Patients risk for mortality at 90 days after proximal femur fracture - a retrospective study in a tertiary care hospital

Safety and complications of antimicrobial coated compared to conventional intramedullary femoral nails in proximal femoral fractures

PURPOSE

The aim of this study was to compare one-year mortality and the incidence of complications, particularly fracture-related infections, between patients with proximal femur fractures treated with novel noble metal-coated implants and those treated with uncoated implants, to detect possible effects of the coating on these endpoints.

METHODS

Design: Retrospective cohort observational study.

SETTING

Level 1 trauma centre. Patient Selection Criteria: All patients ≥ 18 years old with proximal femur fracture, who were treated with an intramedullary femur nail between 01.09.2020 and 01.10.2022 were included. The coated group (COATED) included patients who were treated with a coated implant. The control group (CONTROL) was treated with uncoated implants. Pathological fractures were excluded.

RESULTS

188 patients who matched the criteria were included (COATED: 93, CONTROL: 95). There was no significant difference in the one-year mortality or complication rate between the two groups. The fracture-related infection rate did not differ (p = 0.31) between both groups. Complications were observed in 59% of all cases and the overall one-year mortality rate was 42%. There was a significant correlation between complication occurrence and hospital stay (p < 0.01).

CONCLUSION

The coated intramedullary nail was similar to the uncoated nail in terms of perioperative complications and 1-year mortality rate. This suggests that the novel coated implant is safe for common clinical use. Further prospective multicentre studies with larger sample sizes are needed to detect a potential impact of coated implants on the incidence of fracture-related infections.

AST/ALT ratio as a potential predictor of 1-year mortality in elderly patients operated for femoral neck fracture

PURPOSE

Hip fractures in elderly individuals are associated with high mortality rates, even with advanced treatment options. Identifying factors correlated with mortality could guide potential preventive strategies. Elevated aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels, as well as the AST/ALT ratio (AAR), have been associated with mortality in various diseases, but their association with hip fracture mortality remains underexplored. This study investigates the correlation between AST, ALT, AAR, and routine laboratory parameters with 1-year mortality in elderly patients undergoing partial hip arthroplasty for femoral neck fractures.

METHODS

This retrospective cohort study analyzed data from 179 elderly patients (≥60 years) who underwent partial hip replacement for femoral neck fracture between January 2019 and December 2021.

RESULTS

Of the 179 patients, 29.6% died within one year of surgery. The deceased patients were older, predominantly male, and had higher rates of postoperative complications and transfusions. Univariate analysis identified age, sex, blood type, comorbidities, postoperative complications, transfusions, and laboratory parameters (including AAR, creatinine, and lymphocyte count) as associated with mortality. Multivariate analysis further highlighted advanced age, male sex, blood group A, postoperative transfusions, elevated creatinine levels, and high AAR (>2.1) as independent predictors of mortality.

CONCLUSION

Our findings suggest that preoperative AAR may serve as an independent predictor of mortality in elderly patients undergoing hip fracture surgery, highlighting its potential utility in preoperative risk stratification.

[Potential consequences of the German hospital reform and the resolution of the Federal Joint Committee on the treatment of proximal femoral fractures for the Federal State of Saxony : Improvement or hazard for the quality of care?]

BACKGROUND

The German hospital landscape is undergoing comprehensive changes due to the increasing aging population and staff shortages in the healthcare sector. These changes are driven by the current hospital reform and the guidelines of the Federal Joint Committee (G-BA) for the treatment of proximal femoral fractures.

OBJECTIVE

To investigate the effects of the hospital reform and the implementation of the G‑BA guidelines for the treatment of proximal femoral fractures in Saxony.

METHODS

Based on the number of proximal femoral fracture surgeries performed in all certified trauma centers in Saxony (East Saxony/West Saxony Trauma Network) in 2019 and 2022, a simulation was conducted to visualize the implementation of the G‑BA guidelines and the hospital reform.

RESULTS

Applying the criteria of the G‑BA resolution results in a reduction of hospitals treating proximal femoral fractures in Saxony from 42 to 28 (-33%). The implementation of the planned hospital reform further reduces the number of such hospitals to 15 (-64%). This reduction leads to a significant increase in case numbers in the remaining hospitals (twofold to threefold) and up to a fourfold increase by 2030. This comes with an increased need for operating capacities (1.2 operating rooms per week) and about 7400 secondary transfers per year. In the districts of North Saxony, Bautzen, Central Saxony, and the Erzgebirge District, no hospital would be available to treat geriatric proximal femoral fractures.

CONCLUSION

The planned reform and the current implementation of the G‑BA resolution pose a high risk to create gaps in care in Saxony with a markedly reduced number of hospitals involved in treatment of proximal femoral fractures. The necessary operating resources and inpatient capacities in the remaining hospitals are insufficient to care for the expected number of patients given the personnel and capacity shortages.

Prognostic Factors for Mortality in Patients Aged 90 Years and Older with Proximal Femoral Fractures Undergoing Surgery: A Retrospective Study

Background/Objectives: Proximal femoral fractures (PFFs) among individuals aged ≥90 years are becoming more common with an aging population and are associated with high morbidity and mortality. This study analyzed the prognostic factors influencing survival in nonagenarian patients undergoing surgery for PFFs. Methods: We enrolled 285 patients who underwent surgery between 2016 and 2022. Patients were classified into two groups: those with postoperative survival >1 year (L) and those with postoperative survival ≤1 year (D). Factors assessed included age, sex, body mass index (BMI), cognitive impairment, fracture type, surgical timing, length of hospital stay, implant type, preoperative hemoglobin/albumin/white blood cell levels, and Geriatric Nutritional Risk Index (GNRI). Results: The mean age at surgery was 93.2 ± 2.8 years (mean follow-up = 18.9 months). The 12-month mortality rate was 28.8%. Intertrochanteric fractures were observed in 136/47 patients, and femoral neck fractures were observed in 67/35 patients in the L/D group, respectively (p = 0.13). Days from admission to surgery were not significantly associated with mortality (p = 0.56). The mean hospital stay was 17/22 days in the L/D group, respectively. Univariate analysis identified age, BMI, cognitive impairment, albumin level, and GNRI as statistically significant predictors. Multivariate analysis revealed length of hospital stay (odds ratio [OR] = 1.048 [95% confidence interval (CI): 1.019-1.078]; p = 0.001), cognitive impairment (OR = 3.082 [95% CI: 1.367-6.945]; p = 0.007), and GNRI (OR = 0.929 [95% CI: 0.901-0.958]; p < 0.001) as independent predictors of mortality. Conclusions: This study identified cognitive impairment, a low GNRI, and prolonged hospital stay as independent prognostic factors for 1-year mortality in nonagenarian patients with PFFs. These findings highlight the importance of addressing malnutrition and cognitive decline through tailored interventions, alongside optimizing surgical timing and hospital care. A multidisciplinary approach remains essential for improving survival outcomes in this vulnerable population.

Hip Fractures in Malta: Does Delay in Surgery Affect Clinical Outcomes?

INTRODUCTION

Hip fractures are common and are a major cause of significant morbidity and mortality in the elderly population, particularly when treatment is delayed. The British Orthopaedic Association's (BOA) guidelines state that surgical treatment should be performed within 36 hours of admission. This study aimed to investigate the effects of delays in surgery on clinical outcomes and to evaluate mortality rates over a three-year follow-up period following proximal femoral fractures.

METHODOLOGY

This was a single-center, retrospective observational study of all patients aged ≥60 years admitted with low-energy hip fractures between June 1, 2020, and November 30, 2020. A total of 205 patients were included and followed up for three years. Data were collected from electronic medical records and operating theater notes. Statistical analysis was performed to analyze the effects of delay in surgery on clinical outcomes.

RESULTS

A 45.9% all-cause mortality rate was observed at three years post-hip fracture in this study. A delay of more than 36 hours to surgery was associated with a statistically significant increase in both length of hospital stay and mortality at one and three years, while no difference was observed in hip-related complications.

CONCLUSIONS

The three-year mortality rate compares well with those found in the literature. A delay in the surgical management of hip fractures is associated with overall worse clinical outcomes, with a higher mortality rate at three years.

Intervention for impending pathological fractures at proximal femur is associated with lower mortality rates in patients with intermediate-to-high risk according to the Katagiri-New score

BACKGROUND

Prophylactic intervention for impending pathological fractures (IF) is associated with improved survival in patients with long-bone metastasis. However, information regarding whether the tumor burden and/or physical status are associated with survival benefits of intervention for IF is lacking.

METHODS

This multicenter retrospective study investigated 121 patients who underwent surgery for 63 impending and 58 complete metastatic fractures of the proximal femur between 2008 and 2023. After matching for age, sex, body mass index, and Katagiri-New score, 42 patients with IF were compared with 42 patients with complete pathological fractures. The 1-year mortality rate was considered the primary outcome, and was compared and stratified by risk based on the Katagiri-New score. The 1-year mortality rate was evaluated according to the surgical method in the subgroup analysis of patients with IF.

RESULTS

The 1-year mortality rate was significantly lower in patients with IF with intermediate-to-high risk(p = 0.04), whereas no difference was observed in patients with low-to-high risk. IF was associated with a significantly higher rate of home discharge (p < 0.01) and improved post-operative ambulatory function (p = 0.07). The subgroup analysis of patients with IF revealed no difference in the survival rate between nailing and hemiarthroplasty.

CONCLUSION

Patients with intermediate-to-high risk IF based on the Katagiri-New score had a lower mortality rate than those who underwent surgery for pathological fractures. A higher rate of home discharge was observed in patients with IF. Based on the Katagiri-New score, survival benefits can be obtained from prophylactic intervention for IF of the proximal femur in patients with intermediate-to high-risk.