Gu A, Doe K, Bracey L, Agarwal A, Raffa T, Farley B, Fraychinaud T, Knapp B, Tabaie S, Debritz J, Sterling R. Increased 1-Year Revision Rates Among Left-Sided Intertrochanteric Femur Fractures.
J Orthop Trauma 2024;
38:431-434. [PMID:
39007659 DOI:
10.1097/bot.0000000000002829]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/26/2024] [Indexed: 07/16/2024]
Abstract
OBJECTIVES
To compare 1-year revision rates among left-sided and right-sided intertrochanteric femur fractures.
METHODS
DESIGN
Retrospective.
SETTING
120+ contributing centers to multicentered database.
PATIENT SELECTION CRITERIA
Patients who sustained intertrochanteric femur fracture (ITFF) and had a cephalomedullary nail (CMN) from 2015 to 2022 were identified. Patients were then stratified based on left-sided or right-sided fracture. Patients were excluded if younger than 18 years with <1-year follow-up. The intervention investigated was CMN on left or right side.
OUTCOME MEASURES AND COMPARISONS
One-year revision surgery, comparing CMN performed on left or right side for ITFFs.
RESULTS
In total, 113,626 patients met inclusion criteria, with 55,295 in the right-sided cohort and 58,331 in the left-sided cohort. There was no difference between cohorts with respect to age, gender, diabetes, osteoporosis, chronic kidney disease, or congestive heart failure (P > 0.05 for all). Patients who sustained a left ITFF and treated with a CMN were more likely to have revision surgery at 1 year (Left: 1.24%, Right: 0.90%; OR: 1.24; 95% confidence interval [CI], 1.15-1.1.33) or develop a nonunion or malunion (Left: 1.30%, Right: 0.98%; OR: 1.31; 95% CI, 1.14-1.52). The most common revision surgery conducted for both cohorts was conversion total hip arthroplasty (Left: 70.4% and Right: 70.0%).
CONCLUSIONS
Patients who sustained a left intertrochanteric femur fracture and were treated with a CMN were more likely to undergo revision at 1 year due to nonunion. There were no differences in demographics and comorbidities between cohorts. Though left-sided versus right-sided confounding variables may exist, the difference in nonunion rate may be explained by clockwise torque of the lag screw used in most implants. Increased awareness, implant design, and improved technique during fracture reduction and fixation may help lower this disproportionate nonunion rate and its associated morbidity and financial impact.
LEVEL OF EVIDENCE
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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