Department of Orthopedic Surgery, Kagawa Prefectural Central Hospital, Kagawa, Japan; Systematic Review Workshop Peer Support Group (SRWS-PSG), Japan.
Department of Orthopedic Surgery, Kochi Health Sciences Center, Kochi, Japan.
Injury. 2022 Mar;53(3):1190-1195. doi: 10.1016/j.injury.2021.10.024. Epub 2021 Oct 31.
Proximal peri-implant femoral fractures occur following intramedullary nailing (IMN) fixation for trochanteric, femoral shaft, and distal femoral fractures. However, analyses of secondary hip fractures (SHFs) using large clinical samples are lacking. Therefore, we aimed to report the incidence and clinical outcomes of SHF after nailing fixation (IMN or cephalomedullary nailing [CMN]) for overall femoral fractures. In addition, we focused on IMN for femoral shaft fractures and investigated the risk factors for SHF.
This multicenter, retrospective, cohort study included 2,293 patients aged > 60 years who underwent nailing fixation for femoral fractures. The primary outcome was the incidence of SHF. In the assessment of clinical outcomes, we evaluated reoperation and the regaining of walking ability following SHF management. In addition, we conducted multivariable logistic regression analyses to examine the association between risk factors and SHF.
Seventeen (0.7%) patients had SHFs, including 12 femoral neck fractures and 5 trochanteric fractures. Antegrade IMN was the most common type of nailing fixation. Multivariable analysis demonstrated that the absence of femoral head fixation was significantly associated with the incidence of SHF following IMN for femoral shaft fractures (odds ratio, 17.0; 95% confidence interval, 1.9-2265.7; p=0.006). In the assessment of clinical outcomes, there were two reoperations (16.7%) in the secondary femoral neck fracture group. Patients with secondary trochanteric fractures tended to have a lower probability of regaining walking ability than those with secondary femoral neck fractures (20% vs. 50%).
In this multicenter study, the incidence of SHF after nail fixation for femoral fractures was 0.7%. The absence of femoral head fixation was significantly associated with SHF, and the clinical outcomes were poor. Therefore, femoral head fixation at the initial IMN fixation for femoral fractures may be a fixation option for surgeons to consider as an SHF prevention measure.
股骨近端周围骨折发生在股骨转子间、股骨干和股骨远端骨折髓内钉固定后。然而，缺乏使用大样本临床数据对继发性髋部骨折（SHF）进行的分析。因此，我们旨在报告整体股骨骨折髓内钉（IMN 或顺行交锁髓内钉[CMN]）固定后继发性髋部骨折的发生率和临床结果。此外，我们专注于股骨干骨折的 IMN，并探讨了 SHF 的危险因素。
这是一项多中心、回顾性、队列研究，纳入了 2293 名年龄>60 岁接受髓内钉固定治疗股骨骨折的患者。主要结局是 SHF 的发生率。在评估临床结果时，我们评估了 SHF 管理后的再手术和行走能力的恢复情况。此外，我们还进行了多变量逻辑回归分析，以检查危险因素与 SHF 的关系。
17 名（0.7%）患者发生了 SHF，包括 12 例股骨颈骨折和 5 例转子间骨折。顺行 IMN 是最常见的内固定类型。多变量分析表明，股骨干骨折 IMN 时未固定股骨头与 SHF 的发生显著相关（比值比，17.0；95%置信区间，1.9-2265.7；p=0.006）。在评估临床结果时，继发性股骨颈骨折组有 2 例（16.7%）再手术。继发性转子间骨折患者的行走能力恢复可能性低于继发性股骨颈骨折患者（20%比 50%）。
在这项多中心研究中，股骨骨折髓内钉固定后 SHF 的发生率为 0.7%。未固定股骨头与 SHF 显著相关，临床结果较差。因此，股骨骨折初始 IMN 固定时固定股骨头可能是外科医生预防 SHF 的一种固定选择。
