title: High Complication Rate in Young Patients With High-Energy Intertrochanteric Femoral Fractures.
abstract: Although intertrochanteric femoral fractures in elderly patients are common injuries that have been studied extensively, little has been reported about high-energy intertrochanteric fractures in younger patients. This study examined the injury characteristics and outcomes of high-energy intertrochanteric fractures in patients younger than 65 years treated with either sliding hip screws (SHSs) or cephalomedullary nails (CMNs). A total of 37 patients younger than 65 years (mean age, 45 years) with high-energy intertrochanteric fractures and mean follow-up of 34 weeks were identified; 21 patients were treated with SHSs, and 16 patients were treated with CMNs. All fractures were AO/ Orthopaedic Trauma Association (OTA) fracture type 31A1 or 31A2. Injury characteristics, measures of surgical quality, treatment outcomes, and complications were compared. Despite high-energy mechanisms of injury, 84% of patients had AO/OTA type 31A1 fractures, 60% presented with an Injury Severity Score of 17 or higher, and 78% sustained other injuries. There were no significant differences in tip-apex distance (TAD), reduction quality, blood loss, or surgical time (P>.05) for fractures treated with SHSs or CMNs. The overall rate of major complications requiring revision surgery was 13.5%; this difference was not statistically significant (P=.36). Young patients with intertrochanteric fractures often have multisystem trauma; these fractures are difficult to reduce by closed means, and young patients are more prone to complications than older patients. In particular, varus collapse occurred at a high rate in young patients with intertrochanteric fractures treated with SHSs despite relatively simple fracture patterns, satisfactory TAD, and satisfactory reduction quality. [Orthopedics. 2017; 40(2):e293-e299.].
authors.forename: Michael H
authors.initials: MH
authors.lastname: Amini
authors.forename: John J
authors.initials: JJ
authors.lastname: Feldman
authors.forename: John C
authors.initials: JC
authors.lastname: Weinlein
mesh_terms: D001858:Bone Nails; D001863:Bone Screws; D005260:Female; D006620:Hip Fractures / Q000601:surgery*; D006801:Humans; D015994:Incidence; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D019637:Orthopedic Procedures / Q000009:adverse effects*; D011183:Postoperative Complications / Q000453:epidemiology*; D012086:Reoperation; D016896:Treatment Outcome