When does hip fracture surgery fail?

• Published in: Injury Vol. 45; no. 7; pp. 1059 - 1065
• Main Authors: Tsang, S.T.J, Aitken, S.A, Golay, S.K, Silverwood, R.K, Biant, L.C
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.07.2014
• Subjects: Age Factors; Aged; Aged, 80 and over; Bone Nails - adverse effects; Bone Screws - adverse effects; Complications; Elderly; Female; Fracture Fixation, Intramedullary - adverse effects; Hip fractures; Hip Fractures - mortality; Hip Fractures - physiopathology; Hip Fractures - surgery; Humans; Male; Orthopedics; Postoperative Complications - mortality; Postoperative Complications - physiopathology; Postoperative Complications - surgery; Practice Guidelines as Topic; Prospective Studies; Reoperation - mortality; Reoperation - statistics & numerical data; Risk Factors; Smoking - adverse effects; Socioeconomic Factors; Survival Analysis; Treatment Failure; Wound Infection - mortality; Wound Infection - physiopathology; Wound Infection - surgery; Complications; Elderly; Hip fractures
• ISSN: 0020-1383; 1879-0267
• DOI: 10.1016/j.injury.2014.03.019

Abstract Introduction Hip fractures remain the most common orthopaedic injury requiring hospital admission. Failed surgery for any cause carries a higher morbidity, mortality, and healthcare-related cost. The aims of this study were to determine risk factors for surgical complications of hip fracture surgery, when they occurred and their effect on mortality. Patients and methods From a prospectively collected consecutive database of 795 hip fractures admitted between July 2007 and June 2008, all surgical and non-surgical complications were identified as well as re-operation for any cause and mortality in the 4 years since surgery. Results Fifty-five (6.9%) patients were found to have developed a surgical complication requiring further intervention. Risk factors included younger age, smoking and cannulated screw fixation. Cannulated screw fixation was associated with a 30.9% rate of re-operation. Post-operative medical complication occurred in 21.8%. It was associated with a 78.5% mortality at 4 years with a median time to mortality of 58 days (95% CI 0–120 days). Conclusions Mechanical failure was the most common reason for cannulated screw re-operation. Hip hemiarthroplasty most commonly failed by infection. Inter-trochanteric and sub-trochanteric fracture fixation had very low failure rates. Post-operative medical complications, but not surgical complications, were associated with a higher mortality rate.