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Query: UNIPROT:P50502 (Hip)
 7,003 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Hip fracture mortality was compared for patients treated surgically at the same hospital from 1946 to 1955 and from 1982 to 1986. Almost all hip fractures were treated surgically (98%) in the 1980 series, compared to the 1950 series (69%). The four-week surgical mortality rate decreased significantly from 13% to 4.2%. The internal fixation implants were different except for Knowles pins. The use of prostheses had increased four-fold from 4% to 17%. Most hip fracture patients were mobilized out of bed and earlier in the 1980 series, and most patients started physical therapy earlier. Possible factors contributing to this decrease in mortality include better medical management, better implants to allow rapid mobilization of the patient, emphasis on early physical therapy and advances in anesthesia.
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PMID:Comparison of hip fracture mortality: 1946 to 1955 vs. 1982 to 1986. 234 4

Clinical evaluation of knee instability is often difficult to reproduce, and several different physical tests have become popular. In an attempt to elucidate reasons for variations in the degree of pivot shift phenomenon seen with the use of the various tests, we have prospectively evaluated a group of 37 patients with surgically documented ACL injuries, noting the effects of hip position and tibial rotation. The patients were examined under anesthesia, and the pivot shift was graded as 0 (absent, or negative), 0.5+ (trace), 1+, 2+, or 3+ (with locking). All knees were tested in hip abduction, neutral, and hip adduction, and with the tibia in external and internal rotation, so that six positions were evaluated. Hip position strongly correlated with the degree of pivot shift regardless of tibial rotation. Overall, abduction produced the greatest degree of pivot shift, followed by neutral and finally adduction. External tibial rotation increased the pivot shift score in abduction and neutral, but not in adduction. A grading system for the subject population showed that abduction/external rotation (ABDER) resulted in the highest pivot shift scores, and that adduction/external rotation (ADDER) and adduction/internal rotation (ADDIR) resulted in the lowest scores. Nine patients out of 20 with a 3+ pivot shift in ABDER were negative in ADDER. The pivot shift score was dampened at least one grade from ABDER to ADDER in 92% of the patients. We conclude that hip position and tibial rotation affect the degree of pivot shift phenomenon, and it is our impression that the iliotibial band plays a significant role in controlling the degree of pivot shift observed.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The pivot shift phenomenon: results and description of a modified clinical test for anterior cruciate ligament insufficiency. 323 13

Hip fractures in patients with Parkinson's syndrome present a continuing challenge to orthopaedic surgeons. Sixty-two consecutive such patients have been reviewed. With or without operation, there was very high rate of mortality (31%) and complications. However, the functional results, the ability to walk, progression of the disability, and the quality of life were significantly better after operation. The results suggest that operation is the preferable solution for these patients. They require, however, much more particular care than other patients with hip fractures. This includes adequate adjusted antiparkinson medication, appropriate anesthesia with special attention to adequate ventilation and postoperative analgesia, more intensive respiratory and functional physiotherapy, very meticulous nursing care, and a relatively extended period of preventive antibiotics.
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PMID:Hip fractures in patients with Parkinson's syndrome. 682 45

Pertrochanteric fractures ordinary appear to women 10 to 15 years later than to men. Only 49 per cent of the women and 63 per cent of the men have a good bone structure at that time according to the Singh-index. The classification of pertrochanteric fractures follows the proposal of the AO-ASIF Group. The force which works at the hip joint depends on the function of the limb and is mainly caused by the musculature. This force exceeds up to 4.5 times the body weight. The first 6-24 hours after trauma are the optimal moment for operation. Anaesthesia methods near by the spinal cord should be preferred. The mainly used implant in Germany is the Dynamic Hip Screw (DHS) in more than 60 per cent of cases. Intramedullary implants only reach 15.5 per cent. A fracture table is dispensable for the implantation of a DHS, but the additional fixation of the greater trochanter and in some cases also the lesser trochanter is important. The Gamma Nail is prone to complications caused by the operation. A total hip arthroplasty is performed in about 10 per cent of all pertrochanteric fractures. The AO-document-center can show, that arthroplasty gives very good long-term results. The 130 degrees blade-plate and the Ender-Nail are only used in individual cases. 20 per cent of the patients must have an intensive care follow-up treatment during a medium hospital stay of 29 days, 21 per cent have general non-surgical complications and 8 per cent of the patients die. Nevertheless 78 per cent of all patients can be discharged under partial or full weight-bearing. Scores which allow a comparison of the pre- and postoperative functional status must be applied in order to compare different methods of hip fracture treatment. In a follow-up study 2.7 years after the accident 54 of our own patients had a medium reduction in their functional status of 10 to 15 per cent compared pre- and postoperatively.
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PMID:[Pertrochanteric fractures]. 853 81

A 69-year-old woman was admitted to our hospital complaining of urinary retention. On examination, the labia was found to be fused extensively, with a pinhole opening at the midline. The adhesions were separated under spinal anesthesia. One year after operation, there remains no recurrence. Etiological factor in labial adhesions are thought to include a combination of local inflammation and estrogen deficiency. In our case, the patient had hip joint disease. Hip joint disease is shown to influence the formation of adhesions by interfering with perineal hygiene and decreasing sexual activity.
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PMID:[A case of labial adhesions with urinary retention]. 875 47

The association between dementia and hip fracture was studied in a representative sample of 85-year olds (N = 485). The diagnosis of dementia was made according to the DSM-III-R. The prevalence of hip fracture was obtained by history and inspection of the hip. Bone mineral density was measured with dual photon absorptiometry of the right calcaneus. Hip fracture was associated with both Alzheimer's disease (p < 0.01) and vascular dementia (p < 0.01) in women, but not in men. Among women with dementia, the rate of hip fracture was more than twice that found in the general population (32.7% vs 13.6%). Bone density was not associated with dementia or hip fracture. Body mass index and body weight were lower in women with dementia and in women with hip fracture. The prevalence of hip fracture was also increased in subjects who used psychotropic drugs, especially tricyclic antidepressants. A logistic multiple regression analysis showed that dementia, use of antidepressants and gender independently contributed to hip fracture. The reason why subjects with dementia are at increased risk for hip fractures may be that these subjects have a defective neuromuscular regulation, gait apraxia, use more antidepressants, and have a lower body mass index. Another explanation of the association may be that surgery and anesthesia give rise to systemic hypotension that leads to cerebral hypoperfusion and ischemic and neuronal death in vulnerable brain areas, and as a consequence may lead to dementia or worsen the symptoms in subjects already affected by dementia.
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PMID:A population-based study on the association between dementia and hip fractures in 85-year olds. 886 94

Hip fractures have a high economic and social cost to society. Rising healthcare costs, coupled with managed healthcare systems, have forced a close inspection of healthcare expenditures. To evaluate the impact of geriatric intertrochanteric hip fractures upon a hospital system, an economic cost-analysis was undertaken. An analysis was made of financial and hospital data of elderly patients who sustained an intertrochanteric hip fracture and subsequently underwent open reduction and internal fixation. Increasing patient age did not correlate with length of stay, overall hospital cost, or net hospital income. When costs were subdivided, there were no statistically significant differences relative to patient age for costs of pharmacy, radiology, respiratory therapy, or operating room supply. There were, however, statistically significant correlations between patient age and costs of the operating room, blood, and anesthesia. During the 36-month study period, a case manager was added to the orthopedic surgical team. There was a trend toward decreased length of stay after the addition of the case manager, but the overall cost of patient care was not affected.
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PMID:Geriatric intertrochanteric hip fractures: an economic analysis. 1054 Nov 43

The Baltimore Hip Studies, a multicenter, noninterventional, observational trial, provided an opportunity to investigate the effects of anesthetic technique on the long-term outcome of elderly patients after hip fracture repair. Detailed interviews assessing functional status and pain were conducted during the hospital stay. Out-of-hospital evaluations were repeated after the procedure at 2, 6, 12, 18, and 24 months with a portable gait and balance laboratory. Multivariate analysis was done to determine the effects of anesthetic technique on functional and other outcomes, after controlling for multiple baseline variables. Of 741 enrolled patients who completed the study, 430 and 311 patients received spinal anesthesia or general anesthesia, respectively. Subgroup analysis of three spinal anesthetics, tetracaine, lidocaine, and epinephrine, was also done. In the present large observational study, general anesthesia was at least as efficacious as spinal anesthesia, and possibly better, in affording good long-term outcome.
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PMID:Spinal anesthesia versus general anesthesia for hip fracture repair: a longitudinal observation of 741 elderly patients during 2-year follow-up. 1064 16

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

In 1 year, the Geriatric Orthopaedic Hip Fracture Program saw various positive results. The accomplishments are as follows: Appropriate use of consulting services. Reduction in the mortality rate. Increase in the number of patients (76%) who returned to home versus skilled nursing facilities. Reduction of LOS. Fifty-seven percent of patients are independent with ADLs at 6 months after hip fracture repair. Sixty-four percent remain independent ambulators and use aids on an as needed basis. Our team has learned that we need to improve certain areas of the program. We need to reinforce to the staff the importance of following skin care and toileting guidelines. Other research articles looking at the overall condition of the geriatric patient have used the Apache score or the Anesthesia Rating score and we plan to follow suit. The Apache and Anesthesia ratings have been used to predict outcomes; the higher the score, the less successful the outcome. Within the cost structure, we needed to become more aware of the comorbidity costs and identify opportunities to address these issues.
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PMID:One year later: did the quality circle of geriatric hip fracture care achieve quality outcomes? 1085 50


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