Blade Versus Screw Complication Risk for Intertrochanteric Fracture Fixation

Area of Science:

• Orthopedic Surgery
• Trauma Surgery
• Biomedical Engineering

Background:

• Intertrochanteric femur fractures are common, particularly in elderly patients.
• Cephalomedullary nails (CMN) are a standard treatment for these fractures.
• Fixation of the proximal femur within the CMN can be achieved using either a blade or a screw, with potential implications for stability and complications.

Purpose of the Study:

• To compare the incidence of bony complications and reoperation rates between blade and screw fixation in CMN for intertrochanteric fractures.
• To identify factors influencing outcomes in these patients.

Main Methods:

• Retrospective cohort study involving 1,078 patients with intertrochanteric fractures (OTA/AO 31A) treated with CMN.
• Patients were divided into groups based on blade or screw fixation.
• Propensity matching and stratification by fracture stability were employed for comparative analysis.

Main Results:

• No statistically significant difference in overall complications (5.7% blade vs. 5.4% screw) or reoperations (5.2% blade vs. 3.7% screw) was observed between the blade and screw groups.
• This finding remained consistent when stratifying patients by fracture instability.
• Logistic regression identified adequate fracture reduction parameters and patient characteristics (BMI, ASA status, smoking, fracture stability) as significant predictors of complications and reoperation, not the implant type.

Conclusions:

• The choice between a blade or screw for proximal femur fixation in CMN for intertrochanteric fractures is not associated with significant differences in bony complications or reoperation rates.
• Malreduction emerged as a critical factor correlating with adverse outcomes, underscoring the importance of achieving adequate reduction during surgery.