Does the perioperative morbidity following internal fixation of proximal femur fracture depend on the type of implant? -: Analysis of dynamic hip screw and proximal femur nail

Rationale: Proximal femur fracture is a frequent finding in elderly patients. Both the dynamic hip screw (DHS) and the proximal femur nail (PFN) are established implants. The aim of our study was to assess the perioperative morbidity in a sample of 112 patients with proximal femur fracture, operated on with either DHS or PFN. Material and Methods: Data of 112 consecutive patients (59 DHS, 53 PFN), which consisted of 20 variables, were obtained. Nine variables were selected, which were considered to possess a potential impact on the complication rate. These variables were type of implant, sex, age, period between trauma and surgery, ASA classification, fracture classification of the ASIF, duration of surgery, blood loss, and antibiotics. They were transformed into dichotomous data to enable univariate statistical analysis and logistic regression. Results: The ASA classification only was evaluated to have a predictive value as shown by the odds ratio of 2.23 (90% confidence interval: 1.09-4.56). ASA 3 or 4 patients had an expected frequency, which was 2.2-fold increased as compared to patients classified as ASA 1 or 2, to suffer from perioperative complications. Using logistic regression, again the ASA classification only was shown to have a significant impact (p=0.066, level of significance: p < 0.1) on the perioperative morbidity. Conclusion: As suggested by our results, neither the type of implant nor the other variables mentioned above had a significant impact on the resulting complication rate in our study sample. The ASA classification only was found to significantlyincrease the probability of an adverse event. This finding should be taken into account prior to initiating therapy.