Murphy Michael P, Tiee Madeline S, Johnson Bailey E, Summers Hobie D, Cohen Joseph B, Lack William D
Loyola University Medical Center, Department of Orthopaedic Surgery and Rehabilitation, 2160 S. First Avenue, Maguire Suite 1700, Maywood, IL, 60153, USA.
Harborview Medical Center, Department of Orthopaedic Surgery and Rehabilitation, 325 9th Ave, Seattle, WA, 98104, USA.
J Clin Orthop Trauma. 2024 Aug 13;55:102516. doi: 10.1016/j.jcot.2024.102516. eCollection 2024 Aug.
Following an index femoral fragility fracture, patients are at risk of a subsequent peri-implant fracture. Management of these injuries are further complicated by patient factors and multi-institutional care. This study quantifies such events and compare rate of identification between in-system and out-of-system patients.
A retrospective chart review of index operative femoral fragility fractures at a level I trauma center from January 1, 2005 to January 1, 2018 identified 840 patients with twenty-two subsequent peri-implant fractures. Kaplan Meier survival analyses assessed associations between patient and injury characteristics with the subsequent fracture while accounting for differential follow-up. Cumulative incidence curves were reported, and Cox regression analyses estimated hazard ratios for statistically significant associations. In-system and out-of-system patients were compared with absolute rate of identifying subsequent fracture and follow-up time.
Cumulative incidence of subsequent fracture was 2.1 % at 2 years, 3.4 % at 4 years, and 4.6 % at 6 years. The index fracture pattern (intertrochanteric vs other) was associated with a cumulative incidence of subsequent peri-implant fracture (0.8 % at 2 years, 1.4 % at 4 years, and 2.7 % at 6 years for intertrochanteric fractures vs 3.4 % at 2 years, 5.3 % at 4 years, and 6.4 % at 6 years for non-intertrochanteric fractures), p = 0.029. Follow-up was shorter for out-of-system patients (median 6 versus 28 months, p < 0.001), and only 1 of 348 out-of-system patients (0.3 %) vs. 21 of 492 in-system patients (4.3 %) were diagnosed with a subsequent peri-implant fracture (p < 0.001). There was no association of subsequent peri-implant fracture with patient demographics or comorbidity burden.
Cumulative incidence of subsequent peri-implant fracture was higher for non-intertrochanteric (femoral neck, shaft and distal femur) fractures than intertrochanteric fractures. Out-of-system patients had shorter follow-up and were less likely to be diagnosed with a subsequent peri-implant fracture, indicating ascertainment bias and underscoring the importance of accounting for loss to follow-up.
Therapeutic Level III.
在发生首次股骨脆性骨折后，患者有发生后续植入物周围骨折的风险。患者因素和多机构护理使这些损伤的处理更加复杂。本研究对这类事件进行了量化，并比较了系统内和系统外患者的识别率。
对一家一级创伤中心2005年1月1日至2018年1月1日期间首次手术的股骨脆性骨折进行回顾性病历审查，确定了840例患者，其中22例发生了后续植入物周围骨折。Kaplan-Meier生存分析评估了患者和损伤特征与后续骨折之间的关联，同时考虑了不同的随访情况。报告累积发病率曲线，Cox回归分析估计具有统计学意义的关联的风险比。比较系统内和系统外患者后续骨折的识别绝对率和随访时间。
后续骨折的累积发病率在2年时为2.1%，4年时为3.4%，6年时为4.6%。首次骨折类型（转子间骨折与其他骨折）与后续植入物周围骨折的累积发病率相关（转子间骨折在2年时为0.8%，4年时为1.4%，6年时为2.7%；非转子间骨折在2年时为3.4%，4年时为5.3%，6年时为6.4%），p = 0.029。系统外患者的随访时间较短（中位数为6个月，而系统内患者为28个月，p < 0.001），348例系统外患者中只有1例（0.3%）被诊断为后续植入物周围骨折，而492例系统内患者中有21例（4.3%）被诊断为此类骨折（p < 0.001）。后续植入物周围骨折与患者人口统计学或合并症负担无关。
非转子间（股骨颈、股骨干和股骨远端）骨折的后续植入物周围骨折累积发病率高于转子间骨折。系统外患者的随访时间较短，被诊断为后续植入物周围骨折的可能性较小，这表明存在确诊偏倚，并强调了考虑失访情况的重要性。
治疗性三级。
