Cephalomedullary nails in the management of ipsilateral neck and shaft fractures of the femur—One or two femoral neck screws?

Is Reconstruction Nailing of All Femoral Shaft Fractures Cost Effective? A Decision Analysis

“…6,8,12,13,32 Like standard proximal locking screws, reconstruction locking screws are inserted using a radiolucent guide attached to the proximal nail; therefore, the technical difficulty of the nailing is not dramatically different. Currently, several, but not all, newer femoral nails are designed for reconstruction nailing using both trochanteric and piriformis starting points.…”

“…These 2 cost effectiveness can be analyzed and the difference between them is the ICER (difference in costs by the difference in effectiveness). Probability of femoral neck fracture complications 0.200 0.00 0.50 1-6, 9, 12, 13, 16-20 Probability of reconstruction nail complications 0.010 0.00 0.02 16,22 Probability of death from femur fracture 0.035 0.00 0.10 21 Probability of missed femoral neck fracture 0.370 0.00 0.60 1-6, 9, 12, 13, 16-20 Probability of ipsilateral hip fracture 0.068 0.00 0.20 1-6, 9, 12, 13, 16-20 Utilities Reconstruction nail 0.969 0.800 1.000 16,27 Reconstruction nail complications 0.820 0.500 1.000 12,16,27 Complications such as a revision of an endoprosthesis. The authors assumed that the morbidity associated with the above major complications would be a disutility of 0.3 or 24 weeks at 0.5 QALY.…”

“…However, biomechanical and clinical studies also support using reconstruction nailing for treatment of these known fractures. [12][13][14][15] The concept of placing reconstruction nailing in all femur fractures is being used clinically, but its cost effectiveness remains unknown. 16 A recent study demonstrated that reconstruction nailing of femoral shaft fractures had no clinically meaningful complications (no screw penetration, or proximal fixation failure) and minimally extended the operative time.…”

Analysis of the results of ipsilateral hip and shaft femur fractures treated with reconstruction-type intramedullary nail or various plate combinations

“…Though recent literature shows favourable results with the use of a single implant i.e., reconstruction type of intramedullary nail, we are of the opinion that treating these combination of fractures with two separate devices (plate-screw combinations) does have a role. [7][8][9][10][11][12][13][14][15] In this study we compared the outcome of ipsilateral hip and shaft femur fractures treated with reconstruction-type intramedullary nailing and various plate combinations on the fracture healing and functional outcome in patients. Very few authors have compared these two methods of fixation.…”

“…[7][8][9][10][11][12][13][14][15]  Various plate-screw combinations-including a dynamic hip screw (DHS) and long side plate combination, a hip screw with a short side plate for the neck and separate plate for the shaft or cancellous screws for femoral neck and a plate for the shaft. 13,14,16  Retrograde intramedullary nail of the shaft and screw fixation of the neck.…”