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Anterior Lag Screw Position and Suboptimal Reduction in Lateral Plain as Predictors of Failure in Cephalomedullary Nailing of Intertrochanteric Fractures

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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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Data Availability

All data generated and analyzed during this study are included in this article and are available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. Orthopaedics and Trauma Surgery Department, British Hospital of Buenos Aires, Perdriel 74, C1280 AEB, Buenos Aires, Argentina

    Germán Garabano, Joaquín Rodriguez & Cesar Angel Pesciallo

  2. Orthopaedics and Trauma Surgery Department, Sirio Libanes Hospital, Campana 4658, C1419, Buenos Aires, Argentina

    Sebastián Pereira & Fernando Bidolegui

Authors
  1. Germán Garabano
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  2. Sebastián Pereira
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  3. Joaquín Rodriguez
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  4. Cesar Angel Pesciallo
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  5. Fernando Bidolegui
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All authors made substantial contributions to the design of the study; to the acquisition, analysis, and interpretation of the data; to the intellectual content by means of the critical revision of the manuscript; Finally, everyone approved the final version to be published.

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Correspondence to Germán Garabano.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the British Hospital of Buenos Aires and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards (Project number 2257).

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Informed consent was obtained from all individual participants included in the study.

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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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