The increased number of amputations for arterial occlusive disease noted in western countries is only partly explained by increasing numbers of the elderly. A prospective analysis of the influence of diabetes and smoking habits was therefore carried out. In 1978-81, 188 lower limb amputees in Lund were examined and classified as non-smokers, ex-smokers, light smokers and heavy smokers. These figures were compared with corresponding figures among age-correlated controls and to a group of hip fracture patients. The material was divided into men and women and into non-diabetics and diabetics. Smokers had much lower mean age at amputation. Out of 188 amputees only 23 were not either a diabetic, a smoker or 80 years or more. The population study indicates a correlation between smoking and amputation for ichaemia. The coincident increase in cigarette consumption in Sweden is illustrated and it is suggested that smoking should be noted as routinely as diabetes at amputations.
To describe the analgesic use in hip fracture patients with dementia during the first two postoperative days as reported by nurses.
Nurses play a pivotal role in treating postoperative pain in patients with dementia and monitoring the effects of administered analgesics.
Cross-sectional descriptive questionnaire study in seven university hospitals and 10 central hospitals in Finland.
The study was conducted from March until May in 2011 in Finland. For this analysis, the focus was on the sample of nurses (n = 269) who were working in orthopaedic units. Analgesics were classified according to the Anatomical Therapeutic Chemical Classification System. Nonparametric tests were applied to find out the significant differences between analgesic use and different hospitals.
Paracetamol and strong opioids administered orally or parenterally seemed to be the most typical of postoperatively used types of analgesics in patients with dementia. Nonsteroidal anti-inflammatory analgesics and weak opioids were also commonly reported to be in use. There were no statistically significant differences between hospitals in typical daily doses. The majority of the nurses reported that the primary aim of postoperative pain management in hip fracture patients with dementia was 'slight pain, which does not prevent normal functioning' (72%).
The pharmacological postoperative pain treatment in acute care was commonly based on the use of strong opioids and paracetamol in hip fracture patients with dementia. The reported use of transdermal opioids and codeine combination warrants further examination. Further studies are also needed to find out whether the pain is appropriately and adequately treated.
Transdermal opioids and codeine combination may not be relevant analgesics for acute pain management in older adults. It is important to create a balance between sufficient pain relief and adverse effects of analgesics to allow early mobilisation and functional recovery.
Hip fractures require operation within 36-48 h, and they are most common in the elderly. A high International Normalized Ratio should be corrected before surgery. In the current study, we analyzed the budget impact of various warfarin reversal approaches.
Four reversal strategies were chosen for the budget impact analysis: the temporary withholding of warfarin, administration of vitamin K, fresh frozen plasma (FFP), and a four-factor prothrombin complex concentrate (PCC).
We estimated that, annually, 410 hip fracture patients potentially require warfarin reversal in Finland. The least costly treatment was vitamin K, which accounted for €289,000 in direct healthcare costs, and the most costly treatment option was warfarin cessation, which accounted for €1,157,000. In the budget impact analysis, vitamin K, PCC and FFP would be cost-saving to healthcare compared with the current treatment mix.
The various warfarin reversal strategies have different onset times, which may substantially impact the subsequent healthcare costs.
Cites: Arch Intern Med. 1999 Dec 13-27;159(22):2721-410597763
To study how surgical prophylactic antibiotics (SPAs) were utilized in the perioperative management of surgery for hip fractures.
Retrospective chart review of randomly selected medical records.
Twenty-two hospitals (teaching, nonteaching, community, and large urban referral centers) from across Canada.
Patients admitted in 1990 with a diagnosis of hip fracture.
Complete medical records of 438 patients were examined; 352 cases who underwent surgical repair of a fractured hip with insertion of prosthetic material were included in analysis. Perioperative SPA use was assessed by abstracting the agent(s) chosen, dosages, time given with respect to the incision, and duration of postoperative use. Fourteen patient and process-of-care variables related to SPA were examined.
247 (70%) of 352 cases did not receive a dose of SPA 2 hours preoperatively. Ten percent of preoperative SPA was administered either too early or during the procedure. In 91 (39%) of 231 cases receiving SPA, the first dose was not administered until the end of the procedure. Preoperative SPA consisted of a parenteral first-generation cephalosporin for 94% of cases. SPAs were continued more than 24 hours postoperatively in 78% of cases. Lack of a written order for SPA, being a nonteaching hospital, and shorter duration of surgical procedure were predictive of failure to receive SPA in an effective manner.
Most hip-fracture-surgery patients did not receive effective antibiotic prophylaxis as required to prevent serious wound infections. This important variable can be included for surveillance, so that corrective measures can be taken to assure effective prophylactic antibiotic administration.
An enquiry covering all hospitals in Sweden operating on hip fractures was conducted in 1990. The results were compared with enquiries from 1982 and 1985. In cervical hip fractures the use of single nail has almost disappeared in favor of 2 LIH hook pins and, lately, the Uppsala subchondral screws. Primary hip prosthesis is the ultimate method of choice in Sweden. Among trochanteric hip fracture the Ender nail has almost totally been replaced by a sliding screw and plate device.
BACKGROUND: A custom-made hip prosthesis is developed at St.Olav s Hospital and the Norwegian University of Science and Technology (NTNU) in Trondheim. The purpose was to design an uncemented stem for optimal fit of the proximal femur to achieve secure fixation and optimal strain distribution to the bone. A customized hip prosthesis permits reconstruction of the normal joint mechanism, including reconstruction of leg length, a physiological hip centre and a normal lever arm for the major hip muscles. 6 years of experience with the device at the orthopaedic department at Sørlandet Hospital, Arendal is presented. MATERIAL AND METHOD: 43 hips in 37 patients were operated. Median time of observation was 3 years (3 months-6 years). The patients' age was on average 49 years. 70% of the hips had hip dysplasia. The patients were followed prospectively, both clinically and radiologically for up to 6 years (median 3 years). RESULTS:The operations were performed as planned in all patients with an average operation time of 96 minutes. We have had no re-operations, no post-operative dislocations of the operated hips and no infections. No components have loosened and no patient has complained of thigh pain. One patient had a per-operative femoral fissure that was treated with cerclage, and one patient had an affection of nervus ischiadicus. The mean Harris hip score was 49 pre- and 97 post-operation . INTERPRETATION: Our experience with the Norwegian custom-made hip prosthesis is promising and confirms the good results from the Trondheim group.
The increasing incidence of hip fractures in our aging population challenges orthopedic surgeons and hospital administrators to effectively care for these patients. Many patients present to regional hospitals and are transferred to tertiary care centres for surgical management, resulting in long delays to surgery. Providing timely care may improve outcomes, as delay carries an increased risk of morbidity and mortality.
We retrospectively reviewed the cases of all patients with hip fractures treated in a single Level 1 trauma centre in Canada between 2005 and 2012. We compared quality indicators and outcomes between patients transferred from a peripheral hospital and those directly admitted to the trauma centre.
Of the 1191 patients retrospectively reviewed, 890 met our inclusion criteria: 175 who were transferred and 715 admitted directly to the trauma centre. Transfer patients' median delay from admission to operation was 93 hours, whereas nontransfer patients waited 44 hours (p
Cites: JAMA. 2004 Apr 14;291(14):1738-4315082701
Cites: J Trauma. 1995 Aug;39(2):261-57674394
Cites: J Bone Joint Surg Am. 1995 Oct;77(10):1551-67593064
Cites: J Bone Joint Surg Am. 2005 Mar;87(3):483-915741611
Cites: J Bone Joint Surg Br. 2005 Mar;87(3):361-615773647
Cites: Rheum Dis Clin North Am. 2006 Nov;32(4):617-2917288968
We assessed compliance with new guidelines for prophylactic antibiotics in hip fracture surgery in Norway introduced in 2013.
The data from the Norwegian Hip Fracture Register was used to assess the proportion of antibiotics given according to the national guidelines.
All hospitals in Norway performing hip fracture surgery in the period from 2011 to 2016.
We studied 13 329 hemiarthroplasties (HAs) for acute hip fracture.
Type and timing between first and last dose of prophylactic antibiotics compared with the national guidelines.
Before the guidelines were introduced, the recommended drugs cephalotin or clindamycin was used in only 86.2% of all HAs. In 2016, one of the two recommended drugs was administered in 99.2% of HAs. However, hospitals' adaption of the recommended administration of the two drugs improved slowly, and by the end of the study period, only three out of five HAs were performed with the correct drug administered in the correct manner. We found major differences in compliance between hospitals.
The change towards correct administration of antibiotic prophylaxis was varied both when investigating university and non-university hospitals. We suggest that both hospital leaders and the national Directorate of Health need to investigate routines for better dissemination of information and education to involved parties. Strong leadership concerning evidence-based guidelines on antibiotic prophylaxis in surgery may take away some autonomy from executing healthcare professionals, but will result in better patient care and antibiotic stewardship.