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The importance of reconstruction nailing for diaphyseal atypical femoral fractures: a comparative study with standard nailing

  • Trauma Surgery
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Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Subtrochanteric atypical femoral fractures (AFFs) usually require long cephalomedullary or reconstruction nailing to achieve satisfactory healing. Recently, this type of nailing has also been recommended to fix diaphyseal AFFs and prevent fragility fractures around the proximal femur, although standard antegrade nailing seems sufficient from a biomechanical perspective. This study aimed to compare treatment outcomes and complications between reconstruction and standard nailing for diaphyseal AFFs.

Materials and methods

A retrospective comparative study of 48 female patients with diaphyseal AFFs who underwent surgical treatment with either reconstruction or standard nailing was conducted. The reconstruction nailing group comprised 23 patients with a mean age of 74.4 years and included 16 complete and 7 incomplete AFFs. The mean follow-up period was 30 months. The standard nailing group comprised 25 patients with a mean age of 71.1 years and included 16 complete and 9 incomplete AFFs. The mean follow-up period was 57.8 months. The healing rate, time to union, and complications were analyzed and compared between the two groups.

Results

Bony union was achieved in all 23 cases (100%) of the reconstruction nailing group by a mean of 19.3 weeks postoperative. In the standard nailing group, 23 of 25 cases healed (92%) by a mean of 16 weeks postoperative. The standard nailing group included two delayed fragility fractures of the femoral neck (5 and 10 years after the initial surgery), four cases of newly developed subtrochanteric AFFs at the distal screw of the proximal interlocking screws of the nail (one complete and three incomplete fractures), and two cases of nonunion. Complications only occurred in the standard nailing group (p = 0.01, Fisher’s exact test).

Conclusions

In diaphyseal AFFs, reconstruction nailing may achieve a satisfactory outcome and can also decrease delayed peri-implant fragility fractures of the hip, newly developed subtrochanteric AFFs, and nonunion.

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Funding

This research was supported by Kyungpook National University Research Fund, 2020.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130, Dongduk-ro, Jung-gu, Daegu, 41944, Republic of Korea

    Chang-Wug Oh, Joon-Woo Kim, Kyeong-Hyeon Park & Seung-Ho Chung

  2. Department of Orthopaedic Surgery, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea

    Jong-Keon Oh

  3. Orthopedic Trauma Division, Trauma Center, Gachon University College of Medicine, 21, Namdong-daero 774 Beon-gil, Namdong-gu, Incheon, 21565, Republic of Korea

    Yong-Cheol Yoon

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  1. Chang-Wug Oh
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Correspondence to Joon-Woo Kim.

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The authors declare that they have no conflict of interest.

Ethical approval

The design and protocol of this study were approved by the institutional review board of Kyungpook National University Hospital (IRB No: KNUH 2020-02-028).

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Informed consent was obtained from all individual participants included in the study.

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This article does not contain any studies with human participants or animals performed by any of the authors.

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Oh, CW., Kim, JW., Park, KH. et al. The importance of reconstruction nailing for diaphyseal atypical femoral fractures: a comparative study with standard nailing. Arch Orthop Trauma Surg 142, 2677–2683 (2022). https://doi.org/10.1007/s00402-021-04057-x

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  • DOI: https://doi.org/10.1007/s00402-021-04057-x

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