Surgical Management and Outcomes following Pathologic Hip Fracture—Results from a Propensity Matching Analysis of the Registry for Geriatric Trauma of the German Trauma Society

Abstract

Background and Objectives: The outcomes of patients with pathologic hip fractures remain unclear. Data from a large international geriatric trauma registry were analyzed to examine the outcomes of patients with pathologic hip fractures compared with patients with typical osteoporotic hip fractures. Materials and Methods: Data from the Registry for Geriatric Trauma of the German Trauma Society (Deutsche Gesellschaft für Unfallchirurgie (DGU)) (ATR-DGU) were analyzed. All patients treated surgically for osteoporotic or pathologic hip fractures were included in this analysis. Across both fracture types, a 2:1 optimal propensity score matching and multivariate logistic regression analysis were conducted. In-house mortality rate and mortality at the 120-day follow-up, as well as mobility after 7 and 120 days, reoperation rate, discharge management from the hospital and readmission rate to the hospital until the 120-day follow-up were analyzed as outcome parameters for the underlying fracture type—pathologic or osteoporotic. Results: A total of 29,541 cases met the inclusion criteria. Of the patients included, 29,330 suffered from osteoporotic fractures, and 211 suffered from pathologic fractures. Multivariate logistic regression analysis revealed no differences between the two fracture types in terms of mortality during the acute hospital stay, reoperation during the initial acute hospital stay, walking ability after seven days and the likelihood of being discharged back home. Walking ability and hospital readmission remained insignificant at the 120-day follow-up as well. However, the odds of passing away within the first 120 days were significantly higher for patients suffering from pathologic hip fractures (OR: 3.07; p = 0.003). Conclusions: Surgical treatment of pathologic hip fractures was marked by a more frequent use of arthroplasty in per- and subtrochanteric fractures. Furthermore, the mortality rate among patients suffering from pathologic hip fractures was elevated in the midterm. The complication rate, as indicated by the rate of readmission to the hospital and the necessity for reoperation, remained unaffected.

Arthroplasty for Treating Proximal Femur Metastatic Lesions May Be Associated with Lower Mortality Rates Compared to Intramedullary Nailing within the VA Healthcare System

“…Pathologic hip fractures and their care have many similarities with geriatric hip fractures. A registry study by Bliemel et al [16] showed that walking ability, rates of hospital readmissions, and rate of reoperation were not statistically different. A key finding from this study was that the odds of passing away in the first 120 days were significantly higher in those who sustained a pathologic hip fracture (odds ratio: 3.07, p = 0.003).…”

“…Although there are very limited data regarding the long-term follow-up after pathologic hip fracture, likely due to the increased mortality rate [16], there are certain data within the geriatric hip fracture data literature. Hashimoto et al [21] demonstrated that the main causes of death for geriatric hip fractures were senility, aspiration pneumonia, bronchopneumonia, worsening heart failure, acute myocardial infarction, and abdominal aortic aneurysm.…”

Orthopaedic surgeons’ ability to detect pathologic hip fractures: review of 1484 fractures reported to the Norwegian Hip Fracture Register

“…A retrospective cohort study from the Registry for Geriatric Trauma of the German Trauma Society (Deutsche Gesellschaft für Unfallchirurgie (DGU)) (ATR-DGU) 2016–2020 showed that 211 of 29,541 patients (> 70 years old) suffered from pathologic hip fractures corresponding to a rate of 0.7%. The register does not contain information regarding diagnosis, and the number can be to low due to age > 70 [ 25 ]. A retrospective review of the American College of Surgeons—National Surgical Quality Improvement Program (ACS-NSQIP) database from 2011 to 2017 showed a total of 67,548 patients of which 378 (0.6%) patients had a pathologic fracture, but does not contain information regarding the histologic diagnosis [ 26 ].…”

Current Management of Hip Fracture

“…However, in the follow-up period of 120 days, the mortality rate in pathologic hip fractures is found to be three times higher. Further, they find that pathologic per- and subtrochanteric fractures are more frequently treated by arthroplasty compared to osteoporotic fractures [ 3 ].…”