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Recent Advances in Management of Hip Fracture

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Orthopedics".

Deadline for manuscript submissions: closed (15 February 2024) | Viewed by 6284

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Prof. Dr. Moshe Salai

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Guest Editor

Head of Orthopaedics, Edelson School of Medicine, Ariel University, Ariel, Israel
Interests: hip fractures; femoral fractures; arthroplasty; orthopedic surgery

Special Issue Information

Dear Colleagues,

Throughout my career, the management of hip fractures has gone through major revolution and evolution. At the beginning of my residency in orthopaedic surgery in the early 80s, we were instructed: “do not operate on patients with hip fractures over the age of 80 years old, since they are too old/weak/malfunctioning to sustain ‘complicated hip fracture surgery’”. We also knew little about DVT risks and the advantages of early surgery and rehabilitation. Thus, early mortality and morbidity rates were extremely high, over 50–70%.

This changed dramatically in the late 90s with the understanding that with comprehensive, multidisciplinary approaches utilizing modern, usually regional anaesthesis and early surgery within 24–48 hours of the fracture event, lives and quality of life could be saved. This approach has also resulted in better pain management, early ambulation and rehabilitation, and newer fracture fixation devices. Accordingly, early mortality and morbidity rates have dropped to only 10–18%.

Concomitantly, with life expectancy continuing to increase, along with higher activity levels and expectations of the elderly population, preventive measures against osteoporosis have improved.

It is the aim of this Special Issue to assemble knowledge and data that look toward the future of hip fracture treatment to improve current results. This might include, e.g., better preventive measures in housing, improved medical treatment of osteoporosis, better and less invasive fixation devices, or the addition of percutaneous injectable "cements". Knowing that approximately 20% of patients might suffer from contra lateral fracture within 2 years, we should also consider prophylactic treatment to the contra lateral hip in the same treatment setting as the broken hip using MIS devices and/or injectable "cements".

These and other issues related to the treatment of hip fractures are presented and discussed in this Special Issue.

Prof. Dr. Moshe Salai
Guest Editor

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Keywords

hip fractures
reducing mortality
preventive measures
contra lateral prophylactic surgery
orthopaedic surgery

Published Papers (7 papers)

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Research

10 pages, 1550 KiB

Open AccessArticle

Dynamic Locking Plate versus Multiple Cancellous Screws for the Fixation of Intracapsular Femoral Neck Fractures: Long-Term Results and Quality-Of-Life Assessment Based on Patient-Reported Outcome Measures

by Yoav Krupik, Sagie Haziza and Ran Thein

J. Clin. Med. 2024, 13(4), 1123; https://doi.org/10.3390/jcm13041123 - 16 Feb 2024

Viewed by 539

Abstract

The purpose of this study was to compare the long-term clinical outcomes and quality-of-life measures for two fixation methods in the setting of displaced femoral neck fractures. The two groups included fixation with multiple cancellous screws (group 1) and telescopic femoral neck screws and a small locking plate device (Targon FN) (group 2). Patients underwent reduction and internal fixation with either multiple cancellous screws or the Targon FN device from March 2000 to January 2012. Failure endpoints included nonunion, osteonecrosis of the femoral head, and revision surgery. Patient-reported outcome measures included chronic pain, ability to ambulate, and the use of ambulation assistive devices. Statistical analysis demonstrated a statistically significant lower rate of non-union and overall complication in the Targon FN group (p value < 0.001 and p value = 0.005, respectively). Logistic regression analysis showed that operative fixation with the Targon FN device decreased the odds ratio for overall complication by a factor of 0.34 (p = 0.02). There were no statistically significant differences between groups 1 and 2 in patient-reported outcomes (chronic pain (p = 0.21), ability to ambulate (p = 0.07), and the use of an ambulation assistive device (p = 0.07)). When compared to traditional cancellous screw fixation of femoral neck fractures, the Targon FN device has significantly lower complication rates and equivalent patient-reported outcomes. Full article

(This article belongs to the Special Issue Recent Advances in Management of Hip Fracture)

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8 pages, 468 KiB

Open AccessArticle

Is It Safe to Resume Direct Oral Anticoagulants upon Discharge after Hip Fracture Surgery? A Retrospective Study

by Alona Katzir, Tamar Fisher-Negev, Omer Or, Mahmoud Jammal, Ram Mosheiff and Yoram A. Weil

J. Clin. Med. 2024, 13(1), 17; https://doi.org/10.3390/jcm13010017 - 19 Dec 2023

Viewed by 742

Abstract

This study aimed to examine the incidence rate of early reoperations following hip fracture surgery and determine the safety of resuming direct oral anticoagulants. Many orthopedic surgeons are reluctant to resume chronic anticoagulation therapy for patients after surgical intervention for hip fractures. One of the main reasons is the potential for reoperation in the case of surgical complications. We conducted a retrospective cohort study at an Academic Level I trauma center, reviewing the records of 425 geriatric patients (age > 60) who underwent hip fracture surgery between 2018 and 2020, including a subgroup treated with direct oral anticoagulants prior to hospitalization. The study assessed the incidence rate of complications requiring early reoperation. Out of the 425 patients, only nine (2%) required reoperation within a month after discharge, with two (0.5%) on chronic anticoagulation therapy. None of the reoperations were urgent, and all were performed at least 24 h after re-admission. The findings revealed a very low incidence rate of reoperations in patients who underwent hip fracture surgery, with no reoperations performed within 24 h of re-admission. Consequently, we believe that resuming chronic direct oral anticoagulants is a safe and effective approach when discharging patients after hip fracture surgery. Full article

(This article belongs to the Special Issue Recent Advances in Management of Hip Fracture)

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8 pages, 798 KiB

Open AccessArticle

Computer-Assisted Intramedullary Nailing of Intertrochanteric Fractures Did Not Prevent Tip–Apex Distance Outliers

by Rasmus Holm Hansen, Jan Duedal Rölfing, Christian Lind Nielsen, Ole Brink and Per Hviid Gundtoft

J. Clin. Med. 2023, 12(23), 7448; https://doi.org/10.3390/jcm12237448 - 30 Nov 2023

Viewed by 561

Abstract

Intertrochanteric femoral fractures are commonly treated with intramedullary nails (IMNs). A tip–apex distance (TAD) of more than 20–25 mm is associated with an increased risk of cut-out. The Stryker Adaptive Positioning System (ADAPT) is a computer-assisted navigation system designed to reduce TADs. We aim to assess if the ADAPT reduces the number of outliers with a TAD > 20 mm. All patients with intertrochanteric fractures treated with an IMN between 1 September 2020 and 12 March 2022 were included. Patients were included in three periods: a pre-ADAPT period (55 patients); an ADAPT period (50 patients), where it was compulsory to use the system; and a post-ADAPT period after the discontinuation of the system (59 patients). The TADs and lag screw protrusions beyond the lateral cortex were measured. The median TADs in the three periods were 17.0 mm (8–31 mm), 15.5 mm (9–30 mm), and 18.0 mm (11–32 mm), respectively. The absolute number of outliers with a TAD > 20 mm decreased from 15/55 patients in the pre-ADAPT period to 11/50 patients during the ADAPT period. This observation was not statistically significant, but this is likely due to the lack of power of the present study to show changes of this magnitude. However, our expectation that the ADAPT would diminish outliers markedly or close to zero outliers was not met, as we observed 11/50 = 22% outliers with a TAD > 20 mm when using computer-assisted surgery, i.e., ADAPT and Gamma3 for intertrochanteric fractures. Based on these findings, the use of the ADAPT was discontinued at our level 1 trauma center. Full article

(This article belongs to the Special Issue Recent Advances in Management of Hip Fracture)

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7 pages, 219 KiB

Open AccessArticle

Direct Anterior vs. Direct Lateral Approach Total Hip Arthroplasty for Displaced Femoral Neck Fracture

by Ron Ben Elyahu, Nissim Ohana, Eltaieb Agabaria, Ahmad Biadsi, David Segal, Eyal Yaacobi, Ezequiel Palmanovich, Michael Markushevich and Yaron Shraga Brin

J. Clin. Med. 2023, 12(15), 5019; https://doi.org/10.3390/jcm12155019 - 30 Jul 2023

Viewed by 805

Abstract

Background: This study compared outcomes of the direct anterior approach (DAA) and direct lateral approach (DLA) for treating displaced femoral neck fractures in active elderly patients. Methods: This retrospective study included active elderly patients who sustained a displaced femoral neck fracture and underwent a cementless total hip arthroplasty either with a supine DAA or a decubitus DLA. Patients were assessed using the Harris hip score at discharge and at a 6-week follow-up. Results: A total of 41 women and 18 men were included in the study. Of those, 22 underwent DLA and 37 received DAA, all performed by the same team. In both groups, 69% were women, mean age was 70 years, and mean BMI was 25.2. Mean hemoglobin loss was 2.3 g/dl between admission and the first post-operative day in both groups. Similar numbers in each cohort were discharged home rather than to a rehabilitation center. The patients who underwent the DAA experienced a 2-day reduction in their hospital stay compared to the DLA group (4.2 ± 1.9 vs. 6.8 ± 3.7, respectively; p < 0.001). The Harris hip score in the DAA group was significantly higher at the 6-week follow-up than in the DLA group (87.23 ± 7.75 vs. 81.23 ± 7.67, respectively; p < 0.031). Conclusions: The patients who underwent THA with the DAA demonstrated better short term outcomes compared to the alternative approach for displaced femoral neck fractures in active elderly patients. DAA helped patients regain independence faster and might decrease hospitalization and rehabilitation costs. Based on these results, we recommend using the DAA for active elderly patients with a displaced femoral neck fracture. Full article

(This article belongs to the Special Issue Recent Advances in Management of Hip Fracture)

9 pages, 1402 KiB

Open AccessArticle

Unveiling the Economic Toll of Surgical Learning Curve in Elderly Hip Fractures

by Eyal Yaacobi, Tal Shachar, David Segal, Altaieb Agabaria, Golan Halima, Omer Marom and Nissim Ohana

J. Clin. Med. 2023, 12(15), 4880; https://doi.org/10.3390/jcm12154880 - 25 Jul 2023

Cited by 1 | Viewed by 782

Abstract

Can the financial impact of implant choice during the learning curve of inexperienced surgeons in hip fracture surgery be quantified? Hip fractures in the elderly are a significant medical concern, often requiring surgical interventions performed by orthopedic surgery residents. As healthcare costs rise, exploring cost reduction opportunities within the healthcare system becomes crucial. In this prospective analysis, we examined the financial implications of implant choices encountered by residents during their learning curve in hip fracture surgery. Our study included 278 surgically treated pertrochanteric fractures using the same locking cephalomedullary nail. Data on patients, surgeons (including their experience and seniority), and all implants charged by the hospital were collected. This encompassed documentation of any nail-related equipment that was opened on the operating table and whether it was subsequently used by the end of the procedure. By calculating the number and cost of these implants, we assessed the financial burden associated with suboptimal choices made during the learning curve. Our findings revealed that in 16.18% of surgeries, instances of suboptimal implant utilization occurred, highlighting the complexities of the learning process. Importantly, the rate of these challenges was not influenced by surgeon seniority or patient characteristics. The mean additional cost per surgery was determined to be USD 65.69 ± 157.63 for surgeries with suboptimal implant utilization, compared to USD 56.55 ± 139.13 for surgeries without such challenges. Although there was a trend towards higher implant-related costs in resident-led surgeries, the difference did not reach statistical significance. These findings underscore the feasibility of enabling residents to autonomously perform intramedullary nailing surgeries, even without specialist supervision, while incurring minimal additional expenses during the learning curve. By acknowledging the financial implications associated with the learning curve in the management of hip fractures, we can strive to optimize healthcare costs, thus addressing an important aspect of this issue. Full article

(This article belongs to the Special Issue Recent Advances in Management of Hip Fracture)

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12 pages, 1698 KiB

Open AccessArticle

Endovis Nail versus Dynamic Hip Screw for Unstable Pertrochanteric Fractures: A Feasibility Randomised Control Trial including Patients with Cognitive Impairment

by George Kleftouris, Theodoros H. Tosounidis, Michalis Panteli, Martin Gathen and Peter V. Giannoudis

J. Clin. Med. 2023, 12(13), 4237; https://doi.org/10.3390/jcm12134237 - 23 Jun 2023

Cited by 1 | Viewed by 910

Abstract

A prospective, feasibility, randomised study was performed to compare intramedullary versus extramedullary fixation of unstable pertrochanteric fractures and to assess the feasibility of including patients with dementia. From July 2016 to November 2017, 60 consecutive patients with an unstable pertrochanteric (OTA/AO 31-A2) fracture were randomized to either receive a short cephalomedullary nail (Endovis EBA², Citieffe) or a dynamic hip screw (DHS, Zimmer Biomet). Primary feasibility measures included randomisation, recruitment, and retention rates. Secondary outcomes included peri-operative parameters, patient-reported outcomes and radiographic outcomes. Patients were followed-up at two, four, and twelve weeks. There was no difference in the randomisation rate between patients with and without cognitive impairment. Significantly more patients without cognitive impairment attended the 12-week follow-up. The overall recruitment rate was 0.9 patients per week. Patients treated with the nail had less pain at 2 weeks and less neck collapse, medialisation, and leg shortening at all time points. The rest of secondary outcomes were similar. Patients with dementia can successfully be enrolled in a randomised trial on hip fractures. Patients treated with the Endovis nail had lower levels of pain at two weeks and better radiographic outcomes. Full article

(This article belongs to the Special Issue Recent Advances in Management of Hip Fracture)

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10 pages, 932 KiB

Open AccessArticle

The Effect of Hematocrit on All-Cause Mortality in Geriatric Patients with Hip Fractures: A Prospective Cohort Study

by Yu-Min Zhang, Kun Li, Wen-Wen Cao, Shao-Hua Chen and Bin-Fei Zhang

J. Clin. Med. 2023, 12(5), 2010; https://doi.org/10.3390/jcm12052010 - 3 Mar 2023

Cited by 2 | Viewed by 1332

Abstract

Objective: The present study aimed to evaluate the association between hematocrit (HCT) levels and all-cause mortality in geriatric hip fractures. Methods: Older adult patients with hip fractures were screened between January 2015 and September 2019. The demographic and clinical characteristics of these patients were collected. Linear and nonlinear multivariate Cox regression models were used to identify the association between HCT levels and mortality. Analyses were performed using EmpowerStats and the R software. Results: A total of 2589 patients were included in this study. The mean follow-up period was 38.94 months. Eight hundred and seventy-five (33.8%) patients died due to all-cause mortality. Linear multivariate Cox regression models showed that HCT level was associated with mortality (hazard ratio [HR] = 0.97, 95% confidence interval [CI]: 0.96–0.99, p = 0.0002) after adjusting for confounding factors. However, the linear association was unstable and nonlinearity was identified. A HCT level of 28% was the inflection point for prediction. A HCT level of <28% was associated with mortality (HR = 0.91, 95% CI: 0.87–0.95, p < 0.0001), whereas a HCT level > 28% was not a risk factor for mortality (HR = 0.99, 95% CI: 0.97–1.01, p = 0.3792). We found that the nonlinear association was very stable in the propensity score-matching sensitivity analysis. Conclusions: The HCT level was nonlinearly associated with mortality in geriatric hip fracture patients and could be considered a predictor of mortality in these patients. Registration: ChiCTR2200057323. Full article

(This article belongs to the Special Issue Recent Advances in Management of Hip Fracture)

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