RESEARCH SUPPORT, NON-U.S. GOV'T
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Musculoskeletal function and quality of life after an unstable trochanteric fracture treated with the trochanteric gamma nail.

PURPOSE: The aim of the study was to report the musculoskeletal function and health-related quality of life (HRQoL) after an unstable trochanteric fracture treated with a cephalomedullary nail.

METHODS: One hundred and seventeen patients, mean age 84.1 years, were included in a 1-year prospective cohort study. Outcome measurements included musculoskeletal function according to the Short Musculoskeletal Function Assessment (SMFA) and HRQoL according to the EQ-5D.

RESULTS: Fourteen patients (12.0 %) were reoperated on, all but one being due to a secondary lag-screw penetration/cut-out. The need for revision surgery was significantly higher after a 4-part fracture according to the Jensen-Michaelsen classification as compared to after a 3-part fracture, i.e. 17 versus 6 % (p = 0.048). The reoperation was a hip replacement in 12 of the 14 patients, a total hip replacement (THR) in 10 and a hemiarthroplasty in 2. The SMFA dysfunction and bother indices in all patients showed a significant deterioration at 12 months compared to before the fracture, from 24.8 to 42.4 (p < 0.001) and 14.3 to 33.7 (p < 0.001), respectively. The EQ-5D(index) score decreased from 0.79 prefracture to 0.51 (p < 0.001). The final outcome for the patients who underwent reoperation with THR was surprisingly good with an SMFA dysfunction index of 43.4, a bother index of 36.6 and an EQ-5D(index) score of 0.58.

CONCLUSIONS: An unstable trochanteric fracture treated with a cephalomedullary nail had a substantial negative impact on the patient's musculoskeletal function and HRQoL. The need for revision surgery was significantly higher after a 4-part fracture compared to after a 3-part fracture. The by far most common fracture complication, i.e. a secondary lag-screw penetration/cut-out, was successfully treated with a THR.

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