gms | German Medical Science

Objectives: In Sweden roughly one of 4 women 50 years or older will sustain a hip fracture. Patients previously treated for a femoral shaft fracture are likely to have an even higher risk. Using intramedullary nails with fixation of the femoral head might decrease the risk for subsequent hip fracture and safe the patient from a challenging reoperation. We hypothesized that patients with femoral shaft fractures treated with antegrade intramedullary nails including the femoral head in the fixation, would have a lower risk for a subsequent hip fracture compared to those without (Figure 1 [Fig. 1]). A secondary hypothesis was that even the number of major reoperations would be lower because of a more stable fixation.

Methods: According to the Swedish National Inpatient Register, between 2008 and 2010 in Sweden a total of 5475 fractures, in patients 55 years of age and older occurred in the femoral shaft (including subtrochanteric fractures (ICD 10 codes S72.2, S72.3). Patients with pathological, peri-implant, trochanteric and bilateral fractures, incomplete radiographs and those operated with a plate construct were excluded from the analysis after review of radiographs and registry data. Radiographic imaging and registry data were used to identify implant types, reasons and types of reoperations until 31.12.2015. Implants were divided into intramedullary nails with (FHF) and without fixation of the femoral head (NFHF). Reoperations were divided in major (proximal or distal peri-implant fractures, non-union, implant failure and complete implant removal) and minor. We performed time-to-event analysis using Cox regression to estimate age and multivariable-adjusted cause-specific hazard ratios (csHRs) for proximal, proximal and distal peri-implant fractures and for major reoperations.

Results and conclusion: Among 897 patients a total of 82 reoperations were performed (Table 1 [Tab. 1]). In patients with FHF no proximal peri-implant fracture and among 257 patients with NFHF 14 such fractures occurred. Patients with FHF had a lower hazard for any peri-implant fracture and major reoperation, csHR 0.19 (0.07-0.5), csHR 0.51 (0.28-0.92). Intramedullary nails with femoral head fixation seem to prevent secondary peri-implant fractures and decrease the overall risk for reoperation 5-8 years postoperatively.