Risk factors for implant failure in reverse oblique and transverse intertrochanteric fractures treated with proximal femoral nail antirotation (PFNA)

Abstract

BackgroundThe incidence of intertrochanteric hip fracture is expected to increase as the global population ages. It is one of the most important causes of mortality and morbidities in the geriatric population. The incidence of reverse oblique and transverse intertrochanteric (AO/OTA 31-A3) fractures is relatively low; however, the incidence of implant failure in AO/OTA 31-A3 fractures is relatively high compared with that in AO/OTA 31-A1 and A2 fractures. To date, the risk factors for implant failure in AO/OTA 31-A3 fractures treated with proximal femoral nail antirotation (PFNA) have remained ambiguous. The purpose of this study was to identify the predictive factors of implant failure in AO/OTA 31-A3 fractures treated with PFNA.MethodsThe data of all patients who underwent surgery for trochanteric fractures at our institution between January 2006 and February 2018 were retrospectively reviewed. All AO/OTA 31-A3 fractures treated with PFNA were included. Logistic regression analysis of potential predictors of implant failure was performed. Potential predictors included age, sex, body mass index, fracture type, reduction method, status of posteromedial support and lateral femoral wall, reduction quality, tip-apex distance and position of the helical blade in the femoral head.ResultsOne hundred four (9.3%) patients with AO/OTA 31-A3 fractures were identified. Forty-five patients with AO/OTA 31-A3 fractures treated with PFNA were suitable for our study. Overall, implant failure occurred in six (13.3%) of forty-five patients. Multivariate analysis identified poor reduction quality (OR, 28.70; 95% CI, 1.91–431.88; p = 0.015) and loss of posteromedial support (OR, 18.98; 95% CI, 1.40–257.08; p = 0.027) as factors associated with implant failure.ConclusionsPoor reduction quality and loss of posteromedial support are predictors of implant failure in reverse oblique and transverse intertrochanteric fractures treated with PFNA.

Intracortical Screw Insertion Plus Limited Open Reduction in Treating Type 31A3 Irreducible Intertrochanteric Fractures in the Elderly

“…Since osteoporosis is a prevalent condition in elderly patients, greater importance should be attached to reduction. Forcible screw insertion with poor reduction will nally lead to a dramatic increase in the risk of internal xation [4,10,14]. Therefore, the authors abandoned closed reduction and performed limited open reduction instead to expose the broken end directly.…”

“…However, the reduction may still be unsatisfactory in a few patients receiving closed reduction using a traction table. These patients are known as irreducible intertrochanteric fractures [4][5][6][7], accounting for about 3%-17% of all fractures.…”

Comparison of two methods of locating proximal femoral nail anti-rotation in the treatment of femoral intertrochanteric fractures

“…Once there is a large deviation in the angle, we need to withdraw the guide needle to adjust the angle and reinsert the needle. Moreover, if there is still a rear deviation of approximately 3°after adjustment due to the influence of multiple nail entry points and holes on the outside of the greater trochanter, it is very difficult to accurately adjust the guide needle in the center of the femoral neck, and cause helical blades were placed in different possible zones [20]. After many adjustments, when it was found that the lateral position is satisfactory and the positive perspective is viewed, it was found that it also deviates from the position where the original visual measurement was more satisfactory and needed to be adjusted again or that the less ideal position needed to be accepted, resulting in the inaccurate placement of the spiral blade.…”

Factors associated with the development of screw cut-out after the fixation of intertrochanteric femoral fractures with a proximal femoral nail

“…The state of posteromedial support was defined as present or absent according to the amount of the displacement of the posteromedial segment. A displacement of less than the cortical thickness means that there is contact between proximal and distal fragments, and it is interpreted as the presence of posteromedial support (8).…”