The effect of renal function on surgical outcomes of intracapsular hip fractures with osteosynthesis
Liang-Tseng Kuo1, Su-Ju Lin, Wei-Hsiu Hsu
1Division of Sports Medicine, Department of Orthopedic Surgery, Chang Gung Memorial Hospital at Chia-Yi, Chang Gung University, No 6, West Section, Chia Pu Road, Puzih, Chia-Yi Hsien, 613, Taiwan, 8902078@cgmh.org.tw.
Insights
Patients with chronic kidney disease (CKD) undergoing hip fracture surgery have a higher risk of nonunion and revision surgery. Osteosynthesis remains safe, but CKD impacts outcomes.
Area of Science:
- Orthopedic Surgery
- Nephrology
- Geriatric Medicine
Background:
- Chronic kidney disease (CKD) impacts bone quality, nutrition, and cardiovascular health.
- Femoral neck fractures in dialysis patients have high complication and mortality rates.
- The influence of CKD on hip fracture outcomes post-osteosynthesis is not well understood.
Purpose of the Study:
- To evaluate the clinical outcomes of patients with hip fractures treated with osteosynthesis.
- To compare outcomes between patients with normal renal function and those with CKD.
- To identify risk factors for complications and revision surgery in this patient population.
Main Methods:
- Retrospective analysis of 130 patients with femoral neck fractures treated with internal fixation.
- Group 1: 98 patients with normal renal function (eGFR ≥60 ml/min/1.73 m²).
- Group 2: 32 patients with CKD (eGFR <60 ml/min/1.73 m²) without dialysis; outcomes and complications were recorded.
Main Results:
- Patients with CKD experienced significantly higher complication rates (75% vs. 32.6%) and nonunion rates (OR=5.9, P=0.023).
- CKD and displaced fracture pattern independently predicted the need for revision surgery (OR=3.0, P=0.032 and OR=6.9, P=0.001, respectively).
- No significant difference in overall mortality rates was observed between the groups.
Conclusions:
- Osteosynthesis is a safe and effective treatment for femoral neck fractures, even in patients with CKD.
- Patients with CKD and femoral neck fractures face an elevated risk of nonunion and require more frequent surgical revisions.
- CKD status is a critical factor influencing the success of osteosynthesis for hip fractures.
Background:
Chronic kidney disease (CKD) affects many physiologic systems, including bone quality, nutrition, and cardiovascular condition. Femoral neck fractures in patients on dialysis are associated with frequent complications and a high risk of mortality. However, the effect of CKD on clinical outcomes of patients with hip fractures treated with osteosynthesis remains unclear.
Methods:
One hundred and thirty patients with 130 femoral neck fractures treated with internal fixation were divided into two groups and the data were then analyzed. Group 1 consisted of 98 patients (98 hip fractures) with normal renal function (estimated glomerular filtration rate, or eGFR, ≥60 ml/min/1.73 m(2)). Group 2 was composed of 32 patients (32 hip fractures) with CKD (eGFR <60 ml/min/1.73 m(2)) without dialysis. Clinical outcomes as well as early and late complications were recorded for each group. Survivorship analysis was performed, and the mortality and complication rates for the groups were then compared.
Results:
In Group 1, 32 complications (32.6%) occurred in 98 hips, including 5 cases of nonunion and 16 cases of osteonecrosis. In Group 2, 24 complications (75%) developed in 32 hips; these included 8 cases of nonunion and 3 cases of osteonecrosis. The mean duration of follow-up was 32 months. The overall mortality rate was 11.5%. No difference was noted in early, late, or overall mortality rate between two groups. Patient with CKD had a higher nonunion rate (OR = 5.9, P = 0.023). Meanwhile, CKD and displaced fracture pattern were independent predictors for revision surgery (OR = 3.0, P = 0.032; OR = 6.9, P = 0.001, respectively).
Conclusions:
Osteosynthesis is a safe and effective treatment for femoral neck fractures; however, patients with femoral neck fracture and CKD have a higher risk of nonunion and subsequent surgical revision.
Level Of Relevance:
Prognostic studies, Level III.
