Medium-term Outcomes of Intertrochanteric Femur Fractures at Kenyatta National Hospital

Abstract

Background Proximal femur fractures are prevalent worldwide. They account for up to a third of femur fractures seen in the developing world. Half of all proximal femur fractures are trochanteric fractures. The economic burden for these injuries is above USD 2.5 billion annually in the United States alone. Outcome data for the commonest management protocols of intertrochanteric fractures is lacking in the local context. Purpose of the study To evaluate the one year outcomes of intertrochanteric femur fractures at Kenyatta National Hospital. Methodology A cross-sectional study was conducted at Kenyatta National Hospital. Consecutive sampling was used to select 39 patients with intertrochanteric fractures who had been treated. A modified Harris Hip Score (HHS) was used to measure self-reported functional outcomes of treatment, 12 months post treatment. Descriptive statistics included frequencies and percentages for continuous variables and medians and standard deviations for categorical variables. Inferential statistics included the Kruskal-Walli’s rank sum test and Fisher’s exact test. Results A total of 39 patients participated in the study. Their average age was 44 [SD = 14.8] years with majority (77%) male. All of the injuries were either as a result of road traffic - 21 (54%) or Falls - 18 (46%). Among the patients 17 (47%) were classified as 31. A1, 15 (42%) were 31. A2 and 4 (11%) were 31. A3. Twenty-eight (72%) cases underwent surgical procedures whereas 11 (28%) had non-operative treatment. PFN was the most common fixation method, accounting for 64% (n=18) of all surgeries whereas Traction was the most common non-operative treatment, 82% (n=9). The Modified Harris Hip Score was self-reported by patients at 12 months post treatment. The majority, 39% (n=15) of the patients had Good, 29% (n=11) had excellent scores, whereas Fair and Poor classifications accounted for 16% (n=6) each. This translates to 68% (n=26) who scored Good/Excellent and 32% (n=12) who scored Fair or Poor. Age in years (p=0.015) using the Kruskal-Wallis rank sum test and fracture classification using Fisher’s exact test were significantly associated with HHS score after 12 months post-treatment. Conclusion Intertrochanteric fractures appear to have a good outcome from our study and multiple other literature. There is no statistically significant difference in outcomes between dynamic Hip screw and cephalomedullary nail for intertrochanteric femur fractures. Recommendations. Further studies including cohort studies and clinical trials are recommended to elucidate specific factors that influence outcomes of intertrochanteric fractures and how those factors can be exploited to achieve even better outcomes