Impact of subtrochanteric fractures in the geriatric population: better pre-fracture condition but poorer outcome than pertrochanteric fractures: evidence from the Spanish Hip Fracture Registry.
Aged
Complication
Extracapsular
Fragility fracture
Geriatric
Hip fracture
Intertrochanteric
Outcome
Pertrochanteric
Registry
Subtrochanteric
Journal
Journal of orthopaedics and traumatology : official journal of the Italian Society of Orthopaedics and Traumatology
ISSN: 1590-9999
Titre abrégé: J Orthop Traumatol
Pays: Italy
ID NLM: 101090931
Informations de publication
Date de publication:
26 Mar 2022
26 Mar 2022
Historique:
received:
07
12
2021
accepted:
26
02
2022
entrez:
29
3
2022
pubmed:
30
3
2022
medline:
31
3
2022
Statut:
epublish
Résumé
Clinical management in orthogeriatric units and outcome indicators are similar for extracapsular fragility hip fractures, without discriminating between subtrochanteric and pertrochanteric fractures. Geriatric patients, 75 years or older, with subtrochanteric fractures have worse clinical and functional outcomes than those with pertrochanteric fractures. Retrospective observational study of data prospectively collected by the Spanish Hip Fracture Registry including patients 75 years or older, admitted for extracapsular hip fractures from January 2017 to June 2019. Demographic and baseline status, pre-operative, post-operative and 30-day follow-up data were included. A total of 13,939 patients with extracapsular hip fractures were registered: 12,199 (87.5%) pertrochanteric and 1740 (12.5%) subtrochanteric. At admission, patients with subtrochanteric fractures were younger (86.5 ± 5.8 versus 87.1 ± 5.6 years old), had better pre-fracture mobility (3.7 ± 2.7 versus 3.9 ± 2.8) (1-to-10 scale, 1 being independent) and were more likely to be living at home; those with pertrochanteric fractures had worse cognitive function (Pfeiffer 3.3 ± 3.3 versus 3.8 ± 3.5). The subtrochanteric fracture group showed worse post-fracture mobility (7.3 ± 2.7 versus 6.7 ± 2.7) and greater deterioration of mobility (3.7 ± 3.0 versus 2.9 ± 2.7). Among individuals living at home at baseline, those with subtrochanteric fractures were more likely to remain in an assisted facility at 30-day follow-up. In-hospital mortality during acute admission was higher for the subtrochanteric group (5.6% versus 4.5%) (p = 0.028). To our knowledge, this is the first paper highlighting the differences between these two fracture groups in the geriatric population. Subtrochanteric fractures in the older population are a different and worse entity, with greater morbimortality and functional decline than pertrochanteric fractures. Despite being younger and fitter at admission, older patients with subtrochanteric fractures have a higher risk of remaining non-weight bearing and undergoing re-operation and institutionalization. Orthogeriatric units should be aware of this and manage subtrochanteric fractures accordingly. IV.
Sections du résumé
BACKGROUND
BACKGROUND
Clinical management in orthogeriatric units and outcome indicators are similar for extracapsular fragility hip fractures, without discriminating between subtrochanteric and pertrochanteric fractures.
HYPOTHESIS
OBJECTIVE
Geriatric patients, 75 years or older, with subtrochanteric fractures have worse clinical and functional outcomes than those with pertrochanteric fractures.
MATERIALS AND METHODS
METHODS
Retrospective observational study of data prospectively collected by the Spanish Hip Fracture Registry including patients 75 years or older, admitted for extracapsular hip fractures from January 2017 to June 2019. Demographic and baseline status, pre-operative, post-operative and 30-day follow-up data were included.
RESULTS
RESULTS
A total of 13,939 patients with extracapsular hip fractures were registered: 12,199 (87.5%) pertrochanteric and 1740 (12.5%) subtrochanteric. At admission, patients with subtrochanteric fractures were younger (86.5 ± 5.8 versus 87.1 ± 5.6 years old), had better pre-fracture mobility (3.7 ± 2.7 versus 3.9 ± 2.8) (1-to-10 scale, 1 being independent) and were more likely to be living at home; those with pertrochanteric fractures had worse cognitive function (Pfeiffer 3.3 ± 3.3 versus 3.8 ± 3.5). The subtrochanteric fracture group showed worse post-fracture mobility (7.3 ± 2.7 versus 6.7 ± 2.7) and greater deterioration of mobility (3.7 ± 3.0 versus 2.9 ± 2.7). Among individuals living at home at baseline, those with subtrochanteric fractures were more likely to remain in an assisted facility at 30-day follow-up. In-hospital mortality during acute admission was higher for the subtrochanteric group (5.6% versus 4.5%) (p = 0.028). To our knowledge, this is the first paper highlighting the differences between these two fracture groups in the geriatric population.
CONCLUSIONS
CONCLUSIONS
Subtrochanteric fractures in the older population are a different and worse entity, with greater morbimortality and functional decline than pertrochanteric fractures. Despite being younger and fitter at admission, older patients with subtrochanteric fractures have a higher risk of remaining non-weight bearing and undergoing re-operation and institutionalization. Orthogeriatric units should be aware of this and manage subtrochanteric fractures accordingly.
LEVEL OF EVIDENCE
METHODS
IV.
Identifiants
pubmed: 35347459
doi: 10.1186/s10195-022-00637-8
pii: 10.1186/s10195-022-00637-8
pmc: PMC8960105
doi:
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
17Subventions
Organisme : Fundación Mutua Madrileña
ID : AP169672018
Informations de copyright
© 2022. The Author(s).
Références
Dziadosz D (2015) Considerations with failed intertrochanteric and subtrochanteric femur fractures: how to treat, revise, and replace. J Orthop Trauma 29(Suppl 4):S17-21. https://doi.org/10.1097/BOT.0000000000000289
doi: 10.1097/BOT.0000000000000289
pubmed: 25756822
Frost SA, Nguyen ND, Center JR, Eisman JA, Nguyen TV (2013) Excess mortality attributable to hip-fracture: a relative survival analysis. Bone 56(1):23–29. https://doi.org/10.1016/j.bone.2013.05.006
doi: 10.1016/j.bone.2013.05.006
pubmed: 23684802
The Royal College of Physicians (2019) National Hip Fracture Database annual report 2019. https://www.nhfd.co.uk/files/2019ReportFiles/NHFD_2019_Annual_Report_v101.pdf
Joglekar SB, Lindvall EM, Martirosian A (2015) Contemporary management of subtrochanteric fractures. Orthop Clin North Am 46(1):21–35
doi: 10.1016/j.ocl.2014.09.001
Shukla S, Johnston P, Ahmad MA, Wynn-Jones H, Patel AD, Walton NP (2007) Outcome of traumatic subtrochanteric femoral fractures fixed using cephalo-medullary nails. Injury 8(11):1286–1293. https://doi.org/10.1016/j.injury.2007.05.013
doi: 10.1016/j.injury.2007.05.013
Gjertsen J-E, Engesaeter LB, Furnes O, Havelin LI, Steindal K, Vinje T et al (2008) The Norwegian Hip Fracture Register: experiences after the first 2 years and 15,576 reported operations. Acta Orthop 79(5):583–593. https://doi.org/10.1080/17453670810016588
doi: 10.1080/17453670810016588
pubmed: 18839363
Glassou EN, Kjørholt KK, Hansen TB, Pedersen AB (2019) Delay in surgery, risk of hospital-treated infections and the prognostic impact of comorbidity in hip fracture patients. A Danish nationwide cohort study, 2005–2016. Clin Epidemiol 11:383–395. https://doi.org/10.2147/CLEP.S200454
doi: 10.2147/CLEP.S200454
pubmed: 31191031
pmcid: 6519337
Hartholt KA, Oudshoorn C, Zielinski SM, Burgers PTPW, Panneman MJM, van Beeck EF et al (2011) The epidemic of hip fractures: are we on the right track? PLoS ONE 6(7):e22227. https://doi.org/10.1371/journal.pone.0022227
doi: 10.1371/journal.pone.0022227
pubmed: 21799797
pmcid: 3143130
Lund CA, Møller AM, Wetterslev J, Lundstrøm LH (2014) Organizational factors and long-term mortality after hip fracture surgery. A cohort study of 6143 consecutive patients undergoing hip fracture surgery. PLoS ONE 9(6):e99308. https://doi.org/10.1371/journal.pone.0099308
doi: 10.1371/journal.pone.0099308
pubmed: 24926876
pmcid: 4057264
Ojeda-Thies C, Sáez-López P, Currie CT, Tarazona-Santalbina FJ, Alarcón T, et al. on behalf of the participants in the RNFC (2019) Spanish National Hip Fracture Registry (RNFC): analysis of its first annual report and international comparison with other established registries. Osteoporos Int. 30(6):1243–54. Doi: https://doi.org/10.1007/s00198-019-04939-2
Sayers A, Whitehouse MR, Berstock JR, Harding KA, Kelly MB, Chesser TJ (2017) The association between the day of the week of milestones in the care pathway of patients with hip fracture and 30-day mortality: findings from a prospective national registry—The National Hip Fracture Database of England and Wales. BMC Med 15(1):62. https://doi.org/10.1186/s12916-017-0825-5
doi: 10.1186/s12916-017-0825-5
pubmed: 28343451
pmcid: 5367007
Wu TY, Hu HY, Lin SY, Chie WC, Yang RS, Liaw CK (2017) Trends in hip fracture rates in Taiwan: a nationwide study from 1996 to 2010. Osteoporos Int f28(2):653–665. https://doi.org/10.1007/s00198-016-3783-4
doi: 10.1007/s00198-016-3783-4
Fischer K, Trombik M, Freystätter G, Egli A, Theiler R, Bischoff-Ferrari HA (2019) Timeline of functional recovery after hip fracture in seniors aged 65 and older: a prospective observational analysis. Osteoporos Int 30(7):1371–1381. https://doi.org/10.1007/s00198-019-04944-5
doi: 10.1007/s00198-019-04944-5
pubmed: 30941485
Horner NS, Samuelsson K, Solyom J, Bjørgul K, Ayeni OR, Östman B (2017) Implant-related complications and mortality after use of short or long gamma nail for intertrochanteric and subtrochanteric fractures: a prospective study with minimum 13-year follow-up. JB JS Open Access 2(3):e0026. https://doi.org/10.2106/JBJS.OA.17.00026
doi: 10.2106/JBJS.OA.17.00026
pubmed: 30229225
pmcid: 6133094
Fielding JW (1973) Subtrochanteric fractures. Clin Orthop 92:86–99. https://doi.org/10.1097/00003086-197305000-00008
doi: 10.1097/00003086-197305000-00008
Huang SY, Grimsrud CD, Provus J, Hararah M, Chandra M, Ettinger B et al (2012) The impact of subtrochanteric fracture criteria on hip fracture classification. Osteoporos Int 23(2):743–750. https://doi.org/10.1007/s00198-011-1622-1
doi: 10.1007/s00198-011-1622-1
pubmed: 21562878
Codesido P, Mejía A, Riego J, Ojeda-Thies C (2018) Subtrochanteric fractures in elderly people treated with intramedullary fixation: quality of life and complications following open reduction and cerclage wiring versus closed reduction. Arch Orthop Trauma Surg 137(8):1077–1085. https://doi.org/10.1007/s00402-017-2722-y
doi: 10.1007/s00402-017-2722-y
Sáez-López P, González-Montalvo JI, Ojeda-Thies C, Mora-Fernández J, Muñoz-Pascual A, Cancio JM et al (2018) Spanish National Hip Fracture Registry (SNHFR): a description of its objectives, methodology and implementation. Rev Esp Geriatría Gerontol. 53(4):188–195
doi: 10.1016/j.regg.2017.12.001
Pfeiffer E (1975) A short portable mental status questionnaire for the assessment of organic brain deficit in elderly patients. J Am Geriatr Soc 23(10):433–441. https://doi.org/10.1111/j.1532-5415.1975.tb00927.x
doi: 10.1111/j.1532-5415.1975.tb00927.x
pubmed: 1159263
Wang Z, Ward MM, Chan L, Bhattacharyya T (2014) Adherence to oral bisphosphonates and the risk of subtrochanteric and femoral shaft fractures among female medicare beneficiaries. Osteoporos Int 5(8):2109–2116. https://doi.org/10.1007/s00198-014-2738-x
doi: 10.1007/s00198-014-2738-x
Ng AC, Drake MT, Clarke BL, Sems SA, Atkinson EJ, Achenbach SJ et al (2012) Trends in subtrochanteric, diaphyseal, and distal femur fractures, 1984–2007. Osteoporos Int 23(6):1721–1726
doi: 10.1007/s00198-011-1777-9
Karayiannis P, James A (2019) The impact of cerclage cabling on unstable intertrochanteric and subtrochanteric femoral fractures: a retrospective review of 465 patients. Eur J Trauma Emerg Surg Off Publ Eur Trauma Soc. https://doi.org/10.1007/s00068-018-01071-4
doi: 10.1007/s00068-018-01071-4
Bhandari M, Koo H, Saunders L, Shaughnessy SG, Dunlop RB, Schemitsch EH (1999) Predictors of in-hospital mortality following operative management of hip fractures. Int J Surg Investig 1(4):319–326 (PMID: 12774456)
pubmed: 12774456
Yoo J, Lee JS, Kim S, Kim BS, Choi H, Song DY et al (2019) Length of hospital stay after hip fracture surgery and 1-year mortality. Osteoporos Int 30(1):145–153. https://doi.org/10.1007/s00198-018-4747-7
doi: 10.1007/s00198-018-4747-7
pubmed: 30361752
Lundy DW (2007) Subtrochanteric femoral fractures. J Am Acad Orthop Surg. 15(11):663–71. http://content.wkhealth.com/linkback/openurl?sid=WKPTLP:landingpage&an=00124635-200711000-00005
Bedi A, Le Toan T (2004) Subtrochanteric femur fractures. Orthop Clin North Am 35(4):473–483. https://doi.org/10.1016/j.ocl.2004.05.006
doi: 10.1016/j.ocl.2004.05.006
pubmed: 15363922
Afsari A, Liporace F, Lindvall E, Infante A, Sagi HC, Haidukewych GJ (2010) Clamp-assisted reduction of high subtrochanteric fractures of the femur: surgical technique. J Bone Joint Surg-Am. 92(1):217–25. https://insights.ovid.com/crossref?an=00004623-201009001-00009
Nieves JW, Bilezikian JP, Lane JM, Einhorn TA, Wang Y, Steinbuch M et al (2010) Fragility fractures of the hip and femur: incidence and patient characteristics. Osteoporos Int 21(3):399–408. https://doi.org/10.1007/s00198-009-0962-6
doi: 10.1007/s00198-009-0962-6
pubmed: 19484169
Haidukewych GJ, Berry DJ (2004) Nonunion of fractures of the subtrochanteric region of the femur. Clin Orthop 419:185–188. https://doi.org/10.1097/00003086-200402000-00030
doi: 10.1097/00003086-200402000-00030
Jannelli E, Castelli A, Ferranti Calderoni E, Annunziata S, Maccario G, Ivone A, Pasta G, Mosconi M (2020) Fractures in patients with COVID-19 infection: early prognosis and management. A case series of 20 patients in a single institution in Lombardy, Northern Italy. J Orthop Trauma 34(10):e389–e397. https://doi.org/10.1097/BOT.0000000000001905 (PMID: 32947590)
doi: 10.1097/BOT.0000000000001905
pubmed: 32947590