The Journal of Arthroplasty , Volume 33 , Issue 7 , S253 - S258

Isolated Greater Trochanteric Fracture and the Direct Anterior Approach Using a Fracture Table

Hartford, James M. et al.
Hip

Background

To identify the incidence, contributing factors, and outcomes of perioperative greater trochanter fractures associated with the direct anterior approach.

Methods

This is a retrospective analyses of 1401 primary THAs. Age, side, height, weight, body mass index, preoperative ambulatory status, discharge status, and hospital length of stay were identified. Radiographs were evaluated for femoral neck angle, femoral neck cut ratio (FNCR), and DORR ratio. Bivariate and logistic regression analyses were performed.

Results

Thirty-one hips sustained isolated greater trochanter fractures (2.2%). Multivariate analyses identified worse preoperative ambulatory status, diagnosis of slipped capital femoral epiphysis or rheumatoid arthritis, lower FNCR and greater DORR ratio as statistically significant predictors for fracture. Four intraoperative fractures underwent fixation. All postoperative fractures were treated nonoperatively. Thirty fractures healed with 1 nonunion.

Conclusion

Worse preoperative ambulatory status, diagnosis of slipped capital femoral epiphysis or rheumatoid arthritis, greater DORR ratio, and lower FNCR were associated with increased risk of fracture. Hips with fractures had longer length of stay. Nonoperative treatment was uniformly successful.


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