scholarly journals Does preoperative dipyridamole-thallium scanning reduce 90-day cardiac complications and 1-year mortality in patients with femoral neck fractures undergoing hemiarthroplasty?

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Chin-Yi Liao ◽  
Timothy L. Tan ◽  
Yu-Der Lu ◽  
Cheng-Ta Wu ◽  
Mel S. Lee ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mortality Rate ◽  
Propensity Score ◽  
Femoral Neck ◽  
Femoral Neck Fractures ◽  
Cardiac Complications ◽  
Control Group ◽  
Matched Cohort ◽  
Neck Fracture ◽  
Dipyridamole Thallium

Abstract Background This study aimed to evaluate the effect of dipyridamole-thallium scanning (DTS) on the rates of 90-day cardiac complications and 1-year mortality in patients with a femoral neck fracture treated with hemiarthroplasty. Methods Between 2008 and 2015, 844 consecutive patients who underwent cemented or cementless hemiarthroplasty were identified from the database of a single level-one medical center. One-hundred and thirteen patients (13%) underwent DTS prior to surgery, and 731 patients (87%) did not. Patient characteristics, comorbidities, surgical variables, and length of the delay until surgery were recorded. A propensity score-matched cohort was utilized to reduce recruitment bias in a 1:3 ratio of DTS group to control group, and multivariate logistic regression was performed to control confounding variables. Results The incidence of 90-day cardiac complications was 19.5% in the DTS group and 15.6% in the control group (p = 0.343) among 452 patients after propensity score-matching. The 1-year mortality rate (10.6% vs 13.3%, p = 0.462) was similar in the two groups. In the propensity score-matched patients, utilization of DTS was not associated with a reduction in the rate of 90-day cardiac complications (matched cohort, adjusted odds ratio [aOR] = 1.32; 95% confidence interval [CI] 0.75–2.33, p = 0.332) or the 1-year mortality rate (aOR = 0.62; 95% CI 0.27–1.42, p = 0.259). Risk factors for cardiac complications included an American Society of Anesthesiologists grade ≥ 3 (OR 3.19, 95% CI 1.44–7.08, p = 0.004) and pre-existing cardiac comorbidities (OR 5.56, 95% CI 3.35–9.25, p < 0.001). Risk factors for 1-year mortality were a long time to surgery (aOR 1.15, 95% CI 1.06–1.25, p = 0.001), a greater age (aOR 1.05, 95% CI 1.00 to 1.10, p = 0.040), a low body mass index (BMI; aOR 0.89, 95% CI 0.81–0.98, p = 0.015), and the presence of renal disease (aOR 4.43, 95% CI 1.71–11.46, p = 0.002). Discussion Preoperative DTS was not associated with reductions in the rates of 90-day cardiac complications or 1-year mortality in patients with a femoral neck fracture undergoing hemiarthroplasty. The necessity for DTS should be re-evaluated in elderly patients with femoral neck fractures, given that this increases the length of the delay until surgery. Level of evidence Prognostic level III

scholarly journals Preoperative dipyridamole-thallium scanning did not reduce 90-day cardiac complications and mortality in patients with femoral neck fractures undergoing hemiarthroplasty

2019 ◽  
Author(s):  
Chin-Yi Liao ◽  
Timothy L Tan ◽  
Yu-Der Lu ◽  
Cheng-Ta Wu ◽  
Mel S Lee ◽  
...  
Keyword(s):  
Risk Factors ◽  
Propensity Score ◽  
Femoral Neck ◽  
Femoral Neck Fracture ◽  
Femoral Neck Fractures ◽  
Cardiac Complications ◽  
Matched Cohort ◽  
Neck Fracture ◽  
Complications And Mortality ◽  
Dipyridamole Thallium

Abstract Background: Patients with hip fractures have risk factors that increase the likelihood of postoperative cardiac complications and mortality. This study aimed to evaluate the effect of dipyridamole-thallium scanning on 90-day cardiac complications and mortality in patients with femoral neck fracture treated with hemiarthroplasty. Methods: Between 2008 and 2015, 844 consecutive patients undergoing cemented or cementless hemiarthroplasty were identified from the database of a single level-one medical center. One-hundred and thirteen patients (13.4%) underwent the dipyridamole-thallium scan test prior to surgery, and 731 patients (86.6%) did not. Patient characteristics, comorbidities, surgical variables, and duration to surgery were recorded. Multivariate logistic regression was performed, and a propensity-score-matched cohort was identified in order to determine whether dipyridamole-thallium scanning was associated with 90-day cardiac complications and mortality.Results: The incidence of 90-day cardiac complications was 19.47% in the thallium scan group and 11.58% in the non-thallium scan group (p = 0.343) among 452 patients after propensity score-matching. The 90-day mortality rate was similar in the two groups (0.88% vs. 1.18%, p = 0.795). In the propensity score-matched patients, utilization of the dipyridamole-thallium scan was not associated with cardiac complications (matched cohort, adjusted odds ratio [OR] = 1.32; 95% confidence interval [CI] 0.75 to 2.33) or mortality (adjusted OR = 0.75; 95% CI 0.08 to 6.71) within 90 days. Risk factors for cardiac complications were an American Society of Anesthesiologists grade 3 (OR 3.19, 95% CI 1.44 to 7.08) and pre-existing cardiac comorbidities (OR 5.56, 95% CI 3.35 to 9.25). Discussion: Preoperative dipyridamole-thallium scanning was not associated with reductions in 90-day cardiac complications and mortality in patients with femoral neck fracture undergoing hemiarthroplasty. The necessity for dipyridamole-thallium scanning should be re-evaluated in elderly patients with femoral neck fractures, given that this increases the duration to surgery.

scholarly journals Does preoperative dipyridamole-thallium scanning reduce 90-day cardiac complications and mortality in patients with femoral neck fractures undergoing hemiarthroplasty?

2020 ◽  
Author(s):  
Chin-Yi Liao ◽  
Timothy L. Tan ◽  
Yu-Der Lu ◽  
Cheng-Ta Wu ◽  
Mel S Lee ◽  
...  
Keyword(s):  
Propensity Score ◽  
Femoral Neck ◽  
Femoral Neck Fracture ◽  
Medical Center ◽  
Femoral Neck Fractures ◽  
Cardiac Complications ◽  
Matched Cohort ◽  
Neck Fracture ◽  
Complications And Mortality ◽  
Dipyridamole Thallium

Abstract Background: This study aimed to evaluate the effect of dipyridamole-thallium scanning on 90-day cardiac complications and mortality in patients with femoral neck fracture treated with hemiarthroplasty. Methods : Between 2008 and 2015, 844 consecutive patients undergoing cemented or cementless hemiarthroplasty were identified from the database of a single level-one medical center. One-hundred and thirteen patients (13.4%) underwent the dipyridamole-thallium scan test prior to surgery, and 731 patients (86.6%) did not. Patient characteristics, comorbidities, surgical variables, and duration to surgery were recorded. Multivariate logistic regression was performed, and a propensity-score-matched cohort was identified in order to determine whether dipyridamole-thallium scanning was associated with 90-day cardiac complications and mortality. Results: The incidence of 90-day cardiac complications was 19.47% in the thallium scan group and 11.58% in the non-thallium scan group ( p = 0.343) among 452 patients after propensity score-matching. The 90-day mortality rate was similar in the two groups (0.88% vs. 1.18%, p = 0.795). In the propensity score-matched patients, utilization of the dipyridamole-thallium scan was not associated with cardiac complications (matched cohort, adjusted odds ratio [OR] = 1.32; 95% confidence interval [CI] 0.75 to 2.33) or mortality (adjusted OR = 0.75; 95% CI 0.08 to 6.71) within 90 days. Risk factors for cardiac complications were an American Society of Anesthesiologists grade 3 (OR 3.19, 95% CI 1.44 to 7.08) and pre-existing cardiac comorbidities (OR 5.56, 95% CI 3.35 to 9.25). Discussion : Preoperative dipyridamole-thallium scanning was not associated with reductions in 90-day cardiac complications and mortality in patients with femoral neck fracture undergoing hemiarthroplasty. The necessity for dipyridamole-thallium scanning should be re-evaluated in elderly patients with femoral neck fractures, given that this increases the duration to surgery.

scholarly journals Dipyridamole-thallium scanning doesn't reduce 90-day cardiac complications and mortality in femoral neck fracture patients undergoing hemiarthroplasty: a propensity-score-matched analysis in an Asian population

2020 ◽  
Author(s):  
Chin-Yi Liao ◽  
Timothy L Tan ◽  
Yu-Der Lu ◽  
Cheng-Ta Wu ◽  
Feng-Chih Kuo ◽  
...  
Keyword(s):  
Propensity Score ◽  
Femoral Neck ◽  
Femoral Neck Fracture ◽  
Medical Center ◽  
Asian Population ◽  
Cardiac Complications ◽  
Matched Cohort ◽  
Neck Fracture ◽  
Complications And Mortality ◽  
Dipyridamole Thallium

Abstract Background: This study aimed to evaluate the effect of dipyridamole-thallium scanning on 90-day cardiac complications and mortality in patients with femoral neck fracture treated with hemiarthroplasty.Methods: Between 2008 and 2015, 844 consecutive patients undergoing cemented or cementless hemiarthroplasty were identified from the database of a single level-one medical center. One-hundred and thirteen patients (13.4%) underwent the dipyridamole-thallium scan test prior to surgery, and 731 patients (86.6%) did not. Patient characteristics, comorbidities, surgical variables, and duration to surgery were recorded. Multivariate logistic regression was performed, and a propensity-score-matched cohort was identified in order to determine whether dipyridamole-thallium scanning was associated with 90-day cardiac complications and mortality.Results: The incidence of 90-day cardiac complications was 19.47% in the thallium scan group and 11.58% in the non-thallium scan group (p = 0.343) among 452 patients after propensity score-matching. The 90-day mortality rate was similar in the two groups (0.88% vs. 1.18%, p = 0.795). In the propensity score-matched patients, utilization of the dipyridamole-thallium scan was irrelevant to cardiac complications (matched cohort, adjusted odds ratio [OR] = 1.32; 95% confidence interval [CI] 0.75 to 2.33) or mortality (adjusted OR = 0.75; 95% CI 0.08 to 6.71) within 90 days. Risk factors for cardiac complications were an American Society of Anesthesiologists grade 3 (OR 3.19, 95% CI 1.44 to 7.08) and pre-existing cardiac comorbidities (OR 5.56, 95% CI 3.35 to 9.25). Discussion: Preoperative dipyridamole-thallium scanning was not associated with reductions in 90-day cardiac complications and mortality in patients with femoral neck fracture undergoing hemiarthroplasty. The necessity for dipyridamole-thallium scanning should be re-evaluated in elderly patients with femoral neck fractures, given that this increases the duration to surgery.

scholarly journals Preoperative deep venous thrombosis (DVT) after femoral neck fracture in the elderly, the incidence, timing, location and related risk factors

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Shuai Niu ◽  
Juan Li ◽  
Yan Zhao ◽  
Dianzhu Ding ◽  
Guangwei Jiang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Femoral Neck ◽  
Elderly Patients ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Femoral Neck Fracture ◽  
Femoral Neck Fractures ◽  
Control Group ◽  
Neck Fracture ◽  
Time From Injury

Abstract Objective To investigate the epidemiologic characteristics of deep venous thrombosis (DVT) in elderly patients with femoral neck fracture. Methods Retrospective analysis was performed on elderly patients with femoral neck fractures admitted to two institutions from January 2016 to October 2019. Duplex ultrasonography (DUS) was used to detect DVT. Patients’ hospitalization medical records were retrieved to collect the data, which were related to demographics, comorbidities, injury and laboratory results on admission. Patients with preoperative DVT were defined as the case group and those without DVT as control group, and compared using the univariate analyses. Multivariate logistic regression analysis was used to identify the independent factors associated with DVT. Results Totally, 980 patients met the predefined criteria and were included. Sixty-seven patients were diagnosed to have preoperative DVT, with incidence of 6.8% for overall, 1.7% for proximal and 5.1% for distal DVT. The mean time from injury to diagnosis of DVT was 6.0 ± 4.7 days (median, 5.0). Most (76.1%) patients with DVT had thrombi solely in the injured extremity, in contrast with 14.9% (10/67) in the uninjured and 9.0% (6/67) in both injured and uninjured extremity. Multivariate analysis showed chronic renal insufficiency (OR, 3.37; 95%CI, 1.57 to 7.28), current smoking status (OR, 2.42; 95%CI, 1.23 to 5.63), time from injury to DUS (OR, 1.26; 95%CI, 1.07 to 1.61) and PLT > 220*109/L (OR, 1.94; 95%CI, 1.31 to 3.77) were independent factors for DVT. Conclusion Preoperative DVT is not very prevalent following elderly femoral neck fractures, but with a certain proportion in the uninjured extremity, necessitating the more attention. These identified risk factors aid in patient counseling, individualized risk assessment and risk stratification, and should be kept in mind.

scholarly journals Preoperative Deep Venous Thrombosis (DVT) after Femoral Neck Fracture in the Elderly, the Incidence, Timing, Location and Related Risk Factors

2021 ◽  
Author(s):  
Shuai Niu ◽  
Juan Li ◽  
Yan Zhao ◽  
Dianzhu Ding ◽  
Guangwei Jiang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Femoral Neck ◽  
Elderly Patients ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Femoral Neck Fracture ◽  
Multivariate Logistic Regression Analysis ◽  
Femoral Neck Fractures ◽  
Control Group ◽  
Neck Fracture

Abstract Objective to investigate the epidemiologic characteristics of deep venous thrombosis (DVT) in elderly patients with femoral neck fracture Methods Retrospective analysis was performed on elderly patients with femoral neck fractures admitted to two institutions from January 2016 to October 2019. Duplex ultrasonography (DUS) was used to detect DVT. Patients' hospitalization medical records were retrieved to collect the data, which were related to demographics, comorbidities, injury and laboratory results on admission. Patients with preoperative DVT were defined as the case group and those without DVT as control group, and compared using the univariate analyses. Multivariate logistic regression analysis was used to identify the independent factors associated with DVT. Results Totally, 980 patients met the predefined criteria and were included. Sixty-seven patients were diagnosed to have preoperative DVT, with incidence of 6.8% for overall, 1.7% for proximal and 5.1% for distal DVT. The mean time from injury to diagnosis of DVT was 6.0 ± 4.7 days (median, 5.0). Most (76.1%) patients with DVT had thrombi solely in the injured extremity, in contrast with 14.9% (10/67) in the uninjured and 9.0% (6/67) in both injured and uninjured extremity. Multivariate analysis showed chronic renal insufficiency, current smoking status, delay to DUS and PLT > 220*109/L were independent factors for DVT. Conclusion Preoperative DVT is not very prevalent following elderly femoral neck fractures, but with a certain proportion in the uninjured extremity, necessitating the more attention. These identified risk factors aid in patient counseling, individualized risk assessment and risk stratification, and should be kept in mind.

scholarly journals Occult femoral neck fractures

2014 ◽  
Vol 13 (4) ◽  
pp. 264-268
Author(s):  
Valentinas Uvarovas ◽  
Andrius Vaitiekus ◽  
Igoris Šatkauskas
Keyword(s):  
Mortality Rate ◽  
Femoral Neck ◽  
Elderly Patients ◽  
Femoral Neck Fractures ◽  
Urgent Problem ◽  
Occult Fracture ◽  
Secondary Fracture ◽  
Plain Radiographs ◽  
X Ray ◽  
Neck Fracture

Occult femoral neck fractures are becoming an urgent problem for aging population. In general the term “occult fracture” is used to denote fractures which are occult on plain radiographs, but found to be present on other imaging modalities or intra-operatively. Estimated incidence of occult femoral neck fracture is 2 to 10 per cent according to the literature. There is a risk of secondary fracture displacement, and other related complications in case of late diagnosis of these fractures. Timely diagnosis of these fractures in elderly patients improves treatment outcomes, reduces invalidity risk. The higher mortality rate is associated with well diagnosed femoral neck fractures whose treatment was delayed for reasons other than missing X-ray evidence of a fracture.

scholarly journals Essential Role of Reliable Reduction Quality in Internal Fixation of Femoral Neck Fractures in the Non-elderly Patients—A Propensity Score Matching Analysis

2021 ◽  
Author(s):  
Longhai Qiu ◽  
Yuliang Huang ◽  
Guowen Li ◽  
Hongbo Wu ◽  
Zhiwen Zhang ◽  
...  
Keyword(s):  
Survival Analysis ◽  
Propensity Score ◽  
Femoral Neck ◽  
Internal Fixation ◽  
Femoral Neck Fracture ◽  
Reoperation Rate ◽  
Femoral Neck Fractures ◽  
Kaplan Meier ◽  
Reduction Group ◽  
Neck Fracture

Abstract Background: The rate of failure of internal fixation for femoral neck fractures has remained largely unchanged over the past 30 years. The current study attempted to identify the controllable variables influencing the failure of internal fixation of femoral neck fractures. Methods:The study included 190 patients aged from 20 to 65 with femoral neck fracture caused by low energy violent injuries, who were treated with multiple cannulated screws over the period 2005-2019 at a single centre. Kaplan-Meier (KM) survival analysis was firstly utilized to evaluate the potential interaction between each variable and cumulative rates of reoperation. If P < 0.1 in KM survival analysis, the variables would be included in subsequent Cox survival analysis to explore the influencing need for reoperation of a femoral neck fracture. Next, all of the 190 patients were divided into perfect reduction group (Garden Alignment Index Ⅰ) and imperfect reduction group (Garden Alignment Index Ⅱ, Ⅲ, Ⅳ). Propensity score matching (PSM) analysis resulted in 39 pairs. After the baseline variables were balanced between the two groups, Cox survival analysis was utilized again to explore the variables influencing the need of reoperation of a femoral neck fracture. Finally, KM survival analysis was utilized to compare the cumulative rate of reoperation between perfect reduction (Group PR) and imperfect reduction（Group IR）as a subgroup analysis. Results: Before PSM analysis, the mean age was 49.96±12.02 years and the total reoperation rate was 17.40%. Cox survival analysis showed that only reduction quality was interrelated with the need for reoperation before PSM analysis and after PSM analysis. Kaplan–Meier cumulative reoperation rate was higher in Group IR than in Group PR after PSM analysis. Conclusion: To prolong the service life of the original femoral head, it is essential to achieve a completely anatomical reduction and maintain the reduction quality until the patient fully recovers.

scholarly journals Occult femoral neck fractures

2014 ◽  
Vol 13 (4) ◽  
pp. 264-268
Author(s):  
Valentinas Uvarovas ◽  
Andrius Vaitiekus ◽  
Igoris Šatkauskas
Keyword(s):  
Mortality Rate ◽  
Femoral Neck ◽  
Elderly Patients ◽  
Femoral Neck Fractures ◽  
Urgent Problem ◽  
Occult Fracture ◽  
Secondary Fracture ◽  
Plain Radiographs ◽  
X Ray ◽  
Neck Fracture

Occult femoral neck fractures are becoming an urgent problem for aging population. In general the term “occult fracture” is used to denote fractures which are occult on plain radiographs, but found to be present on other imaging modalities or intra-operatively. Estimated incidence of occult femoral neck fracture is 2 to 10 per cent according to the literature. There is a risk of secondary fracture displacement, and other related complications in case of late diagnosis of these fractures. Timely diagnosis of these fractures in elderly patients improves treatment outcomes, reduces invalidity risk. The higher mortality rate is associated with well diagnosed femoral neck fractures whose treatment was delayed for reasons other than missing X-ray evidence of a fracture.

scholarly journals Bilateral Femoral Neck Fracture in a Postpartum Woman: Beware of the Risk Factors

2019 ◽  
Vol 2019 ◽  
pp. 1-4 ◽  
Author(s):  
Ismail Sahan ◽  
Julie De Deken ◽  
Konstantinos Anagnostakos
Keyword(s):  
Risk Factors ◽  
Femoral Neck ◽  
Renal Osteodystrophy ◽  
Rare Case ◽  
Epileptic Seizures ◽  
Femoral Neck Fractures ◽  
Postpartum Woman ◽  
Transient Osteoporosis ◽  
Rare Injury ◽  
Neck Fracture

Bilateral femoral neck fractures pose a rare injury. Literature data describe this entity in association with epileptic seizures, renal osteodystrophy, electric shock, pregnancy-associated transient osteoporosis, and hypocalcemic seizure. In the present work, we report on a rare case of a 28-year-old woman who suffered from such an injury 3 days postpartum. The patient had two predisposing factors (epilepsy history, transient osteoporosis) that were neglected as possible risk factors by the treating physicians. Awareness of the factors might have prevented the emergence of this injury.

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