Integrated Dual Lag Screw Cephalomeduallary Nails Are Associated With Higher Complication Rates Versus Single Lag Screw Cephalomedullary Nails for Intertrochanteric Femur Fractures

Thursday, October 19, 2023

9:32 AM – 9:38 AM PST

Location: 4B

Presenting Author(s)

NV

Noelle L. Van Rysselberghe, MD

Fellow
Harborview Medical Center
Stanford, California, United States

Disclosure(s): No financial relationships to disclose

Corresponding Author(s)

CG

Christian A. Gonzalez, BS

University of Nevada, Reno School of Medicine
University of Reno, Nevada School of Medicine
Reno, Nevada, United States

Disclosure(s): No financial relationships to disclose

Co-Author(s)

MW

Mathew James Whittaker, MD

Stanford Orthopaedic Surgery
DN

Daniel Ngo, BA

McGovern Medical School
JM

John B. Michaud, BA

Stanford University
HP

Harin Parikh, MD
JW

Juntian Wang, MD

Cedars Sinai Medical Center
AR

Abrianna Robles, BS

Cedars Sinai Medical Center
AH

Andrea Horne, CCRP
Garrett Cavanaugh, MD

Attending Orthopaedic Trauma Surgeon
Einstein Medical Center Philadelphia
Philadelphia, Pennsylvania, United States
Garrett W. Esper, BA

NYU Langone Orthopedic Hospital
NYU Langone Health, New York, United States
AA

Arya Amirhekmat, BS
EB

Eleni Berhaneselase, BA

University of California, San Francisco
NM

Natalie Marie Marenghi, MD

Atrium Health Wake Forest Baptist
MM

Marisa McDow, BS
CH

Christopher G. Herbosa, BS

Medical Student
Washington University School of Medicine in St. Louis
NYU Langone
MD

Maricela Diaz, MA

Indiana University
UE

Uchechukwu Emili, MD
ZL

Zachary Lim, MD

UC San Francisco Medical Center, San Francisco, CA
DP

Dmitry Pokhvashchev, MD, PhD
AM

Aden Malik, MD

UC San Francisco Medical Center, San Francisco, CA
EO

Edmond F. O'Donnell, MD, PhD
MJ

Muhammad Umar Jawad, MD
SC

Sean T. Campbell, MD
ML

Milton TM Little, MD (he/him/his)

Assistant Professor
Cedars-Sinai Medical Center
Cedars Sinai Medical Center
Los Angeles, California, United States
WV

Walt W. Virkus, MD

Indiana University
Philipp Leucht, MD

Associate Professor
NYU Langone Orthopedics
New York, New York, United States
MG

Matthew R. Garner, MD

Director of Fracture Care Services
UPMC, Central PA
Hummelstown, Pennsylvania, United States
Mark A. Lee, MD (he/him/his)

UC Davis
Sacramento, California, United States
John A. Scolaro, MD, MA (he/him/his)

Associate Professor
University of California, Irvine
Orange, California, United States
Marschall Berkes, MD

St Louis, Missouri, United States
Saam Morshed, MD, PhD, MPH (he/him/his)

Professor of Orthopaedic Surgery, Epidemiology and Biostatistics
University of California, San Francisco
University of California, San Francisco
San Francisco, California, United States
Stephen J. Warner, MD, PhD

University of Texas at Houston, McGovern Medical School
Houston, Texas, United States
PP

Paul William Perdue, MD

Virginia Commonwealth University
VCU
EC

Eben Carroll, MD
JL

Justin Lucas, MD

Santa Clara Valley Medical Center
Julius A. Bishop, MD

Associate Professor
Stanford University School of Medicine
HG

Henry Goodnough, MD, PhD

Faculty
Stanford
Redwood City, California, United States
Michael J. Gardner, MD (he/him/his)

Professor of Orthopaedic Surgery
Stanford University, California, United States

Purpose: Systematic reviews and meta-analyses comparing the treatment of intertrochanteric (IT) fractures with integrated dual lag screws (IDL) or single lag (SL) component cephalomedullary nails (CMNs) have reported mixed results in terms of reoperation risk. The purpose of this study was to analyze a large cohort of patients to assess reoperation rates between patients treated with IDL or SL CMNs for IT femur fractures. We hypothesized that there would be no difference in reoperation rates between the groups.

Methods: Adults who sustained IT fractures (AO/OTA 31A1-A3) between January 2014 and May 2021 at 13 Level I trauma centers across the US treated with SL or IDL CMNs with a minimum of 3 months follow-up were included. Exclusion criteria included non-IT fractures and pathologic fractures. Initial differences in outcomes were analyzed with a chi-squared test. Multivariable regression that controlled for age, sex, mechanism, fracture pattern, and reduction quality was used to compare outcomes.

Results: 2132 patients met inclusion criteria. Head segment fixation included 289 (13.6%) IDL CMNs and 1843 (86.4%) SL CMNs. In total, 101 patients (4.7%) underwent a reoperation, most commonly for fixation failure (28.7% of all reoperations). Patients with IDL CMNs had significantly higher rates (7.6% vs 4.3%, P = 0.013) and odds (odds ratio [OR] 1.83 [95% confidence interval (CI) 1.11-3.01], P = 0.018) of reoperation as well as significantly higher rates (4.2% vs 0.9%, P<0.001) and odds (OR 4.79 [95% CI 2.22-10.31], P<0.001) of reoperation for fixation failure compared to patients with SL CMNs.

Conclusion: In this study, intertrochanteric fractures treated with SL CMNs were associated with significantly lower rates of reoperation compared to IDL CMNs. After controlling for age, sex, mechanism, fracture pattern, and reduction quality, IDL CMNs were found to be significantly associated with nearly twice the odds of reoperation and 5 times the odds of reoperation for fixation failure compared to SL CMNs. Future studies are warranted to confirm these results and to evaluate specific modes of failure between IDL and SL CMNs.