Effect of Dorr type on clinical outcomes and perioperative complications in patients who underwent hemiarthroplasty for femoral neck fracture

Abstract

Objective: Femoral neck fractures are defined as epidemics worldwide, especially in the advanced age group, and pose an important risk for public health. Effect of proximal femur anatomy variations according to the Dorr type in elderly patients who underwent hemiarthroplasty for intracapsular femur fractures on perioperative complications and functional outcomes have not been identified clearly yet. In our study we aimed to investigate the effect of proximal femur anatomy on clinical outcomes in patients who underwent cementless hemiarthroplasty. Method: 107 patients who were older than 65 years with displaced intracapsular femur neck fracture and underwent cementless hemiarthroplasty were included. Preoperative radiographies were assessed according to Dorr classification and patients were grouped into 3 groups as type A, B and C. Demographic findings, surgery time, blood loss during surgery, postoperative transfusion amount, complications, intensive care requirement, one year mortality and radiographic findings were assessed. Harris Hip Score (HHS) and Likert pain scores at the last examinations were analyzed for clinical outcomes. Results: 11 (10.3%) type A, 32 (29.9%) type B, 64 (59.8%) type C were detected. Mean age was 79.7 and it was significantly higher in type C patients compared with others (p<0.001). Mean HHS and Likert scores were better in group A compared with B and in group B compared with C however these were statistically insignificant (p=0.205, p=0.091). Periprosthetic and trochanter major fractures were significantly higher in group C compared with other groups (p=0.020). Conclusion: Periprosthetic and trochanter major fractures increase but the clinical outcomes are not affected by a worse Dorr type. A rigorous preoperative planning and cautious implantation should be performed especially in patients who has Dorr type C femur.

Keywords

• Dorr classification
• hemiarthroplasty
• femoral neck fractures
• Harris Hip Score

Femur boyun kırığı nedeniyle hemiartroplasti yapılan hastalarda Dorr tipinin klinik sonuçlara ve perioperatif komplikasyonlara etkisi

Abstract

Amaç: Femur boyun kırıkları, özellikle ileri yaş grubunda dünya çapında epidemik olarak tanımlanmakta ve toplum sağlığı açısından önemli bir risk oluşturmaktadır. Hemiartroplasti uygulanan yaşlı femur boyun kırıklarında Dorr tipine göre proksimal femur anatomisindeki farklılıkların perioperatif komplikasyonlara ve fonksiyonel sonuçlara etkisi henüz tam olarak ortaya konulmamıştır. Çalışmamızda, femur boyun kırığı nedeniyle çimentosuz hemiartroplasti uygulanan hastalarda proksimal femur anatomisinin klinik sonuçlara etkisini araştırmayı amaçladık. Yöntem: Femur boyun kırığı nedeni ile çimentosuz hemiartroplasti yapılmış olan 65 yaş üzeri 107 hastaya röntgen görüntüleri incelenerek Dorr sınıflaması yapıldı ve bu sınıflandırmaya göre hastalar A, B ve C tipi olmak üzere üç gruba ayrıldı. Demografik veriler, ameliyat süreleri, ameliyat sırası kan kaybı, ameliyat sonrası kan transfüzyon miktarları, komplikasyonları, yoğun bakım ihtiyaçları, 1 yıllık mortalite oranları, ameliyat öncesi ve sonrası radyografik bulguları incelendi. Klinik sonuçlar için son kontrollerindeki Harris Kalça Skoru (HKS) ve Likert ağrı skalaları hesaplandı. Bulgular: Hastaların 11’inde (%10.3) Dorr tip A, 32’sinde (%29.9) Dorr tip B, 64’ünde (%59.8) Dorr tip C saptandı. Ortalama yaş 79,7 ve tip C olan hastalarda anlamlı olarak yüksek saptandı (p<0.001). Ortalama HKS ve Likert düzeyi, A tipinde B’ye göre ve B tipinde C’ye göre daha iyi idi fakat gruplar arası anlamlı fark olmadığı saptandı (p=0.205, p=0.091). Periprostetik kırık ve trokanter major kırığı oranlarının C tipinde diğer tiplere göre daha fazla olduğu saptandı (p=0.020). Sonuç: Dorr tip C’ nin daha sık görülmesi ile klinik skorlar anlamlı olarak etkilenmemekle beraber ameliyat sırasında periprostetik kırık ve trokanter major kırığının daha yüksek oranda görüldüğü saptanmıştır. Ameliyat sırası bu komplikasyonları azaltmak adına özellikle Dorr tip C femur anatomisine sahip hastalarda titiz bir preoperatif planlama ve ameliyat sırasında da dikkatli bir implant yerleştirilmesi yapılmalıdır.

Keywords

• Dorr sınıflaması
• hemiartroplasti
• femur boyun kırığı
• Harris kalça skoru

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