Subtrochanteric fractures of the femur: update

Lourenço, Paulo Roberto Barbosa de Toledo; Pires, Robinson Esteves Santos

doi:10.1016/j.rboe.2016.03.001

Cited by 27 publications

(38 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The most commonly accepted definition is that they include fractures that occur within 5 cm distal to the lesser trochanter [ 5 ]. Subtrochanteric fractures pose additional challenges in their management, because of the unique anatomical and biomechanical features of the subtrochanteric region [ 6 ], their “moderate” vascularity [ 7 ], in addition to the reduction difficulties associated with the strong deforming forces acting on the proximal femur [ 8 ]. The mainstay of their management is intramedullary nailing (>90%) [ 9 ], due to the biomechanical advantages offered from this method of fixation compared to others [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Mortality and Medical Complications of Subtrochanteric Fracture Fixation

Panteli

Giannoudi

Lodge

et al. 2021

JCM

View full text Add to dashboard Cite

The aim of this study was to define the incidence and investigate the associations with mortality and medical complications, in patients presenting with subtrochanteric femoral fractures subsequently treated with an intramedullary nail, with a special reference to advancement of age. Materials and Methods: A retrospective review, covering an 8-year period, of all patients admitted to a Level 1 Trauma Centre with the diagnosis of subtrochanteric fractures was conducted. Normality was assessed for the data variables to determine the further use of parametric or non-parametric tests. Logistic regression analysis was then performed to identify the most important associations for each event. A p-value < 0.05 was considered significant. Results: A total of 519 patients were included in our study (age at time of injury: 73.26 ± 19.47 years; 318 female). The average length of hospital stay was 21.4 ± 19.45 days. Mortality was 5.4% and 17.3% for 30 days and one year, respectively. Risk factors for one-year mortality included: Low albumin on admission (Odds ratio (OR) 4.82; 95% Confidence interval (95%CI) 2.08–11.19), dementia (OR 3.99; 95%CI 2.27–7.01), presence of pneumonia during hospital stay (OR 3.18; 95%CI 1.76–5.77) and Charlson comorbidity score (CCS) > 6 (OR 2.94; 95%CI 1.62–5.35). Regarding the medical complications following the operative management of subtrochanteric fractures, the overall incidence of hospital acquired pneumonia (HAP) was 18.3%. Patients with increasing CCS (CCS 6–8: OR 1.69; 95%CI 1.00–2.84/CCS > 8: OR 2.02; 95%CI 1.03–3.95), presence of asthma/chronic obstructive pulmonary disease (COPD) (OR 2.29; 95%CI 1.37–3.82), intensive care unit (ICU)/high dependency unit (HDU) stay (OR 3.25; 95%CI 1.77–5.96) and a length of stay of more than 21 days (OR 8.82; 95%CI 1.18–65.80) were at increased risk of this outcome. The incidence of post-operative delirium was found to be 10.2%. This was associated with pre-existing dementia (OR 4.03; 95%CI 0.34–4.16), urinary tract infection (UTI) (OR 3.85; 95%CI 1.96–7.56), need for an increased level of care (OR 3.16; 95%CI 1.38–7.25), pneumonia (OR 2.29; 95%CI 1.14–4.62) and post-operative deterioration of renal function (OR 2.21; 95%CI 1.18–4.15). The incidence of venous thromboembolism (VTE) was 3.7% (pulmonary embolism (PE): 8 patients; deep venous thrombosis (DVT): 11 patients), whilst the incidence of myocardial infarction (MI)/cerebrovascular accidents (CVA) was 4.0%. No evidence of the so called “weekend effect” was identified on both morbidity and mortality. Regression analysis of these complications did not reveal any significant associations. Conclusions: Our study has opened the field for the investigation of medical complications within the subtrochanteric fracture population. Early identification of the associations of these complications could help prognostication for those who are at risk of a poor outcome. Furthermore, these could be potential “warning shots” for clinicians to act early to manage and in some cases prevent these devastating complications that could potentially lead to an increased risk of mortality.

show abstract

Section: Introductionmentioning

confidence: 99%

Mortality and Medical Complications of Subtrochanteric Fracture Fixation

Panteli

Giannoudi

Lodge

et al. 2021

JCM

View full text Add to dashboard Cite

show abstract

“…In a study by Sun-jun Hu et al, proximal lateral femur locking plate provides an effective and stable management of subtrochantric hip fractures [15] . Because of the complicated anatomy of the subtrochantric region, its management is quite challenging and even with various advancements in implant techniques, there hasn't been much reduction in complication rate [16] . According to David J. Hak et al [17] , there are high chances of complications like malunion, delayed union and non union with implant failure while managing a case of subtrochantric fracture.…”

Section: Discussionmentioning

confidence: 99%

Functional outcome of comminuted unstable subtrochanteric fractures treated by proximal femoral nail [PFN]

Va¹,

Mohammed²

2017

Int. J. Orthop. Sci.

View full text Add to dashboard Cite

Background: Subtrochanteric fractures are often difficult to treat and may well be associated with a mortality of more than 20%. The subtrochanteric region is the site of very high mechanical stresses, the medial and posteromedial cortices were subject to high compressive forces whereas the lateral cortex experiences high tensile forces. Operative management is the treatment of choice to achieve the goals of early rehabilitation and optimal functional recovery. The purpose of the present study is to evaluate functional outcome of the subtrochanteric fractures -both high energy and low energy -treated by PFN. Functional as well as anatomical results were evaluated with regard to pain, limping, activities, deformity and range of movements. The present study was done with the hope to find out a solution for the treatment of unstable comminuted subtrochanteric fractures. Materials and Methods: A total of 24 patients with subtrochanteric fractures presenting in the Department of Orthopaedics from August 2015 to August 2016 were treated by closed intramedullary nailing using PFN and the peroperative and postoperative complications and the functional outcome were studied. All the data was arranged in a tabulate form and analyzed using SPSS software. Chi square test was applied as a test of significance. Probability value of less than 0.05 was considered significant. Result: Out of the 24 patients 16 (66.66%) were males and 8 (33.34%) were females. Most of the cases came under. Type IB (62.50%) and Type IA (20.84%). There were 8.3% cases each of Type II A and Type II B. In this study, 14 cases (58.34%) were locked proximally and distally with 2 screws each. In 4 cases (16.66%), 2 proximal screws and 1 distal screw, in 2 cases of intertrochanteric fracture, only 2 proximal screws were used. Average duration taken for union in this study was 4.5 months (Ranges from 3 months to 7.5 months). 22 (90%) united by 6 months. There were no cases of infection. No shortening in 10 cases. Less than 1 cm shortening in 9 cases and 3.2 cm shortening in one case was found. Proximal screw penetration was noted in one case (RT type II A) at the time of 3 months follow up. Conclusion: PFN is a safe, effective and patient friendly device useful for the treatment of all subtrochanteric fractures irrespective of their comminution. Early mobilization and rehabilitation is possible since it is a closed intramedullary procedure.

show abstract

“…Finally, several authors declare that the quality of fracture reduction is much more important than the choice of the implant. In fact, in a well-reduced fracture, the literature demonstrates that the results of intra-and extra-medullary fixation using the biological technique (minimally invasive) are similar 8 .…”

Section: Complications and Current Evidencementioning

confidence: 99%

“…The Russel Taylor classification considers the presence or absence of the involvement of the piriformis fossa and the lesser trochanter. Today, it has lost its therapeutic and prognostic guidance, due to evolution of the implants used to repair SFF 8 . The Seinsheimer classification, instead, is more practical because it takes into consideration the segments of the fracture with the involvement both the medial and lateral cortices 9 .…”

Section: Anatomy and Classificationmentioning

confidence: 99%

“…The AO classification considers the bone (femur = 3), the location (diaphysis = 2), the energy of the trauma (A, B or C) and the mechanism (1, 2 or 3), but it includes the SFF in diaphyseal fractures which have a different mechanical and biological behavior. Among all, the last is the most widely used for its classification system that describes fracture morphology and mechanism 8 .…”

Section: Anatomy and Classificationmentioning

confidence: 99%

See 1 more Smart Citation

Subtrochanteric femur fractures: management and outcomes

2020

View full text Add to dashboard Cite

Nowadays, subtrochanteric femur fractures (SFF) represent an important orthopedic problem to treat due to instability of the fragments, malunion and mechanical complications. The causes of failure in SFF include the lack of biomechanical consideration and the preoperative planning, wrong choice of synthesis, and reduction of the fracture or the surgical technique can compromise the correct post-operative recovery and the correct bone healing. It is important to understand the forces of this anatomical area in order to use right surgical approach. The following article provides a review of the current literature in order to outline epidemiology, treatment, outcomes and possible complications of subtrochanteric femur fractures.

show abstract

Subtrochanteric fractures of the femur: update

Cited by 27 publications

References 25 publications

Mortality and Medical Complications of Subtrochanteric Fracture Fixation

Mortality and Medical Complications of Subtrochanteric Fracture Fixation

Functional outcome of comminuted unstable subtrochanteric fractures treated by proximal femoral nail [PFN]

Subtrochanteric femur fractures: management and outcomes

Contact Info

Product

Resources

About