Outcome after treatment of complications of Gamma nailing: A prospective study of 554 trochanteric fractures

Figures & data

Table 1.  Background information at index operation showing age at surgery and proportion of patients in each category

	Cases reoperated (52) Age: 78 (43–97) ^a			Cases not reoperated (502) Age: 81 (33–103) ^a
	n	Proportion	95% CI	n	Proportion	95% CI
Sex
Male	22	0.42	0.29–0.56	146	0.29	0.25–0.33
Female	30	0.58	0.44–0.71	356	0.71	0.67–0.75
Habitat
Own home ^b	45	0.87	0.77–0.96	320	0.64	0.60–0.68
Sheltered living**	2	0.04	0.00–0.09	79	0.16	0.13–0.19
Nursing home	5	0.10	0.02–0.18	98	0.20	0.16–0.23
Other	0	0.00	0.00–0.00	5	0.01	0.00–0.02
Walking
Outdoors alone ^b	38	0.73	0.61–0.85	253	0.50	0.46–0.55
Outdoors with company ^b	2	0.04	0.00–0.09	61	0.12	0.09–0.15
Indoor dweller	12	0.23	0.12–0.35	188	0.37	0.33–0.42
ASA
Healthy	1	0.02	0.00–0.06	16	0.03	0.02–0.05
Asymptomatic disease	27	0.56	0.42–0.69	242	0.48	0.44–0.53
Symptomatic disease	22	0.42	0.29–0.56	222	0.44	0.40–0.49
Serious disease	0	0.00	0.00–0.00	22	0.04	0.03–0.06

^aMean (range). T-test (unequal variances assumed) p = 0.07.

^bSignificant difference as evidenced by nonoverlapping confidence intervals.

Table 2.  Type of surgery and indication for primary surgery in cases that were not reoperated (n = 502) and in reoperated cases (n = 52)

	SG without locking screw	SG with locking screw	LG without locking screw	LG with locking screw
Cases not reoperated
Stable trochanteric (n = 254)	232	20	1	1
Unstable trochanteric (n = 248)	28	196	6	18
Cases reoperated
Stable trochanteric (n = 18)	16	2	0	0
Unstable trochanteric (n = 34)	11	21	2	0

SG: short Gamma nail. LG: long Gamma nail

Table 3.  Reason for reoperation in reoperated cases and type of surgery including revisions

Reason for reoperation	Type of reoperation	Second reoperation	Third reoperation	Fourth reoperation
Fracture disocation (1)	Hemiarthroplasty (1)
Cut-out (8)	Removal of implant (1)
	Hemiarthroplasty (4)	Drainage (1)
	Reosteosynthesis (3)
New fracture around	Reosteosynthesis (17)	Removal of implant (1)
the implant (17)		Reosteosynthesis (1)	Hemiarthroplasty
Nonunion (9)	Hemiarthroplasty (8)	Reduction of dislocation (1)	Reduction of dislocation	D^a
	Total hip replacement (1)
Necrosis of femoral	Removal of implant (1)	Hemiarthroplasty (1)
head (1)
Local pain, healed	Removal of implant (11)	Hemiarthroplasty (2)
fracture (11)
Infection (2)	Drainage (2)	Drainage (1)
		Girdlestone (1)
Hematoma (2)	Drainage (2)
Unsatisfactory primary	Reosteosynthesis (1)
osteosynthesis (1)
	52	9	2	1

^aDeepening of acetabulum

Table 4.  Number and proportion of patients who resided in their own home and were independent walkers at surgery and at the follow-up examination. Presented as proportions with 95% confidence interval of proportions

At FU/at surgery	Proportion	95%	CI
Reoperated (38)
Own home	22/27	0.81	0.67–0.96
Walking outdoors alone	14/14	1.00	1.00–1.00
Slight or no pain in the hip	30/38	0.79	0.66–0.92
Not reoperated (347)
Own home	206/320	0.64	0.59–0.70
Walking outdoors alone	139/253	0.55	0.49–0.61
Slight or no pain in the hip	271/347	0.78	0.74–0.82

Table 5.  Estimated change in risk of mortality. Risk below 1 indicates less risk. All risks are significant, as confidence interval does not encompass 1

	Risk	95% CI
Age (per year)	1.05	1.03–1.07
Reoperation	0.58	0.35–0.96
ASA 3–4	2.14	1.68–2.73
Female	0.65	0.51–0.83
Habitat^a
Sheltered living	1.46	1.06–2.03
Nursing home	2.25	1.71–2.97
Other	2.45	1.27–4.70

^aOwn home is reference

Table 6.  Mortality in the cases that were reoperated and Survival proportion not reoperated, and p-values for the difference between 1.0 the groups as determined by chi-square test

	Reoperated (n = 52)		Not reoperated (n = 502)
	n	Percent	n	Percent	P-value
30 days	1	2	52	10	0.05
120 days	5	10	93	19	0.11
1 year	8	15	147	29	0.03
2 years	13	25	199	40	0.04
3 years	17	33	236	47	0.05
4 years	17	33	259	52	0.01
5 years	18	35	272	54	0.01

Survival of cases that were reoperated and not reoperated, adjusted for age, sex, ASA class and habitat.