Introduction: Hip arthroscopy-assisted surgery is the treatment of choice for Pipkin type I and II femoral head fractures. The purpose of this study was to review our mid-term results with posterior fracture-dislocations of the hip. Methods: We followed a consecutive series of 20 patients with Pipkin type I and II femoral head fracture dislocations via a hip arthroscopy surgery between 2016 and 2020. The clinical and radiological mid-term results were assessed. Results: There were two of Pipkin type II and eighteen of Pipkin type I in this study. The percutaneous screws fixation was performed in thirteen patients and excision in seven. The mean follow-up duration was 72.73 (range 50-84) months. The mean Harris hip score was 98.93 (range 95-100) at the last follow-up visit. One patient had grade I Heterotopic ossification. No one showed early osteoarthritis and avascular necrosis. According to The Matta criteria, there were four (30.7%) anatomical reduction, six (46.1%) imperfect reduction and three (23.0%) poor reduction. Conclusion: Managing Pipkin II and I fracture of the femoral head using hip arthroscope surgery can be a safe, effective, and minimally invasive option.

The incidence of avascular necrosis (AVN) of the head of the femur is on the rise. More so, it is seen in young adults where hip replacement may not be ideal. Though hip replacement increases the quality of life and pain relief, it does not allow everyday active life or sporting activities like a normal adult. Preserving the hip is the need of the hour. Autologous cultured osteoblasts are one of the few modalities available for the management of AVN head of the femur. Our study is on 31 adult hips managed with autologous cultured osteoblasts in the Ficart Arlet stages of I and II. The mean follow-up period was 2 years. Pathologies comprise of sickle cell (8), alcoholic (6), steroid (6) use and idiopathic (11). Though we included only stages I and II, the outcome was inconsistent with the disease stage. The results were promising, with complete pain relief and near-normal activities of daily living (ADL) in 30 % of individuals. Mean postoperative improvement in VAS was 7 +/-3, and Harris Hip Score 30 +/-10 from the preoperative values, which was statistically significant. In 2 patients, disease progression continued and has been planned for total hip arthroplasty. Even at two years though the patient is free of symptoms, the X-ray is satisfactory with a spherical head and lack of collapse but the MRI findings are not normal. Autologous cultured osteoblast implantation has the potential in the management of AVN head of femur averting a hip replacement.

Background: It is widely acknowledged that femoroacetabular impingement (FAI) syndrome predisposes individuals to early-onset radiographic hip osteoarthritis (RHOA). We aimed to ascertain whether hip-preserving surgery or conservative treatment for FAI syndrome better impacts the future need for hip replacement surgery, using total hip replacement (THR) rate as a measure of hip survivorship, and surrogate marker of RHOA development. Methods: We conducted PICO search strategy across MEDLINE (via PubMed), Embase (via Ovid), Web of Science and Cochrane Library following PRISMA guidelines. Selection criteria included clinical and radiological diagnosis of FAI syndrome as per the Warwick Agreement, hip-preserving surgery representing patient’s index surgery, and 10-year minimum follow-up. Primary outcome measure was hip replacement rate (%); interpreting THR as a proportion of total hips reviewed. We calculated this for each cohort and conducted single-armed proportional meta-analysis. Results: We identified nine relevant cohort studies containing a total of 1818 hips (1619 patients). Overall, regardless of intervention, conversion rate ranged from 7% – 33% with a pooled effect of 11% (9 – 14) using a random effects model. There was no statistically significant heterogeneity in reported hip failure rates (p = 0.09). Discussion: Despite rigorous selection criteria, included cohorts displayed wide heterogeneity in patient characteristics, demographics and size. We believe that this systematic review has highlighted deficits in scientific literature and will direct future research, including long-term follow-up of published RCTs. Widespread dissemination of this paper would allow patients and clinicians to make better informed, shared decisions, leading to better patient care and clinical outcomes.

Introduction: We conducted a retrospective study to assess one year mortality rate in surgically operated elderly hip fractures patients and to see its possible association with various factors. Methods: The study was a retrospective observational study conducted at a Level-1 trauma centre. Patients >60 years with hip fractures who underwent surgical interventions between July 2018 and March 2023 and having completed or died during one-year follow up were included in the study. Patients who were managed conservatively, age <60 years and patients who had a reoperation of the hip were excluded from the study. Patient evaluation was done on the basis of age, gender, mode of injury, fracture type, co-morbidities, blood parameters and timing of surgery. Follow up was done on OPD basis and telephonic conversations. Mortality rate was calculated for 1 month, 3 months and 1 year interval. Results: Out of a total of 198 hip fracture admissions, 144 met the inclusion-exclusion criteria. 20 patients were lost to follow up and 124 were eventually included. 44 patients were over 75 years of age. There was 19.4%(n=24) mortality within 1 year. One-third (n=8/24) died within the first month itself. There was higher mortality in patients >75 years old (32%) compared to those <75 years (12.5%). Common comorbidities amongst dying patients were hypertension(n=14/24) and diabetes mellitus(n=12/24). Conclusion: Elderly patients with hip fracture have a significantly high mortality. Higher age, presence of comorbidities, higher ASA grade, low haemoglobin level at the time of admission are some of the predictors of increased mortality.

Objectives: To compare the complications associated
with cannulated hip screws (CHS) and dynamic hip
screws (DHS) techniques.
Methods: In this multicenter retrospective chart study,
we reviewed the records and data of all patients operated
upon by DHS or CHS for treatment of Garden type I
and type II intracapsular non-displaced femoral neck
fracture from January 2017 to December 2022. Patients
with incomplete files or follow-ups of less than one year
Original Article
were excluded from the study.
Results: The study enrolled 85 patients, 35 males,
and 50 females, with a mean age of 72±5.4 for males
and 70.6±7.6 for females. A total of 44 patients were
operated upon with DHS, and 41 patients with CHS.
The mortality rate of DHS was 15.9% and was 17.1%
in the CHS group (p>0.05). Non-union was recorded
in 4.5% of the DHS group and 4.9% of CHS patients
(p>0.05). Avascular necrosis (AVN) was significantly
higher in DHS (9.1%) than in CHS (4.9%, p<0.05).
A revision was required in 15.9% of DHS patients and
14.6% of CHS patients (p>0.05).
Conclusion: This study found that DHS was superior
to CHS in AVN rate. However, there was no significant
difference between both methods regarding mortality,
revision, and non-union.
Keywords: femoral neck fracture, internal fixation
devices, complications
Saudi Med J 2024; Vol. 45 (1):
doi: 10.15537/smj.2024.45.1.20230684

ABSTRACT
Background: Hip fracture readmissions within 90 days pose a significant challenge in orthopedics, burdening healthcare systems and affecting patient outcomes. This study, set against the backdrop of an aging population and rising hip fracture incidences, seeks to analyze the factors contributing to these readmissions and propose viable management strategies. Methods: Conducted at Whiston Hospital, this retrospective study reviewed 1264 patients treated for neck of femur fractures between April 2020 and December 2022. Data on patient demographics, comorbidities, surgical interventions, and readmission reasons were collected and analyzed using descriptive statistics and multivariable logistic regression. Results: The study found a 16.6% readmission rate, with the majority being for non-orthopedic reasons such as infections and cardiovascular events. Age and comorbidities were significant predictors of readmission, while surgical factors had a less pronounced impact. A year-wise trend showed a peak in readmissions during the COVID-19 pandemic. Conclusion: The findings emphasize the complexity of managing NOF fractures and the importance of a comprehensive, multidisciplinary approach to care. Targeted interventions, including orthogeriatric co-management and falls assessment, are recommended to mitigate readmission risks and enhance patient care, though further research is needed for more definitive strategies. Keywords: hip fracture, readmission, orthopedics, retrospective study, management strategies, NOF fracture, healthcare burden, multidisciplinary approach.

Introduction: Hip fracture units (HFUs) within Major Trauma Centres (MTCs) have been shown to reduce variances in length of stay and trends to reduce time to theatre (TTT) in short-term studies.

This 10-year study aims to assess the sustained impact of a HFU on patient flow and mortality in a MTC setting.

Methods: A dedicated HFU was established at the study centre on 1st July 2015, our study period extended from 5-years prior to 5-years after its formation; “pre-HFU” and “post-HFU” respectively (bed spaces and theatre capacity remained constant).

Pre-HFU fragility hip fractures were managed concurrently to general and major trauma patients, post-HFU hip fractures were managed in a ring-fenced unit with co-located MDT support.

TTT, patient outcomes (length of stay (LoS), 30-day, 120-day and 1-year mortality) were ascertained from a retrospective interrogation of a prospectively collected database, cross-referenced against the trust’s NHFD dataset.

Results: There were 5346 fragility hip fractures, sustained by 4998 patients, during the study. 2533 cases in the pre-HFU period and 2813 in the post-HFU period, with no significant differences in outcome risk factors between the patient cohorts: age, gender, type of fracture, ASA grade and treatment type (p>0.05).

TTT, LoS, 30-day and 1-year mortality all showed significant improvements (p<0.001) post-HFU introduction when compared to the pre-HFU cohort.

Conclusions: To our knowledge, this is the largest non-registry study on the clinical efficacy of a HFU. In comparison to previous delivery models, the results demonstrate sustained improvements in the timing of surgical treatment, LoS and mortality rates.

Presentation Aim: is to outline our strategy for managing neck of femur fractures, specifically Garden classification III and IV, in patients aged between 55-75 years. This demographic typically experiences a high complication rate (30%) and a significant number of revisions (30-40%) with osteosynthesis, which has led to an increasing global trend towards total hip arthroplasty. At our hospital, minimal hip alloarthroplasty has become the standard procedure for treating coxarthrosis and neck of femur fractures. Study Design: we conducted a retrospective, descriptive evaluation over the first year of application. Results: We performed minimally invasive surgery on 134 patients using the Implantec AnaNova cup and Artiqo A2 stem, ceramic-on-ceramic. The gender distribution was 68 males and 66 females, with an average age of 66.7 years. The primary indications for surgery were coxarthrosis (120 cases, 88%) and femoral neck fractures (14 cases, 12%). We managed to adjust the center of rotation medially by 2.6mm and cranially by 1.8mm. Leg length discrepancy was maintained within +/- 4mm in 96% of cases, and lateral offset was within +/- 6mm in 78% of cases. Complications included intraoperative fractures (Vancouver A) in 3 cases, postoperative hematomas in 2, and no infections or dislocations. Conclusion: Artiqo A2 stem and Implantec AnaNova cup enable minimally invasive hip alloarthroplasty for both coxarthrosis and neck of femur fractures. This minimally invasive approach is safe, reproducible, and effective, offering all the associated benefits. Patients reported higher satisfaction levels and faster rehabilitation. Age, BMI, and gender were not exclusion criteria for joint replacement.

The hip fracture is the leading cause of disability and deaths in elderly. The aim of this study was to determine the predictive values of the functional status, present comorbidities, and the types of treatment on the long-term functional status and mortality in patients with femoral neck fractures. In the General Hospital Sarajevo in the period 01.07.2006. - 01.07.2016, 310 patients were treated for femoral neck fractures. The mean follow - up period was 36.5 ± 5.9 months. Data on patients with hip fracture (comorbidities, functional status at admission, discharge and check-ups, comorbidities, type of treatment and life expectancy) were analyzed. The functional status was approximately determined by dividing the patients in one of the
four categories. The patients were also divided by the presence of comorbidities. According to the type of treatment, the patients were divided into: WS - without surgery, and S - those who underwent surgery. Patients with incomplete data, patients younger than 65 years of age, and patients with the previous history of hip fractures were excluded from the study.
Female sex, older age, and poorer functional status upon admission, conservative treatment, the presence of neurological or lung disease, diabetes, were all significant risk factors leading to poorer functional outcomes on the latest follow-up This study, among other results, showed that in patients with hip fractures there is a direct,
statistically significant association between the existence of neglected internal and neurological conditions with increased mortality and poorer functional outcome at the last
examination.

Introduction: While many studies are comparing early intervention versus delayed surgery in fragility hip fractures, there are few studies regarding the postoperative course of these patients. It is worth looking at the other end of the spectrum of the hospitalization of patients and finding out if an early discharge after hip fracture surgery is favorable. Methodology: This is a retrospective cohort study on elderly hip fracture patients. Subjects were divided into those discharged 1-2 days post-op (early discharge) and 3-6 days post-op (routine discharge). World Health Organization Quality of Life Brief version (WHOQOL BREF) in Tagalog was tabulated at two weeks, six weeks, and twelve weeks post-operation. Repeated ANOVA was used for the WHOQOL, while t-test and Chi-square were used for continuous and nominal data.
Results: Sixty-two subjects were included in this study. WHOQOL BREF scores of all subjects significantly increased up to 12 weeks follow-up. Physical domain score in the WHOQOL BREF was better in the early discharge group in the first 6 weeks only. Hospitalization costs for the two groups are not significantly different. No participant was readmitted due to complications of their index surgery. 73% said they were Very Satisfied with their course of hospital stay, while 27% were Satisfied.
Conclusion: This study shows that even in a low- resource setting, elderly hip fracture patients have good outcomes in terms of quality of life, have a high satisfaction rate, and have no post-op complications if discharged early.

Introduction: The management of bone loss is a challenged procedure especially in complex defects. In past years the individual 3D components are one of the promising methods in revision surgery. Objectives was to evaluate the effectiveness of 3D components in IIIB bone defects acetabulum reconstruction by W.G. Paprosky. Materials and Methods: From 2017 to 2022 we analyzed 90 patients who underwent acetabular reconstruction with IIIB bone defects during revision hip arthroplasty. Patients with pelvic discontinuity predominated in the first group. Patients were divided into 3 groups: the 1st group was reconstructed with individual 3D components, the 2nd group – with hemispheric cup and augments, the 3rd group – with the reinforcement rings. Functional outcomes were evaluated with WOMAC, Harris hip score and VAS scales. Results: We found that before the operation the worse function scales were in the 1st group. The functional results after revision surgery in the 1st group were better than in patients in the 2d and 3d. In general, we got 27 (30%) complications in all groups. The number of all complications was higher in the 2nd and the 3rd groups. In the 1st group the periprosthetic infection was in 2 (6,6%) patients, dislocations were in 2 (6,6%) patients, one case of the sciatic nerve palsy and one aseptic 3D implant loosening. Conclusions: 3D implants allow to achieve personalize solution of each case with better functional results. It became a prior option in revision arthroplasty for IIIB defects especially in cases with pelvic discontinuity.