Local Postoperative Complications after Surgery for Intertrochanteric Fractures Using Cephalomedullary Nails

Abstract

PurposeCephalomedullary nails (CMN) are commonly used for the surgical treatment of intertrochanteric fractures. This study aimed to evaluate overall postoperative local complications by reviewing patients who received surgical treatment using three different types of implants.Materials and MethodsThe study sample included 353 patients (107 males, 246 females) who underwent surgery using CMN for intertrochanteric fractures. Three different types of implants were used: i) the Gamma3® (Stryker) in 80 cases, ii) the Targon® PF (Aesculap) in 225 cases, and iii) the Compression Hip Nail® (Trademedics) in 48 cases. The mean age was 82.6 (range, 60–109) years and the average follow-up period was 15 (range, 6–80) months. Postoperative local complications and risk factors of cut-out were assessed.ResultsThe most common complication was cut-out (n=26). Other complications included non-union (n=3), periprosthetic fracture (n=2), avascular necrosis (n=1), heterotopic ossification (n=1), and sleeve pull out (n=1). Multivariate analysis revealed that the cut-out group had a higher rate of poor reduction compared to the non-complicated group (P<0.001). Although the mean tip-apex distance (TAD) was 18.4 mm in the non-complicated group, lower than that of the cut-out group (P=0.001), multivariate analysis revealed that TAD was not a significant risk factor for cut-out (P=0.065).ConclusionCut-out is the most common local complication associated with surgical treatment of intertrochanteric fractures using CMN. Proper reduction appears to be important in lowering the risk of cut-out. Maintaining low TAD is another critical factor in achieving sufficient fixation of lag screw to the subchondral bone of the femoral head.

Integrated dual lag screws versus single lag screw cephalomedullary nail constructs: a meta-analysis and systematic review

“…Over the years, many design modifications have helped to reduce common complications associated with earlier generations of these CMN These include femoral shaft fractures, fixation failures, cutting-out of screws and screw migrations. 13,14 The current designs provide more solid fixation, even in osteoporotic bone, and prevent rotation of the head and neck fragment via a modified antirotation screw or helical blade design. The integrated dual lag screw (IDL) construct of the InterTan CMN has been marketed as permitting linear compression as well as rotational stability of the head and neck fragment.…”

Routine follow-up is unnecessary after intramedullary fixation of trochanteric femoral fractures—Analysis of 995 cases

“…Blade cut off, blade migration, nail breakage and locking bolt loosening can be surgeon related technical complications which may be avoided with meticulous planning and execution. The cutout rate has varied in the literature between 2 and 7 % [11][12][13][14] We noted a 1,2 % cutout rate, this suggests that the quality of surgery is acceptable at our institution.…”

Proximal Femoral Nail Unlocked versus Locked (ProFNUL): a protocol for a multicentre, parallel-armed randomised controlled trial for the effect of femoral nail mode of lag screw locking and screw configuration in the treatment of intertrochanteric femur fractures

“…Complications recorded will include the number and type of injury and surgery-specific events and complications including, technical complications, surgical site infection, unplanned surgery and death up to 1 year following surgery. This has been reliably collected in previous studies 81 82…”