Treatment of Geriatric Subtrochanteric Femoral Fractures with Nailing. Is Operation on Duty Associated with Inferior Outcome?

Background: Subtrochanteric femoral fractures are often require open reduction and internal fixation. Data regarding the time of operation are missing; therefore, we conducted this retrospective and monocentric study. Material and Methods: Between 2006 and 2020, a total of 115 patients with subtrochanteric fractures were enrolled. Treatment was performed with long nailing. We performed two groups: operations started within regular working hours (8:00 am – 16:00 pm; n = 41); and operations started on duty (n = 74). Based on our database, 24 variables were assessed. The primary outcomes were revision, infection, general complications, and survival. The secondary outcomes were the EuroQol five-dimension scale (EQ-5D-5L) health state, the EQ Visual Analogue Scale (EQ-VAS) and the Parker mobility score. Results: The mean age of the patients was 81.8 years (range 65–97). With one exception (time to operation), the variables were balanced between the two groups. The revision rate was 11.3% (n = 13), with a nonsignificantly higher rate for treatment on duty (n = 11/74 vs. 2/41; p = 0.134). All infections (n = 5) occurred after treatment on duty, but this was nonsignificant. The Kaplan–Meier survival rate was also nonsignificant between the groups (log rank = 0.282), with a total one-year mortality rate of 25.2%. After a mean follow-up of 5.5 years (1.1–14.2), outcome measures were similarly reduced in the two groups. Conclusions: Based on our study, we recommend operation within 24 hours after admission and regardless of time. Further studies with a higher number of cases are provide general recommendations.