ObjectiveTo investigate the effectiveness of multidisciplinary doctor-nurse collaboration team on the perioperation management of geriatric patients with hip fractures.MethodsThe clinical data of 489 geriatric patients with hip fractures (femoral neck fracture and intertrochanteric fracture) between January 1st 2016 and January 1st 2018 was retrospectively analyzed. Among them, 279 patients were treated with the multidisciplinary doctor-nurse collaboration care (observation group) and 210 patients were treated with the conventional therapeutics and nursing care (control group). There was no significant difference in gender, age, cause of injury, type and classification of fracture, the interval between injury and admission, and Charlson index between the two groups (P>0.05). The surgery rates, time from hospitalization to operation, length of stay, and the incidences of perioperative complications were compared between the two groups.ResultsThe surgery rate was 90.32% (252/279) in observation group and 80.48% (169/210) in control group, showing significant difference between the two groups (χ2=9.703, P=0.002). The time from hospitalization to operation and length of stay in observation group [(5.39±2.47), (10.56±3.76) days] were significant shorter than those in control group [(6.13±2.79), (12.27±3.11) days] (t=−3.075, P=0.002; t=−5.330, P=0.000). The incidence of respiratory complications was 46.15% in control group and 30.56% in observation group; the incidence of cardiovascular system complications was 69.23% in control group and 51.19% in observation group; the incidence of cerebrovascular system complications was 20.12% in control group and 11.11% in observation group; the incidence of deep venous thrombosis was 40.24% in control group and 25.40% in observation group. The incidences of perioperative complications were significantly lower in observation group than in control group (P<0.05).ConclusionMultidisciplinary doctor-nurse collaboration team is conducive not only to improve the surgery rates, but also to reduce perioperative complications as well as shorten the length of stay and preoperative waiting time.
Objective To review the progress of perioperative treatments for patients of Parkinson’s disease and hip fractures. Methods The related literature of treatments for patients of Parkinson’s disease and hip fractures were reviewed and analyzed from the aspects such as the perioperative management, selection of operation ways, and prognosis. Results The patients of Parkinson’s disease are more likely to sustain hip fractures because of postural instability and osteoporosis. The perioperative treatments for patients of Parkinson’s disease and hip fractures should be determined by orthopedists, neurologist, anesthesiologist, and physical therapist. There is still controversy about the selection of operation and surgical approach. And the prognosis of patients of Parkinson’s disease and hip fractures are associated with the severity of Parkinson’s disease. Conclusion There are few clinical studies about the patients of Parkinson’s disease and hip fractures. The mid-term and long-term functional outcomes of patients of Parkinson’s disease and hip fractures are unsufficient. And the best treatments of patients of Parkinson’s disease and hip fractures need to be further explored.
Objective To summarize the best evidence for discharge planning of elderly patients with hip fracture. Methods UpToDate, BMJ Best Practice, BMJ Evidence-Based Medicine, Guidelines International Network, National Institute for Health and Clinical Excellence, Registered Nurses’ Association of Ontario, Agency for Healthcare Research and Quality, Scottish Intercollegiate Guidelines Network, Web of Science, PubMed, CINAHL, Embase, Cochrane Library, VIP data, China National Knowledge Infrastructure, SinoMed, Wanfang were searched by computer for literature about discharge planning of elderly patients with hip fracture. The retrieval time was from the establishment of the databases to July 31, 2023. The quality of the included literature was evaluated by 2 researchers with evidence-based training. Results A total of 15 articles were included, including 1 clinical decision, 3 guidelines, 3 expert consensuses, 4 evidence summaries, and 4 systematic reviews, covering 5 aspects of implementers and participants of discharge services, pre-discharge preparation during hospitalization, pre-discharge assessment, discharge guidance, and post-discharge follow-up. A total of 22 best evidences of discharge planning of elderly patients with hip fracture were extracted, including 15 A-level recommendations and 7 B-level recommendations. Conclusions There are many aspects involved in the discharge planning of elderly patients with hip fracture. In future clinical practice, healthcare professionals should develop individualized plans based on the actual conditions of each patient, aiming to meet their specific discharge needs. This approach can help reduce adverse outcomes such as recurrent fractures and readmission rates, while promoting better physical and mental recovery and facilitating the patient’s return to society.
Objective To systematically analyze the relevant research on the application of preoperative exercise training in the pre-rehabilitation of elderly hip fracture patients, identify the specific content, outcome indicators, and application effects of exercise intervention, in order to provide reference for medical staff to carry out relevant interventions. Methods Computer searches were conducted on domestic and foreign databases such as China National Knowledge Infrastructure, Wanfang Database, China Biomedical Literature Database, VIP, Cochrane Library, PubMed, Embase, Web of Science. The search period was from the establishment of the database to January 2024. The scoping review method was used to screen, summarize, and analyze the included studies. ResultsA total of 10 studies were included, including 3 randomized controlled trial, 1 quasi experimental study, 5 retrospective studies and 1 case report. Preoperative exercise preparation includes completing relevant examinations and providing sufficient pain relief. The types of exercise include adaptive training, resistance training, and aerobic exercise. Monitor the patient’s symptoms, signs, and adverse reactions throughout the exercise process. Outcome measures include physical activity and function, pain, average length of hospital stay, and perioperative complications. Conclusions Preoperative exercise training has a positive effect on elderly patients with hip fracture. Elderly patients with hip fracture should be well prepared for preoperative exercise, based on adaptive training, with resistance exercise as the main focus, while monitoring the patient’s physical signs and adverse events during exercise.
Objective To explore the correlation between multimorbidity and hip fractures in middle-aged and elderly populations. Methods The population without hip fractures in 2011 was selected in the China Health and Retirement Longitudinal Study database. According to whether the research subjects experienced hip fractures between 2015 and 2020, they were divided into the hip fracture group and the non-hip fracture group. Multiple logistic regression analysis was used to explore the correlation between multimorbidity and hip fracture occurrence. Results A total of 9644 subjects were included. Among them, there were 4406 males and 5238 females. There were 419 cases in the hip fracture group and 9225 cases in the non-hip fracture group. Multivariate logistic regression analysis showed that diabetes, heart disease, arthritis and hearing impairment were independent risk factors for hip fracture. Compared to those without chronic diseases, individuals with ≥3 types of comorbidities among the 4 chronic diseases had a higher risk of hip fracture. Conclusions In the middle-aged and elderly population, diabetes, heart disease, arthritis and hearing impairment are chronic diseases associated with hip fracture. The higher the number of comorbidities of chronic diseases, the higher the risk of new hip fractures.
ObjectiveTo explore the impact of perioperative average blood-glucose level on the prognosis of patients with hip fracture and diabetes mellitus. MethodsA retrospective analysis was made on the clinical data of 244 patients with hip fracture and diabetes mellitus who accorded with the inclusion criteria between September 2009 and September 2012.Of 244 patients,125 patients with poorly controlled fasting blood-glucose (average fasting blood-glucose level >7.8 mmol/L) were assigned in group A,and 119 patients with well controlled fasting blood-glucose (average fasting blood-glucose level ≤7.8 mmol/L) were assigned in group B according to "China guideline for type 2 diabetes" criteria.There was no significant difference in gender,age,disease duration of diabetes mellitus,serum albumin,fracture type and disease duration,surgical procedure,anaesthesia,and complications between 2 groups (P>0.05).Group A had a higher hemoglobin level and fewer patients who can do some outdoor activities than group B (t=-2.353,P=0.020;χ2=4.333,P=0.037).The hospitalization time,days to await surgery,stitch removal time,the postoperative complication rate,the mortality at 1 month and 1 year after operation,and ambulatory ability at 1 year after operation were compared between the 2 groups. ResultsA total of 223 patients (114 in group A and 109 in group B) were followed up 12-15 months (mean,13.5 months).The days to await surgery of group A were significantly more than those of group B (t=-2.743,P=0.007),but no significant difference was found in hospitalization time and stitch removal time between 2 groups (P>0.05).The postoperative complication rate of group A (19.2%,24/125) was significantly higher than that of group B (8.4%,10/119)(χ2=5.926,P=0.015).Group A had a higher mortality at 1 month after operation than group B (6.1% vs.0)(χ2=5.038,P=0.025),but no significant difference was shown at 1 year after operation between groups A and B (8.8% vs.4.6%)(χ2=1.555,P=0.212).At 1 year after operation in patients who can do some outdoor activities,the proportions of patients who turned to do some indoor activities was 19.2%(15/78) in the group A and 13.5%(12/89) in group B,showing no significant difference (χ2=1.013,P=0.314). ConclusionPoorly controlled perioperative fasting blood-glucose may lead undesirable influence on the prognosis of patients with hip fracture and diabetes mellitus.In order to reduce the complication rate and other accidents,the fasting blood-glucose level should be controlled to 7.8mmol/L or less.
ObjectiveTo analyze the correlation between the trabecular microstructure and the clinical imaging parameters in the fracture region of osteoporotic hip so as to provide a simple method to evaluate the trabecular microstructure by a non-invasive way. MethodsBetween June 2012 and January 2013, 16 elderly patients with femoral neck fracture underwent hip arthroplasty were selected as the trial group; 5 young patients with pelvic fracture were selected as the control group. The hip CT examination was done, and cancellous bone volume/marrow cavity volume (CV/MV) was analyzed with Mimics 10.01 software in the control group. The CT scan and bone mineral density (BMD) measurement were performed on normal hips of the trial group, and cuboid specimens were gained from the femoral necks at the place of the tensional trabeculae to evaluate the trabecular microstructure parameters by Micro-CT, including bone volume fraction (BV/TV), trabecular number (Tb. N), trabecular spacing (Tb.Sp), trabecular thickness (Tb.Th), connect density (Conn.D), and structure model index (SMI). The correlation between imaging parameters and microstructure parameters was analyzed. ResultsIn the trial group, the BMD value was 0.491-0.698 g/cm2 (mean, 0.601 g/cm2); according to World Health Organization (WHO) standard, 10 cases were diagnosed as having osteoporosis, and 6 cases as having osteopenia. The CV/MV of the trial group (0.670 1±0.102 0) was significantly lower than that of the control group (0.885 0±0.089 1) (t=-4.567, P=0.000). In the trial group, CV/MV had correlation with BV/TV, Tb.Th, and SMI (P<0.05); however, CV/MV had no correlation with Tb.N, Tb.Sp, or Conn.D (P>0.05). BV/TV had correlation with Tb.Th, Tb.N, Tb.Sp, and SMI (P<0.05), but it had no correlation with Conn.D (P=0.075). There was no correlation between BMD and microstructure parameters (P>0.05). ConclusionCV/MV obviously decreases in the osteoporotic hip, and there is a correlation between CV/MV and the microstructure parameters of BV/TV, Tb.Th, and SMI, to some extent, which can reflect the variety of the microstructure of the trabeculae. There is no correlation between BMD of femoral neck and microstructure parameters.
ObjectiveTo evaluate the effect of early preoperative mobilization on the rehabilitation of the elderly patients with hip fractures after operation.MethodsThe clinical data of 16 elderly patients with hip fractures between February 2017 and April 2018 who met the selection criteria was retrospectively analyzed. There were 8 males and 8 females, with an average age of 80.3 years (range, 69-90 years). There were 8 cases of intertrochanteric fracture and 8 cases of femoral neck fracture. The preoperative American Society of Anesthesiologists (ASA) scored 2.94±0.43. There were 3 cases of cardiovascular and cerebrovascular diseases, 6 cases of essential hypertension, 5 cases of respiratory diseases, 3 cases of diabetes, and 2 cases of other system diseases. The time from injury to admission was 4 hours to 14 days with an average of 39.5 hours. On the day of admission or on the first day after admission, the patient started to exercise on the floor underwent analgesia treatment. And the patients were treated with closed reduction (9 cases) or artificial hip arthroplasty (7 cases). The time from admission to operation was 4 to 25 days, with an average of 7.4 days. At the time of admission, after the first ground movement before operation, on the second day after operation, and at last follow-up, the Barthel Index was used to assess the patients’ self-care ability, and Barthel effectiveness (BE) was calculated. The complications were observed and recorded during follow-up.ResultsAll 16 patients underwent operation successfully. The hospital stay was 8 to 24 days, with an average of 14.1 days. All patients were followed up 2.5-16.0 months with an average of 6.5 months. One patient developed postoperative pulmonary infection; the remaining patients had no surgical-related complications. No patient died during the follow-up. The Barthel Index scored 30.63±5.56 at admission, 53.13±9.50 after the first ground movement before operation, 60.63±6.09 on the second day after operation, and 96.25±4.84 at last follow-up. There were significant differences in Barthel Index scores between different time points (P<0.05). The BE was 0.23±0.06 after the first ground movement before operation, 0.30±0.04 on the second day after operation, and 0.66±0.06 at last follow-up. There were significant differences in BE between different time points (P<0.05).ConclusionFor elderly patients with hip fractures who have long waiting time before operation, early preoperative mobilization has a positive impact on patients’ activities of daily living.
ObjectiveTo introduce the clinical pathway for geriatric hip fracture regulated by our hospital and report the five-year outcomes after the implementation of the pathway. MethodsThe geriatric hip fracture patients treated between September 2003 and August 2012 were followed up. We did not implement the clinical pathway until January 2007. Statistical analysis was done to evaluate the effect of the clinical pathway on patient outcomes by comparing rate of complication, mortality, and length of hospital stay before and after the implementation of the clinical pathway. ResultsAfter the implementation of the pathway, the in-hospital mortality, one-year mortality and the rate of complication were significantly lower. Besides, the time from admission to operation and the total length of stay in hospital were obviously shortened. ConclusionThe use of clinical pathway for geriatric hip fracture can reduce the rate of complication and mortality, and shorten hospital stay, and the five-year outcomes after the implementation of the pathway are satisfying.
ObjectiveTo summarize the research progress of multidisciplinary team (MDT) co-management models in the clinical treatment of geriatric hip fractures.MethodsThe literature about types and characteristics of MDT for geriatric hip fracture treatment were extensively reviewed, and the advantages of its clinical application were analysed and summarised. Finally, the MDT model and characteristics of geriatric hip fracture in the Zhongda Hospital affiliated to Southeast University were introduced in detail.ResultsClinical models of MDT are diverse and have their own characteristics, and MDT can shorten the length of stay and waiting time before operation, reduce the incidence of internal complications, save labor costs, and reduce patient mortality.ConclusionThe application of MDT in the treatment of geriatric hip fracture has achieved remarkable results, which provides an optimal scheme for the treatment of geriatric hip fracture.