Health economics for intra-capsular hip fractures undertaking fixation

BACKGROUND Hip fracture is a common musculoskeletal injury in the elderly requiring surgery worldwide.The operative mainstay of intra-capsular hip fractures is arthroplasty with a smaller proportion for fixation.AIM To determine the most beneficial method of fixation for patients with intracapsular hip fractures.METHODS A registered audit from 2012-2018 was conducted on all intra-capsular hip fractures treated with 2 commonly used fixation methods.Patient notes,electronic records and clinical codes for cost benefit were evaluated.A validated quality of life measure was collected at least 1 year after surgery.RESULTS A total of 83 patients were identified with intra-capsular fractures undergoing fixation during the retrospective period.There were 47 cannulated cancellous screw and 36 sliding hip screw fixations with the case mix comparable for age,gender,co-morbidities and fracture configuration.There was no significant difference in blood loss,tip apex distance,radiation exposure,length of stay,radiological union time,collapse,avascular necrosis or re-operation between fixation methods.Logistic regression analysis demonstrated displaced intracapsular hip fractures correlated significantly with an undesirable outcome conferring a relative odds ratio of 7.25.There were 9(19%)and 4(11%)patients respectively,who required re-operation.There was no significant difference in health resource group tariff and implant cost with comparable EQ-5D and visual CONCLUSION No significant advantage was identified with differing fixation type,but irrespective there were a high number of patients requiring re-operation.This was predicted by initial fracture displacement and patient age.Arthroplasty may need to be carefully considered for health economics and patient benefit.

Analgesic Effect of Combined Spinal-Epidural Anesthesia and its Effect on TNF-α and CRP Levels in Elderly Patients with Hip Fracture During Surgical Treatment

Objective:To observe the analgesic effect of combined spinal and epidural anesthesia on older patients undergoing hip fracture surgery.Method:One hundred and twenty elderly hip fracture surgery patients treated in our hospital from January 2021 to December 2022 were selected and randomly divided into two groups,with 60 cases in the experimental group and 60 in the control group.The experimental group was given combined spinal-epidural anesthesia intervention measures,while the control group was given epidural anesthesia intervention measures.The analgesic effect,tumor necrosis factor-alpha(TNF-α),C-reactive protein(CRP)levels,and other observation indicators were analyzed after anesthesia intervention.Result:After the intervention,the analgesic effect and the evaluation results of the subjects in the experimental group were better than those in the control group(P<0.05);the obtained values of TNF-αand CRP levels in the experimental group were higher than those of the control group(P<0.05).Conclusion:The combined spinal-epidural anesthesia intervention demonstrated positive outcomes.The analgesic effect of patients during surgery and their inflammatory factor levels improved,which makes this intervention worthy of clinical application and promotion.

Effects of surgical treatment modalities on postoperative cognitive function and delirium in elderly patients with extremely unstable hip fractures

BACKGROUND As the perioperative risk of elderly patients with extremely unstable hip fractures(EUHFs)is relatively high and therapeutic effect is not satisfactory,new therapeutic strategies need to be proposed urgently to improve the efficacy and clinical outcomes of such patients.AIM To determine the influence of two surgical treatment modalities on postoperative cognitive function(CF)and delirium in elderly patients with EUHFs.METHODS A total of 60 elderly patients consecutively diagnosed with EUHF between September 2020 and January 2022 in the Chongqing University Three Gorges Hospital were included.Of them,30 patients received conventional treatment(control group;general consultation+fracture type-guided internal fixation),and the other 30 received novel treatment(research group;perioperative multidisciplinary treatment diagnosis and treatment+individualized surgical plan+risk prediction).Information on hip function[Harris hip score(HHS)],perioperative risk of orthopedic surgery[Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity(POSSUM)],CF[Montreal cognitive assessment scale(MoCA)],postoperative delirium[mini-cognitive(Mini-Cog)],adverse events(AEs;internal fixation failure,infection,nonunion,malunion,and postoperative delirium),and clinical indicators[operation time(OT),postoperative hospital length of stay(HLOS),ambulation time,and intraoperative blood loss(IBL)]were collected from both groups for comparative analyses.RESULTS The HHS scores were similar between both groups.The POSSUM score at 6 mo after surgery was significantly lower in the research group compared with the control group,and MoCA and Mini-Cog scores were statistically higher.In addition,the overall postoperative complication rate was significantly lower in the research than in the control group,including reduced OT,postoperative HLOS,ambulation time,and IBL.CONCLUSION The new treatment modality has more clinical advantages over the conventional treatment,such as less IBL,faster functional recovery,more effectively optimized perioperative quality control,improved postoperative CF,mitigated postoperative delirium,and reduced operation-related AEs.

Two surgical pathways for isolated hip fractures:A comparative study

BACKGROUND Hip fractures(HF)are common among the aging population,and surgery within 48 h is recommended.Patients can be hospitalized for surgery through different pathways,either trauma or medicine admitting services.AIM To compare management and outcomes among patients admitted through the trauma pathway(TP)vs medical pathway(MP).METHODS This Institutional Review Board-approved retrospective study included 2094 patients with proximal femur fractures(AO/Orthopedic Trauma Association Type 31)who underwent surgery at a level 1 trauma center between 2016-2021.There were 69 patients admitted through the TP and 2025 admitted through the MP.To ensure comparability between groups,66 of the 2025 MP patients were propensity matched to 66 TP patients by age,sex,HF type,HF surgery,and American Society of Anesthesiology score.The statistical analyses included multivariable analysis,group characteristics,and bivariate correlation comparisons with theχ^(2)test and t-test.RESULTS After propensity matching,the mean age in both groups was 75-years-old,62%of both groups were females,the main HF type was intertrochanteric(TP 52%vs MP 62%),open reduction internal fixation was the most common surgery(TP 68%vs MP 71%),and the mean American Society of Anesthesiology score was 2.8 for TP and 2.7 for MP.The majority of patients in TP and MP(71%vs 74%)were geriatric(≥65-years-old).Falls were the main mechanism of injury in both groups(77%vs 97%,P=0.001).There were no significant differences in pre-surgery anticoagulation use(49%vs 41%),admission day of the week,or insurance status.The incidence of comorbidities was equal(94%for both)with cardiac comorbidities being dominant in both groups(71%vs 73%).The number of preoperative consultations was similar for TP and MP,with the most common consultation being cardiology in both(44%and 36%).HF displacement occurred more among TP patients(76%vs 39%,P=0.000).Time to surgery was not statistically different(23 h in both),but length of surgery was significantly longer for TP(59 min vs 41 min,P=0.000).Intensive care unit and hospital length of stay were not statistically different(5 d vs 8 d and 6 d for both).There were no statistical differences in discharge disposition and mortality(3%vs 0%).CONCLUSION There were no differences in outcomes of surgeries between admission through TP vs MP.The focus should be on the patient’s health condition and on prompt surgical intervention.

Machine learning applications for the prediction of extended length of stay in geriatric hip fracture patients

BACKGROUND Geriatric hip fractures are one of the most common fractures in elderly individuals,and prolonged hospital stays increase the risk of death and complications.Machine learning(ML)has become prevalent in clinical data processing and predictive models.This study aims to develop ML models for predicting extended length of stay(eLOS)among geriatric patients with hip fractures and to identify the associated risk factors.AIM To develop ML models for predicting the eLOS among geriatric patients with hip fractures,identify associated risk factors,and compare the performance of each model.METHODS A retrospective study was conducted at a single orthopaedic trauma centre,enrolling all patients who underwent hip fracture surgery between January 2018 and December 2022.The study collected various patient characteristics,encompassing demographic data,general health status,injury-related data,laboratory examinations,surgery-related data,and length of stay.Features that exhibited significant differences in univariate analysis were integrated into the ML model establishment and subsequently cross-verified.The study compared the performance of the ML models and determined the risk factors for eLOS.RESULTS The study included 763 patients,with 380 experiencing eLOS.Among the models,the decision tree,random forest,and extreme Gradient Boosting models demonstrated the most robust performance.Notably,the artificial neural network model also exhibited impressive results.After cross-validation,the support vector machine and logistic regression models demonstrated superior performance.Predictors for eLOS included delayed surgery,D-dimer level,American Society of Anaesthesiologists(ASA)classification,type of surgery,and sex.CONCLUSION ML proved to be highly accurate in predicting the eLOS for geriatric patients with hip fractures.The identified key risk factors were delayed surgery,D-dimer level,ASA classification,type of surgery,and sex.This valuable information can aid clinicians in allocating resources more efficiently to meet patient demand effectively.

Trabecular Plate Loss and Deteriorating Elastic Modulus of Femoral Trabecular Bone in Intertrochanteric Hip Fractures

Osteoporotic hip fracture is associated with significant trabecular bone loss, which is typically characterized as low bone density by dual-energy X-ray absorptiometry （DXA） and altered microstructure by micro-computed tomography （pCT）. Emerging morphological analysis techniques, e.g. individual trabecula segmentation （ITS）, can provide additional insights into changes in plate-like and rod-like trabeculae, two major micro- structural types serving different roles in determining bone strength. Using ITS, we evaluated trabecular microstructure of intertrochanteric bone cores obtained from 23 patients undergoing hip replacement surgery for intertrochanteric fracture and 22 cadaveric controls. Micro-finite element （~FE） analyses were performed to further understand how the abnormalities seen by ITS might translate into effects on bone strength. ITS analyses revealed that, near fracture site, plate-like trabeculae were seriously depleted in fracture patients, but trabecular rod volume was maintained. Besides, decreased plate area and rod length were observed in fracture patients. Fracture patients also showed decreased elastic moduli and shear moduli of trabecular bone. These results provided evidence that in intertrochanteric hip fracture, preferential loss of plate-like trabeculae led to more rod-like microstructure and deteriorated mechanical competence adjacent to the fracture site, which increased our understanding of the biomechanical pathogenesis of hip fracture in osteoporosis.

Evidence-based intervention on postoperative fear,compliance,and self-efficacy in elderly patients with hip fracture

BACKGROUND Elderly patients tend to have poor self-efficacy and poor confidence in postoperative rehabilitation for hip fractures,and are prone to negative emotions,which affect treatment compliance.AIM To evaluate the effects of evidence-based intervention on postoperative fear,compliance,and self-efficacy in elderly patients with hip fractures.METHODS A total of 120 patients with hip fracture surgically treated from June 2018 to June 2020 at the orthopedic department of our hospital were selected and divided into intervention and routine groups(n=60 each)according to different nursing methods.The basic rehabilitation methods of the two groups were consistent,but patients in the intervention group received evidence-based nursing interventions at the same time.Differences between groups in the scores of motion phobia,pain fear,rehabilitation training compliance,self-efficacy,nursing satisfaction,and hip joint function were compared before and after the intervention.RESULTS Before the intervention,there were no statistically significant differences in motion phobia and pain fear scores between the groups(all P>0.05).However,motion phobia scores at 1 wk after intervention initiation(P<0.05),and pain fear scores at 1 wk and 2 wk after intervention initiation(all P<0.05),were significantly lower in the intervention group than in the routine group.On the first day of intervention,there was no significant difference in rehabilitation treatment compliance between the groups(P>0.05);however,at 2 wk after intervention initiation,rehabilitation compliance was significantly better in the intervention group than in the routine group(P<0.05).Before the intervention,there were no statistically significant differences in the scores for the two self-efficacy dimensions(overcoming difficulties and rehabilitation exercise self-efficacy)and the total self-efficacy score between the groups(all P>0.05).After 2 wk of intervention,the scores for these two dimensions of self-efficacy and the total self-efficacy score were significantly higher in the intervention group than in the routine group(all P<0.05).At 3 and 6 mo after surgery,hip function as evaluated by the Harris hip score,was significantly better in the intervention group than in the routine group(P<0.05).Additionally,overall nursing satisfaction was significantly higher in the intervention group than in the routine group(P<0.05).CONCLUSION Evidence-based nursing intervention can alleviate fear of postoperative rehabilitation in elderly patients who underwent hip fracture surgery,and improve rehabilitation treatment compliance and patient self-efficacy,which promote hip function recovery.

Effect of weekend admission on geriatric hip fractures

BACKGROUND The care discrepancy for patients presenting to a hospital on the weekend relative to the work week is well documented.With respect to hip fractures,however,there is no consensus about the presence of a so-called“weekend effect”.This study sought to determine the effects,if any,of weekend admission on care of geriatric hip fractures admitted to a large tertiary care hospital.It was hypothesized that geriatric hip fracture patients admitted on a weekend would have longer times to medical optimization and surgery and increased complication and mortality rates relative to those admitted on a weekday.AIM To determine if weekend admission of geriatric hip fractures is associated with poor outcome measures and surgical delay.METHODS A retrospective chart review of operative geriatric hip fractures treated from 2015-2017 at a large tertiary care hospital was conducted.Two cohorts were compared:patients who arrived at the emergency department on a weekend,and those that arrived at the emergency department on a weekday.Primary outcome measures included mortality rate,complication rate,transfusion rate,and length of stay.Secondary outcome measures included time from emergency department arrival to surgery,time from emergency department arrival to medical optimization,and time from medical optimization to surgery.RESULTS There were no statistically significant differences in length of stay(P=0.2734),transfusion rate(P=0.9325),or mortality rate(P=0.3460)between the weekend and weekday cohorts.Complication rate was higher in patients who presented on a weekend compared to patients who presented on a weekday(13.3%vs 8.3%;P=0.044).Time from emergency department arrival to medical optimization(22.7 h vs 20.0 h;P=0.0015),time from medical optimization to surgery(13.9 h vs 10.8 h;P=0.0172),and time from emergency department arrival to surgery(42.7 h vs 32.5 h;P<0.0001)were all significantly longer in patients who presented to the hospital on a weekend compared to patients who presented to the hospital on a weekday.CONCLUSION This study provided insight into the“weekend effect”for geriatric hip fractures and found that day of presentation has a clinically significant impact on delivered care.

Combined fascia iliaca compartment block and monitored anesthesia care for geriatric patients with hip fracture: Two case reports

BACKGROUND Major hip surgery usually requires neuraxial or general anesthesia with tracheal intubation and may be supplemented with a nerve block to provide intraoperative and postoperative pain relief.CASE SUMMARY This report established that hip surgical procedures can be performed with a fascia iliaca compartment block(FICB)and monitored anesthesia care(MAC)while avoiding neuraxial or general anesthesia.This was a preliminary experience with two geriatric patients with hip fracture,American Society of Anesthesiologists status III,and with many comorbidities.Neither patient could be operated on within 48 h after admission.Both general anesthesia and neuraxial anesthesia were high-risk procedures and had contraindications.Hence,we chose nerve block combined with a small amount of sedation.Intraoperative analgesia was provided by single-injection ultrasound-guided FICB.Light intravenous sedation was added.Surgical exposure was satisfactory,and neither patient complained of any symptoms during the procedure.CONCLUSION This report showed that hip surgery for geriatric patients can be performed with FICB and MAC,although complications and contraindications are common.The anesthetic program was accompanied by stable respiratory and circulatory system responses and satisfactory analgesia while avoiding the adverse effects and problems associated with either neuraxial or general anesthesia.

National trends in total hip arthroplasty for traumatic hip fractures:An analysis of a nationwide all-payer database

BACKGROUND Hemiarthroplasty(HA)has traditionally been the treatment of choice for elderly patients with displaced femoral neck fractures.Ideal treatment for younger,ambulatory patients is not as clear.Total hip arthroplasty(THA)has been increasingly utilized in this population however the factors associated with undergoing HA or THA have not been fully elucidated.AIM To examine what patient characteristics are associated with undergoing THA or HA.To determine if outcomes differ between the groups.METHODS We queried the Nationwide Inpatient Sample(NIS)for patients that underwent HA or THA for a femoral neck fracture between 2005 and 2014.The NIS comprises a large representative sample of inpatient hospitalizations in the United States.International Classifications of Disease,Ninth Edition(ICD-9)codes were used to identify patients in our sample.Demographic variables,hospital characteristics,payer status,medical comorbidities and mortality rates were compared between the two procedures.Multivariate logistic regression analysis was then performed to identify independent risk factors of treatment utilized.RESULTS Of the total 502060 patients who were treated for femoral neck fracture,51568(10.3%)underwent THA and the incidence of THA rose from 8.3%to 13.7%.Private insurance accounted for a higher percentage of THA than hemiarthroplasty.THA increased most in urban teaching hospitals relative to urban non-teaching hospitals.Mean length of stay(LOS)was longer for HA.The mean charges were less for HA,however charges decreased steadily for both groups.HA had a higher mortality rate,however,after adjusting for age and comorbidities HA was not an independent risk factor for mortality.Interestingly,private insurance was an independent predictor for treatment with THA.CONLUSION There has been an increase in the use of THA for the treatment of femoral neck fractures in the United States,most notably in urban hospitals.HA and THA are decreasing in total charges and LOS.

Coincident Bilateral Atraumatic Hip Fracture in a Young Patient with Renal Osteodystrophy

Bilateral, coincident, atraumatic hip fracture is extremely uncommon and usually occurs secondary to seizures, trauma and metabolic disease including renal osteodystrophy. One of the major types, secondary hyperparathyroidism is associated with high bone turnover due to excess parathyroid hormone and usually seen in a chronic dialysis patient. We reported a 20-year-old woman with end stage renal failure and renal osteodystrophy. She sustained atraumatic right subtrochanteric fracture and left neck of femur fracture (Garden 1), then underwent bilateral long proximal femoral nail. Renal osteodystrophy causes pathological fracture by affecting calcium metabolism that stimulates bone resorptions and leads to osteoporotic bone. The aim of this case report is to discuss the approach and management done to the patient presented to our center. Bilateral long proximal femoral nail (PFN) was chosen, taking into account the patient’s premorbid, age, fracture pattern and potential complications. Careful multidisciplinary team approach led by the orthopaedic surgeon, nephrologist and physical therapist is vital for the patient to achieve good outcome postoperatively, thus reducing morbidity and mortality.

Preventing Lower Extremity Deep Vein Thrombosis After Hip Fracture Surgery in Elderly Patients by Acupoint Application Combined with Pneumatic Compression Therapy

Objective:To investigate and analyze the long-term clinical effects of acupoint application combined with pneumatic compression therapy in the prevention of deep venous thrombosis after hip fracture surgery among the elderly.Methods:Sixty elderly patients who had undergone hip fracture surgery from February 2021 to February 2022 were selected as the research subjects.The patients were divided into two groups via drawing lots.Both the groups received nursing care,but the patients in the observation group were treated with TCM acupoint application combined with pneumatic compression therapy,whereas the control group received pneumatic compression therapy.The evaluation indicators included the patients’quality of life and complications.Results:The incidence of lower extremity deep vein thrombosis in the observation group was more than twice(0.3%),whereas the incidence of lower extremity complications in the control group was more than 6 times(20%).There was a significant difference between the two groups(p<0.05).Conclusion:Traditional Chinese medicine acupoint application combined with pneumatic compression therapy is beneficial for the prevention of postoperative lower extremity deep vein thrombosis among elderly patients.In addition,the patients’overall quality-of-life scores in both physiological and psychological aspects improved significantly,which carries significant clinical reference value.

Comparative effect of intrathecal meperidine,tramadol,magnesium sulfate,and dexmedetomidine on preventing post-spinal anesthesia shivering and adverse events in hip fracture repair patients:A randomized clinical trial

Objective:To compare effect of intrathecal meperidine,tramadol,magnesium sulfate,and dexmedetomidine on the prevention of post-spinal anesthesia shivering and adverse events in hip fracture repair patients.Methods:In a randomized,double-blind trial,132 patients with American Society of Anesthesiology(ASA)ⅠandⅡspinal anesthesia who needed hip fracture surgery were enrolled.Patients were stratified into 4 intervention groups based on a randomized block pattern:meperidine,tramadol,magnesium sulfate,and dexmedetomidine.Hemodynamic parameters including blood pressure,heart rate,and oxygen saturation,as well as the severity of shivering,core body temperature,Ramsay sedation score,adverse events,meperidine consumption were recorded and compared.Results:There was no statistically significant difference in the normal hemodynamic parameters,temperature,duration of surgery,meperidine consumption,and adverse events such as dizziness,hypotension,nausea,and bradycardia among groups(P>0.05).Compared to other groups,severity of shivering was the lower in the dexmedetomidine group 6 and 8 h after surgery.The Ramsay sedation scores were higher in the dexmedetomidine and meperidine groups 4 h after surgery(P=0.020).Conclusion:Dexmedetomidine acts better than the other three adjuvants in reducing complications such as shivering.Overall,these four adjuvants are helpful to prevent postoperative shivering and could be put forward as promising local anesthetics in spinal anesthesia,based on anesthesiologists’discretion and patients’general conditions.Clinical registration:The study was approved by the Research and Ethics Committee at the Valiasr Hospital(Arak,Iran)with the clinical trial code of IRCT20141209020258N153.

Hip Fracture Risk Assessment Based on Different Failure Criteria Using QCT-Based Finite Element Modeling

Precise evaluation of hip fracture risk leads to reduce hip fracture occurrence in individuals and assist to check the effect of a treatment.A subject-specific QCT-based finite element model is introduced to evaluate hip fracture risk using the strain energy,von-Mises stress,and von-Mises strain criteria during the single-leg stance and the sideways fall configurations.Choosing a proper failure criterion in hip fracture risk assessment is very important.The aim of this study is to define hip fracture risk index using the strain energy,von Mises stress,and von Mises strain criteria and compare the calculated fracture risk indices using these criteria at the critical regions of the femur.It is found that based on these criteria,the hip fracture risk at the femoral neck and the intertrochanteric region is higher than other parts of the femur,probably due to the larger amount of cancellous bone in these regions.The study results also show that the strain energy criterion gives more reasonable assessment of hip fracture risk based on the bone failure mechanism and the von-Mises strain criterion is more conservative than two other criteria and leads to higher estimate of hip fracture risk indices.

Predictors and prognostic impact of post-operative atrial fibrillation in patients with hip fracture surgery

BACKGROUND Atrial fibrillation(AF)is the most common arrhythmia developing in postoperative patients.Limited data are available regarding pre-operative risk factors and prognostic impact of post-operative AF(POAF)following hip fracture surgery(HFS)in Korean population.AIM We aimed to investigate the incidence,predictors,and hospital prognosis of POAF in HFS patients.METHODS This study included 245 patients without history of AF who underwent HFS between August 2014 and November 2016.POAF was defined as new-onset AF that occurred during hospitalization after HFS.RESULTS Twenty patients(8.2%)experienced POAF after HFS.POAF developed on median post-operative day 2(interquartile range,1–3).Multivariable logistic regression analysis showed that age[odds ratio(OR),1.111;95%confidence interval(CI),1.022–1.209],chronic obstructive pulmonary disease(COPD)(OR,6.352;95%CI,1.561–25.841)and E/e’ratio(OR,1.174;95%CI,1.002–1.376)were significant predictors of POAF.Patients with POAF had a significantly higher intensive care unit admission rate(55.0%vs 14.7%,P<0.001)and incidence of congestive heart failure(45.0%vs 10.7%,P<0.001).In multivariable logistic regression analysis,POAF was significantly associated with increased incidence of congestive heart failure(OR,4.856;95%CI,1.437–16.411)and intensive care unit admission(OR,6.615;95%CI,2.112–20.718).CONCLUSION POAF was frequently developed in elderly patients following HFS.Age,COPD and elevated E/e’ratio were found as significant predictors of POAF in HFS patients.Patients with POAF significantly experienced intensive care unit admission and incident congestive heart failure during hospitalization.

Parametric Study of Hip Fracture Risk Using QCT-Based Finite Element Analysis

Various parameters such as age,height,weight,and body mass index(BMI)influence the hip fracture risk in the elderly which is the most common injury during the sideways fall.This paper presents a parametric study of hip fracture risk based on the gender,age,height,weight,and BMI of subjects using the subject-specific QCT-based finite element modelling and simulation of single-leg stance and sideways fall loadings.Hip fracture risk is estimated using the strain energy failure criterion as a combination of bone stresses and strains leading to more accurate and reasonable results based on the bone failure mechanism.Understanding the effects of various parameters on hip fracture risk can help to prescribe more accurate preventive and treatment plans for a community based on the gender,age,height,weight,and BMI of the population.Results of this study show an increase in hip fracture risk with the increase of age,body height,weight,and BMI in both women and men under the single-leg stance and the sideways fall configurations.

Management of hip fracture in COVID-19 infected patients

Given that the global population of elderly individuals is expanding and the difficulty of recovery,hip fractures will be a huge challenge and a critical health issue for all of humanity.Although people have spent more time at home during the coronavirus disease 2019(COVID-19)pandemic,hip fractures show no sign of abating.Extensive studies have shown that patients with hip fracture and COVID-19 have a multifold increase in mortality compared to those uninfected and a more complex clinical condition.At present,no detailed research has systematically analyzed the relationship between these two conditions and proposed a comprehensive solution.This article aims to systematically review the impact of COVID-19 on hip fracture and provide practical suggestions.We found that hip fracture patients with COVID-19 have higher mortality rates and more complicated clinical outcomes.Indirectly,COVID-19 prevents hip fracture patients from receiving regular medical treatment.With regard to the problems we encounter,we provide clinical recommendations based on existing research evidence and a clinical flowchart for the management of hip fracture patients who are COVID-19 positive.Our study will help clinicians adequately prepare in advance when dealing with such patients and optimize treatment decisions.

Evidence-based approach to providing informed consent for hip fracture surgery during the COVID-19 era

BACKGROUND Hip fractures are the most common reason for inpatient orthopaedic trauma admission.Urgent surgical intervention for hip fractures has remained a clinical priority throughout the coronavirus disease 2019(COVID-19)pandemic.Despite this,there is a paucity of clinical guidance addressing the informed consent process for hip fracture surgery in COVID-19 positive patients.This is of paramount medicolegal importance in a high-risk patient population.AIM To quantify the additional perioperative risks for COVID-19 positive patients undergoing hip fracture surgery and provide clinicians with an evidence-based framework to establish an informed consent process.METHODS Two hundred and fifty nine consecutive patients undergoing surgical intervention for hip fractures in four hospitals in the United Kingdom were recruited.51 patients were confirmed positive for COVID-19.Predefined outcomes were analyzed over a 30-d postoperative period.COVID-19 positive and COVID-19 negative patients were compared after adjustment for confounding factors.RESULTS COVID-19 positive patients had more intensive care admissions(27%vs 5%,P<0.001),longer inpatient stays(median 23 d vs 9 d,P<0.001)and a higher 30-d mortality(29%vs 10%,P=0.001)than COVID-19 negative patients.Postoperative complications were evident in 74.5%of COVID-19 positive patients.35.3%of COVID-19 positive patients suffered postoperative lower respiratory tract infections with 13.7%developing acute respiratory distress syndrome(ARDS)and 9.8%experiencing symptomatic thromboembolic events.CONCLUSION The COVID-19 pandemic has created uncertainty in the medical community worldwide and poses unique challenges in providing informed consent for surgery.COVID-19 positive patients undergoing hip fracture surgery should be consented for the additional risk of postoperative complications(including lower respiratory tract infection,ARDS,deep vein thrombosis and pulmonary embolism),increased requirement for intensive care admission,longer inpatient stay and higher risk of mortality.Further,clinicians must be transparent about the potential for unknown risks as research into the long-term surgical outcomes of COVID-19 positive patients continues to evolve.

New-onset depression after hip fracture surgery among older patients:Effects on associated clinical outcomes and what can we do?

BACKGROUND Hip fracture in the elderly is a worldwide medical problem.New-onset depression after hip fracture has also received attention because of its increasing incidence and negative impact on recovery.AIM To provide a synthesis of the literature addressing two very important questions arising from postoperative hip fracture depression(PHFD)research:the risk factors and associated clinical outcomes of PHFD,and the optimal options for intervention in PHFD.METHODS We searched the PubMed,Web of Science,EMBASE,and PsycINFO databases for English papers published from 2000 to 2021.RESULTS Our results showed that PHFD may result in poor clinical outcomes,such as poor physical function and more medical support.In addition,the risk factors for PHFD were summarized,which made it possible to assess patients preoperatively.Moreover,our work preliminarily suggested that comprehensive care may be the optimal treatment option for PHFDs,while interdisciplinary intervention can also be clinically useful.CONCLUSION We suggest that clinicians should assess risk factors for PHFDs preoperatively,and future research should further validate current treatment methods in more countries and regions and explore more advanced solutions.

Thirty-day mortality of patients with hip fracture during COVID-19 pandemic and pre-pandemic periods:A systematic review and metaanalysis

BACKGROUND Timely intervention in hip fracture is essential to decrease the risks of perioperative morbidity and mortality.However,limitations of the resources,risk of disease transmission and redirection of medical attention to a more severe infective health problem during coronavirus disease 2019(COVID-19)pandemic period have affected the quality of care even in a surgical emergency.AIM To compare the 30-d mortality rate and complications of hip fracture patients treated during COVID-19 pandemic and pre-pandemic times.METHODS The search of electronic databases on 1st August 2020 revealed 45 studies related to mortality of hip fracture during the COVID-19 pandemic and pre-pandemic times.After careful screening,eight studies were eligible for quantitative and qualitative analysis of data.RESULTS The pooled data of eight studies(n=1586)revealed no significant difference in 30-d mortality rate between the hip fracture patients treated during the pandemic and pre-pandemic periods[9.63%vs 6.33%;odds ratio(OR),0.62;95%CI,0.33,1.17;P=0.14].Even the 30-d mortality rate was not different between COVID-19 non-infected patients who were treated during the pandemic time,and all hip fracture patients treated during the pre-pandemic period(OR,1.03;95%CI,0.61,1.75;P=0.91).A significant difference in mortality rate was observed between COVID-19 positive and COVID-19 negative patients(OR,6.99;95%CI,3.45,14.16;P<0.00001).There was no difference in the duration of hospital stay(OR,-1.52,95%CI,-3.85,0.81;P=0.20),overall complications(OR,1.62;P=0.15)and incidence of pulmonary complications(OR,1.46;P=0.38)in these two-time frames.Nevertheless,the preoperative morbidity was more severe,and there was less use of general anesthesia during the pandemic time.CONCLUSION There was no difference in 30-d mortality rate between hip fracture patients treated during the pandemic and pre-pandemic periods.However,the mortality risk was higher in COVID-19 positive patients compared to COVID-19 negative patients.There was no difference in time to surgery,complications and hospitalization time between these two time periods.