Approach to patients with hip fracture and concurrent stroke

Lim, Jing Wei; Ang, Guat Cheng

doi:10.1136/bcr-2020-236064

Cited by 4 publications

(1 citation statement)

References 36 publications

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“…A case of intertrochanteric fracture and acute stroke, focusing on individual factors to reduce postoperative complications and recurrent stroke rate by a multidisciplinary team, treated with PFNA has been reported. [16] In our case, the 30-day intertrochanteric fracture had local callus growth at the fracture end on images, which may due to brain injury. [17] Meanwhile, acute post-stroke hemiplegia, pressure sores, and drug eruption of the hip make treatment more difficult.…”

Section: Discussionmentioning

confidence: 87%

Early surgical treatment of closed reduction and internal fixation for a 30-day old intertrochanteric fracture with hemiplegia after acute stroke: A case report

Zhang

Zhao

et al. 2023

Medicine

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Rationale: Currently, there are no clear guidelines to determine whether and when to perform surgical hip repair in patients with acute stroke and hip fracture.Patient concerns: In this case report, we report a case of 75-year-old woman admitted with left hip pain and limited mobility for 1 month.Diagnoses: Patient had a history of acute cerebral infarction 42 days ago, and diagnosed with a left intertrochanteric fracture at another hospital 30 days ago.Intervention: Patient was treated with closed reduction and internal fixation with proximal femoral nail anti-rotation.Outcomes: At 2-year follow-up, the patient's basic function was restored. The fracture healed well, and the Harris hip score was 75.Lessons: Without consistent guidelines, individualized treatment strategies including surgical methods and timing of surgery should be made to weigh the risks and benefits for patients with acute stroke and intertrochanteric fractures.Abbreviations: CRIF = closed reduction and internal fixation, PFNA = proximal femoral nail anti-rotation.

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Section: Discussionmentioning

confidence: 87%

Early surgical treatment of closed reduction and internal fixation for a 30-day old intertrochanteric fracture with hemiplegia after acute stroke: A case report

Zhang

Zhao

et al. 2023

Medicine

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Problems of physical rehabilitation of movement disorders in the pathology of the hip joint in patients with the consequences of a cerebral stroke

et al. 2023

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The purpose of the work was to analyze the experience of foreign specialists regarding movement and structural disorders of the proximal part of the femur in patients with the consequences of stroke and their impact on the effectiveness of rehabilitation programs for hip joint pathology. To fulfill the goal, an analysis of foreign literary sources was carried out in modern databases: Google Scholar, Web of Science, PubMed, Medline, Cochrane, Pedro. The search depth is 22 years (from January 2000 to October 2021). The analysis of literature sources indicated that limitation of motor activity and axial loads in patients after acute cerebrovascular accident, in particular limitation of mobility in the hip joint, impairment of muscle strength and tone due to hemiparesis can lead to the development of osteoporosis. Particularly important from the point of view of adverse consequences is a decrease in mineral density and fractures of the proximal part of the femur. On the other hand, disturbed biomechanics of movements in the hip joint in persons with the consequences of a cerebral stroke, under the condition of axial load on the limb, can lead to the development of osteoarthritis of the hip joint. Osteoarthritis results in limited mobility of the hip joint, which leads to secondary immobilization of the hip joint and, as a result, can also lead to further osteoporosis. Existing disorders of neuromuscular control, muscle tone and strength, limitation of mobility of the hip joint, including due to spasticity, problems with static and dynamic balance, and, as a result, an increased risk of falling in patients with the consequences of a stroke, can negatively affect the recovery of motor functions, activity limitation, and, as a result, reduce the effectiveness of rehabilitation of patients after hip joint replacement. Existing movement disorders, as a result of a stroke, require the development and justification of new rehabilitation programs, including the use of modern technical means and virtual reality.

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Random forest predictive modeling of prolonged hospital length of stay in elderly hip fracture patients

Liu,

Xing,

Jiang

et al. 2024

Front. Med.

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BackgroundIn elderly individuals suffering from hip fractures, a prolonged hospital length of stay (PLOS) not only heightens the probability of patient complications but also amplifies mortality risks. Yet, most elderly hip fracture patients present compromised baseline health conditions. Additionally, PLOS leads to increased expenses for patient treatment and care, while also diminishing hospital turnover rates. This, in turn, jeopardizes the prompt allocation of beds for urgent cases.MethodsA retrospective study was carried out from October 2021 to November 2023 on 360 elderly hip fracture patients who underwent surgical treatment at West China Hospital. The 75th percentile of the total patient cohort’s hospital stay duration, which was 12 days, was used to define prolonged hospital length of stay (PLOS). The cohort was divided into training and testing datasets with a 70:30 split. A predictive model was developed using the random forest algorithm, and its performance was validated and compared with the Lasso regression model.ResultsOut of 360 patients, 103 (28.61%) experienced PLOS. A Random Forest classification model was developed using the training dataset, identifying 10 essential variables. The Random Forest model achieved perfect performance in the training set, with an area under the curve (AUC), balanced accuracy, Kappa value, and F1 score of 1.000. In the testing set, the model’s performance was assessed with an AUC of 0.846, balanced accuracy of 0.7294, Kappa value of 0.4325, and F1 score of 0.6061.ConclusionThis study aims to develop a prognostic model for predicting delayed discharge in elderly patients with hip fractures, thereby improving the accuracy of predicting PLOS in this population. By utilizing machine learning models, clinicians can optimize the allocation of medical resources and devise effective rehabilitation strategies for geriatric hip fracture patients. Additionally, this method can potentially improve hospital bed turnover rates, providing latent benefits for the healthcare system.

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Approach to patients with hip fracture and concurrent stroke

Cited by 4 publications

References 36 publications

Early surgical treatment of closed reduction and internal fixation for a 30-day old intertrochanteric fracture with hemiplegia after acute stroke: A case report

Early surgical treatment of closed reduction and internal fixation for a 30-day old intertrochanteric fracture with hemiplegia after acute stroke: A case report

Problems of physical rehabilitation of movement disorders in the pathology of the hip joint in patients with the consequences of a cerebral stroke

Random forest predictive modeling of prolonged hospital length of stay in elderly hip fracture patients

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