In recent years, considerable progress has been made in the specific development and practice of enhanced recovery after surgery (ERAS) for geriatric hip fracture domestically and internationally. By synthesizing domestic and international research reports, this article analyzes the current status of key development areas of ERAS for geriatric hip fracture and puts forward future prospects. The main contents include the crises and opportunities of geriatric hip fracture against the backdrop of deep aging, the specific implementation of team and model construction in the application of ERAS concept to geriatric hip fracture management, the benefits and effect evaluation of recent studies, as well as the opportunities and innovative pathways brought by the development of big data and artificial intelligence for the future development of ERAS in this field.
ObjectiveTo review the current applications of machine learning in orthopaedic trauma and anticipate its future role in clinical practice. MethodsA comprehensive literature review was conducted to assess the status of machine learning algorithms in orthopaedic trauma research, both nationally and internationally. ResultsThe rapid advancement of computer data processing and the growing convergence of medicine and industry have led to the widespread utilization of artificial intelligence in healthcare. Currently, machine learning plays a significant role in orthopaedic trauma, demonstrating high performance and accuracy in various areas including fracture image recognition, diagnosis stratification, clinical decision-making, evaluation, perioperative considerations, and prognostic risk prediction. Nevertheless, challenges persist in the development and clinical implementation of machine learning. These include limited database samples, model interpretation difficulties, and universality and individualisation variations. ConclusionThe expansion of clinical sample sizes and enhancements in algorithm performance hold significant promise for the extensive application of machine learning in supporting orthopaedic trauma diagnosis, guiding decision-making, devising individualized medical strategies, and optimizing the allocation of clinical resources.
Objective To analyze the disease burden of pelvic fractures at the global, regional, and national levels from 1990 to 2023 using data from the 2023 Global Burden of Disease Study (GBD), and to predict the disease burden through 2050. Methods Leveraging data from the GBD 2023, this study investigated the disease burden of pelvic fractures across 204 countries and regions. Assessment indicators included incidence rate, prevalence rate, and years lived with disability (YLDs). The Joinpoint regression model was employed to analyze trends in pelvic fracture burden from 1990 to 2023, while the average annual percentage change (AAPC) was used to quantify this temporal trend. The relationship between the socio-demographic index and pelvic fracture burden was evaluated. Furthermore, the long short-term memory (LSTM) model was applied to predict trends in pelvic fracture burden through 2050. Results In 2023, the estimated number of new pelvic fracture cases globally was 7 479 884 [95% uncertainty interval (UI): 5 293 401-10 611 876], representing a 42.74% increase from 1990. In the same year, the number of prevalent pelvic fracture cases and YLDs were 23 007 508 (95%UI: 21 021 518-25 327 165) and 3 909 228 person-years (95%UI: 2 725 498-5 194 385), respectively. Additionally, age-standardized rates exhibited an opposing downward trend. Significant disparities in the disease burden of pelvic fractures were identified across different age groups, genders, and social contexts. According to predictions from the LSTM model, the global age-standardized incidence rate (ASIR) of pelvic fractures will be approximately 88.44 per 100 000 persons by 2050, while the total number of incident cases will rise to 8 547 095. Conclusion Although the overall incidence rate, prevalence rate, and YLDs of pelvic fractures have exhibited an upward trend over the past three decades, the ASIR, age-standardized prevalence rate (ASPR), and age-standardized years of life lost rate (ASYR) have shown a downward trend. It is predicted that over the upcoming 26-year period, the age-standardized rate of disease burden due to pelvic fractures will further decrease, while the number of incident cases and prevalent cases will continue to exhibit an upward trend. Formulating more targeted disease prevention strategies is critical to addressing disparities across genders, regions, and other dimensions, and to mitigating the burden of pelvic fractures.
Objective To investigate the perioperative changes in serum interleukin 6 (IL-6) levels in elderly male patients with intertrochanteric fractures, and provide evidence for inflammatory control in this patient population. Methods The clinical data of 40 male patients aged more than 60 years with intertrochanteric fractures who met the selection criteria between January 2021 and December 2022 were retrospectively analyzed, including 25 non-osteoporosis patients (T value>?2.5, group A) and 15 osteoporosis patients (T value≤?2.5, group B). In addition, 40 healthy men aged more than 60 years old were included as controls (group C) according to the age matching rule. There was no significant difference in age, smoking history, drinking history, body mass index, complications (hypertension and diabetes), alanine aminotransferase, aspartate aminotransferase, blood urea nitrogen, creatinine, and total protein among the 3 groups (P>0.05). Serum samples were collected from group C subjects and from groups A and B patients preoperatively and on postoperative days 1, 3, 5, and 7. IL-6 levels were measured using ELISA assay. Pearson correlation analysis was used to assess the relationship between IL-6 levels and T values at various time points in groups A and B. Postoperative complications during hospitalization and 1-year mortality rates were recorded for groups A and B. Results Preoperative IL-6 levels were significantly higher in groups A and B than in group C (P<0.05), with group B being significantly higher than group A (P<0.05). In groups A and B, IL-6 levels increased significantly on postoperative day 1 compared to preoperative levels and then gradually decreased, approaching preoperative levels by postoperative day 7. IL-6 levels in group B were significantly higher than those in group A at all postoperative time points (P<0.05). Correlation analysis showed that IL-6 levels were negatively correlated with T values at all perioperative time points in all patients from groups A and B (P<0.05). Complications occurred in 4 patients (16.0%) in group A, including 2 cases of pulmonary infection, 1 case of urinary tract infection, and 1 case of heart failure, and in 3 patients (20.0%) in group B, including 2 cases of pulmonary infection and 1 case of gastrointestinal bleeding. There was no significant difference in the incidence of complications between the two groups (χ2=0.104, P=0.747). There were 2 cases (8.0%) and 4 cases (26.7%) died within 1 year after operation in groups A and B, respectively, and there was no significant difference in 1-year mortality rates between the two groups (χ2=2.562, P=0.109). Conclusion Serum IL-6 levels significantly increase in the early postoperative period in elderly male patients with intertrochanteric fractures, especially in those with osteoporosis. Monitoring the inflammatory state and promptly controlling the inflammatory response during the perioperative period, may reduce complications and improve postoperative survival in this patient population.
ObjectiveTo investigate the efficacy and safety of emergency administration of tranexamic acid (TXA) in reducing perioperative blood loss and blood transfusion rate in elderly patients with intertrochanteric femoral fractures. Methods A retrospective analysis was conducted on the clinical data of 102 elderly patients with intertrochanteric femoral fractures who were admitted between October 2023 and May 2025 and met the selection criteria. Patients were divided into two groups based on whether TXA was administered in the emergency department: the TXA group (patients received a single intravenous infusion of 1 g TXA immediately upon emergency admission, n=50) and the control group (no TXA was used in the emergency department, n=52). There was no significant difference in baseline data between the two groups (P>0.05), including age, gender, body mass index, American Society of Anesthesiologists (ASA) classification, AO/Orthopaedic Trauma Association (AO/OTA) fracture classification, underlying comorbidities, prothrombin time, activated partial thromboplastin time, fibrin degradation products, D-dimer, bone mineral density T-score, time from injury to admission, time from admission to surgery, hemoglobin (HB), and hematocrit (HCT) levels at emergency admission. The following parameters were collected and analyzed statistically: changes in HB and HCT on the day before surgery (compared with values at emergency admission); hidden blood loss (HBL) on the day before surgery; total blood loss (TBL) on postoperative day 1, day 3, and during the entire perioperative period; in-hospital blood transfusion rate; and incidence of complications such as thrombosis. ResultsThere was no significant difference in operation time between the two groups (P>0.05). All patients were followed up 3-12 months (mean, 6.6 months). On the day before surgery, the decreases in HB and HCT in the TXA group were significantly lower than those in the control group (P<0.05). The HBL on the day before surgery and perioperative TBL in the TXA group were significantly lower than those in the control group (P<0.05), whereas there was no significant difference in TBL on postoperative day 1 or day 3 between the two groups (P>0.05). The in-hospital blood transfusion rate in the TXA group (34.0%) was significantly lower than that in the control group (55.8%, P<0.05). During hospitalization and follow-up, no complication such as deep vein thrombosis of the lower extremities, pulmonary embolism, surgical site infection, or allergic reactions occurred in either group. Intermuscular venous thrombosis occurred in 4 patients (8.0%) in the TXA group and 5 patients (9.6%) in the control group, with no significant difference in incidence between the two groups (P>0.05). Conclusion Elderly patients with intertrochanteric femoral fractures experience significant blood loss due to initial trauma. Emergency administration of TXA can reduce trauma-induced preoperative HBL, perioperative TBL, and in-hospital blood transfusion rate without increasing the incidence of thromboembolic events, thus proving safe and effective.