Abstract
BackgroundChronic renal failure (CRF) predisposes to hip fractures in elderly patients, with high subsequent mortality. Selection and timing of the surgical procedure of such patients is a serious challenge. Many clinicians believe in earlier surgery as preferable and providing better outcomes. Damage control orthopedics (DCO) aids to adjust and optimize the overall condition of patients.MethodsIn 32 patients with femoral neck fractures complicated with CRF, we evaluated how the timing of the surgery determines the mortality rates if the DCO approach is applied. Preoperative ASA grading, POSSUM score, P-POSSUM score and DCO were carried out. Based on the assessment, timing of the surgery was ascertained.ResultsOf a total of 32 patients, twenty-nine patients were accepted for either early (< 48 hours; n = 18) or delayed (3–10 days; n = 10) surgery. Hip arthroplasty (total hip arthroplasty and hemiarthroplasty) was the principal surgery option. All patients survived operation and were followed up postoperatively with the average time of 30 days. Postoperative complications tended to occur at higher rates in the early vs. delayed surgery group (7/18 vs. 5/10). During follow up, a total of 3 patients died in both groups (2/18 in the early surgery and 1/10 in the delayed surgery group), mostly from multi-organ failures and acute respiratory distress syndrome. There was no significant difference in complication rates and Harris hip score between both groups.ConclusionIn patients with femoral neck fracture complicated with CRF, delaying the surgery for several days does not increase the incidence of postoperative adverse events.
Highlights
Frailty and osteoporosis predispose the elderly patients to minor traumatic falls and hip fractures [1]
In 32 patients with femoral neck fractures complicated with Chronic renal failure (CRF), we evaluated how the timing of the surgery determines the mortality rates if the Damage control orthopedics (DCO) approach is applied
A total of 3 patients died in both groups (2/18 in the early surgery and 1/10 in the delayed surgery group), mostly from multi-organ failures and acute respiratory distress syndrome
Summary
Frailty and osteoporosis predispose the elderly patients to minor traumatic falls and hip fractures [1]. These fractures are especially frequent in patients with concomitant chronic organ failure [2,3,4], such as chronic renal failure, a chronic kidney disease (CKD) with diminished glomerular filtration rate. Most hip fractures associated with chronic renal failure occur in the elderly. About onethird of these patients die within a year after the surgery, and about 75% of the deaths is related to comorbidities [7, 8]. Damage control orthopedics (DCO) aids to adjust and optimize the overall condition of patients
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