Hartford JM, Graw BP, Knowles SB, Frosch DL., J Arthroplasty. pii: S0883-5403(18)30199-2. doi: 10.1016/j.arth.2018.02.051. [Epub ahead of print], 2018 Feb 21
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.