Bhadresha Ashwin, De Chiranjit, El Tagy Hassan, Neelapala Venkata, Veettil Manoj
Trauma and Orthopaedics, The Royal London Hospital, London, GBR.
Trauma and Orthopaedics, William Harvey Hospital, Ashford, GBR.
Cureus. 2022 Nov 27;14(11):e31937. doi: 10.7759/cureus.31937. eCollection 2022 Nov.
Introduction The incidence of periprosthetic femoral fractures (PPF) is expected to rise by 4.6% every decade over the next 30 years. The risk of mortality for patients who sustained a PPF was found to be similar to the mortality rate after a native hip fracture, and so The National Institute for Health and Care Excellence (NICE) guidelines advocate the timely management and mobilisation for patients with PPFs. Patient outcomes following these complex surgeries can be highly variable owing to the variability in regional practice and service delivery. This study aimed to review the management trend and outcomes of periprosthetic fractures (PPFs) involving hip and knee prostheses at a busy district general hospital in order to improve the overall efficacy in managing these complex fractures. Methods This retrospective study included 67 patients who presented to a single district general hospital during a two-year period. Data was collected on demographic profile, further onward referral to a tertiary centre, management (operative versus conservative), timing of surgery, complications, length of stay, implant survivorship, 30-day, one-year, and two-year mortality rate. Results Out of the total of 67 PPFs, 51 (76%) were managed operatively, and 16 (24%) were managed conservatively. Of the operatively managed PPFs, 49 (96%) were managed locally at the district general hospital, and two (4%) were managed at the tertiary centre. Eighteen patients (37%) underwent both revision and fixation, whilst 31 (63%) underwent fixation alone. The mortality rates at 30 days, one year, and two years were 10.4%, 20.9%, and 25.4%, respectively. For PPF patients managed operatively, the mean time taken from presentation to operation was 89.2 hours. The overall mean length of hospital stay for all patients was 23.6 days. Eight patients suffered complications. The implant survivorship at two years was 98%. Conclusion This study adds objective support for the successful operative management of PPFs at district general hospitals. However, improvement is required in service delivery and the efficacy of management. This could be achieved by a national database for PPFs, improved resource allocation, and prompt logistical support.
预计在未来30年里，人工关节周围股骨骨折（PPF）的发病率每十年将上升4.6%。研究发现，发生PPF的患者的死亡率与髋部原发性骨折后的死亡率相似，因此英国国家卫生与临床优化研究所（NICE）的指南提倡对PPF患者进行及时的治疗和活动。由于地区实践和服务提供的差异，这些复杂手术的患者预后可能有很大差异。本研究旨在回顾一家繁忙的地区综合医院中涉及髋部和膝部假体的人工关节周围骨折（PPF）的治疗趋势和结果，以提高管理这些复杂骨折的整体疗效。
这项回顾性研究纳入了在两年期间到一家地区综合医院就诊的67例患者。收集了人口统计学资料、进一步转诊至三级中心的情况、治疗方式（手术治疗与保守治疗）、手术时机、并发症、住院时间、植入物存活率、30天、1年和2年死亡率等数据。
在总共67例PPF中，51例（76%）接受了手术治疗，16例（24%）接受了保守治疗。在接受手术治疗的PPF中，49例（96%）在地区综合医院进行了局部治疗，2例（4%）在三级中心进行了治疗。18例患者（37%）接受了翻修和固定手术，而31例（63%）仅接受了固定手术。30天、1年和2年的死亡率分别为10.4%、20.9%和25.4%。对于接受手术治疗的PPF患者，从就诊到手术的平均时间为89.2小时。所有患者的总体平均住院时间为23.6天。8例患者出现并发症。两年时植入物存活率为98%。
本研究为地区综合医院成功手术治疗PPF提供了客观支持。然而，在服务提供和治疗效果方面仍需改进。这可以通过建立全国性的PPF数据库、改善资源分配和及时的后勤支持来实现。
