Clin Orthop Surg.  2018 Mar;10(1):14-19. 10.4055/cios.2018.10.1.14.

Predictors of Intraoperative Fractures during Hemiarthroplasty for the Treatment of Fragility Hip Fractures

• Aslam-Pervez N
• Riaz O
• Gopal S
• Hossain F

• KMID: 2405477
• DOI: http://doi.org/10.4055/cios.2018.10.1.14

Abstract

BACKGROUND
The aim of our study was to determine the rate and preoperative predictors of intraoperative fracture (IOF) during hip hemiarthroplasty (HA) in patients who have sustained a fragility hip fracture injury.
METHODS
We reviewed 626 patients who underwent HA at our institution using the National Hip Fracture Database. Various patient- and surgery-related data including demographic information, cement usage, surgeon grade, time to surgery, and operative duration were collected. The metaphyseal diaphyseal index and modified canal bone ratio were measured on preoperative radiographs. We compared patients with and without IOF with respect to all variables collected. Multivariate regression modeling was used to identify significant preoperative risk factors for IOF.
RESULTS
There was a 7% incidence of IOF in our cohort exclusively comprising of Vancouver A fractures. The majority of these complications were treated nonoperatively (52%). There was no statistically significant difference with respect to cement usage, surgeon grade, operative duration, time to surgery, and radiographic parameters collected. Increasing age was found to be the most significant preoperative risk factor for predicting IOF (p = 0.024, overall relative risk = 1.06).
CONCLUSIONS
Our identified predictor of increasing age is nonmodifiable and illustrates the importance of meticulous surgical technique in older patients. Furthermore, its independence from fixation methods or prosthesis design as a predictor of IOF may support using an uncemented prosthesis in patients at risk from cement implantation.

Keyword

Hemiarthroplasty; Hip fractures; Femur neck fracture; Intraoperative fracture

MeSH Terms

Cohort Studies
Femoral Neck Fractures
Hemiarthroplasty*
Hip Fractures*
Hip*
Humans
Incidence
Prostheses and Implants
Prosthesis Design
Risk Factors

Figure

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  Fig. 1 Description of calculation of metaphyseal diaphyseal index (MDI) score (A) and modified canal bone ratio (CBR) (B).

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  Fig. 2 Treatment for intraoperative fractures in the cohort (n = 33). VAG: Vancouver A greater trochanter fracture, VAL: Vancouver A lesser trochanter fracture.

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