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Rina Jain

Publications and source records attributed to Rina Jain.

5 recordsLinked to original sources
PubMed2002

Nonoperative treatment of hip fractures.

We retrospectively reviewed a population database and a case series to compare the mortality of operative and nonoperative treatment of hip fractures in patients with severe comorbidity. Nonoperative treatment of hip fractures (bed rest or early weight bearing) was administered based on medical assessment of perioperative risk. Comparison of 30-day mortality was performed between the nonoperatively and operatively treated groups. We found that of 50,235 of hip fractures that occurred between 1992 and 1998, 89.4% were treated operatively. Thirty-day mortality rate in the nonoperatively treated patients (18.8%) was higher than the rate in operatively treated patients (11.0%) (odds ratio 1.7 times, 95% confidence interval (CI) 1.6, 1.8). In the case series, of 62 elderly patients with severe comorbidity treated nonoperatively, 41 had bed rest/traction, while 21 were mobilized early. A group of operatively treated patients (n=108) was compared to nonoperatively treated patients. Mortality with nonoperative treatment was higher with bed rest (73%) compared to early mobilization (odds ratio 3.8, 95% CI 1.1-14.0). There was no significant difference in mortality between operatively treated patients (29%) and patients treated nonoperatively with immediate mobilization (19%). Bed rest was 2.5 times more likely to be associated with mortality compared to operative treatment (95% CI 1.1-5.5).

Aged↗
PubMed2002

Comparison of early and delayed fixation of subcapital hip fractures in patients sixty years of age or less.

BACKGROUND: Subcapital hip fractures in younger patients are generally treated with internal fixation rather than with primary hemiarthroplasty, which is generally reserved for older, low-demand patients. Avascular necrosis can occur following this injury because of disruption of the femoral head blood supply. Some believe that emergent fracture reduction is necessary to minimize the risk of avascular necrosis. The purposes of this study were (1) to investigate the functional outcomes of subcapital hip fractures in patients sixty years old or younger and (2) to compare the rates of avascular necrosis after early and delayed fracture fixation. METHODS: This retrospective study included adults in whom a subcapital hip fracture had been treated with reduction and internal fixation when they were sixty years of age or less and who had been followed clinically for a minimum of two years. The patients were divided into two groups: those treated with early fixation (within twelve hours after the injury) and those treated with delayed fixation (more than twelve hours after the injury). Functional outcomes were assessed with use of the Short Form-36 and the Western Ontario and McMaster University (WOMAC) Osteoarthritis Index. The rates of avascular necrosis were compared between the two groups. RESULTS: Thirty-eight patients (average age, 46.4 years) participated in the study. Twenty-nine patients had a displaced subcapital hip fracture. Fifteen patients underwent early fracture fixation, and the remainder underwent delayed fixation. No differences in the Short Form-36 (p = 0.68) or WOMAC (p = 0.69) scores were seen between the early and delayed fixation groups. Radiographic evidence of avascular necrosis developed in six patients treated with delayed fixation, one of whom had had an undisplaced fracture preoperatively, and in no patient treated with early fixation. The difference in the rates of avascular necrosis was significant (p = 0.03). CONCLUSIONS: Although delayed surgical treatment of subcapital hip fractures was associated with a higher rate of avascular necrosis, this complication did not significantly affect functional outcome. Longer follow-up is required to assess the effect of avascular necrosis on the development of arthritis and on long-term patient function. Although the results could be biased because patients were not randomly assigned to delayed or early fixation, the data suggest that urgent reduction and fracture fixation within twelve hours after a displaced subcapital hip fracture in high-demand patients may be associated with a reduced rate of radiographic signs of avascular necrosis.

Adult↗
PubMedDate not supplied

The floating first metatarsal: a case report.

Complete dislocation of the first metatarsal represents an infrequent injury. The authors present the case of a 48-year-old man who sustained dislocation of the first metatarsal from both the metatarsophalangeal and tarsometatarsal joints in a motor vehicle accident. After open reduction, the first metatarsophalangeal joint was temporarily fixated with a Kirschner wire to maintain reduction, while the first metatarso-cuneiform joint was fixated with two cannulated screws. A discussion of the pertinent literature regarding this rare injury is also included.

Ankle Injuries↗