Orthopedics and Traumatology Clinic, Memorial Bahçelievler Hospital, İstanbul-Türkiye.
Orthopedics and Traumatology Clinic, Academic Hospital, İstanbul-Türkiye.
Ulus Travma Acil Cerrahi Derg. 2024 Jun;30(6):458-464. doi: 10.14744/tjtes.2024.35808.
Treatment of reverse oblique fractures has the highest complication rate among proximal femur fractures. Although intramedullary nailing is the preferred treatment option, a high failure rate has been reported. Previous studies have identified several contributing factors to these failures, yet the significance of posterolateral wall integrity in ensuring postoperative stability has not been emphasized. This study aims to investigate the impact of posterolateral wall integrity on the failure rates of reverse oblique intertrochanteric fractures treated with intramedullary nails (IMN) and assess the vulnerability of certain IMN designs to these failures.
Between 2010 and 2016, 53 patients with reverse oblique fractures were analyzed to identify factors associated with IMN failure. Variables such as posterolateral wall integrity, quality of reduction, posteromedial support, and IMN design were considered as potential risk factors. Logistic regression analysis was conducted to evaluate these risk factors, with statistical significance defined as p<0.05.
Eleven cases of implant failure were identified. Univariate statistical analysis indicated that loss of posterolateral support (p=0.002), IMN with single-screw proximal fixation (p=0.048), poor reduction quality (p=0.004), and loss of posteromedial support (p=0.040) were associated with implant failure. Multivariate analysis confirmed loss of posterolateral support (p=0.009), poor reduction quality (p=0.039), and loss of posteromedial support (p=0.020) as independent risk factors for failure. However, IMN with single proximal fixation (p=0.859) did not significantly impact fixation failure.
Reverse oblique intertrochanteric fractures with compromised posterolateral support exhibit a high rate of mechanical failure when treated with IMN. Additionally, poor reduction quality and loss of posteromedial support increase the risk for failure of these fractures. An IMN design featuring dual separate proximal screw fixations could provide better stability compared to a design with a single proximal screw, thereby reducing the risk of mechanical failure.
在股骨近端骨折中，反斜形骨折的治疗并发症发生率最高。虽然髓内钉是首选的治疗方法，但已有报道其失败率较高。既往研究已经确定了导致这些失败的几个因素，但后外侧壁完整性在确保术后稳定性方面的意义尚未得到强调。本研究旨在探讨后外侧壁完整性对髓内钉（IMN）治疗反斜形转子间骨折失败率的影响，并评估某些 IMN 设计对这些失败的脆弱性。
对 2010 年至 2016 年间的 53 例反斜形骨折患者进行分析，以确定与 IMN 失败相关的因素。考虑了后外侧壁完整性、复位质量、后内侧支撑和 IMN 设计等变量作为潜在的危险因素。采用逻辑回归分析评估这些危险因素，以 p<0.05 为统计学意义。
确定了 11 例植入物失败病例。单变量统计分析表明，后外侧支撑丧失（p=0.002）、单枚螺钉近端固定的 IMN（p=0.048）、复位质量差（p=0.004）和后内侧支撑丧失（p=0.040）与植入物失败相关。多变量分析证实后外侧支撑丧失（p=0.009）、复位质量差（p=0.039）和后内侧支撑丧失（p=0.020）是失败的独立危险因素。然而，IMN 单枚近端固定（p=0.859）并不显著影响固定失败。
反斜形转子间骨折后外侧支撑受损时，采用髓内钉治疗会出现较高的机械失败率。此外，复位质量差和后内侧支撑丧失会增加这些骨折失败的风险。与单枚近端螺钉固定的设计相比，采用双枚独立近端螺钉固定的 IMN 设计可提供更好的稳定性，从而降低机械失败的风险。
