Weekend Admission of Intracapsular Femoral Neck Fractures Not Associated With a Greater Rate of Mortality or Morbidity

Introduction: For a number of emergency conditions, admission over the weekend has been associated with rising morbidity and mortality rates. However, different studies have provided conflicting results regarding the increased rates of mortality and morbidity for patients with intracapsular femoral fracture who were admitted over the weekend, compared to weekdays. This study investigated the effect of weekend admissions on the surgical outcomes of patients with intracapsular femoral neck fractures. Materials and Methods: We conducted a retrospective cohort study of all the patients who were admitted to our level-II trauma center with an intracapsular femoral neck fracture between January 2009 and June 2011. Admission was classified as at the weekend if it took place between 18:00 pm on Friday until midnight on Sunday or on bank holidays. We compared the mortality rates within 30 days and 6 months after surgery for weekday and weekend admissions. Secondary outcomes considered included length of hospital stay, postoperative complications, and reoperation rates. Statistical analysis was performed using logistic regression models, which were adjusted for patient and surgical characteristics. Results: In total, 315 patients met our inclusion criteria. The mean age of this group was 77.9 years (standard deviation ±13) and the female to male ratio was 5:2. The average follow-up period was 49 months. Under logistic regression analysis, weekend admission was not a significant independent risk factor for the 30-day mortality rate (odds ratio 1.85, 95% confidence interval, 0.74-4.62; P = .19). Seventy-seven patients admitted over the weekend were treated within 24 hours versus 125 patients for the weekday group (80.2% vs 57.9%; P = .005). There were no differences between the sample groups in relation to implant-related complications (24.9% vs 25.8%, respectively, P = .89) nor in relation to general complications (12% vs 18.6%, respectively, P = .06). The mean hospital stay of patients operated on during weekends or holidays was significantly shorter compared to patients operated on during weekdays (6.7 vs 8.5 days; P = .009). Conclusion: Patients with intracapsular femoral neck fractures who were admitted over the weekend at our trauma center did not have a higher risk of mortality or morbidity. Furthermore, temporary preoperative care provided over the weekend by an internal medical consultant can be safe and efficient even in the circumstances where there is a lack of dedicated geriatric support. The absence of an elective operating list at the weekend could be a potential factor in shortening waiting times for surgery for intracapsular femoral neck fracture at weekends and holidays.

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Internal Fixation Versus Hemiarthroplasty for Displaced Intra-Capsular Femoral Neck Fractures in ASA 3-5 Geriatric Patients

The Open Orthopaedics Journal ◽

10.2174/1874325001610010765 ◽

2016 ◽

Vol 10 (1) ◽

pp. 765-771 ◽

Cited By ~ 1

Author(s):

W. Rezaie ◽

W. Wei ◽

B.I. Cleffken ◽

C.H. van der Vlies ◽

B.I. Cleffken ◽

...

Keyword(s):

Femoral Neck ◽

Internal Fixation ◽

Femoral Neck Fracture ◽

Geriatric Patients ◽

Mortality Rates ◽

Femoral Neck Fractures ◽

Inclusion Criteria ◽

Operation Rate ◽

Neck Fracture ◽

The Mean

Background: The treatment of choice for elderly with a displaced intra-capsular femoral neck fractures is prosthetic replacement. This is however a major surgical procedure for geriatric patients with multiple co-morbidities which can threaten hemodynamic stability and lead to death. In this study we compared the outcome of internal fixation (IF) versus hemiarthroplasty (HA) for the management of intra-capsular femoral neck fractures in the elderly with severe co-morbidities. Methods: We conducted a retrospective cohort study of all the patients who were admitted to our Level-II trauma centre with a femoral neck fracture between January 2009 and June 2011. Inclusion criteria were: 70 years or older, ASA 3 or higher, a displaced femoral neck fracture and treatment with either internal fixation or a cemented hemiprosthesis. The primary outcome was 6-month mortality rate. Secondary outcomes were 30-day mortality, post-operative complications, re-operation rate and length of hospital stay. Results: 80 patients met our inclusion criteria. The mean age of the IF group was 81.6 years and in the HA group it was 84.5 years (P=0.07). The medical records were retrieved 34-64 months after surgery. Two intra-operative deaths due to cement implantation syndrome were found in the HA group and none in the IF group. Twelve patients (21.8%) in the HA group died within 30 days after surgery and 2 (8.0%) in the IF group (P=0.21). The mean operating time was 83 min. for the HA group and 51 min. for the IF group (P=0.000). There were more implant-related complications in the IF than in the HA group (36% vs 9.1% respectively, P=0.008). The 6-month mortality rates didn’t differ between the IF and the HA groups (respectively 28.0% vs 34.5%, P=0.62). Conclusion: The post-operative mortality rates did not differ between the IF and the HA groups in elderly patients with a displaced femoral neck fracture and ASA 3 to 5. However, the HA associated with less implant-related complications than the IF in this group and it is therefore the treatment of choice.

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Intra-Articular Tranexamic Acid Injection During the Hip Hemi-Arthroplasty in Elderly Patients: A Retrospective Study

Geriatric Orthopaedic Surgery & Rehabilitation ◽

10.1177/2151459318803851 ◽

2018 ◽

Vol 9 ◽

pp. 215145931880385 ◽

Cited By ~ 3

Author(s):

Wei Liu ◽

Huangdong Hui ◽

Yunhai Zhang ◽

Weilong Lin ◽

Yongqian Fan

Keyword(s):

Logistic Regression ◽

Femoral Neck ◽

Blood Loss ◽

Elderly Patients ◽

Tranexamic Acid ◽

Femoral Neck Fracture ◽

Mortality Rates ◽

Transfusion Rate ◽

Neck Fracture ◽

Hemi Arthroplasty

Introduction: The objective was to evaluate the safety and efficacy of intra-articular injection of tranexamic acid (TXA) in patients between 80 and 100 years of age with femoral neck fracture undergoing hip hemi-arthroplasty (HA). Material and Methods: We conducted a retrospective review to assess perioperative blood loss and transfusion rate after intra-articular injection of TXA during HA. This was a single-center, retrospective, single-surgeon, and standard care cohort study covering the period between January and December 2016. One hundred three consecutive patients undergoing HA under spinal or general anesthesia were included. Fifty-four and 49 patients received and did not receive intra-articular injection of TXA during the HA, respectively. After closing the capsule, 50 mL of a TXA solution at a concentration of 1 g/100 mL of saline was injected into joint capsule. We compared the following outcomes: preoperative hemoglobin (HB) level, postoperative day 1 HB level, postoperative day 3 HB level, the net reduction of HB level by postoperative day 3, transfusion rate, and 30- and 90-day postoperative mortality rates. In addition, we use logistic regression to analyze the factors affecting the transfusion rate. Result: Day 3 postoperative HB level and the net reduction in HB level within 3 days following surgery were 93.22 ± 11.70 g/L and 25.98 ± 6.29 g/L in TXA group, respectively, while were 87.10 ± 10.52 g/L and 35.44±8.61 g/L in no-TXA group. Transfusion rate was 9% (5/54) in TXA group and 24% (12/49) in no-TXA group, respectively. The differences were statistically significant between the both groups. Logistic regression indicated that the topical administration of TXA would reduce the risk for transfusion, while in male diabetes mellitus would increase the risk. There were no significant differences in the deep venous thrombosis, pulmonary embolism, and mortality rates of 30 and 90 days postoperatively ( P > .05). Discussion: Because of lower systemic absorption and a higher concentration in the wound, topical use of TXA is safer for elderly patients who may have renal or liver dysfunction. TXA at therapeutic concentration does not affect platelet count, platelet aggregation, or coagulation parameters, and is of value in elderly patients who take antiplatelet drug for secondary prevention of cardiovascular diseases. Conclusion: For patients between 80 and 100 years of age with femoral neck fracture undergoing HA, intra-articular injection of TXA may reduce the perioperative blood loss and transfusion rate without increasing risk of thrombosis.

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

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2016.0124 ◽

2016 ◽

Vol 98 (6) ◽

pp. 376-379 ◽

Cited By ~ 4

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.

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Results of postoperative anti-rotation on the intracapsular femoral neck fracture fixed with cannulated screws

10.21203/rs.3.rs-33671/v1 ◽

2020 ◽

Author(s):

bu-fang ren ◽

quan-ping ma ◽

xin lv ◽

yunsheng yin ◽

yaozhu gao

Keyword(s):

Femoral Neck ◽

Femoral Neck Fracture ◽

Bed Rest ◽

Femoral Neck Fractures ◽

Wound Infections ◽

Cannulated Screws ◽

Fracture Nonunion ◽

Neck Fracture ◽

Intracapsular Femoral Neck Fracture ◽

Medical University

Abstract Background: To investigate effect of postoperative anti-rotation on the union of intracapsular displaced femoral neck fracture treated with three cannulated screws. Methods: A retrospective analysis was performed on all the intracapsular femoral neck fractures treated in the department of orthopedics of the second Hospital of Shanxi Medical University from July 2015 to December 2018. Fractures of femoral neck were reduced and fixed with three cannulated screws. The patients who wore anti-rotation shoes in the affected side were kept at bed rest for 10-12 weeks after surgery. The results were analyzed.Results: A total of 135 patients were included in the analysis. Six patients (4.4%) were not united. There were 12 cases of avascular necrosis (9.3%). No wound infections, screw breakages was found.Conclusion: Anti-rotation after surgery can significantly reduce the rate of femoral neck fracture nonunion, but not significantly improve the femoral head necrosis

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Results of postoperative anti-rotation on the intracapsular femoral neck fracture fixed with cannulated screws

10.21203/rs.3.rs-29760/v1 ◽

2020 ◽

Author(s):

Bufang Ren ◽

Quan-ping Ma ◽

Xin Lv ◽

Yun-sheng Yin ◽

Yao-zhu Gao

Keyword(s):

Femoral Neck ◽

Femoral Neck Fracture ◽

Bed Rest ◽

Femoral Neck Fractures ◽

Wound Infections ◽

Cannulated Screws ◽

Fracture Nonunion ◽

Neck Fracture ◽

Intracapsular Femoral Neck Fracture ◽

Medical University

Abstract Background: To investigate effect of postoperative anti-rotation on the union of intracapsular displaced femoral neck fracture treated with three cannulated screws.Methods: A retrospective analysis was performed on all the intracapsular femoral neck fractures treated in the department of orthopedics of the second Hospital of Shanxi Medical University from July 2015 to December 2018. Fractures of femoral neck were reduced and fixed with three cannulated screws. The patients who wore anti-rotation shoes in the affected side were kept at bed rest for 10-12 weeks after surgery. The results were analyzed.Results: A total of 135 patients were included in the analysis. Six patients (4.4%) were not united. There were 12 cases of avascular necrosis (9.3%). No wound infections, screw breakages was found.Conclusion: Anti-rotation after surgery can significantly reduce the rate of femoral neck fracture nonunion, but not significantly improve the femoral head necrosis

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Results of Hemi Arthroplasty in Fracture Neck of Femur in Elderly Person, CBMCHB Experience

Community Based Medical Journal ◽

10.3329/cbmj.v4i2.53816 ◽

2015 ◽

Vol 4 (2) ◽

pp. 8-12

Author(s):

Md Nasir Uddin ◽

Md Saiful Islam ◽

Mamunur Rashid Chowdhury ◽

Md Abul Kalam Azad Khan ◽

Md Rajibul Hasan ◽

...

Keyword(s):

Femoral Neck ◽

Femoral Neck Fracture ◽

Revision Surgery ◽

Elderly Person ◽

Harris Hip Score ◽

Female Ratio ◽

Replacement Arthroplasty ◽

Neck Fracture ◽

The Mean ◽

Intracapsular Femoral Neck Fracture

Intracapsular femoral neck fracture is a common injury in elderly person. The primary goal of treatment is to return the patient to him or her pre-fracture functional status. The surgical treatment is the treatment of choice, lip replacement arthroplasty (hemi or total) is a viable treatment option. Thirty elderly patients (age 50-80 years) with a displaced intracapsular femoral neck fracture were under treatment over a five year period (January 2010 to December 2015). All of them underwent hemiarthroplasty either unipolar or bipolar, after appropriate medical and anesthetic fitness. The patients were reevaluated at six weeks, at six months postoperative interval and assessed using Harris hip score (HHS) and visual analogue scale (vas) for evaluation of outcome. The mean age of patients was 64.5 years and male female ratio was 43.3% - 56.7%. The mean HHS score was 85.3 by the end of the 6 months. The mean score on VAS scale was 60mm (moderate) at 2 weeks, 40mm (mild) at six weeks and 4mm (mu) at 6 months follow up visit. No significant complications were observed except hip pain. No patients needed revision surgery. Herniarthroplasty is the treatment of choice in elderly population with displaced femoral neck fracture (Garden type III or IV); provides early ambulation, good functional outcome, pain free joint with minimal complications without the need for revision surgery. CBMJ 2015 July: Vol. 04 No. 02 P: 8-12

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Comparison outcome in management of femoral neck fracture using multiple cancellous screws with and without fibular graft

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20203688 ◽

2020 ◽

Vol 8 (9) ◽

pp. 3333

Author(s):

I. Komang Indra Teguh Wisesa ◽

I. Wayan Suryanto Dusak

Keyword(s):

Femoral Neck ◽

Femoral Neck Fracture ◽

Femoral Neck Fractures ◽

Fibular Graft ◽

Neck Fracture ◽

Hip Screw ◽

Cancellous Screws ◽

The Mean ◽

Mean Time ◽

Fibular Strut

Multiple cancellous cannulated screw is preferred method in fresh cases of fracture neck of femur in young patients. Fibular strut graft is sometimes used along with multiple cancellous cannulated screws to enhance union and early restoration of function. We conducted a retrospective study to patients aged between 20-50 years old with femoral neck fracture treated with multiple cancellous screws either with or without fibular graft between the period of January 2016 to January 2018. We obtained total of six patients (five males and one female) with femoral neck fracture treated with multiple cancellous screws either with or without fibular graft. All fractures were garden type II-IV fresh femoral neck fractures. The functional outcome based on Harris hip score was excellent for all patients. The mean time of full weight bearing was 16±8 weeks in both multiple cancellous screws without fibular group and multiple cancellous screws with fibular group. The mean time of union was also 16±8 weeks in both groups. There is no complication such as non-union, avascular necrosis of femoral head and/or broken fibular graft in both the groups occurrences. Fixation with cancellous screws and fibular strut grafts for femoral neck fractures is cost effective and technically less demanding and associated with good outcomes. There is no added advantage of non-vascularized fibular grafting with multiple hip screw fixation in fresh femoral neck fractures in young adults over multiple hip screw fixation alone.

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

Hip International ◽

10.1177/11207000211028502 ◽

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.

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Survey of the Outcome of Femoral Head Prosthesis Replacement of Unipolar Type for Intracapsular Femoral Neck Fracture in Elderly Patients.

Orthopedics & Traumatology ◽

10.5035/nishiseisai.44.235 ◽

1995 ◽

Vol 44 (1) ◽

pp. 235-241

Author(s):

Yukihiko Tsutsumi ◽

Tatsuo Kutsuna ◽

Kazuo Konishi ◽

Toshimitsu Koga ◽

Ai Umemura ◽

...

Keyword(s):

Femoral Head ◽

Femoral Neck ◽

Elderly Patients ◽

Femoral Neck Fracture ◽

Prosthesis Replacement ◽

Neck Fracture ◽

Intracapsular Femoral Neck Fracture

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Calcar buttressed screw fixation for femoral neck fracture

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20185337 ◽

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

Background: The incidence of neck of femur fracture among elderly population is increasing day by day. Femoral neck fracture has always been an unsolved fracture 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.Methods: 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.Results: Bone union occurred in 40 patients (93%) with average period of 3-4 months. 51.2% of cases had 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.Conclusions: 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.

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