Center for Orthopaedics and Trauma Surgery, University Hospital Marburg, 35043, Baldingerstrasse, Marburg, Germany.
Philipps University of Marburg, Marburg, Germany.
Arch Orthop Trauma Surg. 2024 Jun;144(6):2561-2572. doi: 10.1007/s00402-024-05297-3. Epub 2024 Apr 20.
The outcomes of patients with atypical subtrochanteric fractures (ASFs) remain unclear. Data from a large international geriatric trauma registry were analysed to examine the outcome of patients with ASFs compared to patients with typical osteoporotic subtrochanteric fractures (TSFs).
Data from the Registry for Geriatric Trauma of the German Trauma Society (Deutsche Gesellschaft für Unfallchirurgie [DGU]) (ATR-DGU) were analysed. All patients treated surgically for ASFs or TSFs were included in this analysis. Across both fracture types, a paired matching approach was conducted, where statistical twins were formed based on background characteristics sex, age, American Society of Anesthesiologists (ASA) score and walking ability. In-house mortality and mortality rates at the 120-day follow-up, as well as mobility at 7 and 120 days, the reoperation rate, hospital discharge management, the hospital readmission rate at the 120-day follow-up, health-related quality of life, type of surgical treatment and anti-osteoporotic therapy at 7 and 120 days, were assessed as outcome measures using a multivariate logistic regression analysis.
Amongst the 1,800 included patients, 1,781 had TSFs and 19 had ASFs. Logistic regression analysis revealed that patients with ASFs were more often treated with closed intramedullary nailing (RR = 3.59, p < 0.001) and had a higher probability of vitamin D supplementation as osteoporosis therapy at 120 days (RR = 0.88, p < 0.002). Patients with ASFs were also more likely to live at home after surgery (RR = 1.43, p < 0.001), and they also tended to continue living at home more often than patients with TSFs (RR = 1.33, p < 0.001). Accordingly, patients with TSFs had a higher relative risk of losing their self-sufficient living status, as indicated by increased rates of patients living at home preoperatively and being discharged to nursing homes (RR = 0.19, p < 0.001) or other hospitals (RR = 0.00, p < 0.001) postoperatively.
Surgical treatment of ASFs was marked by more frequent use of closed intramedullary fracture reduction. Furthermore, patients with ASFs were more likely to be discharged home and died significantly less often in the given timeframe. The rate of perioperative complications, as indicated by nonsignificant reoperation rates, as well as patient walking abilities during the follow-up period, remained unaffected.
非典型股骨转子下骨折（ASFs）患者的预后仍不清楚。本研究分析了来自一个大型国际老年创伤登记处的数据，以检查 ASFs 患者的预后与典型骨质疏松性转子下骨折（TSFs）患者的预后相比。
本研究分析了德国创伤学会（Deutsche Gesellschaft für Unfallchirurgie [DGU]）老年创伤登记处（ATR-DGU）的数据。所有接受手术治疗的 ASFs 或 TSFs 患者均纳入本分析。在这两种骨折类型中，均采用配对匹配方法，根据背景特征（性别、年龄、美国麻醉医师协会 [ASA] 评分和行走能力）形成统计双胞胎。作为预后指标，采用多变量逻辑回归分析评估术后 7 天和 120 天的院内死亡率和死亡率、术后 7 天和 120 天的移动能力、再手术率、出院管理、术后 120 天的院内再入院率、健康相关生活质量、7 天和 120 天的手术治疗类型和抗骨质疏松治疗类型。
在纳入的 1800 名患者中，1781 名患者患有 TSFs，19 名患者患有 ASFs。逻辑回归分析显示，ASFs 患者更常接受闭合髓内钉治疗（RR=3.59，p<0.001），并且在 120 天时更有可能接受维生素 D 补充作为骨质疏松症治疗（RR=0.88，p<0.002）。ASFs 患者术后更有可能在家中生活（RR=1.43，p<0.001），并且他们在家中生活的比例也高于 TSFs 患者（RR=1.33，p<0.001）。相应地，TSFs 患者失去自理生活状态的相对风险更高，这表现为术前在家中生活的患者和术后被安置在疗养院（RR=0.19，p<0.001）或其他医院（RR=0.00，p<0.001）的患者比例更高。
ASFs 的手术治疗以更频繁地使用闭合髓内骨折复位为特征。此外，ASFs 患者出院回家的可能性更高，在给定的时间内死亡的可能性显著降低。手术并发症的发生率（通过无意义的再手术率表明）以及患者在随访期间的行走能力保持不变。
