Health related quality of life and mortality 10 years after a femoral neck fracture in patients younger than 70 years

Anti-Shortening Screw for the Prevention of Postoperative Shortening in Displaced Femoral Neck Fractures: A Retrospective Cohort Study

BACKGROUND

Early femoral neck shortening after femoral neck system (FNS) fixation for displaced femoral neck fractures can occur in 22.3%-39.1% of cases, leading to decreased hip joint function. This study aimed to investigate the effectiveness of using an anti-shortening screw (ASS) in FNS fixation to prevent postoperative femoral neck shortening in displaced femoral neck fractures.

METHODS

We retrospectively analyzed 106 cases of displaced femoral neck fractures treated with FNS at the Hospital from April 2020 to April 2023. Patients were divided into two groups based on the use of an ASS: the traditional group and the ASS group, each consisting of 53 cases. The ASS group was age-matched with the traditional group treated during the same period without an ASS. The study variables included age, sex, body mass index (BMI), smoking and drinking history, injury mechanism, side of injury, fracture type, surgical time, intraoperative blood loss, Harris Hip Score (HHS) at the final follow-up, radiographic assessment (femoral neck shortening), and complications (infection, femoral head necrosis, nonunion, and secondary surgery). Statistical analysis was performed using SPSS software, with continuous and categorical variables analyzed using appropriate parametric (t-test) and nonparametric (Mann-Whitney U test) tests, and chi-square or Fisher's exact tests, respectively. A p-value <0.05 was considered significant.

RESULTS

There were no significant differences in background characteristics between the traditional and ASS groups. The shortening distance at postoperative day 1 did not differ significantly between the two groups (0 vs. 0 mm, p = 0.120). However, at 1, 3 months, and 1 year postoperatively, the femoral neck shortening in the ASS group was significantly less than that in the traditional group (1 month: 2.3 vs. 3.1 mm, p = 0.007; 3 months: 2.6 vs. 3.5 mm, p = 0.005; 1 year: 2.6 vs. 3.5 mm, p = 0.002). The ASS group also had a significantly lower shortening distance during the fracture healing process (0.9 vs. 2.7 mm, p = 0.005). The incidence of moderate to severe shortening (≥5 mm) at 1 year postoperatively was lower in the ASS group compared with the traditional group (15.1% vs. 37.7%, p = 0.001). The ASS group had a longer surgical time (63.0 ± 13.4 vs. 73.0 ± 23.2 min, p = 0.008) and a higher HHS (90.7 vs. 94.8, p = 0.008). There was no significant difference in fracture healing time or postoperative complications between the two groups. The traditional group had 3.8% cutouts, 7.5% nonunions, 5.7% avascular necrosis, and 7.5% secondary hip replacements. The ASS group saw 0% cutouts, 1.9% nonunions, 3.8% avascular necrosis, and 3.8% hip replacements. No significant differences in complication rates (p > 0.05).

CONCLUSION

The use of an ASS in FNS fixation for displaced femoral neck fractures can reduce the degree of postoperative shortening and improve hip joint function.

Comparison between Orthopaedic Trauma versus Arthroplasty Fellowship Training on Outcomes of Total Hip Arthroplasty for Femoral Neck Fracture

BACKGROUND

This study aimed to identify differences in patient characteristics, perioperative management methods, and outcomes for total hip arthroplasty (THA) for femoral neck fracture (FNF) when performed by orthopaedic surgeons who have arthroplasty versus orthopaedic trauma training.

METHODS

This study was a multicenter, retrospective review of 636 patients who underwent THA for FNF between 2010 and 2019. There were 373 patients who underwent THA by an arthroplasty surgeon, and 263 who underwent THA by an orthopaedic trauma surgeon. Comorbidities, management methods, and outcomes were compared between patients operated on by orthopaedic surgeons who had arthroplasty versus trauma training.

RESULTS

Arthroplasty-trained surgeons had shorter operative times (102 vs 128 minutes, P<0.0001) and utilized tranexamic acid more frequently than trauma-trained surgeons (48.8 vs 18.6%, P<0.0001). Orthopaedic trauma surgeons more frequently utilized an anterior approach. Patients of arthroplasty-trained surgeons had lower rates of complications including pulmonary embolism (1.6 vs 6.5%, P=0.0019) and myocardial infarction (1.6 vs 11.0%, P<0.0001). Similarly, patients of arthroplasty-trained surgeons were discharged faster (5.3 vs 7.9 days, P<0.0001) with greater ambulation capacity (92.2 vs 57.2 feet, P<0.0001). Dislocation, periprosthetic joint infection, and revision were similar between both groups. When adjusted for covariates, there was no difference in 90-day, 1-year, or 2-year mortality.

CONCLUSION

A THA performed for FNF by arthroplasty surgeons was associated with lower in-hospital morbidities and improved functional statuses at discharge. However, mortalities and complications after discharge were similar between both specialties when adjusted for confounding variables. Optimization of protocols may further improve outcomes for THA for FNF.

Health-related quality of life and associated factors after hip fracture. Results from a six-month prospective cohort study

Background

Hip fractures are a major public health problem with increasing relevance in aging societies. They are associated with high mortality rates, morbidity, and loss of independence. The aim of the EMAAge study was to determine the impact of hip fractures on patient-reported health-related quality of life (HRQOL), and to identify potential risk factors for worse outcomes.

Methods

EMAAge is a multicenter, prospective cohort study of patients who suffered a hip fracture. Patients or, if necessary, proxies were interviewed after initial treatment and after six months using standardized questionnaires including the EQ-5D-5L instrument, the Oxford Hip Score, the PHQ-4, the Short Nutritional Assessment Questionnaire, and items on patients living situation. Medical data on diagnoses, comorbidities, medications, and hospital care were derived from hospital information systems.

Results

A total of 326 patients were included. EQ-5D index values decreased from a mean of 0.70 at baseline to 0.63 at six months. The mean self-rated health on the EQ-VAS decreased from 69.9 to 59.4. Multivariable linear regression models revealed three relevant associated factors with the six-months EQ-5D index: symptoms of depression and anxiety, pre-fracture limitations in activities of daily living, and no referral to a rehabilitation facility had a negative impact. In addition, the six-months EQ-VAS was negatively associated with polypharmacy, living in a facility, and migration background.

Conclusions

Hip fractures have a substantial negative impact on patients HRQOL. Our results suggest that there are modifying factors that need further investigation including polypharmacy and migration background. Structured and timely rehabilitation seems to be a protective factor.

Dual-mobility cup total hip arthroplasty improves the quality of life compared to internal fixation in femoral neck fractures patients with severe neuromuscular disease in the lower extremity after stroke: a retrospective study

Background

This study aimed to demonstrate that dual-mobility cup total hip arthroplasty (DMC-THA) can significantly improve the quality of life (QOL) of elderly femoral neck fracture patients with severe neuromuscular disease in unilateral lower extremities due to stroke hemiplegia compared to internal fixation (IF).

Methods

Fifty-eight cases of severe neuromuscular disease in the unilateral lower extremities with muscle strength < grade 3/5 due to stroke were retrospectively examined From January 2015 to December 2020. Then, patients were divided into DMC and IF groups. The QOL was examined using the EQ-5D and SF-36 outcome measures. The physical and mental statuses were assessed using the Barthel Index (BI) and e Fall Efficacy Scale-International (FES-I), respectively.

Results

Patients in the DMC group had higher BI scores than those in the IF group at different time point. Regarding mental status, the FES-I mean score was 42.1 ± 5.3 in the DMC group and 47.3 ± 5.6 in the IF group (p = 0.002). For the QOL, the mean SF-36 score was 46.1 ± 18.3 for the health component and 59.5 ± 15.0 for the mental component in the DMC group compared to 35.3 ± 16.2 (p = 0.035), and 46.6 ± 17.4 (p = 0.006) compared to the IF group. The mean EQ-5D-5L values were 0.733 ± 0.190 and 0.303 ± 0.227 in the DMC and IF groups (p = 0.035), respectively.

Conclusion

DMC-THA significantly improved postoperative QOL compared to IF in elderly patients with femoral neck fractures and severe neuromuscular dysfunction in the lower extremity after stroke. The improved outcomes were related to the enhanced early, rudimentary motor function of patients.

Locking compression plate fixation of femoral intertrochanteric fractures in patients with preexisting proximal femoral deformity: a retrospective study

Background

To investigate the clinical efficacy of locking compression plate fixation for the treatment of femoral intertrochanteric fractures in patients with preexisting proximal femoral deformity.

Methods

A retrospective analysis was conducted on 37 patients with femoral intertrochanteric fractures combined with preexisting proximal femoral deformity between January 2013 and July 2019. The patients included 24 males and 13 females aged from 23 to 69 years old, with an average age of 47.5 years. The preexisting proximal femoral deformities resulted from poliomyelitis sequela, proximal femoral fibrous dysplasia, malunion and implant failure combined with coxa vara after intramedullary nailing fixation. There were 6 cases of 31-A2.1, 6 cases of 31-A2.2, 20 cases of 31-A3.1, and 5 cases of 31-A3.2, determined based on the AO classification of intertrochanteric fractures. All fractures were managed through open reduction and locking plate fixation. The hip disability and osteoarthritis outcome score (HOOS) was used to assess hip function before injury and at the last postoperative follow-up. The short form 36 (SF-36) Health Survey Questionnaire was used to assess quality of life.

Results

Thirty-seven patients were followed up for 12 to 27 months (average, 20.7 months). All patients achieved bone healing within 5.1 months on average (range, 3 to 6 months). Postoperative complications included deep vein thrombosis in three patients, bedsores in one and delayed union in one patient. No other complications, such as surgical site infection, fat embolism, nonunion and re-fracture, were presented. There was no significant difference in the HOOS scores and the SF-36 Health Questionnaire outcomes at pre-injury and at the last postoperative follow-up (p > 0.05).

Conclusions

It is difficult to perform intramedullary fixation of femoral intertrochanteric fractures in patients with preexisting proximal femoral deformity, while locking compression plate fixation is a simple and effective method of treatment.