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Proximal Femoral Shortening and Varus Collapse After Fixation of "Stable" Pertrochanteric Femur Fractures.

PMID: 33433142 (view PubMed database entry)
DOI: 10.1097/bot.0000000000001892 (read at publisher's website )

David J Ciufo, John P Ketz,

<h4>Objectives</h4>To evaluate and compare femoral neck shortening and varus collapse in stable pertrochanteric femur fractures treated with sliding hip screws (SHSs) or cephalomedullary nails (CMNs).<h4>Design</h4>Retrospective review.<h4>Setting</h4>Academic medical center.<h4>Patients</h4>A total of 290 patients were included in the study. The average age was 82 years, and most were women. All sustained low-energy pertrochanteric femur fractures (OTA/AO A1.1, 1.2, 1.3, 2.2) treated operatively with SHSs or CMNs. Minimum radiographic follow-up was 3 months, with an average of 28 (range 3-162) months.<h4>Intervention</h4>CMN or SHS fixation.<h4>Main outcome measures</h4>Varus collapse of the femoral neck-shaft angle and proximal femoral shortening.<h4>Results</h4>Both implants allowed some varus collapse. Univariate analysis demonstrated a significantly greater portion of patients with SHSs progressed to varus collapse >5 degrees (P = 0.02), mild horizontal shortening >5 mm (P < 0.01), and severe horizontal shortening >10 mm (P < 0.01). There was no statistical difference in vertical shortening (P = 0.3). There was no difference in implant failure (P = 0.5), with failure rates of 3% for cephalomedullary implants and 5% for SHS constructs.<h4>Conclusions</h4>The SHS group experienced greater varus collapse and horizontal shortening. There was no difference in overall implant failure. These findings suggest that the CMN is a superior construct for maintenance of reduction in stable pertrochanteric fractures, which may lead to improved functional outcomes as patients recover.<h4>Level of evidence</h4>Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

J Orthop Trauma (Journal of orthopaedic trauma)
[2021, 35(2):87-91]

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