The surgical treatment options for patients who have sustained an intra-capsular hip fracture can vary depending on a number of patient and fracture related factors. Currently most national guidelines support the use of cemented prostheses for patient undergoing hemi-arthroplasty surgery. Uncemented prostheses are commonly used for a variety of indications including those patients who have significant medical co-morbidities. To determine whether cemented hemi-arthroplasty is associated with a higher post operative mortality when compared to uncemented procedures. Data was extracted from the Scottish SMR01 database from 01/04/1997 from all patients who were admitted to hospital after sustaining a hip fracture. We investigated mortality at day 1, 2, 4, 7, 30, 120 and 1 year from surgery vs. that on day 0. In order to control for the effects of confounding variables between patients cohorts, 12 case-mix variable were used to construct a multivariable logistic regression analysis model to determine the independent effect of prosthesis fixation method. There were 64,979 patients were included in the study. Mortality for osteosynthesis of extra-capsular fractures was consistently lower when compared to that for surgical procedures for intra-capsular fractures. At day 0, uncemented hemi-arthroplasty operations had a lower associated mortality (p<0.001) when compared to cemented implant designs. Unadjusted figures showed an increased mortality equal to 1 extra death per 424 procedures. By day 1 this had become 1 extra death per 338 procedures. By day 7 cumulative mortality was less for cemented than for uncemented procedures though this did not reach significance until day 120. When compared to uncemented fixation techniques, cemented hemiarthroplasty is associated with a higher mortality in the immediate postoperative period. However, by day 120 and beyond the trend is reversed

The surgical treatment options for patients who have sustained an intra-capsular hip fracture can vary depending on a number of patient and fracture related factors. Currently most national guidelines support the use of cemented prostheses for patient undergoing hemiarthroplasty surgery. Uncemented prostheses are commonly used for a variety of indications including those patients who have significant medical co-morbidities. To determine whether cemented hemiarthroplasty is associated with a higher post operative mortality when compared to uncemented procedures. Data were extracted from the Scottish SMR01 database from 01/04/1997 from all patients who were admitted to hospital after sustaining a hip fracture. We investigated mortality at day 1,2,4,7,30, 120 and 1 year from surgery vs. that on day 0. In order to control for the effects of confounding variables between patients cohorts, 12 case-mix variable were used to construct a multivariable logistic regression analysis model to determine the independent effect of prosthesis design. There were 52283 patients included in the study. Mortality for osteosynthesis of extra-capsular fractures was consistently lower when compared to that for surgical procedures for intra-capsular fractures. At day 0, uncemented hemiarthroplasty had a lower associated mortality (p<0.001) when compared to cemented implant designs. However, this increased mortality was equal to 1 extra death per 2000 procedures. From day 1 onward mortality for cemented procedures was equal to or lower than that of uncemented. By day 4, cumulative mortality was less for cemented than for uncemented procedures. Complication and re-operation rate was significantly higher in the uncemented cohort. The use of uncemented hemiarthroplasty for the treatment of intra-capsular hip fractures cannot be justified in terms of early/late post-operative mortality

Hyponatraemia is one of the most common electrolyte disorders in the elderly and has considerable associated morbidity and mortality. In this study we report the prevalence and independent risk factors for the development of post-operative hyponatraemia after surgery for hip fracture. We conducted a retrospective cohort study of 144 consecutive patients who underwent surgery after sustaining a hip fracture. Patient medical case-notes, operative notes and online biochemistry results were used to obtain relevant data which was entered into a database. Pre-operative (30/144, 21%) and post-operative hyponatraemia (49/144, 34%) was common. However, most cases were mild (plasma sodium >130 mmol/l) and only 1% of pre-operative and 6% of post-operative patients had moderate/severe hyponatraemia (plasma sodium <130mmol/l). One of 3 post-operative deaths involved a patient with moderate hyponatraemia as a consequence of severe congestive cardiac failure. In order to determine the independent relationship between several reported risk factors and hyponatraemia we constructed a multivariable logistic regression model. Female gender, pre-operative hyponatraemia and hypotonic fluid administration were all significantly associated with the development of post-operative hyponatraemia. Age and thiazide diuretics both had positive risk associations however were not statistically significant. Hyponatraemia is a common problem in hip fracture patients. While the majority of cases in this series were mild, 6% of patients suffered from moderate/severe hyponatraemia post-operatively. Female gender, pre-operative hyponatraemia and hypotonic fluid administration are all important and independent risk factors for the development of hyponatraemia. Hypotonic intravenous fluids should be avoided unless clinically indicated in this patient group

Delay to theatre after hip fracture is common in order to medically optimise the patient prior to surgery. The association between delay to surgery and mortality after hip fracture remains a contentious issue. We aimed to investigate how medical postponement, time to surgery and correction of medical abnormalities prior to surgery affect peri-operative mortality after hip fracture. From February to December 2007 prospective data was collected from all acute trauma units in Scotland relating to hip fracture patients' fitness for theatre, reasons for postponement of surgery and subsequent plans of action. The data-set recorded whether medical abnormalities were identified following criteria reported by McLaughlin et al. Survival at 30-days post-operation was used as primary outcome measure. Multivariable logistic regression models were used to control for differences in case-mix between patients. Data were available for 4284 patients. Patients postponed for medical reasons were less likely to survive to 30 days compared to patients who were not postponed (87% (122/947) versus 93% (3098/3337)). Survival also decreased as time to theatre increased - 92% of patients operated on during the same/next day vs. 89% of those operated on admission day four. However, after controlling for differences in case-mix variables and co-morbidities, neither variable significantly affected survival. We then analysed whether delaying surgery to resolve medical problems improved survival. Adjusted survival was not significantly different between those patients who had their medical problem resolved prior to surgery compared to those patients who were not postponed. Individuals who were postponed but did not have their clinical abnormality resolved prior to surgery had significantly lower adjusted 30 day survival. The possible benefits of postponement need to be weighed against prolonged discomfort and the possibility of developing other complications. Postponing patients who cannot be medically improved should be avoided