Straight nail insertion through a laterally shifted entry for diaphyseal atypical femoral fractures with bowing: good indications and limitations of this technique

Byun, Seong Eun; Cho, Young Ho; Lee, Yong Seuk; Park, Jung-Wee; Kim, Seonguk; Koo, Kyung Hoi; Byun, Young Soo

doi:10.1007/s00264-021-05212-0

Cited by 5 publications

(5 citation statements)

References 20 publications

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“…Among 29 studies, 11 cohort articles included both sites of AFF (subtrochanteric and midshaft), 7 13 16 17 18 19 20 21 22 23 24) 9 cohort studies reported outcomes after surgery of subtrochanteric AFFs, 6 9 10 11 14 25 26 27 28) and 9 single cohort studies reported midshaft AFF. 8 12 15 29 30 31 32 33) The overall incidence of nonunion was 10.3% (77 / 742) in total, 17.5% (52 / 297) in the subtrochanteric AFFs group, and 5.6% (25 / 445) in the midshaft AFFs group ( Table 1 ).…”

Section: Resultsmentioning

confidence: 99%

“…IM nailing offers benefits like better biomechanical stability and less stress on the hardware but IM nail insertion poses significant challenges when dealing with severely bowed or narrow femurs. Byun et al 31) found that postoperative malalignment was found in all cases of AFFs with severe bowing, so malreduction including fracture gap and distraction is not rare after nailing in subtrochanteric AFFs. Leg-length discrepancy resulting from femoral straightening and lengthening is also unavoidable when employing an IM nail.…”

Section: Discussionmentioning

confidence: 99%

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Does the Nonunion Rate of Atypical Femoral Fractures Differ According to Fracture Site?: A Meta-Analysis

Yoon,

Kim,

Roh

2024

Clin Orthop Surg

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Background The nonunion rate for atypical femoral fractures (AFF) is known to be higher than that for typical fractures of the femur. We performed a meta-analysis to determine the incidence of nonunion necessitating reoperation following fixation for AFF and compare the rates according to the fracture site (subtrochanter or midshaft). Methods A total of 742 AFFs from 29 studies were included. A proportion meta-analysis utilizing a random-effects model was conducted to estimate the prevalence of nonunion. The outcomes were the incidence of reoperations that included osteosynthesis. To determine the association of nonunion with patient mean age or average duration of bisphosphonate use, meta-regression analysis was done. Results In proportion meta-analysis, the estimated pooled prevalence of nonunion was 7% (95% confidence interval [CI], 5%–10%) from all studies. There was a significant difference in nonunion rate between the 2 groups (I 2 = 34.4%, p = 0.02); the estimated prevalence of nonunion was 15% (95% CI, 10%–20%) in subtrochanteric AFFs and 4% (95% CI, 2%–6%) in midshaft AFFs. From meta-regression analysis, significant correlations were identified between nonunion rate and patient mean age (coefficient: -0.0071, p = 0.010), but not in the average duration of bisphosphonate use (coefficient: -0.0024, p = 0.744). Conclusions A notable disparity existed in the nonunion rate among subtrochanteric AFFs and midshaft AFFs group. Therefore, it is critical for orthopedic surgeons to consider the complexity and challenges associated with AFF and to estimate the proper possibility of nonunion according to the fracture site.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Does the Nonunion Rate of Atypical Femoral Fractures Differ According to Fracture Site?: A Meta-Analysis

Yoon,

Kim,

Roh

2024

Clin Orthop Surg

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“…Anatomically, the femur in different persons possesses varied degrees of anterior bowing, which may be unfit for anterior bowing of the locked femur nail [ 30 ]. Thus, the nonunion site may be not nail-cortical contact tightly between the nail and the canal.…”

Section: Discussionmentioning

confidence: 99%

Aseptic femoral nonunion treated with exchange locked nailing with intramedullary augmentation cancellous bone graft

2022

J Orthop Surg Res

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Background Closed reamed locked intramedullary nailing has been the treatment of choice for most of femoral shaft fractures. A high union rate with a low complication rate is generally predictable. For an aseptic femoral shaft nonunion with a prior inserted intramedullary nail, exchange nailing is one of favored surgical techniques for treatment. However, a greatly varied success rate of 72–100% has been reported. To improve the success rate of exchange femur nailing, a modified bone grafting technique was developed. The purpose of this retrospective study intended to evaluate outcomes of such a revised technique. Methods From July 2011 to March 2019, 48 consecutive adult patients (average, 38 years; range, 19–67 years) with aseptic femoral shaft nonunions after intramedullary nailing treatment were studied. All femoral shaft fractures were initially caused by traffic accidents, which were treated by a closed or open intramedullary nailing technique at various hospitals. The current revision treatment was performed after an average of 2.2 years (range 1.1–6.2 years) from initial injuries. In the surgery, the prior nail was removed and the marrow cavity was reamed widely (at least 2 mm as possible). Sufficient cancellous bone grafts harvested on the trochanteric marrow wall from the inside were placed in the marrow cavity of the junction of nonunion fragments. A new 1-mm smaller size locked intramedullary nail was inserted. Whether the dynamic or static mode of nails were used mainly depended on the nonunion level. Postoperatively, protected weight bearing with crutches was allowed for all patients. Results Forty-one patients were followed for an average of 2.8 years (85.4%; range, 1.9–4.5 years) and all fractures healed. The union rate was 100% (41/41, p < 0.001) with a union time of an average of 3.4 months (range, 2.5–5.0 months). There were no complications of deep infection, nonunions, malunions, implant failures or an avulsed trochanter tip fracture. The satisfactory knee function improved from 73.2% (30/41) preoperatively to 92.7% (38/41) at the latest follow-up (p = 0.019). Conclusions The described modified bone grafting technique may effectively improve a union rate of exchange femur nailing while the surgical procedure is not complicated. It may therefore be used concomitantly in all aseptic femoral shaft nonunions when exchange nailing is performed.

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“…Proximal femur fractures frequently require CMNs for fixation; however, geometrical discrepancies between anatomy and implants often curtail successful surgery [ 12 , 13 ]. This is especially problematic when intraoperative nail options cannot compensate for aspects such as femoral curvature or femur neck anteversion [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

Proximal femur anatomy-implant geometry discrepancies

Cornelissen

Ferreira

Burger

et al. 2022

SICOT-J

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Objectives: Due to ongoing concern about femur anatomy-implant mismatches, this cross-sectional study aimed to create a geometric femur profile and used it to identify and quantify possible mismatches between femur anatomy and cephalomedullary nail dimensions. The work further aimed to assess whether patient demographics affect anatomy-implant coherence. Methods: One hundred skeletally mature complete femur computer tomography (CT) scans were collected and exported to software enabling landmark placement and measures with multiplanar reconstruction techniques. Results: Clinically relevant anatomy-implant discrepancies included the femur neck and shaft axis offset 6.1 ± 1.7 mm (95% CI [5.7–6.4]), femur radius of curvature 1.2 ± 0.3 m (95% CI [1.1–1.2]), femur anteversion 18.8 ± 9.2 (95% CI [16.9–20.6]). The implants reviewed in this study did not compensate for the femur neck and shaft axis offset and had a larger radius of curvature than the studied population. Clinically significant demographic geometry differences were not identified. Conclusion: There were discrepancies between femur anatomy and cephalomedullary nail implant design; however, no clinically significant femur feature inconsistency was identified among the demographic subgroups. Due to the identified anatomy-implant discrepancies, including the femur neck and shaft axis offset, we suggest that these measurements be considered for future implant design and surgical technique.

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Straight nail insertion through a laterally shifted entry for diaphyseal atypical femoral fractures with bowing: good indications and limitations of this technique

Cited by 5 publications

References 20 publications

Does the Nonunion Rate of Atypical Femoral Fractures Differ According to Fracture Site?: A Meta-Analysis

Does the Nonunion Rate of Atypical Femoral Fractures Differ According to Fracture Site?: A Meta-Analysis

Aseptic femoral nonunion treated with exchange locked nailing with intramedullary augmentation cancellous bone graft

Proximal femur anatomy-implant geometry discrepancies

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