American Academy of Orthopaedic Surgeons Annual Meeting

American Academy of Orthopaedic Surgeons Annual Meeting

April 16, 2020
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Kappa Delta Ann Doner Vaughn Award recognizes femoral neck fracture research

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The American Academy of Orthopaedic Surgeons announced Marc F. Swiontkowski, MD, FAAOS, has received the Kappa Delta Ann Doner Vaughn Award for research he and his colleagues conducted into outcomes after operative treatment of femoral neck fractures.

Marc F. Swiontkowski
Marc F. Swiontkowski

“[The research] establishes a difference in reoperation rates among patients randomized to sliding hip screws, [an] increase in rates of avascular necrosis with sliding hip screws and a strong rationale for using these sliding hip screws in displaced fractures.” Swiontkowski said at the Orthopaedic Research Society Annual Meeting where he presented the results.

“I believe we are impacting the outcomes of patient care,” Swiontkowski said at the meeting.

According to the AAOS press release, the impact of hip fractures can be devastating, resulting in disability and potentially death. The cost of hip fractures can be high. In the United States, a patient with a hip fracture typically spends $40,000 in the first year for direct medical costs and approximately $5,000 in following years, the release noted.

Mohit Bhandari
Mohit Bhandari

In 2008, Swiontkowski, Mohit Bhandari, MD, PhD, FRCSC, an Orthopedics Today Editorial Board Member, and their colleagues began studying the most effective ways to manage femoral neck fractures. This resulted in the Fixation Alternatives in the Treatment of Hip Fractures or FAITH trial, which involved 399 orthopedic surgeons at 81 centers in eight countries, most of which were in the United States and Canada.

In the press release, Swiontkowski, who is in the department of orthopedic surgery at University of Minnesota, said what motivated the researchers was the high known failure rate of internal fixation for displaced femoral neck fractures.

The FAITH trial compared results of cannulated screws to sliding hip screws for internal fixation of the displaced fractures.

“Our main objective was to determine the effect of a sliding hip screw vs. cancellous screws on the risk of reoperation over 2 years,” Swiontkowski said at the meeting, noting it was an international, multicenter, concealed, randomized, controlled trial in adults aged 50 years and older with a femoral neck fracture that was displaced and treated within 4 days.

Surgeons who treated patients with sliding hip screws used a screw design of their choice and surgeons who treated patients with cancellous screws used multiple screws, he noted.

Primary outcomes were reoperation within 2 years to promote fracture healing, to relieve pain from a prominent implant, the treatment of infection or to improve function. Secondary outcomes were any fracture complications, mortality, fracture healing and shortening, and medical adverse events.

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“If you pool all the patients, nondisplaced and displaced combined, there was no difference in the primary endpoint,” Swiontkowski said in his presentation.

“The secondary endpoint is where the major clinically relevant findings occurred. [Avascular necrosis] AVN occurred in 9% of the sliding hip screw group vs. 5%, and we have some interesting theories about that. We think it happens when you twist the femoral neck inserting the larger screw. On the secondary endpoints, there were no meaningful differences on any of them,” he said.

Limitations of the study were that surgeons and patients were not blinded and, according to Swiontkowski, investigators were unable to follow up 11% of the living, randomized patients.

According to the press release, Swiontkowski, Bhandari and colleagues plan to earmark the award money for an international cohort study with 3,000 patients in each treatment category that compares the best implant approach for femoral neck fracture fixation with the best arthroplasty approach. – by Susan M. Rapp

 

Reference:

https://aaos-annualmeeting-presskit.org/2020/awards/vaughn_award/

 

Disclosure: The study was supported by research grants from the Canadian Institutes of Health Research, NIH, NIH National Institute of Arthritis and Musculoskeletal and Skin Diseases, Stichting NutsOhra, the Netherlands Organisation for Health Research and Development, Physicians’ Services Incorporated and Stryker GmBH.