Background Transfer fractures in the lower limbs of bedridden and chair-bound nursing home patients can result from trauma induced by the usual lifting, moving, turning, or transferring maneuvers. Treatment entails immobilization for pain control and position change; however, splints/hard casts increase the risk of pressure sores. Therefore, we evaluated the use of a sponge cast. Materials and methods Between March 2011 and October 2017, 17 patients with a lower limb transfer fracture due to transferring maneuvers in a nursing home were recruited. We evaluated the improvement in pseudo-motion and divided the patients as having bony union, fibrous union, or remaining pseudo-motion. We also investigated the occurrence of pressure sores due to immobilization up until the final follow-up. Results Femur fractures occurred in 15 patients and lower leg fractures in two. Six of the 15 femur fractures were periprosthetic (four hip arthroplasty and two knee arthroplasty). Pseudo-motion was improved in 15 of 17 cases, within an average of 17.3 weeks for the improvement (14–23 weeks; bony union: 11 cases and fibrous union: four cases). Pseudo-motion remained in two cases: one periprosthetic fracture around the knee arthroplasty and the other, a femur neck fracture. No pressure sores occurred. Conclusions A sponge cast appears to be one of the effective treatment options available for bedridden or chair-bound patients with a lower limb fracture due to its low risk of complications and satisfactory clinical results.

PurposeThe Korea Veterans Health Service (KVHS) implemented the ‘designated hospital system’ so that veterans can receive prompt medical attention at hospitals near their residences when experience medical emergencies, including hip fractures. We analyzed the hospital-selection process of Korean veterans following a hip fracture. We then evaluated (the validity and considerations) for choosing designated hospitals.Materials and MethodsThe study population consisted of 183 veteran patients (84 treated at a single veterans hospital and the remaining 99 treated at 39 designated hospitals) who underwent hip fracture between January 2010 and February 2015 in the Honam region of South Korea. The subjects were divided into the ‘nearest group’ (those who chose the hospital closest to their residences) and the ‘non-nearest group’ (those who did not choose the hospital closest to their residences). We compared the age, ambulatory status, combined disease and fracture type, factors that we speculated may impact hospital choice.ResultsAlthough the patients had difficulty moving due to hip fractures, 116 (63.4%) patients choose hospitals that were not closest to their residences. Patients with three or more comorbidities (P=0.028) and older ages (P=0.046) were statistically more likely to fall into the non-nearest group. Ambulatory status and fracture type were shown not to significantly impact choice between nearest and non-nearest hospital. Patients in the non-nearest group tended to seek care at larger hospitals.ConclusionKorean veterans with hip fractures tended to seek care at larger hospitals, regardless of distance. We must therefore consider the number of beds and departments when choosing designated hospitals.

PurposeThis study was performed to compare the: i) 1-year survival rate of patients with hip fractures, ii) factors affecting mortality in patients with hip fractures, and iii) results of functional recovery at commissioned hospitals (CH) and veterans hospitals (VH) to characterize the quality of care provided in the Korean commissioned hospital system.Materials and MethodsThe study population consisted of 183 veteran patients (84 and 99 treated at a single VH and 39 CH, respectively) who underwent hip fracture surgery between January 2010 and February 2015. This study compared baseline characteristics (i.e., age, comorbidities, fracture types and surgical treatment approaches) of the two groups vs. clinical outcomes, and evaluated the waiting time, length of hospital stay, total medical expenses, mortality rate within one year, and functional recovery at last follow up.ResultsThere were no significant differences in age, fracture types, comorbidities, ambulatory status before fracture, waiting time, or length of hospital stay between the two groups, however, the total medical cost was higher in the CH group (P=0.009). There was no significant difference in mortality within one year after hip fracture (P=0.224) or functional recovery at last follow-up (P=0.463) between the two groups.ConclusionThe results of this study confirm that the Korean commissioned hospitals system is operating in accordance with its purpose. However, further studies are needed to better characterize the medical expenses of CHs vs. veterans hospitals.