Intraoperative fractures in cephalomedullary nailing for trochanteric fractures. Issue 2 (February 2022)

• Record Type: Journal Article
• Authors: Yamamoto, Norio; Yamakawa, Yasuaki; Tomita, Yosuke; Noda, Tomoyuki; Inoue, Tomoo; Matsumoto, Toshiyuki; Kawasaki, Keisuke; Ozaki, Toshifumi
• Is Part Of: Injury. Volume 53:Issue 2(2022)
• Page Start: 561
• Page End: 568
• Publication Date: 2022-02
• Subjects: Trochanteric fracture -- Cephalomedullary nail -- Intraoperative fracture -- Computed tomography -- Reoperation -- Regaining independent mobility; 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.2021.10.017
• Languages: English
• ISSNs: 0020-1383

Abstract

Highlights: The incidence of intraoperative fractures (IFs) detected by CT in cephalomedullary nailing for trochanteric fractures was 11.8%. Inadequate reduction on the anteroposterior view based on plain radiographs was an independent risk factor of IFs. patients with IFs did not undergo reoperation within 3 months of follow-up. IFs distal to the lag screw entry and those diagnosed with plain radiographs were poor predictors of independent walking at postoperative 3 months. Patients with IFs tended not to regain independent mobility at 3 months postoperatively as much as those without IFs. Abstract: Introduction: Cephalomedullary nailing (CMN) is the standard treatment for internal fixation of trochanteric fractures. Complications related to CMN include intraoperative fracture (IF), which is difficult to detect using only plain radiographs. However, analyses of IFs using plain radiographs and computed tomography (CT) with a large sample size of clinical cases are lacking. Therefore, this study aimed to report the incidence of IFs diagnosed by CT, the risk factors for IFs, and a comparison of clinical outcomes between patients with and without IFs. Methods: This multicenter retrospective cohort study included 638 patients who underwent CMN fixation for trochanteric fractures. We evaluated IF using pre-and postoperative plain radiographs and CT. The primary outcome was reoperation and the secondary outcome was the proportion of patients who regained independent mobility at 3 months postoperatively. Furthermore, we conducted multivariable logistic regression analyses to examine the association between risk factors and IFs. Results: Seventy-five (11.8%) patients had IFs, including 53 patients with occult IFs (8.3%). The most common location of IF was at the interference with the lag screw entry (45.3%). The nail insertion procedure (17.3%) was the most common reason for IF. In the assessment of clinical outcomes, patients with IFs had no reoperations and independent mobility at postoperative 3 months was lower (69.6% vs. 79.1%). Regarding regaining independent walking in the IF group, IF distal to lag screw entry and obvious IF diagnosed with plain radiographs were poor factors. The multivariable analysis showed that only inadequate reduction on the anteroposterior view based on the plain radiograph was significantly associated with the incidence of IFs (odds ratio 3.91; 95% CI, 1.28–11.94; p = 0.017). Conclusions: This multicenter study indicated that the incidence of IFs detected by CT in CMN treatment for trochanteric fractures was 11.8%. An inadequate reduction in the anteroposterior view based on plain radiographs was the only independent risk factor of IFs. In the assessment of clinical outcomes, patients with IF had no incidences of reoperation. However, patients with IFs tended not to regain independent mobility compared with those without IFs.