Increased 1-year revision rates among left-sided intertrochanteric femur fractures

Abstract

Objectives: To compare 1-year revision rates among left and right-sided intertrochanteric femur fractures. Design: Retrospective Setting: 120+ contributing centers to Multicentered database Patient selection criteria: Patients who sustained an intertrochanteric femur fracture (ITFFs) and had a cephalomedullary nail (CMN) from 2015-2022 were identified. Patients were then stratified based on left- or right-sided fracture. Patients were excluded if <18 years old, less than 1-year follow up. The intervention investigated was CMN on left or right side. Outcome Measures and Comparisons: 1-year revision surgery, comparing CMN performed on left or right side for ITFFs Results: In total, 113,626 patients met inclusion criteria, with 55,295 in the right-sided cohort and 58,331 in the left-sided cohort. There was no difference between cohorts with respect to age, gender, diabetes, osteoporosis, chronic kidney disease, or congestive heart failure (p>0.05 for all). Patients who sustained a left intertrochanteric femur fracture (ITFFs) and treated with a CMN were more likely to have revision surgery at 1 year (Left: 1.24%, Right: 0.90%; OR: 1.24; 95% CI: 1.15-1.1.33) or develop a nonunion or malunion (Left: 1.30%, Right: 0.98%; OR: 1.31; 95% CI: 1.14-1.52). The most common revision surgery conducted for both cohorts was conversion total hip arthroplasty (Left: 70.4% and Right: 70.0%). Conclusion: Patients who sustained a left intertrochanteric femur fracture and were treated with a CMN were more likely to undergo revision 1-year due to nonunion. There were no differences in demographics and comorbidities between cohorts. Though left versus right-sided confounding variables may exist, the difference in nonunion rate may be explained by clockwise torque of the lag screw used in most implants. Increased awareness, implant design, and improved technique during fracture reduction and fixation may help lower this disproportionate nonunion rate and its associated morbidity and financial impact. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.