Safety and efficacy of a two-screw cephalomedullary nail for intertrochanteric femur fracture fixation: a retrospective case series in 264 patients

Abstract

IntroductionRecent advances have led to the design of a new cephalomedullary nail, which aims to decrease the risk of failures in patients with intertrochanteric hip fractures by allowing for insertion of two interdigitating screws into the head segment. The goal of this study is to evaluate the safety and efficacy of this two-screw cephalomedullary nailing system.Patients/participantsPatients 18 years of age and older who underwent intramedullary nailing of their intertrochanteric femoral fracture using the InterTAN nailing system (Smith and Nephew, Memphis, TN) from 2012 to 2016 were included in this retrospective study which was performed at two urban certified level-1 trauma centers and one urban certified level-3 trauma center. The study data was collected through a retrospective chart review and review of the existing radiographic studies. Primary outcome measure was mechanical hardware failure and screw cutout. Secondary outcome measures included nonunion, malunion, medical and surgical complications.ResultsA total of 264 patients were included in this analysis. Two patients (0.75%) were found to have a screw cut out requiring revision surgery. Two other revision surgeries were performed for malrotation (n = 1) and malunion (n = 1). Other implant-related complications occurred in 19 cases (7.9%), which included broken distal screws (n = 9), distal screw loosening (n = 8), and loose lag screws (n = 2). There was a total of 10 (3.8%) surgical wound complications, including four deep and six superficial infections.DiscussionThis modified cephalomedullary nail is a reliable, safe, and effective implant for management of intertrochanteric hip fractures. Surgical treatment of patients with intertrochanteric hip fractures can be performed in a safe fashion using this implant.

Does Size Matter for Cephalomedullary Nails in Geriatric Intertrochanteric Fractures?

“…Both nail diameter groups were of adequate size to demonstrate any statistical difference present, and the follow-up period for these cases was long enough to cover the time frame in which mechanical failures are believed to occur most frequently. 13,14 Several of the findings in our study agreed with what is published in the contemporary orthopaedic literature regarding geriatric intertrochanteric femur fractures. Our patient cohort of all nail diameters had an average age of 77.5 with an overall reoperation rate of 8.3%, which is similar to all-cause reoperation rates reported in the literature.…”

“…The minimum follow-up of 12 weeks is adequate for detection of screw cutout and infection but may miss later complications of nonunion and periprosthetic fractures. 13,14 In judging reduction grades, there may be interobserver differences.…”

“…Minimum follow-up of 12 weeks was chosen as previous studies have indicated failure requiring reoperation is most likely to occur in this time frame. 13,14 Multiple data points from the surgery were collected to include in the final analysis as follows: nail diameter, classification of the fracture, short versus long nail, and reduction grade. Nail diameter and length (short vs. long) were obtained from operative reports and the electronic medical record nursing notes regarding surgical implants.…”

A Retrospective Study of 98 Elderly Patients with High-Risk Lateral Femoral Wall Intertrochanteric Hip Fractures to Compare Outcomes Following Surgery with Proximal Femoral Nail Antirotation (PFNA) Versus Dynamic Hip Screw (DHS)

“…Femoral intertrochanteric fracture (FIF) is a fracture mostly associated with osteoporosis that occurs between the base of the femoral neck and the lesser trochanter and, as a common type of hip fracture in clinical practice, accounts for about 36% of hip fractures [ 1 , 2 ]. In recent years, with population aging, the incidence of FIF has also been increasing year by year and has become a serious traumatic disease threatening the health of the elderly [ 3 ], which greatly affects the short-term and long-term quality of life of patients [ 4 , 5 ].…”

Reverse Z-effect phenomenon in a basicervical femoral fracture using cephalomedullary nail with two superior antirotation screws: A case report and procedure evaluation

“…Deneca et al reported that basicervical femoral fractures have larger rotational instability than most other types [ 4 ]. Therefore, an improved cephalomedullary nail was introduced with two proximal screws including an antirotation screw with the purpose of increasing the rotational stability of the fracture, and excellent post-operative results with it were reported [ 5 , 6 ]. Recently, we encountered one basicervical femoral fracture case that caused a rare phenomenon; “reverse Z-effect”; after the surgery using a cephalomedullary nail with two superior antirotation screws.…”