Hip Fractures

It is estimated that Iran accounted for about 1% of hip fracture burden of the world in 2007, but these data are based on incomplete evidence. As the country's population is ageing, it is expected that a dramatic rise in hip fracture incidence will result. There is no single national study that accurately estimates the incidence of all hip fractures in the country or identifies the direct costs for affected patients. To help fill this gap, the current study has been designed to determine the incidence of hip fracture associated with osteoporosis in the Iranian population and to assess the direct costs involved. This is a cross-sectional analysis of 2 years of hospital admissions due to hip fracture in Iran from October 2014 to October 2016 using an electronic health record called SEPAS. SEPAS is a nationwide health information system established by Information Technology (IT) and the Statistics Department of the Ministry of Health. SEPAS has recorded more than 8.5 million inpati...

First published, in a slightly edited form without references, as Diesendorf M. A kick in the teeth for scientific debate. Australasian Science 2003;24:35-7, and reprinted here with the kind permission of the editor of Australasian Science. ©Control Publications 2003. http://www.control.com.au

Background: Hip fractures in older patients are associated with impaired mobility, excess morbidity and mortality, and loss of independence. Objectives: To determine whether total hip arthroplasty is associated with lower reoperation rates, mortality, and complications, and better function and quality of life than hemiarthroplasty for displaced fractures of the femoral neck in older patients. Materials and methods: We prospectively as well as retrospectively studied 46 patients treated with total hip replacement or hemiarthroplasty. Pain, range of motion, hip function, haris hip score and complications were assessed clinically while hip stability, femoral anteversion, acetabular cup inclination and acetabular erosions were assessed radiographically. Results: In our study according to Harris hip score, group A (hemiarthroplasty group) showed 58.33% excellent to good result whereas 33.34% shows fair to poor result. In group B (total hip replacement group) 90.91% showed excellent to go...

Aims/hypothesis Current drug labels for thiazolidinediones (TZDs) warn of increased fractures, predominantly for distal fractures in women. We examined whether exposure to TZDs affects hip fracture in women and men and compared the risk to that found with other drugs used in diabetes. Methods Using a nationwide database of prescriptions, hospital admissions and deaths in those with type 2 diabetes in Scotland we calculated TZD exposure among 206,672 individuals. Discrete-time failure analysis was used to model the effect of cumulative drug exposure on hip fracture during 1999-2008. Results There were 176 hip fractures among 37,479 exposed individuals. Hip fracture risk increased with cumulative exposure to TZD: OR per year of exposure 1.18 (95% CI 1.09, 1.28; p03×10 -5 ), adjusted for age, sex and calendar month. Hip fracture increased with cumulative exposure in both men (OR 1.20; 95% CI 1.03, 1.41) and women (OR 1.18; 95% CI 1.07, 1.29) and risks were similar for pioglitazone (OR 1.18) and rosiglitazone (OR 1.16). The

Introduction Traumatic hip dislocations (THD) often result from high-energy trauma and are frequently associated with fractures of the femoral head, shaft, or acetabulum. Effective management, including timely hip relocation, is essential for favorable outcomes. However, limited literature exists on the functional outcomes of THD, especially in resource-limited settings like Nepal. This study aimed to evaluate the functional outcomes of patients with complex THDs treated at a tertiary care centre in Nepal. Methods This descriptive observational study included 80 patients with complex THDs treated between October 2012 and July 2023. Eligible patients had follow-ups ranging from 6 months to over five years. Data on patient demographics, injury characteristics, treatment details, and functional outcomes were collected. The Harris Hip Score (HHS) was used to assess functional outcomes, with scores categorized as "good" (≥ 80) or "poor" (< 80). Statistical analysis used logistic regression to identify factors associated with better functional outcomes. Results In this study of 80 patients with traumatic hip dislocations (THD), the majority were male (82.5%) and aged under 40 years (53.8%), with road traffic accidents being the predominant cause (73.8%). Most injuries involved posterior dislocations (87.5%), and 76.3% had associated acetabular fractures. Good functional outcomes, defined as a Harris Hip Score (HHS) ≥ 80, were achieved in 83.8% of cases, while 16.3% had poor outcomes. Logistic regression analysis revealed several significant factors associated with better outcomes: a hospital stays of less than three weeks (OR 4.67, 95% CI 1.08-20.21, p = 0.04), anterior dislocation (OR 12.17, 95% CI 1.12-131.70, p = 0.04), and follow-up duration of less than five years (OR 0.07, 95% CI 0.01-0.43, p = 0.00). However, acetabular fractures had a significantly lower likelihood of good outcomes (OR 0.28, 95% CI 0.08-0.96, p = 0.04). Conclusion Timely management of traumatic hip dislocations, such as early discharge and treatment of associated fractures, is vital for achieving favorable functional outcomes, as reflected in the Harris Hip Score. These findings offer valuable insights for optimizing care in resource-limited settings and highlight the necessity for long-term follow-up, especially for patients with more complex injuries.

Hip fractures are a significant cause of mortality and morbidity in the elderly. This study investigated the relationship between initial haemoglobin (Hb) levels and a prognostic parameter for outcome in those patients. A total of 3595 consecutive patients with diagnosed hip fractures were included in our study (72.2% females). Anaemia was defined according to WHO criteria, with according subgroups mild, moderate and severe anaemia. Data collection was performed prospectively and statistical evaluation was performed retrospectively. Mean follow up in our study group was 11.2±0.3 months. The mean age of our study group was 78.5 years (SEM±0.2 years). To facilitate analysis, patients were divided in two groups: ≤84 years (60.1%) and ≥85 years (39.9%). Mortality &lt;12 months was 12.2% (n=439). In our study population lower Hb levels ad admission were associated with a markedly elevated short-term mortality. In a multivariate logistic regression model adjusted for age and sex, mild ana...

We describe the implementation of a care pathway for patients with fractured neck of femur (NOF) using Lean and Six Sigma principles. After introduction of the Lean pathway, 32 patients out a total of 86 (37%) with fractured NOF were admitted to the Trauma Ward within 4 hours presentation to the hospital; prior to implementation this was 16 patients out of a total of 59 (27%). Post-Lean an earlier mean theatre start time of 8.40am was achieved, resulting in a 38 minute increase in daily theatre time. An additional 52 patients (12%) received surgery within 24 hours of admission, resulting in 1 night length of stay reduction. Lean methodology proved an effective method to guide change resulting in an improved journey for the patient and significant workflow gains.

The femur forms the skeleton of the thigh and its proximal segment is a component of the hip joint which is the largest mobile synovial joint of the human body. Although, the hip joint has a very remarkable stability, it may become dislocated with accompanying fracture of the femoral head and neck sequel to considerable trauma. Definitive management of intracapsular fracture neck of the femur in the elderly is surgical operation at which the fractured proximal end of the femur is replaced with an inert metallic implant. Methodology: This study set to establish the length of the femur, diameter of the femur head and the relationship between these two parameters in Nigerians (Black Africans) using direct bone measurement technique.

Hip fracture is a common trauma in older adults with a high incidence of depression, which relates to poorer prognosis including increased risk of infection. Ageing is accompanied by reduced immunity, termed immunesenescence, resulting in increased susceptibility to infection. We examined whether physical trauma (hip fracture) and psychological distress (depressive symptoms) had additive effects upon the aged immune system that might contribute to poor outcomes after injury. Neutrophil function was assessed in 101 hip fracture patients (81 female) 6 weeks and 6 months after injury and 43 healthy age-matched controls (28 female). Thirty eight fracture patients had depressive symptoms at 6 weeks. No difference in neutrophil phagocytosis of Escherichia coli was observed between controls and hip fracture patients, but superoxide production was significantly reduced in hip fracture patients with depressive symptoms compared with patients without symptoms (p = .001) or controls (p = .004) at 6 weeks. Superoxide production improved 6 months following fracture to the level seen in controls. We detected elevated serum cortisol, reduced dehydroepiandrosterone sulphate (DHEAS) and an increased cortisol:DHEAS ratio in fracture patients with depressive symptoms compared with patients without depressive symptoms or controls at 6 weeks and 6 months after injury. Serum IL6, TNFa and IL10 were higher among patients with depressive symptoms at 6 weeks. The cortisol:DHEAS ratio and IL6 levels related to depressive symptom scores but not to neutrophil function. In conclusion, depressive symptoms related to poorer neutrophil function after hip fracture, but this was not driven by changes in stress hormone or cytokine levels.

The aim of our study was to determine the rate and preoperative predictors of intraoperative fracture (IOF) during hip hemiarthroplasty (HA) in patients who have sustained a fragility hip fracture injury. We reviewed 626 patients who underwent HA at our institution using the National Hip Fracture Database. Various patient- and surgery-related data including demographic information, cement usage, surgeon grade, time to surgery, and operative duration were collected. The metaphyseal diaphyseal index and modified canal bone ratio were measured on preoperative radiographs. We compared patients with and without IOF with respect to all variables collected. Multivariate regression modeling was used to identify significant preoperative risk factors for IOF. There was a 7% incidence of IOF in our cohort exclusively comprising of Vancouver A fractures. The majority of these complications were treated nonoperatively (52%). There was no statistically significant difference with respect to cemen...

Moringa oliefera is recognised for its health-promoting nutrients and phenolic compounds, which contribute to its substantial medical value. Previous research have shown that Moringa oleifera consumption has a hypoglycemic effect, improving glucose and HbA1c levels in both preclinical and clinical settings. Previous findings recommended using Moringa oleifera as an osteoprotective agent, notably in in vivo trials. Further research is needed to isolate bioactive components in Moringa extract and investigate their potential as antidiabetic and antiosteoprotective medicines. A thorough search was undertaken in Medline and PubMed for relevant studies published between inception and 2023. This was performed by reviewing abstracts and full articles containing keywords such as Moringa oliefera, diabetes, antidiabetes, osteoporosis, osteoprotective, and osteoinductive.

Purpose: There is currently no gold standard treatment for unstable intertrochanteric fractures of the elderly. Internal fixation and hemiarthroplasty are two common treatment methods but studies comparing the functional outcomes of these procedures in the elderly are limited. This study evaluates the functional outcomes of hip fracture patients treated either with internal fixation or hemiarthroplasty. Methods: Eighty-six elderly (&gt;60 years) patients who presented with isolated, unstable intertrochanteric fractures between 2009 and 2013 were included in the study. According to the classification of Association for Osteosynthesis/Orthopaedic Trauma Association; 12 of the patients had a 31A1.3 fracture type, 36 of the patients had 31A2.2 and 19 had 31A2.3 fracture type, 12 had 31A3.1 and seven had 31A3.3 fracture. Forty-two of 86 hip patients (Group 1) were treated with intramedullary nailing and antirotator proximal femoral nail implant (TST, Turkey), and 44 (Group 2) were treate...

Objectives: Nicotine usage is known to increase postoperative
complications; however, studies show that the general population believes
that non-tobacco nicotine delivery devices are a safer option compared
to tobacco-based nicotine products. This study evaluates postoperative
complications between non-tobacco nicotine dependent and non-nicotine
dependent patients for intramedullary nailing in intertrochanteric femur
fractures.
Methods: Utilizing the TriNetX database, we retrospectively examined
postoperative outcomes in patients aged 18 to 90 who underwent
intramedullary nailing for intertrochanteric femur fractures between
November 21, 2013, and November 21, 2023. Two cohorts were analyzed:
Cohort A comprised nicotine-dependent patients without tobacco product
usage (e.g. cigarettes or chewing tobacco) and Cohort B consisted of patients
without any nicotine dependence. Propensity matching was performed
for BMI, type 2 diabetes, alcohol/substance abuse, socioeconomic status,
and demographic factors. Outcomes assessed included mortality, sepsis,
pneumonia, revision, dehiscence, pulmonary embolism, nonunion, and
deep vein thrombosis within 1 day to 6 months post-treatment.
Results: A total of 2,041 non-tobacco nicotine dependent patients were
matched with 22,872 non-nicotine dependent patients. Non-tobacco
nicotine dependent patients experienced higher associated risk for numerous
postoperative complications compared to non-nicotine dependent patients
including increased risk for mortality within 6 months postoperatively
(RR 1.386, 10.7% vs 7.7%, P = 0.001), sepsis (RR 1.459, 4.4% vs 3.0%,
P = 0.027), and pneumonia (RR 1.751, 5.8% vs 3.3%, P = 0.001).
Conclusions: Non-tobacco nicotine dependence increases postoperative
complications for patients undergoing intramedullary nailing for
intertrochanteric femur fractures. Our findings support the need for
development of perioperative nicotine cessation guidelines for nontobacco nicotine users.
Level of evidence: Level III, Prognostic

We designed an algorithmic model based on the logistic regression analysis and a non-algorithmic model based on the Artificial Neural Network (ANN). The ability of these models was compared together in clinical application to differentiate malignant from benign breast tumors in a study group of 161 patients' records. Each patient's record consisted of 6 subjective features extracted from MRI appearance. These findings were encoded as features for an ANN as well as a logistic regression model (LRM) to predict biopsy outcome. After both models had been trained perfectly on samples (n=100), the validation samples (n=61) were presented to the trained network as well as the established LRMs. Finally, the diagnostic performance of models were compared to that of the radiologist in terms of sensitivity, specificity and accuracy, using receiver operating characteristic curve (ROC) analysis. The average output of the ANN yielded a perfect sensitivity (98%) and high accuracy (90%) similar to that one of an expert radiologist (96% and 92%) while specificity was smaller than that (67% verses 80%). The output of the LRM using significant features showed improvement in specificity from 60% for the LRM using all features to 93% for the reduced logistic regression model, keeping the accuracy around 90%. Results show that ANN and LRM prove the relationship between extracted morphological features and biopsy results. Using statistically significant variables reduced LRM outperformed of ANN with remarkable specificity while keeping high sensitivity is achieved.

La migration de matériel d'ostéosynthèse est une complication bien connue du traitement chirurgical des fractures. Toutefois, la migration pelvienne de broche guide dans la chirurgie des fractures de la hanche est un incident rare et potentiellement grave. Nous rapportons 3 observations dans lesquelles on notait une migration de broche guide dans le pelvis lors d'une ostéosynthèse dela hanche de type DHS. L'indication chirurgicale était une fracture per-trochantérienne dans 2 cas et une fracture du col fémoral type 4 de Garden dans 1 cas.Une minilaparotomie permettait d'objectiver une plaie du ligament large gauche et un hématome ligamentaire dans 1 cas, tandis que dans les 2 autres cas, il n'y avait pas de lésion viscérale. L'extraction de la broche a été effectuée dans les 3 cas. Les suites opératoires ont été simples chez tous les patients.

Twenty four cases of fracture of the proximal femoral shaft treated with dynamic hip screw fixation are included. All had severe comminution with subtrochanteric extensions. Dynamic hip screw provided stable osteosynthesis and helped to achieve bone union within 18 weeks in 19 of 21 followed-up cases. The anatomical configuration of the femur was maintained with minimal limb length discrepancy in one case and knee flexion of more than 110 degrees in all. Weight bearing was achieved after a mean period of 7.5 weeks post-fixation. Complications of treatment are also presented. Different implants are used to treat this injury with variable results. Dynamic hip screw system is a satisfactory implant for internal fixation in patients with these difficult fractures.

The IA-64 architecture is designed with a unique combination of rich features so that it overcomes the limitations of traditional architectures and provides performance scalability for the future. The IA-64 features expose new opportunities for the compiler to optimize applications. We have incorporated into the Intel IA-64 compiler the key technology necessary to exploit these new optimization opportunities and to

OBJECTIVES: To evaluate the effect of emergency department (ED) crowding on assessment and treatment of pain in older adults.DESIGN: Retrospective review of ED records from a prospective cohort study.SETTING: Urban, academically affiliated, tertiary medical center.PARTICIPANTS: One hundred fifty‐eight patients, aged 50 and older, evaluated and hospitalized from the ED with hip fracture.MEASUREMENTS: Patient‐related risk factors: age, sex, nursing home residence, ED triage status, dementia, Acute Physiology in Age and Chronic Health Evaluation II physiological score, and RAND comorbidity score. ED crowding risk factors: ED census and mean length of stay. Outcomes: documentation of pain assessment, time to pain assessment, time to pain treatment, patients reporting pain receiving analgesia, and meperidine use.RESULTS: Mean age was 83 (range 52–101), 81.0% of patients complained of pain, mean time to pain assessment was 40 minutes (range 0–600), time to treatment was 141 minutes (range...

density measured at various skeletal sites, but bone density is not a completely reliable guide to fracture risk ( ), and we are unaware of any previous investigation of infertility and fractures. We explored the risk of hip fracture in a retrospective cohort study among Olmsted County, Minnesota, women with different menstrual patterns who had been evaluated for infertility at the Mayo Clinic (Rochester, Minnesota) between 1935 and 1964.

Community-based rehabilitative exercise programs might be an effective means to improve functional outcomes for hip-fracture patients. The purpose of this study was to evaluate the effectiveness of a community exercise program (CEP) for older adults recovering from hip fracture. Twenty-five older adults (mean age 80.0 ± 6.0 years; 24 women; 71 ± 23 days post–hip fracture) participated in this pilot study (17 exercise, 8 control). The CEP involved functional stepping and lower extremity–strengthening exercises. Control participants received only standard outpatient therapy. Measures of functional mobility, balance confidence, falls efficacy, lower extremity strength, and daily physical activity were evaluated at baseline and at 16 weeks. Improvements for self-reported physical activity, mobility, balance, and knee-extensor strength were observed for the CEP group. This study demonstrated that a CEP is beneficial for community-dwelling older adults post–hip fracture.

This research focuses on the hierarchical structure of bone and associated mechanical properties at different scales to assess damage accumulation leading to premature failure, with or without instrumentation. In this work, an attempt was made to develop a framework of macro, micro, and nano damage accumulation models and implementing them to derive mechanical behavior of the bone. At macrolevel, retrospective evaluation of 313 subjects was conducted, and the damage of bone tissue was investigated with respect to subject demography including age, gender, race, body mass index (BMI), height and weight, and their role in initiating fracture. Experimental data utilized 28 human femoral bones implanted with cephalomedullary nails were used to develop damage prediction models. Investigation of three real life medical device failures identified the mechanical and clinical bases of bone failure. At the micro level, microdamage accumulation of the bone was investigated in 307 subjects and new effective morphological parameters at microscale were proposed. At the nano level, molecular dynamics simulation was performed to investigate the effect of interaction, orientation, and hydration on the atomic models of the bone composed of collagen helix and hydroxyapatite crystal. The results showed that bone density and maximum von Mises stress decreased 334 c 69 Male 175

Background The UK hip fracture best practice tariff (BPT) aims to deliver hip fracture surgery within 36 h of admission. Ensuring that delays are reserved for conditions which compromise survival, but are responsive to medical optimisation, would help to achieve this target. We aimed to identify medical risk factors of surgical delay, and assess their impact on mortality. Materials and methods Prospectively collected patient data was obtained from the National Hip Fracture Database (NHFD). Medical determinants of surgical delay were identified and analysed using a multivariate regression analysis. The mortality risk associated with each factor contributing to surgical delay was then calculated. Results A total 1361 patients underwent hip fracture surgery, of which 537 patients (39.5 %) received surgery within 36 h of admission. Following multivariate analyses, only hyponatraemia was deduced to be a significant risk factor for delay RR = 1.24 (95 % CI 1.06-1.44). However, following a validated propensity score matching process, a Pearson chi-square test failed to demonstrate a statistical difference in mortality incidence between the hypoand normonatraemic patients [v 2 (1, N = 512) = 0.10, p = 0.757]. Conclusions Hip fracture surgery should not be delayed in the presence of non-severe and isolated hyponatraemia. Instead, surgical delay may only be warranted in the presence of medical conditions which contribute to mortality and are optimisable. Level of evidence III Keywords Hip fractures Á Time to treatment Á 36 h & Adeel Aqil

Purpose The aim of this study was to examine causes and potential risk factors for 30-day mortality after hip fracture surgery (HFS) at a high-volume tertiary-care hospital. Methods We retrospectively reviewed 467 patients who underwent HFS at our institution. Multivariate analysis was undertaken to identify potential predictors of early mortality. The 30-day mortality rate was 7.5 % (35/467). The most common causes of death were pneumonia (37.1 %, 13/ 35), acute coronary syndrome (31.4 %, 11/35) and sepsis (14.3 %, 5/35). Surgery after 48 hours of admission had a significantly higher 30-day mortality rate (11 % versus 4 %, p =0.006). There was a significant difference in age (p =0.034), admission source (p <0.001), preoperative haemoglobin (p < 0.001), walking ability (p =0.004), number of comorbidities (p =0.004) and pre-existing dementia (p =0.01), cardiac disease (p <0.001), chronic obstructive pulmonary disorder (COPD) (p =0.036) and renal failure (p =0.007) between the 30-day mortality group and the rest of the cohort. Surgical delay greater than 48 hours, admission source and preexisting cardiac disease were identified as the strongest predictors of 30-day mortality. Conclusion Surgical delay is an important but avoidable determinant of early mortality after HFS. Respiratory and cardiac function needs to be optimised postoperatively with early intervention in patients with signs of cardiovascular compromise or infection. Keywords Trauma . Hip fracture . Neck of femur . Co-morbidities . 30-day mortality . Risk factors M. A.

Mit der Beschreibung des Gesetzes für die Transformation des Knochens durch den Berliner Anatomen und Chirurgen Julius Wolff wurde bereits Ende des 19. Jahrhunderts die Basis für unser heutiges Verständnis des Knochenwachstums sowie der Frakturheilung gelegt [5, 6]. Wolff erkannte die aktive Ausrichtung des knöchernen Wachstums entsprechend der Richtung einwirkender Kräfte als Ursache für die trabekuläre Architektur des Knochens. Mitte des 20. Jahrhunderts entdeckten Fukada u. Yasuda [2] piezoelektrische Eigenschaften des Knochens, die nicht, wie zunächst vermutet, durch die Apatitkristalle, sondern vielmehr die polar uniaxialen Struktureigenschaften des matrixbildenden Kollagens verursacht sind. Die Vermutung lag also nahe, dass physiologisch einwirkende Last im unmittelbaren Zusammenhang mit dem bereits von Wolff beschriebenen gerichteten Knochenwachstum steht. Mit dem Beginn und der rasanten Entwicklung der operativen Frakturversorgung vor etwa 100 Jahren dominierte die Plattenosteosynthese zunächst als führendes Stabilisierungsprinzip. So ist es nicht verwunderlich, dass mit deren verbreiteter Anwendung in zunehmendem Maß auch Plattenversagen und periimplantäre Frakturen beobachtet wurden. Im Lauf der Zeit wurden verschiedene Ursachenmodelle für das Auftreten plattennaher Frakturen postuliert.

Background-Vitamin D is crucial for maintaining musculoskeletal health. Recently, vitamin D insufficiency has been linked to a number of extraskeletal disorders, including diabetes, cancer, and cardiovascular disease. Determinants of circulating 25-hydroxyvitamin D (25-OH D) include sun exposure and dietary intake, but its high heritability suggests that genetic determinants may also play a role. Methods-We performed a genome-wide association study of 25-OH D among ∼30,000 individuals of European descent from 15 cohorts. Five cohorts were designated as discovery cohorts (n=16,125), five as in silico replication cohorts (n=9,366), and five as de novo replication

Bi-dimensional geometrical parameters of the proximal femur (femoral neck axis length, femoral neck width and neck-shaft angle) were evaluated in three identified Portuguese skeletal samples (Coimbra Identified Skeletal Collection; Luis Lopes Collection, Lisbon; and Identified Skeletal Collection of the 21st Century, Santarém) aiming to discern secular trends (considering individual years of birth and death) in the proximal femur phenotype throughout the 20th century in Portugal. The association of the so-called osteoporotic fractures (hip, vertebral, proximal humerus and distal radius fractures; N=89/492; 18,1%) with proximal femur geometry was also evaluated. It was not detected a definite secular trend in the proximal femur geometry during the last century. Notwithstanding, femoral neck width in the females pooled sample is significantly associated with osteoporotic fractures.

Abstract: Neste trabalho pretende-se testar a hipótese de que o período gestacional se encontra relacionado com o decréscimo da massa óssea em mulheres que faleceram durante a sua idade reprodutiva. Desse modo, avaliaram-se alguns parâmetros da massa óssea, através da radiogrametria do segundo metacárpico e da densitometria no fémur proximal, numa amostra feminina da Colecção de Esqueletos Identificados da Universidade de Coimbra. Os valores médios do Índice Cortical do segundo metacárpico (IC) e de ...

Hip fractures are a very serious condition in the elderly, greatly increasing morbidity and mortality. Hip protector garments, with integrated impact absorbing or deflecting pads, are known to help reduce hip fractures when worn by high-risk populations. However, uptake of these products is low. By investigating academic studies and sales and marketing literature, this paper provides a critical and contextual review of barriers to acceptance and adoption of hip protectors amongst older adults. This is part of a broader PhD investigation to establish how hip protection can be improved through human-centred design. Discomfort is the most reported barrier to acceptance although there are several more, including aesthetics and difficulty of use. Receptivity towards hip protectors is key to eventual compliance, and design criteria including aesthetics, convenience, comfort and cost should be as important as the level of impact protection to the hip joint.

of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract contains a brief summary of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn.

This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

Purpose: Hyponatremia is associated with high morbidity and mortality in elderly patients. This study aimed to investigate the incidence of hyponatremia and its effects on the duration of hospitalization, in-hospital and 1-year mortality in elderly patients admitted to the hospital due to hip fracture. Materials and Methods: After the approval of the ethics committee, patients over the age 65 and had hip surgery between January-December 2020 were retrospectively analyzed. The age, gender, fracture type, current comorbidities, and American Society of Anesthesiology physical status scores of the patients were recorded. Plasma Na, K, and Ca values in admission to hospital were recorded. Patients with hyponatremia and normonatremia were compared in terms of demographic data, comorbidities, duration of hospitalization, in-hospital, and 1-year mortality rates. Results: Of the total 253 patients, 52(%20.5) had hyponatremia at hospital admission. Demographic data were similar in hyponatremi...

Background: Intertrochanteric fractures, commonly caused by falls in older people, are a significant issue. This study evaluated a new fixation technique for greater trochanter fractures in elderly hip arthroplasty patients. Unstable intertrochanteric fractures present challenges in orthopedic surgery, and this article assessed a new method for fixing these fractures during hip arthroplasty. Objectives: We assessed the efficacy and clinical outcomes of a new fixation technique for managing greater trochanter fractures in elderly patients during hip arthroplasty. Methods: This retrospective study, conducted from 2019 to 2022 at Poorsina and Pars hospitals in Rasht, included patients with unstable intertrochanteric fractures. It assessed the efficacy and outcomes of a new fixation technique for the greater trochanter following hip arthroplasty. Statistical analyses were conducted using SPSS software, version 24, employing the Shapiro-Wilk test, Levene's test, generalized estimation equations, and the chi-square and Fisher's exact tests. Results: The new fixation technique significantly improved patient outcomes, leading to high rates of complete union, reduced pain levels, improved mobility, and lower complication rates. Conclusion: The novel fixation technique for greater trochanter fractures shows significant promise in improving healing rates and reducing complications in elderly patients undergoing hip arthroplasty. This study provides a foundation for future research and clinical practice enhancements in orthopedic surgery.

Background: A common complication during the healing of hip fractures is depression. It is recognized as a leading cause of disability in such patients. Older adults may face an increased risk of falls and fractures due to the effects of antidepressants or sedative medications. Patients with depression exhibit poorer recovery outcomes following fractures. Objectives: This study examines the prevalence of depression in elderly patients with trochanteric or peri-hip fractures. Methods: This cross-sectional study included all patients aged 65 years and older with trochanteric or peri-hip fractures who were admitted and treated in the orthopedic ward of Imam Khomeini Hospital, Urmia, Iran, in 2021. A demographic questionnaire was used to collect data, including age, gender, duration of depression diagnosis, place of residence, and history of psychiatric medication use. In the study title, we used the term "hip fractures" to broadly refer to various fractures in this area, including subtrochanteric and femoral head fractures. However, our analysis specifically focused on femoral neck and intertrochanteric fractures, as these are more prevalent in the elderly population we examined. Results: A total of 325 patients were included, with a mean age of 74.9±8.9 years; 172(52.9%) were male, and 153(47.1%) were female. Among the patients, 49.5% had femoral neck fractures, 43.4% had intertrochanteric fractures, and 7.1% had both types of fractures. Depression was diagnosed in 24 patients before the fracture, with an average duration of diagnosis of 7.2±4.6 years. The mean depression score at the time of fracture was 4.27±2.98, with 14 patients reporting a depression score of zero. Three months after the fracture, the mean depression score remained 4.27±2.98, with 11 patients reporting a depression score of zero. A paired samples t-test revealed no significant difference between depression levels at the time of the fracture and three months after the fracture (P=0.208). No significant differences in depression levels were observed between men (P=0.936) and women (P=0.077) three months after the fracture, though depression levels were slightly higher in women. Additionally, no significant differences

Many frail elderly experience serious difficulties when executing postural shifts, and around 50% of incidental fall victims are unable to get up again unassisted, despite having sustained non-injurious falls; this consequently leaving them exposed to further potential hazards [7]. The present study aimed therefore to juxtapose diverse rehabilitation regimens in terms of their respective effectiveness in aiding the frail elderly diagnosed with cardiovascular disorders in the safe execution of routine postural shifts, as well as in coping after incidental falls on their own. It is common knowledge that ca. 50% of the elderly fallers are unable to cope afterwards unassisted, despite not having sustained any injuries [8, 10, 13]. Such incidents may potentially be fraught with serious consequences, especially when the period of immobilisation on the floor runs into several hours and the victims are unable to summon any help, as this may easily precipitate hypothermia, dehydration and ge...

Background: the reason why elderly human hips tend to break in one of two anatomical regions is uncertain. Nutritional factors may affect the site of fracture. Objective: to assess possible nutritional differences in patients with proximal femoral fractures. Design: prospective observational cohort study. Setting: university teaching hospital. Subjects: 119 consecutive patients over the age of 65 with a hip fracture admitted to the trauma wards in a single centre. Methods: one researcher measured triceps, biceps and supra-iliac skinfold thickness, and mid upper arm circumference on admission and on the fifth post-operative day. Body mass index was calculated for each patient, and used to classify patients as severely, moderately or mildly malnourished, normal, overweight or obese. Logistic regression was used to determine the influence of various factors on fracture site. Results: according to their body mass index, 31% of patients were classified as malnourished and 11% as severely malnourished. Patients with intracapsular fractures were significantly more malnourished than patients with trochanteric fractures (P < 0.008). Nutritional status was not related to post-operative complications. Ability to weigh a patient on the fifth post-operative day was the single most important prognostic indicator for complications. Conclusions: patients with intracapsular fractures are more malnourished. Those with trochanteric fractures tend to be overweight.

Amaç: Ülkemizde majör ortopedik cerrahi (MOC) için farmakolojik profilaksi uygulanan hastalarda venöz tromboembolizm (VTE) risk faktörleri, kullanılan profilaksi yöntemleri ve klinik bulgu veren derin ven trombozu (DVT) ve pulmoner emboli (PE) sıklığı araştırıldı. Çalışma planı: Prospektif, çokmerkezli, açık, müdahalesiz bir gözlem çalışması planlanarak, 21 merkezden 899 hasta çalışmaya alındı. Olguların 316'sında (%35.2) total kalça protezi (TKP), 328'inde (%36.5) total diz protezi (TDP), 255'inde (%28.4) kalça kırığı (KK) cerrahisi uygulandı. Tüm hastalarda farmakolojik DVT profilaksisine başvuruldu. Sonuçlar: Olguların %73.2'sinde VTE risk faktörleri vardı. En sık görülen risk faktörleri obezite (%72) ve uzamış immobilizasyon (%36.3) idi. Profilaksi için olguların %91.1'inde düşük molekül ağırlıklı heparin, %8.9'unda fondaparinuks kullanıldı. Olguların 273'üne (%30.4) kısa dönem, 626'sına (%69.6) uzun dönem profilaksi uygulandı. Mekanik profilaksi 610 olguda (%67.9) elastik çorap ile, 67 olguda (%7.5) aralıklı hava basınç cihazı ile uygulandı. Üç aylık takip sonucunda sekiz olguda (%0.9) klinik bulgu veren DVT, dört olguda (%0.4) PE gelişti. Mortalite 10 olguda (%1.1) görüldü. Kanama komplikasyonu sekiz olguda (%0.9) majör, 40 olguda (%4.5) minör idi. Çıkarımlar: Etkin VTE profilaksi yapıldığında MOC'de klinik bulgu veren DVT ve PE oranları düşük olmaktadır.

Fracture represents the single most important clinical event in patients with osteoporosis, yet remains under-predicted. As few premonitory symptoms for fracture exist, it is of critical importance that physicians effectively and efficiently identify individuals at increased fracture risk. Of 3426 postmenopausal women in CANDOO, 40, 158, 99, and 64 women developed a new hip, vertebral, wrist or rib fracture, respectively. Seven easily measured risk factors predictive of fracture in research trials were examined in clinical practice including: age (&lt; 65, 65-69, 70-74, 75-79, 80+ years), rising from a chair with arms (yes, no), weight (&lt; 57, &gt; or = 57 kg), maternal history of hip fracture (yes, no), prior fracture after age 50 (yes, no), hip T-score (&gt; -1, -1 to &gt; -2.5, &lt; or = -2.5), and current smoking status (yes, no). Multivariable logistic regression analysis was conducted. The inability to rise from a chair without the use of arms (3.58; 95% CI: 1.17, 10.93) was...

index any site), 37.6% (CI95:36.1-39.1) after second, 21.2% (CI95:18.0-25.0) after third, with the majority of subsequent fractures occurring in the first 2 years post fracture. Risk of subsequent MOF was highest in the first 6 months following index fracture; the adjusted relative risk (RR) of MOF was 2.2 (CI95:2.1-2.2) following any fragility fracture, 4.5 (CI95:4.2-4.9) following a vertebral fracture and 1.9 (CI95:1.8-2.1) following a hip fracture. After a second fracture, these RRs were 2.6 (CI95:2.4-2.8), 3.8 (CI95:2.9-5.2) and 2.0 (CI95:1.9-2.1); and after the third fracture, the RR was 1.5 (CI95:1.5-1.5). ConClusions: Fracture risk significantly increases rapidly within 6 months following a fragility fracture, remains very elevated in the subsequent 2 years and persists over 5 years. The relative risk manifests within 6 months and gradually declines over 5 years following the fracture. A patient who has suffered any fragility fracture requires prompt intervention to minimize that risk and avoid significant personal, economic and societal burden. PMS14 90-Day Mortality anD itS PreDictorS in Men With contralateral hiP Fracture aFter FeMoral neck Fracture

Ziel dieser prospektiven, randomisierten, kontrollierten Studie war es, den Eff ekt einer gezielten Ernährungsintervention auf den post operativen oxidativen Stress und die Krankenhausaufenthaltsdauer bei Hüftfrakturpatienten zu untersuchen. Methoden: Vierzehn Patienteninnen (Interventionsgruppe = SG) erhielten postoperativ eine individuell angepasste Nahrungsergänzung mit Protein und Antioxidantien, neun Patientinnen ohne Ernährungstherapie bildeten die Kontrollgruppe (= CG). Blutproben wurden präoperativ (T1), am Tag der Entlassung (T2) und drei Wochen (T3) danach gesammelt. Die Plasmakonzentrationen an Albumin und Gesamtprotein (TP) wurden mittels Autoanlyzer bestimmt. Advanced Oxidation Protein Products (AOPP) und die Totale Antioxidative Kapazität (TAC) wurden photometrisch, Malondialdehyd (MDA) mittels HPLC analysiert. Ergebnisse: Während die Plasmakonzentration an Albumin, TP und TAC innerhalb der SG postoperativ konstant blieb, wurde in der CG eine signifi kante Reduktion (T1>T2, p < 0,01) dieser Parameter, welche nach der Phase T2-T3 wiederum das Ausgangsniveau (T2 > T3, p < 0,05) erreichten, erfasst. Dies resultierte in signifi kanten Diff erenzen von TP (T2: SG>CG, p < 0,05) und TAC (T2: SG>CG, p < 0,01) zwischen den untersuchten Gruppen. Weiters zeigte sich postoperativ in beiden Gruppen ein signifi kanter Anstieg der Plasmaspiegel an AOPP und MDA (T1 < T2, p < 0,01), welche im weiteren Studienverlauf in der CG (AOPP: T1 < T3, p < 0,05; MDA: T1 < T3, p < 0,01), nicht jedoch in der SG (T2>T3, p < 0,01) signifi kant erhöht blieben. MDA

The number of osteoporotic fractures is increasing along with population aging. Most patients with these type of fractures are older than 65 years, with multiple chronic conditions and different degrees of disability. Hip fracture is the most relevant osteoporotic fracture due to its frequency, costs, severity and complications. Multidisciplinary management is of the utmost importance to obtain good therapeutic results. We herein review the management of this fracture. Orthogeriatric joint management should be incorporated in fragility fracture treatment. We contribute with general recommendations for the perioperative management, which can be homologated for the management of older patients with other type of fragility fractures.

Background: Surgical dislocation of the hip remains an important alternative in hip preservation surgery, especially when a dynamic access to the hip is needed and arthroscopy is not a suitable option. We describe a novel technique for operative dislocation of the hip without trochanteric osteotomy and the clinical results of our patients. Methods: Surgical dislocation of the hip without trochanteric osteotomy was done through a modified lateral approach in all of the cases. A review of demographic, clinical, and radiological data was done in all of the patients operated with this technique between 2010 and 2015. Complications, walking aids, weight-bearing status, and modified Harris Hip Score (mHHS) were also recorded. Results: Six surgical dislocations of the hip were carried out. Indications were tumor resection in five and bulletectomy in one hip. There were two women (four hips) and two men. Mean age was 19 ± 3.8 years. Median follow-up was 2.5 years (range 2–4.5 years). Median...