The influence of entry point and radius of curvature on femoral intramedullary nail position in the distal femur

Kanawati, Andrew; Jang, Bob; McGee, Richard G; Sungaran, Jai

doi:10.1016/j.jor.2014.04.010

Cited by 19 publications

(16 citation statements)

References 7 publications

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“…The results show a mean ROC of 943 mm within the entire population. The radius of curvature of the long femoral nails available today for intramedullary stabilization femoral fractures ranges from 1500mm to 3000mm [ 11 , 19 ] and does not fit our results to a great extent.…”

Section: Discussionmentioning

confidence: 56%

Femoral antecurvation—A 3D CT Analysis of 1232 adult femurs

et al. 2018

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IntroductionFor optimal treatment of femoral fractures, it is essential to understand the anatomical antecurvation of the human femur. Recent clinical studies have highlighted the problem of distal anterior encroachment or even perforation of the nail tip. The aim of this study was to accurately describe the femoral antecurvation in a large cohort. Another objective was to identify the most important influences on femoral antecurvation, such as age, femur length, gender and ethnicity.MethodsA three dimensional modelling and analytical technology was applied for the analysis of 1,232 femurs. Individual femoral antecurvation was precisely computed to determine whether gender, femur length, age, ethnicity or body mass index influence the radius of curvature (ROC).ResultsThe calculated mean ROC for all femurs was 943 mm. The lowest ROC of 826 mm was found in female Asian femurs. A regression analysis demonstrated that age and femur length could predict the variability of the curvature, with femoral length as most powerful predictor. A matched pair subgroup analysis between Asians and Caucasians could not show any significant differences of ROC values.ConclusionsThe mean radius of the femoral antecurvation may be smaller than previously reported revealing a significant mismatch between the actual individual anatomy and existing implants. In opposite to existing literature, this study suggests, that antecurvation differences between various ethnicities may exclusively be attributed to differences in femoral length and age. The findings of this study may be found helpful in the development of novel designs for intra- and extramedullary implants.

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Section: Discussionmentioning

confidence: 56%

Femoral antecurvation—A 3D CT Analysis of 1232 adult femurs

et al. 2018

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“…However, the femur is more bowed in the posterior wall than in the anterior wall and medullary canal because the posterior femoral cortex has a greater thickness. Kanawati et al [ 6 ] compared two intramedullary nails with ROCs of 150 and 200 cm after placement into synthetic femora. They reported that the amount of nail tip impingement on the anterior femoral cortex of the second nail was higher and recommended using nails with low ROCs to avoid anterior cortical impingement during applications.…”

Section: Discussionmentioning

confidence: 99%

The importance of reaming the posterior femoral cortex before inserting lengthening nails and calculation of the amount of reaming

2016

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BackgroundLengthening nails have been used to correct limb length discrepancy caused by different etiologies, as well as for post-traumatic reasons. Two important lengthening nail-related complications are damage to the distraction mechanism and femoral fractures around the nail tip. As a result of the curved anatomy of the femur, straight nails impinge on the anterior cortex. Therefore, proper reshaping of the medullary canal to accommodate straight lengthening nails is crucial for the prevention of this problem. Reaming the dense posterior cortex is important when aiming to insert a lengthening nail without incurring anterior cortex nail tip impingement-related complications. Posterior femoral cortex over-reaming is a solution to this situation.MethodsSixty patients received lengthening nails during 2008–2013, (ISKD, Fitbone, Precice). Posterior cortex rigid-reaming technique was used successfully in 45 retrograde femoral lengthening cases. The preoperatively planned posterior cortex amount was reamed until the impingement was overcome during the operation under fluoroscopic control for each case. Since the preoperative determination of posterior cortex reaming amount is time consuming and operator dependent, we evaluated the X-rays of the patients with computer software and conventional paper-based measurements. The effect of reaming the posterior cortical wall on the inclination of the nail tip to the anterior femoral cortex was detected with measurements on the preoperative and postoperative lateral femoral X-rays by using the CorelDRAW® Graphic Suite X6 software package (Corel, Inc., Ottawa, Ontario, Canada) software. On the same software, X-rays and the posterior reaming amount were also calculated.ResultsThe mean age of the patients was 27 years (11–42), while the mean lengthening was 5.9 cm (2–14). The mean consolidation index was 1.05 (0.75–1.62), and the mean follow-up period was 31 months (range, 18–45 months). The mean distance of the osteotomy site to the intercondylar notch of the femur was 81.2 mm (±16.92). The mean displacement of the nail tip position was 15.42 mm (±4.77) on the measurements on the postoperative X-rays after nail insertion compared to the preoperative simulations on the templates. The mean posterior cortex reaming thickness was 3.68 mm (±1.02).ConclusionsWe derived a formula that allows the required amount of optimal posterior cortex reaming to be determined. No impingement-related complications or nail damage were observed.

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“… 7 , 8 , 16 Using a starting point anterior to the midline and an implant with a smaller radius of curvature has been recommended in order to avoid this complication. 17 Despite the use of a modern nail with a smaller radius of curvature (150 cm), our case demonstrates that anterior cortical perforation may still occur, especially in patients with a radius of curvature that falls outside the normal range. A recent study of 214 antegrade cephalomedullary nails found one anterior cortical perforation (0.47%), while 16% were within 3mm of the anterior cortex and 50% were within 7mm of the cortex.…”

Section: Discussionmentioning

confidence: 73%

Distal femoral complications following antegrade intramedullary nail placement

et al. 2015

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While antegrade nailing for proximal and diaphyseal femur fractures is a commonly utilized fixation method with benefits including early mobilization and high rates of fracture union, both intraoperative and postoperative complications may occur. Intraoperative errors include leg length discrepancy, anterior cortical perforation, malreduction of the fracture, and neurovascular injury, and postoperative complications include nonunion, malunion, infection, and hardware failure. This case series reviews complications affecting the distal femur after intramedullary nailing including fracture surrounding a distal femoral interlocking screw (Case #1), nonunion after dynamization with nail penetration into the knee joint (Case #2), and anterior cortical perforation (Case #3). Prevention of intraoperative and postoperative complications surrounding intramedullary nailing requires careful study of the femoral anatomy and nail design specifications (radius of curvature), consideration of the necessity of distal interlocking screws, the need for close radiographic follow-up after nail placement with X-rays of the entire length of the nail, and awareness of possible nail penetration into the knee joint after dynamization.

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The influence of entry point and radius of curvature on femoral intramedullary nail position in the distal femur

Cited by 19 publications

References 7 publications

Femoral antecurvation—A 3D CT Analysis of 1232 adult femurs

Femoral antecurvation—A 3D CT Analysis of 1232 adult femurs

The importance of reaming the posterior femoral cortex before inserting lengthening nails and calculation of the amount of reaming

Distal femoral complications following antegrade intramedullary nail placement

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