Yoo Je-Hyun, Kim Ki-Tae, Kim Tae-Young, Hwang Ji-Hyo, Chang Jun-Dong
Department of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea.
Department of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea.
Injury. 2017 Feb;48(2):441-446. doi: 10.1016/j.injury.2016.12.013. Epub 2016 Dec 23.
Displaced femoral neck fracture in elderly patients has been treated with hemiarthroplasty as the treatment of choice. Fever following HA is common in these elderly patients. The aim of this study was to determine which post-HA fever workup could be beneficial in this group of patients.
A total of 272 consecutive patients aged ≥70 years undergoing HA for displaced femoral neck fracture were retrospectively investigated. Postoperative fever (POF) was defined as any recorded body temperature ≥38°C in the early postoperative period. POF in each patient was characterized by the maximum temperature, the day of the first fever, and frequency of fever, stratified as either single or multiple fever spikes. Medical records were reviewed to identify positive fever workups and febrile complications.
Of 272 patients, 135 (49.6%) developed POF. A total of 428 routine diagnostic tests were performed in all patients with POF, of which only 57 tests (13.3%) were positive. Urinalysis showed the highest positive rate (21.9%), followed by urine culture (14.3%), chest x-ray (12.6%), and blood culture (1.1%). The most common febrile complication was pneumonia (12.6%), followed by urinary tract infection (8.1%). On multivariate logistic regression for positive workups, only fever after postoperative day (POD) 2 was a risk factor for positive chest x-ray (OR 3.86, p=0.016) and urine culture (OR 5.04, p=0.019). Moreover, fever after POD 2 (OR 6.93, p<0.0001) and multiple fever spikes (OR 2.92, p=0.026) were independent predictors of infectious febrile complications.
Routine workup for POF following hemiarthroplasty in elderly patients with displaced femoral neck fracture is not warranted. However, for fever after POD 2 and multiple fever spikes, chest x-ray and urinalysis would be necessary to rule out the two most common febrile complications such as pneumonia and urinary tract infection.
老年患者移位型股骨颈骨折一直以半髋关节置换术作为首选治疗方法。这些老年患者在半髋关节置换术后发热很常见。本研究的目的是确定哪种半髋关节置换术后发热检查对该组患者有益。
回顾性调查了272例年龄≥70岁因移位型股骨颈骨折接受半髋关节置换术的连续患者。术后发热（POF）定义为术后早期记录的任何体温≥38°C。每位患者的POF以最高体温、首次发热日期和发热频率为特征，分为单次或多次发热高峰。查阅病历以确定阳性发热检查结果和发热并发症。
272例患者中，135例（49.6%）出现POF。所有POF患者共进行了428项常规诊断检查，其中仅57项检查（13.3%）呈阳性。尿液分析显示阳性率最高（21.9%），其次是尿培养（14.3%）、胸部X线检查（12.6%）和血培养（1.1%）。最常见的发热并发症是肺炎（12.6%），其次是尿路感染（8.1%）。在对阳性检查结果进行多因素逻辑回归分析时，仅术后第2天（POD）后发热是胸部X线检查阳性（OR 3.86，p = 0.016）和尿培养阳性（OR 5.04，p = 0.019）的危险因素。此外，POD 2后发热（OR 6.93，p < 0.0001）和多次发热高峰（OR 2.92，p = 0.026）是感染性发热并发症的独立预测因素。
对于老年移位型股骨颈骨折患者，半髋关节置换术后POF的常规检查并无必要。然而，对于POD 2后发热和多次发热高峰，有必要进行胸部X线检查和尿液分析以排除肺炎和尿路感染这两种最常见的发热并发症。
