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. 2021 Mar 15;35(3):312-317.
doi: 10.7507/1002-1892.202010011.

[Treatment of peri-implant refracture after intramedullary nail fixation for intertrochanteric fractures]

[Article in Chinese]
Lin Teng  1 , Yongchuan Xiao  1 , Gang Zhong  2
Affiliations

[Treatment of peri-implant refracture after intramedullary nail fixation for intertrochanteric fractures]

[Article in Chinese]
Lin Teng et al. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. .

Abstract
in English, Chinese

Objective: To investigate the occurrence, treatment, and effectiveness of peri-implant refracture after intramedullary nail fixation for intertrochanteric fractures.

Methods: The clinical data of 16 patients with peri-implant refracture after intramedullary nail fixation for intertrochanteric fractures who met the inclusion criteria between April 2014 and November 2019 were retrospectively analyzed. There were 7 males and 9 females with an average age of 78.4 years (range, 65-93 years). The 14 cases of initial intertrochanteric fractures were classified according to the classification of AO/Orthopaedic Trauma Association (AO/OTA): 5 cases of type A1, 7 cases of type A2, and 2 cases of type A3; the other 2 cases were intertrochanteric combined with subtrochanteric fractures (Seinsheimer type Ⅴ). According to the classification of peri-implant refracture which was proposed by Chan et al., there were 10 cases of type 1 (6 cases of type 1A, 3 cases of type 1B, 1 case of type 1C) and 6 cases of type 2 (4 cases of type 2A and 2 cases of type 2B). The average interval between refracture and initial surgery was 14.6 months (range, 1-52 months). The incidence of peri-implant refracture in short nail group (the length of intramedullary nail used in initial surgery≤240 mm) was 1.92% (11/573), while the incidence of long nail group (the length of intramedullary nail used in initial surgery≥340 mm) was 1.66% (5/301), showing no significant difference between the two groups ( χ 2=0.073, P=0.786). The peri-implant refractures were revised with extended intramedullary nail (5 cases) or fixed with additional limited invasive stabilization system (11 cases).

Results: The average operation time was 115.8 minutes (range, 78-168 minutes) and the average intraoperative blood loss was 283.1 mL (range, 120-500 mL). One patient died of myocardial infarction at 3 months after operation, and the other 15 patients were followed up 9-46 months (mean, 16.8 months). The peri-implant refractures healed at 14-20 weeks (mean, 16.4 weeks) after operation. There was no complications such as incision infection, nonunion, internal fixator loosening and rupture, screw cutting-out, and the second refracture during the follow-up. At last follow-up, all injured limbs regained walking function, and the Hospital for Special Surgery (HSS) score was 56-92 (mean, 80.2). The results were classified as excellent in 2 cases, good in 10, fair in 2, and poor in 1, with the excellent and good rate of 80%.

Conclusion: Stress concentration at the tip of initial intramedullary nail and distal interlocking screw aera is the main cause of peri-implant refracture after intramedullary nail fixation for intertrochanteric fractures. Revision with extended intramedullary nail or fixation with limited invasive stabilization system according to the length of initial intramedullary nail and the type of refracture can get satisfactory effectiveness.

目的: 探讨股骨转子间骨折髓内钉内固定术后内植物周围再骨折的发生情况、治疗方法及临床疗效。.

方法: 回顾分析 2014 年 4 月—2019 年 11 月收治且符合选择标准的 16 例股骨转子间骨折髓内钉内固定术后内植物周围再骨折患者临床资料。男 7 例，女 9 例；年龄 65～93 岁，平均 78.4 岁。初次单纯股骨转子间骨折 14 例，按国际内固定研究协会/美国骨创伤协会（AO/OTA）分型为 A1 型 5 例，A2 型 7 例，A3 型 2 例；股骨转子间合并转子下骨折 2 例，均为 Seinsheimer Ⅴ型。根据 Chan 等提出的非假体内植物周围再骨折分型标准，1 型 10 例（1A 型 6 例、1B 型 3 例、1C 型 1 例），2 型 6 例（2A 型 4 例、2B 型 2 例）。再骨折距初次手术时间为 1～52 个月，平均 14.6 个月。其中短钉组（髓内钉长度≤240 mm）再骨折发生率为 1.92%（11/573），长钉组（髓内钉长度≥340 mm）为 1.66%（5/301），比较差异无统计学意义（ χ 2=0.073， P=0.786）。分别予以加长髓内钉翻修（5 例）或增加微创内固定系统固定（11 例）。.

结果: 患者手术时间 78～168 min，平均 115.8 min；术中出血量 120～500 mL，平均 283.1 mL。1 例患者术后 3 个月发生心肌梗死而死亡；余 15 例均获随访，随访时间 9～46 个月，平均 16.8 个月。内植物周围再骨折于术后 14～20 周，平均 16.4 周达临床愈合。随访期间无切口感染、骨折不愈合、内植物松动断裂、螺钉切出等并发症发生，内植物周围未发生再次骨折。末次随访时，患肢均恢复行走功能，美国特种外科医院（HSS）评分为 56～92 分，平均 80.2 分，其中优 2 例、良 10 例、可 2 例、差 1 例，优良率 80%。.

结论: 髓内钉尖端及远端交锁螺钉周围应力集中是股骨转子间骨折髓内钉内固定术后内植物周围再骨折的主要原因，根据初次手术髓内钉长度及再骨折类型采用加长髓内钉翻修或增加微创内固定系统手术治疗，有望取得满意疗效。.

Keywords: Intertrochanteric fracture; intramedullary nail; refracture; stress concentration.

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Conflict of interest statement

利益冲突：所有作者声明，在课题研究和文章撰写过程中不存在利益冲突。

Figures

图 1
图 1
A 67-year-old male patient with initial intertrochanteric fracture combined with subtrochanteric comminuted fracture (Seinsheimer type Ⅴ) at 2 years after fixation with long intramedullary nail, who suffered from a right peri-implant femoral refracture (type 1A) due to a fall while walking. The original intramedullary nail was retained and the peri-implant refracture was fixed with limited invasive stabilization system (LISS) 患者，男，67 岁，右侧股骨转子间骨折合并转子下粉碎性骨折（Seinsheimer Ⅴ型）行长髓内钉固定术后 2 年，因行走时摔伤致内植物周围再骨折（1A 型），保留原髓内钉，内植物周围再骨折处使用 LISS 桥接固定
图 2
图 2
A 74-year-old male patient with initial left intertrochanteric fracture (type A2) at 2 months after fixation with short intramedullary nail, who suffered from a left peri-implant refracture (type 1B) due to a fall while walking. The refracture aera was revised with an extended intramedullary nail 患者，男，74 岁，左侧股骨转子间骨折（A2 型）行短髓内钉固定术后 2 个月，因行走时摔伤致内植物周围再骨折（1B 型），更换股骨加长髓内钉固定
See this image and copyright information in PMC

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References

    1. Lee SH, Chen IJ, Li YH, et al Incidence of second hip fractures and associated mortality in Taiwan: A nationwide population-based study of 95, 484 patients during 2006-2010. Acta Orthop Traumatol Turc. 2016;50(4):437–442. doi: 10.1016/j.aott.2016.06.008. - DOI - PMC - PubMed
    1. 杨明辉, 朱仕文, 李庭, 等 老年股骨转子间骨折诊疗指南. 中华创伤骨科杂志. 2020;22(2):93–99. doi: 10.3760/cma.j.issn.1671-7600.2020.02.001. - DOI
    1. Arslan A, Utkan A, Koca TT Results of a compression pin alongwith trochanteric external fixation in management of high risk elderly intertrochanteric fractures. Indian J Orthop. 2016;50(6):636–640. doi: 10.4103/0019-5413.193479. - DOI - PMC - PubMed
    1. Anglen JO, Weinstein JN American Board of Orthopaedic Surgery Research Committee. Nail or plate fixation of intertrochanteric hip fractures: changing pattern of practice. A review of the American Board of Orthopaedic Surgery Database. J Bone Joint Surg (Am) 2008;90(4):700–707. doi: 10.2106/JBJS.G.00517. - DOI - PubMed
    1. 张雨, 杨旭辉, 曾秋铭 长型和短型髓内钉用于不稳定转子间骨折疗效比较的 meta 分析. 重庆医学. 2020;49(14):2390–2395, 2403.