| 1. |
- Hommel, Ami, et al.
(författare)
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Influence of optimised treatment of people with hip fracture on time to operation, length of hospital stay, reoperations and mortality within 1 year
- 2008
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Ingår i: Injury. - : Elsevier. - 0020-1383 .- 1879-0267. ; 39:10, s. 1164-1174
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Tidskriftsartikel (refereegranskat)abstract
- Hip fractures are a major cause of hospital stay among the elderly, and result in increased disability and mortality. In this study from 1 April 2003 to 31 March 2004, the influence of optimised treatment of hip fracture on time to operation, length of hospital stay, reoperations and mortality within 1 year were investigated. Comparisons were made between the first 210 patients in the period and the last 210 patients, who followed the new clinical pathway introduced at the University Hospital in Lund, Sweden. Early surgery, within 24h, was not associated with reduced mortality, but was significantly associated with reduced length of stay (p<0.001). Significantly more cases of osteosynthesis for femoral neck fracture were reoperated compared with all other types of surgery (p<0.001) when reoperations with extraction of the hook pins in healed fractures were excluded. Mortality was significantly higher among men than women at 4 (p=0.025) and 12 (p=0.001) months after fracture and among medically fit patients with administrative delay to surgery compared with patients with no delay (p<0.001).
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| 2. |
- 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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| 3. |
- Hommel, Ami, et al.
(författare)
-
Influence of optimised treatment of people with hip fracture on time to operation, length of hospital stay, reoperations and mortality within 1 year.
- 2008
-
Ingår i: Injury. - : Elsevier BV. - 1879-0267 .- 0020-1383. ; 39, s. 1164-1174
-
Tidskriftsartikel (refereegranskat)abstract
- Hip fractures are a major cause of hospital stay among the elderly, and result in increased disability and mortality. In this study from 1 April 2003 to 31 March 2004, the influence of optimised treatment of hip fracture on time to operation, length of hospital stay, reoperations and mortality within 1 year were investigated. Comparisons were made between the first 210 patients in the period and the last 210 patients, who followed the new clinical pathway introduced at the University Hospital in Lund, Sweden. Early surgery, within 24h, was not associated with reduced mortality, but was significantly associated with reduced length of stay (p<0.001). Significantly more cases of osteosynthesis for femoral neck fracture were reoperated compared with all other types of surgery (p<0.001) when reoperations with extraction of the hook pins in healed fractures were excluded. Mortality was significantly higher among men than women at 4 (p=0.025) and 12 (p=0.001) months after fracture and among medically fit patients with administrative delay to surgery compared with patients with no delay (p<0.001).
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| 4. |
- 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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| 5. |
- Nordström, Peter, et al.
(författare)
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Bisphosphonate Use After Hip Fracture in Older Adults : A Nationwide Retrospective Cohort Study
- 2017
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Ingår i: Journal of the American Medical Directors Association. - : Elsevier BV. - 1525-8610 .- 1538-9375. ; 18:6, s. 515-521
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: The aim of this study was to investigate the association between bisphosphonate use and the risk of new fracture in a nationwide cohort of individuals with previous hip fractures, with emphasis on individuals above 80 years of age. Design, setting, and participants: From a nationwide cohort with hip fracture (2006-2012) (n = 93, 601), each individual prescribed bisphosphonates after hip fracture (n = 5845) was matched with up to three individuals not prescribed bisphosphonates, resulting in a cohort of 21,363 individuals. Main outcome measure: A new hip fracture. Results: During a mean follow-up period of 2.98 (range, 0.02-8) years, 4581 fractures occurred in the cohort. Before the initiation of bisphosphonate therapy, individuals later prescribed bisphosphonates had an increased risk of hip fracture (multivariable adjusted odds ratio [OR], 2.63; 95% confidence interval [CI], 2.23-3.24) compared with controls. In the period after bisphosphonate therapy initiation, individuals prescribed bisphosphonates had a lower risk of hip fracture (multivariable adjusted hazard ratio [HR], 0.76; 95% CI, 0.65-0.90) compared with controls. Similar effects were seen after the initiation of bisphosphonates in individuals aged more than 80 years (HR, 0.79; 95% CI, 0.62-0.99). In contrast, the initiation of bisphosphonate therapy did not influence the risk of injurious falls not resulting in fracture (HR, 0.95; 95% CI, 0.86-1.05). Conclusion: Bisphosphonate use was associated with a decreased risk of hip fracture in this nationwide cohort of older men and women, with similar risk reductions in individuals older than 80 years.
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| 6. |
- Ekstrom, Wilhelmina, et al.
(författare)
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Sex effects on short-term complications after hip fracture: a prospective cohort study
- 2015
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Ingår i: Clinical Interventions in Aging. - 1178-1998 .- 1176-9092. ; 10, s. 1259-1266
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To evaluate potential sex differences and other factors associated with complications within 4 months after a hip fracture. Methods: A total of 1,915 patients. 65 years (480 men) with hip fracture were consecutively included in a prospective multicenter cohort study. A review of medical records and patient interviews according to a study protocol based on the Standardized Audit of Hip Fractures in Europe (SAHFE, RIKSHOFT) was performed. Sex differences in comorbidity according to the American Society of Anesthesiologists score and complications 4 months after a hip fracture were registered. Multivariate logistic regression analysis was performed to identify factors related to complications. Results: Male sex was associated with worse general health according to the American Society of Anesthesiologists classification (P=0.005) and with more comorbidities (P<0.001). Male sex emerged as a risk factor for developing pneumonia (P<0.001), and additionally, 18% of the men suffered from cardiac complications compared with 13% of the females (P=0.018). Female sex was predisposed for urinary tract infections, 30% vs 23% in males (P=0.001). Mortality was higher in the male vs female group, both within 30 days (15% vs 10%, P=0.001) and at 4 months (24% vs 14%, P=0.001). Conditions associated with pneumonia were male sex, pulmonary disease, and cognitive impairment. Cardiac complications were associated with delayed surgery and cardiovascular and pulmonary disease. Conclusion: Before surgery, men with hip fracture already have a poorer health status and higher comorbidity rate than women, thus resulting in a twofold increased risk of pneumonia. Cognitive dysfunction and pulmonary disease contributed to pneumonia in men. Delayed surgery seems to increase the risk for cardiac complications. It is important to consider the sex perspective early on together with cardiopulmonary comorbidity and cognitive dysfunction to be able to counteract serious complications that may lead to death.
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| 7. |
- Björkman Björkelund, Karin, et al.
(författare)
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The influence of perioperative care and treatment on the 4-month outcome in elderly patients with hip fracture.
- 2011
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Ingår i: AANA Journal. - 0094-6354. ; 79:1, s. 51-61
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Tidskriftsartikel (refereegranskat)abstract
- The purpose of this descriptive cohort study was to identify perioperative risk factors associated with postoperative outcome up to 4 months after surgery in elderly patients with hip fracture. Data were collected prospectively through the Swedish National Hip Fracture, the local Acute and Emergency, and Anesthesia 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. Perioperative risk factors predicting death within 4 months after surgery were fasting time of 12 or more hours and blood transfusion of 1 U or more. Risk factors predicting postoperative confusion were postoperative oxygen saturation less than 90% and fasting time 12 hours or longer. Risk factors predicting in-hospital complications were transfusion of 1 or more units of blood, preoperative oxygen saturation less than 90%, and fasting time 12 hours or more. Risk factor predicting length of stay longer than 10 days was blood transfusion of 1 U or more. To minimize morbidity and mortality, providers should increase efforts to optimize the patients' oxygen saturation and hemoglobin level and reduce fasting time and waiting time for surgery.
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| 8. |
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| 9. |
- 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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| 10. |
- 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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