Search

Objectives: The orientation of the quadriceps femoris can be represented by the quadriceps angle (Q‐angle) has not yet been approved because of the high incidence of patellar instability. In this study, the correlations among components of the quadriceps femoris and the Q‐angle using the plain radiographic technique were assessed. This retrospective study aims to use the radiographic technique to clarify these doubts from anatomic viewpoints. Methods: One hundred consecutive young adult patients (50 men and 50 women; aged, 34 ± 5 and 33 ± 6 years, respectively) who sustained chronic unilateral lower extremity injuries (unilateral femoral, tibial nonunions or malunions) were enrolled. The contralateral intact lower extremity was used for the study. The full‐length standing scanogram (FLSS) was used to evaluate the rectus Q‐angle (R‐Q angle), vastus Q‐angle (V‐Q angle), and clinical Q‐angle (C‐Q angle; i.e., known as the Q‐angle). The three Q‐angles were compared statistically. The Mann–Whitney U test and the Kruskal–Wallis test were used for comparison among groups. The Spearman rank correlation coefficient was used to evaluate the degree of relationship between two groups. Results: The C‐Q angle or the V‐Q angle was statistically different from the R‐Q angle (p < 0.001). The C‐Q angle between sexes was not different (p = 0.25). High correlation occurred among the C‐Q angle, the R‐Q angle, and the V‐Q angles (correlation coefficient, 0.886–0.979). The multiple linear regression revealed of C‐Q angle = 0.72; R‐Q angle, p < 0.001 + 0.21; and V‐Q angle, (p = 0.009) + 2.61° in 100 patients. Conclusion: Orientation of the quadriceps femoris can be represented by the Q‐angle. Compared to the rectus femoris, the three vastus muscles of the quadriceps femoris are more correlated to the Q‐angle. [ABSTRACT FROM AUTHOR]

Objective: This study examined trajectories of social support and their relationships with health outcomes over 2 years post hip-fracture surgery for older adults with diabetes mellitus (DM).Methods: This was a secondary analysis of data derived from a clinical trial, which included 158 hip fractured older adults with DM who had completed the Medical Outcomes Study Social Support Survey at 1-, 12-, 18-, and 24-months following hospital discharge. Health outcomes for self-care, physical and nutritional status, mental health, and depression were assessed at 3-month intervals up to 24-months after hospital discharge. Trajectories of social support were derived with latent class analysis while hierarchical linear models were employed to assess the associations of social-support trajectory with health outcomes.Results: Four social-support trajectories were derived for persons with DM following hip-fracture surgery: poor and declining (n = 18, 11.4%), moderate and stable (n = 29, 18.4%), high but declining (n = 34, 21.5%), and high and stable (n = 77, 48.7%). Relative to those in the poor and declining group, participants in the high and stable trajectory group performed better in Activities of Daily Living and quadriceps muscle power, had better mental Health-Related Quality of Life and nutritional status, and had fewer depressive symptoms. These differences persisted over the 2 years following hospital discharge.Conclusions: These results suggest social support for persons with DM should be continually assessed following hip-fracture surgery. [ABSTRACT FROM AUTHOR]

Objective: With or without screw stabilization for diastatic syndesmosis in advanced pronation‐external rotation (PE) ankle injuries has not yet been well‐determined. Both techniques were retrospectively compared to investigate the superiority of either of the two. Methods: A retrospective cohort study was carried out. From January 1, 2008, to December 31, 2017, 81 consecutive adult patients (average, 42 years; range, 18–78 years; 44 men and 37 women) with advanced PE ankle injuries (stage 3 or 4 PE type) were treated. After malleolar fractures were internally stabilized with screws and plates, the syndesmotic stability was rechecked by external rotation and hook tests. The necessity of cortical screw insertion to stabilize diastatic syndesmosis was decided by the individual orthopaedic surgeon. Postoperatively, a short leg splint was used for 6 weeks. The syndesmotic screw was removed based on the surgeon's policy. The removal of internal fixation for malleolar fractures was required after 1 year. The outcomes of both approaches were compared clinically, and ankle function was compared using the American Orthopaedic Foot and Ankle Society (AOFAS) score. For statistical comparison, the chi‐square test was used for categorical data and the Mann–Whitney U test was used for numerical data. Results: Seventy‐one patients (average, 40 years; range, 18–78 years; 40 men and 31 women) were followed for at least 1 year (87.7%; average, 2 years; range, 1–11 years). Group 1 (with syndesmotic stabilization) had 22 patients and Group 2 (without syndesmotic stabilization), 49 patients. The union rate in Group 1 patients was 100% (22/22), and in Group 2 patients, 91.8% (45/49; p = 0.17). One deep wound infection occurred in Group 1 patients and two in Group 2 patients. Syndesmosis re‐diastasis occurred in 13.6% (3/22) of Group 1 patients and 30.6% (15/49) of Group 2 patients (p = 0.13). One syndesmotic screw broke at 6 months. Satisfactory ankle function according to the AOFAS score was noted in 86.4% (19/22) of Group 1 patients and 65.3% (32/49) of Group 2 patients (p = 0.07). Conclusion: Insertion of syndesmotic screws to promote ligament healing after internal fixation of malleolar fractures in advanced PE ankle injuries may be reasonable. [ABSTRACT FROM AUTHOR]

Objectives: Subjective memory complaints (SMCs) in the elderly are associated with poor recovery in performing activities of daily living. This study was designed to examine SMCs and their association with recovery and health outcomes of older persons within 1 year following hospital discharge after hip-fracture surgery.Methods: Data were collected between 2012 and 2015 from 194 hip-fractured elders in northern Taiwan. SMCs were assessed by the Prospective and Retrospective Memory Questionnaire. Recovery outcomes included self-care ability (activities of daily living [ADLs] and instrumental activities of daily living [IADLs]), physical function (range of motion and maximal muscle strength), cognitive function, delirium, depressive symptoms, and health-related quality of life (HRQoL). Outcomes were assessed before discharge and 1, 3, 6, and 12 months afterwards. Associations of SMCs with participants' recovery outcomes were examined by the generalized estimating equation approach.Results: Participants with SMCs had significantly poorer recovery outcomes than those without SMCs. Additionally, the interaction term for time-by-SMC was significant on ADLs, IADLs, maximal strength of quadriceps muscles, maximal strength of hip abductor muscles, ankle dorsiflexion, and HRQoL, suggesting that negative associations with SMCs increased over time. Participants with SMCs were at significantly higher risk for cognitive impairment and delirium than those without SMCs.Conclusions: Participants with SMCs not only had worse recovery than those without SMCs, but their rate of recovery was also slower during the first year following hip-fracture surgery. Therefore, SMCs need to be assessed to identify patients at high risk for worse recovery outcomes following hip fracture. [ABSTRACT FROM AUTHOR]

Objectives: A retrospective study was conducted using magnetic resonance image (MRI) and a full‐length standing scanogram (FLSS) to measure the quadriceps angle (Q‐angle) while avoiding soft tissue interference. Methods: Two steps were retrospectively carried out in two case series. The first step involved using MRI to define the standardized patellar center (PC) and the tibial tubercle (TT) on the frontal plane of the MRI in one group of 60 consecutive patients (from July 2016 to December 2016, 29 men and 31 women, average of 46 years). The next step was transferring the location of the standardized PC and the TT from the MRI to the FLSS in another group of 100 consecutive patients (from April 2009 to March 2014, 50 men and 50 women, average of 36 years). The pelvis and intact femur, knee, and tibia were used to determine the Q‐angle on the FLSS. Results: The standardized PC was positioned 42% from the lateral end of femur trans‐epicondylar line. The TT was 2 cm distal to the tibial articular surface and 37% from the lateral end of tibial width. The average Q‐angle was 9.5° in 100 patients (8.8° in 50 men and 10.1° in 50 women, P = 0.02). The average femoral length was 42.9 cm in 100 patients (44.7 cm in 50 men and 41.1 cm in 50 women, P < 0.001). Women and men had similar pelvic width (27.9 vs 27.8 cm, P = 0.89). Conclusion: Using the FLSS may help to accurately determine the Q‐angle. Men and women have similar pelvic width. A larger Q‐angle in women may be mainly due to the shorter femur. [ABSTRACT FROM AUTHOR]

Purpose: This study was undertaken to develop a theoretical framework explaining family caregiving processes for older persons with cognitive impairment recovering from hip fracture surgery. Design and Methods: In this grounded theory study, data were collected in audio‐recorded face‐to‐face interviews with 21 family caregivers. Among these caregivers, 14 cared for hip‐fractured persons with cognitive impairment, and seven cared for those without cognitive impairment. Caregivers were interviewed five times after patients' discharge: at 1 week and at 1, 3, 6, and 12 months. Data were analyzed by constant comparative analysis. Findings: The core category explaining the family caregiving process for hip‐fractured persons with cognitive impairment was "resuming normal life during drip‐like recovery." This category captures the slowness of the recovery process, as slow as dripping water. During the early postoperative period, caregivers attempted to gain control of the postoperative situation, using various maintenance and improvement strategies to deal with the chaos in individuals and the family and to protect hip‐fractured persons with cognitive impairment from further harm. The goal of recovery was to get back to their original life. Conclusions: Family caregivers of hip‐fractured older persons with cognitive impairment needed to deal with more complex chaotic situations, exerted more efforts to administer safety measures, and required more time to achieve a stable life pattern. Clinical Relevance: Since postoperative recovery was perceived as extremely slow, family caregivers of hip‐fractured older persons with cognitive impairment should be patient regarding recovery and be informed before hospital discharge of different strategies to resume normal life during postoperative recovery. [ABSTRACT FROM AUTHOR]

Objectives Few studies describe the trajectories of cognitive function for hip-fracture patients following hospital discharge and the treatment effects of interdisciplinary intervention on cognitive outcomes. The purpose of this study was to explore the 2-year postoperative trajectory for cognitive function of older hip-fracture patients and cognitive effects of an interdisciplinary intervention. Methods Of 160 subjects randomly assigned to groups, 29 (35.8%) in the control group ( n = 81) and 30 (38.0%) in the intervention group ( n = 79) were cognitively impaired at admission. The intervention group received geriatric consultation, continuous rehabilitation, and discharge planning. Subjects' cognitive function was measured using the mini mental state examination Taiwan version at admission, 6, 12, 18, and 24 months after discharge and analyzed using hierarchical generalized linear models. Results Patients who received the intervention program had 75% less likelihood of being cognitively impaired 6 months following discharge than those who received routine care (odds ratio = 0.25, p < 0.001). The difference between the control and intervention groups was small at admission, peaked at 18 months, and decreased from 18 to 24 months following discharge. Conclusions Our interdisciplinary intervention improved the long-term postoperative cognitive functioning of older persons with hip fracture in Taiwan. Copyright © 2013 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Objective This article aims to evaluate the long-term effects of an interdisciplinary intervention program on cognitively impaired older persons after hip fracture in Taiwan. Methods Of 160 subjects randomly assigned to control ( n = 81) and intervention ( n = 79) groups, 24 (29.6%) and 27 (34.2%) were cognitively impaired in the control and intervention groups, respectively, and outcomes were followed for 2 years after discharge. Results Among cognitively impaired subjects, more in the intervention group recovered their previous walking ability (odds ratio [ OR] = 3.49; confidence interval [ CI] = 1.64 to 7.42), activities of daily life performance ( β = 18.59; p = 0.0002), and more were readmitted to the hospital ( OR = 4.44, CI = 1.53 to 12.89) than those in the control group during the first 2 years following discharge. Among subjects without cognitive impairment, more in the intervention group recovered their previous walking ability ( OR = 2.6; CI = 1.33 to 5.07), had fewer falls ( OR = 0.47; CI = 0.25 to 0.86), and made fewer emergency room visits ( OR = 0.33; CI = 0.11 to 0.97) during the first 2 years following discharge than those in the control group. Conclusions Cognitively impaired individuals benefited from our interdisciplinary intervention by improving their walking ability and physical function during the first 2 years following discharge. Specific strategies on fall prevention following hip fracture need to be further developed for cognitively impaired individuals. Copyright © 2011 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To explore the 2-year outcomes of an interdisciplinary intervention for elderly patients with hip fracture. DESIGN: Randomized experimental design. SETTING: A 3,000-bed medical center in northern Taiwan. PARTICIPANTS: Patients with hip fracture (N=162): 80 in the intervention group and 82 in the usual care control group. INTERVENTION: An interdisciplinary program of geriatric consultation, continuous rehabilitation, and discharge planning. MEASUREMENTS: Outcomes (clinical outcomes, self-care ability, health-related quality of life (HRQoL), service utilization, and depressive symptoms) were assessed 1, 3, 6, 12, 18, and 24 months after discharge. Self-care ability (ability to perform activities of daily living (ADLs)) was measured using the Chinese Barthel Index. HRQoL was measured using the Medical Outcomes Study 36-item Short Form Survey, Taiwan version (SF-36). Depressive symptoms were measured using the Chinese Geriatric Depression Scale, short form. RESULTS: Subjects in the intervention group had significantly better ratios of hip flexion ( β=5.43, P<.001), better performance on ADLs ( β=9.22, P<.001), better recovery of walking ability (odds ratio (OR)=2.23, P<.001), fewer falls (OR=0.56, P=.03), fewer depressive symptoms ( β=−1.31, P=.005), and better SF-36 physical summary scores ( β=6.08, P<.001) than the control group during the first 24 months after discharge. The intervention did not affect the peak force of the fractured limb's quadriceps, mortality, service utilization, or SF-36 mental summary score. CONCLUSION: The interdisciplinary intervention for hip fracture benefited elderly persons with hip fracture by improving clinical outcomes, self-care ability, and physical health–related outcomes and by decreasing depressive symptoms during the first 24 months after hospital discharge. [ABSTRACT FROM AUTHOR]

To evaluate an interdisciplinary intervention program for older people with hip fracture in Taiwan.Randomized experimental design.A 3,800-bed medical center in northern Taiwan.Elderly patients with hip fracture (N=137) were randomly assigned to an experimental (n=68) or control (n=69) group.An interdisciplinary program of geriatric consultation, continuous rehabilitation, and discharge planning.Demographic and outcome variables were measured. Outcome variables included service utilization, clinical outcomes, self-care abilities, health-related quality-of-life (HRQOL) outcomes, and depressive symptoms.Subjects in the experimental group improved significantly more than those in the control group in the following outcomes: ratio of hip flexion 1 month after discharge (P=.02), recovery of previous walking ability at 1 month (P=.04) and 3 months (P=.001) after discharge, and activities of daily living at 1 month (P=.01) and 2 months (P=.001) after discharge. Three months after discharge, the experimental group showed significant improvement in peak force of the fractured limb's quadriceps (P=.04) and the following health outcomes: bodily pain (P=.03), vitality (P<.001), mental health (P=.02), physical function (P<.001), and role physical (P=.006). They also had fewer depressive symptoms (P=.008) 3 months after discharge.This intervention program may benefit older people with hip fractures in Taiwan by improving their clinical outcomes, self-care abilities, and HRQOL and by decreasing depressive symptoms within 3 months after discharge. [ABSTRACT FROM AUTHOR]

Objective: To investigate the roles of MAPKs and NF-kappaB in tumor necrosis factor alpha (TNFalpha)-induced expression of vascular cell adhesion molecule 1 (VCAM-1) in human rheumatoid arthritis synovial fibroblasts (RASFs)., Methods: Human RASFs were isolated from synovial tissue obtained from patients with RA who underwent knee or hip surgery. The involvement of MAPKs and NF-kappaB in TNFalpha-induced VCAM-1 expression was investigated using pharmacologic inhibitors and transfection with short hairpin RNA (shRNA) and measured using Western blot, reverse transcriptase-polymerase chain reaction, and gene promoter assay. NF-kappaB translocation was determined by Western blot and immunofluorescence staining. The functional activity of VCAM-1 was evaluated by lymphocyte adhesion assay., Results: TNFalpha-induced VCAM-1 expression, phosphorylation of p42/p44 MAPK, p38 MAPK, and JNK, and translocation of NF-kappaB were attenuated by the inhibitors of MEK-1/2 (U0126), p38 (SB202190), JNK (SP600125), and NF-kappaB (helenalin) or by transfection with their respective shRNA. TNFalpha-stimulated translocation of NF-kappaB into the nucleus and NF-kappaB promoter activity were blocked by Bay11-7082, but not by U0126, SB202190, or SP600125. VCAM-1 promoter activity was enhanced by TNFalpha in RASFs transfected with VCAM-1-Luc, and this promoter activity was inhibited by Bay11-7082, U0126, SB202190, and SP600125. Moreover, up-regulation of VCAM-1 increased the adhesion of lymphocytes to the RASF monolayer, and this adhesion was attenuated by pretreatment with helenalin, U0126, SP600125, or SB202190 prior to exposure to TNFalpha or by anti-VCAM-1 antibody before the addition of lymphocytes., Conclusion: In RASFs, TNFalpha-induced VCAM-1 expression is mediated through activation of the p42/p44 MAPK, p38 MAPK, JNK, and NF-kappaB pathways. These results provide new insights into the mechanisms underlying cytokine-initiated joint inflammation in RA and may inspire new targeted therapeutic approaches.