title: Risk factors for intramedullary nail breakage in proximal femoral fractures: a 10-year retrospective review.
abstract: INTRODUCTION Intramedullary nailing is a common treatment for proximal femoral fractures. Fracture of the nail is a rare but devastating complication that exposes often frail patients to complex revision surgery. We investigated which risk factors predict nail failure. METHODS We reviewed all cases of nail breakage seen over a 10-year period in a single busy trauma unit; 22 nail fractures were seen in 19 patients. Comparison was made with a group of 209 consecutive patients who underwent intramedullary fixation of a proximal femur fracture with no nail breakage over a 2-year period. RESULTS In the fractured nail group, mean age was 70.4 years (range 55-88 years).The mean time to fracture was 10 months (range 2.5-23 months). Logistical regression was used to show that low American Society of Anesthesiologists (ASA) score, subtrochanteric fracture and pathological fracture were independent risk factors for nail fracture. CONCLUSIONS Young patients with a low ASA score are at highest risk of nail breakage. We advise close follow-up of patients with these risk factors until bony union has been achieved. In addition, there may be merit in considering other treatment options, such as proximal femoral replacement, especially for those with pathological fracture with a good prognosis.
authors.affiliation: Leicester Royal Infirmary , Leicester , UK.
authors.forename: N A
authors.initials: NA
authors.lastname: Johnson
authors.affiliation: Leicester Royal Infirmary , Leicester , UK.
authors.forename: C
authors.initials: C
authors.lastname: Uzoigwe
authors.affiliation: Leicester Royal Infirmary , Leicester , UK.
authors.forename: M
authors.initials: M
authors.lastname: Venkatesan
authors.affiliation: Leicester Royal Infirmary , Leicester , UK.
authors.forename: V
authors.initials: V
authors.lastname: Burgula
authors.affiliation: Leicester Royal Infirmary , Leicester , UK.
authors.forename: A
authors.initials: A
authors.lastname: Kulkarni
authors.affiliation: Leicester Royal Infirmary , Leicester , UK.
authors.forename: J N
authors.initials: JN
authors.lastname: Davison
authors.affiliation: Leicester Royal Infirmary , Leicester , UK.
authors.forename: R U
authors.initials: RU
authors.lastname: Ashford
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001858:Bone Nails; D004868:Equipment Failure; D005260:Female; D005264:Femoral Fractures / Q000000981:diagnostic imaging / Q000601:surgery; D005594:Fracture Fixation, Intramedullary / Q000009:adverse effects / Q000295:instrumentation; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000601:surgery; D012189:Retrospective Studies
keywords: Intramedullary nail; Nail fracture; Proximal femoral fracture; Subtrochanteric fracture