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

  • Osteoporotic Fracture Management
  • Published:
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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.

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Acknowledgments

This study was supported in part by grants from the Trygg-Hansa Insurance Company and the Regional Agreement on Medical Training and Clinical Research (ALF) between the Stockholm County Council and the Karolinska Institutet.

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Authors and Affiliations

  1. Section of Orthopaedics, Department of Clinical Science and Education, Karolinska Institutet, Stockholm Söder Hospital, Stockholm, Sweden

    Ricard Miedel, Hans Törnkvist, Sari Ponzer & Jan Tidermark

  2. Department of Orthopaedics, Capio S:t Görans Hospital, Stockholm, Sweden

    Jan Tidermark

  3. Department of Orthopaedics, Stockholm Söder Hospital, SE-118 83, Stockholm, Sweden

    Ricard Miedel

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  1. Ricard Miedel
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Correspondence to Ricard Miedel.

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Miedel, R., Törnkvist, H., Ponzer, S. et al. Musculoskeletal function and quality of life after an unstable trochanteric fracture treated with the trochanteric gamma nail. Arch Orthop Trauma Surg 132, 1495–1503 (2012). https://doi.org/10.1007/s00402-012-1568-6

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