Are Bilateral Femoral Fractures No Longer a Marker for Death?

O’Toole, Robert V.; Lindbloom, Benjamin J.; Hui, Emily; Fiastro, Amelia; Boateng, Henry A.; O’Brien, Michael J.; Murphy, L.; Copeland, Carol E.

doi:10.1097/bot.0b013e3182a83fdf

Cited by 19 publications

(17 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This study is the first to evaluate the cost of conversion THA, although other studies have found an increased complication rate among conversion THAs compared with primary THAs [12–14,25]. Combined with the results of previous studies, the cost differences that we have identified in this study raise the question that conversion THA may be fundamentally different from primary THA.…”

Section: Discussionmentioning

confidence: 61%

Primary vs Conversion Total Hip Arthroplasty: A Cost Analysis

Chin

Wright

Snir³

et al. 2016

The Journal of Arthroplasty

View full text Add to dashboard Cite

Introduction Increasing hip fracture incidence in the United States is leading to higher occurrences of conversion total hip arthroplasty (THA) for failed surgical treatment of the hip. In spite of studies showing higher complication rates in conversion THA, the Centers for Medicare and Medicaid services currently bundles conversion and primary THA under the same diagnosis-related group. We examined the cost of treatment of conversion THA compared with primary THA. Our hypothesis is that conversion THA will have higher cost and resource use than primary THA. Methods Fifty-one consecutive conversion THA patients (Current Procedure Terminology code 27132) and 105 matched primary THA patients (Current Procedure Terminology code 27130) were included in this study. The natural log-transformed costs for conversion and primary THA were compared using regression analysis. Age, gender, body mass index, American Society of Anesthesiologist, Charlson comorbidity score, and smoker status were controlled in the analysis. Conversion THA subgroups formed based on etiology were compared using analysis of variance analysis. Results Conversion and primary THAs were determined to be significantly different (P < .05) and greater in the following costs: hospital operating direct cost (29.2% greater), hospital operating total cost (28.8% greater), direct hospital cost (24.7% greater), and total hospital cost (26.4% greater). Conclusions Based on greater hospital operating direct cost, hospital operating total cost, direct hospital cost, and total hospital cost, conversion THA has significantly greater cost and resource use than primary THA. In order to prevent disincentives for treating these complex surgical patients, reclassification of conversion THA is needed, as they do not fit together with primary THA.

show abstract

Section: Discussionmentioning

confidence: 61%

Primary vs Conversion Total Hip Arthroplasty: A Cost Analysis

Chin

Wright

Snir³

et al. 2016

The Journal of Arthroplasty

View full text Add to dashboard Cite

show abstract

“…Our findings are consistent with previous studies that also found that bilateral femoral shaft fractures are associated with higher morbidity. 2,4,7,16,22 It is well-established that increasing ISS is associated with increased perioperative complications, longer hospital stays, and increased morbidity and mortality, 2,4,[23][24][25] By the nature of its calculation, ISS does not capture the full extent of multiple limb injuries because bilateral and unilateral femur fractures are scored similarly. Therefore, an increase in ISS for this cohort only represents a higher degree of associated injuries.…”

Section: Discussionmentioning

confidence: 99%

“…1 Bilateral femur fractures have been reported to occur in 5%-10% of patients with femur fractures, are associated with a higher mean Injury Severity Score (ISS), increased morbidity, and mortality rates as high as 32%. [2][3][4] Advances in prehospital care and Advanced Trauma Life Support protocols have increased survivorship after highenergy injuries, resulting in surviving patients with higher ISS presentations at trauma centers. 5,6 The care of patients with bilateral femur fractures has added complexity due to the larger physiologic insult associated with increased bleeding, pulmonary complications, longer operative times for management of both femur fractures, and more frequent additional injuries.…”

Section: Introductionmentioning

confidence: 99%

A Comparison of the Prevalence of, Demographics of, and Effects on Outcomes of Bilateral Versus Unilateral Femoral Shaft Fractures: A Retrospective Cohort Analysis From the National Trauma Data Bank

Cosgrove

Wolinsky

Berkes

et al. 2022

Journal of Orthopaedic Trauma

View full text Add to dashboard Cite

show abstract

“…Concurrent reaming has only been investigated in bilateral diaphyseal femoral fractures, finding a complication rate of 2% to 7% and mortality of 31.6% and 9.8% with and without associated injuries, respectively. 37,38 However, Giannoudis et al, 39 described an incidence of complications of 4.6%, comparing their series of 14 cases of bilateral diaphyseal femur fractures with 40 unilateral cases, and found that bilateral cases had significantly higher resuscitation requirements, including more blood units transfused, longer duration of intensive care unit and hospital stay, and higher incidence of other injuries than the unilateral cases. Although not significant, the mortality rate of 14.2% was also higher in the bilateral group when compared with 0% in the unilateral group.…”

Section: Type Of Implant and Other Technical Considerationsmentioning

confidence: 99%

Literature review on the management of simultaneous bilateral extracapsular hip fractures in the elderly

Galán-Olleros

Rodríguez-Zamorano

García-Coiradas

et al. 2022

Current Orthopaedic Practice

View full text Add to dashboard Cite

Currently, there is a wide awareness of the high degree of functional impairment and morbimortality associated with hip fractures in the elderly, and efforts are being made to improve outcomes. As age rises, physiological reserves decline, and more severe complications occur. Simultaneous bilateral extracapsular hip fractures in the setting of low-energy trauma in the elderly are rare but deserve special attention with treatment strategies that are in between those for unilateral hip fractures and elderly patients with multiple injuries. Adequate initial assessment, a multidisciplinary approach to trauma care, and the integration of medical and orthopaedic surgical attention are paramount. Furthermore, there is a need for early single-stage surgical fixation in medically stable patients and optimization of patients who are unfit. Despite some variations from unilateral cases, the main objective remains to achieve painless hips and stable fixation for early mobilization with the lowest morbidity and mortality rates. General anesthesia for intramedullary nailing using short nonreamed nails for stable fracture patterns and minimal reaming when long nails are used may be regarded as the best option. Physicians should be cautious of the higher risk of complications such as blood loss, fat embolism syndrome, and adult respiratory distress syndrome. Orthogeriatric management and multidisciplinary teams may also improve outcomes, as demonstrated for unilateral hip fractures. Secondary prevention of fractures is promoted through the prescription of antiosteoporotic treatment, nutritional assessment, and skills training. This literature review aims to help optimize the management of patients with simultaneous bilateral extracapsular hip fractures, outlining the differential concerns with respect to unilateral cases.

show abstract

Are Bilateral Femoral Fractures No Longer a Marker for Death?

Abstract: Prognostic level III. See instructions for authors for a complete description of levels of evidence.

Cited by 19 publications

References 8 publications

Primary vs Conversion Total Hip Arthroplasty: A Cost Analysis

Primary vs Conversion Total Hip Arthroplasty: A Cost Analysis

A Comparison of the Prevalence of, Demographics of, and Effects on Outcomes of Bilateral Versus Unilateral Femoral Shaft Fractures: A Retrospective Cohort Analysis From the National Trauma Data Bank

Literature review on the management of simultaneous bilateral extracapsular hip fractures in the elderly

Contact Info

Product

Resources

About