Do we really need a surgery for hip fractures in elderly patients? Mortality rate and influencing factors

Hwang, Kyu Tae; Moon, Joonoh; Kim, Young Ho

doi:10.1186/s42836-019-0009-1

Cited by 16 publications

(10 citation statements)

References 24 publications

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“…In our study, patients were allowed to fully weight-bear on POD1 and nearly 70% of them returned to their pre-injury activity level at the latest follow-up. Additionally, the mortality rate was 3.2% (1/31), considerably lower than that reported in previous literature [ 20 ]. These promising results might be attributable to the early mobilization allowed by our surgery.…”

Section: Discussioncontrasting

confidence: 55%

A bone-conserving revision stem for unstable intertrochanteric fractures of the geriatric osteoporotic population

et al. 2022

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Purpose Primary hemiarthroplasty is gaining popularity for the treatment of unstable intertrochanteric fractures in geriatric patients with severe osteoporosis. This study evaluated early clinical and radiographic outcomes by using a bone-conserving revision stem for unstable intertrochanteric fractures in the geriatric osteoporotic population. Methods A retrospective study involving 31 patients with unstable intertrochanteric fractures was conducted. The patients were aged 82.1 years on average. All patients underwent primary hemiarthroplasty using bone-conserving, fully porous-coated revision stem. The operative time, intraoperative blood loss, length of hospitalization, and need for blood transfusion were noted during the hospital stay. Postoperative complications, including dislocations, deep venous thrombosis, infections, peri-prosthetic fractures, and frontal thigh pain were also recorded. Koval's category was used to quantify activity level, and Harris hip score (HHS) was used for functional assessment. Radiographic outcomes, including osteolysis, bone ingrowth, subsidence of the femoral component, lower limb length discrepancy, and heterotopic ossification, were collected at each follow-up. Results The 31 patients were followed for an average time of 23 months postoperatively. The average operative time lasted for 74.2 min, while the mean intraoperative blood loss was 200.1 ml, with an average hemoglobin decrease of 11.1 g/L after the procedure. The mean visual analog scale (VAS) score for pain dropped from 7.4 preoperatively to 2.4 at the 4-week follow-up. At the latest follow-up, the mean Harris hip score was 82.1, and the VAS was 1.7. No intraoperative or postoperative peri-prosthetic fractures were noted. Postoperative complications included one case of thrombosis formation in the posterior tibial vein and one case of congestive heart failure. Both patients were discharged uneventfully after treatment. Radiographically, none of the hips had evidence of stem loosening or osteolysis. Within the follow-up period of 23 months, the mortality rate was 3.2% (1/31), and no revision surgeries were required. Conclusion Primary hemiarthroplasty using a bone-conserving, cementless revision stem could serve as a reliable alternative for the treatment of unstable intertrochanteric fractures in the geriatric population with osteoporosis.

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Section: Discussioncontrasting

confidence: 55%

A bone-conserving revision stem for unstable intertrochanteric fractures of the geriatric osteoporotic population

et al. 2022

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“…This result is similar to the result of the Spanish sample in our study. In addition, some studies have shown that having more than 3 common comorbidities are risk factors that lead to the death of patients in one year [37]. In this study, we have found that the proportion of patients with 3 or more types of comorbidities is signi cantly higher in Spain than in China.…”

Section: Discussionsupporting

confidence: 45%

Epidemiological Comparison of Osteoporotic Hip Fractures in Spain and China: A Multicenter Study

Gao¹,

Capitan-Morales

Wang³

et al. 2021

Preprint

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Objective Compare the epidemiological differences of hip fracture patients in Spain and China. Materials and Method This was a retrospective study. The study population came from patients with hip fractures who underwent surgery between January 1, 2017 and December 30, 2017 at the University Hospital Virgen Macarena (UHVM) in Seville, Spain and Xi’an Daxing Hospital (XDH) in Shaanxi Province, China. Through medical history review and telephone follow-up, the differences of demographic and anthropometric characteristics, lifestyle, personal medical history, variables related to injury, anesthesia, and surgery, length of stay in hospital, days of bed rest, and mortality of patients in the two hospitals were compared. Results A total of 757 patients were enrolled, of which 426 were from UHVM and 331 were from XDH. The average age was 81.4±9.26 years and 76.0±8.08 years, respectively; the male and female distribution was 25.1% and 74.9% vs. 32.0% and 68.0%. The average BMI of Spanish patients was higher than that of Chinese patients. The proportion of drinking and smoking among Spanish patients was significantly higher than that of Chinese patients (p = 0.000, p = 0.000, respectively). The proportion of patients with ≥ 3 comorbidities in Spain was higher than that in China (p = 0.002). The surgery delay time of Spanish patients was significantly longer than that of Chinese patients (p = 0.000). Spanish patients had a shorter hospital stay, but a longer time in bed. During the one-year follow-up, there were 81 deaths in Spain and 43 deaths in China (p = 0.026). Conclusiones There are large epidemiological differences between hip fracture patients in Seville, Spain and Xi'an, China in terms of demographics, lifestyle, comorbidities, surgical methods, and mortality.

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“…In high-income injuries, paediatric forearm fracture are typically treated non-operatively with good outcomes [ 27 ]. On the other hand, 85% of proximal femoral fractures (hip) are treated operatively in high-income countries as they are associated with poor quality of life and function if treated non-operatively [ 28 – 30 ], but our study showed only 15% of proximal femoral fractures were treated operatively. Further studies are needed to clarify the reasons behind these severe injuries not being surgically fixed in LICs.…”

Section: Discussionmentioning

confidence: 74%

Epidemiology of fractures and their treatment in Malawi: Results of a multicentre prospective registry study to guide orthopaedic care planning

Schade

Mbowuwa²,

Chidothi³

et al. 2021

PLoS ONE

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Importance Injuries cause 30% more deaths than HIV, TB and malaria combined, and a prospective fracture care registry was established to investigate the fracture burden and treatment in Malawi to inform evidence-based improvements. Objective To use the analysis of prospectively-collected fracture data to develop evidence-based strategies to improve fracture care in Malawi and other similar settings. Design Multicentre prospective registry study. Setting Two large referral centres and two district hospitals in Malawi. Participants All patients with a fracture (confirmed by radiographs)—including patients with multiple fractures—were eligible to be included in the registry. Exposure All fractures that presented to two urban central and two rural district hospitals in Malawi over a 3.5-year period (September 2016 to March 2020). Main outcome(s) and measure(s) Demographics, characteristics of injuries, and treatment outcomes were collected on all eligible participants. Results Between September 2016 and March 2020, 23,734 patients were enrolled with a median age of 15 years (interquartile range: 10–35 years); 68.7% were male. The most common injuries were radius/ulna fractures (n = 8,682, 36.8%), tibia/fibula fractures (n = 4,036, 17.0%), humerus fractures (n = 3,527, 14.9%) and femoral fractures (n = 2,355, 9.9%). The majority of fractures (n = 21,729, 91.6%) were treated by orthopaedic clinical officers; 88% (20,885/2,849) of fractures were treated non-operatively, and 62.7% were treated and sent home on the same day. Open fractures (OR:53.19, CI:39.68–72.09), distal femoral fractures (OR:2.59, CI:1.78–3.78), patella (OR:10.31, CI:7.04–15.07), supracondylar humeral fractures (OR:3.10, CI:2.38–4.05), ankle fractures (OR:2.97, CI:2.26–3.92) and tibial plateau fractures (OR:2.08, CI:1.47–2.95) were more likely to be treated operatively compared to distal radius fractures. Conclusions and relevance The current model of fracture care in Malawi is such that trained orthopaedic surgeons manage fractures operatively in urban referral centres whereas orthopaedic clinical officers mainly manage fractures non-operatively in both district and referral centres. We recommend that orthopaedic surgeons should supervise orthopaedic clinical officers to manage non operative injuries in central and district hospitals. There is need for further studies to assess the clinical and patient reported outcomes of these fracture cases, managed both operatively and non-operatively.

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Do we really need a surgery for hip fractures in elderly patients? Mortality rate and influencing factors

Cited by 16 publications

References 24 publications

A bone-conserving revision stem for unstable intertrochanteric fractures of the geriatric osteoporotic population

A bone-conserving revision stem for unstable intertrochanteric fractures of the geriatric osteoporotic population

Epidemiological Comparison of Osteoporotic Hip Fractures in Spain and China: A Multicenter Study

Epidemiology of fractures and their treatment in Malawi: Results of a multicentre prospective registry study to guide orthopaedic care planning

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