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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. |
- Söderqvist, Anita, et al.
(författare)
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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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Ingår i: Gerontology. - : S. Karger AG. - 0304-324X .- 1423-0003. ; 55:5, s. 496-504
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Tidskriftsartikel (refereegranskat)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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| 4. |
- Tengstrand, Birgitta, et al.
(författare)
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Effects of protein-rich supplementation and nandrolone on bone tissue after a hip fracture
- 2007
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Ingår i: Clinical Nutrition. - : Elsevier BV. - 0261-5614 .- 1532-1983. ; 26:4, s. 460-465
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Tidskriftsartikel (refereegranskat)abstract
- Background & aims: Osteoporosis is a major health problem worldwide. Low weight is a major risk factor for low bone mass and fractures. The aim of this study was to investigate the effects on bone tissue of protein-rich supplementation alone or in combination with nandrolone decanoate in lean elderly women after a hip fracture. Methods: Sixty elderly women with BMI <24 kg/m2 admitted to hospital due to a femoral neck fracture were randomised to a control group, to receive a protein-rich formula or to receive the same formula with an addition of nandrolone decanoate for 6 months. All patients received additional calcium and vitamin D. The effects after 6 and 12 months were measured by means of bone mineral density (BMD) using dual-energy X-ray absorptiometry (DXA), and with biochemical bone markers. Osteocalcin and C-terminal telopeptide of collagen-1 (CTX) were used to estimate bone formation and bone resorption, respectively. Results: The analyses showed an increase in total body BMD at 6 and 12 months in patients who received protein-rich supplementation. Nandrolone decanoate did not appear to have any additional effect on BMD. Osteocalcin increased in all groups while no significant changes were found for CTX. Conclusion: The overall results of the study indicated that protein-rich supplementation given to lean elderly female hip fracture patients increased the total body BMD.
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| 6. |
- Tidermark, Jan, et al.
(författare)
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Femoral neck fractures in the elderly : Functional outcome and quality of life according to EuroQol
- 2002
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Ingår i: Quality of life research. - : Springer Nature B.V. - 1573-2649 .- 0962-9343. ; 11:5, s. 473-481
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Tidskriftsartikel (refereegranskat)abstract
- The main purpose of this prospective study was to investigate the functional outcome and health-related quality of life according to EuroQol (EQ-5D) after a femoral neck fracture treated with internal fixation in relatively healthy elderly patients. We also aimed to validate the use of the EQ-5D in routine clinical follow-ups of this group of patients. The inclusion criteria were more than 65 years of age, absence of severe cognitive dysfunction, living independently, and unhindered walking ability preoperatively. The mean follow-up period was 17 months. The rated prefracture EQ-5D^sub index^ scores showed good correspondence with the scores of an age-matched Swedish reference population. The EQ-5D^sub index^ scores decreased from 0.78 before the fracture (based on recall) to 0.59 at 4 months and 0.51 at 17 months after surgery. The decrease was significantly larger among patients with fracture healing complications. There was a good correlation between the EQ-5D^sub index^ scores and other outcome measures such as pain, mobility, independence in ADL and independent living status. The questionnaire response rate (EQ-5D) was 89-100% on different follow-up occasions. The EQ-5D appears to be an easy-to-use instrument even for elderly patients with femoral neck fractures. Changes in the quality of life may be useful to identify patients who might benefit from reoperation, i.e. arthroplasty. The EQ-5D also appears to be a relevant clinical end-point in outcome studies.[PUBLICATION ABSTRACT]
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| 7. |
- Tidermark, Jan
(författare)
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Quality of life and femoral neck fractures
- 2002
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The worldwide increase of hip fractures is a major challenge for the health care system and society. The treatment of femoral neck fractures in the elderly is still controversial, and even more so from an international perspective. Optimising the treatment for improved outcome and a reduced need for secondary surgery is mandatory for humanitarian and economical reasons. The importance of incorporating the patients's perspective of outcome in clinical trials is acknowledged and there are now numerous instruments for assessing the quality of life. We evaluated two quality of life instruments, the EQ-5D and the SF-36, in patients with femoral neck fractures and also measured the quality of life two years after different interventions. In two prospective studies the EQ-5D was validated and it appeared to be an appropriate quality of life instrument in elderly patients with femoral neck fractures. There was a good correlation between the quality of life (EQ-5D index scores) and other outcome measures such as pain, mobility and independence in activities of daily living (ADL). The results also showed high responsiveness, i.e. ability to capture clinically important changes, for both the EQ-5D and the SF-36. The questionnaire response rate for both instruments was high. The rated prefracture EQ-5D index scores showed good correspondence with the scores of an age- matched Swedish reference population. The quality of life in patients with femoral neck fractures treated with internal fixation (IF) decreased, particulary in patients with fracture healing complications. The fracture healing complications rate at two years in patients with displaced femoral neck fractures treated with IF was 36% compared to 7% in patients with undisplaced fractures. The quality of life of patients with uneventfully healed fractures at two year was significantly lower in patients with primarily displaced fractures compared with patients with undisplaced fractures. In a prospective randomised trial patients with displaced femoral neck fractures were randomised to IF or a total hip replacement (THR). The failure rate after two years was higher in the IF group compared with the THR group with regard to hip complications, 36% and 4%, and the number of reoperated patients, 42% and 4%. Hip function and quality of life (EQ-5D) were generally better in the THR group. In summary, THR provided a better outcome than IF for an elderly, relatively healthy, lucid patient with a displaced femoral neck fracture. In a study of elderly women with femoral neck fractures almost half of the patients displayed signs of protein-energy malnutrition. Underweight was associated with muscle fatigue, cognitive dysfunction and low quality of life (Nottingham Health Profile, NHP). In a prospective randomised trial protein rich liquid supplementation in combination with an anabolic steroid given during 6 months to lean elderly women after a femoral neck fracture was shown to positively affect lean body mass, ADL and quality of life (EQ-5D). Fracture healing complications had a negative impact on body weight, lean body mass and quality of life.
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