High- Versus Low-Energy Intertrochanteric Hip Fractures in Young Patients: Injury Characteristics and Factors Associated With Complications. Issue 5 (May 2023)

• Record Type: Journal Article
• Authors: Stenquist, Derek S.; Albertson, Spencer; Bailey, Daniel; Paladino, Lucas; Flanagan, Christopher D.; Stang, Thomas; Watson, David T.; Shah, Anjan R.; Maxson, Benjamin J.; Infante, Anthony F.; Donohue, David; Sanders, Roy W.; Mir, Hassan R.
• Is Part Of: Journal of orthopaedic trauma. Volume 37:Issue 5(2023)
• Page Start: 222
• Page End: 229
• Publication Date: 2023-05
• Subjects: young intertroch -- hip fracture -- high energy -- outcomes; Orthopedics -- Periodicals; Wounds and injuries -- Periodicals; Orthopedics -- Periodicals; Wounds and Injuries -- therapy -- Periodicals; Periodicals; 617.47044
• DOI: 10.1097/BOT.0000000000002587
• Languages: English
• ISSNs: 0890-5339

Abstract

Abstract : Supplemental Digital Content is Available in the Text. Abstract : Objective: To compare fracture patterns and associated injuries for young patients with high- versus low-energy intertrochanteric hip fractures and to report on factors associated with complications after surgical fixation of high-energy fractures. Design: Retrospective comparative study. Setting: Academic Level 1 Trauma Center. Patients: A total of 103 patients 50 years of age or younger were included: 80 high-energy fractures and 23 low-energy fractures. Intervention: Cephalomedullary nailing (N = 92) or a sliding hip screw (N = 11). Main Outcome Measures: Radiographic characteristics of fracture morphology, implant position, and reduction quality and postoperative complications were the main outcome measures. Results: Compared with young patients with low-energy fractures, those with high-energy fractures had more fracture comminution ( P = 0.013) and higher ISS scores ( P < 0.003) and were more likely to require open reduction ( P < 0.001). Patients with low-energy fractures from a ground-level fall had higher rates of alcohol abuse (0.032), cirrhosis (0.010), and chronic steroid use (0.048). Overall reoperation rate for high-energy fractures was 7%, including 2 IT fracture nonunions (5%) and 1 deep infection (2%). For high-energy fractures, ASA class ( P = 0.026), anterior lag screw position ( P = 0.001), and varus malreduction ( P < 0.001) were associated with malunion. Four-part fracture (OTA/AO 31A2.3/Jensen 5) ( P = 0.028) and residual calcar gap >3 mm ( P = 0.03) were associated with reoperation. Conclusions: Surgical treatment of high-energy IT fractures in young patients is technically demanding with potential untoward outcomes. Injury characteristics and severity are significantly different for young patients with high-energy IT fractures compared with low-energy fractures. For young patients with a high-energy IT fracture, surgeons can anticipate a high rate of associated injuries and complex fracture patterns requiring open reduction. For young patients with a low-energy IT fracture, comanagement with a hospitalist or a geriatrician should be considered because they may be physiologically older. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.