Poor adherence to guidelines in treatment of fragile and cognitively impaired patients with hip fracture: a descriptive study of 2,804 patients

Frandsen, Christina Frölich; Glassou, Eva Natalia; Stilling, Maiken; Hansen, Torben Bæk

doi:10.1080/17453674.2021.1925430

Cited by 7 publications

(3 citation statements)

References 18 publications

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“…The strength of this study lies in the double-blinded randomized controlled study design, the high precision of RSA as a validated method to measure migrations of both implants and fractures, and the protocolled similarity of the treatment algorithm in both inclusion sites [8,9]. Limitations include a skewed sex distribution, with more women than men.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

“…The incidence of hip fracture is increasing with the growing elderly population [3] and pertrochanteric fractures constitute a little less than half of all hip fractures in the Nordic countries [4,5]. The principal treatment for pertrochanteric fractures is surgery with a sliding hip screw with plate (SHS), which is an implant system where a lag screw fixed in the femoral head can slide in a short barrel of a plate fixed on the lateral side of the proximal femur facilitating pertrochanteric fracture compression and healing [6][7][8][9].…”

Section: Introductionmentioning

confidence: 99%

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No effect of hydroxyapatite-coated sliding hip screw threads on screw migration in the femoral head/neck of pertrochanteric fractures: a randomized controlled trial using radiostereometric analysis

Krogh,

Thillemann,

Hansen

et al. 2023

J Orthop Surg Res

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Introduction Cut-out is the most frequently reported mechanical failure of internal fixation of pertrochanteric fractures. The purpose of this study was to examine if hydroxyapatite-coated screw thread on a sliding hip screw (SHS) could reduce screw migration within the femoral head in patients with stable pertrochanteric fractures. Materials and methods In a double-blinded randomized controlled study, 37 patients at mean age 78 (range 56–96), with pertrochanteric fracture (Evans I, II, IV) received surgery with a SHS with a hydroxyapatite-coated or a non-coated lag screw thread. Radiostereometry and standard radiographs were obtained 1 day, 6 weeks, 3- and 6 months post-operatively to evaluate screw and fracture migration and fracture reposition. The two groups were combined to describe fracture migration. Results There was similar and small screw migration in the femoral head between the two groups at 6 weeks, 3- and 6 months (p > 0.12). Fracture migration occurred predominantly in the first 6 weeks, where fracture impaction was 5.95 mm (CI 95% 2.87 to 9.04) and anterior rotation of the femoral head was -2.94° (CI 95% − 5.22 to − 0.66). Migration of the fracture (total translation) correlated to the post-operative fracture reposition (p = 0.002), but not significantly to screw migration (p = 0.09). Neither screw total translation (rho 0.06, p = 0.79) nor fracture total translation (rho 0.04, p = 0.77) correlated with bone mineral density. Conclusion There was no clinical benefit of hydroxyapatite coating on lag screw migration in this patient cohort. Migration of the pertrochanteric fractures was higher with poor fracture reposition but fractures generally stabilized after 6 weeks follow-up. The study was registered at ClinicalTrials.gov (NCT05677061). Level of evidence II Patient-blinded prospective randomized study. Trial registration number The study was registered at ClinicalTrials.gov (NCT05677061).

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Section: Strengths and Limitationsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

No effect of hydroxyapatite-coated sliding hip screw threads on screw migration in the femoral head/neck of pertrochanteric fractures: a randomized controlled trial using radiostereometric analysis

Krogh,

Thillemann,

Hansen

et al. 2023

J Orthop Surg Res

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“…However, previous studies on missed care have relied exclusively on nurse self‐reporting (Griffiths et al, 2018 ). Patients with hip fractures represent some of the frailest patients admitted to hospitals and may be at high risk of missed care (Frandsen et al, 2021 ). Several clinical quality databases for hip fracture care have been established in European countries with the aim of consistent evidence‐based hip fracture care.…”

Section: Introductionmentioning

confidence: 99%

Are hip fracture patients with high or low body mass index at higher risk of missed care? A cohort study

2023

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Aim To examine whether patients' body mass index is associated with missed hip fracture care consistent with national guideline‐recommended care. Design A nationwide, population‐based cohort study using prospectively collected data from the Danish Multidisciplinary Hip Fracture Registry. Methods The study population consisted of 39,835 patients ≥65 years admitted with a hip fracture and discharged between 1st of January 2012 and 29th of November 2017. National guideline‐recommended care consists of preoperative optimization, early surgery, mobilization within 24 h, basic mobility assessment, nutrition screening, post‐discharge rehabilitation program, and osteoporotic and fall prophylaxis. We used binomial regression to estimate the relative risk for the fulfilment of the individual measures with 95% confidence interval. Multiple imputation method was applied to handle missing values of body mass index. Results The overall fulfilment of the individual measures ranged from 43% for pre‐operative optimization to 95% for receiving a post‐discharge rehabilitation program. The obese patients had a lower fulfilment of surgery within 36 h compared to patients with normal weight. No differences in fulfilment of the other measures were found. However, patients with missing data on body mass index had the highest risk of missed care. In conclusion, patients with missing BMI values had the highest risk of missed care. The obese patients had a slightly higher risk of long waiting times for surgery than normal‐weighted patients. No Patient or Public Contribution This study was done based on population‐based data from medical registries and data was analysed by the authors only.

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The majority of community-dwelling hip fracture patients return to independent living with minor increase in care needs: a prospective cohort study

Frandsen

Stilling

Glassou

et al. 2022

Arch Orthop Trauma Surg

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Poor adherence to guidelines in treatment of fragile and cognitively impaired patients with hip fracture: a descriptive study of 2,804 patients

Cited by 7 publications

References 18 publications

No effect of hydroxyapatite-coated sliding hip screw threads on screw migration in the femoral head/neck of pertrochanteric fractures: a randomized controlled trial using radiostereometric analysis

No effect of hydroxyapatite-coated sliding hip screw threads on screw migration in the femoral head/neck of pertrochanteric fractures: a randomized controlled trial using radiostereometric analysis

Are hip fracture patients with high or low body mass index at higher risk of missed care? A cohort study

The majority of community-dwelling hip fracture patients return to independent living with minor increase in care needs: a prospective cohort study

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