The influence of immediate surgical treatment of proximal femoral fractures on mortality and quality of life

Proximal femoral fractures, including intertrochanetric and subtrochanteric with diaphiseal propagation represent a significant challenge in orthopedic surgery, especially in older population. Retrospective analysis of patients, after the application of 'Bi Nail (Bioimpianti Inc.) intramedullary nail for fractures and pathological conditions of proximal femur, was done at the Department of Adult Orthopedics, Institute of Orthopedic surgery Banjica, during the three year period. We present patients with complex fractures and pathological conditions (metastasis and pseudoarthrosis) of proximal femur; most of the fractures were result of effects of low energy, and the most common pathological fracture is due to metastasis of breast cancer. The analysis included the technical characteristics and duration of surgery, intraoperative and postoperative complications as well as the coalescence time of fracture healing and postoperative quality of life after rehabilitation. We believe that the described surgical method, although technically demanding, with a variable length duration of surgery and treatment of high risk elderly patients, provides stable fracture fixation with early rehabilitation to improve the quality of life.

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The value of nonoperative versus operative treatment of frail institutionalized elderly patients with a proximal femoral fracture in the shade of life (FRAIL-HIP); protocol for a multicenter observational cohort study

BMC Geriatrics ◽

10.1186/s12877-019-1324-7 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 1

Author(s):

Pieter Joosse ◽

◽

Sverre A. I. Loggers ◽

C. L. P. (Marc) Van de Ree ◽

Romke Van Balen ◽

...

Keyword(s):

Quality Of Life ◽

Femoral Fracture ◽

Femoral Fractures ◽

Proximal Femoral Fracture ◽

Nonoperative Treatment ◽

Proximal Femoral Fractures ◽

Institutionalized Elderly ◽

Time To Death ◽

Observational Cohort

Abstract Background Proximal femoral fractures are strongly associated with morbidity and mortality in elderly patients. Mortality is highest among frail institutionalized elderly with both physical and cognitive comorbidities who consequently have a limited life expectancy. Evidence based guidelines on whether or not to operate on these patients in the case of a proximal femoral fracture are lacking. Practice variation occurs, and it remains unknown if nonoperative treatment would result in at least the same quality of life as operative treatment. This study aims to determine the effect of nonoperative management versus operative management of proximal femoral fractures in a selected group of frail institutionalized elderly on the quality of life, level of pain, rate of complications, time to death, satisfaction of the patient (or proxy) and the caregiver with the management strategy, and health care consumption. Methods This is a multicenter, observational cohort study. Frail institutionalized elderly (70 years or older with a body mass index < 18.5, a Functional Ambulation Category of 2 or lower pre-trauma, or an American Society of Anesthesiologists score of 4 or 5), who sustained a proximal femoral fracture are eligible to participate. Patients with a pathological or periprosthetic fractures and known metastatic oncological disease will be excluded. Treatment decision will be reached following a structured shared decision process. The primary outcome is quality of life (Euro-QoL; EQ-5D-5 L). Secondary outcome measures are quality of life measured with the QUALIDEM, pain level (PACSLAC), pain medication use, treatment satisfaction of patient (or proxy) and caregivers, quality of dying (QODD), time to death, and direct medical costs. A cost-utility and cost-effectiveness analysis will be done, using the EQ-5D utility score and QUALIDEM score, respectively. Non-inferiority of nonoperative treatment is assumed with a limit of 0.15 on the EQ-5D score. Data will be acquired at 7, 14, and 30 days and at 3 and 6 months after trauma. Discussion The results of this study will provide insight into the true value of nonoperative treatment of proximal femoral fractures in frail elderly with a limited life expectancy. The results may be used for updating (inter)national treatment guidelines. Trial registration The study is registered at the Netherlands Trial Register (NTR7245; date 10-06-2018).

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PROXIMAL DISABILITY AND SPINAL DEFORMITY INDEX IN PATIENTS WITH PROXIMAL FEMUR FRACTURES

Coluna/Columna ◽

10.1590/s1808-185120151404152847 ◽

2015 ◽

Vol 14 (4) ◽

pp. 276-280

Author(s):

Sylvio Mistro Neto ◽

Marcelo Italo Risso Neto ◽

Guilherme Rebechi Zuiani ◽

Roberto Rossanez ◽

Gabriel Gomes Freitas de Castro ◽

...

Keyword(s):

Quality Of Life ◽

Spinal Deformity ◽

Femoral Fracture ◽

Strong Association ◽

Femoral Fractures ◽

Proximal Femoral Fracture ◽

Proximal Femoral Fractures ◽

Femur Fractures ◽

Spinal Deformity Index

Objective : To evaluate the quality of life related to the spine in patients with proximal femoral fractures. Methods : Study conducted in a tertiary public hospital in patients with proximal femoral fractures caused by low-energy trauma, through the Oswestry Disability Index questionnaire to asses complaints related to the spine at the time of life prior to the femoral fracture. The thoracic and lumbar spine of patients were also evaluated applying the radiographic index described by Gennant (Spinal Deformity Index), which assesses the number and severity of fractures. Results : Seventeen subjects completed the study. All had some degree of vertebral fracture. Patients were classified in the categories of severe and very severe disability in the questionnaire about quality of life. It was found that the higher SDI, the better the quality of life. Conclusion : There is a strong association of disability related to the spine in patients with proximal femoral fracture, and this complaint must be systematically evaluated in patients with appendicular fracture.

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