Risk factors for implant failure after fixation of proximal femoral fractures with fracture of the lateral femoral wall |
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| Affiliation: | 1. Department of Orthopaedic Surgery & Joint Reconstructive Surgery at Toyama Municipal Hospital, 2-1, Imaizumi-hokubu, Toyama City 939-8511, Japan;2. Department of Orthopaedic Surgery at Hokuriku Hospital, 2-13-43, Izumigaoka, Kanazawa City 921-8035, Japan;3. Orthopaedic Department at Saiseikai Toyama Hospital, 33-1 Kusunoki, Toyama City 931-8533, Japan;4. AO Foundation, AO Clinical Investigation and Documentation, Stettbachstrasse 6, 8600 Duebendorf, Switzerland;1. Department of Surgery and Perioperative Care, Dell Medical School, Health Discovery Building 6.706, 1701 Trinity St., Austin, TX 78723, USA;2. Department of General Surgery, OLVG, Oosterpark 9, 1091 AC Amsterdam, The Netherlands;3. Department of Orthopaedic Surgery, JPS Health Network, 1500 S. Main St, Fort Worth, TX 76104, USA;4. Department of Orthopaedic Surgery, Acclaim Physician Group, Ben Hogan Center, 800 5th Ave, Suite 400, Fort Worth, TX 76104, USA;1. Department of Orthopaedic Surgery, Pusan National University Yangsan Hospital, Republic of Korea;2. Department of Orthopaedic Surgery, Bio-medical Research Institute, Pusan National University Hospital, Republic of Korea |
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| Abstract: | IntroductionTo investigate potential predictors of implant failure following fixation of proximal femoral fractures with a fracture of the lateral femoral wall.Materials and methodsMedical records of 99 adult patients who had operative treatment for a proximal femoral fracture with a fracture of the lateral femoral wall between May 2004 and April 2015 were retrospectively analysed to determine factors associated with implant failure. Patients underwent routine surgical procedures for implantation of extramedullary or intramedullary devices. Potential predictors were age, gender, body mass index, comorbidities, type of fracture, reduction method, status of greater and lesser trochanters, course of the lateral fracture line, and presence/absence of a free bone fragment at the junction of the greater trochanter and lateral femoral wall.ResultsTen (10%) implant failures were identified. Univariate analysis identified a free bone fragment at the junction of the greater trochanter and lateral femoral wall (odds ratio [OR], 21.25; 95% confidence interval [CI], 4.31–104.67; p < 0.001) and a transverse fracture line across the lateral femoral wall (primary or iatrogenic) (OR, 5.36; 95% CI, 1.29–22.30; p = 0.021) as factors associated with implant failure. Using a multivariate model, only a free bone fragment at the junction of the greater trochanter and lateral femoral wall (OR, 16.05; 95% CI, 3.06–84.23; p = 0.001) was a risk factor for implant failure.ConclusionsA free bone fragment at the junction of the greater trochanter and lateral femoral wall and a transverse fracture line across the lateral femoral wall are predictors of implant failure in proximal femoral fractures with a fracture of the lateral femoral wall. Integrity of the lateral femoral wall correlates with prognosis of proximal femoral fracture. Lateral femoral wall reconstruction may be required for effective treatment of proximal femoral fractures with a fracture of the lateral femoral wall. |
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| Keywords: | Femoral fracture Lateral wall Internal fixation Implant failure |
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