Peri-implant fracture: a rare complication after intramedullary fixation of trochanteric femoral fracture

Abstract Introduction Trochanteric femoral fractures are among the most common operatively treated fractures. Intramedullary fixation has become the treatment of choice in many centers around the world. Nevertheless, the knowledge of rare complications of these fractures is limited. In this study, the incidence and treatment strategies for peri-implant fractures (PIF) were assessed. Materials and methods A single-center retrospective cohort study was done on 987 consecutive operatively treated trochanteric fractures. PFNA cephalomedullary nail was used as a fixation method. All patients were followed up from patient records for peri-implant fractures. Plain radiographs as well as different salvage methods were analyzed and compared. Results The total rate of peri-implant fractures was 1.4% (n = 14). The rate of PIF for patients treated with short (200 mm) nails, intermediate-length (240 mm) nails, and long nails was 2.7% (n = 2), 1.5% (n = 11), and 0.7% (n = 1), respectively (ns, p > 0.05 for difference). Treatment of choice for PIF was either ORIF with locking plate (57%, n = 8) or exchange nailing (43%, n = 6). None of the PIF patients needed additional surgeries for non-union, malunion, or delayed union. Conclusions A PIF is a rare complication of intramedullary fixation of trochanteric fractures. It can be treated with either locking plates or exchange nailing with sufficient results. There are no grounds for favoring long nails to avoid PIFs.

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Systematic review of dynamization vs exchange nailing for delayed/non-union femoral fractures

World Journal of Orthopedics ◽

10.5312/wjo.v9.i7.92 ◽

2018 ◽

Vol 9 (7) ◽

pp. 92-99 ◽

Cited By ~ 1

Author(s):

Jacob E Vaughn ◽

Ronit V Shah ◽

Tarek Samman ◽

Jacob Stirton ◽

Jiayong Liu ◽

...

Keyword(s):

Systematic Review ◽

Femoral Fractures ◽

Non Union ◽

Exchange Nailing

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Functional outcomes of reverse distal femoral locking plate in the extra capsular fractures of proximal femur

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20191046 ◽

2019 ◽

Vol 5 (3) ◽

pp. 417

Author(s):

Jaspreet Singh ◽

Harpal Singh Selhi ◽

Rahul Gupta ◽

Gurleen Kaur

Keyword(s):

Proximal Femur ◽

Functional Outcomes ◽

Locking Plate ◽

Femoral Fractures ◽

Delayed Union ◽

Bony Union ◽

Proximal Femoral Fractures ◽

Superficial Infection ◽

Non Union ◽

Wound Breakdown

Background: The optimal management of unstable proximal femoral fractures is controversial. In this prospective study, the functional outcomes of reverse distal femoral locking plate for the treatment of comminuted unstable proximal femoral fractures were assessed. Objectives were to study the functional outcomes of reverse locking plate in extra-capsular fractures of the proximal femur, with respect to quality of reduction, time to bony union, mobility achieved, complications of the procedure, secondary procedures performed (if any) and delayed complications like implant breakage, delayed union, non-union.Methods: 17 patients with unstable proximal femoral fractures were assessed and managed with reverse distal femur plates, and evaluated with X-ray, physical examination, Palmer and Parker mobility score.Results: Union was achieved in all the patients, with average time to union 6.43±1.18 months (range 3-12 months). There was one loosening of implant and wound breakdown, which was managed conservatively. One case of loosening of proximal screws was there, but the fracture united in 9 months with some varus angulation. Superficial infection occurred in one patient, which healed after debridement and IV antibiotics.Conclusions: Taking into consideration the simple surgical technique, good healing rate and minimum complications, it is strongly recommended to use reverse locked distal femoral plates for the management of proximal femoral fractures and further in lean patients, sum-muscular MIPPO should be attempted.

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Mechanism of Unstable Inter-trochanteric Fractures in the Elderly

Journal of Pharmaceutical Research International ◽

10.9734/jpri/2020/v32i1430612 ◽

2020 ◽

pp. 120-134

Author(s):

S. Santhosh

Keyword(s):

Femoral Fractures ◽

Early Mobilization ◽

The Elderly ◽

Trochanteric Fractures ◽

Non Union ◽

Prospective Comparative Study ◽

Hip Screw ◽

Hemi Arthroplasty ◽

Tremendous Impact

The aim of this prospective comparative study is to analyse the short term follow-up results of unstable inter-trochanteric fractures in the elderly treated with Bipolar hemi-arthroplasty and Dynamic hip screw fixation done in our institution from March 2017 to October 2018. Proximal femoral fractures in the elderly individuals have a tremendous impact on both the health care system and society. Upon treatment of inter-trochanteric factures with conservative management, it usually unites with a mal-union, non-union and with shortening, but the problem of non –union in trochanteric fractures has less incidence. Because of complications associated with prolonged recumbency and its associated morbidities. Primary hemiarthroplasty in these patients provides for adequate fixation and early mobilization. It alleviates pain and improves function. It also prevents post-operative complications such as pneumonia, lung atelectasis and pressure sores. From our clinical observation we would suggest that unstable intertrochanteric fractures in elderly result most frequently from accidental fall (52.5%), being the most common described mechanism of injury.

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Teriparatide in fracture healing: Case series and review of literature

IP International Journal of Orthopaedic Rheumatology ◽

10.18231/j.ijor.2021.021 ◽

2022 ◽

Vol 7 (2) ◽

pp. 93-100

Author(s):

S S Jha ◽

Amit B Jain ◽

Nilanj Dave ◽

Alok Chaturvedi ◽

Sandesh Warudkar

Keyword(s):

Fracture Healing ◽

Case Reports ◽

Case Series ◽

Femoral Fractures ◽

Delayed Union ◽

Published Data ◽

Mechanical Instability ◽

Mineral Density ◽

Non Union

Teriparatide (TPTD) (recombinant Parathyroid Hormone 1-34) is one of the pioneer osteo-anabolic agents approved for management of osteoporosis. Being an anabolic agent, it increases bone mineral density by inducing formation of new bone by the action on osteoblasts. As new bone formation is an important aspect of fracture healing as well, Teriparatide has long been a product of interest with respect to its effect on the process of fracture healing. Though fracture healing is not an approved indication for Teriparatide, there is quite a substantial amount of published data related to its effectiveness in fracture healing. With an intent to better understand the role of teriparatide in fracture, we share few case reports of successful fracture healing after giving Teriparatide and also review the published evidences of union taking place in difficult delayed union and non-union cases secondary to mechanical instability, inadequate fixation support or other reasons. This article thus, intended to summarize the accumulating preclinical and clinical evidence for role of TPTD in accelerating fracture healing in various conditions like conservative management of fractures, vertebral fractures, non-unions, delayed unions and atypical femoral fractures.

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

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02826-3 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Pengfei Li ◽

Zhishan Zhang ◽

Fang Zhou ◽

Yang Lv ◽

Yan Guo ◽

...

Keyword(s):

Rare Complication ◽

Delayed Union ◽

Warning Sign ◽

Pertrochanteric Fractures ◽

Non Union ◽

Femur Fractures ◽

Initial Surgery ◽

Pubmed Database ◽

Secondary Failure ◽

Pertrochanteric Femur Fractures

Abstract 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.

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Exchange Nailing as Revision Surgery for Post-operative Non-union of Atypical Femoral Fractures: A Case Report and Treatment Strategy

Journal of Orthopaedic Case Reports ◽

10.13107/jocr.2021.v11.i02.2050 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Tomohiro Yasuda ◽

Masayuki Arai ◽

Daichi Shinohara ◽

Yuki Samejima ◽

Koji Kanzaki ◽

...

Keyword(s):

Case Report ◽

Revision Surgery ◽

Femoral Fracture ◽

Callus Formation ◽

Femoral Fractures ◽

Femoral Shaft ◽

Medullary Canal ◽

Atypical Femoral Fractures ◽

Non Union ◽

Exchange Nailing

Introduction: Atypical femoral fractures account for only 0.5% of femoral shaft fractures, but delayed union or non-union occurs in 50% of atypical femoral fractures accompanied by femoral lateral bowing. Such fractures are difficult to treat. Case Report: The case was an 84-year-old woman. She was diagnosed post-operative non-union of atypical femoral fracture. We planned a revision surgery for post-operative non-union of the atypical proximal femoral fracture. A two-dimensional template was used to simulate the intramedullary nail (IMN). Due to the advanced femoral lateral bowing deformity, a mismatch with the nail was noted when the unaffected femur was used to construct the template. When the opposite side nail was used as a template, the nail was aligned with the medullary canal, and the tip of the nail coincided with the center of the medullary canal; hence, the opposite side nail was chosen. Radiographical assessments of healing of the fracture confirmed callus formation and complete bone union 3 months and 1 year after the operation, respectively. Conclusion: We found that exchange nailing as revision surgery for post-operative non-union of atypical femoral fractures combined with an IMN on the opposite side was useful. Keywords: Alendronate, femoral fracture, osteoporosis, revision surgery.

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Outcome of Distal Femoral Fracture Treated with Locking Plate

10.53350/pjmhs211562142 ◽

2021 ◽

Vol 15 (6) ◽

pp. 2142-2144

Author(s):

Muhammad Shoaib Zardad ◽

Abdus S. Awan ◽

Muhammad Younas ◽

Shahkeel A. Shah ◽

S. Sohail Akhtar ◽

...

Keyword(s):

Femoral Fracture ◽

Traffic Accidents ◽

Locking Plate ◽

Road Traffic ◽

Femoral Fractures ◽

Delayed Union ◽

Distal Femoral Fracture ◽

Non Union ◽

One Year

Objective: The aim of this study is to determine the outcome of distal femoral fracture treated with locking plate. Study Design:Prospective study Place and Duration: Conducted at Orthopaedic Unit Ayub Medical Teaching Institute, Abbottabad for one year duration from 1stJanuary 2020 to 31st December 2020. Methods: Total 90 patients of both genders were presented in this study.Patients were aged between 18-80 years of age. Patients’ detailed demographics including age, sex and body mass index were recorded after taking informed written consent. All the patients had distal femoral fracture treated with locking plate. Radiological assessment was done. Mean union time and complications associated to procedure were examined.Functional outcomes were analyzed according to the Flyn’s criteria. Follow-up was taken at 6 months postoperatively. Complete data was analyzed by SPSS 24.0 version. Results:There were 58 (64.4%) patients were males and 32 (35.6%) were females. Mean age of the patients were 42.61±12.88 years with mean BMI 27.65±9.56 kg/m2. According AO/OTA classification 55 (61.1%) had A1, A2 fracture was among 18 (20%) cases and the rest were 17 (18.9%) had A3. 62 (68.9%) fractures were caused due road traffic accidents, falling from height were among 17 (18.9%) cases and 11 (12.2%) cases were due to sports. Right side fracture was the most common side of fracture among 54 (60%). Mean union time among patients was 5.16±1.27 months.According to Flyn’s criteria, 38 (42.2%) cases had excellent results, 32 (35.6%) patients had good, fair results were among 16 (17.8%) cases and poor results were among 4 (4.4%) cases. Complications were delayed union, stiffness, varus deformityand non union observed among all cases. Conclusion: We concluded in this study that the locking plate for the treatment of distal femoral fractures was effective in terms of good results with fewer complications. Keywords:Distal femoral fracture, Locking plate, RTA, Complications

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Medial Pelvic Migration of the Lag Screw after Intramedullary Nailing for Trochanteric Femoral Fracture

Case Reports in Orthopedics ◽

10.1155/2021/5553835 ◽

2021 ◽

Vol 2021 ◽

pp. 1-6

Author(s):

Kohei Kuroshima ◽

Koichi Kasahara ◽

Shinsuke Kihara ◽

Yoshifumi Harada ◽

Masatoshi Sumi

Keyword(s):

Femoral Fracture ◽

Rare Complication ◽

Femoral Fractures ◽

Careful Attention ◽

Older Individuals ◽

Intramedullary Nails ◽

Screw Insertion ◽

Lag Screw ◽

Trochanteric Femoral Fracture ◽

Femoral Side

Internal fixation with intramedullary nails has gained popularity for the treatment of trochanteric femoral fractures, which are common injuries in older individuals. The most common complications are lag screws cut-out from the femoral head and femoral fracture at the distal tip of the nail. Herein, we report a rare complication of postoperative medial pelvic migration of the lag screw with no trauma. The patient was subsequently treated by lag screw removal via laparoscopy. This case suggests that optimal fracture reduction, adequate position of the lag screw, and careful attention to set screw insertion are important to prevent complications. Additionally, laparoscopic surgery might be able to remove the lag screw more safely than removal from the femoral side.

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Reunion of post nail aseptic non-union of diaphyseal femoral fractures by augmentation plating, decortication and bone grafting – Replacement for exchange nailing

Injury ◽

10.1016/j.injury.2020.10.036 ◽

2020 ◽

Author(s):

Krishna Kumar Mittal ◽

Himanshu Gupta ◽

Nitin Kaushik

Keyword(s):

Bone Grafting ◽

Femoral Fractures ◽

Non Union ◽

Exchange Nailing ◽

Augmentation Plating

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Functional outcome of proximal femoral nailing for unstable intertrochanteric fracture in elderly

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20204582 ◽

2020 ◽

Vol 6 (6) ◽

pp. 1186

Author(s):

Ankit Jose ◽

Edward Nazareth ◽

Vivian Roshan D. A. ◽

Mohan Kumar C. R.

Keyword(s):

Functional Outcome ◽

Femoral Fractures ◽

Delayed Union ◽

Harris Hip Score ◽

Non Union ◽

Femoral Nailing ◽

Unstable Intertrochanteric Fracture ◽

Intertrochanteric Femur Fracture ◽

Proximal Femoral Nailing

Background: This study is intended to analyse the functional outcome of proximal femoral nailing (PFN) for unstable intertrochanteric fractures in elderly.Methods: The data was collected from the 35 patients with unstable intertrochanteric femur fracture who were subjected to PFN from 2015 to 2018. All patients were followed up at 3 months and 6 months after the operation to check the functional outcome based on harris hip score (HHS) and complication if any.Result: In 35 patients, 1 patient was lost to follow-up and 34 patients were followed-up at 3 months and 6 months. All patient’s union was achieved at 3 and 6 months follow up. The cause of fractures was trivial fall in all 35 patients. No incidence of non-union and delayed union was reported. Functional outcome was rated as per HHS, we got excellent results in 20 cases, good in 10, fair in 03 and poor in one patient at end of 6 months.Conclusions: PFN provides stable fixation and early post-operative mobilization with fracture union especially complex proximal femoral fractures which includes unstable, communited, reverse oblique fractures and fractures in osteoporotic bones. PFN has shown excellent results in our study.

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