Outcomes of angular stable locked intramedullary nailing in elderly patients with femur fracture

Abstract text (incl. references and figure legends)

Objectives: To compare radiographic outcomes of patients who underwent intramedullary (IM) nailing in the elderly patients with femur fracture according to the use of Angular stable locking system (ASLS) screws.

Methods & Materials: One hundred thirty-six patients aged 60 years or older who underwent IM nail fixation for subtrochanteric or femoral shaft fracture were included. Main outcome Measures were union rate, union time, and reoperation rate.

Results: ASLS was used in 66 patients (48.5%). There were 54 subtrochanteric and 82 diaphyseal femoral fractures and 59 non-atypical and 77 atypical femoral fractures. Overall, 124 patients (91.2%) achieved union without additional surgery and mean union time was 31.2± 13.1 weeks. There were no statistical differences of union rate, time to union, and reoperation rate according to use of ASLS (p>0.05). When compared by fracture type or fracture location, there was no statistical difference in the outcomes according to use of ASLS (p>0.05). In subgroup analysis, only non-atypical, subtrochanteric area group showed statistically shorter time to union when ASLS was used (p=0.011).

Conclusion: In geriatric patients with femoral shaft fracture including subtrochanteric fracture, the use of ASLS is not considered to have a significant effect on fracture healing. Femur shaft fractures in elderly patients seem to be more affected by quality of reduction and fracture characteristics, such as atypical femoral fractures, rather than implants.

References:

Höntzsch D, Blauth M, Attal R. [Angle-stable fixation of intramedullary nails using the Angular Stable Locking System® (ASLS)]. Oper Orthop Traumatol. 2011;23(5):387-96. Horn J, Linke B, Höntzsch D, Gueorguiev B, Schwieger K. Angle stable interlocking screws improve construct stability of intramedullary nailing of distal tibia fractures: a biomechanical study. Injury. 2009;40(7):767-71.

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