Rashmi Yadav

Abstract

The purpose of this study is to realize the challenges experienced by elderly patients with hip fracture and their caregivers after discharge. A total of 65 files of elderly hip fracture operated patients were assessed and out of them responses from 53 patients collected through telephonic conversation over a period of 3 weeks. The responses received from the patient and their attendants were evaluated using the EQ-5D quality of life tool and their challenges noted Background: The most common fractures reported in the elderly are at the wrist, spine and hip. Hip fractures in elderly generally occur after a simple fall. If timely medical attention is not provided or appropriate care not taken the future of the patient after a hip fracture is certain – a dramatic reduction in the quality of life and possibly the beginning of the end of life. The purpose of this study is to evaluate the outcomes of elderly patients with hip fracture following surgery and the challenges they experienced after discharge from the hospital. Materials and Methods: A total of 53 patients were selected for the study who underwent hip surgery at Indian Spinal Injuries Centre. This is a descriptive study carried over a period of 13 months from August 2019 to August 2020. EQ-5D is used to characterize current health status of the patients. It consists of five domains and a visual analogue score. Feedback was collected from the patients and their attendants over telephone with a minimum follow up of 3 months. VAS score was calculated for every patient individually. Collected data was entered in MS Excel sheet. Challenges faced by the patients and their caregivers were documented. Results: Out of 53 patients, 12 had died (22.6%), 07 patients responded themselves to the call and 34 calls were responded by the care givers. Most of the patients had intertrochanteric fractures 56.6% (30 patients) followed by neck femur fracture 24.5% (13 patients). On average every patient was suffering from a minimum of two comorbidities. The average length of hospitalization was 6.8 days. Conclusions: This study suggests that integrated care involving geriatricians in pre-operative optimization of the patient should come in immediate practice. The role of post-surgery rehabilitation is invaluable but often an underestimated modality. The concerns of the patients and their family members regarding home care after discharge are genuine and need to be addressed. Information sharing is the key to reducing anxiety. Consideration for a cost-effective step-down facility must be considered by private institutes and government authorities.   Keywords: Elderly patients, Hip fracture, EQ- 5D (EuroQol).

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Abstract

Locking compression plate technology needs perfect seating of the locking screw head in the corresponding recess in the plate hole for a stable construct. The purpose of this study is to quantify screw-plate angle. In this study, a total of 750 locking screws of different lengths were placed by six residents. The measured angles were compared with Repeated Measures ANOVA method. Significant differences were seen for 40mm, 50mm, 70mm and 80mm screw length (p < 0> Background: The evolution of Locking Compression Plate (LCP) technology has radically changed the practice of fracture fixation. This technology mandates meticulous detail in surgical technique in placing the locking screw. It demands perfect seating of the locking screw head in the corresponding recess in the plate hole. The purpose of this study is to quantify screw-plate angle i.e., off-axis screw trajectory and its change with an increase in the length of screw and strength of the surgeons. Materials and Methods: Six orthopaedic residents were selected. The surgeons were familiarized with the instrumentation. A total of 750 locking screws of different lengths were placed in a locking plate in osteoporotic saw bone models using a torque measuring screw driver. The deviation was assessed for 150 screws inserted in pre-training, post-training and the final test under the supervision of the senior author. Immediate feedback on the performance and objective proof of precision was given within an hour by measuring the angle of deviation on X-ray using InstaPACS. Collected data was entered in MS Excel sheet. Descriptive statistics were presented in mean ±SD for continuous variables and count with percentage for Categorical variables. Repeated Measures ANOVA was used to assess the difference in deviation of angle pre-training, post-training and final experiment with the length of the screw. IBM SPSS 25.0 software was used for data analysis. Results: Surgeon grip strength and torque applied had no significant association with the angle of deviation. The surgeons exceeded 10 Newton meter torque in pretraining. This applied torque decreased after training in the post-training and final experiments. The length of the screw and angle of deviation were found to positively correlate in pre-training and final experiment. In this study, 40 out of 150 (26%) studied screw insertions were off-axis. Most of the deviations (29) were only one degree (19.33%). The remaining 11 were more than 2 degrees (6.67%). The maximum off-axis was 4.3 degrees. Significant differences were seen for 40mm, 50mm, 70mm and 80mm screw length (p < 0> Conclusions: This study signifies that practice under supervision with immediate and objective feedback is a valuable learning tool. Real time feedback definitely improves the surgical confidence that will result in better patient outcome in placing locking screws. The placement of locking screws precisely can help avoid an easily preventable surgical risk factor for fixation failure.   Keywords: Locking compression plate, Saw bone models, Off-axis deviation, Surgeon strength.

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