Nursing staff attitudes of hip protector use in long-term care, and differences in characteristics between adherent and non-adherent residents: A survey and observational study

Background

Hip fractures represent an increasing public health burden with a simple fall to the floor as the most common cause. Because nursing home residents are particularly at risk, nursing homes should implement a broad range of fall prevention strategies. However, not all fall incidents can be avoided and external hip protectors may contribute to prevent hip fractures. A major problem in studying the effectiveness of hip protectors is residents’ poor adherence. In nursing homes, adherence is dependent not only on the resident, but also on staff knowledge of and attitudes about hip protectors.

Objectives

To describe (1) attitudes of day versus night shift caregivers towards the use of a soft hip protector, (2) residents’ adherence about the use of such protectors, and (3) differences in characteristics between adherent and non-adherent residents.

Design

Survey and observational study.

Setting

Nursing home.

Participants/methods

: Survey of care staff (n = 37) in a nursing home after 8 months of continued application of a soft hip protector policy in residents (n = 68). Adherence to wearing the hip protector, measured by weekly unannounced, randomly determined checks during day and night in the 8 months after the start of the study.

Results

Overall, 85% agreed to wear a hip protector. At 8 months, only 29% was still wearing their hip protector; with significant differences between day and night shifts. Although virtually all caregivers (97%) considered a hip protector policy in residential care as feasible, the attitude towards hip protectors was found to be significantly different between day and night caregivers. Pain and discomfort, patient insight in the usefulness of these devices, interference with incontinence materials, and the overall resident mix and care acuity were reported as major barriers.

Conclusion

Implementing a hip protector policy for injury prevention in long-term care is not an issue of whether or not to use the devices. Rather, it is a continued clinical nursing decision process about when and when not, by whom and by whom not, why and why not, for how long, and to what clinical benefit - considering both the needs of the individual resident and the feasibility of such a policy in the context of resident mix and nursing staff.     

The use of CT derived solid modelling of the pelvis in planning cancer resections

Clinical problem

Resection of malignant tumors of the pelvis is demanding. To avoid disabling hemipelvectomies, years ago internal hemipelvectomy combined with partial pelvic replacements had become a surgical procedure. To achieve adequate reconstructions custom-made replacements were recommended. In early stages of the surgical procedure using megaprostheses, individual pelvic models were manufactured.

Aim of the study

Since little is known about the accuracy of such models we analysed the charts of 24 patients (25 models) for whom an individual model of the osseous pelvis had been manufactured.

Results

Two patients refused surgery. In 23 patients partial resection of the bony pelvis was performed followed by a partial pelvic replacement (13×), hip transposition procedure (5×), ilio-sacral resection (4×), or revision surgery.In all patients who received a partial pelvic replacement, the fit of the replacement was optimal. No major unplanned resection was necessary. The same was observed in patients who received a hip transposition procedure or an ilio-sacral resection.Oncologically, in most of the patients we achieved wide resection margins (14×). In 5 patients the margins were marginal (4×) or intralesional (1×). In two cases the aim was a palliative resection because of a metastatic disease (1×) or benign entity (1×).

Conclusion

Pelvic models are helpful tools to planning the manufacture of partial pelvic replacements and ensuring optimal osseous resection of the involved bone. Further attempts have to be made to evaluate the aim of navigational techniques regarding the accuracy of the osseous and soft-tissue resection.     

Early results of whole femoral head allograft with articular cartilage for acetabular impaction grafting in revision hip replacements

INTRODUCTION

Extensive bone loss associated with revision hip surgery is a significant orthopaedic challenge. Acetabular reconstruction with the use of impaction bone grafting and a cemented polyethylene cup is a reliable and durable technique in revision situations with cavitatory acetabular bone defects. Some use cancellous graft alone whilst others morselise the whole femoral head after removal of articular cartilage. This paper asks, if it really necessary to use pure cancellous graft?

PATIENTS AND METHODS

Forty-two acetabular revisions using impacted morselised bone graft without removal of articular cartilage and a cemented cup were studied retrospectively. The mean follow-up was 3 years (range, 2–5.6 years). Clinical and radiographic assessment was made using the Oxford hip score, Hodgkinson''s criteria (1988) for socket loosening and the Gie classification (1993) for evaluation of allograft consolidation and remodelling.

RESULTS

Forty (95%) sockets were considered radiologically stable (type 0, 1, 2 demarcations) and two (5%) sockets were radiologically loose (Type 3 demarcation). There was no socket migration in our series. Twenty-seven(64%) cases showed good trabecular remodelling (grade 3). Twelve (29%) cases showed trabecular incorporation (grade 2). Only three (7%) cases showed poor allograft incorporation (grade 1). Average pre-operative Oxford hip score was 41 and postoperative hip score was 27. There have been no socket re-revisions (100% survival) at an average of 3 years.

CONCLUSIONS

Early radiological and clinical survival results with retaining articular cartilage of femoral head allografts are similar and comparable to other major studies for acetabular impaction bone grafting in revisions. Minimal loss of allograft mass is 40% in obtaining pure cancellous graft. When there is a limited supply and demand of allograft, saving up to 40% of the material is a valuable and cost-effective use of scarce resources.     

Salter骨盆截骨术治疗髋关节发育不良的中期随访

目的 通过对Salter骨盆截骨术治疗髋关节发育不良术后影像学的测量评估,揭示其术后髋臼形态塑形发育规律,并探讨手术疗效与手术年龄及影像学指标间的关系.方法 回顾性分析1990年1月至2004年12月因髋关节发育不良在我科接受Salter骨盆截骨术治疗的患儿的基本资料.随访时间≥3年且具有完整手术前、后影像学资料的患髋共61髋.选取术前、术后6周取克氏针后、术后1年、术后2～3年及末次随访时的骨盆正位片.测量髋臼指数(AI)、Sharp髋臼角(SAA)和中心边缘角(CEA),并对末次随访作Severin评级.结果 术后6周时AI平均改善了14°,术后2～3年为髋臼重塑的高峰时期,末次随访SAA平均为41°,基本已达正常水平.术后6周时CEA平均为23°,术后2～3年增加至25°,末次随访为26°.末次随访Severin评级总体优良率(Ⅰ、Ⅱ级)84%,中差(Ⅲ、Ⅳ、Ⅴ、Ⅵ级)16%.年龄越大,优良率越低,但6岁之后仍能获得70%的优良率.术后6周取克氏针时,Severin评级优良患儿和中差患儿改善的AI差异无统计学意义(P＞0.05);术后2～3年,优良患儿有明显改善,而中差患儿呈恶化趋势,差异有统计学意义(P＜0.05);至末次随访时,优良患儿与中差患儿Sharp角和中心边缘角差异非常显著(P＜0.05).结论 Salter骨盆截骨术治疗髋关节发育不良主要改变异常的髋臼开口方向,使股骨头和髋臼同心复位,髋臼获得重塑能力.术后2～3年是髋臼形态重塑最快速的时期,此时各项影像学指标一般逐渐下降至接近正常.若此时各项指标无明显改善或呈变差趋势,中远期疗效不佳.     

Traumatic Osteochondral Injury of the Femoral Head Treated by Mosaicplasty: A Report of Two Cases

The increased risk of symptomatic progression towards osteoarthritis after chondral damage has led to the development of multiple treatment options for cartilage repair. These procedures have evolved from arthroscopic lavage and debridement, to marrow stimulation techniques, and more recently, to osteochondral autograft and allograft transplants, and autogenous chondrocyte implantation. The success of mosaicplasty procedures in the knee has led to its application to other surfaces, including the talus, tibial plateau, patella, and humeral capitellum. In this report, we present two cases of a chondral defect to the femoral head after a traumatic hip dislocation, treated with an osteochondral autograft (OATS) from the ipsilateral knee, and the inferior femoral head, respectively, combined with a surgical dislocation of the hip. At greater than 1 year and greater than 5 years of follow-up, MRI studies have demonstrated good autograft incorporation with maintenance of articular surface conformity, and both patients clinically continue to have no pain and full active range of motion of their respective hips. In our opinion, treatment of osteochondral defects in the femoral head surface using a surgical dislocation combined with an OATS procedure is a promising approach, as full exposure of the femoral head can be obtained while preserving its vasculature, thus enabling adequate restoration of the articular cartilage surface.     

Determination of the rotational center of the hip

We introduce a new method to determine the anatomic rotation center of the hip. In total, 214 healthy hip joints were examined and statistically analyzed. As a reference point we used the intersection between Koehler’s line and a line between the upper rims of the two foramina obturatoria. In relation to the reference point the anatomic hip center is localized 7.7% in vertical direction and 17.4% in horizontal direction for male individuals and 7.75 and 15.4% for female individuals, respectively. Those data were referred to the pelvic height. Our data can be used to determine the anatomic hip center in an easy and reliable way, not only for preoperative planning but also for retrospective investigations.     

Acute dislocation of the elbow caused by a solitary osteochondroma of the proximal radius

A young man presented with acute dislocation of the left elbow at the radio-capitellar articulation caused by trapping of the biceps tendon at the stalk of a solitary osteochondroma. There was no deformity of the ulna and radius shaft suggestive of a developmental growth disturbance of the forearm bones. Good reduction could be achieved by simple relocation of the biceps tendon. The osteochondroma was excised.     

Total hip arthroplasty of dysplastic hip after previous Chiari pelvic osteotomy

Introduction: Many reports have suggested that Chiari pelvic osteotomy would improve the results of acetabular component placement and fixation in subsequent total hip arthroplasty. However, little is known concerning the biomechanical, radiological, and clinical effects of Chiari pelvic osteotomy on subsequent total hip arthroplasty. Materials and methods: Ten total hip arthroplasties for developmental dysplasia of the hip after previous Chiari pelvic osteotomy (Chiari group) were compared with 20 total hip arthroplasties for developmental dysplasia of the hip without previous surgery (control group). Preoperative patient demographic data and operative technique were well matched between the groups. The mean duration of follow-up was 3.0 years. Biomechanical, radiological, and clinical evaluations were performed. Results: No acetabular or femoral components exhibited loosening. All patients had good or excellent clinical score according to the Merle d’Aubigne-Postel rating system at the most recent follow-up. Abductor force and joint force were smaller in the Chiari group, although long operative time, more blood loss, and verticalization of joint force were noted in this group. Conclusion: This limited study suggested that Chiari pelvic osteotomy changed the biomechanical features of the hip joint, and that this alteration might have compromised subsequent total hip arthroplasty.     

Deep Femoral Artery Aneurysm: Report of a Case

Aneurysms involving the deep femoral artery, otherwise known as the profunda femoris artery (PFA), are extremely rare. Rarer still are bilateral PFA aneurysms (PFAAs). The diagnosis is difficult, but it may be suggested by the presence of a pulsatile tumor in the region of the femoral artery or by symptoms resulting from complications such as rupture or thromboembolism. A high index of suspicion is essential to diagnose them because they may present atypically. Surgery remains the treatment of choice and should be carried out electively for asymptomatic aneurysms. Surgery in an emergency situation can be challenging, especially when it involves vascular reconstruction as dictated by the peripheral vascular circulation.