Late fracture of the hip after reamed intramedullary nailing of the femur

Tn a consecutive series of 498 patients with 528 fractures of the femur tre ated by conventional interlocking intramedullary nailing, 14 fractures of t he femoral neck (2.7%) occurred in 13 patients. The fracture of the hip was not apparent either before operation or on the immediate postoperative rad iographs. It was diagnosed in the first two weeks after operation in three patients and after three months in the remainder. Age over 60 years at the time of the femoral fracture and female gender wer e significantly predictive of hip fracture on bivariate logistic regression analysis, but on multivariate analysis only the location of the original f racture in the proximal third of the femur (p = 0,0022, odds ratio = 6,96, 95% CI 2.01 to 24,14), low-energy transfer (p = 0,0264, odds ratio = 15,56, 95% CI 1.38 to 75.48) and the severity of osteopenia on radiographs (p = 0 ,0128, odds ratio = 7,55, 95% CI 1.54 to 37.07) were significant independen t predictors of later fracture. Five of the 19 women aged over 60 years, wh o sustained an osteoporotic proximal diaphyseal fracture of the femur durin g a simple fall, subsequently developed a fracture of the neck. Eleven of the hip fractures were displaced and intracapsular and, in view o f the advanced age of most of these patients, were usually treated by repla cement arthroplasty, Reduction and internal fixation was used to treat the remaining three intertrochanteric fractures. Three patients developed compl ications requiring further surgery; five died within two years of their fra cture.