Abstract
Purpose The study is aimed at assessing the role of preoperative computerised tomography (CT) examination in the quality of reduction and outcomes in elderly patients with intertrochanteric fracture. Methods The elderly patients with an intertrochanteric fracture who were treated with proximal femoral nail antirotation were included. The patients were divided into the CT group and the no-CT group according to the presence of preoperative CT examination. Patients' baseline characteristics, quality of reduction, and function were recorded at follow-up. Functional outcomes were evaluated using the Harris hip scores (HHS). Results Totally, the study included 182 patients with intertrochanteric fractures, with 85 in the CT group and 97 in the no-CT group, admitted between January 2018 and June 2019. There was no difference in the quality of reduction, HHS, the fracture healing, or postoperative complications between the CT group and the no-CT group. However, the CT group experienced the shorter mean operative time and blood transfusion, compared to the no-CT group. Conclusions The preoperative CT examination seems to be excessive for elderly patients with an intertrochanteric fracture.
Highlights
Intertrochanteric fracture is the extracapsular fracture of the proximal femur between the greater and lesser trochanters, which often suffered low energy falls in osteoporotic patients
All patients were admitted to a level I trauma center in Xi’an, China, and the surgery was conducted by a team of two chief physicians and four attending physicians that treated more than 200 intertrochanteric fractures with proximal femoral nail antirotation (PFNA) annually
The three doctors (Y-L L, LL H, and H G) from the department of emergency were given the computerised tomography (CT)/no-CT for intertrochanteric fractures 30/31, 26/34, and 29/32, respectively; there were no significant differences between these doctors
Summary
Intertrochanteric fracture is the extracapsular fracture of the proximal femur between the greater and lesser trochanters, which often suffered low energy falls in osteoporotic patients. The incidence rates per 100,000 for a primary diagnosis of intertrochanteric fractures were 171 [1] and have been kept increasing recently. These fractures accounted for an annual estimate of $52,512 per patient in America and representing 44% of all hip fracture costs [1]. Operative treatment is the main strategy to reduce the complications in bedding and improve the prognosis. Good reduction could provide enough stability and reduce the postoperative complications [5, 6] and improve the outcomes of intertrochanteric fractures [7]
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