Risk factors for excessive lateral migration of the blade in proximal femoral nail anti-rotation in elderly patients with intertrochanteric femur fracture

Objective: Intertrochanteric femur fractures are prevalent among the elderly, leading to substantial morbidity. Proximal femoral nail anti-rotation (PFNA) is commonly used for internal fixation, but excessive lateral migration of the PFNA blade poses a significant complication. Understanding the risk factors for this complication is crucial for optimizing patient care.

Methods: A retrospective case-control study was conducted on elderly patients with intertrochanteric femur fractures who underwent PFNA internal fixation. Patients were categorized based on the occurrence of excessive lateral migration of the blade. The differences in general information, surgical indices, imaging measures, fracture stability indicators, VAS score, Harris score, and other factors were analyzed. Single factor correlation analysis and multivariate logistic regression were utilized to identify risk factors associated with excessive blade lateral migration.

Results: Risk factors significantly associated with excessive blade lateral migration included the Singh index for osteoporosis, quality of calcar reduction, surgical indices (hospital stays, revision surgery for blade prominence), imaging measures (blade position, lateralization, and migration), fracture stability indicators (tip-apex distance, AO/OTA classification), and postoperative functional outcomes (VAS and Harris scores). Multivariate logistic regression identified these factors as independent predictors of excessive lateral migration, underlining the multifactorial nature of this complication.

Conclusion: This study identified several significant risk factors for excessive lateral migration of the PFNA blade, including bone quality, calcar reduction, surgical indices, imaging measures, and fracture stability indicators.