PURPOSE: Femur fractures are among the most common fractures treated surgically, representing a significant challenge for the orthopedic surgeon. Peri-implant femoral fractures (PIFFs) represent a rare complication of the surgical treatment. It is necessary to pay attention during osteosynthesis, evaluating not only the fracture site but the entire femoral skeletal structure, the characteristics of the fracture, the health comorbidities, and the risk of malunion and pseudarthrosis. There are few studies on the incidence, treatment, and outcomes of PIFFs near osteosynthesis. This study aimed to investigate PIFF after osteosynthesis of femoral fractures and evaluate the mortality after surgery and the morbidity associated with these types of fractures. METHODS: A retrospective cohort study was carried out at the IRCCS Galeazzi Orthopedic Institute, Milan, Italy, between January, 2017 and December, 2022. Inclusion criteria were the presence of a femur fracture around an intramedullary nail to treat a previous fracture, follow-up ≥ 12 months, and patients aged ≥ 65 years. Exclusion criterion was intraoperative periprosthetic fractures. The data were expressed as frequency and percentage. Continuous variables were expressed as mean ± standard deviation or median and range. RESULTS: Overall, 25 patients were enrolled (88.0% female) and the mean age was 84.5 years (range of 70 - 92 years). There were 20 patients having type B PIFF and 5 having type C. In 22 patients, multiple comorbidities were found with an average Charlson comorbidity score of 5.5 and the mean time to peri-implant fracture was 38 months. After surgery, 1 patient (4.0%) presented renal failure, 1 (4.0%) needed removal surgery for their loosening, and 2 (8.0%) presented surgical site infection. Nine patients (36.0%) died within 1 year with a mortality rate of 20.0% at 30 days, 8.0% at 3 months, and 8.0% at 12 months. CONCLUSIONS PIFFs in elderly patients are associated with high short-term mortality and morbidity, so careful planning for primary fracture surgery and patient awareness to ensure prolonged compliance and a healthy lifestyle are essential for prevention.
Humans ; Female ; Male ; Aged ; Femoral Fractures/mortality* ; Retrospective Studies ; Aged, 80 and over ; Periprosthetic Fractures/epidemiology* ; Fracture Fixation, Intramedullary/adverse effects* ; Postoperative Complications/mortality*

BACKGROUND: Because acute cholecystitis in elderly hip fracture is not easily distinguishable from other gastrointestinal symptoms and involves atypical clinical behaviors, it may not be diagnosed in the early stage. However, the exact incidences could not be reported. We utilized data from a nationwide claims database and attempted to assess the incidence of acute cholecystitis in elderly hip fracture patients and how cholecystitis affects mortality rates after hip fracture. METHODS: Study subjects were from the Korean National Health Insurance Service-Senior cohort. From a population of approximately 5.5 million Korean enrollees > 60 years of age in 2002, a total of 588,147 participants were randomly selected using 10% simple random sampling. The subjects included in this study were those who were over 65 years old and underwent surgery for hip fractures. RESULTS: A total of 15,210 patients were enrolled in the cohort as hip fracture patients. There were 7,888 cases (51.9%) of femoral neck fracture and 7,443 (48.9%) cases of hemiarthroplasty. Thirty-six patients developed acute cholecystitis within 30 days after the index date (30-day cumulative incidence, 0.24%). Four of the 36 acute cholecystitis patients (11.1%) died within 30 days versus 2.92% of patients without acute cholecystitis. In the multivariate-adjusted Poisson regression model, hip fracture patients with incident acute cholecystitis were 4.35 (adjusted risk ratio 4.35; 95% confidence interval, 1.66–11.37; P = 0.003) times more likely to die within 30 days than those without acute cholecystitis. CONCLUSION: Incidence of acute cholecystitis in elderly patients after hip fracture within 30 days after the index date was 0.24%. Acute cholecystitis in elderly hip fracture patients dramatically increases the 30-day mortality rate by 4.35-fold. Therefore, early disease detection and management are crucial for patients.
Abdominal Pain ; Aged ; Cholecystitis ; Cholecystitis, Acute ; Cohort Studies ; Femoral Neck Fractures ; Hemiarthroplasty ; Hip Fractures ; Hip ; Humans ; Incidence ; Mortality ; National Health Programs ; Odds Ratio

BACKGROUND: Femoral neck fracture is common in the elderly population. Acute kidney injury (AKI) is an important risk factor for mortality in patients who have had such fracture. We evaluated the incidence of AKI in patients who had femoral neck fracture and identified risk factors for AKI and mortality. METHODS: This was an observational cohort study including 285 patients who were ≥ 65 years of age and who underwent femoral neck fracture surgery between 2013 and 2017. RESULTS: The mean age was 78.63 ± 6.75 years. A total of 67 (23.5%) patients developed AKI during the hospital stay: 57 (85.1%), 5 (7.5%), and 5 (7.5%) patients were classified as having stage 1, 2, and 3 AKI, respectively. Patients with AKI had a lower baseline estimated glomerular filtration rate and higher left atrial dimension, left ventricular mass index, pulmonary artery pressure, and the ratio of early mitral inflow velocity to early diastolic mitral annulus velocity (E/e’) and were more likely to have diabetes or hypertension (HTN) (P < 0.05). The presence of HTN (odds ratio [OR], 4.570; 95% confidence interval [CI], 1.632–12.797) higher E/e’ (OR, 1.105; 95% CI, 1.019–1.198), and lower hemoglobin (OR, 0.704; 95% CI, 0.528–0.938) were independently associated with a higher risk for developing AKI. Severe AKI (OR, 24.743; 95% CI, 2.822–212.401) was associated with a higher risk of mortality. CONCLUSION: Elderly patients with femoral neck fracture had a high incidence of AKI. Diastolic dysfunction was associated with AKI. Severe AKI was associated with in-hospital mortality.
Acute Kidney Injury ; Aged ; Cohort Studies ; Femoral Neck Fractures ; Femur Neck ; Glomerular Filtration Rate ; Heart Failure, Diastolic ; Hospital Mortality ; Humans ; Hypertension ; Incidence ; Length of Stay ; Mortality ; Pulmonary Artery ; Risk Factors

PURPOSE: Many international journals have published studies on the results of distal femoral fractures in elderly people, but only a few studies have been conducted on the Korean population. The aim of this study was to determine the factors that are associated with the outcomes and prognosis of fixation of distal femur fractures using the minimally invasive plate osteosynthesis (MIPO) technique in elderly patients (age≥60) and to determine the risk factors related witht he occurrence of nonunion. MATERIALS AND METHODS: This study is a retrospective study. From January 2008 to June 2018, distal femur fracture (AO/OTA 33) patients who underwent surgical treatment (MIPO) were analyzed. A total of 52 patients were included in the study after removing 121 patients that met with the exclusion criteria. Medical records, including surgical records, were reviewed to evaluate the patients' underlying disease, bone mineral density, the number of days delayed from surgery, complications and mortality. In addition, follow-up radiographs were used to determine bone union, delayed union and nonunion. RESULTS: The average time to achieve bone union was 19.95 weeks, the rate of nonunion was 20.0% (10/50) and the overall mortality was 3.8% (2/52). There were no significant differences in the clinical and radiological results of those patients with or without periprosthetic fracture. On the univariate analysis, which compared the union group vs. the nonunion group, no factors were identified as significant risk factors for nonunion. On the multiple logistic regression analysis, medical history of cancer was identified as a significant risk factor for nonunion (p=0.045). CONCLUSION: The rate of nonunion is high in the Korean population of elderly people suffering from distal femur fracture, but the mortality rate appears to be low. A medical history of cancer is a significant risk factor for nonunion. Further prospective studies are required to determine other associated factors.
Aged ; Bone Diseases ; Femoral Fractures ; Femur ; Follow-Up Studies ; Humans ; Logistic Models ; Medical Records ; Miners ; Mortality ; Periprosthetic Fractures ; Prognosis ; Prospective Studies ; Retrospective Studies ; Risk Factors

PURPOSE: Occult hip fractures in the elderly can be missed on standard radiographs and are a known cause of morbidity. These are generally diagnosed on either magnetic resonance imaging (MRI) or computed tomography scan, depending upon local hospital policy. While there is an abundance of literature on hip fractures in general, little is known about the clinical outcome of patients with occult hip fractures. The aim of this study was to review the demographics, injury characteristics, management and clinical outcome of patients diagnosed with occult femoral neck fractures on MRI. MATERIALS AND METHODS: Using an existing hospital database, a retrospective analysis of all patients with occult hip fractures diagnosed by MRI scan from 2005 to 2014 was conducted. RESULTS: Sixty-four patients (23 males and 41 females) were included. The mean duration of hospitalisation was 16 days. A significantly higher percentage of patients were discharged to their pre-existing residence compared to National Institute for Health and Care Excellence (NICE) commissioning guidelines (66% vs. 45%). The 30- and 60-day mortalities were 3% and 10%, respectively. Mortality was lower in patients who underwent internal fixation (n=3/31) compared with those undergoing replacement (hemi/total hip arthroplasty) (n=5/12) (P=0.056). CONCLUSION: Patients with occult hip fractures diagnosed on an MRI scan are more likely to be discharged to their pre-existing residence and have lower mortality rates compared to NICE guidelines and National Hip Fracture Database (NHFD).
Aged ; Demography ; Femoral Neck Fractures ; Femur ; Hip ; Hip Fractures ; Humans ; Magnetic Resonance Imaging ; Male ; Mortality ; Neck ; Retrospective Studies

The purpose of this study was to compare the outcomes focusing on the functional outcome and clinical results of replacement arthroplasty (AP) vs. internal fixation (IF) for the treatment of unstable intertrochanteric femoral fracture in elderly. Systematic review and meta-analysis were performed on 10 available clinical studies (2 randomized controlled trials and 8 comparative studies). Subgroup analysis was performed by type of methodological quality. Partial weight bearing time in AP group was earlier than that in IF group (SMD = −0.86; 95% CI = −0.42, 1.29; P = 0.050). The overall outcomes such as mortality, reoperation rate, and complication showed no significant diffrence between the 2 groups (AP vs. IF). Therefore, this systematic review demonstrates that AP provides superior functional outcomes especially earlier mobilization, as compared to IF in elderly patients with an unstable intertrochanteric femoral fracture.
Aged* ; Arthroplasty* ; Arthroplasty, Replacement ; Femoral Fractures ; Femur* ; Fracture Fixation ; Hip Fractures* ; Humans ; Mortality ; Rehabilitation* ; Reoperation ; Weight-Bearing

PURPOSEEarly intramedullary nailing (IMN) within the first 24 h for multiply injured patients with femoral fracture and concomitant thoracic trauma is controversial. Previously published studies have been limited in size and their outcomes have been inconclusive. A meta-analysis was conducted to evaluate the available data in order to guide care and help improve the outcomes for these patients.

METHODSWe searched the literature up to December 2011 in the main medical search engines and identified 6 retrospective cohort studies that explored the safety of early IMN in patients with both femoral fracture and chest injury. Our primary outcome was the rates of pulmonary complication (pneumonia, adult respiratory distress syndrome, fat embolism syndrome), multiple organ failure (MOF) and mortality.

RESULTSWe found no statistically significant difference in the rate of pulmonary complications, MOF or mortality in the patients treated with early IMN.

CONCLUSIONEarly IMN for femoral fractures does not increase the mortality and morbidity in chest- injured patients in the studies analyzed.

Femoral Fractures ; surgery ; Fracture Fixation, Intramedullary ; adverse effects ; methods ; mortality ; Humans ; Multiple Organ Failure ; epidemiology ; Pneumonia ; epidemiology ; Respiratory Distress Syndrome, Adult ; epidemiology ; Thoracic Injuries ; surgery

BACKGROUND: The purpose of this study is to report on the mortality of nonagenarians who underwent surgical treatment for a hip fracture, specifically in regards to preexisting comorbidities. Furthermore, we assessed the effectiveness of the Deyo score in predicting such mortality. METHODS: Thirty-nine patients over the age of 90 who underwent surgical repair of a hip fracture were retrospectively analyzed. Twenty-six patients (66.7%) suffered femoral neck fractures, while the remaining 13 (33.3%) presented with trochanteric type fractures. Patient charts were examined to determine previously diagnosed patient comorbidities as well as living arrangements and mobility before and after surgery. RESULTS: Deyo index scores did not demonstrate statistically significant correlations with postoperative mortality or functional outcomes. The hazard of in-hospital mortality was found to be 91% (p = 0.036) and 86% (p = 0.05) less in patients without a history of congestive heart failure (CHF) and chronic pulmonary disease (CPD), respectively. Additionally, the hazard of 90-day mortality was 88% (p = 0.01) and 81% (p = 0.024) less in patients without a history of dementia and CPD, respectively. The hazard of 1-year mortality was also found to be 75% (p = 0.01) and 80% (p = 0.01) less in patients without a history of dementia and CPD, respectively. Furthermore, dementia patients stayed in-hospital postoperatively an average of 5.3 days (p = 0.013) less than nondementia patients and only 38.5% returned to preoperative living conditions (p = 0.036). CONCLUSIONS: Nonagenarians with a history of CHF and CPD have a higher risk of in-hospital mortality following the operative repair of hip fractures. CPD and dementia patients over 90 years old have higher 90-day and 1-year mortality hazards postoperatively. Dementia patients are also discharged more quickly than nondementia patients.
Aged, 80 and over* ; Comorbidity ; Dementia ; Femoral Neck Fractures ; Femur ; Heart Failure ; Hip Fractures* ; Hip* ; Hospital Mortality ; Humans ; Lung Diseases ; Mortality* ; Residence Characteristics ; Retrospective Studies ; Social Conditions

OBJECTIVEIntertrochanteric femur fracture is a common injury in elderly patients. The dynamic hip screw (DHS) has served as the standard choice for fixation; however it has several drawbacks. Studies of the percutaneous compression plate (PCCP) are still inconclusive in regards to its efficacy and safety. By comparing the two methods, we assessed their clinical therapeutic outcome.

METHODSA total of 121 elderly patients with intertrochanteric femur fractures (type AO/OTA 31.A1-A2, Evans type 1) were divided randomly into two groups undergoing either a minimally invasive PCCP procedure or a conventional DHS fixation.

RESULTSThe mean operation duration was significantly shorter in the PCCP group (55.2 min versus 88.5 min, P<0.01). The blood loss was 156.5 ml±18.3 ml in the PCCP group and 513.2 ml±66.2 ml in the DHS group (P<0.01). Among the patients treated with PCCP, 3.1% needed blood transfusions, compared with 44.6% of those that had DHS surgery (P<0.01). The PCCP group displayed less postoperative complications (P<0.05). The mean American Society of Anesthesiologists score and Harris hip score in the PCCP group were better than those in the DHS group. There were no significant differences in the mean hospital stay, mortality rates, or fracture healing.

CONCLUSIONDue to several advantages, PCCP has the potential to become the ideal choice for treating intertrochanteric fractures (type AO/OTA 31.A1-A2, Evans type 1), particularly in the elderly.

Aged ; Blood Transfusion ; statistics & numerical data ; Bone Plates ; Bone Screws ; Female ; Femoral Fractures ; mortality ; surgery ; Fracture Fixation, Internal ; instrumentation ; methods ; Fracture Healing ; Hospital Mortality ; Humans ; Length of Stay ; statistics & numerical data ; Male ; Minimally Invasive Surgical Procedures ; Operative Time ; Postoperative Complications ; epidemiology ; Treatment Outcome

OBJECTIVECurrent guidelines indicate that surgery for femoral neck fracture should be performed within 24 hours. But the effect of early surgery on mortality was not consistent with each other. This study is to explore the effect of early surgery on the risk of death among elderly patients with femoral neck fracture.

METHODSBy searching Medline, PubMed, CENTRAL (the Cochrane central register of controlled trials), CBM, CNKI and VIP et al, published documents about studies of early surgery VS delayed surgery on mortality for femoral neck fractures were collected. The data were analysised by using statistic software Stata 11.0. Random or fixed effect models were applied to conduct meta analysis on the study results, the combined relative risk (RR) and the 95% confidence interval (CI) were calculated as well.

RESULTSSix cohort studies and 8 430 patients were included in the combined analysis,which indicated that 64% death risk was observed in the early surgery group compared to the delayed surgery group (RR = 0.64, 95% CI: 0.55-0.73, P = 0.000). The death was divided into two subgroups: one was early death with 30 days and the other was late death after 6 months. For the early death, there was no statistic significance between early surgery and delayed surgery (RR = 0.93, 95% CI: 0.69-1.18, P = 0.076). And for the late death, only 59% death risk was observed in the early surgery group (RR = 0.59, 95% CI: 0.49-0.69, P = 0.000) compared to the delayed surgery group.

CONCLUSIONEarly surgery was associated with a lower risk of death for femoral neck fracture patients.

Aged ; Aged, 80 and over ; Female ; Femoral Neck Fractures ; mortality ; surgery ; Humans ; Male ; Time Factors