Cephalomedullary nails: factors associated with impingement of the anterior cortex of the femur in a Hispanic population

Peña, Omar R.; Gélvez, Amparo Gómez; Espinosa, Kristian A.; Cardona, José Ramón

doi:10.1007/s00402-015-2313-8

Cited by 13 publications

(8 citation statements)

References 22 publications

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“…7) [36]. But, one thing should be paid attention: the curvature of anterolateral femoral bowing is usually increased in the elderly, which may lead to the mismatching between the cephalomedullary nail and the femur and cause cortical impingement and tail protrusion [37][38][39][40]. For these patients, we performed the following procedures to prevent these complications: 1) using the long main nail; 2) the nail entry point should be selected anterior, but not posterior to the greater trochanter; and 3) when the excellent PSA of the guide pin was achieved by rotation of the main nail, the traction force can be slightly elevated.…”

Section: Discussionmentioning

confidence: 99%

How to get better TAD? Relationship between anteversion angle of nail and position of femoral neck guide pin during nailing of intertrochanteric fractures

Wang

Liu

et al. 2020

BMC Musculoskelet Disord

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Background: To demonstrate the correlation between guide pin-shaft angle (PSA) at the anteroposterior film and anteversion angle of guide pin at the lateral film and investigate whether excellent tip-apex distance (TAD) can be obtained by changing the entry point via axial rotation of the main intramedullary nail. Methods: Fifty patients with intertrochanteric femoral fractures (IFFs) undergoing internal fixation with intramedullary nails under 2D fluoroscopy were retrospectively enrolled. Both of the PSA at the anteroposterior film and anteversion angle at the lateral film before and after adjustment of the guide pin were collected. Pearson correlation analysis was performed to investigate their correlation. Intraoperative and postoperative outcomes were recorded. Furthermore, the software of Mimics 10.0 and Pro/E were used to establish the 3D models of the proximal femur and main intramedullary nail/guide pin, respectively. Surgery was simulated on the Pro/E software platform and solid geometry analysis was conducted to calculate the correlation between the PSA and the anteversion angle. Results: Pearson correlation analysis indicated there was a positive correlation between PSA and anteversion angle, with the correlation coefficient of 0.902 (p < 0.01). By altering the PSA and anteversion angle, TAD was adjusted to be less than 25 mm in all patients. The mean operative time, fluoroscopy time and length of hospital stay were 65.82 ± 11.16 min, 2.03 ± 0.79 min and 6.66 ± 2.49 d. Thirty-one patients received blood transfusions (3.55 ± 1.95 U). Fracture reduction was considered to be good or acceptable in all patients. Complications occurred only in 6 patients (12.00%). At a 3-month follow-up, the mean Timed Up and Go was 31.54 ± 20.95 s and Harris Hip Score was 72.88 ± 8.79. The 3D surgery model also showed when the main intramedullary nail was externally rotated or internally rotated of 20°at the standard location, the PSA of guide pin at the anteroposterior position and anteversion angle of the guide pin at the lateral position were simultaneously increased or decreased. Conclusion: Our findings suggest altering the PSA and anteversion angle may be beneficial for obtaining excellent TAD and achieving superior outcomes.

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Section: Discussionmentioning

confidence: 99%

How to get better TAD? Relationship between anteversion angle of nail and position of femoral neck guide pin during nailing of intertrochanteric fractures

Wang

Liu

et al. 2020

BMC Musculoskelet Disord

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“…Peña et al 9 found that the posterior nail start site was an incidental factor related with cortical impingement. Roberts et al 8 believed that the posterior entry point increases the angle at which the nail is inserted, leading to over contact between the nail and the anterior cortex of the femur.…”

Section: Discussionmentioning

confidence: 99%

“…6 As one of the common complications, cortical impingement caused by the over contact of the tip of the nail and the femoral cortex may often lead to thigh pain and even fractures of the femoral shaft, which seriously affect postoperative rehabilitation and limb function of patients. 7,9 Previous studies have reported a higher incidence in the Asian population, 10 which may be attributed to the differences of bone morphology and mismatch of implant. As it is well known, Asian femurs are smaller than Caucasian and have a larger anterior bow.…”

Section: Introductionmentioning

confidence: 99%

<p>Risk Factors for Anterior Cortical Impingement of Short Cephalomedullary Nail in Chinese Elderly Patients with Intertrochanteric Fracture</p>

Nie

et al. 2020

TCRM

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Background: Anterior cortical impingement is a common phenomenon after intramedullary fixation in Asian patients with intertrochanteric fractures. It may cause thigh pain and even fracture of the femoral shaft, which may seriously affect postoperative rehabilitation and limb function of patients. However, little was known about risk factors for anterior cortical impingement in Chinese elderly after intramedullary nailing. Hence, the aim of this study was to certify the risk factors for anterior cortical impingement treated with intramedullary nails of intertrochanteric fracture, hoping to provide suggestions for surgical treatment. Patients and Methods: A retrospective consecutive series of 94 patients who had been diagnosed as intertrochanteric fracture at our institution was included from January 2019 to November 2019. All patients were treated with intramedullary fixation and followed up for at least 6 months. Demographic, surgical and anesthesiologic information, as well as radiographic data and complications were collected and reviewed. Results: The ratio of anterior cortical impingement is significantly higher in female patients than that of males (80.4% vs 18.6%, P=0.041). Higher incidence of anterior cortical impingement was found in the longer intramedullary nail group, especially in females. Gender (as a female patient) and length of nail were significant risk factors for anterior cortical impingement in intertrochanteric fracture patients treated with intramedullary nail (OR =2.662, 95% CI =1.010-7.018, P=0.447; OR =1.047, 95% CI =1.016-1.079, respectively). The length of nail was a risk factor for anterior cortical impingement in female intertrochanteric fracture patients treated with intramedullary nail (OR =1.051, 95% CI =1.015-1.089). Conclusion: Elderly female patients with intertrochanteric fractures treated with intramedullary nails had a higher incidence of anterior cortical impingement. The length of short intramedullary nail is a risk factor for anterior cortical impingement. Patients with anterior cortical impingement may suffer serious complications.

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“…Nails are designed to be placed in the medullary canal of the femur, but because of a variety of problems (such as entry point errors, osteoporosis, and radius of curvature mismatch between the femur and nail) the nail can abut against or perforate the cortex of the femur distally [2]. Abutment or perforation can cause pain or secondary fracture [4, 6]. The problem of nail abutment or penetration also occurs with femoral shaft fractures but is much less common because these patients are different from those with proximal femur fractures.…”

Section: Where Are We Now?mentioning

confidence: 99%

“…Abutment or perforation can cause pain or secondary fracture [4,6]. The problem of nail abutment or penetration also occurs with femoral shaft fractures but is much less common because these patients are different from those with proximal femur fractures.…”

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confidence: 99%

CORR Insights®: A Simple Method to Improve Detection of Femoral Nail Abutment in the Distal Femur: A Computer Modeling Study

DeCoster

2022

Clin Orthop Relat Res

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Cephalomedullary nails: factors associated with impingement of the anterior cortex of the femur in a Hispanic population

Cited by 13 publications

References 22 publications

How to get better TAD? Relationship between anteversion angle of nail and position of femoral neck guide pin during nailing of intertrochanteric fractures

How to get better TAD? Relationship between anteversion angle of nail and position of femoral neck guide pin during nailing of intertrochanteric fractures

<p>Risk Factors for Anterior Cortical Impingement of Short Cephalomedullary Nail in Chinese Elderly Patients with Intertrochanteric Fracture</p>

CORR Insights®: A Simple Method to Improve Detection of Femoral Nail Abutment in the Distal Femur: A Computer Modeling Study

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