Key result
Poor fracture reduction is linked to ~10-fold higher cut-out risk in intertrochanteric surgery.
Why the study?
Patient positioning can be performed in various ways during surgery for trochanteric femur fractures, but clinical and radiological comparisons between these approaches in geriatric patients are needed.
Does patient positioning (supine hemilithotomy, lateral decubitus, or traction table) affect clinical and radiological outcomes in older patients undergoing PFN surgery for femoral intertrochanteric fractures?
Cross-Sectional (n=170)
Does patient positioning (supine hemilithotomy, lateral decubitus, or traction table) affect clinical and radiological outcomes in older patients undergoing PFN surgery for femoral intertrochanteric fractures?
Effect estimate: OR 10.111 (95% CI 2.313-44.207)
p-value: p=0.002
The choice of preoperative position during PFN surgery for intertrochanteric fractures affects surgical duration, radiological outcomes, and complication rates, highlighting the need to tailor the approach to the surgeon's experience and patient's status.
Lateral decubitus positioning was associated with more complications; hypothesis-generating and requires prospective trials before practice change.
Background and objectives: The incidence of hip fractures in advanced age is increasing due to the aging society. In trochanteric region fractures of the femur, patient positioning can be performed various ways. The aim of this study is to clinically and radiologically compare the use of the supine hemilithotomy position, the lateral decubitus position, and the traction table when performing PFN surgery for femoral intertrochanteric fractures in the geriatric age group.Materials and Methods: A total of 170 older patients with femoral intertrochanteric fractures were included in this cross-sectional study. The patients were divided into three groups the supine hemilithotomy group, lateral decubitus group and fracture table. For the postoperative period, complications, length of stay in the intensive care unit, and length of stay in hospital were examined, while in postoperative radiographs, tip-apex distance (TAD), collodiaphyseal angle (CDA), and Cleveland-Bosworth quadrants were examined to evaluate the placement of the lag screw in the femoral head. Quality of fracture reduction was evaluated according to the modified Baumgaertner criteria.Results: The mean age of the patients was 77.77±8.8; 57.6% of patients were female. According to the modified Baumgaertner criteria, it was determined that patients with ‘poor’ reduction quality had an approximately ten times higher risk of cut-out than those with ‘good’ reduction quality. (OR = 10.111, p = 0.002, 95% confidence interval; 2.313-44.207). The duration of surgery of patient in the fracture table group was found to be higher than in the other groups, the CDA in the supine position group were found lower than in the other groups, and the TAD in the supine position group was found higher than in the other groups. Complications were mostly detected in patients who underwent surgery in the lateral decubitus position. (p<0,05) Conclusion: We believe that it is necessary to be familiar with all methods, since it is very difficult to choose the most appropriate method according to the surgeon’s experience, the hospital’s facilities and conditions, and the patient’s clinical status.
No takes yet. Share an insight, caveat, or question.
Kaya et al. (2024) conducted a cross-sectional in Femoral intertrochanteric fractures (n=170). Supine hemilithotomy position or lateral decubitus position vs. Traction table was evaluated on Risk of cut-out (poor vs. good reduction quality) (OR 10.111, 95% CI 2.313-44.207, p=0.002). Preoperative positioning affected intertrochanteric fracture surgery outcomes, with most complications in the lateral decubitus position (p<0.05) and poor reduction increasing cut-out risk (OR 10.111).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: