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Résumé La prise en charge des fractures du col du fémur est un sujet de santé publique qui concerne une population âgée à prédominance féminine. La mortalité augmente lorsque le délai de prise en charge est supérieur à 24heures chez les patients sans co-morbidités. Les patients souffrant de co-morbidités peuvent être identifiés avec des scores spécifiques et doivent faire l’objet d’une évaluation préopératoire. Les bilans préopératoires doivent faire l’objet de pragmatisme mais des actions correctrices peuvent être nécessaires avant la chirurgie. L’entourage doit être associé à l’appréciation de l’autonomie préopératoire. L’infection concomitante par la COVID-19 augmente fortement la mortalité et le délai opératoire dépend de la sévérité de la maladie. La prise d’un traitement anticoagulant ou antiplaquettaire peut également retarder l’intervention. La technique d’anesthésie a finalement peu d’impact sur la mortalité et la récupération fonctionnelle. Summary Femoral neck fracture is a national health care issue in western countries due to the increase number of aged patients in the whole population. Mortality increases when the operative delay is higher than 24hours in patients without associated morbidity. Patients with co-morbidities have to be evaluated using specific scores. Preoperative check up have to be planned in order to improve patient’ condition without compromising the time for surgery. Relatives have to be questioned about preoperative patient’ autonomy and quality of life. A recent Sars-Cov-2 infection increases postoperative mortality. Operative delay depends on the severity of the disease. Anti-platelets and anticoagulants may also delay surgery. The choice of regional vs. general anaesthesia has no documented effect on mortality.
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INTRODUCTION: Blood transfusion and anaemia are frequent and are associated with poor outcomes in patients with hip fracture (HF). We hypothesised that preoperative intravenous iron and tranexamic acid (TXA) may reduce the transfusion rate in these patients. METHODS AND ANALYSIS: The HiFIT study is a multicentre, 2×2 factorial, randomised, double-blinded, controlled trial evaluating the effect of iron isomaltoside (IIM) (20 mg/kg) vs placebo and of TXA (intravenously at inclusion and topically during surgery) versus placebo on transfusion rate during hospitalisation, in patients undergoing emergency surgery for HF and having a preoperative haemoglobin between 95 and 130 g/L. 780 patients are expected. The primary endpoint is the proportion of patients receiving an allogenic blood transfusion of packed red blood cells from the day of surgery until hospital discharge (or until D30 if patient is still hospitalised). Enrolment started on March 2017 in 11 French hospitals. The study was stopped between July 2017 and August 2018 (because of investigation of serious AEs with IIM in Spain) and slowed down since March 2020 (COVID-19 crisis). The expected date of final follow-up is May 2022. Analyses of the intent-to-treat and per-protocol populations are planned. ETHICS AND DISSEMINATION: The HiFIT trial protocol has been approved by the Ethics Committee of Comité de Protection des Personnes Ouest II and the French authorities (ANSM). It will be carried out according to the principles of the Declaration of Helsinki and the Good Clinical Practice guidelines. The results will be disseminated through presentation at scientific conferences and publication in peer-reviewed journals. The HiFIT trial will be the largest study evaluating iron and TXA in patients with HF. TRIAL REGISTRATION NUMBER: clinicalTrials.gov identifier: NCT02972294; EudraCT Number 2016-003087-40.