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1.
Bone Joint J ; 102-B(6): 693-698, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32475248

RESUMO

AIMS: Despite few good-quality studies on the subject, total hip arthroplasty (THA) is increasingly being performed for displaced intracapsular fractures of the neck of femur. We compared outcomes of all patients with displacement of these fractures treated surgically over a ten-year period in one institution. METHODS: A total of 2,721 patients with intracapsular fractures of the femoral neck treated with either a cemented hemiarthroplasty or a THA at a single centre were retrospectively reviewed. The primary outcomes analyzed were readmission for any reason and revision surgery. We secondarily looked at mortality rates. RESULTS: We found no difference in the overall revision rate or rate of infection. However, the rates of readmission due to dislocation, pain, and trochanteric bursitis were significantly higher in the THA group (p = 0.001, p < 0.001, p < 0.001, and p = 0.001, respectively). CONCLUSION: Our study, comparing the outcomes of neck of femur fractures treated with a cemented hemiarthroplasty and THA, revealed the perceived superiority of THA was not borne out by our results. This should be carefully considered before any radical change in practice regarding the use of THA for displaced intracapsular fractures of the femoral neck. Cite this article: Bone Joint J 2020;102-B(6):693-698.


Assuntos
Artroplastia de Quadril , Fraturas do Colo Femoral/cirurgia , Hemiartroplastia , Idoso , Idoso de 80 Anos ou mais , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
2.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(3): 404-408, 2020 Mar 15.
Artigo em Chinês | MEDLINE | ID: mdl-32174091

RESUMO

Objective: To review the progress of hip fracture treatment in children. Methods: Literature about the hip fracture treatment in children was extensively reviewed and summarized in terms of anatomy and blood supply, fracture classification, surgical treatment principles, and complications. Results: The anatomical structure of children's hips and the characteristics of peripheral blood supply constantly change with age. Delbet classification is the most classic classification of hip fracture in children. Children's age and Delbet classification have significant effects on surgical treatment strategies and post-fracture complications. The timing of surgical treatment, accurate anatomical reduction, and appropriate internal fixation can effectively improve the prognosis and reduce the incidence of complications. Common complications include osteonecrosis of the femoral head, coxa vara, premature physeal closure, and nonunion. Conclusion: There are still some controversies on the treatment concept and internal fixation choice for children's hip fracture. So it is necessary to further study the anatomy and blood supply characteristics of children's hip, improve the selection and application skills of internal fixation devices, so as to avoid serious complications.


Assuntos
Fraturas do Colo Femoral/cirurgia , Fixação de Fratura , Fraturas do Quadril/cirurgia , Criança , Fixação Interna de Fraturas , Quadril , Humanos , Resultado do Tratamento
3.
Medicine (Baltimore) ; 99(13): e19666, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32221095

RESUMO

Supracondylar femoral fractures are uncommon in children, but may result in various deformities. Though many approaches have been used to manage them, there is no literally approved standard yet.From 2015 to 2017, 12 young children at the average age of 2.5 years old (range 3.6-1.6) with displaced supracondylar fractures were admitted to our department and received closed reduction with crossed Kirschner wire (K-wire) fixation as treatment. After the surgeries, we performed follow-up to every patient at the average length of 26 months (range 24-30) and used the Knee Society Score scale to evaluate the outcome.Fracture healing was observed within 10 weeks for all patients and walking was resumed between 10 to 13 weeks. No patient reported a valgus deformity more than 10°, neurovascular injury or knee infection. The average limb length discrepancy was 0.4 cm at the end of our follow-up. Every patient had perfect score on the Knee Society Score scale.Our study suggests that closed reduction with percutaneous crossed Kirschner wire is a favorable method for displaced supracondylar femoral fractures in young children.


Assuntos
Fios Ortopédicos , Fraturas do Colo Femoral/cirurgia , Fixação Interna de Fraturas/métodos , Pré-Escolar , Feminino , Fixação Interna de Fraturas/efeitos adversos , Consolidação da Fratura/fisiologia , Humanos , Lactente , Masculino , Complicações Pós-Operatórias/epidemiologia , Caminhada/fisiologia
4.
Zhongguo Gu Shang ; 33(1): 43-6, 2020 Jan 25.
Artigo em Chinês | MEDLINE | ID: mdl-32115923

RESUMO

OBJECTIVE: To compare the relationship between direct lateral approach and posterolateral approach in the treatment of femoral neck fracture, and to provide reference for the choice of the best approach. METHODS: From January 2015 to December 2018, 266 patients with femoral neck fracture underwent hip replacement were selected, including 154 males and 112 females, aged 58 to 74 (69.8±8.1) years. Direct lateral approach and posterolateral approach were used in 133 cases in each group. The difference of reoperation rate and dislocation rate between the two groups was compared. Cox proportional risk regression model was used to evaluate the potential factors of reoperation and dislocation after total hip replacement. RESULTS: The rate of reoperation and dislocation in direct lateral approach group was lower than that in posterolateral approach group (P<0.05) . Cox proportional risk regression model showed that posterolateral approach had higher postoperative reoperation rate and dislocation rate than direct lateral approach, and its relative risk ratio (95%CI) was, reoperationï¼»2.65 (1.23- 5.36) , P=0.02ï¼½; dislocationï¼»5.15 (1.68-9.15) , P=0.01ï¼½. CONCLUSION: Posterolateral approach is the influencing factor of reoperation and dislocation after hip replacement. Age, gender, cognitive dysfunction, replacement position, ASA score and other factors have no effect on reoperation and dislocation.


Assuntos
Artroplastia de Quadril , Fraturas do Colo Femoral , Luxações Articulares , Idoso , Feminino , Fraturas do Colo Femoral/complicações , Fraturas do Colo Femoral/diagnóstico , Fraturas do Colo Femoral/cirurgia , Humanos , Luxações Articulares/complicações , Luxações Articulares/diagnóstico , Luxações Articulares/cirurgia , Masculino , Pessoa de Meia-Idade , Reoperação , Resultado do Tratamento
5.
PLoS One ; 15(3): e0229947, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32163456

RESUMO

INTRODUCTION: Previous research suggested that patients have increased risk of infection with increased time from presentation with a femoral neck fracture to treatment with a hip hemiarthroplasty (HHA). The purpose of this study was to determine if rates of prosthetic joint infections within 3 months of surgery was affected by the time from patient presentation with a femoral neck fracture to the time of treatment with HHA. MATERIALS AND METHODS: Acute hip fractures treated with HHA between 2005 and 2017 at three centres in Norway were enrolled in the study. Multi-trauma patients were excluded. Univariable analysis was performed to determine any significant effect of pre-operative waiting time on infection rate. Two pre-planned analyses dichotomizing pre-operative waiting time cut-offs were performed. RESULTS: There were 2300 patients with an average age of 82 (range, 48-100) years included of which 3.4% experienced a prosthetic joint infection within 3 months. The primary analysis found no significant difference in infection rate depending on time to surgery (OR = 1.06 (95% CI 0.94-1.20, p = 0.33)). The secondary analyses showed no significant differences in infection rates when comparing pre-operative waiting time of <24 hours vs ≥24 hours (OR = 0.92 (95% CI 0.58-1.46, p = 0.73)) and <48 hours vs ≥48 hours (OR = 1.39 (95% CI 0.81-2.38, p = 0.23)). CONCLUSION: Based off of a large retrospective Norwegian database of hip fractures there did not appear to be a significant difference in infection rate based on pre-operative wait time to surgery.


Assuntos
Artrite Infecciosa/epidemiologia , Fraturas do Colo Femoral/cirurgia , Hemiartroplastia/efeitos adversos , Prótese de Quadril/efeitos adversos , Infecções Relacionadas à Prótese/epidemiologia , Tempo para o Tratamento , Idoso , Idoso de 80 Anos ou mais , Artrite Infecciosa/etiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Seguimentos , Hemiartroplastia/instrumentação , Hemiartroplastia/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Noruega/epidemiologia , Infecções Relacionadas à Prótese/etiologia , Infecções Relacionadas à Prótese/prevenção & controle , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo
6.
Med Sci Monit ; 26: e919708, 2020 Mar 03.
Artigo em Inglês | MEDLINE | ID: mdl-32126061

RESUMO

BACKGROUND Elderly patients often suffer from postoperative cognitive impairment which increases mortality, morbidity, and the economic burden. However, how continuous femoral nerve block (cFNB) influence the incidence of postoperative cognitive dysfunction (POCD) has never been reported. This study tried to explore how cFNB affects the incidence of POCD among low-risk and high-risk patients with femoral neck fractures. MATERIAL AND METHODS We conducted a retrospective propensity score-matched study and allocated matched patients (n=172) with femoral neck fractures into the cFNB group (n=86) and the control group (n=86). Demographical and clinical data were collected and compared, including the visual analog scale (VAS) score, the morphine consumption, and the POCD incidence. Subgroup analysis of high-risk patients (Mini-Cog score ≤2) and low-risk patients (Mini-Cog score ≥3) was also carried out. RESULTS After matching, baseline characteristics of 2 groups were comparable between the 2 groups (all P>0.05). Compared with the control group, the cFNB group had significantly lower visual analog scale (VAS) score and morphine consumption in the postoperative 3 days (P<0.05). For high-risk patients, the Kaplan-Meier survival curve suggested that the incidence of POCD the cFNB group was significantly lower than the control group (P=0.005), without statistical difference for total or low-risk patients (P>0.05). Multivariate Cox hazard regression analysis showed that the adoption of cFNB conferred a protective effect on POCD (HR=0.556, 95% CI 0.316-0.981, P=0.043). CONCLUSIONS For patients undergoing femoral neck fracture surgery, perioperative cFNB administration is useful in decreasing the incidence of POCD, especially for high-risk patients with a Mini-Cog score equal to or less than 2 points.


Assuntos
Fraturas do Colo Femoral/cirurgia , Nervo Femoral , Bloqueio Nervoso/métodos , Complicações Cognitivas Pós-Operatórias/prevenção & controle , Idoso , Feminino , Humanos , Masculino , Morfina/uso terapêutico , Pontuação de Propensão , Estudos Retrospectivos
7.
JAMA ; 323(11): 1077-1084, 2020 Mar 17.
Artigo em Inglês | MEDLINE | ID: mdl-32181848

RESUMO

Importance: Consensus guidelines and systematic reviews have suggested that cemented fixation is more effective than uncemented fixation in hemiarthroplasty for displaced femoral neck fractures. Given that these recommendations are based on research performed outside the United States, it is uncertain whether these findings also reflect the US experience. Objective: To compare the outcomes associated with cemented vs uncemented hemiarthroplasty in a large US integrated health care system. Design, Setting, and Participants: Retrospective cohort study of 12 491 patients aged 60 years and older who underwent hemiarthroplasty treatment of a hip fracture between 2009 and 2017 at 1 of the 36 hospitals owned by Kaiser Permanente, a large US health maintenance organization. Patients were followed up until membership termination, death, or the study end date of December 31, 2017. Exposures: Hemiarthroplasty (prosthetic replacement of the femoral head) fixation via bony growth into a porous-coated implant (uncemented) or with cement. Main Outcomes and Measures: The primary outcome measure was aseptic revision, defined as any reoperation performed after the index procedure involving exchange of the existing implant for reasons other than infection. Secondary outcomes were mortality (in-hospital, postdischarge, and overall), 90-day medical complications, 90-day emergency department visits, and 90-day unplanned readmissions. Results: Among 12 491 patients in the study cohort who underwent hemiarthroplasty for hip fracture (median age, 83 years; 8660 women [69.3%]), 6042 (48.4%) had undergone uncemented fixation and 6449 (51.6%) had undergone cemented fixation, and the median length of follow-up was 3.8 years. In the multivariable regression analysis controlling for confounders, uncemented fixation was associated with a significantly higher risk of aseptic revision (cumulative incidence at 1 year after operation, 3.0% vs 1.3%; absolute difference, 1.7% [95% CI, 1.1%-2.2%]; hazard ratio [HR], 1.77 [95% CI, 1.43-2.19]; P < .001). Of the 6 prespecified secondary end points, none showed a statistically significant difference between groups, including in-hospital mortality (1.7% for uncemented fixation vs 2.0% for cemented fixation; HR, 0.94 [95% CI, 0.73-1.21]; P = .61) and overall mortality (cumulative incidence at 1 year after operation: 20.0% for uncemented fixation vs 22.8% for cemented fixation; HR, 0.95 [95% CI, 0.90-1.01]; P = .08). Conclusions and Relevance: Among patients with hip fracture treated with hemiarthroplasty in a large US integrated health care system, uncemented fixation, compared with cemented fixation, was associated with a statistically significantly higher risk of aseptic revision. These findings suggest that US surgeons should consider cemented fixation in the hemiarthroplasty treatment of displaced femoral neck fractures in the absence of contraindications.


Assuntos
Artroplastia de Quadril/métodos , Cimentos para Ossos , Fraturas do Colo Femoral/cirurgia , Prótese de Quadril , Complicações Pós-Operatórias/epidemiologia , Reoperação/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Artroplastia de Quadril/efeitos adversos , Artroplastia de Quadril/mortalidade , Feminino , Mortalidade Hospitalar , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Readmissão do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Desenho de Prótese , Estudos Retrospectivos , Risco , Estados Unidos
9.
Medicine (Baltimore) ; 99(7): e19108, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32049822

RESUMO

Aspiration pneumonia (AP) 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 AP in elderly patients with femoral neck fractures.We recruited 426 patients (age 84.9 ±â€Š7.4 years) with a history of hip surgery carried out at Toyama Municipal Hospital. AP occurred in 18 out of 426 cases (4.23%). Statistical test has found significant differences in age, gender, serum albumin level, and cognitive impairment, between AP and non-AP groups. Subsequently multiple logistic regression analysis was conducted to investigate the risk factors for AP, including age, gender, serum albumin, cognitive impairment, and activities of daily living (ADL). Adjusted odds ratio showed significant differences in age, gender, and serum albumin, whereas no significant differences were found in cognitive impairment and ADL.This study suggested that serum albumin seemed to be a risk factor for AP but were necessary to assess under adjustment of confounding factors, including age and gender. Monitoring serum albumin level seemed to be important for the postoperative management of AP, especially in elderly patients receiving surgery of femoral neck and trochanteric fractures.


Assuntos
Fraturas do Colo Femoral/complicações , Pneumonia Aspirativa/etiologia , Complicações Pós-Operatórias/etiologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Feminino , Fraturas do Colo Femoral/cirurgia , Humanos , Masculino , Pneumonia Aspirativa/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Albumina Sérica , Fatores Sexuais
10.
Medicine (Baltimore) ; 99(8): e19039, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32080078

RESUMO

AIM: To compare the efficacy and safety of cemented and uncemented hemiarthroplasty in elderly patients with femoral neck fracture. MATERIALS AND METHODS: We searched PubMed, EMBASE, and Cochrane Library databases for published randomized clinical trials comparing cemented hemiarthroplasty with uncemented hemiarthroplasty in elderly patients with a femoral neck fracture. The search was not limited to language, time, or other factors. The quality of each study was assessed using the revised Jadad scale. Two researchers independently extracted data from all selected studies, including the following base line data: study period, fracture stage, number of patients, male female ratio, average age, and per-protocol (PP) or intent-to-treat (ITT), and the interest outcomes: the mortality at 12 months, operative time, hospital stay, common complications, prosthetic-related complications, blood loss and Harris Hip Score (HHS). Fixed-effects or random-effects models with mean differences and odds ratios were used to pool the continuous and dichotomous variables to determine heterogeneity of the included studies. RESULTS: A total of 8 studies involving 1577 hips (782 uncemented and 795 cemented) were included in this meta-analysis. The meta-analysis is indicated that the operation time of cemented hemiarthroplasty was longer than uncemented hemiarthroplasty and there was statistical significance between two groups (OR = -7.30, 95%CI, -13.13, -1.46; P = .01). However, there was no significant difference between the two methods of fixation in mortality at 12 months (OR = 1.22, 95%CI, 0.94-1.59; P = .14), hospital stay (OR = 0.26, 95%CI, -0.41, 0.93; P = .44), blood loss (OR = -17.94, 95%CI, -65.83, 29.95; P = .46), and HHS score. There were significant differences in the common complications of pulmonary embolism between the two groups, but there were no differences in the other five common complications. The results showed that uncemented hemiarthroplasty could reduce the incidence of pulmonary embolism after operation. Moreover, the outcomes of prosthetic-related complications showed that there were significant differences between the two groups in periprosthetic fracture (OR = 8.32, 95%CI, 3.85-17.98; P < .00001) and prosthetic subsidence and loosening (OR = 5.33, 95%CI, 2.18-13.00; P = .0002). CONCLUSIONS: Our study shows that uncemented prosthesis can shorten the operation time and reduce the incidence of pulmonary embolism, but it does not reduce mortality, blood loss, and hospital stay. Most importantly, the incidence of prosthetic-related complications was higher in uncemented patients.


Assuntos
Cimentos para Ossos/efeitos adversos , Fraturas do Colo Femoral/cirurgia , Hemiartroplastia/tendências , Complicações Pós-Operatórias/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Perda Sanguínea Cirúrgica , Feminino , Fraturas do Colo Femoral/mortalidade , Hemiartroplastia/métodos , Hemiartroplastia/mortalidade , Prótese de Quadril/efeitos adversos , Humanos , Incidência , Tempo de Internação/estatística & dados numéricos , Masculino , Duração da Cirurgia , Embolia Pulmonar/epidemiologia , Ensaios Clínicos Controlados Aleatórios como Assunto
11.
Lancet ; 395(10225): 698-708, 2020 02 29.
Artigo em Inglês | MEDLINE | ID: mdl-32050090

RESUMO

BACKGROUND: Observational studies have suggested that accelerated surgery is associated with improved outcomes in patients with a hip fracture. The HIP ATTACK trial assessed whether accelerated surgery could reduce mortality and major complications. METHODS: HIP ATTACK was an international, randomised, controlled trial done at 69 hospitals in 17 countries. Patients with a hip fracture that required surgery and were aged 45 years or older were eligible. Research personnel randomly assigned patients (1:1) through a central computerised randomisation system using randomly varying block sizes to either accelerated surgery (goal of surgery within 6 h of diagnosis) or standard care. The coprimary outcomes were mortality and a composite of major complications (ie, mortality and non-fatal myocardial infarction, stroke, venous thromboembolism, sepsis, pneumonia, life-threatening bleeding, and major bleeding) at 90 days after randomisation. Patients, health-care providers, and study staff were aware of treatment assignment, but outcome adjudicators were masked to treatment allocation. Patients were analysed according to the intention-to-treat principle. This study is registered at ClinicalTrials.gov (NCT02027896). FINDINGS: Between March 14, 2014, and May 24, 2019, 27 701 patients were screened, of whom 7780 were eligible. 2970 of these were enrolled and randomly assigned to receive accelerated surgery (n=1487) or standard care (n=1483). The median time from hip fracture diagnosis to surgery was 6 h (IQR 4-9) in the accelerated-surgery group and 24 h (10-42) in the standard-care group (p<0·0001). 140 (9%) patients assigned to accelerated surgery and 154 (10%) assigned to standard care died, with a hazard ratio (HR) of 0·91 (95% CI 0·72 to 1·14) and absolute risk reduction (ARR) of 1% (-1 to 3; p=0·40). Major complications occurred in 321 (22%) patients assigned to accelerated surgery and 331 (22%) assigned to standard care, with an HR of 0·97 (0·83 to 1·13) and an ARR of 1% (-2 to 4; p=0·71). INTERPRETATION: Among patients with a hip fracture, accelerated surgery did not significantly lower the risk of mortality or a composite of major complications compared with standard care. FUNDING: Canadian Institutes of Health Research.


Assuntos
Artroplastia de Quadril/métodos , Intervenção Médica Precoce/métodos , Fixação Interna de Fraturas/métodos , Hemiartroplastia/métodos , Fraturas do Quadril/cirurgia , Complicações Pós-Operatórias/epidemiologia , Tempo para o Tratamento/estatística & dados numéricos , Atividades Cotidianas , Idoso , Idoso de 80 Anos ou mais , Doenças Cardiovasculares/mortalidade , Comorbidade , Delírio/epidemiologia , Demência/epidemiologia , Diabetes Mellitus/epidemiologia , Feminino , Fraturas do Colo Femoral/epidemiologia , Fraturas do Colo Femoral/cirurgia , Fraturas do Quadril/epidemiologia , Humanos , Infecções/epidemiologia , Internacionalidade , Masculino , Pessoa de Meia-Idade , Mortalidade , Isquemia Miocárdica/epidemiologia , Casas de Saúde , Redução Aberta/métodos , Hemorragia Pós-Operatória/epidemiologia , Modelos de Riscos Proporcionais , Características de Residência/estatística & dados numéricos , Sepse/epidemiologia , Resultado do Tratamento
13.
Acta Orthop ; 91(1): 58-62, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31635502

RESUMO

Background and purpose - In Denmark, 44 per 10,000 persons over the age of 50 years suffered a hip fracture (HF) in 2011. We characterized the patients and identified risk factors associated with 30-day, 90-day, and 1-year postoperative mortality in Denmark from 2000 to 2014.Patients and methods - The study builds upon data from the Danish National Patients Register and the National Causes of Death Register including all acute hospitalized HF patients aged 18 years and above. Outcomes were 30-day, 90-day, and 1-year postoperative mortality. Mortality risk was analyzed with a univariable and multivariable Cox regression including predefined variables.Results - 113,721 acute hospitalized HF patients were admitted to Danish hospitals between 2000 and 2014. The 30-day mortality risk was 9.6%, 16% at 90 days, and 27% at 1 year after HF surgery. Mortality risk was similar from 2000 to 2014 while the median lengths of stay declined from 14 (IQR 8-25) to 8 (IQR 5-11) days. Male sex, increasing age, higher Charlson Comorbidity Index, per- and subtrochanteric fracture, and operation type other than total hip arthroplasty were independently associated with postoperative mortality.Interpretation - Short- and long-term mortality was high after hip fracture surgery and did not decline in Denmark from 2000 to 2014.


Assuntos
Artroplastia de Quadril/estatística & dados numéricos , Fraturas do Colo Femoral/cirurgia , Fraturas do Quadril/cirurgia , Mortalidade , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Dinamarca , Feminino , Fixação de Fratura/estatística & dados numéricos , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Modelos de Riscos Proporcionais , Sistema de Registros , Fatores Sexuais
14.
Acta Orthop ; 91(2): 133-138, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31735103

RESUMO

Background and purpose - Total hip arthroplasty (THA) is increasing as treatment of displaced femoral neck fractures. Several studies compare hemiarthroplasty (HA) with THA, but results vary and few studies report on medical complications. We examined the outcome of THA and HA with a focus on medical complications, hip complications, and death.Patients and methods - Data from the Swedish Hip Arthroplasty Register on 30,953 acute hip fracture patients treated with cemented THA or HA in 2005-2011 were cross-matched with Statistics Sweden for socioeconomic data and with the National Patient Register for diagnostic codes representing medical complications within 180 days or hip complications within the study period. Propensity score matching was used to create comparable groups based on age, sex, income, level of education, marital status, Elixhauser index, and year of surgery. Logistic regression models were created for each outcome.Results - 81% were treated with HA, 73% and 71% were female (HA and THA respectively). Matching resulted in 2 groups of 5,815 patients each. THA was associated with fewer medical complications (OR = 0.83; 95% CI 0.76-0.91) and lower 1-year mortality (OR = 0.42; CI 0.38-0.48), but more hip complications (OR = 1.31; CI 1.20-1.43).Interpretation - THA as treatment of hip fracture was associated with more hip-related complications than HA. The results on mortality and medical complications are, rather, influenced by residual confounding than by the implant design per se. An expansive use of THAs for hip fracture treatment, at the expense of HAs, is not recommended based on our findings if hip complications are to be avoided.


Assuntos
Artroplastia de Quadril/efeitos adversos , Fraturas do Colo Femoral/cirurgia , Hemiartroplastia/efeitos adversos , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Artroplastia de Quadril/métodos , Artroplastia de Quadril/estatística & dados numéricos , Feminino , Fraturas do Colo Femoral/epidemiologia , Hemiartroplastia/estatística & dados numéricos , Prótese de Quadril/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Desenho de Prótese , Falha de Prótese/etiologia , Sistema de Registros , Fatores Socioeconômicos , Suécia/epidemiologia
15.
Acta Orthop ; 91(1): 1-75, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31801400

RESUMO

Background and purpose - Most guidelines use patient age as a primary decision factor when choosing between osteosynthesis or arthroplasty in displaced femoral neck fractures. We evaluate reoperation and death risk within 1 year after osteosynthesis, and estimate the influence of age, sex, degree of displacement, and bone quality.Patients and methods - All surgeries for femoral neck fractures with parallel implants (2 or 3 screws or pins) performed between December 2011 and November 2015 were collected from the Danish Fracture Database. Radiographs were analyzed for initial displacement, quality of reduction, protrusion, and angulation of implants. The bone quality was estimated using the cortical thickness index (CTI). Garden I and II type fractures with posterior tilt < 20° were excluded.Results - 654 patients with a mean age of 69 years were included. 59% were female. 54% were Garden II with posterior tilt > 20° or Garden III, and 46% were Garden IV. Only 38% were adequately reduced. 19% underwent reoperation and 18% died within 12 months. Female sex, surgical delay between 12 and 24 hours vs. < 12 hours, Garden IV type fracture, inadequate reduction, and protrusion of an implant were associated with statistically significant increased reoperation risk. No significant association between reoperation and age, CTI, or the initial angulation of implants was found. Notably, CTI was linked inversely with death risk.Interpretation - Reoperation risk is linked mainly to primary displacement and reduction of the fracture, with no apparent effect of age or bone quality. Bone quality may be linked with risk of death.


Assuntos
Osso Cortical/patologia , Fraturas do Colo Femoral/cirurgia , Fixação Interna de Fraturas/métodos , Fixação de Fratura/métodos , Mortalidade , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Artroplastia de Quadril , Estudos de Coortes , Osso Cortical/diagnóstico por imagem , Dinamarca , Feminino , Fraturas do Colo Femoral/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão , Modelos de Riscos Proporcionais , Reoperação/estatística & dados numéricos , Risco , Fatores Sexuais , Tempo para o Tratamento , Adulto Jovem
16.
Clin Orthop Relat Res ; 478(1): 90-100, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31855192

RESUMO

BACKGROUND: A displaced femoral neck fracture in patients older than 70 years is a serious injury that influences the patient's quality of life and can cause serious complications or death. Previous national guidelines and a Cochrane review have recommended cemented fixation for arthroplasty to treat hip fractures in older patients, but data suggest that these guidelines are inconsistently followed in many parts of the world; the effects of that must be better characterized. QUESTIONS/PURPOSES: The purpose of this study was to evaluate a large group of patients in the Norwegian Hip Fracture Register to investigate whether the fixation method in hemiarthroplasty is associated with (1) the risk of reoperation; (2) the mortality rate; and (3) patient-reported outcome measures (PROMs). METHODS: Longitudinally maintained registry data from the Norwegian Hip Fracture Register with high completeness (93%) and near 100% followup of deaths were used for this report. From 2005 to 2017, 104,993 hip fractures were registered in the Norwegian Hip Fracture Register. Fractures other than intracapsular femoral neck fractures and operative methods other than bipolar hemiarthroplasty, such as osteosynthesis or THA, were excluded. The selection bias risk on using cemented or uncemented hemiarthroplasty is small in Norway because the decision is usually regulated by tender processes at each hospital and not by surgeon. A total of 7539 uncemented hemiarthroplasties (70% women, mean age, 84 years [SD 6] years) and 22,639 cemented hemiarthroplasties (72% women, mean age, 84 years [SD 6] years) were eligible for analysis. Hazard risk ratio (HRR) on reoperation and mortality was calculated in a Cox regression model adjusted for age, sex, comorbidities (according to the American Society of Anesthesiologists classification), cognitive function, surgical approach, and duration of surgery. At 12 months postoperatively, 65% of patients answered questionnaires regarding pain and quality of life, the results of which were compared between the fixation groups. RESULTS: A higher overall risk of reoperation for any reason was found after uncemented hemiarthroplasty (HRR, 1.5; 95% CI, 1.4-1.7; p < 0.001) than after cemented hemiarthroplasty. When assessing reoperations for specific causes, higher risks of reoperation because of periprosthetic fracture (HRR, 5.1; 95% CI, 3.5-7.5; p < 0.001) and infection (HRR, 1.2; 95% CI, 1.0-1.5; p = 0.037) were found for uncemented hemiarthroplasty than for cemented procedures. No differences were found in the overall mortality rate after 1 year (HRR, 1.0; 95% CI, 0.9-1.0; p = 0.12). Hemiarthroplasty fixation type was not associated with differences in patients' pain (19 versus 20 for uncemented and cemented hemiarthroplasties respectively, p = 0.052) or quality of life (EuroQol [EQ]-VAS score 64 versus 64, p = 0.43, EQ5D index score 0.64 versus 0.63, p = 0.061) 1 year after surgery. CONCLUSIONS: Our study found that the fixation method was not associated with differences in pain, quality of life, or the 1-year mortality rate after hemiarthroplasty. Uncemented hemiarthroplasties should not be used when treating elderly patients with hip fractures because there is an increased reoperation risk.Level of Evidence Level III, therapeutic study.


Assuntos
Cimentos para Ossos , Fraturas do Colo Femoral/cirurgia , Hemiartroplastia/métodos , Idoso , Idoso de 80 Anos ou mais , Feminino , Prótese de Quadril , Humanos , Masculino , Noruega , Medidas de Resultados Relatados pelo Paciente , Desenho de Prótese , Falha de Prótese , Qualidade de Vida , Sistema de Registros , Reoperação , Resultado do Tratamento
18.
Orthop Surg ; 11(6): 1173-1179, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31823497

RESUMO

OBJECTIVE: To evaluate clinical and radiological outcomes of proximal femoral nail anti-rotation (PFNA-II) devices and demonstrate the effectiveness of PFNA-II for the treatment of basicervical fractures in elderly patients. METHODS: A retrospective review of all patients treated with PFNA-II for a proximal femoral fracture between January 2013 and February 2017 at three different institutions (Shanghai General Hospital, Shanghai Punan Hospital and Shanghai Seventh People's Hospital) was conducted. The X-ray films were strictly reviewed by three trauma surgeons and a professional radiology doctor. Patients over 60 years of age who met the following criteria were included: (i) sustained low-energy trauma; (ii) a two-part fracture; (iii) fracture line located at the base of the femoral neck and that was medial to the intertrochanteric line and exited above the lesser trochanter but was more lateral than a classic transcervical fracture. Follow-up time should be longer than 6 months. A total of 52 patients who met the inclusion criteria were selected. The average age at diagnosis was 75.1 years (range, 63-91 years); 13 patients were men and 39 were women. The same proximal femoral nail anti-rotation devices and the same surgical procedures were applied to all patients. Postoperative radiographic union time and modified Harris hip scores were used as major indicators for evaluating the effectiveness of surgery. RESULTS: The average follow-up period was 22.5 months (18.5, 23.9, and 21.2 months, respectively) and radiographic unions were observed at an average of 19.6 weeks (range, 12-28 weeks). The patients were evaluated immediately after surgery, as well as 6 weeks, 3 months, 6 months, 1 year, and 2 years postoperatively. Of the 49 patients, 38 had good reduction qualities (75.5%), 9 acceptable (18.3%), and 3 poor (6.1%). Radiographic union was confirmed in all fractures at an average of 19.6 weeks (range, 12-28 weeks). The mean Harris hip score was 84.9 (range, 65-99): excellent in 9 patients (18.36%), good in 30 (61.22%), medium in 8 (16.32%), and poor in 2 (4.08%). Slight persistent pain occurred in 3 patients, but these patients could still walk with the help of a cane. Two patients had symptoms of excessive telescoping. Eight patients experienced postoperative medical complications, mainly pneumonia and urinary tract infection. CONCLUSION: Based on the clinical and radiological outcomes, the PFNA-II devices provide strong rotational stability and excellent clinical prognosis, and are an appropriate treatment option for basicervical proximal femoral fracture in elderly patients.


Assuntos
Fraturas do Fêmur/cirurgia , Fraturas do Colo Femoral/cirurgia , Fixação Intramedular de Fraturas/métodos , Idoso , Idoso de 80 Anos ou mais , Pinos Ortopédicos , Avaliação da Deficiência , Feminino , Fixação Intramedular de Fraturas/instrumentação , Humanos , Fixadores Internos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Rotação
19.
BMC Musculoskelet Disord ; 20(1): 628, 2019 Dec 27.
Artigo em Inglês | MEDLINE | ID: mdl-31881878

RESUMO

BACKGROUND: Hip hemiarthroplasty (HHA) is a common treatment for hip fractures in the elderly population. Because of the fatal effects of bone cement implantation syndrome, the safety of cement utilization to enhance implant firmness in the femur is controversial. The aim of this study was to investigate the postoperative survival of elderly patients receiving HHA with and without cement fixation. METHODS: Claim data from the National Health Insurance Database and the National Register of Deaths Database were used for analysis in this retrospective cohort study. From 2008 to 2014, 25,862 patients aged 80 years or older treated with hip hemiarthroplasty were included in the analysis. A Cox proportional risk model was used to analyse the effects of cement utilization on postoperative mortality. RESULTS: The cemented group had a significantly higher mortality risk than the non-cemented group within 7, 30, 180 days and 1 year after the operation. The effect of bone cement on postoperative mortality was significantly stronger within 7 days than within 30, 180 days and 1 year. In addition, the male gender, age > 85 years and higher score on the Charlson Comorbidity Index were also risk factors for mortality (p < 0.05). Patients who received HHA in lower-volume hospitals had higher mortality rates within 180 days and 1 year than those in higher-volume hospitals. Compared with patients who were operated on by high-volume surgeons, those who received surgery performed by lower-volume surgeons were more likely to die within 30 days (aHR = 1.22), 180 days (aHR = 1.16) and 1 year (aHR = 1.19), respectively. CONCLUSIONS: The postoperative mortality rate of elderly patients undergoing HHA was significantly higher in the cemented group than in the non-cemented group.


Assuntos
Cimentos para Ossos/efeitos adversos , Fraturas do Colo Femoral/cirurgia , Hemiartroplastia/efeitos adversos , Complicações Pós-Operatórias/mortalidade , Fatores Etários , Idoso de 80 Anos ou mais , Feminino , Hemiartroplastia/instrumentação , Hemiartroplastia/métodos , Prótese de Quadril , Humanos , Masculino , Complicações Pós-Operatórias/etiologia , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Síndrome , Taiwan/epidemiologia , Resultado do Tratamento
20.
BMC Musculoskelet Disord ; 20(1): 632, 2019 Dec 29.
Artigo em Inglês | MEDLINE | ID: mdl-31884960

RESUMO

BACKGROUND: Although the risk factors associated with osteonecrosis of femoral head (ONFH) after internal fixation of femoral neck fracture (IFFNF) have been frequently reported, the results remain controversial. Therefore, its related risk factors were systematically evaluated and meta-classified in this study. METHODS: Literature on risk factors of ONFH caused by IFFNF was retrieved in PubMed, Embase and Cochrane Library due June 2019. Review Manager 5.3 software was applied to data synthesis, and Stata 13.0 software was adopted for analyses of publication bias and sensitivity. RESULTS: A total of 17 case-control studies with 2065 patients were included. The risk of ONFH after IF was 0.40-fold higher in patients with Garden III-IV FNF than that in patients with Garden I-II (OR: 0.40, 95%CI: 0.29-0.55). The risk of OFNH with retained IF was uplifted by 0.04 times (OR: 0.04, 95%CI: 0.02-0.07). There was nonsignificant relationship between gender and ONFH after IFFNF (OR: 1.27, 95%CI: 0.84-1.94). Moreover, ONFH after IFFNF presented no association with age (OR:1.66, 95%CI: 0.89-3.11), injury-operation interval (OR:1.29, 95%CI: 0.82-2.04), fracture reduction mode (OR:1.98, 95%CI: 0.92-4.26), preoperative traction (OR:1.69, 95%CI: 0.29-9.98) and mechanism of injury (OR:0.53, 95%CI: 0.06-4.83). Egger's and Begg's tests indicated a publication bias (P = 0.001). CONCLUSION: It was demonstrated that Garden classification and retained IF were important influencing factors of ONFH after IFFNF. Gender, age, injury-operation interval, fracture reduction mode, preoperative traction and the mechanism of ONFH were irrelevant to the complication.


Assuntos
Fraturas do Colo Femoral/cirurgia , Necrose da Cabeça do Fêmur/epidemiologia , Fixação Interna de Fraturas/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Fatores Etários , Feminino , Fraturas do Colo Femoral/complicações , Necrose da Cabeça do Fêmur/etiologia , Fixação Interna de Fraturas/métodos , Humanos , Masculino , Complicações Pós-Operatórias/etiologia , Fatores de Risco , Fatores Sexuais , Fatores de Tempo
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