Analysis Of Risk Factors For Failure Of Intramedullary Fixation For Intertrochanteric Fractures

Objective: To investigate the risk factors of internal fixation failure after intramedullary fixation in the treatment of intertrochanteric fractures,so as to provide clinicians with a reference for treatment plan and reduce the risk of failure after intramedullary fixation.Methods:The clinical data of 387 patients with intertrochanteric fracture admitted to Yijishan Hospital of Wannan Medical College from January 2013 to January 2020 were retrospectively analyzed,and the patients were divided into two groups according to the failure of internal fixation,namely the normal group(n = 361)and the failure group(n =26).General data(gender,age,affected side,fracture stability,preoperative hemoglobin,preoperative albumin,lateral wall integrity,Singh index),type of internal fixation(PFNA/Inter TAN),area of head and neck nailed to femoral head on antero-lateral radiographs,and quality of fracture reduction(as assessed by Baum-gaertner et al.)were collected from both groups.,the displacement of lesser trochanteric bone mass after reduction,postoperative Cal TAD,postoperative weight-bearing time,etc.The above data were analyzed by univariate and multivariate Logistic regression analysis to identify the risk factors of failure after intramedullary fixation for intertrochanteric fractures.Results:The failure group included 26 patients,with an average age of(80.2±7.9)years,including 9 males and 17 females.In the follow-up of 26 patients,there were 13 cases of hip varus,7 cases of nail removal,5 cases of femoral head removal with head and neck nail,and 1 case of delayed fracture union.In the normal group,361 patients,with an average age of(76.5±6.8)years old,including 171 males and 190 females,obtained bone healing after surgery in 361 patients.Univariate analysis showed that there were no significant differences between the two groups in the affected side,preoperative hemoglobin,preoperative albumin,type of internal fixation,and the ratio of minor trochanteric displacement after reduction(P > 0.05).There were significant differences in gender,age,fracture stability,lateral wall integrity,Singh index,quality of fracture reduction,postoperative Cal TAD and postoperative weight-bearing time(P < 0.05).Multivariate Logistic regression analysis showed that Age(OR=0.909,P=0.026),fracture stability(OR=3.832,P=0.031),lateral wall integrity(OR=3.438,P=0.02),Singh index(OR=1.554,P=0.013),poor fracture reduction quality(OR=4.802,P=0.041)Cal TAD(OR=0.547,P=0.00)and weight-bearing time(OR=1.437,P=0.025)were risk factors for failure after intramedullary fixation of intertrochanteric fractures.Conclusion: Older age,osteoporosis,unstable fracture,incomplete lateral wall,poor fracture reduction quality,large postoperative Cal TAD,and short postoperative weight-bearing time are risk factors for failure after intramedullary fixation of intertrochanteric fracture.