Increased Pulmonary Complications Associated with Intramedullary Fixation of Intertrochanteric Fractures: An Analysis of 13,276 Hips

Nathanael Heckmann, J. Ryan Hill, Venus Vakhshori, Braden Mcknight, Amir Mostofi, Jason Davis, George Rick Hatch, Geoffrey Marecek

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

Introduction:Intramedullary devices are being used more frequently to treat intertrochanteric (IT) femur fractures but without clear benefit in several clinical trials. This study determines differences in complication rates in patients with IT fractures treated with intramedullary versus extramedullary devices.Methods:Using the National Surgical Quality Improvement Program database, patients aged ≥55 years with an isolated IT fracture and an American Society of Anesthesiologists score of <5 were identified. Thirty-day mortality and perioperative complications were assessed.Results:Extramedullary fixation was performed in 4,392 patients, whereas 8,884 underwent intramedullary fixation. Intramedullary fixation was associated with increased 30-day mortality (odds ratio [OR], 1.18; P = 0.038), ventilator use (OR, 1.57; P = 0.004), transfusion (OR, 1.12; P < 0.001), and deep vein thrombosis (DVT) (OR, 1.45; P = 0.032). Mean postoperative hospital stay was 1 day shorter for the intramedullary group (P < 0.001). After multivariate analysis, ventilator use (OR, 1.59), DVT (OR, 1.44), and transfusion (OR, 1.15) were more common with intramedullary fixation group.Discussion:Intramedullary fixation for IT fractures was associated with an increased risk of pulmonary complications, DVT, and transfusion. Further randomized controlled studies are required to determine the relative safety of intramedullary versus extramedullary implants.Level of Evidence:Level III, therapeutic, retrospective comparative study.

Original languageEnglish (US)
Pages (from-to)690-695
Number of pages6
JournalJournal of the American Academy of Orthopaedic Surgeons
Volume27
Issue number18
DOIs
StatePublished - Sep 15 2019
Externally publishedYes

Bibliographical note

Publisher Copyright:
© American Academy of Orthopaedic Surgeons.

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