Preliminary results of an early vs delayed timing of surgery in the management of proximal femur fragility fractures

Abstract

SummaryIntroduction. The appropriate surgical timing for the treatment of proximal femur fractures is still debated. Advantages of a delayed surgery may be: stabilization of systemic diseases, decrease of the risk of perioperative mortality and morbidity. An early timing of surgery may allow: early mobilization, reduction of the risks of disability and hospital stays, early return to home of the patients. However, the effects on mortality are still discussed. Purpose. The purpose of this study is to assess the influence of the surgical timing on clinical outcomes, complications, and mortality in a preliminary experience of the early management of these fractures vs the delayed surgery. Methods. A series of 176 patients was retrospectively evaluated. 132 patients were followed-up for one year after surgery. The evaluation was performed by the assessment of the comorbidities, preoperative wait for surgery, type of fracture and procedures, hospital stay, and functional outcomes: 33 patients were operated with an early timing, 99 with a delayed surgery. Results. The mean mortality rate was 18.2% in the early timing (6/33 patients), and 23.2% in the delayed timing (23/99 patients): no significant difference was recorded in the preliminary analysis. Postoperative complications were recorded in 28 patients (21.2%): 4 patients were operated within 48 hours (12.1%) and 24 after 48 hours (24.2%) with no substantial differences. The postoperative hospital stay showed no correlation with the timing of surgery, as no evidence was found on the functional recovery and postoperative disability.

Should we operate on all patients with COVID-19 and proximal femoral fractures? An analysis of thirty, sixty, and ninety day mortality rates based on patients’ clinical presentation and comorbidity: a multicentric study in Northern Italy

“…The proximal femur fracture is associated with high mortality up to 36% [ 5 , 6 ] and, above all, with the patient’s disability in the post-operative period, when only 40 to 60% of patients regain their previous level of independence [ 7 ]. In addition, throughout the pandemic period of COVID-19, the correct management of this pathology has undoubtedly represented a critical parameter for assessing the quality of the assistance that a health system must be able to provide [ 8 , 9 ]. However, it is questionable whether these types of fractures have led to increased post-operative lethality of patients.…”

Closed Limb Fractures With Compromised Vascularization: A Narrative Review

“… 21 It is believed that early fracture reduction and stabilization via surgery may improve femoral head blood flow, resulting in a greater likelihood of union and less complications; delayed treatment may also increase the risk of mortality. 23 , 25 , 30 – 32 Although there is no definitive criteria as to what is considered an “unacceptable delay” for surgical intervention, guidelines suggest that surgery should be performed within 24 h of injury. 32 Surgical options for a femoral neck fracture include internal fixation or an arthroplasty procedure.…”

Impact of Porosity on Interbody Cage Implants: PEEK and Titanium

“…2 Additionally, porosity has been shown to decrease material density, thereby optimizing implant bone load-sharing properties. 2,3 Pore properties and loading environment characteristics have a significant influence on both mechanical and biological properties of interbody devices including cellular migration and osseodifferentiation. 3 Titanium (Ti) and polyetheretherketone (PEEK), representing the 2 most commonly used materials in interbody cages, have notable shortcomings in mechanical modulus and biological response required for fusion, respectively, that may be mitigated by the introduction of porosity.…”