High failure rate after internal fixation and beneficial outcome after arthroplasty in treatment of displaced femoral neck fractures in patients between 55 and 70 years

Bartels, Stefan; Gjertsen, Jan‐Erik; Frihagen, Frede; Rogmark, Cecilia; Utvåg, Stein Erik

doi:10.1080/17453674.2017.1376514

Cited by 63 publications

(65 citation statements)

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“…Large studies from registers can help us to find small differences in complications and patient-reported outcome thereby generating hypotheses for clinical studies. As an example, the above-mentioned question of CRIF versus ORIF seems very challenging to answer within the frames Tables Table 1 Non-elderly hip [51], [55] *Womac, 24 items, total 0-96 score § Pain, stiffness, physical function *1 study ‡ EQ-5D index, 5 items, (3L or 5L answer levels) converted into an index score of 0-1.0 # Mobility, self-care, usual activities, pain/discomfort and anxiety/depression ‡ Pre-fracture and 4 to 24 months [58], [51], [55] ‡ EQ-5D VAS, 0-100 score # From worst to best imaginable health state ‡ 4 to ≥ 12 months [58], [51] Patient satisfaction: ‡ VAS, 0-100 score § From very satisfied to very unsatisfied ‡ 4 to 12 months [58] Our recommendations for a minimum core outcome data set: Level of; return to work, sporting/leisure activities, other activities of daily living, hip-fracture related pain, limping; EQ-5D-3L, EQ-5D-VAS, and objectively assessed functional performance, e.g. evaluated by the Timed Up & Go or 10-meter gait speed test.…”

Section: The Need For Future Researchmentioning

confidence: 99%

Hip fractures in the non-elderly—Who, why and whither?

Rogmark

Kristensen

Viberg

et al. 2018

Injury

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Nonelderly hip fracture patients have gathered little scientific attention, and our understanding of the group may be biased by patient case-mix and lack of follow-up. Preconceptions may thwart adequate investigation of bone health and other comorbidities. This literature review focusses on who these patients between 20 and 60 years are, how to treat them and how to evaluate the outcome. 2-11% of the hip fractures occur in non-elderly, equally common in men and women. Every second to forth patient smoke, have chronic diseases, and abuse alcohol. Poor self-rated health, sleep disturbances, low cognitive function and education are associated with increased hip fracture risk in young adults. Bone health is poorly investigated, but literature suggest young patients to have lower bone mineral density regardless of trauma mechanism. Studies contradict on whether surgery within 8-12 h reduce the risk of avascular necrosis in femoral neck fractures (FNF). Based on rationality, surgery ought to be performed promptly, in order to reduce pain and permit rehabilitation. There is no convincing support from the existing literature to use open reduction. Good reduction is mandatory, preferably using a closed reduction technique. The failure rate following internal fixation of displaced FNF in younger patients can be as high as 59%. In some cases a displaced FNF is better treated with a primary arthroplasty; in case of rheumatoid arthritis or osteoarthritis for example. Complications after extracapsular fractures vary from 6 to 23%. The relatively few studies looking at functional outcome in non-elderly use a multitude of outcome measures, precluding comparisons. Many non-elderly patients seem not to fully recover. While some non-elderly hip fracture patients are healthy individuals sustaining high energy trauma, others have low-energy fractures and comorbidities including reduced bone strength (either as a primary or secondary condition). i.e. non-delaying medical optimization, proper surgical technique, bone health investigation and secondary fracture prevention is necessary. Younger hip fracture patients are at risk of permanent loss of function, and negative socioeconomic and psychological consequences. High-energy trauma does not exclude the presence of osteopenia. A hip fracture in adulthood and middle-age is very seldom caused by bad luck only!

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Section: The Need For Future Researchmentioning

confidence: 99%

Hip fractures in the non-elderly—Who, why and whither?

Rogmark

Kristensen

Viberg

et al. 2018

Injury

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“…The age at which patients cease to be "young" is usually suggested to be 60-70 years, but is still debated. One study from the Norwegian Hip Fracture Register (NHFR) reported a high failure rate of 27% after internal fixation for displaced FNFs in patients aged 55-70 (56), and one recent study from Taiwan reported 84.1% complications in displaced FNFs in patients aged [50][51][52][53][54][55][56][57][58][59][60] years (57), suggesting that more patients should receive an arthroplasty.…”

Section: Displaced Femoral Neck Fracturesmentioning

confidence: 99%

More reoperations for periprosthetic fracture after cemented hemiarthroplasty with polished taper-slip stems than after anatomical and straight stems in the treatment of hip fractures

Dybvik

Furnes

et al. 2018

The Bone & Joint Journal

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Sammendrag på norskDet forekommer ca. 9000 hoftebrudd hos eldre i Norge årlig. Dette er den hyppigste årsaken til akutt innleggelse i kirurgiske avdelinger i norske sykehus. Det er sannsynligvis den mest alvorlige bruddtypen som ortopeder behandler. Hoftebrudd pasienter blir innlagt hele døgnet, blir operert av både ferske og erfarne leger og representerer en høyrisiko pasient-gruppe med mange tilleggs sykdommer og gjennomsnitts alder rundt 80 år. En av fire pasienter dør innen ett år, og flesteparten oppnår ikke funksjonsnivået som de hadde før bruddet. Det er også et stort behov for rehabilitering og hjemmesykepleie etter behandling og derav høye kostnader for samfunnet. Pasienter som får komplikasjoner etter kirurgi har enda dårligere prognose og høyere dødelighet. Hoftebrudd involverer flere typer hoftenaere brudd. Denne avhandlingen konsentrerer seg om lårhalsbrudd, og spesielt de 3500 pasientene som hvert år blir operert med en delprotese etter lårhalsbrudd. I Norge registrerer kirurgen hver hoftebruddoperasjon på et skjema som sendes til Nasjonalt Hoftebruddregister (NHBR). Dersom pasienten får en komplikasjon og må gjennomgå ny operasjon blir denne registrert på et tilsvarende skjema og koblet til den første operasjonen ved hjelp av pasientens personnummer. Hoftebruddpasientene får også tilsendt spørreskjema etter operasjonen for å svare på hvordan de har det. Dødsfall registrert i Norge kan også kobles til hofteoperasjonen. En delprotese operasjon involverer å erstatte lårhals og lårhode med en protese. Det er i dag ikke enighet om hvilken operasjonstilgang som er best når man opererer halvproteser. Det er heller ikke enighet om man skal bruke en protese som festes med bensement eller en protese som gror fast i benet. Hvis man velger å feste protesen med bensement finnes det forskjellige design på de protesene som er på markedet i dag. Man vet ikke hvilke protesedesign som gir best resultat hos pasientene. I denne doktoravhandlingen har vi brukt NHBR til å gi svar på problemstillingene over. Den består av tre publiserte artikler. 4 I første artikkel viser vi at de som er operert med en bakre kirurgisk tilgang til hoften (og svart på spørreskjema etter operasjon) har tendens til mindre smerte, mer tilfredshet, bedre livskvalitet og mindre rapporterte gangproblemer enn en kirurgisk tilgang rett fra siden. Når man skal velge kirurgisk tilgang ved halvprotese må våre resultater sees i sammenheng med andre studier som viser at den bakre tilgangen har større risiko for en fryktet komplikasjon hvor protesen går ut av ledd. I andre artikkel finner vi at halvproteser som er festet med bensement har mindre risiko for en ny operasjon enn halvproteser som skal gro fast. Vi finner ikke forskjell i risiko for dødsfall det første året mellom metodene. Vi finner heller ikke forskjell i smerte eller livskvalitet mellom metodene for de som har svart på spørreskjema. Vi anbefaler bruk av bensement når man skal feste halvprotese etter lårhalsbrudd for å redusere fare for ny operasjon. I tredje artikkel ser vi på forskjellig...

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“…A mortality rate of 8.4% (7/83) was recorded within one year after surgery. Among patients of the similar age, the mortality rate of those patients with PFFs was significantly higher than that of patients with femoral neck fracture but was nearly similar to that of patients with hip fracture [15,16]. Meanwhile, the Swedish National Arthroplasty Registry reported a 13.1% morality rate among patients with PFFs during the first year after their surgery, and this rate agreed with the findings of Fuchtmeier [17], who reported a 13.2% mortality rate among patients within one year after surgery.…”

Section: Discussionmentioning

confidence: 76%

Mid- and long-term efficacy of surgical treatment of Vancouver B2 and B3 periprosthetic femoral fractures

Sun

Zhang

et al. 2020

Preprint

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Background: The incidence of fractures around the femoral prosthesis among patients undergoing hip arthroplasty is increasing and has become the third leading cause of hip revision. While numerous methods for the surgical treatment of periprosthetic femoral fractures (PFFs) have been proposed, only few reports have examined the long-term efficacy of surgical treatment. This study aims to examine the mid-and long-term efficacy of surgical treatment among patients with Vancouver B2 and B3 PFFs.Methods: This retrospective study evaluated the surgical outcomes of patients with Vancouver B2 and B3 PFFs between 2007 and 2011. The minimum follow-up time was eight years. Fracture healing, prosthesis stability, complications, patient quality of life SF-36 score, and survival rate were evaluated during the follow-up assessments.Results: A total of 83 patients were included and had an average follow-up period of 120.3 months. Among these patients, 69 were classified as Vancouver B2 and were treated with a distal fixation stem, whereas 14 cases were classified as Vancouver B3 and were treated with modular femoral prosthesis by using a proximal femoral allograft technique. A total of 15 patients underwent secondary revision surgery, and prosthesis dislocation was identified as the main cause of secondary revision. 80 (96.4%) cases of fractures were clinically healed. The mortality rate in the first year after surgery was 8.4% (7/83). The overall 5-year Kaplan–Meier survival rate for these patients was 75.9%. Meanwhile, the 5-year Kaplan–Meier survival rate for the implants was 86.9%. The final follow-up SF-36 score of the patients was 48.3 ± 9.8.Conclusions: Patients with Vancouver B2 and B3 PFFs show high mortality in the first year after their surgery, and the Kaplan–Meier analysis results showed that such mortality tends to plateau after 5 years. Prosthesis dislocation was identified as the primary cause of secondary revision.

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High failure rate after internal fixation and beneficial outcome after arthroplasty in treatment of displaced femoral neck fractures in patients between 55 and 70 years

Cited by 63 publications

References 24 publications

Hip fractures in the non-elderly—Who, why and whither?

Hip fractures in the non-elderly—Who, why and whither?

More reoperations for periprosthetic fracture after cemented hemiarthroplasty with polished taper-slip stems than after anatomical and straight stems in the treatment of hip fractures

Mid- and long-term efficacy of surgical treatment of Vancouver B2 and B3 periprosthetic femoral fractures

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