Risk factors for mortality in geriatric hip fractures: a compressional study of different surgical procedures in 785 consecutive patients.

BACKGROUND: Only a little is known about whether type of surgical intervention has an effect on mortality of these patients. Our primary objective was to assess whether different type of surgical procedures has an effect on mortality among elderly patients with hip fracture. A secondary objective was to examine factors that are related to mortality in our patient population. Our hypothesis is that type of surgical procedure, especially external fixation, should have an influence on mortality outcomes. METHODS: We included 785 patients age 65 years or older, with hip fractures. Operative treatment consisted of external fixation, internal fixation, total hip arthroplasty and hip hemiarthroplasty. Age, gender, type of fracture, type of surgery performed, American Society of Anesthesiology (ASA) grade, clinical comorbidities, anesthesia type, blood transfusion requirement, time to surgery, intensive care unit requirement, operation length and length of hospital stay and number of comorbidities were documented. RESULTS: During the study period, 785 patients (262 male, 523 female) were included to study, Overall mortality rate was 37.2 % (292/785). Their age ranged between 65 and 100 years (mean 81). Surgery type Kaplan-Meier cumulative mortality curves suggested no significant difference between four different types of surgery groups (p = 0.064). Transfusion requirement was significantly lower in external fixation group comparing to other groups (p = 0.014). Cox regression analysis showed the number of comorbidities 2 and ≥ 3 (p = 0.0027, p = 0.015), transfusion requirement (p = 0.0001), ASA 4 (p = 0.016) to be significant predictors of mortality. CONCLUSIONS: Transfusion requirement, ASA grade 4 and having more than two comorbidities are risk factors for mortality in geriatric hip fractures. Type of surgical intervention and fracture type had similar mortality rates in our patient population.

Arthroscopic treatment of medial femoral condylar coronal fractures and nonunions.

Nonunion of medial femoral condylar coronal fractures are uncommon. In neglected Hoffa fractures despite nonunion, there is a risk of missing accompanying ligamentous and intra-articular injuries. Neither preoperative clinical examination nor magnetic resonance imaging showed these injuries before arthroscopy. Arthroscopy before internal fixation gives additional information and changes the surgical protocol for these fractures and nonunions.

[Treatment of intertrochanteric femur fractures in elderly patients: internal fixation or hemiarthroplasty]. / Yaslilarda intertrokanterik femur kiriklarinin tedavisi: Internal tespit mi, hemiartroplasti mi?

OBJECTIVES: There is no consensus as to whether internal fixation or hemiarthroplasty is more appropriate for the treatment of intertrochanteric femur fractures in elderly patients. While the latter offers early mobilization, internal fixation preserves the hip joint and avoids long-term complications associated with the prosthesis. This retrospective study aimed to compare the early results of these treatment modalities. METHODS: The study included 81 patients who were available for follow-up after surgery for intertrochanteric femur fractures. Of 38 patients (mean age 77.7 years; range 65 to 99 years) treated with internal fixation, 25 were alive; of 43 patients (mean age 80 years; range 67 to 97 years) treated with hemiarthroplasty, 22 were alive at the last follow-ups. The two groups were compared with regard to perioperative characteristics, mobilization time, complications, mortality, and daily activities according to the Barthel Activities of Daily Living Index. The mean follow-up was 22.7 months (range 6 to 39 months) in internal fixation, and 22.3 months (range 7 to 39 months) in hemiarthroplasty groups. RESULTS: Subsequent to the operation, mortality occurred in 34.2% after a mean of 13 months (range 1 to 36 months) and in 48.8% after a mean of six months (range 1 to 24 months) in patients treated with internal fixation and endoprosthesis, respectively. There were no significant differences with respect to mobilization in bed, standing, weight bearing without support, complications, and daily activity scores. The only significant difference in favor of hemiarthroplasty was that full weight bearing with two crutches took a shorter time (p<0.05). CONCLUSION: Short-term results suggest that hemiarthroplasty is not an advantageous alternative to internal fixation; moreover, its postoperative survival is shorter and mortality rate is higher. Osteosynthesis seems to be the first choice in the treatment of elderly patients with intertrochanteric femur fractures.

[Comparison of temperature increments in bone cavities induced by methylmethacrylate and heated saline solution]. / Metilmetakrilat ve isitilmis serum fizyolojik uygulamalarinda kemik kavitelerinde olusan sicaklik degisikliklerinin karsilastirilmasi.

OBJECTIVES: We administered saline solution at 70 degrees C and methylmethacrylate to varying volumes of bone cavities and compared temperature changes produced in bone regions at varying distances to the cavity wall. METHODS: We created varying sizes of cavities in the femoral heads of 20 human cadavers (6, 10, 12, and 20 cubic centimeters) and in the knee region of a human cadaver (6, 10, 12, 20, 30, and 40 cubic centimeters). Initially, saline solution at 70 degrees C was administered to all the cavities for 15 minutes by a pulse-irrigation method, during which temperature changes induced within the bone cavity and at specific distances (1, 2, 3, and 10 mm) to the cavity wall were recorded. The bone temperatures were allowed to return to initial values; thereafter, cement was applied and temperature changes at the same distances to the cavity wall, in the cement center, and on the cement surface were recorded. RESULTS: Cement volumes up to 40 cubic centimeters applied to the bone cavities did not produce temperature increments that are reported to be adequate to induce necrosis in the cavity wall. It was thought that cement-induced necrosis in the bone-cement interface was not related to heat, but to other effects exerted by cement application. Compared to cement-induced temperature changes, saline solution at 70 degrees C was always associated with higher temperature increments in the cavity wall. CONCLUSION: Due to its simple applicability at desired temperatures and for any lengths of time, heated saline solution seems to have credentials to be incorporated into local adjuvants that are utilized to eliminate tumoral contamination in the cavity wall following curettage for local aggressive tumors.