Evaluation of the effect of proximal femur geometry on results of geriatric intertrochanteric fracture surgery

BACKGROUND: This study aimed to explore the relationship between the complications and clinical outcomes after intertrochanteric femoral fracture surgery, and the Singh index (SI), canal-calcar ratio (CCR), cortical thickness index (CTI), and canal flare index (CFI) – the radiological indices defining proximal femoral morphology in the literature – among patients over 60 years of age.
METHODS: The data of 350 patients who were operated between 2015 and 2019 were evaluated retrospectively. The study included patients who underwent dual lag screw proximal femoral nailing and had good intraoperative reduction quality according to Fogagnolo’s criteria. The relationships among radiological indices measured on radiographs acquired after trauma, and post-operative complications, Barthel activity index, and Harris hip score (HHS) were assessed statistically.
RESULTS: Among 121 patients who met the study criteria, there were 63 (52.07%) female and 58 (47.93%) male patients. The mean length of follow-up was 37.09 (36–60) months. The patients had a mean age of 79.78 (60–97) years. At least one mechanical complication developed in 32 (26.4%) patients in the study group. No significant relationship could be established between radiological indices and post-operative complications (p>0.05). The relationship between SI and HHS was statistically significant (p<0.05). CCR, CTI, and CFI did not have a statistically significant relationship with and HHS (p>0.05).
CONCLUSION: No statistically significant relationship could be established between radiological indices and post-operative complications. It should be considered that SI may be a parameter that affects clinical outcomes.

Proksimal femur geometrisinin geriatrik intertrokanterik kýrýk cerrahisi sonuçlarýna etkisinin deðerlendirilmesi

AMAÇ: Bu çalýþmada amacýmýz 60 yaþ üstü hastalarda femur intertrokanterik kýrýk cerrahisi sonrasý yaþanan komplikasyonlar ve klinik sonuçlar ile literatürde femur proksimal morfolojisini tanýmlayan radyolojik indeksler olan Singh Index (SI), Canal Calcar Ratio (CCR), Cortical Thickness Ýndex (CTI), Canal Flare Ýndex (CFI) arasýndaki iliþkiyi incelemektir.
GEREÇ VE YÖNTEM: 2015–2019 yýllarý arasýnda ameliyat edilen 350 hastanýn çalýþma verileri geriye dönük olarak deðerlendirildi. Çiftlag vidalý proksimal femoral çivileme yapýlan ve intraop redüksiyon kalitesi fogagnolo kriterlerine göre iyi olan hastalar çalýþma kapsamýna alýndý. Travma sonrasý çekilen xrayler üzerinden ölçümleri yapýlan radyolojik indeksler ile ameliyat sonrasý komplikasyonlar, Barthel Aktivite Ýndeksi ve Harris Kalça Skorlamasý arasýndaki iliþki istatistiksel olarak deðerlendirildi.
BULGULAR: Çalýþma kriterlerine uyan 121 hastanýn 63’ü kadýn (%52.07) ve 58’i (%47.93) erkekti. Ortalama takip süresi 37.09 ay (36–60) olarak deðerlendirildi. Hastalarýn yaþlarýna baktýðýmýzda ise; ortalama yaþ 79.78 (60–97) idi. Çalýþma grubundan 32 hastada (%26.4) en az bir mekanik komplikasyon geliþti. Radyolojik indeksler ve ameliyat sonrasý komplikasyonlar arasýnda anlamlý iliþki kurulamadý (p>0.05). SI ile Harris kalça skorlamasý arasýndaki iliþki istatistiksel olarak anlamlýydý (p<0.05). CCR, CTI VE CFI ile Barthel Aktivite Ýndeksi ve Harris Kalça Skorlamasý arasýndaki iliþki istatistiksel olarak anlamlý deðildi (p>0.05).
TARTIÞMA: Radyolojik indeksler ile ameliyat sonrasý komplikasyonlar arasýnda istatistiksel olarak anlamlý iliþki kurulamamýþtýr. SI’nin klinik sonuçlarý etkileyen bir parametre olabileceði göz önünde bulundurulmalýdýr.