Research Article
BibTex RIS Cite

Anatomical evaluation of proximal femur fractures in trauma patients aged 65 or older admitted to the emergency department

Year 2025, Volume: 18 Issue: 1, 4 - 4
https://doi.org/10.31362/patd.1483188

Abstract

Purpose: This retrospective study aimed to assess the association between classification systems for proximal femur fractures and mid-term mortality in elderly patients, focusing on their clinical and anatomical aspects.
Materials and methods: Radiological images of patients aged 65 years and older who underwent surgical procedures for proximal femur fractures were reviewed. Various classification systems were applied, including Anatomical, Pipkin, Garden, Evans-Jensen, Seinsheimer, and AO/OTA classifications. Electronic hospital records provided patient data, and statistical analyses were performed.
Results: The study included 298 patients, and the mean age was 81.7±7.3 years, and 63.1% were female. Median length of stay in hospital 7 (1-63) days, 19.1% requiring intensive care, and a 13.8% mortality rate within 3 months. Patients were distributed based on anatomical classification, and the distribution of intracapsular and extracapsular fractures according to clinical classifications was detailed. The findings suggest that proximal femur fracture classification systems do not significantly influence mortality rates (p=0.787).
Conclusion: Anatomical classification systems may be favored for their simplicity and potential to establish a common language among healthcare professionals. This study provides valuable insights into proximal femur fractures in elderly patients, informing clinical practice.

References

  • 1. Raaymakers ELFB. Fractures of the femoral neck: a review and personal statement. Acta Chir Orthop Traumatol Cech 2006;73:45-59.
  • 2. Yin B, He Y, Wang D, Zhou J. Classification of femur trochanteric fracture: evaluating the reliability of Tang classification. Injury 2021;52:1500-1505. https://doi.org/10.1016/j.injury.2020.11.031
  • 3. Collin PG, D'Antoni AV, Loukas M, Oskouian RJ, Tubbs RS. Hip fractures in the elderly-: a clinical anatomy review. Clin Anat 2017;30:89-97. https://doi.org/10.1002/ca.22779
  • 4. Patterson JT, Tangtiphaiboontana J, Pandya NK. Management of pediatric femoral neck fracture. J Am Acad Orthop Surg 2018;26:411-419. https://doi.org/10.5435/JAAOS-D-16-00362
  • 5. Ramponi DR, Kaufmann J, Drahnak G. Hip fractures. Adv Emerg Nurs J 2018;40:8-15. https://doi.org/10.1097/TME.0000000000000180
  • 6. Thomsen NO, Jensen CM, Skovgaard N, et al. Observer variation in the radiographic classification of fractures of the neck of the femur using Garden's system. Int Orthop 1996;20:326-329. https://doi.org/10.1007/s002640050087
  • 7. Zlowodzki M, Bhandari M, Keel M, Hanson BP, Schemitsch E. Perception of Garden's classification for femoral neck fractures: an international survey of 298 orthopaedic trauma surgeons. Arch Orthop Trauma Surg, 2005;125:503-505. https://doi.org/10.1007/s00402-005-0022-4
  • 8. Mears SC. Classification and surgical approaches to hip fractures for nonsurgeons. Clin Geriatr Med 2014;30:229-241. https://doi.org/10.1016/j.cger.2014.01.004
  • 9. İmerci A, Aydogan NH, Tosun K. Evaluation of inter- and intra-observer reliability of current classification systems for subtrochanteric femoral fractures. Eur J Orthop Surg Traumatol 2018;28:499-502. https://doi.org/10.1007/s00590-017-2065-y
  • 10. Sheehan SE, Shyu JY, Weaver MJ, Sodickson AD, Khurana B. Proximal femoral fractures: what the orthopedic surgeon wants to know. Radiographics 2015;35:1563-1584. https://doi.org/10.1148/rg.2015140301
  • 11. Cirovic A, Cirovic A, Djonic D. Three-dimensional microstructural basis for differential occurrence of subcapital versus basicervical hip fractures in men. Calcif Tissue Int 2020;107:240-248. https://doi.org/10.1007/s00223-020-00717-z
  • 12. Chen CY, Chiu FY, Chen CM, Huang CK, Chen WM, Chen TH. Surgical treatment of basicervical fractures of femur--a prospective evaluation of 269 patients. J Trauma 2008;64:427-429. https://doi.org/10.1097/01.ta.0000239255.47280.6f
  • 13. Shen M, Wang C, Chen H, Rui YF, Zhao S. An update on the Pauwels classification. J Orthop Surg Res 2016;11:161. https://doi.org/10.1186/s13018-016-0498-3
  • 14. Meinberg EG, Agel J, Roberts CS, Karam MD, Kellam JF. Fracture and dislocation classification compendium-2018. J Orthop Trauma 2018;32:1-170. https://doi.org/10.1097/BOT.0000000000001063
  • 15. Fischer H, Maleitzke T, Eder C, Ahmad S, Stöckle U, Braun KF. Management of proximal femur fractures in the elderly: current concepts and treatment options. Eur J Med Res 2021;26: 86. https://doi.org/10.1186/s40001-021-00556-0
  • 16. Gullberg B, Johnell O, Kanis JA. World-wide projections for hip fracture. Osteoporos Int 1997;7:407-413. https://doi.org/10.1007/pl00004148
  • 17. Fried LP, Tangen CM, Walston J, and Cardiovascular Health Study Collaborative Research Group. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 2001;56:146-156. https://doi.org/10.1093/gerona/56.3.m146
  • 18. Kanis JA, Odén A, McCloskey EV, Johansson H, Wahl DA, Cooper C, and IOF Working Group on Epidemiology and Quality of Life. A systematic review of hip fracture incidence and probability of fracture worldwide. Osteoporos Int 2012;23:2239-2256. https://doi.org/10.1007/s00198-012-1964-3
  • 19. Romeo NM, Firoozabadi R. Classifications in brief: the pipkin classification of femoral head fractures. Clin Orthop Relat Res 2018;476:1114-1119. https://doi.org/10.1007/s11999.0000000000000045
  • 20. Zhao D, Qiu X, Wang B, et al. Epiphyseal arterial network and inferior retinacular artery seem critical to femoral head perfusion in adults with femoral neck fractures. Clin Orthop Relat Res 2017;475:2011-2023. https://doi.org/10.1007/s11999-017-5318-5
  • 21. Aksu N, Işıklar ZU. Hip fractures. TOTBİD Dergisi 2008;7:8-19.
  • 22. Yıldırım C, Muratoğlu OG, Turan K, Ergün T, Mısır A, Aydın M. The intra- and interobserver reliability of five commonly used intertrochanteric femur fracture classification systems. Jt Dis Relat Surg 2022;33:187-192. https://doi.org/10.52312/jdrs.2022.498
  • 23. Haentjens P, Magaziner J, Colón Emeric CS, et al. Meta-analysis: excess mortality after hip fracture among older women and men. Ann Intern Med 2010;152:380-390. https://doi.org/10.7326/0003-4819-152-6-201003160-00008
  • 24. Klestil T, Röder C, Stotter C, et al. Impact of timing of surgery in elderly hip fracture patients: a systematic review and meta-analysis. Sci Rep 2018;8:13933. https://doi.org/10.1038/s41598-018-32098-7
  • 25. Walter N, Szymski D, Kurtz S, et al. Factors associated with mortality after proximal femoral fracture. J Orthop Traumatol 2023;24:31. https://doi.org/10.1186/s10195-023-00715-5
  • 26. Narula S, Lawless A, D'Alessandro P, Jones CW, Yates P, Seymour H. Clinical frailty scale is a good predictor of mortality after proximal femur fracture: a cohort study of 30-day and one-year mortality. Bone Jt Open 2020;1:443-449. https://doi.org/10.1302/2633-1462.18.BJO-2020-0089.R1

Acil servise kabul edilen 65 yaş ve üzeri travma hastalarında proksimal femur kırıklarının anatomik değerlendirmesi

Year 2025, Volume: 18 Issue: 1, 4 - 4
https://doi.org/10.31362/patd.1483188

Abstract

Amaç: Bu retrospektif çalışma, proksimal femur kırıkları için sınıflandırma sistemleri ile yaşlı hastalarda orta vadeli mortalite arasındaki ilişkiyi değerlendirmeyi amaçlamıştır, odaklanılan nokta ise klinik ve anatomik yönleridir.
Gereç ve yöntem: Cerrahi işlem uygulanan proksimal femur kırıklı hastaların radyolojik görüntüleri incelendi. Anatomik, Pipkin, Garden, Evans-Jensen, Seinsheimer ve AO/OTA sınıflandırmaları olmak üzere çeşitli sınıflandırma sistemleri uygulandı. Elektronik hastane kayıtları hastaya ait verileri sağladı ve istatistiksel analizler yapıldı.
Bulgular: Çalışma, 298 hastayı içeriyordu ve ortalama yaş 81,7±7,3 yıl idi, %63,1'i kadındı. Hastanede kalış süresi, ortalama 7(1-63) gün idi, %19,1'i yoğun bakım gerektiriyordu ve 3 ay içinde %13,8'lik bir mortalite oranı görüldü. Hastalar, anatomik sınıflandırmaya göre dağıtıldı ve klinik sınıflandırmalara göre intrakapsüler ve ekstrakapsüler kırıkların dağılımı detaylandırıldı. Bulgular, proksimal femur kırık sınıflandırma sistemlerinin mortalite oranlarını önemli ölçüde etkilemediğini öne sürmektedir (p=0,787).
Sonuç: Anatomik sınıflandırma sistemleri, basitliği ve sağlık profesyonelleri arasında ortak bir dil oluşturma potansiyeli nedeniyle tercih edilebilir. Bu çalışma, yaşlı hastalarda proksimal femur kırıkları hakkında değerli içgörüler sağlayarak klinik uygulamayı bilgilendirir.

References

  • 1. Raaymakers ELFB. Fractures of the femoral neck: a review and personal statement. Acta Chir Orthop Traumatol Cech 2006;73:45-59.
  • 2. Yin B, He Y, Wang D, Zhou J. Classification of femur trochanteric fracture: evaluating the reliability of Tang classification. Injury 2021;52:1500-1505. https://doi.org/10.1016/j.injury.2020.11.031
  • 3. Collin PG, D'Antoni AV, Loukas M, Oskouian RJ, Tubbs RS. Hip fractures in the elderly-: a clinical anatomy review. Clin Anat 2017;30:89-97. https://doi.org/10.1002/ca.22779
  • 4. Patterson JT, Tangtiphaiboontana J, Pandya NK. Management of pediatric femoral neck fracture. J Am Acad Orthop Surg 2018;26:411-419. https://doi.org/10.5435/JAAOS-D-16-00362
  • 5. Ramponi DR, Kaufmann J, Drahnak G. Hip fractures. Adv Emerg Nurs J 2018;40:8-15. https://doi.org/10.1097/TME.0000000000000180
  • 6. Thomsen NO, Jensen CM, Skovgaard N, et al. Observer variation in the radiographic classification of fractures of the neck of the femur using Garden's system. Int Orthop 1996;20:326-329. https://doi.org/10.1007/s002640050087
  • 7. Zlowodzki M, Bhandari M, Keel M, Hanson BP, Schemitsch E. Perception of Garden's classification for femoral neck fractures: an international survey of 298 orthopaedic trauma surgeons. Arch Orthop Trauma Surg, 2005;125:503-505. https://doi.org/10.1007/s00402-005-0022-4
  • 8. Mears SC. Classification and surgical approaches to hip fractures for nonsurgeons. Clin Geriatr Med 2014;30:229-241. https://doi.org/10.1016/j.cger.2014.01.004
  • 9. İmerci A, Aydogan NH, Tosun K. Evaluation of inter- and intra-observer reliability of current classification systems for subtrochanteric femoral fractures. Eur J Orthop Surg Traumatol 2018;28:499-502. https://doi.org/10.1007/s00590-017-2065-y
  • 10. Sheehan SE, Shyu JY, Weaver MJ, Sodickson AD, Khurana B. Proximal femoral fractures: what the orthopedic surgeon wants to know. Radiographics 2015;35:1563-1584. https://doi.org/10.1148/rg.2015140301
  • 11. Cirovic A, Cirovic A, Djonic D. Three-dimensional microstructural basis for differential occurrence of subcapital versus basicervical hip fractures in men. Calcif Tissue Int 2020;107:240-248. https://doi.org/10.1007/s00223-020-00717-z
  • 12. Chen CY, Chiu FY, Chen CM, Huang CK, Chen WM, Chen TH. Surgical treatment of basicervical fractures of femur--a prospective evaluation of 269 patients. J Trauma 2008;64:427-429. https://doi.org/10.1097/01.ta.0000239255.47280.6f
  • 13. Shen M, Wang C, Chen H, Rui YF, Zhao S. An update on the Pauwels classification. J Orthop Surg Res 2016;11:161. https://doi.org/10.1186/s13018-016-0498-3
  • 14. Meinberg EG, Agel J, Roberts CS, Karam MD, Kellam JF. Fracture and dislocation classification compendium-2018. J Orthop Trauma 2018;32:1-170. https://doi.org/10.1097/BOT.0000000000001063
  • 15. Fischer H, Maleitzke T, Eder C, Ahmad S, Stöckle U, Braun KF. Management of proximal femur fractures in the elderly: current concepts and treatment options. Eur J Med Res 2021;26: 86. https://doi.org/10.1186/s40001-021-00556-0
  • 16. Gullberg B, Johnell O, Kanis JA. World-wide projections for hip fracture. Osteoporos Int 1997;7:407-413. https://doi.org/10.1007/pl00004148
  • 17. Fried LP, Tangen CM, Walston J, and Cardiovascular Health Study Collaborative Research Group. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 2001;56:146-156. https://doi.org/10.1093/gerona/56.3.m146
  • 18. Kanis JA, Odén A, McCloskey EV, Johansson H, Wahl DA, Cooper C, and IOF Working Group on Epidemiology and Quality of Life. A systematic review of hip fracture incidence and probability of fracture worldwide. Osteoporos Int 2012;23:2239-2256. https://doi.org/10.1007/s00198-012-1964-3
  • 19. Romeo NM, Firoozabadi R. Classifications in brief: the pipkin classification of femoral head fractures. Clin Orthop Relat Res 2018;476:1114-1119. https://doi.org/10.1007/s11999.0000000000000045
  • 20. Zhao D, Qiu X, Wang B, et al. Epiphyseal arterial network and inferior retinacular artery seem critical to femoral head perfusion in adults with femoral neck fractures. Clin Orthop Relat Res 2017;475:2011-2023. https://doi.org/10.1007/s11999-017-5318-5
  • 21. Aksu N, Işıklar ZU. Hip fractures. TOTBİD Dergisi 2008;7:8-19.
  • 22. Yıldırım C, Muratoğlu OG, Turan K, Ergün T, Mısır A, Aydın M. The intra- and interobserver reliability of five commonly used intertrochanteric femur fracture classification systems. Jt Dis Relat Surg 2022;33:187-192. https://doi.org/10.52312/jdrs.2022.498
  • 23. Haentjens P, Magaziner J, Colón Emeric CS, et al. Meta-analysis: excess mortality after hip fracture among older women and men. Ann Intern Med 2010;152:380-390. https://doi.org/10.7326/0003-4819-152-6-201003160-00008
  • 24. Klestil T, Röder C, Stotter C, et al. Impact of timing of surgery in elderly hip fracture patients: a systematic review and meta-analysis. Sci Rep 2018;8:13933. https://doi.org/10.1038/s41598-018-32098-7
  • 25. Walter N, Szymski D, Kurtz S, et al. Factors associated with mortality after proximal femoral fracture. J Orthop Traumatol 2023;24:31. https://doi.org/10.1186/s10195-023-00715-5
  • 26. Narula S, Lawless A, D'Alessandro P, Jones CW, Yates P, Seymour H. Clinical frailty scale is a good predictor of mortality after proximal femur fracture: a cohort study of 30-day and one-year mortality. Bone Jt Open 2020;1:443-449. https://doi.org/10.1302/2633-1462.18.BJO-2020-0089.R1
There are 26 citations in total.

Details

Primary Language English
Subjects Emergency Medicine, Anatomy
Journal Section Research Article
Authors

Zeynep Nisa Karakoyun 0000-0003-2933-7443

Ömer Faruk Karakoyun 0000-0002-4476-7989

Kivanç Karaman 0000-0002-4105-2785

Yalcin Golcuk 0000-0002-8530-8607

Early Pub Date September 20, 2024
Publication Date
Submission Date May 13, 2024
Acceptance Date September 10, 2024
Published in Issue Year 2025 Volume: 18 Issue: 1

Cite

AMA Karakoyun ZN, Karakoyun ÖF, Karaman K, Golcuk Y. Anatomical evaluation of proximal femur fractures in trauma patients aged 65 or older admitted to the emergency department. Pam Med J. September 2024;18(1):4-4. doi:10.31362/patd.1483188

Creative Commons Lisansı
Pamukkale Medical Journal is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License