Cephalomedullary nailing of trochanteric fractures in geriatric patients restores natural hip geometry - a retrospective radiological analysis.

BACKGROUND

Trochanteric fractures are common in geriatric patients, and cephalomedullary nailing is widely used. However, its ability to restore and maintain native hip geometry over time remains unclear.

METHODS

In this retrospective single-center study, patients aged ≥ 75 years treated with cephalomedullary nailing between June 2022 and August 2024 were included. Centrum-collum-diaphyseal (CCD) angle, femoral offset, and leg length discrepancy (LLD) were assessed on the operated and contralateral sides postoperatively and at final follow-up (minimum 6 weeks). Changes over time and correlations with the cortical thickness index (CTI) and AO/OTA classification were analyzed. Implant-related complications were systematically recorded in the overall cohort and analyzed descriptively.

RESULTS

Sixty-six patients (mean age 86.2 ± 6.4 years, 76% female) were included. Postoperatively, CCD angle and femoral offset were restored close to the contralateral side without significant differences (p > 0.05). At final follow-up (mean 142 days), both parameters decreased significantly on the operated side (p ≤ 0.005) but remained comparable to the contralateral side (p > 0.05). LLD increased significantly over time (- 3.0 ± 3.3 mm to - 4.2 ± 4.0 mm, p < 0.001). No correlation was found between CTI, fracture classification, and geometric changes. In the overall study cohort, implant-related complications occurred in 13 of 150 patients (8.7%), with no significant independent predictors identified in exploratory multivariable regression analysis.

CONCLUSION

Cephalomedullary nailing was associated with near-anatomical restoration of the proximal femoral geometry in geriatric trochanteric fractures in the short term, despite the nail's dynamic compression mechanism. However, reductions in CCD angle, femoral offset, and leg length occur during the healing phase, underscoring the importance of achieving an optimal initial fracture reduction. These findings are exploratory, and prospective studies are needed to clarify their clinical relevance.

LEVEL OF EVIDENCE: Level III, Therapeutic study.