Proximal femoral fracture outcomes in inpatients and community patients: A comparative study

Ahmed, Hussam Elamin; Zourob, Emadeldeen; Lukic, John; Latimer, Lloyd; Anto, Joseph; Rajeev, Aysha

doi:10.22540/jfsf-06-218

Cited by 4 publications

(5 citation statements)

References 15 publications

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“…The preoperative treatment of femoral shaft fractures is important in the community and in academic practice. 16 It is relevant to the advanced practice provider and the surgeon.…”

Section: Discussionmentioning

confidence: 99%

Skeletal Traction for Isolated Femur Fractures Does not Reduce Opioid Consumption

Mullis,

Caballero,

Seetharam

et al. 2024

Journal of Orthopaedic Trauma

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OBJECTIVES: Isolated femoral shaft fractures can be treated preoperatively with skeletal traction (TXN) or maintenance of a position of comfort (COMF). The goal of this retrospective review was to determine if preoperative opioid consumption differs significantly between these forms of treatment. METHODS: Design: Case-control retrospective study Setting: Two academic level 1 trauma centers Patient Selection Criteria: Patients presenting to the emergency department with isolated OTA/AO 32A-C femoral shaft fractures from 2017-2020. Outcome Measures and Comparisons: The primary outcome was preoperative opioid consumption (morphine milligram equivalents (MME)) comparing patients treated with application of skeletal traction (TXN) or placed in a position of comfort (COMF). RESULTS: Two hundred and twenty patients were studied (COMF n=167, TXN n=53). Multivariate regression analysis revealed significantly greater preoperative opioid consumption in the Emergency Department (ED) for the TXN group compared to COMF (2.6 more MME [CI 0.23,4.96], p=0.031)). There was no difference in preoperative opioid consumption between groups on the hospital floor (p=0.811) nor during the entire preoperative course (p=0.486). The total preoperative rate of opioid consumption (MME/hour) did not differ (p=0.825). CONCLUSIONS: Patients with isolated femoral shaft fractures treated preoperatively with skeletal traction consumed more opioids in the ED compared to patients treated in a position of comfort but no difference in opioid consumption was observed between groups for the entire preoperative course. A position of comfort may be considered as an acceptable alternative to skeletal traction for patients with isolated femur fractures. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

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“…The preoperative treatment of femoral shaft fractures is important in the community and in academic practice. 16 It is relevant to the advanced practice provider and the surgeon.…”

Section: Discussionmentioning

confidence: 99%

Skeletal Traction for Isolated Femur Fractures Does not Reduce Opioid Consumption

Mullis,

Caballero,

Seetharam

et al. 2024

Journal of Orthopaedic Trauma

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“… Length of hospital stay: The duration of hospitalization from admission to discharge ( 16 ). Proportion of patients discharged to the same facility or home as before the fracture: The percentage of patients who could return to their previous facility or home environment ( 17 ). Rate of regaining walking ability: The proportion of patients who regained their ability to walk independently or with minimal assistance ( 18 ).…”

Section: Methodsmentioning

confidence: 99%

“…3. Proportion of patients discharged to the same facility or home as before the fracture: The percentage of patients who could return to their previous facility or home environment (17). 4.…”

Section: Evaluation Itemsmentioning

confidence: 99%

Benefits of surgical treatment within 48 h of proximal femoral fracture in centenarians: a retrospective cohort study

Shitahodo,

Murata,

Kitano

et al. 2024

Front. Surg.

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IntroductionProximal femoral fractures in aging populations represent a significant concern, with an increasing prevalence among individuals aged ≥100 years. The existing research does not provide robust guidance for clinicians managing older patients aged ≥100 years with proximal femoral fractures. We investigated the safety and efficacy of surgical treatment in patients aged ≥100 years with proximal femoral fractures and evaluated the impact of early surgery on their outcomes.MethodsThis retrospective cohort study involved 15 patients aged ≥100 years who underwent surgical treatment of proximal femoral fractures; the control group included 137 patients in their 90s. Data were collected between January 2010 and December 2017. Evaluation items included patient characteristics, surgical details, perioperative complication rates, length of hospital stay, the proportion of patients discharged to the same facility or home, rate of regaining walking ability, and 1-year survival rate.ResultsThe patients aged ≥100 years and those in their 90s had comparable outcomes. Thus, age alone does not dictate surgical success. Early surgery (≤48 h) was associated with trends toward improved perioperative complications, ambulatory ability, and return to original living environment.DiscussionThis study underscores the potential benefits of surgical intervention for proximal femoral fractures in patients aged ≥100 years, indicating the relevance of early surgery (≤48 h). Our findings emphasized the importance of timely intervention and evidence-based decision-making for this demographic. Clinicians, policymakers, and patients could benefit from our insights to enhance fracture management strategies, along with future research endeavors to validate and expand our results in larger multicenter cohorts.

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“…[ 2 , 3 ] PFFs in older patients can lead to complications, such as pulmonary embolism, infection, and heart failure, with a fatality rate of approximately 10% within 1 year. [ 4 , 5 ] Mortality [ 6 , 7 ] and fatal complications [ 8 , 9 ] have been reported in several studies. However, there are few reports on long-term outcomes and few detailed reports on the causes of death.…”

Section: Introductionmentioning

confidence: 99%

How proximal femur fracture patients aged 65 and older fare in survival and cause of death 5+ years after surgery: A long-term follow-up

et al. 2023

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Although the incidence of proximal femur fractures (PFFs) is increasing, few detailed reports on associated long-term outcomes and causes of death exist. We aimed to evaluate long-term outcomes and causes of death ≥5 years after surgical treatment of PFFs. This retrospective study included 123 patients (18 males, 105 females) with PFFs treated at our hospital between January 2014 and December 2016. Cases (median age: 90 [range, 65-106] years) comprised 38 femoral neck fractures (FNFs) and 85 intertrochanteric fractures (IFs). Surgical procedures included bipolar head arthroplasty (n = 35), screw fixation (n = 3), and internal fixation with nails (n = 85). The mean post-surgical follow-up time was 58.9 (range, 1-106) months. Surveyed items included survival (1 vs 5 years; sex; age, >90 vs <90 years; IF vs FNF), comorbidities, waiting time after the injury (died vs survived), operative time (proximal femoral nail antirotations [PFNA] vs FNF, died vs Survived), blood loss (PFNA vs FNF; died vs survived), and cause of death (IF vs FNF; <1 vs >1 year). Among all patients, 83.7% had comorbidities (IF, 90.5%; FNF, 81.5%). Among patients who died and survived, 89.1% and 80.5% had comorbidities, respectively. The most common comorbidities were cardiac (n = 22), renal (n = 10), brain (n = 8), and pulmonary (n = 4) diseases. Overall survival (OS) rates at 1 and 5 years were 88.9% and 66.7%, respectively. Male/female OS rates were 88.8%/88.3% and 66.6%/66.6% (P = .89) at 1 and 5 years, respectively. OS rates for the <90/≥90 age groups were 90.1%/76.7% and 75.3%/53.4 (P < .01) at 1 and 5 years, respectively. The 1-and 5-year OS (IF/FNF) rates were 85.7%/88.8% and 60%/81.5%, respectively; patients with IFs had significantly lower OS than those with FNFs at both timepoints (P = .015). There was a marked difference in the operative time between died (43.5 ± 24.0: mean ± S.D.) and survived (60 ± 24.4: mean ± S.D.) patients. The main causes of death were senility (n = 10), aspiration pneumonia (n = 9), bronchopneumonia (n = 6), worsening heart failure (n = 5), acute myocardial infarction (n = 4), and abdominal aortic aneurysm (n = 4). Overall, 30.4% of the cases were related to comorbidities and related causes (e.g., hypertension-related ruptured large abdominal aneurysm). Managing comorbidities may improve long-term postoperative outcomes of PFF treatment.

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Proximal femoral fracture outcomes in inpatients and community patients: A comparative study

Cited by 4 publications

References 15 publications

Skeletal Traction for Isolated Femur Fractures Does not Reduce Opioid Consumption

Skeletal Traction for Isolated Femur Fractures Does not Reduce Opioid Consumption

Benefits of surgical treatment within 48 h of proximal femoral fracture in centenarians: a retrospective cohort study

How proximal femur fracture patients aged 65 and older fare in survival and cause of death 5+ years after surgery: A long-term follow-up

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