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Malpresentation And Malposition
Published in Vincenzo Berghella, Obstetric Evidence Based Guidelines, 2022
Alexis C. Gimovsky, Andrea Dall’Asta, Giovanni Morganelli, Tullio Ghi
While the rate of short-term fetal bradycardia can be as high as 20%, the rate of the need for urgent CD for nonreassuring fetal heart rate tracing (NRFHT) after an external cephalic version (ECV) is about 1/600 [25]. Placental abruption (<1%) and onset of labor are uncommon complications. Rare fetal deaths following attempts at version have not been determined to be a result of the procedure [1]. Femur fracture has been reported. In a meta-analysis, there was a 4.7% risk of transient abnormal cardiotocography, 0.21% risk of abnormal cardiotocography leading to emergency CD (with good neonatal outcomes), and 0.35% risk of emergency CD. Other risks included 0.24% risk of stillbirth, 0.18% risk of placental abruption, 0.18% risk of cord prolapse, and 0.19% risk of fetal death. These complications were not found to be directly related to the ECV procedure. Vaginal bleeding related to ECV occurred in 0.34% of patients, and rupture of membranes related to ECV occurred in 0.22% of patients [26]. An additional retrospective review showed a 3.32% risk of spontaneous reversion to breech [27].
Classification of Pain
Published in Benjamin Apichai, Chinese Medicine for Lower Body Pain, 2021
Hip pain caused by fractures: A fall, especially a sideways fall, often causes the femur fracture. Certain medical conditions such as cancer and osteoporosis may make patients more susceptible to fractures.
Musculoskeletal trauma
Published in Ian Greaves, Keith Porter, Chris Wright, Trauma Care Pre-Hospital Manual, 2018
Ian Greaves, Keith Porter, Chris Wright
Injury to the hip usually results in the patient complaining of pain in the joint itself, the proximal femur or the groin. Elderly patients and those with osteoporosis are particularly prone to fragility fractures of the neck of the femur. The exact location of the fracture within the femoral neck determines the surgical treatment, but cannot be determined by the pre-hospital clinician. This is an injury with significant long-term morbidity, particularly in older patients. Patients usually complain of pain associated with a fall, often onto the hip itself. The affected leg may be externally rotated and shortened when the patient is in the supine position. A history of minimal or no trauma and signs suggestive of proximal femur fracture should raise the possibility of a pathological fracture. Analgesia will be required for extrication and transfer. Intravenous opiates are appropriate. Where skill and expertise are available, a femoral nerve block offers good analgesia of the hip, which usually lasts for several hours. In the elderly, femoral neck fractures may appear to be associated with surprisingly little discomfort until the patient is moved.
Preliminary Evidence on the Effectiveness of a Multidisciplinary Nutritional Support for Older People with Femur Fracture at an Orthogeriatric Unit in Spain
Published in Journal of Nutrition in Gerontology and Geriatrics, 2022
S. Solsona Fernández, A. Caverni Muñoz, G. Labari Sanz, B. Monterde Hernandez, M. A. Martínez Marco, P. Mesa Lampré
The study was a descriptive, prospective, open-label, real-world research on the health and nutritional outcomes of optimizing dietary habits and providing nutritional support to older patients after surgery due to femur fracture. Patients were admitted to the orthogeriatric unit at the Geriatric ward of Nuestra Señora de Gracia hospital in Zaragoza, Spain and were consecutively enrolled up to 72 h before or within 24 h after surgery to femur fracture (Figure 1). Participants were assessed at 4 study timepoints: at baseline (in-hospital assessment), and at 45 days, 100 days, and 180 days after hospital discharge, respectively. After discharge from the hospital, patients were followed in the outpatient clinic. Telephone calls were made 15 days after discharge and after the 45- and 100-day visits to solve doubts and to assess the general, functional, and cognitive status of patients as well as their appetite and adherence to dietary and nutritional recommendations. Recruitment for the study took place from 11th July 2017 to 23rd January 2020. Due to the SARS-COV 2 pandemic, the study follow up was stopped on 30th April 2020. Two geriatricians (S.S and P.M.), a specialist nurse (G.L.), and a dietitian (A.C.) assessed the patients during admission and follow up and carried out dietary education tasks (G.L. and A.C.) upon discharge from hospital and during follow up (study investigators).
30-day and 1-year mortality after skeletal fractures: a register study of 295,713 fractures at different locations
Published in Acta Orthopaedica, 2021
Camilla Bergh, Michael Möller, Jan Ekelund, Helena Brisby
An increase in mortality after lower extremity fractures has been previously reported (Somersalo et al. 2016, Huette et al. 2020), confirmed in our study by high SMR for patients with femur fractures, acetabulum fractures, and tibial shaft fractures. Hip fractures are among the most studied and common fractures. Proximal femur fractures had the highest mortality rate among all fracture locations; 25% at 1 year with a corresponding SMR of 2.7, which is in accordance with previous studies (Vestergaard et al. 2007b, Gundel et al. 2020). For comparison, distal femur fractures had a 30-day mortality rate of 4.8%, which is similar to the 5% mortality reported by Larsen et al. (2020) and 6.3% by Wolf et al. (2021). The 18% 1-year mortality for distal femur fracture patients in our study was lower than the 25% for proximal femur fractures, with a similar SMR of 2.7.
Epidemiology and mortality of pelvic and femur fractures—a nationwide register study of 417,840 fractures in Sweden across 16 years: diverging trends for potentially lethal fractures
Published in Acta Orthopaedica, 2021
Natalie Lundin, Tuomas T Huttunen, Anders Enocson, Alejandro I Marcano, Li Felländer-Tsai, Hans E Berg
The overall incidence rate remained stable at around 13 per 105 person-years during the study period (Figure 1). The average annual increase in number of fractures was 0.4%. Distal femur fracture incidence increased markedly with age, especially in females (Figure 2). Females aged ≥ 80 years had an almost 5-fold incidence of distal femur fracture compared with males in the same age group (Figure 2d), which corresponds to the largest sex difference among the studied fractures. Distal femur fractures among young individuals were rare, at ≤ 5 fractures per 105 person-years (Table 3).