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Latest & greatest articles for hip fracture
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Nerve Blocks for Management of Pain Following HipFracture Nerve Blocks for Management of Pain Following HipFracture | Emergency Medicine | Washington University in St. Louis Open Menu Back Close Menu Search for: Loading... Welcome Our Team Sections Education Alumni Research ECRC Journal Club Events Jermyn Lectures Open Search Vignette You’re moonlighting in an austere emergency department, and the night has been relatively benign except for your poor 79-year-old severely demented patient who (...) a sign of relief. But what nerve block? And will it work? You nod smartly in agreement and excuse yourself to the bathroom to check out some online resources… PICO Question Population: Elderly patients with acute hipfracture in the emergency department Intervention: Regional nerve block with any local anesthetic for analgesia (femoral nerve block, 3-in-1 nerve block, or fascia iliaca block) Comparison: Standard pain management strategy without regional nerve block Outcome: Pain scores during ED
Total Hip Arthroplasty or Hemiarthroplasty for HipFracture. Globally, hipfractures are among the top 10 causes of disability in adults. For displaced femoral neck fractures, there remains uncertainty regarding the effect of a total hip arthroplasty as compared with hemiarthroplasty.We randomly assigned 1495 patients who were 50 years of age or older and had a displaced femoral neck fracture to undergo either total hip arthroplasty or hemiarthroplasty. All enrolled patients had been able (...) to ambulate without the assistance of another person before the fracture occurred. The trial was conducted in 80 centers in 10 countries. The primary end point was a secondary hip procedure within 24 months of follow-up. Secondary end points included death, serious adverse events, hip-related complications, health-related quality of life, function, and overall health end points.The primary end point occurred in 57 of 718 patients (7.9%) who were randomly assigned to total hip arthroplasty and 60 of 723
Effect of a Multicomponent Home-Based Physical Therapy Intervention on Ambulation After HipFracture in Older Adults: The CAP Randomized Clinical Trial. Disability persists after hipfracture in older persons. Current rehabilitation may not be sufficient to restore ability to walk in the community.To compare a multicomponent home-based physical therapy intervention (training) with an active control on ability to walk in the community.Parallel, 2-group randomized clinical trial conducted at 3 US (...) clinical centers (Arcadia University, University of Connecticut Health Center, and University of Maryland, Baltimore). Randomization began on September 16, 2013, and ended on June 20, 2017; follow-up ended on October 17, 2017. Patients aged 60 years and older were enrolled after nonpathologic, minimal trauma hipfracture, if they were living in the community and walking without human assistance before the fracture, were assessed within 26 weeks of hospitalization, and were not able to walk during daily
Should we provide outreach rehabilitation to very old people living in Nursing Care Facilities after a hipfracture? A randomised controlled trial to determine whether a 4-week postoperative rehabilitation program delivered in Nursing Care Facilities (NCFs) would improve quality of life and mobility compared with receiving usual care.parallel randomised controlled trial with integrated health economic study.NCFs, in Adelaide South Australia.people aged 70 years and older who were recovering (...) from hipfracture surgery and were walking prior to hip fracture.primary outcomes: mobility (Nursing Home Life-Space Diameter (NHLSD)) and quality of life (DEMQOL) at 4 weeks and 12 months.participants were randomised to treatment (n = 121) or control (n = 119) groups. At 4 weeks, the treatment group had better mobility (NHLSD mean difference -1.9; 95% CI: -3.3, -0.57; P = 0.0055) and were more likely to be alive (log rank test P = 0.048) but there were no differences in quality of life. At 12
Effectiveness of Supervised Home-Based Exercise Therapy Compared to a Control Intervention on Functions, Activities, and Participation in Older Patients After HipFracture: A Systematic Review and Meta-analysis The aim of this review was to investigate whether supervised home-based exercise therapy after hospitalization is more effective on improving functions, activities, and participation in older patients after hipfracture than a control intervention (including usual care). Furthermore, we (...) (instrumental) ADL and short-term effects on balance, endurance, and mobility. Conflicting evidence was found for strength, long-term balance, short-term gait (comfortable), long-term self-reported ADL, and long-term mobility.Research findings show no evidence in favor of home-based exercise therapy after hipfracture for most outcomes of functions, activities, and participation. However, trials in this field have low therapeutic validity (absence of rationale for content and intensity and reporting
Pre-operative administration of tranexamic acid in hipfracture surgery Rapid Literature Review 1 Pre-operative administration of tranexamic acid in hipfracture surgery Citation Yap G. & Melder A. 2018. Pre-operative administration of tranexamic acid in hipfracture surgery: Rapid Literature Review. Centre for Clinical Effectiveness, Monash Health, Melbourne, Australia. Email: CCE@monashhealth.org Background The use of Tranexamic acid (TXA) as an antifibrinolytic agent is established (...) in reducing peri- and postoperative blood loss in surgery  . As the fibrinolytic system is activated after the injury and continues to increase during surgery, blood loss in interchochanteric fractures is substantially greater than that in elective total hip arthroplasties. Therefore, it is important to evaluate the safety and effectiveness of TXA in hipfractures  . The CCE was requested to undertake a review of the evidence around the safety and efficacy of pre-operative administration
Chemical thromboprophylaxis after hipfracture surgery Rapid Review 1 Chemical thromboprophylaxis after hipfracture surgery Citation Yap G., Joseph C. & Melder A. 2018. Chemical thromboprophylaxis after hipfracture surgery: Rapid Literature Review. Centre for Clinical Effectiveness, Monash Health, Melbourne, Australia. Contact email@example.com Background Few studies are available in the literature reporting on the prevention of venous thromboembolism in patients with a hipfracture (...) compared to those with hip arthroplasty  . The Director of Orthopaedic Surgery requested a review of the evidence around the most suitable chemical thromboprophylaxis for patients who have undergone hip surgery. Objectives To determine the recommended chemical thromboprophylaxis (choice, dose and duration) for patients after hipfracture surgery in the prevention of venous thromboembolism (VTE); and improvement outcomes related to deep vein thrombosis (DVT), pulmonary embolism (PE), bleeding
Predischarge home visits after hipfracture: a randomized controlled trial The objective of this study is to investigate whether home assessment visits prior to hospital discharge for patients recovering from hipfracture reduce falls and prevent hospital readmissions, within the first 30 days and six months after discharge home.A randomized controlled trial was conducted.The study setting included hospital wards and the community.The study included adults 50 years and over recovering from hip (...) independence at six months (11.2 units, 95% CI 4.2 to 18.2). There were no other between-group differences.Home assessment visits by occupational therapists prior to hospital discharge for patients recovering from hipfracture reduced the number of readmissions to hospital, increased functional independence at six months and may have reduced the risk of falls in the first 30 days after discharge.
Local nerve blocks can improve outcomes for people with hipfracture Local nerve blocks can improve outcomes for people with hipfracture Discover Portal Discover Portal Local nerve blocks can improve outcomes for people with hipfracture Published on 26 September 2017 doi: Local nerve blocks around the time of hipfracture surgery reduced pain on movement within 30 minutes of injection. People had less need for opioid pain-relief and were quicker to mobilise after surgery. Also, one case (...) of pneumonia was prevented for every seven people given pain relief using a nerve block. By injecting local anaesthetics close to the nerves to relieve pain after a hipfracture, it is hoped that the need for opioids can be reduced and people might recover more quickly. Nerve blocks are not standard in UK hospitals for this. This updated Cochrane review identified 31 trials providing moderate to high-quality evidence. The benefits were small but could make a meaningful difference to the patient’s
Specialist hipfracture services linked to fewer deaths in South Central region Specialist hipfracture services linked to fewer deaths in South Central region Discover Portal Discover Portal Specialist hipfracture services linked to fewer deaths in South Central region Published on 31 January 2017 doi: Following a hipfracture, nurse-led fracture liaison services or specialist consultant (orthogeriatrician) input both reduce deaths. They did not reduce the small number of people having (...) a second hipfracture within two years of the first. Both models of care were cost effective, although the orthogeriatric model was favoured. Despite national guidance recommending both use of a fracture liaison service and orthogeriatric model of care, variation exists and some hospitals have neither. This NIHR-funded study analysed linked patient records in a time series analysis conducted in the South Central region of England. It looked at the impact over time of each model. It included people over
Comprehensive assessment may reduce risk of delirium after hipfracture Comprehensive assessment may reduce risk of delirium after hipfracture Discover Portal Discover Portal Comprehensive assessment may reduce risk of delirium after hipfracture Published on 29 August 2017 doi: Comprehensive geriatric assessment reduced the risk of delirium by 20% in patients having hipfracture surgery. Forty-three percent developed delirium on average compared with 53% who didn’t receive these assessments (...) . The assessment of the older persons’ medical condition was typically undertaken by a team of healthcare professionals who assessed functional ability, living circumstances and risk factors in order to develop a tailored plan for prevention and treatment of delirium after surgery. This review identified four trials in people having surgery for hipfracture. Two assessed teams where geriatricians visited patients on orthopaedic wards. The other trials reported ward assessments where patients were already being
Development and Validation of a Simple HipFracture Risk Prediction Tool for Type 2 Diabetes: The Fremantle Diabetes Study Phase I To develop a type 2 diabetes hipfracture risk tool in community-based patients, to validate it in an independent cohort, and to compare its performance against the only published prediction equation to include type 2 diabetes as a risk factor (QFracture).Hipfracture hospitalizations in 1,251 participants with type 2 diabetes aged 40-89 years from the longitudinal (...) Fremantle Diabetes Study Phase I (FDS1) were ascertained between entry (1993-1996) and end-2012. Competing risk regression modeling determined independent predictors of time to first fracture over 10 years and the coefficients incorporated in a risk model. The model was validated in 286 participants with type 2 diabetes from the Busselton Health Study (BHS).Fifty FDS1 participants (4.0%) experienced a first hipfracture during 10,306 person-years of follow-up. Independent predictors of fracture were
Central Nervous System Medication Burden and Risk of Recurrent Serious Falls and HipFractures in Veterans Affairs Nursing Home Residents To examine the association between central nervous system (CNS) medication dosage burden and risk of serious falls, including hipfractures, in individuals with a history of a recent fall.Nested case-control study.Veterans Health Administration (VHA) Community Living Centers (CLCs).CLC residents aged 65 and older with a history of a fall or hipfracture (...) , and the outcome of recurrent serious falls.More cases (44.3%) than controls (35.8%) received 3.0 or more CNS SDDs (p = .02). Risk of serious falls was greater in residents with 3.0 or more SDDs than in those with 0 (adjusted odds ratio (aOR)=1.49, 95% confidence interval (CI)=1.03-2.14). Those with 1.0 to 2.9 SDDs had a risk similar to that of those with 0 SDDs (aOR=1.03, 95%CI=0.72-1.48).Nursing home residents with a history of a fall or hipfracture receiving 3.0 or more CNS SDDs were more likely to have
How Effective Is a Regional Nerve Block for Treating Pain Associated With HipFractures? TAKE-HOME MESSAGE Regional nerve blockade reduces pain on movement, risk of pneumonia, and time to ?rst mobilization among patients with hipfractures with no major complications. How Effective Is a Regional Nerve Block for Treating Pain Associated With HipFractures? EBEM Commentators Michael Gottlieb, MD, RDMS Nicholas Chien, MD Thomas Seagraves, MD Department of Emergency Medicine Rush University Medical (...) independently assessed potentially eligible randomized controlled trials for inclusion. Disagreements were resolved by discussion between the 2 reviewers. DATA EXTRACTION AND SYNTHESIS Two authors independently extracted data and resolved PAIN MANAGEMENT AND SEDATION/SYSTEMATIC REVIEW SNAPSHOT 378 Annals of Emergency Medicine Volume 71, no. 3 : March 2018at overall low or moderate risk of bias. Commentary Hipfractures are a common emer- gency department (ED) presenta- tion,withmorethan300,000visits
Moving Beyond HipFracture Risk Assessment for Patients on Dialysis 30450449 2018 12 07 2468-0249 3 6 2018 Nov Kidney international reports Kidney Int Rep Moving Beyond HipFracture Risk Assessment for Patients on Dialysis. 1253-1254 10.1016/j.ekir.2018.09.004 Nikkel Lucas E LE Penn State College of Medicine, Penn State Bone and Joint Institute, Hershey, Pennsylvania, USA. eng Editorial 2018 09 14 United States Kidney Int Rep 101684752 2468-0249 2018 11 20 6 0 2018 11 20 6 0 2018 11 20 6 1
Effect of Depth of Sedation in Older Patients Undergoing HipFracture Repair on Postoperative Delirium: The STRIDE Randomized Clinical Trial Postoperative delirium is the most common complication following major surgery in older patients. Intraoperative sedation levels are a possible modifiable risk factor for postoperative delirium.To determine whether limiting sedation levels during spinal anesthesia reduces incident delirium overall.This double-blind randomized clinical trial (A Strategy (...) to Reduce the Incidence of Postoperative Delirum in Elderly Patients [STRIDE]) was conducted from November 18, 2011, to May 19, 2016, at a single academic medical center and included a consecutive sample of older patients (≥65 years) who were undergoing nonelective hipfracture repair with spinal anesthesia and propofol sedation. Patients were excluded for preoperative delirium or severe dementia. Of 538 hipfractures screened, 225 patients (41.8%) were eligible, 10 (1.9%) declined participation, 15
Effects of geriatric interdisciplinary home rehabilitation on complications and readmissions after hipfracture: a randomized controlled trial This pre-planned secondary analysis of geriatric interdisciplinary home rehabilitation, which was initially found to shorten the postoperative length of stay in hospital for older individuals following hipfracture, investigated whether such rehabilitation reduced the numbers of complications, readmissions, and total days spent in hospital after (...) discharge during a 12-month follow-up period compared with conventional geriatric care and rehabilitation.Randomized controlled trial.Geriatric department, participants' residential care facilities, and ordinary housing.Individuals aged ⩾70 years with acute hipfracture ( n = 205) were included.Geriatric interdisciplinary home rehabilitation was individually designed and aimed at early discharge with the intention to prevent, detect, and treat complications after discharge.Complications, readmissions
Mortality effects of timing alternatives for hipfracture surgery The appropriate timing of hipfracture surgery remains a matter of debate. We sought to estimate the effect of changes in timing policy and the proportion of deaths attributable to surgical delay.We obtained discharge abstracts from the Canadian Institute for Health Information for hipfracture surgery in Canada (excluding Quebec) between 2004 and 2012. We estimated the expected population-average risks of inpatient death within (...) 30 days if patients were surgically treated on day of admission, inpatient day 2, day 3 or after day 3. We weighted observations with the inverse propensity score of surgical timing according to confounders selected from a causal diagram.Of 139 119 medically stable patients with hipfracture who were aged 65 years or older, 32 120 (23.1%) underwent surgery on admission day, 60 505 (43.5%) on inpatient day 2, 29 236 (21.0%) on day 3 and 17 258 (12.4%) after day 3. Cumulative 30-day in-hospital