Predictors of functional outcome following femoral neck fractures treated with an arthroplasty: limitations of the Harris hip score

Introduction To study the association between potential prognostic factors and functional outcome at 1 and 5 year follow-up in patients with femoral neck fractures treated with an arthroplasty. To analyze the reliability of the Harris hip score (HHS). Materials and methods A multicenter analysis which included 252 patients who sustained a femoral neck fracture treated with an arthroplasty. Functional outcome after surgery was assessed using a modified HHS and was evaluated after 1 (HHS1) and 5 (HHS5) years. Several prognostic factors were analyzed and reliability of the HHS was assessed. Results After 1 year the presence of co-morbidities was a significant (p = 0.002) predictor for a poor functional outcome (mean HHS1 71.8 with co-morbidities, and 80.6 without co-morbidities). After 5 years none of the potential prognostic factors had significant influence on functional outcome. Internal consistency testing of the HHS showed that when pain and function of the HHS were analyzed together, the internal consistency was poor (HHS1 0.38 and HHS5 0.20). The internal consistency of the HHS solely in function (without pain) improved to 0.68 (HHS1) and 0.46 (HHS5). Analyzing the functional aspect exclusively, age and the existence of co-morbidities could be defined as predictors for functional outcome of femoral neck fractures after 1 and 5 years. Conclusion After using the HHS in a modification, age and the existence of pre-operative co-morbidities appeared to be predictors of the functional outcome after 1 and 5 years. The HHS, omitting pain, is a more reliable score to estimate the functional outcome, than HHS analyzing pain and function in one scoring syste

Pre-operative pulmonary assessment for patients with hip fracture

Hip fracture is a common injury among the elderly. Although patients who receive hip fracture surgery carry the best functional recovery compared to other treatment modalities, the presence of postoperative pulmonary complications, such as atelectasis, pneumonia, and pulmonary thromboembolism, may contribute to increased length of hospital stay, perioperative morbidity, and mortality. This review aims to provide evidence-based recommendations for preoperative assessment and perioperative strategies to reduce the risk of pulmonary complications after hip fracture surgery. Clinical assessment and basic laboratory results are sufficient to stratify the risk of postoperative pulmonary complications. Well-documented risk factors for pulmonary complications include advanced age, poor general health status, current infections, pre-existing cardiopulmonary diseases, hypoalbuminemia, and impaired renal function. Apart from optimizing the patient's medical conditions, interventions such as lung expansion maneuvers and thromboprophylaxis have been proven to be effective in reducing the risk of pulmonary complications after hip fracture surgery

Modified Pauwels’ Intertrochanteric Osteotomy in Neglected Femoral Neck Fracture

Many reported treatment methods for neglected femoral neck fractures do not always satisfactorily address nonunion, coxa vara, and limb shortening. We retrospectively reviewed the functional outcome of the modified Pauwels’ intertrochanteric osteotomy in 48 adults (mean age, 48.1 years) to determine whether this approach would correct those problems. The average preoperative limb shortening was 2.7 cm (range, 1.5–5 cm) in 38 patients and mean neck-shaft angle was 107.3° (range, 80°–120°). The minimum followup was 2 years (mean, 6.1 years; range, 2–16.5 years). Union was achieved in 44 of the 48 patients. Union also was achieved in two of the four nonunions after revision osteotomy. Postoperative avascular necrosis of the femoral head developed in two of the 48 patients after an average followup of 6 years. Limb-length equalization was achieved in 40 (83%) patients and 40 had near-normal gait. The average neck-shaft angle at the final followup was 132.7° (range, 120°–155°). The average Harris hip score was 86.7 points and Merle d’Aubigné-Postel score was 14.1. We believe the primary modified Pauwels’ intertrochanteric osteotomy is a reliable alternative to achieve fracture healing in neglected femoral neck fractures and simultaneously correct associated coxa vara and shortening. A two-stage surgical incision makes the procedure simple and less demanding