Analysis of risk factor for nail breakage in patients with mechanical failures after proximal femoral nail antirotation in intertrochanteric fractures.

Autor:	Lee YK; Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea., Kim JT; Department of Orthopedic Surgery, Ajou Medical Center, Ajou University School of Medicine, Suwon, Korea., Park CH; Department of Orthopedic Surgery, Yeungnam University Medical Center, Daegu, Korea., Song JU; Department of Orthopedic Surgery, Chamjoeun Hospital, Gwangju, Korea., Kim TY; Department of Orthopedic Surgery, Konkuk University Medical Center, Seoul, Korea., Koo KH; Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.
Jazyk:	angličtina
Zdroj:	Medicine [Medicine (Baltimore)] 2022 Jun 24; Vol. 101 (25), pp. e29436. Date of Electronic Publication: 2022 Jun 24.
DOI:	10.1097/MD.0000000000029436
Abstrakt:	Abstract: Breakage of the intramedullary nail is a rare complication after proximal femoral nail antirotation (PFNA) in intertrochanteric fracture treatment. The purpose of this study was (1) to investigate the frequency of nail breakage among the patients who were treated for mechanical failure after PFNA for intertrochanteric/pertrochanteric fracture, and (2) to determine the risk factors for nail breakage in PFNA treatment of intertrochanteric fracture.To identify mechanical failure after internal fixation using PFNA, we retrospectively reviewed the data of 35 patients (35 hips) who required reoperation after PFNA with a helical blade for intertrochanteric/pertrochanteric fracture between June 2005 and June 2018.We evaluated the frequency of breakage of PFNA and compared the demographic and radiologic parameters between the breakage and control (non-breakage) groups. We also compared the lever arm for the load of stress from the fulcrum according to the centrum-collum-diaphyseal (CCD) angle of blade by using reverse design technique.Among the 25 patients with mechanical failure after PFNA except 10 patients with peri-implant infection and osteonecrosis, 7 (28.0%) showed breakage of PFNA at average of 8 months (range, 5-13 months) after index surgery. A larger horizontal offset (the horizontal distance from the lateral surface of the IM nail and the medial tip of helical blade) was associated with an increased risk of nail breakage. A CCD angle of 130° has a shorter lever arm for the load of stress from the fulcrum, meaning a higher stress for nail breakage, although there was no association between CCD angle and breakage of the nail.Our study suggested that higher horizontal offset and a higher CCD angle can increase the risk of breakage of the PFNA nail at the aperture for the helical blade. Competing Interests: The authors have no conflicts of interest to disclose. (Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.)
Databáze:	MEDLINE
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