scholarly journals Breakage of intramedullary femoral nailing or femoral plating: how to prevent implant failure

2022 ◽  
Vol 27 (1) ◽  
Author(s):  
Henrik C. Bäcker ◽  
Mark Heyland ◽  
Chia H. Wu ◽  
Carsten Perka ◽  
Ulrich Stöckle ◽  
...  
Keyword(s):  
Risk Factors ◽  
Plate Osteosynthesis ◽  
Femoral Shaft ◽  
Intramedullary Fixation ◽  
Implant Failure ◽  
Average Risk ◽  
Rigid Fixation ◽  
Femoral Shaft Fractures ◽  
Non Union ◽  
Shaft Fractures

Abstract Introduction Intramedullary (IM) fixation is the dominant treatment for pertrochanteric and femoral shaft fractures. In comparison to plate osteosynthesis (PO), IM fixation offers greater biomechanical stability and reduced non-union rates. Due to the minimally invasive nature, IM fixations are less prone to approach-associated complications, such as soft-tissue damage, bleeding or postoperative infection, but they are more prone to fat embolism. A rare but serious complication, however, is implant failure. Thus, the aim of this study was to identify possible risk factors for intramedullary fixation (IMF) and plate osteosynthesis (PO) failure. Materials and methods We searched our trauma surgery database for implant failure, intramedullary and plate osteosynthesis, after proximal—pertrochanteric, subtrochanteric—or femoral shaft fractures between 2011 and 2019. Implant failures in both the IMF and PO groups were included. Demographic data, fracture type, quality of reduction, duration between initial implantation and nail or plate failure, the use of cerclages, intraoperative microbiological samples, sonication, and, if available, histology were collected. Results A total of 24 femoral implant failures were identified: 11 IMFs and 13 POs. The average age of patients in the IM group was 68.2 ± 13.5 years and in the PO group was 65.6 ± 15.0 years, with men being affected in 63.6% and 39.5% of cases, respectively. A proximal femoral nail (PFN) anti-rotation was used in 7 patients, a PFN in one and a gamma nail in two patients. A total of 6 patients required cerclage wires for additional stability. A combined plate and intramedullary fixation was chosen in one patient. Initially, all intramedullary nails were statically locked. Failures were observed 34.1 weeks after the initial surgery on average. Risk factors for implant failure included the application of cerclage wires at the level of the fracture (n = 5, 21%), infection (n = 2, 8%), and the use of an additional sliding screw alongside the femoral neck screw (n = 3, 13%). In all patients, non-union was diagnosed radiographically and clinically after 6 months (n = 24, 100%). In the event of PO failure, the placement of screws within all screw holes, and interprosthetic fixation were recognised as the major causes of failure. Conclusion Intramedullary or plate osteosynthesis remain safe and reliable procedures in the treatment of proximal femoral fractures (pertrochanteric, subtrochanteric and femoral shaft fractures). Nevertheless, the surgeon needs to be aware of several implant-related limitations causing implant breakage. These may include the application of tension band wiring which can lead to a too rigid fixation, or placement of cerclage wires at the fracture site.

scholarly journals Incidence, Costs and Predictors of Non-Union, Delayed Union and Mal-Union Following Long Bone Fracture

2018 ◽  
Vol 15 (12) ◽  
pp. 2845 ◽  
Author(s):  
Christina Ekegren ◽  
Elton Edwards ◽  
Richard de Steiger ◽  
Belinda Gabbe
Keyword(s):  
Fracture Healing ◽  
Hospital Admissions ◽  
Femoral Shaft ◽  
Hospital Length Of Stay ◽  
Long Bone ◽  
Future Research ◽  
Related Factors ◽  
Femoral Shaft Fractures ◽  
Non Union ◽  
Shaft Fractures

Fracture healing complications are common and result in significant healthcare burden. The aim of this study was to determine the rate, costs and predictors of two-year readmission for surgical management of healing complications (delayed, mal, non-union) following fracture of the humerus, tibia or femur. Humeral, tibial and femoral (excluding proximal) fractures registered by the Victorian Orthopaedic Trauma Outcomes Registry over five years (n = 3962) were linked with population-level hospital admissions data to identify two-year readmissions for delayed, mal or non-union. Study outcomes included hospital length-of-stay (LOS) and inpatient costs. Multivariable logistic regression was used to determine demographic and injury-related factors associated with admission for fracture healing complications. Of the 3886 patients linked, 8.1% were readmitted for healing complications within two years post-fracture, with non-union the most common complication and higher rates for femoral and tibial shaft fractures. Admissions for fracture healing complications incurred total costs of $4.9 million AUD, with a median LOS of two days. After adjusting for confounders, patients had higher odds of developing complications if they were older, receiving compensation or had tibial or femoral shaft fractures. Patients who are older, with tibial and femoral shaft fractures should be targeted for future research aimed at preventing complications.

Evaluation of Intramedullary Fixation for Pediatric Femoral Shaft Fractures in Developing Countries

2018 ◽  
Vol 32 (6) ◽  
pp. e210-e214 ◽  
Author(s):  
Andrew T. Chen ◽  
William Z. Morris ◽  
Lewis G. Zirkle ◽  
Raymond W. Liu
Keyword(s):  
Developing Countries ◽  
Femoral Shaft ◽  
Intramedullary Fixation ◽  
Femoral Shaft Fractures ◽  
Shaft Fractures

Incidence and risk factors of knee injuries associated with ipsilateral femoral shaft fractures: A multicentre retrospective analysis of 429 femoral shaft injuries

Injury ◽  
2018 ◽  
Vol 49 (8) ◽  
pp. 1602-1606 ◽  
Author(s):  
Seong-Eun Byun ◽  
Hyun-Chul Shon ◽  
Jai Hyung Park ◽  
Hyoung Keun Oh ◽  
Young-Ho Cho ◽  
...  
Keyword(s):  
Risk Factors ◽  
Retrospective Analysis ◽  
Knee Injuries ◽  
Femoral Shaft ◽  
Femoral Shaft Fractures ◽  
Shaft Fractures

scholarly journals Fracture Table vs. Lateral Positioning for Intramedullary Fixation of Femur Fractures (The FLiP Study): A protocol for a pilot randomized controlled trial

2019 ◽  
Author(s):  
Daniel Axelrod ◽  
Herman Johal ◽  
Kim Madden ◽  
Francesc Marcano ◽  
Carlos Prada
Keyword(s):  
Pilot Trial ◽  
Case Series ◽  
Femoral Shaft ◽  
Intramedullary Fixation ◽  
Femoral Shaft Fractures ◽  
Randomized Controlled ◽  
Femur Fractures ◽  
Shaft Fractures ◽  
Fracture Table ◽  
Lateral Positioning

Background: Femoral Shaft fractures are devastating and life threatening injuries. Femoral shaft fractures are most commonly treated with intramedullary fixation. Malrotation of the injured limb after fixation is a common and significant complication following femoral shaft fractures. During the operation, patients can be positioned either supine or in a lateral position. Additionally, patients can be placed on a standard radiolucent operating room table, or placed on a fracture table with traction statically applied to the operative limb throughout the case. Previous case series and cohort studies have shown equivalence between study groups, but choice between positioning options remains controversial. Methods: This represents a protocol for a randomized controlled pilot trial. We will be compared lateral positioning with use of manual traction to supine positioning with use of a fracture table. Primary outcomes will be in assessment for feasibility for a future full scale randomized trial, including evaluating patient recruitment, patient compliance with followup, contamination between treatment arms and others. Results: The primary outcome will be feasibility for a future trial. Secondary outcomes will include malrotation as measured through postoperative computed tomography scans and gait analysis at 6 months.

scholarly journals Fracture Table vs. Lateral Positioning for Intramedullary Fixation of Femur Fractures (The FLiP Study): A protocol for a pilot randomized controlled trial

2019 ◽  
Author(s):  
Daniel Axelrod ◽  
Herman Johal ◽  
Kim Madden ◽  
Francesc Marcano ◽  
Carlos Prada
Keyword(s):  
Pilot Trial ◽  
Case Series ◽  
Femoral Shaft ◽  
Intramedullary Fixation ◽  
Femoral Shaft Fractures ◽  
Randomized Controlled ◽  
Femur Fractures ◽  
Shaft Fractures ◽  
Fracture Table ◽  
Lateral Positioning

Background: Femoral Shaft fractures are devastating and life threatening injuries. Femoral shaft fractures are most commonly treated with intramedullary fixation. Malrotation of the injured limb after fixation is a common and significant complication following femoral shaft fractures. During the operation, patients can be positioned either supine or in a lateral position. Additionally, patients can be placed on a standard radiolucent operating room table, or placed on a fracture table with traction statically applied to the operative limb throughout the case. Previous case series and cohort studies have shown equivalence between study groups, but choice between positioning options remains controversial. Methods: This represents a protocol for a randomized controlled pilot trial. We will be compared lateral positioning with use of manual traction to supine positioning with use of a fracture table. Primary outcomes will be in assessment for feasibility for a future full scale randomized trial, including evaluating patient recruitment, patient compliance with followup, contamination between treatment arms and others. Results: The primary outcome will be feasibility for a future trial. Secondary outcomes will include malrotation as measured through postoperative computed tomography scans and gait analysis at 6 months.

scholarly journals Safety and efficacy of a novel cephalomedullary nail in femoral shaft fractures: a retrospective observational cohort in 33 patients

2020 ◽  
Author(s):  
Jorge Clint De Leon ◽  
Cooper Benjamin Tye ◽  
Connor Scott Breinholt ◽  
Khang H Dang ◽  
Ravi A. Karia
Keyword(s):  
Failure Rate ◽  
Femoral Shaft ◽  
Implant Failure ◽  
Cephalomedullary Nail ◽  
Safety And Efficacy ◽  
Femoral Shaft Fractures ◽  
Shaft Fractures ◽  
Observational Cohort ◽  
Femur Shaft ◽  
Femur Shaft Fractures

Abstract Background: Despite advances in femoral shaft fracture fixation, the nonunion rate remains relatively high; and there is limited data on the efficacy and failure rate of specific implants. A novel cephalomedullary nail that provides the ability to treat femur shaft fractures in isolation, with associated ipsilateral femur injuries, and provides various options for proximal and distal fixation exists on the market; but little is available on the safety and efficacy of this implant. The aim of this study is to evaluate the early failure rate of this cephalomedullary nail, while comparing the nonunion rate to what is currently presented in the literature. This study is the first of its kind in evaluation of a specific implant for treatment of femoral shaft fractures and ipsilateral pathology.Methods: Patients over 18 years of age, with traumatic femur shaft fractures, treated with this novel cephalomedullary nail and available for a minimum of 3-month follow-up were included for analysis. Retrospective chart review for this retrospective observational cohort study was performed. Demographic data, injury details, AO/OTA fracture classification, and implant details were recorded for each patient. Primary outcome measured was implant failures (screw or nail breakage). Secondary outcomes measured included malunion, nonunion, deep infection, post-operative complications, and need for reoperation. We hypothesize that the union and failure rate will be similar to that reported in the literature for femur shaft fractures.Results: Of the 33 patients included for analysis, 1 patient went on to non-union. There were no cases of implant failure. The single nonunion was a high-energy mechanism, open fracture, and higher level AO/OTA classification. The remaining 32 reached radiographic union at 3 months. Conclusion: The nonunion rate of this novel cephalomedullary nail is comparable to what is reported in the literature. This nail is a safe and effective implant to treat femoral shaft fractures with a variety of ipsilateral femoral shaft injuries and reliably leads fracture union. Further studies are needed analyzing implant failure and comparing specific implants.

Determine the Mean Duration of Union in Femoral Shaft Fracture in Children Treated with Elastic Intra-Medullary Nailing

2021 ◽  
Vol 15 (5) ◽  
pp. 1338-1340
Author(s):  
M. S. Zardad ◽  
M. Younas ◽  
S. A. Shah ◽  
I. Muhammad ◽  
M. Ullah ◽  
...  
Keyword(s):  
Intramedullary Nailing ◽  
Functional Outcomes ◽  
Femoral Shaft Fracture ◽  
Femoral Shaft ◽  
Shaft Fracture ◽  
Femoral Shaft Fractures ◽  
Non Union ◽  
Shaft Fractures ◽  
Fractures In Children ◽  
Medullary Nailing

Objective: The aim of this study is to determine the functional outcomes and mean duration of union in femoral shaft fracture in children treated with elastic intra-medullary nailing. Study Design:Retrospective Place and Duration: Conducted at Orthopaedic Unit Ayub Medical Teaching Institute Abbottabad and District Headquarter Teaching Hospital Gomal Medical College Dera Ismail Khan for duration from May 2020 to January 2021 (09 months). Methods: Total sixty eight patients with age ranges between 5-12 years were presented in this study. Patients detailed demographics age, sex and BMI were calculated after taking informed written consent. Complete patients were treated with elastic intramedullary nailing. 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 8 months postoperatively. Complete data was analyzed by SPSS 22.0 version. Results: Out of 68 patients, there were 48 (68.6%) males and 20 (31.4%) females. Most of the patients 41 (60.35) were aged between 8-12 years and the rest 27 (39.65%) were between 5-8 years.34 (50%) fractures were caused because of road accidents, falling from height were 20 (29.41%), due to sports were 10 (14.70%) and 4 (5.9%) were due to simple fall. 32 (47.06%) patients had left side fracture and 36 (52.94%) had right side fracture. Mean union time among patients was 4.14±2.72 months and there was no any case of non union. According to Flyn’s criteria, 50 (73.53%) cases had excellent results, 14 (20.6%) patients had good and fair results were among 4 (5.9%) cases. Complications were observed bone stiffness, delayed union and varus deformity among all cases. Conclusion: We concluded in this study thatElastic intramedullary nailing for femoral shaft fractures in children is safe and effective treatment modality. Union of bone achieved all the patients and majority of patients had excellent functional outcomes. Keywords: Femoral shaft fractures, Children, Elastic intra-medullary nail

scholarly journals Safety and efficacy of a novel cephalomedullary nail femoral shaft fractures: a retrospective observational cohort in 33 patients

2020 ◽  
Vol 14 (1) ◽  
Author(s):  
Jorge C. De Leon ◽  
Cooper B. Tye ◽  
Connor S. Breinholt ◽  
Khang H. Dang ◽  
Ravi A. Karia
Keyword(s):  
Failure Rate ◽  
Femoral Shaft ◽  
High Energy ◽  
Implant Failure ◽  
Cephalomedullary Nail ◽  
Safety And Efficacy ◽  
Femoral Shaft Fractures ◽  
Shaft Fractures ◽  
Femur Shaft ◽  
Femur Shaft Fractures

Abstract Background Despite advances in femoral shaft fracture fixation, the nonunion rate remains relatively high; and there is limited data on the efficacy and failure rate of specific implants. A novel cephalomedullary nail provides the ability to treat femur shaft fractures in isolation, with associated ipsilateral femur injuries, and provides various options for proximal and distal fixation exists on the market; but literature remains limited on the safety and efficacy of this implant. The aim of this study is to evaluate the early failure rate of this cephalomedullary nail, while comparing the nonunion rate to what is currently presented in the literature. This study is the first of its kind in evaluation of a specific implant for treatment of femoral shaft fractures and ipsilateral pathology. Methods Patients over 18 years of age, with traumatic femur shaft fractures, treated with this particular cephalomedullary nail and available for a minimum of 3-month follow-up were included for analysis. Data was collected by retrospective chart review and review of existing radiographs. Demographic data, injury details, AO/OTA fracture classification, and implant details were recorded for each patient. Primary outcome measured was implant failures (screw or nail breakage). Secondary outcomes measured included malunion, nonunion, deep infection, post-operative complications, and need for reoperation. Results Of the 33 patients included for analysis, 1 patient went on to non-union. There were no cases of implant failure. The single nonunion was a high-energy mechanism, open fracture, and higher level AO/OTA classification. The remaining 32 reached radiographic union at 3 months. Conclusion The nonunion rate of this novel cephalomedullary nail is comparable to what is reported in the literature. This nail is a safe and effective implant to treat femoral shaft fractures with a variety of ipsilateral femoral shaft injuries and reliably leads fracture union. Further studies are needed analyzing implant failure and comparing specific implants.

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