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. 2023 Feb 28;24(1):156.
doi: 10.1186/s12891-023-06213-3.

Insufficient proximal medullary filling of cephalomedullary nails in intertrochanteric femur fractures predicts excessive postoperative sliding: a case-control study

Shi-Jie Li #  1 , Shi-Yi Chen #  2 , Shi-Min Chang  3 , Shou-Chao Du  1 , Sun-Jun Hu  4
Affiliations

Insufficient proximal medullary filling of cephalomedullary nails in intertrochanteric femur fractures predicts excessive postoperative sliding: a case-control study

Shi-Jie Li et al. BMC Musculoskelet Disord. .

Abstract

Objective: Excessive postoperative sliding is a common complication of intramedullary nails in the treatment of intertrochanteric femur fractures. The aim of this study was to identify risk factors for excessive postoperative sliding in the intertrochanteric fractures treated with an intramedullary nail.

Methods: A retrospective analysis of 369 patients with femoral intertrochanteric fractures treated with short intramedullary nails between February 2017 and September 2020 was performed. Patients were classified into an excessive sliding group (ES group) and a control group according to the sliding distance after 6 months of follow-up. The proximal medullary filling degree (MFD), fracture reduction patterns in the anteroposterior (AP) view and lateral view, and tip-apex distance (TAD) were evaluated and compared in each group.

Results: Thirty-three cases were included in the ES group, and 336 cases were included in the control group. No significant differences in age, sex, fracture side, AO Foundation and Orthopaedic Trauma Association (AO/OTA) classification, Dorr classification, Singh Osteoporosis Index (SOI), American Society of Anesthesiologists classification (ASA), TAD or fracture reduction patterns in the AP view were noted between the two groups. The negative reduction pattern can strongly predict excessive postoperative sliding (OR 4.286, 95% CI 1.637-11.216, P = 0.003). The incidence of excessive postoperative sliding increased by 8.713-fold when the MFD decreased by 10% (OR 8.713, 95% CI 1.925-39.437, P = 0.005).

Conclusions: A low medullary filling degree and negative fracture reduction pattern in the lateral view were both independent risk factors for excessive postoperative sliding.

Keywords: Excessive sliding; Intertrochanteric fracture; Medullary filling degree; Reduction pattern.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
The vacuole sign is shown in the lateral fluoroscopic view (red marked)
Fig. 2
Fig. 2
The measurement of MFD. A. Measurement of nail diameter ND (green). B. Measurement of medullary cavity diameter MD. MFD = ND/MD
Fig. 3
Fig. 3
A typical case in the ES group. An 89-year-old women with trochanteric femur fracture by closed reduction and cephalomedullary nail fixation. A. The fracture type was classified as 2018 AO/OTA 31 A2. B-C Immediate postoperative fluoroscopy in lateral and AP view showed a good reduction quality and the MFD was 47%. D. Follow-up X-ray in 6 months. The AP view showed over-sliding of the helical blade. The sliding distance was 17 mm
Fig. 4
Fig. 4
A typical case in the control group. An 89-year-old women with trochanteric femur fracture by closed reduction and cephalomedullary nail fixation. A. The fracture type was classified as 2018 AO/OTA 31 A2. B-C Immediate postoperative fluoroscopy in lateral and AP view showed a good reduction quality and the MFD was 76%. D. Follow-up X-ray in 6 months. The AP view showed slight backout of the helical blade. The sliding distance was 3.8 mm
Fig. 5
Fig. 5
The distribution and proportion of excessive sliding in different ranges of MFDs
See this image and copyright information in PMC

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