Integrated risk scoring model for predicting dynamic hip screw treatment outcome of intertrochanteric fracture.
BACKGROUND
Dynamic hip screw (DHS) is a common device for treating intertrochanteric fracture (ITF). Various risk factors have been reported to be associated with the operative treatment outcome. However, an integrated risk scoring prediction model is lacking. In this study, we aimed to develop a prediction model for treatment outcome of intertrochanteric fracture.


METHODS
We analyzed 442 AO/OTA 31-A1 and A2 fractures which were treated with DHS during the period January 2000 to June 2014 in a level I trauma center. Risk factors including age, gender, injured side, lag screw position, AO/OTA classification, tip-apex distance, postoperative lateral wall fracture, reduction patterns were analyzed to determine their influence on treatment outcome. Integrated risk scores of significant predictors were used to construct a prediction model.


RESULTS
AO/OTA 31-A2 classification, postoperative lateral wall fracture, posteriorly inserted lag screw and varus reduction pattern were significant risk predictors for DHS failure. The failure risk for low- and high-risk groups were significantly different (P<0.001) CONCLUSION: AO/OTA 31-A2 classification, postoperative lateral wall fracture, posteriorly inserted lag screw and varus reduction pattern were significant risk predictors for DHS failure. We developed a model that integrates these factors to predict the treatment outcome, which had excellent prediction accuracy and discriminatory ability. The models may provide useful information for orthopedic doctors to identify patients who need early intervention as well as ITF patients who require more frequent follow-up in the postoperative period.
Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan; Division of Traumatology, Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.
Cheng-En
CE
Hsu
Department of Orthopedics, Asia University Hospital, Taichung, Taiwan; College of Medicine and Health Science, Department of Occupation Therapy, Asia University, Taichung, Taiwan.
Kui-Chou
KC
Huang
Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan; Division of Traumatology, Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan.
Tzu-Chieh
TC
Lin
Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan; Chaoyang University of Technology, Taichung, Taiwan.
Kwok-Man
KM
Tong
Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan. Electronic address: meihlee@ntu.edu.tw.
Mei-Hsuan
MH
Lee
School of Medicine,China Medical University, Taichung, Taiwan; Department of Orthopedics, China Medical University Hospital, Taichung, Taiwan. Electronic address: chouycheng@gmail.com.
Yung-Cheng
YC
Chiu
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001863:Bone Screws; D005260:Female; D005264:Femoral Fractures / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D005471:Fluoroscopy; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods; D017102:Fracture Healing; D006620:Hip Fractures / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013624:Taiwan / Q000453:epidemiology; D014193:Trauma Centers; D016896:Treatment Outcome
DHS; Dynamic hip screw; Garden alignment trabeculae angle; Intertrochanteric fracture; Lateral wall fracture; Prediction model