Time to Surgery and Outcome in the Treatment of Proximal Femoral Fractures

Leicht, Hanna; Gaertner, Thomas; Günster, Christian; Halder, Andreas M.; Hoffmann, Reinhard; Jeschke, Elke; Malzahn, Jürgen; Tempka, A.; Zacher, J.

doi:10.3238/arztebl.m2021.0165

Cited by 12 publications

(14 citation statements)

References 28 publications

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“…Unlike femoral neck fractures, intertrochanteric fractures tended to have a higher preoperative hemoglobin (Hgb) drop for anatomic reasons, which would increase the postoperative complications and the risk of perioperative death ( 12 , 14 ). To reduce mortality and disability rate, early operation was crucial for good functional outcome and the avoidance of serious postoperative complications ( 20 , 21 ). However, the best perioperative care for intertrochanteric femoral fractures remained controversial.…”

Section: Discussionmentioning

confidence: 99%

The Efficacy of Multidisciplinary Team Co-Management Program for Elderly Patients With Intertrochanteric Fractures: A Retrospective Study

Fan

et al. 2022

Front. Surg.

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BackgroundIntertrochanteric fractures increased quickly in past decades owing to the increasing number of aging population. Recently, geriatric co-management was rapidly emerging as a favored clinical care model for older patients with hip fractures. The purpose of this study was to assess the efficacy of a multidisciplinary team (MDT) co-management program in elderly patients with intertrochanteric fractures.MethodsIn this retrospective study, patients were divided into MDT group and traditional orthopedic care (TOC) group according to the healthcare model applied. 249 patients were included in the TOC group from January 2014 to December 2016 and 241 patients were included in the MDT group from January 2017 to December 2019. Baseline data, peri-operative data, and postoperative complications were collected and analyzed using SPSS 21.0.ResultsNo significant differences were observed between the two groups in terms of patient baseline characteristics. Patients in the MDT group had significantly lower time from admission to surgery and length-of-stay (LOS) compared with those in the TOC group. Furthermore, the proportion of patients receiving surgery within 24 h (61.4 vs. 34.9%, p < 0.001) and 48 h (80.9 vs. 63.5%, p < 0.001) after admission to the ward was significantly higher in the MDT group compared with those in the TOC group. In addition, patients in the MDT group had significantly lower proportion of postoperative complications (25.3 vs. 44.2%, p < 0.001), deep vein thrombosis (7.9 vs. 12.9%, p = 0.049), pneumonia (3.8 vs. 8.0%, p = 0.045) and delirium (4.1 vs. 9.2%, p = 0.025) compared with those in the TOC group. However, no significant changes were found for in-hospital and 30-day mortality.ConclusionThe MDT co-management could significantly shorten the time from admission to surgery, LOS, and reduce the postoperative complications for elderly patients with intertrochanteric fractures. Further research was needed to evaluate the impact of this model on patient health outcomes.

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Section: Discussionmentioning

confidence: 99%

The Efficacy of Multidisciplinary Team Co-Management Program for Elderly Patients With Intertrochanteric Fractures: A Retrospective Study

Fan

et al. 2022

Front. Surg.

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“…With the acceleration of population aging, the incidence of FNF is also increasing rapidly. There are many clinical treatment programs for FNF, but there is still a lack of unified treatment standard [ 27 ]. Non-operative treatment often requires long-term bedridden, which leads to an increase in the incidence of complications such as pneumonia, bedsore and deep venous thrombosis in the elderly patients [ 5 ], so many elderly patients with FNF often die within half a year after non-operative treatment because of complications.…”

Section: Discussionmentioning

confidence: 99%

Does Garden type I incomplete femoral neck fracture really exist in older adults? To evaluate the stability and consistency of Garden classification

et al. 2022

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Background Accurate classification of femoral neck fracture (FNF) is crucial for treatment plan and therapeutic outcomes. Garden classification is commonly used in the clinic, but its stability and consistency remain controversial. The aim of this study was to evaluate the stability and consistency of Garden classification based on X and CT images, and to analyze whether it is valid for Garden I in the elderly. Methods X-ray and CT images from 886 elderly patients with FNF were collected, four orthopaedic surgeons and four radiologists evaluated these images independently, and determined the fracture type based on Garden classification. Three months later, The exercise was repeated and the results were compared based on 4 types Garden classification (I, II, III and IV) and 3 types Garden classification (I + II, III and IV). Kappa was used to measure inter- and intraobserver agreement. The patients with Garden I incomplete FNF confirmed by 8 observers together based on images combined with medical history were compared with the intraoperative results. Results Four types Garden classification, there was little consistency inter- and intraobservers (Kappa from 0.18 to 0.43) based on X-ray images, while professors consistency (0.56 to 0.76) was higher than residents (0.28 to 0.35) based on CT. 3 types Garden classification showed almost perfect agreement inter- and intraobservers, which ranged from 0.76 to 0.90. Totally 52 patients were diagnosed as Garden I, 38 of whom underwent arthroplasty. All surgical cases showed complete fracture during operation. Conclusions There was low consistency and repeatability in 4 types Garden classification (I, II, III and IV), while 3 types Garden classification (I + II, III and IV) had high consistency among observers. In the elderly, all undisplaced femoral neck fracture may be Garden II, no Garden I.

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“…Остеосинтез PFNA виконали в середньому протягом 3 діб після травми, зважаючи на часові ризики виникнення ускладнень та периопераційної смертності [15].…”

Section: матеріали і методиunclassified

Functional Results of Cephalomedullary Nail Osteosynthesis of Transtrochanteric Fractures in Elderly Patients

Sulyma

Valovina

Sabsai

et al. 2021

HOTP

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Summary. Relevance. Despite many surgical techniques that use modern metal fixators, treatment of elderly patients with fractures of the proximal part of the hip still remains relevant. Objective: to evaluate the functional results of surgical treatment of elderly patients with transtrochanteric fractures of the femur using a cephalomedullary locking nail (PFNA). Materials and Methods. The study involved 193 elderly patients (mean age 76.2±10.3 years) with transtrochanteric fractures of the femur type 31 A1-A2.1-1.3 (AO/OTA) after osteosynthesis by PFNA cephalomedullar fixator. The functional outcome of the treatment was determined after 1, 3, 12, and 36 months by Harris Hip Score (HHS), radiographic signs of bone union, and the presence of complications. The risk of recurrent trochanteric fractures over the next 10 years was calculated by adapted FRAX scale. Results. Positive changes were found by HSS, in the dynamics: 51.6 after 1 month, 60.2 after 3 months, 79.7 after 12 months, and 84.4 after 36 months. Within 6 months after the surgery, the following changes were found: secondary displacement of bone fragments with the “cut-out” eruption of the cervical blade in 2.3% (n=3), migration of the cervical component outward in 4.7% (n=6), and inflammation of surgical wound in 3.9% (n=5) of cases. Retrospectively, the average FRAX score was assessed (22.12±1.76). Conclusions. Stable functional osteosynthesis of transtrochanteric fractures of the femur using PFNA combined with early dosed loading on the injured limb allowed to obtain satisfactory functional results in 95.4% of cases. Secondary displacement of bone fragments with the “cut-out” effect requires a detailed analysis of all possible endo- and exogenous factors and identification of the most significant ones. The 10-year risk of recurrent fractures in patients with trochanteric fractures significantly increases over the age of 70, especially in females, and accounts for the majority of osteoporotic fractures.

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Time to Surgery and Outcome in the Treatment of Proximal Femoral Fractures

Cited by 12 publications

References 28 publications

The Efficacy of Multidisciplinary Team Co-Management Program for Elderly Patients With Intertrochanteric Fractures: A Retrospective Study

The Efficacy of Multidisciplinary Team Co-Management Program for Elderly Patients With Intertrochanteric Fractures: A Retrospective Study

Does Garden type I incomplete femoral neck fracture really exist in older adults? To evaluate the stability and consistency of Garden classification

Functional Results of Cephalomedullary Nail Osteosynthesis of Transtrochanteric Fractures in Elderly Patients

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