Search Results (18)

Background: Hip fractures represent a major public health challenge in aging populations and are associated with high morbidity, mortality, and healthcare costs. While osteoporosis is the main underlying cause, biochemical markers of bone metabolism may provide additional insight into skeletal remodeling processes. However, the relationship between bone turnover biomarkers and specific hip fracture patterns remains poorly understood. Methods: A retrospective observational study was conducted, including patients admitted with hip fractures between January 2022 and December 2023 at our institution. Serum levels of vitamin D, parathyroid hormone (PTH), N-terminal propeptide of type I collagen (PINP), and beta-C-terminal telopeptide of type I collagen (β-CTX) were analyzed. Fractures were classified as intracapsular or extracapsular. Continuous variables were compared using the Mann–Whitney U test. Multivariable logistic regression analysis was performed to identify factors independently associated with extracapsular fractures. Results: A total of 131 patients were included, comprising 57 intracapsular fractures and 74 extracapsular fractures. Patients with extracapsular fractures were significantly older (83 (75–89) vs. 80 (71–86) years; p = 0.0079). No significant differences were observed in vitamin D levels between fracture groups (p = 0.446). PTH levels were higher in extracapsular fractures (p = 0.030), while β-CTX levels tended to be lower (p = 0.080). In multivariable logistic regression analysis, age remained independently associated with extracapsular fracture pattern (OR 1.05, 95% CI 1.01–1.09; p = 0.03). Higher β-CTX levels were inversely associated with extracapsular fractures (OR 0.65, 95% CI 0.43–0.96; p = 0.03), whereas vitamin D levels were not independently associated with fracture type. Conclusions: Extracapsular hip fractures were primarily associated with older age in this cohort. Among bone metabolism biomarkers, β-CTX showed an inverse association with extracapsular fracture pattern after adjustment for confounding factors. These findings should be interpreted with caution and considered exploratory, highlighting the need for prospective studies to clarify their clinical significance. Full article

Background and Objectives: Regional anesthesia is one of the critical alternatives for managing severe pain in patients with hip fractures. Femoral nerve block (FNB) is a common technique, and pericapsular nerve group block (PENG) has emerged as a promising alternative. However, the comparative efficacy of these techniques in extracapsular hip fractures, which have a distinct innervation pattern from intracapsular fractures, is not well established. Thus, we compared the analgesic efficacy of ultrasound-guided FNB and PENG blocks in emergency department (ED) patients with extracapsular hip fractures. Methods: This single-center, retrospective observational study was conducted from 1 January 2020 to 31 July 2021. We included adult patients presenting to the ED with an acute, isolated extracapsular hip fracture who received FNB or PENG. The primary outcome was pain reduction, analyzed by pain trajectory analysis according to the pain intensity difference (PID) at multiple time points (0, 15, 30, 60, and 120 min) and a time-to-event analysis for meaningful pain relief (PID ≥ 4). Secondary outcomes included rescue morphine consumption, ED length of stay (LOS), and hospital LOS. Results: Thirty-nine patients were included (21 FNB; 18 PENG). The FNB group demonstrated a significantly greater reduction in pain scores over time than the PENG group (likelihood ratio test p < 0.001). In the time-to-event analysis, median time to meaningful pain relief was 1 min in the FNB group versus 114 min in the PENG group. Cox proportional hazards modeling demonstrated that the FNB group achieved meaningful pain relief 2.40 times faster than the PENG group (HR = 2.40, 95% CI = 1.06–5.44, p = 0.03). There were no significant differences between the groups in rescue morphine use, ED LOS, or hospital LOS after multivariable adjustment. Conclusions: In this retrospective observational study of patients with extracapsular hip fractures, FNB was associated with more rapid and effective pain relief than PENG. These findings suggest that FNB may be considered a favorable regional analgesic technique for these patients, though prospective randomized trials are needed to establish definitive treatment recommendations. Full article

Frailty has emerged as a critical determinant of clinical outcomes in elderly patients, shaping postoperative recovery in crucial orthopedic events, such as hip fractures. The purpose of the present study is to examine the impact of frailty syndrome on muscle strength and joint range of motion in the non-fractured lower extremity and upper extremities of hospitalized older adults following hip fracture surgery. The sample consisted of 60 elderly patients recovering from either intracapsular or extracapsular hip fractures. Participants were categorized into either a frail or non-frail group, determined by the Clinical Frailty Scale. The outcome measures of muscle strength and range of motion of the upper and lower extremities were assessed by valid instruments, including a hand-held dynamometer, the Medical Research Council scale, and a digital goniometer. Statistical comparisons between groups were conducted using the independent samples t-test and the Mann–Whitney U test. The results showed that the non-frail group demonstrated greater active range of motion in the shoulder bilaterally (right: t = −2.85, left: U = 628.00, p < 0.05), elbow flexion bilaterally (right: U = 589.50, left: U = 592.50, p < 0.05), hip flexion (U = 679.50, p < 0.01), knee extension (t = −3.07, p < 0.05), and ankle dorsiflexion (t = −2.36, p < 0.05). Regarding the muscle strength, the non-frail group showed significantly higher grip strength bilaterally (right: U = 754.50, left: U = 713.50, p < 0.001), as well as greater strength in hip flexion (U = 641.00, p < 0.01) and ankle dorsiflexion (U = 619.50, p < 0.01). Frailty may negatively influence the muscle strength and joint mobility in non-fractured extremities, thereby hindering postoperative physical recovery in older adults with hip fractures. Further research involving a larger and more homogeneous sample may predict falls in elderly patients after hip or knee surgery using the Clinical Frailty Scale. Full article

Background: Femoral neck fractures (FNFs) in the ageing population carry high risks of postoperative dislocation, with traditional total hip arthroplasty (THA) reporting rates up to 10%. Dual mobility THA (DM-THA) may provide enhanced stability, but evidence for third-generation implants like the Zimmer Biomet G7^® system remains limited. Methods: This retrospective cohort study evaluated 120 patients (mean age 71.6 years; 74% female) with acute displaced intracapsular FNF treated with DM-THA (2021–2023) using the G7^® system. Demographics, surgical details (cemented/uncemented stems), complications, and functional outcomes (Oxford Hip Score (OHS) at one year) were analysed against national benchmarks. Results: Zero dislocations and two peri-prosthetic fracture (0.8%, cemented stem) occurred. Thirty-day mortality was 0.8% (below national averages). Functional recovery was excellent (mean OHS: 41/48; 69% scoring ≥40). Surgical complications were minimal (one deep infection 0.8%). Medical complications (anaemia 6.6%, venous thromboembolism 4.2%) were significantly higher in high ASA groups (III-IV). Radiographs confirmed stable implants without loosening. Conclusions: The G7^® DM-THA system demonstrates exceptional stability and safety in FNF patients, with no dislocation risk and low peri-prosthetic fracture rates—even with cemented stems. These outcomes support its use in high-risk populations, though comparative studies with conventional THA are needed. Full article

Background: Hip fractures in geriatric patients represent a major public health burden, with a clinically important subset presenting with concomitant upper extremity (UE) fractures. The independent impact of these dual injuries on clinical outcomes remains incompletely characterized. Methods: A retrospective study of patients aged ≥65 years who underwent surgical treatment for hip fracture at tertiary medical center, between January 2010 and January 2024. Patients were stratified based on the presence of a UE fracture sustained at the same time as the hip fracture. Multivariable regression models were used to assess outcomes, adjusting for age, sex, hip fracture type, and comorbidity burden. Primary outcomes were hospital length of stay and mortality at 30 days and 1 year. Secondary outcomes included readmission rates, revision surgery, and infection complications. Results: Of 7488 patients, 251 (3.4%) had concomitant upper extremity (UE) fractures. These patients had a longer mean hospital stay compared with isolated hip fractures (20.2 vs. 17.5 days, p = 0.047), with no significant difference in 30-day mortality (p = 0.439) and a trend toward lower 1-year mortality (p = 0.058). In the concomitant UE fracture group, operative treatment was associated with longer hospitalization (26.2 vs. 19.2 days, p = 0.05) and higher revision surgery rates (14.0% vs. 3.1%, p = 0.01). Subgroup analyses by fracture type showed similar trends, with longer hospital stays observed in intracapsular fractures with concomitant injury (p = 0.05). Subgroup analysis by UE fracture location showed significantly longer stays for distal radius fractures compared with isolated hip fractures, whereas no significant differences were observed for proximal humerus or other UE fracture locations. Conclusions: Concomitant UE fractures in geriatric hip fracture patients are associated with prolonged hospitalization. Operative management of UE fractures results in longer hospital stays and an increased risk of revision surgery. These findings highlight the importance of tailored perioperative planning and resource allocation for this vulnerable patient group. Full article

Background: Malnutrition is highly prevalent among older patients with hip fractures and significantly impacts recovery and survival. This narrative review synthesizes current evidence on the prevalence, pathophysiology, and clinical consequences of malnutrition in hip fracture patients, along with diagnostic tools and nutritional interventions. Methods: A literature search of studies from 2000 to 2025 identified consistent associations between malnutrition—defined using tools such as the Mini Nutritional Assessment (MNA), Geriatric Nutritional Risk Index (GNRI), and serum albumin levels—and increased risks of postoperative complications, prolonged hospital stays, functional decline, and mortality. Pathophysiological mechanisms include sarcopenia, systemic inflammation, and impaired bone metabolism. Results: Notably, malnutrition is associated with fracture type, with low lean body mass and poor nutritional status correlating with intracapsular femoral neck fractures. Conclusions: Interventional studies demonstrate that oral nutritional supplementation (ONS) reduces complications and improves biochemical parameters but shows mixed effects on long-term mortality and function. The findings support routine nutritional screening and early intervention in older hip fracture patients to improve outcomes and reduce the healthcare burden. Full article

Background: Hip fractures represent a major clinical challenge, particularly in elderly and frail patients, where postoperative pain control must balance effective analgesia with motor preservation to facilitate early mobilization. Various regional anesthesia techniques are used in this setting, including the pericapsular nerve group (PENG) block, fascia iliaca compartment block (FICB), femoral nerve block (FNB), and quadratus lumborum block (QLB), yet optimal strategies remain debated. Objectives: To systematically review the efficacy, safety, and clinical applicability of major regional anesthesia techniques for pain management in hip fractures, including considerations of fracture type, surgical approach, and functional outcomes. Methods: A systematic literature search was conducted following PRISMA 2020 guidelines in PubMed, Scopus, Web of Science, and the virtual library of the Hospital Central de la Defensa “Gómez Ulla” up to March 2025. Inclusion criteria were RCTs, systematic reviews, and meta-analyses evaluating regional anesthesia for hip surgery in adults. Risk of bias in RCTs was assessed using RoB 2.0, and certainty of evidence was evaluated using the GRADE approach. Results: Twenty-nine studies were included, comprising RCTs, systematic reviews, and meta-analyses. PENG block demonstrated superior motor preservation and reduced opioid consumption compared to FICB and FNB, particularly in intracapsular fractures and anterior surgical approaches. FICB and combination strategies (PENG+LFCN or sciatic block) may provide broader analgesic coverage in extracapsular fractures or posterior approaches. The overall risk of bias across RCTs was predominantly low, and certainty of evidence ranged from moderate to high for key outcomes. No significant safety concerns were identified across techniques, although reporting of adverse events was inconsistent. Conclusions: PENG block appears to offer a favorable balance of analgesia and motor preservation in hip fracture surgery, particularly for intracapsular fractures. For extracapsular fractures or posterior approaches, combination strategies may enhance analgesic coverage. Selection of block technique should be tailored to fracture type, surgical approach, and patient-specific functional goals. Full article

Neck of femur (NOF) fractures are a critical orthopaedic emergency with a high morbidity and mortality prevalence, particularly in people living with Human Immunodeficiency Virus (PLWHIV). A combination of HIV infection, combined antiretroviral therapy (cART), and compromised bone health further increases the risk of fragility fractures. Additionally, HIV-related immune dysfunction, cART-induced osteoporosis, and perioperative infection risks further pose challenges in ongoing surgical management. Despite the rising global prevalence of PLWHIV, no specific guidelines exist for the perioperative and post-operative care of PLWHIV undergoing NOF fracture surgery. This narrative review synthesises the current literature on the surgical management of NOF fractures in PLWHIV, focusing on pre-operative considerations, intraoperative strategies, post-operative complications, and long-term outcomes. It also explores infection control, fracture healing dynamics, and ART’s impact on surgical outcomes while identifying key research gaps. A systematic database search (PubMed, Embase, Cochrane Library) identified relevant studies published up to February 2025. Inclusion criteria encompassed studies on incidence, risk factors, ART impact, and NOF fracture outcomes in PLWHIV. Data were analysed to summarise findings and highlight knowledge gaps. Pre-operative care: Optimisation involves assessing immune status (namely, CD4 counts and HIV-1 viral loads), bone health, and cART to minimise surgical risk. Immunodeficiency increases surgical site and periprosthetic infection risks, necessitating potential enhanced antibiotic prophylaxis and close monitoring of potential start/switch/stopping of such therapies. Surgical management of neck of femur (NOF) fractures in PLWHIV should be individualised based on fracture type (intracapsular or extracapsular), age, immune status, bone quality, and functional status. Extracapsular fractures are generally managed with internal fixation using dynamic hip screws or intramedullary nails. For intracapsular fractures, internal fixation may be appropriate for younger patients with good bone quality, though there is an increased risk of non-union in this group. Hemiarthroplasty is typically favoured in older or frailer individuals, offering reduced surgical stress and lower operative time. Total hip arthroplasty (THA) is considered for active patients or those with pre-existing hip joint disease but carries a higher infection risk in immunocompromised individuals. Multidisciplinary evaluation is critical in guiding the most suitable surgical approach for PLWHIV. Importantly, post-operative care carries the risk of higher infection rates, requiring prolonged antibiotic use and wound surveillance. Antiretroviral therapy (ART) contributes to bone demineralisation and chronic inflammation, increasing delayed union healing and non-union risk. HIV-related frailty, neurocognitive impairment, and socioeconomic barriers hinder rehabilitation, affecting recovery. The management of NOF fractures in PLWHIV requires a multidisciplinary, patient-centred approach ideally comprising a team of Orthopaedic surgeon, HIV Physician, Orthogeriatric care, Physiotherapy, Occupational Health, Dietitian, Pharmacist, Psychologist, and related Social Care. Optimising cART, tailoring surgical strategies, and enforcing strict infection control can improve outcomes. Further high-quality studies and randomised controlled trials (RCTs) are essential to develop evidence-based guidelines. Full article

Introduction: Femoral neck fractures pose significant health risks, particularly in the elderly population, leading to mortality, morbidity, and decreased quality of life. Surgery is the preferred treatment to restore function and alleviate pain, with options including total hip arthroplasty (THA) and hemiarthroplasty (HA). However, clinical guidelines for selecting surgical procedures remain heterogeneous, prompting the need for further investigation into treatment trends and influencing factors. Methods: Data from the NIS database spanning 2016–2019 were analyzed, focusing on patients diagnosed with intracapsular femoral neck fractures and undergoing THA or HA as primary in-hospital surgeries. Advanced statistical analyses using SPSS and MATLAB were conducted to identify trends and factors influencing surgical choices. Results: Comorbidity profiles varied significantly between HA and THA patients, with specific conditions such as Alzheimer’s disease showing higher prevalence in HA patients. Demographic differences included a higher proportion of females and Medicare-insured individuals in the HA group. Racial disparities were observed, with differences in surgical preferences among various ethnic groups. THA adoption gradually increased over the study period, indicating a shift in surgical priorities. Additionally, THA patients tended to be younger on average compared with HA patients. Conclusions: This study highlights evolving trends in surgical management for femoral neck fractures and identifies factors influencing treatment decisions in our cohort. Understanding these trends and disparities is crucial for optimizing patient care and informing future clinical guidelines. Further research should focus on assessing different surgical approaches’ long-term outcomes and cost-effectiveness. Full article

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

Introduction: Hip fractures are common injuries in the elderly and are usually treated with timely surgery. While severe postoperative complications are reported for up to 10% of patients, many studies identified predictive factors for the occurrence of complications postoperatively. A controversially discussed factor is “time-to-surgery”. The aim of the study was to examine if time-to-surgery was associated with the occurrence of complications and if the complication rate differed between the patient individual fracture types of intracapsular on the one hand and extracapsular hip fractures on the other hand. We hypothesized that time-to-surgery had less impact on complications in intracapsular hip fractures compared to extracapsular ones, and therefore, guidelines should pay attention to the patient individual case scenario. Materials and Methods: All patients who were admitted to the Department of Trauma and Orthopaedic Surgery of an academic teaching hospital for hip fracture surgery (n = 650) over a five-year period were included in the study. After the application of the exclusion criteria, such as periprosthetic or pathologic fractures, cases needed immediate surgical treatment, and after outlier adjustment, 629 cases remained in the study. Hip fractures were classified into intracapsular fractures (treated by hip arthroplasty) and extracapsular fractures (treated by intramedullary nailing osteosynthesis). The occurrence of severe complications in patients treated within 24 h was compared with patients treated later than 24 h after injury. For statistical evaluation, a multivariate logistic regression analysis was performed to investigate the impact of time-to-surgery interval on the occurrence of complications. Results: Patients with an extracapsular fracture, which was treated with intramedullary nailing (44.5%), rarely suffered a serious complication when surgery was performed within 24 h after injury. However, when the interval of the time-to-surgery was longer than 24 h, the complication rate increased significantly (8.63% vs. 25.0%, p = 0.002). In contrast to this finding in patients with intracapsular fractures (55.5%), which were treated with cemented arthroplasty, complication rates did not depend on the 24 h interval (26.17% vs. 20.83%, p = 0.567). Conclusions: The occurrence of complications after surgical treatment of hip fractures is associated with the time interval between injury and surgery. A 24 h time interval between injury and surgical procedure seems to play a major role only in extracapsular fractures treated with osteosynthesis but not in intracapsular fractures treated with arthroplasty. Therefore, guidelines should take notice of the patient individual case scenario and, in particular, the individual hip fracture type. Full article

The treatment for hip fractures consists of a wide variety of orthopedic implants ranging from prosthesis to intramedullary nails. The purpose of this study is to determine the correlation between blood-count-derived biomarkers such as the neutrophil-to-lymphocyte ratio (NLR), the platelet-to-lymphocyte ratio (PLR), the monocyte-to-lymphocyte ratio (MLR) and the systemic immune-inflammation index (SII) and the level of aggression sustained by elderly patients during these surgical procedures. A total of 129 patients aged over 70 and diagnosed with acute hip fractures who underwent surgical treatment between November 2021 and February 2023 were included in our observational retrospective cohort study. Two groups were formed depending on the anatomic location of the fracture for statistical comparison: group 1 with extracapsular fractures, who received a closed reduction internal fixation (CRIF) with a gamma nail (GN) as treatment, and group 2 with intracapsular fractures, who received a bipolar hemiarthroplasty (BHA) as treatment. The length of hospital stay (LHS), duration of surgery, preoperative days, pre- and postoperative red blood count (RBC) and hemoglobin (HGB) levels and postoperative NLR, PLR and SII were significantly different between the two groups (p < 0.05). Furthermore, the multivariate analysis indicated that the postoperative NLR (p = 0.029), PLR (p = 0.009), SII (p = 0.001) and duration of surgery (p < 0.0001) were independently related to the invasiveness of the procedures. The ROC curve analysis demonstrated that a postoperative SII > 1564.74 is a more reliable predictor of surgical trauma in terms of specificity (58.1%) and sensitivity (56.7%). Postoperative SII as a biomarker appears to be closely correlated with surgical trauma sustained by an older population with hip fractures. Full article

Femoral nails are used to provide fixation for fractured long bones. These constructs simultaneously provide stability and union in nearly 10% of cases of premature failure. The goal of this investigation was to develop and test different models of the femur using cephalomedullary nail fixation. These models represent three different types of hip fractures (intracapsular, intertrochanteric, and subtrochanteric fractures). By testing the different fracture types, one can determine the fracture tolerance of the constructs from the resulting forces that occur due to the activities of daily living. Understanding the effects that the loads will have on the integrity of the nail-bone construct may help reduce the risks that could arise through its use. The computational simulations performed indicate that an undamaged femur can withstand the forces of 4.4× the body weight of the average adult male. A subtrochanteric femur fracture, however, can only withstand over 2.3× the same weight, nearly 50% lower than the normal femur. Regarding this lower amount, it is not impossible that an overloading scenario could occur. The data from the gait cycle show that, with a subtrochanteric fracture, the nail experiences stress that is just within the fatigue limit of the material. Given the collected data, subtrochanteric fractures are the most likely candidates for causing failures when comparing fracture types. In general, understanding the effects that different loads have on the integrity of the nail-bone construct may help reduce the risks that could arise through its use. Full article

Anteroposterior (AP) alignment assessment for nondisplaced femoral neck fractures is important for determining the treatment strategy and predicting postoperative outcomes. AP alignment is generally measured using the Garden alignment index (GAI). However, its reliability remains unknown. We compared the reliability of GAI and a new AP alignment measurement (valgus tilt measurement [VTM]) using preoperative AP radiographs of nondisplaced femoral neck fractures. The study was designed as an intra- and inter-rater reliability analysis. The raters were four trauma surgeons who assessed 50 images twice. The main outcome was the intraclass correlation coefficient (ICC). To calculate intra- and inter-rater reliability, we used a mixed-effects model considering rater, patient, and time. The overall ICC (95% CI) of GAI and VTM for intra-rater reliability was 0.92 (0.89–0.94) and 0.86 (0.82–0.89), respectively. The overall ICC of GAI and VTM for inter-rater reliability was 0.92 (0.89–0.95), and 0.85 (0.81–0.88), respectively. The intra- and inter-rater reliability of GAI was higher in patients aged <80 years than in patients aged ≥80 years. Our results showed that GAI is a more reliable measurement method than VTM, although both are reliable. Variations in patient age should be considered in GAI measurements. Full article

Background and Objectives: Femoral neck fractures are common and constitute one of the largest healthcare burdens of the modern age. Fractures within the joint capsule (intracapsular) provide a specific surgical challenge due to the difficulty in predicting rates of bony union and whether the blood supply to the femoral head has been disrupted in a way that would lead to avascular necrosis. Most femoral neck fractures are treated surgically, aiming to maintain mobility, whilst reducing pain and complications associated with prolonged bedrest. Materials and Methods: We performed a narrative review of intracapsular hip fracture management, highlighting the latest advancements in fixation techniques, generating an evidence-based algorithm for their management. Results: Multiple different fracture configurations are encountered within the category of intracapsular hip fractures, with each pattern having different optimal surgical strategies. Additionally, these injuries typically occur in patients where further procedures due to operative complications are associated with a considerable increase in mortality, highlighting the need for choosing the correct index operation. Conclusions: Factors such as pathological causes for the fracture, pre-existing symptomatic osteoarthritis, patient’s physiological age and fracture displacement all need to be considered when choosing optimal management. Full article