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Two surgical pathways for isolated hip fractures: A comparative study.

Alexander A Fokin1,2, Joanna Wycech Knight1,3, Maral Darya1,4

  • 1Trauma and Critical Care Services, Delray Medical Center, Delray Beach, FL 33484, United States.

World Journal of Orthopedics
|June 28, 2023
PubMed
Summary

Hip fracture (HF) surgery outcomes were similar regardless of admission via trauma pathway (TP) or medical pathway (MP). Focus on patient health and prompt surgery for optimal results in hip fracture patients.

Keywords:
Admitting serviceAmerican Society of Anesthesiologists scoreIsolated hip fracturesPreoperative consultationsTime to surgeryTrauma center

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Area of Science:

  • Orthopedic Surgery
  • Geriatric Medicine
  • Trauma Care

Background:

  • Hip fractures (HF) are a significant health concern in the aging population.
  • Timely surgical intervention, ideally within 48 hours, is crucial for managing hip fractures.
  • Patients with hip fractures may be admitted through trauma or medical services.

Purpose of the Study:

  • To compare the management and outcomes of hip fracture patients admitted through the trauma pathway (TP) versus the medical pathway (MP.
  • To identify any differences in patient characteristics, surgical procedures, and clinical outcomes between the two admission pathways.

Main Methods:

  • Retrospective study of 2094 patients with proximal femur fractures (AO/OTA Type 31) undergoing surgery.
  • Propensity score matching used to create comparable groups of TP (66 patients) and MP (66 patients).
  • Statistical analyses included multivariable analysis, group characteristics, and bivariate correlations (chi-squared and t-tests).

Main Results:

  • Matched groups showed no significant differences in age, sex, fracture type, surgical procedure, or ASA score.
  • Hip fracture displacement was more common in the TP group (76% vs. 39%).
  • Surgery duration was longer for TP patients (59 min vs. 41 min), but time to surgery, ICU/hospital length of stay, and mortality rates were similar between groups.

Conclusions:

  • Admission pathway (trauma vs. medical) does not impact hip fracture surgery outcomes.
  • Clinical management should prioritize patient health status and expedite surgical intervention.
  • Further research could explore specific interventions to mitigate fracture displacement in the trauma pathway.