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Mortality following surgery for undisplaced intracapsular hip fractures
1Department of Trauma and Orthopaedics, Queen's Medical Centre, University Hospital, Nottingham NG 7 2UH, UK.
Insights
Internal fixation for undisplaced subcapital hip fractures shows lower mortality than hemiarthroplasty. This study found significantly fewer deaths at 1 month and 1 year post-operation for internal fixation patients.
Area of Science:
- Orthopedic Surgery
- Geriatric Medicine
- Trauma Surgery
Background:
- Undisplaced subcapital hip fractures are common in the elderly.
- Operative treatment options include internal fixation and hemiarthroplasty.
- Comparative mortality data is crucial for treatment decisions.
Purpose of the Study:
- To compare mortality rates between internal fixation and hemiarthroplasty for undisplaced subcapital hip fractures.
- To evaluate the effectiveness of two surgical interventions for hip fractures.
Main Methods:
- Prospective audit of hip fracture patients at a university hospital.
- Data collected via standardized questionnaire by an independent research assistant.
- 1-year mortality follow-up utilizing National Office of Statistics data.
Main Results:
- 139 patients underwent surgical treatment (29 hemiarthroplasty, 110 internal fixation).
- Significantly lower mortality at 1 month (2% vs 21%) and 1 year (16% vs 38%) for internal fixation compared to hemiarthroplasty.
- Higher re-operation rate for internal fixation (7.2%) than hemiarthroplasty (3%).
Conclusions:
- Hemiarthroplasty is associated with significantly increased mortality for undisplaced intracapsular hip fractures.
- Internal fixation is recommended over hemiarthroplasty for these specific fractures.
- Further research may explore reasons for differential mortality outcomes.
Purpose:
The aim of the study was to evaluate the mortality following the operative treatment of undisplaced subcapital fracture of the hip by internal fixation (with three lag screws) or hemiarthroplasty.
Methods:
A prospective audit of all patients admitted with hip fracture was undertaken at the university hospital in Nottingham. An independent research assistant collected data on a standardised questionnaire. Mortality was calculated from data received from National office of Statistics allowing 100% 1-year follow up for mortality statistics.
Results:
One hundred and sixty patients were admitted with undisplaced intracapsular fracture of the hip. Twenty-one patients had non-operative management and were excluded from the results. One hundred and thirty-nine patients had surgical treatment. Mean age of patients was 78 years. Twenty-nine patients had hemiarthroplasty and 110 patients underwent internal fixation of their fractures. There was no significant difference between the two groups for age, sex, mobility, residential status, co-morbidity and cognitive state. There was a significant difference in mortality between the two operated groups at 1 month and 1 year after the operation. Six patients (21%) died after hemiarthroplasty in the first month while there were only two (2%) deaths in the internal fixation group (P < 0.001). At 1 year from operation, 11 patients (38%) from the hemiarthroplasty group and 17 patients (16%) from the internal fixation group died (P = 0.0072). The re-operation rate within 1 year was higher for the internal fixation group (n = 8; 7.2%) than the hemiarthroplasty group (n = 1; 3%).
Conclusions:
There is significant increase in mortality when undisplaced intracapsular hip fractures are treated by hemiarthroplasty as compared to internal fixation and we would not recommend it for these fractures.
