Inferior Outcome after Unstable Trochanteric Fracture Patterns Compared to Stable Fractures in the Elderly.
orthogeriatric
osteoporosis
proximal femur fracture
trochanteric fracture
unstable
Journal
Journal of clinical medicine
ISSN: 2077-0383
Titre abrégé: J Clin Med
Pays: Switzerland
ID NLM: 101606588
Informations de publication
Date de publication:
06 Jan 2021
06 Jan 2021
Historique:
received:
23
12
2020
revised:
30
12
2020
accepted:
04
01
2021
entrez:
9
1
2021
pubmed:
10
1
2021
medline:
10
1
2021
Statut:
epublish
Résumé
Various risk factors affecting outcome of elderly patients after proximal femur fracture have been identified. The present study aims to evaluate the impact of the fracture pattern in trochanteric fractures on postoperative mobility and complications. Ninety-two patients with a mean age of 84 years were included. According to the revised AO/OTA classification, fractures were divided into stable (AO 31A1) and unstable (AO 31A2/3) patterns. A follow-up examination was performed 12 months after cephalomedullary fixation to assess outcome parameters for mobility/activities of daily living (Parker Mobility Score (PMS)/Barthel Index (BI)) and complications (increase in requirement of care, hospital readmission, mortality rate). At follow-up, patients with unstable trochanteric fracture patterns presented with lower PMS and BI compared to stable fractures ( Unstable trochanteric fractures presented inferior outcome compared to simple fracture patterns. This might be explained by the increasing surgical trauma in unstable fractures as well as by the mechanical impact of the lesser trochanter, which provides medial femoral support and is of functional relevance. Subsequent studies should assess if treatment strategies adapted to the specific fracture pattern (refixation of lesser trochanter) influence outcome in unstable trochanteric fractures.
Sections du résumé
BACKGROUND
BACKGROUND
Various risk factors affecting outcome of elderly patients after proximal femur fracture have been identified. The present study aims to evaluate the impact of the fracture pattern in trochanteric fractures on postoperative mobility and complications.
METHODS
METHODS
Ninety-two patients with a mean age of 84 years were included. According to the revised AO/OTA classification, fractures were divided into stable (AO 31A1) and unstable (AO 31A2/3) patterns. A follow-up examination was performed 12 months after cephalomedullary fixation to assess outcome parameters for mobility/activities of daily living (Parker Mobility Score (PMS)/Barthel Index (BI)) and complications (increase in requirement of care, hospital readmission, mortality rate).
RESULTS
RESULTS
At follow-up, patients with unstable trochanteric fracture patterns presented with lower PMS and BI compared to stable fractures (
CONCLUSION
CONCLUSIONS
Unstable trochanteric fractures presented inferior outcome compared to simple fracture patterns. This might be explained by the increasing surgical trauma in unstable fractures as well as by the mechanical impact of the lesser trochanter, which provides medial femoral support and is of functional relevance. Subsequent studies should assess if treatment strategies adapted to the specific fracture pattern (refixation of lesser trochanter) influence outcome in unstable trochanteric fractures.
Identifiants
pubmed: 33418912
pii: jcm10020171
doi: 10.3390/jcm10020171
pmc: PMC7825070
pii:
doi:
Types de publication
Journal Article
Langues
eng
Références
Clin Geriatr Med. 2014 May;30(2):175-81
pubmed: 24721358
Md State Med J. 1965 Feb;14:61-5
pubmed: 14258950
Injury. 2019 Jul;50(7):1324-1328
pubmed: 31128909
Injury. 2015 Oct;46(10):1992-5
pubmed: 26264881
Zhongguo Gu Shang. 2017 Oct 25;30(10):906-910
pubmed: 29457411
Osteoporos Int. 2018 May;29(5):1093-1104
pubmed: 29455247
Age Ageing. 1995 Mar;24(2):96-8
pubmed: 7793343
Eur J Trauma Emerg Surg. 2015 Oct;41(5):523-9
pubmed: 26038002
Clin Orthop Relat Res. 2013 Sep;471(9):2831-40
pubmed: 23389806
Bone. 2007 Dec;41(6):958-64
pubmed: 17913614
World J Orthop. 2019 Mar 18;10(3):166-175
pubmed: 30918799
J Bone Joint Surg Br. 1949 May;31B(2):190-203
pubmed: 18150534
Eur J Trauma Emerg Surg. 2020 Dec;46(6):1267-1280
pubmed: 31900496
Clin Biomech (Bristol, Avon). 2017 Feb;42:31-37
pubmed: 28073094
J Orthop Trauma. 2018 Jan;32 Suppl 1:S1-S170
pubmed: 29256945
Injury. 2017 Apr;48(4):803-818
pubmed: 28284469
Eur J Trauma Emerg Surg. 2020 Oct;46(5):947-953
pubmed: 31673714
Osteoporos Int. 2012 Sep;23(9):2239-56
pubmed: 22419370
Injury. 2020 Feb;51(2):395-399
pubmed: 31668574
Eur J Orthop Surg Traumatol. 2018 Oct;28(7):1313-1319
pubmed: 29654407
Medicine (Baltimore). 2017 May;96(21):e6940
pubmed: 28538384
PLoS One. 2019 Feb 7;14(2):e0212000
pubmed: 30730973
J Bone Joint Surg Am. 1998 Mar;80(3):352-6
pubmed: 9531202
Injury. 2018 Dec;49(12):2209-2215
pubmed: 30366830
Arch Phys Med Rehabil. 2015 Jul;96(7):1215-21
pubmed: 25701641
Arch Orthop Trauma Surg. 2019 Sep;139(9):1253-1259
pubmed: 31053870