Department of Orthopaedic Surgery, Park Nicollet Methodist Hospital, St. Louis Park, MN, USA.
TRIA Orthopaedics, Bloomington, MN, USA.
Eur J Orthop Surg Traumatol. 2021 Feb;31(2):235-243. doi: 10.1007/s00590-020-02759-3. Epub 2020 Aug 14.
Subtrochanteric femur fractures associate with a relatively high complication rate and are traditionally treated operatively with a period of limited weight bearing. Transitioning from extramedullary to intramedullary implants, there are increasing biomechanical and clinical data to support early weight bearing. This multicenter retrospective study examines the effect of postoperative weight bearing as tolerated (WBAT) for subtrochanteric femur fractures. We hypothesize that WBAT will result in a decreased length of stay (LOS) without increasing the incidence of re-operation.
This study assesses total LOS and postoperative LOS after intramedullary fixation for subtrochanteric fractures between postoperative weight bearing protocols across 6 level I trauma centers (n = 441). Analysis techniques consisted of multivariable linear regression and nonparametric comparative tests. Additional subanalyses were performed, targeting mechanism of injury (MOI), Winquist-Hansen fracture comminution, 20-year age strata, and injury severity score (ISS).
Total LOS was shorter in WBAT protocol within the overall sample (7.4 vs 9.7 days; p < 0.01). Rates of re-operation were similar between the two groups (10.6% vs 10.5%; p = 0.99). Stratified analysis identified patients between ages 41-80, WH comminution 2-3, high MOI, and ISS between 6-15 and 21-25 to demonstrate a significant reduction in LOS as a response to WBAT.
An immediate postoperative weight bearing as tolerated protocol in patients with subtrochanteric fractures reduced length of hospital stay with no significant difference in reoperation and complication rates. If no contraindication exists, immediate weight bearing as tolerated should be considered for patients with subtrochanteric femur fractures treated with statically locked intramedullary nails.
Therapeutic Level III.
转子下股骨骨折的并发症发生率相对较高，传统上采用手术治疗，限制负重。从髓外植入物过渡到髓内植入物，越来越多的生物力学和临床数据支持早期负重。这项多中心回顾性研究探讨了术后负重耐受（WBAT）治疗转子下股骨骨折的效果。我们假设 WBAT 将降低住院时间（LOS），而不会增加再次手术的发生率。
这项研究评估了 6 个一级创伤中心（n=441）中，髓内固定治疗转子下骨折术后负重协议对总 LOS 和术后 LOS 的影响。分析技术包括多变量线性回归和非参数比较检验。还进行了额外的亚分析，针对损伤机制（MOI）、Winquist-Hansen 骨折粉碎、20 岁年龄分层和损伤严重程度评分（ISS）。
总体样本中，WBAT 方案的总 LOS 更短（7.4 天 vs 9.7 天；p<0.01）。两组的再手术率相似（10.6% vs 10.5%；p=0.99）。分层分析确定了年龄在 41-80 岁、WH 粉碎 2-3 级、高 MOI 和 ISS 在 6-15 级和 21-25 级的患者，表明 WBAT 可显著降低 LOS。
对于转子下骨折患者，术后立即负重耐受方案可缩短住院时间，而再次手术和并发症发生率无显著差异。如果没有禁忌症，应考虑对接受静态锁定髓内钉治疗的转子下股骨骨折患者立即进行负重耐受治疗。
治疗性 3 级。
