Hip fractures following intramedullary nailing fixation for femoral fractures

• Published in: Injury Vol. 53; no. 3; pp. 1190 - 1195
• Main Authors: Yamamoto, Norio, Yamakawa, Yasuaki, Inokuchi, Takashi, Iwamoto, Yuki, Inoue, Tomoo, Noda, Tomoyuki, Kawasaki, Keisuke, Ozaki, Toshifumi
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01-03-2022
• Subjects: atypical femoral fracture; Bone Nails; cephalomedullary nail; Cohort Studies; distal femoral fracture; Femoral Fractures - diagnostic imaging; Femoral Fractures - etiology; Femoral Fractures - surgery; femoral neck fracture; femoral shaft fracture; Fracture Fixation, Intramedullary - adverse effects; hip fracture; Hip Fractures - diagnostic imaging; Hip Fractures - etiology; Hip Fractures - surgery; Humans; intramedullary nail; Middle Aged; reoperation; Retrospective Studies; Treatment Outcome; trochanteric fracture; femoral neck fracture; atypical femoral fracture; intramedullary nail; distal femoral fracture; cephalomedullary nail; hip fracture; reoperation; trochanteric fracture; femoral shaft fracture
• ISSN: 0020-1383; 1879-0267
• DOI: 10.1016/j.injury.2021.10.024

•The incidence of secondary hip fractures (SHFs) after nailing fixations for femoral fractures was 0.7%.•The absence of femoral head fixation was significantly associated with SHF following intramedullary nailing for femoral shaft fractures.•There were two reoperations (16.7%) following management of secondary femoral neck fractures.•Secondary trochanteric fracture patients were less likely to regain walking ability than secondary femoral neck fracture patients.
Proximal peri-implant femoral fractures occur following intramedullary nailing (IMN) fixation for trochanteric, femoral shaft, and distal femoral fractures. However, analyses of secondary hip fractures (SHFs) using large clinical samples are lacking. Therefore, we aimed to report the incidence and clinical outcomes of SHF after nailing fixation (IMN or cephalomedullary nailing [CMN]) for overall femoral fractures. In addition, we focused on IMN for femoral shaft fractures and investigated the risk factors for SHF.
This multicenter, retrospective, cohort study included 2,293 patients aged > 60 years who underwent nailing fixation for femoral fractures. The primary outcome was the incidence of SHF. In the assessment of clinical outcomes, we evaluated reoperation and the regaining of walking ability following SHF management. In addition, we conducted multivariable logistic regression analyses to examine the association between risk factors and SHF.
Seventeen (0.7%) patients had SHFs, including 12 femoral neck fractures and 5 trochanteric fractures. Antegrade IMN was the most common type of nailing fixation. Multivariable analysis demonstrated that the absence of femoral head fixation was significantly associated with the incidence of SHF following IMN for femoral shaft fractures (odds ratio, 17.0; 95% confidence interval, 1.9–2265.7; p=0.006). In the assessment of clinical outcomes, there were two reoperations (16.7%) in the secondary femoral neck fracture group. Patients with secondary trochanteric fractures tended to have a lower probability of regaining walking ability than those with secondary femoral neck fractures (20% vs. 50%).
In this multicenter study, the incidence of SHF after nail fixation for femoral fractures was 0.7%. The absence of femoral head fixation was significantly associated with SHF, and the clinical outcomes were poor. Therefore, femoral head fixation at the initial IMN fixation for femoral fractures may be a fixation option for surgeons to consider as an SHF prevention measure.