Max Gordon1, Per-Olov Berntsson1, Erik Sjölund1, Yilmaz Demir1, Carl Johan Hedbeck1, André Stark1, Olof Sköldenberg2. 1. Division of Orthopaedics, Department of Clinical Sciences, Karolinska Institutet at Danderyd Hospital, 182 88, Danderyd, Sweden. 2. Division of Orthopaedics, Department of Clinical Sciences, Karolinska Institutet at Danderyd Hospital, 182 88, Danderyd, Sweden. olof.skoldenberg@ki.se.
Abstract
PURPOSE: We hypothesised that protruding collum screws in intramedullary nails used for pertrochanteric fractures cause lateral pain/discomfort and that loss of offset relates to poorer hip function. METHODS: Seventy-six patients with an acute pertrochanteric femoral fracture AO types A1 and A2 were operated upon using a short intramedullary nail and were included in a prospective observational cohort study and followed-up for one year. The main outcome variables were lateral pain and hip function as evaluated with the Harris Hip Score. The main exposure was compression along the collum screw and lateral protrusion measured by anteroposterior X-ray images. Perioperative images were compared to images at the follow-up visit. Outcome variables were adjusted in regression models for reduction, fracture type, body mass index, sex and age. RESULTS: A total of 28 (36 %) patients experienced lateral pain at one year. We found a correlation between lateral protrusion and lateral pain, adjusted OR 4.5 per protruding centimetre (95 % CI, 1.1-17.5). Collum compression correlated with a poorer outcome with Harris Hip Score -14.2 per compressed centimetre (95 % CI, -21.8 to -6.7). CONCLUSIONS: In patients with type A1 and A2 pertrochanteric fractures operated on using intramedullary nailing, a large compression and lateral protrusion of the collum screw are associated with poorer hip function and lateral pain. New technical improvements for implants should focus on these factors to improve functional outcome after surgery.
PURPOSE: We hypothesised that protruding collum screws in intramedullary nails used for pertrochanteric fractures cause lateral pain/discomfort and that loss of offset relates to poorer hip function. METHODS: Seventy-six patients with an acute pertrochanteric femoral fracture AO types A1 and A2 were operated upon using a short intramedullary nail and were included in a prospective observational cohort study and followed-up for one year. The main outcome variables were lateral pain and hip function as evaluated with the Harris Hip Score. The main exposure was compression along the collum screw and lateral protrusion measured by anteroposterior X-ray images. Perioperative images were compared to images at the follow-up visit. Outcome variables were adjusted in regression models for reduction, fracture type, body mass index, sex and age. RESULTS: A total of 28 (36 %) patients experienced lateral pain at one year. We found a correlation between lateral protrusion and lateral pain, adjusted OR 4.5 per protruding centimetre (95 % CI, 1.1-17.5). Collum compression correlated with a poorer outcome with Harris Hip Score -14.2 per compressed centimetre (95 % CI, -21.8 to -6.7). CONCLUSIONS: In patients with type A1 and A2 pertrochanteric fractures operated on using intramedullary nailing, a large compression and lateral protrusion of the collum screw are associated with poorer hip function and lateral pain. New technical improvements for implants should focus on these factors to improve functional outcome after surgery.
Entities:
Keywords:
Intramedullary nail; Lateral pain; Offset; Pertrochanteric hip fracture
Authors: Carl Johan Hedbeck; Richard Blomfeldt; Gunilla Lapidus; Hans Törnkvist; Sari Ponzer; Jan Tidermark Journal: Int Orthop Date: 2011-02-08 Impact factor: 3.075
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