The Effect of Proximal Femoral Nail and Position in the Femur on Clinical and Radiological Outcomes of Intertrochanteric Fractures

Abstract

Purpose: Intramedullary nail treatment for intertrochanteric fractures has gained widespread popularity in recent years. Predisposing factors for mechanical failure of the proximal femoral nail include lag screw position, tip apex distance, reduction quality, and the femoral neck/shaft angle (FNSA). Our study aimed to evaluate the effect of the position of the nail end on the mechanical failure rates and radiological parameters. Method: The data of 118 patients who underwent proximal femoral nail repair due to intertrochanteric fractures were analyzed between June 2019 and September 2022. The patients were divided into three groups according to the proximal femoral nail end positioning of the femoral canal, and tip apex distance, FNSA, reduction quality, lag screw position, union time, and complications were evaluated on postoperative and follow-up radiographs. Results: When all patients included in the study were evaluated, cut-out was observed in 9. The cut-out rates were significantly higher in the medial group (n=7, p=0.003). Regarding FNSA, there were statistically significant differences among all three groups (<0.001M-S, M-L, S-L). In the medial group, the superiorly located lag screw, and in the lateral group, the inferiorly located lag screw was higher than in the other groups(p<0.001) Conclusion: It has been observed that placement of the distal tip of the nail in the canal affects both these parameters and clinical results, and the clinical and radiological results were worse in cases where the distal nail was medial to the canal.

Keywords

• Intertrochanteric femur fracture
• Proximal femoral nail
• Tip apex distance
• Reduction

İntertrokanterik Kırıkların Tedavisinde Proksimal Femur Çivi Ucunun Femur Kanalındaki Pozisyonunun Klinik Ve Radyolojik Sonuçlarına Etkisi

Abstract

Amaç : İntertrokanterik femurkırıklarında intramedüller çivi tedavisi son yıllarda yaygın olarak kullanılmaktadır. İntertrokanterik kırıkların intramedüller tespitinden sonra mekanik komplikasyon oranları %2-13 arasındadır. Proksimal femoral çivi uygulamasının mekanik başarısızlığına ilişkin risk faktörleri arasında lag vidası konumu, uç-apeks mesafesi, redüksiyon kalitesi ve femur boynu/şaft açısı yer alır. Çalışmamız femoral çivi ucunun femoral kanaldaki konumunun mekanik başarısızlık oranlarına ve radyolojik parametrelere etkisini değerlendirmeyi amaçlamaktadır. Gereç ve Yöntem : Haziran 2019 ile Eylül 2022 tarihleri arasında intertrokanterik kırık nedeniyle proksimal femur çivisi uygulanan 118 hastanın verileri analiz edildi. Hastalar femur kanalındaki proksimal femoral çivi ucunun pozisyonuna göre üç gruba ayrıldı. Ameliyat sonrası ve takip radyografilerinde uç apeks mesafesi, femur boynu/şaft açısı, redüksiyon kalitesi, lag vida konumu, kaynama süresi ve komplikasyonlar değerlendirildi. Bulgular : Çalışmaya dahil edilen tüm hastalar değerlendirildiğinde 9 hastada femur boynundan sıyrıldığı görüldü. Medial grupta sıyrılma oranları anlamlı olarak daha yüksekti (n=7, p=0,003). FNSA açısından her üç grupta da birbirinden istatistiksel olarak anlamlı farklar mevcuttu (<0,001M-S. M-L, S-L). Medial grupta süperiorda yer alan lag vidası, lateral grupta ise inferiorda yer alan lag vidası diğer gruplara göre daha yüksekti (p<0,001). Medial grupta kötü redüksiyon kalitesi oranı diğer gruplara göre daha yüksekti (p=0,004). Çivinin distal ucunun kanala yerleştirilmesinin hem parametreleri hem de klinik sonuçları etkilediği görülmüştür. Çivi distalinin santral ve lateral olduğu durumlarda istenilen radyolojik parametrelerin ve klinik sonuçların daha iyi olduğu görülmüştür. Ayrıca çivinin distalinin kanal içerisinde medialde olduğu durumlarda klinik ve radyolojik sonuçların daha kötü olduğu gözlendi.

Keywords

• : İntertrokanterik femur kırığı
• Proksimal femur çivisi
• Uç apeks mesafesi
• Redüksiyon

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