Outcomes after unstable pertrochanteric femur fracture: intermediate versus long cephalomedullary nails
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ORIGINAL ARTICLE
Outcomes after unstable pertrochanteric femur fracture: intermediate versus long cephalomedullary nails Sorawut Thamyongkit1,2 · James S. MacKenzie1 · Norachart Sirisreetreerux1 · Babar Shafiq1 · Erik A. Hasenboehler1 Received: 19 March 2018 / Accepted: 20 August 2018 © Springer-Verlag GmbH Germany, part of Springer Nature 2018
Abstract Purpose Optimal cephalomedullary nail (CMN) length for unstable pertrochanteric femur fractures is controversial. Long CMNs (L-CMNs) are currently recommended; however, intermediate-length CMNs (I-CMNs) may provide stable fixation without the additional surgical steps required by L-CMNs. We analyzed outcomes after unstable pertrochanteric femur fractures treated with L-CMNs or I-CMNs to determine whether functional outcomes, perioperative measures, complications, and mortality and reoperation rates differ by CMN length. Methods We retrospectively reviewed medical records at our institution for 100 patients who received surgical treatment for pertrochanteric femur fractures from June 2014 to June 2016. Data from 43 unstable pertrochanteric femur fractures treated with L-CMNs (n = 25) or I-CMNs (n = 18) were analyzed. We evaluated operative time, fluoroscopy time, intraoperative blood loss, blood transfusions, and perioperative complications; peri-implant fracture, malunion, reoperation, and death; and neck–shaft angle, tip–apex distance, and 6-month postoperative functional scores. We analyzed categorical data with Fisher exact tests and continuous data with Student t tests. P 0.05; Table 1). Radiographic assessments for quality of reduction and fixation, including neck–shaft angle and tip–apex distance, were similar between groups (P > 0.05). Neck–shaft angle was defined as the angle formed by the cross-junction of the axis of the femoral shaft and a line drawn along the axis of the femoral neck passing through the center of the femoral head. Tip–apex distance was defined as the sum of the distance from the tip of the hip screw to the apex of the femoral head on anteroposterior and lateral radiographs [12]. Anteroposterior and lateral radiographs were reviewed immediately postoperatively and at 2 weeks, 6 weeks, 3 months, and 6 months after surgery. Radiographs were evaluated using digital imaging software (Carestream Vue Motion, version 12.1.0.2146; Carestream Health Corp., Rochester, NY, USA). All images were evaluated by one of our orthopaedic trauma surgeons.
Table 1 Characteristics of 43 patients who underwent treatment of unstable pertrochanteric femur fractures with intermediate or long CMNs, 2014–2016 Characteristic
Intermediate Long CMN (n = 25) P value CMN (n = 18) No. No.
Age (years) Female sex Fracture side (left/ right) Anticoagulant medicine Body mass index Tobacco use ASA score 1 2 3 4 Osteoporosis Associated injury OTA classification 31-A2b 31-A3c
78 ± 14a 10 7/11
74 ± 16a 12 15/10
0.637 0.114 0.642
12
12
0.939
24 ± 5.8a 12
23 ± 5.9a 12
0.868 0.939
0 5 11 3 15 2
1 9 12 3 15 3
0.765
11 7
14 11
0.357
0.191 0.900
ASA Ame
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