Comparison of Intramedullary Nails in the Treatment of Trochanteric and Subtrochanteric Fractures: An Observational Study of 13,232 Fractures in the Norwegian Hip Fracture Register.

Autor:	Grønhaug KML; Department of Orthopedic Surgery, Østfold Hospital Trust, Sarpsborg, Norway.; Department of Clinical Medicine, University of Bergen, Bergen, Norway., Dybvik E; Norwegian Hip Fracture Register, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway., Matre K; Department of Clinical Medicine, University of Bergen, Bergen, Norway.; Norwegian Hip Fracture Register, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway., Östman B; Department of Orthopedic Surgery, Østfold Hospital Trust, Sarpsborg, Norway., Gjertsen JE; Department of Clinical Medicine, University of Bergen, Bergen, Norway.; Norwegian Hip Fracture Register, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway.
Jazyk:	angličtina
Zdroj:	The Journal of bone and joint surgery. American volume [J Bone Joint Surg Am] 2023 Aug 16; Vol. 105 (16), pp. 1227-1236. Date of Electronic Publication: 2023 Jul 07.
DOI:	10.2106/JBJS.22.01245
Abstrakt:	Background: Intramedullary nails are commonly used in the treatment of trochanteric and subtrochanteric fractures. We aimed to compare intramedullary nails in widespread use in Norway on the basis of reoperation risk. Methods: We assessed data from 13,232 trochanteric or subtrochanteric fractures treated with an intramedullary nail and registered in the Norwegian Hip Fracture Register between 2007 and 2019. The primary outcome measure was the risk of reoperation for various types of short and long intramedullary nails. Secondly, we compared risk of reoperation for the selected nails with respect to fracture type (AO/OTA type A1, A2, A3, and subtrochanteric fractures). Cox regression analysis adjusted for sex, age, and American Society of Anesthesiologists class was used to estimate hazard rate ratios (HRRs) for reoperation. Results: The mean patient age was 82.9 years, and 72.8% of the nails were used in the treatment of female patients. We included 8,283 short and 4,949 long nails. A1 fractures accounted for 29.8%, A2 for 40.6%, A3 for 7.2%, and subtrochanteric fractures for 22.4%. When comparing short nails regardless of fracture type, the TRIGEN INTERTAN had an increased risk of reoperation at 1 year (HRR, 1.31 [95% confidence interval (CI), 1.03 to 1.66]; p = 0.028) and 3 years (HRR, 1.31 [95% CI, 1.07 to 1.61]; p = 0.011) postoperatively compared with the Gamma3. For individual fracture types, we found no significant differences in reoperation risk between the various types of short nails. When comparing long nails, the TRIGEN TAN/FAN had an increased risk of reoperation at 1 year (HRR, 3.05 [95% CI, 2.10 to 4.42]; p < 0.001) and 3 years (HRR, 2.54 [95% CI, 1.82 to 3.54]; p < 0.001) postoperatively compared with the long Gamma3. Conclusions: This study may indicate a slightly increased risk of reoperation for the short TRIGEN INTERTAN compared with other short nails in widespread use in Norway. In analyses of long nails, the TRIGEN TAN/FAN nail was associated with a higher risk of reoperation in the treatment of trochanteric and subtrochanteric fractures. Level of Evidence: Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence. Competing Interests: Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article ( http://links.lww.com/JBJS/H604 ). (Copyright © 2023 by The Journal of Bone and Joint Surgery, Incorporated.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu