The stability of intertrochanteric fractures depends upon multiple factors including the fracture displacement, location and pattern, the type of fixation used for stabilization, and the loading that ...the fracture undergoes postfixation. Traditional classification systems are of limited utility because they typically stratify intertrochanteric fractures as stable or unstable based purely on the fracture pattern without consideration of the stability after fixation. Biomechanical studies evaluating the stability of various fixation constructs should include physiologic loading, including rotation around the axis of the femoral neck, and reproduce clinical failure modes to be clinically relevant. A growing body of evidence indicates that the type of fixation substantially affects postoperative stability of intertrochanteric fractures.
Periprosthetic Femur Fractures Ricci, William M
Journal of orthopaedic trauma,
2015-March, Letnik:
29, Številka:
3
Journal Article
Recenzirano
Successful treatment of periprosthetic femur fractures, like all fractures, requires careful attention to understand the fracture pattern nuances, identifying and executing a rational treatment ...approach, and providing an appropriate postoperative recovery protocol. Unlike most other fractures, modification of standard techniques is often required to obtain a stable fixation construct, and there is a greater role for revision arthroplasty in the treatment of periprosthetic fractures. Optimal indications for surgical repair versus revision arthroplasty and optimal postoperative weight-bearing protocols remain uncertain. Reported outcomes for patients with periprosthetic femoral shaft fractures are generally good and are relatively consistent. Results for periprosthetic distal femur fractures, however, are less good and more inconsistent. Both periprosthetic femoral shaft and distal femur fractures are associated with relatively high mortality rates, approaching that of patients with hip fractures. This review should provide insight into the current solutions and challenges for the treatment of patients with periprosthetic femur fractures.
OBJECTIVE:To evaluate inpatient outcomes among patients with hip fracture treated during the COVID-19 pandemic in New York City.
DESIGN:Multicenter retrospective cohort study.
SETTING:One Level 1 ...trauma center and one orthopaedic specialty hospital in New York City.
PATIENTS/PARTICIPANTS:Fifty-nine consecutive patients (average age 85 years, range65–100 years) treated for a hip fracture (OTA/AO 31, 32.1) over a 5-week period, March 20, 2020, to April 24, 2020, during the height of the COVID-19 crisis.
MAIN OUTCOME MEASUREMENTS:COVID-19 infection status was used to stratify patients. The primary outcome was inpatient mortality. Secondary outcomes were admission to the intensive care unit, unexpected intubation, pneumonia, deep vein thrombosis, pulmonary embolus, myocardial infarction, cerebrovascular accident, urinary tract infection, and transfusion. Baseline demographics, comorbidities, treatment characteristics, and COVID-related symptomatology were also evaluated.
RESULTS:Ten patients (15%) tested positive for COVID-19 (COVID+) (n = 9; 7 preoperatively and 2 postoperatively) or were presumed positive (n = 1), 40 (68%) patients tested negative, and 9 (15%) patients were not tested in the primary hospitalization. American Society of Anesthesiologistsʼ scores were higher in the COVID+ group (d = −0.83; P = 0.04); however, the Charlson Comorbidity Index was similar between the study groups (d = −0.17; P = 0.63). Inpatient mortality was significantly increased in the COVID+ cohort (56% vs. 4%; odds ratio 30.0, 95% confidence interval 4.3–207; P = 0.001). Including the one presumed positive case in the COVID+ cohort increased this difference (60% vs. 2%; odds ratio 72.0, 95% confidence interval 7.9–754; P < 0.001).
CONCLUSIONS:Hip fracture patients with concomitant COVID-19 infection had worse American Society of Anesthesiologistsʼ scores but similar baseline comorbidities with significantly higher rates of inpatient mortality compared with those without concomitant COVID-19 infection.
LEVEL OF EVIDENCE:Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Accuracy of Acetabular Component Position in Hip Arthroplasty Barrack, Robert L; Krempec, Jeffrey A; Clohisy, John C ...
Journal of bone and joint surgery. American volume,
2013-October-2, 2013-Oct-02, 2013-10-2, 20131002, Letnik:
95, Številka:
19
Journal Article
Recenzirano
Odprti dostop
BACKGROUND:Acetabular component malposition is linked to higher bearing surface wear and component instability. Outcomes following total hip arthroplasty and surface replacement arthroplasty depend ...on multiple surgeon and patient-dependent factors. The purpose of this study was to examine the frequency in which acetabular components are placed within a predetermined target range.
METHODS:We evaluated postoperative anteroposterior pelvic radiographs for every consecutive primary total hip arthroplasty and surface replacement arthroplasty completed from 2004 to 2009 at a single institution. Acetabular component abduction and anteversion angles were determined using Martell Hip Analysis Suite software. We defined target ranges for abduction and anteversion for both total hip arthroplasty (30° to 55° and 5° to 35°, respectively) and surface replacement arthroplasty (30° to 50° and 5° to 25°, respectively). Surgeon and patient-related factors were analyzed for risk associated with placing the acetabular component outside the target range.
RESULTS:Of the 1549 total hip arthroplasties, 1435 components (93%) met our abduction target, 1472 (95%) met our anteversion target, and 1363 (88%) simultaneously met both targets. Of the 263 surface replacement arthroplasties, 233 components (89%) met our abduction target, 247 (94%) met our anteversion target, and 220 (84%) simultaneously met both targets. When previously published target ranges of abduction (30° to 45°) and anteversion (5° to 25°) angles were used, only 665 total hip replacements (43%) met the abduction target, 1325 (86%) met the anteversion target, and 584 (38%) simultaneously met both targets. Of the surface replacement arthroplasties, 181 (69%) met the abduction target, 247 (94%) met the anteversion target, and 172 (65%) simultaneously met both targets. Low-volume surgeons were 2.16 times more likely to miss target component position compared with high-volume surgeons (p = 0.002). The odds of missing the target increased by ≥0.2 for every 5 kg/m increase in body mass index. Minimally invasive approaches, diagnosis, years of surgical experience, femoral head size, and age of the patient did not affect component position.
CONCLUSIONS:Increased odds of component malposition were found with lower-volume surgeons and higher body mass index. No other variables had a significant effect on component placement.
LEVEL OF EVIDENCE:Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
PURPOSE:The purpose of this study was to determine factors, including day of week of hospital admission, associated with delay to surgery (DTS) and increased length of stay (LOS) in patients with hip ...fractures.
DESIGN:Retrospective.
SETTING:Level I Trauma Center.
PATIENTS AND METHODS:Six hundred thirty-five consecutive patients admitted to a single hospital between January 1999 and July 2006 aged 65 years or older with a hip fracture (OTA 31) were identified retrospectively from an orthopaedic database. Demographic data, American Society of Anesthesiologists (ASA) score, hospital admission and discharge dates, the date of surgery, and details of any preoperative cardiac testing were extracted from the hospital record. These data were used to identify the day of week for hospital admission and to calculate days for DTS and hospital LOS. Linear regression was used to identify independent variables associated with DTS and increased LOS.
INTERVENTION:All patients underwent surgical treatment of a hip fracture (OTA 31).
MAIN OUTCOME MEASURES:Factors affecting DTS and LOS.
RESULTS:Independent factors associated with DTS included the day of week for hospital admission, ASA score, and the need for preoperative cardiac testing. Patients admitted Thursday through Saturday had longer DTS (mean, 2.2–2.7 days) than did patients admitted other days (mean, 1.7–1.8). DTS increased for increasing ASA1.4 days for ASA 2, 2.0 days for ASA 3, and 3.0 days for ASA 4. Those requiring preoperative cardiac testing had an increased number of days to surgery (mean, 3.2 days) than those without (mean, 1.7 days). Independent factors associated with increasing hospital LOS included ASA, the need for preoperative cardiac testing, male gender, and day of admission. LOS increased for increasing ASA6.3 days for ASA 2, 8.1 days for ASA 3, and 10.1 days for ASA 4. Those requiring preoperative cardiac testing had an increased LOS (mean, 9.4 days) than those without (mean, 7.3 days). Male patients had a longer LOS (mean, 9.8 days) than did females (mean, 7.3 days). Patients admitted on Thursday or Friday (mean, 8.5–9.1 days) had longer LOS than those admitted on other days (mean, 7.3–7.9 days).
CONCLUSIONS:This is the first study to consider and identify the day of admission and need for preoperative cardiac tests as determinants of DTS and LOS for geriatric patients with hip fracture. Relative scarcity of weekend hospital resources, when present, may be responsible for these delays. This study also confirms that patient medical condition as measured by ASA affects both DTS and LOS.
LEVEL OF EVIDENCE:Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
Background
Hip fractures in the elderly are associated with high 1-year mortality rates, but whether patients with other lower extremity fractures are exposed to a similar mortality risk is not ...clear.
Questions/purposes
We evaluated the mortality of elderly patients after distal femur fractures; determined predictors for mortality; analyzed the effect of surgical delay; and compared survivorship of elderly patients with distal femur fractures with subjects in a matched hip fracture group.
Patients and Methods
We included 92 consecutive patients older than 60 years with low-energy supracondylar femur fractures treated between 1999 and 2009. Patient, fracture, and treatment characteristics were extracted from operative records, charts, and radiographs. Data regarding mortality were obtained from the Social Security Death Index.
Results
Age-adjusted Charlson Comorbidity Index and a previous TKA were independent predictors for decreased survival. Congestive heart failure, dementia, renal disease, and history of malignant tumor led to shorter survival times. Patients who underwent surgery more than 4 days versus 48 hours after admission had greater 6-month and 1-year mortality risks. No differences in mortality were found comparing patients with native distal femur fractures with patients in a hip fracture control group.
Conclusions
Periprosthetic fractures and fractures in patients with dementia, heart failure, advanced renal disease, and metastasis lead to reduced survival. The age-adjusted Charlson Comorbidity Index may serve as a useful tool to predict survival after distal femur fractures. Surgical delay greater than 4 days increases the 6-month and 1-year mortality risks. Mortality after native fractures of the distal femur in the geriatric population is high and similar to mortality after hip fractures.
Level of Evidence
Level II, prognostic study. See the guidelines online for a complete description of evidence.
A 67-year-old man with a recalcitrant tibia nonunion with implant failure is presented. Treatment was a single-stage nonunion repair with dual-plating and anterior iliac crest bone graft using ...acetabular reamers. The technical aspects of acetabular reamer for iliac crest bone graft harvest and the principles of nonunion repair are discussed. Video available at: https://ota.org/education/ota-online-resources/video-library-procedures-techniques/anterior-iliac-crest-bone-0
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