Complications after nailing of the pertrochanteric fractures with IMHS nail - influence of the »learning curve«

• Main Author: Matej Andoljšek
• Format: Article
• Language: English
• Published: Slovenian Medical Association 2006-05-01
• Series: Zdravniški Vestnik
• Subjects: pertrochanteric fractures; nailing; complications; learning curve
• Online Access: http://vestnik.szd.si/index.php/ZdravVest/article/view/2008

<p><strong>Background:</strong> Intramedullary hip nails, which combine the advantages of intramedullary fixation with those of a sliding screw, should diminish the incidence of complications after osteosynthesis of the pertrochanteric fractures. Despite less mechanical failures, this has not happened. However, some new specific complications have occured. In this retrospective study of the pertrochanteric fractures treated with IMHS nail, the author is analysing the importance of experience and the impact of »learning curve« on incidence of complications.</p><p><strong>Methods and results: </strong>Between March 1996 and July 1999 65 patients with 65 non-pathologic pertrochanteric fractures were operated with IMHS nail. Thirty-one were operated in 1996/97 (Group I), thirty-four later on (Group II). Between the groups there were no differences in demographic characteristics, types of fractures, used material or outcome. Twelve out of 65 patients (eight from Group I, four from Group II) had at least one complication. In five patients there was a crack of femoral diaphisis. In two reduction of the fracture was insufficient. In another two the hip screw protruded into the joint. One fracture dislocated secondarely. Three patients had infection. One non-union of the femoral neck showed after removal of the nail 2.5 years postinjury. Stratified statistical analysis showed that Group I had signifficantly more mechanical complications (insufficient reduction, hip screw protrusion, secondary dislocation), whereas differences between the groups in femur cracks, infection and non-union were insignificant.</p><p><strong>Conclusions:</strong> This comparative study has shown frequent complications after nailing of the pertrochanteric fractures and that with growing experience the incidence of complications decreases.All this points to an important »learning curve«.</p>