Does integrity of the lesser trochanter influence the surgical outcome of intertrochanteric fracture in elderly patients?

Abstract

BackgroundMost surgeons do not fix the lesser trochanter when managing femoral intertrochanteric fractures with intramedullary nails. We have not found any published clinical studies on the relationship between the integrity of the lesser trochanter and surgical outcomes of intertrochanteric fractures treated with intramedullary nails. The purpose of this study was to evaluate the impact of the integrity of the lesser trochanter on the surgical outcome of intertrochanteric fractures.MethodsA retrospective review of 85 patients aged more than 60 years with femoral intertrochanteric fractures from January 2010 to July 2012 was performed. The patients were allocated to two groups: those with (n = 37) and without (n = 48) preoperative integrity of the lesser trochanter. Relevant patient variables and medical comorbidities were collected. Medical comorbidities were evaluated according to the American Society of Anesthesiologists classification and medical records were also reviewed for age, sex, time from injury to operation, intraoperative blood loss, volume of transfusion, operative time, length of stay, time to fracture union, Harris Hip Score 1 year postoperatively, and incidence of postoperative complications. Postoperative complications included deep infection (beneath the fascia lata), congestive heart failure, pulmonary embolus, cerebrovascular accident, pneumonia, cardiac arrhythmia, urinary tract infection, wound hematoma, pressure sores, delirium, and deep venous thrombosis. Variables were statistically compared between the two groups, with statistical significance at P<0.05.ResultsPatients with and without preoperative integrity of the lesser trochanter were comparable for all assessed clinical variables except fracture type (P < 0.05). There were no statistically significant differences between these groups in time from injury to operation, volume of transfusion, length of stay, time to fracture union, Harris Hip Score at 1 year postoperatively, and incidence of postoperative complication (P > 0.05). The group with preoperative integrity of the lesser trochanter had significantly less blood loss (107.03 ± 49.21 mL) than those without it (133.96 ± 58.08 mL) (P < 0.05) and the operative time was significantly shorter in the former (0.77 ± 0.07 hours) than the latter (0.84 ± 0.11 hours) group (P < 0.05).ConclusionsThe integrity of the lesser trochanter has no significant influence on the surgical outcome of intramedullary nail internal fixation of femoral intertrochanteric fractures.

The Influence of Position of the Displaced Lesser Trochanter on Clinical Outcome of Unstable Trochanteric Femur Fractures in the Elderly

“…As demonstrated in our study, patients in Group B had statistically significant higher complication rate than result of Groups A and C. However, no significant differences were observed in complication rate between Groups A and C, which suggested that complication rate decreased after displaced lesser trochanter reduced operatively in the treatment of trochanteric fractures with intramedullary fixation. Liu et al [ 18 ] reported a comparable complication rate between patients with and without integrity of the lesser trochanter, which partially contradicted with our result. We believed that the thigh pain was analyzed and recorded as complication in our study, and no significant difference was found after thigh pain was excluded.…”

“…In our study, the surgical time was also significantly longer in Group C compared with Groups A and B. That was also in accordance with previous studies, which indicated that trochanteric fractures of A2 and A3 needed a longer operative time [ 18 , 26 , 27 ]. We believed that trochanteric fractures with displaced lesser trochanter treated with intramedullary fixation were much more technically demanding, especially when operative reduction of the displaced lesser trochanter was required.…”

“…Therefore, the position of the displaced lesser trochanter may affect clinical outcome in the treatment of unstable trochanteric fractures. To our knowledge, there was only one study to evaluate whether the integrity of the lesser trochanter affected the surgical outcome, and no significant difference was found [ 18 ]. However, whether the extent of displacement and operative reduction of the lesser trochanter have an influence on hip function and postoperative complications still remains controversial.…”

No difference in flexion power despite iliopsoas fatty degeneration in healed hip fractures with large lesser trochanter displacement

“…This would reduce the risk of loss of fracture reduction, penetration of the hip screw or varus deformity. In fact, there is biomechanical evidence from an in vitro study [ 21 ] that refixation of the lesser trochanter increases primary stability of pertrochanteric fracture osteosynthesis. In a recent published retrospective study, 22 patients with intertrochanteric fractures and lesser trochanter fragment displacement where treated surgically with proximal IM nailing and with a wiring technique for reduction and fixation of the lesser trochanter [ 22 ].…”

Functional outcome of proximal femoral nail antirotation with helical blade fixation in extra capsular hip fractures in Himalayan region

“…50% cases of hip fractures are extra capsular Intertrochanteric femoral fractures in geriatric population [4] . This needs early mobilization to prevent medical co-morbidies and regain preinjury activity operative management have become preferred [5] .…”