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Increased mortality after intramedullary nailing of trochanteric fractures : a comparison of sliding hip screws with nails in 19,935 patients

Wolf, Olof ; Mukka, Sebastian ; Ekelund, Jan ; Rogmark, Cecilia LU ; Möller, Michael and Hailer, Nils P. (2022) In Acta Orthopaedica 93. p.146-150
Abstract

Background and purpose - Intramedullary nails (IMN) have become increasingly common as treatment for trochanteric hip fractures (THF) although they are costlier, and without proven superiority compared with sliding hip screws (SHS). We investigated whether the 2 methods differ in terms of short-term mortality when used in fractures where both methods are suitable. Patients and methods - We extracted data from the Swedish Fracture Register (SFR) on 19,935 patients ≥ 60 years with trochanteric fractures AO type 31-A1 or -A2 who had been treated with either SHS or IMN. We assessed absolute mortality rates and the relative risks (RR) of death after 7, 30, 90, and 365 days using generalized linear models, adjusting for age, sex, and fracture... (More)

Background and purpose - Intramedullary nails (IMN) have become increasingly common as treatment for trochanteric hip fractures (THF) although they are costlier, and without proven superiority compared with sliding hip screws (SHS). We investigated whether the 2 methods differ in terms of short-term mortality when used in fractures where both methods are suitable. Patients and methods - We extracted data from the Swedish Fracture Register (SFR) on 19,935 patients ≥ 60 years with trochanteric fractures AO type 31-A1 or -A2 who had been treated with either SHS or IMN. We assessed absolute mortality rates and the relative risks (RR) of death after 7, 30, 90, and 365 days using generalized linear models, adjusting for age, sex, and fracture type. We performed a sensitivity analysis on a subgroup of 3,673 patients with information on comorbidity to address this potential confounder. Results - 69% of the patients were women and mean age was 84 years (60-107). IMN was used in 35% of A1 and in 71% of A2 fractures. The use of IMN was associated with a slightly increased adjusted risk of death within 30 days compared with SHS (RR = 1.1, 95% CI 1.0-1.2) with no difference at any other time point. Interpretation - The slightly increased risk of death up to 30 days postoperatively does not support the use of IMN instead of SHS in stable THF.

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type
Contribution to journal
publication status
published
subject
in
Acta Orthopaedica
volume
93
pages
5 pages
publisher
Taylor & Francis
external identifiers
  • scopus:85123231499
  • pmid:34984474
ISSN
1745-3682
DOI
10.2340/17453674.2021.862
language
English
LU publication?
yes
id
9fe6542e-8f06-4855-a1be-c162a9dbf6a1
date added to LUP
2022-03-21 14:21:37
date last changed
2024-06-20 12:12:34
@article{9fe6542e-8f06-4855-a1be-c162a9dbf6a1,
  abstract     = {{<p>Background and purpose - Intramedullary nails (IMN) have become increasingly common as treatment for trochanteric hip fractures (THF) although they are costlier, and without proven superiority compared with sliding hip screws (SHS). We investigated whether the 2 methods differ in terms of short-term mortality when used in fractures where both methods are suitable. Patients and methods - We extracted data from the Swedish Fracture Register (SFR) on 19,935 patients ≥ 60 years with trochanteric fractures AO type 31-A1 or -A2 who had been treated with either SHS or IMN. We assessed absolute mortality rates and the relative risks (RR) of death after 7, 30, 90, and 365 days using generalized linear models, adjusting for age, sex, and fracture type. We performed a sensitivity analysis on a subgroup of 3,673 patients with information on comorbidity to address this potential confounder. Results - 69% of the patients were women and mean age was 84 years (60-107). IMN was used in 35% of A1 and in 71% of A2 fractures. The use of IMN was associated with a slightly increased adjusted risk of death within 30 days compared with SHS (RR = 1.1, 95% CI 1.0-1.2) with no difference at any other time point. Interpretation - The slightly increased risk of death up to 30 days postoperatively does not support the use of IMN instead of SHS in stable THF.</p>}},
  author       = {{Wolf, Olof and Mukka, Sebastian and Ekelund, Jan and Rogmark, Cecilia and Möller, Michael and Hailer, Nils P.}},
  issn         = {{1745-3682}},
  language     = {{eng}},
  pages        = {{146--150}},
  publisher    = {{Taylor & Francis}},
  series       = {{Acta Orthopaedica}},
  title        = {{Increased mortality after intramedullary nailing of trochanteric fractures : a comparison of sliding hip screws with nails in 19,935 patients}},
  url          = {{http://dx.doi.org/10.2340/17453674.2021.862}},
  doi          = {{10.2340/17453674.2021.862}},
  volume       = {{93}},
  year         = {{2022}},
}