To describe the impact of COVID-19 on hip fracture care during the first 6 months of the pandemic.
A secondary analysis of 4385 cases in the Irish Hip Fracture Database from 1st June 2019 to 31st ...August 2020 was conducted.
Hip fracture admissions decreased by 15% during the study period (p < 0.001). Patient characteristics were largely unchanged as the majority of cases occurred in females over 80 years admitted from home. Adherence to many of the Irish Hip Fracture Standards (IHFS) changed following the COVID-19 pandemic. There was an increase in patients admitted to an orthopaedic ward from Emergency Department (ED) within 4 h from 27 to 36% (p < 0.001). However, the proportion of patients reviewed by a geriatrician reduced from 85% pre-COVID to 80% (p < 0.001). Fewer patients received a bone health assessment 90% from 95% (p < 0.001) and specialist falls assessment (82% from 88% (p < 0.001). No change was seen in time to surgery or incidence of pressure injuries. There was a significant decrease in length of stay from 18 to 14 days (p < 0.001). There was an increase in patients discharged home during the COVID-19 period and a decrease in patients discharged to rehabilitation, convalescence or nursing home care. There was no statistically significant change in mortality.
Healthcare services were widely restructured during the pandemic, which had implications for hip fracture patients. There was a notable change in compliance with the IHFS. Multidisciplinary teams involved in hip fracture care should be preserved throughout any subsequent waves of the pandemic.
Background
The tibial tuberosity–trochlear groove (TTTG) distance is used to assess patellofemoral instability (PFI) and the likelihood of the development of patellofemoral disorders. The current ...gold standard in the assessment of the TTTG is computed tomography (CT) or magnetic resonance imaging (MRI). The current image software used for viewing these CT images does not allow for easy assessment of the TTTG.
Aims
This study presents a simple method to measure the TTTG on any image software, utilizing easily available and affordable stationary.
Methods
Four consecutive patients with no known knee pathologies were selected from recent studies at our institution. Their TTTGs were measured using this study’s method and validated using the standard, freely available image analysis software Fiji. Pre-defined anatomical landmarks were located and marked using adhesive pieces of paper. The TTTG was defined as the distance between parallel lines through the apex of the tibial tuberosity and trough of the trochlear groove, where each of these lines is perpendicular to the Dorsal Condylar Line.
Results
The TTTG measured using this study’s method was found to be in agreement with the measurements made using Fiji software.
Conclusions
This study demonstrates that the TTTG can be simply and quickly assessed using readily available and affordable stationery, without the need for expensive or complex secondary analysis software. This could allow for the assessment of PFI in the outpatient clinic whilst the patient is present, offering valuable assistance to the orthopaedic surgeon in clinical decision making.
Introduction
This study investigates the metabolic activity of circulating monocytes and their impact on pro‐inflammatory responses in RA and explores whether this phenotype is already primed for ...inflammation before clinical manifestations of disease.
Methods
Blood was collected and CD14+ monocytes isolated from healthy control donors (HC), individuals at‐risk (IAR) and RA patients. Monocyte frequency in blood and synovial tissue was assessed by flow cytometry. Inflammatory responses and metabolic analysis ± specific inhibitors were quantified by RT‐PCR, Western blot, migration assays, Seahorse‐XFe‐technology, mitotracker assays and transmission electron microscopy. Transcriptomic analysis was performed on HC, IAR and RA synovial tissue.
Results
CD14+ monocytes from RA patients are hyper‐inflammatory following stimulation, with significantly higher expression of cytokines/chemokines than those from HC. LPS‐induced RA monocyte migratory capacity is consistent with increased monocyte frequency in RA synovial tissue. RA CD14+ monocytes show enhanced mitochondrial respiration, biogenesis and alterations in mitochondrial morphology. Furthermore, RA monocytes display increased levels of key glycolytic enzymes HIF1α, HK2 and PFKFB3 and demonstrate a reliance on glucose consumption, blockade of which abrogates pro‐inflammatory mediator responses. Blockade of STAT3 activation inhibits this forced glycolytic flux resulting in metabolic reprogramming and resolution of inflammation. Interestingly, this highly activated monocytic phenotype is evident in IAR of developing disease, in addition to an enhanced monocyte gene signature observed in synovial tissue from IAR.
Conclusion
RA CD14+ monocytes are metabolically re‐programmed for sustained induction of pro‐inflammatory responses, with STAT3 identified as a molecular regulator of metabolic dysfunction. This phenotype precedes clinical disease onset and may represent a potential pathway for therapeutic targeting early in disease.
In this study, we demonstrated that rheumatoid arthritis CD14+ monocytes are metabolically re‐programmed for sustained induction of pro‐inflammatory responses, an effect that is mediated by STAT3 signalling and precedes clinical disease onset.
Description A 38-year-old woman presented to the emergency department subsequent to a high-velocity single vehicle road traffic accident with a fracture of left ulna and radius, right clavicle and ...sacrum.
Background
Fragility fractures are described as fractures resulting from low-energy trauma and are considered diagnostic of reduced bone mineral density or osteoporosis. They often present as hip ...fractures with hip fractures remaining a common but devastating injury among older patients. Many factors influence a patient’s risk of hip fracture and their subsequent risk of death.
Aim
In this study, we examined if previous fragility fracture impacts upon mortality after hip fracture.
Methods
This was a retrospective single-center cohort study of patients included in the Irish Hip Fracture registry over a 5-year time period. Epidemiological data including gender, age, type of fracture, type of surgery, bone protection medication, American Society of Anesthetics (ASA) grade, and post-fracture outcomes including death at 30 days and death at 1 year were recorded. The presence or absence of a previous fragility fracture was examined to explore if a previous fragility fracture was an independent predictor of mortality.
Results
There were 964 patients included, and 290 of whom had sustained a previous fragility fracture; 289 patients were males and 675 females, 33 patients had died in the 30 days following their surgery, and 180 patients had died within 1 year. We found statistically significant results for gender and age but not for previous fragility fracture influencing mortality (
p
value 0.230).
Conclusion
We found that previous fragility fracture does not impact upon mortality in a hip fracture cohort. However, gender and age did impact upon mortality in this study.
Background
This study highlights the multiple sources of delay along a hip fracture clinical pathway. The national recommendation is that ‘patients with a hip fracture should be admitted within 4 ...hours of arrival at the Emergency Department to which they first presented’.
Methods
Granular analysis and process mapping of all available hospital and ‘Irish Hip Fracture Database’ data for a 2-month period were used to highlight and compare causes of delay.
Discussion
We identified numerous sources of delay, occurring at every point along the pathway, emphasising the complexity of providing acute integrated care. There was no single stage that persistently contributed to the delay in the patient pathway. The focus is now to achieve marginal gains in each area. Increased staff and resources to the front line are a clear solution but this is complex to achieve.
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