Integrated Dual Lag Screws Have Higher Reoperation Rates for Fixation Failure Than Single Lag Component Cephalomedullary Nails: A Retrospective Study of 2,130 Patients with Intertrochanteric Femoral Fractures.

IF 4.4 1区医学 Q1 ORTHOPEDICS

Journal of Bone and Joint Surgery, American Volume Pub Date : 2024-09-18 Epub Date: 2024-07-24 DOI:10.2106/JBJS.23.01152

Christian A Gonzalez, Noelle L Van Rysselberghe, Mathew J Whittaker, Daniel Ngo, John B Michaud, Michael J Gardner

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引用次数: 0

Abstract

Background: Previous studies comparing reoperation risk between integrated dual lag screw (IDL) and single lag component (SL) cephalomedullary nails (CMNs) in the treatment of intertrochanteric femoral fractures have demonstrated mixed results. The purpose of this study was to assess the rates of reoperation for fixation failure and all-cause reoperation in a large, multi-institutional cohort of patients with an intertrochanteric fracture treated with an IDL or SL CMN. We hypothesized that there would be no difference between the groups with respect to either of the reoperation rates.

Methods: Adults (≥18 years old) who sustained an intertrochanteric fracture (AO/OTA 31A1 to 31A3) treated with an IDL or SL CMN between January 2014 and May 2021 at 1 of 13 Level-I trauma centers were included. Patients with <3 months of follow-up or pathologic fractures were excluded. Rates of reoperation were compared with use of the chi-square test and multivariable regression, controlling for age, gender, injury mechanism, fracture pattern, and postoperative neck-shaft angle.

Results: A total of 2,130 patients met the inclusion criteria. The median age was 78 years, and 62.5% of patients were female. The cohort consisted of 287 patients (13.5%) with an IDL CMN and 1,843 patients (86.5%) with an SL CMN. A total of 99 patients (4.6%) had a reoperation of any type, of whom 29 (1.4% of all patients) had a reoperation for fixation failure. Compared with patients with an SL CMN, those with an IDL CMN had higher rates (4.2% versus 0.9%; p < 0.001) and odds (odds ratio [OR], 4.95 [95% confidence interval (CI), 2.29 to 10.69]; p < 0.001) of reoperation for fixation failure as well as higher rates (7.3% versus 4.2%; p = 0.021) and odds (OR, 1.83 [95% CI, 1.10 to 3.06]; p = 0.021) of all-cause reoperation.

Conclusions: Intertrochanteric femoral fractures treated with an IDL CMN were associated with low but significantly higher rates and significantly higher odds of reoperation for fixation failure and all-cause reoperation compared with those treated with an SL CMN. We suggest caution to surgeons in the use of IDL CMNs for high-risk patients and recommend using SL CMNs for most patients with intertrochanteric femoral fractures.

Level of evidence: Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.

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与单滞后组件头髓内钉相比，一体化双滞后螺钉的固定失败再手术率更高：对 2130 例股骨转子间骨折患者的回顾性研究。

背景：以往的研究比较了集成双滞后螺钉（IDL）和单滞后部件（SL）头髓内钉（CMN）治疗股骨转子间骨折的再手术风险，结果不一。本研究的目的是评估在使用 IDL 或 SL CMN 治疗股骨转子间骨折的大型多机构队列患者中，因固定失败而再次手术的比例以及因各种原因再次手术的比例。我们假设两组患者的再手术率没有差异：方法：纳入 2014 年 1 月至 2021 年 5 月期间在 13 个一级创伤中心中的 1 个中心接受 IDL 或 SL CMN 治疗的转子间骨折（AO/OTA 31A1 至 31A3）成人（≥18 岁）。患者与结果：共有 2130 名患者符合纳入标准。中位年龄为 78 岁，62.5% 的患者为女性。队列中包括 287 名 IDL CMN 患者（13.5%）和 1,843 名 SL CMN 患者（86.5%）。共有 99 名患者（4.6%）进行过任何类型的再次手术，其中 29 人（占所有患者的 1.4%）因固定失败而再次手术。与 SL CMN 患者相比，IDL CMN 患者因固定失败而再次手术的比例（4.2% 对 0.9%；P < 0.001）和几率（几率比 [OR]，4.95 [95% 置信区间 (CI)，2.29 对 10.69]；P < 0.001），因固定失败而再次手术的比例（7.3% 对 4.2%；P = 0.021）和全因再次手术的几率（OR，1.83 [95% CI，1.10 对 3.06]；P = 0.021）也更高：结论：与使用SL CMN治疗的股骨转子间骨折相比，使用IDL CMN治疗的股骨转子间骨折的固定失败率和全因再手术的几率较低，但明显较高。我们建议外科医生慎用IDL CMN治疗高风险患者，并建议大多数股骨转子间骨折患者使用SL CMN：治疗级别 III。有关证据级别的完整描述，请参阅 "作者须知"。

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来源期刊

Journal of Bone and Joint Surgery, American Volume 医学-外科

CiteScore

8.90

自引率

7.50%

发文量

660

审稿时长

1 months

期刊介绍： The Journal of Bone & Joint Surgery (JBJS) has been the most valued source of information for orthopaedic surgeons and researchers for over 125 years and is the gold standard in peer-reviewed scientific information in the field. A core journal and essential reading for general as well as specialist orthopaedic surgeons worldwide, The Journal publishes evidence-based research to enhance the quality of care for orthopaedic patients. Standards of excellence and high quality are maintained in everything we do, from the science of the content published to the customer service we provide. JBJS is an independent, non-profit journal.