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Geriatrik Femur İntertrokanterik Kırıklarda Üç Farklı Fiksasyon Metodunun Erken Mortalite Oranlarının Karşılaştırılması

Year 2022, Volume: 24 Issue: 2, 280 - 288, 31.08.2022
https://doi.org/10.24938/kutfd.1039014

Abstract

Amaç: İleri yaştaki femur intertrokanterik kırıkların tedavisinde çeşitli seçenekler mevcuttur. Mevcut çalışma intrameduller çivi, sementli ve sementsiz hemiartroplasti (HA) seçeneklerinin postoperatif ilk 30 gündeki mortalite oranlarını karşılaştırmayı amaçlamaktadır. Ayrıca bu periyotta mortaliteyi etkileyen faktörlerin incelenmesi amaçlanmıştır.
Gereç ve Yöntemler: İntertrokanterik femur kırığı için 2012-2020 arasında intrameduller çivi (Grup 1), sementli HA (Grup 2) ve sementsiz HA (grup 3) uygulanan hastalar çalışmaya dahil edildi. Demografik verilerle birlikte ameliyat öncesi ve ameliyat sırasındaki değişkenler analiz edilerek üç grup arasında karşılaştırıldı. İlk 24 saat, 7 gün ve 30 gün içerisindeki mortalite oranları her üç grup arasında karşılaştırıldı. Ayrıca 30 günün sonunda sağ kalan hastalar ve ölen hastaların değişkenleri karşılaştırılarak mortaliteyi etkileyen faktörler incelendi.
Bulgular: Çalışmaya 526 hasta dahil edildi (194 erkek, 332 kadın; ortalama yaş: 82.71±6.92/yıl). Sementli ve ya sementsiz HA uygulanan hastalarda ilk 7 ve 30 gündeki mortalite oranı intramedüller çivi fiksasyonu yapılan hastalardan daha yüksekti (sırasıyla, p=0.022; 0.001). İlk 30 gün içerisinde kaybedilen hastaların sağkalanlara göre yaşı (p=0.00), komorbidite sayısı (p=0.015), cerrahiye kadar geçen süresi (p=0.05) ve cerrahi süresi (p=0.013) daha yüksekti.
Sonuç: Yaşlı intertrokanterik kırık hastalarında intramedullar tespit ilk seçenek olarak düşünülmelidir. Cerrahiye kadar geçen süre ve operasyon süresinin kısaltılması mortaliteyi azaltmak için önemlidir.

References

  • 1. Guzon-Illescas O, Perez Fernandez E, Crespí Villarias N, Quirós Donate FJ, Peña M, Alonso-Blas C et al. Mortality after osteoporotic hip fracture: incidence, trends, and associated factors. J Orthop Surg Res. 2019;14(1):203.
  • 2. Veronese N, Maggi S. Epidemiology and social costs of hip fracture. Injury. 2018;49(8):1458-60.
  • 3. Curtis EM, van der Velde R, Moon RJ, van den Bergh JP, Geusens P, de Vries F et al. Epidemiology of fractures in the United Kingdom 1988-2012: Variation with age, sex, geography, ethnicity and socioeconomic status. Bone. 2016;87:19-26.
  • 4. Tsang C, Boulton C, Burgon V, Johansen A, Wakeman R, Cromwell DA. Predicting 30-day mortality after hip fracture surgery: Evaluation of the National Hip Fracture Database case-mix adjustment model. Bone Joint Res. 2017;6(9):550-6.
  • 5. Jolly A, Bansal R, More AR, Pagadala MB. Comparison of complications and functional results of unstable intertrochanteric fractures of femur treated with proximal femur nails and cemented hemiarthroplasty. J Clin Orthop Trauma. 2019;10(2):296-301.
  • 6. Tang P, Hu F, Shen J, Zhang L, Zhang L. Proximal femoral nail antirotation versus hemiarthroplasty: a study for the treatment of intertrochanteric fractures. Injury. 2012;43(6):876-81.
  • 7. Sancheti Kh, Sancheti P, Shyam A, Patil S, Dhariwal Q, Joshi R. Primary hemiarthroplasty for unstable osteoporotic intertrochanteric fractures in the elderly: A retrospective case series. Indian J Orthop. 2010;44(4):428-34.
  • 8. Zhao F, Wang X, Dou Y, Wang H, Zhang Y. Analysis of risk factors for perioperative mortality in elderly patients with intertrochanteric fracture. Eur J Orthop Surg Traumatol. 2019;29(1):59-63.
  • 9. Xie Y, Dong Q, Xie Z. Proximal femoral nail anti-rotation (PFNA) and hemi-arthroplasty in the treatment of elderly intertrochanteric fractures. Acta Orthop Belg. 2019;85(2):199-204.
  • 10. Kumar P, Rajnish RK, Sharma S, Dhillon MS. Proximal femoral nailing is superior to hemiarthroplasty in AO/OTA A2 and A3 intertrochanteric femur fractures in the elderly: a systematic literature review and meta-analysis. Int Orthop. 2020;44(4):623-33.
  • 11. Gölge UH, Pazarci O, Kılınç S, Nusran G, Kaymaz B, Göksel F, Kömürcü E et al. The treatment of intertrochanteric fractures comparison of PFN and hemiarthroplasty 3-year mortality study. Acta Orthop Belg. 2016;82(3):508-15.
  • 12. Agar A, Sahin A, Gunes O, Gulabi D, Erturk C. Comparison of cementless calcar-replacement hemiarthroplasty with proximal femoral nail for the treatment of unstable intertrochanteric fractures at older age group. Cureus. 2021;13(1):e12854.
  • 13. Kim JW, Shon HC, Song SH, Lee YK, Koo KH, Ha YC. Reoperation rate, mortality and ambulatory ability after internal fixation versus hemiarthroplasty for unstable intertrochanteric fractures in elderly patients: a study on Korean Hip Fracture Registry. Arch Orthop Trauma Surg. 2020;140(11):1611-8.
  • 14. Veldman HD, Heyligers IC, Grimm B, Boymans TA. Cemented versus cementless hemiarthroplasty for a displaced fracture of the femoral neck: a systematic review and meta-analysis of current generation hip stems. Bone Joint J. 2017;99-B(4):421-31.
  • 15. Kumar P, Rajnish RK, Neradi D, Kumar V, Agarwal S, Aggarwal S. Hemiarthroplasty for neck of femur fractures: to cement or not? A systematic review of literature and meta-analysis. Eur J Orthop Surg Traumatol. 2019;29(4):731-46.
  • 16. Donaldson AJ, Thomson HE, Harper NJ, Kenny NW. Bone cement implantation syndrome. Br J Anaesth. 2009;102(1):12-22.
  • 17. Olsen F, Kotyra M, Houltz E, Ricksten SE. Bone cement implantation syndrome in cemented hemiarthroplasty for femoral neck fracture: incidence, risk factors, and effect on outcome. Br J Anaesth. 2014;113(5):800-6.
  • 18. Yoo JI, Cha YH, Kim KJ, Kim HY, Choy WS, Hwang SC. Comparison between Cementless and Cemented Bipolar Hemiarthroplasty for Treatment of Unstable Intertrochanteric Fractures: Systematic Review and Meta-analysis. Hip Pelvis. 2018;30(4):241-53.
  • 19. Tan KG, Whitehouse SL, Crawford RW. On-table and short-term mortality: a single-institution experience with cementing all hip arthroplasties for neck of femur fractures. J Arthroplasty. 2020;35(4):1095-100.
  • 20. Chen DX, Yang L, Ding L, Li SY, Qi YN, Li Q. Perioperative outcomes in geriatric patients undergoing hip fracture surgery with different anesthesia techniques: A systematic review and meta-analysis. Medicine (Baltimore). 2019;98(49):e18220.
  • 21. Desai V, Chan PH, Prentice HA, Zohman GL, Diekmann GR, Maletis GB et al. Is anesthesia technique associated with a higher risk of mortality or complications within 90 days of surgery for geriatric patients with hip fractures? Clin Orthop Relat Res. 2018;476(6):1178-88.
  • 22. O'Donnell CM, McLoughlin L, Patterson CC, Clarke M, McCourt KC, McBrien ME et al. Perioperative outcomes in the context of mode of anaesthesia for patients undergoing hip fracture surgery: systematic review and meta-analysis. Br J Anaesth. 2018;120(1):37-50.
  • 23. Nkanang B, Parker M, Parker E, Griffiths R. Perioperative mortality for patients with a hip fracture. Injury. 2017;48(10):2180-3.
  • 24. Karakus O, Ozdemir G, Karaca S, Cetin M, Saygi B. The relationship between the type of unstable intertrochanteric femur fracture and mobility in the elderly. J Orthop Surg Res. 2018;13(1):207.
  • 25. Pfeufer D, Zeller A, Mehaffey S, Böcker W, Kammerlander C, Neuerburg C. Weight-bearing restrictions reduce postoperative mobility in elderly hip fracture patients. Arch Orthop Trauma Surg. 2019;139(9):1253-9.
  • 26. Sasabuchi Y, Matsui H, Lefor AK, Fushimi K, Yasunaga H. Timing of surgery for hip fractures in the elderly: A retrospective cohort study. Injury. 2018;49(10):1848-54.
  • 27. Belmont PJ Jr, Garcia EJ, Romano D, Bader JO, Nelson KJ, Schoenfeld AJ. Risk factors for complications and in-hospital mortality following hip fractures: a study using the National Trauma Data Bank. Arch Orthop Trauma Surg. 2014;134(5):597-604.
  • 28. Malafarina V, Reginster JY, Cabrerizo S, Bruyère O, Kanis JA, Martinez JA et al. Nutritional status and nutritional treatment are related to outcomes and mortality in older adults with hip fracture. Nutrients. 2018;10(5):555.
  • 29. Li S, Zhang J, Zheng H, Wang X, Liu Z, Sun T. Prognostic role of serum albumin, total lymphocyte count, and mini nutritional assessment on outcomes after geriatric hip fracture surgery: a meta-analysis and systematic review. J Arthroplasty. 2019;34(6):1287-96.
  • 30. Bohl DD, Shen MR, Hannon CP, Fillingham YA, Darrith B, Della Valle CJ. Serum albumin predicts survival and postoperative course following surgery for geriatric hip fracture. J Bone Joint Surg Am. 2017;99(24):2110-8.

EARLY POSTOPERATIVE MORTALITY RATES IN ELDERLY PATIENTS WITH INTERTROCHANTERIC FEMORAL FRACTURE: COMPARISON OF THREE FIXATION METHODS

Year 2022, Volume: 24 Issue: 2, 280 - 288, 31.08.2022
https://doi.org/10.24938/kutfd.1039014

Abstract

Objective: Several surgical options are available for the treatment of elderly intertrochanteric femoral fractures (IFF). This study aimed to compare the mortality rates in the first postoperative month between the intramedullary nail fixation (INF), cemented and cementless hemiarthroplasty (HA). Also, we aimed to analyze the factors that affect the mortality rates within the first postoperative month.
Material and Methods: Elderly patients who underwent INF (Group 1), cemented HA (Group 2), and cementless HA (Group 3) for IFF between 2012 and 2020 were selected for the study. Demographic data, pre, and perioperative variables were compared between the three treatment groups. The mortality rates in the first 24 h, 7 days, and 30 days were also compared as well. The patients were divided into survival and non-survival groups according to the outcome in the first postoperative month and factors affecting mortality rates were evaluated.
Results: A total of 526 patients were included in the study (194 men and 332 women; mean age, 82.71±6.92 years). The patients who received cemented or cementless HA had higher mortality rates on the first 7 days and 30 days after the operation than those treated with INF (p=0.022; 0.001, respectively). The patients who died within 30 days postoperatively were older (p=0.00) and had more comorbidities (p =0.015) and longer intervals from trauma to surgery (p=0.05) and operation times (p=0.013) than those who survived in the first postoperative month.
Conclusion: Intramedullary fixation should be the first option in elderly IFFs. The duration between trauma and surgery and operation time should be shortened to reduce mortality.

References

  • 1. Guzon-Illescas O, Perez Fernandez E, Crespí Villarias N, Quirós Donate FJ, Peña M, Alonso-Blas C et al. Mortality after osteoporotic hip fracture: incidence, trends, and associated factors. J Orthop Surg Res. 2019;14(1):203.
  • 2. Veronese N, Maggi S. Epidemiology and social costs of hip fracture. Injury. 2018;49(8):1458-60.
  • 3. Curtis EM, van der Velde R, Moon RJ, van den Bergh JP, Geusens P, de Vries F et al. Epidemiology of fractures in the United Kingdom 1988-2012: Variation with age, sex, geography, ethnicity and socioeconomic status. Bone. 2016;87:19-26.
  • 4. Tsang C, Boulton C, Burgon V, Johansen A, Wakeman R, Cromwell DA. Predicting 30-day mortality after hip fracture surgery: Evaluation of the National Hip Fracture Database case-mix adjustment model. Bone Joint Res. 2017;6(9):550-6.
  • 5. Jolly A, Bansal R, More AR, Pagadala MB. Comparison of complications and functional results of unstable intertrochanteric fractures of femur treated with proximal femur nails and cemented hemiarthroplasty. J Clin Orthop Trauma. 2019;10(2):296-301.
  • 6. Tang P, Hu F, Shen J, Zhang L, Zhang L. Proximal femoral nail antirotation versus hemiarthroplasty: a study for the treatment of intertrochanteric fractures. Injury. 2012;43(6):876-81.
  • 7. Sancheti Kh, Sancheti P, Shyam A, Patil S, Dhariwal Q, Joshi R. Primary hemiarthroplasty for unstable osteoporotic intertrochanteric fractures in the elderly: A retrospective case series. Indian J Orthop. 2010;44(4):428-34.
  • 8. Zhao F, Wang X, Dou Y, Wang H, Zhang Y. Analysis of risk factors for perioperative mortality in elderly patients with intertrochanteric fracture. Eur J Orthop Surg Traumatol. 2019;29(1):59-63.
  • 9. Xie Y, Dong Q, Xie Z. Proximal femoral nail anti-rotation (PFNA) and hemi-arthroplasty in the treatment of elderly intertrochanteric fractures. Acta Orthop Belg. 2019;85(2):199-204.
  • 10. Kumar P, Rajnish RK, Sharma S, Dhillon MS. Proximal femoral nailing is superior to hemiarthroplasty in AO/OTA A2 and A3 intertrochanteric femur fractures in the elderly: a systematic literature review and meta-analysis. Int Orthop. 2020;44(4):623-33.
  • 11. Gölge UH, Pazarci O, Kılınç S, Nusran G, Kaymaz B, Göksel F, Kömürcü E et al. The treatment of intertrochanteric fractures comparison of PFN and hemiarthroplasty 3-year mortality study. Acta Orthop Belg. 2016;82(3):508-15.
  • 12. Agar A, Sahin A, Gunes O, Gulabi D, Erturk C. Comparison of cementless calcar-replacement hemiarthroplasty with proximal femoral nail for the treatment of unstable intertrochanteric fractures at older age group. Cureus. 2021;13(1):e12854.
  • 13. Kim JW, Shon HC, Song SH, Lee YK, Koo KH, Ha YC. Reoperation rate, mortality and ambulatory ability after internal fixation versus hemiarthroplasty for unstable intertrochanteric fractures in elderly patients: a study on Korean Hip Fracture Registry. Arch Orthop Trauma Surg. 2020;140(11):1611-8.
  • 14. Veldman HD, Heyligers IC, Grimm B, Boymans TA. Cemented versus cementless hemiarthroplasty for a displaced fracture of the femoral neck: a systematic review and meta-analysis of current generation hip stems. Bone Joint J. 2017;99-B(4):421-31.
  • 15. Kumar P, Rajnish RK, Neradi D, Kumar V, Agarwal S, Aggarwal S. Hemiarthroplasty for neck of femur fractures: to cement or not? A systematic review of literature and meta-analysis. Eur J Orthop Surg Traumatol. 2019;29(4):731-46.
  • 16. Donaldson AJ, Thomson HE, Harper NJ, Kenny NW. Bone cement implantation syndrome. Br J Anaesth. 2009;102(1):12-22.
  • 17. Olsen F, Kotyra M, Houltz E, Ricksten SE. Bone cement implantation syndrome in cemented hemiarthroplasty for femoral neck fracture: incidence, risk factors, and effect on outcome. Br J Anaesth. 2014;113(5):800-6.
  • 18. Yoo JI, Cha YH, Kim KJ, Kim HY, Choy WS, Hwang SC. Comparison between Cementless and Cemented Bipolar Hemiarthroplasty for Treatment of Unstable Intertrochanteric Fractures: Systematic Review and Meta-analysis. Hip Pelvis. 2018;30(4):241-53.
  • 19. Tan KG, Whitehouse SL, Crawford RW. On-table and short-term mortality: a single-institution experience with cementing all hip arthroplasties for neck of femur fractures. J Arthroplasty. 2020;35(4):1095-100.
  • 20. Chen DX, Yang L, Ding L, Li SY, Qi YN, Li Q. Perioperative outcomes in geriatric patients undergoing hip fracture surgery with different anesthesia techniques: A systematic review and meta-analysis. Medicine (Baltimore). 2019;98(49):e18220.
  • 21. Desai V, Chan PH, Prentice HA, Zohman GL, Diekmann GR, Maletis GB et al. Is anesthesia technique associated with a higher risk of mortality or complications within 90 days of surgery for geriatric patients with hip fractures? Clin Orthop Relat Res. 2018;476(6):1178-88.
  • 22. O'Donnell CM, McLoughlin L, Patterson CC, Clarke M, McCourt KC, McBrien ME et al. Perioperative outcomes in the context of mode of anaesthesia for patients undergoing hip fracture surgery: systematic review and meta-analysis. Br J Anaesth. 2018;120(1):37-50.
  • 23. Nkanang B, Parker M, Parker E, Griffiths R. Perioperative mortality for patients with a hip fracture. Injury. 2017;48(10):2180-3.
  • 24. Karakus O, Ozdemir G, Karaca S, Cetin M, Saygi B. The relationship between the type of unstable intertrochanteric femur fracture and mobility in the elderly. J Orthop Surg Res. 2018;13(1):207.
  • 25. Pfeufer D, Zeller A, Mehaffey S, Böcker W, Kammerlander C, Neuerburg C. Weight-bearing restrictions reduce postoperative mobility in elderly hip fracture patients. Arch Orthop Trauma Surg. 2019;139(9):1253-9.
  • 26. Sasabuchi Y, Matsui H, Lefor AK, Fushimi K, Yasunaga H. Timing of surgery for hip fractures in the elderly: A retrospective cohort study. Injury. 2018;49(10):1848-54.
  • 27. Belmont PJ Jr, Garcia EJ, Romano D, Bader JO, Nelson KJ, Schoenfeld AJ. Risk factors for complications and in-hospital mortality following hip fractures: a study using the National Trauma Data Bank. Arch Orthop Trauma Surg. 2014;134(5):597-604.
  • 28. Malafarina V, Reginster JY, Cabrerizo S, Bruyère O, Kanis JA, Martinez JA et al. Nutritional status and nutritional treatment are related to outcomes and mortality in older adults with hip fracture. Nutrients. 2018;10(5):555.
  • 29. Li S, Zhang J, Zheng H, Wang X, Liu Z, Sun T. Prognostic role of serum albumin, total lymphocyte count, and mini nutritional assessment on outcomes after geriatric hip fracture surgery: a meta-analysis and systematic review. J Arthroplasty. 2019;34(6):1287-96.
  • 30. Bohl DD, Shen MR, Hannon CP, Fillingham YA, Darrith B, Della Valle CJ. Serum albumin predicts survival and postoperative course following surgery for geriatric hip fracture. J Bone Joint Surg Am. 2017;99(24):2110-8.
There are 30 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Articles
Authors

Sinan Oguzkaya 0000-0003-3032-5714

Sebati Baser Canbaz This is me 0000-0002-9197-2942

Erdal Uzun 0000-0002-5456-3699

Gokhan Sayer 0000-0002-4459-2031

Mustafa Özçamdallı 0000-0002-9000-2135

Fatih Golgelioglu 0000-0002-1715-3471

Abdulhamit Mısır 0000-0002-5270-1429

Publication Date August 31, 2022
Submission Date December 20, 2021
Published in Issue Year 2022 Volume: 24 Issue: 2

Cite

APA Oguzkaya, S., Canbaz, S. B., Uzun, E., Sayer, G., et al. (2022). EARLY POSTOPERATIVE MORTALITY RATES IN ELDERLY PATIENTS WITH INTERTROCHANTERIC FEMORAL FRACTURE: COMPARISON OF THREE FIXATION METHODS. Kırıkkale Üniversitesi Tıp Fakültesi Dergisi, 24(2), 280-288. https://doi.org/10.24938/kutfd.1039014
AMA Oguzkaya S, Canbaz SB, Uzun E, Sayer G, Özçamdallı M, Golgelioglu F, Mısır A. EARLY POSTOPERATIVE MORTALITY RATES IN ELDERLY PATIENTS WITH INTERTROCHANTERIC FEMORAL FRACTURE: COMPARISON OF THREE FIXATION METHODS. Kırıkkale Uni Med J. August 2022;24(2):280-288. doi:10.24938/kutfd.1039014
Chicago Oguzkaya, Sinan, Sebati Baser Canbaz, Erdal Uzun, Gokhan Sayer, Mustafa Özçamdallı, Fatih Golgelioglu, and Abdulhamit Mısır. “EARLY POSTOPERATIVE MORTALITY RATES IN ELDERLY PATIENTS WITH INTERTROCHANTERIC FEMORAL FRACTURE: COMPARISON OF THREE FIXATION METHODS”. Kırıkkale Üniversitesi Tıp Fakültesi Dergisi 24, no. 2 (August 2022): 280-88. https://doi.org/10.24938/kutfd.1039014.
EndNote Oguzkaya S, Canbaz SB, Uzun E, Sayer G, Özçamdallı M, Golgelioglu F, Mısır A (August 1, 2022) EARLY POSTOPERATIVE MORTALITY RATES IN ELDERLY PATIENTS WITH INTERTROCHANTERIC FEMORAL FRACTURE: COMPARISON OF THREE FIXATION METHODS. Kırıkkale Üniversitesi Tıp Fakültesi Dergisi 24 2 280–288.
IEEE S. Oguzkaya, “EARLY POSTOPERATIVE MORTALITY RATES IN ELDERLY PATIENTS WITH INTERTROCHANTERIC FEMORAL FRACTURE: COMPARISON OF THREE FIXATION METHODS”, Kırıkkale Uni Med J, vol. 24, no. 2, pp. 280–288, 2022, doi: 10.24938/kutfd.1039014.
ISNAD Oguzkaya, Sinan et al. “EARLY POSTOPERATIVE MORTALITY RATES IN ELDERLY PATIENTS WITH INTERTROCHANTERIC FEMORAL FRACTURE: COMPARISON OF THREE FIXATION METHODS”. Kırıkkale Üniversitesi Tıp Fakültesi Dergisi 24/2 (August 2022), 280-288. https://doi.org/10.24938/kutfd.1039014.
JAMA Oguzkaya S, Canbaz SB, Uzun E, Sayer G, Özçamdallı M, Golgelioglu F, Mısır A. EARLY POSTOPERATIVE MORTALITY RATES IN ELDERLY PATIENTS WITH INTERTROCHANTERIC FEMORAL FRACTURE: COMPARISON OF THREE FIXATION METHODS. Kırıkkale Uni Med J. 2022;24:280–288.
MLA Oguzkaya, Sinan et al. “EARLY POSTOPERATIVE MORTALITY RATES IN ELDERLY PATIENTS WITH INTERTROCHANTERIC FEMORAL FRACTURE: COMPARISON OF THREE FIXATION METHODS”. Kırıkkale Üniversitesi Tıp Fakültesi Dergisi, vol. 24, no. 2, 2022, pp. 280-8, doi:10.24938/kutfd.1039014.
Vancouver Oguzkaya S, Canbaz SB, Uzun E, Sayer G, Özçamdallı M, Golgelioglu F, Mısır A. EARLY POSTOPERATIVE MORTALITY RATES IN ELDERLY PATIENTS WITH INTERTROCHANTERIC FEMORAL FRACTURE: COMPARISON OF THREE FIXATION METHODS. Kırıkkale Uni Med J. 2022;24(2):280-8.

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