Morbidity and Mortality in Intertrochanteric Hip Fractures Treated With Cephalo-medullary Nailing. Predictive Value of the Parker Mobility Score
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Published:
Oct 17, 2023
Keywords:
Intertrochanteric hip fracture, morbidity, mortality, cephalo-medullary nailing, Parker Mobility Score
Main Article Content
Abstract
Introduction: Hip fracture represents an independent predictor of morbidity and mortality. The aim of this retrospective study was to assess the morbidity and mortality associated with intertrochanteric hip fractures fixed with cephalomedullary nails.
Materials and Methods: We analyzed all patients treated between 2018 and 2021 with a cephalomedullary nail for an intertrochanteric hip fracture, with a minimum follow-up of 12 months. We evaluated the demographic data, comorbidities, functional level through the Parker Mobility Score (PMS), complications, and mortality (12 months and at the end of follow-up). Variables related to postoperative complications or death were identified by bivariate and multivariate regression analyses.
Results: 68 patients were included. The mean follow-up was 23 (range 12-40) months. The rate of complications was 8.8% (n=6), 1 urinary tract infection, 1 pneumonia, 1 deep vein thrombosis, and 3 (4.4%) cephalic screw fixation losses. Patients who had complications presented significant differences in age at the time of fracture. Mortality at 12 months and at the end of the study was 2.9% (n=2) and 29.4% (n=20) respectively. Those patients who died presented significant differences in the incidence of kidneycomorbidities, dementia, a Charlson Comorbidity Index > 4, and a PMS < 5. PMS < 5 was the only independent variable related to mortality.
Conclusions: Cephalomedullary nailing in unstable intertrochanteric hip fractures in elderly patients represents a treatment option that offers an acceptable complication rate and a low 12-month mortality rate. The risk of death is significantly increased in patients with low functional scores (Parker < 5) pre-fracture.
Materials and Methods: We analyzed all patients treated between 2018 and 2021 with a cephalomedullary nail for an intertrochanteric hip fracture, with a minimum follow-up of 12 months. We evaluated the demographic data, comorbidities, functional level through the Parker Mobility Score (PMS), complications, and mortality (12 months and at the end of follow-up). Variables related to postoperative complications or death were identified by bivariate and multivariate regression analyses.
Results: 68 patients were included. The mean follow-up was 23 (range 12-40) months. The rate of complications was 8.8% (n=6), 1 urinary tract infection, 1 pneumonia, 1 deep vein thrombosis, and 3 (4.4%) cephalic screw fixation losses. Patients who had complications presented significant differences in age at the time of fracture. Mortality at 12 months and at the end of the study was 2.9% (n=2) and 29.4% (n=20) respectively. Those patients who died presented significant differences in the incidence of kidneycomorbidities, dementia, a Charlson Comorbidity Index > 4, and a PMS < 5. PMS < 5 was the only independent variable related to mortality.
Conclusions: Cephalomedullary nailing in unstable intertrochanteric hip fractures in elderly patients represents a treatment option that offers an acceptable complication rate and a low 12-month mortality rate. The risk of death is significantly increased in patients with low functional scores (Parker < 5) pre-fracture.
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How to Cite
Garabano, G., Taleb, J. P., Cullari, M. L., Pérez Alamino, L., & Pesciallo, C. Ángel. (2023). Morbidity and Mortality in Intertrochanteric Hip Fractures Treated With Cephalo-medullary Nailing. Predictive Value of the Parker Mobility Score. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 88(5), 493-501. https://doi.org/10.15417/issn.1852-7434.2023.88.5.1681
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Clinical Research
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15. Zaki HE, Mousa SM, El Said SMS, Mortagy AK. Morbidity and mortality following surgery for hip fractures in
elderly patients. J Aging Res 2019;5:7084657. https://doi.org/10.1155/2019/7084657
16. Parvizi J, Ereth MH, Lewallen DG. Thirty-day mortality following hip arthroplasty for acute fracture. J Bone Joint
Surg Am 2004;86(9):1983-8. https://doi.org/10.2106/00004623-200409000-00017
17. Kirkland LL, Kashiwagi DT, Burton MC, Cha S, Varkey P. The Charlson Comorbidity Index Score as a predictor of 30-day mortality after hip fracture surgery. Am J Med Qual 2011;26(6):461-7. https://doi.org/10.1177/1062860611402188
18. Schultz KA, Westcott BA, Barber KR, Sandrock TA. Elevated 1-year mortality rate in males sustaining low-energy proximal femur fractures and subgroup analysis utilizing age-adjusted Charlson Comorbidity Index. Geriatr Orthop Surg Rehabil 2020;11:2151459319898644. https://doi.org/10.1177/2151459319898644
19. Kashigar A, Vincent A, Gunton MJ, Backstein D, Safir O, Kuzyk PRT. Predictors of failure for cephalomedullary
nailing of proximal femoral fractures. Bone Joint J 2014;96-B(8):1029-34. https://doi.org/10.1302/0301-620X.96B8.33644
20. Ibrahim I, Appleton PT, Wixted JJ, DeAngelis JP, Rodriguez EK. Implant cut-out following cephalomedullary
nailing of intertrochanteric femur fractures: Are helical blades to blame? Injury 2019;50(4):926-30.
https://doi.org/10.1016/j.injury.2019.02.015
21. Garabano G, Pereira S, Rodriguez J, Pesciallo C, Bidolegui F. Anterior lag crew position and suboptimal reduction in lateral plain as predictors of failure in cephalomedullary nailing of intertrochanteric fractures. SN Compr Clin Med 2022;50:4. https://doi.org/10.1007/s42399-022-01133-0
22. Pérez-Sáez MJ, Prieto-Alhambra D, Barrios C, Crespo M, Redondo D, Nogués X, et al. Increased hip fracture and mortality in chronic kidney disease individuals: the importance of competing risks. Bone 2015;73:154-9.
https://doi.org/10.1016/j.bone.2014.12.020
23. Hou M, Zhang Y, Chen AC, Liu T, Yang H, Zhu X, et al. The effects of dementia on the prognosis and mortality of hip fracture surgery: a systematic review and meta-analysis. Aging Clin Exp Res 2021;33(12):3161-72.
https://doi.org/10.1007/s40520-021-01864-5
24. Schnell S, Friedman SM, Mendelson DA, Bingham KW, Kates SL. The 1-year mortality of patients treated in a hip fracture program for elders. Geriatr Orthop Surg Rehabil 2010;1(1):6-14. https://doi.org/10.1177/2151458510378105
25. Koval KJ, Aharonoff GB, Rosenberg AD, Bernstein RL, Zuckerman JD. Functional outcome after hip fracture.
Effect of general versus regional anesthesia. Clin Orthop Relat Res 1998;(348):37-41. PMID: 9553531
26. Jacelon CS. The Barthel Index and other indices of functional ability. Rehabil Nurs 1986;11(4):9-11.
https://doi.org/10.1002/j.2048-7940.1986.tb00995.x
2011;137(8):355-60. https://doi.org/10.1016/j.medcli.2010.07.005
2. Garabano G, Cubecino A, Simesen de Bielke H, Robador N, Olivetto JM, Sierto M, et al. Epidemiología de la
fractura de cadera en la Argentina. Rev Asoc Argent Ortop Traumatol 2020;85(4):437-46. https://doi.org/10.15417/issn.1852-7434.2020.85.4.1113
3. Garabano G, Simesen de Bielke H, Cubecino A, Robador NA, Olivetto J, Gamarra D, et al. Epidemiología de la
fractura de cadera en la Argentina. Anemia, internación prolongada y puntaje ASA como factores predictivos de
morbimortalidad en el análisis de 1000 pacientes. Rev Asoc Argent Ortop Traumatol 2022;87(1):111-21.
https://doi.org/10.15417/issn.1852-7434.2022.87.1.1340
4. Giversen IM. Time trends of mortality after first hip fractures. Osteoporos Int 2007;18(6):721-32.
https://doi.org/10.1007/s00198-006-0300-1
5. Haleem S, Lutchman L, Mayahi R, Grice JE, Parker MJ. Mortality following hip fracture: trends and geographical
variations over the last 40 years. Injury 2008;39(10):1157-63. https://doi.org/10.1016/j.injury.2008.03.022
6. Bliuc D, Nguyen ND, Milch VE, Nguyen TV, Eisman JA, Center JR. Mortality risk associated with low-trauma
osteoporotic fracture and subsequent fracture in men and women. JAMA 2009;301(5):513-21. https://doi.org/10.1001/jama.2009.50
7. De Luise C, Brimacombe M, Pedersen L, Sørensen HT. Comorbidity and mortality following hip fracture: a
population-based cohort study. Aging Clin Exp Res 2008;20(5):412-8. https://doi.org/10.1007/BF03325146
8. Brossa Torruella A, Tobias Ferrer J, Zorrilla Ribeiro J, López Borras E, Alabart Teixidó A, Belmonte Garrido FM.
Mortalidad a los tres años de los pacientes con fractura de fémur. Med Clin (Barc) 2005;124(2):53-4.
https://doi.org/10.1157/13070452
9. Abrahamsen B, van Staa T, Ariely R, Olson M, Cooper C. Excess mortality following hip fracture: a systematic
epidemiological review. Osteoporos Int 2009;20(10):1633-50. https://doi.org/10.1007/s00198-009-0920-3
10. Tiret L, Hatton F, Desmonts JM, Vourc’h G. Prediction of outcome of anaesthesia in patients over 40 years: a
multifactorial risk index. Stat Med 1988;(9):947-54. https://doi.org/10.1002/sim.4780070906
11. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in
longitudinal studies: development and validation. J Chronic Dis 1987;40(5):373-83. https://doi.org/10.1016/0021-9681(87)90171-8
12. Parker MJ, Palmer CR. A new mobility score for predicting mortality after hip fracture. J Bone Joint Surg Br
1993;75(5):797-8. https://doi.org/10.1302/0301-620X.75B5.8376443
13. Cleveland M, Bosworth DM, Thompson FR, Wilson HJ Jr, Ishizuka T. A ten-year analysis of intertrochanteric
fractures of the femur. J Bone Joint Surg Am 1959;41:1399-408. PMID: 13849408
14. Baumgaertner MR, Curtin SL, Lindskog DM, Keggi JM. The value of the tip-apex distance in predicting failure
of fixation of peritrochanteric fractures of the hip. J Bone Joint Surg Am 1995;77(7):1058-64. https://doi.org/10.2106/00004623-199507000-00012
15. Zaki HE, Mousa SM, El Said SMS, Mortagy AK. Morbidity and mortality following surgery for hip fractures in
elderly patients. J Aging Res 2019;5:7084657. https://doi.org/10.1155/2019/7084657
16. Parvizi J, Ereth MH, Lewallen DG. Thirty-day mortality following hip arthroplasty for acute fracture. J Bone Joint
Surg Am 2004;86(9):1983-8. https://doi.org/10.2106/00004623-200409000-00017
17. Kirkland LL, Kashiwagi DT, Burton MC, Cha S, Varkey P. The Charlson Comorbidity Index Score as a predictor of 30-day mortality after hip fracture surgery. Am J Med Qual 2011;26(6):461-7. https://doi.org/10.1177/1062860611402188
18. Schultz KA, Westcott BA, Barber KR, Sandrock TA. Elevated 1-year mortality rate in males sustaining low-energy proximal femur fractures and subgroup analysis utilizing age-adjusted Charlson Comorbidity Index. Geriatr Orthop Surg Rehabil 2020;11:2151459319898644. https://doi.org/10.1177/2151459319898644
19. Kashigar A, Vincent A, Gunton MJ, Backstein D, Safir O, Kuzyk PRT. Predictors of failure for cephalomedullary
nailing of proximal femoral fractures. Bone Joint J 2014;96-B(8):1029-34. https://doi.org/10.1302/0301-620X.96B8.33644
20. Ibrahim I, Appleton PT, Wixted JJ, DeAngelis JP, Rodriguez EK. Implant cut-out following cephalomedullary
nailing of intertrochanteric femur fractures: Are helical blades to blame? Injury 2019;50(4):926-30.
https://doi.org/10.1016/j.injury.2019.02.015
21. Garabano G, Pereira S, Rodriguez J, Pesciallo C, Bidolegui F. Anterior lag crew position and suboptimal reduction in lateral plain as predictors of failure in cephalomedullary nailing of intertrochanteric fractures. SN Compr Clin Med 2022;50:4. https://doi.org/10.1007/s42399-022-01133-0
22. Pérez-Sáez MJ, Prieto-Alhambra D, Barrios C, Crespo M, Redondo D, Nogués X, et al. Increased hip fracture and mortality in chronic kidney disease individuals: the importance of competing risks. Bone 2015;73:154-9.
https://doi.org/10.1016/j.bone.2014.12.020
23. Hou M, Zhang Y, Chen AC, Liu T, Yang H, Zhu X, et al. The effects of dementia on the prognosis and mortality of hip fracture surgery: a systematic review and meta-analysis. Aging Clin Exp Res 2021;33(12):3161-72.
https://doi.org/10.1007/s40520-021-01864-5
24. Schnell S, Friedman SM, Mendelson DA, Bingham KW, Kates SL. The 1-year mortality of patients treated in a hip fracture program for elders. Geriatr Orthop Surg Rehabil 2010;1(1):6-14. https://doi.org/10.1177/2151458510378105
25. Koval KJ, Aharonoff GB, Rosenberg AD, Bernstein RL, Zuckerman JD. Functional outcome after hip fracture.
Effect of general versus regional anesthesia. Clin Orthop Relat Res 1998;(348):37-41. PMID: 9553531
26. Jacelon CS. The Barthel Index and other indices of functional ability. Rehabil Nurs 1986;11(4):9-11.
https://doi.org/10.1002/j.2048-7940.1986.tb00995.x