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Abstract Identifying osteoporosis in geriatric populations is essential for fragility fracture prevention. While dual-energy X-ray absorptiometry (DXA) remains the gold standard for diagnosing osteoporosis, its availability and cost for mass screening are limited. This study aims to determine an effective fracture risk assessment tool (FRAX) cut-off value for screening osteoporosis in the Thai geriatric population. The demographic data, FRAX hip fracture (HF), major osteoporotic fracture (MOF), and Bone mineral density (BMD) of community-dwelling Thai adults aged ≥ 60 years, conducted between March 2021 to August 2022 were analyzed. Osteoporosis is defined as a BMD T-score ≤ − 2.5. The accuracy of FRAX in identifying osteoporosis was assessed using the area under the receiver operating characteristic curve (AUC). Among 2991 participants (average age 69.2 ± 6.5 years), the discriminative ability was acceptable for both FRAX hip fracture (HF) (AUC = 0.75) and major osteoporotic fracture (MOF) (AUC = 0.72). A cut-off value of 1.5 for FRAX HF and 4.5 for FRAX MOF demonstrated excellent sensitivity (90.4%) and a high negative predictive value (89.7%) in osteoporosis detection. This study identifies FRAX cut-off values that can effectively screen for high-risk osteoporosis in the Thai geriatric population and suggests that FRAX could be a valuable tool for initial osteoporosis screening in Thai seniors.

Abstract Background With the increasing number of older adults, musculoskeletal disorders such as sarcopenia have become increasingly important to research because of their strong association with falls and fractures. Sarcopenia, which is characterized by reduced muscle mass, is common among older adults and significantly increases the risk of falls. This study aimed to assess the effectiveness of the SARC-F and SARC-CalF questionnaires, along with calf circumference measurements, for sarcopenia screening among Thai community-dwelling older adults, following the 2019 criteria of the Asian Working Group for Sarcopenia. Methods This analysis drew on data from the Thai Musculoskeletal Diseases Nationwide Study, which included 2543 participants aged 60 years or older. The SARC-F, SARC-CalF, and calf circumference data were evaluated against the 2019 Asian Working Group for Sarcopenia criteria. We calculated the sensitivity, specificity, and area under the curve to determine the diagnostic performance of each tool. Results Of the 2455 participants analyzed, 18.1% were diagnosed with sarcopenia. The SARC-F and SARC-CalF questionnaires showed limited effectiveness in diagnosing sarcopenia, with area under the curve values of 0.508 and 0.729, respectively. In contrast, calf circumference demonstrated greater diagnostic accuracy, with area under the curve values of 0.897 in males and 0.878 in females. Adjusting the cutoff points to

Objective: To develop models for predicting postoperative ambulation recovery at 3 months following fragility hip fracture surgery. Design: Cross-sectional study. Subjects: Fragility hip fracture patients aged ≥ 50 years who underwent operative treatment and completed a 3-month follow-up. Methods: Potential predictors were collected from eligible patients, while ambulation at 3 months after injury was assessed using the modified functional ambulation classification. These factors were used to develop the Hip Fracture Short-Term Ambulation Prediction, consisting of 2 models: Model 1 for postoperative ambulation and Model 2 for preinjury status recovery. Results: Among the 275 patients, 55 (20.0%) achieved good ambulation, and 59 (21.5%) returned to their preinjury status at 3 months. Age, preinjury ambulatory status, and discharge ambulatory status were identified as significant predictors of 3-month postoperative ambulation. The tool presented (Models 1 and 2) showed strong performance (area under the curve of 0.86 and 0.85, respectively) and good internal validity. Conclusions: Age, preinjury ambulatory status, and discharge ambulatory status significantly predict postoperative ambulation and preinjury status recovery at 3 months after fragility hip fracture surgery. The tool presented may aid clinicians in identifying patients who could benefit from targeted rehabilitation interventions during this crucial period.

Introduction The comparative results of early hip fracture surgery including mortality and postoperative complications in Thailand were not reported. Therefore, we conducted this study to compare the outcomes between patients who received hip surgery within and after 24 hours. Methods A retrospective study was conducted at a single center, a tertiary private hospital in Thailand. The medical records of patients who were admitted from 2018 to 2020 were reviewed. Patients aged .05) or postoperative complications ( P = .410) between the two groups. Conclusion While surgery within 24 hours showed some benefits, such as a shorter hospital stay and reduced pain rescue, it did not reduce mortality or major complications in hip fracture patients.

Abstract Introduction Lateral instability following total knee arthroplasty (TKA) is a rare condition with limited report of treatment options. The objective of this case presentation is to demonstrate the outcomes of different surgical procedures performed in a single patient with lateral collateral ligament (LCL) deficiency. Case presentation We present a case of chronic lateral instability due to LCL deficiency after primary TKA in a 47-year-old Caucasian woman with an obesity problem. Multiple treatment options have been performed in order to manage this problem, including the following: ligament reconstruction; combined ligament reconstruction and constrained implant; and rotating-hinge knee prosthesis that was the most recent surgery. All ligament reconstruction procedures failed within one year. The varus-valgus constrained prosthesis provided stability for six years. Conclusions Ligament reconstruction alone cannot provide enough stability for the treatment of chronic lateral instability in patients with obesity problems and LCL deficiency. When the reconstruction fails, a salvage procedure with rotating-hinge knee is still available.

Background and Objectives: Achieving prefracture functional status is a critical objective following a hip fracture, yet fewer than half of patients reach this milestone. The adoption of tools for assessing functional outcomes is increasingly recognized as essential for evaluating recovery following treatment for fragility hip fractures. We developed multivariable clinical prediction criteria to estimate the likelihood of patients regaining their prefracture activities-of-daily-living (ADL) status one year after sustaining a fragility hip fracture. Materials and Methods: A retrospective cohort of patients treated for fragility hip fractures at a university-affiliated tertiary care center between February 2017 and April 2019 served as the basis for developing and internally validating the clinical prediction criteria. We applied a multivariable fractional polynomial method to integrate several continuous predictors into a binary logistic regression model. Results: The study included 421 patients, 324 (77%) of whom reported regaining their prefracture activities-of-daily-living level one year after experiencing fragility hip fractures. Significant predictors, such as the prefracture Barthel index, EQ-VAS score, and treatment modality, were incorporated into the predictive model. The model demonstrated excellent discriminative power (AuROC of 0.86 [95% CI 0.82–0.91]) and satisfactory calibration. Conclusions: The predictive model has significant discriminative ability with good calibration and provides clinicians with a means to forecast the recovery trajectories of individual patients one year after a fragility hip fracture, which could be useful because prompt clinical decision-making is aided by this information. Patients and caregivers can also be counseled and encouraged to follow up with the medical activities and interventions deemed essential by doctors who used the prediction tool. Access to the model is provided through a web application. External validation is warranted in order to prove its applicability and generalizability.

Identifying osteoporosis in geriatric populations is essential for fragility fracture prevention. While dual-energy X-ray absorptiometry (DXA) remains the gold standard for diagnosing osteoporosis, its availability and cost for mass screening are limited. This study aims to determine an effective fracture risk assessment tool (FRAX) cut-off value for screening osteoporosis in the Thai geriatric population. The demographic data, FRAX hip fracture (HF), major osteoporotic fracture (MOF), and Bone mineral density (BMD) of community-dwelling Thai adults aged ≥ 60 years, conducted between March 2021 to August 2022 were analyzed. Osteoporosis is defined as a BMD T-score ≤ − 2.5. The accuracy of FRAX in identifying osteoporosis was assessed using the area under the receiver operating characteristic curve (AUC). Among 2991 participants (average age 69.2 ± 6.5 years), the discriminative ability was acceptable for both FRAX hip fracture (HF) (AUC = 0.75) and major osteoporotic fracture (MOF) (AUC = 0.72). A cut-off value of 1.5 for FRAX HF and 4.5 for FRAX MOF demonstrated excellent sensitivity (90.4%) and a high negative predictive value (89.7%) in osteoporosis detection. This study identifies FRAX cut-off values that can effectively screen for high-risk osteoporosis in the Thai geriatric population and suggests that FRAX could be a valuable tool for initial osteoporosis screening in Thai seniors. [ABSTRACT FROM AUTHOR]

Abstract Background Hip fractures are common among frail, older people and associated with multiple adverse outcomes, including death. Timely and appropriate care by a multidisciplinary team may improve outcomes. Implementing a team to jointly deliver the service in resource-limited settings is challenging, particularly on the effectiveness of patient outcomes. Methods A retrospective cohort study to compare outcomes of hip fracture patients aged 65 or older admitted at Siriraj hospital before and after implementation of the Fast-track program for Acute Geriatric Hip Fractures. The primary outcome was the incidence of medical complications. The secondary outcomes were time to surgery, factors related to the occurrence of various complications, in-hospital mortality, and mortality at month 3, month 6 and month 12 after the operation. Results Three hundred two patients were enrolled from the Siriraj hospital’s database from October 2016 to October 2018; 151 patients in each group with a mean age of 80 years were analyzed. Clinical parameters were similar between groups except the Fast-track group comprising more patients with dementia (37.1% VS 23.8%, p

Abstract Background The ATTUNE Knee System is a new prosthetic design that has theoretical advantages over the Press Fit Condylar (PFC) Sigma Knee System specific to improved knee kinematics and patellofemoral joint tracking. This study aimed to evaluate functional outcomes compared between the ATTUNE and PFC Sigma designs at a minimum follow-up of 5 years. Methods We retrospectively reviewed data from total knee arthroplasty (TKA) patients who received either the ATTUNE or PFC Sigma system during November 2013 to February 2015 at Siriraj Hospital (Bangkok, Thailand). Functional outcomes were evaluated using Timed Up and Go (TUG) test, 2-min walk test (2MWT), modified knee score, numerical rating scale-pain, range of motion (ROM), and rate of anterior knee pain and crepitation at preoperation, 3-months, 1-year, and 5-years postoperatively. Results Of 113 patients, 59 and 54 received the PFC Sigma and ATTUNE systems, respectively. At a minimum of 5-years follow-up, all functional outcomes improved significantly from the preoperative period although TUG test and 2MWT declined significantly from 1- to 5-years postoperatively only in the PFC Sigma group. The mean ROM at 5-years postoperatively was significantly higher in ATTUNE than in PFC Sigma; however, the difference was small (116° vs. 110°, respectively; p = 0.041). There were no significant differences in any of the other outcome measurements, including anterior knee pain, clunking, and crepitation, between groups at any study time point. Conclusions ​Our results revealed no major differences in functional outcomes between the PFC Sigma and ATTUNE TKA designs at an intermediate-term follow-up of at least 5 years. Longer-term follow-up study is needed to evaluate the benefits of the ATTUNE design relative to polyethylene wear and the rate of aseptic loosening.

Background: With the increasing number of older adults, musculoskeletal disorders such as sarcopenia have become increasingly important to research because of their strong association with falls and fractures. Sarcopenia, which is characterized by reduced muscle mass, is common among older adults and significantly increases the risk of falls. This study aimed to assess the effectiveness of the SARC-F and SARC-CalF questionnaires, along with calf circumference measurements, for sarcopenia screening among Thai community-dwelling older adults, following the 2019 criteria of the Asian Working Group for Sarcopenia. Methods: This analysis drew on data from the Thai Musculoskeletal Diseases Nationwide Study, which included 2543 participants aged 60 years or older. The SARC-F, SARC-CalF, and calf circumference data were evaluated against the 2019 Asian Working Group for Sarcopenia criteria. We calculated the sensitivity, specificity, and area under the curve to determine the diagnostic performance of each tool. Results: Of the 2455 participants analyzed, 18.1% were diagnosed with sarcopenia. The SARC-F and SARC-CalF questionnaires showed limited effectiveness in diagnosing sarcopenia, with area under the curve values of 0.508 and 0.729, respectively. In contrast, calf circumference demonstrated greater diagnostic accuracy, with area under the curve values of 0.897 in males and 0.878 in females. Adjusting the cutoff points to < 33 cm for males and < 31 cm for females improved the overall diagnostic accuracy from 66.4 to 82%. Conclusions: Sarcopenia is relatively prevalent in Thailand. The SARC-F and SARC-CalF questionnaires are inadequate for diagnosing sarcopenia, while calf circumference alone is the most effective screening tool. Adding more parameters to the SARC-F questionnaire could enhance its diagnostic accuracy. Trial registration: This study was registered at ClinicalTrials.gov (NCT06558617). Registration Date 16 August 2024. [ABSTRACT FROM AUTHOR]

Introduction: The comparative results of early hip fracture surgery including mortality and postoperative complications in Thailand were not reported. Therefore, we conducted this study to compare the outcomes between patients who received hip surgery within and after 24 hours. Methods: A retrospective study was conducted at a single center, a tertiary private hospital in Thailand. The medical records of patients who were admitted from 2018 to 2020 were reviewed. Patients aged <50 years, high-energy fracture, pathological fractures, or multiple traumas were excluded. The patients were categorized into two groups for comparison: surgery within and surgery after 24 hours groups. The outcome measures were in-hospital, 30-day, and 1-year mortality rates, length of stay, and the incidences and severities of postoperative complications. Results: A total of 276 hip fracture patients were analyzed, with the majority (77.9%) undergoing surgery within 24 hours. Patients who underwent earlier surgery had a significantly shorter hospital stay [6 (4, 9) vs 8 (7, 13) days, P <.001]. The cumulative mortality rates at in-hospital, 30 days, and 1 year were 0%, 1.1%, and 2.5%, respectively. The most common postoperative complications observed were anemia (43.1%) and acute kidney injury (32.6%). However, there were no statistically significant differences in mortality rates (P >.05) or postoperative complications (P =.410) between the two groups. Conclusion: While surgery within 24 hours showed some benefits, such as a shorter hospital stay and reduced pain rescue, it did not reduce mortality or major complications in hip fracture patients. [ABSTRACT FROM AUTHOR]

A survey of awareness and attitudes to the management of fragility fractures among the membership of the Asia Pacific Orthopaedic Association conducted in 2022 found considerable variation in care across the region. A Call to Action is proposed to improve acute care, rehabilitation and secondary fracture prevention across Asia Pacific. Purpose: Fragility fractures impose a substantial burden on older people and their families, healthcare systems and national economies. The current incidence of hip and other fragility fractures across the Asia Pacific region is enormous and set to escalate rapidly in the coming decades. This publication describes findings of a survey of awareness and attitudes to the management of fragility fractures among the membership of the Asia Pacific Orthopaedic Association (APOA) conducted in 2022. Methods: The survey was developed as a collaboration between the Asia Pacific Osteoporosis and Fragility Fracture Society and the Asia Pacific Fragility Fracture Alliance, and included questions relating to aspects of care upon presentation, during surgery and mobilisation, secondary fracture prevention, and access to specific services. Results: In total, 521 APOA members completed the survey and marked variation in delivery of care was evident. Notable findings included: Fifty-nine percent of respondents indicated that analgesia was routinely initiated in transit (by paramedics) or within 30 minutes of arrival in the Emergency Department. One-quarter of respondents stated that more than 80% of their patients underwent surgery within 48 hours of admission. One-third of respondents considered non-hip, non-vertebral fractures to merit assessment of future fracture risk. One-third of respondents reported the presence of an Orthogeriatric Service in their hospital, and less than a quarter reported the presence of a Fracture Liaison Service. Conclusion: A Call to Action for all National Orthopaedic Associations affiliated with APOA is proposed to improve the care of fragility fracture patients across the region. [ABSTRACT FROM AUTHOR]