Surgical procedures in femoral neck fractures in Finland: a nationwide study between 1998 and 2011

Hongisto, Markus T; Pihlajamäki, Harri; Niemi, Seppo; Nuotio, Maria; Kannus, Pekka; Mattila, Ville M.

doi:10.1007/s00264-014-2346-6

Cited by 27 publications

(15 citation statements)

References 34 publications

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“…Studies addressing hip fractures report cohort characteristics comparable to those of our study, with a greater proportion of women and a similar proportion of comorbidities.…”

Section: Discussionsupporting

confidence: 63%

Hip Fractures: Therapy, Timing, and Complication Spectrum

Saul

Riekenberg

Ammon

et al. 2019

Orthopaedic Surgery

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ObjectiveInvestigation of the treatment of femur fractures and the type of femur fracture‐associated complications regarding timing of surgery and length of hospital stay.MethodsIn this retrospective cohort study, a total of 358 hip fractures were evaluated retrospectively from 1 January 2008 until 31 December 2010 at a level I trauma center in Germany. Inclusion criteria was age >18 years and a proximal femur fracture. Both sexes were evaluated. Mean age was 75.5 years, most patients were female (63.7%). Intervention was the operative treatment of proximal femur fracture. Outcome parameters were time until surgery, complications, reoperations, mortality, and length of hospital stay.ResultsAmong the proximal femur fractures (n = 358), 46.6% were pertrochanteric, 11.2% subtrochanteric, and 42.2% femoral neck fractures. Operation upon hip fractures was managed regularly within 24 hours of injury (73%; mean for femoral neck: 28.3 hrs.; mean for pertrochanteric fractures: 21.4 hrs.; mean for subtrochanteric fractures: 19.5 hrs.). Delayed treatment, as well as implantation of hip total endoprosthesis (TEP), increased the overall length of hospital stay (15.4 vs 17.6 days; 18.1 vs 15.8 days). Accordingly, surgical procedures performed within 24 hours of injury resulted in a shorter hospital residence. Longest delay of operation was measured for hip fractures (28.3 hrs.).In 351 patients, secondary injuries were detected in 94 individuals (26%), with fractures being the most common secondary injury (n = 40). We recorded postoperative complications of nonsurgical and surgical origin, and 33.6% of our patient cohort displayed complications. Complications were distributed among 118 patients. There was no significant difference in complications regarding the time of operation, with most nonsurgical and surgical complications appearing within 24 hours after operation (n = 110 vs n = 31). Nonsurgical complications, such as anemia (n = 49) and electrolyte imbalances (n = 30), were observed more frequently than surgical complications (n = 107 vs n = 34); however, these complications were reduced by delay in surgery (82.0% in 6–24 hrs. vs 74.2% in ≥24 hrs.). Anticoagulant therapy and age did not affect postoperative complications. The hospital mortality of patients was 6.2%. Follow‐up was restrained to ambulatory visits in the clinic.ConclusionsSurgical management of hip fractures performed within 24 hours of injury minimizes hospital stay. We did not detect significant differences in the spectrum or number of complications regarding delay of surgery. Surgical complications mainly occur with rapid primary care, and medical complications can be reduced by more intensive preparation of patient and operation procedures.

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“…Studies addressing hip fractures report cohort characteristics comparable to those of our study, with a greater proportion of women and a similar proportion of comorbidities.…”

Section: Discussionsupporting

confidence: 63%

Hip Fractures: Therapy, Timing, and Complication Spectrum

Saul

Riekenberg

Ammon

et al. 2019

Orthopaedic Surgery

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“…In Finland, the likelihood that a patient over the age of 50 with a displaced femoral neck fracture would be treated with THA nearly doubled between 2005 and 2011. 20 Between 2006 and 2011 in South Korea, there was an increase in the number of THAs performed for femoral neck fractures in patients <65 years old. 21 A recent study conducted by Hochfelder et al in New York state revealed a trend toward increasing utilization of THA among a subset of femoral neck fracture patients younger than 70 years of age but an overall unchanged rate of THA for femoral neck fracture over time.…”

Section: Discussionmentioning

confidence: 99%

“… 19 Recently published national registry data from Finland and Korea demonstrate an increasing utilization in THA over HA. 20 , 21 …”

Section: Introductionmentioning

confidence: 99%

Evaluation of Contemporary Trends in Femoral Neck Fracture Management Reveals Discrepancies in Treatment

Bishop

Yang

Githens

et al. 2016

Geriatr Orthop Surg Rehabil

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Background:Recent evidence supports total hip arthroplasty (THA) as compared to hemiarthroplasty (HA) for the management of displaced femoral neck fractures in a significant subset of elderly patients. The purpose of this study was to examine trends in femoral neck fracture management over the last 12 years.Methods:Using the National Inpatient Sample database, we identified patients treated for femoral neck fractures between 1998 and 2010 with THA, HA, or internal fixation (IF). We examined treatment trends and demographic variables including patient age, gender, socioeconomic status, and payer and hospital characteristics.Results:We identified 362 127 femoral neck fracture patients treated between 1998 and 2010. Overall, there were statistically significant increases in rates of THA and HA, whereas rates of IF decreased. Total hip arthroplasty varied based on patient age, with significant increases occurring in age-groups 0 to 49 years, 50 to 59 years, 60 to 69 years, and 70 to 79 years. Utilization of THA varied significantly based on socioeconomic status and race. Patient sex, urban versus rural hospital location, and teaching versus nonteaching hospital status were not related to rates of THA.Conclusion:Rates of THA for femoral neck fractures increased between 1998 and 2010 in patients younger than 80 years, suggesting that surgeons are responding to clinical evidence supporting THA for the treatment of elderly femoral neck fractures. This is the first study to demonstrate this change and expose disparities in practice patterns over time in response to this evidence in the United States. Further research is indicated to explore the effect of socioeconomic status and race on femoral neck fracture management.

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“…With increasing average life expectancy, the incidence of these fractures is steadily increasing worldwide [ 1 – 3 ]. Internal fixation (IF) is the preferred treatment for undisplaced FNF [ 1 , 4 ]. Operative alternatives for FNFs in young adults are still being debated; the available options include prosthetic replacement (arthroplasty) and IF [ 1 , 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

Prognostic value of the sliding length of cephalocervical screws to predict the risk of non-union after osteosynthesis: a retrospective analysis of 86 patients with intracapsular femoral neck fractures

et al. 2017

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BackgroundHere, we assessed the prognostic value of the early sliding length (ESL) for predicting the risk of non-union after internal fixation of femoral neck fractures (FNFs) by Dual SC Screws (DSCS).MethodsA retrospective analysis of 86 patients with intra-capsular FNFs was performed. They underwent osteosynthesis by DSCS at our institution between 2008 and 2013 with a minimum follow-up duration of 6 months. Preoperative displacement, fracture reduction quality, ESL of screws at 2 weeks postoperatively, and correlation of non-union with the ESL of screws were evaluated.ResultsBone union without complications was achieved in 74 patients (86.0%), whereas 12 patients (14.0%) showed non-union. The ESL was significantly longer in the non-union group (proximal 3.94 ± 2.79 mm, distal 4.03 ± 3.16 mm) than in the union group (proximal 0.98 ± 1.85 mm, distal 1.01 ± 1.84 mm, P = 0.0001* for proximal, P < 0.0001* for distal). The ESL was significantly associated with non-union, both in the proximal [P = 0.0002, unit odds ratio (OR) 1.58, 95% confidence interval (CI) 1.23–2.16] and distal screws (P = 0.0002, unit OR 1.53, 95% CI 1.21–2.02). The areas under the ROC curves for the ESL of proximal and distal screws were 0.845 and 0.867, respectively; the cut-off values to predict non-union were 1.0 mm (sensitivity 91.7% and specificity 74.3%) and 1.4 mm (sensitivity 83.3% and specificity 81.1%), respectively.ConclusionsIn this study, the ESL was a good predictor of postoperative non-union in patients with FNFs fixed by DSCS.

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Surgical procedures in femoral neck fractures in Finland: a nationwide study between 1998 and 2011

Cited by 27 publications

References 34 publications

Hip Fractures: Therapy, Timing, and Complication Spectrum

Hip Fractures: Therapy, Timing, and Complication Spectrum

Evaluation of Contemporary Trends in Femoral Neck Fracture Management Reveals Discrepancies in Treatment

Prognostic value of the sliding length of cephalocervical screws to predict the risk of non-union after osteosynthesis: a retrospective analysis of 86 patients with intracapsular femoral neck fractures

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