Four-month outcome after proximal femur fractures and influence of early geriatric rehabilitation: data from the German Centres of Geriatric Trauma DGU

Schoeneberg, Carsten; Pass, Bastian; Volland, Ruth; Knobe, Matthias; Eschbach, Daphne; Ketter, Vanessa; Lendemans, Sven; Aigner, René; Dgu, Registry for Geriatric Trauma

doi:10.1007/s11657-021-00930-9

Cited by 13 publications

(9 citation statements)

References 41 publications

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“…Missing patient data at follow-up (e.g., due to transfer to nursing facility), as observed in the current study, are common in geriatric hip fracture studies, and similar response rates have been reported in a four-month follow-up period [ 41 ]. Furthermore, a postoperative 120-day follow-up rate of only 48% in the ATR-DGU has been described and attributed to the voluntary nature of the respective data acquisition [ 46 ]. Therefore, selection bias cannot be excluded.…”

Section: Discussionmentioning

confidence: 99%

Internal fixation versus hip arthroplasty in patients with nondisplaced femoral neck fractures: short-term results from a geriatric trauma registry

Laubach

Bläsius

Volland³

et al. 2021

Eur J Trauma Emerg Surg

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Purpose To determine whether internal fixation (IF) or hip arthroplasty (HA) is associated with superior outcomes in geriatric nondisplaced femoral neck fracture (FNF) patients. Methods Data from the Registry for Geriatric Trauma of the German Trauma Society (ATR-DGU) were analyzed (IF Group 449 and HA Group 1278 patients). In-hospital care and a 120-day postoperative follow-up were conducted. Primary outcomes, including mobility, residential status, reoperation rate, and a generic health status measure (EQ-5D score), and the secondary outcome of mortality were compared between groups. Multivariable analyses were performed to assess independent treatment group associations (odds ratios, ORs) with the primary and secondary end points. Results Patients in the HA group were older (83 vs. 81 years, p < 0.001) and scored higher on the Identification of Seniors at Risk screening (3 vs. 2, p < 0.001). We observed no differences in residential status, reoperation rate, EQ-5D score, or mortality between groups. After adjusting for key covariates, including prefracture ambulatory capacity, the mobility of patients in the HA group was more frequently impaired at the 120-day follow-up (OR 2.28, 95% confidence interval = 1.11–4.74). Conclusion Treatment with HA compared to treatment with IF led to a more than twofold increase in the adjusted odds of impaired ambulation at the short-term follow-up, while no significant associations with residential status, reoperation rate, EQ-5D index score, or mortality were observed. Thus, IF for geriatric nondisplaced FNFs was associated with superior mobility 120 days after surgery. However, before definitive treatment recommendations can be made, prospective, randomized, long-term studies must be performed to confirm our findings.

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Section: Discussionmentioning

confidence: 99%

Internal fixation versus hip arthroplasty in patients with nondisplaced femoral neck fractures: short-term results from a geriatric trauma registry

Laubach

Bläsius

Volland³

et al. 2021

Eur J Trauma Emerg Surg

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“…Thus, modern concepts concerning the application of multidisciplinary care teams and specific care programs (e.g., increasing the number of visits by geriatricians, early geriatric rehabilitation program (EGR)) are keys to improving the surgical outcomes and patients’ quality of life. Previous studies had reported the outcomes of implementing these programs, which results in a significant increase in walking ability, early initiation of anti-osteoporotic agents for preventing secondary hip fractures, and decreased patient mortality [ 49 , 50 ].…”

Section: Discussionmentioning

confidence: 99%

Prognostic Factors of the Inability to Bear Self-Weight at Discharge in Patients with Fragility Femoral Neck Fracture: A 5-Year Retrospective Cohort Study in Thailand

Tangchitphisut

Khorana

Phinyo

et al. 2022

IJERPH

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An inability to bear self-weight is one of the unfavorable results in geriatric hip fracture, which needs to be prevented. This study determines pre-operative, intra-operative, and post-operative prognostic factors of the inability to bear self-weight at discharge in patients with fragility femoral neck fracture. This retrospective study was conducted at Chiang Mai University (CMU) hospital with an observational cohort design. Electronic medical records of patients aged ≥ 50 years old with fragility femoral neck fractures between 1 January 2015 and 31 December 2019 were reviewed. Pre-, intra-, and post-operative factors were collected. Ambulation status at discharge time was classified into either ability or inability to bear self-weight. Analysis of prognostic factors was done using multivariable risk ratio regression. In total, 269 patients were recruited in this study. Significantly prognostic factors of inability to bear self-weight at discharge were end-stage renal disease (ESRD), cirrhosis, cerebrovascular disease, pre-fracture ambulatory status, having associated fractures, increasing intra-operative blood loss, and having pressure sore. These prognostic factors could be used to predict patients’ outcomes at discharge. Proper management could then be offered to the patients by the multidisciplinary care team to enhance surgical outcomes.

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“…One key factor influencing QOL in geriatric patients is the living situation. In this context, approximately one out of six patients who live at a home-dwelling location before the fracture need to permanently move to a nursing home, resulting in a significantly reduced QOL [ 11 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

Patient-specific risk factors for adverse outcomes following geriatric proximal femur fractures

Becker

Hafner

Pishnamaz

et al. 2022

Eur J Trauma Emerg Surg

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Background Proximal femur fractures (PFFs) occur frequently among geriatric patients due to diverse risk factors, such as a lower bone mineral density and the increased risk of falls. Methods In this review, we focus on recent literature of patient-specific risk factors and their impact on common complications and outcome parameters in patients with PFF. Results Patient- and treatment related factors have a significant impact on outcome and are associated with an increased risk of mortality, impairments in functional rehabilitation and complicative courses. Conclusion Geriatric patients at high risk for complications are nursing home inhabitants suffering from severe osteoporosis, dementia and sarcopenia. The early and ongoing assessment for these individual risk factors is crucial. Strategies including interdisciplinary approaches, addressing comorbidities and facilitating an optimal risk factor evaluation result in a beneficial outcome. The ongoing ambulant assessment and therapy of complicating factors (e.g., malnutrition, sarcopenia, frailty or osteoporosis) have to be improved.

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Four-month outcome after proximal femur fractures and influence of early geriatric rehabilitation: data from the German Centres of Geriatric Trauma DGU

Cited by 13 publications

References 41 publications

Internal fixation versus hip arthroplasty in patients with nondisplaced femoral neck fractures: short-term results from a geriatric trauma registry

Internal fixation versus hip arthroplasty in patients with nondisplaced femoral neck fractures: short-term results from a geriatric trauma registry

Prognostic Factors of the Inability to Bear Self-Weight at Discharge in Patients with Fragility Femoral Neck Fracture: A 5-Year Retrospective Cohort Study in Thailand

Patient-specific risk factors for adverse outcomes following geriatric proximal femur fractures

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