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Scattergood SD, Berry AL, Flannery O, Burdon A, Mitchell SR, Fletcher JWA. Low avascular necrosis rates in femoral neck fractures: efficacy of cannulated screw fixation. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:2565-2571. [PMID: 38698278 PMCID: PMC11291580 DOI: 10.1007/s00590-024-03956-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 04/08/2024] [Indexed: 05/05/2024]
Abstract
PURPOSE Cannulated screw fixation for femoral neck fractures is often limited by concerns of avascular necrosis (AVN) occurring, historically seen in 5-40% of fixed intracapsular fractures. This study aims to assess the outcomes, particularly the AVN rate, associated with current surgical techniques within our unit. METHODS We conducted a single-center cross-sectional study, manually searching operative records between July 14, 2014, and December 1, 2018, identifying patients with intracapsular fractured neck of femur fixed with cannulated screws, with a minimum of two years follow-up. Patient records and radiographs were reviewed for clinical and radiographic diagnoses of AVN, non-union, post-operative metalwork infection, and screw penetration of the head. Additionally, fracture pattern and displacement, screw configuration, reduction techniques, and adequacy of reduction were recorded, with radiographs independently analyzed by four orthopedic surgeons. RESULTS Fifty-six patients were included; average age of 67 years (range 30-100). Forty-two patients (75%) sustained displaced fractures and 14 patients (25%) had undisplaced fractures. Two (4%) patients developed AVN, with no cases of non-union, post-operative metalwork infection or screw penetration of the head. Eight patients (14%) sustained a high-energy injury, though none of these patients developed AVN. All fractures required closed reduction; no open reductions performed. Twenty-seven (64%) of reductions were adequate. CONCLUSION Our observed AVN rate is notably lower than the widely reported figures, even among a significant proportion of displaced fractures that were fixed. This study underscores that with adequate fixation, cannulated screws represent an excellent option for treating intracapsular neck of femur fractures, even in cases of displaced fracture patterns with imperfect reduction.
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Affiliation(s)
- S D Scattergood
- Department of Trauma and Orthopaedics, Bristol Royal Infirmary, Bristol, UK
| | - A L Berry
- Department of Trauma and Orthopaedics, Bristol Royal Infirmary, Bristol, UK
| | - O Flannery
- Department of Trauma and Orthopaedics, Bristol Royal Infirmary, Bristol, UK
| | - A Burdon
- Department of Mathematical Sciences, University of Bath, Bath, UK
| | - S R Mitchell
- Department of Trauma and Orthopaedics, Bristol Royal Infirmary, Bristol, UK
| | - J W A Fletcher
- Department of Trauma and Orthopaedics, Bristol Royal Infirmary, Bristol, UK.
- Department for Health, University of Bath, Bath, UK.
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Schmitz PP, Somford MP, Jameson SS, Schreurs BW, van Susante JLC. Controversies around hip fracture treatment: clinical evidence versus trends from national registries. Hip Int 2024; 34:144-151. [PMID: 37313801 DOI: 10.1177/11207000231177642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE Several controversies in the optimal treatment of femoral neck fractures persist, together with large variations in clinical practice. METHODS A narrative literature review covering 4 current controversies in the surgical management of femoral neck fractures (total hip arthroplasty (THA) versus hemiarthroplasty (HA), cemented versus uncemented HA, internal fixation versus arthroplasty, operative versus non-operative) was performed. Available literature was balanced against annual trends in the management of femoral neck fractures from the public domain of several national registries (Sweden, Norway, The Netherlands, Australia and New Zealand). RESULTS For most controversies, the literature provides stronger evidence than is reflected by variations encountered in daily practice. Implementation of clinical evidence tends to lag behind and important differences exist between countries. CONCLUSIONS Trends of clinical practice from national registries indicate that implementation of available clinical evidence needs to be improved.
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Affiliation(s)
- Peter P Schmitz
- Department of Orthopaedics, Rijnstate Hospital, Arnhem, The Netherlands
| | | | - Simon S Jameson
- Department of Orthopaedics, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - B Willem Schreurs
- Department of Orthopaedics, Radboud University Medical Centre, Nijmegen, The Netherlands
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Burrack N, Hatfield LA, Bakx P, Banerjee A, Chen YC, Fu C, Godoy Junior C, Gordon M, Heine R, Huang N, Ko DT, Lix LM, Novack V, Pasea L, Qiu F, Stukel TA, Uyl-de Groot C, Ravi B, Al-Azazi S, Weinreb G, Cram P, Landon BE. Variation in care for patients presenting with hip fracture in six high-income countries: A cross-sectional cohort study. J Am Geriatr Soc 2023; 71:3780-3791. [PMID: 37565425 PMCID: PMC10840946 DOI: 10.1111/jgs.18530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/23/2023] [Accepted: 07/01/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Hip fractures are costly and common in older adults, but there is limited understanding of how treatment patterns and outcomes might differ between countries. METHODS We performed a retrospective serial cross-sectional cohort study of adults aged ≥66 years hospitalized with hip fracture between 2011 and 2018 in the US, Canada, England, the Netherlands, Taiwan, and Israel using population-representative administrative data. We examined mortality, hip fracture treatment approaches (total hip arthroplasty [THA], hemiarthroplasty [HA], internal fixation [IF], and nonoperative), and health system performance measures, including hospital length of stay (LOS), 30-day readmission rates, and time-to-surgery. RESULTS The total number of hip fracture admissions between 2011 and 2018 ranged from 23,941 in Israel to 1,219,696 in the US. In 2018, 30-day mortality varied from 3% (16% at 1 year) in Taiwan to 10% (27%) in the Netherlands. With regards to processes of care, the proportion of hip fractures treated with HA (range 23%-45%) and THA (0.2%-10%) differed widely across countries. For example, in 2018, THA was used to treat approximately 9% of patients in England and Israel but less than 1% in Taiwan. Overall, IF was the most common surgery performed in all countries (40%-60% of patients). IF was used in approximately 60% of patients in the US and Israel, but only 40% in England. In 2018, rates of nonoperative management ranged from 5% of patients in Taiwan to nearly 10% in England. Mean hospital LOS in 2018 ranged from 6.4 days (US) to 18.7 days (England). The 30-day readmission rate in 2018 ranged from 8% (in Canada and the Netherlands) to nearly 18% in England. The mean days to surgery in 2018 ranged from 0.5 days (Israel) to 1.6 days (Canada). CONCLUSIONS We observed substantial between-country variation in mortality, surgical approaches, and health system performance measures. These findings underscore the need for further research to inform evidence-based surgical approaches.
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Affiliation(s)
- Nitzan Burrack
- Clinical Research Center, Soroka University Medical Center, and Faculty of Health Sciences, Ben Gurion University of the Negev, Beersheba, Israel
| | - Laura A Hatfield
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Pieter Bakx
- Erasmus School of Health Policy & Management, Erasmus University, Rotterdam, the Netherlands
| | - Amitava Banerjee
- Institute of Health Informatics, University College London, London, UK
- Department of Cardiology, University College London Hospitals, London, UK
| | - Yu-Chin Chen
- Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Christina Fu
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Carlos Godoy Junior
- Erasmus School of Health Policy & Management, Erasmus University, Rotterdam, the Netherlands
| | - Michal Gordon
- Clinical Research Center, Soroka University Medical Center, and Faculty of Health Sciences, Ben Gurion University of the Negev, Beersheba, Israel
| | - Renaud Heine
- Erasmus School of Health Policy & Management, Erasmus University, Rotterdam, the Netherlands
| | - Nicole Huang
- Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Dennis T Ko
- Schulich Heart Program, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Canada
- ICES, Toronto, Canada
- Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Lisa M Lix
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
- George & Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Canada
| | - Victor Novack
- Clinical Research Center, Soroka University Medical Center, and Faculty of Health Sciences, Ben Gurion University of the Negev, Beersheba, Israel
| | - Laura Pasea
- Institute of Health Informatics, University College London, London, UK
| | | | - Therese A Stukel
- ICES, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Carin Uyl-de Groot
- Erasmus School of Health Policy & Management, Erasmus University, Rotterdam, the Netherlands
| | - Bheeshma Ravi
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Canada
- Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Saeed Al-Azazi
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
- George & Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Canada
| | - Gabe Weinreb
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Peter Cram
- Faculty of Medicine, University of Toronto, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Department of Medicine, UTMB, Galveston, Texas, USA
| | - Bruce E Landon
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
- Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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Åberg H, Kalland K, Jonsson KB, Johansson T. Pinloc or Hansson pins: a multicenter, randomized controlled study of 439 patients treated for femoral neck fractures. OTA Int 2023; 6:e282. [PMID: 37744995 PMCID: PMC10516382 DOI: 10.1097/oi9.0000000000000282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 06/06/2023] [Accepted: 07/21/2023] [Indexed: 09/26/2023]
Abstract
Objectives To compare the recently developed Hansson Pinloc system, which features 3 cylindrical parallel pins with hooks connected through a fixed-angle interlocking plate, with the Hansson Pin System (2 hook pins) for the treatment of femoral neck fractures. Design One hundred fourteen patients with displaced femoral neck fractures and 325 patients with nondisplaced fractures from 9 orthopaedic centers were randomized to either Hansson Pinloc system or Hansson Pin System and followed for 2 years or until death. Age at inclusion was 50 years or older. Main Outcome Measurements The primary outcome was failure (defined as early displacement, nonunion, symptomatic avascular necrosis, or deep infection). Secondary outcomes included revision surgery, Timed Up and Go (TUG) test and patient-reported outcome measures (PROMs: EQ-5D and WOMAC). Results For nondisplaced fractures, the incidence of failure was 14% (23/169) in the Pinloc group and 16% (25/156) in the Hansson group. For displaced fractures, the analysis was stratified by age. Patients aged 50-69 years with displaced fractures showed a 2-year failure rate of 44% (17/39) in the Pinloc group versus 44% (16/36) in the Hansson group. For patients 70 years or older with displaced fractures, 33% (7/21) in the Pinloc group versus 22% (4/18) in the Hansson group failed. At 3 and 12 months, no clinically significant differences between treatment groups were found for EQ-5D-3L, WOMAC, or for the TUG in any fracture type or age group. Conclusions There were no advantages for Pinloc in any of the studies aspects. Level of evidence 1.
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Affiliation(s)
- Henrik Åberg
- Department of Orthopedic Surgery, Institution of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Kristine Kalland
- Department of Orthopedic Surgery, Nyköping Hospital, Nyköping, Sweden
| | - Kenneth B. Jonsson
- Department of Orthopedic Surgery, Institution of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Torsten Johansson
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
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Kumar J, Symonds T, Quinn J, Walsh T, Platt S. What is the best method of fixation for minimally displaced subcapital neck of femur fractures? A systematic review. J Orthop 2023; 45:54-60. [PMID: 37854276 PMCID: PMC10579867 DOI: 10.1016/j.jor.2023.09.015] [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: 06/06/2023] [Revised: 07/26/2023] [Accepted: 09/29/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND Femoral neck fractures are a common cause of morbidity and mortality in the community. Minimally displaced subcapital necks of femoral fractures are usually managed with internal fixation, although there is debate as to which method is superior. This systematic review aimed to compare the outcomes of different fixation methods in the management of this common fracture. METHODS This systematic review was conducted in accordance with PRISMA statement guidelines. The databases searched were MEDLINE (Ovid), Cochrane Central Register of Controlled Trials, and EMBASE (Ovid). The study quality and risk of bias were assessed using the Newcastle-Ottawa Quality Assessment Scale, and relevant data were extracted and synthesised. RESULTS Nine articles met the inclusion criteria. A total of 819 patients were included in this study. Eight of the nine studies were case series, and one was a randomised control trial. The mean risk of bias was 7.4/9 for non-randomised articles. The fixation methods used in the included studies were dynamic hip screw (DHS), cannulated screws, Smith-Peterson nail, hooknail, Moore's pins, and Knowle's pins. DHS was found to be a superior method of fixation and was supported by a clinical trial. It has high rates of union (99 %), low rates of avascular necrosis (<1 %), and low rates of fixation failure (<1 %). CONCLUSIONS Based on the available data, DHS appears to be the superior method of fixation for the minimally displaced subcapital neck of femoral fractures. Given the general low level of evidence currently available, additional clinical trials are needed in this area.
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Affiliation(s)
- Joash Kumar
- Department of Orthopaedics, Gold Coast Hospital and Health Service, Southport, Queensland, 4215, Australia
| | - Tristan Symonds
- Department of Orthopaedics, Ipswich Hospital and Health Service, Ipswich, Queensland, 4395, Australia
| | - Jonathan Quinn
- Department of Orthopaedics, Gold Coast Hospital and Health Service, Southport, Queensland, 4215, Australia
| | - Tom Walsh
- Office for Research Governance and Development, Gold Coast Hospital and Health Service, Southport, Queensland, 4215, Australia
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Kelvin Grove, Queensland, 4059, Australia
| | - Simon Platt
- Department of Orthopaedics, Gold Coast Hospital and Health Service, Southport, Queensland, 4215, Australia
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Blümel S, Hanauer M, Franken V, Schwab JM, Tannast M. Persistent femoral neck non-union despite valgus intertrochanteric osteotomy: Relevance for secondary cam-type impingement. Trauma Case Rep 2023; 47:100911. [PMID: 37663374 PMCID: PMC10474228 DOI: 10.1016/j.tcr.2023.100911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2023] [Indexed: 09/05/2023] Open
Abstract
Valgus intertrochanteric osteotomy is a well-established treatment in delayed union of femoral neck fractures as it converts shear forces into compression forces. Non-union of the femoral neck fracture may persist following valgus intertrochanteric osteotomy, and secondary femoroacetabular impingement (FAI) may be a contributing factor. Case We report one case of persistent femoral neck non-union after treatment by valgus intertrochanteric osteotomy with concomitant secondary cam-type impingement from fracture callus as a possible cause for ongoing insufficient healing. Healing was achieved following surgical hip dislocation with corrective osteochondroplasty of the femoral head-neck junction. Two-year follow-up shows good clinical and radiological outcomes. Conclusion In ongoing non-healing of femoral neck fractures following valgus intertrochanteric osteotomy, secondary cam impingement from fracture callus must be excluded.
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Affiliation(s)
- Stefan Blümel
- Department of Orthopedic Surgery, HFR Cantonal Hospital, University of Fribourg, Fribourg, Switzerland
| | - Matthieu Hanauer
- Department of Orthopedic Surgery, HFR Cantonal Hospital, University of Fribourg, Fribourg, Switzerland
| | - Veerle Franken
- Department of Orthopedic Surgery, HFR Cantonal Hospital, University of Fribourg, Fribourg, Switzerland
| | - Joseph M. Schwab
- Department of Orthopedic Surgery, HFR Cantonal Hospital, University of Fribourg, Fribourg, Switzerland
| | - Moritz Tannast
- Department of Orthopedic Surgery, HFR Cantonal Hospital, University of Fribourg, Fribourg, Switzerland
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7
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Schmitz PP, Hannink G, Somford MP, Schreurs BW, Van Susante JLC. Revision risk of salvage compared with acute total hip arthroplasty following femoral neck fracture: an analysis from the Dutch Arthroplasty Register. Acta Orthop 2023; 94:399-403. [PMID: 37522279 PMCID: PMC10388365 DOI: 10.2340/17453674.2023.17743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Indexed: 08/01/2023] Open
Abstract
BACKGROUND AND PURPOSE There is no consensus on the treatment of patients with femoral neck fractures between internal fixation (IF) or directly treated with a total hip arthroplasty (fracture-THA) in particular for the age group 60-70 years. Failure of IF is not uncommon, resulting in salvage total hip arthroplasty (salvage-THA). The aim of our study was to compare revision rates of salvage-THA with fracture-THA and osteoarthritis (OA)-THA. PATIENTS AND METHODS Revision rates and reasons for revision were compared. Data collected in the Dutch Arthroplasty Register (LROI) between 2007 and 2018 was used. The study included 4,310 salvage-THAs, 12,159 fracture-THAs, and 274,147 OA-THAs. We performed Kaplan-Meier survival analyses and Cox regression to evaluate THA survival. RESULTS No statistically significant difference in revision rates between salvage-THAs and fracture-THAs was found (HR 1.0, 95% CI 0.7-1.3) whereas the revision rate was higher compared with OA-THAs (HR 1.3, CI 1.0-1.5). The 5-year revision rate was 5.0% (CI 4.4-5.8) in salvage-THAs, 4.5% (CI 4.1-5.0) in fracture-THAs, and 3.1% (CI 3.0-3.2) in OA-THAs. A higher revision rate for infection was found in salvage-THAs in comparison with fracture-THAs (HR 1.6, CI 1.0-2.3). CONCLUSION We found no difference in revision rates for salvage-THAs compared with fracture-THAs. The risk of revision for infection was higher for salvage-THA.
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Affiliation(s)
- Peter P Schmitz
- Rijnstate Hospital, Department of Orthopedics, Rijnstate Hospital, Arnhem.
| | - Gerjon Hannink
- Radboud University Medical Center, Department of Operating Rooms, Nijmegen
| | - Matthijs P Somford
- Rijnstate Hospital, Department of Orthopedics, Rijnstate Hospital, Arnhem
| | - B Willem Schreurs
- Radboud University Medical Center, Department of Orthopedics, Nijmegen; Dutch Arthroplasty Register (LROI), 's Hertogenbosch, The Netherlands
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Krassnig R, Prager W, Wildburger R, Hohenberger GM. Direct anterior versus antero-lateral approach in hip joint hemiarthroplasty. Arch Orthop Trauma Surg 2023; 143:4141-4148. [PMID: 36394659 DOI: 10.1007/s00402-022-04685-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 10/27/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Femoral neck fractures are common injuries in the elderly and represent a major source of morbidity and mortality. Due to the benefits, bipolar hip hemiarthroplasty (BHH) is a popular method to treat. The purpose of this study is to evaluate the functional and radiographic outcomes for BHH comparing the direct anterior approach (DAA) to the anterolateral approach (ALA) to the hip joint. METHODS We used a prospective, randomized observational study design, where we enrolled 83 patients at a level-I-trauma center presenting with indication for BHH. We followed up the participants at defined intervals over a period of 1 year. The follow-up examinations were carried out at defined time intervals for a period of 1 year. Calculations were performed with Statistical Package for Social Sciences (SPSS) 21.0. RESULTS Concerning postoperative pain sensation, the anterior group had statistically significantly decreased pain levels at one (p = 0.02), seven (p = 0.04) and 14 days (p = 0.02) following the intervention when compared to the ALA sample. The postoperative modified Barthel-Index showed a statistically significant difference on the first postoperative day at the anterior group. CONCLUSION Although we compared two minimally invasive approaches, our results shows a statistically significant difference in pain intensity and mobility for the early postoperative period using the direct anterior approach.
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Affiliation(s)
- Renate Krassnig
- AUVA Rehabilitation Clinic Tobelbad, Dr.-Georg-Neubauer-Straße 6, 8144, Tobelbad, Austria.
| | - Walter Prager
- Department of Trauma Surgery, LKH Feldbach-Fürstenfeld, Ottokar-Kernstock-Straße18, 8330, Fürstenfeld, Austria
| | - Renate Wildburger
- AUVA Rehabilitation Clinic Tobelbad, Dr.-Georg-Neubauer-Straße 6, 8144, Tobelbad, Austria
| | - Gloria M Hohenberger
- Department of Trauma Surgery, LKH Feldbach-Fürstenfeld, Ottokar-Kernstock-Straße18, 8330, Fürstenfeld, Austria
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Regennass L, Brulefert K, Feuillet F, Nich C. No Difference in Dislocation Rates Comparing DMC-THA for Displaced Femoral Neck Fracture and for Osteoarthritis-A Matched-Pair Analysis. Indian J Orthop 2023; 57:436-444. [PMID: 36825264 PMCID: PMC9941398 DOI: 10.1007/s43465-023-00816-7] [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: 10/06/2022] [Accepted: 01/01/2023] [Indexed: 01/28/2023]
Abstract
Background We hypothesized the risk of prosthetic instability would be similar in patients treated for femoral neck fracture (FNF) comparatively to patients treated for osteoarthritis (OA) using a dual-mobility cup-total hip arthroplasty (DMC-THA). Methods One hundred and nine patients (109 hips), with a mean age of 69.6 ± 3 years (65-75 years), underwent DMC-THA using a posterolateral approach for a FNF (study group). Patients were matched for age and sex with 109 OA patients treated by the same procedure (control). Results Postoperatively, there were four dislocations of the large articulation in the study group, and none in the control (p = 0.12). Periprosthetic joint infection (PJI) was the most common surgical complication and was more frequent in the study group. Postoperatively, functional results were at least good in > 90% patients in both groups. At the last follow-up, patients in the study group had recovered autonomy and physical activity comparable to those of the preoperative period. Conclusion We found no increased risk of dislocation after DMC-THA using a posterolateral approach for FNF as compared to the same procedure for OA. In this study, function and independence were restored postoperatively in the vast majority of patients. DMC-THA appears as a viable therapeutic option in autonomous patients with a displaced FNF.
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Affiliation(s)
- Lucie Regennass
- Nantes Université, CHU Nantes, Clinique Chirurgicale Orthopédique Et Traumatologique, 44000 Nantes, France
| | - Kevin Brulefert
- Nantes Université, CHU Nantes, Clinique Chirurgicale Orthopédique Et Traumatologique, 44000 Nantes, France
| | - Fanny Feuillet
- INSERM, SPHERE U1246, Nantes Université, Université de Tours, Nantes, France
- Plateforme de Méthodologie Et de Biostatistique, Direction de La Recherche Et de L’Innovation, CHU de Nantes, Nantes, France
| | - Christophe Nich
- Nantes Université, CHU Nantes, Clinique Chirurgicale Orthopédique Et Traumatologique, 44000 Nantes, France
- INSERM, UMRS 1229, Nantes Université, Regenerative Medicine and Skeleton (RMeS), ONIRIS, 44042 Nantes, France
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10
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Conversion arthroplasty after failed extracapsular hip fracture fixation is associated with high complication rates. JOURNAL OF SURGERY AND MEDICINE 2023. [DOI: 10.28982/josam.7532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Background/Aim: There is no standard treatment of choice that addresses all extracapsular fractures, which account for approximately half of the elderly hip fractures. Arthroplasty is mostly favored secondary to unsuccessful fixation or unstable primary fractures. However, conversion arthroplasty complication rates are high in the literature. This study compares arthroplasty performed after unsuccessful fixation and primary arthroplasty for unstable extracapsular hip fractures.
Methods: In this retrospective study, we compared the first-year results of the groups that underwent conversion arthroplasty (cHA) and the primary arthroplasties (pHA) for extracapsular hip fractures. In the cHA group, patients were indicated for operation if there was a failure of fixation after extracapsular hip fractures (n=44). In the pHA group, patients were for unstable extracapsular hip fractures (n=44). In the cHA group, failure of fixation causes were cut-out of lag screws (54.5%), cut-through of lag screws (9.1%), non-union of fractures (27.3%), and osteonecrosis of femoral heads (9.1%). While total hip replacement was applied to all patients in the cHA group, total hip replacement was applied to ten patients in the pHA group and hemiarthroplasty to 34 patients. In comparing groups, duration of operation, amount of bleeding, intraoperative complications, post-operative complications, mobilization capacities, functional status, and mortality rates were used.
Results: There were 44 patients in both groups. The surgical time (134.3 [34.5)] vs. 66 [16], [P<0.001]), the amount of bleeding (1000 ml [400] vs. 300ml [200], [P<0.001]), the need for red blood cell transfusion in the operations (80% vs. 32%, [P<0.001]), and the frequency of intraoperative femur fracture (30% vs. 0%, [P<0.001]) were larger or longer in the cHA group compared to pHA group (P<0.001). While 14 complications requiring surgical intervention were observed in 12 of 44 patients in the CHA group in the post-operative 1st year, four complications were observed in four of 44 patients in the pHA group. There was no difference in mortality rates (3 vs. 3, [P =1]), mobilization capacities (5.9 [2.1] vs. 5.7 [2.0], [P=0.597]), and functional status (12.5 [3.3] vs. 13.0 [2.7], [P=0.434]) between the groups.
Conclusion: Arthroplasty performed as conversion surgery after unsuccessful fixation has a higher risk of intraoperative and post-operative complications than primary arthroplasty performed after extracapsular hip fractures. We believe the cases prone to implant failure, non-union, or restricted mobilization because of the patient and fracture-type reasons should be treated with primary arthroplasty.
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11
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Sami A, Prabhakar R, Kumar Yadav A, Kumar Jain V. Biplane double supported screw fixation for femoral neck fracture in young adults: A prospective cohort study. J Orthop 2022; 33:117-123. [PMID: 35958981 PMCID: PMC9361214 DOI: 10.1016/j.jor.2022.07.012] [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: 06/08/2022] [Revised: 06/30/2022] [Accepted: 07/20/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction Achieving accurate anatomic reduction and stable internal fixation is mandatory in the management of femoral neck fractures (FNF) in adults. The spatial configuration and direction of the screws have been reported to provide stability to the fracture. The study's goal is to analyse the clinico-radiological outcome of the newer biplane double-supported screw fixation (BDSF) technique in the Indian cohort. Materials and methods Patients with isolated FNFs underwent osteo-synthesis by BDSF technique. Radiological outcome was evaluated by time to union and fracture healing on plain radiographs. Clinical outcome was measured using the Harris hip score (HHS) at 1, 3, 6, and 12 months after surgery. The pain reduction was measured using the VAS score. Results Twenty-seven patients with a mean age of 37.33 ± 9.84 years (24-55 years) were followed up for at least 12 months (12-31 months). The mean HHS at 12 months was 94.81 ± 8.18 (range: 68-100). Twenty-five patients were able to achieve radiological union within a mean time of 14.60 ± 4.69 weeks (range: 8-28). The overall complication rate was found to be 18.51% (5 out of 27 patients). Individual complications were non-union (2 patients; 7.4%), AVN (3 patients; 11.11%), and screw back out with femoral neck shortening (4 patients; 14.81%). Conclusion Screw configuration using the BDSF technique provides a good union rate with minimum complications. The majority of patients resulted in a good (HHS >80) to excellent functional outcome. Based on the clinico-radiological outcome obtained, we conclude that this technique is effective in the fixation of FNF in adults. Level of study Level II.
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Affiliation(s)
- Abdus Sami
- Department of Orthopaedics, Atal Bihari Vajpayee Institute of Medical Sciences, Dr. Ram Manohar Lohia Hospital, New Delhi, 110001, India
| | - Rahul Prabhakar
- Department of Orthopaedics, Atal Bihari Vajpayee Institute of Medical Sciences, Dr. Ram Manohar Lohia Hospital, New Delhi, 110001, India
| | - Ajay Kumar Yadav
- Department of Orthopaedics, Atal Bihari Vajpayee Institute of Medical Sciences, Dr. Ram Manohar Lohia Hospital, New Delhi, 110001, India
| | - Vijay Kumar Jain
- Department of Orthopaedics, Atal Bihari Vajpayee Institute of Medical Sciences, Dr. Ram Manohar Lohia Hospital, New Delhi, 110001, India
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12
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Clinical Score for Predicting the Risk of Poor Ambulation at Discharge in Fragility Femoral Neck Fracture Patients: A Development Study. J Clin Med 2022; 11:jcm11164871. [PMID: 36013106 PMCID: PMC9410020 DOI: 10.3390/jcm11164871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/16/2022] [Accepted: 08/17/2022] [Indexed: 11/17/2022] Open
Abstract
Surgical treatment in patients with fragility femoral neck fractures often leads to a longer length of hospital stay (LOS) and higher costs. Intensive rehabilitation is one of the choices to reduce LOS, but patient selection criteria are controversial. We intended to develop a clinical score to predict the risk of poor ambulation at discharge. This study was based on a retrospective cohort of patients diagnosed with fragility femoral neck fractures surgically managed from January 2010 to December 2019 at Chiang Mai University (CMU) Hospital. Pre-, intra-, and post-operative factors that affect rehabilitation training were candidate predictors. All patients were categorized into able or unable groups based on their ability to bear self-weight at discharge. Logistic regression was used for score derivation. Five hundred and nine patients were included in this study. Male sex, end-stage kidney disease (ESRD), cerebrovascular disease, psychiatric disorders, pre-fracture ambulation with gait aids, concomitant fracture, post-operative intensive care unit (ICU) admission or ventilator use, and urinary catheter use at second day post-operation were identified as the prognostic factors. The score showed an AuROC of 0.84 with good calibration. The score can be used for risk stratification on the second day post-operation. External validation is encouraged before clinical implementation.
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13
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Determinants of Lack of Recovery from Dependency and Walking Ability Six Months after Hip Fracture in a Population of People Aged 65 Years and Over. J Clin Med 2022; 11:jcm11154467. [PMID: 35956084 PMCID: PMC9369508 DOI: 10.3390/jcm11154467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 07/22/2022] [Accepted: 07/27/2022] [Indexed: 01/27/2023] Open
Abstract
Background: Hip fracture in the elderly means that between a quarter and a half of patients do not regain the levels of independence and walking ability that they previously had, according to the literature, after the fracture. Material and methods: Retrospective study of 537 patients aged ≥65 years who survived at the sixth month after fracturing their hip, of which the age, sex, type of fracture, surgical risk, independence (BI), walking ability, cognitive level (PS), comorbidities, indicated drugs, complications, surgical delay, hospital stay, and surgical technique are known. Using Pearson’s χ2 test, all the variables were contrasted with respect to the limitation or not, at the sixth month of the recovery of both independence and pre-admission walking ability. Multivariate analysis provides the necessary adjustment to the previous contrast. Results: We have found that age and PS ≥ 5 at admission limit recovery from both dependency and walking ability. Surgical risk, independence (BI) upon admission, anemia, and constipation during the hospital stay limit the recovery of the BI. Worsening of walking ability during the hospital stay and the type of extra-articular fracture, which was surgically treated by osteosynthesis, limit the recovery of walking ability. Conclusions: The factors previously exposed, and perhaps the fact that patients with hip fractures are not routinely referred to rehabilitation, explain the high proportion of patients who do not recover their previous independency (36%) or walking ability (45%) to the fact of fracturing.
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Peng P, Xiao F, He X, Fang W, Huang J, Wang B, Luo Y, Zhang Q, Zhang Y, He W, Wei Q, He M. Global Research Status and Trends of Femoral Neck Fracture Over the Past 27 Years: A Historical Review and Bibliometric Analysis. Front Surg 2022; 9:875040. [PMID: 35784942 PMCID: PMC9241583 DOI: 10.3389/fsurg.2022.875040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 05/20/2022] [Indexed: 11/24/2022] Open
Abstract
Background Femoral neck fracture (FNF) is a commonly encountered injury in orthopedic practice, and many studies have been conducted in this field. However, no bibliometric studies regarding the global research trend concerning FNF have been performed. This study aims to analyze the knowledge framework, research hotspots, and theme trends in the field of FNF research. Methods The scientific outputs related to FNF from 1994 to 2021 were retrieved from the Web of Science Core Collection. Three bibliometric tools were used for this study. The main analyses include publication and citation counts, contributions of countries, institutions, authors, funding agencies and journals, and clustering of keywords. Results In total, 3,553 articles were identified. The annual publication counts of FNF showed an ascending tendency as a whole. The United States has the most prominent contributions, with the most number of publications and the highest H-index. Karolinska Institutet devoted the most in this domain. Professors Bhandari M, Schemitsch EH, Frihagen F, Parker MJ, and Rogmark C were the core authors in this field. The most productive journal was Injury International Journal of the Care of the Injured. Keywords were divided into four clusters: epidemiology and mortality, fracture prevention, internal-fixation and risk factors, and hip replacement. A trend of balanced and diversified development existed in these clusters. Keywords with the ongoing bursts, including “outcome,” “reoperation,” “complication,” “revision,” “displaced intracapsular,” “fracture,” and “adult,” are considered as the research hotspots in the future and deserve more attention. Conclusions The management of FNF in young patients is drawing more attention from orthopedic surgeons, and it is expected that these research topics may continue to be the research hotspots and focus in the near future.
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Affiliation(s)
- Peng Peng
- The First Clinical Medical School, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Fangjun Xiao
- The Third Clinical Medical School, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiaoming He
- Guangdong Research Institute for Orthopedics & Traumatology of Chinese Medicine, Guangzhou, China
- Department of Orthopaedics, The Third Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Weihua Fang
- The Third Clinical Medical School, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jiewen Huang
- Guangdong Research Institute for Orthopedics & Traumatology of Chinese Medicine, Guangzhou, China
- Department of Orthopaedics, The Third Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Bin Wang
- Guangdong Research Institute for Orthopedics & Traumatology of Chinese Medicine, Guangzhou, China
- Department of Orthopaedics, The Third Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yiwen Luo
- Guangdong Research Institute for Orthopedics & Traumatology of Chinese Medicine, Guangzhou, China
- Department of Orthopaedics, The Third Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Qinwen Zhang
- Guangdong Research Institute for Orthopedics & Traumatology of Chinese Medicine, Guangzhou, China
- Department of Orthopaedics, The Third Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Ying Zhang
- Medical Center of Hip, Luoyang Orthopedic-Traumatological Hospital (Orthopedics Hospital of Henan), China
| | - Wei He
- Guangdong Research Institute for Orthopedics & Traumatology of Chinese Medicine, Guangzhou, China
- Department of Orthopaedics, The Third Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Qiushi Wei
- Guangdong Research Institute for Orthopedics & Traumatology of Chinese Medicine, Guangzhou, China
- Department of Orthopaedics, The Third Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China
- Correspondence: Mincong He Qiushi Wei
| | - Mincong He
- Guangdong Research Institute for Orthopedics & Traumatology of Chinese Medicine, Guangzhou, China
- Department of Orthopaedics, The Third Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China
- Correspondence: Mincong He Qiushi Wei
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15
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Fixation vs Arthroplasty for Femoral Neck Fracture in Patients Aged 40-59 Years: A Propensity-Score-Matched Analysis. Arthroplast Today 2022; 14:175-182. [PMID: 35342781 PMCID: PMC8943217 DOI: 10.1016/j.artd.2021.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 09/26/2021] [Accepted: 10/29/2021] [Indexed: 11/23/2022] Open
Abstract
Background Methods Results Conclusions
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16
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Prognostic Factors of the Inability to Bear Self-Weight at Discharge in Patients with Fragility Femoral Neck Fracture: A 5-Year Retrospective Cohort Study in Thailand. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19073992. [PMID: 35409675 PMCID: PMC8997639 DOI: 10.3390/ijerph19073992] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 03/08/2022] [Accepted: 03/25/2022] [Indexed: 12/14/2022]
Abstract
An inability to bear self-weight is one of the unfavorable results in geriatric hip fracture, which needs to be prevented. This study determines pre-operative, intra-operative, and post-operative prognostic factors of the inability to bear self-weight at discharge in patients with fragility femoral neck fracture. This retrospective study was conducted at Chiang Mai University (CMU) hospital with an observational cohort design. Electronic medical records of patients aged ≥ 50 years old with fragility femoral neck fractures between 1 January 2015 and 31 December 2019 were reviewed. Pre-, intra-, and post-operative factors were collected. Ambulation status at discharge time was classified into either ability or inability to bear self-weight. Analysis of prognostic factors was done using multivariable risk ratio regression. In total, 269 patients were recruited in this study. Significantly prognostic factors of inability to bear self-weight at discharge were end-stage renal disease (ESRD), cirrhosis, cerebrovascular disease, pre-fracture ambulatory status, having associated fractures, increasing intra-operative blood loss, and having pressure sore. These prognostic factors could be used to predict patients’ outcomes at discharge. Proper management could then be offered to the patients by the multidisciplinary care team to enhance surgical outcomes.
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17
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Chung YY, Lee SM, Baek SN, Park TG. Direct Anterior Approach for Total Hip Arthroplasty in the Elderly with Femoral Neck Fractures: Comparison with Conventional Posterolateral Approach. Clin Orthop Surg 2022; 14:35-40. [PMID: 35251539 PMCID: PMC8858892 DOI: 10.4055/cios21008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 07/01/2021] [Accepted: 07/01/2021] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND The aim of this study was to determine if it was feasible and safe to perform total hip arthroplasty (THA) using the direct anterior approach (DAA) when compared with the conventional posterolateral approach (PA) in patients with femoral neck fractures. The time required to start walking was investigated to identify advantages of the muscle-sparing approach. Safety of the approach was judged based on the incidence and nature of all complications. METHODS We retrospectively reviewed 67 THA cases due to femoral neck fractures from October 2015 to January 2019. The PA was used in 31 cases, and the DAA was used in 36 cases. The average operative time and amount of bleeding were evaluated. Cup inclination, anteversion, and leg length discrepancy (LLD) were also measured on radiographs. The time to start walking and complications (e.g., intraoperative fracture, infection, and dislocation) were recorded. RESULTS The mean operative time was 84.35 ± 13.95 minutes in PA group and 99.22 ± 20.33 minutes in DAA group (p = 0.010). But after experiencing 20 cases using the DAA, there was no statistically significant difference in the operative time between the groups. The mean volume of bleeding was 428.73 ± 207.26 mL in the PA group and 482.47 ± 150.14 mL in the DAA group. There was no difference in the acetabular cup position between two groups. Ambulation was started at 3.94 days after surgery on average in the PA group and 3.14 days in the DAA group, showing a statistically significant difference. Intraoperative fracture and infection were not observed in either group. The incidence of LLD was 1 in each group. The dislocation rate was 3.2% (1 case) in the PA group and 5.5% (2 cases) in the DAA group. CONCLUSIONS Although the DAA for THA was similar to the PA in terms of operative time, volume of bleeding, and complications, the DAA showed a great advantage in early rehabilitation as a muscle-sparing procedure in the elderly with femoral neck fractures.
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Affiliation(s)
- Young-Yool Chung
- Department of Orthopedic Surgery, Kwangju Christian Hospital, Gwangju, Korea
| | - Sang-Min Lee
- Department of Orthopedic Surgery, Kwangju Christian Hospital, Gwangju, Korea
| | - Sung-Nyun Baek
- Department of Orthopedic Surgery, Kwangju Christian Hospital, Gwangju, Korea
| | - Tae-Gyu Park
- Department of Orthopedic Surgery, Kwangju Christian Hospital, Gwangju, Korea
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18
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Zelle BA, Salazar LM, Howard SL, Parikh K, Pape HC. Surgical treatment options for femoral neck fractures in the elderly. INTERNATIONAL ORTHOPAEDICS 2022; 46:1111-1122. [DOI: 10.1007/s00264-022-05314-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 01/17/2022] [Indexed: 12/16/2022]
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19
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Total hip arthroplasty compared to bipolar and unipolar hemiarthroplasty for displaced hip fractures in the elderly: a Bayesian network meta-analysis. Eur J Trauma Emerg Surg 2022; 48:2655-2666. [PMID: 35182161 PMCID: PMC9360085 DOI: 10.1007/s00068-022-01905-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 01/29/2022] [Indexed: 11/17/2022]
Abstract
Purpose Displaced femoral neck fractures (FNF) usually require surgical treatment with either a total hip arthroplasty (THA), unipolar hemiarthroplasty (U-HHA), or bipolar hemiarthroplasty (B-HHA). However, there is still controversy regarding the optimal implant. This network meta-analysis compared the outcomes and complication rates of THA versus B-HHA and versus U-HHA in elderly patients with FNF. Material and methods This study was conducted according to the PRISMA extension statement for reporting of systematic reviews, and incorporated network meta-analyses of health care interventions. The literature search was performed in September 2020. All randomized clinical trials comparing two or more of the index surgical interventions for displaced FNF in the elderly were eligible for inclusion. For the Bayesian network meta-analysis, the standardized mean difference (SMD) and Log Odd Ratio (LOR) were used. Results Data from 24 RCTs (2808 procedures) were analysed. The mean follow-up was 33.8 months. The THA group had the longest surgical time (SMD 85.74) and the greatest Harris Hip Score (SMD − 17.31). THA scored similarly in terms of mortality (LOR 3.89), but had lower rates of revision surgeries (LOR 2.24), higher rates of dislocations (LOR 2.60), and lower rates of acetabular erosion (LOR − 0.02). Cementless implants required a shorter surgical duration (− 18.05 min; P = 0.03). Mortality was positively associated with acetabular erosion (P = 0.006), female gender (P = 0.007), revision (P < 0.0001). Conclusion THA led to the highest Harris Hip scores and lowest rate of revision surgery compared to B-HHA and U-HHA. However, B-HHA had the lowest dislocation rate when compared with U-HHA and THA. No significant differences in functional outcomes and complication rates were found between cemented and uncemented implants; however, a tendency for lower mortality, revision and dislocation rates in cemented implants was evidenced. Level of evidence I, Bayesian network meta-analysis of RCTs.
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20
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Tsailas PG, Argyrou C, Valavanis A. Management of femoral neck fractures with the ALMIS approach in elderly patients: Outcomes compared to posterior approach. Injury 2021; 52:3666-3672. [PMID: 34266652 DOI: 10.1016/j.injury.2021.06.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 06/30/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Over the last 2 decades, several minimally invasive surgical techniques and approaches have been introduced for hip arthroplasty, including anterolateral minimally invasive surgery (ALMIS) introduced by Röttinger in 2004. As described, this muscle sparing approach promises faster recovery and lower dislocation rates. Although there has been a peaked recent interest in minimally invasive surgery (MIS) hip arthroplasty, few studies support the superiority of ALMIS compared to the more traditional posterior approach. The present study examines the safety and early complications of elderly patients undergoing ALMIS compared to a posterior approach for hemiarthroplasty of displaced femoral neck fractures. METHODS In a retrograde level III case-control study, 100 consecutive elderly patients with primary hip arthroplasty were divided into two groups. The first group consisted of 50 consecutive cases operated with the ALMIS approach and the second group of 50 consecutive cases operated through a posterior approach. Operative time, postoperative complication rates, length of hospitalization, blood loss, and leg-length discrepancy, were reviewed retrospectively. RESULTS No differences were observed in post-operative complications. Overall, the operative time was significantly greater in the ALMIS group compared to the posterior approach group (75 ± 12 vs 67.5 ± 16 min, respectively; p ≤ 0.01). However, the operating time of the second half of the ALMIS cohort (N = 25), did not differ from the posterior approach group (72.7 ± 10.5 vs 67.5 ± 16, respectively; p = 0.19). Leg length discrepancy was significantly less in the ALMIS group compared to the posterior exposure group (1.5 ± 3.2 vs 3.2 ± 3.3, respectively; P≤0.1). CONCLUSIONS The results of the retrograde analysis, although limited in sample size, shows no major differences in ALMIS compared to a more traditional posterior approach in terms of immediate post-operative complications. Although the overall operating time was longer in the patients treated with ALMIS, the second cohort of patients treated with this method had an operating time that was similar to that observed with posterior approach. Leg-length discrepancies were significantly less in patients treated with ALMIS.
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Affiliation(s)
- Panagiotis G Tsailas
- Larissa General Hospital, Orthopaedic Department, Tsakalof 1, Larissa, Greece; KAT Attica General Hospital, 4th Orthopaedic Department, Nikis 2, Kifisia, Greece.
| | - Chrysoula Argyrou
- KAT Attica General Hospital, 4th Orthopaedic Department, Nikis 2, Kifisia, Greece
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21
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Huggard R, Wicks G, Corfield G. Short-Term Clinical Assessment of Hip Hemi-Arthroplasty in 11 Dogs. Vet Comp Orthop Traumatol 2021; 35:57-63. [PMID: 34547785 DOI: 10.1055/s-0041-1735317] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The aim of this study was to assess the short-term clinical outcome in dogs following a hip hemi-arthroplasty for the treatment of primary pathological disorders of the hip and as a salvage procedure following failure of the cup component of a total hip replacement. MATERIALS AND METHODS Medical records of dogs that had a unilateral hip hemi-arthroplasty performed between 2015 and 2020 were reviewed. Data collected included follow-up orthopaedic examinations performed at 0, 2, 8 and 52 weeks postoperatively, pelvic radiography at 0, 8 and 52 weeks postoperatively and an owner questionnaire (Helsinki chronic pain index [HCPI]). RESULTS Eleven unilateral hip hemi-arthroplasty procedures were identified. The median age at time of surgery was 3.6 years (8 months-10 years) and the median follow-up time was 13 months (range: 2 months-3 years). The HCPI for all dogs at follow-up was median 8 ± 7.30 (range: 5-25). Total HCPI was < 12 for 7/10 dogs and ≥ 12 for 3 dogs. Pelvic radiographs at 1 year confirmed osteointergration of the femoral stem implant and no evidence of implant subsidence or progression of osteoarthritis. However, there was some evidence of mild lucency of the acetabular bed around the prosthetic femoral head and mild peri-acetabular sclerosis in four cases. CONCLUSION Hip hemi-arthroplasty provides a clinically acceptable treatment for disabling disease of the coxofemoral joint with 10/11 patients achieving acceptable short-term clinical function. Long-term assessment of the hip hemi-arthroplasty and comparison with total hip replacement is indicated.
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Affiliation(s)
- Renée Huggard
- Veterinary Specialist Services, Carrara, Queensland, Australia
| | - Grace Wicks
- Veterinary Specialist Services, Carrara, Queensland, Australia
| | - Gordon Corfield
- Veterinary Specialist Services, Carrara, Queensland, Australia
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Abstract
ABSTRACT Hip fractures are considered a significant public health issue, representing a substantial burden on our healthcare system and society. They are one of the leading causes of disability among older adults, especially women. Globally, an estimated 18% of women and 6% of men will be affected by hip fractures at some time in life. Hip fractures are a major cause of long-term disability among older adults and more significant than mortality, as only 60% of patients regain their preinjury level of mobility. This has detrimental effects on quality of life and activities of daily living, imposing a level of dependence that has personal, social, and systemic consequences.
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Affiliation(s)
- Meagan L Barry
- At the time this article was written, Meagan L. Barry was a student in the PA program at the University of Tennessee Health Science Center in Memphis. She now practices at Dallas (Tx.) Orthopaedic Joint Institute. Kristopher R. Maday is an associate professor and program director in the PA program at the University of Tennessee. The authors have disclosed no potential conflicts of interest, financial or otherwise
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Austin MS, Ashley BS, Bedard NA, Bezwada HP, Hannon CP, Fillingham YA, Kolwadkar YV, Rees HW, Grosso MJ, Zeegen EN. What is the Level of Evidence Substantiating Commercial Payers' Coverage Policies for Total Joint Arthroplasty? J Arthroplasty 2021; 36:2665-2673.e8. [PMID: 33867209 DOI: 10.1016/j.arth.2021.03.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 03/08/2021] [Accepted: 03/14/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The prevalence of total joint arthroplasty (TJA) in the United States has drawn the attention of health care stakeholders. The payers have also used a variety of strategies to regulate the medical necessity of these procedures. The purpose of this study was to examine the level of evidence of the coverage policies being used by commercial payers in the United States. METHODS The references of the coverage policies of four commercial insurance companies were reviewed for type of document, level of evidence, applicability to a TJA population, and success of nonoperative treatment in patients with severe degenerative joint disease. RESULTS 282 documents were reviewed. 45.8% were primary journal articles, 14.2% were level I or II, 41.2% were applicable to patients who were candidates for TJA, and 9.9% discussed the success of nonoperative treatment in patients who would be candidates for TJA. CONCLUSION Most of the references cited by commercial payers are of a lower level of scientific evidence and not applicable to patients considered to be candidates for TJA. This is relatively uniform across the reviewed payers. The dearth of high-quality literature cited by commercial payers reflects the lack of evidence and difficulty in conducting high level studies on the outcomes of nonoperative versus operative treatment for patients with severe, symptomatic osteoarthritis. Patients, surgeons, and payers would all benefit from such studies and we encourage professional societies to strive toward that end through multicenter collaboration.
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Affiliation(s)
- Matthew S Austin
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Blair S Ashley
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Nicholas A Bedard
- Department of Orthopaedic Surgery, University of Iowa Hospitals & Clinics, Iowa City, IA
| | | | - Charles P Hannon
- Department of Orthopaedic Surgery, The Mayo Clinic, Ochester, MN
| | - Yale A Fillingham
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Yogesh V Kolwadkar
- Department of Orthopaedic Surgery, VA Central California Health Care System, Fresno, CA
| | - Harold W Rees
- Department of Orthopaedic Surgery, Loyola University Medical Center, Maywood, IL
| | - Matthew J Grosso
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA; Connecticut Joint Replacement Institute, Hartford, CT
| | - Erik N Zeegen
- Department of Orthopaedic Surgery, University of California Los Angeles, Santa Monica, CA
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Vluggen TPMJ, van Vugt R, Boonen B, Keulen MHF. Management of two-level proximal femoral fractures. BMJ Case Rep 2021; 14:14/5/e240684. [PMID: 34059536 DOI: 10.1136/bcr-2020-240684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We present the case of an 82-year-old female, who experienced a ground-level fall on the trochanter of the right femur. X-rays showed a proximal femoral fracture (PFF) with an unclear and unusual fracture pattern. Three-dimensional CT images were obtained and showed a displaced femoral neck fracture and ipsilateral fracture of the greater trochanter. Our patient underwent unipolar hemiarthroplasty and fixation of the greater trochanter with a hook plate and cable grip. At 11 months, functional outcomes, patient satisfaction and quality of life were excellent. Primary osteoporosis was diagnosed and treatment with bisphosphonates was initiated.Two-level PFFs are rare and complex. Due to ageing and a subsequent increase in osteoporosis, numbers of PFFs with complex fracture patterns might increase in the future. Adequate treatment and early prevention of osteoporosis are key to reduce this risk and lower the overall burden. Surgical treatment should be patient-tailored and focus on minimising the risk of complications and reinterventions.
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Affiliation(s)
| | - Raoul van Vugt
- The Department of Orthopaedic and Trauma Surgery, Zuyderland Medical Centre Heerlen, Heerlen, Limburg, The Netherlands.,The Department of General Surgery, Zuyderland Medical Centre Heerlen, Heerlen, Limburg, The Netherlands
| | - Bert Boonen
- The Department of Orthopaedic and Trauma Surgery, Zuyderland Medical Centre Heerlen, Heerlen, Limburg, The Netherlands
| | - Mark Hendrik Franciscus Keulen
- The Department of Orthopaedic and Trauma Surgery, Zuyderland Medical Centre Heerlen, Heerlen, Limburg, The Netherlands.,The Department of General Surgery, Zuyderland Medical Centre Heerlen, Heerlen, Limburg, The Netherlands
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Prognostic performance of clinical assessment tools following hip fracture in patients with chronic kidney disease. Int Urol Nephrol 2021; 53:2359-2367. [PMID: 33686533 PMCID: PMC7939449 DOI: 10.1007/s11255-021-02798-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 02/08/2021] [Indexed: 12/04/2022]
Abstract
Purpose People living with chronic kidney disease (CKD) are at a higher risk of hip fracture with an associated increased mortality risk compared to individuals without CKD. Our study aimed to evaluate the clinical assessment tools that best predict mortality risk following hip fracture for patients with CKD. Methods Patients with CKD G3b-5D admitted to Lancashire Teaching Hospitals NHS Foundation Trust, U.K. between June 2013 and Dec 2019 were included. The association between CKD and post-fracture mortality risk was evaluated. All patients were assessed using tools that evaluated frailty status, co-morbidity, pre-operative risk, functional status and cardiopulmonary fitness. Receiver operating characteristic curve analyses were performed to determine the prognostic accuracy of the assessment tools for 30 day and 1 year mortality following hip fracture in patients with CKD. Results 397 patients fulfilled inclusion criteria with a mean age of 83.5 ± 9.2 years. Older age, female sex, intracapsular fracture and more severe CKD, co-morbidity and frailty status were all associated with an increased mortality risk. Patients with dialysis-dependent CKD and severe/very severe frailty had a hazard ratio for mortality of 2.55 (95% Cl 2.11–2.98) and 3.11 (95% Cl 2.47–3.93), respectively. The Clinical Frailty Scale demonstrated the best prognostic accuracy for both 30 day [Area Under the Curve (AUC) 0.91, 95% Cl 0.84–0.97] and 1 year mortality (AUC 0.93, 95% Cl 0.87–1.00). Conclusion Patients with advanced CKD and severe frailty have a high mortality risk following hip fracture. The Clinical Frailty Scale is an excellent prognostic tool for mortality in this setting and could be easily incorporated into routine clinical practice.
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Zhang RY, Zhao YP, Su XY, Li JT, Zhao JX, Zhang LC, Tang PF. The Oval-like Cross-section of Femoral Neck Isthmus in Three-dimensional Morphological Analysis. Orthop Surg 2021; 13:321-327. [PMID: 33417311 PMCID: PMC7862155 DOI: 10.1111/os.12914] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/28/2020] [Accepted: 11/29/2020] [Indexed: 11/27/2022] Open
Abstract
Objectives To investigate the cross‐section shape of the femoral neck isthmus (FNI) in three‐dimensional reconstruction model of the femoral neck. Methods From December 2009 to December 2012, computed tomography (CT) data of bilateral hip joint from 200 consecutive patients (137 males and 63 females, 69.41 ± 9.21 years old, ranged from 50–85 years old) who underwent surgical treatments for proximal femoral fracture were retrospectively reviewed. The 3D model of the proximal femur was reconstructed, and the “inertia axis” method, which was applied to measure the long and short axes of the cross‐section of the FNI, was established. The cross‐sectional area and perimeter were calculated by a formula using the length of the long and short axes and then compared with the actual measured values by the software. Correlation between the descriptive parameters of the FNI cross‐section (area, perimeter, and eccentricity) and patients' demographics (age, height, and weight) was analyzed. Stepwise linear regression analysis was used to determine the main relevant factors. Results The ICC results showed excellent data reproducibility ranged from 0.989 to 0.996. There was no significant difference in the cross‐sectional area of the FNI between the actual measured values and the predicted values using the formula (732.83 ± 126.74 mm2vs 731.62 ± 128.15 mm2, P = 0.322). The perimeter using the two methods showed narrow while significant difference (97.86 ± 8.60 mm vs 92.84 ± 8.65 mm, P < 0.001), the actual measured values were about 5 mm greater than the predicted values. The parameters (area, perimeter, and eccentricity) were significantly larger in male than female (P < 0.001). A positive correlation between the cross‐sectional area, perimeter, height, and weight was observed. The stepwise linear regression analysis showed that the regression equation of the FNI area was as follows: Y = −1083.75 + 1033.86 × HEIGHT + 1.92 × WEIGHT, R2 = 0.489. Conclusion The cross‐section shape of the FNI appears to be oval‐like in the 3D model, which is separated according to the inertia axis, and the findings proposed an anatomical basis for the further study of the spatial configuration of cannulated screws in the treatment of femoral neck fractures.
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Affiliation(s)
- Ru-Yi Zhang
- Department of Orthopaedics, Shijingshan Teaching Hospital of Capital Medical University, Beijing Shijingshan Hospital, Beijing, China.,Medical School of Chinese PLA, Beijing, China
| | - Yan-Peng Zhao
- Department of Orthopaedics, Chinese PLA General Hospital, National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, China
| | - Xiu-Yun Su
- Department of Orthopaedics, Southern University of Science and Technology Hospital, Shenzhen, China
| | - Jian-Tao Li
- Department of Orthopaedics, Chinese PLA General Hospital, National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, China
| | | | - Li-Cheng Zhang
- Department of Orthopaedics, Chinese PLA General Hospital, National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, China
| | - Pei-Fu Tang
- Medical School of Chinese PLA, Beijing, China.,Department of Orthopaedics, Chinese PLA General Hospital, National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, China
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Anderson JT, Hudyk AR, Haas AR, Ahn NU, Rothberg DL, Gililland JM. Displaced Femoral Neck Fractures in Workers' Compensation Patients Aged 45-65 Years: Is It Best to Fix the Fracture or Replace the Joint? J Arthroplasty 2020; 35:3195-3203. [PMID: 32600808 DOI: 10.1016/j.arth.2020.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 05/29/2020] [Accepted: 06/02/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Optimal surgical management of displaced femoral neck fractures (dFNFs) in subjects 45-65 years old is unclear. We evaluated days out of work (dOOW), medical and indemnity costs, and secondary outcomes at 2 years between internal fixation (IF), hemiarthroplasty (HA), and total hip arthroplasty (THA) among workers' compensation (WC) subjects with isolated dFNFs aged 45-65. METHODS We retrospectively identified 105 Ohio Bureau of WC subjects with isolated subcapital dFNFs aged 45-65 with 2 years of follow-up. In total, 37 (35.2%) underwent IF, 23 (21.9%) THA, and 45 (42.9%) HA from 1993 to 2017. Linear regression was used to determine if surgery type was predictive of dOOW postoperatively and to evaluate inflation-adjusted net medical and indemnity costs at 2 years. RESULTS IF subjects were younger (52.9) than THA (58.5, P < .001) and HA (58.4, P < .001) subjects. Mean dOOW for THA subjects at 6 months, 1 year, and 2 years was 90.8, 114.6, and 136.6. This was significantly lower than IF (136.3, 182.0, 236.6) and HA (114.6, 153.3, 247.6) subjects at all time points. Medical costs were similar. Mean indemnity costs were 3.0 and 2.4 times higher among IF (P < .001) and HA (P = .007) groups compared to THA, respectively. Rates of postoperative permanent disability awards were 13.0%, 43.2%, and 35.6% for the THA, IF, and HA groups (P = .050). IF and HA subjects had a 24.3% and 11.1% revision rate. Overall, 77.8% and 100% of the IF and HA revisions were conversions to THA. CONCLUSION WC subjects aged 45-65 with dFNFs treated with THA had fewer dOOW, lower indemnity costs, and less disability at 2 years. Longer follow-up will help determine the durability and long-term outcomes of these surgeries.
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Affiliation(s)
- Joshua T Anderson
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT
| | | | | | - Nicholas U Ahn
- Department of Orthopaedics, University Hospitals Cleveland Medical Center, Cleveland, OH
| | - David L Rothberg
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT
| | - Jeremy M Gililland
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT
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Lagergren J, MÖller M, Rogmark C. Displaced femoral neck fractures in patients 60-69 years old - treatment and patient reported outcomes in a register cohort. Injury 2020; 51:2652-2657. [PMID: 32773114 DOI: 10.1016/j.injury.2020.08.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 07/30/2020] [Accepted: 08/02/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Several randomized studies have compared arthroplasty and internal fixation (IF) and found better patient reported outcome measure (PROM) and fewer reoperations for arthroplasty. But consensus is lacking regarding which method to use in the "young elderly" patients aged 60-69; IF tend to fail in up to 1/3 of the cases but can offer the benefits of a biologically intact hip if successful. To add to this, revision of failed IF with secondary arthroplasty has increased risk for complications. This register study aims to describe current treatment and mortality rates for displaced hip fractures based on register data, with focus on young elderly. A secondary aim is to compare changes in PROM between treatments. METHODS Data was retrieved from the Swedish Fracture Register, SFR. We found 9,564 femoral neck fractures classified as displaced (AO/OTA 31-B3) in patients 60 years or older. 883 patients were aged 60-69 years. In the final analysis of treatment allocation and PROM mean differences, 723 of these met the inclusion criteria. We adjusted for age, sex and baseline PROM, in patients treated with either IF or total hip arthroplasty (THA) in a regression model. RESULTS In the 60-69 years group, THA was used in 512 (58%), IF 211 (24%) and hemi arthroplasty (HA) 160 (18%) of the patients. As HA patients differed from those selected to THA and IF in regards to baseline characteristics and response rates, we omitted them from the PROM-analysis. When comparing only THA and IF we found no significant differences in mortality nor PROM means one year after injury. Treatment with THA was more common in women. CONCLUSIONS In young elderly patients THA is a common treatment for displaced FNF in Sweden. Patients in this segment treated with HA differ from patients treated with THA and IF, with baseline results in PROM indicating poorer health and function, as well as higher mortality and lower response rates. We found no differences in crude mortality between IF and THA treatment, and no significant influence from treatment on PROM outcome comparing THA and IF.
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Affiliation(s)
| | - Michael MÖller
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Cecilia Rogmark
- Lund University, Skane University Hospital, Department of Orthopaedics Malmö, Sweden
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30
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[Documentation of self-reported patient outcomes in trauma surgery : Clinical benefits of patient reported outcome measures]. Unfallchirurg 2020; 123:354-359. [PMID: 32313987 DOI: 10.1007/s00113-020-00802-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The future progressive aspiration of evidence-based medicine makes it necessary to carry out a comprehensive documentation of functional treatment after trauma surgery. Especially the subjective, patient-centered satisfaction with treatment results will be the focus of attention. Patient centered outcome measures (PROM) are potent instruments to capture the patients' functional status validly and in a cost and time-efficient manner. Additionally, modern technical options have the potential to evaluate specific joint function even better. Parameters, such as range of motion can soon be measured by the patient using the widely spread smartphone technology.
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Alsheikh KA, Alsebayel FM, Alsudairy FA, Alzahrani A, Alshehri A, Alhusain FA, Alsaeed A, Almubarak A, Alhandi AA. One-year postoperative mortality rate among the elderly with hip fractures at a single tertiary care center. Ann Saudi Med 2020; 40:298-304. [PMID: 32757984 PMCID: PMC7410227 DOI: 10.5144/0256-4947.2020.298] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Hip fractures are one of the leading causes of disability and dependency among the elderly. The rate of hip fractures has been progressively increasing due to the continuing increase in average life expectancy. Surgical intervention is the mainstay of treatment, but with an increasing prevalence of comorbid conditions and decreased functional capacity in elderly patients, more patients are prone to postoperative complications. OBJECTIVES Assess the value of surgical intervention for hip fractures among the elderly by quantifying the 1-year mortality rate and assessing factors associated with mortality. DESIGN Medical record review. SETTING Tertiary care center. PATIENTS AND METHODS All patients 60 years o age or older who sustained a hip fracture between the period of 2008 to 2018 in a single tertiary healthcare center. Data was obtained from case files, using both electronic and paper files. MAIN OUTCOME MEASURES The 1-year mortality rate for hip fracture, postoperative complications and factors associated with mortality. SAMPLE SIZE 802 patients. RESULTS The majority of patients underwent surgical intervention (93%). Intra- and postoperative complications were 3% and 16%, respectively. Four percent of the sample died within 30 days, and 11% died within one year. In a multivariate analysis, an increased risk of 1-year mortality was associated with neck of femur fractures and postoperative complications (P=.034, <.001, respectively) CONCLUSION: The 1-year mortality risk in our study reinforces the importance of aggressive surgical intervention for hip fractures. LIMITATION Single-centered study. CONFLICT OF INTEREST None.
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Affiliation(s)
- Khalid A Alsheikh
- From the College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,From the Department of Orthopedic Surgery, National Guard Health Affairs, Riyadh, Saudi Arabia.,From the Research Department, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Firas M Alsebayel
- From the College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,From the Research Department, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Faisal Abdulmohsen Alsudairy
- From the College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,From the Research Department, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Abdullah Alzahrani
- From the College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,From the Department of Orthopedic Surgery, National Guard Health Affairs, Riyadh, Saudi Arabia.,From the Research Department, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Ali Alshehri
- From the Department of Orthopedic Surgery, National Guard Health Affairs, Riyadh, Saudi Arabia.,From the Research Department, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Faisal Ahmed Alhusain
- From the College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,From the Research Department, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Abdullah Alsaeed
- From the Department of Orthopedic Surgery, National Guard Health Affairs, Riyadh, Saudi Arabia.,From the Research Department, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Abdulaziz Almubarak
- From the Research Department, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Ali A Alhandi
- From the Department of Orthopedic Surgery, National Guard Health Affairs, Riyadh, Saudi Arabia.,From the Research Department, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
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Screw Fixation Versus Hemiarthroplasty for Nondisplaced Femoral Neck Fractures in the Elderly: A Cost-Effectiveness Analysis. J Orthop Trauma 2020; 34:348-355. [PMID: 32398470 DOI: 10.1097/bot.0000000000001747] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the cost-effectiveness of screw fixation versus hemiarthroplasty for nondisplaced femoral neck fractures in low-demand elderly patients. METHODS We constructed a Markov decision model using a low-demand, 80-year-old patient as the base case. Costs, health-state utilities, mortality rates, and transition probabilities were obtained from published literature. The simulation model was cycled until all patients were deceased to estimate lifetime costs and quality-adjusted life years (QALYs). The primary outcome was the incremental cost-effectiveness ratio with a willingness-to-pay threshold set at $100,000 per QALY. We performed sensitivity analyses to assess our parameter assumptions. RESULTS For the base case, hemiarthroplasty was associated with greater quality of life (2.96 QALYs) compared with screw fixation (2.73 QALYs) with lower cost ($23,467 vs. $25,356). Cost per QALY for hemiarthroplasty was $7925 compared with $9303 in screw fixation. Hemiarthroplasty provided better outcomes at lower cost, indicating dominance over screw fixation. CONCLUSIONS Hemiarthroplasty is a cost-effective option compared with screw fixation for the treatment of nondisplaced femoral neck fractures in the low-demand elderly. Medical comorbidities and other factors that impact perioperative mortality should also be considered in the treatment decision. LEVEL OF EVIDENCE Economic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Brattgjerd JE, Steen H, Strømsøe K. Increased stability by a novel femoral neck interlocking plate compared to conventional fixation methods. A biomechanical study in synthetic bone. Clin Biomech (Bristol, Avon) 2020; 76:104995. [PMID: 32416403 DOI: 10.1016/j.clinbiomech.2020.104995] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 02/12/2020] [Accepted: 03/15/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Stable fixation promotes union in the common femoral neck fractures, but high non-union rates due to fixation failure remain with traditional fixations. To enhance stability, a plate interlocking pins, but without further fixation to femur has been developed. To our knowledge, no comparison to other conventional fixation methods has been performed. We tested the hypothesis that the novel implant biomechanically leads to a more stable femoral neck fixation. METHODS Fifty synthetic femurs with a cervical wedge osteotomy were allocated to intervention with three hook-pins interlocked in a plate (Hansson Pinloc® System) or standard fixations with a two-hole Dynamic Hip Screw® plate with an anti-rotational screw, three cannulated screws (ASNIS® III) or two screws (Olmed® or Cannulated Hip Screws®). Quasi-static non-destructive torsion around the neck, anteroposterior bending and vertical compression were tested to detect stiffness. The specimen's deformation was evaluated after cyclic compression simulating weight-bearing. Local deformation of implant channels was measured. Fixation failure was defined by fissure formation. FINDINGS Compared to the conventional implants all together, the interlocked pins enhanced mean stiffness 130% in torsion and 33% in bending (P < 0.001), while compressive stability was increased by a reduced deformation of 62% in average of the global test specimen and 95% decreased local implant channel deformation after cycling (P < 0.001). In comparisons with each of the standard fixations the interlocking pins revealed no signs of adverse effects. INTERPRETATION The novel femoral neck interlocking plate allowed dynamic compression and improved multi-directional stability compared to the traditional fixations.
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Affiliation(s)
- Jan Egil Brattgjerd
- Division of Orthopaedic Surgery, Biomechanics Lab, Oslo University Hospital, Pb. 4950 Nydalen, 0424 Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Pb. 1171 Blindern, 0318 Oslo, Norway.
| | - Harald Steen
- Division of Orthopaedic Surgery, Biomechanics Lab, Oslo University Hospital, Pb. 4950 Nydalen, 0424 Oslo, Norway
| | - Knut Strømsøe
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Pb. 1171 Blindern, 0318 Oslo, Norway
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Rogmark C, Gundel O. Postoperative mortality after a hip fracture over a 15-year period in Denmark: a national register study. Acta Orthop 2020; 91:360-361. [PMID: 32233889 PMCID: PMC8023917 DOI: 10.1080/17453674.2020.1744982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Affiliation(s)
| | - Ossian Gundel
- Center for Surgical Science, Department of Surgery, Zealand University Hospital, Koege, Denmark
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35
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Padilla JA, Gabor JA, Ryan SP, Long WJ, Seyler TM, Schwarzkopf RM. Total Hip Arthroplasty for Femoral Neck Fracture: The Economic Implications of Orthopedic Subspecialty Training. J Arthroplasty 2020; 35:S101-S106. [PMID: 32067895 DOI: 10.1016/j.arth.2020.01.047] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 01/14/2020] [Accepted: 01/19/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Hip fractures have significant economic implications as a result of their associated direct and indirect medical costs. Under alternative payment models, it has become increasingly important for institutions to find avenues by which costs could be reduced while maintaining outcomes in these cases. METHODS A multi-institutional retrospective analysis of Medicare patients who underwent total hip arthroplasty (THA) for femoral neck fracture was conducted to assess the impact of fellowship training in adult reconstruction (AR) on the total costs of the 90-day episode of care. Patients were divided into 2 cohorts according to fellowship training status of the operating surgeon: (1) AR-trained and (2) other fellowship training (non-AR). The primary outcome was the total cost of the 90-day episode of care converted to a percentage of the bundled payment target price. RESULTS A total of 291 patients who underwent THA for the treatment of a femoral neck fracture were included. The average total cost percentage of the 90-day episode of care was significantly lower for the AR cohort 70.9% (±36.6%) than the non-AR cohort 82.6% (±36.1%) (P < .01). After controlling for baseline demographics in the multivariable logistic regression, the care episodes in which the operating surgeons were AR fellowship-trained were still found to be significantly lower, at a rate of 0.87 times the costs of the non-AR surgeons (95% confidence interval 0.78-0.97, P = .011). In addition, the non-AR cohort exceeded the bundle target price more frequently than the AR cohort, 49 (28.7%) vs 16 (13.3%) (P = .02). CONCLUSION In an era of bundled payments, ascertaining factors that may increase the value of care while decreasing the cost is paramount for institutions and policymakers alike. The results presented in this study suggest that in the femoral neck fracture population, surgeons trained in AR achieve lower total costs for the THA episode of care. Furthermore, non-AR fellowship-trained surgeons exceeded the bundled payment target more frequently than the AR surgeons.
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Affiliation(s)
- Jorge A Padilla
- Department of Orthopaedic Surgery, Zucker School of Medicine at Hofstra/Northwell Health, Hempstead, New York
| | - Jonathan A Gabor
- Department of Orthopaedic Surgery, NYU Langone Health, New York, New York
| | - Sean P Ryan
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - William J Long
- Department of Orthopaedic Surgery, NYU Langone Health, New York, New York
| | - Thorsten M Seyler
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Ran M Schwarzkopf
- Department of Orthopaedic Surgery, NYU Langone Health, New York, New York
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36
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Wei P, Xu Y, Gu Y, Geng D, Yao Q, Wang L. Conservative vs Surgical Treatment of Impacted Femoral Neck Fracture in Patients 75 Years and Older. J Am Geriatr Soc 2020; 68:2214-2221. [PMID: 32413174 DOI: 10.1111/jgs.16535] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 04/16/2020] [Accepted: 04/23/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate the safety and effectiveness of conservative treatment (CST), internal fixation (IF), and hemiarthroplasty (HA) in treating patients older than 75 years with impacted femoral neck fracture (IFNF). DESIGN A randomized clinical trial to compare clinical outcomes of CST, IF, and HA in IFNF patients older than 75 years with a 1:1:1 ratio. SETTING Nanjing First Hospital, Nanjing Medical University, Nanjing, China. PARTICIPANTS A total of 154 patients with IFNF aged between 75 and 97 years. INTERVENTION Patients with IFNF were allocated to CST, IF, and HA. They all received a 36-month follow-up. MEASUREMENTS All patients were evaluated by Harris hip score (HHS) (primary outcome) for hip function, European Quality of Life-5 Dimensions (EQ-5D) index scores for health-related quality of life, and visual analogue scale score for hip pain. Operation duration, blood loss, mortality, union rate, complications, and reoperation were also recorded. Assessors were blind to the type of treatment. RESULTS The baseline parameters of the three groups were similar. IF group had much lower blood loss than HA group (P < .05), while no significant difference in operative duration was found between the two groups (P > .05). HHS in HA group was significantly higher at 1, 3, and 6 months (P < .05), but no significant difference in HHS was found between CST and IF groups at any of the time points during the overall follow-up (P > .05). EQ-5D index score was higher in HA group at each follow-up within 1 year (P < .05), but the difference was not significant at 2- and 3-year follow-up (P > .05). There was no significant difference in mortality among the three groups at each follow-up point (P > .05). The nonunion rate was 11.76% (6/51) in CST group and 9.80% (5/51) in IF group and showed no significant difference (P > .05). CONCLUSION CST may be a feasible way for IFNF in the older patients. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04219943. J Am Geriatr Soc 68:2214-2221, 2020.
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Affiliation(s)
- Peiran Wei
- Department of Orthopaedics, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Yan Xu
- Department of Orthopaedics, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Yue Gu
- Department of Orthopaedics, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Dawei Geng
- Department of Orthopaedics, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Qingqiang Yao
- Department of Orthopaedics, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Liming Wang
- Department of Orthopaedics, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
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37
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Biberthaler P. [PROM's in Trauma and Othopedic Surgery]. Unfallchirurg 2020; 123:341. [PMID: 32377775 DOI: 10.1007/s00113-020-00803-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Peter Biberthaler
- Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland.
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Nyholm AM, Palm H, Sandholdt H, Troelsen A, Gromov K. Risk of reoperation within 12 months following osteosynthesis of a displaced femoral neck fracture is linked mainly to initial fracture displacement while risk of death may be linked to bone quality: a cohort study from Danish Fracture Database. Acta Orthop 2020; 91:1-75. [PMID: 31801400 PMCID: PMC7006706 DOI: 10.1080/17453674.2019.1698503] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Most guidelines use patient age as a primary decision factor when choosing between osteosynthesis or arthroplasty in displaced femoral neck fractures. We evaluate reoperation and death risk within 1 year after osteosynthesis, and estimate the influence of age, sex, degree of displacement, and bone quality.Patients and methods - All surgeries for femoral neck fractures with parallel implants (2 or 3 screws or pins) performed between December 2011 and November 2015 were collected from the Danish Fracture Database. Radiographs were analyzed for initial displacement, quality of reduction, protrusion, and angulation of implants. The bone quality was estimated using the cortical thickness index (CTI). Garden I and II type fractures with posterior tilt < 20° were excluded.Results - 654 patients with a mean age of 69 years were included. 59% were female. 54% were Garden II with posterior tilt > 20° or Garden III, and 46% were Garden IV. Only 38% were adequately reduced. 19% underwent reoperation and 18% died within 12 months. Female sex, surgical delay between 12 and 24 hours vs. < 12 hours, Garden IV type fracture, inadequate reduction, and protrusion of an implant were associated with statistically significant increased reoperation risk. No significant association between reoperation and age, CTI, or the initial angulation of implants was found. Notably, CTI was linked inversely with death risk.Interpretation - Reoperation risk is linked mainly to primary displacement and reduction of the fracture, with no apparent effect of age or bone quality. Bone quality may be linked with risk of death.
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Affiliation(s)
- Anne M Nyholm
- Clinical Orthopaedic Researc Hvidovre (CORH), Department of Orthopaedics, Copenhagen University Hospital Hvidovre, Copenhagen
- Department of Orthopaedics, Holbaek Sygehus, Holbaek
| | - Henrik Palm
- Department of Orthopaedics, Copenhagen University Hospital Bispebjerg, Copenhagen
| | - Håkon Sandholdt
- Clinical Research Centre, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark
| | - Anders Troelsen
- Clinical Orthopaedic Researc Hvidovre (CORH), Department of Orthopaedics, Copenhagen University Hospital Hvidovre, Copenhagen
| | - Kirill Gromov
- Clinical Orthopaedic Researc Hvidovre (CORH), Department of Orthopaedics, Copenhagen University Hospital Hvidovre, Copenhagen
| | - DFDB COLLABORATORS
- Clinical Research Centre, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark
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Affiliation(s)
- Cecilia Rogmark
- Department of Orthopaedics, Skåne Univerisity Hospital, Malmö, Sweden,
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Hardware removal rates after surgical treatment of proximal femur fractures : Nationwide trends in Finland in 1997-2016. Arch Orthop Trauma Surg 2020; 140:1047-1054. [PMID: 31965281 PMCID: PMC7351871 DOI: 10.1007/s00402-020-03356-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Various internal fixation methods have been used to treat proximal femur fractures and occasionally the fixation material is removed. However, nationwide trends of hardware removals are not known. Thus, this study investigated the hardware removal rates after proximal femur fractures in Finland during 1997-2016. MATERIALS AND METHODS Finnish adults aged 18 years or older in 1997-2016 formed the basic study population. From the National Hospital Discharge Register patients with trochanteric femur fracture treated with an intramedullary nail (IMN) or dynamic hip screw (DHS), and patients with femoral neck fracture treated with screw fixation, were included. Hardware removal and secondary prosthesis rates were assessed. RESULTS Altogether 41,253 patients underwent proximal femoral fracture fixation surgery in Finland in 1997-2016. Of these, 16,152 were DHS surgery and 15,724 IMN surgery and 8491 underwent screw operation of femoral neck fracture. The total removal rates of DHS and IMN were 5.5% and 5.4%. The total removal rate of screw fixations of the femoral neck was higher, 18.5%. The total removal rates during the first 3 years after the IMN more than halved in 1997-2013, from 7.6% to 3.7%, whereas the removal rate of the DHS or screw fixation of femoral neck fractures did not show consistent trend. The rate of secondary prosthesis operations following DHS and IMN was low (1.8% for both). This was in clear contrast to the prosthesis rate following screw fixations of the femoral neck (7.2%). CONCLUSIONS IMN operations largely replaced DHS operations in trochanteric fractures of the proximal femur in Finland in 1997-2016. The removal and secondary prosthesis rates of the DHS and IMN were clearly lower than the corresponding rates after screw fixations of the femoral neck fracture. LEVEL OF EVIDENCE III, Epidemiologic study.
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Biplane Double-supported Screw Fixation of Femoral Neck Fractures: Surgical Technique and Surgical Notes. J Am Acad Orthop Surg 2019; 27:e507-e515. [PMID: 30399029 PMCID: PMC6530978 DOI: 10.5435/jaaos-d-17-00117] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Osteosynthesis of femoral neck fractures is still associated with high complication rates. The novel method of biplane double-supported screw fixation offers better osteosynthesis stability by buttressing two of three medially diverging cannulated screws on the inferior neck cortex. Biomechanically, the most effective component of this fixation is the third, inferior obtuse screw, supported along considerable distance on both the inferior and posterior cortices of the femoral neck following its spiral anterior curve. Thus, biplane double-supported screw fixation achieves greater inferoposterior cortical support of the implants, allowing immediate full weight bearing for patients older than 55 years. Although the method has been recently communicated, some important surgical aspects still remain to be discussed. This report aims at describing a detailed and modified surgical technique and providing criteria and recommendations for its successful application according to the clinical experience over more than 9 years. LEVEL OF EVIDENCE:: Level V, expert evidence.
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Tabori-Jensen S, Hansen TB, Stilling M. Low dislocation rate of Saturne ®/Avantage ® dual-mobility THA after displaced femoral neck fracture: a cohort study of 966 hips with a minimum 1.6-year follow-up. Arch Orthop Trauma Surg 2019; 139:605-612. [PMID: 30547264 DOI: 10.1007/s00402-018-3093-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Dislocation is a serious and common complication and a great concern with the use of total hip arthroplasty (THA) when treating displaced femoral neck fracture (FNF). Dual-mobility (DM) THA might reduce the dislocation risk. We aim to report the dislocation and revision rate of primary DM THA in patients with displaced FNF. MATERIALS AND METHODS Between 2005 and 2015, 966 consecutive patients (676 women) at mean age 80.5 years (range 42-104) with displaced FNF were operated with DM articulation THA by posterolateral approach (PLA). Patient files and radiographs were evaluated for dislocations, revisions, and other complications until death of the patient or August 1st, 2017. Data were crosschecked with the National Patient Registry. Patient's mental state was tested upon admissions. Surgeon's educational level was noted and post-operative cup position was measured. RESULTS At minimum 1.6-year follow-up, there were 45 (4.7%) dislocations and eight (0.8%) cup revisions. The 30-day mortality was 9.2% and 533 patients (55.2%) were dead at the time of last follow-up. We observed eight intraprosthetic dislocations (IPD); six occurred in relation to closed reduction. Cementless stem fixation was associated with higher dislocation risk (p = 0.04) and higher rate of stem complications (p = 0.002). There was no significant association between cognitive impairment and dislocation (OR 2.0, 95% CI 0.96-4.34, p = 0.06). CONCLUSION Overall, DM THA inserted via PLA results in an acceptable dislocation risk and low revision rate in fragile, old patients with acute FNF fracture, regardless of mental status. A unique complication in DM THA is IPD, which requires an immediate open reduction surgery.
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Affiliation(s)
- Steffan Tabori-Jensen
- University Clinic for Hand, Hip and Knee Surgery, Hospital Unit West, Building 8, Entrance N, 1st floor, Laegaardvej 12, 7500, Holstebro, Denmark. .,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - Torben B Hansen
- University Clinic for Hand, Hip and Knee Surgery, Hospital Unit West, Building 8, Entrance N, 1st floor, Laegaardvej 12, 7500, Holstebro, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Maiken Stilling
- University Clinic for Hand, Hip and Knee Surgery, Hospital Unit West, Building 8, Entrance N, 1st floor, Laegaardvej 12, 7500, Holstebro, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Abstract
Distal radial fractures account for up to 18% of all fractures in patients over 65 years of age, and osteoporosis is a predominant factor in these fractures. Fracture treatment may include closed reduction and casting/splinting, external fixation, and open reduction and internal fixation.
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Affiliation(s)
- John C Wu
- Department of Orthopaedic Surgery and Biomedical Engineering, Campbell Clinic, University of Tennessee, 1211 Union Avenue, Suite 510, Memphis, TN 38104, USA.
| | - Carson D Strickland
- Department of Orthopaedic Surgery and Biomedical Engineering, Campbell Clinic, University of Tennessee, 1211 Union Avenue, Suite 510, Memphis, TN 38104, USA
| | - James S Chambers
- Department of Orthopaedic Surgery and Biomedical Engineering, Campbell Clinic, University of Tennessee, 1211 Union Avenue, Suite 510, Memphis, TN 38104, USA
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Kelly MA, McSorley K, Casey MC, Shannon FJ. The long-term outcomes following internal fixation for intracapsular hip fractures in an Irish tertiary referral centre. Ir J Med Sci 2019; 188:1227-1231. [PMID: 30712244 DOI: 10.1007/s11845-019-01972-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 01/19/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND The burden associated with hip fractures is increasing worldwide. Arthroplasty procedures are more commonly performed for intracapsular fractures due to increased risk of compromise to the femoral head blood supply. However, we know from the Irish Hip Fracture Database that a significant proportion of these fractures undergo internal fixation. AIMS We sought to investigate the long-term outcomes for these patients including revision rates, functional outcome and mortality rates. METHODS All intracapsular fractures treated by internal fixation (IF) from 2005 to 2009 were identified. Pre-operative anatomical fracture location and level of fracture displacement was established. Hospital records were used to record mortality and revision rates. The modified Harris hip score was our primary functional outcome measure. RESULT One hundred twelve intracapsular fractures underwent IF over a 5-year period. The mean age was 68.6 (range 14-95 years). A mean follow-up time of 8.15 years (range 6.7-10.1 years) was achieved. There was a 5-year mortality rate of 36.6%. There was a significantly higher revision rate in displaced fractures (24.4%) than in undisplaced fractures (11.1%) (p = 0.01). We found no difference in functional outcome between displaced fractures [85.9 (± 16.9)] and undisplaced fractures [86.01 (± 18.8)]. Those aged younger than 65 at the time of surgery had a significantly better MHHS (p = 0.02) at long-term follow-up; however, there was a revision rate of 43.8% in this group. CONCLUSION Whilst a good functional outcome can be achieved with internal fixation, particularly in younger patients, the risk of requiring revision surgery approaches 50% for these patients.
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Affiliation(s)
- Michael A Kelly
- Department of Trauma and Orthopaedic Surgery, University Hospital Galway, Galway, Ireland.
| | - Kevin McSorley
- Department of Trauma and Orthopaedic Surgery, University Hospital Galway, Galway, Ireland
| | - Maire-Caitlin Casey
- Department of Trauma and Orthopaedic Surgery, University Hospital Galway, Galway, Ireland
| | - Fintan J Shannon
- Department of Trauma and Orthopaedic Surgery, University Hospital Galway, Galway, Ireland
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Robertson GAJ, Wood AM. Hip hemi-arthroplasty for neck of femur fracture: What is the current evidence? World J Orthop 2018; 9:235-244. [PMID: 30479970 PMCID: PMC6242732 DOI: 10.5312/wjo.v9.i11.235] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 08/07/2018] [Accepted: 10/09/2018] [Indexed: 02/06/2023] Open
Abstract
This editorial reviews and summarises the current evidence (meta-analyses and Cochrane reviews) relating to the use of hip hemi-arthroplasty for neck of femur fractures. Regarding the optimal surgical approach, two recent meta-analyses have found that posterior approaches are associated with: higher rates of dislocation compared to lateral and anterior approaches; and higher rates of re-operation compared to lateral approaches. Posterior approaches should therefore be avoided when performing hip hemi-arthroplasty procedures. Assessing the optimal prosthesis head component, three recent meta-analyses and one Cochrane review have found that while unipolar hemi-arthroplasty can be associated with increased rates of acetabular erosion at short-term follow-up (up to 1 year), there is no significant difference between the unipolar hemi-arthroplasty and bipolar hemi-arthroplasty for surgical outcome, complication profile, functional outcome and acetabular erosion rates at longer-term follow-up (2 to 4 years). With bipolar hemi-arthroplasty being the more expensive prosthesis, unipolar hemi-arthroplasty is the recommended option. With regards to the optimal femoral stem insertion technique, three recent meta-analyses and one Cochrane Review have found that, while cemented hip hemi-arthroplasties are associated with a longer operative time compared to uncemented Hip Hemi-arthroplasties, cemented prostheses have lower rates of implant-related complications (particularly peri-prosthetic femoral fracture) and improved post-operative outcome regarding residual thigh pain and mobility. With no significant difference found between the two techniques for medical complications and mortality, cemented hip hemi-arthroplasty would appear to be the superior technique. On the topic of wound closure, one recent meta-analysis has found that, while staples can result in a quicker closure time, there is no significant difference in post-operative infections rates or wound healing outcomes when comparing staples to sutures. Therefore, either suture or staple wound closure techniques appear equally appropriate for hip hemi-arthroplasty procedures.
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Affiliation(s)
- Greg AJ Robertson
- Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, Scotland EH16 4SA, United Kingdom
| | - Alexander M Wood
- Orthopaedic Department, Leeds General Infirmary, Great George St, Leeds LS1 3EX, United Kingdom
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Nyholm AM, Palm H, Sandholdt H, Troelsen A, Gromov K. Osteosynthesis with Parallel Implants in the Treatment of Femoral Neck Fractures: Minimal Effect of Implant Position on Risk of Reoperation. J Bone Joint Surg Am 2018; 100:1682-1690. [PMID: 30277998 DOI: 10.2106/jbjs.18.00270] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to estimate the incidence of reoperation and the effect of implant position on the risk of reoperation within 12 months following osteosynthesis with use of parallel implants for femoral neck fractures. METHODS From cases registered in the Danish Fracture Database, 1,206 consecutive surgeries for a primary femoral neck fracture treated with use of parallel implants during the period of December 2011 to November 2015, and having available radiographs and follow-up data, were reviewed. Data included age, sex, time to surgery, fracture classification, and American Society of Anesthesiologists (ASA) score. Fracture displacement, posterior tilt, the number of implants, posterior distance, calcar distance, tip-cartilage distance, and angulation of implants were measured on pre- and postoperative radiographs. Data on secondary surgeries were collected from the Danish Civil Registration System. The effects of the included variables on the risk of reoperation were evaluated using Cox regression analysis. RESULTS The median age was 73 years (range, 21 to 102 years); in 69% of the cases, the patient was female. Two implants were used in 997 cases and 3 implants were used in 209. In 157 cases, the patient underwent reoperation within 1 year; in 228 cases, the patient died within 1 year. The median time to reoperation was 116 days. Patients <70 years of age were more likely to undergo reoperation (18.0% compared with 9.8%) but less likely to die (7.4% compared with 26.3%) than were patients ≥70 years of age. Female sex, higher ASA score, and displaced fractures were associated with increased risk of reoperation. Time to surgery was associated with increased risk of reoperation for displaced fractures only. Of the variables pertaining to the osteosynthesis, only insufficient fracture reduction, placement of the implants with an angle to the shaft of ≤125°, and femoral head perforation significantly increased the risk of reoperation. We found no effect of the posterior distance, the calcar distance, the tip-caput distance, or whether or not the implants were parallel. CONCLUSIONS Insufficient reduction, varus position of the implants, and perforation of the femoral head cartilage were the only surgical factors influencing the risk of reoperation. Sufficient fracture reduction is perhaps more important than focusing on an optimal position of the implants. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Anne Marie Nyholm
- Department of Orthopaedics (A.M.N., H.P., A.T., and K.G.) and Clinical Research Centre (H.S.), Copenhagen University Hospital Hvidovre, Copenhagen, Denmark
| | - Henrik Palm
- Department of Orthopaedics (A.M.N., H.P., A.T., and K.G.) and Clinical Research Centre (H.S.), Copenhagen University Hospital Hvidovre, Copenhagen, Denmark
| | - Håkon Sandholdt
- Department of Orthopaedics (A.M.N., H.P., A.T., and K.G.) and Clinical Research Centre (H.S.), Copenhagen University Hospital Hvidovre, Copenhagen, Denmark
| | - Anders Troelsen
- Department of Orthopaedics (A.M.N., H.P., A.T., and K.G.) and Clinical Research Centre (H.S.), Copenhagen University Hospital Hvidovre, Copenhagen, Denmark
| | - Kirill Gromov
- Department of Orthopaedics (A.M.N., H.P., A.T., and K.G.) and Clinical Research Centre (H.S.), Copenhagen University Hospital Hvidovre, Copenhagen, Denmark
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Saxer F, Studer P, Jakob M, Suhm N, Rosenthal R, Dell-Kuster S, Vach W, Bless N. Minimally invasive anterior muscle-sparing versus a transgluteal approach for hemiarthroplasty in femoral neck fractures-a prospective randomised controlled trial including 190 elderly patients. BMC Geriatr 2018; 18:222. [PMID: 30241509 PMCID: PMC6151034 DOI: 10.1186/s12877-018-0898-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Accepted: 08/27/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The relevance of femoral neck fractures (FNFs) increases with the ageing of numerous societies, injury-related decline is observed in many patients. Treatment strategies have evolved towards primary joint replacement, but the impact of different approaches remains a matter of debate. The aim of this trial was to evaluate the benefit of an anterior minimally-invasive (AMIS) compared to a lateral Hardinge (LAT) approach for hemiarthroplasty in these oftentimes frail patients. METHODS Four hundred thirty-nine patients were screened during the 44-months trial, aiming at the evaluation of 150 patients > 60 yrs. of age. Eligible patients were randomised using an online-tool with completely random assignment. As primary endpoint, early mobility, a predictor for long-term outcomes, was evaluated at 3 weeks via the "Timed up and go" test (TUG). Secondary endpoints included the Functional Independence Measure (FIM), pain, complications, one-year mobility and mortality. RESULTS A total of 190 patients were randomised; both groups were comparable at baseline, with a predominance for frailty-associated factors in the AMIS-group. At 3 weeks, 146 patients were assessed for the primary outcome. There was a reduction in the median duration of TUG performance of 21.5% (CI [- 41.2,4.7], p = 0.104) in the AMIS-arm (i.e., improved mobility). This reduction was more pronounced in patients with signs of frailty or cognitive impairment. FIM scores increased on average by 6.7 points (CI [0.5-12.8], p = 0.037), pain measured on a 10-point visual analogue scale decreased on average by 0.7 points (CI: [- 1.4,0.0], p = 0.064). The requirement for blood transfusion was lower in the AMIS- group, the rate of complications comparable, with a higher rate of soft tissue complications in the LAT-group. The mortality was higher in the AMIS-group. CONCLUSION These results, similar to previous reports, support the concept that in elderly patients at risk of frailty, the AMIS approach for hemiarthroplasty can be beneficial, since early mobilisation and pain reduction potentially reduce deconditioning, morbidity and loss of independence. The results are, however, influenced by a plethora of factors. Only improvements in every aspect of the therapeutic chain can lead to optimisation of treatment and improve outcomes in this growing patient population. TRIAL REGISTRATION www.clinicaltrials.gov : NCT01408693 (registered August 3rd 2011).
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Affiliation(s)
- Franziska Saxer
- Department of Orthopaedics and Traumatology, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland
| | - Patrick Studer
- Department of Orthopaedics and Traumatology, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland
- Clinic for Orthopaedics and Trauma Surgery Stephanshorn, Brauerstrasse 95, 9016 St. Gallen, Switzerland
| | - Marcel Jakob
- Department of Orthopaedics and Traumatology, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland
| | - Norbert Suhm
- Department of Orthopaedics and Traumatology, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland
| | - Rachel Rosenthal
- Faculty of Medicine, University of Basel, Klingelbergstr. 61, 4056 Basel, Switzerland
| | - Salome Dell-Kuster
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Spitalstrasse 12, 4031 Basel, Switzerland
- Department of Department of Anaesthesiology, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland
| | - Werner Vach
- Department of Orthopaedics and Traumatology, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland
| | - Nicolas Bless
- Department of Orthopaedics and Traumatology, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland
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Khan AM, Rafferty M, Daurka JS. Hemiarthroplasty compared with total hip arthroplasty in fractured neck of femur: a shift in national practice? Ann R Coll Surg Engl 2018; 101:86-92. [PMID: 30112942 DOI: 10.1308/rcsann.2018.0123] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The aim of this study was to determine the trends in national practice regarding total hip arthroplasty compared with hemiarthroplasty in fractured neck of femur between 2010 and 2016. MATERIALS AND METHODS A retrospective review was conducted of NHS Digital data (England) between 2010 and 2016. 'Emergency' neck of femur fracture admissions, hemiarthroplasties and total hip arthroplasties were included. Elective total hip arthroplasties, revisions and prostheses relocations were excluded. Annual percentages for each operation were calculated. Trends were tabulated and displayed graphically for analysis. RESULTS The total number of emergency neck of femur diagnoses was 257,789. Total hip arthroplasty was performed in 2217, 2737, 3305, 3686, 3670 and 3825 patients and hemiarthroplasty was performed in 21,335, 21,744, 21,115, 21,798, 21,804 and 22,163 patients for each year between 2011 and 2016, respectively. The rate of change for total hip arthroplasty slowed from 24.54% increase/year (2011-2013) to 5.24% increase/year (2013-2016). Uncemented arthroplasties decreased over the same time period. DISCUSSION Increasing numbers of total hip arthroplasties are conducted for hip fractures; however, this trend has slowed since 2013. Possible explanations include all eligible fractures being treated with total hip arthroplasty, trauma surgeon preference for hemiarthroplasty due to lower surgical specialism or publication of individual surgeon data (National Joint Registry) which may lead to surgeons favouring hemiarthroplasties which have a lower complication rate compared to elective total hip arthroplasties.
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Affiliation(s)
- A M Khan
- Department of Trauma and Orthopaedics, Imperial College Healthcare NHS Trust, St Mary's Hospital , London , UK
| | - M Rafferty
- Department of Trauma and Orthopaedics, Imperial College Healthcare NHS Trust, St Mary's Hospital , London , UK
| | - J S Daurka
- Department of Trauma and Orthopaedics, Imperial College Healthcare NHS Trust, St Mary's Hospital , London , UK
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Kahlenberg CA, Richardson SS, Schairer WW, Cross MB. Rates and Risk Factors of Conversion Hip Arthroplasty After Closed Reduction Percutaneous Hip Pinning for Femoral Neck Fractures-A Population Analysis. J Arthroplasty 2018; 33:771-776. [PMID: 29089225 DOI: 10.1016/j.arth.2017.10.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 09/27/2017] [Accepted: 10/02/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Closed reduction with percutaneous pinning (CRPP) for nondisplaced or valgus impacted femoral neck fractures is a relatively low-risk operation that can produce excellent union rates in some patients; however, failure can occur in selected patients requiring conversion to arthroplasty. The primary aim of this study was to perform a population-level analysis to determine the rate and timeframe of conversion from CRPP to total hip arthroplasty (THA) or hemiarthroplasty. METHODS The PearlDiver database was queried from 2007-2015 for all patients who underwent CRPP for a femoral neck fracture. Survival analysis was used to evaluate the rate of conversion of CRPP to hemiarthroplasty or THA. Risk factors for conversion arthroplasty were identified using a multivariable cox proportional hazards model that included patient demographics and comorbidities. RESULTS There were 5122 patients in the Humana database and 4840 patients in the Medicare database that were included in analysis. At 5 years after CRPP, the conversion rate was 10.0% in the Medicare patients and 10.8% in the Humana patients. Risk factors for undergoing conversion from CRPP to arthroplasty in the Medicare cohort included preexisting diagnoses of pulmonary and/or circulatory comorbidities, peripheral vascular disease, hypertension, hypothyroidism, and metastatic cancer. In the Humana cohort, the only risk factors were male gender and acute blood loss anemia. CONCLUSION Although CRPP remains a successful operation in elderly patients and patients with certain comorbidities, failure of CRPP for the treatment of a femoral neck fracture is high at approximately 10%-11%, which is much higher than reported failure rates for THA in the same population. Patients with femoral neck fractures being considered for CRPP should be counseled about the possibility of further surgery.
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Affiliation(s)
- Cynthia A Kahlenberg
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Shawn S Richardson
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - William W Schairer
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Michael B Cross
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
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Bartels S, Gjertsen JE, Frihagen F, Rogmark C, Utvåg SE. High failure rate after internal fixation and beneficial outcome after arthroplasty in treatment of displaced femoral neck fractures in patients between 55 and 70 years. Acta Orthop 2018; 89:53-58. [PMID: 28914130 PMCID: PMC5810833 DOI: 10.1080/17453674.2017.1376514] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - The treatment of patients between 55 and 70 years with displaced intracapsular femoral neck fracture remains controversial. We compared internal fixation (IF), bipolar hemiarthroplasty (HA) and total hip arthroplasty (THA) in terms of mortality, reoperations and patient-reported outcome by using data from the Norwegian Hip Fracture Register. Patients and methods - We included 2,713 patients treated between 2005 and 2012. 1,111 patients were treated with IF, 1,030 with HA and 572 patients with THA. Major reoperations (defined as re-osteosynthesis, secondary arthroplasty, exchange, or removal of prosthesis components and Girdlestone procedure), patient-reported outcome measures (satisfaction, pain, and health-related quality of life (EQ5D) after 4 and 12 months), 1-year mortality, and change in treatment methods over the study period were investigated. Results - Major reoperations occurred in 27% after IF, 3.8% after HA and 2.8% after THA. 549 patients (20% of total study population) answered both questionnaires. Compared with IF, patients treated with THA were more satisfied after 4 and 12 months, reported less pain after 4 months and 12 months, had a higher EQ5D-index score after 4 months and 12 months, and EQ-VAS score after 4 months. Compared with IF, patients treated with HA were more satisfied and reported less pain after 4 months. EQ5D-index and EQ-VAS were similar. Patients treated with HA had higher 1-year mortality and had more comorbidities than both the THA and IF group. All these differences were statistically and clinically significant. Interpretation - This study showed high reoperation rate after IF and better patient-reported outcome after both THA and HA with medium follow-up. Patients selected for HA represented a frailer group than patients treated with THA or IF.
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Affiliation(s)
- Stefan Bartels
- Department of Orthopaedic Surgery, Akershus University Hospital, Lørenskog, Norway,Correspondence:
| | - Jan-Erik Gjertsen
- Norwegian Hip Fracture Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen,Department of Clinical Sciences, University of Bergen, Bergen, Norway
| | - Frede Frihagen
- Department of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
| | - Cecilia Rogmark
- Department of Orthopaedics, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Stein Erik Utvåg
- Department of Orthopaedic Surgery, Akershus University Hospital, Lørenskog, Norway,Institute of Clinical Medicine, University of Oslo, Norway
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