Transtrochanteric approach can provide better postoperative care and lower complication rate in the treatment of hip fractures

Figures & data

Table 1 Distribution of the demographic and clinical characteristics of the patients included in the study by groups and statistical analysis of the differences between the two groups

		Posterolateral (Group 1)	Transtrochanteric (Group 2)		P-value
		n (%)	n (%)
Gender
Female	31 (64.6)		47 (73.4)		0.407
Male	17 (35.4)		17 (26.6)
Age, years (mean ± SD)	86.5±6.5		87.1±5.7		0.602
BMI, kg/m^2 (mean ± SD)	27.2±3.9		26.4±4.2		0.325
Follow-up, months (mean ± SD)	50.5±4.1		37.1±5.1		0.0001
Cognitive disorder
No	37 (77.1)			51 (79.7)	0.818
Yes	11 (22.9)			13 (20.3)
ASA
1	6 (12.5)			9 (14.1)	0.571
2	14 (29.2)			24 (37.5)
3	28 (58.3)			31 (48.4)
Prosthesis
Bi-Metric (cemented fixation)	34 (70.8)			38 (59.4)	0.237
T2 (uncemented fixation)	14 (29.2)			26 (40.6)
Head size	47.9±3.2			47.1±3.2	0.170

Abbreviation: ASA, American Society of Anesthesiologists classification.

Note: Bold values indicate statistical significance P<0.05.

Figure 1 Transtrochanteric approach surgical technique.

Note: Accessing the femoral neck from the fracture line on the proximal femur indicated by dots.

Abbreviations: F, femur; FL, fracture line; GM, gluteus medius; GT, greater trochanter.

Figure 2 Transtrochanteric approach surgical technique.

Note: Discarding the proximal part after accessing through the fracture line and reaching the femoral neck.
Abbreviations: F, femur; FN, femoral neck; GT, greater trochanter.

Table 2 Comparison of the two surgical techniques

Parameter	Posterolateral (Group 1, n=48)	Transtrochanteric (Group 2, n=64)	Total	P-value
Surgical duration, minutes	66.6±10.4	60.0±10.5	62.9±10.9	0.001
Amount of blood replacement (units of RBCs)	2 (2–5)	1 (0–4)	1 (0–5)	0.175
Dislocation, n (%)  Yes  No	8 (16.7) 40 (83.3)	3 (4.7) 61 (95.3)	11 (10.7) 101 (89.3)	0.035
Deep infection, n (%)  Yes  No	2 (4.2) 46 (95.8)	2 (3.1) 62 (96.9)	4 (3.6) 108 (96.4)	1.000
Mortality in 90 days, n (%)  Yes  No	14 (29.2) 34 (70.8)	13 (20.3) 51 (79.7)	27 (24.1) 85 (75.9)	0.372
Trochanteric nonunion, n (%)  Yes  No	10 (20.9) 38 (79.1)	9 (14.1) 55 (85.9)	19 (16.9) 93 (83.1)	0.447

Notes: According to the analysis, there was a statistically significant difference in terms of dislocation and surgical duration. Bold values indicate statistical significance P<0.05.

Abbreviations: RBCs, red blood cells.

Table 4 Logistic regression analysis

	B	SE	Wald	df	P-value	OR	95% CI for OR
							Lower	Upper
Surgical approach (posterolateral)	2.12	1.016	4.36	1	0.037	8.3	1.14	61.10
Cognitive disorder (yes)	2.72	0.941	8.35	1	0.004	15.1	2.40	95.81
Trochanteric nonunion (yes)	3.02	0.918	10.79	1	0.001	20.4	3.38	123.69
Constant	−5.88	1.384	18.02	1	0.0001	0.003

Notes: The table shows that the presence of a cognitive disorder, trochanteric nonunion, and use of posterolateral surgical approach increase the risk of developing dislocation in a patient. Bold values indicate statistical significance P<0.05.

Abbreviation: SE, standard error.

Table 3 Analysis of other factors that affect the formation of dislocation

	Dislocation no (n=101)	Dislocation yes (n=11)	P-value
Age, years	86.9±5.9	85.9±7.4	0.592
BMI, kg/m^2	26.6±4.1	27.6±3.9	0.428
Head size, mm	47.4±3.2	47.4±3.8	0.978
Time period until surgery, days	4 (1–10)	3 (2–8)	0.320
Gender
Female	71 (70.3)	7 (63.6)	0.733
Male	30 (29.7)	4 (36.4)
Cognitive disorder (yes)	16 (15.8)	8 (72.7)	0.0001
Trochanteric nonunion (yes)	11 (10.9)	8 (72.7)	0.0001
Surgical approach
Posterolateral	40 (36.9)	8 (72.7)	0.035
Transtrochanteric	61 (60.4)	3 (27.3)
Prosthesis type
Bi-Metric (cemented fixation)	64 (63.4)	8 (72.7)	0.743
T2 (uncemented fixation)	37 (36.6)	3 (27.3)

Notes: It is seen from the table that the presence of a cognitive disorder, trochanteric nonunion, and use of posterolateral surgical approach result in a statistically significant increase in the rate of dislocation. Bold values indicate statistical significance P<0.05.