Characteristics and Management of Neck and Trochanteric Femur Fractures at a Tertiary Hospital in Indonesia: A Retrospective, Single-Center Study
Downloads
Background: Although hip fractures are common among the elderly population, there are still limited studies on neck-trochanteric fractures, one of the less common types of hip fractures. This study aims to describe the characteristics of patients and their management in patients with neck trochanteric fractures.
Methods: This retrospective cross-sectional study analyzed medical records of patients aged >18 years with trochanteric fractures from a tertiary hospital in Central Java, Indonesia, between January and December 2021. Fracture types were identified and classified using the Garden, Pauwels, and AO/OTA classifications. Demographic data, risk factors, fracture locations, and treatment types were also collected. Statistical analysis was performed using SPSS 21.0 to describe patient characteristics.
Results: The total sample was 77 patients, most were female (n = 55 (71.4%)) and aged > 60 years. More than a third of diagnosed fractures were neck of the femur fractures in 33 patients (42.9%). Among the most common classification types of fractures were Garden Type 3, Pauwels Type 3, and AO/OTA type A1.1. A total of 33 patients (42.9%) underwent open reduction of the fracture with internal fixation.
Conclusions: Our findings show that the prevalence of neck-trochanteric fractures mostly occurs in patients > 60 years of age and in females. Although open reduction with internal fixation is generally performed, there are several cases of fractures that are not classifiable due to limited imaging examinations. Further research on a wider population is needed to confirm the findings of this study.
Groff H, Kheir MM, George J, Azboy I, Higuera CA, Parvizi J. Causes of in-hospital mortality after hip fractures in the elderly. HIP Int 2020;30(2):204-9.
Xu BY, Yan S, Low LL, Vasanwala FF, Low SG. Predictors of poor functional outcomes and mortality in patients with hip fracture: A systematic review. BMC Musculoskelet Disord 2019;20(1):568.
Hagino H. Current and future Burden of hip and vertebral fractures in asia. Yonago Acta Med 2021;64(2):147-54.
Maffulli N, Aicale R. Proximal femoral fractures in the elderly: A few things to know, and some to forget. Medicina (Kaunas) 2022;58(10):1314.
Haider IT, Schneider P, Michalski A, Edwards WB. Influence of geometry on proximal femoral shaft strains: Implications for atypical femoral fracture. Bone 2018;110:295-303.
Adam P. Treatment of recent trochanteric fracture in adults. Orthop Traumatol Surg Res. 2014;100(Suppl 1):S75-S83.
Usami T, Takada N, Nishida K, Sakai H, Iwata H, Sekiya I, et al. Banding with lesser trochanter fragment using nonabsorbable tape in trochanteric femoral fractures. SICOT J 2021;7:33.
Song HK, Choi HJ, Yang KH. Risk factors of avascular necrosis of the femoral head and fixation failure in patients with valgus angulated femoral neck fractures over the age of 50 years. Injury 2016;47(12):2743-8.
Hasankhani E, Omidi-Kashani F, Hajitaghi H, Hasankhani G. How to treat the complex unstable intertrochanteric fractures in elderly patients? DHS or arthroplasty. Arch Bone Jt Surg 2014;2(3):174-9.
Liu L, Sun Y, Wang L, Gao Q, Li A, Wang J, Gao Y. Total hip arthroplasty for intertrochanteric fracture fixation failure. Eur J Med Res 2019;24(1):39.
Lu Y, Uppal HS. Hip fractures: Relevant anatomy, classification, and biomechanics of fracture and fixation. Geriatr Orthop Surg Rehabil 2019;10:1-10.
Bishnoi M, Kirmani TT, Huda N, Chahal G, Bishnoi S. Epidemiological analysis of hip fractures at a tertiary care center: a retrospective study. Int J Res Orthop 2018;4(4):568.
Pawar DED, Gop DA, Shah DN, Yadav DAK, Chobing DH, Kasam DHM. Risk factor for intertrochanteric fracture and their functional outcome: A retrospective study. Natl J Clin Orthop 2020;4(4):35-7.
Loggers SAI, Van Lieshout EMM, Joosse P, Verhofstad MHJ, Willems HC. Prognosis of nonoperative treatment in elderly patients with a hip fracture: A systematic review and meta-analysis. Injury 2020;51(11):2407-13.
Fischer H, Maleitzke T, Eder C, Ahmad S, Stöckle U, Braun KF. Management of proximal femur fractures in the elderly: current concepts and treatment options. Eur J Med Res 2021;26(1):86.
Kazley JM, Banerjee S, Abousayed MM, Rosenbaum AJ. Classifications in brief: Garden classification of femoral neck fractures. Clin Orthop Relat Res 2018;476(2):441-5.
Shen M, Wang C, Chen H, Rui YF, Zhao S. An update on the Pauwels classification. J Orthop Surg Res 2016;11(1):161.
Cazzato G, Oliva MS, Masci G, Vitiello R, Smimmo A, Matrangolo MR, et al. Femoral neck fracture: the reliability of radiologic classifications. BMC Musculoskelet Disord 2021;22(Suppl 2):1063.
Meinberg EG, Agel J, Roberts CS, Karam MD, Kellam JF. Fracture and dislocation classification compendium-2018. J Orthop Trauma 2018;32(Suppl 1):S1-S170.
Clohisy JC, Nunley RM, Carlisle JC, Schoenecker PL. Incidence and characteristics of femoral deformities in the dysplastic hip. Clin Orthop Relat Res 2009;467(1):128-34.
Soontrapa S, Soontrapa S, Srinakarin J, Chowchuen P. Singh index screening for femoral neck osteoporosis. J Med Assoc Thai 2005;88 Suppl 5:13-6.
Reeve J, Loveridge N. The fragile elderly hip: Mechanisms associated with age-related loss of strength and toughness. Bone 2014;61(100):138-48.
Merlijn T, Swart KMA, van der Horst HE, Netelenbos JC, Elders PJM. Fracture prevention by screening for high fracture risk: a systematic review and meta-analysis. Osteoporos Int 2020;31(2):251-7.
Chotiyarnwong P, McCloskey EV, Harvey NC, Lorentzon M, Prieto-Alhambra D, Abrahamsen B, et al. Is it time to consider population screening for fracture risk in postmenopausal women? A position paper from the International Osteoporosis Foundation Epidemiology/Quality of Life Working Group. Arch Osteoporos 2022;17(1):87.
Yeh PS, Lee YW, Chang WH, Wang W, Wang JL, Liu SH, et al. Biomechanical and tomographic differences in the microarchitecture and strength of trabecular and cortical bone in the early stage of male osteoporosis. Wallace JM, ed. PLoS One 2019;14(8):e0219718.
Zhang YW, Lu PP, Li YJ, Dai GC, Chen MH, Zhao YK, et al. Prevalence, characteristics, and associated risk factors of the elderly with hip fractures: A cross-sectional analysis of nhanes 2005– 2010. Clin Interv Aging 2021;16:177-85.
Rufus-Membere P, Holloway-Kew KL, Diez-Perez A, Kotowicz MA, Pasco JA. Associations Between Bone Impact Microindentation and Clinical Risk Factors for Fracture. Endocrinology 2019;160(9):2143-50.
Mortensen SJ, Mohamadi A, Wright CL, Chan JJ, Weaver MJ, von Keudell A, et al. Medications as a Risk Factor for Fragility Hip Fractures: A Systematic Review and Meta-analysis. Calcif Tissue Int 2020;107(5):1-9.
Hughes JM, Popp KL, Yanovich R, Bouxsein ML, Matheny RW. The role of adaptive bone formation in the etiology of stress fracture. Exp Biol Med 2017;242(9):897-906.
Savvidis C, Tournis S, Dede AD. Obesity and bone metabolism. Hormones. 2018;17(2):205-17.
Momii K, Fujiwara T, Mae T, Tokunaga M, Iwasaki T, Shiomoto K, et al. Risk factors for excessive postoperative sliding of femoral trochanteric fracture in elderly patients: A retrospective multicenter study. Injury 2021;52(11):3369-76.
Stenquist DS, Albertson S, Bailey D, Paladino L, Flanagan CD, Stang T, et al. High Versus Low Energy Intertrochanteric Hip Fractures in Young Patients: Injury Characteristics and Factors Associated with Complications. J Orthop Trauma 2023;37(5):222-9.
Almigdad AK, Alazaydeh SA, Mustafa MSB, Alshawish MI, Alfukaha HA. A review of proximal femur fracture patterns, etiologies and sociodemographic features. Int J Orthop Sci 2022;8(3):115-8.
Irving D, Hinkley J, Marquart M. The Relationship Between BMI and Stability of Intertrochanteric Fracture Following Low-Energy Falls. A Retrospective Cohort Study. Geriatr Orthop Surg Rehabil 2019;10: 10:2151459319857555.
Cauley JA, Cawthon PM, Peters KE, Cummings SR, Ensrud KE, Bauer DC, et al. Risk Factors for Hip Fracture in Older Men: The Osteoporotic Fractures in Men Study (MrOS). J Bone Miner Res 2016;31(10):1810-19.
Pachore JA, Shah VI, Sheth AN, Shah KP, Marothi DP, Puri R. Hip arthroplasty in failed intertrochanteric fractures in elderly. Indian J Orthop 2013;47(6):572-7.
Zeng X, Zhan K, Zhang L, Zeng D, Yu W, Zhang X, Zhao M. Conversion to total hip arthroplasty after failed proximal femoral nail antirotations or dynamic hip screw fixations for stable intertrochanteric femur fractures: A retrospective study with a minimum follow-up of 3 years. BMC Musculoskelet Disord. 2017;18(1):1-38.
Zhong G, Teng L, Li H bo, Huang F guo, Xiang Z, Cen S qiang. Surgical Treatment of Internal Fixation Failure of Femoral Peritrochanteric Fracture. Orthop Surg. 2021;13(6):1739-47.
Copyright (c) 2024 Journal Orthopaedi and Traumatology Surabaya
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
- The author acknowledges that the copyright of the article is transferred to the Journal of Orthopaedi and Traumatology Surabaya (JOINTS), whilst the author retains the moral right to the publication.
- The legal formal aspect of journal publication accessibility refers to Creative Commons Attribution-Non Commercial-Share Alike 4.0 International License (CC BY-NC-SA).
- All published manuscripts, whether in print or electronic form, are open access for educational, research, library purposes, and non-commercial uses. In addition to the aims mentioned above, the editorial board is not liable for any potential violations of copyright laws.
- The form to submit the manuscript's authenticity and copyright statement can be downloaded here.
Journal of Orthopaedi and Traumatology Surabaya (JOINTS) is licensed under a Creative Commons Attribution-Non Commercial-Share Alike 4.0 International License.
Journal Orthopaedi and Traumatology Surabaya (JOINTS) (