The postoperative prognosis of older intertrochanteric fracture patients as evaluated by the Chang reduction quality criteria

Abstract

Objective: The aim of this study was to investigate the relationship between the Chang reduction quality criteria (CRQC) and the outcome of intertrochanteric fractures in older adults according to follow-up time.

Methods: This was a retrospective analysis of 389 older adult patients with intertrochanteric fractures treated surgically from January 2019 to June 2021, including 130 males and 259 females aged 84.6 (77.5-89.7) years. Patient survival was determined by telephone as the time between admission to hospital for fracture and death or until the study deadline (June 1, 2022). According to the CRQC, the patients were divided into the Poor, Acceptable, and Excellent groups. Univariate and multivariate Cox proportional hazard models were used to assess the association between CRQC and all-cause mortality in older adult intertrochanteric fractures at 1 year and the total follow-up time. Further subgroup analysis was performed according to different clinical and biological characteristics to improve the accuracy of the results.

Results: The mortality rates were 24.7% and 15.4% at 1 year and the total follow-up time, respectively. Both at one year and the total follow-up time, the mortality of the CRQC-Excellent group was significantly lower than that of the CRQC-Acceptable group (p.adj < 0.05) and the CRQC-Poor group (p.adj < 0.05). After multifactor adjustment, CRQC grades of Acceptable and Poor were independent risk factors affecting the overall and 1-year mortality. In addition, advanced age, ≥ 1 comorbidities, ASA 3 + 4, and prolonged preoperative waiting time were independent risk factors for survival at the total follow-up time. At 1 year, only ASA 3 + 4 and prolonged preoperative waiting time were independent risk factors for survival. Subgroup analysis according to different characteristics at the total follow-up time and at one year showed that in most subgroups, a decrease in the CRQC grade was significantly associated with an increase in all-cause mortality (p for trend < 0.05).

Conclusions: This study highlights that CRQC grades of Acceptable and Poor are associated with increased all-cause mortality in older adult intertrochanteric fractures. We should attempt to achieve good reduction of these fractures.

Keywords: Chang reduction quality criteria; Intertrochanteric fractures; Mortality; Older adults.

Fig. 1

Postoperative X-ray of intertrochanteric fractures. A X-ray shows positive medial cortical support, meaning that the inferior edge of the medial cortex of the femoral head-neck fragment is medial to the superior edge of the medial cortex of the femoral shaft with a displacement of less than one cortical thickness. B X-ray shows negative medial cortical support, meaning that the inferior edge of the medial cortex of the femoral head-neck fragment is lateral to the superior edge of the medial cortex of the femoral shaft, regardless of displacement distance. C X-ray shows neutral medial cortical support, meaning that the medial cortex of the head–neck fragment and the femoral shaft are in smooth contact

Fig. 2

Column diagram comparing mortality in older adult intertrochanteric fracture patients at the 1-year and total follow-up for different Chang reduction quality criteria (CRQC) grades. P values obtained using the chi-square test

Fig. 3

Forest plot of the subgroup analyses estimating the association between the Chang reduction quality criteria (CRQC) grade and total follow-up mortality based on different characteristics. Differences between subgroups were analyzed by Cox regression analysis. The black rhombuses represent the hazard ratio (HR), and the black horizontal lines represent the 95% confidence interval (CI)

Fig. 4

Forest plot of the subgroup analyses estimating the association between the Chang reduction quality criteria (CRQC) grade and 1-year follow-up mortality based on different characteristics. Differences between subgroups were analyzed by Cox regression analysis. The black rhombuses represent the hazard ratio (HR), and the black horizontal lines represent the 95% confidence interval (CI)