Wiik A, Ashdown T, Holloway I. Health economics for intra-capsular hip fractures undertaking fixation. World J Orthop 2024; 15(1): 30-38 [PMID: 38293259 DOI: 10.5312/wjo.v15.i1.30]
Corresponding Author of This Article
Anatole Wiik, BSc, FRCS, MBBS, MD, Surgeon, Department of Surgery, Trauma and Orthopaedics, London North West University Healthcare, Northwick Park Hospital, London HA1 3UJ, United Kingdom. wiikav@hotmail.com
Research Domain of This Article
Orthopedics
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Orthop. Jan 18, 2024; 15(1): 30-38 Published online Jan 18, 2024. doi: 10.5312/wjo.v15.i1.30
Health economics for intra-capsular hip fractures undertaking fixation
Anatole Wiik, Thomas Ashdown, Ian Holloway
Anatole Wiik, Department of Surgery, Trauma and Orthopaedics, London North West University Healthcare, London HA1 3UJ, United Kingdom
Thomas Ashdown, Ian Holloway, Department of Surgery, Trauma and Orthopaedics, London North West University Hospital, London HA1 3UJ, United Kingdom
Author contributions: Wiik AV designed the study; Wiik AV and Ashdown T collected the clinical data; Wiik AV and Ashdown T analysed the data; Wiik AV, Ashdown T and Holloway I interpreted and wrote the report.
Institutional review board statement: The study was a registered audit so no ethical approval was sought nor required. No individual patient or related identity information have been presented.
Informed consent statement: As a registered audit without any patient or related identity no consent was required.
Conflict-of-interest statement: All authors had no conflicts.
Data sharing statement: Raw data is not available freely for use as per National Health Service audit regulations.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Anatole Wiik, BSc, FRCS, MBBS, MD, Surgeon, Department of Surgery, Trauma and Orthopaedics, London North West University Healthcare, Northwick Park Hospital, London HA1 3UJ, United Kingdom. wiikav@hotmail.com
Received: September 26, 2023 Peer-review started: September 26, 2023 First decision: November 14, 2023 Revised: November 26, 2023 Accepted: December 19, 2023 Article in press: December 19, 2023 Published online: January 18, 2024
Abstract
BACKGROUND
Hip fracture is a common musculoskeletal injury in the elderly requiring surgery worldwide. The operative mainstay of intra-capsular hip fractures is arthroplasty with a smaller proportion for fixation.
AIM
To determine the most beneficial method of fixation for patients with intra-capsular hip fractures.
METHODS
A registered audit from 2012-2018 was conducted on all intra-capsular hip fractures treated with 2 commonly used fixation methods. Patient notes, electronic records and clinical codes for cost benefit were evaluated. A validated quality of life measure was collected at least 1 year after surgery.
RESULTS
A total of 83 patients were identified with intra-capsular fractures undergoing fixation during the retrospective period. There were 47 cannulated cancellous screw and 36 sliding hip screw fixations with the case mix comparable for age, gender, co-morbidities and fracture configuration. There was no significant difference in blood loss, tip apex distance, radiation exposure, length of stay, radiological union time, collapse, avascular necrosis or re-operation between fixation methods. Logistic regression analysis demonstrated displaced intracapsular hip fractures correlated significantly with an undesirable outcome conferring a relative odds ratio of 7.25. There were 9 (19%) and 4 (11%) patients respectively, who required re-operation. There was no significant difference in health resource group tariff and implant cost with comparable EQ-5D and visual analogue scores.
CONCLUSION
No significant advantage was identified with differing fixation type, but irrespective there were a high number of patients requiring re-operation. This was predicted by initial fracture displacement and patient age. Arthroplasty may need to be carefully considered for health economics and patient benefit.
Core Tip: Both sliding and cannulated hip screws had undesirable outcomes in older patients with displaced fractures. More predictable methods of treatment such as hip arthroplasty should be considered for older patients with displaced fractures.
