Management of hip fracture in the older people: rationale and design of the Italian consensus on the orthogeriatric co-management

Vincentis, Antonio De; Behr, Astrid Ursula; Bellelli, Giuseppe; Bravi, Marco; Castaldo, Anna; Cricelli, Claudio; Galluzzo, Lucia; Iolascon, Giovanni; Maggi, Stefania; Martini, Emilio; Momoli, Alberto; Onder, Graziano; Paoletta, Marco; Roselli, Mauro; Ruggeri, Mauro; Santacaterina, Fabio; Tritapepe, Luigi; Zurlo, Amedeo; Incalzi, Raffaele Antonelli

doi:10.1007/s40520-020-01574-4

Cited by 21 publications

(24 citation statements)

References 33 publications

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“…The relationship between the surgical delay and the increase in morbidity and mortality, the risk of infection and other complications is well described in the literature [16]. It has been shown that surgically treating patients with hip fractures in the rst 24-48 hours decreases their hospital stay, the incidence of pressure ulcers [3,17], the perioperative pain and medical complications signi cantly, favouring their return to independent living and decreasing the mortality rate, especially at 30 days [3,4,7,18].…”

Section: Discussionmentioning

confidence: 99%

“…Several studies found that up to 70% of the these patients need perioperative allogeneic blood transfusion [14,26]. It is described that the major factors that have an in uence to receive blood transfusion are age, comorbidities, type of fracture and surgery performed (extracapsular fractures treated with intramedullary nailing are the cause of more anaemia) [26], the type of surgery performed and the haemoglobin concentration at admission [7,14]. Close monitoring of patients and presurgical optimization have made that in our sample the level of blood transfusions have increased from 27.2% in 2012 to 53.1% in 2017.…”

Section: Discussionmentioning

confidence: 99%

“…The specialty of Orthogeriatrics was developed in England at the end of 1950. In the literature it is described that the joint work with the Department of Orthopaedics has a long history when treating patients with hip fractures and it is associated with important bene ts such as reduced mortality rates, hospital stay and decreased hospital costs [6,7]. This leads to improvements in clinical and functional outcomes since it allows an early mobilization and a faster functional recovery of these patients [8].…”

Section: Introductionmentioning

confidence: 99%

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Influence of Orthogeriatrics on the Morbidity and Mortality of Patients with Hip Fracture.

Balvís-Balvís¹,

Domínguez-Prado²,

Ferradas-Garcia³

et al. 2020

Preprint

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BACKGROUND: Osteoporotic hip fractures often occur in fragile, elderly patients and are associated with a significant morbidity and mortality. The objective of this study is to evaluate the morbidity and mortality together with the length of hospital stay in patients with hip fracture in two non-consecutive years and to compare their evolution with the involvement of a specialist in orthogeriatric care.MATERIAL AND METHODS: Retrospective study that reviewed a total of 633 patients with an average age of 85.5 years who suffered a hip fracture and were treated in the same service of Trauma and Orthopaedics in two different years (2012 and 2017). We have analysed mortality, morbidity during their hospital stay, the length of hospital stays and the cost-benefit after the implication of a specialist in orthogeriatric care in 2017.RESULTS: Mortality during their hospital stay decreased significantly from 10% in 2012 to 3.6% in 2017. We have also observed a decrease in mortality at 30 days (10.5% versus 7%) and after one year (28.9% versus 24.9%) between both groups, although these differences were not statistically significant. The length of hospital stays decreased significantly between both periods observed. The average stay decreased by 4.8 days, the surgical delay decreased by 1.1 days and the postoperative hospital stay decreased by 3.4 days. The total annual economic savings estimated due to the involvement of a geriatrician in the follow-up of patients with hip fracture was 1,017.084.94€.CONCLUSIONS: The multidisciplinary approach of patients with hip fracture results in a more effective and more efficient care model. The quality of care and the clinical care optimisation of patients in the perioperative period improve and both hospital stay and mortality during hospital stay decrease significantly. A significant economic saving is also obtained in the treatment of this pathology.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Influence of Orthogeriatrics on the Morbidity and Mortality of Patients with Hip Fracture.

Balvís-Balvís¹,

Domínguez-Prado²,

Ferradas-Garcia³

et al. 2020

Preprint

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“…It is important to note that osteoporotic acetabular fractures might be managed following different surgical principles, compared to the high-energy fractures observed in young patients. Moreover, it could be difficult to achieve the anatomical reduction and stable fixation of osteoporotic QP fractures, because of the QP location in the true pelvis and juxta-articular position, the frequent fracture comminution and the poor bone quality [18,19].…”

Section: Introductionmentioning

confidence: 99%

Internal fixation of acetabular quadrilateral plate fractures in elderly patients: Could the fracture reduction quality affect their functional recovery?

et al. 2020

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Background Osteoporotic acetabular fractures frequently involve the quadrilateral plate (QP), a flat and thin bone constituting the medial wall of the acetabulum. This study aims to assess the impact of the quality of osteoporotic QP fractures reduction on the patients’ functional recovery, at 24 months follow-up. Methods Patients referring with osteoporotic QP fractures to our Level I trauma centre were prospectively recruited. Inclusion criteria: patients aged 60 years old or older; osteoporosis, defined as Dual-energy X-ray Absorptiometry (DXA) T-score ≤ − 2.5; acute acetabular fracture; anatomic or good fracture reduction according to Matta on postoperative CT. Exclusion criteria: moderate cognitive impairment (defined as Mini-Mental State Examination < 19); a history of malignant neoplasm; concomitant fractures in other sites; traumatic head injury; lower limb joint prostheses; patient not able to walk independently before trauma; poor fracture reduction, according to Matta, on postoperative CT. All the QP fractures were surgically managed. After surgery, the reduction of each QP fracture was classified as anatomical (displacement 0–1 mm), good (displacement 2–3 mm) and poor (displacement > 3 mm) on postoperative CT. Based on this classification: patients with a poor fracture reduction were excluded from this study, patients with an anatomical reduction were recruited in Group-A and patients with a good reduction in Group-B. All the patients underwent a clinical and radiographic 24-months follow-up. Results 68 patients (males 38; females 30; mean age 68.6 years old; range 60–79) were finally included in in the study. No cases of open fractures or concomitant pelvic ring fractures were observed. Based on the post-operative CT, 39 patients showed an anatomic fracture reduction (Group-A) while the remaining 29 patients revealed a good fracture reduction (Group-B). Complication rates and mean clinical scores showed no significant differences between groups, at 24-months follow-up. Conclusions In this study, the functional recovery at 24 months follow-up showed no significant differences in elderly patients with QP fracture undergoing anatomical reconstruction (displacement 0–1 mm) compared to patients receiving a good QP fracture reconstruction (displacement ≤ 3 mm).

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“…In this scenario, the prolonged life expectancy, the inappropriate eating behaviors and lifestyle have contributed to the increased incidence of osteoporosis, a skeletal metabolic chronic disease characterized by compromised bone strength due to the reduction of both bone quantity and quality. The decreased bone strength leads the affected subjects to an increased risk of developing vertebral e non-vertebral fragility fractures, with increased morbidity, mortality, health service utilization, health care costs, and deterioration of quality of life [2][3][4][5][6][7][8].…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of Denosumab Therapy after Treatment with Bisphosphonates in Women Affected by Osteoporosis: A Real-Life Study

Marocco¹,

Zimatore²,

Mocini³

et al. 2020

Preprint

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Denosumab is a human monoclonal antibody that neutralizes RANKL, a cytokine able to interact with the RANK receptor on preosteoclasts and osteoclasts, decreasing their recruitment and differentiation, leading to a decreased bone resorption. The aim of this observational real-life study was to analyze adherence to denosumab therapy, its effectiveness in increasing bone mineral density (BMD) and in modulating biochemical skeletal markers upon previous treatments with bisphosphonates in a group of post-menopausal women affected by osteoporosis. Women were recruited in the specialized center from March 2012 to September 2019. Biochemical markers were recorded at baseline and every six months prior to subsequent drug injection. Dual X-ray Absorptiometry was requested at baseline and after 18/24 months. Comparing BMD at baseline and after denosumab therapy in naive patients and in those previously treated with bisphosphonates, a positive therapeutic effect was observed in both groups. The results of our real-life study demonstrate, as expected, that BMD values significantly increased upon denosumab treatment. Interestingly, denosumab showed an increased effectiveness in patients previously treated with bisphosphonates. Moreover, biochemical markers data indicate that osteoporotic patients, without other concomitant unstable health conditions, could be evaluated once a year, decreasing the number of specialistic center access.

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Management of hip fracture in the older people: rationale and design of the Italian consensus on the orthogeriatric co-management

Cited by 21 publications

References 33 publications

Influence of Orthogeriatrics on the Morbidity and Mortality of Patients with Hip Fracture.

Influence of Orthogeriatrics on the Morbidity and Mortality of Patients with Hip Fracture.

Internal fixation of acetabular quadrilateral plate fractures in elderly patients: Could the fracture reduction quality affect their functional recovery?

Effectiveness of Denosumab Therapy after Treatment with Bisphosphonates in Women Affected by Osteoporosis: A Real-Life Study

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