Are Cephalomedullary Nail Guides Accurate? A Case Report of an Unexpected Complication After Nailing an Intertrochanteric Femoral Fracture

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Abstract

Intramedullary nailing is the mainstay of treatment for unstable intertrochanteric hip fractures. Various complications have been described with the use of these nails. We report an unusual complication whereby the lag screw completely missed the nail. We hypothesize that this previously unreported complication may be related to a specific flexible carbon fiber aiming device. Surgeon awareness and thorough intraoperative imaging are crucial to avoiding this complication.

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Most cited references 14

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Fracture and dislocation classification compendium - 2007: Orthopaedic Trauma Association classification, database and outcomes committee.

J L Marsh, Theddy Slongo, Julie Agel … (2008)

The purpose of this new classification compendium is to republish the Orthopaedic Trauma Association's (OTA) classification. The OTA classification was originally published in a compendium of the Journal of Orthopaedic Trauma in 1996. It adopted The Comprehensive Classification of the Long Bones developed by Müller and colleagues and classified the remaining bones. In this compendium, the introductory chapter reviews new scientific information about classifying fractures that has been published in the last 11 years. The classification is presented in a revised format that is easier to follow. The OTA and AO classification will now have a unified alpha-numeric code eliminating the differences that have existed between the 2 codes. The code was significantly revised for the clavicle and scapula, foot and hand, and patella. Dislocations have been expanded on an anatomic basis and for most joints will be coded separately. This publication should stimulate new developments and interest in a unified language to code and classify fractures. Further improvements in classification will result in better patient care and clinical research.

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The value of the tip-apex distance in predicting failure of fixation of peritrochanteric fractures of the hip.

Kristaps J. Keggi, S Curtin, M Lindskog … (1995)

Failure of fixation of peritrochanteric fractures that have been treated with a fixed-angle sliding hip-screw device is frequently related to the position of the lag screw in the femoral head. A simple measurement has been developed to describe the position of the screw. This measurement, the tip-apex distance, is the sum of the distance from the tip of the lag screw to the apex of the femoral head on an anteroposterior radiograph and this distance on a lateral radiograph, after controlling for magnification. To determine the value of this measurement in the prediction of so-called cutout of the lag screw, 198 peritrochanteric fractures (193 patients) were studied. The minimum duration of follow-up was three months (average, thirteen months), during which period all of the fractures either healed or had failure of the fixation. Of the nineteen failures that were identified, sixteen were due to the device cutting out of the femoral head. The average tip-apex distance was twenty-four millimeters (range, nine to sixty-three millimeters) for the successfully treated fractures compared with thirty-eight millimeters (range, twenty-eight to forty-eight millimeters) for those in which the screw cut out (p = 0.0001). None of the 120 screws with a tip-apex distance of twenty-five millimeters or less cut out, but there was a very strong statistical relationship between an increasing tip-apex distance and the rate of cutout, regardless of all other variables related to the fracture.(ABSTRACT TRUNCATED AT 250 WORDS)

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Reverse obliquity fractures of the intertrochanteric region of the femur.

George Haidukewych, D. Berry, Gary Israel (2001)

The reverse obliquity fracture of the proximal part of the femur is a distinct fracture pattern that is mechanically different from most intertrochanteric fractures. The purpose of this retrospective study was to determine the prevalence of these fractures and the results and complications of different types of internal fixation used in their treatment. Between 1988 and 1998, 2472 consecutive patients with a hip fracture were treated at our Level-One Trauma Center; 1035 of the fractures were classified as intertrochanteric or subtrochanteric. Clinical and radiographic records were retrospectively reviewed, and fifty-five fractures with a reverse obliquity pattern were identified. Forty-nine patients were followed until the fracture united or a revision operation was performed. The duration of clinical follow-up averaged eighteen months (range, three to sixty-seven months), and the duration of radiographic follow-up averaged fifteen months (range, three to sixty months). Fractures were classified with the Orthopaedic Trauma Association scheme. Results were analyzed according to the fracture pattern, type of implant, quality of the reduction, position of the implant, and use of bone graft at the index operation. Function was assessed on the basis of pain, living situation, need for walking aids, need for analgesics, and walking capacity. Thirty-two (68%) of forty-seven hips treated with internal fixation healed without an additional operation. Fifteen (32%) of the forty-seven failed to heal or had a failure of fixation. The failure rate was nine of sixteen for the sliding hip screws, two of fifteen for the blade-plates, three of ten for the dynamic condylar screws, one of three for the cephalomedullary nails, and zero of three for the intramedullary hip screws. Use of the fixed-angle devices (the blade-plate and the dynamic condylar screw) resulted in fewer failures than did use of the sliding hip screw (p = 0.023). Eleven (46%) of twenty-four nonanatomically reduced fractures and four (17%) of twenty-three anatomically reduced fractures had a failure of treatment (p = 0.060). Eleven (26%) of forty-two fractures with an ideally placed implant and four (80%) of five fractures with a non-ideally placed implant had a failure of treatment (p = 0.023). Of the fifteen fractures that failed to heal or had a failure of fixation, five were treated with revision to a calcar-replacement prosthesis, seven were treated with revision open reduction and internal fixation with bone-grafting, and one was treated with bone-grafting without revision of the fixation. Two patients refused additional surgery because they had limited functional demands. The two-year mortality rate was 33%. Functional results were poor, with many patients requiring walking aids and losing the capacity for independent walking and self-care. In this series, reverse obliquity fractures accounted for 2% of all hip fractures and 5% of all intertrochanteric and subtrochanteric fractures. Ninety-five-degree fixed-angle internal fixation devices performed significantly better than did sliding hip screws. Results were also worse for fractures with poor reduction and those with a poorly placed implant.

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Author and article information

Journal

Journal ID (nlm-ta): Geriatr Orthop Surg Rehabil

Journal ID (iso-abbrev): Geriatr Orthop Surg Rehabil

Journal ID (publisher-id): GOS

Journal ID (hwp): spgos

Title: Geriatric Orthopaedic Surgery & Rehabilitation

Publisher: SAGE Publications (Sage CA: Los Angeles, CA )

ISSN (Print): 2151-4585

ISSN (Electronic): 2151-4593

Publication date (Electronic): 22 March 2018

Publication date Collection: 2018

Volume: 9

Electronic Location Identifier: 2151458518757797

Affiliations

[1 ]Division of Orthopaedic Surgery, Montreal Children Hospital, McGill University, Montreal, QC, Canada

[2 ]Department of Orthopedic Surgery, King Abdulaziz University, Jeddah, Saudi Arabia

[3 ]Division of Orthopedic Surgery, St. Mary's Hospital, McGill University, Montreal, QC, Canada

Author notes

[*]Rayan Fairag, Montreal General Hospital, McGill University Health Centre, 1650 Cedar Avenue, T8-200, Montreal, QC, Canada H3G 1A4. Email: rayan.fairag@ 123456gmail.com

Article

Publisher ID: 10.1177_2151458518757797

DOI: 10.1177/2151458518757797

PMC ID: 5871037

SO-VID: 55121778-c290-4259-8d4b-06ed0b481b1b

License:

This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ( http://www.creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

History

Date received : 12 August 2017

Date revision received : 7 December 2017

Date accepted : 16 December 2017

Custom metadata

cover-date January-December 2018

Keywords: hip fracture,intertrochanteric fractures,cephalomedullary nails,complication

Data availability:

Keywords: hip fracture, intertrochanteric fractures, cephalomedullary nails, complication

Are Cephalomedullary Nail Guides Accurate? A Case Report of an Unexpected Complication After Nailing an Intertrochanteric Femoral Fracture

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Most cited references 14

Fracture and dislocation classification compendium - 2007: Orthopaedic Trauma Association classification, database and outcomes committee.

The value of the tip-apex distance in predicting failure of fixation of peritrochanteric fractures of the hip.

Reverse obliquity fractures of the intertrochanteric region of the femur.

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