Modulare inverse Frakturendoprothese bei nichtrekonstruierbarer Humeruskopffraktur des alten Menschen

Objective

Primary endoprosthetic joint replacement in non-reconstructable proximal humeral fracture in the elderly. Alternative to fracture hemi-endoprosthesis with resorption of tuberosities and secondary rotator cuff insuffiency which leads to unsatisfying functional results.

Indications

Non-reconstructable proximal humeral fracture in mainly old patients with osteoporotic bone, multifragment tuberosity fracture and degenerative rotator cuff lesion.

Contraindications

Patient not fit for surgery, pre-existing shoulder infection or sepsis, severe general medical condition, nerve damage (axillay nerve, Plexus)

Surgical technique

Deltopectoral or delta-split approach. Removal of head fragments. Reinforcement of tuberosities and exposure of glenoid. Implantation of the metaglene and fixation of glenosphere after removal of labrum and capsule. Reaming of humeral shaft and cementing of the prosthesis stem. The retroversion and height of the reverse central part then can be adjusted freely. The tuberosities can be fixed with suture at the middle part. With a titanium cable an additional compression osteosynthesis of the tuberosities can be done by direct pressing on the osseoinductive coated central part.

Postoperative management

Positioning of the arm on an abduction pillow for 4 weeks, then active exercise treatment until week 6. Free movement exercise under guidance for 6 months.

Results

Multicentre study with 43 patients (40 women, 3 men), average age 79.8 years (range 66.9–95.8 years), 36 patients with 4-part-fracture according to Neer classification. To date, follow-up of 24 patients after at least 24 months, 9 patients lost to follow-up. Mean Constant Score 65.5 points, age and gender corrected Constant Score 96.7?%. Visual Analog Scale (VAS) for pain 1.9. VAS for subjective satisfaction 7.5. Mean American Shoulder and Elbow Surgeons Shoulder Score (ASES) 72.8 points. Mean active range of motion: flexion 142.3°, abduction 135.9°, external rotation 18.6°, internal rotation 47°, the radiological evaluation so far did not show any signs of scapular notching. Complications: One dislocated acromion fracture.     

Plate fixation of proximal humerus fractures using the minimally invasive anterolateral delta split approach

Objective

Minimally invasive plate osteosynthesis of proximal humerus fractures via an anterolateral delta split approach.

Indications

All proximal humerus fractures classified as 11-A1-3, 11-B1-2 (B3), and 11-C1-2 (C3) according to the AO/OTA system.

Contraindications

Head split and closed irreducible dislocation type fractures, fractures with primary neurovascular impairment, and fractures in children with open growth plate.

Surgical technique

Beach chair position. Anterolateral delta split approach. Maintain rotator cuff insertions with nonabsorbable sutures. Reduction and K-wire retention of the tuberosities to the head fragment. Establish a tunnel along the anterolateral aspect of the proximal humerus with a blunt instrument (e.g., elevatorium). Attachment of the rotator cuff sutures to the corresponding plate holes of a 5-hole PHILOS? plate. Insertion of the plate underneath the deltoid muscle along the prepared tunnel. Preliminary fixation of the plate to the humerus head. Distal alignment of the plate and preliminary fixation. Reduction of the fracture onto the plate with a cortical screw in the shaft segment. Definitive plate fixation in the shaft and head segment. The nonabsorbable sutures are then tightened onto the plate.

Postoperative management

Immediate guided active exercise is encouraged. Weight bearing is increased according to radiological signs of consolidation.

Results

In a prospective evaluation from 2003?C2006, 29?patients (8?male and 21?female) with a mean age of 64?years (16?C91?years) were analyzed. The mean follow-up time was 12?months (6?C32?months). The operation was accomplished in 75?min (55?C155?min) with an image intensifier time of 160?s (48?C807?s). All fractures healed in a timely manner. The median Constant score reached 78?points (28?C93?points). In one case (3%), clinical evidence of a lesion of the anterior branch of the axillary nerve was found.     

Treatment of three- and four-part proximal humeral fractures with locking proximal humerus plate

Objective

The purpose of this study was to evaluate the effectiveness and complications of the locking proximal humerus plate to treat proximal humerus fractures.

Design

A retrospective clinical trial.

Setting

Department of Orthopaedics, Tianjin Medical University General Hospital.

Patients

Sixty-eight consecutive patients with three- or four-part fractures of the proximal humerus were treated with locking proximal humerus plates.

Intervention

The deltopectoral anterolateral acromial approach was used to the proximal humerus; open reduction and locking proximal humerus plate were applied.

Main outcome measurements

Constant Score was used to measure the shoulder functional recovery, and Visual Analog Scale (VAS) was used to measure subjective evaluation of pain. The radiology was observed.

Results

After average 26.7 months, the average Constant Score was 72.6 ± 13.2 points and the average VAS was 1.2 ± 0.8 points. All the complications such as screw perforation into the glenohumeral joint, screws loosening, soft tissue infections, avascular necrosis and delayed union occurred in eight cases (11.8 %).

Conclusions

The effectiveness of the locking proximal humerus plate was similar to other published literatures on treating fractures of the proximal humerus; however, a lower complications rate in short follow-up time was observed in this study. It may potentially provide a favorable option for treating three- or four-part fractures of the proximal humerus. Dealing with each particular fracture pattern, surgeons should have a decision of appropriate way to internal fixation.     

Meta-analysis comparing locking plate fixation with hemiarthroplasty for complex proximal humeral fractures

Background

There remains no consensus on the surgical treatment of complex proximal humeral fractures. In this meta-analysis, we pool available trials to compare the clinical outcomes of locking plate fixation and hemiarthroplasty for this injury.

Methods

A literature search between January 1990 and May 2012 in the main medical search engines (Pubmed, Medline, Embase search, and the Cochrane library) was included. We selected available trials that compared locking plate fixation and hemiarthroplasty in patients with complex proximal humeral fractures and that reported on functional outcomes, revisions, and method-related complications. The quality of the studies was assessed, and meta-analyses were performed with the Cochrane Collaboration’s REVMAN 5.0 software.

Results

A total of 567 patients from 9 trials were included in this meta-analysis (302 fractures treated with locking plate and 265 with hemiarthroplasty). In this comparison, we found that patients with locking plate fixation had better Constant–Murley score than with hemiarthroplasty, and hemiarthroplasty could reduce the rate of revisions and the method-related complications significantly.

Conclusions

Compared with hemiarthroplasty, patients with locking plate fixation could obtain more favorable functional outcomes, but technical detail was critical to minimize the risk of implant failure, avascular necrosis, and re-operation. As the possible significant bias and inconclusive evidence arising from the included trials, further randomized trials and observational studies should be recommended to support these finding.     

Delayed ORIF of proximal humerus fractures at a minimum of 3 weeks from injury: a functional outcome study

Purpose

To evaluate the clinical results of open reduction and internal fixation (ORIF) in proximal humerus fractures with delayed presentation.

Design

Retrospective comparative study.

Setting

Level III.

Methods

From June 2005 to June 2010, thirty-nine (39) proximal humerus fractures were treated with ORIF after a delay of 21–120 days from the initial injury. Patients were divided into three groups: (1) isolated 2-part greater tuberosity fractures; (2) part surgical neck fractures; and (3) 3- and 4-part complex fractures. The range of motion (ROM), visual analogue scale (VAS), Constant–Murley score, University of California Los Angeles (UCLA) scoring system score and Simple Shoulder Test (SST) score were all recorded. The results were analyzed with the use of the Mann–Whitney U test and stratified by age, gender, side of injury, interval from injury to surgery, and postoperative functional results. Additionally, the results of different fracture types and complications were compared across the three groups.

Results

The mean forward flexion was 143.8° ± 28.9°, external rotation was 33.2° ± 19.6°, and internal rotation was up to the T10 level. The mean VAS was 0.8 ± 1.2; the mean Constant score was 82.0 ± 15.0; the UCLA score was 27.2 ± 7.1; and the mean SST was 9.5 ± 2.0 at the last follow-up. There were no significant differences among the three groups except in internal rotation. Compared to those without any complications, patients with complications demonstrated worse ROM and a lower functional score (p < 0.05).

Conclusions

Delayed treatment of proximal humerus fractures is a challenging problem. With appropriate surgical technique, satisfactory results can be expected with respect to different fracture types, and complications may be avoided regardless of delay.

Level of evidence

Therapeutic Level IV.     

Hemiarthroplasty compared to internal fixation with percutaneous cannulated screws as treatment of displaced femoral neck fractures in the elderly: cost-utility analysis performed alongside a randomized, controlled trial

Summary

We estimated the cost-effectiveness of hemiarthroplasty compared to internal fixation for elderly patients with displaced femoral neck fractures. Over 2?years, patients treated with hemiarthroplasty gained more quality-adjusted life years than patients treated with internal fixation. In addition, costs for hemiarthroplasty were lower. Hemiarthroplasty was thus cost effective.

Introduction

Estimating the cost utility of hemiarthroplasty compared to internal fixation in the treatment of displaced femoral neck fractures in the elderly.

Methods

A cost-utility analysis (CUA) was conducted alongside a clinical randomized controlled trial at a university hospital in Norway; 166 patients, 124 (75%) women with a mean age of 82?years were randomized to either internal fixation (n?=?86) or hemiarthroplasty (n?=?80). Patients were followed up at 4, 12, and 24?months. Health-related quality of life was assessed with the EQ-5D, and in combination with time used to calculate patients’ quality-adjusted life years (QALYs). Resource use was identified, quantified, and valued for direct and indirect hospital costs and for societal costs. Results were expressed in incremental cost-effectiveness ratios.

Results

Over the 2-year period, patients treated with hemiarthroplasty gained 0.15–0.20 more QALYs than patients treated with internal fixation. For the hemiarthroplasty group, the direct hospital costs, total hospital costs, and total costs were non-significantly less costly compared with the internal fixation group, with an incremental cost of €2,731 (p?=?0.81), €2,474 (p?=?0.80), and €14,160 (p?=?0.07), respectively. Thus, hemiarthroplasty was the dominant treatment. Sensitivity analyses by bootstrapping supported these findings.

Conclusion

Hemiarthroplasty was a cost-effective treatment. Trial registration, NCT00464230.     

Treatment of Two-Part Proximal Humerus Fractures: Intramedullary Nail Compared to Locked Plating

Background

Two-part proximal humerus fractures are common orthopedic injuries for which surgical intervention is often indicated. Choosing a fixation device remains a topic of debate.

Purpose

The purpose of this study is to compare two methods of fixation for two-part proximal humerus fractures, locking plate (LP) with screws versus intramedullary nailing (IMN), with respect to alignment, healing, patient outcomes, and complications. To our knowledge, a direct comparison of these two devices in treating two-part proximal humerus fractures has never before been studied. We hope that our results will help surgeons assess the utility of LP versus IMN.

Methods

A retrospective chart review was performed on 24 cases of displaced two-part surgical neck fractures of the humerus. Twelve shoulders were treated using IMN fixation and 12 others were fixated with LP. Data collected included sociodemographic, operative details, and postoperative care and function.

Results

Radiographic comparison of fixation demonstrated an average neck-shaft angle of 124° and 120° in the IMN group and LP group, respectively. Adjusted postoperative 6-month follow-up range of motion was 134° of forward elevation in the IMN group and 141 in the LP group. The differences in range of motion and in complication rates were not found to be significant.

Conclusions

Our results suggest that either LP fixation or IMN fixation for a two-part proximal humerus fracture provides acceptable fixation and results in a similar range of shoulder motion. Although complication rates were low and insignificant between the two groups, a trend toward increased complications in the IMN group is noted.     

Latissimus-dorsi-Transfer bei nichtrekonstruierbarem Rotatorenmanschettendefekt

Objective

Improvement of glenohumeral dynamic centering and active external rotation by a transfer of the latissimus dorsi tendon to the greater tuberosity or the lateral proximal humerus.

Indications

Irreparable posterosuperior rotator cuff tears.

Contraindications

Cuff tear arthropathy, subscapularis tendon tear, deltoid insufficiency, palsy of the axillary nerve.

Surgical technique

Diagnostic arthroscopy in lateral decubitus position. Placement of suture through the biceps tendon and supragleonidal tenotomy. Posterior approach. Preparation and mobilization of a pedicled latissimus dorsi flap. Second anterior incision with delta split. Debridement of the torn rotator cuff. Insertion of suture anchors in the greater tuberosity. Passing of the muscle flap inferior to the posterior deltoid and fixation with suture anchors to the greater tuberosity (where applicable suturing with remaining rotator cuff tissue).

Postoperative management

Immobilization in a thorax abduction cast for 6?weeks. Passive exercises out of the cast (IR/ER 0-0-free and ABD/ADD free-45-0°). Active assistive exercises from week?4 postoperatively. Stepwise increase of passive range of motion from week?7. Unlimited active range of motion from week?10.

Results

After an average follow-up of 57.6 (SD?27.5) months 17?patients were examined clinically. The average age at time of surgery was 55.6 (SD?7.7) years. At follow-up the patients showed an average Constant score of 64.4?points (SD?17.4). The active external rotation in 0° abduction was 16° (SD?17). The 4?patients (23%) with a sonographically-detected retear of the latissimus flap presented worse clinical results.     

Biomechanische Untersuchung zur Refixation der Tuberkula an Frakturschulterendoprothesen

Background

Elderly patients suffering from complex, non-reconstructable fractures of the proximal humerus are commonly treated by primary implantation of a shoulder endoprosthesis. One of the most critical factors for success or failure of treatment is still the refixation of the tuberosities.

Method

Using sheep infraspinatus tendons with attached tuberosities three different suture materials were investigated. For 2 of the suture materials 4 tests were accomplished and 5 tests were carried out for the third suture material. A material testing machine was used to perform cyclic loading tests (20 mm/min, F_min = 50 N, F_max = 100 N, respectively after 50 cycles: F_max + 50 N until failure).

Results

The results showed large variations in the average maximum forces (152.4 N for suture 1, 219.9 N for suture 2 and 452.3 N for suture 3). All tests showed a high initial lengthening and caused incision-like defects in the bone or tendon and led to failure and high displacement of the tuberosities.

Conclusion

Due to these results suture materials have a limited usefulness for refixation of tuberosities as an increased risk of obstruction for bony consolidation can result.     

Reattachment of the tuberosities with cable wires and bone graft in hemiarthroplasties done for proximal humeral fractures with cable wire and bone graft: 58 patients with a 22-month minimum follow-up

OBJECTIVE: The stability of 2 fixation techniques for the tuberosities in patients with 3- or 4-part proximal humerus fractures treated with hemiarthroplasties was compared. DESIGN: Retrospective review of a nonrandomized sequential series of patients. SETTING: Level I university orthopaedic surgery department. PATIENTS: A consecutive series of 58 patients (average age, 64 years) from 1990 to 1999 with 3- and 4-part fractures of the proximal humerus. INTERVENTION: In group 1, 31 patients were treated with either a Neer or Aequalis shoulder prosthesis using nonabsorbable sutures and no bone graft for the reattachment of the tuberosities. In group 2, 27 patients were treated with either an Aequalis or Epoca shoulder prosthesis and a combination of cable fixation and bone grafting. MAIN OUTCOME MEASUREMENTS: At follow-up (average, 32 months), radiographs were taken to confirm tuberosity fixation or degree of displacement or resorption. Functional outcome was assessed by the Constant-Murley Score. RESULTS: Significantly more dislocated tuberosities were found radiographically in group 1 (10 of 13 in total, P = 0.011), and significantly more tuberosities were resorbed in group 1 (9 of 12 in total, P = 0.012). Significant differences in functional results among healed versus failed tuberosity fixation were observed for activity of daily living (P = 0.05), range of motion (P = 0.002), strength (P = 0.01), the total score (P = 0.008), and the passive rotation amplitude (P = 0.04). CONCLUSION: In hemiarthroplasties for proximal humeral fractures, the reattachment of the tuberosities with cable wire and bone grafting gives consistently better radiographic and functional results than with suture fixation alone.     

Die Humeruskopfmehrfragmentfraktur – Versorgung mit einer Humeruskopfprothese?

Background

Proximal humerus fractures are one of the most common fractures in elderly patients. In the treatment of complex proximal humerus fractures, primary hemiarthroplasty is still discussed controversially. The present study was undertaken to evaluate the results of primary hemiarthroplasty in the treatment of proximal humerus fractures with a modular prosthesis (EPOCA, Fa. Argomedical, Gifhorn, Germany).

Material and methods

A prospective study of 24 patients with complex humerus fracture (NEER: IV/4, V/4, VI/4, and head split fracture) was performed from August 2000 to December 2002. Mean age was 75.6 years (range: 52–92); 18 patients were seen for follow-up after 0.5 and 1 year, respectively. The Constant-Murley score (max. 100 points) and the UCLA Rating System (max. 35 points) were calculated for functional assessment of the operated shoulder.

Results

Fifteen patients (83%) were pain free 1 year after the operation. The Constant-Murley score improved from 52 (±17) to 56 (±18) at the second follow-up after 1 year. On the contralateral side a score of 86 (±10) was assessed (p<0.05 vs operated side). Correspondingly, shoulder function according to the UCLA Rating System improved [25 (±4); 27 (±5)].

Conclusions

Osteoporotic bone of older patients often may not permit stable internal fixation of complex proximal humerus fractures. In these situations primary hemiarthroplasty is the treatment of choice.     

Prothetik bei proximalen Humerusfrakturen

Background

The purpose of this present study was to review the functional and radiological results of patients with complex fractures of the proximal humerus who were treated with an anatomical shoulder prosthesis.

Patients and methods

Between 1999 and 2005 a total of 61 patients were treated with an anatomical trauma prosthesis after an acute fracture.

Results

Thirty-eight patients (31 women and 7 men) with a mean age of 72 (range, 31–85) years could be followed-up. The absolute Constant score averaged 57.7 of 100 (range, 32–86) points by a mean of 86 (range, 60–129) months. Postoperative active elevation averaged 105 (range, 50–180)° and active abduction averaged 96 (50–180)°. Tuberosity resorption was found in 52% (20/38) at final follow-up. The outcome was significantly better in patients with healing of the tuberosities (p?=?0.02).

Conclusion

With the use of an anatomical trauma prosthesis the reduction of the pain level is excellent while the gain in function is only slight. The bony union of the tuberosities in an anatomical position is essential to achieve good results.     

Osteosynthese dislozierter Tuberculum-majus-Frakturen mit der Bamberger Platte

Objective

Internal fixation of displaced fractures of the greater tuberosity allowing functional aftercare.

Indications

Displaced fractures of the greater tuberosity >5 mm. Displaced fractures of the greater tuberosity >3 mm in athletes or overhead workers. Multiply fragmented fractures of the greater tuberosity.

Contraindications

Displaced 3? or 4?part fractures of the proximal humerus. Nondisplaced fractures of the greater tuberosity.

Surgical technique

Exposure of the fracture of the greater tuberosity by an anterolateral approach. Open reduction and temporary retention with a Kirschner wire or a “Kugelspieß” or reinforcement of the supraspinatus tendon and distal retention. Bending and positioning of the Bamberg plate and fixation by conventional or locking screws. Optional fixation of the rotator cuff to the plate. Exact monitoring of the implant position using the image intensifier to avoid inadequate distalization of the greater tuberosity.

Postoperative management

Arm sling (e.?g. Gilchrist) for 2 weeks. Start passive assisted exercise on postoperative day 1. Movement allowed up to the pain threshold. Physiotherapeutic treatment to prevent adhesions and capsular shrinking.

Results

In all, 10 patients with displaced fractures of the greater tuberosity underwent osteosynthesis using the Bamberg plate. After a follow-up of at least 6 months, a Constant–Murley score of 94.2  points (range 91–98 points) was achieved. The patients’ average age was 45.6 years (range 29–68 years).

     

Primary fracture arthroplasty of the proximal humerus using a new and freely adjustable modular prosthesis combined with compression osteosynthesis of the tuberosities

Objective

Prosthetic joint replacement in case of non-reconstructable proximal humerus fracture in order to obtain a pain-free shoulder and an acceptable range of motion.

Indications

The non-reconstructable proximal humerus fracture in aged, frail patients (over 70?years of age or ASA?3).

Contraindications

Patient inoperable or rehabilitation is inacceptable, pre-existing infection of the shoulder, coexisting bacteremia, or rotator cuff insufficiency.

Surgical technique

Using a deltopectoral or deltoid split approach, the head fragment is removed. After reaming of the humeral canal, a stem is cemented in place. The Affinis Fracture prosthesis consists of three parts: the stem (3?sizes), a metaphyseal part (2?sizes), and a ceramic head (3?sizes). The retroversion of the metaphyseal part is freely adjustable (360°) after cementing the stem. The length can be adjusted over 1?cm. After reconstruction of the height and retroversion, the tuberosities are reattached anatomically. Finally, a compression osteosynthesis of the tuberosities is realized, using a metal cable, compressing the tuberosities directly upon the metaphyseal part.

Postoperative management

As the stability of this construct is very high, early postoperative mobilization is allowed. In order to avoid adhesion, rehabilitation exercises are started the day after surgery. During the first few days, passive mobilization, within pain limits, is performed. As soon as possible, active assisted mobilization is started. No stretching is performed, especially in rotation, before the sixth postoperative week. The arm is supported in a sling, only for analgesic reasons.

Results

Using this technique, anatomical healed tuberosities were obtained in 84% of the 44?patients with a mean Constant score of 59?points.     

Smoking as a predictor of negative outcome in diaphyseal fracture healing

Purpose

The purpose of this study was to evaluate the impact of tobacco abuse in the consolidation of fractures.

Methods

We retrospectively identified all patients with a diaphyseal fracture (femur, tibia, or humerus), between January 1999 and December 2010, in our orthopaedic trauma registry (Erasme hospital, Brussels, Belgium). Thirty-eight diaphyseal nonunions (ten femurs, 16 tibias and 12 humerus) were identified. Each nonunion was paired (on age, sex and location) with two control-healed fractures (76 control patients). The chi-squared test and a binary logistic regression were used for statistical analysis.

Results

In multivariate analysis, smoking (tobacco use) was significantly associated with nonunion, whether the fracture was open or closed (p?<?0.01). In univariate analysis, open fracture was associated with a higher risk of nonunion (p?<?0.05), while external fixation was associated with better bone healing (p?<?0.05).

Conclusion

Tobacco is confirmed as a deleterious factor for diaphyseal bone healing.     

Hemiarthroplasty versus reverse shoulder arthroplasty: comparative study of functional and radiological outcomes in the treatment of acute proximal humerus fracture

Purpose

To compare functional and radiographic results of reverse prosthesis versus hemiarthroplasty after complex displaced proximal humeral fractures in elderly patients when adequate ORIF cannot be achieved and prosthetic shoulder replacement is required.

Methods

From 2008 to 2012, 67 patients were treated with hemiarthroplasty or reverse arthroplasty. We evaluated 53 cases with an average follow-up of 27.5 months (range 12–64). Twenty-eight patients with an average age of 71.4 years were treated with a hemiarthroplasty and 25 patients with an average age of 77.3 years with a reverse prosthesis. All patients were assessed before and after surgery by Constant–ASES–DASH score, strength in abduction, ER1, ER2, and X-rays.

Results

In hemiarthroplasty group, we observed a mean Constant score of 42.3 pt, ASES score 51.3 pt, and DASH score 46.1, with an average strength of 1.3 lb in abduction and of 3.7 lb in ER1 and 1.8 lb in ER2. In reverse arthroplasty group, we measured a mean Constant of 56.2 pt, ASES 69.3 pt, and DASH score 40.4, with an average strength of 4.3 lb in abduction and of 3.3 lb in ER1 and 3.2 lb in ER2. Radiographically, it is interesting to observe that greater tuberosity healing rate was 37 % in hemiarthroplasty group compared to 84 % in reverse arthroplasty group. About complications, the highest rate was recorded in the hemiarthroplasty group.

Conclusion

Reverse shoulder arthroplasty indication is steadily increasing in acute displaced proximal humeral fracture. Pain and articular movement results appear better than those with hemiarthroplasty. Our data are similar to the international literature.

     

Shoulder hemiarthroplasty for complex humeral fractures: a 5 to 10-year follow-up retrospective study

Purpose

The purpose of this study is to review our experience with proximal humeral locking plates, including complications, functional outcomes, strength recovery and predictors of successful treatment.

Methods

Seventy unstable proximal humeral fractures were treated with open reduction internal fixation (ORIF) with the use of locking proximal humerus plate. At an average follow-up of 31 months, the clinical and subjective outcomes were evaluated, and complication was analysed.

Results

The average Constant score was 72. The mean disabilities of the arm, shoulder and hand score was 23. The average range of motion was as follows: mean range of anterior elevation and abduction 120°–150°; external rotation in abduction 64° and in adduction 44°; and internal rotation T12.

Conclusion

On the basis of the overall functional and clinical outcome obtained, it is possible to suggest that the ORIF of the proximal humerus fractures using locking plate represents a helpful option that can lead to a good clinical and functional outcome even in the most complex fractures. Level of evidence, Case Series, Treatment Study, Level IV.     

Revision rates and cumulative financial burden in patients treated with hemiarthroplasty compared to cannulated screws after femoral neck fractures

Introduction

This study compares re-operation rates and financial burden following the treatment of femoral neck fractures treated with hemiarthroplasty compared to non-displaced femoral neck fractures treated with cannulated screws.

Methods

Data was retrospectively analyzed from a prospective database at a university hospital setting on patients undergoing hemiarthroplasty after femoral neck fractures and those with non-displaced femoral neck fractures treated with cannulated screws over a 7-year period. Re-operation rates were determined and financial data was analyzed. Charges refer to amounts billed by the hospital to insurance carriers, while costs refer to financial burden carried by the hospital during treatment.

Results

There were 491 femoral neck fractures (475 patients) that underwent hemiarthroplasty (HA) and 120 non-displaced fractures (119 patients) treated with cannulated screw (CannS) fixation. Both groups had similar age, sex, Charlson co-morbidity scores, pre-operative Parker mobility scores, and 12-month mortality. There were 29 (5.9 %) reoperations in the HA group and 16 (13.3 %) in the CannS group (P = 0.007). The majority of re-operations occurred within 12 months for both groups [21/29 (72 %) HA group; 15/16 (94 %) CannS group; P = 0.13]. Average hospital charges per patient for the index procedure were higher in the HA group ($17,880 ± 745) compared to the CannS group ($14,104 ± 5,047; P < 0.001). After accounting for additional procedures related to their initial surgical fixation, average hospital charges and costs remained higher in the HA group.

Conclusion

Patients treated with hemiarthroplasty for femoral neck fractures have lower re-operation rates than patients treated with cannulated screws for non-displaced femoral neck fractures, with 80 % of re-operations occurring in the first 12 months. Hospital charges and costs to the hospital for treating patients undergoing hemiarthroplasty were higher than patients treated with cannulated screws for the index procedure alone, and after accounting for re-operations.