Intraoperative periprosthetic femur fracture during bipolar hemiarthroplasty for displaced femoral neck fractures
We aim to review the incidence and risk factors for the development of intraoperative periprosthetic femur fractures while performing a bipolar hemiarthroplasty for displaced neck of femur fractures. Our secondary aim is to characterize the types of intraoperative periprosthetic fractures, the steps leading to the fractures, and the salvage treatments instituted.
Materials and methods
271 patients treated with bipolar hemiarthroplasty after traumatic displaced femoral neck fractures were retrospectively analyzed. Demographic data, co-morbidities, vitamin D level, consumption of steroids, ASA score, surgical approach, surgeon experience, use of cemented or uncemented implants, proximal femur morphology, and types of anaesthesia were analyzed statistically.
There were 28 patients (10.3%) with intraoperative periprosthetic femur fractures. We found two significant independent risk factors which were the use of uncemented prosthesis (OR 4.15; 95% CI 1.65–10.46; p = 0.003) and Dorr type C proximal femurs (Dorr A OR 3.6; 95% CI 1.47–8.82; p = 0.005). In addition, patients with Dorr type C proximal femurs who underwent uncemented bipolar hemiarthroplasty were more likely to sustain an intraoperative periprosthetic fracture (14(73.7%) out of 19 patients; p = 0.002). There were no significant differences found in other risk factors. The most common location for these fractures was at the greater trochanter at 11 (39.3%) cases. Majority of them, 15 (53.6%), had intraoperative fractures during trial implant insertion and reduction.
The overall incidence of intraoperative periprosthetic femur fractures during hemiarthroplasty for displaced neck of femur fractures was 10.3%. The incidence was significantly higher for uncemented (14.7%) when compared to cemented prosthesis (5.4%) and the greater trochanter was the commonest area for periprosthetic fractures during trial implant insertion and reduction. Uncemented prosthesis and Dorr type C proximal femurs were two significant independent risk factors contributing to intraoperative periprosthetic fractures. By identifying these risk factors, surgeons can take ample precautions to prevent complications.
KeywordsIntraoperative periprosthetic femur fracture Hemiarthroplasty Femoral neck fracture Risk factors
We are exceedingly grateful for the help of Ms. Teo Siew Ling and Ms. Wang Xin Yu from the Department of Orthopaedic Surgery, University Orthopaedics, Hand and Reconstructive Microsurgery Cluster, at National University Hospital, Singapore, for their impeccable assistance in data collection. Each author certifies that he or she has no commercial associations (e.g., consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) or funding sources that might pose a conflict of interest in connection with the submitted article.
- 3.Handoll HH, Parker MJ (2008) Conservative versus operative treatment for hip fractures in adults. Cochrane Database Syst Rev 16(3):CD000337Google Scholar
- 4.Kitamura S, Hasegawa Y, Suzuki S et al. (1998) Functional outcome after hip fracture in Japan. Clin Orthop Relat Res (348):29–36Google Scholar
- 5.Lee YH, Lim YW, Lam KS (2008) Economic cost of osteoporotic hip fractures in Singapore. Singap Med J 49:980–984. 9Google Scholar
- 7.Parker MJ, Gurusamy KS, Azegami S (2010) Arthroplasties (with and without bone cement) for proximal femoral fractures in adults. Cochrane Database Syst Rev 6:CD001706Google Scholar
- 9.Bhandari M, Devereaux PJ, Tornetta P 3rd, Swiontkowski MF, Berry DJ, Haidukewych G, Schemitsch EH, Hanson BP, Koval K, Dirschl D, Leece P, Keel M, Petrisor B, Heetveld M, Guyatt GH (2005) Operative management of displaced femoral neck fractures in elderly patients: an international survey. J Bone Joint Surg Am 87:2122–2130CrossRefPubMedGoogle Scholar
- 24.Dripps RD (1963) New classification of physical status. Anesthesiol 24:111Google Scholar
- 25.National Kidney Foundation (2002) K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis 39(2 Suppl 1):S1–S266Google Scholar
- 28.National Institute for Health and Care Excellence (2011) Hip fracture: management. NICE, LondonGoogle Scholar
- 36.Bhattacharyya T (2012) Cement emerges as the most predictable option for hip hemiarthroplasty: commentary on an article by Fraser Taylor, BSc, MBChB, FRACS. et al.: Hemiarthroplasty of the hip with and without cement: a randomized clinical trial. J Bone Joint Surg Am 94(7):e45CrossRefPubMedPubMedCentralGoogle Scholar