Abstract
Failed fixation of the proximal femur has a great impact on morbimortality, especially in elderly patients after hip fracture. The purpose of this study was to identify the variables associated with failure in intertrochanteric fractures treated with cephalomedullary nails. We retrospectively analyzed 247 consecutive patients who underwent surgery between January 2016 and July 2019. Age, gender, fracture stability (AO/OTA), femoral neck angle (FNA), FNA difference with contralateral hip, lag screw position and tip-apex distance (TAD), union, and failure rates were analyzed. Uni and multivariate logistic regression analyses were used to identify whether these variables were related to a risk of failure (cut-out, cut-through, and/or non-union). The failure rate was 9.7%: 7 non-union (2.8%), 10 cut-out (4.0%), and 7 cut-through cases (2.8%). Female sex (p = 0.0112), FNA < 125° (p = 0.0025), FNA difference 7.5° with contralateral side in lateral view (p = < 0.001), superior (p = 0.0309)-anterior (p ≤ 0.001) lag screw position, and TAD > 25 mm (p = 0.0401) were identified as risk factors for these complications in univariate logistic regression. Female gender (OR 10.90 95CI 1.27–1134.96; p 0.0396), FNA difference in lateral view (OR 1.47 95CI 1.19–1.78; p < 0.001), and anterior screw position (OR 59.41 95CI 12.25–97.99; p < 0.001) were confirmed as independent predictors of failure in multivariate analysis. This study confirmed female sex, malreduction in the lateral plane, and anterior screw position as independent predictors of failure. Every effort should be made to achieve an accurate reduction and proper implant positioning to improve failure rates.
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Garabano, G., Pereira, S., Rodriguez, J. et al. Anterior Lag Screw Position and Suboptimal Reduction in Lateral Plain as Predictors of Failure in Cephalomedullary Nailing of Intertrochanteric Fractures. SN Compr. Clin. Med. 4, 50 (2022). https://doi.org/10.1007/s42399-022-01133-0
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DOI: https://doi.org/10.1007/s42399-022-01133-0