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Wintertime surgery increases the risk of conversion to hip arthroplasty after internal fixation of femoral neck fracture

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Abstract

Summary

The study demonstrates that wintertime surgeries are associated with impaired fracture healing and increases the risk of conversion to hip arthroplasty after osteosynthesis of femoral neck fracture. Furthermore, the results raise the possibility of association between seasonal changes in vitamin D levels and impaired fracture healing of femoral neck fracture.

Introduction

Although the changes of vitamin D level and calcitropic hormones influencing bone metabolism are seasonal, the effect of seasons on hip fracture healing is unknown. We assessed the effects of seasonal periodicity on conversion to hip arthroplasty after primary osteosynthesis of femoral neck fracture.

Methods

This nationwide retrospective observational cohort study involved 2779 patients aged ≥60 years who underwent internal screw fixation for primary femoral neck fracture and were discharged in 2000. Cases requiring conversion to arthroplasty during the 8-year follow-up derived from the Hungarian health insurance database were registered. Risk factors assessed included sex, age, fracture type, season of primary surgery and surgical delay. Competing-risks regression analysis was used for data analyses.

Results

During the observation period, 190 conversions to hip arthroplasty (6.8 %) were identified, yielding an overall incidence of 19.5 per 1000 person-years. The crude incidence rates of conversions after osteosynthesis in winter, spring, summer and fall were 28.6, 17.8, 16.9 and 14.7 per 1000 person-years, respectively. Besides younger age, female sex and intracapsular fracture displacement, wintertime primary osteosynthesis significantly increased the risk of conversion (fall vs. winter, hazard ratio (HR): 0.50, 95 % confidence interval [95 % CI 0.33–0.76]; spring vs. winter, HR: 0.63, [95 % CI 0.44–0.92]; summer vs. winter, HR: 0.62, [95 % CI 0.42–0.91]).

Conclusions

Our study demonstrate that wintertime primary osteosynthesis increases the risk of conversion surgeries. The results may help improving the outcome of primary fixation of femoral neck fractures.

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Conflicts of interest

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Authors and Affiliations

  1. South-Transdanubian Regional Office, National Health Insurance Fund Administration, Pécs, Nagy Lajos király út 3, H-7623, Hungary

    A. Sebestyén

  2. Institute for Health Insurance, Faculty of Health Science, University of Pécs, Pécs, Mária utca 5-7, 7635, Hungary

    A. Sebestyén, J. Bódis & I. Boncz

  3. Department of Traumatology, Saint George County Hospital, Székesfehérvár, Seregélyesi út 3, 8000, Hungary

    S. Mester

  4. Department of Health Policy & Health Economics, Faculty of Social Sciences, Eötvös Loránd University, Budapest, Pázmány Péter sétány 1/A, 1114, Hungary

    Z. Vokó

  5. Syreon Research Institute, Budapest, Thököly út 119, 1146, Hungary

    Z. Vokó

  6. National Health Insurance Fund Administration, Budapest, Váci út 73/A, 1139, Hungary

    J. Gajdácsi

  7. National Institute for Medical Rehabilitation, Budapest, Szanatórium utca 19, 1528, Hungary

    P. Cserháti

  8. Polyclinic of Hospitaller Brothers of St. John of Good, Budapest, Frankel Leó út 54, 1023, Hungary

    G. Speer

  9. Department of Traumatology and Hand Surgery, Faculty of Medicine, University of Pécs, Pécs, Akác utca 1, 7632, Hungary

    B. Patczai

  10. Department of Languages for Specific Purposes, Faculty of Medicine, University of Pécs, Pécs, Szigeti út 12, 7624, Hungary

    V. Warta

  11. Department of Obstetrics and Gynecology, Faculty of Medicine, University of Pécs, Pécs, Édesanyák útja 17, 7624, Hungary

    J. Bódis

  12. First Department of Medicine, Semmelweis University, Budapest, Korányi Sándor utca 2/a, 1083, Hungary

    C. Horváth

Authors
  1. A. Sebestyén
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  2. S. Mester
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  3. Z. Vokó
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  4. J. Gajdácsi
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  5. P. Cserháti
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  11. I. Boncz
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Correspondence to A. Sebestyén.

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Sebestyén, A., Mester, S., Vokó, Z. et al. Wintertime surgery increases the risk of conversion to hip arthroplasty after internal fixation of femoral neck fracture. Osteoporos Int 26, 1109–1117 (2015). https://doi.org/10.1007/s00198-014-2966-0

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  • DOI: https://doi.org/10.1007/s00198-014-2966-0

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