Internal fixation implants for intracapsular hip fractures in older adults.
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ABSTRACT:
SUBMITTER: Lewis SR
PROVIDER: S-EPMC8092427 | biostudies-literature | 2021 Mar
REPOSITORIES: biostudies-literature
Publications
Internal fixation implants for intracapsular hip fractures in older adults.
Lewis Sharon R SR Macey Richard R Eardley Will Gp WG Dixon Ján Robert JR Cook Jonathan J Griffin Xavier L XL
The Cochrane database of systematic reviews 20210309
<h4>Background</h4>Hip fractures are a major healthcare problem, presenting a huge challenge and burden to patients, healthcare systems and society. The increased proportion of older adults in the world population means that the absolute number of hip fractures is rising rapidly across the globe. The majority of hip fractures are treated surgically. This review evaluates evidence for types of internal fixation implants used in joint-preserving surgery for intracapsular hip fractures.<h4>Objectiv ...[more]
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Project description:BackgroundDisplaced intracapsular hip fractures are typically treated with hemiarthroplasty (HA) or total hip arthroplasty (THA). A number of professional bodies recommend considering THA for patients that were independently mobile and cognitively intact before injury. The aim of this study was to compare the outcomes between HA and THA for independently mobile older adults with hip fractures.MethodsA systematic review and meta-analysis of RCTs was undertaken alongside analysis of a propensity score matched national cohort of older adults (aged > 60) with hip fractures. Participants were identified for the propensity score matched cohort from the National Hip Fracture Database (NHFD), which was linked to Hospital Episode Statistics (HES) and civil death registration data. The primary outcomes were 12-month dislocation, revision, and mortality. The secondary outcomes were length of stay, discharge home, unplanned re-admission, functional outcomes, and health-related quality of life.ResultsFive RCTs reported higher THA dislocation but this was not statistically significant (THA risk ratio [RR] 2.77, 95% CI 0.81 to 9.48). However, THA dislocation was significantly higher in the national observational dataset (sub-distribution hazard ratio [SHR] 1.73, 95% CI 1.24 to 2.41). Meta-analysis of data from four RCTs did not identify a significant difference in terms of revision (RR 1.52, 95% CI 0.56 to 4.14). However, THA revision was significantly lower in the national dataset (SHR 0.66, 95% CI 0.48 to 0.90). Meta-analysis of data from 5 RCTs suggested higher mortality amongst patients undergoing HA (RR 0.63, 95% CI 0.38 to 1.04), which was also observed within the national registry dataset (hazard ratio 0.45, 95% CI 0.37 to 0.54).ConclusionsNational clinical registries can provide important context when interpreting RCT data, which may alone be inadequate for comparing the safety profile of surgical interventions. These data suggest that THA is at significantly higher risk of dislocation but lower risk of revision within 12 months. The finding from both RCT and clinical registry data that THA is associated with lower 12-month mortality amongst the fittest patients with hip fractures requires urgent further study to determine whether or not this can be replicated in other balanced populations.
| S-EPMC6525472 | biostudies-literature
Project description:ObjectiveTo compare the functional results after displaced fractures of the femoral neck treated with internal fixation or hemiarthroplasty.DesignRandomised trial with blinding of assessments of functional results.SettingUniversity hospital.Participants222 patients; 165 (74%) women, mean age 83 years. Inclusion criteria were age above 60, ability to walk before the fracture, and no major hip pathology, regardless of cognitive function.InterventionsClosed reduction and two parallel screws (112 patients) and bipolar cemented hemiarthroplasty (110 patients). Follow-up at 4, 12, and 24 months.Main outcome measuresHip function (Harris hip score), health related quality of life (Eq-5d), activities of daily living (Barthel index). In all cases high scores indicate better function.ResultsMean Harris hip score in the hemiarthroplasty group was 8.2 points higher (95% confidence interval 2.8 to 13.5 points, P=0.003) at four months and 6.7 points (1.5 to 11.9 points, P=0.01) higher at 12 months. Mean Eq-5d index score at 24 months was 0.13 higher in the hemiarthroplasty group (0.01 to 0.25, P=0.03). The Eq-5d visual analogue scale was 8.7 points higher in the hemiarthroplasty group after 4 months (1.9 to 15.6, P=0.01). After 12 and 24 months the percentage scoring 95 or 100 on the Barthel index was higher in the hemiarthroplasty group (relative risk 0.67, 0.47 to 0.95, P=0.02. and 0.63, 0.42 to 0.94, P=0.02, respectively). Complications occurred in 56 (50%) patients in the internal fixation group and 16 (15%) in the hemiarthroplasty group (3.44, 2.11 to 5.60, P<0.001). In each group 39 patients (35%) died within 24 months (0.98, 0.69 to 1.40, P=0.92)ConclusionsHemiarthroplasty is associated with better functional outcome than internal fixation in treatment of displaced fractures of the femoral neck in elderly patients.Trial registrationNCT00464230.
| S-EPMC2137068 | biostudies-literature
Project description: Not available
| S-EPMC8791231 | biostudies-literature
Project description:BACKGROUND:Femoral neck fractures are associated with high rates of revision surgery after management with internal fixation. Using data from the Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH) trial evaluating methods of internal fixation in patients with femoral neck fractures, we investigated associations between baseline and surgical factors and the need for revision surgery to promote healing, relieve pain, treat infection or improve function over 24 months postsurgery. Additionally, we investigated factors associated with (1) hardware removal and (2) implant exchange from cancellous screws (CS) or sliding hip screw (SHS) to total hip arthroplasty, hemiarthroplasty, or another internal fixation device. METHODS:We identified 15 potential factors a priori that may be associated with revision surgery, 7 with hardware removal, and 14 with implant exchange. We used multivariable Cox proportional hazards analyses in our investigation. RESULTS:Factors associated with increased risk of revision surgery included: female sex, [hazard ratio (HR) 1.79, 95% confidence interval (CI) 1.25-2.50; P = 0.001], higher body mass index (for every 5-point increase) (HR 1.19, 95% CI 1.02-1.39; P = 0.027), displaced fracture (HR 2.16, 95% CI 1.44-3.23; P < 0.001), unacceptable quality of implant placement (HR 2.70, 95% CI 1.59-4.55; P < 0.001), and smokers treated with cancellous screws versus smokers treated with a sliding hip screw (HR 2.94, 95% CI 1.35-6.25; P = 0.006). Additionally, for every 10-year decrease in age, participants experienced an average increased risk of 39% for hardware removal. CONCLUSIONS:Results of this study may inform future research by identifying high-risk patients who may be better treated with arthroplasty and may benefit from adjuncts to care (HR 1.39, 95% CI 1.05-1.85; P = 0.020). LEVEL OF EVIDENCE:Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
| S-EPMC5986292 | biostudies-literature
Project description:BackgroundTotal hip arthroplasty (THA) is the treatment of choice for posttraumatic arthritis with failed internal fixation for hip fractures. However, the postoperative prognosis is not clear.Questions/purposesThe primary aim of the study is to report the postoperative outcome, prognosis, and complication rates of total hip arthroplasty in posttraumatic hip arthritis after failed internal fixation of fractures around the hip. The secondary aim of the study is to report results among different fracture types around the hip.Patients and methodsWe enrolled salvage THA patients after failed internal fixation of fractures around the hip and matched control patients undergoing primary THA for hip osteoarthritis. Subgroup analysis was performed to compare the postoperative outcomes, prognosis, and complication rates of salvage THA in posttraumatic hip arthritis after failed internal fixation of different fracture types around the hip.ResultsA total of 315 THAs (105 salvage THAs and 210 primary THAs) were analyzed. Patients with salvage THA had a longer operative time, lower postoperative hemoglobin (Hb) level, more Hb drop (2.2 ± 1.4 vs. 1.7 ± 1.2 gm/dl, p = 0.002), and delayed ambulation. The salvage THA group also had a higher dislocation rate within 2 months after salvage THA (9.5% vs. 1.9%, p = 0.002), reoperation rate (10.5% vs. 3.8%, p = 0.019, including debridement, open and closed reduction under sedation, revision surgery, surgical fixation for periprosthetic fractures), and revision rate (5.7% vs. 0.5%, p = 0.003) than patients undergoing primary THA. Patients who had failed fixation for acetabular fractures were younger and tended to recover well. Patients with previous intertrochanteric fracture had the longest operative time, more hip pain (83.8%, p = 0.022) and more complications.ConclusionSalvage THA in posttraumatic hip arthritis after failed internal fixation required a longer operative time and led to more blood loss and postoperative complications. The dislocation, reoperation, and revision rates after salvage THA were higher than those after primary THA. Patients with salvage THA after failed internal fixation for intertrochanteric fractures were the most susceptible to more complications compared to those with femoral neck fracture or acetabular fracture. Level of Evidence level III.
| S-EPMC9843827 | biostudies-literature
Project description:Introduction:Failure of hip implant surgeries can be caused by various factors. Failure of internal fixation results in pain and restricted ambulation. In management of an elderly patient with hip fractures, the aim is to ambulate patient. The purpose of our study is to assess the outcomes of proximal femur replacement in the management of failed hip surgeries for fractures of the proximal femur. Materials and methods:A retrospective analysis of 26 patients, who underwent proximal femur replacement for failed surgeries of hip fracture during the period from April 2011 to March 2018, was conducted. All patients who underwent proximal femur replacement for failed hip implants were enrolled into the study. Results:Total patients were 26. The mean follow was (12-91 months). The mean Harris Hip score improved from 26 preoperative to 66.7(45-91). Three patients developed dislocations which were managed with closed reduction. Three patients died within one year of surgery, one patent died of sepsis from implant infection at four months after surgery, one patient died of Myocardial infarction. Three patients developed surgical site infection of which one has superficial surgical site infection which was managed with oral antibiotics, in other case developed deep surgical site infection and was managed with wound debridement and IV antibiotics for 6 weeks, in third wound debridement was done but patient died of sepsis. Conclusion:Proximal femur replacement with modular stem implant has advantages over conventional hip implant in patients undergoing surgery after failure of internal fixation.
| S-EPMC7251496 | biostudies-literature
Project description:BackgroundWe studied the safety and efficacy of dynamic locking plate vs. other implants (cannulated cancellous screws [CCS] or sliding hip screw [SHS]) in patients undergoing intracapsular hip fracture (ICHF).MethodsWe searched Pubmed, Embase, Web of Science, Cochrane library and Google database from inception to March 25, 2018. We selected any studies comparing dynamic locking plate for treatment ICHF. Non-union rate, osteonecrosis rate, cutout rate, revision rate, the replacement rate, and Harris hip scores were the outcomes. Stata 12.0 was used for meta-analysis.ResultsFour studies involving 419 patients (143 patients in the dynamic locking plate group and 276 patients in the other implants group) were finally included. Compared with CCS or SHS, dynamic locking plate was associated with a reduction of nonunion rate, revision rate, replacement rate (P?<.05). Furthermore, dynamic locking plate was also associated with an increase of the Harris hip scores (P?<.05). There was no significant difference between the osteonecrosis rate and cutout rate (P?>.05).ConclusionsCurrent meta-analysis revealed that dynamic locking plate has a benefit role in improving postoperative clinical outcome than CCS or SHS in ICHF patients. Further high quality and large-scale randomized controlled trials (RCTs) are needed to further identify the efficacy of dynamic locking plate for ICHF.
| S-EPMC6392746 | biostudies-literature
Project description:The purpose of our study was to compare the curative effect of two surgical methods for Schatzker type I to III tibia plateau fractures, arthroscopy assisted reduction percutaneous internal fixation (ARIF) and open reduction internal fixation (ORIF), with the intent of evaluating the quality of evidence to assist treatment selection. Searches of PubMed, Cochrane and China National Knowledge Infrastructure (CNKI) databases were performed to identify randomized controlled trials (RCTs) and quasi-RCTs comparing ARIF and ORIF regarding the following outcomes: functional outcomes, perioperative complications and post-traumatic osteoarthritis. Odds ratios (OR) and weighted mean differences (MDs) were pooled using either a fixed-effects model or random-effects model, depending on the heterogeneity of the trials included in the analysis. 19 RCTs and one quasi-RCT provided the data from 1272 patients. ARIF was associated with better functional outcomes, a lower risk of perioperative complications, and lower risk of post-traumatic osteoarthritis. After consideration of the quality of evidence of the included studies, the advantages provided by ARIF are not substantive over ORIF for the treatment of Schatzker type I to III tibia plateau fractures, except reducing the risk of perioperative complications.
| S-EPMC6145938 | biostudies-literature
Project description:Fractures of the coracoid process are uncommon injuries and are usually the result of high-energy trauma or avulsion-type injuries. Typically coracoid fractures treated with nonoperative management have yielded good results. Operative treatment of coracoid fractures is reserved for a subset of clinical situations, including fracture nonunion. We detail our technique for arthroscopic debridement of a Type II coracoid fracture nonunion, as well as the use of arthroscopic-assisted percutaneous fixation for a Type II coracoid fracture.
| S-EPMC9437606 | biostudies-literature
Project description:Failed internal fixation of intertrochanteric (IT) hip fractures presents a significant challenge in the elderly, osteoporotic population. Conversion total hip arthroplasty (cTHA) and hemiarthroplasty (cHA) are both accepted salvage operations for failed IT fracture fixation, though limited clinical data exist regarding the optimal treatment between these procedures.A systematic review of 3 databases (PubMed, Cochrane, and Embase) was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Inclusion criteria were English-language studies that compared clinical or functional outcomes after failed fixation of IT fractures with total hip arthroplasty and hemiarthroplasty in adult subjects (>18 years of age). Data regarding research design, surgical technique, and clinical or functional outcomes were obtained and analyzed from eligible studies using a Mantel-Haenszel random-effects analysis model.Six studies with 188 patients (100, total hip arthroplasty; 88, hemiarthroplasty) met inclusion and exclusion criteria. There was no significant difference between cTHA and cHA for postoperative dislocation, reoperation, infection, intraoperative fractures, postoperative fractures, or stem subsidence. The mean change in Harris Hip Scores was significantly higher (P < .001) in the cTHA group (47.5 ± 4.9) than that in the cHA (38.9 ± 7.2) group at minimum 14-month follow-up.Despite potential advantages of cTHA or cHA for failed IT fractures, there were no differences in complications between either of the salvage procedures. Our analysis found a slight advantage in functional outcomes (Harris Hip Score) for cTHA at a minimum 14-month follow-up. Our study suggests that cTHA and cHA are both effective salvage procedures. Additional prospective studies are warranted to further delineate outcomes after salvage arthroplasty performed for failed IT fracture fixation.
| S-EPMC6123233 | biostudies-other