Department of Traumatology and Orthopaedics, University of Tartu, L. Puusepa 8, 50406, Tartu, Estonia.
Traumatology and Orthopaedics Clinic, Tartu University Hospital, L. Puusepa 8, 50406, Tartu, Estonia.
BMC Musculoskelet Disord. 2022 Apr 27;23(1):394. doi: 10.1186/s12891-022-05336-3.
Isolated greater trochanter fracture (IGT) and conventional hip fracture (HF) affect the same anatomical area but are usually researched separately. HF is associated with high mortality, and its management is well established. In contrast, IGT's effect on mortality is unknown, and its best management strategies are unclear. This study aims to compare these patient populations, their acute- and post-acute care, physical and occupational therapy use, and up to three-year mortality.
This retrospective cohort study is based on population-wide data of Estonia, where routine IGT management is non-operative and includes immediate weight-bearing as tolerated. The study included patients aged ≥ 50 years with a validated index HF or IGT diagnosis between 2009-2017. The fracture populations' acute- and post-acute care, one-year physical and occupational therapy use and three-year mortality were compared.
A total of 0.4% (50/11,541) of included patients had an IGT. The baseline characteristics of the fracture cohorts showed a close resemblance, but the IGT patients received substantially less care. Adjusted analyses showed that the IGT patients' acute care was 4.5 days [3.4; 5.3] shorter they had 39.2 percentage points [25.5; 52.8] lower probability for receiving post-acute care, and they had 50 percentage points [5.5: 36]] lower probability for receiving physical and occupational therapy. The IGT and HF patients' mortality rates were comparable, being 4% and 9% for one month, 28% and 31% for one year, and 46% and 49% for three years, respectively. Crude and adjusted analyses could not find significant differences in their three-year mortality, showing a p-value of 0.6 and a hazard ratio of 0.9 [0.6; 1.3] for the IGT patients, retrospectively.
Despite IGT being a relatively minor injury, the evidence from this study suggests that it may impose a comparable risk on older patients' survival, as does HF due to the close resemblance of the two fracture populations. Therefore, IGT in older patients may signify an underlying need for broad-based medical attention, ensuring need-based, ongoing, coordinated care.
Retrospectively registered.
孤立性大转子骨折（IGT）和传统髋部骨折（HF）影响相同的解剖区域，但通常分别进行研究。HF 死亡率高，其治疗方法已得到很好的确立。相比之下，IGT 对死亡率的影响尚不清楚，其最佳治疗策略也不清楚。本研究旨在比较这两种患者人群、他们的急性期和康复期护理、物理治疗和职业治疗的使用情况以及最长 3 年的死亡率。
本回顾性队列研究基于爱沙尼亚的人群数据，IGT 的常规管理是非手术的，包括立即根据耐受情况负重。该研究纳入了 2009-2017 年间年龄≥50 岁且有经验证的 HF 或 IGT 诊断的患者。比较了骨折患者的急性期和康复期护理、一年的物理治疗和职业治疗的使用情况以及 3 年的死亡率。
纳入患者中有 0.4%（50/11541）为 IGT。骨折患者的基线特征非常相似，但 IGT 患者接受的护理明显较少。调整分析显示，IGT 患者的急性期护理时间缩短了 4.5 天[3.4；5.3]，他们接受康复期护理的可能性低了 39.2 个百分点[25.5；52.8]，接受物理治疗和职业治疗的可能性低了 50 个百分点[5.5：36]。IGT 和 HF 患者的死亡率相当，一个月时分别为 4%和 9%，一年时分别为 28%和 31%，三年时分别为 46%和 49%。粗分析和调整分析均未发现两组患者在三年死亡率方面存在显著差异，p 值为 0.6，HR 为 0.9[0.6；1.3]，这表明 IGT 患者具有回溯性。
尽管 IGT 是一种相对较小的损伤，但本研究的证据表明，它可能会对老年患者的生存造成类似的风险，这与 HF 类似，因为这两种骨折患者人群非常相似。因此，老年患者的 IGT 可能表明他们需要广泛的医疗关注，以确保有需要的、持续的、协调的护理。
回顾性注册。
