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The Impact of Banana-Shaped Fragments on Trochanteric Hip Fractures Treated by PFNA

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Abstract

Background

Regarding trochanteric hip fractures, one type of posterior coronal fragments was described as the “banana-shaped fragment”, while the impact of the banana-shaped fragment on mechanical stability has not been further studied. The current study investigated the association between the banana-shaped fragment and mechanical complications after surgery.

Methods

This retrospective cohort study included 273 patients treated by proximal femoral nail antirotation (PFNA) in the full analysis. The age, the sex, the fracture side, the follow-up time, the American Society of Anesthesiologists classification, the operators, the fracture classification, the tip-apex distance, the blade positions, the reduction quality and the bone mineral density were analyzed in relation to mechanical complications, through univariate and multivariate approaches.

Results

Mechanical complications happened in 33 patients. The banana-shaped fragment (adjusted odds ratio 5.240, 95% CI 2.172 to 12.641; p < 0.001), the tip-apex distance and the reduction quality showed significant association with mechanical complications in both univariate and multivariate analysis. Moreover, for 118 patients with the banana-shaped fragment, we found that the use of wire cerclage couldn’t significantly lower the rates of mechanical complications (p = 0.648).

Conclusions

The banana-shaped fragment had a negative impact on mechanical stability of trochanteric hip fractures treated by PFNA. In the perioperative period, the BSF should be carefully evaluated, and its specific handling deserves further study.

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Data availability

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

The work was supported by the Project of the Shanghai Municipal Health Commission (Grant No. 20214Y0317).

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Author notes

  1. Wei Mao and Ao-lei Yang contributed equally to this work.

Authors and Affiliations

  1. Department of Orthopedic Surgery, Yangpu Hospital, School of Medicine, Tongji University, 450 Tengyue Road, Shanghai, 200090, People’s Republic of China

    Wei Mao & Shi-min Chang

  2. Department of Orthopedics, Shanghai Fifth People’s Hospital, Fudan University, No. 801 Heqing Rd, Minhang District, Shanghai, 200240, China

    Wei Mao, Ao-lei Yang, Lin-li Li & You-hai Dong

  3. Division of Orthopaedics and Biotechnology, Department of Clinical Science Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden

    Yan Li

  4. Theme Trauma and Reparative Medicine, Department of Orthopedics and Traumatology, Karolinska University Hospital, Stockholm, Sweden

    Yan Li

  5. Department of Orthopaedic Surgery, Tongji Hospital, Tongji University School of Medicine, Shanghai, China

    Hao-fei Ni

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Contributions

WM: the design of the work; analysis and interpretation of data; substantively revised it. AY: the acquisition, analysis of data; have drafted the work. SC: the conception; analysis of data; substantively revised it. YL: the analysis of data; the conception; substantively revised it. LL: the acquisition, analysis of data. HN: the acquisition, analysis of data. YD: the conception; the analysis of data; funding acquisition. All authors read and approved the final manuscript. WM, and AY contributed equally to this work. All authors have read and approved the final manuscript.

Corresponding author

Correspondence to You-hai Dong.

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The authors declare that they have no competing interests.

Ethics approval and consent to participate

This cohort study was retrospectively registered by the Ethics Committee of the Shanghai Fifth People’s Hospital (2020EC171), with waiver of informed consent. This study was conducted in accordance with the relevant guidelines and regulations.

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For this type of study informed consent is not required.

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Mao, W., Yang, Al., Chang, Sm. et al. The Impact of Banana-Shaped Fragments on Trochanteric Hip Fractures Treated by PFNA. JOIO 57, 1452–1460 (2023). https://doi.org/10.1007/s43465-023-00964-w

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  • DOI: https://doi.org/10.1007/s43465-023-00964-w

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