Table 4.
Operative characteristics and radiographic measurements (pre-operative and post-operative), stratified according to the type of nail used
| All patients | Long Gamma nail | Long Affixus nail | |
|---|---|---|---|
| Demographics | |||
| Total number | 238 | 119 | 119 |
| Age (years) | 73.40 (16.81) | 73.02 (16.86) | 73.78 (16.82) |
| Gender | |||
| Male | 84 (35.5%) | 42 (35.3%) | 42 (35.3%) |
| Female | 154 (64.7%) | 77 (64.7%) | 77 (64.7%) |
| Injury characteristics | |||
| Mechanism of injury | |||
| Low energy | 200 (84.0%) | 100 (84.0%) | 100 (84.0%) |
| High energy | 4 (1.7%) | 2 (1.7%) | 2 (1.7%) |
| Pathological | 34 (14.3%) | 17 (14.3%) | 17 (14.3%) |
| Isolated | 205 (86.1%) | 103 (86.6%) | 102 (85.7%) |
| ISS > 16 | 12 (5.0%) | 7 (5.9%) | 5 (4.2%) |
| Side | |||
| Left | 119 (50%) | 58 (48.7%) | 61 (51.3%) |
| Right | 119 (50%) | 61 (51.3%) | 58 (48.7%) |
| Open fracture | 2 (0.8%) | 1 (0.8%) | 1 (0.8%) |
| Russell–Taylor classification | |||
| 1A | 68 (28.6%) | 29 (24.4%) | 39 (32.8%) |
| 1B | 79 (33.2%) | 42 (35.3%) | 37 (31.1%) |
| 2A | 11 (4.6%) | 6 (5.0%) | 5 (4.2%) |
| 2B | 80 (33.6%) | 42 (35.3%) | 38 (31.9%) |
| Medical comorbidities | |||
| ASA | |||
| 1 | 19 (7.9%) | 8 (6.7%) | 11 (9.2%) |
| 2 | 69 (28.9%) | 36 (30.3%) | 33 (27.7%) |
| 3 | 114 (47.9%) | 55 (46.2%) | 59 (49.6%) |
| 4 | 36 (15.1%) | 20 (16.8%) | 16 (13.4%) |
| Charlson Comorbidity Score | 10.12 (4.30) | 5.21 (2.80) | 4.91 (2.88) |
| Diabetes | 37 (15.5%) | 15 (12.6%) | 22 (18.5%) |
| Steroids | 10 (4.2%) | 4 (3.4%) | 6 (5.0%) |
| Malignancy | 50 (21.0%) | 29 (24.4%) | 21 (17.6%) |
| Dementia | 39 (16.4%) | 22 (18.5%) | 17 (14.3%) |
| Osteoporosis | |||
| Bisphosphonates pre-admission | 45 (18.9%) | 24 (20.2%) | 21 (17.6%) |
| Bisphosphonates on discharge | 70 (29.4%) | 43 (36.4%) | 27 (22.7%) |
| Calcium/vitamin D pre-admission | 73 (30.7%) | 35 (29.4%) | 38 (31.9%) |
| Calcium/vitamin D on discharge | 129 (54.2%) | 72 (61.0%) | 57 (47.9%) |
| Vitamin D loading on admission | 32 (13.4%) | 3 (2.5%) | 29 (24.4%) |
| Fragility fractures before | 49 (20.6%) | 17 (14.3%) | 32 (26.9%) |
| Fragility fractures after | 52 (21.8%) | 34 (28.6%) | 18 (15.1%) |
| Social history | |||
| Smoking | 49 (20.6%) | 25 (21.0%) | 24 (20.2%) |
| Alcohol > 10 units/week | 45 (18.9%) | 21 (17.6%) | 24 (20.2%) |
| Pre-operative mobility | |||
| Independent | 119 (50.0%) | 62 (52.1%) | 57 (47.9%) |
| Stick(s)/crutch(es) | 80 (33.6%) | 40 (33.6%) | 40 (33.6%) |
| Frame | 30 (12.6%) | 13 (10.9%) | 17 (14.3%) |
| Wheelchair/hoisted | 9 (3.8%) | 4 (3.4%) | 5 (4.2%) |
| Frequent falls | 73 (30.7%) | 44 (37.0%) | 29 (24.4%) |
| Operation characteristics | |||
| Operation in less than 48 h | 187 (78.6%) | 79 (66.4%) | 108 (90.8%) |
| Simultaneous procedures | 20 (8.4%) | 10 (8.4%) | 10 (8.4%) |
| Nail diameter (mm) | |||
| 9 | 7 (2.9%) | 0 (0.0%) | 7 (5.9%) |
| 11 | 153 (64.3%) | 82 (70.1%) | 71 (60.2%) |
| 13 | 75 (31.5%) | 35 (29.9%) | 40 (33.9%) |
| Open reduction | 117 (49.2%) | 59 (49.6%) | 58 (48.7%) |
| Use of cerclage wires | 35 (14.7%) | 17 (14.3%) | 18 (15.1%) |
| Post-op mobilisation (first 6 weeks) | |||
| FWB | 114 (47.9%) | 52 (43.7%) | 62 (52.1%) |
| PWB | 61 (25.6%) | 33 (27.7%) | 28 (23.5%) |
| TTWB | 38 (15.9%) | 22 (18.5%) | 16 (13.4%) |
| NWB | 25 (10.5%) | 12 (10.1%) | 13 (10.9%) |
| Surgical time (min) | 109.26 (42.94) | 104.06 (46.38) | 114.51 (38.65) |
| Anaesthetic time (min) | 49.30 (24.53) | 45.78 (28.15) | 52.85 (19.72) |
| Time from induction to recovery (min) | 178.00 (49.82) | 171.44 (54.65) | 184.63 (43.66) |
| Level of first surgeon | |||
| Registrar | 150 (63.0%) | 72 (60.5%) | 78 (66.1%) |
| Consultant | 87 (36.6%) | 47 (39.5%) | 40 (33.9%) |
| Level of senior surgeon present | |||
| Registrar | 140 (58.8%) | 68 (57.1%) | 72 (61.0%) |
| Consultant | 97 (40.8%) | 51 (42.9%) | 46 (39.0%) |
| Complications | |||
| Re-operation | 50 (21.0%) | 34 (28.6%) | 16 (13.4%) |
| Nail failure (any cause) | 25 (10.5%) | 18 (15.1%) | 7 (5.9%) |
| Failure at lag screw junction** | 18 (7.6%) | 11 (9.2%) | 7 (5.9%) |
| Self-dynamisation | 13 (5.5%) | 9 (7.6%) | 4 (3.4%) |
| Cut-out | 6 (2.5%) | 5 (4.2%) | 1 (0.8%) |
| Nail infection | 2 (0.8%) | 1 (0.8%) | 1 (0.8%) |
| Peri-implant fracture | 8 (3.4%) | 5 (4.2%) | 3 (2.5%) |
| Non-union | 53 (22.3%) | 30 (25.2%) | 23 (19.3%) |
| HAP/CAP | 40 (16.8%) | 17 (14.3%) | 23 (19.3%) |
| UTI | 35 (14.7%) | 12 (10.1%) | 23 (19.3%) |
| Wound infection | |||
| Superficial | 8 (3.4%) | 4 (3.4%) | 4 (3.4%) |
| Deep | 6 (2.5%) | 3 (2.5%) | 3 (2.5%) |
| Washout/revision for Infection | 4 (1.7%) | 3 (9.1%) | 1 (6.2%) |
| CKD stage pre-operatively | |||
| Mild | 163 (68.5%) | 72 (62.6%) | 91 (77.1%) |
| Moderate/severe | 70 (29.4%) | 43 (37.4%) | 27 (22.9%) |
| CKD stage post-operatively | |||
| Mild | 170 (71.4%) | 84 (74.3%) | 86 (73.5%) |
| Moderate/severe | 60 (25.2%) | 29 (25.7%) | 31 (26.5%) |
| Pre-operative transfusion | 16 (6.7%) | 11 (9.2%) | 5 (4.2%) |
| Post-operative transfusion (48 h) | 148 (62.2%) | 76 (63.9%) | 72 (60.5%) |
| Hb drop (g/L) | 42.83 (17.80) | 44.9 (19.09) | 40.84 (16.30) |
| Radiographic measurements | |||
| Femoral neck shaft anglea | |||
| Normal | 159 (66.8%) | 80 (67.2%) | 79 (66.9%) |
| Coxa valga | 67 (28.2%) | 32 (26.9%) | 35 (29.7%) |
| Coxa vara | 11 (4.6%) | 7 (5.9%) | 4 (3.4%) |
| Number of fragments (comminution) | |||
| Simple | 60 (25.2%) | 31 (26.1%) | 29 (24.4%) |
| Moderate | 125 (52.5%) | 57 (47.9%) | 68 (57.1%) |
| Severe | 53 (22.3%) | 31 (26.1%) | 22 (18.5%) |
| Only subtrochanteric extension | 32 (13.4%) | 14 (11.8%) | 18 (15.1%) |
| Atypical | 15 (6.3%) | 8 (6.7%) | 7 (5.9%) |
| Pathological | 3 (1.3%) | 2 (1.7%) | 1 (0.8%) |
| Distal extension | 94 (39.5%) | 53 (44.5%) | 41 (34.5%) |
| Greater trochanter fracture | 24 (10.1%) | 10 (8.4%) | 14 (11.8%) |
| Lesser trochanter fracture | 163 (68.5%) | 80 (67.2%) | 83 (69.7%) |
| Medial calcar comminution | 18 (7.6%) | 9 (7.6%) | 9 (7.6%) |
| Lateral cortex gap size (mm) | |||
| ≤ 4 | 136 (57.1%) | 60 (50.4%) | 76 (63.9%) |
| 5–9 | 68 (28.6%) | 39 (32.8%) | 29 (24.4%) |
| ≥ 10 | 34 (14.3%) | 20 (16.8%) | 14 (11.8%) |
| Medial cortex gap size (mm) | |||
| ≤ 4 | 156 (65.5%) | 83 (69.7%) | 73 (61.3%) |
| 5–9 | 57 (23.9%) | 25 (21.0%) | 32 (26.9%) |
| ≥ 10 | 25 (10.5%) | 11 (9.2%) | 14 (11.8%) |
| Anterior cortex gap size (mm) | |||
| ≤ 4 | 156 (65.5%) | 82 (68.9%) | 74 (62.2%) |
| 5–9 | 52 (21.8%) | 21 (17.6%) | 31 (26.1%) |
| ≥ 10 | 30 (12.6%) | 16 (13.4%) | 14 (11.8%) |
| Posterior cortex gap size (mm) | |||
| ≤ 4 | 180 (75.6%) | 85 (71.4%) | 95 (79.8%) |
| (5–9) | 42 (17.6%) | 23 (19.3%) | 19 (16.0%) |
| ≥ 10 | 16 (6.7%) | 11 (9.2%) | 5 (4.2%) |
| Reduction angle groupedb (degrees) | |||
| Valgus 5–varus 5 | 170 (71.4%) | 84 (70.6%) | 86 (72.3%) |
| Valgus > 5 | 12 (5.0%) | 4 (3.4%) | 8 (6.7%) |
| Varus 5–10 | 44 (18.5%) | 24 (20.2%) | 20 (16.8%) |
| Varus > 10 | 12 (5.0%) | 7 (5.9%) | 5 (4.2%) |
| Anti-rotation screw | 74 (31.1%) | 0 (0.0%) | 74 (62.2%) |
| TAD (mm) | |||
| < 25 | 210 (88.2%) | 107 (89.9%) | 103 (87.3%) |
| ≥ 25 | 27 (11.3%) | 12 (10.1%) | 15 (12.7%) |
| Distal locking (number of screws) | |||
| 1 | 7 (2.9%) | 4 (3.4%) | 3 (2.5%) |
| 2 | 231 (97.1%) | 115 (96.6%) | 116 (97.5%) |
| Method of locking | |||
| Static locking | 155 (65.1%) | 72 (60.5%) | 83 (69.7%) |
| Secondary dynamisation | 81 (34.0%) | 46 (38.7%) | 35 (29.4%) |
| Dynamic | 2 (0.8%) | 1 (0.8%) | 1 (0.8%) |
| Distance of tip of the nail from centre (AP) (mm) | |||
| − 4 to 4 | 148 (62.2%) | 71 (59.7%) | 77 (64.7%) |
| Lateral ≥ 5 | 50 (21.0%) | 27 (22.7%) | 23 (19.3%) |
| Medial ≥ 5 | 40 (16.8%) | 21 (17.6%) | 19 (16.0%) |
| Distance of tip of the nail from centre (LAT) (mm) | |||
| − 4 to 4 | 187 (78.6%) | 90 (75.6%) | 97 (81.5%) |
| Anterior ≥ 5 | 46 (19.3%) | 27 (22.7%) | 19 (16.0%) |
| Posterior ≥ 5 | 5 (2.1%) | 2 (1.7%) | 3 (2.5%) |
| Distance of tip of the nail from knee (mm) | |||
| < 10 | 1 (0.4%) | 1 (0.8%) | 0 (0.0%) |
| 10 to 19 | 18 (7.6%) | 6 (5.0%) | 12 (10.1%) |
| 20–29 | 79 (33.2%) | 35 (29.4%) | 44 (37.0%) |
| ≥ 30 | 140 (58.8%) | 77 (64.7%) | 63 (52.9%) |
| Touching anterior cortex | 74 (31.1%) | 45 (37.8%) | 29 (24.4%) |
| Nail/canal ratio | 0.82 (0.08) | 0.83 (0.08) | 0.82 (0.07) |
| Hospital stay/mortality | |||
| HDU/ICU stay | 25 (10.5%) | 10 (8.4%) | 15 (12.6%) |
| Total length of hospital stay (days) | 23.65 (21.29) | 23.74 (20.19) | 23.56 (22.42) |
| Died within a year | 14 (5.9%) | 10 (8.4%) | 4 (3.4%) |
Dichotomous variables are presented as absolute numbers (percentages) of the positive event
Continuous variables are presented as mean (SD)
aFemoral neck shaft angle: pre-injury angles, assumed to be same and measured from the opposite uninjured hip. In cases of bilateral fractures, measurements were taken from the radiographs closest to the date of injury
bReduction angle: measured in the immediate post-operative period