Division of Orthopaedic Traumatology, Department of Orthopaedic Surgery, Musculoskeletal Research Center, Chang Gung Memorial Hospital, Tao-Yuan, 33302, Taiwan.
Department of Orthopedics, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist, Taoyuan City, 33305, Taiwan.
BMC Musculoskelet Disord. 2024 Nov 21;25(1):943. doi: 10.1186/s12891-024-08085-7.
Perioperative peri-implant fractures (PPIFs) pose infrequent yet significant challenges in orthopedic surgery, particularly in the context of femoral pertrochanteric fractures (FPF) treated with proximal femoral nail antirotation 2 (PFNA-2) nails. PPIFs can lead to prolonged recovery and may necessitate re-osteosynthesis in severe cases. Despite the effectiveness of PFNA-2 in the management of FPFs, our understanding of PPIFs in this specific context remains limited. This study aimed to elucidate the factors contributing to PPIFs in patients with PFNA-2-treated FPF.
In this retrospective analysis spanning from 2019 to 2022, patients with FPF treated with PFNA-2 nails were examined. Demographic data, fracture characteristics, and radiological parameters were collected, along with details of the PPIF management strategies and rehabilitation protocols. Radiological assessments included femoral morphology measurements and reduction and fixation quality evaluation. The area under the curve (AUC) was analyzed in this specific group.
Among 157 patients, 3.2% experienced acute PPIFs managed conservatively with successful union without secondary surgical intervention. Younger age and increased femoral isthmus diameter (DI) emerged as significant predictors of PPIFs in the univariate regression analyses (P = 0.01). The AUCs for age (65.5 years) and DI (1.4 cm) were 0.78 and 0.79, respectively, indicating moderate accuracy.
Although PFNA-2 nails are reliable in managing FPFs, the persistence of PPIFs emphasizes their complex causes. This study highlights that younger age and increased femoral DI are crucial factors for PPIF occurrence in patients with PFNA-2-treated FPF. Conservative treatment with delayed weight-bearing ambulation may be effective in treating these fractures.
围手术期种植体周围骨折（PPIFs）在骨科手术中虽不常见但极具挑战性，尤其是在股骨转子间骨折（FPF）采用股骨近端抗旋髓内钉 2 型（PFNA-2）治疗的情况下。PPIFs 可能导致恢复时间延长，在严重情况下可能需要再次进行骨合成。尽管 PFNA-2 在 FPF 治疗中具有有效性，但我们对该特定情况下的 PPIFs 的理解仍有限。本研究旨在阐明 PFNA-2 治疗 FPF 患者中发生 PPIFs 的相关因素。
在这项回顾性分析中，纳入了 2019 年至 2022 年期间采用 PFNA-2 钉治疗的 FPF 患者。收集了患者的人口统计学数据、骨折特征和影像学参数，以及 PPIF 管理策略和康复方案的详细信息。影像学评估包括股骨形态测量、复位和固定质量评估。对该特定人群进行了曲线下面积（AUC）分析。
在 157 例患者中，3.2%发生急性 PPIFs，经保守治疗成功愈合，无需进行二次手术干预。在单变量回归分析中，年龄较小和股骨峡部直径（DI）增加是 PPIFs 的显著预测因素（P=0.01）。年龄（65.5 岁）和 DI（1.4cm）的 AUC 分别为 0.78 和 0.79，表明具有中等准确性。
尽管 PFNA-2 钉在治疗 FPF 方面可靠，但 PPIFs 的持续存在强调了其复杂的病因。本研究强调，年龄较小和股骨 DI 增加是 PFNA-2 治疗的 FPF 患者发生 PPIFs 的关键因素。对于这些骨折，延迟负重活动的保守治疗可能是有效的。
