Use of a modified IMHS for unstable intertrochanteric fractures

Maniscalco, Pietro; Bertone, Celeste; Rivera, Fabrizio; Urgelli, Stefano

doi:10.1007/s101950200017

Cited by 3 publications

(2 citation statements)

References 24 publications

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“…The sliding system allows proximal fragment telescopes along the helical blade after loading, which increases osseous contact between the proximal and distal fragment, maintains a constant neck-shaft angle, and reduces the risk of cut-out, cut through, and nonunion compared with previous implants without a sliding mechanism [ 17 , 18 ]. However, this sliding system may also increase the risk of excessive backout of lag screw/ helical blade [ 19 , 20 ], resulting in hip pain, unacceptable shortening, or rotation deformity of the limb with poor function [ 21 , 22 ].…”

Section: Discussionmentioning

confidence: 99%

Insufficient proximal medullary filling of cephalomedullary nails in intertrochanteric femur fractures predicts excessive postoperative sliding: a case–control study

Chen

Chang

et al. 2023

BMC Musculoskelet Disord

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Objective Excessive postoperative sliding is a common complication of intramedullary nails in the treatment of intertrochanteric femur fractures. The aim of this study was to identify risk factors for excessive postoperative sliding in the intertrochanteric fractures treated with an intramedullary nail. Methods A retrospective analysis of 369 patients with femoral intertrochanteric fractures treated with short intramedullary nails between February 2017 and September 2020 was performed. Patients were classified into an excessive sliding group (ES group) and a control group according to the sliding distance after 6 months of follow-up. The proximal medullary filling degree (MFD), fracture reduction patterns in the anteroposterior (AP) view and lateral view, and tip-apex distance (TAD) were evaluated and compared in each group. Results Thirty-three cases were included in the ES group, and 336 cases were included in the control group. No significant differences in age, sex, fracture side, AO Foundation and Orthopaedic Trauma Association (AO/OTA) classification, Dorr classification, Singh Osteoporosis Index (SOI), American Society of Anesthesiologists classification (ASA), TAD or fracture reduction patterns in the AP view were noted between the two groups. The negative reduction pattern can strongly predict excessive postoperative sliding (OR 4.286, 95% CI 1.637–11.216, P = 0.003). The incidence of excessive postoperative sliding increased by 8.713-fold when the MFD decreased by 10% (OR 8.713, 95% CI 1.925–39.437, P = 0.005). Conclusions A low medullary filling degree and negative fracture reduction pattern in the lateral view were both independent risk factors for excessive postoperative sliding.

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Section: Discussionmentioning

confidence: 99%

Insufficient proximal medullary filling of cephalomedullary nails in intertrochanteric femur fractures predicts excessive postoperative sliding: a case–control study

Chen

Chang

et al. 2023

BMC Musculoskelet Disord

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“…Controlling fracture impaction through axial telescoping and rotational stability is essential in unstable proximal femoral fractures [22–24]. These factors allow direct contact between the fracture fragments, and promote healing, while decreasing the moment arm and consequent stresses on the implant.…”

Section: Discussionmentioning

confidence: 99%

Failure of intertrochanteric nailing due to distal nail jamming

Maniscalco

Rivera

D'ascola

et al. 2012

J Orthopaed Traumatol

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Nail impingement against the anterior femoral cortex during nail insertion, or anterior cortex penetration, has been described in the literature as a worrying complication. We describe a previously unreported surgical failure due to a compromised dynamic distal locking caused by distal jamming of the nail. An 80-year-old male suffered a closed right intertrochanteric femoral fracture. Due to the presence of a long medial fragment, a 240 mm long titanium trochanteric nail was chosen to stabilize the fracture. Dynamic distal locking was performed by placing the distal screw at the inferior rim of the elliptical locking hole to allow compression of the fracture site during weight-bearing. Six-month X-ray follow-up revealed a broken nail and nonunion of the fracture due to failed dynamization of the distal locking screw. The nail was removed and replaced by a total arthroplasty. Due to the femoral anterior bow of the shaft, anterior cortical impingement of the distal tip of a nail may result in the failure of the nail to slide within the diaphyseal canal when using a medium-length nail preventing compression of the fracture. Dynamic distal locking can be ineffective if the ability of the distal nail to slide within the diaphyseal canal is hindered. This type of scenario can represent an opportunity for anterior nail impingement. Distal jamming of the nail can thus compromise dynamic compression at the fracture site during loading, thus inducing nonunion of the fracture, and leading to breakage of the osteosynthesis device. For these reasons, caution is recommended when using medium-length trochanteric nails for unstable trochanteric fractures.

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Cause of an implant fracture: Material- or fabrication failure?

Wallstabe

Klinger

2012

Engineering Failure Analysis

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Use of a modified IMHS for unstable intertrochanteric fractures

Cited by 3 publications

References 24 publications

Insufficient proximal medullary filling of cephalomedullary nails in intertrochanteric femur fractures predicts excessive postoperative sliding: a case–control study

Insufficient proximal medullary filling of cephalomedullary nails in intertrochanteric femur fractures predicts excessive postoperative sliding: a case–control study

Failure of intertrochanteric nailing due to distal nail jamming

Cause of an implant fracture: Material- or fabrication failure?

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