Risk Factors for Anterior Cortical Impingement of Short Cephalomedullary Nail in Chinese Elderly Patients with Intertrochanteric Fracture

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Abstract

Background

Anterior cortical impingement is a common phenomenon after intramedullary fixation in Asian patients with intertrochanteric fractures. It may cause thigh pain and even fracture of the femoral shaft, which may seriously affect postoperative rehabilitation and limb function of patients. However, little was known about risk factors for anterior cortical impingement in Chinese elderly after intramedullary nailing. Hence, the aim of this study was to certify the risk factors for anterior cortical impingement treated with intramedullary nails of intertrochanteric fracture, hoping to provide suggestions for surgical treatment.

Patients and Methods

A retrospective consecutive series of 94 patients who had been diagnosed as intertrochanteric fracture at our institution was included from January 2019 to November 2019. All patients were treated with intramedullary fixation and followed up for at least 6 months. Demographic, surgical and anesthesiologic information, as well as radiographic data and complications were collected and reviewed.

Results

The ratio of anterior cortical impingement is significantly higher in female patients than that of males (80.4% vs 18.6%, P=0.041). Higher incidence of anterior cortical impingement was found in the longer intramedullary nail group, especially in females. Gender (as a female patient) and length of nail were significant risk factors for anterior cortical impingement in intertrochanteric fracture patients treated with intramedullary nail (OR =2.662, 95% CI =1.010–7.018, P=0.447; OR =1.047, 95% CI =1.016–1.079, respectively). The length of nail was a risk factor for anterior cortical impingement in female intertrochanteric fracture patients treated with intramedullary nail (OR =1.051, 95% CI =1.015–1.089).

Conclusion

Elderly female patients with intertrochanteric fractures treated with intramedullary nails had a higher incidence of anterior cortical impingement. The length of short intramedullary nail is a risk factor for anterior cortical impingement. Patients with anterior cortical impingement may suffer serious complications.

Most cited references 23

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Mortality rates after incident non-traumatic fractures in older men and women.

Lisa Lix, P Caetano, S. Morin … (2011)

Non-traumatic fractures at typical osteoporotic sites are associated with increased mortality across all age groups, particularly in men. Furthermore, in certain age subgroups of women and men, this rate remained elevated beyond 5 years for fractures of the hip, vertebrae, humerus, and other sites. Increased mortality rates have been documented following non-traumatic hip, vertebral, and shoulder fractures. However, data are lacking as to the duration of excess mortality and whether there is increased mortality following fractures at other sites. We determined mortality up to 15 years following incident fractures at typical osteoporotic sites. Using healthcare databases for the Province of Manitoba, Canada, we identified individuals 50 years and older with an incident non-traumatic fracture between 1986 and 2007. Each fracture case was matched to three fracture-free controls. Generalized linear models were used to test for trends in mortality and to estimate the relative risk for cases after adjusting for co-morbidity and living arrangements. During the study period, we identified 21,067 incident fractures in men followed by 10,724 (50.1%) deaths and 49,197 incident fractures in women followed by 22,018 deaths (44.8%). Seventy-six percent of the fractures were at sites other than the hip and vertebrae. After adjustment for age, number of co-morbidities, and level of dependence in living arrangements, the risk of death in cases, relative to controls, was increased in both sexes for hip, vertebral, humerus, wrist (in men only), and other fracture sites. Post-fracture mortality was higher in men than women. Relative mortality was the highest in the younger age groups across the spectrum of fracture sites. Fractures at typical osteoporotic sites are associated with increased mortality across all age groups, particularly in men. Better understanding of factors associated with increased post-fracture mortality should inform the development of management strategies.

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Author and article information

Journal

Journal ID (nlm-ta): Ther Clin Risk Manag

Journal ID (iso-abbrev): Ther Clin Risk Manag

Journal ID (publisher-id): TCRM

Journal ID (pmc): tcriskman

Title: Therapeutics and Clinical Risk Management

Publisher: Dove

ISSN (Print): 1176-6336

ISSN (Electronic): 1178-203X

Publication date (Electronic): 18 June 2020

Publication date Collection: 2020

Volume: 16

Pages: 523-530

Affiliations

[1 ]Department of Orthopedics, The First Medical Centre, Chinese PLA General Hospital, National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation , Beijing 100853, People’s Republic of China

Author notes

Correspondence: Wei Zhang; Peifu Tang Department of Orthopedics, The First Medical Centre, Chinese PLA General Hospital, National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation , Beijing100853, People’s Republic of ChinaTel +86-10-68212342 Email bszw@hotmail.com; pftang301@163.com

[*]

These authors contributed equally to this work

Author information

Jiantao Li http://orcid.org/0000-0003-3454-4236

Peifu Tang http://orcid.org/0000-0003-4279-1704

Article

Publisher ID: 252214

DOI: 10.2147/TCRM.S252214

PMC ID: 7308130

SO-VID: 6506d7f5-2e46-4589-93a2-358a0a0df4eb

License:

This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

History

Date received : 03 March 2020

Date accepted : 31 May 2020

Page count

Figures: 3, Tables: 5, References: 23, Pages: 8

Funding

Funded by: PLA Major Project

Funded by: Capital Health Research and Development of Special Grants

Funded by: National Natural Science Foundation of China 10.13039/501100001809

This work was supported by the PLA Major Project (AWS17J004), the Capital Health Research and Development of Special Grants (2016-1-5012), the National Natural Science Foundation of China (81702153).

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Risk Factors for Anterior Cortical Impingement of Short Cephalomedullary Nail in Chinese Elderly Patients with Intertrochanteric Fracture

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Abstract

Background

Patients and Methods

Results

Conclusion

Most cited references 23

Fracture and dislocation classification compendium - 2007: Orthopaedic Trauma Association classification, database and outcomes committee.

Changes in trabecular pattern of the upper end of the femur as an index of osteoporosis.

Mortality rates after incident non-traumatic fractures in older men and women.

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Cited by 1

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