Osteoporotic Hip Fractures: The Burden of Fixation Failure

• Published in: TheScientificWorld Vol. 2013; no. 2013; pp. 1 - 7
• Main Authors: Mulhall, K. J., Stanley, E., Bruce-Brand, R., Broderick, J. M.
• Format: Journal Article
• Language: English
• Published: Cairo, Egypt Hindawi Publishing Corporation 01-01-2013; John Wiley & Sons, Inc; Hindawi Limited
• Subjects: Aged; Arthroplasty, Replacement, Hip - economics; Arthroplasty, Replacement, Hip - methods; Biomedical materials; Bone density; Care and treatment; Complications and side effects; Cost of Illness; Dependence; Failure rates; Fixation; Fracture Fixation - adverse effects; Fracture Fixation - economics; Fracture Fixation - methods; Fractures; Fragility; Health care; Hip Fractures - economics; Hip Fractures - mortality; Hip Fractures - surgery; Hip joint; Hip Joint - surgery; Humans; Incidence; Internal fixation in fractures; Joint surgery; Length of Stay; Morbidity; Mortality; Older people; Osteoporosis; Osteoporotic Fractures - economics; Osteoporotic Fractures - mortality; Osteoporotic Fractures - surgery; Quality of Life; Reoperation - economics; Reoperation - methods; Review; Risk Factors; Surgical implants; Treatment Outcome
• ISSN: 2356-6140; 1537-744X; 1537-744X
• DOI: 10.1155/2013/515197

Osteoporotic hip fractures are a major cause of morbidity and mortality in the elderly. Furthermore, reduced implant anchorage in osteoporotic bone predisposes towards fixation failure and with an ageing population, even low failure rates represent a significant challenge to healthcare systems. Fixation failure in fragility fractures of the hip ranges from 5% in peritrochanteric fractures through to 15% and 41% in undisplaced and displaced fractures of the femoral neck, respectively. Our findings, in general, support the view that failed internal fixation of these fragility fractures carries a poor prognosis: it leads to a twofold increase in the length of hospital stay and a doubling of healthcare costs. Patients are more likely to suffer a downgrade in their residential status upon discharge with a consequent increase in social dependency. Furthermore, the marked disability and reduction in quality of life evident before salvage procedures may persist at long-term followup. The risk, of course, for the elderly patient with a prolonged period of decreased functioning is that the disability becomes permanent. Despite this, however, no clear link between revision surgery and an increase in mortality has been demonstrated in the literature.