Prospective assessment of trochanteric fracture managed by intramedullary nailing with controlled and limited blade back-out

Barla, Manuela; Egrise, François; Zaharia, Bogdan; Bauer, Camille; Parot, Jauffrey; Mainard, Didier

doi:10.1016/j.otsr.2019.11.028

Cited by 3 publications

(6 citation statements)

References 23 publications

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“…This was explained by the difficulty of reducing these unstable fractures. This was in line with several works in the literature [6], [11], [15], [19], [34]. However, in our series, we did not find this association.…”

Section: Discussionsupporting

confidence: 93%

“…The association between age and mechanical complications was not found in the majority of studies in the literature [6], [15]. This was also the case in our study.…”

Section: Discussionsupporting

confidence: 69%

“…Our study is one of the few studies assessing predictive factors of fixation failure of trochanteric fractures by analyzing various mechanical complications [15], [16], [17]. In addition, we also studied factors that may influence functional outcomes.…”

Section: Discussionmentioning

confidence: 99%

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Predictors of Failure Following Fixation of Trochanteric Fractures

Abdennadher

Hjaiej

Ayari

et al. 2023

Open Access Maced J Med Sci

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BACKGROUND: Trochanteric fractures are frequent and mainly affect the elderly causing autonomy loss. Their incidence is increasing, and they are associated with substantial morbidity and high cost. AIM: The aim of our study was to identify epidemiological, radiological, and technical predictors of failure of trochanteric fracture fixation in the elderly. METHODS: We conducted a retrospective study including 188 patients aged over 65 years, who underwent surgery for trochanteric fractures, in the period between 2015 and 2020 at the orthopedics department of the Military Hospital of Tunis. The minimum follow-up was 12 months. RESULTS: Thirty-four patients had a mechanical failure (18.1% of cases), including 12 cases of cephalic screw migration (CSM) (6.4%), 12 cases of disassembly (6.4%), eight cases of malunion (4.3%), and four cases of non-union (2.1%). Bone fragility with a Singh index ≤III was associated with CSM, disassembly of fixation material, and malunion (respectively, p < 0.001; p = 0.01 and p = 0.044). Reduction quality was associated with disassembly (p < 0.001) and CSM (p = 0.004). Eccentric screw positioning on anteroposterior (p < 0.001) and lateral views (p = 0.018), high tip-apex distance (TAD) (p < 0.001), and calcar-referenced TAD (p < 0.001) were predictive of CSM. Logistic regression analysis showed that poor reduction quality was an independent factor associated with the occurrence of mechanical complications. Functional outcomes were assessed using Parker and Postel Merle d’Aubigné scores. CONCLUSION: To minimize the risk of mechanical complications, the surgeon must pay close attention to the fracture reduction and to the correct positioning of the cervical screw.

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Section: Discussionsupporting

confidence: 93%

“…The association between age and mechanical complications was not found in the majority of studies in the literature [6], [15]. This was also the case in our study.…”

Section: Discussionsupporting

confidence: 69%

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Predictors of Failure Following Fixation of Trochanteric Fractures

Abdennadher

Hjaiej

Ayari

et al. 2023

Open Access Maced J Med Sci

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“…For implant selection, more surgeons now prefer the use of intramedullary nails [ 25 – 27 ]. For the position of the helical blade in the femoral head, the TAD, Cal-TAD, and Parker ratios provide good guidance and are practiced in daily work [ 3 , 28 – 30 ]. For the quality of fracture reduction, there has been a recent tendency for surgeons to pay more attention to the anteromedial cortex rather than to the posteromedial lesser trochanter, as has been previously described [ 31 ].…”

Section: Discussionmentioning

confidence: 99%

“…Currently, trochanteric hip fractures (AO/OTA 31A) are primarily treated using cephalomedullary nails [ 1 – 3 ]. However, postoperative complications and mechanical failures are frequent, ranging from 3 to 22%[ 4 – 6 ], with complications including over collapse of the head–neck fragment with femoral neck shortening or varus, helical blade/lag screw lateral back-out, cut-out from the superior femoral head, cut-in through the central femoral head, fracture non-union, and implant nail breakage.…”

Section: Introductionmentioning

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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The influence of proximal femur canal size on reduction of intertrochanteric fracture with cephalomedullary nail

Chiang

Lin

et al. 2021

Orthopaedics & Traumatology: Surgery & Research

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Prospective assessment of trochanteric fracture managed by intramedullary nailing with controlled and limited blade back-out

Cited by 3 publications

References 23 publications

Predictors of Failure Following Fixation of Trochanteric Fractures

Predictors of Failure Following Fixation of Trochanteric Fractures

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

The influence of proximal femur canal size on reduction of intertrochanteric fracture with cephalomedullary nail

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