Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, NY.
Department of Orthopedic Surgery, Jamaica Hospital Medical Center, Richmond Hill, New York.
J Bone Joint Surg Am. 2024 Feb 7;106(3):190-197. doi: 10.2106/JBJS.23.00583. Epub 2023 Nov 22.
The purpose of the present study was to evaluate differences in demographic features and clinical outcomes between patients who sustained a typical versus atypical subtrochanteric femoral fracture.
We reviewed the records for a cohort of consecutive patients who had undergone operative treatment of a subtrochanteric femoral fracture. Fractures were classified as either "typical" or "atypical" on the basis of the criteria of the American Society for Bone and Mineral Research (ASBMR). All patients were treated with a similar surgical algorithm and postoperative protocol. Groups were compared on the basis of demographic features, injury characteristics, operative quality measures, postoperative complications and outcomes, and radiographic time to healing. Comparative analyses were performed to compare the typical and atypical cohorts.
Of 220 subtrochanteric fractures, 165 (75.0%) were classified as typical and 55 (25.0%) were classified as atypical. The atypical cohort was predominately female and more likely to have bisphosphonate usage (odds ratio [OR], 7.975; [95% confidence interval (CI), 3.994-15.922]; p < 0.001) and fractures with lower-energy mechanisms (p < 0.001). Patients in the atypical cohort were more likely to be treated with a 10-mm cephalomedullary nail (CMN) (OR, 2.100 [95% CI, 1.119-3.939]; p = 0.020), whereas patients in the typical cohort were treated more frequently with an 11-mm CMN (OR, 0.337 [95% CI, 0.168-0.674]; p = 0.002). There were no differences between the groups in terms of other operative parameters; however, anatomic fracture reduction in neutral lateral alignment was achieved more frequently in the typical cohort (OR, 0.438 [95% CI, 0.220-0.875]; p = 0.018). There were no differences between the groups in terms of hospital quality measures, mortality rates, readmission rates, or complication rates (including implant failure [broken screw or nail] and fracture nonunion) (p = 1.00). Interestingly, there was no significant difference between the groups in terms of time to radiographic healing (260.30 ± 187.97 days in the typical group, compared with 246.40 ± 116.33 days in the atypical group) (OR, 0.999 [95% CI, 0.997-1.002]; p = 0.606).
Despite differences in terms of demographic and injury characteristics, patients who sustain a subtrochanteric femur fracture can expect similar outcome profiles regardless of fracture type.
Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.
本研究的目的是评估发生典型与非典型股骨转子下骨折患者的人口统计学特征和临床结局差异。
我们回顾了一组连续接受股骨转子下骨折手术治疗患者的病历。根据美国骨与矿物质研究学会（ASBMR）的标准，将骨折分为“典型”或“非典型”。所有患者均采用相似的手术方案和术后方案进行治疗。基于人口统计学特征、损伤特征、手术质量指标、术后并发症和结局以及影像学愈合时间，对两组进行比较。进行了对比分析以比较典型组和非典型组。
在 220 例转子下骨折中，165 例（75.0%）为典型骨折，55 例（25.0%）为非典型骨折。非典型组主要为女性，且更可能使用双膦酸盐（比值比[OR]，7.975；[95%置信区间（CI），3.994-15.922]；p<0.001）和低能量机制引起的骨折（p<0.001）。非典型组患者更可能接受 10-mm 股骨近端髓内钉（CMN）治疗（OR，2.100[95%CI，1.119-3.939]；p=0.020），而典型组患者更常接受 11-mm CMN 治疗（OR，0.337[95%CI，0.168-0.674]；p=0.002）。然而，两组在其他手术参数方面没有差异；然而，在典型组中更常达到解剖复位（OR，0.438[95%CI，0.220-0.875]；p=0.018）。两组在医院质量指标、死亡率、再入院率或并发症率（包括植入物失败[螺钉或钉断裂]和骨折不愈合）方面没有差异（p=1.00）。有趣的是，两组在影像学愈合时间方面没有显著差异（典型组为 260.30±187.97 天，非典型组为 246.40±116.33 天）（OR，0.999[95%CI，0.997-1.002]；p=0.606）。
尽管在人口统计学和损伤特征方面存在差异，但发生股骨转子下骨折的患者无论骨折类型如何，都可以预期具有相似的结局特征。
预后 III 级。有关证据水平的完整描述，请参阅作者说明。
