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Scientific Articles   |    
Evidence Summary: Systematic Review of Surgical Treatments for Geriatric Hip Fractures
Mary Butler, PhD, MBA1; Mary L. Forte, PhD, DC2; Siddharth B. Joglekar, MD3; Marc F. Swiontkowski, MD4; Robert L. Kane, MD1
1 Minnesota Evidence-based Practice Center, School of Public Health, University of Minnesota, 420 Delaware Street S.E., Minneapolis, MN 55455
2 Departments of Epidemiology and Orthopaedics, University of Maryland School of Medicine, 22 South Greene Street, Suite S11B, Baltimore, MD 21201. E-mail address: mforte@umoa.umm.edu
3 Department of Orthopedics, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905
4 Department of Orthopaedic Surgery, University of Minnesota, 2450 Riverside Avenue South, Minneapolis, MN 55454
View Disclosures and Other Information
Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants in excess of $10,000 from the Agency for Healthcare Research and Quality. In addition, one or more of the authors or a member of his or her immediate family received, in any one year, payments or other benefits of less than $10,000 or a commitment or agreement to provide such benefits from commercial entities (Medtronic, SCAN Health Plan, and UnitedHealth Group).

Investigation performed at the University of Minnesota, Minneapolis, Minnesota
This project was funded under Contract No. 290-2007-10064-I from the Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services. The authors of this article are responsible for its content. Statements in the article should not be construed as endorsement by the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services.

Copyright © 2011 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2011 Jun 15;93(12):1104-1115. doi: 10.2106/JBJS.J.00296
The erratum to this article has been published | view the erratum
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Abstract

Update 

This article was updated on September 21, 2011, because of a previous error. On page 1104, in the Results section of the Abstract, the text had previously read “We found eighty-one articles representing seventy-six unique, randomized, controlled trials, including thirty-five on femoral neck fractures, forty on intertrochanteric fractures, and one on subtrochanteric fractures.” The text now reads “We found eighty-four articles representing seventy-four unique, randomized, controlled trials, including thirty-three on femoral neck fractures, forty on intertrochanteric fractures, and one on subtrochanteric fractures.”

An erratum has been published: J Bone Joint Surg Am 2011;93(21):2032.

Background: 

There is a growing body of literature on surgical treatments for elderly patients with a hip fracture and the effects of various surgical procedures on complications and postoperative outcomes. No single review has previously summarized the literature on the effects of surgical procedures on outcomes after treatment across all types of hip fractures. We conducted a comprehensive systematic literature review to organize the clinical evidence for patient-centered outcomes across all types of geriatric hip fractures.

Methods: 

We searched MEDLINE, the Cochrane Database of Systematic Reviews, Scirus, and ClinicalTrials.gov for randomized clinical trials and observational studies published between 1985 and 2008. We also manually searched reference lists from relevant systematic reviews.

Results: 

We found eighty-four articles representing seventy-four unique, randomized, controlled trials, including thirty-three on femoral neck fractures, forty on intertrochanteric fractures, and one on subtrochanteric fractures. Nine observational studies addressed the link between patient characteristics and outcome variables by fracture type. Age, sex, prefracture functioning, and cognitive impairment are related to mortality and functional outcomes. Fracture type does not appear to be independently related to patient outcomes. Mortality, pain, function, and quality of life did not differ by surgical implant class, or by implants within a class. Neither the randomized controlled trials nor the observational literature include the full complement of potential covariates that can impact treatment outcomes after treatment.

Conclusions: 

The broader questions about the relationship of patient factors, fracture type, and specific treatments to the outcomes of mortality, functional status, and quality of life cannot be addressed with the existing literature. Research should include comprehensive conceptual models that capture complete sets of important independent variables. Studies of musculoskeletal outcomes, including hip fracture, require well-defined patient groups and consistent use of validated outcome measures.

Level of Evidence: 

Therapeutic Level II. See Instructions to Authors for a complete description of levels of evidence.

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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