Distal femoral complications following antegrade intramedullary nail placement

Fantry, Amanda; Elia, Gregory; Vopat, Bryan G.; Daniels, Alan H.

doi:10.4081/or.2015.5820

Cited by 19 publications

(10 citation statements)

References 18 publications

(32 reference statements)

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“…One anterior perforation was observed. The problem of anterior perforation and the mismatch between femoral and nail radius of curvature is well-documented [32][33][34] , and might prompt the surgeon to choose a shorter nail that leaves the distal part of the femur unprotected. While we believe that increasing working length of the nail and individualizable radius of nail curvature should decrease the risk for distal complications [33][34][35] , further studies will be needed to elucidate this problem.…”

Section: Discussionmentioning

confidence: 99%

Reduced Risk of Reoperation Using Intramedullary Nailing with Femoral Neck Protection in Low-Energy Femoral Shaft Fractures

Bögl

Zdolsek

Michaëlsson

et al. 2020

Journal of Bone and Joint Surgery

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BackgroundIn Sweden, approximately one in four women aged 50 years or older will sustain a hip fracture. Patients treated for a femoral shaft fracture are likely to have an even higher risk. We hypothesized that intramedullary nails (IMN) protecting the femoral neck reduce the risk of subsequent hip fracture and allow the patient to avoid a challenging reoperation. MethodsBetween 2008 and 2010, 5,475 fractures of the femoral shaft, in patients aged ≥55 years, were registered in Sweden. Of these, 897 patients fulfilled the inclusion criteria. We used radiographs and register data to identify reasons for and types of reoperation that occurred between the index surgery and December 31, 2014. Categories of implants were determined through review of x-rays as: IMN with protection of the femoral neck (FNP) and without protection of the femoral neck (NFNP). Reoperations related to peri-implant fractures (including hip fractures), were analyzed as a subgroup of all major reoperations.Multivariable-adjusted, cause-specific hazard ratios (csHRs) were calculated to compare the risk for reoperation between nails with FNP and NFNP. ResultsAmong the 897 patients, a total of 82 reoperations were performed. In 640 patients who were treated with IMN with FNP, there were 7 peri-implant fractures (no hip fractures), and 27 major reoperations. Among the 257 patients who were treated with IMN with NFNP, 14 periimplant hip fractures and 24 major reoperations were identified. Patients who received nails with FNP had a lower hazard for any peri-implant fracture and major reoperation, with multivariable-adjusted csHR values of 0.19 (95% CI 0.07-0.5) and 0.51 (0.28-0.92), respectively. ConclusionsIntramedullary nails with femoral neck protection in the treatment of low-energy femoral shaft fractures prevent secondary hip fractures and decrease the overall risk for reoperation for 4-6 years postoperatively.

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Section: Discussionmentioning

confidence: 99%

Reduced Risk of Reoperation Using Intramedullary Nailing with Femoral Neck Protection in Low-Energy Femoral Shaft Fractures

Bögl

Zdolsek

Michaëlsson

et al. 2020

Journal of Bone and Joint Surgery

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“…The radius of curvature of the native femur has been shown to be 110-120 cm 1,3 Femoral bow increases with age 5 and undergoes morphological change with thinner cortices, because of increasing bow, the anterior tensile cortex becomes thinner and posterior compressive cortex becomes relatively thicker. 2,5 Hence it is easy to perforate the anterior cortex either while reaming or during nail insertion with a straight nail put in a curved femur.…”

Section: Discussionmentioning

confidence: 99%

Mismatch of long Gamma intramedullary nail with bow of the femur: Does radius of curvature of the nail increase risk of distal femoral complications?

Shetty

Shenoy

Swaminathan

2019

Journal of Clinical Orthopaedics and Trauma

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Introduction: Anterior cortical penetration of the distal nail tip is a recognized complication of intramedullary nailing of the femur particularly in the geriatric population. This has been attributed to a mismatch between the femoral bow and the radius of curvature (ROC) of the femoral nail. We wanted to see if there was a reduction of this risk comparing cephalomedullary nails with ROC of 200 cm and 150 cm. Methods: 52 patients were split into 2 groups similar with respect to age, sex and comorbidities. Group A with 25 patients used a nail with a ROC of 200 cm and Group B with 27 patients used a 150 cm ROC nail. Lateral radiographs of the distal femur were evaluated to note the position of the nail tip in relation to the femoral canal. The diameter of the femur at the tip of the nail was divided into 3 equal zones. The anterior one-third was designated as Zone1, the middle one-third as Zone 2 and the posterior one-third as Zone 3. Results: 80% of the cases with a 200 cm ROC nail had the tip of the nail in the anterior one-third of the canal (zone 1). Fracture of the anterior femoral cortex distally by the nail tip was seen in 2 patients. Only 18.5% of cases with a 150 cm ROC nail had the tip of the nail in anterior one-third of the canal (zone 1). There were no incidences of complications such as fractures and anterior cortical perforation. Conclusions: A cephalomedullary nail with a ROC of 150 cm had its distal tip more towards the center of the femoral canal when compared to a nail with ROC of 200 cm. No case of anterior femoral penetration was seen when using a nail with an ROC of 150 cm.

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“…The most commonly used femoral nails have a radius of curvature of 1500-2500 mm, whereas newer CT studies on human femurs show that the average anatomic radius of curvature is lower than 1000 mm, particularly in women and Asians (Thiesen et al, 2018). This mismatch may be a reason to choose a slightly shorter nail to avoid the complication of anterior penetration (Fantry et al, 2015, Shetty et al, 2019. More recently, newer nail designs with a lower radius of curvature have become available to account for this surgical dilemma.…”

Section: Discussionmentioning

confidence: 99%

Atypical femoral fractures: Another brick in the wall : On aspects of healing, treatment strategies and surveillance

Bögl

2021

Linköping University Medical Dissertations

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Distal femoral complications following antegrade intramedullary nail placement

Cited by 19 publications

References 18 publications

Reduced Risk of Reoperation Using Intramedullary Nailing with Femoral Neck Protection in Low-Energy Femoral Shaft Fractures

Reduced Risk of Reoperation Using Intramedullary Nailing with Femoral Neck Protection in Low-Energy Femoral Shaft Fractures

Mismatch of long Gamma intramedullary nail with bow of the femur: Does radius of curvature of the nail increase risk of distal femoral complications?

Atypical femoral fractures: Another brick in the wall : On aspects of healing, treatment strategies and surveillance

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