Cephalomedullary Nails for Isolated Subtrochanteric Femur Fractures: Age-Related Variations in Fracture Pattern and Perioperative Factors Do Not Affect Clinical and Radiographic Outcomes.

Abstract

Introduction: There is scarce data in literature on the demographics, treatment, and outcomes of subtrochanteric femur fracture patients. This study evaluated the effect of age on injury details, perioperative and hospital parameters, and outcomes following subtrochanteric fracture fixation.

Methods: An IRB-approved review of a consecutive series of subtrochanteric femoral fractures was performed. Patient charts and radiographs were examined to confirm patients were operatively treated for an AO/OTA Type 32A, B or C subtrochanteric femur fracture, as well as for demographics, injury information, perioperative details, radiographic parameters, hospital quality measures, and outcomes. Patients were divided into younger (Y) (< 65 years old) and older (O) (≥ 65 years old) cohorts. Comparative analyses were conducted between cohorts.

Results: Of 205 patients, 161 (78.5%) comprised the O cohort and 44 (21.5%) the Y cohort. The O cohort represented a sicker (higher CCI and ASA), less ambulatory population. Patients in the Y cohort sustained more high-energy injuries (p < 0.001). The most common fracture pattern was type 32A in both cohorts (p = 0.003). Older patients were treated more frequently with a 1-screw nail design (p = 0.005). The Y cohort had a shorter time to surgery (p = 0.002) and were more likely to be discharged home (p < 0.001). There were no differences in post-op complications, readmission or mortality rates, nonunion, fixation failure, or radiographic time to healing between cohorts.

Conclusion: Younger patients present with different subtrochanteric fracture patterns and discharge profiles than older patients and are treated with different implants. However, despite these differences, younger and older patients have similar radiographic and clinical outcomes.

Level of evidence: III.