Ka Hung Chan and colleagues argue that monitoring influenza-like illness could be a complementary approach to assessing the effectiveness of general infection control measures against covid-19
In network theory depression is conceptualized as a complex network of individual symptoms that influence each other, and central symptoms in the network have the greatest impact on other symptoms. ...Clinical features of depression are largely determined by sociocultural context. No previous study examined the network structure of depressive symptoms in Hong Kong residents. The aim of this study was to characterize the depressive symptom network structure in a community adult sample in Hong Kong during the COVID-19 pandemic. A total of 11,072 participants were recruited between 24 March and 20 April 2020. Depressive symptoms were measured using the Patient Health Questionnaire-9. The network structure of depressive symptoms was characterized, and indices of "strength", "betweenness", and "closeness" were used to identify symptoms central to the network. Network stability was examined using a case-dropping bootstrap procedure. Guilt, Sad Mood, and Energy symptoms had the highest centrality values. In contrast, Concentration, Suicide, and Sleep had lower centrality values. There were no significant differences in network global strength (p = 0.259), distribution of edge weights (p = 0.73) and individual edge weights (all p values > 0.05 after Holm-Bonferroni corrections) between males and females. Guilt, Sad Mood, and Energy symptoms were central in the depressive symptom network. These central symptoms may be targets for focused treatments and future psychological and neurobiological research to gain novel insight into depression.
Older adults with fragility hip fractures have high 1-year mortality and significant functional loss. This study aimed to identify the factors that predict the post-operative ambulatory prognosis of ...patients with fragility hip fracture.
A total of 233 patients who were consecutively admitted with fragility hip fracture to the orthopaedic unit of an acute hospital in Hong Kong between March and July 2016, were included in this retrospective observational cohort study. The outcome variable was the binary classification of whether patients could or could not walk independently without assistance for more than10 m at the time of discharge from hospital to community. The prognostic model was developed by using multivariate logistic regression.
Eighty-nine (38.2%) patients could walk independently upon discharge. The statistically significant factors that affected walking independence on discharge were age (Odds Ratio OR = 0.93), Charlson Comorbidity Index (OR = 0.67), baseline Mini-Mental Status Examination score (OR = 1.15) and pre-fracture mobility (p = 0.012). Patients who walked unaided before the fracture had a better prognosis than patients requiring a stick walker (OR = 0.57), quadripod walker (OR = 0.28) or frame walker (OR = 0.12). The area under the ROC curve was 0.848.
The model provides healthcare professionals with evidence to personalize the rehabilitation regime according to the patient's age, comorbidity, baseline cognitive function and pre-fracture mobility.
Background The mortality rate in patients with haemodynamically unstable pelvic fractures is as high as 40–60%. In recent years, angioembolisation and pelvic packing have been introduced as part of a ...multimodality treatment for these patients. Protocol-driven management has been shown to improve outcomes. Patients and methods This is a Level III retrospective cohort study of patients suffering from unstable pelvic fractures from 1 January 1996 to 30 September 2011. The aim of the study was to review our results, particularly in terms of mortality through the evolution of three phases of treatment protocols: preangiography, angiography and pelvic packing. Results The overall 30-day mortality rate for all patients was 47.2%, with a rate of 63.5% in the preangiography phase, 42.1% in the angiography phase and 30.6% in the pelvic packing phase. Multivariate logistic regression analysis identified the use of retroperitoneal packing as a significant independent predictive factor for 24 h mortality. Conclusions Our results showed an improvement in patient survival with sequential protocols over the study period, during which we incorporated a multidisciplinary approach to managing these complicated pelvic fractures. The results strongly suggest that retroperitoneal packing should be highly recommended for bleeding subsequent to pelvic fracture, in addition to other modalities of treatment.
Background/Purpose
Fragility hip fracture (FHF) is the most prevalent fragility fracture, causing deterioration in ambulatory ability and disability. Early detection of patients who are at risk of ...prolonged hospitalization and functional decline after FHF is crucial as this facilitates post-operative management and healthcare resources allocation. Handgrip strength (HGS) is an easily-administered and cost-effective tool to assess whole body strength. The objectives of this study were to examine the relationship between pre-operative HGS, length of stay (LOS) and functional outcomes at 1-year follow up in patients with FHF in Hong Kong.
Methods
Patients aged 65 years old or above who were admitted to a local acute hospital from April 2017 to March 2020 due to FHF that were treated operatively, and subsequently attended the multidisciplinary fragility fracture clinic at 1-year follow up were evaluated. HGS measured at pre-operative physiotherapy initial assessment, post-fracture total LOS, Modified Functional Ambulation Classification (MFAC) and Elderly Mobility Scale (EMS) at 1-year follow up were retrieved for analysis. Correlation between HGS and LOS was analyzed using Pearson's correlation coefficient. Correlations between HGS and MFAC, and HGS and EMS were analyzed using Spearman's rank correlation coefficient.
Results
One hundred and nineteen patients (mean age = 80.8 ± 7.3 years) (33 males, 86 females) were evaluated. Statistical significant negative correlation between HGS and LOS was found (r = -0.245, p = 0.007), implying that the lower the HGS, the longer the period of hospitalization. HGS also showed statistical significant positive correlation with MFAC (r = 0.358, p < 0.001) and EMS (r = 0.507, p < 0.001), suggesting that the greater the HGS, the better the functional outcomes after 1 year. In short, pre-operative HGS measured by physiotherapists was shown to be associated with LOS and functional outcomes at 1-year follow up.
Conclusion
HGS is significantly associated with patient's LOS, MFAC and EMS after FHF. HGS is an easily-administered and cost-effective tool to facilitate frontline practitioners to determine and stratify patients’ rehabilitation potential and subsequently establish customized rehabilitation and discharge plan, such as intensive training, caregiver education and potential prediction of discharge destination.
Key Messages
HGS is significantly associated with patient's LOS, MFAC and EMS after FHF. HGS is an easily-administered and cost-effective tool to facilitate frontline practitioners to determine and stratify patients’ rehabilitation potential and subsequently establish customized rehabilitation and discharge plan.
Post-traumatic limb deformity is often multiplanar and thus is a difficult pathology to deal with surgically. Precise preoperative planning and accurate intraoperative execution are two main ...important steps that lead to satisfactory outcome. Computer-assisted planning and three-dimensional-printed patient-specific instrumental guides provide excellent aid to the two steps, respectively. We report a case of post-traumatic lower limb deformity in a patient who underwent closing wedge corrective osteotomy with the aid of the aforementioned new technologies.
創傷後肢體畸形通常是多平面的，因此是手術治療的困難病理。 準確的術前規劃和準確的術中執行是導致滿意結果的兩個主要重要步驟。電腦輔助術前規劃和三維打印患者特定器械指南分別為兩個步驟提供了極好的幫助。 我們報告了在創傷後下肢畸形，借助上述新技術來進行閉合楔形矯正截骨術的病例。
To investigate the effectiveness and cost of an 18-month multi-disciplinary Comprehensive Fragility Fracture Management Program (CFFMP) for fragility hip fracture patients.
Prospective cohort study.
...Elderly patients with hip fracture were recruited at their first postoperative follow-up in 2 district hospitals. The intervention group comprised patients from the hospital undergoing CFFMP, and the control group comprised patients from another hospital undergoing conventional care. CFFMP provided geri-orthopaedic co-management, physician consultations, group-exercise and vibration-therapy. Timed-up-and-go test (TUG), Elderly Mobility Scale (EMS), Berg Balance Scale (BBS) and fall risk screening (FS) were used to assess functional performance. Incidences of falls and secondary fractures, the cost of the programme and related healthcare resources were recorded.
A total of 76 patients were included in the intervention group (mean age 77.9 years ((standard deviation; SD) 6.1) ) and 77 in the control group (79.9 (SD 7.2)), respectively. The re-fracture rate in the control group (10.39%) was significantly higher than in the intervention group (1.32%) (p = 0.034). The intervention group improved significantly in TUG, EMS and FS after a 1-year programme. The overall healthcare costs per patient in the intervention and control groups were US$22,450 and US$25,313, respectively.
Multi-disciplinary CFFMP is effective, with reduced overall cost, reduced length of hospital stay and reduced secondary fracture rate. The rehabilitation community service favours rehabilitation and improved quality of life of hip fracture patients.
Purpose
The mortality rate in patients with haemodynamically unstable pelvic fractures is as high as 40–60%. Despite the new advances in trauma care which are in phase in trauma centres in Hong Kong, ...the management of haemodynamically unstable pelvic fracture is still heterogeneous. The aim of this study is to review the results of management of haemodynamically unstable pelvic fracture patients in Hong Kong over a five year period.
Methods
This is a retrospective multi-centred cohort study of patients with haemodynamic and mechanically unstable pelvic fractures from 1 January 2010 to 31 December 2014. The primary outcome investigated is mortality of patients (including overall, 30-day, 7-day and 24-hour mortalities).
Results
Implementation of three-in-one pelvic damage control protocol was identified to be a significant independent predictive factor for overall, 30-day, seven-day and 24-hour mortalities. The overall in-hospital and 30-day mortality rates for patients managed with three-in-one protocol was 12.5%, while it was 11% for seven day mortality and 6% for 24 hour mortality. There were no significant differences in demographic characteristics, physiological measurements, types of pelvic fracture, severity and mechanism of injury between patients managed with or without three-in-one protocol.
Conclusions
Implementation of the multidisciplinary three-in-one pelvic damage control protocol reduces mortality and therefore should be highly recommended. The results are convincing as it has eliminated the limitations of our previous single-centred trial.
Background:
Three-dimensional (3D)-guided navigation percutaneous screw fixation of pelvi-acetabular fractures has been reported in patients with high-energy trauma. Its use in fragility fractures of ...the pelvis is expanding and its results are promising.
Methods:
We report a series of 17 consecutive patients with fragility fractures of the pelvis treated with 3D-guided navigation percutaneous screw fixation from 2016 to 2017. Percutaneous screw trajectories were planned preoperatively for the majority of patients. Closed reduction was performed prior to fixation in grossly displaced fractures.
Results:
The mean time to surgery was 8.6 ± 2.4 days, and the mean intraoperative blood loss was 94.1 ± 26.6 mL. One early surgical complication occurred involving an infected pelvic external fixator iliac pin track site, and there were no cases of neurological deficits after fixation. In total, 7 of the 14 patients had screw backout, and the mean backout distance was 8.3 ± 4.4 mm. Cortical perforation was seen in one patient involving an anterior column screw by 5.7 mm; 14 patients were followed up for a mean of 18.7 ± 2.8 months; 13 patients achieved complete fracture union, and 1 patient had a fracture non-union. Premorbid ambulatory function was restored in 8 of the 14 patients. The mean visual analogue scale for pain severity at follow-up was 0.36 ± 0.50. There were no cases of 30-day and 1-year mortality.
Conclusion:
3D-guided navigation percutaneous screw fixation is a safe, precise, and effective surgical technique for managing fragility fractures of the pelvis.
Open pelvic fractures are one of the most challenging and severe injuries of orthopaedics. These patients usually are associated with high mortality and morbidity. Therefore, multiple studies have ...suggested different methods to deal with this challenging problem. Our hospital is one of the few trauma centers in Hong Kong that deals with these patients. We have developed a “3-in-1” pelvic damage control protocol that strategically treats patients with pelvic injuries with open fractures. This article aims to review the outcomes of patients suffering from open pelvic fractures, admitted from January 2011 to 2016.
All patients diagnosed with hemodynamically unstable open fracture admitted from January 2011 to 2016 were retrospectively reviewed. All these patients were treated with our hospital’s “3-in-1” pelvic damage control protocol. We analyzed their demographics, associated injuries, Injury Severity and final outcomes.
Twelve consecutive patients were included in this study. Seventy-five percent (n = 9) of them were successfully resuscitated and discharged from hospital as their final outcome.
Our hospital’s “3-in-1” pelvic damage control protocol improves the survival rate of patients suffering from haemodynamically unstable open fracture, including open fracture. External fixation of pelvis, retroperitoneal packing and emergency angiography with embolization play important and inseparable roles in management of these critical patients. Adequate wound lavage, timely urinary and faecal diversion will improve the overall morbidity and survival further.
開放性骨盆骨折是骨科最具挑戰性和嚴重的損傷之一。 這些患者通常伴有高死亡率和高發病率。 因此，多項研究提出了不同的方法來處理這個具有挑戰性的問題。 我們醫院是香港處理這些病人的少數幾個創傷中心之一。 我們制定了“三合一”骨盆損傷控制方案，策略性地治療骨盆開放性骨折患者。 本文旨在回顧2011年1月至2016年期間收治的開放性骨盆骨折患者的結果。
回顧性分析2011年1月至2016年間所有確診為血流動力學不穩定開放性骨盆骨折的患者。 所有這些患者都接受了我們醫院的“三合一”骨盆損傷控制方案。 我們分析了他們的人口統計學、相關的傷害、傷害嚴重程度和最終結果。
連續12例患者納入本研究。作為最終結果，75％（n = 9）成功復甦出院。
我院“三合一”骨盆損傷控制方案提高了包括開放性骨折等血流動力學不穩定骨盆骨折患者的生存率。 骨盆外固定、腹膜後填密、急診血管造影和栓塞在這些危重病人的治療中起著重要和不可分割的作用。 充分的傷口灌洗，及時的尿路和糞便分流將進一步提高整體的發病率和生存率。
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