Makoa Mau, Tyler Thorne, Cole Payne, Kaleb Roach, Reese Svetgoff, Patrick J Kellam, Graham J DeKeyser, Stephen J Warner, Lucas S Marchand, Justin Haller
{"title":"双植入物治疗老年股骨远端骨折可使患者在家更健康。","authors":"Makoa Mau, Tyler Thorne, Cole Payne, Kaleb Roach, Reese Svetgoff, Patrick J Kellam, Graham J DeKeyser, Stephen J Warner, Lucas S Marchand, Justin Haller","doi":"10.1097/BOT.0000000000002999","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>To compare Healthy Days At Home (HDAH90) within 90 days of hospital discharge after single implant (SI) or dual implant (DI) fixation in geriatric distal femur fractures.</p><p><strong>Methods: </strong>Design: Retrospective Review.</p><p><strong>Setting: </strong>Three Level I Trauma Centers.</p><p><strong>Patient selection criteria: </strong>Geriatric (age ≥ 60 years) distal femur fracture patients (OTA/AO 33 A, C) operatively treated with SI (lateral plate or retrograde intramedullary nail (IMN)) or DI (two plates or plate and IMN) between January 2018-January 2024 were included.</p><p><strong>Outcome measures and comparisons: </strong>The primary outcome was HDAH90, which was calculated from date of surgery to 90 days follow-up and accounted for days after mortality, skilled nursing facilities (SNF), readmissions, and secondary surgeries. HDAH90, days at SNF, 90-day readmission, 90-day mortality, return to baseline ambulatory status at 180-days, and length of hospitalization were compared between patients with SI or DI. A binary logistic multivariate regression was used to compare outcomes while controlling for age, gender, dependence on assistive device, periprosthetic fracture, and post-operative weight bearing status.</p><p><strong>Results: </strong>The 229 SI patients were 2 years younger than the 70 DI patients (73 vs. 75 years, p=0.03). The DI cohort had more female patients (82.9% vs 70.7%, p=0.044), and more periprosthetic fractures (55.7% vs. 35.4%, p=0.002). There was no other demographic, fracture characteristic, or preoperative ambulatory differences between groups (p>0.05). Following regression analysis, DI patients had greater HDAH90 (55 vs 45, p=0.024) and fewer days at SNF (22 vs 32, p=0.026) than SI patients. There were no differences in 90-day readmission (DI odds 1.36, p=0.353), 90-day mortality (DI odds 0.94 p=0.935), return to baseline ambulatory status at 180 days (DI 1.64, p=0.433), and length of hospitalization (DI 10 days vs SI 9 days, p=0.579).</p><p><strong>Conclusions: </strong>Geriatric patients treated with dual implants for distal femur fractures experienced an additional 10 Healthy Days at Home90 as compared to those treated with single implants. Given that a 10-day difference is clinically significant in geriatric fractures for Healthy Days at Home90, using dual implant constructs may represent an improvement in care for distal femur patients.</p><p><strong>Level of evidence: </strong>III, prognostic.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.6000,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Dual Implants for Geriatric Distal Femur Fractures Results in Greater Healthy Days at Home.\",\"authors\":\"Makoa Mau, Tyler Thorne, Cole Payne, Kaleb Roach, Reese Svetgoff, Patrick J Kellam, Graham J DeKeyser, Stephen J Warner, Lucas S Marchand, Justin Haller\",\"doi\":\"10.1097/BOT.0000000000002999\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objectives: </strong>To compare Healthy Days At Home (HDAH90) within 90 days of hospital discharge after single implant (SI) or dual implant (DI) fixation in geriatric distal femur fractures.</p><p><strong>Methods: </strong>Design: Retrospective Review.</p><p><strong>Setting: </strong>Three Level I Trauma Centers.</p><p><strong>Patient selection criteria: </strong>Geriatric (age ≥ 60 years) distal femur fracture patients (OTA/AO 33 A, C) operatively treated with SI (lateral plate or retrograde intramedullary nail (IMN)) or DI (two plates or plate and IMN) between January 2018-January 2024 were included.</p><p><strong>Outcome measures and comparisons: </strong>The primary outcome was HDAH90, which was calculated from date of surgery to 90 days follow-up and accounted for days after mortality, skilled nursing facilities (SNF), readmissions, and secondary surgeries. HDAH90, days at SNF, 90-day readmission, 90-day mortality, return to baseline ambulatory status at 180-days, and length of hospitalization were compared between patients with SI or DI. A binary logistic multivariate regression was used to compare outcomes while controlling for age, gender, dependence on assistive device, periprosthetic fracture, and post-operative weight bearing status.</p><p><strong>Results: </strong>The 229 SI patients were 2 years younger than the 70 DI patients (73 vs. 75 years, p=0.03). The DI cohort had more female patients (82.9% vs 70.7%, p=0.044), and more periprosthetic fractures (55.7% vs. 35.4%, p=0.002). There was no other demographic, fracture characteristic, or preoperative ambulatory differences between groups (p>0.05). Following regression analysis, DI patients had greater HDAH90 (55 vs 45, p=0.024) and fewer days at SNF (22 vs 32, p=0.026) than SI patients. There were no differences in 90-day readmission (DI odds 1.36, p=0.353), 90-day mortality (DI odds 0.94 p=0.935), return to baseline ambulatory status at 180 days (DI 1.64, p=0.433), and length of hospitalization (DI 10 days vs SI 9 days, p=0.579).</p><p><strong>Conclusions: </strong>Geriatric patients treated with dual implants for distal femur fractures experienced an additional 10 Healthy Days at Home90 as compared to those treated with single implants. Given that a 10-day difference is clinically significant in geriatric fractures for Healthy Days at Home90, using dual implant constructs may represent an improvement in care for distal femur patients.</p><p><strong>Level of evidence: </strong>III, prognostic.</p>\",\"PeriodicalId\":16644,\"journal\":{\"name\":\"Journal of Orthopaedic Trauma\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":1.6000,\"publicationDate\":\"2025-04-23\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Orthopaedic Trauma\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1097/BOT.0000000000002999\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"ORTHOPEDICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Orthopaedic Trauma","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/BOT.0000000000002999","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
Dual Implants for Geriatric Distal Femur Fractures Results in Greater Healthy Days at Home.
Objectives: To compare Healthy Days At Home (HDAH90) within 90 days of hospital discharge after single implant (SI) or dual implant (DI) fixation in geriatric distal femur fractures.
Methods: Design: Retrospective Review.
Setting: Three Level I Trauma Centers.
Patient selection criteria: Geriatric (age ≥ 60 years) distal femur fracture patients (OTA/AO 33 A, C) operatively treated with SI (lateral plate or retrograde intramedullary nail (IMN)) or DI (two plates or plate and IMN) between January 2018-January 2024 were included.
Outcome measures and comparisons: The primary outcome was HDAH90, which was calculated from date of surgery to 90 days follow-up and accounted for days after mortality, skilled nursing facilities (SNF), readmissions, and secondary surgeries. HDAH90, days at SNF, 90-day readmission, 90-day mortality, return to baseline ambulatory status at 180-days, and length of hospitalization were compared between patients with SI or DI. A binary logistic multivariate regression was used to compare outcomes while controlling for age, gender, dependence on assistive device, periprosthetic fracture, and post-operative weight bearing status.
Results: The 229 SI patients were 2 years younger than the 70 DI patients (73 vs. 75 years, p=0.03). The DI cohort had more female patients (82.9% vs 70.7%, p=0.044), and more periprosthetic fractures (55.7% vs. 35.4%, p=0.002). There was no other demographic, fracture characteristic, or preoperative ambulatory differences between groups (p>0.05). Following regression analysis, DI patients had greater HDAH90 (55 vs 45, p=0.024) and fewer days at SNF (22 vs 32, p=0.026) than SI patients. There were no differences in 90-day readmission (DI odds 1.36, p=0.353), 90-day mortality (DI odds 0.94 p=0.935), return to baseline ambulatory status at 180 days (DI 1.64, p=0.433), and length of hospitalization (DI 10 days vs SI 9 days, p=0.579).
Conclusions: Geriatric patients treated with dual implants for distal femur fractures experienced an additional 10 Healthy Days at Home90 as compared to those treated with single implants. Given that a 10-day difference is clinically significant in geriatric fractures for Healthy Days at Home90, using dual implant constructs may represent an improvement in care for distal femur patients.
期刊介绍：
Journal of Orthopaedic Trauma is devoted exclusively to the diagnosis and management of hard and soft tissue trauma, including injuries to bone, muscle, ligament, and tendons, as well as spinal cord injuries. Under the guidance of a distinguished international board of editors, the journal provides the most current information on diagnostic techniques, new and improved surgical instruments and procedures, surgical implants and prosthetic devices, bioplastics and biometals; and physical therapy and rehabilitation.
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