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Health economics for intra-capsular hip fractures undertaking fixation
Anatole Wiik1, Thomas Ashdown2, Ian Holloway2
1Department of Surgery, Trauma and Orthopaedics, London North West University Healthcare, London HA1 3UJ, United Kingdom. wiikav@hotmail.com.
Insights
This study found no significant difference between two hip fracture fixation methods. Displaced fractures and older age predicted poor outcomes, suggesting arthroplasty may be a better option for some patients.
Area of Science:
- Orthopedic Surgery
- Geriatric Medicine
- Musculoskeletal Injury
Background:
- Hip fractures are a common injury in the elderly, often requiring surgical intervention.
- Intra-capsular hip fractures are typically managed with arthroplasty or fixation.
Purpose of the Study:
- To compare the effectiveness of two common fixation methods for intra-capsular hip fractures.
- To identify factors influencing outcomes in surgically treated hip fractures.
Main Methods:
- A retrospective audit of 83 patients with intra-capsular hip fractures treated between 2012-2018.
- Evaluation of patient records for clinical outcomes, cost-benefit analysis, and quality of life measures (EQ-5D, VAS) at least one year post-surgery.
- Comparison of outcomes between cannulated cancellous screws and sliding hip screws.
Main Results:
- No significant differences were observed in blood loss, tip-apex distance, radiation exposure, length of stay, or union time between the two fixation methods.
- Displaced intra-capsular hip fractures were significantly associated with poorer outcomes (OR 7.25).
- Re-operation rates were 19% for cannulated screws and 11% for sliding hip screws, with no significant difference in health resource group tariffs or implant costs.
Conclusions:
- Neither fixation method demonstrated a significant advantage for intra-capsular hip fractures.
- Initial fracture displacement and patient age were key predictors of re-operation.
- Arthroplasty should be carefully considered for its potential health economic and patient benefit advantages.
Background:
Hip fracture is a common musculoskeletal injury in the elderly requiring surgery worldwide. The operative mainstay of intra-capsular hip fractures is arthroplasty with a smaller proportion for fixation.
Aim:
To determine the most beneficial method of fixation for patients with intra-capsular hip fractures.
Methods:
A registered audit from 2012-2018 was conducted on all intra-capsular hip fractures treated with 2 commonly used fixation methods. Patient notes, electronic records and clinical codes for cost benefit were evaluated. A validated quality of life measure was collected at least 1 year after surgery.
Results:
A total of 83 patients were identified with intra-capsular fractures undergoing fixation during the retrospective period. There were 47 cannulated cancellous screw and 36 sliding hip screw fixations with the case mix comparable for age, gender, co-morbidities and fracture configuration. There was no significant difference in blood loss, tip apex distance, radiation exposure, length of stay, radiological union time, collapse, avascular necrosis or re-operation between fixation methods. Logistic regression analysis demonstrated displaced intracapsular hip fractures correlated significantly with an undesirable outcome conferring a relative odds ratio of 7.25. There were 9 (19%) and 4 (11%) patients respectively, who required re-operation. There was no significant difference in health resource group tariff and implant cost with comparable EQ-5D and visual analogue scores.
Conclusion:
No significant advantage was identified with differing fixation type, but irrespective there were a high number of patients requiring re-operation. This was predicted by initial fracture displacement and patient age. Arthroplasty may need to be carefully considered for health economics and patient benefit.
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