PMD25 Risk of Nail Breakage in Treatment with Cephalomedullary Nails for Proximal Femoral Fractures

Chitnis, A.S.; Holy, C.E.; Vanderkarr, M.; Sparks, Charles H.

doi:10.1016/j.jval.2020.08.1058

Cited by 1 publication

(3 citation statements)

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“…It is also worth noting that 3 of the 4 large-scale database searches were conducted by employees of a medical technology company that manufactured the implant it studied, which would have the potential to introduce bias from conflict of interest. [14][15][16] With no gold standard reference, the true accuracy of all of the studies remains unknown.…”

Section: Discussionmentioning

confidence: 99%

“…For database papers, 3 of the studies detected breakage by ICD code searches for "breakdown of internal device" AND (femur fracture repair OR device removal from femur) occurring in one hospital admission. [14][15][16] The fourth study detected revisions defined as any operation after index procedure in which a component was removed and/or replaced; however, it did not specify how the database was queried for that outcome. 13 Those patients then had a hospital record review.…”

Section: Detection Of Breakagementioning

confidence: 99%

“…12 To increase participant numbers, some authors have interrogated large-scale US health care databases. [13][14][15][16] These are considered administrative rather than clinical databases, because the information is typically compiled from billing information and is not recorded primarily for clinical research purposes. 17 Administrative databases that use the International Classification of Diseases (ICD) codes to capture implantation or breakages rely on accurate translation of records and operation reports by health information managers who may not understand the differences between implant types or revision procedures.…”

Section: Introductionmentioning

confidence: 99%

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Defining Cephalomedullary Nail Breakage Rates: A Systematic Review and Meta-Analysis

Lambers,

D'Alessandro,

Yates

2023

Journal of Orthopaedic Trauma

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Objective: To establish the background rate of breakage of cephalomedullary nails. Data Sources: MEDLINE, PubMed, and Web of Science were searched on April 3, 2023. Study Selection: All English-language studies that examined trochanteric with or without subtrochanteric fractures and identified cephalomedullary nail breakage as an outcome measure and a breakage rate could be derived were included. Implants captured were predominantly the TFNA, TFN, and PFN by DePuy Synthes, various versions of the Gamma nail by Stryker, the Zimmer Natural Nail by Zimmer Biomet, and the Intertan by Smith and Nephew. Data Extraction: The author, year of publication, dates of implant insertion, study design, method of detection of breakages, implant used, number of implant breakages, number of implants inserted, breakage rate, and follow-up were extracted. Data Synthesis: Meta-analysis of included studies used descriptive nonparametric statistics and a noncomparative proportion for the pooled result. Differences in results between study design types were compared using the mean breakage rate per study design. Conclusions: Cephalomedullary nail breakage is a rare complication with a median reported rate of 0.6% and a pooled result rate of 0.4%. Ninety-five percent of studies had a breakage rate of 1.3% or less, which sets a benchmark from the reported literature for future studies. There is wide variability in rates of breakage reported between different types of study designs with single-center review studies reporting breakage rates nearly 4-fold greater than large-scale administrative database reviews. The rate of implant breakage should not be used in isolation to judge an implant's performance. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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Section: Discussionmentioning

confidence: 99%