The learning curve with a new cephalomedullary femoral nail

Fine, Nicola; Sexton, Shaun; Williams, Dan

doi:10.1016/j.injury.2017.05.030

Cited by 8 publications

(5 citation statements)

References 15 publications

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“…As a result of the nature of pathologic fractures and their general lack of bone healing, IM nails and locking screws carry more pressure and during a longer period than in general trauma care. The common persisting nonunion often leads to implant fractures (that is, breakage of screws and nails) over time [6]. In the current cohort, 3% (seven of 228) of the nails fractured, all at the junction with the collum screw.…”

Section: Discussionmentioning

confidence: 70%

What Factors Are Associated With Implant Breakage and Revision After Intramedullary Nailing for Femoral Metastases?

Willeumier

Kaynak

Zwaal

et al. 2018

Clin Orthop Relat Res

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Background Actual and impending pathologic fractures of the femur are commonly treated with intramedullary nails because they provide immediate stabilization with a minimally invasive procedure and enable direct weightbearing. However, complications and revision surgery are prevalent, and despite common use, there is limited evidence identifying those factors that are associated with complications. Questions/purposes Among patients treated with intramedullary nailing for femoral metastases, we asked the following questions: (1) What is the cumulative incidence of local complications? (2) What is the cumulative incidence of implant breakage and what factors are associated with implant breakage? (3) What is the cumulative incidence of revision surgery and what factors are associated with revision surgery? Methods Between January 2000 and December 2015, 245 patients in five centers were treated with intramedullary nails for actual and impending pathologic fractures of the femur One of the authors (JJW) received funding from KWF Kankerbestrijding (UL2013-6286). Clinical Orthopaedics and Related Research® neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA-approval status, of any drug or device prior to clinical use. Each author certifies that his or her institution approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

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Section: Discussionmentioning

confidence: 70%

What Factors Are Associated With Implant Breakage and Revision After Intramedullary Nailing for Femoral Metastases?

Willeumier

Kaynak

Zwaal

et al. 2018

Clin Orthop Relat Res

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“…At this location the cross-sectional area of the intramedullary nail is narrowed by 73% [26–28] . Prior reports also show evidence of eccentric drilling at the proximal nail aperture causing implant notching and decreased fatigue strength [28–31] . Other previously reported sites of implant breakage include the distal screw aperture, the distal locking screw itself, and the shaft of the cephalomedullary implant [19,20,22,28,32] .…”

Section: Discussionmentioning

confidence: 77%

“…[ 26 – 28 ] Prior reports also show evidence of eccentric drilling at the proximal nail aperture causing implant notching and decreased fatigue strength. [ 28 – 31 ] Other previously reported sites of implant breakage include the distal screw aperture, the distal locking screw itself, and the shaft of the cephalomedullary implant. [ 19 , 20 , 22 , 28 , 32 ] We present a unique failure of the TFNA cephalomedullary nail in a peritrochanteric nonunion.…”

Section: Discussionmentioning

confidence: 99%

Case report: unique failure of a Synthes TFNA fenestrated lag screw in a peritrochanteric nonunion

Smidt

Perry

Andre

et al. 2022

OTA International: The Open Access Journal of Orthopaedic Trauma

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Background: Intertrochanteric femur fractures are a common orthopaedic injury that are often treated surgically. Cephalomedullary nails (CMN) are frequently the implant of choice for intertrochanteric femur fractures, resulting in low complication rates. Implant failure is a rare but reported complication. Common locations of failure include the proximal nail aperture, distal screw holes, and implant shaft. In this case report, we describe a CMN failure pattern through fenestrated cephalic screw holes.Case: A 70-year-old female sustained an OTA 31A-2.2 peritrochanteric fracture during a motor vehicle collision. She was treated the following day with a Synthes Trochanteric Fixation Nail-Advanced CMN utilizing a fenestrated cephalic screw. There were no intraoperative complications. She was made non-weight bearing for 8 weeks after the procedure due to ipsilateral foot fractures. At 6 months follow-up she was noted to have a delayed union. 11 months postoperatively she suffered a ground level fall and the cephalic lag screw failed through its fenestrations, resulting in varus collapse of her fracture at the femoral neck. The patient then underwent nail extraction and salvage total hip arthroplasty. Conclusion:Cephalomedullary nail implant failure is presented with implant fracture propagation through a fenestrated cephalic screw. Cephalomedullary lag screw failure is rare and can be difficult to manage. It is important to monitor new implants for unique failure mechanisms.

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“…A key procedure of the intramedullary nailing technique is to insert the guide wire into the desired position from the proximal medullary cavity into the distal cavity [19][20][21]. However, residual displacement after the initial closed reduction of the femoral shaft fracture may make insertion of the guide wire and subsequent nail fixation difficult [22][23][24][25].…”

Section: Discussionmentioning

confidence: 99%

The design of an “H” joystick for closed reduction and its application in segmental and comminuted femoral shaft fractures: an innovative technique

et al. 2020

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Background: Closed reduction and locked intramedullary nailing has become a common surgical method in the treatment of femoral shaft fractures. Overlap and rotation displacements can usually be corrected through the use of an orthopedic traction table. However, lateral displacement and angulation persist. Methods: In this paper, we describe a joystick that can be used in the closed reduction of a fracture. It can correct lateral displacement and angulation, and has the advantage of multi-direction reduction. The device described in this paper includes two parallel horizontal joysticks, one vertical main joystick and four assistant rods. Moreover, there are many specific spacing holes in the two parallel horizontal joysticks and a groove structure in the vertical main joystick. When the main "H" joystick is pressed, it can adjust lateral displacements and angulation because of the lever principle. The distance between parallel horizontal joysticks and assistant rods can be adjusted to the fracture position and body mass index of different patients. Results: The study participants consisted of 11 males and 5 females with a mean age of 31.0 years. All participants had good closed reduction and achieved bony union without any complications such as infection, nerve injury, non-union, malunion, and limb length discrepancy. By using an "H" joystick, closed femoral shaft fracture reduction and locked intramedullary nailing becomes simpler and faster. Conclusion: Based on the use of this instrument, we can easily and conveniently obtain the correct reduction situation, which leads to better surgical results. This device can be applied in the reduction of clinical femoral fractures and gradually extended to the reduction of other fractures.

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The learning curve with a new cephalomedullary femoral nail

Cited by 8 publications

References 15 publications

What Factors Are Associated With Implant Breakage and Revision After Intramedullary Nailing for Femoral Metastases?

What Factors Are Associated With Implant Breakage and Revision After Intramedullary Nailing for Femoral Metastases?

Case report: unique failure of a Synthes TFNA fenestrated lag screw in a peritrochanteric nonunion

The design of an “H” joystick for closed reduction and its application in segmental and comminuted femoral shaft fractures: an innovative technique

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