Hip Fracture Research Articles

What is the best surgical treatment for a young patient with a combination displaced ipsilateral femoral neck and femoral shaft fracture - one or two implants?

What is the best surgical treatment for a young patient with a combination displaced ipsilateral femoral neck and femoral shaft fracture - one or two implants?

Heterogeneous fracture toughness of human cortical bone tissue

CT-based finite element analysis (FEA) of human bones helps estimate fracture risk in clinical practice by linking bone ash density (ρash) to mechanical parameters. However, phase field models for fracture prediction require the heterogeneous fracture toughness GIc, which can be derived from the critical stress intensity factor KIc, determined through various experimental methods. Due to a lack of standards for determining cortical bone’s KIc, an experimental campaign is presented using 53 cortical specimens from two fresh frozen femurs to investigate whether a correlation exists between KIc and ρash. We investigated various experimental techniques for correlating KIc with ρash. We conducted FEAs employing the phase field method (PFM) to determine the most suitable correlation among the five possible ones stemming from the experimental methods. The ASTM standard using displacement at force application point was found to be the recommended experimental method for the estimation of KIc perpendicular to osteons’ direction KIc[MPam]=1.89ρash[gr/cc]1.88R2=0.5374.The corresponding statistical critical energy release rate bounds were determined: GIc[N/m]=321.94(ρash[gr/cc])1.69×exp(±2SD),with a standard deviation SD=0.30 representing a 95.4% confidence interval. The average GIc resulted in good correlations between the predicted fracture force by PFM-FEA of four representative specimens and experimental fracture forces. The proposed correlations will be used in CT-based PFM FEA to estimate the risk of hip and humeral fractures.

Comparing total medical costs of surgical treatment versus nonoperative care for femoral neck fractures among Alzheimer's disease patients: A retrospective cohort study

Comparing total medical costs of surgical treatment versus nonoperative care for femoral neck fractures among Alzheimer's disease patients: A retrospective cohort study

Displaced Femoral Neck Fracture in a Young Patient: Should I Perform an Open Reduction?

Displaced Femoral Neck Fracture in a Young Patient: Should I Perform an Open Reduction?

Additional Screw Added to the Femoral Neck System Could Enhance the Stability of Pauwel Type III Femoral Neck Fractures: a Finite Element Analysis

Additional Screw Added to the Femoral Neck System Could Enhance the Stability of Pauwel Type III Femoral Neck Fractures: a Finite Element Analysis

Global Trends in the Incidence and Primary Causes of Femoral Fractures, Excluding Femoral Neck Fractures: A Global Epidemiological Study.

Fractures pose a significant global health challenge, with varying incidence trends and causes across demographics and regions. This study aims to analyze global patterns in the incidence and primary causes of femoral shaft fractures. Data from the Global Burden of Disease database were analyzed for femoral fractures (excluding femoral neck fractures) by age, gender, and socio-demographic index regions. The estimated annual percentage change (EAPC) was calculated to assess trends in the incidence of femoral shaft fractures. Global femoral fracture cases increased from 8,559,886 in 1990 to 11,566,429 in 2021, a rise of 35.12%. However, the incidence rate dropped from 160.49 to 146.57 per 100,000 (EAPC: -0.35). Males consistently had higher rates, reaching 155.53 per 100,000 in 2021. The 15-49 age group recorded the most cases, while individuals aged 75 and older saw the largest rise in incidence, from 445.91 to 603.32 per 100,000. In 2021, Slovenia (616.1 per 100,000), Croatia (568.51 per 100,000), and Czechia (434.77 per 100,000) reported the highest rates, while Malawi, Kiribati, and Liberia had the lowest (<63 per 100,000). Leading causes were mechanical forces, motor vehicle injuries, and pedestrian injuries, with notable regional disparities. Although the global incidence rate of femoral shaft fractures has declined, it has risen significantly among older adults, increasing their burden. Understanding regional variations in causes is crucial for developing targeted public health interventions to address this growing issue.

A novel load-sensing sliding hip screw to aid in the assessment of intertrochanteric fracture healing.

Bone healing after sliding hip screw internal fixation of intertrochanteric hip fractures is difficult to monitor with radiography. In this study, we describe and evaluate a device to non-invasively determine the loading on the screw implant as a possible qualitative indicator of bone healing. A novel load-sensing sliding hip screw (LS-SHS) was fabricated containing a radio-dense tungsten indicator rod that moves and can be measured within the screw cannulation when the screw bends under load via plain radiography. Screw bending was assessed in intact femurs and unstable A1 intertrochanteric fractures using experimental axial loading of femoral composite Sawbones® and femoral human cadaveric specimens. Sensor readings were visually tracked using plain radiographs at each load state. The sensor exhibited linear response to implant strain in the unstable fracture indicating that the implant supported the major component of the applied load. This was consistently measurable using radiography throughout loading cycles across the mechanical and cadaveric fracture models. Sensor readings indicated that the implant was mostly unloaded in the intact models. The slope of the curve was approximately equal in the composite and cadaveric models (1.0µm/N and 0.08µm/N, respectively). Sensor noise levels were sufficient to detect 10% of the applied load of 80kg, which has the potential to qualitatively assist clinicians in tracking fracture healing progression. Clinicians must carefully monitor their patients for signs of SHS implant failure after surgery. This device quantitively measures implant loading which could qualitatively assist clinicians in the assessment of fracture healing.

Lumbar Erector Spinae Plane Block Provides Effective Postoperative Analgesia in Hip Fracture Surgery.

To compare the postoperative analgesic effectiveness of ultrasound-guided lumbar erector spinae plane (LESP) block with lumbar plexus block (LPB) in patients operated for proximal femur fractures. A randomised controlled trial. Place and Duration of the Study: Sakarya Training and Research Hospital Operation Theatre, Sakarya, Turkiye, between January and June 2023. Patients undergoing proximal femur fracture surgery were randomised to receive either an LESP block or an LPB block. The primary outcome was 24 hour opioid consumption, which was given via a standard patient-controlled analgesia protocol. The secondary outcome was postoperative pain scores (numerical rating scale between 0 and 10) at the 30th minute, 2nd, 6th, 12th, and 24th hour time points. Mann-Whitney U test was used to compare the primary and secondary outcomes. A total of 64 patients were randomised, and 53 were analysed (25 patients in the LESP group and 28 patients in the LPB group). Demographic data were comparable between the groups. Mean NRS pain scores in 30th minute, 2nd, 6th, 12th, and 24th hours were 0.7 ± 1.3, 1.2 ± 1.8, 2.2 ± 2.3, 1.8 ± 1.9, and 1.9 ± 2.0 in the LESP group and 0.5 ± 1.0, 1.1 ± 1.8, 1.6 ± 1.9, 1.9 ± 1.9, and 1.6 ± 1.7 in the LPB group, respectively without significant difference. No significant differences were observed in fentanyl consumption between the LESP group (183.6 ± 171.7µg) and LPB group (131.1 ± 113.3µg, p = 0.415). Single injection LESP block provided satisfactory postoperative analgesia and comparable opioid consumption without a major complication. Therefore, the LESP block is an effective method for hip fracture surgery as a strong alternative to the LPB. Lumbar erector spinae plane block, Lumbar plexus block, Ultrasound-guided, Hip surgery, Femur fracture, Postoperative analgesia.

Independent Association Between Frailty and Fear of Falling in Older Adults After Hip Fracture Surgery: A Cross-Sectional Study Using a Secondary Analysis.

Purpose: This study aimed to investigate the independent association between the fear of falling (FOF) and frailty in Korean older adults after hip fracture surgery. Methods: The study included 149 participants. Participants were asked to provide general characteristics and complete walking speed, grip strength, frailty, and Short Falls Efficacy Scale-International assessments. A binary logistic regression model was used to investigate the independent association of the FOF with frailty. Results: Among the participants, 49% were found to be prefrail and 24.8% were frail. Additionally, 86.5% reported a moderate to severe FOF. Participants with a FOF were 1.23 times more likely to be frail, and those aged 85 years and older were 13.25 times more likely to be frail. Conclusion: This study's findings serve as a basis for developing and applying interventions to reduce frailty in older adults after hip fracture surgery. These interventions should consider the oldest-old (≥ 85 years) age group when they are designed.

Injury-Associated Anemia in Orthopaedic Trauma: A Comprehensive Review.

» Anemia is a common comorbidity in orthopaedic trauma patients with important clinical consequences, significantly negatively affecting a patient's course following orthopaedic trauma.» Anemia remains relatively understudied in the orthopaedic trauma population with a large amount of current literature focused solely on geriatric hip fracture patients.» Greater investigation into alternatives to blood transfusions such as iron therapy or cell salvaging for treatment of anemia in the orthopaedic trauma population is needed.

Prediction of 5-Year Survival Rate After Hip Fracture Surgery Using a Comprehensive Geriatric Assessment-Based Frailty Score Model

Prediction of 5-Year Survival Rate After Hip Fracture Surgery Using a Comprehensive Geriatric Assessment-Based Frailty Score Model

Efficacy and Safety of Topical Tranexamic Acid in Elderly Hip Fractures Undergoing Surgical Treatment: Meta-Analysis of Randomized Controlled Trials

Efficacy and Safety of Topical Tranexamic Acid in Elderly Hip Fractures Undergoing Surgical Treatment: Meta-Analysis of Randomized Controlled Trials

Characterization of LIPUS Parameters Suitable for Hip Bone Fracture.

To investigate the effects of ultrasound treatment on the healing of hip bone fractures using frequencies of 0.5 MHz and 1.5 MHz with constant intensity (30 mW/cm2) at the fractured site. For the ex vivo experiments, acoustic attenuations of 0.5 MHz and 1.5 MHz ultrasound were measured and compared using different thicknesses of human cadaver and porcine tissues in a hydrophone system. For the in vivo experiments, 20 hip-fractured rabbits were divided into four groups, namely: control, 1.5 MHz with unchangeable intensity (positive control), 0.5 MHz with changeable intensity, and 1.5 MHz with changeable intensity. For the 0.5 and 1.5 MHz groups with changeable intensity, a constant intensity of 30 mW/cm2 at the fracture site was achieved using a compensation method for power transmission with reference to the acoustic attenuation. The effective intensity measured using a hydrophone was substantially reduced to 6.16 mW/cm2 from 30 mW/cm2 in the positive control device after propagating soft tissues with a thickness of 5.0 cm, with an attenuation of approximately 6.0 dB. Meanwhile, for the 0.5 and 1.5 MHz groups, the ultrasound intensity was consistently controlled at 30 mW/cm2 after passing through tissues with different thicknesses using the compensation method. In the in vivo study using a newly established hip fracture rabbit model, the best results in bone histomorphometry, mechanical properties, and histological evaluation were consistently found in the 0.5 MHz group, while the 1.5 MHz group exhibited relatively better bone healing than the positive control group. The results suggest a LIPUS frequency of 0.5 MHz together with the consistent intensity of 30 mW/cm2 at the fracture site for more effective treatment of hip bone fractures.

Biomechanical comparison of locking femoral neck plate versus cannulated screws with or without a medial buttress plate in Pauwels type 3 femoral neck fractures.

The aim of this study was to evaluate whether the locking femoral neck plate (LFNP) can be an alternative fixation method to the cannulated screws with a medial buttress plate. For this purpose, we compared biomechanically the LFNP and cannulated screws with or without a medial buttress plate in Pauwels type 3 femoral neck fractures. A vertical fracture model was created at an 80-degree angle to the femoral neck in 28 synthetic bone models. The models were randomly divided into 4 groups, each containing 7 bones each. The bone fracture models were fixed with 3 parallel cannulated screws in group 1, 3 parallel cannulated screws combined with a medial buttress plate in group 2, LFNP in group 3, LFNP combined with a medial buttress plate in group 4. The stability of the specimens was tested biomechanically at a 7° valgus inclination to simulate normal 2-legged weight-bearing through an anatomical femur. The forces corresponding to 0.5 mm, 1 mm, 1.5 mm, and 2 mm displacement and failure loads were calculated in all groups. The axial load values corresponding to 4 di!erent fracture displacements and the failure load values of the groups were compared, group 1 was significantly weaker (P < .05 for each) while group 4 was significantly stronger (P < .05 for each) compared to the other groups. There was no statistically significant di!erence between group 2 and group 3 (P > .05 for each). The results of this biomechanical study showed that the LFNP fixation system provided su"cient biomechanical stability for unstable Pauwels type 3 femoral neck fractures. The biomechanical performance of LFNP was similar to that of cannulated screws with medial buttress plate and better than that of cannulated screws alone. This suggests that LFNP can be a promising stable alternative fixation method to cannulated screws with a medial buttress plate in unstable femoral neck fractures.

A NEW ANALYTICAL METHOD FOR RISK FACTOR IDENTIFICATION IN ANALYZING LONGITUDINAL POSTFRACTURE RECOVERY OUTCOMES

Abstract Hip fracture is a highly disabling event experienced disproportionately by older adults with Alzheimer’s disease or related dementias (ADRD). Older adults with ADRD are up to three times more likely than cognitively intact older adults to sustain a hip fracture, have worse functional outcomes, and spend more than 50 fewer days at home (DAH) in the year after fracture. Given the significant consequences of hip fracture among older adults, improving recovery for those with ADRD is a crucial national priority. However, the population of patients with ADRD is highly heterogeneous, hindering our ability to risk stratify patients and focus interventions on those at highest risk and with greatest likelihood of benefit. We develop a new data science approach to unbiasedly detect high-dimensional patient-level risk factors associated with less DAH, while existing toolboxes may fail to address potential biases from unmeasured hospital-level confounders, informative hospital size, and loss to follow-up in analyzing Medicare claims. Analysis of 16562 Medicare beneficiaries with ADRD, aged 65 or above, and experienced a hip fracture between 2017 and 2019 demonstrated that older age, longer length of stay in the hospital, heavier comorbidity burden, and less days at home before fracture are significantly associated less days spent at home in the 12-month period after hip fracture (p&amp;lt;.05), while existing methods fail to detect some effects. Findings demonstrate that the proposed method can overcome bias in using Medicare data and can lead to findings that may inform target for intervention to promote healthy aging.

SEX-SPECIFIC BIOMARKER PREDICTION OF FEMORAL NECK BONE LOSS AFTER HIP FRACTURE

Abstract Hip fracture exacerbates age-related inflammation and metabolic dysfunction, which could accelerate bone loss post-fracture. This study aimed to develop biomarker prediction models for declines in femoral neck bone mineral density (BMD) after hip fracture. Participants were Caucasian men (n=99) and women (n=75) from the Baltimore Hip Studies 7th cohort with a hip fracture who were not receiving glucocorticoids, sex-hormone therapy, or bone-active medications. Data were collected at baseline (within 15 days of admission) and 2-, 6-, and 12-months later. Biomarkers were categorized into tertiles: interleukin-1 receptor antagonist (IL-1RA), interleukin-6 (IL-6), soluble tumor necrosis factor-alpha (TNF-alpha) receptor type 1, estradiol (E), testosterone (T), intact parathyroid hormone (iPTH), sex hormone binding globulin (SHBG), insulin-like growth factor-1 (IGF-1), C-terminal telopeptide of type I collagen (CTX), and procollagen type I N-propeptide (PINP). Femoral neck BMD was measured using dual energy x-ray absorptiometry. Mixed-effects models adjusted for age, height, and weight estimated 1-year changes in femoral neck BMD after hip fracture. Bone loss was classified as accelerated for intra-individual changes that exceeded the mean decline. Logistic regression models were stratified by biological sex and implemented using stepwise selection. The area under the curve (AUC) estimate among men was 0.68, and biomarkers related to bone loss were E, IGF-1, SHBG, and CTX. Similarly, the AUC metric among women was 0.69, but identified biomarkers were IL-6, iPTH, IGF-1, and SHBG. Findings indicate that both inflammatory and hormonal biomarkers relate to accelerated bone loss post-fracture; however, there are differential associations in physiological mechanisms between men and women.

Functional Outcomes, Operating Time, Bleeding Rate and Weight Bearing in Short Vs Long PFNA in IT Femur Fracture

Objective: In order to manage intertrochanteric (IT) femur fractures, this study compares the functional outcomes, operating time, bleeding rate, and weight-bearing capability using short and long proximal femoral nail antirotation (PFNA). Methods: Patients who received PFNA for IT femur fractures between April and September of 2024 were the subjects of a retrospective investigation. Based on the length of the PFNA used, sixty patients were split into two groups: thirty received a short PFNA and thirty received a long PFNA. The time it took to reach full weight-bearing, operating time, intraoperative bleeding rate, and functional results as measured by the Harris Hip Score (HHS) at 6 and 12 weeks were among the important factors assessed. A statistical analysis was performed on the data to identify any noteworthy variations between the two groups. Results: There were 60 patients in the trial; 30 were in the long PFNA group and 30 were in the short PFNA group. The short PFNA group had an average operating duration of 45 minutes, which was considerably less than the long PFNA group's 65 minutes (p&lt;0.05). The short PFNA group experienced a considerably lower intraoperative blood loss (average of 140 ml) than the long PFNA group (average of 210 ml) (p&lt;0.05). The HHS's measure of functional outcomes showed no statistically significant difference in scores at 12 weeks (p=0.65) between the two groups. There was no discernible difference in the recovery period between the two groups' average time to reach full weight-bearing, which was 8 weeks. The lengthy PFNA group had slightly fewer complications, such as fixation failure, but the difference was not statistically significant (p=0.58). Conclusion: Reduced operating time and less intraoperative bleeding are two benefits of short PFNA, without sacrificing weight-bearing ability or functional results. While both short and long PFNA offer comparable functional outcomes, addressing IT femur fractures may benefit more from short PFNA's potential for greater effectiveness and safety. Additional investigation, including prospective studies, is important to corroborate these results and evaluate enduring consequences.

IMPACT OF FRAILTY AND DEMENTIA ON REHABILITATION OUTCOMES IN OLDER ADULTS SURGICALLY TREATED FOR HIP FRACTURE

Abstract We investigated the impact of frailty and dementia on rehabilitation outcomes after hip fracture (HF) surgery in an Italian Orthogeriatric Unit (OGU). We prospectively enrolled all patients aged ≥70 years admitted to the OGU at Sondrio Hospital (Italy) in 2011-2019, with HF requiring surgery. We administered a comprehensive geriatric assessment, including factors related to fracture and surgery. A frailty index (FI) based on 16 variables expressed frailty (FI=number of deficits/16), with which we obtained three categories: fit (FI&amp;lt; 0.15; reference), mild (0.15&amp;lt; FI&amp;lt; 0.34), moderate-to-severe (FI≥0.35). Among 818 participants (mean age 85.6 years, 83.3% females), 21.6% had pre-existing dementia. The average time-to-surgery was 1.9 days (77.6% in spinal anesthesia). Rehabilitation success, i.e. Rehabilitation Efficiency Index (REI)&amp;gt;0.5, was achieved by 70.2% of subjects. From multivariable logistic regression, factors impacting rehabilitation success were frailty (both categories), dementia (OR: 0.14, 95% CI: 0.10-0.21), and age ≥90 years (OR: 0.37, 0.21-0.64). The chances of rehabilitation success were lower for patients with dementia than for those without. Although there is no clear link between age and rehabilitation success, frailty has a decreasing influence as age increases. In nonagenarians, severe frailty does not limit rehabilitation success as much as in younger patients. Previous research showed that dementia potentially acts as a surrogate for frailty in predicting post-operative 1-year mortality after HF surgery. We show that dementia and frailty significantly influence rehabilitation success, thus early mobilization and initiation of physical therapy regardless of age should target non only frail subjects, but also those with dementia, possibly with specifically dedicated interventions.

NEIGHBORHOOD SOCIOECONOMIC DISADVANTAGE AND RECOVERY AFTER HIP FRACTURE: EVIDENCE FROM REAL-WORLD MEDICARE DATA

Abstract Neighborhood environments—or the exposome—are a powerful influence on function recovery among older adults. This study examines the influence of neighborhood socioeconomic disadvantage on the recovery trajectory of older adults following a fall-related hip fracture. Utilizing Medicare fee-for-service claims data, we identified 52,012 older adults with hip fractures via ICD-9 and ICD-10 codes, and identified fall-related mechanisms using validated E codes in claims. These individuals were linked to the Area Deprivation Index (ADI) using 9-digit ZIP codes, categorizing them into the top 10%, bottom 10%, and middle 80%. Days at home, a validated claims-based measure, was calculated for each participant over 6 months. We employed weighted generalized estimating equations with a Poisson distribution to account for the time-varying probability of death in each post-fracture month, and adjusting for age, sex, medical complexity, time (quadratic), and pre-fracture days at home to estimate rate ratios and predicted mean counts of days at home by ADI group. The cohort’s mean age was 82.1 years (SD = 8.1), with 74% female sex. In adjusted models, individuals in the lowest socioeconomic neighborhoods spent more than 7% fewer days at home (RR=0.93, 95% CI 0.91, 0.94) compared to their counterparts in the wealthiest 10%, translating to nearly 8 more days alive and in facilities—exceeding clinically important differences reported in prior work. The study highlights the need for tailored rehabilitation strategies and community support systems that address the unique barriers encountered by this vulnerable population, promoting equitable recovery outcomes across different socioeconomic contexts.

RISK FACTORS FOR MORBIDITY AND MORTALITY IN PROXIMAL FEMORAL FRACTURES

Proximal femoral fractures (hip fractures) are a major public health concern, particularly in the elderly, due to their high morbidity and mortality rates. This retrospective descriptive study, conducted at the Mohammed V Military Teaching Hospital between January 2018 and June 2021, aimed to identify risk factors for short- and long-term morbidity and mortality in patients over 50 years of age undergoing surgery for proximal femoral fractures. A total of 125 patients were included in the study. The analysis revealed several significant risk factors for morbidity and mortality, including age over 70, anemia, preoperative renal insufficiency, and delayed treatment beyond 48 hours. Multivariate analysis indicated that treatment delay was the only statistically significant factor associated with postoperative morbidity and mortality (p=0.015). Postoperative complications were found to be associated with neurological, cardiovascular, respiratory, thromboembolic, and chronic pain, with significant relationships to anesthesia techniques, prolonged hospitalization, and pre-existing comorbidities. In-hospital mortality was 4%, with a 3-month mortality rate of 8.8% and a 1-year mortality rate of 20.8%. The study highlighted the impact of early surgical intervention, revealing that a delay in treatment by more than 48 hours was associated with a higher risk of complications and mortality. Furthermore, the study explored the influence of anesthesia techniques on patient outcomes, noting a slightly higher incidence of mortality in patients receiving general anesthesia compared to spinal anesthesia, though the difference was not statistically significant. The findings emphasize the importance of early intervention, identification of risk factors, and the need for multidisciplinary care to improve patient outcomes and reduce the burden of these fractures on healthcare systems.