Analysis of the use of the Anti-Rotational Device in Cephalomedullary Nail and its Implications in Fractures of the Proximal Femur

Abstract

Objective: Evaluate the influence in the position of the anti-rotational device in cephalomedullary nails and its influences on the consolidation of trochanteric fractures. Methods:Retrospective case series comprising 58 patients with unstable trochanteric fractures that underwent osteosynthesis with cephalomedullary nail and anti-rotational device. Were analyzed the radiographs of the pelvis and ipsilateral hip osteosynthesis with 6 months postoperatively and compared to initial. The radiographic parameters used were tip-apex index (TAD), the positioning of the sliding screw in relation to the central axis of the femoral neck, the angle of reduction and fracture healing.Results: From the 58 patients selected for initial postoperative examination, 15 (26%) died, 6 (10%) lost the thread of the treatment and 37 (64%) were reassessed. Most of them were female patients, beteween the ninth and tenth decade of life. It was observed that 31 (84%) fractures were consolidated, while 6 (16%) patients had their fractures not yet consolidated. The reduction angle in healed fractures was 129o and in non-healed were 136o. In these, the position of the sliding screw was far from the central axis of femoral neck. Conclusion:The fixation of trochanteric fractures with cephalomedullary nail with anti-rotational device is safe. The reduced fractures with valgus above 135 ° showed higher rates of nonunion. In these cases the position of the sliding screw was lower than ideal to fit the anti-rotational device, which may have affected negatively the fracture healing.