Giuseppe Toro1, Enrico Pola1, Roberta Miranda1, Michele Conte2, Adriano Braile1, Raffaele Pezzella3, Annalisa De Cicco1, Salvatore D'auria4, Antonio Piscopo4, Alfredo Schiavone Panni1. 1. Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli". 2. Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli"; Unit of Orthopaedics and Traumatology, Ospedale Sacro Cuore di Gesù Fatebenefratelli. 3. Unit of Orthopaedics and Traumatology, AORN San Giuseppe Moscati. 4. Unit of Orthopaedics and Traumatology, Ospedale Sacro Cuore di Gesù Fatebenefratelli.
Abstract
Background: Femoral neck fractures (FNF) are associated to patient's disability, reduced quality of life and mortality. None of the fixation devices commonly used for extracapsular (EC) FNF (i.e., dynamic hip screws (DHS) and intramedullary nails (IN)) is clearly superior to the other, especially in case of unstable fractures (31.A2 and 31.A3 according to AO/OTA classification). The aim of our study was to identify a sub-population of patients with EC fractures in which better outcomes could be obtainable using total hip arthroplasty (THA). Methods: All patients with EC unstable fractures treated with THA were included in the present study. Demographic data, American Society of Anesthesiologists (ASA) score, hospitalization length, transfusion rate, implant-related complications and mortality rate were collected. Clinical outcomes were evaluated using the Oxford Hip Score (OHS), while patients' general health status through the 12 Item Short Form questionnaires (SF-12). Results: 30 patients (7 male; 23 female) with a mean age of 78.8 years were included. The 1-year mortality rate was 13.3%. The mean OHS was 27.5, while the mean SF-12 were 45.84 for the mental item and 41.6 for the physical one. Age was the only factor associated with the OHS and patients older than 75 years presented a 12- fold higher risk of developing bad outcomes. Conclusions: THA seems to be a viable option for unstable EC fractures, with good clinical outcomes, especially in patients younger than 75 years of age. The mortality rate associated with THA in EC fractures is low and anyway comparable with IN.
Background: Femoral neck fractures (FNF) are associated to patient's disability, reduced quality of life and mortality. None of the fixation devices commonly used for extracapsular (EC) FNF (i.e., dynamic hip screws (DHS) and intramedullary nails (IN)) is clearly superior to the other, especially in case of unstable fractures (31.A2 and 31.A3 according to AO/OTA classification). The aim of our study was to identify a sub-population of patients with EC fractures in which better outcomes could be obtainable using total hip arthroplasty (THA). Methods: All patients with EC unstable fractures treated with THA were included in the present study. Demographic data, American Society of Anesthesiologists (ASA) score, hospitalization length, transfusion rate, implant-related complications and mortality rate were collected. Clinical outcomes were evaluated using the Oxford Hip Score (OHS), while patients' general health status through the 12 Item Short Form questionnaires (SF-12). Results: 30 patients (7 male; 23 female) with a mean age of 78.8 years were included. The 1-year mortality rate was 13.3%. The mean OHS was 27.5, while the mean SF-12 were 45.84 for the mental item and 41.6 for the physical one. Age was the only factor associated with the OHS and patients older than 75 years presented a 12- fold higher risk of developing bad outcomes. Conclusions: THA seems to be a viable option for unstable EC fractures, with good clinical outcomes, especially in patients younger than 75 years of age. The mortality rate associated with THA in EC fractures is low and anyway comparable with IN.
Entities:
Keywords:
extracapsular fracture; femoral neck fractures; intertrochanteric fractures; outcomes; total hip arthroplasty; unstable fractures
Authors: Simcha G Fichman; Tatu J Mäkinen; Oleg Safir; Alex Vincent; Benjamin Lozano; Aidin Kashigar; Paul R T Kuzyk Journal: Int Orthop Date: 2015-05-07 Impact factor: 3.075