The postoperative prognosis of elderly intertrochanteric fracture patients as evaluated by the Chang reduction quality criteria

Abstract Objective The aim of this study was to investigate the relationship between the Chang reduction quality criteria (CRQC) and the outcome of elderly intertrochanteric fractures based on a subgroup of follow-up time. Methods Retrospective analysis of 389 elderly patients with intertrochanteric fractures treated surgically from January 2019 to June 2021, including 130 males and 259 females; age 84.64 (77.50-89.74) years. Patient survival was followed by telephone between admission to hospital for fracture and death, or until study deadline (June 1, 2022). According to the CRQC, were divided into Poor, Acceptable, Excellent three groups. Based on total follow-up time and 1-year follow-up, univariate and multivariate Cox proportional hazard models were used to assess the association between CRQC and all-cause mortality in elderly intertrochanteric fractures. Further subgroup analysis was performed according to different clinical and biological characteristics to make the results more accurate. Results The mortality were 24.68% and 15.42% at 1 year and total follow-up, respectively. In the total follow-up time and 1-year follow-up time, the mortality of CRQC-Excellent was significantly lower than that of CRQC-Acceptable (p.adj < 0.05), and was significantly lower than that of CRQC-Poor (p.adj < 0.05). After multi-factor adjustment, CRQC-Acceptable and Poor in were independent risk factors affecting the overall mortality and 1-year mortality. In addition, advanced age, comorbidities ≥ 1, ASA3 + 4, and prolonged preoperative waiting time were independent risk factors for survival in the total follow-up time. At 1-year follow-up, only ASA3 + 4 and prolonged preoperative waiting time were independent risk factors for survival. Subgroup analysis according to different characteristics at the total follow-up time and at the one-year follow-up time showed that in most subgroups as CRQC decreased was significantly associated with an increase in all-cause mortality (p for trend < 0.05). Conclusions This study highlights that CRQC-Acceptable and Poor are associated with increased all-cause mortality in elderly intertrochanteric fractures. We should try to achieve good reduction of these fractures.