Predictors of Mechanical Failure Rate in Reduction of Intertrochanteric Fracture of the Femur Using Proximal Femoral Nail with Helical Blade

Abstract Background: Breakage of the intramedullary nail is a rare complication after proximal femoral nail antirotation (PFNA) in intertrochanteric fracture treatment. The purpose of this study was (1) to investigate the frequency of nail breakage among the patients who were treated for mechanical failure after PFNA for intertrochanteric/ pertrochanteric fracture, and (2) to determine the risk factors for nail breakage in PFNA treatment of intertrochanteric fracture.Methods: To identify mechanical failure after internal fixation using PFNA, we retrospectively reviewed the data of 35 patients (35 hips) who required reoperation after PFNA with a helical blade for intertrochanteric/ pertrochanteric fracture between June 2005 and June 2018. We evaluated the frequency of breakage of PFNA and compared the demographic and radiologic parameters between the breakage and control (non-breakage) groups. We also compared the lever arm for the load of stress from the fulcrum according to the centrum-collum-diaphyseal (CCD) angle of blade by using reverse design technique.Results: Among the 25 patients with mechanical failure after PFNA except 10 patients with peri-implant infection and osteonecrosis, 7 (28.0%) showed breakage of PFNA at average of 8 months (range, 5 to 13 months) after index surgery. A larger horizontal offset (the horizontal distance from the lateral surface of the IM nail and the medial tip of helical blade) was associated with an increased risk of nail breakage. A CCD angle of 130° has a shorter lever arm for the load of stress from the fulcrum, meaning a higher stress for nail breakage, although there was no association between centrum-collum-diaphyseal (CCD) angle and breakage of the nail.Conclusions: Our study suggested that higher horizontal offset and a higher CCD angle can increase the risk of breakage of the PFNA nail at the aperture for the helical blade.Levels of Evidence: Level III

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A rare complication of pelvic perforation by an excessive medial slide of the helical blade after treatment of an intertrochanteric fracture with proximal femoral nail anti-rotation: a case report and literature review

Chinese Journal of Traumatology ◽

10.1016/j.cjtee.2021.08.007 ◽

2021 ◽

Author(s):

Xiao-Kun Chen ◽

Jian Xiong ◽

Yi-Jun Liu ◽

Quan Han ◽

Tian-Bing Wang ◽

...

Keyword(s):

Case Report ◽

Literature Review ◽

Intertrochanteric Fracture ◽

Rare Complication ◽

Proximal Femoral Nail ◽

Femoral Nail ◽

Helical Blade

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Critical analysis of factors determining mechanical failures in proximal femoral nailing

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20190504 ◽

2019 ◽

Vol 5 (2) ◽

pp. 275 ◽

Cited By ~ 1

Author(s):

Karthik Ramachandran ◽

K. K. Arvind Manoj ◽

A. Vishnu Sankar

Keyword(s):

Failure Rate ◽

Mechanical Failure ◽

Proximal Femoral Nail ◽

Harris Hip Score ◽

Intertrochanteric Fractures ◽

Excellent Outcome ◽

Lag Screw ◽

Femoral Nailing ◽

Femoral Nail ◽

Proximal Femoral Nailing

Background: Intertrochanteric fractures are one of the commonest fractures encountered in elderly population. Though there are various implants, proximal femoral nail has been the standard choice for management of unstable fractures. Inspite of its biomechanical advantages, various complications like screw cut out, Z effect, reverse Z effect does occur in proximal femoral nailing. The aim of the study is to analyse various factors determining the mechanical failures in patients operated with proximal femoral nail.Methods: This is a prospective study conducted in our institution from June 2014 to May 2018. The study included 72 patients with unstable intertrochanteric fractures treated with proximal femoral nail. All patients were followed for average period of 2 years. Functional outcome was assessed using Harris Hip score.Results: Among the patients 33% had excellent outcome. 42% had good and 14% had fair outcome. 11% of cases ended with poor outcome. Mechanical failure rate was less in patients with positive medial cortical support (PMCS) and in patients with tip apex distance difference between antirotation screw and lag screw (TADAR -TADLS) more than 15 mm. Whereas the difference in the position of lag screw centre had no significant influence in the mechanical failure rate in our study.Conclusions: From our study we like to conclude that the fracture reduction with positive medial cortical support and the TAD difference play a major role in determining the incidence of mechanical failure in proximal femoral nailing.

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Proximal Femoral Nail Anti-rotation with Cement Augmentation Reduces the Prevalence of Mechanical Failure for Unstable Type Intertrochanteric fracture in Elderly Patient: A Preliminary Study

Journal of Clinical Case Studies ◽

10.16966/2471-4925.192 ◽

2019 ◽

Vol 4 (3) ◽

Author(s):

Phruetthiphat OA ◽

Tutaworn T ◽

Plumarom Y ◽

Punyaratabandhu T ◽

Chaichankul C ◽

...

Keyword(s):

Elderly Patient ◽

Intertrochanteric Fracture ◽

Cement Augmentation ◽

Mechanical Failure ◽

Proximal Femoral Nail ◽

Femoral Nail ◽

Preliminary Study ◽

Unstable Type

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Proximal Femoral Nail Anti-rotation with cement augmentation reduces the prevalence of mechanical failure for intertrochanteric fracture in elderly patient: A preliminary study

Osteoporosis and Sarcopenia ◽

10.1016/j.afos.2019.12.007 ◽

2019 ◽

Vol 5 (4) ◽

pp. S4

Author(s):

Ong-art Phruetthiphat ◽

Thipachart Punyaratabhandhu ◽

Yanin Pumarom ◽

Phuripan Jirangkul ◽

Thawee Songpatanasilp

Keyword(s):

Elderly Patient ◽

Intertrochanteric Fracture ◽

Cement Augmentation ◽

Mechanical Failure ◽

Proximal Femoral Nail ◽

Femoral Nail ◽

Preliminary Study

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Comparison of osteoporotic intertrochanteric fracture fixation using a proximal femoral nail with a helical blade and lag screw type proximal femoral nail

Medical Biological Science and Engineering ◽

10.30579/mbse.2018.1.2.45 ◽

2018 ◽

Vol 1 (2) ◽

pp. 45-50

Author(s):

Woong Chae Na ◽

Chae Won Lim ◽

Sang Hong Lee

Keyword(s):

Fracture Fixation ◽

Intertrochanteric Fracture ◽

Proximal Femoral Nail ◽

Lag Screw ◽

Femoral Nail ◽

Helical Blade

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Avoid to over-unlocking the helical blade in proximal femoral nail anti-rotation: a case report and literature review

10.21203/rs.3.rs-33753/v1 ◽

2020 ◽

Author(s):

Wenchen Ji ◽

Kai Liu ◽

Meng Li

Keyword(s):

Case Report ◽

Literature Review ◽

Femoral Neck ◽

Intertrochanteric Fracture ◽

Lateral Wall ◽

Treatment Method ◽

Proximal Femoral Nail ◽

Femoral Nail ◽

Intraoperative Fluoroscopy ◽

Helical Blade

Abstract Purpose To discuss the reason and treatment method of helical blade over-unlocking. Methods The case reported in this paper is that the helical blade cannot be locked due to over-unlocking during the treatment of intertrochanteric fracture with PFNA, which is very rare. We expound why it happens and how to deal with it. Results When the helical blade is over-unlocking, if the aiming arm is not disassembled, you can try to take out the helical blade and fix it again. If the aiming arm has been removed, it is not recommended to remove the helical blade, we suggest that we should consider adding a screw from the lateral wall through the femoral neck for anti-rotation, or you can observe the tail of helical blade and find suitable screw driver to fix it if there is one. Conclusions In order to avoid over-unlocking of the helical blade, intraoperative fluoroscopy should not only pay attention to the position of the helical blade, but also pay more attention to the abnormal shape of the helical blade itself. Once the helical blade is over-unlocking, it needs to be handled in time.

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