Mechanical complications of intertrochanteric hip fractures treated with trochanteric femoral nails

Liu, Wanjun; Zhou, Dongsheng; Liu, Fang; Weaver, Michael J.; Vrahas, Mark

doi:10.1097/ta.0b013e31829a2c43

Cited by 90 publications

(88 citation statements)

References 24 publications

(23 reference statements)

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“…We observed axial migration of the helical blade although the blade shaft was allowed to slide freely in the test fixture. Clinical series of intertrochanteric fractures demonstrated similar failure mechanisms as observed in our study . Deficient lateral buttress and unstable calcar patterns as mimicked by our test setup, have been described as additional factors for nail toggling and medial migration in intertrochanteric fractures …”

Section: Discussionsupporting

confidence: 83%

“…Helical blades exhibited axial migration with joint perforation in clinical series and revealed a higher cutout rate compared to other implant designs. 12,[24][25][26] A previous biomechanical study reported different direction of the migration vector of helical blades in comparison to dynamic hip screws. 4 We observed a nearly equidistant cranial/vertical and axial migration of helical blades in our test setup.…”

Section: Tip-apex Distance Of Helical Bladesmentioning

confidence: 99%

“…Clinical series of intertrochanteric fractures demonstrated similar failure mechanisms as observed in our study. 12,[25][26][27][28]33 Deficient lateral buttress and unstable calcar patterns as mimicked by our test setup, have been described as additional factors for nail toggling and medial migration in intertrochanteric fractures. 27,32,34 Our study has several limitations.…”

Section: Tip-apex Distance Of Helical Bladesmentioning

confidence: 99%

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Influence of reduced tip‐apex distance on helical blade fixation—a biomechanical study

Lenz

Schwinn

Hofmann‐Fliri

et al. 2019

Journal Orthopaedic Research

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Migration profile of helical blades differs from conventional screw design. Tip‐apex distance (TAD) greater than 25 mm is associated with early failure in hip screws. This study investigates the effect of a reduced TAD on helical blade fixation. Six pairs of human femoral heads were used. Bone mineral density (BMD) was determined by pQCT. Local bone quality was evaluated by breakaway torque. Helical blades were implanted with TAD of 20 mm (normal) and 6 mm (reduced). Specimens were cyclically tested under progressively increasing physiologic loading at 2 Hz with starting peak force of 1′000N, increasing by 0.1N/cycle. Implant migration was monitored by radiographs every 250 cycles. Paired Student's t‐test and Spearman rank correlation coefficient were used for statistical evaluation (p < 0.05). Mean BMD was 246.7 mgHA/cm3 SD48.7 (normal), 244.3 mgHA/cm3 SD47.6 (reduced); p = 0.93. Mean breakaway torque was 3.59 Nm SD2.11 (normal), 3.72 Nm SD1.83 (reduced); p = 0.91. Number of cycles to failure (1 mm vertical migration) was 16′416 SD7972 (normal), 20′000 SD5232 (reduced); p = 0.38. They correlated significantly with BMD (p = 0.01;R2 = 0.91) and breakaway torque (p < 0.049; R2 = 0.814) (normal). Breakaway torque correlated significantly with BMD (p = 0.02; R2 = 0.898) (normal). In reduced TAD these parameters did not correlate significantly. Normal TAD resulted in failure in varus collapse (n = 6), whereas reduced TAD showed blade perforation (n = 3), rotation (n = 2), varus collapse (n = 1). Fixation stability of helical blades correlates with bone quality when implants are fixed in cancellous bone. Near cortical blade fixation might increase the risk of intraarticular blade perforation. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 9999:1–6, 2019.

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Section: Discussionsupporting

confidence: 83%

Section: Tip-apex Distance Of Helical Bladesmentioning

confidence: 99%

Section: Tip-apex Distance Of Helical Bladesmentioning

confidence: 99%

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Influence of reduced tip‐apex distance on helical blade fixation—a biomechanical study

Lenz

Schwinn

Hofmann‐Fliri

et al. 2019

Journal Orthopaedic Research

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“…Of note, our study assumed that the long Gamma nail eliminated the risk of periprosthetic fracture; however, the original model of this implant was not free of complications, including periprosthetic fractures. In a study by Liu et al, 16 fracture at the tip of the TFN occurred in 1.3% of patients and was related to a new trauma. In a systematic review, on the occurrence of secondary fractures around intramedullary nails used to treat intertrochanteric hip fractures, Norris et al 15 reported the results from three data sets in which patients were treated with either a long or short TFN and there was no occurrence of secondary fractures.…”

Section: Discussionmentioning

confidence: 96%

Long Gamma nail versus short Gamma nail in the treatment of stable intertrochanteric fractures

Markowicz

Newman

Plymale

et al. 2014

Current Orthopaedic Practice

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Background:The short Gamma nail (Stryker, Mahwah, NJ) is a commonly used device for the treatment of stable intertrochanteric hip fractures. First generation Gamma nails have been complicated by fractures at the tip of the nail. The long Gamma nail has been shown to reduce the incidence of periprosthetic fractures. The purpose of this metaanalysis was to compare the cost-effectiveness of the long Gamma nail as an alternative to second and third generation short Gamma nails as the initial treatment of stable intertrochanteric fractures.

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“…A 2013 retrospective review reported a 9.4% incidence of lateral migration of greater than 1 cm. 8 Excessive lateral migration of the helical blade may cause hip pain with ambulation, iliotibial band irritation, or trochanteric bursitis, and some patients require blade exchange or hardware removal. Any complication that impedes mobilization or necessitates reoperation is significant.…”

mentioning

confidence: 99%

Extent and Morbidity of Lateralization of a Trochanteric Fixation Nail Blade

Sandifer¹,

Hulick²,

Graves³

et al. 2017

Orthopedics

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This study examined the incidence and risk factors associated with lateral helical blade migration and trochanteric pain with the trochanteric fixation nail. A retrospective review was performed of 141 cases of pertrochanteric femur fracture treated with a trochanteric fixation nail at a level I trauma center over a period of 42 months. Exclusion criteria included follow-up of less than 60 days, preexisting osteonecrosis of the femoral head, and prophylactic trochanteric fixation nail treatment. Patient demographics, operative findings, and radiographic findings were recorded. Medical records were reviewed to identify symptomatic hardware. Overall, 27 patients (19.1%) were symptomatic, and 3 (2.1%) required revision surgery for blade prominence. Of the patients, 42 (30%) had lateralization of greater than 1 cm, and 16 of these (38.1%) were symptomatic (P<.02). A risk factor for lateralization was AO classification, with 46.1% of type A2 fractures showing lateralization of greater than 1 cm. The quality of calcar reduction nearly reached statistical significance, and 44.8% of patients who had inadequate reduction had lateralization of greater than 1 cm compared with 26.4% of patients who had adequate reduction (P=.054). Lateralization of greater than 1 cm was directly associated with the presence of symptoms (P<.001) and removal of hardware because of trochanteric pain (P=.007). Multivariate analysis showed that increasing tip-apex distance, inadequate calcar reduction, and greater fracture severity were predictive of excessive lateralization of greater than 1 cm. Nearly 20% of patients had lateral hip pain associated with cephalomedullary fixation. Final lateralization of the helical blade of greater than 1 cm was a very strong predictor of symptoms. During preoperative counseling, surgeons should caution patients about this relatively frequent and likely underreported complication. [Orthopedics. 2017; 40(5):e886-e891.].

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Mechanical complications of intertrochanteric hip fractures treated with trochanteric femoral nails

Cited by 90 publications

References 24 publications

Influence of reduced tip‐apex distance on helical blade fixation—a biomechanical study

Influence of reduced tip‐apex distance on helical blade fixation—a biomechanical study

Long Gamma nail versus short Gamma nail in the treatment of stable intertrochanteric fractures

Extent and Morbidity of Lateralization of a Trochanteric Fixation Nail Blade

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