Arthroplasty versus internal fixation for femoral neck fractures in the elderly

Nicolaides, Vassilios; Galanakos, Spyridon P.; Mavrogenis, Andreas F.; Sakellariou, Vasileios I.; Papakostas, Ioannis; Nikolopoulos, Constantinos E.; Papagelopoulos, Panayiotis J.

doi:10.1007/s11751-010-0099-3

Cited by 20 publications

(11 citation statements)

References 38 publications

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“…In general, less invasive surgical techniques are preferred for frail, elderly patients [24][25][26]. This is reflected in our data in which hemiarthroplasties were 20% more common and total hip replacements were 125% more common in the low RCRI cohort, which were younger, less burdened by comorbidities, and more fit for surgery, based on their CCI and ASA scores respectively.…”

Section: Discussionmentioning

confidence: 82%

The association between the Revised Cardiac Risk Index and short-term mortality after hip fracture surgery

Forssten

Ismail

Sjölin

et al. 2020

Eur J Trauma Emerg Surg

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Purpose The post-operative mortality after hip fracture surgery is high and has remained largely unchanged during the last decades. The Revised Cardiac Risk Index (RCRI) is a tool used to evaluate the 30-day risk of, among other outcomes, post-operative mortality. The aim of this study is to determine the association between the RCRI score and post-operative mortality in patients undergoing hip fracture surgery. Methods Data was obtained from the national hip fracture register which was cross-referenced with patients’ electronic hospital records. All adults who underwent primary emergency hip fracture surgery in Orebro County, Sweden, between January 1, 2013 and December 31, 2017, were included. Patients were divided into two cohorts: low RCRI (score = 0–1) and high RCRI (score ≥ 2). A Poisson regression model was employed to investigate the association between a high RCRI score and 30- and 90-day post-operative mortality. Results A total of 2443 patients, of whom 446 (18%) had a high RCRI score, were included in the current study. When adjusting for age, sex, comorbidities and type of surgery, the incidence of 30-day mortality increased by 46% in the high RCRI cohort (adj. IRR 1.46, 95% CI, 1.10–1.94, p = 0.010). Similar results were observed for 90-day mortality (adj. IRR 1.50, 95% CI, 1.21–1.84, p < 0.001). Conclusion The RCRI is applicable to patients that undergo surgery for traumatic hip fractures. A high RCRI score is associated with an increased incidence of both 30- and 90-day post-operative mortality. Future studies to evaluate these findings are needed.

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Section: Discussionmentioning

confidence: 82%

The association between the Revised Cardiac Risk Index and short-term mortality after hip fracture surgery

Forssten

Ismail

Sjölin

et al. 2020

Eur J Trauma Emerg Surg

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“…A recent comparative study showed that functional outcomes were higher in the arthroplasty group in the first year following the operation but the results became comparable from the second year onward. 36 Another common argument is that osteoporosis in the physiologically older group affords poor purchase of internal fixation devices and increases the failure rates. 37 However, in 1 study that objectively examined this claim, no correlation was found between bone mineral density and the clinical outcome of the fracture.…”

Section: Fracture Of the Neck Of Femur In Adultsmentioning

confidence: 99%

PET/CT Study of Temporal Variations in Blood Flow to the Femoral Head Following Low-energy Fracture of the Femoral Neck

Kumar¹,

Belehalli²,

Ramachandra³

2014

Orthopedics

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Earlier studies on femoral neck fractures have assessed the blood flow in either the pre- or postoperative period and information is lacking regarding changes in vascular flow to the femoral head after injury. Sixty-two adults with low-energy intracapsular femoral neck fractures were studied prospectively. Mean patient age was 57.2 years (range, 45-82 years). All patients underwent positron emission tomography/computed tomography (PET/CT) prior to surgical intervention and 6 weeks after internal fixation. Internal fixation was done using cannulated cancellous titanium screws and serial follow-up radiographs were obtained (at monthly intervals for the first 3 months followed by 3 monthly intervals between radiographs up to 2 years). On the preoperative PET/CT, 13 patients showed intact vascularity, 31 showed total loss of vascularity, and 18 showed partial loss of vascularity of the femoral head. The 6-week postoperative PET/CT scan showed recovery of blood supply in 23 of the 31 patients with total loss of vascularity and 15 of the 18 patients with partial loss of vascularity of the femoral head. Eleven of 62 patients had total or partial avascularity at the 6-week postoperative PET/CT scan and all 11 patients showed evidence of avascular necrosis on plain radiographs at the end of 2 years. The association between the vascular status of the femoral head at 6 weeks and avascular necrosis at the end of 2 years was statistically significant (P<.001). This study shows that the femoral head undergoes temporal variations in blood flow following femoral neck fracture. Decreased or absent vascularity is seen in approximately 75% of the fractures and 80% of the femoral heads with initial vascular compromise seem to regain blood flow within 6 weeks. Thus, prognostication about vascularity based on single-point preoperative imaging is difficult. The 6-week postoperative PET/CT scan seems to be reliable in predicting the future status of the femoral head. However, decision making regarding hemiarthroplasty or internal fixation at the time of injury may have to depend on factors other than the preoperative vascular status of the femoral head.

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“…On the other hand, it has been controversial for aged patient. The failure rate of osteosynthesis is reported to be as high as 20 % in elderly femoral neck fracture due to osteonecrosis, nonunion and fixation failure, and also post-operative ambulation might be delayed in this population due to the difficulty of achieving firm fixation [ 3 , 4 ]. Especially, the elderly asian women have low bone density compared to the westerners, which may be a risk factor that can lead to osteoporotic fractures and show the higher possibility of fixation failure after femoral neck fracture [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Osteosynthesis versus endoprosthesis for the treatment of femoral neck fracture in Asian elderly patients

Kang

Jeon

Ahn

et al. 2016

BMC Musculoskelet Disord

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BackgroundThe purpose of this study was to compare the clinical results between osteosynthesis and endoprosthesis for femoral neck fractures in asian elderly patients, and to analysis the factors that may affect the failure of osteosynthesis.MethodsA retrospective review of 382 hips over 65-year old with femoral neck fracture was done. Within non-displaced fracture group, 81 cases (56.6 %) underwent internal fixation (IF) and with 62 cases (43.3 %) having bipolar hemiarthroplasty (BPHA). As for displaced fracture group, 60 cases (25.1 %) underwent internal fixation (IF) with 179 cases (74.8 %) having BPHA. Average follow-up period for the patients was 36.8 months. Analysis was conducted on complications depending on fracture types and osteoporosis, and clinical evaluation was done on gait capability by using Koval walking ability.ResultsIn non-displaced group, BPHA group showed statistically significant lower percentage of complications compared to IF group, but re-operation rate and the degradations of Koval score were no significant differences. In displaced group, complication, re-operation rate and the degradations of Koval score of BPHA group were statistically better than those of IF group. Association between osteoporosis and non-union is no statistically significant.ConclusionsEndoprosthetic replacement could be a primary option for displaced femoral neck fracture in elderly asian patients. The choice of surgical treatment methods of non-displaced fracture in elderly asian patients should be determined carefully considering the age and the presence of osteoporosis.

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Arthroplasty versus internal fixation for femoral neck fractures in the elderly

Cited by 20 publications

References 38 publications

The association between the Revised Cardiac Risk Index and short-term mortality after hip fracture surgery

The association between the Revised Cardiac Risk Index and short-term mortality after hip fracture surgery

PET/CT Study of Temporal Variations in Blood Flow to the Femoral Head Following Low-energy Fracture of the Femoral Neck

Osteosynthesis versus endoprosthesis for the treatment of femoral neck fracture in Asian elderly patients

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