THE RADIOLOGICAL RISK FACTORS AFFECTING MECHANICAL FAILURE IN THE SURGICAL TREATMENT WITH PROXIMAL FEMORAL NAIL OF INTERTROCHANTERIC FRACTURES IN ELDERLY PATIENTS: A RETROSPECTIVE COHORT STUDY

OpenAlex İngilizce

Introduction: The aim of this study was to determine the rates of mechanical failure in patients who underwent proximal femoral nail fixation for intertrochanteric femur fractures, to identify the radiological risk factors for these failures, and to examine in particular the influence of the tip-apex distance and the femoral neck-shaft angle on treatment outcomes. Materials and Method: A total of 90 patients who underwent proximal femoral nail fixation for intertrochanteric femoral neck fractures between 2019 and 2024 were retrospectively evaluated. Demographic, clinical, and radiological data were analyzed. The relationship between treatment success and the femoral neck-shaft angle and tip-apex distance was investigated. Statistical analyses included the Mann–Whitney U test, chi-square test, receiver operating characteristic curve analysis, and logistic regression. Results: Mechanical failure occurred in 66.7% of the patients. In this group, the femoral neck-shaft angle was significantly higher (129.66 ± 7.20°, p=0.037), and the tip-apex distance value was greater (25.25 ± 8.37 mm, p=0.045). Receiver operating characteristic curve analysis revealed cutoff values of 119° for the femoral neck-shaft angle and 27 mm for the tip-apex distance. Conclusion: The most important factors associated with treatment failure are improper implant positioning with an unfavorable femoral neck-shaft angle and an increased tip-apex distance. Maintaining the femoral neck-shaft angle within the range of 125°–130° and a tip-apex distance of less than 25 mm during surgical planning appears to improve success rates. However, these parameters alone are insufficient, and comprehensive evaluation of all contributing factors remains essential for clinical success. Keywords: Bone Nails; Fracture Fixation; Hip Fractures; Prosthesis Failure; Treatment Failure.