From the NYU Langone Orthopedic Hospital, New York, NY (Fisher, Parola, Anil, Herbosa, Boadi, Ganta, Tejwani, Konda, and Egol), and the Jamaica Hospital Medical Center, Richmond Hill, NY (Ganta, Tejwani, Konda, and Egol).
J Am Acad Orthop Surg. 2024 Jan 15;32(2):83-91. doi: 10.5435/JAAOS-D-22-00972. Epub 2023 Sep 22.
Determine if any fracture characteristics or radiographic parameters were predictive of fixation failure [FF] within 1 year following cephalomedullary nailing for intertrochanteric fractures.
A consecutive series of intertrochanteric hip fracture patients (AO/OTA 31A) treated with a cephalomedullary nail were reviewed. Pre-fixation (neck-shaft angle [NSA], distance from ischial tuberosities to greater and lesser trochanters, integrity of lesser trochanter, and fracture angulation) and post-fixation (post-fixation NSA, posteromedial cortex continuity, lag screw position, tip to apex distance [TAD], and post-fixation angulation and translation) radiographic parameters were measured by blinded independent reviewers. The FF and non-FF groups were statistically compared. Logistic regression was performed to determine radiographic parameter correlates of FF.
Of 1249 patients, 23 (1.8%) developed FF within 1 year. The FF patients were younger than their non-FF counterparts (77.2 years vs 81.0 years, p=0.048), however there were no other demographic differences. The FF cohort did not differ in frequency of TAD over 25 mm (4.3% vs 9.6%, p=0.624) and had decreased mean TAD (13.6mm vs 16.3mm, p=0.021) relative to the non-FF cohort. The FF cohort had a higher rate of a post-fixation coronal plane NSA more than 10° different from the contralateral side (delta NSA>10°, 34.8% vs 13.7%, p=0.011) with the majority fixed in relative varus. For every 1° increase in varus compared to the contralateral side the odds of FF increased 7% (OR=1.065, 95%CI[1.005-1.130], p=0.034) on univariate analysis. On univariate logistic regression, patients with an absolute post-fixation NSA of 10° or more of varus compared to contralateral were significantly more likely to have a FF (OR=3.139, 95%CI[1.067-8.332], p=0.026).
Despite an acceptable TAD, post-fixation NSA in relative varus as compared to the contralateral side was significantly associated with failure in intertrochanteric hip fractures fixed with a cephalomedullary nail.
Prognostic Level III.
确定股骨髓内钉治疗股骨转子间骨折后 1 年内是否存在任何骨折特征或影像学参数与固定失败[FF]相关。
回顾性分析了连续收治的股骨转子间骨折患者（AO/OTA 31A），均采用股骨髓内钉治疗。测量术前（颈干角[NSA]、坐骨结节至大、小转子的距离、小转子完整性、骨折角度）和术后（术后 NSA、后内侧皮质连续性、拉力螺钉位置、尖端到顶点距离[TAD]、术后角度和移位）影像学参数。由两名独立的盲审人员进行测量。FF 组和非 FF 组进行统计学比较。Logistic 回归分析确定与 FF 相关的影像学参数。
1249 例患者中，23 例（1.8%）在 1 年内发生 FF。FF 组患者比非 FF 组患者年轻（77.2 岁 vs 81.0 岁，p=0.048），但其他人口统计学差异无统计学意义。FF 组 TAD 超过 25mm 的频率（4.3% vs 9.6%，p=0.624）和平均 TAD（13.6mm vs 16.3mm，p=0.021）均低于非 FF 组。FF 组冠状面 NSA 与对侧相比相差超过 10°的比例较高（delta NSA>10°，34.8% vs 13.7%，p=0.011），大部分呈相对内翻。与对侧相比，每增加 1°内翻，FF 的可能性增加 7%（OR=1.065，95%CI[1.005-1.130]，p=0.034）。单因素分析发现，与对侧相比，术后 NSA 绝对内翻 10°或以上的患者发生 FF 的可能性显著更高（OR=3.139，95%CI[1.067-8.332]，p=0.026）。
尽管 TAD 可接受，但与对侧相比，术后相对内翻的 NSA 与股骨转子间骨折采用髓内钉固定后发生 FF 显著相关。
预后 III 级。
