Fragility fractures and imminent fracture risk in Hong Kong: one of the cities with longest life expectancies

Journal of Orthopaedic Translation

Chong

Law

et al. 2020

Summary Objective To analyze the effectiveness of exercise interventions on falls and fall-related fracture prevention among community-dwelling elderlies. Methods Literature search was conducted in Pubmed and Embase. Keywords used for literature search were “fracture” AND “fall” AND “exercise”. Randomized controlled trials involving community-dwelling elderlies older than 60 years old with physical exercises as intervention were included. A systematic review and meta-analysis was performed. The primary outcomes were falls and fractures. Results Twelve studies were included and 4784 participants were involved with a mean age of 75.4. The most common exercise interventions were strength and balance exercises. The results of meta-analysis of 11 studies showed that exercise intervention had beneficial effect on fall prevention (RR = 0.71, 95% CI, 0.62–0.82; I 2 = 24%, p < 0.0001). The effect was better when exercise intervention applied to women participants (RR = 0.64, 95% CI, 0.49–0.83; I 2 = 28%, p = 0.00009) compared to men and women participants (RR = 0.75, 95% CI, 0.64–0.89; I 2 = 24%, p = 0.001). The results of meta-analysis of seven studies showed that physical exercise had significant effect on fracture prevention (RR = 0.54, 95% CI, 0.35–0.83; I 2 = 25%, p = 0.005). However, the effect was significant when exercise intervention applied to women participants only (RR = 0.37, 95% CI, 0.20–0.67; I 2 = 0%, p = 0.001) but not significant when exercise intervention applied to both genders (RR = 0.80, 95% CI, 0.58–1.09; I 2 = 0%, p = 0.15). Conclusion Exercise interventions, especially the combination of strength and balance training, were effective in preventing falls. Resistance exercises and jumping exercises were effective for fracture prevention among community-dwelling older population. The effectiveness of exercise interventions on fracture prevention have more significant effect on women. Further studies are needed to test the effectiveness of exercise interventions in men. Translational potential The use of effective exercises or biophysical interventions including vibration therapy can be incorporated into Fracture Liaison Services to prevent future fall and fracture.

Section: Introductionmentioning

confidence: 99%

The effectiveness of exercises on fall and fracture prevention amongst community elderlies: A systematic review and meta-analysis

Journal of Orthopaedic Translation

Chong

Law

et al. 2020

“…42 Particularly with the ageing population and increase in osteoporotic fractures, there is also an expected increase in the number of more complex surgeries. 43,44…”

Section: Discussionmentioning

confidence: 99%

3D printing in orthopaedic surgery: a scoping review of randomized controlled trials

Liu

et al. 2021

Bone & Joint Research

Self Cite

Aims The use of 3D printing has become increasingly popular and has been widely used in orthopaedic surgery. There has been a trend towards an increasing number of publications in this field, but existing literature incorporates limited high-quality studies, and there is a lack of reports on outcomes. The aim of this study was to perform a scoping review with Level I evidence on the application and effectiveness of 3D printing. Methods A literature search was performed in PubMed, Embase, and Web of Science databases. The keywords used for the search criteria were ((3d print*) OR (rapid prototyp*) OR (additive manufactur*)) AND (orthopaedic). The inclusion criteria were: 1) use of 3D printing in orthopaedics, 2) randomized controlled trials, and 3) studies with participants/patients. Risk of bias was assessed with Cochrane Collaboration Tool and PEDro Score. Pooled analysis was performed. Results Overall, 21 studies were included in our study with a pooled total of 932 participants. Pooled analysis showed that operating time (p < 0.001), blood loss (p < 0.001), fluoroscopy times (p < 0.001), bone union time (p < 0.001), pain (p = 0.040), accuracy (p < 0.001), and functional scores (p < 0.001) were significantly improved with 3D printing compared to the control group. There were no significant differences in complications. Conclusion 3D printing is a rapidly developing field in orthopaedics. Our findings show that 3D printing is advantageous in terms of operating time, blood loss, fluoroscopy times, bone union time, pain, accuracy, and function. The use of 3D printing did not increase the risk of complications. Cite this article: Bone Joint Res 2021;10(12):807–819.

“…This concurs with other studies that have stated the higher risk of revision for cementless fixation, which is largely due to implant subsidence with poor bone quality elderly patients 28 . With the emergence of Fracture Liaison Services (FLS) 1 , 5 , 29 , 30 as the standard of care, coordinators need to identify these patients, especially those at-risk, promptly for physiotherapy to maximize functional outcome. In fact, the International Osteoporosis Foundation recommendations for FLS aims to treat the bone as well as the rehabilitation of patients for best clinical outcomes 30 .…”

Section: Discussionmentioning

confidence: 99%

“…Fragility hip fractures are one of the most common injuries which is significantly associated with high morbidity and mortality 1 . More importantly, the recent concept of imminent risk of fragility fractures after an initial one has highlighted the importance in identifying the prognostic factors of deterioration 1 , 2 . In fact, approximately 50% of secondary fractures occur during this period of 2 years after the primary fragility fracture.…”

Section: Introductionmentioning

confidence: 99%

Prognostic factors related to ambulation deterioration after 1-year of geriatric hip fracture in a Chinese population

Qin

Chau

et al. 2021

Sci Rep

Self Cite

The objective of this study was to investigate the prognostic factors predicting the ambulation recovery of fragility hip fracture patients. 2286 fragility hip fracture patients were collected from the Fragility Fracture Registry in Hong Kong. Predictive factors of ambulation deterioration including age, gender, pre-operation American Society of Anesthesiologists grade, pre-fracture mobility, delay to surgery, length of stay, fracture type, type of surgery, discharge destination and complications were identified. Patients with outdoor unassisted and outdoor with aids ambulatory function before fracture had 3- and 1.5-times increased risk of mobility deterioration, respectively (Odds Ratio (OR) = 2.556 and 1.480, 95% Confidence Interval (CI) 2.101–3.111 and 1.246–1.757, both p < 0.001). Patients living in old age homes had almost 1.4 times increased risk of deterioration when compared to those that lived in their homes (OR = 1.363, 95% CI 1.147–1.619, p < 0.001). The risk also increased for every 10 years of age (OR = 1.831, 95% CI 1.607–2.086, p < 0.001). Patients in the higher risk ASA group shows a decreased risk of ambulation deterioration compared to those in lower risk ASA group (OR = 0.831, 95% CI 0.698–0.988, p = 0.038). Patients who suffered from complications after surgery did not increased risk of mobility decline at 1-year post-surgery. Delayed surgery over 48 h, delayed discharge (> 14 days), early discharge (less than 6 days), and length of stay also did not increased risk of mobility decline. Male patients performed worse in terms of their mobility function after surgery compared to female patients (OR = 1.195, 95% CI 1.070–1.335, p = 0.002). This study identified that better premorbid good function, discharge to old age homes especially newly institutionalized patients, increased age, lower ASA score, and male patients, correlate with mobility deterioration at 1-year post-surgery. With the aging population and development of FLS, prompt identification of at-risk patients should be performed for prevention of deterioration.