Aims

National hip fracture registries audit similar aspects of care but there is variation in the actual data collected; these differences restrict international comparison, benchmarking, and research. The Fragility Fracture Network (FFN) published a revised minimum common dataset (MCD) in 2022 to improve consistency and interoperability. Our aim was to assess compatibility of existing registries with the MCD.

Aims

The aim of this study was to explore current use of the Global Fragility Fracture Network (FFN) Minimum Common Dataset (MCD) within established national hip fracture registries, and to propose a revised MCD to enable international benchmarking for hip fracture care.

This international multicentre retrospective cohort study aimed to assess: 1) prevalence of COVID-19 in hip fracture patients, 2) effect on mortality, and 3) clinical factors associated mortality among COVID-19-positive patients.

A collaboration among 112 centres in 14 nations collected data on all patients with a hip fracture between 1st March-31st May 2020. Patient, injury and surgical factors were recorded, and outcome measures included admission duration, COVID-19 and 30-day mortality status.

There were 7090 patients and 651 (9.2%) were COVID-19-positive. COVID-19 was independently associated with male sex (p=0.001), residential care (p<0.001), inpatient fall (p=0.003), cancer (p=0.009), ASA grade 4–5 (p=0.008; p<0.001), and longer admission (p<0.001). Patients with COVID-19 had a significantly lower chance of 30-day survival versus those without (72.7% versus 92.6%, p<0.001), and COVID-19 was independently associated with increased 30-day mortality risk (p<0.001). Increasing age (p=0.028), male sex (p<0.001), renal (p=0.017) and pulmonary disease (p=0·039) were independently associated with higher 30-day mortality risk in patients with COVID-19 when adjusting for confounders.

The prevalence of COVID-19 in hip fracture patients was 9% and was independently associated with a three-fold increased 30-day mortality risk. Clinical factors associated with mortality among COVID-19-positive hip fracture patients were identified for the first time. This is the largest study, and the only global cohort, reporting on the effect of COVID-19 in hip fracture patients. The findings provide a benchmark against which to determine vaccine efficacy in this vulnerable population and are especially important in the context of incomplete vaccination programmes and the emergence of vaccine-resistant strains.

Aim

Radiologic signs such as radiolucent lines around the implant, hardware fracture or displacement and periosteal reaction have been considered suggestive of implant-associated infection. The goal of this study is to assess the correlation of these signs with confirmed internal fixation-associated infection evaluated in a prospective cohort.

Aim

Unexpected positive infections are distinct entity in prosthetic revision surgery. The prevalence and characteristics of unexpected positive cultures in internal fixation are however less established. The aim of this study was to describe the prevalence and characteristics of unexpected diagnosis of infection in a prospective cohort of revision surgeries following internal fixation.

Introduction: There are protocols on the management of polytrauma in obstetric patients. However, there is little information about osteo-articular injuries sustained in these patients. The object of this study is to review the management of these patients and to suggest a guideline.

Material and method: Inclusion criteria: Pregnant patients treated during the last 6 years, treated as inpatients in our center during pregnancy due to osteo-articular injuries.

Variables studied: Gestational age, mechanism of injury, fracture type, management, termination of pregnancy and sequelae.

Results: We treated 13 patients with 21 fractures in our center, with an incidenc of 2,13 fractures/10.000 births. The mechanism of injury was low degree trauma in 6 cases (60% 3rd trimester) and high-degree in 7 (83% 1st and 2nd trimester). There was a predominance of lower extremity fractures, especially tibia and fibula (7 cases) and pelvis (3 cases).

Gestational age was 1st trimester (3 cases), 2nd trimester (5 cases), 3rd trimester (5 cases). 10 women were treated surgically, 8 before finishing gestation. Gestation ended as and induced abortion (3 cases, 1 due to fetal death and 2 due to teratogenic risk), and birth (10 cases, all alive, 50% eutocic). Only 3 babies needed type II or type III neonatal reanimation.

CONCLUSIONS: Pregnant women can get injured by low-energy trauma, especially during the third trimester. Pregnancy does not necessarily compromise surgical management of fractures. We review diagnostic and therapeutic management strategies for these patients.

Introduction: The main symptom of osteoporosis is fractures. Osteoporostic hip fractures are and increasing problem due to their morbid-mortality and health cost. The necessity of recommending treatment for osteoporosis upon discharge after hip fractures is generally accepted. The object of this study is to evaluate secondary prevention upon discharge and at 6 months after a hip fracture

MATERIAL AND Methods: Prospective observational study analyzing all osteoporòtica hip fractures among patients older than 50 treated during 2004, with telephonic follow-up.

RESULTS: We attended 563 fractures in 556 patients, with a mean age of 82,96 years (50 – 105) and a female: male ratio of 2,9:1. Mortality was 7,8% in-hospital and 20,2% at 6 months. Though 52,1% had suffered a previous osteoporotic fracture an 13,7% a previous hip fracture, only 16,3% had at some time been treated for osteoporosis.

Pharmacological treatment for osteoporosis (%, Upon discharge vs. at 6 months): Global (38,1 vs. 31%), Calcium +/− vitamin D (8,2 vs. 18%), Ca-VitD + biphosphonate (28,1 vs. 10,8%), Biphosphonate only (3,4 vs. 1,7%). The patients that had received treatment upon discharge were morle likely to receive it at 6 months (RR 2,2, CI95% 1,5 – 3,2). Women, patients that had been sent to a temporary nursing home and patients that had a better functional status were more likely to receive treatment (p< 0,05). There was no significant correlation with patient age or previous fractures.

CONCLUSIONS: Our study’s patients are similar to other studies published. Treatment compliance with biphosphonate falls at 6 month after discharge. It is important to recommend treatment for osteoporosis upon discharge.

Introduction and purpose: Osteoporotic hip fractures are a major cause of hospital morbidity and mortality in geriatric patients. Our purpose was to study hospital mortality due to osteoporotic hip fractures in persons over 50 in our hospital and evaluate the prognostic factors for mortality.

Materials and methods: We carried out a prospective evaluation of all patients with osteoporotic hip fractures admitted to our hospital between March and September 2004. We emphasised the possible predictive factors for hospital mortality, such as individual background, clinical situation, cognitive aspects, functional and social situation, treatment used and complications. We excluded patients with high-energy or pathological fractures and those who did not want to sign the informed consent form for inclusion in the study. The data were analysed with SPSS statistical software v11.0.

Results: In the six-month period mentioned above, 357 patients were admitted for osteoporotic hip fracture. The female/male ratio was 2.9:1. 37.6% were over 85 and 28.1% had been institutionalised prior to admission. 27 patients died while in hospital (7.6%), with a similar distribution between preoperative and postoperative mortality. The most common causes of death were related to decompensation of the patient’s baseline pathology, mainly of cardiorespiratory origin. Multivariate analysis showed significant prognostic factors independent of hospital mortality (p< 0.05): male sex (RR=4.3), age over 80 (RR=2.9), prior institutionalisation in a care home, the presence of confusional syndrome, low haemoglobin on admission and anaesthetic risk above III.

Conclusions: Hospital mortality was found to be high in cases of hip fracture. This was similar to previous studies carried out in our hospital and others. The prognostic factors for mortality were, above all, those that could not be changed (age, sex, anaesthetic risk, institutionalisation). Patients over 85, men, those coming from a care home and those with high anaesthetic risk have a greater risk of dying while in hospital. We should also be attentive to haemoglobin on admission and the presence of acute confusional syndrome.