Predictability of Neutrophil to Lymphocyte Ratio in preoperative elderly hip fracture patients for post-operative short-term complications: a retrospective study.

PURPOSE: Neutrophil to Lymphocyte Ratio (NLR) is a simple biomarker of systemic inflammatory response. We investigated predictability of NLR for early adverse outcome after surgery for hip fracture in elderly population. METHODS: We reviewed a total of 971 elderly patients with hip fracture who underwent emergency surgery between January 2017 and July 2020 in the Department of Orthopaedics Surgery at the Wollongong Hospital. After considering exclusion criteria, data from a total of 834 patients included in our study. Socio-demographic data, NLR in admission, updated Charlson comorbidity index (uCCI), biochemical markers, mortality rate and 15 short term post-operative complications were collected to determine predictability of NLR for post-operative complications and mortality. RESULTS: After hip surgery, Hospital in-patient case fatality rate was 3.7% (31). In addition, 63.1% (511) of the patients had at least one complication or more. Logistic regression demonstrated that raised NLR (P-value < 0.001, OR 1.05) and uCCI≥4 (P-Value < 0.001, OR 1.75) are associated with post-operative complications. Moreover, decreased haemoglobin was associated with adverse effects (P-value < 0.001, OR 0.97). No association was found for any of these variables with in-patient mortality except for albumin (P-value: 0.03). In addition, despite significant association, ROC analyses showed a low predictability for each of the above variables including NLR (AUC 0.59) for post-operative complications. CONCLUSIONS: Despite significant association, NLR was unable to prognosticate early adverse outcomes. However, it can be considered as a risk factor in admission for postoperative complications in combination with other risk factors and clinical context.

Management Challenges in Atypical Femoral Fractures: A Case Report.

A 78-year-old woman presented with an atypical femoral fracture of her right femur associated with a left thigh stress fracture following 9 years of bisphosphonate therapy. The fracture was managed with femoral nailing. However, she represented 3 years later with peri-prosthetic infection, worsening of the left-side stress fracture, and low bone turnover in a bone metabolic study, consistent with an ongoing bisphosphonate effect. This case highlights the increased rate of postoperative complications in atypical femoral fractures even years after surgery as well as the challenging management issues for contralateral fracture and the risk of missing bilateral fractures.