Loss of Reduction after Cephalomedullary Nail Fixation of Intertrochanteric Femoral Fracture: A Brief Report

Abstract

Objective: At present, cephalomedullary nail is the most frequently used implant in the management of intertrochanteric fractures around the world. The implant design and fixation techniques of the cephalomedullary nail have been continuously improved to ensure uncomplicated bone union during the past decade. However, a degree of reduction loss during bone healing is still not rare in clinical work. Many attributed this complication to misoperation during the surgery and hold that a series of techniques and tips could help to avoid the loss of reduction. However, until now there has been no research to explore whether the reduction loss after the operation can be fully prevented in the best cases. The purposes of the study are as follows: (i) to evaluate the efficiency of the current established CMN techniques; (ii) to quantify the loss of reduction under an appropriately implanted CMN to anatomically realigned intertrochanteric fractures; and (iii) to explore the possible underlying causes for the inevitable loss of reduction. Methods: In the retrospective study, 163 consecutive cases with the intertrochanteric fractures fixed with standard cephalomedullary nail technique were reviewed. The anatomical reduction and optimal positioning of the nail were confirmed by postoperative imaging. The fracture types ranged from 31-A1.1-2.3 according to the OTA/AO fracture classification. One hundred and fifteen cases with stable fracture types (31A1.1-2.1) were allocated to Group A, and 48 cases with unstable 31A2.2-2.3 fracture types were allocated to Group B. The radiological measurements included femoral neck shortening, loss of the neck-shaft angle, cutout, and cut-through of the blade. The outcomes between postoperative and 1 year after the operation were evaluated and compared. Results: The patients consisted of 66 males and 97 females with an average age of 69.4 (range: 46-78, SD: 14.6) years. At the 1-year follow-up, no fixation failure or nonunion was observed in each group. The mean femoral neck shortening and loss of the neck-shaft angle were 4.

Increased 1-Year Revision Rates Among Left-Sided Intertrochanteric Femur Fractures

“…2 The majority of these fractures are treated with a cephalomedullary nail (CMN) technique. 2,3 Risks of the fracture include revision surgery, nonunion, or malunion, and while the incidence of this complication is low, it is a devastating complication for patients and the healthcare system. 4 Understanding the deforming forces acting on both the proximal and distal segments of an intertrochanteric fracture is crucial for appropriate reduction.…”

“…2 The majority of these fractures are treated with a cephalomedullary nail (CMN) technique. 2,3 Risks of the fracture include revision surgery, nonunion, or malunion, and while the incidence of this complication is low, it is a devastating complication for patients and the healthcare system. 4…”

The role of postoperative piriformis fossa and greater trochanter tubercle distance to predict cutout failure after cephalomedullary nail fixation

“…Intertrochanteric fracture (ITF) of the femur remains as one of the leading burdens on the health care system as the average population grows more elderly. 1,2 The surgical outcome and patient survival can be negatively affected by patients' comorbidities and osteoporotic status. Moreover, unstable ITFs distinguished by lateral wall fractures, medial calcar fragmentation, or reverse oblique fracture pattern can lead to increased postoperative complications and mortality.…”

Is Nail–Canal Diameter Discordance a Risk Factor for the Excessive Sliding of Cephalomedullary Nails in Geriatric Intertrochanteric Fracture Surgery?

“…The cephalomedullary nail (CMN) is one of the most commonly used modalities for the fixation of fragility ITF [4]. The outcomes of CMN surgery have greatly improved with Medicina 2023, 59, 1035 2 of 9 the development of fixation devices and its surgical techniques [5]. However, the fixation failure of the CMN in fragility ITF remains a sticking point.…”