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The management of displaced intracapsular femoral neck fractures at a Sub-Saharan Academic Hospital

Background: Femoral neck fractures (FNFs) remain “the unsolved fracture” and optimal management is still controversial. The outcomes of hemiarthroplasty (HA) and total hip arthroplasty (THA) in the treatment of FNFs are inconsistent. As demand for management of FNFs continues to grow globally, evalu...

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Autores principales: Mukiibi, Winifred, Maharaj, Zia, Sekeitto, Allan Roy, Mokete, Lipalo, Pietrzak, Jurek Rafal Tomasz
Formato: Online Artículo Texto
Lenguaje:English
Publicado: EDP Sciences 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8132601/
https://www.ncbi.nlm.nih.gov/pubmed/34009118
http://dx.doi.org/10.1051/sicotj/2021023
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author Mukiibi, Winifred
Maharaj, Zia
Sekeitto, Allan Roy
Mokete, Lipalo
Pietrzak, Jurek Rafal Tomasz
author_facet Mukiibi, Winifred
Maharaj, Zia
Sekeitto, Allan Roy
Mokete, Lipalo
Pietrzak, Jurek Rafal Tomasz
author_sort Mukiibi, Winifred
collection PubMed
description Background: Femoral neck fractures (FNFs) remain “the unsolved fracture” and optimal management is still controversial. The outcomes of hemiarthroplasty (HA) and total hip arthroplasty (THA) in the treatment of FNFs are inconsistent. As demand for management of FNFs continues to grow globally, evaluation of the appropriateness of treatment remains essential, particularly in resource-constrained settings. Methods: We conducted a retrospective chart review of all patients presenting with isolated low energy intracapsular FNFs to an orthopaedic academic unit in Sub-Saharan Africa from January 2016 to April 2019. The decision regarding HA or THA was largely based upon the Sernbo score and ASA classification. The majority of patients with a Sernbo score of ≥15 and ASA class III or better received THA. Results: There were 117 patients (33 male/84 female) 72 years (33–97 years) with FNFs who underwent 56 THA and 61 HA between January 2016 and April 2019. The mean Sernbo score was 15.99 overall (range 8–20) and was 18.95 (11–20) for THA patients compared to 14.46 (8–20) for HA patients (p = 0.042). Time taken from admission to the theatre was 8–19 days (1–22) and 7–61 days (2–31) for HA and THA respectively. The average length of stay (LOS) was 16.04 days and the main reason for same-day cancellations was the lack of post ICU/High Care beds. The 30-day mortality rates were 1.78% and 4.91% for THA and HA patients, respectively (p = 0.07). The mortality rate for patients with a Sernbo score < 15 was 15.38% overall, 8.93% for THA patients, and 21.31% for HA patients, respectively (p = 0.021). Conclusion: The 30-day mortality rate was comparable with published rates from developed countries. There were significant delays in time to theatre, high rates of same-day surgical cancellations, and increased LOS for both HA and THA. These factors play a cumulative role in inflating costs on a strained healthcare system in a developing country. A multidisciplinary approach including the care provision of a specialized geriatric unit is recommended. Retrospective Study, Level III evidence
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spelling pubmed-81326012021-05-24 The management of displaced intracapsular femoral neck fractures at a Sub-Saharan Academic Hospital Mukiibi, Winifred Maharaj, Zia Sekeitto, Allan Roy Mokete, Lipalo Pietrzak, Jurek Rafal Tomasz SICOT J Original Article Background: Femoral neck fractures (FNFs) remain “the unsolved fracture” and optimal management is still controversial. The outcomes of hemiarthroplasty (HA) and total hip arthroplasty (THA) in the treatment of FNFs are inconsistent. As demand for management of FNFs continues to grow globally, evaluation of the appropriateness of treatment remains essential, particularly in resource-constrained settings. Methods: We conducted a retrospective chart review of all patients presenting with isolated low energy intracapsular FNFs to an orthopaedic academic unit in Sub-Saharan Africa from January 2016 to April 2019. The decision regarding HA or THA was largely based upon the Sernbo score and ASA classification. The majority of patients with a Sernbo score of ≥15 and ASA class III or better received THA. Results: There were 117 patients (33 male/84 female) 72 years (33–97 years) with FNFs who underwent 56 THA and 61 HA between January 2016 and April 2019. The mean Sernbo score was 15.99 overall (range 8–20) and was 18.95 (11–20) for THA patients compared to 14.46 (8–20) for HA patients (p = 0.042). Time taken from admission to the theatre was 8–19 days (1–22) and 7–61 days (2–31) for HA and THA respectively. The average length of stay (LOS) was 16.04 days and the main reason for same-day cancellations was the lack of post ICU/High Care beds. The 30-day mortality rates were 1.78% and 4.91% for THA and HA patients, respectively (p = 0.07). The mortality rate for patients with a Sernbo score < 15 was 15.38% overall, 8.93% for THA patients, and 21.31% for HA patients, respectively (p = 0.021). Conclusion: The 30-day mortality rate was comparable with published rates from developed countries. There were significant delays in time to theatre, high rates of same-day surgical cancellations, and increased LOS for both HA and THA. These factors play a cumulative role in inflating costs on a strained healthcare system in a developing country. A multidisciplinary approach including the care provision of a specialized geriatric unit is recommended. Retrospective Study, Level III evidence EDP Sciences 2021-05-19 /pmc/articles/PMC8132601/ /pubmed/34009118 http://dx.doi.org/10.1051/sicotj/2021023 Text en © The Authors, published by EDP Sciences, 2021 https://creativecommons.org/licenses/by/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0 (https://creativecommons.org/licenses/by/4.0/) ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Mukiibi, Winifred
Maharaj, Zia
Sekeitto, Allan Roy
Mokete, Lipalo
Pietrzak, Jurek Rafal Tomasz
The management of displaced intracapsular femoral neck fractures at a Sub-Saharan Academic Hospital
title The management of displaced intracapsular femoral neck fractures at a Sub-Saharan Academic Hospital
title_full The management of displaced intracapsular femoral neck fractures at a Sub-Saharan Academic Hospital
title_fullStr The management of displaced intracapsular femoral neck fractures at a Sub-Saharan Academic Hospital
title_full_unstemmed The management of displaced intracapsular femoral neck fractures at a Sub-Saharan Academic Hospital
title_short The management of displaced intracapsular femoral neck fractures at a Sub-Saharan Academic Hospital
title_sort management of displaced intracapsular femoral neck fractures at a sub-saharan academic hospital
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8132601/
https://www.ncbi.nlm.nih.gov/pubmed/34009118
http://dx.doi.org/10.1051/sicotj/2021023
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