DOCSLIB.ORG

Osteoarthritis Epidemiologicosteoarthritis and Genetic Aspects Epidemiologic and Genetic Aspects

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Osteoarthritis Epidemiologicosteoarthritis and Genetic Aspects Epidemiologic and Genetic Aspects From the Department of Orthopedics, Clinical Sciences From the DepartmentLund University, of Orthopedics, Lund, Sweden Clinical Sciences Lund University, Lund, Sweden Osteoarthritis EpidemiologicOsteoarthritis and genetic aspects Epidemiologic and genetic aspects Jonas Franklin Jonas Franklin Thesis 2010 Thesis 2010 Contact address Jonas Franklin Department of Orthopedics Akureyri University Hospital IS-600 Akureyri Iceland E-mail: [email protected] ISSN 1652-8220 ISBN 978-91-86443-87-0 Lund University, Faculty of Medicine Doctoral Dissertation Series 2010:71 Printed in Sweden Mediatryck, Lund 2010 To Hlíf Atli Egill and Jóhann Jonas Franklin 1 Contents List of papers, 2 Radiographic techniques, 17 Radiographic classification, 17 Definitions and abbreviations, 3 Statistical methods, 17 Thesis at a glance, 4 Ethics, 18 Description of contributions, 6 Data encryption and protection of the individual, 18 Introduction, 7 Symptoms and signs of osteoarthritis, 7 Summary of results of papers I-V, 19 Natural history of osteoarthritis, 8 Discussion, 24 Radiographic features of osteoarthritis, 8 Research methodology, 24 Definition of osteoarthritis, 9 Abnormal mechanical loading is a risk factor for Definition of hip fractures, 9 OA, 25 Study methodology, 9 Natural history of OA, 27 Epidemiology of osteoarthritis, 11 OA and hip fracture, 28 Epidemiology of hip fractures, 11 Conclusions, 30 Risk factors for osteoarthritis ,12 Summary, 31 Risk factors for hip fracture, 13 Populärvetenskaplig sammanfattning på Aims, 14 svenska, 33 Patients and methods, 15 Ágrip á íslensku, 35 Overview of patient/subject allocation, 15 Acknowledgements, 37 Patient identification, 15 References, 38 Populations examined, 16 2 Osteoarthritis - Epidemiologic and genetic aspects List of papers This thesis is based on the following papers: I. Franklin J, Ingvarsson T, Englund M, IV. Franklin J, Englund M, Ingvarsson T, Lohmander LS. Sex differences in the Lohmander LS. The association between association between body mass index hip fracture and hip osteoarthritis. A and total hip or knee joint replacement case-control study. Submitted. resulting from osteoarthritis. Ann Rheum Dis 2009;68:536–540. V. Franklin J, Ingimarsson O, Styrkarsdottir U, Jonsson GF, Ingvarsson T, Englund II. Franklin J, Ingvarsson T, Englund M, M, Lohmander LS. Relatives of patients Lohmander LS. Association between with total hip replacement due to occupation and knee and hip replacement osteoarthritis do not have reduced risk of due to osteoarthritis: A case-control hip fracture: A study of the inheritance study. Submitted. of hip osteoarthritis and hip fracture in Iceland. Manuscript. III. Franklin J, Ingvarsson T, Englund M, Ingimarsson O, Robertsson O, Lohmander LS. The natural history of radiographic hip osteoarthritis. A retrospective cohort study with 11-28 years follow-up. Submitted. Jonas Franklin 3 Definitions and abbreviations ACR American College of Rheumatology MRI Magnetic resonance imaging AGES study Age, Gene, Environment, OA Osteoarthritis Susceptibility Study OR Odds ratio AP Anteroposterior PIN Personal Identification Number BMI Body mass index Qualitative measurement Measurement with an CI Confidence interval ordinal, subjective scale such as K&L grading of radiological OA Dichotome A binary variable Quantitative measurement Measurement with a Extracapsular fracture Hip fracture that is quantitative scale such as millimetres outside the joint capsule (basocervical, pertrochanteric, and subtrochanteric fractures) ROC Receiver Operator Characteristic HR Hazard ratio RR Relative Risk IBD Identical by descent SD Standard Deviation ILO International Labour Organization THR Total hip replacement Intracapsular fracture Hip fracture that is TJR Total joint replacement inside the joint capsule (fractures of the femoral neck) TKR Total knee replacement K & L Kellgren and Lawrence WHO World Health Organization MJS Minimal joint space WOMAC Index Western Ontario and McMaster Universities Osteoarthritis Index 4 Osteoarthritis - Epidemiologic and genetic aspects Thesis at a glance Paper I: Sex differences in the association inheritance of occupation a possible confounder between body mass index and total hip in this question? or knee joint replacement resulting from Patients: 1408 patients (832 women) with THR osteoarthritis and/or TKR and 1082 (592) controls that Is body mass index associated with total joint participated in the Icelandic OA Genealogy replacement in the hip or knee? study. Patients: 1473 patients (872 women) with THR Methods: Questionnaire data as outlined for and/or TKR and 1103 controls (599 women) that Paper I above. Inheritance was calculated by participated in the Icelandic OA Genealogy comparing the cohort with the Icelandic study. A randomly selected population sample Genealogy Database. was used as a secondary control group. Results: The age adjusted odds ratio (OR) for Methods: All cases and controls answered a male farmers getting a TKR due to OA was 5.1 standardised questionnaire containing 79 (95% confidence interval (CI) 2.1-12.4) and for a questions on the subject’s height and weight, male farmer getting a THR due to OA the OR general health status, occupation, family history, was 3.6 (95% CI 2.1-6.2). The OR for a physical activities, previous injuries and a fisherman getting a TKR was 3.3 (95%CI 1.3- detailed description of all musculoskeletal 8.4). No other occupations showed increased risk symptoms. The hospital records of all cases were for men. For women there was no increased risk reviewed to confirm that the diagnosis of OA. for any occupation. Farming and fishing were Results: The OR, adjusted for age, occupation also the occupations that showed the greatest and presence of hand OA, for having a THR was degree of inheritance. 1.1 (95% CI 0.9 to 1.5) for overweight men and Conclusion: These results support an association 1.7 (95% CI 1.0 to 2.9) for obese men. The OR in males between physically demanding work for having a TKR was 1.7 (95% CI 1.1 to 2.6) for and both TKR and THR for OA, particularly overweight men and 5.3 (95% CI 2.8 to 10.1) for farming. Farming is however also the occupation obese men. The OR for having a THR was 1.0 that has the greatest degree of inheritance and (95% CI 0.8 to 1.3) for overweight women and this might interact with the results. 1.0 (95% CI 0.6 to 1.5) for obese women. The OR for having a TKR was 1.6 (95% CI 1.1 to 2.2) for overweight women and 4.0 (95% CI 2.6 Paper III: The natural history of to 6.1) for obese women. radiographic hip osteoarthritis. A Conclusion: The results of this study support a retrospective cohort study with 11-28 positive association between high BMI and TKR years follow-up in both sexes, but for THR the association with What is the future risk of THR and hip fracture in BMI seems to be weaker, and possibly negligible subjects with radiographic hip OA? for women. Patients: A cohort of subjects that had colon radiography in 1980-1997. Methods: MJS was measured in each hip it and graded according to Kellgren & Lawrence. Paper II: Association between occupation Subjects were followed until end of 2008. 1498 and knee and hip replacement due to subjects supplied 2953 hips for analysis. osteoarthritis: A case-control study Results: The cumulative incidence of THR was Is occupation associated with total joint 2.5% and the cumulative incidence of hip replacement in the hip or knee? Is the fracture was 2.6%. For hips with radiographic Jonas Franklin 5 hip OA (MJS 2.5 mm or less) the cumulative higher than for subjects with hip fracture without incidence of THR was 16.9%, and the hazard hip OA. ratio (HR) for THR was 13.2 (95% CI 8.1-21). Conclusions: The results of our study support Using Kellgren and Lawrence grading, the HR the inverse relationship between osteoporosis and for THR was 12.9 (95% CI 7.9-21) for hips with hip OA. radiographic OA, compared to those without. The HR for all types of hip fracture for hips with radiographic OA (MJS 2.5 mm or less) was 0.47 Paper V: Relatives of patients with total (95% CI 0.15-1.5), for intracapsular fractures hip replacement due to osteoarthritis do 0.29 (95% CI 0.04-2.1) and for extracapsular not have reduced risk of hip fracture: A fractures 0.67 (95% CI 0.16-2.8). study of the inheritance of hip Conclusions: The risk for THR due to OA is osteoarthritis and hip fracture in Iceland substantially increased in patients with Are patients with hip fracture and THR due to radiographic hip OA, regardless of symptoms OA less related to each other, than can be and increases with decreasing MJS. However, expected in the Icelandic population? 11-28 years after having had radiographic hip Patients: 4228 patients with THR due to OA OA, more than 4 out 5 of those having (THR-OA) and 8165 patients with hip fracture radiographic signs of hip OA had not had a THR compared with controls from the Icelandic for OA. Genealogy Database. Methods: The average pairwise kinship coefficient (KC) was calculated for patient lists Paper IV: The association between hip and control lists and the relative risk (RR) was fracture and hip osteoarthritis. A case- estimated for THR-OA and for hip fracture control study among relatives of patients with THR-OA. Ten What is the prevalence of hip OA in patients with thousand matched control lists, each the same hip fracture? size as the patient list, were created using the Patients: 562 patients with hip fracture at Genealogy Database. Akureyri University Hospital in 1990-2008 Results: The RR for THR-OA among relatives compared with 803 subjects from a colon of THR-OA patients was 2.80 for parents (95% radiography cohort. CI 2.45-3.18), and 2.27 (95% CI 2.08-2.37) for Methods: Radiographies of cases and controls siblings.
Load more

Recommended publications
  • Treatment of Common Hip Fractures: Evidence Report/Technology
    This report is based on research conducted by the Minnesota Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. HHSA 290 2007 10064 1). The findings and conclusions in this document are those of the authors, who are responsible for its content, and do not necessarily represent the views of AHRQ. No statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services. The information in this report is intended to help clinicians, employers, policymakers, and others make informed decisions about the provision of health care services. This report is intended as a reference and not as a substitute for clinical judgment. This report may be used, in whole or in part, as the basis for the development of clinical practice guidelines and other quality enhancement tools, or as a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied. Evidence Report/Technology Assessment Number 184 Treatment of Common Hip Fractures Prepared for: Agency for Healthcare Research and Quality U.S. Department of Health and Human Services 540 Gaither Road Rockville, MD 20850 www.ahrq.gov Contract No. HHSA 290 2007 10064 1 Prepared by: Minnesota Evidence-based Practice Center, Minneapolis, Minnesota Investigators Mary Butler, Ph.D., M.B.A. Mary Forte, D.C. Robert L. Kane, M.D. Siddharth Joglekar, M.D. Susan J. Duval, Ph.D. Marc Swiontkowski, M.D.
    [Show full text]
  • Single Screw Type of Lag Screw Results Higher Reoperation Rate in the Osteosynthesis of Basicervical Hip Fracture
    Journal of Orthopaedic Science xxx (xxxx) xxx Contents lists available at ScienceDirect Journal of Orthopaedic Science journal homepage: http://www.elsevier.com/locate/jos Original Article Single screw type of lag screw results higher reoperation rate in the osteosynthesis of basicervical hip fracture * Jung-Taek Kim a, Yong-Chan Ha b, Chan-Ho Park c, Jun-Il Yoo d, Tae-Young Kim e, a Ajou University Hospital, Department of Orthopaedic Surgery, 164, World cup-ro, Yeongtong-gu, Suwon-si, Gyeonggi-do, 16499, South Korea b Chung-Ang University, College of Medicine, Department of Orthopaedic Surgery, 102, Heukseok-ro, Dongjak-gu, Seoul, 06973, South Korea c Yeungnam University Medical Center, Department of Orthopedic Surgery, 170, Hyeonchung-ro, Nam-gu, Daegu, 42415, South Korea d Gyeongsang National University Hospital, Department of Orthopaedic Surgery, 79, Gangnam-ro, Jinju, Gyeongsangnam-do, 52727, South Korea e Konkuk University Medical Center, Department of Orthopaedic Surgery, School of Medicine, Konkuk University, 120-1, Neungdong-ro, Gwangjin-gu, Seoul, 05030, South Korea article info abstract Article history: Background: Basicervical hip fractures are relatively rare with greater biomechanical instability Received 8 January 2019 compared to the other types of hip fractures. Several studies have reported ambivalent surgical outcomes Received in revised form of basicervical hip fractures. The purpose of this multicenter study was to analyze surgical outcomes of 7 February 2019 basicervical hip fractures according to the fixation type of proximal femur and lag screw type. Accepted 12 February 2019 Methods: Among 3220 hip fractures, 145 were classified as basicervical hip fractures. Of those, 106 Available online xxx patients treated with osteosynthesis were included to analyze the surgical complications according to fixation type of proximal femur: sliding hip screw(SHS) and cephalomedullary nail (CMN) groups.
    [Show full text]
  • Extracapsular Hip Fractures—Aspects of Intramedullary and Extramedullary Fixation
    D 990 OULU 2008 D 990 UNIVERSITY OF OULU P.O.B. 7500 FI-90014 UNIVERSITY OF OULU FINLAND ACTA UNIVERSITATIS OULUENSIS ACTA UNIVERSITATIS OULUENSIS ACTA SERIES EDITORS DMEDICA Ismo Saarenpää ASCIENTIAE RERUM NATURALIUM IsmoSaarenpää Professor Mikko Siponen EXTRACAPSULAR HIP BHUMANIORA FRACTURES—ASPECTS OF University Lecturer Elise Kärkkäinen CTECHNICA INTRAMEDULLARY AND Professor Hannu Heusala EXTRAMEDULLARY DMEDICA Professor Olli Vuolteenaho FIXATION ESCIENTIAE RERUM SOCIALIUM Senior Researcher Eila Estola FSCRIPTA ACADEMICA Information officer Tiina Pistokoski GOECONOMICA University Lecturer Seppo Eriksson EDITOR IN CHIEF Professor Olli Vuolteenaho PUBLICATIONS EDITOR Publications Editor Kirsti Nurkkala FACULTY OF MEDICINE, INSTITUTE OF CLINICAL MEDICINE, DEPARTMENT OF SURGERY, DIVISION OF ORTHOPAEDIC AND TRAUMA SURGERY, ISBN 978-951-42-8933-0 (Paperback) UNIVERSITY OF OULU ISBN 978-951-42-8934-7 (PDF) ISSN 0355-3221 (Print) ISSN 1796-2234 (Online) ACTA UNIVERSITATIS OULUENSIS D Medica 990 ISMO SAARENPÄÄ EXTRACAPSULAR HIP FRACTURES—ASPECTS OF INTRAMEDULLARY AND EXTRAMEDULLARY FIXATION Academic Dissertation to be presented, with the assent of the Faculty of Medicine of the University of Oulu, for public defence in Auditorium 1 of Oulu University Hospital, on November 7th, 2008, at 12 noon OULUN YLIOPISTO, OULU 2008 Copyright © 2008 Acta Univ. Oul. D 990, 2008 Supervised by Professor Pekka Jalovaara Reviewed by Docent Peter Lüthje Docent Jari Salo ISBN 978-951-42-8933-0 (Paperback) ISBN 978-951-42-8934-7 (PDF) http://herkules.oulu.fi/isbn9789514289347/ ISSN 0355-3221 (Printed) ISSN 1796-2234 (Online) http://herkules.oulu.fi/issn03553221/ Cover design Raimo Ahonen OULU UNIVERSITY PRESS OULU 2008 Saarenpää, Ismo, Extracapsular hip fractures—aspects of intramedullary and extramedullary fixation Faculty of Medicine, Institute of Clinical Medicine, Department of Surgery, Division of Orthopaedic and Trauma Surgery, University of Oulu, P.O.Box 5000, FI-90014 University of Oulu, Finland Acta Univ.
    [Show full text]
  • Posters, Which Were Displayed on All Orthopaedic Wards and Emailed Individually to All Orthopaedic Trainees and Consultants
    Abstract no.: 36413 PATHOLOGICAL INFLUENCES OF CONNECTIVE TISSUES DYSPLASTIC DISORDERS ON SURGICAL TREATMENT RESULTS OF PECTUS EXCAVATUM IN CHILDREN Iskandar KHODJANOV, Sherali KHAKIMOV, Khatam KASYMOV Scientific Research Institute Traumatology and Orthopedics, Tashkent city (UZBEKISTAN) Recently, several complications associating with the instability of the installed bar, PC deformity occurrence and the PE relapse have been occurred in more than 20% after surgery. Purpose was the determination of the role of the connective tissues dysplastic disorders for remodeling processes of the anterior chest wall in children with PE in post- operative periods. Investigation performed on 40 children, who underwent operative treatment by the D. Nuss procedure in Clinic of SRITO RUz, with PE. Genetic assessment was carried out by the T. Milkovska-Dmitrova and A. Karakeshev classification (1985). Good results were obtained in 35 cases in the nearest postoperative periods, 5 cases were with the severe pain and in long-term periods was occurred the PC deformity in 2 cases, secondary atypical deformation in 1, the relapse of PE till I degree in 1 and in 1 case was saved the neuralgic pain. The connective tissues dysplasia is a congenital character genesis, characterized by metabolic disorders in the stroma tissues and several enzymopathy. The osseo-cartilaginous structural system growth processes were not behavioral in the necessary age norm of locomotors apparatus and with the delaying of ossification processes also in the adolescent's age and the sterno-costal complex became most pliable. These changes complicated the correction method of PE, extended the period of immobilization. It is hard to determine the outcome operative results of the patients with severe degrees of conjunctive tissues dysplasia.
    [Show full text]
  • Case Files Orthopaedic Surgery
    CASE FILES® Orthopaedic Surgery Eugene C. Toy, MD Timothy T. Roberts, MD Vice Chair of Academic Affairs, Resident of Orthopaedic Surgery Department of Obstetrics and Division of Orthopaedic Surgery Gynecology Albany Medical Center The John S. Dunn, Senior Academic Albany, New York Chair and Program Director The Methodist Hospital Ob/Gyn Joshua S. Dines, MD Residency Program Orthopaedic Surgeon Houston, Texas Sports Medicine and Shoulder Service Clerkship Director, Clinical Professor Hospital for Special Surgery Department of Obstetrics and Gynecology New York, New York The University of Texas—Houston Assistant Professor of Orthopaedic Surgery Medical School Weill Cornell Medical College Houston, Texas New York, New York Andrew J. Rosenbaum, MD Resident of Orthopaedic Surgery Division of Orthopaedic Surgery Albany Medical Center Albany, New York New York Chicago San Francisco Lisbon London Madrid Mexico City Milan New Delhi San Juan Seoul Singapore Sydney Toronto Copyright © 2013 by McGraw-Hill Education, LLC. All rights reserved. Except as permitted under the United States Copyright Act of 1976, no part of this publication may be reproduced or distributed in any form or by any means, or stored in a database or retrieval system, without the prior written permission of the publisher. ISBN: 978-0-07-179029-1 MHID: 0-07-179029-2 The material in this eBook also appears in the print version of this title: ISBN: 978-0-07-179030-7, MHID: 0-07-179030-6. All trademarks are trademarks of their respective owners. Rather than put a trademark symbol after every occurrence of a trademarked name, we use names in an editorial fashion only, and to the benefi t of the trademark owner, with no intention of infringement of the trademark.
    [Show full text]
  • Correlation Between Hip Osteoarthritis and Proximal Femoral Fracture Site: Could It Be Protective for Intracapsular Neck Fractures? a Retrospective Study on 320 Cases
    Osteoporosis International (2019) 30:1591–1596 https://doi.org/10.1007/s00198-019-05015-5 ORIGINAL ARTICLE Correlation between hip osteoarthritis and proximal femoral fracture site: could it be protective for intracapsular neck fractures? A retrospective study on 320 cases Tommaso Maluta1 & Giovanna Toso1 & Stefano Negri1 & Elena Manuela Samaila1 & Bruno Magnan1 Received: 24 February 2019 /Accepted: 13 May 2019 /Published online: 8 June 2019 # International Osteoporosis Foundation and National Osteoporosis Foundation 2019 Abstract Summary Proximal femoral fractures affect elderly people, showing high morbidity and mortality incidence resulting in a major economic burden on national healthcare systems. Understanding the causes of these injuries is of paramount importance to prevent the serious consequences of these fractures. Introduction Hip osteoarthritis and proximal femoral fractures mainly affect elderly patients. Several authors, in their studies, tried to document a correlation between these conditions, but the results are conflicting. The aim of this study was to evaluate the relationship between hip osteoarthritis and the fracture site. Secondly, to evaluate if the grade of osteoarthritis could influence the fracture pattern. Methods A retrospective study on 320 patients admitted for hip fracture between June 2015 and December 2016 was carried on. Radiographic images were evaluated, assessing the type of fracture, presence and grade of osteoarthritis according to Kellgren- Lawrence and Tönnis classifications, and their correlations. Results Osteoarthritis was found to affect the fracture site showing a higher prevalence among subjects with extracapsular than those with intracapsular fractures (p < 0.00001). Patients with radiographic signs of arthritis had mainly trochanteric fracture. Conversely, patients without arthritis more frequently presented a femoral neck fracture.
    [Show full text]
  • Differences in Mortality Among Hip Fracture Patients in the Swedish Fracture Register
    Differences in mortality among hip fracture patients in the Swedish Fracture Register Master Thesis in Medicine Author: Lars Söderström The Sahlgrenska Academy: Programme in Medicine Gothenburg, Sweden 2018 Supervisors: Alicja Bojan, MD, PhD & Michael Möller, MD, PhD Sahlgrenska University Hospital, Department of Orthopaedics Sahlgrenska Academy, University of Gothenburg Table of contents ABSTRACT .............................................................................................................................. 3 ABBREVIATIONS .................................................................................................................. 5 BACKGROUND ...................................................................................................................... 6 INTRODUCTION ....................................................................................................................... 6 EPIDEMIOLOGY ....................................................................................................................... 7 HIP FRACTURES AND SURGICAL TREATMENT .......................................................................... 8 Fracture classification ..................................................................................................... 8 Müller AO/ASIF Classification ........................................................................................ 9 Intracapsular fractures .................................................................................................. 11 Extracapsular
    [Show full text]
  • A Treatise on Fractures in the Vicinity of Joints, and on Certain Forms Of
    J' J^JJJ ^4WHI»*»— ' riHiM ——————— : ; ; In the Tress, and nearly ready, Fifth Edition, Fcp. 8w., THE DUBLIN DISSECTOR, OE MANUAL OF ANATOMY; COMPKISING A CONCISE DESCRIPTION OF THE BONES, MUSCLES, VESSELS, NERVES, AND VISCERA ALSO, 'Eiiz wlatibc Unatomg of tj^c liiffctcnt i^cgiong of t^c l^timan 23olig FOR THE USE OF STUDENTS IN THE DISSECTING-ROOM. By ROBERT HARRISON, M. D. New Edition, illustrated by upwards of 150 Engravings. PART L^ANATOMY OF THE MUSCULAR SYSTEM. Chap. I. Dissection of the external Parts op the Head and Face External Parts of the Head ; Dissection of the external Parts of the Face ; Vessels and Nerves of the Face. Chap. II Dissection of the Neck—Of the Muscles ; Dissection of the Vessels and Nerves of the Neck; of the Mouth, Pharynx, and Larynx; of the Pharynx; of the Palate and its Muscles ; of the Larynx ; of the deep Muscles of the Neck. Chap. Ill Dissection of the Thorax—Of the Muscles on the anterior and lateral Parts of the Thorax ; Dissection of the AxiUa ; of the Cavity of the Thorax. Chap, IV. Muscles of the Back. Chap. V Dissection of the upper Extremity Dissection of the Muscles of the Shoulder and Arm ; of the Fore-arm and Hand. Chap. VI Dissection of the Abdomen Of the Muscles on the anterior and la- teral Parts of the Abdomen; Dissection of the Viscera of the Abdomen; of the Vessels and Nerves of the Abdomen ; Dissection of the Kidney and Ureters ; of the deep Muscles of the Abdomen; of the Perinaeum in the Male ; of the Pelvis ; of the Organs of Generation in the Male.
    [Show full text]
  • It, and Is Very Satisfactory in Its End-Result. Complications, As
    View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by ZENODO and bandage only makes a bad matter worse, the materially in differentiating the variety and location vessels and nerves being compressed between bone of the fracture. The major or direct causes almost and board. That which is absolutely essential to invariably cause the extracapsular variety of frac¬ thoroughly satisfactory répair, is early and complete ture with or without impaction, while the minor or adjustment. This is one of the few fractures in which indirect cause produces intracapsular fracture. the chief difficulty lies in securing not maintaining Symptoms.—In all cases of suspected fracture of apposition. Once secured, only the simplest after- the neck of the femur, the entire person, from the treatment is really required ; a band around the wrist anterior superior spinous process of the ilium to the perhaps, to lessen the after-spreading due to separa¬ toes, with the exception of the external genital or¬ tion of and later somewhat misplaced attachment of gans which can be protected from view by a napkin, the inter-articular cartilage. should be exposed to inspection. After the clothing In view of possible after-ligation, as professional has been removed above the pelvis we are at once en¬ opinion is now, it is wiser as a rule to employ some abled to see the relationship of the two opposite tro- form of splint, plaster-of-paris or other, never extend¬ chanters to each other, their corresponding appear¬ ing below the wrist line and thus supporting the ance, their relative prominence.
    [Show full text]
  • Guidelines to Compliment the Integrated Care Pathway for Hip Fracture
    Guidelines to compliment the Integrated Care Pathway for Hip Fracture Contents Pre-hospital care ED Management Blue Book Standards for hip fracture care Analgesia/ Pain Supplementary oxygen/ hypoxaemia Anaesthesia/ Fasting Consent/ Mental capacity Delirium Falls & fractures Role of Occupational therapist Pre-hospital care HIPS- Acronym for pre-hospital management H - Hydrate the patient if required, dehydration increase confusion and complicates patient assessment. There is some evidence that poorly addressed dehydration in the initial period of injury and prior to surgery may contribute to increased mortality in the early days I - Immobilisation of the fracture using simple means such as padding and triangular bandages and where necessary in association with Vacuum mattresses is all that is required. In addition prevention of chilling is also a key initiative. P - Pain management that is sub-optimal increases mortality and morbidity. In a number of studies effective pre-hospital pain management has been shown to be in the order of 50%. We need to put more emphasis on the role of analgesia for these patients. NSAID medications are relatively contra-indicated. S - Specific facilities that can offer prompt intervention to repair the fractures offer these patients the best level of care. Transporting patients to an ED that cannot offer surgical management necessitates a secondary transfer and delays care. This is not to the benefit of the patient and places a demand on the Ambulance Service to provide secondary transport, possibly delaying definitive care further. National Ambulance Service 2014 Emergency Department Management British Orthopaedic Association/ British Geriatric Association Blue Book Standards 1) All patients with hip fractures should be admitted to an acute orthopaedic ward within 4 hours of presentation.
    [Show full text]
  • Evaluation of Dynamic Hip Screw Blade in Extracapsular Fracture Neck of Femur in the Elderly
    DOI: 10.7860/JCDR/2019/26357.12914 Original Article Evaluation of Dynamic Hip Screw Blade in Extracapsular Fracture Orthopaedics Section Neck of Femur in the Elderly TEJASVI BHATIA1, ANIL JUYAL2, RAJESH MAHESHWARI3, AtUL AGRAWAL4, DIGVIJAY AGARWAL5 ABSTRACT Results: The male to female ratio was 1:2.75. The mean age of Introduction: Intertrochanteric fractures account for 50% of patients was 73.4±8.64 years (range 60-97 years). Thirty patients all fractures of the proximal femur, the average age of incidence were operated with DHS blade and followed up for a minimum being 66 to 77 years. Dynamic Hip Screw (DHS) fixation is of six months. Pre-operatively, the patients were categorised considered to be one of the standard treatments of trochanteric as per Singh’s Index; 66.7% (20 cases) were in Grade 3 while fractures. The most common mode of failure with the DHS is cut- 33.3% (10 cases) fell in Grade 2. out of the screw which significantly relates to the bone mineral Postoperatively, the average Tip Apex Distance (TAD) was density of proximal femur. DHS blade was developed in an attempt 21.66 mm (range 18-28 mm), 25 cases (83.3%) had TAD <25 mm. to enhance anchorage of the implant in the osteoporotic bone. Neck-shaft angle of the contralateral hip was measured for Aim: To assess the radiological and functional outcome of comparison. No change in neck-shaft angle was observed in extracapsular fracture neck femur in osteoporotic patients 21 cases (70%) however varus collapse more than 4° was seen treated with DHS blade.
    [Show full text]
  • Current Concepts in the Mandibular Condyle Fracture Management Part I: Overview of Condylar Fracture
    Topic Current Concepts in the Mandibular Condyle Fracture Management Part I: Overview of Condylar Fracture Kang-Young Choi, Jung-Dug Yang, Ho-Yun Chung, Byung-Chae Cho Department of Plastic and Reconstructive Surgery, Kyungpook National University School of Medicine, Daegu, Korea The incidence of condylar fractures is high,but the management of fractures of the mandibular Correspondence: Kang-Young Choi condyle continues to be controversial. Historically, maxillomandibular fixation, external Department of Plastic and Reconstructive Surgery, Kyungpook fixation, and surgical splints with internal fixation systems were the techniques commonly National University School of used in the treatment of the fractured mandible. Condylar fractures can be extracapsular Medicine, 130 Dongduk-ro, Jung-gu, Daegu 700-721, Korea or intracapsular, undisplaced, deviated, displaced, or dislocated. Treatment depends on the Tel: +82-53-420-5685 age of the patient, the co-existence of other mandibular or maxillary fractures, whether the Fax: +82-53-425-3879 condylar fracture is unilateral or bilateral, the level and displacement of the fracture, the E-mail: [email protected] state of dentition and dental occlusion, and the surgeonnds on the age of the patient, the co-existence of othefrom which it is difficult to recover aesthetically and functionally;an appropriate treatment is required to reconstruct the shape and achieve the function ofthe uninjured status. To do this, accurate diagnosis, appropriate reduction and rigid fixation, and This article was invited as part of a panel complication prevention are required. In particular, as mandibular condyle fracture may cause presentation, which was one of the most highly rated sessions by participants, at long-term complications such as malocclusion, particularly open bite, reduced posterior facial the 69th Congress of the Korean Society height, and facial asymmetry in addition to chronic pain and mobility limitation, great caution of Plastic and Reconstructive Surgeons should be taken.
    [Show full text]