Analysis of the Influence of Osteosynthesis Technique and Patient-specific Factors on the Outcome of Subtrochanteric Fracture Treatment

Christoph Schulze,Erwin Kollig,Katharina Estel,Andre Gutcke,Claudia Hacke,Dan Bieler

doi:10.2174/1874325002014010140

Christoph Schulze, Erwin Kollig + Show 4 more

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https://doi.org/10.2174/1874325002014010140

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Abstract

Objective:The number of subtrochanteric femoral fractures will continue to grow on account of demographic developments. The treatment of choice is reduction and surgical stabilisation. Intramedullary (IO) and extramedullary (EO) techniques are available for this purpose. A final assessment has not been made of which technique is superior with regard to treatment outcome, complication rates, and revision rates. The objective of this retrospective study was to compare surgical procedures with regard to weight bearing, length of hospital stay, the occurrence of complications, and the necessity of surgical revisions.Methods:This retrospective study included 77 patients (74.9 ± 14.9 years; 42.9% male). Associations between surgical procedures and treatment outcomes, complications and revision rates were calculated by linear and logistic regression analysis. To investigate the effect of surgical procedure within patients with fracture type 2 B according to Russel-Taylor classification, a subgroup analysis was performed.Results:In case of fracture type 2 B, according to Russell-Taylor classification, EO took 80 minutes longer on average than the intramedullary technique (p = 0.001), although surgeon experience plays an important role. Common complications were more frequently associated with IO than with EO. Surgical revisions were required more often in the extramedullary group (OR 4.5; 95% CI: 0.87 – 23.19). Patients in the intramedullary group were discharged 3.4 days earlier from the hospital (p = 0.024). Older patients had a higher risk for the occurrence of complications, but BMI and the experience of the surgeon did not. Patients with intramedullary stabilisation frequently showed better postoperative weight-bearing stability.Conclusion:The intramedullary technique offers advantages to both patients and hospitals with regard to outcome, duration of surgery, and length of stay in the hospital. Although, extramedullary implants are less expensive, this advantage is clearly reduced by the longer duration of surgery and hospital stays.

Highlights

Common complications were more frequently associated with IO than with extramedullary osteosynthesis (EO)
Surgical revisions were required more often in the extramedullary group
Older patients had a higher risk for the occurrence of complications, but BMI and the experience of the surgeon did not

Summary

Introduction

The Open Orthopaedics Journal, 2020, Volume 14 141 unmatched in other regions of the human body [8] This leads to a thick cortical layer, and fractures are often comminuted [8]. The medullary cavity in the intertrochanteric region is relatively wide, which makes it more difficult to stably fixate an intramedullary nail than further distal [7] Another problem is that many strong muscles are attached to the proximal femur around the hip joint. Typical signs of a fracture are external rotation, shortening, and adduction of the affected leg [2, 10]. This is why subtrochanteric fractures pose biomechanical challenges to every kind of implant. Pseudoarthrosis rates range from 2 to 20% depending on reduction and cerclage wire use [12, 13]

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