Surgical interventions for treating extracapsular hip fractures in older adults: a network meta-analysis

Lewis, Sharon R; Macey, Richard; Lewis, Joseph D.; Stokes, Jamie R.; Gill, James R.; Cook, Jonathan; Eardley, William; Parker, Martyn J.

doi:10.1002/14651858.cd013405.pub2

Cited by 27 publications

(24 citation statements)

References 235 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Dynamic sliding implants such as Dynamic Hip Screw (DHS) or Proximal Femoral Nail Anti‐rotation (PFNA‐II) is the golden standard in trochanteric fractures as it did yield a lower risk of unplanned return to theater 14 . However, excessive sliding or femoral medialization of those implants is a risk factor for implant failure 15 and is a unique complication that occurs almost exclusively in the treatment of unstable trochanteric fractures with cephalomedullary nailing 16 .…”

Section: Introductionmentioning

confidence: 99%

“…6 Dynamic sliding implants such as Dynamic Hip Screw (DHS) or Proximal Femoral Nail Anti-rotation (PFNA-II) is the golden standard in trochanteric fractures as it did yield a lower risk of unplanned return to theater. 14 However, excessive sliding or femoral medialization of those implants is a risk factor for implant failure 15 and is a unique complication that occurs almost exclusively in the treatment of unstable trochanteric fractures with cephalomedullary nailing. 16 Law et al found that intramedullary nailing of unstable intertrochanteric fractures is inherently predisposed to femoral neck element medial migration making it more susceptible to consequent cut-out compared to fixation with the DHS.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Finite‐Element Analysis of a Novel Cephalomedullary Nail for Restricted Sliding to Reduce Risk of Implant Failure in Unstable Intertrochanteric Fractures

Nie

et al. 2022

Orthopaedic Surgery

View full text Add to dashboard Cite

Objective How to restrict sliding of cephalomedullary nail and rigid reconstruct medial support for unstable intertrochanteric fractures remains a challenge. This study aims to explore the feasibility of a novel cephalomedullary nail for restriction sliding and reconstruction of medial femoral support to prevent failure in unstable trochanteric fractures through finite element analysis. Methods The DICOM files of a unilateral femur spiral computed tomography (CT) scans from a elderly female were converted into STL files, and the most common clinical trochanteric fracture model with the absence of medial support, AO/OTA 31‐A2.3 was simulated by removing the posterior medial femur. The model of a novel medial sustain nail (MSN‐II) and a widely used nail (proximal femoral nail anti‐rotation PFNA‐II) were modeled according to the manufacturer‐provided engineering drawing. Different loads were applied to the femoral head to simulate the postoperative weight bearing gait. The sliding distance of helical blade in femoral neck, maximum stress of femur and nail, displacement of proximal fragment were analyzed to revealing the mechanical stability of unstable trochanteric fracture stabilized by different implant. Results The sliding distance of helical blade in the femoral neck, the maximum stress on the femur and nail, the displacement of proximal fragment in MSN‐II under 2100N axial load were 0.65 mm, 689 MPa, 1271 MPa, 16.84 mm respectively, while that were 1.43 mm, 720.8 MPa, 1444 MPa, 18.18 mm, respectively in PFNA‐II. The difference between the two groups was statistically significant (P < 0.05) and the stress was mainly distributed in medial distal side of nail but helical blade and the proximal aperture for the nail in MSN‐II. Compared to PFNA‐II, MSN‐II demonstrates biomechanical merit against femur medialization, cut‐out and coax varus. Conclusion The sliding distance of helical blade in femoral neck, the maximum stress on the femur and nail, and the displacement of proximal fragment of MSN‐II were less than those of PFNA‐II in the treatment of unstable intertrochanteric fractures. Therefore MSN‐II has better stability than PFNA‐II and it may have the potential to avoid femur medialization and cut out. It might be an option in unstable trochanteric fracture because of its superiority in restricted sliding and medial support reconstruction.

show abstract

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Finite‐Element Analysis of a Novel Cephalomedullary Nail for Restricted Sliding to Reduce Risk of Implant Failure in Unstable Intertrochanteric Fractures

Nie

et al. 2022

Orthopaedic Surgery

View full text Add to dashboard Cite

show abstract

“…2 Randomized controlled trials of SHS versus IMN, systematic reviews, registry data, and guidelines all inform implant selection. 1,[3][4][5][6][7][8] SHS and IMN (which may be short or long) are comparable for most (AO, A1, and A2) extracapsular trochanteric fractures. 1 Despite this, many patients with these fractures are treated with IMN.…”

Section: Introductionmentioning

confidence: 99%

“…1,[3][4][5][6][7][8] SHS and IMN (which may be short or long) are comparable for most (AO, A1, and A2) extracapsular trochanteric fractures. 1 Despite this, many patients with these fractures are treated with IMN. [9][10][11] This is important as SHS are considerably more cost-effective, and implant costs have a positive linear association with overall inpatient cost of care.…”

Section: Introductionmentioning

confidence: 99%

Variation of implant use in A1 and A2 trochanteric hip fractures

et al. 2022

View full text Add to dashboard Cite

Aims Patients with A1 and A2 trochanteric hip fractures represent a substantial proportion of trauma caseload, and national guidelines recommend that sliding hip screws (SHS) should be used for these injuries. Despite this, intramedullary nails (IMNs) are routinely implanted in many hospitals, at extra cost and with unproven patient outcome benefit. We have used data from the National Hip Fracture Database (NHFD) to examine the use of SHS and IMN for A1 and A2 hip fractures at a national level, and to define the cost implications of management decisions that run counter to national guidelines. Methods We used the NHFD to identify all operations for fixation of trochanteric fractures in England and Wales between 1 January 2021 and 31 December 2021. A uniform price band from each of three hip fracture implant manufacturers was used to set cost implications alongside variation in implant use. Results We identified 18,156 A1 and A2 trochanteric hip fractures in 162 centres. Of these, 13,483 (74.3%) underwent SHS fixation, 2,352 (13.0%) were managed with short IMN, and 2,321 (12.8%) were managed with long IMN. Total cost of IMN added up to £1.89 million in 2021, and the clinical justification for this is unclear since rates of IMN use varied from 0% to 97% in different centres. Conclusion Most trochanteric hip fractures are managed with SHS, in keeping with national guidelines. There is considerable variance between hospitals for implant choice, despite the lack of evidence for clinical benefit and cost-effectiveness of more expensive nailing systems. This suggests either a lack of awareness of national guidelines or a choice not to follow them. We encourage provider units to reassess their practice if outwith the national norm. Funding bodies should examine implant use closely in this population to prevent resource waste at a time of considerable health austerity. Cite this article: Bone Jt Open 2022;3(10):741–745.

show abstract

“… 19 Most recently, two network meta-analyses including over 100 randomized controlled trails have showed that the 1-year mortality rates were as high as 23.5% and 20.2% in patients with intracapsular and extracapsular hip fracture, respectively. 20 , 21 This increased mortality risk persisted for more than two decades after hip fracture. 22 Due to the advanced age of hip fracture patients, the prevalence of widowhood is relatively high, such as 46.2% in Sweden, 23 43.1% in USA, 24 42.6% in Denmark, 25 and 39.2% in Norway.…”

Section: Introductionmentioning

confidence: 99%

The Widowhood Effect on Mortality in Older Patients with Hip Fracture

Zhu¹,

Wang²,

Wu³

et al. 2022

IJGM

View full text Add to dashboard Cite

Objective Widowed people have increased mortality than married people of the same age, a phenomenon known as the widowhood effect. This study aimed to investigate whether this effect exists in older patients with hip fracture. Methods Using our own hip fracture database, a total of 1101 hip fracture patients were consecutively included from January 2014 to December 2021. Marital status was stratified as married (n = 793) and widowed (n = 308). Patients survival status was obtained from medical records or telephone follow-ups, and the outcomes were all-cause mortality at 30 days, 1 year and at latest follow-up. Univariate and multivariate Cox proportional hazard models were used to assess the association between marital status and mortality, and subgroup analyses according to sex were also conducted. Results Compared with married patients, widowed patients were more likely to be older, female and intertrochanteric fracture, and were less likely to be urban area, smoking, drinking, and surgical treatment ( P < 0.05). After a median follow-up of 37.1 months, the 30-day mortality was 4.3% (n = 47), 1-year mortality was 19.3% (n = 178), and total mortality was 34.2% (n = 376). Multivariate Cox analysis showed that widowed marital status remained an independent risk factor for 1-year mortality ( HR = 1.437, 95% CI : 1.054–1.959, P = 0.022), and total mortality ( HR = 1.296, 95% CI : 1.038–1.618, P = 0.022), whereas this association was not found in 30-day mortality ( HR = 1.200, 95% CI : 0.607–2.376, P = 0.599). Moreover, subgroup analyses also found that the widowhood effect on mortality was present in both male and female. Conclusion Widowed marital status seems to be an independent risk factor for long-term mortality in older patients with hip fracture.

show abstract

Surgical interventions for treating extracapsular hip fractures in older adults: a network meta-analysis

Cited by 27 publications

References 235 publications

Finite‐Element Analysis of a Novel Cephalomedullary Nail for Restricted Sliding to Reduce Risk of Implant Failure in Unstable Intertrochanteric Fractures

Finite‐Element Analysis of a Novel Cephalomedullary Nail for Restricted Sliding to Reduce Risk of Implant Failure in Unstable Intertrochanteric Fractures

Variation of implant use in A1 and A2 trochanteric hip fractures

The Widowhood Effect on Mortality in Older Patients with Hip Fracture

Contact Info

Product

Resources

About