Lateral locked plating for distal femur fractures by low-energy trauma: what makes a difference in healing?

Kim, Sang Min; Yeom, Jae-Woo; Song, Hyung Keun; Hwang, Kyu Tae; Hwang, Jihyo; Yoo, Je-Hyun

doi:10.1007/s00264-018-3881-3

Cited by 22 publications

(17 citation statements)

References 35 publications

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“…In most cases, the fractures of the neck of the femur are caused by chronic diseases of the bone (e.g. senile osteoporosis) and occur due to low-energy trauma (accidental falls in the home environment) (Kim et al , 2018), mainly in women suffering from severe osteoporosis in association with internal pathologies and/or motor coordination (Benzinger et al , 2015; Taylor et al , 2004; Chen et al , 2018). The international guidelines agree that the best treatment of fractures of the neck of the femur is surgical and the available scientific evidences show that surgery within 48 h of admission represents an effective treatment that can significantly reduce short, medium and long-term complications[2] (Colais et al , 2015; Nyholm et al , 2015; Moja et al , 2012).…”

Section: Introductionmentioning

confidence: 99%

The application of six sigma to reduce the pre-operative length of hospital stay at the hospital Antonio Cardarelli

Improta¹,

Ricciardi

Borrelli³

et al. 2019

IJLSS

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Purpose The best treatment for femur fractures is the surgical one within 48 h from the admission to the hospital. These fractures have serious consequences, both in terms of morbidity and socio-economic impact. In the hospital A.O.R.N. Cardarelli of Naples in Italy, the mean pre-operative length of hospital stay (LOS) was nine days and just 4 per cent of patients was operated within the suggested time. Therefore, a diagnostic-therapeutic-assistance path (DTAP) was implemented to improve the process. Design/methodology/approach This paper analyzes two groups of patients (534 and 562, respectively) before and after the introduction of DTAP, through six sigma (SS) based on define, measure, analyze, improve and control cycle. Age, gender, American Society of Anaesthesiologists (ASA) score, cardiovascular diseases, diabetes and allergies were used as independent subgrouping variables. The t-tests and chi-square were performed to compare the groups, tools of SS were used. Findings The analyses were conducted considering overall patients and some subgroups. The overall reduction in LOS was about 54 per cent, patients without cardiovascular diseases and with a low ASA score had the highest reduction, more than 60 per cent. All the p-values proved a high statistically significant difference between the two groups. Research limitations/implications The influence of the Italian health-care system is a minor limitation while, unfortunately, the lack of a follow-up did not allow quantifying the real gain in health of patients. A lean thinking analysis would suit this context. Practical implications There are practical advantages for both hospital and patients: the hospital will have an increase in admissions and more beds available, while patients will benefit of a faster intervention and a shorter wait. Originality/value This is the first analysis through SS of DTAP showing its positive influences in terms of both socio-economic impact and patients’ outcome. Policy leaders could use this study as an example to evaluate the introduction of the same clinical pathway in other health facilities.

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Section: Introductionmentioning

confidence: 99%

The application of six sigma to reduce the pre-operative length of hospital stay at the hospital Antonio Cardarelli

Improta¹,

Ricciardi

Borrelli³

et al. 2019

IJLSS

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show abstract

“…Fractures of the neck of the femur have proved to be frequent in older people and women seem to be more affected (Rossini et al , 2005; Kim et al , 2018). In most cases, chronic diseases of the bone (e.g.…”

Section: Introductionmentioning

confidence: 99%

Lean Six Sigma approach to reduce LOS through a diagnostic-therapeutic-assistance path at A.O.R.N. A. Cardarelli

Ricciardi

Fiorillo

Valente

et al. 2019

TQM

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Purpose The rise of the mean age incremented the occurrence of femur fractures with respect to the past, leading thus to serious consequences, as regards morbidity and socio-economic impact. The direction of the A.O.R.N. Cardarelli of Naples has introduced a DTAP whose aim was the reduction of LOS. The paper aims to discuss this issue. Design/methodology/approach The aim of this paper is to analyze the introduction of DTAP, employing Lean Thinking and Six Sigma methodology based on the DMAIC cycle. To evaluate the effectiveness of DTAP, two groups of patients have been observed for 14 months (before and after the implementation of DTAP). Findings Statistical tests were performed on the groups and graphics were provided to visualize the decrease of LOS (29.9 per cent). The overall population was also divided in subgroups according to six variables potentially influencing LOS. Research limitations/implications Authors considered six variables of influences; yet, others could be taken into account in the future. Practical implications The decrease of costs due to the management of elderly patients with femur fracture, the optimization of care processes in hospitals and a faster recovery for patients is the tangible contribute of DTAP. Originality/value The implementation of DTAP allowed the hospital to obtain a significant reduction of LOS with a consequently decrease of costs alleviating the hospital and the society from the socio-economic burden and the morbidity of this pathology.

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“…In addition, it would be useful if all studies on distal femur fractures would specify the weight-bearing strategy used, which is currently not the case. 12,[56][57][58][59] Based on available knowledge regarding the effects of restrictive and non-restrictive weight-bearing discussed in the preceding paragraphs, it seems reasonable to suggest nonrestrictive weight-bearing for elderly patients with distal femur fractures. Non-restrictive weight-bearing might, however, not be appropriate for all patients.…”

Section: Discussionmentioning

confidence: 99%

Immediate Full Weight-Bearing Versus Partial Weight-Bearing After Plate Fixation of Distal Femur Fractures in Elderly Patients. A Randomized Controlled Trial

Ekholm

Jonsson

Rolfson

2021

Geriatr Orthop Surg Rehabil

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Introduction After surgery for distal femur fractures in elderly patients, weight-bearing is commonly restricted. Immediate non-restrictive weight-bearing might have beneficial effects. There are no randomized studies on the topic. The purpose of this study was to compare the functional outcome between immediate full weight-bearing (FWB) as tolerated and partial weight-bearing (PWB) during the first 8 weeks following plate fixation of distal femur fractures in elderly patients. Methods Patients aged 65 years or older with distal femur fractures of AO/OTA types 33 A2, A3, B1, B2, C1, and C2 were included. Exclusion criteria were impaired cognitive function, concomitant injuries, or inability to follow the postoperative regimen. Internal fixation was achieved with an anatomical lateral distal femur plate applied as a strictly bridge-plating construct. The primary outcome measure was the function index of the short musculoskeletal functional assessment (SMFA) after 52 weeks from injury. Results Thirty-two patients were randomized to FWB (n = 11) or PWB (n = 21). After 16 and 52 weeks, there were no differences in the mean SMFA function index between FWB and PWB (36 vs 43, P = .42 and 52 vs 40, P = .18, respectively) nor in the mean EuroQol 5-dimension index or range of motion (ROM). Overall, the SMFA function index was higher at 52 weeks compared with before injury (44 vs 30, P = .001) as was the mean bothersome index (37 vs 21, P = .011). There was no clear difference in the occurrence of adverse events between the treatment groups. Conclusions There were no differences in functional outcome, adverse events, or ROM between immediate FWB and PWB following plate fixation for a distal femur fracture in elderly patients. A distal femur fracture has a negative effect on the functional status of elderly patients that persists at least up to 1 year following injury.

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Lateral locked plating for distal femur fractures by low-energy trauma: what makes a difference in healing?

Cited by 22 publications

References 35 publications

The application of six sigma to reduce the pre-operative length of hospital stay at the hospital Antonio Cardarelli

The application of six sigma to reduce the pre-operative length of hospital stay at the hospital Antonio Cardarelli

Lean Six Sigma approach to reduce LOS through a diagnostic-therapeutic-assistance path at A.O.R.N. A. Cardarelli

Immediate Full Weight-Bearing Versus Partial Weight-Bearing After Plate Fixation of Distal Femur Fractures in Elderly Patients. A Randomized Controlled Trial

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