Department of Orthopaedic Surgery, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan.
Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan.
BMC Musculoskelet Disord. 2022 May 14;23(1):456. doi: 10.1186/s12891-022-05418-2.
The incidence and characteristics of iatrogenic comminution (IC) are unknown, and the influence of IC on fracture union is unclear. This study was aimed to investigate the (1) incidence and characteristics of IC and (2) the outcomes of IC following antegrade interlocking nailing of simple femoral shaft fractures.
We retrospectively collected data on patients who experienced simple femoral shaft fractures and underwent antegrade interlocking nailing between February 2009 and December 2016. The incidence and characteristics of IC were examined. According to the presence of IC, patients were divided into two groups: an IC group and a non-IC (NIC) group. Demographic information and nonunion rates were compared between the two groups. Potential risk factors for IC (age, gender, body mass index (BMI), nail fit ratio, reduction technique, and greater trochanter nail entry) were analyzed using univariate and multivariate logistic regression. The aforementioned variables, along with IC occurrence, were also assessed as potential risk factors for nonunion at 12 and 24 months after operation using multivariate logistic regression.
Of the 211 total patients, IC occurred in 20.9% (n = 44) of patients. Most ICs were found at the level of the isthmus, and involved the medial cortex. Compared with the NIC group, higher nonunion rates were observed in the IC group at 12 months (31.8% vs. 12.5%, p = 0.002) and 24 months (18% vs. 6.5%, p = 0.017) after surgery. Age older than 35 years old was related with the occurrence of IC in univariate analysis. Multivariate analysis found no risk factor associated with IC. Open reduction technique, IC occurrence and higher BMI were identified as the risk factors of nonunion at 12 months and 24 months after surgery in multivariate analysis.
IC is a non-rare complication in antegrade interlocking nailing of simple femoral shaft fractures and was associated with higher nonunion rate. Age older than 35 years old showed a trend toward increasing risk of iatrogenic fracture comminution. In multivariate analysis, open reduction technique, IC occurrence and higher BMI significantly correlated with fracture nonunion.
Level IV.
医源性粉碎性骨折（IC）的发生率和特征尚不清楚，其对骨折愈合的影响也不明确。本研究旨在探讨（1）IC 的发生率和特征，以及（2）顺行交锁髓内钉治疗单纯股骨干骨折后 IC 的结果。
我们回顾性收集了 2009 年 2 月至 2016 年 12 月期间接受顺行交锁髓内钉治疗的单纯股骨干骨折患者的数据。检查了 IC 的发生率和特征。根据 IC 的存在，将患者分为粉碎性骨折组（IC 组）和非粉碎性骨折组（NIC 组）。比较两组患者的人口统计学资料和不愈合率。使用单变量和多变量逻辑回归分析 IC 的潜在危险因素（年龄、性别、体重指数（BMI）、钉适配比、复位技术和大转子钉入口）。使用多变量逻辑回归分析上述变量以及 IC 的发生与术后 12 和 24 个月时不愈合的潜在相关性。
在 211 例患者中，IC 的发生率为 20.9%（n=44）。大多数 IC 发生在峡部水平，累及内侧皮质。与 NIC 组相比，IC 组在术后 12 个月（31.8%比 12.5%，p=0.002）和 24 个月（18%比 6.5%，p=0.017）的不愈合率更高。年龄大于 35 岁与单变量分析中的 IC 发生有关。多变量分析发现，IC 无相关危险因素。多变量分析发现，切开复位技术、IC 发生和较高 BMI 是术后 12 个月和 24 个月发生骨折不愈合的危险因素。
IC 是顺行交锁髓内钉治疗单纯股骨干骨折的一种非罕见并发症，与较高的不愈合率相关。年龄大于 35 岁的患者发生医源性骨折粉碎性骨折的风险呈上升趋势。多变量分析显示，切开复位技术、IC 发生和较高 BMI 与骨折不愈合显著相关。
IV 级。
