Salvage of cephalomedullary nail cutout with the variable angle proximal femoral plate

Albareda-Albareda, J.; Redondo-Trasobares, B.; Calvo-Tapies, J.R.; Blanco-Baiges, E; Campos, Agustı́n; Gómez-Vallejo, Jesús; Rubio, Nancy

doi:10.1016/j.injury.2021.01.051

Cited by 4 publications

(5 citation statements)

References 19 publications

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“…One of the main complications of CMN fixation is cutout, which is defined as the femoral head and neck intramedullary implant perforating through the superior posterolateral cortex of the femoral neck/head followed by rotation and varus collapse of the head-neck fragment [ 17 ]. This patient experienced a significant cutout of the nail, which resulted in a revision to a THA with a modular diaphyseal press-fit component (Figures 5 - 7 ).…”

Section: Discussionmentioning

confidence: 99%

A Cautionary Tale of a Complex Peri-Trochanteric Fracture in a Very Important Person (VIP) Patient at a Community-Based Hospital: A Case Report

Haese¹,

Delgadillo²,

Anderson³

et al. 2022

Cureus

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Peri-trochanteric fractures with an extension into the femoral neck are relatively rare. Due to the lack of a defined treatment in the literature, these fractures pose a challenge to orthopedic surgeons. This case report highlights the value of timing to surgical intervention, choosing the appropriate operative course, not treating very important person (VIP) patients differently than standard patients, and decreasing unnecessary costs for the patient and the US healthcare system.An 85-year-old male VIP patient presented to the emergency department (ED) with a left peri-trochanteric fracture with an extension into the ipsilateral femoral neck. The initial plan was to perform arthroplasty with diaphyseal fixation. However, the community-based hospital would have to wait two to three days for the proper implants, and the patient insisted on being treated at this hospital. Due to concerns about increased mortality with delayed treatment, the patient underwent short cephalomedullary nail (CMN) fixation the next day. On postoperative day (POD) 49, a pop was heard and felt while ambulating, and radiographs revealed substantial lateral cutout of the CMN and subsidence of the femoral head. On POD 54, the patient underwent a successful left total hip arthroplasty using a modular diaphyseal press-fit femoral component, which resulted in an uneventful recovery. This case illustrates a cautionary tale in choosing the appropriate operative course for a VIP patient with a peri-trochanteric fracture extending into the femoral neck (a relatively rare fracture type that has no clearly defined treatment option). This is imperative to reduce pain and length of stay for the patient, postoperative complications, and cost. Based on the results from the second procedure and weighing the risk of prolonged treatment, the authors believe that this patient would likely have benefited from a primary arthroplasty procedure given his body habitus and complex fracture pattern.

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Section: Discussionmentioning

confidence: 99%

A Cautionary Tale of a Complex Peri-Trochanteric Fracture in a Very Important Person (VIP) Patient at a Community-Based Hospital: A Case Report

Haese¹,

Delgadillo²,

Anderson³

et al. 2022

Cureus

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“…These associations highlight the necessity of considering these anatomical parameters when planning surgical approaches and internal fixation strategies. Currently, lag screw cutout due to improper placement remains one of the major causes of proximal femoral internal fixation failure 33 . Therefore, the ability to accurately localize the distribution of PCT in true AP radiographs of the hip joint represents a significant advancement.…”

Section: Discussionmentioning

confidence: 99%

“…Currently, lag screw cutout due to improper placement remains one of the major causes of proximal femoral internal fixation failure. 33 Therefore, the ability to accurately localize the distribution of PCT in true AP radiographs of the hip joint represents a significant advancement. Our findings enable clinicians to utilize standard imaging techniques to identify the optimal regions for screw placement, thereby improving the precision and effectiveness of proximal femur fixation.…”

Section: Discussionmentioning

confidence: 99%

Quantitative Analysis of Primary Compressive Trabeculae Distribution in the Proximal Femur of the Elderly

Xu,

Li,

Zhang

et al. 2024

Orthopaedic Surgery

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ObjectiveAs osteoporosis progresses, the primary compressive trabeculae (PCT) in the proximal femur remains preserved and is deemed the principal load‐bearing structure that links the femoral head with the femoral neck. This study aims to elucidate the distribution patterns of PCT within the proximal femur in the elderly population, and to assess its implications for the development and optimization of internal fixation devices used in hip fracture surgeries.MethodsThis is a retrospective cohort study conducted from March 2022 to April 2023. A total of 125 patients who underwent bilateral hip joint CT scans in our hospital were enrolled. CT data of the unaffected side of the hip were analyzed. Key parameters regarding the PCT distribution in the proximal femur were measured, including the femoral head's radius (R), the neck‐shaft angle (NSA), the angle between the PCT‐axis and the head–neck axis (α), the distance from the femoral head center to the PCT‐axis (δ), and the lengths of the PCT's bottom and top boundaries (L‐bottom and L‐top respectively). The impact of gender differences on PCT distribution patterns was also investigated. Student's t‐test or Mann–Whitney U test were used to compare continuous variables between genders. The relationship between various variables was investigated through Pearson's correlation analysis.ResultsPCT was the most prominent bone structure within the femoral head. The average NSA, α, and δ were 126.85 ± 5.85°, 37.33 ± 4.23°, and 0.39 ± 1.22 mm, respectively, showing no significant gender differences (p > 0.05). Pearson's correlation analysis revealed strong correlations between α and NSA (r = −0.689, p < 0.001), and R and L‐top (r = 0.623, p < 0.001), with mild correlations observed between δ and NSA (r = −0.487, p < 0.001), and R and L‐bottom (r = 0.427, p < 0.001). Importantly, our study establishes a method to accurately localize PCT distribution in true anteroposterior (AP) radiographs of the hip joint, facilitating precise screw placement in proximal femur fixation procedures.ConclusionOur study provided unprecedented insights into the distribution patterns of PCT in the proximal femur of the elderly population. The distribution of PCT in the proximal femur is predominantly influenced by anatomical and geometric factors, such as NSA and femoral head size, rather than demographic factors like gender. These insights have crucial implications for the design of internal fixation devices and surgical planning, offering objective guidance for the placement of screws in hip fracture treatments.

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“…Albareda et al [ 29 ] found that the hip preservation treatment of a variable angle femoral plate is an attractive option with good outcomes and few complications in the cut-out treatment. 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.…”

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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Salvage of cephalomedullary nail cutout with the variable angle proximal femoral plate

Cited by 4 publications

References 19 publications

A Cautionary Tale of a Complex Peri-Trochanteric Fracture in a Very Important Person (VIP) Patient at a Community-Based Hospital: A Case Report

A Cautionary Tale of a Complex Peri-Trochanteric Fracture in a Very Important Person (VIP) Patient at a Community-Based Hospital: A Case Report

Quantitative Analysis of Primary Compressive Trabeculae Distribution in the Proximal Femur of the Elderly

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

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