BackgroundRecent research indicates that the monocyte lymphocyte ratio (MLR), neutrophil lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR), C-reactive protein (CRP), and systemic immune-inflammation index (SII) may serve as valuable predictors of early postoperative mortality in elderly individuals with hip fractures. The primary objective of the study was to examine the association between preoperative MLR, NLR, PLR, CRP, and SII levels and 3-year mortality risk in geriatric patients after hip fracture surgery.Patients and methodsThe study included patients aged 65 years or older who underwent hip fracture surgery between November 2018 and November 2019. Admission levels of MLR, NLR, PLR, CRP, and SII were measured. The median follow-up period was 3.1 years. Cox proportional hazards models were used to calculate the hazard ratio (HR) for mortality with adjusting for potential covariates. Time-dependent receiver operating characteristic (ROC) curves were employed to assess the predictive capability of inflammatory indicators for mortality.ResultsA total of 760 patients completed the follow-up (79.4 ± 7.8 years, 71.1% female). A higher preoperative MLR was found to be significantly associated with an increased 3-year postoperative mortality risk (HR 1.811, 95% CI 1.047–3.132, P = 0.034). However, no significant correlations were observed between preoperative NLR, PLR, CRP, SII and 3-year mortality. The areas under the ROC curve (AUCs) of MLR for predicting 30-day, 120-day, 1-year, and 3-year mortality were 0.74 (95% CI 0.53–0.95), 0.70 (95% CI 0.57–0.83), 0.67 (95% CI 0.60–0.74), and 0.61 (95% CI 0.56–0.66), respectively.ConclusionPreoperative MLR is a useful inflammatory marker for predicting 3-year mortality in elderly hip fracture patients, but its predictive ability diminishes over time.

ObjectiveThe prognostic nutritional index (PNI) has been reported as a significant predictor in various diseases. However, the prognostic value of the PNI in geriatric hip fracture patients has not been thoroughly evaluated. This study aimed to investigate the association between admission PNI and 3‐year mortality in those patients.MethodsIn this post hoc analysis, we included patients aged ≥65 years who underwent surgery for hip fracture between 2018 and 2019. The admission PNI was calculated as serum albumin (g/L) +5 × total lymphocyte count (×109/L). Patients were categorized into four groups based on PNI quartiles (≤ 43.55, 43.55–46.55, 46.55–49.20, and >49.20, respectively). The median follow‐up duration was 3.1 years. Cox proportional hazards models were used to calculate the hazard ratio (HR). Receiver operating characteristic curve (ROC) was conducted for using PNI to predict mortality.ResultsOf the 942 eligible patients, 190 (20.2%) patients died during the follow‐up. Compared to patients in the first quartile (Q1), those in the second (Q2), third (Q3), and fourth (Q4) quartiles had significantly lower mortality risks (HRs 0.50, 95% CI 0.35–0.74; 0.41, 95% CI 0.26–0.64; and 0.26, 95% CI 0.15–0.45, respectively). The optimal cutoff of PNI for predicting mortality was set as 45.275 (sensitivity, 0.674; specificity, 0.692; area under the curve (AUC), 0.727). Patients with higher PNI (>45.275) had a significant lower mortality risk (HR 0.39, 95% CI 0.28–0.55) compared to those with lower PNI (≤ 45.275).ConclusionPNI is a reliable and independent predictor of 3‐year mortality after hip fracture surgery in the elderly.

The prognostic nutritional index (PNI) is a useful tool for assessing nutritional status using serum albumin and lymphocyte count. This study indicates that a higher preoperative PNI correlates with improved mobility and health-related quality of life during the initial postoperative period in elderly patients with hip fractures. To investigate the prognostic value of the prognostic nutritional index (PNI) in predicting mobility and health-related quality of life (HRQoL) in elderly hip fracture patients after surgery. We prospectively involved patients aged 65 and above, who could walk freely before injury and underwent surgery between 2018 and 2019. Admission PNI was calculated as serum albumin (g/L) + 5 × total lymphocyte count (× 109/L). Patients were classified into two groups based on PNI median value. All patients were followed up by telephone for four times (30-day, 120-day, 1-year, and 3-year after surgery). The Fracture Mobility Score (FMS) and EuroQol 5-Dimension 5-Level (EQ-5D 5L) were used to evaluate mobility and HRQoL, respectively. Of 705 eligible patients, 487 completed all assessments. Patients in the higher PNI group had a significantly increased possibility of achieving unrestricted mobility at the 120-day follow-up (OR 1.69, 95

BACKGROUND The evidence on use of supplementary titanium cable cerclage (TCC) in treating femoral subtrochanteric fractures (FSF) remains scarce. Therefore, this study aimed to investigate the potential therapeutic effects for FSF patients using TCC. MATERIAL AND METHODS A retrospective study of 68 FSF patients treated by a long intramedullary (IM) nailing with (Observation group, n=41) or without (Control group, n=27) TCC was conducted from January 2020 to December 2021. The primary outcome measure was time to postoperative full weight-bearing. Secondary outcome measures were operation time, intraoperative blood loss, number of blood transfusions needed, varus angle loss, excellent and good rate of fracture reduction, Harris score, and survival rate. RESULTS Patients were followed up for 13 to 36 months. The excellent and good rate of fracture reduction was 100% in the Observation group versus 92.6% in the Control group (P=0.013), and the varus angle loss and time to postoperative full weight-bearing in the Observation group were significantly less than in the Control group (P<0.05). The intraoperative blood loss in the Observation group was significantly higher than in the Control group (P<0.001). No differences were noted between groups for Harris scores and survival rates at last follow-up. CONCLUSIONS TCC fixation combined with IM nailing can improve the excellent and good rate of fracture reduction and reduce varus angle loss, as well as shorten the time to full weight-bearing and promote early functional exercise, which offers an effective treatment option for FSF patients who have failed closed reduction.

BACKGROUND It is unclear whether preoperative thyroid-stimulating hormone (TSH) level is correlated with long-term mortality in the elderly after hip fracture surgery. We aimed to assess the association between TSH levels and 3-year mortality in these patients. MATERIAL AND METHODS We enrolled patients aged 65 and above who had hip fracture surgery and thyroid function tests upon admission from 2018 to 2019. Patients were categorized based on TSH median value, quartiles, or thyroid function status. The median follow-up time was 3.1 years. Cox proportional hazards models were used to examine the correlation between TSH levels and mortality, adjusting for covariates. RESULTS Out of 799 eligible patients, 92.7% (741/799) completed the follow-up, with 20.6% (153/741) of those having died by the end of the follow-up. No statistically significant differences in mortality risks were found when stratified by TSH median value (HR 0.88, 95% CI 0.64-1.22, P=0.448) or quartiles (HR ranging from 0.90 to 1.13, P>0.05). Similarly, when categorized based on admission thyroid function status, patients who presented with hypothyroidism, subclinical hypothyroidism, hyperthyroidism, and subclinical hyperthyroidism upon admission did not demonstrate a statistically significant difference in mortality risk compared to those who were considered euthyroid (HR 1.34, 95% CI 0.72-2.49, P=0.359; HR 0.77, 95% CI 0.38-1.60, P=0.489; HR 1.15, 95% CI 0.16-8.30, P=0.890; HR 1.07, 95% CI 0.34-3.38, P=0.913, respectively). CONCLUSIONS Admission TSH is not significantly associated with 3-year mortality in geriatric patients after hip fracture surgery.

[This corrects the article DOI: 10.3389/fsurg.2024.1440990.].

Objective:To elucidate the recent therapeutic efficacy of the intelligent fracture reduction robotic system in managing pelvic fractures.Methods:A retrospective evaluation of 49 pelvic fracture patients treated using the intelligent fracture reduction robotic system at Beijing Jishuitan Hospital's trauma orthopedics department between March 2021 and December 2022 was conducted. The cohort included 30 males and 19 females, with a mean age of 51.51±18.71 years (20-92 years range). Fractures were classified according to the Tile system: B1 type in 2 cases, B2 in 7, B3 in 3, C1 in 30, and C2 in 3. The median interval between injury and surgery was 6 days, with a range of 2-22 days. The robotic system assisted in pelvic fracture reduction and stabilization surgeries. Preoperative and postoperative evaluations involved pelvic CT scans, anteroposterior, inlet, and outlet radiographic images. Fracture displacement and reduction outcomes were assessed via X-ray imagery. Data captured included intraoperative blood loss, duration of surgery, fracture stabilization techniques, and postoperative monitoring period. The Majeed scoring system gauged functional outcomes.Results:Of the patients, 48 underwent minimally invasive interventions with robotic assistance, while one case necessitated open reduction and internal fixation due to an unsuccessful reduction. The duration between injury and operation ranged from 2 to 22 days. Average surgical time stood at 206.5±7.1 minutes (105-440 min range), and median intraoperative blood loss was 100ml (10-600 ml range). Using the Matta reduction criteria, 30 postoperative cases exhibited excellent and 9 good outcomes for posterior pelvic ring displacement, translating to a 93% (38/41) positive rate. For anterior pelvic ring shifts, 45 showed excellent and 3 good outcomes, culminating in a 100% (48/48) success rate. Follow-up for the 48 cases lasted 11.0 months (3-23 months range), with the Majeed functional score averaging 81.9±17.0 points (42-100 point range). 27 cases scored excellent, and 11 good, yielding a combined positive outcome rate of 79.2% (38/48).Conclusion:Employing the intelligent fracture reduction robotic system in pelvic fracture treatments facilitates minimally invasive interventions and yields favorable short-term clinical results.

Objective To evaluate the clinical effectiveness of orthogeriatric co-management care in long-lived elderly hip fracture patients (age ≥ 90). Methods Secondary analysis was conducted in long-lived hip fracture patients between 2018 to 2019 in 6 hospitals in Beijing, China. Patients were divided into the orthogeriatric co-management group (CM group) and traditional consultation mode group (TC group) depending on the management mode. With 30-day mortality as the primary outcome, multivariate regression analyses were performed after adjusting for potential covariates. 30-day mobility and quality of life were compared between groups. Results A total of 233 patients were included, 223 of whom completed follow-up (125 in CM group, 98 in TC group). The average age was 92.4 ± 2.5 years old (range 90–102). The 30-day mortality in CM group was significantly lower than that in TC group after adjustments for (2.4% vs. 10.2%; OR = 0.231; 95% CI 0.059 ~ 0.896; P = 0.034). The proportion of patients undergoing surgery and surgery performed within 48 h also favored the CM group (97.6% vs. 85.7%, P = 0.002; 74.4% vs. 24.5%, P < 0.001; respectively). In addition, much more patients in CM group could walk with or without aids in postoperative 30 days than in the TC group (87.7% vs. 60.2%, P < 0.05), although differences were not found after 1-year follow-up. And there was no significant difference in total cost between the two groups ( P > 0.05). Conclusions For long-lived elderly hip fracture patients, orthogeriatric co-management care lowered early mortality, improved early mobility and compared with the traditional consultation mode.

Purpose To explore the epidemiological trends in acetabular fracture and report the mid-term to long-term clinical outcomes of the elderly treated with operation. Methods Retrospective study. Patients aged ≥ 14 years with operative treatment of the Acetabular fracture from Jan 2010 to Dec 2019 at a level-1 trauma centre were identified to analyze the epidemiological trends, and the difference in fracture patterns between young and elderly patients (≥ 60 years old) were compared. The elderly patients were followed up to evaluate their clinical outcomes and satisfaction degree (worst to best: 0 to10). The patients were divided into the 2010–2014 group and the 2015–2019 group according to the year of admission, and the clinical outcomes of the two groups were compared to verify the stability from mid-term to long-term after surgery for acetabular fracture. Results A total of 1024 patients (mean age 43.35 years, range 14–86 years) with acetabular fractures received operative treatment in this decade. The mean age of the acetabular fracture patients increased from 41.1 years to 47.7 years, and the proportion of elderly patients increased from 5.7% to 24.0%, with some volatility. The ratio of male to female decreased year by year, and the proportion of female patients increased with age. And the anterior fracture patterns were more common in the elderly patients compared to the young patients ( P < 0.001). 118 elderly patients (82 males, 36 females; mean age 66.91 years, range 60–86 years) were followed-up (mean 77.4 months, range 35–152 months). The overall mortality rate of the elderly patients was 7.69% (9/118). The Harris hip score of those alive patients was 90.41 ± 12.91 points (excellent and good rate 84.4%). 87 patients completed the SF-12 with a normal HRQoL (PCS 50.49 ± 8.88 points; MCS 55.66 ± 8.86 points). 90.8% of the patients achieved a satisfaction score of 9 or higher. And there was no significant difference in clinical outcomes between the 2010–2014 group and the 2015–2019 group ( P > 0.05). Conclusions In conclusion, acetabular fractures presented an obvious ageing trend in China, and the fracture patterns of the elderly patients differed from those in the young patients. Operative treatment for elderly acetabular fractures yielded satisfactory and persistent clinical outcomes from mid-term to long-term clinical.

目的:研究周末入院对老年髋部骨折患者疗效的影响.方法:采用回顾性研究方法,连续纳入2018年11月至2019年11月收治的老年(年龄≥65岁)髋部骨折患者1 009例,根据患者入院时间分为工作日入院组(周一至周四入院)388例和周末入院组(周五至周日入院)621例.收集患者基线资料和治疗相关资料,并于入院后30 d、120 d、1年进行随访,随访患者生存情况和并发症情况.结果:周末入院组与工作日入院组患者基线资料差异均无统计学意义(P＞0.05).与工作日入院组患者相比,周末入院组患者入院48 h内手术率显著降低(64.2％vs.81.6％,P＜0.001),术前等待时间和住院时间均显著增加(P＜0.05),30 d内并发症发生率显著增加(11.9％vs.7.7％,P=0.028).两组患者院内、30 d、120 d和1年死亡率及1年内再次手术率差异均无统计学意义(P＞0.05).结论:周末入院会延长老年髋部骨折患者术前等待时间,增加并发症发生率,应制定相应的流程和路径以降低周末入院对老年髋部骨折患者疗效的影响.

Factors related to mortality after osteoporotic hip fracture (HF) have been investigated intensively, except for proximal femoral bone mineral density (BMD), which is also the primary cause of osteoporosis. In this study, we aimed to investigate the association of hip BMD with mortality risk after HF. Four hundred and eleven elderly patients with HF in Beijing, China, were included and prospectively followed up with a median time of 3 years. At baseline, quantitative CT technique (QCT) was used to measure areal BMD (aBMD) of the unaffected hip. Areal BMDs of the total hip (TH), femoral neck (FN), trochanter (TR), and intertrochanter were analyzed with postoperative mortality as the primary outcome. A total of 394 patients (78.59 ± 7.59 years, 75.4% female) were included in our final analysis, with 86 (82.23 ± 7.00 years, 81.4% female) dead. All hip bone densities demonstrated a significant association with mortality risks in the unadjusted model, but only TR aBMD remained significantly correlated after adjusting for all covariates. Compared to the lower TR aBMD group, the higher TR aBMD group yielded significantly lower death risks (HR 0.21 95% CI 0.05–0.9, P = 0.036). Higher survival probabilities were observed for higher TH and TR aBMD in survival analysis ( P < 0.001). Hip BMD, especially TR BMD assessed by QCT, is an independent risk factor for postoperative mortality following HF. QCT may present a promising avenue for opportunistic analysis in immobilized patients, providing valuable information for early detection and personalized interventions to enhance patient outcomes.

目的 探讨踝部骨折双切口手术中使用止血带与否对治疗效果的影响.方法 选取2017年7月至2019年7月北京积水潭医院创伤骨科连续收治的踝部骨折患者90例,以随机数字表法分为止血带组和非止血带组,每组45例.对非止血带组患者在手术过程中不使用止血带止血,对止血带组患者在非止血带组的治疗基础上使用止血带.对两组患者的血压、手术时间、出血量和手术视野评分等术中指标,下肢肿胀程度、引流量、疼痛视觉模拟评分(VAS)与神经损伤、下肢静脉血栓、切口渗出和感染、肌损伤等并发症的发生率等术后指标以及术后3个月Tinetti平衡与步态量表(Tinetti POMA)、Berg平衡量表(BBS)、踝部功能Olerud Molander(OM)评分和美国矫形足踝协会量表(AOFAS)等踝关节功能评价指标进行比较.采用SPSS 26.0软件对数据进行统计学分析;P<0.05为差异有统计学意义.结果 与非止血带组相比,止血带组患者术中血压和手术视野评分显著提高,出血量显著降低(均P<0.001);术后止血带组患者中足和下肢周长,下肢静脉血栓发生率(17.78％)以及水泡、切口渗出和感染等并发症发生率(44.44％)均高于非止血带组(22.00％,28.89％)(均P<0.05);止血带组患者术后引流量[493(473,513)ml]和VAS评分[8(6,8)分]较非止血带组[472(452,495)ml,6(5,7)分]均显著升高(均P<0.001);术后3个月止血带组患者Tinetti POMA评分、BBS评分、OM评分优良率和AOFAS评分优良率与非止血带组差异均无统计学意义(均P>0.05).结论 在踝部骨折双切口手术中使用止血带可维持患者术中血压,减少术中出血,使手术视野更加清晰,但是可能带来不可忽视的术后并发症;术中使用止血带与否对踝关节的远期功能没有显著影响;临床工作中应重视止血带使用的安全性和规范性.