Proximal Femoral Shortening and Varus Collapse After Fixation of “Stable” Pertrochanteric Femur Fractures
David J. Ciufo, John Ketz
Abstract
OBJECTIVES: To evaluate and compare femoral neck shortening and varus collapse in stable pertrochanteric femur fractures treated with sliding hip screws (SHSs) or cephalomedullary nails (CMNs). DESIGN: Retrospective review. SETTING: Academic medical center. PATIENTS: A total of 290 patients were included in the study. The average age was 82 years, and most were women. All sustained low-energy pertrochanteric femur fractures (OTA/AO A1.1, 1.2, 1.3, 2.2) treated operatively with SHSs or CMNs. Minimum radiographic follow-up was 3 months, with an average of 28 (range 3-162) months. INTERVENTION: CMN or SHS fixation. MAIN OUTCOME MEASURES: Varus collapse of the femoral neck-shaft angle and proximal femoral shortening. RESULTS: Both implants allowed some varus collapse. Univariate analysis demonstrated a significantly greater portion of patients with SHSs progressed to varus collapse >5 degrees (P = 0.02), mild horizontal shortening >5 mm (P < 0.01), and severe horizontal shortening >10 mm (P < 0.01). There was no statistical difference in vertical shortening (P = 0.3). There was no difference in implant failure (P = 0.5), with failure rates of 3% for cephalomedullary implants and 5% for SHS constructs. CONCLUSIONS: The SHS group experienced greater varus collapse and horizontal shortening. There was no difference in overall implant failure. These findings suggest that the CMN is a superior construct for maintenance of reduction in stable pertrochanteric fractures, which may lead to improved functional outcomes as patients recover. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.