Is Full-Length Intramedullary Nail Necessary for Atypical Subtrochanteric Femoral Fracture Associated with Bisphosphonate?

Abstract

Background: American Society for Bone and Mineral Research recommend the use of intramedullary reconstruction of full length-nail for atypical subtrochanteric femoral fracture (ASFF). However, there is no study on the incidence of the ipsilateral femoral fracture after index operation of ASFF, and full-length nail has disadvantage as iatrogenic fracture and leg length discrepancy (LLD). The aim of this study was to investigate the incidence of ipsilateral secondary fracture after using partial-length nail, and to compare the outcomes on surgery of ASFF between partial length-nails and full length-nails. Methods: Forty-five consecutive fractures with ASFFs which had undergone intramedullary fixation using cephalomedullary nail between 2011 and 2018 were enrolled. The 45 cases were grouped based on nail length into the partial-length nail group (n =26) and the full-length nail group (n=19). Ipsilateral secondary fracture, time to union, intraoperative iatrogenic fracture, metal failure, LLD, operative duration, and post-operative 24-hr blood loss were investigated. Results: There was no ipsilateral secondary fracture after index operation. There were no statistically significant differences between the partial-length nail and full-length nail groups in the time to union, LLD, and post-operative 24-hr blood loss (P=0.427, 0.478, and 0.228, respectively). Operative duration showed statistically significant difference between 2 groups (P=0.034). Metal failure were occurred in 1 (3%) case of the partial-length nail group and 2 (10%) cases of the full-length nail group. Iatrogenic fractures during nail insertion occurred in 2 (7%) cases of the partial-length-nail group and 3 cases (15%) of the full-length nail group. Conclusions: Although large scale studies are required, our study indicate that full-length nails are not usually required for the treatment of ASFF.

A secondary atypical diaphyseal femoral fracture after intramedullary nailing for an atypical subtrochanteric femoral fracture: A case report

“…The appropriate length of the intramedullary nail for atypical subtrochanteric femoral fracture fixation is controversial. Kim et al [ 9 ] compared the clinical outcomes of partial- and full-length nails used for atypical subtrochanteric femoral fractures and concluded that full-length nails are not usually required. According to their report, no ipsilateral secondary atypical femoral fractures were found during the follow-up period; however, the mean follow-up period was a short 1.9 years.…”

Stress Fracture of the Femoral Shaft in Paget’s Disease of Bone: A Case Report

“…[ 30 ] Regarding the type of nail, a full-length intramedullary nail is preferred [ 31 ]; however, a partial-length intramedullary nail has also shown similar outcomes as full-length nail. [ 32 ] In this case, we chose to treat our patient conservatively due to her severe lateral femoral bowing. More specifically, insertion of a relatively straight intramedullary nail into a curved bone would be technically challenging and may not effectuate the intended effect.…”

A comparison of functional and radiological outcome of combine compression antegrade intertrochanteric nail (InterTan) and proximal femoral nail anti-rotation II (PFNA-II) in elderly patients with intertrochanteric fractures

“…Made up mainly of metal alloy, it has been successfully applied in orthopedics clinics. 3 Studies have shown that this system has the biomechanical characteristics of central fixation and has become the first choice in the clinical treatment of patients with intertrochanteric fractures. 4 The common clinical intramedullary nail fixation devices include proximal femoral combined tension interlocking intramedullary nail (InterTan) and Asian proximal femoral anti rotation intramedullary nail (PFNA-II).…”

“…Made up mainly of metal alloy, it has been successfully applied in orthopedics clinics. 3 Studies have shown that this system has the biomechanical characteristics of central fixation and has become the first choice in the clinical treatment of patients with intertrochanteric fractures. 4 …”