324 COPYRIGHT © 2007 BY THE JOURNAL OF BONE AND JOINT SURGERY, INCORPORATED Analysis of Outcomes for Surgically Treated Hip Fractures in Patients Undergoing Chronic Hemodialysis By Oguz Karaeminogullari, MD, Huseyin Demirors, MD, Orcun Sahín, MD, Metin Ozalay, MD, Nurhan Özdemir, MD, and Reha N. Tandogan, MD Investigation performed at Baskent University, Ankara, Turkey Background: Hip fractures in patients with end-stage renal disease are associated with frequent complications. This study analyzed clinical outcomes for patients on chronic hennodialysis who sustained hip fractures and were treated with a variety of fracture repair methods. IVIethods: 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, thir- teen 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 complica- tion rates for the groups were compared. Results: In Group 1, eight complications occurred In six hips and nonunion developed in fîve hips. In Group 2. six- teen 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 compli- cations, 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 propor- tions. 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 hemodi- alysis is associated with frequent complications and a high mortality rate. Osteosynthesis is an acceptable option for treating intertrochanteric fractures and nondisplaced fennoral 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. I n patients with end-stage renal disease, hip fractures are I bers of subjects and have not analyzed the effects of fracture associated with a high risk of mortality and frequent type or treatment method on outcome'"'", complications' \ The reported one-year mortality rates for Our goals were to clarifj/ the range of clinical outcomes elderly patients without end-stage renal disease who sustain a after treatment of a hip fracture in patients with end-stage re- femoral neck fracture have ranged from 15% to 40%'". The nal disease who are on chronic hemodialysis and to evaluate corresponding rate for patients who are on chronic hemodial- how the type of fracture and treatment affect the outcome, ysis becau.se of renal disease is 50%'. Hip fractures in this pa- tient group are frequently complicated hy problems such as Materiais and Methods hemiitonia, prolonged wound drainage, infection, implant »T^he study involved patients with end-stage renal disease failure, and nonunion. Most studies of hip fractures in pa- -L who were admitted to two hospitals affiliated with our in- tients with end-stage renal disease have involved small num- stitution for the treatment of a femoral neck or intertrochan- Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commerciai entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, ciinicai prac- tice, or other ctiaritable or nonprofit organization with which the authors, or a member of their immediate families, are affiiiated or associated.