Perioperative Implant-associated Fractures in Geriatric Pertrochanteric Fixation: Incidence, Risk Factors, and the Influence of Proximal Femoral Geometry
Retrospective study reveals narrow femoral anatomy and specific nail designs increase intraoperative fracture risk in older adults, highlighting the need for tailored implant selection.
Key Points
To determine the incidence, anatomical risk factors, and radiographic characteristics of perioperative implant-associated fractures during cephalomedullary nailing for geriatric pertrochanteric fractures.
Retrospective review of 258 patients aged ≥60 years treated with proximal femoral nail antirotation II or INTERTAN devices between 2019 and 2022.
Assessed demographic variables, proximal femoral morphology, reduction quality, and implant positioning using early postoperative radiographs.
Perioperative implant-associated fractures occurred in 6.6% (17/258) of patients.
Multivariate regression identified reduced low–lesser trochanter width (OR = 0.73) and INTERTAN device use (OR = 12.66) as independent risk factors.
Sixteen fractures were nondisplaced and resolved with protected weight-bearing, while one distal cortical fracture required revision to a long nail.