Risk factors for implant failure of intertrochanteric fractures with lateral femoral wall fracture after intramedullary nail fixation |
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| Affiliation: | 1. Department of Orthopedics, Peking University Third Hospital, Beijing 100191, China;2. Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing 100191, China;1. University of Bari “Aldo Moro”. Department of Basic Medical Sciences, Neuroscience and Sense Organs. Orthopaedic and Trauma Unit, Piazza Giulio Cesare, 11. 70124. Bari, Italy;2. Orthopaedic and Trauma Unit, Humanitas Research Hospital, Milano, Italy;1. Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India;2. Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India;3. Department of Orthopedics, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India;4. Mahatma Gandhi Mission Medical College, Aurangabad, India;5. Department of Orthopedics, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India;1. Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, 6 Jiefang Street, Dalian, Liaoning 116001, China;2. Department of Orthopaedics, Yantai Hospital of Shandong Wendeng Orthrpaedics & Traumatology, Shanhai South Road, Laishan district, Yantai 264003, Shandong Province, China;1. Department of Traumatology, Fukushima Medical University, Trauma & Reconstruction Center, SouthernTOHOKU General Hospital;2. Department of Orthopaedic Surgery, Teikyo University School of Medicine;3. Department of Orthopaedic Surgery, Chikamori Hospital;4. Department of Orthopaedic Surgery, Nagasaki Memorial Hospital;1. Department of Orthopedic Surgery, Suwa Central Hospital, 4300 Tamagawa, Chino, Nagano 391-8503, Japan;2. Department of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan;3. Department of Anestheology, Suwa Central Hospital, Nagano, Japan;4. Second Department of Orthopedic Surgery, Dokkyo Medical University, Saitama Medical Center, Saitama, Japan;5. Department of Public Health in Global Health, Graduate School of Medicine, Tokyo Medical and Dental University, Japan;6. Office for Global Education and Career Development, International Exchange Center, Tokyo Medical and Dental University, Japan;7. Physical Medicine and Rehabilitation Research Copenhagen (PMR-C), Departments of Physiotherapy and Orthopaedic Surgery, Copenhagen University Hospital Amager-Hvidovre & Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark |
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| Abstract: | IntroductionFew studies have specifically evaluated the comminution extent of lateral femoral wall (LFW) fracture and risk factors of implant failure in intertrochanteric fractures with LFW fracture. The aim of present study was to evaluate the influence of comminution extent of LFW fracture on implant failure and identify risk factors of implant failure in cases with LFW fracture after intramedullary fixation.MethodsThis retrospective study included 130 intertrochanteric fracture with LFW fracture treated with intramedullary fixation at a teaching hospital over a 13-year period from January 2006 to December 2018. Demographic information, cortical thickness index, the reduction quality, status of medial support, position of the screw/blade and status of lateral femoral wall were collected and compared. The logistic regression analyzes was performed to evaluate risk factors of implant failure in intertrochanteric fractures with LFW fracture after intramedullary nail fixation.Results10 patients (7.69%) suffered from mechanical failure after intramedullary fixation. Univariate analyzes showed that comminuted LFW fracture (OR, 7.625; 95%CI, 1.437~40.446; p = 0.017), poor reduction quality (OR, 49.375; 95%CI, 7.217~337.804; p < 0.001) and loss of medial support (OR, 17.818; 95%CI, 3.537~89.768; p < 0.001) were associated with implant failure. After adjustment for confounding variables, the multivariable logistic regression analyzes showed that poor reduction quality (OR, 11.318; 95%CI, 1.126~113.755; p = 0.039) and loss of medial support (OR, 7.734; 95%CI, 1.062~56.327; p = 0.043) were independent risk factors for implant failure. Whereas, comminuted LFW fracture was not associated with implant failure (p = 0.429).ConclusionsThe comminution extent of the LFW fracture might influence the stability of intertrochanteric fractures; and intramedullary fixation might be an effective treatment method. Furthermore, poor reduction quality and loss of medial support could increaze the risk of implant failure in intertrochanteric fractures with LFW fractures after intramedullary fixation. Therefore, we should pay great emphasis on fracture reduction quality in future. |
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