Impact of subtrochanteric fractures in the geriatric population : better pre-fracture condition but poorer outcome than pertrochanteric fractures: evidence from the Spanish Hip Fracture Registry
Aguado, Héctor J. (Universidad de Valladolid)
Castillón-Bernal, Pablo (Universitat Autònoma de Barcelona)
Ventura-Wichner, Paula S.. (Institut Germans Trias i Pujol)
Cervera-Díaz, María C. (Hospital Clínico Universitario de Valladolid)
Abarca-Vegas, Javier (Hospital Universitari MútuaTerrassa (Terrassa, Catalunya))
García-Flórez, Luis (Hospital Clínico Universitario de Valladolid)
Salvador-Carreño, Jordi (Hospital Universitari MútuaTerrassa (Terrassa, Catalunya))
García-Virto, Virginia (Hospital Clínico Universitario de Valladolid)
Simón-Pérez, Clarisa (Universidad de Valladolid)
Ojeda-Thies, Cristina (Hospital Universitario 12 de Octubre (Madrid))
Sáez-López, Pilar (Head Coordinator of the Spanish National Hip Fracture Registry (Madrid))
González-Montalvo, Juan Ignacio (Universidad Autónoma de Madrid. Departamento de Medicina)

Date:	2022
Abstract:	Clinical management in orthogeriatric units and outcome indicators are similar for extracapsular fragility hip fractures, without discriminating between subtrochanteric and pertrochanteric fractures. Geriatric patients, 75 years or older, with subtrochanteric fractures have worse clinical and functional outcomes than those with pertrochanteric fractures. Retrospective observational study of data prospectively collected by the Spanish Hip Fracture Registry including patients 75 years or older, admitted for extracapsular hip fractures from January 2017 to June 2019. Demographic and baseline status, pre-operative, post-operative and 30-day follow-up data were included. A total of 13,939 patients with extracapsular hip fractures were registered: 12,199 (87. 5%) pertrochanteric and 1740 (12. 5%) subtrochanteric. At admission, patients with subtrochanteric fractures were younger (86. 5 ± 5. 8 versus 87. 1 ± 5. 6 years old), had better pre-fracture mobility (3. 7 ± 2. 7 versus 3. 9 ± 2. 8) (1-to-10 scale, 1 being independent) and were more likely to be living at home; those with pertrochanteric fractures had worse cognitive function (Pfeiffer 3. 3 ± 3. 3 versus 3. 8 ± 3. 5). The subtrochanteric fracture group showed worse post-fracture mobility (7. 3 ± 2. 7 versus 6. 7 ± 2. 7) and greater deterioration of mobility (3. 7 ± 3. 0 versus 2. 9 ± 2. 7). Among individuals living at home at baseline, those with subtrochanteric fractures were more likely to remain in an assisted facility at 30-day follow-up. In-hospital mortality during acute admission was higher for the subtrochanteric group (5. 6% versus 4. 5%) (p = 0. 028). To our knowledge, this is the first paper highlighting the differences between these two fracture groups in the geriatric population. Subtrochanteric fractures in the older population are a different and worse entity, with greater morbimortality and functional decline than pertrochanteric fractures. Despite being younger and fitter at admission, older patients with subtrochanteric fractures have a higher risk of remaining non-weight bearing and undergoing re-operation and institutionalization. Orthogeriatric units should be aware of this and manage subtrochanteric fractures accordingly. Level of evidence: IV. The online version contains supplementary material available at 10. 1186/s10195-022-00637-8.
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Subject:	Aged ; Geriatric ; Hip fracture ; Pertrochanteric ; Subtrochanteric ; Intertrochanteric ; Extracapsular ; Registry ; Outcome ; Complication ; Fragility fracture
Published in:	Journal of Orthopaedics and Traumatology : Official Journal of the Italian Society of Orthopaedics and Traumatology, Vol. 23 (march 2022) , ISSN 1590-9999

DOI: 10.1186/s10195-022-00637-8
PMID: 35347459

8 p, 917.4 KB

The record appears in these collections:
Research literature > UAB research groups literature > Research Centres and Groups (research output) > Health sciences and biosciences > Institut d'Investigació en Ciencies de la Salut Germans Trias i Pujol (IGTP)
Articles > Research articles
Articles > Published articles