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. 2024 Jul 2;16(7):e63647.
doi: 10.7759/cureus.63647. eCollection 2024 Jul.

Unsatisfactory Post-operative Imaging Is Predictive of Revision Surgery in Intracapsular Hip Fracture Fixation

Duncan E Whittaker  1 , Luke Farrow  1 , David Neilly  1 , Sahil Gaba  1 , Joaquim Goffin  1 , Iain Stevenson  1
Affiliations

Unsatisfactory Post-operative Imaging Is Predictive of Revision Surgery in Intracapsular Hip Fracture Fixation

Duncan E Whittaker et al. Cureus. .

Abstract

Failed fixation of intracapsular hip fractures in young patients is associated with high morbidity and cost. Accordingly, we set out to determine the association between unsatisfactory post-operative imaging (judged by two fellowship-trained trauma consultants and a senior trainee) and the risk of subsequent reoperation, including adjustment for potential confounding variables. Ninety-four (94) patients aged <60 were included in the study from a single major trauma centre. Exhausted patients (19%) required further surgery, with the most common reason being avascular necrosis (n=10) followed by non-union (n=6). Univariate analysis found only smokers and unsatisfactory fracture reduction to be predictive of failure (p < 0.05). Other demographics and recognised scoring systems from the literature were poor predictors of failure apart from the Haiduewych classification system, utilised to assess the quality of reduction, which showed a trend towards significance (p0.053). Multivariate analysis showed smoking and unsatisfactory fracture reduction to be strong predictors of failure (p<0.05). In those with unsatisfactory fracture reduction, 50% required reoperation compared to 17.5% of those with satisfactory reduction. This study highlights the key principles of ensuring adequate intraoperative reduction and fixation, in keeping with GIRFT principles. Avoiding secondary reoperation is crucial to prevent long-term negative outcomes for this typically high functional demand group of patients. We recommend regular, consultant peer review of post-operative imaging as a method of identifying substandard fracture fixations and those at risk of failure. This will allow opportunities for teaching, clinical improvement, and multidisciplinary team (MDT) discussions of at-risk patients.

Keywords: failure; fixation; hip fixation; hip fracture; intracapsular.

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Conflict of interest statement

Human subjects: Consent was obtained or waived by all participants in this study. North of Scotland Research Ethics Service issued approval NA. Research ethics was sought from the North of Scotland Research Ethics service. Using the HRA decision tool, it was deemed unnecessary and was classed by the NHS as a service evaluation. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Receiver operating characteristic (ROC) area under the curve (AUC) for the model, including unsatisfactory fracture reduction and positive smoking status
See this image and copyright information in PMC

References

    1. NHFD 2023 annual report. [ May; 2024 ]. 2023. https://www.nhfd.co.uk/FFFAP/Resources.nsf/pages/NHFD+Reports https://www.nhfd.co.uk/FFFAP/Resources.nsf/pages/NHFD+Reports
    1. Impact of hip fracture on hospital care costs: a population-based study. Leal J, Gray AM, Prieto-Alhambra D, Arden NK, Cooper C, Javaid MK, Judge A. Osteoporos Int. 2016;27:549–558. - PMC - PubMed
    1. National Institute for Health and Care Excellence. Recommendations. Hip fracture: management. Guidance. [ May; 2024 ]. 2021. https://www.nice.org.uk/guidance/cg124/chapter/Recommendations https://www.nice.org.uk/guidance/cg124/chapter/Recommendations
    1. Internal fixation versus arthroplasty for intracapsular proximal femoral fractures in adults. Parker MJ, Gurusamy K. Cochrane Database Syst Rev. 2006;2006:0. - PMC - PubMed
    1. Fracture fixation in the operative management of hip fractures (FAITH): an international, multicentre, randomised controlled trial. Nauth A, Creek A, Zellar A, et al. Lancet. 2017;389:1519–1527. - PMC - PubMed

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