Mortality and comorbidity after non-operatively managed, low-energy pelvic fracture in patients over age 70: a comparison with an age-matched femoral neck fracture cohort and general population

Abstract Background Research on mortality and comorbidity associated with pelvic fractures in older patients is scarce. We aimed to determine the short- and long-term mortality rates of older patients with a pelvic ring fracture compared with both an age-matched cohort of patients with a femoral neck fracture and a general population, and to investigate 30- and 60-day readmission rates after pelvic fracture. Methods This was a retrospective cohort study done in an emergency department of a level II/III trauma center. All patients aged over 70 years diagnosed with a pelvic or acetabular fracture between January 2010 and December 2016 in our ED were identified. Two reference populations were used: patients operated due to femoral neck fracture in our institution between 2007 and 2008 and a general population aged 70 years or more. Results Two hundred nineteen patients were identified. 30- and 90-day mortality was 7.3 and 11.4%, respectively. Compared to the general population, a pelvic fracture was associated with an 8.5-fold (95% CI: 5.2–13.9) and 11.0-fold (95% CI: 5.4–22.3) 90-day mortality risk in females and males, respectively. We could not observe a difference in the risk of 90-day mortality between femoral neck fracture patients and patients with a pelvic fracture. Within 30 days, 28 (12.8%) pelvic fracture patients were readmitted for in-patient care in our hospital. Conclusions The mortality of older patients with pelvic ring fractures resembles that after hip fracture. Although older patients with a pelvic ring fracture rarely require operative treatment, the severity of the injury should not be considered as a class apart from hip fracture.

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PMS40 270-DAYMORTALITY AND ITS PREDICTORS IN WOMEN WITH CONTRALATERAL HIP FRACTURE AFTER FEMORAL NECK FRACTURE

Value in Health ◽

10.1016/j.jval.2019.09.1584 ◽

2019 ◽

Vol 22 ◽

pp. S701

Author(s):

K. Juhász ◽

I. Boncz ◽

B. Molics ◽

B. Gratz ◽

A. Sebestyén

Keyword(s):

Hip Fracture ◽

Femoral Neck ◽

Femoral Neck Fracture ◽

Neck Fracture

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Az ellenoldali csípőtáji törésig eltelt időt befolyásoló prognosztikai tényezők vizsgálata

Orvosi Hetilap ◽

10.1556/650.2018.31179 ◽

2018 ◽

Vol 159 (38) ◽

pp. 1543-1547

Author(s):

Krisztina Juhász ◽

Imre Boncz ◽

Péter Kanizsai ◽

Andor Sebestyén

Keyword(s):

Risk Factors ◽

Prognostic Factors ◽

Hip Fracture ◽

Femoral Neck ◽

Femoral Neck Fracture ◽

Hip Fractures ◽

Age Groups ◽

Significant Difference ◽

Neck Fracture ◽

The Impact

Abstract: Introduction: Although several national studies reported on the risk factors for contralateral hip fracture, there are no data about the prognostic factors of the time until contralateral hip fractures. Aim: The aim of the study was to analyse the impact of different prognostic factors on the time until the development of contralateral fracture and to determine the incidence of contralateral hip fractures after femoral neck fractures. Method: Patients aged 60 years and over with contralateral hip fracture between 01 Jan 2000 and 31 Dec 2008 were identified among those who suffered their femoral neck fracture in Hungary in 2000. Risk factors as age, sex, comorbidities, type of fracture and surgery, place of living and hospitals providing treatment for primary fracture were analysed by one way ANOVA focusing on the time until the development of contralateral hip fracture. Results: 312 patients met the inclusion criteria. The incidence of contralateral hip fracture after femoral neck fracture ranged between 1.5% and 2.1%, the cumulative incidence was 8.24%. The mean time until the development of contralateral hip fracture was 1159.8 days. The incidence of contralateral hip fracture showed no significant deviation. Significantly shorter time (p = 0.010) was detected until the contralateral hip fracture in older patients with femoral neck fracture. Conclusions: The yearly incidence of contralateral hip fracture showed no significant difference by patients with femoral neck fracture over 60 years. The shorter time until the contralateral hip fracture by the older age groups highlights the need of elaboration of prevention strategies. Orv Hetil. 2018; 159(38): 1543–1547.

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The Effect of Type of Femoral Component Fixation on Mortality and Morbidity after Hip Hemiarthroplasty: A Systematic Review and Meta-Analysis

HSS Journal ® ◽

10.1007/s11420-020-09769-1 ◽

2020 ◽

Vol 16 (3) ◽

pp. 222-232

Author(s):

Mohamed Imam ◽

Mohamed Shehata ◽

Mahmoud Morsi ◽

Muhammad Shawqi ◽

Ahmed Elsehili ◽

...

Keyword(s):

Systematic Review ◽

Postoperative Pain ◽

Femoral Neck ◽

Femoral Neck Fracture ◽

Older Patients ◽

Observational Studies ◽

Meta Analysis ◽

Hip Hemiarthroplasty ◽

Uncemented Hemiarthroplasty ◽

Neck Fracture

Abstract Background Hip hemiarthroplasty is a well-established treatment of displaced femoral neck fracture, although debate exists over whether cemented or uncemented fixation is superior. Uncemented prostheses have typically been used in younger, healthier patients and cemented prostheses in older patients with less-stable bone. Also, earlier research has suggested that bone cement has cytotoxic effects and may trigger cardiovascular and respiratory adverse events. Questions/Purposes The aim of this systematic review and meta-analysis was to compare morbidity and mortality rates after cemented and uncemented hemiarthroplasty for the treatment of displaced femoral neck fractures in elderly patients. Methods Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched seven medical databases for randomized clinical trials and observational studies. We compared cemented and uncemented hemiarthroplasty using the Harris Hip Score (HHS), as well as measures of postoperative pain, mortality, and complications. Data were extracted and pooled as risk ratios or standardized mean difference with their corresponding 95% confidence intervals in a meta-analysis model. Results The meta-analysis included 34 studies (12 randomized trials and 22 observational studies), with a total of 42,411 patients. In the pooled estimate, cemented hemiarthroplasty was associated with less risk of postoperative pain than uncemented hemiarthroplasty. There were no significant differences between groups regarding HHS or rates of postoperative mortality, pulmonary embolism, cardiac arrest, myocardial infarction, acute cardiac arrhythmia, or deep venous thrombosis. Conclusions While we found that cemented hemiarthroplasty results in less postoperative pain than uncemented hemiarthroplasty in older patients with femoral neck fracture, the lack of significant differences in functional hip scores, mortality, and complications was surprising. Further high-level research is needed.

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Using Patient-Reported Outcomes to Predict Revision Arthroplasty Following Femoral Neck Fracture: Enhancing the Value of Clinical Registries through Data Linkage

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16081325 ◽

2019 ◽

Vol 16 (8) ◽

pp. 1325 ◽

Cited By ~ 2

Author(s):

Christina L Ekegren ◽

Richard de Steiger ◽

Elton R Edwards ◽

Richard S Page ◽

Raphael Hau ◽

...

Keyword(s):

Hip Fracture ◽

Femoral Neck ◽

Femoral Neck Fracture ◽

Data Linkage ◽

Multivariable Analysis ◽

Revision Arthroplasty ◽

Factors Associated ◽

Clinical Registries ◽

Patient Reported ◽

Neck Fracture

The aim of this study was to determine the association between patient-reported outcome measures (PROMs) six months following femoral neck fracture after a low fall and future arthroplasty, and the factors associated with this. Six-month post-fracture PROMs were collected from the Victorian Orthopaedic Trauma Outcomes Registry (VOTOR) for patients aged >55 years who were admitted for a femoral neck fracture after a low fall between March 2007 and June 2015. These cases were linked with those registered by Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) up to October 2016. Multivariable analysis was performed using a Cox proportional hazards model to determine factors associated with future arthroplasty, including six-month PROMs. Of the 7077 hip fracture patients registered by VOTOR during the study period, 2325 met the inclusion criteria. Internal fixation being used for the initial hip fracture surgery, being younger and having no pre-injury disability were all independently associated with future revision or conversion to arthroplasty. Out of all PROMs, reporting pain and discomfort six months post-fracture was associated with a 9.5-fold increase in the risk of future arthroplasty (95% CI: 3.81, 23.67). The value of clinical registries can be enhanced via data linkage, in this case by using PROMs to predict arthroplasty following femoral neck fracture.

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Antithrombotics in Patients With a Femoral Neck Fracture: Evaluating Daily Practice in an Observational Cohort Study

Geriatric Orthopaedic Surgery & Rehabilitation ◽

10.1177/21514593211037755 ◽

2021 ◽

Vol 12 ◽

pp. 215145932110377

Author(s):

Veronique A. J. I. M. van Rijckevorsel ◽

Gert R. Roukema ◽

Taco M. A. L. Klem ◽

Tjallingius M. Kuijper ◽

Louis de Jong

Keyword(s):

Cohort Study ◽

Hip Fracture ◽

Femoral Neck ◽

Femoral Neck Fracture ◽

Observational Cohort Study ◽

Total N ◽

Hip Hemiarthroplasty ◽

Time To Surgery ◽

Neck Fracture ◽

Observational Cohort

Introduction Geriatric hip fracture patients are characterized by frailty due to multiple comorbidities, such as cardiovascular disease, in which the use of antithrombotics is frequent. The aim of this study is to assess the effect of antithrombotics on perioperative care and patient outcomes after hip hemiarthroplasty following current guidelines. Materials and Methods This observational cohort study included all consecutively admitted patients with a femoral neck fracture requiring hip hemiarthroplasty between January 1st 2010, and May 16th 2016, in two level II trauma teaching hospitals. Patients with multiple trauma injuries were excluded. Results In total, n = 907 patients (68% female (n = 615), median age 84 years) were included of which n = 142 used a vitamin K antagonist (VKA) and n = 213 used antiplatelet (AP) therapy. Both were associated with more packed cell supplementation (.4 ± 1.1 units and .3 ± .8 units vs .2 ± .6 units, P < .001 and P = .03, respectively). VKA was associated with more hematomas compared no antithrombotics (23% vs 11%, P = .001). VKA had a longer time to surgery compared to no antithrombotics and AP (24 hours vs 19 and 20 hours, P < .001 and P < .001, respectively) and longer admission duration (9 days vs 7 days P < .001. There were no differences in 30 day mortality nor in 1-year mortality rates. Discussion All modifiable causes for deep SSI, such as hematomas, should be prevented in acute hip fracture surgery. Since antithrombotics are associated with hematomas, an optimal handling in perioperative setting is necessary. Conclusion VKA was associated with longer time to surgery, more hematomas, and longer admission duration. VKA and AP were associated with more packed cell supplementation.

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Non-Traumatic Tile Type B3 Pelvic Fracture Combined With Garden Type III Femoral Neck Fracture Caused By Hypocalcaemia-Induced Convulsions

10.21203/rs.3.rs-792266/v1 ◽

2021 ◽

Author(s):

Minghan Dou ◽

Guangkai Ren ◽

Baoming Yuan ◽

Chuangang Peng ◽

Dankai Wu

Keyword(s):

Femoral Neck ◽

Femoral Neck Fracture ◽

Pelvic Fracture ◽

Pelvic Fractures ◽

Maintenance Hemodialysis ◽

Tile Type ◽

Conventional Radiograph ◽

Type Iii ◽

Neck Fracture

Abstract BACKGROUND Non-traumatic fractures caused by convulsions are relatively rare and are often overlooked due to the lack of obvious evidence of injury. Non-traumatic fractures due to convulsions are diverse, but the concomitant of pelvic and femoral fractures has not been reported previously. CASE SUMMARY A 47-year-old woman with a no significant medical history, was taken to the nearest hospital after one episode of generalized tonic-clonic seizure that had occurred during sleep. After the postictal phase, the patient regained consciousness and experienced diffuse pain in the inguinal regions bilaterally with inability to stand or walk. The entire attack was witnessed by the family members who confirmed that there was not external trauma. Blood investigations revealed high creatinine and uric acid levels, along with a low calcium level. Conventional radiograph of the pelvis was performed to detect the cause of pain. The patient was noted to have a pelvic fracture and unilateral fracture of the neck of the femur. She was then transferred to our hospital for further management. The patient was diagnosed as having Tile type B3 pelvic fractures combined with a Garden type III femoral neck fracture on three-dimensional computed tomography (3D-CT). In view of her blood results, nephrology consultation was sought. The patient was identified as having a stage 5 chronic kidney disease (CKD), hypocalcemia, and hyperphosphatemia. However, neurological examination showed no abnormalities. No surgical intervention was adopted for her pelvic fractures. In addition to complete bed rest, closed reduction and percutaneous cannulated screw fixation was performed for the treatment of the right femoral neck fracture. An arteriovenous fistula was created for maintenance hemodialysis on the tenth postoperative day. At follow-up, twelve months follow-up after the operation, the patient had a normally gait and was satisfied with the outcome. CONCLUSION Patients who present with convulsive seizures especially patients with ion metabolism disorder should be examined thoroughly to ensure that no injury is missed.

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Consolidation of femoral neck fractures depending on fracture type

Medicine and Physical Education: Science and Practice ◽

10.20310/2658-7688-2021-3-3(11)-12-16 ◽

2021 ◽

pp. 12-16

Author(s):

Maksim D. OSIPOV

Keyword(s):

Hip Fracture ◽

High Risk ◽

Femoral Neck ◽

Fracture Healing ◽

Femoral Neck Fracture ◽

Statistical Data ◽

Femoral Neck Fractures ◽

Anatomical Features ◽

Clinical Hospital ◽

Neck Fracture

We study the terms of the femoral neck fracture healing, depending on the type of fractures. Currently, the diagnosis of “hip fracture” occupies a significant place in the work of a traumatologist, since this fracture tends to increase the frequency of cases, especially among people over 60 years old. This problem has long been one of the most urgent in traumatology and orthopedics, includes many facets, among which there is a high risk of complications during the operation of these fractures among elderly and senile people, the growth of people at high risk of hip fracture due to osteoporotic changes in the composition of bone tissue. And one of the sides of this problem is the non-healing and the timing of the femoral neck fracture healing, due to its anatomical features. We present the results of studies conducted at the clinical bases of the Kotovsk City Clinical Hospital and Archbishop Luke Tambov City Clinical Hospital. Aim: to study the terms of the femoral neck fracture healing, depending on the type of fractures. Task: to conduct studies, observations, collect statistical data on the management of patients with femoral neck fracture and, based on the results obtained, to characterize and evaluate the terms of femoral neck fractures healing

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90-Day Mortality and Its Predictors In Women With Contralateral Hip Fracture After Femoral Neck Fracture

Value in Health ◽

10.1016/j.jval.2017.08.735 ◽

2017 ◽

Vol 20 (9) ◽

pp. A528

Author(s):

K Juhász ◽

I Boncz ◽

B Molics ◽

A Sebestyén

Keyword(s):

Hip Fracture ◽

Femoral Neck ◽

Femoral Neck Fracture ◽

Neck Fracture

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Trends and predictors of mortality in unstable pelvic ring fracture: a 10-year experience with a multidisciplinary institutional protocol

World Journal of Emergency Surgery ◽

10.1186/s13017-019-0282-x ◽

2019 ◽

Vol 14 (1) ◽

Cited By ~ 1

Author(s):

Hsien-Te Chen ◽

Yu-Chun Wang ◽

Chen-Chou Hsieh ◽

Li-Ting Su ◽

Shih-Chi Wu ◽

...

Keyword(s):

Diabetes Mellitus ◽

Mortality Rate ◽

Glasgow Coma Scale ◽

Pelvic Fracture ◽

Pelvic Ring ◽

Multivariable Analysis ◽

Vital Signs ◽

Pelvic Ring Fracture ◽

Ring Fracture ◽

Coma Scale

Abstract Background Pelvic ring fracture is often combined with other injuries and such patients are considered at high risk of mortality and complications. There is controversy regarding the gold standard protocol for the initial treatment of pelvic fracture. The aim of this study was to assess which risk factors could affect the outcome and to analyze survival using our multidisciplinary institutional protocol for traumatic pelvic ring fracture. Material and methods This retrospective study reviewed patients who sustained an unstable pelvic ring fracture with Injury Severity Score (ISS) ≥ 5. All patients were admitted to the emergency department and registered in the Trauma Registry System of a level I trauma center from January 1, 2008, to December 31, 2017. The annular mortality rate after the application of our institutional protocol was analyzed. Patients with different systems of injury and treatments were compared, and regression analysis was performed to adjust for factors that could affect the rate of mortality and complications. Results During the 10-year study period, there were 825 unstable pelvic ring injuries, with a mean ISS higher than that of other non-pelvic trauma cases. The annual mortality rate declined from 7.8 to 2.4% and the mean length of stay was 18.1 days. A multivariable analysis showed that unstable initial vital signs, such as systolic blood pressure < 90 mmHg (odds ratio [OR] 2.53; confidence interval [CI] 1.11–5.73), Glasgow Coma Scale < 9 (OR 3.87; CI 1.57–9.58), 24 > ISS > 15 (OR 4.84; CI 0.85–27.65), pulse rate < 50 (OR 11.54; CI 1.21–109.6), and diabetes mellitus (OR 3.18; CI 1.10–9.21) were associated with higher mortality. No other specific system in the high Abbreviated Injury Scale increased the rates of mortality or complications. Conclusion Poor initial vital signs and Glasgow Coma Scale score, higher ISS score, and comorbidity of diabetes mellitus affect the mortality rate of patients with unstable pelvic ring fractures. No single system of injury was found to increase mortality in these patients. The mortality rate was reduced through institutional efforts toward the application of guidelines for the initial management of pelvic fracture.

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