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Purpose: Several controversies in the optimal treatment of femoral neck fractures persist, together with large variations in clinical practice. Methods: A narrative literature review covering 4 current controversies in the surgical management of femoral neck fractures (total hip arthroplasty (THA) versus hemiarthroplasty (HA), cemented versus uncemented HA, internal fixation versus arthroplasty, operative versus non-operative) was performed. Available literature was balanced against annual trends in the management of femoral neck fractures from the public domain of several national registries (Sweden, Norway, The Netherlands, Australia and New Zealand). Results: For most controversies, the literature provides stronger evidence than is reflected by variations encountered in daily practice. Implementation of clinical evidence tends to lag behind and important differences exist between countries. Conclusions: Trends of clinical practice from national registries indicate that implementation of available clinical evidence needs to be improved. [ABSTRACT FROM AUTHOR]

Background and purpose -- Waiting time to surgery is a modifiable risk factor in hip fracture surgery. However, there is no consensus regarding the acceptable duration of waiting time. We used the Swedish Hip Fracture Register RIKSHÖFT and 3 administrative registers to explore the association between time to surgery and adverse outcomes after discharge. Patients and methods -- 63,998 patients ≥ 65 years, admitted to a hospital between January 1, 2012, and August 31, 2017 were included. Time to surgery was divided into < 12, 12-24, and > 24 hours. Diagnoses investigated were atrial fibrillation/flutter (AF), congestive heart failure (CHF), pneumonia, and "acute ischemia" (a combination of stroke/ intracranial bleeding, myocardial infarction, and acute kidney injury). Crude and adjusted survival analyses were performed. Time spent in hospital following the initial hospitalization was described for the 3 groups. Results -- Waiting > 24 hours was associated with an increased risk of AF (HR 1.4, 95%CI 1.2-1.6), CHF (HR 1.3, CI 1.1-1.4) and "acute ischemia" (HR 1.2, CI 1.01-1.3). However, stratifying for ASA grade revealed that these associations were present only in patients with ASA 3-4. There was no association between waiting time and pneumonia after the initial hospitalization (HR 1.1, CI 0.97-1.2), but one was found with pneumonia during hospital stay OR 1.2 (CI 1.1-1.4). Time in hospital after the initial hospitalization was similar over the waiting time groups. Conclusion -- The associations between waiting > 24 hours for hip fracture surgery and AF, CHF, and acute ischemia suggest that shorter waiting time may reduce adverse outcomes for the sicker patients. [ABSTRACT FROM AUTHOR]

Background and purpose — Studies regarding hip fractures in young patients are rare since the patient population is small. We assessed clinical outcomes 4 months after hip fracture in patients < 50 years of age and whether there were differences between sexes and different age groups. Patients and methods — We included adult patients < 50 years with a hip fracture between January 1, 2014 and December 31, 2018. Baseline data were extracted from the Swedish Registry for Hip Fracture Patients and Treatment (RIKSHÖFT) and mortality data was obtained from Statistics Sweden. The outcome variables were change of walking ability, pain in fractured hip, use of analgesics, living conditions, and mortality rate at 4 months. Results — Of the 905 patients included, 72% were men and femoral neck fractures were most common (58%). 4 months after surgery, 23% used a walking aid and 7% reported severe pain. Women reported slightly more pain and higher usage of analgesics. Patients aged 40–49 reported higher usage of analgesics than patients aged 15–39, although the latter group reported more pain. Nearly all of those who lived independently before fracture did so at 4 months. The mortality rate was < 1%. Interpretation — Most patients did not use any walking aid and few had severe pain at 4 months. Furthermore, a hip fracture is not a life-threatening event in a patient < 50 years. The living conditions did not change for those who lived independently before the fracture. [ABSTRACT FROM AUTHOR]

Introduction: Ambulance organisations in Sweden have introduced prehospital fast track care (PFTC) for patients with suspected hip fracture. This means that the ambulance nurse starts the pre-operative procedure otherwise implemented at the accident & emergency ward (A&E) and transports the patient directly to the radiology department instead of A&E. If the diagnosis is confirmed, the patient is transported directly to the orthopaedic ward. No previous randomised, controlled studies have analysed PFTC to describe its possible advantages. The aim of this study is to examine whether PFTC has any impact on outcomes such as time to surgery, length of stay, post-operative complications and mortality.Methods: The design of this study is a prehospital randomised, controlled study, powered to include 400 patients. The patients were randomised into PFTC or the traditional care pathway (A&E group).Results: Time from arrival to start for X-ray was faster for PFTC (mean, 28 vs. 145 min; p<0.001), but the groups did not differ with regard to time from start of X-ray to start of surgery (mean 18.40 h in both groups). No significant differences between the groups were observed with regard to: time from arrival to start of surgery (p=0.07); proportion operated within 24h (79% PFTC, 75% A&E; p=0.34); length of stay (p=0.34); post-operative complications (p=0.75); and 4 month mortality (18% PFTC, 15% A&E p=0.58).Conclusion: PFTC improved time to X-ray and admission to a ward, as expected, but did not significantly affect time to start of surgery, length of stay, post-operative complications or mortality. These outcomes were probably affected by other factors at the hospital. Patients with either possible life-threatening conditions or life-threatening conditions prehospital were excluded. [ABSTRACT FROM AUTHOR]

Background: Hip surgery is associated with the risk of postoperative urinary retention. To avoid urinary retention hip surgery patients undergo urinary catheterisation. Urinary catheterisation, however, is associated with increased risk for urinary tract infection (UTI). At present, there is limited evidence for whether intermittent or indwelling urinary catheterisation is the preferred choice for short-term bladder drainage in patients undergoing hip surgery. Objectives: The aim of the study was to investigate differences between intermittent and indwelling urinary catheterisation in hip surgery patients in relation to nosocomial UTI and cost-effectiveness. Design: Randomised controlled trial with cost-effectiveness analysis. Setting: The study was carried out at an orthopaedic department at a Swedish University Hospital. Methods: One hundred and seventy hip surgery patients (patients with fractures or with osteoarthritis) were randomly allocated to either intermittent or indwelling urinary catheterisation. Data collection took place at four time points: during stay in hospital, at discharge and at 4 weeks and 4 months after discharge. Results: Eighteen patients contracted nosocomial UTIs, 8 in the intermittent catheterisation group and 10 in the indwelling catheterisation group (absolute difference 2.4%, 95% CI -6.9-11.6%) The patients in the intermittent catheterisation group were more often catheterised (p<0.001) and required more bladder scans (p<0.001) but regained normal bladder function sooner than the patients in the indwelling catheterisation group (p<0.001). Fourteen percent of the patients in the intermittent group did not need any catheterisation. Cost-effectiveness was similar between the indwelling and intermittent urinary catheterisation methods. Conclusions: Both indwelling and intermittent methods could be appropriate in clinical practice. Both methods have advantages and disadvantages but by not using routine indwelling catheterisation, unnecessary catheterisations might be avoided in this patient group. [ABSTRACT FROM AUTHOR]

Aim To describe patients' experiences of bladder emptying and urinary catheterization in connection with hip surgery. Background The capacity of bladder emptying in connection with hip surgery is affected by pain, medication and confinement to bed. In connection with such surgery urinary catheterization is often performed, either intermittent or indwelling. Hip surgery patients' experiences of urinary catheterization and urination have not been studied before. Design A qualitative study with descriptive design was conducted among hip surgery patients. Methods Thirty face-to-face interviews were conducted from October 2009-March 2010 and analysed with inductive qualitative content analysis. Results The main category 'An issue but of varying impact' illustrated the patients' experiences of bladder emptying and urinary catheterization. Five generic categories were identified: ability to urinate, catheter is convenient, bothersome bladder emptying, intrusion on dignity and concern about complications. Irrespectively of whether the patients were able to urinate or were catheterized, the bladder emptying situation was not as usual. It was described as uncomplicated and experienced as being positive if the patients were able to urinate by themselves or when catheterization was experienced as convenient. Some patients did not want to be catheterized, approving it only reluctantly. Independently of the method for bladder emptying, the patients in our study would choose the same method next time. Conclusions The patients undergoing hip surgery seem to experience bladder emptying as an issue but of varying impact. Both bladder emptying through micturition and bladder emptying through catheterization are described in positive and negative terms. [ABSTRACT FROM AUTHOR]

Postoperative death within 1 year following hip fracture surgery is reported to be up to 27%. In the current study, we benchmarked the predictive precision and accuracy of the algorithms support vector machine (SVM), naïve Bayes classifier (NB), and random forest classifier (RF) against logistic regression (LR) in predicting 1-year postoperative mortality in hip fracture patients as well as assessed the relative importance of the variables included in the LR model. All adult patients who underwent primary emergency hip fracture surgery in Sweden, between 1 January 2008 and 31 December 2017 were included in the study. Patients with pathological fractures and non-operatively managed hip fractures, as well as those who died within 30 days after surgery, were excluded from the analysis. A LR model with an elastic net regularization were fitted and compared to NB, SVM, and RF. The relative importance of the variables in the LR model was then evaluated using the permutation importance. The LR model including all the variables demonstrated an acceptable predictive ability on both the training and test datasets for predicting one-year postoperative mortality (Area under the curve (AUC) = 0.74 and 0.74 respectively). NB, SVM, and RF tended to over-predict the mortality, particularly NB and SVM algorithms. In contrast, LR only over-predicted mortality when the predicted probability of mortality was larger than 0.7. The LR algorithm outperformed the other three algorithms in predicting 1-year postoperative mortality in hip fracture patients. The most important predictors of 1-year mortality were the presence of a metastatic carcinoma, American Society of Anesthesiologists(ASA) classification, sex, Charlson Comorbidity Index (CCI) ≤ 4, age, dementia, congestive heart failure, hypertension, surgery using pins/screws, and chronic kidney disease. [ABSTRACT FROM AUTHOR]

Hip fracture patients have a high risk of mortality after surgery, with 30-day postoperative rates as high as 10%. This study aimed to explore the predictive ability of preoperative characteristics in traumatic hip fracture patients as they relate to 30-day postoperative mortality using readily available variables in clinical practice. All adult patients who underwent primary emergency hip fracture surgery in Sweden between 2008 and 2017 were included in the analysis. Associations between the possible predictors and 30-day mortality was performed using a multivariate logistic regression (LR) model; the bidirectional stepwise method was used for variable selection. An LR model and convolutional neural network (CNN) were then fitted for prediction. The relative importance of individual predictors was evaluated using the permutation importance and Gini importance. A total of 134,915 traumatic hip fracture patients were included in the study. The CNN and LR models displayed an acceptable predictive ability for predicting 30-day postoperative mortality using a test dataset, displaying an area under the ROC curve (AUC) of as high as 0.76. The variables with the highest importance in prediction were age, sex, hypertension, dementia, American Society of Anesthesiologists (ASA) classification, and the Revised Cardiac Risk Index (RCRI). Both the CNN and LR models achieved an acceptable performance in identifying patients at risk of mortality 30 days after hip fracture surgery. The most important variables for prediction, based on the variables used in the current study are age, hypertension, dementia, sex, ASA classification, and RCRI. [ABSTRACT FROM AUTHOR]