Outcome of traumatic subtrochanteric femoral fractures fixed using cephalo-medullary nails

Shukla, Sagrika; Johnston, Phillip; Ahmad, M. Z.; Wynn-Jones, Henry; Patel, A.D.; Walton, N. P.

doi:10.1016/j.injury.2007.05.013

Cited by 104 publications

(87 citation statements)

References 22 publications

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“…A deficient medial cortex with high bending forces in the subtrochanteric region accentuated by varus misalignment is known to lead to a significant risk of failure and non-union. 20 The second largest series of 14 broken nails described by Giannoudis et al observed similar trends to ours. 7 They reported that varus misalignment was a common feature of nail breakage due to non-union.…”

Section: Discussionsupporting

confidence: 89%

Risk factors for intramedullary nail breakage in proximal femoral fractures: a 10-year retrospective review

Johnson

Uzoigwe

Venkatesan

et al. 2017

annals

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INTRODUCTION Intramedullary nailing is a common treatment for proximal femoral fractures. Fracture of the nail is a rare but devastating complication that exposes often frail patients to complex revision surgery. We investigated which risk factors predict nail failure. METHODS We reviewed all cases of nail breakage seen over a 10-year period in a single busy trauma unit; 22 nail fractures were seen in 19 patients. Comparison was made with a group of 209 consecutive patients who underwent intramedullary fixation of a proximal femur fracture with no nail breakage over a 2-year period. RESULTS In the fractured nail group, mean age was 70.4 years (range 55-88 years).The mean time to fracture was 10 months (range 2.5-23 months). Logistical regression was used to show that low American Society of Anesthesiologists (ASA) score, subtrochanteric fracture and pathological fracture were independent risk factors for nail fracture. CONCLUSIONS Young patients with a low ASA score are at highest risk of nail breakage. We advise close follow-up of patients with these risk factors until bony union has been achieved. In addition, there may be merit in considering other treatment options, such as proximal femoral replacement, especially for those with pathological fracture with a good prognosis.

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Section: Discussionsupporting

confidence: 89%

Risk factors for intramedullary nail breakage in proximal femoral fractures: a 10-year retrospective review

Johnson

Uzoigwe

Venkatesan

et al. 2017

annals

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“…Femoral fracture, which is one of frequently occurring fracture of orthopedics, can lead to bleeding, shock and the fat embolism syndrome [9,10] . Open reduction and plates fixation has been a standard method of treatment for the fractures previously [11,12] .…”

Section: Discussionmentioning

confidence: 99%

Four pins assisted reduction of complex segmental femoral fractures: a technique for closed reduction

Zheng

Xin

et al. 2014

J. Huazhong Univ. Sci. Technol. [Med. Sci.]

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Complex segmental femoral fractures are usually not amenable to closed reduction. The purpose of this study was to evaluate a series of patients who had undergone four pins assisted reduction and intramedullary nail fixation to determine the therapeutic effect of this closed reduction technique. Between December 2010 and January 2013, 15 consecutive patients with segmental femoral fractures were treated with four pins assisted reduction at our hospital. The patient was placed in a supine position on a radiolucent fracture table and a gentle traction was attempted on the limb. Usually, the proximal fracture segment exhibited the typical deformity of flexion, external rotation, and abduction, the middle segment exhibited adduction and distal fracture segment exhibited flexion. Four Schanz pins were placed percutaneously to fix one cortex and did not penetrate into the medullary cavity, and the "T" sharp handles were fixed on the Schanz pins. The fragments were then reduced by reversing the deforming forces for segmental fractures by two assistants. And then, the reduction could be easily achieved and intramedullary nail fixation was performed. Radiographs were evaluated for the quality of the reduction and fracture union. Closed reduction was achieved in all patients using the four pins technology. All 15 fractures united uneventfully. No patient had a rotational malunion or limb length discrepancy at the time of the last follow-up. Thirteen of the fifteen (86.7%) patients had anatomic reduction and two of them (13.3%) had minor varus alignment of 3° and 5°. Knee stiffness was observed in 2 patients and no implant failure was observed. Surgical treatment of complex segmental femoral fractures with four pins assisted reduction and intramedullary nail fixation techniques can result in excellent reductions and a high union rate.

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“…The difficulties encountered in the treatment of subtrochanteric fractures are related to the unique anatomy and high bending forces transmitted across the subtrochanteric region of the proximal femur 5 with significant rates of complications reported with their surgical treatment. Despite numerous studies to improve technology and implant designs and outcomes of these injuries, malunion, nonunion and implant failure can occur with some frequency.…”

Section: Introductionmentioning

confidence: 99%

Intramedullary nailing of subtrochanteric femur fractures caused by low velocity gunshots

Swanepoel¹,

Chivers²,

Leong³

et al. 2017

SA orthop. j.

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Outcome of traumatic subtrochanteric femoral fractures fixed using cephalo-medullary nails

Cited by 104 publications

References 22 publications

Risk factors for intramedullary nail breakage in proximal femoral fractures: a 10-year retrospective review

Risk factors for intramedullary nail breakage in proximal femoral fractures: a 10-year retrospective review

Four pins assisted reduction of complex segmental femoral fractures: a technique for closed reduction

Intramedullary nailing of subtrochanteric femur fractures caused by low velocity gunshots

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