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Residual lateral wall width predicts a high risk of mechanical complications in cephalomedullary nail fixation of intertrochanteric fractures: a retrospective cohort study with propensity score matching

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Abstract

Purpose

The purpose of this study is to determine whether the integrity of the entry portal of head-neck implant is related to postoperative mechanical complications.

Methods

We retrospectively reviewed consecutive patients with pertrochanteric fractures in our hospital treated from January 1, 2018, to September 1, 2021. Based on the integrity of the entry portal for head-neck implants on the femoral lateral wall, patients were divided into two groups, including the ruptured entry portal (REP) group and the intact entry portal (IEP) group. After 4:1 propensity score-matched analyses were used to balance the baseline of the two groups, a total of 55 patients were extracted from the original participants, including 11 patients in the REP group and 44 matched patients in the IEP group. The anterior to posterior cortex width on the mid-level of the lesser trochanter was measured and defined as the residual lateral wall width (RLWW).

Results

Compared with the IEP group, the REP group was correlated with postoperative mechanical complications (OR = 12.00, 95% CI 1.837–78.369, P = 0.002) and hip-thigh pain (OR = 26.67, 95% CI 4.98–142.86). RLWW ≤ 18.55 mm indicated a high likelihood (tau-y = 0.583, P = 0.000) of becoming the REP type postoperatively and being more likely to suffer from mechanical complications (OR = 30.67, 95% CI 3.91–240.70, P = 0.000) and hip-thigh pain (OR = 14.64, 95% CI 2.36–90.85, P = 0.001).

Conclusion

Rupture of entry portal is a high-risk factor for mechanical complications in intertrochanteric fractures. RLWW ≤ 18.55 mm is a reliable predictor of the postoperative REP type.

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Availability of data and material

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Funding

The study was supported by the National Natural Science Foundation of China (NSFC, No. 81772323) and Natural Science Foundation of Shanghai (No. 23ZR14593000).

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Yangpu Hospital, School of Medicine, Tongji University, 450 Tengyue Road, Shanghai, 200090, China

    Shi-Jie Li, Shi-Min Chang, Hui Liu, Sun-Jun Hu & Shou-Chao Du

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Contributions

SJL and SMC performed most of the investigation and data analysis and wrote the manuscript; SMC, SJH, HL, and SCD contributed to the interpretation of the data and analyses. All of the authors have read and approved the manuscript.

Corresponding authors

Correspondence to Shi-Min Chang or Shou-Chao Du.

Ethics declarations

Ethics approval and consent to participate

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Yangpu Hospital (No. 2017ZRKX-013). Written informed consent was obtained from all patients.

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Not applicable.

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The authors declare no competing interests.

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Li, SJ., Chang, SM., Liu, H. et al. Residual lateral wall width predicts a high risk of mechanical complications in cephalomedullary nail fixation of intertrochanteric fractures: a retrospective cohort study with propensity score matching. International Orthopaedics (SICOT) 47, 1827–1836 (2023). https://doi.org/10.1007/s00264-023-05780-3

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