Influence of Internal Fixation and Cemented Hemiarthroplasty on 1-Year Mortality in Geriatric Hip Fracture Patients

Johannes Karl Maria Fakler, Antonia Grafe, Nikolaus von Dercks, Jan Theopold, Ulrich Josef Albert Spiegl, Christoph Josten

Abstract


AIM: Results after cemented Hemiarthoplasty (HA) in elderly patients with a femoral neck fracture improved over the last 20 years. We conducted this study in order to evaluate the influence of modern cemented HA compared to IF with a sliding hip screw (SHS) with regard to one year mortality.

PATIENTS AND METHODS: 183 patients with a low-energy medial femoral neck fracture (AO/OTA 31-B) either treated with a SHS (n = 67) or cemented HA (n = 116) were included. Follow-up was performed at 6 and 12 months. A multivariate Cox regression analysis including nine confounding variables (age, ASA score, body mass index (BMI), cognitive function, time from admission to surgery, creatinine, c-reactive protein (CRP), 25-hydroxyvitamin D (25(OH)D) was performed.

RESULTS: Patients in the HA group were significantly older (p < 0.001) and had more severe comorbidities according to the ASA-Score (p = 0.017). The time interval from admission to surgery (skin incision) was beyond 48h in 6.0% of SHS patients and 17.2% in HA patients (p < 0.001). Despite of detrimental prerequisites for cemented HA, mortality rates at 1 year for HA (23.3%) showed no significant difference (p = 0.58) to IF (19.4%). After correcting for confounding variables mortality risk at one year was significantly higher in patients treated with a SHS (HR = 2.5, 95%CI 1.1-5.7; p = 0.027).

CONCLUSION: We conclude that elderly patients with a femoral neck fracture might benefit from cemented HA compared to IF with a SHS in terms of 1-year mortality. New randomised controlled trials considering modern cementing techniques are needed to validate these results.


Keywords


Femoral neck fracture; Hip fracture; Internal fixation; Sliding hip screw; Hemiarthroplasty; Mortality

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