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Bellova P, Linne M, Postler AE, Günther KP, Stiehler M, Goronzy J. Girdlestone resection arthroplasty for femoral neck fractures has poorer outcomes than hemiarthroplasty in frail patients with increased risk for arthroplasty-related complications: a retrospective case study of 21 patients. Acta Orthop 2024; 95:61-66. [PMID: 38288960 PMCID: PMC10826842 DOI: 10.2340/17453674.2024.34901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 11/23/2023] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND AND PURPOSE Hemiarthroplasty (HA) is the usual treatment for displaced femoral neck fractures (FNF) in elderly patients. Patients may be unsuitable for HA due to secondary conditions such as systemic infections or severe neurological conditions, which is why Girdlestone resection arthroplasty (GRA) may be an option. We aimed to determine (1) patient survival in matched patient groups treated with either GRA or HA and (2) functional outcomes. PATIENTS AND METHODS 21 patients treated with GRA for FNF in a German university hospital were retrospectively reviewed (2015-2019). After matching for age and comorbidities, a control group of 42 HA patients was established. Patient survival was determined by a Kaplan-Meier analysis. The mean follow-up (FU) was 1.5 (0-4.4) years. Function at FU was documented using the modified Harris Hip Score (mHHS) and the National Hip Fracture Database (NHFD) mobility score. RESULTS The 1-month-mortality was 19% in the GRA group and 12% in the HA group; the 1-year mortality was 71% and 49%, respectively (P = 0.01). The mHHS at FU was lower in the GRA group than in the HA group (22 [range 0-50] vs. 46 [11-80]). 82% of patients in the GRA group were bedridden post-surgery as opposed to 19% in the HA group. CONCLUSION Patients with HA after FNF had higher survival and better functional outcomes when compared with GRA in matched patient groups. Considering this, GRA for FNF should be selected restrictively.
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Affiliation(s)
- Petri Bellova
- Department of Orthopaedics, Trauma and Plastic Surgery, University Clinic Garl Gustav Carus, Technical University (TU) Dresden, Germany.
| | - Marcus Linne
- Department of Orthopaedics, Trauma and Plastic Surgery, University Clinic Garl Gustav Carus, Technical University (TU) Dresden, Germany
| | - Anne Elisabeth Postler
- Department of Orthopaedics, Trauma and Plastic Surgery, University Clinic Garl Gustav Carus, Technical University (TU) Dresden, Germany
| | - Klaus-Peter Günther
- Department of Orthopaedics, Trauma and Plastic Surgery, University Clinic Garl Gustav Carus, Technical University (TU) Dresden, Germany
| | - Maik Stiehler
- Department of Orthopaedics, Trauma and Plastic Surgery, University Clinic Garl Gustav Carus, Technical University (TU) Dresden, Germany
| | - Jens Goronzy
- Department of Orthopaedics, Trauma and Plastic Surgery, University Clinic Garl Gustav Carus, Technical University (TU) Dresden, Germany
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Sioutis S, Zikopoulos A, Karampikas V, Mitsiokapa E, Tsatsaragkou A, Katsanos S, Mastrokalos D, Koulalis D, Mavrogenis AF. Hip Fractures in Patients with Dementia: An Emerging Orthopedic Concern. J Long Term Eff Med Implants 2024; 34:85-93. [PMID: 37938210 DOI: 10.1615/jlongtermeffmedimplants.2023046658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Hip fractures are a very common injury in the elderly population associated with an increased mortality rate. Currently, more and more elderly patients are diagnosed with dementia. Demented patients are more prone to falls and hip fractures compared to the general population because of conditions related to their disease such as instability, osteoporosis, poor muscle control and weakness. The coexistence of dementia and hip fractures is a difficult situation for both the patients and the treating physicians because of postoperative complications in this frail subgroup of patients and their inability to stand up and walk. To enhance the literature, we reviewed published studies of hip fracture patients suffering from dementia to discuss why they have more frequent hip fractures, to review their associated in-hospital complications, and to emphasize on their postoperative management to be able to reach the pre-injury activity level and optimal quality of life.
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Affiliation(s)
- Spyridon Sioutis
- First Department of Orthopaedics, National and Kapodistrian University of Athens, University Medical School, Athens, Greece
| | - Alexandros Zikopoulos
- First Department of Orthopaedics, National and Kapodistrian University of Athens, Athens, Greece
| | - Vasileios Karampikas
- First Department of Orthopedics, National and Kapodistrian University of Athens, ATTIKON University General Hospital, Athens, Greece
| | - Evanthia Mitsiokapa
- Department of Physical and Rehabilitation Medicine, Thoracic Diseases General Hospital Sotiria, Athens, Greece
| | | | - Spyridon Katsanos
- Department of Emergency Medicine and Cardiology, National and Kapodistrian University of Athens
| | - Dimitrios Mastrokalos
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Dimitrios Koulalis
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Andreas F Mavrogenis
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, ATTIKON University Hospital, Athens, Greece
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Wang Y, Ma JX, Bai HH, Lu B, Sun L, Jin HZ, Ma XL. Mechanical analysis of the femoral neck dynamic intersection system with different nail angles and clinical applications. World J Clin Cases 2023; 11:4814-4823. [PMID: 37584003 PMCID: PMC10424033 DOI: 10.12998/wjcc.v11.i20.4814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/07/2023] [Accepted: 06/25/2023] [Indexed: 07/11/2023] Open
Abstract
BACKGROUND The femoral neck dynamic intersection system (FNS) is mechanically more stable than other internal fixation techniques. Current studies have confirmed that the structural design of FNS has good biomechanical properties in European and American populations. However, whether the suitability of the FNS's 130° main nail angle design for Asian populations has been thoroughly investigated remains unclear. AIM To compare the biomechanical stability differences among different main nail angles of the FNS in the treatment of femoral neck fractures in Asian populations. METHODS Computed tomography data of the femur of healthy adult male volunteers were imported into Mimics software to create a three-dimensional model of the femur. The model was adapted to the curve using Geomagic software and imported into Solidworks software to construct the Pauwels I femoral neck fracture model and design the FNS internal fixation model using different main nail angles. Afterward, the models were assembled with the FNS fracture model and meshed using the preprocessing Hypermesh software. Subsequently, they were imported into Abaqus software to analyze and evaluate the biomechanical effects of different angles of the FNS main nail on the treatment of femoral neck fractures. RESULTS The peak displacement of the proximal femur under different angles of FNS fixation under stress was 7.446 millimeters in the 120° group and 7.416 millimeters in the 125° group; in the 130°, 135°, and 140° FNS fixation groups, the peak displacement was 7.324 millimeters, 8.138 millimeters, and 8.246 millimeters, respectively. In the 120° and 125° FNS fixation groups, the maximum stresses were concentrated at the main nail and the anti-rotation screw, which intersected the fracture line of the femur neck, resulting in peak stresses of 200.7 MPa and 138.8 MPa, respectively. Peak stresses of 208.8 MPa, 219.8 MPa, and 239.3 MPa were observed on the angular locking plate distal to the locking screw in the 130°, 135°, and 140° fixation groups. CONCLUSION FNS has significant stress distribution properties, a minimal proximal femoral displacement, and an optimal stability for treating femoral neck fractures in Asian populations when performed with a 130° main nail angle.
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Affiliation(s)
- Ying Wang
- Orthopaedics Institute, Tianjin Hospital, Tianjin University, Tianjin 300050, China
| | - Jian-Xiong Ma
- Orthopaedics Institute, Tianjin Hospital, Tianjin University, Tianjin 300050, China
| | - Hao-Hao Bai
- Orthopaedics Institute, Tianjin Hospital, Tianjin University, Tianjin 300050, China
| | - Bin Lu
- Orthopaedics Institute, Tianjin Hospital, Tianjin University, Tianjin 300050, China
| | - Lei Sun
- Orthopaedics Institute, Tianjin Hospital, Tianjin University, Tianjin 300050, China
| | - Hong-Zhen Jin
- Orthopaedics Institute, Tianjin Hospital, Tianjin University, Tianjin 300050, China
| | - Xin-Long Ma
- Orthopaedics Institute, Tianjin Hospital, Tianjin University, Tianjin 300050, China
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Wang Y, Ma JX, Bai HH, Lu B, Sun L, Jin HZ, Ma XL. Mechanical analysis of the femoral neck dynamic intersection system with different nail angles and clinical applications. World J Clin Cases 2023; 11:4810-4819. [DOI: 10.12998/wjcc.v11.i20.4810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/07/2023] [Accepted: 06/25/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND The femoral neck dynamic intersection system (FNS) is mechanically more stable than other internal fixation techniques. Current studies have confirmed that the structural design of FNS has good biomechanical properties in European and American populations. However, whether the suitability of the FNS's 130° main nail angle design for Asian populations has been thoroughly investigated remains unclear.
AIM To compare the biomechanical stability differences among different main nail angles of the FNS in the treatment of femoral neck fractures in Asian populations.
METHODS Computed tomography data of the femur of healthy adult male volunteers were imported into Mimics software to create a three-dimensional model of the femur. The model was adapted to the curve using Geomagic software and imported into Solidworks software to construct the Pauwels I femoral neck fracture model and design the FNS internal fixation model using different main nail angles. Afterward, the models were assembled with the FNS fracture model and meshed using the preprocessing Hypermesh software. Subsequently, they were imported into Abaqus software to analyze and evaluate the biomechanical effects of different angles of the FNS main nail on the treatment of femoral neck fractures.
RESULTS The peak displacement of the proximal femur under different angles of FNS fixation under stress was 7.446 millimeters in the 120° group and 7.416 millimeters in the 125° group; in the 130°, 135°, and 140° FNS fixation groups, the peak displacement was 7.324 millimeters, 8.138 millimeters, and 8.246 millimeters, respectively. In the 120° and 125° FNS fixation groups, the maximum stresses were concentrated at the main nail and the anti-rotation screw, which intersected the fracture line of the femur neck, resulting in peak stresses of 200.7 MPa and 138.8 MPa, respectively. Peak stresses of 208.8 MPa, 219.8 MPa, and 239.3 MPa were observed on the angular locking plate distal to the locking screw in the 130°, 135°, and 140° fixation groups.
CONCLUSION FNS has significant stress distribution properties, a minimal proximal femoral displacement, and an optimal stability for treating femoral neck fractures in Asian populations when performed with a 130° main nail angle.
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Affiliation(s)
- Ying Wang
- Orthopaedics Institute, Tianjin Hospital, Tianjin University, Tianjin 300050, China
| | - Jian-Xiong Ma
- Orthopaedics Institute, Tianjin Hospital, Tianjin University, Tianjin 300050, China
| | - Hao-Hao Bai
- Orthopaedics Institute, Tianjin Hospital, Tianjin University, Tianjin 300050, China
| | - Bin Lu
- Orthopaedics Institute, Tianjin Hospital, Tianjin University, Tianjin 300050, China
| | - Lei Sun
- Orthopaedics Institute, Tianjin Hospital, Tianjin University, Tianjin 300050, China
| | - Hong-Zhen Jin
- Orthopaedics Institute, Tianjin Hospital, Tianjin University, Tianjin 300050, China
| | - Xin-Long Ma
- Orthopaedics Institute, Tianjin Hospital, Tianjin University, Tianjin 300050, China
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Longo UG, Viganò M, de Girolamo L, Banfi G, Salvatore G, Denaro V. Epidemiology and Management of Proximal Femoral Fractures in Italy between 2001 and 2016 in Older Adults: Analysis of the National Discharge Registry. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16985. [PMID: 36554865 PMCID: PMC9778915 DOI: 10.3390/ijerph192416985] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 12/12/2022] [Accepted: 12/15/2022] [Indexed: 06/17/2023]
Abstract
This study aims to determine the annual incidence of proximal femoral fractures in Italy in the period between 2001 and 2016 among older adults, and to describe the trends in the clinical management of these cases. Data were retrieved from the National Hospital Discharge records issued by the Italian Ministry of Health and from the Italian Institute for Statistics. The number of hospitalizations increased between 2001 and 2016, while the age-adjusted yearly incidence decreased from 832.2 per 100,000 individuals to 706.2. The median age was 83 years (IQR 78-88) with a large majority of females (76.6%). The type of fracture varied with age in female subjects, with older women more frequently reporting pertrochanteric fractures. Therapeutic strategies for the different types of fracture depended on patients' age. During the study years, improvements in fracture classification and management strategies were observed, with a clear decreasing trend for non-operative solutions. In conclusion, the number of proximal femur fractures in older adults is growing, even if at a lower rate compared to population aging. The Italian surgical practice changed during the study period towards the implementation of the most recent guidelines.
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Affiliation(s)
- Umile Giuseppe Longo
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Rome, Italy
| | - Marco Viganò
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161 Milano, Italy
| | - Laura de Girolamo
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161 Milano, Italy
| | - Giuseppe Banfi
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161 Milano, Italy
| | - Giuseppe Salvatore
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Rome, Italy
| | - Vincenzo Denaro
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Rome, Italy
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