Impact of Wedge Effect on Outcomes of Intertrochanteric Fractures Treated with Intramedullary Proximal Femoral Nail
Abstract
:1. Introduction
2. Materials and Methods
Statistical Analysis
3. Results
3.1. The Decreased NSA and Increased FO after PFNA-II Fixation in ITF
3.2. The Presence of Lateral Wall Fracture and Parker’s Ratio on AP Radiography Are Risk Factors of Wedge Effect
3.3. Parker’s Ratio on AP Radiographs Was Highly Associated with the Occurrence of Blade Cut-Out
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Conflicts of Interest
References
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Patients | |
---|---|
N | 113 |
Age (years), mean (SD) | 77.67 (12.11) |
Sex, n(%) | |
Female | 73 (64.60) |
Male | 40 (35.40) |
Fracture side, n(%) | |
Left | 54 (47.79) |
Right | 59 (52.21) |
Fracture classification, n(%) | |
11 | 1 (0.88) |
12 | 14 (12.39) |
13 | 5 (4.42) |
21 | 40 (35.4) |
22 | 22 (19.47) |
23 | 12 (10.62) |
31 | 4 (3.54) |
32 | 7 (6.19) |
33 | 8 (7.08) |
Lateral wall fracture, n(%) | |
No | 84 (74.34) |
Yes | 29 (25.66) |
TAD (cm), mean (SD) | 2.27 (0.63) |
Parker’s ratio in AP(%), mean (SD) | 49.38 (7.96) |
Parker’s ratio in Lat(%), mean (SD) | 46.44 (8.59) |
NSA (°), mean (SD) | |
Non-injury (n = 113) | 133.07 (4.41) |
Injury (n = 113) | 128.90 (5.27) |
Difference of SN angle (n = 113) | −4.16 (4.73) |
p value for Wilcoxon-Signed-Rank test | <0.0001 |
FO (cm), mean (SD) | |
Non-injury (n = 113) | 6.80 (0.73) |
Injury (n = 113) | 7.35 (0.77) |
Difference of offset (n = 113) | 0.55 (0.68) |
p value for Wilcoxon-Signed-Rank test | <0.0001 |
Nail length, n(%) | |
170 cm | 6 (5.31) |
200 cm | 23 (20.35) |
240 cm | 48 (42.48) |
Long nail | 36 (31.86) |
Blade cut-out, n (%) | |
No | 110 (97.35) |
Yes | 3 (2.65) |
N | Change of NSA | p Value | Adjusted P | Change of FO | p Value | Adjusted P | |
---|---|---|---|---|---|---|---|
Age, Spearman’s rho † | 113 | 0.09 | 0.364 | 0.1048 | −0.1 | 0.3058 | 0.2191 |
Sex, median (IQR) | |||||||
Female | 73 | −3.50 (−7.80, −0.20) | 0.45 (0.08, 0.76) | ||||
Male | 40 | −4.75 (−8.85, −1.60) | 0.2229 | 0.6532 | 0.62 (0.26, 1.01) | 0.0951 | 0.0700 |
Fracture side, median (IQR) | |||||||
Left | 54 | −3.60 (−7.1, −0.10) | 0.42 (0.07, 0.83) | ||||
Right | 59 | −4.10 (−8.90, −0.50) | 0.5310 | 0.3084 | 0.54 (0.23, 1.02) | 0.1100 | 0.0418 |
Fracture classification, median (IQR) | |||||||
11 | 1 | −0.20 (−0.20, −0.20) | 0.50 (0.50, 0.50) | ||||
12 | 14 | −4.15 (−7.10, −2.10) | 0.69 (0.15, 1.04) | ||||
13 | 5 | −5.00 (−10.00, −1.40) | 0.70 (0.53, 1.16) | ||||
21 | 40 | −3.45 (−6.60, −0.25) | 0.51 (0.22, 0.97) | ||||
22 | 22 | −2.05 (−6.90, 0.10) | 0.46 (0.24, 0.87) | ||||
23 | 12 | −8.10 (−9.30, −3.95) | 0.51 (0.06, 0.77) | ||||
31 | 4 | −7.05 (−8.70, −2.50) | 0.12 (0.05, 0.61) | ||||
32 | 7 | −0.70 (−7.10, 0.10) | 0.19 (−0.37, 0.91) | ||||
33 | 8 | −4.30 (−9.10, −0.45) | 0.5225 | 0.9187 | 0.55 (0.02, 0.78) | 0.8076 | 0.5030 |
Subgroup with fracture stability | |||||||
Stable fracture type (11, 12, 13, 21) | 60 | −3.70 (−7.05, −0.65) | 0.53 (0.22, 1.01) | ||||
Unstable fracture type (22, 23, 31, 32, 33) | 53 | −3.60 (−8.80, −0.30) | 0.7041 | 0.7338 | 0.45 (0.07, 0.82) | 0.2884 | 0.6887 |
Subgroup with AO classification | |||||||
1 (11,12,13) | 20 | −4.15 (−7.70, −1.55) | 0.69 (0.20, 1.04) | ||||
2 (21,22,23) | 74 | −3.55 (−8.30, −0.40) | 0.47 (0.22, 0.89) | ||||
3 (31,32,33) | 19 | −3.00 (−8.40, −0.10) | 0.9016 | 0.9158 | 0.23 (0.02, 0.78) | 0.2082 | 0.6213 |
Lateral wall fracture, median (IQR) | |||||||
No | 84 | −3.35 (−7.00, −0.15) | 0.48 (0.15, 0.90) | ||||
Yes | 29 | −6.30 (−9.80, −0.60) | 0.0422 | 0.0919 | 0.48 (0.15, 1.02) | 0.6081 | 0.8448 |
TAD, Spearman’s rho † | −0.1 | 0.2845 | 0.2289 | 0.18 | 0.0590 | 0.0793 | |
Parker’s ratio in AP%, Spearman’s rho † | −0.37 | <0.0001 | <0.0001 | 0.09 | 0.3584 | 0.0158 | |
Parker’s ratio in lateral %, Spearman’s rho † | −0.09 | 0.3355 | 0.4066 | 0.1 | 0.2904 | 0.9513 | |
Nail length, median (IQR) | |||||||
170 mm | 6 | −1.55 (−3.60, −0.20) | 0.65 (0.50, 0.96) | ||||
200 mm | 23 | −5.00 (−7.70, 0.10) | 0.43 (0.14, 0.91) | ||||
240 mm | 48 | −3.80 (−8.55, −0.20) | 0.56 (0.12, 1.04) | ||||
Long nail | 36 | −4.10 (−8.75, −0.50) | 0.6938 | 0.4790 | 0.45 (0.12, 0.75) | 0.4783 | 0.1263 |
Blade cut-out, median (IQR) | |||||||
No | 110 | −3.6 (−7.80, −0.30) | 0.49 (0.14, 0.95) | ||||
Yes | 3 | −8.9 (−9.30, −0.40) | 0.4267 | 0.5937 | 0.45 (0.41, 0.52) | 0.8373 | 0.5878 |
No Blade Cut-Out Group | Blade Cut-Out Group | p | Adjusted OR (95%CI) | p | |
---|---|---|---|---|---|
N | 110 | 3 | |||
Age years, median (IQR) | 81.00 (74.00, 85.00) | 78.00 (77.00, 81.00) | 0.6230 | - | - |
Sex | |||||
Female | 70 (63.64) | 3 (100.00) | |||
Male | 40 (36.36) | 0 (0.00) | 0.5510 | - | - |
Fracture classification, n(%) | |||||
Subgroup with fracture stability | |||||
Stable (11, 12, 13, 21) | 59 (53.64) | 1 (33.33) | |||
Unstable (22, 23, 31, 32, 33) | 51 (46.36) | 2 (66.67) | 0.5993 | - | - |
Subgroup with AO classification | |||||
1 (11,12,13) | 20 (18.18) | 0 (0.00) | |||
2 (21,22,23) | 71 (64.55) | 3 (100.00) | |||
3 (31,32,33) | 19 (17.27) | 0 (0.00) | 1.0000 | - | - |
Lateral wall fracture, n(%) | |||||
No | 83 (75.45) | 1 (33.33) | |||
Yes | 27 (24.55) | 2 (66.67) | 0.1613 | - | - |
TAD, median (IQR) | 2.22 (1.87, 2.62) | 2.52 (1.94, 2.68) | 0.6617 | - | - |
Parker’s ratio in AP%, median (IQR) | 48.27 (43.83, 52.95) | 60.82 (59.1, 66.67) | 0.0118 | 1.20 (1.03–1.40) | 0.0181 |
Parker’s ratio in lateral%, median (IQR) | 46.83 (39.73, 52.82) | 47.66 (47.19, 52.44) | 0.5921 | - | - |
NS angle difference, median (IQR) | −3.60 (−7.80, −0.30) | −8.90(−9.30, −0.40) | 0.4267 | - | - |
FO difference, median (IQR) | 0.49 (0.14, 0.95) | 0.45(0.41, 0.52) | 0.8373 | - | - |
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Yen, S.-H.; Lu, C.-C.; Ho, C.-J.; Huang, H.-T.; Tu, H.-P.; Chang, J.-K.; Chen, C.-H.; Lin, S.-Y. Impact of Wedge Effect on Outcomes of Intertrochanteric Fractures Treated with Intramedullary Proximal Femoral Nail. J. Clin. Med. 2021, 10, 5112. https://doi.org/10.3390/jcm10215112
Yen S-H, Lu C-C, Ho C-J, Huang H-T, Tu H-P, Chang J-K, Chen C-H, Lin S-Y. Impact of Wedge Effect on Outcomes of Intertrochanteric Fractures Treated with Intramedullary Proximal Femoral Nail. Journal of Clinical Medicine. 2021; 10(21):5112. https://doi.org/10.3390/jcm10215112
Chicago/Turabian StyleYen, Shen-Ho, Cheng-Chang Lu, Cheng-Jung Ho, Hsuan-Ti Huang, Hung-Pin Tu, Je-Ken Chang, Chung-Hwan Chen, and Sung-Yen Lin. 2021. "Impact of Wedge Effect on Outcomes of Intertrochanteric Fractures Treated with Intramedullary Proximal Femoral Nail" Journal of Clinical Medicine 10, no. 21: 5112. https://doi.org/10.3390/jcm10215112