“Damage Control” Fixation of Displaced Femoral Neck Fractures in High-Risk Elderly Patients: A Feasibility Case Series

Konda, Sanjit R.; Dedhia, Nicket; Rettig, Samantha; Davidovitch, Roy I.; Ganta, Abhishek; Egol, Kenneth A.

doi:10.1097/bot.0000000000002104

Cited by 6 publications

(3 citation statements)

References 37 publications

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“…In the high-risk cohort, there was likely a tendency to shift arthroplasty procedures toward less costly cannulated screw fixation procedures. 14 Our study reflects this as the rate of arthroplasty for femoral neck fracture decreased by 7% during the pandemic, whereas the rate of cannulated screw fixation procedures increased by 7%. These procedures may have been performed to minimize the need for postoperative higher level-of-care status, which was not readily available because of hospital resources being drained by the overall COVID burden.…”

Section: Discussionsupporting

confidence: 69%

The Cost We Bear: Financial Implications for Hip Fracture Care Amidst the COVID-19 Pandemic

Konda

Esper

Meltzer-Bruhn

et al. 2023

J Am Acad Orthop Surg

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Introduction:The purpose of this study was to assess the impact of COVID-19 on the cost of hip fracture care in the geriatric/middle-aged cohort, hypothesizing the cost of care increased during the pandemic, especially in COVID1 patients. Methods: Between October 2014 and January 2022, 2,526 hip fracture patients older than 55 years were analyzed for demographics, injury details, COVID status on admission, hospital quality measures, and inpatient healthcare costs from the inpatient admission. Comparative analyses were conducted between: (1) All comers and high-risk patients in the prepandemic (October 2014 to January 2020) and pandemic (February 2020 to January 2022) cohorts and (2) COVID1 and COVID2 patients during the pandemic. Subanalysis assessed the difference in cost breakdown for patients in the overall cohorts, the high-risk quartiles, and between the prevaccine and postvaccine pandemic cohorts. Results: Although the total costs of admission for all patients, and specifically high-risk patients, were not notably higher during the pandemic, further breakdown showed higher costs for the emergency department, laboratory/pathology, radiology, and allied health services during the pandemic, which was offset by lower procedural costs. High-risk COVID1 patients had higher total costs than high-risk COVID2 patients (P , 0.001), most notably in roomand-board (P = 0.032) and allied health (P = 0.023) costs. Once the pandemic started, subgroup analysis demonstrated no change in the total cost in the prevaccine and postvaccine cohort. Conclusion:The overall inpatient cost of hip fracture care did not increase during the pandemic. Although individual subdivisions of cost signified increased resource utilization during the pandemic, this was offset by lower procedural costs. COVID1 patients, however, had notably higher total costs compared with COVID2 patients driven primarily by increased room-and-board costs. The overall cost of care for high-risk patients did not decrease after the widespread administration of the COVID-19 vaccine.

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Section: Discussionsupporting

confidence: 69%

The Cost We Bear: Financial Implications for Hip Fracture Care Amidst the COVID-19 Pandemic

Konda

Esper

Meltzer-Bruhn

et al. 2023

J Am Acad Orthop Surg

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“…[19][20][21][22][23] Nevertheless, in high risk patients for arthroplasty, closed reduction and internal fixation might be a feasible option. 24 For the low-demand elderly patients hemiarthroplasty is often the preferred treatment. There is a plethora of implant options including cemented and cementless fixation, collared and uncollared stems, modular and nonmodular necks, and unipolar and bipolar head designs.…”

Section: Discussionmentioning

confidence: 99%

“…19–23 Nevertheless, in high risk patients for arthroplasty, closed reduction and internal fixation might be a feasible option. 24…”

Section: Discussionmentioning

confidence: 99%

Revision rate following unipolar versus bipolar hemiarthroplasty

Kugelman,

Robin,

Schaffler

et al. 2024

HIP International

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Introduction: There has been much debate on use of bipolar or unipolar femoral heads in hemiarthroplasty for the treatment of femoral neck fractures. The outcome of these implants should be studied in the America Joint Replacement Registry (AJRR). Methods: All primary femoral neck fractures treated with hemiarthroplasty between January 2012 and June 2020 were searched in the AJRR. All cause-revision of unipolar and bipolar hemiarthroplasty and reasons for revision were assessed for these patients until June of 2023. Results: There were no differences in number and reason for all cause revisions between unipolar and bipolar hemiarthroplasty ( p = 0.41). Bipolar hemiarthroplasty had more revisons at 6 months postoperatively ( p = 0.0281), but unipolar hemiarthroplasty had more revisions between 2 and 3 years ( p = 0.0003), and after 3-years ( p = 0.0085), as analysed with a Cox model. Patients with older age (HR = 0.999; 95% CI, 0.998–0.999; p = 0.0006) and higher Charlson Comorbidity Index (HR = 0.996; 95% CI, 0.992– 0.999; p = 0.0192) had a significant increase in revision risk. Conclusions: We suggest that surgeons should consider using bipolar prosthesis when performing hemiarthroplasty for femoral neck fracture in patients expected to live >2 years post injury.

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Anesthetic Methods for Hip Fracture

Reider,

Furgiuele,

Wan

et al. 2023

Curr Osteoporos Rep

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“Damage Control” Fixation of Displaced Femoral Neck Fractures in High-Risk Elderly Patients: A Feasibility Case Series

Abstract: Objectives: To assess the outcomes of patients who underwent closed reduction and percutaneous pinning (CRPP) with cannulated screws for treatment of a displaced femoral neck fracture (DFNF) as they were deemed too high risk to undergo hemiarthroplasty (HA).

Cited by 6 publications

References 37 publications

The Cost We Bear: Financial Implications for Hip Fracture Care Amidst the COVID-19 Pandemic

The Cost We Bear: Financial Implications for Hip Fracture Care Amidst the COVID-19 Pandemic

Revision rate following unipolar versus bipolar hemiarthroplasty

Anesthetic Methods for Hip Fracture

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