Journal of Musculoskeletal Trauma

Acute Compartment Syndrome of Thigh: Ten-Year Experiences from a Level I Trauma Center: Hyung Keun Song, Won-Tae Cho, Wan-Sun Choi, Seung-Yeob Sakong, Sumin Im; J Musculoskelet Trauma 2024;37(4):171-174. Published online October 25, 2024; DOI: https://doi.org/10.12671/jmt.2024.37.4.171

Abstract PDF: Purpose
To assess the demographics, injury mechanisms, treatments, and outcomes of traumatic acute compartment syndrome in the thigh.
Materials and Methods
Patients diagnosed with thigh compartment syndrome were analyzed retrospectively at the authors’ level I trauma center from March 2012 to February 2022. Data were collected from medical and radiological records, focusing on demographics, injury details, treatment timelines, and clinical outcomes.
Results
The cohort included 13 patients (11 males and 2 females) with a mean age of 46 years. Injuries primarily resulted from falls (6 patients) and vehicle accidents (5 patients). Fractures were noted in 11 patients, with seven involving the lower extremities and seven having open fractures; three of these were severe enough to be classified as Gustilo–Anderson type IIIc with associated femoral artery injuries. Time from the injury to fasciotomy ranged from within six hours to more than 24 hours. Fasciotomies were mainly single-sided (10 patients), targeting primarily the anterior compartments, and bilateral in three cases. Wound closures were performed using delayed primary closure (four patients) and partial- thickness skin grafts (five patients). Two patients died from multi-organ failure; other complications included infections (three patients), amputations (three patients), and long-term disabilities like drop foot (two patients), sensory deficits, joint stiffness (eight patients), and fracture non-unions requiring additional surgery (two patients).
Conclusion
Thigh-compartment syndrome, though infrequent, poses significant risks of mortality and chronic disability. This underscores the importance of prompt diagnosis and intervention.

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Hip Fractures in the Elderly: Perioperative Management and Prevention of Medical Complications: Keong-Hwan Kim; J Korean Fract Soc 2023;36(1):39-44. Published online January 31, 2023; DOI: https://doi.org/10.12671/jkfs.2023.36.1.39

Abstract PDF: Elderly patients with hip fractures are at an increased risk of developing medical complications with higher mortality rates. Most patients require surgical treatment, and an early surgical intervention can reduce complications and lower mortality risk. A restrictive red blood cell transfusion strategy is usually applied, and the amount of transfusion can be reduced through medications such as tranexamic acid. Delirium can be prevented using non-pharmacological methods. In addition, it is necessary to prevent venous thromboembolism through mechanical or chemical prophylaxis. A multidisciplinary approach using the ERAS (Enhanced Recovery After Surgery) protocol and orthogeriatric care can help to reduce medical complications and mortality.

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Distal Femur Fractures Treated with Distal Femoral Locking Plate Fixation: A Retrospective Study of One Year Mortality and Risk Factors: Kwang-Hwan Jung, Yoon-Seok Youm, Seung-Hyun Jung, Jae-Min Oh, Ki Bong Park; J Korean Fract Soc 2023;36(1):10-16. Published online January 31, 2023; DOI: https://doi.org/10.12671/jkfs.2023.36.1.10

Abstract PDF: Purpose
This study examined the one-year mortality after locking plate fixation for distal femur fractures and the risk factors related to death.
Materials and Methods
From July 2011 to June 2020, 128 patients who underwent locking plate fixation for distal femur fractures were analyzed retrospectively. Epidemiologic information of the patients, characteristics related to fracture and surgery, and death were investigated. The risk factors related to death were investigated using Cox analysis, and a subgroup analysis was also performed based on the age of 65 years.
Results
The one-year mortality rate after locking plate fixation for distal femur fractures was 3.9%, and the mortality rates in patients younger than 65 years and older than 65 years were 0% and 6.7%, respectively. There were no significant risk factors related to death in the total population. On the other hand, in patients aged 65 years or older, however, high-energy fracture and high comorbidity index increased the risk of death after surgery by 6.9-fold and 1.9-fold, respectively.
Conclusion
The one-year mortality rate for the total patients was 3.9%, but the mortality rate for patients over 65 years of age increased to 6.7%. High-energy fractures and high comorbidity index were risk factors related to death after surgery for distal femur fractures in patients aged 65 years or older.

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Mortality-Related Risk Factors in Total Hip Arthroplasty for Femoral Neck Fractures in Elderly Patients: Jae Sung Suh, Hyung Gon Ryu, Young Ju Roh, Dae Won Shin; J Korean Fract Soc 2022;35(2):51-56. Published online April 30, 2022; DOI: https://doi.org/10.12671/jkfs.2022.35.2.51

Abstract PDF: Purpose
Total hip arthroplasty (THA) using dual mobility components (DMC) is a reasonable surgical option for displaced femoral neck fractures in elderly patients, resulting in lower dislocation rates and improved stability. The purpose of this study was to investigate the clinical outcomes and risk factors responsible for mortality in elderly patients who were diagnosed with a displaced femoral neck fracture and had undergone DMC-THA.
Materials and Methods
Out of 147 cases of THA from December 2018 to June 2020, a total of 79 cases were enrolled in this study, with the following characteristics: (1) Garden stage III or IV, (2) over 75 years of age, and (3) over 1 year of follow-up. All the patients received DMC-THA surgery using the anterolateral approach.
Results
The mean follow-up period was 15.0±8.43 months and a total of one dislocation case was observed. The mortality rate was 17.7% (14/79), and it was especially higher in patients with a past medical history of malignancy (odds ratio [OR]=7.18, p=0.03) or a cognitive disorder such as dementia (OR=5.48, p=0.03). Preoperative low initial hemoglobin levels (OR=0.65, p=0.04) and low UCLA (Uni-versity of California at Los Angeles) score (OR=0.47, p=0.02) were also associated with mortality.
Conclusion
When considering THA as a treatment approach in elderly patients with a displaced femoral neck fracture, a high mortality rate is expected in patients with low preoperative hemoglobin levels or a history of malignancy or cognitive disorders. Hence, thorough monitoring and management should be undertaken before and after surgery.

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Morbidity and Mortality of the Elderly after Early Operation for Trochanteric Fractures: Se Ang Jang, Young Ho Cho, Young Soo Byun, Ki Hong Park, Hyun Seong Yoo, Chul Jung; J Korean Fract Soc 2013;26(3):199-204. Published online July 31, 2013; DOI: https://doi.org/10.12671/jkfs.2013.26.3.199

Abstract PDF

PURPOSE
To find out the effect of early closed reduction and internal fixation (within 24 hours after admission to hospital) on the morbidity and mortality in the elderly with intertrochanteric fractures of the femur.
MATERIALS AND METHODS
Retrospectively, we analyzed 99 patients with intertrochanteric fracture of the femur who underwent surgery from January, 2009 to December, 2010. We reviewed 89 of the 99 patients and checked for early complications and reviewed the mortality rates 3 months, 6 months and 1 year after surgery. There were 24 males and 65 females. The average age was 79.8 years (61-99 years). According to the American Society of Anesthesiologists classification, 25 patients were class 1, 37 patients were class 2, 26 patients were class 3, and 1 patient was class 4. All patients were operated on by one surgeon, who was skilled in inserting intramedullary nail.
RESULTS
The average surgical time was 43 minutes and the average intraoperative blood loss was 165 ml. Sixteen patients experienced delirium but all of them recovered. One patient had pneumonia at one month after surgery. Pressure sores developed in one patient but improved with conservative treatment. Pulmonary thromboembolism developed in some patients one month after surgery. Three patients (3.4%) died within three months and one patient (1.1%) died between three and six months after surgery, but no patient died between six months and one year after surgery.
CONCLUSION
If patients are optimized for the operation, early internal fixation of trochanteric fracture in elderly patients after arrival at the hospital should be considered to reduce early complications and mortality.

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PREOPERATIVE NUTRITIONAL STATUS OF HIP FRACTURE PATIENTS: A PILOT STUDY IN 116 PATIENTS
Myung-Sang Moon, Min-Suk Park, Bong-Keun Park, Dong-Hyeon Kim, Min-Geun Yoon
Journal of Musculoskeletal Research.2017; 20(01): 1750002. CrossRef

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Postoperative Mortality Rate of Hip Fracture in Elderly Patients: Duk Hwan Kho, Ki Hwan Kim, Ju Yong Shin, Jun Hyuck Lee, Dong Heon Kim; J Korean Fract Soc 2006;19(2):117-121. Published online April 30, 2006; DOI: https://doi.org/10.12671/jkfs.2006.19.2.117

Abstract

PURPOSE
To evaluate the rate of mortality for the elderly patients after treatment of hip fractures and analyze the associated risk factors which might affect their mortality rate.
MATERIALS AND METHODS
About the clinical records on 305 patients who had undergone the treatment in hip fractures, we evaluated the mortality rate of the total number of 248 patients whose age between 70 and 103 who were followed more than 12 months of period between March 1994 and March 2003. The mean age was 81.3 years. The composition of each female and male were 176 and 72 cases respectively. 99 cases were femoral neck fractures, and 149 cases were femoral intertrochanteric fractures. The operation included bipolar hemiarthroplasty and internal fixation using multiple cannulated screws, compression hip screws and Ender nails. We compared and analyzed the relating factors for the mortality rate.
RESULTS
The mean postoperative mortality rate was 14.1% (35 cases). The highest mortality rate showed for the postoperative 3 months which was 57.1% (20 cases), between 4 and 6 months was 25.7% (9 cases), and 17.1% (6 cases) were presented for 7 and 12 months. The postoperative mortality rate within 1 year was affected by underlying diseases, ASA (American society of Anesthesiologists) and cemented bipolar hemiarthroplasty. but, there were no significant difference of the other factors such as the age, gender, osteoporosis and delayed operation.
CONCLUSION
The variable factors which affect the mortality rate of the hip fractures in the elderly patients whose age over 70 were mostly determined by underlying diseases, ASA grade, and cemented bipolar hemiarthroplasty. Further study should be necessary for the factors influencing on the mortality rate.

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Finite element modeling and simulation of hip joints in elderly women: for development of protective clothing against fracture
Jinhee Park, Yun Ja Nam
International Journal of Clothing Science and Technology.2020; 32(5): 661. CrossRef
Anesthetic considerations for surgical treatment of geriatric hip fracture
Dong Kyu Lee, Seunguk Bang, Sangseok Lee
Anesthesia and Pain Medicine.2019; 14(1): 8. CrossRef
The Influence of Stroke on Postoperative Prognosis of Femoral Intertrochanteric Fractures
Youn Soo Hwang, Kyu Pill Moon, Kyung Taek Kim, Won Seok Park, Joon Yeon Song, Jeong Hoon Chae
Journal of the Korean Orthopaedic Association.2016; 51(4): 273. CrossRef
Analysis of the Risk Factors and Clinical Outcomes of Femoral Intertrochanteric Fractures in Patients over 65 Years Old
Chul Hong Kim, Kyu Yeol Lee, Sung Soo Kim, Myung Jin Lee, Lih Wang, Hyeon Jun Kim, Jung Mo Kang
Hip & Pelvis.2013; 25(2): 127. CrossRef
Postoperative Mortality and the Associated Factors in Elderly Patients with Hip Fracture
You-Sung Suh, Yong-Beom Kim, Hyung-Suk Choi, Hong-Kee Yoon, Gi-Won Seo, Byung-Ill Lee
Journal of the Korean Orthopaedic Association.2012; 47(6): 445. CrossRef
Risk Factors for Cardiovascular Complications Following Hip Surgery
Kuen Tak Suh, Seung Joon Rhee, Jung Sub Lee, Jeung Il Kim
Hip & Pelvis.2012; 24(2): 71. CrossRef
Current Recommendations for Laboratory Testing and Use of Bone Turnover Markers in Management of Osteoporosis
Jehoon Lee, Samuel Vasikaran
Annals of Laboratory Medicine.2012; 32(2): 105. CrossRef
The Daily Life Functions of Elderly Peritrochanteric Fracture Patients after Surgical Treatment
Dae Moo Shim, Tae Kyun Kim, Jong Yun Kim, Duk Hwa Choi, Joung Suk Lee, Seong In Lee
Journal of the Korean Fracture Society.2012; 25(1): 8. CrossRef
One-Year Mortality Rate of Patients over 65 Years Old with a Hip Fracture
Phil Hyun Chung, Suk Kang, Jong Pil Kim, Young Sung Kim, Ho Min Lee, Young Hwa Choi
Hip & Pelvis.2011; 23(2): 137. CrossRef
Usefulness of the Cementless Stem for the Treatment of Hip Fracture in Elderly Patients with Osteoporosis - Comparative Analysis between Cementless Stem and Cemented Stem -
Joon Soon Kang, Kyoung Ho Moon, Rhu Seop Kim, Sang Ho Lee, Jong Min Choi
Journal of the Korean Fracture Society.2011; 24(1): 16. CrossRef
Bipolar Hemiarthroplasty for Hip Fractures in Patients Aged over 90 Years - The Factors Influencing the Postoperative Mortality -
Jun-Dong Chang, Je-Hyun Yoo, Sang-Soo Lee, Tae-Young Kim, Kyu-Hak Jung, Yong-Kuk Kim
Hip & Pelvis.2010; 22(4): 283. CrossRef
Determination of an Applicable FRAX Model in Korean Women
Dong-Yun Lee, Seung-Jae Lim, Young-Wan Moon, Yong-Ki Min, DooSeok Choi, Byung-Koo Yoon, Youn-Soo Park
Journal of Korean Medical Science.2010; 25(11): 1657. CrossRef
Postoperative Mortality and the Associated Factors for Senile Hip Fracture Patients
Dong-Soo Kim, Hyun-Chul Shon, Yong-Min Kim, Eui-Sung Choi, Kyoung-Jin Park, Se-Hyuk Im
The Journal of the Korean Orthopaedic Association.2008; 43(4): 488. CrossRef

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Morbidity and Mortality of Bilateral Hip Fractures in Elderly Patients: Suk Ku Han, Nam Yong Choi, Seong Jin Park, Seong Keun Lee, Chan Woong Moon; J Korean Soc Fract 2000;13(4):788-794. Published online October 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.4.788

Abstract PDF

PURPOSE
The purpose of this study was to estimate the morbidity and mortality rate of bilateral hip fractures in elderly patients compared to that in unilateral hip fractures and to evaluate it's related risk factors.
MATERIALS AND METHODS
Twenty-two cases of bilateral hip fractures in patients who were older than 70 years with at least two year follow-up were included in our study. We analysed the risk factors of bilateral hip fractures by comparing with age, sex and diagnosis matched 22 cases of ipsilateral hip fractures including onset of secondary fracture, injury mechanism and the rate of morbidity and mortality, respectively.
RESULTS
The onset of secondary fracture and death were mostly within 1 year after operation for the first hip fracture. Comorbidity of cardiovascular, neurologic, urologic or history of previous fracture and decreased ambulation ability were related with the occurrence of bilateral hip fractures. The rate of morbidity and mortality of bilateral hip fractures were about two- fold than that of ipsilateral hip fractures. High mortality rate was noted in patients who had operation delay from injury. But no significant relationship between nutrition, body weight or bone mineral density and the development of secondary hip fractures.
CONCLUSION
To prevent the occurence of bilateral hip fractures which had more serious results than that of ipsilateral hip fractures, more aggressive rehabilitation to improve walking ability and appropriate environmental circumstances to avoid falls were important, especially in older patients.

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Assessment of the Clinical Features of Bilateral Sequential Hip Fractures in the Elderly
Duk-Hwan Kho, Ju-Yong Shin, Hyeung-June Kim, Dong-Heon Kim
The Journal of the Korean Orthopaedic Association.2009; 44(3): 369. CrossRef

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Comparison between results of treatment of the Femoral Neck and Intertrochanteric Fractures : Focused on Mortality rate and Complications: Chung Soo Hwang, Phil Hyun Chung, Suk Kang, Tae Hoon Kim, Han Chul Kim, Yong Soon Kim; J Korean Soc Fract 1999;12(4):792-802. Published online October 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.4.792

Abstract PDF

The incidence of femoral neck and intertrochanteric fractures has steadily increased with lengthening of the life span. It is well known that anatomical characteristics of femoral neck may evoke complications such as nonunion and avascular necrosis. And there are many problems in the treatment of femoral intertrochanteric fractures due to osteoporosis, unstable pattern of fracture and poor general condition in elderly patients. The author analyzed 56 cases(56 patients) of femoral neck fractures and 63 cases(61 patients) of femoral intertrochanteric fractures which we have been able to follow up more than 1 year from March 1991 to March 1997. The purpose of this study is 1) to analyze results of treatment, predisposing factors, complications and mortality rates, and so 2) to reduce the mortality rate and complication in these fractures. The results were as follows , 1. The difference in union time between both type of fractures was not significant. 2. The mortality rate during admission was 1.8% in femoral neck fractures and 6.3% in intertrochanteric fractures. 3. The mortality rate during 1 years was 3.6% in femoral neck fractures and 9.5% in femoral intertrochanteric fractures. 4. The predisposing factors associated with postoperative mortality rate were malnutrition. chronic obstructive pulmonary disease, previous contralateral hip fracture, and operation within 3 days.

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Anesthetic considerations for surgical treatment of geriatric hip fracture
Dong Kyu Lee, Seunguk Bang, Sangseok Lee
Anesthesia and Pain Medicine.2019; 14(1): 8. CrossRef
A Comparison of Clinical Results between Compression Hip Screw and Proximal Femoral Nail as the Treatment of AO/OTA 31-A2.2 Intertrochanteric Femoral Fractures
Phil Hyun Chung, Suk Kang, Jong Pil Kim, Young Sung Kim, Ho Min Lee, In Hwa Back, Kyeong Soo Eom
Journal of the Korean Orthopaedic Association.2016; 51(6): 493. CrossRef
Postoperative Mortality and the Associated Factors in Elderly Patients with Hip Fracture
You-Sung Suh, Yong-Beom Kim, Hyung-Suk Choi, Hong-Kee Yoon, Gi-Won Seo, Byung-Ill Lee
Journal of the Korean Orthopaedic Association.2012; 47(6): 445. CrossRef
One-Year Mortality Rate of Patients over 65 Years Old with a Hip Fracture
Phil Hyun Chung, Suk Kang, Jong Pil Kim, Young Sung Kim, Ho Min Lee, Young Hwa Choi
Hip & Pelvis.2011; 23(2): 137. CrossRef

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Ambulatory Ability & Mortality Study after Intertrochanteric Fractures of the Femur in Geriatric Patients: Bong Gee Park, Beom Koo Lee, Do Hyun Moon, Jin Hong Ko, Young Gue Go; J Korean Soc Fract 1997;10(4):755-760. Published online October 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.4.755

Abstract PDF: Intertrochanteric fractures are common in older age group. But still many patients suffer from high morbidity and mortality and decreased ambulation levels, because of accompanying general weak- ness and various senile diseases. From January 1991 to February 1995, we treated 46 patients older than 65 years with intertrochanteric fractures of femur. A retrospective study was performed to determine which Pre- and postinjury factors were predictive of mortality and ambulatory capacity 1 year after operation. Potential causative factors included age, gender, prefracture ambulatory ability, postoperative ambulatory ability, associated medical problem, fracture type, degree of osteoporosis, American. Society of Anesthesiologists rating of operative risk, interval between injury and operatiorl. This retrospective study were analyEed with following results ; 1. Mortality was releated to prefracture ambulatory ability, postoperative ambulatory ability, ASA risk, interval between injury and operation, which were statistically significant. 2. Eighteen(39%) patients maintained their prerfacture ambulatory ability at a poslinjury 1 year ; Twenty-eight(61%) patients lost some degree of ambulatory ability.

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Mortality Rate in Older Patients Who Have a Hip Fracture: Joo Chul Ihn, Poog Taek Kim, Il Hyung Park, Shin Yoon Kim, Chang Wug Oh, Jae Hyung Kim; J Korean Soc Fract 1997;10(1):1-7. Published online January 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.1.1

Abstract PDF

The significant risk to life associated with the hip fracture has long been recognized, and the reports of poor prognosis are well known with wide range of mortality rates. We retrospectively studied 164 patients(older than 60 years) who had a hip fracture to determine the effects of the age, treatment methods, pre-existing medical condition, operative delay after injury, type of fracture, and others on patient mortality. The summarized results were as follows ; 1. One hundred twenty three patients survived and forty one patients died(overall mortality rate; 25.0%). 2. Twenty one patients died within one year(one-year mortality rate, 12.8%). 3. Mortality was related to age of patient at injury, ASA classification, absense or presence of operative treatment, operation-related complication, which were statistically ignificant (P<0.05). 4. The operative delay after injury did not influence mortality, but we think that it is not signifcant because this study was done retrospectively.

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Analysis of the Risk Factors and Clinical Outcomes of Femoral Intertrochanteric Fractures in Patients over 65 Years Old
Chul Hong Kim, Kyu Yeol Lee, Sung Soo Kim, Myung Jin Lee, Lih Wang, Hyeon Jun Kim, Jung Mo Kang
Hip & Pelvis.2013; 25(2): 127. CrossRef
The Analysis of Postoperative Mortality after Bipolar Hemiarthroplasty for Hip Fractures in the Elderly
Dukhwan Kho, Kyoungmo Nam, Sunghak Oh, Hyeungjune Kim
Hip & Pelvis.2013; 25(4): 267. CrossRef
Postoperative Mortality and the Associated Factors in Elderly Patients with Hip Fracture
You-Sung Suh, Yong-Beom Kim, Hyung-Suk Choi, Hong-Kee Yoon, Gi-Won Seo, Byung-Ill Lee
Journal of the Korean Orthopaedic Association.2012; 47(6): 445. CrossRef
One-Year Mortality Rate of Patients over 65 Years Old with a Hip Fracture
Phil Hyun Chung, Suk Kang, Jong Pil Kim, Young Sung Kim, Ho Min Lee, Young Hwa Choi
Hip & Pelvis.2011; 23(2): 137. CrossRef
Postoperative Mortality and the Associated Factors for Senile Hip Fracture Patients
Dong-Soo Kim, Hyun-Chul Shon, Yong-Min Kim, Eui-Sung Choi, Kyoung-Jin Park, Se-Hyuk Im
The Journal of the Korean Orthopaedic Association.2008; 43(4): 488. CrossRef

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