Impact of echocardiography on one-month and one-year mortality of intertrochanteric fracture patients

Objective: The aim of this study was to analyze the effects of preoperative echocardiography on patient survival, timing of surgery in length of hospital stay in patients who will undergo hip nailing for an intertrochanteric fracture. Methods: The clinical records of the patients who were admitted to a tertiary university hospital with an intertrochanteric femur fracture were retrospectively analyzed. The age, gender, American Society of Anesthesiologists (ASA) score, days to surgery, total hospital stay, cardiac drug prescription/modification, cardiac intervention and presence of an echocardiography assessment including detailed findings were reviewed. Mortality data were accessed from the national civil registration system. Results: 181 (110 women and 71 men; mean age 81 (44–98)) cases were studied whom 65 underwent pre-operative echocardiography. Time to surgery and total hospital stay was 2 days longer at transthoracic echocardiography (TTE) group (p < 0.001). At one month control group survival rate was 93.1% on contrary it was 75.4% at TTE group. One-year survival rates were 77.3% and 55.1% respectively. Likewise mean expected survival time was 21.6 ± 1.03 months for control group and 15.12 ± 1.64 months for TTE group (p < 0.001). Only increased left ventricular end diastolic diameter (LVEDD) was showed to be associated with increasing one-year mortality with a hazard ratio of 10.78 (2.572–45.19) at multivariate model. Conclusion: Cardiac findings and requisite for preoperative TTE and increased LVEDD is a strong predictor for mortality. TTE significantly lengthens the time to surgery. Also LVEDD measurement can be easily performed in the bedside which we believe would save time and reduce mortality. Level of evidence: Level III Diagnostic study. Keywords: Trochanteric fracture, Mortality, Transthoracic echocardiography, Risk assessmen

The Effect of C-Arm Mobility and Field of Vision on Radiation Exposure in the Treatment of Proximal Femoral Fractures: A Randomized Clinical Trial

Objectives. To examine the effect of fluoroscopy devices with different sizes of image intensifier and C-arm maneuverability on operating time, fluoroscopy time, radiation dose and reduction, and fixation quality at intertrochanteric femoral fractures. Design. Single-center, randomized, prospective study. Setting. Academic Level I trauma hospital. Patients and Intervention. 34 patients treated with cephalomedullary nailing for a stable, intertrochanteric proximal femur fracture (OTA A1). Main Outcome Measurement. The total working time of the fluoroscopy device, the dose-area product (DAP), operating time, reduction quality (cortical continuity, symmetrical collodiaphyseal angle, and shortness), and fixation quality (Bosworth quadrants, the tip-apex distance, TAD). Results. There were no cases of poor reduction; also the placement of the blade was optimal for 14 patients and suboptimal in 3 patients in each group. Superior-posterior placement of the blade or TAD > 25 mm was not seen in any patient. Total operating time was significantly shorter when using device A compared to the use of device B (20.1±3.4 mins versus 25.3±5.4 mins, p<0.001). Total radiation time was significantly shorter with device A compared to the use of device B (58.1±19.4 secs versus 98.9  ±  55.4 secs, p=0.008). The measured radiation dose was lower with the use of device A compared to device B (3.5  ±  1.2 Gy·cm2 versus 7.3  ±  4.5 Gy·cm2, p=0.002). Conclusion. Physical properties of fluoroscopy devices used during the fixation of intertrochanteric fractures could yield significant differences in operating times and the radiation dose while having comparable clinical results

Altered Mental Status and General Condition Disorder in Young Case: Bonsai

Yoğun bakım ünitelerinde takip ve tedavi edilen olguların bir kısmını bilinç durum değişiklikleri oluşturmaktadır. Bilinç durum değişikliği; alkol intoksikasyonu, endokrin bozukluklar, travma, serebrovasküler sorunlar, zehirlenmeler vb. gibi birçok nedene bağlı olabilir. Sentetik kannabinoid reseptör agonistlerinin elde edilmesi oldukça kolay ve ucuz olması nedeniyle son yıllarda genç yaş gurubu insan popülasyonunda kullanımı oldukça yaygınlaşmaktadır. Bu ajanlar esrar benzeri psikoaktif etkiler oluşturmaktadır. Kullanım sonrası değişken semptomlarla sağlık kuruluşlarına başvurulabilirler. Biz de bonzai kullanımı sonrası bilinç durum değişikliği nedeniyle yoğun bakım ünitesinde takip ve tedavi ettiğimiz olguyu paylaştık.Alterations in consciousness of some of the patients treated, and followed up in intensive care units are observed. Altered mental status may emerge due to several causes such as alcohol intoxication, endocrine disorders, trauma, cerebrovascular problems, and poisoning. The use of synthetic cannabinoid receptor agonists among young population has become prevalent in recent years due to their easy availability and low price. These agents cause psychoactive effects similar to marihuana. Users experiencing various symptoms can consult to health institutions. We presented the case we treated and followed in our intensive care unit who was diagnosed with altered mental status as a consequence of bonsai use

Prospective Associations Between Fear of Falling, Anxiety, Depression, and Pain and Functional Outcomes Following Surgery for Intertrochanteric Hip Fracture

Objective Fear of falling, anxiety, depression, and pain levels are important risk factors for poor functional outcomes that may potentially be modifiable. We aimed to examine prospective associations between those factors following surgery for intertrochanteric hip fracture. Methods This study is a prospective observational cohort study of patients aged over 65 diagnosed with isolated intertrochanteric hip fracture. Three hundred and seventy patients who underwent intramedullary fixation surgery were screened; 188 cases were included in our final evaluation. Patients with any concomitant fracture, major psychiatric/neurocognitive and neurological disorders and those with any other major disease were excluded from the study. Age, Charlson Comorbidity Index (CCI), Geriatric Depression Scale (GDS), State–Trait Anxiety Inventory (STAI), Falls Efficacy Scale International (FES-I), and Visual Analog Scale (VAS) scores on the day of surgery (baseline) were evaluated as predictors of poor/good outcome at 90 days after surgery, by Harris Hip Score (HHS) with a cut-off score of 70. Results HHS score was significantly predicted at baseline by the full model [χ 2 (7) = 18.18, P = .01]. However, only STAI-state scores were significantly added to the model [Exp (B) 95% CI: .92 (.86-.99)]. Conclusions In this prospective cohort study, we found that higher levels of anxiety state on the day of surgery predicts a poor outcome at 90 days following surgery. We did not find significant associations between other variables, including age, GDS, STAI-trait, FES-I, VAS, and CCI. This potentially modifiable psychological factor may inform surgeons and could be a potential mediator. Future prospective studies are needed to replicate these findings. Level of evidence Prognostic level I