Summary

Atypical femoral fractures are burdened with a high rate of reoperation. In our nationwide analysis, the increased rate of reoperation was related to patient background characteristics, such as age and health status, rather than fracture type.

Introduction

Patients with atypical fractures are complex to treat and burdened with a high risk of reoperation. We hypothesized that patients with surgically treated, complete atypical fractures have a higher risk of any reoperation and reoperation related to healing complications than patients with common femoral shaft fractures but that this increase would become insignificant when adjusted for predefined characteristics.

Methods

A cohort of 163 patients with atypical fractures and 862 patients with common femoral shaft or subtrochanteric fractures treated from 2008 to 2010 and who had follow-up radiographs and register data available until 31 December 2014 was included. Reoperations were identified by a complementary review of radiographs and register data and were used to calculate risks for any reoperation and reoperations related to healing complications.

Results

Patients with atypical fractures were more likely to be reoperated for any reason, age-adjusted OR 1.76 (95% CI, 1.08 to 2.86). However, patients with common fractures had a shorter follow-up due to a threefold higher death rate. Accordingly, in a multivariable-adjusted time-to-event model, the increased risk lost statistical significance for any reoperations, cause-specific HR 1.34 (95% CI, 0.85 to 2.13), and for reoperations related to healing complications, HR 1.32 (95% CI, 0.58 to 3.0). Continued use of bisphosphonate in the first year after the fracture did not affect the reoperation rate.

Conclusions

Our findings suggest that the increased risk of reoperation after an atypical femur fracture is largely explained by patient characteristics and not fracture type.

中文翻译：

---

非典型股骨骨折再手术率增加与患者特征有关，与骨折类型无关。全国队列研究

概要

非典型股骨骨折的再手术率很高。在我们的全国性分析中，再次手术率的提高与患者背景特征（例如年龄和健康状况）有关，而不是与骨折类型有关。

介绍

具有非典型骨折的患者治疗复杂且负担重手术的高风险。我们假设接受手术治疗的完全性非典型骨折的患者与常见股骨干骨折的患者相比，发生任何再手术和与治愈并发症相关的再手术的风险更高，但是如果根据预定义的特征进行调整，这种增加将变得微不足道。

方法

纳入了从2008年至2010年接受治疗的163例非典型性骨折患者和862例股骨干或股骨粗隆下常见骨折患者的队列研究，这些患者均接受了X线照片检查和登记数据，直到2014年12月31日为止。通过对X线片和记录数据的补充审查来确定再次手术，并用于计算任何再次手术和与治愈并发症相关的再次手术的风险。

结果

具有非典型骨折的患者因年龄调整后的手术可能性更高，OR 1.76（95％CI，1.08至2.86）。然而，由于高死亡率三倍，普通骨折患者的随访时间较短。因此，在经过多变量调整的事件发生时间模型中，增加的风险对于任何再次手术，因果关系的HR 1.34（95％CI，0.85至2.13）以及与治愈并发症相关的再次手术，HR 1.32（ 95％CI，0.58至3.0）。骨折后第一年继续使用双膦酸盐不影响再次手术率。

结论

我们的研究结果表明，非典型股骨骨折后再次手术的风险增加很大程度上是由患者特征而非骨折类型引起的。