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Predicting 1-Year Mortality after Hip Fracture Surgery: An Evaluation of Multiple Machine Learning Approaches. J Pers Med 2021; 11:jpm11080727. [PMID: 34442370 PMCID: PMC8401745 DOI: 10.3390/jpm11080727] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 07/24/2021] [Accepted: 07/24/2021] [Indexed: 12/15/2022] Open
Abstract
Postoperative death within 1 year following hip fracture surgery is reported to be up to 27%. In the current study, we benchmarked the predictive precision and accuracy of the algorithms support vector machine (SVM), naïve Bayes classifier (NB), and random forest classifier (RF) against logistic regression (LR) in predicting 1-year postoperative mortality in hip fracture patients as well as assessed the relative importance of the variables included in the LR model. All adult patients who underwent primary emergency hip fracture surgery in Sweden, between 1 January 2008 and 31 December 2017 were included in the study. Patients with pathological fractures and non-operatively managed hip fractures, as well as those who died within 30 days after surgery, were excluded from the analysis. A LR model with an elastic net regularization were fitted and compared to NB, SVM, and RF. The relative importance of the variables in the LR model was then evaluated using the permutation importance. The LR model including all the variables demonstrated an acceptable predictive ability on both the training and test datasets for predicting one-year postoperative mortality (Area under the curve (AUC) = 0.74 and 0.74 respectively). NB, SVM, and RF tended to over-predict the mortality, particularly NB and SVM algorithms. In contrast, LR only over-predicted mortality when the predicted probability of mortality was larger than 0.7. The LR algorithm outperformed the other three algorithms in predicting 1-year postoperative mortality in hip fracture patients. The most important predictors of 1-year mortality were the presence of a metastatic carcinoma, American Society of Anesthesiologists(ASA) classification, sex, Charlson Comorbidity Index (CCI) ≤ 4, age, dementia, congestive heart failure, hypertension, surgery using pins/screws, and chronic kidney disease.
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Hsu HW, Lee KH, Shih KS. Bilateral dislocation and recurrent instability of bipolar hip prosthesis. Asian J Surg 2020; 43:781-782. [PMID: 32371012 DOI: 10.1016/j.asjsur.2020.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 03/04/2020] [Indexed: 11/28/2022] Open
Affiliation(s)
- Hao-Wei Hsu
- Orthopedics Department, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.
| | - Kun-Han Lee
- Orthopedics Department, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.
| | - Kao-Shang Shih
- Orthopedics Department, Shin Kong Wu Ho-Su Memorial Hospital, School of Medicine, College of Medicine, Fu Jen Catholic University, Taiwan.
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Abstract
Neck of femur fractures are occurring at an increased incidence. Functionally independent patients without cognitive impairment can expect reasonable life expectancy. This indicates the need for a durable surgical option that optimises the chance to return to pre-injury functional status, with minimal risk of complications and reoperation. Most fractures are displaced. Surgical options include internal fixation, hemiarthroplasty or total hip arthroplasty (THA). Evidence is conclusive that arthroplasty options outperform internal fixation in terms of function, quality of life and reoperation rates. In anyone other than young patients where head preserving surgery is required, arthroplasty is the standard of care. Hemiarthroplasty is the heavily favoured arthroplasty option for surgeons. However, in patients other than the extreme elderly, medically infirm, neurologically impaired, or with little or no ambulatory capacity, the evidence to support hemiarthroplasty is lacking. In functionally independent patients without cognitive impairment, THA should be considered the gold standard, producing better functional and quality of life outcomes, lower reoperation rates and better cost effectiveness, with no difference in complications or mortality. An increased risk of dislocation does exist. This may be reduced with modern surgical technique and implant options. Low amounts of research have been afforded to undisplaced fractures. For this fracture type, surgery is the standard of care. Despite a higher risk of reoperation, internal fixation is the preferred option for all age groups. Further study is required to identify the difference between internal fixation and THA, in particular, for unstable fracture patterns in elderly patients.
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Mukka S, Knutsson B, Krupic F, Sayed-Noor AS. The influence of cognitive status on outcome and walking ability after hemiarthroplasty for femoral neck fracture: a prospective cohort study. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2016; 27:653-658. [PMID: 27796582 PMCID: PMC5486608 DOI: 10.1007/s00590-016-1873-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 10/17/2016] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Femoral neck fracture (FNF) is a devastating injury with serious medical and social consequences. One-third of these patients have some degree of impaired cognitive status. Despite this, a high proportion of hip fracture trials exclude patients with cognitive impairment (CI). We aimed to evaluate whether moderate to severe CI could predict walking ability, quality of life, functional outcome, reoperations and mortality in elderly patients with displaced FNF treated with hemiarthroplasty (HA). METHODS This cohort study included a consecutive series of 188 patients treated with HA for a displaced FNF. Patients were assessed for estimated preoperative and 1 year postoperatively with regard to walking ability, cognitive status, quality of life with EQ-5D and hip function with Harris hip score. RESULTS There were 188 patients who met the inclusion criteria. A total of 130 patients were in the control group, and 58 were in the CI group. At 1-year follow-up, 31 patients (24%) had died in the control group and 22 patients (38%) had died in the cognitive impaired group. This difference in reoperation and mortality rate was statistically significant (log-rank test, p = 0.016). The CI had a significantly higher incidence of being non-walker (28 vs. 4%, OR 9.2, p = 0.001). The EQ-5D was higher in the control group, while the Harris hip score was comparable in the two groups. CONCLUSIONS Moderate to severe CI was associated with a high incidence of non-walking ability, worse quality of life, high mortality and re-operation rate after femoral neck fractures treated with HA.
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Affiliation(s)
- Sebastian Mukka
- Department of Surgical and Perioperative Science, Umeå University, 901 87, Umeå, Sweden
| | - Björn Knutsson
- Department of Surgical and Perioperative Science, Umeå University, 901 87, Umeå, Sweden
| | - Ferid Krupic
- Department of Orthopaedics, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Arkan S Sayed-Noor
- Department of Surgical and Perioperative Science, Umeå University, 901 87, Umeå, Sweden.
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Karademir G, Bilgin Y, Erşen A, Polat G, Buget MI, Demirel M, Balcı HI. Hip fractures in patients older than 75 years old: Retrospective analysis for prognostic factors. Int J Surg 2015; 24:101-4. [PMID: 26563486 DOI: 10.1016/j.ijsu.2015.11.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 11/02/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Proximal femoral fractures are often seen in older patients and are associated with high mortality. Introduction to old age population is latening due to advancements in medical sciences and increasing life expectancy. OBJECTIVES The aim of the study was to evaluate factors affecting mortality in patients above 75 years of age who had been operated because of proximal femur fractures. PATIENTS AND METHODS Patients with age 75 and over who suffers from post-fall proximal femoral fracture who underwent surgery with one of following three methods (hemiarthroplasty, proximal femoral nail or total hip arthroplasty) were evaluated retrospectively. Effects on mortality were examined for factors such as type of surgery, type of anesthesia, preoperative ASA score (American Society of Anesthesiologists Score), need for intensive care, need for blood transfusion, operation waiting time and hospitalization duration. 115 patients who met inclusion criterion were included in the study out of 224 overall. 75 patients were women and 40 were males. RESULTS Mortality rate after first year was found to be 40%. Patients over 85 years old had higher rates of mortality (p = 0,0003) than respectively younger patients (75-85). Sex was found to have no impact on mortality (p = 0.5039). There was no statistically significant difference in terms ASA score (p = 0.1518). Order of applied surgical methods with mortality risk rates was found to be total hip arthroplasty > hemiarthroplasty > proximal femoral nail (p = 0.0003). Type of anesthesia, the use of cement during arthroplasty, operation waiting time and hospitalization duration was not directly related with mortality rate (type of anesthesia p = 0.63, the use of cement during arthroplasty p = 0.223, operation waiting time p = 0.5 and hospitalization duration p = 0.19). CONCLUSIONS Age is the primary risk factor on first year mortality in patients older than 75 years old with hip fractures. Addition to older age, more need to blood transfusions, and arthroplasty are other risk factors for first year mortality. It should be kept in mind that after 75 years old first year mortality may be higher if the patient is treated with arthroplasty.
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Affiliation(s)
- Gökhan Karademir
- Istanbul University, Istanbul Faculty of Medicine, Department of Orthopedics and Traumatology, Çapa Fatih, Istanbul, 34050, Turkey.
| | - Yücel Bilgin
- Istanbul University, Istanbul Faculty of Medicine, Department of Orthopedics and Traumatology, Çapa Fatih, Istanbul, 34050, Turkey.
| | - Ali Erşen
- Istanbul University, Istanbul Faculty of Medicine, Department of Orthopedics and Traumatology, Çapa Fatih, Istanbul, 34050, Turkey.
| | - Gökhan Polat
- Istanbul University, Istanbul Faculty of Medicine, Department of Orthopedics and Traumatology, Çapa Fatih, Istanbul, 34050, Turkey.
| | - Mehmet I Buget
- Istanbul University, Istanbul Faculty of Medicine, Department of Anesthesiology and Reanimation, Çapa Fatih, Istanbul, 34050, Turkey.
| | - Mehmet Demirel
- Istanbul University, Istanbul Faculty of Medicine, Department of Orthopedics and Traumatology, Çapa Fatih, Istanbul, 34050, Turkey.
| | - Halil Ibrahim Balcı
- Istanbul University, Istanbul Faculty of Medicine, Department of Orthopedics and Traumatology, Çapa Fatih, Istanbul, 34050, Turkey.
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Lin JCF, Liang WM. Outcomes after fixation for undisplaced femoral neck fracture compared to hemiarthroplasty for displaced femoral neck fracture among the elderly. BMC Musculoskelet Disord 2015; 16:199. [PMID: 26286551 PMCID: PMC4543452 DOI: 10.1186/s12891-015-0671-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 08/10/2015] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND This study compared the rates of mortality, medical complication, and reoperation after fixation surgery for displaced femoral neck fracture with those after hemiarthroplasty surgery for undisplaced femoral neck fracture using competing risk analysis in inpatients aged 60 years and above from a population database in Taiwan. METHODS We identified 13,772 subjects who underwent fixation for undisplaced cervical fracture and 13,772 matched controls who underwent hemiarthroplasty for displaced cervical fracture from 1998 to 2007, and followed them up until the end of 2009. The outcomes of patients who received internal fixation for undisplaced fracture and those of patients who received hemiarthroplasty for displaced fracture were compared. RESULTS The 3-month, 2-year, and 10-year mortality rates were 4.9%, 22.1%, and 67.1% for fixation, and 5.6%, 23.8%, and 71.0% for hemiarthroplasty, respectively. The 3-month, 2-year, and 10-year cumulative incidence rates of the first reoperation were 7.4%, 18.1%, and 27.7% for fixation and 6.3%, 12.0%, and 22.3% for hemiarthroplasty, respectively. The 3-month cumulative incidence rates of the first medical complication were 14.4% for fixation and 15.4% for hemiarthroplasty, respectively. Hemiarthroplasty had a 1.09 times (95% CI: 1.05-1.12) higher hazard ratio for overall death than fixation. However, fixation had a 1.36 times (95% CI: 1.29-1.43) higher subdistribution hazard ratio for first reoperation than hemiarthroplasty after adjusting for gender, age, and comorbidities. CONCLUSIONS The short-term overall mortality and medical complication rate of fixation for undisplaced fracture were slightly lower than those of hemiarthroplasty for displaced fracture. However, the short-term cumulative incidence of first reoperation after fixation was significantly higher than that for hemiarthroplasty. Further prospective studies or clinical trials based on the competing risk model, and which include important risk factors, are necessary to quantify the adjusted effects more precisely.
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Affiliation(s)
- Jeff Chien-Fu Lin
- Department of Statistics, National Taipei University, Taipei, Taiwan. .,Department of Orthopedic Surgery, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
| | - Wen-Miin Liang
- Graduate Institute of Biostatistics, China Medical University, Taichung, Taiwan. .,Department of Public Health, China Medical University, Taichung, Taiwan.
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Lee YK, Joung HY, Kim SH, Ha YC, Koo KH. Cementless bipolar hemiarthroplasty using a micro-arc oxidation coated stem in patients with displaced femoral neck fractures. J Arthroplasty 2014; 29:2388-92. [PMID: 24851787 DOI: 10.1016/j.arth.2014.04.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Revised: 03/17/2014] [Accepted: 04/16/2014] [Indexed: 02/01/2023] Open
Abstract
Femoral stem fixation for displaced femoral neck fractures in osteoporotic patients is an ongoing debate. We evaluated the outcome of 136 cementless bipolar hemiarthroplasty using a Micro-arc oxidation (MAO) coated stem. All patients survived the procedure and were discharged from the hospital. Thirty- and 90-day mortality rates were 0.7% and 2.2%, respectively. Ninety-eight hips were followed for a minimum of 2years (mean, 44months) postoperatively. Three stems were revised because of a periprosthetic fracture. Although cortical stress shielding around the stem was observed in 3 hips, there was no loosening or osteolysis. Cementless bipolar hemiarthroplasty using a MAO-coated stem is a useful and safe option to treat displaced femoral neck fractures.
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Affiliation(s)
- Young-Kyun Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam 463-707, South Korea
| | - Ho-Yun Joung
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam 463-707, South Korea
| | - Sang-Hwan Kim
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam 463-707, South Korea
| | - Yong-Chan Ha
- Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, 224-1 Heukseok-dong, Dongjak-gu, Seoul 156-755, South Korea
| | - Kyung-Hoi Koo
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam 463-707, South Korea
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Nilsson I, Rogmark C. Hemiarthroplasty for displaced femoral neck fracture: good clinical outcome but uneven distribution of occupational therapy. Disabil Rehabil 2011; 33:2329-32. [DOI: 10.3109/09638288.2011.570412] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Önnerfält R. Treatment of the displaced femoral neck fracture, as reflected in Acta Orthopaedica Scandinavica. Acta Orthop 2010; 81:15-20. [PMID: 20170419 PMCID: PMC2856200 DOI: 10.3109/17453671003635801] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Affiliation(s)
- Rolf Önnerfält
- Department of Orthopedics, Lund University Hospital, LundSweden
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Mauffrey C. The management of subcapital fractures in the elderly population. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2009. [DOI: 10.1007/s00590-009-0570-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Rogmark C, Johnell O. Orthopaedic treatment of displaced femoral neck fractures in elderly patients. Disabil Rehabil 2009; 27:1143-9. [PMID: 16278183 DOI: 10.1080/09638280500055933] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE AND METHOD A review article concerning orthopaedic treatment and rehabilitation of displaced femoral neck fractures, focusing on evidence-based knowledge. RESULTS Properly performed randomized controlled studies comparing internal fixation and primary arthroplasty provides the best basis to decide which method should be used. During the last decade, several such studies have been published, in addition to a few earlier works. After internal fixation with pins, screws or sliding hip screw and plate, the failure rate was 21 - 57% and re-operations were performed in 14 - 53% of all the cases. In the studies using THA, the failure rate was 4 - 11% and the re-operation rate 2 - 8%. The corresponding numbers for hemi-arthroplasty were 3 - 23% and 0 - 24%. A primary arthroplasty tends to result in better function and less pain during the rehabilitation period. CONCLUSION With support in evidence-based literature, an elderly patient with displaced femoral neck fracture should be treated with a primary arthroplasty. If the individual is healthy, active and mentally intact, a total hip arthroplasty should be performed, otherwise a hemi-arthroplasty. This rationale ensures fewer failures and re-operations, as well as better function and less pain during the rehabilitation.
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Affiliation(s)
- Cecilia Rogmark
- Department of Orthopaedics, Malmö University Hospital, Sweden.
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Abstract
Dislocation of a hip prosthesis is a common complication. In usual cases of hip prosthesis dislocation, the prosthetic femoral head comes out from either the natural acetabular cavity in a bipolar hemiarthroplasty or the prosthetic acetabulum in a total hip arthroplasty. Only a few cases of bipolar hip prosthesis dislocation due to dissociation between the polyethylene and inner head of the prosthesis have been reported. We describe a rare case of disassembly of the inner head from the bipolar outer prosthesis in an osteoarthritic acetabulum. A 72-year-old woman had undergone bipolar hemiarthroplasty due to fracture of the left femoral neck about 10 years previously. Recently, she sustained an injury after falling from a chair, and examinations revealed an unusual disassembly-dislocation of the bipolar hip prosthesis. We classified this failure in our patient as a type II failure, representing extreme varus position of the outer head in the acetabulum, dislocation of the inner head from the outer head, and a detached locking ring around the stem neck. This mechanism of failure as shown in our patient rarely occurs in the bipolar prosthesis of the self-centering system. Osteoarthritic change of the acetabulum would place the outer head in the varus position, increasing wear on the beveled rim by impinging the femoral stem neck and causing dislodgment of the inner locking ring and consequent disassembly-dislocation of the inner head.
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Affiliation(s)
- Hsieh-Hsing Lee
- Division of Traumatology, Department of Surgery, Municipal Wan-Fang Hospital, Taipei Medical University, Taipei, Taiwan
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Abstract
BACKGROUND The optimal treatment for femoral neck fracture is a matter of controversy. We compared the outcome of displaced fractures with good healing potential (moderately displaced fractures) to the outcome of undisplaced fractures treated by internal fixation with 2 parallel screws. METHODS In a consecutive series of hip fracture patients, the rates of reoperation and mortality for 225 undisplaced fractures were compared to those for 241 moderately displaced fractures. The patients were followed for 1-6 years. RESULTS The total rate of reoperation was 19% (9% because of healing complications) for the undisplaced fractures and 33% (20% because of healing complications) for the moderately displaced fractures. Fracture displacement was the main predictor of reoperation. There was no difference in mortality between the groups, and patient-related background parameters (rather than fracture displacement) were the main predictors of mortality. INTERPRETATION Undisplaced fractures should be treated by internal fixation. The best treatment for moderately displaced fractures remains to be determined.
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Affiliation(s)
- Kristian Bjørgul
- Department of Orthopaedics, Østfold Hospital, Fredrikstad, Norway.
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Hasegawa Y, Suzuki S, Wingstrand H. Risk of mortality following hip fracture in Japan. J Orthop Sci 2007; 12:113-7. [PMID: 17393264 DOI: 10.1007/s00776-006-1097-7] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2006] [Accepted: 10/31/2006] [Indexed: 10/23/2022]
Abstract
BACKGROUND Excessive mortality and morbidity are serious problems after hip fracture in the elderly. METHODS Hip fractures in persons aged 50 years or older were prospectively registered in Japan in 2000. Questionnaires regarding both the first onset and the second 120-day period after hip fracture were obtained from 759 patients, 546 of whom were female and 213 male. RESULTS Their average age at the time of fracture was 80 years. Altogether, 68 people (9%) died within 120 days after fracture; and 25 patients died within 30 days. Those dying within 120 days and those alive after hip fracture were compared. By univariate analysis, risk factors were poor walking ability, need for a walking aid, low body mass index, history of falls, and lack of active exercise; however, none of these factors was identified as a risk factor by multivariate analysis. By multivariate analysis, the five risk factors associated with mortality were male sex, older age, high American Academy of Anesthesiology (ASA) grade, dementia, and residence in an institution. CONCLUSIONS During the treatment and rehabilitation period special attention should be paid to patients with chronic diseases and reduced mental status.
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Affiliation(s)
- Yukiharu Hasegawa
- Department of Orthopedic Surgery, Nagoya University, School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 446-8550, Japan
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Bjørgul K, Reikerås O. Hemiarthroplasty in worst cases is better than internal fixation in best cases of displaced femoral neck fractures: a prospective study of 683 patients treated with hemiarthroplasty or internal fixation. Acta Orthop 2006; 77:368-74. [PMID: 16819673 DOI: 10.1080/17453670610046271] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Studies have shown that the degree of initial displacement and also comminution of the femoral calcar, size of the head and varus angulation are prognostic of failure in displaced femoral neck fracture. We have applied these radiographic criteria in order to select patients who would benefit from internal fixation as opposed to primary hemiarthroplasty, and this prospective study was conducted in order to monitor the results of this strategy. METHODS 683 displaced fractures of the femoral neck were treated with internal fixation or primary hemiarthroplasty based on the proposed radiographic criteria in a prospective consecutive study, and the patients were followed for 1-6 years. We treated 228 fractures with internal fixation and 455 by bipolar hemiprosthesis. The choice of operation was based on clinical evaluation of the patient and assessment of the assumed healing potential of the fracture, as determined by radiographic evaluation. Revision and mortality were primary endpoints. RESULTS 54 (24%) of the patients originally treated by osteosynthesis were revised, whereas 9 (2%) of the patients treated with hemiarthroplasty had revision surgery. There were no significant differences in mortality between the groups at 30, 120 or 365 days. INTERPRETATION Even when treating only the fractures with the assumed best healing potential with internal fixation, the results are inferior to hemiarthroplasty.
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MESH Headings
- Aged
- Aged, 80 and over
- Arthroplasty, Replacement, Hip/adverse effects
- Arthroplasty, Replacement, Hip/methods
- Arthroplasty, Replacement, Hip/mortality
- Femoral Neck Fractures/diagnostic imaging
- Femoral Neck Fractures/surgery
- Follow-Up Studies
- Fracture Fixation, Internal/adverse effects
- Fracture Fixation, Internal/methods
- Fracture Fixation, Internal/mortality
- Humans
- Prospective Studies
- Radiography
- Reoperation
- Survival Rate
- Treatment Outcome
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Affiliation(s)
- Kristian Bjørgul
- Department of Orthopedics, Rikshospitalet University Hospital, Oslo, Norway.
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Rogmark C, Johnell O. Primary arthroplasty is better than internal fixation of displaced femoral neck fractures: a meta-analysis of 14 randomized studies with 2,289 patients. Acta Orthop 2006; 77:359-67. [PMID: 16819672 DOI: 10.1080/17453670610046262] [Citation(s) in RCA: 147] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The treatment of displaced femoral neck fractures has long been debated. 14 randomized controlled studies (RCTs) comparing internal fixation with primary arthroplasty may give material for evidence-based decision making. METHODS Computerized databases were searched for RCTs published between 1966 and 2004. 14 RCTs containing 2,289 patients were included in a metaanalysis regarding complications, reoperations and mortality. The analysis was performed with software from the Cochrane collaboration. RESULTS Primary arthroplasty leads to significantly fewer major method-related hip complications and reoperations, compared to internal fixation. There was no significant difference in mortality between the two groups at 30 days and 1 year. Most of the studies found better function and less pain after primary arthroplasty. INTERPRETATION Primary arthroplasty should be used in most patients with displaced femoral neck fracture. The healthy, lucid individual, 70-80 years old, should be given a total hip arthroplasty. The older, impaired or institutionalized patient would benefit from a hemiarthroplasty.
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Affiliation(s)
- Cecilia Rogmark
- Lund University, Department of Orthopaedics, Malmö University Hospital. Malmö, Sweden.
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Hargrove R, Ridgeway S, Russell R, Norris M, Packham I, Levy B. Does pulse lavage reduce hip hemiarthroplasty infection rates? J Hosp Infect 2006; 62:446-9. [PMID: 16488057 DOI: 10.1016/j.jhin.2005.07.012] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2005] [Accepted: 07/06/2005] [Indexed: 11/30/2022]
Abstract
This paper reports a prospective randomized trial involving four hospitals in the south of England, in which every hemiarthroplasty (American Association of Anaesthetists grade IV and above) was randomized to one of two limbs. In the first group, the patients received a 2-L pulse lavage normal saline washout; in the second group, they received a 2-L normal saline washout via a jug or a syringe. All wounds were reviewed during their time in hospital up to 30 days post surgery or discharge (using criteria from the Nosocomial Infection National Surveillance Survey). Any re-admissions for infection were recorded. The pulse lavage group had a significantly lower total infection rate and, specifically, a decreased 'joint space' or deep infection rate.
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Affiliation(s)
- R Hargrove
- Orthopaedic Department, SW Thanes, Frimley Park Hospital, Portsmouth Road, GU16 Frimley, UK.
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