The characteristics and predictors of mortality in periprosthetic fractures around the knee.
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Ошибки и ограничения
История · было → стало
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Nasser Ahmed A H H, Sidhu Manpreet, Prakash Rohan, Mahmood Ansar, PPF Study Collaborative, PPF Study Collaborative, Osman Khabab, Chauhan Govind S, Nandra Rajpal, Dewan Varun, Davidson Jerome, Al-Azzawi Mohammed, Smith Christian, Gawad Mothana, Palaiologos Ioannis, Cuthbert Rory, Wignadasan Warran, Banks Daniel, Archer James, Odeh Abdulrahman, Moores Thomas, Tahir Muaaz, Brooks Margaret, Biring Gurdeep, Jordan Stevan, Elahi Zain, Shaath Mohammed, Veettil Manoj, De Chiranjit, Handford Charles, Bansal Mohit, Bawa Akshdeep, Mattar Ahmed, Tandra Varun, Daadipour Audrina, Taha Ahmed, Gangoo Shafat, Srinivasan Sriram, Tarisai Mandishona, Budair Basil, Subbaraman Krishna, Khan Farrukh, Gomindes Austin, Samuel Arjun, Kang Niel, Kapur Karan, Mainwaring Elizabeth, Bridgwater Hannah, Lo Andre, Ahmed Usman, Khaleeq Tahir, El-Bakoury Ahmed, Rashed Ramy, Hosny Hazem, Yarlagadda Rathan, Keenan Jonathan, Hamed Ahmed, Riemer Bryan, Qureshi Arham, Gupta Vatsal, Waites Matthew, Bleibleh Sabri, Westacott David, Phillips Jonathan, East Jamie, Huntley Daniel, Masud Saqib, Mirza Yusuf, Mishra Sandeep, Dunlop David, Khalefa Mohamed, Balakumar Balasubramanian, Thibbaiah Mahesh, Payton Olivia, Berstock James, Deano Krisna, Sarraf Khaled M, Logishetty Kartik, Lee George, Subbiah-Ponniah Hariharan, Shah Nirav, Venkatesan Aakaash, Cheseldene-Culley James, Ayathamattam Joseph, Tross Samantha, Randhawa Sukhwinder, Mohammed Faisal, Ali Ramla, Bird Jonathan, Khan Kursheed, Akhtar Muhammad A, Brunt Andrew, Roupakiotis Panagiotis, Subramanian Padmanabhan, Bua Nelson, Hakimi Mounir, Bitar Samer, Al Najjar Majed, Radhakrishnan Ajay, Gamble Charlie, James Andrew, Gilmore Catherine, Dawson Dan, Sofat Rajesh, Antar Mohamed, Raghu Aashish, Heaton Sam, Tawfeek Waleed, Charles Christerlyn, Burnand Henry, Duffy Sean, Taylor Luke, Magill Laura, Perry Rita, Pettitt Michala, Okoth Kelvin, Pinkney Thomas
Аннотация
METHODS: Using a multicentre study design, independent of registry data, we included adult patients sustaining a PPF around a knee arthroplasty between 1 January 2010 and 31 December 2019. Univariate, then multivariable, logistic regression analyses were performed to study the impact of patient, fracture, and treatment on mortality.
RESULTS: Out of a total of 1,667 patients in the PPF study database, 420 patients were included. The in-hospital mortality rate was 6.4%. Multivariable analyses suggested that American Society of Anesthesiologists (ASA) grade, history of peripheral vascular disease (PVD), history of rheumatic disease, fracture around a loose implant, and cerebrovascular accident (CVA) during hospital stay were each independently associated with mortality. Each point increase in ASA grade independently correlated with a four-fold greater mortality risk (odds ratio (OR) 4.1 (95% confidence interval (CI) 1.19 to 14.06); p = 0.026). Patients with PVD have a nine-fold increase in mortality risk (OR 9.1 (95% CI 1.25 to 66.47); p = 0.030) and patients with rheumatic disease have a 6.8-fold increase in mortality risk (OR 6.8 (95% CI 1.32 to 34.68); p = 0.022). Patients with a fracture around a loose implant (Unified Classification System (UCS) B2) have a 20-fold increase in mortality, compared to UCS A1 (OR 20.9 (95% CI 1.61 to 271.38); p = 0.020). Mode of management was not a significant predictor of mortality. Patients managed with revision arthroplasty had a significantly longer length of stay (median 16 days; p = 0.029) and higher rates of return to theatre, compared to patients treated nonoperatively or with fixation.
CONCLUSION: The mortality rate in PPFs around the knee is similar to that for native distal femur and neck of femur fragility fractures. Patients with certain modifiable risk factors should be optimized. A national PPF database and standardized management guidelines are currently required to understand these complex injuries and to improve patient outcomes.