Rehabilitation After Hip Fracture in the Elderly

Sixty-eight patients with hip fracture, mean age 79 years, from the city of Lund, were studied with special reference to functional and social rehabilitation at follow-up 1 year later. As compared with patients coming from institutions for permanent care, patients coming from their own homes had a significantly better prognosis in terms of survival, mobility and ability to cope with activities of daily living (ADL). However, patients returning home needed increased domestic help. Patients living with someone returned home sooner than those living alone. Although many of the patients who returned home could walk without support or with a walking-stick, more than one half did not go out shopping. More active measures, e.g. early home visits by a rehabilitation team, might give the patients more self-confidence and independence. Immediate weight-bearing did not appear to impair healing of the hip fracture or increase the risk of necrosis of the femoral head.     

Rehabilitation After Hip Arthroscopy

Rehabilitation after hip arthroscopy has not been well understood in the past. While surgical procedures continue to advance, athletes are already pushing the limits to return to competition as quickly as possible. As postoperative protocols evolve, it is essential to follow the basic guidelines of rehabilitation. Initially, soft-tissue healing constraints must be considered while focusing on controlling swelling and pain, restoring ROM, and preventing muscle atrophy. As physiological healing occurs, rehabilitation must address progressive lower-extremity strengthening, proprioceptive retraining, and sport-specific training.     

老年髋部骨折术后患者康复需求程度与康复状况调查

目的 了解老年髋部骨折术后患者康复需求程度、需求满足度与康复状况的关系。方法 上门随访82例老年髋部骨折术后患者家庭康复现状和康复需求情况。结果 康复需求10个维度中他人支持、康复信息及功能训练指导位居前3位；需求程度与生理功能、躯体功能和社会功能有关（P〈0．05，P〈0．01）；与髋关节功能评分中的疼痛程度、上楼梯、穿鞋袜和行走距离4个方面有关（P〈0．05，P〈0．01）。结论 出院后定期给予针对性的康复训练指导和健康教育是患者迫切的需求；康复需求程度高者，相应需求满足率低，其生活质量及髋关节功能恢复应成为干预的重点。     

老年髋部骨折术后患者康复需求程度与康复状况调查

目的了解老年髋部骨折术后患者康复需求程度、需求满足度与康复状况的关系.方法上门随访82例老年髋部骨折术后患者家庭康复现状和康复需求情况.结果康复需求10个维度中他人支持、康复信息及功能训练指导位居前3位;需求程度与生理功能、躯体功能和社会功能有关(P＜0.05,P＜0.01);与髋关节功能评分中的疼痛程度、上楼梯、穿鞋袜和行走距离4个方面有关(P＜0.05,P＜0.01).结论出院后定期给予针对性的康复训练指导和健康教育是患者迫切的需求;康复需求程度高者,相应需求满足率低,其生活质量及髋关节功能恢复应成为干预的重点.     

Re-Admissions Following Hip Fracture Surgery

INTRODUCTION

Hip fractures in the elderly are a growing problem with a predicted incidence of 117,000 cases per year by 2016. Re-admission following a healthcare episode is an important outcome measure, which reflects non-fatal adverse events and indicates the natural history of disease. The purpose of this observational, multicentre audit was to examine rates and reasons for re-admission following hip fracture, to identify areas in the index admission and rehabilitation care that could be improved to prevent re-admission.

PATIENTS AND METHODS

A total of 535 patients (> 65 years old) in two district general hospitals in the UK who underwent hip fracture surgery were recruited into the study.

RESULTS

Of the study cohort, 72 patients (13.5%) died during their index admission and 88 (19.0%) of 463 patients were re-admitted once within 3 months. Causes of re-admission were attributed to medical (54.8%), failure to rehabilitate (23.8%), orthopaedic (19.0%) and surgical (2.4%) reasons. Infection was the most common (31.0%) reason for re-admission and arguably the most treatable. During the 3-month postoperative period, the mortality rate was 21.3%, increasing in those re-admitted to 35.1% representing the frailty of this group of patients.

CONCLUSIONS

High rates of re-admission are seen following discharge in elderly patients with hip fractures. Re-admitted patients have high mortality rates. Understanding causes of re-admission may help to reduce this burden.     

Prosthetic Rehabilitation After Craniofacial Surgery

We report our experience during the last 6 years with 20 patients fitted with prosthesis (19 patients with osseointegration of screw, 1 patient with primarily gluing method) for camouflage of congenital or acquired (trauma, tumor resection) defects of the ear, nose, or eye. Out of a total of 53 extra-oral implants fitted, 3 were lost in the orbital area due to loosening 6 months after radiation treatment. Another three implants were removed at the request of an 80-year-old patient who preferred a prosthesis retained by spectacles because of recurring infection around one of the implants. On average, 43 months (range, 7 months to 8 years) after completion of the prosthesis, 85% of the patients assessed the result as excellent, 15% as good, 0% as fair, and 0% as poor. The ENT surgeon and the prosthesis designer were slightly more critical (ENT surgeon—95% good or excellent and 5% fair, prosthesis designer—90% good or excellent, 10% fair).     

Serum Enzymes After Hip Joint Surgery

The effect of hip joint surgery on routine serum enzyme values was studied. The increase in creatine kinase was most marked and normal levels were restored again after approximately 1 week. Asparatate aminotransferase was slightly elevated throughout the first two postoperative weeks. Alanine aminotransferase was essentially unchanged during the first three postoperative days in contrast to lactate dehydrogenase which reached preoperative values again after only 2–3 days. Alkaline phosphatase showed an increase after 1 week whereas S-amylase was essentially normal throughout the 2 weeks studied.     

Serum Enzymes After Hip Joint Surgery

The effect of hip joint surgery on routine serum enzyme values was studied. The increase in creatine kinase was most marked and normal levels were restored again after approximately 1 week. Asparatate aminotransferase was slightly elevated throughout the first two postoperative weeks. Alanine aminotransferase was essentially unchanged during the first three postoperative days in contrast to lactate dehydrogenase which reached preoperative values again after only 2-3 days. Alkaline phosphatase showed an increase after 1 week whereas S-amylase was essentially normal throughout the 2 weeks studied.     

Lung Complications After Elective Hip Surgery

A total of 350 patients undergoing elective hip surgery were retrospectively studied as regards pulmonary complications. The study is based on the findings of pre-and postoperative chest X-rays and of pulmonary perfusion scintigrams. Twenty-seven per cent of the patients had pulmonary complications of some kind. Twelve per cent had a change in the postoperative as compared to the preoperative X-ray, though most of the changes were minute. In 15.4 per cent there were scintigraphic signs of pulmonary embolism and of these 30 per cent had signs or symptoms of pulmonary embolism; 1.7 per cent of the patients had symptoms of pulmonary infectious disease. Two patients died from pulmonary embolism. The study shows a low frequency of serious pulmonary complications after elective hip surgery.     

Lung Complications After Elective Hip Surgery

A total of 350 patients undergoing elective hip surgery were retrospectively studied as regards pulmonary complications. The study is based on the findings of pre-and postoperative chest X-rays and of pulmonary perfusion scintigrams. Twenty-seven per cent of the patients had pulmonary complications of some kind. Twelve per cent had a change in the postoperative as compared to the preoperative X-ray, though most of the changes were minute. In 15.4 per cent there were scintigraphic signs of pulmonary embolism and of these 30 per cent had signs or symptoms of pulmonary embolism; 1.7 per cent of the patients had symptoms of pulmonary infectious disease. Two patients died from pulmonary embolism. The study shows a low frequency of serious pulmonary complications after elective hip surgery.     

髋臼骨折后的全髋关节置换初步疗效观察

目的　探讨髋臼骨折治疗失败后全髋关节置换的方法及临床疗效。方法　回顾性地总结分析本院近三年来 10例髋臼骨折后行全髋关节置换病例髋臼重建的方法以及临床疗效。结果　 10例髋臼骨折后行全髋关节置换的病例均取得了良好的临床疗效 ,术后髋关节功能有明显改善 ,Harris评分较术前提高 44分。结论　髋臼骨折后全髋关节置换重建髋关节功能临床疗效满意 ,是一种很好的治疗方法。     

Internal Fixation After Subtrochanteric Femoral Fracture After Hip Resurfacing Arthroplasty

Periprosthetic fractures around total hip arthroplasty create surgical challenges with many described techniques of either fixation or revision. The increasing popularity of hip resurfacing arthroplasty poses different problems especially if there is a desire to retain the prosthesis rather than converting to a total hip arthroplasty. We describe a previously unreported technique of fixation for a comminuted, proximal femoral fracture, beneath a hip resurfacing.     

股骨假体周围骨折的处理

目的探讨JohanssonⅠ型和Ⅱ型股骨假体周围骨折的治疗方法。方法股骨假体周围的JohanssonⅠ型和Ⅱ型骨折8例采用切开复位、内固定的方法进行处理,术后平均随访15个月(12~18个月),观察骨折的愈合情况,采用Harris髋关节评分法对患髋做评估。另选同时期接受髋关节置换术的10例患者作为对照组。结果最后一次随访时,对照组患者髋关节的平均Harris评分为88分(69~97分),股骨假体周围骨折患者的髋关节平均Harris评分为77分(P<0.05)。骨折平均愈合时间为3.1个月(2~6.2个月),无感染或者假体松动现象,无深静脉栓塞现象。结论对于JohanssonⅠ型和Ⅱ型股骨假体周围骨折,切开复位、钢板内固定可以取得良好的结果。     

Incidence,Risk Factors,and Clinical Implications of Pneumonia After Surgery for Geriatric Hip Fracture

Background

Little is known regarding the occurrence of pneumonia after hip fracture surgery. The purpose of this study is to determine the incidence, risk factors, and clinical implications of pneumonia after surgery for geriatric hip fracture.

Preemptive Analgesic Effects of Ketorolac in Ankle Fracture Surgery

Background: Preemptive analgesia has been difficult to show in human experiments. If ketorolac has preemptive effects, then there may be an advantage to administering it at the beginning of surgery despite the potential for increased blood loss.

Methods: The authors performed a randomized, double-blind, controlled trial of 48 patients scheduled for ankle fracture surgery in a county trauma hospital. Anesthesia management was standardized and included adequate opioid analgesia (5 [mu]g/kg fentanyl and 0.1 mg/kg morphine). Intravenous 30 mg ketorolac was administered to 23 patients before tourniquet inflation and to 25 patients after tourniquet inflation. Visual analog scale pain scores, morphine patient-controlled analgesia consumption, nausea-vomiting, and postoperative bleeding were measured.

Results: The 23 patients given ketorolac before tourniquet inflation had no increase in pain postoperatively compared with their preoperative baseline (P = 0.280). The 25 patients who received ketorolac minutes later after tourniquet inflation had significant increases in their postoperative pain compared with their preoperative baseline (P = 0.00116). This effect was short-lived, and by 6 h the pain score in this group was not significantly more than it was preoperatively. Intergroup comparison showed a lower visual analog scale score at 2 (P = 0.0203) and 4 h (P = 0.00549) in the preemptive group and lower nausea scores at hour 6 (P = 0.00704). There was no difference in patient-controlled analgesia consumption between groups.     

Frequency,Risk Factors,and Prognosis of Prolonged Delirium in Elderly Patients After Hip Fracture Surgery

Background  

Delirium in elderly patients after hip fracture surgery is believed to be a transient event, although it frequently lasts for more than 4 weeks.