Correlation between perioperative surgical factors and implant-related complications in the basicervical fractures of femoral neck treated with proximal femoral nail antirotation: a retrospective review study in 149 elderly patients.

PURPOSE: Basicervical femoral neck fractures (BFNFs) are uncommon in the elderly but associated with higher postoperative complications compared to intertrochanteric fractures. Proximal femoral nail antirotation (PFNA) is one of the preferred surgical options for intertrochanteric fracture due to its minimal invasiveness, fewer complications, and better in postoperative functional outcomes. However, limited research addressed the outcomes and the risk factors for implant-related complications after using PFNA.

METHODS

This retrospective study included 149 patients treated with PFNA fixation in a University hospital. Inclusion criteria were age over 65 years, BFNFs from low-energy trauma, prefracture ambulatory level as independent ambulation with or without gait aids, with available data and follow-up period of at least 1 year. Exclusion criteria included open fracture, pathological fracture, multiple or high-energy traumas, and open fractures. Implant-related complications was defined as nail breakage, peri-implant fracture, varus collapse, blade cut-out or cut-through, and excessive sliding (> 10 mm). Demographic, clinical, and radiographic data were collected and analyzed. Multivariate logistic regression analysis was used to identify the risk factors.

RESULTS

Of the 149 patients (26 males, 123 females) with an average age of 81 ± 9 years. Seventeen patients (11.4%) had mechanical complication and 11 patietns (7.4%) had reoperation. Univariate analysis showed that BMI, ASA grade 4, diabetes, tip-apex distance (TAD), calcar-referenced TAD, neck shaft angle, lateral angulation, anteromedial cortical support (AMCS) reduction, and Chang reduction quality criteria were potential predictors. Following multivariate analysis, only BMI, ASA grade 4, lateral angulation and AMCS were significant risk factors for implant-related complication (p < 0.05 all).

CONCLUSION

The elderly patients with BFNFs and treated with PFNA are generally safe with acceptable reoperation rate. However, the proper reduction technique using AMCS and lateral angulation are essential for successful outcomes. Moreover, the patients with high BMI and ASA grade 4 are significantly associated with implant failure and required special attention.