Session 1: Trauma
15. November
09:00 - 10:30
Lokale: Lokale 01+02
Chair: Bjarke Viberg and Christina F Frandsen
1. Intensified in-hospital physiotherapy for patients after hip fracture surgery – a randomized feasibility trial
Camilla Kampp Zilmer1, S. Peter Magnusson1,2,3, Inger Birgitte Bährentz1, Thomas Giver Jensen4, Signe Østergaard Zoffmann1, Henrik Palm4, Morten Tange Kristensen1,5, Theresa Bieler1
1 Department of Physical and Occupational Therapy, Copenhagen University
Hospital Bispebjerg and Frederiksberg, Copenhagen, Denmark.
2 Institute of Sports Medicine, Department of Orthopaedic Surgery M,
Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen,
Denmark.
3 Center for Healthy Aging, Faculty of Health and Medical Sciences, University of
Copenhagen, Copenhagen, Denmark.
4 Department of Orthopedic Surgery, Copenhagen University Hospital Bispebjerg
and Frederiksberg, Copenhagen, Denmark.
5 Department of Clinical Medicine, University of Copenhagen, Copenhagen,
Denmark.
Background: Intensified acute in-hospital physiotherapy for
patients with hip fracture may enhance
patient’s ability to regain basic mobility at
discharge, but frail patients may not be able to
complete such intensified physiotherapy.
Aim: The primary aim was to investigate the
feasibility of intensified physiotherapy and
secondarily to assess the effect of intensified
physiotherapy on regained basic mobility at
discharge in patients with hip fracture in a
single-center, pragmatic, randomized,
unblinded feasibility trial.
Materials and Methods: Sixty home-dwelling patients (41 women/19
men, mean age 79 years) with hip fracture
and an inde-pendent pre-fracture basic
mobility level were randomized (2:1) to
intensified physiotherapy with two daily
sessions on weekdays focused on training of
basic mobility and weight-bearing activities
(n=40) versus usual care physiotherapy once
daily (n=20). Outcomes were physiotherapy
completion rates during hospitalization
(successful, partial, cancellation), causes of
non-successful completed physiotherapy
and recovery of basic mobility evaluated with
the Cumulated Ambulation Score (CAS).
Results: In the intensified physiotherapy group 82% of
the sessions were successfully- or partially
completed versus 94% in the usual care group.
The main reason for not completing
physiotherapy was fatigue. At discharge
(median of 7 days post-surgery) significantly
(p=0.02) more patients in the intensified
physiotherapy group (50%) had regained their
pre-fracture basic mobility level (CAS=6) than
in the usaul care group (16%).
Interpretation / Conclusion: Intensified acute in-hospital physiotherapy
seems feasible for patients after hip fracture
surgery, and it may enhance recovery.
Intensified in-hospital physiotherapy is mainly
restricted by fatigue. The sizeable proportion of
patients that regained basic mobility at
discharge should be further evaluated in a
future full-scale randomized controlled trial.
2. Extent of informal caregiving to older persons after hip fracture: a prospective cohort study
Jonas Ammundsen Ipsen 1,2, Viberg Bjarke4,5,6, Draborg Eva3, Hansen Bruun Inge1,2
1. Department of Physical Therapy and Occupational Therapy, Lillebaelt Hospital,
University Hospital of Southern Denmark, Kolding
2. Department of Regional Health Research, University of Southern Denmark,
Odense
3. Danish Centre for Health Economics, Department of Public Health, University
of Southern Denmark, Odense
4. Department of Orthopaedic Surgery and Traumatology. Lillebaelt Hospital,
University Hospital of Southern Denmark, Kolding
5. Department of Orthopaedic Surgery and Traumatology. Odense University
Hospital, Odense
6. Department of Clinical Research, University of Southern Denmark, Odense
Background: Patients has a need for help upon discharge
to home after hip fracture. To meet the need,
patients receive formal care from
municipalities and/or informal care (IC) from
family/friends. IC can help patients with tasks
as collecting medication, buying groceries
and showering. Tasks that otherwise would
require assistance by formal caregivers.
Thus, informal care can cloak an otherwise
unmet need for care after hip fracture.
Nevertheless, knowledge on informal
caregiving are very scarce and current
estimates does not fit older home-dwelling
persons.
Aim: To explore the extent of informal caregiving to
older home-dwelling persons after hip fracture.
Materials and Methods: This prospective study is part of the
‘Rehabilitation for Life’ trial and encompasses
a regional hospital and the municipalities of
the catchment area. Inclusion criteria was
65+ home-dwelling persons cognitively un-
impaired, after hip fracture. Exclusion criteria:
short life expectancy and revised surgery. IC
was reported in diaries and collected biweekly
for 12 weeks after discharge. Outcome was
total amount of IC the first 12 weeks after
discharge, presented as median and
interquartile range. As a sub-analysis, the
median amount of IC was used as cut-off for
a high and low dependent group.
Results: A total of 226 person’s participated, median age
78 years (73-84) and 60% were women. Ninety-
one percent received IC median 28 hours (10,
64). Week 1-2, 72% received IC median 8 hours
(0, 28). At week 11-12, 35% received IC median
0 hours (0, 7). Fourty-seven percent were high
dependent median 66 hours (46-107), fifty-three
percent were low-dependent median 11 hours (2-
20). The high dependent persons had lower
mobility and Barthel-20 scores (p=0.02 and
p=0.00) and less frequently lived alone (p=0.04).
Interpretation / Conclusion: Even though formal care in Denmark is free of
charge, a staggering 91% of the cohort received
IC median 28 hours. The proportions and
amounts declined during the 12 weeks. At
discharge, persons’ high dependent on IC had
difficulties with everyday activities and relied
more on partners. Indicating that persons with
poor mobility, difficulties with everyday tasks and
IC may have an unmet need for care.
3. Infection among patients with hip fracture: Predictive ability of Charlson, Elixhauser, Rx-risk, and Nordic multimorbidity indices
Dorete K. Storbjerg1, Nadia R. Gadgaard1, Alma B. Pedersen1
1. Department of Clinical Epidemiology, Aarhus University Hospital and Aarhus University;
Background: Post-surgery infection is a common complication
among hip fracture patients. Comorbidity indices are
important for case-mix confounder adjustment. It is
however unknown whether different comorbidity
indices have equal predictive ability for post-surgery
infections.
Aim: The aim of this population-based cohort study was
to evaluate the predictive ability of Charlson
Comorbidity Index (CCI), Elixhauser Comorbidity
Index (ECI), Rx-Risk Index (Rx-Risk), and Nordic
Multimorbidity Index (NMI) for any infection up to 1
year after discharge for hip fracture surgery.
Materials and Methods: We included 92,600 hip fracture patients from
the Danish Multidisciplinary Hip Fracture
Registry (2004-2018) and linked their data to the
Danish National Patient Registry and Danish
National Prescription Database. Disease
categories in the CCI and ECI were based on
diagnosis codes, Rx-Risk was based on
prescription codes, and NMI was based on both
diagnosis- and prescription codes. A 1, 5, and
10-year lookback period were applied to
calculate comorbidity indices. Logistic regression
was used to calculate c-index to assess
discrimination ability of indices individually and
combined with a base model of age and sex.
Outcomes were any infection in-hospital and any
infection 1 year after discharge.
Results: Majority of patients were females (71%), and mean
age was 83 years. With a 10-year lookback period,
the c-index for individual comorbidity indices for in-
hospital infections varied from c-index=0.53 to c-
index=0.56, similar to base model alone (c-
index=0.56). The predictive ability of comorbidity
indices in combination with base model varied from
c-index=0.56 to c-index=0.57.
Within 1 year after discharge, NMI in combination
with base model had best predictive ability for
infections (c-index=0.615), followed by CCI and ECI
(c-index=0.60) and Rx-Risk (c-index=0.58).
Discrimination was similar for all lookback periods.
Interpretation / Conclusion: Comorbidity indices have low predictive ability for
infection up to 1 year after hip fracture surgery,
similar to predictive ability of age and sex alone.
Thus, use of comorbidity indices as a tool for
predicting infections is limited. For case-mix
adjustment, evaluated comorbidity indices are of
equal value.
4. Dual mobility total hip arthroplasty shows similar dislocation rate as hemiarthroplasty in cognitively impaired patients with hip fracture
Christina Frølich Frandsen1, Maiken Stilling1,2,3, Torben Bæk Hansen1,2, Tobias Kvanner Aasvang4, Morten Tange Kristensen4,5,6
1. University Clinic for Hand, Hip and Knee Surgery, Department of Orthopaedics,
Gødstrup Hospital, Denmark
2. Department of Clinical Medicine, Aarhus University, Denmark
3. Department of Orthopaedics, Aarhus University Hospital, Aarhus, Denmark
4. Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre,
Denmark.
5. Department of Physiotherapy, Copenhagen University Hospital, Amager-Hvidovre,
Denmark.
6. Department of Physical and Occupational Therapy, Copenhagen University Hospital,
Bispebjerg-Frederiksberg and Department of Clinical Medicine, University of
Copenhagen, Denmark
Background: Cognitive impairment is seen in approximately
30% of patients with hip fractures and associated
with poorer outcome. When treating displaced
femoral neck fractures (FNF) hemiarthroplasty
(HA) has been the preferred choice of
arthroplasty, especially in cognitively impaired
patients. A total hip arthroplasty (THA) is
considered a relevant alternative but rarely
chosen, partly due to an expected increased risk
of dislocation compared to HA. However, dual-
mobility THA has shown reduced risk of
dislocation, but no studies have compared the
risk in cognitively impaired patients.
Aim: Primarily, to compare the 90-day dislocation rate of
HA versus THA in cognitively impaired patients with
FNF. Secondly, to compare the 30-day post-surgery
mortality and 30-day post-discharge readmission
rates.
Materials and Methods: A consecutive cohort of 436 patients, 65 years or
older, with a FNF admitted at two hospitals from
January 2018 to June 2019 were evaluated for
inclusion. Patients were screened for cognitive
impairment upon admission and surgically
treated with one hospital using uncemented HA
and the other using dual-mobility THA
(cemented, uncemented or hybrid). Outcome
was extracted from electronic patient records
regarding dislocation, readmission (defined as
any acute physical hospital contact for any
cause), and mortality. Chi-squared and Fishers
exact test was used to evaluated between group
differences.
Results: 164 out of the 436 patients (38%) with a median age
of 85 years had cognitive impairment and were
included. 101 patients were treated with HA and 63
with THA. Baseline characteristics of the two groups
were similar. The 90-day dislocation rate was 11.9%
in the HA-group and 6.5% in the THA-group (p=0.3).
A higher readmission rate was observed in the HA-
group (37.6%) versus THA-group (19.1%), p=0.01.
Corresponding, mortality rates were 15.8% for HA
and 14.3% for THA (p=0.8), respectively.
Interpretation / Conclusion: Our findings do not support the hypothesis of a
higher risk of dislocation in cognitive impaired
patients treated with THA in comparison with the
more commonly used HA. Furthermore, the premise
of a larger surgical stress when using THA resulting
in poorer outcomes such as readmission and
mortality is not supported.
5. Low haemoglobin nine days after discharge is associated with reduced mobility two months after hip fracture surgery
Martin Aasbrenn1,2, Thomas Giver Jensen3, Marie West Pedersen4, Nicolai Henning Jensen4, Troels Haxholdt Lunn6,7, Eckart Pressel1,7, Henrik Palm2,3, Anette Ekmann1, Charlotte Suetta1,2,7, Søren Overgaard2,3, Morten Tange Kristensen2,4
1. Department of Geriatric and Palliative Medicine, Bispebjerg-Frederiksberg
University Hospital;
2. University of Copenhagen, Department of Clinical Medicine, Faculty of Health and
Medical Science;
3. Department of Orthopaedic Surgery and Traumatology, Bispebjerg-Frederiksberg
University Hospital;
4. Department of Physical and Occupational Therapy, Bispebjerg-Frederiksberg
University Hospital;
5. Department of Orthopaedic Surgery, North Zealand Hospital;
6. Department of Anaesthesia and Intensive Care, Bispebjerg-Frederiksberg
University Hospital;
7. Copenhagen University Hospital Herlev and Gentofte, Department of Internal
Medicine
Background: Haemoglobin is essential for optimal skeletal muscle
function and anaemia can be a limiting factor in
rehabilitation after acute disease.
Aim: We examined the association between haemoglobin
early after discharge and mobility two months after a
surgically treated hip fracture.
Materials and Methods: Older patients (=65 years) surgically treated for a
hip fracture at Copenhagen University Hospital
Bispebjerg and Frederiksberg in 2021 and
referred to a outpatient visit two months after
discharge were included in the study.
Haemoglobin was measured 9 days after
discharge from the hospital. New Mobility Score
(NMS, 0-9 points) was evaluated by a
physiotherapist two months after the admission.
Anaemia was defined according to the WHO
definition (Haemoglobin <13 g/dL in men, <12
g/dL in women) The association between
haemoglobin and NMS was evaluated by linear
regression, with age and sex as covariates.
Results: We included 102 patients with a mean (SD) age of
78 (9) years; 75 (74%) were women. Haemoglobin
at the 9-day visit was 10.6 g/dL (SD 1.3) and 89
(87%) had anaemia according to the WHO
definition. The average NMS two months after the
admission was 4.7 (SD 2.2). Low haemoglobin at
the 9th day after discharge was associated with
reduced NMS at the 2 month control (ß=0.80, 95%
CI 0.36-1.38, p=0.002).
Interpretation / Conclusion: In hip fracture patients, we found an association
between haemoglobin in the second week after
discharge and mobility two months after surgery.
Whether treatments to increase haemoglobin in the
postoperative phase could enhance rehabilitation
and increase recovery should be evaluated in further
studies.
6. Quality of care and mortality in hip fracture patients in the course of the COVID pandemic. A population based cohort study
Alma B. Pedersen1,2, Nickolaj Risbo1,2, Bjarke L. Viberg3,4, Henrik Palm5, Niels Dieter Rock3
1. Department of Clinical Epidemiology, Aarhus University Hospital
2. Department of Clinical Medicine, Aarhus University
3. Department of Orthopaedic Surgery and Traumatology, Odense University
Hospital
4. Department of Clinical Research, University of Southern Denmark
5. Department of Orthopaedic Surgery, Copenhagen University Hospital Bispebjerg
Background: Few international studies on hip fracture patients
suggested no increase in mortality but negative
impact on quality of care indicators during
COVID compared to pre-COVID period.
Aim: We assessed the quality of in-hospital care for
hip fracture patients in Denmark and subsequent
mortality before and during the early stages of
COVID pandemic.
Materials and Methods: We obtained data on hip fracture patients and
quality indicators from the Danish
Multidisciplinary Hip Fracture Registry in the
COVID period (11 Marts 2019 to 27 January
2021, overall and in five separate periods),
and compared these to a pre-COVID period
(13 March 2019 to 10 March 2020). Mortality
and comorbidity data were from the other
Danish medical databases. By different
COVID periods, we calculated the proportion
of patients (%) that have fulfilled >80% of the
relevant quality indicators (a composite
score). We used Cox regression to calculate
hazard ratios (HR) comparing 30-day
mortality in COVID period with pre-COVID
period, adjusting for age, gender, comorbidity
and residence.
Results: A total of 6575 were treated for hip fracture in
the pre-COVID period, and 5919 in the
COVID period. Overall, there was no
difference in gender, age, fracture and
surgery type, body mass index, and
comorbidity prevalence between pre-COVID
and COVID periods.
The composite score was 73% in pre-COVID
period, compared to 73% to 80% in the five
COVID periods.
30-day mortality was 9.5% in pre-COVID
period, compared to 10.8% in the overall
COVID period. Mortality varied from 10% in
the COVID period with few restrictions, 11.1%
in the first national lockdown, to 11.9% in the
second national lockdown.
HR for mortality was 1.15 (1.02-1.30) in the
overall COVID compared to pre-COVID
period. HRs varied from 1.07 (0.89-1.29) to
1.31 (1.06-1.62) in five COVID periods. We
observed regional variations in the HRs when
comparing overall COVID with pre-COVID
period.
Interpretation / Conclusion: The quality of in-hospital care for hip fracture
patients in Denmark was higher in the COVID
compared to pre-COVID period. Unfortunately,
30-day mortality was also higher in the COVID
compared to pre-COVID period.
8. Adjusting perioperative methadone dose for elderly and fragile hip fracture patients (MetaHip-trial) - an adaptive dose-finding trial
Jesper Ougaard Schønnemann1, Thomas Strøm 2, Kirsten Specht 3, Kevin Heebøll Nygaard1
1. Department of orthopaedics, University hospital of southern Denmark, Kresten
Philipsensvej 15, 6200 Aabenraa
2. Department of anesthesiology and intensive care, University hospital of
southern Denmark, Kresten Philipsensvej 15, 6200 Aabenraa
3. Center for COPD, Center for Health and Rehabilitation, Randersgade 60, 2100
København Ø
Background: Hip fractures are associated with severe pain
and are sustained by the elderly. Demand for
adequate pain relief combined with a low
tolerance for drugs makes the analgesic
treatment of elderly patients difficult. A single
dose of methadone reduces postoperative pain
and opioid consumption. However, the safety of
using methadone for elderly and fragile patients
is unknown.
Aim: Determining the maximal tolerable dose of
methadone in elderly hip fracture patients.
Materials and Methods: Hip fracture patients =60 years were
consecutively included at a Danish
University Hospital in 2023. An adaptive
algorithm assigned either 0.10 mg/kg, 0.15
mg/kg, or 0.20 mg/kg of methadone to each
patient, administered one time intravenously
at the induction of anesthesia. Primary
outcome was respiratory depression (RD)
and the algorithm would continuously
monitor the occurrence throughout the study.
The occurrence of RD required a decrease
in dosage for the next patient and the
absence allowed an increase. This allowed
real-time dose adjustment during our study.
Data collection was initiated at the post-
anesthesia care unit (PACU) and continued
at the orthopedic ward where observation
charts were completed at 6, 24, and 72
hours after surgery. Secondary outcomes
include time spent in PACU, verbal rating
pain score (VRS), opioid consumption, and
nausea/vomiting.
Results: 30 patients completed the study of which 14
underwent general anesthesia and 16
underwent spinal anesthesia. Three patients
experienced RD in PACU. All three received
0.15 mg/kg methadone and they all underwent
general anesthesia. None of the patients in
spinal anesthesia experienced RD and no
patients experienced RD after discharge from
PACU. Elderly hip fracture patients undergoing
spinal anesthesia did not experience respiratory
depression after 0.15 mg/kg methadone.
Interpretation / Conclusion: We have demonstrated that methadone is safe
to use during hip fracture surgery. Our data
suggest that the maximal tolerable dose of
methadone in elderly hip fracture patients
undergoing general anesthesia is 0.10 mg/kg.
Our results show a great divergence in the
tolerability of methadone depending on the type
of anesthesia and call for further studies.
9. Quantifying Variability in Daily Accelerations Recorded by Inertial Sensor in Healthy Individuals: Implications for Gait Measurements in Free-Living Environments
Arash Ghaffari1, John Rasmussen 2, Søren Kold1, Ole Rahbek1
1. Interdisciplinary Orthopaedics, Aalborg University Hospital;
2. Department of Materials and Production, Aalborg University.
Background: Gait measurements can vary due to various
intrinsic and extrinsic factors, and this variability
becomes more pronounced using inertial sensors
in a free-living environment. Therefore,
identifying and quantifying the sources of
variability is essential to ensure measurement
reliability and maintain data quality.
Aim: This study aimed to determine the variability of
daily accelerations recorded by an inertial sensor
in a group of healthy individuals.
Materials and Methods: Ten participants, including six females, with a
mean age of 50 years (range: 29–61) and
BMI of 26.9 kg/m² (range: 21.4–36.8), were
included. A single accelerometer continuously
recorded lower limb accelerations over two
weeks. We extracted and analyzed the
accelerations of three consecutive strides
within walking bouts if the time difference
between the bouts was more than two hours.
Multivariate mixed-effects modeling was
performed on both the discretized
acceleration waveforms at 101 points (0-100)
and the harmonics of the signals in the
frequency domain to determine the variance
components for different subjects, days,
bouts, and steps as the random effect
variables. Intraclass correlation coefficients
(ICCs) were calculated for between-day,
between-bout, and between-step
comparisons.
Results: The results showed that the ICCs for the
between-day, between-bout, and between-step
comparisons were 0.73, 0.82, 0.99 for the
vertical axis; 0.64, 0.75, 0.99 for the
anteroposterior axis; and 0.55, 0.96, 0.97 for the
mediolateral axis. For the signal harmonics, the
respective ICCs were 0.98, 0.98, 0.99 for the
vertical axis; 0.54, 0.93, 0.98 for the
anteroposterior axis; and 0.69, 0.78, 0.95 for the
mediolateral axis.
Interpretation / Conclusion: Overall, this study demonstrated that
accelerations recorded continuously for multiple
days in a free-living environment exhibit high
variability, mainly between subjects, with some
variability arising from differences between days
and walking bouts, particularly in the
anteroposterior and mediolateral axes. However,
reliable and repeatable gait measurements can
be obtained by identifying and quantifying the
sources of variability.
10. Risk of secondary surgery following surgical treatment of fractures in adults
Anders Bo Rønnegaard1, Signe Steenstrup Jensen1, Peter Toft Tengberg2, Per Hviid Gundtoft1,3, Bjarke Viberg1,4
1. Department of Orthopedic Surgery and Traumatology, Kolding Hospital - part of
Hospital Lillebaelt
2. Department of Orthopedic Surgery, Hvidovre Hospital
3. Department of Orthopedic Surgery, Aarhus University Hospital
4. Department of Orthopedic Surgery, Odense University Hospital
Background: The risk of secondary surgery following primary,
fracture-related surgery of the extremities is either
unknown or only described in a limited number of
studies. In order to inform patients adequately it is
important to have studies concerning large cohorts
for statistical accuracy and subgroup analyses.
Aim: To estimate the risk of experiencing any secondary,
musculoskeletal surgery within 2 years of primary
fracture-related surgery using osteosynthesis.
Materials and Methods: We performed a nationwide register study on
adult patients surgically treated for fractures at a
Danish hospital in 2016 with 2 years of follow-up
using data from the Danish Fracture Database,
the Danish National Patient Registry and the
Danish Civil Registration System. Primary
outcome was risk of any secondary,
musculoskeletal surgery defined as any surgical
procedure code within 2 years after primary
surgery. Secondary outcome was risk of major
reoperation defined as reosteosynthesis,
nonunion, arthroplasty, and deep infection. We
calculated risk using the cumulative incidence
function accounting for death as a competing risk
and presented with 95% confidence intervals (CI)
overall and stratified on age, sex and anatomical
area.
Results: We included 9,719 adult patients of which 63% were
female and the median age was 70 years (20–100).
Fractures of the upper leg were most frequent. The
overall risk of secondary musculoskeletal surgery
was 20% (95% CI (19.1–20.6)) and for major
reoperation it was 8% (95% CI (7.1–8.2)). Males had
a higher risk of all outcomes compared to females.
Across anatomical areas risk of secondary surgery
ranged from 11% (95% CI 9.9–11.7) in the upper leg
to 70% (95% CI 66.6–73.6) in the hand. For major
reoperations it ranged from 4% (95% CI 3.5–5.3) in
the forearm to 13% (95% CI 11.2–14.8) in the ankle
and foot.
Interpretation / Conclusion: This study provide estimates for the risk of
experiencing secondary, musculoskeletal surgery
and major reoperations following primary, fracture-
related surgery of the extremities, which can be
used by orthopedic surgeons counselling patients
prior to fracture-related surgical procedures.