A retrospective cohort study of concomitant ipsilateral extra-capsular and intra-capsular fractures of the proximal femur. Are they casual findings or an undervalued reality?
| Autor: | Joan Girós-Torres, José-Miguel Sales-Pérez, Sebastián Videla, Rubén Sánchez-Navés, Miquel Videla-Cés |
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| Rok vydání: | 2017 |
| Předmět: |
Male
medicine.medical_specialty Intra-Articular Fractures Osteoporosis 03 medical and health sciences Fracture Fixation Internal 0302 clinical medicine medicine Humans Cumulative incidence 030212 general & internal medicine Range of Motion Articular General Environmental Science Fixation (histology) Aged Retrospective Studies Aged 80 and over 030222 orthopedics Proximal femur business.industry Hip Fractures Incidence (epidemiology) Incidence Retrospective cohort study Middle Aged medicine.disease Confidence interval Surgery Treatment Outcome Geriatrics Spain Concomitant General Earth and Planetary Sciences Female business |
| Zdroj: | Injury. 48(7) |
| ISSN: | 1879-0267 |
| Popis: | Background Fractures of the proximal femur constitute a major public health problem, with an annual incidence in Spain of 7.6 cases per 1000 inhabitants over 65 years of age. Hip fractures are frequent in elderly patients, related to osteoporosis and with low energy trauma, which means that they can be considered a geriatric syndrome. Simultaneous ipsilateral extra- and intra-articular hip fractures are considered as very rare are, and generally speaking, classified as extra- or intra-capsular fractures. Moreover, there is no consensus with regard to treatment of these concomitant fractures. Aim To estimate the incidence of concomitant ipsilateral extra- and intra-capsular fractures of the proximal femur, and to describe the diagnostic process and the clinical characteristics of these concomitant fractures. Patients and methods Retrospective cohort study of patients with hip fractures. The incidence of combined extra- and intra-capsular fractures was estimated, a confidence interval of 95% (95%CI) was calculated and a descriptive analysis was drawn up. Results Between May 2010 (the date on which the Orthopaedic and Trauma Surgery Department of our new Hospital began the surgical activity) and December 2016, 33 (median age, 86 years-old) of the 2625 hip fractures were classified as simultaneous extra- and intra-capsular ipsilateral fractures. The overall cumulative incidence was of 1.3% (95%CI:0.9–1.8%). In 32 (97%) of the patients, the fracture was a consequence of a low energy trauma (ground level fall), while the remainder was due to a medium energy trauma (skating). In all cases the two fracture lines seem to be independent of each other, which suggests different mechanisms of injury from that of isolated subcapital or intrertrochanteric fracture. Conclusion The incidence of concomitant ipsilateral extra- and intra-capsular fractures of the proximal femur must be taken into account in patients over 65 years of age. It is clinically relevant to identify these concomitant fractures in order to arrive at a correct diagnosis, which will facilitate preoperative planning and the choice of the best treatment to achieve a better outcome. Misdiagnosis may cause further problems, such as fixation failures, disability and, in a worst case scenario, an increased risk of death. Therefore, a good and complete preoperative study is important, along with both good quality X-ray projections and 2D and 3D Ct-Scans in case of doubt. |
| Databáze: | OpenAIRE |
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