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Characteristics and risk factors of UCS fracture subtypes in periprosthetic fractures around the hip: results from the National Periprosthetic Fracture study
AIMS: Periprosthetic fractures (PPFs) following hip arthroplasty are complex injuries. This study evaluates patient demographic characteristics, management, outcomes, and risk factors associated with PPF subtypes over a decade. METHODS: Using a multicentre collaborative study design, independent of...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
The British Editorial Society of Bone & Joint Surgery
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10471444/ https://www.ncbi.nlm.nih.gov/pubmed/37654129 http://dx.doi.org/10.1302/2633-1462.49.BJO-2023-0065.R1 |
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author | Nasser, Ahmed A. H. H. Osman, Khabab Chauhan, Govind S. Prakash, Rohan Handford, Charles Nandra, Rajpal S. Mahmood, Ansar |
author_facet | Nasser, Ahmed A. H. H. Osman, Khabab Chauhan, Govind S. Prakash, Rohan Handford, Charles Nandra, Rajpal S. Mahmood, Ansar |
author_sort | Nasser, Ahmed A. H. H. |
collection | PubMed |
description | AIMS: Periprosthetic fractures (PPFs) following hip arthroplasty are complex injuries. This study evaluates patient demographic characteristics, management, outcomes, and risk factors associated with PPF subtypes over a decade. METHODS: Using a multicentre collaborative study design, independent of registry data, we identified adults from 29 centres with PPFs around the hip between January 2010 and December 2019. Radiographs were assessed for the Unified Classification System (UCS) grade. Patient and injury characteristics, management, and outcomes were compared between UCS grades. A multinomial logistic regression was performed to estimate relative risk ratios (RRR) of variables on UCS grade. RESULTS: A total of 1,104 patients were included. The majority were female (57.9%; n = 639), ethnically white (88.5%; n = 977), used mobility aids (67%; n = 743), and had a median age of 82 years (interquartile range (IQR) 74 to 87). A total of 77 (7%) had pain prior to the PPF. The most common UCS grade was B2 (33%; n = 368). UCS type D fractures had the longest length of stay (median 19 days (IQR 11 to 26)), highest readmission to hospital (21%; n = 9), and highest rate of discharge to step-down care (52%; n = 23). Multinomial regression suggests that uncemented femoral stems are associated with a reduced risk of UCS C (RRR 0.36 (95% confidence interval (CI) 0.2 to 0.7); p = 0.002) and increased risk of UCS A (RRR 3.3 (95% CI 1.9 to 5.7); p < 0.001), compared to UCS B fracture. CONCLUSION: The most common PPF type in elderly frail patients is UCS B2. Uncemented stems have a lower risk of UCS C fractures compared to cemented stems. A national PPF database is needed to further identify correlation between implants and fracture subtypes. Cite this article: Bone Jt Open 2023;4(9):659–667. |
format | Online Article Text |
id | pubmed-10471444 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | The British Editorial Society of Bone & Joint Surgery |
record_format | MEDLINE/PubMed |
spelling | pubmed-104714442023-09-01 Characteristics and risk factors of UCS fracture subtypes in periprosthetic fractures around the hip: results from the National Periprosthetic Fracture study Nasser, Ahmed A. H. H. Osman, Khabab Chauhan, Govind S. Prakash, Rohan Handford, Charles Nandra, Rajpal S. Mahmood, Ansar Bone Jt Open Trauma AIMS: Periprosthetic fractures (PPFs) following hip arthroplasty are complex injuries. This study evaluates patient demographic characteristics, management, outcomes, and risk factors associated with PPF subtypes over a decade. METHODS: Using a multicentre collaborative study design, independent of registry data, we identified adults from 29 centres with PPFs around the hip between January 2010 and December 2019. Radiographs were assessed for the Unified Classification System (UCS) grade. Patient and injury characteristics, management, and outcomes were compared between UCS grades. A multinomial logistic regression was performed to estimate relative risk ratios (RRR) of variables on UCS grade. RESULTS: A total of 1,104 patients were included. The majority were female (57.9%; n = 639), ethnically white (88.5%; n = 977), used mobility aids (67%; n = 743), and had a median age of 82 years (interquartile range (IQR) 74 to 87). A total of 77 (7%) had pain prior to the PPF. The most common UCS grade was B2 (33%; n = 368). UCS type D fractures had the longest length of stay (median 19 days (IQR 11 to 26)), highest readmission to hospital (21%; n = 9), and highest rate of discharge to step-down care (52%; n = 23). Multinomial regression suggests that uncemented femoral stems are associated with a reduced risk of UCS C (RRR 0.36 (95% confidence interval (CI) 0.2 to 0.7); p = 0.002) and increased risk of UCS A (RRR 3.3 (95% CI 1.9 to 5.7); p < 0.001), compared to UCS B fracture. CONCLUSION: The most common PPF type in elderly frail patients is UCS B2. Uncemented stems have a lower risk of UCS C fractures compared to cemented stems. A national PPF database is needed to further identify correlation between implants and fracture subtypes. Cite this article: Bone Jt Open 2023;4(9):659–667. The British Editorial Society of Bone & Joint Surgery 2023-09-01 /pmc/articles/PMC10471444/ /pubmed/37654129 http://dx.doi.org/10.1302/2633-1462.49.BJO-2023-0065.R1 Text en © 2023 Authors et al. https://creativecommons.org/licenses/by-nc-nd/4.0/https://online.boneandjoint.org.uk/TDMThis is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives (CC BY-NC-ND 4.0) licence, which permits the copying and redistribution of the work only, and provided the original author and source are credited. See https://creativecommons.org/licenses/by-nc-nd/4.0/ |
spellingShingle | Trauma Nasser, Ahmed A. H. H. Osman, Khabab Chauhan, Govind S. Prakash, Rohan Handford, Charles Nandra, Rajpal S. Mahmood, Ansar Characteristics and risk factors of UCS fracture subtypes in periprosthetic fractures around the hip: results from the National Periprosthetic Fracture study |
title | Characteristics and risk factors of UCS fracture subtypes in periprosthetic fractures around the hip: results from the National Periprosthetic Fracture study |
title_full | Characteristics and risk factors of UCS fracture subtypes in periprosthetic fractures around the hip: results from the National Periprosthetic Fracture study |
title_fullStr | Characteristics and risk factors of UCS fracture subtypes in periprosthetic fractures around the hip: results from the National Periprosthetic Fracture study |
title_full_unstemmed | Characteristics and risk factors of UCS fracture subtypes in periprosthetic fractures around the hip: results from the National Periprosthetic Fracture study |
title_short | Characteristics and risk factors of UCS fracture subtypes in periprosthetic fractures around the hip: results from the National Periprosthetic Fracture study |
title_sort | characteristics and risk factors of ucs fracture subtypes in periprosthetic fractures around the hip: results from the national periprosthetic fracture study |
topic | Trauma |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10471444/ https://www.ncbi.nlm.nih.gov/pubmed/37654129 http://dx.doi.org/10.1302/2633-1462.49.BJO-2023-0065.R1 |
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