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Article

Early Surgery Does Not Improve Outcomes for Patients with Periprosthetic Femoral Fractures—Results from the Registry for Geriatric Trauma of the German Trauma Society

1
Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg, 35043 Marburg, Germany
2
AUC, Akademie der Unfallchirurgie GmbH, 80639 Munich, Germany
*
Author to whom correspondence should be addressed.
Working Committee on Geriatric Trauma Registry (AK ATR) of the German Trauma Society (DGU).
Academic Editor: Andrea Mingoli
Medicina 2021, 57(6), 517; https://doi.org/10.3390/medicina57060517
Received: 9 April 2021 / Revised: 12 May 2021 / Accepted: 19 May 2021 / Published: 21 May 2021
(This article belongs to the Special Issue Hip and Fragility Fracture Management)
Background and Objectives: Appropriate timing of surgery for periprosthetic femoral fractures (PFFs) in geriatric patients remains unclear. Data from a large international geriatric trauma register were analyzed to examine the outcome of patients with PFF with respect to the timing of surgical stabilization. Materials and Methods: The Registry for Geriatric Trauma of the German Trauma Society (Deutsche Gesellschaft für Unfallchirurgie (DGU)) (ATR-DGU) was analyzed. Patients treated surgically for PFF were included in this analysis. As outcome parameters, in-house mortality rate and mortality at the 120-day follow-up as well as mobility, the EQ5D index score and reoperation rate were analyzed in relation to early (<48 h) or delayed (≥48 h) surgical stabilization. Results: A total of 1178 datasets met the inclusion criteria; 665 fractures were treated with osteosynthesis (56.4%), and 513 fractures were treated by implant change (43.5%). In contrast to the osteosynthesis group, the group with implant changes underwent delayed surgical treatment more often. Multivariate logistic regression analysis of mortality rate (p = 0.310), walking ability (p = 0.239) and EQ5D index after seven days (p = 0.812) revealed no significant differences between early (<48 h) and delayed (≥48 h) surgical stabilization. These items remained insignificant at the follow-up as well. However, the odds of requiring a reoperation within 120 days were significantly higher for delayed surgical treatment (OR: 1.86; p = 0.003). Conclusions: Early surgical treatment did not lead to decreased mortality rates in the acute phase or in the midterm. Except for the rate of reoperation, all other outcome parameters remained unaffected. Nevertheless, for most patients, early surgical treatment should be the goal, so as to achieve early mobilization and avoid secondary nonsurgical complications. If early stabilization is not possible, it can be assumed that orthogeriatric co-management will help protect these patients from further harm. View Full-Text
Keywords: periprosthetic femoral fracture; time to surgery; mortality; outcome; AltersTraumaRegister DGU® periprosthetic femoral fracture; time to surgery; mortality; outcome; AltersTraumaRegister DGU®
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MDPI and ACS Style

Bliemel, C.; Rascher, K.; Knauf, T.; Hack, J.; Eschbach, D.A.; Aigner, R.; Oberkircher, L.; on behalf of the AltersTraumaRegister DGU. Early Surgery Does Not Improve Outcomes for Patients with Periprosthetic Femoral Fractures—Results from the Registry for Geriatric Trauma of the German Trauma Society. Medicina 2021, 57, 517. https://doi.org/10.3390/medicina57060517

AMA Style

Bliemel C, Rascher K, Knauf T, Hack J, Eschbach DA, Aigner R, Oberkircher L, on behalf of the AltersTraumaRegister DGU. Early Surgery Does Not Improve Outcomes for Patients with Periprosthetic Femoral Fractures—Results from the Registry for Geriatric Trauma of the German Trauma Society. Medicina. 2021; 57(6):517. https://doi.org/10.3390/medicina57060517

Chicago/Turabian Style

Bliemel, Christopher, Katherine Rascher, Tom Knauf, Juliana Hack, Daphne A. Eschbach, Rene Aigner, Ludwig Oberkircher, and on behalf of the AltersTraumaRegister DGU. 2021. "Early Surgery Does Not Improve Outcomes for Patients with Periprosthetic Femoral Fractures—Results from the Registry for Geriatric Trauma of the German Trauma Society" Medicina 57, no. 6: 517. https://doi.org/10.3390/medicina57060517

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