Low ASA score, subtrochanteric fracture, and pathological fracture were independent risk factors for intramedullary nail breakage (mean time to fracture 10 months) in proximal femoral fractures.
Case-Control (n=228)
No
INTRODUCTION Intramedullary nailing is a common treatment for proximal femoral fractures. Fracture of the nail is a rare but devastating complication that exposes often frail patients to complex revision surgery. We investigated which risk factors predict nail failure. METHODS We reviewed all cases of nail breakage seen over a 10-year period in a single busy trauma unit; 22 nail fractures were seen in 19 patients. Comparison was made with a group of 209 consecutive patients who underwent intramedullary fixation of a proximal femur fracture with no nail breakage over a 2-year period. RESULTS In the fractured nail group, mean age was 70.4 years (range 55-88 years).The mean time to fracture was 10 months (range 2.5-23 months). Logistical regression was used to show that low American Society of Anesthesiologists (ASA) score, subtrochanteric fracture and pathological fracture were independent risk factors for nail fracture. CONCLUSIONS Young patients with a low ASA score are at highest risk of nail breakage. We advise close follow-up of patients with these risk factors until bony union has been achieved. In addition, there may be merit in considering other treatment options, such as proximal femoral replacement, especially for those with pathological fracture with a good prognosis.
Johnson et al. (Fri,) conducted a case-control in Proximal femoral fractures (n=228). Intramedullary nailing vs. No nail breakage was evaluated on Intramedullary nail breakage. Low ASA score, subtrochanteric fracture, and pathological fracture were independent risk factors for intramedullary nail breakage (mean time to fracture 10 months) in proximal femoral fractures.