Department of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea.
Department of Orthopaedic Surgery, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwasung, Korea.
Clin Orthop Surg. 2020 Mar;12(1):29-36. doi: 10.4055/cios.2020.12.1.29. Epub 2020 Feb 13.
Intramedullary (IM) nailing is widely performed in elderly patients with trochanteric fractures. Thus, it is important to identify causative factors associated with fixation failure. We investigated fixation failures after IM nailing in elderly patients with trochanteric fractures and compared the failure group with nonfailure group to identify risk factors of fixation failure.
A total of 396 patients aged 65 years or older underwent IM nailing for trochanteric fractures between January 2012 and August 2016 at our institution. Of those, 194 patients who were followed up for more than 12 months were enrolled in this study; 202 patients were excluded due to death during follow-up, bedridden status before injury, and loss to follow-up. All patients underwent plain radiography and preoperative computed tomography (CT).
Fixation failure occurred in 11 patients (5.7%). Seven patients had stable fractures (AO/OTA); eight patients had basicervical fractures (confirmed by CT). Five patients had comminution in the greater trochanter (confirmed by CT). Regarding fracture reduction, eight patients showed discontinuity in the anterior cortex. The position of the lag screw on the lateral view was in the center in six patients and in a posterior area in the other five patients. On the basis of comparison with the 183 patients without fixation failure, risk factors of fixation failure were higher body mass index (BMI; = 0.003), basicervical type of fracture ( = 0.037), posterior placement of the lag screw on the lateral view ( < 0.001), and inaccurate reduction of the anterior cortex ( = 0.011).
Among the risk factors of fixation failure after IM nailing in elderly patients with trochanteric fractures, discontinuity of the anterior cortex and posterior position of the lag screw are modifiable surgeon factors, whereas higher BMI and basicervical type of fracture are nonmodifiable patient factors. Therefore, care should be taken to avoid fixation failure in IM nailing for patients with a basicervical type of fracture or higher BMI or both.
髓内钉（IM）固定广泛应用于老年股骨转子间骨折患者。因此，确定与固定失败相关的因素非常重要。我们研究了老年股骨转子间骨折患者 IM 钉固定后的固定失败，并将失败组与非失败组进行比较，以确定固定失败的危险因素。
2012 年 1 月至 2016 年 8 月，我院对 396 名年龄在 65 岁及以上的股骨转子间骨折患者行 IM 钉固定治疗。其中，194 名随访时间超过 12 个月的患者纳入本研究；202 名患者因随访期间死亡、受伤前卧床不起和失访而被排除在外。所有患者均行 X 线平片和术前 CT 检查。
11 例（5.7%）患者发生固定失败。7 例为稳定型骨折（AO/OTA）；8 例为基底部骨折（CT 证实）。5 例大转子粉碎性骨折（CT 证实）。骨折复位方面，8 例患者前皮质连续性中断。侧位片上拉力螺钉的位置在 6 例患者位于中心，5 例患者位于后区。与 183 例无固定失败的患者相比，固定失败的危险因素包括较高的体重指数（BMI； = 0.003）、基底部骨折类型（ = 0.037）、侧位片上拉力螺钉的后位（ < 0.001）和前皮质复位不准确（ = 0.011）。
在老年股骨转子间骨折患者 IM 钉固定失败的危险因素中，前皮质连续性中断和拉力螺钉的后位是可改变的术者因素，而 BMI 较高和基底部骨折类型是不可改变的患者因素。因此，对于基底部骨折类型或 BMI 较高或两者均有的患者，在使用 IM 钉固定时应注意避免固定失败。
