Extramedullary versus intramedullary fixation of unstable trochanteric femoral fractures (AO type 31-A2):a systematic review and meta-analysis

Objective: The aim of this systematic review was to compare extramedullary fixation and intramedullary fixation for AO type 31-A2 trochanteric fractures in the elderly, with regard to functional outcomes, complications, surgical outcomes, and costs. Methods: Embase, Medline, Web of Science, Cochrane Central Register of Controlled Trials, and Google Scholar were searched for randomized controlled trials (RCTs) and observational studies. Effect estimates were pooled across studies using random effects models. Results are presented as weighted risk ratio (RR) or weighted mean difference (MD) with corresponding 95% confidence interval (95% CI). Results: Fourteen RCTs (2039 patients) and 13 observational studies (22,123 patients) were included. Statistically superior results in favor of intramedullary fixation were found for Harris Hip Score (MD 4.09, 95% CI 0.91–7.26, p = 0.04), Parker mobility score (MD − 0.67 95% CI − 1.2 to − 0.17, p = 0.009), lower extremity measure (MD − 4.07 95% CI − 7.4 to − 0.8, p = 0.02), time to full weight bearing (MD 1.14 weeks CI 0.92–1.35, p &lt; 0.001), superficial infection (RR 2.06, 95% CI 1.18–3.58, p = 0.01), nonunion (RR 3.67, 95% CI 1.03–13.10, p = 0.05), fixation failure (RR 2.26, 95% CI 1.16–4.44, p = 0.02), leg shortening (MD 2.23 mm, 95% CI 0.81–3.65, p = 0.002), time to radiological bone healing (MD 2.19 months, 95% CI 0.56–3.83, p = 0.009), surgery duration (MD 11.63 min, 95% CI 2.63–20.62, p = 0.01), operative blood loss (MD 134.5 mL, 95% CI 51–218, p = 0.002), and tip-apex distance &gt; 25 mm (RR 1.73, 95% CI 1.10–2.74, p = 0.02). No comparable cost/costs-effectiveness data were available.Conclusion: Current literature shows that several functional outcomes, complications, and surgical outcomes were statistically in favor of intramedullary fixation when compared with extramedullary fixation of AO/OTA 31-A2 fractures. However, as several of the differences found appear not to be clinically relevant and for many outcomes data remains sparse or heterogeneous, complete superiority of IM fixation for AO type 31-A2 fractures remains to be confirmed in a detailed cost-effectiveness analysis.</p

Extramedullary versus intramedullary fixation of unstable trochanteric femoral fractures (AO type 31-A2):a systematic review and meta-analysis

Objective: The aim of this systematic review was to compare extramedullary fixation and intramedullary fixation for AO type 31-A2 trochanteric fractures in the elderly, with regard to functional outcomes, complications, surgical outcomes, and costs. Methods: Embase, Medline, Web of Science, Cochrane Central Register of Controlled Trials, and Google Scholar were searched for randomized controlled trials (RCTs) and observational studies. Effect estimates were pooled across studies using random effects models. Results are presented as weighted risk ratio (RR) or weighted mean difference (MD) with corresponding 95% confidence interval (95% CI). Results: Fourteen RCTs (2039 patients) and 13 observational studies (22,123 patients) were included. Statistically superior results in favor of intramedullary fixation were found for Harris Hip Score (MD 4.09, 95% CI 0.91–7.26, p = 0.04), Parker mobility score (MD − 0.67 95% CI − 1.2 to − 0.17, p = 0.009), lower extremity measure (MD − 4.07 95% CI − 7.4 to − 0.8, p = 0.02), time to full weight bearing (MD 1.14 weeks CI 0.92–1.35, p &lt; 0.001), superficial infection (RR 2.06, 95% CI 1.18–3.58, p = 0.01), nonunion (RR 3.67, 95% CI 1.03–13.10, p = 0.05), fixation failure (RR 2.26, 95% CI 1.16–4.44, p = 0.02), leg shortening (MD 2.23 mm, 95% CI 0.81–3.65, p = 0.002), time to radiological bone healing (MD 2.19 months, 95% CI 0.56–3.83, p = 0.009), surgery duration (MD 11.63 min, 95% CI 2.63–20.62, p = 0.01), operative blood loss (MD 134.5 mL, 95% CI 51–218, p = 0.002), and tip-apex distance &gt; 25 mm (RR 1.73, 95% CI 1.10–2.74, p = 0.02). No comparable cost/costs-effectiveness data were available.Conclusion: Current literature shows that several functional outcomes, complications, and surgical outcomes were statistically in favor of intramedullary fixation when compared with extramedullary fixation of AO/OTA 31-A2 fractures. However, as several of the differences found appear not to be clinically relevant and for many outcomes data remains sparse or heterogeneous, complete superiority of IM fixation for AO type 31-A2 fractures remains to be confirmed in a detailed cost-effectiveness analysis.</p

Afstudeerwerk

Voorwoord bij een nieuwe rubriek met afstudeerwerk Het Bulletin KNOB biedt een podium aan zowel ervaren onderzoekers als aanstormend talent. Met een zekere regelmaat publiceren afgestudeerden een artikel op basis van hun masterscriptie of ander onderzoek dat zij aan de universiteit deden. Maar dit is slechts een topje van de ijsberg. Er is immers veel meer werk van studenten dat de aandacht van de lezer verdient. Daarom starten wij in het Bulletin KNOB een rubriek met afstudeerwerk. Eens in de twee jaar vragen wij een aantal pas afgestudeerden van wie de masterthesis of eindopdracht goed is beoordeeld hiervan een synthese te maken. Voor de eerste aflevering van deze rubriek zijn dat degenen die meedongen naar de KNOB Stimuleringsprijs 2021. Het resultaat vindt u in dit nummer: zeventien bijdragen over uiteenlopende onderwerpen, van Cubex-keuken tot herbestemming van industrieel erfgoed en van klimaatverbetering in steden tot Antwerpse zeemanshuizen. De auteurs zijn alumni van universitaire opleidingen op het gebied van architectuur- en stadsgeschiedenis, erfgoed en (landschaps)architectuur in Nederland en België. Met deze rubriek laten wij onze lezers kennisnemen van door studenten verricht onderzoek en bieden wij beginnende onderzoekers en ontwerpers een gelegenheid hun werk in het Bulletin KNOB te presenteren. Onze dank gaat daarbij uit naar collega Jeroen Goudeau, die ons het idee voor een rubriek met afstudeerwerk aan de hand deed. Wij wensen u veel leesplezier en inspiratie toe. De redactieVoorwoord bij een nieuwe rubriek met afstudeerwerk Het Bulletin KNOB biedt een podium aan zowel ervaren onderzoekers als aanstormend talent. Met een zekere regelmaat publiceren afgestudeerden een artikel op basis van hun masterscriptie of ander onderzoek dat zij aan de universiteit deden. Maar dit is slechts een topje van de ijsberg. Er is immers veel meer werk van studenten dat de aandacht van de lezer verdient. Daarom starten wij in het Bulletin KNOB een rubriek met afstudeerwerk. Eens in de twee jaar vragen wij een aantal pas afgestudeerden van wie de masterthesis of eindopdracht goed is beoordeeld hiervan een synthese te maken. Voor de eerste aflevering van deze rubriek zijn dat degenen die meedongen naar de KNOB Stimuleringsprijs 2021. Het resultaat vindt u in dit nummer: zeventien bijdragen over uiteenlopende onderwerpen, van Cubex-keuken tot herbestemming van industrieel erfgoed en van klimaatverbetering in steden tot Antwerpse zeemanshuizen. De auteurs zijn alumni van universitaire opleidingen op het gebied van architectuur- en stadsgeschiedenis, erfgoed en (landschaps)architectuur in Nederland en België. Met deze rubriek laten wij onze lezers kennisnemen van door studenten verricht onderzoek en bieden wij beginnende onderzoekers en ontwerpers een gelegenheid hun werk in het Bulletin KNOB te presenteren. Onze dank gaat daarbij uit naar collega Jeroen Goudeau, die ons het idee voor een rubriek met afstudeerwerk aan de hand deed. Wij wensen u veel leesplezier en inspiratie toe. De redacti

Investigating positioning and gaze behaviors of social robots:people's preferences, perceptions, and behaviors

As technology advances, application areas for robots are no longer limited to the factories where they perform repetitive tasks behind fences. Robots are envisioned to provide services to us in everyday public spaces - in which they will encounter and interact with people. These types of robots can be considered as social robots, and should interact with people following the behavioral norms people expect of the robot within a specific context. Compared to interactions people have with social robots in homes and classrooms, interactions with guide robots in public spaces are likely to be of a more incidental nature and shorter duration. This makes it perhaps even more important that users immediately understand how to use the robot. And what intentions and messages the robot communicates. Given that people apply social rules when interpreting the behavior of media (such as computers and robots), we have investigated social norms for social robots; in particular the non-verbal behaviors of (interpersonal) distance and gaze. In this thesis we have investigated people's preferences for, perceptions of, and behaviors towards social robots through a series nine (lab and field) studies. The work presented in this thesis provides empirical and methodological contributions to the development of social robots in semi-public spaces. The research in this thesis shows that the behaviors of social robots that provide services such as wayfinding in public spaces (such as airports) should, to an extent, be designed in a human-like way. This thesis offers practical guidelines for designers and developers of social robots. Specifically in terms of which distance robots should keep from groups of people, and in which direction a robot should gaze when guiding (small) groups. The results of this thesis contribute toward the development of social robots in semi-public spaces. The behavior of social robots should suit the context of use. In order to design behaviors for future social robots it is necessary for HRI researchers to study people's interactions with robots in this context of use during the development cycle of a social robot

Prognosis of nonoperative treatment in elderly patients with a hip fracture: A systematic review and meta-analysis

Objective: Hip fractures in frail elderly patients are associated with significant mortality and morbidity. Surgery remains the predominant treatment of choice, despite the poor prognosis. Limited research has been done with regards to nonoperative management of frail elderly patients with a hip fracture and therefore the natural course is relatively unknown. This systematic review aimed to provide an overview of the prognosis of nonoperative management in frail elderly patients with a hip fracture in terms of mortality, complications, mobility, and quality of life (QoL). Design: A systematic review of the literature was conducted in PubMed, EMBASE, and Cochrane Central. In addition, a meta-analysis was performed. The primary outcome measurement was 30-days mortality. Results: A total of 4,318 studies were screened. In total eighteen studies matched the eligibility criteria; with low to moderate quality. Approximately two-thirds of the patients were managed nonoperatively due to medical reasons and one-third due to non-medical reasons. Pooled mortality rates after 30 days, six months and one year were 36%, 46%, and 60%, respectively. 33% of the patients developed in-hospital complications. At six months post trauma, 9.6% of the patients were able to mobilize. Data on quality of life (QoL), functional outcome, pain, comfort during nursing care, and costs were not reported. Conclusion

Improving performance and agreement in injury coding using the Abbreviated Injury Scale: a training course helps

The aim of this study was to determine the influence of a dedicated training course on the ability of participants to assign correct codes and their inter-observer agreement using the Abbreviated Injury Scale (AIS98). Twelve participants followed a one-day training course in injury coding. Codes were recorded before, during and after the course. The number of correctly assigned codes and severity codes, as well as the Fleiss' kappas improved significantly during and after the course. This study emphasises the benefit of training in injury coding. Training improves the ability to assign correct codes and it reduces inter-observer variability. We advise all who are involved in injury coding to follow a dedicated training cours

Kwetsbaar en een heupfractuur: altijd opereren?

Een heupfractuur bij kwetsbare ouderen kent over het algemeen een sombere prognose. Bij verpleeghuispatiënten met vergevorderde dementie treden vaak complicaties op en is het functioneel herstel beperkt; de mortaliteit na 6 maanden loopt op tot 53%. Besluitvorming over het wel of niet opereren van patiënten in de laatste levensfase is uitdagend. Het is de vraag of een operatie altijd toegevoegde waarde heeft. Er is echter beperkt inzicht in de uitkomsten van de operatieve versus de niet-operatieve behandeling van proximale femurfracturen bij zeer kwetsbare ouderen

The value of nonoperative versus operative treatment of frail institutionalized elderly patients with a proximal femoral fracture in the shade of life (FRAIL-HIP); protocol for a multicenter observational cohort study

Background: Proximal femoral fractures are strongly associated with morbidity and mortality in elderly patients. Mortality is highest among frail institutionalized elderly with both physical and cognitive comorbidities who consequently have a limited life expectancy. Evidence based guidelines on whether or not to operate on these patients in the case of a proximal femoral fracture are lacking. Practice variation occurs, and it remains unknown if nonoperative treatment would result in at least the same quality of life as operative treatment. This study aims to determine the effect of nonoperative management versus operative management of proximal femoral fractures in a selected group of frail institutionalized elderly on the quality of life, level of pain, rate of complications, time to death, satisfaction of the patient (or proxy) and the caregiver with the management strategy, and health care consumption. Methods: This is a multicenter, observational cohort study. Frail institutionalized elderly (70 years or older with a body mass index < 18.5, a Functional Ambulation Category of 2 or lower pre-trauma, or an American Society of Anesthesiologists score of 4 or 5), who sustained a proximal femoral fracture are eligible to participate. Patients with a pathological or periprosthetic fractures and known metastatic oncological disease will be excluded. Treatment decision will be reached following a structured shared decision process. The primary outcome is quality of life (Euro-QoL; EQ-5D-5 L). Secondary outcome measures are quality of life measured with the QUALIDEM, pain level (PACSLAC), pain medication use, treatment satisfaction of patient (or proxy) and caregivers, quality of dying (QODD), time to death, and direct medical costs. A cost-utility and cost-effectiveness analysis will be done, using the EQ-5D utility score and QUALIDEM score, respectively. Non-inferiority of nonoperative treatment is assumed with a limit of 0.15 on the EQ-5D score. Data will be acquired at 7, 14, and 30 days and at 3 and 6 months after trauma. Discussion: The results of this study will provide insight into the true value of nonoperative treatment of proximal femoral fractures in frail elderly with a limited life expectancy. The results may be used for updating (inter)national treatment guidelines. Trial registration: The study is registered at the Netherlands Trial Register (NTR7245; date 10-06-2018)