Summary
Low vitamin D in patients with hip fracture is common. In the present study, 407 of 872 (47%) patients had serum calcidiol less than 50 nmol/L. Patients with low vitamin D had more delirium, ...more new hip fractures, and more medical readmissions, but not more orthopedic complications after 1 year.
Introduction
We wanted to study the relation between vitamin D level and postoperative orthopedic and medical complications in patients with hip fracture. In addition, we investigated the effect of giving a single-dose cholecalciferol 100.000 IU.
Methods
Data were taken from the local hip fracture register. Logistic regression analyses including vitamin D level and potentially confounding variables were performed for complications and readmissions.
Results
A total of 407 (47%) of 872 included hip fractures had low vitamin D at baseline. A total of 155 (18%) developed delirium, and the risk was higher in vitamin D-deficient patients (odds ratio (OR) 1.48, 95% confidence interval (CI) 1.04 to 2.12;
p
= 0.03). A total of 261 (30%) were readmitted for non-hip-related conditions. Low vitamin D was associated with a higher risk of medical readmissions within 30 days (OR 1.64 (1.03 to 2.61);
p
= 0.036) and 12 weeks (OR 1.47 (95% CI 1.02 to 2.12);
p
= 0.039). There was a higher risk of a new hip fracture (OR 2.84 (95% CI 1.15 to 7.03)
p
= 0.024) in vitamin D-deficient patients. A total of 105 (12%) developed at least one orthopedic complication, with no correlation to baseline vitamin D. Among vitamin D-deficient patients, those receiving a single-dose of 100.000 IU cholecalciferol had fewer orthopedic complications (OR 0.32 (95% CI 0.11 to 0.97)
p
= 0.044) the first 30 days after surgery.
Conclusion
Low vitamin D at admission for hip fracture increased the risk of delirium, a new hip fracture, and medical readmissions, but not orthopedic complications. The role of vitamin D supplementation to prevent orthopedic complications requires further study.
Summary
The population of Oslo has the highest incidence of hip fracture reported. The present study shows that the overall incidence of distal forearm fractures in Oslo is higher than in other ...countries and has not changed significantly when comparing the incidence of 1998/99 with 1979.
Introduction
The population of Oslo has the highest incidence of hip fracture reported. The present study reports the incidence of distal forearm fracture in Oslo and the fracture rates of immigrants.
Methods
Patients aged ≥20 years resident in Oslo sustaining a distal forearm fracture in a one-year period in 1998/99 were identified using electronic diagnosis registers, patient protocols, and/or X-ray registers of the clinics in Oslo. Medical records were obtained and the diagnosis verified. The age- and sex-specific incidence rates were calculated and compared with those for 1979. Data on immigrant category and country of origin of the patients were obtained.
Results
The age-adjusted fracture rates per 10,000 for the age group ≥50 years were 109.8 and 25.4 in 1998/99 compared with 108.3 and 23.5 in 1979 for women and men, respectively (n.s.). The relative risk of fracture in Asians was 0.72 (95% CI 0.53–1.00) compared with ethnic Norwegians.
Conclusions
The overall incidence of distal forearm fractures in Oslo is higher than in other countries and has not changed significantly when comparing the incidence of 1998/99 with 1979. Furthermore, the present data suggest that Asian immigrants in Oslo have a slightly lower fracture risk than ethnic Norwegians.
Summary
This study reported the incidence of validated adult distal radius fractures in Oslo, Norway, in 2019. The incidence has been reduced over the last 20 years. However, it is still high ...compared to other regions in Norway and some of the other Nordic countries.
Purpose
We aimed to report the incidence of distal radius fractures in Oslo in 2019 and compare it to the incidence rates in 1998/1999.
Methods
Patients aged ≥ 20 years resident in Oslo sustaining a distal radius fracture in 2019 were identified by electronic diagnosis registers, patient protocols, and/or radiology registers. The diagnosis was verified using medical records and/or radiology descriptions. We used the same method as the previous study from Oslo, making the comparison over time more accurate. The age-adjusted incidence rates and the age-standardized incidence rate ratio (IRR) were calculated.
Results
The absolute number of fractures decreased from 1490 in 1998/1999 to 1395 in 2019. The IRR for women and men in the age group ≥ 20 years in 2019 compared to 1998/1999 was 0.77 (95% CI 0.71–0.84) and 0.77 (95% CI 0.66–0.90), respectively. The IRR for women and men in the age group ≥ 50 years in 2019 compared to 1998/1999 was 0.78 (95% CI 0.71–0.86) and 0.78 (95% CI 0.63–0.97), respectively. For the population in Oslo with Asian background compared to Norwegian background in the age group ≥ 50 years, the IRR in 2019 was 0.57 (95% CI 0.40–0.80) for women and 0.77 (95% CI 0.44–1.37) for men.
Conclusions
The incidence of distal radius fractures in Oslo has decreased over the last 20 years. It is still, however, higher than in other areas of Norway and in some of the other Nordic countries.
Summary
Determinants of trabecular bone score (TBS) and vertebral fractures assessed semiquantitatively (SQ1–SQ3) were studied in 496 women with fragility fractures. TBS was associated with age, ...parental hip fracture, alcohol intake and BMD, not SQ1–SQ3 fractures. SQ1–SQ3 fractures were associated with age, prior fractures, and lumbar spine BMD, but not TBS.
Introduction
Trabecular bone score (TBS) and vertebral fractures assessed by semiquantitative method (SQ1–SQ3) seem to reflect different aspects of bone strength. We therefore sought to explore the determinants of and the associations between TBS and SQ1–SQ3 fractures.
Methods
This cross-sectional sub-study of the Norwegian Capture the Fracture Initiative included 496 women aged ≥ 50 years with fragility fractures. All responded to a questionnaire about risk factors for fracture, had bone mineral density (BMD) of femoral neck and/or lumbar spine assessed, TBS calculated, and 423 had SQ1–SQ3 fracture assessed.
Results
Mean (SD) age was 65.6 years (8.6), mean TBS 1.27 (0.10), and 33.3% exhibited SQ1–SQ3 fractures. In multiple variable analysis, higher age (β
per SD
= − 0.26, 95% CI: − 0.36,− 0.15), parental hip fracture (β = − 0.29, 95% CI: − 0.54,− 0.05), and daily alcohol intake (β = − 0.43, 95% CI − 0.79, − 0.08) were associated with lower TBS. Higher BMD of femoral neck (β
per SD
= 0.34, 95% CI 0.25–0.43) and lumbar spine (β
per SD
= 0.40, 95% CI 0.31–0.48) were associated with higher TBS. In multivariable logistic regression analyses, age (OR
per SD
= 1.94, 95% CI 1.51–2.46) and prior fragility fractures (OR = 1.71, 95% CI 1.09–2.71) were positively associated with SQ1–SQ3 fractures, while lumbar spine BMD (OR
per SD
= 0.75 95% CI 0.60–0.95) was negatively associated with SQ1–SQ3 fractures. No association between TBS and SQ1–SQ3 fractures was found.
Conclusion
Since TBS and SQ1–SQ3 fractures were not associated, they may act as independent risk factors, justifying the use of both in post-fracture risk assessment.
Summary
We found no difference in the rate of radiological hip osteoarthritis in the injured hip when comparing 349 patients with proximal femoral fractures and 112 patients with hip contusion. There ...was, however, a tendency for more osteoarthritis in patients with trochanteric fractures than in patients with femoral neck fractures.
Introduction
Osteoarthritis (OA) and osteoporotic fractures are two age-related disorders associated with considerable morbidity. There is a clinical impression of an inverse relation between osteoarthritis and osteoporosis, and a protective effect of OA against osteoporotic fractures has been proposed.
Methods
We performed a case–control study in 461 subjects. Cases (
n
= 349) were patients aged 50 years or above who sustained a proximal femoral fracture from November 2003 to October 2004, registered prospectively in the department’s fracture register. Controls (
n
= 112) were patients aged 50 years or above with the diagnosis of hip contusion, recruited from the hospital’s discharge register. Radiographic OA was scored according to Kellgren and Lawrence (K&L), and minimal joint space (MJS) was measured in both hips when possible. A K&L grade II or higher or an MJS less than 2.5 mm was defined as OA.
Results
Both in the hip fracture group and in the contusion group mean, the MJS was 3.5 mm on the injured side (
p
= 0.79). In the fracture group, 31/250 (12%) had MJS <2.5 mm and 16/112 (14%) in the contusion group (
p
= 0.18). In the fracture group, 40/250 (16%) had a K&L OA grade II or higher, and in the contusion group 20/112 (18%) persons had a K&L OA grade II or higher (p = 0.66). There was a tendency for a higher incidence of OA in patients with trochanteric fractures compared with patients with cervical fractures.
Conclusions
We found no differences on the injured side in the rate of hip OA between hip fracture patients and hip contusion patients.
Despite the availability of clinical guidelines for hip fracture patients, adherence to these guidelines is challenging, potentially resulting in suboptimal patient care. The goal of this study was ...(1) to evaluate and benchmark the adherence to recently established quality indicators (QIs), and (2) to study clinical outcomes, in fragile hip fracture patients from different European countries.
This observational, cross-sectional multicenter study was performed in 10 hospitals from 9 European countries including data of 298 consecutive patients.
A large variation both within and between hospitals were seen regarding adherence to the individual QIs. QIs with the lowest overall adherence rates were the administration of systemic steroids (5.4%) and tranexamic acid (20.1%). Indicators with the highest adherence rates (above 95%) were pre-operative (99.3%) and post-operative haemoglobin level assessment (100%). The overall median time to surgery was 22.6 h (range 15.7-42.5 h). The median LOS was 9.0 days (range 5.0-19.0 days). The most common complications were delirium (23.2%) and postsurgical constipation (25.2%).
The present study shows large variation in the care for fragile patients with hip fractures indicating room for improvement. Therefore, hospitals should invest in benchmarking and knowledge-sharing. Large quality improvement initiatives with longitudinal follow up of both process and outcome indicators should be initiated.
Purpose
The aim of this study was to describe complication rates and long-term functional outcomes among patients with amputated versus reconstructed limb after high-energy open tibial fractures.
...Methods
Patients treated operatively for a high-energy open tibial fracture, classified as Gustilo–Anderson (GA) grade 3, at our hospital in the time period 2004–2013 were invited to a clinical and radiographic follow-up at minimum 2 years after injury. Eighty-two patients with 87 GA grade 3 fractures were included. There were 39 type GA 3A, 34 GA 3B, and 14 GA 3C.
Results
The GA 3A reconstruction group had the lowest complication rate and the best long-term outcome scores at mean 5 years (range 2–8 years) after injury. Within the group of GA 3B and 3C fractures, we found no significant differences in long-term outcomes among patients with reconstructed versus amputated limbs. The mean physical component summary score of the SF-36 in the reconstruction versus amputation group was 54.2 (95% CI 46.3–62.1) versus 47.7 (95% CI 32.6–62.2), respectively (
p
= 0.524), while the mean mental component summary score was 63.7 (95% CI 50.6–71.8) versus 59.2 (95% CI 48.8–68.0), respectively (
p
= 0.603). On the 6-minute walk test, the reconstruction group walked on average 493 m (95% CI 447–535 m) versus 449 m (95% CI 384–518 m) in the amputation group. The return to work rate was 73% (16 of 22) in the reconstruction group versus 50% (7 of 14) in the amputation group (
p
= 0.166). The mean patient satisfaction score (VAS 0–100) was 67 (95% CI 67–77) in the reconstruction group versus 65 (95% CI 51–76) in the amputation group (
p
= 0.795). Regardless of the treatment strategy, the complication rate was high.
Conclusions
Amputation should be considered as a viable treatment option, equal to limb salvage, after high-energy open tibial fracture with severe vascular damage or soft tissue loss.
Summary
We estimated the cost-effectiveness of hemiarthroplasty compared to internal fixation for elderly patients with displaced femoral neck fractures. Over 2 years, patients treated with ...hemiarthroplasty gained more quality-adjusted life years than patients treated with internal fixation. In addition, costs for hemiarthroplasty were lower. Hemiarthroplasty was thus cost effective.
Introduction
Estimating the cost utility of hemiarthroplasty compared to internal fixation in the treatment of displaced femoral neck fractures in the elderly.
Methods
A cost-utility analysis (CUA) was conducted alongside a clinical randomized controlled trial at a university hospital in Norway; 166 patients, 124 (75%) women with a mean age of 82 years were randomized to either internal fixation (
n
= 86) or hemiarthroplasty (
n
= 80). Patients were followed up at 4, 12, and 24 months. Health-related quality of life was assessed with the EQ-5D, and in combination with time used to calculate patients’ quality-adjusted life years (QALYs). Resource use was identified, quantified, and valued for direct and indirect hospital costs and for societal costs. Results were expressed in incremental cost-effectiveness ratios.
Results
Over the 2-year period, patients treated with hemiarthroplasty gained 0.15–0.20 more QALYs than patients treated with internal fixation. For the hemiarthroplasty group, the direct hospital costs, total hospital costs, and total costs were non-significantly less costly compared with the internal fixation group, with an incremental cost of €2,731 (
p
= 0.81), €2,474 (
p
= 0.80), and €14,160 (
p
= 0.07), respectively. Thus, hemiarthroplasty was the dominant treatment. Sensitivity analyses by bootstrapping supported these findings.
Conclusion
Hemiarthroplasty was a cost-effective treatment. Trial registration, NCT00464230.
Elevated levels of the neurotransmitter glutamate and the presence of its receptor, N‐methyl‐d‐aspartate receptor type 1 (NMDAR1), have been established in patients with tendinopathy, i.e. chronic ...tendon pain and degeneration. However, whether NMDAR1 is up‐ or down‐regulated in tendinopathy and co‐localized with glutamate is still unexplored. We hypothesize that an alteration in tissue expression and in the coexistence of NMDAR1 and glutamate occurs in tendinopathy and might play a role in nociception and possibly also progression of tendon degeneration (tendinosis). We therefore examined the tissue distribution and levels of NMDAR1 and glutamate in biopsies from patients with patellar tendinopathy (n=10) and from controls (n=8). The biopsies were single‐ and double‐stained immunohistochemically for glutamate and NMDAR1 and assessed subjectively and semi‐quantitatively. The chronic painful tendons exhibited a significant elevation of NMDAR1 (ninefold), which was independent of the observed increase in glutamate (10‐fold). This up‐regulation of NMDAR1 and glutamate was found to be co‐localized on nerve fibers as well as on morphologically altered tenocytes and blood vessels. None of the controls exhibited neuronal coexistence of glutamate and NMDAR1. The neuronal coexistence of glutamate and NMDAR1, observed in painful tendinosis but not in controls, suggests a regulatory role in intensified pain signalling.
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