Elderly trochanteric fracture outcomes: Unveiling the risks of excessive postoperative sliding - A retrospective multicenter (TRON group) investigation.

IF 1.5 4区 医学 Q3 ORTHOPEDICS
Makoto Suzuki, Yasuhiko Takegami, Katsuhiro Tokutake, Hiroaki Nakasima, Kenichi Mishima, Hiroaki Kumagai, Shiro Imagama
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引用次数: 0

Abstract

Background: Intramedullary nailing (IMN) for femoral trochanteric fractures (FTF) is the primary surgical intervention. Excessive lag screw sliding (ES) of the femoral neck screw sometimes occurs. This multicenter investigation sought to 1) determine the prevalence of ES, 2) evaluate the relationship between ES and postoperative complications, and 3) identify the factors of ES in elderly patients with FTF undergoing IMN.

Methods: From 2016 to 2020, 1448 patients with FTF were treated using a short IMN across 11 institutions (TRON group). Upon applying exclusion criteria, 519 patients (127 men, 392 women; mean age, 84.4 years) were included. The postoperative sliding distance was measured immediately after surgery and at final follow-up. A sliding distance of ≥8 mm categorized patients as having ES. We identify the factors contributing to ES using the logistic regression analysis, with a p < 0.05 as statistical significance.

Results: ES was observed in 116 patients (22.4 %). Patients with ES had a higher incidence of postoperative cut-out and peri-implant fracture. Logistic regression analysis showed that achieving optimal reduction in both AP and lateral views (odds ratio (OR) 0.48, p = 0.0012) and the use of a double screw system or twin screws with integrated locking mechanism significantly reduced the risk of ES (OR 0.27, 0.17; p = 0.0027, <0.001).

Conclusions: The incidence rate of ES was 22.4 %. ES was associated with a higher risk of postoperative complications. The surgeons should aim for optimal reduction and use a double screw or twin screws with an integrated interlocking mechanism as the implant of choice.

老年转子间骨折的预后:揭示术后过度滑动的风险 - 一项多中心(TRON 小组)回顾性调查。
背景:髓内钉(IMN)是治疗股骨转子间骨折(FTF)的主要手术方法。股骨颈螺钉过度滞后滑动(ES)的情况时有发生。这项多中心调查旨在:1)确定ES的发生率;2)评估ES与术后并发症之间的关系;3)确定接受IMN治疗的老年股骨转子间骨折患者发生ES的因素:从 2016 年到 2020 年,11 家机构(TRON 组)的 1448 名 FTF 患者接受了短程 IMN 治疗。根据排除标准,共纳入 519 名患者(127 名男性,392 名女性;平均年龄 84.4 岁)。术后立即测量了滑动距离,并在最后随访时进行了测量。滑动距离≥8 毫米的患者即为 ES 患者。我们利用逻辑回归分析确定了导致 ES 的因素,并采用了 p 结果:116名患者(22.4%)出现了ES。ES 患者术后切口和种植体周围骨折的发生率较高。逻辑回归分析表明,在正侧切面和侧切面都达到最佳缩小效果(几率比(OR)0.48,p = 0.0012),以及使用双螺钉系统或带有集成锁定机制的双螺钉,可显著降低 ES 风险(OR 0.27,0.17;p = 0.0027,结论:ES的发病率为22.4%。ES与较高的术后并发症风险相关。外科医生应力求达到最佳缩窄效果,并选择双螺钉或带有集成互锁机制的双螺钉作为植入物。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Journal of Orthopaedic Science
Journal of Orthopaedic Science 医学-整形外科
CiteScore
3.00
自引率
0.00%
发文量
290
审稿时长
90 days
期刊介绍: The Journal of Orthopaedic Science is the official peer-reviewed journal of the Japanese Orthopaedic Association. The journal publishes the latest researches and topical debates in all fields of clinical and experimental orthopaedics, including musculoskeletal medicine, sports medicine, locomotive syndrome, trauma, paediatrics, oncology and biomaterials, as well as basic researches.
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