Effect of 4DryField® PH on blood loss in hip bipolar hemiarthroplasty following intracapsular femoral neck fracture – a randomized clinical trial

Background One of the most common complications of hip arthroplasty is excessive blood loss that could necessitate allogenic blood transfusion, which is further associated with other complications, such as infections, transfusion reactions or immunomodulation. In gynecology, 4DryField®PH, an absorbable polysaccharide-based formulation, is used for hemostasis and adhesion prophylaxis. In this study, we evaluated its hemostatic effect in patients undergoing hip bipolar hemiarthroplasty following intracapsular femoral neck fracture. Methods We studied 40 patients with intracapsular femoral neck fractures (Garden III or IV) admitted at our institution between July 2016 and November 2017. We included patients above 60 years with simple fracture and without pathologic fractures. Patients were randomized into intervention and control groups. The intervention group received 5 g of 4DryField® PH (subfascially and subcutaneously) during wound closure. Three drainages were inserted in a standardized manner (submuscular, subfascial, and subcutaneous) and drainage volume was measured immediately before extraction. Total blood loss was calculated using Mercuriali’s formula and standard hemograms upon admission and five days after surgery. Volume of postoperative hematoma was measured using point-of-care ultrasound seven days after surgery. Results Volume of the postoperative hematoma was reduced by 43.0 mL. However, significant reduction of total blood loss and drainage volume was not observed. Conclusions We observed that 4DryField® PH had a local hemostatic effect, thereby reducing volume of the postoperative hematoma. However, this reduction was small and had no effect on the total blood loss. Further studies are warranted to improve the application algorithm. Trial registration DRKS, DRKS00017452, Registered 11 June 2019 – Retrospectively registered.

Risk factors for intraoperative greater trochanteric fractures in hemiarthroplasty for intracapsular femoral neck fractures

Purpose Hemiarthroplasty is widely accepted as the treatment of choice in elderly patients with a displaced intracapsular femoral neck fracture. Intraoperative greater trochanteric fractures thwart this successful procedure, resulting in prolonged recovery, inferior outcome, and increased risk of revision surgery. Hence, this study analyzed factors potentially associated with an increased risk for intraoperative greater trochanteric fracture. Methods This retrospective study included 512 hemiarthroplasties in 496 patients with a geriatric intracapsular femoral neck fracture from July 2010 to March 2020. All patients received the same implant type of which 90.4% were cemented and 9.6% non-cemented. Intra- and postoperative radiographs and reports were reviewed and particularly screened for greater trochanteric fractures. Results Female patients accounted for 74% and mean age of the patients was 82.3 (± 8.7) years. 34 (6.6%) intraoperative greater trochanteric fractures were identified. In relation to patient-specific factors, only a shorter prothrombin time was found to be significantly associated with increased risk of intraoperative greater trochanteric fracture (median 96%, IQR 82–106% vs. median 86.5%, IQR 68.8–101.5%; p = 0.046). Other factors associated with greater trochanteric fracture were a shorter preoperative waiting time and changes in perioperative settings. Outcome of patients with greater trochanteric fracture was worse with significantly more surgical site infection requiring revision surgery (17.6% vs. 4.2%, p = 0.005). Conclusion Prolonged prothrombin time, a shorter preoperative waiting time, and implementing new procedural standards and surgeons may be associated with an increased risk of a greater trochanteric fracture. Addressing these risk factors may reduce early periprosthetic infection which is strongly related to greater trochanteric fractures.

Results of postoperative anti-rotation on the intracapsular femoral neck fracture fixed with cannulated screws

Background: To investigate effect of postoperative anti-rotation on the union of intracapsular displaced femoral neck fracture treated with three cannulated screws. Methods: A retrospective analysis was performed on all the intracapsular femoral neck fractures treated in the department of orthopedics of the second Hospital of Shanxi Medical University from July 2015 to December 2018. Fractures of femoral neck were reduced and fixed with three cannulated screws. The patients who wore anti-rotation shoes in the affected side were kept at bed rest for 10-12 weeks after surgery. The results were analyzed.Results: A total of 135 patients were included in the analysis. Six patients (4.4%) were not united. There were 12 cases of avascular necrosis (9.3%). No wound infections, screw breakages was found.Conclusion: Anti-rotation after surgery can significantly reduce the rate of femoral neck fracture nonunion, but not significantly improve the femoral head necrosis

Results of postoperative anti-rotation on the intracapsular femoral neck fracture fixed with cannulated screws

Background: To investigate effect of postoperative anti-rotation on the union of intracapsular displaced femoral neck fracture treated with three cannulated screws.Methods: A retrospective analysis was performed on all the intracapsular femoral neck fractures treated in the department of orthopedics of the second Hospital of Shanxi Medical University from July 2015 to December 2018. Fractures of femoral neck were reduced and fixed with three cannulated screws. The patients who wore anti-rotation shoes in the affected side were kept at bed rest for 10-12 weeks after surgery. The results were analyzed.Results: A total of 135 patients were included in the analysis. Six patients (4.4%) were not united. There were 12 cases of avascular necrosis (9.3%). No wound infections, screw breakages was found.Conclusion: Anti-rotation after surgery can significantly reduce the rate of femoral neck fracture nonunion, but not significantly improve the femoral head necrosis

Weekend Admission of Intracapsular Femoral Neck Fractures Not Associated With a Greater Rate of Mortality or Morbidity

Introduction: For a number of emergency conditions, admission over the weekend has been associated with rising morbidity and mortality rates. However, different studies have provided conflicting results regarding the increased rates of mortality and morbidity for patients with intracapsular femoral fracture who were admitted over the weekend, compared to weekdays. This study investigated the effect of weekend admissions on the surgical outcomes of patients with intracapsular femoral neck fractures. Materials and Methods: We conducted a retrospective cohort study of all the patients who were admitted to our level-II trauma center with an intracapsular femoral neck fracture between January 2009 and June 2011. Admission was classified as at the weekend if it took place between 18:00 pm on Friday until midnight on Sunday or on bank holidays. We compared the mortality rates within 30 days and 6 months after surgery for weekday and weekend admissions. Secondary outcomes considered included length of hospital stay, postoperative complications, and reoperation rates. Statistical analysis was performed using logistic regression models, which were adjusted for patient and surgical characteristics. Results: In total, 315 patients met our inclusion criteria. The mean age of this group was 77.9 years (standard deviation ±13) and the female to male ratio was 5:2. The average follow-up period was 49 months. Under logistic regression analysis, weekend admission was not a significant independent risk factor for the 30-day mortality rate (odds ratio 1.85, 95% confidence interval, 0.74-4.62; P = .19). Seventy-seven patients admitted over the weekend were treated within 24 hours versus 125 patients for the weekday group (80.2% vs 57.9%; P = .005). There were no differences between the sample groups in relation to implant-related complications (24.9% vs 25.8%, respectively, P = .89) nor in relation to general complications (12% vs 18.6%, respectively, P = .06). The mean hospital stay of patients operated on during weekends or holidays was significantly shorter compared to patients operated on during weekdays (6.7 vs 8.5 days; P = .009). Conclusion: Patients with intracapsular femoral neck fractures who were admitted over the weekend at our trauma center did not have a higher risk of mortality or morbidity. Furthermore, temporary preoperative care provided over the weekend by an internal medical consultant can be safe and efficient even in the circumstances where there is a lack of dedicated geriatric support. The absence of an elective operating list at the weekend could be a potential factor in shortening waiting times for surgery for intracapsular femoral neck fracture at weekends and holidays.

Serum albumin and fixation failure with cannulated hip screws in undisplaced intracapsular femoral neck fracture

Introduction Internal fixation of undisplaced intracapsular femoral neck fractures with cannulated hip screws is a widely accepted surgical technique, despite reported failure rates of 12%–19%. This study determined whether preoperative serum albumin levels are linked to fixation failure. Methods We retrospectively reviewed 251 consecutive undisplaced intracapsular femoral neck fracture patients treated with cannulated hip screws in a district general hospital. Preoperative albumin levels were measured, and the fixation technique, classification and posterior tilt on radiography assessed. Fixation failure was defined as a screw cut, avascular necrosis (AVN) or non-union. Results Of the patients, 185 were female and 66 male. The mean age was 77 years (range 60–101 years). Thirty seven (15%) patients had fixation failure: 10 (4%) due to AVN; 12 (5%) due to non-union; and 15 (6%) due to fixation collapse. Low serum albumin levels were significantly associated with failure (p=0.01), whereas gender (p=0.56), operated side (p=0.62), age (p=0.34) and screw configuration (p=0.42) were not. A posterior tilt angle greater than 20° on lateral radiography significantly predicted failure (p=0.002). Conclusions Preoperative serum albumin is an independent predictor of cannulated hip screw fixation failure in undisplaced femoral neck fractures. Nutritional status should therefore be considered when deciding between surgical fixation and arthroplasty to avoid the possibility of revision surgery, along with an increased risk of morbidity and mortality.

Results of Hemi Arthroplasty in Fracture Neck of Femur in Elderly Person, CBMCHB Experience

Intracapsular femoral neck fracture is a common injury in elderly person. The primary goal of treatment is to return the patient to him or her pre-fracture functional status. The surgical treatment is the treatment of choice, lip replacement arthroplasty (hemi or total) is a viable treatment option. Thirty elderly patients (age 50-80 years) with a displaced intracapsular femoral neck fracture were under treatment over a five year period (January 2010 to December 2015). All of them underwent hemiarthroplasty either unipolar or bipolar, after appropriate medical and anesthetic fitness. The patients were reevaluated at six weeks, at six months postoperative interval and assessed using Harris hip score (HHS) and visual analogue scale (vas) for evaluation of outcome. The mean age of patients was 64.5 years and male female ratio was 43.3% - 56.7%. The mean HHS score was 85.3 by the end of the 6 months. The mean score on VAS scale was 60mm (moderate) at 2 weeks, 40mm (mild) at six weeks and 4mm (mu) at 6 months follow up visit. No significant complications were observed except hip pain. No patients needed revision surgery. Herniarthroplasty is the treatment of choice in elderly population with displaced femoral neck fracture (Garden type III or IV); provides early ambulation, good functional outcome, pain free joint with minimal complications without the need for revision surgery. CBMJ 2015 July: Vol. 04 No. 02 P: 8-12