Higher 30-day mortality associated with the use of intramedullary nails compared with sliding hip screws for the treatment of trochanteric hip fractures

Whitehouse, Michael R; Berstock, James R; Kelly, Michael; Gregson, Celia L; Judge, Andrew; Sayers, Adrian; Chesser, T.J.S.

doi:10.1302/0301-620x.101b1.bjj-2018-0601.r2

Cited by 46 publications

(49 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Additionally, four studies 7 , 35 , 42 , 47 reported an increased mortality with intramedullary fixation, as shown in our results (RR 1.33, p = 0.04) in patients with COVID-19 infection. The obvious difference between this type of implant and other forms of extracapsular fixation is the instrumentation of the femoral canal which is known to be associated with increased mortality due to increased intramedullary pressure, embolic showers and fat extravasation and may be catastrophic to COVID-19 patients, representing a “second-hit” postulated by Lebrun et al and Egol et al 39 , 42 , 60 , 61 .…”

Section: Discussionmentioning

confidence: 99%

Meta-analysis and metaregression of risk factors associated with mortality in hip fracture patients during the COVID-19 pandemic

Raheman

Rojoa

Parekh

et al. 2021

Sci Rep

View full text Add to dashboard Cite

Incidence of hip fractures has remained unchanged during the pandemic with overlapping vulnerabilities observed in patients with hip fractures and those infected with COVID-19. We aimed to investigate the independent impact of COVID-19 infection on the mortality of these patients. Healthcare databases were systematically searched over 2-weeks from 1st–14th November 2020 to identify eligible studies assessing the impact of COVID-19 on hip fracture patients. Meta-analysis of proportion was performed to obtain pooled values of prevalence, incidence and case fatality rate of hip fracture patients with COVID-19 infection. 30-day mortality, excess mortality and all-cause mortality were analysed using a mixed-effects model. 22 studies reporting 4015 patients were identified out of which 2651 (66%) were assessed during the pandemic. An excess mortality of 10% was seen for hip fractures treated during the pandemic (OR 2.00, p = 0.007), in comparison to the pre-pandemic controls (5%). Estimated mortality of COVID-19 positive hip fracture patients was four-fold (RR 4.59, p < 0.0001) and 30-day mortality was 38.0% (HR 4.73, p < 0.0001). The case fatality rate for COVID-19 positive patients was 34.74%. Between-study heterogeneity for the pooled analysis was minimal (I2 = 0.00) whereas, random effects metaregression identified subgroup heterogeneity for male gender (p < 0.001), diabetes (p = 0.002), dementia (p = 0.001) and extracapsular fractures (p = 0.01) increased risk of mortality in COVID-19 positive patients.

show abstract

Section: Discussionmentioning

confidence: 99%

Meta-analysis and metaregression of risk factors associated with mortality in hip fracture patients during the COVID-19 pandemic

Raheman

Rojoa

Parekh

et al. 2021

Sci Rep

View full text Add to dashboard Cite

show abstract

“…Within the A1/2 intertrochanteric proximal femoral fractures, the SHS construct remains the implant of choice for various reasons, including lower cost and decreased mortality compared with cephalomedullary devices based on the NHFD [ 9 - 10 ]. We have demonstrated the importance of intraoperative screw placement besides presenting technical tips to improve this.…”

Section: Discussionmentioning

confidence: 99%

The Importance of Flare: A Radiological Evaluation of Fixed-Angle Guide and Barrel-Plate in Sliding Hip Screws

Subhash

Liew²

2021

Cureus

View full text Add to dashboard Cite

Background and objective The sliding hip screw (SHS) remains the main operative implant of choice for A1/2 intertrochanteric fractures. These implants are often fixed-angled with a corresponding guide to decrease inventory and implant cost. However, there are varying sizes of base plates on the fixed-angle device between industries. Screw placement is crucial to achieving optimal tip-apex distance (TAD) and position. Due to the flare of the greater trochanter (GT), we hypothesise that the fixed-angle guide can lead to malpositioning. In this study, we aimed to describe the discrepancy between the fixed-angle guide (short: 38 mm, long: 60 mm), the flare of the GT, and the effects on screw placement. Methods Patients who received SHS between August to December 2019 were evaluated. We measured the neck-shaft angle, GT flare angle to the femoral axis, screw-plate angle, screw position, and TAD. We templated the optimal 135° fixed-angle barrel-plate, angle guides, and measured the divergence between the angles. Results A total of 30 patients were identified to be included in the study; 24/30 (80%) were female, with 16/30 (53%) receiving SHS on the right hip. The average age of the participants was 82 ±9 years. The average neck-shaft angle was 132.4° ±5.9. The GT flare angle was 3.2° ±1.6. Of note, 66% of patients had a screw-plate angle of ≥135° with an average of 137° ±3.7. However, only 10/30 (33%) screws were placed superiorly, with an average TAD of 21 mm ±11 compared to screws placed in the centre and inferiorly at 9.5 mm ±3 (p=0.0004). The long fixed-angle guide resulted in a lower divergence angle at 3° ±1.7 compared to 5.2° ±2.6 for the short fixed-angle guide (p=0.0001). Conclusion Using the fixed-angle guide at 135° on the GT flare results in a sub-optimum screw-plate angle. This can lead to malpositioning of the screw, as well as increased TAD and screw-plate angle. Preoperative planning is crucial to measure the femoral neck-shaft angle, GT flare, as well as utilising a longer fixed-angle guide.

show abstract

“…1 Impacto da fratura na QV 1, 2, 3, 5 e 7 2 Programa de prevenção de fraturas e QV 4, 6 e 10 3 Relação entre fatores intrínsecos para risco de fraturas e QV 8 e 9 Fonte: Dados da Pesquisa. outras pessoas e proporciona a melhora da QV do idoso (WHITEHOUSE et al, 2019).…”

Section: Categorias Artigosunclassified

Qualidade de Vida em Idosos após a ocorrência de Fratura: Uma Revisão Integrativa / Quality of Life in the Elderly after a Fracture: An Integrative Review

Sousa¹,

Sousa²,

Dantas³

et al. 2020

IDonline

View full text Add to dashboard Cite

O envelhecimento da população é um fenômeno crescente onde o número de idosos tem aumentado consideravelmente e, de modo particular nos países em desenvolvimento como é o caso do Brasil. Somada ao aumento da expectativa de vida vem os problemas que afetam esta população, destacando-se entre estes as fraturas. As fraturas são eventos relevantes a saúde dos idosos e a sua qualidade de vida (QV). Assim, o objetivo do estudo foi realizar um levantamento na literatura relativo a ocorrência de fraturas em idosos e seus impactos na qualidade de vida destes indivíduos. Trata-se de uma revisão integrativa de abordagem qualitativa. Realizada nas seguintes bases de dados LILACS, Medline, SciElo e PubMed, utilizando-se dos seguintes descritores em saúde (DeCS): “qualidade de vida”, “idosos” e “fratura”. Adotou-se como critério de inclusão artigos nos idiomas português e inglês, disponíveis na integra, na forma gratuita e publicados entre 2014 a 2019. Aparte da procura dos descritores nas bases de dados encontrou-se 43 antigos relacionado ao tema, após leitura e análise minuciosa, selecionou-se 10 artigos para compor a amostra final. Os achados revelados nos estudos permitiu observa que as fraturas em idosos são determinantes para perda da QV deste endividou, onde, fatores intrínsecos relativos ao modo de vida dos idosos e complicações durante o período de recuperação são os principais motivos para perda da QV do idoso. Conclui-se que, existe a necessidade de se propor ações voltadas a minimiza os efeitos negativos das fraturas, assim, proporcionando uma melhor QV a esta população.

show abstract

Higher 30-day mortality associated with the use of intramedullary nails compared with sliding hip screws for the treatment of trochanteric hip fractures

Cited by 46 publications

References 30 publications

Meta-analysis and metaregression of risk factors associated with mortality in hip fracture patients during the COVID-19 pandemic

Meta-analysis and metaregression of risk factors associated with mortality in hip fracture patients during the COVID-19 pandemic

The Importance of Flare: A Radiological Evaluation of Fixed-Angle Guide and Barrel-Plate in Sliding Hip Screws

Qualidade de Vida em Idosos após a ocorrência de Fratura: Uma Revisão Integrativa / Quality of Life in the Elderly after a Fracture: An Integrative Review

Contact Info

Product

Resources

About