New Prognostic Factors in Operated Extracapsular Hip Fractures: Infection and GammaTScore
Abstract
:1. Introduction
- -
- Physiopathology: It is probably underdiagnosed when we only observe disrotation without migration. However, there are some cases when the cut-out does not progress and the fracture consolidates, but we do not know when and why this occurs [8];
- -
- -
- -
- Design improvements [16]: Smaller nail diameters and advances in PLDs;
- -
- Learning curve [17]: The quick widespread use of nails in all ECFs (instead of DHSs);
- -
- Biomechanical factors: Cleveland and Bosworth [18] wrote that the PLD distal end in the centre–centre or posteroinferior quadrant prevents from this complication. Parker [6] pointed out that the ideal position was central or inferior in anteroposterior view and central in lateral view. There is no consensus on the peripheral position with worst prognosis [4]. Baumgaertner demonstrated that a < 25 mm tip–apex distance (TAD), as the sum of anteroposterior and axial projections, is a protective factor [7]. Subsequently, new factors or modifications of previous ones have been described, but they have not been as universally accepted or recognized [19]: calcar-referenced TAD < 25 mm [20], varus reduction [21], ECF extension to the femoral neck [22], posterior subtype of Ikuta’s classification [23], vertical shear fracture [24] and intraoperative breakage/lack of lateral wall competency [25].
2. Materials and Methods
- Reduction parameter (R):
- CCD (Varus/Neutral/Valgus): Difference between the caput–collum–diaphyseal (CCD) angle of the currently operated hip and that of the contralateral one (if the latter was previously operated on, this CCD was taken as a reference);
- AP%: Percentage of cortical contact in AP view;
- P, N or A: Posterior, normal or anterior types (Ikuta’s classification, axial view).
- Osteosynthesis parameter (O):
- TAD: Tip-to-apex distance;
- PLD: Location of the proximal locking device (PLD) in the femoral head (Cleveland–Bostworth classification).
- Instability parameter (I):
- Avulsion: Defined as a radiolucent space > 5 mm in any radiological view of the greater trochanter (GT) or the lesser trochanter (LT);
- LW (lateral wall) in/competence (AO Foundation/Orthopaedic Trauma Association classification; AO/OTA classification 2018).
3. Results
3.1. Preoperative Variables (Table 1)
Variable | Early Cut-Out | No Early Cut-Out | p |
---|---|---|---|
Age (years-old) | 83 (SD 10.31) (65;99) | 85.82 (SD 6.59) (65;103) | 0.512 c |
Sex | 0.640 a | ||
-Female | 5 (71.4%) | 156 (79.2%) | |
-Male | 2 (28.6%) | 41 (20.8%) | |
Side | 1.000 a | ||
-Left | 3 (42.4%) | 81 (41.1%) | |
-Right | 4 (57.6%) | 116 (58.9%) | |
Social situation | 0.121 a | ||
-Home, alone | 3 (42.9%) | 26 (13.2%) | |
-Home, not alone | 3 (42.9%) | 104 (52.8%) | |
-Institutionalized | 1 (14.3%) | 67 (34.0%) | |
Dependency | |||
-Barthel pre-Sx. | 86.43 (SD 16.51) (55;100) | 75.28 (SD 21.57) (10;100) | 0.150 c |
-Barthel post-Sx. | 43.57 (SD 21.74) (15;75) | 46.78 (SD 20.93) (10;85) | 0.697 c |
Comorbidity | |||
-Non-age-adjusted CMI | 2.57 (SD 1.13) (1;4) | 2.15 (SD 1.29) (0;7) | 0.293 c |
-Age-adjusted CMI | 6.42 (SD 1.27) (5;8) | 6.11 (SD 1.30) (4;11) | 0.467 c |
Cognitive status | 1.000 a | ||
-None | 1 (14.3%) | 33 (16.8%) | |
-Mild | 5 (71.4%) | 130 (66.0%) | |
-Moderate | 1 (14.3%) | 33 (16.8%) | |
-Severe | 0 (0%) | 1 (0.5%) | |
Previous Fx. | 1.000 a | ||
-None | 5 (71.4%) | 114 (57.9%) | |
-Traumatic | 0 (0%) | 6 (3.0%) | |
-OP fracture | |||
--Hip | 0 (0%) | 15 (7.6%) | |
--Other locations | 2 (28.6%) | 54 (27.4%) | |
--Both locations | 0 (0%) | 8 (4.1%) | |
OP treatment # | 0.596 b | ||
-No | 129 (85.4%) | 47 (82.5%) | |
-Yes | 22 (14.6%) | 10 (17.5%) | |
APT/ACT | 0.882 a | ||
-None | 5 (71.4%) | 110 (55.8%) | |
-AAS 100 | 2 (28.6%) | 39 (19.8%) | |
-AAS 300 | 0 (0%) | 17 (8.6%) | |
-Clopidogrel | 0 (0%) | 1 (0.5%) | |
-Acenocumarol | 0 (0%) | 26 (13.2%) | |
-Direct Xa | 0 (0%) | 2 (2.0%) | |
-LMWH | 0 (0%) | 2 (2.0%) | |
ASA | 3 (1;4) | 3 (1;4) | 0.503 d |
3.2. Perioperative Variables (Table 2)
Variable | Early Cut-Out | No Early Cut-Out | p |
---|---|---|---|
Jensen | 0.345 a | ||
Stability (Jensen) | 0.713 a | ||
-Stable (I + II) | 3 (42.9%) | 73 (37.1%) | |
-Unstable (III + IV + V) | 4 (57.1%) | 124 (62.9%) | |
AO/OTA, 2007 * | 0.033 b, * | ||
-A1 | 3 (42.9%) | 59 (29.9%) | |
-A2 | 1 (14.3%) | 111 (56.3%) | |
-A3 | 2 (28.6%) | 17 (8.6%) | |
Stability(AO/OTA, 2007) | 0.305 b | ||
Stable | 3 (42.9%) | 118 (59.9%) | |
Unstable | 3 (42.9%) | 69 (35.0%) | |
Basicervical (B2.1) | 1 (14.3%) | 10 (5.1%) | |
Massoud | 1.000 b | ||
-Stable | 4 (57.1%) | 68 (34.5%) | |
-Unstable | 3 (42.9%) | 129 (65.5%) | |
Average stay (days) | 9.57 (SD 2.63) (6;13) | 9.71 (SD 3.36) (4;26) | 0.880 c |
Pre-Sx. stay (days) | 3.00 (SD 2.00) (0;5) | 3.30 (SD 2.56) (0;9) | 0.749 c |
Post-Sx. stay (days) | 6.57 (SD 2.22) (3;9) | 6.37 (SD 2.79) (3;25) | 0.431 c |
Blood loss (g/dl Hb) | 1.42 (SD 1.16) (0;3.0) | 1.92 (SD 1.75) (−3.5;5.9) | 0.323 c |
Transfusions [RBC] | 1.85 (SD 1.67) (0;5) | 1.35 (SD 1.37) (0;8) | 0.427 c |
3.3. Postperative Variables
3.4. Consolidation (Figure 5)
3.5. Survival (Figure 6)
3.6. Summary of Evolution of Early Cut-Out Cohort (Table 4)
No. | Sex/(Age) | Jensen Stability | AO/OTA (1997) Stability | Massoud Stability | Immediate PWB | Detection Grade (Weeks) | IAFF (Weeks) | Consolidation/Reintervention (Weeks) | ||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Yes | No | Yes | No | 2.1 | Yes | No | ||||||
1 | M (88) | √ | × | √ | × | × | × | √ | Yes | III (4.7) | Yes (10.0) | No/ROM (10.7) |
2 | F (88) | × | √ | × | √ | × | × | √ | No | III (23) | Yes (0.71) | No/ROM (25.7) |
3 | F (79) | × | √ | × | √ | × | √ | × | No | II (13) | Yes (29.4) | Yes/ROM (30.0) |
4 | M (77) | × | √ | × | √ | × | √ | × | No | II (3.0) | No | No/PHA (3.7) |
5 | F (65) | √ | × | × | × | √ | √ | × | No | III (5.0) | No | No/THA (16.4) |
6 | F (87) | × | √ | √ | × | × | × | √ | No | I (4.3) | No | Yes/- |
7 | F (97) | √ | × | √ | × | × | √ | × | Yes | III (2.1) | No | No/PHA (2.86) |
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Variable | Early Cut-Out | No early Cut-Out | p |
---|---|---|---|
Number of patients | 7 | 197 | |
TAD | 25.54 (SD 8.81) | 22.67 (SD 6.44) | 0.395 c |
Baumgaertner–Fogagnolo | |||
Poor | 1 (14.3%) | 7 (3.6%) | 0.072 a |
Moderate | 4 (57.1%) | 64 (32.5%) | |
Good | 2 (28.6%) | 126 (64.0%) | |
Infection (IAFF) * | 0.002 a, * | ||
-No | 4 (57.2%) | 191 (96.9%) | |
-Yes | 3 (42.8%) | 6 (3.1%) | |
Immediate post-Sx. PWB | 0.451 a | ||
-No | 5 (71.4%) | 103 (52.8%) | |
-Yes | 2 (28.6%) | 94 (47.2%) |
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Hernández-Pascual, C.; Santos-Sánchez, J.Á.; Hernández-Rodríguez, J.; Silva-Viamonte, C.F.; Pablos-Hernández, C.; Villanueva-Martínez, M.; Mirón-Canelo, J.A. New Prognostic Factors in Operated Extracapsular Hip Fractures: Infection and GammaTScore. Int. J. Environ. Res. Public Health 2022, 19, 11680. https://doi.org/10.3390/ijerph191811680
Hernández-Pascual C, Santos-Sánchez JÁ, Hernández-Rodríguez J, Silva-Viamonte CF, Pablos-Hernández C, Villanueva-Martínez M, Mirón-Canelo JA. New Prognostic Factors in Operated Extracapsular Hip Fractures: Infection and GammaTScore. International Journal of Environmental Research and Public Health. 2022; 19(18):11680. https://doi.org/10.3390/ijerph191811680
Chicago/Turabian StyleHernández-Pascual, Carlos, José Ángel Santos-Sánchez, Jorge Hernández-Rodríguez, Carlos Fernando Silva-Viamonte, Carmen Pablos-Hernández, Manuel Villanueva-Martínez, and José Antonio Mirón-Canelo. 2022. "New Prognostic Factors in Operated Extracapsular Hip Fractures: Infection and GammaTScore" International Journal of Environmental Research and Public Health 19, no. 18: 11680. https://doi.org/10.3390/ijerph191811680