A proximal femur fracture (PFF) is a common orthopaedic presentation, with an incidence of over 25,000 cases reported in the Australian and New Zealand Hip Fracture Registry (ANZHFR) in 2018. Hip fractures are known to have high mortality. The purpose of this study was to determine the utility of the Clinical Frailty Scale (CFS) in predicting 30-day and one-year mortality after a PFF in older patients. A retrospective review of all fragility hip fractures who met the inclusion/exclusion criteria of the ANZHFR between 2017 and 2018 was undertaken at a single large volume tertiary hospital. There were 509 patients included in the study with one-year follow-up obtained in 502 cases. The CFS was applied retrospectively to patients according to their documented pre-morbid function and patients were stratified into five groups according to their frailty score. The groups were compared using Aims
Methods
Periprosthetic femoral fractures are a challenging problem to manage. In the literature various constructs have been designed and tested, most requiring cables for proximal fixation. The Synthes Locking Attachment Plate (LAP) has been designed to achieve proximal fixation without the use of cables. The aim of this study was to biomechanically evaluate the LAP construct in comparison to a Cable plate construct, for the fixation of periprosthetic femoral fractures after cemented total hip arthroplasty (THA). Twelve synthetic femora were tested in axial compression, lateral bending and torsion to determine initial stiffness, and stiffness following fixation of a simulated midshaft fracture with and without a bone gap. Two different fracture fixation constructs (six per group) were assessed. Each construct incorporated a broad curved LCP with bi-cortical locking screws for distal fixation. In the Cable construct, 2 cables and 2 uni-cortical locking screws were used for proximal fixation. In the LAP construct, the cables were replaced by a LAP with 4 bicortical locking screws. Axial, lateral bending and torsional stiffness were assessed using intact specimen values as a baseline. Axial load to failure was also measured. The LAP construct was significantly stiffer than the cable construct under axial load with a bone gap (simulating a comminuted fracture) (p=0.01). There were no significant differences between the two constructs in any of the other modalities tested. Loading to failure resulted in no significant differences between constructs, in either initial stiffness or peak load. In conclusion the LAP construct enables bi-cortical screw fixation around a prosthesis. Compared to cables, this was stiffer when there was a bone gap and thus should offer improved proximal fixation of Vancouver B1 proximal femoral fractures in cemented THA.
We determined the effect of the surgical approach on perfusion of the femoral head during hip resurfacing arthroplasty by measuring the concentration of cefuroxime in bone samples from the femoral head. A total of 20 operations were performed through either a transgluteal or an extended posterolateral approach. The concentration of cefuroxime in bone was significantly greater when using the transgluteal approach (mean 15.7 mg/kg; 95% confidence interval 12.3 to 19.1) compared with that using the posterolateral approach (mean 5.6 mg/kg; 95% confidence interval 3.5 to 7.8; p <
0.001). In one patient, who had the operation through a posterolateral approach, cefuroxime was undetectable. Using cefuroxime as an indirect measure of blood flow, the posterolateral approach was found to be associated with a significant reduction in the blood supply to the femoral head during resurfacing arthroplasty compared with the transgluteal approach.
