Increased 1-Year Revision Rates Among Left-Sided Intertrochanteric Femur Fractures.

OBJECTIVES: To compare 1-year revision rates among left-sided and right-sided intertrochanteric femur fractures. DESIGN: Retrospective. SETTING: 120+ contributing centers to multicentered database. PATIENT SELECTION CRITERIA: Patients who sustained intertrochanteric femur fracture (ITFF) and had a cephalomedullary nail (CMN) from 2015 to 2022 were identified. Patients were then stratified based on left-sided or right-sided fracture. Patients were excluded if younger than 18 years with <1-year follow-up. The intervention investigated was CMN on left or right side. OUTCOME MEASURES AND COMPARISONS: One-year revision surgery, comparing CMN performed on left or right side for ITFFs. RESULTS: In total, 113,626 patients met inclusion criteria, with 55,295 in the right-sided cohort and 58,331 in the left-sided cohort. There was no difference between cohorts with respect to age, gender, diabetes, osteoporosis, chronic kidney disease, or congestive heart failure (P > 0.05 for all). Patients who sustained a left ITFF and treated with a CMN were more likely to have revision surgery at 1 year (Left: 1.24%, Right: 0.90%; OR: 1.24; 95% confidence interval [CI], 1.15-1.1.33) or develop a nonunion or malunion (Left: 1.30%, Right: 0.98%; OR: 1.31; 95% CI, 1.14-1.52). The most common revision surgery conducted for both cohorts was conversion total hip arthroplasty (Left: 70.4% and Right: 70.0%). CONCLUSIONS: Patients who sustained a left intertrochanteric femur fracture and were treated with a CMN were more likely to undergo revision at 1 year due to nonunion. There were no differences in demographics and comorbidities between cohorts. Though left-sided versus right-sided confounding variables may exist, the difference in nonunion rate may be explained by clockwise torque of the lag screw used in most implants. Increased awareness, implant design, and improved technique during fracture reduction and fixation may help lower this disproportionate nonunion rate and its associated morbidity and financial impact. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Chest Wall Injury Society recommendation for surgical stabilization of nonunited rib fractures to decrease pain, reduce opiate use, and improve patient reported outcomes in patients with rib fracture nonunion after trauma.

BACKGROUND: Rib fractures are common injuries which can be associated with acute pain and chronic disability. While most rib fractures ultimately go on to achieve bony union, a subset of patients may go on to develop non-union. Management of these nonunited rib fractures can be challenging and variability in management exists. METHODS: The Chest Wall Injury Society's Publication Committee convened to develop recommendations for use of surgical stabilization of nonunited rib fractures (SSNURF) to treat traumatic rib fracture nonunions. PubMed, Embase, and the Cochrane database were searched for pertinent studies. Using a process of iterative consensus, all committee members voted to accept or reject the recommendation. RESULTS: No identified studies compared SSNURF to alternative therapy and the overall quality of the body of evidence was rated as low. Risk of bias was identified in all studies. Despite these limitations, there is lower-quality evidence suggesting that SSNURF may be beneficial for decreasing pain, reducing opiate use, and improving patient reported outcomes among patients with symptomatic rib nonunion. However, these benefits should be balanced against risk of symptomatic hardware failure and infection. CONCLUSION: This guideline document summarizes the current CWIS recommendations regarding use of SSNURF for management of rib nonunion. LEVEL OF EVIDENCE: Therapeutic/Care Management; Level IV.