Darbandi Aria Darius, Saadat Ghulam H, Siddiqi Ahmed, Butler Bennet A
From the California University of Science and Medicine, Colton, CA (Darbandi), the Department of Trauma and Burn Surgery, John H Stroger Hospital of Cook County, Chicago, IL (Saadat), the Orthopedic Institute of Central Jersey, a division of Ortho Alliance NJ, Manasquan, NJ (Siddiqi), the Department of Orthopedic Surgery, Hackensack Meridian School of Medicine, Jersey Shore University Medical Center, Nutley, NJ (Siddiqi), and the Department of Orthopedic Surgery, Northwestern Memorial Hospital, Chicago, IL (Butler).
J Am Acad Orthop Surg. 2022 May 15;30(10):e779-e788. doi: 10.5435/JAAOS-D-21-00657. Epub 2022 Feb 22.
Although intramedullary implants are commonly used to treat stable intertrochanteric (IT) fractures, there is a lack of evidence to demonstrate their superiority over extramedullary implants in treating these fractures. The purpose of this study was to compare short-term outcomes (<30 days) between intramedullary and extramedullary implants in patients with closed nondisplaced stable IT fractures.
Patients with closed nondisplaced stable IT fractures were identified from the American College of Surgeons National Surgical Quality Improvement Program database between 2016 and 2019. Patients who either underwent extramedullary implant or intramedullary implant fixation were selected for this analysis. Postoperative outcomes included transfusion, surgical complications (stroke, myocardial infarction, venous thromboembolism, pneumonia, renal failure/insufficiency, surgical site infection, urinary tract infections, and sepsis), weight-bearing on postoperative day 1, discharge destination, place of residence at 30 days after the operation, days from operation to discharge, readmission related to the index procedure, any readmission, revision surgery, and mortality.
Of the 3,244 cases identified for the study, 2,521 (77.7%) underwent intramedullary nailing (IMN). Based on adjusted multivariable analysis, surgical complications between the two intervention groups were not statistically significantly (odds ratio [OR] 1.142; confidence interval [CI], 0.838 to 1.558; P = 0.4). However, patients who underwent IMN were associated with higher rates of blood transfusions (OR, 1.35, CI, 1.042 to 1.748, P = 0.023), more likely discharged to a place other than home (OR, 1.372, CI, 1.106 to 1.700, P = 0.004), and more likely to get readmitted (OR, 1.783, CI, 1.157 to 2.75, P = 0.009). Patients treated with IMN were associated with lower postoperative length of stay (OR 0.982, CI 0.967 to 0.998, P = 0.030).
Our study found that extramedullary implants were associated with lower transfusions rates, lower readmissions, and better patient disposition. We recommend surgeons to consider extramedullary implants when treating stable IT fractures, especially if the patient is anemic or at high risk for hospital readmission.
Level III. Retrospective cohort study.
尽管髓内植入物常用于治疗稳定型转子间骨折，但缺乏证据表明其在治疗此类骨折方面优于髓外植入物。本研究的目的是比较闭合性无移位稳定型转子间骨折患者髓内和髓外植入物的短期结局（<30天）。
从2016年至2019年美国外科医师学会国家外科质量改进计划数据库中识别出闭合性无移位稳定型转子间骨折患者。选择接受髓外植入物或髓内植入物固定的患者进行本分析。术后结局包括输血、手术并发症（中风、心肌梗死、静脉血栓栓塞、肺炎、肾衰竭/肾功能不全、手术部位感染、尿路感染和败血症）、术后第1天负重、出院目的地、术后30天居住地点、手术至出院天数、与索引手术相关的再入院、任何再入院、翻修手术和死亡率。
在本研究确定的3244例病例中，2521例（77.7%）接受了髓内钉固定（IMN）。基于调整后的多变量分析，两组干预措施之间的手术并发症无统计学显著差异（优势比[OR]1.142；置信区间[CI]，0.838至1.558；P = 0.4）。然而，接受IMN的患者输血率较高（OR，1.35，CI，1.042至1.748，P = 0.023），更有可能出院至非家中的其他地方（OR，1.372，CI，1.106至1.700，P = 0.004），且更有可能再次入院（OR，1.783，CI，1.157至2.75，P = 0.009）。接受IMN治疗的患者术后住院时间较短（OR 0.982，CI 0.967至0.998，P = 0.030）。
我们的研究发现，髓外植入物与较低的输血率、较低的再入院率和更好的患者处置情况相关。我们建议外科医生在治疗稳定型转子间骨折时考虑使用髓外植入物，特别是如果患者贫血或再次入院风险较高。
III级。回顾性队列研究。
