Trends in surgical treatment of femoral neck fractures in the elderly

Lehtonen, Eva; Stibolt, Robert; Smith, Walter R.; Wills, Bradley W.; Pinto, Martim; McGwin, Gerald; Shah, Ashish; Godoy‐Santos, Alexandre Leme; Naranje, Sameer

doi:10.1590/s1679-45082018ao4351

Cited by 16 publications

(19 citation statements)

References 23 publications

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“…Several studies have looked at trends in surgical treatment strategies for patients experiencing native femoral neck fractures . Most have found that HA is the most common treatment modality, with rates ranging from 60% to 75% of all surgically treated fractures.…”

Section: Discussionmentioning

confidence: 99%

“…All inpatient and post‐discharge events are recorded through the 30th postoperative day. This database has been used successfully in reporting trends in orthopedic surgery, including in assessing native femoral neck fractures …”

Section: Methodsmentioning

confidence: 99%

“…Operative treatment is the standard of care for most patients pathologic proximal femur fractures (PPFFs) . Surgical options include intramedullary fixation (IMN) and endoprosthetic reconstruction, including hemiarthroplasty (HA), and total hip arthroplasty (THA) . While numerous studies have described trends in proximal femur fractures, to date, no studies have examined trends in the pathologic fracture setting beyond professional opinion surveys .…”

Section: Introductionmentioning

confidence: 99%

“…Surgical options include intramedullary fixation (IMN) and endoprosthetic reconstruction, including hemiarthroplasty (HA), and total hip arthroplasty (THA) . While numerous studies have described trends in proximal femur fractures, to date, no studies have examined trends in the pathologic fracture setting beyond professional opinion surveys . In the largest previous study of PPFFs, Tsuda et al utilized Japanese claims data to identify patient‐level predictors of postoperative complications and short‐term mortality after surgical fixation of PPFFs.…”

Section: Introductionmentioning

confidence: 99%

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Trends in the surgical treatment of pathological proximal femur fractures in the United States

Varady

Ameen

Schwab

et al. 2019

Journal of Surgical Oncology

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Background and objectives Large scale data on the treatment of pathologic proximal femur fractures (PPFFs) are lacking. The purpose of this study was to evaluate trends in patient demographics, complication rates, and relative utilization rates of various techniques associated with PPFFs. Methods The American College of Surgeons‐National Surgical Quality Improvement Program (NSQIP) database was queried for PPFFs from 2009 to 2017. Patient demographics, 30‐day complications, and utilization rates were recorded. Trends in these variables were determined over the study period. Results Most patient demographics did not change during the study period. There were no trends toward decreasing rates of major complications (P = .82), reoperations (P = .65), non‐home discharges (P = .17), readmissions (P = .07), or deaths (P = .75); transfusion rates significantly decreased (P < .001). Rates of hemiarthroplasty decreased (P = .03) and rates of intramedullary nailing increased (P = .001). Discussion Despite advances in cancer therapeutics, the average PPFF patient has not significantly changed over the past decade. Similarly, most short‐term outcomes after PPFF surgery have not improved, demonstrating a need for improved perioperative protocols. Finally, rates of IMN fixation are increasing while rates of HA are falling at NSQIP hospitals. Given that orthopedic oncologists favor endoprosthetic reconstruction in most cases, there may be a need for increased communication between orthopedic oncologists and other members of the orthopedic community treating PPFFs.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Trends in the surgical treatment of pathological proximal femur fractures in the United States

Varady

Ameen

Schwab

et al. 2019

Journal of Surgical Oncology

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“…Femoral neck fractures (FNF) are common in the geriatric population and they represent a significant health care problem and have an enormous impact on health insurance costs [1,2]. The fragile physical health of this age group often leads to risks of post-operative morbidity, complications and even mortality.…”

Section: Introductionmentioning

confidence: 99%

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2020

Ann Clin Anal Med

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Aim: In this study, we aimed to evaluate preliminary results and determine the rate of complications of bipolar hemiarthroplasty in patients aged 65 and older. Material and Methods: Patients aged 65 years and older with femoral neck fractures who underwent surgery at 7A Military Hospital from September 2013 to September 2018 were included into this study. The research is a descriptive and prospective study. Results: A total of 60 patients were studied. Aside from 1 deceased, 59 cases with 59 joints were replaced and followed up for an average of 15.3 months. Age and gender were not associated with the outcome of treatment. Implants included Zimmer 29, Serf 13, Stryker 9, and Depuy 9. There were 28 joints using cement and 32 joints cementless. The position of the stem was neutral in 54 cases, valgus in two instances, and varus in 4 cases. There were no loosen stem case. The cement technique was used in 17 cases (68%) type A and 8 cases (32%) Type B, according to Barrack classification. Clinical results according to Harris were as follows: 31 cases were very good, 12 cases were good, 5 cases were mean, and 11 cases were poor, equivalent to other authors. There were 6 cases of short limbs that reduced patient satisfaction. One case of incision infection was cleaned twice and stabilized after four weeks. One case of acetabulum worn after 32 months, but there were no clinical signs; one case dead from a stroke four weeks after the surgery without association with the operation. Discussion: Poor results are often caused by a combination of medical problems or aging. Early surgery provided better results than late surgery. There was no damage to blood vessels, nerves, fractures, or death during surgery. The bipolar hemiarthroplasty in the elderly group with very good and good rates accounted for a high proportion (72.88%). Early surgery was better (90%) compared to late surgery (69.38%). There were a few complications due to surgery.

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