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Current Management of Hip Fracture

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A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Surgery".

Deadline for manuscript submissions: closed (30 September 2022) | Viewed by 29664

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Special Issue Editor

Prof. Dr. Carsten Schoeneberg

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Guest Editor

Department of Orthopedic and Emergency Surgery, Alfried Krupp Hospital, Essen, Germany
Interests: hip fracture; fragility fracture; orthogeriatric co-management; geriatric trauma center

Special Issue Information

Dear Colleagues,

The incidence of hip fracture as a typical fragility fracture is increasing worldwide due to demographic changes and aging populations. Due to the patients‘ age, existing comorbidities, reduced daily life activities, poor bone quality, and preexisting implants, the treatment of hip fractures remains challenging. Therefore, proximal femur fractures are often life-changing events in older adults and are associated with high mortality rate, up to 35% after a year. Moreover, these fractures are associated with a decreased walking ability, reduced quality of life and loss of independence. Furthermore, hip fractures are associated with high socioeconomic costs, due to surgical complications, reduced coping capacities and high institutionalization rates.

These dramatic consequences have led to the development of optimized implants and the establishment of an orthogeriatric co-management. This concept indicates and includes multi-professional and interdisciplinary cooperation between surgeons and geriatrics. The advantages of such a cooperation are well documented by evidence in reducing mortality and complications. In addition, special national guidelines were established to provide best care of patients with a hip fracture.

Moreover, special geriatric hip fracture registries have been established in different countries. These registries enable the analysis of big data and have the potential to improve the treatment of geriatric patients with hip fracture.

However, in most of the countries worldwide, there is a large supply gap in the prevention of secondary fractures following fragility fractures. For example, in the United States, the prevalence of pre- and post-fracture anti-osteoporotic medication is beneath 25%. Similar results are reported from China, Italy, Germany and other countries.

The body of literature concerning hip fractures has risen exponentially in the past years. Nevertheless, due to divergent reported results, several questions remain unsolved: e.g., What are predictors for worse outcome? Are there easy to use predictor scores? What is the best time-to-surgery? What is the best implant for the individual patient? Should we perform cement augmentation? What is the best concept of orthogeriatric co-management? In addition to many more questions.

The purpose of this Special Issue is to discuss the evidence of the current management of hip fractures. Therefore, the scope is not tailored to only surgical strategies and the choice of implant, but should also focus on the whole process of treating patients after suffering a hip fracture. This includes epidemiology, process optimization, orthogeriatric co-management concepts, geriatric fracture centers, and secondary prevention of fractures. Even the analyses of the socioeconomic consequences are of interest. Moreover, the type of fracture is not limited to femoral neck fractures, but also included trochanteric and subtrochanteric femur fractures, proximal periprosthetic and periimplant fractures, and acetabular fractures.

Prof. Dr. Carsten Schoeneberg
Guest Editor

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Keywords

hip fracture
orthogeriatric co-management
osteoporotic treatment
geriatric fracture center
fracture liaison service
fragility fracture
fracture fixation
hemiarthroplastic
total hip replacement
hip fracture registry
surgical complications

Published Papers (12 papers)

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Editorial

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4 pages, 225 KiB

Open AccessEditorial

Current Management of Hip Fracture

by Carsten Schoeneberg

Medicina 2023, 59(1), 26; https://doi.org/10.3390/medicina59010026 - 23 Dec 2022

Viewed by 1652

Abstract

This Special Issue, entitled “Current Management of Hip Fracture”, ran in the Medicina journal of MDPI’s “Surgery” section, reports the findings of international studies regarding different aspects in the treatment of patients suffering a proximal femur fracture [...] Full article

(This article belongs to the Special Issue Current Management of Hip Fracture)

Research

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13 pages, 1074 KiB

Open AccessArticle

High Percentage of Complications and Re-Operations Following Dynamic Locking Plate Fixation with the Targon^® FN for Intracapsular Proximal Femoral Fractures: An Analysis of Risk Factors

by Emanuel Kuner, Jens Gütler, Dimitri E. Delagrammaticas, Bryan J. M. van de Wall, Matthias Knobe, Frank J. P. Beeres, Reto Babst and Björn-Christian Link

Medicina 2022, 58(12), 1812; https://doi.org/10.3390/medicina58121812 - 9 Dec 2022

Cited by 2 | Viewed by 2348

Abstract

The ideal surgical treatment of femoral neck fractures remains controversial. When treating these fractures with internal fixation, many fixation constructs exist. The primary aim of this study was to evaluate the incidence and specific risk factors associated with complication and re-operation following fixation of intracapsular proximal femoral fractures using the Targon-FN system (B.Braun Melsungen AG). A secondary aim was to identify if lateral prominence of the implant relative to the lateral border of the vastus ridge was a specific risk factor for elective plate removal. Methodically, a retrospective case series was conducted of all consecutive adult patients treated at a single level 1 trauma center in Switzerland for an intracapsular proximal femoral fracture with the Targon-FN. Demographic data were collected. Patients with a follow-up of less than three months were excluded. Complications as well as plate position were recorded. Statistical analysis to identify specific risk factors for re-operation and complications was performed. In result, a total of 72 cases with intracapsular femoral neck fractures were treated with the Targon-FN locking plate system between 2010 and 2017. Thirty-four patients (47.2%) experienced one or more complications. The most common complication was mechanical irritation of the iliotibial band (ITB) (23.6%, n = 17). Complications included intraarticular screw perforation (6.9%, n = 5), avascular necrosis (5.6%, n = 4), non-union (5.6%, n = 4) among others. In total, 46 re-operations were required. Younger age, fracture displacement and time to postoperative weight bearing were identified as risk factors for re-operation. In conclusion, intracapsular femoral neck fractures treated with the Targon-FN system resulted in a high rate of post-operative complication and re-operation. Statistical analysis revealed patient age, fracture displacement, time to postoperative full weight bearing were risk factors for re-operation. The main limitation is the limited number of cases and a short follow-up of less than 12 months in a subgroup of our patients. Full article

(This article belongs to the Special Issue Current Management of Hip Fracture)

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12 pages, 1219 KiB

Open AccessArticle

Impact of Anterior Malposition and Bone Cement Augmentation on the Fixation Strength of Cephalic Intramedullary Nail Head Elements

by Torsten Pastor, Ivan Zderic, Clemens Schopper, Pascal C. Haefeli, Philipp Kastner, Firas Souleiman, Boyko Gueorguiev and Matthias Knobe

Medicina 2022, 58(11), 1636; https://doi.org/10.3390/medicina58111636 - 13 Nov 2022

Cited by 5 | Viewed by 1541

Abstract

Background and Objectives: Intramedullary nailing of trochanteric fractures can be challenging and sometimes the clinical situation does not allow perfect implant positioning. The aim of this study was (1) to compare in human cadaveric femoral heads the biomechanical competence of two recently launched cephalic implants inserted in either an ideal (centre–centre) or less-ideal anterior off-centre position, and (2) to investigate the effect of bone cement augmentation on their fixation strength in the less-ideal position. Materials and Methods: Fourty-two paired human cadaveric femoral heads were assigned for pairwise implantation using either a TFNA helical blade or a TFNA screw as head element, implanted in either centre–centre or 7 mm anterior off-centre position. Next, seven paired specimens implanted in the off-centre position were augmented with bone cement. As a result, six study groups were created as follows: group 1 with a centre–centre positioned helical blade, paired with group 2 featuring a centre–centre screw, group 3 with an off-centre positioned helical blade, paired with group 4 featuring an off-centre screw, and group 5 with an off-centre positioned augmented helical blade, paired with group 6 featuring an off-centre augmented screw. All specimens were tested until failure under progressively increasing cyclic loading. Results: Stiffness was not significantly different among the study groups (p = 0.388). Varus deformation was significantly higher in group 4 versus group 6 (p = 0.026). Femoral head rotation was significantly higher in group 4 versus group 3 (p = 0.034), significantly lower in group 2 versus group 4 (p = 0.005), and significantly higher in group 4 versus group 6 (p = 0.007). Cycles to clinically relevant failure were 14,919 ± 4763 in group 1, 10,824 ± 5396 in group 2, 10,900 ± 3285 in group 3, 1382 ± 2701 in group 4, 25,811 ± 19,107 in group 5 and 17,817 ± 11,924 in group 6. Significantly higher number of cycles to failure were indicated for group 1 versus group 2 (p = 0.021), group 3 versus group 4 (p = 0.007), and in group 6 versus group 4 (p = 0.010). Conclusions: From a biomechanical perspective, proper centre–centre implant positioning in the femoral head is of utmost importance. In cases when this is not achievable in a clinical setting, a helical blade is more forgiving in the less ideal (anterior) malposition when compared to a screw, the latter revealing unacceptable low resistance to femoral head rotation and early failure. Cement augmentation of both off-centre implanted helical blade and screw head elements increases their resistance against failure; however, this effect might be redundant for helical blades and is highly unpredictable for screws. Full article

(This article belongs to the Special Issue Current Management of Hip Fracture)

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10 pages, 499 KiB

Open AccessArticle

The Influence of a Modified 3rd Generation Cementation Technique and Vaccum Mixing of Bone Cement on the Bone Cement Implantation Syndrome (BCIS) in Geriatric Patients with Cemented Hemiarthroplasty for Femoral Neck Fractures

by Ulf Bökeler, Alissa Bühler, Daphne Eschbach, Christoph Ilies, Ulrich Liener and Tom Knauf

Medicina 2022, 58(11), 1587; https://doi.org/10.3390/medicina58111587 - 3 Nov 2022

Cited by 7 | Viewed by 1770

Abstract

Background and Objectives: Cemented hemi arthroplasty is a common and effective procedure performed to treat femoral neck fractures in elderly patients. The bone cement implantation syndrome (BCIS) is a severe and potentially fatal complication which can be associated with the implantation of a hip prosthesis. The aim of this study was to investigate the influence of a modified cementing technique on the incidence of BCIS. Material and Methods: The clinical data of patients which were treated with a cemented hip arthroplasty after the introduction of the modified 3rd generation cementing technique were compared with a matched group of patients who were treated with a 2nd generation cementing technique. The anesthesia charts for all patients were reviewed for the relevant parameters before, during and after cementation. Each patient was classified as having no BCIS (grade 0) or BCIS grade 1,2, or 3 depending on the severity of hypotension, hypoxia loss of consciousness. Results: A total of 92 patients with complete data sets could be included in the study. The mean age was 83 years. 43 patients (Group A) were treated with a 2nd and 49 patients (Group B) with a 3rd generation cementing technique. The incidence of BCIS grade 1,2, and 3 was significantly higher (p = 0,036) in group A (n = 25; 58%) compared to group B (n = 17; 35%). Early mortality was higher in group A (n = 4) compared to group B (n = 0). Conclusions: BCIS is a potentially severe complication with a significant impact on early mortality following cemented hemiarthroplasty of the hip for the treatment of proximal femur fracture. Using a modified 3rd generation cementing technique, it is possible to significantly reduce the incidence of BCIS and its associated mortality. Full article

(This article belongs to the Special Issue Current Management of Hip Fracture)

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12 pages, 2534 KiB

Open AccessArticle

Internal Fixation of Garden Type III Femoral Neck Fractures with Sliding Hip Screw and Anti-Rotation Screw: Does Increased Valgus Improve Healing?

by Simon Hackl, Christian von Rüden, Ferdinand Weisemann, Isabella Klöpfer-Krämer, Fabian M. Stuby and Florian Högel

Medicina 2022, 58(11), 1573; https://doi.org/10.3390/medicina58111573 - 1 Nov 2022

Cited by 2 | Viewed by 2044

Abstract

Background and Objectives: The aim of this study was to compare the effect of valgus versus anatomic reduction on internal fixation of Garden type III femoral neck fractures using the sliding hip screw (SHS) and anti-rotation screw (ARS) regarding the radiographic and therapeutic outcome. Patients and Methods: A retrospective case-controlled study was performed in a level I trauma center. All patients between 2006 and 2020 aged younger than 70 years with a Garden type III femoral neck fracture and a Kellgren–Lawrence score under grade III stabilized using SHS and ARS were identified. One-hundred and nine patients were included, with a group distribution of sixty-eight patients in group A (anatomic reduction) and forty-one patients in group B (valgus reduction). Results: Mean age was 55 years, and the mean Kellgren–Lawrence score was 1 in both groups. Mean femoral neck angle was 130.5 ± 3.8° in group A and 142.8 ± 4.3° in group B (p = 0.001), with an over-correction of 12° in group B. Tip-apex distance was 10.0 ± 2.8 mm in group A versus 9.3 ± 2.8 mm in group B (p = 0.89). Healing time was 9 weeks in group A compared to 12 weeks in group B (p = 0.001). Failure rate was 4.4% in group A and 17.1% in group B (p = 0.027). Conclusions: Anatomic reduction of Garden type III femoral neck fractures in patients younger than 70 years treated using SHS and ARS resulted in significantly lower failure rates and shorter healing times than after valgus reduction. Therefore, it can be recommended to achieve anatomic reduction. Full article

(This article belongs to the Special Issue Current Management of Hip Fracture)

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11 pages, 666 KiB

Open AccessArticle

Reduced Awareness for Osteoporosis in Hip Fracture Patients Compared to Elderly Patients Undergoing Elective Hip Replacement

by Moritz Kraus, Carl Neuerburg, Nicole Thomasser, Ulla Cordula Stumpf, Matthias Blaschke, Werner Plötz, Maximilian Michael Saller, Wolfgang Böcker and Alexander Martin Keppler

Medicina 2022, 58(11), 1564; https://doi.org/10.3390/medicina58111564 - 31 Oct 2022

Cited by 2 | Viewed by 1664

Abstract

Background: Osteoporotic fractures are associated with a loss of quality of life, but only few patients receive an appropriate therapy. Therefore, the present study aims to investigate the awareness of musculoskeletal patients to participate in osteoporosis assessment and to evaluate whether there are significant differences between acute care patients treated for major fractures of the hip compared to elective patients treated for hip joint replacement.; Methods: From May 2015 to December 2016 patients who were undergoing surgical treatment for proximal femur fracture or total hip replacement due to osteoarthritis and were at risk for an underlying osteoporosis (female > 60 and male > 70 years) were included in the study and asked to complete a questionnaire assessing the awareness for an underlying osteoporosis. ASA Score, FRAX Score, and demographic information have also been examined. Results: In total 268 patients (female = 194 (72.0%)/male = 74 (28%)), mean age 77.7 years (±7.7) undergoing hip surgery were included. Of these, 118 were treated for fracture-related etiology and 150 underwent total hip arthroplasty in an elective care setting. Patients were interviewed about their need for osteoporosis examination during hospitalization. Overall, 76 of 150 patients receiving elective care (50.7%) considered that an examination was necessary, whereas in proximal femur fracture patients the awareness was lower, and the disease osteoporosis was assessed as threatening by significantly fewer newly fractured patients. By comparison, patients undergoing trauma surgery had a considerably greater risk of developing another osteoporotic fracture than patients undergoing elective surgery determined by the FRAX^® Score (p ≤ 0.001).; Conclusions: The patients’ motivation to endure additional osteoporosis diagnostic testing is notoriously low and needs to be increased. Patients who underwent acute care surgery for a fragility proximal femur fracture, although acutely affected by the potential consequences of underlying osteoporosis, showed lower awareness than the elective comparison population that was also on average 6.1 years younger. Although elective patients were younger and at a lower risk, they seemed to be much more willing to undergo further osteoporosis assessment. In order to better identify and care for patients at risk, interventions such as effective screening, early initiation of osteoporosis therapy in the inpatient setting and a fracture liaison service are important measures. Full article

(This article belongs to the Special Issue Current Management of Hip Fracture)

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7 pages, 598 KiB

Open AccessArticle

Development and Validation of a New Tool in Predicting In-Hospital Mortality for Hip-Fractured Patients: The PRIMOF Score

by Giuseppe Di Martino, Pamela Di Giovanni, Fabrizio Cedrone, Michela D’Addezio, Francesca Meo, Piera Scampoli, Ferdinando Romano and Tommaso Staniscia

Medicina 2022, 58(8), 1082; https://doi.org/10.3390/medicina58081082 - 11 Aug 2022

Cited by 1 | Viewed by 1333

Abstract

Background and Objectives: The improved life expectancy was associated to the increased in the incidence of hip fractures among elderly people. Subjects suffering hip fractures frequently show concomitant conditions causing prolonged lengths of stay and higher in-hospital mortality. The knowledge of factors associated to in-hospital mortality or adverse events can help healthcare providers improve patients’ outcomes and management. The aim of this study was to develop a score to predict in-hospital mortality among hip fractured patients. Materials and Methods: Cases were selected from hospital admissions that occurred during the period 2006–2015 in Abruzzo region, Italy. The study population was split into two random samples in order to evaluate the accuracy of prediction models. A multivariate logistic regression was performed in order to identify factors associated to in-hospital mortality. All diagnoses significantly associated to in-hospital mortality were included in the final model. Results: The PRIMOF ranged between 0 and 27 and was divided into four risk categories to allow the score interpretation. An increase in odds ratio values with the increase in PRIMOF score was reported in both study groups. Conclusions: This study showed that a simple score based on the patient’ clinical comorbidities was able to stratify the risk of hip-fractured patients in terms of in-hospital mortality. Full article

(This article belongs to the Special Issue Current Management of Hip Fracture)

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11 pages, 1285 KiB

Open AccessArticle

Multipronged Programmatic Strategy for Preventing Secondary Fracture and Facilitating Functional Recovery in Older Patients after Hip Fractures: Our Experience in Taipei Municipal Wanfang Hospital

by Yu-Pin Chen, Wei-Chun Chang, Tsai-Wei Wen, Pei-Chun Chien, Shu-Wei Huang and Yi-Jie Kuo

Medicina 2022, 58(7), 875; https://doi.org/10.3390/medicina58070875 - 30 Jun 2022

Cited by 4 | Viewed by 2098

Abstract

Background and Objectives: The study assessed the effectiveness of a fracture liaison service (FLS) after 1 year of implementation in improving the outcomes of hip fracture surgery in older adult patients at Taipei Municipal Wanfang Hospital. Materials and Methods: The Wanfang hospital’s FLS program was implemented using a multipronged programmatic strategy. The aims were to encourage the screening and treatment of osteoporosis and sarcopenia, to take a stratified care approach for patients with a high risk of poor postoperative outcomes, and to offer home visits for the assessment of environmental hazards of falling, and to improve the patient’s adherence to osteoporosis treatment. The clinical data of 117 and 110 patients before and after FLS commencement, respectively, were collected from a local hip fracture registry; the data were analyzed to determine the outcomes 1 year after hip fracture surgery in terms of refracture, mortality, and activities of daily living. Results: The implementation of our FLS significantly increased the osteoporosis treatment rate after hip fracture surgery from 22.8% to 72.3%, significantly decreased the 1-year refracture rate from 11.8% to 4.9%, non-significantly decreased 1-year mortality from 17.9% to 11.8%, and improved functional outcomes 1 year after hip fracture surgery. Conclusions: Implementation of our FLS using the multipronged programmatic strategy effectively improved the outcomes and care quality after hip fracture surgery in the older adult population, offering a successful example as a valuable reference for establishing FLS to improve the outcomes in vulnerable older adults. Full article

(This article belongs to the Special Issue Current Management of Hip Fracture)

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13 pages, 442 KiB

Open AccessArticle

Surgical Management and Outcomes following Pathologic Hip Fracture—Results from a Propensity Matching Analysis of the Registry for Geriatric Trauma of the German Trauma Society

by Christopher Bliemel, Katherine Rascher, Ludwig Oberkircher, Torsten Schlosshauer, Carsten Schoeneberg, Matthias Knobe, Bastian Pass, Steffen Ruchholtz, Antonio Klasan and on behalf of the AltersTraumaRegister DGU

Medicina 2022, 58(7), 871; https://doi.org/10.3390/medicina58070871 - 29 Jun 2022

Cited by 5 | Viewed by 1623

Abstract

Background and Objectives: The outcomes of patients with pathologic hip fractures remain unclear. Data from a large international geriatric trauma registry were analyzed to examine the outcomes of patients with pathologic hip fractures compared with patients with typical osteoporotic hip fractures. Materials and Methods: Data from the Registry for Geriatric Trauma of the German Trauma Society (Deutsche Gesellschaft für Unfallchirurgie (DGU)) (ATR-DGU) were analyzed. All patients treated surgically for osteoporotic or pathologic hip fractures were included in this analysis. Across both fracture types, a 2:1 optimal propensity score matching and multivariate logistic regression analysis were conducted. In-house mortality rate and mortality at the 120-day follow-up, as well as mobility after 7 and 120 days, reoperation rate, discharge management from the hospital and readmission rate to the hospital until the 120-day follow-up were analyzed as outcome parameters for the underlying fracture type—pathologic or osteoporotic. Results: A total of 29,541 cases met the inclusion criteria. Of the patients included, 29,330 suffered from osteoporotic fractures, and 211 suffered from pathologic fractures. Multivariate logistic regression analysis revealed no differences between the two fracture types in terms of mortality during the acute hospital stay, reoperation during the initial acute hospital stay, walking ability after seven days and the likelihood of being discharged back home. Walking ability and hospital readmission remained insignificant at the 120-day follow-up as well. However, the odds of passing away within the first 120 days were significantly higher for patients suffering from pathologic hip fractures (OR: 3.07; p = 0.003). Conclusions: Surgical treatment of pathologic hip fractures was marked by a more frequent use of arthroplasty in per- and subtrochanteric fractures. Furthermore, the mortality rate among patients suffering from pathologic hip fractures was elevated in the midterm. The complication rate, as indicated by the rate of readmission to the hospital and the necessity for reoperation, remained unaffected. Full article

(This article belongs to the Special Issue Current Management of Hip Fracture)

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7 pages, 673 KiB

Open AccessArticle

COVID-19 Elderly Patients Treated for Proximal Femoral Fractures during the Second Wave of Pandemic in Italy and Iran: A Comparison between Two Countries

by Riccardo Giorgino, Erfan Soroush, Sajjad Soroush, Sara Malakouti, Haniyeh Salari, Valeria Vismara, Filippo Migliorini, Riccardo Accetta and Laura Mangiavini

Medicina 2022, 58(6), 781; https://doi.org/10.3390/medicina58060781 - 9 Jun 2022

Cited by 5 | Viewed by 1758

Abstract

Background and objevtive: The worldwide spread of SARS-CoV-2 has affected the various regions of the world differently. Italy and Iran have experienced a different adaptation to coexistence with the pandemic. Above all, fractures of the femur represent a large part of the necessary care for elderly patients. The aim of this study was to compare the treatment in Italy and Iran of COVID-19-positive patients suffering from proximal femur fractures in terms of characteristics, comorbidities, outcomes and complications. Materials and Methods: Medical records of COVID-19-positive patients with proximal femoral fractures treated at IRCCS Istituto Ortopedico Galeazzi in Milan (Italy) and at Salamat Farda and Parsa hospitals in the province of Tehran (Iran), in the time frame from 1 October 2020 to 16 January 2021, were analyzed and compared. Results: Records from 37 Italian patients and 33 Iranian patients were analyzed. The Italian group (mean age: 83.89 ± 1.60 years) was statistically older than the Iranian group (mean age: 75.18 ± 1.62 years) (p value = 0.0003). The mean number of transfusions for each patient in Italy was higher than the Iranian mean number (p value = 0.0062). The length of hospital stay in Italy was longer than in Iran (p value < 0.0001). Furthermore, laboratory values were different in the post-operative value of WBC and admission and post-operative values of CRP. Conclusions: The present study shows that differences were found between COVID-19-positive patients with proximal femoral fractures in these two countries. Further studies are required to validate these results and to better explain the reasons behind these differences. Full article

(This article belongs to the Special Issue Current Management of Hip Fracture)

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10 pages, 4627 KiB

Open AccessArticle

Comparing Perioperative Outcome Measures of the Dynamic Hip Screw and the Femoral Neck System

by Marcel Niemann, Karl F. Braun, Sufian S. Ahmad, Ulrich Stöckle, Sven Märdian and Frank Graef

Medicina 2022, 58(3), 352; https://doi.org/10.3390/medicina58030352 - 26 Feb 2022

Cited by 7 | Viewed by 3373

Abstract

Background and Objective: Various fixation devices and surgical techniques are available for the management of proximal femur fractures. Recently, the femoral neck system (FNS) was introduced, and was promoted on the basis of less invasiveness, shorter operating time, and less fluoroscopy time compared to previous systems. The aim of this study was to compare two systems for the internal fixation of femoral neck fractures (FNF), namely the dynamic hip screw (DHS) with an anti-rotation screw (ARS) and an FNS. The outcome measures included operating room time (ORT), dose–area product (DAP), length of stay (LOS), perioperative changes in haemoglobin concentrations, and transfusion rate. Materials and Methods: A retrospective single-centre study was conducted. Patients treated for FNF between 1 January 2020 and 30 September 2021 were included, provided that they had undergone closed reduction and internal fixation. We measured the centrum-collum-diaphyseal (CCD) and the Pauwels angle preoperatively and one week postoperatively. Results: In total, 31 patients (16 females), with a mean age of 62.81 ± 15.05 years, were included. Fracture complexity assessed by the Pauwels and Garden classification did not differ between groups preoperatively. Nonetheless, the ORT (54 ± 26.1 min vs. 91.68 ± 23.96 min, p < 0.01) and DAP (721 ± 270.6 cGycm² vs. 1604 ± 1178 cGycm², p = 0.03) were significantly lower in the FNS group. The pre- and postoperative CCD and Pauwels angles did not differ statistically between groups. Perioperative haemoglobin concentration changes (–1.77 ± 1.19 g/dl vs. –1.74 ± 1.37 g/dl) and LOS (8 ± 5.27 days vs. 7.35 ± 3.43 days) were not statistically different. Conclusions: In this cohort, the ORT and DAP were almost halved in the patient group treated with FNS. This may confer a reduction in secondary risks related to surgery. Full article

(This article belongs to the Special Issue Current Management of Hip Fracture)

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Review

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Open AccessReview

Proximal Femoral Fractures in the Elderly: A Few Things to Know, and Some to Forget

by Nicola Maffulli and Rocco Aicale

Medicina 2022, 58(10), 1314; https://doi.org/10.3390/medicina58101314 - 20 Sep 2022

Cited by 37 | Viewed by 7393

Abstract

Hip fractures are a leading cause of hospitalisation in elderly patients, representing an increasing socioeconomic problem arising from demographic changes, considering the increased number of elderly people in our countries. Adequate peri-operative treatment is essential to decrease mortality rates and avoid complications. Modern management should involve a coordinated multidisciplinary approach, early surgery, pain treatment, balanced fluid therapy, and prevention of delirium, to improve patients’ functional and clinical outcomes. The operative treatment for intertrochanteric and subtrochanteric fractures is intramedullary nail or sliding/dynamic hip screw (DHS) on the basis of the morphology of the fracture. In the case of neck fractures, total hip replacement (THR) or hemiarthroplasty are recommended. However, several topics remain debated, such as the optimum thromboprophylaxis to reduce venous thromboembolism or the use of bone cement. Postoperatively, patients can benefit from early mobilisation and geriatric multidisciplinary care. However, during the COVID-19 pandemic, a prolonged time to operation with a subsequent increased complication rate have burdened frail and elderly patients with hip fractures. Future studies are needed with the aim to investigate better strategies to improve nutrition, postoperative mobility, to clarify the role of home-based rehabilitation, and to identify the ideal analgesic treatment and adequate tools in case of patients with cognitive impairment. Full article

(This article belongs to the Special Issue Current Management of Hip Fracture)

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