Acil servise kabul edilen 65 yaş ve üzeri travma hastalarında proksimal femur kırıklarının anatomik değerlendirmesi

Yıl 2025, Cilt: 18 Sayı: 1, 43 - 52, 01.01.2025

Zeynep Nisa Karakoyun , Ömer Faruk Karakoyun , Kivanç Karaman , Yalcin Golcuk

https://doi.org/10.31362/patd.1483188

Öz

Amaç: Bu retrospektif çalışma, proksimal femur kırıkları için sınıflandırma sistemleri ile yaşlı hastalarda orta
vadeli mortalite arasındaki ilişkiyi değerlendirmeyi amaçlamıştır, odaklanılan nokta ise klinik ve anatomik
yönleridir.
Gereç ve yöntem: Cerrahi işlem uygulanan proksimal femur kırıklı hastaların radyolojik görüntüleri incelendi.
Anatomik, Pipkin, Garden, Evans-Jensen, Seinsheimer ve AO/OTA sınıflandırmaları olmak üzere çeşitli
sınıflandırma sistemleri uygulandı. Elektronik hastane kayıtları hastaya ait verileri sağladı ve istatistiksel
analizler yapıldı.
Bulgular: Çalışma, 298 hastayı içeriyordu ve ortalama yaş 81,7±7,3 yıl idi, %63,1'i kadındı. Hastanede kalış
süresi, ortalama 7 (1-63) gün idi, %19,1'i yoğun bakım gerektiriyordu ve 3 ay içinde %13,8'lik bir mortalite
oranı görüldü. Hastalar, anatomik sınıflandırmaya göre dağıtıldı ve klinik sınıflandırmalara göre intrakapsüler
ve ekstrakapsüler kırıkların dağılımı detaylandırıldı. Bulgular, proksimal femur kırık sınıflandırma sistemlerinin
mortalite oranlarını önemli ölçüde etkilemediğini öne sürmektedir (p=0,787).
Sonuç: Anatomik sınıflandırma sistemleri, basitliği ve sağlık profesyonelleri arasında ortak bir dil oluşturma
potansiyeli nedeniyle tercih edilebilir. Bu çalışma, yaşlı hastalarda proksimal femur kırıkları hakkında değerli
içgörüler sağlayarak klinik uygulamayı bilgilendirir.

Anahtar Kelimeler

Anatomi, sınıflandırma, femur, geriatri, kalça kırıkları

Anatomical evaluation of proximal femur fractures in trauma patients aged 65 or older admitted to the emergency department

Öz

Purpose: This retrospective study aimed to assess the association between classification systems for proximal
femur fractures and mid-term mortality in elderly patients, focusing on their clinical and anatomical aspects.
Materials and methods: Radiological images of patients aged 65 years and older who underwent surgical
procedures for proximal femur fractures were reviewed. Various classification systems were applied, including
Anatomical, Pipkin, Garden, Evans-Jensen, Seinsheimer, and AO/OTA classifications. Electronic hospital
records provided patient data, and statistical analyses were performed.
Results: The study included 298 patients, and the mean age was 81.7±7.3 years, and 63.1% were female.
Median length of stay in hospital 7 (1-63) days, 19.1% requiring intensive care, and a 13.8% mortality rate within
3 months. Patients were distributed based on anatomical classification, and the distribution of intracapsular and
extracapsular fractures according to clinical classifications was detailed. The findings suggest that proximal
femur fracture classification systems do not significantly influence mortality rates (p=0.787).
Conclusion: Anatomical classification systems may be favored for their simplicity and potential to establish a
common language among healthcare professionals. This study provides valuable insights into proximal femur
fractures in elderly patients, informing clinical practice.

Anahtar Kelimeler

Anatomy, classification, femur, geriatric, hip fractures

Kaynakça

• Raaymakers EL. Fractures of the femoral neck: a review and personal statement. Acta Chir Orthop Traumatol Cech. 2006;73:45-59.
• Yin B, He Y, Wang D, Zhou J. Classification of femur trochanteric fracture: evaluating the reliability of Tang classification. Injury. 2021;52(7):1500-1505. doi:10.1016/j.injury.2020.11.031
• Collin PG, D'Antoni AV, Loukas M, Oskouian RJ, Tubbs RS. Hip fractures in the elderly: a clinical anatomy review. Clin Anat. 2017;30(1):89-97. doi:10.1002/ca.22779
• Patterson JT, Tangtiphaiboontana J, Pandya NK. Management of pediatric femoral neck fracture. J Am Acad Orthop Surg. 2018;26(11):411-419. doi:10.5435/JAAOS-D-16-00362
• Ramponi DR, Kaufmann J, Drahnak G. Hip fractures. Adv Emerg Nurs J. 2018;40(1):8-15. doi:10.1097/TME.0000000000000180
• Thomsen NO, Jensen CM, Skovgaard N, et al. Observer variation in the radiographic classification of fractures of the neck of the femur using Garden's system. Int Orthop. 1996;20(5):326-329. doi:10.1007/s002640050087
• Zlowodzki M, Bhandari M, Keel M, Hanson BP, Schemitsch E. Perception of Garden's classification for femoral neck fractures: an international survey of 298 orthopaedic trauma surgeons. Arch Orthop Trauma Surg. 2005;125(7):503-505.
• Mears SC. Classification and surgical approaches to hip fractures for nonsurgeons. Clin Geriatr Med. 2014;30(2):229-241. doi:10.1016/j.cger.2014.01.004
• İmerci A, Aydogan NH, Tosun K. Evaluation of inter- and intra-observer reliability of current classification systems for subtrochanteric femoral fractures. Eur J Orthop Surg Traumatol. 2018;28(4):499-502. doi:10.1007/s00590-017-2065-y
• Sheehan SE, Shyu JY, Weaver MJ, Sodickson AD, Khurana B. Proximal femoral fractures: what the orthopedic surgeon wants to know. Radiographics. 2015;35(5):1563-1584. doi:10.1148/rg.2015140301
• Cirovic A, Djonic D, Zivkovic V, et al. Three-dimensional microstructural basis for differential occurrence of subcapital versus basicervical hip fractures in men. Calcif Tissue Int. 2020;107(3):240-248. doi:10.1007/s00223-020-00717-z
• Chen CY, Chiu FY, Chen CM, Huang CK, Chen WM, Chen TH. Surgical treatment of basicervical fractures of femur: a prospective evaluation of 269 patients. J Trauma. 2008;64(2):427-429. doi:10.1097/01.ta.0000239255.47280.6f
• Shen M, Wang C, Chen H, Rui Y, Song Z. An update on the Pauwels classification. J Orthop Surg Res. 2016;11:161. doi:10.1186/s13018-016-0498-3
• Meinberg EG, Agel J, Roberts CS, Karam MD, Kellam JF. Fracture and dislocation classification compendium-2018. J Orthop Trauma. 2018;32(Suppl 1). doi:10.1097/BOT.0000000000001063
• Fischer H, Maleitzke T, Eder C, et al. Management of proximal femur fractures in the elderly: current concepts and treatment options. Eur J Med Res. 2021;26:86. doi:10.1186/s40001-021-00556-0
• Gullberg B, Johnell O, Kanis JA. Worldwide projections for hip fracture. Osteoporos Int. 1997;7(5):407-413. doi:10.1007/pl00004148
• Fried LP, Tangen CM, Walston J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56(3). doi:10.1093/gerona/56.3.m146
• Kanis JA, Odén A, McCloskey EV, et al. A systematic review of hip fracture incidence and probability of fracture worldwide. Osteoporos Int. 2012;23(9):2239-2256. doi:10.1007/s00198-012-1964-3
• Romeo NM, Firoozabadi R. Classifications in brief: the Pipkin classification of femoral head fractures. Clin Orthop Relat Res. 2018;476(5):1114-1119. doi:10.1007/s11999.0000000000000045
• Zhao D, Qiu X, Wang B, et al. Epiphyseal arterial network and inferior retinacular artery seem critical to femoral head perfusion in adults with femoral neck fractures. Clin Orthop Relat Res. 2017;475(8):2011-2023. doi:10.1007/s11999-017-5318-5
• Aksu N, Işıklar ZU. Hip fractures. TOTBİD Dergisi. 2008;7:8-19.
• Yıldırım C, Muratoğlu OG, Turan K, et al. The intra- and interobserver reliability of five commonly used intertrochanteric femur fracture classification systems. Jt Dis Relat Surg. 2022;33(2):187-192. doi:10.52312/jdrs.2022.498
• Haentjens P, Magaziner J, Colón-Emeric CS, et al. Meta-analysis: excess mortality after hip fracture among older women and men. Ann Intern Med. 2010;152(6):380-390. doi:10.7326/0003-4819-152-6-201003160-00008
• Klestil T, Röder C, Stotter C, et al. Impact of timing of surgery in elderly hip fracture patients: a systematic review and meta-analysis. Sci Rep. 2018;8:13933. doi:10.1038/s41598-018-32098-7
• Walter N, Szymski D, Kurtz S, et al. Factors associated with mortality after proximal femoral fracture. J Orthop Traumatol. 2023;24:31. doi:10.1186/s10195-023-00715-5
• Narula S, Lawless A, D'Alessandro P, et al. Clinical Frailty Scale is a good predictor of mortality after proximal femur fracture: a cohort study of 30-day and one-year mortality. Bone Jt Open. 2020;1(8):443-449. doi:10.1302/2633-1462.18.BJO-2020-0089.R1