HIP FRACTURES IN 5 YEARS AT HUE UNIVERSITY HOSPITAL

Aim: This study aimed to review the clinical findings and surgical intervention of the hip fracture at the Hue University Hospital in Vietnam. Methods:The data of proximal femoral fractures was collected retrospectively. All patients, in a period of 5 years, from Jan 2008 to December 2012, suffered either from intertrochanteric or femoral neck fractures. The numbers of patients were gathered separately for each year, by age groups (under 40, 40-49, 50-59, 60-69, 70-79, older) and by sex. We analyzed what kind of treatment options were used for the hip fracture. Results:Of 224 patients (93 men and 131 women) studied, 71% patients are over 70 years old, 103 women and 56 men (p<0.05). For patients under 40 years, there were 1 woman and 11 men (p<0.05). There were 88 intertrochanteric and 136 femoral neck fractures. There was no significant difference in the two fractures between men and women. The numbers of hip fracture increased by each year, 29/224 cases in 2010, 63/224 cases in 2011, 76/224 cases in 2012. Treatment of 88 intertrochanteric fractures: 49 cases (55.7%) of dynamic hip screw (DHS), 14 cases of hemiarthroplasty (15.9%), 2 cases of total hip replacement (2.3%). Treatment of 136 femoral neck fractures: 48 cases of total replacement (35.3%), 43 cases of hemiarthroplasty (31.6%), 15 cases of screwing (11%). In cases of 40 patients (17.9%) hip fracture was managed conservatively, 23 were femoral neck fractures and 17 were intertrochanteric fractures. Conclusions: Hip fracture is growing challenge in Hue medical university hospital. The conservative approach is still high in people who could not be operable due to severe medical conditions as well as for patients with economic difficulties. Over 70% of the hip fractures in people 70+ are caused by osteoporosis. The number of hip fracture is increasing in the following years, most likely due to the increase in the prevalence of osteoporosis. Early detection and prevention of osteoporosis should be addressed, particularly in high risk population. More aggressive surgical approach should be implemented in order to improve the quality of life in patients with hip fractures. Key words:Hip fracture.

Download Full-text

Hip fractures among the elderly in Kyoto, Japan: a 10-year study

Archives of Osteoporosis ◽

10.1007/s11657-021-00888-8 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Maki Asada ◽

Motoyuki Horii ◽

Kazuya Ikoma ◽

Tsuyoshi Goto ◽

Naoki Okubo ◽

...

Keyword(s):

Hip Fracture ◽

Femoral Neck ◽

Incidence Rate ◽

Acute Care ◽

Hip Fractures ◽

Age Groups ◽

The Elderly ◽

Femoral Neck Fractures ◽

Age Group ◽

Trochanteric Fractures

Abstract Summary In Kyoto Prefecture, Japan, the number of hip fractures increased during 2013–2017 compared to 2008–2012. However, the estimated overall incidence rate increased only in femoral neck fractures in men aged ≥75 and women aged ≥85. Purpose The incidence rate of hip fractures in Japan has plateaued or decreased. We investigated the annual hip fracture occurrences in Kyoto Prefecture, Japan, from 2008 to 2017. Methods Patients aged 65 years and above who sustained hip fractures between 2008 and 2017 and were treated at one of the participating 11 hospitals were included. The total number of beds in these institutions was 3701, accounting for 21.5% of the 17,242 acute-care beds in Kyoto Prefecture. The change in incidence rate was estimated utilizing the population according to the national census conducted in 2010 and 2015. Results The total number of hip fractures was 10,060, with 47.5% femoral neck fractures and 52.5% trochanteric fractures. A decrease in number was seen only in trochanteric fractures in the group of 75- to 84-year-old women. The population-adjusted numbers of femoral neck fractures showed a significant increase in all age groups in men, whereas in women, there was an increase in femoral neck fractures in the ≥85 group and trochanteric fractures in the age group 65–74, and a decrease in trochanteric fractures in the age group 75–84. The estimated change in incidence rate showed an increase in femoral neck fractures in men aged ≥75 and women aged ≥85. Conclusion In Kyoto Prefecture, the number of hip fractures increased in the second half of the study period (2013–2017) compared to the first half (2008–2012). However, the incidence rate had not increased, except in femoral neck fractures in men aged ≥75 and women aged ≥85.

Download Full-text

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.

Download Full-text

Comparison of Bone Mineral Density at Hip and Lumbar Spine in Patients with Femoral Neck Fractures and Pertrochanteric Fractures

Ortopedia Traumatologia Rehabilitacja ◽

10.5604/01.3001.0014.7567 ◽

2021 ◽

Vol 23 (1) ◽

pp. 45-49

Author(s):

Chulin Chewakidakarn ◽

Varah Yuenyongviwat

Keyword(s):

Lumbar Spine ◽

Femoral Neck ◽

Hip Fractures ◽

Dual Energy ◽

Femoral Neck Fractures ◽

University Hospital ◽

Mineral Density ◽

Pertrochanteric Fractures ◽

X Ray ◽

Total Hip

Background. Geriatric hip fractures, including femoral neck and pertrochanteric fractures, are common nowadays, which is related to increasing numbers of elderly people worldwide. Osteoporosis is an important risk factor associated with hip fractures. This study aimed to describe the association of hip fractures and osteoporosis at different BMD measurement sites and determine any differences between these two types of hip fracture. Material and methods. A retrospective study conducted in a university hospital in the south of Thailand enrolled 223 patients aged over 50 years with low-energy trauma hip fractures. Each patient had undergone dual energy x-ray absorptiometry (DXA) within 2 weeks of injury. T-scores were recorded for the total hip, femoral neck and lumbar spine areas and classified as normal, osteopenia and osteoporosis according to WHO osteoporosis diagnostic criteria. Results. The highest proportion of T-scores in the osteoporotic range were registered at the femoral neck (68.6%) compared to total hip (52.9%) and lumbar spine (47.7%). At least 31.4% of patients were in the non-osteoporotic range. No significant differences were found at all sites of BMD measurement between the two types of fracture. Conclusions. 1. At least 1/3 of patients with geriatric hip fractures had their T-scores in the normal to osteopenic range. 2. BMD in different areas is not different between types of hip fractures.

Download Full-text

Errores de osteosíntesis en fracturas laterales de cadera tratadas con placa/tornillo deslizante [Osteosynthesis pitfalls in lateral hip fractures treated with plate / sliding screw system].

Revista de la Asociación Argentina de Ortopedia y Traumatología ◽

10.15417/issn.1852-7434.2019.84.4.961 ◽

2019 ◽

Vol 84 (4) ◽

pp. 328-335

Author(s):

César Ángel Pesciallo ◽

Leonel Pérez Alamino ◽

Germán Garabano ◽

Hernán Del Sel

Keyword(s):

Hip Fracture ◽

Femoral Head ◽

Failure Rate ◽

Hip Fractures ◽

Fixation Method ◽

Intertrochanteric Fractures ◽

Medial Migration ◽

Significant Difference ◽

Proximal Screw

Introducción: El uso de los sistemas placa/tornillo deslizante para fracturas intertrocantéricas ha demostrado ser un método de fijación eficaz, pero no está exento de fallas. El propósito de este estudio fue evaluar las causas de falla en los pacientes con fracturas laterales de cadera, tratados con placa/tornillo deslizante, puntualizando los defectos técnicos en la colocación.Materiales y Métodos: En nuestro centro, se trató a 177 pacientes por fractura lateral de cadera, a 151 de ellos se les practicó osteosíntesis con placa/tornillo deslizante. Se analizaron la adecuada reducción posoperatoria, la medición de la distancia punta a vértice, la posición del tornillo cefálico en la cabeza femoral y las posibles complicaciones.Resultados: La serie quedó conformada por 143 pacientes. El seguimiento promedio fue de 18 meses (rango 12-48). La tasa de fallas fue del 8,4% (n = 12): 7 (4,8%) por migración cefálica (cut-out) del tornillo proximal, 2 (1,4%) por migración medial (cut-through), 2 (1,4%) presentaron seudoartrosis y un caso (0,70%) de reducción inadecuada en varo. El porcentaje de una segunda operación fue del 7,7% (n = 11). La peor posición fue la superior/posterior con un 100% de migración (n = 4) (p <0,001, diferencia estadísticamente significativa).Conclusión: El posicionamiento superior/posterior del tornillo cefálico podría incrementar la posibilidad de migración y, en consecuencia, la tasa de falla del sistema. AbstractIntroduction: The use of Dynamic Hip/Sliding Screw (DHS) for intertrochanteric fractures has proven to be an effective fixation method, but it also has its failures.The purpose of this study was to evaluate the reason of failures in patients with lateral hip fractures that were treated with a DHS.Method:177 patients were treated in our center for lateral hip fracture. In 151 of them we used a DHS. The adequate postoperative reduction, the measurement of the tip-to-apex distance, the position of the cephalic screw in the femoral head and the possible complications were analyzed.Results: The series was made up of 143 patients. The average follow-up was 18 months (range 12-48). The failure rate was 8.4% (n = 12): 7 (4.8%) due to cephalic migration (cut-out) of the proximal screw, 2 (1.4%) due to medial migration (cut-through) , 2 (1.4%) presented pseudoarthrosis and one case (0.70%) of inadequate reduction in varus. The percentage of a second operation was 7.7% (n = 11). The worst position was the superior / posterior with 100% migration (n = 4) (p <0.001, statistically significant difference).Conclusion: The superior / posterior positioning of the head screw could increase the possibility of migration and, consequently, the failure rate of the system.

Download Full-text

Anchorage strategies in geriatric hip fracture management

Innovative Surgical Sciences ◽

10.1515/iss-2016-0034 ◽

2016 ◽

Vol 1 (2) ◽

pp. 73-78

Author(s):

Matthias Knobe ◽

Hans-Christoph Pape

Keyword(s):

Hip Fracture ◽

Femoral Head ◽

Femoral Neck ◽

Bone Quality ◽

Femoral Fractures ◽

Cement Augmentation ◽

Femoral Neck Fractures ◽

Patient Specific ◽

Mechanical Complication ◽

Augmentation Strategies

AbstractThere is an enormous humanitarian and socioeconomic need to improve the quality and effectiveness of care for patients with hip fracture. To reduce mechanical complications in the osteosynthesis of proximal femoral fractures, improved fixation techniques have been developed including blade or screw-anchor devices, locked minimally invasive or cement augmentation strategies. However, despite numerous innovations and advances regarding implant design and surgical techniques, systemic and mechanical complication rates remain high. Treatment success depends on secure implant fixation in often-osteoporotic bone as well as on patient-specific factors (fracture stability, bone quality, comorbidity, and gender) and surgeon-related factors (experience, correct reduction, and optimal screw placement in the head/neck fragment). For fracture fixation, the anchorage of the lag screw within the femoral head plays a crucial role depending on the implant’s design. Meta-analyses and randomized controlled studies demonstrate that there is a strong trend towards arthroplasty treating geriatric femoral neck fractures. However, for young adults as well as older patients with less compromised bone quality, or in undisplaced fractures, head-preserving therapy is preferred as it is less invasive and associated with good functional results. This review summarizes the evidence for the internal fixation of femoral neck fractures and trochanteric femoral fractures in elderly patients. In addition, biomechanical considerations regarding implant anchorage in the femoral head including rotation, migration, and femoral neck shortening are made. Finally, cement augmentation strategies for hip fracture implants are evaluated critically.

Download Full-text

Hip fracture treatment in Norway

Bone & Joint Open ◽

10.1302/2633-1462.110.bjo-2020-0124.r1 ◽

2020 ◽

Vol 1 (10) ◽

pp. 644-653

Author(s):

Cato Kjærvik ◽

Eva Stensland ◽

Hanne Sigrun Byhring ◽

Jan-Erik Gjertsen ◽

Eva Dybvik ◽

...

Keyword(s):

Hip Fracture ◽

Femoral Neck ◽

Hip Fractures ◽

Best Practice ◽

Treatment Guidelines ◽

Treatment Recommendations ◽

Femoral Neck Fractures ◽

Evidence Based ◽

Fracture Treatment ◽

One Year

Aims The aim of this study was to describe variation in hip fracture treatment in Norway expressed as adherence to international and national evidence-based treatment guidelines, to study factors influencing deviation from guidelines, and to analyze consequences of non-adherence. Methods International and national guidelines were identified and treatment recommendations extracted. All 43 hospitals routinely treating hip fractures in Norway were characterized. From the Norwegian Hip Fracture Register (NHFR), hip fracture patients aged > 65 years and operated in the period January 2014 to December 2018 for fractures with conclusive treatment guidelines were included (n = 29,613: femoral neck fractures (n = 21,325), stable trochanteric fractures (n = 5,546), inter- and subtrochanteric fractures (n = 2,742)). Adherence to treatment recommendations and a composite indicator of best practice were analyzed. Patient survival and reoperations were evaluated for each recommendation. Results Median age of the patients was 84 (IQR 77 to 89) years and 69% (20,427/29,613) were women. Overall, 79% (23,390/29,613) were treated within 48 hours, and 80% (23,635/29,613) by a surgeon with more than three years’ experience. Adherence to guidelines varied substantially but was markedly better in 2018 than in 2014. Having a dedicated hip fracture unit (OR 1.06, 95%CI 1.01 to 1.11) and a hospital hip fracture programme (OR 1.16, 95% CI 1.06 to 1.27) increased the probability of treatment according to best practice. Surgery after 48 hours increased one-year mortality significantly (OR 1.13, 95% CI 1.05 to 1.22; p = 0.001). Alternative treatment to arthroplasty for displaced femoral neck fractures (FNFs) increased mortality after 30 days (OR 1.29, 95% CI 1.03 to 1.62)) and one year (OR 1.45, 95% CI 1.22 to 1.72), and also increased the number of reoperations (OR 4.61, 95% CI 3.73 to 5.71). An uncemented stem increased the risk of reoperation significantly (OR 1.23, 95% CI 1.02 to 1.48; p = 0.030). Conclusion Our study demonstrates a substantial variation between hospitals in adherence to evidence-based guidelines for treatment of hip fractures in Norway. Non-adherence can be ascribed to in-hospital factors. Poor adherence has significant negative consequences for patients in the form of increased mortality rates at 30 and 365 days post-treatment and in reoperation rates. Cite this article: Bone Joint Open 2020;1-10:644–653.

Download Full-text

Femoral Neck Shaft Angle in Men with Fragility Fractures

Journal of Osteoporosis ◽

10.4061/2011/903726 ◽

2011 ◽

Vol 2011 ◽

pp. 1-7 ◽

Cited By ~ 10

Author(s):

S. P. Tuck ◽

D. J. Rawlings ◽

A. C. Scane ◽

I. Pande ◽

G. D. Summers ◽

...

Keyword(s):

Hip Fracture ◽

Femoral Neck ◽

Fracture Risk ◽

Hip Fractures ◽

Distal Forearm ◽

Neck Shaft Angle ◽

Hip Fracture Risk ◽

Significant Difference ◽

Shaft Angle ◽

Combined Data

Introduction. Femoral neck shaft angle (NSA) has been reported to be an independent predictor of hip fracture risk in men. We aimed to assess the role of NSA in UK men.Methods. The NSA was measured manually from the DXA scan printout in men with hip (62, 31 femoral neck and 31 trochanteric), symptomatic vertebral (91), and distal forearm (67) fractures and 389 age-matched control subjects. Age, height, weight, and BMD (g/cm2: lumbar spine, femoral neck, and total femur) measurements were performed.Results. There was no significant difference in mean NSA between men with femoral neck and trochanteric hip fractures, so all further analyses of hip fractures utilised the combined data. There was no difference in NSA between those with hip fractures and those without (either using the combined data or analysing trochanteric and femoral neck shaft fractures separately), nor between fracture subjects as a whole and controls. Mean NSA was smaller in those with vertebral fractures (129.2°versus 131°:P=0.001), but larger in those with distal forearm fractures (129.8°versus 128.5°:P=0.01).Conclusions. The conflicting results suggest that femoral NSA is not an important determinant of hip fracture risk in UK men.

Download Full-text

The impact of COVID-19 infection on hip fracture 30-day mortality

Trauma ◽

10.1177/1460408620949725 ◽

2021 ◽

pp. 146040862094972

Author(s):

Ahmed Fadulelmola ◽

Rob Gregory ◽

Gavin Gordon ◽

Fiona Smith ◽

Andrew Jennings

Keyword(s):

Hip Fracture ◽

Hip Fractures ◽

Hospital Admissions ◽

The Elderly ◽

Primary Outcome Measure ◽

Time To Death ◽

Significant Difference ◽

The Mean ◽

The Impact ◽

Mean Time

Introduction: A novel virus, SARS-CoV-2, has caused a fatal global pandemic which particularly affects the elderly and those with comorbidities. Hip fractures affect elderly populations, necessitate hospital admissions and place this group at particular risk from COVID-19 infection. This study investigates the effect of COVID-19 infection on 30-day hip fracture mortality. Method: Data related to 75 adult hip fractures admitted to two units during March and April 2020 were reviewed. The mean age was 83.5 years (range 65–98 years), and most (53, 70.7%) were women. The primary outcome measure was 30-day mortality associated with COVID-19 infection. Results: The COVID-19 infection rate was 26.7% (20 patients), with a significant difference in the 30-day mortality rate in the COVID-19-positive group (10/20, 50%) compared to the COVID-19-negative group (4/55, 7.3%), with mean time to death of 19.8 days (95% confidence interval: 17.0–22.5). The mean time from admission to surgery was 43.1 h and 38.3 h, in COVID-19-positive and COVID-19-negative groups, respectively. All COVID-19-positive patients had shown symptoms of fever and cough, and all 10 cases who died were hypoxic. Seven (35%) cases had radiological lung findings consistent of viral pneumonitis which resulted in mortality (70% of mortality). 30% ( n = 6) contracted the COVID-19 infection in the community, and 70% ( n = 14) developed symptoms after hospital admission. Conclusion: Hip fractures associated with COVID-19 infection have a high 30-day mortality. COVID-19 testing and chest X-ray for patients presenting with hip fractures help in early planning of high-risk surgeries and allow counselling of the patients and family using realistic prognosis.

Download Full-text

Comparison of Human Thymus Gland between Young and Old Age

10.53350/pjmhs211561907 ◽

2021 ◽

Vol 15 (6) ◽

pp. 1907-1909

Author(s):

Faiza Mehboob ◽

Ponum Mirani ◽

M. Kamran Ameer ◽

Khurram Shabeer ◽

Muhammad Ali Qamar ◽

...

Keyword(s):

Connective Tissue ◽

Old Age ◽

Age Groups ◽

Young Age ◽

University Hospital ◽

P Value ◽

Old Patients ◽

Human Thymus ◽

Group I ◽

Significant Difference

Aim: Study was conducted to examine the different parameters of human thymus glands of young and old patients and compare the findings between both age groups. Study Design: Comparative/observational study Place and Study: Study was conducted at Anatomy department of Nishtar Medical University Hospital, Multan for duration of six months from 15th January 2020 to 15th July 2020. Methods: Total 54 specimens of human thymus of 54 patients were enrolled in this study. All specimens were divided in to two groups I and II, Group I contains 27 patients with ages <30 years and group II with 27 patients having ages 45 to 60 years. All specimens were fixed in 10% formalin solution and then processed for paraffin embedding. Compare the different parameters such as thickness of interlobular connective tissue and thymic capsule, length and number of Hassal’s corpuscles between both groups. Data was analyzed by SPSS 24.0. Results: In group I 12 (44.44%) patients were ages <15 years and 15 (55.56%) patients were ages >15 years. In group 13 (48.15%) and 14 (51.85%) patients were ages <50 years and >50 years. There was a significant difference observed between both groups regarding thickness of interlobular connective tissue and thymic capsule, quantity and length of Hassal’s corpuscles with p-value <0.05. Conclusion: It is to be concluded that patients with young age had significantly less thickness of thymic capsule and interlobular connective tissue with more in number and decreasing size of Hassal’s corpuscles as compared to old age patients. Keywords: Human Thymus Glands, Young Age, Old Age

Download Full-text

Revision Rates After Surgical Treatment for Femoral Neck Fractures: Results of 2-Year Follow-up

Medicina ◽

10.3390/medicina49030022 ◽

2013 ◽

Vol 49 (3) ◽

pp. 22

Author(s):

Jaunius Kurtinaitis ◽

Narūnas Porvaneckas ◽

Giedrius Kvederas ◽

Tomas Butėnas ◽

Valentinas Uvarovas

Keyword(s):

Total Hip Arthroplasty ◽

Femoral Neck ◽

Internal Fixation ◽

Hip Arthroplasty ◽

Revision Surgery ◽

Femoral Neck Fractures ◽

Total Hip ◽

Significant Difference ◽

Surgery Rates

Background and Objective. Intracapsular fractures of the femoral neck account for a major share of fractures in the elderly. Open reduction and internal fixation has been shown to have a higher rate of revision surgery than arthroplasty. The aim of this study was to assess and compare the rates of revision surgery performed after internal fixation and primary total hip arthroplasty. Material and Methods. Between 2004 and 2006, 681 intracapsular femoral neck fractures in 679 consecutive patients were treated with internal fixation or total hip arthroplasty at our institution. Revision surgery rates were evaluated at 1-, 3-, 6-, 12-, and 24-month follow-up. Results. There was no significant difference in the ratio of internal fixation to total hip arthroplasty during 2004–2006 (P=0.31). The mean rate of total hip arthroplasty was 19.1% with a lower rate being among patients younger than 60 years. Revision surgery rates at the 2-year followup were higher in the internal fixation group compared with total hip arthroplasty group (28.9% vs. 7.0%, P<0.001). Patients who underwent internal fixation were at a 4-fold greater risk of having revision surgery at the 2-year follow-up than those who underwent total hip arthroplasty (odds ratio, 4.11; 95% CI, 1.95–8.65; P<0.001). Age was a significant risk factor for revision surgery after total hip arthroplasty (hazard ratio, 0.93; 95% CI, 0.87–0.98; P=0.02), but not significant after the internal fixation (P=0.86). Conclusions. Higher revision surgery rates after internal fixation favors arthroplasty as a primary choice of treatment for the femoral neck fractures.

Download Full-text