Analysis of outcomes for surgically treated hip fractures in patients undergoing chronic hemodialysis.
BACKGROUND
Hip fractures in patients with end-stage renal disease are associated with frequent complications. This study analyzed clinical outcomes for patients on chronic hemodialysis who sustained hip fractures and were treated with a variety of fracture repair methods.


METHODS
Twenty-nine patients with thirty-two hip fractures were analyzed in three groups. Group 1 consisted of eleven hips in eleven patients with an intertrochanteric fracture that was treated with internal fixation; Group 2, thirteen hips in ten patients with a femoral neck fracture that was treated with screw fixation; and Group 3, eight hips in eight patients with a femoral neck fracture that was treated with hemiarthroplasty. The outcomes and early and late complications were recorded for each group. Survivorship analysis was performed, and the mortality and complication rates for the groups were compared.


RESULTS
In Group 1, eight complications occurred in six hips and nonunion developed in five hips. In Group 2, sixteen complications developed in eleven hips. Union was achieved in two of the thirteen hips, nine hips had nonunion, and two hips had osteonecrosis develop. In Group 3, only one hip had early complications, there were no late complications, and three patients died. The mean duration of follow-up was twenty-three months, and the overall mortality rate was 45%. There were no significant differences among the groups with respect to the cumulative survival proportions. Regression analysis of age, sex, and total hemodialysis duration in relation to mortality risk revealed that only age had a significant influence on mortality (p = 0.019).


CONCLUSIONS
Surgical treatment of hip fractures in patients with end-stage renal disease who are on chronic hemodialysis is associated with frequent complications and a high mortality rate. Osteosynthesis is an acceptable option for treating intertrochanteric fractures and nondisplaced femoral neck fractures, but displaced femoral neck fractures should be treated with hemiarthroplasty.
Karaeminogullari
Oguz
O
Department of Orthopaedics and Traumatology, Baskent University, Feuzi Caknak Caddesi 10, Sokak No. 45, Bahcelievler, 06490 Ankara, Turkey. okaraemin@yahoo.com
Demirors
Huseyin
H
Sahin
Orcun
O
Ozalay
Metin
M
Ozdemir
Nurhan
N
Tandogan
Reha N
RN
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000379:methods; D015897:Comorbidity; D005260:Female; D005265:Femoral Neck Fractures / Q000601:surgery*; D005593:Fracture Fixation, Internal; D006620:Hip Fractures / Q000453:epidemiology* / Q000601:surgery*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012044:Regression Analysis; D006435:Renal Dialysis; D016896:Treatment Outcome