157 / 210
Poster presentations / European Geriatric Medicine 6S1 (2015) S32
–
S156
S149
recorded each patient’s age, mobility and residence at the time of
fracture.
Results:
In total 2,699 (4.2%) presentations were people who
were already inpatients. A further 450 (0.7%) were people in
rehabilitation units. A very small proportion of these 3,149 injuries
may have arisen without an inpatient fall, but
<
3% were pathological
fractures, many of which still presented following a fall. Both
mortality and length of stay were significantly greater than for
other patients with hip fracture.
Conclusions:
This annual total of 3,149 is three times higher
than previous estimates based on critical incident reporting. Inter-
hospital variation was considerable – individual trauma units
reporting from 0 to 7.6% (mean 4.9%) as being current inpatients.
We are developing this approach as a marker of serious inpatient
falls. The NHFD website therefore now features ‘live’ online charts
which provide inpatient hip fracture data specific to each trauma
unit – so hospitals can monitor the effectiveness of local initiatives
to prevent inpatient falls and hip fractures.
P-436
The incidence of periprosthetic femoral fractures after total
hip replacement in the Pirkanmaa Hospital District, Finland
during 2002–2010
E. J¨amsen
1
, H. Salonen
2
, A. Taukoj¨arvi
3
, H. Huhtala
3
, M. Laitinen
2
,
T. Puolakka
4
, J. Nieminen
4
1
Hatanp¨a¨a hospital, Tampere, Finland;
2
Tampere University Hospital,
Tampere, Finland;
3
University of Tampere, Tampere, Finland;
4
Coxa,
Hospital for Joint Replacement, Tampere, Finland
Objectives:
As population ages, increasing number of patients with
hip replacements are at risk of experiencing periprosthetic fracture.
The aim of this study was to determine the incidence trends of
periprosthetic femoral fractures in a Finnish region.
Methods:
We conducted a retrospective analysis of 154 patients
treated for femoral periprosthetic fractures between 2002–2010 in
the Pirkanmaa Hospital District, Tampere, Finland. The incidence
was determined in relation to the number of hip replacements at
risk in the area. The incidence rate ratio (IRR) was calculated using
the Poisson regression model.
Results:
The annual incidence in 2002 was 1.6/1,000 THA (95% CI
0.73–3.02), increasing to 3.1/1,000 THA (95% CI 2.10–4.43) by 2010
(IRR 1.13, 95% CI 1.06–1.12, p
<
0.001). In subgroup analyses, a
statistically significant increase in the incidence was observed in all
age-groups in women but not in men. The average occurrence of
periprosthetic fracture was 6.7 years after the last hip replacement.
Early fractures (occurring
<
1 year postoperatively) accounted for
27%, late fractures (1–8 years) for 37% and very late fractures
(
>
8 years) for 34% of the fractures. Very late fractures were
associated with old age, chronic disease and functional disability,
whereas early fractures were often related to uncemented fixation
of the hip replacement.
Conclusions:
We observed a significant increase in the incidence of
periprosthetic fractures independent of the rise in annual numbers
of hip replacements. Patient profiles differ between early and late
periprosthetic fractures, and particularly very late fractures seem
comparable to fragility fractures of the aged.
P-437
Self-rated health and the functional outcome of primary knee
replacement in the aged
E. J¨amsen
1
, L. Vekama
2
, T. Puolakka
2
1
Hatanp¨a¨a hospital, Tampere, Finland;
2
Coxa, Hospital for Joint
Replacement, Tampere, Finland
Objectives:
Factors predicting the outcomes of joint replacement in
the aged are poorly understood. We evaluated how self-rated health
(SRH) associates with performance in activities of daily living (ADL)
in knee replacement recipients.
Methods:
Information about ADL performance and global SRH
were collected from 300 knee osteoarthritis patients aged 75 years
or over using a mailed questionnaire before and one year after
primary knee replacement. Primary outcome was the number ADLs
activities that the patient was able to perform without difficulty.
Results:
Of the 165 patients (mean age 79 years, 63% females)
who responded both to pre- and postoperative questionnaire, 36%
considered their health good/very good, 51% fair, and 13% poor/very
poor before the operation. These groups were similar in terms of
age (p = 0.367), sex (p = 0.902), body mass index (p = 0.601), Charlson
comorbidity index (p = 0.645), and severity of OA (p = 0.302). After
surgery, the proportion of patients with good/very good SRH
increased to 48%.
Preoperatively, patients with good/very good SRH were able to
perform more ADLs without difficulty than those with fair or
poor/very poor SRH (7 out of 10 vs. 5 and 4, respectively; p
<
0.001).
Postoperatively the respective figures were 9, 8, and 6.5 (p
<
0.001).
The change was similar in all groups (p = 0.723). Improvement was
observed in all ten ADLs independent of preoperative SRH although
not all changes reached statistical significance.
Conclusions:
Self-rated health predicts ADL performance following
knee replacement but it does not seem to affect how much the
patients gain from surgery.
P-438
Hip fracture outcomes in patients with Parkinson’s disease
R. Lisk
1
, K. Yeong
1
, Z. Dhakam
1
1
Ashford & St. Peter’s NHS Trust, Chertsey, United Kingdom
Objectives:
Patients with chronic idiopathic Parkinson’s disease
(PD) are at a high risk for fractures, particularly of the hip. The
causes may be multifactorial, including poor balance and other
forms of neurological dysfunction. Osteopenia and osteoporosis
leading to decreased bone mass are common in these patients.
The aim of this audit of a prospective hip-fracture database was to
establish outcomes from hip fracture in people with and without
PD living in North West Surrey.
Methods:
Using data collected prospectively for the National Hip
Fracture Database for Ashford & St. Peter’s NHS Foundation Trust in
the UK. Data was reviewed between Dec 2012 and Dec 2014. The
type of fracture, time to surgery, length of stay, home to home for
PD patients was calculated and compared for people without PD.
Results:
28 PD patients were identified and the results reported in
the table.
PD patients
All patients
Age (y)
82
84
Female
60%
72.2%
Mobility without aids
21.4%
48.3%
AMTS
6.4
6.9
Fracture-intrascapular
69.1%
56.2%
Theatre within 36hrs
89%
82%
Length of stay (days)
26.1
21
Home to home in 30 days
28.5%
58.1%
Mortality
7.7%
5.5%
Conclusions:
PD patients with hip fracture tend to have a
longer hospital stay and unlikely to return home within 30 days.
Multidisciplinary teams managing these patients need to be more
aware of these patients and their potential complications so as
to improve outcomes. Ideally preventing these fractures whenever
possible is better because of its debilitating nature.