gms | German Medical Science

Objectives: The cortical thickness index (CTI) is a radiological measure and correlates with diminishing local bone quality in the proximal femur. The aim of this study was to evaluate if a lower CTI is associated with a higher rate of peri- and postoperative surgical complications.

Methods: A total of 228 prospectively enrolled patients treated with endomedullary nailing for trochanteric fracture (TFx) (AO/OTA 31A1.1–31A2.3) (n=99) and hemi-/total hip arthroplasty for femoral neck fracture (FNFx) (n=129) with a mean age of 82±9.9 (50–99) years were reviewed. These cases were evaluated after a mean follow-up of 83±106 (1–450) days for surgery-related complications. Eighteen cases (7.9%) of complications undergoing revision surgery were identified. Patient demographics and radiographic measurements of these groups were compared to the cases without complications (n=210) and statistically analysed.

Result: Of the 18 patients undergoing revision surgery, ten (55.6%) demonstrated a biomechanical complication. Eight cases were revised due to infection (n=4), seroma/hematoma (n=3) or a running wound (n=1). In the FNFx group no intraoperative fracture but two traumatic periprosthetic fractures occurred after a fall 59 and 36 days postoperatively. In the TFx group five cut-ins/outs of the helical blade. Among all analyzed variables, including age, body mass index and hemoglobin level, merely the CTI of the unaffected side in the TFx group was significantly lower in the complications as well as the biomechanical complications group (0.51±0.09, 0.58±0.05, 0.58±0.05; p=0.029).

Poor local bone quality, indicated by a low CTI, is not associated with increased complication rates following surgically managed proximal femoral fractures. Other factors such as inadequate fracture reduction, improper blade positioning, and technical errors appear to be the primary contributors to biomechanical complications.