Complication Risk After Treatment of Intertrochanteric Hip Fractures in the Medicare Population

Abstract

The study evaluated the incidence of and complications associated with the use of an intramedullary nail vs open reduction and internal fixation (ORIF) with a sliding compression hip screw and plate in treating intertrochanteric fractures. The authors hypothesized that the biomechanically stronger and less invasive intramedullary nail would have superior results and fewer complications compared with ORIF. Patients followed for up to 1 year postoperatively were identified from the 5% nationwide sample of Medicare administrative claims data (1998-2007) using the corresponding International Classification of Diseases, 9th revision, Clinical Modification, codes 820.21 and 820.31. There were 9157 patients treated with intramedullary nails and 27,687 treated with compression screw and plate fixation. Intertrochanteric hip fractures treated with an intramedullary nail during this period increased from 3.3% to 63.1% compared with ORIF. Patients treated with an intramedullary nail had a higher adjusted risk of pulmonary embolism at 90 days (P=.003) and a higher risk of mortality at 1 year (P<.001) compared with those treated with ORIF. Patients who underwent intramedullary nailing during 2006 to 2007 had a lower adjusted risk of conversion to total hip replacement at 1 year (P=.037) compared with those who had ORIF. Over the decade of the study, intramedullary nail usage increased 59.8% compared with ORIF. Increased use of intramedullary nails compared with ORIF has not shown improved outcomes or decreased complications in patients with intertrochanteric hip fractures. The increased use of intramedullary nails for intertrochanteric hip fractures appears to be multifactorial, including the less invasive nature of the surgery and increased experience with the closed surgical technique.

Mortality After Osteoporotic Fractures: What Proportion Is Caused by Fracture and Is Preventable?

“…The study of Andrich and colleagues did not describe specific causes of death in the early period after pelvis fracture. Prior studies have examined cause of death primarily after hip fracture; although a minority of the early deaths are the result of postoperative complications such as delirium, pneumonia, acute cardiovascular events, and pulmonary embolism (Fig. , arrow a), the majority of deaths post‐hip fracture are from the same common comorbid conditions that are the causes of death in the broader older population (Fig.…”

A retrospective analysis of the InterTan nail and proximal femoral nail anti-rotation in the treatment of intertrochanteric fractures in elderly patients with osteoporosis: a minimum follow-up of 3 years

“…Studies have shown that early surgical intervention (within 24 h) can significantly reduce mortality [ 5 ]. Intramedullary fixation, with the advantages of withstanding the stress of the axis shift, good anti-fatigue performance, smaller incisions, and less damage to the local blood supply, is the most current treatment for IFs [ 2 , 6 ].…”

Hemiarthroplasty for the Management of unstable femoral intertrochanteric fractures in elderly patients over 75 years old: a retrospective matched comparative study

“…The movement time of partial weight-bearing patients in the hemiarthroplasty group was earlier than that in the PFNA group, and the Harris score of hip joints in the hemiarthroplasty group before discharge was also higher than that in the PFNA group. Therefore, for elderly patients with three or more intertrochanteric fractures, hemiarthroplasty can shorten the length of hospitalization and recovery time, and reduce the economic burden of such patients (23,24).…”