Does matching degree matter for proximal femoral intramedullary nail on reoperation rate in intertrochanteric fractures?

Abstract

Introduction Previous articles reported on the tip–apex distance, lag screw placement, fracture pattern, reduction quality, osteoporosis and other factors associated with second surgery. The current study focused on investigating the association of the matching degree between proximal femoral intramedullary nail and femoral medullary cavity on reoperation rate. Patients and methods A retrospective cohort study was conducted. It included patients with intertrochanteric fracture who were treated with proximal femoral anti-rotatory intramedullary nail (PFNA) between January 2016 and April 2021. The gap between the intramedullary nail and the femoral medullary cavity was equal to the difference in diameter between the two. According to the gap size, all patients were divided into three groups, as follows: high-matching group: gap ≤ 2 mm; middle-matching group: 2 < gap < 4 mm; and low-matching group: gap ≥ 4 mm. The mean gap was measured through standard images. The primary observational index was whether the reoperation was needed, and secondary observational indexes included operative time, length of hospital stay. Patient characteristics were recorded, as follows: age, sex, follow-up time, fracture pattern, reduction grade and length of intramedullary nail. Results A total of 203 eligible patients were recorded, including 78 males (38.4%) and 125 females (61.6%). They had a mean age of 77.8 ± 9.9 years old and an average follow-up time of 58.1 ± 24.0 weeks. Twenty-seven patients (13.3%) needed a second operation. Coxa varus combined with screw cutting was the most common reason for reoperation (11 cases). Unstable fracture pattern with poor reduction grade tended to contribute to reoperation, whose odds ratio (OR) was 6.61 (95% confidence interval [CI], 1.98–22.09; P = 0.002). The three groups had 11 cases (13.7%), 12 cases (13.8%) and 4 cases (11.1%) of reoperation, respectively, and logistic regression showed no significant association was noted between matching degree of intramedullary nail and reoperation rate. Conclusions The matching degree between proximal femoral intramedullary nail and femoral medullary cavity did not seem to be an important factor for reoperation, which offered more options of intramedullary nail size intraoperatively and reduced implants stock from inventory.

Extending the intermedullary nail will not reduce the potential risk of femoral head varus in PFNA patients biomechanically: a clinical review and corresponding numerical simulation

“…First, femoral head varus values were recorded to determine patient prognosis. The reoperation rate of PFNA-fixed patients was recorded to determine the complication rate in several studies [ 9 , 10 ]. Traditionally, only patients who underwent reoperation were considered to suffer complications [ 10 , 38 ].…”

Intertrochanteric Femoral Fractures: A Comparative Analysis of Clinical and Radiographic Outcomes Between Talon Intramedullary Nail and Intertan Nail

“…It has been found that nails filling the medulla in femur shaft fractures reduce interfragmentary movement, resulting in better fracture healing. To reduce revision rates, 90% nail fit is required [ 18 , 19 ]. In the Talon PFN group, because the only nail option is 11 mm wide in the distal part, resistance against rotational and axial forces in osteoporotic patients with a broad medulla is provided solely by Talon hooks.…”

Changes in nail position and antirotation blade angles on the risk of femoral head varus in PFNA fixed patients: a clinical review and comprehensive biomechanical research

“…With the aggravation of aging population tendency, the fracture incidence stepwise increased. Internal fixation operation is an effective method to treat the intertrochanteric fracture, and several different fixation devices have been used in the fracture treatment in which the proximal femoral nail antirotation (PFNA) is the most widely used fixation device and achieved definite clinical effect [ 3 , 4 ]. However, as a hardware related complication, femoral head varus can trigger patient’s poor prognosis.…”