Primary prosthetic replacement in per- and intertrochanteric fractures

Area of Science:

• Orthopaedic Surgery
• Traumatology
• Geriatric Fracture Management

Background:

• Per- and intertrochanteric femur fractures are common, particularly in older adults.
• While closed- or open reduction and internal fixation (CRIF/ORIF) are standard, some cases necessitate arthroplasty.
• Current decision-making for treatment is challenging due to a lack of established scoring systems.

Purpose of the Study:

• To review predictors of inferior outcomes following CRIF/ORIF for per- and intertrochanteric fractures.
• To propose a novel scoring system to aid treatment decision-making.
• To identify patient and fracture characteristics that may favor arthroplasty over fixation.

Main Methods:

• Comprehensive literature review to identify prognostic factors for CRIF/ORIF.
• Synthesis of identified predictors to develop a new clinical decision-making tool.
• Proposed Hamburg Per- and Intertrochanteric Fracture Score (HPIFS) based on evidence.

Main Results:

• Several factors predict poorer outcomes with CRIF/ORIF, including advanced age, female gender, poor bone quality, hip osteoarthritis, prolonged operation time, and weight-bearing restrictions.
• These identified predictors form the basis for the proposed HPIFS.
• The HPIFS aims to stratify patients and guide treatment selection.

Conclusions:

• CRIF/ORIF remain the primary treatment for most per- and intertrochanteric femur fractures.
• Arthroplasty is a viable and advantageous option for a specific subset of patients and fracture patterns.
• The HPIFS offers a potential tool to support orthopaedic surgeons in complex treatment decisions.