The effect of postoperative weight-bearing status on mortality rate following proximal femoral fractures surgery

Introduction: Proximal femoral fractures with severe outcome are most common in the increasing group of elderly patients. Aim: Based on the regular data gathered by the EuroHOPE research, the most important aspects and results of the treatment of proximal femoral fractures were studied. Method: Data of hospital admissions due to proximal femoral fractures were analyzed. Results: There was a slight increase in the number of hospitalized patients between 2004 and 2009 in Hungary. 88% of the patients received operative treatment, 41% suffered femoral neck fractures. Mortality rates did not change significantly in the analyzed period. Standardized annual mortality rates for patients who had suffered a femoral neck fracture were 28% when prosthesis was implanted; this result was somewhat more favorable than in case of other surgical procedures. Annual mortality rates were higher in the peritrochanteric fracture group where intramedullary nailing was performed (36%). The ratio of operated patients did not differ significantly from international results. Mortality rates in Hungary were significantly less favorable. 30 day standardized mortality rate was 13.6% in 2008, twice as high as the rate in Finland, The Netherlands, Norway, Scotland and Sweden. The 40% mortality rate calculated for 365 days was significantly higher than international results. Conclusion: To define the measures needed to improve results, systematic analysis of both in-hospital treatment protocols, and follow-up treatment is necessary. Orv. Hetil., 2016, 157(41), 1642–1648.

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Comparison of Clinical Outcomes Between Cephalomedullary Nails and Dynamic Hip Screws for Basicervical Proximal Femoral Fractures

10.21203/rs.3.rs-37367/v1 ◽

2020 ◽

Author(s):

Zhen Jian ◽

Tao Lv ◽

Rongguang Ao ◽

Xinhua Jiang ◽

Jianhua Zhou ◽

...

Keyword(s):

Clinical Outcomes ◽

Weight Bearing ◽

Femoral Fractures ◽

Osteoporosis Treatment ◽

Proximal Femoral Fracture ◽

Proximal Femoral Fractures ◽

Anatomic Reduction ◽

Significant Difference ◽

The Mean ◽

Cephalomedullary Nails

Abstract Background Basicervical proximal femoral fractures have greater biomechanical instability and higher incidence of implant-related complications than other types of proximal femoral fractures. The present retrospective study was performed to find a proper fixation treating basicervical proximal femoral fractures by a comparation of clinical outcomes between cephalomedullary nails and dynamic hip screws, and introduce our experience in surgical tricks and perioperative management. Methods Between January 2015 and December 2018, 821 patients aged 60 years or older suffering from a proximal femoral fracture and receive internal fixation surgery were reviewed. 25 patients of basicervical femoral fractures were included in the study according to inclusion and exclusion criteria. 7 patients were treated with a DHS, 18 with the CMN. Relevant operational data and clinical evaluation were collected. Results Reduction qualities of 6 patients were good (85.7%), 1 were acceptable (14.3%) in DHS Group and 14 of the 18 patients were good (77.8%), 4 were acceptable (22.2%) in CMN Group. The mean TAD in DHS Group of was 17.4 mm while 20.3 mm in CMN Group. Bone union had been achieved 19.9 weeks in DHS Group and 17.8 weeks in CMN Group. The mean Harris score at the final follow up was 83.9, 84.4 respectively in DHS and CMN Group with no significant difference. Conclusions DHS was not inferior for the treatment of basicervical proximal femoral fractures compared to CMNs with blade type or two integrated screw type. When applied properly, both CMNs with blade type or two integrated screw type and DHS can achieve satisfied prognosis. Our unique experiences included anatomic reduction during surgery, anti-osteoporosis treatment and prolonged weight-bearing time.

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Association of hip osteoporosis with pattern of proximal femoral fractures

Journal of Analytical Research in Clinical Medicine ◽

10.15171/jarcm.2019.008 ◽

2019 ◽

Vol 7 (2) ◽

pp. 41-44

Author(s):

Nasrin Navaeifar ◽

Ali Tabrizi ◽

Fatemeh Shirzadi

Keyword(s):

Vitamin D ◽

Mortality Rate ◽

Elderly Patients ◽

Femoral Fractures ◽

The Elderly ◽

Proximal Femoral Fractures ◽

Mineral Density ◽

Articular Fracture ◽

Articular Fractures ◽

Significant Difference

Introduction: Proximal femoral fractures account for a large number of hospitalization cases among the elderly patients. The proximal femoral fractures pattern based on intra-articular or extra-articular could affect the treatment options and induce several complications. The aim of this study is to evaluate the relationship between the severity of osteoporosis and pattern of proximal femoral fractures among elderly patients. Methods: In this cross-sectional study, 83 patients over than 65 years old were enrolled from 2014 to 2018 in the orthopedic department of Urmia University of Medical Sciences, Urmia, Iran. Bone mineral density (BMD) was determined by dual energy x-ray absorptiometry (DXA) at the time of hospitalization. Vitamin D level was also measured. Finally, the mortality rate was determined in 12-month follow-up after the operation. Results: In this study, 83 patients with proximal femoral fractures including 60 cases (72.3%) with extra-articular fractures and 23 cases (27.7%) with intra-articular fractures were investigated. The mean vitamin D level of these two groups [patients with intra-articular fracture (34.4 ± 24.7 nmol/l) and extra-articular fracture (11.3 ± 5.4 nmol/l)] was significantly different (P = 0.020). A significant difference was also observed in the bone densities (based on T-score) of these two groups (P < 0.001). The patients’ mortality rate was significantly different and it was higher in patients with extra-articular fracture (23.0%) compared to those with intra-articular fracture (17.3%) (P = 0.020). Conclusion: In the case of elderly patients, the hip bone density and vitamin D levels play a decisive role in predicting the pattern of proximal femoral fractures. It was also associated with increased mortality among the elderly patients.

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Mortality escalates in patients of proximal femoral fractures with COVID-19: A systematic review and meta-analysis of 35 studies on 4225 patients

Journal of Clinical Orthopaedics and Trauma ◽

10.1016/j.jcot.2021.03.023 ◽

2021 ◽

Author(s):

Mohit Kumar Patralekh ◽

Vijay Kumar Jain ◽

Karthikeyan P. Iyengar ◽

Gaurav Kumar Upadhyaya ◽

Raju Vaishya

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Femoral Fractures ◽

Proximal Femoral Fractures

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Finite element analysis of double‐plate fixation using reversed locking compression‐distal femoral plates for Vancouver B1 periprosthetic femoral fractures

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04152-5 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Daisuke Takahashi ◽

Yoshihiro Noyama ◽

Tsuyoshi Asano ◽

Tomohiro Shimizu ◽

Tohru Irie ◽

...

Keyword(s):

Finite Element Analysis ◽

Finite Element ◽

Plate Fixation ◽

Weight Bearing ◽

Femoral Fractures ◽

Full Weight Bearing ◽

Loading Test ◽

Lateral Plate ◽

Element Analysis ◽

Periprosthetic Femoral Fractures

Abstract Background Internal fixation is recommended for treating Vancouver B1 periprosthetic femoral fractures. Although several fixation procedures have been developed with high fixation stability and union rates, long-term weight-bearing constructs are still lacking. Therefore, the aim of the present study was to evaluate the stability of a double-plate procedure using reversed contralateral locking compression-distal femoral plates for fixation of Vancouver B1 periprosthetic femoral fractures under full weight-bearing. Methods Single- and double-plate fixation procedures for locking compression-distal femoral plates were analysed under an axial load of 1,500 N by finite element analysis and biomechanical loading tests. A vertical loading test was performed to the prosthetic head, and the displacements and strains were calculated based on load-displacement and load-strain curves generated by the static compression tests. Results The finite element analysis revealed that double-plate fixation significantly reduced stress concentration at the lateral plate place on the fracture site. Under full weight-bearing, the maximum von Mises stress in the lateral plate was 268 MPa. On the other hand, the maximum stress in the single-plating method occurred at the defect level of the femur with a maximum stress value of 1,303 MPa. The principal strains of single- and double-plate fixation were 0.63 % and 0.058 %, respectively. Consistently, in the axial loading test, the strain values at a 1,500 N loading of the single- and double-plate fixation methods were 1,274.60 ± 11.53 and 317.33 ± 8.03 (× 10− 6), respectively. Conclusions The present study suggests that dual-plate fixation with reversed locking compression-distal femoral plates may be an excellent treatment procedure for patients with Vancouver B1 fractures, allowing for full weight-bearing in the early postoperative period.

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Early Surgery Does Not Improve Outcomes for Patients with Periprosthetic Femoral Fractures—Results from the Registry for Geriatric Trauma of the German Trauma Society

Medicina ◽

10.3390/medicina57060517 ◽

2021 ◽

Vol 57 (6) ◽

pp. 517

Author(s):

Christopher Bliemel ◽

Katherine Rascher ◽

Tom Knauf ◽

Juliana Hack ◽

Daphne Eschbach ◽

...

Keyword(s):

Surgical Treatment ◽

Mortality Rate ◽

Femoral Fractures ◽

Geriatric Trauma ◽

Outcome Parameters ◽

Periprosthetic Femoral Fractures ◽

Trauma Society ◽

Eq5d Index ◽

Early Surgical Treatment

Background and Objectives: Appropriate timing of surgery for periprosthetic femoral fractures (PFFs) in geriatric patients remains unclear. Data from a large international geriatric trauma register were analyzed to examine the outcome of patients with PFF with respect to the timing of surgical stabilization. Materials and Methods: The Registry for Geriatric Trauma of the German Trauma Society (Deutsche Gesellschaft für Unfallchirurgie (DGU)) (ATR-DGU) was analyzed. Patients treated surgically for PFF were included in this analysis. As outcome parameters, in-house mortality rate and mortality at the 120-day follow-up as well as mobility, the EQ5D index score and reoperation rate were analyzed in relation to early (<48 h) or delayed (≥48 h) surgical stabilization. Results: A total of 1178 datasets met the inclusion criteria; 665 fractures were treated with osteosynthesis (56.4%), and 513 fractures were treated by implant change (43.5%). In contrast to the osteosynthesis group, the group with implant changes underwent delayed surgical treatment more often. Multivariate logistic regression analysis of mortality rate (p = 0.310), walking ability (p = 0.239) and EQ5D index after seven days (p = 0.812) revealed no significant differences between early (<48 h) and delayed (≥48 h) surgical stabilization. These items remained insignificant at the follow-up as well. However, the odds of requiring a reoperation within 120 days were significantly higher for delayed surgical treatment (OR: 1.86; p = 0.003). Conclusions: Early surgical treatment did not lead to decreased mortality rates in the acute phase or in the midterm. Except for the rate of reoperation, all other outcome parameters remained unaffected. Nevertheless, for most patients, early surgical treatment should be the goal, so as to achieve early mobilization and avoid secondary nonsurgical complications. If early stabilization is not possible, it can be assumed that orthogeriatric co-management will help protect these patients from further harm.

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