{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T14:46:24Z","timestamp":1787755584763,"version":"build-2784847793"},"reference-count":33,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"15","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,8,6]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Whether the fixation of pertrochanteric and intertrochanteric fragility fractures impacts the risk of subsequent peri-implant fracture remains unclear. We hypothesized that peri-implant fracture after an index pertrochanteric or intertrochanteric fragility fracture is associated with fixation that does not reach the distal metaphysis (non-spanning fixation).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Retrospective chart review was performed of patients treated for index pertrochanteric and intertrochanteric femoral fragility fractures at 2 health-care systems between January 1, 2005, and January 1, 2018. Cases were categorized by whether or not fixation reached the distal metaphysis (spanning compared with non-spanning). Kaplan-Meier survival analyses estimated cumulative incidences of peri-implant fracture stratified by patient, injury, and treatment characteristics, with hazard ratios (HRs) reported when significant. We also assessed whether spanning or non-spanning fixation was associated with a contralateral femoral fracture (a proxy for patient-related fracture risk). Significance was set at p &lt; 0.05.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>In this study, 913 patients with a median age of 80 years had a median follow-up of 5 months (interquartile range [IQR], 3 weeks to 2.7 years). The OTA\/AO classification included 388 type 31-A1 fractures, 324 type 31-A2 fractures, and 201 type 31-A3 fractures. There were 18 subsequent peri-implant fractures (1.9%) and 40 subsequent contralateral femoral fractures (4.4%). The cumulative incidence of peri-implant fracture was lower over time (p &lt; 0.01) with spanning fixation (0% prior to 1 year) compared with non-spanning (3.3% prior to 1 year). The HR of spanning fixation for the entire time period was 0.14 (95% confidence interval, 0.03 to 0.62; p &lt; 0.01). Peri-implant fracture risk was greater with non-spanning plates (p &lt; 0.01) and non-spanning nails (p &lt; 0.01) than spanning fixation, with cumulative 1-year incidences of 3.5% for non-spanning plates, 2.6% for non-spanning nails, and 0% for spanning fixation. Peri-implant fracture was not associated with other variables (p &gt; 0.05). Contralateral fracture was not associated with the fixation group (p = 0.77), tempering concern regarding potential bias.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Spanning fixation following pertrochanteric and intertrochanteric femoral fragility fractures mitigates the risk of a peri-implant fracture. However, the choice of fixation for a given patient requires that this risk be considered within the greater context of surgical decision-making.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>\n                      Therapeutic\n                      <jats:underline>Level III<\/jats:underline>\n                      . See Instructions for Authors for a complete description of levels of evidence.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.24.01169","type":"journal-article","created":{"date-parts":[[2025,7,8]],"date-time":"2025-07-08T14:01:25Z","timestamp":1751983285000},"page":"1709-1716","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":2,"title":["A Multicenter Study of Intertrochanteric and Pertrochanteric Fragility Fractures: Spanning Fixation Mitigates the Risk of Peri-Implant Fractures"],"prefix":"10.2106","volume":"107","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1496-759X","authenticated-orcid":false,"given":"Michael P.","family":"Murphy","sequence":"first","affiliation":[{"name":"Loyola University Medical Center, Maywood, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7259-1426","authenticated-orcid":false,"given":"Kaden 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Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9055-5824","authenticated-orcid":false,"given":"Bailey","family":"Johnson","sequence":"additional","affiliation":[{"name":"Loyola University Medical Center, Maywood, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5225-2600","authenticated-orcid":false,"given":"Hobie","family":"Summers","sequence":"additional","affiliation":[{"name":"Loyola University Medical Center, Maywood, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Cohen","sequence":"additional","affiliation":[{"name":"Loyola University Medical Center, Maywood, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5720-2808","authenticated-orcid":false,"given":"William D.","family":"Lack","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery and 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