Risk factors for excessive postoperative sliding of femoral trochanteric fracture in elderly patients: A retrospective multicenter study. Issue 11 (November 2021)

• Record Type: Journal Article
• Authors: Momii, Kenta; Fujiwara, Toshifumi; Mae, Takao; Tokunaga, Masami; Iwasaki, Takeshi; Shiomoto, Kyohei; Kubota, Kensuke; Onizuka, Toshihiro; Miura, Tatsuhiko; Hamada, Takahiro; Nakamura, Tetsuro; Itokawa, Takashi; Iguchi, Takahiro; Yamashita, Akihisa; Kikuchi, Naoshi; Nakaie, Kazutoshi; Matsumoto, Yoshihiro; Nakashima, Yasuharu
• Is Part Of: Injury. Volume 52:Issue 11(2021)
• Page Start: 3369
• Page End: 3376
• Publication Date: 2021-11
• Subjects: Excessive sliding -- Trochanteric fracture -- Reduction classification -- Tip-apex distance; Wounds and injuries -- Surgery -- Periodicals; Accidents -- Periodicals; Wounds and Injuries -- surgery -- Periodicals; Lésions et blessures -- Chirurgie -- Périodiques; Electronic journals; Electronic journals; 617.1
• DOI: 10.1016/j.injury.2021.07.039
• Languages: English
• ISSNs: 0020-1383

Abstract

Highlights: Postoperative excessive sliding resulted in hip joint dysfunction in femoral trochanteric fracture. Female, unstable fracture, high tip-apex distance, and poor reduction were risk factors of excessive sliding. The fracture reduction from two directions prevented postoperative excessive sliding. Abstract: Introduction: The application of a load on the internal fixation of a trochanteric fracture exerts a moment along the lag screw, causing the proximal bone fragment to slide along the lag screw, allowing contact between the proximal and distal bone fragments, which promotes healing. However, excessive sliding is related to poor postoperative outcomes. We aimed to identify the risk factors for excessive sliding. Materials and Methods: We conducted a multicenter retrospective study including 115 trochanteric fractures sustained through low-energy trauma in 19 male and 96 female patients aged 60 years or older (mean age: 82.9 years) between September 2013 and December 2014. We measured the postoperative sliding distance after osteosynthesis using a sliding hip screw or intramedullary nailing, and classified participants with ≥8 mm of sliding into the excessive sliding group (ESG) and with <8 mm into non-ESG. Finally, we investigated the risk factors of excessive postoperative sliding. Results: Fifty participants were classified into the ESG and 65 participants into the non-ESG. Female sex ( p = 0.0264), an A3 fracture type ( p = 0.0003), greater tip-apex distance ( p = 0.0250), and poor reduction in either the anteroposterior or lateral radiographic views ( p = 0.0156) were identified as risk factors for excessive sliding by multivariate regression analysis. Conclusions: Female sex, an unstable fracture type, a greater tip-apex distance, and a poor reduction, in either the anteroposterior or lateral views, are associated with excessive postoperative sliding. Therefore, surgery should aim to achieve good reduction and stabilization from both radiographic views.