Academic Department of Trauma and Orthopaedics, School of Medicine, University of Leeds, Clarendon Wing, Level D, Great George Street, Leeds, LS1 3EX, West Yorkshire, UK.
Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.
Eur J Trauma Emerg Surg. 2022 Jun;48(3):1759-1768. doi: 10.1007/s00068-021-01834-6. Epub 2021 Nov 26.
The aim of this study was to identify factors associated with the need for open reduction in subtrochanteric femoral fractures and investigate the effect of cerclage wiring compared to open reduction alone, on the development of complications, especially infection and non-union.
All consecutive patients with a fracture involving the subtrochanteric region were retrospectively identified, over an 8-year period. Data documented and analysed included patient demographics, fracture characteristics, patient comorbidities, time to fracture union and development of complications.
A total of 512 patients met the inclusion criteria (523 fractures). Open reduction was performed in 48% (247) of the fractures. Following matching and regression analysis, we identified diaphyseal extension of the fracture to be associated with an open reduction (OR: 2.30; 95% CI 1.45-3.65; p < 0.001). Open reduction was also associated with an increased risk of superficial infection (OR: 7.88; 95% CI 1.63-38.16; p = 0.010), transfusion within 48 h following surgery (OR: 2.44; 95% CI 1.96-4.87; p < 0.001) and a prolonged surgical time (OR: 3.09; 95% CI 1.96-4.87; p < 0.001). The risk of non-union, deep infection and overall mortality was not increased with open reduction. The use of cerclage wires [50 out of 201 fractures (24.9%) treated with an open reduction] to achieve anatomical reduction as compared to open reduction alone significantly reduced the risk of non-union (OR: 0.20; 95% CI 0.06-0.74; p = 0.015).
Open reduction of subtrochanteric fractures is not associated with an increased risk of deep infection and non-union, even though it is associated with an increased risk of superficial infection, prolonged surgical time and transfusion. The use of cerclage wire is associated with reduced risk of non-union with little evidence of an increase in complications.
III.
本研究旨在确定与转子下骨折切开复位相关的因素，并探讨环扎钢丝与单纯切开复位相比，对并发症发展的影响，尤其是感染和不愈合。
回顾性分析 8 年间所有累及转子下区域的骨折患者资料。记录和分析的数据包括患者人口统计学特征、骨折特征、患者合并症、骨折愈合时间和并发症的发生情况。
共纳入 512 例患者（523 处骨折），其中 48%（247 例）接受切开复位。经过匹配和回归分析，我们发现骨折骨干延伸与切开复位有关（OR：2.30；95%CI 1.45-3.65；p<0.001）。切开复位还与浅表感染（OR：7.88；95%CI 1.63-38.16；p=0.010）、术后 48 小时内输血（OR：2.44；95%CI 1.96-4.87；p<0.001）和手术时间延长（OR：3.09；95%CI 1.96-4.87；p<0.001）的风险增加有关。切开复位不会增加不愈合、深部感染和总体死亡率的风险。与单纯切开复位相比，使用环扎钢丝（50 例切开复位骨折中使用了环扎钢丝[24.9%]）来实现解剖复位显著降低了不愈合的风险（OR：0.20；95%CI 0.06-0.74；p=0.015）。
切开复位转子下骨折不会增加深部感染和不愈合的风险，尽管与浅表感染、手术时间延长和输血的风险增加有关。使用环扎钢丝与不愈合风险降低相关，并发症增加的证据很少。
III。
