Surgical treatment and management of hip fracture patients
Tóm tắt
Osteoporosis-related hip fractures are associated with high mortality and costs. The optimum type of treatment for such fractures is controversial. To shed some light on this issue, the surgical treatment and management of osteoporotic hip fractures were discussed during a hip fracture surgical working group at the 2009 International Society For Fracture Repair Annual Meeting comprising leading experts in the field. The working group consisted of eight orthopaedic surgeons, six industry representatives and one research scientist. Eleven participants were from Europe and four were from the USA and Canada. Two chairmen posed 12 questions relating to the surgical treatment and management of osteoporotic hip fractures. Each question was discussed and key points were noted. Surgery should commence within 24–48 h but the patient should be optimized if presenting with ≥3 comorbidities. Specialized centres integrating orthopaedics, geriatricians and rheumatologists could be a solution for the lack of specialist care post-surgery. Surgical technique is important in fracture fixation, as is the implant, but there has been no improvement in implant design in the past 50 years. As a consequence, malunion has become unjustifiably accepted. Fracture healing can be accelerated using pharmaceuticals which are also important in secondary prophylaxis. All displaced femoral neck fractures in geriatric patients should be treated with hip replacement, the choice between using cemented or uncemented fixation being at the surgeon’s discretion. This working group discussion highlighted several important issues which could be of interest to the orthopaedic community.
Tài liệu tham khảo
Cummings SR, Melton LJ III (2002) Epidemiology and outcomes of osteoporotic fractures. Lancet 359:1761–1767
Johnell O (1997) The socioeconomic burden of fractures: today and in the 21st century. Am J Med 103:20S–25S
Keene GS, Parker MJ, Pryor GA (1993) Mortality and morbidity after hip fractures. BMJ 307:1248–1250
Lyritis GP (1995) Epidemiology of hip fracture: the MEDOS study. Mediterranean osteoporosis study. Osteoporos Int 6(3):11–15
Laursen JO (1999) Treatment of intracapsular fractures of the femoral neck in Denmark: trends in indications over the past decade. Acta Orthop Belg 65:478–484
Chua D, Jaglal SB, Schatzker J (1997) An orthopaedic surgeon survey on the treatment of displaced femoral neck fracture: opposing views. Can J Surg 40:271–277
Parker MJ, Pryor GA (2000) Internal fixation or arthroplasty for displaced cervical hip fractures in the elderly: a randomised controlled trial of 208 patients. Acta Orthop Scand 71:440–446
Blomfeldt R, Tornkvist H, Ponzer S, Soderqvist A, Tidermark J (2005) Comparison of internal fixation with total hip replacement for displaced femoral neck fractures. Randomized controlled trial performed at four years. JBJS Am 87:1680–1688
Geiger F, Schreiner K, Schneider S, Pauschert R, Thomsen M (2006) Proximal fracture of the femur in elderly patients: the influence of surgical care and patient characteristics on post-operative mortality. Orthopade 35:651–658
Macaulay W, Pagnotto MR, Iorio R, Mont MA, Saleh KJ (2006) Displaced femoral neck fractures in the elderly: hemiarthroplasty versus total hip arthroplasty. J Am Acad Orthop Surg 14(5):287–293
Faldini C, Grandi G, Romagnoli M, Pagkrati S, Digennaro V, Faldini O, Giannini S (2006) Surgical treatment of instable intertrochanteric fractures by bipolar hip replacement or total hip replacement in elderly osteoporotic patients. J Orthopaed Traumatol. 7:117–121
Shiga T, Wajima Z, Ohe Y (2008) Is operative delay associated with increased mortality of hip fracture patients? Systematic review, meta-analysis, and meta-regression. Can J Anaesth 55(3):146–154
Moroni A, Faldini C, Pegreffi F, Giannini S (2004) HA-coated screws decrease the incidence of fixation failure in osteoporotic trochanteric fractures. Clin Orthop Rel Res 425:87–92
Moroni A, Faldini C, Hoang-Kim A, Pegreffi F, Giannini S (2007) Alendronate improves screw fixation in osteoporotic bone. JBJS Am 89(1):96–101
Barnes L, Kakar S, Vora S, Morgan EF, Gerstenfeld LC, Einhhorn TA (2008) Stimulation of fracture-healing with systemic intermittent parathyroid hormone treatment. JBJS 90:120–127
Hoang-Kim A, Gelsomini L, Luciani D, Moroni A, Giannini S (2009) Fracture healing and drug therapies in osteoporosis. Clin Cases Miner Bone Metab 6(2):136–143
Baumgaertner MR, Curtin SL, Lindskog DM, Keggi IM (1995) The value of the tip-apex distance in predicting failure of fixation of peritrochanteric fractures of the hip. JBJS Am 77(7):1058–1064
MacLean C, Newberry S, Maglione M, McMahon M, Ranganath V, Suttorp M, Mojica W, Timmer M, Alexander A, McNamara M, Desai SB, Zhou A, Chen S, Carter J, Tringale C, Valentine D, Johnsen B, Grossman J (2008) Systematic review: comparative effectiveness of treatments to prevent fractures in men and women with low bone density or osteoporosis. Ann Intern Med 148:197–213
Bozic KJ, Kurtz S, Lau E, Ong K, Chiu V, Vail TP, Rubash HE, Berry DJ (2009) The epidemiology of bearing surface usage in total hip arthroplasty in the United States. JBJS Am 91(7):1614–1620
Siebert WE, Mai S, Moroni A, Chiarello E, Giannini S (2009) A two-year prospective and retrospective multi-center study of the Tribofit® Hip System. J Long Term Eff Med Implants 19(2):149–155
Smith TM, Berend KR, Lombardi AV Jr, Emerson RH Jr, Mallory TH (2005) Metal-on-metal total hip arthroplasty with large heads may prevent early dislocation. Clin Orthop Relat Res. 441:1337–1342