Open Reduction in Subtrochanteric Femur Fractures Is Not Accompanied by a Higher Rate of Complications
Abstract
:1. Introduction
2. Materials and Methods
2.1. Data Source
2.2. Patient Inclusion
2.3. Statistical Analyses
3. Results
3.1. Baseline Characteristics
3.2. Primary Outcome Parameter
3.3. Secondary Outcome Parameters
4. Discussion
4.1. Primary Outcome Parameter
4.2. Secondary Outcome Parameters
4.3. Strengths and Limitations of the Study
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Patient Characteristics | All (n = 506) |
---|---|
Baseline Data—Initial Stay | |
Age (n) | n = 506 |
Median (Interquartile Range) (IQR) | 85 (81, 89) |
Gender | n= 506 |
Female | 74.1% (n = 375) |
ASA Score | n= 480 |
1 | 0.417% (n = 2) |
2 | 23.1% (n = 111) |
3 | 67.9% (n = 326) |
4 | 8.12% (n = 39) |
5 | 0.417% (n = 2) |
Type of Surgery (Subtrochanteric Fracture) | n = 506 |
Intramedullary nail open reduction without wire cerclage | 73.3% (n = 371) |
Intramedullary nail open reduction with wire cerclage | 5.5% (n = 28) |
Intramedullary nail closed reduction | 21.1% (n = 107) |
Length of Stay (Median/IQR) (n = 463) (Survivors) | 17.04 (11.06, 22.08) |
Anticoagulation on Admission (n = 487) | |
No anticoagulation | 50.3% (n = 245) |
Vitamin K antagonist | 18.2% (n = 44) |
Acetylsalicylic acid | 49.6% (n = 120) |
Other thrombocyte aggregation inhibitors | 7.02% (n = 17) |
Direct thrombin inhibitor (Dabigatran) | 3.72% (n = 9) |
Direct factor Xa inhibitor (Rivaroxaban, Apixaban) | 22.3% (n = 54) |
Heparin | 2.07% (n = 5) |
Other | 2.07% (n = 5) |
Surgical Complication (during initial stay) | 3.56% (n = 18) |
Removal of implant or osteosynthesis | 11.1% (n = 2) |
Revision of osteosynthesis | 22.2% (n = 4) |
Soft tissue intervention | 66.7% (n = 12) |
Others | 16.7% (n = 3) |
Mortality | (n = 505) |
During initial stay | 7.52% (n = 38) |
Length of Stay (Median/IQR) (n=) (Survivors) | n = 463 17.04 (11.06, 22.08) |
Discharge After Hospital (initial stay) | n = 461 |
Home | 22.28% (n = 105) |
Nursing home | 29.9% (n = 138) |
Geriatric rehabilitation | 41.6% (n = 192) |
Clinic for follow-up treatment | 3.90% (n = 18) |
Other (different hospital, different department, other) | 1.74% (n = 8) |
Baseline data—follow-up | |
Surgical Complication | |
Yes | 1.38% (n = 7) |
Removal of implant or osteosynthesis | 42.9% (n = 3) |
Revision of osteosynthesis | 14.3% (n = 1) |
Conversion in total hip arthroplasty | 14.3% (n = 1) |
Girdlestone | 14.3% (n = 1) |
Soft tissue intervention | 14.3% (n = 1) |
Others | 28.6% (n = 2) |
Mortality | |
Yes | 2.57% (n = 13) |
Current Location | n = 140 |
Home | 72.9% (n = 102) |
Nursing home | 25.7% (n = 36) |
Hospital | 0.714% (n = 1) |
Other | 0.714% (n = 1) |
Open Reduction (n = 399) | Closed Reduction (n = 107) | p | |
---|---|---|---|
Baseline Data | |||
Age n | 399 | 107 | 0.327 * |
Median (Interquartile Range) (IQR) | 85 (81; 89) | 84 (80; 89) | |
Gender | 0.233 + | ||
Female | 301(75.4%) | 74 (69.2%) | |
Male | 98 (24.6%) | 33 (30.8%) | |
ASA Score | 0.198 + | ||
1 | 1 (0.3%) | 1 (1.0%) | |
2 | 92 (24.4%) | 19 (18.4%) | |
3 | 256 (67.9%) | 70 (68.0%) | |
4 | 26 (6.9%) | 13 (12.6%) | |
5 | 2 (0.5%) | ||
Anticoagulation on Admission | 0.088 + | ||
No Anticoagulation | 48.2% (n = 185) | 58.3 ((n = 60) | |
Walking Ability Before Fracture | |||
Without aids/forearm crutches | 168 (46.2%) | 52 (52%) | 0.538 + |
Walker | 128 (35.2%) | 28 (28%) | |
Only at home | 58 (15.9%) | 16 (16%) | |
No walking possible | 10 (2.8%) | 4 (4%) | |
Full Weight Bearing of the Fracture is Allowed | 0.073 | ||
Yes | 66.0% (n = 262) | 75.7% (n = 81) | |
Primary Outcome Parameter | |||
Surgical Complication | 0.687 | ||
Yes | 3.26% (n = 13) | 4.67% (n = 5) | |
Soft tissue intervention | 2.5% (n = 10) | 1.8% (n = 2) | |
Removal of Implant or osteosynthesis | 0.3% (n = 1) | 0.9% (n = 1) | |
Revision of osteosynthesis | 0.5% (n = 2) | 1.8% (n = 2) | |
Periosteosynthetic fracture | 0% (n = 0) | 0.9% (n = 1) | |
Others | 0.8% (n = 3) | 0% (n = 0) | |
Secondary Outcome Parameter | |||
Discharge After Hospital (initial stay) (Survivors) | n = 366 | n = 95 | p = 0.846 |
Home | 23.5% (n = 86) | 20% (n = 19) | |
Nursing home | 30.3% (n = 111) | 28.4% (n = 27) | |
Geriatric rehabilitation | 40.4% (n = 148) | 46.3% (n = 44) | |
Clinic for follow-up treatment | 4.10% (n = 15) | 3.16% (n = 3) | |
Other | 1.64% (n = 6) | 2.11% (n = 2) | |
Mortality | 6.78% (n = 27) | 10.3% (n = 11) | 0.312 |
Change in Walking Ability (pre-fracture to 7 days post-op) | 0.008 + | ||
Worse | 61.8% (n = 218) | 77.1% (n = 74) | |
No change | 28.9% (n = 102) | 20.8% (n = 20) | |
Better | 9.4% (n = 33) | 2.1% (n = 2) | |
Lengths of stay (days) (Survivors) | n = 367 | n = 96 | 0.968 ^ |
Median (IQR) | 17 (11, 22.1) | 16.6 (12, 21.6) |
Open Reduction | Closed Reduction | ||
---|---|---|---|
Follow-Up Conducted | 38.8% (n = 155) | 36.4% (n = 39) | |
Primary Outcome Parameter | |||
Surgical Complication | n = 130 | n = 36 | p = 1 |
Yes | 3.9% (n = 5) | 5.6% (n = 2) | |
Soft tissue intervention | n = 0 | n = 1 | |
Removal of implant or osteosynthesis | n = 2 | n = 1 | |
Revision of osteosynthesis | n = 1 | n = 0 | |
Conversion in HTEP | n = 1 | n = 0 | |
Girdlestone | n = 1 | n = 0 | |
Others | n = 1 | n = 1 | |
Secondary Outcome Parameter | |||
Mortality | 8.39% (n = 13 additional deaths in FU Period) | 0% (n = 0) | 0.075 |
Change in Walking Ability (pre-fracture to 120-day follow-up) | 0.82 + | ||
Worse | 65 (60.2%) | 19 (59.4%) | |
No change | 39 (36.1%) | 11 (34.4%) | |
Better | 4 (3.7%) | 2 (6.3%) |
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Knauf, T.; Eschbach, D.; Buecking, B.; Knobe, M.; Barthel, J.; Rascher, K.; Ruchholtz, S.; Aigner, R.; Schoeneberg, C.; on behalf of the Registry for German Trauma DGU. Open Reduction in Subtrochanteric Femur Fractures Is Not Accompanied by a Higher Rate of Complications. Medicina 2021, 57, 659. https://doi.org/10.3390/medicina57070659
Knauf T, Eschbach D, Buecking B, Knobe M, Barthel J, Rascher K, Ruchholtz S, Aigner R, Schoeneberg C, on behalf of the Registry for German Trauma DGU. Open Reduction in Subtrochanteric Femur Fractures Is Not Accompanied by a Higher Rate of Complications. Medicina. 2021; 57(7):659. https://doi.org/10.3390/medicina57070659
Chicago/Turabian StyleKnauf, Tom, Daphne Eschbach, Benjamin Buecking, Matthias Knobe, Juliane Barthel, Katherine Rascher, Steffen Ruchholtz, Rene Aigner, Carsten Schoeneberg, and on behalf of the Registry for German Trauma DGU. 2021. "Open Reduction in Subtrochanteric Femur Fractures Is Not Accompanied by a Higher Rate of Complications" Medicina 57, no. 7: 659. https://doi.org/10.3390/medicina57070659
APA StyleKnauf, T., Eschbach, D., Buecking, B., Knobe, M., Barthel, J., Rascher, K., Ruchholtz, S., Aigner, R., Schoeneberg, C., & on behalf of the Registry for German Trauma DGU. (2021). Open Reduction in Subtrochanteric Femur Fractures Is Not Accompanied by a Higher Rate of Complications. Medicina, 57(7), 659. https://doi.org/10.3390/medicina57070659