Factors associated with one year mortality in ill patients with proximal femoral fractures treated non operatively.

INTRODUCTION: Non-operative treatment is an exceptional indication for the treatment of proximal femur fracture. The aim of the study was to analyze the mortality rate in one year and associated factors in severely ill patients submitted to non-operative treatment. METHODS: It was included 28 patients treated from August 2014 to September 2019. Eighteen (64.3%) patients were female and 10 (35.7%) were male. The mean age was 78.7 ± 11.9 years old. The main outcome evaluated was the mortality rate in one year. It was also evaluated the correlation with gender, age, personal habits, number of comorbidities and Charlson Comorbidity Index (CCI). RESULTS: The functional result was assessed with WOMAC score via telephone call. The mortality rate in one year was 42.8% without statistical positive correlation with any of the studied parameters. Patients with three or more comorbidities didn't have a higher mortality rate comparing to survived patients (83.3% vs 81.3%). The CCI also didn't show any correlation with high mortality (6.9 vs 7.1). The functional result of the survived patients was poor (78.2 points WOMAC). CONCLUSION: The conclusion is that the mortality rate in one year of ill patients with hip fractures treated non-operatively is 42.8% without correlation with age, gender of number of comorbidities, and the functional result of the survived patients is poor.

Pantrochanteric Fracture: Incidence of the Complication in Patients with Trochanteric Fracture Treated with Dynamic Hip Screw in a Hospital of Southern Brazil.

OBJECTIVE: The aim of the present study was to investigate the incidence of pantrochanteric fractures in cases of trochanteric fractures treated with dynamic hip screw in our service. METHODS: A sample of 54 patients with trochanteric fractures treated with dynamic hip screws was included in this retrospective study. Preoperative radiographs were evaluated for fracture classification using the Arbeitsgemeinschaft für Osteosynthesefragen (Association for the Study of Internal Fixation, in German)/Orthopedic Trauma Association (AO/OTA) system for the identification of radiographic osteoporosis and for the measurement of the lateral femoral wall thickness. In the immediate postoperative images, the presence of pantrochanteric fracture was evaluated. RESULTS: The final sample presented an incidence of 16.7% of pantrochanteric fractures. The thickness of the lateral wall was significantly lower in the group with the complication ( p < 0.001). Although fractures classified as 31-A2 were more numerous in the group with pantrochanteric fracture, the difference was not statistically significant ( p = 0.456). CONCLUSION: The percentage of pantrochanteric fractures in this service is in accordance with previous studies. There was an association between lateral femoral wall thickness and the occurrence of iatrogenic fracture of the lateral cortex. There was no significant difference between fracture classification and pantrochanteric fracture, possibly due to sample size.

Pantrochanteric Fracture: Incidence of the Complication in Patients with Trochanteric Fracture Treated with Dynamic Hip Screw in a Hospital of Southern Brazil / Fratura pantrocantérica: incidência da complicação em pacientes comfratura trocantérica tratados comparafuso dinâmico de quadril em um hospital do Sul do Brasil

Abstract Objective The aim of the present study was to investigate the incidence of pantrochanteric fractures in cases of trochanteric fractures treated with dynamic hip screw in our service. Methods A sample of 54 patients with trochanteric fractures treated with dynamic hip screws was included in this retrospective study. Preoperative radiographs were evaluated for fracture classification using the Arbeitsgemeinschaft für Osteosynthesefragen (Association for the Study of Internal Fixation, in German)/Orthopedic Trauma Association (AO/OTA) system for the identification of radiographic osteoporosis and for the measurement of the lateral femoral wall thickness. In the immediate postoperative images, the presence of pantrochanteric fracture was evaluated. Results The final sample presented an incidence of 16.7% of pantrochanteric fractures. The thickness of the lateral wall was significantly lower in the group with the complication (p < 0.001). Although fractures classified as 31-A2 were more numerous in the group with pantrochanteric fracture, the difference was not statistically significant (p = 0.456). Conclusion The percentage of pantrochanteric fractures in this service is in accordance with previous studies. There was an association between lateral femoral wall thickness and the occurrence of iatrogenic fracture of the lateral cortex. There was no significant difference between fracture classification and pantrochanteric fracture, possibly due to sample size.

Resumo Objetivo Investigar a incidência de fraturas pantrocantéricas nos casos de fraturas trocantéricas tratadas com parafuso dinâmico de quadril em nosso serviço. Métodos Uma amostra de 54 pacientes comfraturas trocantéricas tratadas comparafuso dinâmico dequadril foi incluída neste estudo retrospectivo. Foramavaliadas radiografias précirúrgicas para classificação das fraturas com o sistema AO/OTA, identificação de osteoporose radiográfica emensuração da espessura da cortical lateral, enquanto nas imagens pósoperatórias imediatas foi avaliada a presença de fratura pantrocantérica. Resultados Aamostrafinal apresentou a incidência de 16,7%defraturaspantrocantéricas. A espessura da parede lateral foi significativamentemais baixa no grupo coma complicação (p < 0,001). Embora a incidência de fraturas classificadas como 31.A2 tenha sido maior no grupo com fratura pantrocantérica, a diferença não foi significativa (p = 0,456). Conclusão O percentual de fraturas pantrocantéricas nesse serviço encontra-se em acordo com trabalhos prévios. Houve associação entre espessura da cortical lateral e ocorrência de fratura iatrogênica da parede lateral. Não houve diferença significativa entre classificação das fraturas e fratura pantrocantérica, possivelmente devido ao tamanho da amostra.