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Query: UMLS:C0038454 (stroke)
 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In a series of 57 hemiplegic patients who subsequently fractured their hips, it was found that hip fracture occurred significantly more often on the hemiplegic side. Hip fracture was equally common in right- and left-sided hemiplegia, and often occurred within one year of the stroke. Two factors seem to be important in the genesis of hip fractures in hemiplegic patients: the tendency of stroke patients to fall to the affected side as a result of impaired locomotor function, and the development of disuse osteoporosis in the hemiplegic limb.
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PMID:Hip fracture after hemiplegia. 47 62

Four hundred consecutive hip fractures were studied prospectively. Two hundred forty-seven patients were classified as unhealthy (poor cardiac status, pneumonia, cancer history, bowel obstruction history, malnutrition, dehydration, stroke history, renal failure history, cirrhosis). Twenty-two percent of this unhealthy group died, while only 6% of the remaining healthy group died. Death rates varied with admission activity level and mental status but not when patient health status was factored out. After factoring out health status, age was associated with higher death rates only in patients older than age 85. Confusion, a change of mental status in the hospital, occurred in 25% of patients. Confusion was associated with a medical complication in 94% of cases, was the presenting symptom of a medical complication in 79% of cases, and was associated with a 39% death rate. Major medical complications occurred in 9% of the healthy group (29% of them died) and 21% of the unhealthy group (64% of them died). Major medical complications in unhealthy, shut-in patients were associated with an 80% death rate. Vigorous urinary tract monitoring and early treatment of bacteriuria decreased death rate. Postfracture malnutrition was associated with higher complication rates. Hip surgery performed within 72 hours on patients with acute medical illnesses in addition to their fracture was associated with a higher death rate. Whether a patient walked postfracture seemed not to be correlated with the death rate. Patients who were not walking prefracture but treated by internal fixation had a 34% failure rate.
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PMID:Hip fracture mortality. A prospective, multifactorial study to predict and minimize death risk. 161 47

Hip fractures are a burden to both the individual and the community. Only 50% of patients regain the mobility and independence they enjoyed 12 months before the hip fracture occurred. Direct costs are high: about US$7,000 for the immediate hospital care and $21,000 in total costs for the first year. The numbers of hip fractures worldwide are projected to increase from 1.7 million in 1990 to 6.3 million in 2050 because of the aging of the population; therefore, the total cost of these fractures will also increase. Based on today's currency values and a cost of $21,000 per patient, the total cost of hip fractures in the year 2050 will be $131.5 billion. The costs and morbidity associated with other fractures, such as vertebral fractures, are less well defined. Because hip fractures are associated with the highest and most well-defined costs, morbidity, and mortality of all fragility fractures, models with high sensitivity can now be devised for evaluating the costs and benefits of interventions. These models are constructed using data on incidence, morbidity, mortality, and costs of fractures, along with the efficacy of an intervention, to estimate the impact of that intervention against osteoporosis. According to one model, the cost per hip fracture avoided is $48,600 if a 62-year-old woman with osteoporosis receives treatment with a drug that is administered for 5 years at $830/year and produces a 50% reduction in fracture rate. The cost per life-year saved is $30,600, and the cost per quality-adjusted life-year is $14,900. By comparison, using this model, treatment of a 62-year-old woman with a diastolic pressure of 95 mm Hg using a drug costing $420/year that reduces risk of stroke by 38% results in costs of $144,200 per stroke avoided, $17,800 per life-year saved, and $14,300 per quality-adjusted life-year. Health economic models allow for changes in assumptions, such as extent of compliance, effectiveness of therapy, and risk of side effects. Cost-effectiveness varies according to treatment and is highly sensitive to the estimated efficacy of treatment, patient compliance, age of the patient at the start of treatment, and fracture risk assigned to the patient. Greater cost-effectiveness occurs when treatments are more efficacious and when they are directed at patients with the highest risk of fracture.
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PMID:The socioeconomic burden of fractures: today and in the 21st century. 930 94

The earliest assessments of bone "mass" involved metacarpal morphometry that provided insight into age-related changes, the effects of low habitual dietary calcium intake, and the effects of estrogen deficiency and replacement. Single photon absorptiometry (SPA) made quantitative mass measurement possible but this was intellectually unsatisfactory since osteoporotic fractures are more of a concern at the spine and hip than at the wrist. Necessity forced the development of axial bone mass measurement (dual photon absorptiometry--DPA, dual energy xray absorptiometry--DXA, quantitative computed tomography--QCT). Hip measurements provide a better prediction of hip fracture risk than measurements at any other skeletal site. For every standard deviation decrement of bone mass at the hip, relative risk of fracture is 3.0. At non-hip sites the relative risk is only 2.0 for each standard deviation decrement in bone mass. However measurement at non-hip sites provide a fracture risk prediction that is at least the equal of blood pressure measurement for predicting risk of CVA, and substantially better than the risk assessment of acute MI afforded by cholesterol measurement. An important caveat of the superiority of hip measurement is that the data are derived from short-term studies in older women (> 70 years). The relative risk data from phalangeal, forearm, and heel measurements have all been obtained from longer-term studies in younger women. From a community health perspective, bone density measurements, no matter how accurate, precise, and meaningful, have limited value if access to the technology is limited. Peripheral measurements can be obtained on existing radiographic equipment (phalanges), or small, portable, inexpensive dedicated equipment (forearm, heel). This technology is more likely to make it to the office of the primary care physician than the larger, more expensive, dedicated equipment needed for hip measurements. The peripheral measurement technology is also suitable for high traffic areas, just as blood pressure and cholesterol measurements are widely available. This presentation reviewed the scientific validity of peripheral bone mass measurement and explored the potential for making this technology available at non-traditional facilities such as pharmacies, shopping malls, health clubs, etc.
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PMID:Peripheral bone densitometry: an old friend revisited. 960 Nov 28

Fractures are a serious complication after stroke. Among patients with femoral neck fractures, a large subgroup have had a previous stroke. This study aimed to investigate the incidence of fractures after stroke. Included in the study were 1139 patients consecutively admitted for acute stroke. Fractures occurring from stroke onset until the end of the study or death were registered retrospectively. Hip fracture incidence was compared with corresponding rates from the general population. Patients were followed up for a total of 4132 patient-years (median 2.9 years). There were 154 fractures in 120 patients and median time between the onset of stroke and the first fracture was 24 months. Women had significantly more fractures than men (chi 2 = 15.6; p < 0.001). In patients with paresis most of the fractures affected the paretic side (chi 2 = 22.5; p < 0.001) and 84% of the fractures were caused by falls. Hip fracture was the most frequent fracture and the incidence was 2-4 times higher in stroke patients compared with the reference population. Fractures are thus a common complication after stroke. They are usually caused by falls and affect the paretic side. It is necessary to focus on the prevention of post-stroke fractures, including the prevention of both falls and osteoporosis.
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PMID:Fractures after stroke. 969 83

To estimate the prevalence and impact of self-reported hip fracture in elderly women an age-stratified random sample of 3841 community-dwelling women aged 65 years and above were interviewed to determine the occurrence of 13 chronic conditions and difficulty performing 15 tasks. Associations were examined using multiple logistic regression analysis. The weighted prevalence of hip fracture was 4.7 per 100. Prevalence increased with increasing age from 2.9 per 100 in women aged 65-74 years to 12.6 per 100 in women aged 85 years and above, and was higher in white women than black women. Women with hip fracture were significantly more likely to report concomitant Parkinson's disease (age-adjusted odds ratio [aOR] = 2.8) and stroke (aOR = 1.8). After adjustment for potential confounding variables, women with hip fracture were significantly more likely to report difficulty performing 11 activities that map into domains of mobility/exercise tolerance, self-care tasks and higher functioning domains. Hip fracture is common among elderly community-dwelling women and is associated with difficulty in performing activities of daily living.
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PMID:The prevalence and impact of self-reported hip fracture in elderly community-dwelling women: the Women's Health and Aging Study. 1002 10

Hip fracture surgery is common and the population at risk is generally elderly. There is no consensus of opinion regarding the safest form of anaesthesia for these patients. We performed a meta-analysis of 15 randomized trials that compare morbidity and mortality associated with general or regional anaesthesia for hip fracture patients. There was a reduced 1-month mortality and incidence of deep vein thrombosis in the regional anaesthesia group. Operations performed under general anaesthesia had a reduction in operation time. No other outcome measures reached a statistically significant difference. There was a tendency towards a lower incidence of myocardial infarction, confusion and postoperative hypoxia in the regional anaesthetic group, and cerebrovascular accident and intra-operative hypotension in the general anaesthetic group. We conclude that there are marginal advantages for regional anaesthesia compared to general anaesthesia for hip fracture patients in terms of early mortality and risk of deep vein thrombosis.
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PMID:General versus regional anaesthesia for hip fracture surgery: a meta-analysis of randomized trials. 1110

Hip fractures on the paretic side are a serious post-stroke complication and may result from disuse hemiosteopenia, hypovitaminosis D, and an increasing risk of falls. To evaluate short-term immobilization effects, we assessed calcium metabolism in 89 patients 1 week after the hemiplegic stroke and in 36 controls. Patient activity was rated using the Barthel index (BI). Sera from stroke patients and control subjects were assayed for ionized calcium, parathyroid hormone (PTH), 25-hydroxyvitamin D (25-OHD), 1, 25-dihydroxyvitamin D (1,25-(OH)(2)D), bone Gla protein (BGP; a bone formation marker) and pyridinoline cross-linked carboxy-terminal telopeptide of type I collagen (ICTP; a bone resorption marker). Patients' serum concentrations of ionized calcium and ICTP were higher than in controls and correlated negatively with BI; their BGP concentrations were low, correlating positively with BI. Concentrations of serum 25-OHD, 1,25-(OH)(2)D, and PTH also were low; serum 25-OHD was at a deficient level (<10 ng/ml) in nine patients (10%), an insufficient level (10-20 ng/ml) in 56 (63%), and a sufficient level (>20 ng/ml) in only 24 (27%). PTH correlated negatively with calcium and 1,25-(OH)(2)D. Hypovitaminosis D is common in acute stroke patients. Immobilization from acute hemiplegia can increase bone resorption and serum calcium, and inhibit PTH secretion and 1,25-(OH)(2)D production to add to the effects of hypovitaminosis D.
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PMID:Influence of immobilization upon calcium metabolism in the week following hemiplegic stroke. 1083 74

Heterotopic ossification (HO) is an important cause of restriction in range of movements and secondary motor disability following neurotrauma, orthopaedic interventions and burns. It has not received focussed attention in non-traumatic neurological disorders. In a prospective study of 377 patients, on medical problems in neurological rehabilitation setting, 15 subjects (3.97%) had neurogenic heterotopic ossification. Their clinical diagnosis was: transverse myelitis (7), neurotuberculosis (4), traumatic myelopathy (2) and stroke (2). Hip (10), knee (4) and elbow joints (1) were involved. The risk factors included urinary tract infection (15), spasticity (6), pressure sores (13) and deep venous thrombosis (DVT) (6). The initial diagnosis was often other than HO and included DVT (3), haematoma (2) and arthritis (2). ESR and serum alkaline phosphatase levels were elevated in all but one subject. The diagnosis of HO was established using X-rays, CT Scan and three-phase bone scan. Following treatment with non-steroidal anti-inflammatory drugs, the range of motion improved in only four patients. HO resulted in significant loss of therapy time during rehabilitation. High index of suspicion about this complication is necessary for early diagnosis and prompt intervention.
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PMID:Neurogenic heterotopic ossification : a diagnostic and therapeutic challenge in neurorehabilitation. 1130 39

Hip fracture is the most serious consequence of osteoporosis, frequently occurring in the elderly; however, no research has been performed to identify the fall characteristics, functional mobility and bone mineral density (BMD) concurrently as risk factors. We investigated the risk factors of hip fractures using a multifactorial approach for a further preventive strategy. This age- and sex-matched case-control study was conducted in a community-based general hospital. A total of 252 consecutive community-dwelling ambulatory elderly, aged between 65 and 85 years, were studied: 127 patients (faller with hip fracture) and 125 controls (faller without hip fracture). Body mass index (BMI), predisposing medical conditions, fall characteristics, functional mobility and BMD of the hip were evaluated by direct interview and clinical examination. In the final model of multivariate regression analysis, risk factors for hip fracture were direct hip impact (adjusted odds ratio (OR), 4.9; 95% confidence interval (CI), 2.7-8.8), previous stroke (adjusted OR, 2.9; 95% CI, 1.3-6.3), sideways fall (adjusted OR, 2.5; 95% CI, 1.6-3.9), functional mobility (a decrease of 1 SD; adjusted OR, 2.0; 95% CI, 1.1-3.5), BMI (a decrease of 1 SD; adjusted OR, 1.8; 95% CI, 1.1-2.8) and femoral neck BMD (a decrease of 1 SD; adjusted OR, 1.7; 95% CI, 1.0-2.8). The effect of risk factors remained the same in different analysis sets, and adding or removing femoral neck BMD did not change other risk factors, though BMD was significantly correlated with functional mobility and BMI. Importantly, both sideways fall and direct hip impact are independent predictors of hip fracture. From these results, we suggest a preventive strategy of hip fracture in the elderly: besides the maintenance of BMD, keeping an appropriate body weight and maintaining a physically active lifestyle might be crucial.
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PMID:Fall characteristics, functional mobility and bone mineral density as risk factors of hip fracture in the community-dwelling ambulatory elderly. 1184 32


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