Breakage in Two Points of a Short and Undersized “Affixus” Cephalomedullary Nail in a Very Active Elderly Female: A Case Report and Review of the Literature

Rollo, Giuseppe; Rinonapoli, Giuseppe; Pichierri, Paolo; Bisaccia, Michele; Caraffa, Auro; Meccariello, Luigi

doi:10.1155/2018/9580190

Cited by 4 publications

(13 citation statements)

References 28 publications

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“…6 Reasons for the breakage may also be attributed to excessive premature weight bearing or prolonged cyclical loading (eg, with nonunion). [19][20][21] The current study found that age 50-64 (vs 75+) and subtrochanteric or pathological fracture were more often associated with IMN breakage. These factors are mostly consistent with a study in the UK from 2004 to 2013 by Johnson et al 15 who found that younger age, low American Society of Anesthesiologists (ASA) score, subtrochanteric fracture, and pathological fracture were independent nail fracture risk factors in proximal femoral fractures.…”

Section: Discussionmentioning

confidence: 45%

“…Multiple factors such as fracture type, patient comorbidities, surgical approach, and the type of IMN may affect the likelihood of nail breakage. [19][20][21][24][25][26] Subtrochanteric fractures, which occur in the area within 5 cm distal to the lesser trochanter, are prone to nonunion and malunion and require proper reduction before and during fixation to ensure favorable results. 6 Reasons for the breakage may also be attributed to excessive premature weight bearing or prolonged cyclical loading (eg, with nonunion).…”

Section: Discussionmentioning

confidence: 99%

“…15 Implant breakage usually occurs at the level of the lag screw aperture, 15 although the nail itself may also break, usually at distal barrel taper or at the nail lag screw aperture. 15,[19][20][21] Reasons for the breakage may be excessive premature weight bearing or prolonged cyclical loading (eg, with nonunion). [19][20][21] Mechanical displacement of IMN occurs when there is problematic movement of the IMN (eg, rotation, angulation, etc) that may be associated with malreduction and subsequently fracture malunion, nonunion, or shortening.…”

Section: Introductionmentioning

confidence: 99%

“…15,[19][20][21] Reasons for the breakage may be excessive premature weight bearing or prolonged cyclical loading (eg, with nonunion). [19][20][21] Mechanical displacement of IMN occurs when there is problematic movement of the IMN (eg, rotation, angulation, etc) that may be associated with malreduction and subsequently fracture malunion, nonunion, or shortening. 22,23 Rates of nail breakage or mechanical displacement following surgical repair of proximal femoral fractures with IMN are not well established as these depend on multiple factors such as fracture type, patient comorbidities, surgical approach, and the type of IMN.…”

Section: Introductionmentioning

confidence: 99%

“…22,23 Rates of nail breakage or mechanical displacement following surgical repair of proximal femoral fractures with IMN are not well established as these depend on multiple factors such as fracture type, patient comorbidities, surgical approach, and the type of IMN. [19][20][21] A better understanding of the rates and patterns of occurrence of IMN breakage and mechanical displacement would be helpful to evaluate the magnitude of these problems and possibly how to avoid them. The objective of this study was to use administrative claims data to evaluate the rates of, and factors associated with, IMN breakage and mechanical displacement in patients with subtrochanteric, intertrochanteric, or basicervical femoral neck fractures.…”

Section: Introductionmentioning

confidence: 99%

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Intramedullary Nail Breakage and Mechanical Displacement in Patients with Proximal Femoral Fractures: A Commercial and Medicare Supplemental Claims Database Analysis

Chitnis

Ray²,

Sparks³

et al. 2021

MDER

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Objective This study evaluated the rates and patterns of intramedullary nail (IMN) breakage and mechanical displacement for proximal femur fractures and the factors associated with their occurrence. Patients and Methods Patients with subtrochanteric, intertrochanteric, or basicervical femoral neck fractures treated with IMN from 2016 to 2019 were identified from commercial and Medicare supplemental claims databases and were followed for up to two years. Kaplan–Meier analysis estimated the cumulative incidence of and patterns of breakage/mechanical displacement. Multivariable Cox regression models evaluated the factors associated with breakage/mechanical displacement. Results A total of 11,128 patients had IMN fixation for subtrochanteric, intertrochanteric, or basicervical femoral neck fractures: (mean SD) age 75.6 (16.4) years, 66.2% female, 74.3% Medicare supplemental vs 26.7% commercial insurance. Comorbidities included hypertension (62.9%), osteoporosis (27.3%), cardiac arrhythmia (23.1%), diabetes (30.7%), and chronic pulmonary disease (16.3%). Most fractures were closed (97.2%), intertrochanteric or basicervical femoral neck (80.1%), and not pathological (91.0%). The cumulative incidence of nail breakage over two years was 0.66% overall, 1.44% for combination fractures, 1.16% for subtrochanteric fractures, and 0.49% for intertrochanteric or basicervical fractures. The cumulative incidence of mechanical displacement was 0.37% overall, 0.43% for subtrochanteric fractures, 0.42% for combination fractures, and 0.36% for intertrochanteric or basicervical femoral neck fractures. Half of the breakages occurred within five months after surgery and half of the mechanical displacements occurred within 75 days. Age 50–64 (vs 75+) and subtrochanteric or pathological fracture were more commonly associated with nail breakage. Complicated hypertension was more commonly associated with mechanical displacement. Conclusion The incidence of IMN breakage and mechanical displacement in US commercial and Medicare supplemental patients with proximal femur fractures from 2016 to 2019 was low (0.66% and 0.37%, respectively up to two years). Age 50–64 (vs 75+) and subtrochanteric or pathological fracture were more commonly associated with breakage. Complicated hypertension was associated with mechanical displacement.

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Section: Discussionmentioning

confidence: 45%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Intramedullary Nail Breakage and Mechanical Displacement in Patients with Proximal Femoral Fractures: A Commercial and Medicare Supplemental Claims Database Analysis

Chitnis

Ray²,

Sparks³

et al. 2021

MDER

View full text Add to dashboard Cite

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Defining Cephalomedullary Nail Breakage Rates: A Systematic Review and Meta-Analysis

Lambers,

D'Alessandro,

Yates

2023

Journal of Orthopaedic Trauma

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Objective: To establish the background rate of breakage of cephalomedullary nails. Data Sources: MEDLINE, PubMed, and Web of Science were searched on April 3, 2023. Study Selection: All English-language studies that examined trochanteric with or without subtrochanteric fractures and identified cephalomedullary nail breakage as an outcome measure and a breakage rate could be derived were included. Implants captured were predominantly the TFNA, TFN, and PFN by DePuy Synthes, various versions of the Gamma nail by Stryker, the Zimmer Natural Nail by Zimmer Biomet, and the Intertan by Smith and Nephew. Data Extraction: The author, year of publication, dates of implant insertion, study design, method of detection of breakages, implant used, number of implant breakages, number of implants inserted, breakage rate, and follow-up were extracted. Data Synthesis: Meta-analysis of included studies used descriptive nonparametric statistics and a noncomparative proportion for the pooled result. Differences in results between study design types were compared using the mean breakage rate per study design. Conclusions: Cephalomedullary nail breakage is a rare complication with a median reported rate of 0.6% and a pooled result rate of 0.4%. Ninety-five percent of studies had a breakage rate of 1.3% or less, which sets a benchmark from the reported literature for future studies. There is wide variability in rates of breakage reported between different types of study designs with single-center review studies reporting breakage rates nearly 4-fold greater than large-scale administrative database reviews. The rate of implant breakage should not be used in isolation to judge an implant's performance. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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Characteristics of intramedullary nail breakage in pertrochanteric femur fractures: a summary of 70 cases

Zhang

Zhou

et al. 2021

J Orthop Surg Res

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Objective To reveal noteworthy characteristics of intramedullary (IM) nail breakage in pertrochanteric femur fractures. Materials and methods The data from 6 patients with IM nail breakage in our hospital between August 2008 and May 2018 were reviewed retrospectively. With an additional 64 cases reported in articles in the PubMed database prior to October 2019, a total of 70 cases were reviewed and analysed; epidemiological patient data and data on the initial trauma, fracture type, nail selected for the original surgery, time from surgery to breakage, mechanism and location of breakage, status of fracture healing, salvage treatment and prognosis were assessed. Results Seventy patients with pertrochanteric fractures, including 2 stable fractures and 68 unstable fractures, experienced IM nail breakage at a mean of 9.4 months after the initial surgery. Among them, 9 (12.9%) occurred within 3 months, 23 (32.9%) between 3 and 6 months and 38 (54.3%) after 6 months. The mean age was 72.3 years, and 16 (22.9%) patients were younger than 65 years old. When nail breakage occurred, 66 fractures (94.3%) exhibited delayed union/non-union. Self-dynamisation was found in 12 cases (17.1%). The salvage procedures included 4 partial/total implant removal procedures, 17 hemi/total hip arthroplasty procedures, 3 conservative treatment procedures, and 46 revised osteosyntheses, of which 7 cases (15.2%) sustained secondary implant failure. No significant differences were found between the failure rates of IM nails and extramedullary(EM) devices (odds ratio [OR], 3.429; 95% confidence interval [CI], 0.632–18.877; p = 0.330). Conclusion IM nail breakage is a rare complication lack of time regularity and mostly occurs in unstable pertrochanteric fractures in the presence of delayed union/non-union. Osteosynthesis revision can be conduct by a new IM nail or EM device but considerable secondary failure rate is noteworthy. Self-dynamisation may be a warning sign of nail breakage.

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Breakage in Two Points of a Short and Undersized “Affixus” Cephalomedullary Nail in a Very Active Elderly Female: A Case Report and Review of the Literature

Cited by 4 publications

References 28 publications

Intramedullary Nail Breakage and Mechanical Displacement in Patients with Proximal Femoral Fractures: A Commercial and Medicare Supplemental Claims Database Analysis

Intramedullary Nail Breakage and Mechanical Displacement in Patients with Proximal Femoral Fractures: A Commercial and Medicare Supplemental Claims Database Analysis

Defining Cephalomedullary Nail Breakage Rates: A Systematic Review and Meta-Analysis

Characteristics of intramedullary nail breakage in pertrochanteric femur fractures: a summary of 70 cases

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