Key Decision‐Making in Post‐Failed Internal Fixation of Intertrochanteric Fractures Hip Arthroplasty: A Multicenter Retrospective Study on Fracture Healing's Impact on Femoral Component Selection
ABSTRACT Purpose Following failed internal fixation of intertrochanteric fractures (FIF‐ITF), the decision to use a long‐stem or standard‐stem femoral implant in hip arthroplasty is still debated. This study aimed to explore how the healing status of fractures after FIF‐ITF failure affects the choic...
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| Format: | Article |
| Language: | English |
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Wiley
2025-02-01
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| Series: | Orthopaedic Surgery |
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| Online Access: | https://doi.org/10.1111/os.14303 |
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| _version_ | 1832557716121321472 |
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| author | Jiexin Huang Jiagu Huang Haiqi Ding Jianhua Lyu Changyu Huang Yang Chen Qijin Wang Hongyan Li Baijian Wu Ying Huang Minghui Yang Xinyu Fang Wenming Zhang |
| author_facet | Jiexin Huang Jiagu Huang Haiqi Ding Jianhua Lyu Changyu Huang Yang Chen Qijin Wang Hongyan Li Baijian Wu Ying Huang Minghui Yang Xinyu Fang Wenming Zhang |
| author_sort | Jiexin Huang |
| collection | DOAJ |
| description | ABSTRACT Purpose Following failed internal fixation of intertrochanteric fractures (FIF‐ITF), the decision to use a long‐stem or standard‐stem femoral implant in hip arthroplasty is still debated. This study aimed to explore how the healing status of fractures after FIF‐ITF failure affects the choice of femoral stem and clinical outcomes. Methods Our retrospective cohort study reviewed 105 cases of patients with FIF‐ITF who underwent hip arthroplasty at three tertiary Grade A hospitals between December 2012 and December 2022. We compared the clinical outcomes between patients with healed and unhealed fractures, focusing on the selection of femoral stems in relation to proximal medial support and the healing status of the greater trochanter. The primary outcomes measured were functional results, operative time, blood loss, and incidence of complications. A subgroup analysis was conducted to further evaluate the influence of the proximal medial buttress and greater trochanteric healing on femoral stem selection. Statistical analysis included binary and ordinal logistic regression to identify factors influencing the choice of femoral stems. Additionally, a decision tree model was developed to visually represent and explore the relationship between fracture healing status and the selection of femoral components. Results The study included 38 patients with healed fractures and 67 patients with unhealed fractures. Patients in the healed group predominantly chose standard stems and experienced better functional outcomes (p < 0.001, p = 0.002). In contrast, the unhealed group preferred long stems, resulting in longer surgical durations and increased blood loss (p = 0.008, p < 0.001). Binary logistic regression analysis revealed that nonunion of the proximal femoral medial buttress was an independent risk factor for long stems (p < 0.0001, OR = 10.402). Conclusion The selection of femoral prostheses following FIF‐ITF is influenced by the fracture healing status, particularly the presence of proximal femoral medial buttress. The decision tree model suggested that long‐stem prostheses are more appropriate when there is inadequate fracture healing and the proximal femoral medial buttress is absent. |
| format | Article |
| id | doaj-art-9a3cbe5f59bd45cfa59896c894c00c0d |
| institution | Kabale University |
| issn | 1757-7853 1757-7861 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | Wiley |
| record_format | Article |
| series | Orthopaedic Surgery |
| spelling | doaj-art-9a3cbe5f59bd45cfa59896c894c00c0d2025-02-03T03:10:59ZengWileyOrthopaedic Surgery1757-78531757-78612025-02-0117247048110.1111/os.14303Key Decision‐Making in Post‐Failed Internal Fixation of Intertrochanteric Fractures Hip Arthroplasty: A Multicenter Retrospective Study on Fracture Healing's Impact on Femoral Component SelectionJiexin Huang0Jiagu Huang1Haiqi Ding2Jianhua Lyu3Changyu Huang4Yang Chen5Qijin Wang6Hongyan Li7Baijian Wu8Ying Huang9Minghui Yang10Xinyu Fang11Wenming Zhang12Department of Orthopaedic Surgery, the First Affiliated Hospital Fujian Medical University Fuzhou ChinaDepartment of Orthopaedic Surgery, the First Affiliated Hospital Fujian Medical University Fuzhou ChinaDepartment of Orthopaedic Surgery, the First Affiliated Hospital Fujian Medical University Fuzhou ChinaDepartment of Orthopaedic Surgery, the First Affiliated Hospital Fujian Medical University Fuzhou ChinaDepartment of Orthopaedic Surgery Quanzhou Orthopedic‐Traumatological Quanzhou ChinaDepartment of Orthopaedic Surgery, the First Affiliated Hospital Fujian Medical University Fuzhou ChinaDepartment of Orthopaedic Surgery, the First Affiliated Hospital Fujian Medical University Fuzhou ChinaDepartment of Orthopaedic Surgery, the First Affiliated Hospital Fujian Medical University Fuzhou ChinaDepartment of Orthopaedic Surgery, the First Affiliated Hospital Fujian Medical University Fuzhou ChinaDepartment of Orthopaedic Surgery, the First Affiliated Hospital Fujian Medical University Fuzhou ChinaDepartment of Orthopaedics and Traumatology Beijing Jishuitan Hospital Beijing ChinaDepartment of Orthopaedic Surgery, the First Affiliated Hospital Fujian Medical University Fuzhou ChinaDepartment of Orthopaedic Surgery, the First Affiliated Hospital Fujian Medical University Fuzhou ChinaABSTRACT Purpose Following failed internal fixation of intertrochanteric fractures (FIF‐ITF), the decision to use a long‐stem or standard‐stem femoral implant in hip arthroplasty is still debated. This study aimed to explore how the healing status of fractures after FIF‐ITF failure affects the choice of femoral stem and clinical outcomes. Methods Our retrospective cohort study reviewed 105 cases of patients with FIF‐ITF who underwent hip arthroplasty at three tertiary Grade A hospitals between December 2012 and December 2022. We compared the clinical outcomes between patients with healed and unhealed fractures, focusing on the selection of femoral stems in relation to proximal medial support and the healing status of the greater trochanter. The primary outcomes measured were functional results, operative time, blood loss, and incidence of complications. A subgroup analysis was conducted to further evaluate the influence of the proximal medial buttress and greater trochanteric healing on femoral stem selection. Statistical analysis included binary and ordinal logistic regression to identify factors influencing the choice of femoral stems. Additionally, a decision tree model was developed to visually represent and explore the relationship between fracture healing status and the selection of femoral components. Results The study included 38 patients with healed fractures and 67 patients with unhealed fractures. Patients in the healed group predominantly chose standard stems and experienced better functional outcomes (p < 0.001, p = 0.002). In contrast, the unhealed group preferred long stems, resulting in longer surgical durations and increased blood loss (p = 0.008, p < 0.001). Binary logistic regression analysis revealed that nonunion of the proximal femoral medial buttress was an independent risk factor for long stems (p < 0.0001, OR = 10.402). Conclusion The selection of femoral prostheses following FIF‐ITF is influenced by the fracture healing status, particularly the presence of proximal femoral medial buttress. The decision tree model suggested that long‐stem prostheses are more appropriate when there is inadequate fracture healing and the proximal femoral medial buttress is absent.https://doi.org/10.1111/os.14303decision tree modelfailed internal fixation of intertrochanteric fracturesfemoral stem selectionfracture healing statuship arthroplasty |
| spellingShingle | Jiexin Huang Jiagu Huang Haiqi Ding Jianhua Lyu Changyu Huang Yang Chen Qijin Wang Hongyan Li Baijian Wu Ying Huang Minghui Yang Xinyu Fang Wenming Zhang Key Decision‐Making in Post‐Failed Internal Fixation of Intertrochanteric Fractures Hip Arthroplasty: A Multicenter Retrospective Study on Fracture Healing's Impact on Femoral Component Selection Orthopaedic Surgery decision tree model failed internal fixation of intertrochanteric fractures femoral stem selection fracture healing status hip arthroplasty |
| title | Key Decision‐Making in Post‐Failed Internal Fixation of Intertrochanteric Fractures Hip Arthroplasty: A Multicenter Retrospective Study on Fracture Healing's Impact on Femoral Component Selection |
| title_full | Key Decision‐Making in Post‐Failed Internal Fixation of Intertrochanteric Fractures Hip Arthroplasty: A Multicenter Retrospective Study on Fracture Healing's Impact on Femoral Component Selection |
| title_fullStr | Key Decision‐Making in Post‐Failed Internal Fixation of Intertrochanteric Fractures Hip Arthroplasty: A Multicenter Retrospective Study on Fracture Healing's Impact on Femoral Component Selection |
| title_full_unstemmed | Key Decision‐Making in Post‐Failed Internal Fixation of Intertrochanteric Fractures Hip Arthroplasty: A Multicenter Retrospective Study on Fracture Healing's Impact on Femoral Component Selection |
| title_short | Key Decision‐Making in Post‐Failed Internal Fixation of Intertrochanteric Fractures Hip Arthroplasty: A Multicenter Retrospective Study on Fracture Healing's Impact on Femoral Component Selection |
| title_sort | key decision making in post failed internal fixation of intertrochanteric fractures hip arthroplasty a multicenter retrospective study on fracture healing s impact on femoral component selection |
| topic | decision tree model failed internal fixation of intertrochanteric fractures femoral stem selection fracture healing status hip arthroplasty |
| url | https://doi.org/10.1111/os.14303 |
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