Trochanteric hip fractures treated surgically-outcome in a ten-year cohort of 46,121 patients from the Swedish National Hip Fracture Registry.

Abstract

To compare postoperative mortality regarding 2 techniques in the treatment of trochanteric hip fractures (THFs). Retrospective cohort study. National databases. All consecutive surgically treated THF cases between 2008 and 2017 were included. Pathological fractures or patients younger than 60 years were excluded. Patients were grouped based on the surgical technique: sliding hip screw (SHS) or intramedullary (IM) nail. This data set was cross-referenced with a National Board of Health and Welfare's patient registry and a Cause of Death registry. Mortality, comorbidities, and length of stay (LOS). Forty-six thousand one hundred twenty-one cases were included. Twenty-five thousand eight hundred seventy-seven patients received a SHS, and 20,244 received an IM nail. Patients in the IM group were more often female (71.8% vs. 69.2%, <i>P</i> < 0.001), slightly less fit for surgery (American Society of Anesthesiologists score ≥3: 61.2% vs. 60.1%, <i>P</i> = 0.003), and more frail (Orthopedic Frailty Score ≥2: 54.2% vs. 52.8%, <i>P</i> = 0.005). Multifragment fractures were more prevalent in the IM nail group (66.6% vs. 32.0%, <i>P</i> < 0.001), which suffered from a higher comorbidity burden. After adjusting for potential confounders, no clinically significant differences in 7-day, 30-day, 90-day, or 1-year postoperative mortality were observed. Subgroup analyses focusing on 2-fragment and multifragment fractures could not detect any difference in mortality. LOS was 1 day shorter for the IM nail group as a whole. Based on 10 years of data including 46,121 patients with THF managed with SHS or IM nail, no difference was observed in mortality up to 1 year postoperatively, when comparing surgical technique. LOS was shorter for the IM nail group.