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The long-term outcomes following internal fixation for intracapsular hip fractures in an Irish tertiary referral centre

  • Michael A. KellyEmail author
  • Kevin McSorley
  • Maire-Caitlin Casey
  • Fintan J. Shannon
Original Article
  • 16 Downloads

Abstract

Background

The burden associated with hip fractures is increasing worldwide. Arthroplasty procedures are more commonly performed for intracapsular fractures due to increased risk of compromise to the femoral head blood supply. However, we know from the Irish Hip Fracture Database that a significant proportion of these fractures undergo internal fixation.

Aims

We sought to investigate the long-term outcomes for these patients including revision rates, functional outcome and mortality rates.

Methods

All intracapsular fractures treated by internal fixation (IF) from 2005 to 2009 were identified. Pre-operative anatomical fracture location and level of fracture displacement was established. Hospital records were used to record mortality and revision rates. The modified Harris hip score was our primary functional outcome measure.

Result

One hundred twelve intracapsular fractures underwent IF over a 5-year period. The mean age was 68.6 (range 14–95 years). A mean follow-up time of 8.15 years (range 6.7–10.1 years) was achieved. There was a 5-year mortality rate of 36.6%. There was a significantly higher revision rate in displaced fractures (24.4%) than in undisplaced fractures (11.1%) (p = 0.01). We found no difference in functional outcome between displaced fractures [85.9 (± 16.9)] and undisplaced fractures [86.01 (± 18.8)]. Those aged younger than 65 at the time of surgery had a significantly better MHHS (p = 0.02) at long-term follow-up; however, there was a revision rate of 43.8% in this group.

Conclusion

Whilst a good functional outcome can be achieved with internal fixation, particularly in younger patients, the risk of requiring revision surgery approaches 50% for these patients.

Keywords

Functional outcome Hip fractures Mortality Revision surgery 

Notes

Compliance with ethical standards

This research was carried out with the approval of the ethics committee of the institution involved.

Conflict of interest

The authors declare that they have no conflicts of interest.

References

  1. 1.
    Johnell O, Kanis JA (2006) An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int 17:1726–1733CrossRefGoogle Scholar
  2. 2.
    Kelly MA, McGowan B, McKenna MJ, Bennett K, Carey JJ, Whelan B, Silke C (2018) Emerging trends in hospitalisation for fragility fractures in Ireland. Irish J Med Sci (1971–) 187:601–608Google Scholar
  3. 3.
    McGowan B, Casey MC, Silke C, Whelan B, Bennett K (2013) Hospitalisations for fracture and associated costs between 2000 and 2009 in Ireland: a trend analysis. Osteoporos Int 24:849–857CrossRefGoogle Scholar
  4. 4.
  5. 5.
    Rogmark C, Johnell O (2006) Primary arthroplasty is better than internal fixation of displaced femoral neck fractures: a meta-analysis of 14 randomized studies with 2,289 patients. Acta Orthop 77:359–367CrossRefGoogle Scholar
  6. 6.
    Rogmark C, Leonardsson O (2016) Hip arthroplasty for the treatment of displaced fractures of the femoral neck in elderly patients. Bone Joint J 98–B:291–297Google Scholar
  7. 7.
    Rogmark C, Carlsson A, Johnell O, Sernbo I (2002) 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 84:183–188CrossRefGoogle Scholar
  8. 8.
    Davison JN, Calder SJ, Anderson GH, Ward G, Jagger C, Harper WM, Gregg PJ (2001) Treatment for displaced intracapsular fracture of the proximal femur. A prospective, randomised trial in patients aged 65 to 79 years. J Bone Joint Surg Br 83:206–212CrossRefGoogle Scholar
  9. 9.
    Chammout GK, Mukka SS, Carlsson T, Neander GF, Helge Stark AW, Sköldenberg OG (2012) Total hip replacement versus open reduction and internal fixation of displaced femoral neck fractures. J Bone Jt Surgery-American 94:1921–1928CrossRefGoogle Scholar
  10. 10.
    Bhandari M, Devereaux PJ, Swiontkowski MF, Tornetta P, Obremskey W, Koval KJ, Nork S, Sprague S, Schemitsch EH, Guyatt GH (2003) Internal fixation compared with arthroplasty for displaced fractures of the femoral neck. A meta-analysis. J Bone Joint Surg Am 85–A:1673–81Google Scholar
  11. 11.
    Parker MJ, Gurusamy KS (2006) Internal fixation versus arthroplasty for intracapsular proximal femoral fractures in adults. In: Parker MJ (ed) Cochrane Database Syst. Rev. John Wiley & Sons, Ltd, Chichester, p CD001708Google Scholar
  12. 12.
    (2007) British Orthopaedic Association. The care of patients with fragility fractureGoogle Scholar
  13. 13.
    Nauth A, Creek AT, Zellar A, Lawendy AR, Dowrick A, Gupta A, Dadi A, van Kampen A, Yee A, de Vries AC, de Mol van Otterloo A, Garibaldi A, Liew A, McIntyre AW, Prasad AS, Romero AW, Rangan A, Oatt A, Sanghavi A, Foley AL, Karlsten A, Dolenc A, Bucknill A, Chia A, Evans A, Gong A, Schmidt AH, Marcantonio AJ, Jennings A, Ward A, Khanna A, Rai A, Smits AB, Horan AD, Brekke AC, Flynn A, Duraikannan A, Stødle A, van Vugt AB, Luther A, Zurcher AW, Jain A, Amundsen A, Moaveni A, Carr A, Sharma A, Hill AD, Trommer A, Rai BS, Hileman B, Schreurs B, Verhoeven B, Barden BB, Flatøy B, Cleffken BI, Bøe B, Perey B, Hanusch BC, Weening B, Fioole B, Rijbroek B, Crist BD, Halliday B, Peterson B, Mullis B, Richardson CG, Clark C, Sagebien CA, van der Pol CC, Bowler C, Humphrey CA, Coady C, Koppert CL, Coles C, Tannoury C, DePaolo CJ, Gayton C, Herriott C, Reeves C, Tieszer C, Dobb C, Anderson CG, Sage C, Cuento C, Jones CB, Bosman CHR, Linehan C, van der Hart CP, Henderson C, Lewis CG, Davis CA, Donohue C, Mauffrey C, Sundaresh DC, Farrell DJ, Whelan DB, Horwitz D, Stinner D, Viskontas D, Roffey DM, Alexander D, Karges DE, Hak D, Johnston D, Love D, Wright DM, Zamorano DP, Goetz DR, Sanders D, Stephen D, Yen D, Bardana D, Olakkengil DJ, Lawson D, Maddock D, Sietsema DL, Pourmand D, den Hartog D, Donegan D, Heels-Ansdell D, Nam D, Inman D, Boyer D, Li D, Gibula D, Price DM, Watson DJ, Hammerberg EM, Tan ETCH, de Graaf EJR, Vesterhus EB, Roper E, Edwards E, Schemitsch EH, Hammacher ER, Henderson ER, Whatley E, Torres ET, Vermeulen EGJ, Finn E, van Lieshout EMM, Wai EK, Bannister ER, Kile E, Theunissen EBM, Ritchie ED, Khan F, Moola F, Howells F, de Nies F, van der Heijden FHWM, de Meulemeester FRAJ, Frihagen F, Nilsen F, Schmidt GB, Albers GHR, Gudger GK Jr, Johnson G, Gruen G, Zohman G, Sharma G, Wood G, Tetteroo GWM, Hjorthaug G, Jomaas G, Donald G, Rieser GR, Reardon G, Slobogean GP, Roukema GR, Visser GA, Moatshe G, Horner G, Rose G, Guyatt G, Chuter G, Etherington G, Rocca GJD, Ekås G, Dobbin G, Lemke HM, Curry H, Boxma H, Gissel H, Kreder H, Kuiken H, Brom HLF, Pape HC, van der Vis HM, Bedi H, Vallier HA, Brien H, Silva H, Newman H, Viveiros H, van der Hoeven H, Ahn H, Johal H, Rijna H, Stockmann H, Josaputra HA, Carlisle H, van der Brand I, Dawson I, Tarkin I, Wong I, Parr JA, Trenholm JA, Goslings JC, Amirault JD, Broderick JS, Snellen JP, Zijl JAC, Ahn J, Ficke J, Irrgang J, Powell J, Ringler JR, Shaer J, Monica JT, Biert J, Bosma J, Brattgjerd JE, Frölke JPM, Wille J, Rajakumar J, Walker JE, Baker JK, Ertl JP, de Vries JPPM, Gardeniers JWM, May J, Yach J, Hidy JT, Westberg JR, Hall JA, van Mulken J, McBeth JC, Hoogendoorn J, Hoffman JM, Cherian JJ, Tanksley JA Jr, Clarke-Jenssen J, Adams JD, Esterhai J, Tilzey JF, Murnaghan J, Ketz JP, Garfi JS, Schwappach J, Gorczyca JT, Wyrick J, Rydinge J, Foret JL, Gross JM, Keeve JP, Meijer J, Scheepers JJG, Baele J, O'Neil J, Cass JR, Hsu JR, Dumais J, Lee J, Switzer JA, Agel J, Richards JE, Langan JW, Turckan K, Pecorella K, Rai K, Aurang K, Shively K, van Wessem K, Moon K, Eke K, Erwin K, Milner K, Ponsen KJ, Mills K, Apostle K, Johnston K, Trask K, Strohecker K, Stringfellow K, Kruse KK III, Tetsworth K, Mitchell K, Browner K, Hemlock K, Carcary K, Jørgen Haug K, Noble K, Robbins K, Payton K, Jeray KJ, Rubino LJ, Nastoff LA, Leffler LC, Stassen LPS, O'Malley LK II, Specht LM, Thabane L, Geeraedts LMG, Shell LE, Anderson LK, Eickhoff LS, Lyle L, Pilling L, Buckingham L, Cannada LK, Wild LM, Dulaney-Cripe L, Poelhekke LMSJ, Govaert L, Ton L, Kottam L, Leenen LPH, Clipper L, Jackson LT, Hampton L, de Waal Malefijt MC, Simons MP, van der Elst M, Bronkhorst MWGA, Bhatia M, Swiontkowski M, Lobo MJ, Swinton M, Pirpiris M, Molund M, Gichuru M, Glazebrook M, Harrison M, Jenkins M, MacLeod M, de Vries MR, Butler MS, Nousiainen M, van’t Riet M, Tynan MC, Campo M, Eversdijk MG, Heetveld MJ, Richardson M, Breslin M, Fan M, Edison M, Napierala M, Knobe M, Russ M, Zomar M, de Brauw M, Esser M, Hurley M, Peters ME, Lorenzo M, Li M, Archdeacon M, Biddulph M, Charlton M, McDonald MD, McKee MD, Dunbar M, Torchia ME, Gross M, Hewitt M, Holt M, Prayson MJ, Edwards MJR, Beckish ML, Brennan ML, Dohm MP, Kain MSH, Vogt M, Yu M, Verhofstad MHJ, Segers MJM, Segers MJM, Siroen MPC, Reed M, Vicente MR, Bruijninckx MMM, Trivedi M, Bhandari M, Moore MM, Kunz M, Smedsrud M, Palla N, Jain N, Out NJM, Simunovic N, Simunovic N, Schep NWL, Müller O, Guicherit OR, van Waes OJF, Wang O, Doornebosch PG, Seuffert P, Hesketh PJ, Weinrauch P, Duffy P, Keller P, Lafferty PM, Pincus P, Tornetta P III, Zalzal P, McKay P, Cole PA, de Rooij PD, Hull P, Go PMNYM, Patka P, Siska P, Weingarten P, Kregor P, Stahel P, Stull P, Wittich P, de Rijcke PAR, Oprel P, Devereaux PJ, Zhou Q, Lee Murphy R Jr, Alosky R, Clarkson R, Moon R, Logishetty R, Nanda R, Sullivan RJ, Snider RG, Buckley RE, Iorio R, Farrugia RJ, Jenkinson R, Laughlin R, Groenendijk RPR, Gurich RW Jr, Worman R, Silvis R, Haverlag R, Teasdall RJ, Korley R, McCormack R, Probe R, Cantu RV, Huff RB, Simmermacher RKJ, Peters R, Pfeifer R, Liem R, Wessel RN, Verhagen R, Vuylsteke R, Leighton R, McKercher R, Poolman RW, Miller R, Bicknell R, Finnan R, Khan RM, Mehta S, Vang S, Singh S, Anand S, Anderson SA, Dawson SA, Marston SB, Porter SE, Watson ST, Festen S, Lieberman S, Puloski S, Bielby SA, Sprague S, Hess S, MacDonald S, Evans S, Bzovsky S, Hasselund S, Lewis S, Ugland S, Caminiti S, Tanner SL, Zielinski SM, Shepard S, Sems SA, Walter SD, Doig S, Finley SH, Kates S, Lindenbaum S, Kingwell SP, Csongvay S, Papp S, Buijk SE, Rhemrev SJ, Hollenbeck SM, van Gaalen SM, Yang S, Weinerman S, Subash, Lambert S, Liew S, Meylaerts SAG, Blokhuis TJ, de Vries Reilingh TS, Lona T, Scott T, Swenson TK, Endres TJ, Axelrod T, van Egmond T, Pace TB, Kibsgård T, Schaller TM, Ly TV, Miller TJ, Weber T, le T, Oliver TM, Karsten TM, Borch T, Hoseth TM, Nicolaisen T, Ianssen T, Rutherford T, Nanney T, Gervais T, Stone T, Schrickel T, Scrabeck T, Ganguly U, Naumetz V, Frizzell V, Wadey V, Jones V, Avram V, Mishra V, Yadav V, Arora V, Tyagi V, Borsella V, Willems WJ, Hoffman WH, Gofton WT, Lackey WG, Ghent W, Obremskey W, Oxner W, Cross WW III, Murtha YM, Murdoch Z (2017) Fracture fixation in the operative management of hip fractures (FAITH): an international, multicentre, randomised controlled trial. Lancet 389:1519–1527CrossRefGoogle Scholar

Copyright information

© Royal Academy of Medicine in Ireland 2019

Authors and Affiliations

  1. 1.Department of Trauma and Orthopaedic SurgeryUniversity Hospital GalwayGalwayIreland

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