scholarly journals Outcomes for Elderly Patients With Atypical Femoral Fractures Compared to Typical Femoral Fractures for Length of Stay, Discharge Destination, and 30-Day Mortality Rate

2018 ◽  
Vol 9 ◽  
pp. 215145931882022 ◽  
Author(s):  
Dominic Davenport ◽  
James Duncan ◽  
Robert Duncan ◽  
Alastair Dick ◽  
Mohit Bansal ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Femoral Fracture ◽  
Femoral Fractures ◽  
Proximal Femoral Fracture ◽  
Short Term ◽  
Fractured Neck Of Femur ◽  
Neck Of Femur ◽  
Geriatric Population ◽  
Atypical Femoral Fractures ◽  
Trauma Unit

Introduction: Despite increasing recognition of atypical femoral fractures (AFFs), there’s conflicting evidence about incidence, aetiology, and short-term outcomes of these injuries. This study reports the incidence of AFFs at our center and compares the early postoperative outcomes against typical femoral fractures (TFFs). Methods: A retrospective observational cohort study of patients presenting to our trauma unit between November 2015 and July 2016 was undertaken. Inclusion criteria required radiologically confirmed proximal femoral fracture, which was then categorized as AFF or TFF. Primary outcome measures included length of stay, discharge destination, and 30-day mortality. Results: Two hundred thirty-nine patients presented to our trauma unit over 9 months with either a fractured neck of femur or proximal femoral fracture. A total of 122 were identified as pertrochanteric, subtrochanteric, or proximal femoral shaft fractures of which 25 (20.5%) displayed atypical radiographic features consistent with AFF. The 2 groups were similar for average age (TFF 85.3 years vs AFF 85.0 years), gender (19% vs 16% male gender), American Society of Anaesthesiology grade (3.0 vs 3.0), cognitive score (abbreviated mental test score = 7.03 vs 7.08), and preinjury place of residence (88.9% vs 92.0% lived in own home). Typical fractures were fixed with either dynamic hip screw or intramedullary nailing, all atypical fractures were fixed with intramedullary nailing. There was no statistical difference between the 2 groups for length of stay (12.8 days vs 14.3 days; P > .05), discharge to preinjury residence (45.1% vs 36%; P > .05), or 30-day mortality (8.1% vs 12%; P > .05). Discussion: In our predominantly geriatric population atypical radiographic features were observed in around 10% of patients presenting with proximal femoral fractures or fractured neck of femur. Previous studies have reported poor outcomes for pain, mobility, and length of stay after AFF. However, we observed no difference in short-term outcome measures when compared to patients with typical proximal femoral fracture patterns at our trauma unit. Conclusion: With modern principles of trauma care outcomes achieved following AFFs may be equivalent to typical femoral fractures in the geriatric population.

Necrosis avascular

2020 ◽  
Vol 63 (2) ◽  
pp. 18-23
Author(s):  
Alejandro Jardón Gómez ◽  
Ana Cristina King ◽  
Carlos Pacheco Díaz
Keyword(s):  
Femoral Head ◽  
Avascular Necrosis ◽  
Femoral Fracture ◽  
Open Fracture ◽  
Clinical Presentation ◽  
Femoral Fractures ◽  
Proximal Femoral Fracture ◽  
Young Population ◽  
Steroid Use

The clinical presentation of a proximal femoral fracture is completely different between young and adult patients. Unlike closed proximal femoral fractures, the incidence of exposed fractures is found in the young population between 15 and 30 years of age. Osteonecrosis of the femoral head is one the complications we can find in this type of fractures. Avascular necrosis (AVN or osteonecrosis) is defined as the interruption of blood supply to the femoral head due to trauma, infectionalcohol or steroid use, resulting in bone necrosis, joint collapse and osteoarthrosis. The treatment will depend on the clinical presentation, age of the patient and when the diagnosis is made. This is a case report of a 16-year-old patient with a gunshot wound on the hip. Surgical cleansing and closed reduction plus internal fixation with a nail in the center of the spine were performed. A 3-year clinical and radiographic follow up was made, observing the evolution of the fracture and the subsequent avascular necrosis that the patient presented. Key words: Proximal femoral fracture; hip; avascular necrosis (AVN, osteonecrosis); open fracture; osteoarthritis.

scholarly journals Endoprosthetic Reconstruction for a Displaced Atypical Femoral Fracture in a Cancer Patient with Poor Prognosis

2018 ◽  
Vol 2018 ◽  
pp. 1-5
Author(s):  
Hironari Tamiya ◽  
Hiroki Hagizawa ◽  
Takaaki Nakai ◽  
Yoshinori Imura ◽  
Takaaki Tanaka ◽  
...  
Keyword(s):  
Cancer Patient ◽  
Activities Of Daily Living ◽  
Cancer Patients ◽  
Femoral Fracture ◽  
Daily Living ◽  
Poor Prognosis ◽  
Femoral Fractures ◽  
Endoprosthetic Reconstruction ◽  
Atypical Femoral Fractures ◽  
Patients With Poor Prognosis

Zoledronate or denosumab treatment is beneficial for cancer patients with bone metastasis. However, each agent may trigger atypical femoral fractures. Incomplete atypical femoral fractures can be successfully treated with prophylactic intramedullary nailing. On the other hand, intramedullary nailing for displaced atypical femoral fractures occasionally causes problems with regard to bone healing, resulting in long-term treatment. In cancer patients with poor prognosis who experience atypical femoral fractures, improvement in activities of daily living should be the priority. Thus, we performed endoprosthetic reconstruction for a displaced atypical femoral fracture in a breast cancer patient with poor prognosis to enable walking in the early stage after the operation. Two weeks after the operation, she could successfully walk. The postoperative Musculoskeletal Tumor Society score was 47%, and it had improved to almost the preoperative level before injury (50%). In conclusion, endoprosthetic reconstruction for displaced atypical femoral fractures may be a first-line treatment approach to acquire early postoperative walking ability for improving activities of daily living in cancer patients with poor prognosis.

Atypical Femoral Fractures during Prolonged Use of Bisphosphonates: Short-Term Responses to Strontium Ranelate and Teriparatide

2011 ◽  
pp. P3-112-P3-112
Author(s):  
Nara Carvalho ◽  
Daniele Fontan ◽  
Lara Voss ◽  
Cynthia Lucena ◽  
Francisco Bandeira
Keyword(s):  
Strontium Ranelate ◽  
Femoral Fractures ◽  
Short Term ◽  
Atypical Femoral Fractures

Impact of postoperative haemoglobin on length of stay post fractured hip repair in patients with standardised perioperative management

2018 ◽  
Vol 29 (2) ◽  
pp. 172-176
Author(s):  
Siu-Wai Choi ◽  
Frankie K L Leung ◽  
Tak-Wing Lau ◽  
Gordon T C Wong
Keyword(s):  
Length Of Stay ◽  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Postoperative Recovery ◽  
Medical Complications ◽  
Fractured Neck Of Femur ◽  
Neck Of Femur ◽  
Total Length ◽  
The Impact ◽  
Postoperative Haemoglobin

Introduction: Perioperative blood transfusion is not without risk and effort should be made to limit patients’ exposure to allogeneic blood. However, there is conflicting data regarding the impact of anaemia on postoperative recovery in patients with repaired hip fractures. It is hypothesised that for a given baseline functional status and fracture type, lower postoperative haemoglobin will increase rehabilitation time and prolong total length of hospital stay. Methods: This is a retrospective study on data collected prospectively on patients entered into the Clinical Pathway aged >65 years admitted to Queen Mary Hospital (QMH) with a fractured neck of femur during 2011–2013. Potential predictor variables were analysed with linear regression with respect to total length of stay and those that reached a significance level of 0.05 were included in further analysis. Results: 1092 patients were admitted to QMH with a suspected fractured neck of femur; data from 747 patients were analysed. The fracture sites were neck of femur (50%), intertrochanteric (48%) and subtrochanteric fracture (2%). Approximately 30% of patients received blood transfusions. Of these only the development of postoperative medical complications statistically prolonged hospital stay. No relationship was seen with haemoglobin levels cut-off above and below 10 g/dl with the result remaining non-significant down to a cut-off of above and below 8 g/dl. Discussion: This study revealed that post-surgical haemoglobin level of between 8 g/dl and 10 g/dL did not have an impact on the total length of hospital stay. The development of postoperative medical complications was the only factor that prolonged the total length of stay.

scholarly journals The Prognostic Value of Metabolic Profiling in Older Patients With a Proximal Femoral Fracture

2020 ◽  
Vol 11 ◽  
pp. 215145932096009
Author(s):  
Max P.L. van der Sijp ◽  
H. Eka D. Suchiman ◽  
Monica Eijk ◽  
Dina Vojinovic ◽  
Arthur H. P. Niggebrugge ◽  
...  
Keyword(s):  
Risk Score ◽  
Functional Recovery ◽  
Mortality Risk ◽  
Femoral Fracture ◽  
Patient Population ◽  
Prediction Accuracy ◽  
Prognostic Value ◽  
Femoral Fractures ◽  
Proximal Femoral Fracture ◽  
Proximal Femoral Fractures

Introduction: High mortality rates of approximately 20% within 1 year after treatment are observed for patients with proximal femoral fractures. This preliminary study explores the prognostic value of a previously constructed mortality risk score based on a set of 14 metabolites for the survival and functional recovery in patients with proximal femoral fractures. Materials and Methods: A prospective observational cohort study was conducted including patients admitted with a proximal femoral fracture. The primary outcome was patient survival, and the recovery of independence in activities of daily living was included as a secondary outcome. The mortality risk score was constructed for each patient and its prognostic value was tested for the whole population. Results: Data was available form 136 patients. The mean age of all patients was 82.1 years, with a median follow-up of 6 months. Within this period, 19.0% of all patients died and 51.1% recovered to their prefracture level of independence. The mortality score was significantly associated with mortality (HR, 2.74; 95% CI, 1.61-4.66; P < 0.001), but showed only a fair prediction accuracy (AUC = 0.68) and a borderline significant comparison of the mortality score tertile groups in survival analyses (P = 0.049). No decisive associations were found in any of the analyses for the functional recovery of patients. Discussion: These findings support the previously determined prognostic value of the mortality risk score. However, the independent prognostic value when adjusted for potential confounding factors is yet to be assessed. Also, a risk score constructed for this specific patient population might achieve higher accuracies for the prediction of survival and functional recovery. Conclusions: A modest prediction accuracy was observed for the mortality risk score in this population. More elaborate studies are needed to validate these findings and develop a tailored model for clinical purposes in this patient population.

scholarly journals Atypical Femoral Fractures during Prolonged Use of Bisphosphonates: Short-Term Responses to Strontium Ranelate and Teriparatide

2011 ◽  
Vol 96 (9) ◽  
pp. 2675-2680 ◽  
Author(s):  
N. N. C. Carvalho ◽  
L. A. Voss ◽  
M. O. P. Almeida ◽  
C. L. Salgado ◽  
F. Bandeira
Keyword(s):  
Strontium Ranelate ◽  
Femoral Fractures ◽  
Short Term ◽  
Atypical Femoral Fractures

scholarly journals The effect of time to surgery on outcomes and complication rates following total hip arthroplasty for fractured neck of femur

2019 ◽  
Vol 101 (5) ◽  
pp. 342-345
Author(s):  
J Craik ◽  
R Geleit ◽  
J Hiddema ◽  
E Bray ◽  
R Hampton ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Length Of Stay ◽  
Hip Arthroplasty ◽  
Functional Outcomes ◽  
Best Practice ◽  
Complication Rates ◽  
Delayed Presentation ◽  
Fractured Neck Of Femur ◽  
Neck Of Femur ◽  
Total Hip

Introduction Total hip arthroplasty is recommended for elderly patients with fractured neck of femur who are independently mobile, have few co-morbidities and are not cognitively impaired. Providing a daily total hip arthroplasty service is challenging for some units in the UK and considering that these patients may be physiologically distinct from the average hip fracture patient, loss of the best practice tariff as a result of surgical delay may be unjustified. The aim of this study was to determine whether time to surgical intervention for patients eligible for total hip arthroplasty had a negative impact on patient complications, length of stay and functional outcomes. Methods All patients undergoing total hip arthroplasty for fractured neck of femur at our institution over a ten-year period were identified. Complications and functional outcomes were compared between patients receiving total hip arthroplasty before and after 36 hours. Results Of 112 consecutive patients undergoing total hip arthroplasty, 70 responded to a questionnaire or telephone consultation. Four patients were excluded owing to delayed presentation, the presence of advanced rheumatoid arthritis or a pathological fracture. Two-thirds (64%) of the remaining 66 patients underwent surgery within 36 hours of presentation. There were no significant differences between the groups of patients receiving surgery before or after 36 hours with regard to postoperative length of stay, complications, Oxford hip scores or visual analogue scale scores for state of health. Conclusions Delaying surgery for patients eligible for total hip arthroplasty as per the National Institute for Health and Care Excellence guidelines is justified and should not incur loss of the best practice tariff.

Femoral Fractures in Severe Hemophilia

1977 ◽  
Author(s):  
J.P. Allain ◽  
M.H. Ageron ◽  
Y. Laurian ◽  
J.Y. De La Caffinière
Keyword(s):  
Replacement Therapy ◽  
Plate Fixation ◽  
Femoral Fractures ◽  
Femoral Shaft ◽  
Plaster Cast ◽  
Fractured Neck Of Femur ◽  
Neck Of Femur ◽  
Minimal Trauma ◽  
Internal Plate Fixation ◽  
Metaphyseal Fractures

Increasing physical activity of hemophilic children has resulted in more frequent fractures. Within the last ten years, fourteen severe hemophiliacs (8-19 years)sustained femoral fractures. Four of these hemophiliacs had an inhibitor. Eight were the result of minimal trauma. There was no obvious correlation in these eight cases with prolonged immobilisation and/or treatment with steroids. Co-existing knee hemarthrosis or thigh hematoma often led to a delay in the diagnosis of the fracture. Metaphyseal fractures(8 cases) were treated by plaster cast (4) or, skin or pin traction (4) with good anatomical result and normal union. Replacement therapy was given in 3 cases for 3 days and in 1 case for 2 weeks. No complication occurred in any of the non transfused patients(4). Epiphyseal and femoral shaft fractures were treated by skin or pin traction (3) or internal plate fixation (2)associated with replacement therapy for at least 2 weeks. Unsatisfactory anatomical result was obtained in three cases. One impacted fractured neck of femur was discovered on X-ray examination 3 weeks after trauma. Guide lines for orthopedic and medical treatment of femoral fractures in hemophiliacs are suggested according to the anatomical feature.

scholarly journals Standardised Warfarin Reversal Expedites Time to Theatre for Fractured Neck of Femur Surgery and Improves Mortality Rates: A Matched Cohort Study

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Thomas S. Moores ◽  
Benjamin D. Chatterton ◽  
Matthew J. Walker ◽  
Phillip J. Roberts
Keyword(s):  
Cohort Study ◽  
Hip Fracture ◽  
Length Of Stay ◽  
Nearest Neighbour ◽  
Fractured Neck Of Femur ◽  
Neck Of Femur ◽  
The United Kingdom ◽  
Before And After ◽  
Warfarin Reversal ◽  
Guideline Group

Background. This study aims to evaluate outcomes for warfarinised hip fracture patients and compare them with a matched nonwarfarinised group, before and after the introduction of national hip fracture guidelines in the United Kingdom. Methods. A retrospective cohort study of 1743 hip fracture patients was undertaken. All patients admitted taking warfarin were identified. These patients were then matched to nonwarfarinised patients using nearest neighbour propensity score matching, accounting for age, sex, hip fracture type, and Nottingham Hip Fracture Score. A pre-guideline group (no standardised warfarin reversal regimen) and a post-guideline group (standardised regimen) were identified. Outcomes assessed included time to INR less than 1.7, time to theatre, length of stay, and 30-day and 1-year mortality. Results. Forty-six warfarinised hip fracture patients were admitted in the pre-guideline group (mean age 80.5, F:M 3:1) and 48 in the post-guideline group (mean age 81.2 years, F:M 3:1). Post-guideline patients were reversed to a safe operative INR level within 18 hours of admission, decreasing the time to first dose vitamin K (p<0.001). 70% of warfarinised patients were operated upon within 36 hours, compared to 19.6% with no regimen (p<0.05). After anticoagulation reversal protocol, thirty-day mortality decreased from 15.2% to 8.3% and 1-year mortality from 43.5% to 33% for warfarinised patients, which is comparable to nonwarfarinised matched patients. There was no significant change in the length of stay pre- and post-guideline for both groups of patients. Conclusions. Proactive anticoagulant management and expedient surgery reduces morbidity and mortality when managing this surgically challenging subset of hip fracture patients.

Sign in / Sign up

Export Citation Format

Share Document