Inferior Outcome after Unstable Trochanteric Fracture Patterns Compared to Stable Fractures in the Elderly

Abstract

Background: Various risk factors affecting outcome of elderly patients after proximal femur fracture have been identified. The present study aims to evaluate the impact of the fracture pattern in trochanteric fractures on postoperative mobility and complications.

Methods: Ninety-two patients with a mean age of 84 years were included. According to the revised AO/OTA classification, fractures were divided into stable (AO 31A1) and unstable (AO 31A2/3) patterns. A follow-up examination was performed 12 months after cephalomedullary fixation to assess outcome parameters for mobility/activities of daily living (Parker Mobility Score (PMS)/Barthel Index (BI)) and complications (increase in requirement of care, hospital readmission, mortality rate).

Results: At follow-up, patients with unstable trochanteric fracture patterns presented with lower PMS and BI compared to stable fractures (p < 0.05). Further, higher requirement of care and higher readmission rates compared to stable patterns were observed.

Conclusion: Unstable trochanteric fractures presented inferior outcome compared to simple fracture patterns. This might be explained by the increasing surgical trauma in unstable fractures as well as by the mechanical impact of the lesser trochanter, which provides medial femoral support and is of functional relevance. Subsequent studies should assess if treatment strategies adapted to the specific fracture pattern (refixation of lesser trochanter) influence outcome in unstable trochanteric fractures.

Keywords: orthogeriatric; osteoporosis; proximal femur fracture; trochanteric fracture; unstable.

Figure 1

Radiographic images of different trochanteric fracture patterns according to the revised AO/OTA Classification. (A) = 31A1; (B) = 31A2; (C) = 31A3.

Figure 2

Requirement for open reduction (A), duration of the surgery (B), amount of perioperative transfused packed red blood concentrates (PRBC) (C) and impact in pre-/peri- and postoperative blood loss (D) depending on the fracture pattern; * p < 0.05.

Figure 3

Mean values of Parker Mobility Score (A) and Barthel Index (B) in respect to the AO/OTA classification at 12 months follow-up and correlation of both parameters (C); * p < 0.05.

Figure 4

Requirement of care at preoperative and follow-up assessment (A), reasons for readmission (B) and mortality (C) in respect to the AO/OTA classification; * p < 0.05.