Kelly Linda, Moloney Darren, Collins Denis
Trauma and Orthopaedic Department, Beaumont Hospital, Dublin, Ireland.
Ir J Med Sci. 2025 Jul 9. doi: 10.1007/s11845-025-04000-8.
Intramedullary (IM) femoral nailing in the form of cephalomedullary (CM) nailing is a common treatment of intertrochanteric femoral fractures. Previous literature has demonstrated higher revision rates of left intertrochanteric fractures. Helical blade constructs offer a theoretical advantage over a screw design.
The objective of this study is to examine 3 year revision rates for right vs left CM nails with helical blade head screw. No current studies exist which compare revision rates in left versus right IM nails over this defined time period.
Patients who sustained intertrochanteric femoral fracture subsequently treated by CM nailing between July 2021 and December 2022 were retrospectively identified from a database of orthopaedic patients. Patients were stratified based on left-sided or right-sided fracture. Criteria for inclusion were anterograde femoral nails, performed for Intertrochanteric hip fractures. Exclusion criteria included revision nails, retrograde nails, diaphyseal and subtrochanteric fractures, reverse oblique fracture patterns and prophylactic nails. The primary outcome was 3 year revision rate. Relevant frequency statistics were generated for each cohort with odds ratios comparing revision rates between the two groups.
n = 104 patients were included in the final sample, comprising n = 48 left and n = 56 right sided intertrochanteric fractures who underwent CM nailing. n = 4 (3.8%) TFNAs underwent subsequent surgical revision. Incidence of revision was higher in patients undergoing left IM nailing Left: 3/48, 0.063, Right: 1/56, 0.018, Odds Ratio: 3.667, 95% Confidence Interval: 0.37 - 36.47, p = 0.268).
A greater proportion of patients who sustained a left sided intertrochanteric fracture and were surgically treated with CM nailing underwent revision surgery within 3 years of initial surgery compared to right sided CM nails.
髓内（IM）股骨钉以头髓内钉（CM）的形式是治疗股骨粗隆间骨折的常用方法。先前的文献表明，左侧股骨粗隆间骨折的翻修率较高。螺旋刀片结构在理论上比螺钉设计具有优势。
本研究的目的是检查使用螺旋刀片头部螺钉的右侧与左侧CM钉的3年翻修率。目前尚无研究比较在这一特定时间段内左侧与右侧IM钉的翻修率。
从骨科患者数据库中回顾性识别出2021年7月至2022年12月期间因股骨粗隆间骨折而接受CM钉治疗的患者。患者根据骨折部位分为左侧或右侧。纳入标准为用于股骨粗隆间髋部骨折的顺行股骨钉。排除标准包括翻修钉、逆行钉、骨干和转子下骨折、反向斜形骨折模式以及预防性钉。主要结局是3年翻修率。为每个队列生成相关频率统计数据，并计算两组之间翻修率比较的比值比。
最终样本纳入n = 104例患者，其中n = 48例左侧和n = 56例右侧股骨粗隆间骨折患者接受了CM钉治疗。n = 4例（3.8%）TFNA随后接受了手术翻修。左侧IM钉治疗患者的翻修发生率更高（左侧：3/48，0.063；右侧：1/56，0.018；比值比：3.667，95%置信区间：0.37 - 36.47，p = 0.268）。
与右侧CM钉相比，因左侧股骨粗隆间骨折接受CM钉手术治疗的患者中，有更大比例在初次手术后3年内接受了翻修手术。
