This study aims to determine pre-morbid parameters as possible predictors of outcome of hip fracture in octogenarians with unstable intertrochanteric fracture treated operatively. Presence of co-morbidities, pre-injury level of ambulation, type of surgery, and period of delay in surgery were considered, and their effect on the post-operative outcome was evaluated using the Harris Hip Score. The computed probability of survival of octogenarians who had surgery was approximately 11 months. In patients with two or more co-morbidities, there is a significant effect on Harris Hip Score in terms of pain and deformity. Delay in surgery of more than two weeks significantly decreased the distance travelled at one year. The overall recovery is correlated to preinjury level of ambulation and delay in surgery. Patients with intertochanteric fracture in this age group, who have less co-morbidities and with more independent ambulation, are good candidates for timely operative treatment.
The aim of this paper is to document a rare case of construct failure in a 68-year old Filipina who sustained an atypical femoral fracture (AFF) in her left subtrochanteric area. The patient previously had a 40-month history of alendronate 70mg + vitamin D 5600u therapy for osteoporosis and underwent closed intramedullary nailing for the AFF. Six months postoperatively, she began to experience progressive pain in her operated thigh. Radiographs revealed a broken nail at the proximal screw hole and non-union of the AFF. The patient was treated with exposure of the fracture site, removal of the broken device, exchange intramedullary nailing, and iliac bone grafting. She had radiographic and clinical union and was full weight bearing after three months.
Objective: This study investigated the correlation of 8 domains of psychosocial factors with functional outcome one year after hip fracture surgery.A prospective cohort study of patients who had unilateral hip fracture surgery was included. A total of 89 subjects were interviewed between 3rd to 7th day after the hip surgery using the short length Multi-level Assessment Instrument and followed up after 1 year. The functional outcomes were measured through the Harris Hip Score.All of the psychosocial factors have little to no correlation on the functional recovery of the patient but the cognitive domain had a fair correlation in Harris Hip Score (r=0.46) and is significant (p-value<0.0001).The study did not find strong correlation between psychosocial factors and functional outcome one year after unilateral hip surgery. Although statistics have shown little effect on psychosocial factors to functional outcome, it may still be prudent to consider every aspect that may contribute to the whole wellbeing of our patients, which includes their psychosocial background.
The aim of this study was to evaluate our experience with regard to the outcome of displaced two-part fractures of the humeral neck in elderly patients that were treated conservatively. Between July 2008 and June 2010, 53 consecutive patients (42 females and 11 males; mean age = 74; range = 60-92) with an acute, displaced, two-part fracture of the humeral neck were treated conservatively using a sling and swathe for two weeks, followed by a standard rehabilitation protocol. The inclusion criteria were a displacement of the shaft >50% of its width and/or angulation of the shaft >45 degrees on standard radiographs. The exclusion criteria were patients younger than 60 years of age and those with cognitive or systemic impairment that would preclude the recommended physiotherapy. Patients were followed-up for one year, and were assessed at 3, 6, and 12 months using the Constant- Murley Score (CMS) and the Disabilities of the Arm, Shoulder, and Hand Questionnaire (DASH). Patients were divided into two groups, those below 70 years of age and those above 70-. Two-way repeated measures analysis of variance (ANOVA) was used to determine if there were significant differences between the results at 3, 6 and 12 months for both groups, and if the results were significantly different between the two groups.Forty-eight out of 53 patients (91%) were able to complete the follow-up schedule, while five patients died. The mean CMS improved progressively at three (51.3), six (60.4), and 12 (61.3) months. The mean DASH also improved progressively at three (38.8), six (34.8), and 12 (32.6) months. For both groups, the CSS and DASH improved significantly from three to six months and from three to 12 months. However, the improvements were not significant from just six to 12 months. Between the two groups, the results at three, six, and 12 months were not significantly different from each other. On final follow-up, 42 out of 48 patients (88%) were satisfied with their outcome and reported that they would choose to undergo the same treatment if they had to do everything all over again.Conservative management of displaced two-part fractures of the humeral neck in elderly patients is a safe, efficacious, and acceptable treatment.
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