Thursday, February 6, 2003
Based on 30-day mortality rates, open reduction/internal fixation (ORIF) may be a better treatment for intertrochanteric (IT) hip fractures than arthroplasty, according to the researchers for Poster Exhibit 034.
During a single period, 1,873 patients with IT hip fractures were treated with either ORIF or hemiarthroplasty. Researchers reviewed in detail the clinical records of 85 patients who died within 30 days of the surgery, and compared the findings with computerized data on the 1,788 patients who survived more than 30 days.
The overall incidence of 30-day mortality after IT fracture was 4.5 percent. This was significantly higher than the overall mortality for all types of hip fractures treated at that institution, which was 2.9 percent (186 deaths within 30 days out of 6,218 admissions for hip fracture). The mortality rate was slightly, but not significantly, higher for patients with an IT fracture who were treated with arthroplasty compared to those treated with ORIF (4.8 percent versus 4.5 percent) (p=0.3).
However, 62 percent of patients with an IT fracture who were treated with arthroplasty exhibited serious intraoperative cardiorespiratory disturbances. Only 24 percent of patients treated with ORIF experienced similar disturbances. Furthermore, patients with serious intraoperative hypotension, hypoxemia and arrhythmia were more likely to die in-hospital and to have a protracted postoperative course. Among the arthroplasty patients, 77 percent died in the hospital compared to an in-hospital death rate of 35 percent among the ORIF group.
Multivariate analysis revealed that risk for mortality included old age, history of previous cardiorespiratory disease and evidence of intraoperative cardiorespiratory instability. Researchers found that perioperative mortality was significantly higher for patients with a hip fracture than it was for patients undergoing elective hip arthroplasty.
Although the incidence of mortality was not significantly different for IT fracture patients being treated with ORIF than for those treated with arthroplasty, the arthroplasty patients were more likely to have a complicated intraoperative course and die in the hospital. Researchers concluded that arthroplasty, as a treatment for IT fracture, should be reserved for highly complex fractures that are not amenable to ORIF. Additionally, these patients should undergo full medical evaluation and optimization prior to their arthroplasty.
Researchers included Ryan E. Dobbs, MD, Javad Parvizi, MD, and David G. Lewallen, all of Rochester, Minn.
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