A comparison of internal fixation and hemiarthroplasty in the management of un- or minimally displaced hip fractures in patients over 60 years old |
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| Institution: | 1. University Hospitals Sussex, Brighton BN2 5BE, United Kingdom;2. William Harvey Hospital, Ashford TN24 0LZ, United Kingdom;3. Eastbourne District General Hospital, Eastbourne BN21 2UD, United Kingdom;4. St Mary''s Hospital, London W2 1NY, United Kingdom;5. East Surrey Hospital, Redhill RH1 5RH, United Kingdom;6. Luton and Dunstable University Hospital, Luton LU4 0DZ, United Kingdom;7. Royal Surrey County Hospital, Guildford GU2 7XX, United Kingdom;8. Stoke Mandeville Hospital, Buckinghamshire HP21 8AL, United Kingdom;9. University College London Hospital, London NW1 2PG, United Kingdom;10. Addenbrooke''s Hospital, Cambridge CB2 0QQ, United Kingdom;11. Princess Royal University Hospital, Orpington BR6 8ND, United Kingdom;12. St Richard''s Hospital, Chichester PO19 6SE, United Kingdom;13. Wythenshawe Hospital, Manchester M23 9LT, United Kingdom;14. Hereford County Hospital, Hereford HR1 2ER, United Kingdom;15. Glan Clwyd Hospital, Rhyl, Wales LL18 5UJ, United Kingdom;1. University Hospitals Sussex, Brighton BN2 5BE, United Kingdom;2. William Harvey Hospital, Ashford TN24 0LZ, United Kingdom;3. Eastbourne District General Hospital, Eastbourne BN21 2UD, United Kingdom;4. St Mary''s Hospital, London W2 1NY, United Kingdom;1. Department of Orthopedic Surgery, Tazawako Hospital, 17-1 Ukiyozaka Obonai, Tazawako, Semboku, Akita, 014-1201, Japan;2. Scientific Research WorkS Peer Support Group (SRWS-PSG), 1-7-7 Koraibashi, Chuo-ku, Osaka 541-0043, Japan;3. Department of Orthopedic Surgery, Miyamoto Orthopedic Hospital, Okayama 773-8236, Japan;4. Department of Physical Therapy, Faculty of Health Care, Takasaki University of Health and Welfare, Takasaki 370-0033, Japan;1. Department of Orthopaedic Surgery and Traumatology, Sohag Faculty of Medicine, Sohag University, Sohag, Egypt;2. Department of Orthopaedic Surgery and Traumatology, Qena Faculty of Medicine, South Valley University, Kilo 6 Qena-Safaga highway, Qena, Egypt;1. Department of Orthopedic Surgery, Regional Rheumatoid and Degenerative Arthritis Center, Chungnam National University Hospital, Chungnam National University School of Medicine, 266 Munwha-ro, Jung-Gu, Daejeon, South Korea;2. Department of Orthopaedic Surgery, Chungnam National University Sejong Hospital, Chungnam National University College of Medicine, Sejong, South Korea;1. The Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou 510006, China;2. The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510006,China;3. Panyu Hospital of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou 511401, China |
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| Abstract: | BackgroundThe incidence of hip fractures in the elderly is increasing. Minimally displaced and undisplaced hip fractures can be treated with either internal fixation or hemiarthroplasty.ObjectivesTo identify the revision rate of internal fixation and hemiarthroplasty in patients 60 years or older with Garden I or II hip fractures and to identify risk factors associated with each method.MethodA retrospective analysis was conducted from 2 Major Trauma Centres and 9 Trauma Units between 01/01/2015 and 31/12/2020. Patients managed conservatively, treated with a total hip replacement and missing data were excluded from the study.Results1273 patients were included of which 26.2% (n = 334) had cannulated hip fixation (CHF), 19.4% (n = 247) had a dynamic hip screw (DHS) and 54.7% (n = 692) had a hemiarthroplasty. 66 patients in total (5.2%) required revision surgery. The revision rates for CHF, DHS and hemiarthroplasty were 14.4%, 4%, 1.2% (p<0.001) respectively. Failed fixation was the most common reason for revision with the incidence increasing by 7-fold in the CHF group 45.8% (n = 23) vs. 33.3% (n = 3) in DHS; p<0.01]. The risk factors identified for CHF revision were age >80 (p<0.05), female gender (p<0.05) and smoking (p<0.05). The average length of hospital stay was decreased when using CHF compared to DHS and hemiarthroplasty (12.6 days vs 14.9 days vs 18.1 days respectively, p<0.001) and the 1 year mortality rate for CHF, DHS and hemiarthroplasty was 2.5%, 2% and 9% respectively.ConclusionsFixation methods for Garden I and II hip fractures in elderly patients are associated with a higher revision rate than hemiarthroplasty. CHF has the highest revision rate at 14.4% followed by DHS and hemiarthroplasty. Female patients, patients over the age of 80 and patients with poor bone quality are considered high risk for fixation failure with CHF. Hemiarthroplasty is a suitable alternative with lowest revision rates. When considering an internal fixation method, DHS is more robust than a screw construct. |
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