Treatment of patients with proximal femoral fractures. I. Orthopaedic care. Guidelines of the Czech Rheumatological Society and the Czech Society for Metabolic Bone Diseases


Authors: J. Vaculík;  P. Dungl;  T. Malkus;  M. Majerníček;  A. Podškubka;  K. Pavelka 2;  J. Štěpán 2
Authors‘ workplace: Ortopedická klinika IPVZ FN Na Bulovce Praha, 2Revmatologický ústav, 1. lékařská fakulta UK, Praha
Published in: Čes. Revmatol., 17, 2009, No. 3, p. 134-144.
Category: Recommendations for Treatment

Overview

In addition to standard surgical procedure, the success of treatment of proximal femoral fracture is influenced by further factors. The sooner surgery is carried out following a preoperative medical examination, the greater the rate of patient improvement. Prevention of infection and thrombosis is a standard part of treatment of proximal femoral fractures. As a factor in improving a patient’s postoperative development, local anesthesia is preferable. Femoral neck fractures are treated surgically by osteosynthesis, total hip arthroplasty or hemiarthroplasty, depending on the degree of fracture dislocation, as well the patient’s age and condition. Intertrochanteric and subtrochanteric fractures are treated by osteosynthesis by dynamic hip screw or intramedullary implant. In the treatment of patients with proximal femoral fractures, it is also important to look at rehabilitation treatment and the patient’s social situation. Evaluating the risk of future fractures, recommending secondary fracture prevention in patients with proximal femoral fracture should be an integral part of treatment.

Key words:
proximal femoral fracture, surgical treatment, postoperative care


Sources

1. Vaculík J, Malkus T, Majerníček M, Podškubka A, Dungl P. Incidence zlomenin proximálního femuru. Ortopedie 2007; 1(2): 62–8.

2. Štěpán JJ, Havelka S, Kamberská Z, Bernátová M. Epidemiologie der Osteoporose in der Tschechischen Republik. J Mineralstoffwechsel 2002; 9(3): 7–13.

3. Boonen S, Autier P, Barette M, Vanderschueren D, Lips P, Haentjens P. Functional outcome and quality of life following hip fracture in elderly women: a prospective controlled study. Osteoporos Int 2004; Feb; 15(2): 87–94.

4. Giversen IM. Time trends of mortality after first hip fractures. Osteoporos Int 2007; Jun; 18(6): 721–32.

5. Koot VC, Peeters PH, de Jong JR, Clevers GJ, van der Werken C. Functional results after treatment of hip fracture: a multicentre, prospective study in 215 patients. Eur J Surg 2000; Jun; 166(6): 480–5.

6. Burge R, Dawson-Hughes B, Solomon DH, Wong JB, King A, Tosteson A. Incidence and economic burden of osteoporosis-related fractures in the United States. 2005-2025. J Bone Miner Res 2007; Mar; 22(3): 465–75.

7. Davis FM, Woolner DF, Frampton C, Wilkinson A, Grant A, Harrison RT, et al. Prospective, multi-centre trial of mortality following general or spinal anaesthesia for hip fracture surgery in the elderly. Br J Anaesth 1987 Sep; 59(9): 1080–8.

8. Villar RN, Allen SM, Barnes SJ. Hip fractures in healthy patients: operative delay versus prognosis. British medical journal (Clinical research ed. 1986; Nov 8; 293(6556): 1203–4.

9. Hefley FG, Jr, Nelson CL, Puskarich-May CL. Effect of delayed admission to the hospital on the preoperative prevalence of deep-vein thrombosis associated with fractures about the hip. J Bone Joint Surg Am 1996 Apr; 78(4): 581–3.

1 0. Perez JV, Warwick DJ, Case CP, Bannister GC. Death after proximal femoral fracture an autopsy study. Injury 1995; May; 26(4): 237–40.

11. Bredahl C, Nyholm B, Hindsholm KB, Mortensen JS, Olesen AS. Mortality after hip fracture: results of operation within 12 h of admission. Injury 1992; 23(2): 83–6.

12. Hamlet WP, Lieberman JR, Freedman EL, Dorey FJ, Fletcher A, Johnson EE. Influence of health status and the timing of surgery on mortality in hip fracture patients. Am J Orthop 1997; Sep; 26(9): 621–7.

13. Holt EM, Evans RA, Hindley CJ, Metcalfe JW. 1000 femoral neck fractures: the effect of pre-injury mobility and surgical experience on outcome. Injury 1994 Mar; 25(2): 91–5.

14. Parker MJ, Handoll HH. Pre-operative traction for fractures of the proximal femur in adults. Cochrane Database Syst Rev 2006; 3: CD000168.

15. Levi N. Urinary tract infection and cervical hip fracture. Int J Risk Safety Med 1998; 11: 41–4.

16. Gillespie WJ, Walenkamp G. Antibiotic prophylaxis for surgery for proximal femoral and other closed long bone fractures. Cochrane Database Syst Rev 2001; (1): CD000244.

17. Nelson CL, Green TG, Porter RA, Warren RD. One day versus seven days of preventive antibiotic therapy in orthopedic surgery. Clin Orthop Relat Res 1983; Jun(176): 258–63.

18. Gillespie W, Murray D, Gregg PJ, Warwick D. Risks and benefits of prophylaxis against venous thromboembolism in orthopaedic surgery. J Bone Joint Surg Br 2000 May; 82(4): 475–9.

19. Salvati EA, Pellegrini VD, Jr., Sharrock NE, Lotke PA, Murray DW, Potter H, et al. Recent advances in venous thromboembolic prophylaxis during and after total hip replacement. J Bone Joint Surg Am 2000; Feb; 82(2): 252–70.

20. Handoll HH, Farrar MJ, McBirnie J, Tytherleigh-Strong G, Awal KA, Milne AA, et al. Heparin, low molecular weight heparin and physical methods for preventing deep vein thrombosis and pulmonary embolism following surgery for hip fractures. Cochrane Database Syst Rev 2000(2): CD000305.

21. Prevention of pulmonary embolism and deep vein thrombosis with low dose aspirin: Pulmonary Embolism Prevention (PEP) trial. Lancet 2000; Apr 15; 355(9212): 1295–302.

22. Amaragiri SV, Lees TA. Elastic compression stockings for prevention of deep vein thrombosis. Cochrane Database Syst Rev 2001(1).

23. Powers PJ, Gent M, Jay RM, Julian DH, Turpie AG, Levine M, et al. A randomized trial of less intense postoperative warfarin or aspirin therapy in the prevention of venous thromboembolism after surgery for fractured hip. Arch Intern Med 1989; Apr; 149(4): 771–4.

24. Hamilton HW, Crawford JS, Gardiner JH, Wiley AM. Venous thrombosis in patients with fracture of the upper end of the femur. A phlebographic study of the effect of prophylactic anticoagulation. J Bone Joint Surg Br 1970; May; 52(2): 268–89.

25. Borgstroem S, Greitz T, Van Der Linden W, Molin J, Rudics I. Anticoagulant Prophylaxis of Venous Thrombosis in Patients with Fractured Neck of the Femur; a Controlled Clinical Trial Using Venous Phlebography. Acta Chir Scand 1965; May;129: 500–8.

26. Eriksson BI, Lassen MR. Duration of prophylaxis against venous thromboembolism with fondaparinux after hip fracture surgery: a multicenter, randomized, placebo-controlled, double-blind study. Arch Intern Med 2003; Jun 9; 163(11): 1337–42.

27. Geerts WH, Pineo GF, Heit JA, Bergqvist D, Lassen MR, Colwell CW, et al. Prevention of venous thromboembolism: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy Chest 2004 Sep; 126(3 Suppl): 338S–400S.

28. Sorenson RM, Pace NL. Anesthetic techniques during surgical repair of femoral neck fractures. A meta-analysis. Anesthesiology 1992; Dec; 77(6): 1095–104.

29. Parker MJ, Handoll HH, Griffiths R. Anaesthesia for hip fracture surgery in adults. Cochrane Database Syst Rev 2004(4): CD000521.

30. Raaymakers EL, Marti RK. Non-operative treatment of impacted femoral neck fractures. A prospective study of 170 cases. J Bone Joint Surg Br 1991 Nov;73(6): 950–4.

31. Parker MJ, Myles JW, Anand JK, Drewett R. Cost-benefit analysis of hip fracture treatment. J Bone Joint Surg Br 1992 Mar; 74(2): 261–4.

32. Parker MJ, Blundell C. Choice of implant for internal fixation of femoral neck fractures. Meta-analysis of 25 randomised trials including 4,925 patients. Acta Orthop Scand 1998 Apr; 69(2): 138–43.

33. Hui AC, Anderson GH, Choudhry R, Boyle J, Gregg PJ. Internal fixation or hemiarthroplasty for undisplaced fractures of the femoral neck in octogenarians. J Bone Joint Surg Br 1994 Nov; 76(6): 891–4.

34. Davison JN, Calder SJ, Anderson GH, Ward G, Jagger C, Harper WM, et al. Treatment for displaced intracapsular fracture of the proximal femur. A prospective, randomised trial in patients aged 65 to 79 years. J Bone Joint Surg Br 2001; Mar; 83(2): 206–12.

35. Blomfeldt R, Tornkvist H, Ponzer S, Soderqvist A, Tidermark J. Comparison of internal fixation with total hip replacement for displaced femoral neck fractures. Randomized, controlled trial performed at four years. J Bone Joint Surg Am 2005; Aug; 87(8): 1680–8.

36. Frihagen F, Nordsletten L, Madsen E. Hemiarthroplasty of internal fixation for intracapsular displaced femoral neck fractures: randomised controlled trial. BMJ 2007.

37. Keating JF, Grant A, Masson JM, Scott NW, Forbes JF. Randomized comparison of reduction and fixation, bipolar hemiarthroplasty, and total hip arthroplasty: Treatment of displaced intracapsular hip fractures in healthy older patients. J Bone Joint Surg Am 2006; 88: 249–60.

38. Tidermark J, Ponzer S, Svensson O, Soderqvist A, Tornkvist H. Internal fixation compared with total hip replacement for displaced femoral neck fractures in the elderly. A randomised, controlled trial. J Bone Joint Surg Br 2003; Apr; 85(3): 380–8.

39. van Vugt AB, Oosterwijk WM, Goris RJ. Osteosynthesis versus endoprosthesis in the treatment of unstable intracapsular hip fractures in the elderly. A randomised clinical trial. Arch Orthop Trauma Surg 1993; 113(1): 39–45.

40. Rogmark C, Carlsson A, Johnell O, Sernbo I. A prospective randomised trial of internal fixation versus arthroplasty for displaced fractures of the neck of the femur: Functional outcomes for 450 patients at 2 years. J Bone Joint Surg Br 2002; 84: 183–8.

41. Squires B, Bannister G. Displaced intracapsular neck of femur fractures in mobile independent patients: total hip replacement or hemiarthroplasty? Injury 1999; Jun; 30(5): 345–8.

42. Kuokkanen HO, Suominen PK, Korkala OL. The late outcome of femoral neck fractures. Int Orthop 1990; 14(4): 377–80.

43. Jalovaara P, Virkkunen H. Quality of life after primary hemiarthroplasty for femoral neck fracture. 6-year follow-up of 185 patients. Acta Orthop Scand 1991 Jun; 62(3): 208–17.

44. Gebhard JS, Amstutz HC, Zinar DM, Dorey FJ. A comparison of total hip arthroplasty and hemiarthroplasty for treatment of acute fracture of the femoral neck. Clin Orthop Relat Res 1992; Sep(282): 123–31.

45. Nilsson LT, Jalovaara P, Franzen H, Niinimaki T, Stromqvist B. Function after primary hemiarthroplasty and secondary total hip arthroplasty in femoral neck fracture. J Arthroplasty 1994; Aug; 9(4): 369–74.

46. Garden RS. Malreduction and avascular necrosis in subcapital fractures of the femur. J Bone Joint Surg Br 1971; May; 53(2): 183–97.

47. Swiontkowski MF, Hansen ST, Jr., Kellam J. Ipsilateral fractures of the femoral neck and shaft. A treatment protocol. J Bone Joint Surg Am 1984; Feb; 66(2): 260–8.

48. Garden RS. Reduction and fixation of subcapital fractures of the femur. Orthop Clin North Am 1974; Oct; 5(4): 683–712.

49. Banks HH. Nonunion in fractures of the femoral neck. Orthop Clin North Am 1974; Oct;5(4): 865–85.

50. Skinner P, Riley D, Ellery J, Beaumont A, Coumine R, Shafighian B. Displaced subcapital fractures of the femur: a prospective randomized comparison of internal fixation, hemiarthroplasty and total hip replacement. Injury 1989; Sep; 20(5): 291–3.

51. Parker MJ, Tripuraneni G, McGreggor-Riley J. Osteotomy, compression and reaming techniques for internal fixation of extracapsular hip fractures. Cochrane Database Syst Rev 2001; (3): CD000522.

52. Christie J, Robinson CM, Singer B, Ray DC. Medullary lavage reduces embolic phenomena and cardiopulmonary changes during cemented hemiarthroplasty. J Bone Joint Surg Br 1995; May; 77(3): 456–9.

53. Wheelwright EF, Byrick RJ, Wigglesworth DF, Kay JC, Wong PY, Mullen JB, et al. Hypotension during cemented arthroplasty. Relationship to cardiac output and fat embolism. J Bone Joint Surg Br 1993; Sep; 75(5): 715–23.

54. Yamagata M, Chao EY, Ilstrup DM, Melton LJ, 3rd, Coventry MB, Stauffer RN. Fixed-head and bipolar hip endoprostheses. A retrospective clinical and roentgenographic study. J Arthroplasty 1987; 2(4): 327–41.

55. Emery RJ, Broughton NS, Desai K, Bulstrode CJ, Thomas TL. Bipolar hemiarthroplasty for subcapital fracture of the femoral neck. A prospective randomised trial of cemented Thompson and uncemented Moore stems. J Bone Joint Surg Br 1991; Mar; 73(2): 322–4.

56. Dorr LD, Glousman R, Hoy AL, Vanis R, Chandler R. Treatment of femoral neck fractures with total hip replacement versus cemented and noncemented hemiarthroplasty. J Arthroplasty 1986; 1(1): 21–8.

57. Eiskjaer S, Gelineck J, Soballe K. Fractures of the femoral neck treated with cemented bipolar hemiarthroplasty. Orthopedics 1989; Dec; 12(12): 1545–50.

58. Wetherell RG, Hinves BL. The Hastings bipolar hemiarthroplasty for subcapital fractures of the femoral neck. A 10-year prospective study. J Bone Joint Surg Br 1990; Sep; 72(5): 788–93.

59. Calder SJ, Anderson GH, Jagger C, Harper WM, Gregg PJ. Unipolar or bipolar prosthesis for displaced intracapsular hip fracture in octogenarians: a randomised prospective study. J Bone Joint Surg Br 1996; May; 78(3): 391–4.

60. Marcus RE, Heintz JJ, Pattee GA. Don’t throw away the Austin Moore. J Arthroplasty 1992; Mar; 7(1): 31–6.

61. Bartoníček J, Džupa V, Skála-Rosenbaum J, Pazdírek P. Zlomeniny krčku u dospělých – Souhrnný referát. Úraz chir 2003; 11(3). 10–23.

62. Chan RN, Hoskinson J. Thompson prosthesis for fractured neck of femur. A comparison of surgical approaches. J Bone Joint Surg Br 1975; Nov; 57(4): 437–43.

63. Unwin AJ, Thomas M. Dislocation after hemiarthroplasty of the hip: a comparison of the dislocation rate after posterior and lateral approaches to the hip. Ann R Coll Surg Engl 1994; Sep; 76(5): 327–9.

64. Keene GS, Parker MJ, Pryor GA. Mortality and morbidity after hip fractures. BMJ 1993; Nov 13; 307(6914): 1248–50.

65. Sikorski JM, Barrington R. Internal fixation versus hemiarthroplasty for the displaced subcapital fracture of the femur. A prospective randomised study. J Bone Joint Surg Br 1981; 63–B(3): 357–61.

66. Ravikumar KJ, Marsh GD. Internal fixation versus heimarthroplasty versus total hip arthroplasty for displaced subcapital fractures of femur – 13 year results of a prospective randomized study. Injury 2000; 31: 793–7.

67. Parker MJ, Handoll HH. Gamma and other cephalocondylic intramedullary nails versus extramedullary implants for extracapsular hip fractures in adults. Cochrane Database Syst Rev 2008; (3): CD000093.

68. Palm H, Jacobsen S, Sonne-Holm S, Gebuhr P. Integrity of the lateral femoral wall in intertrochanteric hip fractures: an important predictor of a reoperation. J Bone Joint Surg Am 2007; Mar; 89(3): 470–5.

69. Gotfried Y. The lateral trochanteric wall: a key element in the reconstruction of unstable pertrochanteric hip fractures. Clin Orthop Relat Res 2004; Aug(425): 82–6.

70. Anglen JO, Weinstein JN. Nail or plate fixation of intertrochanteric hip fractures: changing pattern of practice. A review of the American Board of Orthopaedic Surgery Database. J Bone Joint Surg Am 2008; Apr; 90(4): 700–7.

71. Forte ML, Virnig BA, Kane RL, Durham S, Bhandari M, Feldman R, et al. Geographic variation in device use for intertrochanteric hip fractures. J Bone Joint Surg Am 2008; Apr; 90(4): 691–9.

72. Douša P, Bartoníček J, Jehlička D, Skála-Rosenbaum J. Osteosyntéza trochanterických zlomenin proximálním femorálním hřebem (PFN Synthes). Acta Chirurgiae Orthopaedicae et Traumatologiae Čechosl 2002; 69: 22–30.

73. Pavelka T, Kortus J, Linhart M. Osteosyntéza zlomenin proximálního femuru krátkým proximálním femorálním hřebem. Acta Chirurgiae Orthopaedicae et Traumatologiae Čechosl 2003; 70(31–38).

74. Pavelka T, Matějka J, Červenková H. Komplikace osteosyntézy krátkým proximálním femorálním hřebem. Acta Chirurgiae Orthopaedicae et Traumatologiae Čechosl 2005; 72: 344–54.

75. Čech O, Košťál R, Váchal J. Nestabilní pertorchanterické zlomeniny – jejich biomechanika, klasifikace a terapie. Acta Chirurgiae Orthopaedicae et Traumatologiae Čechosl 2000; 67: 17–27.

76. Koval KJ, Zuckermann JD. Hip fractures: II. Evaluation and treatment of intertrochanteric fractures. J Am Acad Orthop Surg 1994; 2: 150–6.

77. Janzing HM, Houben BJ, Brandt SE. The Gotfried Percutaneous Compression Plate versus the Dynamic Hip Screw in the treatment of pertrochanteric hip fractures: minimal invasive treatment reduces operative time and postoperative pain. J Trauma 2002; 52(293–298).

78. Krasheninnikoff M, Gramkow J, Trholm C, Gotfried PC. CP: a new method for osteosynthesis of intertrochanteric fractures of the femur. Acta Orthop Scand 1998; 280(Suppl): 30–1.

79. Giannoudis P, Tzioupis C, Almalki T, Buckley R. Fracture healing in osteoporotic fractures: is it really different? A basic science perspective. Injury 2007 Mar; 38 Suppl 1: S90–9.

80. D’Ippolito G, Schiller PC, Ricordi C, Roos BA, Howard GA. Age-related osteogenic potential of mesenchymal stromal stem cells from human vertebral bone marrow. J Bone Miner Res 1999; Jul; 14(7): 1115–22.

81. Yingjie H, Ge Z, Yisheng W, Ling Q, Hung WY, Kwoksui L, et al. Changes of microstructure and mineralized tissue in the middle and late phase of osteoporotic fracture healing in rats. Bone 2007 Oct; 41(4): 631–8.

82. McCann RM, Colleary G, Geddis C, Clarke SA, Jordan GR, Dickson GR, et al. Effect of osteoporosis on bone mineral density and fracture repair in a rat femoral fracture model. J Orthop Res 2008; Mar; 26(3): 384–93.

83. van der Poest Clement E, Patka P, Vandormael K, Haarman H, Lips P. The effect of alendronate on bone mass after distal forearm fracture. J Bone Miner Res 2000; Mar; 15(3): 586–93.

84. Goldhahn J, Suhm N, Goldhahn S, Blauth M, Hanson B. Influence of osteoporosis on fracture fixation–a systematic literature review. Osteoporos Int 2008 Jun; 19(6): 761–72.

85. Schurch MA, Rizzoli R, Slosman D, Vadas L, Vergnaud P, Bonjour JP. Protein supplements increase serum insulin-like growth factor-I levels and attenuate proximal femur bone loss in patients with recent hip fracture. A randomized, double-blind, placebo-controlled trial. Ann Intern Med 1998; May 15; 128(10): 801–9.

86. Jingushi S, Iwaki A, Higuchi O, Azuma Y, Ohta T, Shida JI, et al. Serum 1alpha,25-dihydroxyvitamin D3 accumulates into the fracture callus during rat femoral fracture healing. Endocrinology 1998; Apr; 139(4): 1467–73.

87. Kato A, Bishop JE, Norman AW. Evidence for a 1 alpha,25-dihydroxyvitamin D3 receptor/binding protein in a membrane fraction isolated from a chick tibial fracture-healing callus. Biochem Biophys Res Commun 1998; Mar 27; 244(3): 724–7.

88. Doetsch AM, Faber J, Lynnerup N, Watjen I, Bliddal H, Danneskiold-Samsoe B. The effect of calcium and vitamin D3 supplementation on the healing of the proximal humerus fracture: a randomized placebo-controlled study. Calcif Tissue Int 2004; Sep; 75(3): 183–8.

89. Pun KK, Chan LW. Analgesic effect of intranasal salmon calcitonin in the treatment of osteoporotic vertebral fractures. Clin Ther 1989; Mar-Apr; 11(2): 205–9.

90. Huusko TM, Karppi P, Kautiainen H, Suominen H, Avikainen V, Sulkava R. Randomized, double-blind, clinically controlled trial of intranasal calcitonin treatment in patients with hip fracture. Calcif Tissue Int 2002; Dec; 71(6): 478–84.

91. Cebesoy O, Tutar E, Kose KC, Baltaci Y, Bagci C. Effect of strontium ranelate on fracture healing in rat tibia. Joint Bone Spine 2007 Dec; 74(6): 590–3.

92. Peter CP, Cook WO, Nunamaker DM, Provost MT, Seedor JG, Rodan GA. Effect of alendronate on fracture healing and bone remodeling in dogs. J Orthop Res 1996 Jan; 14(1): 74–9.

93. Li C, Mori S, Li J, Kaji Y, Akiyama T, Kawanishi J, et al. Long-term effect of incadronate disodium (YM-175) on fracture healing of femoral shaft in growing rats. J Bone Miner Res 2001; Mar; 16(3): 429–36.

94. McDonald MM, Dulai S, Godfrey C, Amanat N, Sztynda T, Little DG. Bolus or weekly zoledronic acid administration does not delay endochondral fracture repair but weekly dosing enhances delays in hard callus remodeling. Bone 2008; Jun 3.

95. Kakar S, Einhorn TA, Vora S, Miara LJ, Hon G, Wigner NA, et al. Enhanced Chondrogenesis and Wnt Signaling in PTH-Treated Fractures. J Bone Miner Res 2007; Dec; 22(12): 1903–12.

96. Andreassen TT, Fledelius C, Ejersted C, Oxlund H. Increases in callus formation and mechanical strength of healing fractures in old rats treated with parathyroid hormone. Acta Orthop Scand 2001; Jun; 72(3): 304–7.

97. Gardner MJ, van der Meulen MC, Carson J, Zelken J, Ricciardi BF, Wright TM, et al. Role of parathyroid hormone in the mechanosensitivity of fracture healing. J Orthop Res. 2007; Nov; 25(11): 1474–80.

98. Pfeifer M, Sinaki M, Geusens P, Boonen S, Preisinger E, Minne HW. Musculoskeletal rehabilitation in osteoporosis: a review. J Bone Miner Res 2004; Aug; 19(8):1208–14.

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