Predictors of early failure of the cannulated screw system in patients, 65 years and older, with non-displaced femoral neck fractures

Biomechanical analysis of fixation strength at different nailing angles for femoral neck fracture with insufficient reduction

To analyze the fixation strength of cannulated screws fixation in the treatment of femoral neck fracture with posterior tilt due to insufficient reduction. Two sets of digital models of anatomical reduction and 15° tilting reduction were established by CT data. Each group of models was modeled with two different fixation methods. One fixation method was fixed according to the standard cannulated screws recommended by AO. Another fixation method is to tilt the screw posterior tilt 15°. The final four groups of models were obtained: AO principle nailing posterior tilt model (Group A), posterior direction nailing posterior tilt model (Group B), AO principle nailing anatomic reduction model (Group C) and posterior direction nailing anatomic reduction model (Group D). The maximum displacement of the fracture end, the maximum Von-Mises stress and the stress distribution of the internal fixation were compared among the four groups. Four groups of models were established on artificial bone by 3D printing guide plate technology. The 600 N pressure test and yield test were performed on a biomechanical machine. The finite element and biomechanical models showed that groups B and C were more stable than groups A and D. The stability of group B was not worse than that of group C. When the femoral neck fracture produces a posterior tilt, a posterior reduction is allowed. The change of AO screw to posterior tilting screw fixation has more powerful advantages. No posterior tilt or posterior reduction, AO screw placement is still required.

The significance of reduction of valgus-intercalated femoral neck fracture with valgus angle > 15°and the selection of internal fixation by finite element analysis

BACKGROUND

Currently, consensus is lacking on the necessity of internal fixation after reducing valgus-intercalated femoral neck fractures with abduction > 15°. This study employs finite element analysis to compare the biomechanical differences between the femoral neck dynamic cross nail system (FNS) and inverted cannulated screw (ICS), aiming to provide a foundation for clinical procedures.

METHODS

Human femur CT scan data were processed using MimICS21.0 and Geomagic 2021 software, imported into Solidworks2021 to create fracture models, based on Garden I abduction and Valgus-intercalated femoral neck fractures. The internal fixation model was divided into two groups: A-Anatomic reduction group; B-Valgus-intercalated femoral neck fracture group. ANSYS software facilitated meshing, material assignment, and data calculation for stress and displacement comparisons when ICS and FNS were applied in reduction or non-reduction scenarios.

RESULTS

Without internal fixation, peak femur stress in both groups was 142.93 MPa and 183.62 MPa. Post FNS fixation, peak stress was 254.11 MPa and 424.81 MPa; peak stresses for the two FNS models were 141.26 MPa and 248.33 MPa. Maximum displacements for the two FNS groups were 1.91 mm and 1.26 mm, with peak fracture-end stress at 50.751 MPa and 124.47 MPa. After ICS fixation, femur peak stress was 204.76 MPa and 274.08 MPa; maximum displacements were 1.53 mm and 1.15 mm. ICS peak stress was 123.88 MPa and 174.61 MPa; maximum displacements were 1.17 mm and 1.09 mm, with peak fracture-end stress at 61.732 MPa and 104.02 MPa, respectively.

CONCLUSIONS

Our finite element study indicates superior mechanical stability with internal fixation after reducing valgus-intercalated femoral neck fractures (> 15°) compared to in situ fixation. Additionally, ICS biomechanical properties are more suitable for this fracture type than FNS.

Clinical observation of Gofried positive buttress reduction in the treatment of young femoral neck fracture: A systematic review and meta-analysis

BACKGROUND

Femoral neck fractures in young adults(<65 years), have always been a difficult problem, characterized by high rates of nonunion and avascular necrosis (AVN). The clinical efficacy of anatomical reduction and non-anatomical reduction methods needs to be supported by clinical data. Therefore, we conduct a meta-analysis on the clinical efficacy of different reduction methods to better guide clinical practice.

METHODS

Relevant studies published using internal fixation to treat femoral neck fracture in several databases were searched. The outcomes sought included Harris score and the rate of AVN, nonunion and femoral neck shortening (<5 mm). Included studies were assessed for methodological bias and estimates of effect were calculated. Potential reasons for heterogeneity were explored.

RESULTS

The clinical results showed that compared with the anatomical reduction and positive buttress, there is no significant difference in the rate of AVN (OR = 0.87, 95%CI: 0.55-1.37, P = .55), nonunion (OR = 0.54, 95%CI: 0.21-1.41, P = .21), femoral neck shortening (<5 mm) (OR = 1.03,95%CI: 0.57-1.86, P = .92), the Harris score (MD = -0.28, 95%CI: -1.36-0.80, P = .61) and the excellent and good rate of Harris score (OR = 1.73, 95%CI: 0.84-3.56, P = .61). However, compared with negative buttress, the rate of AVN (OR = 0.62, 95%CI: 0.38-1.01, P = .05), nonunion (OR = 0.34, 95%CI: 0.12-1.00, P = .05) and femoral neck shortening (<5 mm) (OR = 0.27, 95%CI: 0.16-0.45, P < .00001) were significantly lower, and the Harris score (MD = 6.53, 95%CI: 2.55 ~ 10.51, P = .001) was significantly better in positive buttress.

CONCLUSIONS

In the case of difficult to achieve anatomical reduction, for young patients (< 65 years) with femoral neck fracture, reduction with positive buttress can be an excellent alternative and negative buttress should be avoided as much as possible.

Factors associated with early failure of the femoral neck system (FNS) in patients with femoral neck fractures

BACKGROUND

Femoral neck system (FNS) is a new type of internal fixation system which has been widely used for treating femoral neck fractures (FNFs).Compared with other internal fixation methods, FNS is minimally invasive and stable, and often achieves satisfactory short-term efficacy.Early failure of FNS (EFFNS) is not uncommon, however, there are few literatures and reports on factors associated with EFFNS.This study aimed to survey the prevalence and risk factors of EFFNS.

METHODS

We retrospectively analysed 62 patients with FNFs and underwent FNS fixation between 2019 and 2021. Demographic data, clinical characteristics, radiographic features and treatment process were described. Multifactor logistic regression analysis was used to analyse the different influencing factors.

RESULTS

Out of the 62 FNFs patients, 10 patients (16.1%) developed EFFNS, including 6 cases of severe femoral neck shortening, 2 cases of screw-out, 1 case of avascular necrosis of the femoral head and 1 case of nonunion. In the failure group, all patients were younger than 65 years old, which was significantly higher than 59.6% in the healing group (P = 0.012). There were no significant differences in sex(P = 0.490), BMI (P = 0.709), injured side (P = 0.312), injury mechanism (P = 0.617), reduction method(P = 0.570),femoral neck-shaft angle(P = 0.545), Pauwels classification (P = 0.564) and Garden classification (P = 0.195). Moreover, we not found that Garden classification (P = 0.464) and age (P = 0.128) were statistically significant risk factors for EFFNS at multivariate analysis.

CONCLUSION

In this study, sex, BMI, injury side, injury mechanism, reduction method, Pauwels angle, femoral neck-shift angle, Pauwels classification and Garden classification were excluded as EFFNS risk factors. Moreover, our study demonstrated that age and Garden classification were not significant risk factors at multivariate analysis.

TRIAL REGISTRATION

ChiCTR, ChiCTR2100051360. Registered on 21 September, 2021. https://www.chictr.org.cn/index.aspx .

Prediction of hip joint function and analysis of risk factors for internal fixation failure after Femoral Neck System (FNS)

OBJECTIVE

Analysis of the risk factors affecting hip function and complications after femoral neck system (FNS) surgery for femoral neck fractures is of great significance for improving the procedure's efficacy.

METHODS

The data of patients with femoral neck fractures who underwent FNS surgery in our hospital between October 2019 and October 2020 were retrospectively analyzed. Age, gender, time from injury to operation, fracture classification, operation time, fracture reduction, and postoperative weight-bearing time information were set as potential factors that may affect the results. Hip Harris scores were performed at 12 months postoperatively, and postoperative complication data (e.g., femoral head necrosis, nonunion, and femoral neck shortness) were collected. The risk factors affecting hip function and complications after FNS surgery were predicted using linear and logistic regression analyses.

RESULTS

A total of 69 cases of femoral neck fracture were included, with an average age of 56.09 ± 11.50 years. The linear analysis demonstrated that the age and fracture type of the patients were the risk factors affecting the Harris score of the hip joint after FNS surgery. Older patients with displaced femoral neck fractures had an inferior postoperative hip function. In addition, fracture type, reduction of the femoral neck, and postoperative weight-bearing significantly impacted postoperative complications. Displaced fractures, negative fixation, and premature weight-bearing (< 6 weeks) were risk factors for postoperative complications. The Harris score of patients with a shortened femoral neck in the included cases was not significantly different from that of patients without shortening (P = 0.25).

CONCLUSIONS

Advanced age and fracture type are important evaluation indicators of the Harris score after FNS internal fixation of femoral neck fractures in young patients. Fracture type, fracture reduction, and postoperative weight-bearing time are risk factors for complications after FNS.

Functional autonomy and 12-month mortality in older adults with proximal femoral fractures in an orthogeriatric setting: risk factors and gender differences

BACKGROUND

Proximal femur fractures have a negative impact on loss of functional autonomy and mortality.

OBJECTIVE

The aim of this retrospective study was to evaluate functional autonomy and mortality in a group of older adults with hip fractures managed in an orthogeriatric setting 12 months after discharge and to determine if gender affected outcome.

METHODS

In all participants, we assessed clinical history, functional pre-fracture status using activities of daily living (ADL) and in-hospital details. At 12 months after discharge, we evaluated functional status, place of residence, hospital readmissions and mortality.

RESULTS

We studied 361 women and 124 men and we observed a significant reduction in the ADL score at 6 months (1.15 ± 1.58/p < 0.001 in women and 1.45 ± 1.66/p < 0.001 in men). One-year mortality (33.1% in men and 14.7% in women) was associated with pre-fracture ADL score and reduction in ADL at 6 months (HR 0.68/95%, CI 0.48-0.97/p < 0.05 and HR 1.70/95%, CI 1.17-2.48/p < 0.01, respectively) in women, and new hospitalisations at 6 months and polypharmacy in men (HR 1.65/95%, CI 1.07-2.56/p < 0.05 and HR 1.40/95%, CI 1.00-1.96/p = 0.05, respectively) in Cox's regression model.

DISCUSSION AND CONCLUSIONS

Our study suggests that functional loss in older adults hospitalised for proximal femur fractures is greatest in the first 6 months after discharge, and this increases the risk of death at 1 year. Cumulative mortality at 12 months is higher in men and appears to be related to polypharmacy and new hospital admissions 6 months after discharge.

Increasing trend toward joint-preserving procedures for hip osteonecrosis in the United States from 2010 to 2019

INTRODUCTION

The incidence of osteonecrosis of the femoral head is estimated at about 10 to 20,000 patients annually, and, when left untreated, 80% or more of cases progress to femoral head collapse. A series of joint-preserving procedures have been developed to prevent/delay the need for hip arthroplasty. The aim of this study was to provide a five-year update: (1) evaluating temporal trends of arthroplasty vs. joint-preservation techniques such as core decompression, bone grafting, osteotomies, and arthroscopy; (2) determining proportions of procedures in patients aged less than vs. over 50 years; and (3) quantifying rates of specific operative techniques.

METHODS

A total of 10,334 patients diagnosed with osteonecrosis of the femoral head and having received hip surgery were identified from a nationwide database between 1 January 2010 and 31 December 2019, by using the International Classification of Disease, the Ninth/Tenth revision (ICD-9/10) codes. The percentage of patients managed by each operative procedure was calculated annually. To identify trends, patients were grouped by age under/over 50 years and divided into a joint-preserving and a non-joint-preserving (arthroplasty) group. Chi-squared tests were performed to compare the total number of procedures per year.

RESULTS

Rates of arthroplasty far exceeded those for joint-preserving procedures. However, from 2015 to 2019, significantly more joint-preserving procedures were performed than in 2010 to 2014 (4.3% vs. 3.0%, P < 0.001). Significantly more joint-preserving procedures were performed in patients aged < 50 years relative to those ≥ 50 years (7.56% vs. 1.86%, P < 0.001). Overall, total hip arthroplasty was the most common procedure (9,814; 94.97%) relative to core decompression (331; 3.20%), hemiarthroplasty/resurfacing (102; 0.99%), bone grafting (48; 0.46%), and osteotomy (5; 0.05%).

CONCLUSION

Management of patients who have osteonecrosis of the femoral head continues to be predominantly arthroplasty procedures, specifically, total hip arthroplasty. Our findings suggest a small, but significant trend toward increased joint-preserving procedures, especially in patients under 50 years. In particular, the proportion of patients receiving core decompression has increased significantly from 2015 to 2019 relative to prior years.

The correlates of post-surgical haematoma in older adults with proximal femoral fractures

BACKGROUND

Little is known about the incidence of haematoma, and clinical correlates among orthogeriatric patients.

AIMS

This study aims to describe the incidence of haematoma after surgical repair of hip fracture and to identify the clinical correlates of haematoma among orthogeriatric patients.

METHODS

Two orthopaedic surgeons and a dedicated operator using ultrasound technique, each other in blindness, evaluated 154 orthogeriatric patients during their hospital stay. All patients received a comprehensive geriatric assessment. We investigated the concordance between clinical diagnosis and ultrasound detection of haematoma, and then we explored the clinical correlates of the onset of post-surgical haematoma.

RESULTS

Blood effusion at the surgical site was detected in 77 (50%) patients using ultrasound technique; orthopaedic surgeons reached a clinical agreement about post-surgical haematoma in 18 (23%) patients. The sensitivity of clinical evaluation was 0.66, and the specificity was 0.70. Independent of age, clinical, pharmacological, and surgical confounders, proton pump inhibitors (PPIs) were associated with post-surgical haematoma (OR 2.28; 95% CI 1.15-4.49). A tendency towards association was observed between selective serotonin reuptake inhibitors and post-surgical haematoma (OR 2.10; 95% CI 0.97-4.54), CONCLUSIONS: Half of older patients undergoing surgical repair of proximal femoral fracture develop a post-surgical haematoma. Clinical assessment, even if made by senior orthopaedic surgeons, underestimates the actual occurrence of post-surgical haematoma compared to ultrasound detection. Ultrasound technique may help to detect haematoma larger than 15 mm better than clinical assessment. PPIs's use is a risk factor for post-surgical haematoma independent of several medical and surgical confounders.

Outcomes of direct superior approach and posterolateral approach for hemiarthroplasty in the treatment of elderly patients with displaced femoral neck fractures: A comparative study

Hemiarthroplasty is a surgical choice for super-aged patients with a high surgical risk and a sedentary lifestyle. The direct superior approach (DSA), a minimally invasive modification of the posterior approach, is rarely studied in hemiarthroplasty. The aim of the present study was to compare the clinical outcomes in elderly patients with displaced femoral neck fractures undergoing hemiarthroplasty via DSA with the conventional posterolateral approach (PLA). A total of 48 elderly patients with displaced femoral neck fractures who underwent hemiarthroplasty between February 2020 and March 2021 were retrospectively included in the study. Of them, 24 patients (mean age 84.54 ± 2.11 years) were treated with hemiarthroplasty via DSA (DSA group), while the other 24 patients (mean age 84.92 ± 2.15 years) were treated with hemiarthroplasty via PLA (PLA group). Clinical outcomes, perioperative data, and complications were recorded. There were no obvious differences in the baseline characteristics between the DSA and PLA groups, including age, gender, body mass index, Garden type, American Society of Anesthesiologists score, and hematocrit. Perioperative data showed that the length of the incision in the DSA group was smaller than that in the PLA group (p &lt; 0.001). However, the duration of the operation and blood loss in the DSA group were longer and higher than those in the PLA group, respectively (p &lt; 0.001). In addition, the DSA group had a shorter hospitalization time than the PLA group (p &lt; 0.001). The visual analog scale score and Harris score 1 month postoperatively in the DSA group were better than those in the PLA group (p &lt; 0.001). Moreover, there were no significant differences between the two groups in Harris score (for assessment dysfunction) 6 months postoperatively (p &gt; 0.05). DSA is less invasive and has better clinical outcomes, which can allow an early return to daily living activities in elderly patients with displaced femoral neck fractures undergoing hemiarthroplasty.

Concomitant fractures in patients with proximal femoral fractures lead to a prolonged hospital stay but not to increased complication rates or in-house mortality if treated surgically: a matched pair analysis

BACKGROUND

Impact of concomitant fractures on patients sustaining a proximal femur fracture remains unclear. Rising numbers and patient need for rehab is an important issue. The objective of our study was to investigate the impact of concomitant fractures, including all types of fractures, when treated operatively, for proximal femur fractures on the length of hospital stay, in-house mortality and complication rate.

METHODS

Observational retrospective cohort single-center study including 85 of 1933 patients (4.4%) with a mean age of 80.5 years, who were operatively treated for a proximal femoral and a concomitant fracture between January 2016 and June 2020. A matched pair analysis based on age, sex, fracture type and anticoagulants was performed. Patient data, length of hospital stay, complications and mortality were evaluated.

RESULTS

The most common fractures were osteoporosis-associated fractures of the distal forearm (n = 34) and the proximal humerus (n = 36). The group of concomitant fractures showed a higher CCI than the control group (5.87 vs. 5.7 points; p < 0.67). Patients with a concurrent fracture had a longer hospital stay than patients with an isolated hip fracture (15.68 vs. 13.72 days; p < 0.056). Complications occurred more often in the group treated only for the hip fracture (11.8%, N = 20), whilst only 7.1% of complications were recorded for concomitant fractures (p < 0.084). The in-house mortality rate was 2.4% and there was no difference between patients with or without a concomitant fracture.

CONCLUSIONS

A concomitant fracture to a hip fracture increases the length of hospital stay significantly but does not increase the complication rate or the in-house mortality. This might be due to the early mobilization, which is possible after early operative treatment of both fractures.

Evaluation of the Posterior Tilt Angle in Predicting Failure of Nondisplaced Femoral Neck Fractures After Internal Fixation: A Systematic Review

OBJECTIVE

To evaluate the posterior tilt angle (PTA) in predicting treatment failure after internal fixation of nondisplaced femoral neck fractures as graded by the Garden classification, which is based solely on anterior-posterior radiographic evaluation.

DATA SOURCES

A search was conducted of all published literature in the following databases from inception to December 20, 2021: PubMed, Embase, Cochrane Library, Web of Science, Scopus, and ClinicalTrials.gov .

STUDY SELECTION

We included English-language randomized controlled trials, prospective and retrospective cohort studies that reported malunion/nonunion, avascular necrosis, fixation failure, or reoperations in patients with nondisplaced femoral neck fractures treated with internal fixation who were evaluated for PTA using either lateral radiograph or computed tomography.

DATA EXTRACTION

All abstract, screening, and quality appraisal was conducted independently by 2 authors. Data from included studies were extracted manually and summarized. The Methodological Index for Non-Randomized Studies criteria was used for quality appraisal.

DATA SYNTHESIS

Odds ratios with 95% confidence intervals were calculated for treatment failure, defined as nonunion/malunion, avascular necrosis, fixation failure, or reoperation, in cases involving preoperative PTA ≥20-degrees and <20-degrees. Statistical significance was set at P < 0.05.

RESULTS

Nondisplaced femoral neck fractures with PTA >20-degrees had a 24% rate of treatment failure compared with 12% for those <20-degrees [odds ratios, 3.21 (95% confidence intervals, 1.95-5.28); P < 0.001].

CONCLUSION

PTA is a predictor of treatment failure in nondisplaced femoral neck fractures treated with internal fixation. Nondisplaced femoral neck fractures with a PTA >20-degrees may warrant alternative treatment modalities.

LEVEL OF EVIDENCE

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Effect of Early Mobilization on Hip and Lower Extremity Postoperative: A Literature Review

INTRODUCTION

The incidence of fracture and surgery of the hip and lower extremities is still high. Long postoperative bed rest can potentially increase the incidence of various complications that may increase patients' morbidity and mortality rate after hip and lower extremities surgery. This literature review aimed to identify the effects of early mobilization on hip and lower extremity postoperative.

METHODS

Search for articles on several databases such as ProQuest, ScienceDirect, CINAHL, Medline, Wiley Online, and Scopus, using the Boolean operator tools with "AND" and "OR" words by combining several keywords according to the literature review topic, with inclusion criteria of those published in the last three years (2019-2021), using a quantitative design, written in English and full-text articles. A total of 435 articles were obtained, screened, and reviewed so that there were 16 (sixteen) eligible articles.

RESULTS

There were 11 (eleven) effects of early mobilization, that is, shorter the length of stay, lower postoperative complication, lower the pain, increase walking ability, increase quality of life, decrease the rate of readmission, decrease mortality rate, lower the total hospitalization cost, higher number of physical therapy sessions prior to discharge, increase in satisfaction, and no fracture displacement or implant failure.

CONCLUSION

This literature review showed that early mobilization is safe and effective in postoperative patients to reduce the risk of complications and adverse events. Nurses and health workers who care for patients can implement early mobilization and motivate patients to cooperate in undergoing early mobilization.

Proportion of stable femoral neck fracture types in different age groups: a population-based study

OBJECTIVE

The treatment and incidence of femoral neck fracture (FNF) in older patients is controversial. We investigated the new AO (Arbeitsgemeinschaft für Osteosynthese) classification in patients with FNF by age to determine the proportions of stable fracture and change trends according to patients' age.

METHODS

We divided patients with FNF hospitalized in Xi'an Honghui Hospital from 2018 to 2020 into five groups according to age: young (<50 years), middle-aged (50-59 years), young-elderly (60-69 years), middle-elderly (70-79 years), and very elderly (≥80 years) groups. We retrospectively collected data of patients' sex, admission date, fracture side, mechanism of injury, and new AO classification.

RESULTS

In total, 2071 patients were included for analysis, with 1329 women (64.2%); 1106 patients (53.4%) had left-side fracture. The main mechanism of injury was falling. In the young-elderly, middle-elderly, and very-elderly groups, 33.3%, 29.2%, and 24.1% had stable fracture type, respectively). The proportion of patients with FNF did not show a change trend by age during the 3-year investigation period.

CONCLUSION

In our study, the proportion of older patients with FNF did not increase, and as many as a third of patients with FNF aged 50 to 70 years had stable fracture.

Reduction of posterior dislocated hip prosthesis using a modified lateral position maneuver: a retrospective, clinical comparative, and follow-up study

BACKGROUND

Posterior dislocation (PD) is a common complication after total hip arthroplasty (THA), and the Allis maneuver is the most widely used method for reduction. However, this classic maneuver has some disadvantages. The aim of the present study was to investigate whether a modified lateral position (MLP) reduction maneuver provides an easier and safer method for PD reduction than the Allis maneuver.

METHODS

Between August 2019 and September 2021, a series of 88 consecutive PD patients who underwent THA were retrospectively evaluated. The patients were divided into the MLP reduction group and Allis reduction group according to the electronic health medical record. The success rate of closed reduction, Harris hip score (HHS), and radiographic outcomes were determined. Satisfaction scores, doctor safety events and complications were also determined and compared between the groups. The mean follow-up period was 1.66 ± 0.88 years.

RESULTS

The success rate of reduction in the MLP group was significantly 12.5% higher than that in the Allis group (P = 0.024). Periprosthetic fracture and implant loosening were retrospectively identified in 2 hips and 1 hip, which all occurred in the Allis group. The mean doctor and patient SAPS scores in the MLP group were 84.00 points and 76.97 points, respectively, which were significantly higher than those in the Allis group (72.12, P = 0.008 and 63.28 points, P = 0.001). Four adverse events were reported in the Allis group, compared with 0 in the MLP group.

CONCLUSIONS

For PD after THA, the MLP reduction maneuver can effectively increase the reduction success rate, satisfaction, and doctor safety without increasing the risk of complications compared with the traditional Allis supine reduction maneuver.

TRIAL REGISTRATION

This study was registered in the Chinese Clinical Trial Registry (ChiCTR2100054562) in December 19th 2021.

Association between hyperglycemia on admission and preoperative deep venous thrombosis in patients with femoral neck fractures

Background

Elevated blood glucose is the most frequent electrolyte disturbance in acutely ill patients. This study aimed to determine whether admission hyperglycemia is associated with the incidence of preoperative deep venous thrombosis (DVT) in patients with femoral neck fractures.

Methods

This retrospective study was conducted on consecutive patients with femoral neck fractures admitted to our institution from March 2018 to March 2022. Blood glucose levels were measured within 24 h of admission and categorized into quartiles (Q1 = 5.30; Q2 = 5.70; Q3 = 6.60). Patients were divided into four groups (Group1-4) based on the quartiles. Preoperative DVT was diagnosed using venous compression ultrasonography. Multivariable logistic regression models and propensity score matching analysis evaluated the association between blood glucose and preoperative DVT in patients.

Results

Of 217 patients included in this study, 21(9.7%) had preoperative DVT in hospital, and admission hyperglycemia was observed in 83 (38.2%). Preoperative DVT was higher in patients with hyperglycemia (n = 15) than patients without hyperglycemia (n = 6) in the multivariable logistic regression models (OR 3.03, 95% CI 0.77–11.87). Propensity scores matching analyses manifested that compared with patients with group 2 (5.30 – 5.70 mmol/L) of glucose levels, the odds of preoperative DVT were slightly higher (OR 1.94, 95% CI 0.31–12.12) in patients with group 3 (5.70 – 6.60 mmol/L), substantially higher (OR 6.89, 95% CI 1.42–33.44, P trend < 0.01) in patients with the group 4 (> 6.60 mmol/L) of glucose levels.

Conclusions

In patients hospitalized for femoral neck fracture, markedly elevated blood glucose is associated with increased preoperative DVT in patients. The development of this biomarker could help in guiding patient counseling, risk assessment, and future management decisions.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12891-022-05862-0.

Treatment of Distal Radius Fractures with Bridging External Fixator with Optional Percutaneous K-Wires: What Are the Right Indications for Patient Age, Gender, Dominant Limb and Injury Pattern?

The aim of this retrospective study was to evaluate the medium-term clinical and functional outcomes of patients with closed, displaced, and unstable, simple or complex, intra- and extra-articular distal radius fractures (DRFs) treated with a bridging external fixator (BEF) and optional K-wires (KWs). AO classification was used to differentiate the injuries radiographically. Clinical-functional outcomes were evaluated using the Patient-Rated Wrist and Hand Evaluation Score (PRWHE Score) and the Quick Disabilities of the Arm Shoulder and Hand Score (QuickDASH). A total of 269 dorsally displaced fractures of 202 female (75%) and 67 male subjects (25%) were included, with a mean follow-up of 58.0 months. Seventy-five patients (28%) were treated by additional KWs. No differences were found comparing the two groups of patients (BEF vs. BEF + KWs) regarding age, sex, and fracture side (dominant vs. non-dominant). PRWHE and QuickDASH scores were lower in the BEF + KWs group compared to the BEF group (p < 0.0001 and p = 0.0007, respectively). Thus, patients treated with KWs had a better clinical outcome. Beta multivariate regression analysis confirmed that patients of the BEF + KWs group exhibited a better PRWHE score but not a better QuickDASH score. Patients treated by the BEF + KWs with the fracture on the dominant site were characterised by better clinical outcomes. Older patients had a better PRWHE score independently from the treatment. Our findings suggest that the use of BEF for DRFs with optional KWs can be indicated in both young and elderly patients of any gender, independent of limb side and fracture pattern. As the best functional results were achieved in the elderly when KWs were added, the combination of BEF and KWs seems to be mainly indicated for the treatment of DRF, also complex, in the elderly population.

Are there really specific risk factors for heterotopic ossifications? A case report of 'non-risk factor' after total hip replacement

Femoral neck fractures are one of the most common fractures in the elderly population. Due to frequent complications of the fixation of these fractures, patients are more and more often eligible for hip replacement surgery. One of the most frequently mentioned postoperative complication is the formation of heterotopic ossification. This case report describes as a 70-year-old male patient that presented with an old hip fracture accompanied by a mild craniocerebral trauma. The patient underwent total cementless hip arthroplasty followed by rehabilitation. At 8 months after surgery, the patient was diagnosed with Brooker IV° heterotopic ossification in the area of the operated hip joint. Due to the persistent pain and complete loss of mobility in the operated joint, computed tomography imaging was performed and the patient was recommended for a revision surgery. The procedure was performed 14 months after the original surgical treatment, resulting in a significant improvement in the range of motion and reduction of pain.

Incidence and risk factors associated with surgical site infection after surgically treated hip fractures in older adults: a retrospective cohort study

BACKGROUND

Surgical site infection (SSI) is one of the most common complications in the traumatic orthopedics field, but remains not adequately studied after hip fractures.

AIMS

This study aims to investigate the incidence and risk factors associated with SSI after surgically treated hip fractures in older adults.

METHODS

A retrospective cohort study including 2932 older adult patients (1416 with femoral neck fracture and 1516 with intertrochanteric fracture) surgically treated from Jan 2015 to Dec 2019 due to hip fractures was performed. Their data on demographics, injury-related data, surgery-related data, and preoperative laboratory test results were collected from hospitalization medical records. Univariate analyses were used to compare between the patients with and without SSI, and multivariate logistic regression analyses were used to identify the risk factors.

RESULTS

A total of 89 patients developed SSI, with an accumulated incidence rate of 3.04% (95%CI 2.41-3.66). Staphylococcus aureus was the most common source of infection. In univariate analysis, 11 items were found to be significant in femoral neck fractures and 5 items were found to be significant in intertrochanteric fracture. In the multivariable logistic regression model, cerebrovascular disease (OR 2.17, 95%CI 1.14-4.15) and hematocrit (HCT) (< Lower limit) (OR 3.46, 95%CI 1.13-10.56) were independent risk factors for SSI in femoral neck fracture. Heart disease (OR 2.13, 95%CI 1.18-3.85) was a risk factor for SSI, while LDH (> 250 U/L) (OR 0.44, 95%CI 0.20-0.95) was a protective factor for SSI in intertrochanteric fracture.

DISCUSSION

We observed 89 cases (3.04%) of SSI in 2932 older adult patients with hip fractures in this study. Cerebrovascular disease and lower HCT were two independent risk factors for SSI in femoral neck fracture, whereas heart disease was a risk factor and LDH was a protective factor for SSI in intertrochanteric fracture.

CONCLUSIONS

Targeted preoperative management, such as predicting the probability of SSI and taking appropriate measures accordingly is essential and highly regarded. Future multicentric studies with more patients evaluated are expected to better address the risk factors for SSI in older hip fracture patients.

Comorbidity and the association with 1-year mortality in hip fracture patients: can the ASA score and the Charlson Comorbidity Index be used interchangeably?

Background

Charlson Comorbidity Index (CCI) has been suggested to be associated with mortality in hip fracture patients, to the same extent as more expensive and time-consuming tools. However, even CCI might be too time-consuming in a clinical setting.

Aim

To investigate whether the American Society of Anaesthesiologists score (ASA score), a simple grading from the anaesthesiologist’s examination, is comparable with CCI in the association with 1-year mortality after a hip fracture.

Methods

The study population was patients 60 + years registered in the Swedish Hip Fracture Registry with a first-time hip fracture between 1997 and 2017 (N = 165,596). The outcome was 1-year mortality, and the exposures were ASA score and CCI. The association between comorbidity and mortality was described with Kaplan–Meier curves and analyzed with Cox proportional hazards models.

Results

The Kaplan–Meier curves showed a stepwise increase in mortality for increasing values of both ASA and CCI. The Hazard Ratios (HRs) for the highest ASA (4–5) were 3.8 (95% Confidence Interval 3.5–4.2) for women and 3.2 (2.8–3.6) for men in the fully adjusted models. Adjusted HRs for the highest CCI (4 +) were 3.6 (3.3–3.9) for women and 2.5 (2.3–2.7) for men. Reference was the lowest score value for both tools. The correlation between the tools was moderate.

Conclusions

Both ASA and CCI show a similar stepwise association with 1-year mortality in hip fracture patients, despite measuring different factors and capturing different individuals at risk. Since the ASA score is already accessible for health care staff, it might be preferable to aid in prioritizing vulnerable hip fracture patients at risk of adverse outcomes.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40520-021-01896-x.

Revisiting Pauwels' classification of femoral neck fractures

Pauwels' femoral neck fracture classification is based on the biomechanical principle that shear stress and varus force increase along more vertically oriented fractures, resulting in higher risk of fracture displacement and ultimately nonunion. This principle continues to guide construct selection for femoral neck fracture internal fixation and is the foundation for treating non-union with valgus osteotomy. However, with poor inter- and intra-rater reliability, dated treatment recommendations, and unreliable prognostic value, the Pauwels classification cannot be directly applied in its entirety to the management of femoral neck fractures in modern practice.

Total hip arthroplasty or hemiarthroplasty for femoral neck fractures in elderly patients with neuromuscular imbalance

AIM

This study aimed at comparing clinical outcomes between total hip arthroplasty (THA) and hemiarthroplasty (HA) in elderly patients with neuromuscular imbalance (stroke, Parkinsonism, etc.).

METHODS

A total of 226 elderly patients with neuromuscular imbalance and femoral neck fractures treated with THA or HA were recruited at a single center, and their clinical data retrospectively reviewed. Mean follow-up time was 40.5 months (range 24-78), the primary outcome was secondary hip procedure while secondary outcomes included function, pain, health-related quality of life, complications, and death. Kaplan-Meier survival curves were used to determine the estimated survivorship, with re-operation as the end point. Logistic regression analyses were performed to assess the effects of different surgical procedures on mortality while linear regression analysis was used to evaluate the function, pain and quality of life.

RESULTS

Kaplan-Meier survivorship, with an end point of re-operation for any reason in the THA group, was 90.3% (95% CI 82.3-98.3), which was not significantly different from 95.9% (95% CI 93.0-98.8) for the HA group (p = 0.137). The most common cause of re-operation in both groups was dislocation. There were no significant differences with regards to postoperative complications (including dislocation). Compared to HA, THA exhibited better functional outcomes, quality of life and low pain intensity. Notably, there was no difference in 2 year mortality rates between the groups, however, HA was associated with a higher mortality rate beyond 2 years (OR 0.137; 95% CI 0.030-0.630; p = 0.011).

CONCLUSION

THA is an effective therapeutic procedure for femoral neck fractures in elderly patients with neuromuscular imbalance.

A new preoperative risk score for predicting mortality of elderly hip fracture patients: an external validation study

BACKGROUND

Hip fractures are common in the elderly and have a high risk of mortality. Several risk prediction models for mortality of hip fracture have been developed, but most of them are difficult to apply accurately in clinical practice.

AIMS

The objective of the present study was to perform an external validation of a new published preoperative risk score for predicting mortality.

METHODS

We carried out a retrospective cohort study from January 2014 to December 2018 for elderly hip fracture patients discharged from a orthopedic center in China. The preoperative risk score was calculated for each patient, and further divided into two groups: low-risk group (score < 24 points) and high-risk group (score ≥ 24 points) using the receiver operating characteristic (ROC) curve. The outcome was 30-day, 6-month and 1-year all-cause mortality, and the relationship between the risk score and mortality was assessed by univariate and multivariate Cox proportional hazard models. The area under the curve (AUC), Hosmer-Lemeshow test and calibration plots were used to test the discrimination and calibration.

RESULTS

A total of 460 consecutive patients were included in the study, and high-risk score was an independent risk factor for 30-day mortality [Hazard ratio (HR) 6.70; 95% Confidence interval (CI) 1.82-24.69; p = 0.004], 6-month mortality (HR 2.94; 95% CI 1.68-5.17; p < 0.001) and 1-year mortality (HR 3.30; 95% CI 2.09-5.20; p < 0.001). Also, each point increase in the risk score resulted in a 11% increase in 30-day mortality (HR 1.11; 95% CI 1.07-1.16; p < 0.001), 6% increase in 6-month mortality (HR 1.06; 95% CI 1.04-1.09; p < 0.001), and 5% increase in 1-year mortality (HR 1.05; 95% CI 1.03-1.07; p < 0.001). Moreover, the risk score had an AUC of 0.89 (95% CI 0.80-0.98) for 30-day mortality, 0.77 (95% CI 0.70-0.83) for 6-month mortality, and 0.76 (95% CI 0.70-0.81) for 1-year mortality. Calibration plots showed a good calibration between observed and predicted mortality, which was also demonstrated by the Hosmer-Lemeshow test.

CONCLUSION

Our present study findings indicated that the preoperative risk score was an accurate mortality risk assessment tool for elderly hip fracture patients, regardless of short- and long-term follow-up.

Nomogram for predicting reoperation following internal fixation of nondisplaced femoral neck fractures in elderly patients

OBJECTIVE

We aimed to evaluate risk factors and develop a nomogram for reoperation after internal fixation of nondisplaced femoral neck fractures (FNFs) in elderly patients.

METHODS

We conducted a retrospective study involving a total of 255 elderly patients who underwent closed reduction and internal fixation with cannulated screw system for nondisplaced FNFs between January 2016 and January 2019. We collected data on demographics, preoperative radiological parameters, surgery, serum biochemical markers, and postoperative rehabilitation. In addition, we performed univariate and multivariate logistic regression analyses to determine independent risk factors for reoperation, and then developed a nomogram to assess the risks of reoperation. Besides, discriminative ability, calibration, and clinical usefulness of the nomogram were evaluated using the concordance index (C-index), the receiver operating characteristic (ROC) curve, calibration curve and decision curve analysis (DCA), respectively. We employed bootstrap method to validate the performance of the developed nomogram.

RESULTS

Our analysis showed that among the 255 patients, 28 (11.0%) underwent reoperation due to osteonecrosis of the femoral head (14 cases), mechanical failure (8 cases) or nonunion (6 cases). All of the 28 patients underwent conversion surgery to arthroplasty. The multivariate logistic regression analysis demonstrated that preoperative posterior tilt angle ≥ 20°, Pauwel's III type, younger patients, preoperative elevated levels of alkaline phosphatase (ALP), preoperative hypoalbuminemia, and early postoperative weight-bearing were independent risk factors for reoperation. In addition, the C-index and the bootstrap value of the developed nomogram was 0.850 (95% CI = 0.803-0.913) and 0.811, respectively. Besides, the calibration curve showed good consistency between the actual diagnosed reoperation and the predicted probability, while the DCA indicated that the nomogram was clinically valuable.

CONCLUSIONS

Our analysis showed we successfully developed and validated a nomogram for personalized prediction of reoperation after internal fixation of nondisplaced FNFs in elderly patients. This model would help in individualized evaluation of the need for reoperation and inform strategies aimed at eliminating the need for the reoperation.

Cemented and uncemented hemiarthroplasty for femoral neck fracture in elderly patients: a systematic review and meta-analysis

BACKGROUND

Cemented hemiarthroplasty to treat femoral neck fractures (FNFs) in elderly patients is controversial. Therefore, this study aimed to compare cemented vs uncemented outcomes.

METHODS

A literature review using Pubmed, EMBASE, Cochrane Library, and Science Citation Index databases was conducted. Studies comparing outcomes of cemented with uncemented hemiarthroplasty for FNFs in elderly patients up to March 2020 were included. Dichotomous outcomes were pooled and reported as relative risk (RR) or odds ratio (ORs), while continuous outcomes were pooled and reported as the mean difference (MD) or standardized mean difference (SMD).

RESULTS

The analysis included 39 studies with a total of 112 576 patients. Pooled analysis revealed that compared with cemented, patients with uncemented intervention had better outcomes for intraoperative blood loss (OR 0.19; 95% CI 0.01-0.37), systolic blood pressure (OR 2.83; 95% CI 1.51-5.28), surgery duration (SMD, 0.51; 95% CI 0.2-0.81), length of anesthesia (OR 0.28; 95% CI 0.11-0.45), 6-month mortality (OR 1.11; 95% CI 1.03-1.2), cardiovascular accidents (OR 2.14; 95% CI 1.07-4.28), respiratory failure (OR 8.26; 95% CI 1.38-49.4), fat embolisms (OR 1.58; 95% CI 1.29-1.93), and heterotrophic ossification (OR 2.3; 95% CI 1.3-4.06), but more intraoperative accidents (OR 0.34; 95% CI 0.26-0.45), postoperative fractures (OR 0.27; 95% CI 0.21-0.34), reoperations (OR 0.59; 95% CI 0.53-0.65), and revisions (OR 0.62; 95% CI 0.44-0.88).

CONCLUSIONS

Meta-analysis of hemiarthroplasty outcomes shows that elderly patients who underwent uncemented vs cemented procedures had better results for several factors that are important for not only improved recovery in elderly populations, but also more intraoperative and postoperative risks.

Direct anterior approach versus direct lateral approach in total hip arthroplasty and bipolar hemiarthroplasty for femoral neck fractures: a retrospective comparative study

BACKGROUND

In the current literature, there is no consensus on the best surgical approach in hip replacement for femoral neck fractures (FNFs).

AIM

The aim of this study is to compare the direct anterior approach (DAA) and the direct lateral approach (DLA) in patients treated with bipolar hemiarthroplasty (BHA) and total hip arthroplasty (THA) for FNFs.

MATERIALS AND METHODS

Patients with displaced FNFs (Garden type III and IV) treated operatively using BHA and THA were enrolled. The surgical approach techniques DAA and DLA are compared. The analysed variables are: mean surgery time, number of blood units transfused perioperatively, percentage of patients transfused, perioperative complications, pain and functional outcomes at 1 and 6 months and mortality at 1, 3 and 12 months.

RESULTS

Between 2015 and 2017, 37 patients underwent BHA by the DAA and 38 patients underwent BHA by the DLA, 69 patients underwent THA by the DAA and 60 patients underwent THA by the DLA. For THA, the DAA compared to the DLA had a higher mean surgery time (100.8 min vs. 97.7 min), a lower mean number of blood units transfused perioperatively (1.4 U vs. 1.9 U), a significantly lower percentage of patients transfused (53.6% vs. 71.7%), a higher rate of perioperative complications (10.1% vs. 1.6%), a lower pain referred and better functional outcomes in the first 6 postoperative months and a significantly lower mortality rate at 12 months (2.9% vs. 16.7%). For BHA, the advantages of the DAA over DLA are not as significant.

CONCLUSIONS

The direct anterior approach in THA for FNFs provides significant benefits in the early post-operative period compared to the direct lateral approach in terms of functional recovery, residual pain, blood loss and mortality rate in the elderly active population.

LEVEL OF EVIDENCE

Level IV, retrospective cohort study.

Primary hemiarthroplasty for the elderly patient with cognitive dysfunction and a displaced femoral neck fracture: a prospective, observational cohort study

BACKGROUND

At least one-third of hip fracture patients have some degree of impaired cognitive status, which may complicate their postoperative rehabilitation.

AIM

We aimed to describe the outcome for elderly patients with cognitive dysfunction operated with hemiarthroplasty (HA) for a femoral neck fracture and to study the impact postoperative geriatric rehabilitation has on functional outcome up to 1 year after surgery.

METHODS

98 patients with a displaced femoral neck fracture with a mean age of 86 years were included and followed up to 1 year. The outcomes were hip-related complications and reoperations, the capacity to return to previous walking ability, health-related quality of life, hip function and mortality.

RESULTS

The prevalence of hip complications leading to a major reoperation was 6% and the 1-year mortality rate was 31%. The lack of geriatric rehabilitation was correlated with poorer outcomes overall and those who receive geriatric rehabilitation were less likely to be confined to a wheelchair or bedridden at the 1-year follow-up.

CONCLUSIONS

Hemiarthroplasty is an acceptable option for elderly patients with a displaced femoral neck fracture and cognitive dysfunction. A lack of structured rehabilitation is associated with a significant deterioration in walking ability despite a well-functioning hip. However, the causality of this could be due to selection bias of healthier patients being sent to geriatric rehabilitation.

Role of preoperative posterior tilt on the outcomes of internal fixation of non-displaced femoral neck fractures: A systematic review and meta-analysis

INTRODUCTION

There has been an increased interest in the role of preoperative posterior tilt, as measured on lateral radiographs, on the outcomes of internal fixation of non-displaced femoral neck fractures (FNF). The goal was to assess the available evidence for this in the literature.

PATIENTS AND METHODS

PRISMA guidelines were followed. PubMed, Embase and Cochrane were searched on June 10th, 2020 for studies assessing the role of posterior tilt on outcomes of internal fixation of non-displaced FNF. Primary outcomes were non-union and fixation failure, avascular necrosis (AVN), treatment failure, and reoperation (excluding symptomatic hardware removal). Outcomes were reported in Odds Ratio (OR) with 95% confidence intervals [CI].

RESULTS

Fourteen studies and 3729 patients were included (mean age 76 years, 72% female, mean follow-up 25 months). Moderate evidence was noted for the following: patients with greater preoperative posterior tilt had an increased risk of non-union and fixation failure (OR 2.4 [1.3 - 4.3]; p = 0.006), no increased risk of AVN (p = 0.550), an increased risk of treatment failure (OR 6.0 [2.2 - 15.9]; p<0.001) and reoperation (OR 2.5 [1.4 - 4.4]; p = 0.002). Furthermore, a greater preoperative tilt of 9.0° [4.1° - 13.9°] for treatment failure and 6.1° [3.7° - 8.5°] (p<0.001) for reoperation were noted in the unsuccessfully treated groups when compared to the successfully treated groups. Four studies found a threshold for posterior tilt ranging from 7° to 20° CONCLUSION: There is moderate evidence that patients with non-displaced FNF and greater tilt have an increased risk of unsuccessful outcomes following internal fixation. Older patients with a preoperative tilt of ≥20° might benefit from arthroplasty surgery, although studies assessing the optimal threshold are needed.

Long-Term Efficacy of Screw Fixation vs Hemiarthroplasty for Undisplaced Femoral Neck Fracture in Patients over 65 Years of Age: A Systematic Review and Meta-Analysis

Objective

To compare the long‐term efficacy of screw fixation and hemiarthroplasty in elderly patients with undisplaced femoral neck fractures.

Methods

We searched Cochrane Library, EMBASE, and MEDLINE from inception to 10 June 2020 to identify studies about undisplaced femoral neck fracture in elderly patients over 65 years of age. The included studies were assessed by two researchers according to the Cochrane risk‐of‐bias criteria and Newcastle–Ottawa Scale. Meta‐analysis was performed with Revman 5.3 software. The odds ratios (OR) and mean differences (MD) were used to compare dichotomous and continuous variables.

Results

A total of 750 patients were included in this meta‐analysis. In elderly patients, undisplaced femoral neck fracture treated with hemiarthroplasty had a lower implant‐related complication rate (OR, 4.05 [95% CI, 2.38 to 6.89]; P < 0.00001; I² = 0), lower reoperation rate (OR, 4.88 [95% CI, 2.84 to 8.38]; P < 0.00001; I² = 0), and superior Harris score (WMD, −5.05 [95% CI, −7.30 to −2.80]; P < 0.0001; I² = 0) in the early postoperative period. Although screw fixation was associated with shorter operative time (WMD, −36.22 [95% CI, −50.72 to −21.73]; P < 0.00001; I² = 98%) and less blood loss (WMD, −165.84 [95% CI, −209.29 to −122.38]; P < 0.00001; I² = 96%), there was no significant difference in long‐term mortality (OR, 0.65 [95% CI, 0.28 to 1.48]; P < 0.31; I² = 75%) between these two treatments.

Conclusion

In elderly patients with undisplaced femoral neck fractures, hemiarthroplasty provided a lower implant‐related complication rate, lower reoperation rate, superior hip function without increased long‐term mortality. Hemiarthroplasty should be recommended as a better alternative in such patients compared with multiple cannulated screws.

Nonanatomical Reduction of Femoral Neck Fractures in Young Patients (≤65 Years Old) with Internal Fixation Using Three Parallel Cannulated Screws

Purpose

The study is aimed at investigating the association between different reduction classifications (anatomic reduction, positive buttress position reduction, and negative buttress position reduction) and two end points (complications and reoperations).

Methods

The study retrospectively analyzed 110 patients undergoing internal fixation with three parallel cannulated screws from January 2012 to January 2019 in Huashan Hospital. Based on the principles of the “Gotfried reduction,” all enrolled patients were divided into three groups: anatomic reduction, positive buttress position reduction, and negative buttress position reduction intraoperatively or immediately after surgery. Clinical characteristics including age, sex, side, Garden classification, Pauwels classification, fracture level, reduction classification, Garden alignment index angles, cortical thickness index (CTI), tip-caput distance (TCD), angle of the inferior screw, and the two ending points (complications and reoperations) were included in the statistical analysis. The Mann-Whitney U-test, the chi-square test, Fisher's exact test, and multiple logistic regression analysis were used in the study.

Results

Of the 110 patients included in our study, the mean ± standard deviation (SD) of age was 51.4 ± 10.4 years; 41 patients showed anatomic reduction, 35 patients showed positive buttress position reduction, and 34 patients showed negative buttress position reduction. For the outcomes, 24 patients (anatomic reduction: 6 [14.6%]; positive buttress position reduction: 5 [14.3%]; negative buttress position reduction: 13 [38.2%]) had complications, while 18 patients (anatomic reduction: 5 [12.2%]; positive buttress position reduction: 3 [8.6%]; negative buttress position reduction: 10 [29.4%]) underwent reoperations after surgery. In the multivariate logistic regression analysis of complications, negative buttress position reduction (negative buttress position reduction vs. anatomic reduction, OR = 4.309, 95%CI = 1.137 to 16.322, and p = 0.032) was found to be correlated with higher risk of complications. The same variable (negative buttress position reduction vs. anatomic reduction, OR = 5.744, 95%CI = 1.177 to 28.042, and p = 0.031) was also identified as risk factor in the multivariate logistic regression analysis of reoperations. However, no significant difference between positive reduction and anatomical reduction was investigated in the analysis of risk factors for complications, not reoperations.

Conclusion

Positive buttress position reduction of femoral neck fractures in young patients showed a similar incidence of complications and reoperations compared with those of anatomic reduction. For irreversible femoral neck fractures, if positive buttress position reduction has been achieved intraoperatively, it is not necessary to pursue anatomical reduction; however, negative reduction needs to be avoided.

Retrospective cohort trial protocol of screw fixation compared with hemiarthroplasty for displaced femoral neck fractures in elderly patients

BACKGROUND

There is limited evidence for the evaluation of the efficacy and safety of the hemiarthroplasty versus screw fixation in elderly patients with the displaced femoral neck fractures. Our current investigation aimed at assessing the complications, functional outcome, and revision rate of the patients (over 65 years old) who received internal fixation or hemiarthroplasty via a same senior surgeon.

METHODS

A retrospective study was conducted on elderly patients with displaced femoral neck fractures from May 2014 to February 2018. The current study was carried out at our hospital and it was approved through our institutional review committee of West China Hospital. Inclusion criteria were as follows: the patients were 65 years or older, this is the anesthesia grade. The higher grade of the patients,the greater risk of surgery. level I-III, and the patients with displaced intracapsular fractures of the femoral neck, with the radiographic and clinical follow-up of 12 months or more. The major outcome was the revision rate between the 2 groups. And the secondary outcomes contained the life quality and functional outcome detected via utilizing the interview-administered and self-administered questionnaires, length of hospital stay, surgery time, and hip-related complications (such as hip dislocation, loosening or breakage of implant, wound problems, infection, osteolysis, neurovascular injury, and bone nonunion).

RESULTS

It was assumed that hemiarthroplasty would result in fewer revisions or complications and better functional scores in comparison with internal fixation technique.