Fracturas interimplante de fémur: factores de riesgo, tratamiento y evolución / Interimplant femoral fractures: risk factors, treatment and evolution

Objetivo: Determinar los factores de riesgo implicados en el desarrollo de las fracturas interimplante de fémur, analizar los tratamientos empleados en las mismas y su influencia en el pronóstico clínico y funcional de los pacientes. Material y métodos: Estudio analítico, observacional, tipo casos y controles en una muestra de 38 pacientes (40 fémures) intervenidos en nuestro centro, con presencia de 2 implantes femorales ipsilaterales, proximal y distal. Se han registrado 10 casos de fractura interimplante frente a 28 pacientes sin fractura, y se ha analizado la influencia de diferentes variables, como la edad, el sexo, las comorbilidades, las variables radiológicas, los tipos de tratamiento empleados, la evolución, etc. Resultados: El sexo femenino fue predominante en ambos grupos, con 80,7 años de edad media. La osteoporosis resultó estadísticamente significativa (p=0,007) para el desarrollo de estas fracturas. Las variables radiológicas no mostraron significación estadística. El tratamiento quirúrgico fue el más habitual, siendo la osteosíntesis con placa la opción más utilizada. La mortalidad fue del 40% a los 4 años. Aunque todas las fracturas consolidaron, se objetivó un deterioro significativo en la deambulación en los supervivientes. Conclusiones: Son fracturas predominantes en mujeres de edad avanzada. La osteoporosis constituye un factor de riesgo estadísticamente significativo. A pesar de un tratamiento óptimo y buena evolución de las fracturas se observó un deterioro en la capacidad funcional de los pacientes. Son necesarios sistemas de clasificación y algoritmos terapéuticos específicos que optimicen el manejo y pronóstico de estos pacientes

Objective: The aim of this study is to determine the risk factors involved in the development of these fractures and analyze the treatments used as well as their influence on the clinical and functional prognosis of patients. Materials and methods: We made an observational, retrospective case-control study, with a sample of 38 patients (40 femoral bones) operated in our hospital, who had two femoral ipsilateral implants, proximal and distal. We found 10 cases of interimplant fracture and 28 patients who had not suffered a fracture (2 of them had bilateral implants). We analyzed the influence of different variables, such as age, gender, comorbidities, radiological variables, type of treatments employed, clinical evolution, etc. Results: the female sex was predominant in both groups, 80.7 was the average age. Osteoporosis was statistically significant (P=.007) for the development of these fractures. We did not find statistical significance in the radiological variables. Surgical treatment was the most frequent, and the plate of osteosynthesis the most employed option. We found a death rate of 40% at 4 years. Although all fractures healed, the survivors' ambulation ability was reduced. Conclusions: interimplant fractures are predominant in elderly women. Osteoporosis is a statistically significant risk factor. Despite optimal treatment and fracture healing, functional outcomes were decreased. Specific classification systems and therapeutic algorithms are necessary to improve the management and prognosis of these patients

Interimplant femoral fractures: risk factors, treatment and evolution. / Fracturas interimplante de fémur: factores de riesgo, tratamiento y evolución.

OBJECTIVE: The aim of this study is to determine the risk factors involved in the development of these fractures and analyze the treatments used as well as their influence on the clinical and functional prognosis of patients. MATERIALS AND METHODS: We made an observational, retrospective case-control study, with a sample of 38 patients (40 femoral bones) operated in our hospital, who had two femoral ipsilateral implants, proximal and distal. We found 10 cases of interimplant fracture and 28 patients who had not suffered a fracture (2 of them had bilateral implants). We analyzed the influence of different variables, such as age, gender, comorbidities, radiological variables, type of treatments employed, clinical evolution, etc. RESULTS: the female sex was predominant in both groups, 80.7 was the average age. Osteoporosis was statistically significant (P=.007) for the development of these fractures. We did not find statistical significance in the radiological variables. Surgical treatment was the most frequent, and the plate of osteosynthesis the most employed option. We found a death rate of 40% at 4 years. Although all fractures healed, the survivors' ambulation ability was reduced. CONCLUSIONS: interimplant fractures are predominant in elderly women. Osteoporosis is a statistically significant risk factor. Despite optimal treatment and fracture healing, functional outcomes were decreased. Specific classification systems and therapeutic algorithms are necessary to improve the management and prognosis of these patients.