Clin Orthop Surg.  2020 Mar;12(1):29-36. 10.4055/cios.2020.12.1.29.

Risk Factors Associated with Failure of Cephalomedullary Nail Fixation in the Treatment of Trochanteric Hip Fractures

Affiliations
  • 1Department of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea.
  • 2Department of Orthopaedic Surgery, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwasung, Korea.
  • 3Department of Orthopaedic Surgery, Hallym University Gangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea. hwangjihyo7309@gmail.com

Abstract

BACKGROUND
Intramedullary (IM) nailing is widely performed in elderly patients with trochanteric fractures. Thus, it is important to identify causative factors associated with fixation failure. We investigated fixation failures after IM nailing in elderly patients with trochanteric fractures and compared the failure group with nonfailure group to identify risk factors of fixation failure.
METHODS
A total of 396 patients aged 65 years or older underwent IM nailing for trochanteric fractures between January 2012 and August 2016 at our institution. Of those, 194 patients who were followed up for more than 12 months were enrolled in this study; 202 patients were excluded due to death during follow-up, bedridden status before injury, and loss to follow-up. All patients underwent plain radiography and preoperative computed tomography (CT).
RESULTS
Fixation failure occurred in 11 patients (5.7%). Seven patients had stable fractures (AO/OTA); eight patients had basicervical fractures (confirmed by CT). Five patients had comminution in the greater trochanter (confirmed by CT). Regarding fracture reduction, eight patients showed discontinuity in the anterior cortex. The position of the lag screw on the lateral view was in the center in six patients and in a posterior area in the other five patients. On the basis of comparison with the 183 patients without fixation failure, risk factors of fixation failure were higher body mass index (BMI; p = 0.003), basicervical type of fracture (p = 0.037), posterior placement of the lag screw on the lateral view (p < 0.001), and inaccurate reduction of the anterior cortex (p = 0.011).
CONCLUSIONS
Among the risk factors of fixation failure after IM nailing in elderly patients with trochanteric fractures, discontinuity of the anterior cortex and posterior position of the lag screw are modifiable surgeon factors, whereas higher BMI and basicervical type of fracture are nonmodifiable patient factors. Therefore, care should be taken to avoid fixation failure in IM nailing for patients with a basicervical type of fracture or higher BMI or both.

Keyword

Fixation failure; Intramedullary nailing; Basicervical fracture type; Trochanteric fracture

MeSH Terms

Aged
Body Mass Index
Femur*
Follow-Up Studies
Fracture Fixation, Intramedullary
Hip Fractures*
Hip*
Humans
Radiography
Risk Factors*
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