Archives of Orthopaedic and Trauma Surgery

, Volume 132, Issue 10, pp 1495–1503

Musculoskeletal function and quality of life after an unstable trochanteric fracture treated with the trochanteric gamma nail

  • Ricard Miedel
  • Hans Törnkvist
  • Sari Ponzer
  • Jan Tidermark
Osteoporotic Fracture Management

DOI: 10.1007/s00402-012-1568-6

Cite this article as:
Miedel, R., Törnkvist, H., Ponzer, S. et al. Arch Orthop Trauma Surg (2012) 132: 1495. doi:10.1007/s00402-012-1568-6

Abstract

Purpose

The aim of the study was to report the musculoskeletal function and health-related quality of life (HRQoL) after an unstable trochanteric fracture treated with a cephalomedullary nail.

Methods

One hundred and seventeen patients, mean age 84.1 years, were included in a 1-year prospective cohort study. Outcome measurements included musculoskeletal function according to the Short Musculoskeletal Function Assessment (SMFA) and HRQoL according to the EQ-5D.

Results

Fourteen patients (12.0 %) were reoperated on, all but one being due to a secondary lag-screw penetration/cut-out. The need for revision surgery was significantly higher after a 4-part fracture according to the Jensen–Michaelsen classification as compared to after a 3-part fracture, i.e. 17 versus 6 % (p = 0.048). The reoperation was a hip replacement in 12 of the 14 patients, a total hip replacement (THR) in 10 and a hemiarthroplasty in 2. The SMFA dysfunction and bother indices in all patients showed a significant deterioration at 12 months compared to before the fracture, from 24.8 to 42.4 (p < 0.001) and 14.3 to 33.7 (p < 0.001), respectively. The EQ-5Dindex score decreased from 0.79 prefracture to 0.51 (p < 0.001). The final outcome for the patients who underwent reoperation with THR was surprisingly good with an SMFA dysfunction index of 43.4, a bother index of 36.6 and an EQ-5Dindex score of 0.58.

Conclusions

An unstable trochanteric fracture treated with a cephalomedullary nail had a substantial negative impact on the patient’s musculoskeletal function and HRQoL. The need for revision surgery was significantly higher after a 4-part fracture compared to after a 3-part fracture. The by far most common fracture complication, i.e. a secondary lag-screw penetration/cut-out, was successfully treated with a THR.

Keywords

Trochanteric fracturesElderlyFracture fixationIntramedullaryTreatment outcomeQuality of life

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Ricard Miedel
    • 1
    • 3
  • Hans Törnkvist
    • 1
  • Sari Ponzer
    • 1
  • Jan Tidermark
    • 1
    • 2
  1. 1.Section of Orthopaedics, Department of Clinical Science and Education, Karolinska InstitutetStockholm Söder HospitalStockholmSweden
  2. 2.Department of OrthopaedicsCapio S:t Görans HospitalStockholmSweden
  3. 3.Department of OrthopaedicsStockholm Söder HospitalStockholmSweden