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

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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A systematic review of short versus long intramedullary fixation in the management of pertrochanteric fractures

Trauma ◽

10.1177/1460408617717538 ◽

2017 ◽

Vol 20 (3) ◽

pp. 161-168

Author(s):

MA Sohatee ◽

J Bennet

Keyword(s):

Length Of Stay ◽

Blood Loss ◽

Operative Time ◽

Transfusion Requirement ◽

Delayed Union ◽

Non Union ◽

Femur Fractures ◽

Transfusion Requirements ◽

Significant Difference ◽

Pertrochanteric Femur Fractures

Introduction The aim was to determine whether there is a significant difference in clinical outcomes when using short vs. long nails for pertrochanteric femur fractures. Methods A systematic literature search was undertaken of Pubmed and Embase in April 2016. All papers published in English reporting studies comparing long vs. short nails for pertrochanteric femur fractures were studied. Data were pooled for blood loss and transfusion requirement, operative time, length of stay, incidence of delayed or non-union, incidence of avascular necrosis or infection, fracture or metalware failure and was analysed to examine the differences between long and short nails. Results From 90 potential studies, nine were considered to be eligible for inclusion. The short nail resulted in a statistically significant benefit when looking at transfusion requirement (p = 0.02); however, blood loss was not statistically different (p = 0.33) Operative time was also quicker with the short nail (p = 0.004), but the length of stay was no different (p = 0.41). When examining complications and fixation outcomes, there was no difference in delayed union rates (p = 0.29) and non-union rates (p = 0.19) nor when looking at metalware failure (p = 0.41) and fracture (p = 0.14). Discussion The use of short intramedullary nails for pertrochanteric femur fractures appeared to be beneficial when looking at transfusion requirements and operative time. When looking at complications such as fracture and metalware failure, despite there being a slightly higher incidence of these in the short nail group, it is not statistically significant. This study advocates that both devices are safe to use, however, the short nail may have some perceived benefits in reducing transfusion requirements and have cost benefits with a shorter operative time.

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

Archives of Orthopaedic and Trauma Surgery ◽

10.1007/s00402-021-04193-4 ◽

2021 ◽

Author(s):

Lauri M. Halonen ◽

Antti Stenroos ◽

Henri Vasara ◽

Jussi Kosola

Keyword(s):

Rare Complication ◽

Treatment Strategies ◽

Femoral Fractures ◽

Delayed Union ◽

Intramedullary Fixation ◽

Fixation Method ◽

Trochanteric Fractures ◽

Non Union ◽

Trochanteric Femoral Fracture ◽

Exchange Nailing

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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Bipolar Hemiarthroplasty as Coxofemoral Bypass Technique in Treating Unstable Pertrochanteric Comminuted Fracture of Elderly Patients

Journal of Evolution of Medical and Dental Sciences ◽

10.14260/jemds/2021/746 ◽

2021 ◽

Vol 10 (43) ◽

pp. 3683-3688

Author(s):

Neetin Pralhad Mahajan ◽

Pramod K. Bagimani ◽

Kartik Prashant Pande ◽

Ravi Rameshbhai Dadhaniya

Keyword(s):

Average Duration ◽

Harris Hip Score ◽

Common Mechanism ◽

Bipolar Hemiarthroplasty ◽

Pertrochanteric Fractures ◽

Femur Fractures ◽

Early Return ◽

Study Results ◽

Duration Of Surgery ◽

Pertrochanteric Femur Fractures

BACKGROUND Pertrochanteric fractures in the elderly are highly unstable and osteoporotic. Comminution of fragments and distraction fragments make union difficult owing to forces acting on the proximal hip joint. The internal fixation in these cases leads to prolonged bed rest and immobilization to prevent implant failure. The purpose of this study was to analyse the role of bipolar hemiarthroplasty in cases of unstable pertrochanteric femur fractures as bypassing forces transmission through the proximal femur. METHODS 30 patients with pertrochanteric fractures were randomized and operated on as bipolar hemiarthroplasty using the indigenous bipolar prosthesis between July 2017 and July 2021. The inclusion criteria were patients more than 65 years of age, Type 4 intertrochanteric fracture (As per Evans classification) AO/ OTA type 31A2.3, 31A3.2, 31A3.3. Patients with polytrauma, compound injuries, pathological fractures and medically unfit patients were excluded from the study. RESULTS The mean age was 67 ± 5 years. The most common mechanism of injury was domestic fall comprising 80 %. The average duration of surgery from the time of injury was 3.5 ± 1.5 days. The average surgical duration was 85.5 mins. The average duration of stay in the hospital was 8.5 ± 1.5 days. Final results were calculated using the Harris Hip score with 33.3 % cases as excellent, 56.6 % cases as good and 10 % cases had fair results respectively. Follow-up was done at 6 weeks, 3, 6, 12 and 24 months. CONCLUSIONS Bipolar hemiarthroplasty in pertrochanteric femur fractures has the advantage of stable adequate fixation with early return to activities of daily living, thus preventing serious life-threatening complications. KEY WORDS Intertrochanteric Fractures, Hemiarthroplasty, Femur, Harris Hip Score

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Intramedullary nail in the treatment of pertrochanteric fractures in elderly patients

Acta chirurgica iugoslavica ◽

10.2298/aci1501039f ◽

2015 ◽

Vol 62 (1) ◽

pp. 39-44 ◽

Cited By ~ 1

Author(s):

Gabriele Falzarano ◽

Antonio Medici ◽

Predrag Grubor ◽

Milan Grubor ◽

Elizabeth Barron ◽

...

Keyword(s):

Intramedullary Nail ◽

Elderly Population ◽

Femoral Fractures ◽

Empty Space ◽

Proximal Femoral Fractures ◽

Risk Of Infection ◽

Intramedullary Nails ◽

Pertrochanteric Fractures ◽

Femur Fractures ◽

Pertrochanteric Femur Fractures

Introduction. Intramedullary nail is an important component of modern treatment of pertrochanteric femur fractures. Objective. In elderly population, pertrochanteric fractures treated with unreamed intramedullary nails cause less deep infections when compared to reamed intramedullary nails. Patients and Methods. From April, 2010 to May, 2012 at the Department of Orthopedics and Traumatology, Gaetano Rummo Hospital (Benevento, Italy), 156 patients with pertrochanteric fracture, average age 82.7 years (75-102 years), were treated. In the analyzed case, there were 90 females and 66 males with pertrochanteric fractures. The respondents were divided into two groups. The first group consisted of 78 respondents who were treated with reamed intramedullary nails and the second group of 78 respondents treated with unreamed intramedullary nails. Discussion. Infections are not the most common postoperative complications. The risk of infection is increased in patients with comorbidity and in cases when there is an empty space between the intramedullary nail fixation and bone. Proximal femoral fractures carry a high mortality, but its causes are unclear. Conclusion. Our research has shown that the application of unreamed intramedullary nails in the treatment of pertrochanteric femoral fractures reduces a mortality risk and risk of infection.

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