OTA 2012 Posters

Scientific Poster #6 Hip/Femur OTA-2012

Intramedullary Nailing of Subtrochanteric Fractures: Does Malreduction Matter?

John Riehl, MD; George J. Haidukewych, MD; Mark W. Munro, MD; Joshua Langford, MD; Stanley Kupiszewski, MD; Kenneth J. Koval, MD;
Orlando Regional Medical Center, Orlando, Florida, USA

Background/Purpose: Subtrochanteric femur fractures remain challenging injuries to treat. Historically, varus malreduction has been linked to the development of nonunion; however, there is a paucity of literature evaluating the impact of sagittal plane malreduction. The purpose of this study was to evaluate the influence of coronal and sagittal plane malreductions on time to union of subtrochanteric femur fractures treated with an intramedullary device.

Methods: A retrospective study was performed of all subtrochanteric fractures (AO/OTA type 32) treated at our institution between March 2008 and February 2011. Inclusion criteria included: (1) age ≥18 years old, (2) fracture stabilization using an intramedullary device, and (3) minimum 3-month follow-up. Patients were followed to union or revision surgery. Radiographic evidence of healing was defined as bridging callus on 3 of 4 cortices on AP and lateral views. Delayed union was defined as lack of radiographic healing by 4 months postoperatively and nonunion as lack of healing by 6 months. The definition of malreduction was coronal or sagittal plane deformity greater than 10° at the fracture site.

Results: 35 patients (35 fractures) met inclusion criteria—20 men and 15 women with an average age of 55 years (range, 19-100). Mean clinical follow-up was 7 months (range, 3-18). 34 of 35 fractures (97%) healed without need for additional surgery. 21 of the 35 fractures (60%) healed within 4 months of surgery. 13 fractures (37%) had delayed union and 1 (2.9%) developed nonunion requiring reoperation. 7 of 35 fractures (20%) had a malreduction >10°, defined as varus (2 fractures), flexion (4 fractures), or both (1 fracture). Of the 7 fractures with a malreduction, all (100%) developed a delayed union (6) or nonunion (1). Of the 28 fractures without malreduction, 21 (75%) healed within 4 months, 7 (25%) had a delayed union, and none had a nonunion. The presence of a malreduction >10° in any plane resulted in a significantly higher rate of delayed or nonunion (P = 0.0005).

Conclusion: For patients with subtrochanteric fractures treated with an intramedullary device, malreduction in any plane of greater than 10° resulted in a significantly increased rate of delayed union and/or nonunion.

• The FDA has not cleared this drug and/or medical device for the use described in this presentation   (i.e., the drug or medical device is being discussed for an “off label” use).  ◆FDA information not available at time of printing. Δ OTA Grant.