The aims of this study were to identify the early in-hospital mortality rate after hip fracture, identify factors associated with this mortality, and identify the cause of death in these patients. A retrospective cohort study was performed on 4426 patients admitted to our institution between the 1 January 2006 and 31 December 2013 with a hip fracture (1128 male (26%), mean age 82.0 years (60 to 105)). Admissions increased annually, but despite this 30-day mortality decreased from 12.1% to 6.5%; 77% of these were in-hospital deaths. Male gender (odds ratio (OR) 2.0, 95% confidence interval (CI) 1.3 to 3.0), increasing age (age ≥ 91; OR 4.1, 95% CI 1.4 to 12.2) and comorbidity (American Society of Anesthesiologists grades 3 to 5; OR 4.2, 95% CI 2.0 to 8.7) were independently and significantly associated with increased odds of in-hospital mortality. From 220 post-mortem reports, the most common causes of death were respiratory infections (35%), ischaemic heart disease (21%), and cardiac failure (13%). A sub-group of hip fracture patients at highest risk of early death can be identified with these risk factors, and the knowledge of the causes of death can be used to inform service improvements and the development of a more didactic care pathway, so that multidisciplinary intervention can be focused for this sub-group in order to improve their outcome.

BackgroundFoot pain drawings (manikins) are commonly used to describe foot pain location in self-report health surveys. Respondents shade the manikin where they experience pain. The manikin is then scored via a transparent overlay that divides the drawings into areas. In large population based studies they are often scored by multiple raters. A difference in how different raters score manikins (inter-rater repeatability), or in how an individual rater scores manikins over time (intra-rater repeatability) can therefore affect data quality. This study aimed to assess inter- and intra-rater repeatability of scoring of the foot manikin.MethodsA random sample was generated of 50 respondents to a large population based survey of adults aged 50 years and older who experienced foot pain and completed a foot manikin. Manikins were initially scored by any one of six administrative staff (Rating 1). These manikins were re-scored by a second rater (Rating 2). The second rater then re-scored the manikins one week later (Rating 3). The following scores were compared: Rating 1 versus Rating 2 (inter-rater repeatability), and Rating 2 versus Rating 3 (intra-rater repeatability). A novel set of clinically relevant foot pain regions made up of one or more individual areas on the foot manikin were developed, and assessed for inter- and intra-rater repeatability.ResultsScoring agreement of 100% (all 50 manikins) was seen in 69% (40 out of 58) of individual areas for inter-rater scoring (range 94 to 100%), and 81% (47 out of 58) of areas for intra-rater scoring (range 96 to 100%). All areas had a kappa value of ≥0.70 for inter- and intra-rater scoring. Scoring agreement of 100% was seen in 50% (10 out of 20) of pain regions for inter-rater scoring (range 96 to 100%), and 95% (19 out of 20) of regions for intra-rater scoring (range 98 to 100%). All regions had a kappa value of >0.70 for inter- and intra-rater scoring.ConclusionsIndividual and multiple raters can reliably score the foot pain manikin. In addition, our proposed regions may be used to reliably classify different patterns of foot pain using the foot manikin.

ObjectiveTo identify the population prevalence of posterior heel pain (HP), related disability, and associated factors.MethodsA total of 9,334 adults ages ≥50 years were mailed a questionnaire. Participants reporting foot pain in the last month shaded the foot pain location on a manikin. The Manchester Foot Pain and Disability Index assessed disabling foot pain. Population prevalence of any, bilateral, and disabling posterior HP was estimated using weighted logistic regression accounting for nonresponse. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated between posterior HP and age, sex, neighborhood deprivation, occupational class (professional, intermediate, and manual), body mass index (BMI, kg/m2), physical activity, heel height, and diabetes mellitus.ResultsA total of 5,109 questionnaires were received (adjusted response 56%). Six hundred seventy‐five respondents (13%) reported posterior HP, of whom 382 had bilateral symptoms. A total of 398 (8%) reported disabling posterior HP. Posterior HP in either foot was associated with increasing BMI (25.0–29.9 [OR 1.58], 30.0–34.9 [OR 2.13], and ≥35.0 [OR 4.09]) and with manual occupations (OR 1.96, 95% CI 1.47–2.62). Bilateral posterior HP was associated with increasing BMI (25.0–29.9 [OR 1.79], 30.0–34.9 [OR 2.43], and ≥35.0 [OR 5.79]), diabetes mellitus (OR 1.48, 95% CI 1.07–2.05), and manual occupations (OR 2.21, 95% CI 1.48–3.30). Disabling posterior HP was associated with increasing BMI (25.0–29.9 [OR 1.44], 30.0–34.9 [OR 2.50], and ≥35.0 [OR 4.69]), age (≥75 years OR 1.41, 95% CI 1.01–1.96), manual occupations (OR 1.97, 95% CI 1.35–2.88), and diabetes mellitus (OR 1.56, 95% CI 1.04–1.95). High physical activity was negatively associated with posterior HP in either heel (OR 0.43, 95% CI 0.33–0.56), bilateral posterior HP (OR 0.35, 95% CI 0.25–0.49), and disabling posterior HP (OR 0.33, 95% CI 0.23–0.46).ConclusionPosterior HP is prevalent and associated with obesity, manual occupations, and physical inactivity. Prospective studies should assess the roles of obesity in causation and weight loss in treatment.

Lipomas are benign tumours that consist of mature adipocytes. They are the commonest soft tissue tumours, most frequently seen in the trunk and proximal extremities. Lesions in the hand are uncommon, and giant lipomas of the hand, defined as greater than 5 cm in size, are particularly rare. We present a case of an exceptionally large giant lipoma of the hand, presenting as an extremely large inconvenient swelling of the palm in a 67-year-old woman. The diagnosis of lipoma was suggested via ultrasonography, and confirmed via MRI and histology. The lesion was successfully excised with no postoperative neurovascular deficit. The excised lesion measured 8×6×3 cm, one of the largest giant lipomas of the hand reported to date. When patients present with large lesions such as these a malignant cause must always be considered, and appropriate early imaging is essential when assessing these patients.

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