Surgical outcomes of intramedullary nailing for diaphyseal atypical femur fractures: is it safe to modify a nail entry in bowed femur?

Abstract

Changing the entry point laterally allowed the nail to be accommodated in bowed femurs, decreasing the risk of deformity and improving healing time. In severely varus femur, the lateral entry of the straight nail can be a useful technique.

Plate Fixation for Atypical Fractures of the Femoral Diaphysis

“… 17) Several modified operation techniques including far lateral entry point, use of the opposite site nail, overreaming more than 2.5 mm have been introduced to overcome excessive anterolateral bowing of the femur. 9 10 22) Even if an IM nail is inserted after addressing these difficulties, leg-length discrepancy caused by femoral straightening and lengthening is inevitable.…”

“…Also, several surgical methods have been proposed to overcome excessive femoral bowing. 9 10) Despite these efforts to use IM nails, iatrogenic fracture during the insertion of IM nails and leg length discrepancy due to straightening of the bowed femur are expected complications.…”

Surgical Treatment of the Atypical Femoral Fracture: Overcoming Femoral Bowing

“…7 ). Kim et al 17) reported that, upon comparing the results of using a lateral entry point beginning at the greater trochanter and the original entry point for intramedullary nail insertion in patients with atypical femoral shaft fracture accompanied by severe anterolateral bowing, there was no observed difference in the degree of union, however, the time to union was significantly reduced.…”

MANAGEMENT OF ENDOCRINE DISEASE: Atypical femoral fractures: risks and benefits of long-term treatment of osteoporosis with anti-resorptive therapy

“…In most cases a medullary nail is placed to provide fixation of the fracture and allow healing. For patients with bowed femurs, an alternative nail entry site may be necessary [22], and lateral fixation has been suggested as an alternative [23]. In any event, surgery followed by a rehabilitation program is necessary for those who have had a complete fracture; it is possible that the surgical technique will be refined over time.…”