Urinary retention as a postoperative complication associated with functional decline in elderly female patients with femoral neck and trochanteric fractures: A retrospective study of a patient cohort.

Urinary retention (UR) has been recognized as one of the most common postoperative complications after hip surgery in elderly. The objective of the present study was to evaluate risk for postoperative complications of UR in elderly female patients with femoral neck fractures.We recruited 221 female patients (age 85.3 ±â€Š7.0 years) with a history of hip surgery carried out at Toyama Municipal Hospital. UR occurred in 34 out of 221 cases (15.4%). Multiple logistic regression analysis was conducted to investigate the risk factors for UR, including age, body mass index (BMI), serum albumin, cognitive impairment, and activities of daily living (ADL).The results showed significant association of UR with cognitive impairment (P = .005, odds ratio [OR] 4.11, 95% confidence interval [CI] 1.53-11.03), and ADL (P = .029, OR 2.61, 95% CI 1.11-6.18), under adjustment with age and BMI.This study demonstrated that cognitive function and ADL were the important risk factors for UR, suggested that the postoperative management of UR is important with taking account of neurofunctional assistance and nursing care in daily living, especially in elderly female patients receiving surgery of femoral neck and trochanteric fractures.

Neural predisposing factors of postoperative delirium in elderly patients with femoral neck fracture.

Elderly adults are more likely to develop delirium after major surgery, but there is limited knowledge of the vulnerability for postoperative delirium. In this study, we aimed to identify neural predisposing factors for postoperative delirium and develop a prediction model for estimating an individual's probability of postoperative delirium. Among 57 elderly participants with femoral neck fracture, 25 patients developed postoperative delirium and 32 patients did not. We preoperatively obtained data for clinical assessments, anatomical MRI, and resting-state functional MRI. Then we evaluated gray matter (GM) density, fractional anisotropy, and the amplitude of low-frequency fluctuation (ALFF), and conducted a group-level inference. The prediction models were developed to estimate an individual's probability using logistic regression. The group-level analysis revealed that neuroticism score, ALFF in the dorsolateral prefrontal cortex, and GM density in the caudate/suprachiasmatic nucleus were predisposing factors. The prediction model with these factors showed a correct classification rate of 86% using a leave-one-out cross-validation. The predicted probability computed from the logistic model was significantly correlated with delirium severity. These results suggest that the three components are the most important predisposing factors for postoperative delirium, and our prediction model may reflect the core pathophysiology in estimating the probability of postoperative delirium.

Good function and high patient satisfaction at mean 2.8 years after dual mobility THA following femoral neck fracture: a cross-sectional study of 124 patients.

AIMS: Our aim was to investigate function, health status and satisfaction in patients treated with primary dual mobility (DM) total hip arthroplasty (THA) after displaced femoral neck fracture (FNF). PATIENTS AND METHODS: From 2005-2011, 414 consecutive FNF patients received Saturne DM THA. At a minimum of 1-year follow-up, 124 (95 women) were evaluated with Oxford Hip Score (OHS), Harris Hip Score (HHS), health-related quality of life (HRQoL) measure (EQ-5D) and two functional tests: Timed Up and Go (TUG) and Sit to Stand 10 times (STS). The FNF patients were matched 1:2 by age, sex and surgery date with patients receiving THA due to osteoarthrosis (OA group) and 1-year OHS and EQ5D were compared. FNF patients were matched by age and sex with the general population index (GPI) for EQ-5D comparison. RESULTS: Patient age at surgery after FNF was mean 74.8 (range 30-92) years. At mean follow-up of 2.8 (range 1.0-7.7) years, mean EQ-5D score was 0.79 (SD 0.15) in the FNF group, which was similar to the matched GPI (p = 0.4), but lower (p = 0.014) compared to the OA group. Mean OHS was 36.4 (SD 9.5) in the FNF group and 38.4 (SD 7.2) in the OA group (p = 0.18). HHS in the FNF group was 78.7 (SD 15.5). Mean TUG time was 13.5 (SD 4.9) secs, and mean STS was 37.9 (SD 15.3) secs. Eighty nine percent (n = 111) of FNF patients were satisfied with the operation result. CONCLUSION: DM THA following displaced FNF provides a good functional result and quality of life in addition to high patient satisfaction.

Functional outcome and health related quality of life after dual mobility cup total hip replacement for displaced femoral neck fractures in middle aged Egyptian patients.

AIM: This study was done to assess the functional and clinical results after one year of cemented THR with dual mobility cup for the treatment of fracture neck femur in active middle-aged patients in Egypt (Middle Eastern population). PATIENTS AND METHODS: This study included 31 patients (32 hips) with displaced femoral neck fractures that were admitted to El Hadara University Hospital, Alexandria, Egypt. Their mean age was 66.4 ±â€¯5.9 years. Fifteen patients were females. All the patients were treated with total hip replacement using a cemented dual mobility cup (Ecofit® 2 M, Implantcast GmbH, Germany) total hip replacement through the standard posterior approach. Functional assessment was done using Harris Hip Score (HHS), SF-36 questionnaire for health related quality of life (HRQoL) with assistance of a physiotherapist. RESULTS: The mean HHS improved over the follow up period from 79.04 ±â€¯7.9 at 12 weeks to an average of 92.8 ±â€¯11.1 at 1 year follow up. HRQoL measures showed a pattern of initial drop at 3 months postoperatively, then a steady rise to be restored at 1 year as compared to the preoperative baseline measures. There were no dislocations encountered in this series over one year follow up. The following complications were encountered; 1 deep infection, 2 deep vein thrombosis, 2 heterotopic ossifications, and 1 patient died within one year after surgery. CONCLUSIONS: Dual mobility cup total hip replacement is an acceptable method for treatment of displaced femoral neck fracture in active middle aged patients in Egypt as it provides pain relief and good function without compromising the stability.

Development of dementia in patients with femoral neck fracture who experience postoperative delirium-A three-year follow-up study.

OBJECTIVES: It remains unclear to what extent postoperative delirium (POD) affects the incidence of dementia in hip fracture patients, and the methods used to detect delirium and dementia require validation. The aim of this study was to investigate the development of dementia within 3 years of femoral neck fracture repair surgery, with a focus on POD as a potential predictive factor. METHODS: Patients were assessed for cognition, delirium, depression, psychological well-being, and nutritional status during their hospitalization as well as 4, 12, and 36 months after the operation. Logistic regression models were used to analyse factors associated with POD and factors associated with the development of dementia. RESULTS: The study sample consisted of 135 patients without a history of dementia, of whom 20 (14.8%) were delirious preoperatively and 75 (55.5%) postoperatively. Three years after their operations, 43/135 patients (31.8%) were diagnosed with dementia. A greater portion of patients diagnosed with dementia (39/43, 90.6%) than patients with no dementia (36/92, 39.1%) were included among the 75 patients who had experienced POD (P < 0.001). In a logistic regression model, after adjustment for covariates (age, sex, diabetes, delirium pre-and postoperatively, hyperactive delirium, days with delirium, urinary tract infection, and Mini Nutritional Assessment score), POD emerged an independent predictor for the development of new dementia (odds ratio, 15.6; 95% confidence interval, 2.6-91.6) within 3 years after the operation. CONCLUSION: Geriatric hip fracture patients who exhibit POD should be monitored closely for the development of dementia.

Good functional outcome but not regained health related quality of life in the majority of 20-69 years old patients with femoral neck fracture treated with internal fixation: A prospective 2-year follow-up study of 182 patients.

BACKGROUND AND PURPOSE: Prospective studies on patient related outcome in patients <70years with a femoral neck fracture (FNF) are few. We aimed to investigate functional outcome and health-related quality of life (HRQoL) in 20-69years old patients with a FNF treated with internal fixation. PATIENTS AND METHODS: 182 patients, 20-69years with a FNF treated with internal fixation were prospectively included in a multicenter study. Follow up included radiographic and clinical examination at 4, 12 and 24 months. Collected data were hip function using Harris Hip Score (HHS), HRQoL (EQ-5D and SF-36), fracture healing and re-operations. RESULTS: At 24 months, HHS was good or excellent in 73% of the patients with a displaced fracture and 85% of the patients with a non-displaced fracture (p=0.15). Of the patients with displaced fracture (n=120), 23% had a non-union (NU) and 15% had an avascular necrosis (AVN) with a 28% re-operation rate. None of the patients with non-displaced fracture (n=50) had an NU, 12% had a radiographic AVN and 8% needed a re-operation. The mean EQ-5Dindex in patients with displaced fracture decreased from 0.81 to 0.59 at 4 months, 0.63 at 12 months and 0.65 at 24 months (p<0.001). The corresponding values for patients with non-displaced fracture were 0.88, 0.69, 0.75 and 0.74 respectively (p<0.001). The mean SF-total score in patients with displaced fracture decreased from 76 to 55 at 4 months, 63 at 12 months and 65 at 24 months (p<0.001). The corresponding values for patients with non-displaced fracture were 80, 67, 74 and 76 respectively (p<0.001). INTERPRETATION: Two thirds of the patients with displaced femoral neck fracture healed after one operation and three quarters reported good or excellent functional outcome at 24 months. However, they did not regain their pre-fracture level of HRQoL.

The difference in activity of daily living (ADL) and mortality in patients aged over 80 years with femoral neck fracture treated with hemiarthroplasty or osteosynthesis at 2 years of follow-up.

INTRODUCTION: Hip fractures are one of the major causes of morbidity and mortality in the elderly and outcomes following hip fracture have been the focus of several studies over recent decades. Among all types of fall-related injuries, hip fractures cause the greatest number of deaths, lead to severe health problems and reduce quality of life. Improving the outcome of hip fracture surgery has thus become one of the main areas of interest for orthopaedic surgeons. The aim of this study was to compare the difference in activity of daily living (ADL) and mortality between patients aged over 80 years with hip fracture treated with osteosynthesis versus prosthesis at 2 years of follow-up. MATERIALS AND METHODS: The data were collected on admission and during in-hospital stay. Information recorded on admission included: age, sex, type and mechanism of fracture, functional and cognitive status, comorbidity, and severity of illness. Prefracture functional status was measured. The follow-up was clinical and radiographical, or was by telephone for patients who were not able to come to the clinic. Patients aged over 80 years who underwent a single surgical procedure treated with intramedullary nail or hemiarthroplasty were included in the study. RESULTS: A total of 174 patients (45 male and 129 female) were included in the study. The two treatment groups were comparable for all preoperative parameters except for preoperative haemoglobin, which was an average of 1g/dl higher in the patients given hemiarthroplasty compared with those treated with intramedullary nail (t-test: p<0.05). The average observation period was 594.99days; the number of deaths was 62 of 164 contacted patients, and the survival rate at 2 years was 62.2%. There was increased mortality in patients who underwent hemiarthroplasty (Log-rank Mantel-Cox, p: 0,048). The difference in ADL between preoperative and follow-up is not statistically significant between the two groups. DISCUSSION: In the literature, there are few specific studies that consider these parameters in this population. However, these findings are consistent with the findings from other studies. CONCLUSION: Patients who received hemiarthroplasty have a higher mortality risk than those treated with intramedullary nail; there are no differences in ADL at follow-up.

[THE USE OF THE METHOD FOR DETERMINING THE "ORTHOPEDIC INDEX" IN THE TREATMENT OF PATIENTS WITH FEMORAL NECK FRACTURE].

The choice of surgical strategy for the treatment of femoral neck fracture is a serious challenge to modern traumatology and orthopedics. Group I of this study was comprised of patients in whom orthopedic age was determined by our original method including assessment of the quality of life based on the SF-36 questionnaire. The somatic state of the patients was evaluated from the Charlson index and bone quality in the surgical area by densitometry. Patients of the control group were treated by the standard methods adopted in this country and abroad. It was shown that the difference between orthopedic and calendar ages results in the increase of the frequency of complications. The clinical and statistical results of the study indicate that the new method permits to reduce the number of revision interventions, decrease postoperative lethality, and improve the patients' quality of life.

Fixation using alternative implants for the treatment of hip fractures (FAITH): design and rationale for a multi-centre randomized trial comparing sliding hip screws and cancellous screws on revision surgery rates and quality of life in the treatment of femoral neck fractures.

BACKGROUND: Hip fractures are a common type of fragility fracture that afflict 293,000 Americans (over 5,000 per week) and 35,000 Canadians (over 670 per week) annually. Despite the large population impact the optimal fixation technique for low energy femoral neck fractures remains controversial. The primary objective of the FAITH study is to assess the impact of cancellous screw fixation versus sliding hip screws on rates of revision surgery at 24 months in individuals with femoral neck fractures. The secondary objective is to determine the impact on health-related quality of life, functional outcomes, health state utilities, fracture healing, mortality and fracture-related adverse events. METHODS/DESIGN: FAITH is a multi-centre, multi-national randomized controlled trial utilizing minimization to determine patient allocation. Surgeons in North America, Europe, Australia, and Asia will recruit a total of at least 1,000 patients with low-energy femoral neck fractures. Using central randomization, patients will be allocated to receive surgical treatment with cancellous screws or a sliding hip screw. Patient outcomes will be assessed at one week (baseline), 10 weeks, 6, 12, 18, and 24 months post initial fixation. We will independently adjudicate revision surgery and complications within 24 months of the initial fixation. Outcome analysis will be performed using a Cox proportional hazards model and likelihood ratio test. DISCUSSION: This study represents major international efforts to definitively resolve the treatment of low-energy femoral neck fractures. This trial will not only change current Orthopaedic practice, but will also set a benchmark for the conduct of future Orthopaedic trials. TRIAL REGISTRATION: The FAITH trial is registered at ClinicalTrials.gov (Identifier NCT00761813).

[Early results after surgical treatment of femoral neck fractures with total cementless hip arthroplasty]. / Wczesne wyniki leczenia operacyjnego zlaman szyjki kosci udowej calkowita alloplastyka bezcementowa stawu biodrowego.

UNLABELLED: The aim of the study was to assess early results after the treatment of femoral neck fractures with the cementless hip arthroplasty as well as complications after the earlier fixation of these fractures in patients aged 55-70 years. MATERIAL AND METHODS: 40 cementless hip arthroplasty procedures with the use of Bicontact S endoprosthesis were performed, including 33 due to the femoral neck Garden III and IV type fractures, 7 due to the destabilization of the earlier performed bone fixation with DHS (Dynamic Hip Screw) or the nonunion after the fracture fixation. Postoperative complications as well as early clinical and radiological results were assessed. Outpatient follow-up examinations assessed patients using Harris Hip Score (HHS) and Visual Analogue Scale (VAS), to estimate their quality of life and the level of contentment. RESULTS: The total cementless hip arthroplasty with the use of Bicontact endoprosthesis allows to achieve very good early clinical results in patients who have undergone the surgical procedure due to the femoral neck fracture and good clinical results in patients who have undergone this surgery because of complications after the fixation of fractures. In the examined group of patients early radiological results were good. CONCLUSIONS: Based on the very good and good early results of clinical trials can be assumed that the total cementless hip arthroplasty will be an effective and recommended method of treatment of femoral neck fractures and complications after the earlier fixation of these fractures in patients aged 55 to 70 years, but this requires further, long-term observation. Total hip arthroplasty, not the fixation, should be more often considered as a primary care management of fractures of this type because it allows for a pain-free walking faster and faster return to pre-injury functioning.

Symptom profile of postoperative delirium in patients with and without dementia.

This study compares the symptom profile of patients with postoperative delirium after femoral neck fracture surgery in those with and without dementia. In this study, 129 patients of age ≥70 years (mean age ±SD, 86±6 yr, 72% women) with postoperative delirium, were included. Delirium and dementia were diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) criteria. Of the 129 patients with delirium, 54 (42%) had a dementia disorder. Patients with delirium superimposed on dementia more often had any hyperactive and pure emotional delirium. Communication difficulties and symptoms such as restlessness/agitation, aggressive behavior, and irritability were more commonly found in the dementia group. In contrast, patients with delirium but without dementia were more often diagnosed with pure hypoactive and any psychotic delirium. The symptom profile of postoperative delirium varies according to whether it occurs in patients with or without dementia. This may indicate that postoperative delirium among patients with hip fracture differs based on the presence or absence of dementia.

The influence of process and patient factors on the recall of consent information in mentally competent patients undergoing surgery for neck of femur fractures.

INTRODUCTION: Informed consent is an ethical and legal prerequisite for major surgical procedures. Recent literature has identified 'poor consent' as a major cause of litigation in trauma cases. We aimed to investigate the patient and process factors that influence consent information recall in mentally competent patients (abbreviated mental test score [AMTS] ≥6) presenting with neck of femur (NOF) fractures. METHODS: A prospective study was conducted at a tertiary unit. Fifty NOF patients (cases) and fifty total hip replacement (THR) patients (controls) were assessed for process factors (adequacy and validity of consent) as well as patient factors (comprehension and retention) using consent forms and structured interview proformas. RESULTS: The two groups were matched for ASA (American Society of Anesthesiologists) grade and AMTS. The consent forms were adequate in both groups but scored poorly for validity in the NOF group. Only 26% of NOF patients remembered correctly what surgery they had while only 48% recalled the risks and benefits of the procedure. These results were significantly poorer than in THR patients (p = 0.0001). CONCLUSIONS: This study confirms that NOF patients are poor at remembering the information conveyed to them at the time of consent when compared with THR patients despite being intellectually and physiologically matched. We suggest using preprinted consent forms (process factors), information sheets and visual aids (patient factors) to improve retention and recall.

Recovery after hip fractures: influence of bipolar hemiarthroplasty on physical disability and social dependency in the elderly.

Surgical treatment of femoral neck fractures is associated with a significant impact on quality of life. The aim of this study was to determine the long-term influence of displaced femoral neck fractures treated by bipolar hemiarthroplasty on the activities of daily living, quality of life and social dependency. We studied 487 geriatric patients treated in the years 1989 to 2003. At the beginning of follow-up in 2004, 166 patients were alive and evaluation was carried out on 145 patients (87.3%) at 91.3 (14 - 244) months postoperatively by a standardized questionnaire. All enrolled patients had been treated with cemented bipolar hemiarthroplasty for a displaced femoral neck fracture. Patients were evaluated concerning their average pre- and postoperative ability to walk, the need for assisting devices, type of residency and the SF-12® Score. Femoral neck fracture and hemiarthroplasty had a significant influence on all recorded aspects of quality of life. Even though almost two thirds of the patients needed assisting devices to walk after surgery, about two thirds returned to their original type of accommodation and the majority reached their original degree of mobility. Compared to a normal population no significant impact was observed on the quality of life measured by the SF-12® score. We consider bipolar hemiarthroplasty an effective treatment option for displaced femoral neck fractures in geriatric patients. Most patients returned to their original type of accommodation and level of mobility, even though the majority required a number of assisting devices to do so.

Undisplaced femoral neck fractures--no problems? A consecutive study of 224 patients treated with internal fixation.

224 patients with undisplaced femoral neck fractures treated with two parallel Hansson hook pins were studied. After a mean follow-up time of 32 months (S.D. 5.2), 15% had a reoperation. 11% were considered failures, mostly avascular necrosis, and 9% had a secondary arthroplasty. Possible risk factors for poor outcome were analysed. Neither high age nor surgical delay was associated with increased failure rate. Survivors received a questionnaire, and 40% stated that they had mild or severe pain in the hip when walking, 25% had pain at rest and 25 stated that they thought "always" or "often" about their injury. The younger the patient, the more frequent the report of subjective pain. 51% of individuals under 80 years reported pain when walking, compared to 27% aged 80 or older (p=0.016). Corresponding numbers for pain at rest were 32 and 12% (p=0.034). The failure rate did not differ between the age groups, but the younger patients had more reoperations (p=0.046) and thought more frequently about their injury (p=0.016). An undisplaced femoral neck fracture is a major injury with a long-term daily discomfort in about 25% and clinical failure in 11%.

[Anesthetic management in a patient previously diagnosed with takotsubo cardiomyopathy]. / Manejo anestésico en una paciente previamente diagnosticada de síndrome de takotsubo.

Takotsubo cardiomyopathy (transient apical ballooning of the left ventricle) is a recently described and often underdiagnosed entity. The syndrome is observed predominately in postmenopausal women and the clinical signs are similar to those of an acute anterior myocardial infarction. In most of the reported cases an emotional or physical stress event has been identified as a trigger, and perioperative stress has been suggested as the trigger in some of these cases. Outcome is favorable with the right treatment, though recurrences are possible. We report the anesthetic management of a 79-year-old woman with a previously diagnosed episode of Takotsubo cardiomyopathy, who was admitted to our hospital for total hip replacement. Care was taken to provide proper preoperative sedation before provision of hyperbaric spinal anesthesia, followed by sedation with intravenous propofol. Surgery and the early postoperative period were uneventful. We believe that minimizing perioperative anxiety should be a priority in these patients due to the possibility that a catecholamine discharge might trigger an episode of Takotsubo cardiomyopathy.

Use of the Abbreviated Mental Test Score by junior doctors on patients with fractured neck of femur.

INTRODUCTION: The mental state of patients with fractured neck of femur is important as a predictor of post-operative outcome. The Hodgkinson Abbreviated Mental Test Score (AMTS) is a validated and simple method of assessing the pre-operative mental state of patients with fractured neck of femur. This survey investigated whether or not orthopaedic junior doctors (SHOs) appreciated the importance of mental state assessment in patients with fractured neck of femur and whether they were able to recall the questions used in the AMTS. METHOD: A total of 47 on-call orthopaedic and trauma SHOs from the UK were randomly contacted by telephone and agreed to answer questions from a standard questionnaire to assess awareness of the ten-question AMTS. RESULTS: A total of 96% of SHOs claimed awareness of the importance of mental state assessment; 89% used the AMTS in their practice, of which 26% were aided by a pro forma. A mean of five (out of the ten) standard questions on the AMTS were correctly identified (95% CI = 0.68); 11% correctly identified all 10 questions. There was no correlation between use of a pro forma and correct identification of questions. CONCLUSIONS: Patients with fractured neck of femur and low AMTS have higher morbidity and mortality. If the AMTS is to be used as an assessment tool in this setting, then SHOs need to be better informed and educated as to its use. Furthermore, the validity of data collection for research and audit purposes is potentially flawed; as data collected using such scoring systems may be inaccurate.

Evaluation of the health-related quality of life in elderly patients according to the type of hip fracture: femoral neck or trochanteric

OBJECTIVE: To evaluate the effect the type of hip fracture (femoral neck or trochanteric) has on the Health-Related Quality of Life of elderly subjects. METHODS: Forty-five patients with hip fractures (mean 74.30 ± 7.12 years), 24 with a femoral neck fracture and 21 with a trochanteric fracture, completed the 36-item Short Form Health Survey (SF-36) at baseline and four months after fracture. The Health-Related Quality of Life scores were compared according to fracture type, undisplaced and displaced femoral neck fractures, and stable and unstable trochanteric fractures. RESULTS: Compared to baseline, all patients scored lower in the physical functioning, role limitation-physical, bodily pain and vitality categories four months after the fracture had occurred. The SF-36 scores for all the scales did not differ significantly between patients with femoral neck versus trochanteric fractures, or between patients with displaced versus undisplaced femoral neck fractures and stable versus unstable trochanteric fractures. CONCLUSIONS: The mental and physical quality of life of elderly patients with a hip fracture is severely impaired one month after fracture, with partial recovery by the end of the fourth month. The negative impact on the Health-Related Quality of Life did not differ significantly according to fracture type.

Displaced femoral neck fracture: comparison of primary total hip replacement with secondary replacement after failed internal fixation: a 2-year follow-up of 84 patients.

INTRODUCTION: Recent randomized controlled trials have shown that for the active and lucid elderly patient with a displaced femoral neck fracture, a primary total hip replacement (THR) is superior to internal fixation (IF) regarding the need for secondary surgery, hip function and health-related quality of life (HRQoL). Despite the high failure rate for IF, the method is still recommended for this patient cohort by some authors. One argument is that if IF fails, there is always the possibility of performing a secondary salvage THR. The main aim of our study was to determine whether a primary THR, as compared to a secondary THR after failed IF, gives a better outcome after 2 years. METHODS: We compared outcome for 43 patients with a primary THR to the outcome for 41 patients who were treated with a secondary THR after failed IF. All patients (mean age 80 years) were lucid and had a displaced femoral neck fracture. Hip function (Charnley score) and health-related quality of life (HRQoL, EQ5D) were assessed 2 years after the THR procedure. RESULTS: Hip function was better in the primary THR group: the mean Charnley score was 15/18 as compared to 13/18 in the secondary THR group (p < 0.001). The patients with failed IF who later underwent a secondary THR experienced a more pronounced decrease in HRQoL (EQ-5D index score) during the first year of treatment compared to patients in the primary THR group, with a difference of 0.25 in the EQ-5D index score at the 4-month follow-up (p = 0.02). INTERPRETATION: We found that a secondary THR after failed IF results in inferior hip function compared to a primary THR for a displaced femoral neck fracture in the active and lucid elderly patient. Moreover, the patients with failed IF had to undergo at least one re-operation and experienced a significant reduction in HRQoL before the salvage THR.

[Evaluation of the postoperative quality of life in the elderly over 80 years old who underwent hip hemiarthroplasty for femoral neck fracture].

OBJECTIVE: To evaluate the postoperative quality of life of aged patients (> 80 years old) who underwent hip hemiarthroplasty for femoral neck fracture one year ago. METHODS: From February 1995 to February 2001, 52 elderly patients (> 80 years old) underwent the hip hemiarthroplasty after femoral neck fractures. There were 28 males and 24 females, with the average age of 84.2 years old (ranged from 80 - 95 years old). The fracture type was Garden III or IV, and all the patients underwent the hip hemiarthroplasty of domestic prosthesis. Before the operation, most of them were accompanied with pre-existed diseases. Harris hip score including symptoms and the ability of daily life at the one year after operation was adopted for the follow-up. Postoperative A-P and lateral X-ray of hip joint in different phase were also assayed. RESULTS: Forty-six patients (88.46%) were free of pain and satisfied their operations, only 6 patients (11.54%) complained about slight pain. Twenty-four patients (46.2%) were able to walk without any assistant, 24 patients (46.2%) managed to walk by walker, 4 patients (7.7%) could only lie on the bed or move by wheel chair. Postoperatively, patients with neurological diseases such as Parkinson dementia, Senile dementia, cerebrovascular diseases got poor result of the quality of life. However, the other comorbid diseases such as cardiovascular diseases, diabetes mellitus, chronic renal failure, chronic bronchitis did not affect the result. Thirty-eight patients had the postoperative X-ray when they were followed up. Postoperatively, the X-ray were taken from 3 months to 5 years and 6 months, averaged 54.2 months. Sclerotic line were discovered around the shaft of prosthesis only in 3 patients. No complications such as femoral head central dislocation or hip osteoarthritis were found. CONCLUSION: Operative treatment could be actively adopted for aged femoral neck fracture patients without surgical contraindication, which can contribute to obtain the motion ability, reduce complication caused by lying in bed, and keep a good quality of life.

Quality of life and femoral neck fractures.

The worldwide increase in hip fractures is a major challenge to the health care system and society. The proper treatment of femoral neck fractures in the elderly is still controversial, and even more so from an international perspective. Optimising the treatment for improved outcomes and a reduced need for secondary surgery is mandatory for humanitarian and economical reasons. The importance of incorporating the patient's perspective of the outcome in clinical trials has been acknowledged and there are now numerous instruments for assessing the quality of life. We evaluated two quality of life instruments, the EQ-5D and the SF-36, in patients with femoral neck fractures and also measured the quality of life two years after different interventions. The EQ-5D was validated in two prospective studies and it appeared to be an appropriate quality of life instrument in elderly patients with femoral neck fractures. There was a good correlation between the quality of life (EQ-5Dindexscores) and other outcome measures such as pain, mobility and independence in activities of daily living (ADL). The results also showed high responsiveness, i.e., ability to capture clinically important changes, for both the EQ-5D and the SF-36. The questionnaire response rate for both instruments was high. The rated prefracture EQ-5Dindexscores showed good correspondence with the scores of an age-matched Swedish reference population. The quality of life in patients with femoral neck fractures treated with internal fixation (IF) decreased, particularly in patients with fracture healing complications. The fracture healing complications rate at two years in patients with displaced femoral neck fractures treated with IF was 36% compared with 7% in patients with undisplaced fractures. The quality of life of patients with uneventfully healed fractures at two year was lower in patients with primary displaced fractures than in patients with primary undisplaced fractures. In a prospective randomised trial, patients with displaced femoral neck fractures were randomised to IF or total hip replacement (THR). IF resulted in more complications than THR, 36% versus 4%, and necessitated more reoperations, 42% versus 4%. Hip function and quality of life (EQ-5D) were generally better in the THR group. In summary, THR yielded a better outcome than IF for an elderly, relatively healthy, lucid patient with a displaced femoral neck fracture. In a study of elderly women with femoral neck fractures, nearly half of the patients displayed signs of protein-energy malnutrition. Underweight was associated with muscle fatigue, cognitive dysfunction and a low quality of life (Nottingham Health Profile). In a prospective randomised trial, protein-rich liquid supplementation in combination with an anabolic steroid given for 6 months to lean elderly women after a femoral neck fracture was shown to positively affect lean body mass, ADL and quality of life (EQ-5D). Fracture healing complications had a negative impact on body weight, lean body mass and quality of life.