Salvage hip replacement after cut-out failure of cephalomedullary nail fixation for proximal femur fractures: a case series describing the technique and results

Corró, Sebastián; Óleo-Taltavull, Rafael; Teixidor-Serra, Jordi; Tomàs-Hernández, Jordi; Selga-Marsà, Jordi; García-Sánchez, Yaiza; Guerra-Farfán, Ernesto; Andrés-Peiró, José Vicente

doi:10.1007/s00264-022-05529-4

Cited by 5 publications

(1 citation statement)

References 38 publications

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“…A multicenter study by Brunner et al [ 10 ] compared a number of treatments, from solitary lag screw exchange to THA, and came to the conclusion that THA was the best option with the fewest problems. Sebastián et al [ 30 ] reported that hip replacement appeared to be a relatively safe and reliable salvage procedure for elderly and physically frail patients. Tetsunaga et al 31 report that the rate of postoperative complications was significantly higher in the group of patients who had trochanteric fractures than in the group who had femoral neck fractures (25 vs. 0%, p 0.0001), which raises questions about the superiority of hip replacement in all patients who had this complication.…”

Section: Discussionmentioning

confidence: 99%

A biomechanical investigation of a novel intramedullary nail used to salvage failed internal fixations in intertrochanteric fractures

Chen,

Fan,

et al. 2023

J Orthop Surg Res

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Purpose The ideal approach for revision surgery following femoral head salvage treatments for an intertrochanteric fracture is still up for debate. A novel variety of proximal femoral bionic intramedullary nail (PFBN) has been created in clinical practice. We aimed to compare the biomechanical results of the novel implant to conventional intramedullary and extramedullary fixation in the treatment of intertrochanteric fracture following primary internal fixation failure. Methods Using finite element analysis, we created a three-dimensional model of the intertrochanteric fracture's helical blade cut-out for this investigation. The PFBN 1 group, the PFBN 2 group, the PFNA group, and the DHS group were our four test groups. For each fracture group, the von Mises stress and displacements of the femur and internal fixation components were measured under 2100 N axial loads. Results The values for the femoral displacement in the PFBN1 group, PFBN2 group, PFNA group, and DHS group were 6.802 mm, 6.716 mm, 8.080 mm, and 8.679 mm, respectively. The internal implant displacement values were 6.201 mm, 6.138 mm, 7.396 mm, and 8.075 mm in the PFBN1 group, PFBN2 group, PFNA group, and DHS group, respectively. The maximum von Mises Stress in the femoral was 187.2 MPa, 85.18 MPa, 106.6 MPa, and 386.2 MPa in the PFBN1 groups, PFBN2 groups, PFNA groups, and DHS groups, respectively. In the PFBN1 groups, PFBN2 groups, PFNA groups, and DHS groups, the maximum von Mises Stress in internal fixation was 586.7 MPa, 559.8 MPa, 370.7 MPa, and 928.4.8 MPa, respectively. Conclusion Our biomechanical research demonstrates that intramedullary fixation is more stable than extramedullary fixation when salvaging failed internal fixations in intertrochanteric fracture. Compared with PFNA and DHS, PFBN showed better biomechanical stability in the treatment of patients with revised intertrochanteric fractures. In light of this, we advocate PFBN fixation as the method of choice for intertrochanteric fracture revision. This result still has to be confirmed in more clinical research.

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Section: Discussionmentioning

confidence: 99%

A biomechanical investigation of a novel intramedullary nail used to salvage failed internal fixations in intertrochanteric fractures

Chen,

Fan,

et al. 2023

J Orthop Surg Res

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Management des Cut-out verschiedener Osteosyntheseformen bei proximalen Femurfrakturen

Henze,

Vogel,

Wienhöfer

et al. 2024

Unfallchirurgie

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Key Decision‐Making in Post‐Failed Internal Fixation of Intertrochanteric Fractures Hip Arthroplasty: A Multicenter Retrospective Study on Fracture Healing's Impact on Femoral Component Selection

Huang,

Ding

et al. 2024

Orthopaedic Surgery

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PurposeFollowing failed internal fixation of intertrochanteric fractures (FIF‐ITF), the decision to use a long‐stem or standard‐stem femoral implant in hip arthroplasty is still debated. This study aimed to explore how the healing status of fractures after FIF‐ITF failure affects the choice of femoral stem and clinical outcomes.MethodsOur retrospective cohort study reviewed 105 cases of patients with FIF‐ITF who underwent hip arthroplasty at three tertiary Grade A hospitals between December 2012 and December 2022. We compared the clinical outcomes between patients with healed and unhealed fractures, focusing on the selection of femoral stems in relation to proximal medial support and the healing status of the greater trochanter. The primary outcomes measured were functional results, operative time, blood loss, and incidence of complications. A subgroup analysis was conducted to further evaluate the influence of the proximal medial buttress and greater trochanteric healing on femoral stem selection. Statistical analysis included binary and ordinal logistic regression to identify factors influencing the choice of femoral stems. Additionally, a decision tree model was developed to visually represent and explore the relationship between fracture healing status and the selection of femoral components.ResultsThe study included 38 patients with healed fractures and 67 patients with unhealed fractures. Patients in the healed group predominantly chose standard stems and experienced better functional outcomes (p < 0.001, p = 0.002). In contrast, the unhealed group preferred long stems, resulting in longer surgical durations and increased blood loss (p = 0.008, p < 0.001). Binary logistic regression analysis revealed that nonunion of the proximal femoral medial buttress was an independent risk factor for long stems (p < 0.0001, OR = 10.402).ConclusionThe selection of femoral prostheses following FIF‐ITF is influenced by the fracture healing status, particularly the presence of proximal femoral medial buttress. The decision tree model suggested that long‐stem prostheses are more appropriate when there is inadequate fracture healing and the proximal femoral medial buttress is absent.

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Salvage hip replacement after cut-out failure of cephalomedullary nail fixation for proximal femur fractures: a case series describing the technique and results

Cited by 5 publications

References 38 publications

A biomechanical investigation of a novel intramedullary nail used to salvage failed internal fixations in intertrochanteric fractures

A biomechanical investigation of a novel intramedullary nail used to salvage failed internal fixations in intertrochanteric fractures

Management des Cut-out verschiedener Osteosyntheseformen bei proximalen Femurfrakturen

Key Decision‐Making in Post‐Failed Internal Fixation of Intertrochanteric Fractures Hip Arthroplasty: A Multicenter Retrospective Study on Fracture Healing's Impact on Femoral Component Selection

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