Guías clínicas de fractura de cadera. Comparación de sus principales recomendaciones

Mas, Yadira Bardales; González-Montalvo, Juan Ignacio; Soler, Pedro Abizanda; Alarcón, María Teresa Alarcón

doi:10.1016/j.regg.2012.02.014

Cited by 42 publications

(28 citation statements)

References 15 publications

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“…Even if there is no clear and structured protocol to improve mobility after surgery for femoral fracture (Cochrane Review, Handoll [16], AAOS), numerous international guidelines (NICE [17], SIGN [18], NZGG, SEGG-SECOT, and GEIOS [19]) recommend that mobilization start on the day of the operation or the day after. A prospective study by Koval et al.…”

Section: Discussionmentioning

confidence: 99%

48 h for femur fracture treatment: are we choosing the wrong quality index?

et al. 2019

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Background In the last 10 years, the rate of femur fractures treated within 48 h from trauma has been introduced as a performance index for hospital management in Italy. Literature showed a significant indirect correlation between early treatment and mortality/comorbidity. The aims of early treatment are pain management and reduction of time to ambulation. The purpose of this study is to evaluate whether early treatment has reduced time to ambulation in femur fracture. Materials and methods All patients admitted to two level I trauma centers with proximal femoral fracture between 1/1/2017 and 31/12/2017 were included in this study. Exclusion criteria were patient age younger than 65 years, death before surgery, and nonsurgical treatment. The following data were collected: age, gender, date and time of admission to emergency department, height, weight, body mass index (BMI), type and side of fracture, American Society of Anesthesiologists (ASA) score, date and time of surgery, surgical time, length of hospitalization, death during hospitalization, time from surgery to physiotherapy start, and time from surgery to first walking day. Results The study sample resulted in 660 patients. Mean age was 82 years, 64 % were female, mean BMI was 24 kg/m 2 , mean ASA score was 2.7, and 42 % were medial fractures. Mean time from admission to surgery was 95 h; 49.8 % were treated within the first 48 h. Mean time from surgery to physiotherapy start was 2 days, 21 % were not able to walk during hospitalization, time from surgery to first walking day was 5 days, and mean hospitalization time was 15 days. Early surgery was significantly ( p = 0.008) associated with the probability of ambulation recovery during hospitalization. No association ( p = 0.513) was found between early surgery and time in bed without walking. Conclusions Early surgery in femur fracture became a priority in the health system. However, according to our data, although 51 % of patients were treated within the first 48 h, time from surgery to physiotherapy start (2 days) was still too long. Furthermore, time from surgery to first walking day was 6 days, longer than in most published papers. These data suggest that the performance index (rate of femur fractures treated within 48 h) may be improved by changing it to rate of femur fractures surgically treated with return to walking in 96 h. Level of evidence Level 4 (retrospective study).

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Section: Discussionmentioning

confidence: 99%

48 h for femur fracture treatment: are we choosing the wrong quality index?

et al. 2019

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“…Osteoporotic frailty fractures can cause substantial pain, and one of the side effects of the analgesic opiate derivatives used to treat this condition is constipation [ 38 ], also present in this pattern, although it can be caused by immobility as well [ 39 ]. Moreover, the severe and abrupt disabilities associated with hip fractures often lead to a decreased quality of life in older women, which may explain the inclusion of depression in this pattern [ 40 ].…”

Section: Discussionmentioning

confidence: 99%

Multimorbidity Patterns in Hospitalized Older Patients: Associations among Chronic Diseases and Geriatric Syndromes

et al. 2015

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Background/ObjectivesThe clinical status of older individuals with multimorbidity can be further complicated by concomitant geriatric syndromes. This study explores multimorbidity patterns, encompassing both chronic diseases and geriatric syndromes, in geriatric patients attended in an acute hospital setting.DesignRetrospective observational study.SettingUnit of Social and Clinical Assessment (UVSS), Miguel Servet University Hospital (HUMS), Zaragoza (Spain). Year, 2011.ParticipantsA total of 924 hospitalized patients aged 65 years or older.MeasurementsData on patients’ clinical, functional, cognitive and social statuses were gathered through comprehensive geriatric assessments. To identify diseases and/or geriatric syndromes that cluster into patterns, an exploratory factor analysis was applied, stratifying by sex. The factors can be interpreted as multimorbidity patterns, i.e., diseases non-randomly associated with each other within the study population. The resulting patterns were clinically assessed by several physicians.ResultsThe mean age of the study population was 82.1 years (SD 7.2). Multimorbidity burden was lower in men under 80 years, but increased in those over 80. Immobility, urinary incontinence, hypertension, falls, dementia, cognitive decline, diabetes and arrhythmia were among the 10 most frequent health problems in both sexes, with prevalence rates above 20%. Four multimorbidity patterns were identified that were present in both sexes: Cardiovascular, Induced Dependency, Falls and Osteoarticular. The number of conditions comprising these patterns was similar in men and women.ConclusionThe existence of specific multimorbidity patterns in geriatric patients, such as the Induced Dependency and Falls patterns, may facilitate the early detection of vulnerability to stressors, thus helping to avoid negative health outcomes such as functional disability.

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“…Orthogeriatric models of care have demonstrated being the future for the elderly fractured patient, with a special interest in the organization of an additional estructure of secondary prevention that it is giving extraordinary results, the Fracture Liason Services. 128,[142][143][144][145]…”

Section: Discussionmentioning

confidence: 99%

“…Currently, the principal CPGs recommend orthogeriatric collaboration in the treatment of patients with hip fractures, 128 because it has demonstrated important benefits such as reduction in hospital complications, higher rate of surgical treatment, earlier surgery, shorter average hospital stay, improvement in the functional situation upon discharge and long term, greater prescription of treatment for osteoporosis upon discharge, better planning of the level of care after hospital discharge, lower rate of re-admittance and overall, a reduction in mortality. [129][130][131][132][133][134][135][136][137][138][139][140][141][142][143] There are numerous studies that indicate that the multidisciplinary treatment of hip fractures improves the percentage of patients who receive treatment for osteoporosis.…”

Section: Methods For the Treatment Of Fractures And The Secondary Prevmentioning

confidence: 99%

Efficacy, cost, and aspects to take into account in the treatment of osteoporosis in the elderly

Sáez-López

Etxebarría-Foronda

Lampré³

et al. 2019

Revista Española de Geriatría y Gerontología

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Age is one of the principal risk factors for development of frailty fractures. Age pyramids show a population that is becoming increasingly more elderly, with an increasing incidence of fractures, and the forecasts for the future are truly alarming. Adequate handling of these patients who are especially at risk, at both the preventive and care levels, with a well-defined orthogeriatric model is necessary to respond to this clinical challenge. The objective of this review is to analyze the efficacy of the different strategies for the handling of geriatric patients with fracture risk.

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Guías clínicas de fractura de cadera. Comparación de sus principales recomendaciones

Cited by 42 publications

References 15 publications

48 h for femur fracture treatment: are we choosing the wrong quality index?

48 h for femur fracture treatment: are we choosing the wrong quality index?

Multimorbidity Patterns in Hospitalized Older Patients: Associations among Chronic Diseases and Geriatric Syndromes

Efficacy, cost, and aspects to take into account in the treatment of osteoporosis in the elderly

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