Bao-Shan Hu
      Abstract: Geriatric Orthopaedic Surgery & Rehabilitation, Volume 13, Issue , January-December 2022.
      ObjectiveSpinal osteochondromas are rare, and approximately less than 5% occur as spinal lesions. We report the case of a solitary osteochondroma of the spine and review and update the literature on spinal osteochondroma, including surgical treatment and subsequent results.Case DescriptionA 73-year-old female patient complained of a 10-year history of back pain and a 4-year history of right-side lower extremity radiating pain with paresthesia. Computed tomography and magnetic resonance imaging (MRI) revealed a bony mass arising from the inferior articular process (IAP) of L3, presenting with features of compressive spinal stenosis at the L3–L4 level. The treatment strategy included the complete marginal excision of the lesion through the posterior approach, as well as complete decompression of the spinal canal and nerve roots. The patient’s symptoms resolved after surgery, and histopathological examination identified the lesion as an osteochondroma.Review ResultsThis review study included 168 solitary osteochondroma cases. The most commonly involved spinal level was cervical (51.8%), and the most frequent spinal anatomic column involved was the posterior column (70.8%). Radiculopathy accounted for 30.3% of all cases, myelopathy accounted for 31.0%, and 7.7% exhibited both symptoms simultaneously. The recurrence rate was 6.0%.ConclusionComputed tomography and MRI can effectively diagnose spinal osteochondroma, and surgical treatment can effectively improve clinical outcomes. In almost all symptomatic cases, the best treatment is marginal excision of the tumor. Complete resection of the cartilaginous cap of the tumor is especially important to prevent recurrence.
      Citation: Geriatric Orthopaedic Surgery & Rehabilitation
      PubDate: 2022-01-25T09:21:34Z
      DOI: 10.1177/21514593211073028
      Issue No: Vol. 13 (2022)
  • Transdermal Buprenorphine for Pain Management Following a Neck of Femur

    • Authors: Andrew Davies, Jane Murray, Pardis Zalmay, Ewan Ross, Shumaila Dar, Helen Wilson
      Abstract: Geriatric Orthopaedic Surgery & Rehabilitation, Volume 13, Issue , January-December 2022.
      IntroductionPain management in patients with hip fractures can be challenging. Poor pain control is associated with reduced mobility and increased morbidity. Inadequate analgesia in patients with dementia is a concern. After using several different alternatives, transdermal buprenorphine was chosen as a standardised approach for analgesia in patients with fragility fracture in our hospital. There is limited evidence on the use of buprenorphine in this population. Our aim was to investigate the safety and effectiveness of transdermal buprenorphine in patients with hip fractures.MethodsA review of consecutive patients presenting with a hip fracture from June 2018 to December 2018 was conducted using medical records. Our primary outcome was the incidence of complications as a consequence of transdermal buprenorphine. Our secondary outcome was adequate analgesia measured by reviewing the requirement for analgesia during the first week following the patient’s admission. Analgesia demands were considered adequate if patients required less than 20 mg of oral morphine in total during the first week following injury.ResultsIn total, 148 patients presented with a hip fracture during the study period. 128 patients had documented evidence of buprenorphine patch application. Complete data was available for the primary outcome of complications in all cases. Data was available for the secondary outcome in 124 patients. Buprenorphine was discontinued in 24 patients (19%), most commonly due to due to concerns about contribution to hypoactive delirium (9%), and when strong analgesia was no longer required (4%). There were no severe complications. Adequate analgesia was achieved using this regime in 68% patients. 38 patients (32%) required more than 20 mg of oral morphine sulphate solution in the first week post-admission.ConclusionThis series suggests that transdermal buprenorphine is safe and effective in the management of pain following a neck of femur fragility fracture.
      Citation: Geriatric Orthopaedic Surgery & Rehabilitation
      PubDate: 2022-01-17T12:35:40Z
      DOI: 10.1177/21514593211070260
      Issue No: Vol. 13 (2022)
  • Risk Factor Analysis for Fat Infiltration in the Lumbar Paraspinal Muscles
           in Patients With Lumbar Degenerative Diseases

    • Authors: Kenta Suzuki, Yuki Hasebe, Mitsuru Yamamoto, Kazuo Saita, Satoshi Ogihara
      Abstract: Geriatric Orthopaedic Surgery & Rehabilitation, Volume 13, Issue , January-December 2022.
      IntroductionThis study aimed to investigate factors related to fat infiltration in patients with lumbar degenerative diseases (lumbar disc herniation and/or spinal stenosis), examining a wide range of potential risk variables.Materials and methodsWe studied consecutive adult patients who underwent posterior lumbar spinal surgery for degenerative diseases at our hospital between July 2013 and June 2017. Preoperative magnetic resonance imaging was used to evaluate the presence or absence of fat infiltration at the level of the L4-5 lumbar paraspinal muscles using Kjaer’s evaluation method. Patients without fat infiltration (0%–10%) were rated as grade 0, grade 1 for moderate fat infiltration (10%–50%), and grade 2 for severe fat infiltration (>50%). Patients were then divided into two groups: Group A (without fat infiltration, grade 0) and Group B (with fat infiltration, grade 1 or 2). Detailed patient clinical data were collected and analyzed.ResultsA total of 205 consecutive patients were enrolled; 54 (26.3%) patients were assigned to Group A and 151 (73.7%) to Group B. Logistic regression analysis revealed two independent risk factors for fat infiltration of the lumbar paraspinal muscles: female sex and older age (P < .001).DiscussionFat infiltration of the lumbar paraspinal muscles is reported to be associated with the development of pain and dysfunction of the lumbar region and postoperative complications of spinal instrumented fusion surgery. To the best of our knowledge, no previous studies have identified female sex and older age as independent risk factors for fat infiltration in the lumbar paraspinal muscles using multivariate analysis.ConclusionsFemale sex and older age were independent risk factors for fat infiltration in the lumbar paraspinal muscles. The results of the current study may provide useful information for the study of preventive measures for fat infiltration.
      Citation: Geriatric Orthopaedic Surgery & Rehabilitation
      PubDate: 2022-01-13T04:19:16Z
      DOI: 10.1177/21514593211070688
      Issue No: Vol. 13 (2022)
  • Association of Acute Perioperative Myocardial Injury With All-Cause
           Mortality Within 90 Days After Hip Fracture Repair in the Elderly: A
           Prospective Study

    • Authors: Lei Wang, Meng Cai, Xiaoying Li, Xiaohui Deng, Qiang Xue, Li Zhou, Minghui Yang
      Abstract: Geriatric Orthopaedic Surgery & Rehabilitation, Volume 13, Issue , January-December 2022.
      IntroductionIt remains unclear whether acute perioperative myocardial injury (APMI) increases mortality in the elderly. This study aimed to investigate APMI’s association with mortality within 90 days after hip fracture repair in elderly patients.Materials and MethodsThis prospective study enrolled elderly patients admitted to the department of Traumatology and Orthopaedics in XXX Hospital, who underwent surgery in 2018–2019 with a 90-day follow-up. According to survival status within 90 days, survival and death groups were constituted. Clinical, demographic, and laboratory indicators and 90-day mortality post-surgery were recorded. APMI’s association with 90-day mortality post-surgery was analyzed by logistic regression.ResultsTotally 248 participants were enrolled, including 224 and 24 in the survival and death groups, respectively, for a mortality rate of 9.7%. Compared with surviving individuals, the death group was older [81 (75–86) vs 87 (82–89) years], and had higher incidence rates of APMI (24.6% vs 58.3%), intertrochanteric fractures (41.1% vs 62.5%), preoperative atrial fibrillation (8.9% vs 29.2%), and dementia (73.7% vs 95.8%) (all P
      Citation: Geriatric Orthopaedic Surgery & Rehabilitation
      PubDate: 2022-01-12T03:32:15Z
      DOI: 10.1177/21514593211070129
      Issue No: Vol. 13 (2022)
School of Mathematical and Computer Sciences
Heriot-Watt University
Edinburgh, EH14 4AS, UK
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