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. 2020 Aug;140(8):1047-1054.
doi: 10.1007/s00402-020-03356-z. Epub 2020 Jan 21.

Hardware removal rates after surgical treatment of proximal femur fractures : Nationwide trends in Finland in 1997-2016

Ville T Ponkilainen  1 , Tuomas T Huttunen  2   3   4 , Pekka Kannus  5   2 , Ville M Mattila  5   2   6
Affiliations

Hardware removal rates after surgical treatment of proximal femur fractures : Nationwide trends in Finland in 1997-2016

Ville T Ponkilainen et al. Arch Orthop Trauma Surg. 2020 Aug.

Abstract

Background: Various internal fixation methods have been used to treat proximal femur fractures and occasionally the fixation material is removed. However, nationwide trends of hardware removals are not known. Thus, this study investigated the hardware removal rates after proximal femur fractures in Finland during 1997-2016.

Materials and methods: Finnish adults aged 18 years or older in 1997-2016 formed the basic study population. From the National Hospital Discharge Register patients with trochanteric femur fracture treated with an intramedullary nail (IMN) or dynamic hip screw (DHS), and patients with femoral neck fracture treated with screw fixation, were included. Hardware removal and secondary prosthesis rates were assessed.

Results: Altogether 41,253 patients underwent proximal femoral fracture fixation surgery in Finland in 1997-2016. Of these, 16,152 were DHS surgery and 15,724 IMN surgery and 8491 underwent screw operation of femoral neck fracture. The total removal rates of DHS and IMN were 5.5% and 5.4%. The total removal rate of screw fixations of the femoral neck was higher, 18.5%. The total removal rates during the first 3 years after the IMN more than halved in 1997-2013, from 7.6% to 3.7%, whereas the removal rate of the DHS or screw fixation of femoral neck fractures did not show consistent trend. The rate of secondary prosthesis operations following DHS and IMN was low (1.8% for both). This was in clear contrast to the prosthesis rate following screw fixations of the femoral neck (7.2%).

Conclusions: IMN operations largely replaced DHS operations in trochanteric fractures of the proximal femur in Finland in 1997-2016. The removal and secondary prosthesis rates of the DHS and IMN were clearly lower than the corresponding rates after screw fixations of the femoral neck fracture.

Level of evidence: III, Epidemiologic study.

Keywords: Endoprosthesis; Fixation; Material; Removal; Secondary.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Incidence of screw fixation for femoral neck fracture, and dynamic hip screw (DHS) and intramedullary nail (IMN) fixation for trochanteric fracture of the proximal femur
Fig. 2
Fig. 2
Boxplot of time intervals between the primary and the two secondary operations of the proximal femur fracture. The category “endoprosthesis” consisted of hardware removal and prosthesis surgery during the same hospital stay
Fig. 3
Fig. 3
Total hardware removal and prosthesis rates during the first three years after intramedullary nail fixation of the trochanteric fracture of the proximal femur
Fig. 4
Fig. 4
Total hardware removal and prosthesis rates during the first three years after dynamic hip screw fixation of the trochanteric fracture of the proximal femur
Fig. 5
Fig. 5
Total hardware removal and prosthesis rates during the first three years after screw fixation of the fracture of the femoral neck
See this image and copyright information in PMC

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