Peri-implant femoral fractures in hip fracture patients treated with osteosynthesis: a retrospective cohort study of 1965 patients

Kruse, Mark; Mohammed, Jabbar; Sayed-Noor, Arkan S.; Wolf, Olof; Holmgren, Gunnar; Nordström, Robin; Crnalic, Sead; Sköldenberg, Olof; Mukka, Sebastian

doi:10.1007/s00068-020-01596-7

Cited by 9 publications

(7 citation statements)

References 29 publications

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“…The early designs of IMN were burdened by a risk of fractures adjacent to the nail tip; thereafter, some studies suggested that this risk had diminished 10,33 . Nevertheless, the most recent findings still identified a peri-implant fracture to be more frequent after IMN use than after SHS use 23,34 .…”

Section: Discussionmentioning

confidence: 99%

No Difference in Conversion Rate to Hip Arthroplasty After Intramedullary Nail or Sliding Hip Screw for Extracapsular Hip Fractures

Pyrhönen

Lagergren

Wolf

et al. 2022

Journal of Bone and Joint Surgery

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Background:The widespread use of intramedullary nails (IMNs) compared with sliding hip screws (SHSs) in extracapsular hip fractures (AO/OTA 31-A1, 31-A2, 31-A3) has been questioned because of a higher complication rate, although the outcome might have improved through more recent implant designs and the learning curve. This study aimed to investigate if there is a difference with regard to the cumulative incidence of conversion to arthroplasty or any reoperation during the first 5 years after IMN or SHS fixation of extracapsular hip fractures.Methods:In this nationwide, observational cohort study, individuals who were ≥60 years of age and were registered in the Swedish Fracture Register (SFR) from 2012 to 2018 due to extracapsular fracture and were primarily treated with an IMN or SHS were followed in the SFR and the Swedish Arthroplasty Register (SAR) for a minimum of 1 year. The primary outcome was the cumulative incidence of conversion to arthroplasty (conversion rate). The secondary outcome was the cumulative incidence of all reoperations (reoperation rate). Both were calculated in a competing risk analysis during the first 5 years.Results:We included 19,604 individuals (70% women), with a median age of 85 years (range, 60 to 107 years). The 31-A2 fracture was most prevalent (52%), followed by the 31-A1 fracture (28%). No significant differences were seen in the 1-year conversion rate after IMN or SHS use (1.0% compared with 0.9% in the 31-A1 fractures, 1.7% compared with 1.3% in the 31-A2 fractures, and 1.3% compared with 1.5% in the 31-A3 fractures) or in the 1-year reoperation rate (1.9% compared with 1.9% in the type-A1 fractures, 3.4% compared with 2.5% in the type-A2 fractures, and 4.0% compared with 5.2% in the type-A3 fractures). Only in 31-A2 fractures were more reoperations seen after IMN use at 2 and 5 years (p < 0.05). The crude 1-year-mortality was 26.4% (5,178 of 19,604), without significant differences between implants.Conclusions:Considering conversion arthroplasty, IMNs and SHSs performed equally well in general. IMN use was associated with more reoperations than SHS use in 31-A2 fractures at 2 years. However, from a clinical perspective, the differences between the implants were small, in particular when considering the competing risk of dying.Level of Evidence:Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

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Section: Discussionmentioning

confidence: 99%

No Difference in Conversion Rate to Hip Arthroplasty After Intramedullary Nail or Sliding Hip Screw for Extracapsular Hip Fractures

Pyrhönen

Lagergren

Wolf

et al. 2022

Journal of Bone and Joint Surgery

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“…Muller et al [22] stated a higher risk of peri-implant fractures for femoral fractures treated with nails than for those treated with screws. In contrast, Kruse et al [23] reported a higher incidence of fractures in previously implanted sliding-hip devices than in cephalomedullary nails.…”

Section: Discussionmentioning

confidence: 90%

A Novel Comprehensive Classification for Non-Prosthetic Peri-Implant Fractures

Lucenti,

de Cristo,

Costarella

et al. 2023

Surgeries

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Non-prosthetic peri-implant fractures (NPPIFs) are often reported mixed with periprosthetic fractures (PPFs), but they are different entities. Due to the increase in the age of the world’s population and to the intensification of surgeries for fractures, nowadays, peri-implant fractures are a very frequent entity in clinical practice, with an increasing trend expected in the future. A clear exclusive classification of NPPIFs is not reported in the literature. The aim of this study is to provide a valid comprehensive classification for all the NPPIFs. X-rays of all the peri-implant cases treated in our unit in a 3-year period were retrospectively collected. Five orthopedic surgeons reviewed 30 X-rays of NPPIFs, providing a code according to the classification proposed. After a 3-month interval, they reviewed the same X-rays. Eighteen femoral, eight humeral, and four forearm peri-implant fractures were collected and showed to the raters. Inter- and intra-observer reliability was calculated using a k-statistic, showing a moderate agreement between observers (κ = 0.73) and a substantial agreement between the observations of the same viewer (κ = 0.82). The literature lacks a comprehensive classification for peri-implant fractures that considers all the bones and all the types of implants. The proposed classification is meant to be an instrument for orthopedic surgeons to categorize these types of fractures and seems to be simple, easy to comprehend, and reproducible. This new classification can provide the orthopedic surgeon a reliable method to clearly catalogue different fractures according to the site and the implants; the physicians can use it, through a code, in clinical practice to describe an NPPIF without the need of images. Further studies may be necessary to confirm the validity and eventually to improve the suggested classification.

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“…Conversely, Kruse et al. 10 found that the cumulative incidence of PIFF was 0.8% with cephalomedullary nails compared to 2.7% with sliding hip screw, and Chan et al. 7 reported a marked prevalence of PIFF near extramedullary implants compared to intramedullary implants (68% vs .…”

Section: Discussionmentioning

confidence: 98%

“… 7 As PIFF following osteosynthesis of proximal femoral fractures are seen mainly in the elderly population, the initial fracture is usually healed. 10 , 11 If this does not occur, fixation failure is expected, with loss of reduction and varus collapse of the proximal segment, both in medial and lateral fractures. Chan et al.…”

Section: Discussionmentioning

confidence: 99%

Peri-implant femoral fractures: Challenges, outcomes, and proposal of a treatment algorithm

Bidolegui¹,

Pereira²,

Munera³

et al. 2023

Chinese Journal of Traumatology

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Peri-implant femoral fractures in hip fracture patients treated with osteosynthesis: a retrospective cohort study of 1965 patients

Cited by 9 publications

References 29 publications

No Difference in Conversion Rate to Hip Arthroplasty After Intramedullary Nail or Sliding Hip Screw for Extracapsular Hip Fractures

No Difference in Conversion Rate to Hip Arthroplasty After Intramedullary Nail or Sliding Hip Screw for Extracapsular Hip Fractures

A Novel Comprehensive Classification for Non-Prosthetic Peri-Implant Fractures

Peri-implant femoral fractures: Challenges, outcomes, and proposal of a treatment algorithm

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