Lower 1-Year Postoperative Mortality After Acetabular Versus Proximal Femoral Fractures in Elderly Patients

Stetzelberger, Vera M.; Brouze, Iris F; Steppacher, Simon D.; Bastian, Johannes Dominik; Schwab, Joseph M.; Tannast, Moritz

doi:10.2106/jbjs.20.01805

Cited by 7 publications

(3 citation statements)

References 69 publications

(169 reference statements)

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“…Khoshbin et al [ 3 ] from the University of Toronto in a matched cohort study that included patients older than 60 years, concluded that acetabular fractures had a much higher risk of early mortality compared to hip fractures. On the other hand, Stetzelberger et al [ 4 ] from Switzerland documented that whilst there was no difference in mortality between the acetabular and hip fracture patients at the first 30 postinjury days, the 1-year mortality was double for hip fracture patients (18% acetabular vs 36% hip fractures). Mortality has also been studied by comparing operative vs no-operative management.…”

Section: Introductionmentioning

confidence: 99%

Management of geriatric acetabular fractures: Contemporary treatment strategies

Tosounidis,

Chalidis

2024

World J Clin Cases

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Acetabular fractures in the geriatric population are typically low-energy fractures resulting from a fall from standing height. Compromised bone quality in the elderly, as well as this population’s concomitant medical comorbidities, render the management of such fractures challenging and controversial. Non-operative management remains the mainstay of treatment, although such a choice is associated with numerous and serious complications related to both the hip joint as well as the general condition of the patient. On the other hand, operatively treating acetabular fractures (e.g. , with osteosynthesis or total hip arthroplasty) is gaining popularity. Osteosynthesis can be performed with open reduction and internal fixation or with minimally invasive techniques. Total hip arthroplasty could be performed either in the acute phase combined with osteosynthesis or as a delayed procedure after a period of non-operative management or after failed osteosynthesis of the acetabulum. Regardless of the implemented treatment, orthogeriatric co-management is considered extremely crucial, and it is currently one of the pillars of a successful outcome after an acetabular fracture.

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Section: Introductionmentioning

confidence: 99%

Management of geriatric acetabular fractures: Contemporary treatment strategies

Tosounidis,

Chalidis

2024

World J Clin Cases

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“…Failed fixations of proximal femoral fractures (PFFs) are infrequent but distressing and incapacitating complications and may be frequently accompanied by persistent pain, dysfunction, poor quality of life, and even life threatening [1][2][3]. With the expansion of surgical indications for total hip replacements (THRs) [4], it is expected to increase the demand for THRs, which are a universal and reliable procedure characteristically executed for the reduction of hip symptoms and have been approved as a surgical protocol for converting a failed fixation of PFFs with the aim of relieving pain, strengthening stability, and restoring function [5,6].…”

Section: Introductionmentioning

confidence: 99%

Implant survival of cemented arthroplasty following failed fixation of proximal femoral fractures in patients aged 30–60 years: a retrospective study with a median follow-up of 10 years

Zhang

et al. 2022

BMC Musculoskelet Disord

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Background Given the unremitting growth in the volume of failed fixations of proximal femoral fractures (PFFs) in recent years, it is predictable that total hip replacements (THRs) will be the preferred surgical procedure. The long-term survival of cemented THR (CTHR) revisions remains controversial in patients aged 30–60 years. The goal of this retrospective review was to evaluate the 10-year survival of CTHRs following prior failed primary fixations of PFFs in patients aged 30–60 years. Methods We retrospectively identified CTHR revisions implemented at four medical centres during 2008–2017 for a failed primary fixation of PFFs in consecutive patients aged 30–60 years. The primary endpoint was implant survival calculated using the Kaplan–Meier method with 95% confidence intervals (CIs); secondary endpoints included functional scores assessed by Harris hip scores (HHS) and main revision-related orthopaedic complications. Follow-up was executed at 1, 2, 3, and 8 years following revision and then at 1-year intervals until the revision, death, or study deadline, whichever occurred first. Results In total, 120 patients (120 hips) who met the eligibility criteria were eligible for follow-up. The median follow-up was 10.2 years (range, 8–12 years). Kaplan–Meier survivorship showed that implant survival with revision for any reason as the endpoint was 95% at 5 years (CI: 93–97%), 89% at 8 years (CI: 86–92%), and 86% at 10 years (CI: 83–89%). Patients treated with three hollow screws had better revision-free survival than patients treated with proximal femoral nail antirotation (PFNA), dynamic hip screw (DHS) or titanium plate plus screws (three p < 0.05). Functional scores were apt to decrease gradually, and at the final follow-up, the mean HHS was 76.9 (range, 67.4–86.4). The overall rate of main revision-related orthopaedic complications was 18.3% (22/120). Conclusion CTHR implemented following prior failed primary fixations of PFFs tends to afford an acceptable 10-year survival, along with advantageous HHS and a low rate of main revision-related orthopaedic complications, which may support an inclination to follow the utilisation of CTHRs, especially in revision settings for intracapsular fractures.

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“…Level of evidence: Prognostic Level III F ractures of the acetabulum (AO/OTA 62A-C) in the elderly are associated with prolonged hospital stays, perioperative complications, 30-day mortality of between two and seven percent, and 1-year mortality rates of between and eight and 20%. [1][2][3][4][5] Treatment can be nonsurgical or surgical. Surgical treatment options include open reduction and internal fixation (ORIF), closed reduction and percutaneous fixation, total hip arthroplasty (THA), and combined ORIF-THA.…”

mentioning

confidence: 99%

For Surgically Treated Geriatric Acetabular Fractures, Longer Duration between Admission and Surgery Is Associated with an Increase in Post-operative Complications: A Study Using the National Trauma Data Bank

Danford,

Mehta,

Lack

et al. 2023

J Am Acad Orthop Surg

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Introduction: The purpose of this study was to determine whether time from hospital admission to surgery is associated with inpatient complications and mortality for geriatric patients undergoing surgical treatment of acetabular fractures. Methods: This was a retrospective cohort study using the National Trauma Data Bank from 2016 to 2018 of patients presenting to level I through IV trauma centers in the United States. All patients aged 60 years or older with acetabular fractures requiring surgical treatment were included. The main outcome measurements were inpatient mortality and complication rates. Results: There were 6,036 patients who met inclusion criteria. The median age was 69 years (interquartile range 64-76 years). The odds of a complication increased by 7% for each additional day between hospital admission and surgery (multivariable regression OR 1.07, 95% CI = 1.04 to 1.10; P < 0.001). Complications were also associated with patient age (OR 1.05, 95% CI = 1.03 to 1.06; P < 0.001) and mCCI ≥ 5 (OR 2.52, 95% CI = 1.4 to 4.2; P = 0.001). Inpatient mortality was not associated with time to surgery (OR 0.97, 95% CI = 0.92 to 1.02; P = 0.30), but was associated with patient age (OR 1.07, 95% CI = 1.05 to 1.10; P < 0.001; P < 0.001) and mCCI ≥ 5 (OR 4.62, 95% CI = 2.31 to 8.50; P < 0.001). Discussion: In this database study, time from hospital admission to surgery was associated with a notable increase in inpatient complications but not inpatient mortality after adjusting for potentially confounding variables while age and mCCI were associated with both mortality and complications. Additional research is needed to determine the relationship between time to surgery with longer term mortality and complications and to assess causality. Level of evidence: Prognostic Level III

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Lower 1-Year Postoperative Mortality After Acetabular Versus Proximal Femoral Fractures in Elderly Patients

Cited by 7 publications

References 69 publications

Management of geriatric acetabular fractures: Contemporary treatment strategies

Management of geriatric acetabular fractures: Contemporary treatment strategies

Implant survival of cemented arthroplasty following failed fixation of proximal femoral fractures in patients aged 30–60 years: a retrospective study with a median follow-up of 10 years

For Surgically Treated Geriatric Acetabular Fractures, Longer Duration between Admission and Surgery Is Associated with an Increase in Post-operative Complications: A Study Using the National Trauma Data Bank

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