Open Reduction in Subtrochanteric Femur Fractures Is Not Accompanied by a Higher Rate of Complications
<i>Background</i><i>and Objectives</i>: Hip fractures are among the most typical geriatric fractures. Subtrochanteric fractures are considered difficult to treat, and, to date, there is no consensus on the optimal surgical treatment. <i>Materialis</i><i>and...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2021-06-01
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| Series: | Medicina |
| Subjects: | |
| Online Access: | https://www.mdpi.com/1648-9144/57/7/659 |
| Summary: | <i>Background</i><i>and Objectives</i>: Hip fractures are among the most typical geriatric fractures. Subtrochanteric fractures are considered difficult to treat, and, to date, there is no consensus on the optimal surgical treatment. <i>Materialis</i><i>and Methods</i>: We analyzed data from the Registry for Geriatric Trauma, which includes patients ≥ 70 years old with hip fractures or periprosthetic fractures requiring surgery (21,734 patients in 2017–2019). For this study, we analyzed only the subgroup of patients with a subtrochanteric fracture. We analyzed the difference between closed and open surgical methods on a range of outcomes, including mortality, mobility, length of acute hospital stay, and the need for surgical revisions. <i>Results</i>: A total of 506 patients with subtrochanteric fractures were analyzed in this study. The median age was 85 years (interquartile range of 81–89). About 21.1% (<i>n</i> = 107) were operated on with a closed technique, 73.3% (<i>n</i> = 371) with open reduction without using a cerclage, and 5.53% (<i>n</i> = 28) with open reduction with the additional use of one or more cerclage wires. A total of 3.56% (<i>n</i> = 18) of the patients had complications requiring operative revision, most commonly soft tissue interventions (open vs. closed reduction—3.26% vs. 4.67%) (<i>p</i> = 0.687). Patients treated with open reduction were significantly more mobile 7 days after surgery (<i>p</i> = 0.008), while no significant effects on mortality (<i>p</i> = 0.312), length of hospital stay (<i>p</i> = 0.968), or surgical complications (<i>p</i> = 0.687) were found. <i>Conclusion</i>: Proper reduction is the gold standard practice for successful union in subtrochanteric fractures. This study shows that open reduction is not associated with a higher complication rate but does lead to increased mobility 7 days after operation. Therefore, in case of doubt, a good reduction should be aimed for, even using open techniques. |
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| ISSN: | 1010-660X 1648-9144 |