From Prospective Enrollments to Predictive Modeling: Exploring the Comprehensive Methods Used in Studying Open Proximal Femoral Fractures
Mohammad Hutaif, Abdullah Al-Moaish, Anwar Al-Fadliy
PMID: 38214007, PMCID: PMC10773698, DOI: 10.2106/JBJS.OA.23.00085
Abstract
Explore the rare but devastating injuries of open proximal femoral fractures caused by gunshot wounds in Yemen. This study evaluates the functional and radiographic outcomes, identifies influential factors, and highlights the challenges of prognosis and management.
Methods
Discover the comprehensive study that prospectively enrolled 174 patients with open proximal femoral fractures caused by gunshot wounds. The Gustilo-Anderson and OTA/AO systems were used for classification, and the study analyzed fracture union, infection, and functional outcomes. Explore the primary outcome measures and multivariable logistic regression modeling utilized to predict complications and poor functional outcomes.
Results
Uncover the results of the study, indicating an 87% rate of fracture union. Complication rates include infection (18%), nonunion (13%), reoperation (23%), delayed union (12%), osteonecrosis (4%), heterotopic ossification (6%), and amputation (2%). Furthermore, the mean Harris hip score (HHS) was 78.4, and the mean Short Form-36 (SF-36) score was 67.3.
Conclusion
Understand the implications of open proximal femoral fractures caused by gunshot wounds, which often result in high complication rates and poor functional outcomes. Early debridement, appropriate fixation, infection control, and sufficient soft-tissue coverage are emphasized to achieve satisfactory results. The type of wound, fracture, and definitive fixation are identified as significant predictors of outcomes. Future studies are recommended to compare fixation methods and evaluate long-term outcomes and complications.
Abstract
Methods
We prospectively enrolled 174 patients with open proximal femoral fractures caused by gunshot wounds. The fractures were classified according to the Gustilo-Anderson and OTA/AO systems. The primary outcome measures were fracture union, infection, and functional outcomes. The secondary outcome measures were the Harris hip score (HHS) and the Short Form-36 (SF-36) health survey score. We performed multivariable logistic regression modeling to identify the predictors of complications and poor functional outcomes.
Results
The overall rate of fracture union was 87%. The complication rates were 18% for infection, 13% for nonunion, 23% for reoperation, 12% for delayed union, 4% for osteonecrosis, 6% for heterotopic ossification, and 2% for amputation. The mean HHS at the final follow-up was 78.4, and the mean SF-36 score was 67.3.
Conclusions
Open proximal femoral fractures caused by gunshot wounds are associated with high rates of complications and poor functional outcomes in Yemen. Early debridement, appropriate fixation, infection control, and adequate soft-tissue coverage are essential for achieving satisfactory results. The type of wound, the type of fracture, and the type of definitive fixation are significant predictors of the outcomes. Future studies should compare different fixation methods and evaluate the long-term outcomes and complications of these injuries.
