Influence of Fracture Stability on Early Patient Mortality and Reoperation After Pertrochanteric and Intertrochanteric Hip Fractures

Chehade, Mellick; Carbone, Tania A.; Awward, Danny; Taylor, Alfred; Wildenauer, Corinna I; Ramasamy, Boopalan; McGee, Margaret A.

doi:10.1097/bot.0000000000000359

Cited by 44 publications

(36 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…We found that the AO/OTA type 31-A1 and 31-A2 fractures, which are sometimes referred to as stable, were most common (78%). This finding is similar to Chehade et al [ 20 ] who in 2015 published a prospective consecutive cohort of 743 patients were the majority (60%) were classified as stable trochanteric and only 40% as unstable trochanteric or subtrochanteric fractures. We found that with increasing fracture complexity, the proportion of intramedullary nails was increasing, and also the use of long versus short nails.…”

Section: Discussionsupporting

confidence: 89%

Epidemiology, treatment and mortality of trochanteric and subtrochanteric hip fractures: data from the Swedish fracture register

Mattisson

Bojan

Enocson

2018

BMC Musculoskelet Disord

226

140

View full text Add to dashboard Cite

BackgroundHip fractures are a major worldwide public health problem and includes two main types of fractures: the intracapsular (cervical) and the extracapsular (trochanteric and subtrochanteric) fractures. The aim of this study on patients with trochanteric and subtrochanteric hip fractures was to describe the epidemiology, treatment and outcome in terms of mortality within the context of a large register study.MethodsA descriptive epidemiological register study including patients registered in the national Swedish Fracture Register from January 2014 to December 2016. Inclusion criteria were all primary surgically treated traumatic non-pathological trochanteric and subtrochanteric femoral fractures in patients aged 18 years and above. Individual patient data (age, gender, injury location, injury cause, fracture type, treatment and timing of surgery) were retrieved from the register database. Mortality data was obtained via linkage to the Swedish Death Register.ResultsA total of 10,548 consecutive patients were identified and included in the study. The mean (±SD) age for all patients was 82 ± 11 years and the majority of the patients were females (69%). Most of the fractures were caused by a fall at the same level (83%) at the patients’ accommodation (75%). Fractures were classified using the AO/OTA classification as 31-A1 in 29%, as 31-A2 in 49% and as 31-A3 in 22% of the cases. The most commonly used implant was a short antegrade intramedullary nail (42%), followed by a plate with sliding hip screw (37%). With increasing fracture complexity, the proportion of intramedullary nails was increasing, and also the use of long versus short nails. The majority of the patients were operated within 36 h (90%). There was a higher mortality at 30 days and 1 year for males, and for all those who were delayed to surgery > 36 h.ConclusionSafety measures to prevent fall at elderly patient’s accommodation might be a way to reduce the number of trochanteric and subtrochanteric hip fractures. Surgery as soon as possible without delay should be considered to reduce the mortality rate. The selection of surgical methods depends on the fracture complexity.

show abstract

Section: Discussionsupporting

confidence: 89%

Epidemiology, treatment and mortality of trochanteric and subtrochanteric hip fractures: data from the Swedish fracture register

Mattisson

Bojan

Enocson

2018

BMC Musculoskelet Disord

226

140

View full text Add to dashboard Cite

show abstract

“… 18 The impact of mean interval between the incidence of fracture and surgery was also carried out the results revealed that delay in surgery probably increases the likelihood of complications. 17 The reason for this delay could be related to the patient’s late referral to our hospital and also for treatment of their underlying diseases to ready for anesthesia and surgical procedure. However the delay due to surgery would not seem to have adverse effect on the mortality rates.…”

Section: Discussionmentioning

confidence: 99%

The assessment of mortality and quality of life after intertrochanteric fracture of femur in elderly patients

Nasab

Khorramdin

2017

Pak J Med Sci

View full text Add to dashboard Cite

Objective:To investigate the mortality and disability rates after surgical treatment of intertrochanteric fractures in patients older than 60 years old.Method:In this retrospective study, 385 patients aged 60 or older who were admitted because of intertrochanteric fracture to treatment and teaching center of Emam Khomeini hospital of Ahvaz, Iran between Mar. 2010 to Feb. 2015 and underwent surgery were included. All the patients were treated by open reduction and internal fixation by dynamic hip screw. Two hundred and six patients were men (53.5%) and 179 were women (46.4%). Age of patients was between 60 to 89 years old with the average of 75.2 years old. Minimum time required after surgery to enter this study was one year. Results were gathered based on examination of patient or calling patients and their families by phone number.Result:Rate of mortality was 36.9%, including 54.9% for men and 41.9% for women. In eleven patients (2.85%), initial reduction was lost because of failure of fixation device. For these patients reoperation was performed, and 7 of them (63.63%) expired within the mean of 10.1 months after reoperation. Time delay for surgery after occurrence of the fracture was in range of 2 to 15 days with an average of 4.8 days.24 patients (6.23%) went under surgery later than one week after fracture had been happened which seven of them (29.16%) expired. Highest mortality rate was in the age group of 80-89 years old with 50 patients (63.01%) and lowest one was in the group of 60-69 years old with three patients (4.67%). Disability rate and quality of life of the patients was measured by Modified Harris Hip Score and divided in 3 group of good (with a score of 71 to 90), fair (with a score of 51 to 70) and weak (with a score of 0 to 50). Patients who had good score consisted of 35.54% of patients with the average age of 64.63 years old and majority of male patients, fair group consisted of 30.5% of patients with average age of 73.45 years old and equal percentage of male and female patients and for Weak group it was 34.2% and 73.45 years old and by majority of male patients.Conclusion:Mortality rate of intertrochanteric fracture of femur is high even after treated with surgery and it’s highly related to age of patient. Furthermore, quality of life after surgery is still low and follow up of the patients should be improved.

show abstract

“…Both current and prior investigators did not find value in conducting EPI studies for patients who underwent IFF CRIF, even when the fractures were defined pre-operatively as unstable or the fixations were sub-optimal [ 15 , 22 , 26 ]. Furthermore, the current study found that too early radiographs did not provide new information and were of low quality because it was difficult for patients to cooperate with positioning on the radiography table due to post-operative pain and discomfort.…”

Section: Discussionmentioning

confidence: 99%

Routine early post-operative X-ray following internal fixation of intertrochanteric femoral fractures is unjustified: a quality improvement study

et al. 2018

View full text Add to dashboard Cite

BackgroundThere is no consensus regarding the proper radiographic protocol following closed or open reduction and internal fixation for intertrochanteric femoral fractures. The objective of this study was to assess the role of early postoperative imaging studies when deciding about weight bear limitations and reoperations.MethodsA prospective cohort study of 100 patients (26 men and 74 women, at a mean age of 79.8 years) treated by closed or open reduction and internal fixation for AO31A fractures was conducted. According to the AO classification, there were 25 cases of 31A1, 54 cases of 31A2, and 21 cases of 31A3. For every patient, the intraoperative fluoroscopy studies were recorded and post-operative radiograms were taken during the first week. Excluded were patients for whom the early X-rays were clinically indicated. The intraoperative AP and axial fluoroscopy studies were compared with the radiograms taken during the first post-operative week. The investigators compared the decisions regarding weight-bearing limitations and the need for re-operation before and after conducting the radiograms.ResultsThe early post-operative imaging studies did not change weight-bearing limitations nor did they lead to consecutive surgical treatments.ConclusionsUnless indicated by physical examination, there is no value to routine post-operative radiograms within the first few days after closed reduction and internal fixation of intertrochanteric femoral fractures with regard to weight-bearing limitations and re-operation decisions.Trial registrationIdentifier: NCT02868125.

show abstract

Influence of Fracture Stability on Early Patient Mortality and Reoperation After Pertrochanteric and Intertrochanteric Hip Fractures

Abstract: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Cited by 44 publications

References 24 publications

Epidemiology, treatment and mortality of trochanteric and subtrochanteric hip fractures: data from the Swedish fracture register

Epidemiology, treatment and mortality of trochanteric and subtrochanteric hip fractures: data from the Swedish fracture register

The assessment of mortality and quality of life after intertrochanteric fracture of femur in elderly patients

Routine early post-operative X-ray following internal fixation of intertrochanteric femoral fractures is unjustified: a quality improvement study

Contact Info

Product

Resources

About