Sat., 10/20/07 Geriatrics/Injury Prevention, Paper #52, 9:49 am OTA-2007
Factors Influencing One-Year Mortality in Patients with Trochanteric Fractures:
A National Study of 4293 Patients
Kjell Matre, MD (n); Jonas Fevang, PhD (n);
Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
Purpose: Our objective was to calculate 1-year survival after trochanteric and subtrochanteric fractures and to assess factors associated with increased risk of death.
Patients: 4293 patients treated for trochanteric femoral fractures since January 2005 were registered in the Norwegian Hip Fracture Registry and were included in the present study.
Methods: The Norwegian Hip Fracture Registry was established in January 2005. Since then, proximal femoral fractures have been registered through standard forms filled in by the operating surgeons at all the 53 hospitals in which these fractures were treated. Survival was calculated using Kaplan Meier survival analyses and the impact of factors possibly influencing the survival was estimated using Cox regression analysis. Mortality data for all patients were obtained from Statistics Norway.
Results: The fractures were divided into three groups: trochanteric two-part (A1/48.5%), trochanteric multifragmentary (A2/36.4%,) and subtrochanteric (A3/15.1%) fractures. The sliding hip screw (SHS) was the implant most frequently used (3725/86.8%) and this was used either with (24.2%) or without (62.6%) the trochanteric support plate (TSP). Different nails were used in 568 patients (13.2%). Overall 1-year mortality was 25.6%. The type of fracture did not affect mortality. However, mortality was significantly influenced by the type of implant used, the 1-year mortality being 26.9%, 24.2%, and 22.1% with SHS, SHS with TSP, or nails, respectively. Adjusted for age, gender, dementia, ASA classification, and fracture type, the relative risk of death was 1.3 for SHS (with or without TSP) compared to nailing. Age, male gender, dementia, and increasing ASA classification adversely influenced survival. The preoperative delay did not.
Conclusion: Age, gender, dementia, and ASA classification influenced 1- year survival after trochanteric and subtrochanteric fractures. Rather surprisingly, nailing was associated with better survival than the SHS. The type of fracture or preoperative delay did not influence the 1-year mortality.
Significance: The present study indicates better survival with the use of nails compared to SHS. This finding is very interesting, but further investigations are required to confirm the result.
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