Introduction: Hip fractures affects more than 65,000 people in the UK each year and this number is increasing. The standard treatment is insertion of either a dynamic hip screw or hemiarthroplasty depending on fracture configuration. Because of their advanced age, associated co-morbid factors as well as having had an implant inserted, hip fracture patients are at increased risk of developing post-operative wound infections. The infection rate for hip fracture surgery is quoted at 0.6 – 3.6%1.
Methods: We carried out a retrospective study of the readmission rate due to wound infection following treatment of their fractured neck of femur. 20 patients (16 females and 4 males) were identified over a 24 month period out of a total 1786 femoral neck fractures treated (1.1%).
Results: 11 patients re-admitted with a wound infection had had a hemiarthroplasty fixation, 9 following insertion of a DHS. 7 patients (0.4%) had a superficial wound infection (3 hemi, 4 DHS) and 13 (0.7%) a deep wound infection (8 hemi, 5 DHS). Treatment for the superficial wound infections included 6 patients requiring IV antibiotics and 1 requiring washout and resuturing of the wound.
Treatment of deep wound infections included 6 who had a Girdlestone procedure, 2 had wound washout, debridement and 2 who had removal of DHS. All received IV antibiotics. 2 patients were deemed unfit for surgery and received IV antibiotics only.
3 patients with a deep wound infection (23%) died (2 deemed unfit for surgery, and 1 Girdlestone) during their admission. 85% of the readmissions had an ASA score of three or over. We looked at the length of operation time and found that 15 took less than 45 minutes, 4 took between 45 and 60 minutes and one took over 60 minutes. Three of the operations which took over 45 minutes developed deep infections.
Conclusion: Fractured neck of femur accounts for a large proportion of fracture admissions. Accepted methods of treatment carry significant infection rates. Superficial wound infections can in the majority be treated with IV antibiotics. Deep wound infections carry a significant mortality rate. Operating time should be within 45 minutes where possible to reduce the risk of deep infection. Post-operative wound infections are associated with an ASA grade of 3 or greater.
