Heterotopic Ossification Following Proximal Femoral Nail For Treatment Of Intertrochanteric Fracture:Risk Factors

Objective:This study intended to investigate the incidence and risk factors of heterotopic ossification(HO)after proximal femoral nail for intertrochanteric fractures,so as to provide evidence for clinical prevention and mitigation of HO.Methods:The development of Heterotopic ossification after proximal femoral nail surgery in 387 patients with intertrochanteric fractures from January 2018 to January 2020 was retrospectively analyzed.A total of 350 patients with communication skills and a minimum of 6 months of retrospective follow-up were included in the study.Based on the diagnosis of pelvic orthotopic position and lateral position of hip joint,according to the formation of postoperative ectopic ossification around the hip,350 patients were divided into 87 patients with ectopic ossification group(group A)and 263 patients with ectopic ossification group(group B).On two groups of patients age,gender,height,body weight,body mass index(BMI),fracture type(AO),whether in open reduction,delayed surgery(fracture to operation time),the operation time,postoperative nail tail is outstanding big rotor area,single factor analysis and Logistics of line there are statistically significant factors more factors regression analysis,concluded with proximal femoral nail postoperative heterotopic ossification of correlation.Through medical inquiry and physical examination,the tenderness in the greater trochanter area and the activity of the hip joint in the two groups were recorded,and the differences were analyzed by statistical methods.Results:Univariate analysis showed that the occurrence of heterotopic ossification was related to gender,fracture type(OA),surgical delay,duration of operation,and protrusion of tail cap in the greater trochanter area(P<0.05).Logistic multivariate regression analysis showed that fracture type(type 0A),intraoperative open reduction,operative delay and operative duration were risk factors for ectopic ossification after proximal femoral nail(P<0.05).Heterotopic ossification occurred in 23.53%(87/350)of patients.There were 45 cases(12.85%)of Class Brumback I,87 cases(6.86%)of Class II,15 cases(4.28%)of Class III,and 3 case(0.85%)of Class IV.No difference ossification group was superior to ectopic ossification group in postoperative tenderness of greater trochanter area and postoperative range of motion of hip joint.Conclusion:Heterotopic ossification is a common complication after proximal femoral nail surgery,and its risk factors include age,fracture type,intraoperative open reduction,surgical delay,and surgical duration.It is suggested that clinical prevention and intervention should be done for all kinds of risk factors.For patients with high risk factors of ectopic ossification,NSAIDs or radiotherapy can be applied postoperatively for prevention,but the side effects of NSAIDs and radiotherapy should also be paid attention to.