EVALUATION OF COMPLICATIONS OF THREE DIFFERENT TYPES OF PROXIMAL EXTRA-ARTICULAR FEMUR FRACTURES

Abstract

The comparability of studies of extra-articular proximal femur fractures is compromised by the lack of a widely accepted, simple classification system with clinical and prognostic relevance. The aim of the study is to define the complication profile as well as differences relating to age, gender and survival rate of simple trochanteric fractures (typ 1), intertrochanteric comminute (typ 2) and subtrochanteric fractures (typ 3).

The records of 335 consecutive patients were analysed prospectively. Patients had a mean follow-up of 10 (0–56) months, and were treated operatively with three intramedullary nailing systems.

Simple trochanteric fractures (n=67) show only wound healing problems (1.5%). Median age is m/f 76.4(45–98) years/82.7(39–101), and the two-year survival rate is m/f 50.3%/84.9%. Intertrochanteric comminute fractures (n=204) demonstrate the highest complication rates (25%) with 9.7% femur head perforations, 3.5% other hardware related problems and 11.8% wound healing problems. Median age is m/f 72.5(41–94) years/83.6(54–100), survival rate is m/f 92.7%/66.5%. We observe a complication rate of 17.0% in subtrochanteric fractures (n=64), no femur head perforation but 9.1 % other hardware problems and 7.8% wound healing problems. Median age is m/f 61.1(24–91) years/81.6(38–99), surviving rate is m/f 92.3%/67.9%. The overall complication rate is nearly twice as high in females compared to males (19% versus 10%).

The 3 types of proximal extraarticular femur fractures show diferrences in epidemiological data such as median age and surviving rates. Furthermore intramedullary nail osteosynthesis of extraarticular proximal femur fractures lead to different complication patterns in simple trochanteric fractures, in comparison to inter-trochanteric comminuted fractures and subtrochanteric fractures. The recommended surgical treatment in Type 1 fractures leads to a low complication rate. Type 3 fractures exhibit an acceptable complication level; pseudarthrosis and intraoperative shaft fissures as well as wound healings problems are the main complications. Type 2 fractures represent fractures whose treatment is problematic, with the highest complication rate of hardware-related problems (13.2%), including femoral head perforation (9.7%), and the highest number of wound healing complications (11.8%), more than a third of which are infections.