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      Novo método de imobilização provisória nas fraturas do fêmur proximal Translated title: New method of preoperative immobilization for the proximal femoral fractures

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          Abstract

          OBJETIVO: Avaliar a eficácia do uso de um novo método de imobilização provisória para os pacientes com fratura transtrocanteriana durante o período pré-operatório. MÉTODOS: Durante três meses, 33 pacientes foram atendidos no Serviço de Ortopedia e Traumatologia devido à fratura transtrocantérica. Foram selecionados 22 pacientes e divididos em um grupo que utilizou a imobilização desenvolvida e outro que não utilizou. Os pacientes participaram da avaliação com a Escala Visual Analógica de Dor (EVA) em três momentos distintos durante o período perioperatório para se observarem o consumo de analgésicos e as possíveis complicações. RESULTADOS: O grupo que utilizou a imobilização queixou-se de menos dor, utilizou menor quantidade de analgésicos e apresentou menor incidência de complicações clínicas. CONCLUSÃO: O uso do aparelho pareceu ser eficaz, porém foi estatisticamente não significativo. Nível de Evidência II, Estudo Prospectivo Comparativo.

          Translated abstract

          OBJECTIVE: To evaluate the efficacy of a new method of provisional preoperative imobilization for patientes with transtrochanteric femoral fractures. METHODS: Over a three-month period, 33 patients were treated at the Orthopaedic Trauma Service for transtrochanteric femoral fracture. We selected 22 patients and they were divided into groups with and without the use of the developed imobilization. The patients were evaluated according to the Visual Analogue Scale for Pain (VAS) during the preoperative and postoperative period in order to verify the analgesic consume and clinical complications. RESULTS: The group that used the imobilization had lower pain, reduced analgesic consume and had less clinical complications. CONCLUSION: The new imobilization therefore presents good results, however not statistical significant. Level of Evidence II, Prospective Comparative Study.

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          Effect of comorbidities and postoperative complications on mortality after hip fracture in elderly people: prospective observational cohort study.

          To evaluate postoperative medical complications and the association between these complications and mortality at 30 days and one year after surgery for hip fracture and to examine the association between preoperative comorbidity and the risk of postoperative complications and mortality. Prospective observational cohort study. University teaching hospital. 2448 consecutive patients admitted with an acute hip fracture over a four year period. We excluded 358 patients: all those aged < 60; those with periprosthetic fractures, pathological fractures, and fractures treated without surgery; and patients who died before surgery. Routine care for hip fractures. Postoperative complications and mortality at 30 days and one year. Mortality was 9.6% at 30 days and 33% at one year. The most common postoperative complications were chest infection (9%) and heart failure (5%). In patients who developed postoperative heart failure mortality was 65% at 30 days (hazard ratio 16.1, 95% confidence interval 12.2 to 21.3). Of these patients, 92% were dead by one year (11.3, 9.1 to 14.0). In patients who developed a postoperative chest infection mortality at 30 days was 43% (8.5, 6.6 to 11.1). Significant preoperative variables for increased mortality at 30 days included the presence of three or more comorbidities (2.5, 1.6 to 3.9), respiratory disease (1.8, 1.3 to 2.5), and malignancy (1.5, 1.01 to 2.3). In elderly people with hip fracture, the presence of three or more comorbidities is the strongest preoperative risk factor. Chest infection and heart failure are the most common postoperative complications and lead to increased mortality. These groups offer a clear target for specialist medical assessment.
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            Association of timing of surgery for hip fracture and patient outcomes.

            Previous studies of surgical timing in patients with hip fracture have yielded conflicting findings on mortality and have not focused on functional outcomes. To examine the association of timing of surgical repair of hip fracture with function and other outcomes. Prospective cohort study including analyses matching cases of early ( 24 hours) surgery with propensity scores and excluding patients who might not be candidates for early surgery. Four hospitals in the New York City metropolitan area. A total of 1206 patients aged 50 years or older admitted with hip fracture over 29 months, ending December 1999. Function (using the Functional Independence Measure), survival, pain, and length of stay (LOS). Of the patients treated with surgery (n = 1178), 33.8% had surgery within 24 hours. Earlier surgery was not associated with improved mortality (hazard ratio, 0.75; 95% confidence interval [CI], 0.52-1.08) or improved locomotion (difference of -0.04 points; 95% CI, -0.49 to 0.39). Earlier surgery was associated with fewer days of severe and very severe pain (difference of -0.22 days; 95% CI, -0.41 to -0.03) and shorter LOS by 1.94 days (P<.001), but postoperative pain and LOS after surgery did not differ. Analyses with propensity scores yielded similar results. When the cohort included only patients who were medically stable at admission and therefore eligible for early surgery, the results were unchanged except that early surgery was associated with fewer major complications (odds ratio, 0.26; 95% CI, 0.07-0.95). Early surgery was not associated with improved function or mortality, but it was associated with reduced pain and LOS and probably major complications among patients medically stable at admission. Additional research is needed on whether functional outcomes may be improved. In the meantime, patients with hip fracture who are medically stable should receive early surgery when possible.
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              Efficacy of a comprehensive geriatric intervention in older patients hospitalized for hip fracture: a randomized, controlled trial.

              To evaluate whether an early multidisciplinary geriatric intervention in elderly patients with hip fracture reduced length of stay, morbidity, and mortality and improved functional evolution. Randomized, controlled intervention trial. Orthopedic ward in a university hospital. Three hundred nineteen patients aged 65 and older hospitalized for hip fracture surgery. Participants were randomly assigned to a daily multidisciplinary geriatric intervention (n=155) or usual care (n=164) during hospitalization in the acute phase of hip fracture. Primary endpoints were in-hospital length of stay and incidence of death or major medical complications. Secondary endpoints were the rate of recovery of previous activities of daily living and ambulation ability at 3, 6, and 12 months. Median length of stay was 16 days in the geriatric intervention group and 18 days in the usual care group (P=.06). Patients assigned to the geriatric intervention showed a lower in-hospital mortality (0.6% vs 5.8%, P=.03) and major medical complications rate (45.2% vs 61.7%, P=.003). After adjustment for confounding variables, geriatric intervention was associated with a 45% lower probability of death or major complications (95% confidence interval=7-68%). More patients in the geriatric intervention group achieved a partial recovery at 3 months (57% vs 44%, P=.03), but there were no differences between the groups at 6 and 12 months. Early multidisciplinary daily geriatric care reduces in-hospital mortality and medical complications in elderly patients with hip fracture, but there is not a significant effect on length of hospital stay or long-term functional recovery.
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                Author and article information

                Journal
                aob
                Acta Ortopédica Brasileira
                Acta ortop. bras.
                ATHA EDITORA (São Paulo, SP, Brazil )
                1413-7852
                1809-4406
                February 2013
                : 21
                : 1
                : 40-42
                Affiliations
                [01] Ribeirão Preto SP orgnameHospital Beneficência Portuguesa de Ribeirão Preto orgdiv1Serviço de Residência Médica em Ortopedia e Traumatologia Brasil
                Article
                S1413-78522013000100008 S1413-7852(13)02100100008
                fd578252-ea98-4ff0-9e47-5023ba0e0a32

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                History
                : 28 January 2012
                : 01 February 2012
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 11, Pages: 3
                Product

                SciELO Brazil

                Categories
                Artigo Original

                Fraturas do Fêmur,Hip fractures,Femoral fractures,Immobilization,Fraturas do quadril,Imobilização

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