Lateral migration with telescoping of a trochanteric fixation nail in the treatment of an intertrochanteric hip fracture.

Wanjun Liu; Junqiang Wang; Michael J Weaver; Mark S Vrahas; Dongsheng Zhou

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Lateral migration with telescoping of a trochanteric fixation nail in the treatment of an intertrochanteric hip fracture.

Author: Wanjun LIU ¹ ; Junqiang WANG ² ; Michael J WEAVER ³ ; Mark S VRAHAS ⁴ ; Dongsheng ZHOU ¹
Author Information

1. Department of Orthopaedics, Shandong Provincial Hospital, Shandong University, Jinan, Shandong 250021, China.
2. Department of Orthopaedics, Beijing Jishuitan Hospital, Beijing 100035, China.
3. Partners Orthopaedics, Massachusetts General Hospital, Harvard School of Medicine, Boston MA 02114, USA.
4. Partners Orthopaedics, Massachusetts General Hospital, Harvard School of Medicine, Boston MA 02114, USA. Email: mvrahas@partners.org.
Publication Type:Journal Article
MeSH: Aged; Aged, 80 and over; Bone Nails; Female; Follow-Up Studies; Fracture Fixation, Internal; methods; Hip Fractures; classification; surgery; Humans; Male; Middle Aged; Retrospective Studies; Treatment Outcome
From: Chinese Medical Journal 2014;127(4):680-684
CountryChina
Language:English
Abstract:
BACKGROUNDThe trochanteric fixation nail (TFN) can be used to treat stable and unstable fractures of intertrochanteric hip fractures. We study the common lateral migration that occurs with telescoping of intertrochanteric hip fractures treated with TFN and identify the predictors and relationships to clinical outcomes.
METHODSPatient demographic information, fracture type (Arbeitsgemeinschaft für Osteosynthesefragen (AO)/Orthopaedic Trauma Association (OTA) classification), radiographic data, and clinical data were collected. Lateral migration with telescoping was measured. Statistical analyses were performed to determine which variables predicted lateral migration with telescoping. Patient outcome scores were recorded using the Modified Harris Hip Score (MHHS), Hip Outcome Score-Activity of Daily Living (HOS-ADL), and Visual Analog Scale for pain.
RESULTSTwo hundred and twenty-three patients (67 males, 156 females) fitted the radiographic and follow-up (average 24.6 months) criteria. The average age was 77.2 years. The average lateral migration with telescoping was 4.8 mm. Twenty-one patients (9.4%) had excessive lateral migration with telescoping ( = 10 mm). The quality of calcar reduction (P = 0.01) and unstable fracture patterns (P = 0.006) were significant predictive factors of lateral migration with telescoping. The mean outcome scores (MHHS and HOS-ADL) were 80.1 points and 78.7 points, respectively. All subjects had no significant relationship to lateral migration with telescoping (P > 0.05). Of all the patients who developed lateral migration with telescoping, only one required removal of the blade for hip pain and all patients went on to uneventful union at an average time of 4.5 months.
CONCLUSIONSLateral migration with telescoping is a common mechanical complication of intertrochanteric hip fracture treated with the TFN procedure. It was predicted by the quality of calcar reduction and fracture type. However, this did not affect stable fixation and fracture healing, so rarely leads to clinical problems.