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Andrés-Peiró JV, Nomdedéu J, Aguado HJ, González-Morgado D, Minguell-Monyart J, Joshi-Jubert N, Teixidor-Serra J, Tomàs-Hernández J, Selga-Marsà J, García-Sánchez Y, Noriega-González DC, Mateos-Álvarez E, Pereda-Manso A, Cervera-Díaz MC, Balvis-Balvis P, García-Pérez Á, Rodríguez-Arenas M, Castro-Menéndez M, Moreta J, Olías-López B, Amaya-Espinosa P, Boluda-Mengod J, Bárcena-Goitilandia L, Blas-Dobón JA, Freile-Pazmiño P, Castillón P, Lanuza-Lagunilla L, Cabria-Fernández J, Valle-Cruz J, García-Coiradas J, Bonome-Roel C, Cano-Leira MDLÁ, Benjumea-Carrasco A, Chico-García M, Fernández-Juan A, Saura-Sánchez E, Sánchez-Gómez P, Ricón-Recarey FJ, García-García EM, Medrano-Morte I, Cuadrado-Abajo F, Pérez-Núñez MI, García-González S, Pozo-Manrique PD, García-Navas-García FM, García-Paredero E, Guijarro-Valtueña A, Navas-Pernía I, Videla-Cés M, Muñoz-Vives JM, Querolt-Coll J, Triana-López de Santamaría G, Serra-Porta T, Carrasco-Becerra MC, Pena-Paz S, Otero-Naveiro V, Fernández-Dorado F, Martínez-Menduiña A, Galián-Muñoz E, Hernández JM, Renau-Cerrillo M, Campuzano-Bitterling B, Carreras-Castañer A, Vives-Barquiel M, Camacho-Carrasco P, Jornet-Gibert M, Muñoz-Vicente A, Gámez-Asunción C, Plaza-Salazar N, Benito-Santamaría J, Cuenca-Copete A, Alonso-Viana L, Mingo-Robinet J, Briso-Montiano R, Barbería-Biurrun A, Chouza-Montero L, Ojeda-Thies C, Ajuria-Fernández E, Díaz-Suárez R, Gasset-Teixidor A, Domínguez-Ibarrola A, Gosálbez J, Pérez-Hevia I, Riera-Álvarez L, Roche-Albero A, Macho-Mier M, Criado-Albillos G, Cabello-Benavides HG, Cunchillos-Pascual J, Saló-Cuenca JC, Espona-Roselló J, Salamanca-Ontiveros C, García-Portabella P, Martínez-Íñiguez Blasco J, Sevilla-Ortega P, Cano-Porras JR, Martínez-Díaz S, Carabelli GS, Slullitel P, Astore I, Hernández-Pascual C, Marín-Sánchez J, Córdova-Peralta JC, Sánchez-Hernández N, García-García G, Rodríguez-Gangoso A, Pérez-Sánchez JM, Piñeiro-Borrero A, Mandía-Martínez A, De Caso-Rodríguez J, Benito-Mateo M, Murillo-Vizuete AD, Herrán-Núnez GDL, Nunes-Ugarte N, Pérez-Salazar NE, De Sande-Díaz M, García-Fuentes XD, de Cortázar-Antolín UG, Sánchez DE. Predictors of outcomes after internal fixation of periprosthetic femoral hip fractures Subgroup analysis of the peri-implant and peri-prosthetic fractures Spanish registry (PIPPAS). Injury 2024; 55:111715. [PMID: 39032221 DOI: 10.1016/j.injury.2024.111715] [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: 04/02/2024] [Revised: 06/02/2024] [Accepted: 06/30/2024] [Indexed: 07/23/2024]
Abstract
PURPOSE To identify risk factors predisposing patients to poor outcomes after fixation of periprosthetic hip fractures around femoral stems. METHODS Prospective multicentre cohort study of fractures around a hip replacement stem managed by internal fixation. The primary outcome was one-year mortality, while secondary outcomes were local complications and healthcare burden-related outcomes (nursing facility utilization and hospital length of stay). RESULTS One-year mortality was 16.2%. Age-adjusted Charlson Comorbidity Index score (OR=1.17; 95%CI=1.03-1.33)), Pfeiffer Short Portable Mental Status Questionnaire (SPMSQ) score (OR=1.16; 1.06-1.28), prosthetic dysfunction (OR=1.90; 1.00-3.61), and postoperative medical complications (OR=1.97; 1.06-3.68) were predictors of mortality. Patients with prior prosthetic dysfunction, lower Pfeiffer SPMSQ scores, Vancouver A fractures, and fractures fixed only using cerclages were at higher risk of local complications, which occurred in 9.3% of cases. Medical (OR=1.81; 1.05-3.13) and local complications (OR=5.56; 2.42-3.13) emerged as consistent risk factors for new institutionalization. Average hospitalization time was 13.9±9.2 days. Each day of fixation delay led to an average 1.4-day increase in total hospitalization. CONCLUSION Frail periprosthetic hip-fracture patients with poorer functional status, dysfunctional replacements, and postoperative complications are at increased risk of mortality. Postoperative complications are more common in patients with dysfunctional arthroplasties, Vancouver A fractures, and fixation using cerclages alone. Postoperative complications were the most consistent predictor of higher healthcare resource utilization.
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Affiliation(s)
- José Vicente Andrés-Peiró
- Department of Surgery, Universitat Autònoma de Barcelona, Barcelona, Spain; Department of Orthopaedic Surgery, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Reconstructive Surgery of the Locomotor System research group, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Josep Nomdedéu
- Department of Surgery, Universitat Autònoma de Barcelona, Barcelona, Spain; Department of Orthopaedic Surgery, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Héctor J Aguado
- Department of Orthopaedic Surgery, Hospital Clínico Universitario de Valladolid, Valladolid, Spain; Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain.
| | - Diego González-Morgado
- Department of Orthopaedic Surgery, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Joan Minguell-Monyart
- Department of Surgery, Universitat Autònoma de Barcelona, Barcelona, Spain; Department of Orthopaedic Surgery, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Reconstructive Surgery of the Locomotor System research group, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Nayana Joshi-Jubert
- Department of Surgery, Universitat Autònoma de Barcelona, Barcelona, Spain; Department of Orthopaedic Surgery, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Reconstructive Surgery of the Locomotor System research group, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
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Wulbrand C, Füchtmeier B, Weber M, Eckstein C, Hanke A, Müller F. Surgery Within 24 Hours Reduces Mortality and General Complication Rates in Patients Who Have Periprosthetic Femoral Fractures at the Hip. J Arthroplasty 2024; 39:2104-2110.e1. [PMID: 38437886 DOI: 10.1016/j.arth.2024.02.077] [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: 11/02/2023] [Revised: 02/24/2024] [Accepted: 02/27/2024] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND In patients who have hip fractures, treatment within 24 hours reduces mortality and complication rates. A similar relationship can be assumed for patients who have hip periprosthetic femoral fractures (PPFs) owing to the similar baseline characteristics of the patient populations. This monocentric retrospective study aimed to compare the complication and mortality rates in patients who had hip PPF treated within and after 24 hours. METHODS In total, 350 consecutive patients who had hip PPF in a maximum-care arthroplasty and trauma center between 2006 and 2020 were retrospectively evaluated. The cases were divided into 2 groups using a time to surgery (TTS) of 24 hours as the cutoff value. The primary outcome variables were operative and general complications as well as mortalities within 1 year. RESULTS Overall, the mean TTS was 1.4 days, and the 1-year mortality was 14.6%. The TTS ≤ 24 hours (n = 166) and TTS > 24 hours (n = 184) groups were comparable in terms of baseline characteristics and comorbidities. Surgical complications were equally frequent in the 2 groups (16.3 versus 15.2%, P = .883). General complications occurred significantly more often in the late patient care group (11.4 versus 28.3%, P < .001). In addition, the 30-day mortality (0.6 versus 5.5%, P = .012), and 1-year mortality (8.3 versus 20.5%, P = .003) rates significantly increased in patients who had TTS > 24 hours. Cox regression analysis yielded a hazard ratio of 4.385 (P < .001) for the TTS > 24 hours group. CONCLUSIONS Prompt treatment is required for patients who have hip PPF to reduce mortality and overall complications.
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Affiliation(s)
- Christian Wulbrand
- Department for Trauma, Orthopaedics and Sports Medicine, Hospital Barmherzige Brüder Regensburg, Regensburg, Germany
| | - Bernd Füchtmeier
- Department for Trauma, Orthopaedics and Sports Medicine, Hospital Barmherzige Brüder Regensburg, Regensburg, Germany
| | - Markus Weber
- Department for Trauma, Orthopaedics and Sports Medicine, Hospital Barmherzige Brüder Regensburg, Regensburg, Germany
| | - Christoph Eckstein
- Department for Trauma, Orthopaedics and Sports Medicine, Hospital Barmherzige Brüder Regensburg, Regensburg, Germany
| | - Alexander Hanke
- Department for Trauma, Orthopaedics and Sports Medicine, Hospital Barmherzige Brüder Regensburg, Regensburg, Germany
| | - Franz Müller
- Department for Trauma, Orthopaedics and Sports Medicine, Hospital Barmherzige Brüder Regensburg, Regensburg, Germany
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Khawar H, Jones C, Eardley W, Johansen A, Inman D, Whitehouse M, Evans J. The burden of periprosthetic femoral fractures in England and Wales: Insights from the first two years of data collection in the National Hip Fracture Database and regional variation in care. Injury 2024; 55:111609. [PMID: 38781619 DOI: 10.1016/j.injury.2024.111609] [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: 11/29/2023] [Revised: 04/24/2024] [Accepted: 05/10/2024] [Indexed: 05/25/2024]
Abstract
INTRODUCTION Periprosthetic femoral fractures (PPFFs) represent an important healthcare problem, with a rising incidence noted due to an increase in the number of arthroplasty surgeries being performed. There is a current lack of national consensus as to how these complex, often frail patients are managed. AIMS Our primary aim was to present the epidemiology of PPFFs in England and Wales over the first two years of data collection by the National Hip Fracture Database (NHFD). Secondary aims included how well the NHFD Key Performance Indicators (KPIs) are met for PPFF patients, whether centres reporting a higher burden of PPFF patients are more likely to meet KPIs compared to lower volume centres, and to also identify if regional variation in care for these patients exist. METHODS Patients aged 60 years or over, admitted to any acute hospital in England or Wales with a PPFF within the period 1st January 2020 to 31st December 2021 were included. Fractures were classified using the Vancouver system. The primary outcome of interest was the incidence of PPFF in England and Wales. Secondary outcomes included i) geographical distribution, ii) pattern of injury, iii) treatment received, iv) KPI performance nationally, v) KPI performance by top 5 highest volume hospitals vs the rest, vi) KPI performance by region and vii) KPI performance compared with native hip fracture patients. RESULTS A total of 5,566 PPFFs were reported during our study period. A 31 % increase in cases was seen between 2020 and 2021 (2,405 to 3,161). The South-West of England reported the highest burden of PPFFs (14 % of all cases reported in 2021). Vancouver B subtypes were most common around hip replacements (62 %) and C subtype around knee replacements (55 %). A total of 4,598 patients (82.6 %) underwent operative management. There was regional variation in KPI attainment. When compared to KPI attainment for native hip fractures PPFF care under performed in most regions and domains. High volume PPFF centres were not associated with improved attainment of KPIs. CONCLUSION We have described the incidence, nature, and management of PPFF at national and regional levels using routinely collected NHFD data. Both numerically and due to case complexity, PPFF are a considerable challenge to patients and health services alike. This epidemiology is not captured by other existing datasets and increased case contribution to the NHFD is encouraged to improve understanding and enable prioritisation and delivery of further care and research.
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Affiliation(s)
| | - Conor Jones
- Royal Devon University Healthcare NHS Trust, United Kingdom
| | | | | | - Dominic Inman
- Northumbria Healthcare NHS Foundation Trust, United Kingdom
| | | | - Jonathan Evans
- Royal Devon University Healthcare NHS Trust, United Kingdom
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Kennedy JW, Rooney EJ, Ryan PJ, Siva S, Kennedy MJ, Wheelwright B, Young D, Meek RMD. Does delay to theatre influence morbidity or mortality in femoral periprosthetic fractures? Bone Jt Open 2024; 5:452-456. [PMID: 38821502 PMCID: PMC11142848 DOI: 10.1302/2633-1462.56.bjo-2024-0017.r1] [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] [Indexed: 06/02/2024] Open
Abstract
Aims Femoral periprosthetic fractures are rising in incidence. Their management is complex and carries a high associated mortality. Unlike native hip fractures, there are no guidelines advising on time to theatre in this group. We aim to determine whether delaying surgical intervention influences morbidity or mortality in femoral periprosthetic fractures. Methods We identified all periprosthetic fractures around a hip or knee arthroplasty from our prospectively collated database between 2012 and 2021. Patients were categorized into early or delayed intervention based on time from admission to surgery (early = ≤ 36 hours, delayed > 36 hours). Patient demographics, existing implants, Unified Classification System fracture subtype, acute medical issues on admission, preoperative haemoglobin, blood transfusion requirement, and length of hospital stay were identified for all patients. Complication and mortality rates were compared between groups. Results A total of 365 patients were identified: 140 in the early and 225 in the delayed intervention group. Mortality rate was 4.1% at 30 days and 19.2% at one year. There was some indication that those who had surgery within 36 hours had a higher mortality rate, but this did not reach statistical significance at 30 days (p = 0.078) or one year (p = 0.051). Univariate analysis demonstrated that age, preoperative haemoglobin, acute medical issue on admission, and the presence of postoperative complications influenced 30-day and one-year mortality. Using a multivariate model, age and preoperative haemoglobin were independently predictive factors for one-year mortality (odds ratio (OR) 1.071; p < 0.001 and OR 0.980; p = 0.020). There was no association between timing of surgery and postoperative complications. Postoperative complications were more likely with increasing age (OR 1.032; p = 0.001) and revision arthroplasty compared to internal fixation (OR 0.481; p = 0.001). Conclusion While early intervention may be preferable to reduce prolonged immobilization, there is no evidence that delaying surgery beyond 36 hours increases mortality or complications in patients with a femoral periprosthetic fracture.
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Affiliation(s)
| | | | - Paul J. Ryan
- Queen Elizabeth University Hospital, Glasgow, UK
| | - Soorya Siva
- Queen Elizabeth University Hospital, Glasgow, UK
| | | | | | - David Young
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
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Chuluunbaatar Y, Benachar N, Khroud-Dhillon H, Srinivasan A, Rojoa D, Raheman F. Early and 1-year mortality of native geriatric distal femur fractures: A systematic review and time-to-event meta-analysis. J Clin Orthop Trauma 2024; 50:102375. [PMID: 38495682 PMCID: PMC10943051 DOI: 10.1016/j.jcot.2024.102375] [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: 09/13/2023] [Revised: 12/27/2023] [Accepted: 02/19/2024] [Indexed: 03/19/2024] Open
Abstract
Purpose Distal femur fractures (DFF) account for 6% of all femoral fractures and predominate in females. The current 1-year mortality of DFF is currently reported to be between 10 and 38%, a wide margin, and confounded by multiple factors including age, high energy mechanisms, pathological and periprosthetic fractures. The purpose of this study was to assess and determine all-cause mortality following geriatric native distal femur fractures at 30 days, six months and one year. Methods - The databases Cochrane CENTRAL, MEDLINE, EMBASE and NHS NICE Healthcare Databases Advanced Search Interface were searched in accordance with PRISMA guidelines. Original research articles relevant to mortality outcomes in native geriatric distal femur fractures following low energy trauma were included. A time-to-event data meta-analysis model was used to estimate pooled 30-day, six month and one-year mortality. A random effects meta-regression model was performed to assess potential sources of heterogeneity when studies reported on factors affecting the mortality observed in patients with geriatric distal femur fractures. Results - Thirteen studies were included in the meta-analysis with a mean age of 79.6 years. Eight studies reported the 30-day mortality of distal femur fractures in patients as a pooled estimate of 8.14%. Pooled estimate for 6-month mortality reported was 19.5% and the one-year mortality reported by ten studies was 26.10%. Time-to-event modelling showed that risk of mortality at one year in elderly patients with distal femur fractures was significantly higher HR = 4.31 (p < 0.001). When evaluating prognostic predictors, age and Type C fracture were predictive of highest mortality rates. Conclusions - This study is the first meta-analysis to evaluate the early and long-term mortality observed in elderly patients presenting with native distal femoral fractures. Through our results we have shown the quantifiable impact patient age and fracture configuration has on one-year mortality in this patient cohort.
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Affiliation(s)
- Yanjinlkham Chuluunbaatar
- Department of Orthopaedics, Lister Hospital, East and North Hertfordshire Trust, Corey Mill Lane, Stevenage, SG1 4AB , United Kingdom
| | - Nawal Benachar
- Department of Orthopaedics, Lister Hospital, East and North Hertfordshire Trust, Corey Mill Lane, Stevenage, SG1 4AB , United Kingdom
| | - Harnoor Khroud-Dhillon
- Department of Orthopaedics, Lister Hospital, East and North Hertfordshire Trust, Corey Mill Lane, Stevenage, SG1 4AB , United Kingdom
| | | | - Djamila Rojoa
- Leicester Royal Infirmary, Leicester, LE1 5WW, United Kingdom
| | - Firas Raheman
- Department of Orthopaedics, Lister Hospital, East and North Hertfordshire Trust, Corey Mill Lane, Stevenage, SG1 4AB , United Kingdom
- Royal Free London NHS Trust, London, NW3 2QG, United Kingdom
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Farhan-Alanie MM, Jonas SC, Gallacher D, Whitehouse MR, Chesser TJS. Fewer native and periprosthetic femoral fracture patients receive an orthogeriatric review and expedited surgery compared to hip fracture patients. Hip Int 2024; 34:281-289. [PMID: 37720960 PMCID: PMC10935621 DOI: 10.1177/11207000231198459] [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: 01/21/2023] [Accepted: 07/01/2023] [Indexed: 09/19/2023]
Abstract
INTRODUCTION Disproportionate emphasis has been attributed to hip fracture over other femoral fractures through implementation of Best Practice Tariff (BPT).This retrospective comparative observational cohort study aimed to evaluate the epidemiology of native and periprosthetic femoral fractures and establish any disparities in their management relative to hip fractures. METHODS All patients ⩾60 years admitted with a native or periprosthetic femoral fracture during July 2016-June 2018 were identified using our hospital database. Results were compared to National Hip Fracture Database data over the same period. RESULTS 58 native femoral, 87 periprosthetic and 1032 hip fractures were identified. (46/58) 79% and 76/87 (89%) of native and periprosthetic femoral fractures were managed operatively. Surgery was performed <36 hours for 34/46 (74%) of native femoral and 33/76 (43%) of periprosthetic fractures compared to 826/1032 (80%) for hips. Median time to surgery was longer in periprosthetic femoral than hip fracture patients (44.7 vs. 21.6 hours; p < 0.0001). Orthogeriatrician review occurred in 24/58 (41%) and 48/87 (55%) of native and periprosthetic fractures compared to 1017/1032 (99%) for hips (p < 0.0001). One year mortality was 35%, 20% and 26% for native femoral, periprosthetic and hip fracture patients. Cox proportional hazard ratio was higher for native femoral than hip fracture patients (1.75; 95% CI, 1.12-2.73). CONCLUSIONS This study demonstrates large disparities in management of other femoral and periprosthetic fractures compared to hip fractures, specifically time to surgery and orthogeriatrician review. This may have resulted in the comparatively higher mortality rate of native femoral fracture patients. Expansion of the BPT to include the whole femur is likely to improve outcomes.
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Affiliation(s)
| | - Sam C Jonas
- Cardiff and Vale Orthopaedic Centre, University Hospital Llandough, Penarth, UK
| | - Daniel Gallacher
- Warwick Medical School, University of Warwick, Coventry, CV4 7HL, UK
| | - Michael R Whitehouse
- Department of Trauma and Orthopaedics, North Bristol NHS Trust, Southmead Hospital, Bristol, UK
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol, Bristol, UK
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, UK
| | - Tim JS Chesser
- Department of Trauma and Orthopaedics, North Bristol NHS Trust, Southmead Hospital, Bristol, UK
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Gilmore C, Mayne A, Goodland C, Cassidy R, MacDonnell L, Mogey P, Murphy L, Diamond O. Early surgery improves survival after femoral fractures in the elderly: A retrospective review of 502 fragility fractures. Injury 2024; 55:111275. [PMID: 38134490 DOI: 10.1016/j.injury.2023.111275] [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: 11/07/2023] [Revised: 11/29/2023] [Accepted: 12/06/2023] [Indexed: 12/24/2023]
Abstract
AIMS Fragility fractures are a growing global healthcare burden; fragility fractures of the femur have been shown to occur in a highly comorbid patient group, with parallels to hip fracture patients. This study aimed to investigate if early surgery for femoral fractures, distal to the hip, resulted in a reduction in mortality in patients over 65 years of age. METHODS A retrospective review of prospectively collected data for all consecutive femoral fractures in patients aged over 65 years who underwent surgical management between January 2000 and December 2018. Data was extracted from the Fracture Outcomes Research Database (FORD) and analysed to assess if early surgery, defined as occurring within 48 h of hospital admission with a fragility femur fracture, had an effect on 30 day and 1 year mortality. RESULTS 502 eligible patients were included; median follow up time was 57 months. 24 patients (4.7%) died within 30 days of surgery and 105 patients (20.9%) had died within 1 year of surgery. Patients who underwent surgery within 48 h of admission had a significantly reduced chance of mortality within 1 year of surgery compared to patients who had surgery more than 48 h after admission (OR = 0.401, 95% CI 0.25-0.65, p<0.001). Following Multivariate Cox Regression analysis the hazard ratio of 1 year mortality following early surgery remained significantly reduced (HR = 0.57, 95% CI 0.36-0.92, p = 0.020). CONCLUSIONS This study demonstrates that fragility femoral fracture patients represent a similar cohort to hip fracture patients, with high mortality rates. We recommend that hip fracture management principles are also employed for fragility femoral fractures in patients over 65 years, with rapid pre-operative optimisation to ensure these patients undergo early surgical intervention.
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Affiliation(s)
- Catherine Gilmore
- Royal Victoria Hospital, 274 Grosvenor Road Belfast BT12 6BA, United Kingdom.
| | - Alistair Mayne
- Royal Victoria Hospital, 274 Grosvenor Road Belfast BT12 6BA, United Kingdom
| | | | - Roslyn Cassidy
- Outcomes Department, Musgrave Park Hospital, Stockman's Lane, Belfast BT9 7JB, United Kingdom
| | - Lisa MacDonnell
- Royal Victoria Hospital, 274 Grosvenor Road Belfast BT12 6BA, United Kingdom
| | - Paul Mogey
- Royal Victoria Hospital, 274 Grosvenor Road Belfast BT12 6BA, United Kingdom
| | - Lynn Murphy
- Royal Victoria Hospital, 274 Grosvenor Road Belfast BT12 6BA, United Kingdom
| | - Owen Diamond
- Royal Victoria Hospital, 274 Grosvenor Road Belfast BT12 6BA, United Kingdom; Outcomes Department, Musgrave Park Hospital, Stockman's Lane, Belfast BT9 7JB, United Kingdom
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Boddice T, Harrison P, Anthony C, Ng ABY. Periprosthetic Fractures around Total Hip Replacement-Is There a Rush to Fix? J Clin Med 2023; 12:jcm12103512. [PMID: 37240618 DOI: 10.3390/jcm12103512] [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: 04/15/2023] [Revised: 05/01/2023] [Accepted: 05/15/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Periprosthetic fractures now account for 14.1% of all hip revisions. Surgery is often highly specialised and can involve the revision of implants, fixation of fractures, or a combination of both. Delays to surgery are frequent as specialist equipment and surgeons are often required. UK guidelines are currently moving in favour of early surgery in a similar way to the neck of femur fractures, despite a lack of evidential consensus. METHODS A retrospective review of all patients who underwent surgery for periprosthetic fractures around a total hip replacement (THR) at a single unit between 2012 and 2019 was performed. Risk factors for complications, length of stay (LOS), and time to surgery data were collected and analysed using regression analysis. RESULTS A total of 88 patients met the inclusion criteria: 63 (72%) were treated with open reduction internal fixation (ORIF) and 25 (28%) underwent revision THR. Baseline characteristics were similar in both the ORIF and revision groups. Revision surgery was more likely to be delayed than ORIF owing to the need for specialist equipment and personnel (median 143 h vs. 120 h, p = 0.04). Median LOS was 17 days if operated within 72 h and 27 days if delayed beyond this (p < 0.0001), but there was no increase in 90-day mortality (p = 0.66), HDU admission (p = 0.33), or perioperative complications (p = 0.27) with delay beyond 72 h. CONCLUSION Periprosthetic fractures are complex and require a highly specialised approach. Delaying surgery does not result in increased mortality or complications but does increase length of stay. Further multicentre research into this area is required.
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Affiliation(s)
- Timothy Boddice
- Pinderfields General Hospital, Aberford Road, Wakefield WF1 4DG, UK
| | - Peter Harrison
- Pinderfields General Hospital, Aberford Road, Wakefield WF1 4DG, UK
| | | | - Aaron B Y Ng
- Pinderfields General Hospital, Aberford Road, Wakefield WF1 4DG, UK
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Padilla-Rojas LG, Garín-Zertuche DE, López-Almejo L, Garabano G, Pesciallo CÁ, Leal JA, Pinzón A, Giordano V, Esteves-Pires R. Periprosthetic fracture management of the proximal femur. OTA Int 2023; 6:e246. [PMID: 37006453 PMCID: PMC10064640 DOI: 10.1097/oi9.0000000000000246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 12/22/2022] [Indexed: 03/30/2023]
Abstract
The most common periprosthetic fractures occur around the hip. The most widely used classification is the Vancouver classification, and management requires careful planning and skill in both arthroplasty and fracture surgery. This article presents an overview of the diagnosis, classification, and management of periprosthetic fractures of the proximal femur. This work represents a summary review from Latin American Society Members of the International Orthopaedic Trauma Association.
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Jain S, Farook MZ, Aslam-Pervez N, Amer M, Martin DH, Unnithan A, Middleton R, Dunlop DG, Scott CEH, West R, Pandit H. A multicentre comparative analysis of fixation versus revision surgery for periprosthetic femoral fractures following total hip arthroplasty with a cemented polished taper-slip femoral component. Bone Joint J 2023; 105-B:124-134. [PMID: 36722066 DOI: 10.1302/0301-620x.105b2.bjj-2022-0685.r1] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
AIMS The aim of this study was to compare open reduction and internal fixation (ORIF) with revision surgery for the surgical management of Unified Classification System (UCS) type B periprosthetic femoral fractures around cemented polished taper-slip femoral components following primary total hip arthroplasty (THA). METHODS Data were collected for patients admitted to five UK centres. The primary outcome measure was the two-year reoperation rate. Secondary outcomes were time to surgery, transfusion requirements, critical care requirements, length of stay, two-year local complication rates, six-month systemic complication rates, and mortality rates. Comparisons were made by the form of treatment (ORIF vs revision) and UCS type (B1 vs B2/B3). Kaplan-Meier survival analysis was performed with two-year reoperation for any reason as the endpoint. RESULTS A total of 317 periprosthetic fractures (in 317 patients) with a median follow-up of 3.6 years (interquartile range (IQR) 2.0 to 5.4) were included. The fractures were type B1 in 133 (42.0%), B2 in 170 (53.6%), and B3 in 14 patients (4.4%). ORIF was performed in 167 (52.7%) and revision in 150 patients (47.3%). The two-year reoperation rate (15.3% vs 7.2%; p = 0.021), time to surgery (4.0 days (IQR 2.0 to 7.0) vs 2.0 days (IQR 1.0 to 4.0); p < 0.001), transfusion requirements (55 patients (36.7%) vs 42 patients (25.1%); p = 0.026), critical care requirements (36 patients (24.0%) vs seven patients (4.2%); p < 0.001) and two-year local complication rates (26.7% vs 9.0%; p < 0.001) were significantly higher in the revision group. The two-year rate of survival was significantly higher for ORIF (91.9% (standard error (SE) 0.023%) vs 83.9% (SE 0.031%); p = 0.032) compared with revision. For B1 fractures, the two-year reoperation rate was significantly higher for revision compared with ORIF (29.4% vs 6.0%; p = 0.002) but this was similar for B2 and B3 fractures (9.8% vs 13.5%; p = 0.341). The most common indication for reoperation after revision was dislocation (12 patients; 8.0%). CONCLUSION Revision surgery has higher reoperation rates, longer surgical waiting times, higher transfusion requirements, and higher critical care requirements than ORIF in the management of periprosthetic fractures around polished taper-slip femoral components after THA. ORIF is a safe option providing anatomical reconstruction is achievable.Cite this article: Bone Joint J 2023;105-B(2):124-134.
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Affiliation(s)
- Sameer Jain
- Chapel Allerton Hospital, Leeds, UK.,Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | | | | | - Mohammad Amer
- University Hospital Southampton NHS Foundation Trust, Southampton, UK.,Trauma and Orthopaedics Department, Cairo University, Cairo, Egypt
| | | | | | | | - Douglas G Dunlop
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | | | - Robert West
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Hemant Pandit
- Chapel Allerton Hospital, Leeds, UK.,Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
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11
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Sakic L, Tonkovicc D, Hrgovic Z, Klasan A. Spinal Dexamethasone Effect on Cognitive Disorders After Hip Surgery. Med Arch 2023; 77:18-23. [PMID: 36919129 PMCID: PMC10008248 DOI: 10.5455/medarh.2023.77.18-23] [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: 12/04/2022] [Accepted: 01/25/2023] [Indexed: 02/23/2023] Open
Abstract
Background Proximal femoral fractures (PrFF) are one of the most common causes of emergency admission in the elderly population. The majority of patients have pre-existing conditions that get worsened by unplanned surgery. Objective Purpose of this article was to evaluate if a is single shot of dexamethasone with levobupivacaine administered intrathecally reduces postoperative pain and cognitive complications in patients with proximal femoral fractures. Methods The study was performed at a level II trauma center which is a part of a teaching hospital with a catchment population of around 300,000 patients, the first author's affiliation. Around 500 PrFF are performed yearly in the center. All participants gave oral and written informed consent before randomization. Results In total, 60 patients with a PrFF, ASA status 2 or 3 were randomized into two groups for spinal anaesthesia as DLSA study group (received 8 mg of dexamethasone and 12.5 mg of 0.5 % levobupivacaine) or LSA control group (received 12.5 mg of 0,5 % levobupivacaine). Postoperative cognitive disturbance was evaluated using simplified Confusion Assessment Method (CAM) scale, pain intensity was measured using Visual Analogue Scale (VAS) and blood samples for defining cortisol concentrations were taken before and after the surgical procedure. The primary outcomes were effects of intrathecal dexamethasone on plasma cortisol affecting cognitive disturbances. Secondary outcomes included pain scores and length of hospital stay. The DLSA group demonstrated a reduced incidence of postoperative cognitive dysfunction (POCD), p=0.043, longer analgesia duration, p<0.001, decreased cortisol levels and shorter hospitalization p=0.045. Intrathecal dexamethasone was the only significant predictor of postoperative delirium, OR 7.76, p=0.019. Conclusion Single shot intrathecal administration of dexamethasone with levobupivacaine used in anaesthesia for proximal femoral fractures reduces the stress response by decreasing plasma cortisol concentrations prolonging analgesia. Complications such as delirium and POCD occurred with significantly lower frequency allowing better postoperative rehabilitation and shortening the hospitalization.
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Affiliation(s)
- Livija Sakic
- Department of Anesthesiology, Reanimatology and Intensive Medicine, University Hospital "Sveti Duh", Zagreb, Croatia.,Faculty of Dental Medicine and Health Osijek, Josip Juraj Strossmayer University of Osijek, Croatia.,School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Dinko Tonkovicc
- School of Medicine, University of Zagreb, Zagreb, Croatia.,Department of Anesthesiology, Reanimatology and Intensive Medicine, University Hospital Center, Zagreb, Croatia
| | | | - Antonio Klasan
- AUVA UKH Steiermark, Graz, Austria.,Johannes Kepler University, Linz, Austria
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12
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Makaram NS, Ross LA, Keenan OJ, Magill M, Moran M, Scott CEH. Reliability of current classification systems for periprosthetic distal femur fractures. Injury 2022; 53:3430-3437. [PMID: 35948511 DOI: 10.1016/j.injury.2022.08.002] [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: 03/06/2022] [Revised: 07/29/2022] [Accepted: 08/01/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION This study aims to determine which Periprosthetic Distal Femur Fracture (PDFF) classification system is the most reliable. The secondary aim was to determine which classification system correlated most accurately with the surgical management recommended and delivered. METHODS Between 2011 and 2019, 83 patients with 83 PDFFs that extended to the femoral component of a total knee arthroplasty (TKA) were retrospectively identified from a trauma database. Minimum follow-up was 1 year. Age, BMI, time from TKA, operative management, and Nottingham Hip Fracture Scores were collected, and AP and lateral radiographs used to classify all fractures using seven established classification systems by two observers blinded to management. In patients treated operatively (n = 69), preoperative radiographs were reviewed by two surgeons with expertise in trauma and knee revision who recommended fixation or distal femoral replacement (DFR) requirement. RESULTS Mean age was 80.7 years (SD9.4) and 50 (84.7%) were female. PDFFs occurred at a mean 9.5 years (SD5.2) after primary TKA. Mean follow-up was 3.8 years (SD2.9). Management was fixation in 47, DFR in 22 and non-operative for 14. The Fakler classification demonstrated highest interobserver reliability (ICC=0.948), followed by the Rorabeck (ICC=0.903), UCS (ICC=0.850) and Chen (ICC=0.906). The Neer classification demonstrated weakest agreement (ICC=0.633). Overall accuracy of predicting DFR requirement (as determined by two experts) was highest for the Fakler system (83.9%). Compared with actual management delivered the Rorabeck system was most accurate (94.1%). Multivariate regression demonstrated that the ultimate need for DFR (n = 22) was independently associated with medial comminution (HR 2.66 (1.12-6.35 95%CI), p = 0.027) and fractures distal to the anterior flange and posterior condyle of the femoral component (HR 2.45 (1.13-5.31), p = 0.024). CONCLUSION The Fakler classification showed highest interobserver agreement and was most accurately predictive of the management recommended by two experts. No classification system accurately predicted the fractures that required DFR, and none included medial comminution which was independently associated with DFR requirement. There remains a need for a PDFF classification system that reliably guides operative management of PDFFs.
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Affiliation(s)
- Navnit S Makaram
- Department of Orthopaedics and Trauma, Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh EH16 4SA, United Kingdom; The University of Edinburgh, Little France Crescent, United Kingdom.
| | - Lauren A Ross
- Department of Orthopaedics and Trauma, Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh EH16 4SA, United Kingdom
| | - Oisin Jf Keenan
- Department of Orthopaedics and Trauma, Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh EH16 4SA, United Kingdom
| | - Matthew Magill
- The University of Edinburgh, Little France Crescent, United Kingdom
| | - Matt Moran
- Department of Orthopaedics and Trauma, Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh EH16 4SA, United Kingdom
| | - Chloe E H Scott
- Department of Orthopaedics and Trauma, Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh EH16 4SA, United Kingdom; The University of Edinburgh, Little France Crescent, United Kingdom
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13
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Management and outcomes of femoral periprosthetic fractures at the hip : data from the characteristics, outcomes and management of periprosthetic fracture service evaluation (COMPOSE) cohort study. Bone Joint J 2022; 104-B:997-1008. [PMID: 35909379 DOI: 10.1302/0301-620x.104b8.bjj-2021-1682.r1] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The aim of this study was to describe the management and associated outcomes of patients sustaining a femoral hip periprosthetic fracture (PPF) in the UK population. METHODS This was a multicentre retrospective cohort study including adult patients who presented to 27 NHS hospitals with 539 new PPFs between 1 January 2018 and 31 December 2018. Data collected included: management strategy (operative and nonoperative), length of stay, discharge destination, and details of post-treatment outcomes (reoperation, readmission, and 30-day and 12-month mortality). Descriptive analysis by fracture type was performed, and predictors of PPF management and outcomes were assessed using mixed-effects logistic regression. RESULTS In all, 417 fractures (77%) were managed operatively and 122 (23%) conservatively. The median time to surgery was four days (interquartile range (IQR) 2 to 7). Of those undergoing surgery, 246 (59%) underwent revision and/or fixation and 169 (41%) fixation alone. The surgical strategy used differed by Unified Classification System for PPF type, with the highest rate of revision in B2/B3 fractures (both 77%, 176/228 and 24/31, respectively) and the highest rate of fixation alone in B1- (55/78; 71%) and C-type (49/65; 75%) fractures. Cemented stem fixation (odds ratio (OR) 2.66 (95% confidence interval (CI) 1.42 to 4.99); p = 0.002) and B2/B3 fracture type (OR 7.56 (95% CI 4.14 to 13.78); p < 0.001) were predictors of operative management. The median length of stay was 15 days (IQR 9 to 23), 12-month reoperation rate was 5.6% (n = 30), and 30-day readmission rate was 8.4% (n = 45). The 30-day and 12-month mortality rates were 5.2% (n = 28) and 21.0% (n = 113). Nonoperative treatment, older age, male sex, admission from residential or nursing care, and sustaining the PPF around a revision prosthesis were significant predictors of an increased 12-month mortality. CONCLUSION Femoral hip PPFs have mortality, reoperation, and readmission rates comparable with hip fracture patients. However, they have a longer wait for surgery, and surgical treatment is more complex. There is a need to create a national framework for data collection for this heterogeneous group of patients in order to understand the outcomes of different approaches to treatment. Cite this article: Bone Joint J 2022;104-B(8):997-1008 .
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14
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Mudiganty S, Hughes L, Choudry Q, Bokhari A. Managing periprosthetic fractures - a review of the hub and spoke model. SICOT J 2022; 8:2. [PMID: 35040775 PMCID: PMC8765126 DOI: 10.1051/sicotj/2022001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 12/31/2021] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Periprosthetic fractures are associated with significant morbidity and mortality. The "hub and spoke model" consists of a central organisation (the hub) and a series of secondary units (the spokes). This study reviews the presentation, management, and outcomes of periprosthetic fractures at a large general district hospital, the Royal Blackburn Hospital. METHODS A retrospective data analysis for patients presenting with periprosthetic fractures from a single general district hospital between January 2011 and December 2020. Details recorded were patient demographics, primary arthroplasty procedure, fracture management, ASA grade, morbidity and mortality, and Unified Classification System for Periprosthetic Fractures (UCSPF). RESULTS With 229 periprosthetic fractures, the number tripled in 2020 that admitted in 2011. The mean age was 78.6 years (range 33-100), 151 were females. Seventy-five percent of the fractures were managed locally, while 25% a referral to the higher specialist centre was sort. Of the 57 referrals, 50 were transferred to the hub, 5 were operated on locally, and 2 were managed non-operatively. Higher-level care transfer resulted in a delayed definitive treatment (4.8 versus 12 days, p = 0.001). About 94.4% of patients treated locally had a favourable outcome versus 92% of patients treated at the hub hospital. Cumulative mortality rates for the two sites were comparable. DISCUSSION Most of the patients presenting to the local spoke hospital with periprosthetic fractures were managed in house. For this practice to be preserved, there is a need for future planning, such as maintaining an appropriate skill mix at spoke units. Discussion between specialists at the hub and spoke hospitals reduced patient transfer by 14%.
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Affiliation(s)
- Srikanth Mudiganty
- Senior Clinical Fellow, Trauma and Orthopaedics, Barts Health NHS Trust, E1 1FR London, UK
| | - Luke Hughes
- Specialist Registrar, Trauma and Orthopaedics, East Lancashire NHS Hospitals Trust, BB2 3HH Blackburn, UK
| | - Qaisar Choudry
- Consultant, Trauma and Orthopaedics, East Lancashire NHS Hospitals Trust, BB2 3HH Blackburn, UK
| | - Awais Bokhari
- Consultant, Trauma and Orthopaedics, East Lancashire NHS Hospitals Trust, BB2 3HH Blackburn, UK
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15
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Quinzi DA, Ramirez G, Kaplan NB, Myers TG, Thirukumaran CP, Ricciardi BF. Early complications and reoperation rates are similar amongst open reduction internal fixation, intramedullary nail, and distal femoral replacement for periprosthetic distal femur fractures: a systematic review and meta-analysis. Arch Orthop Trauma Surg 2021; 141:997-1006. [PMID: 33743062 DOI: 10.1007/s00402-021-03866-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 03/12/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Our purpose was to perform a systematic review and meta-analysis to evaluate complication and revision rates for periprosthetic distal femur fractures (PPDFF) treated with: (1) ORIF using periarticular locking plates (ORIF), (2) retrograde intramedullary nail (IMN), and (3) distal femoral replacement (DFR). METHODS Systematic review of the literature was performed to identify eligible studies (N = 52). Identified treatment groups were: ORIF (N = 1205 cases), IMN (N = 272 cases), and DFR (N = 353 cases). Median follow-up was 30 months (range 6-96 months). Primary outcomes were: (1) major complication rates and (2) reoperation rates over the follow-up period. Secondary outcomes were incidence of deep infection, periprosthetic fracture, mortality over the follow-up period, 1-year mortality, non-union, malunion, delayed union, and hardware failure. Data for primary and secondary outcomes were pooled and unadjusted analysis was performed. Meta-analysis was performed on subset of individual studies comparing at least two of three treatment groups (N = 14 studies). Odds-ratios and their respective standard errors were determined for each treatment group combination. Maximum likelihood random effects meta-analysis was conducted for primary outcomes. RESULTS From the systematic review, major complication rates (p = 0.55) and reoperation rates (p = 0.20) were not significantly different between the three treatment groups. DFR group had a higher incidence of deep infection relative to IMN and ORIF groups (p = 0.03). Malunion rates were higher in IMN versus ORIF (p = 0.02). For the meta-analysis, odds of major complications were not significantly different between IMN versus DFR (OR 1.39 [0.23-8.52]), IMN versus ORIF (OR 0.86 [0.48-1.53]), or the ORIF versus DFR (OR 0.91 [0.52-1.59]). Additionally, odds of a reoperation were not significantly different between IMN versus DFR (OR 0.59 [0.08-4.11]), IMN versus ORIF (OR 1.26 [0.66-2.40]), or ORIF versus DFR (OR 0.91 [0.51-1.55]). CONCLUSIONS There was no difference in major complications or reoperations between the three treatment groups. Deep infection rates were higher in DFR relative to internal fixation, malunion rates were higher in IMN versus ORIF, and periprosthetic fracture rates were higher in DFR and IMN versus ORIF.
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Affiliation(s)
- David A Quinzi
- Department of Orthopaedics, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY, 14620, USA
| | - Gabriel Ramirez
- Department of Orthopaedics, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY, 14620, USA
| | - Nathan B Kaplan
- Department of Orthopaedics, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY, 14620, USA
| | - Thomas G Myers
- Department of Orthopaedics, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY, 14620, USA
| | - Caroline P Thirukumaran
- Department of Orthopaedics, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY, 14620, USA.,Division of Health Policy and Outcomes Research, Department of Public Health Sciences, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY, 14620, USA.,Department of Orthopedic Surgery, Center for Musculoskeletal Research, University of Rochester School of Medicine, 601 Elmwood Avenue, Rochester, NY, 14620, USA
| | - Benjamin F Ricciardi
- Department of Orthopaedics, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY, 14620, USA. .,Department of Orthopedic Surgery, Center for Musculoskeletal Research, University of Rochester School of Medicine, 601 Elmwood Avenue, Rochester, NY, 14620, USA. .,Orthopaedic Surgery, University of Rochester School of Medicine, 1000 South Avenue, Suite 050, Rochester, NY, 14607, USA.
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16
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Early Surgery Does Not Improve Outcomes for Patients with Periprosthetic Femoral Fractures-Results from the Registry for Geriatric Trauma of the German Trauma Society. ACTA ACUST UNITED AC 2021; 57:medicina57060517. [PMID: 34064211 PMCID: PMC8224313 DOI: 10.3390/medicina57060517] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 05/12/2021] [Accepted: 05/19/2021] [Indexed: 01/28/2023]
Abstract
Background and Objectives: Appropriate timing of surgery for periprosthetic femoral fractures (PFFs) in geriatric patients remains unclear. Data from a large international geriatric trauma register were analyzed to examine the outcome of patients with PFF with respect to the timing of surgical stabilization. Materials and Methods: The Registry for Geriatric Trauma of the German Trauma Society (Deutsche Gesellschaft für Unfallchirurgie (DGU)) (ATR-DGU) was analyzed. Patients treated surgically for PFF were included in this analysis. As outcome parameters, in-house mortality rate and mortality at the 120-day follow-up as well as mobility, the EQ5D index score and reoperation rate were analyzed in relation to early (<48 h) or delayed (≥48 h) surgical stabilization. Results: A total of 1178 datasets met the inclusion criteria; 665 fractures were treated with osteosynthesis (56.4%), and 513 fractures were treated by implant change (43.5%). In contrast to the osteosynthesis group, the group with implant changes underwent delayed surgical treatment more often. Multivariate logistic regression analysis of mortality rate (p = 0.310), walking ability (p = 0.239) and EQ5D index after seven days (p = 0.812) revealed no significant differences between early (<48 h) and delayed (≥48 h) surgical stabilization. These items remained insignificant at the follow-up as well. However, the odds of requiring a reoperation within 120 days were significantly higher for delayed surgical treatment (OR: 1.86; p = 0.003). Conclusions: Early surgical treatment did not lead to decreased mortality rates in the acute phase or in the midterm. Except for the rate of reoperation, all other outcome parameters remained unaffected. Nevertheless, for most patients, early surgical treatment should be the goal, so as to achieve early mobilization and avoid secondary nonsurgical complications. If early stabilization is not possible, it can be assumed that orthogeriatric co-management will help protect these patients from further harm.
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