Causes and influencing factors of fixation failure by intramedullary nailing for elderly patients with intertrochanteric fractures

Zheng Huayong; Gao Jie; Liu Zhi; Zhang Zhicheng; Sun Tiansheng; Wang Xiaowei

doi:10.3969/j.issn.1009-4237.2025.05.007

Abstract：Objective To analyze the causes,timing,and risk factors of postoperative failure in the treat-ment of elderly patients with intertrochanteric fractures managed by intramedullary nailing.Methods A retrospec-tive analysis was conducted on 107 cases of intertrochanteric fractures treated with intramedullary nails in our ortho-pedic department from Jan.2020 to Dec.2021.The age range was 60-101 years,80.7 years on average,including 43 males and 64 females.All the fractures were caused by falls,with 52 stable injuries and 55 unstable.Patients were followed up for 6-22(mean 15.5)months.Demographic information,type of internal fixation,and fracture re-duction status of the patients were recorded.The timing of failure was recorded,and the reasons and risk factors were also explored.Results A total of 15 patients had nail failure,with a failure rate of 14.0%.The causes of failure were cutout in 4 cases,cut through in 1,nail breakage in 1,and excessive sliding in 9,with 10 failures occurring within 3 months after surgery,3 during 3-6 months,and 2 during 6-12 months.Univariate analysis showed that renal dysfunction,fracture type,reduction quality,and bone density were closely related to fixation failure(all P＜0.05).The abovementioned variables with statistical differences were further taken into multivariate logistic regression anal-ysis,which showed that poor reduction quality(OR=8.840,95%CI=2.056-38.016,P=0.003),unstable fractures(OR=10.569,95%CI=1.638-68.178,P=0.013),and bone density T score≤-3.0(OR=3.621,95CI=1.281-10.236,P=0.015)were independent risk factors for fixation failure.Conclusion The failure rates of intertro-chanteric fractures treated with intramedullary nailing are high in elderly patients,which mainly occurs within 3 months after surgery.Excessive sliding of the nail is the most common,and the failure type is related to the selected in-ternal fixation.The risk factors for failure are mainly related to osteoporosis,unstable fractures,and reduction quality.