Radiographic and clinical outcomes of traumatic subtrochanteric femur fracture fixation and reduction methods.

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Abstract

[Indexed for MEDLINE] Conflict of interest statement: Declarations. Conflict of interest: The authors declare that they have no conflict of interest. 5. J Orthop Sci. 2024 Jul;29(4):1073-1077. doi: 10.1016/j.jos.2023.05.010. Epub 2023 Jun 15. AO/OTA 31A3 fractures and postoperative complications in older patients. Yamanaka T(1), Matsumura T(2), Ae R(3), Takeshita K(1). Author information: (1)Department of Orthopedic Surgery, School of Medicine, Jichi Medical University, Shimotsuke, Japan. (2)Jichi Medical University Hospital Life Saving Emergency Center, Shimotsuke, Japan. Electronic address: tomohiro616@jichi.ac.jp. (3)Division of Public Health, Center for Community Medicine, Jichi Medical University, Shimotsuke, Japan. BACKGROUND: AO/OTA 31A3 fractures (A3 fractures) have risk for postoperative complications with major impact on morbidity and mortality. For older patients, limited information is available for factors associated with postoperative complications. We aimed to assess factors associated with postoperative complications after surgery using cephalomedullary nails. METHODS: A retrospective cohort study was conducted using the information on patients aged ≥65 years who underwent surgery using cephalomedullary nails for trochanteric fractures due to low-energy trauma in three hospitals. Postoperative complications were diagnosed when patients were identified as nonunion, cutout of lag screw, or nail breakage. First, we compared differences including age, sex, body mass index, American Society of Anesthesiologists physical status classification system, preoperative waking ability, fracture type, nail length, neck shaft angle, reduction method, reduction quality and tip apex distance between patients with and without postoperative complications. Second, multivariable logistic regression analysis was employed to assess factors associated with postoperative complications resulting from A3 fractures. RESULTS: Among 120 patients with A3 fractures, postoperative complications were identified in 12 patients (10.0%). Postoperative complications were significantly more likely to develop among patients with poor reduction quality (adjusted odds ratio [95% confidence interval], 35.0 [4.43-275.9]) and a tip-apex distance ≥25 mm (16.4 [1.92-140.3]). CONCLUSIONS: These findings suggest that surgeons should aim to perform appropriate postoperative reduction and to prevent postoperative complications when using a cephalomedullary nail for A3 fractures among older patients. Copyright © 2023. Published by Elsevier B.V. DOI: 10.1016/j.jos.2023.05.010