Official Journal of the Italian Society of Orthopaedics and Traumatology
Table 1 Demographics/characteristics of patients with a subtrochanteric fracture treated with a long cephalomedullary nail, stratified according to re-operation
All patients | No re-operation | Re-operation | |
|---|---|---|---|
Demographics | |||
Total number | 309 | 240 (77.7%) | 69 (22.3%) |
Age < 75 y.o. | 143 (46.3%) | 99 (41.2%) | 44 (63.8%) |
Gender | |||
Male | 111 (35.9%) | 85 (35.4%) | 26 (37.7%) |
Female | 198 (64.1%) | 155 (64.6%) | 43 (62.3%) |
Injury characteristics | |||
Mechanism of injury | |||
Low energy | 244 (78.9%) | 197 (82.1%) | 47 (68.1%) |
High energy | 47 (15.2%) | 32 (13.3%) | 15 (21.7%) |
Pathological | 18 (5.8%) | 11 (4.6%) | 7 (10.1%) |
Isolated | 266 (86.1%) | 206 (85.8%) | 60 (87.0%) |
ISS > 16 | 18 (5.8%) | 13 (5.4%) | 5 (7.2%) |
Side | |||
Left | 161 (52.1%) | 119 (49.6%) | 42 (60.9%) |
Right | 148 (47.9%) | 121 (50.4%) | 27 (39.1%) |
Open fracture | 3 (0.9%) | 1 (0.4%) | 2 (2.9%) |
Medical comorbidities | |||
ASA | |||
1 | 28 (9.1%) | 21 (8.8%) | 7 (10.1%) |
2 | 93 (30.1%) | 66 (27.5%) | 27 (39.1%) |
3 | 148 (47.9%) | 118 (49.2%) | 30 (43.5%) |
4 | 40 (12.9%) | 35 (14.6%) | 5 (7.2%) |
Charlson Comorbidity Score | 4.97 (2.95) | 5.20 (2.92) | 4.16 (2.92) |
Diabetes | 46 (14.9%) | 39 (16.2%) | 7 (10.1%) |
Steroids | 17 (5.5%) | 15 (6.2%) | 2 (2.9%) |
Malignancy | 72 (23.3%) | 55 (22.9%) | 17 (24.6%) |
Dementia | 44 (14.2%) | 41 (17.1%) | 3 (4.3%) |
Osteoporosis | |||
Bisphosphonates pre-admission | 63 (20.4%) | 47 (19.6%) | 16 (23.2%) |
Bisphosphonates on discharge | 90 (29.1%) | 71 (29.7%) | 19 (27.9%) |
Calcium/vitamin D pre-admission | 93 (30.1%) | 76 (31.7%) | 17 (24.6%) |
Calcium/vitamin D on discharge | 155 (50.2%) | 126 (52.7%) | 29 (42.6%) |
Vitamin D loading on admission | 42 (13.6%) | 37 (15.5%) | 5 (7.4%) |
Fragility fractures before | 61 (19.7%) | 50 (20.8%) | 11 (15.9%) |
Fragility fractures after | 67 (21.7%) | 51 (21.2%) | 16 (23.2%) |
Social history | |||
Smoking | 62 (20.1%) | 39 (16.2%) | 23 (33.3%) |
Alcohol > 10 units/week | 63 (20.4%) | 44 (18.3%) | 19 (27.5%) |
Pre-operative mobility | |||
Independent | 161 (52.1%) | 120 (50.0%) | 41 (59.4%) |
Stick(s)/crutch(es) | 98 (31.7%) | 77 (32.1%) | 21 (30.4%) |
Frame | 37 (11.9%) | 32 (13.3%) | 5 (7.2%) |
Wheelchair/hoisted | 13 (4.2%) | 11 (4.6%) | 2 (2.9%) |
Frequent falls | 85 (27.5%) | 68 (28.3%) | 17 (24.6%) |
Operation characteristics | |||
Operation in less than 48 h | 245 (79.3%) | 194 (80.8%) | 51 (73.9%) |
Simultaneous procedures | 23 (7.4%) | 19 (7.9%) | 4 (5.8%) |
Type of nail | |||
Long Affixus nail | 170 (55.0%) | 143 (59.6%) | 27 (39.1%) |
Long Gamma nail | 139 (44.9%) | 97 (40.4%) | 42 (60.9%) |
Nail diameter (mm) | |||
9 | 14 (4.5%) | 10 (4.2%) | 4 (5.9%) |
11 | 202 (65.4%) | 156 (65.5%) | 46 (67.6%) |
13 | 90 (29.1%) | 72 (30.3%) | 18 (26.5%) |
Open reduction | 148 (47.9%) | 110 (45.8%) | 38 (55.1%) |
Use of cerclage wires | 43 (13.9%) | 37 (15.4%) | 6 (8.7%) |
Post-op mobilisation (first 6 weeks) | |||
FWB | 151 (48.9%) | 124 (51.7%) | 27 (39.1%) |
PWB | 76 (24.6%) | 57 (23.8%) | 19 (27.5%) |
TTWB | 50 (16.2%) | 37 (15.4%) | 13 (18.8%) |
NWB | 32 (10.4%) | 22 (9.2%) | 10 (14.5%) |
Surgical time (min) | 111.20 (43.61) | 108.95 (42.50) | 119 (46.75) |
Anaesthetic time (min) | 48.91 (22.89) | 49.03 (22.93) | 48.48 (22.91) |
Time from induction to recovery (min) | 179.75 (49.73) | 177.56 (48.86) | 187.36 (52.28) |
Level of first surgeon | |||
Registrar | 192 (62.1%) | 148 (61.9%) | 44 (63.8%) |
Consultant | 116 (37.5%) | 91 (38.1%) | 25 (36.2%) |
Level of senior surgeon present | |||
Registrar | 141 (45.6%) | 137 (57.3%) | 41 (59.4%) |
Consultant | 130 (42.1%) | 102 (42.7%) | 28 (40.6%) |
Complications | |||
Failure at lag screw junction* | 24 (7.8%) | 7 (2.9%) | 17 (24.6%) |
Self-dynamisation | 20 (6.5%) | 8 (3.3%) | 12 (17.4%) |
Cut-out** | 7 (2.3%) | 1 (0.4%) | 6 (8.7%) |
Nail infection | 5 (1.6%) | 0 (0.0%) | 5 (7.2%) |
Peri-implant fracture | 8 (2.6%) | 5 (2.1%) | 3 (4.3%) |
Non-union*** | 74 (23.9%) | 28 (11.7%) | 46 (66.7%) |
HAP/CAP | 45 (14.6%) | 35 (14.6%) | 10 (14.5%) |
UTI | 43 (13.9%) | 37 (15.4%) | 6 (8.7%) |
Fracture-related infection | 11 (3.6%) | 2 (0.8%) | 9 (13.0%) |
Revision for fracture-related infection | 5 (1.6%) | 0 (0%) | 5 (7.4%) |
CKD stage pre-operatively | |||
Mild | 211 (68.3%) | 159 (67.9%) | 52 (75.4%) |
Moderate/severe | 92 (29.8%) | 75 (32.1%) | 17 (24.6%) |
CKD stage post-operatively | |||
Mild | 220 (71.2%) | 166 (71.6%) | 54 (79.4%) |
Moderate/severe | 80 (25.9%) | 66 (28.4%) | 14 (20.6%) |
Pre-operative transfusion | 22 (7.1%) | 19 (7.9%) | 3 (4.3%) |
Post-operative transfusion (48 h) | 190 (61.5%) | 142 (59.2%) | 48 (69.6%) |
Hb drop (g/L) | 43.24 (18.04) | 43.17 (17.63) | 43.46 (19.48) |
Radiographic measurements | |||
Femoral neck shaft angle† | |||
Normal | 209 (67.6%) | 156 (65.5%) | 53 (77.9%) |
Coxa valga | 83 (26.9%) | 76 (31.9%) | 7 (10.3%) |
Coxa vara | 14 (4.5%) | 6 (2.5%) | 8 (11.8%) |
Number of fragments (comminution) | |||
Simple | 90 (29.1%) | 69 (28.7%) | 21 (30.4%) |
Moderate | 147 (47.6%) | 122 (50.8%) | 25 (36.2%) |
Severe | 72 (23.3%) | 49 (20.4%) | 23 (33.3%) |
Isolated subtrochanteric extension | 50 (16.2%) | 38 (15.8%) | 12 (17.4%) |
Distal extension**** | 116 (37.5%) | 91 (37.9%) | 25 (36.2%) |
Lesser trochanter fracture | 202 (65.4%) | 157 (65.4%) | 45 (65.2%) |
Medial calcar comminution | 22 (7.1%) | 16 (6.7%) | 6 (8.7%) |
Lateral cortex gap size (mm) | |||
≤ 4 | 183 (59.2%) | 156 (65.0%) | 27 (39.1%) |
5–9 | 86 (27.8%) | 59 (24.6%) | 27 (39.1%) |
≥ 10 | 40 (12.9%) | 25 (10.4%) | 15 (21.7%) |
Medial cortex gap size (mm) | |||
≤ 4 | 208 (67.3%) | 169 (70.4%) | 39 (56.5%) |
5–9 | 69 (22.3%) | 49 (20.4%) | 20 (29.0%) |
≥ 10 | 32 (10.4%) | 22 (9.2%) | 10 (14.5%) |
Anterior cortex gap size (mm) | |||
≤ 4 | 199 (64.4%) | 160 (66.7%) | 39 (56.5%) |
5–9 | 61 (19.7%) | 49 (20.4%) | 15 (21.7%) |
≥ 10 | 46 (14.9%) | 31 (12.9%) | 15 (21.7%) |
Posterior cortex gap size (mm) | |||
≤ 4 | 234 (75.7%) | 193 (80.4%) | 41 (59.4%) |
5–9 | 57 (18.4%) | 37 (15.4%) | 20 (29.0%) |
≥ 10 | 18 (5.8%) | 10 (4.2%) | 8 (11.6%) |
Reduction angle grouped ‡ (degrees) | |||
Valgus 5–varus 5 | 218 (70.6%) | 184 (76.7%) | 34 (49.3%) |
Valgus > 5 | 17 (5.5%) | 13 (5.4%) | 4 (5.8%) |
Varus 5–10 | 56 (18.1%) | 35 (14.6%) | 21 (30.4%) |
Varus > 10 | 18 (5.8%) | 8 (3.3%) | 10 (14.5%) |
Anti-rotation screw | 101 (32.7%) | 84 (35.0%) | 17 (24.6%) |
TAD (mm) | |||
< 25 | 271 (87.7%) | 214 (89.5%) | 57 (82.6%) |
≥ 25 | 37 (11.9%) | 25 (10.5%) | 12 (17.4%) |
Distal locking (number of screws) | |||
1 | 11 (3.6%) | 11 (4.6%) | 0 (0.0%) |
2 | 298 (96.4%) | 229 (95.4%) | 69 (100.0%) |
Method of locking | |||
Static locking | 201 (65.0%) | 158 (66.1%) | 43 (62.3%) |
Secondary dynamisation | 105 (33.9%) | 79 (33.1%) | 26 (37.7%) |
Dynamic | 2 (0.6%) | 2 (0.8%) | 0 (0.0%) |
Distance of tip of the nail from centre (AP) (mm) | |||
−4 to 4 | 196 (63.4%) | 154 (64.4%) | 42 (60.9%) |
Lateral ≥ 5 | 63 (20.4%) | 51 (21.3%) | 12 (17.4%) |
Medial ≥ 5 | 49 (15.9%) | 34 (14.2%) | 15 (21.7%) |
Distance of tip of the nail from centre (LAT) (mm) | |||
−4 to 4 | 244 (78.9%) | 187 (78.2%) | 57 (82.6%) |
Anterior ≥ 5 | 58 (18.8%) | 47 (19.7%) | 11 (15.9%) |
Posterior ≥ 5 | 6 (1.9%) | 5 (2.1%) | 1 (1.4%) |
Distance of tip of the nail from knee (mm) | |||
< 10 | 2 (0.6%) | 2 (0.8%) | 0 (0.0%) |
10 to 19 | 23 (7.4%) | 15 (6.3%) | 8 (11.6%) |
20–29 | 96 (31.1%) | 79 (33.1%) | 17 (24.6%) |
≥ 30 | 187 (60.5%) | 143 (59.8%) | 44 (63.8%) |
Nail/canal ratio | 0.83 (0.07) | 0.82 (0.08) | 0.83 (0.07) |
Hospital stay/mortality | |||
HDU/ICU stay | 32 (10.4%) | 25 (10.4%) | 7 (10.1%) |
Total length of hospital stay (days) | 21.76 (19.58) | 22.24 (19.13) | 20.09 (21.13) |
Died within a year | 17 (5.5%) | 14 (5.8%) | 3 (4.3%) |