Computer-assisted three-dimensional correlation between the femoral neck-shaft angle and the optimal entry point for antegrade nailing

Anastopoulos, G.; Chissas, D.; Dourountakis, J.; Ntagiopoulos, Panagiotis G.; Zacharakis, Nikolaos; Asimakopoulos, A.; Xenakis, Theodoros

doi:10.1016/j.injury.2009.07.025

Cited by 3 publications

(5 citation statements)

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“…The anatomical offset between the femoral neck and femoral shaft axes was inherently determined. As mentioned above, previous studies reported average anterior offsets of the femoral neck of 3.5 mm and 4.6 mm [17,20].…”

Section: Tablementioning

confidence: 62%

“…This may be due to an anterior offset of the femoral neck relative to the femoral shaft. In fact, Anastopoulos et al [20] reported that the optimum entry point of intramedullary nails was 3.5±1.5 mm behind the femoral neck axis in the sagittal plane, indicating that the femoral neck is located an average of 3.5 mm anterior to the femoral shaft axis, re ecting an anterior offset. Similarly, the anterior offset of the femoral neck relative to the femoral shaft averaged 4.6 mm on CT analysis in our previous study [17].…”

Section: Discussionmentioning

confidence: 99%

“…It has been reported that posterior displacement of the proximal fragment in the lateral radiographic view (intramedullary type) should be avoided in intertrochanteric fracture reduction because it increases the risk of excessive telescoping and cut-out [7,8,10,20]. In conventional non-offset nail xation, lag screws are frequently inserted from the posterior of the femoral neck axis because of the anterior offset of the femoral neck, and tend to interfere with the posterior wall of the proximal fragments, causing posterior displacement of the fragments (intramedullary type) when screws are inserted parallel to the femoral neck.…”

Section: Discussionmentioning

confidence: 99%

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Offset nail fixation for intertrochanteric fractures improves reduction and lag screw position

Tanaka

Matsubara

Soma

et al. 2022

Preprint

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Background: Surgery for intertrochanteric fractures using intramedullary hip nails (IHNs) is one of the most common surgeries in the orthopedic field. Although IHNs provide a good overall outcome, they sometimes cause complications (e.g. a loss of reduction and cut-out). We compared the usefulness of IHNs with an anterior offset (Best Fit Nail® [BFN]) in maintaining the reduction of fragments and ensuring proper lag screw positioning to that with conventional non-offset nails, using postoperative computed tomography (CT). Methods: Fifty consecutive patients with intertrochanteric fractures who underwent surgery with BFNs (BFN group) and 50 patients who underwent surgery with conventional non-offset nails (control group) were retrospectively analyzed. Indices evaluated by postoperative CT comprised the displacement distance of proximal fragments relative to distal fragments, reduction status (intramedullary, anatomical, and extramedullary types), screw direction, and the angle between the screw and the femoral neck axis (deviation angle).Results: The median displacement distance [interquartile range] was significantly smaller in the BFN group (0 [0, 0] mm) and in the control group (4.4 [3.1, 6.3] mm) (p<0.0001). Additionally, the reduction status was significantly better in the BFN group (anatomical type in 40 cases, intramedullary type in 9 cases, and extramedullary type in 1 case) than in the control group (anatomical type in 6 cases, intramedullary type in 40 cases, and extramedullary type in 4 cases) (p<0.0001). Deviation of the lag screw direction was observed in significantly fewer cases in the BFN group (20 cases; 40%) than in the control group (35 cases; 70%). The deviation angle of the lag screw was significantly smaller in the BFN group (-0.71°±4.0°) than in the control group (5.7°±5.3°). No adverse events related to surgery were observed in either group.Conclusions: Intertrochanteric fracture surgeries using BFNs exhibited significantly smaller displacement distance, better reduction status, and higher frequency of no deviation, with central lag screw positioning, compared to those using conventional non-offset nails.

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Section: Tablementioning

confidence: 62%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Offset nail fixation for intertrochanteric fractures improves reduction and lag screw position

Tanaka

Matsubara

Soma

et al. 2022

Preprint

View full text Add to dashboard Cite

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“…Precise preoperative planning and surgical operation can reduce the occurrence of postoperative The morphology of the proximal femur is complex, and the clinical measurement of the nuchal stem angle and other related parameters is often performed with the help of X-ray, which is two-dimensional imaging and simple to operate, but due to the existence of the anterior inclination angle of the proximal femur, the measurement of the nuchal stem angle in the two-dimensional plane inevitably has some errors. Anastopoulos et al [10] found that the coronal projection of the femoral neck-stem angle was on average 5°larger than its 3D value after 3D modeling of 22 cadavers. Bonneau et al [11] measured the difference between the femoral neck-stem angle and X-ray measurements in 91 European subjects using a 3D model with a mean value of 4.5°(2.4°-6.0°).…”

Section: Discussionmentioning

confidence: 99%

Mathematical calculation of the difference in shortening length after two types of proximal femoral varus and an investigation of their applicable conditions: an own-pair design

Sun

Cui

et al. 2022

J Orthop Surg Res

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Background The shortening length of the lower extremity after the proximal femoral osteotomy is an important issue to be considered in preoperative planning of developmental dysplasia of the hip (DDH) in children. There is still a lack of research on shortening the length of the lower extremities in different proximal femoral osteotomy varus styles. We aimed to verify the relationship between the shortening length after “point-to-face” and “face-to-face” varus osteotomy and proposed a formula for calculating the difference in shortening length and verified its feasibility. Methods Fifty-five children with unilateral DDH were enrolled. The preoperative hip CT data were imported into mimics 21, 3-Matic 10 (Materialise, Leuven, Belgium) for femoral reconstruction and simulated osteotomy, and the difference (t) was calculated by directly measuring the length of the proximal femur after osteotomy. d* sinθ was measured in a three-dimensional environment to calculate the difference in femoral shortening length between the two osteotomy methods (t'). Results The results of the direct measurement method and the formula measurement method are shown in the table; the differences in the results of the femoral shortening length difference were not statistically significant (P > 0.05). The limits of agreement (95%) of the difference values using Bland–Altman analysis were between − 0.50 and 0.46 mm, with a mean of − 0.02 mm, indicating a high agreement between the two methods. r = 0.99 (P < 0.05) for the Pearson correlation analysis between the direct measurement method and the calculated method showed that the two methods were significantly correlated. Conclusions The derived formula can accurately calculate the difference in the shortening length of the proximal femur after “point-to-face” and “face-to-face” varus osteotomy in children with DDH, which is suitable for clinical application.

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“…is may be attributed to many factors like old age, fracture type, implant design, quality of reduction, and fixation. e entry point plays an important role in acceptable reduction, stable fixation, and avoiding implant-related complications [8,9]. It has been suggested in a study that lateral entry point causes damage to the gluteus muscle tendon while reaming of intramedullary nail insertion.…”

Section: Introductionmentioning

confidence: 99%

The Results of Unstable Intertrochanteric Femur Fracture Treated with Proximal Femoral Nail Antirotation-2 with respect to Different Greater Trochanteric Entry Points

Mallya

Kamath

Annappa

et al. 2020

Advances in Orthopedics

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Background. Proximal femoral nail antirotation-2 (PFNA-2) has been widely used to treat intertrochanteric fractures with varied outcomes in the previous studies. The entry point of the nail plays an important role in achieving acceptable reduction, stable fixation, and avoiding implant related complications. This study was proposed to determine the optimal greater trochanteric entry point for PFNA-2 in unstable intertrochanteric femur fractures. Methods. We conducted an observational study on 40 patients with unstable intertrochanteric fracture treated with PFNA-2 implant in a tertiary care hospital. The patients were grouped into two based on the entry point: group L for lateral and group M for medial entry. Randomization was carried out by assigning the patients to the group by alternate allocation. The quality of reduction, tip apex distance, Cleveland index, and all the complications were noted. The final follow-up was conducted at six months. The functional outcome was evaluated using modified Harris hip score. The data analysis was performed using Student’s t-test, chi square test, and Mann–Whitney test. A P value below 0.05 was considered significant. Results. Forty patients with 20 patients treated with medial entry point were included in group M and 20 patients in group L with lateral entry point. The group L had an average tip apex distance of 20.53 and group M had 20.02 (P=0.8). The complication of screw back out was seen in 3 out of 4 patients with poor reduction in group L. As per the Cleveland index, 6 patients in each group had suboptimal position and 4 out of 6 patients in group L with suboptimal position had screw back out. The lateral cortex impingement was seen in 14 patients of group L and 6 patients in group M with significant comparison (P=0.01). Three patients in group L had varus collapse with screw back out. Also, none in group M (0.05). The average modified Harris hip score in group L at six months follow-up was 71.94 and 76.8 in group M (P=0.84). Conclusion. Overall, to achieve good quality of fixation and reducing damage to gluteus medius entry point for PFNA-2 should be 5 mm medial to the greater trochanter tip.

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Computer-assisted three-dimensional correlation between the femoral neck-shaft angle and the optimal entry point for antegrade nailing

Cited by 3 publications

References 0 publications

Offset nail fixation for intertrochanteric fractures improves reduction and lag screw position

Offset nail fixation for intertrochanteric fractures improves reduction and lag screw position

Mathematical calculation of the difference in shortening length after two types of proximal femoral varus and an investigation of their applicable conditions: an own-pair design

The Results of Unstable Intertrochanteric Femur Fracture Treated with Proximal Femoral Nail Antirotation-2 with respect to Different Greater Trochanteric Entry Points

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