Complications After Hip Nailing for Fractures

Abstract

Pertrochanteric fractures in elderly patients represent a major health issue. The available surgical options are fixation with extramedullary devices, intramedullary nailing, and arthroplasty. Intramedullary nailing for hip fractures has become more popular in recent years. Advantages of intramedullary nailing for hip fracture fixation include a more efficient load transfer due to the proximity of the implant to the medial calcar, less implant strain and shorter lever arm because of its closer positioning to the mechanical axis of the femur, significantly less soft tissue disruption and periosteal stripping of the femoral cortex, shorter operative time and hospital stay, fewer blood transfusions, better postoperative walking ability, and lower rates of leg-length discrepancy. Compromise of the posteromedial cortex and/or the lateral cortex, a subtrochanteric extension of the fracture, and a reversed obliquity fracture pattern represent signs of fracture instability, warranting the use of intramedullary nailing. However, the use of intramedullary nailing, with its unique set of clinical implications, has introduced a new set of complications. The reported complications include malalignment, cutout, infection, false drilling, wrong lag screw length and drill bit breakage during the interlocking procedure, external or internal malrotation (≥20°) of the femoral diaphysis, elongation of the femur (2 cm), impaired bone healing, periprosthetic fracture distal to the tip of the nail, fracture collapse, implant failure, lag screw intrapelvic migration, neurovascular injury, secondary varus deviation, complications after implant removal, trochanteric pain, and refracture. Many of these complications are related to technical mistakes. This article reviews intramedullary nailing for the treatment of pertrochanteric femoral fractures, with an emphasis on complications.

Proximal femoral nail antirotation versus dynamic hip screw fixation for treatment of osteoporotic type 31-A1 intertrochanteric femoral fractures in elderly patients

“…Most previous studies tended to ignore type 31-A1 IFFs among elderly patients with osteoporosis, which has resulted in a lack of research among these patients and a greater tendency to encounter a deteriorating postoperative HHS together with an increased risk of radiographic complications. 16 , 25 – 27 Consequently, it is crucial to achieve a near-anatomic reduction and maintain it until union. Unfortunately, this is often difficult to achieve in elderly osteoporotic patients with type 31-A1 IFFs because intraoperative and postoperative collapse or fracture may occur; this increases the difficulty of the operation because osteoporotic type 31-A1 IFFs are at high risk of instability, without regard to type 31-A2/A3 IFFs.…”

“…Because the guide device is only part of the PFNA process, the procedure of nailing will in fact empower surgeons to achieve an improved PFNA position and thereby reduce the risk of uneven distribution of biomechanics. 34 , 16 , 22 …”

Imaging of Pelvic and Femoral Fixation Hardware: Normal Findings and Hardware Failure

“…75 Common complications after treatment of intertrochanteric and subtrochanteric fractures include screw cutout, malalignment, implant failure, nonunion, infection, and trochanteric pain. 79,80 Most intramedullary implants used in the treat-ment of intertrochanteric fractures allow for a small amount of controlled collapse through the fracture site during healing. This can lead to prominence of the cephalomedullary screw base that may be symptomatic 79 (►Fig.…”

Ausgeprägtes Emphysem nach Marknagelung einer pertrochantären Fraktur

“…Sie erlaubt die frühe Mobilisierung und ist bekannt für ihr gutes Outcome. Nichtsdestotrotz wurden zahlreiche Komplikationen, die mitunter aufgrund technischer Fehler entstehen, beschrieben [6]. Während des Aufbohrens eines langen Röhrenknochens entsteht neben großer Hitze u. a. ein hoher intramedullärer Druck.…”

“…B. Nekrosen, Frakturen, Embolien u. a. führen [5,8,9]. Die Infektionsrate, als weitere Komplikation der intramedullären Versorgung proximaler Femurfrakturen, wird in der Literatur mit 1,1-3,2 % beziffert [6,10]. Als ausgesprochen rare Komplikation wurde bis dato nur einziger weiterer Fall eines lokal begrenzten nichtinfektiösen Hautemphysems nach Marknagelung einer Humerusfraktur beschrieben.…”