No rest for elderly femur fracture patients: early surgery and early ambulation decrease mortality.

BACKGROUND: Literature has shown a significant correlation between early treatment and mortality in femur fractures, but the influence of time to ambulation on mortality has not been studied. The purpose of the present study is to evaluate whether time to ambulation is correlated to femur fracture mortality independently from time to surgery. PATIENTS AND METHODS: All patients older than 65 years admitted at a level I trauma center with proximal femoral fracture during a 1-year period were included. The following data were collected: age, gender, date and time of admission to emergency department, height, weight, body mass index, type and side of fracture, ASA score, date and time of surgery, surgical time, time to ambulation, length of hospitalization, death during hospitalization, and mortality at 6 and 12 months. RESULTS: The study sample comprises 516 patients. The mean age was 83.6 years; ASA score was 3-5 in 53% of patients; 42.7% presented with medial fracture; mean time between admission and surgery was 48.4 h; 22.7% of patients were not able to walk during the first 10 days after fracture; mean duration of hospitalization was 13 days; and mortality was 17% at 6 months and 25% at 1 year. Early surgery and walking ability at 10 days after trauma were independently and significantly associated with mortality at 6 months (p = 0.014 and 0.002, respectively) and at 1 year (0.027 and 0.009, respectively). CONCLUSIONS: Early surgery in femur fracture became a priority in health systems, but early postoperative physiotherapy also plays a major role in prevention of mortality: independently from surgical timing, patients who did not walk again within 10 days from surgery showed mortality rates higher than those of patients who did. LEVEL OF EVIDENCE: IV.

Surgical hip dislocation vs arthroscopy for fixation of subfoveal femoral head fractures: A new technique for Pipkin type 1 fractures.

BACKGROUND: Reduction and fixation of Pipkin type I femoral head fractures may be performed either via surgical dislocation either via hip arthroscopy but to our knowledge no studies compared those techniques. Aim of our study is to compare (1) Fracture reduction quality, (2) modified Harris hip score at a minimum of 2 years, and (3) Frequency of complications in a case series of patients with femoral head fractures treated with those approaches. Methods Five cases of arthroscopic fixation of femoral head fracture (AG) have been compared with our historical cohort (8 patients, SDG). Patient demographic, injury, and surgical variables as well as complications were recorded and retrospectively evaluated. Radiographic outcome was scored according to Matta's criteria on postoperative radiographs and clinical outcomes were evaluated with the modified Harris hip score. Results Fracture reduction was anatomic in five hips and imperfect in two in the SDG while four hip were classified as anatomic and one imperfect in the AG. The mean clinical scores were significantly different between the two groups (p=0.03): 88 points in SDG (SD 7) and 94 points in AG (SD 5). In the SDG, one patient developed symptomatic femoral head AVN and one had heterotopic ossification. In the AG, no complication (heterotopic ossification and AVN) but one grade I sign of arthritis were noted. Conclusions Arthroscopic reduction and fixation of Pipkin type I fracture shows radiographic results comparable to surgical dislocation but better clinical results and lower rate of comorbidity.