Impaired renal function is an independent risk factor for complications after surgery for femoral neck fracture

2021 ◽  
pp. 112070002110285
Author(s):  
Pradip Ramamurti ◽  
Safa C Fassihi ◽  
David Sacolick ◽  
Alex Gu ◽  
Chapman Wei ◽  
...  
Keyword(s):  
Renal Function ◽  
Risk Factor ◽  
Femoral Neck ◽  
Femoral Neck Fracture ◽  
Impaired Renal Function ◽  
Independent Risk Factor ◽  
Femoral Neck Fractures ◽  
Stage 4 ◽  
Ckd Stage ◽  
Neck Fracture

Background: The metabolic abnormalities that occur secondary to chronic kidney disease (CKD) increase the risk of femoral neck fractures compared to the general population. The purpose of this study is to determine whether impaired renal function is an independent risk factor for complications after surgery for femoral neck fracture. Methods: The ACS-NSQIP database was reviewed for patients who underwent total hip arthroplasty, hemiarthroplasty and open reduction internal fixation (ORIF) for femoral neck fractures between 2007 and 2018. Patients were split into cohorts based on calculated estimated glomerular filtration rate. Demographic information, comorbidities, and 30-day complications were analysed with univariate and multivariate analyses using chi-square, Fischer’s exact and analysis of variance testing. Results: The total number of patients for the study was 163,717. Patients with CKD stage 4 and 5 had an increased rate of any complication (39.1 and 36.7% respectively) compared with higher eGFRs ( p  < 0.001). Similarly, 30-day mortality was increased at 6.0% and 6.7% for both stage 4 and 5 ( p  < 0.001). By multivariate regression, those with CKD Stage 4 and 5 were at increased risk for any complication compared to patients with a normal preoperative eGFR of 90–120 ( p  < 0.001). Conclusions: This study demonstrated that patients with CKD Stage 4 and 5 are at increased risks of all complications, including death, renal, pulmonary and thromboembolic disease. Therefore, these patients should be cared for from a multidisciplinary approach with close attention to postoperative medications and fall prevention to help mitigate the risk of complications in the immediate postoperative period.

scholarly journals Deep vein thrombosis in the lower extremities after femoral neck fracture: A retrospective observational study

2020 ◽  
Vol 28 (1) ◽  
pp. 230949901990117
Author(s):  
Ya-Hui Fu ◽  
Ping Liu ◽  
Xin Xu ◽  
Peng-Fei Wang ◽  
Kun Shang ◽  
...  
Keyword(s):  
Risk Factor ◽  
Femoral Neck ◽  
Femoral Neck Fracture ◽  
Independent Risk Factor ◽  
Incidence Rates ◽  
Femoral Neck Fractures ◽  
Vein Thrombosis ◽  
Before And After ◽  
Neck Fracture ◽  
Deep Vein

Purpose: The actual incidence of deep vein thrombosis (DVT) in femoral neck fractures is underestimated. This study aimed to investigate the incidence of DVT in the lower extremities after femoral neck fracture before and after operation. Methods: The clinical data of patients with femoral neck fractures treated at Xi’an Honghui Hospital between July 1, 2016, and December 31, 2018, were collected. The patients were examined with ultrasonography before and after operation and divided into thrombosis and non-thrombosis groups according to their ultrasonographic results. The incidence of DVT was reported as a percentage. Results: The incidence rates of preoperative and postoperative DVT were 32% and 56%, respectively. DVT on the uninjured side constituted 45% of all preoperative DVT and 43% of all postoperative DVT. Peripheral DVT constituted 90% and 84% of all preoperative and postoperative DVT, respectively. Diabetes was an independent risk factor of preoperative DVT. Blood loss was an independent risk factor of postoperative DVT, and open reduction and internal fixation surgical procedure was independent protective factor of postoperative DVT as compared with hemiarthroplasty and total hip replacement. Conclusions: The incidence rates of preoperative and postoperative DVT in the patients with femoral neck fracture were high, and orthopedists should pay more attention to DVT as a complication.

scholarly journals The Probability of And Risk Factors For Femoral Neck Shortening And Internal Fixation Failure After Femoral Neck Fracture Treatment Using Cannulated Screws Combined With A Medial Buttress Plate

2021 ◽  
Author(s):  
Jinglei Xu ◽  
Xue Bai ◽  
Chenyang Xu ◽  
Xianzhong Ma
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Femoral Neck ◽  
Internal Fixation ◽  
Femoral Neck Fracture ◽  
Independent Risk Factor ◽  
Cannulated Screws ◽  
Fixation Failure ◽  
Neck Fracture ◽  
Buttress Plate

Abstract Background: Femoral neck shortening and internal fixation failure are two most prevalent complications associated with surgical treatment of femoral neck fracture. This study evaluates the probability of and risk factors for these complications after the treatment of femoral neck fracture using cannulated screws combined with a medial buttress plate.Methods: Data of 70 patients with femoral neck fractures treated using cannulated screws combined with a medial buttress plate in our hospital between March 2016 and March 2019 were retrospectively analyzed, and 40 patients who were followed up for no less than 6 months were enrolled in the study. We evaluated the probability of postoperative femoral neck shortening and internal fixation failure and conducted multivariate logistic regression analysis to determine risk factors.Results: Among 40 patients, 11 had femoral neck shortening＞5 mm and 8 had fracture nonunion or screw cutout. There were significant differences in screw quality between the shortening and non-shortening groups; There were significant differences in fracture site and shortening between the fixation failure and non-failure groups. According to the multivariate analysis, screw quality was an independent risk factor for femoral neck shortening (odds ratio [OR]: 8.58; 95% confidence interval [CI]: 1.35–50.57; P=0.022), and femoral neck shortening was an independent risk factor for internal fixation failure (OR: 11.82; 95% CI: 1.66–84.36; P=0.014).Conclusions: Femoral neck fracture treatment using cannulated screws combined with a medial buttress plate led to a femoral neck shortening rate lower than that of other internal fixation methods and an internal fixation failure rate lower than or equivalent to that of other internal fixation methods. The quality of cannulated screws is a risk factor for postoperative shortening of the femoral neck, and femoral neck shortening is a risk factor for postoperative internal fixation failure.

scholarly journals Calcar buttressed screw fixation for femoral neck fracture

2018 ◽  
Vol 5 (1) ◽  
pp. 145
Author(s):  
K. K. Arvind Manoj ◽  
R. Karthik ◽  
A. Vishnu Sankar
Keyword(s):  
Femoral Neck ◽  
Functional Outcome ◽  
Femoral Neck Fracture ◽  
Screw Fixation ◽  
Femoral Neck Fractures ◽  
Fixation Strength ◽  
Harris Hip Score ◽  
Average Period ◽  
Excellent Outcome ◽  
Neck Fracture

<p class="abstract"><strong>Background:</strong> The incidence of neck of femur fracture among elderly population is increasing day by day. Femoral neck fracture has always been an unsolved fracture<strong> </strong>as far as treatment and results are concerned. There are different views regarding the optimal method of internal fixation in femoral neck fractures. Biomechanical data from literature suggest that calcar fixation is superior to central screws placement. This study aims to analyse the functional and radiological outcome of femoral neck fractures treated by calcar buttressed screw fixation described by Filipov as biplane double supported screw fixation.</p><p class="abstract"><strong>Methods:</strong> This is a prospective study conducted in our institution from May 2015 to May 2018.The study included 43 patients (31 male, 12 female) with femoral neck fracture. Three 6.5-mm cannulated screws were laid in two medially diverging oblique planes. The distal and the middle screws were supported on the calcar. The distal screw had additional support on the posterior neck cortex. Patients were followed up for average period of 2 years. Functional outcome was evaluated using Harris Hip score.<strong></strong></p><p class="abstract"><strong>Results:</strong> Bone union occurred in 40 patients (93%) with average period of 3-4 months.<strong> </strong>51.2% of cases had<strong> </strong>excellent outcome. 23.2% of cases had good and 16.3% of cases had fair outcome. 9.3% of cases ended with poor outcome. Non union was reported in 3 patients (7%) and AVN in one patient. Various factors like age, Garden and Pauwel fracture types, time of presentation and time of surgery were statistically significant to the final functional outcome in our study.</p><p><strong>Conclusions:</strong> By providing additional calcar buttress compared to conventional method, this technique of screw fixation enhances femoral neck fracture fixation strength and reduces the fixation failure. </p>

scholarly journals Impact of Cigarette Smoking on Re-operation and Revision Surgery after Femoral Neck Fracture Treatment

2020 ◽  
Vol 13 ◽  
pp. 195-201
Author(s):  
Mitchell Messner ◽  
Alexander Chong ◽  
Bruce Piatt
Keyword(s):  
Femoral Neck ◽  
Femoral Neck Fracture ◽  
Femoral Neck Fractures ◽  
Non Union ◽  
Initial Fixation ◽  
Neck Fracture ◽  
Group 3 ◽  
Former Smokers ◽  
Group 2 ◽  
Group 1

Introduction. Smokers and nicotine users have a higher risk of femoral neck fracture non-union and prolonged time to fracture union. The impact of smoking resulting in revision surgery after fixation of femoral neck fractures, however, rarely has been studied. The aim of this retrospective study was to review if cigarette smoking had an influence on re-operation and revision after femoral neck fracture treatment. Methods. Three groups of patients (Group 1: active smokers; Group 2: former smokers; and Group 3: non-smokers) who sustained a femoral neck fracture from January 2012 through August 2018 were included. Outcomes investigated included femoral neck fracture type, operative fixation type, fixation failure, and time interval between initial fixation and revision. Results. A total of 1,452 subjects were identified (Group 1: 165 subjects; Group 2: 507 subjects; and Group 3: 780 subjects). In the male population, Groups 1 and 2 had higher rates of femoral neck fracture than Group 3. Twelve cases required revisions (Group 1: three cases (6%); Group 2: two cases (2%); Group 3: seven cases (4%)), with all but one revision within the first year following initial fixation. Group 1 patients tended to be younger than the other two groups. Conclusion. Smoking has a positive association with the risk of femoral neck fracture amongst active and former male smokers. This study concluded that active smokers have a higher risk of non-union compared with non-smokers or former smokers. Smoking history, especially heavy or long-term, should play a role in deciding which fixation construct type to use for femoral neck fractures.

scholarly journals Serum albumin and fixation failure with cannulated hip screws in undisplaced intracapsular femoral neck fracture

2016 ◽  
Vol 98 (6) ◽  
pp. 376-379 ◽  
Author(s):  
O Riaz ◽  
R Arshad ◽  
S Nisar ◽  
R Vanker
Keyword(s):  
Femoral Neck ◽  
Serum Albumin ◽  
Femoral Neck Fracture ◽  
Femoral Neck Fractures ◽  
Fixation Failure ◽  
Non Union ◽  
Preoperative Serum ◽  
Neck Fracture ◽  
Posterior Tilt ◽  
Intracapsular Femoral Neck Fracture

Introduction Internal fixation of undisplaced intracapsular femoral neck fractures with cannulated hip screws is a widely accepted surgical technique, despite reported failure rates of 12%–19%. This study determined whether preoperative serum albumin levels are linked to fixation failure. Methods We retrospectively reviewed 251 consecutive undisplaced intracapsular femoral neck fracture patients treated with cannulated hip screws in a district general hospital. Preoperative albumin levels were measured, and the fixation technique, classification and posterior tilt on radiography assessed. Fixation failure was defined as a screw cut, avascular necrosis (AVN) or non-union. Results Of the patients, 185 were female and 66 male. The mean age was 77 years (range 60–101 years). Thirty seven (15%) patients had fixation failure: 10 (4%) due to AVN; 12 (5%) due to non-union; and 15 (6%) due to fixation collapse. Low serum albumin levels were significantly associated with failure (p=0.01), whereas gender (p=0.56), operated side (p=0.62), age (p=0.34) and screw configuration (p=0.42) were not. A posterior tilt angle greater than 20° on lateral radiography significantly predicted failure (p=0.002). Conclusions Preoperative serum albumin is an independent predictor of cannulated hip screw fixation failure in undisplaced femoral neck fractures. Nutritional status should therefore be considered when deciding between surgical fixation and arthroplasty to avoid the possibility of revision surgery, along with an increased risk of morbidity and mortality.

Modified F Configuration in the Treatment of Pauwels Type III Femoral Neck Fracture: a Finite Element Analysis

2021 ◽  
Author(s):  
Shiyuan Lin ◽  
Huizi Li ◽  
Kai Tong ◽  
Zihang Feng ◽  
Gang Wang ◽  
...  
Keyword(s):  
Finite Element ◽  
Stress Distribution ◽  
Femoral Neck ◽  
Femoral Neck Fracture ◽  
Femoral Neck Fractures ◽  
Cannulated Screw ◽  
Type Iii ◽  
Neck Fracture ◽  
Maximum Crack ◽  
Hip Screw

Abstract Background: The optimal treatment of Pauwels type III femoral neck fracture in young patients remains a worldwide challenge in orthopedic surgery. Methods: Finite element models of four internal fixations were developed to treat Pauwels type III Femoral neck fracture: a: the traditional inverted triangular cannulated screw model, b: the F-technique cannulated screw model, c: the modified F-technique cannulated screw model using a fully threaded screw instead of a partially threaded distally, d: the dynamic hip screw coupled with anti-rotational screw model. Under the same conditions, finite element analyses were carried out to compare the displacement and von Mises stress distribution of four internal fixations and femurs, the maximum crack distances of the fracture surfaces, Z axis displacements of four models as well as the stress distribution in the subtrochanteric region. Results: The modified F-technique configuration resulted in a more stable fixation as compared to the other three approaches, with respect to the maximum displacement and stress peaks of femur and internal fixations, the maximum crack distances of the fracture surfaces, Z axis displacements of four configurations as well as the stress distribution in the subtrochanteric region.Conclusions: Our results suggested that modified F-technique configuration show a better performance in resisting shearing and rotational forces in treating Pauwels type III femoral neck fractures compared to those using traditional inverted triangular, the F-technique configuration or dynamic hip screw coupled with anti-rotational screw, providing a new choice for the treatment of femoral neck fractures.

Comparative Analysis of Preoperative and Postoperative Muscle Around Hip Joint by Computed Tomography Between Intertrochanteric Fracture and Femur Neck Fracture

2020 ◽  
Author(s):  
Sung Yoon Jung ◽  
Hyeon Jun Kim ◽  
Kyu Taek Oh
Keyword(s):  
Femoral Neck ◽  
Femoral Neck Fracture ◽  
Intertrochanteric Fracture ◽  
Femoral Neck Fractures ◽  
Final Visit ◽  
Cross Sectional ◽  
Fracture Group ◽  
Significant Difference ◽  
Neck Fracture

Abstract Background:This study assessed the changes in hip muscles by comparing the preoperative and postoperative CT scan results between patients with intertrochanteric versus femoral neck fractures. Methods:48 patients who received surgical treatment for intertrochanteric or femoral neck fractures from February 2013 to February 2019 and underwent pelvic computed tomography(CT) preoperative and postoperatively aged 65 and older with a minimum follow-up of 1 year were included. The subjects were divided into two groups: 26 patients with intertrochanteric fracture and 22 patients with femoral neck fracture. We measured the cross-sectional area(CSA) and attenuation of the gluteus medius(G.med), gluteus minimus(G.min), iliopsoas(IP), and rectus femoris(RF) on the contralateral side. Patient basic data were collected from medial records including sex, age, height, weight, BMI, BMD, Harris hip score (HHS), and length of follow-up until the final visit. Results: There was no significant difference in sex, age, height, weight, BMI, BMD, HHS, and length of follow-up until the final visit between two groups. The femoral neck fracture group had significantly larger CSA and cross-sectional area per weight(CSA/Wt) of the G.med and G.min(G.med CSA, CSA/wt preoperative 1995.29 vs 1713.64, 38.87 vs 32.74; postoperative 2144.98 vs 1815.56, 37.48 vs 32.78/G.min preoperative 745.22 vs 566.59, 14.32 vs 10.96; postoperative 764.39 vs 619.17, 14.78 vs 11.25). On the contrary, the intertrochanteric fracture group had significantly greater CSA and CSA/Wt of the IP and RF(IP preoperative 810.86 vs 661.88, 17.73 vs 9.42; postoperative 681.98 vs 571.32, 12.68 vs 9.88/RF preoperative 503.66 vs 386.72, 9.42 vs 7.23; postoperative 426.24 vs 349.31, 7.17 vs 5.23). HHS related with function had no significant correlation with postoperative CSA and CSA/Wt. There was no significant difference in attenuation between two groups. All subjects had a significant decrease of muscle attenuation postoperatively.Conclusions: The CSA of the hip abductor(G.med and G.min) was significantly larger in the femoral neck fracture group, while the CSA of the hip flexor(IP and RF) was significantly higher in the intertrochanteric fracture group. Based on these findings, choosing the rehabilitation program suitable for the fracture site is expected to be beneficial in hip fracture rehabilitation.

scholarly journals P0292CONSTIPATION IN CHINESE ELDERLY: A HIDDEN CAUSE OF CHRONIC KIDNEY DISEASE AND THE RISK OF RAPID RENAL FUNCTION DECLINE

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Guihua Jian ◽  
Dongsheng Cheng ◽  
Zhi Wang ◽  
Junhui Li ◽  
Qi Yang ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Renal Function ◽  
Risk Factor ◽  
Retrospective Cohort ◽  
Independent Risk Factor ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Renal Function Decline ◽  
Ckd Stage

Abstract Background and Aims Both constipation and chronic kidney disease (CKD) are common among seniors. However, the association between constipation and CKD remain unclear. This study investigates the correlation between the two to provide a new basis for clinical treatment. Method Data from Shanghai community elderly physical examination database (2010-2018) were used to conduct a cross-sectional study and a retrospective cohort to evaluate the relationship between constipation and the prevalence of CKD and rapid renal function decline in the elderly community. Results The cross-sectional study covered 16,177 participants, with an average age of 71.3. Comparing to no constipation group, seniors with constipation have a higher proportion of suffering from CKD stage 3. Constipation is an independent risk factor contributing to the high prevalence of CKD stage 3 (OR:1.238,95% CI,1.045-1.466). This finding was further tested through a retrospective cohort study that included 4,203 participants with a medium following time of 6.1 years. As a result, 9.5% (n=401) reported to have rapid progression of renal function. After adjustment of confounding factors, the logistic regression analysis indicates that, constipation is an independent predictive variable of rapid renal function decline among aged population. Conclusion Constipation is an independent risk factor for the prevalence of CKD and an independent predictor of rapid renal function decline among seniors in the community. Prevention and treatment for constipation should be taken at an early stage, which may reduce the incidence of CKD and delay the progression of CKD.

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