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- Al-Ani, Amer, et al.
(author)
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Low bone mineral density and fat free mass in young and middle-aged patients with a femoral neck fracture
- 2015
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In: European Journal of Clinical Investigation. - : Wiley. - 0014-2972 .- 1365-2362. ; 45:8, s. 800-806
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Journal article (peer-reviewed)abstract
- BackgroundReduced bone mineral density (BMD) together with muscle wasting and dysfunction, that is sarcopenia, emerges as a risk factor for hip fracture. The aim of this study was to examine body composition and BMD and their relationship with trauma mechanisms in young and middle-aged patients with femoral neck fracture.Materials and methodsAltogether, 185 patients with femoral neck fracture aged 20–69 were included. BMD, body composition and fat-free mass index (FFMI) were determined by dual-X-ray absorptiometry (DXA), and trauma mechanisms were registered.ResultsNinety per cent of the whole study population had a femoral neck BMD below the mean for age. In the young patients (< 50 years), 27% had a Z-score of BMD ≤ −2 SD. More than half of the middle-aged patients (50–69 years) had osteopenia, that is T-score −1 to −2·5, and 35% had osteoporosis, that is T-score < −2·5, at the femoral neck. Patients with low-energy trauma, sport injury or high-energy trauma had a median standardised BMD of 0·702, 0·740 vs. 0·803 g/cm2 (P = 0·03), and a median FFMI of 15·9, 17·7 vs. 17·5 kg/m2 (P < 0·001), respectively. FFMI < 10th percentile of an age- and gender-matched reference population was observed in one-third.ConclusionsA majority had low BMD at the femoral neck, and one-third had reduced FFMI (i.e. sarcopenia). Patients with fracture following low-energy trauma had significantly lower femoral neck BMD and FFMI than patients with other trauma mechanisms. DXA examination of both BMD and body composition could be of value especially in those with low-energy trauma.
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| 3. |
- Ekström, Wilhelmina, et al.
(author)
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Functional outcome in treatment of unstable trochanteric and subtrochanteric fractures with the proximal femoral nail and the Medoff sliding plate
- 2007
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In: Journal of Orthopaedic Trauma. - 0890-5339 .- 1531-2291. ; 21:1, s. 18-25
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Journal article (peer-reviewed)abstract
- Objective: To compare outcome between the proximal femoral nail (PFN) and the Medoff sliding plate (MSP) in patients with unstable trochanteric or subtrochanteric fractures. Methods: This was a consecutive prospective randomized clinical study. In all, 203 patients admitted to two university hospitals with an unstable trochanteric or a subtrochanteric fracture type were included. Surgery was performed with a short intramedullary nail or a dual-sliding plate device. Follow up visits occurred at 6 weeks, 4 months, and 12 months. Functional outcome was measured by walking ability, rising from a chair, curb test, and additional assessments of abductor strength, pain, living conditions, and complications. Results: The ability to walk 15 m at 6 weeks was significantly better in the PFN group compared to the MSP group with an odds ratio 2.2 (P = 0.04, 95% confidence limits 1.03-4.67). No statistical difference in walking ability could be found between trochanteric and subtrochanteric fractures. The major complication rate (8% in the PFN group and 4% in the MSP group) did not differ statistically (P = 0.50) but reoperations were more frequent in the PFN group (9%) compared to the MSP group (1%; P < 0.02). Conclusions: There were no major differences in functional outcome or major complications between the treatment groups. Reasons other than the operated fracture seem to be equally important in determining the long-term functional ability of the patients in our study. An advantage with the MSP was the lower reoperation rate.
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| 4. |
- Ekström, Wilhelmina
(author)
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Proximal femoral fractures : functional outcome, quality of life and mortality
- 2008
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Doctoral thesis (other academic/artistic)abstract
- A hip fracture in the elderly is one of the most devastating consequences of osteoporosis and has a high rate of complications, including death and a serious threat to the patient s future mobility, social functioning, quality of life and autonomy. The aim of this thesis was to gain a better knowledge of the functional outcome after treatment with an intramedullary (proximal femoral nail;PFN) or an extramedullary (Medoff sliding plate; MSP) fixation device in patients with unstable trochanteric and subtrochanteric fractures. The purpose was also to report on the long-term outcome for the health-related quality of life in patients with stable trochanteric fractures treated with a sliding hip screw and patients with subtrochanteric fractures treated with a cephalomedullary nail. A further intention was to identify factors associated with mortality in hip fracture patients and to create a predictive model to assess the mortality risk. In Study I patients with a trochanteric or subtrochanteric fracture were assessed with regard to walking ability, rising from a chair, the curb test and abductor strength. The ability to walk 15 metres at 6 weeks was significantly better in the PFN group with no difference in other functional parameters. The major complication rate, 8% in the PFN group and 4% in the MSP group, did not differ statistically but reoperations were more frequent in the PFN group. Studies II and III evaluated the patients with regard to function, HRQoL and mortality. Among patients with a stable trochanteric fracture, 55% had regained their prefracture walking ability, 66% had regained their prefracture level of ADL function and almost their prefracture HRQoL level 2 years after surgery. Among patients with a subtrochanteric fracture, 46% had regained their prefracture walking ability and 48% their prefracture level of ADL function but showed a substantial and persistent deterioration in their HRQoL at 2 years. Study IV focused on predictors of mortality among patients with hip fractures. 1944 patients were assessed with regard to gender, age, type of hip fracture, smoking habits, comorbidities, the ASA classification and cognitive function according to the SPMSQ. A predictive model was created based on factors that were significantly associated with death and were all readily accessible upon admission. The mortality rate was 4% during the acute hospitalisation period, 16% at 4 months, and 38% at 24 months. High ASA scores, low SPMSQ scores, advanced age and male gender were the most prominent factors associated with mortality. The analyses showed that the combination of ASA and SPMSQ could effectively identify patients at risk for increased mortality. In conclusion, the PFN contributed to a better walking ability in the early rehabilitation period but also caused more reoperations than the MSP. There was an obvious deterioration in the HRQoL in the early rehabilitation phase after both stable trochanteric and subtrochanteric fractures. However, in patients with subtrochanteric fractures this deterioration persisted over time. A combined use of ASA and SPMSQ and a predictive model, also including age and gender, can be used to identify patients with an increased risk of mortality.
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| 5. |
- Söderqvist, Anita, et al.
(author)
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Prediction of mortality in elderly patients with hip fractures : a two-year prospective study of 1,944 patients
- 2009
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In: Gerontology. - : S. Karger AG. - 0304-324X .- 1423-0003. ; 55:5, s. 496-504
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Journal article (peer-reviewed)abstract
- BACKGROUND: Hip fracture patients are reported to have an increased mortality rate compared to the general population. In order to be able to reduce the morbidity and mortality after a hip fracture, our efforts to identify the patients at risk already upon admission to the hospital need to be increased. For such a risk assessment, robust, validated, and reproducible criteria are mandatory. OBJECTIVE: To determine preoperative factors associated with mortality and to evaluate the combined use of the American Society of Anesthesiologists (ASA) and the Short Portable Mental Status Questionnaire (SPMSQ) to identify patients with an increased mortality rate and to create a predictive model to assess the mortality risk after hip fracture surgery. METHODS: A total of 1,944 consecutive patients aged 66 years or older admitted for a hip fracture were included in a prospective cohort study with a 24-month follow-up. The patients were assessed with regard to gender, age, type of hip fracture, smoking habits, comorbidities, general physical health according to the ASA classification, and cognitive function according to the SPMSQ. A higher ASA score indicates an increasingly severe systemic disease and a lower SPMSQ score indicates an increasingly severe cognitive dysfunction. We used Cox proportional hazard models and classification trees to identify the factors associated with mortality. The predictive model was created based on factors that were significantly associated with death and all readily accessible upon admission. RESULTS: The mortality rate during the acute hospitalization period was 4%, at 4 months 16%, and at 24 months 38%. The most prominent factors associated with mortality were high ASA scores, low SPMSQ scores, high age and male gender. The SPMSQ score provided additional information about the survival time, compared to when the ASA score was used alone. CONCLUSION: The combined use of the ASA classification for assessing physical health and the SPMSQ for assessing cognitive function effectively identified hip fracture patients with an increased mortality rate. We present a predictive model including age, gender, ASA, and SPMSQ that can be used to assess the mortality risk after hip fracture surgery.
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