Objectives:
In patients with wide femoral canals, an undersized short nail may not provide adequate stability, leading to toggling of the nail around the distal interlocking screw and subsequent loss of reduction. The purpose of this study was to identify risk factors associated with nail toggle and to examine whether increased nail toggle is associated with increased varus collapse.
Design:
Retrospective cohort study.
Setting:
Level 1 and level 3 trauma center.
Patients/Participants:
Seventy-one patients with intertrochanteric femur fractures treated with short cephalomedullary nails (CMN) from October 2013 to December 2017.
Intervention:
Short CMN.
Main Outcome Measurements:
Nail toggle and varus collapse were measured on intraoperative and final follow-up radiographs. Risk factors for nail toggle including demographics, fracture classification, quality of reduction, Dorr type, nail/canal diameter ratio, lag screw engaging the lateral cortex, and tip-apex distance (TAD) were recorded.
Results:
On multivariate regression analysis, shorter TAD (
P
= .005) and smaller nail/canal ratio (
P
< .001) were associated with increased nail toggle. Seven patients (10%) sustained nail toggle >4 degrees. They had a smaller nail/canal ratio (0.54 vs 0.74,
P
< .001), more commonly Dorr C (57% vs 14%,
P
= .025), lower incidence of lag screw engaging the lateral cortex (29% vs 73%,
P
= .026), shorter TAD (13.4 mm vs 18.5 mm,
P
= .042), and greater varus collapse (6.2 degrees vs 1.3 degrees,
P
< .001) compared to patients with nail toggle < 4 degrees.
Conclusions:
Lower percentage nail fill of the canal and shorter TAD are risk factors for increased nail toggle in short CMNs. Increased nail toggle is associated with increased varus collapse.
Level of evidence:
Therapeutic Level III
We report the synthesis and evaluation of an enantiomerically enriched bifunctional chelator, (S)‐C‐NE3TA. The bifunctional chelator was efficiently prepared by regioselective and stereoselective ring opening of an aziridinium ion. The new chiral chelator instantly and almost completely bound to 64Cu at room temperature. The corresponding 64Cu‐radiolabeled complex remained intact in human serum for 48 h without any measurable transchelation and was tolerant to a rigorous EDTA challenge for 24 h. The 64Cu‐radiolabeled (S)‐C‐NE3TA complex was stable in mice and produced an excellent biodistribution profile. The results of the in vitro and in vivo evaluations indicate that the new optically active chelator is a promising candidate for PET imaging applications.
Pelvic ring fractures range from low-energy falls in the elderly to high-energy mechanisms in young patients. These injuries can be a significant cause of morbidity and mortality and are frequently associated with additional injuries. Hemorrhage and resultant hemodynamic instability are often associated with high-energy injuries and require prompt management. Circumferential pelvic antishock sheeting is an effective and readily available tool for reducing pelvic volume at the accident scene or in the emergency department, while still allowing access to the abdomen and lower extremities for ongoing resuscitation. This article, and the associated instructional video, reviews the indications and proper technique for placing a pelvic sheet.
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