Perioperative peri-implant fracture after osteosynthesis for geriatric femoral pertrochanteric fracture with the linear compression integrated screw intramedullary nail system (INTERTAN™): a retrospective study

• Published in: Journal of orthopaedic surgery and research 2023-12, Vol.18 (1), p.932-932, Article 932
• Main Authors: Lai, Chih-Yang, Liu, Chang-Heng, Lai, Po-Ju, Hsu, Yung-Heng, Chou, Ying-Chao, Yu, Yi-Hsun
• Format: Article
• Language: English
• Subjects: Aged; Aged patients; Biomechanics; Bone implants; Bone Nails - adverse effects; Bone screws; Bone Screws - adverse effects; Compression; Femoral fractures; Femoral Fractures - surgery; Femur; Fracture Fixation, Internal - adverse effects; Fracture Fixation, Internal - methods; Fracture Fixation, Intramedullary - adverse effects; Fractures; Geriatrics; Hip Fractures - complications; Hip Fractures - surgery; Humans; Internal fixation in fractures; Medical research; Medicine, Experimental; Morphology; Multiple regression analysis; Orthopedics; Osteosynthesis; Patients; Periprosthetic fractures; Periprosthetic Fractures - etiology; Rehabilitation; Retrospective Studies; Risk factors; Transplants & implants; Trauma; Trochanter
• ISSN: 1749-799X; 1749-799X
• DOI: 10.1186/s13018-023-04441-w

Osteosynthesis for geriatric femoral pertrochanteric fractures using the linear compression integrated screw intramedullary nail system (INTERTAN™) has become popular. Nonetheless, cases of perioperative peri-implant fractures have been reported following this surgical technique. The factors responsible for this complication remain unclear. Therefore, we investigated perioperative peri-implant fracture risk factors and incidence, as well as overall outcomes, using the INTERTAN™ system for geriatric femoral pertrochanteric fractures. We retrospectively reviewed 98 consecutive patients with geriatric femoral pertrochanteric fractures after INTERTAN™ fixation, with at least a 12-month follow-up period between May 2020 and April 2022 at a single medical institute. The patients' demographic characteristics, fracture pattern, quality of reduction, quality of fixation, nail length, morphology of the femur, and perioperative complications were recorded and analyzed. Among the 98 patients, 92 achieved union during follow-up. Twelve perioperative peri-implant fractures (12.2%) were recorded, all of which occurred during or within 1 month of osteosynthesis. Except for one patient who underwent re-osteosynthesis, the others underwent nonoperative treatment, and all achieved union. Multiple regression analysis revealed morphology of the femur with low-lesser trochanter width (odds ratio (OR) 0.532, 95% confidence interval (CI) 0.33-0.86, p = 0.01) to be the only factor contributing to perioperative peri-implant fractures. When the Youden index was used, the optimal cut-off value was 20.2 mm of low-lesser trochanter width. Low-lesser trochanter width