Effectiveness of controlled telescoping system for lateral hip pain caused by sliding of blade following intramedullary nailing of trochanteric fracture

Choo, Suk Kyu; Oh, Hyoung Keun; Ko, Hyeong Tak; Min, Dong-Uk; Kim, Youngwoo

doi:10.1016/j.injury.2017.07.023

Cited by 14 publications

(6 citation statements)

References 13 publications

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“…A more cautious interpretation of results is warranted. Choo et al14) reported favorable outcomes of a controlled telescoping system for lateral hip pain relief in their study using Compression Hip Nail. Yi et al17) reported a higher complication rate of Compression Hip Nail in cases using 10 mm sliding lag screw.…”

Section: Discussionmentioning

confidence: 99%

“…The Targon PF nail is threaded in the support sleeve of the lag screw and can prevent the lateral protrusion of the implant; an additional anti-rotation pin helps prevent rotation of the fragments and this nail has been proven safe and effective in clinical trials1213). The Compression Hip Nail is characterized by a sliding lag screw that can be controlled by the end caps of static or dynamic mode and helps relieve lateral hip pain with controlled telescoping14). This study was meaningful in that it evaluated complications more comprehensively in a larger number of patients managed with different implant types compared to small-scale studies involving a single implant.…”

Section: Discussionmentioning

confidence: 99%

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Local Postoperative Complications after Surgery for Intertrochanteric Fractures Using Cephalomedullary Nails

et al. 2018

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PurposeCephalomedullary nails (CMN) are commonly used for the surgical treatment of intertrochanteric fractures. This study aimed to evaluate overall postoperative local complications by reviewing patients who received surgical treatment using three different types of implants.Materials and MethodsThe study sample included 353 patients (107 males, 246 females) who underwent surgery using CMN for intertrochanteric fractures. Three different types of implants were used: i) the Gamma3® (Stryker) in 80 cases, ii) the Targon® PF (Aesculap) in 225 cases, and iii) the Compression Hip Nail® (Trademedics) in 48 cases. The mean age was 82.6 (range, 60–109) years and the average follow-up period was 15 (range, 6–80) months. Postoperative local complications and risk factors of cut-out were assessed.ResultsThe most common complication was cut-out (n=26). Other complications included non-union (n=3), periprosthetic fracture (n=2), avascular necrosis (n=1), heterotopic ossification (n=1), and sleeve pull out (n=1). Multivariate analysis revealed that the cut-out group had a higher rate of poor reduction compared to the non-complicated group (P<0.001). Although the mean tip-apex distance (TAD) was 18.4 mm in the non-complicated group, lower than that of the cut-out group (P=0.001), multivariate analysis revealed that TAD was not a significant risk factor for cut-out (P=0.065).ConclusionCut-out is the most common local complication associated with surgical treatment of intertrochanteric fractures using CMN. Proper reduction appears to be important in lowering the risk of cut-out. Maintaining low TAD is another critical factor in achieving sufficient fixation of lag screw to the subchondral bone of the femoral head.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Local Postoperative Complications after Surgery for Intertrochanteric Fractures Using Cephalomedullary Nails

et al. 2018

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“…Varus collapse was defined as NSA reduced by > 10°. Over-sliding was defined as helical blade lateral telescoping of ≥ 10 mm [ 20 , 21 ].…”

Section: Methodsmentioning

confidence: 99%

Low filling ratio of the distal nail segment to the medullary canal is a risk factor for loss of anteromedial cortical support: a case control study

Song

Chang

et al. 2022

J Orthop Surg Res

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Background Anteromedial cortical support apposition (positive and/or neutral cortical relations) is crucial for surgical stability reconstruction in the treatment of trochanteric femur fractures. However, the loss of fracture reduction is frequent in follow-ups after cephalomedullary nail fixation. This paper aimed to investigate the possible predictive risk factors for postoperative loss of anteromedial cortex buttress after nail fixation. Methods A retrospective analysis of 122 patients with AO/OTA 31A1 and A2 trochanteric femur fractures treated with cephalomedullary nails between January 2017 and December 2019 was performed. The patients were classified into two groups according to the postoperative status of the anteromedial cortical apposition in 3D CT images: Group 1 with contact “yes” (positive or anatomic) and Group 2 with contact “No” (negative, loss of contact). The fracture reduction quality score, tip-apex distance (TAD), calcar-referenced TAD (Cal-TAD), Parker ratio, neck-shaft angle (NSA), and the filling ratio of the distal nail segment to medullary canal diameter in anteroposterior (AP) and lateral fluoroscopies (taken immediately after the operation) were examined in univariate and multivariate analyses. Mechanical complications were measured and compared in follow-up radiographs. Results According to the postoperative 3D CT, 84 individuals (69%) were categorized into Group 1, and 38 individuals (31%) were classified as Group 2. The multivariate logistic regression analysis showed that the poor fracture reduction quality score (P < 0.001) and decreasing filling ratio in the lateral view (P < 0.001) were significant risk factors for the loss of anteromedial cortical contact. The threshold value for the distal nail filling ratio in lateral fluoroscopy predicting fracture reduction re-displacement was found to be 53%, with 89.3% sensitivity and 78.9% specificity. The mechanical complication (varus and over lateral sliding) rate was higher in Group 2. Conclusions The fracture reduction quality score and the decreasing filling ratio of the distal nail to the medullary canal in the lateral view (a novel parameter causing pendulum-like movement of the nail) were possible risk factors for postoperative loss of anteromedial cortical support.

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“…1,2 Most trochanteric fractures require surgery to prevent bed-related complications and mortality, and poor stability after fracture fixation causes mechanical complications such as cut-out, varus displacement, and excessive lateral migration of the screw or blade. 3-5 These complications can lead to limb shortening, hip pain, functional impairment, and even reoperation. 4,6,7…”

Section: Introductionmentioning

confidence: 99%

“…4,12,16-18 Subsequent studies have made some minor changes to the BRQC but did not provide reasons for these changes. 5,10,11,19 In 2015, on the basis of the Gotfried reduction technique for subcapital femoral fractures, 20 the Chang reduction quality criteria (CRQC) 21 proposed the concepts of positive medial cortical support (PMCS; Fig. 1) and negative medial cortical support (NMCS; Fig.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Baumgaertner and Chang reduction quality criteria for the assessment of trochanteric fractures

Mao

et al. 2019

Bone & Joint Research

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Objectives Different criteria for assessing the reduction quality of trochanteric fractures have been reported. The Baumgaertner reduction quality criteria (BRQC) are relatively common and the Chang reduction quality criteria (CRQC) are relatively new. The objectives of the current study were to compare the reliability of the BRQC and CRQC in predicting mechanical complications and to investigate the clinical implications of the CRQC. Methods A total of 168 patients were assessed in a retrospective observational study. Clinical information including age, sex, fracture side, American Society of Anesthesiologists (ASA) classification, tip-apex distance (TAD), fracture classification, reduction quality, blade position, BRQC, CRQC, bone quality, and the occurrence of mechanical complications were used in the statistical analysis. Results A total of 127 patients were included in the full analysis, and mechanical complications were observed in 26 patients. The TAD, blade position, BRQC and CRQC were significantly associated with mechanical complications in the univariate analysis. Only the TAD (p = 0.025) and the CRQC (p < 0.001) showed significant results in the multivariate analysis. In the comparison of the receiver operating characteristic curves, the CRQC also performed better than the BRQC. Conclusion The CRQC are reliable in predicting mechanical complications and are more reliable than the BRQC. Future studies could use the CRQC to assess fracture reduction quality. Intraoperatively, the surgeon should refer to the CRQC to achieve good reduction in trochanteric fractures. Cite this article: Bone Joint Res 2019;8:502–508. DOI: 10.1302/2046-3758.810.BJR-2019-0032.R1.

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Effectiveness of controlled telescoping system for lateral hip pain caused by sliding of blade following intramedullary nailing of trochanteric fracture

Cited by 14 publications

References 13 publications

Local Postoperative Complications after Surgery for Intertrochanteric Fractures Using Cephalomedullary Nails

Local Postoperative Complications after Surgery for Intertrochanteric Fractures Using Cephalomedullary Nails

Low filling ratio of the distal nail segment to the medullary canal is a risk factor for loss of anteromedial cortical support: a case control study

Comparison of Baumgaertner and Chang reduction quality criteria for the assessment of trochanteric fractures

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