Jennison T, Yarlagadda R
Department of Trauma and Orthopaedics, Plymouth Hospitals NHS Trust, Derriford Rd., Crownhill, Plymouth, PL6 8DH, United Kingdom.
Injury. 2018 Mar;49(3):702-704. doi: 10.1016/j.injury.2018.01.001. Epub 2018 Jan 2.
Mortality rates following hip fractures are decreasing. As these outcomes improve, it increases the potential for further falls and the potential to sustain a periprosthetic fracture. The aim of this study was to analyse the 1 year mortality of periprosthetic fractures around an implant used to treat an extracapsular hip fracture. Secondary outcomes included 30 day mortality, complications and risk factors associated with mortality.
A retrospective case note and radiographic review of all patients who presented to a single institution with a periprosthetic femoral fracture around an implant previously used to treat an extracapsular hip fracture between 1st January and 2008 and 31st May 2015.
29 patients with a mean age of 75.8. 6 males and 23 females. 20 (69.0%) patients had capacity to consent for surgery. Pre-operatively 34.5% mobilised independently without any walking aids. 79.3% lived at home. 62.1% had a Charlson co-morbidity score of 0 or 1, 27.6% a score of 2 or 3, 6.9% a score of 4 and 5, and 3.4% a score of more than 5.3.4% was ASA grade 1, 13.8% ASA2, 65.5% ASA 3 and 17.2% were ASA 4. The previous implant a dynamic hip screw in 75.9% dynamic hip screws and an intramedullary nail in 24.1%. There were 4 (13.8%) in-patient deaths. The 30 day mortality 17.2% (5 patients) was and the 1 year mortality was 44.8% (13 patients). There were 0 complications that required return to surgery during admission. 1 patient with a revision intramedullary nail had dynamisation performed due to delayed union 7 months following surgery. 1 patient required removal of metalwork 2 years following surgery for infection. When comparing risk factors for mortality, there were no significant risk factors found in this study for 30 day and 1 year mortality.
This paper suggests that periprosthetic fractures sustained after the surgical treatment of extra capsular neck of femur fractures have higher mortality rates than hip fractures. These patients should be given the same priority as these patients in there management.
髋部骨折后的死亡率正在下降。随着这些结果的改善，进一步跌倒的可能性以及发生假体周围骨折的可能性增加。本研究的目的是分析用于治疗囊外髋部骨折的植入物周围假体周围骨折的1年死亡率。次要结局包括30天死亡率、并发症以及与死亡率相关的危险因素。
对2008年1月1日至2015年5月31日期间在单一机构就诊的所有假体周围股骨骨折患者的病历和影像学资料进行回顾性分析，这些患者之前接受过用于治疗囊外髋部骨折的植入物治疗。
29例患者，平均年龄75.8岁。男性6例，女性23例。20例（69.0%）患者有能力同意手术。术前，34.5%的患者无需任何助行器即可独立活动。79.3%的患者居家生活。62.1%的患者Charlson合并症评分为0或1，27.6%的评分为2或3，6.9%的评分为4和5，3.4%的评分为超过5。3.4%为ASA 1级，13.8%为ASA2级，65.5%为ASA 3级，17.2%为ASA 4级。先前的植入物中，75.9%为动力髋螺钉，24.1%为髓内钉。有4例（13.8%）住院死亡。30天死亡率为17.2%（5例患者），1年死亡率为44.8%（13例患者）。住院期间无需要再次手术的并发症。1例接受翻修髓内钉治疗的患者因术后7个月骨不连进行了动力化处理。1例患者术后2年因感染需要取出内固定物。在比较死亡率的危险因素时，本研究未发现30天和1年死亡率的显著危险因素。
本文表明，股骨颈囊外骨折手术治疗后发生的假体周围骨折的死亡率高于髋部骨折。在治疗这些患者时，应给予他们与髋部骨折患者相同的优先级。
