Replacement arthroplasty versus internal fixation for extracapsular hip fractures in adults
ABSTRACT Internal fixation, commonly used for extracapsular hip fractures, may fail particularly in unstable fractures. Replacement of the hip using arthroplasty, often used for intracapsular fractures, has been used as an alternative.
To compare replacement arthroplasty with internal fixation for the treatment of extracapsular hip fractures in adults.
We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (December 2005), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 4, 2005), MEDLINE, EMBASE, the UK National Research Register, several orthopaedic journals, conference proceedings and reference lists of articles.
Randomised and quasi-randomised trials comparing replacement arthroplasty with an internal fixation implant for adults with an extracapsular hip fracture.
Both review authors independently assessed 10 aspects of trial quality and extracted data. We requested additional information from trial investigators. Where appropriate, limited pooling of data was performed.
Two randomised controlled trials including a total of 148 people aged 70 years or over with unstable extracapsular hip fractures in the trochanteric region were identified and included in this review. Both had methodological limitations, including inadequate assessment of longer-term outcome. One trial compared a cemented arthroplasty with a sliding hip screw. This found no significant differences between the two methods of treatment for operating time, local wound complications, mechanical complications, reoperation, mortality or loss of independence of previously independent patients at one year. There was, however, a higher blood transfusion need in the arthroplasty group. The other trial compared a cementless arthroplasty versus a proximal femoral nail. It also found a higher blood transfusion need in the arthroplasty group, together with a greater operative blood loss, and a longer length of surgery. There were no significant differences between the two interventions for mechanical complications, local wound complications, reoperation, general complications, mortality at one year or long-term function. None of the pooled outcome data yielded statistically significant differences between the arthroplasty and internal fixation, with the exception of the significantly higher numbers of participants in the arthroplasty group requiring blood transfusion (relative risk 1.71, 95% confidence interval 1.05 to 2.77).
There is insufficient evidence from randomised trials to determine whether replacement arthroplasty has any advantage over internal fixation for extracapsular hip fractures. Further larger well-designed randomised trials comparing arthroplasty versus internal fixation for the treatment of unstable fractures are required.
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ABSTRACT: The third proximal femur fractures are divided into medial and lateral ones. For medial fractures already exists unanimity of thought for the choice of treatment that involves the prosthetic replacement of the hip joint in patients over 60 without indications to the synthesis. Regarding the lateral femur fractures this unanimity does not exist yet even if the majority of surgeons practice treatment with osteosynthesis. We want to highlight if there are any types of lateral fractures associated with patient's clinical condition in which it might be more useful to a prosthetic replacement with the aim of being able to allow a total load and earlier deambulation, reducing complications related to a possible patient immobilization.
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ABSTRACT: Purpose Hip fractures, a common manifestation of fragility fractures, represent a major cause of morbidity and mortality in the elderly population and may have devastating consequences to the patient, their family, and society thereafter. We attempted to define the epidemiology of pertrochanteric fractures treated at a large university teaching hospital in the UK and compared our findings with the national and international literature. Methods Between April 2008 and March 2013, we conducted a retrospective cohort study at our institution. All adult patients sustaining a proximal femoral fracture were included in our study. The following parameters were collected and evaluated: (1) demographics, (2) fracture pattern, (3) American Society of Anaesthesiologists (ASA) grade, (4) type of pre-injury mobilization, and (5) method of stabilization. Our findings were then compared to the national data as published in the National Hip Fracture Database (NHFD). Results Over a period of 5 years, 3,036 proximal femoral fractures were managed at our institution, with 916 (30.2 %) being classified as pertrochanteric fractures (250 male; mean age 82.0, SD 11.2). No significant change in the incidence of pertrochanteric fractures was evident during the same period. Between 2012 and 2013, 51,705 proximal femoral fractures were recorded in England, of which 19,569 (37.8 %) were classified as pertrochanteric fractures. Comparison between pertrochanteric and intracapsular fractures with respect to their demographics did not reveal any significant difference. In female patients, the relative incidence of pertrochanteric fractures was shown to increase with age. However, this was not the case in the male population. Conclusions The incidence of pertrochanteric fractures remained unchanged over the last 5 years. The relative incidence of pertrochanteric fractures is higher in elderly females; this may be explained by reduced bone mineral density and reduced trochanteric bone strength. Rigorous preventive treatments of osteoporosis should be considered in high-risk patients, along with improved safety measures to reduce falls.European Journal of Trauma and Emergency Surgery 06/2014; 40(3):225-232. DOI:10.1007/s00068-014-0375-x · 0.38 Impact Factor
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ABSTRACT: Previous studies suggest total hip arthroplasty may have some benefits compared to hemi-arthroplasty for displaced intracapsular femoral neck fractures in patients more than 60 years of age. The primary research question of our study was whether in-hospital adverse events, post-operative length of stay (LOS) and mortality in patients 60 year of age or older differed between total hip and hemi-arthroplasty for femoral neck fracture.