Characteristics and outcomes of hospitalised patients with vertebral fragility fractures: a systematic review

Background: The complex management for patients presenting to hospital with vertebral fragility fractures provides justification for the development of specific services for them. A systematic review was undertaken to determine the incidence of hospital admission, patient characteristics, and health outcomes of vertebral fragility fracture patients to inform the development of such a service. Methods: Non-randomised studies of vertebral fragility fracture in hospital were included. Searches were conducted using electronic databases and citation searching of the included papers. Results: 19 studies were included. The incidence of hospital admission varied from 2.8-19.3 per 10,000/year. The average patient age was 81 years, the majority having presented with a fall. A diagnosis of osteoporosis or previous fragility fracture was reported in around one third of patients. Most patients (75% men and 78% women) had five or more co-pathologies. Most patients were managed non-operatively with a median hospital length of stay of 10 days. One third of patients were started on osteoporosis treatment. Inpatient and one year mortality was between 0.9-3.5%, and 20–25% respectively: between 34-50% were discharged from hospital to a care facility. Many patients were more dependent with activities of daily living on discharge compared to their pre-admission level. Older age and increasing comorbidities was associated with longer hospital stay and higher mortality. Conclusion: These findings indicate that specific hospital services for patients with vertebral fragility fractures should take into consideration local hospitalisation rates for the condition, and should be multifaceted - providing access to diagnostic, therapeutic, surgical and rehabilitation interventions

Usefulness of Pain Distribution Pattern Assessment in Decision-Making for the Patients with Lumbar Zygapophyseal and Sacroiliac Joint Arthropathy

There are currently no initial guides for the diagnosis of somatic referred pain of lumbar zygapophyseal joint (LZJ) or sacroiliac joint (SIJ). We developed a classification system of LZJ and SIJ pain, the "pain distribution pattern template (PDPT)" depending on the pain distribution patterns from a pool of 200 patients whose spinal pain source was confirmed. We prospectively applied the PDPT to determine its contribution to clinical decision-making for 419 patients whose pain was presumed to arise from the LZJs (259 patients) or SIJs (160 patients). Forty-nine percent (128/259) of LZJ and 46% (74/160) of SIJ arthopathies diagnosed by PDPT were confirmed by nerve blocks. Diagnostic reliabilities were significantly higher in Type A and C patterns in LZJ and Type C in SIJ arthropathies, 64%, 80%, and 68.4%, respectively. For both LZJ and SIJ arthropathies, favorable outcome after radiofrequency (RF) neurotomies was similar to the rate of positive responses to diagnostic blocks in Type A to Type D, whereas the outcome was unpredictable in those with undetermined type (Type E). Considering the paucity of currently available diagnostic methods for LZJ and SIJ arthropathies, PDPT is useful in clinical decision-making as well as in predicting the treatment outcome

Correlation Between Walking Ability and Monthly Care Costs in Elderly Patients After Surgical Treatments for Hip Fractures

Objective To validate the relationship between residual walking ability and monthly care cost as well as long-term care insurance (LTCI) certification level in elderly patients after surgical treatment for hip fractures in Japan. Methods Elderly patients aged >75 years who underwent surgical treatment for hip fractures in our hospital were included. The preand post-surgical (6-month) walking ability and LTCI certification and the presence or absence of dementia was determined from medical records and questionnaires. Walking ability was classified into 6 levels used in our daily medical practice. Based on these data, we correlated the relationship between walking ability and the LTCI certification level. Further, based on the official statistics pertaining to the average monthly costs per person at each LTCI certification level, we evaluated the relationship between walking ability and monthly care cost. Results A total of 105 cases (mean age, 80.2 years; 16 men; 39 patients with dementia) were included. The correlation between walking ability and average monthly cost per person as well as LTCI certification level at 6 months postoperatively (r=0.58) was demonstrated. The correlation was found in both groups with and without dementia. Conclusion The ability to walk reduced the cost of care in elderly patients who experienced hip fracture, regardless of the presence of dementia

PROSES KARBURASI PADAT BAJA SS400 DENGAN VARIASI WAKTU PENAHANAN TERHADAP KEKERASAN DAN LAJU KEAUSAN MATERIAL SADDLE PADA MESIN PENGEMASAN SEMEN

Saddle merupakan salah satu komponen yang digunakan pada mesin packer semen. Alat yang berfungsi sebagai tempat penahan kantong semen saat proses pengisian dan mengalami pembebanan yang bisa memicu terjadinya keausan. Jika hal tersebut terjadi, maka saddle harus diganti dengan yang baru. Berdasarkan hasil wawancara langsung dengan salah seorang pekerja workshop di Semen Padang, umur pakai saddle dengan material SS400 yang tergolong baja karbon rendah ini hanya sekitar empat bulan saja. Hal itu akan mengakibatkan penggantian rutin setiap empat bulan sekali, yang berdampak pada penambahan biaya operasional. Untuk itu perlu dilakukan suatu cara agar biaya ini bisa berkurang. Salah satu cara yang bisa dilakukan adalah meningkatkan kekerasan permukaan material dengan cara karburasi. Penelitian ini dilakukan pada temperatur 900ºC dengan memvariasikan waktu penahanan saat pemanasan. Waktu penahanan yang digunakan adalah 30 menit, 60 menit, dan 90 menit dengan menggunakan BaCO3 sebagai katalis. Selanjutnya dilakukan pendinginan cepat dengan menggunakan media cair berupa air laut. Untuk mengetahui hasil karburasi, dilakukan beberapa cara yaitu pengujian kekerasan, pengujian keausan, pengukuran scar diameter, dan pemeriksaan kandungan unsur material. Dari hasil penelitian diperoleh bahwa peningkatan nilai kekerasan tertinggi terjadi pada waktu holding selama 90 menit dengan persentase sebesar 63.40%. Hal ini mengakibatkan penurunan laju keausan mencapai 85.9%. Selanjutnya diperoleh hasil pengukuran scar diameter yaitu semakin lama proses holding yang diberikan, maka semakin besar penurunan scar diameter. Sedangkan untuk pemeriksaan kandungan unsur material, terjadi peningkatan unsur karbon pada holding 90 menit yaitu sebesar 0.961%. Kata kunci : saddle, baja karbon rendah, karburasi, kekerasan, keausa