Hip fracture care—Latin America

Rojas, Luis Gerardo Padilla; Hernández, Sergio Quintero; Ávila, José María Jiménez; Cervantes, Roberto Enrique López; Enghelmayer, Rafael Amadei; Pesciallo, César Ángel; Garabano, Germán; MacKechnie, Madeline C.; Quintero, José Eduardo; Kojima, Kodi Edson

doi:10.1097/oi9.0000000000000064

Cited by 10 publications

(6 citation statements)

References 16 publications

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“…Hip fractures in the elderly are already a public health issue in the world and they are only expected to grow with increasing life expectancy levels. 1,2 The most common treatments for unstable intertrochanteric hip fractures are internal fixation and prosthetic surgery. 3e5 Mechanical failure has been reported in 20e36% of the cases treated with osteosynthesis and between 2 and 8.4% of those treated with prosthesis.…”

Section: Introductionmentioning

confidence: 99%

Bipolar hemiarthroplasty in unstable intertrochanteric fractures in elderly patients. The predictive value of the Charlson Comorbidity Index in 1-year mortality

Garabano

Pesciallo

Alamino

et al. 2022

Journal of Clinical Orthopaedics and Trauma

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Background: Hip fractures have a significant impact on morbidity and mortality in the elderly. Aims: We retrospectively evaluated the predictive role of the Charlson Comorbidity Index (CCI) for 1-year mortality in elderly patients with unstable intertrochanteric hip fractures (ITHF) treated with bipolar hemiarthroplasty. The secondary objective was to identify other relationships, if any, between the variables recorded and mortality. Methods: We included 75-year-old patients with unstable ITHF treated with bipolar hemiarthroplasty. We recorded patient gender, age, Body Mass Index, pre-fracture walking ability (Parker Mobility score, modified Harris Hip Score), America Society of Anesthesiologists (ASA) score, Charlson Comorbidity Index (CCI), time to surgery, time to mobilization, hospital stay, and postoperative complications. Uniand multivariate logistic regression analysis were performed. Sensitivity and specificity were calculated using a ROC curve. Results: A total of 135 patients with a mean age of 87.34 ± 5.5 years were included. The overall 1-year mortality rate was 18.5%. The CCI (OR 1.64 CI 95% 1.21e2.23; p 0.00821) and postoperative complications (OR 3.5 CI 95% 1.19e10.23 p 0.0202) were identified as independent predictors of 1-year mortality in the univariate regression and confirmed in the multivariate regression. CCI sensitivity to predict 1-year mortality was 80%. Conclusion: CCI has shown acceptable sensitivity in the prediction of 1-year mortality in elderly patients with unstable ITHF treated with bipolar hemiarthroplasty. It is of utmost importance to prevent postoperative complications due to their significant impact on 1-year mortality.

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Section: Introductionmentioning

confidence: 99%

Bipolar hemiarthroplasty in unstable intertrochanteric fractures in elderly patients. The predictive value of the Charlson Comorbidity Index in 1-year mortality

Garabano

Pesciallo

Alamino

et al. 2022

Journal of Clinical Orthopaedics and Trauma

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“…In Mexico, hip fracture rates are suggested to be increasing at a rate of 1% per year 27 . With the rising burden of geriatric hip fractures in Latin America, and associated morbidity and mortality, it is not surprising that hip fracture management is important to orthopaedic trauma surgeons in the region 28 .…”

Section: Discussionmentioning

confidence: 99%

Orthopaedic Trauma Research Priorities in Latin America

Roberts

MacKechnie

Shearer

et al. 2021

Journal of Bone and Joint Surgery

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Background: Despite a substantial burden of musculoskeletal injury, orthopaedic trauma studies in Latin America are lacking.The purpose of the present study was to identify research priorities among orthopaedic trauma surgeons in Latin America.Methods: Research questions were solicited from members of the Asociación de Cirujanos Traumatólogos de las Américas. Participants rated questions by importance from 1 to 9. All questions were redistributed with an aggregate rating, and participants rerated questions with knowledge of group responses.Results: Seventy-eight participants completed the first survey and were included in subsequent surveys. The mean age was 51.8 years, and most participants were male (92%), had completed an orthopaedic trauma fellowship (60.3%), and participated in research (80.8%). Seventeen countries were represented; 5 respondents were from a high-income country, 67 were from an upper middle-income country, and 6 were from a lower middle-income country. Sixty-five questions were identified. Six questions were rated from 1 to 3 ("more important") by >70% of participants: (1) What is the optimal treatment protocol for elderly patients with hip fracture? (2) What is the most effective initial and definitive management of musculoskeletal injury, including timing and surgical strategy, for the polytraumatized patient? (3) What is the ideal state of open fracture treatment, including timeliness and method of antibiotics, debridement, surgical fixation, and closure or coverage, at each hospital level in the health-care system? (4) What patient and fracture characteristics predict infection after musculoskeletal injury? (5) What is the current state of treatment for fracture-related infection, including timeliness and method of antibiotics and surgical intervention, at each hospital level in the health-care system? (6) What is the optimal protocol for temporary management for the hemodynamically unstable patient with a pelvic or acetabular fracture?Conclusions: This modified Delphi study of orthopaedic trauma surgeons in Latin America identified geriatric hip fractures, polytrauma, open fractures, musculoskeletal infection, and pelvic and acetabular fractures as top research priorities. This information is important for resource allocation and goal setting for orthopaedic trauma in the region. Building health research capacity is necessary to help guide future treatment on critical clinical questions 1 . Over the last 2 decades, developing and advancing health research has become an increasingly recognized global health priority, particularly for musculoskeletal injury care. Traumatic injury is a leading cause of mortality and disability worldwide, with an estimated 1.2 million deaths and 50 million non-fatal injuries every year, many of which are due to musculoskeletal trauma [2][3][4][5] . Low and middle-income countries (LMICs), including those in Latin America, are dispropor-tionately affected by this burden, with the highest number of deaths per capita compared with higher-income countries 5 .De...

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“…As mentioned, hip fracture is one of the most important problems the elderly face, affecting approximately 1.6 million people per year worldwide, with a projection of 6.3 million for 2050 [ 6 , 7 ]. In Latin America, a rise in hip fractures has been noted, but the accuracy of the information is generally poor [ 8 , 9 ]. Argentina is not the exception, with some approximations extracted from published research estimating an incidence in women of 252 fractures/100,000 inhabitants/year (range 144 to 405) and men from 78 to 181 [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Alliance for the development of the Argentinian Hip Fracture Registry

Monteverde

Diehl²,

Saieg³

et al. 2022

Arch Osteoporos

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Summary Age expectancy has significantly increased over the last 50 years, as well as some age-related health conditions such as hip fractures. The development of hip fracture registries has shown enhanced patient outcomes through quality improvement strategies. The development of the Argentinian Hip Fracture Registry is going in the same direction. Introduction Age expectancy has increased worldwide in the last 50 years, with the population over 64 growing from 4.9 to 9.1%. As fractures are an important problem in this age group, specific approaches such as hip fracture registries (HFR) are needed. Our aim is to communicate the Argentinian HFR (AHFR) development resulting from an alliance between Fundación Trauma, Fundación Navarro Viola, and the Argentinian Network of Hip Fracture in the elderly. Methods Between October 2020 and May 2021, an iterative consensus process involving 5 specialty-focused meetings and 8 general meetings with more than 20 specialists was conducted. This process comprised inclusion criteria definitions, dataset proposals, website deployment with data protection and user validation, the definition of hospital-adjusted registry levels, implementation planning, and sustainability strategies. Results By June 2021, we were able to (1) outline data fields, including epidemiological, clinical, and functional dimensions for the pre-admission, hospitalization, discharge, and follow-up stages; (2) define three levels: basic (53 fields), intermediate (85), and advanced (99); (3) identify 21 benchmarking indicators; and (4) make a correlation scheme among fracture classifications. Simultaneously, we launched a fundraising campaign to implement the AHFR in 30 centers, having completed 18. Conclusion AHFR development was based on four pillars: (1) representativeness and support, (2) solid definitions from onset, (3) committed teams, and (4) stable funding. This tool may contribute to the design of evidence-based health policies to improve patient outcomes, and we hope this experience will help other LMICs to develop their own tailored-to-their-needs registries.

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Hip fracture care—Latin America

Cited by 10 publications

References 16 publications

Bipolar hemiarthroplasty in unstable intertrochanteric fractures in elderly patients. The predictive value of the Charlson Comorbidity Index in 1-year mortality

Bipolar hemiarthroplasty in unstable intertrochanteric fractures in elderly patients. The predictive value of the Charlson Comorbidity Index in 1-year mortality

Orthopaedic Trauma Research Priorities in Latin America

Alliance for the development of the Argentinian Hip Fracture Registry

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