Femoral offset loss and internal arch restoration defect are correlated with intramedullary nail cut-out complications after pertrochanteric fractures: a case-control study
| Autor: | Julia Donadio, Zied Chenguel, Marc-Antoine Rousseau, Pascal Guillon, Baptiste Boukebous, C H Flouzat-Lachaniette |
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| Rok vydání: | 2018 |
| Předmět: |
Male
Rotation Bone Nails law.invention Intramedullary rod Combinatorics 03 medical and health sciences 0302 clinical medicine Postoperative Complications law Femoral offset Medicine Humans Orthopedics and Sports Medicine 030212 general & internal medicine Sensitivity (control systems) Treatment Failure Aged Retrospective Studies Aged 80 and over 030222 orthopedics Fracture stability Osteosynthesis business.industry Hip Fractures Mechanical failure Femoral rotation Closed Fracture Reduction Fracture Fixation Intramedullary ROC Curve Area Under Curve Case-Control Studies Surgery Female Hip Joint Level iii business |
| Zdroj: | European journal of orthopaedic surgerytraumatology : orthopedie traumatologie. 29(7) |
| ISSN: | 1432-1068 |
| Popis: | In a previous study, we investigated the link between the femoral offset (FO) loss by trochanteric impaction (TI) and cut-out complication occurrence after pertrochanteric fractures. Three major factors are likely to drive to failure after intramedullary nailing (IN): fracture stability, reduction quality and osteosynthesis quality. We wanted to investigate the quality of the fracture reduction through the TI and the neck-shaft angle (NSA) measurement and correlate these parameters with the risk of mechanical failure occurrence. It was a retrospective multicentric one case–one control match design study with age and gender randomization. The cases presented a mechanical failure of nailing: $${\text{TI}} = 1 - \frac{{{\text{FO}}_{\text{fractured}} }}{{{\text{FO}}_{\text{healthy}} }}$$ in percentage. Femoral rotation was taken into account, and all TI were rotation-corrected (TIcorrected). Rotation-corrected neck-shaft angles (NSAcorrected) were calculated. The neck-shaft angle gap between the fractured and the healthy sides (NSAgap) was a ratio: $${\text{NSA}}_{\text{gap}} = 1 - \frac{{{\text{NSA}}_{\text{corrected}} }}{{{\text{NSA}}_{\text{healthy}} }}$$ in percentage. The tip–apex distance (TAD) was measured. Absolute values of TIcorrected and NSAgap were analyzed. Twenty-one cases and 21 controls were examined. The average TIcorrected rate was 30% for the cases and 11% for the controls (p = 0.007). A 13% TIcorrected threshold had maximum specificity and sensitivity, equal to 71%. The average TAD was 27 mm for cases and 19 mm for controls (p = 0.004). The average NSAgap rate was 7% for the case group and 4% for the control group (p = 0.009). The areas under the ROC curves for TIcorrected, TAD and NSAgap were 0.73, 0.73 and 0.66, respectively. Closed reduction and exclusive implantation of IN do not seem optimal in case of FO or NSA restoration failure after pertrochanteric fractures. Level III, case–control study. |
| Databáze: | OpenAIRE |
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