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

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 respons...

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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
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Chou, Ying-Chao
Yu, Yi-Hsun
description 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 
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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 &lt; 20.2 mm was found to be a potential factor causing perioperative peri-implant fractures (OR 17.81, 95% CI 1.67-19.76, p = 0.017). Morphology of the femur with a low-lesser trochanter width smaller than 20.2 mm was found to be the only potential contributor to perioperative peri-implant fractures when using INTERTAN™ for geriatric femoral pertrochanteric fractures. Care should be taken during osteosynthesis, focusing not only on the fracture site but also on the femoral cortex around the implant. Although perioperative peri-implant fractures were observed within one month following osteosynthesis, the majority of these cases were effectively treated without surgical intervention.</description><identifier>ISSN: 1749-799X</identifier><identifier>EISSN: 1749-799X</identifier><identifier>DOI: 10.1186/s13018-023-04441-w</identifier><identifier>PMID: 38057901</identifier><language>eng</language><publisher>England: BioMed Central Ltd</publisher><subject>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 &amp; implants ; Trauma ; Trochanter</subject><ispartof>Journal of orthopaedic surgery and research, 2023-12, Vol.18 (1), p.932-932, Article 932</ispartof><rights>2023. The Author(s).</rights><rights>COPYRIGHT 2023 BioMed Central Ltd.</rights><rights>2023. This work is licensed under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c459t-2ad0de4663549d17adb17601f6689669ff451280ad0b44110dfcd2fdb6e54a8b3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/2902133031?pq-origsite=primo$$EHTML$$P50$$Gproquest$$Hfree_for_read</linktohtml><link.rule.ids>314,780,784,25753,27924,27925,37012,37013,44590</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38057901$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Lai, Chih-Yang</creatorcontrib><creatorcontrib>Liu, Chang-Heng</creatorcontrib><creatorcontrib>Lai, Po-Ju</creatorcontrib><creatorcontrib>Hsu, Yung-Heng</creatorcontrib><creatorcontrib>Chou, Ying-Chao</creatorcontrib><creatorcontrib>Yu, Yi-Hsun</creatorcontrib><title>Perioperative peri-implant fracture after osteosynthesis for geriatric femoral pertrochanteric fracture with the linear compression integrated screw intramedullary nail system (INTERTAN™): a retrospective study</title><title>Journal of orthopaedic surgery and research</title><addtitle>J Orthop Surg Res</addtitle><description>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. 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Care should be taken during osteosynthesis, focusing not only on the fracture site but also on the femoral cortex around the implant. 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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 &lt; 20.2 mm was found to be a potential factor causing perioperative peri-implant fractures (OR 17.81, 95% CI 1.67-19.76, p = 0.017). Morphology of the femur with a low-lesser trochanter width smaller than 20.2 mm was found to be the only potential contributor to perioperative peri-implant fractures when using INTERTAN™ for geriatric femoral pertrochanteric fractures. Care should be taken during osteosynthesis, focusing not only on the fracture site but also on the femoral cortex around the implant. Although perioperative peri-implant fractures were observed within one month following osteosynthesis, the majority of these cases were effectively treated without surgical intervention.</abstract><cop>England</cop><pub>BioMed Central Ltd</pub><pmid>38057901</pmid><doi>10.1186/s13018-023-04441-w</doi><tpages>1</tpages><oa>free_for_read</oa></addata></record>
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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
title Perioperative peri-implant fracture after osteosynthesis for geriatric femoral pertrochanteric fracture with the linear compression integrated screw intramedullary nail system (INTERTAN™): a retrospective study
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