Analysis of risk factor for nail breakage in patients with mechanical failures after proximal femoral nail antirotation in intertrochanteric fractures

Lee, Yong Seuk; Kim, Jung-Taek; Park, Chan Ho; Song, Ji-Ung; Kim, Tae‐Young; Koo, Kyung‐Hoi

doi:10.1097/md.0000000000029436

Cited by 4 publications

(2 citation statements)

References 19 publications

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“…Presently, PFNA is widely used in treating intertrochanteric fractures of the femur (19). Although satisfactory clinical outcomes have been reported, internal fixation failure still occurs in some cases, adversely affecting fracture healing, especially for unstable intertrochanteric fractures (20,21). The complications associated with PFNA include screw cut-outs and cut-ins, any blade migration irrespective of the direction, telescoping effect, loss of reduction, and implant fracture, et al, which are critical and should not be overlooked (19).…”

Section: Discussionmentioning

confidence: 99%

Comparison of curative effect between OBS assisted by 3D printing and PFNA in the treatment of AO/OTA type 31-A3 femoral intertrochanteric fractures in elderly patients

Huang,

Xiong,

Mithu

et al. 2023

Front. Med.

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ObjectiveTo compare and analyze the Ortho-Bridge System (OBS) clinical efficacy assisted by 3D printing and proximal femoral nail anti-rotation (PFNA) of AO/OTA type 31-A3 femoral intertrochanteric fractures in elderly patients.MethodsA retrospective analysis of 25 elderly patients diagnosed with AO/OTA type 31-A3 femoral intertrochanteric fracture was conducted from January 2020 to August 2022 at Yan’an Hospital, affiliated to Kunming Medical University. The patients were divided into 10 patients in the OBS group and 15 in the PFNA group according to different surgical methods. The OBS group reconstructed the bone models and designed the guide plate by computer before the operation, imported the data of the guide plate and bone models into a stereolithography apparatus (SLA) 3D printer, and printed them using photosensitive resin, thus obtaining the physical object, then simulating the operation and finally applying the guide plate to assist OBS to complete the operation; the PFNA group was treated by proximal femoral nail anti-rotation. The operation time, the intraoperative blood loss, Harris hip score (HHS), Oxford Hip Score (OHS), and complications were compared between the two groups.ResultsThe operation time and the intraoperative blood loss in the PFNA group were less than that in the OBS group, and there was a significant difference between the two groups (P < 0.05). The HHS during the 6th month using OBS was statistically higher than PFNA (P < 0.05), however, there were no significant differences in OHS during the 6th month between the OBS group and PFNA group (P > 0.05). The HHS and OHS during the 12th month in the OBS group were statistically better than in the PFNA group (P < 0.05).ConclusionThe OBS assisted by 3D printing and PFNA are effective measures for treating intertrochanteric fractures. Prior to making any decisions regarding internal fixation, it is crucial to evaluate the distinct circumstances of each patient thoroughly.

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Section: Discussionmentioning

confidence: 99%

Comparison of curative effect between OBS assisted by 3D printing and PFNA in the treatment of AO/OTA type 31-A3 femoral intertrochanteric fractures in elderly patients

Huang,

Xiong,

Mithu

et al. 2023

Front. Med.

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“…Risk factors for cephalomedullary nail breakage include low American Society of Anaesthesiologists score, unstable fracture types (pathologic, reverse oblique, subtrochanteric), younger age, poor reduction quality, loss of posteromedial support, prior radiotherapy, and a large offset from nail to medial blade/screw tip. [2][3][4][5] Implant damage at insertion may also play a role, as discussed by Klima et al 6 Thus, the implant at risk of breakage is one that is poorly supported biomechanically (unstable fracture pattern, pathologic lesions) for an extended period of time (nonunion or delayed union for more than 4 months) and placed in an active (younger, healthier) patient who will put the device through many load cycles. Breakages that occur early (during the expected fracture healing time) are unusual and do not fit this paradigm of delayed healing resulting in fatigue failure of the implant.…”

Section: Introductionmentioning

confidence: 99%

Defining Cephalomedullary Nail Breakage Rates: A Systematic Review and Meta-Analysis

Lambers,

D'Alessandro,

Yates

2023

Journal of Orthopaedic Trauma

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Objective: To establish the background rate of breakage of cephalomedullary nails. Data Sources: MEDLINE, PubMed, and Web of Science were searched on April 3, 2023. Study Selection: All English-language studies that examined trochanteric with or without subtrochanteric fractures and identified cephalomedullary nail breakage as an outcome measure and a breakage rate could be derived were included. Implants captured were predominantly the TFNA, TFN, and PFN by DePuy Synthes, various versions of the Gamma nail by Stryker, the Zimmer Natural Nail by Zimmer Biomet, and the Intertan by Smith and Nephew. Data Extraction: The author, year of publication, dates of implant insertion, study design, method of detection of breakages, implant used, number of implant breakages, number of implants inserted, breakage rate, and follow-up were extracted. Data Synthesis: Meta-analysis of included studies used descriptive nonparametric statistics and a noncomparative proportion for the pooled result. Differences in results between study design types were compared using the mean breakage rate per study design. Conclusions: Cephalomedullary nail breakage is a rare complication with a median reported rate of 0.6% and a pooled result rate of 0.4%. Ninety-five percent of studies had a breakage rate of 1.3% or less, which sets a benchmark from the reported literature for future studies. There is wide variability in rates of breakage reported between different types of study designs with single-center review studies reporting breakage rates nearly 4-fold greater than large-scale administrative database reviews. The rate of implant breakage should not be used in isolation to judge an implant's performance. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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Construction and validation of a nomogram prediction model for internal fixation failure after proximal femoral anti-rotation intramedullary nailing in the treatment of intertrochanteric fractures of the femur

Wu,

Zhang,

et al. 2024

Medicine

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The aim was to study the independent risk factors of internal fixation failure in proximal femoral anti-rotation intramedullary nailing for intertrochanteric femur fracture, and to build a nomogram prediction model accordingly. Clinical data of patients with intertrochanteric femoral rotor fractures admitted to the First People’s Hospital of Longquanyi District from January 2018 to January 2023 were retrospectively collected. The occurrence of spiral blade cut out, internal fixation breakage, peri-internal fixation fracture, hip internal rotation deformity, and fracture nonunion within 1 year after surgery were included in the internal fixation failure group, and the rest were included in the internal fixation success group. Univariate and multivariate logistic regression analyses were used to determine the independent risk factors for postoperative internal fixation failure, and the corresponding nomogram was established. Subject operating characteristic curves and calibration curves were plotted to assess model performance, and to further improve the reliability of the validation results, internal validation was performed using Bootstrap combined with 10-fold cross-validation rows to assess the clinical utility of the model using decision curve analysis. Ultimately, 374 patients with intertrochanteric fractures were included in the study, and 57 patients were included in the internal fixation failure group, with an internal fixation failure rate of 15.24%. After univariate and multivariate logistic regression analyses, a total of 5 factors were identified as independent risk factors for internal fixation failure after intertrochanteric femur fracture surgery: unstable fracture, comorbid underlying disease, severe osteoporosis, a cusp distance of >30 mm, and poor quality of fracture reduction. Postoperative internal fixation failure of intertrochanteric fractures of femur is affected by multiple factors, and clinically orthopedic surgeons should formulate reasonable and effective solutions for high-risk patients in order to protect the surgical effect and improve the success rate of surgery.

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Analysis of risk factor for nail breakage in patients with mechanical failures after proximal femoral nail antirotation in intertrochanteric fractures

Cited by 4 publications

References 19 publications

Comparison of curative effect between OBS assisted by 3D printing and PFNA in the treatment of AO/OTA type 31-A3 femoral intertrochanteric fractures in elderly patients

Comparison of curative effect between OBS assisted by 3D printing and PFNA in the treatment of AO/OTA type 31-A3 femoral intertrochanteric fractures in elderly patients

Defining Cephalomedullary Nail Breakage Rates: A Systematic Review and Meta-Analysis

Construction and validation of a nomogram prediction model for internal fixation failure after proximal femoral anti-rotation intramedullary nailing in the treatment of intertrochanteric fractures of the femur

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