Salvage for intramedullary nailing breakage after operative treatment of trochanteric fractures

Tomàs-Hernández, Jordi; Núñez, Jorge H.; Teixidor-Serra, Jordi; Guerra-Farfán, Ernesto; Selga, Jordi; Porcel, Juan Antonio; Andrés-Peiró, José Vicente; Molero, Vicente

doi:10.1016/j.injury.2018.07.018

Cited by 13 publications

(20 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The breakage of metallic osteosynthesis devices in clinical use, namely, bone plates [11,12,13], intramedullary nail rods [14,15,16,17,18,19], spinal rods [20,21], compression hip screws (CHSs) [22], short femoral nails [23,24,25,26,27,28,29], and metaphyseal plates [22,30], due to fatigue fracture in the stress concentration region has been reported. In particular, the stress concentration region around a hole leads to crack initiation, resulting in fatigue fracture.…”

Section: Introductionmentioning

confidence: 99%

Strength–Durability Correlation of Osteosynthesis Devices Made by 3D Layer Manufacturing

2019

View full text Add to dashboard Cite

To develop orthopedic implants that are optimized for each patient’s needs or skeletal structure (custom-made implants), evaluations of the bending strength, bending stiffness, and durability of various types of conventional osteosynthesis devices have become important. Four-point bending tests and compression bending tests of osteosynthesis devices (bone plates, intramedullary nail rods, spinal rods, compression hip screws (CHSs), short femoral nails, and metaphyseal plates) were carried out to measure their bending stiffness, bending strength, and durability. The bending stiffness of bone plates, intramedullary nails, spinal rods, CHSs, short femoral nails, and metaphyseal plates increased with increasing bending strength. The durability limit of various types of osteosynthesis devices linearly increased with increasing bending strength. The relationship (durability limit at 106 cycles) = 0.67 × (bending strength) (N·m) (R2 = 0.85) was obtained by regression. The relationship for the highly biocompatible Ti-15Zr-4Nb-4Ta alloy was also linear. The mechanical strength and ductility of specimens that were cut from various osteosynthesis devices were excellent and their microstructures consisted of fine structures, which were considered to be related to the excellent durability. These results are expected to be useful for the development of implants suitable for the skeletal structure of patients using three-dimensional (3D) layer manufacturing technologies.

show abstract

Section: Introductionmentioning

confidence: 99%

Strength–Durability Correlation of Osteosynthesis Devices Made by 3D Layer Manufacturing

2019

View full text Add to dashboard Cite

show abstract

“…Senventy cases were analysed, including the 6 cases above and 64 cases reported in 19 previous papers [ 4 , 5 , 7 – 23 ] (Table 2 ). The mean age of the included patients was 72.3 years old (range 35–94 years), and 16 (22.9%) patients were younger than 65 years old.…”

Section: Resultsmentioning

confidence: 99%

“…IM nail breakage in pertrochanteric fractures is a rare complication that usually occurs in unstable cases [ 3 ], the prevalence of this complication has been reported to be 0.87–0.88% in previous studies [ 7 , 11 ]. Some authors found the incidence to be high, ranging from 2.9 to 5.7%, while they included both pertrochanteric fractures and subtrochanteric fractures [ 10 , 13 , 21 ].…”

Section: Discussionmentioning

confidence: 99%

Characteristics of intramedullary nail breakage in pertrochanteric femur fractures: a summary of 70 cases

Zhang

Zhou

et al. 2021

J Orthop Surg Res

View full text Add to dashboard Cite

Objective To reveal noteworthy characteristics of intramedullary (IM) nail breakage in pertrochanteric femur fractures. Materials and methods The data from 6 patients with IM nail breakage in our hospital between August 2008 and May 2018 were reviewed retrospectively. With an additional 64 cases reported in articles in the PubMed database prior to October 2019, a total of 70 cases were reviewed and analysed; epidemiological patient data and data on the initial trauma, fracture type, nail selected for the original surgery, time from surgery to breakage, mechanism and location of breakage, status of fracture healing, salvage treatment and prognosis were assessed. Results Seventy patients with pertrochanteric fractures, including 2 stable fractures and 68 unstable fractures, experienced IM nail breakage at a mean of 9.4 months after the initial surgery. Among them, 9 (12.9%) occurred within 3 months, 23 (32.9%) between 3 and 6 months and 38 (54.3%) after 6 months. The mean age was 72.3 years, and 16 (22.9%) patients were younger than 65 years old. When nail breakage occurred, 66 fractures (94.3%) exhibited delayed union/non-union. Self-dynamisation was found in 12 cases (17.1%). The salvage procedures included 4 partial/total implant removal procedures, 17 hemi/total hip arthroplasty procedures, 3 conservative treatment procedures, and 46 revised osteosyntheses, of which 7 cases (15.2%) sustained secondary implant failure. No significant differences were found between the failure rates of IM nails and extramedullary(EM) devices (odds ratio [OR], 3.429; 95% confidence interval [CI], 0.632–18.877; p = 0.330). Conclusion IM nail breakage is a rare complication lack of time regularity and mostly occurs in unstable pertrochanteric fractures in the presence of delayed union/non-union. Osteosynthesis revision can be conduct by a new IM nail or EM device but considerable secondary failure rate is noteworthy. Self-dynamisation may be a warning sign of nail breakage.

show abstract

“…Surgical treatment especially intramedullary nailing has been the common treatment method due to the central xation, less postoperative pain, and earlier recovery of mobilization 4,5 . Page et al 6 reported that the rate of intramedullary nailing in intertrochanteric fracture has increased from 3.8% in 2011 to 57.6% in 2015.…”

Section: Introductionmentioning

confidence: 99%

Risk factors for mechanical failure of proximal femoral nail anti-rotation (PFNA–II) in the treatment of intertrochanteric fractures (AO/OTA 31-A1, A2)

Nie¹,

Jiang²,

Li³

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: Intertrochanteric fracture is associated with severe morbidity and mortality. The results of postoperative implant failure are catastrophic. The aim of this study was to determine risk factors for implant failure in intertrochanteric fractures treated with proximal femoral nail anti-rotation (PFNA–II) through the assessment of early therapeutic effects.Methods: A single-center retrospective study was conducted on a continuous series of 123 intertrochanteric fracture patients treated with PFNA-II between Dec 2018 and Oct 2019. Perioperative medical and imaging data were collected. The patients were divided into two groups according to whether implant failure of not. The differences in reduction quality, nail length and tip apex distance (TAD) were analyzed to determine the risk factors of implant failure.Results: A total of 80 patients were enrolled, with an average age of 80.2 years old. There were 6 patients with implant failure. There was no significant difference in demographic index between the two groups. The reduction quality of failure group was good, accept and poor with each 2 patients, and that of the non-failure group was 35, 35 and 4 patients respectively. The difference of reduction quality between the two groups was statistically significant. The risk of postoperative implant failure in patients with poor reduction quality was 8.75 times that of patients with good and acceptable reduction from the Logistic regression analysis（OR=8.75，95%CI 1.215-62.99）. The differences in nail length, ASA and bone quality were not statistically significant. Conclusion: Reduction quality is a risk factor of implant failure in intertrochanteric fractures treated with PFNA-II. Even if the medial femoral cortex is anatomically reduced, there will be a triangular void area between the nail and the medial femur, which are prone to coxa vara and implant failure. Therefore, good reduction is the key to treat intertrochanteric fracture.

show abstract

Salvage for intramedullary nailing breakage after operative treatment of trochanteric fractures

Cited by 13 publications

References 20 publications

Strength–Durability Correlation of Osteosynthesis Devices Made by 3D Layer Manufacturing

Strength–Durability Correlation of Osteosynthesis Devices Made by 3D Layer Manufacturing

Characteristics of intramedullary nail breakage in pertrochanteric femur fractures: a summary of 70 cases

Risk factors for mechanical failure of proximal femoral nail anti-rotation (PFNA–II) in the treatment of intertrochanteric fractures (AO/OTA 31-A1, A2)

Contact Info

Product

Resources

About