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A Comparative Study of Bipolar Hemiarthroplasty for Intertrochanteric Fracture: Direct Anterior Approach versus Conventional Posterolateral Approach. 双极半关节成形术治疗转子间骨折的比较研究:直接前方入路与传统后外侧入路的比较研究
Hip & pelvis Pub Date : 2023-12-01 Epub Date: 2023-12-04 DOI: 10.5371/hp.2023.35.4.246
Young Yool Chung, Seung-Woo Shim, Min Young Kim, Young-Jae Kim
{"title":"A Comparative Study of Bipolar Hemiarthroplasty for Intertrochanteric Fracture: Direct Anterior Approach versus Conventional Posterolateral Approach.","authors":"Young Yool Chung, Seung-Woo Shim, Min Young Kim, Young-Jae Kim","doi":"10.5371/hp.2023.35.4.246","DOIUrl":"https://doi.org/10.5371/hp.2023.35.4.246","url":null,"abstract":"<p><strong>Purpose: </strong>The aim of this study was to compare short-term results from use of the direct anterior approach (DAA) and the conventional posterolateral approach (PLA) in performance of bipolar hemiarthroplasty for treatment of femoral intertrochanteric fractures in elderly patients.</p><p><strong>Materials and methods: </strong>A retrospective review of 100 patients with intertrochanteric fractures who underwent bipolar hemiarthroplasty was conducted. The PLA was used in 50 cases from 2016 to 2019; since that time we have used the DAA in 50 cases from 2019 to 2021. Measurements of mean operative time, blood loss, hospitalization period, and ambulation status, greater trochanter (GT) migration and stem subsidence were performed. And the incidence of complications was examined.</p><p><strong>Results: </strong>Operative time was 73.60±14.56 minutes in the PLA group and 79.80±8.89 minutes in the DAA group (<i>P</i><0.05). However, after experiencing 20 cases using DAA, there was no statistically difference in operative time between two groups (<i>P</i>=0.331). Blood loss was 380.76±180.67 mL in the PLA group and 318.14±138.51 mL in the DAA group (<i>P</i><0.05). The hospitalization was 23.76±11.89 days in the PLA group and 21.45±4.18 days in the DAA group (<i>P</i>=0.207). In both groups, there were no progressive GT migration, intraoperative fractures or dislocations, although there was one case of infection in the PLA group.</p><p><strong>Conclusion: </strong>Although use of the DAA in performance of bipolar hemiarthroplasty required slightly more time in the beginning compared with the PLA, the DAA may well be an alternative, safe surgical technique as a muscle preserving procedure in elderly patients with intertrochanteric fractures.</p>","PeriodicalId":73239,"journal":{"name":"Hip & pelvis","volume":"35 4","pages":"246-252"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10728045/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138833355","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Open Reduction and Internal Fixation for Vancouver B1 and B2 Periprosthetic Femoral Fractures: A Proportional Meta-Analysis. Vancouver B1 和 B2 股骨假体周围骨折的切开复位和内固定术:比例元分析。
Hip & pelvis Pub Date : 2023-12-01 Epub Date: 2023-12-04 DOI: 10.5371/hp.2023.35.4.217
Byung-Ho Yoon, Seong Gyun Park, Young Hak Roh
{"title":"Open Reduction and Internal Fixation for Vancouver B1 and B2 Periprosthetic Femoral Fractures: A Proportional Meta-Analysis.","authors":"Byung-Ho Yoon, Seong Gyun Park, Young Hak Roh","doi":"10.5371/hp.2023.35.4.217","DOIUrl":"https://doi.org/10.5371/hp.2023.35.4.217","url":null,"abstract":"<p><strong>Purpose: </strong>Periprosthetic femoral fracture (PFF) is a common complication after total hip arthroplasty, and open reduction and internal fixation (ORIF) is a common surgical treatment. We conducted a meta-analysis to compare the outcomes of ORIF in patients with different fracture patterns (Vancouver B1 and B2).</p><p><strong>Materials and methods: </strong>We conducted a systematic search of PubMed, Embase, Cochrane Library and KoreaMed from inception to August 2022. We conducted a pair-wise meta-analysis (with a fixed-effects model) on the 10 comparative studies and a proportional meta-analysis on the data from the 39 articles to determine a consensus. The outcomes were the incidence of reoperations that included osteosynthesis, irrigation/debridement and revision arthroplasty.</p><p><strong>Results: </strong>The pair-wise meta-analysis showed similar outcomes between two groups; the risk of reoperation (odds ratio [OR]=0.82, confidence interval [CI] 0.43-1.55, <i>P</i>=0.542), nonunion (OR=0.49; CI 0.22-1.10, <i>P</i>=0.085) and deep infection (OR=1.89, CI 0.48-7.46, <i>P</i>=0.361). In proportion meta-analysis, pooled prevalence of reoperation was 9% (95% CI, 6-12) in B1 and 8% (95% CI, 2-15) in B2 (heterogeneity between two groups (Q), <i>P</i>=0.772). The pooled prevalence of nonunion was same as of 4% in B1 and B2 (Q, <i>P</i>=0.678), and deep infection was 2% (95% CI, 1-3) in B1 and 4% (95% CI, 2-7) in B2 (Q, <i>P</i>=0.130).</p><p><strong>Conclusion: </strong>ORIF is a feasible treatment for B1 and B2 periprosthetic femoral fractures, with acceptable outcomes in terms of, nonunion and infection. The results of this study would help clinicians and provide baseline data for further studies validating PFF.</p>","PeriodicalId":73239,"journal":{"name":"Hip & pelvis","volume":"35 4","pages":"217-227"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10728046/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138833268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Surgical Resection of Neurogenic Heterotopic Ossification around Hip Joint in Stroke Patients: A Safety and Outcome Report. 中风患者髋关节周围神经源性异位骨化的手术切除:安全性和结果报告
Hip & pelvis Pub Date : 2023-12-01 Epub Date: 2023-12-04 DOI: 10.5371/hp.2023.35.4.268
Jae-Young Beom, WengKong Low, Kyung-Soon Park, Taek-Rim Yoon, Chan Young Lee, Hyeongmin Song
{"title":"Surgical Resection of Neurogenic Heterotopic Ossification around Hip Joint in Stroke Patients: A Safety and Outcome Report.","authors":"Jae-Young Beom, WengKong Low, Kyung-Soon Park, Taek-Rim Yoon, Chan Young Lee, Hyeongmin Song","doi":"10.5371/hp.2023.35.4.268","DOIUrl":"https://doi.org/10.5371/hp.2023.35.4.268","url":null,"abstract":"<p><strong>Purpose: </strong>Resection remains the most reliable treatment for established heterotopic ossification, despite questions regarding its effectiveness due to the potential for complications. This study evaluated the clinical outcomes and complications of neurogenic heterotopic ossification (NHO) resection in stroke patients' ankylosed hips.</p><p><strong>Materials and methods: </strong>We retrospectively analyzed nine hip NHO resections performed on seven patients from 2010 to 2018. The pre- and postoperative range of motion of the operated hip were compared. Analysis of postoperative complications, including infection, recurrence, iatrogenic fracture, and neurovascular injury was performed.</p><p><strong>Results: </strong>The mean operative time was 132.78±21.08 minutes, with a mean hemoglobin drop of 3.06±0.82 g/dL within the first postoperative week. The mean duration of postoperative follow-up was 52.08±28.72 months for all patients. Postoperative range of motion showed improvement from preoperative. Flexion and external rotation (mean, 58.89±30.60° and 16.67±18.03°, respectively) showed the greatest gain of motion of the operated hip joint. Postoperative infections resolved in two cases through surgical debridement, and one case required conversion to total hip arthroplasty due to instability. There were no recurrences, iatrogenic fractures, or neurovascular injuries.</p><p><strong>Conclusion: </strong>Resection is a beneficial intervention for restoring the functional range of motion of the hip in order to improve the quality of life for patients with NHO and neurological disorders. We recommend performance of a minimal resection to achieve a targeted functional arc of motion in order to minimize the risk of postoperative complications.</p>","PeriodicalId":73239,"journal":{"name":"Hip & pelvis","volume":"35 4","pages":"268-276"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10728050/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138833271","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Change of Symptoms after Total Hip Arthroplasty in Patients with Hip-Spine Syndrome. 髋关节脊柱综合征患者全髋关节置换术后症状的变化。
Hip & pelvis Pub Date : 2023-12-01 Epub Date: 2023-12-04 DOI: 10.5371/hp.2023.35.4.238
Sung-Hyun Yoon, Ju Hyun Kim, Hyung Jun Lee, Ki-Choul Kim
{"title":"Change of Symptoms after Total Hip Arthroplasty in Patients with Hip-Spine Syndrome.","authors":"Sung-Hyun Yoon, Ju Hyun Kim, Hyung Jun Lee, Ki-Choul Kim","doi":"10.5371/hp.2023.35.4.238","DOIUrl":"https://doi.org/10.5371/hp.2023.35.4.238","url":null,"abstract":"<p><strong>Purpose: </strong>Elderly patients with degenerative diseases undergo treatment for the hip and spine; these patients present with various symptoms. This study focused on patients with residual symptoms, predominantly pain, even after receiving treatment for their spinal lesions.</p><p><strong>Materials and methods: </strong>Patients who underwent total hip arthroplasty (THA) between 2016 and 2022 at a single tertiary hospital were included in the study. Of the 417 patients who underwent primary THA, a retrospective review of 40 patients with previous lesions of the spine was conducted. Patients were stratified to two cohorts: Patients with symptoms related to the spine (Group A), and those with hip-related symptoms (Group B). Pre- and postoperative comparisons of groups A and B were performed.</p><p><strong>Results: </strong>Improvements in patients' symptoms were observed in groups A and B after THA. In Group A, the mean preoperative visual analog scale (VAS) score was 5.10±0.876, which showed a postoperative decrease to 2.70±1.767. In Group B, the mean preoperative VAS score was 5.10±1.539, which showed a postoperative decrease to 2.67±1.493.</p><p><strong>Conclusion: </strong>According to the findings, promising results were achieved with THA in treatment of debilitating diseases of the hip for both the prognosis of the disease, as well as the patients' symptoms. In addition, in some cases elderly patients with dual pathologies underwent treatment for spinal lesions without performance of any evaluation related to the hip. Thus, evaluation of a patient's hip must be performed and performance of THA in patients with symptoms even after treatment of spinal lesions is recommended.</p>","PeriodicalId":73239,"journal":{"name":"Hip & pelvis","volume":"35 4","pages":"238-245"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10728047/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138833266","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Reduction of the Femoral Head First, and Assembly of the MUTARS® Device in Case of Impossible Reduction during Total Hip Arthroplasty. 在全髋关节置换术中先行股骨头截骨,并在无法截骨的情况下组装 MUTARS® 装置。
Hip & pelvis Pub Date : 2023-12-01 Epub Date: 2023-12-04 DOI: 10.5371/hp.2023.35.4.277
Jee Young Lee, Ye Jun Lee, Gyu Min Kong
{"title":"Reduction of the Femoral Head First, and Assembly of the MUTARS<sup>®</sup> Device in Case of Impossible Reduction during Total Hip Arthroplasty.","authors":"Jee Young Lee, Ye Jun Lee, Gyu Min Kong","doi":"10.5371/hp.2023.35.4.277","DOIUrl":"https://doi.org/10.5371/hp.2023.35.4.277","url":null,"abstract":"<p><p>Dislocation after a total hip arthroplasty occurs in approximately 1% of patients; however, the frequency is much higher after revision surgery. To prevent dislocation, use of a larger femoral head is recommended, and a dual mobility femoral head has been introduced. However, reducing the dual mobility femoral head to the acetabular component is difficult in cases involving contracture in the soft tissue around the joint. A 72-year-old male patient who developed a periprosthetic joint infection underwent two-stage revision surgery using MUTARS<sup>®</sup>. Two months after the revision, the hip joint became dislocated and manual reduction was attempted; however, dislocation occurred again. During another revision using a dual mobility bearing, the soft tissue around the hip joint was too tight to reduce. The problem was overcome by first repositioning the dual mobility head into the acetabular socket, followed by assembly of the diaphyseal portion of the implant.</p>","PeriodicalId":73239,"journal":{"name":"Hip & pelvis","volume":"35 4","pages":"277-280"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10728048/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138833270","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Updating Osteonecrosis of the Femoral Head. 更新股骨头坏死。
Hip & pelvis Pub Date : 2023-09-01 Epub Date: 2023-09-06 DOI: 10.5371/hp.2023.35.3.147
Young-Seung Ko, Joo Hyung Ha, Jung-Wee Park, Young-Kyun Lee, Tae-Young Kim, Kyung-Hoi Koo
{"title":"Updating Osteonecrosis of the Femoral Head.","authors":"Young-Seung Ko,&nbsp;Joo Hyung Ha,&nbsp;Jung-Wee Park,&nbsp;Young-Kyun Lee,&nbsp;Tae-Young Kim,&nbsp;Kyung-Hoi Koo","doi":"10.5371/hp.2023.35.3.147","DOIUrl":"https://doi.org/10.5371/hp.2023.35.3.147","url":null,"abstract":"<p><p>Osteonecrosis of the femoral head (ONFH), a condition characterized by the presence of a necrotic bone lesion in the femoral head, is caused by a disruption in the blood supply. Its occurrence is more common in young and middle-aged adults and it is the main reason for performance of total hip arthroplasty in this age group. Its incidence is increasing along with increased use of glucocorticoids for management of adjuvant therapy for treatment of leukemia as well as organ transplantation and other myelogenous diseases. Current information on etiology and pathogenesis, as well as natural history, stage system, and treatments is provided in this review. A description of the Association Research Circulation Osseous (ARCO) criteria for classification of glucocorticoids- and alcohol-associated ONFH, 2019 ARCO staging system, and 2021 ARCO classification using computed tomography for the early stages of ONFH is also provided.</p>","PeriodicalId":73239,"journal":{"name":"Hip & pelvis","volume":"35 3","pages":"147-156"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/07/71/hp-35-147.PMC10505838.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41164335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Risk Factors of the 2-Year Mortality after Bipolar Hemiarthroplasty for Displaced Femoral Neck Fracture. 双极性股骨颈置换术后2年死亡率的危险因素。
Hip & pelvis Pub Date : 2023-09-01 Epub Date: 2023-09-06 DOI: 10.5371/hp.2023.35.3.164
Jung Wook Huh, Han Eol Seo, Dong Ha Lee, Jae Heung Yoo
{"title":"Risk Factors of the 2-Year Mortality after Bipolar Hemiarthroplasty for Displaced Femoral Neck Fracture.","authors":"Jung Wook Huh,&nbsp;Han Eol Seo,&nbsp;Dong Ha Lee,&nbsp;Jae Heung Yoo","doi":"10.5371/hp.2023.35.3.164","DOIUrl":"https://doi.org/10.5371/hp.2023.35.3.164","url":null,"abstract":"<p><strong>Purpose: </strong>This study investigates the relationship between preoperative neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-C-reactive protein ratio (LCR), albumin, and 2-year mortality in elderly patients having hemiarthroplasty for displaced femoral neck fracture (FNF).</p><p><strong>Materials and methods: </strong>We retrospectively reviewed 284 elderly patients who underwent hemiarthroplasty for Garden type IV FNF from September 2014 to September 2020. Using the receiver operating characteristic curve, optimal cutoff values for LCR, NLR, and albumin were established, and patients were categorized as low or high. Associations with 2-year mortality were evaluated through univariate and multivariate Cox regression analyses.</p><p><strong>Results: </strong>Of the 284 patients, 124 patients (45.9%) died within 2 years post-surgery. The optimal cutoff values were: LCR at 7.758 (specificity 58.5%, sensitivity 25.0%), NLR at 3.854 (specificity 39.2%, sensitivity 40.0%), and albumin at 3.750 (specificity 65.9%, sensitivity 21.9%). Patients with low LCR (<7.758), high NLR (≥3.854), and low albumin (<3.750) had a statistically significant reduced survival time compared to their counterparts.</p><p><strong>Conclusion: </strong>Lower preoperative LCR and albumin levels, along with higher NLR, effectively predict 2-year mortality and 30-day post-surgery complications in elderly patients with Garden type IV FNF undergoing hemiarthroplasty.</p>","PeriodicalId":73239,"journal":{"name":"Hip & pelvis","volume":"35 3","pages":"164-174"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/0a/7e/hp-35-164.PMC10505842.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41172200","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Treatment of Femoral Neck Fractures in the Elderly: A Survey of the Korean Hip Society Surgeons. 老年人股骨颈骨折的治疗:韩国髋关节学会外科医生的调查。
Hip & pelvis Pub Date : 2023-09-01 Epub Date: 2023-09-06 DOI: 10.5371/hp.2023.35.3.157
Hong Seok Kim, Je-Hyun Yoo, Young-Kyun Lee, Jong-Seok Park, Ye-Yeon Won
{"title":"Treatment of Femoral Neck Fractures in the Elderly: A Survey of the Korean Hip Society Surgeons.","authors":"Hong Seok Kim,&nbsp;Je-Hyun Yoo,&nbsp;Young-Kyun Lee,&nbsp;Jong-Seok Park,&nbsp;Ye-Yeon Won","doi":"10.5371/hp.2023.35.3.157","DOIUrl":"https://doi.org/10.5371/hp.2023.35.3.157","url":null,"abstract":"<p><strong>Purpose: </strong>This study examined the methods for treatment of femoral neck fracture (FNF) preferred by members of the Korean Hip Society (KHS) and identified factors that influence decisions regarding the surgical intervention of choice.</p><p><strong>Materials and methods: </strong>A total of 97 members of the KHS responded to the 16-question survey which included questions about the mean number of surgeries performed each month for treatment of femoral neck fractures, the cut-off age for deciding between internal fixation and arthroplasty, the implant used most often, usage of cement, and factors influencing each decision.</p><p><strong>Results: </strong>The mean cut-off age used when deciding between internal fixation and arthroplasty was 64 years old. Hemiarthroplasty (HA) (70%) was the most preferred option for treatment of displaced FNFs in cases where arthroplasty was indicated (total hip arthroplasty [THA] 19% and dual mobility THA 11%). The main reasons for selection of arthroplasty over reduction with internal fixation were age and pre-fracture ambulatory status. Pre-trauma ambulatory status and/or sports activity were the main factors in selection of HA over THA. Cement was used by 33% of responders. Poor bone quality and a broad femoral canal were factors that influenced the usage of cement.</p><p><strong>Conclusion: </strong>Management of FNFs in the elderly is a major health problem worldwide; thus, remaining alert to current trends in treatment is essential for surgeons. The mean cut-off age used in deciding between internal fixation and arthroplasty was 64 years old. HA is the preferred method for treatment of displaced FNFs for members of the KHS.</p>","PeriodicalId":73239,"journal":{"name":"Hip & pelvis","volume":"35 3","pages":"157-163"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/fc/35/hp-35-157.PMC10505840.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41124765","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The Impact of Surgical Timing of Hip Fracture on Mortality: Do the Cause and Duration of Delay Matter? 髋部骨折手术时机对死亡率的影响:延迟的原因和持续时间重要吗?
Hip & pelvis Pub Date : 2023-09-01 Epub Date: 2023-09-06 DOI: 10.5371/hp.2023.35.3.206
Jaiben George, Vijay Sharma, Kamran Farooque, Samarth Mittal, Vivek Trikha, Rajesh Malhotra
{"title":"The Impact of Surgical Timing of Hip Fracture on Mortality: Do the Cause and Duration of Delay Matter?","authors":"Jaiben George,&nbsp;Vijay Sharma,&nbsp;Kamran Farooque,&nbsp;Samarth Mittal,&nbsp;Vivek Trikha,&nbsp;Rajesh Malhotra","doi":"10.5371/hp.2023.35.3.206","DOIUrl":"https://doi.org/10.5371/hp.2023.35.3.206","url":null,"abstract":"<p><strong>Purpose: </strong>Delay in performance of hip fracture surgery can be caused by medical and/or administrative reasons. Although early surgery is recommended, it is unclear what constitutes a delayed surgery and whether the impact of delayed surgery can differ depending on the reason for the delay.</p><p><strong>Materials and methods: </strong>A total of 269 consecutive hip fracture patients over 50 years of age who underwent surgery were prospectively enrolled. They were divided into two groups: early and delayed (time from reaching the hospital to surgery less than or more than 48 hours). Patients were also categorized as fit or unfit based on anesthetic fitness. One-year mortality was recorded, and regression analyses were performed to assess the impact of delay on mortality.</p><p><strong>Results: </strong>A total of 153 patients (56.9%) had delayed surgery with a mean time to surgery of 87±70 hours. A total of 115 patients (42.8%) were considered medically fit to undergo surgery. No difference in one-year mortality was observed between patients with early surgery and those with delayed surgery (<i>P</i>=0.854). However, when assessment of the time to surgery was performed in a continuous manner, mortality increased with prolonged time to surgery, particularly in unfit patients, and higher mortality was observed when the delay exceeded six days (fit: <i>P</i>=0.117; unfit: <i>P</i>=0.035).</p><p><strong>Conclusion: </strong>The effect of delay on mortality was predominantly observed in patients who were not considered medically fit, suggesting that surgical delays might have a greater impact on patients with medical reasons for delay.</p>","PeriodicalId":73239,"journal":{"name":"Hip & pelvis","volume":"35 3","pages":"206-215"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/4f/74/hp-35-206.PMC10505843.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41159597","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Assessing the Necessity of Extra Reduction Aides in Intramedullary Nailing of Intertrochanteric Hip Fractures. 评估额外复位辅助在股骨转子间骨折髓内钉扎中的必要性。
Hip & pelvis Pub Date : 2023-09-01 Epub Date: 2023-09-06 DOI: 10.5371/hp.2023.35.3.183
John W Yurek, Nikki A Doerr, Alex Tang, Adam S Kohring, Frank A Liporace, Richard S Yoon
{"title":"Assessing the Necessity of Extra Reduction Aides in Intramedullary Nailing of Intertrochanteric Hip Fractures.","authors":"John W Yurek,&nbsp;Nikki A Doerr,&nbsp;Alex Tang,&nbsp;Adam S Kohring,&nbsp;Frank A Liporace,&nbsp;Richard S Yoon","doi":"10.5371/hp.2023.35.3.183","DOIUrl":"https://doi.org/10.5371/hp.2023.35.3.183","url":null,"abstract":"<p><strong>Purpose: </strong>This study aims to determine which intertrochanteric (IT) hip fracture and patient characteristics predict the necessity for adjunct reduction aides prior to prep and drape aiming for a more efficient surgery.</p><p><strong>Materials and methods: </strong>Institutional fracture registries from two academic medical centers from 2017-2022 were analyzed. Data on patient demographics, comorbidities, fracture patterns identified on radiographs including displacement of the lesser trochanter (LT), thin lateral wall (LW), reverse obliquity (RO), subtrochanteric extension (STE), and number of fracture parts were collected, and the need for additional aides following traction on fracture table were collected. Fractures were classified using the AO/OTA classification. Regression analyses identified significant risk factors for needing extra reduction aides.</p><p><strong>Results: </strong>Of the 166 patients included, the average age was 80.84±12.7 years and BMI was 24.37±5.3 kg/m<sup>2</sup>. Univariate regression revealed increased irreducibility risk associated with RO (odds ratio [OR] 27.917, <i>P</i>≤0.001), LW (OR 24.882, <i>P</i><0.001), and STE (OR 5.255, <i>P</i>=0.005). Multivariate analysis significantly correlated RO (OR 120.74, <i>P</i><0.001) and thin LW (OR 131.14, <i>P</i><0.001) with increased risk. However, STE (<i>P</i>=0.36) and LT displacement (<i>P</i>=0.77) weren't significant. Fracture types 2.2, 3.2, and 3.3 displayed elevated risk (<i>P</i><0.001), while no other factors increased risk.</p><p><strong>Conclusion: </strong>Elderly patients with IT fractures with RO and/or thin LW are at higher risk of irreducibility, necessitating adjunct reduction aides. Other parameters showed no significant association, suggesting most fracture patterns can be achieved with traction manipulation alone.</p>","PeriodicalId":73239,"journal":{"name":"Hip & pelvis","volume":"35 3","pages":"183-192"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/f5/28/hp-35-183.PMC10505845.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41171863","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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