Lateral wall thickness is not associated with revision risk of medially stable intertrochanteric fractures fixed with a sliding hip screw

Bin Chen; Andrew D. Duckworth; Luke Farrow; You J. Xu; Nick D. Clement

doi:10.1302/2633-1462.52.BJO-2023-0141.R1

Lateral wall thickness is not associated with revision risk of medially stable intertrochanteric fractures fixed with a sliding hip screw

Bin Chen
, Andrew D. Duckworth
, Luke Farrow
, You J. Xu
, Nick D. Clement^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

1 Citation (Scopus)

5 Downloads (Pure)

Abstract

This study aimed to determine whether lateral femoral wall thickness (LWT) < 20.5 mm was associated with increased revision risk of intertrochanteric fracture (ITF) of the hip following sliding hip screw (SHS) fixation when the medial calcar was intact. Additionally, the study assessed the association between LWT and patient mortality. Methods This retrospective study included ITF patients aged 50 years and over treated with SHS fixation between 2019 and 2021 at a major trauma centre. Demographic information, fracture type, delirium status, American Society of Anesthesiologists grade, and length of stay were collected. LWT and tip apex distance were measured. Revision surgery and mortality were recorded at a mean follow-up of 19.5 months (1.6 to 48). Cox regression was performed to evaluate independent risk factors associated with revision surgery and mortality. Results The cohort consisted of 890 patients with a mean age of 82 years (SD 10.2). Mean LWT was 27.0 mm (SD 8.6), and there were 213 patients (23.9%) with LWT < 20.5 mm. Overall, 20 patients (2.2%) underwent a revision surgery following SHS fixation. Adjusting for covariates, LWT < 20.5 mm was not independently associated with an increased revision or mortality risk. However, factors that were significantly more prevalent in LWT < 20.5 mm group, which included residence in care home (hazard ratio (HR) 1.84; p < 0.001) or hospital (HR 1.65; p = 0.005), and delirium (HR 1.32; p = 0.026), were independently associated with an increased mortality risk. The only independent factor associated with increased risk of revision was older age (HR 1.07; p = 0.030). Conclusion LWT was not associated with risk of revision surgery in patients with an ITF fixed with a SHS when the calcar was intact, after adjusting for the independent effect of age. Although LWT < 20.5 mm was not an independent risk factor for mortality, patients with LWT < 20.5 mm were more likely to be from care home or hospital and have delirium on admission, which were associated with a higher mortality rate.

Original language	English
Pages (from-to)	123-131
Number of pages	9
Journal	Bone and Joint Open
Volume	5
Issue number	2
DOIs	https://doi.org/10.1302/2633-1462.52.BJO-2023-0141.R1
Publication status	Published - 12 Feb 2024

Bibliographical note

Funding Information:
The authors report that they received open access funding for this manuscript from the National Key R&D Program of China (2021YFC2501702), Suzhou Key Disciplines (SZXK202104).

Data Availability Statement

The datasets generated and analyzed in the current study are notpublicly available due to data protection regulations. Access todata is limited to the researchers who have obtained permissionfor data processing. Further inquiries can be made to thecorresponding author.

Funding

The following authors have disclosures, all of which were unrelated to this work: B. Chen has a grant from the China Scholarship Council (no.201905320001). N. D. Clement is an editorial board member for The Bone and Joint Journal (BJJ) and Bone and Joint Research (BJR). A. D. Duckworth has grants from the National Institute for Health and Care Research, the The Orthopaedic Trauma Association (OTA), and SORT-IT; royalties from Taylor and Francis and Elsevier; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from AgNovos Healthvare, Swemac, and Smith & Nephew; and having a leadership or role in a board, society, committee, or advocacy group for BJJ, BJR, and BJ360, and for Trials, OTA International, JBJS Case Connector, the OTA and OTS research committees, and the Journal of Orthopaedic Trauma. L. Farrow is currently in receipt of a CSO Clinical Academic Fellowship (that relates to the application of intelligence to orthopaedic surgery), and is chair of the Scottish Hip Fracture Audit Quality Improvement and Research Sub-Group Committee. The authors report that they received open access funding for this manuscript from the National Key R&D Program of China (2021YFC2501702), Suzhou Key Disciplines (SZXK202104).

Keywords

Anesthesiologists
calcar
chi-squared test
Cox regression analysis
delirium
hip
intertrochanteric fracture
intertrochanteric fractures
lateral femoral wall thickness
Orthopaedic Trauma
revision surgery
sliding hip screw

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10.1302/2633-1462.52.BJO-2023-0141.R1Licence: CC BY-NC-ND

Chen_etal_BJO_Lateral_Wall_Thickness_VOR
This is an open-access article distributedunder the terms of the Creative Commons Attribution Non-Commercial No Derivatives (CC BY-NC-ND 4.0) licence, whichpermits the copying and redistribution of the work only, andprovided the original author and source are credited. See https://creativecommons.org/licenses/by-nc-nd/4.0/Lateral wall thickness is not associated with revision risk of medially stable intertrochanteric fractures fixed with a sliding hip screwB. Chen, A. D. Duckworth, L. Farrow, Y. J. Xu, N. D. Clement131
Final published version, 1.13 MBLicence: CC BY-NC-ND

Cite this

@article{1dc266f3098941c78679053ba696a250,

title = "Lateral wall thickness is not associated with revision risk of medially stable intertrochanteric fractures fixed with a sliding hip screw",

abstract = "This study aimed to determine whether lateral femoral wall thickness (LWT) < 20.5 mm was associated with increased revision risk of intertrochanteric fracture (ITF) of the hip following sliding hip screw (SHS) fixation when the medial calcar was intact. Additionally, the study assessed the association between LWT and patient mortality. Methods This retrospective study included ITF patients aged 50 years and over treated with SHS fixation between 2019 and 2021 at a major trauma centre. Demographic information, fracture type, delirium status, American Society of Anesthesiologists grade, and length of stay were collected. LWT and tip apex distance were measured. Revision surgery and mortality were recorded at a mean follow-up of 19.5 months (1.6 to 48). Cox regression was performed to evaluate independent risk factors associated with revision surgery and mortality. Results The cohort consisted of 890 patients with a mean age of 82 years (SD 10.2). Mean LWT was 27.0 mm (SD 8.6), and there were 213 patients (23.9\%) with LWT < 20.5 mm. Overall, 20 patients (2.2\%) underwent a revision surgery following SHS fixation. Adjusting for covariates, LWT < 20.5 mm was not independently associated with an increased revision or mortality risk. However, factors that were significantly more prevalent in LWT < 20.5 mm group, which included residence in care home (hazard ratio (HR) 1.84; p < 0.001) or hospital (HR 1.65; p = 0.005), and delirium (HR 1.32; p = 0.026), were independently associated with an increased mortality risk. The only independent factor associated with increased risk of revision was older age (HR 1.07; p = 0.030). Conclusion LWT was not associated with risk of revision surgery in patients with an ITF fixed with a SHS when the calcar was intact, after adjusting for the independent effect of age. Although LWT < 20.5 mm was not an independent risk factor for mortality, patients with LWT < 20.5 mm were more likely to be from care home or hospital and have delirium on admission, which were associated with a higher mortality rate.",

keywords = "Anesthesiologists, calcar, chi-squared test, Cox regression analysis, delirium, hip, intertrochanteric fracture, intertrochanteric fractures, lateral femoral wall thickness, Orthopaedic Trauma, revision surgery, sliding hip screw",

author = "Bin Chen and Duckworth, \{Andrew D.\} and Luke Farrow and Xu, \{You J.\} and Clement, \{Nick D.\}",

note = "Funding Information: The authors report that they received open access funding for this manuscript from the National Key R\&D Program of China (2021YFC2501702), Suzhou Key Disciplines (SZXK202104). ",

year = "2024",

month = feb,

day = "12",

doi = "10.1302/2633-1462.52.BJO-2023-0141.R1",

language = "English",

volume = "5",

pages = "123--131",

journal = "Bone and Joint Open",

issn = "2633-1462",

publisher = "British Editorial Society of Bone and Joint Surgery",

number = "2",

}

TY - JOUR

T1 - Lateral wall thickness is not associated with revision risk of medially stable intertrochanteric fractures fixed with a sliding hip screw

AU - Chen, Bin

AU - Duckworth, Andrew D.

AU - Farrow, Luke

AU - Xu, You J.

AU - Clement, Nick D.

N1 - Funding Information: The authors report that they received open access funding for this manuscript from the National Key R&D Program of China (2021YFC2501702), Suzhou Key Disciplines (SZXK202104).

PY - 2024/2/12

Y1 - 2024/2/12

N2 - This study aimed to determine whether lateral femoral wall thickness (LWT) < 20.5 mm was associated with increased revision risk of intertrochanteric fracture (ITF) of the hip following sliding hip screw (SHS) fixation when the medial calcar was intact. Additionally, the study assessed the association between LWT and patient mortality. Methods This retrospective study included ITF patients aged 50 years and over treated with SHS fixation between 2019 and 2021 at a major trauma centre. Demographic information, fracture type, delirium status, American Society of Anesthesiologists grade, and length of stay were collected. LWT and tip apex distance were measured. Revision surgery and mortality were recorded at a mean follow-up of 19.5 months (1.6 to 48). Cox regression was performed to evaluate independent risk factors associated with revision surgery and mortality. Results The cohort consisted of 890 patients with a mean age of 82 years (SD 10.2). Mean LWT was 27.0 mm (SD 8.6), and there were 213 patients (23.9%) with LWT < 20.5 mm. Overall, 20 patients (2.2%) underwent a revision surgery following SHS fixation. Adjusting for covariates, LWT < 20.5 mm was not independently associated with an increased revision or mortality risk. However, factors that were significantly more prevalent in LWT < 20.5 mm group, which included residence in care home (hazard ratio (HR) 1.84; p < 0.001) or hospital (HR 1.65; p = 0.005), and delirium (HR 1.32; p = 0.026), were independently associated with an increased mortality risk. The only independent factor associated with increased risk of revision was older age (HR 1.07; p = 0.030). Conclusion LWT was not associated with risk of revision surgery in patients with an ITF fixed with a SHS when the calcar was intact, after adjusting for the independent effect of age. Although LWT < 20.5 mm was not an independent risk factor for mortality, patients with LWT < 20.5 mm were more likely to be from care home or hospital and have delirium on admission, which were associated with a higher mortality rate.

AB - This study aimed to determine whether lateral femoral wall thickness (LWT) < 20.5 mm was associated with increased revision risk of intertrochanteric fracture (ITF) of the hip following sliding hip screw (SHS) fixation when the medial calcar was intact. Additionally, the study assessed the association between LWT and patient mortality. Methods This retrospective study included ITF patients aged 50 years and over treated with SHS fixation between 2019 and 2021 at a major trauma centre. Demographic information, fracture type, delirium status, American Society of Anesthesiologists grade, and length of stay were collected. LWT and tip apex distance were measured. Revision surgery and mortality were recorded at a mean follow-up of 19.5 months (1.6 to 48). Cox regression was performed to evaluate independent risk factors associated with revision surgery and mortality. Results The cohort consisted of 890 patients with a mean age of 82 years (SD 10.2). Mean LWT was 27.0 mm (SD 8.6), and there were 213 patients (23.9%) with LWT < 20.5 mm. Overall, 20 patients (2.2%) underwent a revision surgery following SHS fixation. Adjusting for covariates, LWT < 20.5 mm was not independently associated with an increased revision or mortality risk. However, factors that were significantly more prevalent in LWT < 20.5 mm group, which included residence in care home (hazard ratio (HR) 1.84; p < 0.001) or hospital (HR 1.65; p = 0.005), and delirium (HR 1.32; p = 0.026), were independently associated with an increased mortality risk. The only independent factor associated with increased risk of revision was older age (HR 1.07; p = 0.030). Conclusion LWT was not associated with risk of revision surgery in patients with an ITF fixed with a SHS when the calcar was intact, after adjusting for the independent effect of age. Although LWT < 20.5 mm was not an independent risk factor for mortality, patients with LWT < 20.5 mm were more likely to be from care home or hospital and have delirium on admission, which were associated with a higher mortality rate.

KW - Anesthesiologists

KW - calcar

KW - chi-squared test

KW - Cox regression analysis

KW - delirium

KW - hip

KW - intertrochanteric fracture

KW - intertrochanteric fractures

KW - lateral femoral wall thickness

KW - Orthopaedic Trauma

KW - revision surgery

KW - sliding hip screw

UR - https://www.scopus.com/pages/publications/85185248186

U2 - 10.1302/2633-1462.52.BJO-2023-0141.R1

DO - 10.1302/2633-1462.52.BJO-2023-0141.R1

M3 - Article

AN - SCOPUS:85185248186

SN - 2633-1462

VL - 5

SP - 123

EP - 131

JO - Bone and Joint Open

JF - Bone and Joint Open

IS - 2

ER -

Lateral wall thickness is not associated with revision risk of medially stable intertrochanteric fractures fixed with a sliding hip screw

Abstract

Bibliographical note

Data Availability Statement

Funding

Keywords

Access to Document

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