Wintertime surgery increases the risk of conversion to hip arthroplasty after internal fixation of femoral neck fracture

A. Sebestyén, S. Mester, Z. Vokó, J. Gajdácsi, P. Cserháti, G. Speer, B. Patczai, V. Warta, J. Bódis, C. Horváth, I. Boncz

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Summary: The study demonstrates that wintertime surgeries are associated with impaired fracture healing and increases the risk of conversion to hip arthroplasty after osteosynthesis of femoral neck fracture. Furthermore, the results raise the possibility of association between seasonal changes in vitamin D levels and impaired fracture healing of femoral neck fracture.

Introduction: Although the changes of vitamin D level and calcitropic hormones influencing bone metabolism are seasonal, the effect of seasons on hip fracture healing is unknown. We assessed the effects of seasonal periodicity on conversion to hip arthroplasty after primary osteosynthesis of femoral neck fracture.

Methods: This nationwide retrospective observational cohort study involved 2779 patients aged ≥60 years who underwent internal screw fixation for primary femoral neck fracture and were discharged in 2000. Cases requiring conversion to arthroplasty during the 8-year follow-up derived from the Hungarian health insurance database were registered. Risk factors assessed included sex, age, fracture type, season of primary surgery and surgical delay. Competing-risks regression analysis was used for data analyses.

Results: During the observation period, 190 conversions to hip arthroplasty (6.8 %) were identified, yielding an overall incidence of 19.5 per 1000 person-years. The crude incidence rates of conversions after osteosynthesis in winter, spring, summer and fall were 28.6, 17.8, 16.9 and 14.7 per 1000 person-years, respectively. Besides younger age, female sex and intracapsular fracture displacement, wintertime primary osteosynthesis significantly increased the risk of conversion (fall vs. winter, hazard ratio (HR): 0.50, 95 % confidence interval [95 % CI 0.33–0.76]; spring vs. winter, HR: 0.63, [95 % CI 0.44–0.92]; summer vs. winter, HR: 0.62, [95 % CI 0.42–0.91]).

Conclusions: Our study demonstrate that wintertime primary osteosynthesis increases the risk of conversion surgeries. The results may help improving the outcome of primary fixation of femoral neck fractures.

Original languageEnglish
Pages (from-to)1109-1117
Number of pages9
JournalOsteoporosis International
Volume26
Issue number3
DOIs
Publication statusPublished - 2015

Fingerprint

Femoral Neck Fractures
Arthroplasty
Hip
Fracture Healing
Vitamin D
Incidence
Hip Fractures
Periodicity
Health Insurance
Observational Studies
Cohort Studies
Regression Analysis
Observation
Databases
Hormones
Confidence Intervals
Bone and Bones

Keywords

  • Elderly
  • Femoral neck fractures
  • Osteosynthesis
  • Seasonal variation
  • Surgical revision

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism

Cite this

Wintertime surgery increases the risk of conversion to hip arthroplasty after internal fixation of femoral neck fracture. / Sebestyén, A.; Mester, S.; Vokó, Z.; Gajdácsi, J.; Cserháti, P.; Speer, G.; Patczai, B.; Warta, V.; Bódis, J.; Horváth, C.; Boncz, I.

In: Osteoporosis International, Vol. 26, No. 3, 2015, p. 1109-1117.

Research output: Contribution to journalArticle

Sebestyén, A. ; Mester, S. ; Vokó, Z. ; Gajdácsi, J. ; Cserháti, P. ; Speer, G. ; Patczai, B. ; Warta, V. ; Bódis, J. ; Horváth, C. ; Boncz, I. / Wintertime surgery increases the risk of conversion to hip arthroplasty after internal fixation of femoral neck fracture. In: Osteoporosis International. 2015 ; Vol. 26, No. 3. pp. 1109-1117.
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abstract = "Summary: The study demonstrates that wintertime surgeries are associated with impaired fracture healing and increases the risk of conversion to hip arthroplasty after osteosynthesis of femoral neck fracture. Furthermore, the results raise the possibility of association between seasonal changes in vitamin D levels and impaired fracture healing of femoral neck fracture.Introduction: Although the changes of vitamin D level and calcitropic hormones influencing bone metabolism are seasonal, the effect of seasons on hip fracture healing is unknown. We assessed the effects of seasonal periodicity on conversion to hip arthroplasty after primary osteosynthesis of femoral neck fracture.Methods: This nationwide retrospective observational cohort study involved 2779 patients aged ≥60 years who underwent internal screw fixation for primary femoral neck fracture and were discharged in 2000. Cases requiring conversion to arthroplasty during the 8-year follow-up derived from the Hungarian health insurance database were registered. Risk factors assessed included sex, age, fracture type, season of primary surgery and surgical delay. Competing-risks regression analysis was used for data analyses.Results: During the observation period, 190 conversions to hip arthroplasty (6.8 {\%}) were identified, yielding an overall incidence of 19.5 per 1000 person-years. The crude incidence rates of conversions after osteosynthesis in winter, spring, summer and fall were 28.6, 17.8, 16.9 and 14.7 per 1000 person-years, respectively. Besides younger age, female sex and intracapsular fracture displacement, wintertime primary osteosynthesis significantly increased the risk of conversion (fall vs. winter, hazard ratio (HR): 0.50, 95 {\%} confidence interval [95 {\%} CI 0.33–0.76]; spring vs. winter, HR: 0.63, [95 {\%} CI 0.44–0.92]; summer vs. winter, HR: 0.62, [95 {\%} CI 0.42–0.91]).Conclusions: Our study demonstrate that wintertime primary osteosynthesis increases the risk of conversion surgeries. The results may help improving the outcome of primary fixation of femoral neck fractures.",
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AU - Sebestyén, A.

AU - Mester, S.

AU - Vokó, Z.

AU - Gajdácsi, J.

AU - Cserháti, P.

AU - Speer, G.

AU - Patczai, B.

AU - Warta, V.

AU - Bódis, J.

AU - Horváth, C.

AU - Boncz, I.

PY - 2015

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N2 - Summary: The study demonstrates that wintertime surgeries are associated with impaired fracture healing and increases the risk of conversion to hip arthroplasty after osteosynthesis of femoral neck fracture. Furthermore, the results raise the possibility of association between seasonal changes in vitamin D levels and impaired fracture healing of femoral neck fracture.Introduction: Although the changes of vitamin D level and calcitropic hormones influencing bone metabolism are seasonal, the effect of seasons on hip fracture healing is unknown. We assessed the effects of seasonal periodicity on conversion to hip arthroplasty after primary osteosynthesis of femoral neck fracture.Methods: This nationwide retrospective observational cohort study involved 2779 patients aged ≥60 years who underwent internal screw fixation for primary femoral neck fracture and were discharged in 2000. Cases requiring conversion to arthroplasty during the 8-year follow-up derived from the Hungarian health insurance database were registered. Risk factors assessed included sex, age, fracture type, season of primary surgery and surgical delay. Competing-risks regression analysis was used for data analyses.Results: During the observation period, 190 conversions to hip arthroplasty (6.8 %) were identified, yielding an overall incidence of 19.5 per 1000 person-years. The crude incidence rates of conversions after osteosynthesis in winter, spring, summer and fall were 28.6, 17.8, 16.9 and 14.7 per 1000 person-years, respectively. Besides younger age, female sex and intracapsular fracture displacement, wintertime primary osteosynthesis significantly increased the risk of conversion (fall vs. winter, hazard ratio (HR): 0.50, 95 % confidence interval [95 % CI 0.33–0.76]; spring vs. winter, HR: 0.63, [95 % CI 0.44–0.92]; summer vs. winter, HR: 0.62, [95 % CI 0.42–0.91]).Conclusions: Our study demonstrate that wintertime primary osteosynthesis increases the risk of conversion surgeries. The results may help improving the outcome of primary fixation of femoral neck fractures.

AB - Summary: The study demonstrates that wintertime surgeries are associated with impaired fracture healing and increases the risk of conversion to hip arthroplasty after osteosynthesis of femoral neck fracture. Furthermore, the results raise the possibility of association between seasonal changes in vitamin D levels and impaired fracture healing of femoral neck fracture.Introduction: Although the changes of vitamin D level and calcitropic hormones influencing bone metabolism are seasonal, the effect of seasons on hip fracture healing is unknown. We assessed the effects of seasonal periodicity on conversion to hip arthroplasty after primary osteosynthesis of femoral neck fracture.Methods: This nationwide retrospective observational cohort study involved 2779 patients aged ≥60 years who underwent internal screw fixation for primary femoral neck fracture and were discharged in 2000. Cases requiring conversion to arthroplasty during the 8-year follow-up derived from the Hungarian health insurance database were registered. Risk factors assessed included sex, age, fracture type, season of primary surgery and surgical delay. Competing-risks regression analysis was used for data analyses.Results: During the observation period, 190 conversions to hip arthroplasty (6.8 %) were identified, yielding an overall incidence of 19.5 per 1000 person-years. The crude incidence rates of conversions after osteosynthesis in winter, spring, summer and fall were 28.6, 17.8, 16.9 and 14.7 per 1000 person-years, respectively. Besides younger age, female sex and intracapsular fracture displacement, wintertime primary osteosynthesis significantly increased the risk of conversion (fall vs. winter, hazard ratio (HR): 0.50, 95 % confidence interval [95 % CI 0.33–0.76]; spring vs. winter, HR: 0.63, [95 % CI 0.44–0.92]; summer vs. winter, HR: 0.62, [95 % CI 0.42–0.91]).Conclusions: Our study demonstrate that wintertime primary osteosynthesis increases the risk of conversion surgeries. The results may help improving the outcome of primary fixation of femoral neck fractures.

KW - Elderly

KW - Femoral neck fractures

KW - Osteosynthesis

KW - Seasonal variation

KW - Surgical revision

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