Key result
The presence of a basicervical fracture extension was a significant risk factor for postoperative screw cut-out after intramedullary nailing, with an adjusted OR of 169.45 in the proximal femoral nail group.
Why the study?
Intramedullary nails are commonly used for extracapsular hip fractures, but clinical outcomes and risk factors associated with screw cut-out required evaluation across different nail devices.
Does the type of intramedullary nail (PFN vs CMN) affect the risk of screw cut-out in patients with extracapsular hip fractures?
Cohort (n=138)
No
Does the type of intramedullary nail (PFN vs CMN) affect the risk of screw cut-out in patients with extracapsular hip fractures?
Odds Ratio: 169.45 (95% CI 1.935–1483.447)
Absolute Event Rate: 28.6% vs 2.9%
p-value: p=0.024
Basicervical fracture extension is a significant risk factor for screw cut-out after intramedullary nailing of extracapsular hip fractures, highlighting the need for careful management of these unstable fractures.
BackgroundsThe basic method of surgical treatment for extracapsular hip fracture (ECF), including intertrochanteric fracture and basicervical fracture (BCF), is osteosynthesis. Intramedullary nails are among the most commonly used fixation devices for such fractures. Our study aimed to report the clinical outcomes of ECF treatment with two different nail devices and to analyze the risk factors associated with screw cut-out.MethodsWe retrospectively reviewed the medical records of 273 patients (300 cases) from a single institution who underwent surgical treatment for ECF between January 2013 and October 2018. Overall, 138 patients were eligible for the study and were divided into two groups according to the osteosynthesis device used. We evaluated the clinical outcomes of fracture surgery and performed univariate and multivariate regression analyses to identify risk factors associated with screw cut-out in each group.ResultsWe used proximal femoral nails (group 1) to treat 83 patients and cephalomedullary nails (group 2) to treat 55 patients. Nine cut-outs (group 1, 6 cases; group 2, 3 cases) occurred during follow-up. The patients’ high body mass index (BMI) (p=0.019), BCFs (p=0.007), non-extramedullary reduction in the anteroposterior and lateral planes (p=0.032 and p=0.043, respectively), and anti-rotation screw pull-outs (p=0.041) showed a positive correlation to screw cut-out in the univariate analysis of group 1. In group 2, only BCFs was positively correlated (p=0.020). In the multivariate analysis of group 1, the patients’ BMIs (p=0.024) and BCFs (p=0.024) showed a positive correlation with cut-out. Meanwhile, the multivariate analysis of group 2 did not identify any factors associated with cut-out.ConclusionsThe cut-out risk was significantly higher in the BCF cases, regardless of the nail design used. Considerable attention should be paid to treating such unstable fractures. We expect that new-generation nails using a helical blade, or interlocking derotation and interlocking screws may improve surgical outcomes.
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Yoon et al. (2021) conducted a cohort in Extracapsular hip fracture (n=138). Basicervical fracture extension vs. No basicervical fracture extension was evaluated on Screw cut-out (OR 169.45, 95% CI 1.935-1483.447, p=0.024). The presence of a basicervical fracture extension was a significant risk factor for postoperative screw cut-out after intramedullary nailing, with an adjusted OR of 169.45 in the proximal femoral nail group.
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