What is the importance of distal nail diameter in the treatment of intertrochanteric femur fractures?

Abstract

Hip fractures have become an important public health problem all over the world due to increased life expectancy. The main causes of hip fractures in the elderly are higher incidence of falls and osteoporosis. Hip fractures have many negative impacts on individuals due to their morbidity and mortality, as well as negative socioeconomic effects on society. [1,2] Intertrochanteric femur fractures (ITFFs) constitute about 50% of hip fractures. [3] Cephalomedullary nailing (CMN) has become the primary treatment method for ITFF in many trauma centers in the past decade due to its biomechanical advantages such as allowing mobilization by weight-bearing in the early postoperative period, and being more reliable and less invasive than other surgical options. [4] Objectives: The aim of this study was to investigate the effect of distal nail diameter in the treatment of geriatric intertrochanteric femur fractures (ITFFs).Patients and methods: Between January 2017 and January 2021, a total of 91 patients (34 males, 57 females; mean age: 80.6±7.8 years; range, 65 to 96 years) who had osteosynthesis due to an ITFF with a short cephalomedullary nail (CMN) were retrospectively analyzed. The patients were divided into two groups: Group 1 (n=18) included patients with a distal nail diameter of ≤10 mm and Group 2 (n=73) included patients with a distal nail diameter of >10 mm. Patients' age, sex, fracture type according to AO classification, intramedullary femoral canal diameter, canal fit ratio, operation duration, reduction quality, the distal diameter of the CMN, and complications were evaluated.Results: There was no statistically significant difference between Group 1 and Group 2 in terms of the mean age, sex, fracture type, mean intramedullary canal diameter, reduction quality, and implant failure (p>0.05). The mean operation duration was significantly shorter in Group 2 (112.9±39.9 min) compared to Group 1 (128.8±36.4 min) (p=0.048). A total of three intraoperative peri-implant fractures occurred which included one 9 mm nail, one 12 mm nail, and one 14 mm nail. Conclusion:Our study results suggest that there is no advantage of using a >10-mm CMN in the treatment of geriatric ITFFs in terms of reducing the implant failure rate. However, the utility of a >10-mm CMN can reduce the operation duration.