Is it really advantageous to operate proximal femoral fractures within 48 h from diagnosis? – A multicentric retrospective study exploiting COVID pandemic-related delays in time to surgery

Objectives: Hip fractures in the elderly are common injuries that need timely surgical management. Since the beginning of the pandemic, patients with a proximal femoral fracture (PFF) experienced a delay in time to surgery. The primary aim of this study was to evaluate a possible variation in mortality in patients with PFF when comparing COVID-19 negative versus positive. Methods: This is a multicentric and retrospective study including 3232 patients with PFF who underwent surgical management. The variables taken into account were age, gender, the time elapsed between arrival at the emergency room and intervention, pre-operative American Society of Anesthesiology score, pre-operative cardiovascular and respiratory disease, and 10-day/1-month/6-month mortality. For 2020, we had an additional column, “COVID-19 swab positivity.” Results: COVID-19 infection represents an independent mortality risk factor in patients with PFFs. Despite the delay in time-to-surgery occurring in 2020, no statistically significant variation in terms of mortality was detected. Within our sample, a statistically significant difference was not detected in terms of mortality at 6 months, in patients operated within and beyond 48 h, as well as no difference between those operated within or after 12/24/72 h. The mortality rate among subjects with PFF who tested positive for COVID-19 was statistically significantly higher than in patients with PFF who tested. COVID-19 positivity resulted in an independent factor for mortality after PFF. Conclusion: Despite the most recent literature recommending operating PFF patients as soon as possible, no significant difference in mortality was found among patients operated before or after 48 h from diagnosis

Effect of surgical correction of adolescent idiopathic scoliosis on the quality of life: a prospective study with a minimum 5-year follow-up

Purpose: To prospectively evaluate the quality of life (QoL), functionality, and body image of subjects who had undergone surgery for adolescent idiopathic scoliosis (AIS) 5–12 years previously, and to identify the outcome predictors. Methods: The sample consisted of 87 patients for whom follow-up data were available out of a series of 91 patients who had surgery for AIS between 2002 and 2009. We assessed the preoperative, 1-year postoperative, and 5-year or more postoperative SF-36 and SRS-23 questionnaire scores. Longitudinal clinical and radiographic data also were evaluated. Changes in the patient-oriented outcomes were compared with age and sex-adjusted normative values. A multiple regression analysis was used to identify possible outcome predictors. Results: Preoperatively, patients had impaired QoL, functionality, and body image compared to age- and sex-matched healthy controls. Surgery led to significant improvement of the SF-36 and SRS scores at the one-year and final control date, but the final scores on SF-36’s physical indexes were lower than control subjects’ scores. No clinically relevant differences with the normative values were detected in the final SRS scores. The height of the residual rib hump negatively predicted the total SRS and self-image scores; a more caudal level of fusion correlated with more postoperative pain. Conclusions: Patients who underwent surgery for AIS a minimum of 5 years earlier had impaired self-reported physical QoL compared to control subjects, but they nevertheless performed better than before their surgery. Greater size of the residual hump and greater distal extension of the fusion area are negatively correlated with final self reported outcome

Functional outcome and short-term mortality after surgery for hip fractures

Introduction Hip fractures are associated with significant disability and mortality. We conducted a prospective study to investigate the mortality rate and functional ability in patients who underwent surgery for hip fracture over a one-year period. Materials and methods One-hundred patients (72 females and 28 males; mean age, 78.2 years (range 32–102) surgically treated for hip fracture were prospectively followed-up for 1 year. Fifty-five and 45 patients sustained a trochanteric fracture or a fracture of the femoral neck, respectively. Daily-life activities (ADL scale), cognitive impairment (MMSE Scale), comorbidity (CIRS scale), functional status, and personal mobility were prospectively evaluated 4 months and 1 year after the operation by telephonic interviews with the patient, his/her relatives, or primary care providers. Mortality data was also recorded. Possible outcome predictors were evaluated by regression analysis. Results The overall mortality rate at 1 year was 19 percent. Male sex, comorbidity, and a poor pre-fracture functional status were significant predictors of mortality. ADL scale and personal mobility significantly improved between 4-month and 1-year follow-up controls. Forty-five percent of patients without preoperative walking limitations dropped out their walking aids 1-year postoperatively. Patients with trochanteric fracture treated with hip prosthesis showed greater and faster postoperative functional improvement with respect to patients treated by gamma nail. Discussion Current results represent the first report of a wider ongoing prospective study aimed to evaluate possible outcome predictors of hip fractures to be used to improve and personalize the surgical treatment. The preoperative functional status and comorbidities are major determinants of 4-month and 1-year postoperative mortality and ability of subjects. Conclusions Our preliminary findings demonstrate the role of surgery in promoting the functional improvement of patients who sustained hip fracture

HEMIARTHROPLASTY VERSUS TOTAL HIP ARTHROPLASTY FOR THE TREATMENT OF FEMORAL NECK FRACTURES. A PROSPECTIVE COMPARATIVE STUDY

Introduction: The treatment of femoral neck fractures may affect the postoperative functional outcome in the elderly. Objectives: This comparative prospective study was carried out to evaluate the outcome of total hip arthroplasty (THA) versus hemiarthroplasty for femoral neck fractures. Methods: We selected 80 patients (17 males and 63 females) who underwent hemiarthroplasty (40 cases; mean age 74,0 ± 5.5 years) or THA (40 cases; mean age 71,4 ± 6.5 years) for a femoral neck fracture at our Institutions between January 2011 and April 2012. These two therapeutic groups were carefully matched for their preoperative characteristics including age, gender, body mass index, ASA class, comorbidities (CIRS score), cognitive function (MMSE). Four- and twelve-month mortality, walking ability, and activities of daily living (ADL Index) were prospectively assessed in the two groups. Hip-related and general complications also were specifically noted. Models of multiple regression analysis were constructed to evaluate the effect of the surgical treatment (hemiarthroplasty or THA) on functional outcomes and mortality. Results: The mortality at 4 and 12 months was not significantly different in the two therapeutic groups. The walking ability at 4 months (P<0.05) and the ADL score at 4 months (P<0.01) and one year (P = 0.01) was superior in patients with THA as compared to those who underwent hemiarthroplasty. The pre-fracture functional level (P<0.001) and the use of THA versus hemiarthroplasty (P = 0.01) represented strong predictors of the four-month ambulatory activity and ADL Index. The use of THA versus hemiarthroplasty was not associated with a better one-year functional outcome. There was a higher risk of hip-related complications at four months in patients undergoing THA (P = 0.002). Conclusions: Despite more hip-related complications, THA can benefit patients with femoral neck fractures with higher four-month functional scores