Whittaker Duncan E, Farrow Luke, Neilly David, Gaba Sahil, Goffin Joaquim, Stevenson Iain
Department of Trauma and Orthopaedics, NHS Grampian, Aberdeen, GBR.
Cureus. 2024 Jul 2;16(7):e63647. doi: 10.7759/cureus.63647. eCollection 2024 Jul.
Failed fixation of intracapsular hip fractures in young patients is associated with high morbidity and cost. Accordingly, we set out to determine the association between unsatisfactory post-operative imaging (judged by two fellowship-trained trauma consultants and a senior trainee) and the risk of subsequent reoperation, including adjustment for potential confounding variables. Ninety-four (94) patients aged <60 were included in the study from a single major trauma centre. Exhausted patients (19%) required further surgery, with the most common reason being avascular necrosis (n=10) followed by non-union (n=6). Univariate analysis found only smokers and unsatisfactory fracture reduction to be predictive of failure (p < 0.05). Other demographics and recognised scoring systems from the literature were poor predictors of failure apart from the Haiduewych classification system, utilised to assess the quality of reduction, which showed a trend towards significance (p0.053). Multivariate analysis showed smoking and unsatisfactory fracture reduction to be strong predictors of failure (p<0.05). In those with unsatisfactory fracture reduction, 50% required reoperation compared to 17.5% of those with satisfactory reduction. This study highlights the key principles of ensuring adequate intraoperative reduction and fixation, in keeping with GIRFT principles. Avoiding secondary reoperation is crucial to prevent long-term negative outcomes for this typically high functional demand group of patients. We recommend regular, consultant peer review of post-operative imaging as a method of identifying substandard fracture fixations and those at risk of failure. This will allow opportunities for teaching, clinical improvement, and multidisciplinary team (MDT) discussions of at-risk patients.
年轻患者髋关节囊内骨折内固定失败与高发病率和高成本相关。因此，我们着手确定术后影像学结果不理想（由两名接受过专科培训的创伤顾问和一名高级实习生判断）与后续再次手术风险之间的关联，包括对潜在混杂变量进行校正。来自单一大型创伤中心的94例年龄<60岁的患者纳入本研究。19%的患者需要进一步手术，最常见的原因是缺血性坏死（n = 10），其次是骨不连（n = 6）。单因素分析发现只有吸烟者和骨折复位不理想可预测失败（p < 0.05）。除用于评估复位质量的Haiduewych分类系统外，文献中的其他人口统计学特征和公认的评分系统对失败的预测性较差，该系统显示出显著趋势（p = 0.053）。多因素分析显示吸烟和骨折复位不理想是失败的强预测因素（p < 0.05）。在骨折复位不理想的患者中，50%需要再次手术，而复位满意的患者中这一比例为17.5%。本研究强调了确保术中充分复位和固定的关键原则，符合GIRFT原则。避免二次手术对于预防这类通常功能需求较高的患者的长期不良后果至关重要。我们建议定期由顾问同行对术后影像学进行评估，作为识别不合格骨折固定和有失败风险患者的一种方法。这将为教学、临床改进以及对有风险患者的多学科团队（MDT）讨论提供机会。
