Longo Luis Henrique, Zimmermann Faggion Heloisa, Costa Sartor Matheus, Senna Klipp Matheus U, Vogt Paulo Henrique, Navarro Vergara Alberto Daniel, Valenza Weverley R
Department of Orthopedics and Traumatology, Hospital do Trabalhador, Curitiba, BRA.
Department of Pediatrics, Child Orthopedics and Traumatology Unit, Hospital de Trauma Manuel Giagni, Asunción, PRY.
Cureus. 2024 May 30;16(5):e61363. doi: 10.7759/cureus.61363. eCollection 2024 May.
Proximal femur fractures are common in older patients and typically require surgical treatment, with cephalomedullary nails being the gold standard device for this approach. This study aimed to identify the factors associated with the failure of cephalomedullary nailing.
We retrospectively evaluated 380 patients treated with a cephalomedullary nail between August 2021 and August 2022 in a trauma referral center in Brazil. A total of 221 (58.1%) patients were included in the study after applying specific eligibility criteria. Data were collected and rates were determined by reviewing patients' medical records and radiographs.
Of 221 patients, 14 (6.3%) had nail failures A significant association was found between post-fixation cervico-diaphyseal angle and the occurrence of nail failure (p<0.001). Furthermore, calcar-referenced tip-apex distance (CalTAD) and tip-apex distance (TAD) values were higher in cases with nail failure than in those without nail failure. Cutoff points were established for TAD and CalTAD to measure the correspondence with nail failures.
The present study supports previous evidence that varus reduction potentially causes collapse and nail failure in pertrochanteric fractures treated with cephalomedullary nailing and that high TAD and CalTAD values contribute to the incidence of cut-out.
股骨近端骨折在老年患者中很常见，通常需要手术治疗，而髓内钉是这种治疗方法的金标准器械。本研究旨在确定与髓内钉固定失败相关的因素。
我们回顾性评估了2021年8月至2022年8月期间在巴西一家创伤转诊中心接受髓内钉治疗的380例患者。在应用特定纳入标准后，共有221例（58.1%）患者纳入研究。通过查阅患者病历和X光片收集数据并确定发生率。
在221例患者中，14例（6.3%）出现髓内钉固定失败。发现固定后颈干角与髓内钉固定失败的发生之间存在显著关联（p<0.001）。此外，髓内钉固定失败病例的参照股骨距尖顶距（CalTAD）和尖顶距（TAD）值高于未发生髓内钉固定失败的病例。确定了TAD和CalTAD的截断点，以衡量与髓内钉固定失败的相关性。
本研究支持先前的证据，即内翻复位可能导致髓内钉固定治疗的转子间骨折发生塌陷和髓内钉固定失败，且高TAD和CalTAD值会导致穿出发生率增加。
