Abstract
The purpose of this study is to investigate the risk factors for wedge effect and its relevance between blade cut-out in patients with intertrochanteric fractures (ITF) treated with proximal femoral nail antirotation II (PFNA-II). A total of 113 patients with ITF treated with PFNA-II between 2012 and 2016 were retrospectively analyzed. Radiographic variables including preoperative fracture pattern, fracture classification, lateral wall fracture, and postoperative neck–shaft angle (NSA), femoral offset (FO), blade cut-out, and Parker’s ratio were measured for analysis. An average of 4.16° of varus malalignment in NSA and 5.5 mm of femoral shaft lateralization in FO was found post-operatively. The presence of lateral wall fracture was significantly related to post-operative varus change of NSA (p < 0.05). After at least one year of follow up, the blade cut-out rate was 2.65% (3/113), and Parker’s ratio was significantly higher in patients with blade cut-out (p = 0.0118). This study concluded that patients with ITF-present preoperative lateral wall fracture and postoperative higher Parker’s ratio in AP radiography showed higher incidence of wedge effect that might increase risk of blade cut out.
Highlights
Intertrochanteric fractures (ITF) frequently occur in the elderly, with an incidence that continues to rise as life expectancy increases [1]
Potential risk factors were included in the analysis model, including age, sex, the fracture classification, the subgroup with fracture stability, lateral wall fracture, tip-apex distance (TAD), Parker’s ratio in AP and lateral, as well as neck–shaft angle (NSA) and femoral offset (FO) difference
25.7% (n = 29) of ITF occurred in the presence of lateral wall fracture on preoperative radiographs
Summary
Intertrochanteric fractures (ITF) frequently occur in the elderly, with an incidence that continues to rise as life expectancy increases [1]. ITF is mainly fixed with either extramedullary screw-plate devices such as dynamic hip screws (DHS) or intramedullary (IM) nails. DHS is considered the standard treatment for ITF and has been widely employed with long-lasting results. IM nailing became a popular option for ITF stabilization because of its mechanical advantage and rapid recovery from surgery compared with DHS [2]. The rate of IM nailing for ITF surprisingly increased from 3% in 1999 to 67% in 2006 in the USA [3]. Important issues concerned with increasing complications of proximal femur nail fixation have been recognized [4,5]
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