Serum albumin and fixation failure with cannulated hip screws in undisplaced intracapsular femoral neck fracture

Riaz, Osman; Arshad, Rizwan; Nisar, Sohail; Vanker, R

doi:10.1308/rcsann.2016.0124

Cited by 18 publications

(15 citation statements)

References 16 publications

(15 reference statements)

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“…Femoral neck fractures are treated surgically and accompanied by high mortality and morbidity, it is essential to use appropriate and efficient treatment approaches that comply with some parameters such as age, complexity of fractures and presence of other injuries [ 1 - 3 ]. Femur neck fractures substantially damage ascending cervical arteries of extracapsular arterial ring.…”

Section: Introductionmentioning

confidence: 99%

Femur neck fracture in young adults, is it really an urgent surgery indication: retrospective clinical study

Gümüştaş¹,

Tosun²,

Isyar³

et al. 2018

Pan Afr Med J

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IntroductionFemur neck fracture comprises a significant part of intracapsular femur fracture in the intracapsular area of proximal femur and it is mostly seen in elder people. However, these kinds of fractures may be seen in young adults. The present study aims to search factors that affect femoral neck fractures in young adults after surgery carried out by internal determination method.MethodsFiles of patients who were applied internal determination through closed reduction and cannulated screw because of intracapsular femur neck fractures between 2010 and 2015 were analyzed retrospectively. Fractures were evaluated by means of Garden classification, which is based on radiological appearance. The cases were examined in terms of timing of surgery in two groups. Cases operated in the first 24 hours after trauma consisted of group 1 and after 24 hours group 2. Radiological staging in femoral head avascular necrosis was evaluated by Ficat-Arlet classification system whereas acetabular fractures and hip functionality was evaluated by Letournel and Judet system, which is based on direct graph of fracture line.ResultsMean age at the time of surgery for 31 cases included in the study was 40.04 ± 9.63 year. The average duration from injury to surgery was 6.6 (1-20) days. Thirty nine percent of fractures was nondisplaced whereas 61% was displaced. The average follow-up period was 4.9 ± 1.35 years. The rate of nonunion was found 16% and femoral head avascular necrosis 6.4%. According to Judet System, 67.7% of cases showed excellent/good and 32.3% moderate/bad functional results. Six cases had a secondary surgery. Cases who had displaced fractures statistically showed worse functional results and underwent more secondary surgery than patients with nondisplaced fractures (P>0.05). As a result of logistic regression analysis, presence of displacement was a factor negatively affecting the judet score but did not affect the rate of complication. There were no significant differences between the two groups according to the surgical timing in terms of functional outcomes and complications.ConclusionBecause of surgical treatment of femoral neck fractures in the first 24 hours does not affect functional outcomes and complication rate, surgery is recommended in optimal conditions. In the case of displacement, care must be taken in terms of poor functional results.

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Section: Introductionmentioning

confidence: 99%

Femur neck fracture in young adults, is it really an urgent surgery indication: retrospective clinical study

Gümüştaş¹,

Tosun²,

Isyar³

et al. 2018

Pan Afr Med J

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show abstract

“…Hence, as an independent risk factor for reoperation, the ALP level should be integral in the evaluation of reoperation risk in the elderly patients with FNFs. On the other hand, low albumin level has been reported to be a significant risk factor for reoperation [ 12 , 35 ]. However, data on the exact reason remains scant.…”

Section: Discussionmentioning

confidence: 99%

Nomogram for predicting reoperation following internal fixation of nondisplaced femoral neck fractures in elderly patients

Zhu

Deng

et al. 2021

J Orthop Surg Res

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Objective We aimed to evaluate risk factors and develop a nomogram for reoperation after internal fixation of nondisplaced femoral neck fractures (FNFs) in elderly patients. Methods We conducted a retrospective study involving a total of 255 elderly patients who underwent closed reduction and internal fixation with cannulated screw system for nondisplaced FNFs between January 2016 and January 2019. We collected data on demographics, preoperative radiological parameters, surgery, serum biochemical markers, and postoperative rehabilitation. In addition, we performed univariate and multivariate logistic regression analyses to determine independent risk factors for reoperation, and then developed a nomogram to assess the risks of reoperation. Besides, discriminative ability, calibration, and clinical usefulness of the nomogram were evaluated using the concordance index (C-index), the receiver operating characteristic (ROC) curve, calibration curve and decision curve analysis (DCA), respectively. We employed bootstrap method to validate the performance of the developed nomogram. Results Our analysis showed that among the 255 patients, 28 (11.0%) underwent reoperation due to osteonecrosis of the femoral head (14 cases), mechanical failure (8 cases) or nonunion (6 cases). All of the 28 patients underwent conversion surgery to arthroplasty. The multivariate logistic regression analysis demonstrated that preoperative posterior tilt angle ≥ 20°, Pauwel’s III type, younger patients, preoperative elevated levels of alkaline phosphatase (ALP), preoperative hypoalbuminemia, and early postoperative weight-bearing were independent risk factors for reoperation. In addition, the C-index and the bootstrap value of the developed nomogram was 0.850 (95% CI = 0.803–0.913) and 0.811, respectively. Besides, the calibration curve showed good consistency between the actual diagnosed reoperation and the predicted probability, while the DCA indicated that the nomogram was clinically valuable. Conclusions Our analysis showed we successfully developed and validated a nomogram for personalized prediction of reoperation after internal fixation of nondisplaced FNFs in elderly patients. This model would help in individualized evaluation of the need for reoperation and inform strategies aimed at eliminating the need for the reoperation.

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“…Specifically, cachectic patients or those with prealbumin < 16 mg/dL or albumin < 3.5 mg/dL were provided with oral protein supplements. 11 Vitamin A and micronutrient supplements (zinc and selenium) were provided to patients with perioperative steroid exposure. Patients with prior radiation therapy were placed on a micronutrient supplement.…”

Section: Methodsmentioning

confidence: 99%

A multidisciplinary approach to complex oncological spine coverage in high-risk patients

Nguyen

Patel

West

et al. 2021

Journal of Neurosurgery: Spine

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OBJECTIVEThe consequences of failed spinal hardware secondary to wound complications can increase the burden on the patient while also significantly escalating the cost of care. The objective of this study was to demonstrate the effectiveness of a protocol-based multidisciplinary approach in optimizing wound outcome in complex oncological spine care patients.METHODSA retrospective consecutive case series was performed from 2015 to 2019 of all patients who underwent oncological spine surgery. A protocol was established to identify oncological patients at high risk for potential wound complications. Preoperative and postoperative treatment plans were developed by the multidisciplinary tumor board team members. Wound healing risk factors such as diabetes, obesity, prior spine surgery, pre- or postoperative chemotherapy or radiation exposure, perioperative steroid use, and poor nutritional status were recorded. Operative details, including the regions of spinal involvement, presence of instrumentation, and number of vertebral levels operated on, were reviewed. Primary outcomes were the length of hospitalization and major (requiring reoperation) and minor wound complications in the setting of the aforementioned identified risk factors.RESULTSA total of 102 oncological cases were recorded during the 5-year study period. Of these patients, 99 had local muscle flap reconstruction with layered closure over their surgical hardware. The prevalence of smoking, diabetes, and previous spine surgery for the cohort was 21.6%, 20.6%, and 27.5%, respectively. Radiation exposure was seen in 72.5% of patients (37.3% preoperative vs 48% postoperative exposure). Chemotherapy was given to 66.7% of the patients (49% preoperatively and 30.4% postoperatively). The rate of perioperative steroid exposure was 60.8%. Prealbumin and albumin levels were 15.00 ± 7.47 mg/dL and 3.23 ± 0.43 mg/dL, respectively. Overall, an albumin level of < 3.5 mg/dL and BMI < 18.5 were seen in 64.7% and 13.7% of the patients, respectively. The mean number of vertebral levels involved was 6.76 ± 2.37 levels. Instrumentation of 7 levels or more was seen in 52.9% of patients. The average spinal wound defect size was 22.06 ± 7.79 cm. The rate of minor wound complications, including superficial skin breakdown (epidermolysis) and nonoperative seromas, was 6.9%, whereas that for major complications requiring reoperation within 90 days of surgery was 2.9%.CONCLUSIONSA multidisciplinary team approach utilized in complex multilevel oncological spine reconstruction surgery optimizes surgical outcomes, reduces morbidities, and improves care and satisfaction in patients with known risk factors.

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Serum albumin and fixation failure with cannulated hip screws in undisplaced intracapsular femoral neck fracture

Cited by 18 publications

References 16 publications

Femur neck fracture in young adults, is it really an urgent surgery indication: retrospective clinical study

Femur neck fracture in young adults, is it really an urgent surgery indication: retrospective clinical study

Nomogram for predicting reoperation following internal fixation of nondisplaced femoral neck fractures in elderly patients

A multidisciplinary approach to complex oncological spine coverage in high-risk patients

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