Management of hip fractures among elderly patients at Jordan University Hospital: A cross-sectional study

Abstract

Background: This study compared the practice of elderly hip fractures management at Jordan University Hospital against the practice recommended by American Academy of Orthopaedic Surgeons (AAOS). Methods: Medical records between Oct 1, 2017, and Oct 31, 2018, were reviewed retrospectively. Inclusion criteria included patients over the age of 65 yr who were admitted from the emergency department. Patients excluded from the study were involved in motor vehicle accidents, had pathological fractures, or were transferred from other hospitals. One hundred and thirteen patients were included. Results: All patients received venous thromboembolism prophylaxis, and none had preoperative traction. Surgery was done within 48 hr in 83% (94/113) of patients. All patients with unstable femoral neck fractures underwent arthroplasty. Sliding hip screws were used in 93.5% (29/31) of stable intertrochanteric fractures, but cephalomedullary devices were used in 86.7% of unstable fractures (46 patients). Rehabilitation was done for a majority of patients. Unfortunately, preoperative regional analgesia was not used at all. Bipolar heads were used in a majority of hemiarthroplasty cases. A blood transfusion threshold of no higher than 8 g/dL was only followed in 16 cases. Only 23.9% of patients continued physical therapy at home. Fewer than one-third of the patients underwent nutritional assessment or support. Only 15 patients received a secondary mode of analgesia postoperatively. Vitamin D and calcium were prescribed for less than 50% of patients. Only 10.6% were evaluated for osteoporosis after fracture. Conclusions: Compliance with AAOS guidelines is reasonable, and it can be increased by following recommendations regarding: preoperative analgesia, femoral head type, blood transfusion threshold, home physical therapy, nutritional assessment, pain management, vitamin D and calcium supplementation, and osteoporosis treatment. Level of Evidence: Level III.

Comparison Between Cemented and Uncemented Hemiarthroplasty in Patients With Femoral Neck Fractures: A Systematic Review and Meta-analysis

“…Kumar [8] reported that CHA had higher 1-year mortality, while Kristensen [6] showed that there was no difference. Our study shows that the mortality rate lower at 1 year postoperatively in CHA group, which is consistent with mainstream previous reports [5,7,43].…”

“…Although 8 meta-analyses have been published [5][6][7][8][9][10][11][12][13], the results of modern implants had not been fully considered and previous results were inconsistent, indicating a need for more robust evidence. The most recent study carried a substantial risk of bias in its methodology due to the lack of publication bias plots and sensitivity analysis for high heterogeneity outcomes and it is not known how or to what extent these risks of bias in uence the ndings [14].…”

“…Imam summarized 9 RCTs and 20 observations and found greater intraoperative blood loss and heterotopic ossi cation in CHA [9]. CHA had a higher 1-year mortality rate in several studies, but this result was revised in a later analysis [7,5]. These studies were criticized for their patients samples, inclusion criteria, poor randomization, limited reporting of outcomes, inadequate follow-up, and exclusion of modern implants.…”

Characteristics of Elderly Hip Fracture Patients in Jordan: A Multicenter Epidemiological Study

“…The first study discussed the practice of management of elderly hip fracture in a single center within one year compared to the guidelines recommended by the American Academy of Orthopaedic Surgeons. 9 Their findings were close to our findings regarding average age, female gender and trochanteric type predominance, medical comorbidities, and the average length of hospital stay. The second study focused on the relationship between red cell distribution width and 6-months mortality of hip fractures.…”

“…There were only two single-center studies from Jordan that discussed hip fracture-related issues. 9 , 10 …”