Trends in surgical treatment of femoral neck fractures in the elderly / Tendências no tratamento cirúrgico das fraturas do colo do fêmur em idosos

ABSTRACT Objective To analyze recent demographic and medical billing trends in treatment of femoral neck fracture of American elderly patients. Methods The American College of Surgeons National Surgical Quality Improvement Program database was analyzed from 2006 to 2015, for patients aged 65 years and older, using the Current Procedural Terminology codes 27130, 27125, 27235, and 27236. Patient demographics, postoperative complications, and frequency of codes were compared and analyzed over time. Our sample had 17,122 elderly patients, in that, 70% were female, mean age of 80.1 years (standard deviation±6.6 years). Results The number of cases increased, but age, gender, body mass index, rates of diabetes and smoking did not change over time. Open reduction internal fixation was the most commonly billed code, with 9,169 patients (53.6%), followed by hemiarthroplasty with 5,861 (34.2%) patients. Combined estimated probability of morbidity was 9.8% (standard deviation±5.2%), and did not change significantly over time. Postoperative complication rates were similar between treatments. Conclusion Demographics and morbidity rates in femoral neck fractures of elderly patients did not change significantly from 2006 to 2015. Open reduction internal fixation was the most common treatment followed by hemiarthroplasty.

RESUMO Objetivo Analisar tendências recentes demográficas e de faturamento médico no tratamento de fraturas do colo do fêmur em idosos americanos. Métodos O banco de dados National Surgical Quality Improvement Program, do American College of Surgeons, foi analisado de 2006 a 2015, para pacientes com idade igual ou superior a 65 anos, usando os códigos de Current Procedural Terminology 27130, 27125, 27235 e 27236. Dados demográficos dos pacientes, complicações pós-operatórias e frequência de códigos foram comparados e analisados ao longo do tempo. A amostra teve 17.122 pacientes geriátricos, sendo 70% do sexo feminino, com média de idade de 80,1 anos (desvio padrão±6,6 anos). Resultados O número de casos aumentou no período, mas idade, gênero, índice de massa corporal e taxas de diabetes e tabagismo não mudaram ao longo do tempo. A fixação interna de redução aberta foi o código faturado mais comum, com 9.169 pacientes (53,6%), seguido por artroplastia parcial do quadril, com 5.861 (34,2%) pacientes. A probabilidade estimada combinada de morbidade foi de 9,8% (desvio padrão±5,2%) e não mudou significativamente ao longo do tempo. As taxas de complicações pós-operatórias foram semelhantes entre os tratamentos. Conclusão Os dados demográficos e as taxas de morbidade relacionadas às fraturas geriátricas do colo do fêmur não apresentaram mudança significativa entre 2006 e 2015. A redução aberta e a fixação interna foram as opções de tratamento mais comuns, seguidas da artroplastia parcial do quadril.

Fractures of the femoral neck: results of cannulated screw fixation in patients above 50 years old

The results of stabilization of an intracapsular fracture of the femoral neck with cannulated screws placed in 40 patients between 2002 and 2003 were reviewed. Fourteen patients [35%] had a non-displaced fracture [Garden Stage I or II] and twenty-six [65%] had a displaced fracture [Garden Stage HI or IV]. The mean age of the patients was sixty-two years [range, fifty-four to seventy-five years]. The minimum duration of follow-up was two years [range twenty-four to thirty-six months]. No patient died, had a wound infection or D VT during the stay in the hospital. The hospital stay averaged 3 days [range two to five]. Two patients died within six months after treatment; one of them aged seventy-five years and the other sixty-eight and both were excluded from the study. There was a loss of position or a non-union of the fracture in five patients [12.5%] and healing of the fracture in 35 patients [87.5%]. Nine patients [22.5%] had roentgeno-graphic evidence of osteonecrosis within the first twenty-four months after treatment. Seven of these patients have had a displaced fracture, one had a non-displaced fracture and one was on top of non-union. Osteonecrosis developed in one of the nine patients [11%] who had a Garden Stage-H fracture, in three of the fifteen patients [20%] who had had a Garden Stage-Ill fracture, and in five of the eleven patients [45%] who had had a Garden Stage-IV fracture. The twenty-sevenpatients [67.5%] in whom the fracture healed without complications were found to be functioning well more than eighteen months after the fracture treatment

Total hip arthroplasty following failed primary surgery of fracture neck femur

Reporting the problems and early results of total hip arthroplasty following primary surgery of fracture neck femur whether it was by open reduction and internal fixation or hemi-arthroplasty . Sixty Jive cases with failed primary surgery of fracture neck femur 26 cases with ORIF. 19 cases with Austin Moore prosthesis . 17 cases with Thompson prosthesis . 3 cases with Bipolar arthroplasty. Hardinge approach was used in all cases . Bone defects were evaluated and filled with bone graft if needed. The total hip prosthesis was then inserted. The approach used did not affect the duration of operation . Extraction of the prosthesis was difficult in 6 cases and this only was encountered in Thompson prosthesis [5 cases and Bipolar prosthesis [one case] . Cracks of the shaft of the femur occurred in 5 cases of patients with cemented prosthesis during cement removal but no evident fractures happened . Early wound complications were seen in one case after ORIF, and 2 cases of hemiarthroplasty . Early postoperative dislocation of the prosthesis were not encountered in any case . One case encountered 3 months post operatively . Harris Hip Score at the final follow up showed a mean 80.1 . At the end of follow up ; 38 cases [58.4%] had an excellent results . 15 cases [23.1%] had a good results . 7 cases [10.8%] had a fair results . 5 cases [7.7%] had a poor results