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Archives of Orthopaedic and Trauma Surgery

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Open Access 01-06-2019 | Femoral Fracture | Trauma Surgery

Risk factors for nonunion after intramedullary nailing of subtrochanteric femoral fractures

Authors: Dietmar Krappinger, Bernhard Wolf, Dietmar Dammerer, Martin Thaler, Peter Schwendinger, Richard A. Lindtner

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 6/2019

Abstract

Introduction

Nonunion is a common complication after intramedullary nailing of subtrochanteric femoral fractures. A more detailed knowledge, particularly of avoidable risk factors for subtrochanteric fracture nonunion, is thus desired to develop strategies for reducing nonunion rates. The aim of the present study therefore was to analyse a wide range of parameters as potential risk factors for nonunion after intramedullary nailing of subtrochanteric fractures.

Materials and methods

Seventy-four patients who sustained a subtrochanteric fracture and were treated by femoral intramedullary nailing at a single level 1 trauma centre within a 6-year period were included in this study. A total of 15 patient-related, fracture-related, surgery-related, mechanical and biological parameters were analysed as potential risk factors for nonunion. Furthermore, the accuracy of each of these parameters to predict nonunion was calculated.

Results

Nonunion occurred in 17 of 74 patients (23.0%). Of the 15 potential risk factors analysed, only 3 were found to have a significant effect on the nonunion rate (p < 0.05): postoperative varus malalignment, postoperative lack of medial cortical support and autodynamisation of the nail within the first 12 weeks post-surgery. Accuracy of each of these 3 parameters to predict nonunion was > 0.70. Furthermore, the nonunion rate significantly increased with the number of risk factors (no risk factor: 2.9%, one risk factor: 23.8%, two risk factors: 52.9%, and three risk factors: 100% [Chi-square test, p = 0.001)].

Conclusions

Our study indicates that intraoperative correction of varus malalignment and restoration of the medial cortical support are the most critical factors to prevent nonunion after intramedullary nailing of subtrochanteric femoral fractures. In addition, autodynamisation of the nail within the first 3 months post-surgery is a strong predictor for failure and should result in revision surgery.

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Title: Risk factors for nonunion after intramedullary nailing of subtrochanteric femoral fractures
Authors: Dietmar Krappinger
Bernhard Wolf
Dietmar Dammerer
Martin Thaler
Peter Schwendinger
Richard A. Lindtner
Publication date: 01-06-2019
Publisher: Springer Berlin Heidelberg
Keywords: Femoral Fracture
Varus Malalignment
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 6/2019
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-019-03131-9

2024 ASCO Annual Meeting

Springer Medicine

Risk factors for nonunion after intramedullary nailing of subtrochanteric femoral fractures

Abstract

Introduction

Materials and methods

Results

Conclusions

2024 ASCO Annual Meeting

Springer Medicine

Abstract

Introduction

Materials and methods

Results

Conclusions

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