Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg, 35043 Marburg, Germany.
AUC, Akademie der Unfallchirurgie GmbH, 80639 Munich, Germany.
Medicina (Kaunas). 2021 May 21;57(6):517. doi: 10.3390/medicina57060517.
Appropriate timing of surgery for periprosthetic femoral fractures (PFFs) in geriatric patients remains unclear. Data from a large international geriatric trauma register were analyzed to examine the outcome of patients with PFF with respect to the timing of surgical stabilization. The Registry for Geriatric Trauma of the German Trauma Society (Deutsche Gesellschaft für Unfallchirurgie (DGU)) (ATR-DGU) was analyzed. Patients treated surgically for PFF were included in this analysis. As outcome parameters, in-house mortality rate and mortality at the 120-day follow-up as well as mobility, the EQ5D index score and reoperation rate were analyzed in relation to early (<48 h) or delayed (≥48 h) surgical stabilization. A total of 1178 datasets met the inclusion criteria; 665 fractures were treated with osteosynthesis (56.4%), and 513 fractures were treated by implant change (43.5%). In contrast to the osteosynthesis group, the group with implant changes underwent delayed surgical treatment more often. Multivariate logistic regression analysis of mortality rate ( = 0.310), walking ability ( = 0.239) and EQ5D index after seven days ( = 0.812) revealed no significant differences between early (<48 h) and delayed (≥48 h) surgical stabilization. These items remained insignificant at the follow-up as well. However, the odds of requiring a reoperation within 120 days were significantly higher for delayed surgical treatment (OR: 1.86; = 0.003). Early surgical treatment did not lead to decreased mortality rates in the acute phase or in the midterm. Except for the rate of reoperation, all other outcome parameters remained unaffected. Nevertheless, for most patients, early surgical treatment should be the goal, so as to achieve early mobilization and avoid secondary nonsurgical complications. If early stabilization is not possible, it can be assumed that orthogeriatric co-management will help protect these patients from further harm.
对于老年患者的股骨假体周围骨折（PFF），手术时机仍不明确。本研究分析了一个大型国际老年创伤登记处的数据，以研究 PFF 患者手术固定的时机与预后的关系。该研究分析了德国创伤学会（Deutsche Gesellschaft für Unfallchirurgie (DGU)）老年创伤登记处（ATR-DGU）的数据。本研究纳入了接受 PFF 手术治疗的患者。作为预后参数，本研究分析了内固定死亡率和 120 天随访死亡率以及活动能力、EQ5D 指数评分和再次手术率与早期（<48 小时）或延迟（>=48 小时）手术固定的关系。共纳入 1178 例数据集，其中 665 例骨折采用内固定治疗（56.4%），513 例骨折采用假体更换治疗（43.5%）。与内固定组相比，假体更换组更常接受延迟手术治疗。多变量逻辑回归分析死亡率（ = 0.310）、行走能力（ = 0.239）和 7 天 EQ5D 指数（ = 0.812）表明，早期（<48 小时）和延迟（>=48 小时）手术固定之间无显著差异。在随访中，这些项目也无显著差异。然而，延迟手术治疗 120 天内再次手术的几率显著较高（OR：1.86； = 0.003）。早期手术治疗在急性期或中期并未降低死亡率。除再次手术率外，所有其他预后参数均未受影响。然而，对于大多数患者，早期手术治疗应该是目标，以便实现早期活动并避免继发性非手术并发症。如果不能早期稳定，可假设骨科老年科联合管理将有助于保护这些患者免受进一步伤害。
