Ulus Travma Acil Cerrahi Derg. 2024; 30(6): 458-464 | DOI: 10.14744/tjtes.2024.35808

Posterolateral wall integrity in reverse oblique intertrochanteric fracture fixation: A new perspective in evaluation

Ahmed Majid Heydar¹, Görkem Kýyak^2
1Orthopedics and Traumatology Clinic, Memorial Bahçelievler Hospital, Ýstanbul-Türkiye
²Orthopedics and Traumatology Clinic, Academic Hospital, Ýstanbul-Türkiye

BACKGROUND: Treatment of reverse oblique fractures has the highest complication rate among proximal femur fractures. Although intramedullary nailing is the preferred treatment option, a high failure rate has been reported. Previous studies have identified several contributing factors to these failures, yet the significance of posterolateral wall integrity in ensuring postoperative stability has not been emphasized. This study aims to investigate the impact of posterolateral wall integrity on the failure rates of reverse oblique intertrochanteric fractures treated with intramedullary nails (IMN) and assess the vulnerability of certain IMN designs to these failures.
METHODS: Between 2010 and 2016, 53 patients with reverse oblique fractures were analyzed to identify factors associated with IMN failure. Variables such as posterolateral wall integrity, quality of reduction, posteromedial support, and IMN design were considered as potential risk factors. Logistic regression analysis was conducted to evaluate these risk factors, with statistical significance defined as p<0.05.
RESULTS: Eleven cases of implant failure were identified. Univariate statistical analysis indicated that loss of posterolateral support (p=0.002), IMN with single-screw proximal fixation (p=0.048), poor reduction quality (p=0.004), and loss of posteromedial support (p=0.040) were associated with implant failure. Multivariate analysis confirmed loss of posterolateral support (p=0.009), poor reduction quality (p=0.039), and loss of posteromedial support (p=0.020) as independent risk factors for failure. However, IMN with single proximal fixation (p=0.859) did not significantly impact fixation failure.
CONCLUSION: Reverse oblique intertrochanteric fractures with compromised posterolateral support exhibit a high rate of mechanical failure when treated with IMN. Additionally, poor reduction quality and loss of posteromedial support increase the risk for failure of these fractures. An IMN design featuring dual separate proximal screw fixations could provide better stability compared to a design with a single proximal screw, thereby reducing the risk of mechanical failure.

Keywords: Hip fractures, proximal femoral fractures, intertrochanteric fractures; intramedullary nailing; implant failure.

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Ters oblik intertrokanterik kýrýk tespitinde posterolateral duvar bütünlüðü: Deðerlendirmede yeni bir konu

Ahmed Majid Heydar¹, Görkem Kýyak^2
1Memorial Bahçelievler Hastanesi, Ortopedi ve Travmatoloji Kliniði, Ýstanbul, Türkiye
²Academic Hospital, Ortopedi ve Travmatoloji Kliniði, Ýstanbul, Türkiye

AMAÇ: Bu çalýþmanýn amacý intramedüller çivi (IMN) ile tedavi edilen ters oblik intertrokanterik kýrýklarýn baþarýsýzlýk oraný üzerinde posterolateral duvar bütünlüðünün rolünü araþtýrmak ve bazý IMN tasarýmlarýnýn bu baþarýsýzlýklara karþý özellikle duyarlý olup olmadýðýný belirlemektir.
GEREÇ VE YÖNTEM: 2010'dan 2016'ya kadar ters oblik kýrýðý olan 53 hasta, IMN baþarýsýzlýðýyla iliþkili faktörleri belirlemek için analiz edildi. Redüksiyon kalitesi, posteromedial destek durumu ve IMN tasarýmýnýn yaný sýra posterolateral duvar bütünlüðü de potansiyel risk faktörleri olarak deðerlendirildi. Risk faktörlerini deðerlendirmek için lojistik regresyon analizi yapýldý ve istatistiksel anlamlýlýk p<0.05 olarak tanýmlandý. BULGULAR: 11 vakada implant baþarýsýzlýðý tespit edildi. Çalýþmamýzda tek deðiþkenli istatistiksel analizde; posterolateral destek kaybý (p=0,002), tek vida proksimal fiksasyonlu ÝMN (p=0.048), kötü redüksiyon kalitesi (p=0.004) ve posteromedial destek kaybýnýn (p=0.040) implant baþarýsýzlýðýyla iliþkili faktörler olduðu görüldü. Çok deðiþkenli analiz; posterolateral destek kaybýnýn (p=0,009), kötü redüksiyon kalitesinin (p=0.039) ve posteromedial destek kaybýnýn (p=0.020) baþarýsýzlýk için baðýmsýz risk faktörleri olduðunu ortaya çýkardý. Ancak tek vida proksimal fiksasyonlu ÝMN (p=0.859) fiksasyon baþarýsýzlýðý ile iliþkili deðildi.
SONUÇ: Posterolateral duvar bütünlüðü kaybýyla birlikte ters oblik intertrokanterik kýrýk, IMN ile tedavi edildiðinde yüksek mekanik baþarýsýzlýk oranýyla iliþkilidir. Ayrýca kötü redüksiyon kalitesi ve posteromedial desteðin kaybý bu kýrýklarýn baþarýsýzlýk riskini arttýrmaktadýr. Ýki ayrý proksimal vida fiksasyonuna sahip bir IMN tasarýmý, tek proksimal vidalý bir IMN'ye göre daha iyi tespite izin verebilir ve bu da baþarýsýzlýk riskini azaltabilir.

Anahtar Kelimeler: Ýntertrokanterik kýrýklar, intramedüller çivileme, implant baþarýsýzlýðý; kalça kýrýklarý; proksimal femur kýrýklarý; ters oblik kýrýklar.

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