Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Jul;47(7):1827-1836.
doi: 10.1007/s00264-023-05780-3. Epub 2023 Mar 28.

Residual lateral wall width predicts a high risk of mechanical complications in cephalomedullary nail fixation of intertrochanteric fractures: a retrospective cohort study with propensity score matching

Shi-Jie Li  1 , Shi-Min Chang  2 , Hui Liu  1 , Sun-Jun Hu  1 , Shou-Chao Du  3
Affiliations

Residual lateral wall width predicts a high risk of mechanical complications in cephalomedullary nail fixation of intertrochanteric fractures: a retrospective cohort study with propensity score matching

Shi-Jie Li et al. Int Orthop. 2023 Jul.

Abstract

Purpose: The purpose of this study is to determine whether the integrity of the entry portal of head-neck implant is related to postoperative mechanical complications.

Methods: We retrospectively reviewed consecutive patients with pertrochanteric fractures in our hospital treated from January 1, 2018, to September 1, 2021. Based on the integrity of the entry portal for head-neck implants on the femoral lateral wall, patients were divided into two groups, including the ruptured entry portal (REP) group and the intact entry portal (IEP) group. After 4:1 propensity score-matched analyses were used to balance the baseline of the two groups, a total of 55 patients were extracted from the original participants, including 11 patients in the REP group and 44 matched patients in the IEP group. The anterior to posterior cortex width on the mid-level of the lesser trochanter was measured and defined as the residual lateral wall width (RLWW).

Results: Compared with the IEP group, the REP group was correlated with postoperative mechanical complications (OR = 12.00, 95% CI 1.837-78.369, P = 0.002) and hip-thigh pain (OR = 26.67, 95% CI 4.98-142.86). RLWW ≤ 18.55 mm indicated a high likelihood (tau-y = 0.583, P = 0.000) of becoming the REP type postoperatively and being more likely to suffer from mechanical complications (OR = 30.67, 95% CI 3.91-240.70, P = 0.000) and hip-thigh pain (OR = 14.64, 95% CI 2.36-90.85, P = 0.001).

Conclusion: Rupture of entry portal is a high-risk factor for mechanical complications in intertrochanteric fractures. RLWW ≤ 18.55 mm is a reliable predictor of the postoperative REP type.

Keywords: Cephalomedullary nail; Coronal fragment; Entry portal; Intertrochanteric fracture; Residual lateral wall width.

PubMed Disclaimer

References

    1. Investigators HA (2020) Accelerated surgery versus standard care in hip fracture (HIP ATTACK): an international, randomised, controlled trial. Lancet 395(10225):698–708. https://doi.org/10.1016/S0140-6736(20)30058-1 - DOI
    1. Crandall CJ, Hunt RP, LaCroix AZ et al (2021) After the initial fracture in postmenopausal women, where do subsequent fractures occur? EClin Med 35:100826. https://doi.org/10.1016/j.eclinm.2021.100826 - DOI
    1. Nherera L, Trueman P, Horner A et al (2018) Comparison of a twin interlocking derotation and compression screw cephalomedullary nail (InterTAN) with a single screw derotation cephalomedullary nail (proximal femoral nail antirotation): a systematic review and meta-analysis for intertrochanteric fractures. J Orthop Surg Res 13(1):46. https://doi.org/10.1186/s13018-018-0749-6 - DOI - PubMed - PMC
    1. Law GW, Wong YR, Yew AK et al (2019) Medial migration in cephalomedullary nail fixation of pertrochanteric hip fractures: a biomechanical analysis using a novel bidirectional cyclic loading model. Bone Joint Res 8(7):313–322. https://doi.org/10.1302/2046-3758.87.BJR-2018-0271.R1 - DOI - PubMed - PMC
    1. Mingke Z, Chen Y, Qian J et al (2022) Treatment of coronal plane femoral intertrochanteric fractures with a microexternal fixator combined with proximal femoral nail antirotation. J Healthc Eng 2022:1735603. https://doi.org/10.1155/2022/1735603 - DOI

Publication types

MeSH terms

LinkOut - more resources