Nationwide Analysis of Femoral Neck Fractures in Elderly Patients

Ju, Derek G; Rajaee, Sean S.; Mirocha, James; Lin, Carol A.; Moon, Charles N.

doi:10.2106/jbjs.16.01247

Cited by 90 publications

(83 citation statements)

References 34 publications

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“…Femoral neck fracture is a representative trauma causing disability and morbidity, especially among elderly people. Open reduction and internal fixation often result in poor outcomes, and either hemiarthroplasty (HA) or total hip arthroplasty (THA) is recommended for displaced femoral neck fractures [ 1 , 2 ]. Previous studies have found that functionally demanding patients occasionally have problems after HA, such as pain, acetabular erosion, or implant loosening which, consequently, requires revision surgery.…”

Section: Introductionmentioning

confidence: 99%

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Association between Hemiarthroplasty vs. Total Hip Arthroplasty and Major Surgical Complications among Patients with Femoral Neck Fracture

Ogawa

Yoshii

Moriwaki

et al. 2020

JCM

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Previous studies have shown better clinical outcomes after total hip arthroplasty (THA) compared to hemiarthroplasty (HA) for displaced femoral neck fracture. However, few studies have focused on the surgical risks of the two procedures. Therefore, we investigated the perioperative complications of HA and THA in femoral neck fracture, using a large nationwide inpatient database. A total of 286,269 patients (281,140 patients with HA and 5129 with THA) with a mean age of 81.7 were enrolled and HA and THA patients were matched by a propensity score to adjust for patient and hospital characteristics. Patients in a matched cohort were analyzed to compare complications and mortality. The systemic complication rate was not significantly different after a propensity score matching of 4967 pairs of patients. However, the incidence of both hip dislocation and revision surgery was more frequent in the THA group (Risk difference (RD), 2.74; 95%Confidence interval(CI), 2.21–3.27; p < 0.001; RD, 2.82; 95%CI, 2.27–3.37; p < 0.001, respectively). There was no significant difference in 30 day in-hospital mortality among the two groups. The risk of dislocation and reoperation was higher for THA than for HA in elderly patients with a femoral neck fracture in this retrospective study using a nationwide database.

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Section: Introductionmentioning

confidence: 99%

“…Previous studies have reported that THA requires a greater amount of blood transfusion than HA [ 1 , 6 , 8 , 15 ] and that it could be associated with a higher incidence of perioperative complications [ 16 , 17 ]. However, other studies reported no differences in the complication rate between the two procedures [ 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

Association between Hemiarthroplasty vs. Total Hip Arthroplasty and Major Surgical Complications among Patients with Femoral Neck Fracture

Ogawa

Yoshii

Moriwaki

et al. 2020

JCM

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“…It is not common in healthy individuals but common among athletes, military recruits, and young adults because of high energy activities such as sports and road traffic accidents, in adults because of falls, in women because of estrogen imbalances, and in patients because of bone mineralization and deficiencies [ [1] , [2] , [3] , [4] ]. In the USA in 2013, there were a reported 146 cases per 100,000 people [ 5 ]. Mortality can be as high as 30% in one year, particularly if treatment is delayed over 24 h [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

The relationship between femoral neck fracture in adult and avascular necrosis and nonunion: A retrospective study

Koaban

Alatassi

Alharbi

et al. 2019

Annals of Medicine and Surgery

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BackgroundOne of the most serious sequelae of femoral neck fractures (FNFs) is avascular necrosis (AVN), and this complication translates to significant morbidity and mortality. This study was conducted to determine the relationship between the etiologies and management of FNFs at our institution and the development of AVN or nonunion.Materials and methodsThis study was a retrospective medical chart review of all adult patients admitted and managed for FNF.ResultsThere were a total of 69 FNF patients reviewed. FNF was caused by a fall in 37 patients (53.6%), a road traffic accident in 16 (23.2%), motorcycle and motorbike accidents in 8 (11.6%), and heavy exercise in 8 (11.6%). Twenty-four patients (34.8%) had fixation within 24 h of injury, and 45 (65.2%) went more than 24 h before fixation. The mean RUSH score at 6 months was 21.4 ± 5.1. There were 4 patients (5.8%) with a collapsed FNF and 4 patients (5.8%) had a nonunion FNF. AVN was documented in 12 patients (17.4%). Of the 12 patients who had AVN, 8 (66.7%) received fixation within 24 h from the time of the injury, whereas only 4 (33.3%) received fixation more than 24 h after the injury. There was a significant negative correlation between the time of fixation and AVN.ConclusionWe report a 17.4% incidence of AVN over 10 years in patients managed with FNF. AVN was found to be significantly correlated with the mode of injury (fall and RTA among younger male patients).

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“…Femur neck fractures are generally seen in patients with advanced age with co-morbidities which put them in high-risk category. [ 1 2 ] Anaesthesia maintenance in these patients depends on physical status, medications and co-morbidities and is generally maintained with general or neuraxial anaesthesia. [ 3 4 ] Erector spinae plane block (ESPB) is a recently described regional anaesthesia technique leading to multiple paravertebral blocks.…”

Section: Introductionmentioning

confidence: 99%

Combination of lumbar erector spinae plane block and transmuscular quadratus lumborum block for surgical anaesthesia in hemiarthroplasty for femoral neck fracture

2018

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Femur neck fractures may occur in elderly patients with multiple co-morbidities. Spinal or general anaesthesia may not be safe in such patients, leading to a search for other safer alternatives. Herein, we report a case in which a never previously reported combination of quadratus lumborum block (QLB) and erector spinae plane block (ESPB) was successfully used as the main anaesthetic method for hemiarthroplasty. An 86-year-old female patient with severe aortic stenosis was scheduled for internal fixation or hemiarthroplasty due to right femoral neck fracture. Following sedoanalgesia, the patient was placed in lateral decubitis position and ESPB and transmuscular QLB were performed from the fourth lumbar vertebra level. Adequate and effective surgical anaesthesia was achieved and hemiarthroplasty was performed. The combination of lumbar ESPB and QLB can be used for the anaesthesia management in high-risk patients undergoing hemiarthroplasty.

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Nationwide Analysis of Femoral Neck Fractures in Elderly Patients

Cited by 90 publications

References 34 publications

Association between Hemiarthroplasty vs. Total Hip Arthroplasty and Major Surgical Complications among Patients with Femoral Neck Fracture

Association between Hemiarthroplasty vs. Total Hip Arthroplasty and Major Surgical Complications among Patients with Femoral Neck Fracture

The relationship between femoral neck fracture in adult and avascular necrosis and nonunion: A retrospective study

Combination of lumbar erector spinae plane block and transmuscular quadratus lumborum block for surgical anaesthesia in hemiarthroplasty for femoral neck fracture

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