title: Damage Control Orthopedics Management as Vital Procedure in Elderly Patients with Femoral Neck Fractures Complicated with Chronic Renal Failure: A Retrospective Cohort Study.
abstract: Chronic renal failure (CRF) predisposes to hip fractures in elderly patients, with high subsequent mortality. Selection and timing of the surgical procedure of such patients is a serious challenge. Many clinicians believe in earlier surgery as preferable and providing better outcomes. Damage control orthopedics (DCO) aids to adjust and optimize the overall condition of patients.
  
  
  
  In 32 patients with femoral neck fractures complicated with CRF, we evaluated how the timing of the surgery determines the mortality rates if the DCO approach is applied. Preoperative ASA grading, POSSUM score, P-POSSUM score and DCO were carried out. Based on the assessment, timing of the surgery was ascertained.
  
  
  
  Of a total of 32 patients, twenty-nine patients were accepted for either early (< 48 hours; n = 18) or delayed (3-10 days; n = 10) surgery. Hip arthroplasty (total hip arthroplasty and hemiarthroplasty) was the principal surgery option. All patients survived operation and were followed up postoperatively with the average time of 30 days. Postoperative complications tended to occur at higher rates in the early vs. delayed surgery group (7/18 vs. 5/10). During follow up, a total of 3 patients died in both groups (2/18 in the early surgery and 1/10 in the delayed surgery group), mostly from multi-organ failures and acute respiratory distress syndrome. There was no significant difference in complication rates and Harris hip score between both groups.
  
  
  
  In patients with femoral neck fracture complicated with CRF, delaying the surgery for several days does not increase the incidence of postoperative adverse events.
authors.affiliation: Department of Orthopedics, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, 400042, China.
authors.forename: Chenhui
authors.initials: C
authors.lastname: Dong
authors.affiliation: Department of Orthopedics, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, 400042, China.
authors.forename: Yunjiao
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Department of Orthopedics, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, 400042, China.
authors.forename: Ziming
authors.initials: Z
authors.lastname: Wang
authors.affiliation: Department of Orthopedics, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, 400042, China.
authors.forename: Yu
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Department of Orthopedics, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, 400042, China.
authors.forename: Siyu
authors.initials: S
authors.lastname: Wu
authors.affiliation: Department of Orthopedics, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, 400042, China.
authors.forename: Quanyin
authors.initials: Q
authors.lastname: Du
authors.affiliation: Department of Orthopedics, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, 400042, China.
authors.forename: Aimin
authors.initials: A
authors.lastname: Wang
mesh_terms: D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000379:methods; D005260:Female; D005265:Femoral Neck Fractures / Q000150:complications* / Q000601:surgery; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications*; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome