Pelvic migration of the helical blade after treatment of transtrochanteric fracture using a proximal femoral nail

Gomes, Pedro Teixeira; Castelo, Luís Sá; Lopes, António Lemos; Maio, Marta; Miranda, Adélia; Dias, António Marques

doi:10.1016/j.rboe.2015.07.013

Cited by 5 publications

(9 citation statements)

References 15 publications

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“…11 In the second case however, that was reported by Gomes PL et al, there was no mal-reduction and the medial cortex was intact. 13 We can speculate therefore that insufficiency of the medial buttress of the femur is only one of the contributing factors that results in medial migration. Werner-Tutschku et al were the first to suggest a possible mechanism for medial migration in the PFN (Synthes Produktions, GmbH, Bettlach, Switzerland).…”

Section: Discussionmentioning

confidence: 97%

“…One of the most uncommon is intrapelvic migration of the hip screw. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] Apart from the two presented cases in this article, twenty cases have been documented in the international literature in English language. Weil, Gardner et al attempted in 2008 to give a hypothesis in order to understand the biomechanical contributors to this phenomenon.…”

Section: Introductionmentioning

confidence: 97%

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Intrapelvic migration of the hip screw of a proximal femoral nail: report of two cases and review of the literature

2020

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<p>Two cases of medial migration of the hip screw in cases of cephalon-medullary nailing for the treatment of extra-articular proximal femoral fractures are reported. The first case was revised to hemiarthroplasty, that was subsequently complicated with infection and death of the patient, while the second was revised to a similar devise with favorable outcome. A review of the literature is performed in order to identify the contributing factors that result in the medial migration of the hip screw. Emphasis is given in further reporting of similar cases in order to abolish this potentially lethal complication. </p>

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Section: Discussionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 97%

Intrapelvic migration of the hip screw of a proximal femoral nail: report of two cases and review of the literature

2020

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“…[17] A number of factors have been suggested to be a potential reason for this phenomenon, which include inappropriate tip-apex distance, unstable fracture pattern, and the z-effect phenomena. [18,19] In addition, medial migration of the lag screw can also be attributed to the bone strength of the femoral head. [9] Theoretically, the trabecular bone surrounding the helical blade may function to resist further advancement of the lag screw.…”

Section: Discussionmentioning

confidence: 99%

Can the Bone Mineral Density of the Non-fractured Contralateral Hip Predict Medial Migration of Helical Blade-type Lag Screws in Osteoporotic Hip Fractures?

Jo¹,

Lee²,

Lee

et al. 2020

Preprint

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Background: In this study, we performed a biomechanical tests on the osteoporotic femoral heads to validate whether the bone mineral density (BMD) measured at the non-fractured contralateral hip can predict the BMD and potential medial migration of helical blade-type lag screws on the fractured femoral head.Methods: Twenty-four osteoporotic femoral heads were retrieved from patients with femoral neck fracture undergoing hip arthroplasty. The patients had their BMD measured from the contralateral hip using dual-energy X-ray absorptiometry prior to surgery. The BMD of the retrieved femoral heads was measured using micro-computed tomography. The mechanical properties for the medial migration of lag screw were measured by performing an uniaxial compression test on the femoral head using a helical blade-type lag screw. Statistical analysis was performed to determine the correlation among the BMDs of the non-fractured contralateral hip and the retrieved femoral head and the mechanical properties of the fractured femoral head.Results: The mean BMD of the contralateral hip was 0.60±0.14 g/cm2 in the neck region and 0.63±0.15 g/cm2 in the total proximal femur. The mean BMD of the fractured femoral head was 463.3±48.05 mg HA/cm3. The mechanical properties of the fractured femoral head were measured to be 0.92 kN for the maximum compressive load and 14.50±5.48 kN for the accumulated compression load. In the analysis of the correlation among the parameters, we found no correlation between the BMD of the non-fractured contralateral hip and the mechanical properties of the fractured femoral head. In addition, we observed no correlation between the BMD of the fractured femoral head and that of the contralateral hip.Conclusions: Our results indicate that the BMD of the contralateral hip does not reflect the BMD or the mechanical properties of the fractured femoral head. Therefore, helical blade-type lag screw migration may not be predicted from the BMD of the non-fractured contralateral hip.

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“…Similar mechanism of failure of implant was termed as “cut through” by Frei et al [13] in seven patients and the cause was attributed to the failure of the lateralization of the blade. Takigami et al [4] and Gomes et al [5] also reported medial migration of the blade causing acetabular perforation but did not comment about any specific cause for the same. Imperfect blade locking has been described with back out of the helical blade [14] but none with medial migration of the blade.…”

Section: Discussionmentioning

confidence: 99%

“…However, it is associated with a number of complications, most common being femur fracture at the distal tip and cut out of the helical blade [2,3]. Post-operative femoral head perforation with helical blade has been addressed as a unique complication in with PFNA [4,5]. The present case reports an unusual case of loosening of the locking bolt of the helical blade following treatment of an unstable intertrochanteric fracture with PFNA-II causing perforation of the femoral head.…”

Section: Introductionmentioning

confidence: 99%

An unusual case of femoral head perforation following fixation with proximal femoral nail antirotation (PFNA-II) for an unstable intertrochanteric fracture: Case report and literature review

Nayak

Yadav

Ganesh

et al. 2019

Trauma Case Reports

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The proximal femoral nail antirotation (PFNA-II) is designed for fixation of unstable proximal femoral fractures in Asian patients due to its superior biomechanical properties. The helical blade achieves purchase through bone compaction and requires less removal of bone than a screw. Medial migration of the helical blade with perforation into the hip joint without loss of reduction is a rare problem noted with PFNA. Past literature reporting the migration of the helical blade medially, perforating the femoral head has been addressed as a characteristic complication of the PFNA. A review of literature suggests various reasons for the same such as fresh trauma, fracture settlement and failure of lateralization of the blade. We report a case of postoperative medial migration of the helical blade perforating the femoral head due to loosening of the locking bolt of the helical blade without any signs of rotational or varus displacement of the fracture.

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Pelvic migration of the helical blade after treatment of transtrochanteric fracture using a proximal femoral nail

Cited by 5 publications

References 15 publications

Intrapelvic migration of the hip screw of a proximal femoral nail: report of two cases and review of the literature

Intrapelvic migration of the hip screw of a proximal femoral nail: report of two cases and review of the literature

Can the Bone Mineral Density of the Non-fractured Contralateral Hip Predict Medial Migration of Helical Blade-type Lag Screws in Osteoporotic Hip Fractures?

An unusual case of femoral head perforation following fixation with proximal femoral nail antirotation (PFNA-II) for an unstable intertrochanteric fracture: Case report and literature review

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