Pathological subtrochanteric fractures in 194 patients: a comparison of outcome after surgical treatment of pathological and non-pathological fractures.
BACKGROUND
The surgical treatment of pathological subtrochanteric fractures has been associated with technical difficulties and frequent failures. We analyzed survival, risk factors for death, and outcome after surgical treatment.


METHODS
The study group consisted of 194 patients with pathological subtrochanteric femur fractures operated during 1999-2009. Cox multiple-regression analysis was performed to study risk factors and results were expressed as hazard ratios (HR). We included a control group with non-pathological subtrochanteric fractures (n = 87) for comparison.


RESULTS
The median age at surgery was 68 (29-96) years in the study group and 82 (66-101) in the controls. The 1-year survival rate after surgery was 33% (95% CI: 26-40) in the study group and 85% (79-93) in the controls. In the study group, the risk of death after surgery was increased for patients ≥65 years of age (HR 1.5, 95% CI: 1.1-2.1), with a moderate (HR 2.2, 1.5-3.4) and poor (HR 2.9, 1.6-5.2) Karnofsky score, with visceral metastases (HR 1.6, 1.1-2.3), and perioperative hemoglobin levels <100 g/L (HR 2.2, 1.3-3.7). In patients with pathological fractures, there was no statistically significant difference concerning reoperation rates comparing intramedullary nails (9%) with endoprostheses (6%; P = 0.3).


CONCLUSIONS
Surgery for pathological subtrochanteric femur fractures is a relatively safe and effective procedure.
Department of Molecular Medicine and Surgery, Section of Orthopaedics and Sports Medicine, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden. rudiger.weiss@karolinska.se
Rüdiger J
RJ
Weiss
Wilhelmina
W
Ekström
Bjarne H
BH
Hansen
Johnny
J
Keller
Minna
M
Laitinen
Clement
C
Trovik
Olga
O
Zaikova
Rikard
R
Wedin
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip; D016022:Case-Control Studies; D005260:Female; D005264:Femoral Fractures / Q000209:etiology / Q000601:surgery*; D005266:Femoral Neoplasms / Q000150:complications* / Q000401:mortality*; D005592:Fracture Fixation; D062785:Hemiarthroplasty; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D011183:Postoperative Complications; D016016:Proportional Hazards Models; D012086:Reoperation / Q000706:statistics & numerical data
D006454:Hemoglobins