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Whittaker DE, Farrow L, Neilly D, Gaba S, Goffin J, Stevenson I. Unsatisfactory Post-operative Imaging Is Predictive of Revision Surgery in Intracapsular Hip Fracture Fixation. Cureus 2024; 16:e63647. [PMID: 39092380 PMCID: PMC11292592 DOI: 10.7759/cureus.63647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2024] [Indexed: 08/04/2024] Open
Abstract
Failed fixation of intracapsular hip fractures in young patients is associated with high morbidity and cost. Accordingly, we set out to determine the association between unsatisfactory post-operative imaging (judged by two fellowship-trained trauma consultants and a senior trainee) and the risk of subsequent reoperation, including adjustment for potential confounding variables. Ninety-four (94) patients aged <60 were included in the study from a single major trauma centre. Exhausted patients (19%) required further surgery, with the most common reason being avascular necrosis (n=10) followed by non-union (n=6). Univariate analysis found only smokers and unsatisfactory fracture reduction to be predictive of failure (p < 0.05). Other demographics and recognised scoring systems from the literature were poor predictors of failure apart from the Haiduewych classification system, utilised to assess the quality of reduction, which showed a trend towards significance (p0.053). Multivariate analysis showed smoking and unsatisfactory fracture reduction to be strong predictors of failure (p<0.05). In those with unsatisfactory fracture reduction, 50% required reoperation compared to 17.5% of those with satisfactory reduction. This study highlights the key principles of ensuring adequate intraoperative reduction and fixation, in keeping with GIRFT principles. Avoiding secondary reoperation is crucial to prevent long-term negative outcomes for this typically high functional demand group of patients. We recommend regular, consultant peer review of post-operative imaging as a method of identifying substandard fracture fixations and those at risk of failure. This will allow opportunities for teaching, clinical improvement, and multidisciplinary team (MDT) discussions of at-risk patients.
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Affiliation(s)
| | - Luke Farrow
- Department of Trauma and Orthopaedics, NHS Grampian, Aberdeen, GBR
| | - David Neilly
- Department of Trauma and Orthopaedics, NHS Grampian, Aberdeen, GBR
| | - Sahil Gaba
- Department of Trauma and Orthopaedics, NHS Grampian, Aberdeen, GBR
| | - Joaquim Goffin
- Department of Trauma and Orthopaedics, NHS Grampian, Aberdeen, GBR
| | - Iain Stevenson
- Department of Trauma and Orthopaedics, NHS Grampian, Aberdeen, GBR
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Andriollo L, Fravolini G, Sangaletti R, Perticarini L, Benazzo F, Rossi SMP. Angle-Adjustable Dynamic Hip Screw Plate for Unstable Trochanteric Fractures in Middle-Aged Patients: Mid-Term Outcomes and Return to Sport. J Clin Med 2024; 13:988. [PMID: 38398302 PMCID: PMC10889291 DOI: 10.3390/jcm13040988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Revised: 02/02/2024] [Accepted: 02/07/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND There are conflicting results in the literature regarding the superiority of proximal femoral nails over dynamic hip screw (DHS) plates. The primary aim of this study is to evaluate mid-term post-injury patient-reported outcome measures (PROMs) and return to sport (RTS) in middle-aged patients treated with the DHS plate for unstable trochanteric fractures. METHODS Fifty-seven middle-aged patients (35-64 years) treated for proximal femoral fractures of type 31-A2 and 31-A3 according to the AO/OTA classification with the DMS Dynamic Martin Screw (KLS Martin Group, Jacksonville, FL, USA) between January 2017 and December 2019 were enrolled. RESULTS Forty-nine patients were included in this retrospective study, and the average age was 54.1 years (SD 8.4). The average follow-up duration at final follow-up was 60.5 months (SD 8.6). Post-operative complications included only one case of aseptic loosening of the implant, with a complication rate of 2%. There were no infections, peri-implant fractures, or other complications reported. Two out of the forty-nine patients (4.1%) required treatment with a total hip arthroplasty due to post-traumatic arthritis. The Harris Hip Score at final follow-up was 77.1 (SD 20.1), and the Western Ontario and McMaster Universities Osteoarthritis Index was 21.6 (SD 13.7). The overall rate of RTS was 57.7%. CONCLUSIONS Treatment with DHS for unstable trochanteric fractures is a safe option in middle-aged patients, ensuring a good functional recovery.
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Affiliation(s)
- Luca Andriollo
- Robotic Prosthetic Surgery Unit—Sports Traumatology Unit, Fondazione Poliambulanza Istituto Ospedaliero, 25124 Brescia, Italy; (L.A.); (G.F.); (R.S.); (L.P.); (F.B.)
- Department of Orthopedics, Catholic University of the Sacred Heart, 00168 Rome, Italy
| | - Giorgio Fravolini
- Robotic Prosthetic Surgery Unit—Sports Traumatology Unit, Fondazione Poliambulanza Istituto Ospedaliero, 25124 Brescia, Italy; (L.A.); (G.F.); (R.S.); (L.P.); (F.B.)
- Department of Orthopedics, Catholic University of the Sacred Heart, 00168 Rome, Italy
| | - Rudy Sangaletti
- Robotic Prosthetic Surgery Unit—Sports Traumatology Unit, Fondazione Poliambulanza Istituto Ospedaliero, 25124 Brescia, Italy; (L.A.); (G.F.); (R.S.); (L.P.); (F.B.)
| | - Loris Perticarini
- Robotic Prosthetic Surgery Unit—Sports Traumatology Unit, Fondazione Poliambulanza Istituto Ospedaliero, 25124 Brescia, Italy; (L.A.); (G.F.); (R.S.); (L.P.); (F.B.)
| | - Francesco Benazzo
- Robotic Prosthetic Surgery Unit—Sports Traumatology Unit, Fondazione Poliambulanza Istituto Ospedaliero, 25124 Brescia, Italy; (L.A.); (G.F.); (R.S.); (L.P.); (F.B.)
- Biomedical Sciences Area, IUSS University School for Advanced Studies, 27100 Pavia, Italy
| | - Stefano Marco Paolo Rossi
- Robotic Prosthetic Surgery Unit—Sports Traumatology Unit, Fondazione Poliambulanza Istituto Ospedaliero, 25124 Brescia, Italy; (L.A.); (G.F.); (R.S.); (L.P.); (F.B.)
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Lindestrand AG, Rönnquist SS, Viberg B, Overgaard S, Palm H, Rogmark C, Kristensen MT. Physical activity in young hip fracture patients is associated with health-related quality of life and strength; results from a multicenter study. Injury 2023; 54:1191-1197. [PMID: 36759311 DOI: 10.1016/j.injury.2023.01.037] [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: 09/20/2022] [Revised: 12/20/2022] [Accepted: 01/19/2023] [Indexed: 01/22/2023]
Abstract
BACKGROUND The World Health Organization recommends a minimum of 150 min of moderate intensity exercise per week or 75 min of strenuous activity weekly for adults. Younger hip fracture patients are often assumed less active than the general population, however, knowledge on physical activity (PA) and health-related quality of life (HRQoL) in younger hip fracture patients is limited. OBJECTIVES We aimed to 1) investigate the variation in pre-fracture PA for adult patients with hip fractures under the age of 60; and 2) to quantify the association with patient characteristics, including outcomes of HRQOL and handgrip strength. DESIGN AND METHODS A prospective multicenter cohort study of 207 adult hip fracture patients under 60 years admitted to four study hospitals from July 2015 to December 2018. Data was collected through medical records, questionnaires, physical tests and interviews. PA level was assessed using a validated questionnaire from the Swedish National Board of Health and Welfare, providing a total score from 3 to 19. A score ≥11 corresponds to fulfillment of the WHO recommendation for weekly PA. Handgrip strength was measured in kilograms using a handheld dynamometer following a standardized protocol. Recall pre-fracture HRQoL was assessed using the EQ-5D-3L questionnaire. RESULTS Fifty-nine percent had a PA score ≤10 out of these 46% had an ASA grade of 3 or 4, 38% had a BMI over 25 and 81% had a low energy fracture. A PA score ≤10 was associated with a lower HRQoL compared to those who had a PA score ≥11. PA score ≤10 points was associated with weaker hand grip strength and a worse health status (higher ASA-grade) p<0.001. CONCLUSION We found that close to two-thirds of the patients had a pre-fracture PA level below WHO recommendations. Being more active was associated with better handgrip strength, HRQoL, and ASA score. Our findings indicate that individuals under 60 years who sustain a hip fracture form a heterogeneous group, some severely comorbid and others highly active and seemingly healthy. This suggests a more nuanced approach to rehabilitation, as the more active patient might need a more individualized plan than the standard program can offer.
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Affiliation(s)
- Anna Gaki Lindestrand
- Department of Orthopedic Surgery and Traumatology, Copenhagen University Hospital Bispebjerg, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark.
| | - Sebastian Strøm Rönnquist
- Department of Orthopedics, Lund University, Skåne University Hospital, Carl-Bertil Laurells gata 9, 21428 Malmö, Sweden; Department of Orthopaedic Surgery and Traumatology, J.B. Winsløws Vej 4 5000 Odense University Hospital, Odense, Denmark
| | - Bjarke Viberg
- Department of Orthopaedic Surgery and Traumatology, J.B. Winsløws Vej 4 5000 Odense University Hospital, Odense, Denmark; Department of Orthopedic Surgery and Traumatology, Lillebaelt Hospital, University Hospital of Southern Denmark, Sygehusvej 24, 6000 Kolding, Denmark
| | - Søren Overgaard
- Department of Orthopedic Surgery and Traumatology, Copenhagen University Hospital Bispebjerg, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - Henrik Palm
- Department of Orthopedic Surgery and Traumatology, Copenhagen University Hospital Bispebjerg, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark
| | - Cecilia Rogmark
- Department of Orthopedics, Lund University, Skåne University Hospital, Carl-Bertil Laurells gata 9, 21428 Malmö, Sweden
| | - Morten Tange Kristensen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark; Departments of Physiotherapy and Orthopedic Surgery, Copenhagen University Hospital - Amager and Hvidovre, Kettegård Allé 30, 2650 Hvidovre, Denmark; Department of Physical and Occupational Therapy, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark
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Magan AA, Radhakrishnan GT, Kayani B, Ronca F, Khanduja V, Meek RMD, Haddad FS. Time for return to sport following total hip arthroplasty: a meta-analysis. Hip Int 2023; 33:221-230. [PMID: 34538122 DOI: 10.1177/11207000211041975] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Total Hip Arthroplasty (THA) is being increasingly undertaken in younger and more active patients, with many of these patients wanting to return to sport (RTS) after surgery. However, the percentage of patients RTS and time at which they are able to get back to sport following surgery remains unknown. The objective of this meta-analysis was to determine the time patients RTS after THA. METHODS A search was performed on PUBMED, MEDLINE, EMBASE, and the Cochrane Library for trials on THA and RTS, in the English language, published from the inception of the database to October 2020. All clinical trials reporting on to RTS following THA were included. Data relating to patient demographics, methodological quality, RTS, clinical outcomes and complications were recorded. The PRISMA guidelines were used to undertake this study. RESULTS The initial literature search identified 1720 studies. Of these, 11 studies with 2297 patients matched the inclusion criteria. 3 studies with 154 patients demonstrated an overall pooled proportion of 40.0% (95% CI, 32.5-47.9%) of patients RTS between 2 and 3 months after surgery. 4 studies with 242 patients demonstrated an overall pooled proportion of 76.9% (95% CI, 71.5-82.0) of patients RTS by 6 months after surgery. Pooled proportion analysis from 7 trials with 560 patients demonstrated 93.9% (95% CI, 82.7-99.5%) of patients RTS between 6 and 12 months after surgery. CONCLUSIONS Pooled proportion analysis showed increasingly more patients were able to RTS after THA over the first 1 year after surgery. There remains marked inter and intra-study variations in time for RTS but the pooled analysis shows that over 90% of patients were able to RTS at 6-12 months after THA. These finding will enable more informed discussions between patients and healthcare professionals about time for RTS following THA.
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Affiliation(s)
- Ahmed A Magan
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, UK.,Department of Orthopaedic Surgery, The Princess Grace Hospital, London, UK
| | - Ganan T Radhakrishnan
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, UK.,Department of Orthopaedic Surgery, The Princess Grace Hospital, London, UK
| | - Babar Kayani
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, UK.,Department of Orthopaedic Surgery, The Princess Grace Hospital, London, UK
| | - Flaminia Ronca
- Institute of Sports, Health and Exercise, University College Hospital, London, UK
| | - Vikas Khanduja
- Department of Trauma and Orthopaedic Surgery, Young Adult Hip Service, Addenbrooke's - Cambridge University Hospital, Cambridge, UK
| | - Robert M D Meek
- Department of Trauma and Orthopaedic surgery, Glasgow University, Glasgow, UK
| | - Fares S Haddad
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, UK.,Department of Orthopaedic Surgery, The Princess Grace Hospital, London, UK.,Institute of Sports, Health and Exercise, University College Hospital, London, UK
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Wong RMY, Zu Y, Chau WW, Tso CY, Liu WH, Ng RWK, Chow SKH, Cheung WH, Tang N, Ho KKW. High Charlson Comorbidity Index Score is associated with early fracture-related complication for internal fixation of neck of femur fractures. Sci Rep 2022; 12:4749. [PMID: 35306533 PMCID: PMC8934361 DOI: 10.1038/s41598-022-08855-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 03/14/2022] [Indexed: 12/19/2022] Open
Abstract
The incidence of geriatric hip fractures continues to rise in our aging population and has become a major public health concern globally. The primary outcome of this study was to determine whether Age-adjusted Charlson Comorbidity Index (ACCI) is associated with increased fracture-related complications in neck of femur fractures treated by internal fixation. This was a cohort study between January 2014 to June 2018. All patients ≥ 50 years old with an acute neck of femur fracture after low-energy trauma fixed with cannulated hip screws were included and followed-up for 1 year at a tertiary centre. Primary outcome was to determine whether ACCI was associated with increased fracture-related complications. Secondary outcomes were revision rate, mortality, and function after surgery. Further analysis were performed within a “younger” group (age 50–65) and “elder” group (age > 65), as displaced fractures (Garden Type III/IV) were in “younger” group. 233 hip fractures (68 males; 165 females) with a mean age of 73.04 ± 12.89 were included in the study. Surgical outcomes showed that the complication rate of hip screw fixation for all patients was 21.5% (50 patients) at 1 year. ACCI was significantly higher in all patients with complications (p = 0.000). Analysis within “younger” (p = 0.000) and “elder” groups (p = 0.006) both showed significance. Stepwise logistic regression modelling showed ACCI had positive correlation with complications with ACCI = 6 (OR 4.27, p = 0.02). R2 values were comparatively better after controlled by Garden Type III/IV at ACCI = 4 (OR 6.42 (1.70, 24.25), p = 0.01). The authors recommend that for patients with a Garden Type I/II and ACCI ≥ 6 or a Garden Type III/IV and ACCI ≥ 4, a direct arthroplasty surgery should be considered.
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Keohane D, Al Azawi L, Downey C, Quinlan JF. Assessing outcomes in hip fracture patients under the age of 60. Ir J Med Sci 2021; 191:233-238. [PMID: 33580858 DOI: 10.1007/s11845-021-02532-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 01/28/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Hip fractures are a common and serious orthopaedic injury. The principle of treatment for hip fractures in the "non-elderly" patient is to preserve the native hip. There is limited published literature in this area. AIM The aim of this research is to review all of the "non-elderly" hip fracture patients to report on the demographics, fracture patterns, fixation types, and revisions. METHODS This was a retrospective single-site review of all of the "non-elderly" patients who underwent operative management for hip fractures between 1999 and 2019. A manual review was done of all of the x-rays for the identified patients to confirm the fracture type and identify further surgeries. RESULTS Three hundred and eighty-one patients were identified. The average age was 48.4 years old. Two hundred and thirty nine of them were intra-capsular, and 142 of them were extra-capsular fractures. Dynamic hip screw (DHS) was the most popular fixation method. In the recent decade of data, the number of hemi-arthroplasties remained consistent, but the number of total hip arthroplasties (THAs) performed increased sevenfold. Mean follow-up was 35 months. Forty-three (11%) patients required follow-up surgery. Non-union accounted for 56% of all revisions and avascular necrosis for 19%. THA was performed in 70% of all revisions. CONCLUSION DHS remains the most widely used fixation technique in an effort to preserve the native hip. The use of THA has increased and surpassed the usage of hemi-arthroplasty in recent times. A high proportion of these patients will go on to develop complications requiring secondary surgery; therefore, they all need long-term follow-up.
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Affiliation(s)
- David Keohane
- Department of Orthopaedics, Tallaght University Hospital, Dublin, Ireland.
| | - Laith Al Azawi
- Medical School, Trinity College Dublin, College Green, Dublin, Ireland
| | - Colum Downey
- Department of Orthopaedics, Tallaght University Hospital, Dublin, Ireland
| | - John F Quinlan
- Department of Orthopaedics, Tallaght University Hospital, Dublin, Ireland
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Haddad FS. COVID-19 and beyond. Bone Joint J 2020; 102-B:653-654. [PMID: 32475238 DOI: 10.1302/0301-620x.102b6.bjj-2020-0759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Fares S Haddad
- The Bone & Joint Journal, Professor of Orthopaedic Surgery, University College London Hospitals, The Princess Grace Hospital, and The NIHR Biomedical Research Centre at UCLH, London, UK
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