BACKGROUND

This first clinical practice guideline (CPG) on osteoporosis prevention and management in the Philippines is the output of a shared undertaking by a multidisciplinary CPG development team spearheaded by the Osteoporosis Society of the Philippines Foundation, Inc. and joined by the Philippine Academy of Family Physicians; the Philippine College of Endocrinology, Diabetes, and Metabolism; the Philippine Orthopedic Association; the Philippine Obstetrics and Gynecological Society and the Philippine Rheumatology Association. This guideline seeks to augment and update the "Consensus statements on osteoporosis diagnosis, prevention and management in the Philippines," initially published in 2011, incorporating evidence-based practices developed in the last decade.

METHODOLOGY

The steering committee formulated and prioritized clinical questions based on meetings and stakeholder consultations. A PICO (population, intervention, comparator, outcome) format was used to develop clinical questions and guide the systematic search for evidence. The development of guidelines followed the ADAPTE process. Once completed, panel discussions were done using the Evidence to Decision Framework. After the panel discussions, the final recommendations were revised.

RESULTS

Thirty-four recommendations were formulated to address 27 clinical questions related to screening, prevention, diagnosis, pharmacologic and nonpharmacologic treatment, surgical management, follow-up, and continuity of care. With these recommendations, the developers aim to establish a standard of care in the prevention, diagnosis and management of osteoporosis and fragility fractures in both in-patient and out-patient cases that are appropriate to the Philippine context. Specifically, the CPG development group aims to use these recommendations to define the standard of care for osteoporosis as part of universal healthcare services once the program is implemented nationally. Relevant stakeholders may also use the recommendations to inform public and private payor policies for patients with fragility fractures, as well as by local government units or private companies looking to establish orthogeriatric centers with fracture liaison services.

CONCLUSION

This guideline is helpful for physicians and other allied health personnel in screening, diagnosis, management and prevention of primary osteoporosis and fragility fractures among postmenopausal women and older men.

Human ; Philippines ; Guideline ; Osteoporosis

OBJECTIVES: Presence of COVID-19 infection in patients with acute fragility hip fracture complicates the decision-making process in the management of these patients. This study aims to describe outcomes of patients with coexisting fragility hip fracture and COVID-19 infection who underwent surgery. METHODS: In this retrospective study, the patient database of a university hospital designated as a COVID-19 referral center with an orthogeriatric team was reviewed to determine the mortality and morbidity rates, and short-term functional outcomes of patients with coexisting COVID-19 and acute fragility hip fracture who underwent surgery. RESULTS: A total of 18 patients were admitted with COVID-19 infection and acute fragility hip fracture – 12 had surgery. Mean injury-to-admission and admission-to-surgery intervals were 6.5 and 4.8 days, respectively. Most patients (91.7%) had an incidental finding of SARS-CoV-2 infection. Mean ASA score was 2.9. Arthroplasty was done in all patients with a mean operative time of 155.8 minutes and an average blood loss of 366.7 mL. Thirty-day mortality and morbidity rates were 16.7% and 33.3%, respectively. Mean EuroQoL overall health score was 79.3. CONCLUSION A multidisciplinary team approach is recommended to expedite timely surgery prior to the onset of clinical deterioration. Asymptomatic and mildly symptomatic patients with acute fragility hip fracture are candidates for urgent surgical intervention even in the presence of COVID-19 infection

Objective. The study compared functional outcomes among post-operative geriatric fragility hip fracture patients who received complete and incomplete rehabilitation.

Methods. This is an ambispective cohort study of 50 acute fragility hip fractures over a 40-month period (October 2017 to November 2020) treated with either arthroplasty or internal fixation under the UP-PGH Orthogeriatric Fracture Liaison Service (FLS). Patients were contacted and interviewed through Telemedicine. They were asked to answer two questionnaires - the Modified Harris Hip Score (MHHS) and the EuroQol-5D-5L (EQ-5D-5L). The scores were tallied and used to describe and compare the post-operative functional outcomes between the two rehabilitation pathways.

Results. Among the 50 patients included in this study, twenty-three (46%) patients underwent complete rehabilitation, while 27 (54%) underwent incomplete rehabilitation. The average corrected MHHS was at 82.5 suggesting good outcomes among all patients, with a higher-than-average outcome of 83.6 among patients who underwent complete rehabilitation, and an outcome of 75.9 among patients who underwent incomplete rehabilitation. Results to the EQ-5D--5L survey showed that a majority of patients who underwent complete rehabilitation reported having 'no problems' in terms of self-care, and anxiety or depression. However, the same group had more patients reporting 'any problems' in terms of mobility. On the other hand, a bigger proportion of patients from the incomplete rehabilitation group presented with 'any problems' in terms of usual activities. Proportions were similar for both groups in terms of pain or discomfort, with neither group having patients who reported extreme pain or discomfort.

Conclusion. In spite of the heterogenous nature of the hip fracture population, functional outcome measures show generally good outcomes of patients under the UP-PGH Orthogeriatric FLS, with no significant difference among patients who receive complete rehabilitation from those who undergo incomplete rehabilitation. Continuing this study may better describe and differentiate the functional outcomes in order to pave the way for evidence-based protocols dedicated to providing the highest quality of care for acute fragility fracture patients.

Rehabilitation

Objectives: Fragility hip fractures present not only as a significant cause of morbidity and mortality to the elderly population but also as an important source of financial burden due to staggering costs for treatment. This study is designed to determine the effects of timing of hospitalization to the treatment costs of patients with acute fragility hip fractures. Methods: In this retrospective cohort study, the patient database of the University of the Philippines Manila-Philippine General Hospital Orthogeriatric Multidisciplinary Fracture Management Model and Fracture Liaison Service was reviewed to investigate the effects of timing of hospitalization to the treatment cost of patients with acute fragility hip fractures admitted in a tertiary government hospital. The economic burden of this group of patients was also computed. Results: A total of 118 patients were enrolled in the study with 54 patients in the early hospitalization (EH) group ( 3 days from injury) and 64 in the delayed hospitalization (DH) group (4e28 days). Median treatment cost is less among the EH group than those who were in the DH group (P ¼ 0.0362). The computed economic burden of patients with acute fragility hip fractures is PhP 1,094,048,363.00 (USD 22,595,007.79) per year in the Philippines. Conclusions Fragility hip fractures impose significant financial impact; and therefore, recommend early hospitalization to lessen treatment cost. Future studies should also be undertaken to investigate other interventions that may help alleviate this burden.

Objectives: Fragility hip fractures present not only as a significant cause of morbidity and mortality to the elderly population but also as an important source of financial burden due to staggering costs for treatment. This study is designed to determine the effects of timing of hospitalization to the treatment costs of patients with acute fragility hip fractures. Methods: In this retrospective cohort study, the patient database of the University of the Philippines Manila-Philippine General Hospital Orthogeriatric Multidisciplinary Fracture Management Model and Fracture Liaison Service was reviewed to investigate the effects of timing of hospitalization to the treatment cost of patients with acute fragility hip fractures admitted in a tertiary government hospital. The economic burden of this group of patients was also computed. Results: A total of 118 patients were enrolled in the study with 54 patients in the early hospitalization (EH) group ( 3 days from injury) and 64 in the delayed hospitalization (DH) group (4e28 days). Median treatment cost is less among the EH group than those who were in the DH group (P ¼ 0.0362). The computed economic burden of patients with acute fragility hip fractures is PhP 1,094,048,363.00 (USD 22,595,007.79) per year in the Philippines. Conclusions Fragility hip fractures impose significant financial impact; and therefore, recommend early hospitalization to lessen treatment cost. Future studies should also be undertaken to investigate other interventions that may help alleviate this burden.

Unstable posterior acetabular fractures resulting from high energy trauma present major challenges to any orthopedic surgeon especially if the treatment has been delayed.
OBJECTIVE: The purpose of this paper is to describe the early results of delayed treatment of a series of patients with posterior acetabular fractures with concomitant hip dislocations, surgically approached using the Kocher-Langenbeck with a trochanteric flip osteotomy.
METHODS: Five (5) male patients (mean age 35.6 years, range 23-58 years) who sustained unstable posterior acetabular fractures, underwent surgical treatment using the Kocher-Langenbeck approach with the trochanteric flip osteotomy, during the period of May 2014 to October 2015. Clinical and radiographic evaluations of each patient were performed, while complications were documented.
RESULTS: Mean follow-up was 8 weeks (range 2-12 weeks). There was adequate exposure of the posterior and superior acetabulum in all patients. Post-operative radiographs in four of five patients were graded "anatomic" while hip range of motion of these four patients averaged 78.7% of the uninjured hip. One patient with "poor" reduction underwent a second operation to reserve a failure of the initial fixation using the same surgical approach. No other complications were reported.
CONCLUSION: This modified approach provides adequate exposure of both posterior and superior acetabulum and also allows inspection of the articular surfaces of both acetabulum and femoral head, which are limited in the standard Kocher-Lagenbeck approach. With excellent exposure, congruent reduction can readily be achieved while permitting early hip range of motion post-surgery.

Human ; Male ; Female ; Middle Aged ; Adult ; Young Adult ; Acetabulum ; Femur ; Femur Head ; Follow-up Studies ; Hip Dislocation ; Hip Injuries ; Orthopedic Surgeons ; Osteotomy ; Range Of Motion, Articular

BACKGROUND: Studies comparing the relative strength of polymethylmethacrylate (PMMA) augmented fixation, standard plating and locked compression plate (LCP) system are few. The use of either the bone cement-augmented dynamic compression plate or the Hybrid LCP constructs may provide an additional tool for the treatment of fractures in patients with osteoporosis.

METHODS: Eighteen (18) osteoporotic cadaveric humeral bones were assigned randomly to each of three groups (Dynamic Compression Plate [DCP], DCP augmented with bone cement, and the Hybrid LCP system) and tested in anterior-posterior bending and torsion/external rotation. The load to failure values were obtained and the results for each specimen compared.

RESULTS: Significant differences were observed between the standard DCP and Hybrid LCP group (p-value=0.012), and in the cement-augmented and Hybrid LCP group (p-value=0.099) in torsion/external rotation loading. No significant difference was observed between the standard DCP and bone-cement augmented group (p-value=0.248). No significant difference was observed among the three groups in terms of stiffness (p-value=0.3868) in the four-point anterior-posterior bending modality. Screw pull-out of the implant was observed only in the regular DCP group in torsion/external rotation loading stress.

CONCLUSION: Significant differences were seen between the three constructs in torsion/external rotation but not in anterior-posterior four-point bending. Bone failure, but not screw pull-out, was seen in the Hybrid LCP and bone cement-augmented DCP groups in torsion. This study showed that the LCP system and the bone cement-augmented constructs may provide greater screw purchase to the osteoporotic humerus.

Human ; Humans ; Bone Cements ; Bone Screws ; Polymethyl Methacrylate ; Rotation ; Bone Plates ; Fracture Fixation, Internal ; Fractures, Bone ; Osteoporosis ; Humerus