Koh Don Jun Rui, Yeo Kuei Siong Andy, Kon Kam King Charles, Moo Ing How
Singapore Changi General Hospital, Singapore.
Geriatr Orthop Surg Rehabil. 2024 Aug 9;15:21514593241273208. doi: 10.1177/21514593241273208. eCollection 2024.
Hip fractures are a common and debilitating condition posing not only a huge health care but also socioeconomic burden. Surgical management for a neck of femur fracture is typically with arthroplasty in the form of total hip arthroplasty or hip hemiarthroplasty. Serial radiographs are typically performed routinely as part of follow-up to look for complications, although their clinical utility in asymptomatic patients is yet to be validated. Our paper therefore aims to review the utility and necessity of radiographic follow-up following arthroplasty for NOF fractures.
Patients who underwent operative management for acute fragility neck of femur fractures in the year from 1 January 2018 to 31 December 2018 at the author's institution were identified. All patients who underwent surgery, and had at least one pre and one post-operative plain film radiograph of the affected hip were included in this study. Exclusion criteria included patients who had undergone surgery for chronic fractures, avascular necrosis of the femoral head, mortality within 1 year, peri-prosthetic fractures, pathological fractures from metastases, had concomitant injuries, or had inaccessible or incomplete records. Clinical records were assessed for the number of visits, an abnormal presenting history or clinical examination, as well as changes in management of the patient. The number and type of radiographs were also assessed, and each radiograph analyzed for abnormal findings.
A total of 157 patients were included in our study with a mean age of 79.5 at the time of surgery, and a mean follow up of 17.3 months. Data was collected from 626 clinical visits and a total of 973 radiographs. The 3 abnormal radiographic series identified with a corresponding normal consult did not result in a change of management for the patient. A negative change in management was only observed in 1 patient with an abnormal consult and a corresponding normal radiograph.
Post-operative complications following arthroplasty for NOF fractures are likely to result in a symptomatic presentation of the patient. Routine radiographic follow-up provides limited utility in asymptomatic patients and should only be performed if clinically indicated.
髋部骨折是一种常见且使人衰弱的病症，不仅带来巨大的医疗保健负担，还造成社会经济负担。股骨颈骨折的手术治疗通常采用全髋关节置换术或半髋关节置换术形式的关节成形术。作为随访的一部分，通常会定期进行系列X线片检查以查找并发症，尽管其在无症状患者中的临床效用尚未得到验证。因此，我们的论文旨在综述股骨颈骨折关节成形术后X线片随访的效用和必要性。
确定2018年1月1日至2018年12月31日在作者所在机构接受急性股骨颈脆性骨折手术治疗的患者。本研究纳入所有接受手术且患侧髋关节至少有一张术前和一张术后平片X线片的患者。排除标准包括接受慢性骨折手术、股骨头缺血性坏死、1年内死亡、假体周围骨折、转移性病理骨折、有合并伤或记录无法获取或不完整的患者。评估临床记录中的就诊次数、异常的病史或临床检查情况以及患者治疗方案的变化。还评估X线片的数量和类型，并分析每张X线片的异常发现。
我们的研究共纳入157例患者，手术时平均年龄为79.5岁，平均随访17.3个月。收集了626次临床就诊的数据和总共973张X线片。3个X线片异常系列且相应会诊正常的情况并未导致患者治疗方案的改变。仅1例会诊异常且X线片相应正常的患者出现了治疗方案的负面变化。
股骨颈骨折关节成形术后的并发症很可能导致患者出现症状。常规X线片随访在无症状患者中的效用有限，仅在有临床指征时才应进行。
