Inferior Outcome after Unstable Trochanteric Fracture Patterns Compared to Stable Fractures in the Elderly

Abstract

Background: Various risk factors affecting outcome of elderly patients after proximal femur fracture have been identified. The present study aims to evaluate the impact of the fracture pattern in trochanteric fractures on postoperative mobility and complications. Methods: Ninety-two patients with a mean age of 84 years were included. According to the revised AO/OTA classification, fractures were divided into stable (AO 31A1) and unstable (AO 31A2/3) patterns. A follow-up examination was performed 12 months after cephalomedullary fixation to assess outcome parameters for mobility/activities of daily living (Parker Mobility Score (PMS)/Barthel Index (BI)) and complications (increase in requirement of care, hospital readmission, mortality rate). Results: At follow-up, patients with unstable trochanteric fracture patterns presented with lower PMS and BI compared to stable fractures (p < 0.05). Further, higher requirement of care and higher readmission rates compared to stable patterns were observed. Conclusion: Unstable trochanteric fractures presented inferior outcome compared to simple fracture patterns. This might be explained by the increasing surgical trauma in unstable fractures as well as by the mechanical impact of the lesser trochanter, which provides medial femoral support and is of functional relevance. Subsequent studies should assess if treatment strategies adapted to the specific fracture pattern (refixation of lesser trochanter) influence outcome in unstable trochanteric fractures.

age is the main prognostic factor regarding functional outcome in intertrochanteric fracture

“…Our ndings regarding the fracture type and surgical outcome was the same as the previous studies (9,19,20). Before, it was shown that unstable intertrochanteric fracture patterns need more health care system involvement (9,21).…”

Predictive factors of non-treatment and non-persistence to osteoporosis medication after fragility hip fractures at 3 years after discharge: a multicentre, prospective cohort study in the northern Kyushu district of Japan

“…These results are consistent with our study results. Instability of the fracture site may contribute to lower ADL in patients with trochanteric fracture in the early postoperative period [28]. Discharge to another place was also associated with low BI.…”

Biomechanical stability of short versus long proximal femoral nails in osteoporotic subtrochanteric A3 reverse-oblique femoral fractures: a cadaveric study

“…Additionally, open reduction inherits the risk of injury to vascular and nerve structures on the medial side of the femur, ultimately increasing the second hit in this highly vulnerable ortho-geriatric patient population. Only recently it has been shown in a geriatric patient collective, that with increasing instability of proximal femur fractures, clinical outcome worsens in respect to functional outcome, rehabilitation potential, loss of self-care potential and ultimately mortality [ 26 ]. Although it is not clear which part of the poor outcome is fracture-specific and which is care-specific, it is obvious that elderly, multimorbid patients in particular benefit from the gentlest possible surgical procedure.…”