Patient, implant factors linked with nonunion after IM nailing of intertrochanteric femoral fractures

SAN DIEGO — Results of a retrospective study presented here showed patients’ current smoking status was associated with nonunion after intramedullary nailing for intertrochanteric femoral fracture and linked fixation with cephalomedullary nails to lower nonunion rates, but higher rates of painful hardware.

“Intramedullary nailing is a reliable surgical technique when performed with adequate reduction,” Martin Hoffmann, MD, said in his presentation. “Varus reduction with a neck shaft angle less than 125° resulted in a significant increase in fixation failures. Patient and implant factors affected nonunion formation. Smoking significantly increased nonunion formation and the utilization of a cephalomedullary device significantly reduced the nonunion rate, but had a high rate of painful, prominent hardware compared to reconstruction nailing.”

Hoffmann and his colleagues analyzed 193 intertrochanteric femoral fractures (60% women) for 15 months. Hoffmann noted 91% of implants were cephalomedullary nails and 9% of implants were stainless steel.

Results showed 86% of patients healed after the index procedure, while 6% of patients had revision surgery for nonunion and 5% for hardware or fixation failure.

Martin Hoffmann

He noted patients treated with a straight nail experienced a significantly greater risk of nonunion. “Hardware removal was performed in 9% of our patients due to painful hardware. All of them were treated with a cephalomedullary nail, but that was not significant,” Hoffmann said.

Smoking was also a factor for nonunion, with a three- to four-times greater risk of nonunion found among current smokers compared with non-smokers.

“More than 50% of our patients did not complain of any pain at the last follow-up, with the remaining having a median VAS of three,” Hoffmann said. “Range of motion was reduced in the majority of our patients compared to the contralateral side.” — by Casey Tingle

Reference:

Hoffmann M, et al. Paper #23. Presented at the: Orthopaedic Trauma Association Annual Meeting. Oct. 7-10, 2015; San Diego.

Disclosure: Hoffmann reports no relevant financial disclosures.