High Versus Low Energy Intertrochanteric Hip Fractures in Young Patients: Injury Characteristics and Factors Associated with Complications.

Abstract

To compare fracture patterns and associated injuries for young patients with high-versus low-energy intertrochanteric hip fractures and to report on factors associated with complications after surgical fixation of high-energy fractures. Retrospective comparative study. Academic Level 1 Trauma Center. A total of 103 patients < 50 years old were included: 80 high-energy fractures and 23 low-energy fractures. Cephalomedullary nailing (CMN) (N=92) or a sliding hip screw (SHS) (N=11). Radiographic characteristics of fracture morphology, implant position, and reduction quality as well as post-operative complications. Compared to young patients with low-energy fractures, those with high-energy fractures had more fracture comminution (p=0.013) and higher ISS scores (p<0.003), and were more likely to require open reduction (p<0.001). Patients with low-energy fractures from a ground level fall had higher rates of alcohol abuse (0.032), cirrhosis (0.010), and chronic steroid use (0.048). Overall reoperation rate for high-energy fractures was 7% including 2 IT fracture nonunions (5%) and 1 deep infection (2%). For high-energy fractures, ASA class (p=0.026), anterior lag screw position (p=0.001), and varus malreduction (p<0.001) were associated with malunion. Four-part fracture (OTA/AO 31A2.3/Jensen 5) (p=0.028) and residual calcar gap >3mm (p=0.03) were associated with reoperation. Surgical treatment of high-energy IT fractures in young patients is technically demanding with potential untoward outcomes. Injury characteristics and severity are significantly different for young patients with high-energy IT fractures compared to low-energy fractures. For young patients with a high-energy IT fracture, surgeons can anticipate a high rate of associated injuries and complex fracture patterns requiring open reduction. For young patients with a low-energy IT fracture, co-management with a hospitalist or geriatrician should be considered since they may be physiologically older.