Treatment Of Proximal Femoral Fractures Research Articles

Lateral imaging technique of the femoral neck in a supine-semilithotomy position without a fracture table

Treatment of proximal femoral fractures in the supine position poses has certain challenges, especially due to difficulties in lateral imaging of the femoral neck in cases where there is no fracture table, such as prolonging the surgery time and increasing the dose of radiation exposure. The purpose of this study is to present the lateral imaging technique of the femoral neck by fluoroscopy on the conventional operating table in the treatment of proximal femoral fractures. We applied proximal femoral nail by positioning the healthy leg in a semilithotomy position to facilitate lateral imaging of the femoral neck by fluoroscopy while the patients were in the supine position.The study analyzed 22 patients (12 women, 10 men) with femoral pertrochanteric and basicervical fractures with the following types of fractures (9 patients had AO type 31-A1, 9 patients had AO type 31-A2, 4 patients had AO type 31-B2.1), and with a mean age of 62.1 years (33-75 years). The preparation time of the supine-semilithotomy position was about 2 minutes, and the reduction was finished within 9 intraoperative fluoroscopy exposure times. No patient suffered from a postoperative complication. The mean surgery time was 20 minutes (18-22 minutes), the average number of scopy shots was 8 (7-9), and the mean hospital stay duration was 2 days (2-2 days). We believe that the supine-semilithotomy technique is a suitable treatment option for proximal femoral intramedullary nailing and cannulated screw application. Since the lateral view of the femoral neck is obtained quickly and clearly with this technique, fluoroscopy does not need to be performed repeatedly, so fluoroscopy time and the number of shots are reduced, and the time spent by the patient and the surgical team in the surgery is shortened.

Treatment of Proximal Femur Fracture with a Newly Designed Nail: Trochanteric Fixation Nail-Advanced (TFNA)

Treatment of Proximal Femur Fracture with a Newly Designed Nail: Trochanteric Fixation Nail-Advanced (TFNA)

Clinical pathways for geriatric patients with proximal femoral fracture improve process and outcome

ObjectiveThe objective of the current study was to evaluate the implementation of clinical pathways (CPs) in hip fracture management. MethodsSix hundred and five proximal femoral fractures were prospectively included into a hospital data-base. The effects of CPs were evaluated using a pre-during-post design. Different procedural (time to surgery, length of stay, discharge, etc.) and patient outcome parameters (mortality, complications, etc.) were evaluated. ResultsIn both categories significant changes could be detected during the three-year period. E.g. significant reduction of time to surgery, improvement of discharge management, reduction of internal complications. However, no significant changes could be demonstrated for mortality or revision rate. ConclusionWe could show a relevant improvement with the implementation of clinical pathways for the treatment of proximal femoral fractures in elderly patients. Level of evidenceIII, prospective non-randomised cohort study.

Impact of Antiplatelet Therapies on Patients Outcome in Osteosynthetic Surgery of Proximal Femoral Fractures.

Background: Proximal femoral fractures should be treated in a timely manner. Affected patients often require antiplatelet therapy (APT) due to cardiovascular diseases. Guidelines recommend 5-7 days APT interruption for elective surgery. Early osteosynthetic surgery of proximal femoral fractures despite of APT should be considered. Aim of the study: To evaluate whether early osteosynthetic surgery despite of APT is associated with increased blood loss, complications and mortality. Methods: Data of patients with proximal femoral fractures, who were treated by osteosynthesis at the Department of Trauma Surgery at the Medical University of Vienna were collected retrospectively. Study groups were formed by time to surgery and APT interruption. The primary endpoint of the study was the perioperative blood loss. Secondary endpoints were complications, 30-day and 1-year mortality, time to surgery, and the total length of hospital stay. Results: The osteosynthetic treatment of proximal femoral fractures despite of APT resulted in a shorter time to surgery (13.8 vs. 66.0 h; p < 0.01). In patients on APT, the TBL (total perioperative blood loss) was higher without need for revision or an increase in the need for packed red blood cells if surgery was performed within 24 h after admission. APT had no significant influence on mortality. Patients who underwent surgery within 24 h after admission had a lower mortality. The complication rate was higher in patients who underwent surgery later than 24 h after admission. Conclusions: Surgery within 24 h after admission, regardless of APT, resulted in a shorter hospitalization length and was associated with less common complications and a lower mortality.

The value of nonoperative versus operative treatment of frail institutionalized elderly patients with a proximal femoral fracture in the shade of life (FRAIL-HIP); protocol for a multicenter observational cohort study

BackgroundProximal femoral fractures are strongly associated with morbidity and mortality in elderly patients. Mortality is highest among frail institutionalized elderly with both physical and cognitive comorbidities who consequently have a limited life expectancy. Evidence based guidelines on whether or not to operate on these patients in the case of a proximal femoral fracture are lacking. Practice variation occurs, and it remains unknown if nonoperative treatment would result in at least the same quality of life as operative treatment. This study aims to determine the effect of nonoperative management versus operative management of proximal femoral fractures in a selected group of frail institutionalized elderly on the quality of life, level of pain, rate of complications, time to death, satisfaction of the patient (or proxy) and the caregiver with the management strategy, and health care consumption.MethodsThis is a multicenter, observational cohort study. Frail institutionalized elderly (70 years or older with a body mass index < 18.5, a Functional Ambulation Category of 2 or lower pre-trauma, or an American Society of Anesthesiologists score of 4 or 5), who sustained a proximal femoral fracture are eligible to participate. Patients with a pathological or periprosthetic fractures and known metastatic oncological disease will be excluded. Treatment decision will be reached following a structured shared decision process. The primary outcome is quality of life (Euro-QoL; EQ-5D-5 L). Secondary outcome measures are quality of life measured with the QUALIDEM, pain level (PACSLAC), pain medication use, treatment satisfaction of patient (or proxy) and caregivers, quality of dying (QODD), time to death, and direct medical costs. A cost-utility and cost-effectiveness analysis will be done, using the EQ-5D utility score and QUALIDEM score, respectively. Non-inferiority of nonoperative treatment is assumed with a limit of 0.15 on the EQ-5D score. Data will be acquired at 7, 14, and 30 days and at 3 and 6 months after trauma.DiscussionThe results of this study will provide insight into the true value of nonoperative treatment of proximal femoral fractures in frail elderly with a limited life expectancy. The results may be used for updating (inter)national treatment guidelines.Trial registrationThe study is registered at the Netherlands Trial Register (NTR7245; date 10-06-2018).

Failure of the proximal locking compression plate in treatment of trochanteric femoral fractures

Treatment of proximal femoral fractures constantly draw attention of trauma surgeons because of their greater incidence. Last 10 years, shows the prevalence of intramedullary techniques, however plate osteosynthesis with proximal locking plate is still quite common in everyday practice.Objective: to conduct a retrospective analysis of treatment results of patients with proximal femoral fractures operated with locking proximal femoral plate and to identify the main mechanisms causing the high rate of unsatisfactory results. Methods: the study included 21 patients (mean age (65 ± 12) years) with fractures 31А2 and 31А3 according to the AO classification, that undergone osteosynthesis with proximal femoral LCP plate. Mean follow-up period was 7.5 months after surgery.Results: the absence of displacement and initial consolidation of the fracture was achieved in 17 of 21 patients (80.9 %). The average time of union was 6 months. Unsatisfactory results of treatment were observed in 4 cases (19.1 %). All of them were associated with fracture of the plate and nonunion of bone fragments. The fracture of the plate occurred at the level of the distal 7.3 mm locking hole in 8–9 months after the surgical intervention. In all this cases the revision surgery- implantation of proximal femoral antirotational nail (PFNA) was performed. In our opinion, such a large number of unsatisfactory results associated with excessive rigidity and an undesirable concentration of load. Conclusions: usage of proximal plates with angular stability of the screws is not always effective for the treatment of unstable fractures of the proximal femur. The high frequency of unsatisfactory results that required re-osteosynthesis with the PFNA, indicates the need for careful preoperative planning and selection of stabilization method for proximal femoral fracture treatment.

Hip Fractures: Therapy, Timing, and Complication Spectrum.

ObjectiveInvestigation of the treatment of femur fractures and the type of femur fracture‐associated complications regarding timing of surgery and length of hospital stay.MethodsIn this retrospective cohort study, a total of 358 hip fractures were evaluated retrospectively from 1 January 2008 until 31 December 2010 at a level I trauma center in Germany. Inclusion criteria was age >18 years and a proximal femur fracture. Both sexes were evaluated. Mean age was 75.5 years, most patients were female (63.7%). Intervention was the operative treatment of proximal femur fracture. Outcome parameters were time until surgery, complications, reoperations, mortality, and length of hospital stay.ResultsAmong the proximal femur fractures (n = 358), 46.6% were pertrochanteric, 11.2% subtrochanteric, and 42.2% femoral neck fractures. Operation upon hip fractures was managed regularly within 24 hours of injury (73%; mean for femoral neck: 28.3 hrs.; mean for pertrochanteric fractures: 21.4 hrs.; mean for subtrochanteric fractures: 19.5 hrs.). Delayed treatment, as well as implantation of hip total endoprosthesis (TEP), increased the overall length of hospital stay (15.4 vs 17.6 days; 18.1 vs 15.8 days). Accordingly, surgical procedures performed within 24 hours of injury resulted in a shorter hospital residence. Longest delay of operation was measured for hip fractures (28.3 hrs.).In 351 patients, secondary injuries were detected in 94 individuals (26%), with fractures being the most common secondary injury (n = 40). We recorded postoperative complications of nonsurgical and surgical origin, and 33.6% of our patient cohort displayed complications. Complications were distributed among 118 patients. There was no significant difference in complications regarding the time of operation, with most nonsurgical and surgical complications appearing within 24 hours after operation (n = 110 vs n = 31). Nonsurgical complications, such as anemia (n = 49) and electrolyte imbalances (n = 30), were observed more frequently than surgical complications (n = 107 vs n = 34); however, these complications were reduced by delay in surgery (82.0% in 6–24 hrs. vs 74.2% in ≥24 hrs.). Anticoagulant therapy and age did not affect postoperative complications. The hospital mortality of patients was 6.2%. Follow‐up was restrained to ambulatory visits in the clinic.ConclusionsSurgical management of hip fractures performed within 24 hours of injury minimizes hospital stay. We did not detect significant differences in the spectrum or number of complications regarding delay of surgery. Surgical complications mainly occur with rapid primary care, and medical complications can be reduced by more intensive preparation of patient and operation procedures.

Outcome of non-surgical treatment of proximal femur fractures in the fragile elderly population

IntroductionWith the aging of the population the rate of fragility hip fractures increases. While medical recommendations are for hasten surgical treatment, for some older patients burdened with severe comorbidities, this might be risky. AimsTo compare the outcomes of patients treated non-surgically to those of the most fragile patients treated surgically. Patients and methodsA retrospective cohort study, of individuals aged ≥65 yearswho presented with fragility hip fractures between 01.01.2011-30.06.2016, to a primary trauma center. Patients treated surgically were stratified according to their age-adjusted Charlsons' comorbidity index (ACCI) score. Patients in the upper third of ACCI score, representing the more fragile population, were compared to patients treated non-surgically. Results847 patients presented with fragility fractures. 94 (11%) were treated non-surgically and 753 (89%) underwent surgery. Medical reasons were the leading cause for non-surgical treatment (61.7%). Surgically-treated patients were stratified according to their ACCI and 114 patients with ACCI > 9 were chosen for comparison. While both groups were comparable in terms of age, the non-surgical treatment group had more female patients (p. = 0.026) and a smaller proportion of independent walkers (p < 0.001). The ACCI was higher for the surgical treatment group (p < 0.001). In-hospital mortality was similar (14.9% and 18.1% for the operative and non-surgical groups respectively, P. = 0.575). However, one-year mortality was significantly higher for the non-surgical group (48.2% vs. 67.0%, P. = 0.005). The rates of in-hospital complications and 1-year readmissions were similar. ConclusionsOperative treatment for fragility hip fracture reduces long-term mortality rates even in the more fragile patients, compared to non-surgical treatment.

Management of pre-existing anticoagulation for timely treatment of proximal femoral fractures

Proximal femoral fractures are urgent indications for surgery. In cases of delayed surgical treatment more than 48 h after hospital admittance, increased rates of general complications, local complications and mortality have been proven. Since 2015, the quality target for the external quality assurance by order of the Federal Joint Committee (G-BA) is surgical treatment within 24 h after hospital admittance for osteosynthesis and within 48 h for joint replacement. The foundations for these time intervals are the S2e guidelines for the treatment of femoral neck fractures of adults from the German Society of Trauma Surgery (DGU) and the Austrian Society of Trauma Surgery (ÖGU) and several other international guidelines. The distinction of the temporal specifications between osteosynthesis and joint replacement in Germany is unusual in comparison with other countries. For 15% of each group of patients aprolonged preoperative preparation is accepted. In the structured dialog within the external quality management anticoagulants are quoted as the most frequent reason for delayed surgery. The present review provides away to achieve compliance with statutory provisions, to minimize the risks of both bleeding and thromboembolism and to achieve surgical treatment of proximal femoral fractures within the agreed time limit.

Preliminary experience with MEDGAL DHS for treatment of proximal femoral fractures.

Background and aim of the study: The Authors report their implant’s analysis and preliminary experience with a new fixation device, the MEDGAL DHS for treatment of proximal femoral fractures, producted by MEDGAL Sp.z o.o, Niewodnicka, Poland. Materials: Between January 2019 and September 2019 in Orthopedics and Traumatology Department of Piacenza, 12 patients with stable pertrocanteric fractures were treated with the MEDGAL DHS. Results: No patients presented perioperative complications with low bleeding and mean surgical time of 40 minutes. Conclusions: DHS is an optimal implant for the treatment of stable pertrochanteric femural fractures. (www.actabiomedica.it)

融合式股骨近端交锁髓内钉治疗老年股骨近端骨折的临床研究

融合式股骨近端交锁髓内钉治疗老年股骨近端骨折的临床研究

DEXAMETHASONE - INTRATHECAL MINIMISER OF SIMPLE HAEMATHOLOGIC STRESS BIOMARKERS IN HIP FRACTURE.

SUMMARYProximal femoral fractures are the most common cause of emergency admission to hospital with high postoperative morbidity. The hypothesis was that a single shot of intrathecal dexamethasone and levobupivacaine in anaesthesia for surgical correction of proximal femoral fracture in elderly patients reduces surgical stress with better quality hospitalisation. The study included sixty elderly patients with proximal femoral fracture, ASA status 2 and 3, randomised into two groups. The study group of thirty patients received 8 mg of dexamethasone and 12,5 mg of levobupivacaine 0,5% intrathecally, DLSA group, and the parallel group of thirty patients received 12,5 mg of levobupivacaine 0,5% intrathecally, LSA group. Plasma cortisol and glucose concentrations were assessed before and after anaesthesia, pain intensity was evaluated using Visual Analogue Scale score and hospitalisation was analysed. Results showed decreased cortisol concentrations, longer analgesia duration and shorter hospitalisation in the DLSA group. Glucose concentrations did not differ significantly between the patients in either group. Enlightening the study results collected, single shot of intrathecal administration of dexamethasone in spinal anaesthesia for surgical treatment of proximal femoral fractures reduces the stress response by decreasing plasma cortisol concentrations prolonging analgesia with better rehabilitation possibilities, hence shortening hospitalisation which explains this pattern of anaesthesia.

Continuous improvement process: ortho-geriatric co-management of proximal femoral fractures.

The objective of the current study was to evaluate the effect of a quality management system on treatment and care delivery of proximal femoral fractures. Specifically, our hypothesis was that the "plan-do-check-act (PDCA)" philosophy of the ISO 9001 quality management system results in a continuous improvement process. 1015 proximal femoral fractures were prospectively included into a hip fracture database over a 5-year period, after a restructuring process with implementation of clinical pathways and standard operation procedures. A close and structured ortho-geriatric co-management (certified ortho-geriatric center) was the basis for treatment. ISO 9001 certification was granted for the first time in 2012. Procedural and patient outcome parameters were analyzed by year and evaluated statistically using SPSS 25.0. In both categories (procedural and outcome) significant changes could be detected during the 5-year period, e.g., significant reduction of time to surgery for the first 2years, improvement in discharge management, and reduction of surgical complications. However, no significant changes could be demonstrated for mortality or internal complications such as pneumonia, urinary tract infections, or postoperative delirium. However, the incidence of the latter was already on a very low level at the onset of the quality improvement process. We could show a relevant and continuous improvement of several quality indicators during a 5-year period after implementation of a quality management system based on the PDCA philosophy for the treatment of proximal femoral fractures in elderly patients. However, other parameters (internal complications, cost-effectiveness, etc.) need our close attention in the future.

Failure Prevention and Management of Complications after Proximal Femoral Fractures

Proximal femoral fractures belong to the most common fractures, especially of the elderly. There is a high load of cases and most of them have to be treated surgically. With 20% and above, the rate of complications is very high. On the one hand these are due to limited biological healing competence as well as to surgical pitfalls. Based on the literature and our own clinical experience we want to demonstrate a standard surgical treatment of proximal femoral fractures, draw attention to the most frequent complications and provide an overview of salvage procedures. Because of the aging population and increasing morbidity, trauma surgery will become even more difficult. Excellent training and knowledge about the patient are becoming more important to avoid manifold complications. Once present, these complications need a detailed analysis and further diagnostics to determine which salvage procedure should be preferred. Due to the fact that there are so many different complications and procedures, evidenced based studies with large numbers cannot be found in literature.

Risk factors for early readmission due to surgical complications after treatment of proximal femoral fractures – A Finnish National Database study of 68,800 patients

IntroductionHip fracture surgery is associated with a considerable amount medical and surgical complications, which adversely impacts the patient’s outcome and/or increases costs. We evaluated what risk factors were associated with the occurrence of early readmission due to surgical complications after hip fracture surgery. Material and methodsA nationwide database with 68,800 hip fracture patients treated between 1999 and 2011 was studied to uncover the association of readmissions with co-morbidities, fracture types, different hospital types and treatment methods using the Cox proportional hazards model. ResultsEarly readmission within three months due to hip fracture surgery complications occurred at a rate of 4.6%. Increased occurrence of readmission was found among patients with: heavy alcoholism (HR 1.38; 95% CI: 1.23–1.53); Parkinson’s disease (PD; HR 1.22; 95% CI: 1.05–1.42); pre-existing osteoarthritis (HR 2.02; 95% CI: 1.83–2.23); rheumatic disease (HR 1.44; 95% CI: 1.27–1.65); as well as those with a fracture of the femur neck, depression, presence of a psychotic disorder, an operative delay of at least three days, or previous treatment with total hip arthroplasty. ConclusionOur results indicate that there are several factors associated with an increased risk of early readmission. We suggest that in the presence of these factors, the surgical treatment method and postoperative protocol should be carefully planned and performed.

Late Presentation of an Iatrogenic Pseudoaneurysm of the Profunda Femoris Artery following Intramedullary Nailing

Introduction Hip fractures are one of the most common osteoporotic fractures, and the incidence is expected to increase in the future. Vascular injury of the femoral vessels, although uncommon, is an intermittently reported complication in the treatment of proximal femoral fractures. This may be iatrogenic or less frequently as a result of the fracture itself. The profunda femoris artery is most commonly involved, probably because of its close relationship to the femur in the subtrochanteric region. Case Presentation We report a well-documented case of pseudoaneurysm of the profunda femoris artery after intramedullary nailing of an intertrochanteric femoral fracture. Arterial damage was due to overpenetration when drilling the distal locking hole. Because of the late presentation, pressure on the medial femoral diaphysis caused severe cortical scalloping. This resulted in an obvious radiographic image rarely reported before. Conclusion This case report illustrates the uncommon complication of pseudoaneurysm after intramedullary hip nailing. Because of the risk of potentially limb- and life-threatening complications, we advise careful drilling and placement of the distal locking screw. Excessive screw length should be avoided. The injured limb should be returned to the neutral position and lower-limb traction should be reduced before drilling the distal locking hole.

Validation of Activity Tracking Procedures in Elderly Patients after Operative Treatment of Proximal Femur Fractures.

Background Early postoperative physical activity in elderly patients suffering from proximal femoral fractures may reduce mortality. We hypothesized that activity trackers can reliably and objectively monitor the in-hospital mobilization, correlating with functional independence and quality of life. Methods Three different tracker types (Fitbit™ flex, Misfit™ Shine, and Axivity AX3) at three locations (wrist, ankle, and femur) recorded steps and signal vector magnitudes (SVM) in 22 patients. They were 81 ± 8 years old, were equally distributed between the sexes, and had an ASA score of 2.5 ± 0.6. Single protocoled activity events (n = 191) were clinically categorized into 4 levels and correlated with the monitored signals. Additionally, 2 ± 1 and 8 ± 3 days after the operation, the EuroQol-5D and the Barthel-20 index supplemented this data. Results All measurements at the wrist (Fitbit, Misfit) resulted in unacceptable accuracy; however, sensitivity and specificity reached around 90% using the Misfit at the ankle. Applying this combination, the correlation between real and measured steps (R2 = 0.99) and the category discrimination were statistically significant (p < 0.002). A discriminant analysis featured the calculation of four activity levels based on SVM measurements using the Axivity tracker at the femur. A cluster analysis showed a 100% agreement between the clinically observed and the calculated activity levels. The amount of active minutes or periods and both the EuroQol-5D and the Barthel-20 indices significantly increased between the analyzed time points after the operation. However, only the Barthel-20 was associated with the measured activity levels (p < 0.01). Conclusion The Misfit and the Axivity trackers can reliably monitor activity in elderly patients after operative treatment of proximal femur fractures. However, the wear location is decisive. Objectively measured activity correlated with functional independence and quality of life.

COMplex Fracture Orthopedic Rehabilitation (COMFORT) - Real-time visual biofeedback on weight bearing versus standard training methods in the treatment of proximal femur fractures in the elderly: study protocol for a multicenter randomized controlled trial

BackgroundProximal femur fractures are a common injury after low energy trauma in the elderly. Most rehabilitation programs are based on restoring mobility and early resumption of weight-bearing. However, therapy compliance is low in patients following lower extremity fractures. Moreover, little is known about the relevance of gait parameters and how to steer the rehabilitation after proximal femur fractures in the elderly. Therefore, the aim of this prospective, randomized controlled trial is to gain insight in gait parameters and evaluate if real-time visual biofeedback can improve therapy compliance after proximal femur fractures in the elderly.MethodsThis is a two-arm, parallel-design, prospective, randomized controlled trial. Inclusion criteria are age ≥ 60 years, a proximal femur fracture following low energy trauma, and unrestricted-weight bearing. Exclusion criteria are cognitive impairment and limited mobility before trauma. Participants are randomized into either the control group, which receives care as usual, or the intervention group, which receives real-time visual biofeedback about weight-bearing during gait in addition to care as usual. Spatiotemporal gait parameters will be measured in 94 participants per group during a 30-m walk with an ambulatory biofeedback system (SensiStep). The progress of rehabilitation will be evaluated by the primary outcome parameters maximum peak load and step duration in relation to the discharge date. Secondary outcome parameters include other spatiotemporal gait parameters in relation to discharge date. Furthermore, the gait parameters will be related to three validated clinical tests: Elderly Mobility Scale; Functional Ambulation Categories; and Visual Analogue Scale. The primary hypothesis is that participants in the intervention group will show improved and faster rehabilitation compared to the control group.DiscussionThe first aim of this multicenter trial is to investigate the normal gait patterns after proximal femur fractures in the elderly. The use of biofeedback systems during rehabilitation after proximal femur fractures in the elderly is promising; therefore, the second aim is to investigate the effect of real-time visual biofeedback on gait after proximal femur fractures in the elderly. This could lead to improved outcome. In addition, analysis of the population may indicate characteristics of subgroups that benefit from feedback, making a differentiated approach in rehabilitation strategy possible.Trial registrationTrialRegister.nl, NTR6794. Registered on 31 October 2017.

A cirurgia precoce nas fraturas do fêmur proximal em idosos reduz a taxa de mortalidade?

ObjectiveTo analyze whether a reduction in the waiting time for orthopedic surgery in elderly patients with fracture of the proximal end of the femur leads to a reduction of in‐hospital mortality, six‐month mortality, and duration of hospitalization. MethodsThis was a retrospective cohort study including 81 patients with intertrochanteric and subtrochanteric fractures who underwent surgical repair between 2015 and 2016 in a referral hospital, before and after a protocol for early surgical fixation (< 48h) was implemented. ResultsMean length of stay in hospital decreased from 17 to 11 days. Regarding in‐hospital mortality rate, five patients died before the protocol was implemented, and five after. Six‐month postoperative mortality decreased from 26.7% to 19.4%. Statistical analysis showed no significant difference between groups. ConclusionThe present study demonstrated that there is a tendency to reduce the length of hospital stay and six‐month mortality when the surgery for treatment of proximal femoral fractures in the elderly is performed within 48hours of hospitalization.

Infection Versus Hematoma Following Surgical Treatment of Proximal Femoral Fractures in Geriatric Patients.

Introduction:The surgical treatment of proximal femoral fractures predominantly involves geriatric patients and is associated with high morbidity and mortality. However, analyses on postoperative infections or hematoma are rare.Methods:Patients requiring surgical revision due to infection (n = 90) or hematoma (n = 77) in the postoperative phase were identified from an electronic database of 2000 consecutive patients surgically treated for proximal femoral fractures between 2006 and 2014. Demographic and clinical data were retrieved, including information on the pathogens in patients with infection. A follow-up on morbidity and mortality was conducted via telephone for at least 2 years postsurgery.Results:The follow-up rate was 100%, and the mean age was 81.9 years. The incidence rate of infection was 4.1% (90/2000), and women were commonly affected. Staphylococcus aureus and Staphylococcus epidermidis were the most commonly detected pathogens (35.5% and 25.5%, respectively). Mixed infections were observed in 15 patients, and Methicillin-resistant Staphylococcus aureus infections were observed in only 4 patients. A total of 77 (85.6%) infections occurred within 30 days postsurgery. The implant was preserved in 76 (84.4%) patients, and resection arthroplasty was required in 14 patients. Dementia and pertrochanteric fractures were significantly more common in the infection than in the hematoma group. Although infections were associated with high mortality rates for up to 2 years postsurgery, the rates did not significantly differ from those in the hematoma control group.Conclusion:One of every 2 patients who developed an infection following the surgical treatment of a proximal femoral fracture died within 2 years postsurgery. In addition, infections were significantly associated with dementia. Avoiding postoperative infection should be a high priority in the surgical treatment of proximal femoral fractures.