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Higher risk of thrombotic events, worse function with delayed hip fracture surgery
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DENVER — New research on displaced acetabular fractures associates surgical delay with decreasing functional and radiographic outcomes and an increasing risk for thrombotic complications.
Using a pelvic trauma database, Richard J. Jenkinson, MD, FRCS, of Toronto, and his colleagues identified 232 patients who were surgically treated for displaced acetabular fractures. Of these, 162 patients completed functional outcome surveys using the SF-36 and Musculoskeletal Functional Assessment, which were prospectively gathered at 6 months, 1 year and 2 years postoperatively. The investigators also collected standard radiographs of 67 patients.
Jenkinson presented the study at the 24th Annual Meeting of the Orthopaedic Trauma Association, here.
They discovered that patients with longer surgical delays had significantly worse functional outcomes. A delay of 7 to 13 days decreased the SF-36 physical component summary z-scores by 0.75, while a delay of 14 or more days decreased the z-score 1.5 standard deviations.
A review of patients with radiographic follow-up revealed that those with a delay of 14 days or more had a five-times higher odds ratio for having a postoperative gap of greater than 2 mm.
In addition, the investigators found that a delay to surgery was linked to a higher risk of thrombotic complications. Patients who developed a pulmonary embolism had a mean delay of 11.3 days to surgery compared to 7.3 days for those who did not have the complication, he said. Also, patients who had a deep vein thrombosis (DVT) were delayed an average of 14.1 days, while those without DVT had a delay of only 7.1 days.
Jenkinson cited the retrospective design and incomplete radiographic and functional data as study limitations.
“Despite these limitations, we find some deterioration in the functional outcomes after as little as 7 days of delay,” he said. “And after 14 days of delay, the patients did have worse outcomes both radiographically and functionally. We should really try to get these patients operated on before these delays become a problem for them.”
For more information:
- Jenkinson JR, Maathuis MAW, Ristevski B, et al. Effect of delay to surgery on functional outcomes for displaced acetabular fractures. Paper #30. Presented at the 24th Annual Meeting of the Orthopaedic Trauma Association. Oct. 16-18, 2008. Denver.