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Einfluss des Operationszeitpunktes auf die Komplikationsraten nach zementierter Hemiarthroplastik zur Behandlung medialer Schenkelhalsfrakturen

Influence of timing of surgery on complication rates after cemented hemiarthroplasty for treatment of medial femoral neck fractures

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Zusammenfassung

Hintergrund

Der optimale Zeitpunkt der Implantation einer Hemiarthroplastik zur Behandlung einer traumatischen Schenkelhalsfraktur ist nach wie vor Gegenstand der aktuellen Forschung. Laut den aktuellen Empfehlungen sollten diese Fälle innerhalb der ersten 24 h versorgt werden. Das Ziel der vorliegenden Arbeit war, den Einfluss des operativen Zeitpunkts auf die Komplikations- und Mortalitätsrate zu evaluieren.

Material und Methoden

Hundertzweiundfünfzig Fälle wurden retrospektiv hinsichtlich verschiedener Parameter (demografische und operative Daten, Komorbiditäten, Dauer des stationären Aufenthalts, der intensivmedizinische Verlauf sowie allgemeine, operationsspezifische und Blutungskomplikationen) ausgewertet. Die statistische Auswertung erfolgte mittels des Chi-Quadrat- und des ungepaarten Student-t-Tests sowie logistischer Regressionsanalyse.

Ergebnisse

Von den 152 eingeschlossenen Operationen fanden 71,1 % innerhalb von 24 h sowie 28,9 % nach 24 h statt. Die Patienten zeigten ein ähnliches Profil an Nebenerkrankungen. Die Analyse des Intensivaufenthalts zeigte keinen signifikanten Unterschied zwischen den einzelnen Gruppen. Operationen nach 24 h zeigten eine leicht erhöhte Rate an postoperativen Pneumonien, jedoch mit mildem Verlauf. Es konnten keine signifikanten Unterschiede sowohl hinsichtlich aller anderen Komplikationen als auch der Mortalität zwischen den einzelnen Operationszeitpunkten festgestellt werden.

Diskussion

Die vorliegende Studie zeigt, dass Operationen nach 24 h keinen wesentlichen Nachteil bezüglich weiterer Komplikationen, des Intensivaufenthalts oder der Mortalität aufweisen. Diese Resultate könnten sinnvollerweise bei der nächsten Aktualisierung der Leitlinie berücksichtigt werden.

Abstract

Background

The optimal timing of the implantation of a cemented hemiarthroplasty in the management of displaced medial femoral neck fractures is still the subject of current research. According to the current recommendations, these cases should be surgically treated within 24 h. The aim of this study was to evaluate the impact of the timing of surgery on operation-specific and nonspecific complications, intensive care treatment as well as mortality.

Material and methods

Overall, 152 cases were retrospectively investigated regarding several parameters (demographic data, comorbidities, surgery time, duration of hospital stay, intensive care treatment, general, bleeding, operation-specific and nonspecific complications). The statistical analysis was performed using the χ2-test and the unpaired Student’s t‑test as well as logistic regression analyses.

Results

A total of 152 patients were included and 71.1% of the operations were performed within 24 h and the remaining 28.9% after 24 h. All groups showed a similar profile of comorbidities. The analysis of the intensive care treatment showed no significant differences between the individual groups. The rate of postoperative pneumonia was moderately higher among the patients with a procedure after 24 h; however, with no severe courses. There were no significant differences regarding all other complications and the mortality rate between the individual time points of surgery.

Conclusion

The present study demonstrated that patients operated on after 24 h showed no disadvantages regarding other complications, intensive care treatment or mortality, except from an increased postoperative pneumonia rate. These results could be taken into consideration for the next update of the treatment guidelines.

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Authors and Affiliations

  1. Klinikum Saarbrücken, Winterberg 1, 66119, Saarbrücken, Deutschland

    Laura-Ann Blatt, Ismail Sahan, Christof Meyer & Konstantinos Anagnostakos

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  1. Laura-Ann Blatt
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  2. Ismail Sahan
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Correspondence to Laura-Ann Blatt.

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L.-A. Blatt, I. Sahan, C. Meyer und K. Anagnostakos geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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W. Mutschler, München

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Blatt, LA., Sahan, I., Meyer, C. et al. Einfluss des Operationszeitpunktes auf die Komplikationsraten nach zementierter Hemiarthroplastik zur Behandlung medialer Schenkelhalsfrakturen. Unfallchirurg 124, 990–999 (2021). https://doi.org/10.1007/s00113-021-00972-1

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