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| 2. |
- Lunsjö, Karl, et al.
(författare)
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Extramedullary fixation of 569 unstable intertrochanteric fractures: a randomized multicenter trial of the Medoff sliding plate versus three other screw-plate systems
- 2001
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Ingår i: Acta Orthopaedica Scandinavica. - : Medical Journals Sweden AB. - 0001-6470. ; 72, s. 133-
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Tidskriftsartikel (refereegranskat)abstract
- We compared the efficacy of the Medoff sliding plate (MSP) with 3 other screw-plate systems for fixation of unstable intertrochanteric fractures in a randomized multicenter trial of 569 elderly patients. The MSP has biaxial dynamic capacity along both the neck and the shaft of the femur unlike the other systems, which lack dynamic capacity along the shaft. 268 fractures were operated on with the MSP, and 301 with the dynamic hip screw (DHS), with or without a trochanteric stabilizing plate (DHS/TSP) or with the dynamic condylar screw (DCS). The MSP had recently been shown to the surgeons.The patients in the groups were similar as regards age, domestic situation, preinjury walking ability and type of fracture. We followed the patients clinically and radiographically for at least 1 year. There was no significant difference in walking ability at follow-up or rate of return to home. Fixation failure occurred in 18/268 fractures operated on with the MSP, in 8/238 with the DHS, in 3/49 with the DHS/TSP and in 1/14 with the DCS. The difference in the rate of fixation failure was not statistically significant when the MSP group was compared to the 3 other groups. In 14 of the 18 fixation failures in the MSP group, the biaxial dynamic capacity of the MSP had not been used due to technical errors by surgeons, unfamiliar with the new method. No selection bias was found regarding fracture types in the 2 subgroups of patients with correct or inadequate biaxial dynamization. Extramedullary fixation of unstable intertrochanteric fractures with these implants showed a low failure rate. When using the MSP, biaxial dynamization must be correctly performed.
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| 3. |
- Nordström, Peter, et al.
(författare)
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Geriatric Rehabilitation and Discharge Location After Hip Fracture in Relation to the Risks of Death and Readmission
- 2016
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Ingår i: Journal of the American Medical Directors Association. - : Elsevier. - 1525-8610 .- 1538-9375. ; 17:1
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To investigate the effects of geriatric rehabilitation on short-term risk of death and readmission after a hip fracture were investigated in a nationwide cohort. In addition, the association of discharge location (nursing home or patient's home) with the short-term risk of death was assessed.DESIGN, SETTING, AND PARTICIPANTS: The cohort consisted of 89,301 individuals at least 50 years of age, with a first hip fracture registered in the Swedish quality register RIKSHÖFT, the years 2004-2012.MEASURES: Short-term risk of death and readmission to hospital after discharge was compared at 8 hospitals, where most patients received inpatient care in geriatric wards, and those treated at 71 regular hospitals.RESULTS: The risks of death within 30 days of admission were 7.1% in patients admitted to geriatric ward hospitals and 7.4% in those treated at regular hospitals (multivariable-adjusted hazard ratio [HR] 0.91, 95% CI 0.85-0.97), whereas the odds of readmission within 30 days of discharge were 8.7% and 9.8%, respectively (multivariable-adjusted odds ratio 0.86, 95% CI 0.81-0.91). The risk of death was influenced by discharge location and inpatient length of stay (LOS). Thus, for patients discharged to short-term nursing homes with a LOS of at most 10 days, each additional day of LOS reduction increased the risk of death within 30 days of discharge by 13% (HR 1.13, 95% CI 1.08-1.18). This association was reduced in patients discharged to permanent nursing homes (HR 1.04, 95% CI 1.02-1.07), and not significant in those discharged to their own home (OR 1.00, 95% CI 0.91-1.10).CONCLUSION: The risks of death and readmission were lower in patients with hip fracture who received care in hospitals with geriatric wards. The risk of death after discharge increased with shorter LOS, especially in patients discharged to short-term nursing homes.
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| 4. |
- Thorngren, Karl-Göran, et al.
(författare)
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Epidemiology of femoral neck fractures
- 2002
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Ingår i: Injury. - 1879-0267. ; 33:Suppl 3, s. 1-7
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Tidskriftsartikel (refereegranskat)abstract
- Fractures of the femoral neck, that is, "cervical hip fractures" constitute 53% of all fractures of the proximal femur (hip fractures) according to the Swedish National Hip Fracture Register linked to SAHFE (Standardised Audit of Hip Fractures in Europe). The most reproducible classification system divides cervical hip fractures into undisplaced (33%) and displaced (67%). Hip fractures are common and costly. Due to the expected increase in the number of elderly in the world during the coming decades the number of hip fractures will increase dramatically, particularly in developing countries. In Sweden three quarters of the patients are women, the mean age is now 81 years and half of the patients are living alone. Hip fractures are rare below 50 years of age. In recent years there has been an incidence increase in the oldest patients, i.e. those over 80 years of age. For these elderly, the incidence in Lund, Sweden, increased from 13.2/1000 in 1966 to 25.5/1000 in 1986. The high number of patients with hip fractures and the cost of treatment increases the need for prevention as well as optimization of operative treatment and rehabilitation. National guidelines are being developed in Europe. Linked with national audits like SAHFE they can improve the quality of care by audit and feedback.
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| 5. |
- Thorngren, Karl-Göran, et al.
(författare)
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Influence of age, sex, fracture type and pre-fracture living on rehabilitation pattern after hip fracture in the elderly
- 2005
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Ingår i: Disability and Rehabilitation. - : Informa UK Limited. - 0963-8288 .- 1464-5165. ; 27:18-19, s. 1091-1097
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: To evaluate the influence of background factors on the rehabilitation pattern after a hip fracture in the elderly.Method: Prospective registration based on the Swedish national register for hip fracture patients called RIKSHÖFT/SAHFE (Standardised Audit of Hip Fractures in Europe). The place of living was registered both before fracture and during the following four months period (120 days). Graphs were calculated and drawn based on day-to‐day changes. Also influences of age, sex, fracture type and type of operation were analyzed.Results: The patient's pre-fracture functional capacity as evidence by the place they were able to manage to live before the fracture was the most discriminating factor for the rehabilitation; more than sex, fracture type or type of operation. Age was also a highly discriminating factor with a pronounced influence on the rehabilitation pattern.Conclusions: These background parameters are very important factors when planning the rehabilitation of hip fracture patients. A strategy with individualized planning of the rehabilitation procedure will be highly necessary in the future, in view of the increasing amount of elderly with hip fractures prognosticated during the coming decades. The knowledge about influencing factors here presented will be useful when planning and performing the rehabilitation for this resource-consuming group of patients.
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| 6. |
- Ahrengart, L, et al.
(författare)
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A randomized study of the compression hip screw and gamma nail in 426 fractures
- 2002
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Ingår i: Clinical Orthopaedics and Related Research. - 0009-921X. ; :401, s. 209-222
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Tidskriftsartikel (refereegranskat)abstract
- A prospective, randomized study comparing the compression hip screw with the Gamma nail in the treatment of 426 intertrochanteric fractures is reported. The median patient age was 80 years, and 71 % were women The compression hip screw operation took less time except in Evans Type 5 fractures. Blood loss generally was less in the compression hip screw group except in patients with Type 5 fractures. The most frequent surgical problem for patients in the Gamma group was problems with distal locking. Cephalic position of the femoral head screw and cut-out were seen more often in the Gamma nail group. The Gamma nail more frequently preserved the fracture position obtained perioperatively. Whether there was distal locking of the Gamma nail in unstable fractures did not seem to affect the healing rate. Additional fissures or fractures in the proximal femur occurred during five Gamma nail operations and two compression hip screw operations. Postoperative walking ability did not differ between the groups. At 6 months 88% of the fractures were healed. In less comminuted fractures, the compression hip screw method is the preferred method of treatment whereas the Gamma nail is an alternative treatment for more comminuted Evans Type 5 fractures.
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| 7. |
- Aspenberg, Per, et al.
(författare)
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Rabbit bone matrix induces bone formation in the athymic rat
- 1988
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Ingår i: Acta Orthopaedica. - : Medical Journals Sweden AB. - 1745-3674 .- 0001-6470. ; 59:3, s. 276-278
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Tidskriftsartikel (refereegranskat)abstract
- Rabbit and rat bone matrix were implanted in athymic rat muscle, and the bone yield was measured as total calcium content after 4, 6, and 8 weeks. Matrix from both species induced equal amounts of new bone in the athymic rat. In rabbit and normal rat, the xenogenic matrix induced little or no bone formation. Thus, in the case of rabbit and rat, bone induction is species specific due to immunogenic mechanisms. the athymic rat can be used to measure inductive properties of bone matrix from different species.
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| 8. |
- Bartha, Erzsebet, et al.
(författare)
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Cost-effectiveness Analysis of Goal-directed Hemodynamic Treatment of Elderly Hip Fracture Patients : Before Clinical Research Starts
- 2012
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Ingår i: Anesthesiology. - : Lippincott Williams & Wilkins. - 0003-3022 .- 1528-1175. ; 117:3, s. 519-530
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Tidskriftsartikel (refereegranskat)abstract
- Background: Health economic evaluations are increasingly used to make the decision to adopt new medical interventions. Before such decisions, various stakeholders have invested in clinical research. But health economic factors are seldom considered in research funding decisions. Cost-effectiveness analysis could be informative before the launch of clinical research projects, particularly when a targeted intervention is resource-intensive, total cost for the trial is very high, and expected gain of health benefits is uncertain. This study analyzed cost-effectiveness using a decision analytic model before initiating a large clinical research project on goal-directed hemodynamic treatment of elderly patients with hip fracture.Methods: A probabilistic decision analytic cost-effectiveness model was developed; the model contains a decision tree for the postoperative short-term outcome and a Markov structure for long-term outcome. Clinical effect estimates, costs, health-related quality-of-life measures, and long-term survival constituted model input that was extracted from clinical trials, national databases, and surveys. Model output consisted of estimated medical care costs related to quality-adjusted life-years.Results: In the base care analysis, goal-directed hemodynamic treatment reduced average medical care costs by €1,882 and gained 0.344 qualilty-adjusted life-years. In 96.5% of the simulations, goal-directed hemodynamic treatment is less costly and provides more quality-adjusted life-years. The results are sensitive to clinical effect size variations, although goal-directed hemodynamic treatment seems to be cost-effective even with moderate clinical effect.Conclusion: This study demonstrates that cost-effectiveness analysis is feasible, meaningful, and recommendable before launch of costly clinical research projects.
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| 9. |
- Bartha, Erzsebet, et al.
(författare)
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Cost-effectiveness Analysis of Goal-directed Hemodynamic Treatment of Elderly Hip Fracture Patients
- 2012
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Ingår i: Anesthesiology. - : ASA Publishers. - 0003-3022 .- 1528-1175. ; 117:3, s. 519-530
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundHealth economic evaluations are increasingly used to make the decision to adopt new medical interventions. Before such decisions, various stakeholders have invested in clinical research. But health economic factors are seldom considered in research funding decisions. Cost-effectiveness analyses could be informative before the launch of clinical research projects, particularly when a targeted intervention is resource-intensive, total cost for the trial is very high, and expected gain of health benefits is uncertain. This study analyzed cost-effectiveness using a decision analytic model before initiating a large clinical research project on goal-directed hemodynamic treatment of elderly patients with hip fracture.MethodsA probabilistic decision analytic cost-effectiveness model was developed; the model contains a decision tree for the postoperative short-term outcome and a Markov structure for long-term outcome. Clinical effect estimates, costs, health-related quality-of-life measures, and long-term survival constituted model input that was extracted from clinical trials, national databases, and surveys. Model output consisted of estimated medical care costs related to quality-adjusted life-years.ResultsIn the base case analysis, goal-directed hemodynamic treatment reduced average medical care costs by €1,882 and gained 0.344 quality-adjusted life-years. In 96.5% of the simulations, goal-directed hemodynamic treatment is less costly and provides more quality-adjusted life-years. The results are sensitive to clinical effect size variations, although goal-directed hemodynamic treatment seems to be cost-effective even with moderate clinical effect.ConclusionThis study demonstrates that cost-effectiveness analysis is feasible, meaningful, and recommendable before launch of costly clinical research projects.
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| 10. |
- Björkman Björkelund, Karin, et al.
(författare)
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Factors at admission associated with 4 months outcome in elderly patients with hip fracture.
- 2009
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Ingår i: AANA Journal. - 0094-6354. ; 77:1, s. 49-58
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Tidskriftsartikel (refereegranskat)abstract
- The purpose of this descriptive cohort study was to describe patients with hip fracture on the basis of ASA physical status and to identify preoperative risk factors associated with postoperative outcome up to 4 months after surgery. Data were collected prospectively through the Swedish National Hip Fracture and Anesthetic registers and retrospectively from medical and nursing records. The 428 patients (aged > or = 65 years) with hip fracture were consecutively included. Multiple logistic regression analyses were used to identify factors predicting each of 4 outcomes. Risk factors for a poorer 4-month survival after hip fracture were ASA physical status 3 and 4, more extensive fractures, 85 years or older, male sex, and dependency in living. Mortality within 4 months was significantly associated with ASA physical status 3 and 4, age 85 years or older, male sex, dementia diagnosis, fewer than 8 correct answers on the Short Portable Mental Status Questionnaire, 4 or more prescribed drugs, hemoglobin level less than 100 g/L, creatinine level more than 100 micromol/L, dependency in living, inability to walk alone, and fracture other than undisplaced intracapsular. Elderly patients with hip fracture should be identified immediately at admission regarding risk factors leading to a poorer survival and more complications.
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