Medial Calcar Comminution and Intramedullary Nail Failure in Unstable Geriatric Trochanteric Hip Fractures
<i>Background and Objectives</i>: An increasing global burden of geriatric hip fractures is anticipated. The appropriate treatment for fractures is of ongoing interest and becoming more relevant with an aging population and finite health resources. Trochanteric fractures constitute appro...
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| Format: | Article |
| Language: | English |
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MDPI AG
2021-04-01
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| Series: | Medicina |
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| Online Access: | https://www.mdpi.com/1648-9144/57/4/338 |
| _version_ | 1797539145654992896 |
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| author | Seth M. Tarrant David Graan Drew J. Tarrant Raymond G. Kim Zsolt J. Balogh |
| author_facet | Seth M. Tarrant David Graan Drew J. Tarrant Raymond G. Kim Zsolt J. Balogh |
| author_sort | Seth M. Tarrant |
| collection | DOAJ |
| description | <i>Background and Objectives</i>: An increasing global burden of geriatric hip fractures is anticipated. The appropriate treatment for fractures is of ongoing interest and becoming more relevant with an aging population and finite health resources. Trochanteric fractures constitute approximately half of all hip fractures with the medial calcar critical to fracture stability. In the management of unstable trochanteric fractures, it is assumed that intramedullary nails and longer implants will lead to less failure. However, the lack of power, inclusion of older generation femoral nails, and a variable definition of stability complicate interpretation of the literature. <i>Materials and Methods</i>: Between January 2012 and December 2017, a retrospective analysis of operatively treated geriatric trochanteric hip fracture patients were examined at a Level 1 Trauma Centre. The treatment was with a long and short version of one type of trochanteric nail. Unstable trochanteric fractures with medial calcar comminution were examined (AO31A2.3, 2.3 & 3.3). The length of the medial calcar loss, nail length, demographics, fracture morphology, and relevant technical factors were examined in univariate and multivariate analysis using competing risk regression analysis. The primary outcome was failure of fixation with post-operative death the competing event and powered to previously reported failure rates. <i>Results</i>: Unstable patterns with medial calcar comminution loss constituted 617 (56%) of operatively treated trochanteric fractures. Failure occurred in 16 (2.6%) at a median post-operative time of 111 days (40–413). In univariate and multivariate analysis, only younger age was a significant predictor of failure (years; SHR: 0.91, CI 95%: 0.86–0.96, <i>p</i> < 0.001). Nail length, medial calcar loss, varus reduction, and other technical factors did not influence nail failure. <i>Conclusions</i>: In a cohort of unstable geriatric trochanteric hip fractures with medial calcar insufficiency, only younger patient age was predictive of nail failure. Neither the length of the medial calcar fragment or nail was predictive of failure. |
| first_indexed | 2024-03-10T12:42:04Z |
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| id | doaj.art-e723f2117c1a41f0bb1cc8253120f51d |
| institution | Directory Open Access Journal |
| issn | 1010-660X 1648-9144 |
| language | English |
| last_indexed | 2024-03-10T12:42:04Z |
| publishDate | 2021-04-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Medicina |
| spelling | doaj.art-e723f2117c1a41f0bb1cc8253120f51d2023-11-21T13:51:33ZengMDPI AGMedicina1010-660X1648-91442021-04-0157433810.3390/medicina57040338Medial Calcar Comminution and Intramedullary Nail Failure in Unstable Geriatric Trochanteric Hip FracturesSeth M. Tarrant0David Graan1Drew J. Tarrant2Raymond G. Kim3Zsolt J. Balogh4Department of Traumatology, John Hunter Hospital, Lookout Rd, New Lambton Heights, NSW 2305, AustraliaDepartment of Traumatology, John Hunter Hospital, Lookout Rd, New Lambton Heights, NSW 2305, AustraliaDepartment of Traumatology, John Hunter Hospital, Lookout Rd, New Lambton Heights, NSW 2305, AustraliaDepartment of Traumatology, John Hunter Hospital, Lookout Rd, New Lambton Heights, NSW 2305, AustraliaDepartment of Traumatology, John Hunter Hospital, Lookout Rd, New Lambton Heights, NSW 2305, Australia<i>Background and Objectives</i>: An increasing global burden of geriatric hip fractures is anticipated. The appropriate treatment for fractures is of ongoing interest and becoming more relevant with an aging population and finite health resources. Trochanteric fractures constitute approximately half of all hip fractures with the medial calcar critical to fracture stability. In the management of unstable trochanteric fractures, it is assumed that intramedullary nails and longer implants will lead to less failure. However, the lack of power, inclusion of older generation femoral nails, and a variable definition of stability complicate interpretation of the literature. <i>Materials and Methods</i>: Between January 2012 and December 2017, a retrospective analysis of operatively treated geriatric trochanteric hip fracture patients were examined at a Level 1 Trauma Centre. The treatment was with a long and short version of one type of trochanteric nail. Unstable trochanteric fractures with medial calcar comminution were examined (AO31A2.3, 2.3 & 3.3). The length of the medial calcar loss, nail length, demographics, fracture morphology, and relevant technical factors were examined in univariate and multivariate analysis using competing risk regression analysis. The primary outcome was failure of fixation with post-operative death the competing event and powered to previously reported failure rates. <i>Results</i>: Unstable patterns with medial calcar comminution loss constituted 617 (56%) of operatively treated trochanteric fractures. Failure occurred in 16 (2.6%) at a median post-operative time of 111 days (40–413). In univariate and multivariate analysis, only younger age was a significant predictor of failure (years; SHR: 0.91, CI 95%: 0.86–0.96, <i>p</i> < 0.001). Nail length, medial calcar loss, varus reduction, and other technical factors did not influence nail failure. <i>Conclusions</i>: In a cohort of unstable geriatric trochanteric hip fractures with medial calcar insufficiency, only younger patient age was predictive of nail failure. Neither the length of the medial calcar fragment or nail was predictive of failure.https://www.mdpi.com/1648-9144/57/4/338hip fractureosteoporosisgeriatricfragilityfracturefemoral nail |
| spellingShingle | Seth M. Tarrant David Graan Drew J. Tarrant Raymond G. Kim Zsolt J. Balogh Medial Calcar Comminution and Intramedullary Nail Failure in Unstable Geriatric Trochanteric Hip Fractures Medicina hip fracture osteoporosis geriatric fragility fracture femoral nail |
| title | Medial Calcar Comminution and Intramedullary Nail Failure in Unstable Geriatric Trochanteric Hip Fractures |
| title_full | Medial Calcar Comminution and Intramedullary Nail Failure in Unstable Geriatric Trochanteric Hip Fractures |
| title_fullStr | Medial Calcar Comminution and Intramedullary Nail Failure in Unstable Geriatric Trochanteric Hip Fractures |
| title_full_unstemmed | Medial Calcar Comminution and Intramedullary Nail Failure in Unstable Geriatric Trochanteric Hip Fractures |
| title_short | Medial Calcar Comminution and Intramedullary Nail Failure in Unstable Geriatric Trochanteric Hip Fractures |
| title_sort | medial calcar comminution and intramedullary nail failure in unstable geriatric trochanteric hip fractures |
| topic | hip fracture osteoporosis geriatric fragility fracture femoral nail |
| url | https://www.mdpi.com/1648-9144/57/4/338 |
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