Hip disease is a global public health issue, associated with high morbidity, mortality, and healthcare costs. Although research on proximal femoral trabeculae has been conducted for over a century, no bibliometric analysis has been carried out. The purpose of this study is to evaluate the existing research landscape, identify emerging trends, and offer insights for future studies.

The scientific output related to the trabeculae within the human proximal femur from 2004 to 2023 was sourced from the Web of Science Core Collection. Moreover, both the annual publications and cumulative totals over this period were summarized in Excel. The VOS viewer was utilized to analyze co-authorship and co-citation relationship between authors, institutions, countries, references and journals. CiteSpace was used to cluster the keywords and research frontiers in this field.

A total of 365 publications were extracted, with the USA emerging as the primary contributor to this field, accounting for 133 publications with 5807 total citations, averaging 43.7 citations per publication. The Journal of Bone and Mineral Research has been identified as the most co-cited journal with a total of 1742 citations. The journals can be categorized into 5 distinct clusters, including medical imaging, orthopedic clinical research, research on endocrine and metabolic related diseases, human evolution and anatomy related research, biomechanics and modeling. The keyword with the highest co-occurrence frequency is "bone mineral density". The keywords were stratified into six clusters, including DXA, bone remodeling, diagnosis, titanium alloy bionic cannulated screws, individual trabecula segmentation, and QCT. More recently, the focus has expanded to three-dimensional modeling, falls, microarchitecture, and avascular necrosis.

Evaluation of proximal femoral strength can be improved by combining structural parameters with bone mineral density by DXA or QCT. Three-dimensional analysis, microarchitecture, and bionic implants are emerging as significant areas of focus and trends for future research.

Both liver fibrosis and osteoporosis share inflammatory pathways, with liver fibrosis potentially contributing to decreased bone mineral density (BMD). The rising prevalence of non-alcoholic fatty liver disease (NAFLD) and associated liver fibrosis, especially in older populations, may increase the risk of osteoporosis, but evidence remains inconclusive. This study aims to investigate the relationship between liver fibrosis and osteoporosis in individuals over 50 years old.

This cross-sectional study used data from the Bushehr Elderly Health Program (BEHP), a cohort of 2,000 participants aged 50 and older, selected through multistage stratified random sampling. BMD and trabecular bone score (TBS) measurements were assessed. The Fibrosis-4 (FIB-4) index, a surrogate marker for liver fibrosis, was also calculated to examine its association with these bone health indicators. Multiple linear regression was applied to assess the relationship between FIB-4 and lumbar, hip, femoral neck BMD, and TBS scores, while logistic regression was used to evaluate osteoporosis as the dependent variable.

A total of 1,959 participants with adequate data were included in our analysis. 538 participants had osteoporosis, 936 participants had osteopenia, and 485 participants had normal bone density. FIB-4 index was higher in osteoporotic groups (1.45 ± 0.90) than in osteopenic (1.26 ± 0.58, p < 0.001) and normal groups (1.17 ± 0.48, p < 0.001). After controlling for confounders, FIB-4 index was negatively associated with hip BMD (βmen=-0.0162; 95% CI: -0.0313, -0.0012 and βwomen=-0.0221; 95% CI: -0.0340, -0.0102), femoral neck BMD (βmen=-0.0216; 95% CI: -0.0356, -0.0076 and βwomen=-0.0233; 95% CI: -0.0342, 0.0124), and TBS (βmen=-0.0154; 95% CI: -0.0264, -0.0043 and βwomen=-0.0244; 95% CI: -0.0338, -0.0149) in both genders and with lumbar BMD in women (β=-0.0176; 95% CI: -0.0307, -0.0045). An increase in the FIB-4 index was associated with more than a twofold rise in the risk of developing osteoporosis in women (OR = 2.123; 95% CI: 1.503, 3.000; p < 0.001) and a 36% higher risk in men (OR = 1.366; 95% CI: 1.012, 1.844; p = 0.042).

Liver fibrosis is associated with decreased bone density and attenuated bone architecture. Elevated FIB-4 index has been identified as a risk factor for osteoporosis, indicating a potential link between liver fibrosis and deteriorating bone health.

There is a paucity of longer-term outcome data in younger adult patients who undergo fixation for an intracapsular hip fracture. The aims of this study were to evaluate the outcomes for young adult patients undergoing intracapsular hip fracture fixation and to assess factors associated with failure and patient-reported outcome measures (PROMs).

From 2008 to 2018, 112 consecutive patients ≤60 years of age (mean age, 48 years [range, 20 to 60 years]; 54% male) were retrospectively identified as having undergone fixation of an intracapsular hip fracture. Displaced fractures (n = 81) were more common than nondisplaced or minimally displaced fractures (n = 31). Failure was defined as loss of fixation, nonunion, or osteonecrosis. PROMs that were assessed included the Oxford Hip Score (OHS), Forgotten Joint Score (FJS), EuroQol 5-Dimension (EQ-5D) index and Visual Analogue Scale (EQ-VAS), and University of California Los Angeles (UCLA) Activity Scale.

Eighty-six patients (77%) had union without evidence of failure, and 26 patients (23%) had a failure, including loss of fixation (6 patients; 5.4%), nonunion (5 patients; 4.5%), and osteonecrosis (16 patients; 14.3%). Overall, 39 patients (35%) required secondary surgery, with hardware removal (21 patients; 18.8%) and total hip arthroplasty (21 patients; 18.8%) being the most frequent procedures. Long-term functional outcomes were obtained for 81 patients (72%) at a mean of 7 years (range, 2.8 to 12.8 years). The median OHS was 47 (interquartile range [IQR], 40-48), the median FJS was 75 (IQR, 49-85), the median EQ-5D index was 1.00 (IQR, 0.77-1.00), and the median EQ-VAS was 90 (IQR, 70-95). The mean UCLA score fell from 6.8 preinjury to 6.0 postinjury (p < 0.001). Compared with the patients who had primary union, those who had a complication had significantly lower median OHS scores (44.5 versus 47, p = 0.008), EQ-5D index scores (0.825 versus 1.00, p = 0.001), EQ-VAS scores (70 versus 90, p = 0.01), and UCLA scores (4.5 versus 6.5, p = 0.001).

One in 4 young adult patients undergoing intracapsular hip fracture fixation had a failure. Failure was associated with inferior long-term function and health-related quality of life.

Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.

With the aging population and rising life expectancy the incidence of trauma-related injuries, particularly proximal femur fractures, is expected to increase. Complications such as fracture-related infections (FRI) significantly impede the healing process and pose substantial risks to patients. Despite advancements in understanding, diagnosing, and treating FRI, challenges persist in achieving optimal outcomes. This review addresses the significance of FRI following proximal femur fractures, emphasizing diagnostic methodologies and therapeutic modalities to enhance clinical care.

Notably, a consensus definition for FRI has been established, providing clarity for accurate diagnosis. Diagnostic criteria encompass confirmatory and suggestive elements, facilitating precise identification of FRI. Therapeutic strategies for FRI in proximal femur fractures include a spectrum of surgical and antimicrobial approaches. Surgical interventions, ranging from debridement with implant retention over implant removal/exchange to staged conversions to arthroplasty, are tailored based on fracture stability, individual patient factors, and infection characteristics. The intricate decision-making process is elucidated, highlighting the importance of individualized treatment plans and multidisciplinary collaboration. Antimicrobial therapy plays a pivotal role in FRI management, with empirical regiments targeting common pathogens and local delivery systems offering sustained antibiotic release. Microbiological analysis and collaboration with infectious disease specialists should guide antimicrobial treatment and ensure optimal therapy efficacy.

Managing FRI following proximal femur fractures requires a tailored, multidisciplinary approach. Treatment strategies should be guided by diagnostic precision, patient-specific considerations, and collaboration among surgical, infectious disease, and clinical teams. Implementing comprehensive therapeutic approaches is essential for mitigating the impact of FRI and improving patient outcomes.

BackgroundLow bone mineral density (LBMD) significantly contributes to loss of independence, gait impairment, and increased fall risk. Instrumental gait analysis provides an accurate evaluation of walking ability, that represent the first step for a personalized rehabilitation.ObjectiveTo collect and describe the available literature on the effect of LBMD on walking characteristics and the use of motion analysis systems in patients with LBMD.MethodsWe performed a literature search of the last ten years on PubMed, Web of Science and Scopus of papers on older people and patients with LBMD in terms of gait parameters, balance, and fall risk. The review protocol was registered on PROSPERO (CRD42024590090).ResultsThe database search identified totally 756 records; after duplicates deletion, 13 were considered eligible. The results reported that subjects with LBMD had kinematic alterations of the walk, alterations of posture, speed of walking and the strength generated in the gait. Patients with osteoporosis show a reduction of gait speed and trunk asymmetry; moreover, there is a a decrease in body rotation and lower hip and ankle moments in post-menopausal women.ConclusionsPatients with LBMD showed gait alterations that can higher the risk of falls. In this context, gait analysis can be useful in detecting variations in pattern, symmetry, gait speed and posture in elderly patients, that can represent an essential step for a personalized rehabilitation program.

Approximately 1.3 to 2.2 million femoral neck fractures occur annually globally, with up to 80% being displaced, requiring hemiarthroplasty or total hip arthroplasty (THA). As the population ages, femoral neck fractures may surpass six million by 2050. Optimal treatment for displaced femoral neck fractures is debated with literature supporting both hemiarthroplasty and THA. Our objective was to determine if subspecialty training plays a role in the decision-making and outcomes of displaced femoral neck fractures.

A retrospective analysis was performed of 386 patients who underwent hemiarthroplasty or THA for displaced femoral neck fracture at an academic health system from 2017 to 2023. To assess subspecialty training impact, patients were stratified based on training: adult reconstruction (AR) fellowship or other orthopaedic training (non-AR). Procedure duration, 90-day postoperative complications, length of stay, and discharge disposition were compared between cohorts. A sub-analysis was performed comparing procedures.

The AR surgeons performed THA 31.8% for femoral neck fractures compared to 10.5% for non-AR-trained surgeons (P< 0.001). Patients treated by AR-trained surgeons were on average younger (79 versus 82 years; P = 0.01). Procedure duration was shorter for hemiarthroplasty (80.4 versus 90.1 minutes; P = 0.01) and THA (94.9 versus 132.6 minutes; P = 0.01) when performed by AR surgeons (overall P = 0.01). The THA patients were more likely discharged home when treated by AR surgeons (55.3 versus 28%; P = 0.03). The AR-trained surgeons used cemented prostheses less compared to non-AR surgeons (16.9 versus 33.2%; P < 0.001).

Subspecialty training plays a role in decision-making, procedure duration, and discharge disposition for femoral neck fractures. The AR-trained surgeons more often perform THA for femoral neck fractures compared to non-AR-trained surgeons. The AR-trained surgeons completed hemiarthroplasty and THA in significantly shorter time compared with non-AR-trained surgeons and more frequently discharged patients home.

The study aimed to explore associations of metabolomic data based on nuclear magnetic resonance (NMR) with the risk of fractures and bone mineral density (BMD).

We included 69,963 participants without fractures at baseline in the UK Biobank. Cox proportional hazard models were used to estimate the associations of metabolomic biomarkers measured by NMR technology with the risk of all fractures and hip fracture. We used principal component analysis (PCA) to obtain uncorrelated principal components (PC), which were further used to estimate the associations of each PC with BMD, all fractures, and hip fracture separately.

During a median follow-up of 12.6 years, 3840 incidents of all fractures and 666 incidents of hip fracture were documented. Ninety-four of the 143 metabolomic biomarkers were significantly associated with incident all fractures, and 81 were significantly associated with incident hip fracture. The very low-density lipoprotein (VLDL) subclasses in different lipid constituents were associated with increased BMD at multiple sites, whereas high-density lipoprotein (HDL) subclasses were associated with decreased BMD. Higher concentrations of small (HR per SD increment: 0.92; 95 % CI: 0.88-0.97), medium (HR per SD increment: 0.91; 95 % CI: 0.88-0.94), and large (HR per SD increment: 0.93; 95 % CI: 0.90-0.96) low-density lipoprotein (LDL) particles were associated with a lower risk of all fractures. Similarly, higher VLDL subclasses (excluding very small VLDL particles) were associated with a lower risk of all fractures. Besides, higher levels of lipid constituents (including total lipids, cholesteryl esters, cholesterol, and free cholesterol) of very large and large HDL were associated with an increased risk of all fractures. PC1 (mainly contributed by lipid subclasses of LDL and VLDL), which explained the most variance of individual biomarkers, showed a negative association with the risk of all fractures (P = 7.80E-08). Similar associations were observed for hip fracture.

Higher levels of large and very large HDL were associated with an increased risk of fractures, whereas higher lipid subclasses of LDL and VLDL were associated with a lower risk of fracture. Higher levels of VLDL subclasses in different lipid constituents were associated with increased BMD at multiple sites, while higher level of HDL was associated with decreased BMD.

Positive medial cortical support is a reliable fracture reduction pattern, but existing research on its use is mainly qualitative. We conducted this finite element analysis study to quantitatively evaluate the usefulness of positive cortical support for intertrochanteric fracture reduction.

Twenty-five models of intramedullary nail fixation for AO type 31-A1.2 intertrochanteric fractures subjected to different reduction patterns were established. The peak von Mises stress at the femoral fracture surface, proximal intersection of the intramedullary nail, and distal intersection of the intramedullary nail, as well as the maximum fracture displacement, were determined by finite element analysis under the three working conditions of standing, walking, and walking stairs.

As the head-neck fragment moved forward, the von Mises stress at the fracture surface, the proximal intersection point of the intramedullary nail, and the distal intersection point gradually decreased. This resulted in reduced fracture displacement, a significant decrease in trabecular bone volume, and a slight increase in the risk of screw cut-out. As the head-neck fragment moved medially, the fracture gained positive support from the medial cortex, leading to a gradual decrease in von Mises stress at the fracture surface and the proximal intersection point of the intramedullary nail, as well as reduced fracture displacement. However, the von Mises stress at the distal intersection point gradually increased.

The reduction pattern involving positive medial, anteromedial, and anterior cortical support may be an effective alternative to anatomical reduction for the treatment of difficult-to-reduce intertrochanteric fractures.

With life expectancies increasing worldwide, there is a concomitant rise in the incidence of fragility fractures. As such, low-income and lower-middle-income countries (LICs and LMICs) will be faced with increased incidences of hip fractures. The care of these fractures is adversely affected by various factors that include under-resourced healthcare systems and large socioeconomic disparities, which disproportionately affect patient care in these regions relative to high-income countries. The purpose of this study was to determine treatment trends and outcomes of hip fracture care in lesser resourced regions as reported in primary literature sources through a systematic review.

The article search was conducted on December 16, 2020, and April 14, 2022, in 3 databases: PubMed, Web of Science, and Embase. A search strategy unique to each database was developed with a research librarian using English search terms.

Studies were selected using DistillerSR systematic review software. Two rounds of screening were performed for inclusion: 1) title and abstract screening and 2) full-text screening. Two researchers independently reviewed all articles. No articles were excluded based on language.

The extracted information included country, study demographics and design, hip fracture location, treatment, and outcomes.

Of the 2533 initially identified abstracts, a total of 24 articles met the criteria for inclusion and were selected for final data extraction after full-text screening.

This systematic review demonstrates a paucity of research evaluating geriatric hip fractures in LICs and LMICs. Additional research is needed to better characterize the preferred treatment by fracture type and associated complications in resource-limited environments.

Our aim is to analyse whether the Frail-VIG index (frailty index validated in the geriatric population) maintains its predictive capacity for mortality in geriatric patients with femur fracture (FF).

Observational prospective cohort study including patients over 65 years of age consecutively admitted for FF to a community hospital. Patients were classified according to their frailty degree into three groups: none/initial frailty (Frail-VIG index < 0.36), moderate frailty (Frail-VIG index: 0.36-0.50), and advanced frailty (Frail-VIG index > 0.50). The association between 12-month mortality and frailty was estimated in an adjusted Cox regression model and expressed as hazard ratio (HR) with 95% confidence interval (95% CI). ROC curves were analysed to assess the prognostic capacity of Frail-VIG index. The reliability and feasibility were also assessed.

150 patients were included (78% women and mean age 88 years). Patients with advanced frailty had more geriatric syndromes and comorbidities and worse cognitive, emotional, and functional status. In-hospital and 30-day mortality were similar between the three groups. After 12 months of follow-up, all-cause mortality was higher in patients with moderate and advanced frailty with an adjusted HR (95% CI) of 3.1 (1.33-7.43; p = 0.009) and 3.93 (1.52-10.1; p = 0.005), respectively. The under the ROC curve area at 12 months was 0.71 (0.62-0.80). The intraclass correlation coefficient for reliability was 0.891 (0.804-0.891) and the feasibility showed a mean (SD) of 4.83 (1.39) min.

The Frail-VIG index has a good predictive capacity for 12-month mortality in geriatric population with FF and also shows very good reliability and feasibility.

The lack of osteoporosis treatment initiation after fragility fractures is a significant gap, especially in primary care. It is unclear whether barriers for primary care physicians (PCPs) arise from uncertainty about investigations, treatment initiation, or medication side effects. Key questions remain about whether active learning platforms improve treatment initiation rates better than passive methods and how PCP demographics affect learning outcomes. With PCPs increasingly using web-based platforms for continuing professional development due to time constraints and heavy workloads, an interactive community fracture capture (CFC) tool may serve as an effective alternative to in-person learning. Our CFC pilot study tested this new program's design and content, showing promising potential.

We aim to evaluate the interactive, case-based, web-based CFC Learning Hub, examining user acceptance and engagement with the platform, focusing on participants' interactions, satisfaction levels, and overall experience.

Participating PCPs are recruited through Praxhub, a web-based medical education platform, and provide electronic consent for data use after deidentification. They have been allocated into small groups (12-20 members) and join the CFC Learning Hub, a secure web-based community. This hub includes a web-based discussion forum with participant-contributed case studies and a knowledge repository. Over the 6-week program, participants will receive weekly modules with instructions, resources, discussion threads, and quizzes, along with interactive discussions moderated by experienced PCPs and physicians. The platform also hosts web-based surveys that, in combination with platform analytics, allow assessment of baseline knowledge gaps, level of activity or engagement, and improvements following the course completion. This study protocol demonstrates the creation and proposed evaluation of the CFC Learning Hub, featuring an interactive, case-based, small-group web-based learning platform equipped with flexibly scheduled, tailored modules to address the fracture treatment gap within the community. Both qualitative (via thematic analysis) and quantitative (by using 2-tailed paired t tests, Wilcoxon signed rank tests, and multivariable regression analysis) analyses will be used to assess levels of engagement and acceptance and changes in PCPs' knowledge and confidence after engagement with the CFC Learning Hub.

Recruitment of participants started in May 2022. Data collection, analysis, and reporting will be completed following the completion of four 6-week cycles of the program.

The study described in this protocol will provide important insights into the function and effectiveness of the CFC Learning Hub. This information will guide the expansion of the program. This initiative offers a simple digital solution for promoting current bone health practices tailored to PCPs' needs and thereafter to expand the rollout of the e-learning hub and implementation of fracture liaison models at a primary care level in Australia and elsewhere. Future applications may extend to other clinical areas and professions.

DERR1-10.2196/57511.

This study aimed to investigate the role of dipeptidyl peptidase-8 and 9 (DPP-8/9) enzymes in inflammatory bone loss using a 4-vinylcyclohexene diepoxide (VCD)-induced model in Wistar rats. Additionally, we evaluated the therapeutic potential of inhibiting these enzymes with the flavonoid chrysin.

Inflammatory osteoporosis was induced by administering VCD that elevated interleukin-6 (IL-6) and tumour necrosis factor-alpha (TNF-α) levels. DPP-8/9 enzyme expression and various bone markers were assayed using serum. Further analysis included bone microarchitecture, histology, and immunohistochemistry. Additionally, chrysin's potential to inhibit DPP-8/9 and mitigate VCD-induced inflammatory bone loss was also evaluated.

VCD administration in rats caused ovotoxicity that increased IL-6 and TNF-α levels, resulting in significant bone loss. Serum analysis revealed elevated bone resorption markers and DPP-8/9 enzyme levels. Inhibiting DPP-8/9 with 1G244 reversed these effects, confirmed by histology, immunohistochemistry, and micro-CT scans. Moreover, chrysin significantly reduced DPP-8/9 levels compared with the untreated group, improved bone markers, and lower inflammatory cytokines, indicating reduced osteoclastogenesis.

This study highlights the role of DPP-8/9 in inflammation-induced osteoporosis. Following inhibition of DPP-8/9, we observed improved bone markers with preservation of trabecular bone mineral density in rats. Additionally, chrysin demonstrated potential as an anti-DPP-8/9 agent, suggesting its viability for future therapeutic interventions in DPP-8/9-related inflammatory diseases.

Despite several surgical options, there has yet to be a consensus on the best treatment for femoral neck fracture (FNF) due to higher complication rates compared to other bone fractures. This study aims to examine the possible consequences and solution suggestions of changing screws during surgery for various reasons in FNF surgical treatment from a biomechanical perspective.

FNF and treatment materials were analyzed biomechanically using a package program based on the finite element method (FEM). This study created a solid model with images of femur bone tomography. Dynamic hip screws (DHS), cannulated screws (CCS), and medial buttress plates (MBP) were obtained by making three-dimensional designs. The required elements for the models were assigned, and the material properties of the elements were defined. The solutions were obtained as crack distance and deformation results after defining the boundary conditions and applying the necessary loading.

The strain and crack distance values created by six models on the fracture line under different parameters were obtained, and the numerical results were evaluated. The DHS and CCS models produced the highest crack distance and deformation values when all screws were loose. The lowest values were obtained in the intact-85 model when all CCS were tight. When the results are evaluated, it is seen that the MBP has a decreasing effect on the results. Mechanical evaluation of six different options used in femoral neck fractures was performed. 85 mm CCS applied to our standard model gave the best results, while the use of 80 mm CCS in the same model showed promising results compared to other models. It is understood that CCS have the best stability even in loosening models with the medial support plate. Different models are from intact-85 mm DHS+1CS+MBP to DHS+1CS, which was worked with LSR+USR-2, according to decreasing stability.

This study offers various biomechanical solutions to possible intraoperative problems in FNF treatment. The following results were obtained from the study data. When the CCS needs to be lengthened or replaced, it is appropriate to use the CCS with the MBP. A single anti-rotation screw is sufficient for lag screw extensions of the DHS plate, and the MBP may be a savior procedure in surgery.

Tranexamic acid is widely accepted for hip fractures but there is no agreement about dose or application method and the use is still off label for hip fractures. The aim of our study was to find the best application method of tranexamic acid in patients with femoral neck fractures comparing total blood loss, hemoglobin and transfusion rate.

A retrospective single centre cohort study (level I trauma centre) with 2008 patients treated operatively for a proximal femur fracture between January 2016 and January 2022 was performed. 1 g of tranexamic acid was applied in 314 cases (systemic, topic or combined application) if patients consented. Patient data, surgical procedure, complications, and mortality were assessed. Haemoglobin levels, blood loss and transfusion rates were compared amongst application methods.

For 884 femoral neck fractures treated with arthroplasty blood loss was significantly reduced by tranexamic acid which 314 had received in total (1151.0 ml vs 738.28 ml; p < 0.001). 151 patients received 1 g of tranexamic acid systemically which reduced blood loss from 1151 to 943.25 ml. Combined application of 1 g i.v. and 1 g topically reduced blood loss even further to 869.79 ml and topical application achieved the lowest total blood loss at 391.59 ml (average reduction of 759.41 ml compared to without tranexamic acid), p < 0.001. Transfusion rate and amount of RBC units transfused were the lowest for topical use and showed the highest hemoglobin levels postoperatively. Complication rates did not differ for adverse vascular events.

Tranexamic acid effectively reduces blood loss and transfusion rates and shows higher hemoglobin levels postoperatively, without increasing the risk of thromboembolic events after proximal femoral fractures. Single topic application of 1 g for arthroplasty treatment of femoral neck fractures has better results for blood loss reduction than single i.v. or combined application.

Background/Objectives: Osteoporotic fractures, particularly subcapital hip fractures (SCF), pose a significant healthcare and economic burden. The routine pathological examination of resected femoral heads in such cases is common practice, aimed at identifying malignancies that may have contributed to bone fragility. This study evaluated the cost-effectiveness and clinical utility of routine femoral head pathology in patients undergoing surgical treatment for SCF. Methods: A retrospective cohort study was conducted at a university-affiliated, tertiary care hospital. Patients undergoing surgical treatment for SCF between 2015 and 2018, with available femoral head pathology reports, were included. Data on demographics, prior or active malignancies, surgical procedures, and pathology results were analyzed. Results: The study included 230 patients with a mean age of 82.4 ± 14.1 years, of whom 57% were female. A total of 72 (31%) patients had a history of malignancy at the time of surgery. Pathological examination identified malignancies in eight patients (3.4%), all of whom had active malignancies at the time of admission. The most common malignancies detected were breast cancer and multiple myeloma (three cases each). None of the findings led to changes in patient management. Conclusions: The routine pathological examination of femoral heads following SCF provided a limited diagnostic yield and did not alter clinical management in this cohort. These findings suggest that routine pathology may not be cost-effective and support the adoption of selective screening approaches based on clinical risk factors such as a history of malignancy or atypical fracture presentations.

Knee osteoarthritis (OA) is a common degenerative musculoskeletal condition that impairs mobility and balance, increasing fall risk. When combined with osteoporosis, it further increases the risk of fragility fractures. Despite its prevalence, the frequency of knee OA in patients who have fragility hip fractures (FHFs) is not well established. This study aimed to determine the prevalence of knee OA among FHF patients.

We conducted a cross-sectional analysis of patients who underwent surgical treatment for FHF. The knee OA diagnoses followed the American College of Rheumatology criteria, and severity was assessed via the Kellgren-Lawrence classification system. Bone mineral density (BMD) was evaluated at the lumbar spine and contralateral hip, and fall risk was assessed using a self-report questionnaire.

Among the 162 patients who had FHF (mean age 79 ± 8.1 years; 80.2% women), 66% had symptomatic knee osteoarthritis (SKOA). Of these, 21.0% were classified as end-stage knee osteoarthritis. Notably, 47.1% of these end-stage knee osteoarthritides were recommended for knee OA surgery before their hip fracture. The presence of SKOA was significantly associated with a history of multiple falls (P = 0.013) and a high fall risk (P = 0.020). Among the 120 patients who had BMD data, 68% had low BMD (T-score ≤ -2.5) at the contralateral hip or lumbar spine. Almost half (45%) of the FHF patients had concurrent SKOA and low BMD, whereas approximately 20% had SKOA, low BMD, and a high fall risk.

There is a high prevalence of SKOA among FHF patients. Comprehensive evaluation and management of knee OA and osteoporosis are essential to reduce the risk of subsequent fractures in this vulnerable population.

The influence of advanced imaging modalities on the reliability of 2018 AO/OTA classification and detection of features contributing to fracture instability have not been adequately studied in the literature.

This prospective study was conducted to assess the reliability of 2018 AO/OTA classification for trochanteric femoral fractures, and features of instability in 50 patients using radiographs, multiplanar reformats (MPR), and 3D-reconstruction with fracture segmentation (3DR-FS) by 3 observers on 2 occasions at an interval of 4 weeks.

Mean inter-observer reliabilities on radiographs, MPR, 3DR-FS were 0.36, 0.39, 0.46 after first reading, and 0.35, 0.35, 0.44 after second reading respectively. The mean intra-observer reliabilities for radiographs, MPR, 3DR-FS were 0.36, 0.43, and 0.50 respectively. Inter-observer reliabilities on subgroup analysis were 0.35, 0.27, 0.40 for subgroup A1 and 0.19, 0.22, and 0.30 for subgroup A2 on radiographs, MPR and 3DR-FS respectively. All results were statistically significant (p-value <0.05). Posterior comminution was detected in 125(41 %), 247(82 %), and 255 (85 %) out of total 300 instances on radiographs, MPR and 3DR-FS respectively. Coronal split was detected in 113(37 %), 189(63 %), and 242 (80 %) out of total 300 instances on radiographs, MPR, and 3DR-FS respectively. Flexion of the proximal fragment was detected in 106(35 %), 163(54 %), and 180 (60 %) out of total 300 instances on radiographs, MPR, and 3DR-FS respectively. Lateral wall fracture was detected in 45(15 %), 80(26 %), and 138 (46 %) out of total 300 instances on radiographs, MPR, and 3DR-FS respectively. The banana fragment was detected in 5(1 %), 16(5 %), and 83 (27 %) out of a total of 300 instances on radiographs, MPR, and 3DR-FS respectively.

2018 AO/OTA classification for trochanteric femoral fractures has 'fair' reliabilities on radiographs and MPR that improve to 'moderate' on adding 3DR-FS. We attribute it mostly to the difficulty in localizing innominate tubercle. Adding advanced imaging helps better detect fracture instabilities.

Level I, Diagnostic.

The number of patients with hip and femoral fractures is increasing and is expected to further increase in upcoming years due to the ageing population and the life expectancy of the general population. In this analysis, we aimed to systematically assess the post-operative complications associated with the pre-operative use of Aspirin in patients undergoing surgery for hip or femoral fracture.

Common online databases: Google Scholar, Web of Science, MEDLINE, Cochrane database, EMBASE ( www.sciencedirect.com ), and http://www.

gov were searched for English-based studies which reported post-operative outcomes in patients with versus without the use of Aspirin prior to surgery for hip or femoral fracture. The endpoints of this analysis included cerebro-vascular attack, acute coronary syndrome/cardiovascular complications, hematoma, deep venous thrombosis, pulmonary embolism, patients requiring blood transfusion, bleeding events, and in-hospital mortality. RevMan software 5.4 was the statistical software used for this meta-analysis. Risk ratio (RR) with 95% confidence intervals (CI) was used to represent the post-analytical result.

A total number of 2823 participants were included in this analysis whereby 821 were assigned to Aspirin prior to surgery. Results of this analysis showed that post-operatively the risk of cerebrovascular attack (RR: 1.62, 95% CI 0.29-9.20; P = 0.58), cardiovascular complication (RR: 1.86, 95% CI 0.62-5.52; P = 0.27), pulmonary embolism (RR: 2.45, 95% CI 0.77-7.77; P = 0.13), bleeding events (RR: 1.24, 95% CI 0.39-3.96; P = 0.71), and in-hospital mortality (RR: 0.95, 95% CI 0.47-1.91; P = 0.89) were not significantly higher in those patients who were and who were not taking Aspirin pre-operatively. The risk of deep venous thrombosis (RR: 1.82, 95% CI 0.23-14.60; P = 0.57), hematoma formation (RR: 1.57, 95% CI 0.11-21.49; P = 0.74) and patients requiring blood transfusion post-operatively (RR: 1.22, 95% CI 0.99-1.52; P = 0.07) were not significantly different in patients who were on Aspirin and those who were not on Aspirin pre-operatively.

The post-operative complications associated with the pre-operative use of Aspirin in patients undergoing surgery for hip or femoral fracture were apparently not significantly different when compared to patients who were not on Aspirin. Therefore, Aspirin should not be considered an absolute contraindication in patients undergoing surgery for hip or femoral fracture. Hence, an early or emergency surgery for hip or femoral neck fracture in patients on Aspirin therapy should apparently not pose any problem. Further larger trials should be able to confirm this hypothesis.

The primary aim of this study is to compare mobility status of patients receiving oral oxycodone with those receiving subcutaneous alfentanil as analgesic methods prior to mobilization to help physiotherapy compliance after hip fracture surgery. The secondary aims are to assess postoperative pain, health-related quality of life, in-hospital length of stay, total use of analgesia over postoperative days 1 and 2 (POD 1 and POD 2), complication rates within 30 days, and 30-day mortality rates.

A single-centre, prospective cohort study of 64 patients will be undertaken. Patients undergoing surgery for femoral neck fractures at the study centre will be recruited. Patients with a hip fracture meeting the inclusion/exclusion criteria will be enrolled on admission. Patients who have been administered oral oxycodone will be compared to those prescribed alfentanil for pain prior to mobilization with physiotherapists on POD 1 and POD 2. Which drug a patient receives is reliant of the prescriptions given by the medical team, and in current practice this varies at approximately 50:50. Mobilization will be defined as the ability to stand on and weightbear both feet with or without assistance.

Visual analogue scale pain scores, mobility status, and total analgesia use will be assessed on POD 1 and POD 2. EuroQol five-dimension health questionnaire scores, complication rates, and mortality rates will be assessed up to 30 days following surgery (POD 1, 2, 7, and 30).

This study will help to build a wider protocol aiming to improve early mobilization after hip fracture surgery. The results of this study will provide pain scores and mobility status which will either support use of subcutaneous alfentanil as the standard analgesic modality prior to physiotherapy sessions, or highlight its limitations compared to the standard oral oxycodone. Secondary outcomes will also help to assess if early mobilization improves outcomes compared to delayed mobilization.

Osteoporosis has been usually considered a female disease, generally causing more fracture risk and complications in adult and older women compared to older men. While vertebral fractures occur in a small proportion of men during middle age, men generally fracture about 10 years later than women, with significant increases in fracture risk after about age 75. Independent of age, men experiencing fragility fractures have a higher risk of life-threatening events compared to women, but the risk of secondary fragility fracture overlaps between men and women. Often, male osteoporosis recognizes the overlap between secondary causes and primary osteoporosis risk factors. Assessment through physical examination, history, and laboratory tests is recommended, with dual-energy X-ray absorptiometry of bone density being the preferred diagnostic test for osteoporosis in men. A treatment program should include awareness of diet and vitamin D status, fall risk reduction, and pharmaceutical therapy. Medications that are fracture-reducing in older women should also achieve fewer fractures in older men; however, there is a paucity of studies in men with the primary outcome of fracture risk reduction. Most older men with osteoporosis should be treated with oral or intravenous bisphosphonates, denosumab especially when on androgen deprivation therapy, and initial anabolic treatment should be considered for men at very high risk of fracture. This review summarizes the main features of osteoporosis and fragility fractures in men and reports findings from the available pharmacological and non-pharmacological studies conducted in men.

Hip fractures in the elderly, especially those discharged to a rehab facility, have historically been associated with poor outcomes. There has yet to be identified which patients have a higher likelihood of a rehab discharge after isolated hip fracture fixation. The purpose of this study was to identify factors that predispose patients to require short or long-term rehab after surgical intervention of traumatic, isolated hip fractures.

Patients undergoing operative management of hip fractures (n = 71,849) from 2017 to 2019 at institutions that submitted data to a nationwide database were analyzed retrospectively. Various factors were compared between patients discharged to inpatient rehab (n = 56,178) versus home (n = 15,671).

The rehab discharge group was significantly older and predominantly female. This cohort had a longer average hospital stay, higher incidence of diabetes, congestive heart failure, chronic renal failure, history of cerebrovascular accident, functionally dependent health status, hypertension, chronic obstructive pulmonary disease, dementia, baseline anticoagulation therapy, and history of myocardial infarction. DVT during hospitalization was encountered more often in patients discharged to rehab. Patients with femoral neck fractures and those undergoing total hip arthroplasty were more often discharged home. Patients with intertrochanteric hip fractures and those undergoing fracture fixation were more often discharged to rehab.

Multiple risk factors associated with a significantly higher likelihood of a rehab discharge after isolated hip fracture surgery were identified. Early identification of these patients may provide an opportunity to optimize patients for home discharge and better outcomes.

Level III, Case-Control Study.

The impact of preoperative consultations on mortality and morbidity rates, and their association with delays and hospital stays for surgery, remains a topic of discussion. This study aims to elucidate the necessity of consultations for those undergoing femoral neck fracture surgery, examining their influence on delays, hospital durations, and their correlation with mortality rates.

The study examined data from 320 emergency department patients with femoral neck fractures undergoing hip arthroplasty surgery at our hospital between 2011 and 2021, using digital medical records. Patients were consulted in relevant departments for risk optimization. They were categorized into two groups based on the time of surgery: Group 1 (operated within 48 h) and Group 2 (delayed surgery). The analysis included days from admission to surgery, total hospital stay, and time from surgery to discharge. Mortality rates, with a minimum 2-year follow-up, were assessed using digital records, patient contact, or a death notification system. Statistical analyses involved Mann-Whitney U, Kruskal-Wallis, post hoc analysis, Pearson's chi-squared, and Fisher-Freeman-Halton tests (α = 0.05). SPSS v25.0 software was used.

Patients with consultation requests experience significantly delayed surgery compared to those without (p < 0.001). Statistically significant differences were observed between consulted and nonconsulted groups in time until surgery (p < 0.001), time from surgery to discharge (p < 0.001), and overall length of hospital stay (p < 0.001). However, there is no statistically significant difference in 30-day and 1-year mortality between consulted and nonconsulted patients, both departmentally and overall.

This study found that advanced age and high ASA scores were the main factors causing surgical delays in hip fracture patients. While modifiable comorbidities could reduce hospital stays, they did not significantly affect postoperative mortality. Streamlining elective consultations and reducing organizational delays could help prevent delayed surgeries and improve outcomes.

To evaluate the risk factors contributing to preoperative malnutrition in elderly patients with hip fractures.

The study retrospectively analysed clinical data from 182 elderly patients aged 60 years or older with hip fractures. Nutritional status was assessed according to the Global Leadership Initiative on Malnutrition diagnostic criteria, and risk factors associated with malnutrition were identified through univariate and logistic regression analyses. Based on the findings, a nomogram was developed, and a calibration curve model was constructed. The predictive performance of the model was evaluated using the receiver operating characteristic (ROC) curve. Finally, the model was validated using an independent cohort of 78 patients.

Data analysis revealed that among the 182 elderly patients with hip fractures, 76 were men and 106 were women, with a mean age of 75.77 ± 8.66 years. The fractures included 135 femoral neck fractures and 47 intertrochanteric fractures. Malnutrition was identified in 39.01% (71/182) of the patients. Independent risk factors for malnutrition included age, body mass index, the number of comorbidities, haemoglobin level and serum albumin level. A nomogram model incorporating these indicators was developed, demonstrating robust predictive performance, with an area under the ROC curve of 0.886 (95% confidence interval: 0.809-0.962).

It is anticipated that the proposed model will serve as a valuable tool for the timely and accurate clinical identification of malnutrition risk in elderly patients with hip fractures.

This systematic review and meta-analysis was performed to assess effectiveness of home-based exercise compared with control interventions for functional rehabilitation in elderly patients after hip fracture surgery. Comprehensive literature search was performed on PubMed, EMBASE, Web of Science, Cochrane library, and Clinicaltrails.gov to identify eligible randomized controlled trials (RCTs). Standard mean difference (SMD) and risk ratio (RR) with 95% confidence interval (CI) was calculated. The certainty of evidence of each outcome was assessed by using Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. A total of 28 articles reporting 21 unique RCTs (n = 2470) were finally included. Compared with control interventions, home-based exercise significantly improved Berg balance scale (BBS, SMD = 0.28, 95%CI: 0.03 to 0.53, P = 0.030), timed-up-and-go test (TUG, SMD = -0.28, 95%CI: -0.50 to -0.07, P = 0.009), Short Fort-36 physical component score (SF-36 PCS, SMD = 0.49, 95%CI: 0.28 to 0.70, P<0.001), and knee extensor strength (SMD = 0.23, 95%CI: 0.09 to 0.37, P = 0.001). No significant improvement was observed in gait speed, 6-minute walking test, short physical performance battery performance (SPPB), activities of daily living (ADL), or fear of falling in the home exercise group. Risk of adverse events, including emergency department visits, hospital readmissions, and falls, did not differ between both groups. According to GRADE, the overall certainty of evidence was moderate for usual gait speed, SPPB, ADL, fear of falling, and SF-36 PCS, and was low or very low for the other outcomes. Our meta-analysis demonstrated home-based exercise had positive effect on physical function after hip fracture surgery. Home-based rehabilitation might be recommended for rehabilitation of fractured patients after hospital discharge.

The intertrochanteric fracture is a common fragility fracture typically resulting from low-energy falls. The functional outcome of intertrochanteric fractures is closely linked to the patient's underlying physical condition, intraoperative procedures, and postoperative complications. In terms of surgery, while timely surgery and appropriate internal fixation have demonstrated favorable outcomes, attention to intraoperative reduction is crucial. In recent years, there have been further developments in the evaluation of reduction of intertrochanteric fractures, particularly in the anteromedial cortical reduction, and these advances have been further scientifically elucidated in terms of their ability to provide stable fracture reduction and resist loss of reduction. In order to gain a comprehensive understanding of the anteromedial cortex theory, this article reviewed the anatomy, related theoretical progress, and controversies in recent years.

Fracture union after osteosynthesis of a fracture neck femur (FNF) occurs by compression of the fracture ends and potential neck shortening. Selection of an implant for fixation of a femoral fracture of the neck can be challenging when making management decisions. Femoral neck shortening after internal fixation of FNFs using a femoral neck system (FNS) or multiple cannulated cancellous screws (MCS) was compared.

This prospective interventional single-blinded randomized controlled trial was conducted at a university teaching hospital. Sixty patients undergoing internal fixation for management of sub-capital or trans-cervical FNFs were randomized and assigned, to one of the two groups-the test group (FNS group) and the control group (MCS group). Primary outcome was determined by measuring the difference in 1-year shortening of the femoral neck on radiographs between FNS and MCS. The secondary objective was to determine the correlation between neck shortening with patient reported outcome measures (PROMs) at the end of the final follow-up.

At the final follow-up, shortening of the femoral neck was 3.77±1.87 mm in the FNS group, significantly lower compared with the MCS group, 6.53±1.59 mm.

Significantly less shortening of the femoral neck was observed in the FNS group compared with the MCS group. No statistically significant difference in PROMs was observed at 1-year follow-up. The findings of the study suggest that FNS can be regarded as a suitable alternative for internal fixation in young adults (<60 years) with trans-cervical and subcapital FNFs.

Bone marrow adipose tissue (BMAT) accrues in osteoporosis, whereas its contribution to the progression of bone resorption remains insufficiently understood. To understand the mechanisms that promote BMAT expansion in osteoporosis, in the present study, we performed extensive analysis of the spatiotemporal pattern of BMAT expansion during the progression of bone resorption in TgRANKL transgenic mouse models of osteoporosis expressing human RANKL (receptor activator of nuclear factor-κB ligand). Our results showed that TgRANKL mice of both sexes developed dramatically increased BMAT expansion compared to wild-type (WT) littermates, that was analogous to the levels of RANKL expression and the severity of the bone loss phenotype. BMAT was formed at close proximity to areas undergoing active bone remodelling and bone resorption, whereas bone resorption preceded BMAT development. Expression analysis in bone fractions demonstrated that BMAT constitutes a major source for RANKL production. Ex vivo analysis of isolated bone marrow stromal cells from TgRANKL mice showed an increased adipogenic differentiation capacity compared to WT, while osteoclast supernatants further exaggerated adipogenesis, supporting a critical role of the osteoclast-derived secretome in the differentiation of bone marrow adipocytes. Furthermore, the effectiveness of an antiosteoporosis treatment in BMAT development was investigated upon treatment of TgRANKL models with the bisphosphonate alendronate. Notably, alendronate effectively improved bone mass and attenuated BMAT expansion, indicating a possible involvement of osteoclasts and bone resorption in BMAT development. On the contrary, inhibition of BMAT with PPARγ antagonists (GW9662 or BADGE) effectively ameliorated BMAT expansion but failed to reverse the osteoporotic phenotype of TgRANKL mice. Overall, our data demonstrate that TgRANKL mice constitute unique genetic mouse models for investigating the pathogenic mechanisms that regulate the development and expansion of BMAT in osteolytic diseases.

Background Postoperative delirium (POD) is a common and debilitating complication in elderly hip fracture patients, associated with significant clinical and functional consequences. Early identification of risk factors, such as cognitive impairment and vitamin D deficiency, is essential to mitigate its impact. However, preoperative screening practices are often inconsistent. This quality improvement initiative aimed to assess and improve compliance with early confusion and vitamin D screening in elderly hip fracture patients, with the goal of facilitating timely interventions to reduce the risk of POD. Methods A two-cycle audit was conducted in the Trauma and Orthopaedics Department at Royal Shrewsbury Hospital. The first cycle (April-June 2023) assessed baseline compliance with confusion (Abbreviated Mental Test Score (AMTS)) and vitamin D screening within 24 hours of admission. Identified barriers informed an intervention consisting of educational sessions, visual prompts, and checklist integration. The second cycle (August-October 2023) evaluated the impact of these measures. Compliance rates, timing of assessments, and prevalence of abnormal biochemical and cognitive screening results were analyzed using Fisher's exact test (p < 0.05). Results Baseline compliance with screening was 27 patients (27%) out of 100, with primary barriers including lack of awareness and logistical challenges. Post-intervention compliance improved significantly for 54 patients (52.4%) out of 103 (p = 0.0003). Screening timeliness also increased, with 45 patients (83.33%) out of 54 screenings completed within 24 hours in cycle 2 compared to 14 patients (51.85%) out of 27 in cycle 1 (p = 0.0039). Biochemical analysis revealed persistently high rates of vitamin D deficiency, underscoring the need for early detection. AMTS scores correlated with abnormal confusion screens but highlighted limitations in cognitive-only assessments. Conclusion This quality improvement (QI) initiative demonstrated the efficacy of targeted interventions in improving screening compliance for confusion and vitamin D deficiency in elderly hip fracture patients. The findings advocate for integrating proactive, dual-focused screening protocols into clinical workflows to address modifiable risk factors for POD. Future research should explore the long-term impact of such measures on POD incidence, recovery trajectories, and functional outcomes while emphasizing the need for sustained adherence to screening protocols.

Osteoporosis poses a significant health and quality-of-life burden on older adults, particularly with associated fractures after a fall. A notable increase in pro-inflammatory cytokines associated with aging contributes to a decline in bone mineral density (BMD). Certain food components have been shown to influence an individual's inflammatory state and may contribute to optimal bone health as a modifiable risk factor, particularly later in life. This study aims to explore the relationship between the dietary inflammatory index (DII) and dietary intake with BMD in community-dwelling older adults.

Heathy community-dwelling older adults aged 65-85 years. DII scores were calculated using 24-h dietary recalls, and lumbar spine (L1-L4) and femoral neck (ward's triangle) BMD was assessed via dual-energy x-ray absorptiometry.

A total of 94 participants were recruited (72.9 ± 4.9 years, 76.6% female) with 61.7% identified having an anti-inflammatory diet (average DII = - 0.50 ± 1.6), 88.3% were physically active, 47.8% were osteopenic and 27.7% osteoporotic. There was no significant difference between DII scores, nutrient or food group intake in groups stratified by BMD T-Score except for lean meats and alternatives food group (p = 0.027). Multiple regression analysis found no associations between DII and lumbar spine (unadjusted model β = 0.020, p = 0.155) or femoral neck BMD (unadjusted model β = - 0.001, p = 0.866).

Most of this cohort of functionally able community-dwelling older adults followed an anti-inflammatory diet. DII and dietary intake were not associated with BMD. This research underlines the complex interplay between modifiable and non-modifiable risk factors on the BMD of older, physically active adults.

The purpose of this study is to compare 30-day perioperative outcomes following treatment of intertrochanteric (IT) fractures with intramedullary nail (IMN), total hip arthroplasty (THA), or hemiarthroplasty (HA).

Using the National Surgical Quality Improvement Program database, we conducted a retrospective cohort study of patients who had sustained an IT fracture treated with primary IMN, THA, or HA between 2017 and 2020. International Classification of Diseases, 10th Revision codes S72.141-S72.146, subtypes A through C, were used to identify eligible patients and were cross-referenced to primary Current Procedural Terminology codes, used to identify the following procedure types: 27245: IMN; 27130: THA; and 27236: HA. Revision cases and patients who underwent arthroplasty for osteoarthritis were excluded. Outcomes of interest included reoperation, readmission, operative time, length of stay, and major and minor complications. Multivariate regression was used to evaluate differences in postoperative outcomes between groups.

There were 29,809 IT fractures treated with IMN (94.6%), 1493 treated with HA (4.7%), and 217 treated with THA (0.70%). There was a statistically significant increase in 30-day reoperation rates (adjusted odds ratio [aOR] = 1.99 [95% confidence interval = 1.51, 2.63], P < .001) when combining all arthroplasty patients compared to IMN. There was no statistically significant difference in the overall complication rate between IMN (13.58%) and HA (14.60%, aOR = 1.09, P = .315) or THA (11.98%, aOR = 1.00, P = .998). When compared to IMN (0.12%), there was a statistically significantly decreased need for transfusion in the HA group (aOR = 0.71 [95% confidence interval = 0.61, 0.80], P < .001).

Primary HA is associated with an increased 30-day reoperation rate and decreased need for blood transfusion, but there were no other significant differences in postoperative morbidity identified among IMN, THA, and HA in the treatment of IT fractures. Given the challenges and inferior outcomes associated with conversion arthroplasty, the lack of significant difference in morbidity between the 3 groups suggests that primary arthroplasty may be a safe and viable treatment option in selected patients with IT fractures. Comparative studies with longer clinical follow-up will be necessary to establish the appropriate indications and further evaluate the clinical outcomes of primary arthroplasty in the treatment of IT fractures.

Hip fractures are increasingly common among the elderly population, who often present with a high burden of comorbidities necessitating preoperative stabilization. As a result, preoperative cardiology consultations are frequently conducted in clinical practice. The aim of this study was to investigate the additional recommendations provided by preoperative cardiology consultations and the impact of consultations on the management and outcomes of elderly patients undergoing hip fracture surgery.

This matched cohort study was performed to retrospectively assess the clinical data of patients who were treated for hip fractures at our institution between January 2016 and December 2017. Individuals who were 60 years old or older with available clinical and radiological data were included. A total of 262 patients who met these criteria were included, with 192 undergoing cardiology consultation and 70 not. Through matching for age, sex, ASA grade, fracture type, and surgery type, two groups (Group A, preoperative cardiology consultation requested; Group B, preoperative cardiology consultation not requested) of 50 patients each were formed. The duration between hospital admission and surgery, recommendations provided by cardiology consultation, type of anaesthesia and surgery, length of hospital stay, incidence of medical and orthopaedic complications, and one-year mortality status were compared between the groups.

The mean age of Group A was 78.5 (± 7.4) years, whereas that of Group B was 78.4 (± 7.4) years (p = 0.99). Both groups included 30 female patients and 20 male patients each. There were no significant differences in anaesthesia type or the incidence of medical or orthopaedic complications between the groups. However, Group A experienced a significantly longer duration between admission and surgery (5 [1/9] days vs. 3 [0/7] days; p = 0.00) and a longer hospital stay (7 [3/15] days vs. 5 [1/19] days; p = 0.01) than did Group B. The one-year mortality rate did not significantly differ between the groups (30% vs. 20%; p = 0.36). Notably, only 3 out of 50 patients received additional treatments following cardiology consultation beyond routine recommendations.

Preoperative cardiology consultations before hip fracture surgery rarely leads to a change in treatment. Additionally, these evaluations delay surgery and extend the hospital stay.

Due to the high incidence of proximal femoral fractures, classifications of these fractures are often used in daily practice. Most classifications are eponymous terms since they bear the name of the person(s) who developed them. In this study we provide an insight in the origin of the classifications and the background of their name givers. The clinical implication and background of the eponymous proximal femur fracture classifications of Garden, Pauwels and Evans-Jensen are discussed. With the rising use of modern classification systems, the relevance of historically important classifications is food for discussion. Nevertheless, these classification systems are still used in daily communication and decision making.

The optimal treatment for Pauwels type III femoral neck fractures remains contentious. We aim to compare the biomechanical properties of three inverted cannulated compression screw (ICCS), femoral neck system (FNS), and percutaneous compression plate (PCCP) to determine which offers superior stability for unstable femoral neck fractures.

Finite element analysis and artificial bone models were used to establish Pauwels III femoral neck fracture models. They were divided into ICCS, FNS, and PCCP groups based on respective internal fixation assemblies. The models were subjected to vertical axial loads (2100 N) and torsional forces (10 N × mm) along the femoral neck axis in the finite element analysis. The primary outcomes such as the Z axis fragmentary displacements, as well as displacements and the von Mises stress (VMS) distributions of internal fixations, were analyzed. Additionally, the artificial bones were subjected to progressively increasing vertical axial pressures and torsional moments at angles of 2°, 4°, and 6°, respectively. The vertical displacements of femoral heads and the required torque values were recorded.

Finite element analysis revealed that under single-leg stance loading, the maximum Z-axis fragmentary displacements were 5.060 mm for ICCS, 4.028 mm for FNS, and 2.796 mm for PCCP. The maximum displacements of internal fixations were 4.545 mm for ICCS, 3.047 mm for FNS, and 2.559 mm for PCCP. Peak VMS values were 512.21 MPa for ICCS, 242.86 MPa for FNS, and 413.85 MPa for PCCP. Under increasing vertical loads applied to the artificial bones, the average vertical axial stiffness for the ICCS, FNS, and PCCP groups were 244.86 ± 2.84 N/mm, 415.03 ± 27.10 N/mm, and 529.98 ± 23.08 N/mm. For the torsional moment tests, the PCCP group demonstrated significantly higher torque values at 2°, 4°, and 6° compared with FNS and ICCS, with no significant difference between FNS and ICCS (P > 0.05).

Finite element analysis and artificial bone models indicated that PCCP offers the best compressive and rotational stability for fixing Pauwels type III femoral neck fractures, followed by FNS and then ICCS. No significant difference in rotational resistance was observed between FNS and ICCS in synthetic bones. Level of Evidence Level 5.

The clinical significance of the genetic influence of vitamin D receptor polymorphisms has still not been well-analyzed.

To verify whether rs1544410, rs7975232 and rs731236 polymorphisms are associated with a higher 10-year fracture risk in postmenopausal women.

The study group was a subset of a pre-defined population as part of the broader epidemiological research called the RAC-OST-POL Study and consisted of 358 postmenopausal women, chosen randomly from Racibórz (Poland) inhabitants (mean baseline age 65 ± 6.9 years, BMI 31.2 ± 5.5 kg/m2). From all participants' medical history, data concerning co-morbidities, fracture history, the medication used, parental history of bone fractures, cigarettes and alcohol use were taken at baseline. Moreover, rs1544410, rs7975232 and rs731236 polymorphisms were analyzed. Next, over the following 10 years, participants were contacted once a year and questioned concerning new fractures events and their circumstances.

We did not find statistically significant main effects on the fracture incidence of single-polymorphism variants. However, there were some significant findings dependent on the co-existence of these polymorphisms and medical factors. Women with a positive history of parental fracture and configuration of CC rs7975232, AA rs731236 and CC rs1544410 had a higher fracture incidence. The risk of bone fracture was also significantly higher in the group of heterozygotes of AC rs7975232 if their BMI value was in the categories of normal weight or overweight, or if they were treated with calcium or vitamin D.

Polymorphisms of rs1544410, rs7975232 and rs731236 are connected with the fracture incidence in postmenopausal women. Nevertheless, its influence should be considered with co-existing clinical factors, especially paternal fracture history, prior fracture, BMI value, any osteoporotic treatment or calcium/vit. D supplementation.

Falls and fractures are emerging as a near-pandemic and major global health concern, placing an enormous burden on ageing patients and public health economies. Despite the high risk of polypharmacy in the elderly patients, falls are usually attributed to age-related changes. For the "Individual Pharmacotherapy Management (IPM)" established at the University Hospital Halle, the IPM medication adjustments and their association with in-hospital fall prevention were analysed.

On the basis of the most updated digital overall patient view via his inpatient electronic health record (EHR), IPM adapts each drug's Summary of Product Characteristics to the patient's condition. A retrospective pre-post intervention study in geriatric traumatology on ≥70 years old patients compared 200 patients before IPM implementation (CG) with 204 patients from the IPM intervention period (IG) for the entire medication list, organ, cardiovascular and vital functions and fall risk parameters.

Statistically similar baseline data allowed a comparison of the average 80-year-old patient with a mean of 11.1 ± 4.9 (CG) versus 10.4 ± 3.6 (IG) medications. The IPM adjusted for drug-drug interactions, drug-disease interactions, overdoses, anticholinergic burden, adverse drug reactions, esp. from opioids inducing increased intrasynaptic serotonin, psychotropic drugs, benzodiazepines, contraindications and missing prescriptions. IPM was associated with a significant reduction in in-hospital falls from 18 (9%) in CG to 3 (1.5%) in IG, a number needed to treat of 14, relative risk reduction 83%, OR 0.17 [95% CI 0.04; 0.76], p = 0.021 in multivariable regression analysis. Factors associated with falls were antipsychotics, digitoxin, corticosteroids, Würzburg pain drip (combination of tramadol, metamizole, metoclopramide), head injury, cognitive impairment and aspects of the Huhn Fall Risk Scale including urinary catheter.

The results indicate medication risks constitute a major iatrogenic cause of falls in this population and support the use of EHR-based IPM in standard care for the prevention of falls in the elderly and for patient and drug safety. In terms of global efforts, IPM contributes to the running WHO and United Nations Decade of Healthy Ageing (2021-2030).

This study examined the sex-specific mortality risk and causes of death soon after hip fracture in Taiwan. The objective of this study was to evaluate the 30-day mortality risk and cause of death in patients with hip fracture and identify its associated risk factors. We conducted a retrospective cohort study using data from the National Health Insurance Research Database in Taiwan from 2000 to 2015. This study included patients aged 50 years or older who were admitted to a hospital with a hip fracture diagnosis for the first time. Of 285,891 patients hospitalized for their first hip fracture, 8,505 (2.98%) died within 30 days. The mortality risk of hip fracture declined from 3.76% in 2000 to 2.92% in 2015. Circulatory system diseases like ischemic heart disease and cerebrovascular disease were the most common cause of death and accounted for 22% of deaths within 30 days after fracture. Accidents and unintentional injuries caused 18% of deaths, followed by malignant neoplasms in 10% of deaths. Multivariate Cox regression identified older age, male sex, higher Charlson Comorbidity Index (CCI), suburban or rural residence, and lower income as risk factors for hip fracture mortality. The 30-day mortality risk of hip fractures has decreased but remains correlated with male sex, older age, and comorbidities. Circulatory diseases were the main cause of death. Early identification and treatment by experienced clinicians may optimize outcomes, minimize complications, and reduce mortality risk in the 30 days following hip fracture.

The risk of postoperative sequelae and in-hospital mortality in Japanese patients aged 90 years and older with hip fractures is unexplored. This study aims to use a comprehensive medical claims database in Japan to compare super-elderly patients aged 90 years and older with elderly aged 65-89 and clarify the risk of sequelae and in-hospital mortality in super-elderly patients.

We retrospectively analyzed the Diagnosis Procedure Combination (DPC) database for all of Japan from April 2016 to March 2022. Medical records from approximately 1100 DPC-related hospitals were provided with consistent consent during this period. In this study, we focused on super-elderly patients and examined the association with the risk of postoperative pneumonia, pulmonary embolism, myocardial infarction, urinary tract infection, acute renal dysfunction, subsequent cognitive dysfunction, and in-hospital mortality after one-to-one propensity score matching.

After performing propensity score matching based on sex and comorbidities, 129,953 pairs of patients were identified. These pairs were compared to elderly and super-elderly patients. The results of this study showed that compared with hip fractures in the elderly, hip fractures in the super-elderly were associated with an increased risk of pneumonia, urinary tract infection, acute renal dysfunction, subsequent cognitive dysfunction, and in-hospital mortality after adjustment for confounders. The odds ratio of in-hospital mortality was 2.190 (95% CI 2.062-2.325).

As it has been shown that super-elderly patients with hip fractures are at greater risk of respiratory and urinary tract infections and increased in-hospital mortality, careful attention should be required for perioperative management.

Many studies have indicated that abnormal bone mineral density (BMD) is related to abnormal liver and kidney function, but the effect of serum albumin level on abnormal BMD and osteoporotic fracture is still controversial. The aim of this retrospective study was to investigate the effects of serum albumin levels on abnormal BMD and osteoporotic fractures.

The study included 538 patients through the electronic medical records of inpatients and outpatients stored at Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology. A multivariate logistic regression model was employed to test the relationship between serum albumin levels and abnormal BMD, and the effect of serum albumin levels on osteoporotic fractures was verified through the U test. Correlation between age, sex, kidney stones, coronary heart disease, hypertension, diabetes, fatty liver disease, haemoglobin (HB), mean corpuscular haemoglobin concentration (MCHC), platelets (PLT), platelet distribution width (PDW), lymphocytes (LYMP), alanine aminotransferase (ALT), total protein (TP), albumin (ALB), uric acid (UA), total bilirubin (TBIL), total cholesterol (TC), high-density lipoprotein (HDL) and abnormal BMD were analysed by logistic regression modelling after excluding confounding factors.

The ALB level in osteoporotic patients was 41.70 (36.40-45.00) g/L, which was significantly lower than those in the normal BMD and reduced BMD groups. The odds ratio (OR) (95% confidence interval [CI]) between the osteoporosis and normal BMD groups was 0.445 (0.394-0.502); the OR (95% CI) between the osteoporosis and reduced BMD groups was 0.395 (0.341-0.459). In the subgroup analysis by whether or not a fracture was present, the OR (95% CI) was 0.073 (0.045-0.119).

ALB is a protective factor against osteoporosis and osteoporotic fractures, suggesting that it may have the potential to predict osteoporosis onset and fractures.

We studied factors affecting osteoporotic hip fracture mortality in Hawai'i, a region with unique geography and racial composition. Men, older adults, higher ASA score, lower BMI, and NHPI race were associated with higher mortality. This is the first study demonstrating increased mortality risk after hip fracture in NHPI patients.

To estimate mortality rates and identify specific risk factors associated with 1-year mortality after osteoporotic hip fracture in Hawai'i.

A retrospective review of adults (≥ 50 years) hospitalized with an osteoporotic hip fracture at a large multicenter healthcare system in Hawai'i from 2011 to 2019. The Kaplan-Meier curves and log-rank tests examined survival probability by sex, age group, race/ethnicity, primary insurance, body mass index (BMI), and American Society of Anesthesiologists (ASA) physical status classification. After accounting for potential confounders, adjusted hazard ratios (aHR) and 95% confidence intervals (CI) were obtained from Cox proportional hazards regression models.

We identified 1755 cases of osteoporotic hip fracture. The cumulative mortality rate 1 year after fracture was 14.4%. Older age (aHR 3.50; 95% CI 2.13-5.76 for ≥ 90 vs 50-69), higher ASA score (aHR 5.21; 95% CI 3.09-8.77 for ASA 4-5 vs 1-2), and Native Hawaiian/Pacific Islander (NHPI) race (aHR 1.84; 95% CI 1.10-3.07 vs. White) were independently associated with higher mortality risk. Female sex (aHR 0.64; 95% CI 0.49-0.84 vs male sex) and higher BMI (aHR 0.35; 95% CI 0.18-0.68 for obese vs underweight) were associated with lower mortality risk.

In our study, men, older adults, higher ASA score, lower BMI, and NHPI race were associated with significantly higher mortality risk after osteoporotic hip fracture. NHPIs are an especially vulnerable group and comprise a significant portion of Hawai'i's population. Further research is needed to address the causes of higher mortality and interventions to reduce hip fractures and associated mortality.

Introduction Neck-of-femur (NOF) fractures have high prevalence rates and require prompt surgical intervention for better outcomes. Perioperative hypotension (POH) in the geriatric population has poor outcomes with several contributing factors. The study intends to explore these risk factors and their correlation with patient outcomes.  Methodology We studied a total of 276 patients who underwent surgical fixation of the NOF fracture at St Peter's Hospital, Surrey, from June 1, 2022, to June 1, 2023. Patients with POH were identified; the risk factors and one-year outcome were studied to obtain the results. We used odds ratio (OR), relative risk (RR), and multivariate regression to analyse the statistical association within the data. Results The incidence of POH was 68% (188/276) which included preoperative hypotension (9.78%), intraoperative hypotension (48.55%), and postoperative hypotension with a mean arterial pressure (MAP) of <65 mmHg (24.63%) and fall of systolic blood pressure to less than 80% (34.42%). Statistically significant risk factors were hypertension (OR: 1.330), heart disease (OR: 2.768), and hemoglobin (Hg) drop (OR: 1.42). The outcomes we studied were all statistically significant, with an RR of more than one. It includes postoperative delirium (RR: 2.037), postoperative 30-day morbidity (RR: 4.008), postoperative 30-day mortality (RR: 6.12), 365-day mortality (RR: 2.224), postoperative delay in mobilisation (RR: 1.329), and prolonged length of stay (RR: 1.273).  Conclusion The study shows a clear association between POH and increased postoperative complications, highlighting the need for prompt intervention. This case-control study identified hypertension, history of heart disease, and perioperative blood loss as significant risk factors for developing POH. Also, this study demonstrates that POH is significantly associated with adverse outcomes, including the increased risk of delirium, prolonged hospital stays, and elevated 30-day morbidity in elderly patients undergoing hip fracture surgery. The findings also indicated that the duration of hypotension did not directly influence the outcomes; its occurrence alone is a significant factor in developing these complications.

Periprosthetic femoral fractures (PFFs) are serious complications in hip arthroplasty for femoral neck fractures. The rates of intraoperative (iPFFs) and postoperative PFFs (pPFFs) are higher in cementless stem cases than in cemented cases. This study aimed to investigate the effects of cerclage cabling on PFF prevention in cementless arthroplasty for femoral neck fractures.

This retrospective study included 329 consecutive patients who underwent hip arthroplasty using a cementless stem for femoral neck fractures. A total of 159 and 170 patients were in the non-cabling and cabling groups, respectively. Patient characteristics were comparable in both groups. The PFF occurrence (iPFF and pPFF) rates, reoperation rates, operative time, and blood loss volume were compared between the groups.

The iPFF rate was significantly higher in the noncabling group (6.3%) than in the cabling group (0%, P < .001). The rate of pPFF was significantly higher in the non-cabling group (5.1%) than in the cabling group (0.6%; P = .016). All patients in the non-cabling group required reoperation (5.1%), whereas the patient in the cabling group was an ambulatory case and required no reoperation (0%, P = .003). No significant difference in either operative time or blood loss volume was observed between the non-cabling (50 minutes, 133 mL) and cabling (52 minutes, P = .244; 149 mL, P = .212, respectively) groups.

When a cementless stem is used to treat unstable femoral neck fractures, cerclage cabling effectively prevents iPPF and pPPF without increasing surgical time or blood loss volume.

Treatment options for displaced intracapsular femoral neck fractures in elderly patients include unipolar hemiarthroplasty (UHA), bipolar hemiarthroplasty (BHA), unipolar total hip arthroplasty (UTHA), and dual-mobility total hip arthroplasty (DMTHA). This network meta-analysis (NMA) of randomized controlled trials (RCTs) quantitatively compares these treatments to identify the optimal surgical technique.

Following PRISMA guidelines, a comprehensive literature search in Medline (PubMed), Cochrane, and EMBASE databases was conducted. RCTs comparing UHA, BHA, UTHA, or DMTHA were included. Interventions were ranked using the SUCRA score.

Among 5,542 studies, 12 RCTs met inclusion criteria, involving 1,490 patients. Procedures were ranked by prosthetic dislocation, mortality, operating time, intraoperative blood loss, revision rate, Harris Hip Score (HHS). BHA ranked the best in dislocation rate, intraoperative blood loss and mortality. UHA had the shortest operating time. DMTHA had the greatest ranking for HHS. However, the differences between these treatment modalities were rarely statistically significantly different.

A variety of arthroplasty procedures can be used to treat displaced intracapsular femoral neck fractures. Our results indicate that while BHA resulted in the best post-operative ranking amongst the compared treatment strategies in terms of dislocation rates, blood loss and mortality, the differences between the treatment options does not clearly favor a specific treatment option.

Background Extracapsular hip fractures are routinely treated with fixation, and the majority heal without complication. The fixation fails in a minority of cases, typically either by 'cutting out' of the superior femoral head or through breakage of the metalwork following non-union. In such cases, if operative treatment is thought appropriate, there are two major treatment options: revision fixation of the fracture or joint replacement surgery. Methods Medline on OvidSP was searched using relevant medical-specific subject headings (MeSH) and keywords. The inclusion criteria were: study regarding management of failed extracapsular hip fracture fixation (not osteoarthritis alone, following such surgery), mean age >60 years, comparative study of joint replacement vs. revision fixation. The search returned 1053 results, of which two were relevant. Both studies were considered poor quality and neither study was randomised. Instead, outcomes from the current Hospital Trust were used instead through a prospectively generated trauma database. Results From the trauma database, 37 patients (mean age 81), of whom 21 had received cephalomedullary nails and the remainder dynamic hip screw (DHS), were identified. Fourteen patients underwent revision fixation (seven cephalomedullary nail; seven blade plate), while 23 underwent hip replacement (17 total hip replacement; six hemiarthroplasty). Although the difference did not reach statistical significance according to the log-rank test (p = 0.233), there is a trend towards lower re-operation rate following joint replacement, with the difference becoming apparent after over one year's follow-up. Conclusion  Despite the quality of evidence, the default operation for failed extracapsular hip fracture fixation should be joint replacement, based on a likely lower re-operation rate and permitting immediate full-weight-bearing. In selected instances, particularly younger patients and those who can partially-weight-bear, revision fixation would still be considered. As the number of hip fractures continues to increase both within the UK and worldwide, we can expect to see more patients with previous failed fixations, and more evidence regarding the advantages and disadvantages of different treatment strategies is required.