![]() įor the past several decades, fractures in the trochanteric area have been treated with either a variation of a sliding hip screw (SHS) or a short or long intramedullary nail (IMN). The risk of an ipsilateral Sffx is higher after an initial fracture in the trochanteric, subtrochanteric or shaft region, as compared to a femoral neck fracture. reported that 92% of all Sffxs are contralateral, but without documenting any pre-existing implant in the contralateral femur at the time of surgery. Without securing a native contralateral femur pre- and postoperatively, it is impossible to evaluate the true impact of the implant on Sffx. An implant may increase the risk of some fracture types and decrease the risk of others. Ipsilateral Sffxs appear to be less common. Sffx pattern will be influenced by the presence and type of implant in situ at the time of reinjury. Previous studies have stated that 2–12% of patients with a hip fracture of any type sustain a contralateral Sffx. The incidence of a subsequent femoral fracture (Sffx) is significant among patients who have suffered an initial hip fracture. ConclusionĪn intramedullary nail significantly changes the fracture pattern in the event of a second low-energy trauma, reducing the risk of subsequent proximal ipsilateral femoral fractures and increasing the risk of subsequent ipsilateral femoral fractures in the shaft and distal metaphyseal area compared with the native contralateral femur. Twenty-six (8.7%) of all subsequent femoral fractures occured in the ipsilateral shaft, 14 (4.7%) in the ipsilateral metaphyseal area, one (0.33%) in the contralateral shaft, and three (1.0%) in the contralateral metaphysis (OR 10 CI 3.6–29). The number of patients presenting with subsequent ipsilateral and contralateral femoral fractures was 51 (2.5%) and 248 (12.3%) respectively (OR 5.0 CI 3.7–6.9). The total number of patients presenting with subsequent femoral fractures was 299 (14.9%). The mean age of the cohort was 82.4 years and 72.1% were female. Odds ratios (ORs) for subsequent femoral fracture were calculated using robust variance estimates in logistic regression. Only patients with no previous femoral surgery performed, other than the index nailing were followed. Subsequent presentations with ipsi- and contralateral femoral fractures were documented. Retrospective analysis was performed of a two-centre cohort of 2012 patients treated with a short or long intramedullary nail for the management of trochanteric or subtrochanteric fracture between January 2005 and December 2018. We have compared the incidence, localisation, and fracture pattern of subsequent femoral fractures after intramedullary nailing of trochanteric or subtrochanteric fractures in patients without previous implants in either femur at the time of surgery. The literature is inconclusive as to whether an intramedullary nail changes the distribution of a subsequent ipsi- or contralateral fracture of the femur.
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