Fractured Neck of Femur Management at a District General Hospital: Adherence to NICE guidelines CG124 for total hip replacement

Mudiganty, Srikanth; Kosmidis, Ilias; Edwin, John

doi:10.1051/sicotj/2020045

Cited by 4 publications

(5 citation statements)

References 1 publication

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“…There is a paucity of data in the literature regarding fractures following TOP (Table 1). In cases where closed extremity fracture occurs due to TOP, the management can be conservative (i.e., nonoperative) or surgical treatment that can be delayed until postpartum when appropriate [18]. Sorbi et al described [19] a case of a 40-year-old woman, at 36 weeks of pregnancy suffering a displaced midshaft tibia fracture.…”

Section: Discussionmentioning

confidence: 99%

Displaced femoral neck fracture in a pregnant patient diagnosed with transient osteoporosis of the hip

Factor

Barriga

Halperin

et al. 2022

SICOT-J

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Transient osteoporosis of pregnancy (TOP) is a self-limiting pathology with unspecified etiology. It is typically found in women in late pregnancy or early postpartum. A femoral neck fracture is an infrequent complication. Herein, we describe a TOP case in a 38-year-old female who suffered a displaced sub-capital femoral neck fracture without obvious trauma at 28 weeks of gestation. The patient underwent operative treatment using closed reduction and internal fixation (CRIF), using cannulated screws, with no intraoperative complications. The postoperative radiograph revealed a collapse and further displacement of the femoral neck. A decision was made to postpone a definitive treatment to a postpartum date. The patient underwent a cesarean section at 38-week of gestation with no complications. At her latest follow-up, 24 months postoperatively, the patient was asymptomatic. Pelvic and hip radiographs demonstrated consolidation of the fracture. Level of evidence: IV.

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Section: Discussionmentioning

confidence: 99%

Displaced femoral neck fracture in a pregnant patient diagnosed with transient osteoporosis of the hip

Factor

Barriga

Halperin

et al. 2022

SICOT-J

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“…Globally, the management of FNFs may serve as an indicator of the quality of care of the geriatric population [ 28 , 41 ]. In this study, there were significant delays in time to theatre, high rates of same-day surgical cancellations, and increased LOS.…”

Section: Discussionmentioning

confidence: 99%

“…A multidisciplinary approach including the care provision of a specialized geriatric unit is recommended to potentiate the best possible clinical outcomes [ 30 , 42 ]. This was also emphasized by Mudiganty et al who described a coordinated team effort, including the emergency doctors, surgeons, and anaesthetic team involvement [ 41 ]. Few institutions in developing countries, currently have access to such clinical service provisions [ 43 ].…”

Section: Discussionmentioning

confidence: 99%

The management of displaced intracapsular femoral neck fractures at a Sub-Saharan Academic Hospital

Mukiibi

Maharaj

Sekeitto

et al. 2021

SICOT-J

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Background: Femoral neck fractures (FNFs) remain “the unsolved fracture” and optimal management is still controversial. The outcomes of hemiarthroplasty (HA) and total hip arthroplasty (THA) in the treatment of FNFs are inconsistent. As demand for management of FNFs continues to grow globally, evaluation of the appropriateness of treatment remains essential, particularly in resource-constrained settings. Methods: We conducted a retrospective chart review of all patients presenting with isolated low energy intracapsular FNFs to an orthopaedic academic unit in Sub-Saharan Africa from January 2016 to April 2019. The decision regarding HA or THA was largely based upon the Sernbo score and ASA classification. The majority of patients with a Sernbo score of ≥15 and ASA class III or better received THA. Results: There were 117 patients (33 male/84 female) 72 years (33–97 years) with FNFs who underwent 56 THA and 61 HA between January 2016 and April 2019. The mean Sernbo score was 15.99 overall (range 8–20) and was 18.95 (11–20) for THA patients compared to 14.46 (8–20) for HA patients (p = 0.042). Time taken from admission to the theatre was 8–19 days (1–22) and 7–61 days (2–31) for HA and THA respectively. The average length of stay (LOS) was 16.04 days and the main reason for same-day cancellations was the lack of post ICU/High Care beds. The 30-day mortality rates were 1.78% and 4.91% for THA and HA patients, respectively (p = 0.07). The mortality rate for patients with a Sernbo score < 15 was 15.38% overall, 8.93% for THA patients, and 21.31% for HA patients, respectively (p = 0.021). Conclusion: The 30-day mortality rate was comparable with published rates from developed countries. There were significant delays in time to theatre, high rates of same-day surgical cancellations, and increased LOS for both HA and THA. These factors play a cumulative role in inflating costs on a strained healthcare system in a developing country. A multidisciplinary approach including the care provision of a specialized geriatric unit is recommended. Retrospective Study, Level III evidence

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“…The National Institute of Health and Care Excellence (NICE) in the United Kingdom (UK) has laid down clear guidelines regarding surgical treatment of intracapsular femoral neck fractures. They have recommended that THR be offered to all patients who are able to independently mobilise outdoors with no more than the use of a stick and have no diagnosed cognitive impairment [ 4 ]. For other elderly patients, and patients deemed high risk for anaesthesia (American Society of Anaesthesiology Grade more than 2), it is recommended that a HA be offered [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

“…They have recommended that THR be offered to all patients who are able to independently mobilise outdoors with no more than the use of a stick and have no diagnosed cognitive impairment [ 4 ]. For other elderly patients, and patients deemed high risk for anaesthesia (American Society of Anaesthesiology Grade more than 2), it is recommended that a HA be offered [ 4 ]. Routine practice throughout the UK is to obtain a postoperative check radiograph for all HA patients prior to their discharge from the hospital [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Routine Post-operative Radiographs Following Hip Hemiarthroplasty: Is It a Necessity?

Bhan¹,

Hasan²,

Khan³

et al. 2021

Cureus

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Femoral neck fractures are one of the most common fractures treated by an Orthopaedic surgeon. Arthroplasty is the recommended management for intracapsular neck of femur fractures in the elderly population owing to the high risk of avascular necrosis of the femoral head following an internal fixation. Elderly patients with intracapsular fractures deemed high risk for anaesthesia (American Society of Anaesthesiology Grade more than 2) are recommended a hip hemiarthroplasty. Routine practice throughout the United Kingdom is to obtain a postoperative check radiograph for all hip hemiarthroplasty patients prior to their discharge from the hospital. This may be done for various reasons like checking the presence of any peri-prosthetic fracture, the position of the components along with the presence of any dislocation. However, it is unclear whether a radiograph is the sole identifier of such complications. Through this study, we aim to analyse whether routine recommendation of post-operative radiographs following hip hemiarthroplasty affects the clinical outcome, and whether it is effective in identifying potential complications before the patients report any signs or symptoms.

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Fractured Neck of Femur Management at a District General Hospital: Adherence to NICE guidelines CG124 for total hip replacement

Cited by 4 publications

References 1 publication

Displaced femoral neck fracture in a pregnant patient diagnosed with transient osteoporosis of the hip

Displaced femoral neck fracture in a pregnant patient diagnosed with transient osteoporosis of the hip

The management of displaced intracapsular femoral neck fractures at a Sub-Saharan Academic Hospital

Routine Post-operative Radiographs Following Hip Hemiarthroplasty: Is It a Necessity?

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