Objective To review the progress of perioperative treatments for patients of Parkinson’s disease and hip fractures. Methods The related literature of treatments for patients of Parkinson’s disease and hip fractures were reviewed and analyzed from the aspects such as the perioperative management, selection of operation ways, and prognosis. Results The patients of Parkinson’s disease are more likely to sustain hip fractures because of postural instability and osteoporosis. The perioperative treatments for patients of Parkinson’s disease and hip fractures should be determined by orthopedists, neurologist, anesthesiologist, and physical therapist. There is still controversy about the selection of operation and surgical approach. And the prognosis of patients of Parkinson’s disease and hip fractures are associated with the severity of Parkinson’s disease. Conclusion There are few clinical studies about the patients of Parkinson’s disease and hip fractures. The mid-term and long-term functional outcomes of patients of Parkinson’s disease and hip fractures are unsufficient. And the best treatments of patients of Parkinson’s disease and hip fractures need to be further explored.
Objective To evaluate the surgical efficiency of treating the intertrochanteric hip fracture with the Gamma nail fixation and to compare two operating methods of the Gamma nail fixation. Methods From August 2000 to August 2006, 69 patients (32 males, 37 females; age, 43-98 years；average, 72.3 years)with the intertrochanteric hip fracture but with no associated injury weretreated with the Gamma nail fixation. The patients’ average illness course was 5.6 days (range, 3-14 days). Among the 69 patients, 36 were treated with the traditional method of the Gamma nail fixation (Group A) and 33 were treated with animproved method of the Gamma nail fixation (Group B). According to the Association for the Study of Internal Fixation (AO-ASIF) classification, in Group A, 5 patients had a disease of Type A1, 23 of Type A2, and 8 of Type A3; inGroup B, 8 patients had a disease of Type A1, 21 of Type A2, and 4 of Type A3. The data from the two groups were analyzed, and the statistical analysis was made on the following aspects: incision length, operating time, intraoperative bleeding, X-ray exposure frequency, drainage amount, blood transfusion volume, postoperative infection of the lungs, superficial infection of the incision, duration of antibiotic use, standing with the walking stick after operation, complication due to internal fixation, healing time for the fracture, and the hip function recovery half a year after operation assessed with the Harris scoring system. Results All the 69 patients were followed up for 8-80 months(average, 42 months). We studied the indexes such as incision length, operating time, intraoperative bleeding, X-ray exposure frequency, drainage amount, and blood transfusion volum; aboveindexes in Group A were 9.5±4.7 cm, 85±35 min, 186.0±87.3 ml, 9.0±5.1 times, 102.7±49.8 ml, 325.0±169.5 ml; and those were 5.3±1.2 cm,46±10 min, 65.0±26.0 ml,3.0±2.1 times,52.5±16.2 ml,203.0± 61.2 ml in Group B. The above indexes showed that the surgical efficiency in Group B was significantly better than that in Group A (Plt;0.05). The postoperative recoveryindexes such as infection of the lungs, infection of the incision, duration of antibiotic use, standing time after operation, union time of fracture, and functionscore, were studied. There was a statistically significiant difference in lung infection, incision infection, duration of antibiotic use, and standing time after operation between Group A and Group B(Plt;0.05). Conclusion The improved method of the Gamma nail fixation fortreating the intertrochanteric hip fracture can increase the surgical efficiency and improve the patient’s early recovery after operation, especially suitable for the elderly patients who have more complications. This kind of method can shorten the operating time and the anesthesia duration, reducing the incision infection and the blood loss during operation, and decrease the frequency of the X-ray use.
Objective To investigate epidemiological characteristics of geriatric hip fractures between 2010 and 2011 in Hebei province. Methods The digital radiography image data and basic information of patients above 60 years old with hip fractures (femoral neck fracture, femoral intertrochanteric fracture, and femoral head fracture) in 5 hospitals of Hebei province between January 2010 and December 2011 were analyzed retrospectively. All the data including patients’ gender, age, and AO types were abstracted and analyzed to investigate the epidemiologic characteristics of geriatric hip fractures in Hebei province. Results A total of 4 207 hip fracture patients above 60 years old were included, accounting for 59.61% of all patients with hip fractures and 26.24% of all fractures patients over 60 years old in the same period. There were 1 703 (40.48%) males and 2 504 (59.52%) females (M∶F=1∶1.47). The patients ranged in age from 61 to 99 years, with an average of 75.4 years; the majority of patients aged 70-79 years (43.97%) and the minority of the patients aged 90-99 years (2.02%); women of all ages were more than men, but the difference was not significant (P>0.05). According to AO classification, there were 2 118 cases (50.34%) of type 31-A, 2 004 case (47.63%) of type 31-B, and 85 cases (2.02%) of type 31-C. Except for the type 31-A1, 31-A3, and 31-C1 of 60-69 age group, and the type 31-A3 of 80-89 age groups, women were significantly more than men. Conclusion There are more women than men in hip fractures in Hebei province, and 70-79 age group is the high-risk age group of geriatric hip fractures. Among them, intertrochanteric comminuted fractures are common types.
Objective To observe the clinical application of multidisciplinary team (MDT) treatment in the management of geriatric hip fractures and evaluate its effectiveness. Methods The clinical data of 76 elderly patients with hip fracture managed by MDT approach between August 2016 and February 2018 (MDT group) were retrospectively analyzed and compared with 102 patients managed by traditional orthopedics approach between January 2014 and December 2015 (conventional group). There was no significant difference in gender, age, fracture type, surgical procedure, and other general data between the two groups (P>0.05). However, the number of comorbidities in the MDT group was significantly higher than that in the conventional group (t=6.295, P=0.000), and the proportion of the number of comorbidities between the two groups was also significantly different (χ2=28.442, P=0.000). The consultation rate and transfer rate, time to surgery, rate of surgery within 2 or 3 days, operation time, postoperative hospitalization stay, length of hospitalization stay, hospitalization expense, rate of loss to follow-up, and mortality during hospitalization, 30-day mortality, 90-day mortality, and 1-year mortality after operation were compared between the two groups. Results The rates of total consultations of the conventional group and the MDT group were 56.86% (58/102) and 56.58% (43/76), respectively, and the rates of total transferred patients were 15.69% (16/102) and 15.79% (12/76), respectively, with no significant differences (P>0.05). Among them, the proportion of patients who transferred into intensive care unit (ICU) in conventional group was significantly higher than that in MDT group and the rates of patients who received geriatric consultation or transferred into geriatric department in MDT group were both significantly higher than those in conventional group (P<0.05). There was no significant difference in rates of other department consultation or transfer between the two groups (P>0.05). The time to surgery, operation time, postoperative hospitalization stay, and length of hospitalization stay in MDT group were significantly less than those in conventional group, but the proportion of patients who received surgery within 3 days in MDT group was significantly higher than that in conventional group (P<0.05). There was no significant difference in the proportion of patients who received surgery within 2 days (χ2=2.027, P=0.155). The hospitalization expenses of total patients, femoral neck fracture, and intertrochanteric fracture subgroups in MDT group were all significantly higher than those in conventional group (P<0.05). However, there was no significant difference in hospitalization expense of subtrochanteric fracture subgroup between the two groups (Z=?1.715, P=0.086). The rate of loss to follow-up in conventional group and MDT group was 6.86% (7/102) and 3.95% (3/76), respectively, with no significant difference (χ2=0.698, P=0.403). The mortalities at hospitalization, 1 month, 3 months, and 1 year after operation in conventional group were 0, 1.05% (1/95), 3.16% (3/95), and 7.37% (7/95), respectively, and in MDT group were 0, 0, 2.74% (2/73), 6.85% (5/73), respectively, showing no significant differences in mortalities between the two groups (P>0.05). Conclusion MDT model in the management of geriatric hip fractures has been shown to reduce time to surgery, postoperative hospitalization stay, length of hospitalization stay, operation time, and the proportion of patients who received ICU consultation or transferred into ICU. Furthermore, MDT can improve the capacity for developing operations for patients with complex medical conditions and make medical resources used more rationally.
Objective To systematically analyze the relevant research on the application of preoperative exercise training in the pre-rehabilitation of elderly hip fracture patients, identify the specific content, outcome indicators, and application effects of exercise intervention, in order to provide reference for medical staff to carry out relevant interventions. Methods Computer searches were conducted on domestic and foreign databases such as China National Knowledge Infrastructure, Wanfang Database, China Biomedical Literature Database, VIP, Cochrane Library, PubMed, Embase, Web of Science. The search period was from the establishment of the database to January 2024. The scoping review method was used to screen, summarize, and analyze the included studies. ResultsA total of 10 studies were included, including 3 randomized controlled trial, 1 quasi experimental study, 5 retrospective studies and 1 case report. Preoperative exercise preparation includes completing relevant examinations and providing sufficient pain relief. The types of exercise include adaptive training, resistance training, and aerobic exercise. Monitor the patient’s symptoms, signs, and adverse reactions throughout the exercise process. Outcome measures include physical activity and function, pain, average length of hospital stay, and perioperative complications. Conclusions Preoperative exercise training has a positive effect on elderly patients with hip fracture. Elderly patients with hip fracture should be well prepared for preoperative exercise, based on adaptive training, with resistance exercise as the main focus, while monitoring the patient’s physical signs and adverse events during exercise.
Objective To construct an intervention program for postoperative fear of falling in elderly patients with hip fracture based on cognitive behavioral theory. Methods Based on cognitive behavioral theory and literature review, an initial draft of intervention plan for postoperative fear of falling in elderly patients with hip fracture was constructed. From January to March 2025, after two rounds of expert consultations and revisions, the final plan was formed. Results A total of 16 experts across the country were invited to participate in two rounds of Delphi expert consultations, covering areas such as orthopedic clinical nursing, orthopedic clinical medicine, nursing education, nursing management, rehabilitation therapy, and psychological therapy. The active participation rates for the two rounds of consultations were 94.12% and 100.00%, respectively. The expert authority coefficients were 0.860 and 0.907, respectively, and the Kendall harmony coefficients were 0.369 and 0.524, respectively. Ultimately, a program composed of 5 primary indicators (fall fear management team, fall fear management goals, fall fear assessment, fall fear intervention measures, and post-intervention effect evaluation), 17 secondary indicators, and 31 tertiary indicators was constructed. Conclusion The intervention program for postoperative fear of falling in elderly patients with hip fracture based on cognitive behavior theory constructed in this study is scientific and operable, which can provide reference and guidance for clinical nursing staff.
Objective To investigate the effect of virtual reality (VR) sham feeding on gastrointestinal function in elderly patients with hip fracture. Methods Elderly patients with hip fracture admitted to Trauma Center, West China Hospital, Sichuan University between June and December 2024 who met the case selection criteria were selected. Patients who were willing to complete the postoperative VR operation were assigned to the experimental group (VR group), and the other patients were assigned to the control group by 1∶1 manual interval matching according to sex, age (±5 years), and body mass index (±2 kg/m2). The control group received fasting and nutrition management strategy during perioperative period of accelerated rehabilitation. In the VR group, VR sham feeding intervention was performed on the basis of the control group. The time of first postoperative exhaust and defecation, postoperative gastrointestinal symptoms, postoperative nutrition (hemoglobin, serum albumin) and inflammatory indicators (white blood cell count, erythrocyte sedimentation rate, C-reactive protein, interleukin-6), postoperative appetite and postoperative complications (bleeding, fever, delirium, aspiration, vertigo) were compared between the two groups. Results A total of 70 patients were enrolled, with 35 in each group. There were statistically significant differences (P<0.05) between the VR group and the control group in the time of postoperative first exhaust [(9.17±4.81) vs. (13.66±5.97) h], time of postoperative first defecation [(49.00±28.61) vs. (66.83±29.93) h], degree of abdominal distension 3 d after surgery (grade 0/1/2: 26/7/2 vs. 16/12/7 cases), appetite score 1 d after surgery (62.86±12.85 vs. 54.71±11.50), appetite score 3 d after surgery (76.29±9.95 vs. 62.43±8.86), albumin level 3 d after surgery [(33.18±3.41) vs. (31.40±3.07) g/L], and hospitalization days [(7.97±1.38) vs. (9.06±2.43) d], while there was no statistically significant difference in other indicators (P>0.05). Conclusions The incidence of postoperative gastrointestinal dysfunction is high in elderly patients with hip fracture. VR sham feeding can promote the early recovery of gastrointestinal function, alleviate postoperative abdominal distension, significantly improve postoperative appetite, and increase albumin level after surgery.
ObjectiveTo introduce the clinical pathway for geriatric hip fracture regulated by our hospital and report the five-year outcomes after the implementation of the pathway. MethodsThe geriatric hip fracture patients treated between September 2003 and August 2012 were followed up. We did not implement the clinical pathway until January 2007. Statistical analysis was done to evaluate the effect of the clinical pathway on patient outcomes by comparing rate of complication, mortality, and length of hospital stay before and after the implementation of the clinical pathway. ResultsAfter the implementation of the pathway, the in-hospital mortality, one-year mortality and the rate of complication were significantly lower. Besides, the time from admission to operation and the total length of stay in hospital were obviously shortened. ConclusionThe use of clinical pathway for geriatric hip fracture can reduce the rate of complication and mortality, and shorten hospital stay, and the five-year outcomes after the implementation of the pathway are satisfying.
ObjectiveTo summarize the research progress on the application of tranexamic acid (TXA) in traumatic orthopedic surgery in recent years.MethodsThe domestic and foreign literature in recent years was reviewed, and the efficacy and safety of TXA in traumatic orthopedic surgeries with different regimen, dose and route of administration were comprehensively summarized and compared.ResultsThe application of TXA in traumatic orthopedic surgeries increased gradually in recent years. Intravenous or topical administration of TXA efficaciously reduced blood loss and transfusion requirements during hip fracture surgery without significantly increasing the risk of thromboembolic events. However, the efficacy was not clear in other traumatic orthopedic surgeries such as pelvic and acetabular fractures.ConclusionMore studies are needed to confirm the efficacy and safety of TXA in traumatic orthopedic surgeries.
Objective To explore the correlation between multimorbidity and hip fractures in middle-aged and elderly populations. Methods The population without hip fractures in 2011 was selected in the China Health and Retirement Longitudinal Study database. According to whether the research subjects experienced hip fractures between 2015 and 2020, they were divided into the hip fracture group and the non-hip fracture group. Multiple logistic regression analysis was used to explore the correlation between multimorbidity and hip fracture occurrence. Results A total of 9644 subjects were included. Among them, there were 4406 males and 5238 females. There were 419 cases in the hip fracture group and 9225 cases in the non-hip fracture group. Multivariate logistic regression analysis showed that diabetes, heart disease, arthritis and hearing impairment were independent risk factors for hip fracture. Compared to those without chronic diseases, individuals with ≥3 types of comorbidities among the 4 chronic diseases had a higher risk of hip fracture. Conclusions In the middle-aged and elderly population, diabetes, heart disease, arthritis and hearing impairment are chronic diseases associated with hip fracture. The higher the number of comorbidities of chronic diseases, the higher the risk of new hip fractures.