Salvage hip replacement after cut-out failure of cephalomedullary nail fixation for proximal femur fractures: a case series describing the technique and results

Corró, Sebastián; Óleo-Taltavull, Rafael; Teixidor-Serra, Jordi; Tomàs-Hernández, Jordi; Selga-Marsà, Jordi; García-Sánchez, Yaiza; Guerra-Farfán, Ernesto; Andrés-Peiró, José Vicente

doi:10.1007/s00264-022-05529-4

Cited by 3 publications

(1 citation statement)

References 38 publications

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“…A multicenter study by Brunner et al [ 10 ] compared a number of treatments, from solitary lag screw exchange to THA, and came to the conclusion that THA was the best option with the fewest problems. Sebastián et al [ 30 ] reported that hip replacement appeared to be a relatively safe and reliable salvage procedure for elderly and physically frail patients. Tetsunaga et al 31 report that the rate of postoperative complications was significantly higher in the group of patients who had trochanteric fractures than in the group who had femoral neck fractures (25 vs. 0%, p 0.0001), which raises questions about the superiority of hip replacement in all patients who had this complication.…”

Section: Discussionmentioning

confidence: 99%

A biomechanical investigation of a novel intramedullary nail used to salvage failed internal fixations in intertrochanteric fractures

Chen,

Fan,

et al. 2023

J Orthop Surg Res

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Purpose The ideal approach for revision surgery following femoral head salvage treatments for an intertrochanteric fracture is still up for debate. A novel variety of proximal femoral bionic intramedullary nail (PFBN) has been created in clinical practice. We aimed to compare the biomechanical results of the novel implant to conventional intramedullary and extramedullary fixation in the treatment of intertrochanteric fracture following primary internal fixation failure. Methods Using finite element analysis, we created a three-dimensional model of the intertrochanteric fracture's helical blade cut-out for this investigation. The PFBN 1 group, the PFBN 2 group, the PFNA group, and the DHS group were our four test groups. For each fracture group, the von Mises stress and displacements of the femur and internal fixation components were measured under 2100 N axial loads. Results The values for the femoral displacement in the PFBN1 group, PFBN2 group, PFNA group, and DHS group were 6.802 mm, 6.716 mm, 8.080 mm, and 8.679 mm, respectively. The internal implant displacement values were 6.201 mm, 6.138 mm, 7.396 mm, and 8.075 mm in the PFBN1 group, PFBN2 group, PFNA group, and DHS group, respectively. The maximum von Mises Stress in the femoral was 187.2 MPa, 85.18 MPa, 106.6 MPa, and 386.2 MPa in the PFBN1 groups, PFBN2 groups, PFNA groups, and DHS groups, respectively. In the PFBN1 groups, PFBN2 groups, PFNA groups, and DHS groups, the maximum von Mises Stress in internal fixation was 586.7 MPa, 559.8 MPa, 370.7 MPa, and 928.4.8 MPa, respectively. Conclusion Our biomechanical research demonstrates that intramedullary fixation is more stable than extramedullary fixation when salvaging failed internal fixations in intertrochanteric fracture. Compared with PFNA and DHS, PFBN showed better biomechanical stability in the treatment of patients with revised intertrochanteric fractures. In light of this, we advocate PFBN fixation as the method of choice for intertrochanteric fracture revision. This result still has to be confirmed in more clinical research.

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Section: Discussionmentioning

confidence: 99%

A biomechanical investigation of a novel intramedullary nail used to salvage failed internal fixations in intertrochanteric fractures

Chen,

Fan,

et al. 2023

J Orthop Surg Res

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Management des Cut-out verschiedener Osteosyntheseformen bei proximalen Femurfrakturen

Henze,

Vogel,

Wienhöfer

et al. 2024

Unfallchirurgie

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Complications Following Short Femoral Nail Fixation for Intertrochanteric Hip Fractures: A Retrospective Study

Vasilopoulou,

Trichonas,

Palaiologos

et al. 2024

J Long Term Eff Med Implants

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The incidence of proximal femur fractures is increasing due to aging of the population. Intramedullary nails are the mainstay of treatment for intertrochanteric hip fractures mainly due to their better biomechanical properties compared to dynamic hip screw devices, shorter operative time, and less blood loss during surgery. However intramedullary nail fixation is not devoid of complications. The purpose of this study is to look at complications related to intramedullary nailing for intertrochanteric hip fractures in a major trauma center. A retrospective study was conducted including all patients having suffered an intertrochanteric femur fracture and treated with intramedullary nails from October 1, 2020, to October 1, 2022, in the Orthopaedic Surgery Clinic. The intramedullary hip systems used were the Stryker Gamma3 Nail and the VITUS PF Nail. All complications following the postoperative period were recorded in detail. Overall, 240 patients with a mean age of 82.3 years treated with hip intramedullary devices were identified. Superior cutout of the lag screw in two patients (females 90 and 87 years old) was identified 8 and 10 weeks following initial surgery. Avascular necrosis (AVN) of the femoral head was identified in one patient (male 81 years old) which occurred 12 weeks postoperatively. All three cases were revised by replacing the nail with cemented hemiarthroplasty. Periprosthetic fractures occurred in an 88-year-old male and a 73-year-old female following an injury distal to the stem and were managed by replacing the nail with a long stem device (Long Gamma3). One case of metalwork fracture was also recorded. There are many advantages in managing intertrochanteric hip fractures with intramedullary hip devices such as shorter theater time, less blood loss, and improved biomechanical properties. However, complications such as cutout of the lag screw, AVN, and periprosthetic fracture are serious and require complex revision surgery.

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Salvage hip replacement after cut-out failure of cephalomedullary nail fixation for proximal femur fractures: a case series describing the technique and results

Cited by 3 publications

References 38 publications

A biomechanical investigation of a novel intramedullary nail used to salvage failed internal fixations in intertrochanteric fractures

A biomechanical investigation of a novel intramedullary nail used to salvage failed internal fixations in intertrochanteric fractures

Management des Cut-out verschiedener Osteosyntheseformen bei proximalen Femurfrakturen

Complications Following Short Femoral Nail Fixation for Intertrochanteric Hip Fractures: A Retrospective Study

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