Risk analysis and clinical outcomes of intraoperative periprosthetic fractures: a retrospective study of 481 bipolar hem
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(2019) 14:432
RESEARCH ARTICLE
Open Access
Risk analysis and clinical outcomes of intraoperative periprosthetic fractures: a retrospective study of 481 bipolar hemiarthroplasties Petri Bellova1* , Hinnerk Baecker1, Sebastian Lotzien1, Marvin Brandt2, Thomas A. Schildhauer1 and Jan Gessmann1
Abstract Background: Intraoperative periprosthetic fractures (IPF) are a well-described complication following hip hemiarthroplasty. Our aims were to identify risk factors that characterize IPF and to investigate postoperative mobility. Methods: We retrospectively reviewed 481 bipolar hemiarthroplasties for displaced femoral neck fractures; of which, 421 (87.5%) were performed without cement, from January 2013 to March 2018. Data on the patients’ demographics, comorbidities, femoral canal geometry (Dorr canal type, Canal Flare Index), surgeon’s experience (junior vs. senior surgeon), and timing of surgery (daytime vs. on-call duty) were obtained. In patients with intraoperative fractures, further information was obtained. Patient mobility was assessed using matched-pair analysis. Mobility was classified according to the NHFD mobility score. The chi-square test, Fisher’s exact test, and Fisher-Freeman-Halton exact test were used for comparison between categorical variables, while the Mann-Whitney U test was used for continuous variables. The data analysis was performed using SPSS. Results: Of 481 procedures, 34 (7.1%) IPFs were encountered. The Dorr canal type C was identified as a significant risk factor (p = .004). Other risk factors included female sex (OR 2.30, 95% CI .872–6.079), stovepipe femur (OR 1.749, 95% CI .823–3.713), junior surgeon (OR 1.204, 95% CI .596–2.432), and on-call-duty surgery (OR 1.471, 95% CI .711–3.046), although none showed a significant difference. Of 34 IPFs, 25 (73.5%) were classified as Vancouver type A. The treatment of choice was cerclage wiring. Within the 12 matched pairs identified, the postoperative mobility was slightly worse for the IPF group (delta = .41). Conclusions: IPF is a serious complication with bipolar hemiarthroplasty. The identification of risk factors preoperatively, in particular femur shape, is crucial and should be incorporated into the decision-making process. Keywords: Femoral neck fracture, Hemiarthroplasty, Intraoperative fracture, Risk factor, Femur shape, Dorr, mobility, Decisionmaking
Background Life expectancy is increasing worldwide, as is the proportion of older people in the overall population. Associated with increasing age is a decrease in bone mineral density, as well as muscle mass and strength, increasing the risk of falls and fall-related injuries. Approximately * Correspondence: [email protected] Jan Gessmann is the senior author. 1 Department of Orthopedic and Trauma Surgery, BG University Clinic Bergmannsheil Bochum, Bürkle-de-la-Camp Platz 1, 44789 Bochum, Germany Full list of author information is available at the end of the article
95% of hip fractures are caused by falls from standing height [1, 2]. Fractures of the proximal femur are respo
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