Risk factors for intraoperative greater trochanteric fractures in hemiarthroplasty for intracapsular femoral neck fractu
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ORIGINAL ARTICLE
Risk factors for intraoperative greater trochanteric fractures in hemiarthroplasty for intracapsular femoral neck fractures Johannes Karl Maria Fakler1 · Alexander Brand1 · Christian Lycke1 · Christina Pempe1 · Mohamed Ghanem1 · Andreas Roth1 · Georg Osterhoff1 · Ulrich Josef Albert Spiegl1 · Andreas Höch1 · Dirk Zajonz1,2,3 Received: 24 August 2020 / Accepted: 5 November 2020 © The Author(s) 2020
Abstract Purpose Hemiarthroplasty is widely accepted as the treatment of choice in elderly patients with a displaced intracapsular femoral neck fracture. Intraoperative greater trochanteric fractures thwart this successful procedure, resulting in prolonged recovery, inferior outcome, and increased risk of revision surgery. Hence, this study analyzed factors potentially associated with an increased risk for intraoperative greater trochanteric fracture. Methods This retrospective study included 512 hemiarthroplasties in 496 patients with a geriatric intracapsular femoral neck fracture from July 2010 to March 2020. All patients received the same implant type of which 90.4% were cemented and 9.6% non-cemented. Intra- and postoperative radiographs and reports were reviewed and particularly screened for greater trochanteric fractures. Results Female patients accounted for 74% and mean age of the patients was 82.3 (± 8.7) years. 34 (6.6%) intraoperative greater trochanteric fractures were identified. In relation to patient-specific factors, only a shorter prothrombin time was found to be significantly associated with increased risk of intraoperative greater trochanteric fracture (median 96%, IQR 82–106% vs. median 86.5%, IQR 68.8–101.5%; p = 0.046). Other factors associated with greater trochanteric fracture were a shorter preoperative waiting time and changes in perioperative settings. Outcome of patients with greater trochanteric fracture was worse with significantly more surgical site infection requiring revision surgery (17.6% vs. 4.2%, p = 0.005). Conclusion Prolonged prothrombin time, a shorter preoperative waiting time, and implementing new procedural standards and surgeons may be associated with an increased risk of a greater trochanteric fracture. Addressing these risk factors may reduce early periprosthetic infection which is strongly related to greater trochanteric fractures. Keywords Hemiarthroplasty · Femoral neck fracture · Greater trochanteric fracture · Periprosthetic fracture
Introduction Hemiarthroplasty (HA) is widely accepted as the treatment of choice in elderly patients with a displaced intracapsular femoral neck fracture [1]. It provides good functional results [2, 3] at a fairly low rate of serious complications * Johannes Karl Maria Fakler [email protected]‑leipzig.de 1
Department of Orthopaedic, Trauma and Plastic Surgery, University Hospital of Leipzig, Liebigstr. 20, 04105 Leipzig, Germany
2
Department of Orthopaedic and Trauma Surgery, Zeisigwald Hospitals Chemnitz, Chemnitz, Germany
3
ZESBO-Center for Research on Musculoskeletal Systems, Semmelweisstra
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