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Bone & Joint Open
Vol. 5, Issue 6 | Pages 524 - 531
24 Jun 2024
Woldeyesus TA Gjertsen J Dalen I Meling T Behzadi M Harboe K Djuv A

Aims

To investigate if preoperative CT improves detection of unstable trochanteric hip fractures.

Methods

A single-centre prospective study was conducted. Patients aged 65 years or older with trochanteric hip fractures admitted to Stavanger University Hospital (Stavanger, Norway) were consecutively included from September 2020 to January 2022. Radiographs and CT images of the fractures were obtained, and surgeons made individual assessments of the fractures based on these. The assessment was conducted according to a systematic protocol including three classification systems (AO/Orthopaedic Trauma Association (OTA), Evans Jensen (EVJ), and Nakano) and questions addressing specific fracture patterns. An expert group provided a gold-standard assessment based on the CT images. Sensitivities and specificities of surgeons’ assessments were estimated and compared in regression models with correlations for the same patients. Intra- and inter-rater reliability were presented as Cohen’s kappa and Gwet’s agreement coefficient (AC1).


The Bone & Joint Journal
Vol. 106-B, Issue 6 | Pages 603 - 612
1 Jun 2024
Ahmad A Egeland EH Dybvik EH Gjertsen J Lie SA Fenstad AM Matre K Furnes O

Aims

This study aimed to compare mortality in trochanteric AO/OTA A1 and A2 fractures treated with an intramedullary nail (IMN) or sliding hip screw (SHS). The primary endpoint was 30-day mortality, with secondary endpoints at 0 to 1, 2 to 7, 8 to 30, 90, and 365 days.

Methods

We analyzed data from 26,393 patients with trochanteric AO/OTA A1 and A2 fractures treated with IMNs (n = 9,095) or SHSs (n = 17,298) in the Norwegian Hip Fracture Register (January 2008 to December 2020). Exclusions were made for patients aged < 60 years, pathological fractures, pre-2008 operations, contralateral hip fractures, fractures other than trochanteric A1/A2, and treatments other than IMNs or SHSs. Kaplan-Meier and Cox regression analyses adjusted for type of fracture, age, sex, cognitive impairment, American Society of Anesthesiologists (ASA) grade, and time period were conducted, along with calculations for number needed to harm (NNH).


The Bone & Joint Journal
Vol. 106-B, Issue 4 | Pages 394 - 400
1 Apr 2024
Kjærvik C Gjertsen J Stensland E Dybvik EH Soereide O

Aims

The aims of this study were to assess quality of life after hip fractures, to characterize respondents to patient-reported outcome measures (PROMs), and to describe the recovery trajectory of hip fracture patients.

Methods

Data on 35,206 hip fractures (2014 to 2018; 67.2% female) in the Norwegian Hip Fracture Register were linked to data from the Norwegian Patient Registry and Statistics Norway. PROMs data were collected using the EuroQol five-dimension three-level questionnaire (EQ-5D-3L) scoring instrument and living patients were invited to respond at four, 12, and 36 months post fracture. Multiple imputation procedures were performed as a model to substitute missing PROM data. Differences in response rates between categories of covariates were analyzed using chi-squared test statistics. The association between patient and socioeconomic characteristics and the reported EQ-5D-3L scores was analyzed using linear regression.


The Bone & Joint Journal
Vol. 104-B, Issue 7 | Pages 884 - 893
1 Jul 2022
Kjærvik C Gjertsen J Stensland E Saltyte-Benth J Soereide O

Aims

This study aimed to identify risk factors (patient, healthcare system, and socioeconomic) for mortality after hip fractures and estimate their relative importance. Further, we aimed to elucidate mortality and survival patterns following fractures and the duration of excess mortality.

Methods

Data on 37,394 hip fractures in the Norwegian Hip Fracture Register from January 2014 to December 2018 were linked to data from the Norwegian Patient Registry, Statistics Norway, and characteristics of acute care hospitals. Cox regression analysis was performed to estimate risk factors associated with mortality. The Wald statistic was used to estimate and illustrate relative importance of risk factors, which were categorized in modifiable (healthcare-related) and non-modifiable (patient-related and socioeconomic). We calculated standardized mortality ratios (SMRs) comparing deaths among hip fracture patients to expected deaths in a standardized reference population.


The Bone & Joint Journal
Vol. 104-B, Issue 2 | Pages 274 - 282
1 Feb 2022
Grønhaug KML Dybvik E Matre K Östman B Gjertsen J

Aims

The aim of this study was to investigate if there are differences in outcome between sliding hip screws (SHSs) and intramedullary nails (IMNs) with regard to fracture stability.

Methods

We assessed data from 17,341 patients with trochanteric or subtrochanteric fractures treated with SHS or IMN in the Norwegian Hip Fracture Register from 2013 to 2019. Primary outcome measures were reoperations for stable fractures (AO Foundation/Orthopaedic Trauma Association (AO/OTA) type A1) and unstable fractures (AO/OTA type A2, A3, and subtrochanteric fractures). Secondary outcome measures were reoperations for A2, A3, and subtrochanteric fractures individually, one-year mortality, quality of life (EuroQol five-dimension three-level index score), pain (visual analogue scale (VAS)), and satisfaction (VAS) for stable and unstable fractures. Hazard rate ratios (HRRs) for reoperation were calculated using Cox regression analysis with adjustments for age, sex, and American Society of Anesthesiologists score.


Bone & Joint Open
Vol. 1, Issue 10 | Pages 644 - 653
14 Oct 2020
Kjærvik C Stensland E Byhring HS Gjertsen J Dybvik E Søreide O

Aims

The aim of this study was to describe variation in hip fracture treatment in Norway expressed as adherence to international and national evidence-based treatment guidelines, to study factors influencing deviation from guidelines, and to analyze consequences of non-adherence.

Methods

International and national guidelines were identified and treatment recommendations extracted. All 43 hospitals routinely treating hip fractures in Norway were characterized. From the Norwegian Hip Fracture Register (NHFR), hip fracture patients aged > 65 years and operated in the period January 2014 to December 2018 for fractures with conclusive treatment guidelines were included (n = 29,613: femoral neck fractures (n = 21,325), stable trochanteric fractures (n = 5,546), inter- and subtrochanteric fractures (n = 2,742)). Adherence to treatment recommendations and a composite indicator of best practice were analyzed. Patient survival and reoperations were evaluated for each recommendation.


The Bone & Joint Journal
Vol. 101-B, Issue 9 | Pages 1129 - 1137
1 Sep 2019
Leer-Salvesen S Engesæter LB Dybvik E Furnes O Kristensen TB Gjertsen J

Aims

The aim of this study was to investigate mortality and risk of intraoperative medical complications depending on delay to hip fracture surgery by using data from the Norwegian Hip Fracture Register (NHFR) and the Norwegian Patient Registry (NPR).

Patients and Methods

A total of 83 727 hip fractures were reported to the NHFR between 2008 and 2017. Pathological fractures, unspecified type of fractures or treatment, patients less than 50 years of age, unknown delay to surgery, and delays to surgery of greater than four days were excluded. We studied total delay (fracture to surgery, n = 38 754) and hospital delay (admission to surgery, n = 73 557). Cox regression analyses were performed to calculate relative risks (RRs) adjusted for sex, age, American Society of Anesthesiologists (ASA) classification, type of surgery, and type of fracture. Odds ratio (OR) was calculated for intraoperative medical complications. We compared delays of 12 hours or less, 13 to 24 hours, 25 to 36 hours, 37 to 48 hours, and more than 48 hours.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXVII | Pages 28 - 28
1 Sep 2012
Vinje T Gjertsen J Lie S Engesaeter L Havelin L Furnes O Matre K Fevang J
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Background

Systematic reviews disagree, but some recent studies have shown better function and less pain after operation with bipolar hemiarthroplasty compared to fixation by two screws in elderly patients operated for displaced femoral neck fractures. There is still uncertainty regarding the mortality associated with both procedures.

Aim of the study

To investigate mortality and the risk factors for death among patients with displaced femoral neck fractures within the first three years after surgery, comparing operation with bipolar hemiarthroplasty (HA) and internal fixation (IF) by two screws.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXVII | Pages 30 - 30
1 Sep 2012
Vinje T Fevang J Engesaeter L Lie S Havelin L Matre K Gjertsen J Furnes O
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Background

A well conducted randomised study found similar functional results for patients with displaced femoral neck fracture comparing operation with a modern uncemented bipolar hemiarthroplasty with a cemented bipolar hemiarthroplasty. The mortality associated with the two procedures has not been sufficiently investigated.

Aim of study

To investigate the mortality and the risk factors for death among patients with displaced femoral neck fractures the first year after surgery, comparing operation with modern uncemented and cemented bipolar hemiarthroplasty (HA).


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXVII | Pages 31 - 31
1 Sep 2012
Gjertsen J Vinje T Fevang J Lie SA Furnes O Havelin LI Engesaeter LB
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Introduction

Displaced femoral neck fractures in elderly are normally treated with 2 screws/pins (IF) or bipolar hemiarthroplasty (HA). The aim of this study was to compare IF and HA as treatment for displaced femoral neck fractures using reoperations and functional result (patient satisfaction, pain, and quality of life) as outcome.

Material and Methods

From January 2005 all hip fractures in Norway are reported to the Norwegian Hip Fracture Register. At 4, 12, and 36 months postoperatively a questionnaire assessing satisfaction (VAS 0-100), pain (VAS 0-100), and quality of life (EQ-5D) is sent to the patients. To ensure more than 3 years follow-up, only patients operated in 2005 were included in the present study. Consequently 1,968 patients over 70 years of age operated with IF (n = 958) or HA (n = 1,010) due to displaced femoral neck fractures were included in the analyses on reoperations. Of these, 280 patients responded to all questionnaires and were included in the analyses on functional results (IF: n = 135, HA: n = 145). The patients remained in the same treatment group according to the intention-to-treat principle.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXVII | Pages 26 - 26
1 Sep 2012
Gjertsen J Fevang J Vinje T Matre K Engesaeter LB
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Introduction

Undisplaced femoral neck fractures have been given little attention in the literature. By using data from the Norwegian Hip Fracture Register, this study investigates risk for reoperation and the clinical results, including pain, patient satisfaction, and quality of life, after undisplaced femoral neck fractures in elderly patients.

Material and Methods

Data on 4,468 patients over 70 years of age with undisplaced femoral neck fractures operated with internal fixation (IF) were compared to 10,289 patients with displaced femoral neck fractures treated with IF (n = 3,389) or bipolar hemiarthroplasty (n = 6,900). The evaluation was based on number of reported reoperations and patients' assessment (visual analogue scales concerning pain (0–100) and patient satisfaction (0–100), and quality of life (EQ-5D)) four and twelve months postoperatively. The patients were followed for 0–1 year. The Cox multiple regression model was used to construct adjusted survival curves. Subanalyses were performed on undisplaced femoral neck fractures to investigate different risk factors for reoperation.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXVII | Pages 230 - 230
1 Sep 2012
Matre K Vinje T Havelin LI Gjertsen J Furnes O Espehaug B Fevang J
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Introduction

The treatment of trochanteric and subtrochanteric fractures remains controversial, and new implants are constantly being developed trying to improve outcome and minimize the number of complications in these fractures.

In Norway the Sliding Hip Screw(SHS), with or without a Trochanteric Stabilizing Plate (TSP), is still the most commonly used implant, but worldwide nailing of these fractures is increasing. This trend, however, has not been supported by documentation of better clinical results compared to the SHS in well designed studies. Therefore, in the present study we compared the recently launched Trigen Intertan nail (Smith and Nephew) with the SHS in the treatment of trochanteric and subtrochanteric fractures.

Patients and Methods

In a prospective, randomized multicenter study with 697 patients, we compared the Trigen Intertan nail with the SHS regarding postoperative pain, functional mobility, complications, and reoperation rates.

Patients older than 60 years with trochanteric and subtrochanteric fractures were included in 5 hospitals. At day 5, and 3 and 12 months postoperatively, pain was measured using a Visual Analogue Scale (VAS), and the Timed Up and Go-test (TUG-test) was performed to evaluate functional mobility. Complications and reoperations were recorded at discharge, and after 3 and 12 months.


The Journal of Bone & Joint Surgery British Volume
Vol. 94-B, Issue 8 | Pages 1113 - 1119
1 Aug 2012
Gjertsen J Lie SA Vinje T Engesæter LB Hallan G Matre K Furnes O

Using data from the Norwegian Hip Fracture Register, 8639 cemented and 2477 uncemented primary hemiarthroplasties for displaced fractures of the femoral neck in patients aged > 70 years were included in a prospective observational study. A total of 218 re-operations were performed after cemented and 128 after uncemented procedures. Survival of the hemiarthroplasties was calculated using the Kaplan-Meier method and hazard rate ratios (HRR) for revision were calculated using Cox regression analyses. At five years the implant survival was 97% (95% confidence interval (CI) 97 to 97) for cemented and 91% (95% CI 87 to 94) for uncemented hemiarthroplasties. Uncemented hemiarthroplasties had a 2.1 times increased risk of revision compared with cemented prostheses (95% confidence interval 1.7 to 2.6, p < 0.001). The increased risk was mainly caused by revisions for peri-prosthetic fracture (HRR = 17), aseptic loosening (HRR = 17), haematoma formation (HRR = 5.3), superficial infection (HRR = 4.6) and dislocation (HRR = 1.8). More intra-operative complications, including intra-operative death, were reported for the cemented hemiarthroplasties. However, in a time-dependent analysis, the HRR for re-operation in both groups increased as follow-up increased.

This study showed that the risk for revision was higher for uncemented than for cemented hemiarthroplasties.