Published online Jan 18, 2024. doi: 10.5312/wjo.v15.i1.30
Peer-review started: September 26, 2023
First decision: November 14, 2023
Revised: November 26, 2023
Accepted: December 19, 2023
Article in press: December 19, 2023
Published online: January 18, 2024
Processing time: 111 Days and 7.1 Hours
Hip fracture is a common musculoskeletal injury in the elderly requiring surgery worldwide. The operative mainstay of intra-capsular hip fractures is arthroplasty with a smaller proportion for fixation.
To determine the most beneficial method of fixation for patients with intra-capsular hip fractures.
A registered audit from 2012-2018 was conducted on all intra-capsular hip fractures treated with 2 commonly used fixation methods. Patient notes, electronic records and clinical codes for cost benefit were evaluated. A validated quality of life measure was collected at least 1 year after surgery.
A total of 83 patients were identified with intra-capsular fractures undergoing fixation during the retrospective period. There were 47 cannulated cancellous screw and 36 sliding hip screw fixations with the case mix comparable for age, gender, co-morbidities and fracture configuration. There was no significant difference in blood loss, tip apex distance, radiation exposure, length of stay, radiological union time, collapse, avascular necrosis or re-operation between fixation methods. Logistic regression analysis demonstrated displaced intracap
No significant advantage was identified with differing fixation type, but irrespective there were a high number of patients requiring re-operation. This was predicted by initial fracture displacement and patient age. Arthroplasty may need to be carefully considered for health economics and patient benefit.
Core Tip: Both sliding and cannulated hip screws had undesirable outcomes in older patients with displaced fractures. More predictable methods of treatment such as hip arthroplasty should be considered for older patients with displaced fractures.