The Cost and Consequences of Failed Osteosynthesis of Intertrochanteric Femur Fractures: A Matched Cohort Study

• Published in: Indian journal of orthopaedics Vol. 55; no. 3; pp. 629 - 635
• Main Authors: Özdemir, Erdi, Okkaoglu, Mustafa Caner, Evren, Ali Teoman, Yaradilmis, Yuksel Ugur, Ates, Ahmet, Altay, Murat
• Format: Journal Article
• Language: English
• Published: New Delhi Springer India 01-06-2021
• Subjects: Conservative Orthopedics; Medicine; Medicine & Public Health; Original; Original Article; Orthopedics; Surgical Orthopedics; Intertrochanteric femur fracture; Revision; Cost; Mortality; Morbidity
• ISSN: 0019-5413; 1998-3727
• DOI: 10.1007/s43465-020-00322-0

Background
We aimed to evaluate the cost and consequences of failed osteosynthesis of intertrochanteric femur fracture (ITFF) patients and compare with primary ITFF patients.
Methods
We retrospectively evaluated 689 patients who underwent surgery due to ITFF via cephalomedullary nail. 31 patients (5.8%) had revision surgery because of osteosynthesis failure of ITFF. Each revision case included in the study was matched with four primary ITFF cases as control group based on age, gender, year of operation, type of fracture and American Society of Anesthesiologists (ASA) grade. Total cost for the admission that patients underwent surgery, mortality rate at first year, infection rate, length of stay at hospital, length of stay at intensive care unit, and erythrocyte transfusion amounts were recorded from hospital registry records. Tip apex distances (TAD) were noted.
Results
The mean total cost of the revision cases and primary cases was 10,027 ± 6387 and 5261 ± 1773 Turkish Liras, respectively (
p
 < 0.001). TAD was ≥ 20 mm in 32.3% (10/31) of patients in revision group while 2.4% (3/124) of the patients in control group (
p
 < 0.001). The mean length of stay at hospital, length of stay at intensive care unit, erythrocyte transfusion amounts, infection rate and mortality rate at first year were significantly higher in revision cases compared to matched primary control cases (
p
 < 0.05).
Conclusion
Revision surgeries due to failed osteosynthesis of ITFFs with cephalomedullary nail have at least two times higher mean total cost than primary cases. The awareness of the cost, morbidity and mortality of the revision surgeries may reduce the modifiable risk factors of osteosynthesis failure including maintenance of TAD below 20 mm, obtaining optimal lag screw position and reduction quality.
Level of Evidence
Level 3, retrospective cohort study.