Journal of Clinical Medicine

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9 pages, 427 KiB

Open AccessArticle

Short and Middle Functional Outcome in the Static vs. Dynamic Fixation of Syndesmotic Injuries in Ankle Fractures: A Retrospective Case Series Study

by Vito Pavone, Giacomo Papotto, Andrea Vescio, Gianfranco Longo, Salvatore D’Amato, Marco Ganci, Emanuele Marchese and Gianluca Testa

J. Clin. Med. 2023, 12(11), 3637; https://doi.org/10.3390/jcm12113637 - 24 May 2023

Cited by 2 | Viewed by 1672

Abstract

Background: Syndesmotic injuries are common lesions associated with ankle fractures. Static and dynamic fixation are frequently used in syndesmotic injury-associated ankle fractures. The purpose of this study is to compare short- and mid-term quality of life, clinical outcomes, and gait after static stabilization [...] Read more.

Background: Syndesmotic injuries are common lesions associated with ankle fractures. Static and dynamic fixation are frequently used in syndesmotic injury-associated ankle fractures. The purpose of this study is to compare short- and mid-term quality of life, clinical outcomes, and gait after static stabilization with a trans-syndesmotic screw or dynamic stabilization with a suture button device. Methods: Here, 230 patients were enrolled in a retrospective observational study. They were divided in two groups according to the fixation procedure (Arthrex TightRope^®, Munich, Germany) synthesis vs. osteosynthesis with a 3.5 mm trans-syndesmotic tricortical screw). They then underwent clinical assessment using the American Foot and Ankle Score (AOFAS) at 1, 2, 6, 12, and 24 months after surgery. Quality of life was assessed according to the EuroQol-5 Dimension (EQ-5D) at 2 and 24 months after surgery in the follow-up; gait analysis was performed 2 and 24 months postoperatively. Results: Significant differences were found at a two-month follow-up according to the AOFAS (p = 0.0001) and EQ-5D (p = 0.0208) scores. No differences were noted in the other follow-ups (p > 0.05) or gait analysis. Conclusion: The dynamic and static fixation of syndesmotic injuries in ankle fracture are both efficacious and valid procedures for avoiding ankle instability. The suture button device was comparable to the screw fixation according to functional outcomes and gait analysis. Full article

(This article belongs to the Special Issue Orthopedic Treatment of Diseases and Fractures in Elderly)

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16 pages, 4539 KiB

Open AccessArticle

Changes in Sleep Problems in Patients Who Underwent Surgical Treatment for Degenerative Spinal Disease with a Concurrent Sleep Disorder: A Nationwide Cohort Study in 3183 Patients during a Two-Year Perioperative Period

by Jihye Kim, Jang Hyun Kim and Tae-Hwan Kim

J. Clin. Med. 2022, 11(24), 7402; https://doi.org/10.3390/jcm11247402 - 14 Dec 2022

Cited by 1 | Viewed by 1624

Abstract

Sleep disturbance is prevalent in patients with degenerative spinal disease, and recent studies have reported that surgical treatment is more effective for improving sleep quality than conservative treatment. We aimed to investigate the perioperative changes of sleep problems in patients who underwent surgical [...] Read more.

Sleep disturbance is prevalent in patients with degenerative spinal disease, and recent studies have reported that surgical treatment is more effective for improving sleep quality than conservative treatment. We aimed to investigate the perioperative changes of sleep problems in patients who underwent surgical treatment for degenerative spinal disease with a concurrent sleep disorder, and presented them according to various clinical profiles possibly associated with sleep disturbance. In addition, we identified factors associated with poor sleep improvement after surgery. This study used data from the Korea Health Insurance Review and Assessment Service database from 2016 to 2018. We included 3183 patients aged ≥19 years who underwent surgery for degenerative spinal disease and had a concurrent sleep disorder. Perioperative changes in the two target outcomes, including the use of sleep medication and hospital visits owing to sleep disorders, were precisely investigated according to factors known to be associated with sleep disturbance, including demographics, comorbidities, and spinal regions. Logistic regression analysis was performed to identify factors associated with poor improvement in terms of sleep medication after surgery. All estimates were validated using bootstrap sampling. During the 1-year preoperative period, the use of sleep medications and hospital visits owing to sleep disorder increased continuously. However, they abruptly decreased shortly after surgical treatment, and throughout the 1-year postoperative period, they remained lower than those in the late preoperative period. At the 1-year follow-up, 75.6% (2407 of 3183) of our cohort showed improvement in sleep medication after surgery. Multivariable analysis identified only two variables as significant factors associated with non-improvement in sleep medication after surgery: depressive disorder (odds ratio (OR) = 1.25 [1.06–1.48]; p = 0.008), and migraine (OR = 1.42 [1.04–1.94]; p = 0.028). We could not investigate the actual sleep quality and resultant quality of life; however, our results justify the necessity for further high-quality studies that include such information and would arouse clinicians’ attention to the importance of sleep disturbance in patients with degenerative spinal disease. Full article

(This article belongs to the Special Issue Orthopedic Treatment of Diseases and Fractures in Elderly)

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16 pages, 3871 KiB

Open AccessArticle

A Prospective Randomized Study Comparing Functional Outcome in Distal Fibula Fractures between Conventional AO Semitubular Plating and Minimal Invasive Intramedullary “Photodynamic Bone Stabilisation”

by Michael Zyskowski, Markus Wurm, Frederik Greve, Philipp Zehnder, Patrick Pflüger, Michael Müller, Peter Biberthaler and Chlodwig Kirchhoff

J. Clin. Med. 2022, 11(23), 7178; https://doi.org/10.3390/jcm11237178 - 2 Dec 2022

Cited by 2 | Viewed by 2416

Abstract

(1) Background: As age in western populations is rising, so too are fractures, e.g., of the distal fibula. The aim of this study was to find out whether a novel, minimally invasive intramedullary osteosynthesis technique for the treatment of distal fibula fractures in [...] Read more.

(1) Background: As age in western populations is rising, so too are fractures, e.g., of the distal fibula. The aim of this study was to find out whether a novel, minimally invasive intramedullary osteosynthesis technique for the treatment of distal fibula fractures in elderly patients results in not only a reduction of postoperative complications, but also a shorter hospitalization time, an improved clinical outcome, and preserved autonomy in geriatric trauma patients. (2) Methods: In this prospective study, the results following surgical treatment for distal fibula fractures in geriatric patients after using DePuy Synthes^® one-third semitubular plate (Group I) or a minimally invasive intramedullary photodynamic Bone StabilizationSystem (IlluminOss^®) (Group II) were compared at 6 weeks, 12 weeks, 6 months, and 1 year after initial treatment. (3) Results: Significant improvement regarding clinical outcome was shown in Group II 6 and 12 weeks after surgery. (4) Conclusions: Our study results demonstrate that the use of this new intramedullary stabilization system in combination with an immediate postoperative weight bearing seems to be a safe and stable treatment option for ankle fractures in geriatric patients, especially in the early stages of recovery. Full article

(This article belongs to the Special Issue Orthopedic Treatment of Diseases and Fractures in Elderly)

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8 pages, 858 KiB

Open AccessArticle

Association of Body Mass Index with Long-Term All-Cause Mortality in Patients Who Had Undergone a Vertebroplasty for a Vertebral Compression Fracture

by Wen-Chien Wang, Yun-Che Wu, Yu-Hsien Lin, Yu-Tsung Lin, Kun-Hui Chen, Chien-Chou Pan, Jun-Sing Wang and Cheng-Hung Lee

J. Clin. Med. 2022, 11(21), 6519; https://doi.org/10.3390/jcm11216519 - 2 Nov 2022

Cited by 1 | Viewed by 1566

Abstract

We aimed to investigate the association between preoperative body mass index (BMI) and postoperative long-term mortality in patients who underwent a vertebroplasty. We retrospectively enrolled patients with a vertebral compression fracture who underwent a vertebroplasty between May 2013 and June 2020 in a [...] Read more.

We aimed to investigate the association between preoperative body mass index (BMI) and postoperative long-term mortality in patients who underwent a vertebroplasty. We retrospectively enrolled patients with a vertebral compression fracture who underwent a vertebroplasty between May 2013 and June 2020 in a medical center in Taiwan. The survival status of the study sample was confirmed by the end of March 2021. Cox-proportional hazard models were conducted to examine the effects of being overweight/obese (≥25 kg/m² vs. <25 kg/m²) and BMI (as a continuous variable) on all-cause mortality after adjusting for age, sex, history of smoking, diabetes, hypertension, chronic kidney disease, and osteoporosis. A total of 164 patients were analyzed (mean age 75.8 ± 9.3 years, male 25.6%, mean BMI 24.0 ± 4.1 kg/m²) after a median follow-up of 785 days. Compared with a BMI < 25 kg/m², a BMI ≥ 25 kg/m² was associated with a significantly lower risk of all-cause mortality (HR 0.297, 95% CI 0.101 to 0.878, p = 0.028). These findings were consistent when BMI was examined as a continuous variable (HR 0.874, 95% CI 0.773 to 0.988, p = 0.031). A low BMI (<22 kg/m²) should be considered as a risk factor for postoperative long-term mortality in this ageing population. Full article

(This article belongs to the Special Issue Orthopedic Treatment of Diseases and Fractures in Elderly)

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17 pages, 982 KiB

Open AccessArticle

Reliability of the Spanish Version of the Movement Imagery Questionnaire-3 (MIQ-3) and Characteristics of Motor Imagery in Institutionalized Elderly People

by Manuel Enrique Suárez Rozo, Sara Trapero-Asenjo, Daniel Pecos-Martín, Samuel Fernández-Carnero, Tomás Gallego-Izquierdo, José Jesús Jiménez Rejano and Susana Nunez-Nagy

J. Clin. Med. 2022, 11(20), 6076; https://doi.org/10.3390/jcm11206076 - 14 Oct 2022

Cited by 1 | Viewed by 2117

Abstract

Motor imagery (MI) training is increasingly used to improve the performance of specific motor skills. The Movement Imagery Questionnaire-3 (MIQ-3) is an instrument for assessing MI ability validated in Spanish although its reliability has not yet been studied in the elderly population. The [...] Read more.

Motor imagery (MI) training is increasingly used to improve the performance of specific motor skills. The Movement Imagery Questionnaire-3 (MIQ-3) is an instrument for assessing MI ability validated in Spanish although its reliability has not yet been studied in the elderly population. The main objective of this study was to test its reliability in institutionalized elderly people. Secondarily, we studied whether there are differences according to gender and age in MI ability (measured by the MIQ-3) and in temporal congruency (measured by mental chronometry of elbow and knee flexion-extension and getting up and sitting down from chair movements). The subjects were 60 elderly, institutionalized, Spanish-speaking individuals without cognitive impairment or dementia, and aged between 70 and 100 years. Cronbach’s alpha showed high internal consistency in the internal visual and external visual subscales and moderate in the kinesthetic subscale. The intraclass correlation coefficient showed good test-retest reliability for all three subscales. Mixed factorial analysis of variances (ANOVAs) showed that MI ability decreased with increasing age range, the imagery time decreased concerning the execution of the same movement, and there were no gender differences in either IM ability or temporal congruence. The Spanish version of the MIQ-3 is a reliable instrument for measuring MI ability in institutionalized elderly. Full article

(This article belongs to the Special Issue Orthopedic Treatment of Diseases and Fractures in Elderly)

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15 pages, 2155 KiB

Open AccessArticle

Prevalence of Sleep Disturbance and Its Risk Factors in Patients Who Undergo Surgical Treatment for Degenerative Spinal Disease: A Nationwide Study of 106,837 Patients

by Jihye Kim, Min Seong Kang and Tae-Hwan Kim

J. Clin. Med. 2022, 11(19), 5932; https://doi.org/10.3390/jcm11195932 - 8 Oct 2022

Cited by 3 | Viewed by 1769

Abstract

Spinal surgeons have not yet considered sleep disturbance an area of concern; thus, a comprehensive study investigating the epidemiology of sleep disturbance in patients with degenerative spinal disease is yet to be conducted. This study aimed to fill this research gap by investigating [...] Read more.

Spinal surgeons have not yet considered sleep disturbance an area of concern; thus, a comprehensive study investigating the epidemiology of sleep disturbance in patients with degenerative spinal disease is yet to be conducted. This study aimed to fill this research gap by investigating the epidemiology of sleep disturbance in patients who underwent spinal surgery for degenerative spinal disease and identifying the associated risk factors. This nationwide, population-based, cohort study, used data from January 2016 and December 2018 from the Korea Health Insurance Review and Assessment Service database. This study included 106,837 patients older than 19 years who underwent surgery for degenerative spinal disease. Sleep disorder was initially defined as a diagnosis of a sleep disorder made within one year before the index surgery and identified using the International Classification of Diseases, 10th revision, codes F51 and G47 (main analysis). We also investigated the use of sleep medication within 90 days prior to the index surgery, which was the target outcome of the sensitivity analysis. The prevalence of sleep disturbance was precisely investigated according to various factors, including demographics, comorbidities, and spinal region. Logistic regression analysis was performed to identify the independent factors associated with sleep disturbance. The results of the statistical analysis were validated using sensitivity analysis and bootstrap sampling. The prevalence of sleep disorder was 5.5% (n = 5847) in our cohort. During the 90 days before spinal surgery, sleep medication was used for over four weeks in 5.5% (n = 5864) and over eight weeks in 3.8% (n = 4009) of the cohort. Although the prevalence of sleep disturbance differed according to the spinal region, the spinal region was not a significant risk factor for sleep disorder in multivariable analysis. We also identified four groups of independent risk factors: (1) Age, (2) other demographic factors and general comorbidities, (3) neuropsychiatric disorders, and (4) osteoarthritis of the extremities. Our results, including the prevalence rates of sleep disturbance in the entire patient population and the identified risk factors, provide clinicians with a reasonable reference for evaluating sleep disturbance in patients with degenerative spinal disease and future research. Full article

(This article belongs to the Special Issue Orthopedic Treatment of Diseases and Fractures in Elderly)

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7 pages, 257 KiB

Open AccessArticle

Sarcopenia Is an Independent Risk Factor for Subsequent Osteoporotic Vertebral Fractures Following Percutaneous Cement Augmentation in Elderly Patients

by Shira Lidar, Khalil Salame, Michelle Chua, Morsi Khashan, Dror Ofir, Alon Grundstein, Uri Hochberg, Zvi Lidar and Gilad J. Regev

J. Clin. Med. 2022, 11(19), 5778; https://doi.org/10.3390/jcm11195778 - 29 Sep 2022

Cited by 8 | Viewed by 1767

Abstract

Introduction: Subsequent osteoporotic vertebral fractures (SOVF) are a serious complication of osteoporosis that can lead to spinal deformity, chronic pain and disability. Several risk factors have been previously identified for developing SOVF. However, there are conflicting reports regarding the association between sarcopenia [...] Read more.

Introduction: Subsequent osteoporotic vertebral fractures (SOVF) are a serious complication of osteoporosis that can lead to spinal deformity, chronic pain and disability. Several risk factors have been previously identified for developing SOVF. However, there are conflicting reports regarding the association between sarcopenia and multiple vertebral compression fractures. As such, the goal of this study was to investigate whether sarcopenia is an independent risk factor of SOVF. Methods: This was a retrospective case–control study of elderly patients who underwent percutaneous vertebral augmentation (PVA) due to a new osteoporotic vertebral compression fracture (OVCF). Collected data included: age, sex, BMI, steroid treatment, fracture level and type, presence of kyphosis at the level of the fracture and bone mineral density (BMD). Identification of SVOFs was based on clinical notes and imaging corroborating the presence of a new fracture. Sarcopenia was measured using the normalized psoas muscle total cross-sectional area (nCSA) at the L4 level. Results: Eighty-nine patients that underwent PVA were followed for a minimum of 24 months. Average age was 80.2 ± 7.1 years; 58 were female (65.2%) and 31 male (34.8%). Psoas muscle nCSA was significantly associated with age (p = 0.031) but not with gender (p = 0.129), corticosteroid treatment (p = 0.349), local kyphosis (p = 0.715), or BMD (p = 0.724). Sarcopenia was significantly associated with SOVF (p = 0.039) after controlling for age and gender. Conclusions: Psoas muscle nCSA can be used as a standalone diagnostic tool of sarcopenia in patients undergoing PVA. In patients undergoing PVA for OVCF, sarcopenia is an independent risk factor for SOVF. Full article

(This article belongs to the Special Issue Orthopedic Treatment of Diseases and Fractures in Elderly)

15 pages, 1100 KiB

Open AccessArticle

Determinants of Lack of Recovery from Dependency and Walking Ability Six Months after Hip Fracture in a Population of People Aged 65 Years and Over

by Enrique González Marcos, Enrique González García, Josefa González-Santos, Jerónimo J. González-Bernal, Adoración del Pilar Martín-Rodríguez and Mirian Santamaría-Peláez

J. Clin. Med. 2022, 11(15), 4467; https://doi.org/10.3390/jcm11154467 - 31 Jul 2022

Cited by 1 | Viewed by 1777

Abstract

Background: Hip fracture in the elderly means that between a quarter and a half of patients do not regain the levels of independence and walking ability that they previously had, according to the literature, after the fracture. Material and methods: Retrospective study of [...] Read more.

Background: Hip fracture in the elderly means that between a quarter and a half of patients do not regain the levels of independence and walking ability that they previously had, according to the literature, after the fracture. Material and methods: Retrospective study of 537 patients aged ≥65 years who survived at the sixth month after fracturing their hip, of which the age, sex, type of fracture, surgical risk, independence (BI), walking ability, cognitive level (PS), comorbidities, indicated drugs, complications, surgical delay, hospital stay, and surgical technique are known. Using Pearson’s χ² test, all the variables were contrasted with respect to the limitation or not, at the sixth month of the recovery of both independence and pre-admission walking ability. Multivariate analysis provides the necessary adjustment to the previous contrast. Results: We have found that age and PS ≥ 5 at admission limit recovery from both dependency and walking ability. Surgical risk, independence (BI) upon admission, anemia, and constipation during the hospital stay limit the recovery of the BI. Worsening of walking ability during the hospital stay and the type of extra-articular fracture, which was surgically treated by osteosynthesis, limit the recovery of walking ability. Conclusions: The factors previously exposed, and perhaps the fact that patients with hip fractures are not routinely referred to rehabilitation, explain the high proportion of patients who do not recover their previous independency (36%) or walking ability (45%) to the fact of fracturing. Full article

(This article belongs to the Special Issue Orthopedic Treatment of Diseases and Fractures in Elderly)

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5 pages, 415 KiB

Open AccessArticle

Hip Fractures and Visual Impairment: Is There a Cause–Consequence Mechanism?

by Gianluca Testa, Sara De Salvo, Silvia Boscaglia, Marco Montemagno, Antonio Longo, Andrea Russo, Giuseppe Sessa and Vito Pavone

J. Clin. Med. 2022, 11(14), 3926; https://doi.org/10.3390/jcm11143926 - 6 Jul 2022

Cited by 4 | Viewed by 1525

Abstract

Background: Numerous studies have pointed out how visual impairment relates to falls in the elderly, causing dangerous consequences, such as fractures. The proximal femur fracture is one of the most frequent fracture types related to poor vision. This study investigates the link between [...] Read more.

Background: Numerous studies have pointed out how visual impairment relates to falls in the elderly, causing dangerous consequences, such as fractures. The proximal femur fracture is one of the most frequent fracture types related to poor vision. This study investigates the link between fall-related hip fractures and visual impairment. Methods: The present is an observational monocentric case–control study. We collected the ophthalmologic anamnesis and measured the visual acuity of 88 subjects with femur neck fracture (case group), comparing it with 101 adults without fractures and a recent fall history. Results: The results showed no statistical difference between the two groups regarding visual acuity, with a p-value of 0.08 for the right eye and 0.13 for the left one. One of the major ophthalmologic morbidities found was cataracts, present in 48% of the control group and 30% of the case group. Conclusions: The data obtained suggest that visual impairment might not be crucial in determining falls in the elderly. Full article

(This article belongs to the Special Issue Orthopedic Treatment of Diseases and Fractures in Elderly)

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10 pages, 905 KiB

Open AccessArticle

Association of Thiazide Use in Patients with Hypertension with Overall Fracture Risk: A Population-Based Cohort Study

by Cheng-Hsun Chuang, Shun-Fa Yang, Pei-Lun Liao, Jing-Yang Huang, Man-Yee Chan and Chao-Bin Yeh

J. Clin. Med. 2022, 11(12), 3304; https://doi.org/10.3390/jcm11123304 - 9 Jun 2022

Cited by 2 | Viewed by 1769

Abstract

Thiazide diuretics have long been widely used as antihypertensive agents. In addition to reducing blood pressure, thiazides also control calcium homeostasis and increase bone density. We hypothesized that the use of thiazides in patients with hypertension would reduce overall fracture risk. We used [...] Read more.

Thiazide diuretics have long been widely used as antihypertensive agents. In addition to reducing blood pressure, thiazides also control calcium homeostasis and increase bone density. We hypothesized that the use of thiazides in patients with hypertension would reduce overall fracture risk. We used the Taiwan National Health Insurance Research Database to find patients with a hypertension diagnosis who accepted antihypertensive treatment from 2000 to 2017. The patients were further classified into thiazide users and nonthiazide users. Multivariable Cox regression analysis and Kaplan–Meier survival analysis were performed to estimate the adjusted hazard ratios (aHRs) and cumulative probability of fractures. After 1:1 propensity score matching by sex, age, urbanization level of place of residence, income, comorbidities, and medications, there were 18,483 paired thiazide users and non-users, respectively. The incidence densities of fractures (per 1000 person-months) were 1.82 (95% CI: 1.76–1.89) and 1.99 (95% CI: 1.92–2.06) in the thiazide and nonthiazide groups, respectively. The results indicated a lower hazard ratio for fractures in thiazide users (aHR = 0.93, 95% CI: 0.88–0.98). Kaplan–Meier survival analysis revealed a significantly lower cumulative incidence of fractures in the thiazide group (log-rank test; p = 0.0012). In conclusion, our results reveal that thiazide use can reduce fracture risk. When antihypertensive agents are being considered, thiazide may be a better choice if the patient is at heightened risk of fracture. Full article

(This article belongs to the Special Issue Orthopedic Treatment of Diseases and Fractures in Elderly)

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6 pages, 474 KiB

Open AccessArticle

Peri-Implant Distal Radius Fracture: Proposal of a New Classification

by Leonardo Stramazzo, Giuseppe Rovere, Alessio Cioffi, Giulio Edoardo Vigni, Nicolò Galvano, Antonio D’Arienzo, Giulia Letizia Mauro, Lawrence Camarda and Michele D’Arienzo

J. Clin. Med. 2022, 11(9), 2628; https://doi.org/10.3390/jcm11092628 - 7 May 2022

Cited by 6 | Viewed by 2185

Abstract

A peri-implant fracture near the volar plate of the distal radius represents a rarity and can be associated with a mechanical failure of the devices. A literature review was conducted including all fractures that occurred around a volar wrist plate, which could be [...] Read more.

A peri-implant fracture near the volar plate of the distal radius represents a rarity and can be associated with a mechanical failure of the devices. A literature review was conducted including all fractures that occurred around a volar wrist plate, which could be associated with an ulna fracture. All articles published until December 2021 were considered according to the guidelines presented in the PRISMA Statement. The search was conducted with the PubMed electronic database, Cochrane Database of Systematic Reviews, Medline, Embase, and Google Scholar. Only nine cases of these fractures were reported in the literature. The causes could be due to delayed union/non-union of the old fracture after low energy traumas, high energy trauma in patients with poor bone quality, or hardware mechanical failure. Furthermore, the literature review of peri-implant radius fracture shows different level of radius fracture and types of implant failure. In accordance with these different cases, a new classification of peri-implant fracture of the distal radius is proposed. Full article

(This article belongs to the Special Issue Orthopedic Treatment of Diseases and Fractures in Elderly)

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8 pages, 273 KiB

Open AccessArticle

Ethical Dilemmas with Regard to Elderly Patients with Hip Fracture: The Problem of Nonagenarians and Centenarians

by Mario Herrera-Pérez, David González-Martín, Emilio J. Sanz and José L. Pais-Brito

J. Clin. Med. 2022, 11(7), 1851; https://doi.org/10.3390/jcm11071851 - 27 Mar 2022

Cited by 7 | Viewed by 2433

Abstract

Hip fracture is the most feared complication of osteoporosis, producing up to 30% mortality at the first year. With the aging of society, it is increasingly common to deal with ethical dilemmas that involve decision making in the elderly patient with a hip [...] Read more.

Hip fracture is the most feared complication of osteoporosis, producing up to 30% mortality at the first year. With the aging of society, it is increasingly common to deal with ethical dilemmas that involve decision making in the elderly patient with a hip fracture. The objectives of the present work are to describe the main bioethical dilemmas in this group of patients and their relationship with surgical delay. We conducted a retrospective descriptive study that studied an elderly population admitted to a University Hospital with a diagnosis of hip fracture. In total, 415 patients were analyzed. The majority received surgical treatment, a correct application of the principles of justice, non-maleficence and beneficence is verified, but a possible violation of the principle of autonomy is confirmed. Based on the results of this study, the elderly population may somehow lose their principle of autonomy when they enter a hospital due to a hip fracture. On the other hand, the so-called ageism due to ignorance can influence the surgical delay and therefore the mortality of these patients. Full article

(This article belongs to the Special Issue Orthopedic Treatment of Diseases and Fractures in Elderly)

11 pages, 4846 KiB

Open AccessArticle

Family Caregivers’ Experiences with Tele-Rehabilitation for Older Adults with Hip Fracture

by Patrocinio Ariza-Vega, Rafael Prieto-Moreno, Herminia Castillo-Pérez, Virginia Martínez-Ruiz, Dulce Romero-Ayuso and Maureen C. Ashe

J. Clin. Med. 2021, 10(24), 5850; https://doi.org/10.3390/jcm10245850 - 13 Dec 2021

Cited by 6 | Viewed by 3141

Abstract

Background: There is a knowledge gap for implementing tele-rehabilitation (telerehab) after hip fracture. We recently conducted a clinical trial (ClinicalTrials.gov Identifier: NCT02968589) to test a novel online family caregiver-supported rehabilitation program for older adults with hip fracture, called @ctivehip. In this qualitative substudy, [...] Read more.

Background: There is a knowledge gap for implementing tele-rehabilitation (telerehab) after hip fracture. We recently conducted a clinical trial (ClinicalTrials.gov Identifier: NCT02968589) to test a novel online family caregiver-supported rehabilitation program for older adults with hip fracture, called @ctivehip. In this qualitative substudy, our objective was to use semi-structured interviews to explore family caregivers experience with the telerehab program. Methods: Twenty-one family caregivers were interviewed between three and six months after the older adults completed @ctivehip. One occupational therapist with research and clinical experience, but not involved in the main trial, conducted and transcribed the interviews. We conducted a multi-step content analysis, and two authors completed one coding cycle and two recoding cycles. Results: Family caregivers who enrolled in @ctivehip were satisfied with the program, stated it was manageable to use, and perceived benefits for older adults’ functional recovery after hip fracture. They also suggested improvements for the program content, such as more variety with exercises, and increased monitoring by health professionals. Conclusions: This work extends existing literature and generates research hypotheses for future studies to test telerehab content and program implementation. Full article

(This article belongs to the Special Issue Orthopedic Treatment of Diseases and Fractures in Elderly)

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11 pages, 696 KiB

Open AccessArticle

Associations between Early Surgery and Postoperative Outcomes in Elderly Patients with Distal Femur Fracture: A Retrospective Cohort Study

by Norio Yamamoto, Hiroyuki Ohbe, Yosuke Tomita, Takashi Yorifuji, Mikio Nakajima, Yusuke Sasabuchi, Yuki Miyamoto, Hiroki Matsui, Tomoyuki Noda and Hideo Yasunaga

J. Clin. Med. 2021, 10(24), 5800; https://doi.org/10.3390/jcm10245800 - 11 Dec 2021

Cited by 6 | Viewed by 3375

Abstract

Previous literature has provided conflicting results regarding the associations between early surgery and postoperative outcomes in elderly patients with distal femur fractures. Using data from the Japanese Diagnosis Procedure Combination inpatient database from April 2014 to March 2019, we identified elderly patients who [...] Read more.

Previous literature has provided conflicting results regarding the associations between early surgery and postoperative outcomes in elderly patients with distal femur fractures. Using data from the Japanese Diagnosis Procedure Combination inpatient database from April 2014 to March 2019, we identified elderly patients who underwent surgery for distal femur fracture within two days of hospital admission (early surgery group) or at three or more days after hospital admission (delayed surgery group). Of 9678 eligible patients, 1384 (14.3%) were assigned to the early surgery group. One-to-one propensity score matched analyses showed no significant difference in 30-day mortality between the early and delayed groups (0.5% versus 0.5%; risk difference, 0.0%; 95% confidence interval, −0.7% to 0.7%). Patients in the early surgery group had significantly lower proportions of the composite outcome (death or postoperative complications), shorter hospital stays, and lower total hospitalization costs than patients in the delayed surgery group. Our results showed that early surgery within two days of hospital admission for geriatric distal femur fracture was not associated with a reduction in 30-day mortality but was associated with reductions in postoperative complications and total hospitalization costs. Full article

(This article belongs to the Special Issue Orthopedic Treatment of Diseases and Fractures in Elderly)

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10 pages, 1742 KiB

Open AccessArticle

A Randomized Trial Assessing the Muscle Strength and Range of Motion in Elderly Patients following Distal Radius Fractures Treated with 4- and 6-Week Cast Immobilization

by Jarosław Olech, Grzegorz Konieczny, Łukasz Tomczyk and Piotr Morasiewicz

J. Clin. Med. 2021, 10(24), 5774; https://doi.org/10.3390/jcm10245774 - 9 Dec 2021

Cited by 3 | Viewed by 2439

Abstract

Background: There is no consensus among orthopedic surgeons as to the required period of cast immobilization in distal radius fractures in elderly patients. The purpose of this study was to assess muscle strength and range of motion symmetry in elderly patients after distal [...] Read more.

Background: There is no consensus among orthopedic surgeons as to the required period of cast immobilization in distal radius fractures in elderly patients. The purpose of this study was to assess muscle strength and range of motion symmetry in elderly patients after distal radius fractures with different periods of cast immobilization. Methods: This study evaluated 50 patients (33 women and 17 men), aged over 65 years, after cast immobilization treatment for distal radius fracture. The mean age at the beginning of treatment was 71 years. The mean duration of follow-up was 1 year and 3 months. The first subgroup (n = 24) comprised the patients whose fractures had been immobilized in a cast for 6 weeks, another subgroup (n = 26) comprised the patients with 4-week cast immobilization. We assessed: (1) muscle strength, (2) range of motion. Results: The mean grip strength in the treated limb was 71% and 81% of that in the healthy limb in the groups with 4-week and 6-week cast immobilization, respectively (p = 0.0432). The study groups showed no differences in the mean grip strength in the treated limbs or the mean grip strength in the healthy limbs. The mean treated limb flexion was 62° and 75° in the 4-week and 6-week immobilization groups, respectively (p = 0.025). The evaluated groups showed no differences in terms of any other range of motion parameters. The grip strength and range of motion values were significantly lower in the treated limb than in the healthy limb in both evaluated groups. Only the values of wrist radial deviation in the 6-week cast immobilization group showed no differences between the treated and healthy limbs. Conclusion: Higher values of injured limb muscle strength and greater mean range of wrist flexion were achieved in the 6-week subgroup. Neither of the evaluated groups achieved a symmetry of muscle strength or range of motion after treatment. Full limb function did not return in any of the elderly distal radius fracture patients irrespective of cast immobilization duration. Full article

(This article belongs to the Special Issue Orthopedic Treatment of Diseases and Fractures in Elderly)

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9 pages, 1646 KiB

Open AccessArticle

Displacement of the Greater Tuberosity in Humeral Head Fractures Does Not only Depend on Rotator Cuff Status

by Lisa Klute, Christian Pfeifer, Isabella Weiss, Agnes Mayr, Volker Alt and Maximilian Kerschbaum

J. Clin. Med. 2021, 10(18), 4136; https://doi.org/10.3390/jcm10184136 - 14 Sep 2021

Cited by 2 | Viewed by 1797

Abstract

It is assumed that dorsocranial displacement of the greater tuberosity in humeral head fractures is caused by rotator cuff traction. The purpose of this study was to investigate the association between rotator cuff status and displacement characteristics of the greater tuberosity in four-part [...] Read more.

It is assumed that dorsocranial displacement of the greater tuberosity in humeral head fractures is caused by rotator cuff traction. The purpose of this study was to investigate the association between rotator cuff status and displacement characteristics of the greater tuberosity in four-part humeral head fractures. Computed tomography scans of 121 patients with Neer type 4 fractures were analyzed. Fatty infiltration of the supra- and infraspinatus muscles was classified according to Goutallier. Position determination of the greater tuberosity fragment was performed in both coronary and axial planes to assess the extent of dorsocranial displacement. Considering non-varus displaced fractures, the extent of the dorsocranial displacement was significantly higher in patients with mostly inconspicuous posterosuperior rotator cuff status compared to advanced fatty degenerated cuffs (cranial displacement: Goutallier 0–1: 6.4 mm ± 4.6 mm vs. Goutallier 2–4: 4.2 mm ± 3.5 mm, p = 0.020; dorsal displacement: Goutallier 0–1: 28.4° ± 32.3° vs. Goutallier 2–4: 13.1° ± 16.1°, p = 0.010). In varus displaced humeral head fractures, no correlation between the displacement of the greater tuberosity and the condition of the posterosuperior rotator cuff could be detected (p ≥ 0.05). The commonly accepted theory of greater tuberosity displacement in humeral head fractures by rotator cuff traction cannot be applied to all fracture types. Full article

(This article belongs to the Special Issue Orthopedic Treatment of Diseases and Fractures in Elderly)

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7 pages, 232 KiB

Open AccessArticle

Mild Traumatic Brain Injury in Older Adults: Are Routine Second cCT Scans Necessary?

by Valeska Hofmann, Christian Deininger, Stefan Döbele, Christian Konrads and Florian Wichlas

J. Clin. Med. 2021, 10(17), 3794; https://doi.org/10.3390/jcm10173794 - 25 Aug 2021

Cited by 5 | Viewed by 1621

Abstract

Fall-related hospitalizations among older adults have been increasing in recent decades. One of the most common reasons for this is minimal or mild traumatic brain injury (mTBI) in older individuals taking anticoagulant medication. In this study, we analyzed all inpatient stays from January [...] Read more.

Fall-related hospitalizations among older adults have been increasing in recent decades. One of the most common reasons for this is minimal or mild traumatic brain injury (mTBI) in older individuals taking anticoagulant medication. In this study, we analyzed all inpatient stays from January 2017 to December 2019 of patients aged > 75 years with a mTBI on anticoagulant therapy who received at least two cranial computer tomography (cCT) scans. Of 1477 inpatient stays, 39 had primary cranial bleeding, and in 1438 the results of initial scans were negative for cranial bleeding. Of these 1438 cases, 6 suffered secondary bleeding from the control cCT scan. There was no significance for bleeding related to the type of anticoagulation. We conclude that geriatric patients under anticoagulant medication don’t need a second cCT scan if the primary cCT was negative for intracranial bleeding and the patient shows no clinical signs of bleeding. These patients can be dismissed but require an evaluation for need of home care or protective measures to prevent recurrent falls. The type of anticoagulant medication does not affect the risk of bleeding. Full article

(This article belongs to the Special Issue Orthopedic Treatment of Diseases and Fractures in Elderly)

10 pages, 722 KiB

Open AccessArticle

Regional Nerve Block Decreases the Incidence of Postoperative Delirium in Elderly Hip Fracture

by Eic Ju Lim, Won Uk Koh, Hyungtae Kim, Ha-Jung Kim, Hyun-Chul Shon and Ji Wan Kim

J. Clin. Med. 2021, 10(16), 3586; https://doi.org/10.3390/jcm10163586 - 15 Aug 2021

Cited by 12 | Viewed by 4226

Abstract

Postoperative delirium is common in elderly patients with hip fracture. Pain is a major risk factor for delirium, and regional nerve blocks (RNBs) effectively control pain in hip fractures. This study aimed to evaluate the effect of RNB on delirium after hip surgery [...] Read more.

Postoperative delirium is common in elderly patients with hip fracture. Pain is a major risk factor for delirium, and regional nerve blocks (RNBs) effectively control pain in hip fractures. This study aimed to evaluate the effect of RNB on delirium after hip surgery in elderly patients. This retrospective comparative study was performed in a single institution, and the data were collected from medical records between March 2018 and April 2021. Patients aged ≥60 years who underwent proximal femoral fracture surgery were included, while those with previous psychiatric illness and cognitive impairment were excluded. Two hundred and fifty-two patients were enrolled and divided into an RNB or a control group according to RNB use. Delirium was assessed as the primary outcome and postoperative pain score, pain medication consumption, and rehabilitation assessment as the secondary outcomes. Between the RNB (n = 129) and control groups (n = 123), there was no significant difference in the baseline characteristics. The overall incidence of delirium was 21%; the rate was lower in the RNB group than in the control group (15 vs. 27%, respectively, p = 0.027). The average pain score at 6 h postoperatively was lower in the RNB group than in the control group (2.8 ± 1.5 vs. 3.3 ± 1.6, respectively, p = 0.030). There was no significant difference in the pain score at 12, 24, and 48 h postoperatively, amount of opioids consumed for 2 postoperative days, and time from injury to wheelchair ambulation. We recommend RNB as a standard procedure for elderly patients with hip fracture due to lower delirium incidence and more effective analgesia in the early postoperative period. Full article

(This article belongs to the Special Issue Orthopedic Treatment of Diseases and Fractures in Elderly)

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Review

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13 pages, 273 KiB

Open AccessReview

Non-Adherence to Anti-Osteoporosis Medication: Factors Influencing and Strategies to Overcome It. A Narrative Review

by Giulia Rita Agata Mangano, Marianna Avola, Chiara Blatti, Alessia Caldaci, Marco Sapienza, Rita Chiaramonte, Michele Vecchio, Vito Pavone and Gianluca Testa

J. Clin. Med. 2023, 12(1), 14; https://doi.org/10.3390/jcm12010014 - 20 Dec 2022

Cited by 9 | Viewed by 2506

Abstract

To evaluate the reasons for inadequate adherence to osteoporosis therapy and to describe the strategies for improving adherence to and persistence with regular medications, we conducted a review of the literature. The primary outcome of the study was the determination of the factors [...] Read more.

To evaluate the reasons for inadequate adherence to osteoporosis therapy and to describe the strategies for improving adherence to and persistence with regular medications, we conducted a review of the literature. The primary outcome of the study was the determination of the factors adverse to the onset and maintenance of anti-osteoporosis therapies. Secondly, we focused on studies whose efforts led to finding different strategies to improve adherence and persistence. We identified a total of 26 articles. The most recurrent and significant factors identified were aging, polypharmacy, and smoking habits. Different strategies to guide patients in their osteoporosis care have been identified, such as monitoring and follow-up via telephone calls, email, and promotional meetings, and proactive care interventions such as medication monitoring, post-fracture care programs, and decision aids. Changes in the drugs regimen and dispensation are strategies tried to lead to better adherence and persistence, but also improved satisfaction of patients undergoing anti-osteoporosis treatment. Patient involvement is an important factor to increase medication persistence while using a flexible drugs regimen. Full article

(This article belongs to the Special Issue Orthopedic Treatment of Diseases and Fractures in Elderly)

9 pages, 2522 KiB

Open AccessReview

Forearm Fracture Nonunion with and without Bone Loss: An Overview of Adult and Child Populations

by Sara Dimartino, Vito Pavone, Michela Carnazza, Enrica Rosalia Cuffaro, Francesco Sergi and Gianluca Testa

J. Clin. Med. 2022, 11(14), 4106; https://doi.org/10.3390/jcm11144106 - 15 Jul 2022

Cited by 2 | Viewed by 3436

Abstract

Nonunion occurs in 2–10% of all forearm fractures due to different mechanical and biological factors, patient characteristics, and surgeon-dependent causes. It is a condition that causes functional and psychosocial disability for the patient because it is a unique anatomical segment in which all [...] Read more.

Nonunion occurs in 2–10% of all forearm fractures due to different mechanical and biological factors, patient characteristics, and surgeon-dependent causes. It is a condition that causes functional and psychosocial disability for the patient because it is a unique anatomical segment in which all the bones and structures involved embody a complex functional unit; therefore, it is a challenge for the orthopedic surgeon. The ultimate goal of the care of these patients is the restoration of function and limitations related to impairment and disability. The aim of this review is to provide an extended description of nonunion forearm fractures, related risk factors, diagnosis, classification systems, and the available evidence for different types of treatment as a tool to better manage this pathology. Full article

(This article belongs to the Special Issue Orthopedic Treatment of Diseases and Fractures in Elderly)

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10 pages, 32762 KiB

Open AccessReview

Biological Approach in the Treatment of External Popliteal Sciatic Nerve (Epsn) Neurological Injury: Review

by Alejandro León-Andrino, David C. Noriega, Juan P. Lapuente, Daniel Pérez-Valdecantos, Alberto Caballero-García, Azael J. Herrero and Alfredo Córdova

J. Clin. Med. 2022, 11(10), 2804; https://doi.org/10.3390/jcm11102804 - 16 May 2022

Cited by 2 | Viewed by 9344

Abstract

The external popliteal sciatic nerve (EPSN) is the nerve of the lower extremity most frequently affected by compressive etiology. Its superficial and sinuous anatomical course is closely related to other rigid anatomical structures and has an important dynamic neural component. Therefore, this circumstance [...] Read more.

The external popliteal sciatic nerve (EPSN) is the nerve of the lower extremity most frequently affected by compressive etiology. Its superficial and sinuous anatomical course is closely related to other rigid anatomical structures and has an important dynamic neural component. Therefore, this circumstance means that this nerve is exposed to multiple causes of compressive etiology. Despite this fact, there are few publications with extensive case studies dealing with treatment. In this review, we propose to carry out a narrative review of the neuropathy of the EPSN, including an anatomical reminder, its clinical presentation and diagnosis, as well as its surgical and biological approach. The most novel aspect we propose is the review of the possible role of biological factors in the reversal of this situation. Full article

(This article belongs to the Special Issue Orthopedic Treatment of Diseases and Fractures in Elderly)

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Other

Jump to: Research, Review

14 pages, 479 KiB

Open AccessSystematic Review

Comparison between Vascular and Non-Vascular Bone Grafting in Scaphoid Nonunion: A Systematic Review

by Gianluca Testa, Ludovico Lucenti, Salvatore D’Amato, Marco Sorrentino, Pierluigi Cosentino, Andrea Vescio and Vito Pavone

J. Clin. Med. 2022, 11(12), 3402; https://doi.org/10.3390/jcm11123402 - 14 Jun 2022

Cited by 10 | Viewed by 3115

Abstract

Background: Scaphoid fractures correspond to 60% of all carpal fractures, with a risk of 10% to progress towards non-union. Furthermore, ~3% present avascular necrosis (AVN) of the proximal pole, which is one of the main complications related to the peculiar vascularization of the [...] Read more.

Background: Scaphoid fractures correspond to 60% of all carpal fractures, with a risk of 10% to progress towards non-union. Furthermore, ~3% present avascular necrosis (AVN) of the proximal pole, which is one of the main complications related to the peculiar vascularization of the bone. Scaphoid non-union can be treated with vascularized and non-vascularized bone grafting. The aim of the study is to evaluate the rates of consolidation of scaphoid non-union treated using two types of grafts. Methods: A systematic review of two electronic medical databases was carried out by two independent authors, using the following inclusion criteria: non-union of the proximal pole of the scaphoid bone, treated with vascular bone grafting (VBG) or non-vascular bone grafting (NVBG), with or without the use of internal fixation, patients aged ≥ 10 years old, and a minimum of 12 months follow-up. Research of any level of evidence that reports clinical results and regarding non-union scaphoid, either using vascularized or non-vascularized bone grafting, has been included. Results: A total of 271 articles were identified. At the end of the first screening, 104 eligible articles were selected for the whole reading of the text. Finally, after reading the text and the control of the reference list, we selected 26 articles following the criteria described above. Conclusions: The choice of the VBG depends mainly on the defect of the scaphoid and on the surgeon’s knowledge of the different techniques. Free vascular graft with medial femoral condyle (MFC) seems to be a promising alternative to local vascularized bone grafts in difficult cases. Full article

(This article belongs to the Special Issue Orthopedic Treatment of Diseases and Fractures in Elderly)

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