Femoral offset loss and internal arch restoration defect are correlated with intramedullary nail cut-out complications after pertrochanteric fractures: a case–control study

Boukebous, Baptiste; Flouzat-Lachaniette, Charles-Henri; Donadio, Julia; Chenguel, Z; Guillon, P.; Rousseau, M.-A.

doi:10.1007/s00590-019-02481-9

Cited by 3 publications

(2 citation statements)

References 29 publications

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“…Femoral offset and precision of neck-shaft angle restoration were correlated with TAD outcomes. During the closed reduction procedure, rigorous intraoperative control of femoral offset and neck-shaft angle distinguishes non-optimal reductions [ 13 ]. With our technical note of double compression in two-screw cephalomedullary nailing systems, we eliminate any fracture gap remaining by implant limitations and reach a stable osteosynthesis of the peritrochanteric fracture.…”

Section: Discussionmentioning

confidence: 99%

Double lag-screw compression for optimal fixation of intertrochanteric fractures with large fragment gap: A technical note

Karampinas

Galanis

Papagrigorakis

et al. 2023

SICOT-J

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Cephalomedullary nailing of unstable intertrochanteric fractures has been established as a fruitful surgical approach with relatively limited complications. Anatomic fracture reduction and proper implant positioning are vital to attaining a favorable long-term surgical outcome. Appropriate intraoperative fracture compression augments stability and invigorates healing. The amount of compression permitted by cephalomedullary nails cannot always adequately reduce large fragment gaps. This paper presents a novel technical trick of double compression of the fracture site, in order to achieve the essential extra compression and reduction when required, thus decreasing the risk of postoperative implant cut-out. The technique was used in 14 out of 277 peritrochanteric fractures treated with cephalomedullary nailing in our trauma center for 12 months, with satisfactory outcomes regarding both fracture site union and postoperative functional capacity.

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Section: Discussionmentioning

confidence: 99%

Double lag-screw compression for optimal fixation of intertrochanteric fractures with large fragment gap: A technical note

Karampinas

Galanis

Papagrigorakis

et al. 2023

SICOT-J

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“…There was evidence to show the potential correlation between the neck-shaft angle and TAD in IEF patients. For example, Boukebous et al calculated the neck-shaft angle gap between the fractured and the healthy sides and found the average TAD can reach 27 mm in patients with a 7% eck-shaft angle gap rate [32]. Walton et al demonstrated the number of patients with TAD greater than 25 mm was more in the group with the neck-shaft angle < 125°compared to those having the neck-shaft angle > 125°(27.8% vs 12.6%) [33].…”

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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Is rotation the mode of failure in pertrochanteric fractures fixed with nails? Theoretical approach and illustrative cases

Kokoroghiannis

Vasilakos

Zisis

et al. 2019

Eur J Orthop Surg Traumatol

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Femoral offset loss and internal arch restoration defect are correlated with intramedullary nail cut-out complications after pertrochanteric fractures: a case–control study

Cited by 3 publications

References 29 publications

Double lag-screw compression for optimal fixation of intertrochanteric fractures with large fragment gap: A technical note

Double lag-screw compression for optimal fixation of intertrochanteric fractures with large fragment gap: A technical note

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

Is rotation the mode of failure in pertrochanteric fractures fixed with nails? Theoretical approach and illustrative cases

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