Risk Factors for Anterior Cortical Impingement of Short Cephalomedullary Nail in Chinese Elderly Patients with Intertrochanteric Fracture

BACKGROUND: Anterior cortical impingement is a common phenomenon after intramedullary fixation in Asian patients with intertrochanteric fractures. It may cause thigh pain and even fracture of the femoral shaft, which may seriously affect postoperative rehabilitation and limb function of patients. However, little was known about risk factors for anterior cortical impingement in Chinese elderly after intramedullary nailing. Hence, the aim of this study was to certify the risk factors for anterior cortical impingement treated with intramedullary nails of intertrochanteric fracture, hoping to provide suggestions for surgical treatment. PATIENTS AND METHODS: A retrospective consecutive series of 94 patients who had been diagnosed as intertrochanteric fracture at our institution was included from January 2019 to November 2019. All patients were treated with intramedullary fixation and followed up for at least 6 months. Demographic, surgical and anesthesiologic information, as well as radiographic data and complications were collected and reviewed. RESULTS: The ratio of anterior cortical impingement is significantly higher in female patients than that of males (80.4% vs 18.6%, P=0.041). Higher incidence of anterior cortical impingement was found in the longer intramedullary nail group, especially in females. Gender (as a female patient) and length of nail were significant risk factors for anterior cortical impingement in intertrochanteric fracture patients treated with intramedullary nail (OR =2.662, 95% CI =1.010–7.018, P=0.447; OR =1.047, 95% CI =1.016–1.079, respectively). The length of nail was a risk factor for anterior cortical impingement in female intertrochanteric fracture patients treated with intramedullary nail (OR =1.051, 95% CI =1.015–1.089). CONCLUSION: Elderly female patients with intertrochanteric fractures treated with intramedullary nails had a higher incidence of anterior cortical impingement. The length of short intramedullary nail is a risk factor for anterior cortical impingement. Patients with anterior cortical impingement may suffer serious complications.