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European Journal of Trauma and Emergency Surgery

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Open Access 01-04-2022 | Dementia | Original Article

Surgical management of displaced femoral neck fractures in patients with dementia: a comparison in mortality between hemiarthroplasty and pins/screws

Authors: Ioannis Ioannidis, Ahmad Mohammad Ismail, Maximilian Peter Forssten, Rebecka Ahl, Yang Cao, Tomas Borg, Shahin Mohseni

Published in: European Journal of Trauma and Emergency Surgery | Issue 2/2022

Abstract

Introduction

Dementia is common in patients with hip fractures and is strongly associated with increased postoperative mortality. The choice of surgical intervention for displaced femoral neck fractures (dFNF) in patients with dementia has been a matter of debate. This study aims to investigate how short- and long-term mortality differs between those who have been operated with hemiarthroplasty or pins/screws.

Methods

All patients with dementia and dFNF, i.e., Garden III and IV, who underwent primary emergency hip fracture surgery, with either hemiarthroplasty or pins/screws, in Sweden between Jan 1, 2008 and Dec 31, 2017 were eligible for inclusion in the current study. Patients were divided into two groups based on the surgical intervention: hemiarthroplasty and pins/screws. The primary outcome of interest was 30-day postoperative mortality, and the secondary outcome was 1-year postoperative mortality. Poisson and Cox regression analyses were performed both before and after propensity score matching.

Results

A total of 9394 cases met the inclusion criteria; 84% received hemiarthroplasty and 16% received pins/screws. In the unmatched analysis, the adjusted incidence rate ratio (IRR) for 30-day postoperative mortality was not affected by the chosen surgical method (adj. IRR 0.96, CI 95% 0.83–1.12, p = 0.629). After propensity score matching, similar results were observed with no difference in 30-day postoperative mortality (adj. IRR 0.89, CI 95% 0.74–1.09, p = 0.286). There was a statistically significant decrease in the risk of 1-year postoperative mortality in the hemiarthroplasty group compared to the pins/screws group, both before and after propensity score matching.

Conclusion

This study could not demonstrate any difference in 30-day mortality in patients with dementia and dFNFs when comparing hemiarthroplasty with pins/screws. Patients that received hemiarthroplasties did, however, have a lower risk of 1-year postoperative mortality.

The Swedish Council on Technology assessment in health care. Int J Technol Assess Health Care. 1989; 5(1):154–8.

Statensberedningförmedicinskutvärdering. Rehabiliteringaväldrepersoner med höftfrakturer-interdisciplinära team: en systematisklitteraturöversikt. Stockholm: Statensberedningförmedicinskutvärdering (SBU); 2015.

Kanis JA, Odén A, McCloskey EV, Johansson H, Wahl DA, Cooper C, et al. A systematic review of hip fracture incidence and probability of fracture worldwide. OsteoporosInt. 2012;23(9):2239–56.CrossRef

Årsrapporter– RIKSHÖFT [Internet]. [cited 2020 Sep 13]. Available from: https://rikshoft.se/arsrapporter/

Forssten MP, Mohammad Ismail A, Sjolin G, Ahl R, Wretenberg P, Borg T, et al. The association between the Revised Cardiac Risk Index and short-term mortality after hip fracture surgery. Eur J Trauma Emerg Surg [Internet]. 2020 Sep 17 [cited 2020 Sep 20]; Available from: https://doi.org/https://doi.org/10.1007/s00068-020-01488-w

Bai J, Zhang P, Liang X, Wu Z, Wang J, Liang Y. Association between dementia and mortality in the elderly patients undergoing hip fracture surgery: a meta-analysis. J Orthop Surg Res [Internet]. 2018 Nov 23 [cited 2020 Sep 11];13. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6260652/

Nationella riktlinjer för vård och omsorg vid demenssjukdom [Internet]. Socialstyrelsen. [cited 2020 Sep 11]. Available from: https://www.socialstyrelsen.se/regler-och-riktlinjer/nationella-riktlinjer/publicerade-riktlinjer/demens/2018-3-1.pdf

Rogmark C, Carlsson A, Johnell O, Sernbo I. Primary hemiarthroplasty in old patients with displaced femoral neck fracture: a 1-year follow-up of 103 patients aged 80 years or more. ActaOrthopScand. 2002;73(6):605–10.

Om Rikshöft–RIKSHÖFT [Internet]. [cited 2020 Sep 11]. Available from: https://rikshoft.se/om-rikshoft/

10.

Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373–83.CrossRef

11.

R Development Core Team. R: A Language and Environment for Statistical Computing [Internet]. Vienna, Austria: R Foundation for Statistical Computing; 2008. Available from: http://www.R-project.org/

12.

Rogmark C, Carlsson A, Johnell O, Sernbo I. A prospective randomised trial of internal fixation versus arthroplasty for displaced fractures of the neck of the femur Functional outcome for 450 patients at two years. J Bone Joint Surg Br. 2002;84(2):183–8.CrossRef

13.

Ding T, Zhang B, Tian S, Wang Y, Sun K. Selection principles and application status of surgical methods for hip fracture in the elderly. ZhongguoXiu Fu Chong Jian WaiKeZaZhi. 2018;32(11):1435–40.

14.

Nicolaides V, Galanakos S, Mavrogenis AF, Sakellariou VI, Papakostas I, Nikolopoulos CE, et al. Arthroplasty versus internal fixation for femoral neck fractures in the elderly. Strategies Trauma Limb Reconstr. 2011;6(1):7–12.CrossRef

15.

Tidermark J, Ponzer S, Svensson O, Söderqvist A, Törnkvist H. Internal fixation compared with total hip replacement for displaced femoral neck fractures in the elderly. A randomised, controlled trial. J Bone Joint Surg Br. 2003;85(3):380–8.CrossRef

16.

Palmer SJ, Parker MJ, Hollingworth W. The cost and implications of reoperation after surgery for fracture of the hip. J Bone Joint Surg Br. 2000;82(6):864–6.CrossRef

17.

Parker MJ, Pryor GA. Internal fixation or arthroplasty for displaced cervical hip fractures in the elderly: a randomised controlled trial of 208 patients. ActaOrthopScand. 2000;71(5):440–6.

18.

Nationella riktlinjer för rörelseorganens sjukdomar, remissversion [Internet]. Socialstyrelsen. [cited 2020 Sep 11]. Available from: https://www.socialstyrelsen.se/globalassets/sharepoint-dokument/artikelkatalog/nationella-riktlinjer/2020-4-6743-indikatorer.pdf

19.

Kazley J, Bagchi K. Femoral Neck Fractures. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 [cited 2020 Sep 11]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK537347/

20.

Borges FK, Bhandari M, Guerra-Farfan E, Patel A, Sigamani A, Umer M, et al. Accelerated surgery versus standard care in hip fracture (HIP ATTACK): an International, randomised, controlled trial. Lancet. 2020;395(10225):698–708.CrossRef

21.

Meyer AC, Hedström M, Modig K. The Swedish hip fracture Register and National Patient Register were valuable for research on hip fractures: comparison of two registers. J ClinEpidemiol. 2020;125:91–9.

22.

Forbes SP, Dahabreh IJ. Benchmarking observational analyses against randomized trials: a review of studies assessing propensity score methods. J Gen Intern Med. 2020;35(5):1396–404.CrossRef

23.

Dahabreh IJ, Sheldrick RC, Paulus JK, Chung M, Varvarigou V, Jafri H, et al. Do observational studies using propensity score methods agree with randomized trials? A systematic comparison of studies on acute coronary syndromes. Eur Heart J. 2012;33(15):1893–901.CrossRef

24.

Rosenbaum PR, Rubin DB. The central role of the propensity score in observational studies for causal effects. Biometrika. 1983;70(1):41–55.CrossRef

25.

Graulich T, Graeff P, Jaiman A, Nicolaides S, Omar Pacha T, Örgel M, et al. Risk factors for dislocation after bipolar hemiarthroplasty: a retrospective case–control study of patients with CT data. Eur J Orthop Surg Traumatol [Internet]. 2020 Oct 23 [cited 2021 Feb 2]; Available from: http://link.springer.com/https://doi.org/10.1007/s00590-020-02819-8

Title: Surgical management of displaced femoral neck fractures in patients with dementia: a comparison in mortality between hemiarthroplasty and pins/screws
Authors: Ioannis Ioannidis
Ahmad Mohammad Ismail
Maximilian Peter Forssten
Rebecka Ahl
Yang Cao
Tomas Borg
Shahin Mohseni
Publication date: 01-04-2022
Publisher: Springer Berlin Heidelberg
Keywords: Dementia
Dementia
Published in: European Journal of Trauma and Emergency Surgery / Issue 2/2022
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI: https://doi.org/10.1007/s00068-021-01640-0

At a glance: The STEP trials

Springer Medicine

Surgical management of displaced femoral neck fractures in patients with dementia: a comparison in mortality between hemiarthroplasty and pins/screws

Abstract

Introduction

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusion

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