Medial Calcar Comminution and Intramedullary Nail Failure in Unstable Geriatric Trochanteric Hip Fractures

Abstract

Background and Objectives: An increasing global burden of geriatric hip fractures is anticipated. The appropriate treatment for fractures is of ongoing interest and becoming more relevant with an aging population and finite health resources. Trochanteric fractures constitute approximately half of all hip fractures with the medial calcar critical to fracture stability. In the management of unstable trochanteric fractures, it is assumed that intramedullary nails and longer implants will lead to less failure. However, the lack of power, inclusion of older generation femoral nails, and a variable definition of stability complicate interpretation of the literature. Materials and Methods: Between January 2012 and December 2017, a retrospective analysis of operatively treated geriatric trochanteric hip fracture patients were examined at a Level 1 Trauma Centre. The treatment was with a long and short version of one type of trochanteric nail. Unstable trochanteric fractures with medial calcar comminution were examined (AO31A2.3, 2.3 & 3.3). The length of the medial calcar loss, nail length, demographics, fracture morphology, and relevant technical factors were examined in univariate and multivariate analysis using competing risk regression analysis. The primary outcome was failure of fixation with post-operative death the competing event and powered to previously reported failure rates. Results: Unstable patterns with medial calcar comminution loss constituted 617 (56%) of operatively treated trochanteric fractures. Failure occurred in 16 (2.6%) at a median post-operative time of 111 days (40–413). In univariate and multivariate analysis, only younger age was a significant predictor of failure (years; SHR: 0.91, CI 95%: 0.86–0.96, p < 0.001). Nail length, medial calcar loss, varus reduction, and other technical factors did not influence nail failure. Conclusions: In a cohort of unstable geriatric trochanteric hip fractures with medial calcar insufficiency, only younger patient age was predictive of nail failure. Neither the length of the medial calcar fragment or nail was predictive of failure.

Proximal Femur Fracture: Common Doubts on Frequently Used Terminologies

“…Because the definition of the stability of trochanteric fractures is still controversial, it is the possible cause of the complication of the choice of osteosynthesis [8], especially in the elderly; for that reason, continues to be a tremendous public health problem in terms of patient mortality, morbidity, and burden to the healthcare system. We agree that the definitions of unstable fractures vary but include those with a fractured lesser trochanter, reverse fracture line, or intertrochanteric comminution associated with a big posteromedial component, a broken greater trochanter, and lateral cortex breach [9].…”

Finite Element Analysis of PFNA and PFNA Combined with Locking Plate in Treatment of Femoral Intertrochanteric Fracture with Lateral Wall Fracture

“…Applying PFNA xation alone on patients is prone to complications such as coxa vara, internal xation loosening and cutting out, resulting in internal xation failure. [9,10] Clinically, some scholars attempted to achieve early stability by reconstructing the lateral femoral wall with locking plate, improving the mechanical conduction at proximal femoral and increasing the balance and stability of the soft tissues of hip joint. Through the comparison between the effects of locking plate reconstruction of the lateral wall and PFNA internal xation, the former method proves to have obvious advantages in the aspects of fracture healing time, weight-bearing exercise time and improvement of hip joint function.…”

Medial Calcar Restoration Using Femoral Head Autograft in Conversion Hip Arthroplasty for Failed Fixation after an Unstable Intertrochanteric Hip Fracture: A Case Report and Technique Description

“…The calcar femorale, or medial calcar, plays a critical role in managing the compressive loads on the femoral head and effectively redistributing such forces through the diaphysis. In addition, the medial calcar has been identified as essential in determining intertrochanteric (IT) fracture stability [ 1 ]. Recent trends have shown that IT fractures are most commonly managed with intramedullary nailing [ 2 ].…”