Influence de la taille du canal fémoral proximal sur la réduction des fractures intertrochantériennes avec clou céphalomédullaire

Abstract

BackgroundMalalignment is the most important risk factor for fixation failure after intertrochanteric fracture treated with a cephalomedullay nail (CMN). Malalignment continues to occur despite advances in surgical techniques. HypothesisWe hypothesized that small femur canal size causes intra-operative reduction loss during cephalomedullary nail insertion. MethodsA retrospective study was performed from 2014 to 2017. Patients with acute intertrochanteric fracture implanted with the same sized CMN (Stryker, Mahwah, NJ, USA, diameter: 10mm, length: 170mm, degree 130) were included. Evaluated radiographic parameters included femoral canal size, corrected neck-shaft angle, and calcar reduction. ResultsThe study totally included and analyzed the data from 108 patients. Patients with smaller femoral canal size tended to have increased calcar distance according to Pearson's correlation coefficient analysis (r(106)=−0.805, p<0.001). Patients with calcar malreduction had higher corrected neck-shaft angle postoperatively. This observed correction tended to be lost during follow up. ConclusionsSmall femoral canal size resulted in poorer reduction quality. Reduction loss during nail insertion may be due to the whole proximal fragment instead of the superolateral femoral neck. Reaming the isthmus before nail insertion or choosing a smaller sized CMN is indicated in this patient population to prevent intra- or postoperative loss of reduction. Level of evidenceIII; retrospective study.