Michael A Kelly1, Kevin McSorley2, Maire-Caitlin Casey2, Fintan J Shannon2. 1. Department of Trauma and Orthopaedic Surgery, University Hospital Galway, Galway, Ireland. MichaelKelly@rcsi.ie. 2. Department of Trauma and Orthopaedic Surgery, University Hospital Galway, Galway, Ireland.
Abstract
BACKGROUND: The burden associated with hip fractures is increasing worldwide. Arthroplasty procedures are more commonly performed for intracapsular fractures due to increased risk of compromise to the femoral head blood supply. However, we know from the Irish Hip Fracture Database that a significant proportion of these fractures undergo internal fixation. AIMS: We sought to investigate the long-term outcomes for these patients including revision rates, functional outcome and mortality rates. METHODS: All intracapsular fractures treated by internal fixation (IF) from 2005 to 2009 were identified. Pre-operative anatomical fracture location and level of fracture displacement was established. Hospital records were used to record mortality and revision rates. The modified Harris hip score was our primary functional outcome measure. RESULT: One hundred twelve intracapsular fractures underwent IF over a 5-year period. The mean age was 68.6 (range 14-95 years). A mean follow-up time of 8.15 years (range 6.7-10.1 years) was achieved. There was a 5-year mortality rate of 36.6%. There was a significantly higher revision rate in displaced fractures (24.4%) than in undisplaced fractures (11.1%) (p = 0.01). We found no difference in functional outcome between displaced fractures [85.9 (± 16.9)] and undisplaced fractures [86.01 (± 18.8)]. Those aged younger than 65 at the time of surgery had a significantly better MHHS (p = 0.02) at long-term follow-up; however, there was a revision rate of 43.8% in this group. CONCLUSION: Whilst a good functional outcome can be achieved with internal fixation, particularly in younger patients, the risk of requiring revision surgery approaches 50% for these patients.
BACKGROUND: The burden associated with hip fractures is increasing worldwide. Arthroplasty procedures are more commonly performed for intracapsular fractures due to increased risk of compromise to the femoral head blood supply. However, we know from the Irish Hip Fracture Database that a significant proportion of these fractures undergo internal fixation. AIMS: We sought to investigate the long-term outcomes for these patients including revision rates, functional outcome and mortality rates. METHODS: All intracapsular fractures treated by internal fixation (IF) from 2005 to 2009 were identified. Pre-operative anatomical fracture location and level of fracture displacement was established. Hospital records were used to record mortality and revision rates. The modified Harris hip score was our primary functional outcome measure. RESULT: One hundred twelve intracapsular fractures underwent IF over a 5-year period. The mean age was 68.6 (range 14-95 years). A mean follow-up time of 8.15 years (range 6.7-10.1 years) was achieved. There was a 5-year mortality rate of 36.6%. There was a significantly higher revision rate in displaced fractures (24.4%) than in undisplaced fractures (11.1%) (p = 0.01). We found no difference in functional outcome between displaced fractures [85.9 (± 16.9)] and undisplaced fractures [86.01 (± 18.8)]. Those aged younger than 65 at the time of surgery had a significantly better MHHS (p = 0.02) at long-term follow-up; however, there was a revision rate of 43.8% in this group. CONCLUSION: Whilst a good functional outcome can be achieved with internal fixation, particularly in younger patients, the risk of requiring revision surgery approaches 50% for these patients.
Entities:
Keywords:
Functional outcome; Hip fractures; Mortality; Revision surgery
Authors: Ghazi Khalil Chammout; Sebastian Simon Mukka; Thomas Carlsson; Gustaf Fredrik Neander; Andre Wilhelm Helge Stark; Olof Gustaf Skoldenberg Journal: J Bone Joint Surg Am Date: 2012-11-07 Impact factor: 5.284
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