Effect of hip fracture on prognosis of acute cerebral infarction

Abstract

Hip fractures are a worldwide public health problem. The incidence of hip fracture is high among the elderly, and it is an important cause of death and disability in this population. This observational study aimed to investigate the effect of acute hip fracture on the recovery of neurological function and the prognosis of patients with acute cerebral infarction, as well as whether surgical treatment of combined acute fracture can improve the prognosis of patients. METHODS: Thirty patients with acute cerebral infarction combined with acute hip fracture, who were hospitalized in two hospitals between January 1, 2013 and December 31, 2019, were included. The patients did not undergo surgical treatment. The control group included patients with common acute cerebral infarction without hip fracture admitted in the same period. The neurological function recovery, hospitalization period, half a year recovery rate, incidence of complications, and one-year mortality rate between the two groups were compared. Eleven patients with acute cerebral infarction combined with hip fracture, who underwent surgical treatment, were selected and compared with those in the non-surgery group. RESULTS: Compared with patients with common acute cerebral infarction, the National Institutes of Health Stroke Scale score of those with acute cerebral infarction combined with hip fracture was higher (7.2 ± 5.4 vs. 5.6%±4.3, p=0.034), the hospitalization period was prolonged (16.1±8.9% vs. 12.2±5.3, p=0.041), and the half a year recovery rate was lower (26.7% vs. 53.3%, p=0.016). Additionally, the incidence of pulmonary infection and lower extremity deep vein thrombosis was increased (30% vs. 11.7%, p=0.03; 6.7% vs. 0, p=0.043). The oneyear mortality rate of patients with hip fracture was higher than that of patients with common cerebral infarction (23.3% vs. 6.7%, p=0.027). Compared with the non-surgical group, the good recovery rate after half a year of surgical treatment of the group with cerebral infarction and acute hip fracture had an increasing trend, while the hospitalization cycle, incidence of complications, and one-year mortality rate were all decreased, although this was not statistically significant. CONCLUSIONS: Acute cerebral infarction combined with hip fracture leads to worse neurological recovery, prolonged hospitalization period, increased complications, decreased patient prognosis, and increased one-year mortality. Surgical treatment improves the prognosis of patients with acute cerebral infarction. These findings may provide insights into the management of acute cerebral infarction.

Early surgical treatment of closed reduction and internal fixation for a 30-day old intertrochanteric fracture with hemiplegia after acute stroke: A case report

“…Although acute cerebral infarction is a relative contraindication to surgery, a small sample study (11 cases) in which the patients and family members requested and insisted on hip reconstructive surgery has reported that surgical treatment can improve the prognosis of patients with acute cerebral infarction. [4] However, the study did not address the timing of surgery or the surgical treatment method of hip reconstruction. A case of intertrochanteric fracture and acute stroke, focusing on individual factors to reduce postoperative complications and recurrent stroke rate by a multidisciplinary team, treated with PFNA has been reported.…”

“…[9] Prior studies have shown that hemiplegia after acute stroke combined with hip fracture leads to worse neurological recovery, prolonged hospitalization period, increased complications, decreased patient prognosis, and increased 30-day and one-year mortalities. [3,4] The surgical treatment goals of intertrochanteric fractures were fracture stabilization, early patient mobilization, and restoring to previous level of independence and function. [10] The mainstream treatment is internal fixation (including intramedullary and extramedullary), and hip arthroplasty has also been reported.…”

“…[9] Prior studies have shown that hemiplegia after acute stroke combined with hip fracture leads to worse neurological recovery, prolonged hospitalization period, increased complications, decreased patient prognosis, and increased 30-day and one-year mortalities. [3,4]…”

“…At the same time, acute cerebral infarction is a relative contraindication to hip reconstructive surgery, therefore, most of these patients cannot undergo surgical treatment. [4] In general, elective surgery after acute stroke is best delayed by 2 weeks, preferably 6 weeks. However, there are no clear guidelines to determine whether and when to perform surgical hip repair in patients with acute stroke and hip fracture.…”

Application of machine learning model to predict lacunar cerebral infarction in elderly patients with femoral neck fracture before surgery

“…Compared with non-LCI patients, LCI patients often experience additional problems after trauma, such as surgery [ 5 , 6 ]. When patients with hip fractures are complicated by cerebral infarction, recovery of limb function is poor and postoperative mortality is higher [ 7 , 8 ]. In addition, when fracture patients are complicated with cerebral infarction, multidisciplinary management often accelerates postoperative recovery and improves their quality of life [ 9 , 10 ].…”