OBJECTIVES

: Intramedullary nailing (IMN) is a common procedure for patients with femoral fractures requiring surgical repair. The technology has been utilized for more than 50 years and has shown favorable outcomes. This study evaluates patient characteristics associated with postoperative complications.

METHODS

: A retrospective database analysis was conducted in the IBM® MarketScan® Commercial Database. Patients with femoral fractures during an inpatient admission with surgery requiring IMN (aka “Index”) between 2010-2018 were identified. Patient demographics, comorbidities at time of index repair procedure (31 Elixhauser comorbidity indices), fracture type (open vs closed), precise fracture anatomy and postoperative complication occurrence (compartment syndrome (CS), deep infection (DI), nonunion and mechanical complication (MC)) were identified for all cases. Kaplan-Meier survival analyses and Cox proportional hazard models were built for each complication type.

RESULTS

: 17,081 patients with femoral fractures requiring IMN were identified (mean age: 41.98 (standard deviation (SD): 19.01), 45.2% female). Orthopedic risk factors (osteoporosis, rheumatoid arthritis (RA) and obesity) were present in 15.2%, 4.3% and 9.5% patients, respectively. Most patients had few comorbidities at time of index (Elixhauser index: mean: 2.39 (SD: 2.43)). At 365-days, nonunion, CS, DI and MC rates reached 9.4% (95% confidence interval (CI): 8.9%-9.4%), 0.3% (95%CI: 0.2%-0.4%), 2.0% (95%CI: 1.8%-2.3%), 6.6% (95%CI: 6.2%-7.0%) respectively. Obesity, RA and depression were significantly associated with nonunion (Hazard Ratio (HR): 1.28 (95%CI: 1.08-1.53 – p=0.005), 1.38 (95%CI: 1.10-1.76 – p=0.006), 1.25 (95%CI: 1.08-1.45 – p=0.003). Obesity was associated with DI (HR: 1.47 (95% CI: 1.07-2.03 – p=0.019) and only RA was strongly associated with CS (HR: 4.33 (95%CI: 1.7-11.0 – p=0.002).

CONCLUSIONS

: Nonunion was the greatest complication following fracture treatment with IMN. Patient characteristics present at time of index surgery, such as obesity, RA and depression, were associated with increased risks for complications.