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.
Level of Evidence: Therapeutic Level III. See
Instructions to Authors for a complete description of levels of evidence.