Reduction quality and nail fixation ratio as bone-implant stability factors associated with reoperation for trochanteric fractures. Issue 7 (July 2021)

• Record Type: Journal Article
• Authors: Yamamoto, Norio; Tomita, Yosuke; Noda, Tomoyuki; Inoue, Tomoo; Mochizuki, Yusuke; Ozaki, Toshifumi
• Is Part Of: Injury. Volume 52:Issue 7(2021)
• Page Start: 1813
• Page End: 1818
• Publication Date: 2021-07
• Subjects: Trochanteric fracture -- Nail length -- Nail diameter -- Reduction -- Reoperation; Wounds and injuries -- Surgery -- Periodicals; Accidents -- Periodicals; Wounds and Injuries -- surgery -- Periodicals; Lésions et blessures -- Chirurgie -- Périodiques; Electronic journals; Electronic journals; 617.1
• DOI: 10.1016/j.injury.2021.04.048
• Languages: English
• ISSNs: 0020-1383

Abstract

Highlights: Bone quality, fracture type, reduction quality, implant selection, and implant placement affect bone-implant stability. We evaluated the association between bone-implant stability factors, including nail construct, and the rate of reoperation. Reduction quality and fracture type, but not nail length and diameter, affect bone-implant stability for reoperation. A nail length with a distal femoral fragment fixation ratio >0.8 is preferred if inadequate reduction remains. Abstract: Introduction: Geriatric trochanteric fractures are a major global issue, and their incidence is steadily rising. Bone quality, fracture type, fracture reduction quality, implant selection, and implant placement affect bone-implant stability in osteoporotic fractures. Our aim in this study was to evaluate the association between bone-implant stability factors, including nail construct, and the rate of reoperation in a more extensive case series with comprehensive variables. Methods: This was a retrospective cohort study of 390 patients with trochanteric fractures aged ≥60 years and treated with intramedullary nailing. The primary outcome was the rate of reoperation due to any cause. Univariate and multivariable logistic regression analyses were used to identify factors associated with reoperation. Results: In this study, 15 patients (3.8%) required reoperation. Univariate analysis showed that the following variables were significantly different between patients who required reoperation and those who did not: T-score at the total hip and lumbar spine, cortical thickness index, fracture type, and reduction quality. Multivariable logistic regression analysis showed that the odds ratio (OR) for A3 fracture type was 2.76 (95% confidence interval [CI], 0.77-9.76; p=0.116) and that for inadequate reduction, assessed by computed tomography, was 2.94 (95% CI, 0.89-9.69; p=0.076). These were independent predictors of reoperation. There was only one case (6.7%) of reoperation among patients with a distal femoral fragment fixation ratio (FR) >0.8. Considering the intraoperative decision-making process, the combination of inadequate reduction and an FR ≤0.8 were associated with the highest reoperation at a rate of 9.3% (OR, 3.327; 95% CI, 1.091-10.142; p=0.043). Conclusions: Risk factors on bone-implant stability for reoperation were the reduction quality and fracture type. Regarding the intraoperative decision-making process, the selection of a nail length with an FR >0.8 is a better option when the intramedullary reduction has been maintained intraoperatively.