BACKGROUND Previous studies comparing reoperation risk between integrated dual lag screw (IDL) and single lag component (SL) cephalomedullary nails (CMNs) in the treatment of intertrochanteric femoral fractures have demonstrated mixed results. The purpose of this study was to assess the rates of reoperation for fixation failure and all-cause reoperation in a large, multi-institutional cohort of patients with an intertrochanteric fracture treated with an IDL or SL CMN. We hypothesized that there would be no difference between the groups with respect to either of the reoperation rates. METHODS Adults (≥18 years old) who sustained an intertrochanteric fracture (AO/OTA 31A1 to 31A3) treated with an IDL or SL CMN between January 2014 and May 2021 at 1 of 13 Level-I trauma centers were included. Patients with <3 months of follow-up or pathologic fractures were excluded. Rates of reoperation were compared with use of the chi-square test and multivariable regression, controlling for age, gender, injury mechanism, fracture pattern, and postoperative neck-shaft angle. RESULTS A total of 2,130 patients met the inclusion criteria. The median age was 78 years, and 62.5% of patients were female. The cohort consisted of 287 patients (13.5%) with an IDL CMN and 1,843 patients (86.5%) with an SL CMN. A total of 99 patients (4.6%) had a reoperation of any type, of whom 29 (1.4% of all patients) had a reoperation for fixation failure. Compared with patients with an SL CMN, those with an IDL CMN had higher rates (4.2% versus 0.9%; p < 0.001) and odds (odds ratio [OR], 4.95 [95% confidence interval (CI), 2.29 to 10.69]; p < 0.001) of reoperation for fixation failure as well as higher rates (7.3% versus 4.2%; p = 0.021) and odds (OR, 1.83 [95% CI, 1.10 to 3.06]; p = 0.021) of all-cause reoperation. CONCLUSIONS Intertrochanteric femoral fractures treated with an IDL CMN were associated with low but significantly higher rates and significantly higher odds of reoperation for fixation failure and all-cause reoperation compared with those treated with an SL CMN. We suggest caution to surgeons in the use of IDL CMNs for high-risk patients and recommend using SL CMNs for most patients with intertrochanteric femoral fractures. LEVEL OF EVIDENCE Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.

中文翻译：

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集成双方头螺钉比单方头髓钉对固定失败的再手术率更高：一项对 2,130 名股骨粗隆间骨折患者的回顾性研究。


背景 先前的研究比较了集成双方螺钉 （IDL） 和单方头髓钉 （CMN） 治疗股骨粗隆间骨折的再手术风险，结果喜忧参半。本研究的目的是评估接受 IDL 或 SL CMN 治疗的大型多机构股骨粗隆间骨折患者再手术固定失败和全因再手术的发生率。我们假设两组之间在二次手术率方面没有差异。方法 纳入 2014 年 1 月至 2021 年 5 月期间在 13 个 I 级创伤中心中的 1 个接受 IDL 或 SL CMN 治疗的股粗隆间骨折 （AO/OTA 31A1 至 31A3） 的成人 （≥18 岁）。排除随访 <3 个月或病理性骨折的患者。将再次手术率与使用卡方检验和多变量回归进行比较，控制年龄、性别、损伤机制、骨折类型和术后颈干角度。结果 共有 2,130 例患者符合纳入标准。中位年龄为 78 岁，62.5% 的患者为女性。该队列包括 287 例 IDL CMN 患者 （13.5%） 和 1,843 例 SL CMN 患者 （86.5%）。共有 99 例患者 （4.6%） 进行了任何类型的再次手术，其中 29 例 （占所有患者的 1.4%） 因固定失败而再次手术。与 SL CMN 患者相比，IDL CMN 患者再次手术固定失败的发生率更高（4.2% 对 0.9%;p < 0.001）和比值（比值比 [OR]，4.95 [95% 置信区间 （CI），2.29 至 10.69];p < 0.001）以及更高的固定失败率（7.3% 对 4.2%;p = 0.021）和比值（OR，1.83 [95% CI， 1.10 到 3.06];p = 0。021） 全因再手术。结论 与 SL CMN 治疗相比，IDL CMN 治疗的股骨粗隆间骨折固定失败和全因再次手术的发生率较低但显著较高，且再次手术的几率显著较高。我们建议外科医生谨慎使用IDL CMNs用于高危患者，并推荐大多数股骨粗隆间骨折患者使用SL CMN。证据级别 治疗级别 III .有关证据级别的完整描述，请参阅作者说明。