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Zhang X, Zhang Y, Huang S, Qi X, Li W, Lv Y, Zhu Z. Biomechanical effects of FNS on femoral neck fractures based on different reduction quality: finite element analysis. BMC Musculoskelet Disord 2024; 25:914. [PMID: 39548463 PMCID: PMC11566252 DOI: 10.1186/s12891-024-08041-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2024] [Accepted: 11/07/2024] [Indexed: 11/18/2024] Open
Abstract
BACKGROUND AND OBJECTIVE The femoral neck system (FNS) has been extensively studied and applied for the treatment of young patients with femoral neck fractures. The purpose of this study was to explore the biomechanical impact variations in reduction qualities on femoral neck fractures, considering factors such as tip-apex distance, the positioning of the bolt in the cortical corridor of the femoral neck, and bone mineral density. MATERIALS AND METHODS A randomly selected volunteer was recruited, whose clinical data on the femur were collected to establish finite element models for positive reduction, anatomical reduction, and negative reduction respectively. Based on the constructed models, different scenarios were established by varying the tip-apex distance, bone mineral density, and positioning of the bolt in the cortical corridor of the femoral neck. Under a vertical load of 2100 N, the displacement and Von Mises stress (VMS) distribution of each group of models were evaluated through simulation testing. RESULTS Under a load of 2100 N, the maximum VMS values of the femoral neck system and femoral head was recorded during negative reduction, 968.85 MPa and 80.09 MPa respectively. In addition, factors influencing the negative reduction of FNS and the femoral head were identified to be the tip-apex distance > 10 mm, the presence of osteoporosis, and the bolt positioned in the lower-middle to the third part of the cortical corridor of the femoral neck. CONCLUSION The displacement and stress of negative reduction were greater than those of positive reduction and anatomical reduction when the tip-apex distance > 10 mm, and the bolt was situated in the lower-middle to the third part of the cortical corridor of the femoral neck, and in the presence of osteoporosis. This means that we recommend positive repositioning over negative repositioning when anatomical repositioning is not clinically feasible.
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Affiliation(s)
- Xu Zhang
- Department of Orthopaedics, The Second Affiliated Hospital of XuZhou Medical University, No 32 Meijian Road, Xuzhou, Jiangsu, 221000, China.
- Graduate school of Xuzhou Medical University, Xuzhou, Jiangsu, 221000, China.
| | - Yazhong Zhang
- Department of Orthopaedics, The Second Affiliated Hospital of XuZhou Medical University, No 32 Meijian Road, Xuzhou, Jiangsu, 221000, China
| | - Shaolong Huang
- Department of Orthopaedics, The Second Affiliated Hospital of XuZhou Medical University, No 32 Meijian Road, Xuzhou, Jiangsu, 221000, China
- Graduate school of Xuzhou Medical University, Xuzhou, Jiangsu, 221000, China
| | - Xiangyu Qi
- Department of Orthopaedics, The Second Affiliated Hospital of XuZhou Medical University, No 32 Meijian Road, Xuzhou, Jiangsu, 221000, China
- Graduate school of Xuzhou Medical University, Xuzhou, Jiangsu, 221000, China
| | - Wenbo Li
- Department of Orthopaedics, The Second Affiliated Hospital of XuZhou Medical University, No 32 Meijian Road, Xuzhou, Jiangsu, 221000, China
| | - Yongxiang Lv
- Department of Orthopaedics, The Second Affiliated Hospital of XuZhou Medical University, No 32 Meijian Road, Xuzhou, Jiangsu, 221000, China
| | - Ziqiang Zhu
- Department of Orthopaedics, The Second Affiliated Hospital of XuZhou Medical University, No 32 Meijian Road, Xuzhou, Jiangsu, 221000, China.
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Heidari MM, Khaledi A, Taravati AM, Rastegar-Kashkouli A, Moammer F, Saffari I. Relationship Between Ankylosing Spondylitis and Cerebrovascular Disorders: A Systematic Review. Eurasian J Med 2024; 56:127-135. [PMID: 39110116 PMCID: PMC11332256 DOI: 10.5152/eurasianjmed.2024.23330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 03/25/2024] [Indexed: 08/21/2024] Open
Abstract
Cerebrovascular events are linked to ankylosing spondylitis. Accelerated atherosclerosis and endothelial dysfunction against a backdrop of inflammation have been widely blamed for the increased cerebrovascular risk in ankylosing spondylitis. The absence of a comprehensive review encouraged us to consider the link between ankylosing spondylitis and cerebrovascular diseases. Web of Science, PubMed, Medline, Scopus, and EMBASE were searched to identify studies published from 2000 to June 10, 2023. All observational and cohort studies reporting myocardial infarction or stroke and considering classic cerebrovascular risk in ankylosing spondylitis patients and healthy controls were included. Most of the included studies reported that the risk of cerebrovascular disorders was greater in ankylosing spondylitis than in the general population. Also, most studies showed that for both sexes, the prevalence of cardiovascular illnesses rose with age, and this trend was consistent across all subgroups of cardiovascular disorders. Also, most studies reported that the rate of cerebrovascular accidents in ankylosing spondylitis patients was higher than in control groups. Some studies reported that the risk of developing an ischemic stroke was higher in young patients with ankylosing spondylitis, while others did not. Our systematic analysis found that most studies agreed that ankylosing spondylitis patients had a higher risk of cerebrovascular diseases than the general population. Still, this increased risk was influenced by several factors that need further research exploration.
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Affiliation(s)
- Mohammad Mahdi Heidari
- Department of Pediatrics, Kashan University of Medical Sciences Faculty of Medicine, Kashan, Iran
| | - Azad Khaledi
- Infectious Diseases Research Center, Kashan University of Medical Sciences, Kashan, Iran
- Department of Microbiology and Immunology, Kashan University of Medical Sciences School of Medicine, Kashan, Iran
| | | | | | - Farzaneh Moammer
- Student Research Committee, Guilan University of Medical Sciences School of Medicine, Rasht, Iran
| | - Iman Saffari
- Department of Food Hygiene and Quality Control, Islamic Azad University Faculty of Veterinary Medicine Science and Research Branch, Tehran, Iran
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Shitova AD, Kovaleva ON, Olsufieva AV, Gadzhimuradova IA, Zubkov DD, Kniazev MO, Zharikova TS, Zharikov YO. Risk modeling of femoral neck fracture based on geometric parameters of the proximal epiphysis. World J Orthop 2022; 13:733-743. [PMID: 36159625 PMCID: PMC9453284 DOI: 10.5312/wjo.v13.i8.733] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 12/10/2021] [Accepted: 07/26/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Fractures of the proximal femur epiphysis are problematic for state health care because they are associated with severe medical and social problems and high morbidity and mortality rates.
AIM To model the potential risk of hip fracture via femur geometric parameters.
METHODS Seventy educational cadaveric femurs from people aged 14 to 80 years, 10 X-ray images from the records of the Human Anatomy Department and 10 X-ray images from the Department of Traumatology, Orthopedics and Disaster Surgery of Sechenov University, were evaluated. The parameters of the fractured bone were measured using images captured with a Canon d60 camera. The projection values of the proximal epiphysis of the cadaveric femurs and geometric parameters of the bones shown in the X-ray images were measured with Autodesk software (AutoCAD 2018). Analysis of the video frames showing bone rotation reveal that the greater trochanter can be inscribed in a parallelepiped, where one of the faces is parallel to the plane of view in the frontal standard projection and is rectangular. The angle of bone rotation obtained by turning the cube corresponded to the angle measured with the second technique. This reliable method of calculating the rotation of the bone relative to the anterior projection was employed in subsequent calculations. The geometric parameters of the femur were measured using X-ray images according to the proposed method.
RESULTS The geometric parameters of 70 femurs were analyzed, and correlation coefficients were calculated. Our measurement results were compared with those reported by other authors. The potential influence of femur geometry on force distribution in the proximal epiphysis of the femur was described, and a 2-dimensional model of the femur epiphysis associated with minimal neck fracture risk was provided. The assessment of the geometric parameters of the femoral epiphysis indicated the greatest risk of a varus fracture of the neck if the angle of the minimal resistance zone (AMRZ) index > 24° and the neck-shaft angle (NSA) < 127.5°. In contrast, the minimum risk was observed at AMRZ < 14° and NSA > 128.87°.
CONCLUSION The proposed method provides the potential femur neck fracture risk based on geometric parameters.
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Affiliation(s)
- Anna D Shitova
- International School “Medicine of the Future”, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow 119991, Moscow, Russia
| | - Olga N Kovaleva
- Department of Human Anatomy, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow 125009, Moscow, Russia
| | - Anna V Olsufieva
- Department of Biomedical Disciplines of the Faculty of Medicine, Nonstate Educational Private Institution of Higher Education "Moscow Financial and Industrial University “Synergy”, Moscow 125190, Moscow, Russia
| | - Inchekhanum A Gadzhimuradova
- International School “Medicine of the Future”, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow 119991, Moscow, Russia
| | - Dmitry D Zubkov
- International School “Medicine of the Future”, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow 119991, Moscow, Russia
| | - Mikhail O Kniazev
- Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow 119991, Moscow, Russia
| | - Tatyana S Zharikova
- Department of Human Anatomy, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow 125009, Moscow, Russia
| | - Yury O Zharikov
- Department of Human Anatomy, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow 125009, Moscow, Russia
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Bartels S, Kristensen TB, Gjertsen JE, Frihagen F, Rogmark C, Dolatowski FC, Figved W, Benth JŠ, Utvåg SE. Total Hip Arthroplasty Leads to Better Results After Low-Energy Displaced Femoral Neck Fracture in Patients Aged 55 to 70 Years: A Randomized Controlled Multicenter Trial Comparing Internal Fixation and Total Hip Arthroplasty. J Bone Joint Surg Am 2022; 104:1341-1351. [PMID: 35700073 DOI: 10.2106/jbjs.21.01411] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The optimal treatment of displaced femoral neck fractures in patients 55 to 70 years old remains controversial. The aim of the present study was to assess the effect of closed reduction and internal fixation with cannulated screws (IF) compared with total hip arthroplasty (THA) on hip pain and function, with use of data for outcome measures, complications, and reoperations. METHODS This multicenter randomized controlled trial included all patients 55 to 70 years old who presented with a low-energy displaced femoral neck fracture between December 2013 and December 2018. Patients were randomly allocated to undergo either IF or THA. The primary outcome was the Harris Hip Score (HHS) at 12 months postoperatively. Secondary outcomes were the HHS at 4 and 24 months postoperatively, Oxford Hip Score (OHS), Hip Disability and Osteoarthritis Outcome Score (HOOS), health-related quality of life (EQ-5D-3L [EuroQol 5 Dimensions 3 Levels] index score and EQ-VAS [visual analogue scale]), VAS for pain, and VAS for patient satisfaction at 4, 12, and 24 months postoperatively. Complications and reoperations were continuously monitored. The primary analyses were performed according to the intention-to-treat principle. RESULTS A total of 102 patients with a mean (± standard deviation) age of 63.7 ± 4.2 years were allocated to IF (n = 51) or THA (n = 51). The mean difference in the primary outcome, the HHS at 12 months postoperatively (5.3; 95% confidence interval, 0.9 to 9.7; p = 0.017), was below the predefined minimal clinically important difference of 10 points. However, patients who underwent THA had a significantly higher HHS at 4 and 12 months, better OHS at 4 and 12 months, and better HOOS at 4, 12, and 24 months postoperatively. Patients who underwent THA also reported better health-related quality of life at 4 months postoperatively and reported greater satisfaction and less pain at 4 and 12 months postoperatively. A total of 26 patients in the IF group (51%; 95% confidence interval, 37% to 65%) and 2 patients in the THA group (4%; 95% confidence interval, 0.5% to 13%) underwent a major reoperation. CONCLUSIONS In this randomized controlled trial, we showed that patients between 55 and 70 years old who underwent THA for a low-energy displaced femoral neck fracture experienced better outcomes than those who underwent closed reduction and internal fixation. LEVEL OF EVIDENCE Therapeutic Level I . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Stefan Bartels
- Department of Orthopaedic Surgery, Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Torbjørn B Kristensen
- Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway.,Norwegian Hip Fracture Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Jan-Erik Gjertsen
- Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway.,Norwegian Hip Fracture Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Frede Frihagen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Orthopaedic Surgery, Østfold Hospital Trust, Grålum, Norway
| | - Cecilia Rogmark
- Department of Orthopaedics, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Filip C Dolatowski
- Department of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
| | - Wender Figved
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Orthopaedic Surgery, Bærum Hospital, Vestre Viken Hospital Trust, Gjettum, Norway
| | - Jūratė Šaltytė Benth
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
| | - Stein Erik Utvåg
- Department of Orthopaedic Surgery, Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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A Comparison of Risks and Benefits Regarding Hip Arthroplasty Fixation. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2021; 5:01979360-202111000-00001. [PMID: 34726640 PMCID: PMC8565793 DOI: 10.5435/jaaosglobal-d-21-00014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 10/05/2021] [Indexed: 11/18/2022]
Abstract
Since the field-changing invention of noncemented hip arthroplasty fixation in the 1980s, noncemented fixation has been progressively replacing cemented fixation. However, analyses of fixation frequencies reveal new patterns in cement versus noncemented preferences. Although cementation is again gaining ground in the United States, noncemented models remain the dominant fixation mode, seen in more than 90% of all hip arthroplasties. This stark preference is likely driven by concerns regarding implant durability and patient safety. Although advances in surgical techniques, intensive perioperative care, and improved instrument have evolved in both methods, data from large arthroplasty registries reveal shifting risks in contemporary hip arthroplasty, calling the use of noncemented fixation into question. Varying risk profiles regarding sex, age, or health comorbidities and morphological and functional differences necessitate personalized risk assessments. Furthermore, certain patient populations, based on the literature and data from large registries, have superior outcomes from cemented hip arthroplasty techniques. Therefore, we wanted to critically evaluate the method of arthroplasty fixation in primary hip arthroplasties for unique patient populations.
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Liao JC, Chen WJ. The Influences of Spinopelvic Parameters and Associated Factors on Development of Proximal Instrumented Fracture After Posterior Instrumentation. World Neurosurg 2021; 157:e308-e315. [PMID: 34648985 DOI: 10.1016/j.wneu.2021.10.070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 10/01/2021] [Accepted: 10/04/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To investigate influences of spinopelvic parameters, such as lumbar lordosis (LL) angles, pelvic incidence, sacral slope, pelvic tilt, and sagittal vertical axis, on development of the proximal junctional failure fracture type after posterior instrumentation. METHODS This retrospective 1:3 matched case-control cohort study included 24 patients who developed proximal instrumented fracture in the study group and 72 patients without proximal junctional failure in the control group. Weighted Charlson Comorbidity Index and bone mineral density with T-score were recorded. In addition to spinopelvic parameters, proximal local kyphosis (PLK), which refers to a kyphosis angle between the upper end plate of upper instrumented vertebra plus 1 level and the lower end plate of upper instrumented vertebra; pelvic incidence-LL mismatch; and spinopelvic realignment score were calculated. RESULTS More comorbidities (Charlson Comorbidity Index, P = 0.002) and poorer bone density (T-score, P = 0.001) were noted in the study group. Before surgery, the study group had significantly lower LL (P = 0.046) and sacral slope (P = 0.043) and significantly higher PLK (P < 0.001) and pelvic tilt (P = 0.044) than the control group. Postoperatively, the study group had significantly higher PLK (P < 0.001) and lower LL (P = 0.031) than the control group; the degree of pelvic incidence-LL mismatch (P = 0.007) remained significantly higher in the study group. Preoperative (P = 0.026) and postoperative (P = 0.045) spinopelvic realignment scores was worse in the study group. Multivariate analysis revealed that postoperative PLK was the most significant radiographic factor to predict proximal instrumented fracture (P = 0.002, odds ratio 1.140, 95% confidence interval). CONCLUSIONS In our experience, appropriate LL and lower PLK should be obtained at surgery to prevent development of instrumented fracture.
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Affiliation(s)
- Jen-Chung Liao
- Department of Orthopedics Surgery, Bone and Joint Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.
| | - Wen-Jer Chen
- Department of Orthopedics Surgery, Bone and Joint Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
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The Effect on the Fracture Healing following Femoral Neck Shortening after Osteoporotic Femoral Neck Fracture Treated with Internal Fixation: Finite Element Analysis. BIOMED RESEARCH INTERNATIONAL 2021; 2021:3490881. [PMID: 34395612 PMCID: PMC8360725 DOI: 10.1155/2021/3490881] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 07/09/2021] [Indexed: 11/29/2022]
Abstract
Objective To evaluate the stress status of fracture site caused by femoral neck shortening and to analyze the stress of fracture site and the implants from the finite element point of view. Methods CT scan data of hip of a normal adult female were collected. Three-dimensional reconstruction MICs and related module function simulation was used to establish the postoperative shortening model of femoral neck fracture with Pauwels angle > 50°, which was treated with cannulated screws. The models were divided into four groups: normal femoral neck, shortening in 2.5 mm, shortening in 7.5 mm, and shortening in 12.5 mm. The finite element analysis software msc.nastran2012 was used, and the data of maximum stress and stress nephogram of fracture site and implants were carried out. Results From normal femoral neck to shortening in 12.5 mm of the femoral neck, the maximum tensile stress increased gradually in the fracture site above the cannulated screws while compressive stress decreased gradually in the fracture site below the cannulated screws, and the maximum stress of the cannulated screws increased gradually with obvious stress concentration at the screw holes in the fracture site, and the peak value of stress concentration was about 179 MPa. Conclusion The biomechanical environment of the fracture site changed by femoral neck shortening. With the increasing of femoral neck shortening, the stress of the fracture site and implants would be uneven; then, the stability of fracture site would become worse, and the possibility of implant sliding or even breakage would be increased.
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Peng L, Liu H, Hu X, Liu J. Hemiarthroplasty versus total hip arthroplasty for displaced femoral neck fracture in patients older than 80 years: A randomized trial protocol. Medicine (Baltimore) 2020; 99:e23530. [PMID: 33327300 PMCID: PMC7738070 DOI: 10.1097/md.0000000000023530] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The forms of treatment which are available for these patients include internal fixation, hemiarthroplasty (HA), or total hip arthroplasty (THA). Both HA and THA are widely used methods of hip replacement after displaced femoral neck fracture (DFNF). Our purpose is to analyze the long-term outcomes of these 2 different forms of treatment, which are suitable for active patients with femoral neck intracapsular fractures ≥80 years of age without advanced osteoarthritis or rheumatoid arthritis. METHODS This study is designed as a single-center randomized controlled trial. The participants will be randomly assigned to either the THA group or the HA group. Information will be collected from all participants after obtaining written informed consent in accordance with the Declaration of Helsinki and ethical board approval. Inclusion criteria include: displaced intracapsular femoral neck fracture, capability to obtain informed consent, no known metastatic disease, no contraindications to anesthesia, age ≥80 years, and ability to understand written Chinese. Patients will be evaluated at 3 months, 6 months, 1 year, and 3 years after surgery. At the time of the final follow-up, patients were assessed with use of the Harris hip score (HHS) and walking distance. Secondary outcomes of interest include postoperative complications, including 90-day medical complications (acute myocardial infarction, deep vein thrombosis, pulmonary embolism, intestinal obstruction, renal failure, and pneumonia) and surgical complications within 1 year (dislocation, infection, and revision replacement). RESULTS This trial is expected to be the largest randomized trial assessing the efficacy of THA and HA and powered to detect a potential difference in the primary outcome. TRIAL REGISTRATION This study protocol has been registered in Research Registry (researchregistry6203).
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Affiliation(s)
- Lin Peng
- Department of Orthopaedics, The Fourth People's Hospital of Jinan, The Third Affiliated Hospital of Shandong First Medical University
| | - Hongyu Liu
- Department of Orthopaedics, The Fourth People's Hospital of Jinan, The Third Affiliated Hospital of Shandong First Medical University
| | - Xiaoyi Hu
- Department of Disease Control and Prevention, PLA 960th Hospital, Shandong, China
| | - Jianqiang Liu
- Department of Orthopaedics, The Fourth People's Hospital of Jinan, The Third Affiliated Hospital of Shandong First Medical University
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Li Z, Lin H, Wang X, Huang M, Feng J, Feng J, Gao J, Wu J, Jiang Z. Intelligent rehabilitation assistant system to promote the early functional recovery of the elderly patients with femoral neck fracture after hemiarthroplasty (HA): A protocol for a randomized controlled trial. Medicine (Baltimore) 2020; 99:e23078. [PMID: 33181672 PMCID: PMC7668524 DOI: 10.1097/md.0000000000023078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Femoral neck fracture is a common type of hip fracture, which has a high morbidity and mortality. Surgical treatment is the first choice. However, the functional rehabilitation after operation has not been paid enough attention. In addition, the quality of exercise is difficult to quantify, and the rehabilitation is lack of standards. Therefore, the intelligent rehabilitation assistant system which could record exercise details, might be used to evaluate the quality and adherence to the prescribed exercise to this fragile group of patients has great relevance, so as to provide new ideas for postoperative rehabilitation of hip fracture. METHODS This is an opening, prospective, double-dummy RCT. Fifty femoral neck fractures patients, older than 65 years and are about to hospitalize for HA, will be invited to study. The sample will be divided into monitoring group and control group randomly at a 1:1 ratio. The prescribed exercises need to be done continuously for 2 weeks. The monitoring group needs additional use intelligent rehabilitation assistant system. Each subject will receive a total of 4 follow-up visits at the designated time (2 weeks, 4 weeks, 12 weeks, and 24 weeks). The following factors will be talked as dependent variables:Each subject will receive a total of 4 follow-up visits at the designated time, and the findings will be analyzed statistically considering a 5% significance level (P < .05). DISCUSSION Exercise under monitor may improve patients compliance and exercise quality, and accelerate the rehabilitation process. This protocol reported in accordance with the CONSORT 2010 checklist and SPIRIT 2013 Checklist. TRIAL REGISTRATION The trial is registered at Chinese Clinical Trials Registry (ChiCTR2000033213, May 24, 2020).
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Affiliation(s)
- Zige Li
- The First School of Clinical Medicine
| | | | - Xiaotong Wang
- Clinical Medical College of Acupuncture, Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine
| | | | | | | | | | | | - Ziwei Jiang
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, People's Republic of China
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Wahlsten LR, Smedegaard L, Brorson S, Gislason G, Palm H. Living settings and cognitive impairment are stronger predictors of nursing home admission after hip fracture surgery than physical comorbidities A nationwide Danish cohort study. Injury 2020; 51:2289-2294. [PMID: 32622625 DOI: 10.1016/j.injury.2020.06.041] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 05/13/2020] [Accepted: 06/24/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Sustaining a hip fracture is a life changing event for many elderlies. While doctors and researchers tend to be preoccupied with mortality and complication rates, patients are more concerned by other aspects e.g. loss of independence and ability to remain in their own home. This study aimed to i) determine age-stratified one-year event rates of admission to nursing home after discharge, and ii) identify risk factors associated with nursing home admission. METHODS Community dwelling patients aged 60-100 years undergoing their first hip fracture surgery in 2005 - 2015 were identified in nationwide administrative registries. Outcome was admission to nursing home within one year of discharge. To assess risk factors, we performed age-stratified cumulative incidence curves and multivariate cause specific cox regression models adjusted for age, sex, social factors, and comorbidities. RESULTS A total of 53,157 patients were included. One-year risk increased with advancing age from 3.2% of patients aged 60 to 69, up to 22.4% in the eldest group aged 90-100 years. Living alone and dementia were strong risk factors HR 9.22 [95% CI 5.60-15.18, p = <0.0001] and HR 6.73 [95% CI 4.80- 9.44, p = 0.0001] respectively for patients aged 60 to 69 years, the effect decreased with higher age down to HR 2.75 [95% CI 2.12- 3.57, p = <0.0001] and HR 2.15 [95% CI 1.88- 2.46, p = <0.0001] for patients ≥ 90 years. Other important risk factors were pre-injury home care, Parkinson's disease and depression. Surprisingly, physical comorbidities i.e. kidney disease, chronic obstructive pulmonary disease, diabetes and cancer did not increase the risk of nursing home admission. CONCLUSION Future initiatives aimed to reduce loss of independence and nursing home admission, among patients with first time hip fracture, should devote attention to living settings and cognitive impairment rather than physical comorbidity.
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Affiliation(s)
- Liv Riisager Wahlsten
- Department of Orthopaedics, Copenhagen University Hospital Herlev-Gentofte, Hospitalsvej 1, 2900 Hellerup, Denmark.
| | - Lærke Smedegaard
- Department of Cardiology, Research 1, Copenhagen University Hospital Herlev-Gentofte, Hospitalsvej 6 3.sal, 2900 Hellerup, Denmark
| | - Stig Brorson
- Department of Orthopaedic Surgery, Zealand University Hospital, Lykkebækvej 1, 4600 Køge, Denmark
| | - Gunnar Gislason
- Department of Cardiology, Research 1, Copenhagen University Hospital Herlev-Gentofte, Hospitalsvej 6 3.sal, 2900 Hellerup, Denmark
| | - Henrik Palm
- Department of Orthopaedics, Copenhagen University Hospital Bispebjerg, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark
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Qin B, Cui L, Ren Y, Zhang H. Retrospective cohort trial protocol of screw fixation compared with hemiarthroplasty for displaced femoral neck fractures in elderly patients. Medicine (Baltimore) 2020; 99:e22397. [PMID: 32991464 PMCID: PMC7523755 DOI: 10.1097/md.0000000000022397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND There is limited evidence for the evaluation of the efficacy and safety of the hemiarthroplasty versus screw fixation in elderly patients with the displaced femoral neck fractures. Our current investigation aimed at assessing the complications, functional outcome, and revision rate of the patients (over 65 years old) who received internal fixation or hemiarthroplasty via a same senior surgeon. METHODS A retrospective study was conducted on elderly patients with displaced femoral neck fractures from May 2014 to February 2018. The current study was carried out at our hospital and it was approved through our institutional review committee of West China Hospital. Inclusion criteria were as follows: the patients were 65 years or older, this is the anesthesia grade. The higher grade of the patients,the greater risk of surgery. level I-III, and the patients with displaced intracapsular fractures of the femoral neck, with the radiographic and clinical follow-up of 12 months or more. The major outcome was the revision rate between the 2 groups. And the secondary outcomes contained the life quality and functional outcome detected via utilizing the interview-administered and self-administered questionnaires, length of hospital stay, surgery time, and hip-related complications (such as hip dislocation, loosening or breakage of implant, wound problems, infection, osteolysis, neurovascular injury, and bone nonunion). RESULTS It was assumed that hemiarthroplasty would result in fewer revisions or complications and better functional scores in comparison with internal fixation technique.
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Affiliation(s)
- Boquan Qin
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University
| | - Linxian Cui
- Department of Cardiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Sichuan, China
| | - Yi Ren
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University
| | - Hui Zhang
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University
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