Timing of surgery for internal fixation of intracapsular hip fractures and complications at 1 year; a 32 year clinical study of 2,366 patients at a single center |
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| Institution: | 1. Division of Trauma and Orthopaedic Surgery, Addenbrookes Hospital, Cambridge University Hospitals, Hills Road, Cambridge CB2 0QQ, United Kingdom;2. Department of Trauma and Orthopaedics, Lister Hospital, East and North Hertfordshire NHS Trust, United Kingdom;3. Department of Trauma and Orthopaedics, University Hospitals of Leicester NHS Trust, United Kingdom;4. Department of Trauma and Orthopaedics, Peterborough City Hospital, North West Anglia NHS Foundation Trust, United Kingdom;1. Section of Orthopedic Surgery, University of Calgary, Calgary, Alberta, Canada;2. Assistant Professor, University of Toronto, Orthopedic Surgeon, St. Michael''s Hospital, Toronto, Ontario, Canada;3. University of Calgary, Dept. of Surgery, 0490 McCaig Tower, Foothills Hospital, 3134 Hospital Drive NW Calgary, Alberta, T2N 5A1, Canada;1. Department of Orthopaedic Surgery, National University Hospital Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 11, Singapore 119228;2. Centre for Additive Manufacturing, National University of Singapore, 3 Research Link, #05-01, Innovation 4.0 Building, Singapore 117602;3. Department of Orthopaedic Surgery, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 11, Singapore 119228;1. Department of Orthopaedic surgery, CHA Bundang medical center, CHA university, Korea;2. Department of Orthopaedic surgery, Gyeongsang national university, college of medicine, Gyeongsang national university Changwon hospital, 1, Samjeongja-ro, Seongsan-gu, Changwon-si, Gyeongsangnam-do, 51472, Republic of Korea;1. Basaksehir Çam and Sakura City Training and Research Hospital, Department of Orthopaedics and Traumatology, ?stanbul, Turkey;2. University of Health Sciences, Kanuni Sultan Süleyman Training and Research Hospital, Department of Orthopaedics and Traumatology, ?stanbul, Turkey |
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| Abstract: | BackgroundTiming of hip fracture surgery for the internal fixation of an intracapsular fracture remains controversial and few studies to date have been able to determine the optimum time to surgery in minimizing osteonecrosis and non-union with intracapsular fractures after fixation.MethodsUsing a local hip fracture database managed by the senior author over a 32 year period, those who underwent osteosynthesis following intracapsular fractures were assessed for risk of development of non-union and osteonecrosis. Multivariate regression analysis was performed focusing on factors that were predictive of complications. Patient demographics, time from injury to surgery, fixation method, fracture pattern and complications at one year were reported. The primary outcome was whether delay to surgery contributed to risk of complications, defined as non-union or osteonecrosis. Secondary outcomes assessed the contribution of other factors to these complications.Results2,366 patients were identified with an average age of 74.7 years and 66.5% were female. 1189 (50.3%) of fractures were displaced. 481 (20.3%) had a complication at one year following fixation. 78 (3.3%) were fixed by DHS, 6 (0.3%) by cephalomedullary nail, (1257) 53.1% by cannulated screws and 1025 (43.3%) by Targon® screw. Multivariate regression revealed no significant correlation between delay to surgery and complication rates (OR 0.99, 95% CI 0.99, 1.01, p = 0.55). Significant variables include female sex (OR 2.03, 95% CI 1.58, 2.62, p<0.0001), fracture displacement (OR 4.8, 95% CI 3.79, 6.14, p<0.0001), independent mobility (OR 0.64, 95% CI 0.47, 0.87, p = 0.004) and use of Targon® screws compared to parallel screws (OR 0.61, 95% CI 0.48, 0.76, p<0.0001).ConclusionsOur study demonstrates no relationship between timing of surgery for fixation of intracapsular fracture and complication rates. Female sex and fracture displacement increased risk of complications whereas independent mobility and use of Targon® screw device in comparison to parallel screws were protective against non-union but not avascular necrosis. |
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