Gao Zhechen, Lv Yang, Zhou Fang, Ji Hongquan, Tian Yun, Zhang Zhishan, Guo Yan
Department of Orthopedics, Peking University Third Hospital, No 49, North Garden Rd, Haidian District, Beijing, China 100191.
Department of Orthopedics, Peking University Third Hospital, No 49, North Garden Rd, Haidian District, Beijing, China 100191.
Injury. 2018 Feb;49(2):315-322. doi: 10.1016/j.injury.2017.11.011. Epub 2017 Nov 14.
To investigate potential predictors of implant failure following fixation of proximal femoral fractures with a fracture of the lateral femoral wall.
Medical 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.
Ten (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.
A 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.
探讨股骨近端骨折合并股骨外侧壁骨折内固定术后植入物失败的潜在预测因素。
回顾性分析2004年5月至2015年4月期间99例接受股骨近端骨折合并股骨外侧壁骨折手术治疗的成年患者的病历，以确定与植入物失败相关的因素。患者接受了植入髓外或髓内装置的常规手术。潜在预测因素包括年龄、性别、体重指数、合并症、骨折类型、复位方法、大转子和小转子状态、外侧骨折线走行以及大转子与股骨外侧壁交界处有无游离骨块。
确定了10例（10%）植入物失败病例。单因素分析确定大转子与股骨外侧壁交界处的游离骨块（比值比[OR]，21.25；95%置信区间[CI]，4.31 - 104.67；p<0.001）以及横跨股骨外侧壁的横行骨折线（原发性或医源性）（OR，5.36；95%CI，1.29 - 22.30；p = 0.021）为与植入物失败相关的因素。使用多变量模型，仅大转子与股骨外侧壁交界处的游离骨块（OR，16.05；95%CI，3.06 - 84.23；p = 0.001）是植入物失败的危险因素。
大转子与股骨外侧壁交界处的游离骨块以及横跨股骨外侧壁的横行骨折线是股骨近端骨折合并股骨外侧壁骨折植入物失败的预测因素。股骨外侧壁的完整性与股骨近端骨折的预后相关。对于股骨近端骨折合并股骨外侧壁骨折的有效治疗，可能需要进行股骨外侧壁重建。
