Update on medical management of acute hip fracture

Ackermann, Lily; Schwenk, Eric S.; Lev, Yair; Weitz, Howard H.

doi:10.3949/ccjm.88a.20149

Cited by 13 publications

(14 citation statements)

References 48 publications

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“…The incidence of POD after surgery in elderly hip fracture patients is even higher [ 23 ]. Many studies on postoperative analgesia of hip fractures have confirmed that nerve block analgesia can prevent delirium [ 5 , 14 , 24 ]. The influence of nerve block on delirium may be multifactorial, including improving pain, enhancing analgesic effects and reducing opioid consumption [ 25 ].…”

Section: Discussionmentioning

confidence: 99%

Application of a preoperative pain management mode based on instant messaging software in elderly hip fracture patients: a randomized controlled trial

et al. 2023

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Background Preoperative analgesia of hip fracture in elderly patients is important, but it is also lacking. In particular, nerve block was not provided in time. In order to provide more effective analgesia, we designed a multimodal pain management mode based on instant messaging software. Methods From May to September 2022, a total of 100 patients with unilateral hip fracture aged over 65 were randomly divided into the test group and the control group. Finally, 44 patients in each group completed the result analysis. A new pain management mode was used in the test group. This mode focuses on the full information exchange between medical personnel in different departments, early fascia iliaca compartment block (FICB), and closed-loop pain management. Outcomes include the time when FICB is completed for the first time; The number of cases of FICB completed by emergency doctors; Patients' pain score, pain duration. Results The time for patients in the test group to complete FICB for the first time was 3.0 [1.925–3.475] h, which was less than the time for patients in the control group (4.0 [3.300–5.275] h). The difference was statistically significant (P < 0.001). Compared with 16 patients in the control group, 24 patients in the test group completed FICB by emergency doctors, and there was no statistical difference between the two groups (P = 0.087). The test group was superior to the control group in the highest NRS score (4.00 [3.00–4.00] vs 5.00 [4.00–5.75]), the duration of the highest NRS score (20.00 [20.00–25.00] mins vs 40.00 [30.00–48.75] mins), and the NRS > 3 time (35.00 [20.00–45.00] mins vs 72.50 [60.00–45.00] mins). The analgesic satisfaction of patients in the test group (5.00 [4.00–5.00]) was also significantly higher than that of the control group (3.00 [3.00–4.00]). The above four indexes were different between the two groups (P < 0.001). Conclusions Using instant messaging software, the new model of pain management can enable patients to receive FICB as soon as possible and improve the timeliness and effectiveness of analgesia. Trial registration Chinese Clinical Registry Center, ChiCTR2200059013, 23/04/2022.

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Section: Discussionmentioning

confidence: 99%

Application of a preoperative pain management mode based on instant messaging software in elderly hip fracture patients: a randomized controlled trial

et al. 2023

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“…Ackermann et al considered delaying surgery no more than 48 h if necessary. 21 In clinical practice, for patients admitted on Fridays, surgery is often postponed until the Monday of the following week if they do not have surgery over the weekend to treat the hip fracture. This leads to a higher risk of delayed surgery for geriatric patients with hip fractures admitted on Fridays.…”

Section: Introductionmentioning

confidence: 99%

“…At the same time, we found that most studies have underscored the importance of timely surgery. Ackermann et al considered delaying surgery no more than 48 h if necessary 21 . In clinical practice, for patients admitted on Fridays, surgery is often postponed until the Monday of the following week if they do not have surgery over the weekend to treat the hip fracture.…”

Section: Introductionmentioning

confidence: 99%

Is There a “Black Friday” for Geriatric Hip Fracture Surgery?

Tian

Zhu

Shi

et al. 2023

Orthopaedic Surgery

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Objectives Reports show an increase in the short‐term mortality rates of hip fracture patients admitted on weekends. However, there are few studies on whether there is a similar effect in Friday admissions of geriatric hip fracture patients. The aim of this study was to evaluate the effects of Friday admission on mortality and clinical outcomes in elderly patients with hip fractures. Methods A retrospective cohort study was performed at a single orthopaedic trauma centre and included all patients who underwent hip fracture surgery between January 2018 and December 2021. Patient characteristics, including age, sex, BMI, fracture type, time of admission, ASA grade, comorbidities, and laboratory examinations, were collected. Data pertaining to surgery and hospitalization were extracted from the electronic medical record system and tabulated. The corresponding follow‐up was performed. The Shapiro–Wilk test was applied to evaluate the distributions of all continuous variables for normality. The overall data were analyzed by Student's t test or the Mann–Whitney U test for continuous variables and the chi‐square test for categorical variables, as appropriate. Univariate and multivariate analyses were used to further test for the independent influencing factors of prolonged time to surgery. Results A total of 596 patients were included, and 83 patients (13.9%) were admitted on Friday. There was no evidence supporting that Friday admission had an effect on mortality and outcomes, including length of stay, total hospital costs and postoperative complications. However, the patients admitted on Friday had delayed surgery. Then, patients were regrouped into two groups according to whether surgery was delayed, and 317 patients (53.2%) underwent delayed surgery. The multivariate analysis showed that younger age ( p = 0.014), Friday admission ( p < 0.001), ASA classification III‐IV ( p = 0.019), femoral neck fracture ( p = 0.002), time from injury to admission more than 24 h ( p = 0.025), and diabetes ( p = 0.023) were risk factors for delayed surgery. Conclusions Mortality and adverse outcome rates for elderly hip fracture patients admitted on Friday were similar to those admitted at other time periods. However, Friday admission was identified as one of the risk factors for delayed surgery.

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“…[8][9][10] Pain management in elderly hip fracture patients is often challenging. 11 Non-steroidal anti-inflammatory drugs are not recommended due to their side effects; increased risk of gastrointestinal bleeding, renal function impairment and platelet aggregation inhibition. 12 Paracetamol alone is often insufficient and opioids have many potentially harmful side effects 13,14 The role of regional analgesia, especially peripheral nerve blocks, is rising but they are still not used as often as they should.…”

Section: Introductionmentioning

confidence: 99%

“…( 12 ) Paracetamol alone is often insufficient and opioids have many potentially harmful side effects ( 13 - 15 ) The role of regional analgesia, especially peripheral nerve blocks, is rising but they are still not used as often as they should. ( 5 , 11 )…”

Section: Introductionmentioning

confidence: 99%

Peripheral Nerve Blocks for Hip Fractures in Emergency Medicine

Simić

Adam

Rošić

et al. 2022

ACC

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Hip fractures represent a major public health issue with increasing incidence as a population ages. The aim of this review is to describe peripheral nerve block techniques (the fascia iliaca compartment block and the pericapsular nerve group block) as pain management for hip fractures in emergency medicine, and to emphasize their benefits. Hip fractures are extremely painful injuries. The pain itself is unpleasant for patients and if left untreated it can lead to multiple complications during preoperative, operative and postoperative patient management. Pain management for elderly hip fracture patients is often challenging. Non-steroidal anti-inflammatory drugs are not recommended due to their side effects, the increased risk of gastrointestinal bleeding, renal function impairment and platelet aggregation inhibition. Paracetamol alone is often insufficient, and opioids have many potentially harmful side effects, such as delirium development. Peripheral nerve blocks for hip fractures are safe and effective, also in emergency medicine settings. The benefits for patients are greater pain relief, especially during movement, less opioid requirements and decreased incidence of delirium. Regional analgesia should be routinely used in hip fracture pain management.

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Update on medical management of acute hip fracture

Cited by 13 publications

References 48 publications

Application of a preoperative pain management mode based on instant messaging software in elderly hip fracture patients: a randomized controlled trial

Application of a preoperative pain management mode based on instant messaging software in elderly hip fracture patients: a randomized controlled trial

Is There a “Black Friday” for Geriatric Hip Fracture Surgery?

Peripheral Nerve Blocks for Hip Fractures in Emergency Medicine

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