High- Versus Low-Energy Intertrochanteric Hip Fractures in Young Patients: Injury Characteristics and Factors Associated With Complications.

Objective: To compare fracture patterns and associated injuries for young patients with high- versus low-energy intertrochanteric hip fractures and to report on factors associated with complications after surgical fixation of high-energy fractures.
Design: Retrospective comparative study.
Setting: Academic Level 1 Trauma Center.
Patients: A total of 103 patients 50 years of age or younger were included: 80 high-energy fractures and 23 low-energy fractures.
Intervention: Cephalomedullary nailing (N = 92) or a sliding hip screw (N = 11).
Main Outcome Measures: Radiographic characteristics of fracture morphology, implant position, and reduction quality and postoperative complications were the main outcome measures.
Results: Compared with young patients with low-energy fractures, those with high-energy fractures had more fracture comminution ( P = 0.013) and higher ISS scores ( P < 0.003) and were more likely to require open reduction ( P < 0.001). Patients with low-energy fractures from a ground-level fall had higher rates of alcohol abuse (0.032), cirrhosis (0.010), and chronic steroid use (0.048). Overall reoperation rate for high-energy fractures was 7%, including 2 IT fracture nonunions (5%) and 1 deep infection (2%). For high-energy fractures, ASA class ( P = 0.026), anterior lag screw position ( P = 0.001), and varus malreduction ( P < 0.001) were associated with malunion. Four-part fracture (OTA/AO 31A2.3/Jensen 5) ( P = 0.028) and residual calcar gap >3 mm ( P = 0.03) were associated with reoperation.
Conclusions: Surgical treatment of high-energy IT fractures in young patients is technically demanding with potential untoward outcomes. Injury characteristics and severity are significantly different for young patients with high-energy IT fractures compared with low-energy fractures. For young patients with a high-energy IT fracture, surgeons can anticipate a high rate of associated injuries and complex fracture patterns requiring open reduction. For young patients with a low-energy IT fracture, comanagement with a hospitalist or a geriatrician should be considered because they may be physiologically older.
Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Competing Interests: D. T. Watson—Smith & Nephew: paid consultant; paid presenter or speaker; A. R. Shah—Smith & Nephew: paid presenter or speaker; R. Sanders— JOT : Editorial or governing board; publishing royalties, financial or material support; OTA: Board or committee member; Smith & Nephew: IP royalties; paid presenter or speaker; H. R. Mir—AO Trauma: Research support; JOT : Associate Editor: Editorial or governing board; OTA: Board or committee member; Smith & Nephew: paid consultant; research support; Synthes: paid consultant. The remaining authors report no conflict of interest.
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