Complications and survival rates of subtrochanteric fractures are similar between short and long intramedullary nail fixation and independent of weight-bearing.

Autor: Cohen D; Department of Orthopedic Surgery, Shaare Zedek Medical Center, 12 Shmuel Bait St, PO Box 3235, 9103102, Jerusalem, Israel. dannyc@szmc.org.il., Tolwin Y; Department of Orthopedic Surgery, Shaare Zedek Medical Center, 12 Shmuel Bait St, PO Box 3235, 9103102, Jerusalem, Israel., Toybenshlak M; Department of Orthopedic Surgery, Shaare Zedek Medical Center, 12 Shmuel Bait St, PO Box 3235, 9103102, Jerusalem, Israel., Zinger G; Department of Orthopedic Surgery, Shaare Zedek Medical Center, 12 Shmuel Bait St, PO Box 3235, 9103102, Jerusalem, Israel., Peyser A; Department of Orthopedic Surgery, Shaare Zedek Medical Center, 12 Shmuel Bait St, PO Box 3235, 9103102, Jerusalem, Israel., Levy Y; Department of Orthopedic Surgery, Shaare Zedek Medical Center, 12 Shmuel Bait St, PO Box 3235, 9103102, Jerusalem, Israel.
Jazyk: angličtina
Zdroj: European journal of orthopaedic surgery & traumatology : orthopedie traumatologie [Eur J Orthop Surg Traumatol] 2024 Jul; Vol. 34 (5), pp. 2779-2784. Date of Electronic Publication: 2024 May 21.
DOI: 10.1007/s00590-024-03992-w
Abstrakt: Purpose: Intertrochanteric fractures are treated surgically, allowing rapid weight-bearing to improve ambulation and lower complications and mortality. Subtrochanteric fractures are mechanically less stable and are traditionally treated with a non-weight approach and longer intramedullary nails. This study compared immediate weight-bearing versus limited weight-bearing and different intramedullary nail lengths regarding patient outcomes.
Methods: We analyzed all consecutive cases of low-energy subtrochanteric fractures treated surgically at our institution between January 2016 and November 2020. One hundred and nine patients were found. We compared nail length and immediate versus delayed weight-bearing concerning the length of stay, time to painless ambulation, time to radiographic fracture union, and revision rates. Fracture severity was also examined using the Seinsheimer classification.
Results: Length of stay and time to painless ambulation were shorter in the immediate weight-bearing group. Time to radiographic union and rate of complications were lower; however, they were not statistically significant. Conversely, no significant difference in revision rates was found. Regarding nail length, the length of stay was shorter, and the time to painless ambulation was faster in the short-length group. The rate of complications and time to union were similar. No difference in revision rate was found. Seinsheimer classification of the fracture did not influence the decision to allow weight-bearing or nail selection (p = 0.65).
Conclusions: This study demonstrates that immediate weight-bearing as tolerated and short intramedullary nails allow a quicker time for painless ambulation and hospitalization, with possibly fewer perioperative complications and faster radiographic union, without increasing complications.
(© 2024. The Author(s).)
Databáze: MEDLINE
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