Neck of femur fracture: who gets a total hip replacement? A review of 230 eligible patients

Bhattacharjee, Atanu; Richards, Owen; Marusza, Chris; Topliss, Claire; Wilson, Ian; Phillips, Stephen J.; Starks, Ian

doi:10.1007/s00068-020-01358-5

Cited by 4 publications

(4 citation statements)

References 20 publications

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“…Emergency patients in our study spent longer in hospital than elective patients, in accordance with previous studies [ 25 , 40 ]. This disparity in LOS can be explained by the extensive preoperative planning and patient optimisation that goes into an elective procedure compared to an emergency admission [ 41 ].…”

Section: Discussionsupporting

confidence: 93%

Comparison of acute outcomes from elective total hip replacements and after fragility femoral neck fractures in nonagenarians

Al-Essah,

Curlewis,

Chan

et al. 2024

BMC Musculoskelet Disord

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Background Hip hemiarthroplasty has traditionally been used to treat displaced femoral neck fractures in older, frailer patients whilst total hip replacements (THR) have been reserved for younger and fitter patients. However, not all elderly patients are frail, and some may be able to tolerate and benefit from an acute THR. Nonagenarians are a particularly heterogenous subpopulation of the elderly, with varying degrees of independence. Since THRs are performed electively as a routine treatment for osteoarthritis in the elderly, its safety is well established in the older patient. The aim of this study was to compare the safety of emergency THR to elective THR in nonagenarians. Methods A retrospective 10-year cohort study was conducted using data submitted to the National Hip Fracture Database (NHFD) across three hospitals in one large NHS Trust. Data was collected from 126 nonagenarians who underwent THRs between 1st January 2010 – 31st December 2020 and was categorised into emergency THR and elective THR groups. Mortality rates were compared between the two groups. Secondary outcomes were also compared including postoperative complications (dislocations, revision surgeries, and periprosthetic fracture), length of stay in hospital, and discharge destination. Results There was no significant difference in mortality between the two groups, with 1-year mortality rates of 11.4% and 12.1% reported for emergency and elective patients respectively (p = 0.848). There were no significant differences in postoperative complication rate and discharge destination. Patients who had emergency THR spent 5.56 days longer in hospital compared to elective patients (p = 0.015). Conclusion There is no increased risk of 1-year mortality in emergency THR compared to elective THR, in a nonagenarian population. Therefore, nonagenarians presenting with a hip fracture who would have been considered for a THR if presenting on an elective basis should not be precluded from an emergency THR on safety grounds. Trial registration Not necessary as this was deemed not to be clinical research, and was considered to be a service evaluation.

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Section: Discussionsupporting

confidence: 93%

Comparison of acute outcomes from elective total hip replacements and after fragility femoral neck fractures in nonagenarians

Al-Essah,

Curlewis,

Chan

et al. 2024

BMC Musculoskelet Disord

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“…Internal fixation of fracture neck of the femur is clearly indicated for all undisplaced fractures and for those aged less than about 60 years with a displaced intracapsular fracture in which preservation of the femoral head is desired [12,13] . The use of partially threaded cancellous screws cannulated or not, inserted perpendicular to the fracture plane and directly adjacent to the femoral neck cortices, has been the standard treatment intervention for femoral neck fixation in the past several decades [14,15] . This construct allows for compression intraoperatively to aid in primary bone healing.…”

Section: Introductionmentioning

confidence: 99%

Locking Plate Versus Cannulated Screws in The Management of Transcervical Fracture Neck Femur

Hosni

Yousef²,

Said³

2022

International Journal of Medical Arts

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Article informationBackground: Transcervical neck fracture is common in daily orthopedic practice.Internal fixation is the curative option. However, there is controversy exists regarding the ideal fixation device. The aim of the work:This study aims to compare the clinical, functional and radiological results of cannulated screws versus dynamic locking plate in fixations of femoral neck fractures.Patients and Methods: Thirty patients with transcervical fracture neck femur were included. They were divided into two groups; the first for dynamic locked plate, and the second for cannulated screws. All were assessed preoperatively by radiological and clinical methods. Postoperative care consisted of routine vital data recording, intravenous antibiotics and appropriate analgesia. X-rays were done in the first postoperative to check fixation and after 12 weeks to check for union. The followup evaluation included questioning the patient about pain during activity and rest and about ability to walk and stand determining the range of motion of the hip joint using modified Harris Hip Scoring System. Results:The mean operative time in screws group was 38 minute compared to 72 minutes in plate group with significant difference between both groups. Both groups showed high successful union rate with no significant difference. In the screw group, 3 cases fail to union while in plate group only one case failed. The mean union time in screws group was 19.7 weeks while in plate group was 18.3 weeks. Screws group showed 8 cases of complication, compared to 5 cases in the plate group. There was a significant blood loss [more than 500ml] in plate group. Conclusion:Although both groups were comparable regarding union rate, the screw group was associated with significantly shorter operative time, and lower blood loss. The anatomical reduction is the main determining factor of success regardless the type of device used in fixation.

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“…The worldwide incidence of hip fractures is 2.3% per year [5]. Surgical indications for femoral neck fractures (CFF) are clearer than those for intertrochanteric femoral fractures (ITF) [6]. If the rate of fracture union is high in CFF, osteosynthesis is preferred, otherwise, arthroplasty is the procedure of choice [6].…”

Section: Introductionmentioning

confidence: 99%

“…Surgical indications for femoral neck fractures (CFF) are clearer than those for intertrochanteric femoral fractures (ITF) [6]. If the rate of fracture union is high in CFF, osteosynthesis is preferred, otherwise, arthroplasty is the procedure of choice [6]. However, ITFs have higher fracture union rates compared to CFFs.…”

Section: Introductionmentioning

confidence: 99%

Comparison of long-stemmed cementless hemiarthroplasty with proximal femur nail in unstable intertrochanteric femur fractures over 85 years of age

Dağtaş¹,

Ünal²

2020

Journal of Surgery and Medicine

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Neck of femur fracture: who gets a total hip replacement? A review of 230 eligible patients

Cited by 4 publications

References 20 publications

Comparison of acute outcomes from elective total hip replacements and after fragility femoral neck fractures in nonagenarians

Comparison of acute outcomes from elective total hip replacements and after fragility femoral neck fractures in nonagenarians

Locking Plate Versus Cannulated Screws in The Management of Transcervical Fracture Neck Femur

Comparison of long-stemmed cementless hemiarthroplasty with proximal femur nail in unstable intertrochanteric femur fractures over 85 years of age

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