Should nails be locked dynamically or statically in atypical femoral fractures? - A radiological analysis of time to union and reoperations in 236 displaced fractures with 4 years average follow-up.

Autor: Fang C; Department of Orthopaedics and Traumatology, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong., Shen WY; Department of Orthopaedics and Traumatology, Queen Elizabeth Hospital, Kowloon, Hong Kong., Wong JSH; Department of Orthopaedics and Traumatology, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong. Electronic address: januswong@connect.hku.hk., Yee DK; Department of Orthopaedics and Traumatology, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong., Yung CS; Department of Orthopaedics and Traumatology, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong., Fang E; Department of Orthopaedics and Traumatology, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong., Lai YS; Department of Orthopaedics and Traumatology, Kwong Wah Hospital, Yau Ma Tei, Hong Kong., Woo SB; Department of Orthopaedics and Traumatology, Kwong Wah Hospital, Yau Ma Tei, Hong Kong., Cheung J; Department of Orthopaedics and Traumatology, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong., Chau JY; Department of Orthopaedics and Traumatology, Kwong Wah Hospital, Yau Ma Tei, Hong Kong., Ip KC; Department of Orthopaedics and Traumatology, Queen Elizabeth Hospital, Kowloon, Hong Kong., Li W; Department of Orthopaedics and Traumatology, Queen Elizabeth Hospital, Kowloon, Hong Kong., Leung F; Department of Orthopaedics and Traumatology, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong.
Jazyk: angličtina
Zdroj: Injury [Injury] 2023 Aug; Vol. 54 (8), pp. 110909. Date of Electronic Publication: 2023 Jun 21.
DOI: 10.1016/j.injury.2023.110909
Abstrakt: Introduction: Atypical femoral fractures (AFFs) are associated with delayed union and higher reoperation rates. Axial dynamization of intramedullary nails is hypothesized to reduce time-to-union (TTU) and fixation failure as compared to static locking.
Methods: Consecutive acutely displaced AFFs fixed with long intramedullary nails across five centres between 2006 and 2021 with a minimum postoperative follow-up of three months were retrospectively reviewed. The primary outcome was TTU, compared between AFFs treated with dynamically or statically locked intramedullary nails. Fracture union was defined as a modified Radiographic Union Score for Tibial fractures score of 13 or greater. Secondary outcomes involved revision surgery and treatment failure, defined as non-union beyond 18 months or revision internal fixation for mechanical reasons.
Results: A total of 236 AFFs (127 dynamically locked and 109 statically locked) were analysed with good interobserver reliability of fracture union assessment (intraclass correlation coefficient = 0.89; 95% CI = 0.82-0.98). AFFs treated with dynamized nails had significantly shorter median TTU (10.1 months; 95% CI = 9.24-10.96 vs 13.0 months; 95% CI = 10.60-15.40) (log-rank test, p = 0.019). Multivariate Cox regression revealed that dynamic locking was independently associated with greater likelihood of fracture union within 24 months (p = 0.009). Reoperations were less frequent in the dynamic locking group (18.9% vs 28.4%), although the difference was not statistically significant (p = 0.084). Static locking was an independent risk factor for reoperation (p = 0.049), as were varus reduction and lack of teriparatide use within three months of surgery. Static locking also demonstrated a higher frequency of treatment failure (39.4% vs 22.8%, p = 0.006) and was an independent predictor of treatment failure in logistic regression (p = 0.018). Other factors associated with treatment failure included varus reduction and open reduction.
Conclusions: Dynamic locking of intramedullary nails in AFFs is associated with faster time to union, lower rate of non-union, and fewer treatment failures.
Competing Interests: Declaration of Competing Interest Christian Fang is a shareholder of Lifespans Ltd and is also a speaker for Depuy Synthes. He has received research support from AO Foundation and Agnovos LLC. Frankie Leung is a shareholder of Lifespans Ltd and is also a speaker for Depuy Synthes, he has received research support from AO Trauma. All other authors declare no conflicts of interest.
(Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)
Databáze: MEDLINE
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