AUTHOR=Fan Jixing , Lv Yang , Xu Xiangyu , Zhou Fang , Zhang Zhishan , Tian Yun , Ji Hongquan , Guo Yan , Yang Zhongwei , Hou Guojin 

TITLE=Evaluation of femoral head bone quality by Hounsfield units: A predictor of implant failure for intertrochanteric fractures after intramedullary nail fixation

JOURNAL=Frontiers in Surgery

VOLUME=Volume 9 - 2022

YEAR=2023

URL=https://www.frontiersin.org/journals/surgery/articles/10.3389/fsurg.2022.816742

DOI=10.3389/fsurg.2022.816742

ISSN=2296-875X

ABSTRACT=Purpose The aim of present study was to evaluate the femoral head bone quality by Hounsfield units and its relationship to the occurrence of implant failure for intertrochanteric fractures after intramedullary nail fixation.
Methods This retrospective study assessed 160 intertrochanteric fractures treated with intramedullary fixation. The patients were divided into control group and failure group according to patients with and without implant failure. The demographic information, femoral head HU value, the reduction quality, status of posteromedial support and position of the screw/blade were collected and compared. The logistic regression analyzes was performed to evaluate risk factors of implant failure in intertrochanteric fractures after intramedullary nail fixation.
Results 15 patients (9.38%) suffered from implant failure after intramedullary fixation. The mean HU value of femoral head was much lower in the failure group than the control group (133.25 ± 34.10 vs 166.12 ± 42.68, p=0.004). And the univariate analyzes showed that A3 fracture and poor reduction quality were associated with implant failure (P<0.05). After adjustment for confounding variables, the multivariable logistic regression analyzes showed that femoral head HU value (OR, 0.972; 95%CI, 0.952~0.993; p=0.008) and poor reduction quality (OR, 7.614; 95%CI, 1.390~41.717; p=0.019) were independent influencing factors for implant failure.
Conclusion The femoral head HU value was significantly correlated with the incidence of implant failure and can be used as an independent factor to predict implant failure for intertrochanteric fractures after intramedullary fixation.