ABSTRACT
INTRODUCTION: Intracapsular femoral neck fractures remain associated with high rates of post-traumatic femoral head necrosis, non-union, and revision surgery. AIM: Our aim was to identify factors associated with revision surgery in intracapsular femoral neck fractures treated with sliding hip screws (SHS) in adults aged <65 years. PATIENTS AND METHODS: Consecutive admissions were identified retrospectively from the Royal Victoria Hospital, Belfast, which was the largest volume hospital on the National Hip Fracture Database. Of 2201 hip fractures between 1st August 2008 and 31st December 2010, 97 (4%) intracapsular fractures treated with SHS in adults <65 years were followed for a mean of 2.9 years (range 0-6.6). RESULTS: Twenty-one (22%) hips were revised to arthroplasty. Avascular necrosis developed in 28 (29%) femoral heads. Eight (8%) fractures proceeded to non-union. Displaced fractures (p<0.001, Fisher's exact [FE]), posterior comminution (p=0.049, FE), chronic respiratory disease (p=0.006, FE) and residual distraction (p=0.011, χ2) were associated with revision to arthroplasty. Multiple regression found displaced fractures (p=0.006) and chronic respiratory disease (p=0.017) significant; in the latter 4 of 6 were revised (67%), including all four patients with chronic obstructive pulmonary disease (COPD). Eleven (11%) individuals required walking aids before injury, which rose to 34 (35%) at one year (p<0.0001, χ2). Eighty-nine (92%) individuals could walk alone outdoors before injury, but only 76 (78%) at one year (p=0.009, χ2). CONCLUSIONS: Displaced fractures in individuals with chronic respiratory disease should be considered high risk for revision to arthroplasty. Posterior cortex deficiency should be evaluated prior to choice of operation. Fracture biology and revascularisation play a greater role than operation timing. A significant proportion of individuals do not recovery pre-morbid mobility by one year.
Subject(s)
Arthroplasty, Replacement, Hip , Femoral Neck Fractures/surgery , Femur Head Necrosis/surgery , Fracture Fixation, Internal , Reoperation/statistics & numerical data , Adult , Alcoholism/epidemiology , Bone Screws , Comorbidity , Female , Femoral Neck Fractures/diagnostic imaging , Femoral Neck Fractures/physiopathology , Femur Head Necrosis/epidemiology , Femur Head Necrosis/physiopathology , Follow-Up Studies , Fracture Fixation, Internal/methods , Fracture Healing , Humans , Kidney Failure, Chronic/epidemiology , Male , Middle Aged , Northern Ireland/epidemiology , Patient Outcome Assessment , Pulmonary Disease, Chronic Obstructive/epidemiology , Retrospective Studies , Young AdultABSTRACT
OBJECTIVE: To assess secondary preventative therapy among postmenopausal female inpatients (aged 75 years and over) receiving surgical management for a fractured neck of femur using two service delivery models. DESIGN: Practice in two fracture units was audited and compared using the NICE guidelines (TA 87) as an audit standard. SETTING: TWO FRACTURE UNITS: one with a fracture liaison service and one without. PARTICIPANTS: Postmenopausal female inpatients (aged 75 years and over) receiving surgical management for a fractured neck of femur. MAIN OUTCOME MEASURES: Rate of anti-resorptive treatment and rate of enquiry into risk factors. RESULTS: There was a significantly higher rate of anti-resorptive treatment (90.5% compared to 60.9% with a difference of 29.6%, p < 0.001) and enquiry into risk factors (83% compared to 7%) in the unit with a fracture liaison service. CONCLUSIONS: We propose that a hospital-based enhanced fracture liaison service may result in higher osteoporosis treatment rates among postmenopausal hospitalized hip fracture patients aged 75 years and over.
