Kalça ve Femur Kırıklarında Kırık Tipi ile Mortalite İlişkisi

Year 2020, Volume: 3 Issue: 3, 71 - 75, 30.09.2020

Çağrı Kokkoz , Arife Erdoğan , Funda Karbek

Abstract

Amaç: Bu çalışmaya acil servise kalça ve femur kırığı şikayeti olan hastalar dahil edildi. Hangi kırık tipinin mortalite için en yüksek riski taşıdığını araştırarak, cerrahların hastaları önceliklendirmelerine yardımcı olmaları için bir temel oluşturmayı amaçladık.

Gereç ve Yöntemler: Bu tek merkezli retrospektif bir çalışmaydı. Acil servise travmatik, izole kalça veya femur kırığı şikayeti ile başvuran 336 hasta dahil edildi. Tüm hastalar aynı cerrahi ekip tarafından 4 gün içinde ameliyat edildi. Kırıklar kırık tiplerine göre kategorize edildi. Hastalar mortalite açısından 28 gün boyunca takip edildi.
Bulgular: Çalışmaya toplam 336 hasta alındı ve 28 gün takipte 51 hasta öldü. Hastalar yaşlarına göre 18-44, 45-64 ve > 64 olarak 3 gruba ayrıldı. Kırık tipleri ile yaş grupları arasında mortalite açısından anlamlı fark yoktu. Çalışmaya alınan hastalar tek bir grup olarak değerlendirildiğinde, intertrokanterik kırık tipleri mortalite ile anlamlı olarak ilişkiliydi. (p <0.010).

Sonuç: Bu çalışmada tüm hastalardan intertrokanterik kırığı olanların mortalite oranları daha yüksek bulundu.

Keywords

kırık, mortalite, kalça, femur, acil

Association Between Type of Fracture and Mortality Rate in Hip and Femur Fractures

Abstract

Aim: This study included patients who presented to the emergency department with hip and femur fractures. By investigating which fracture type carried the highest risk for mortality, we aimed to provide a basis for surgeons to help them prioritize patients.

Material and Methods: This was a single-center retrospective study. A total of 336 patients who presented to the emergency department with traumatic, isolated hip or femur fractures were included. The same surgical team operated all patients within four days. The fractures were categorized according to the fracture types. Patients were followed up about mortality during 28 days.

Results: A total of 336 patients were included in the study, and 51 patients died in 28 days follow-up. Patients were divided into three groups according to their ages as 18-44, 45-64, and > 64. There was no significant difference between the fracture types and mortality according to age groups. When the patients included in the study were evaluated as a single group, intertrochanteric fracture types were significantly related to mortality (p<0.010).

Discussion: In this study, mortality rates were found to be higher in patients with intertrochanteric fractures among all patients.

Keywords

fracture, mortality, hip, femur, emergency

References

• Somersalo A, Paloneva J, Kautiainen H, et al. Incidence of fractures requiring inpatient care. Acta Orthop 2014; 85 (5): 525-30.
• Penrod JD, Litke A, Hawkes WG, et al. The association of race, gender, and comorbidity with mortality and function after hip fracture. J Gerontol A Biol Sci Med Sci 2008;63 (8):867-72.
• Cummings SR, Melton LJ. Epidemiology and outcomes of osteoporotic fractures. Lancet 2002; 359 (9319): 1761-7.
• Haentjens P, Magaziner J, Colon-Emeric CS, et al. Meta-analysis: Excess mortality after hip fracture among older women and men. Ann Intern Med 2010; 152 (6): 380-90.
• Vestergaard P, Rejnmark L, Mosekilde L. Loss of life years after a hip fracture. Acta Orthop 2009;80(5):525-30.
• Beloosesky Y, Grinblat J, Pirotsky A, et al. Different C-reactive protein kinetics in post-operativehip-fractured geriatric patients with and without complications. Gerontology 2004;50(4):216-22.
• Beloosesky Y, Hendel D, Weiss A, et al. Cytokinesand C-reactive protein production in hip-fracture-operated elderly patients. J Gerontol A Biol Sci Med Sci 2007;62(4):420-
• Gdalevich M, Cohen D, Yosef D, et al. Morbidity and mortality after hip fracture: the impact of operative delay. Arch Orthop Trauma Surg 2004;124(5):334-40. Epub 2004 Apr 17.
• McGuire KJ, Bernstein J, Polsky D, et al. The 2004 Marshall Urist Award: delays until surgery after hip fracture increases mortality. Clin Orthop Relat Res 2004;428:294-301.
• Weller I, Wai EK, Jaglal S, et al. The effect of hospital type and surgical delay on mortality after surgery for hip fracture. J Bone Joint Surg Br. 2005;87 (3):361-6.
• Bottle A, Aylin P. Mortality associated with delay in operation after hip fracture: observationa lstudy. BMJ. 2006;332(7547):947-51. Epub 2006 Mar 22.
• Sheehan KJ, Sobolev B, Guy P. Mortality by Timing of HipFracture Surgery: Factors and Relationships at Play.J Bone Joint Surg Am. 2017;99(20):e106.
• Kristensen PK, Thillemann TM, Johnsen SP. Is bigger always better? A nationwide study of hip fracture unit volume, 30-day mortality, quality of in-hospitalcare, and length of hospital stay. MedCare. 2014;52(12):1023-9.
• Lunn JN, Elwood PC. Anaemia and surgery. BMJ 1970;3:71–73.
• Rawstron RE. Anemia and surgery. A retrospective clinical study. Aust NZ J Surg. 1970;39:425–432.
• Reid IR, Bolland MJ, Grey A. Effect of calcium supplementation on hip fractures. Osteoporos Int. 2008;19(8):1119-23. doi: 10.1007/s00198-008-0563-9.
• Oppl B, Michitsch G, Misof B, et al. Low bone mineral density and fragility fractures in permanent vegetative state patients. J Bone Min Res. 2014;29(5):1096-100. doi: 10.1002/jbmr.2122.
• Haentjens P, Magaziner J, Col´on-Emeric CS,et al. Meta-analysis: excess mortality after hip fracture among older women and men. Ann Intern Med. 2010;152(6):380-90.
• Maheshwari K, Planchard J, You J, et al. Early Surgery Confers 1-Year Mortality Benefit in Hip-Fracture Patients. J OrthopTrauma. 2018 Mar;32(3):105-110.
• Velásquez-Sarria A, Andrade-Montoya IA, Flores-Luce A, et al. Comparison of mortality by femur fracture versus hip fracture in elderly patients in a period of fiveyears. Rev Med Inst Mex Seguro Soc. 2017;55(6):704-707.
• Streubel PN, Ricci WM, Wong A, et al. Mortality after distal femur fractures in elderly patients. Clin Orthop Relat Res. 2011;469(4):1188-96.
• Czertock G, Geiss C, Ribeyre JP, et al. Reeducation desfractures de l’extrémité supérieure du fémur. Étudechez 506 patients de 60 ans et plus. In: La fracture de l’extrémité supérieure du fémur. Paris: Masson; 1990. p. 195—7
• Gruson, KI, Aharonoff GB, Egol KA, Zuckerman J D, et al. The relationship between admission hemoglobin level and outcome after hip fracture. Journal of orthopaedic trauma. 2002;16(1), 39-44.
• Li PF, Lin ZL, Pang ZH, et al. Does serum calcium relate to different types of hip fracture? A retrospective study. Chinese Journal of Traumatology, 2016;19(5), 275-277.