Resumo

CANGIANO, Lucía V.; YAPUR, Pablo M.  e  TALAMO, Francisco. Fracturas intertrocantéricas en adultos mayores: análisis de los factores de riesgo asociados con falla en la osteosíntesis con clavo cefalomedular. Rev. Asoc. Argent. Ortop. Traumatol. [online]. 2022, vol.87, n.1, pp.41-50. ISSN 1852-7434.  http://dx.doi.org/https://doi.org/10.15417/issn.1852-7434.2022.87.1.1368.

Objectives: Intertrochanteric fractures are increasingly frequent due to population aging. Osteosynthesis with cephalomedullary nail is widely used for the treatment of these fractures. The objective of this study is to analyze the rate of failure in osteosynthesis associated with cephalomedullary nail and the risk factors for this event. Materials and Methods: All cases of patients older than 75 years with intertrochanteric fractures treated in our center with cephalomedullary nails between January 2016 and December 2019 were retrospectively analyzed. The cervico-diaphyseal angle of the operated hip was determined in the immediate postoperative period. We also analyzed the tip-apex distance (TAD) and the position of the lag screw in the femoral head. Results: 66 patients were included in the study. There were 8 cases of failure in osteosynthesis (12.12%). It was found that previously recognized factors in the literature (TAD>25 mm and reduction in varus) were also significant risk factors for failure in osteosynthesis in our cohort. The inadequate position of the lag screw was a risk factor that showed statistical significance in the univariate analysis, but not in the multivariate one in this study. Conclusions: When treating intertrochanteric fractures with cephalomedullary nail, a neutral or slightly valgus reduction aiming for a TAD ≤25 mm significantly reduced the risk of failure in osteosynthesis. We found evidence that a superior or posterior location of the lag screw increases the risk of fixation failure, although the location of the screw was not a significant risk factor in the multivariate analysis.

Palavras-chave : Intertrochanteric fractures; cephalomedullary nail; risk factors; cut-out; pull-out.

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