Accurate and Easy Measurement of Sliding Distance of Intramedullary Nail in Trochanteric Fracture

Chinzei, Nobuaki; Hiranaka, Takafumi; Niikura, Takahiro; Fujishiro, Takaaki; Hayashi, Shinya; Kanzaki, Noriyuki; Hashimoto, Shingo; Sakai, Yoshitada; Kuroda, Ryosuke; Kurosaka, Masahiro

doi:10.4055/cios.2015.7.2.152

Cited by 6 publications

(4 citation statements)

References 22 publications

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“…This criterion proves that intramedullary implants are superior to other implants in preventing excessive collapse [7] . We measured the difference in the lateral sliding of the screws using the modified NAR method as recommended by Nobuaki Chinzei et al [8] In our study, the average lateral screw sliding was 3.8mm, with a less than 3mm sliding in 21 cases, all of whom showed a very good functional outcome and early union. Among the 16 those who developed Trendelenburg's gait, the sliding was more than 5mm in 15 cases, with an average of 7.8mm.…”

Section: Discussionmentioning

confidence: 92%

Analysis of factors affecting the radiological and functional outcome of proximal femoral nailing in unstable intertrochanteric fractures

Balachandran¹,

Maharajan²,

Pratheeban³

2020

Int. J. Orthop. Sci.

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Introduction: The incidence of hip fracture continues to increase as the elderly population increases, as a result of the extension of the average life span. Intertrochanteric fractures have been treated successfully by various methods, and now we are in an era where functional rehabilitation of patients to their preinjury levels is of prime importance. Reconstruction-type proximal femoral nailing is one of the surgical techniques used to treat intertrochanteric fractures. This implant faces less criticism than the previous ones, but it also has its own disadvantages. Aim: To analyze the factors that affect the functional and radiological outcomes of unstable intertrochanteric fractures treated by proximal femoral nailing and to identify the factors responsible for an abnormal gait pattern after union in some patients. Materials and Method: Forty-two patients treated in our facility who were categorized as having unstable intertrochanteric fractures were followed up until radiological union was achieved and 16 patients who had abnormal gait patterns were further studied to find the factor responsible. Tip Apex Distance, lateral screw sliding/collapse, screw position in the neck, initial and final neck-shaft angles, quality of reduction by the modified Fogagnolo et al. criteria and functional outcomes based on Harris Hip Score were analyzed. Results: The average Harris Hip Score in our study was 83.8. Thirty-eight patients did not have any complications, but 16 our patients had abnormal gait patterns at the final follow-up. The reason for the abnormal gait pattern was secondary varus collapse caused by excessive lag screw sliding. Conclusion:The initial quality of reduction as recommended by Fogagnolo is the key factor to achieve a favorable outcome. Proximal femoral nail helps in early return to their preinjury status in most of the patients. It also prevents the varus collapse in unstable intertrochanteric fractures, given the screws are positioned ideally.

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Section: Discussionmentioning

confidence: 92%

Analysis of factors affecting the radiological and functional outcome of proximal femoral nailing in unstable intertrochanteric fractures

Balachandran¹,

Maharajan²,

Pratheeban³

2020

Int. J. Orthop. Sci.

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“…In the cases treated with a screw and side plate device, sliding distance was measured on anteroposterior radiographs [ 10 , 20 , 21 ]. The distance was defined as the distance the inserted lag screw slid within the fixed angle sliding hip screw device.…”

Section: Methodsmentioning

confidence: 99%

Three-Dimensional Computed Tomographic Analysis for Comminution of Pertrochanteric Femoral Fracture: Comminuted Anterior Cortex as a Predictor of Cutting Out

Tsukada¹,

Wakui²,

Yamada³

et al. 2016

TOORTHJ

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Background:Fixed angle sliding hip screw devices allow controlled impaction between the head neck fragment and the femoral shaft fragment in the surgical treatment of pertrochanteric fractures. This study was performed to evaluate the frequency and pattern of comminution at the fracture site, which may prevent the intended impaction.Materials and Methods:Three-dimensional computed tomography was used to investigate 101 pertrochanteric fractures treated with fixed angle sliding hip screw devices, with emphasis on the comminuted cortex. A comminuted fracture was defined as a fracture that had a third fracture fragment at the main fracture line.Results:There were 40 fractures without comminution and 61 with comminution. All 61 comminuted fractures had a comminuted posterior cortex, and 3 of 61 fractures also had comminution at the anterior cortex. The prevalence of cutting out of the implant from the femoral head was significantly higher in cases involving comminution at both the posterior and anterior cortices than in cases involving comminution only at the posterior cortex (66.7 % and 3.4 %, p < 0.0001).Conclusion:The posterior cortex was comminuted in 60.4% of pertrochanteric fractures and the anterior cortex in 3.0%. Intended impaction at the fracture site could not be obtained at any cortex in cases with comminution at both the anterior and posterior cortices; comminution at the anterior cortex may be a predictor of cutting out.

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“…The TAD measured on the postoperative radiograph was calibrated using the known diameter of the lag screw [2]. We measured the amount of lag screw sliding within 2 weeks according to the change in the distance between the tip of the lag screw and intersection with the center of the nail after calibrating the rotational difference using the known length of the lag screw from the surgical record (continuous variable, < 6 mm or $ 6 mm) [9]. Patients in the case group had a higher proportion of TAD $ 20 mm, anterior malreduction, and postoperative sliding of lag screw within 2 weeks $ 6 mm than patients in the control group (Table 1).…”

Section: Variablesmentioning

confidence: 99%

Anterior Malreduction is Associated With Lag Screw Cutout After Internal Fixation of Intertrochanteric Fractures

Inui,

Watanabe,

Suzuki

et al. 2023

Clin Orthop Relat Res

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Background Lag screw cutout is a devastating complication after internal fixation of an intertrochanteric fracture. Although the tip-apex distance (TAD) is known to be associated with this complication, another factor we thought was potentially important—fracture reduction on an oblique lateral view—has not, to our knowledge, been explored. Questions/purposes (1) Is a well-reduced fracture position on an oblique lateral view after internal fixation of intertrochanteric fracture associated with a lower odds of postoperative cutout, independently of the TAD? (2) Is postoperative sliding of the lag screw after fixation associated with postoperative cutout? Methods Patients with intertrochanteric fractures who were at least 65 years old and who had been treated with internal fixation in one of six facilities between July 2011 and December 2017 were included. All patients in the study group had lag screw cutout, and controls were selected by risk-set sampling of age-matched and sex-matched patients using a ratio of 4:1 for patients from each hospital. Of the 2327 intertrochanteric fractures, there were 36 patients (0.02 per person-year), with a mean age of 85 years; 89% (32) were women. In the control group, there were 135 controls. There was no difference in age or sex between the two groups. Sagittal reduction was evaluated using an immediate postoperative oblique lateral radiograph (anterior malreduction versus anatomic reduction or posterior malreduction). The association between anterior malreduction and the odds of cutout was estimated by conditional logistic regression analysis with the TAD and interaction between the TAD and the reduced position as covariates. As a sensitivity analysis, we estimated whether sliding within 2 weeks postoperatively was associated with cutout. Results After controlling for the potentially confounding variables of age and sex, we found that anterior malreduction was independently associated with a higher odds of cutout compared with anatomic reduction or posterior malreduction (adjusted OR 4.2 [95% CI 1.5 to 12]; p = 0.006). There was also an independent association between cutout and larger TAD (≥ 20 mm) (adjusted OR 4.4 [95% CI 1.4 to 14]; p = 0.01). However, the association between cutout and reduction was not modified by the TAD (adjusted OR of interaction term 0.6 [95% CI 0.08 to 4]; p = 0.54). Postoperative sliding ≥ 6 mm within 2 weeks was associated with higher odds of cutout after adjusting for age and sex (adjusted OR 11 [95% CI 3 to 40]; p < 0.001). Conclusion In patients older than 65 years with intertrochanteric fractures, anterior malreduction on a lateral oblique view was associated with much greater odds of postoperative cutout than anatomic reduction or posterior malreduction. Because anterior malreduction is within the surgeon's control, our findings may help surgeons focus on intraoperative reduction on an oblique lateral view to prevent cutouts. Although this factor is a reliable indicator, the results should be applied to cephalomedullary nails, because there was only one patient with cutout among those with sliding hip screws. Because this study was conducted in a homogenous Japanese population, future studies should focus on the association between anterior malreduction and cutout in people of different ethnicities, adjusting for confounding factors such as implant type and surgeon level. Level of Evidence Level III, therapeutic study.

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Accurate and Easy Measurement of Sliding Distance of Intramedullary Nail in Trochanteric Fracture

Cited by 6 publications

References 22 publications

Analysis of factors affecting the radiological and functional outcome of proximal femoral nailing in unstable intertrochanteric fractures

Analysis of factors affecting the radiological and functional outcome of proximal femoral nailing in unstable intertrochanteric fractures

Three-Dimensional Computed Tomographic Analysis for Comminution of Pertrochanteric Femoral Fracture: Comminuted Anterior Cortex as a Predictor of Cutting Out

Anterior Malreduction is Associated With Lag Screw Cutout After Internal Fixation of Intertrochanteric Fractures

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