A New Postoperative Stability Score to Predict Loss of Reduction in Intertrochanteric Fractures in Elderly Patients

Abstract

The study aimed to validate a newly developed postoperative stability score for evaluating clinical follow-up in elderly patients with low-energy hip fractures. From 1 January 2020 to 31 December 2021, we enrolled patients aged over 65 who underwent cephalomedullary nail fixation using proximal femoral nail antirotation II (PFNAII) and had at least 6 months of follow-up; excluding multiple fractures, pathological fractures, and periprosthetic fractures. We collected general patient data. Parameters such as TAD, Parker's ratio (AP and lateral), and the new postoperative stability score were recorded. A loss of reduction was defined using the decline in the Chang reduction quality criteria (CRQC) score within one month. Among the 108 enrolled patients, 23 (21.3%) experienced a loss of reduction, with a mean age of 82.1 years and a mean follow-up time of 7.4 months. Univariate analysis showed no significant association between loss of reduction and general data. However, the new postoperative stability score correlated significantly with loss of reduction (mean scores: 6.68 vs. 4.83, p = 0.045). Multivariate analysis confirmed this association (odds ratio: 0.076, 95% confidence interval: 0.022-0.263, p < 0.05). The newly developed postoperative stability score, incorporating surgical technique assessment, improves prediction accuracy for loss of reduction in elderly intertrochanteric fracture (ITF) patients.

Keywords: geriatric; hip fracture; intramedullary nailing; stability score.

Figure 1

(A) Lateral wall fracture gap length defined as the distance in millimeters from a reference point 3 cm below the innominate tubercle of the greater trochanter, angled at 130° upward to the fracture line (distance between A and B). (B) Distance between the posterior tip of the blade and the lateral cortex (distances C and D). (C,C’) TAD was defined as measurement of tip apex distance and is the sum of the distance from the apex of the femoral head to the top of the lag screw on anteroposterior and lateral radiographs (Xap + Xlat). (D) Parker’s ratio in AP% was AB/AC. (D’) Parker’s ratio in lateral% was AB/AC.

Figure 2

Flow chart describing patient groups and patient selection. PENA II, proximal femoral nail antirotation.