Hip & pelvis

  • 제30권3호
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  • Pages.168-174
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  • 2018
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  • 2287-3260(pISSN)
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  • 2287-3279(eISSN)
대한고관절학회 (The Korean Hip Society)
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Local Postoperative Complications after Surgery for Intertrochanteric Fractures Using Cephalomedullary Nails

  • Kim, Keong-Hwan (Department of Orthopaedic Surgery, Kangwon National University College of Medicine) ;
  • Han, Kye Young (Department of Orthopaedic Surgery, Kangwon National University College of Medicine) ;
  • Kim, Keun Woo (Department of Orthopaedic Surgery, Kangwon National University College of Medicine) ;
  • Lee, Jun Hee (Department of Orthopaedic Surgery, Kangwon National University College of Medicine) ;
  • Chung, Myung Ki (Department of Orthopaedic Surgery, Kangwon National University College of Medicine)
  • 투고 : 2018.07.04
  • 심사 : 2018.07.25
  • 발행 : 2018.09.01
⟨ 이전 논문 다음 논문 ⟩

초록

Purpose: Cephalomedullary nails (CMN) are commonly used for the surgical treatment of intertrochanteric fractures. This study aimed to evaluate overall postoperative local complications by reviewing patients who received surgical treatment using three different types of implants. Materials and Methods: The study sample included 353 patients (107 males, 246 females) who underwent surgery using CMN for intertrochanteric fractures. Three different types of implants were used: i) the $Gamma3^{(R)}$ (Stryker) in 80 cases, ii) the $Targon^{(R)}$ PF (Aesculap) in 225 cases, and iii) the Compression Hip $Nail^{(R)}$ (Trademedics) in 48 cases. The mean age was 82.6 (range, 60-109) years and the average follow-up period was 15 (range, 6-80) months. Postoperative local complications and risk factors of cut-out were assessed. Results: The most common complication was cut-out (n=26). Other complications included non-union (n=3), periprosthetic fracture (n=2), avascular necrosis (n=1), heterotopic ossification (n=1), and sleeve pull out (n=1). Multivariate analysis revealed that the cut-out group had a higher rate of poor reduction compared to the non-complicated group (P<0.001). Although the mean tip-apex distance (TAD) was 18.4 mm in the non-complicated group, lower than that of the cut-out group (P=0.001), multivariate analysis revealed that TAD was not a significant risk factor for cut-out (P=0.065). Conclusion: Cut-out is the most common local complication associated with surgical treatment of intertrochanteric fractures using CMN. Proper reduction appears to be important in lowering the risk of cut-out. Maintaining low TAD is another critical factor in achieving sufficient fixation of lag screw to the subchondral bone of the femoral head.

키워드

참고문헌

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피인용 문헌

  1. Superior Gluteal Artery Bleed After Cephalomedullary Nail Fixation vol.20, pp.3, 2018, https://doi.org/10.31486/toj.19.0084
  2. Proximal Femoral Nail Unlocked versus Locked (ProFNUL): a protocol for a multicentre, parallel-armed randomised controlled trial for the effect of femoral nail mode of lag screw locking and screw conf vol.10, pp.2, 2018, https://doi.org/10.1136/bmjopen-2019-032640
  3. Septic Dislocation of Hip After Cephalomedullary Nail Fixation of Intertrochanteric Fractures of Femur : A Case Report vol.11, pp.2, 2018, https://doi.org/10.2106/jbjs.cc.20.00242
  4. Intramedullary Fixation of Trochanteric Fractures Can Be Safely Performed by Senior Residents Without Immediate Consultant Supervision vol.79, pp.1, 2022, https://doi.org/10.1016/j.jsurg.2021.06.026