Borg Tomas, Forssten Maximilian Peter, Mohammad Ismail Ahmad, Cao Yang, Mohseni Shahin
Department of Orthopedic Surgery, Orebro University Hospital & School of Medical Sciences, Orebro University, Orebro, Sweden.
OTA Int. 2025 Jan 29;8(1):e358. doi: 10.1097/OI9.0000000000000358. eCollection 2025 Mar.
To compare postoperative mortality regarding 2 techniques in the treatment of trochanteric hip fractures (THFs).
Retrospective cohort study.
National databases.
All consecutive surgically treated THF cases between 2008 and 2017 were included. Pathological fractures or patients younger than 60 years were excluded.
Patients were grouped based on the surgical technique: sliding hip screw (SHS) or intramedullary (IM) nail. This data set was cross-referenced with a National Board of Health and Welfare's patient registry and a Cause of Death registry.
Mortality, comorbidities, and length of stay (LOS).
Forty-six thousand one hundred twenty-one cases were included. Twenty-five thousand eight hundred seventy-seven patients received a SHS, and 20,244 received an IM nail. Patients in the IM group were more often female (71.8% vs. 69.2%, < 0.001), slightly less fit for surgery (American Society of Anesthesiologists score ≥3: 61.2% vs. 60.1%, = 0.003), and more frail (Orthopedic Frailty Score ≥2: 54.2% vs. 52.8%, = 0.005). Multifragment fractures were more prevalent in the IM nail group (66.6% vs. 32.0%, < 0.001), which suffered from a higher comorbidity burden. After adjusting for potential confounders, no clinically significant differences in 7-day, 30-day, 90-day, or 1-year postoperative mortality were observed. Subgroup analyses focusing on 2-fragment and multifragment fractures could not detect any difference in mortality. LOS was 1 day shorter for the IM nail group as a whole.
Based on 10 years of data including 46,121 patients with THF managed with SHS or IM nail, no difference was observed in mortality up to 1 year postoperatively, when comparing surgical technique. LOS was shorter for the IM nail group.
比较两种治疗股骨转子间骨折（THF）的技术的术后死亡率。
回顾性队列研究。
国家数据库。
纳入2008年至2017年间所有连续接受手术治疗的THF病例。排除病理性骨折或年龄小于60岁的患者。
根据手术技术将患者分组：滑动髋螺钉（SHS）或髓内（IM）钉。该数据集与国家卫生和福利委员会的患者登记处以及死因登记处进行了交叉对照。
死亡率、合并症和住院时间（LOS）。
共纳入46121例病例。25877例患者接受了SHS治疗，20244例接受了IM钉治疗。IM组患者女性比例更高（71.8%对69.2%，<0.001），手术适应性稍差（美国麻醉医师协会评分≥3：61.2%对60.1%，=0.003），且更虚弱（骨科虚弱评分≥2：54.2%对52.8%，=0.005）。IM钉组多段骨折更为普遍（66.6%对32.0%，<0.001），合并症负担更高。在调整潜在混杂因素后，未观察到术后7天、30天、90天或1年死亡率的临床显著差异。针对两部分和多部分骨折的亚组分析未发现死亡率有任何差异。IM钉组总体住院时间短1天。
基于10年的数据，包括46121例接受SHS或IM钉治疗的THF患者，比较手术技术时，术后1年内死亡率无差异。IM钉组住院时间更短。
